Barré and Strohl in 1916. Although GBS has a good prognosis (5% mortality rate), about 10% of patients experience serious disability one year after the start of neurological onset. Recent research of GBS shows that the process involves a number of subtypes with different immunological mechanism and a spectrum of clinical syndrome of acute inflammatory neuropathy. Antibodies against peripheral nerve gangliosides and their own complements are recognized as an important mechanism of nerve damage in GBS. Pharmacokinetics of intravenous immunoglobulin (IVIg) therapy and other related factors that influence prognosis has been researched. In order to investigate the possible role of complement inhibition in GBS management, new studies will be conducted. The management of GBS should be provided in appropriate hospital units, with specialist teams, intensive care and rehabilitation facilities as essential parts. This article aims to provide updated management of GBS.Citation: Imelda NC, Baktir F, Fidiana, Hidayati HB, Basuki M. Updates in the management of Guillain Barre Syndrome. Anaesth Pain & Intensive Care 2018;22 Suppl 1:S54-S57
Background and Purpose Guillain-Barre syndrome (GBS) is a common cause of inflammation-related acute flaccid paralysis, and is characterized by acute onset, rapid progression, and symmetrical weakness. GBS is an emergency with high morbidity and long-term disability rates. It is important to determine the prognostic factors for GBS in order to improve the disease outcomes. This study aimed to identify the correlation between the neutrophil-to-lymphocyte ratio (NLR) on day 1 of hospitalization (D1) and motor deterioration in GBS patients. Methods This observational analytical study applied a cross-sectional analysis to the medical records of GBS patients who were hospitalized at Dr. Soetomo General Hospital Surabaya from January 2018 to March 2020. The analysis used the chi-square bivariate test, multivariate analysis with logistic regression, and correlation analysis with the Spearman test. Results The study included 61 subjects. Statistical tests showed that there was no correlation between NLR and changes in the Medical Research Council sum scores (ΔMRC sum scores) during D1–D3, D1–D7, D1–D14, and D1 to the day of discharge ( p >0.05). There was a significant correlation between NLR and the Erasmus GBS outcome score (EGOS) ( p =0.006). NLR values differed significantly within each treatment group ( p =0.001). Therefore, a subanalysis within each treatment group was conducted, which revealed a significant negative correlation ( p <0.05) between NLR and the ΔMRC sum score during D1–D14 in the group treated without immunotherapy. Conclusions There was no correlation between NLR and motor deterioration in patients with GBS during hospitalization. However, NLR was significantly correlated with EGOS, and there was a negative correlation between NLR and motor deterioration during D1–D14 in GBS patients treated without immunotherapy.
Background and Objective. The poor control of blood glucose levels in patients with diabetes mellitus is a major risk factor from various complications of diabetes mellitus, such as polyneuropathy. One of the nerves that are often affected in the case of diabetic neuropathy is the peroneal nerve. This study aimed to determine the association between blood glucose level control measured with serum hemoglobin A1c (HBA1c) levels with peroneal motor nerve conduction velocity in type 2 diabetes mellitus patients with polyneuropathy.Methods. The study was conducted on diabetic neuropathy patients who fulfilled inclusion and exclusion criteria in neurology unit and diabetes unit Dr. Soetomo General Hospital Surabaya on a consecutive basis from February to July 2013. The serum HbA1c level and nerve conduction velocity in peroneal motor nerve were examined; then, the results were grouped into two groups which were serum HbA1c <7% and ≥7% and NCV in normal and low peroneal motor nerve Results. There were 26 subjects, consisting of 6 subjects with serum HbA1c <7% and 20 subjects with serum HbA1c ≥ 7%. There was an association between blood glucose level control measured by serum HbA1c levels and NCV in peroneal motor nerve with statistical significance of p = 0.0018 (Odd ratio 15; 95% IK 1.397 -161.045). Conclusion.There was an association between blood glucose level control measured by serum HbA1c levels with NCV in peroneal motor nerve in type 2 diabetes mellitus patients with polyneuropathy.
Carpal Tunnel Syndrome (CTS) is known to be the most common type of compression neuropathy of the upper extremities. Carpal Tunnel Syndrome (CTS) is caused by compression of the nerve that runs through the carpal tunnel, namely the median nerve. Carpal Tunnel Syndrome (CTS) is very often experienced by workers whose daily activities always use repetitive movements of the wrist and a fixed position for a long time. Several factors are known to be a risk factor for CTS, such as repetitive movements with force, pressure on the muscles, non-ergonomic work postures, and others. Carpal Tunnel Syndrome (CTS) is a syndrome that can actually be prevented because there are no risk factors that cannot be changed except for age.
Background: Distal diabetic sensorimotor polyneuropathy is a common complication occurred in diabetes mellituspatients. Even though the number of diabetes mellitus patients has been increasing, the prevalence is still far from its actual numbers due to diagnostic and method criteria. Objectives:We aimed to determine Toronto Clinical Neuropathy (TCN) and modified Toronto clinical neuropathy (mTCN) scores in distal diabetic sensorimotor polyneuropathy patients. Methods: Cross-sectional study was carried out from October 29 th , 2014-June 1 st , 2015 in 77 diabetes mellitus patients who visited Outpatient Clinic. Polyneuropathy diagnosis was based on TCN and mTCN scores, with gold standard of peroneal and/or sural nerve conduction velocity examination.
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