Andhra Pradesh PHC doctors announce hunger strike from October 3

Vijayawada: Upset and frustrated over the government’s continued ignorance towards their basic demands, doctors working at Primary Health Centres (PHCs) across the state have announced a hunger strike on October 3, suspending outpatient services if their demands, on issues such as promotions, allowances, increments, and other service-related concerns, are not addressed.   

Calling the doctors’ demands ‘unjustifiable’, the health department has deployed doctors from district and teaching hospitals to the PHCs to ensure zero disruption in providing medical services to the patients. The department has also urged the doctors to resume their duties and call off the strike. 

This comes after talks between the doctors and the Commissioner of Health and Family Welfare failed to yield a resolution. Recently, the Commissioner of Health and Family Welfare invited APPHCDA leaders for a discussion regarding their concerns. However, when the meeting did not yield any results, the doctors decided to intensify their protest. 

Also read- Andhra Pradesh doctor suspended over patient death at PHC

Doctors under the Andhra Pradesh Primary Health Centres Doctors Association (APPHCDA) recently submitted a strike notice to the Director of Public Health, Dr P Padma Sasidhar, and higher authorities, giving the government a five-day window to address their demands before launching agitation.

The association has planned a series of protests, including sit-ins at the district centres on September 30, October 1, and 2, to step up pressure on the government.

“Our demands are genuine and repeatedly ignored. Without immediate resolution, we will escalate with a hunger strike in Vijayawada beginning on October 3,” APPHCDA President Ravindra Naik told PTI.

He said that for 2025–26, the in-service PG quota was reduced to 15 per cent in only seven branches, compared to 20 per cent across all branches last year.

The doctors have demanded a uniform 15 per cent in-service quota across all specialities for the next three years to ensure fairness for Primary Health Centre (PHC) doctors pursuing postgraduate courses.

Another demand is time-bound promotions, noting that PHC doctors have served 20 years without advancement. In comparison, District Speciality Hospital (Andhra Pradesh Vaidya Vidhana Parishad) doctors were promoted within just three years of service.

The association also highlighted the absence of tribal allowances for PHC doctors working in remote forest areas, while District Speciality Hospital doctors have been receiving these benefits for two years.

Further demands include a mobile medical services allowance and other service-related issues, the association said.

However, the state government mentioned that a recent GO has allotted 15% clinical and 30% non-clinical PG seats for in-service doctors. Therefore, the government claimed that the protest is unjust. Approximately 1,000 PG doctors will join duties from November, vacancies in secondary hospitals will be filled by 2027, and teaching hospitals by 2028, said the government. 

In case the doctors continue with their hunger strike on October 3, the services at the PHCs will be severely hit, as 1 lakh patients a day on average, particularly in rural and tribal areas, receive their treatment from these centres, report TNIE. 

To ensure that the centres run smoothly without disruption, the health department deployed 1,014 PG students, senior residents, and MBBS tutors, and 1,017 MBBS doctors from other hospitals to the PHCs. 

Also read- Madras HC rejects plea for doctor’s appointment at PHC, says it’s a departmental matter

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Overweight and obesity patients have improve survival against chronic total occlusion: BMJ

A new study published in the British Medical Journal showed that diabetes mellitus (DM) and low BMI have negative influence on long-term survival in individuals with chronic total occlusion (CTO).

One of the more difficult subtypes of coronary artery disease (CAD) is chronic complete occlusion. About one-fourth of individuals with chronic coronary syndrome and 16% to 30% of patients undergoing coronary angiography have CTO. Diabetes mellitus (DM), which is characterized by insulin resistance, β-cell dysfunction, and chronic hyperglycemia, is a primary contributor to vascular problems.

Another important factor influencing cardiovascular outcomes in individuals with CAD is body mass index (BMI), as obesity is becoming much more common in the general population. Thus, this study assessed how body mass index (BMI) and diabetes mellitus affected the long-term all-cause mortality of patients with CTO.

The Swedish Coronary Angiography and Angioplasty Registry was a part of this retrospective, countrywide cohort research, which ran from June 2015 to December 2021. 24,284 patients had CTO that was verified by angiography. Excluded is previous coronary artery bypass graft surgery. DM status and BMI classifications (underweight, healthy weight, overweight, and obesity) were used to create subgroups. 

