Objectives At the end of 2019, SARS‐CoV‐2 was identified, the one responsible for the COVID‐19 disease. Between a 5.1% and a 98% of COVID‐19 patients present some form of alteration in their sense of smell. The objective of this study is to determine the diagnostic yield of the smell dysfunction as screening tool for COVID‐19. Methods Cross‐sectional, observational, and pro‐elective study was performed in a tertiary care hospital from May 25th to June 30th, 2020. One hundred and thirty‐nine patients were included in the study. Demographic characteristics were collected from anamnesis. A Self‐Perception Questionnaire and psychophysical olfactory test (POT) were applied to all participants. The presence of SARS‐CoV2, was detected by RT‐PCR methods. Results 51.7% of patients were SARS‐CoV‐2 positive. A sensitivity of 50% was obtained for the self‐perception questionnaire as a screening tool for SARS‐CoV2, with a specificity of 80.59%. The positive predictive value (PPV) was of 73.46%, the negative predictive value (NPV) was of 60%. The POT as a screening tool had a PPV of 82.35%, a NPV of 52.45%, a LR+ of 4.34, a LR‐ 0.84. The combination of anosmia (according to the POT) plus cough and asthenia got an OR of 8.25 for the SARS CoV‐2 infection. Conclusion There is a strong association between olfactory dysfunction and COVID‐19. However, it is not really efficient in the screening of SARS‐CoV‐2 infection and thus, they should not be considered as a single diagnostic instrument. Level of Evidence 4.

Objective: To analyze, in a cohort of acromegalic patients, the results of the efficiency and safety of radiosurgery (CyberKnife), as well as the prognostic factors associated with disease remission. Material and methods: Observational, retrospective, longitudinal, and analytical study that included acromegalic patients with persistent biochemical activity after initial medical–surgical treatment, who received treatment with CyberKnife radiosurgery. GH and IGF-1 levels at baseline after one year and at the end of follow-up were evaluated. Results: 57 patients were included, with a median follow-up of four years (IQR, 2–7.2 years). The biochemical remission rate was 45.6%, 33.33% achieved biochemical control, and 12.28% attained biochemical cure at the end of follow-up. A progressive and statistically significant decrease was observed in the comparison of the concentrations of IGF-1, IFG-1 x ULN, and baseline GH at one year and at the end of follow-up. Both cavernous sinus invasion and elevated baseline IGF-1 x ULN concentrations were associated with an increased risk of biochemical non-remission. Conclusion: Radiosurgery (CyberKnife) is a safe and effective technique in the adjuvant treatment of GH-producing tumors. Elevated levels of IGF x ULN before radiosurgery and invasion of the cavernous sinus by the tumor could be predictors of biochemical non-remission of acromegaly.

The presence of cardio-metabolic and respiratory comorbidities, immunosuppression, and chronic kidney disease have been associated with an increase in mortality from COVID-19. The objective of this study is to establish the risk factors associated with 30-day mortality in a cohort of hospitalized patients with COVID-19. This paper conducts a retrospective and analytical study of patients hospitalized for COVID-19 in a tertiary care center. A Cox proportional hazard analysis was performed to estimate the association of comorbidities with 30-day mortality. A total of 1215 patients with a median age of 59 years were included. In the adjusted Cox proportional hazards regression model, hypothyroidism, D-dimer ≥ 0.8 μg/mL, LHD ≥ 430 IU/L, CRP ≥ 4.83 ng/mL, and triglycerides ≥ 214 mg/dL were associated with an increased risk of death. The presence of a history of hypothyroidism and biomarkers (D-dimer, lactic dehydrogenase, CRP, and triglycerides) were associated with an increase in mortality in the studied cohort.

