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Residual blood specimens provide a sample repository that could be analyzed to estimate and track changes in seroprevalence with fewer resources than household-based surveys. We conducted parallel facility and community-based cross-sectional serological surveys in two districts in India, Kanpur Nagar District, Uttar Pradesh, and Palghar District, Maharashtra, before and after a measles-rubella supplemental immunization activity (MR-SIA) from 2018 to 2019. Anonymized residual specimens from children 9 months to younger than 15 years of age were collected from public and private diagnostic laboratories and public hospitals and tested for IgG antibodies to measles and rubella viruses. Significant increases in seroprevalence were observed following the MR SIA using the facility-based specimens. Younger children whose specimens were tested at a public facility in Kanpur Nagar District had significantly lower rubella seroprevalence prior to the SIA compared to those attending a private hospital, but this difference was not observed following the SIA. Similar increases in rubella seroprevalence were observed in facility-based and community-based serosurveys following the MR SIA, but trends in measles seroprevalence were inconsistent between the two specimen sources. Despite challenges with representativeness and limited metadata, residual specimens can be useful in estimating seroprevalence and assessing trends through facility-based sentinel surveillance.
The COVID-19 pandemic amplified known challenges associated with the conduct of inpatient clinical trials, while also introducing new ones that needed to be addressed.
Methods:
Stakeholders based in the United States who participated in the conduct of inpatient therapeutic trials for the treatment of COVID-19 as part of the Accelerating COVID-19 Therapeutic Interventions and Vaccines program identified challenges experienced in the conduct of these trials through a series of meeting to discuss and identify common themes. In addition, innovations developed to address these challenges and other potential solutions that may be utilized in future pandemics were highlighted.
Results:
Six thematic challenges including infection control considerations, the interplay between provision of clinical care and research, competing clinical trials, arduous consenting procedures, onerous procedural requirements, and participant recruitment including achieving representation of diverse populations were identified and are discussed here.
Conclusions:
Consideration of the lessons learned and recommendation outlined here may allow for more efficient conduct of inpatient clinical trials in future pandemics.
Background: Reliable real-world data on the burden of MG is needed to inform Canadian clinical and policy decisions in the era of new MG therapeutics, including FcRn inhibitors. Given the lack of recent Canadian data on MG disease burden, the MG-REST Study aims to estimate the clinical burden of MG in Ontario. Methods: Ontario administrative data from ICES were utilized for a retrospective population-based cohort study of adults with MG identified through a validated algorithm (April 2013-March 2019) and followed for up to seven years (March 2020) to determine myasthenic crisis characteristics and overall survival (OS). Results: The MG cohort (n=2,601) had an average age of 65.7 years and 53.3% were males. Incidence of first myasthenic crisis was 9%, with 87% of events occurring at/after diagnosis. MG OS was 89%, 85% and 75% at 1-year, 2-years and 5-years, respectively, while OS after first crisis was 60%, 52%, and 39% for the same years. Conclusions: Despite the availability of conventional therapies throughout the study, MG crisis remains a serious, common complication of MG, with decreased survival at 1-year post-crisis (29% difference versus 1-year OS following MG diagnosis). Study highlights MG burden and unmet need for new effective therapies for MG treatment.
