Clinical outcome of Guillain-Barré syndrome with various treatment methods and cost effectiveness: A study from tertiary care center in South India: Yashoda GBS Registry

Back ground and Objective: Both plasmapheresis and intra venous immunoglobulin (IVIG) are effective for Guillain-Barré syndrome (GBS) but differ in cost and ease of administration. The aim of this study was to evaluate and compare clinical outcome after treatment with IVIg and plasmapheresis in patients with various GBS subtypes and assess their cost effectiveness. Methods: Thirty seven consecutive GBS patients, recruited from May 2008 to September 2012, from Department of Neurology, Yashoda hospital Hyderabad, underwent detailed clinical and electrophysiological assessment. Patients randomly received either IVIG or plasmapheresis. Outcome was measured using change in mean motor power and Hughes grade at discharge. Effectiveness and duration of hospital stay was compared with cost effectiveness of both therapies. Results: Out of 37 patients; men were 23 (62.1%), mean age was 42.3 +14.1 years. Electro physiologically acute inflammatory demyelinating neuropathy (AIDP) was most common (56.7%). Nineteen patients (51.3%) received IVIG and plasmapheresis was done in 18 (48.6%). Cost of plasmapheresis was significantly lower (mean USD 2,584.5 versus USD 4,385.3) (p=0.01). At discharge, significant and similar improvement was noted in both groups although duration of hospital stay was longer in plasmapheresis group Three patients (2 in plasmapheresis and one in IVIG group) died. Conclusion: In developing countries, plasmapheresis may be a better option in treatment of GBS.

Serum 25-Hydroxyvitamin D Deficiency in Ischemic Stroke and Subtypes in Indian Patients / 대한뇌졸중학회지

BACKGROUND AND PURPOSE: Vitamin D deficiency is common across all age groups and may contribute to cardiovascular diseases. Serum 25-hydroxyvitamin D deficiency causing ischemic stroke has been documented in recent reports. AIM: To investigate the association of serum 25-hydroxyvitamin D deficiency with ischemic stroke and subtypes. METHODS: We recruited 250 consecutive ischemic stroke patients and 250 age and sex matched controls attending the Department of Neurology, at Yashoda hospital, Hyderabad, India, from January 2011 to December 2012. All ischemic stroke patients underwent stroke subtyping. We measured 25-hydroxyvitamin D by chemiluminescence test, serum calcium, phosphorus, alkaline phosphatase, and C-reactive protein (CRP) in cases and controls. RESULTS: Out of 250 stroke patients, 190 (76%) were men and mean age was 58.4+/-11.1 years (age range-26-89 years). 25-hydroxyvitamin D deficiency was observed in 122 (48.8%) stroke patients and 79 (31.6%) controls (P=0.001). Among stroke patients, serum 25-hydroxyvitamin D deficiency was found in 54.9% (50/91) of patients with large artery atherosclerosis, 54% (20/37) in cardioembolic stroke, 44.4% (20/45) in small artery diseases, 42.8% (15/35) in stroke of other determined etiology and 40.4% (17/42) in stroke of un-determined etiology. Multiple logistic regression analysis showed an independent association of 25-hydroxyvitamin D deficiency with ischemic stroke (odds ratio: 1.6; 95% CI 1.2-2.8). The association was strongest with large artery atherosclerosis (odds ratio: 2.4; 95% CI 1.6-3.5) and cardioembolic stroke (odds ratio: 2.0; 95% CI 1.0-3.2). CONCLUSIONS: We found that 25-hydroxyvitamin D deficiency had an independent association with ischemic stroke. The association was established in large artery arthrosclerosis and cardioembolic stroke.

Hyperhomocysteinemia associated with Chlamydia pneumoniae infection in ischemic stroke: A hospital based study from South India

Background and objective: While Chlamydia pneumoniae infection and hyperhomocysteinemia have been shown to contribute independently to the atherosclerotic risk, recent evidence has linked the association of C. pneumoniae positivity and hyperhomocysteinemia in patients with established atherosclerosis. The aim of this study was to investigate whether such a relationship can be replicated in India, where both infections and hyperhomocysteinemia are prevalent. Methods: Patients of acute ischemic stroke enrolled consecutively and prospectively in the Nizam’s Institute Stroke Registry, Hyderabad, India (NISHI) were subjected to thorough clinical and neuroimaging evaluation. Blood was drawn in fasting state for estimation of homocysteine level and the titers of C. pneumoniae antibodies (IgG and IgA) by microimmunofluorescence method. Results: Of the 200 stroke patients, 72 (36%) were tested positive for C. pneumoniae antibodies, and 128 (64%) tested negative. The percentage of subjects with hyperhomocysteinemia, smoking, hypercholesterolemia and C-reactive protein positivity was higher in C. pneumoniae positive group compared with C. pneumoniae negative group. Multiple logistic regression analysis showed that hyperhomocysteinemia was an independent variable in the C. pneumoniae positive group (Odds ratio 4.71 95% CI 2.2-9.8). Conclusion: This study has shown that C. pneumoniae seropositivity is linked with hyperhomocysteinemia in patients with ischemic stroke in a sample of South Indian population.