Surgical interventions for the early management of Bell's palsy

Background: Bell's palsy is an acute paralysis of one side of the face of unknown aetiology. Bell's palsy should only be used as a diagnosis in the absence of all other pathology. As the proposed pathophysiology is swelling and entrapment of the nerve, some surgeons suggest surgical decompression of the nerve as a possible management option.Objectives: The objective of this review was to assess the effectiveness of surgery in the management of Bell's palsy and to compare this to outcomes of medical management.Search strategy: We searched the Cochrane Neuromuscular Disease Group Specialized Register (23 November 2010). We also searched the Cochrane Central Register of Controlled Trials (CENTRAL) (23 November in The Cochrane Library, Issue 4 2010). We adapted this strategy to search MEDLINE (January 1966 to November 2010) and EMBASE (January 1980 to November 2010).Selection criteria: We included all randomised or quasi-randomised controlled trials involving any surgical intervention for Bell's palsy.Data collection and analysis: Two review authors independently assessed whether trials identified from the search strategy were eligible for inclusion. Two review authors assessed trial quality and extracted data independently.Main results: Two trials with a total of 69 participants met the inclusion criteria. The first study considered the treatment of 403 patients but only included 44 in their surgical study. These were randomised into a surgical and non surgical group. The second study had 25 participants which they randomly allocated into surgical or control groups. The nerves of all the surgical group participants in both studies were decompressed using a retroauricular approach. The primary outcome was recovery of facial palsy at 12 months. The first study showed that both the operated and non operated groups had comparable facial nerve recovery at nine months. This study did not statistically compare the groups but the scores and size of the groups suggested that statistically significant differences are unlikely. The second study reported no statistically significant differences between their operated and control groups. One operated patient in the first study had 20 dB sensorineural hearing loss and persistent vertigo.Authors' conclusions: There is only very low quality evidence from randomised controlled trials and this is insufficient to decide whether surgical intervention is beneficial or harmful in the management of Bell's palsy. Further research into the role of surgical intervention is unlikely to be performed because spontaneous recovery occurs in most cases.</p

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

Perceptions of Lebanese female university students about the Human Papillomavirus (HPV) Vaccine : a qualitative study -

Thesis. M.Sc. American University of Beirut. Department of Epidemiology and Population Health, Faculty of Health Sciences 2016. W 4 Y123p 2016Advisor: Dr. Jocelyn DeJong, Professor and Associate, Dean Department of Epidemiology and Population Health, Faculty of Health Sciences ; Committee members: Dr. Huda Zurayk, Retired Professor, Department of Epidemiology and Population Health, Faculty of Health Sciences ; Dr. Faysal El-Kak, Senior Lecturer and Clinical Associate, Department of Health Promotion and Communication Health, Faculty of Health Sciences, Department of Obstetrics and Gynecology, AUBMC.Includes bibliographical references (leaves 100-104)The thesis explores perceptions about the human papillomavirus (HPV) vaccine among Lebanese female undergraduate and graduate students aged 18-26 years at the American University of Beirut. These students were from all faculties except for the Faculty of Health Sciences. The study aims to determine these students’ knowledge and attitudes regarding HPV and the HPV vaccine.The HPV vaccine was introduced worldwide and provides protection against several types of HPV. HPV infection can cause cervical, vaginal, vulvar, anal, penile and oropharyngeal cancers and genital warts. The Advisory Committee on Immunization Practices recommends vaccinating girls and boys from age 13 to 26 years in three doses prior to sexual debut. This thesis investigates the perceptions of HPV and the HPV vaccine among students using qualitative research methods. I conducted in-depth interviews with 35 women related to facilitators and barriers to vaccination, messages received from the surrounding environments and strategies for raising awareness.HPV awareness is low and so is awareness about cervical cancer, other sexually transmitted infections (STIs) and the Pap smear. Very few participants had been vaccinated and those who were interested to receive vaccination focused on the cancer prevention part of the vaccine rather than HPV prevention. As for those who refused to receive the HPV vaccine, their concerns were about side effects, cost, fear of introducing a new substance in the body and perception of being low risk. Interviewees stated that educational institutions do not teach about HPV, but should include it in their education curriculum. Although this study shows that many physicians recommended vaccination, some physicians did not, especially family medicine physicians. Students were also hesitant to discuss health related issues such as vaccination with peers and physicians. The taboo surrounding sex was a prominent barrier in the society and therewas lack of communication between parents and students about sex that may ac

