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Papri N, Islam Z, Ara G, Saha T, Leonhard SE, Endtz HP, Jacobs BC, Mohammad QD. Management of Guillain-Barré syndrome in Bangladesh: Clinical practice, limitations and recommendations for low- and middle-income countries. J Peripher Nerv Syst 2023; 28:564-577. [PMID: 37698165 DOI: 10.1111/jns.12597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/07/2023] [Accepted: 09/10/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND AND AIMS Considerable variation in clinical practice for management of Guillain-Barré syndrome (GBS) has been observed worldwide. Diagnosis and treatment are challenging in low- and middle-income countries (LMIC) due to lack of facilities and treatment availability. We aimed to evaluate current clinical practice and limitations and to provide recommendation for GBS management in low-resource settings. METHODS We conducted an explanatory-sequential mixed-methods survey among neurologists and internists working in tertiary and secondary government hospitals in Bangladesh. There were two phases: (1) quantitative (cross-sectional survey to evaluate clinical practice and limitations); (2) qualitative (key informant interview to explain certain clinical practice and provide recommendations for GBS management in LMIC). Data were analyzed by frequencies, χ2 test and thematic analysis. RESULTS Among 159 physicians (65 neurologists and 94 internists), 11% and 8% physicians used Brighton and NINDS criteria respectively to diagnose GBS. Specific treatment protocols of GBS were used by 12% physicians. Overcrowding of patients, inadequate diagnostic facilities, high costs of standard therapy, and inadequate logistics and trained personnel for intensive care unit and rehabilitation services were considered major challenges for GBS management. In qualitative part, respondents recommended regular training for the physicians, development of cost-effective treatment strategies and appropriate patients' referral and management guideline considering existing limitations in health service delivery and socio-economic status of the country. INTERPRETATION Current study design and recommendations might be applied for other LMIC. Such data can assist policymakers to identify areas requiring urgent attention and take required action to improve GBS management in LMIC.
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Affiliation(s)
- Nowshin Papri
- Laboratory of Gut-Brain Axis, Infectious Diseases Division (IDD), icddr,b, Dhaka, Bangladesh
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Zhahirul Islam
- Laboratory of Gut-Brain Axis, Infectious Diseases Division (IDD), icddr,b, Dhaka, Bangladesh
| | - Gulshan Ara
- Nutrition Research Division, icddr,b, Dhaka, Bangladesh
- Department of Nutrition, Sports and Exercise, University of Copenhagen, Copenhagen, Denmark
| | - Tamal Saha
- Laboratory of Gut-Brain Axis, Infectious Diseases Division (IDD), icddr,b, Dhaka, Bangladesh
| | - Sonja E Leonhard
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Hubert P Endtz
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Bart C Jacobs
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Quazi D Mohammad
- National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
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Papri N, Doets AY, Mohammad QD, Endtz HP, Lingsma HF, Jacobs BC, Islam Z. Validation and adjustment of modified Erasmus GBS outcome score in Bangladesh. Ann Clin Transl Neurol 2022; 9:1264-1275. [PMID: 35908170 PMCID: PMC9380155 DOI: 10.1002/acn3.51627] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/06/2022] [Accepted: 06/20/2022] [Indexed: 11/28/2022] Open
Abstract
Objective We have assessed and improved the performance of the modified Erasmus GBS Outcome Score (mEGOS) among patients with Guillain‐Barré syndrome (GBS) from Bangladesh. Methods Validation cohort consisted of patients with GBS from two prospective cohort studies in Bangladesh. Poor outcome was defined as being unable to walk independently at week 4 and week 26. We excluded patients able to walk independently, patients who died within the first week, or with missing GBS disability scores. Performance of mEGOS at entry and week 1 was determined based on the discriminative ability (ability to differentiate between patients able and unable to walk independently; measured using the area under the receiver operating characteristic curves [AUC]) and calibration (observed probability versus predicted probability of poor outcome). Results A total of 506 patients aged ≥6‐year‐old were enrolled, with 471 and 366 patients included in mEGOS validation analysis at entry and week 1, respectively. The AUC values for predicting poor outcome (1) at week 4 were 0.69 (mEGOS entry) and 0.78 (mEGOS week 1) and (2) at week 26 were 0.67 (mEGOS entry) and 0.70 (mEGOS week 1). Mean predicted probabilities of poor outcome corresponded with observed outcomes except for the probability of poor outcome at week 4 which was overestimated by mEGOS week 1. This was resolved by updating the model intercept. Interpretation The mEGOS shows valid outcome predictions among patients with GBS from Bangladesh. The model can aid the identification of patients at high risk of poor outcome and help to adequately allocate healthcare resources in low‐resource settings.
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Affiliation(s)
- Nowshin Papri
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh.,Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Alex Y Doets
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Quazi D Mohammad
- National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
| | - Hubert P Endtz
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Hester F Lingsma
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Bart C Jacobs
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Zhahirul Islam
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh
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Jahan I, Hayat S, Khalid MM, Ahammad RU, Asad A, Islam B, Mohammad QD, Jacobs BC, Islam Z. Association of mannose-binding lectin 2 gene polymorphisms with Guillain-Barré syndrome. Sci Rep 2022; 12:5791. [PMID: 35388043 PMCID: PMC8987049 DOI: 10.1038/s41598-022-09621-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/24/2022] [Indexed: 11/29/2022] Open
Abstract
Complement activation plays a critical role in the pathogenesis of Guillain-Barré syndrome (GBS), a debilitating immune-mediated neuropathy. Mannose-binding lectin (MBL) is a complement activation factor of lectin pathway which as genetic host factor may influence the susceptibility or severity of GBS. We investigated the frequency of MBL2 promoter (- 550H/L and - 221X/Y) and functional region (exon 1 A/O) polymorphisms and their association with disease susceptibility, clinical features and serum MBL among GBS patients (n = 300) and healthy controls (n = 300) in Bangladesh. The median patient age was 30 years (IQR: 18-42; males, 68%). MBL2 polymorphisms were not significantly associated with GBS susceptibility compared to healthy controls. HL heterozygosity in GBS patients was significantly associated with mild functional disability at enrolment (P = 0.0145, OR, 95% CI 2.1, 1.17-3.82). The HY, YA, HA and HYA heterozygous haplotypes were more common among mildly affected (P = 0.0067, P = 0.0086, P = 0.0075, P = 0.0032, respectively) than severely affected patients with GBS. Reduced serum MBL was significantly associated with the LL, OO and no HYA variants and GBS disease severity. No significant association was observed between MBL2 polymorphisms and electrophysiological variants, recent Campylobacter jejuni infection or anti-ganglioside (GM1) antibody responses in GBS. In conclusion, MBL2 gene polymorphisms are related to reduced serum MBL and associated with the severity of GBS.
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Affiliation(s)
- Israt Jahan
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr, b, Mohakhali, Dhaka, 1212, Bangladesh
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Shoma Hayat
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr, b, Mohakhali, Dhaka, 1212, Bangladesh
| | - Mir M Khalid
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr, b, Mohakhali, Dhaka, 1212, Bangladesh
| | | | - Asaduzzaman Asad
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr, b, Mohakhali, Dhaka, 1212, Bangladesh
| | - Badrul Islam
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr, b, Mohakhali, Dhaka, 1212, Bangladesh
| | - Quazi D Mohammad
- National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
| | - Bart C Jacobs
- Department of Neurology and Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Zhahirul Islam
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr, b, Mohakhali, Dhaka, 1212, Bangladesh.
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Islam B, Islam Z, Endtz HP, Jahan I, Jacobs BC, Mohammad QD, Franssen H. Electrophysiology of Guillain-Barré syndrome in Bangladesh: A prospective study of 312 patients. Clin Neurophysiol Pract 2022; 6:155-163. [PMID: 35112034 PMCID: PMC8790160 DOI: 10.1016/j.cnp.2021.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/24/2021] [Accepted: 03/28/2021] [Indexed: 11/27/2022] Open
Abstract
Classification of neurophysiologic subtypes of Guillain-Barré syndrome largely depended on the applied criteria. Anti-GM1 antibodies were not exclusively associated with axonal Guillain-Barré syndrome. Conduction block was not exclusively associated with demyelinating Guillain-Barré syndrome.
Objective To describe the electrophysiological features in relation to clinical and serological findings of Guillain-Barré syndrome (GBS) in the national neuroscience hospital in Bangladesh. This is one of the few studies that investigated GBS patients using standardized electrophysiology in low-income countries. Methods In a prospective and observational study, we investigated 312 GBS patients by standardized clinical, serological and electrophysiological methods. Unilateral motor and sensory nerve conduction studies (NCS) were performed within two weeks of onset of weakness. Follow up NCS were performed in 189 patients and classified according to eight sets of established GBS criteria. Serology included assessment of anti-GM1 antibodies and anti-campylobacter jejuni lipo-oligosaccharide (LOS) antibodies. Results Depending on the criteria used, 44–59% patients had axonal GBS with anti-GM1 antibodies being present in 55–58% and 9–42% patients had demyelinating GBS with anti-GM1 antibodies being present in 7–35%. Conduction block (CB) with demyelinative slowing in the same nerve segment was found in 24% (74/312) patients, and CB without demyelinative slowing in the same nerve segment was found in 18% (56/312) patients, of whom anti-GM1 antibodies were found in 27% and 57% patients respectively. Follow-up NCS showed a change in GBS classification in 11–26% of patients, mainly from demyelinating to axonal GBS. Conclusions The predominant subtype of GBS in Bangladesh is axonal but demyelinating GBS also occurs with classification being strongly dependent on the applied criteria. Significance The present study demonstrates the importance of reaching international agreement on GBS criteria that should be based on the best evidence.
