Clinical features of patients who had two COVID-19 episodes: a European multicentre case series

OBJECTIVE

To investigate the clinical features of patients who had two demonstrated coronavirus disease 2019 (COVID-19) episodes.

METHODS

Data of patients with both COVID-19 episodes were recruited from 22 March to 27 December 2020. The following outcomes were studied: epidemiological, comorbidities, prevalence and severity of general and otolaryngological symptom, olfactory, aroma, and gustatory dysfunctions. A comparison between first and second episodes was performed.

RESULTS

Forty-five patients reported having two confirmed COVID-19 episodes. The majority of patients had mild infections in both episodes. The second clinical episode was significantly similar to the first. The symptom duration of the second episode was shorter than the first. The occurrence of loss of smell was unpredictable from the first to the second episode.

CONCLUSION

The recurrence of COVID-19 symptoms is associated with a similar clinical picture than the first episode in patients with initial mild-to-moderate COVID episode. The pathophysiological mechanisms underlying the development of second episode remain uncertain and may involve either true reinfection or virus reactivation from sanctuaries.

Is anosmia the price to pay in an immune-induced scorched-earth policy against COVID-19?

Since the outbreak of Coronavirus Disease 2019 (COVID-19), loss of smell has increasingly been reported as a frequent clinical sign. Understanding the underlying mechanism and the prognostic value of this symptom will help better manage patients. SARS-CoV-2, as SARS-CoV-1, may likely spread to the central nervous system (CNS) via the olfactory nerve, a known gateway for respiratory neurotropic viruses. We hypothesise that sudden loss of smell due to COVID-19 is the consequence of a protective host defence mechanism involving apoptosis of olfactory receptor neurons. Sacrificing smelling over neuroprotection is a logical strategy, even more so as olfaction is the only sense with the ability to regenerate in adults. Induced apoptosis of olfactory neurons has been shown in mice, successfully preventing neuroinvasion. On the other hand, adult olfactory neurogenesis has been shown to be regulated in part by the immune system, allowing to restore olfactory function. Understanding anosmia as part of a defence mechanism would support the concept of sudden anosmia as being a positive prognostic factor in the short term. Also, it may orient research to investigate the risk of future neurodegenerative disease linked to persisting coronavirus in neurons.

Erratum: Direct Observation of Proton Emission in ^{11}Be [Phys. Rev. Lett. 123, 082501 (2019)]

This corrects the article DOI: 10.1103/PhysRevLett.123.082501.

Direct Observation of Proton Emission in ^{11}Be

The elusive β^{-}p^{+} decay was observed in ^{11}Be by directly measuring the emitted protons and their energy distribution for the first time with the prototype Active Target Time Projection Chamber in an experiment performed at ISAC-TRIUMF. The measured β^{-}p^{+} branching ratio is orders of magnitude larger than any previous theoretical model predicted. This can be explained by the presence of a narrow resonance in ^{11}B above the proton separation energy.

Two cases of pulsatile tinnitus: Key points for the clinician

INTRODUCTION

Pulsatile tinnitus is a sound generated by an acoustic source from within the body, which is perceived by the auditory system of the patient.

CASES SUMMARY

We report two puzzling cases of pulsatile tinnitus with normal ENT examinations: the first was due to a cervical internal carotid artery dissection, and the second to the compression of the foramina of Monro by a craniopharyngioma, leading to hydrocephalus.

DISCUSSION

We review the systematic management and emphasize the decisive role of the ENT clinician regarding this pulsatile tinnitus complaint, because of the potentially severe complications of its underlying pathology.

MALDI-TOF MS contribution to the diagnosis of Campylobacter rectus multiple skull base and brain abscesses

Campylobacter rectus is rarely associated with invasive infection. Both the isolation and the identification requirements of C. rectus are fastidious, probably contributing to an underestimation of its burden. We report the case of a 66-year-old man who developed several skull base and intracerebral abscesses after dental intervention. Campylobacter rectus was isolated from the brain biopsy. Within 45 minutes of reading the bacterial plate, the strain was accurately identified by MALDI-TOF MS. This rapid identification avoided the extra costs and delays present with 16S rRNA gene sequencing and allowed for a rapid confirmation of the adequacy of the empirical antibiotic treatment.

