ABSTRACT
Resumen El síndrome de Guillain-Barré (SGB) es una enfermedad inmunológica del nervio periférico y las raíces nerviosas, poco frecuente, potencialmente mortal y que suele desencadenarse por infecciones. La incidencia del SGB puede aumentar durante el brote de enfermedades infecciosas, tal como se observó en las epidemias del virus Zika en la Polinesia Francesa en 2013 y en América Latina en 2015. El diagnóstico y el manejo clínico del SGB pueden ser complicados ya que su presentación y el curso de la enfermedad son heterogéneos, y actualmente no se cuenta con guías clínicas internacionales. Para respaldar a los médicos, especialmente en el contexto de un brote de una enfermedad infecciosa, hemos desarrollado una guía clínica aplicable en todo el mundo para el diagnóstico y el tratamiento del SGB. La guía se basa en literatura actualizada y el consenso de expertos, y tiene una estructura de diez pasos para facilitar su uso en la práctica clínica. Inicialmente, brindamos una introducción a los criterios de diagnóstico, variantes clínicas y diagnósticos diferenciales del SGB. Los diez pasos luego abordan el reconocimiento y el diagnóstico temprano del SGB, la admisión a la unidad de cuidados intensivos, indicación y selección de tratamiento, seguimiento y tratamiento de la progresión de la enfermedad, predicción del curso clínico, resultados y tratamiento de complicaciones y secuelas.
Abstract Guillain-Barré syndrome (GBS) is a rare, but potentially fatal, immune-mediated disease of the peripheral nerves and nerve roots that is usually triggered by infections. The incidence of GBS can therefore increase during outbreaks of infectious diseases, as was seen during the Zika virus epidemics in 2013 in French Polynesia and in 2015 in Latin America. Diagnosis and management of GBS can be complicated as its clinical presentation and disease course are heterogeneous, and no international clinical guidelines are currently available. To support clinicians, especially in the context of an outbreak, we have developed a globally applicable guideline for the diagnosis and management of GBS. The guideline is based on current literature and expert consensus, and has a ten-step structure to facilitate its use in clinical practice. We first provide an introduction to the diag nostic criteria, clinical variants and differential diagnoses of GBS. The ten steps then cover early recognition and diagnosis of GBS, admission to the intensive care unit, treatment indication and selection, monitoring and treatment of disease progression, prediction of clinical course and outcome, and management of complications and sequelae.
Subject(s)
Humans , Guillain-Barre Syndrome/diagnosis , Guillain-Barre Syndrome/therapy , Guillain-Barre Syndrome/epidemiology , Zika Virus Infection/diagnosis , Zika Virus Infection/therapy , Zika Virus Infection/epidemiology , Incidence , Disease Outbreaks , Zika VirusABSTRACT
The objective of this study was to formulate appropriate responses by the public-health sector to reduce acute malnutrition among children in Cambodia. A cross-sectional survey to identify wasting together with a simple wealth-ranking exercise was conducted. Thereafter, separate focus-group discussions were also conducted with mothers of malnourished and non-malnourished children, who belonged to the poorest strata, to identify coping mechanisms and to assess feeding and hygiene practices. There was no statistical correlation between wasting and socioseconomic status (df=3, p=0.06). Reported feeding practices were poor, including not giving of colostrum, too early introduction of weaning, low feeding frequency, and late introduction of nutritious foods. Healthcare-seeking behaviour appeared inadequate, and hand-washing with soap was not practised. Acute malnutrition was mainly related to these factors rather than to food insecurity. An education campaign in tandem with peer-counselling would be the most appropriate option.