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Affiliation(s)
- Badrul Islam
- Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh
| | - Zhahirul Islam
- Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh
| | - Hubert P Endtz
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Israt Jahan
- Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh
| | - Bart C Jacobs
- Department of Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Quazi D Mohammad
- National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
| | - Hessel Franssen
- Department of Neuromuscular Disorders, Utrecht Brain Center, the Netherlands
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Drenthen J, Islam B, Islam Z, Mohammad QD, Maathuis EM, Visser GH, van Doorn PA, Blok JH, Endtz HP, Jacobs BC. Changes in motor nerve excitability in acute phase Guillain-Barré syndrome. Muscle Nerve 2021; 63:546-552. [PMID: 33452679 PMCID: PMC8049016 DOI: 10.1002/mus.27172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND The most common subtypes of Guillain-Barré syndrome (GBS) are acute inflammatory demyelinating polyneuropathy (AIDP) and acute motor axonal neuropathy (AMAN). In the first days after the onset of weakness, standard nerve conduction studies (NCS) may not distinguish GBS subtypes. Reduced nerve excitability may be an early symptom of nerve dysfunction, which can be determined with the compound muscle action potential (CMAP) scan. The aim of this study was to explore whether early changes in motor nerve excitability in GBS patients are related to various subtypes. METHODS Prospective case-control study in 19 GBS patients from The Netherlands and 22 from Bangladesh. CMAP scans were performed within 2 days of hospital admission and NCS 7-14 days after onset of weakness. CMAP scans were also performed in age- and country-matched controls. RESULTS CMAP scan patterns of patients who were classified as AMAN were distinctly different compared to the CMAP scan patterns of the patients who were classified as AIDP. The most pronounced differences were found in the stimulus intensity parameters. CONCLUSIONS CMAP scans made at hospital admission demonstrate several characteristics that can be used as an early indicator of GBS subtype.
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Affiliation(s)
- Judith Drenthen
- Depts. of Clinical NeurophysiologyUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Badrul Islam
- Laboratory of Gut‐Brain Signaling, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, (icddr,b)DhakaBangladesh
| | - Zhahirul Islam
- Laboratory of Gut‐Brain Signaling, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, (icddr,b)DhakaBangladesh
| | | | - Ellen M. Maathuis
- Depts. of Clinical NeurophysiologyUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Gerhard H. Visser
- Stichting Epilepsie Instellingen Nederland (SEIN)HeemstedeThe Netherlands
| | | | - Joleen H. Blok
- Medisch Centrum Eindhoven VeldhovenEindhovenThe Netherlands
| | - Hubert P. Endtz
- Medical microbiology and infectious diseases, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Bart C. Jacobs
- NeurologyUniversity Medical Center RotterdamRotterdamThe Netherlands
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Papri N, Islam Z, Leonhard SE, Mohammad QD, Endtz HP, Jacobs BC. Guillain-Barré syndrome in low-income and middle-income countries: challenges and prospects. Nat Rev Neurol 2021; 17:285-296. [PMID: 33649531 PMCID: PMC7920001 DOI: 10.1038/s41582-021-00467-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 01/31/2023]
Abstract
The epidemiology, clinical characteristics, management and outcome of Guillain-Barré syndrome (GBS) differ between low-income and middle-income countries (LMIC) and high-income countries (HIC). At present, limited data are available on GBS in LMIC and the true incidence of GBS in many LMIC remains unknown. Increased understanding of GBS in LMIC is needed because poor hygiene and high exposure to infections render populations in LMIC vulnerable to GBS outbreaks. Furthermore, insufficient diagnostic and health-care facilities in LMIC contribute to delayed diagnosis in patients with severe presentations of GBS. In addition, the lack of national clinical guidelines and absence of affordable, effective treatments contribute to worse outcomes and higher mortality in LMIC than HIC. Systematic population-based surveillance studies, cohort and case-control studies are required to understand the incidence and risk factors for GBS. Novel, targeted and cost-effective treatment strategies need to be developed in the context of health system challenges in LMIC. To ensure integrative rehabilitation services in LMIC, existing prognostic models must be validated, and responsive outcome measures that are cross-culturally applicable must be developed. Therefore, fundamental and applied research to improve the clinical management of GBS in LMIC should become a critical focus of future research programmes.
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Affiliation(s)
- Nowshin Papri
- grid.414142.60000 0004 0600 7174Laboratory of Gut–Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh ,grid.5645.2000000040459992XDepartment of Neurology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Zhahirul Islam
- grid.414142.60000 0004 0600 7174Laboratory of Gut–Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh
| | - Sonja E. Leonhard
- grid.5645.2000000040459992XDepartment of Neurology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Quazi D. Mohammad
- grid.489064.7National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
| | - Hubert P. Endtz
- grid.5645.2000000040459992XDepartment of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center, Rotterdam, Netherlands ,grid.434215.50000 0001 2106 3244Fondation Mérieux, Lyon, France
| | - Bart C. Jacobs
- grid.5645.2000000040459992XDepartment of Neurology, Erasmus MC, University Medical Center, Rotterdam, Netherlands ,grid.5645.2000000040459992XDepartment of Immunology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
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Jahan I, Ahammad RU, Khalid MM, Rahman MI, Hayat S, Islam B, Mohammad QD, Islam Z. Toll-like receptor-4 299Gly allele is associated with Guillain-Barré syndrome in Bangladesh. Ann Clin Transl Neurol 2019; 6:708-715. [PMID: 31019995 PMCID: PMC6469239 DOI: 10.1002/acn3.744] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/07/2019] [Accepted: 02/07/2019] [Indexed: 01/08/2023] Open
Abstract
Objective TLR4 plays an important role in the pathogenesis of Guillain‐Barré syndrome (GBS). The relationships between TLR4 polymorphisms and susceptibility to GBS are poorly understood. We investigated the frequency and assessed the association of two single nucleotide polymorphisms (SNPs) in the extracellular domain of TLR4 (Asp299Gly and Thr399Ile) with disease susceptibility and the clinical features of GBS in a Bangladeshi cohort. Methods A total of 290 subjects were included in this study: 141 patients with GBS and 149 unrelated healthy controls. The TLR4 polymorphisms Asp299Gly and Thr399Ile were genotyped using polymerase chain reaction‐restriction fragment length polymorphism (PCR‐RFLP) assay. Results The minor 299Gly allele was significantly associated with GBS susceptibility (P = 0.0137, OR = 1.97, 95% CI = 1.17–3.31), and was present at a significantly higher frequency in patients with the acute motor axonal neuropathy (AMAN) subtype of GBS (P = 0.0120, OR = 2.37, 95% CI = 1.26–4.47) than acute inflammatory demyelinating polyneuropathy (AIDP) subtype (P = 0.961, OR = 1.15, 95% CI = 0.38–3.48); when compared to healthy controls. The genotype frequency of the Asp299Gly polymorphism was not significantly different between patients with GBS and healthy controls. The Asp299‐Thr399 haplotype was associated with a significantly lower risk of developing GBS (P = 0.0451, OR = 0.63, 95% CI = 0.40–0.99). No association was observed between the Thr399Ile polymorphism and GBS disease susceptibility. Interpretation The TLR4 minor 299Gly allele was associated with increased susceptibility to GBS and the axonal GBS subtype in the Bangladeshi population. However, no associations were observed between the genotypes of the Asp299Gly and Thr399Ile SNPs and antecedent C. jejuni infection or disease severity in Bangladeshi patients with GBS.