Epilithic biomass in a large gravel-bed river (the Garonne, France): a manifestation of eutrophication?

In order to evaluate the impact of outputs of the city of Toulouse (740 000 inhabitants) on the epilithic communities colonizing pebble banks in the river Garonne, a large gravel-bed river (eighth order), dry mass (DM), ash-free dry mass (AFDM) and chlorophyll-a (chla) epilithic biomass per unit area were measured and autotrophic index (AI) (i.e. ratio AFDM/chla) was calculated at four stations. This river is morphologically characterized by a succession of pools and riffles and by highly fluctuating hydraulic conditions. At the four stations studied (223 km apart), the means of AFDM values varied between 17.1 and 31.1 g m−2 of colonized surface and the chla concentration varied between 112 and 254 mg m−2. However, there were no significant differences in AFDM per unit area between the parts of the river upstream and downstream of the Toulouse area (Mann–Whitney U-test statistic), nor between the four stations (Kruskal–Wallis test statistic), and the AI did not allow the description of changes in periphyton communities between sampling locations. This study showed that epilithic biomass should be considered as the typical microbial community of the river rather than as a manifestation of eutrophication

Dossiê “Educação musical na pós-modernidade”: um amplo espaço dialógico

Apresentação do dossiê “Educação musical na pós-modernidade: epistemologias, práticas e contextos”

“Festa na Bahia”, africanias na obra de Francisco Mignone

A pesquisa sobre a presença do legado africano na música brasileira demanda metodologias com aportes da musicologia e da etnomusicologia, visto que os cantos com línguas africanas que influenciam nossa música, presentes nos terreiros e festas populares, utilizam de uma língua que não é mais falada: nos textos os saberes concentram-se sobretudo a partir de uma competência simbólica, sendo esta mais importante que a linguística. Tal especificidade torna muitas vezes impossível realizar uma tradução literal. E ainda torna necessária a utilização de entrevistas e conversas com colaboradores dos diversos contextos pesquisados, acrescentando à visão musicológica, um ponto de vista êmico. Este artigo trata das africanias presentes na canção “Festa na Bahia” para canto e piano do compositor Francisco Mignone, com poesia de Ribeiro Couto, composta em 1953. A metodologia utilizada para a construção dos saberes apresentados neste artigo consistiu na consulta em fontes históricas e etnolinguísticas. Os levantamentos relizados nos periódicos de época, disponíveis na Hemeroteca Digital Brasileira, visam compreender e contextualizar a composição e a repercussão da obra na época de sua estreia. Os aportes etnolinguísticos oferecidos por Castro (2005) fundamentam a elucidação de saberes a respeito do léxico africano presente na canção, contrapondo aos dicionários de português e evidenciam a importância da construção de um vocabulário de africanias na música vocal brasileira