A 31% increased risk of death was associated with DM, which was present in 30.3% of patients (HR: 1.31, 95% CI: 1.20 to 1.42; p<0.001). Diabetes patients who used insulin had a 52% higher risk (HR: 1.52; 95% CI: 1.38 to 1.67; p<0.001).

BMI showed that the risk was lower for overweight (HR: 0.70, 95% CI: 0.64 to 0.77; p<0.001) and obese (HR: 0.74, 95% CI: 0.68 to 0.81; p<0.001) groups than for the healthy-weight group, while the risk was higher for underweight people (HR: 1.61, 95% CI: 1.25 to 2.08; p<0.001).

An asymmetric U-shaped correlation was found using a continuous BMI spline: mortality increased sharply below 23 kg/m2, reached its lowest risk (nadir) at 32 kg/m2, and increased moderately beyond 35 kg/m2.

Overall, insulin treatment further increased risk, and diabetes mellitus (DM) independently predicted higher long-term mortality in this national CTO population, along with more severe comorbidities and greater CTO complexity. The patients who were overweight or obese fared better, whereas those who were underweight fared the worst. 

Source:

Mohammed, M., Sundström, J., Louca, A., Hellsen, G., Rawshani, A., Olivecrona, G. K., Mohammad, M. A., Ioanes, D., Jensen, U., Erlinge, D., MD, PhD, Angerås, O., Petursson, P., Myredal, A., Völz, S., Dworeck, C., Odenstedt, J., Rawshani, A., & Råmunddal, T. (2025). Impact of diabetes mellitus and body mass index on long-term survival in chronic total occlusion patients: a nationwide cohort study from the SCAAR registry. BMJ Open, 15(9), e100074. https://doi.org/10.1136/bmjopen-2025-100074

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Fortified foods and dietary supplements key to bone health in vegan diets, suggests research

A study conducted at the University of Helsinki found that children and adults who follow a vegan diet had on average adequate intakes of calcium and vitamin D, nutrients important to bone health, but their bone metabolism differed from those who follow an omnivorous diet.

The MIRA2 study conducted at the University of Helsinki investigated bone metabolism and the intakes of nutrients critical to bone health, such as calcium, vitamin D and protein. The study involved children residing in Helsinki aged between two and seven who followed a vegan, vegetarian or omnivorous diet, as well as their caregivers.

The study subjects following a vegan diet adhered almost without exception also to the recommendations on the consumption of dietary supplements and fortified foods, and they had on average adequate vitamin D and calcium intakes. The children on a vegan diet had higher vitamin D intake than those on an omnivorous or a vegetarian diet due to more active consumption of vitamin D supplements with higher doses. On average, vitamin D status measured from blood was also adequate in all diet groups.

The study found that the more plant-based diets, namely vegan and vegetarian ones, were in adults associated with higher concentrations of bone formation and resorption markers, which may indicate accelerated bone metabolism. In contrast, more plant-based diets among children were associated with higher parathyroid hormone concentrations, which have been associated with more active bone resorption. While these observations can indicate long-term adverse effects on bone health, their clinical significance is unclear.

“The calcium naturally occurring in plant-based foods is fairly poorly absorbed. In fact, the widespread vitamin D and calcium fortification of plant-based dairy alternatives in Finland is important for the adequate intake of these nutrients among vegans and, consequently, for their bone health,” says Docent Suvi Itkonen from the Faculty of Agriculture and Forestry, University of Helsinki.

Many international studies have raised concerns about the potential adverse effects of vegan diets on bone health. However, these studies have typically targeted populations where vitamin D intake is low, the selection of vegan products on the market is narrow, and the consumption of fortified foods or dietary supplements is less widespread than in Finland.

Vegan diets require careful planning especially for children

The researchers found that vegans and vegetarians had lower protein intake compared to those who followed an omnivorous diet, although on average it was adequate. Proteins are composed of amino acids.

“It’s possible that the poorer absorption and different amino acid composition of plant-based proteins compared to animal proteins partly explain the observed differences in bone metabolism, but more research is needed on the topic. In fact, we will next investigate amino acid intake among the MIRA2 subjects and the amino acid composition of vegan diets,” Itkonen says.

