Background Anosmia and ageusia are symptoms commonly associated with COVID-19, but the relationship with disease severity, onset and recovery are unclear. Objective To examine factors associated with anosmia and ageusia and the recovery from these symptoms in an ethnically diverse cohort. Methods Individuals tested for SARS-CoV-2 between March and April 2020 were eligible for the study. Randomly selected participants answered a telephone questionnaire on COVID-19 symptoms with a focus on anosmia and ageusia. Additionally, relevant past medical history and data on the COVID-19 clinical course were obtained from electronic medical records. 486 patients were in the COVID-19 group and 103 were COVID-19-negative. Results Patients who were younger were more likely to report anosmia and/or ageusia (odds ratio (OR) for anosmia per 1-year increase in age: 0·98, 95%CI:0–97-0·99, p = 0·003; for ageusia: 0·98, 95%CI:0·97-0·99, p = 0·005) as were patients with lower eosinophil counts (OR for anosmia per 0.1-K/μL increase in eosinophils: 0·02, 95%CI:0·001-0·46, p = 0·01, for ageusia 0·10, 95%CI:0·01-0·97, p = 0·047). Male gender was independently associated with a lower probability of ageusia (OR:0·56, 95%CI:0·38-0·82, p = 0·003) and earlier sense of taste recovery (HR:1·44, 95%CI:1·05-1·98, p = 0·02). Latinos showed earlier sense of taste recovery than white patients (HR:1·82, 95%CI:1·05-3·18, p = 0·03). Conclusion Anosmia and ageusia were more common among younger patients and those with lower blood eosinophil counts. Ageusia was less commonly reported among men, and time to taste recovery was earlier among both men and Latinos.

The popularity of electronic cigarettes (e-cigs) that utilize nicotine salts has rapidly increased since the introduction of JUUL pods in 2015. The immunotoxicology of nicotine salts in the respiratory tract is understudied. We hypothesized that nicotine salt counteranions induce airway inflammation and alter immune responses to inhaled allergens independent of nicotine. METHODS: The nicotine salt counteranions lactate, levulinate, salicylate or benzoate (5% solution) were administered to C57BL/6J mice by oropharyngeal aspiration daily for three days (acute exposure model) or three times weekly for three weeks (persistent exposure model). In some studies, mice were also exposed to house dust mite (HDM) allergen alone or in combination with benzoate three times weekly for three weeks. Airway inflammation was assessed by enumeration of inflammatory cells in bronchoalveolar lavage fluid and lung histology. RESULTS: Acute exposure to nicotine salt counteranions induced an influx of neutrophils into the airways. Persistent exposure to nicotine salt counteranions resulted in a mixed neutrophilic and lymphocytic airway inflammatory response. Neither acute nor persistent exposure to nicotine salt counteranions caused airway eosinophilia. In a HDM-mediated allergic airway inflammation model, co-exposure to benzoate and HDM increased the percentage of airway neutrophils but decreased the percentage of eosinophils compared to HDM alone. CONCLUSIONS: Both acute and persistent exposure to nicotine salt counteranions induces airway inflammation in mice independent of nicotine. Benzoate also induced neutrophilic inflammation in a HDMmediated allergic airway inflammation model, suggesting that exposure to e-cigs containing nicotine salts may promote a neutrophilic asthma phenotype.

