Idiopathic unilateral paralysis of the facial nerve causing peripheral facial weakness or Bell's palsy occurs between 11and 40 people per 100,000 each year. All age groups are affected but it occurs most commonly in the 30-45 year age group. Fortunately most patients recover completely but about a quarter of them may have permanent facial weakness or paralysis and other sequelae such as hyperacusis, a loss of taste, and an inability to produce tears. Because a viral cause has also been suggested antiviral drugs have been used in treatment. Sullivan, et al. report this large study which was randomized, controlled, and double-blind with defined outcome measures. Patients were recruited within 72 hours of onset of their symptoms and were randomly assigned to treatment with prednisolone, acyclovir, both or placebo. Recovery at nine months was achieved in 94% of patients treated with prednisolone within 72 hours and in 82% of patients not treated with prednisolone. Adding acyclovir did not seem to add any benefit. Several previous studies have suggested the addition of valacyclovir, which is a pro-drug that is nearly clearly completely converted to acyclovir and has substantially increased bioavailability adds benefit. The authors conclude that early treatment with prednisolone significantly increases the chances of complete recovery at 3 and 9 months from Bell's palsy but the addition of acyclovir produces no evidence of benefit. I think the jury is still out on valacylcovir. I believe that I personally would use both drugs since the only down side is the cost of the valacyclovir. (N Engl J Med 2007 October 18; 357;16)

Falls related to osteoporosis cause over 300,000 hip fractures annually in the United States. A 2-year mortality rate of 36% has been observed and many patients never return to their previous level of functioning. Persons who have had one hip fracture are 2.5 times more likely to sustain another one. Few patients who have a hip fracture undergo treatment for osteoporosis. Lyles et al. enrolled over 2000 men and women with a mean age of 74 years and treated them with a new intravenous biophosphonate zoledronic acid (Reclast) initiated within 3 months after hip fracture repair. The treatment resulted in a 35% reduction in new clinical fractures and a 28% reduction in death from any cause as compared with placebo. Zoledronic acid is given by IV infusion once yearly. About 40% of an IV dose is eliminated in the urine but the remaining 60% binds to bone and is released slowly into the systemic circulation. The oral forms of biophosphonate must be taken in an upright position with a full glass of water and at best less than 1% is absorbed and have been reported to cause esophageal injury hence compliance is less than perfect. The IV form can cause flu like symptoms, headaches and myalgia. The cost is substantial, about $1200.00 for one IV infusion but when compared against the oral form isn't that much more. This compelling study should encourage clinicians to initiate biophosphonate treatment in patients who have sustained a previous hip fracture. (N Engl J Med 2007 November 1; 357; 18)

Many over-the-counter treatments are touted as helpful for the common cold. Zinc has been used for 20+ years and studies regarding its efficacy have been mixed. Researchers conducted a literature review of 105 studies. 14 of which were randomized and placebo controlled to evaluate the effects of zinc, either by lozenges, nasal spray, or gel. Only one of these studies found a positive effect of zinc nasal gel on cold symptoms. In spite of this, its use has increased in recent years because it is considered to be a natural remedy without side effects. However intranasal preparations have been associated with some anosmia. The bottom line for me is that it will probably last a week and a half if you take something and 10 days if you don't. (Clin Infect Dis 2007 Sep; 45:569-74)

John J. Mohr, M.D.