Comparison of oral versus intravenous steroid in the management of Bell's palsy: a systematic review and meta-analysis of randomized clinical trials.

BACKGROUND: Bell's palsy is a condition affecting cranial nerve VII that results in acute peripheral unilateral facial weakness or paralysis of unclear etiology. Corticosteroids are the primary therapy choice, because they improve outcomes. According to a recent study, prednisolone effectively treats Bell's palsy in the short and long term. This study aimed to assess the effectiveness and safety of Single-Dose Intravenous Methylprednisolone to Oral Prednisolone in treating Bell's palsy patients. METHODS: PRISMA statement guidelines were used to design and conduct this systemic review. MEDLINE, Cochrane Library, and EMBASE databases were used in our search. We conducted the database search in November 2022. RESULTS: Thirty-three publications were reviewed as a result of the literature review. Three studies were included in the meta-analysis after applying our criteria. 317 Bell's palsy patients were included in our study. Regarding complete recovery to grade 1 in 1 month, IV methylprednisolone was higher than oral prednisolone; (log OR = 0.52, 95% CI [0.08, 0.97], P = 0.022). However, at 3 months, the two groups had no significant difference. Patients with grade 4 Bell's palsy were more likely to fully recover to grade 1 in 1 month with IV methylprednisolone than with oral prednisolone (log OR = 0.73, 95% CI [0.19, 1.26], P = 0.008), but not for patients with grade 3 or grade 2 Bell's palsy. CONCLUSION: This study shows evidence that patients with Bell's palsy can fully recover to grade 1 in 1 month when IV methylprednisolone is used instead of oral prednisolone. At 3 months, however, there was no discernible difference between the two treatments. Within 3 days of the onset of symptoms, IV methylprednisolone treatment can be started, which may help patients recover fully to grade 1 in 1 month. However, administering IV methylprednisolone may not always have long-term advantages compared to oral prednisolone.

Psychosocial Development in Saudi Adolescents With Type 1 Diabetes Mellitus: A Descriptive Comparative Study.

Background Diabetes mellitus imposes a significant psychological and social burden on the affected individuals. The impact of type 1 diabetes mellitus (T1DM) on psychosocial development has not been well investigated in the literature. We aim to fill the aforementioned gap by conducting a comparative study to accurately assess the impact of this chronic disease on psychosocial development among adolescents in Saudi Arabia. Methodology This structured, phone-based, comparative, and cross-sectional study targets adolescents with T1DM and those without diabetes in Jeddah, Saudi Arabia. Our study utilized a validated instrument psychosocial inventory of ego strengths (PIES), to assess the psychosocial development among the participants. An IRB approval has been granted for this study. The data were analyzed using SPSS. The data collection spanned the duration from November 1, 2020, until June 8, 2021. Results A total of 310 individuals were included in the study, 90 of whom were adolescents living with diabetes, and 220 were adolescents not living with diabetes. This study indicates that the individuals with diabetes showed significantly lower development in the Hope and Care subscales compared to the control group. We found no significant correlation between HbA1C levels and scores on the psychosocial development subscales. With regards to comorbidities, adolescents living with T1DM had significantly higher rates than the control group, with asthma being the most frequently reported comorbidity. Conclusion This study in Saudi Arabia found that adolescents living with diabetes demonstrated lower scores in Hope and Care subscales compared to adolescents not living with diabetes. It highlights the importance of healthcare professionals monitoring and addressing the psychosocial needs of T1DM patients through a multidisciplinary approach and referral to specialized support services when necessary. Further research and interventions are needed to promote the psychosocial well-being of individuals with T1DM.

Safety and efficacy of a laser refractive procedure in eyes with previous keratoplasty: systematic review and meta-analysis.

