Medical Specialties Commons^™

Evaluation Of A Digital Diabetes Prevention Program Adapted For The Medicaid Population: Study Design And Methods For A Non-Randomized, Controlled Trial., Sue E Kim, Cynthia M Castro Sweet, Eliza Gibson, Erica N Madero, Barbara Rubino, Janina Morrison, Debra Rosen, Wendy Imberg, Michael R Cousineau

Articles, Abstracts, and Reports

Previous studies have shown that lifestyle modification can successfully prevent or delay development of type 2 diabetes. This trial aimed to test if an underserved, low-income population would engage in a digital diabetes prevention program and successfully achieve lifestyle changes to reduce their risk of type 2 diabetes. Participants were recruited from three health care facilities serving low-income populations. The inclusion criteria were: a recent blood test indicating prediabetes, body mass index (BMI) > 24 kg/m

Using A Randomized Controlled Trial To Test Whether Modifications To Contingency Management Improve Outcomes For Heavy Drinkers With Serious Mental Illness., Oladunni Oluwoye, Jordan Skalisky, Ekaterina Burduli, Naomi S Chaytor, Sterling Mcpherson, Sean M Murphy, Jalene Herron, Katherine Hirchak, Mason Burley, Richard K Ries, John M Roll, Michael G Mcdonell

Articles, Abstracts, and Reports

BACKGROUND: In contingency management (CM), individuals receive rewards for alcohol abstinence. CM is associated with reduced alcohol use in adults with co-occurring serious mental illnesses (SMI). Pre-treatment urine ethyl glucuronide (uEtG) levels equivalent to daily heavy drinking (uEtG >349ng/mL) are associated with poor response to CM. Modifications to CM are needed to improve outcomes for non-responders.

AIMS: To determine if pre-treatment heavy drinkers, defined by uEtG, with SMI achieve higher levels of alcohol abstinence when they receive an increased magnitude of reinforcement for abstinence (High-Magnitude CM) or reinforcers for reduced drinking, prior to receiving reinforcers for abstinence (Shaping CM), relative …

Congenitally Corrected Transposition Of The Great Arteries In A Septuagenarian From The Developing Country Of Pakistan, Hunaina Shahab, Salima Ashiqali, Mehnaz Atiq

Section of Pulmonary & Critical Care

Congenitally corrected transposition of the great arteries (CCTGA) is a rare congenital cardiac defect with atrioventricular and ventriculoarterial discordance which leads to heart failure and limits patients' lifespan. We report the case of a 70-year-old lady, from a poor province in Pakistan, who presented for the first time with palpitations and was diagnosed to have CCTGA. She had moderate pulmonic valve stenosis which was protective against heart failure. She had six children all born via spontaneous vertex delivery in her local village. This case exemplifies the fact that pulmonic stenosis is favourable for patients with CCTGA. In a country where …

Secukinumab Improves Active Psoriatic Arthritis Symptoms And Inhibits Radiographic Progression: Primary Results From The Randomised, Double-Blind, Phase Iii Future 5 Study., Philip Mease, Désirée Van Der Heijde, Robert Landewé, Shephard Mpofu, Proton Rahman, Hasan Tahir, Atul Singhal, Elke Boettcher, Sandra Navarra, Karin Meiser, Aimee Readie, Luminita Pricop, Ken Abrams

Articles, Abstracts, and Reports

OBJECTIVES: To evaluate the effect of subcutaneous (s.c.) secukinumab, an interleukin-17A inhibitor, on clinical signs and symptoms and radiographic progression in patients with psoriatic arthritis (PsA).

METHODS: Adults (n=996) with active PsA were randomised 2:2:2:3 to s.c. secukinumab 300 mg or 150 mg with loading dose (LD), 150 mg without LD or placebo. All groups received secukinumab or placebo at baseline, weeks 1, 2 and 3 and then every 4 weeks from week 4. The primary endpoint was the proportion of patients achieving an American College of Rheumatology 20 (ACR20) response at week 16.

RESULTS: Significantly more patients achieved an …

Erratum To Inequivalence Of Non-Aggressiveness In Clinically Diagnosed Lung Cancers And Overdiagnosis In Lung Cancer Screening Trials., Jerome M Reich, Jong S Kim

Articles, Abstracts, and Reports

[This corrects the article DOI: 10.21037/jtd.2018.01.164.].

