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Khan SA, Das PR, Nahar Z, Dewan SMR. An updated review on Guillain-Barré syndrome: Challenges in infection prevention and control in low- and middle-income countries. SAGE Open Med 2024; 12:20503121241239538. [PMID: 38533198 PMCID: PMC10964449 DOI: 10.1177/20503121241239538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 02/28/2024] [Indexed: 03/28/2024] Open
Abstract
Guillain-Barré syndrome is a rare condition that can be potentially life-threatening. Guillain-Barré syndrome does not have a definitive etiological agent. It is a syndrome that can arise from multiple factors, including various infectious diseases and immunizations. The severity of Guillain-Barré syndrome is exacerbated by these variables, especially in low-income and middle-income countries where healthcare systems are already constrained and struggle to meet the demands of other diseases. The primary aim of our article is to comprehensively examine the life-threatening nature and intensity of Guillain-Barré syndrome by assessing its etiology, progression, and prevalence in low- and middle-income nations while also considering global trends. Furthermore, we proposed the implementation of standard and efficacious treatment and diagnostic resources that are readily accessible and successful in affluent nations and should also be readily accessible in impoverished nations without any unnecessary delay. Our study also emphasized the epidemiological data with molecular epidemiological analysis and the utilization of artificial technology in low- and middle-income nations. The goal was to decrease the incidence of Guillain-Barré syndrome cases and facilitate early detection.
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Affiliation(s)
- Sakif Ahamed Khan
- Department of Pharmacy, School of Medicine, University of Asia Pacific, Dhaka, Bangladesh
| | - Proma Rani Das
- Department of Pharmacy, School of Medicine, University of Asia Pacific, Dhaka, Bangladesh
| | - Zabun Nahar
- Department of Pharmacy, School of Medicine, University of Asia Pacific, Dhaka, Bangladesh
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Netto AB, Chandrahasa N, Koshy SS, Taly AB. Hyponatremia in Guillain-Barre Syndrome: A Review of Its Pathophysiology and Management. Can J Neurol Sci 2024:1-11. [PMID: 38361453 DOI: 10.1017/cjn.2024.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Guillain-Barre syndrome (GBS) is the commonest cause of acute polyradiculoneuropathy that requires hospitalization. Many of these patients experience systemic and disease-related complications during its course. Notable among them is hyponatremia. Though recognized for decades, the precise incidence, prevalence, and mechanism of hyponatremia in GBS are not well known. Hyponatremia in GBS patients is associated with more severe in-hospital disease course, prolonged hospitalization, higher mortality, increased costs, and a greater number of other complications in the hospital and worse functional status at 6 months and at 1 year. Though there are several reports of low sodium associated with GBS, many have not included the exact temporal relationship of sodium or its serial values during GBS thereby underestimating the exact incidence, prevalence, and magnitude of the problem. Early detection, close monitoring, and better understanding of the pathophysiology of hyponatremia have therapeutic implications. We review the complexities of the relationship between hyponatremia and GBS with regard to its pathophysiology and treatment.
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Affiliation(s)
- Archana B Netto
- Departments of Neurology, Bangalore Medical College & Research Institute, Bangalore, India
| | - Niveditha Chandrahasa
- Departments of Neurology, Bangalore Medical College & Research Institute, Bangalore, India
| | - Sheril S Koshy
- Departments of Neurology, Bangalore Medical College & Research Institute, Bangalore, India
| | - Arun B Taly
- Departments of Neurology, Bangalore Medical College & Research Institute, Bangalore, India
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A P, Shende V, Pawar S. A Study of Sensory Nerve Conduction in Pre- and Post-immunoglobulin Treatment of Guillain-Barré Syndrome. Cureus 2024; 16:e51673. [PMID: 38313916 PMCID: PMC10838190 DOI: 10.7759/cureus.51673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Guillain-Barré syndrome (GBS) is a condition characterized by acute and progressive weakness that impacts the limbs, facial muscles, and bulbar muscles due to acute polyneuro-radiculopathy. Typically, an infection that results in immune-mediated nerve dysfunction is what starts the disease. Patients often encounter paresthesia or discomfort before progressing to muscle weakness, initially in the lower extremities (which may include some proximal components) and subsequently in the upper extremities. The features of polyneuropathy identified during electrophysiology tests, bolstered by evidence of acquired demyelination in the nerve conduction study (NCS), support the clinical diagnosis of GBS. In peripheral neuropathies, NCS often reveals abnormalities in nerve conduction parameters. A specific pattern observed in the sensory nerve conduction study (SNCS), referred to as "sural sparing," signifies that the sural nerve, located near the calf muscles, remains relatively unaffected compared to other sensory nerves. Very few studies have been conducted to investigate improvements in sensory nerve conduction (SNC) parameters before and after intravenous immunoglobulin (IVIG), offering limited clinical correlation for the recovery and prognosis of the disease. The study aimed to observe the NCS parameters of the sensory nerves in both the upper and lower limbs, before and after the infusion of IVIG. METHODOLOGY This study was an observational investigation conducted in the neurophysiology laboratory of the Physiology Department at a rural medical college in central India. Fifty clinically diagnosed cases of GBS aged between 18 and 60 years were referred from the Department of Medicine to the Physiology Department for conducting the NCS. Basic sociodemographic information, along with clinical history, was collected. Subsequently, the RMS EMG EP Mark-II machine was employed to examine the sensory nerve action potentials (SNAPs), such as amplitude (in mV) and conduction velocity (in ms), of the sensory nerves in both the upper and lower limbs before and after IVIG infusion. The IVIG infusion occurs within one week of clinically diagnosing GBS. Following an initial NCS, a second NCS follow-up study was conducted one week after the IVIG infusion to analyze the changing trend in sensory nerves. RESULTS Upon analysis, no significant correlation was observed between the pre- and post-IVIG SNAPs of the median and ulnar nerves. However, the sural nerve conduction velocity's p-value of 0.033 demonstrated statistical significance, suggesting that the sural nerve is comparatively spared, confirming sural sparing. However, the SNAP of the sensory nerves in GBS patients showed a significant improvement overall, and only NCS quantified the percentage of improvement. CONCLUSION According to the study, the NCS of sensory nerves showed a positive change in the parameters examined before and after the infusion of IVIG. This underscores the timely intervention of GBS with IVIG, and conducting the sensory conduction study diligently will enhance knowledge about the recovery period. Additionally, it supports the treating physician in making informed interventions based on the results post-IVIG infusion. This enhancement in the sensory nerves can only be quantified through NCS.
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Affiliation(s)
- Prashanth A
- Physiology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, IND
| | - Vinod Shende
- Physiology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, IND
| | - Sachin Pawar
- Physiology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, IND
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Zautner AE. Advances in Campylobacter: Molecular Epidemiology, Virulence Factors, Immune Responses and Drug Resistance. Microorganisms 2023; 12:28. [PMID: 38257855 PMCID: PMC10820548 DOI: 10.3390/microorganisms12010028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
Campylobacter infections, caused by Campylobacter jejuni and Campylobacter coli, are a major global concern, particularly as they are the leading cause of bacterial enteritis [...].
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Affiliation(s)
- Andreas E. Zautner
- Institute of Medical Microbiology and Hospital Hygiene, Medical Faculty, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany;
- Health Campus Immunology, Infectiology and Inflammation (GCI), Medical Faculty, Otto-von-Guericke University Magdeburg, 39104 Magdeburg, Germany
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Wachira VK, Farinasso CM, Silva RB, Peixoto HM, de Oliveira MRF. Incidence of Guillain-Barré syndrome in the world between 1985 and 2020: A systematic review. GLOBAL EPIDEMIOLOGY 2023; 5:100098. [PMID: 37638372 PMCID: PMC10445966 DOI: 10.1016/j.gloepi.2023.100098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 01/13/2023] Open
Abstract
Introduction Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating polyradiculoneuropathy that affects the peripheral nervous system. The study aimed to describe the incidence of GBS in the world up to the year 2020. Methods A systematic review was conducted. Searches were done in four databases, PUBMED, EMBASE, EBSCO and Biblioteca virtual em Saude (BVS), and in grey literature and manual search in the reference lists of eligible studies. Results A total of 72 studies were included. The incidence of GBS among the cohort studies varied from 0.30 to 6.08 cases per 100.000 habitants and 0.42 to 6.58 cases per 100.000 person-years. Among the self-controlled studies, the risk incidence ranged from 0.072 to 1 case per 100.000 habitants and 1.73 to 4.30 cases per 100.000 person-years. Conclusions The reported incidence of GBS in the world among the studies included in the review is slightly higher than that reported in previous studies. The highest incidence rates were associated with public health events of international concern.
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Affiliation(s)
- Virginia Kagure Wachira
- Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
| | | | | | - Henry Maia Peixoto
- Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
- Instituto de Avaliação de Tecnologia em Saúde, Porto Alegre, Brazil
| | - Maria Regina Fernandes de Oliveira
- Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
- Instituto de Avaliação de Tecnologia em Saúde, Porto Alegre, Brazil
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Bhat EA, Ali T, Sajjad N, Kumar R, Bron P. Insights into the structure, functional perspective, and pathogenesis of ZIKV: an updated review. Biomed Pharmacother 2023; 165:115175. [PMID: 37473686 DOI: 10.1016/j.biopha.2023.115175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/04/2023] [Accepted: 07/12/2023] [Indexed: 07/22/2023] Open
Abstract
Zika virus (ZIKV) poses a serious threat to the entire world. The rapid spread of ZIKV and recent outbreaks since 2007 have caused worldwide concern about the virus. Diagnosis is complicated because of the cross-reactivity of the virus with other viral antibodies. Currently, the virus is diagnosed by molecular techniques such as RT-PCR and IgM-linked enzyme immunoassays (MAC-ELISA). Recently, outbreaks and epidemics have been caused by ZIKV, and severe clinical symptoms and congenital malformations have also been associated with the virus. Although most ZIKV infections present with a subclinical or moderate flu-like course of illness, severe symptoms such as Guillain-Barre syndrome in adults and microcephaly in children of infected mothers have also been reported. Because there is no reliable cure for ZIKV and no vaccine is available, the public health response has focused primarily on preventing infection, particularly in pregnant women. A comprehensive approach is urgently needed to combat this infection and stop its spread and imminent threat. In view of this, this review aims to present the current structural and functional viewpoints, structure, etiology, clinical prognosis, and measures to prevent this transmission based on the literature and current knowledge. Moreover, we provide thorough description of the current understanding about ZIKV interaction with receptors, and a comparative examination of its similarities and differences with other viruses.
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Affiliation(s)
- Eijaz Ahmed Bhat
- CBS (Centre de Biologie Structurale), Univ. Montpellier, CNRS, INSERM, 29 rue de Navacelles, 34090 Montpellier, France.
| | - Tufail Ali
- Department of Biosciences, Jamia Millia Islamia, Jamia Nagar, New Delhi 110025, India
| | - Nasreena Sajjad
- Department of Biochemistry, University of Kashmir, Hazratbal, Jammu and Kashmir 190006, India
| | - Rohit Kumar
- Department of Plant Molecular Biology, University of Delhi South Campus, New Delhi 110021, India
| | - Patrick Bron
- CBS (Centre de Biologie Structurale), Univ. Montpellier, CNRS, INSERM, 29 rue de Navacelles, 34090 Montpellier, France.