The MIRA2 dataset was collected in Helsinki, where vegan food in daycare centres and various vegan food products are abundantly available. The families who participated in the study were well versed in guidelines for vitamin D supplementation and fortified food consumption.

“People in the Helsinki Metropolitan Area live in a kind of veggie bubble. Due to that one has to keep in mind that the findings of the study are not directly applicable to the populations of other regions or countries,” Itkonen points out.

The nutrition recommendations published last autumn emphasise a predominantly plant-based diet, restricting meat consumption and moderating milk consumption. If a food is entirely excluded from the diet, it is important to replace it with nutritionally comprehensive alternatives. When planning a vegan diet for children and adolescents, a visit to a registered dietitian is recommended.

“In terms of bone health, it is essential when consuming plant-based drinks and yoghurt-like products to choose the option fortified with calcium and vitamin D. Children should take a daily vitamin D supplement throughout the year. If the daily diet contains no margarines, dairy products or plant-based drinks fortified with vitamin D, and if fish is eaten less than 2–3 times per week, it’s important to ensure adequate vitamin D intake, especially during the dark season, by taking a vitamin D supplement. Among vegans, the need for vitamin D supplementation is common,” Itkonen notes.

Reference:

Itkonen, S.T., Hovinen, T., Kettunen, E. et al. Bone and mineral metabolism in 2–7-year-old Finnish children and their caregivers following vegan, vegetarian, and omnivorous diets. Eur J Nutr 64, 276 (2025). https://doi.org/10.1007/s00394-025-03758-y

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Acoustic Cardiography with ECG may predict Preeclampsia, reveals study

A new study published in the journal of Clinical Cardiology revealed that acoustic cardiography (ACG), which combines ECG with heart sound analysis, may help in the early detection of preeclampsia (PE). Key parameters like Left Ventricular Ejection Time (LVET) and Q2S2Max showed significant changes in women with preeclampsia.

When these measures were combined with clinical risk factors (e.g., hypertension history), the predictive accuracy improved. This suggests acoustic cardiography could be a noninvasive, cost-effective tool for identifying preeclampsia risk, though larger studies are needed for validation.

This study involved a total of 59 pregnant women, including 31 diagnosed with PE and 28 healthy controls. Using synchronized ECG and phonocardiogram (PCG) monitoring, the study examined LVET and other heart function indicators to test whether subtle cardiovascular changes could flag PE risk before severe complications arise.

Women with PE had significantly prolonged LVET, averaging 320 milliseconds when compared to 301 milliseconds in healthy pregnancies. This extension reflects increased cardiac afterload, when the heart works harder to pump blood against stiffened vessels.

LVET alone demonstrated moderate predictive value, with a sensitivity of 72% but lower specificity at 57%. However, when LVET was combined with a clinical factor, the diagnostic accuracy improved considerably. In this combined model, the area under the curve (AUC) rose to 0.776, with specificity climbing to nearly 78%, significantly reducing false positives and making screening more reliable.

Beyond LVET, the study also found differences in Q2S2Max, which represents the interval between electrical and mechanical heart activity. Women with PE displayed higher Q2S2Max values (426 ms compared to 404 ms in controls), a sign of vascular stiffness and early dysfunction in how the heart and blood vessels interact. This supports the hypothesis that cardiovascular impairment is deeply linked to PE’s progression.

Overall, this study suggests that ACG-derived metrics, particularly LVET and Q2S2Max, when considered alongside known clinical risks, can serve as effective early-warning tools for PE. Unlike invasive methods, ACG offers a portable, AI-assisted, and cost-efficient approach, potentially transforming maternal health monitoring in resource-limited settings.

Reference:

Tang, C., Zhang, X., Wang, M., Xiong, Y., Zhu, Y., Huang, Q., & Zhou, N. (2025). Acoustic cardiography (ACG) for left ventricular ejection time (LVET) monitoring in preeclampsia risk prediction. Clinical Cardiology, 48(9), e70210. https://doi.org/10.1002/clc.70210

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Aspirin therapy proved ineffective in treating chronic rhinosinusitis with nasal polyps: Study

A randomised placebo-controlled Finnish study showed that aspirin therapy does not provide significant relief for people suffering from chronic rhinosinusitis with nasal polyps who are hypersensitive to non-steroidal anti-inflammatory drugs (NSAIDs). The results of a joint study performed by the University of Eastern Finland, University of Helsinki and HUS Inflammation Center were published in the Allergy journal.