Trevo Stent-Retriever Mechanical Thrombectomy For Acute Ischemic Stroke Secondary To Large Vessel Occlusion Registry., Osama O Zaidat, Alicia C Castonguay, Raul G Nogueira, Diogo C Haussen, Joey D English, Sudhakar R Satti, Jennifer Chen, Hamed Farid, Candace Borders, Erol Veznedaroglu, Mandy J Binning, Ajit Puri, Nirav A Vora, Ron F Budzik, Guilherme Dabus, Italo Linfante, Vallabh Janardhan, Amer Alshekhlee, Michael G Abraham, Randall Edgell, Muhammad Asif Taqi, Ramy El Khoury, Maxim Mokin, Aniel Q Majjhoo, Mouhammed R Kabbani, Michael T Froehler, Ira Finch, Sameer A Ansari, Roberta Novakovic, Thanh N Nguyen

Articles, Abstracts, and Reports

BACKGROUND: Recent randomized clinical trials (RCTs) demonstrated the efficacy of mechanical thrombectomy using stent-retrievers in patients with acute ischemic stroke (AIS) with large vessel occlusions; however, it remains unclear if these results translate to a real-world setting. The TREVO Stent-Retriever Acute Stroke (TRACK) multicenter Registry aimed to evaluate the use of the Trevo device in everyday clinical practice.

METHODS: Twenty-three centers enrolled consecutive AIS patients treated from March 2013 through August 2015 with the Trevo device. The primary outcome was defined as achieving a Thrombolysis in Cerebral Infarction (TICI) score of ≥2b. Secondary outcomes included 90-day modified Rankin Scale (mRS), …

Serious Mental Illness In Heavy Drinkers Is Associated With Poor Treatment Outcomes In Outpatients With Co-Occurring Disorders., Oladunni Oluwoye, Emily Leickly, Jordan Skalisky, Sterling Mcpherson, Katherine Hirchak, Debra Srebnik, John M Roll, Richard K Ries, Michael G Mcdonell

Articles, Abstracts, and Reports

The objective of this study was to determine whether the interaction between type of serious mental illness (SMI) and pre-treatment drinking severity, assessed by ethyl glucuronide (EtG), predicts EtG-positive urine samples submitted during treatment in outpatients with co-occurring alcohol dependence and SMI. Seventy-nine participants were randomized to treatment-as-usual or treatment-as-usual and contingency management (CM) targeting alcohol abstinence. Generalized estimating equations were used to assess the interaction of pre-treatment drinking (heavy drinking or light drinking) and SMI diagnosis (major depression, bipolar, or schizophrenia-spectrum disorders) across a 12-week treatment period. In the overall sample, the interaction of drinking severity and SMI diagnosis …

Creutzfeldt-Jakob Disease: A Case Report Presenting To The Emergency Department, Muhammad Akbar Baig, Sadaf Sheikh

Pakistan Journal of Neurological Sciences (PJNS)

Creutzfeldt-Jakob disease is lethal and most common spongiform encephalopathy worldwide and is rarely encountered in the Emergency department. For the benefit of patients and healthcare workers, rapid consideration of this condition needs to be sought in the setting of rapid neurological decline and myoclonic jerky movements. We present a case of a 54-year old male with behavioral changes, jerky body movements, cognitive dysfunction and left sided weakness developing over the course of few months and presented to our Emergency Department for the evaluation for stroke. Due to the non-specific nature of psychiatric and neurologic complaints, the initial diagnosis remained unclear. …

Frequency Of Vitamin D Deficiency In Multiple Sclerosis Patients: A Cross Sectional Study., Samar Iltaf Pechuho, Alam Ibrahim Siddiqui, Sajjad Husain Jalbani, Safia Sultana, Samina Shaikh, Nagina Shaikh, Fahim Soomro, Mukesh Kumar, Abdul Rehman, Tariq Qazi, Shoaib Soomro, Rizwan Shaikh, Ghulam Mustafa Tunio, Abdul Qayoom Memon

Pakistan Journal of Neurological Sciences (PJNS)

Vitamin D deficiency is linked to poor treatment response in patients with Multiple S clerosis. The aim of this study is to define the frequency of Vitamin D deficiency for early detection and timely intervention leading to improved morbidity rates.