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Sharma V, Chhabra T, Singh TG. Correlation of covid-19 and Guillain-Barré syndrome: A Mechanistic Perspective. OBESITY MEDICINE 2023; 40:100493. [PMID: 37131407 PMCID: PMC10091783 DOI: 10.1016/j.obmed.2023.100493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/03/2023] [Accepted: 04/12/2023] [Indexed: 05/04/2023]
Abstract
Aims Coronaviruses, SARS-CoV-2 particles are spherical and have proteins called spikes that stick out on the surface. COVID-19 most commonly affects the respiratory system, but various clinical manifestations on coronavirus have revealed their potential neurotropism. The neuroinvasive affinity of Coronavirus infections has been reported nearly for all the β Coronavirus infections, including MERS-CoV, SARS-CoV, HCoV-OC43 and HEV. Coronavirus invasion occurs through hypoxia injury, immune injury, ACE2, and direct infection. The pathophysiology of SARS-CoV-2 and other human Coronaviruses reveals the possible mechanisms of neurodegeneration. Methods A systematic literature review carried out from various search engines like Scopus, PubMed, Medline, and Elsevier for investigating the therapeutic perspective of association between Covid-19 and Guillain-Barré syndrome. Results SARS-CoV-2 uses angiotensin-converting enzyme 2 as its entry receptor and enters the central nervous system through a Blood-brain barrier constituted of inflammatory mediators, direct infection of the endothelial cells, or endothelial injury. Guillain-Barré syndrome is an autoimmune disease that injures and attacks the nerves in the peripheral nervous system. Studies suggest that the virus can infect peripheral neurons to cause direct damage through various mechanisms, including direct damage by cytokine-related injury, ACE2 receptors, and the sequelae of hypoxia. Conclusion we have discussed the possible mechanisms between neuroinvasion of SARs-cov2 and Guillain-barre syndrome.
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Affiliation(s)
- Veerta Sharma
- Chitkara College of Pharmacy, Chitkara University, Punjab, 140401, India
| | - Tarun Chhabra
- Chitkara College of Pharmacy, Chitkara University, Punjab, 140401, India
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Landscape of Guillain-Barré Syndrome Interventional Clinical Trials. J Clin Neuromuscul Dis 2023; 24:119-129. [PMID: 36809199 DOI: 10.1097/cnd.0000000000000441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
INTRODUCTION Guillain-Barré syndrome (GBS) is an immune-mediated polyradiculoneuropathy that remains a debilitating disease despite medical treatment. Numerous challenges still exist, including the development of disease-modifying therapies that can improve prognosis, particularly in patients with poor prognostic outcomes. In this study, we explored clinical trials related to GBS, analyzed the trial characteristics, suggested some ideas for improvement, and discussed recent advances. METHODS On December 30, 2021, the authors searched ClinicalTrials.gov for all interventional and therapeutic clinical trials related to GBS, without any restrictions on the date or location. Trial characteristics including trial duration, location, phase, sample size, and publications were retrieved and analyzed. RESULTS Twenty-one trials fulfilled the selection criteria. Clinical trials were conducted in 11 different countries, most of them occurring in Asia. On average, the trial duration across the phases was around 2 years. About two-thirds of trials were completed, and 39% of trials were in the early phases (1 and 2). Only 24% of all trials and 60% of completed trials have publications in this study. CONCLUSIONS The study revealed a low number of trials, lack of geographic diversity, scanty enrollment of patients, and paucity of clinical trial duration and publications regarding GBS clinical trials. Optimization of GBS trials is fundamental to achieving effective therapies for this disease.
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Carpenter K, Iqbal A, Singh R, Deepika K, Koritala T, Jain N, Alur RS, Adhikari R, Mellekate VS. COVID-19 Infection and Guillain-Barre Syndrome: A Case Series. Cureus 2022; 14:e21998. [PMID: 35282522 PMCID: PMC8906908 DOI: 10.7759/cureus.21998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2022] [Indexed: 12/16/2022] Open
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Malik A, Brudvig JM, Gadsden BJ, Ethridge AD, Mansfield LS. Campylobacter jejuni induces autoimmune peripheral neuropathy via Sialoadhesin and Interleukin-4 axes. Gut Microbes 2022; 14:2064706. [PMID: 35442154 PMCID: PMC9037470 DOI: 10.1080/19490976.2022.2064706] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/29/2022] [Indexed: 02/04/2023] Open
Abstract
Campylobacter jejuni is a leading cause of gastroenteritis that has been causally linked with development of the autoimmune peripheral neuropathy Guillain Barré Syndrome (GBS). Previously, we showed that C. jejuni isolates from human enteritis patients induced Type1/17-cytokine dependent colitis in interleukin-10 (IL-10)-/- mice, while isolates from GBS patients colonized these mice without colitis but instead induced autoantibodies that cross-reacted with the sialylated oligosaccharide motifs on the LOS of GBS-associated C. jejuni and the peripheral nerve gangliosides. We show here that infection of IL-10-/- mice with the GBS but not the colitis isolate led to sciatic nerve inflammation and abnormal gait and hind limb movements, with character and timing consistent with this syndrome in humans. Autoantibody responses and associated nerve histologic changes were dependent on IL-4 production by CD4 T cells. We further show that Siglec-1 served as a central antigen presenting cell receptor mediating the uptake of the GBS isolates via interaction with the sialylated oligosaccharide motifs found specifically on the LOS of GBS-associated C. jejuni, and the ensuing T cell differentiation and autoantibody elicitation. Sialylated oligosaccharide motifs on the LOS of GBS-associated C. jejuni therefore acted as both the Siglec-1-ligand for phagocytosis, as well as the epitope for autoimmunity. Overall, we present a mouse model of an autoimmune disease induced directly by a bacterium that is dependent upon Siglec-1 and IL-4. We also demonstrate the negative regulatory role of IL-10 in C. jejuni induced autoimmunity and provide IL-4 and Siglec-1 blockade as potential therapeutic interventions against GBS.
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Affiliation(s)
- Ankit Malik
- Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, MI, USA
- Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI, USA
| | - Jean M. Brudvig
- Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, MI, USA
- Comparative Medicine and Integrative Biology Program, Michigan State University, East Lansing, MIUSA
| | - Barbie J. Gadsden
- Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, MI, USA
- Comparative Medicine and Integrative Biology Program, Michigan State University, East Lansing, MIUSA
| | - Alexander D. Ethridge
- Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, MI, USA
- Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI, USA
| | - Linda S. Mansfield
- Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, MI, USA
- Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI, USA
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Morales-Ruiz V, Juárez-Vaquera VH, Rosetti-Sciutto M, Sánchez-Muñoz F, Adalid-Peralta L. Efficacy of intravenous immunoglobulin in autoimmune neurological diseases. Literature systematic review and meta-analysis. Autoimmun Rev 2021; 21:103019. [PMID: 34920107 DOI: 10.1016/j.autrev.2021.103019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/12/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Corticosteroids are the first-line treatment for several common autoimmune neurological diseases. Other therapeutic approaches, including intravenous immunoglobulin (IVIg) and plasmapheresis, have shown mixed results in patient improvement. OBJECTIVE To compare the efficacy of IVIg administration with that of corticosteroids, plasmapheresis, and placebo in autoimmune neurological diseases like Guillain-Barré syndrome, myasthenia gravis, chronic inflammatory demyelinating polyneuropathy, optic neuritis, and multiple sclerosis. METHODS A systematic review was performed on the databases PubMed, MEDLINE, Embase, and Cochrane. Controlled, randomized studies comparing the efficacy of IVIg with placebo, plasmapheresis, and/or glucocorticoid administration were selected. Only studies reporting the number of patients who improved after treatment were included, irrespective of language or publication year. In total, 23 reports were included in the meta-analysis study. RESULTS Our meta-analysis showed a beneficial effect of IVIg administration on patient improvement over placebo (OR = 2.79, CI [95%] = 1.40-5.55, P = 0.01). Meanwhile, IVIg administration showed virtually identical effects to plasmapheresis (OR = 0.83, CI [95%] = 0.45-1.55, P < 0.01). Finally, no significant differences were found in the efficacy of IVIg and glucocorticoid administration (OR = 0.98, Cl [95%] = 0.58-1.68, P = 0.13). CONCLUSION IVIg can be regarded as a viable therapeutic approach, either as a first- or second-line therapy, and as an adjuvant therapy for autoimmune neurological diseases.
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Affiliation(s)
- Valeria Morales-Ruiz
- Unidad Periférica para el Estudio de la Neuroinflamación en Patologías Neurológicas del Instituto de Investigaciones Biomédicas de la UNAM en el Instituto Nacional de Neurología y Neurocirugía, Insurgentes Sur 3877, Col. La Fama, Ciudad de México 14269, Mexico; Posgrado en Ciencias Biológicas, Universidad Nacional Autónoma de México, Av. Ciudad Universitaria 3000, Coyoacán, Ciudad de México 04510, Mexico
| | - Víctor Hugo Juárez-Vaquera
- Unidad Periférica para el Estudio de la Neuroinflamación en Patologías Neurológicas del Instituto de Investigaciones Biomédicas de la UNAM en el Instituto Nacional de Neurología y Neurocirugía, Insurgentes Sur 3877, Col. La Fama, Ciudad de México 14269, Mexico
| | - Marcos Rosetti-Sciutto
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico; Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, México-Xochimilco 101, Col. Huipulco, Ciudad de México 14370, Mexico
| | - Fausto Sánchez-Muñoz
- Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Col. Belisario Domínguez Secc. 16, Ciudad de México 14080, Mexico
| | - Laura Adalid-Peralta
- Unidad Periférica para el Estudio de la Neuroinflamación en Patologías Neurológicas del Instituto de Investigaciones Biomédicas de la UNAM en el Instituto Nacional de Neurología y Neurocirugía, Insurgentes Sur 3877, Col. La Fama, Ciudad de México 14269, Mexico; Instituto Nacional de Neurología y Neurocirugía, Insurgentes Sur 3877, Col. La Fama, Ciudad de México 14269, Mexico.
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Zang X, Huang P, Li J, Jiao X, Huang J. Genomic Relatedness, Antibiotic Resistance and Virulence Traits of Campylobacter jejuni HS19 Isolates From Cattle in China Indicate Pathogenic Potential. Front Microbiol 2021; 12:783750. [PMID: 34956150 PMCID: PMC8698899 DOI: 10.3389/fmicb.2021.783750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 11/08/2021] [Indexed: 11/30/2022] Open
Abstract
Although campylobacteriosis is a zoonotic foodborne illness, high-risk isolates from animal sources are rarely characterized, and the pathogenic potential of zoonotic strains remains an obstacle to effective intervention against human infection. HS19 has been acknowledged as a maker serotype represented by Campylobacter jejuni (C. jejuni) isolates from patients with post-infection Guillain-Barré syndrome (GBS), which is circulation in developed countries. However, a previous serotype epidemiological study of C. jejuni isolates in an animal population revealed that HS19 was also prevalent in isolates from cattle in China. In this study, to investigate the hazardous potential of zoonotic strains, 14 HS19 isolates from cattle were systematically characterized both by genotype and phenotype. The results showed that all of these cattle isolates belonged to the ST-22 complex, a high-risk lineage represented by 77.2% HS19 clinical isolates from patients worldwide in the PubMLST database, indicating that the ST-22 complex is the prominent clonal complex of HS19 isolates, as well as the possibility of clonal spread of HS19 isolates across different regions and hosts. Nevertheless, these cattle strains clustered closely with the HS19 isolates from patients, suggesting a remarkable phylogenetic relatedness and genomic similarity. Importantly, both tetracycline genes tet(O) and gyrA (T86I) reached a higher proportional representation among the cattle isolates than among the human clinical isolates. A worrying level of multidrug resistance (MDR) was observed in all the cattle isolates, and two MDR profiles of the cattle isolates also existed in human clinical isolates. Notably, although shared with the same serotype HS19 and sequence type ST-22, 35.7% of cattle isolates induced severe gastrointestinal pathology in the IL-10–/– C57BL/6 mice model, indicating that some bacteria could change due to host adaptation to induce a disease epidemic, thus the associated genetic elements deserve further investigation. In this study, HS19 isolates from cattle were first characterized by a systematic evaluation of bacterial genomics and in vitro virulence, which improved our understanding of the potential zoonotic hazard from food animal isolates with high-risk serotypes, and provided critical information for the development of targeted C. jejuni mitigation strategies.