The diagnosis of functional constipation (FC) relies on patient-reported outcomes evaluated as criteria based on the clustering of symptoms. Although the ROME IV criteria for FC diagnosis is relevant for a multicultural population(1), how an individual’s lifestyle, environment and culture may influence the pathophysiology of FC remains a gap in our knowledge. Building on insights into mechanisms underpinning disorders of gut-brain interactions (formerly functional gastrointestinal disorders) in the COMFORT Cohort(2), this study aimed to investigate the differences in gastrointestinal (GI) symptom scores among participants with FC in comparison to healthy controls between Chinese and non-Chinese New Zealanders. The Gastrointestinal Understanding of Functional Constipation In an Urban Chinese and Urban non-Chinese New Zealander Cohort (GUTFIT) study was a longitudinal cohort study, which aimed to determine a comprehensive profile of characteristics and biological markers of FC between Chinese and non-Chinese New Zealanders. Chinese (classified according to maternal and paternal ethnicity) or non-Chinese (mixed ethnicities) adults living in Auckland classified as with or without FC based on ROME IV were enrolled. Monthly assessment (for 3 months) of GI symptoms, anthropometry, quality of life, diet, and biological samples were assessed monthly over March to June 2023. Demographics were obtained through a self-reported questionnaires and GI symptoms were assessed using the Gastrointestinal Symptom Rating Scale (GSRS) and Structured Assessment of Gastrointestinal Symptoms Scale (SAGIS). This analysis is a cross-sectional assessment of patient-reported outcomes of GI symptoms. Of 78 enrolled participants, 66 completed the study (male, n = 10; female, n = 56) and were distributed across: Chinese with FC (Ch-FC; n = 11), Chinese control (Ch-CON; n = 19), non-Chinese with FC (NCh-FC; n = 16), non-Chinese control (NCh-CON; n = 20). Mean (SD) age, body mass index, and waist circumference were 40 ± 9 years, 22.7 ± 2.5 kg/m2, and 78.0 ± 7.6 cm, respectively. Ethnicity did not impact SAGIS domain scores for GI symptoms (Ethnicity x FC severity interaction p>0.05). Yet, the constipation symptoms domain of the GSRS was scored differently depending on ethnicity and FC status (Ethnicity x FC interaction p<0.05). In post hoc comparison, NCh-FC tended to have higher GSRS constipation severity scores than Ch-FC (3.4 ± 1.0 versus 3.8 ± 0.8 /8, p<0.1) Although constipation symptom severity tended to be higher in NCh-FC, on the whole, ethnicity did not explain variation in this cohort. FC status was a more important predictor of GI symptoms scores. Future research will assess differences in symptom burden to explore ethnicity-specific characteristics of FC.
Distinct pathophysiology has been identified with disorders of gut-brain interactions (DGBI), including functional constipation (FC)(1,2), yet the causes remain unclear. Identifying how modifiable factors (i.e., diet) differ depending on gastrointestinal health status is important to understand relationships between dietary intake, pathophysiology, and disease burden of FC. Given that dietary choices are culturally influenced, understanding ethnicity-specific diets of individuals with FC is key to informing appropriate symptom management and prevention strategies. Despite distinct genetic and cultural features of Chinese populations with increasing FC incidence(3), DGBI characteristics are primarily described in Caucasian populations(2). We therefore aimed to identify how dietary intake of Chinese individuals with FC differs to non-Chinese individuals with FC, relative to healthy controls. The Gastrointestinal Understanding of Functional Constipation In an Urban Chinese and Urban non-Chinese New Zealander Cohort (GUTFIT) study was a longitudinal case-control study using systems biology to investigate the multi-factorial aetiology of FC. Here we conducted a cross-sectional dietary intake assessment, comparing Chinese individuals with FC (Ch-FC) against three control groups: a) non-Chinese with FC (NCh-FC) b) Chinese without FC (Ch-CON) and c) non-Chinese without FC (NCh-CON). Recruitment from Auckland, New Zealand (NZ) identified Chinese individuals based on self-identification alongside both parents self-identifying as Chinese, and FC using the ROME IV criteria. Dietary intake was captured using 3-day food diaries recorded on consecutive days, including one weekend day. Nutrient analysis was performed by Foodworks 10 and statistical analysis with SPSS using a generalised linear model (ethnicity and FC status as fixed factors). Of 78 enrolled participants, 66 completed the study and 64 (39.4 ± 9.2 years) completed a 3-day food diary at the baseline assessment. More participants were female (84%) than male (16%). FC and ethnicity status allocated participants into 1 of 4 groups: Ch-FC (n = 11), Ch-CON (n = 18), NCh-FC (n = 16), NCh-CON (n = 19). Within NCh, ethnicities included NZ European (30%), non-Chinese Asian (11%), Other European (11%), and Latin American (2%). Fibre intake did not differ between Ch-FC and NCh-FC (ethnicity × FC status interaction p>0.05) but was independently lower overall for FC than CON individuals (21.8 ± 8.7 versus 27.0 ± 9.7 g, p<0.05) and overall for Ch than NCh (22.1 ± 8.0 versus 27.0 ± 10.4 g, p<0.05). Carbohydrate, protein, and fat intakes were not different across groups (p>0.05 each, respectively). In the context of fibre and macronutrient intake, there is no difference between Ch-FC and NCh-FC. Therefore, fibre and macronutrients are unlikely to contribute to potential pathophysiological differences in FC between ethnic groups. A more detailed assessment of dietary intake concerning micronutrients, types of fibre, or food choices may be indicated to ascertain whether other dietary differences exist.
