Background: Guillian--Barre' Syndrome (GBS) has been shown to be associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. The aim of our study was to study the clinical profile and outcomes of GBS in COVID-19 from the Western region of India, the State of Maharashtra. Methods: This was a retrospective, multicenter observation study from different hospitals in Maharashtra beginning from March 2020 until November 2020. Results: We report 42 patients with COVID-19 GBS. Mean age was 59 years (range, 24--85 years). 31/42 (73.8%) were men. GBS was the presenting symptom in 14/42 (33%), while six of them remained asymptomatic for COVID-19 despite positive SARS-CoV-2 on nasopharyngeal swab reverse transcriptase polymerase chain reaction. The median interval between COVID-19 and GBS was 14 days (SD + 11), with minimum of 1 and maximum 40 days. Clinical presentation was like that of typical GBS. Electrophysiological studies showed a predominant demyelinating pattern in 25/42 (59.5%). Inflammatory markers were elevated in 35/42 (83.3%) and 38/42 (90.5%) had an Abnormal high-resolution CT (HRCT) chest. 14/42 (33.3%) patients required a ventilator, with nine deaths. Intravenous immunoglobulin was the mainstay of treatment for GBS. Majority had a good outcome and were walking independently or with minimal support at discharge. In subgroup analysis, the postinfectious group had a better outcome than the parainfectious group. Conclusion: GBS in COVID-19 occurs as both parainfectious and postinfectious GBS. Parainfectious GBS needs more rigorous monitoring and may benefit from COVID-19 specific treatment. Routine screening for SARS-CoV-2 should be implemented in patients with GBS in view of the ongoing pandemic.

Background: Factors associated with risk with leaving hospital against medical advice (AMA) in neurology patients is unknown. Objective: To determine prospectively, the association of gender, age, religion, care type received, economic status and prognosis of the neurology patients, with the discharge AMA (DAMA) and correlate them with the reasons for DAMA cited by the patients or their relatives. Material and Methods: In-patients who left AMA between the year 2013 and 2016 (n = 689), were prospectively included in the study. Determinants of DAMA and the factors associated with DAMA within eight hours of admission (AMAe; n = 177) were analysed. A pre-AMA questionnaire was completed by those who left AMA after 8 hours (AMAd; n = 512). Results: Higher odds of AMA were associated with female gender (OR:1.48), age beyond 50 years (OR:1.35) and admission to intensive care (OR:2.59). Financial constraint was cited as reason of AMAd by the patients with low income (OR:1.72). Higher odds of association of influence of a first degree relative in the decision of AMAd were found in women (OR: 1.33) and persons more than 50 years (OR: 2.95). Discussion: Women and person older than 50 years had higher risk of DAMA, mostly due to the influence of a first-degree relative. The risk of leaving AMA was significant in those admitted in the neurological intensive care unit. Of all cited reasons of leaving AMA, financial constraint was most significant. Conclusion:The study provides an insight into the factors for associated with risk of DAMA from neurology wards.

The co-occurrence of Guillain–Barre syndrome (GBS) and tuberculosis is rare. Even in countries like India, where tuberculosis is common, there is only one case report of co-occurrence of GBS with tuberculosis. We report a case of GBS in association with sputum-positive pulmonary tuberculosis. The earliest treatment with intravenous immunoglobulin in acute motor axonal neuropathy variant of GBS would show good early recovery despite associated pulmonary tuberculosis.

Cardiac and renal diseases are becoming increasingly common today, and are seen to frequently coexist, thus causing a significant increase in the mortality rate, morbidity, complexity of treatment and cost of care. Syndromes describing the interaction between heart and kidney have been defined and classified; however, never as a result of a consensus process. Though the incidence of cardiorenal syndrome is increasing, the associated pathophysiology and effective management are still not well understood. For many years, diuretics and ultrafiltration, have been the mainstay of treatment for cardiorenal syndrome, although a significant proportion of patients develop resistance to diuretics, and even deteriorate while on diuretics. Here, we will discuss one such patient who failed to respond to the optimum doses of diuretics; however, his blood urea and serum creatinine touched the baseline levels post-ultrafiltration.

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