Corticosteroids significantly reduced sequelae in patients with Bellâ€™s palsy (idiopathic facial paralysis)
Madhok VB, Gagyor I, Daly F et al. (2016) Corticosteroids for bellâ€™s palsy (idiopathic facial paralysis). Cochrane Database Syst Rev 18:CD001942.
Bellâ€™s palsy is a relatively common presentation to emergency departments (incidence of 25/100 000/year). Though the prognosis is generally good, adverse sequelae can have a serious social impact for patients. Theuse of corticosteroids in the treatment of Bellâ€™s palsy is very controversial.
Should I prescribe corticosteroids to patients with Bellâ€™s palsy?
Corticosteroids should be prescribed in Bellâ€™s palsy. They significantly reduced incomplete recovery of facial motor function at 6 months without adverse effects (high quality evidence). The number of people who need to be treated with corticosteroids to avoid one incomplete recovery was 10. Corticosteroids also reduced the development of motor synkinesis and crocodile tears syndrome (moderate quality evidence).
The administration of corticosteroids (dosage, route and administration time since the beginning of the symptoms) differed between included studies.
All authors did not use a standardized scale to evaluate recovery of motor facial function.
Hospices Civils de Lyon, CHU Lyon-Sud
Dalhousie University â€“ Halifax Infirmary
Nova Scotia, Canada
Bystander chest compression-only cardiopulmonary resuscitation increased survival of non-asphyxial out-of hospital cardiac arrest patients
Zhan L, Yang LJ, Huang Y, et al (2017)Â Continuous chest compression versus interrupted chest compression for cardiopulmonary resuscitation of non-asphyxial out-of-hospital cardiac arrest. Cochrane Database Syst Rev 27;3:CD010134.
Non-asphyxial out-of-hospital cardiac arrest (OHCA) is a significant cause of death worldwide. Cardiopulmonary resuscitation (CPR) is a well-established treatment for cardiac arrest and must be rapidly initiated by rescuers (bystanders or professional CPR providers).
For non-asphyxial OHCA, should the rescuersperform continuous chest compression CPR (with or without rescue breaths, CCC-CPR) or conventional CPR plus rescue breathing (interrupted chest compression withpauses for breaths)?
Chest compression-only CPR (without rescue breaths), supported by telephone instruction, increased the proportion of people who survive to hospital discharge compared with conventional interrupted chest compression CPR with rescue breaths (high quality of evidence).
There is no significant difference regarding the return of spontaneous circulation, survival to hospital admission, survival to hospital dischargeand adverse events between CCC-CPR with asynchronous rescue breaths compared to interrupted chest compressions with rescue breaths (moderate quality of evidence).
Only four articles were selected and contributed to the results: one for trained professionals, and three for bystanders. In one of these articles, children older than one year of age were also included. It did not allow to conclude which CPR to be used.Finally, there is no data available regarding survival at one year or quality of life, and evidence regarding the neurological outcomes of survival was insufficient.
Bataillon de Marins Pompiers de Marseille
Marmara University Faculty of Medicine