Somatic tinnitus prevalence and treatment with tinnitus retraining therapy

OBJECTIVES

Somatic tinnitus originates from increased activity of the dorsal cochlear nucleus, a cross-point between the somatic and auditory systems. Its activity can be modified by auditory stimulation or somatic system manipulation. Thus, sound enrichment and white noise stimulation might decrease tinnitus and associated somatic symptoms. The present uncontrolled study sought to determine somatic tinnitus prevalence among tinnitus sufferers, and to investigate whether sound therapy with counselling (tinnitus retraining therapy; TRT) may decrease tinnitus-associated somatic symptoms.

METHODS

To determine somatic tinnitus prevalence, 70 patients following the TRT protocol completed the Jastreboff Structured Interview (JSI) with additional questions regarding the presence and type of somatic symptoms. Among 21 somatic tinnitus patients, we further investigated the effects of TRT on tinnitus-associated facial dysesthesia. Before and after three months of TRT, tinnitus severity was evaluated using the Tinnitus Handicap Inventory (THI), and facial dysesthesia was assessed with an extended JSI-based questionnaire.

RESULTS

Among the evaluated tinnitus patients, 56% presented somatic tinnitus-including 51% with facial dysesthesia, 36% who could modulate tinnitus by head and neck movements, and 13% with both conditions. Self-evaluation indicated that TRT significantly improved tinnitus and facial dysesthesia in 76% of patients. Three months of TRT led to a 50% decrease in mean THI and JSI scores regarding facial dysesthesia.

CONCLUSIONS

Somatic tinnitus is a frequent and underestimated condition. We suggest an extension of the JSI, including specific questions regarding somatic tinnitus. TRT significantly improved tinnitus and accompanying facial dysesthesia, and could be a useful somatic tinnitus treatment.

Acute external ear lesions: clinical aspects, assessment and management

Acute external ear lesions: clinical aspects, assessment and management. We reviewed the literature concerning the assessment and the management of the external ear traumas, which is not very rich. Nevertheless, we outlined the practical attitudes in the four major conditions met: the auricular haematoma, the auricular perichondritis, the auricular laceration and auricular bums. All these pathologies must be promptly treated because there is a risk of perichondritis, which can destroy the cartilage and will result in a severely deformed ear. Auricular haematomas must be drained as soon as possible, lacerations with exposed cartilage must be stitched urgently, and burnt ears should be washed, coated with alginates (Flaminal@) and covered with a loose dressing. Antibioprophyl- axy should always be prescribed after a complete microbiological sampling.

Nuclear structure aspects of neutrinoless double-β decay

We decompose the neutrinoless double-β decay matrix elements into sums of products over the intermediate nucleus with two less nucleons. We find that the sum is dominated by the J(π)=0(+) ground state of this intermediate nucleus for both the light and heavy neutrino decay processes. This provides a new theoretical tool for comparing and improving nuclear structure models. It also provides the connection to two-nucleon transfer experiments.

Shell-model analysis of the 136Xe double beta decay nuclear matrix elements

Neutrinoless double beta decay, if observed, could distinguish whether the neutrino is a Dirac or a Majorana particle, and it could be used to determine the absolute scale of the neutrino masses. 136Xe is one of the most promising candidates for observing this rare event. However, until recently there were no positive results for the allowed and less rare two-neutrino double beta decay mode. The small nuclear matrix element associated with the long half-life represents a challenge for nuclear structure models used for its calculation. We report a new shell-model analysis of the two-neutrino double beta decay of 136Xe, which takes into account all relevant nuclear orbitals necessary to fully describe the associated Gamow-Teller strength. We further use the new model to analyze the main contributions to the neutrinoless double beta decay matrix element, and show that they are also diminished.

