Ventilación mecánica, tiempo de hospitalización, muertes y discapacidad según las variantes del síndrome de Guillain-Barré: revisión sistemática y metaanálisis / Mechanical ventilation, hospitalization time, deaths and disability according to the variants of Guillain-Barré syndrome: systematic review and meta-analysis

RESUMEN Objetivos. Determinar el requerimiento y tiempo para ventilación mecánica y Unidad de Cuidados Intensivos (UCI), hospitalización y tiempo de hospitalización, muerte y discapacidad de las variantes axonales del Síndrome de Guillain-Barré (SGB) en comparación con la variante aguda desmielinizante en pacientes de todas las edades. Materiales y métodos. Revisión sistemática que incluyó pacientes con SGB; la exposición fueron las variantes axonales y el comparador la polineuropatía desmielinizante inflamatoria aguda (AIDP) los desenlaces fueron el requerimiento y tiempo en ventilación mecánica (VM), requerimiento y tiempo en la UCI, tiempo de hospitalización, discapacidad y muerte. Se utilizó la escala NewCasttle-Ottawa (NOS) para evaluar el riesgo de sesgo. Se realizó un metaanálisis para calcular las diferencias de medias y los riesgos relativos (RR) con sus intervalos de confianza (IC) del 95% utilizando varianzas inversas y modelos de efectos aleatorios. Resultados. De los 3116 artículos encontrados, 46 cumplieron los criterios de selección. El tiempo en VM fue 7,42 días (IC95%: 0,36 a 1,48) y el tiempo de hospitalización fue 3,11 (IC95%: 0,73 a 5,49) días en las variantes axonales. Las variantes axonales tuvieron un RR de 0,47 (IC95%: 0,24 a 0,92) para el requerimiento de VM en adultos, pero en niños fue de 1,68 (IC95%: 1,25 a 2,25). Hubo una alta heterogeneidad estadística. Conclusiones. Las variantes axonales tienen en promedio mayor tiempo de VM y de hospitalización, en total y por subgrupos. Se observó un mayor requerimiento de VM para las variantes axonales en niños; mientras que en los adultos fue menor.

ABSTRACT Objectives. To determine the requirement and time to mechanical ventilation and Intensive Care Unit (ICU), hospitalization and hospitalization time, death and disability of the axonal variants of Guillain-Barré Syndrome (GBS) in comparison with the acute demyelinating variant in patients of all the ages. Materials and methods. The systematic review that included patients with GBS. The exposure variable was the axonal variants and the comparator was acute inflammatory demyelinating polyneuropathy (AIDP). The outcomes were the requirement and time on mechanical ventilation (MV), requirement and time in the ICU, hospitalization time, disability and death. The NewCasttle-Ottawa Scale (NOS) was used to assess risk of bias. A meta-analysis was conducted to calculate mean differences and relative risks (RR) with their 95% confidence intervals (CI) using inverse variances and random effects models. Results. Of the 3116 articles found, 46 met the selection criteria. The time on MV was 7.42 days (95% CI: 0.36 to 1.48) and the hospitalization time was 3.11 (95% CI: 0.73 to 5.49) days for the axonal variants. The axonal variants had a RR of 0.47 (95% CI: 0.24 to 0.92) for the requirement of MV in adults, but it was 1.68 (95% CI: 1.25 to 2.25) in children. There was a high statistical heterogeneity. Conclusions. Axonal variants showed, on average, longer MV and hospitalization time, overall and by subgroups. A high MV requirement was found for axonal variants in children; it was lower for adults.

Coletânea de Respostas Rápidas-Turma 1: programa educacional em vigilância em saúde no enfrentamento da COVID-19 e de outras doenças virais VigiEpidemia / Collection of Rapid Responses-Class 1: educational program in health surveillance in coping with COVID-19 and other viral diseases VigiEpidemia

Coletânea dedicada aos estudos das respostas rápidas do Programa Educacional em Vigilância em Saúde no enfrentamento da COVID-19 e outras Doenças Virais (VigiEpidemia). Esse tema é de extrema relevância e atualidade em nosso contexto da saúde global e na resposta as emergências em saúde pública (ESP) de forma geral. As ESP, que englobam surtos e epidemias, desastres e desassistência à população, representam desafios complexos que exigem respostas ágeis e eficazes por parte das autoridades sanitárias, profissionais da saúde e comunidades como um todo. Até o momento, a pandemia de COVID-19 foi a maior ESP do Século XXI. Ela serviu como um lembrete doloroso da vulnerabilidade da humanidade diante da ameaça de doenças virais. Esta ESP, que teve resposta catastrófica em diversos momentos, evidenciou a importância do investimento em preparação, vigilância e resposta, destacando a necessidade de sistemas de vigilância robustos, colaboração internacional, Inteligência epidemiológica e comunicação transparente para mitigar o impacto devastador das doenças infecciosas na sociedade. As lições aprendidas com a pandemia de COVID-19 são vastas e multifacetadas. A importância da pesquisa, da educação em saúde e do desenvolvimento de vacinas foi evidenciada como uma prioridade crucial na proteção da saúde pública mundial. O investimento em pesquisas e em cursos para formação de profissionais que possam estar atentos as mudanças nos padrões e comportamentos das doenças infecciosas, além de atuar na resposta rápida quando necessário, é fundamental para estarmos preparados para as futuras pandemias. A vacinação, por exemplo, sempre foi uma das ferramentas mais poderosas para evitar surtos e epidemias e, durante a pandemia de COVID-19, ajudou a controlar os óbitos pela doença e possibilitou que voltássemos a ter uma vida normal. Além da vacina contra COVID-19, as vacinas de influenza e dengue também são exemplos notáveis de avanços científicos que desempenham um papel fundamental na prevenção de futuras ESP. Ao explorar os diversos aspectos da resposta, monitoramento e controle de surtos, epidemias e pandemias, esta coletânea visa fornecer uma compreensão abrangente dos desafios enfrentados, das melhores práticas e das estratégias eficazes para mitigar os impactos adversos desses eventos. Espera-se que este trabalho não apenas informe e eduque, mas também inspire ações concretas para fortalecer a recuperação e resiliência dos sistemas de saúde e proteger o bem-estar das comunidades mais vulneráveis do nosso pais.

