Health Care : Current Reviews

Table 1: Laboratory tests.

At the 1^st day of the hospitalization patient kept NPO. Inj Methyl is given stat than for three days. Inj IVIg 30 gm is given iv stat than for three days. Inj D/W 550 ml with Kcl 2cc is given to patient. Inj Diclo, Cap Gabapentine for OD. At the same time the parental nutrition also started. In this disorder the electrolyte balance is also necessary. Soft diet and fluids also necessary. The care and nutrition support is important as like patient in CCU. The lacking or starvation of diet also leads to GBS. According to the need of patient the minerals and water also given [3].

In physical examination no neurological and orthopaedic findings. All the labs send. According to the result of labs GBS diagnosed. Some features rule out, no evidence of diphtheria, no porphyria, no poliomyelitis. In this situation pt. take not only medication, he also take palliative care. Patient is fully cooperated [2].

During examination he had no fever, respiratory infection and no gastroenteritis. The signs and symptoms of the GBS is sensations of pins, needles on fingers toes wrist or ankles. Unable to walk unable to speak. In this disorder severe condition leads to death [4].

GBS treatment depends on the condition of patient either they are acute, severe, chronic. Corticosteroids are not beneficial. Plasma exchange is effective therapy in this disorder. In every cases of this disorder the pain management and psychological support should be given [2].

Plasma exchange and immunoglobulin therapies are very effective In GBS patient’s multidisciplinary care is good need to manage the complication. With this psychosocial support is also necessary. Physiotherapy and rehabilitation for patient is effective [5].

Patients have less or absence of deep tendon reflexes, in affected peripheral areas. The lumber puncture always done in those patients which have GBS. In the suspected patients the lumber puncture is done and white CSF is examined. If the protein level is increased the GBS is suspected.

Discussion

Guillain-Barre-Syndrome is a disorder, which is acute areflexic polyneuropathy in autoimmune system. In this disorder weakness reach on the peak minimum 4 weeks. GBS have various sub types. The sub types treated with different treatment some patients with acute effect of GBS others are severe. Some want ventilator support. In this disorder immunoglobulin iv is given. In some patients plasma exchange is effective [6,7].

In this disorder the diagnosis is very difficult because lack of test reports. The ethology of GBS is unclear. It is immune mediated disease. Peripheral nervous involves after this it involves the axonal. Mostly patients develops weakness in lower extremities, the reason is demyelination of the nerves. Paralysis of lower extremities [8]. This may acute, chronic. It depends on the destruction of nervous system. In this condition muscles stretch and sensation may be loss. Patient is unable to walk, stand and climb stairs. The pathogenesis of the GBS is edematous changes in the roots of the nerves at the junction of the anterior and posterior roots. At this time myelin sheeth become irregular at the 3^rd day of onset. After this phagocytes appear. This appears in rare cases which may leads to death.

In physiologic and variables it is stated that daily activities and physical burden leads to fatigue than GBS occur. In this way limbs become weak [9,2].

Conclusion

Guillain-Barre-Syndrome is neurological disorder. In this disease the peripheral region disturbed. In this disorder the lower extremities become weak. Patient unable to walk, stand or run. After the proper tests, labs, than it would be diagnose. This may be acute severe or life threatening. It can be treated with immunoglobulin IV, plasma exchange or palliative care. In GBS the major subtype is AMAN in the eastern countries and South American countries. By epidemiologically this subtype is growing very rapidly. GBS related with the high risk of mortality rate due to progressive in weakness gradually.

REFERENCES

1. Meythaler JM. Rehabilitation of Guillain-Barré syndrome. Arc Phys Med Rehabil. 1997;78(8):872-879.
2. Pikula JR. Guillain-Barre Syndrome: A case report. J Canadian Chiropractic Assoc. 1995;39(2):80.
3. Mazidi M, Imani B, Norouzy A, Rezaei P. Guillain Barre Syndrome: A case report. Int J Hosp Res. 2013;2(2):91-93.
4. Modupalli C, Sriramulu C, Gopineni YPR, Diviti R. Acute Guillain Barre Syndrome. A Case report in Pediatrics. J Acute Dis. 2017;6(2):89.
5. Kuwabara S, Yuki N. Axonal Guillain Barre Syndrome: Concepts and controversies. Lancet Neurol. 2013;12(12):1180-1188.
6. Van DPA, Ruts L, Jacobs BC.Clinical features, pathogenesis, and treatment of Guillain Barre Syndrome. Lancet Neurol. 2008;7(10):939-950.
7. Yuan J, Zhang J, Zhang B, Hu W. The clinical features of patients concurrent with Guillain-Barre syndrome and myasthenia gravis. Neurosciences (Riyadh). 2018;23(1):66-70.
8. Misawa S, Kuwabara S, Sato Y, Yamaguchi N, Nagashima K, Katayama K, et al. Safety and efficacy of eculizumab in Guillain-Barré syndrome: a multicentre, double-blind, randomized phase 2 trial. Lancet Neurol. 2018;17(6):519-529.
9. Garssen MPJ, Bussmann JBJ, Schmitz PIM, Zandbergen A, Welter TG, Merkies ISJ, et al. Physical training and fatigue, fitness, and quality of life in Guillain Barre Syndrome and CIDP. Neurol. 2004;63(12):2393-2395.