Management of Bell's palsy

Bell’s palsy is facial nerve paralysis of unknown cause. Left untreated, 70–75% of patients make a full recovery.Early treatment with prednisolone increases the chance of complete recovery of facial function to 82%. Eleven people need to be treated for one extra complete recovery at six months.There may be benefit in adding an antiviral drug to prednisolone in some cases. Additional research is needed on this treatment.The palsy may leave the surface of the eye exposed. Early eye protection with lubrication and a patch is crucial to prevent long-term complications

Corticosteroids for Bell's palsy (idiopathic facial paralysis)

Background: Inflammation and oedema of the facial nerve are implicated in causing Bell's palsy. Corticosteroids have a potent anti-inflammatory action that should minimise nerve damage. This is an update of a review first published in 2002 and last updated in 2010. Objectives: To determine the effectiveness and safety of corticosteroid therapy in people with Bell's palsy. Search Methods: On 4 March 2016, we searched the Cochrane Neuromuscular Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and LILACS. We reviewed the bibliographies of the randomised trials and contacted known experts in the field to identify additional published or unpublished trials. We also searched clinical trials registries for ongoing trials. Selection criteria: Randomised trials and quasi-randomised trials comparing different routes of administration and dosage schemes of corticosteroid or adrenocorticotrophic hormone therapy versus a control group receiving no therapy considered effective for this condition, unless the same therapy was given in a similar way to the experimental group. Data collection and analysis: We used standard Cochrane methodology. The main outcome of interest was incomplete recovery of facial motor function (i.e. residual facial weakness). Secondary outcomes were cosmetically disabling persistent sequelae, development of motor synkinesis or autonomic dysfunction (i.e. hemifacial spasm, crocodile tears) and adverse effects of corticosteroid therapy manifested during follow-up. Main results: We identified seven trials, with 895 evaluable participants for this review. All provided data suitable for the primary outcome meta-analysis. One of the trials was new since the last version of this Cochrane systematic review. Risk of bias in the older, smaller studies included some unclear- or high-risk assessments, whereas we deemed the larger studies at low risk of bias. Overall, 79/452 (17%) participants allocated to corticosteroids had incomplete recovery of facial motor function six months or more after randomisation; significantly fewer than the 125/447 (28%) in the control group (risk ratio (RR) 0.63, 95% confidence interval (CI) 0.50 to 0.80, seven trials, n = 895). The number of people who need to be treated with corticosteroids to avoid one incomplete recovery was 10 (95% CI 6 to 20). The reduction in the proportion of participants with cosmetically disabling sequelae six months after randomisation was very similar in the corticosteroid and placebo groups (RR 0.96, 95% CI 0.40 to 2.29, two trials, n = 75, low-quality evidence). However, there was a significant reduction in motor synkinesis during follow-up in participants receiving corticosteroids (RR 0.64, 95% CI 0.45 to 0.91, three trials, n = 485, moderate-quality evidence). Three studies explicitly recorded the absence of adverse effects attributable to corticosteroids. One trial reported that three participants receiving prednisolone had temporary sleep disturbances and two trials gave a detailed account of adverse effects occurring in 93 participants, all non-serious; the combined analysis of data from these three trials found no significant difference in adverse effect rates between people receiving corticosteroids and people receiving placebo (RR 1.04, 95% CI 0.71 to 1.51, n = 715). Author's conclusions: The available moderate- to high-quality evidence from randomised controlled trials showed significant benefit from treating Bell's palsy with corticosteroids.Publisher PDFPeer reviewe

The Minimum Backlog Problem

We study the minimum backlog problem (MBP). This online problem arises, e.g., in the context of sensor networks. We focus on two main variants of MBP. The discrete MBP is a 2-person game played on a graph $G=(V,E)$. The player is initially located at a vertex of the graph. In each time step, the adversary pours a total of one unit of water into cups that are located on the vertices of the graph, arbitrarily distributing the water among the cups. The player then moves from her current vertex to an adjacent vertex and empties the cup at that vertex. The player's objective is to minimize the backlog, i.e., the maximum amount of water in any cup at any time. The geometric MBP is a continuous-time version of the MBP: the cups are points in the two-dimensional plane, the adversary pours water continuously at a constant rate, and the player moves in the plane with unit speed. Again, the player's objective is to minimize the backlog. We show that the competitive ratio of any algorithm for the MBP has a lower bound of $\Omega(D)$, where $D$ is the diameter of the graph (for the discrete MBP) or the diameter of the point set (for the geometric MBP). Therefore we focus on determining a strategy for the player that guarantees a uniform upper bound on the absolute value of the backlog. For the absolute value of the backlog there is a trivial lower bound of $\Omega(D)$, and the deamortization analysis of Dietz and Sleator gives an upper bound of $O(D\log N)$ for $N$ cups. Our main result is a tight upper bound for the geometric MBP: we show that there is a strategy for the player that guarantees a backlog of $O(D)$, independently of the number of cups.Comment: 1+16 pages, 3 figure

Assessment of fetal nutrition status at birth using the clinical assessment of nutritional status score

