Correlation Of Baseline Serum Albumin Levels With Prognosis Of Guillain-Barre Syndrome

INTRODUCTION:Guillain-Barre syndrome (GBS) is a polyradiculoneuropathy characterized by a rapidly progressive bilateral paresis of the limbs. There is a limited number of studies in the literature which have explored the correlation between prognosis of GBS patients and serum albumin levels. So the present study was carried out.MATERIALAND METHODS: Prospective Longitudinal study was conducted among 60 patients admitted in the Neurology Department of MDM Hospital, Dr.SN Medical College, Jodhpur over a period of two years from January 2017 to December 2018.Serum albumin levels were determined. Patients were assigned into two groups. One with low albumin level (GROUP1) and other with normal albumin level (GROUP2 ). And the groups were compared based on Hughe's disability scores.RESULTS:The albumin levels were negatively correlated with the Hughes' scores (admission/discharge). After treatment mean of the disability score in group 1 was significantly higher(p<0.05) as compared to group 2.The difference of means of disability score {end line - baseline} was significantly higher in group 1 (0.09) as compared to group 2 (-0.92).CONCLUSION: This study determined albumin level as an independent factor for assessing the prognosis of GBS.

Effect of blood culture reports on antibiotics use by physicians in septic patients of intensive care unit.

Background: To limit the emergence and spread of antibiotic resistance, adjustments in the antibiotic regimen should be done according to the results of blood cultures as soon as they are available. This study was planned to determine the effect of blood culture and sensitivity tests on the antibiotics use in ICU patients of a tertiary care teaching hospital. Methods: This chart review retrospective study was carried out in ICU patients of a tertiary care teaching hospital. The data was collected from patients’ medical record file in a case record form which included patient’s demographic details, provisional diagnosis/or diagnosis, blood culture reports, and antimicrobial treatment (both the empiric treatment as well as the change made after the release of the blood culture results). The effect of blood culture results on antibiotic treatment was analysed. Results: A total of 245 patients were subjected to blood culture during the period of 6 months with an average of 40.8/month. 86 (35.1%) patients showed positive blood culture results, while 159 (64.9%) patients showed negative blood culture results. 55 patients discharged after the release of blood culture and sensitivity results. Antibiotic regimens were modified or changed in 26 (47.27%), and in 29 (52.72%) there was no modification. Most commonly used antibiotic after blood culture reports were meropenem (34.62%) followed by 11.54% of each teicoplanin, piperacillin+ tazobactum and tigecyclin. Conclusions: Blood culture reports help in management of critically ill patients if bacteria are resistant to previously used antibiotic, but do not help in narrowing the therapy in ICU patients.

CADASIL in a family from north-west India.

We here with report a family with two sibs having history of recurrent familial stroke. Neuroimaging revealed diffuse hyperintense signals in subcortical white matter and basal ganglia on MR images in younger sib suggestive of cerebral autosomal dominant arteriopathy with sub-cortical infarcts and leucoencephalopathy (CADASIL). The diagnosis was further strengthened on skin biopsy showing presence of PAS positive granules with thickening of dermal vessels.

Acute inflammatory demyelinating polyneuropathy with P. falciparum malaria.

Various types of neuropsychiatric manifestations are described in P. falciparum malaria of which peripheral neuropathy has been described mainly from India. We are reporting such a case who presented with seven days history of fever and weakness of two days duration. On investigations it turned out to be acute inflammatory demyelinating polyneuropathy (AIDP) with peripheral blood showing heavy parasitaemia of P. falciparum. All other causes of acute polyneuropathy were ruled out by history and relevant examination. Patient improved with quinine and other supportive therapy.

Cerebral malaria in Indian adults: a prospective study of 441 patients from Bikaner, north-west India.

