A 61-year-old man presented to the ENT emergency clinic with a history of unilateral facial nerve palsy occurring shortly after each dose of the Pfizer-BioNTech COVID-19 vaccine. The first episode developed 5 hours after administration of the first dose and the second 2 days after administration of the second dose. Investigations at initial presentation to the emergency department were unremarkable, and the patient was diagnosed with Bell’s palsy on both occasions. We describe the first case of Bell’s palsy occurring after each dose of any UK-approved COVID-19 vaccine. Single episodes of unilateral facial nerve palsies have been reported in clinical trials and in subsequent case reports. There has been no evidence, however, of an episode after each dose. We also describe the earliest onset of symptoms from timing of administration of the vaccine, further suggesting the Bell’s palsy was associated with the vaccine.
Objective: Pelvic fracture can be complicated by posterior urethral injury (PUI) in up to 25% of cases. PUI can produce considerable morbidity, including urethral stricture, erectile dysfunction (ED), and urinary incontinence. Optimal management of PUI is unclear, however, the current gold standard is placement of a suprapubic cystostomy with delayed urethroplasty (SCDU) performed several months later. Another option is early primary realignment (PR) with urethral catheter, performed either open or endoscopically. Through a systematic review and meta-analysis, we aimed to compare PR and SCDU regarding stricture, ED, and urinary incontinence rates. In light of advancing endoscopic techniques, we also aimed to compare early endoscopic realignment (EER) alone with SCDU. Methods: PubMed, Medline, and Embase were searched for eligible studies comparing PR, including EER, and suprapubic cystostomy plus delayed urethroplasty from database inception until July 17th, 2018. We also reviewed reference lists from relevant articles. Study quality assessment was conducted using a modified Newcastle-Ottawa (mNOS) scale (maximum score 9). Results: From 461 identified articles, 13 studies encompassing 414 PR and 308 SCDU patients met our eligibility criteria. Twelve studies were retrospective non-randomized case studies, with 1 prospective randomized case study. Included studies were of moderately low quality (mNOS mean score: 6.0 ± 0.6). Meta-analysis demonstrated that PR and SCDU had similar stricture rates [odds ratio (OR): 2.14; 95% confidence interval (CI): 0.67-6.85; p = 0.20], similar rates of ED (OR: 1.06; 95% CI: 0.62-1.81; p = 0.84), and similar rates of urinary incontinence (OR: 0.94; 95% CI: 0.49-1.79; p = 0.86). Six studies compared EER alone (229 patients) versus SCDU (195 patients). Meta-analysis demonstrated that these modalities also had similar stricture rates (OR: 4.14; 95% CI: 0.76-22.45; p = 0.10), similar rates of ED (OR: 0.79; 95% CI: 0.41-1.54; p = 0.49), and similar rates of urinary incontinence (OR: 1.10; 95% CI: 0.48-2.53; p = 0.82). Conclusion: For PUI patients, neither PR nor EER produces superior outcomes compared to SCDU regarding stricture, ED, and urinary incontinence rates. The quality of studies in the literature, however, is very poor, with the majority of studies being non-randomized retrospective case studies with potentially high bias. Additional high-quality research, particularly prospective studies and randomized controlled trials, are needed to strengthen the evidence base.
Stellar variability is a key obstacle in reaching the sensitivity required to recover Earth-like exoplanetary signals using the radial velocity (RV) detection method. To explore activity signatures in Sun-like stars, we present SolAster, a publicly distributed analysis pipeline 10 10 https://tamarervin.github.io/SolAster/ that allows for comparison of space-based measurements with ground-based disk-integrated RVs. Using high-spatial-resolution Dopplergrams, magnetograms, and continuum filtergrams from the Helioseismic and Magnetic Imager aboard the Solar Dynamics Observatory (SDO), we estimate “Sun-as-a-star” disk-integrated RVs due to rotationally modulated flux imbalances and convective blueshift suppression, as well as other observables such as unsigned magnetic flux. Comparing these measurements with ground-based RVs from the NEID instrument, which observes the Sun daily using an automated solar telescope, we find a strong relationship between magnetic activity indicators and RV variation, supporting efforts to examine unsigned magnetic flux as a proxy for stellar activity in slowly rotating stars. Detrending against measured unsigned magnetic flux allows us to improve the NEID RV measurements by ∼20% (∼50 cm s−1 in a quadrature sum), yielding an rms scatter of ∼60 cm s−1 over five months. We also explore correlations between individual and averaged spectral line shapes in the NEID spectra and SDO-derived magnetic activity indicators, motivating future studies of these observables. Finally, applying SolAster to archival planetary transits of Venus and Mercury, we demonstrate the ability to recover small amplitude (<50 cm s−1) RV variations in the SDO data by directly measuring the Rossiter–McLaughlin signals.
Objectives Fatigue is a common symptom in primary care. Chronic fatigue research highlights the value of preventing chronicity, but little research has investigated the early, subacute stage of the fatigue trajectory (<3 months). We aimed to examine patient and general practitioner ( GP ) perspectives of subacute fatigue in primary care: (1) to gain a better understanding of fatigue during this stage and (2) to explore how management could be improved. Design A qualitative study design was used. In‐depth, semi‐structured telephone interviews were conducted with 14 patients and 14 GP s (non‐dyadic), recruited from 19 primary care practices. Methods Interview transcripts were thematically analysed. Initially, patient and GP accounts were analysed separately, before themes were merged to identify shared and independent perspectives. Results Three main themes were identified. Within these, subthemes from patients’, GP s’, or shared patient/ GP perspectives emerged. The main themes encompassed the following: (1) Change from normal – the impact of fatigue; (2) The challenges of managing fatigue; and (3) The consultation GP s’ knowledge was often not reflected in patients’ accounts, even for those reporting positive experiences, suggesting knowledge was not effectively translated. Conclusions Some findings, such as impact, mirror those described in chronic fatigue. New insights into early‐stage fatigue management also arose, including mismatches in patient and GP perceptions on negative tests and not re‐presenting. These highlight the need for better communication and shared understanding. GP s should pre‐emptively present a biopsychosocial model of fatigue and keep communication channels open, particularly in the light of negative physiological tests. Statement of contribution What is already known on this subject? Patients with chronic fatigue retrospectively report lack of understanding from GP s in early stage of illness. Little research has investigated the early stages of the fatigue trajectory. What does this study add? Consequences of an episode of subacute fatigue are similar to those reported for CFS . There is discordance between GP s’ positive view of negative tests and patients’ need for explanation of symptoms. The length of appointments is a significant barrier for creating shared understanding.
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