Guillain-Barré syndrome (GBS) is a life-threatening form of inflammatory polyneuropathy. Immunotherapy with intravenous immunoglobulin (IVIG) has been used successfully in the treatment of GBS. In this case report, we present a severe axonal form of GBS that showed improvement after 3 cycles of IVIG. Repeated cycles of IVIG may be an option for treating severe forms of GBS not responding to the first course of such treatment. The recent work suggests that patients who are severely affected and have severe gadolinium enhancement on the magnetic resonance imaging of the spine should be considered for retreatment with IVIG. Although the cost of management was high, the outcome was excellent, which is definitely considered a reasonable approach. This case report is an urgent call for performing large multicenter trials on the use of repeated cycles of IVIG in the management of severe cases of GBS.
The concomitance between Parkinson's disease (PD) and myasthenia gravis (MG) is rare, with only a few case reports in the literature and only one of them with positive anti-muscle specific kinase (anti-MuSK) MG. The overlap between PD and MG symptoms can cause a diagnostic dilemma for the treating physician. In this report, we present a 73-year-old lady with a history of recurrent falls, dysphagia, and diplopia. She was found to have ptosis, vertical gaze restriction, neck extension, and flexion weakness, as well as features of parkinsonism, including masked face appearance, asymmetrical limbs rigidity, and bradykinesia. She was found to have a high titer antibody for MuSK MG. Her MG symptoms were treated successfully with rituximab.
Study Objective: The COVID-19 pandemic has placed an unprecedented psychological burden on emergency medicine (EM) providers who have experienced anxiety, depression, isolation, burnout, and poor self-care. ACEP along with 44 medical organizations issued a statement in support of clinician health in the postpandemic period calling for the removal of barriers to mental health care and using non-clinical mental health support, specifically peer support, to foster resilience and recovery. While physicians prefer to seek support from colleagues, formal peer support interventions are not well studied. The objectives of the study were to determine feasibility, receptivity, and effect of physician peer support groups on symptoms of acute distress, anxiety, depression, and burnout.Methods: A quasi-experimental design was used to determine pre-post intervention changes in anxiety and depression (primary outcomes) using the Patient Health Questionnaire (PHQ-4); provider burnout using the Maslach Burnout Inventory; and distress symptoms (fatigue, trouble sleeping, nervousness, feeling down, anger, helplessness, guilt, difficulty concentrating) using the SPADE Symptom Screener and PROMIS measure. The Participant-rated Global Impression of Change was used to monitor whether feeling better at the end of each session compared to the beginning. Receptivity was assessed using a net promoter score question. The study population was emergency physicians serving 10 academic and community hospitals who selfidentified as having any mental health challenge during the pandemic. Three groups of 8 providers were recruited via departmental email listservs to participate in eight 1-hour virtual, peer support group sessions via Zoom Health. The visit structure was based on the National Alliance of Mental Illness (NAMI) peer support model and adapted for use in the clinician population. Three physicians were trained to cofacilitate with a NAMI support group leader. Data were collected using the Zoom polling function. Change analysis was conducted using dependent t-tests in SPSS. A sample size of 16 clinicians was needed to provide 80% power for two-sided tests at an alpha of 0.05 to detect a large effect size of 1.0 (3-point absolute change) for the PHQ-4.Results: Of the 24 participating physicians, the majority were faculty physicians, white, female, and in practice 5 years or less. Average attendance was 6.5 sessions with 83% of physicians reaching the attendance goal of 6 out of 8 sessions. On average, participants reported feeling better at the end compared to the beginning of each session. Eighty six percent of physicians reported they would recommend peer support groups to a friend or colleague. Positive effect sizes showed improvement in 8 of 11 distress symptoms, and marginal significance (p<.10) for guilt and anxiety.Conclusions: High levels of attendance, feeling better at the end of sessions, and willingness to recommend peer support groups to friends or colleagues demonstrate high physician receptivity to peer support and feasibil...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.