Clinical Features Indicating the Need for Mechanical Ventilation in Patients with Guillain Barre Syndrome.

Background Guillain Barre Syndrome (GBS) is an immune-mediated inflammatory polyradiculoneuropathy. Respiratory failure is one of its recognized and most dreaded complications, requiring ventilatory assistance. Early recognition of distinct clinical predictors of mechanical ventilation may help in the better management of GBS patients in our setup. Objective To determine the clinical predictors indicating the need for mechanical ventilation in patients with Guillain Barre Syndrome and to compare the presenting features in patients who require mechanical ventilation and who do not. Method It was a prospective observational study. A total of 100 consecutive patients, over the period of one year, were included in this study. All patients were clinically examined for limb weakness, neck weakness, bulbar and facial nerve involvement, and followed up till seven days of hospitalization for whether the patient required mechanical ventilation or not. Results were recorded on a specifically designed proforma. Data were entered and analyzed using SPSS version 20.0 (IBM Corp., Armonk, NY, US). Results Out of 100 patients, 13% required mechanical ventilation. When clinical presentations were compared in patients who required mechanical ventilation and those who did not, a shorter interval between the onset of symptoms and the attainment of maximal disability, facial weakness, bulbar dysfunction, and neck weakness turned out to be significant factors (p-value<0.000). Conclusion According to these significant outcomes of our study, the course of patients with GBS leading to mechanical ventilation can be predicted on the basis of clinical presentations. So we can recommend that shorter time duration between symptom onset and peak disability, along with the presence of facial, bulbar, and neck weakness, should be taken as an indication of impending respiratory failure.

Evaluation of Hyponatremia in Ischemic Stroke Patients in a Tertiary Care Hospital of Karachi, Pakistan.

Introduction Electrolyte disturbances are commonly found in acute stroke settings. Hypernatremia, hyponatremia and hypokalemia are the commonest types of electrolyte disturbances. Data on electrolyte changes in neurological disorders like stroke is insufficient in Asia. This study aims to quantify the decrease in sodium levels in patients of ischemic stroke and to see whether the presence of co-morbidities like hypertension and diabetes result in decrement in the sodium level of the patients admitted. Methodology This is a cross-sectional study conducted in Ruth M Pfau Civil hospital Karachi on 132 consenting patients diagnosed with ischemic stroke on a clinical and radiological basis using a preformed questionnaire with all the necessary information to evaluate the objective like gender, level of sodium and co-morbidities. The data was analyzed using Chi­squared test using SPSS (Statistical Package for Social Science) software version 22 (IBM, NY, USA). Result The study showed that the majority of the patients (25%) had mild hyponatremia (130-134 mMol/L), only a few (9.8%) had moderate (125-129 mMol/L) or profound (<125) hyponatremia (3.8%) and 17 out of 44 patients who were hypertensive had their sodium levels changed while only 10 out of 17 diabetics had fluctuating sodium levels (p-value = 0.00). We also found out that most of the patients with altered sodium levels were male in the age range of above 55. Conclusion Patients with ischemic stroke do develop hyponatremia, but only with a slight alteration in the sodium levels.