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Affiliation(s)
- Xiaoqi Zang
- Jiangsu Key Laboratory of Zoonosis, Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou University, Yangzhou, China
| | - Pingyu Huang
- Key Laboratory of Prevention and Control of Biological Hazard Factors (Animal Origin) for Agrifood Safety and Quality, Ministry of Agriculture of China, Yangzhou, China
| | - Jie Li
- Jiangsu Key Laboratory of Zoonosis, Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou University, Yangzhou, China
| | - Xinan Jiao
- Joint International Research Laboratory of Agriculture and Agri-Product Safety, Ministry of Education of China, Yangzhou, China
| | - Jinlin Huang
- Jiangsu Key Laboratory of Zoonosis, Jiangsu Co-Innovation Center for Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou University, Yangzhou, China
- Key Laboratory of Prevention and Control of Biological Hazard Factors (Animal Origin) for Agrifood Safety and Quality, Ministry of Agriculture of China, Yangzhou, China
- Joint International Research Laboratory of Agriculture and Agri-Product Safety, Ministry of Education of China, Yangzhou, China
- *Correspondence: Jinlin Huang,
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Sri Dewi Untari NK, Kusumastuti K, Suryokusumo G, Sudiana IK. Protective Effect of Hyperbaric Oxygen Treatment on Axon Degeneration after Acute Motor Axonal Neuropathy. Autoimmune Dis 2021; 2021:6627779. [PMID: 34790416 PMCID: PMC8592739 DOI: 10.1155/2021/6627779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 09/22/2021] [Accepted: 10/04/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Acute motor axonal neuropathy (AMAN) is a disease that leads to acute flaccid paralysis and may result from the binding of antibody and antigen to the spinal cord. The objective of this study is to evaluate the protective effect of hyperbaric oxygen treatment (HBOT) on axon degeneration of the spinal cord and sciatic nerve of the AMAN model rabbit. Axonal degeneration was assessed by evaluating glutathione (GSH) activity, interleukin-1β (IL-1β) expression, and clinical and histopathological features. METHODS Twenty-one New Zealand rabbits were divided into three groups. The treatment group was exposed to 100% oxygen at 2.4 ATA 90 minutes for 10 days at a decompression rate of 2.9 pounds per square inch/minute. GSH level was evaluated using an enzyme-linked immune-sorbent assay. An expression of IL-1β in the spinal cord was determined by immunohistochemistry. Clinical appearances were done by motor scale and body weight. Histological features observed neuronal swelling and inflammatory infiltration in the sagittal lumbar region and the undulation of the longitudinal sciatic nerve. RESULTS Rabbits exposed to HBO had high GSH activity levels (p < 0.05) but unexpectedly had high IL1β expression (p > 0.05). In addition, the HBO-exposed rabbits had a better degree of undulation, the size of neuronal swelling was smaller, the number of macrophages was higher, and motor function was better than the AMAN model rabbits (p < 0.05). CONCLUSIONS These findings indicate that HBO therapy can decrease axon degeneration by triggering GSH activity, increasing IL-1β level, and restoring tissues and motor status. In conclusion, HBO has a protective effect on axon degeneration of the spinal cord and sciatic nerve of the AMAN model rabbit.
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Affiliation(s)
- Ni Komang Sri Dewi Untari
- Department of Hyperbaric, Drs. Med. Rijadi S. Phys. Naval Health Institute, Surabaya, Indonesia
- Department of Neurology, Faculty of Medicine, Hang Tuah University, Surabaya, Indonesia
- Department of Neurology, Dr. Ramelan Navy Hospital, Surabaya, Indonesia
- Hyperbaric Medicine, Basic Medical Science, Airlangga University, Surabaya, Indonesia
| | - Kurnia Kusumastuti
- Department of Neurology, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Guritno Suryokusumo
- Department of Hyperbaric, Faculty of Medicine, Pembangunan Nasional University, Jakarta, Indonesia
| | - I Ketut Sudiana
- Department of Pathology Anatomy, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
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14
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Sobue T, Fukuda H, Matsumoto T, Lee B, Ito S, Iwata S. The background occurrence of selected clinical conditions prior to the start of an extensive national vaccination program in Japan. PLoS One 2021; 16:e0256379. [PMID: 34437567 PMCID: PMC8389412 DOI: 10.1371/journal.pone.0256379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/04/2021] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic caused by SARS-CoV-2 has now affected tens of millions of people globally. It is the hope that vaccines against SARS-CoV-2 will deliver a comprehensive solution to this global pandemic; however, this will require extensive national vaccination programs. Ultimately, clinical conditions and even sudden unexplained death will occur around the time of vaccination, thus a distinction needs to be made between events that are causally related to the vaccine or temporally related to vaccination. This study aimed to estimate the background occurrence of 43 clinical conditions in the Japanese population. METHODS A retrospective cohort study was conducted from 2013 to 2019 using data from two large healthcare claims databases (MDV and JMDC) in Japan. The estimated number of new cases and incidence were calculated based on the actual number of new cases identified in the databases. The PubMed and Ichushi-web databases, as well as grey literature such as guidelines and government statistics, were also searched to identify any publications related to incidence of these conditions in Japan. RESULTS AND CONCLUSION The estimates of the number of total cases and incidence were similar for the MDV and JMDC databases for some diseases. In addition, some estimates were similar to those in the scientific literature. For example, from the MDV and JMDC databases, estimates of incidence of confirmed Bell's palsy in 2019 were 41.7 and 47.9 cases per 100,000 population per year, respectively. These estimates were of the same order from the scientific publication. Determining whether clinical conditions occurring around the time of vaccination are causally or only temporally related to vaccination will be critical for public health decision makers as well as for the general public. Comparison of background occurrence at the population level may provide some additional objective evidence for the evaluation of temporality or causality.
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Affiliation(s)
- Tomotaka Sobue
- Division of Environmental Medicine and Population Science, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Haruhisa Fukuda
- Department of Health Care Administration and Management, Kyushu University, Fukuoka, Japan
| | - Tetsuya Matsumoto
- Department of Infectious Diseases, International University of Health and Welfare, Narita, Japan
| | - Bennett Lee
- Vaccine Medical Affairs, Pfizer Japan Inc., Tokyo, Japan
| | - Shuhei Ito
- Vaccine Medical Affairs, Pfizer Japan Inc., Tokyo, Japan
| | - Satoshi Iwata
- Department of Infectious Diseases, National Cancer Center Hospital, Tokyo, Japan
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
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15
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Lawley KS, Rech RR, Elenwa F, Han G, Perez Gomez AA, Amstalden K, Welsh CJ, Young CR, Threadgill DW, Brinkmeyer-Langford CL. Host genetic diversity drives variable central nervous system lesion distribution in chronic phase of Theiler's Murine Encephalomyelitis Virus (TMEV) infection. PLoS One 2021; 16:e0256370. [PMID: 34415947 PMCID: PMC8378701 DOI: 10.1371/journal.pone.0256370] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/04/2021] [Indexed: 02/06/2023] Open
Abstract
Host genetic background is a significant driver of the variability in neurological responses to viral infection. Here, we leverage the genetically diverse Collaborative Cross (CC) mouse resource to better understand how chronic infection by Theiler's Murine Encephalomyelitis Virus (TMEV) elicits diverse clinical and morphologic changes in the central nervous system (CNS). We characterized the TMEV-induced clinical phenotype responses, and associated lesion distributions in the CNS, in six CC mouse strains over a 90 day infection period. We observed varying degrees of motor impairment in these strains, as measured by delayed righting reflex, paresis, paralysis, seizures, limb clasping, ruffling, and encephalitis phenotypes. All strains developed neuroparenchymal necrosis and mineralization in the brain, primarily localized to the hippocampal regions. Two of the six strains presented with axonal degeneration with myelin loss of the nerve roots in the lumbar spinal cord. Moreover, we statistically correlated lesion distribution with overall frequencies of clinical phenotypes and phenotype progression to better understand how and where TMEV targets the CNS, based on genetic background. Specifically, we assessed lesion distribution in relation to the clinical progression of these phenotypes from early to late TMEV disease, finding significant relationships between progression and lesion distribution. Finally, we identified quantitative trait loci associated with frequency of lesions in a particular brain region, revealing several loci of interest for future study: lysosomal trafficking regulator (Lyst) and nidogen 1 (Nid1). Together, these results indicate that the genetic background influences the type and severity of clinical phenotypes, phenotypic resilience to TMEV, and the lesion distribution across strains.
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Affiliation(s)
- Koedi S. Lawley
- Department of Veterinary Integrative Biosciences, College Station, TX, United States of America
- College of Veterinary Medicine and Biomedical Sciences, College Station, TX, United States of America
- Texas A&M University, College Station, TX, United States of America
- * E-mail:
| | - Raquel R. Rech
- College of Veterinary Medicine and Biomedical Sciences, College Station, TX, United States of America
- Texas A&M University, College Station, TX, United States of America
- Department of Veterinary Pathobiology, College Station, TX, United States of America
| | - Faith Elenwa
- Texas A&M University, College Station, TX, United States of America
- Department of Epidemiology and Biostatistics, College Station, TX, United States of America
- School of Public Health, College Station, TX, United States of America
| | - Gang Han
- Texas A&M University, College Station, TX, United States of America
- Department of Epidemiology and Biostatistics, College Station, TX, United States of America
- School of Public Health, College Station, TX, United States of America
| | - Aracely A. Perez Gomez
- Department of Veterinary Integrative Biosciences, College Station, TX, United States of America
- College of Veterinary Medicine and Biomedical Sciences, College Station, TX, United States of America
- Texas A&M University, College Station, TX, United States of America
| | - Katia Amstalden
- Department of Veterinary Integrative Biosciences, College Station, TX, United States of America
- College of Veterinary Medicine and Biomedical Sciences, College Station, TX, United States of America
- Texas A&M University, College Station, TX, United States of America
| | - C. Jane Welsh
- Department of Veterinary Integrative Biosciences, College Station, TX, United States of America
- College of Veterinary Medicine and Biomedical Sciences, College Station, TX, United States of America
- Texas A&M University, College Station, TX, United States of America
- Department of Veterinary Pathobiology, College Station, TX, United States of America
- Texas A&M Institute for Neuroscience, College Station, TX, United States of America
| | - Colin R. Young
- Department of Veterinary Integrative Biosciences, College Station, TX, United States of America
- College of Veterinary Medicine and Biomedical Sciences, College Station, TX, United States of America
- Texas A&M University, College Station, TX, United States of America
| | - David W. Threadgill
- Texas A&M University, College Station, TX, United States of America
- Department of Molecular and Cellular Medicine, College Station, TX, United States of America
| | - Candice L. Brinkmeyer-Langford
- Department of Veterinary Integrative Biosciences, College Station, TX, United States of America
- College of Veterinary Medicine and Biomedical Sciences, College Station, TX, United States of America
- Texas A&M University, College Station, TX, United States of America
- Texas A&M Institute for Neuroscience, College Station, TX, United States of America
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16
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Ten years evaluation of epidemiology- and mortality-related factors in adults and children with Guillain-Barré syndrome in the north of Iran. Neurol Sci 2021; 43:1929-1938. [PMID: 34403028 PMCID: PMC8369876 DOI: 10.1007/s10072-021-05562-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 08/08/2021] [Indexed: 12/03/2022]
Abstract
Background Guillain-Barré syndrome (GBS) is the main cause of acute and subacute flaccid paralysis in western nations since the eradication of poliomyelitis. Objective The aim of this study is to investigate epidemiology and mortality characteristics of GBS in the north of Iran. Material and methods In this study, the hospital information system (HIS) was used to access each patient’s information. The final 174 cases were examined in terms of age, sex, place of residence, the year of referral, the month of referral, the season of referral, client city, accompanying background disease, and the type of GBS. Results The mean incidence rate in Guilan province was about 0.69 in 100,000 persons, and the case fatality rate was 10.34%. The most reported type of GBS was AIDP (33.90%), and the most common symptom was upper and lower limbs paresis in 65 cases (37%). Respiratory distress (P = < 0.001), complications during hospitalization (P = 0.0001), and ICU requirement (P = 0.001) were significantly higher in dead patients. Conclusion In this study, the incidence of GBS was higher in men than women and the highest number of cases was in the age group of 60 to 75 years. The significant point was the high-case fatality rate in Guilan province compared to the previous studies. The complications during hospitalization such as respiratory distress, ICU requirement, and underlying disease had a significant relation with the fatality of GBS. Supplementary Information The online version contains supplementary material available at 10.1007/s10072-021-05562-y.