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Affiliation(s)
- Israt Jahan
- Laboratory Sciences and Services Division icddr,b Dhaka Bangladesh
| | - Rijwan U Ahammad
- Laboratory Sciences and Services Division icddr,b Dhaka Bangladesh.,Graduate School of Medicine Department of Neuroscience Nagoya University Nagoya Japan
| | - Mir M Khalid
- Laboratory Sciences and Services Division icddr,b Dhaka Bangladesh.,Gladstone Institutes San Francisco California
| | - Mohammad I Rahman
- Laboratory Sciences and Services Division icddr,b Dhaka Bangladesh.,School of Molecular Sciences Arizona State University Tempe Arizona
| | - Shoma Hayat
- Laboratory Sciences and Services Division icddr,b Dhaka Bangladesh
| | - Badrul Islam
- Laboratory Sciences and Services Division icddr,b Dhaka Bangladesh.,Department of Medical Microbiology and Infectious Diseases Erasmus Medical Center Rotterdam The Netherlands
| | - Quazi D Mohammad
- National Institute of Neurosciences and Hospital Dhaka Bangladesh
| | - Zhahirul Islam
- Laboratory Sciences and Services Division icddr,b Dhaka Bangladesh
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Islam Z, Papri N, Ara G, Ishaque T, Alam AU, Jahan I, Islam B, Mohammad QD. Risk factors for respiratory failure in Guillain-Barré syndrome in Bangladesh: a prospective study. Ann Clin Transl Neurol 2019; 6:324-332. [PMID: 30847364 PMCID: PMC6389747 DOI: 10.1002/acn3.706] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 11/06/2022] Open
Abstract
Objective We investigated clinical, biological, and electrophysiological risk factors for mechanical ventilation (MV) and patient outcomes in Bangladesh using one of the largest, prospective Guillain-Barré syndrome (GBS) cohorts in developing world. Methods A total of 693 GBS patients were included in two GBS studies conducted between 2006 and 2016 in Dhaka, Bangladesh. Associations between baseline characteristics and MV were tested using Fisher's exact test, χ2 test, or Mann-Whitney U-test, as appropriate. Risk factors for MV were assessed using multivariate logistic regression. Survival analysis was performed using Kaplan-Meier method; comparisons between groups performed using log-rank test. Results Of 693 patients, 155 (23%) required MV (median age, 26 years; interquartile range [IQR] 17-40). Among the ventilated patients, males were predominant (68%) than females. The most significant risk factor for MV was bulbar involvement (adjusted odds ratio [AOR]:19.07; 95% CI = 89.00-192.57, P = 0.012). Other independently associated factors included dysautonomia (AOR:4.88; 95% CI = 1.49-15.98, P = 0.009) and severe muscle weakness at study entry (AOR:6.12; 95% CI = 0.64-58.57, P = 0.048). At 6 months after disease onset, 20% of ventilated and 52% of non-ventilated patients (P < 0.001) had recovered completely or with minor symptoms. Mortality rate was significantly higher among ventilated patients than non-ventilated patients (41% vs. 7%, P < 0.001). Interpretation Bulbar involvement, dysautonomia and severe muscle weakness were identified as the most important risk factors for MV among GBS patients from Bangladesh. The findings may help to develop predictive models for MV in GBS in developing countries to identify impending respiratory failure and proper clinical management of GBS patients.
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Affiliation(s)
- Zhahirul Islam
- Laboratory Sciences and Services Division icddr,b Dhaka Bangladesh
| | - Nowshin Papri
- Laboratory Sciences and Services Division icddr,b Dhaka Bangladesh
| | - Gulshan Ara
- Nutrition and Clinical Services Division icddr,b Dhaka Bangladesh
| | - Tanveen Ishaque
- Laboratory Sciences and Services Division icddr,b Dhaka Bangladesh.,Department of Surgery Johns Hopkins School of Medicine Baltimore Maryland
| | - Arafat U Alam
- Laboratory Sciences and Services Division icddr,b Dhaka Bangladesh
| | - Israt Jahan
- Laboratory Sciences and Services Division icddr,b Dhaka Bangladesh
| | - Badrul Islam
- Laboratory Sciences and Services Division icddr,b Dhaka Bangladesh.,Department of Medical Microbiology and Infectious Diseases Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands
| | - Quazi D Mohammad
- National Institute of Neurosciences and Hospital Dhaka Bangladesh
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Saha UK, Alam MB, Rahman AKMF, Hussain AHME, Mashreky SR, Mandal G, Mohammad QD. Epidemiology of stroke: findings from a community-based survey in rural Bangladesh. Public Health 2018; 160:26-32. [PMID: 29709700 DOI: 10.1016/j.puhe.2018.03.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 02/07/2018] [Accepted: 03/19/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study was designed to determine the epidemiology of stroke in a rural population of Bangladesh. STUDY DESIGN In a cross-sectional study, we surveyed stroke patients. METHODS The survey was conducted in a rural community of Bangladesh from January 2016 to June 2016. All community members 15 years and older in a surveillance system were included in this study. The Questionnaire for Verifying Stroke-Free Status was used to screen stroke cases at household level which were again examined by the neurologist for confirmatory diagnosis. RESULTS The prevalence of stroke was 1.96 (95% confidence interval [CI] 1.69-2.26) per 1000 population. The highest prevalence was 9.65 (95% CI 7.42-12.33) per 1000 population, identified among patients aged 65-79 years. Males had higher prevalence (2.38 per 1000 population) than females (1.55 per 1000 population). Of the 24% of patients who had radiological examination (magnetic resonance imaging and computed tomography scan) reports, 17.2% of stroke cases were ischemic, 4.8% were intracerebral, and about 1.1% were subarachnoid. The ratio of infarction to hemorrhage was 2.91. Approximately 67% of patients were diagnosed as hypertensive, and 37% of patients had elevated blood glucose level. While 15% of patients were found to be overweight or obese, 45% of patients had raised blood cholesterol level. More than 10% of patients reported that they had heart disease before the occurrence of stroke. About 40% of patients had the history of tobacco consumption. CONCLUSIONS The prevalence of stroke is higher among elderly and male populations. A significant proportion of patients presented with hypertension and/or diabetes.
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Affiliation(s)
- U K Saha
- National Institute of Neurosciences and Hospital, Dhaka, Bangladesh.
| | - M B Alam
- National Institute of Neurosciences and Hospital, Dhaka, Bangladesh.
| | - A K M F Rahman
- Centre for Injury Prevention and Research Bangladesh, Dhaka, Bangladesh; Department of Epidemiology, Bangladesh University of Health Sciences, Bangladesh.
| | | | - S R Mashreky
- Centre for Injury Prevention and Research Bangladesh, Dhaka, Bangladesh; Department of Epidemiology, Bangladesh University of Health Sciences, Bangladesh.
| | - G Mandal
- National Institute of Neurosciences and Hospital, Dhaka, Bangladesh.
| | - Q D Mohammad
- National Institute of Neurosciences and Hospital, Dhaka, Bangladesh.
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GeurtsvanKessel CH, Islam Z, Islam MB, Kamga S, Papri N, van de Vijver DAMC, Reusken C, Mogling R, Heikema AP, Jahan I, Pradel FK, Pavlicek RL, Mohammad QD, Koopmans MPG, Jacobs BC, Endtz HP. Zika virus and Guillain-Barré syndrome in Bangladesh. Ann Clin Transl Neurol 2018; 5:606-615. [PMID: 29761123 PMCID: PMC5945960 DOI: 10.1002/acn3.556] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 02/26/2018] [Indexed: 11/11/2022] Open
Abstract
Objective Previous studies have associated Guillain–Barré syndrome (GBS) with Zika virus (ZIKV) outbreaks in South America and Oceania. In Asia, ZIKV is known to circulate widely, but the association with Guillain–Barré syndrome is unclear. We investigated whether endemic ZIKV infection is associated with the development of GBS. Methods A prospective study was conducted from 2011 to 2015 in Bangladesh. A total of 418 patients and 418 healthy family controls were included in the study. Patients were diagnosed with GBS prior to inclusion according to established criteria. Detailed information on the epidemiology, clinical presentation, electrophysiology, diagnosis, disease severity, and clinical course were obtained during a follow‐up of 1 year using a predefined protocol. Results ZIKV‐neutralizing antibodies were detected in our study from 2013 onwards. The prevalence of ZIKV‐neutralizing antibodies was not significantly higher in patients with GBS compared to healthy controls (OR 2.23, P = 0.14, 95% CI 0.77–6.53). Serological evidence for prior ZIKV infection in patients with GBS was associated with more frequent cranial, sensory, and autonomic nerve involvement compared to GBS patients with Campylobacter jejuni, the predominant preceding infection in GBS worldwide. Nerve‐conduction studies revealed that ZIKV antibodies were associated with a demyelinating subtype of GBS, while C. jejuni infections were related to an axonal subtype. Interpretation No significant association was found between ZIKV infection and GBS in Bangladesh, but GBS following ZIKV infection was characterized by a distinct clinical and electrophysiological subtype compared to C. jejuni infection. These findings indicate that ZIKV may precede a specific GBS subtype but the risk is low.