[Somatic tinnitus (review). A consequence of plasticity and bimodal integration in the dorsal cochlear nucleus]

Somatic tinnitus is a peculiar tinnitus type that can be defined as a tinnitus that can be modulated in intensity and/or pitch by manipulating some regions of the head and neck but also as tinnitus associated with facial pain or dysesthesis in the same area. Those areas are innervated by the trigeminal nerve and the cervical plexus. This can be explained by functional connections between the trigeminal system and the auditory brainstem and mid-brain. A literature overview shows how different messages coming from the head and neck are able to modulate the hearing information. Tinnitus is generated by an increase of the spontaneous discharges of the dorsal cochlear nucleus neurons, tonotopic reorganisation and an increase of the neural synchronism in the auditory cortex. Trigeminal stimulations have an influence on the activity of the dorsal cochlear nucleus especially in case of an associated hearing loss.

External or internal lateral osteotomy: why I choose the external percutaneous approach

The authors present their surgical experience with the management of patients with dorsum deformities using a precise technique: the external percutaneous approach. The indications for this technique have still not been set out very clearly in the rhinological textbooks or manuals, and so novices (and not only novices) have difficulty in understanding and applying it. We therefore try to systematise and clarify these indications in brief, together with the technical details, providing a comparison with another technique that is in very widespread use at present: the internal lateral osteotomy. Although the external percutaneous approach is not used very often--in our experience in 30% of cases only--we find the results very satisfactory and we recommend it when it is required by the anatomic conditions.

Survey of excited state neutron spectroscopic factors for Z=8-28 nuclei

We have extracted 565 neutron spectroscopic factors of sd and fp shell nuclei by systematically analyzing more than 2000 measured (d, p) angular distributions. We are able to compare 125 of the extracted spectroscopic factors to values predicted by large-basis shell-model calculations and evaluate the accuracies of spectroscopic factors predicted by different shell-model interactions in these regions. We find that the spectroscopic factors predicted for most excited states of sd-shell nuclei using the latest USDA or USDB interactions agree with the experimental values. For fp shell nuclei, the inability of the current models to account for the core excitation and fragmentation of the states leads to considerable discrepancies. In particular, the agreement between data and shell-model predictions for Ni isotopes is not better than a factor of 2 using either the GXPF1A or the XT interaction.

Coupled-cluster and configuration-interaction calculations for odd-A heavy nuclei

We compare coupled-cluster (CC) and configuration-interaction (CI) results for 55Ni and 57Ni obtained in the pf-shell basis, focusing on the practical equation-of-motion (EOM) CC approximations that can be applied to systems with dozens of correlated fermions. The weight of the reference state and the strength of correlation effects are controlled by the gap between the f7/2 orbit and the f5/2, p3/2, p1/2 orbits. Independent of the gap, the CC methods with up to 2p-2h components in the cluster operator and 3p-2h/3h-2p components in the EOMCC excitation operator are more accurate than the computationally more demanding CI approach with up to 3p-3h excitations and almost as accurate as the even more demanding CI approach truncated at 4p-4h excitations.

Z = 50 shell gap near 100Sn from intermediate-energy Coulomb excitations in even-mass 106-112Sn isotopes

Rare isotope beams of neutron-deficient 106,108,110Sn from the fragmentation of 124Xe were employed in an intermediate-energy Coulomb excitation experiment. The measured B(E2,0(1)(+)-->2(1)(+)) values for 108Sn and 110Sn and the results obtained for the 106Sn show that the transition strengths for these nuclei are larger than predicted by current state-of-the-art shell-model calculations. This discrepancy might be explained by contributions of the protons from within the Z = 50 shell to the structure of low-energy excited states in this region.

Shape and structure of N=Z 64Ge: electromagnetic transition rates from the application of the recoil distance method to a knockout reaction

Transition rate measurements are reported for the 2(1)+ and 2(2)+ states in N=Z 64Ge. The experimental results are in excellent agreement with large-scale shell-model calculations applying the recently developed GXPF1A interactions. The measurement was done using the recoil distance method (RDM) and a unique combination of state-of-the-art instruments at the National Superconducting Cyclotron Laboratory (NSCL). States of interest were populated via an intermediate-energy single-neutron knockout reaction. RDM studies of knockout and fragmentation reaction products hold the promise of reaching far from stability and providing lifetime information for excited states in a wide range of nuclei.