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17
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Shabani Z. Demyelination as a result of an immune response in patients with COVID-19. Acta Neurol Belg 2021; 121:859-866. [PMID: 33934300 PMCID: PMC8088756 DOI: 10.1007/s13760-021-01691-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/23/2021] [Indexed: 01/08/2023]
Abstract
The coronavirus disease of 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus-2 (SARS CoV-2), that already appeared as a global pandemic. Presentation of the disease often includes upper respiratory symptoms like dry cough, dyspnea, chest pain, and rhinorrhea that can develop to respiratory failure, needing intubation. Furthermore, the occurrence of acute and subacute neurological manifestations such as stroke, encephalitis, headache, and seizures are frequently stated in patients with COVID-19. One of the reported neurological complications of severe COVID-19 is the demolition of the myelin sheath. Indeed, the complex immunological dysfunction provides a substrate for the development of demyelination. Nevertheless, few published reports in the literature describe demyelination in subjects with COVID-19. In this short narrative review, we discuss probable pathological mechanisms that may trigger demyelination in patients with SARS-CoV-2 infection and summarize the clinical evidence, confirming SARS-CoV-2 condition as a risk factor for the destruction of myelin.
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Affiliation(s)
- Zahra Shabani
- Department of Neurosciences, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
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18
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Syczewska M, Święcicka A, Szczerbik E, Kalinowska M, Dunin-Wąsowicz D, Łukowicz M. Types of gait deviations in children and adolescents with Guillain-Barre syndrome identified using cluster analysis. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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19
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Travi G, Rossotti R, Merli M, D'Amico F, Chiappetta S, Giussani G, Panariello A, Corradin M, Vecchi M, Raimondi A, Baiguera C, Nocita B, Epis OM, Tarsia P, Galbiati F, Colombo F, Fumagalli R, Scaglione F, Moreno M, Percudani ME, Agostoni EC, Puoti M. Neurological manifestations in patients hospitalized with COVID-19: A retrospective analysis from a large cohort in Northern Italy. Eur J Neurosci 2021; 53:2912-2922. [PMID: 33624380 PMCID: PMC8013571 DOI: 10.1111/ejn.15159] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/09/2021] [Accepted: 02/16/2021] [Indexed: 12/29/2022]
Abstract
SARS‐CoV2 infection is a systemic disease that may involve multiple organs, including the central nervous system (CNS). Aims of our study are to describe prevalence and clinical features of neurological manifestations, mortality and hospital discharge in subjects hospitalized with COVID‐19. All individuals admitted for to our hospital COVID‐19 were retrospectively included. Patients were classified according to the symptoms at hospital entry in (1) isolated respiratory, (2) combined respiratory and neurologic, (3) isolated neurologic and (4) stroke manifestations. Descriptive statistics and nonparametric tests to compare the groups were calculated. Kaplan Meier probability curves and multivariable Cox regression models for survival and hospital discharge were applied. The analysis included 901 patients: 42.6% showed a severe or critical disease with an overall mortality of 21.2%. At least one neurological symptom or disease was observed in 30.2% of subjects ranging from dysgeusia/anosmia (9.1%) to postinfective diseases (0.8%). Patients with respiratory symptoms experienced a more severe disease and a higher in‐hospital mortality compared to those who showed only neurologic symptoms. Kaplan Meier estimates displayed a statistically significant different survival among groups (p = 0.003): subjects with stroke had the worst. After adjusting for risk factors such as age, sex and comorbidity, individuals with isolated neurologic manifestations exhibited a better survival (aHR 0.398, 95% CI [0.206, 0.769], p = 0.006). Neurologic manifestations in COVID‐19 are common but heterogeneous and mortality in subjects with isolated neurologic manifestations seems lower than in those with respiratory symptoms.
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Affiliation(s)
- Giovanna Travi
- Department of Infectious Diseases Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Roberto Rossotti
- Department of Infectious Diseases Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marco Merli
- Department of Infectious Diseases Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Federico D'Amico
- Department of Infectious Diseases Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Stefania Chiappetta
- Department of Infectious Diseases Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giuditta Giussani
- Department of Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Adelaide Panariello
- Department of Mental Health and Addiction Services, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Matteo Corradin
- Healthcare Management Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marta Vecchi
- Department of Infectious Diseases Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alessandro Raimondi
- Department of Infectious Diseases Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Chiara Baiguera
- Department of Infectious Diseases Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Benedetta Nocita
- Department of Internal Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Paolo Tarsia
- Pneumology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Filippo Galbiati
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Fabrizio Colombo
- Department of Internal Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Roberto Fumagalli
- Department of Anesthesia and Critical Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Francesco Scaglione
- Chemical-Clinical and Microbiological Analysis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Mauro Moreno
- Healthcare Management Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Mauro Emilio Percudani
- Department of Mental Health and Addiction Services, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Elio Clemente Agostoni
- Department of Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Massimo Puoti
- Department of Infectious Diseases Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
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20
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Twitter vs. Zika—The role of social media in epidemic outbreaks surveillance. HEALTH POLICY AND TECHNOLOGY 2021. [DOI: 10.1016/j.hlpt.2020.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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21
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Ning P, Yang B, Yang X, Huang H, Shen Q, Zhao Q, Xie D, Lu H, Xu Y. Lymphocyte-based ratios for predicting respiratory failure in Guillain-Barré syndrome. J Neuroimmunol 2021; 353:577504. [PMID: 33548620 DOI: 10.1016/j.jneuroim.2021.577504] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/24/2021] [Accepted: 01/25/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE Up to 20-30% of patients with Guillain-Barré syndrome (GBS) suffer serious clinical manifestations such as respiratory failure. We aim to determine whether two new prognostic biomarkers, the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), could reliably predict respiratory failure in GBS.we MATERIALS AND METHODS: Data from 426 patients diagnosed at our center with GBS between January 2015 and July 2019 were retrospectively analyzed. Data were collected from the hospital database. Logistic regression and receiver operating characteristic curves were used to examine whether NLR alone, PLR alone or the combination, as measured at admission, could predict respiratory failure during hospitalization. Nomograms for predicting respiratory failure in GBS individuals were established, and predictive accuracy was evaluated using Harrell's concordance index (C-index). RESULTS A total of 74 (17%) patients developed respiratory failure during hospitalization, and this was predicted independently by neutrophil count, NLR, PLR, and a combined "NLR-PLR" index, with the combined index performing best. The C-index of nomograms was 0.952 (95%CI 0.930-0.974) when NLR-PLR was included, or 0.933 (95%CI 0.911-0.955) when it was excluded. CONCLUSIONS The prognostic biomarkers NLR and PLR may be independent predictors of respiratory failure in GBS. Combining the two indices may be more effective than either one on its own.
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Affiliation(s)
- Pingping Ning
- Department of Neurology, West China Hospital, Sichuan University, 37, Guo Xue Xiang, Chengdu, Sichuan Province 610041, China
| | - Baiyuan Yang
- Department of Neurology, Seventh People's Hospital of Chengdu, No. 1, Twelve Middle Street, Wuhou District, Chengdu, Sichuan Province 610041, China
| | - Xinglong Yang
- Department of Geriatric Neurology, First Affiliated Hospital of Kunming Medical University, 295, Xi Change Road, Kunming, Yunnan Province 650032, China
| | - Hongyan Huang
- Department of Neurology, West China Hospital, Sichuan University, 37, Guo Xue Xiang, Chengdu, Sichuan Province 610041, China
| | - Qiuyan Shen
- Department of Neurology, West China Hospital, Sichuan University, 37, Guo Xue Xiang, Chengdu, Sichuan Province 610041, China
| | - Quanzhen Zhao
- Department of Neurology, West China Hospital, Sichuan University, 37, Guo Xue Xiang, Chengdu, Sichuan Province 610041, China
| | - Dan Xie
- Department of Neurology, West China Hospital, Sichuan University, 37, Guo Xue Xiang, Chengdu, Sichuan Province 610041, China
| | - Haitao Lu
- Department of Neurology, West China Hospital, Sichuan University, 37, Guo Xue Xiang, Chengdu, Sichuan Province 610041, China
| | - Yanming Xu
- Department of Neurology, West China Hospital, Sichuan University, 37, Guo Xue Xiang, Chengdu, Sichuan Province 610041, China.
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22
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Wachira VK, Nascimento GL, Peixoto HM, de Oliveira MRF. Burden of Disease of Guillain-Barré Syndrome in Brazil before and during the Zika virus epidemic 2014-2016. Trop Med Int Health 2020; 26:66-81. [PMID: 33151584 DOI: 10.1111/tmi.13508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To estimate the burden of disease of Guillain-Barré syndrome (GBS) in Brazil in 2014, 1 year before the Zika virus epidemic, and in 2015 and 2016 during the epidemic. METHODS The burden of disease of GBS was estimated using the summary measure of population health: Disability Adjusted Life Years (DALY), that combines both mortality (Years of Life Lost YLLs) and morbidity (Years Lived with Disability) components. The study population was composed of GBS hospitalised cases and deaths from the information systems of the Brazilian Unified Health System. RESULTS The GBS incidence rate in 2014, 2015 and 2016 was 0.74, 0.96, 1.02/100 000 respectively, and the mortality rate in the same period was 0.08, 0.009 and 0.11/100 000 habitants. The DALYs calculated using the point estimate of GBS disability weight and its values of the confidence interval (0.198 and 0.414) were 5725.90 (5711.79-5742.89) in 2014, 6054.61 (6035.57-6077.54) in 2015 and 7588.49 (7570.20-7610.51) in 2016. The DALYs were high among the male population and in age groups between 20 and 50 years. CONCLUSIONS The increase in DALYs in the years 2015 and 2016 compared to 2014 probably resulted from the introduction of ZIKV in Brazil, reinforcing the importance of investments in the prevention of ZIKV infection and in the care of GBS patients.
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Affiliation(s)
- Virginia Kagure Wachira
- Center of Tropical Medicine, Faculty of Medicine, Universidade de Brasília, Brasília, Brazil
| | | | - Henry Maia Peixoto
- Center of Tropical Medicine, Faculty of Medicine, Universidade de Brasília, Brasília, Brazil.,National Institute of Science and Technology for Health Technology Assessment, Porto Alegre, Brazil
| | - Maria Regina Fernandes de Oliveira
- Center of Tropical Medicine, Faculty of Medicine, Universidade de Brasília, Brasília, Brazil.,National Institute of Science and Technology for Health Technology Assessment, Porto Alegre, Brazil
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Kazmi SS, Ali W, Bibi N, Nouroz F. A review on Zika virus outbreak, epidemiology, transmission and infection dynamics. ACTA ACUST UNITED AC 2020; 27:5. [PMID: 32158705 PMCID: PMC7057477 DOI: 10.1186/s40709-020-00115-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 02/24/2020] [Indexed: 02/07/2023]
Abstract
Zika virus (ZIKV) is a newly emergent relative of the Flaviviridae family and linked to dengue (DENV) and Chikungunya (CHIVKV). ZIKV is one of the rising pathogens promptly surpassing geographical borders. ZIKV infection was characterized by mild disease with fever, headache, rash, arthralgia and conjunctivitis, with exceptional reports of an association with Guillain–Barre syndrome (GBS) and microcephaly. However, since the end of 2015, an increase in the number of GBS associated cases and an astonishing number of microcephaly in fetus and new-borns in Brazil have been related to ZIKV infection, raising serious worldwide public health concerns. ZIKV is transmitted by the bite of infected female mosquitoes of Aedes species. Clarifying such worrisome relationships is, thus, a current unavoidable goal. Here, we extensively described the current understanding of the effects of ZIKV on heath, clinical manifestation, diagnosis and treatment options based on modern, alternative and complementary medicines regarding the disease.