A collection dedicated to the study of rapid responses by the Educational Program in Health Surveillance in addressing COVID-19 and other Viral Diseases (VigiEpidemia). This theme is of utmost relevance and timeliness in our context of global health and in responding to public health emergencies (PHE) in general. PHEs, which encompass outbreaks and epidemics, disasters, and neglect of the population, represent complex challenges that require swift and effective responses from health authorities, healthcare professionals, and communities as a whole. To date, the COVID-19 pandemic has been the largest PHE of the 21st century. It served as a painful reminder of humanity's vulnerability in the face of viral disease threats. This PHE, which had catastrophic responses at various times, highlighted the importance of investing in preparedness, surveillance, and response, underscoring the need for robust surveillance systems, international collaboration, epidemiological intelligence, and transparent communication to mitigate the devastating impact of infectious diseases on society. The lessons learned from the COVID-19 pandemic are vast and multifaceted. The importance of research, health education, and vaccine development was highlighted as a crucial priority in protecting global public health. Investing in research and training courses to prepare professionals who can be attentive to changes in the patterns and behaviors of infectious diseases and act quickly when needed is essential to be prepared for future pandemics. Vaccination, for example, has always been one of the most powerful tools to prevent outbreaks and epidemics, and during the COVID-19 pandemic, it helped control disease-related deaths and allowed us to return to a normal life. In addition to the COVID-19 vaccine, influenza and dengue vaccines are also notable examples of scientific advancements that play a key role in preventing future PHEs. By exploring the various aspects of response, monitoring, and control of outbreaks, epidemics, and pandemics, this collection aims to provide a comprehensive understanding of the challenges faced, best practices, and effective strategies to mitigate the adverse impacts of these events. It is hoped that this work will not only inform and educate but also inspire concrete actions to strengthen the recovery and resilience of health systems and protect the well-being of the most vulnerable communities in our country.

Concurrencia de síndrome de Guillain-Barré y colangitis biliar primaria no vinculado a SARS-CoV-2: reporte de caso / Concurrence of Guillain-Barré syndrome and primary biliary cholangitis not related to SARS-CoV-2: case report

INTRODUCCIÓN: El síndrome de Guillain-Barré es una polirradiculoneuropatia de origen autoinmune, considerada la causa más frecuente de parálisis flácida aguda. Se han reportado diversas asociaciones del síndrome de Guillain-Barré con otras enfermedades autoinmunes no neurológicas, algunas de ellas extremadamente raras, como la que ocurre con la colangitis biliar primaria, una enfermedad crónica de etiología autoinmune cuyo diagnóstico se sustenta, además del cuadro clínico, en la alteración de las enzimas hepáticas y la presencia de anticuerpos anti-mitocondriales. CASO CLÍNICO: Paciente varón de 38 años, sin antecedente de comorbilidades previas, quien luego de presentar enfermedad diarreica dos semanas antes, desarrolló debilidad ascendente de inicio subagudo asociado a parestesias en cuatro extremidades que progresó hasta generar cuadriplejia y dificultad respiratoria. Se le realizó examen citoquímico de líquido cefalorraquídeo que evidenció disociación albumino-citológica y electromiografía que mostró hallazgos compatibles con neuropatía axonal motora aguda. Recibió tratamiento con inmunoglobulina intravenosa a dosis de 0,4 gramos por kilogramo al día, logrando mejoría del cuadro neurológico. Desde su ingreso y durante la hospitalización, presentó alteración persistente de las enzimas hepáticas que seguía un patrón colestásico. Además, se agregó dolor abdominal de leve intensidad y prurito generalizado, por lo cual fue evaluado por gastroenterología, quienes solicitaron anticuerpos anti-mitocondriales que resultaron positivos. Con esta prueba, se comprobó el diagnóstico de colangitis biliar primaria. CONCLUSIÓN: El presente caso muestra una asociación extremadamente rara de dos enfermedades autoinmunes; síndrome de Guillain-Barré y colangitis biliar primaria, tanto así que representa el primer caso reportado, no vinculado a SARS-CoV-2.

INTRODUCTION: Guillain-Barré syndrome is a polyradiculoneuropathy of autoimmune origin, considered the most frequent cause of acute flaccid paralysis. Various associations of Guillain-Barré syndrome with other non-neurological autoimmune diseases have been reported, some of them extremely rare, such as that which occurs with primary biliary cholangitis, a chronic disease of autoimmune etiology whose diagnosis is also supported by the clinical picture. , in the alteration of liver enzymes and the presence of anti-mitochondrial antibodies. CLINICAL CASE: A 38-year-old male patient, with no history of previous comorbidities, who, after presenting with diarrheal disease two weeks prior, developed subacute onset ascending weakness associated with paresthesias in four extremities that progressed to quadriplegia and respiratory distress. Cerebrospinal fluid cytochemistry was performed, which showed albuminocytological dissociation and electromyography, which showed findings compatible with acute motor axonal neuropathy, for which he received treatment with intravenous immunoglobulin at 0.4g/kg/day, achieving improvement in the neurological condition. Since admission and during hospitalization, he presented persistent changes in liver enzymes which followed a cholestatic pattern, in addition to mild abdominal pain and generalized itching, for which he was evaluated by gastroenterology, who requested anti-mitochondrial antibodies that were positive. Concluding in the diagnosis of primary biliary cholangitis. CONCLUSION: The present case shows an extremely rare association of two autoimmune diseases Guillain-Barré syndrome and primary biliary cholangitis, so much so that it represents the first case reported, not linked to SARS-CoV-2.

