A Systematic Review on Immunotherapy for Guillain- Barre Syndrome

Guillain-Barré syndrome (GBS) is an acute immunemediated polyradiculoneuropathy with a highly variable clinical course and outcome. Intravenous immunoglobulin (IVIG) and plasma exchange (PE) are proven effective treatments, but about half of the patients may not respond to these therapies; moreover, these are not established yet to treat patients of every stage of GBS or its variants. Results from the International Guillain-Barré Syndrome Outcome Study suggest that geographical variations exist in Guillain-Barré syndrome, including insufficient access to immunotherapy in low-income countries. There is a need to provide improved access to treatment for all patients with Guillain-Barré syndrome, and to develop effective disease-modifying therapies that can limit the extent of nerve injury. In this review, the current literature about immunotherapeutic options is highlighted in the context of stages of the disease and its variants and additionally, upcoming modalities are discussed briefly. J Bangladesh Coll Phys Surg 2022; 40: 57-64

One versus two adjacent interdigital neuroma excision: a patient outcome study

Objective: We aimed to evaluate patient satisfaction after surgery for both single and two adjacent neuromas. Methods: We reviewed the data of patients treated operatively for interdigital neuromas between 2003 and 2016. We interviewed them and administered the Self-Reported Foot and Ankle Score questionnaire. Patient scores were then analyzed categorically, and variation between groups was assessed. Results: Sixty-two patients were available for review. Thirty-one patients had a single interdigital neuroma excised and 31 had two adjacente interdigital neuromas excised. Twenty-eight of the 31 (90%) patients with a single neuroma had good or excellent results while 23 (74.2%) of those with adjacent neuromas had similar outcomes. One patient with a single neuroma had a poor result while four patients with adjacent neuromas had poor results. The mean score was 41 (excellent) for patients with a single interdigital neuroma and 37 (good) for those with adjacent neuromas (p=0.473). The majority of patients in both groups would undergo surgery again. Conclusion: We found no statistically significant difference in outcomes of patients who undergo surgery for either single or two adjacent interdigital neuromas. General patient satisfaction is good and/or excellent post excision. Level of Evidence II; Prognostic Studies; Retrospective Study.

Is There a Benefit of Antenatal Corticosteroid When Given < 48 Hours Before Delivery?

Objective We assessed the association between a short Antenatal Corticosteroid Administration-to-Birth Interval and neonatal outcome. Study design: A retrospective study between 2010- 2020. Eligible cases were singleton preterm live-born neonates born between 24 0/7 and 33 6/7 weeks of gestation and were initiated an ACS course of Betamethasone. We divided the first 48 hours following 1st ACS administration to four-time intervals and compared each time interval to those born more than 48 hours following ACS administration. The primary outcome was a composite of adverse neonatal outcome, including neonatal mortality or any major neonatal morbidity. Results A total of 200 women gave birth less than 48 hours from receiving the first betamethasone injection, and 172 women gave birth within 2-7 days (48-168 hours) from ACS administration. Composite adverse neonatal outcome was higher for neonates born less than 12 hours from initial ACS administration compared to neonates born 2-7 days from first betamethasone injection (55.45% vs. 29.07%, OR 3.45 95% CI [2.02-5.89], p.value<0.0001). However, there was no difference in composite adverse neonatal outcomes between neonates born 12-48 hours following ACS administration and those born after 2-7 days. That was also true after adjusting for confounders. Conclusions 12-24 hours following ACS Administration may be sufficient in reducing the same risk of neonatal morbidities as > 48 hours following ACS administration. It may raise the question regarding the utility of the second dose of ACS.