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Affiliation(s)
| | - Zhahirul Islam
- Laboratory Sciences and Services Division International Centre for Diarrhoeal Disease Research, (icddr,b) Dhaka Bangladesh
| | - Md Badrul Islam
- Laboratory Sciences and Services Division International Centre for Diarrhoeal Disease Research, (icddr,b) Dhaka Bangladesh.,Department of Medical Microbiology and Infectious Diseases Erasmus Medical Center Rotterdam The Netherlands
| | - Sandra Kamga
- Department of Viroscience Erasmus Medical Center Rotterdam The Netherlands
| | - Nowshin Papri
- Laboratory Sciences and Services Division International Centre for Diarrhoeal Disease Research, (icddr,b) Dhaka Bangladesh
| | | | - Chantal Reusken
- Department of Viroscience Erasmus Medical Center Rotterdam The Netherlands
| | - Ramona Mogling
- Department of Viroscience Erasmus Medical Center Rotterdam The Netherlands
| | - Astrid P Heikema
- Department of Medical Microbiology and Infectious Diseases Erasmus Medical Center Rotterdam The Netherlands
| | - Israt Jahan
- Laboratory Sciences and Services Division International Centre for Diarrhoeal Disease Research, (icddr,b) Dhaka Bangladesh
| | | | | | - Quazi D Mohammad
- National Institute of Neurosciences and Hospital Dhaka Bangladesh
| | | | - Bart C Jacobs
- Departments of Neurology and Immunology Erasmus Medical Center Rotterdam The Netherlands
| | - Hubert P Endtz
- Laboratory Sciences and Services Division International Centre for Diarrhoeal Disease Research, (icddr,b) Dhaka Bangladesh.,Department of Medical Microbiology and Infectious Diseases Erasmus Medical Center Rotterdam The Netherlands.,Fondation Mérieux Lyon France
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11
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Ishaque T, Islam MB, Ara G, Endtz HP, Mohammad QD, Jacobs BC, Islam Z. High mortality from Guillain-Barré syndrome in Bangladesh. J Peripher Nerv Syst 2018; 22:121-126. [PMID: 28447405 DOI: 10.1111/jns.12215] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 03/28/2017] [Accepted: 04/03/2017] [Indexed: 12/23/2022]
Abstract
Although Guillain-Barré syndrome (GBS) has higher incidence and poor outcome in Bangladesh, mortality from GBS in Bangladesh has never been explored before. We sought to explore the frequency, timing, and risk factors for deaths from GBS in Bangladesh. We conducted a prospective study on 407 GBS patients who were admitted to Dhaka Medical College Hospital, Dhaka, Bangladesh from 2010 to 2013. We compared deceased and alive patients to identify risk factors. Cox regression model was used to adjust for confounders. Of the 407 GBS patients, 50 (12%) died, with the median time interval between the onset of weakness and death of 18 days. Among the fatal cases, 24 (48%) were ≥40 years, 36 (72%) had a Medical Research Council sum score ≤20 at entry, 33 (66%) had a progressive phase <8 days, and 27 (54%) required ventilation support. Ten patients (20%) died due to unavailability of ventilator. The strongest risk factor for deaths was lack of ventilator support when it was required (HR: 11.9; 95% confidence interval [CI]: 4.6-30.7). Other risk factors for death included age ≥40 years (HR: 5.9; 95% CI: 2.1-16.7), mechanical ventilation (HR: 2.3; 95% CI: 1.02-5.2), longer progressive phase (>8 days) (HR: 2.06; 95% CI: 1.1-3.8), autonomic dysfunction (HR: 1.9; 95% CI: 1.05-3.6), and bulbar nerve involvement (HR: 5.4; 95% CI: 1.5-19.2). In Bangladesh, GBS is associated with higher mortality rates, which is related to lack of ventilator support, disease severity, longer progressive phase of the disease, autonomic dysfunction, and involvement of the bulbar nerves.
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Affiliation(s)
- Tanveen Ishaque
- Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, (icddr,b), Dhaka, Bangladesh.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mohammad B Islam
- Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, (icddr,b), Dhaka, Bangladesh.,Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Gulshan Ara
- Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, (icddr,b), Dhaka, Bangladesh
| | - Hubert P Endtz
- Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, (icddr,b), Dhaka, Bangladesh.,Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Fondation Mérieux, Lyon, France
| | - Quazi D Mohammad
- National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
| | - Bart C Jacobs
- Department of Neurology, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Immunology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Zhahirul Islam
- Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, (icddr,b), Dhaka, Bangladesh
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12
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Islam Z, Jahan I, Ahammad RU, Shahnaij M, Nahar S, Mohammad QD. FAS promoter polymorphisms and serum sFas level are associated with increased risk of nerve damage in Bangladeshi patients with Guillain-Barré syndrome. PLoS One 2018; 13:e0192703. [PMID: 29432441 PMCID: PMC5809046 DOI: 10.1371/journal.pone.0192703] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 01/29/2018] [Indexed: 12/20/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is an autoimmune disorder of the peripheral nervous system triggered by molecular mimicry between pathogen lipopolysaccharides and host nerve gangliosides. Polymorphisms in the Fas receptor (FAS) and Fas ligand (FASL) genes may potentially alter the elimination of autoreactive immune cells and affect disease susceptibility or disease severity in GBS. We detected single nucleotide polymorphisms (SNPs) in FAS (-1377G/A and -670A/G) and FASL (-843C/T) in a prospective cohort of 300 patients with GBS and 300 healthy controls from the Bangladeshi population. Genotype distributions were not significantly different between patients with GBS and healthy controls. The FAS -670 AG heterozygous (P = 0.0005, OR = 2.5, 95% CI = 1.5–4.2) and GG homozygous (P = 0.0048, OR = 2.6, 95% CI = 1.3–5.0) genotypes were more common in patients with anti-GM1 antibodies than patients without anti-GM1 antibodies. The FAS -670 G allele was more prevalent in anti-GM1 antibody-positive than -negative patients (P = 0.0002, OR = 1.9, 95% CI = 1.4–2.7) and also in patients with the axonal subtype than demyelinating subtype (P < 0.0001, OR = 4.8, 95% CI = 2.3–10.1). The 1377G/-670G GG haplotype was significantly associated with the axonal subtype (P < 0.0001) and anti-ganglioside antibody-positivity (P = 0.0008) in GBS. Serum sFas (237.5 pg/mL vs. 159.5 pg/mL; P < 0.0001) and sFasL (225.1 pg/mL vs. 183.4 pg/mL; P = 0.0069) were elevated in patients with GBS compared to healthy controls, and among patients with high serum sFas was associated with severe GBS (P = 0.0406). In conclusion, this study indicates FAS-FASL promoter SNPs may promote the production of cross-reactive anti-ganglioside antibodies in GBS.
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Affiliation(s)
- Zhahirul Islam
- Laboratory Sciences and Services Division, International Centre for Diarrheal Disease Research (icddr,b), Dhaka, Bangladesh
- * E-mail:
| | - Israt Jahan
- Laboratory Sciences and Services Division, International Centre for Diarrheal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Rijwan U. Ahammad
- Laboratory Sciences and Services Division, International Centre for Diarrheal Disease Research (icddr,b), Dhaka, Bangladesh
- School of Medicine, Nagoya University, Nagoya, Japan
| | - Mohammad Shahnaij
- Laboratory Sciences and Services Division, International Centre for Diarrheal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Shamsun Nahar
- Laboratory Sciences and Services Division, International Centre for Diarrheal Disease Research (icddr,b), Dhaka, Bangladesh
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Islam MB, Islam Z, Farzana KS, Sarker SK, Endtz HP, Mohammad QD, Jacobs BC. Guillain-Barré syndrome in Bangladesh: validation of Brighton criteria. J Peripher Nerv Syst 2018; 21:345-351. [PMID: 27616152 DOI: 10.1111/jns.12189] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 09/03/2016] [Accepted: 09/07/2016] [Indexed: 11/29/2022]
Abstract
Guillain-Barré syndrome has a diverse clinical phenotype related to geographical origin. To date, the majority of large-scale studies on Guillain-Barré syndrome (GBS) have been conducted in developed countries. We aimed to evaluate the key diagnostic features and assess the suitability of the Brighton criteria in 344 adult GBS patients from Bangladesh. All patients fulfilled the National Institute of Neurological Diseases and Stroke (NINDS) diagnostic criteria. Standardized data on demographic characteristics and clinical features, cerebrospinal fluid (CSF) analysis, and nerve conduction study (NCS) results were elaborated to measure the sensitivity of Brighton criteria. Most patients (88%) were admitted to hospital after the nadir weakness. Symmetrical weakness and reduced reflexes were found in 98% of patients. CSF albuminocytologic dissociation was detected in 238/269 (89%) cases and abnormal nerve physiology in 258/259 (>99%) cases. Only 27 (8%) patients received either intravenous immunoglobulin (IVIg) or plasmapheresis. In total, 200 (58%) patients met level 1 of the Brighton criteria; 97 (28%) patients met level 2; 42 (12%) patients met level 3; and 5 (2%) patients met level 4. This analysis showed that despite the heterogeneity of GBS in Bangladesh, the Brighton criteria showed a high sensitivity in the diagnosis of GBS.
