Family planning considerations in people with multiple sclerosis

Multiple sclerosis is often diagnosed in patients who are planning on having children. Although multiple sclerosis does not negatively influence most pregnancy outcomes, less is known regarding the effects of fetal exposure to novel disease-modifying therapies (DMTs). The withdrawal of some DMTs during pregnancy can modify the natural history of multiple sclerosis, resulting in a substantial risk of pregnancy-related relapse and disability. Drug labels are typically restrictive and favour fetal safety over maternal safety. Emerging data reporting outcomes in neonates exposed to DMTs in utero and through breastfeeding will allow for more careful and individualised treatment decisions. This emerging research is particularly important to guide decision making in women with high disease activity or who are treated with DMTs associated with risk of discontinuation rebound. As increasing data are generated in this field, periodic updates will be required to provide the most up to date guidance on how best to achieve multiple sclerosis stability during pregnancy and post partum, balanced with fetal and newborn safety.

Guillain–Barré syndrome following different COVID-19 vaccines: a case series

Background

The COVID-19 vaccine-related Guillain–Barré syndrome (GBS) has been described for both messenger-RNA vaccine and adenovirus-vectored types in a few cases with great public concern and the necessity to inform physicians about the variations of its presentations given its life-threatening consequences.

Case presentation

This case series highlighted the presentation with GBS following different COVID-19 vaccinations in seven cases with ages ranging from 29 to 59 years. Three patients received the AstraZeneca vaccine, two received the Pfizer vaccine, one received Sinopharm, and one received the Janssen vaccine. Latency ranged from 5 to 60 days and cases achieved either partial or complete improvement after treatment trials. Patients responded to plasmaphereses, but not pulse steroid therapy.

Conclusion

This case series highlights the variable presentations and outcomes of GBS following different COVID-19 vaccination from one center. The early identification and appropriate management of such cases can lead to better outcomes.

Predicting successful supraclavicular brachial plexus block using pulse oximeter perfusion index

Background

Supraclavicular nerve block is a popular approach for anaesthesia for upper limb surgeries. Conventional methods for evaluation of block success are time consuming and need patient cooperation. The aim of this study was to evaluate whether the perfusion index (PI) can be used to predict and provide a cut-off value for ultrasound-guided supraclavicular nerve block success.

Methods

The study included 77 patients undergoing elective orthopaedic procedures under ultrasound-guided supraclavicular nerve block. After local anaesthetic injection, sensory block success was assessed every 3 min by pinprick, and motor block success was assessed every 5 min by the ability to flex the elbow and the hand against resistance. The PI was recorded at baseline and at 10, 20, and 30 min after anaesthetic injection in both blocked and non-blocked limbs. The PI ratio was calculated as the PI after 10 min divided by the PI at the baseline. Receiver operating characteristic curves were constructed for the accuracy of the PI in detection of block success.

Results

The PI was higher in the blocked limb at all time points, and this was paralleled by a higher PI ratio compared with the unblocked limb. Both the PI and the PI ratio at 10 min after injection showed a sensitivity and specificity of 100% for block success at cut-off values of 3.3 and 1.4, respectively.

Conclusions

The PI is a useful tool for evaluation of successful supraclavicular nerve block. A PI ratio of > 1.4 is a good predictor for block success.