Antiviral treatment for Bell's palsy (idiopathic facial paralysis)

BACKGROUND: Antiviral agents against herpes simplex virus are widely used in the treatment of idiopathic facial paralysis (Bell's palsy), but their effectiveness is uncertain. Significant morbidity can be associated with severe cases. OBJECTIVES: This review addresses the effect of antiviral therapy on Bell's palsy. SEARCH STRATEGY: We updated the search of the Cochrane Neuromuscular Disease Group Trials Register (December 2008), MEDLINE (from January 1966 to December 8 2008), EMBASE (from January 1980 to December 8 2008) and LILACS (from January 1982 to December 2008). SELECTION CRITERIA: Randomized trials of antivirals with and without corticosteroids versus control therapies for the treatment of Bell's palsy. DATA COLLECTION AND ANALYSIS: Twenty-three papers were selected for consideration. MAIN RESULTS: Seven trials including 1987 participants met the inclusion criteria, adding five studies to the two in the previous review.Incomplete recovery at one year. There was no significant benefit in the rate of incomplete recovery from antivirals compared with placebo (n = 1886, RR 0.88, 95% CI 0.65 to 1.18). In meta-analyses with some unexplained heterogeneity, the outcome with antivirals was significantly worse than with corticosteroids (n = 768, RR 2.82, 95% CI 1.09 to 7.32) and the outcome with antivirals plus corticosteroids was significantly better than with placebo (n = 658, RR 0.56, 95% CI 0.41 to 0.76).Motor synkinesis or crocodile tears at one year. In single trials, there was no significant difference in long term sequelae comparing antivirals and corticosteroids with corticosteroids alone (n = 99, RR 0.39, 95% CI 0.14 to 1.07) or antivirals with corticosteroids (n = 101, RR 1.03, 95% CI 0.51 to 2.07).Adverse events.There was no significant difference in rates of adverse events between antivirals and placebo (n = 1544, RR 1.06, 95% CI 0.81 to 1.38), between antivirals and corticosteroids (n = 667, RR 0.96, 95% CI 0.65 to 1.41) or between the antiviral-corticosteroid combination and placebo (n = 658, RR 1.15, 95% CI 0.79 to 1.66). AUTHORS' CONCLUSIONS: High quality evidence showed no significant benefit from anti-herpes simplex antivirals compared with placebo in producing complete recovery from Bell's palsy. Moderate quality evidence showed that antivirals were significantly less likely than corticosteroids to produce complete recovery.</p

Detection of group A Streptococcus in tonsils from pediatric patients reveals high rate of asymptomatic streptococcal carriage

<p>Abstract</p> <p>Background</p> <p>Group A <it>Streptococcus </it>(GAS) causes acute tonsillopharyngitis in children, and approximately 20% of this population are chronic carriers of GAS. Antibacterial therapy has previously been shown to be insufficient at clearing GAS carriage. Bacterial biofilms are a surface-attached bacterial community that is encased in a matrix of extracellular polymeric substances. Biofilms have been shown to provide a protective niche against the immune response and antibiotic treatments, and are often associated with recurrent or chronic bacterial infections. The objective of this study was to test the hypothesis that GAS is present within tonsil tissue at the time of tonsillectomy.</p> <p>Methods</p> <p>Blinded immunofluorescent and histological methods were employed to evaluate palatine tonsils from children undergoing routine tonsillectomy for adenotonsillar hypertrophy or recurrent GAS tonsillopharyngitis.</p> <p>Results</p> <p>Immunofluorescence analysis using anti-GAS antibody was positive in 11/30 (37%) children who had tonsillectomy for adenotonsillar hypertrophy and in 10/30 (33%) children who had tonsillectomy for recurrent GAS pharyngitis. Fluorescent microscopy with anti-GAS and anti-cytokeratin 8 & 18 antibodies revealed GAS was localized to the tonsillar reticulated crypts. Scanning electron microscopy identified 3-dimensional communities of cocci similar in size and morphology to GAS. The characteristics of these communities are similar to GAS biofilms from <it>in vivo </it>animal models.</p> <p>Conclusion</p> <p>Our study revealed the presence of GAS within the tonsillar reticulated crypts of approximately one-third of children who underwent tonsillectomy for either adenotonsillar hypertrophy or recurrent GAS tonsillopharyngitis at the Wake Forest School of Medicine.</p> <p>Trial Registration</p> <p>The tissue collected was normally discarded tissue and no patient identifiers were collected. Thus, no subjects were formally enrolled.</p

β-Lactam Effects on Mixed Cultures of Common Respiratory Isolates as an Approach to Treatment Effects on Nasopharyngeal Bacterial Population Dynamics

