Efficacy of Prednisolone for Bell Palsy in Children: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial.

BACKGROUND AND OBJECTIVE: Corticosteroids are used to treat the early stages of idiopathic facial paralysis (Bell's palsy) in children, but their effectiveness is uncertain. We set out to determine if prednisolone improves the proportion of children with Bell's palsy with complete recovery at one month. METHODS: We conducted a double-blind, placebo-controlled, randomised trial of prednisolone in children presenting to emergency departments with Bell's palsy. Patients aged 6 months to less than 18 years, recruited within 72 hours after symptom onset, were randomly assigned to receive 10 days of treatment with oral prednisolone (approximately 1 mg/kg) or placebo. The primary outcome was complete recovery of facial function at 1 month rated on the House-Brackmann scale. Secondary outcomes included facial function, adverse events and pain up to 6 months. Target recruitment was n=540 (270 per group). RESULTS: Between 13 October 2015 to 23 August 2020, 187 children were randomised (94 to prednisolone and 93 to placebo) and included in the intention-to-treat analysis. At 1 month, the proportions of patients who had recovered facial function were 49% (n=43/87) in the prednisolone group compared with 57% (n=50/87) in the placebo group (risk difference -8.1%, 95% CI -22.8 to 6.7; adjusted odds ratio [aOR] 0.7, 95% CI 0.4 to 1.3). At 3 months these proportion were 90% (n=71/79) for the prednisolone group versus 85% (n=72/85) for the placebo group (risk difference 5.2%, 95%, CI -5.0 to 15.3; aOR 1.2, 95% CI 0.4 to 3.0) and at 6 months 99% (n=77/78) and 93% (n=76/82) respectively (risk difference 6.0%, 95% CI -0.1 to 12.2; aOR 3.0 95% CI 0.5 to 17.7) There were no serious adverse events and little evidence for group differences in secondary outcomes. DISCUSSION: In children with Bell's palsy the vast majority recover without treatment. The study, although underpowered, does not provide evidence that early treatment with prednisolone improves complete recovery. REGISTRATION: Registered with the Australian New Zealand Clinical Trials Registry ACTRN12615000563561, registered 1 June 2015, ://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368505&isReview=true CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that for children with Bell's palsy, prednisolone does not significantly change recovery of complete facial function at one month. However, the study lacked the precision to exclude an important harm or benefit from prednisolone.

Biosensor for heavy metals detection in wastewater: A review.

Pollution due to heavy metals is a global issue in recent years. Initially, there were fewer contaminants, which has increased exponentially owing to rapid industrialization and various anthropogenic activities. Toxicity due to heavy metals causes a lot of health problems and organ system failure in human beings. It also affects other forms of living beings such as plants, animals and even the microbiota. This has been reported by various press reports and research findings. In this review, the production of heavy metals, associated effects on the environment and the technologies employed for detecting these heavy metals are comprehensively discussed. The analytical instruments, including biosensors, have been found to be more beneficial than other techniques. Biosensor exhibits numerous special features, such as reproducibility, reusability, linearity, sensitivity, selectivity, and stability. Over the last three years, biosensors have also had a detection limit of 65.36 ng/mL for heavy metals. The design of biosensors, features and types were also explained in detail. The limit of detection for the heavy metals in wastewater using biosensors was also included with recent references up to the last five years.

Functionalization of MXene-based nanomaterials for the treatment of micropollutants in aquatic system: A review.

The increased industrialization and urbanization generate a larger quantity of effluent that is discharged into the environment regularly. Based on the effluent composition produced from various industries, the number of hazardous substances such as heavy metals, hydrocarbons, volatile organic compounds, organic chemicals, microorganisms introduced into the aquatic systems vary. The conventional wastewater treatment systems do not meet the effluent standards before discharge and require a different treatment system before reuse. Adsorption is an eco-friendly technique that uses selective adsorbents to remove hazardous pollutants even at microscale levels. MXene, a 2-Dimensional nanomaterial with resplendent properties like conductivity, hydrophilicity, stability, and functionalized surface characteristics, is found as a potential candidate for pollutant removal systems. This review discusses the fabrication, characterization, and application of MXene based nanoparticles to remove many pollutants in water treatment systems. The improvement in surface properties and adsorption capacity of MXene based NPs, when modified using different modification agents, has also been discussed. Their feasibility in terms of economic and environmental aspects has been evaluated to understand their scope for practical application in large-scale industries. The challenges towards the synthesis and toxicity's importance have been discussed, with the appropriate recommendations.

