Evidence-based Case Report Research Articles

A Small Effect of Adding Antiviral Agents in Treating Patients with Severe Bell Palsy

In this evidence-based case report, the authors studied the following clinical question: What is the effect of adding antiviral agents to corticosteroids in the treatment of patients with severe or complete Bell palsy? The search yielded 250 original research articles. The 6 randomized trials of these that could be used all reported low-quality data for answering the clinical question; apart from apparent flaws, they did not primarily include patients with severe or complete Bell palsy. Complete functional facial nerve recovery was seen in 75% of the patients receiving prednisolone only and in 83% with additional antiviral treatment. The pooled risk difference of 7% (95% confidence interval, -1% to 15%) results in a number needed to treat of 14 (ie, slightly favors adding an antiviral agent). The authors conclude that although a strong recommendation for adding antiviral agents to corticosteroids to further improve the recovery of patients with severe Bell palsy is precluded by the lack of robust evidence, it should be discussed with the patient.

ARB Compared with non-ARB in Preventing Cardiac Events in High Risk Hypertensive Patients: An Evidence Based Case Report

ARB Compared with non-ARB in Preventing Cardiac Events in High Risk Hypertensive Patients: An Evidence Based Case Report

The Value of a Mandibular Repositioning Appliance for the Treatment of Nonapneic Snoring

In this evidence-based case report, the authors addressed the following clinical question: What is the effect of a mandibular repositioning appliance (MRA) in patients with nonapneic snoring on the snoring loudness, partners' sleep disturbance, and quality of life? The authors retrieved relevant publications from Embase, PubMed, Cinahl, CENTRAL, and Web of Science. They used title and abstract field searches with relevant synonyms for the domain, patients with nonapneic snoring, and for the determinant, MRA. The search yielded 499 records. After selection based on relevance and validity, 2 articles remained for answering the authors' clinical question. The authors pooled the data for the level of snoring. MRA as compared to placebo resulted in a reduction of snoring loudness in 38% of patients with nonapneic snoring and in an improvement of sleep disturbance in 54% of the partners. No effect on quality of life and daytime sleepiness of partners was found. Furthermore, evidence for sustained long-term effects and complete recovery is lacking.

Salvage Laryngectomy After Primary Radiotherapy

In this evidence based case report we addressed the clinical question: which factors predict the occurrence of a pharyngocutaneous fistula after total laryngectomy in patients that already were treated with radiotherapy for a squamous cell carcinoma of the larynx? We searched for relevant synonyms for the domain, being patients earlier treated with radiotherapy for a squamous cell carcinoma of the larynx and having a recurrence for which a salvage total laryngectomy is necessary, with the outcome being the development of a post-operative pharyngocutaneous fistula. We searched for relevant publications in Embase, Pubmed and Web of Science using search terms in title and abstract fields. The search yielded 1764 records, of which three were relevant and valid for our clinical question. Our results show that the absolute risk of a pharyngocutaneous fistula after total laryngectomy in patients earlier treated with radiotherapy for a squamous cell carcinoma of the larynx mainly depends on characteristics and site of the primary tumor. In patients who have a primary glottic laryngeal T1 or T2 tumor the absolute risk of developing a fistula is 11% (95% CI 6; 15%), whereas the risk of developing a fistula in patients with a T3 or T4 extra laryngeal tumor is 35% (95% CI 25; 46%). Other patient and surgical characteristics can however not be ruled out as important prognostic factors since many of them have to date not been studied, e.g. diabetes mellitus, alcohol consumption, smoking, suture materials and surgical technique used.