What Influences Family Planning In Rural Pakistan: Franchised Service Provider And Community Health Worker Perspective, Waqas Hameed, Junaid-Ur-Rehman Siddiqui, Muhammad Ishaque, Sharmeen Hussain, Xaher Gul, Hina Najmi, Shehla Noorani, Ghulam Mustafa, Asma Balal

Community Health Sciences

Background: Pakistan has a low modern contraceptive prevalence rate, 26%, leading family planning (FP) programmes to explore partnerships with local private providers to improve access to quality FP services. This study aims to understand the socio-cultural and organizational factors that influence delivery of quality family planning services.
Methods: This qualitative study was conducted with private service providers and community health workers (CHW) in Marie Stopes Society's (MSS) social franchise network. A total of 31 providers and 28 CHWs from Sindh, Punjab, and Khyber Pakhtunkhwa provinces of Pakistan were purposively selected for in-depth interviews. The study used thematic content analysis to …

An Uncommon And Elusive Cause Of Cerebral Venous Thrombosis, Farheen Niazi, Saadia Riaz

Pakistan Journal of Neurological Sciences (PJNS)

We present a case of of young 27year male who was admitted with history of headache and vomiting for one week. He was diagnosed as having dural sinus thrombosis of superior sagittal, right lateral, right sigmoid sinus. There was previous history of uveitis 6 months prior to it. All thrombophilia workup was negative except homocysteine levels were moderately high. He was also found to be having recurring genital and oral ulcers. Pathergy test was negative. His HLA B 51/5 testing came back positive. Final diagnosis of Bechet’s disease was made and responded well to long term steroids and Colchicine. A …

Metachronous Renal Ewing Sarcoma/Primitive Neuroectodermal Tumour In A Survivor Of Burkitt Lymphoma, Kumail Khandwala, Kiran Hilal, Zehra Fadoo, Khurram Minhas

Department of Radiology

We present a case of a 14-year-old girl who was diagnosed with Burkitt lymphoma in 2014. She was managed with chemotherapy and remained in remission for 3 years. On her surveillance imaging in 2017, a left-sided renal neoplastic mass was incidentally discovered. She underwent nephrectomy and pathology of the resected specimen revealed small cell tumour of the kidney with features favouring renal Ewing sarcoma/primitive neuroectodermal tumour. Molecular genetic analysis by fluorescence in situ hybridisation was performed which showed translocation of 22q12, thereby confirming the diagnosis. This is a rare secondary malignancy and an unusual association. This case highlights the importance …

Targeting Twist1 Through Loss Of Function Inhibits Tumorigenicity Of Human Glioblastoma., Andrei M Mikheev, Svetlana A Mikheeva, Liza J Severs, Cory C Funk, Lei Huang, José L Mcfaline-Figueroa, Jeanette Schwensen, Cole Trapnell, Nathan D Price, Stephen Wong, Robert C Rostomily

Articles, Abstracts, and Reports

TWIST1 (TW) is a bHLH transcription factor (TF) and master regulator of the epithelial-to-mesenchymal transition (EMT). In vitro, TW promotes mesenchymal change, invasion, and self-renewal in glioblastoma (GBM) cells. However, the potential therapeutic relevance of TW has not been established through loss-of-function studies in human GBM cell xenograft models. The effects of TW loss of function (gene editing and knockdown) on inhibition of tumorigenicity of U87MG and GBM4 glioma stem cells were tested in orthotopic xenograft models and conditional knockdown in established flank xenograft tumors. RNAseq and the analysis of tumors investigated putative TW-associated mechanisms. Multiple bioinformatic tools revealed significant …

One Pulmonary Lesion, 2 Synchronous Malignancies, Masooma Aqeel, Nevin Uysal Biggs, Timothy S. Fenske, Nagarjun Rao

Section of Cardiology

Introduction. Mantle cell lymphoma (MCL) comprises approximately 3% to 10% of all non-Hodgkin lymphomas. Although there is an increased risk for secondary malignancies after treatment among non-Hodgkin lymphomas survivors, a synchronous diagnosis of primary lung cancer arising in conjunction with lymphoma at the same site has rarely been reported. We report an unusual case of primary lung adenocarcinoma with coexistent MCL within the same lung lesion. Case Presentation. A 55-year-old female with newly diagnosed stage IV-B MCL was referred for workup of a right upper lobe cavitary lesion detected during lymphoma staging. A whole-body positron-emission tomography-computed tomography scan …

