Journal club GUILLIAN BARRE SYNDROME IN ETHIOPIAN PATIENTS Zenebe Melaku,Guta Zenebe,Abera Bekele,2005,Ethiop Med J,43

Introduction GBS-acute inflammatory demyelinating polyradiculoneuropathy Epidemiology: Incidence-Worldwide average annually /100,000 popn. Race-no selection -in US blacks<<whites Etiology-unclear -usually associated with antecedent triggering agent(infection commonly) -HIV implicated

Introduction… Pathogenesis-generally accepted that an immune mediated process Clinical & pathologic features— generally similar worldwide Mortality- markedly in developed nations (20%  2-3%) due to plasma exchange & intensive respiratory & cardiovascular care

Background information There was no study in Ethiopia b/r this & published African studies were few. Black lion hospital;a 3 0 hospital serving the whole country of >70 million people in the capital of Ethiopia,Addis Ababa,is selected for the study. All GBS suspected patients other than children are admitted to internal medicine wards & MICU.

Objective of the study To describe clinical characteristics & outcome of GBS in Ethiopian patients.

Definition used for diagnosis Based on the national institute of Neurological & communicative disorders & stroke diagnostic criteria: 1-Progressive weakness of >1 limb due to neuropathy 2-Areflexia or hyporeflexia 3-Duration of progress <4 weeks 4-Absence of sharp sensory level on the trunk 5-Absence of other causes of acute neuropathy 6-<50 mononuclear leukocytes/mm 3 in CSF

Methodology Study period-sept.1992-sept.2001 Study population-all patients admitted with diagnosis of GBS Target population-those who met the specified dxic criteria Study type-descriptive retrospective study Sampling-convenient sampling Data collection-clinical & laboratory information from hospital records transferred into structured data sheet. Data analysis-Epi info stat.software version 6.04

Results 95 patients admitted with diagnosis of GBS.81 met the dxic criteria. Sex- 55.6% M & 44.4% F Age range-13-75yrs  mean34.4yrs -71.6% are <40yrs -most in age gp.30-39(37.9%)

Results… C/F--Antecedent event (58.1%)  URTI(30.9%),Diarrhea (23.5%),Antecedent hx of vaccination (3.7%anti-rabies vaccine in all cases) At the end of 1 st &2 nd wk~80%& 90% of pts respectively had developed max.weakness CN palsies-commonest-facial diplegia(30.9%) -9 th &10 th CN involvement in(12.3%) -multiple CN palsy(12.3%) Autonomic dysfun.-BP,tachycardia,sphinicter dysfucnction,rhythm d/o & sweating more common. EMG was done for 47 patients. Demyelinating (55.3%), axonal (19.1%),mixed(25.5%)

Results…. 70.3% of 27 patients for whom serology for HIV was done were seropositive C/f similar for both HIV+&-pts except the higher frequency of CSF pleocytosis,need for ventilatory support & mortality among HIV+

Results Specific Rx (IV Ig)given only for five(6.2%) of the patients.  None received plasmapheresis or steroids. Mortality–21/81pts(25.9%)-main causes of death:resp.failure(4),pneumonia(5),UTI with uncontrolled sepsis(2)& sudden cardiac arrest(5)&not specified(5). Outcome on discharge-64.2% had partial to complete recovery. -9.8% discharged with no change

Discussion Comparison with African studies Similar in:-higher male sex -lower mean age -time interval from onset to maximum weakness -longer duration from onset to admission(lack of accessibility to medical facilities) -higher % of HIV+ -HIV+GBS  initial AIDS defining illness

Discussion Different in: -higher antecedent infection than that of Tanzania& Nigeria and ~Kenya -higher mortality than Nigeria(better intensive care).~to Tanzania & Kenya report. -higher frequency of cranial nerve involvement

Comment Strength:-pioneer study in Ethiopian set up & adds up to few African studies. -the selected 3 0 teaching hospital is better in terms of patient flow & chart registry -the study used standard diagnostic criteria -peaks out important defects that lead to delayed presentation,management & bad outcome -stimulates & leaves background for future studies.

Comment Weak points: retrospective study - may miss potential candidate due to improper registry or other reason. - may make data inadequate as to standard. (eg-only 27 patients were found to be screened for HIV) - the sample size is inadequate to give validated statistical analysis. (larger prospective study is needed)

THANK YOU