ABSTRACT
Introduction: Olfactory dysfunction (OD) affects more than 3 million US adults. The number of patients with post viral olfactory dysfunction (PVOD) is expected to increase secondary to the worldwide COVID-19 pandemic. Preliminary studies have demonstrated the efficacy of platelet-rich plasma (PRP) in restoration of smell in both animals and humans. To date, human studies have utilized injectable PRP only. We describe our pilot study investigating the use of topical PRP as a novel delivery method for smell restoration and contribute to existing literature demonstrating the promise of PRP as a therapeutic. Method(s): Pilot study from September 2020 to January 2022. Patients >18 years with hyposmia diagnosed via Brief Smell Identification Test (B-SIT) score <8 were included. PRPimpregnated Surgifoam was placed into bilateral olfactory clefts monthly for at least 3 months. Patients completed the B-SIT at baseline and 1 month after each treatment. Result(s): Eight patients underwent at least 3 treatments and completed the B-SIT at month 4. Average age was 56.3 years;mean smell loss duration was 19.3 months. Etiologies included PVOD, post-COVID (5), and idiopathic. Mean change in B-SIT after 3 treatments was +1.06. Of patients, 62.5% had achieved the minimal clinically significant difference of >1 on B-SIT after treatments 2 and 3. Patients with smell loss <12 months demonstrated greater B-SIT scores at 4 months (+1.6 vs +0.2). Two patients achieved B-SIT >8 after 3 treatments. Of patients who have returned thus far for a fourth treatment, 1 additional patient scored >8. Conclusion(s): We present the largest pilot study to date for the use of PRP in treatment of OD and the first study to develop methods for topical delivery in human subjects. Topical PRP may serve as a less invasive, efficacious therapy for patients. Further, randomized control trials are warranted to investigate the required number of topical PRP treatments for smell restoration.
ABSTRACT
Introduction: Almost 30% of olfactory dysfunction (OD) arises after a viral infection with increased incidence due to COVID-19. Hypothesized SARS-CoV-2 viral attachment to the olfactory epithelium differs from the traditional postviral OD (PVOD) mechanism. Hence, manifestations of OD may differ between the two etiologies. This study evaluates the difference in smell perception between post-COVID-19 OD and postviral or idiopathic etiologies. Method(s): This observational study, approved by the institutional review board, was conducted between September 2020 and January 2022 in adult patients with more than 6 months nontraumatic OD with no perceived improvement in smell even after 3 months of conservative treatment. OD in these patients was categorized as COVID-19 or non-COVID-19 related. Demographics, duration of OD, and Brief Smell Identification Test (B-SIT) scores were analyzed. Continuous variables were compared by t test, while categorical variables were compared by chi2 test using SPSS 27 (IBM Corp). Result(s): Of the 26 patients included in the study, 42.3% reported persistent OD following COVID-19 infection, while 57.7% had non-COVID-19-related OD. The mean B-SIT score in post-COVID-19 OD was 6.81+/-2.15 compared with 3.87+/-2.2 in the non-COVID-19 OD group, with the difference being statistically significant at 3.40 (P=.001). While race and gender ratios were similar between the groups, age (42 vs 54, P=.048) and duration of loss of smell (10 months vs 49 months, P<.001) had significant differences. Conclusion(s): This study shows that patients suffering from COVID-19-related OD may have normal scores on scratch and sniff smell tests, possibly because of the difference in the affected site of the olfactory pathway. Current hypotheses focus on olfactory epithelial damage in COVID-19 vs neuronal in PVOD. Differences seen in age and duration of smell loss between groups may be secondary to newfound worldwide attention to OD, while patients with OD etiologies predating COVID-19 may have newly sought treatment at this time. Olfactory threshold testing may be required for accurate assessment of post- COVID-19 OD. Larger studies are required to help delineate differences between these olfactory disturbance etiologies.
ABSTRACT
Background. Brazillian authorities reported a total of 16.3 million cases and 454. 000 deaths during COVID-19 pandemic in Brazil by may 2021. It became necessary to educate healthcare professionals on diagnosis and treatment of the syndrome. Game based learning surfaced as an effective alternative, since it promotes critical thinking and problem solving skills. A team of Brazilian and Peruvian students, physicians, designers and programmers gathered to create a decision based computer game that simulates a hospital scenario and allows medical students to analise, make decisions and receive feedback. This work describes the creative process and showcase the initial version of the software. Methods. Professors and students of Medicine, Information Technology (IT), Design and Architecture from Brazil and Peru assembled a team in order to develop the computer game. Clinical cases were created by the medical students and professors, comprising medical procedures for the treatment and management of COVID 19, and a video game script was developed exploring gamification principles of challenge, objectivity, persistence, failure, reward and feedback. Algorithms (image 1) were created, under supervision of professors of Medicine, to define possible courses of action and outcomes (e.g. gain or loss of points, improvement or worsening of the patient). Students of Design created artistic elements, and IT students programmed with a game engine software. This fluxogram, written in portuguese, describes in detail all the possible courses of actions that can be exercised by the player. It is created by a team of Professors of Medicine and medical students, in accordance with evidence-based guidelines. Primarily, this document guides the programmers and designers throughout the development phase of the game. Results. Initially, an expandable minimum viable product was obtained. The game, visualized on image 2, consists in a non-playable character and a playable character (i.e. doctor), with a scenario and a dialogue script simulating a clinical examination of a COVID 19 patient. The player can interact with certain elements within the game, e.g. the computer and other characters, to retrieve test results or start dialogues with relevant information. Hospital scenario and dialogue window between doctor (player in black) and patient (non playable character) are displayer in the game engine software (Unity 2D). On the bottom half of the screen, the dialogue box allows the player to collect the patient's medical history. The player can interact with certain elements to obtain relevant information to make decision and progress in the game. Conclusion. The game allows medical students to practice diagnosis and treatment of COVID 19. Future versions will include assessment reports of player's actions, and a new score system will be implemented. New diseases will be incorporated in the gameplay to match the variety of scenarios offered by real hospitals and patients. Artificial intelligence will be employed to optimize gameplay, feedback and learning.