Non-steroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD) typically involves hypersensitivity to anti-inflammatory drugs, asthma, and chronic rhinosinusitis with nasal polyps (CRSwNP). Nasal polyps are caused by excess growth of the nasal mucous membranes. Hospitals have been treating this disorder with long-term aspirin (ASA) therapy for approximately 15 years.

“ASA therapy is affordable, but there hasn’t been sufficient evidence of its effectiveness. Obtaining information on the effectiveness of treatment is important because several biologic medications currently available to treat the symptoms are effective but also very expensive,” says Professor Sanna Toppila-Salmi from the University of Eastern Finland, who led the study.

The study involved administering aspirin desensitization therapy to 26 patients with N-ERD, asthma and severe CRSwNP and then randomising them into groups taking either aspirin or a placebo orally for 11 months.

“No differences in symptoms or lung function was found between the aspirin and placebo groups at the end of therapy. There were signs that ASA therapy could slightly reduce nasal polyps and improve quality of life related to nasal symptoms compared to a placebo, but the difference was not statistically significant,” says Doctoral Researcher Alma Helevä from the University of Helsinki.

There was also no difference between the groups concerning how many courses of cortisone were needed during exacerbation phases.

Based on the results, only 25% of patients who received aspirin could be classified as benefiting from the therapy, and 18% of patients in the aspirin group had to stop the treatment due to side effects. The side effects – such as respiratory symptoms, worsening of asthma, abdominal symptoms or increased bleeding tendency – occurred in 56% of the participants who received aspirin, but also in 30% of those who received a placebo.

“Based on this study, ASA therapy did not have a significant effect compared to a placebo, and a significant number of patients also suffered adverse effects. A small number of patients benefited from the therapy, but at this time it is not possible to identify which patients who are hypersensitive to NSAIDs would benefit from ASA therapy,” stated the researchers.

Reference:

Alma Helevä, Annina Lyly, Viljami Salmi, Mika Mäkelä, Paula Kauppi, Anu Laulajainen-Hongisto, Lena Hafrén, Paula Virkkula, Mikko Nuutinen, Sanna Toppila-Salmi, Efficacy of ASA Therapy After Desensitization on CRSwNP Patients With Asthma and N-ERD—A Randomized Clinical Trial, Allergy, https://doi.org/10.1111/all.16679

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Depot Medroxyprogesterone Acetate Use Linked to Higher Meningioma Risk in Women: JAMA

Researchers have found in a new study that women using depot medroxyprogesterone acetate had a higher risk of developing meningioma. Investigators have determined that women who used depot medroxyprogesterone acetate (DMPA) were at higher risk for the development of meningioma, especially with long-term use or when it was initiated at an older age. This finding is based on a large retrospective population-based cohort study that examined data in the TriNetX US national database from about 68 health care organizations from 2004 through 2024. The study was published in JAMA Neurology by Tianqi X. and colleagues.

The objective was to elucidate the risk of meningioma in women exposed to depot medroxyprogesterone acetate, oral medroxyprogesterone acetate, and other contraceptives like combined oral contraceptives, intrauterine devices (IUDs), progestin-only pills, and subdermal implants, versus women with no exposure to such agents.

The investigation had a cohort of 10,425,438 women with a mean age of 33.4 years at entry. The final analysis in propensity-score matched the final sample of 88,667 women on depot medroxyprogesterone acetate (mean age 26.2 years) against a matched control group. The main outcome was meningioma diagnosis identified through routine diagnostic codes. Relative risks (RRs) and number needed to harm (NNH) were estimated to evaluate clinical significance.

Results

  • The results showed women who were administered depot medroxyprogesterone acetate to have a relative risk of 2.43 (95% CI, 1.77–3.33) for meningioma versus controls.

  • This elevated risk was experienced mainly in those patients with greater than 4 years of treatment or initiators who began therapy at ages greater than 31 years.

  • Oral medroxyprogesterone acetate had a less dramatic but statistically significant risk (RR 1.18; 95% CI, 1.10–1.27).