Research progress on the relationship between COVID-19 and autoimmune diseases / 中华预防医学杂志

Different autoantibodies can be detected in patients with coronavirus disease 2019 (COVID-19). It is reported that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection could induce autoimmune diseases (AID), including children's multisystem inflammatory syndrome (MIS-C), Guillain Barre syndrome (GBS), Autoimmune hemolytic anemia (AIHA), immune thrombocytopenia (ITP) and thyroid autoimmune diseases. This article mainly reviews the similarities between COVID-19 and AID, the possibility of COVID-19 inducing AID, the risk of AID patients infected or vaccinated against COVID-19. The purpose is to provide strategies for the prevention, management and treatment of AID during the epidemic.

Síndrome de Guillain barre asociado a infección por sars-cov-2: a propósito de un caso / Guillain-Barré Syndrome Associated with SARS-CoV-2 infection: A pediatric presentation

Introducción: la pandemia de SARS-CoV-2 exige una medicina fiable, basada en evidencia para poder comprender y tratar oportunamente las nuevas manifestaciones de esta enfermedad, previniendo así las complicaciones y la mortalidad infantil. Materiales y método: femenina de seis años ingresada en urgencias con síntomas neurológicos de entumecimiento en extremidades inferiores y superiores, ataxia, somnolencia y disartria. Después de un análisis de sangre, un examen del líquido cefalorraquídeo y una prueba de electromiografía, la paciente fue diagnosticada con síndrome de Guillain-Barré e infección concomitante por COVID-19. Resultados y discusión: se obtuvieron resultados positivos, tanto para el anticuerpo IgM como para la RT-PCR, para infección por SARS-CoV-2. No se encontró evidencia de celularidad en el examen del líquido cefalorraquídeo, pero se observó un alto nivel de proteína de 100 mg/dL y un nivel anormal de glucosa (58 mg/dL) en este paciente. Por último, se administró una terapia consistente en dexametasona 3,5 mg/kg, paracetamol 315 mg/kg, azitromicina 105 mg/kg y 50 mg/kg de inmunoglobulina intravenosa. Conclusión: considerando este caso clínico, reforzamos la hipótesis de la asociación entre el síndrome de Guillain-Barré y la infección por el virus SARS-CoV-2, como ya han documentado otros autores, tanto en adultos como en pacientes pediátricos.

Introduction: Ongoing SARS-CoV-2 pandemic calls for trustworthy, evidence-based medicine to be able to comprehend and treat opportunely new manifestations of this disease, therefore preventing complications and children mortality. Materials and methods: This case report adresses a unique presentation of Guillain-Barre syndrome (GBS) & COVID-19. Results: The patient was a 6-year-old girl admitted to the emergency room with neurological symptoms numbness in lower and upper extremities, ataxia, drowsiness, and dysarthria. After blood work, cerebrospinal fluid examination, and electromyography test, the patient was diagnosed with Guillain-Barre syndrome and concomitant COVID-19 infection. Both IgM antibody and RT-PCR were positive for SARS-coV-2 infection and no evidence of cellularity was found in cerebrospinal fluid examination, but a high protein level of 100 mg/dL and an abnormal glucose level (58mg/dL) was observed within this patient. Lastly, a therapy consisted of dexamethasone 3.5mg/kg, acetaminophen 315 mg/kg, azithromycin 105mg/kg and 50 mg/kg of intravenous immune globulin was administered. Conclusion: Considering this clinical case, we reinforce the hypothesis of the association between Guillain-Barré syndrome and SARS-CoV-2 virus infection, as has already been documented by other authors in both adults and pediatrics patients.

Alteraciones neuromusculares asociadas a la COVID-19. Revisión de la literatura científica / Neuromuscular Alterations Associated with COVID-19. A Scientific Literature Review

Introduction: The COVID-19 pandemic has brought short, medium, and long-term consequences on the quality of life of those affected. Among the complications are those related to the involvement of the nervous system and the structures involved in body movement, with sequelae that may be transitory and/or definitive, and require rehabilitation. Objective: Identify the neuromuscular alterations that affect body movement, associated with COVID-19. Material and methods: A search was made for observational works published in the SCOPUS, PubMed, EBSCO, and Nature databases between January 2020 and June 2022 under the PRISMA methodology, to answer the PICO question: what are the neuromuscular alterations that can potentially affect movement, associated with COVID-19? The established filters were type of study, language, age, availability, publication dates. The MeSH terms were SARS-Cov-2, COVID-19, Long Covid, Motor Activity Neuromuscular Diseases, Neurological Disorders, Guillain-Barré Syndrome, Myelitis Transverse, Stroke, Patient, Peripheral Nervous System Diseases. The methodological quality was evaluated according to STROBE and the level of evidence was established according to CEBM. Results: In the first search, 645 articles were identified. 637 were discarded by filters, titles, duplicate abstracts, methodological quality, and level of evidence. There were 8 articles selected for the present review in which neuromuscular alterations of central and peripheral origin were identified, such as myalgias, fatigue, polyneuroradiculopathies, CNS inflammation, among others, with clinical manifestations that affect movement. Conclusion: COVID-19 is a multisystemic disease that can affect the nervous system with symptoms of neuromuscular alterations that compromise body movement.

