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.
BACKGROUND: Emergency contraception refers to methods that women can use to prevent pregnancy after unprotected sexual intercourse, method failure or incorrect use. Unwanted pregnancy followed by unsafe abortion can be avoided by using different contraceptive methods including emergency contraceptives. The objective of this study was to assess the knowledge, attitude and practice of emergency contraception among graduating female students of Jimma University main campus. METHODS: A cross-sectional study was conducted in Jimma University main campus in 2009. The calculated sample size was allocated to each faculty proportions to size of female students. Then within the faculty the sample unit was selected by using simple random sampling technique. Data was collected using self administered questionnaire and analyzed using SPSS for widow version 16.0. RESULTS: A total of 389 (96.5%) volunteered graduating female students participated in the study. One hundred sixty three (41.9%) were ever heard of Emergency Contraceptive, only 11(6.8%) used the method. The common sources of information were friends 60 (36.5%), radio 37 (22.8%) and television 20 (12.3%). One hundred sixteen (71.2%) agreed to use Emergency Contraceptive when they practice unintended sexual intercourse. CONCLUSION: Awareness and use of emergency contraception among graduating female students of Jimma University was low. There is a need to educate adolescents about emergency contraceptives, with emphasis on available methods and correct timing of use.
Recent pharmacotherapeutic advances in the treatment of depression have included the development of selective serotonin reuptake inhibitors (SSRIs), thereby providing an alternative to tricyclic antidepressants (TCAs). SSRIs have achieved a rapid acceptance by prescribers worldwide due to a superior safety profile to that observed with the TCAs, and the potential for once daily administration. However, to date there exists limited data regarding the effect of antidepressant pharmacotherapy on health service expenditures. Herein, we review the inherent strengths and weaknesses of the five study designs which have been employed in the economic appraisal of antidepressant pharmacotherapy: randomized controlled trials; meta-analyses stemming from the results of controlled clinical trials; decision-analytical models predicated on results stemming from randomized clinical trials and/or meta-analyses; retrospective data archive investigations; and prospective randomized naturalistic inquiry. What emerges is the necessity of establishing a portfolio of evidence as to the safety, efficacy, and effectiveness of a given pharmacotherapeutic category (e.g. SSRIs) and/or a specific medication. Thus, the economic appraisal of antidepressant pharmacotherapy will require an iterative process extending from the developmental through post-marketing phase.
Antidepressive Agents/therapeutic use , Depressive Disorder/drug therapy , Humans
The extensive use of benzodiazepines in treating anxiety and insomnia makes clinicians ask themselves about the risk of addiction relating to these drugs.(1-3) Indeed, it is estimated that in Canada, the United-States, and Western Europe, between 10% and 20% of persons use tranquilizers or hypnotics (mostly benzodiazepines) during a one-year period. Of these persons 70% are 50 years of age or more. It has been noted that 15% of those persons have been using these drugs for more than 12 months.(4, 5) In 1980, Tyrer reported that 50% of the patients who receive a prescription for benzodiazepines renew that prescription without consulting their physician.(6) In this article, the authors briefly review the dependency, risk factors and clinical signs resulting from withdrawal of these drugs. They also define a rational therapeutic approach to discontinuing their use.