AIMS OF THE STUDY: As per WHO (1993) the assessment and analysis of local problems and an appropriate epidemiological information system is an essential part of a control programme before embarking any control activity. METHODOLOGY: Four hundred and fourty one (441) adults of strictly defined admitted cerebral malaria patients were studied. Detailed clinical/neurological examination was done at the time of admission, daily thereafter, at the time of regaining consciousness, at the time of discharge and at weekly intervals in those having neurological sequelae. All patients were treated by i.v./oral quinine and specific syndromes were managed according to WHO guidelines. RESULTS: Apart from fever and unconsciousness in all the patients, other features were convulsion (21.31%), neck rigidity (19%), psychosis (5.21%), conjugate deviation of eyes (2.26%), extrapyramidal rigidity (2.25%), trismus (1.31%), decorticate rigidity (1.13%) and decerebrate rigidity (0.90%). One hundred forty five (32.87%) patients expired and mortality was highest in pregnant ladies (39.28%). The important neurological sequelae in survivors were psychosis in 15 (5.06%), cerebellar ataxia in 14 (4.72%), hemiplegia in five (1.68%), extrapyramidal rigidity (EPR) in four (1.35%), peripheral neuropathy in three (1.01%), EPR with trismus in one (0.33%) and isolated sixth nerve palsy in one (0.33%) patients and all showed complete recovery in further follow up. CONCLUSION: The important observations of this study were stormy presentation, increased incidence of haemoglobinuria and jaundice, presence of neck rigidity, no prognostic relation to fundus abnormalities and high incidence of cerebellar ataxia and psychosis as neurological sequelae in survivors. Knowledge of self-limiting course of neurological sequelae may be helpful in reducing economic strain of expensive investigations and treatment.

Successful management of hypokalaemia related conduction disturbances in acute aluminium phosphide poisoning.

A case of acute aluminium phosphide poisoning is described, who presented in shock secondary to electrolyte related cardiac rhythm disturbance and the judicious correction of the same could save his life without any consequence.

Prognostic significance of eye changes in cerebral malaria.

AIMS: Eye in Plasmodium falciparum malaria are described by various workers all over the world but its prognostic significance is not clear because of conflicting observation by different authors from different regions. No such study is available on Indian adult patients of cerebral malaria. So we want to describe our observations on various eye abnormalities in these patients and study its prognostic significance. METHODOLOGY: Two hundred and fourteen adult (> 14 years) patients of strictly defined cerebral malaria admitted in classified malaria ward in this tertiary level health care station were studies. Detailed ophthalmoscopic examination was done through dilated pupils at the time of admission, daily thereafter, at the time of discharge and at weekly intervals in those with persistent changes at the time of discharge. RESULT: Retinal haemorrhage was found in 25 (11.68%) patients, papilloedema in 17 (7.94%), blurring of disc margins in 25 (11.68%), retinal oedema in six (2.8%), disc pallor in five (2.33%), vitreous haemorrhage and hard exudate in one (0.46%) each and subconjunctival haemorrhage in six (2.8%) patients. The mortality associated with individual finding was not statistically significant except disc pallor. CONCLUSION: None of the above finding except disc pallor (p < 0.05) was associated with statistically significant mortality (p > 0.05); whereas any of the fundus findings as a whole was related to statistically significant mortality (p < 0.05).

Brainstem auditory evoked potentials and somatosensory evoked potentials in cerebral malaria--a prognostic significance.

OBJECTIVE: To study the changes in brainstem auditory evoked potentials (BAEPs) and somatosensory evoked potentials (SSEPs) in cerebral malaria and to see their prognostic significance. METHODS: BAEPs and right median nerve SSEPs were performed in 25 adult patients of strictly defined cerebral malaria in acute stage in a semi-dark, sound proof chamber on four channel computerized multi-basis OTE-Biomedica machine in department of neurology, SP Medical College, Bikaner. RESULTS: The abnormalities of BAEPs were delayed peak latency of wave III in 13/25 (52%) and wave V in 20/25 (80%) patients and delayed interpeak latencies (IPLs) of wave I-III in 9/25 (36%), wave I-V in 15/25 (60%) and wave III-V in 12/25 (48%) patients. In SSEPs delayed N20 was seen in 11/25 (44%); delayed IPLs of N13-N20 (central conduction time; CCT) in 12/25 (48%) patients. Distorted N20 was recorded in 12/25 (48%) patients. Both N13-N20 IPLs in SSEPs and wave III-V IPLs in BAEPs were delayed in five patients and all of them expired. Delayed N13-N20 with normal III-V IPLs was present in seven patients and two of them died, whereas delayed III-V IPLs with normal N13-N20 was present in seven patients, and one of them expired. In remaining six patients both the parameters were normal and one of them died. CONCLUSIONS: The values of BAEPs and SSEPs were abnormal in patients of cerebral malaria and it was observed that BAEPs/SSEPs alone was not useful for predicting the outcome of coma, whereas abnormalities in both was predictive of worst prognosis. The changes in evoked potentials (BAEPs and SSEPs) could be due to either interruption of conduction in central pathways because of structural changes due to petechial hemorrhages and malarial granuloma at multiple levels in the brain including brainstem or due to metabolic abnormalities.