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Purpose@#An association between Guillain-Barré syndrome (GBS) and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccination has been reported. We aimed to summarize the clinical features of GBS associated with SARS-CoV-2 vaccination and determine the contrasting features from coronavirus disease-19 (COVID-19) associated GBS and GBS following other causes. @*Materials and Methods@#We performed PubMed search for articles published between 1 December 2020 and 27 January 2022 using search terms related to “SARS-CoV-2 vaccination” and “GBS”. Reference searching of the eligible studies was performed. Sociodemographic and vaccination data, clinical and laboratory features, and outcomes were extracted. We compared these findings with post-COVID-19 GBS and International GBS Outcome Study (IGOS) (GBS from other causes) cohorts. @*Results@#We included 100 patients in the analysis. Mean age was 56.88 years, and 53% were males. Six-eight received non-replicating virus vector and 30 took messenger RNA (mRNA) vaccines. The median interval between the vaccination and the GBS onset was 11 days. Limb weakness, facial palsy, sensory symptoms, dysautonomia, and respiratory insufficiency were seen in 78.65%, 53.3%, 77.4%, 23.5%, and 25%, respectively. The commonest clinical and electrodiagnostic subtype were sensory-motor variant (68%) and acute inflammatory demyelinating polyneuropathy (61.4%), respectively. And 43.9% had poor outcome (GBS outcome score ≥3). Pain was common with virus vector than mRNA vaccine, and the latter had severe disease at presentation (Hughes grade ≥3). Sensory phenomenon and facial weakness were common in vaccination cohort than post-COVID-19 and IGOS. @*Conclusion@#There are distinct differences between GBS associated with SARS-CoV-2 vaccination and GBS due to other causes. Facial weakness and sensory symptoms were commonly seen in the former and outcomes poor.
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@#The Indian data comparing the efficacy and safety outcomes of tenecteplase and alteplase in acute ischemic stroke is scarce. We aimed to compare the outcomes of two agents in an Indian population. Methods: TENVALT study was a single centre, retrospective study. Patients aged 18 years or older with acute ischemic stroke were included in this study if they presented within 3 hours of symptom onset and had a deficit with National Institute of Health Stroke Scale (NIHSS) score > 4, had a modified Rankin score (mRS) of 2 or less before the stroke onset and had no evidence of hemorrhage on non-contrast computed tomography of brain. A good functional recovery (mRS score of 0-2) at the end of three months was defined as the primary efficacy outcome. The development of symptomatic intracerebral hemorrhage was considered as the primary safety outcome. Results: A total of 120 patients (alteplase, n=65; tenecteplase, n=55) underwent stroke thrombolysis during this study. The mean age of the presentation in tenecteplase group was 66.6 years and in alteplase group was 62.5 years. Most of the study subjects were males in both the groups (tenecteplase, 78.2%; alteplase, 61.5%). Hypertension was the most common comorbidity in both the groups (tenecteplase, 67.3%; alteplase, 76.9%). Median mRS score at 3 months of follow up was 2 in tenecteplase and 1 in alteplase group; however, the difference between the total number of patients having good functional recovery (mRS 0-2) in the two groups was not statistically significant (tenecteplase 74.5 vs alteplase 87.7%, P=0.09). The total number of patients who had symptomatic intracranial hemorrhage was comparable between the two groups (tenecteplase, 5.5%; alteplase, 6.2%).
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@#Objective: To study the incidence of seizures due to degenerative phase of neurocysticercosis (NCC) in a cohort of primary school children in south India. Methods: The study cohort included 7,408 (age 5-15 years, boys 44.5% and girls 55.5%) children registered on roles on the date of start of study. The children were followed through first to fifth standard for new-onset of seizures. The data collected included demographic data, date of seizure, any antecedent events, seizure semiology, neurologic findings, 40 minutes EEG findings, and contrast CT brain findings. This analysis is limited to seizures due to degenerative phase of NCC. The average annual incidence rates (AAIR) and 95% confidential intervals (CI) were calculated. Results: During the study period, of the 58 children with new-onset seizure, 19 (32.7%) had seizure due to degenerative phase of NCC [mean age 9.42 years; range7-13 years; 8 boys and 11 girls]. Contrast CT scans in all the 19 children showed solitary cysticercus granuloma (SCG). The common seizure type by mode of onset was focal. The AAIR of seizure disorder was 36.64 (95%CI 22.1-57.2) per 100,000. All the children received antiepileptic drug treatment and four weeks of albendazole and steroids. The seizure disorder resolved with the resolution of the lesion on follow-up CT scan and AEDs were withdrawn. Conclusions: In this highly selective cohort of primary school children from low economic strata, the AAIR of seizure disorder due to degenerative phase of NCC, SCG was high. Seizure disorder due to SCG has an enduring predisposition for seizure recurrence and need AEDs for the period of resolution of lesion and AEDs could safely be withdrawn with the resolution of the lesion.