  • No enhanced risk of meningioma was recognized in combined oral contraceptives, IUDs, progestin-only pills, or subdermal implants.

  • The number needed to harm (NNH) was calculated to be 1,152 patients for depot medroxyprogesterone acetate and 3,020 patients for oral medroxyprogesterone acetate, showing that the absolute clinical risk is still quite low even with the relative increase in risk.

This big US-based study gives strong evidence that depot medroxyprogesterone acetate is related to an increased risk of meningioma, especially with long duration and advanced age at start. Nevertheless, the great number needed to harm implies that the absolute clinical risk is still low.

Reference:

Xiao T, Kumar P, Lobbous M, et al. Depot Medroxyprogesterone Acetate and Risk of Meningioma in the US. JAMA Neurol. Published online September 02, 2025. doi:10.1001/jamaneurol.2025.3011

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Vitamin D Deficiency tied to increased Respiratory Infection Risk in Preschool Children: Study

Researchers have found in a new study that vitamin D deficiency independently increased the risk of respiratory infections in preschool children, especially in vulnerable groups. Hence, targeted screening and supplementation may help reduce early childhood morbidity.

Vitamin D is well known for its role in skeletal health and calcium metabolism, but in recent years growing evidence has pointed to its broader influence on immune regulation. Preschool children are particularly susceptible to respiratory infections due to the immaturity of their immune systems and frequent exposure to pathogens in daycare and school environments. Identifying modifiable risk factors, such as micronutrient deficiencies, is critical in reducing the global burden of pediatric respiratory illness. In this new investigation, researchers evaluated vitamin D status in preschool children and analyzed its association with the frequency of respiratory infections. The findings showed that children with vitamin D deficiency were more likely to develop recurrent respiratory tract infections compared to those with sufficient levels. Importantly, this association persisted even after adjusting for other contributing factors such as age, nutrition, and environmental exposures, suggesting that vitamin D deficiency is an independent risk factor rather than a byproduct of poor health. The implications of these results are significant for both clinical practice and public health. Routine screening for vitamin D levels in preschool children, particularly in regions with limited sunlight exposure or in populations with dietary inadequacies, may provide an opportunity for early intervention. Supplementation strategies tailored to at-risk groups could help strengthen immune defenses and reduce the frequency and severity of infections. This in turn has the potential to decrease healthcare utilization, lower parental stress, and improve long-term child development outcomes. Nevertheless, the authors emphasized the need for randomized controlled trials to establish optimal supplementation protocols and confirm the causality of the observed association. Future studies should also examine whether vitamin D supplementation can directly lower infection incidence and severity in diverse populations of children.

Keywords: Vitamin D deficiency, preschool children, respiratory infections, pediatric health, supplementation, immune function, morbidity risk

Reference:
Hussain S, et al. Vitamin D deficiency and risk of respiratory infections in preschool children. European Journal of Pediatrics. 2025. doi:10.1007/s00431-025-06387-z

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DMF Effectively Manages Moderate-to-Severe Psoriasis in Real-World Study

According to a new study, treatment with dimethyl fumarate provided significant clinical improvement in patients with moderate-to-severe psoriasis when observed under real-world practice conditions. Psoriasis is a chronic inflammatory skin disorder marked by erythematous scaly plaques, impaired quality of life, and systemic comorbidities such as cardiovascular disease and metabolic syndrome. Conventional systemic therapies and biologics are available, but long-term management remains challenging due to safety concerns, high costs, and variable patient responses. Dimethyl fumarate, an oral fumaric acid ester derivative with immunomodulatory and anti-inflammatory properties, has been increasingly used as a therapeutic option. The real-world data confirmed that dimethyl fumarate reduced disease severity and extent over the course of up to one year of treatment, as reflected in both clinical and patient-reported outcomes. The improvement was observed consistently across diverse patient groups, including those who had previously failed other systemic therapies. Importantly, the safety profile aligned with prior clinical trial findings, with the most frequently reported adverse effects being mild-to-moderate gastrointestinal symptoms and flushing, which were generally manageable with supportive care or dose adjustments. The study highlighted that long-term use of dimethyl fumarate was well tolerated without new safety concerns emerging, thereby reinforcing its role as a sustainable treatment choice. Researchers emphasized that fumarate therapy not only alleviates skin lesions but also addresses systemic inflammation, which may contribute to reducing risks of associated comorbidities. The real-world evidence adds value by demonstrating effectiveness outside the controlled settings of clinical trials, where patient variability and adherence patterns more closely resemble routine clinical practice. This makes the findings particularly relevant for dermatologists who must individualize therapy based on disease severity, comorbidities, and patient preferences. While dimethyl fumarate is not as rapid in onset as some biologics, its favorable safety, oral administration, and cost-effectiveness make it a compelling choice for long-term disease control in many patients. Future studies with extended follow-up are needed to evaluate its durability of response and comparative performance against newer targeted therapies.