BACKGROUND: Streptococcus pneumoniae, Streptococcus pyogenes and Haemophilus influenzae are bacteria present in the nasopharynx as part of normal flora. The ecological equilibrium in the nasopharynx can be disrupted by the presence of antibiotics. METHODOLOGY/PRINCIPAL FINDINGS: A computerized two-compartment pharmacodynamic model was used to explore beta-lactam effects on the evolution over time of a bacterial load containing common pharyngeal isolates by simulating free serum concentrations obtained with amoxicillin (AMX) 875 mg tid, amoxicillin/clavulanic acid (AMC) 875/125 mg tid and cefditoren (CDN) 400 mg bid regimens over 24 h. Strains and MICs (microg/ml) of AMX, AMC and CDN were: S. pyogenes (0.03, 0.03 and 0.015), S. pneumoniae (2, 2 and 0.25), a beta-lactamase positive H. influenzae (BL(+); >16, 2 and 0.06) and a beta-lactamase positive AMC-resistant H. influenzae (BLPACR, >16, 8 and 0.06). Mixture of identical 1:1:1:1 volumes of each bacterial suspension were prepared yielding an inocula of approximately 4 x 10(6) cfu/ml. Antibiotic concentrations were measured both in bacterial and in bacteria-free antibiotic simulations. beta-lactamase production decreased AMX concentrations and fT(>MIC) against S. pneumoniae (from 43.2% to 17.7%) or S. pyogenes (from 99.9% to 24.9%), and eradication was precluded. The presence of clavulanic acid countered this effect of co-pathogenicity, and S. pyogenes (but not BL(+) and S. pneumoniae) was eradicated. Resistance of CDN to TEM beta-lactamase avoided this co-pathogenicity effect, and CDN eradicated S. pyogenes and H. influenzae strains (fT(>MIC) >58%), and reduced in 94% S. pneumoniae counts (fT(>MIC) approximately 25%). CONCLUSIONS/SIGNIFICANCE: Co-pathogenicity seems to be gradual since clavulanic acid countered this effect for strains very susceptible to AMX as S. pyogenes but not for strains with AMX MIC values in the limit of susceptibility as S. pneumoniae. There is a potential therapeutic advantage for beta-lactamase resistant cephalosporins with high activity against streptococci

Energy Access for the Most Vulnerable Groups : A Study on the Long-Term Effects of Energy Access in a Refugee Camp Context with Inclusion of the Host Community

The UN 2030 Agenda for Sustainable Development outlines 17 goals to end poverty and ensure the right to development for everyone. Previous research has found that 2/3 of the goals partly depend their success upon whether SDG 7 Ensure access to sustainable, affordable and modern energy for all is achieved or not. Given that the Agenda targets everyone it cannot be achieved without reaching the most vulnerable groups, among these groups are migrants, refugees and those internally displaced. Low- and middle-income countries host 84% of this group. Almost 30% of refugees live in managed camp settings and it has been estimated that 80% of these have minimal or no access to electricity. For cooking needs a majority depend on traditional cooking with firewood and charcoal. In many cases this spurs tensions and at times conflict with the local host community, -who often also heavily depend on this resource. On the national level energy is often seen as part of the long-term development planning and as refugee camps and humanitarian setting are recognized as temporary by the host country this creates a vacuum. However, the reality is that 2/3 of all refugees are in protracted refugee situations and the average lifespan of a camp is 17 years. This thesis studied the links between energy and the nexus of environment, social stability and economy in a refugee camp context, and outlined how different energy systems could impact the situations for both groups and also for the relationship between these groups. This was done using the Long-range Energy Alternative Planning systems (LEAP) and by creating a Multi Criteria Analysis template. The case study of Kakuma camp in Turkana County in the North of Kenya was used. The results showed that there are positive and negative aspects related to all energy systems studied here (for household energy access both for electricity and cooking). A refugee camp is a highly complex setting, operating both under the authority of local actors and of international humanitarian actors. For electricity access, Solar Home Systems was found to be a good choice due to the fast deployment time and the low level of infrastructure needed. For already existing households PV Hybrid mini-grids are to be recommended. For cooking options, it was found that for Turkana county, rather than just focusing on GHG emissions it is vital to mitigate deforestation seeing the county’s vulnerability to land-use change. However, changing from firewood and charcoal would affect the livelihood of the host community who depends on the income deriving from the charcoal business. This highlights some of the complexity of the study and the importance of knowing the local context before carrying out energy interventions in a refugee camp and surrounding area. The author’s conclusion is that this methodology could be implemented on any camp setting seeing that modern and clean energy access poses many benefits to people across the world, whether in an urban, rural or refugee camp setting. The thesis found that the main barriers identified for electricity projects of scale are the current funding structure of humanitarian organizations and national government’s attitude towards the camp

Energy Access for the Most Vulnerable Groups : A Study on the Long-Term Effects of Energy Access in a Refugee Camp Context with Inclusion of the Host Community

