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Item Open Access Management, morbidity and mortality of Guillain Barré Syndrome patients admitted to ICU at Universitas Academic Hospital(University of the Free State, 2021-04) Diale, Mamonokane Innocentia; Moodley, A. A.Background: Guillain Barré Syndrome is the commonest cause of acute flaccid paralysis. It is an autoimmune post-infectious disorder that is monophasic and has good prognosis. However, a third of hospitalised patients with GBS are admitted to ICU with respiratory failure or dysautonomia. ICU mortality and morbidity has been associated with prolonged ICU stay of more than nine days and mechanical ventilation. Objective: The main aim of the study was to describe the clinical presentation, ICU management, complications and outcome of patients with Guillain Barré Syndrome requiring ICU management at the Universitas Academic Hospital, Free State Province of South Africa. Methods: The study was a retrospective observational study. A medical audit was carried out in all patients above the age of 13 years admitted to ICU at UAH with a diagnosis of GBS or AIDP. Telephonic interviews were also conducted to follow up on disease progression post discharge from hospital. Results: Twenty-six patients were included in the study. The median age was 30 years (range 13-77 years), males were predominant (65.8%) and black ethnicity comprised 83.3% of the patients. The median length of ICU stay was 9 days (range 1-140 days). The main indicator for ICU admission was respiratory monitoring (73%) followed by both respiratory monitoring and dysautonomia (26%) and dysautonomia (4%). Seventeen of the 25 (68%) patients were intubated and 11/17 (65%) had a tracheostomy for prolonged intubation. All patients were treated with intravenous immunoglobulin and four patients had additional immunosuppressive therapy. Eighteen patients (69,2%) had comorbidities with HIV infection being the commonest. Nineteen patients (73%) had complications that included prolonged ICU stay of more than nine days, mechanical ventilation, electrolyte imbalance, hypoalbuminaemia, anaemia, ventilator associated pneumonia and sepsis. The median ICU stay for patients with complications was 14 days (range 3-140 days) and for patients without complications was 3 days (range 1-7 days) (p<0.01). The serious complication rate was 88.9% in HIV infected patients versus 64.7% in HIV non-infected patients (p = 0.357). The use of traditional medicine was associated with a high complication rate, especially hepatic and multi-organ failure. Four ICU managed patients died. Conclusion: Prolonged ICU stay was associated with multiple complications. There was no significant difference between patients with co-morbidities and those without co-morbidities in terms of length of ICU stay and complications.Item Open Access Electrodiagnostic tests to confirm clinically suspected carpal tunnel syndrome(University of the Free State, 2020-04) Nkoana-Erasmus, Dikeledi Lucia; Moodley, A.Background: Compression of the median nerve at the wrist is the most common entrapment neuropathy. Patients present with sensory symptoms in the median nerve distribution, pain in the hand, wrist or forearm and weakness of thumb opposition or abduction in severe cases. The value of nerve conduction studies (NCS) in the diagnosis of carpal tunnel syndrome (CTS) is not clear. There are contradicting results from different reports, other reports citing the importance of electrodiagnostic (EDX) test in the diagnosis of CTS while other reports did not establish that link. In the Free State Province, patients with CTS are mainly managed by orthopaedic surgeons. Only a small proportion of patients are managed by neurosurgeons at Universitas Academic Hospital. The diagnosis is primarily made on clinical grounds. Conservative measures are tried first, but patients who do not respond to these, undergo carpal tunnel release surgery (CTRS). Objectives: The aim was to determine which EDX tests best correlate with the clinical diagnosis and severity of CTS. The objective was to establish EDX guidelines to be used in the neurology electrophysiology unit when diagnosing CTS. Method: A cross sectional analytic study. Patients with a diagnosis of CTS based on clinical signs and symptoms were recruited into the study from January 2019 to October 2019. They were requested to complete the Boston questionnaire (BQ) which assesses symptoms severity and functional capacity. Nine NC parameters were then tested and results compared with those from the BQ to determine whether they correlate. EDX severity score for CTS was assessed and was compared to the two components of the BQ. Results: Eighty-three percent of hands had severe to very severe symptoms on Boston 1 however, only 37.5% had severe to very severe functional impairment on Boston 2. Weighted kappa of 0.19 indicating no agreement between Boston 1 and 2, severe symptoms is not associated with an increase in functional impairment. No statistically significant correlation was found between EDX severity score, symptoms and functional status with a p value of 0.44 and 0.77 respectively. Conclusion: • There was no linear relationship between symptom severity and functional impairment; the majority of patients reported severe symptoms but no disability. • Clinical and EDX tests showed a weak positive correlation which is statistically insignificant. • Symptomatology rather than functional impairment was more indicative of severity of CTS. • No correlation was found between EDX tests, Boston 1 and Boston 2. • We were unable to answer with confidence the question of whether NCS is always necessary and feel that a follow-up post-op study will provide useful insights.