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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 19  |  Issue : 3  |  Page : 459-462

The severity of clinical symptoms and paranasal sinuses CT-scan finding in COVID-19 patients in Kirkuk Province


Kirkuk General Hospital, Kirkuk Health Directorate, Kirkuk, Iraq

Date of Submission30-May-2022
Date of Acceptance13-Jun-2022
Date of Web Publication29-Sep-2022

Correspondence Address:
Fadya Lutfi Dawood Dalloo
Kirkuk General Hospital, Kirkuk Health Directorate, Kirkuk
Iraq
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/MJBL.MJBL_81_22

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  Abstract 

Introduction: COVID-19, first detected in Wuhan, China in December 2019, fast spread across the globe, causing a pandemic affecting many countries around the world. Objectives: The aim of this study was to assess the severity of clinical features and paranasal sinuses computed tomography (CT)-scan findings in COVID-19 patients and find the relationship between smoking and severity of COVID-19 symptoms. Materials and Methods: A cross-sectional study was achieved on a cohort of 399 patients, who clinically suffer from COVID-19 symptoms. The collected data for those patients included COVID-19 polymerase chain reaction (PCR) tests, presence of the IgG and IgM antigens, and paranasal sinuses CT-scan images. Results: This was a cross-sectional study of 399 patients infected with COVID-19. The mean age of the patients was 39 ± 11 years. Approximately 53.6% of them were males, whereas 46.4% were females. 55.6% of them performed CT scan for sinuses. 28.6% of the patients were with severe clinical features. 51.1% of them were smoking. 77.4% of them were of positive PCR, 57.9% positive IgG, and 86.7% positive IgM. 27.8% of patients were of the age group of 40–49 years. There was a significant association between the severity of COVID infection and age group. There was a significant association between the severity of COVID infection and sinus CT-scan findings. There was a significant association between the severity of COVID infection and positive PCR. There was a significant association between the severity of COVID infection and positive IgM. There was a significant association between smoking and sinus CT-scan findings. Conclusion: At the time of COVID infection, the severity of infection ranged from mild to moderate. More severe infection with COVID-19 associated with significant finding in sinus CT scan in patients at age group 50–59 years, and sinus also more severe COVID infection associate with positive CT scan finding that occur more in smocking patients.

Keywords: COVID, CT-scan finding, Kirkuk province, paranasal sinuses, the severity


How to cite this article:
Dalloo FL, Shukur MS, Taha AO. The severity of clinical symptoms and paranasal sinuses CT-scan finding in COVID-19 patients in Kirkuk Province. Med J Babylon 2022;19:459-62

How to cite this URL:
Dalloo FL, Shukur MS, Taha AO. The severity of clinical symptoms and paranasal sinuses CT-scan finding in COVID-19 patients in Kirkuk Province. Med J Babylon [serial online] 2022 [cited 2022 Dec 7];19:459-62. Available from: https://www.medjbabylon.org/text.asp?2022/19/3/459/357278




  Introduction Top


COVID-19, first detected in Wuhan, China in December 2019, fast spread across the globe, causing a pandemic affecting many countries around the world. The main manifestations of COVID-19 include fever, dry cough, and dyspnea. Other manifestations such as constitutive, gastrointestinal, or neurologic symptoms were also reported along with fatigue, headache, nausea, vomiting, and myalgia.[1] Following several reports of anosmia as a common symptom of COVID-19, the American Academy of Otolaryngology-Head and Neck Surgery and the British Association of Otorhinolaryngology added anosmia and dysgeusia to the list of manifestations mandating screening for COVID-19.[2] Olfactory dysfunction (loss of smell) includes anosmia (complete loss), hyposmia (partial loss), phantosmia (sensing odors without external stimulant), and parosmia (a change in the usual feeling of odor). Anosmia is the cardinal olfactory symptom of COVID-19. Interestingly, despite SARS-COV-2 and SARS-COV having similarities in genetic sequence, pathogenesis, and cellular entry, anosmia has not been reported as a common symptom during the SARS-COV epidemic.[3] Conductive, sensorineural, and mixed etiologies constitute the pathogenesis of post-viral anosmia. Sinonasal disease may lead to nasal obstruction, preventing the entry of odorants to the olfactory cleft, thus leading to conductive loss of olfaction. Treatment and outcomes of smell disorder due to conductive loss (mucosal thickening) are different from sensorineural loss. Nonetheless, nasal endoscopy for evaluation of patients with COVID-19 is not recommended due to the risk of virus transmission to health-care workers. Therefore, vast majority of studies in anosmia of COVID-19 are based on the symptoms rather than complete ENT examination.[4] The aim of this study was to assess the severity of clinical features and paranasal sinuses computed tomography (CT)-scan findings in COVID-19 patients and find the relationship between smoking and severity of COVID-19 symptoms.