Objective To characterize the relationship between severity of sleep apnea and coronavirus disease 2019 (COVID-19) hospitalization and severe illness. Study Design Retrospective cohort study. Setting Montefiore Health System in the Bronx, New York. Methods The data set consisted of adult patients with an active diagnosis of obstructive sleep apnea in the past 2 years and a positive severe acute respiratory syndrome coronavirus 2 quantitative polymerase chain reaction test at our institution between March 16, 2020, and May 26, 2020. Sleep apnea severity and continuous positive airway pressure compliance data were abstracted from the electronic medical record. The International Classification of Diseases, 10th Revision was used to classify comorbidities. Results A total of 461 patients with sleep apnea tested positive for COVID-19, of whom 149 were excluded for missing data in the electronic medical record. Patients with moderate and severe sleep apnea had higher rates of COVID-19 hospitalization compared to those with mild sleep apnea ( P = .003). This association was reduced when accounting for confounders, most notably the Charlson Comorbidity Index, a measure of comorbid illness burden. Moderate and severe sleep apnea were associated with increased Charlson Comorbidity Indices, compared to mild sleep apnea ( P = .01). Sleep apnea severity was not associated with a composite outcome of mechanical ventilation, intensive care unit admission, and death. Conclusion Sleep apnea severity was associated with the Charlson Comorbidity Index and may be a risk factor for COVID-19 hospitalization. We found no evidence that sleep apnea severity among hospitalized patients was associated with a composite outcome of mechanical ventilation, intensive care unit admission, and death.

Serum 25-hydroxycholecalciferol (25[OH]D₃) levels and other parameters of vitamin D nutriture were examined in 58 subjects aged 70 or more, living in Jerusalem. They were compared with those of 54 young adults living in the same neighbourhood. No evidence was obtained of a lower level of vitamin D nutriture in the elderly compared to younger adults. Serum 25(OH)D₃ of the elderly adults was 18.4 (SEM: 1.4) ng/ml and in the younger adults, 17.8 (1.0) ng/ml. There was no seasonal variation in serum 25(OH)D₃, nor could a strong association be found between reported vitamin D intake nor with exposure to sunshine. There was a negative correlation between serum alkaline phosphatase and the calcium-phosphorus product in serum. High values of alkaline phosphatase were associated with reported low exposure to sunlight and, in elderly persons, with a reported low consumption of vitamin D.

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189 Background: Data at our institution shows lung cancer is more prevalent and aggressive in HIV patients. A study of lung cancer patients revealed a mean age of 55.8 years in those with HIV vs. 68.0 in those without. Additionally, 67% of HIV patients had metastasis at time of diagnosis, compared to 49% in the overall population. One study found an 18.9% reduction in lung cancer mortality among HIV patients who receive NLST-recommended screening. Despite this, data from 2018 estimated only 13% of eligible HIV patients had completed screening at our institution. We pursued a quality improvement initiative to increase lung cancer screening in our HIV clinics. Methods: Our multi-disciplinary team studied charts of the 628 HIV clinic patients seen in a four-month span to identify those who had not received lung cancer screening and potential reasons why referrals were not made. We also spoke with clinic providers to identify improvement areas. Our intervention encompassed HIV patients that met CMS screening criteria (i.e. age 55-77, 30 pack-year smoking). Our process measure was new referrals to our dedicated screening coordinator, who contacts patients to arrange for CT scans. We plotted trends in appointment referrals on a run chart. Results: Areas for improvement included EMR documentation to assess screening eligibility and an occasional lack of awareness regarding criteria. Providers also cited time constraints may limit referrals. Our team identified patients that met screening criteria and generated EMR reminders for providers to refer patients to radiology. We also held sessions with providers and nursing staff to increase awareness of our screening program. Of 628 patients, 128 (20.4%) had sufficient documented smoking history to assess for screening eligibility. 81 patients (63.3%) met our criteria. Of these patients, 58 (71.6%) had not been screened or referred for screening. Through our most recent interventions, 16 (31.3%) patients have been referred to our screening coordinator, and 7 (12.1%) have received screening CT scans. Our interventions ultimately led to an increase from 23 of 81 (28.4%) patients with completed screening to a projected 46 of 81 (56.8%). Conclusions: Providing education and EMR alerts to raise awareness regarding eligibility, we substantially increased the screening rate in our clinics. Our interventions will be broadened as we return from COVID stoppages. Future interventions include increasing smoking history documentation in the EMR to allow for automated identification of screening eligibility. PDSA and interventions are ongoing with continued follow-up of efficacy.

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