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Affiliation(s)
- Syeda Sidra Kazmi
- 1Department of Bioinformatics, Hazara University Mansehra, Mansehra, Pakistan
| | - Waqar Ali
- 1Department of Bioinformatics, Hazara University Mansehra, Mansehra, Pakistan
| | - Nousheen Bibi
- 1Department of Bioinformatics, Hazara University Mansehra, Mansehra, Pakistan
| | - Faisal Nouroz
- 1Department of Bioinformatics, Hazara University Mansehra, Mansehra, Pakistan.,2Department of Botany, Hazara University Mansehra, Mansehra, Pakistan
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Xu S, Wang YS, Li S, Liu HY. [Guillain-Barre syndrome complicated on post-operation with renal carcinoma and meningioma: a case report]. JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:775-777. [PMID: 31420639 DOI: 10.19723/j.issn.1671-167x.2019.04.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Guillain-Barre syndrome (GBS) is an autoimmune disease on the injury of peripheral nerve myelin proteins or axon, of which the acute motor axonal neuropathy (AMAN) as a subtype is of infrequence and an extremely low incidence of post-operation. This article originally reported one case from Peking University People's Hospital on successful treatment of severe GBS (AMAN) on post-operation with renal carcinoma and meningioma. The diagnostic criteria of AMAN refer to AIDP, of which the feature of AMAN suggests a pure motor nerve dysfunction and significant damage on motor axon. It is reported that infection and surgery may induce GBS. The positive result of IgM and IgG was considered the application of ganglioside and blood-brain barrier might be damaged after meningioma surgery which eased the drug to enter the cerebrospinal fluid circulation and induced lesions, therefore the etiology on this GBS case was of high confidence of administrating ganglioside drugs. Autonomic nerve dysfunctions, such as blood pressure fluctuations and arrhythmia could be caused in GBS, of which about 3%-10% of GBS patients would die. Early use of gamma globulin or plasma exchange was recommended internationally, but recently some new ideas, to some extent, of significance on GBS treatment emerged. However, there was still no consensus on GBS treatment systematically all over the world. Till now, the general treatment program on GBS may be still gamma globulin or plasma exchange and a curious judgment of prognosis is essential in order to make a reasonable plan. That it was usually of no omen on severe autonomic nerve dysfunction must be successively monitored, the same as the management of the respiratory tract and nutrition support. The key measures taken on lung recruitment was postural drainage on this case with a low cost but a qualified effectiveness. This case report aimed to deepen the understanding of AMAN and acquaint the cutting-edge advances on the treatment of GBS, as well as providing successful treatment experience for the prevention on similar cases.
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Affiliation(s)
- S Xu
- Department of Spinal Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Y S Wang
- Department of Neurosurgery, Peking University People's Hospital, Beijing 100044, China
| | - S Li
- Department of Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China
| | - H Y Liu
- Department of Spinal Surgery, Peking University People's Hospital, Beijing 100044, China
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25
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Sava M, Catană MG, Roman-Filip C. The importance of early neurorehabilitation in the recovery of post-vaccination Guillain-Barre syndrome – a case report. BALNEO RESEARCH JOURNAL 2019. [DOI: 10.12680/balneo.2019.246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Guillain-Barre syndrome (GBS) is the most common cause of acute flaccid paralysis worldwide, having an incidence of about 1/100,000 across several studies in a number of countries. We present the case of a 60-year-old female patient, with known hypertension, admitted to our department for paresthesia and muscle weakness predominantly in the distal upper and lower limbs. Symptomatology had an acute onset after 14 days from influenza vaccine administration. Lumbar puncture revealed CSF glucose (91 mg/dl), CSF protein (0.508 g/l) and no pleocytosis. Electromyography supported the presumptive diagnosis of polyradiculoneuritis. The patient underwent three sessions of double filtration and the final diagnosis was Guillain-Barre polyradiculoneuritis secondary to influenza vaccination. Approximately 80% of patients with polyradiculoneuritis recover completely within a few months to one year; however, 5-10% of these patients experience one or more recurrences. It should be emphasized that acute-phase rehabilitation must start immediately and include an individualized program of gentle strengthening, and manual resistive and progressive resistive exercises.
Key words: polyradiculoneuropathy, influenza vaccine, neurorehabilitation,
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Affiliation(s)
- Mihai Sava
- 2Emergency Clinical Hospital Sibiu, Intensive Care Unit 3"Lucian Blaga" University, Sibiu, Romania
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26
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Leitzen E, Raddatz BB, Jin W, Goebbels S, Nave KA, Baumgärtner W, Hansmann F. Virus-triggered spinal cord demyelination is followed by a peripheral neuropathy resembling features of Guillain-Barré Syndrome. Sci Rep 2019; 9:4588. [PMID: 30872675 PMCID: PMC6418285 DOI: 10.1038/s41598-019-40964-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 02/27/2019] [Indexed: 12/29/2022] Open
Abstract
Theiler’s murine encephalomyelitis virus (TMEV)-induces a demyelinating disease in the spinal cord (SC) of susceptible but not in resistant (B6) mouse strains. The aim of the present study was to induce SC demyelination and a peripheral neuropathy in resistant mice by switching the infection site from cerebrum to SC. B6 mice were intraspinally inoculated with TMEV. Infected mice showed clinical signs starting at 7 days post infection (dpi). Histopathology revealed a mononuclear myelitis, centred on the injection site at 3 dpi with subsequent antero- and retrograde spread, accompanied by demyelination and axonal damage within the SC. Virus protein was detected in the SC at all time points. SC inflammation decreased until the end of the investigation period (28 dpi). Concurrent with the amelioration of SC inflammation, the emergence of a peripheral neuropathy, characterized by axonal damage, demyelination and macrophage infiltration, contributing to persistent clinical sings, was observed. Intraspinal TMEV infection of resistant mice induced inflammation, demyelination and delayed viral clearance in the spinal cord and more interestingly, subsequent, virus-triggered inflammation and degeneration within the PN associated with dramatic and progressive clinical signs. The lesions observed in the PN resemble important features of Guillain-Barré syndrome, especially of acute motor/motor-sensory axonal forms.
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Affiliation(s)
- Eva Leitzen
- Department of Pathology, University of Veterinary Medicine Hannover, Bünteweg 17, 30559, Hannover, Germany.,Center for Systems Neuroscience, Hannover, Germany
| | - Barbara B Raddatz
- Department of Pathology, University of Veterinary Medicine Hannover, Bünteweg 17, 30559, Hannover, Germany
| | - Wen Jin
- Department of Pathology, University of Veterinary Medicine Hannover, Bünteweg 17, 30559, Hannover, Germany.,Center for Systems Neuroscience, Hannover, Germany
| | - Sandra Goebbels
- Department of Neurogenetics, Max-Planck-Institute for Experimental Medicine, Hermann-Rein-Straße 3, 37075, Göttingen, Germany
| | - Klaus-Armin Nave
- Center for Systems Neuroscience, Hannover, Germany.,Department of Neurogenetics, Max-Planck-Institute for Experimental Medicine, Hermann-Rein-Straße 3, 37075, Göttingen, Germany
| | - Wolfgang Baumgärtner
- Department of Pathology, University of Veterinary Medicine Hannover, Bünteweg 17, 30559, Hannover, Germany. .,Center for Systems Neuroscience, Hannover, Germany.
| | - Florian Hansmann
- Department of Pathology, University of Veterinary Medicine Hannover, Bünteweg 17, 30559, Hannover, Germany.,Center for Systems Neuroscience, Hannover, Germany
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27
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Wachira VK, Peixoto HM, de Oliveira MRF. Systematic review of factors associated with the development of Guillain-Barré syndrome 2007-2017: what has changed? Trop Med Int Health 2018; 24:132-142. [PMID: 30444562 DOI: 10.1111/tmi.13181] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The objective of this study was to describe the factors associated with the development of Guillain-Barré syndrome, both infectious and non-infectious, during and after the A(H1N1) influenza pandemic in 2009 and the recent Zika virus epidemic in the Americas. METHOD Systematic review of literature on factors associated with the development of the Guillain-Barré syndrome published between 2007 and 2017 listed in EBSCO, MEDLINE and LILACS databases. The quality of the studies was evaluated using the Newcastle Ottawa Scale. RESULTS Thirty-four articles met inclusion criteria and were selected for analysis. Their quality was considered good in relation to most of the items evaluated. Many aetiological agents had the results of association with Guillain-Barré syndrome, among them Campylobacter jejuni, influenza vaccine - both pandemic and seasonal vaccines, respiratory infection, gastrointestinal infection among others. The aetiological agents found are, in most part, the same reported prior to the study period. The association with surgeries, chikungunya virus (CHIKV), Zika virus and quadrivalent human papillomavirus vaccine stand out as new aetiological agents in the list of the various possible agents that trigger Guillain-Barré syndrome reported in the study period. There were no Brazilian studies identified during this period. CONCLUSIONS The results of the review reaffirmed C. jejuni as the major trigger of GBS, whereas the association of influenza vaccines and GBS is less clear; Zika virus infection in association with GBS was found in only one study.
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Affiliation(s)
| | - Henry Maia Peixoto
- Centre for Tropical Medicine, University of Brasília, Brasília, Federal District, Brazil.,National Institute for Science and Technology for Health Technology Assessment, Porto Alegre, Brazil
| | - Maria Regina Fernandes de Oliveira
- Centre for Tropical Medicine, University of Brasília, Brasília, Federal District, Brazil.,National Institute for Science and Technology for Health Technology Assessment, Porto Alegre, Brazil
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Xu S, Peng F, Wang YS, Li S, Liu HY. Guillain-Barre Syndrome Complicated on Postoperation on Renal Carcinoma and Meningioma. Chin Med J (Engl) 2018; 131:1122-1123. [PMID: 29692389 PMCID: PMC5937327 DOI: 10.4103/0366-6999.230728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Shuai Xu
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing 100044, China
| | - Fen Peng
- Department of Dermatology, Peking University People's Hospital, Peking University, Beijing 100044, China
| | - Yang-Shuo Wang
- Department of Neurosurgery, Peking University People's Hospital, Peking University, Beijing 100044, China
| | - Shu Li
- Department of Critical Care Medicine, Peking University People's Hospital, Peking University, Beijing 100044, China
| | - Hai-Ying Liu
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing 100044, China
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29
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Motamed-Gorji N, Matin N, Tabatabaie O, Pavone P, Romano C, Falsaperla R, Vitaliti G. Biological Drugs in Guillain-Barré Syndrome: An Update. Curr Neuropharmacol 2018; 15:938-950. [PMID: 27964705 PMCID: PMC5652014 DOI: 10.2174/1570159x14666161213114904] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 11/30/2016] [Accepted: 12/06/2016] [Indexed: 12/25/2022] Open
Abstract
Background: Guillain-Barré Syndrome (GBS) is currently considered the most common global cause of acute flaccid paralysis. Currently, standard therapy for Guillain-Barré Syndrome includes intravenous immunoglobulin or plasma exchange. Despite medical advances regarding these treatments, many treated patients do not reach full recovery. Therefore several biological agents have attracted the attentions from researchers during the last decades, and various studies have investigated their role in Guillain-Barré Syndrome. Objective: The present study aims to address emerging biological approaches to GBS while considering their efficiency and safety in treating the disease. Materials and Methods: An extensive electronic literature search was conducted by two researchers from April 2016 to July 2016. Original articles, clinical trials, systematic reviews (with or without meta-analysis) and case reports were selected. Titles and abstracts of papers were screened by reviewers to determine whether they met the eligibility criteria, and full texts of the selected articles were retrieved. Results: Herein authors focused on the literature data concerning emerging biological therapeutic agents, namely anti-C5 monoclonal antibody (Eculizumab), anti-C1q monoclonal antibody, anti-T cell monoclonal antibody, anti-CD2 monoclonal antibody, anti L-selectin monoclonal antibody, anti-CD20 monoclonal antibody (Rituximab), anti-CD52 monoclonal antibody (Alemtuzumab) and cytokine targets. By far, none of these agents have been approved for the treatment of GBS by FDA. Conclusion: Literature findings represented in current review herald promising results for using these biological targets. Current review represents a summary of what is already in regards and what progress is required to improve the immunotherapeutic approach of treating GBS via future studies.
