Successful outcome of pregnancy in a case of Guillain Barre syndrome-report of a rare case and review of literature

Guillain Barre syndrome (GBS) is a rare autoimmune neurological disorder that has been reported to carry a high maternal risk and maternal mortality risk of >10% if occurred during pregnancy. It is characterized by acute onset of symmetrical ascending paralysis with or without respiratory depression and autonomic dysfunction secondary to gastrointestinal or respiratory infection. This is case report of 30 years old multigravida who presented at 19 weeks period of gestation with sudden onset back pain and bilateral lower limb weakness that progressed to involve bilateral upper limbs with respiratory insufficiency.  Based on clinical presentation and relevant investigations like serum electrolyte, arterial blood gas analysis and nerve conduction studies, provisional diagnosis of GBS was made. In collaboration with the physician, she was managed with ventilator support for 12 days, intravenous immunoglobulin and supportive therapy. This was followed by complete and rapid recovery as she was extubated on 12th day and discharged on day 16. Patient was followed by strict maternal and fetal surveillance. She successfully delivered a healthy boy at 38 weeks of period of gestation by caesarean section done in view of meconium-stained liquor grade 3 in early labour and she was discharged on day 3 of LSCS.

Primary Cytomegalovirus Infection Causing Guillain-Barré Syndrome in a Living Renal Allograft Recipient

Guillain-Barré Syndrome (GBS) is a common acute autoimmune polyneuropathy in adults. There have been few reported cases of Guillain-Barré Syndrome associated with active cytomegalovirus (CMV) infection in renal transplant recipients. Here we present a case of active CMV viremia inducing Guillain-Barré Syndrome in a renal transplant recipient. We discuss the treatment regimen utilized. Furthermore, we performed a review of the literature and discuss the cases of CMV induced GBS in renal transplant recipients

Approach to the Pretransplant Evaluation of the Living Kidney Donor

Evaluation of the potential kidney donor is a complex activity that differs substantially from other types of preoperative assessments. The well being of the donor, who derives no medical benefit from this surgery, must be assured in both the short term and long term, and the potential adverse consequences to the recipient must be determined as well. The criteria that must be met for a person to donate a kidney are rigorous and include medical, social, psychosocial, ethical, and legal issues. Donor evaluation can be divided into assessments to protect the health and safety of the donor and assessments to protect the health and safety of the recipient. This article provides an approach to evaluating a donor, focusing on the complex issues that an evaluator is faced with. A careful assessment of risks and benefits to both the donor and recipient can lead to favorable outcomes

Clinical Study The Initial Vascular Access Type Contributes to Inflammation in Incident Hemodialysis Patients

Copyright © 2012 Mala Sachdeva et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. The contribution of the hemodialysis (HD) vascular access type to inflammation is unclear. Methods. Weconducted a prospective observational study in an incident HD population. C-reactive protein (CRP), interleukin-6 (IL-6), and interferon-γinduced protein (IP-10) were measured before and at 6-time points after access placement for 1 year. Results. Sixty-four incident HD patients were included (tunneled catheter (TC), n = 40, arteriovenous fistula (AVF), n = 14, and arteriovenous graft (AVG), n = 10). A mixed effects model was performed to adjust for age, sex, race, coronary artery disease, diabetes mellitus, infections, access thrombosis, initiation of HD, and days after access surgery. In comparison to AVFs, the presence of a TC was associated with significantly higher levels of CRP (P = 0.03), IL-6 (P = 0.07), and IP-10 (P = 0.03). The presence of an AVG was associated with increases in CRP (P = 0.01) and IP-10 (P = 0.07). Conclusions. Patients who initiate HD with a TC or an AVG have a heightened state of inflammation, which may contribute to the excess 90-day mortality after HD initiation. 1

Barriers to Peritoneal Dialysis in Aboriginal Patients

Background: Aboriginal people in Canada have an unduly high burden of end-stage kidney disease (ESKD) and many live in rural settings. Peritoneal dialysis (PD) is a home-based dialysis modality that may provide a valuable alternative to in-center hemodialysis which is relatively underutilized by the Aboriginal population. Objective: We aim to assess the barriers to PD utilization in Aboriginal patients with ESKD. Design: This article is a prospective observational cohort study. Setting: The setting involves 3 predialysis clinics in Winnipeg, Kingston, and Moose Factory. Patients: The patients were 99 individuals (67 non-Aboriginal and 32 Aboriginal) who were at least 18 years of age with an estimated glomerular filtration rate of less than 30 mL/min/1.73m 2 , and were enrolled in one of the 3 study sites from April 2011 to October 2013. Measurements: Patient demographics and comorbidities were documented. Barriers to PD, PD as modality choice, and Aboriginal status were assessed via patient survey upon study enrollment. PD use as the initial dialysis modality was assessed via monthly patient follow-up for 1 year after enrollment in the study. Methods: The patient survey was created based on literature review of known barriers to PD, repaired based on direct patient feedback, and tested for reliability via the test-retest method. Differences in PD choice, barriers to PD, and PD use between Aboriginal and non-Aboriginal patients were determined by chi-square test and logistic regression. Results: All patients enrolled in the study completed the survey. Mean age was 65.5 versus 54.6 years for non-Aboriginals and Aboriginals, respectively. Barriers to PD significantly associated with Aboriginal status were lack of money (odds ratio [OR]: 21.3; 95% confidence interval [CI]: 5.3-86.4; P < .0001) and anxiety (OR: 2.8; 95% CI: 1.1-7.1; P = .03). There was no difference in PD choice between non-Aboriginals and Aboriginals (66.7% vs 68.8%, respectively; P = .83). One of 67 non-Aboriginals (1.5%) and 5 of 32 Aboriginals (15.6%) died prior to initiating dialysis ( P = .013). No significant difference was observed between non-Aboriginals (33%) and Aboriginals (28%) in use of PD ( P = .81). Limitations: Small sample size was a limitation of this study. Conclusions: Aboriginal people in Canada have a disproportionately large burden of ESKD, and PD could provide an alternative to in-center hemodialysis for those living in rural areas. Our study identified anxiety and lack of money as barriers to PD significantly associated with Aboriginal status. When choosing dialysis modality, shared decision making between physicians and patient is of key importance to weigh all potential benefits and risks and emphasize the Aboriginal patient’s values and preferences. These results can be used to guide future research and to help devise interventions targeting barriers to PD in Aboriginals

Sarcoidosis presenting as Wallenberg syndrome and panuveitis

Sarcoidosis is a multi-system disease with neurological involvement being one of the more rare manifestations. We report a case of a patient who presented with the lateral medullary syndrome and panuveitis as her initial manifestation of sarcoidosis. The patient’s course was further complicated by renal involvement. Lacrimal gland and renal biopsies showed noncaseating granulomas without evidence of infection, establishing the diagnosis. Intracranial vertebral artery involvement was confirmed by brain imaging. Bilateral hilar lymphadenopathy with upper lobe predominant nodules on chest imaging was consistent with asymptomatic pulmonary involvement. Systemic steroid therapy is indicated for treatment of ocular sarcoidosis, with standard stroke management indicated for the treatment of lateral medullary syndrome