Coupled-cluster and configuration-interaction calculations for heavy nuclei

We compare coupled-cluster (CC) and configuration-interaction (CI) results for (56)Ni obtained in the pf-shell basis, focusing on practical CC approximations that can be applied to systems with dozens or hundreds of correlated fermions. The weight of the reference state and the strength of correlation effects are controlled by the gap between the f(7/2) orbit and the f(5/2), p(3/2), p(1/2) orbits. Independent of the gap, the CC method with 1p-1h and 2p-2h clusters and a noniterative treatment of 3p-3h clusters is as accurate as the more demanding CI approach truncated at the 4p-4h level.

Measurement of excited states in (40)Si and evidence for weakening of the N=28 shell gap

Excited states in (40)Si have been established by detecting gamma rays coincident with inelastic scattering and nucleon removal reactions on a liquid hydrogen target. The low excitation energy, 986(5) keV, of the 2(1)(+) state provides evidence of a weakening in the N=28 shell closure in a neutron-rich nucleus devoid of deformation-driving proton collectivity.

Structure, bonding, and magnetism in manganese clusters

We investigate the structures and magnetic properties of small Mn(n) clusters in the size range of 2-13 atoms using first-principles density functional theory. We arrive at the lowest energy structures for clusters in this size range by simultaneously optimizing the cluster geometries, total spins, and relative orientations of individual atomic moments. The results for the net magnetic moments for the optimal clusters are in good agreement with experiment. The magnetic behavior of Mn(n) clusters in the size range studied in this work ranges from ferromagnetic ordering (large net cluster moment) for the smallest (n=2, 3, and 4) clusters to a near degeneracy between ferromagnetic and antiferromagnetic solutions in the vicinity of n=5 and 6 to a clear preference for antiferromagnetic (small net cluster moment) ordering at n=7 and beyond. We study the details of this evolution and present a picture in which bonding in these clusters predominantly occurs due to a transfer of electrons from antibonding 4s levels to minority 3d levels.

Random versus realistic interactions for low-lying nuclear spectra

We compare the shell-model results for realistic interactions with those obtained for various ensembles of random matrix elements. We show that, although the quantum numbers of the ground states in the even-even nuclei have a high probability ( approximately 60%) to be J(pi)T = 0(+)0, the overlap of those states with the realistic wave functions is very small in average. The transition probabilities B(E2) predicted with random interactions are also too small. The presence of the regular pairing is shown to be a significant element of realistic physics not reproduced by random interactions.

Spectral statistics of the two-body random ensemble revisited

Using longer spectra we reanalyze spectral properties of the two-body random ensemble studied 30 years ago. At the center of the spectra the old results are largely confirmed, and we show that the nonergodicity is essentially due to the variance of the lowest moments of the spectra. The longer spectra allow us to test and reach the limits of validity of French's correction for the number variance. At the edge of the spectra we discuss the problems of unfolding in more detail. With a Gaussian unfolding of each spectrum the nearest-neighbor spacing distribution between ground state and first exited state is shown to be stable. Using such an unfolding the distribution tends toward a semi-Poisson distribution for longer spectra. For comparison with the nuclear table ensemble we could use such unfolding obtaining similar results as in the early papers, but an ensemble with realistic splitting gives reasonable results if we just normalize the spacings in accordance with the procedure used for the data.

Single-parent evolution algorithm and the optimization of Si clusters

We describe a novel method for the structural optimization of molecular systems. Similar to genetic algorithms (GA), our approach involves an evolving population in which new members are formed by cutting and pasting operations on existing members. Unlike previous GA's, however, the population in each generation has a single parent only. This scheme has been used to optimize Si clusters with 13-23 atoms. We have found a number of new isomers that are lower in energy than any previously reported and have properties in much better agreement with experimental data.