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Affiliation(s)
| | - Nassim Matin
- Department of Neurology, Massachusetts General Hospital, Boston, MA. United States
| | - Omidreza Tabatabaie
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. United States
| | - Piero Pavone
- General Paediatrics Operative Unit, Policlinico-Vittorio Emanuele University Hospital, University of Catania, Catania. Italy
| | - Catia Romano
- General Paediatrics Operative Unit, Policlinico-Vittorio Emanuele University Hospital, University of Catania, Catania. Italy
| | - Raffaele Falsaperla
- General Paediatrics Operative Unit, Policlinico-Vittorio Emanuele University Hospital, University of Catania, Catania. Italy
| | - Giovanna Vitaliti
- General Paediatrics Operative Unit, Policlinico-Vittorio Emanuele University Hospital, University of Catania, Catania. Italy
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Huang Y, Ying Z, Quan W, Xiang W, Xie D, Weng Y, Li X, Li J, Zhang X. The clinical significance of neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio in Guillain–Barré syndrome. Int J Neurosci 2018; 128:729-735. [PMID: 29251087 DOI: 10.1080/00207454.2017.1418342] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Yuanyuan Huang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhaojian Ying
- Department of Emergency, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Weiwei Quan
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Weiwei Xiang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dewei Xie
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yiyun Weng
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiang Li
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jia Li
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xu Zhang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Shepherd SJ, Black H, Thomson EC, Gunson RN. HIV positive patient with GBS-like syndrome. JMM Case Rep 2017; 4:e005107. [PMID: 29026634 PMCID: PMC5610709 DOI: 10.1099/jmmcr.0.005107] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 07/21/2017] [Indexed: 12/17/2022] Open
Abstract
Introduction. Guillain-Barré Syndrome (GBS) is an acute demyelinating polyneuropathy which can occur post-infection. Criteria of diagnosis of GBS include areflexia with progressive bilateral weakness in arms and legs. GBS can lead to severe respiratory and cardiac complications. The fatality rate can be up to 5 % in patients, depending on the severity of the symptoms. HIV can cause a range of neurological disorders including, on rare occasions, GBS. GBS can occur at any stage of HIV infection, highlighting the complexity of diagnosis of GBS within HIV patients. Case presentation. A 57 year old female with lumbar back pain radiating to the legs, poor mobility and tiredness, with reports of a viral-like illness four days previously, was initially diagnosed with a lower respiratory tract infection and discharged. Seventeen days later the patient was readmitted to hospital with progressive lower and upper limb weakness, areflexia and sensory loss. She was diagnosed with GBS and was unexpectedly discovered to be HIV-positive. HIV avidity was low indicating a recently acquired HIV infection. The patient was treated with intravenous immunoglobulin for five days for the GBS and commenced antriretrovirals for HIV. The patient was discharge from hospital 53 days after admission with walking aids and regular physiotherapy follow-up. CONCLUSION . This case highlighted the need for all clinicians to be aware that patients with symptoms of GBS, regardless of clinical history should be offered an HIV test. GBS can be the first sign a patient is HIV-positive.
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Affiliation(s)
- Samantha J Shepherd
- West of Scotland Specialist Virology Centre, Level 5, New Lister Building, 10-16 Alexandra Parade, Glasgow G31 2ER, UK
| | - Heather Black
- Infectious Diseases Unit, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Emma C Thomson
- MRC-University of Glasgow Centre for Virus Research, Stoker Building, 464 Bearsden Road, Glasgow G61 1QH, UK
| | - Rory N Gunson
- West of Scotland Specialist Virology Centre, Level 5, New Lister Building, 10-16 Alexandra Parade, Glasgow G31 2ER, UK
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32
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Lakhotia AN, Chouksey D, Jain R, Sodani AK. Guillain-Barre Syndrome following Tuberculosis: A Rare Association. J Neurosci Rural Pract 2017; 8:296-299. [PMID: 28479815 PMCID: PMC5402507 DOI: 10.4103/jnrp.jnrp_387_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The co-occurrence of Guillain–Barre syndrome (GBS) and tuberculosis is rare. Even in countries like India, where tuberculosis is common, there is only one case report of co-occurrence of GBS with tuberculosis. We report a case of GBS in association with sputum-positive pulmonary tuberculosis. The earliest treatment with intravenous immunoglobulin in acute motor axonal neuropathy variant of GBS would show good early recovery despite associated pulmonary tuberculosis.
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Affiliation(s)
| | - Dinesh Chouksey
- Department of Neurology, Sri Aurobindo Medical College and PGI, Indore, Madhya Pradesh, India
| | - Rahul Jain
- Department of Neurology, Sri Aurobindo Medical College and PGI, Indore, Madhya Pradesh, India
| | - Ajoy Kumar Sodani
- Department of Neurology, Sri Aurobindo Medical College and PGI, Indore, Madhya Pradesh, India
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33
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Esposito S, Longo MR. Guillain–Barré syndrome. Autoimmun Rev 2017; 16:96-101. [DOI: 10.1016/j.autrev.2016.09.022] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 09/15/2016] [Indexed: 12/13/2022]
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34
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St Charles JL, Bell JA, Gadsden BJ, Malik A, Cooke H, Van de Grift LK, Kim HY, Smith EJ, Mansfield LS. Guillain Barré Syndrome is induced in Non-Obese Diabetic (NOD) mice following Campylobacter jejuni infection and is exacerbated by antibiotics. J Autoimmun 2016; 77:11-38. [PMID: 27939129 DOI: 10.1016/j.jaut.2016.09.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 08/25/2016] [Accepted: 09/04/2016] [Indexed: 01/10/2023]
Abstract
Campylobacter jejuni is a leading cause of bacterial gastroenteritis linked to several serious autoimmune sequelae such as the peripheral neuropathies Guillain Barré syndrome (GBS) and Miller Fisher syndrome (MFS). We hypothesized that GBS and MFS can result in NOD wild type (WT) mice or their congenic interleukin (IL)-10 or B7-2 knockouts secondary to C. jejuni infection. Mice were gavaged orally with C. jejuni strains HB93-13 and 260.94 from patients with GBS or CF93-6 from a patient with MFS and assessed for clinical neurological signs and phenotypes, anti-ganglioside antibodies, and cellular infiltrates and lesions in gut and peripheral nerve tissues. Significant increases in autoantibodies against single gangliosides (GM1, GQ1b, GD1a) occurred in infected NOD mice of all genotypes, although the isotypes varied (NOD WT had IgG1, IgG3; NOD B7-2-/- had IgG3; NOD IL-10-/- had IgG1, IgG3, IgG2a). Infected NOD WT and NOD IL-10-/- mice also produced anti-ganglioside antibodies of the IgG1 isotype directed against a mixture of GM1/GQ1b gangliosides. Phenotypic tests showed significant differences between treatment groups of all mouse genotypes. Peripheral nerve lesions with macrophage infiltrates were significantly increased in infected mice of NOD WT and IL-10-/- genotypes compared to sham-inoculated controls, while lesions with T cell infiltrates were significantly increased in infected mice of the NOD B7-2-/- genotype compared to sham-inoculated controls. In both infected and sham inoculated NOD IL-10-/- mice, antibiotic treatment exacerbated neurological signs, lesions and the amount and number of different isotypes of antiganglioside autoantibodies produced. Thus, inducible mouse models of post-C. jejuni GBS are feasible and can be characterized based on evaluation of three factors-onset of GBS clinical signs/phenotypes, anti-ganglioside autoantibodies and nerve lesions. Based on these factors we characterized 1) NOD B-7-/- mice as an acute inflammatory demyelinating polyneuropathy (AIDP)-like model, 2) NOD IL-10-/- mice as an acute motor axonal neuropathy (AMAN)-like model best employed over a limited time frame, and 3) NOD WT mice as an AMAN model with mild clinical signs and lesions. Taken together these data demonstrate that C. jejuni strain genotype, host genotype and antibiotic treatment affect GBS disease outcomes in mice and that many disease phenotypes are possible.
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Affiliation(s)
- J L St Charles
- Comparative Enteric Diseases Laboratory, Michigan State University, East Lansing, MI 48824, USA; Comparative Medicine and Integrative Biology Graduate Program, Michigan State University, East Lansing, MI 48824, USA; College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - J A Bell
- Comparative Enteric Diseases Laboratory, Michigan State University, East Lansing, MI 48824, USA; College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - B J Gadsden
- Comparative Enteric Diseases Laboratory, Michigan State University, East Lansing, MI 48824, USA; Comparative Medicine and Integrative Biology Graduate Program, Michigan State University, East Lansing, MI 48824, USA; College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - A Malik
- Comparative Enteric Diseases Laboratory, Michigan State University, East Lansing, MI 48824, USA; Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI 48824, USA; College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - H Cooke
- College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - L K Van de Grift
- College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - H Y Kim
- Comparative Enteric Diseases Laboratory, Michigan State University, East Lansing, MI 48824, USA
| | - E J Smith
- Comparative Enteric Diseases Laboratory, Michigan State University, East Lansing, MI 48824, USA; College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - L S Mansfield
- Comparative Enteric Diseases Laboratory, Michigan State University, East Lansing, MI 48824, USA; Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI 48824, USA; College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824, USA.