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Affiliation(s)
- Mohammad B Islam
- Emerging Diseases and Immunobiology Research Group, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, (icddr,b), Dhaka, Bangladesh.,Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Zhahirul Islam
- Emerging Diseases and Immunobiology Research Group, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, (icddr,b), Dhaka, Bangladesh
| | - Kaniz S Farzana
- Emerging Diseases and Immunobiology Research Group, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, (icddr,b), Dhaka, Bangladesh
| | - Sumit K Sarker
- Emerging Diseases and Immunobiology Research Group, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, (icddr,b), Dhaka, Bangladesh
| | - Hubert P Endtz
- Emerging Diseases and Immunobiology Research Group, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, (icddr,b), Dhaka, Bangladesh.,Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Fondation Mérieux, Lyon, France
| | - Quazi D Mohammad
- National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
| | - Bart C Jacobs
- Departments of Neurology and Immunology, Erasmus University Medical Centre, Rotterdam, The Netherlands
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14
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Islam MB, Islam Z, Rahman S, Endtz HP, Vos MC, van der Jagt M, van Doorn PA, Jacobs BC, Mohammad QD. Small volume plasma exchange for Guillain-Barré syndrome in resource poor settings: a safety and feasibility study. Pilot Feasibility Stud 2017; 3:40. [PMID: 28975040 PMCID: PMC5622586 DOI: 10.1186/s40814-017-0185-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 09/21/2017] [Indexed: 02/07/2023] Open
Abstract
Background In Bangladesh, most patients with Guillain-Barré syndrome (GBS) cannot afford standard treatment with intravenous immunoglobulin (IVIG) or a standard plasma exchange (PE) course, which partly explains the high rate of mortality and residual disability associated with GBS in this country. Small volume plasma exchange (SVPE) is an affordable and potentially effective alternative form of plasma exchange. SVPE is the repeated removal of small volumes of supernatant plasma over several days via sedimentation of patient whole blood. The aim of this study is to define the clinical feasibility and safety of SVPE in patients with GBS in resource poor settings. Methods A total of 20 adult patients with GBS will be enrolled for SVPE at a single center in Bangladesh. Six daily sessions of whole blood sedimentation and plasma removal will be performed in all patients with GBS with a target to remove an overall volume of at least 8 liters (L) of plasma over a total of 8 days. Serious adverse events (SAE) are defined as the number of patients developing severe sepsis associated with the central venous catheter or deep venous thrombosis in the limb where the catheter is placed for SVPE. Based upon a predictive success rate of 75%, the SVPE procedure will be considered safe if less than 5 of 20 SVPE-treated GBS patients have a SAE. The procedure will be considered feasible if 8 L of plasma can be removed in at least 15 of 20 patients with GBS who receive SVPE. In addition, detailed clinical and neurological outcome assessments will be performed until discharge of the patient from the hospital and up to 4 weeks after study entry. Discussion This is the first clinical study to evaluate the feasibility and safety of SVPE as a potential alternative low-cost treatment for the patients with GBS in resource poor settings. Trial registration Clinicaltrials.gov NCT02780570 Electronic supplementary material The online version of this article (10.1186/s40814-017-0185-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Md Badrul Islam
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands.,Laboratory Sciences and Services Division (LSSD), International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Zhahirul Islam
- Laboratory Sciences and Services Division (LSSD), International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shafiqur Rahman
- Department of Intensive Care Medicine, Uttara Adhunik Medical College & Hospital, Dhaka, Bangladesh
| | - Hubert P Endtz
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands.,Laboratory Sciences and Services Division (LSSD), International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.,Fondation Mérieux, Lyon, France
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mathieu van der Jagt
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Pieter A van Doorn
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Bart C Jacobs
- Departments of Neurology and Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Quazi D Mohammad
- National Institute of Neurosciences & Hospital, Dhaka, Bangladesh
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15
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Halstead SK, Kalna G, Islam MB, Jahan I, Mohammad QD, Jacobs BC, Endtz HP, Islam Z, Willison HJ. Microarray screening of Guillain-Barré syndrome sera for antibodies to glycolipid complexes. Neurol Neuroimmunol Neuroinflamm 2016; 3:e284. [PMID: 27790627 PMCID: PMC5055300 DOI: 10.1212/nxi.0000000000000284] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 08/05/2016] [Indexed: 12/14/2022]
Abstract
Objective: To characterize the patterns of autoantibodies to glycolipid complexes in a large cohort of Guillain-Barré syndrome (GBS) and control samples collected in Bangladesh using a newly developed microarray technique. Methods: Twelve commonly studied glycolipids and lipids, plus their 66 possible heteromeric complexes, totaling 78 antigens, were applied to polyvinylidene fluoride–coated slides using a microarray printer. Arrays were probed with 266 GBS and 579 control sera (2 μL per serum, diluted 1/50) and bound immunoglobulin G detected with secondary antibody. Scanned arrays were subjected to statistical analyses. Results: Measuring antibodies to single targets was 9% less sensitive than to heteromeric complex targets (49.2% vs 58.3%) without significantly affecting specificity (83.9%–85.0%). The optimal screening protocol for GBS sera comprised a panel of 10 glycolipids (4 single glycolipids GM1, GA1, GD1a, GQ1b, and their 6 heteromeric complexes), resulting in an overall assay sensitivity of 64.3% and specificity of 77.1%. Notable heteromeric targets were GM1:GD1a, GM1:GQ1b, and GA1:GD1a, in which exclusive binding to the complex was observed. Conclusions: Rationalizing the screening protocol to capture the enormous diversity of glycolipid complexes can be achieved by miniaturizing the screening platform to a microarray platform, and applying simple bioinformatics to determine optimal sensitivity and specificity of the targets. Glycolipid complexes are an important category of glycolipid antigens in autoimmune neuropathy cases that require specific analytical and bioinformatics methods for optimal detection.
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Affiliation(s)
- Susan K Halstead
- Institute of Infection, Immunity and Inflammation (S.K.H., H.J.W.), College of Medical, Veterinary and Life Sciences, University of Glasgow; The Beatson Institute for Cancer Research (G.K.), Glasgow, UK; Laboratory Sciences and Services Division (M.B.I., I.J., Q.D.M., Z.I.), International Centre for Diarrheal Disease Research; Shaheed Tajuddin Ahmed Sarani (M.B.I., I.J., Q.D.M., Z.I.), Mohakhali, Dhaka, Bangladesh; Departments of Immunology and Neurology (B.C.J.) and Medical Microbiology and Infectious Diseases (H.P.E.), Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; and Fondation Mérieux (H.P.E.), Lyon, France
| | - Gabriela Kalna
- Institute of Infection, Immunity and Inflammation (S.K.H., H.J.W.), College of Medical, Veterinary and Life Sciences, University of Glasgow; The Beatson Institute for Cancer Research (G.K.), Glasgow, UK; Laboratory Sciences and Services Division (M.B.I., I.J., Q.D.M., Z.I.), International Centre for Diarrheal Disease Research; Shaheed Tajuddin Ahmed Sarani (M.B.I., I.J., Q.D.M., Z.I.), Mohakhali, Dhaka, Bangladesh; Departments of Immunology and Neurology (B.C.J.) and Medical Microbiology and Infectious Diseases (H.P.E.), Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; and Fondation Mérieux (H.P.E.), Lyon, France
| | - Mohammad B Islam
- Institute of Infection, Immunity and Inflammation (S.K.H., H.J.W.), College of Medical, Veterinary and Life Sciences, University of Glasgow; The Beatson Institute for Cancer Research (G.K.), Glasgow, UK; Laboratory Sciences and Services Division (M.B.I., I.J., Q.D.M., Z.I.), International Centre for Diarrheal Disease Research; Shaheed Tajuddin Ahmed Sarani (M.B.I., I.J., Q.D.M., Z.I.), Mohakhali, Dhaka, Bangladesh; Departments of Immunology and Neurology (B.C.J.) and Medical Microbiology and Infectious Diseases (H.P.E.), Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; and Fondation Mérieux (H.P.E.), Lyon, France
| | - Israt Jahan
- Institute of Infection, Immunity and Inflammation (S.K.H., H.J.W.), College of Medical, Veterinary and Life Sciences, University of Glasgow; The Beatson Institute for Cancer Research (G.K.), Glasgow, UK; Laboratory Sciences and Services Division (M.B.I., I.J., Q.D.M., Z.I.), International Centre for Diarrheal Disease Research; Shaheed Tajuddin Ahmed Sarani (M.B.I., I.J., Q.D.M., Z.I.), Mohakhali, Dhaka, Bangladesh; Departments of Immunology and Neurology (B.C.J.) and Medical Microbiology and Infectious Diseases (H.P.E.), Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; and Fondation Mérieux (H.P.E.), Lyon, France