Introducción: La pandemia por la COVID-19 ha traído consecuencias a corto, mediano y largo plazo sobre la calidad de vida de los afectados. Entre las complicaciones se encuentran aquellas relacionadas con la afectación del sistema nervioso y las estructuras involucradas en el movimiento corporal, con secuelas que pueden ser transitorias y/o definitivas, y requieren rehabilitación Objetivo: Identificar las alteraciones neuromusculares que afectan el movimiento corporal, asociadas a la COVID-19. Material y métodos: Se hizo una búsqueda de trabajos observacionales publicados en las bases de datos SCOPUS, PubMed, EBSCO y Nature entre enero de 2020 y junio de 2022 bajo metodología PRISMA, para dar respuesta a la pregunta PICO: ¿cuáles son las alteraciones neuromusculares que potencialmente pueden afectar el movimiento, asociadas a la COVID-19? Los filtros establecidos fueron tipo de estudio, idioma, edad, disponibilidad y fechas de publicación. Los términos MesH fueron SARS-Cov-2, COVID-19, Long Covid, Motor Activity Neuromuscular Diseases, Neurological Disorders, Guillain-Barré Syndrome, Myelitis Transverse, Stroke, Patient, Peripheral Nervous System Diseases. La calidad metodológica se evaluó según STROBE y el nivel de evidencia se estableció según CEBM. Resultados: En la primera búsqueda se identificaron 645 artículos. Posteriormente se descartaron 637 por filtros, títulos, resúmenes duplicados, calidad metodológica y nivel de evidencia. Así, quedaron seleccionados 8 para la presente revisión, en los cuales se identificaron alteraciones neuromusculares de origen central y periférico, como mialgias, fatiga, polineuroradiculopatías, inflamación del SNC, entre otras, con manifestaciones clínicas que afectan el movimiento. Conclusión: La COVID-19 es una enfermedad multisistémica que puede afectar el sistema nervioso con síntomas de alteraciones neuromusculares que comprometen el movimiento corporal.

Síndrome de Guillain-Barré como manifestación neurológica autoinmune asociado a COVID-19: Una revisión de la literatura / no

La enfermedad por coronavirus (COVID-19) producida por el SARS-CoV-2 ha sido un reto para los servicios de salud en todo el mundo. La pandemia se ha extendido ampliamente con más de 80 millones de casos confirmados y más de un millón de muertes a nivel mundial, por lo que ha estado bajo constante investigación para entender todos los aspectos de la enfermedad. Recientemente se han reportado varios casos de pacientes con síndrome de Guillain-Barré asociado a COVID-19 como manifestación principal, convirtiéndola en la primera enfermedad neurológica autoinmune desencadenada por SARS-CoV-2; sin embargo, es necesario obtener más información para entender completamente los mecanismos inmunopatogénicos implicados en esta asociación.

The coronavirus disease (COVID-19) caused by SARS-CoV-2 has been a challenge for health services around the world. The pandemic has spread widely, with more than 80 million confirmed cases and more than one million deaths globally. There have been many studies to understand all aspects of the disease. Recently, several cases have been reported of patients with Guillain-Barré syndrome associated with COVID-19 as the main manifestation. As it may be one of the first autoimmune neurological diseases triggered by SARS-CoV-2, it is necessary to obtain more information to fully understand the immunopathogenic mechanisms involved in this association.

Guillain Barré syndrome in the paediatric population. Consequence of active infection or long Covid?

Background: Guillain-Barre syndrome is a polyradiculoneuropathy that has been associated with infectious diseases as triggers. There is currently little medical evidence exploring the relationship between the development of Guillain-Barre syndrome caused by SARS-CoV-2 infection and long Covid. Objective: To synthesize the medical evidence that describes the relationship between post Covid syndrome and Guillain-Barre syndrome in the paediatric population. Methodology: A scoping review was developed using Scopus and PubMed databases, including analytical and/or descriptive experimental and observational studies. Results: The main clinical manifestations presented by paediatric patients were distal and ascending weakness in the lower limbs and myalgia. The diagnostic approach was based on clinical findings, imaging findings on spinal magnetic resonance and electromyography. The therapeutic strategy is based on the use of intravenous human immunoglobulins. Conclusion: Guillain-Barre syndrome is a frequent disease in the paediatric population with active SARS-CoV-2 infection or in survivors, however, it is necessary to encourage further clinical studies that increase the medical literature that describes this association.

Introducción: El síndrome de Guillain-Barré es una polirradiculoneuropatía que se ha asociado con enfermedades infecciosas como desencadenantes. En la actualidad es escasa la evidencia médica que explore la relación entre el desarrollo del síndrome de Guillain-Barré causado por la infección por SARS-CoV-2 y la COVID prolongada. Objetivo: Sintetizar la evidencia médica que describe la relación entre el síndrome pos-COVID y el síndrome de Guillain-Barré en la población pediátrica. Metodología: Se realizó una revisión exploratoria utilizando las bases de datos de Scopus y PubMed, incluyendo estudios experimentales y observacionales analíticos o descriptivos. Resultados: Las principales manifestaciones clínicas presentadas por los pacientes fueron debilidad distal y ascendente en miembros inferiores y mialgias. El enfoque diagnóstico se apoyó en los hallazgos clínicos, hallazgos imagenológicos por resonancia magnética de columna y electromiografía. La estrategia terapéutica se basó en el uso de inmunoglobulinas humanas intravenosas. Conclusión: El síndrome de Guillain-Barré es una enfermedad frecuente en la población pediátrica con infección activa por SARS-CoV-2 o en sobrevivientes, sin embargo, es necesario incentivar el desarrollo de estudios clínicos que incrementen la literatura médica que describe esta asociación.