The diagnostic value of diffusion-weighted magnetic resonance imaging in detecting a residual cholesteatoma

In this evidence-based case report, we address the following clinical question: What is the predictive value of diffusion-weighted magnetic resonance imaging (DW MRI) for detecting a residual cholesteatoma in patients with chronic otitis media with cholesteatoma who have previously undergone a canal-wall-up procedure? We searched for relevant synonyms for the determinant, MRI, and for the outcome, cholesteatoma, and retrieved relevant publications in Embase, PubMed, Cinahl, and Web of Science by using search terms in the title and abstract fields. The search yielded 683 records, of which 11 were relevant and valid for our clinical question. We pooled the data of the MRI findings of the included studies by adding the two-by-two tables of the individual studies. For the eight echo planar imaging (EPI) DW MRI studies, this resulted in a pooled sensitivity, specificity, positive predictive value, and negative predictive value of 68 percent, 87 percent, 81 percent, and 78 percent, respectively. For the three non-echo planar (non-EPI) DW MRI studies, the sensitivity, specificity, positive predictive value, and negative predictive value were 97 percent, 97 percent, 97 percent, and 97 percent, respectively. DW MRI, especially the non-EPI DW MRI, appears to be a rather accurate method, as opposed to a standard second-look operation, for the follow-up of patients who have undergone a canal-wall-up procedure for a chronic otitis media with cholesteatoma and who have no clinical signs of recurrent cholesteatoma.

Intranasal corticosteroid monotherapy in acute rhinosinusitis: An evidence-based case report

In this evidence-based case report we studied the clinical question: Does intranasal corticosteroid (INCS) monotherapy reduce time to recovery in adults with acute noncomplicated rhinosinusitis? The search yielded 490 papers, of which only two were relevant and had a high validity regarding our clinical question.

Is a positive family history predictive for recurrent acute otitis media in children? An evidence-based case report

In this evidence-based case report, we studied the clinical question: Is a positive family history of acute otitis media (AOM) predictive for recurrent acute otitis media (rAOM) in children between zero and two years of age? The search yielded 3178 articles, of which only two were relevant and had a high validity regarding our clinical question. Neither of these two studies provided the final answer to our clinical question because they did not report stratified absolute risks for a positive family history. Fortunately, we were able to study the absolute risks in one of the two studies. The absolute risk of rAOM without distinguishing family history was 33 percent; the risk was 27 percent for children without a family history and 45 percent for children with a positive family history. Family history increases the absolute risk, but not in a way that it will help to predict rAOM accurately.

Non-synostotic deformational plagiocephaly: An evidence-based case report

Summary Objective This article addresses the key questions facing a manual physician when presented with an infant with manifestations of plagiocephaly. The issues highlighted include an evidence-based approach to: long-term health and developmental implications secondary to plagiocephaly; the scope of safe and effective conservative management, including manual therapy; various outcome measures; prognosis; and alternative treatment modalities. Design An evidence-based case report. Setting A chiropractic clinic in the United Kingdom. Subject A 15-week-old male presenting with overt manifestations of plagiocephaly. Methods A systematic database search and critical review of best evidence to answer typical clinical questions that might arise in everyday practice. Results Several systematic reviews, clinical guideline reports, and cohort studies were returned from a systematic database search. Critical review of these articles generated a simple but effective evidence-based approach to the chiropractic management of infantile plagiocephaly. The literature provides the best evidence to consider the aim and scope of treatment. A photographic method of assessment is suggested for baseline recording and as an outcome measure, with a structured approach on when, why and how to refer to an alternative medical provider if chiropractic management proves unsuccessful. Conclusions A simple guideline approach to safe and effective chiropractic management of an infant with plagiocephaly was established, based upon the best available evidence from the literature in conjunction with the paediatric training available to a chiropractor.

Evidence-Based Case Report for Analgesic and Anesthetic Management of a Parturient With Ebstein's Anomaly and Wolff- Parkinson-White Syndrome

Evidence-Based Case Report for Analgesic and Anesthetic Management of a Parturient With Ebstein's Anomaly and Wolff- Parkinson-White Syndrome

Arthroscopic management of acute painful hip following occult subluxation: evidence-based case report

Arthroscopy of the hip joint has gained popularity in the recent past leading to an explosive increase in our knowledge of intra-articular hip pathologies. However, a spectrum of intra-articular hip lesions still needs to be explored to further advance the understanding, diagnosis and treatment of hip pathologies. The orthopedic surgeon occasionally affronts a situation when etiology of traumatic painful hip joint is not vivid and lack of definitive diagnosis prolongs the patient's suffering; however, an elaborate history taking and pragmatic apt arthroscopic intervention can curtail the illness span. Radiological examination generally fails to provide complete diagnosis in hip joints due to compact anatomy of the joint, and a negative report should not be considered as a deterrent for arthroscopic intervention. We report two evidence-based cases to highlight the significance of arthroscopic evaluation and management for occult subluxation of the hip. In both the cases, there was significant and prompt relief of symptoms after arthroscopic debridement.

