Background:Guillain–Barre syndrome (GBS) is an autoimmune acute inflammatory demyelinating polyneuropathy affecting the peripheral nervous system treated with high-dose immunoglobulin, physical therapy, or plasmapheresis. Immunoglobulins are expensive and even plasmapheresis might not be affordable to patients visiting government set-ups.Aims:This study was undertaken to emphasize the efficacy of plasmapheresis in treatment of adult GBS patients and to narrate methods of reducing the economic burden in the treatment of these patients using modified plasmapheresis.Methods:A study was conducted on 12 adult GBS patients at Sir Takhtasinhji General Hospital, Bhavnagar from July 2012 to July 2014. Patients were assessed on a 6-point disability scale. They were treated with plasmapheresis over 10 days with REF627 kit from Haemonetics Corporation Limited on MCS+ machine. Improvement was noted by the change in the disability scale score and expenses of various modes of treatment were also considered.Results:Seventy-five percent showed improvement at the end of the treatment. The cost of modified plasmapheresis was Rs. 8000/cycle, i.e., Rs. 40,000/patient.Conclusion:Plasmapheresis along with proper supportive measures is a more cost-effective efficacious mode of therapy in adult patients of GBS. Further, modified plasmapheresis using REF627 kit and 6% hexastarch as replacement fluid on MCS+ apheresis machine reduces the cost of therapy for poor patients visiting government set-ups.

Background: Disorders of thyroid gland are very common. Thyroid cancers comprise 1% of all malignancies, and are the most common cancer of endocrine system. It is more common in females as compared to males.Method: 51 Patients with enlarged thyroid gland were studied. All the thyroid FNAC cases were reported and compared by using both the conventional and the Bethesda System for Reporting Thyroid Cytopathology (TBSTRC). The conventional system includes description of the microscopic findings of the case along with a final impression at the end. In equivocal cases, the differentials were given. However, for statistical analysis, the reporting system was modified into five category system. The categories were-1) Inadequate 2) Benign 3) Equivocal 4) Follicular 5) Malignant Results:The age at presentation of the patient varied widely from 10 years to 100 years. The mean age of presentation is 40 years. There was female preponderance amongst the patients (94.1% females). In the vast majority of the cases TBSRTC is equivalent to the conventional system in the pattern of reporting.Conclusion: TBSRTC may be viewed as a better screening test for thyroid lesions. Follicular patterned lesions pose the greatest difficulty in evaluating thyroid FNAC smears with their being significant overlap in the cytological features of different lesions.