| | - Quazi D Mohammad
- Institute of Infection, Immunity and Inflammation (S.K.H., H.J.W.), College of Medical, Veterinary and Life Sciences, University of Glasgow; The Beatson Institute for Cancer Research (G.K.), Glasgow, UK; Laboratory Sciences and Services Division (M.B.I., I.J., Q.D.M., Z.I.), International Centre for Diarrheal Disease Research; Shaheed Tajuddin Ahmed Sarani (M.B.I., I.J., Q.D.M., Z.I.), Mohakhali, Dhaka, Bangladesh; Departments of Immunology and Neurology (B.C.J.) and Medical Microbiology and Infectious Diseases (H.P.E.), Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; and Fondation Mérieux (H.P.E.), Lyon, France
| | - Bart C Jacobs
- Institute of Infection, Immunity and Inflammation (S.K.H., H.J.W.), College of Medical, Veterinary and Life Sciences, University of Glasgow; The Beatson Institute for Cancer Research (G.K.), Glasgow, UK; Laboratory Sciences and Services Division (M.B.I., I.J., Q.D.M., Z.I.), International Centre for Diarrheal Disease Research; Shaheed Tajuddin Ahmed Sarani (M.B.I., I.J., Q.D.M., Z.I.), Mohakhali, Dhaka, Bangladesh; Departments of Immunology and Neurology (B.C.J.) and Medical Microbiology and Infectious Diseases (H.P.E.), Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; and Fondation Mérieux (H.P.E.), Lyon, France
| | - Hubert P Endtz
- Institute of Infection, Immunity and Inflammation (S.K.H., H.J.W.), College of Medical, Veterinary and Life Sciences, University of Glasgow; The Beatson Institute for Cancer Research (G.K.), Glasgow, UK; Laboratory Sciences and Services Division (M.B.I., I.J., Q.D.M., Z.I.), International Centre for Diarrheal Disease Research; Shaheed Tajuddin Ahmed Sarani (M.B.I., I.J., Q.D.M., Z.I.), Mohakhali, Dhaka, Bangladesh; Departments of Immunology and Neurology (B.C.J.) and Medical Microbiology and Infectious Diseases (H.P.E.), Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; and Fondation Mérieux (H.P.E.), Lyon, France
| | - Zhahirul Islam
- Institute of Infection, Immunity and Inflammation (S.K.H., H.J.W.), College of Medical, Veterinary and Life Sciences, University of Glasgow; The Beatson Institute for Cancer Research (G.K.), Glasgow, UK; Laboratory Sciences and Services Division (M.B.I., I.J., Q.D.M., Z.I.), International Centre for Diarrheal Disease Research; Shaheed Tajuddin Ahmed Sarani (M.B.I., I.J., Q.D.M., Z.I.), Mohakhali, Dhaka, Bangladesh; Departments of Immunology and Neurology (B.C.J.) and Medical Microbiology and Infectious Diseases (H.P.E.), Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; and Fondation Mérieux (H.P.E.), Lyon, France
| | - Hugh J Willison
- Institute of Infection, Immunity and Inflammation (S.K.H., H.J.W.), College of Medical, Veterinary and Life Sciences, University of Glasgow; The Beatson Institute for Cancer Research (G.K.), Glasgow, UK; Laboratory Sciences and Services Division (M.B.I., I.J., Q.D.M., Z.I.), International Centre for Diarrheal Disease Research; Shaheed Tajuddin Ahmed Sarani (M.B.I., I.J., Q.D.M., Z.I.), Mohakhali, Dhaka, Bangladesh; Departments of Immunology and Neurology (B.C.J.) and Medical Microbiology and Infectious Diseases (H.P.E.), Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; and Fondation Mérieux (H.P.E.), Lyon, France
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Chowdhury AH, Ghose SK, Mohammad QD, Habib M, Khan SU, Rahman KM. Digital Subtraction Angiography is Superior to Magnetic Resonance Angiography in Diagnosis of Cerebral Arteriovenous Malformation. Mymensingh Med J 2015; 24:356-365. [PMID: 26007266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study was carried out to compare MRA and DSA in diagnosis of cerebral AVM. It was a retrospective observational study conducted in the Department of Neurology Dhaka Medical College Hospital (DMCH), Dhaka during the period of January 2010 to December 2010. Thirty patients with haemorrhagic stroke age ranging from 13 to 65 years were selected on the basis of inclusion and exclusion criteria as the study sample. MRA and DSA were done in all the selected patients. The mean age of the patients of haemorrhagic stroke was 30.3 ± 14.3 years and male female ratio was 2.7:1. Regarding the venous drainage of AVM 13 and 12 were superficial and deep respectively, and evaluated 100% by MRA. In the diagnosis of cerebral AVM nidus size S1: <3 and S2: 3-6 cm sensitivity was 100% but accuracy was 100% and 73.3% respectively. DSA was 100% sensitive in the diagnosis of superficial and deep venous drainage AVM. Regarding the eloquence of brain area 15 had no eloquence by both MRA and DSA and identification of eloquence of brain area sensitivity was 73.3% and accuracy was 86.7%. The main feeding vessels was found (22, 73.3%) in both DSA and MRA findings. Distal vessels was seen (8, 26.7%) in DSA but not seen in MRA findings. Intranidal aneurysm and Angiopathic AVM were seen in 3(10.0%) and 4(13.3%) respectively in DSA. This study was carried out to diagnose the patients presented with cerebral AVM by MRA and DSA. MRA could not be evaluated flow status of AVM, distal feeding arteries, intranidal aneurysm and angiopathic AVM which could be detected by DSA. So, DSA is superior to MRA in diagnosis of cerebral AVM.
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Affiliation(s)
- A H Chowdhury
- Dr Ahmed Hossain Chowdhury, Assistant Professor, Department of Neurology, Dhaka Medical College & Hospital, Dhaka, Bangladesh
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Sarker UK, Mohammad QD, Uddin MJ, Chowdhury RN, Bhattacharjee M, Mondol G, Roy N. Socio-demographic characteristics, types and Slit Skin Smear (SSS) of the leprosy patients: a hospital based study. Mymensingh Med J 2014; 23:435-440. [PMID: 25178593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This study was aimed to identify the socio-demographic profile, to know the types and to find out the Slit Skin Smear (SSS) result associated with leprosy. It was a descriptive type of cross sectional study. Total 62 patients having clinical features of leprosy, attending in Department of Neurology of Mymensingh Medical College Hospital (MMCH) and Mymensingh Tuberculosis and Leprosy Hospital, Mymensingh from January 2010 to December 2011 were included. Patients underwent a detailed clinical evaluation followed by laboratory investigations. Out of 62 cases, the results showed that the mean age of leprosy patients were 37.8±14.6 years with the age range 12-80 years and the peak incidence was between 20-40 years. The frequency of male and female was 70.9% and 29.1% respectively with M: F of 2.4:1. From rural area 74.2% leprosy patients and 25.8% patients were from urban area and mainly day-labours (25.8%) and housewife (24.2%) by occupation. Married was 87.1% of patients and 12.9% were unmarried. Twenty one percent (21%) leprosy patients were found contact with leprosy. It was observed in this study that, 35.5% patients were PB (Pauci Bacillary) group and 64.5% of the patients were in MB (Multi Bacillary) group. Lepromatous Leprosy (LL) patients were (17.7%) and Borderline Lepromatous (BL) patients were (11.3%). Patients with Tuberculoid Type (TT) were (3.2%) and patients with Borderline Tuberculoid (BT) were (61.3%). The result of Slit skin smear (SSS) examination was negative in 59.7% patients and positive in 40.3%.
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Affiliation(s)
- U K Sarker
- Dr Uttam Kumar Sarker, Registrar, Department of Neurology, Mymensingh Medical College Hospital, Mymensingh, Bangladdesh
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Mohammad QD, Habib M, Mondal BA, Chowdhury RN, Hasan MH, Hoque MA, Rahman KM, Khan SU, Chowdhury AH, Haque B. Stroke in Bangladeshi patients and risk factor. Mymensingh Med J 2014; 23:520-529. [PMID: 25178605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
To evaluate comprehensively the distribution of established risk factors of stroke among Bangladeshi patients. This is an observational study. It involved 8400 stroke patients from different hospitals in Bangladesh over a period of sixteen years. Common established risk factors of stroke e.g. age, sex, family history, hypertension, diabetes, ischemic heart disease, smoking, obesity, dyslipidaemia, alcoholism, use of oral contraceptive pill, lack of fresh fruit consumption etc. were evaluated in these patients through a preformed questionnaire and data were analyzed. Majority of the stroke events occurred after the age of forty (82.3%) and the ischemic stroke (72%) is the most common. Apart from non modifiable risk factors (advancing age, sex, Family history of stroke) hypertension was the most common modifiable risk factor found in stroke patients (57.6%) followed by smoking (44.6%), tobacco use (24.3%), OCP use in female (40% of female stroke), diabetes (23%), ischemic heart disease (17.1%), obesity (10.6%) and dyslipidaemia (5.3%). Lack of fresh fruit consumption and alcoholism were found in some of the patients. Stroke is common after the age of forty. Ischemic events are commonest type of stroke. Hypertension, smoking, tobacco use, diabetes and ischemic heart disease were five most common risk factors of stroke. Outlining the common stroke risk factors in our settings, may help the physicians and care givers in managing this disabling disease properly.