Vissungo: o cantar banto nas Américas

This study is an investigation of four different documents, on which we seek to distinguish, both in Brazil and the United States, the richness of musical elements related to a Bantu heritage, presentified by the enslaved Africans brought to the Americas and their descendants. We have therefore selected two Brazilian documents: O Negro e o Garimpo em Minas Gerais, written by Aires da Mata Machado Filho and published in 1943; and the recordings made in Minas Gerais, in 1944, by Luiz HeitorCorrêa de Azevedo, a professor at Escola Nacional de Música, in collaboration with musicologist Alan Lomax from the American Folklife Center at the Library of Congress. We have equally selected two North-American documents: Slave Songs of the United States: The Classic 1867 anthology, compiled by William Francis Allen et al; and therecordings of songs from the South of the United States, made by Alan Lomax for the Library of Congress, beginning in 1933, and compliled at the CD Negro Work Songs and Calls. These documents share the fact of being the first written and phonographic records of chants of African origins in the Americas. The work of Aires da Mata Machado Filho presents the musical notation of the songs collected in the year of 1928, in the regions of São João da Chapada and Quartel do Indaiá, districts of Diamantina, Minas Gerais. According to him, these songs, called vissungos, were chanted in the language of Benguela. The word vissungo itself has Bantu origins, being etymologically translated assinging. The phonograms, recorded in the same field, in 1944, by Luiz Heitor Corrêa de Azevedo, help us perceive the limitations of models for registering music when in comparison with the production of singers belonging to this culture. These limitations are also seen when comparing the document recorded by Alan Lomax and the work ofWilliam Allen. The most important consideration from this study is that singing is the essence here, and, through the voice, the singers constitute a continuous temporality, uniting the past, present and future by the memory of ancestrality. By searching for contours, the registers neither indicate the importance of pause, absence, silence, nor dothey translate the voice and its ways of use. These are elements that cannot be neglected since they convey sense. As a song, vissungos make voices and silence present, thus rebuilding the past and projecting itself as education (ex-ducere), edificating its tradition in the Americas.A proposta deste trabalho é a investigação de quatro documentos, buscando distinguir a riqueza dos elementos musicais relacionados à presença da cultura banto no Brasil e nos Estados Unidos, resentificada pelos africanos escravizados e trazidos para as Américas, e seus descendentes. Para tanto, foram selecionados dois documentos brasileiros: O Negro e o Garimpo em Minas Gerais, de Aires da Mata Machado Filho, publicado em 1943, e as gravações realizadas em Minas Gerais, no ano de 1944, por Luiz Heitor Corrêa de Azevedo, então professor da Escola Nacional de Música, em colaboração com omusicólogo Alan Lomax, do America Folklife Center da Library of Congress. Selecionamos, igualmente, dois documentos estadunidenses: Slave Songs of The United States: The Classic 1867 anthology, cantos compilados por William Francis Allen et alii, eas gravações de cantos da região sul dos Estados Unidos realizadas por Alan Lomax para a Library of Congress, a partir de 1933, registradas no CD Negro Work Songs and Calls. O que estes documentos possuem em comum é o fato de serem os primeiros registros escritos e fonográficos das músicas de raiz africana nas Américas. A publicação de Aires da Mata Machado Filho traz os cantos que ele coletou em forma de notação musical, no ano de 1928, na região de São João da Chapada e Quartel de Indaiá, no município Diamantina, em Minas Gerais. Segundo ele, esses cantos, chamados Vissungos, eramentoados em língua benguela. Por sua vez, a palavra vissungo, de origem banto, traduzse, etimologicamente, como cantar. Os fonogramas, registrados em 1944 por Luiz Heitor Corrêa de Azevedo, deste mesmo campo, auxiliam na percepção e na compreensão dos limites de qualquer modelo de registro musical, quando comparados com a produção do cantor desta cultura. Esta limitação também é percebida na comparação do documento gravado por Alan Lomax com a publicação de William Allen. A mais importante consideração que emerge deste estudo é o fato de que, aqui, o cantar é essência, e, por meio da voz, constitui uma temporalidade em contínuo, que une o passado, o presente e o futuro, pela memória da ancestralidade. Na busca de contornos, os registros não denotam a importância das pausas, ausências, silêncios e tampouco traduzem a voz e seus modos de vigência; elementos que não podem ser negligenciados, pois estabelecem sentido... Como cantar, o Vissungo presentifica as vozes e silêncios; e assim reelabora o passado e projeta-se como educação (ex-ducere), edificando sua tradição nas Américas