N Engl J Med 2007;357:1,598-607.
Standard treatment for Bell's palsy is combination corticosteroids and antiviral therapy, despite a lack of convincing evidence. This trial aimed to evaluate the benefit of these agents. Nearly 500 patients were randomised to receive either aciclovir, prednisolone, a combination of the two or placebo. Outcome measures in this double-blinded study were facial function, quality of life, appearance and pain.
At 12 weeks, 83 per cent of those who received corticosteroids had recovered facial function, nearly 20 per cent more than those who had not taken prednisolone. There was no significant advantage in the aciclovir group. At nine months, prednisolone offered a 13 per cent advantage over those who did not take steroids. Again, there was no advantage in taking aciclovir.
The authors found no therapeutic benefit with aciclovir, but corticosteroids had an advantage over placebo.
Urgent treatment of TIA
Lancet 2007;370:1,432-42.
In the week following a TIA, 10 per cent of patients have a stroke. This prospective study evaluated the benefit of aggressive treatment following a TIA or minor stroke. Nearly 1,300 patients were involved in the study: 607 patients were immediately referred to an acute hospital clinic; 620 were referred to an outpatients clinic; 51 were managed in primary care.
During the early phase (I) of the trial, the median delay to treatment was 20 days, whereas the median delay to treatment in phase II was one day. The rate of stroke at 90 days during phase I was 10.3 per cent. This rate fell to 2.1 per cent in the phase II patients. The study demonstrated early and aggressive intervention must be a priority when managing cerebrovascular events.
Novel approach to asthma
Lancet 2007;370:1,422-31.
Asthma continues to sour our mortality statistics, killing 1,500 people per year.
The underlying inflammatory pathogenesis lends itself to much immunological research. Interleukin (IL)-4 and 13 are both thought to play a pivotal role in the allergic response in atopic asthma. Pitrakinra, a novel therapeutic agent, is an IL-4 variant that inhibits both IL-4 and 13 binding affecting T helper 2 mediated inflammation.
This blinded early-phase study assessed patients' FEV1 in response to either subcutaneous or nebulised pitrakinra or placebo after an allergen exposure. The FEV1 fell less after exposure to an allergen in the pitrakinra groups compared with placebo. The patients who were exposed to the test drug required less rescue medication.
By reducing the effects of IL-4 and 13, pitrakinra may offer a substantial benefit in the control of asthma.
Invasive MRSA infections in the US
JAMA 2007;298:1,763-71.
This interesting American study investigated community-based MRSA infections. Nearly 9,000 cases of MRSA were evaluated. Of these, almost 59 per cent of cases of invasive MRSA were found to have originated from community sources. Patients over the age of 65, males and Afro-Caribbeans were particularly at risk.
The message here is a simple one: all healthcare professionals must employ robust hygienic practices, whether in hospital or the community.
Dr Thakkar is a GP in Wooburn Green, Buckinghamshire, and a member of our team who regularly review the journals.
The quick study
Bell's palsy patients recover facial function more quickly given prednisolone; aciclovir confers no benefit.
TIA and minor stroke should be treated early and aggressively to prevent later stroke.
Asthma responded well in a study to a novel therapeutic agent, a variant of IL-4 that inhibits inflammation.
MRSA in the US often originates in the community and robust hygiene measures should be employed by all healthcare professionals.
Research of the week
Mammograms in over-70s
Arch Intern Med 2007;167:2,039-46.
Women aged 50-70 are routinely invited for breast screening in the UK, but after this age, are encouraged to make their own appointment.
This Australian study tested a decision aid in over 700 70-year-old women who had participated in screening. The aid came in the form of a paper booklet outlining the likelihood of death with or without continued mammography compared with other outcomes, such as extra tests.
The decision aid increased the proportion of women who made an informed choice, from 49 per cent to 74 per cent and reduced decisional conflict without increasing anxiety. There was no difference in the proportion of women who were screened within the next month.
The authors say the tool seems to be a feasible way to help women make this decision within a population screening programme.