  Materials and Methods Top


A cross-sectional study was achieved on a cohort of 399 patients, who clinically suffered from COVID-19 symptoms. The study was carried out from July 2020 until February 2022 in Kirkuk General Hospital. In this study, we wanted to find out the relationship between the smoking behavior and the severity of the COVID-19 symptoms in our patients. The collected data for those patients included the following:

  • COVID-19 polymerase chain reaction (PCR) tests.


  • Presence of the IgG and IgM antigens.


  • Paranasal Sinuses CT-scan images.


  • The 399 patients were divided into two groups (204 smokers and 195 nonsmokers). Every group was classified according to the clinical severity of the symptoms and then further according to the findings in the CT-scan images of the paranasal sinuses (mucosal thickening). Statistical analysis was done by SPSS software program, version 22.0. Frequency and percentage used for categorical data, mean, median and SD for continuous data. Chi-square and fisher exact test used for assessed association between categorical variables. A P-value ≤ 0.05 was considered significant.

    Ethical approval

    The study was conducted in accordance with the ethical principles that have their origin in the Declaration of Helsinki. It was carried out with patients' verbal and analytical approval before the sample was taken. The study protocol and the subject information and consent form were reviewed and approved by a local ethics committee according to the document number 123 (including the number and the date in 12/06/2020) to get this approval.


      Results Top


    This was a cross-sectional study of 399 patients infected with COVID-19. The mean age of the patients was 39 ± 11 years. 53.6% of them were males, whereas 46.4% were females. 55.6% of them performed CT scan for sinuses. 28.6% of the patients were with severe clinical features. 51.1% of them were smoker, 77.4% of them were of positive PCR, 57.9% positive IgG, and 86.7% positive IgM. 27.8% of the patients were in the age group of 40–49 years [Table 1].
    Table 1: Distribution of variable included in this study

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    As shown in [Table 2], there was a significant association between the severity of COVID infection and age group. 56.1% of them were of having a severe infection at 50–59 years old. There was a significant association between the severity of COVID infection and sinus CT-scan findings; 63.2% of severe infections had sinus CT-scan findings. There was a significant association between the severity of COVID infection and PCR; 87.7% of severe infections had positive PCR. There was a significant association between the severity of COVID infection and IgM; 92.1% of severe infections had positive IgM. Other variables had no significant association with the severity of COVID infection.
    Table 2: Association between severity of COVID infection and variables in this study

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    As shown in [Table 3], there was a significant association between patients smocking and positive sinus CT scan finding. 75.5% of patients they smoked have positive sinus CT scan finding.
    Table 3: Association between smoking and sinus CT scan of patients

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    As shown in [Table 4], there was no significant association between severity of symptoms and sinus CT scan finding in smoking patients infected with COVID-19.
    Table 4: Association between severity of symptoms and sinus CT scan finding in smoking patients infected with COVID-19

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      Discussion Top


    Numerous clinical features have been described from starting of COVID-19 pandemic; one of the very important ones is anosmia.[5],[6],[7] Post-viral olfactory loss is explained by altered mechanisms such as congestion, secretions, inflammatory changes in the nasal mucosa,[8],[9],[10] and obstruction in the olfactory cleft or neurogenic invasion/olfactory bulb involvement.[8],[9] Olfactory disturbance consists of airflow obstruction, sensory insufficiency ascending from direct neuro epithelium damage; and neural insufficiencies consist of injury to the olfactory bulb, olfactory tract, or the central olfactory pathway including the prefrontal lobe, septal nuclei, amygdala, and temporal lobe.[4] Inflammation, infection, and chemical agents can impact the dendritic processes of the olfactory receptors in the cleft area via inflammatory cytokine release, thus inducing apoptosis in neurons.[11] Coronaviruses are one of the many viruses identified to cause post-infection olfactory dysfunction.[12],[13] Detailed clinical history and imaging (e.g., CT scan and/or magnetic resonance imaging [MRI]) are necessary in the assessment of anosmic patients to identify the underlying etiology. In this study, the mean age of the patients was 39 ± 11 years. 53.6% of them were males, whereas 46.4% were females. This is similar to other study they also stated that the mean of age of COVID-19 infected patients are 45 years old, and also they stated that males more infected with COVID-19 than females.[14] In this study, there was a significant association between the severity of COVID infection and age group; 56.1% of them were of having a severe infection at 50–59 years. There was a significant association between the severity of COVID infection and sinus CT-scan finding, PCR, and IgM; 63.2% of severe infections had sinus CT scan finding; 87.7% of severe infections had positive PCR; 92.1% of severe infections had positive IgM. This is similar to other studies that state a strong positive correlation between higher CT severity score and male gender (P = 0.0002, R2 = 0.9). Also, there was a significant correlation between CT severity score and increasing age (P < 0.00018). A significant correlation was found between sinus positive CT scan finding percentage of lung involvement and positive PCR test results (P = 0.001917), as the CT severity index is increasing, the PCR test is more likely to be positive.[15] Nasal congestion was reported by 41% of SARS-CoV-2 positive patients, this is similar to finding done by Lechien et al.,[16] (36.9%) and Naeini et al.,[14] (32.7%). A recent article included 49 COVID-19 positive patients with anosmia, used the original Lund Mackay scoring system, and showed partial opacification in less than 10% of maxillary, frontal, and sphenoid sinuses, and the ethmoid air cells were normally aerated in all patients.[16] In a cohort of 16 patients infected with COVID-19 and their tests are positive with olfactory dysfunction, Lechien et al.[14] In this study, no association was observed between gender and severity of symptoms; also, this is similar to other studies that show no association.[17] In this study, there was a significant association between patients they smocking and sinus CT scan positive finding. (75.5%) of patients they smocking have positive sinus CT scan finding. This is similar to other studies that stated that mucosal thickening was present in 97.4% of maxillary sinuses, 80% of anterior ethmoid air cells, 75.3% of posterior ethmoid air cells, 74.7% of frontal sinuses, and 66.3% of sphenoid sinuses.[17] Multiple studies have analyzed the pathophysiologic effects of tobacco smoke on sinonasal mucosa. Cigarette smoke induces a physiologic nasal response including increased nasal airway resistance, nasal irritation, nasal congestion, and rhinorrhea. Tobacco smoke extract has been shown to have adverse effects on sinonasal epithelial mucociliary clearance and innate immune function as well as olfactory mucosal metaplasia.[18]