Post-keratoplasty (KP) patients' visual acuity can be severely limited by ametropia. Irregular astigmatisms are frequently encountered in these patients and is commonly associated with high degrees of hyperopia or myopia. This systematic review investigates the safety and efficacy of laser refractive surgery for post KP vision correction. 31 studies with 683 participants (732 eyes) enrolled in this review. Mean astigmatism improved significantly (mean difference [MD] = -2.70, 95% CI, -3.13 to -2.28, P < .0001). As well as Mean spherical equivalent (MD = -3.35, 95% CI, -3.92 to -2.78, P < .0001). From 586 participants 5.8% lost 2 or more lines of corrected distance visual acuity after treatment. The proportion of eyes with 20/40 uncorrected distance visual acuity or better was reported and the percentage was 46.79% overall. Laser refractive procedures (laser in situ keratomileusis [LASIK] or photorefractive keratectomy [PRK] or transepithelial PRK) on eyes with corneal transplantation were found to be relatively safe and effective. Our systematic review shows there is improvement in all outcomes. Main adverse effects were haze for PRK and epithelial ingrowth for LASIK.

Sarcopenia and associated risk factors in oncology outpatients in specialized cancer centers in Saudi Arabia: a cross-sectional study.

Sarcopenia is a comorbidity associated with cancer, which takes advantage of a patient's deteriorating state and decreases the survival rate. Thus, early detection of sarcopenia could improve oncology outpatient prognosis, treatment, and general quality of life. Objective: To measure the prevalence of probable sarcopenia and the associated risk factors in patients with cancer. Methods: This is a cross-sectional study. A total of 324 cancer patients were screened for sarcopenia using a simple questionnaire to rapidly diagnose sarcopenia [SARC-F (strength, assistance with walking, rising from a chair, climbing stairs, and falls)] and a hand grip dynamometer tool. The study was conducted from 1 January 2021 till 28 February 2021, in the outpatient department of Princess Noorah Oncology Center. Results: Among 324 cancer patients receiving active chemotherapy treatment, 28.4% screened positive for sarcopenia (SARC-F score ≥4). Moreover, 23.45% were identified as probable cases [SARC-F score ≥4 and a low hand grip strength (HGS)] of sarcopenia, according to the European Working Group on Sarcopenia in Older People consensus 2 (EWGSOP2) case-finding algorithm, which is sufficient to initiate a management plan. Conclusions: One-quarter of the cancer patients had probable sarcopenia at our institution. Sarcopenia risk was independently associated with patient age, and the risk of sarcopenia was low among patients with higher albumin concentrations. Screening cancer patients for sarcopenia using the SARC-F questionnaire and HGS may offer a useful strategy to mitigate the risk of unfavorable consequences that may occur during cancer treatment.

Anesthetic Considerations for Carotid Endarterectomy: A Postgraduate Educational Review.

Carotid endarterectomy (CEA) has shown a significant benefit in preventing ipsilateral stroke when it is compared to conservative management. Surgical morbidity and mortality must be kept to a minimum to achieve this benefit. Neurological status of the CEA patients can be monitored easily during regional anesthesia depending on the awake testing (neurocognitive assessment) method of the CEA patients. In addition, specific parameters can help us to monitor and to predict the neurological status of the CEA patients during the procedures such as regional cerebral oxygen saturation (rSO2) and middle cerebral artery velocity (MCAv) changes. We conducted a computerized literature search involving humans, published in English until December 2017, and indexed through Medical Databases; MEDLINE/PubMed, EMBASE, and Web of Science. We reviewed articles performed for prospective and other types of studies related to CEA procedures and techniques which can predict patient's status during the procedure. Searching relevant articles and discussing the results to allow meaningful rate comparison, and to conclude a result view which benefits the CEA patients and the medical staff during the CEA procedures. In total, studies observed cerebral rSO2 and MCAv have significant value during CEA procedures. Patients with neurological symptoms during the procedures showed changes of cerebral rSO2 and MCAv more than the patients without neurological symptoms. Mentioned parameters (cerebral rSO2 and MCAv) showed significant increasing right after the procedure. Mostly, CEA surgeries under local anesthesia were observed, for monitoring patients' consciousness status and comparing it to patients who undergo general anesthesia, to view the reliability of these techniques during CEA procedures, and to predict and avoid intraoperative neurological symptoms.