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Journal club

Journal club. GUILLIAN BARRE SYNDROME IN ETHIOPIAN PATIENTS Zenebe Melaku,Guta Zenebe,Abera Bekele,2005,Ethiop Med J,43. Introduction. GBS -acute inflammatory demyelinating polyradiculoneuropathy Epidemiology: Incidence -Worldwide average annually 0.4-1.7/100,000 popn.

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Journal club

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  1. Journal club GUILLIAN BARRE SYNDROME IN ETHIOPIAN PATIENTS Zenebe Melaku,Guta Zenebe,Abera Bekele,2005,Ethiop Med J,43

  2. Introduction GBS-acute inflammatory demyelinating polyradiculoneuropathy Epidemiology: Incidence-Worldwide average annually 0.4-1.7/100,000 popn. Race-no selection -in US blacks<<whites Etiology-unclear -usually associated with antecedent triggering agent(infection commonly) -HIV implicated

  3. Introduction… • Pathogenesis-generally accepted that an immune mediated process • Clinical & pathologic features—generally similar worldwide • Mortality- markedly in developed nations (20%2-3%) due to plasma exchange & intensive respiratory & cardiovascular care

  4. Background information • There was no study in Ethiopia b/r this & published African studies were few. • Black lion hospital;a 30 hospital serving the whole country of >70 million people in the capital of Ethiopia,Addis Ababa,is selected for the study. • All GBS suspected patients other than children are admitted to internal medicine wards & MICU.

  5. Objective of the study • To describe clinical characteristics & outcome of GBS in Ethiopian patients.

  6. Definition used for diagnosis • Based on the national institute of Neurological & communicative disorders & stroke diagnostic criteria: • 1-Progressive weakness of >1 limb due to neuropathy • 2-Areflexia or hyporeflexia • 3-Duration of progress <4 weeks • 4-Absence of sharp sensory level on the trunk • 5-Absence of other causes of acute neuropathy • 6-<50 mononuclear leukocytes/mm3 in CSF

  7. Methodology • Study period-sept.1992-sept.2001 • Study population-all patients admitted with diagnosis of GBS • Target population-those who met the specified dxic criteria • Study type-descriptive retrospective study • Sampling-convenient sampling • Data collection-clinical & laboratory information from hospital records transferred into structured data sheet. • Data analysis-Epi info stat.software version 6.04

  8. Results • 95 patients admitted with diagnosis of GBS.81 met the dxic criteria. • Sex- 55.6% M & 44.4% F • Age range-13-75yrsmean34.4yrs -71.6% are <40yrs -most in age gp.30-39(37.9%)

  9. Results… • C/F--Antecedent event (58.1%) URTI(30.9%),Diarrhea (23.5%),Antecedent hx of vaccination (3.7%anti-rabies vaccine in all cases) • At the end of 1st&2nd wk~80%& 90% of pts respectively had developed max.weakness • CN palsies-commonest-facial diplegia(30.9%) -9th&10th CN involvement in(12.3%) -multiple CN palsy(12.3%) • Autonomic dysfun.-BP,tachycardia,sphinicter dysfucnction,rhythm d/o & sweating more common. • EMG was done for 47 patients. Demyelinating (55.3%) , axonal (19.1%),mixed(25.5%)

  10. Results…. • 70.3% of 27 patients for whom serology for HIV was done were seropositive • C/f similar for both HIV+&-pts except the higher frequency of CSF pleocytosis,need for ventilatory support & mortality among HIV+

  11. Results • Specific Rx (IV Ig)given only for five(6.2%) of the patients. None received plasmapheresis or steroids. • Mortality–21/81pts(25.9%)-main causes of death:resp.failure(4),pneumonia(5),UTI with uncontrolled sepsis(2)& sudden cardiac arrest(5)&not specified(5). • Outcome on discharge-64.2% had partial to complete recovery. -9.8% discharged with no change

  12. Discussion • Comparison with African studies • Similar in:-higher male sex -lower mean age -time interval from onset to maximum weakness -longer duration from onset to admission(lack of accessibility to medical facilities) -higher % of HIV+ -HIV+GBSinitial AIDS defining illness

  13. Discussion • Different in: -higher antecedent infection than that of Tanzania& Nigeria and ~Kenya -higher mortality than Nigeria(better intensive care).~to Tanzania & Kenya report. -higher frequency of cranial nerve involvement

  14. Comment • Strength:-pioneer study in Ethiopian set up & adds up to few African studies. -the selected 30 teaching hospital is better in terms of patient flow & chart registry -the study used standard diagnostic criteria -peaks out important defects that lead to delayed presentation,management & bad outcome -stimulates & leaves background for future studies.

  15. Comment • Weak points: retrospective study - may miss potential candidate due to improper registry or other reason. - may make data inadequate as to standard. (eg-only 27 patients were found to be screened for HIV) - the sample size is inadequate to give validated statistical analysis. (larger prospective study is needed)

  16. THANK YOU

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