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Lei JH, Tian Y, Luo HY, Chen Z, Peng F. Guillain-Barré syndrome following acute co-super-infection of hepatitis E virus and cytomegalovirus in a chronic hepatitis B virus carrier. J Med Virol 2016; 89:368-372. [PMID: 27358107 DOI: 10.1002/jmv.24620] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2016] [Indexed: 12/18/2022]
Abstract
Guillain-Barré syndrome (GBS) is a rare neurological complication of hepatitis B. GBS presence in acute hepatitis E virus (HEV) and cytomegalovirus (CMV) infection is also sporadically reported. Here, a rare case of GBS in a chronic Hepatitis B virus carrier co-infected with HEV and CMV was reported. Based on the analysis on the progress of the manifestations and virus serological detection results, it could be concluded that GBS might mostly likely result from super-infection of HEV and CMV. This case report is clinically important in that it provides a good example of differential diagnosis and appropriate treatment on such a rare but life-threatening case. J. Med. Virol. 89:368-372, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jian-Hua Lei
- Department of Infectious Diseases, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Yi Tian
- Department of Infectious Diseases, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Hong-Yu Luo
- Department of Infectious Diseases, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Zi Chen
- Department of Infectious Diseases, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Feng Peng
- Department of Infectious Diseases, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
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Iyer RR, Shah PH, Roy SSK, Suri SKK. Reducing the economic burden in management of Guillain-Barre syndrome using modified plasmapheresis. Asian J Transfus Sci 2016; 10:118-21. [PMID: 27605847 PMCID: PMC4993079 DOI: 10.4103/0973-6247.187940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Guillain-Barre syndrome (GBS) is an autoimmune acute inflammatory demyelinating polyneuropathy affecting the peripheral nervous system treated with high-dose immunoglobulin, physical therapy, or plasmapheresis. Immunoglobulins are expensive and even plasmapheresis might not be affordable to patients visiting government set-ups. AIMS This study was undertaken to emphasize the efficacy of plasmapheresis in treatment of adult GBS patients and to narrate methods of reducing the economic burden in the treatment of these patients using modified plasmapheresis. METHODS A study was conducted on 12 adult GBS patients at Sir Takhtasinhji General Hospital, Bhavnagar from July 2012 to July 2014. Patients were assessed on a 6-point disability scale. They were treated with plasmapheresis over 10 days with REF627 kit from Haemonetics Corporation Limited on MCS+ machine. Improvement was noted by the change in the disability scale score and expenses of various modes of treatment were also considered. RESULTS Seventy-five percent showed improvement at the end of the treatment. The cost of modified plasmapheresis was Rs. 8000/cycle, i.e., Rs. 40,000/patient. CONCLUSION Plasmapheresis along with proper supportive measures is a more cost-effective efficacious mode of therapy in adult patients of GBS. Further, modified plasmapheresis using REF627 kit and 6% hexastarch as replacement fluid on MCS+ apheresis machine reduces the cost of therapy for poor patients visiting government set-ups.
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Affiliation(s)
| | | | - Sher Sankar K. Roy
- Department of Pathology, Government Medical College, Bhavnagar, Gujarat, India
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37
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Tomita MR, Buckner K, Saharan S, Persons K, Liao SH. Extended Occupational Therapy Reintegration Strategies for a Woman With Guillain-Barré Syndrome: Case Report. Am J Occup Ther 2016; 70:7004210010p1-7. [PMID: 27294986 DOI: 10.5014/ajot.2016.017871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This case report describes a unique long-term functional recovery process to promote successful community reintegration for a woman with Guillain-Barré syndrome (GBS), a rare autoimmune disease. Her main symptoms were very limited mobility and depressive symptoms due to the unknown cause of and cure for the illness. Holistic occupational strategies helped the client stabilize her emotional state, create a safe home environment, improve a communication method, increase physical activity, and promote social participation. Participation in a fall prevention clinical trial lowered her risk of falling; at 9 mo, she reached 75% of the maximum Social Integration score; at 13 mo, she reached near-normal level for activities of daily living (ADLs) and her fastest time for the Timed Up and Go test; and at 2 yr, she achieved a 100% score in instrumental ADLs. For community integration of clients with GBS, a comprehensive strategic self-management approach should be prescribed for long-term recovery.
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Affiliation(s)
- Machiko R Tomita
- Machiko R. Tomita, PhD, is Clinical Professor, Department of Rehabilitation Science, University at Buffalo, Buffalo, NY;
| | - Kathryn Buckner
- Kathryn Buckner, MS, OTR/L, is Occupational Therapist, Warren Barr Gold Coast, Chicago, IL
| | - Sumandeep Saharan
- Sumandeep Saharan, MS, OTR/L, is Occupational Therapist, HCR ManorCare, Chevy Chase, MD
| | - Kimberley Persons
- Kimberley Persons, DHS, OTR/L, is Clinical Assistant Professor, Department of Rehabilitation Science, University at Buffalo, Buffalo, NY
| | - Sheng Hui Liao
- Sheng Hui Liao, MS, OTR/L, is Occupational Therapist, Multilingual Therapy Associates, Brooklyn, NY
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Yang B, Lian Y, Liu Y, Wu BY, Duan RS. A retrospective analysis of possible triggers of Guillain–Barre syndrome. J Neuroimmunol 2016; 293:17-21. [DOI: 10.1016/j.jneuroim.2016.02.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 02/04/2016] [Accepted: 02/08/2016] [Indexed: 02/07/2023]
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Ashmus RA, Jayasuriya AB, Lim YJ, O’Doherty GA, Lowary TL. De Novo Asymmetric Synthesis of a 6-O-Methyl-d-glycero-l-gluco-heptopyranose-Derived Thioglycoside for the Preparation of Campylobacter jejuni NCTC11168 Capsular Polysaccharide Fragments. J Org Chem 2016; 81:3058-63. [DOI: 10.1021/acs.joc.6b00296] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Roger A. Ashmus
- Alberta
Glycomics Centre and Department of Chemistry, The University of Alberta, Edmonton, Alberta T6G 2G2, Canada
| | - Anushka B. Jayasuriya
- Alberta
Glycomics Centre and Department of Chemistry, The University of Alberta, Edmonton, Alberta T6G 2G2, Canada
| | - Ying-Jie Lim
- Alberta
Glycomics Centre and Department of Chemistry, The University of Alberta, Edmonton, Alberta T6G 2G2, Canada
| | - George A. O’Doherty
- Department
of Chemistry, Northeastern University, 360 Huntington Ave., Boston, Massachusetts 02115, United States
| | - Todd L. Lowary
- Alberta
Glycomics Centre and Department of Chemistry, The University of Alberta, Edmonton, Alberta T6G 2G2, Canada
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Saad K, Mohamad IL, Abd El-Hamed MA, Tawfeek MSK, Ahmed AE, Abdel Baseer KA, El-Shemy AS, El-Houfey AA, Tamer DM. A comparison between plasmapheresis and intravenous immunoglobulin in children with Guillain-Barré syndrome in Upper Egypt. Ther Adv Neurol Disord 2016; 9:3-8. [PMID: 26788127 PMCID: PMC4710103 DOI: 10.1177/1756285615610471] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The aim of our study is to assess the clinico-electrophysiological profile of children with Guillain-Barré syndrome (GBS) in Upper Egypt and to compare the efficacy of plasmapheresis versus other treatment modalities. PATIENTS AND METHODS This was a retrospective study of children from January 2010 to October 2014 diagnosed as GBS. It included 62 cases. RESULTS Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) was the most prevalent type of GBS in our locality. As regards the treatment, 32 cases received plasmapheresis while 30 patients received intravenous immunoglobulin. We found a significant decrease in the duration of hospitalization and a significant increase in the number of children with complete recovery in cases treated with plasmapheresis. CONCLUSION GBS is not uncommon in children of Upper Egypt, with AIDP the most prevalent type. Plasmapheresis is the best treatment modalities for GBS as it reduces the duration of hospital stay and hastens the recovery of those children.
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Affiliation(s)
| | - Ismail L. Mohamad
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Mostafa S K Tawfeek
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed E. Ahmed
- Department of Pediatrics, Qena Faculty of Medicine, South Valley University, Egypt
| | | | - Ahmed S. El-Shemy
- Department of Pediatrics, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | - Amira A. El-Houfey
- Department of Community Health Nursing, Assiut University, Assiut, Egypt
| | - Diaa M. Tamer
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
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Jin PP, Sun LL, Ding BJ, Qin N, Zhou B, Xia F, Li L, Liu LJ, Liu XD, Zhao G, Wang W, Deng YC, Hou SX. Human Leukocyte Antigen DQB1 (HLA-DQB1) Polymorphisms and the Risk for Guillain-Barré Syndrome: A Systematic Review and Meta-Analysis. PLoS One 2015. [PMID: 26204120 PMCID: PMC4512729 DOI: 10.1371/journal.pone.0131374] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is an autoimmune disorder of the peripheral nervous system. There is no consensus regarding reported associations between human leukocyte antigen DQB1 (HLA-DQB1) polymorphisms and the risk for developing GBS. Here, we evaluated possible associations between HLA-DQB1 polymorphisms and the risk for GBS using a meta-analysis. We searched PubMed for case-control genetic association studies for HLA-DQB1 polymorphisms (*020x, *030x, *040x, *050x, and *060x) and the risk for GBS. Fixed-effect meta-analytical methods were used for the outcome measure and subgroup analyses. Estimated odds ratios (ORs) and 95% confidence intervals (CIs) were used to investigate the associations between HLA-DQB1 polymorphisms and the risk for GBS. Nine case-control studies involving 780 cases of GBS and 1353 controls were identified in the current study. The meta-analysis demonstrated no significant associations between HLA-DQB1 polymorphisms and the risk for GBS in Asian and Caucasian populations. There were two associations that approached significance: HLA-DQB1*030x in Asian patients (P = 0.07; OR: 0.76, 95% CI: 0.57–1.03) and HLA-DQB1*060x in all patients (P = 0.08; OR: 1.48, 95% CI: 0.96–2.29). Additional studies with larger sample sizes are required to establish a definitive assessment of the contribution of HLA-DQB1 polymorphisms to GBS risk.
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Affiliation(s)
- Peng-Peng Jin
- Centre for Medical Research and Innovation, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Shanghai 201399, China
| | - Li-Li Sun
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Bo-Jun Ding
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Na Qin
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Bin Zhou
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Feng Xia
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Li Li
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Li-Juan Liu
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Xue-Dong Liu
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Gang Zhao
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Wen Wang
- Unit of Evidence-Based Medicine, K. K. Leung Brain Research Centre, Fourth Military Medical University, Xi’an 710032, China
| | - Yan-Chun Deng
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Shuang-Xing Hou
- Department of Neurology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Shanghai 201399, China
- * E-mail:
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Lin JH, Tu KH, Chang CH, Chen YC, Tian YC, Yu CC, Hung CC, Fang JT, Yang CW, Chang MY. Prognostic factors and complication rates for double-filtration plasmapheresis in patients with Guillain-Barré syndrome. Transfus Apher Sci 2014; 52:78-83. [PMID: 25544386 DOI: 10.1016/j.transci.2014.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 10/13/2014] [Accepted: 12/15/2014] [Indexed: 01/04/2023]
Abstract
Guillain-Barré syndrome (GBS) is an acute immune-mediated demyelinating polyradiculoneuropathy that could lead to disabilities if not properly treated. There are only limited data on the prognostic factors and complications when using double-filtration plasmapheresis in these patients. We reviewed the medical records of 60 GBS patients who underwent double-filtration plasmapheresis as the first-line therapy at a tertiary care teaching hospital. The severity of disease was evaluated at different time points using disability scores. Functional outcome was defined as good (GBS disability score 0 to 2) or poor (GBS disability score 3 to 6) at 28 days after admission. The cohort included 22 women and 38 men with a mean age of 50 ± 18 years. In univariate logistic regression analysis, potential factors associated with poor outcome include an older age (P = 0.101), the absence of preceding respiratory tract infection (P = 0.043), mechanical ventilation (P = 0.016), a lower hematocrit (p = 0.072), a lower serum sodium level (P = 0.153) and a higher disability score on admission (P < 0.001). In multivariate analysis, a higher disability score on admission was associated with a poorer outcome (OR, 5.61; 95% CI, 2.34 to 13.43; P < 0.001), whereas the presence of prodromal upper respiratory tract infection correlated with a better outcome (OR, 0.13; 95% CI, 0.03-0.59; P = 0.009). Among 60 patients, eleven (18.3%) have various complications attributed to plasmapheresis treatment. Six patients (10.0%) developed deep vein thrombosis and two experienced catheter-related infection (3.3%). Hypotension, allergy and hemolysis occurred in one patient each (1.7%). In conclusion, we describe our experiences of using DFPP in the treatment of GBS. The pretreatment severity score was the most significant predictor of treatment outcome, suggesting that early referral and timely treatment are important. Potential complications such as catheter-related infection and deep vein thrombosis should be monitored carefully.