An experimental study to investigate the effect of an external magnetic field on the propagation of ion-acoustic waves (IAWs) has been carried out in hydrogen plasma containing two-temperature electrons and dust grains. It is a first step in understanding the propagation properties of IAWs in such an environment. A low-pressure hot cathode discharge method is chosen for plasma production. The desired two-electron groups with distinct temperatures are achieved by inserting two magnetic cages with a cusp-shaped magnetic field of different surface field strengths in the same chamber. The dust grains are dropped into the plasma with the help of a dust dropper, which gain negative charges by interacting with the plasma. The IAWs are excited with the help of a mesh grid inserted into the plasma. A planar Langmuir probe is used as a detector to detect the IAWs. The time-of-flight technique has been applied to measure the phase velocity of the IAWs. The results suggest that in the presence of a magnetic field, the phase velocity of IAWs increases, whereas introducing the dust particles leads to the lower phase velocity. The magnetic field is believed to have a significant effect on the wave damping. This study will aid in utilising IAWs as a diagnostic tool to estimate plasma parameters in the presence of an external magnetic field.
Cannabis (aka marijuana) is the most frequently consumed illicit substance worldwide, and a subset of frequent cannabis smokers (up to 30%) develop dependence. A less well-known consequence of cannabis dependence is withdrawal syndrome, characterized by a time-dependent constellation of symptoms (Lafaye et al. Dialogues Clin Neurosci 2017;19(3), 309-316).
Objectives
This study aims to prospectively assess the course of cannabis withdrawal symptoms within a controlled inpatient detoxification setting and to correlate the severity of withdrawal symptoms with the serum levels of neurotransmitters (NT).
Methods
N=45 treatment-seeking chronic cannabis dependents (assessed by ICD-10) were enrolled, and their withdrawal symptoms were assessed prospectively from admission (Day-0) to 28 days using Marijuana withdrawal checklist (MWC). Sociodemographic characteristics and self-reported drug use histories were reported. Serum levels of dopamine, serotonin, norepinephrine, epinephrine, and cortisol were measured. Cannabis abstinence symptoms were assessed daily using MWC for 4 weeks, and serum neurotransmitter levels were analyzed at admission (Day 0), 7, 14, 21, and 28. Comparison between groups was done using Friedman’s test. Correlation between NT level and MWC scores was performed using linear regression spearman correlation analysis
Results
The follow-up NT levels from Day 0 to 28 showed a significant (p<0.05) decrease in serotonin and dopamine, whereas epinephrine levels showed a significant increase (Fig 1) with the course of withdrawal. Withdrawal symptoms like decreased appetite, sweating, and craving were significantly and positively correlated with serotonin, dopamine, and epinephrine NT levels (Fig 2).
Image:
Image 2:
Conclusions
Findings support the presence of clinically significant cannabis withdrawal symptoms with NT levels in subjects with cannabis dependence seeking substance abuse treatment. The data of this study determine the relationship between observed withdrawal symptoms and changes in brain chemistry and evaluate its possible utility as a predictor of relapse.
This study aimed to evaluate the management practices and outcomes in children with sinogenic intracranial suppuration.
Method
This was a retrospective cohort study in a single paediatric tertiary unit that included patients younger than 18 years with radiologically confirmed intracranial abscess, including subdural empyema and epidural or intraparenchymal abscess secondary to sinusitis. Main outcomes studied were rate of return to the operating theatre, length of hospital stay, death in less than 90 days and neurological disability at 6 months.
Results
A cohort of 39 consecutive patients presenting between 2000 and 2020 were eligible for inclusion. Subdural empyema was the most common intracranial complication followed by extradural abscess and intraparenchymal abscess. Mean length of hospital stay was 42 days. Sixteen patients were managed with combined ENT and neurosurgical interventions, 15 patients underwent ENT procedures alone and 4 patients had only neurosurgical drainage. Four patients initially underwent non-operative management. The rates of return to the operating theatre, neurological deficits and 90-day mortality were 19, 9 and 3, respectively, and were comparable across the 4 treatment arms. In the univariate logistic regression, only the size of an intracranial abscess was found be associated with an increased likelihood of return to the operating theatre, whereas combined ENT and neurosurgical intervention did not result in improved outcomes.
