The use of Platelet rich Plasma in COVID-19 Induced Olfactory Dysfunction: Systematic Review.

PURPOSE: Different modalities of treatment have been suggested in the treatment for post COVID-19 olfactory dysfunction (OD). Starting with lifestyle modification, smoking cessation, for example, was shown to improve the symptoms for patients with OD. Intranasal and oral corticosteroids have been described in the literature for the treatment of OD. In this review, we are looking at a novel intervention using platelet-rich plasma injection into the nasal cleft for treatment of post COVID-19 infection olfactory dysfunction. METHODS: A literature search was done using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 2020 Guidelines, the databases of PMC, Medline, CINAHL, Wiley online library were searched from their year of inception until February 2023. Search terms were used and included a combination of the following keywords; "platelet-rich plasma", "platelet rich plasma", "PRP", "Anosmia", "olfactory dysfunction" and "COVID". RESULTS: The four studies in this review included a total of 238 adult patients who presented with olfactory dysfunction. The studies were heterogenic in terms of follow up period which was not long enough through all the included studies. Additionally, different protocol of injecting was seen in different studies. CONCLUSION: Injecting PRP for treatment of COVID-19 induced olfactory dysfunction is a safe technique with what seems like promising initial results with low complication rate. However, there are not enough studies assessing its effectiveness compared to other treatment modalities. Further randomized controlled trials with shared protocol are needed to establish further understanding of its role in treatment of COVID-19 induced OD.

Acne Keloidalis Nuchae: A Staged Reconstruction.

Acne keloidalis nuchae (AKN) is a chronic scarring folliculitis that affects the occipital area. It is characterized by papule and pustule formation which eventually leads to tumor-like mass. Early cases can be managed by medical treatment that may require months, and, usually, lesions recur. In more severe cases, surgical excision is the mainstay of treatment. In our case, we proposed a staged approach when dealing with advanced stages of AKN. This includes deep excision of the lesion down to deep subcutaneous tissue with application of negative-pressure wound therapy (NPWT) for a week followed by resurfacing of the resultant defect with a split-thickness skin graft and NPWT for another week. This approach achieved quicker wound healing with no recurrence compared with other techniques such as healing by secondary intention. To our knowledge, this case is one of the most extensive cases published in the literature.

Investigation and Management of Apparently Sporadic Central Nervous System Haemangioblastoma for Evidence of Von Hippel-Lindau Disease.

Haemangioblastomas are rare, highly vascularised tumours that typically occur in the cerebellum, brain stem and spinal cord. Up to a third of individuals with a haemangioblastoma will have von Hippel-Lindau (VHL) disease. Individuals with haemangioblastoma and underlying VHL disease present, on average, at a younger age and frequently have a personal or family history of VHL disease-related tumours (e.g., retinal or central nervous system (CNS) haemangioblastomas, renal cell carcinoma, phaeochromocytoma). However, a subset present an apparently sporadic haemangioblastoma without other features of VHL disease. To detect such individuals, it has been recommended that genetic testing and clinical/radiological assessment for VHL disease should be offered to patients with a haemangioblastoma. To assess "real-world" clinical practice, we undertook a national survey of clinical genetics centres. All participating centres responded that they would offer genetic testing and a comprehensive assessment (ophthalmological examination and CNS and abdominal imaging) to a patient presenting with a CNS haemangioblastoma. However, for individuals who tested negative, there was variability in practice with regard to the need for continued follow-up. We then reviewed the results of follow-up surveillance in 91 such individuals seen at four centres. The risk of developing a potential VHL-related tumour (haemangioblastoma or RCC) was estimated at 10.8% at 10 years follow-up. The risks of developing a recurrent haemangioblastoma were higher in those who presented <40 years of age. In the light of these and previous findings, we propose an age-stratified protocol for surveillance of VHL-related tumours in individuals with apparently isolated haemangioblastoma.

Late urological manifestation of stress incontinence surgery.

The Stamey procedure was a popular procedure for female stress incontinence practiced widely in the 1980s before it was abandoned owing to high complication rates. The procedure aimed to suspend the bladder neck by placing two transvaginal Dacron buttress grafts either side of the bladder neck and suspending them with sutures passed through the retropubic space and tied suprapubically. Erosion of the graft into the bladder was a recognised complication. We report a case of an 84-year-old lady who presented with urinary symptoms forty years after an unspecified stress incontinence procedure. Imaging and cystoscopy revealed an eroded graft in her bladder wall. Further investigation revealed the graft was a Dacron buttress from a Stamey procedure. This case highlights the importance of having a working knowledge of historical techniques that may present with complications many years later and recognising the symptoms that should prompt early investigation.