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Affiliation(s)
- Q D Mohammad
- Professor Quazi Deen Mohammad, Professor & Head, Department of Neurology, Dhaka Medical College (DMC), Dhaka, Bangladesh
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Geurtsvankessel CH, Islam Z, Mohammad QD, Jacobs BC, Endtz HP, Osterhaus ADME. Hepatitis E and Guillain-Barre syndrome. Clin Infect Dis 2013; 57:1369-70. [PMID: 23899686 DOI: 10.1093/cid/cit512] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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20
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Islam Z, Gilbert M, Mohammad QD, Klaij K, Li J, van Rijs W, Tio-Gillen AP, Talukder KA, Willison HJ, van Belkum A, Endtz HP, Jacobs BC. Guillain-Barré syndrome-related Campylobacter jejuni in Bangladesh: ganglioside mimicry and cross-reactive antibodies. PLoS One 2012; 7:e43976. [PMID: 22952833 PMCID: PMC3428305 DOI: 10.1371/journal.pone.0043976] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 07/27/2012] [Indexed: 12/11/2022] Open
Abstract
Background Campylobacter jejuni is the predominant antecedent infection in Guillain-Barré syndrome (GBS). Molecular mimicry and cross-reactive immune responses to C. jejuni lipo-oligosaccharides (LOS) precipitate the development of GBS, although this mechanism has not been established in patients from developing countries. We determined the carbohydrate mimicry between C. jejuni LOS and gangliosides, and the cross-reactive antibody response in patients with GBS in Bangladesh. Methodology Sera from 97 GBS patients, and 120 neurological and family controls were tested for antibody reactivity against LOS from C. jejuni isolates from GBS patients in Bangladesh (BD-07, BD-39, BD-10, BD-67 and BD-94) by enzyme-linked immunosorbent assay (ELISA). Cross-reactivity to LOS was determined by ELISA. The LOS outer core structures of C. jejuni strains associated with GBS/MFS were determined by mass spectrometry. Principle Findings IgG antibodies to LOS from C. jejuni BD-07, BD-39, BD-10, and BD-67 IgG antibodies were found in serum from 56%, 58%, 14% and 15% of GBS patients respectively, as compared to very low frequency (<3%) in controls (p<0.001). Monoclonal antibodies specific for GM1 and GD1a reacted strongly with LOS from the C. jejuni strains (BD-07 and BD-39). Mass spectrometry analysis confirmed the presence of GM1 and GD1a carbohydrate mimics in the LOS from C. jejuni BD-07 and BD-39. Both BD-10 and BD-67 express the same LOS outer core, which appears to be a novel structure displaying GA2 and GD3 mimicry. Up to 90–100% of serum reactivity to gangliosides in two patients (DK-07 and DK-39) was inhibited by 50 µg/ml of LOS from the autologous C. jejuni isolates. However, patient DK-07 developed an anti-GD1a immune response while patient DK-39 developed an anti-GM1 immune response. Conclusion Carbohydrate mimicry between C. jejuni LOS and gangliosides, and cross-reactive serum antibody precipitate the majority of GBS cases in Bangladesh.
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Affiliation(s)
- Zhahirul Islam
- Emerging Diseases and Immunobiology, Centre for Food and Waterborne Diseases, icddr,b, Dhaka, Bangladesh.
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Mohammad QD, Habib M, Hoque A, Alam B, Haque B, Hossain S, Rahman KM, Khan SU. Prevalence of stroke above forty years. Mymensingh Med J 2011; 20:640-644. [PMID: 22081183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Number of elderly persons gradually increased in Bangladesh due to improved health awareness and health care. Age is the single most important risk factor for stroke. This study aims at finding the prevalence of stroke in a Bangladeshi population aged forty years and above. The cases of stroke were ascertained in two phases of door-to-door survey. In phase-I, trained interviewers performed face-to-face interview with subjects for the detection stroke cases using the World Health Organization (WHO) screening protocol for neurological diseases. In phase-II, subjects suspected to have a stroke underwent a clinical evaluation for diagnosis or exclusion of stroke by a neurological team. The study involved 15627 participants aged 40 years and above. A total of 47 participants found to have stroke, expressing an overall prevalence rate of 3.00 per 1000 (95% CI 0.95 to 2.45). Prevalence of stroke were 2.0, 3.0, 2.0, 10.0, and 10.0 per 1000 within age groups of 40-49 years, 50-59 years, 60-69 years, 70-79 years and 80 years and above age group respectively. Prevalence of stroke in people with age range 70-79 years compared to 40-49 years age range is 4.988 (95% CI 2.309 to 10.77) times and people with age range ≥80 years compared to 40-49 years age range is 4.798 (95% CI 1.597 to14.416) times. Prevalence was higher among men in comparison with women. The male: female ratio is 3.44:2.41 per 1000 respectively. Bangladeshi male populations in rural areas are found to have stroke more than urban people. A large community based study should be undertaken to further confirm the result of this present study.
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Affiliation(s)
- Q D Mohammad
- Department of Neurology, Dhaka Medical College, Dhaka, Bangladesh
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Shaikh AK, Mohammad QD, Ullah MA, Ahsan MM, Rahman A, Shakoor MA. Effect of dexamethasone on brain oedema following acute ischemic stroke. Mymensingh Med J 2011; 20:450-458. [PMID: 21804511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A randomized clinical trial was conducted to asses the effects of dexamethasone on brain oedema following acute ischemic stroke in the departments of Medicine of different hospitals from July, 2003 to December, 2006. A total of 60 patients were included in the study. They were divided into two groups keeping the similarity regarding the age, sex and severity of the stroke between two groups. There were 30 patients in experimental group and 30 in control group. The level of consciousness was compared by Glasgow Coma Scale (GCS) on 3rd, 7th and 10th day of intervention and improvement was found in both the groups, but the improvement of level of consciousness was statistically significant in Dexamethasone treated group. The volume of hypodense area did not differ significantly in two groups in CT scans before and after treatment (p=0.74). The study results demonstrate that Dexamethasone improves the level of consciousness in acute ischemic stroke associated with brain oedema but did not reduce volume of hypodense area.
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Affiliation(s)
- A K Shaikh
- Department of Neurology, Bangabandhu Sheikh Mujib Medical University, Shahbagh, Dhaka, Bangladesh
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Abstract
Moyamoya disease is a rare cerebral vasculopathy characterised by progressive narrowing of the major intracranial vessels and development of collateral vessels. Clinically, it presents with cerebral ischaemic or haemorrhagic events, with eventual severe morbidity and mortality. A 10-year-old girl presented with episodic vascular headache and transient left sided hemiparesis, which persisted for a few hours and was clinically labelled as sporadic hemiplegic migraine according to International Headache Society criteria. We investigated all possible causes of unusual headache. Cerebral digital subtraction angiogram was carried out and moyamoya disease was finally diagnosed.
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Affiliation(s)
- M R Siddiqui
- Department of Internal Medicine, Dhaka Medical College Hospital, Dhaka, Bangladesh.
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Khan SU, Rahman KM, Siddiqui MR, Hoque MA, Mondol BA, Hussain S, Mohammad QD. Endovascular embolization of life threatening intracranial arterio-venous malformation. Mymensingh Med J 2010; 19:438-441. [PMID: 20639841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Haemorrhagic stroke from cerebral arteriovenous malformations (AVMs) represents 2% of all hemorrhagic strokes. A clear understanding of the diagnostic and treatment algorithms of cerebral AVM management is very important, because AVMs are a cause of hemorrhage in young adults. Surgery, endovascular therapy, and radiosurgery can be used alone or in combination to treat an AVM. We reported a 40 years old man of cerebral arteriovenous malformation (AVM), complicated with intracerebral hemorrhage (ICH). Digital subtraction angiogram was done for diagnosis and endovascular embolization for treatment of the case. This is the first successful cerebral arteriovenous malformations (AVMs) embolization in any government hospital of Bangladesh. The aim of this case report is to inform about this new technologies and emerging treatment strategies in these areas.
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Affiliation(s)
- S U Khan
- Department of Neurology, Dhaka Medical College (DMC), Dhaka, Bangladesh. sharif.911@ gmail.com
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Daisy S, Mohammad QD, Alam B, Hoque A, Haque B, Rahman KM, Khan SU. Epilepsy and abnormal electroencephalogram in children with autism spectrum disorder. Mymensingh Med J 2010; 19:264-266. [PMID: 20395924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Epilepsy occurs in 30 to 40% of individuals with autism spectrum disorder (ASD). However the association of epilepsy or abnormal electroencephalogram is not known in our population. This study addresses the incidence of epilepsy and or abnormal electroencephalogram in Bangladeshi children with autism spectrum disorder. The clinical history and electroencephalogram of 18 children diagnosed with autism spectrum disorder were retrospectively reviewed. Forty four percent were diagnosed with epilepsy or abnormal electroencephalogram. This abnormal electroencephalogram or epilepsy occurred at significantly higher rates in children with more impaired range of autism spectrum disorder. These finding suggest that the use of neurological investigative technique such as electroencephalogram (EEG) should be considered routinely in children with autism spectrum disorder especially in more impaired individuals.