Conclusion
Sinogenic intracranial abscesses are associated with significant morbidity and mortality. The size of an intracranial abscess has a strong association with a need for a revision surgery.
Wu and Shi [‘A note on k-Galois LCD codes over the ring
$\mathbb {F}_q + u\mathbb {F}_q$
’, Bull. Aust. Math. Soc.104(1) (2021), 154–161] studied
$ k $
-Galois LCD codes over the finite chain ring
$\mathcal {R}=\mathbb {F}_q+u\mathbb {F}_q$
, where
$u^2=0$
and
$ q=p^e$
for some prime p and positive integer e. We extend the results to the finite nonchain ring
$ \mathcal {R} =\mathbb {F}_q+u\mathbb {F}_q+v\mathbb {F}_q+uv\mathbb {F}_q$
, where
$u^2=u,v^2=v $
and
$ uv=vu $
. We define a correspondence between the
$ l $
-Galois dual of linear codes over
$ \mathcal {R} $
and the
$ l $
-Galois dual of their component codes over
$ \mathbb {F}_q $
. Further, we construct Euclidean LCD and
$ l $
-Galois LCD codes from linear codes over
$ \mathcal {R} $
. We prove that any linear code over
$ \mathcal {R} $
is equivalent to a Euclidean code over
$\mathbb {F}_q$
with
$ q>3 $
and an
$ l $
-Galois LCD code over
$ \mathcal {R}$
with
$0<l<e$
and
$p^{e-l}+1\mid p^e-1$
. Finally, we investigate MDS codes over
$ \mathcal {R}$
.
This study assessed the impact of improved green fodder production activities on technical efficiency (TE) of dairy farmers in climate vulnerable landscapes of central India. We estimated stochastic production frontiers, considering potential self-selection bias stemming from both observable and unobservable factors in adoption of fodder interventions at farm level. The empirical results show that TE for treated group ranges from 0.55 to 0.59 and that for control ranges from 0.41 to 0.48, depending on how biases are controlled. Additionally, the efficiency levels of both adopters and non-adopters would be underestimated if the selectivity bias is not appropriately accounted. As the average TE is consistently higher for adopter farmers than the control group, promoting improved fodder cultivation would increase input use efficiency, especially in resource-deprived small holder dairy farmers in the semi-arid tropics.
Scapolite occurrences are widely observed in the metasedimentary rocks exposed around the Khetri Copper Belt and adjoining Nim ka Thana copper mineralized area in western India. Amoeboidal to well-developed and rounded/elliptical-shaped marialitic scapolite (Na-rich end-member) rich zones with variable Cl contents ranging from 1.0 wt % to 2.9 wt % have been identified in proximity to the ore-bearing hydrothermal fluid activity zones. Although scapolite is formed as a product of regional metamorphism in many places, in this study, we propose a strong possibility that scapolite was formed by hydrothermal ore-bearing fluid interaction with metasediments. The evidence of hydrothermal activity and Cl sourcing is attributed to (i) the absence of evaporite beds in the area and no Na-rich plagioclase as inclusions within the scapolite suggesting the formation of marialitic scapolite from sodic plagioclase in the metasediments with the interacting hydrothermal fluid; (ii) an epithermal to mesothermal hydrothermal fluid with moderate salinity responsible for the Cu mineralization that is ascribed to be the source of Cl for the formation of marialitic scapolite; (iii) diffusion of SO2 in the scapolite in close association with the sulfide mineral phase (chalcopyrite) supporting the involvement of ore-bearing fluid in the development of scapolite; (iv) the absence of zoned scapolite, the spatial distribution of scapolite in a particular lithology, the occasional incorporation of sulfur into marialitic scapolite and the texture/geometry in the scapolite suggesting a broad hydrothermal linkage instead of a pure metamorphic origin.
Poor academic performance has been linked to factors such as sleep, health, illicit drug use, physical fighting, social media use, cyber bullying, physical activity, homelessness, times spent in video games and television. It is difficult to get a sense of the interplay between and relative importance of different behaviours/factors on academic performance as only limited research has been aimed at quantifying these factors.