Evidence-based case report for analgesic and anesthetic management of a parturient with Ebstein’s Anomaly and Wolff-Parkinson-White syndrome

The rare congenital heart defect of Ebstein's anomaly is characterized by downward displacement and elongation of the septal cusp of tricuspid valve. As a result, it is often associated with a thin-walled and poorly contractile right ventricle, an enlarged atrium, tricuspid regurgitation, atrial septal defect with intracardiac shunt, pulmonary hypertension and tachyarrhythmia. Published reports or studies on analgesic and/or anesthetic management of laboring parturients with Ebstein's anomaly are limited. We present an evidence-based case report of the successful management of an obese laboring parturient with Ebstein's anomaly and Wolff-Parkinson-White syndrome under epidural analgesia. We reviewed the literature and present the best evidence available or its lack of, and the reasoning in supporting the choice of the analgesic and anesthetic management.

Chiropractic High-Velocity Low-Amplitude Spinal Manipulation in the Treatment of a Case of Postsurgical Chronic Cauda Equina Syndrome

To present an evidence-based case report on the use of chiropractic high-velocity low-amplitude spinal manipulation in the treatment a postsurgical, chronic cauda equina syndrome patient. A 35-year-old woman presented with complaints of midback pain, low-back pain, buttock pain, saddle anesthesia, and bladder and bowel incontinence, all of 6 months duration. The patient was 6 months post emergency surgery for acute cauda equina syndrome due to lumbar disc herniation. She had been released from neurosurgical care with the current symptoms considered to be residual and nonprogressive. The patient was treated with high-velocity low-amplitude spinal manipulation and ancillary myofascial release. After 4 treatments, the patient reported full resolution of midback, low back, and buttock pain. The patient was seen another 4 times with no improvement in her neurologic symptoms. No adverse effects were noted. This appears to be the first published case of chiropractic high-velocity low-amplitude spinal manipulation being used for a patient with chronic cauda equina syndrome. It seems that this type of spinal manipulation was safe and effective for reducing back pain and had no effect on neurologic deficits in this case.

Treating hypertension: an evidence based case report

A 66 year old retired publican, Mr C, was admitted to hospital with a sudden onset of weakness affecting his right arm and right leg. His wife had been unable to get her husband out of bed earlier that morning. She had noted that his speech was very slurred and initially had thought that he was very confused. The day before he had knocked his head against a car door but had seemed all right at the time. There was no history of transient ischaemic attacks. A diagnosis of essential hypertension had been made four years previously, and angina pectoris had been diagnosed two years previously. Although his general practitioner had prescribed antihypertensive treatment, Mr C did not like the side effects of the drug and stopped taking it three and half years ago. His only other current medication was sublingual glyceryl trinitrate as required. He smoked 20 cigarettes a day, having started at age of 20, and consumed 40 units of alcohol per week. Mr C's father had died of a myocardial infarction at age 69, and his mother had died of a stroke at age 70. He had no siblings. Physical examination revealed power to be reduced at 3/5 in his right arm and right leg with an expressive dysphasia. Tone was increased on the right with a right extensor plantar response and hyperreflexia on the right compared to the left. He was continent and had reasonable sitting balance. A 12 lead electrocardiogram confirmed him to be in sinus rhythm with left …

Evidence based case report Sore throat: diagnostic and therapeutic dilemmas

Evidence based case report Sore throat: diagnostic and therapeutic dilemmas