      Conclusion Top


    At the time of diagnosis, the severity of clinical features ranged from mild to moderate, with more severe infection with COVID-19 associated with significant findings in sinus CT scan in the age group 50–59 years, and sinus CT scan findings occur more in smoking infected patients.

    Financial support and sponsorship

    Not applicable.

    Conflicts of interest

    There are no conflicts of interest.



     
      References Top

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    Xu YH, Dong JH, An WM, Lv XY, Yin XP, Zhang JZ, et al. Clinical and computed tomographic imaging features of novel coronavirus pneumonia caused by SARS-cov-2. J Infect 2020;80:394-400.  Back to cited text no. 1
        
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    Busaba NY Is imaging necessary in the evaluation of the patient with an isolated complaint of anosmia? Ear Nose Throat J 2001;80:892-6.  Back to cited text no. 4
        
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    7.
    Wilson MP, Jack AS Coronavirus disease 2019 (COVID-19) in neurology and neurosurgery: A scoping review of the early literature. Clin Neurol Neurosurg 2020;193:105866.  Back to cited text no. 7
        
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    Yao L, Yi X, Pinto JM, Yuan X, Guo Y, Liu Y, et al. Olfactory cortex and olfactory bulb volume alterations in patients with post-infectious olfactory loss. Brain Imaging Behav 2018;12:1355-62.  Back to cited text no. 9
        
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    Duncan HJ Postviral Olfactory Loss. Taste and Smell Disorders. New York: Thieme; 1997. p. 72-8.  Back to cited text no. 10
        
    11.
    Kim BG, Kang JM, Shin JH, Choi HN, Jung YH, Park SY Do sinus computed tomography findings predict olfactory dysfunction and its postoperative recovery in chronic rhinosinusitis patients? Am J Rhinol Allergy 2015;29:69-76.  Back to cited text no. 11
        
    12.
    Hwang CS Olfactory neuropathy in severe acute respiratory syndrome: Report of A case. Acta Neurol Taiwan 2006;15:26-8.  Back to cited text no. 12
        
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    Naeini AS, Karimi-Galougahi M, Raad N, Ghorbani J, Taraghi A, Haseli S, et al. Paranasal sinuses computed tomography findings in anosmia of COVID-19. Am J Otolaryngol 2020;41:102636.  Back to cited text no. 14
        
    15.
    Al-Mosawe AM, Abdulwahid HM, Fayadh NAH Spectrum of CT appearance and CT severity index of COVID-19 pulmonary infection in correlation with age, sex, and PCR test: An Iraqi experience. Egypt J Radiol Nucl Med 2021;52:40.  Back to cited text no. 15
        
    16.
    Lechien JR, Michel J, Radulesco T, Chiesa-Estomba CM, Vaira LA, De Riu G, et al. Clinical and radiological evaluations of COVID-19 patients with anosmia: Preliminary report. Laryngoscope 2020;130:2526-31.  Back to cited text no. 16
        
    17.
    Sumi DV, Loureiro RM, Collin SM, Deps PD, Bezerra LL, Gomes RLE, et al. Sinus computed tomography findings in patients with COVID-19. Einstein (Sao Paulo) 2021;19:eAO6255.  Back to cited text no. 17
        
    18.
    Reh DD, Higgins TS, Smith TL Impact of tobacco smoke on chronic rhinosinusitis: A review of the literature. Int Forum Allergy Rhinol 2012;2:362-9.  Back to cited text no. 18
        



     
     
        Tables

      [Table 1], [Table 2], [Table 3], [Table 4]



     

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