Controversias en neuroinmunología: esclerosis múltiple, vacunación, SARS-CoV-2 y otros dilemas / Controversies in neuroimmunology: multiple sclerosis, vaccination, SARS-CoV-2 and other dilemas

La neuroinmunología es una disciplina que cada vez amplía más sus horizontes en la comprensión de las enfermedades neurológicas. Contemporáneamente, y a la luz de los nexos fisiopatológicos de las enfermedades neurológicas y la inmunología, se han planteado enfoques diagnósticos y terapéuticos específicos. A pesar de los importantes avances de esta disciplina, existen múltiples dilemas que le conciernen y se filtran en la práctica clínica. En esta revisión, se presentan y discuten 15 controversias, las cuales se construyen con la información clínica disponible más actualizada. Los temas incluidos son: disminución de esteroides en recaídas de esclerosis múltiple; recomendaciones terapéuticas en esclerosis múltiple a la luz de la pandemia por el SARS-CoV-2; evidencia de vacunación en esclerosis múltiple y en otras enfermedades desmielinizantes; panorama actual del síndrome clínico y radiológico aislado; y fallas terapéuticas en esclerosis múltiple; además, criterios para suspender las terapias modificadoras de la enfermedad; evidencia del manejo en recaídas leves; recomendaciones para la profilaxis contra Strongyloides stercolaris; utilidad de un segundo ciclo de inmunoglobulina en el síndrome de Guillain-Barré; criterios para diferenciar una polineuropatía crónica desmielinizante inflamatoria de inicio agudo de un síndrome de Guillain-Barré y, utilidad de la enzima convertidora de angiotensina en neurosarcoidosis. En cada una de las controversias, se presenta la problemática general y se ofrecen recomendaciones específicas que pueden adoptarse en la práctica clínica diaria.

Neuroimmunology is a discipline that increasingly broadens its horizons in the understanding of neurological diseases. At the same time, and in front of the pathophysiological links of neurological diseases and immunology, specific diagnostic and therapeutic approaches have been proposed. Despite the important advances in this discipline, there are multiple dilemmas that concern and filter into clinical practice. This article presents 15 controversies and a discussion about them, which are built with the most up-to-date evidence available. The topics included in this review are: steroid decline in relapses of multiple sclerosis; therapeutic recommendations in MS in light of the SARS-CoV-2 pandemic; evidence of vaccination in multiple sclerosis and other demyelinating diseases; overview current situation of isolated clinical and radiological syndrome; therapeutic failure in multiple sclerosis, as well as criteria for suspension of disease-modifying therapies; evidence of the management of mild relapses in multiple sclerosis; recommendations for prophylaxis against Strongyloides stercolaris; usefulness of a second course of immunoglobulin in the Guillain-Barré syndrome; criteria to differentiate an acute-onset inflammatory demyelinating chronic polyneuropathy versus Guillain-Barré syndrome; and, the utility of angiotensin-converting enzyme in neurosarcoidosis. In each of the controversies, the general problem is presented, and specific recommendations are offered that can be adopted in daily clinical practice.

Síndrome de Guillain-Barré postinfección por SARS-CoV-2 y postvacunación contra covid-19: una revisión sistemática de casos / Guillain-Barré syndrome post-SARS-CoV-2 infection and post-vaccination against COVID-19: a systematic review of cases

RESUMEN INTRODUCCIÓN: El síndrome de Guillain-Barré (SGB) se ha asociado recientemente con la infección por SARS-CoV-2 y su vacunación. El objetivo de esta revisión es describir los datos sociodemográficos y la presentación clínica del SGB asociado con la infección y la vacunación contra covid--19. MATERIALES Y MÉTODOS: Se realizó una búsqueda sistemática en las bases de datos Medline, Embase y LILACS. Se incluyeron reportes de casos publicados entre los años 2021 y 2022. De los artículos seleccionados se extrajo edad, sexo, comorbilidades, laboratorio de la vacuna, tiempo de inicio de síntomas, manifestaciones clínicas, método diagnóstico, tratamiento recibido y desenlace. RESULTADOS: Se seleccionaron 93 artículos, en los que se reporta un total de 131 casos: 82 asociados con la infección por SARS-CoV-2 y 49 asociados con la vacunación contra el covid-19. La población más afectada fue el sexo masculino y se encontró entre los 31 y los 65 años. Las principales manifestaciones descritas fueron: paresia de extremidades, compromiso de la sensibilidad, arreflexia, compromiso de los pares craneales. DISCUSIÓN: El cuadro clínico del SGB presentó características similares a la presentación clásica. La disautonomía y la falla respiratoria son las principales complicaciones mortales de esta entidad. CONCLUSIÓN: El SGB se puede presentar de manera postinfecciosa o parainfecciosa. Se debe sospechar cuando se consulta por cuadro clínico de neuropatía desmielinizante con antecedentes de inmunización o síntomas concomitantes sugestivos de covid-19. Se necesitan más estudios para establecer una asociación entre el virus y el SGB.

ABSTRACT INTRODUCTION: Guillain-Barre syndrome (GBS) has recently been associated with SARS-CoV-2 infection and vaccination. The objective of this review is to describe the sociodemographic data and the clinical presentation of GBS associated with infection and vaccination against COVID-19. MATERIALS AND METHODS: A systematic search was performed in the Medline, Embase and LILACS databases. Case reports published in 2021-2022 are included. From the selected articles, age, sex, comorbidi-ties, vaccine brand, symptom onset time, clinical manifestations, diagnostic method, treatment received and outcome were extracted. RESULTS: 93 articles were selected, reporting a total of 131 cases: 82 associated with SARS-CoV-2 infection and 49 associated with vaccination against COVID-19. The most affected population was the male sex and was between 31 and 65 years old. The main manifestations described were: limb paresis, compromised sensitivity, areflexia, compromised cranial nerves. DISCUSSION: The clinical picture of GBS presented characteristics similar to the classic presentation. Dys-autonomia and respiratory failure are the main fatal complications of this entity. CONCLUSION: GBS can present in a postinfectious, parainfectious manner. It should be suspected when consulting for a clinical picture of demyelinating neuropathy with a history of immunization or concomitant symptoms suggestive of COVID-19. More studies are needed to establish an association between the virus and GBS.

