Background: There is emerging evidence that Guillain–Barré syndrome (GBS) may be associated with coronavirus disease 2019 (COVID-19) infection. The aim of this review was to investigate the strength of the evidence.Method: The review was registered in PROSPERO (CDR42020184822). Three electronic databases, MEDLINE, PubMed, and Web of Science, and three preprint servers, MedRvix, ChemRvix, and BioRvix, were searched from December 2019 to 24th September 2020. Studies were included if they were on COVID-19 and of any design. Articles that are reviews or opinion were excluded. The selection process was carried out using EndNote and Rayyan software. The main outcomes in the study were study design, sample size, sex, age, overall GBS symptoms, other COVID-19 symptoms, comorbidity, timing between infection and the onset of neurological symptoms, CT, MRI, and EMG results. Methodological quality of the studies was assessed using the McMaster Critical Review Form. The collected data was analyzed using qualitative synthesis.Findings: Fifty-one high-quality studies (mostly) consisting of 83 patients were included in the study. All of the patients (except in a very few) in the included studies had confirmed diagnosis of COVID-19. Similarly, the diagnosis of GBS was based on standard clinical, electrophysiological, and cerebrospinal fluid (CSF) criteria.Conclusion: GBS may be associated with COVID-19, and therefore, testing for COVID-19 is recommended in patients presenting with GBS during this pandemic.
Letter to the Editor
Risk of COVID-19 disease in the elderly population and physiotherapyDear Editor, COVID-19 occurs with symptoms like fever, cough, myalgia, fatigue, muscle weakness, and impairment in other important bodily functions [1]. As a result of the clinical course of COVID-19 infection, rapidly developing acute respiratory distress syndrome (ARDS) requires intubation and mechanical ventilation (MV) [2]. Comorbid diseases like aging, diabetes mellitus, hypertension, cerebrovascular diseases, chronic respiratory diseases, cancer, etc. along with ARDS were reported to be risk factors for death in patients with . Elderly individuals who are vulnerable to disease are hospitalized in the intensive care unit because they experience the disease more severely and their mortality risk is higher [4]. However, while the health services attempt to prevent patients from dying, early physiotherapy management of COVID-19 patients with ARDS in ICU has been ignored. Studies show that early respiratory physiotherapy of patients with ARDS is an important evidence-based method for the treatment of ARDS. But in the ICU, patients with ARDS are immobilized due to MV or intubation. Immobilization has a dominant effect on diaphragm and limb muscle weakness in patients with critical illness in the ICU [5]. So passive-active mobilization with specific muscle training is required for COVID-19 patients with ARDS in ICU, not only respiratory training. Immobilization, infections, MV and prolonged steroid administration are well-known risk factors for ICU-acquired weakness (ICUAW) which has significant effects not only on patient recovery, and length of ICU stay, but also on rehabilitation in 100% of ICU survivors. Patients with ICUAW develop muscle atrophy, paresis, and reduced deep tendon reflexes which are effective on long-term (after ICU or hospital discharge) rehabilitation management [6]. Rehabilitation after discharge from the ICU is often noticeably slow, particularly in elderly patients. Neuromuscular
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