Guillain Barre Syndrome in the elderly: Experience from a tertiary-care hospital in India

Nagappa, Madhu; Rahul, W.; Sinha, Sanjib; Bindu, Parayil Sankaran; Mathuranath, P. S.; Rao, Shivaji; Periyavan, Sundar; Gs, Rao; Taly, Arun B.

doi:10.1016/j.jocn.2017.08.048

Cited by 13 publications

(14 citation statements)

References 29 publications

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“…We took cut off of albumin as less than 2.8 as it represented the lowest threshold while calculating CTP score. The finding was similar to the study by Vanbiervliet G et al 6 where albumin was shown to be predictor of bleeding risk along with presence of peptic esophagitis, high APRI and low prothrombin index. The low albumin can be associated with delayed ulcer healing and thus more ulcer related complications.…”

Section: Discussionsupporting

confidence: 91%

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Outcome of Post Esophageal Variceal Band Ligation with Sucralfate and Proton Pump Inhibitor vs. Proton Pump Inhibitor Alone in Cirrhotic Patients

et al. 2019

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Introduction:Endoscopic band ligation is the mainstay of treatment in bleeding varices in cirrhosis. Subsequent bleeding from the band ulcers is a possible complication. Proton pump inhibitors and Sucralfate are commonly used post band ligation and often in combination. The aim of the study was to identify the advantage of combining Sucralfate to proton pump inhibitor in reducing the number and size of band ulcers. Materials and Methods:This was an open label comparative study conducted in a tertiary level hospital of Nepal. Patients with cirrhosis after band ligation were included. Eligible patients were randomized into a proton pump inhibitor alone (Group A) or proton pump inhibitor and sucralfate group (Group B) and they underwent upper gastrointestinal endoscopy after two weeks. Baseline parameters, number and mean size of band ulcers were compared. Results:A total of 58 patients, 29 in each group, were evaluated. The baseline characteristics were comparable. EBL was done for bleeding varices in 51.7% and as primary prophylaxis in the rest of them. All the patients had band ulcers after two weeks. The mean size of the largest ulcer was 1.62±0.72 and 1.10±0.60 (p=0.78) respectively in group A and B. Low albumin was significantly associated with OR of 8.7 (95% CI:1.68-44.99) for the formation of multiple (more than two) ulcers (p=0.01). Conclusions:The ulcer formation was universal after band application. The addition of sucralfate did not offer more benefits in terms of the number and mean size of the ulcer. Low albumin was the independent predictor for multiple ulcer formation.

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Section: Discussionsupporting

confidence: 91%

“…5 Once there is EBL ulcer bleeding, the management can be challenging and the mortality can reach as high as 52%. 6 The EBL ulcers heal faster than post-sclerotherapy ulcers. 7 Use of either proton pump inhibitors (PPI) or mucoprotectant like Sucralfate can reduce the ulcer size and its numbers.…”

mentioning

confidence: 99%

Outcome of Post Esophageal Variceal Band Ligation with Sucralfate and Proton Pump Inhibitor vs. Proton Pump Inhibitor Alone in Cirrhotic Patients

et al. 2019

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“…12 Variation in the number of patients treated with IVIg, PE or symptomatic management has been found in different studies. 6,12 In our study, 50% of the patients presented at our center just had mild symptoms at presentation, didn't progress much to nadir, and earlier improvement was seen.…”

Section: Discussionmentioning

confidence: 51%

“…In a recent study in India, only 16% elderly and 6% adult GBS patients were treated with IVIg infusion, whereas 84% elderly and 92% adult GBS patients received PE. 6 In low economic countries, use of plasma exchange is high due to the cost factor where the facility of low volume plasma exchange is available. 12 Variation in the number of patients treated with IVIg, PE or symptomatic management has been found in different studies.…”

Section: Discussionmentioning

confidence: 99%

“…4 Respiratory failure, Dysautonomia, sepsis and myocardial infarction were the common causes of mortality. 6,18,25 Since IVIg is given in patients with severe Weakness with or without respiratory muscles weakness, it is likely that these patients are at higher risk of complications. One of our patients died in ICU due to sepsis and another due to dysautonomia in recovery phase.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Outcome of Intravenous Immunoglobulin in the treatment of Guillain Barre Syndrome in a Nepalese Tertiary Centre

Ojha

Karn

2019

Nep. Med. J.