Association Of Tissue Vitamin D Receptor Expression With Breast Cancer Molecular Subtypes In Kenyan Women, Mutambuki Kimondo

Master of Medicine in Anatomic Pathology

Background: Previous studies have shown that reduced vitamin D receptor expression in breast cancer tissue is associated with worse disease outcomes. Furthermore, studies show that estrogen negative and triple negative breast cancer is associated with a poor prognosis and a low breast tissue vitamin D receptor (VDR) expression. Other studies also report that low serum vitamin D levels are associated with more aggressive breast cancer. Methods: This was a cross-sectional study with both a retrospective and a prospective arm. The retrospective part was nested within a larger study; previously constructed tissue microarray blocks (TMA) blocks were used for analysis of …

Musician As Physician: Interwoven Artistry For Complex, Cancer Pain Management, Douglas E. Brandoff

Crossroads of Music and Medicine

The author, who is both a classical musician and a physician, reflects on how to interweave the skills he has from experience in both realms to become a more "complete" palliative care physician when working with patients.

Women And Maternal Health Care Providers’ Perceptions, Beliefs And Attitudes Towards Use Of Epidural Analgesia For Labour Pain Relief, Stella Njenga

Master of Medicine in Obstetrics and Gynecology

Background: Epidural analgesia (EA) is considered the gold standard for relief of labour pains due to its effectiveness, safety and flexibility of use. There is a disparity of utilization between high and low & middle income countries with lack of knowledge and resources implicated. Aga Khan University Hospital Nairobi is a well-resourced facility with a well-established EA service. This study explores the perceptions, beliefs and attitudes of women seen at the facility towards EA and how these affect their decision to use the method. It also explores health care providers’ views on the method and how they influence the women’s …

Injuries In The Chinese Arena Football League: American Versus Chinese Players., Tianwu Chen, Austin Wetzler, Scott Singer, Michael Feldman, David Rubenstein, Gunnar Gillespie, Shiyi Chen, Merrick Wetzler

Rothman Institute Papers

Background: Arena football is an indoor version of American football played in indoor arenas on a smaller field with 8 players per team. Only 1 study has evaluated injury rates in arena football, and no study had compared 2 distinct cohorts of players.

Purpose/Hypothesis: The purpose of this study was to evaluate and compare injury rates in American versus Chinese athletes in the Chinese Arena Football League. Our hypothesis was that the rate of significant injuries (≥7 days of time lost from play) would be statistically significantly higher in Chinese athletes.

Study Design: Cohort study; Level of evidence, 2.

Methods: …

Fibrous Pseudotumor Of Tunica Albuginea Testis Mimicking Testicular Neoplasm In A Young Man, Nazim Syed Muhammad, Ayesha Nusrat, Zehra Kazmi

Section of Urology

ntrascrotal lesions are common findings with a majority occurring in paratesticular tissue. Fibrous pseudotumors are rare, benign lesions of the testicular tunics and present with mass lesion(s) in the scrotum. Preoperative clinical and radiological diagnosis is challenging. We report a case of a 34-year-old man who presented with a 3-year history of left testicular swelling and was advised left radical orchidectomy by another surgeon. Physical examination revealed a firm, nontender mass attached to the lower pole of the testis. Testicular tumor markers were all negative, and ultrasound scan showed a relatively hypoechoic lesion closely associated with the left testis and …

Acinetobacter Infections: A Retrospective Study To Determine In – Hospital Mortality Rate And Clinical Factors Associated With Mortality, Rajiv Patel

Master of Medicine in Internal Medicine

Background: Acinetobacter infections are increasingly being recognized as a cause for significant in – hospital morbidity and mortality worldwide. Increasingly multi – drug resistant strains of Acinetobacter are being isolated, increasing the burden on healthcare resources. Our objectives were to determine the outcomes and clinical factors related to outcomes of Acinetobacter infections at the Aga Khan University Hospital. Methods: A retrospective study of Acinetobacter infections (from any site) was conducted. Patient records were used to gather relevant clinical information. The collected data was tabulated and analysed for any significant differences in demographic or clinical variables. The Pearson Chi squared test …

