Olfactory Training and Visual Stimulation Assisted by a Web-Application for Patients With Persistent Olfactory Dysfunction After SARS-CoV-2 Infection

IntroductionWe aimed to quantify the benefit of olfactory training and visual stimulation assisted by a dedicated web application for patients who experienced olfactory dysfunction for ≥1 month after Sars-Cov-2 infection and compared it with published cohorts of spontaneous recoveries.Materials and MethodsWe performed a prospective observational study. Participants performed olfactory training and visual stimulation assisted by a dedicated web-application. Improvement was defined as a 2-point increase on a 10-point, self-assessed olfactory visual analogue scale.ResultsIn total, 1155 patients were assessable. Improvement was observed in patients who trained 4 weeks and 4 to 8 weeks with high concentration oils in 63.0% (58/92) and 72.9% (137/188) respectively, whereas in historical cohorts, a spontaneous improvement was observed in 7% to 27% without training respectively (p<.001). The benefit was observed regardless of the duration of the olfactory dysfunction. No or mild toxicity was reported by 86.6% (662/764) of patients. Severe toxicity leading to stop training was reported in 0.5% of patients.ConclusionsOlfactory training and visual stimulation assisted by a dedicated web application seems to accelerate olfactive improvement in persistent olfactory dysfunction following SARS-CoV-2 infection, especially after 30 days of olfactory training. Maximal duration of training appeared to be 8 weeks.

Resolution of Optic Disc Pit Maculopathy Following Posterior Vitreous Detachment

Purpose: This work presents a case of significant improvement of optic pit disc maculopathy following an acute posterior vitreous detachment (PVD) and discusses the possible mechanisms of this phenomenon. Methods: A case report and review of the literature are presented. Results: A 56-year-old man presenting with progressive visual decline in his left eye was found to have an optic disc pit with optical coherence tomography (OCT) evidence of severe intraretinal edema and maculoschisis. His visual acuity and macular anatomy on OCT improved dramatically in the months following a PVD. Conclusions: This report presents an interesting case of spontaneous improvement of optic disc pit–related maculopathy following PVD. We discuss the cause of the retinal fluid accumulation in optic disc pit maculopathy and consider that the OCT findings in our case lend credence to the theory that this fluid originates from the vitreous humor.

Imaging Changes and Immune-Checkpoint Expression on T Cells in Bronchoalveolar Lavage Fluid from Patients with Pulmonary Sarcoidosis

Sarcoidosis is a systemic, granulomatous disease caused by unknown immunological abnormalities. The organs most vulnerable to sarcoidosis are the lungs. Patients often resolve spontaneously, but the lungs can also be severely affected. Although details regarding prognostic factors in sarcoidosis patients with lung involvement remain unclear, several reports have suggested that immune checkpoint molecules are involved in the pathogenesis of sarcoidosis. In this study, we divided sarcoidosis patients into two groups based on chest computed tomography (CT) findings and compared immune checkpoint molecules expressed on T cells in bronchoalveolar lavage fluid (BALF) in the two groups, using flow cytometry. We found elevated programmed cell death 1 (PD-1) or T cell immunoglobulin- and mucin-domain-containing molecule-3 (TIM-3) expression on T cells in BALF in patients with spontaneous improvement in CT findings, compared with those in patients without improvement in CT findings. In conclusion, our study implies that PD-1 or TIM-3 expression on T cells in BALF may be a prognostic factor for pulmonary lesions in sarcoidosis.

Clinicopathological correlates with theoretical grades

Nerve injury may present with temporary and short-lived loss of function progressing to full recovery or with complete loss of function, severe pain, and no prospect of spontaneous improvement. Many cases lie between these two extremes and the classification systems described in this chapter will aid identification and understanding of an individual injury with the intention to predict outcome and so guide management.

Case of COVID-19-induced vestibular neuritis in a child

Since the outbreak of the COVID-19 pandemic, there has been a growing need to fully understand all the possible clinical features of the epidemic, which often presents with unusual manifestations, especially in children. In this report, we describe the case of a child with a COVID-19 infection and suffering exclusively from vertigo and fever. Altogether, considering the clinical manifestation, laboratory tests and imaging, given the patient’s positivity to SARS-CoV-2 infection and its neurotropic potential, we assumed that the child had COVID-19-induced vestibular neuritis, which, in consideration of the spontaneous improvement of symptoms, did not require any therapeutic adjustments, apart from the natural compensation of the central nervous system.This case suggests the importance of having an index of suspicion for a COVID-19 infection in patients with paediatrics presenting with vertigo and adds valuable information to the limited literature on COVID-19 presentation and management in children.

Spontaneous improvement of carbohydrate-deficient transferrin in PMM2-CDG without mannose observed in CDG natural history study

A recent report on long-term dietary mannose supplementation in phosphomannomutase 2 deficiency (PMM2-CDG) claimed improved glycosylation and called for double-blind randomized study of the dietary supplement in PMM2-CDG patients. A lack of efficacy of short-term mannose supplementation in multiple prior reports challenge this study’s conclusions. Additionally, some CDG types have previously been reported to demonstrate spontaneous improvement in glycosylated biomarkers, including transferrin. We have likewise observed improvements in transferrin glycosylation without mannose supplementation. This observation questions the reliability of transferrin as a therapeutic outcome measure in clinical trials for PMM2-CDG. We are concerned that renewed focus on mannose therapy in PMM2-CDG will detract from clinical trials of more promising therapies. Approaches to increase efficiency of clinical trials and ultimately improve patients’ lives requires prospective natural history studies and identification of reliable biomarkers linked to clinical outcomes in CDG. Collaborations with patients and families are essential to identifying meaningful study outcomes.

The use of shoe type «squeakers» in children with idiopathic transient toe walking

Introduction.Transient toe walking is a common benign condition in young children. Nevertheless, it leads to parents concern and becomes a frequent reason for visits to orthopaedists. Aim:apreliminary assessment of the effectiveness of squeakers shoes for optimizing of gait in children with transient idiopathic toe walking. Material and methods.A prospective study of 24 children (mean age: 21.4 months) which are under surveillance in outpatient clinics for toe walking as the main complaint. Children supplied free of charge with squeakers shoes. Parents filled questionnaires 1 month after the usage of these shoes. Results.Positive changes in gait (normalization or improvements) were reported in the majority (22 from 24) children. More than half of parents noticed normal gait in regular shoes and one third barefoot. No deterioration has been observed. Discussion.We conducted a preliminary study assessing the effectiveness of modified shoes (squeakers) in children with transient idiopathic toe walking. Most of the parents reported improvements in walking. As a potential mechanism, we suggest positive biofeedback with the recruiting of the sensory (audial) pathway. Conclusion.Based on our study we can recommend squeakers for children with transient idiopathic toe walking demonstrating delayed spontaneous improvement.