Objectives
To evaluate association of school performance and variables in five categories of the YRBSS: physical fighting, diet/lifestyle, electronic device usage, concurrent substance use, and violence/self-harm.
Methods
The CDC Youth Risk Behavior Surveillance System (YRBSS) data from 1991-2019 was used in study. Respondents were grouped by good and poor school performance and variables related to nutrition/lifestyle, electronic device use, concurrent substance use, mood/violence/self-harm were analyzed using chi-square test.
Results
A total of 41,235 student respondents.Nutrition/Lifestyle, electronic device use, concurrent substance use, mood/violence/self-harm are found to be significantly correlated with school performance.
Poor Performance n(%)
Good Performance n(%)
Total n(%)
p-Value
Nutrition/Lifestyle
Daily breakfast
2,715(26)
11,429(38.22)
14,144(35.06)
<0.0001
Sodas ≥2/day
1,998(19.12)
2,710(9.03)
4,708(11.63)
<0.0001
Concurrent Substance Use
Alcohol use
3,544(37.55)
8,067(28.49)
11,611(30.75)
<0.0001
Cigarette smoking
1,616(15.74)
1,845(6.17)
3,461(8.61)
<0.0001
Mood/Violence/Self-Harm
Difficulty concentrating
4,188(46.34)
7,327(28.27)
11,516(32.94)
<0.0001
Felt sad or hopeless
4,373(41.06)
9,038(29.67)
13,410(32.62)
<0.0001
Considered suicide
2,567(24.14)
4,810(15.8)
7,377(17.96)
<0.0001
Conclusions
In national data, we found school performance is affected by nutrition, lifestyle, substance use, mood and exposure to surrounding violence, and self-harm. Further studies should be planned to evaluate benefits from the risk stratification to reduce this burden amongst US adolescents.
Rhino-orbito-cerebral mucormycosis is a rapidly progressive disease with high mortality rates of about 60 per cent. The increasing incidence of rhino-orbito-cerebral mucormycosis in coronavirus disease 2019 patients in India and worldwide has become a matter of concern owing to the case fatality rate. This study explored the use of low dose aspirin in decreasing the mortality rate of coronavirus disease 2019 associated mucormycosis.
Method
This was a retrospective observational study. Patients suffering from post-coronavirus disease 2019 mucormycosis were included in the study. Each patient was treated with surgical debridement and systemic amphotericin B. Low dose aspirin was added, and mortality rates were compared with the patients who did not receive aspirin.
Results
The demographic data and rhino-orbito-cerebral mucormycosis staging between the two groups were not significantly different. There was a statistically significant difference in mortality outcomes between the two groups (p = 0.029) and a 1.77 times higher risk of dying for patients not receiving aspirin. Kaplan–Meier survival indicated that patients receiving aspirin had better survival rates (p = 0.04).
By studying the odds of developing idiopathic subglottic stenosis in the isolated and genetically unique Hutterite population, this study sought to strengthen the hypothesis that an underlying genetic predisposition may exist for its development.
Methods
A retrospective chart review examined the medical records of all adult patients treated for idiopathic subglottic stenosis in Saskatchewan between 2008 and 2018. Cases were segregated into Hutterite and non-Hutterite.
Results
Four out of 36 cases of idiopathic subglottic stenosis occurred among Hutterites. The odds of a Hutterite developing idiopathic subglottic stenosis are 21.89 times higher than for non-Hutterites. Positive family history was only observed in the Hutterite population.
Conclusion
The study strengthens the hypothesis that genetics may play a role in the aetiology of idiopathic subglottic stenosis by demonstrating that the genetically and socially unique Hutterites are more likely to develop this rare disease. This study is the first to demonstrate that a specific subpopulation is at a higher risk for developing idiopathic subglottic stenosis.