Additive Drug-Specific And Sex-Specific Risks Associated With Co-Use Of Marijuana And Tobacco During Pregnancy: Evidence From 3 Recent Developmental Cohorts (2003-2015)., Suena H Massey, Daniel K Mroczek, David Reiss, Emily S Miller, Jessica A Jakubowski, Eileen K Graham, Shannon M Shisler, Meaghan Mccallum, Marilyn A. Huestis, Jody M Ganiban, Daniel S Shaw, Leslie D Leve, Rina D Eiden, Laura R Stroud, Jenae M Neiderhiser

Institute of Emerging Health Professions Faculty Papers

BACKGROUND: Methodologic challenges related to the concomitant use (co-use) of substances and changes in policy and potency of marijuana contribute to ongoing uncertainty about risks to fetal neurodevelopment associated with prenatal marijuana use. In this study, we examined two biomarkers of fetal neurodevelopmental risk-birth weight and length of gestation-associated with prenatal marijuana use, independent of tobacco (TOB), alcohol (ALC), other drug use (OTH), and socioeconomic risk (SES), in a pooled sample (N = 1191) derived from 3 recent developmental cohorts (2003-2015) with state-of-the-art substance use measures. We examined differential associations by infant sex, and multiplicative effects associated with co-use of …

Amniotic Fluid Embolism, Nadia Nawaz, Ahmed Raheem Buksh

Department of Obstetrics & Gynaecology

Amniotic fluid embolism is a rare and severe problem in obstetric patients. We experienced a 21-year primigravida who underwent emergency cesarean section due to sudden collapse and fetal distress after rupture of membranes in labour. Subsequently, she developed intraoperative coagulopathy, hemorrhage, hypotension, and respiratory collapse requiring ventilation. Both maternal and neonatal lives were saved with full recovery and discharged in stable condition. The clinical diagnosis of amniotic fluid embolism (AFE) was made, which is a very rare complication of pregnancy/puerperium with varying presentation, ranging from cardiac arrest, circulatory collapse and death through mild degrees of organ system dysfunction with or …

Secukinumab Versus Adalimumab For Psoriatic Arthritis: Comparative Effectiveness Up To 48 Weeks Using A Matching-Adjusted Indirect Comparison., Peter Nash, Iain B Mcinnes, Philip Mease, Howard Thom, Matthias Hunger, Andreas Karabis, Kunal Gandhi, Shephard Mpofu, Steffen M Jugl

Articles, Abstracts, and Reports

INTRODUCTION: Secukinumab and adalimumab are approved for adults with active psoriatic arthritis (PsA). In the absence of direct randomized controlled trial (RCT) data, matching-adjusted indirect comparison can estimate the comparative effectiveness in anti-tumor necrosis factor (TNF)-naïve populations.

METHODS: Individual patient data from the FUTURE 2 RCT (secukinumab vs. placebo; N = 299) were adjusted to match baseline characteristics of the ADEPT RCT (adalimumab vs. placebo; N = 313). Logistic regression determined adjustment weights for age, body weight, sex, race, methotrexate use, psoriasis affecting ≥ 3% of body surface area, Psoriasis Area and Severity Index score, Health Assessment Questionnaire Disability Index …

Monitoring Of Birth Registry Coverage And Data Quality Utilizing Lot Quality Assurance Sampling Methodology: A Pilot Study, Shiyam Sunder Tikmani, Sarah Saleem, Elizabeth Mcclure, Farnaz Naqvi, Farina Abrejo, Zahid Soomro, Dennis Wallace, Robert L. Goldenberg

Community Health Sciences

Background: Effectively monitoring the coverage and quality of data in low-resource settings is challenging. Lot quality assurance sampling (LQAS) is a method to classify coverage as adequate or inadequate. The aim of this pilot study is sought to determine the coverage and quality of a birth registry in a rural district in Pakistan.
Methods: This survey was conducted in 14 clusters of Thatta, Pakistan. LQAS methodology was used to monitor the birth registry from December 2015 to February 2016. We randomly selected 19 villages from each cluster. We used a short questionnaire to review the quality of data collection for …

The Project To Understand And Research Preterm Pregnancy Outcomes And Stillbirths In South Asia (Purpose): A Protocol Of A Prospective, Cohort Study Of Causes Of Mortality Among Preterm Births And Stillbirths, Elizabeth M. Mcclure, Sarah Saleem, Shivaprasad S. Goudar, Sangappa Dhaded, G. Guruprasad, Yogesh Kumar, Shiyam Sunder Tikmani, Muhammad Masood Kadir, Jamal Raza, Haleema Yasmin