Keywords: Dimethyl fumarate, psoriasis, moderate-to-severe psoriasis, real-world study, fumarates, systemic therapy, disease severity, patient-reported outcomes, safety profile, long-term treatment

Reference:
Reich, K., Schäkel, K., Thaçi, D., et al. Real-world effectiveness and safety of dimethyl fumarate in patients with moderate-to-severe psoriasis: a one-year observational study. Journal of the European Academy of Dermatology and Venereology. 2025. https://doi.org/10.1111/jdv.19876

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Prolonged labour duration in women with pregestational diabetes: A Population-Based Cohort Study

Women with pregestational diabetes have increased rates of
adverse obstetric and perinatal outcomes, including congenital malformations,
preeclampsia, stillbirth, fetal macrosomia, and caesarean delivery compared to
women without diabetes. The risk of emergency caesarean section (CS) is 3–4
times higher compared to women without diabetes and despite therapeutic
initiatives and technological advancements, the overall CS rate in women with
pregestational diabetes remains persistently above 60%. A common indication for
elective CS in women with pregestational diabetes is macrosomia.

It is essential to specifically investigate active labour
duration in a well-defined cohort of women with pregestational diabetes and to
include emergency CS in order to explore whether prolonged labour contributes
to the elevated CS risk in this population. Authors hypothesised that
pregestational diabetes is associated with longer duration of active labour, in
addition to other known factors influencing labour progression. Therefore, the
aims of this study were to evaluate the impact of pregestational diabetes on
DAL in nulliparous women in induced and spontaneous onset of labour and to
compare CS indications and rates, -both elective and emergency, -with those of
women without diabetes.

It was a population-based cohort study in Sweden. 243 537
nulliparous women, registered in the Swedish Pregnancy Register, who delivered
a singleton fetus at ≥34+0 gestational weeks+days between 2014 and 2020 were
included. Women with gestational diabetes mellitus were excluded.

Women with pregestational diabetes had longer active labour
and a reduced chance of vaginal delivery at a given time point compared to
women without diabetes, adjusted hazard ratio 0.65 (p <0.001). Among those
with spontaneous labour, median DAL in diabetic vs. non-diabetic women was 9.60
h versus 8.75 h, difference 0.85 h, p <0.001. Corresponding numbers for
induced labours were 8.92 h versus 7.20 h, difference 1.72 h, p<0.001.
Elective and emergency CS rates were higher in women with pregestational
diabetes than non-diabetic women (7.4% and 29.4% vs. 2.6% and 7.1%
respectively), with suspected macrosomia (50.4%) and fetal distress (31.9%)
being the most common indications for CS among women with pregestational
diabetes.

In this nation-wide population-based cohort of nulliparous
women, we observed a longer duration of both spontaneous and induced active
labour in women with pregestational diabetes, as well as a reduced likelihood
of vaginal delivery at any given time during active labour, compared with women
without diabetes.

The prolonged labour duration in women with pregestational
diabetes highlights the significance of the labour ward staff’s support and
patience in managing diabetic parturients, potentially allowing more time
before diagnosing labour dystocia in this population. An extended period of
active labour may influence how women perceive their birth experience and
emphasises the importance of providing these women with comprehensive
information prior to labour.

Source: Sofia Nevander, Sara Carlhäll,
Karin Källén; BJOG: An International Journal of Obstetrics &
Gynaecology, 2025; 0:1–9 https://doi.org/10.1111/1471-0528.18276

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While it may go unnoticed, loss of smell may linger for years after COVID-19, reports study

People who suspect that their sense of smell has been dulled after a bout of COVID-19 are likely correct, a new study using an objective, 40-odor test shows. Even those who do not notice any olfactory issues may be impaired.