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Affiliation(s)
- S Daisy
- Department of Neurology, Dhaka Medical College, Dhaka, Bangladesh
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Mondol BA, Siddiqui MR, Mohammad QD, Saha NC, Hoque MA, Uddin MJ. Tuberculosis of the central nervous system. Mymensingh Med J 2010; 19:312-322. [PMID: 20395933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Tuberculosis can involve any organ system of the body. Although rare tuberculosis of nervous system (NS) is not uncommon in our country. In the nervous system tubercle bacilli can cause tuberculous meningitis, abscess , tuberculoma in brain & spinal cord. Untreated Central Nervous System (CNS) tuberculosis is devastating. Early diagnosis & prompt treatment of NS is essential to avoid morbidity & mortality. Tubercle bacilli causes chronic caseating granulomatous lesion. Tubercular meningitis presents with fever, headache, neck stiffness & cranial nerve palsy. Tuberculoma may present with headache, seizure and focal deficit. In the spinal cord tuberculoma or tubercular abscess may result in para paresis or quadri-paresis. For diagnosis of nervous system tuberculosis CSF analysis and neuroimaging are important. CSF cell count, Gram staining, Culture and Polymerase Chain Reaction (PCR) are helpful for diagnosis. Imaging helps in the diagnosis of tuberculoma and tubercular abscess. Computed tomography (CT) guided Fine Needle Aspiration for Cytology (FNAC) helps to establish the histopathological diagnosis. Use of combination antitubercular drugs for long period (12-18 months) is necessary to treat nervous system tuberculosis.
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Affiliation(s)
- B A Mondol
- Department of Neurology, Dhaka Medical College and Hospital, Dhaka, Bangladesh
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Islam Z, Jacobs BC, van Belkum A, Mohammad QD, Islam MB, Herbrink P, Diorditsa S, Luby SP, Talukder KA, Endtz HP. Axonal variant of Guillain-Barre syndrome associated with Campylobacter infection in Bangladesh. Neurology 2010; 74:581-7. [PMID: 20157160 DOI: 10.1212/wnl.0b013e3181cff735] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Campylobacter jejuni enteritis is the predominant bacterial infection preceding Guillain-Barré syndrome (GBS), an acute postinfectious immune-mediated polyradiculoneuropathy. The purpose of this study was to define the clinical phenotype of GBS and the relation with preceding C jejuni infections in Bangladesh. METHODS We performed a prospective matched case-control hospital surveillance including 100 patients fulfilling the National Institute of Neurological Disorders and Stroke criteria for GBS from 2006 to 2007 in the Dhaka area of Bangladesh. Detailed clinical, electrophysiologic, serologic, and microbiologic data were obtained with a follow-up of 6 months. RESULTS GBS affected predominantly young adult males living in rural areas. Sixty-nine percent of the patients had clinical evidence of a preceding infection. The most frequent symptom was diarrhea (36%). The majority of patients had a pure motor variant of GBS (92%) with relatively infrequent cranial nerve involvement (30%). Twenty-five percent of patients required respiratory support. Electrophysiologic studies showed that 67% of patients had an axonal variant of GBS. Eleven patients (14%) died, and 23 (29%) remained severely disabled during the follow-up. Positive C jejuni serology was found in an unprecedented high frequency of 57% as compared with 8% in family controls and 3% in control patients with other neurologic diseases (p < 0.001). C jejuni infection was significantly associated with serum antibodies to the gangliosides GM1 and GD1a, axonal neuropathy, and greater disability. CONCLUSIONS We report an unusually high frequency of the axonal variant of Guillain-Barré syndrome in Bangladesh, associated with preceding Campylobacter jejuni infection, severe residual disability, and high mortality.
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Affiliation(s)
- Z Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka-1000, Bangladesh.
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Hoque MA, Siddiqui MR, Arafat Y, Khan SU, Rahman KM, Mondol BA, Mohammad QD. Fahr's disease: a very rare cause of epilepsy. Mymensingh Med J 2010; 19:127-129. [PMID: 20046186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Fahr's disease, first described by Karl Theodor Fahr in 1930, refers to sporadic or familial idiopathic basal ganglia calcification that is associated with many neurological and psychiatric abnormalities, but may also be secondary to other diseases. Most cases present with extrapyramidal symptoms. But here we describe a case of Fahr's disease, who presented with complex partial seizure and behavioral abnormalities. On screening, the cause of seizure was found to be bilateral calcification of cerebellum, basal ganglia and thalamus, due to abnormal calcium and phosphate metabolism. A clinical diagnosis of complex-partial seizure with secondary generalization due to secondary Fahr's disease was done on the basis of clinical features, investigations, and exclusion of other causes of intracranial calcification.
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Affiliation(s)
- M A Hoque
- Dhaka Medical College Hospital, Dhaka, Bangladesh
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Uddin MJ, Alam B, Jabbar MA, Mohammad QD, Ahmed S. Association of lipid profile with ischemic stroke. Mymensingh Med J 2009; 18:131-135. [PMID: 19623135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This study is an observational case control study conducted in the Neurology department of Dhaka Medical college Hospital (DMCH) to see the relation of ischemic stroke with different components of serum lipids. Cases and controls were selected following certain inclusion and exclusion criteria. Result showed that ischemic stroke was more common after the age of 50 years with mean age of 63.58+/-10.22 years. Male suffered more than female from ischemic stroke (M:F=2.57:1). 80% of the stroke patients belong to middle class economic condition who avail free services of Govt. hospitals. Hypertension and diabetes mellitus (DM) were found to be significant risk factors for ischemic stroke (P<0.01 and P<0.05 respectively). High level of serum total cholesterol and low density lipoprotein (LDL) cholesterol showed significant risk in ischemic stroke (p<0.05). In contrast, low level of high density lipoprotein (HDL) cholesterol appeared as a significant risk factor (p<0.01) indicating beneficial effect of HDL cholesterol on atherosclerotic process. Serum triglyceride level showed no significant effect on ischemic stroke (p>0.05).
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Affiliation(s)
- M J Uddin
- Department of Neurology, Mymensingh Medical College, Mymensingh, Bangladesh
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Hayee MA, Mohammad QD, Haque A. Diabetic neuropathy and zinc therapy. Bangladesh Med Res Counc Bull 2005; 31:62-7. [PMID: 16967811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
This was a double blind study conducted on 60 subjects; 20 age and sex matched healthy controls (Group-I), 20 patients of diabetes mellitus with neuropathy who received placebo for 6 weeks (Group-IIA); and 20 patients of diabetes mellitus with neuropathy who were given oral 660 mg zinc sulphate for 6 weeks (Group-IIB). Serum zinc level, fasting blood sugar (FBS), blood sugar 2 hour after breakfast (2HABF) and motor nerve conduction velocity (MNCV) were estimated on day 0 and after 6 weeks in all subjects. Serum zinc levels were significantly low (p<0.001) in group II-A and II-B as compared to healthy controls (group-I) at base line. After 6 weeks the changes in pre and post therapy values of FBS, 2HABF and MNCV (median and common peroneal nerve) were highly significant (p<0.001) for group II-B alone with insignificant change (p>0.05) in group II-A. Therefore, zinc therapy helps in achieving better glycemic control and improvement in peripheral neuropathy as assessed by MNCV.
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Affiliation(s)
- M A Hayee
- Deptt. of Neuromedicine, SSMC, Dhaka
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Rahman KM, Sarker CB, Mohammad QD, Dhar DK, Hossain MS, Siddiqui MNI, Alam KS. Risk factors & clinical presentations--a study of eighty-five hospital admitted stroke cases. Mymensingh Med J 2002; 11:113-5. [PMID: 12395682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Stroke is the commonest neurological cause of morbidity and mortality. Changes in risk factors may influence stroke incidence. Definitive diagnosis of the type of stroke is necessary for management and it has a strong impact on stroke outcome. A total of eighty-five consecutive stroke patients irrespective of age and sex admitted during the period of August 2000 to June 2001 were studied. They were asked about occupation, area of habitat, smoking habit, family history of ischaemic heart disease and/or stroke, any febrile illness, recent history of productive cough, dysuria and diarrhoea. They were searched for hypertension, diabetes mellitus, ischaemic heart disease, valvular heart disease and dislipidaemia. In every patient complete blood count, urine examination, fasting blood glucose and serum lipids, ECG, x-ray chest were performed. CT scan of brain was performed in 68 cases. Male was found 81.18% of cases with age 62.54 +/- 13.08 (m +/- SD) years. Female were 18.82% of cases with age 58.81 +/- 12.77 (m +/- SD). 75.29% of patients were belongs to middle class family. 51.76% of patients came from rural area and 48.24% of patients came from urban area. 78.82% of patients were hypertensive. Infection was associated with 37.65% of cases. Hemiplegia was commonest presentation (88.24%). Though altered consciousness was found more in haemorrhagic stroke (54.84%) but it was not significantly. High from ischaemic cases (p > 0.10) Male suffer more from stroke. Hypertension is the commonest risk factor. Infection is a common association of stroke. Altered consciousness is not a reliable guide to differentiate between ischaemic and haemorrhagic stroke is hospitalized cases.
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Affiliation(s)
- K M Rahman
- Department of Neuromedicine, Mymensingh Medical College, Mymensingh
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Mondol MB, Rahman MM, Ullah AK, Quraishi FA, Mohammad QD. SPECT in the field of Neurology. Bangladesh Med Res Counc Bull 2000; 26:96-104. [PMID: 11766006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- M B Mondol
- Deptt. of Neuromedicine, Dhaka Medical College
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