Community Health Sciences

Background: In South Asia, where most stillbirths and neonatal deaths occur, much remains unknown about the causes of these deaths. About one-third of neonatal deaths are attributed to prematurity, yet the specific conditions which cause these deaths are often unclear as is the etiology of stillbirths. In low-resource settings, most women are not routinely tested for infections and autopsy is rare.
Methods: This prospective, cohort study will be conducted in hospitals in Davengere, India and Karachi, Pakistan. All women who deliver either a stillbirth or a preterm birth at one of the hospitals will be eligible for enrollment. …

Neuroimmunology Diagnostics, Mohammad Saeed, Tariq Gazdar, Nadir Ali Syed, Arsalan Ahmad

Pakistan Journal of Neurological Sciences (PJNS)

Neuroimmunology has led to advanced diagnostics of previously cryptic disorders, using autoantibody testing against neurological targets. Neuropsychiatric syndromes and autoimmune encephalitis can now be routinely diagnosed using specialized antibody tests such as immunofluorescence and immunoblot assays in specialized laboratories. This helps in early and accurate diagnosis, leading to favorable patient prognosis. Here, we briefly review the diagnostics for Neuroimmunologic and related disorders including autoimmune encephalitis, demyelinating diseases, neuropathies, paraneoplastic syndromes, stiffperson syndrome, inflammatory myopathies as well as Alzheimer’s disease.

Cerebral Venous Thrombosis Presenting As Subarachnoid Haemorrhage, Farheen Niazi

Pakistan Journal of Neurological Sciences (PJNS)

We present a 31 years old lady who was 19 days postpartum who was admitted with fits and loss of consciousness. At presentation Glasgow Coma Scale was 8/15. No focal deficit. CT scan brain showed findings suggestive of subarachnoid haemorrhage(SAH) in left sylvian fissure along with few parenchymal haemorrhagic areas in frontal and parietal lobes. MRI brain and MRV confirmed superior sagittal sinus thrombosis, inferior sagittal, straight and right transverse and sigmoid sinus thrombosis. Patient was treated conservatively and was anticoagulated for 6 months and had a complete recovery. Further workup of thrombophilia was negative. Postpartum being the only risk …

Pattern Of Mental Health Disorders In Adult Population Attending A Tertiary Mental Health Care Setting, Nasir Mehmood, Uroosa Talib, Raza Ur Rehman

Pakistan Journal of Neurological Sciences (PJNS)

Mental health disorders contribute significantly to the global burden of disease (32.4%), . Mental health disorders are the 4th leading cause of disability in developed countries, and the most disabling disorders in low-income and middle-income countries (LAMIC). Over one third of people in most LIMIC fulfill sufficient diagnostic criteria for a mental health disorder at some point in their life.

Profile Of Dementia Patients From A Tertiary Care Center In Karachi, Pakistan, Qurat Ul Ain Khan, Sana Siddiqui, Mohammad Zaman, Abdullah Waqar, Sumera Aziz Ali

Pakistan Journal of Neurological Sciences (PJNS)

BACKGROUND: According to an estimate currently over 46 million people live with dementia worldwide and 58% reside in developing countries. However like some other developing countries, not much is known about the demographics, characteristics, and associated conditions of those suffering from dementia in Pakistan. OBJECTIVE: To study profile of dementia patients from a tertiary care hospital in Karachi, Pakistan.

Association Of Serum Albumin Levels And Guillain Barre Syndrome (Gbs) Outcome., Mazhar Badshah, Ghulam Shabbir, Sumaira Fazal Nabi, Daniyal Ahmed

Pakistan Journal of Neurological Sciences (PJNS)

Guillain-Barre syndrome (GBS) is a polyradiculoneuropathy characterized by a rapidly progressive bilateral paresis of the limbs. Nadir is typically reached within a number of days or weeks, followed by a recovery that is generally much slower and often incomplete. Guillain-Barre syndrome is usually preceded by infection or other immune stimulation that induces an aberrant autoimmune response targeting peripheral nerves and their spinal roots.IVIG and Plasmapheresis are used first line treatments in GBS treatment. For better assessment of treatment response, biomarkers reflecting Plasmapheresis and IVIG efficacy are needed. Aim of this study is to determine serum albumin as an independent biomarker …