The launch of the Sentinel-1B satellite in April 2016 completed the two-satellite synthetic aperture radar (SAR) constellation of the European Copernicus Sentinel-1 mission. The European Space Agency executed the calibration of this sensor during the commissioning phase and an independent calibration by the German Aerospace Center (DLR) in 2016. The calibration parameters must be monitored to assess the stability of the instrument. This study reports the temporal stability assessment of radiometric calibration and image quality parameters of Sentinel-1B SAR data using the corner reflector (CR) array, Surat Basin, Australia. Impulse response functions generated from the CRs in the satellite images were used to derive the image quality parameters. The average radar cross-section difference between estimated and theoretical values (38.40 dB m2) was 0.53 dB m2 for 1.5 m CRs, which is accordant with the absolute radiometric accuracy specified for the Sentinel-1 SAR system. Derived image quality parameters viz. the mean peak-to-side lobe ratio, mean integrated side lobe ratio, and spatial resolutions in the range and azimuth directions were found to be accordant with the specified value for the Sentinel-1 SAR system. The results indicate the excellent quality of the Sentinel-1B data.
Prior research finds that Dodd–Frank Act’s regulations on credit rating agencies (CRAs) increase rated firms’ risk of rating downgrades, regardless of their credit quality. Our difference-in-difference estimates suggest that after Dodd–Frank, low-rated firms, which face steep costs from a further downgrade, significantly reduce their debt issuance and investments compared to similar unrated firms. Our results are not driven by credit supply or the financial crisis. They reveal an unintended consequence of Dodd–Frank: Greater regulatory pressure on CRAs leads to negative spillover effects on firms concerned about credit ratings, regardless of their credit quality.
In spite of continuous refinements in tympanoplasty techniques, results are variable, and it is not uncommon to see a discharging eardrum even after a good graft uptake. This study aimed to evaluate the efficacy of total annulus excision tympanoplasty in comparison with conventional underlay tympanoplasty.
Method
This was a double blinded, randomised, controlled trial performed at a tertiary care centre. After inclusion and exclusion criteria were met, 56 patients were enrolled and randomised, and 28 patients were allocated to each group (group A (conventional tympanoplasty) and group B (total annulus excision)). Patients and evaluators were blind to the procedure performed.
Results
Patients in group B (total annulus excision) showed better graft uptake and no discharge with better gains in air conduction thresholds (p < 0.05) when compared with group A (conventional tympanoplasty).
Conclusion
In view of the advantages it offers, total annulus excision tympanoplasty may be preferred over the conventional techniques in patients with central perforations.
Coronavirus disease 2019 (COVID-19) has posed formidable challenges, including overwhelming biomedical waste management. Guidelines have been rapidly changing along with the mounting pressure of waste generation.
Methods:
These challenges were managed by smart re-engineering of structure and processes for the desired outcomes. Dedicated staff, in personal protective equipment with appropriate training, were deployed to collect waste using dedicated trolleys. A dedicated route plan was drawn with a dedicated elevator meant for COVID-19. A new temporary holding area was created. Dedicated trucks with requisite labels were deployed to transport COVID-19 waste to a common biomedical waste treatment facility. Communication challenges were addressed through timely circulars, which were further reinforced and reiterated during various on-going training programs.
Results:
Before the onset of COVID-19 pandemic, the amount of biomedical waste generated was 1.93 kg/bed/day; currently, the quantity of COVID-19 biomedical waste generated is 7.76 kg/COVID bed/day. Daily COVID-19 waste generation data are maintained and uploaded in an android application monitored by Central Pollution Control Board, Government of India. To date, none of the workers handling COVID-19 waste has acquired health-care associated COVID-19 infection, which reflects on the soundness of the new system and the infection control practices in the institute.
Conclusions:
A responsive leadership harmonizing with a robust communication and training system has augmented timely re-engineering of structure and processes for better outcomes in the war on waste.
Bell's palsy is a lower motor neurone facial weakness of unknown aetiology, although reactivation of a virus within the facial nerve has been proposed.
Methods
A prospective study was conducted of Bell's palsy cases presenting to our paediatric ENT unit over a 19-week period, from February to June 2020. Patients were invited for severe acute respiratory syndrome coronavirus-2 antibody testing. A text-message questionnaire was sent to other ENT centres to determine their observational experience.
Results
During the study period, 17 children presented with Bell's palsy, compared with only 3 children in the same time period in the previous year (p < 0.0001). Five patients underwent severe acute respiratory syndrome coronavirus-2 antibody testing, the results of which were all negative. Four out of 15 centres questioned perceived an increased incidence in paediatric Bell's palsy.
Conclusion
Clinicians are encouraged to be vigilant to the increase in paediatric Bell's palsy seen during the coronavirus disease 2019 pandemic, which may represent a post-viral sequela of coronavirus disease 2019.