Síndrome de Guillain-Barré como forma de presentación de lupus eritematoso sistémico en paciente masculino / Guillain Barré Syndrome as a form of presentation of systemic lupus erythematosus in a male patient

El lupus eritematoso sistémico es una enfermedad reumática, autoinmune, inflamatoria, sistémica y crónica que se caracteriza por afectar principalmente pacientes femeninas en edad fértil. Su mecanismo patogénico se centra en la presencia de un proceso inflamatorio crónico que es el responsable de las manifestaciones clínicas y complicaciones de la enfermedad. Las manifestaciones clínicas se subdividen en articulares y extraarticulares. Entre estas últimas la afectación neurológica cobra especial atención tanto por su frecuencia de presentación elevada como por la gravedad de estas. El síndrome de Guillain-Barré es una enfermedad autoinmune, que puede aparecer como complicación del lupus eritematoso sistémico y se caracteriza por parálisis motora y otros síntomas y signos neurológicos. El objetivo del presente trabajo es reportar el caso de un paciente masculino, de 27 años de edad, que comienza con manifestaciones neuropáticas y se llega a diagnosticar un síndrome de Guillain-Barré que constituyó la forma de presentación del lupus eritematoso sistémico. Por ser una forma de presentación poco común, se considera importante su reporte para conocimiento de la comunidad médica(AU)

Systemic lupus erythematosus is a rheumatic, autoimmune, inflammatory, systemic and chronic disease that is characterized by mainly affecting female patients of childbearing age. Its etiopathogenic mechanism focuses on the presence of a chronic inflammatory process that is responsible for the clinical manifestations and complications of the disease. Clinical manifestations are subdivided into articular and extra-articular. Within the latter, neurological involvement receives special attention both due to its high frequency of presentation and its severity. Guillain-Barré syndrome is an autoimmune disease that can appear as a complication of lupus erythematosus and is characterized by motor paralysis and other neurological signs and symptoms. The objective of this paper is to report the case of a 27-year-old male patient who began with neuropathic manifestations and was diagnosed with Guillain-Barré syndrome, which was the presentation of systemic lupus erythematosus. Because it is an uncommon form of presentation, its report is considered important for the knowledge of the medical community(AU)

Concurrencia entre el síndrome de Guillain-Barré y púrpura trombocitopénica inmune posiblemente inducidos por COVID-19 prolongado / Concurrence between Guillain-Barré syndrome and immune thrombocytopenic purpura possibly induced by long COVID-19

RESUMEN Durante la infección aguda por el SARVS-CoV-2 se produce una desregulación del sistema inmune que puede durar hasta ocho meses después de controlado el cuadro agudo. Esto, sumado a otros factores, posiblemente este asociado con un aumento del riesgo de aparición y concurrencia de enfermedades autoinmunes. La aparición simultanea del síndrome de Guillain-Barré (SGB) y púrpura trombocitopénica (PTI) se ha reportado poco en la literatura, y el SGB raramente se asocia con otra enfermedad autoinmune. Presentamos el caso de un varón que luego de un mes de tener un cuadro agudo de COVID-19 moderado, presentó concurrentemente SGB y PTI con respuesta adecuada al tratamiento.

ABSTRACT During acute SARS-CoV-2 infection, there is persistent deregulation of the immune system that can last up to 8 months after the acute condition is controlled. This, added to other factors, is possibly associated with an increased risk of the appearance and concurrence of autoimmune diseases. The simultaneous occurrence of GBS and ITP has been rarely reported in the literature, and GBS is rarely associated with another autoimmune disease. We present the case of a man who, one month after his recovery from acute moderate COVID-19, presented concurrent GBS and ITP with an adequate response to treatment.

Reporte de un caso de Síndrome de Guillain Barré post vacuna Coronavac: ¿rol causal o asociación temporal? / Guillain Barre syndrome associated with Coronavac vaccine: report of one case

We report a 50-year-old woman with a history of celiac disease, who presented with lumbar pain and progressive flaccid tetraparesis 48 hours after the inoculation of the first dose of CoronaVac inactivated SARS-CoV-2 vaccine. CSF was normal and electrodiagnostic studies showed an axonal motor polyneuropathy. No other triggers were identified, and other etiologies were ruled out. The presentation was compatible with the AMAN (Acute Motor Axonal Neuropathy) subtype of GBS, and intravenous immunoglobulin halted the progression of symptoms. Intensive neurorehabilitation was performed. The patient was discharged five weeks after admission, walking with poles and climbing stairs with minimal assistance. To date no cases of inactivated SARSCoV-2 vaccine related GBS have been reported. Thus, description of its clinical presentation is relevant. We discuss the current evidence relating GBS with vaccines, highlighting that vaccine associated GBS is a controversial entity and causality must be interpreted cautiously given the actual COVID-19 pandemic context.

