Long-term outcomes of patients affected by Guillain-Barré syndrome in Colombia after the Zika virus epidemic.

BACKGROUND: Guillain-Barré Syndrome (GBS) can lead to significant functional impairments, yet little is understood about the recovery phase and long-term consequences for patients in low- and medium-income countries. OBJECTIVE: To evaluate the functional status and identify factors influencing outcomes among patients with GBS in Colombia. METHODS: Telephone interviews were conducted with GBS patients enrolled in the Neuroviruses Emerging in the Americas Study between 2016 and 2020. The investigation encompassed access to health services and functional status assessments, utilizing the modified Rankin Scale (mRS), GBS Disability Score (GDS), Barthel Index (BI), and International Classification of Functioning (ICF). Univariate analysis, principal component analysis, linear discriminant analysis, and linear regression were employed to explore factors influencing functional status. RESULTS: Forty-five patients (mean age = 50[±22] years) with a median time from diagnosis of 28 months (IQR = 9-34) were included. Notably, 22% and 16% of patients did not receive rehabilitation services during the acute episode and post-discharge, respectively. Most patients demonstrated independence in basic daily activities (median BI = 100, IQR = 77.5-100), improvement in disability as the median mRS at follow-up was lower than at onset (1 [IQR = 0-3] vs. 4.5 [IQR = 4-5], p < 0.001), and most were able to walk without assistance (median GDS = 2, IQR = 0-2). A shorter period from disease onset to interview was associated with worse mRS (p = 0.015) and ICF (p = 0.019). Negative outcomes on GDS and ICF were linked to low socioeconomic status, ICF to the severity of weakness at onset, and BI to an older age. CONCLUSIONS: This study underscores that the functional recovery of GBS patients in Colombia is influenced not only by the natural course of the disease but also by socioeconomic factors, emphasizing the crucial role of social determinants of health.

Caracterización sociodemográfica y clínica de pacientes diagnosticados con dengue y chikungunya en Nariño, Colombia / Clinical and socio-demographic characterization of patients diagnosed with dengue and chikungunya in Nariño, Colombia

RESUMEN Introducción: Existen más de 390 millones de personas infectadas y 20 000 muertes anualmente a causa del dengue en el mundo. El chikungunya ocasionó una larga epidemia en las Américas con más de 2 millones y medio de casos hasta el 2017. Objetivo: Identificar las características sociodemográficas y clínicas de los casos de dengue y chikungunya informados para el periodo 2014-2017 en Nariño, Colombia. Métodos: Se realizó un estudio observacional, descriptivo, de corte transversal. Se revisaron retrospectivamente las bases de datos del Instituto Departamental de Salud de Nariño y del Hospital Universitario Departamental de Nariño. Resultados: Para el periodo de estudio hubo 2 514 hospitalizaciones por dengue y 460 por chikungunya. Se identificaron 22 casos de dengue grave, con una muerte para el año 2017. La revisión de expedientes de 1 735 pacientes con información completa reveló que las manifestaciones clínicas más frecuentes para dengue fueron: fiebre (100 por ciento), cefalea (84,6 por ciento) y mialgias (83,7 por ciento), seguidos de artralgias, rash y dolor abdominal. El sexo masculino predominó en los casos de diagnóstico de dengue (56,8 por ciento) y el femenino en el diagnóstico de chikungunya (52,0 por ciento. Tanto dengue como chikungunya fueron más frecuentes en la población mayor de 40 años con el 24,5 por ciento y 27,2 por ciento, respectivamente. Conclusiones: La sintomatología similar y los casos complicados resaltan la necesidad de contar con diagnósticos oportunos y diferenciales y capacitación al personal de salud, apoyados por entidades gubernamentales. Se requiere generar programas de intervención enfocados a edades productivas y en regiones con condiciones medioambientales propicias para el desarrollo de vectores transmisores de enfermedades(AU)

Introduction: More than 390 million dengue cases and 20 000 deaths due to this condition are reported worldwide every year. Chikungunya caused a large epidemic in the Americas with more than two and a half million cases until the year 2017. Objective: Identify the clinical and socio-demographic characteristics of the dengue and chikungunya cases reported for the period 2014-2017 in Nariño, Colombia. Methods: A cross-sectional observational descriptive study was conducted. A retrospective review was carried out of the databases at Nariño Departmental Health Institute and Nariño Departmental University Hospital. Results: During the study period there were 2 514 hospital admissions with dengue and 460 with chikungunya. A total 22 severe dengue cases and one death were identified for the year 2017. Review of the medical records of 1 735 patients with complete information revealed that the most common clinical manifestations of dengue were fever (100 percent), headache (84.6 percent) and myalgia (83.7 percent), followed by arthralgia, rash and abdominal pain. A predominance was found of the male sex in dengue cases (56.8 percent) and of the female sex in chikungunya cases (52.0 percent). Both conditions were more frequent in the population aged over 40 years, with 24.5 percent and 27.2 percent, respectively. Conclusions: The similar symptoms and the presence of complicated cases highlight the need for timely differential diagnosis and the training of the health personnel, with the support of government agencies. It is required to develop intervention programs aimed at working ages and regions with environmental conditions favorable for the spread of disease(AU)

Características Clínicas Del Síndrome De Guillain-Barré En Relación A Chikungunya Y Zika: Revisión Sistemática / Clinical Manifestations Of Guillain-Barre Syndrome And Its Relation To Chikungunya And Zika

Resumen Antecedentes: En los últimos cinco años se han registrado en el mundo diversos casos de infecciones por zika y chikungunya simultáneos al incremento de los casos de Síndrome de Guillain-Barré, que han mostrado una relación causal potencial que aún no es del todo clara. Objetivo: Describir las manifestaciones clínicas del Síndrome de Guillain-Barré (SGB) y su relación con las infecciones por zika y chikungunya, de acuerdo a la literatura científica. Metodología: Se utilizaron las bases de datos PubMed y ScienceDirect para llevar a cabo la búsqueda para el periodo 2014-2016 con las palabras clave: zika, chikungunya y Guillain-Barre Syndrome; se incluyeron artículos en inglés y español. Resultados: Se encontraron 35 artículos: uno del 2014, dos del 2015 y 32 del 2016. Conclusión: Las variaciones en las características clínicas y el incremento en la incidencia de SGB ante la presencia de zika y chikungunya, resaltan la necesidad de realizar vigilancia a estas infecciones y de realizar estudios analíticos para determinar la asociación entre los arbovirus con diferentes alteraciones neurológicas.

Abstract Background: In the last five years, there have been several cases of zika and chikungunya infections in the world, simultaneous with the increase in cases of Guillain-Barre syndrome, which have shown a potential causal relationship that is still not entirely clear. Objective: To describe the main clinical manifestations of Guillain-Barre syndrome in relation to chikungunya and zika, according to scientific literature. Methods: The databases PubMed and ScienceDirect were used to perform the search for the period 2014-2016 using with the keywords: zika, chikungunya and Guillain-Barre Syndrome; articles in English and Spanish were included. Results: 35 articles were found, one for the year 2014, two for 2015 and 32 for 2016. Conclusion: Variations in clinical characteristics and the increased incidence of GBS in the presence of zika and chikungunya, highlight the need to monitor these infections and perform analytic studies to determine the association between arboviruses and different neurological alterations.