Analysis on the removal of emerging contaminant from aqueous solution using biochar derived from soap nut seeds.

For clearing pollutants and emerging contaminants like ciprofloxacin-500mg from wastewaters generated from pharmaceutical industries, soapnut seeds biochar was synthesized and used as an adsorbent for the effective removal process. Tubular furnace operated under nitrogen gas environment was used to synthesize biochar. The batch analysis were carried out successfully to study the removal mechanism and the removal efficiency of the chosen pollutant. The soapnut seeds biochar showed excellent adsorption of ciprofloxacin at pH 6 and temperature 303 K when the dosage was 0.07 g. The Langmuir removal capacity of 33.44 mg/g was received and the Freundlich model provided the best-fits. The ciprofloxacin-500mg adsorption process correlated well with the pseudo-second-order kinetics equation, and the intraparticle diffusion mechanism mainly controlled the process. The characterization of biochar concluded that O-H groups, CO groups, COO-groups and C-F groups, and π-π interactions, pore-filling effect, and cation exchange interactions played a role in the adsorption process. Therefore, the findings of the present work revealed that soapnut seeds biochar would be an excellent low-cost adsorbent for the removal of ciprofloxacin-500mg from wastewater.

Correction: RESPECT-ED: Rates of Pulmonary Emboli (PE) and Sub-Segmental PE with Modern Computed Tomographic Pulmonary Angiograms in Emergency Departments: A Multi-Center Observational Study Finds Significant Yield Variation, Uncorrelated with Use or Small PE Rates.

[This corrects the article DOI: 10.1371/journal.pone.0166483.].

RESPECT-ED: Rates of Pulmonary Emboli (PE) and Sub-Segmental PE with Modern Computed Tomographic Pulmonary Angiograms in Emergency Departments: A Multi-Center Observational Study Finds Significant Yield Variation, Uncorrelated with Use or Small PE Rates.

INTRODUCTION: Overuse of CT Pulmonary Angiograms (CTPA) for diagnosing pulmonary embolism (PE), particularly in Emergency Departments (ED), is considered problematic. Marked variations in positive CTPA rates are reported, with American 4-10% yields driving most concerns. Higher resolution CTPA may increase sub-segmental PE (SSPE) diagnoses, which may be up to 40% false positive. Excessive use and false positives could increase harm vs. benefit. These issues have not been systematically examined outside America. AIMS: To describe current yield variation and CTPA utilisation in Australasian ED, exploring potential factors correlated with variation. METHODS: A retrospective multi-centre review of consecutive ED-ordered CTPA using standard radiology reports. ED CTPA report data were inputted onto preformatted data-sheets. The primary outcome was site level yield, analysed both intra-site and against a nominated 15.3% yield. Factors potentially associated with yield were assessed for correlation. RESULTS: Fourteen radiology departments (15 ED) provided 7077 CTPA data (94% ≥64-slice CT); PE were reported in 1028 (yield 14.6% (95%CI 13.8-15.4%; range 9.3-25.3%; site variation p <0.0001) with four sites significantly below and one above the 15.3% target. Admissions, CTPA usage, PE diagnosis rates and size of PE were uncorrelated with yield. Large PE (≥lobar) were 55% (CI: 52.1-58.2%) and SSPE 8.8% (CI: 7.1-10.5%) of positive scans. CTPA usage (0.2-1.5% adult attendances) was correlated (p<0.006) with PE diagnosis but not SSPE: large PE proportions. DISCUSSION/ CONCLUSIONS: We found significant intra-site CTPA yield variation within Australasia. Yield was not clearly correlated with CTPA usage or increased small PE rates. Both SSPE and large PE rates were similar to higher yield historical cohorts. CTPA use was considerably below USA 2.5-3% rates. Higher CTPA utilisation was positively correlated with PE diagnoses, but without evidence of increased proportions of small PE. This suggests that increased diagnoses seem to be of clinically relevant sized PE.