Calidad de vida en pacientes con Síndrome de Guillain-Barre en un institución de tercer nivel / Quality of life in patients with Guillain-Barre syndrome in a third-level institution

Introducción: Desde la disciplina de enfermería, este artículo analiza las relaciones entre calidad de vida relacionada con la salud (CVRS) y el estado emocional, enfocándose en los casos de pacientes con síndrome de Guillain-Barré (SGB). La salud es un factor constitutivo de la calidad de vida (CV), a partir del cual se la puede considerar buena o mala. Por lo tanto, la enfermedad no sólo se limita a la afectación física, sino también a la psicológica, social y familiar, sobre las que tiene incluso mayor incidencia si la etiología es poco común. Al conocer la experiencia que los pacientes con SGB tienen de estos aspectos, se puede determinar cuáles son los patrones funcionales alterados según el modelo de Marjory Gordon. Objetivo: Evaluar la CV de pacientes con SGB en una institución de tercer nivel. Material y Métodos: Se utilizó una metodología cuantitativa de tipo analítica con un diseño observacional, prospectivo y longitudinal. Los estudios longitudinales de la CVRS en pacientes con SGB aún son escasos. Por lo tanto, se investigó la CVRS en pacientes con SGB en una institución de tercer nivel, específicamente el día 28 y el tercer mes desde el inicio de la enfermedad, tomando en cuenta la fase de progresión del trastorno neurológico y la fase de recuperación. El estudio se realizó durante once meses, desde septiembre de 2021 hasta julio de 2022, previa revisión y aceptación del protocolo del comité de investigación (CI) y del comité de ética en investigación (CEI). Participaron treinta pacientes adultos bajo un muestreo no probabilístico por conveniencia, cumpliendo con los criterios de inclusión y previo consentimiento informado. La CVRS se indagó mediante el cuestionario World Health Organization Quality of Life, versión breve (WHOQOLBREF), traducido al español y diseñado y validado por la OMS. Se determinó la distribución de normalidad de los datos con la prueba Shapiro Wilk. Para el análisis estadístico se hicieron descripciones de medias, estadísticos de dispersión y la prueba de chi-cuadrado con el programa SPSS statics V.25 Resultados: En las medidas de CV, la percepción de los sujetos con SGB en el día 28 fue "regular", con una media de 60.13 y una desviación típica de 7.26. En el tercer mes no hubo una mejoría significativa, pues la percepción de los participantes fue "normal", mostrando una media de 76.66 y una desviación de 11.21. Conclusiones: Durante el seguimiento de once meses a los pacientes con SGB se observó una recuperación en la CV gradual. Se lograron los objetivos planteados. Nuestro estudio confirma que el SGB sí interviene en la CV de los pacientes.

Introduction: From the discipline of nursing, this article analyzes the association between healthrelated quality of life (HRQOL) and emotional state, focusing on the case of patients with Guillain-Barré syndrome (GBS). Health is a constitutive factor of quality of life (QOL), from which it could be assessed as good or bad. Therefore, diseases are not only limited to physical involvement, but also to psychological, social and familiar, on which it has an even higher incidence if the etiology is uncommon. By knowing the experience that GBS patients have of these aspects, it is possible to determine which are the altered functional patterns according to the Marjory Gordon model. Objective: To evaluate the QOL in patients with GBS in a third-level institution. Material and Methods: A quantitative analytical methodology was used with an observational, prospective and longitudinal design. Longitudinal studies of HRQOL in patients with GBS are still scarce. Therefore, HRQOL was studied in patients with GBS in a third-level institution, specifically on day 28 and the third month from the onset of the disease, considering the neurological disorder progression phase and the recovery phase. After review and acceptance of the research committee and the research ethics committee protocol, the investigation was carried out for eleven months, from September 2021 to July 2022. Thirty adult patients participated through a convenience nonprobability sampling, fulfilling the inclusion criteria and prior informed consent. HRQOL was studied by means of the World Health Organization Quality of Life questionnaire, brief version (WHOQOL-BREF), translated into Spanish, designed and validated by the WHO. The normality distribution of the data was determined with the Shapiro Wilk test. In order to carry out statistical analysis, descriptions of median, dispersion statistics, and chi-square test were made with the SPSS statics V.25 program. Results: Regarding QOL measurements, the perception of patients at day 28 was "regular", with a medium of 60.13 and a standard deviation of 7.26. In the third month there was not meaningful improvement, since their perception was "normal", showing a medium of 76.66 and a deviation of 11.21. Conclusions: During the eleven-month follow up of GBS patients, a gradual recovery in QOL was observed. The objectives set were achieved. Our study confirms that GBS does intervene in the QOL of patients.

Guillain-Barré Syndrome in a pediatric patient with COVID-19: A case report and review of literature

@#The novel coronavirus disease 2019 (COVID-19) has created a global health impact to millions of people. There have been studies of COVID-19 patients manifesting with neurologic symptoms. Although the number of adult COVID-19 infections diagnosed with Guillain-Barré Syndrome (GBS) is increasing, the occurrence of cases in pediatric population remains limited or perhaps underreported. We report a rare case of an asymptomatic COVID-19 infection manifesting as acute progressive ascending polyneuropathy and hyporeflexia in a 16-year-old teen. The diagnosis of COVID-19 infection was confirmed by reverse transcription polymerase chain reaction for SARS-CoV-2 of oropharyngeal and nasopharyngeal swab specimens. Magnetic resonance imaging of the spine revealed abnormal enhancement of the cauda equina, including the dorsal and ventral roots. Electromyography and nerve conduction studies were compatible with an acute inflammatory demyelinating polyneuropathy subtype of GBS. Although lumbar puncture was not done, the clinical findings and electrodiagnostic tests were both consistent with GBS. The patient had improvement of both motor and sensory functions after completing the treatment of intravenous immunoglobulins. Neurologic manifestations of systemic illness especially in children during this time of pandemic warrants scrutiny, as these may mask a potentially dangerous and infectious ongoing COVID infection.