The UN 2030 Agenda for Sustainable Development outlines 17 goals to end poverty and ensure the right to development for everyone. Previous research has found that 2/3 of the goals partly depend their success upon whether SDG 7 Ensure access to sustainable, affordable and modern energy for all is achieved or not. Given that the Agenda targets everyone it cannot be achieved without reaching the most vulnerable groups, among these groups are migrants, refugees and those internally displaced. Low- and middle-income countries host 84% of this group. Almost 30% of refugees live in managed camp settings and it has been estimated that 80% of these have minimal or no access to electricity. For cooking needs a majority depend on traditional cooking with firewood and charcoal. In many cases this spurs tensions and at times conflict with the local host community, -who often also heavily depend on this resource. On the national level energy is often seen as part of the long-term development planning and as refugee camps and humanitarian setting are recognized as temporary by the host country this creates a vacuum. However, the reality is that 2/3 of all refugees are in protracted refugee situations and the average lifespan of a camp is 17 years. This thesis studied the links between energy and the nexus of environment, social stability and economy in a refugee camp context, and outlined how different energy systems could impact the situations for both groups and also for the relationship between these groups. This was done using the Long-range Energy Alternative Planning systems (LEAP) and by creating a Multi Criteria Analysis template. The case study of Kakuma camp in Turkana County in the North of Kenya was used. The results showed that there are positive and negative aspects related to all energy systems studied here (for household energy access both for electricity and cooking). A refugee camp is a highly complex setting, operating both under the authority of local actors and of international humanitarian actors. For electricity access, Solar Home Systems was found to be a good choice due to the fast deployment time and the low level of infrastructure needed. For already existing households PV Hybrid mini-grids are to be recommended. For cooking options, it was found that for Turkana county, rather than just focusing on GHG emissions it is vital to mitigate deforestation seeing the county’s vulnerability to land-use change. However, changing from firewood and charcoal would affect the livelihood of the host community who depends on the income deriving from the charcoal business. This highlights some of the complexity of the study and the importance of knowing the local context before carrying out energy interventions in a refugee camp and surrounding area. The author’s conclusion is that this methodology could be implemented on any camp setting seeing that modern and clean energy access poses many benefits to people across the world, whether in an urban, rural or refugee camp setting. The thesis found that the main barriers identified for electricity projects of scale are the current funding structure of humanitarian organizations and national government’s attitude towards the camp

Energy Access for the Most Vulnerable Groups : A Study on the Long-Term Effects of Energy Access in a Refugee Camp Context with Inclusion of the Host Community

The UN 2030 Agenda for Sustainable Development outlines 17 goals to end poverty and ensure the right to development for everyone. Previous research has found that 2/3 of the goals partly depend their success upon whether SDG 7 Ensure access to sustainable, affordable and modern energy for all is achieved or not. Given that the Agenda targets everyone it cannot be achieved without reaching the most vulnerable groups, among these groups are migrants, refugees and those internally displaced. Low- and middle-income countries host 84% of this group. Almost 30% of refugees live in managed camp settings and it has been estimated that 80% of these have minimal or no access to electricity. For cooking needs a majority depend on traditional cooking with firewood and charcoal. In many cases this spurs tensions and at times conflict with the local host community, -who often also heavily depend on this resource. On the national level energy is often seen as part of the long-term development planning and as refugee camps and humanitarian setting are recognized as temporary by the host country this creates a vacuum. However, the reality is that 2/3 of all refugees are in protracted refugee situations and the average lifespan of a camp is 17 years. This thesis studied the links between energy and the nexus of environment, social stability and economy in a refugee camp context, and outlined how different energy systems could impact the situations for both groups and also for the relationship between these groups. This was done using the Long-range Energy Alternative Planning systems (LEAP) and by creating a Multi Criteria Analysis template. The case study of Kakuma camp in Turkana County in the North of Kenya was used. The results showed that there are positive and negative aspects related to all energy systems studied here (for household energy access both for electricity and cooking). A refugee camp is a highly complex setting, operating both under the authority of local actors and of international humanitarian actors. For electricity access, Solar Home Systems was found to be a good choice due to the fast deployment time and the low level of infrastructure needed. For already existing households PV Hybrid mini-grids are to be recommended. For cooking options, it was found that for Turkana county, rather than just focusing on GHG emissions it is vital to mitigate deforestation seeing the county’s vulnerability to land-use change. However, changing from firewood and charcoal would affect the livelihood of the host community who depends on the income deriving from the charcoal business. This highlights some of the complexity of the study and the importance of knowing the local context before carrying out energy interventions in a refugee camp and surrounding area. The author’s conclusion is that this methodology could be implemented on any camp setting seeing that modern and clean energy access poses many benefits to people across the world, whether in an urban, rural or refugee camp setting. The thesis found that the main barriers identified for electricity projects of scale are the current funding structure of humanitarian organizations and national government’s attitude towards the camp

En studie av den idiosynkratiska riskutvecklingen på OMX Stockholm.

This paper uses a quantitative method of analysing if the idiosyncratic risk on the Stockholm Exchange has changed over time. In order to do so we divided the risk, measured as volatility, into three different risk categories, idiosyncratic-, industrial-, and market volatility. Analysing the result received from the data of 85 listed corporations, that represents the five major sections on the Swedish Exchange, tells us that the idiosyncratic risk on OMX Stockholm has not changed noticeably over time. In the final pages of the study a short discussion, and comparison with, the American stock Exchanges are made since this study is based on and similar to a study on Dow Jones and NASDAQ