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Introduction: Intravenous Immunoglobulin is an approved therapy for Guillain Barre Syndrome. Our objective is to understand the management and outcome in Guillain Barre Syndrome patients treated with Immunoglobulin.Materials and Methods: All consecutive patients were retrospectively evaluated in the study were of age ≥16 years and were being admitted in the department of Neurology of Tribhuvan University Teaching Hospital, Kathmandu, Nepal from 2016 March to 2017 February.Results: A total of 46 patients were included, mean age= 36.5±16.2 years, range = 16years to 80 years. Thirty-two patients (70%) were axonal variant, acute motor axonal neuropathy is more common (18 patients). Intravenous immunoglobulin was used in 23 patients (50%), 17 of them were axonal variant and 6 were demyelinating. Guillain Barre Syndrome patients with bilateral facial weakness (70% vs 30%; p<0.05) were likely to receive immunoglobulin therapy. Patients with immunoglobulin were found to have higher ODSS at Nadir (9.3±1.8 vs 6.9±1.9; p <0.001) and discharge than patients without immunoglobulin treatment (6.2±1.7 vs 5.0±1.6; p=0.001). At Nadir, Patients with immunoglobulin were found to have higher Guillain Barre Syndrome disability score (4.1±0.7 vs 3.2±0.9; p<0.095). In immunoglobulin group, Axonal variants were found to havehigher ODSS score (9.6±1.9 vs 8.2±0.9, p=0.027) and Guillain Barre Syndrome disability score (4.2±0.7 vs 3.5±0.5; p=0.019) at nadir than demyelinating group.Conclusions: Intravenous Immunoglobulin is easier to administer and is safe with fewer adverse effects. Although expensive, it is an effective treatment option in a resource-limited center. Axonal variants are clinically severe and likely to be need of Intravenous Immunoglobulin therapy.

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Ganglioside complex antibodies in an Indian cohort of Guillain‐Barré syndrome

et al. 2020

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Background: Antibodies against ganglioside complexes (GSCs) are associated with various clinical features and subtypes of Guillain-Barré syndrome (GBS). Methods: One-hundred patients were evaluated for antibodies to GSCs formed by combination of GM1, GM2, GD1a, GD1b, GT1b, and GQ1b using manual enzyme linked immuno-sorbent assay (ELISA). Results: Twenty-six patients were GSC antibody-positive, most frequent being against GM1-containing GSC (76.9%). Gender distribution, mean age, symptom-duration, antecedent events, electrophysiological subtypes, requirement for mechanical ventilation, and median duration of hospital stay were comparable between the GSC antibody-positive and negative groups. There was no association between specific GSC antibody and electrophysiological subtypes or clinical variants. After controlling for false discovery rate (FDR) using the Benjamini-Hochberg method, the number of subjects who improved in overall disability sum score, modified Erasmus GBS outcome score, and neuropathy symptom score at discharge was significantly higher in the GSC antibody-positive group. Improvements in Medical Research Council sum scores and Hughes Disability Scale during the hospital stay between the GSC antibody-positive and negative groups were not significantly different after controlling for FDR.

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Guillain Barre Syndrome in the elderly: Experience from a tertiary-care hospital in India

Cited by 13 publications

References 29 publications

Outcome of Post Esophageal Variceal Band Ligation with Sucralfate and Proton Pump Inhibitor vs. Proton Pump Inhibitor Alone in Cirrhotic Patients

Outcome of Post Esophageal Variceal Band Ligation with Sucralfate and Proton Pump Inhibitor vs. Proton Pump Inhibitor Alone in Cirrhotic Patients

Clinical Outcome of Intravenous Immunoglobulin in the treatment of Guillain Barre Syndrome in a Nepalese Tertiary Centre

Ganglioside complex antibodies in an Indian cohort of Guillain‐Barré syndrome

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