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Affiliation(s)
- Jui-Hsiang Lin
- Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan; Division of Nephrology, Department of Internal Medicine, Ministry of Health and Welfare, Tao Yuan General Hospital, Taoyuan, Taiwan
| | - Kun-Hua Tu
- Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chih-Hsiang Chang
- Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yung-Chang Chen
- Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ya-Chung Tian
- Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chun-Chen Yu
- Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Cheng-Chieh Hung
- Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ji-Tseng Fang
- Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chih-Wei Yang
- Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ming-Yang Chang
- Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
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Cakırgöz MY, Duran E, Topuz C, Kara D, Turgut N, Türkmen UA, Turanç B, Dolap MÖ, Hancı V. [Not Available]. Rev Bras Anestesiol 2014; 64:195-8. [PMID: 25456480 DOI: 10.1016/j.bjan.2013.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 03/20/2013] [Indexed: 11/15/2022] Open
Affiliation(s)
- Mensure Yılmaz Cakırgöz
- Departamento de Anestesiologia e Reanimação, Okmeydani Training and Research Hospital, Istanbul, Turquia
| | - Esra Duran
- Şehit Kamil State Hospital, Gaziantep, Turquia
| | - Cem Topuz
- Departamento de Anestesiologia e Reanimação, Okmeydani Training and Research Hospital, Istanbul, Turquia
| | - Deniz Kara
- Departamento de Anestesiologia e Reanimação, Okmeydani Training and Research Hospital, Istanbul, Turquia
| | - Namigar Turgut
- Departamento de Anestesiologia e Reanimação, Okmeydani Training and Research Hospital, Istanbul, Turquia
| | - Ulkü Aygen Türkmen
- Departamento de Anestesiologia e Reanimação, Okmeydani Training and Research Hospital, Istanbul, Turquia
| | - Bülent Turanç
- Departamento de Anestesiologia e Reanimação, Çorlu Vatan Private Hospital, Tekirdağ, Turquia
| | - Mustafa Önder Dolap
- Departamento de Cirurgia Genral, Çorlu Vatan Private Hospital, Tekirdağ, Turquia
| | - Volkan Hancı
- Departamento de Anestesiologia e Reanimação, Faculdade de Medicina, Dokuz Eylül University, Konak, Turquia.
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Carr KR, Shah M, Garvin R, Shakir A, Jackson C. Post-Traumatic brain injury (TBI) presenting with Guillain-Barré syndrome and elevated anti-ganglioside antibodies: a case report and review of the literature. Int J Neurosci 2014; 125:486-92. [PMID: 25158009 DOI: 10.3109/00207454.2014.957760] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Guillain-Barré Syndrome (GBS) is a demyelinating polyneuropathy resulting in sensory, motor and autonomic symptoms. The severity of the disease can range from mild to severe but it is classically described as an ascending demyelinating process. Initially thought to be the sequelae of a bacterial or viral infection, the clinical symptoms of post-infective GBS can present up to 4 weeks after sentinel injury. A rarely defined post-surgical GBS has been since described after major cranial, cardiothoracic and gastro-intestinal surgery. Post traumatic GBS is an even more unusual presentation with very few cases reported in contemporary academic literature. We present a case of GBS presenting two weeks after non-operative traumatic brain injury (TBI) and a review of the literature.
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Affiliation(s)
- Kevin R Carr
- 1Department of Neurosurgery, University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA
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47
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Dash S, Pai AR, Kamath U, Rao P. Pathophysiology and diagnosis of Guillain-Barré syndrome - challenges and needs. Int J Neurosci 2014; 125:235-40. [PMID: 24731000 DOI: 10.3109/00207454.2014.913588] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Guillain-Barré syndrome (GBS) is an autoimmune polyneuropathy which presents with acute onset and rapid progression of flaccid, hyporeflexi quadriparesis. Both sensory and autonomic nerve involvement is seen. GBS has various subtypes that vary in their pathophysiology. The pathogenesis involves an immune response triggered by a preceding event which may be an infection, immunisation or surgical procedure. Clinical diagnosis has been largely the primary diagnosing criterion for GBS along with electrodiagnosis, which has several pitfalls and is supported by ancillary testing of cerebrospinal fluid (CSF) analysis and Nerve Conduction Studies. Measurement of anti-ganglioside antibodies is also an effective tool in its diagnosis. Further understanding of pathophysiology and better diagnostic methods are required for better management of GBS.
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Affiliation(s)
- Sambit Dash
- 1Department of Biochemistry, Melaka Manipal Medical College (Manipal Campus)
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48
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Corso J, Lugert R, Groß U, Zautner AE. Is the Campylobacter jejuni secretory protein Cj0069 a suitable antigen for serodiagnostics? Eur J Microbiol Immunol (Bp) 2014; 1:86-94. [PMID: 24466437 DOI: 10.1556/eujmi.1.2011.1.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Campylobacter spp. is the most common bacterial pathogen of gastroenteritis worldwide. Poultry is the main reservoir and consequently the main origin of infections for humans. As a consequence of a primary Campylobacter infection which typically manifests as diarrhea, there is an increased risk to suffer from post-infectious complications such as reactive arthritis, neuropathia, myositis or a Guillain-Barré Syndrome. Usually the verification of acute campylobacteriosis is made by stool culture. In contrast, post-infectious complications can be diagnosed by serological assays. Since most of them are based on whole cell lysates, an insufficient specificity results from cross-reactions between related species. Therefore, the use of recombinant antigens becomes more and more favorable. Campylobacter is able to secrete a number of proteins, which are amongst others necessary for cell invasion and therefore play a crucial role for virulence. One of these, Cj0069, has a similar specificity and sensitivity in the detection of anti-Campylobacter jejuni IgG compared to the well-established antigens OMP18 and P39. This makes it a suitable antigen for diagnosing C. jejuni post-infectious complications.
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Affiliation(s)
- J Corso
- Abteilung für Medizinische Mikrobiologie, Universitätsmedizin Göttingen Kreuzbergring 57, D-37075 Göttingen Germany
| | - R Lugert
- Abteilung für Medizinische Mikrobiologie, Universitätsmedizin Göttingen Kreuzbergring 57, D-37075 Göttingen Germany
| | - U Groß
- Abteilung für Medizinische Mikrobiologie, Universitätsmedizin Göttingen Kreuzbergring 57, D-37075 Göttingen Germany
| | - A E Zautner
- Abteilung für Medizinische Mikrobiologie, Universitätsmedizin Göttingen Kreuzbergring 57, D-37075 Göttingen Germany
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Ye Y, Zhu D, Liu L, Wang K, Huang K, Hou C. Electrophysiological measurement at Erb's point during the early stage of Guillain-Barré syndrome. J Clin Neurosci 2014; 21:786-9. [PMID: 24412297 DOI: 10.1016/j.jocn.2013.07.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 07/10/2013] [Accepted: 07/10/2013] [Indexed: 12/01/2022]
Abstract
This study aimed to find the electrophysiological significance of proximal nerve stimulation at Erb's point during the early stage of Guillain-Barré syndrome (GBS). Twenty-one healthy volunteers and 13 patients within the first week of GBS were studied. Latency and amplitude at wrist, elbow and Erb's point, and F waves were calculated after compound muscle action potentials (CMAP) were obtained at the median and ulnar nerve. There were statistically significant differences between groups for CMAP latency and amplitude at Erb's point for the median (p=0.005 and 0.001, respectively) and ulnar nerves (p=0.007 and 0.007, respectively). Latency or amplitude of CMAP after Erb's point stimulation was abnormal in 77% of patients while F wave latency was abnormal in only 46% of patients. Conduction block was observed in 62% of patients. Abnormal parameters at Erb's point were the only abnormality in four patients at the first electrophysiological examination. We conclude that electrophysiological examination at Erb's point is a simple and non-invasive method that can be used in the early stage of GBS, especially for patients who exhibit normal F waves and nerve conduction studies at distal nerves.
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Affiliation(s)
- Yuqin Ye
- Department of Neurology, First Hospital, Jilin University, Changchun, China
| | - Dan Zhu
- Department of Neurology, First Hospital, Jilin University, Changchun, China
| | - Lingyun Liu
- Department of Andrology, First Hospital, Jilin University, Changchun, China
| | - Keren Wang
- Breast Surgery, China-Japan Union Hospital, Jilin University, No.126 Xiantai Street, Changchun 130033, China.
| | - Keke Huang
- State Key Laboratory of Inorganic Synthesis and Preparative Chemistry, College of Chemistry, Jilin University, Changchun, China
| | - Changmin Hou
- State Key Laboratory of Inorganic Synthesis and Preparative Chemistry, College of Chemistry, Jilin University, Changchun, China
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Çakırgöz MY, Duran E, Topuz C, Kara D, Turgut N, Türkmen ÜA, Turanç B, Dolap MÖ, Hancı V. Syndrome of inappropriate antidiuretic hormone secretion related to Guillain-Barré syndrome after laparoscopic cholecystectomy. Braz J Anesthesiol 2013; 64:195-8. [PMID: 24907880 DOI: 10.1016/j.bjane.2013.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 03/20/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Guillain-Barré Syndrome is one of the most common causes of acute polyneuropathy in adults. Recently, the occurrence of Guillain-Barré Syndrome after major and minor surgical operations has been increasingly debated. In Guillain-Barré syndrome, syndrome of inappropriate antidiuretic hormone secretion and dysautonomy are generally observed after maximal motor deficit. CASE REPORT A 44-year-old male patient underwent a laparoscopic cholecystectomy for acute cholecystitis. After the development of a severe headache, nausea, diplopia, and attacks of hypertension in the early postoperative period, a computer tomography of the brain was normal. Laboratory tests revealed hyponatremia linked to syndrome of inappropriate antidiuretic hormone secretion, the patient's fluids were restricted, and furosemide and 3% NaCl treatment was initiated. On the second day postoperative, the patient developed numbness moving upward from the hands and feet, loss of strength, difficulty swallowing and respiratory distress. Guillain-Barré syndrome was suspected, and the patient was moved to intensive care. Cerebrospinal fluid examination showed 320 mg/dL protein, and acute motor-sensorial axonal neuropathy was identified by electromyelography. Guillain-Barré syndrome was diagnosed, and intravenous immune globulin treatment (0.4 g/kg/day, 5 days) was initiated. After 10 days in the intensive care unit, at which the respiratory, hemodynamic, neurologic and laboratory results returned to normal, the patient was transferred to the neurology service. CONCLUSIONS Our case report indicates that although syndrome of inappropriate antidiuretic hormone secretion and autonomic dysfunction are rarely the initial characteristics of Guillain-Barré syndrome, the possibility of postoperative syndrome of inappropriate antidiuretic hormone secretion should be kept in mind. The presence of secondary hyponatremia in this type of clinical presentation may delay diagnosis.
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Affiliation(s)
- Mensure Yılmaz Çakırgöz
- Department of Anesthesiology and Reanimation, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Esra Duran
- Şehit Kamil State Hospital, Gaziantep, Turkey
| | - Cem Topuz
- Department of Anesthesiology and Reanimation, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Deniz Kara
- Department of Anesthesiology and Reanimation, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Namigar Turgut
- Department of Anesthesiology and Reanimation, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Ülkü Aygen Türkmen
- Department of Anesthesiology and Reanimation, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Bülent Turanç
- Department of Anesthesiology and Reanimation, Çorlu Vatan Private Hospital, Tekirdağ, Turkey
| | - Mustafa Önder Dolap
- Department of General Surgery Çorlu Vatan Private Hospital, Tekirdağ, Turkey
| | - Volkan Hancı
- Department of Anesthesiology and Reanimation, School of Medicine, Dokuz Eylül University, Konak, Turkey.
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