Casos clínicos de los síndromes de Guillain-Barré y Miller-Fisher relacionados con la COVID-19 / Clinical cases of Guillain-Barré and Miller-Fisher syndromes linked to COVID-19

Introducción: la enfermedad por coronavirus del 2019 (COVID-19), causada por el nuevo coronavirus SARSCoV-2, se ha asociado con el desarrollo de enfermedades neurológicas como el síndrome de Guillain-Barré (SGB) y sus variantes. En el presente trabajo se reportan dos casos de síndromes desmielizantes asociados con la COVID-19. Casos clínicos: hombre de 53 años con SGB y mujer de 29 años con la variante del síndrome de Miller-Fisher (SMF), respectivamente. Ambos presentaron los signos y síntomas neurológicos clásicos de polineuropatía desmielinizante que caracterizan a estos síndromes. De las pruebas bioquímicas paraclínicas, el aumento de proteínas en líquido cefalorraquídeo fue distintiva. La positividad de la RT-qPCR para el SARS-CoV-2 indicó la asociación de los SGB y SMF con la COVID-19. Ambos pacientes se trataron con inmunoglobulina intravenosa y mostraron mejoría. La electromiografía realizada en semanas posteriores aún mostrabaafectación desmielinizante crónica. Conclusión: los casos de los SGB y SMF, junto con otros casos similares reportados en todo el mundo, proporcionan más evidencia para el SARS-CoV-2 como nueva posible etiología de estas raras enfermedades neurológicas.

Background: coronavirus disease 2019 (COVID-19), caused by the new coronavirus SARS CoV-2, has been associated with the development of neurological diseases such as Guillain-Barré syndrome (GBS) and its variants. In the present work, two cases of demyelinating syndromes associated with COVID-19 are reported. Clinical cases: 53-year-old male with GBS and and 29-yearold female with Miller-Fisher syndrome (MFS) variant, respectively. Both patients presented the classic neurological signs and symptoms of demyelinating polyneuropathy that characterizes the syndromes. From the paraclinical biochemical tests, the increase of proteins in cerebrospinal fluid was distinctive. The positivity of the RT-qPCR for SARSCoV-2 suggested the association of GBS and MFS with COVID-19. Both patients were treated with intravenous immunoglobulin showing improvement. Electromyography performed weeks ahead still showed chronic demyelinating involvement. Conclusion: The cases of GBS and MFS, along with other similar cases reported around the world, provide further evidence for SARS-CoV-2 as a new possible etiology of these rare neurological diseases.

Síndrome de Miller Fisher, un desafío diagnóstico de oftalmoplejía: reporte de un caso / Miller Fisher syndrome, a diagnostic challenge of ophthalmoplegia: a case report

El síndrome de Guillain-Barré (SGB), y sus derivados, entre ellos el síndrome de Miller Fisher (SMF); junto a otras patologías de origen neurológico como la Polineuropatía desmielinizante inflamatoria crónica (CIDP), las polineuropatías de causa metabólica, miastenia gravis, esclerosis lateral amiotrófica (ELA), síndrome de Lambert-Eaton, encefalopatía de Wernicke entre otras; presentan signos y síntomas neurológicos de presentación común. De este modo, la importancia del examen neurológico acabado; y los exámenes de apoyo diagnóstico como: laboratorio -destacando el líquido cefalorraquídeo (LCR)-, electromiografía, y toma de imágenes, son cruciales para esclarecer el diagnóstico. Así, es posible ofrecer un tratamiento de forma precoz, basado en la evidencia, y con el objetivo de disminuir la letalidad de la enfermedad. En el presente texto se plasma un subgrupo de patología de SGB, el SMF, el cual posee una incidencia significativamente baja, una clínica característica, y un pronóstico bastante ominoso sin un tratamiento adecuado. En el presente texto se plasma el reporte de un caso abordado en el Hospital San Pablo de Coquimbo, Chile.

Guillain-Barré syndrome (GBS) and its derivatives, including Miller Fisher syndrome (MFS), along others pathologies of neurological origin such as chronic inflammatory demyelinating polyneuropathy (CIDP), metabolic polyneuropathies, myasthenia gravis, amyotrophic lateral sclerosis (ALS), Lambert-Eaton syndrome, Wernicke's encephalopathy and well as others, have common neurological signs and symptoms. In this way, the importance of a thorough neurological examination, and supporting diagnostic tests such as: laboratory, -cerebrospinal fluid (CSF)-electromyography, and imaging, are crucial to clarify the diagnosis. Thus, it is possible to offer early, evidence-based treatment with an aim of reducing the disease's lethality. In the text below we present a subgroup of GBS pathology, MFS, which has a significantly low incidence, a characteristic clinical picture, and a rather ominous prognosis without adequate treatment. In the following text/paper is shown the report of a case approached in San Pablo Hospital, from Coquimbo, Chile.

Ecocardiografia Tridimensional na avaliação de endocardite de válvula nativa: um relato de caso e semelhança entre achados ecocardiográficos e cirúrgicos / Three-Dimensional transesophageal echocardiography in native valve endocarditis: a case report and similarities between echocardiography and surgical findings

A endocardite de valva nativa é uma doença incomum, complexa, e de alta morbimortalidade. Requer tratamento clínico prolongado, com várias complicações possíveis, e o seu tratamento cirúrgico é complexo e tecnicamente difícil. O ecocardiograma transtorácico e transesofágico são fundamentais na avaliação da doença, inclusive seus achados são parte dos critérios diagnósticos de endocardite. Adicionalmente, o ecocardiograma tridimensional (3D) contribui com detalhamento anatômico na avaliação das estruturas cardíacas acometidas pela doença. Mostramos um caso em que é ilustrado o papel da ecocardiografia no diagnóstico e avaliação de complicações da endocardite, comparando as imagens do ecocardiograma 3D pré-operatórias, com os achados durante o ato cirúrgico. (AU)

Native valve bacterial endocarditis is an uncommon, complex, and highly morbid disease that requires prolonged clinical treatment and challenging surgical interventions. Transthoracic and transesophageal echocardiography are paramount assessment tools whose findings are included in the diagnostic criteria. Three-dimensional echocardiography shows further realistic imaging details. Here we present a case demonstrating the role of echocardiography in the diagnosis of endocarditis and the identification of its complications to show how advanced imaging techniques may have a remarkable resemblance with in vivo surgical findings. (AU)