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Background:: Corticosteroids are widely used in the treatment of idiopathic facial paralysis (Bell’s palsy), but the effectiveness of additional treatment with an antiviral agent is uncertain. Significant morbidity can be associated with severe cases of Bell’s palsy.
Objectives:: To assess the effects of antiviral treatments alone or in combination with any other therapy for Bell’s palsy.
Methods:: On 7 October 2014 we searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE, EMBASE, LILACS, DARE, NHS EED, and HTA. We also reviewed the bibliographies of the identified trials and contacted trial authors and known experts in the field and relevant drug companies to identify additional published or unpublished data. We searched clinical trials registries for ongoing studies. We considered randomised controlled trials or quasi-randomised controlled trials of antivirals with and without corticosteroids versus control therapies for the treatment of Bell’s palsy. We excluded trials that had a high risk of bias in several domains. Pairs of authors independently assessed trials for relevance, eligibility, and risk of bias, using standard Cochrane procedures.
Main Results:: Eleven trials, including 2883 participants, met the inclusion criteria and are included in the final analysis. We added four studies to the previous review for this update. Some of the trials were small, and a number were at high or unclear risk of bias. Other trials did not meet current best standards in allocation concealment and blinding. We found no significant benefit from adding antivirals to corticosteroids in comparison with corticosteroids alone for people with Bell’s palsy (risk ratio (RR) 0.69, 95% confidence interval (CI) 0.47 to 1.02, n = 1715). For people with severe Bell’s palsy (House Brackmann scores of 5 and 6 or the equivalent in other scales), we found a reduction in the rate of incomplete recovery at month six when antivirals plus corticosteroids were used (RR 0.64, 95% CI 0.41 to 0.99, n = 478). The outcome for the participants receiving corticosteroids alone was significantly better than for those receiving antivirals alone (RR 2.09, 95% CI 1.36 to 3.20, n = 1169). The treatment effect of placebo was significantly lower than that of antivirals plus corticosteroids (RR 0.56, 95% CI 0.41 to 0.76, n = 658). Antivirals alone had a non-significant detrimental effect on the outcome compared with placebo (RR 1.10, 95% CI 0.87 to 1.40, n = 658). In three trials comparing antivirals and corticosteroids with corticosteroids and placebo that assessed this outcome, we found a significant difference in long-term sequelae in favour or antivirals plus corticosteroids (RR 0.73, 95% CI 0.54 to 0.99, n = 869). Three trials comparing antivirals alone with corticosteroids alone investigating this outcome showed fewer sequelae with corticosteroids (RR 1.44, 95% CI 1.11 to 1.85, n = 873). We found no data on long-term sequelae for other comparisons. Adverse event data were available in three studies giving comparison data on 1528 participants. None of the four comparisons (antivirals plus corticosteroids versus corticosteroids plus placebo or no treatment; antivirals versus corticosteroids; antivirals plus corticosteroids versus placebo; antivirals versus placebo) showed significant differences in adverse events between treatment and control arms. We could find no correlation with specific treatment within these results.
Authors’ Conclusions:: Moderate-quality evidence from randomised controlled trials showed no additional benefit from the combination of antivirals with corticosteroids compared to corticosteroids alone or with placebo, and no benefit from antivirals alone compared to placebo, for the treatment of Bell’s palsy. Moderate-quality evidence showed a small but just significant benefit of combination therapy compared with corticosteroids alone in severe Bell’s palsy. We found no significant increase in adverse events from the use of antivirals compared with either placebo or corticosteroids.
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http://dx.doi.org/10.1590/1516-3180.20151334T1 | DOI Listing |
Ocul Immunol Inflamm
December 2024
Uvea Services, Sankara Nethralaya, Chennai, India.
Purpose: To report a case of exudative retinal detachment (ERD) in a child with Acute retinal necrosis (ARN).
Method: Retrospective Chart Review.
Result: A six-year-old boy presented with anterior uveitis with hypopyon and exudative retinal detachment with peripheral confluent patches of retinitis in the left eye.
Ital J Pediatr
December 2024
Department of Pediatrics, Santa Maria delle Croci Hospital, AUSL della Romagna, Viale Vincenzo Randi, 5, Ravenna, Ravenna, 48121, RA, Italy.
Parvovirus B19 (B19V) is a significant pathogen responsible for a wide range of clinical manifestations, particularly in children and pregnant women. While B19V is most commonly recognized as the cause of Fifth disease, a mild erythematous illness in children, its clinical impact extends far beyond this condition. B19V can lead to severe complications, including transient aplastic crisis in individuals with chronic hemolytic anemias, arthralgia, and more severe joint diseases.
View Article and Find Full Text PDFThe Hepatitis B vaccine's safety profile is considered safe, but sometimes neurological complications, like Bell's palsy (acute peripheral facial neuropathy), can occur after its administration. A 35-year-old female doctor experienced left-sided facial weakness and paralysis six days after getting the Hepatitis B vaccine. On examination, she had lower motor neuron facial nerve palsy.
View Article and Find Full Text PDFBMJ Open
August 2024
Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
Objective: To identify the associations of in-hospital cardiovascular events and mortality with pre-existing comorbidities and cardiovascular disease (CVD) risk factors among COVID-19 patients in Bangladesh without vaccine availability.
Design: A secondary analysis of a prospective multicountry study.
Setting: Three COVID-19-designated hospitals in Bangladesh.
Diagn Microbiol Infect Dis
December 2024
The Affiliated Hospital of Shao Xing University/The Affiliated Hospital of Shao Xing University(Shao Xing Municipal Hospital), China. Electronic address:
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