Led by the National Institutes of Health’s RECOVER initiative and supported by its Clinical Science Core at NYU Langone Health, a team of researchers from across the country explored a link between the coronavirus that causes COVID-19 and hyposmia — the reduced ability to smell.

The results revealed that 80% of participants who reported a change in their smelling ability after having COVID-19 earned low scores on a clinical scent-detection test taken about two years later. Of this group, 23% were severely impaired or had entirely lost their sense of smell.

Notably, 66% of infected participants who did not notice any smelling issues scored abnormally low on the evaluation as well, the authors say.

“Our findings confirm that those with a history of COVID-19 may be especially at risk for a weakened sense of smell, an issue that is already underrecognized among the general population,” said study co-lead author Leora Horwitz, MD.

Horwitz, a professor in the Departments of Population Health and Medicine at NYU Grossman School of Medicine, adds that 60% of uninfected participants who did not report olfactory problems also tested poorly during the clinical evaluation.

Hyposmia has long been connected to weight loss, reduced quality of life, and depression, among other concerns. Those with a diminished sense of smell may also struggle to detect dangers such as spoiled food, gas leaks, and smoke, experts say. In addition, scientists have flagged smelling dysfunction as an early sign of certain neurodegenerative disorders such as Parkinson’s disease and Alzheimer’s disease, which can affect the brain’s scent-processing region.

While past research has identified hyposmia as a symptom of coronavirus infection, most of these studies have relied on patients’ own assessments of their smelling ability. Such subjective measures are not always reliable and cannot effectively track the problem’s severity and persistence, notes Horwitz.

The new study in 3,535 men and women, publishing online Sept. 25 in the journal JAMA Network Open, is the largest to date to examine loss of smell after COVID-19 by using a formal test, the authors say.

Along with Horwitz, Jacqueline Becker, PhD at Icahn School of Medicine at Mount Sinai in New York is co-lead author. Hassan Ashktorab, PhD, at Howard University in Washington, D.C.; Andrea Foulkes, ScD, at Massachusetts General Hospital in Boston; and Joyce Lee-Iannotti, MD, at the University of Arizona in Phoenix, are study co-senior authors.

For the investigation, the research team assessed thousands of Americans who had participated in the RECOVER adult study, a multicenter analysis designed to shed light on the long-term health effects of the coronavirus. Throughout the study, those with and without a history of COVID-19 completed surveys about their symptoms every 90 days from October 2021 through June 2025.

To measure olfactory function, the team used a clinical tool: the University of Pennsylvania Smell Identification Test (UPSIT). In this scratch-and-sniff evaluation, which is considered the gold standard of its kind, participants were asked to identify 40 scents by selecting the right multiple-choice option for each odor. A correct answer earned one point, and the total UPSIT score was compared with a database of thousands of healthy volunteers of the same sex and as. Based on the results, smelling ability was characterized as normal, mildly impaired, moderately impaired, severely impaired, or lost altogether.

“These results suggest that health care providers should consider testing for loss of smell as a routine part of post-COVID care,” said Horwitz. “While patients may not notice right away, a dulled nose can have a profound impact on their mental and physical well-being.”

Experts are now exploring ways to restore smelling ability after having COVID-19, such as vitamin A supplementation and olfactory training to “rewire” the brain’s response to odors. Having a deeper understanding of how the coronavirus affects the brain’s sensory and cognitive systems may help refine these therapies, notes Horwitz.

Horwitz cautions that the study team did not directly assess loss of taste, which often accompanies problems with smell. In addition, it is possible that some uninfected participants were misclassified due to the lack of universal testing for the virus. This may help explain the surprisingly high rate of hyposmia identified in those without a supposed history of COVID-19, she says.   

Reference:

Horwitz LI, Becker JH, Huang W, et al. Olfactory Dysfunction After SARS-CoV-2 Infection in the RECOVER Adult Cohort. JAMA Netw Open. 2025;8(9):e2533815. doi:10.1001/jamanetworkopen.2025.33815.

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