Introduction: Assessment of fetal malnutrition (FM) among neonates has been a major concern to health personnel due to the potentially serious sequelae of malnutrition on multiple organ systems. There is a dearth of research in the use of a clinical assessment of nutritional (CAN) status score as a method of assessing FM in term newborns regarding the Indian context. Objective: This study was conducted to assess the FM by CAN score and to verify the validity of CAN score in relation to other anthropometric variables. Materials and Methods: A hospital-based observational study was carried out at a tertiary care hospital, Chamarajanagar, for a period of 3 months from March 2018 to May 2018. All liveborn, singleton term infants >37 weeks of gestation were included in the study. All measurements were carried out between 24 and 48 h of newborn age and data were collected using a structured questionnaire. Results: In this study, out of 250 neonates included, 52.8% of newborns were female and 47.2% were males. Total 8% of the study population was low birth weight, and 92% had normal birth weight. The CAN score of <25 was found in 21.2% while the rest of 78.8% of cases had CAN score of >25. CAN score had a sensitivity of 90%, specificity of 84.78%, and diagnostic accuracy of 85.2%. Conclusion: CAN score, a simple clinical index for identifying FM, is a good indicator than other anthropometric methods of determining intrauterine growth restriction like ponderal index

Patient Record Maintenance Among Private Dental Practitioners in Bangalore City

Aim and Objectives: The aim of the study was to obtain information on documentation of patient record maintenance among private dental practitioners in Bangalore city”. The objective was to assess the knowledge, attitude and behavior regarding documentation and patient record maintenance among private dental practitioners in Bangalore city. Method: A self- administered questionnaire survey was conducted in August-September 2021 among Dentists engaged in active clinical practices in private clinics/hospitals in Bangalore city, India [ N=470]. Results: A response rate of 86.4% [n=411] was obtained.73% of them were aware of the documentation of patient records as per Laws, Ethics and Jurisprudence act of 1997. 53% of them documented patient records in their clinical practice and 64% mentioned that only they have access to patient records.13% mentioned that they include patient consent as a part of documentation. Although 73% of them said that they were aware of all the guidelines, a large proportion of respondents lack knowledge about the minimum time period for which patient records should be maintained in their possession. 21% of them felt that patient record keeping is not necessary and the most common problem cited for documentation of patient records was lack of time to give attention to the records. Conclusion: Dentists needs more information and should spare more time for documentation of patient records

JAK2/IDH-mutant–driven myeloproliferative neoplasm is sensitive to combined targeted inhibition

Patients with myeloproliferative neoplasms (MPNs) frequently progress to bone marrow failure or acute myeloid leukemia (AML), and mutations in epigenetic regulators such as the metabolic enzyme isocitrate dehydrogenase (IDH) are associated with poor outcomes. Here, we showed that combined expression of Jak2V617Fand mutant IDH1R132Hor Idh2R140Q induces MPN progression, alters stem/progenitor cell function, and impairs differentiation in mice. Jak2V617FIdh2R140Q–mutant MPNs were sensitive to small-molecule inhibition of IDH. Combined inhibition of JAK2 and IDH2 normalized the stem and progenitor cell compartments in the murine model and reduced disease burden to a greater extent than was seen with JAK inhibition alone. In addition, combined JAK2 and IDH2 inhibitor treatment also reversed aberrant gene expression in MPN stem cells and reversed the metabolite perturbations induced by concurrent JAK2 and IDH2 mutations. Combined JAK2 and IDH2 inhibitor therapy also showed cooperative efficacy in cells from MPN patients with both JAK2mutand IDH2mutmutations. Taken together, these data suggest that combined JAK and IDH inhibition May offer a therapeutic advantage in this high-risk MPN subtype.Damon Runyon Cancer Research Foundation (DRG-2241-15)Howard Hughes Medical Institute (Faculty Scholars Award)Stand Up To CancerNational Cancer Institute (U.S.) (P50CA165962)National Cancer Institute (U.S.) (P30CA14051)Koch Institute for Integrative Cancer Research ( Dana-Farber Harvard Cancer Center Bridge Project)Leukemia & Lymphoma Society of America. Specialized Center of Research (SCOR) ProgramNational Institutes of Health (U.S.) (grant U54OD020355-01)National Institutes of Health (U.S.) (grant NCI R01CA172636)National Institutes of Health (U.S.) (grant R35CA197594)National Cancer Institute (U.S.) (Cancer Center Support Grant (P30 CA008747)

On-demand fuzzy clustering and ant-colony optimisation based mobile data collection in wireless sensor network

In a wireless sensor network (WSN), sensor nodes collect data from the environment and transfer this data to an end user through multi-hop communication. This results in high energy dissipation of the devices. Thus, balancing of energy consumption is a major concern in such kind of network. Appropriate cluster head (CH) selection may provide to be an efficient way to reduce the energy dissipation and prolonging the network lifetime in WSN. This paper has adopted the concept of fuzzy if-then rules to choose the cluster head based on certain fuzzy descriptors. To optimise the fuzzy membership functions, Particle Swarm Optimisation (PSO) has been used to improve their ranges. Moreover, recent study has confirmed that the introduction of a mobile collector in a network which collects data through short-range communications also aids in high energy conservation. In this work, the network is divided into clusters and a mobile collector starts from the static sink or base station and moves through each of these clusters and collect data from the chosen cluster heads in a single-hop fashion. Mobility based on Ant-Colony Optimisation (ACO) has already proven to be an efficient method which is utilised in this work. Additionally, instead of performing clustering in every round, CH is selected on demand. The performance of the proposed algorithm has been compared with some existing clustering algorithms. Simulation results show that the proposed protocol is more energy-efficient and provides better packet delivery ratio as compared to the existing protocols for data collection obtained through Matlab Simulations