For Bell's palsy, start steroids early; no need for an antiviral

A 10-day course of corticosteroids (prednisolone 25 mg twice daily) started within 72 hours significantly improves the chances of complete recovery. There is no added benefit from acyclovir. Stength of recommendation: A: Based on a large, well-designed randomized controlled trial

Use physical therapy to head off this deformity in infants

Identify infants with positional preference early and consider referral to pediatric physical therapy at 7 or 8 weeks to prevent severe deformational plagiocephaly (DP). Stength of recommendation: B: Based on a single well-done randomized controlled trial (RCT)

Glucose control: How low should you go with the critically ill?

For hyperglycemic patients admitted to an intensive care unit (ICU), the target blood glucose level should be [less than or equal to] 180 mg/dL, not 81 to 108 mg/dL. More aggressive glucose lowering is associated with a higher mortality rate. Strength of recommendation: B: Based on a single, high-quality randomized clinical trial

Glucose control: How low should you go with the critically ill?

Being too aggressive in lowering blood sugar levels of ICU patients may increase their risk of death, a new study shows

Reduction of Intestinal Neoplasia With Adenomatous Polyposis Coli Gene Replacement and COX-2 Inhibition Is Additive

Mutations of the adenomatous polyposis coli (APC) gene are implicated early in colorectal tumorigenesis. Restoration of normal APC expression through gene therapy may prevent or reduce intestinal neoplasia. Furthermore, the relationship between colorectal tumors and increased cyclooxygenase-2 (COX-2) activity provides a rationale for the use of selective COX-2 inhibitors such as rofecoxib (Vioxx) to prevent the formation of polyps. This study was performed to determine the effects of liposome-mediated APC gene therapy and a selective COX-2 inhibitor on intestinal neoplasia in vivo. Five-week-old Min mice weaned on a 30% high-fat diet were randomized to receive no treatment (control), APC only, Vioxx only, and APC/Vioxx. APC-treated mice received a plasmid containing the human APC cDNA (pCMV-APC) mixed with a liposome preparation that was administered biweekly. Vioxx was administered at 200 ppm in the high-fat rodent chow. The control mice were treated similarly with a plasmid construct lacking the APC gene. Confirmation of exogenous APC gene expression was determined by Western blot analysis. After 2 months, there was a 54% and 70% reduction in the total number of intestinal polyps after APC and Vioxx treatment, respectively. Combined APC/Vioxx therapy reduced polyp formation by 87%. The reduction of intestinal neoplasia by APC gene replacement and COX-2 inhibition suggests their separate roles in intestinal tumorigenesis. Each modality, both individually and together, may prove therapeutic and therefore contribute to new strategies in the prevention and treatment of colorectal cancer. ( J Gastrointest Surg 2002;6:563–568.