The COVID-19 pandemic has modified several aspects of medical care, resulting in a change in the profile of visits to the Emergency Department. To compare the number and reasons for consultation related to the specialty of Otolaryngology in the Emergency Department of a tertiary-care hospital, in the periods defined as: pre-COVID-19 (from March 13, 2019, to March 12, 2020) and COVID-19 (from March 13, 2020, to March 13, 2021). An observational, retrospective, cross-sectional and analytical study was conducted. It included 2409 patients, out of which 1764 belonged to the pre-COVID-19 period and 645 to the COVID-19 period. Odds ratios were estimated for the association between the period of presentation and the type of emergency. We observed an increase in consultations for epistaxis (from 19.16 to 26.82%), followed by tracheostomy care (from 3.17 to 5.89%), laryngotracheal stenosis (from 0.96 to 2.5%) and otalgia (from 4.47 to 6.67%), during the COVID-19 period. Similarly, there was an increase in the proportion of actual emergencies during the COVID-19 period. Overall, there was a 63% of decrease in the number of urgent Ear, Nose and Throat (ENT) consultations during the COVID-19 period, with a significant increase in the number of attendances secondary to epistaxis, tracheostomy care, laryngotracheal stenosis and a significant percentage in cochleovestibular pathology care.

The COVID-19 disease has represented one of the most important threats to health. The most severe form is acute respiratory distress syndrome (ARDS). The inflammatory response can cause hematologic changes. To determine the association between the Neutrophil/lymphocyte ratio (NLR) and the mean platelet volume (MPV) associated with mortality in critically ill patients with COVID-19 and ARDS. A retrospective study was carried out in an intensive care unit (ICU) in a public hospital, with patients in critical condition due to COVID-19 and on mechanical ventilation. The clinical characteristics of admission and severity of the disease were recorded. The end point was the ICU discharge condition. 162 subjects were gathered, 103 were men, with a mean age of 54.54 ± 13.53 years. 66.7% died in the ICU. The NLR had an area under the curve (aROC) of 0.62, with a cut-off point for mortality of > 7.04, sensitivity of 94.4%, specificity of 29.63%. The VPM had an aROC of 0.65 with a cut-off point > 9.5, sensitivity of 30.84%, and specificity of 92.59%; finally, the APACHE II had an aROC of 0.67 with a cut-off point > 14, sensitivity of 51.4% and specificity of 80%. The NLR presented an odds ratio (OR) of 5.02, the VPM 2.06 and the APACHE II score 1.16. NLR, MPV, and APACHE II at ICU admission are associated with mortality for critically ill patients with COVID-19.

Background: The SARS-CoV-2 pandemic continues to be a priority health problem; According to the World Health Organization data from October 13, 2020, 37,704,153 confirmed COVID-19 cases have been reported, including 1,079,029 deaths, since the outbreak. The identification of potential symptoms has been reported to be a useful tool for clinical decision-making in emergency departments to avoid overload and improve the quality of care. The aim of this study was to evaluate the performances of symptoms as a diagnostic tool for SARS -CoV-2 infection.Methods: An observational, cross-sectional, prospective and analytical study was carried out, during the period of time from April 14 to July 21, 2020. Data (demographic variables, medical history, respiratory and non-respiratory symptoms) were collected by emergency physicians. The diagnosis of COVID-19 was made using SARS-CoV-2 RT-PCR. The diagnostic accuracy of these characteristics for COVID-19 was evaluated by calculating the positive and negative likelihood ratios. A Mantel-Haenszel and multivariate logistic regression analysis was performed to assess the association of symptoms with COVID-19.Results: A prevalence of 53.72% of SARS-CoV-2 infection was observed. The symptom with the highest sensitivity was cough 71%, and a specificity of 52.68%. The symptomatological scale, constructed from 6 symptoms, obtained a sensitivity of 83.45% and a specificity of 32.86%, taking ≥ 2 symptoms as a cut-off point. The symptoms with the greatest association with SARS-CoV-2 were: anosmia odds ratio (OR) 3.2 (95% CI; 2.52-4.17), fever OR 2.98 (95% CI; 2.47-3.58), dyspnea OR 2.9 (95% CI; 2.39-3.51]) and cough OR 2.73 (95% CI: 2.27-3.28).Conclusion: The combination of ≥ 2 symptoms / signs (fever, cough, anosmia, dyspnea and oxygen saturation <93%, and headache) results in a highly sensitivity model for a quick and accurate diagnosis of COVID-19, and should be used in the absence of ancillary diagnostic studies. Symptomatology, alone and in combination, may be an appropriate strategy to use in the emergency department to guide the behaviors to respond to the disease.Trial registration: Institutional registration R-2020-3601-145, Federal Commission for the Protection against Sanitary Risks 17 CI-09-015-034, National Bioethics Commission: 09 CEI-023-2017082.