BACKGROUND:Zika produced the highest increase in the incidence of Guillain-Barré syndrome (GBS) in Latin America in the last decade. The Neuroinfections Emerging in the Americas Study (NEAS) was established in 2016 to investigate the association of emerging infectious disorders with GBS in Colombia. The present study assessed the role of preceding infections, including arboviruses and other pathogens, as risk factors for GBS. METHODS:A case-control study was conducted prospectively between June 2016 and December 2019 in 5 Colombian cities. We recruited newly diagnosed patients with GBS and a house control plus an age and season-matched-hospital control per case. Clinical information, blood, CSF, and urine samples were used to diagnose bacterial and viral infections. Anti-glycolipid antibodies were identified in serum. Statistical analyses were performed using conditional logistic regression. FINDINGS:Fifty-seven patients with GBS, 66·7% male, 52 years of median age, were recruited along with 77 (55 house and 22 hospital) controls. GBS was associated with presenting diarrhea (adjusted OR 10·94; 95% CI 1·8-66·29; p=0·009) and a history of recent upper respiratory tract infection (aOR 13·91; 95% CI 2·38-81·1 p=0·003). Specific recent infections did not significantly differ between cases and controls, but the number of infections was associated with GBS (aOR=1·77 95% CI 1·04-3·01 p=0·03). C. jejuni (74%), M. pneumoniae (23%), and Chikungunya (7%) were the most frequent infections. Anti-glycolipid IgG against GM1 and their heterodimer complexes were identified to be associated with GBS. CONCLUSIONS:After the Zika epidemic, infections causing diarrhea and upper respiratory diseases contributed to the burden of GBS in Colombia. Prevention and control of food-borne pathogens could reduce the incidence of GBS in Colombia.

BACKGROUND:Guillain-Barré Syndrome (GBS) can lead to significant functional impairments, yet little is understood about the recovery phase and long-term consequences for patients in low- and medium-income countries. OBJECTIVE:To evaluate the functional status and identify factors influencing outcomes among patients with GBS in Colombia. METHODS:Telephone interviews were conducted with GBS patients enrolled in the Neuroviruses Emerging in the Americas Study between 2016 and 2020. The investigation encompassed access to health services and functional status assessments, utilizing the modified Rankin Scale (mRS), GBS Disability Score (GDS), Barthel Index (BI), and International Classification of Functioning (ICF). Univariate analysis, principal component analysis, linear discriminant analysis, and linear regression were employed to explore factors influencing functional status. RESULTS:Forty-five patients (mean age = 50[±22] years) with a median time from diagnosis of 28 months (IQR = 9-34) were included. Notably, 22% and 16% of patients did not receive rehabilitation services during the acute episode and post-discharge, respectively. Most patients demonstrated independence in basic daily activities (median BI = 100, IQR = 77.5-100), improvement in disability as the median mRS at follow-up was lower than at onset (1 [IQR = 0-3] vs. 4.5 [IQR = 4-5], p < 0.001), and most were able to walk without assistance (median GDS = 2, IQR = 0-2). A shorter period from disease onset to interview was associated with worse mRS (p = 0.015) and ICF (p = 0.019). Negative outcomes on GDS and ICF were linked to low socioeconomic status, ICF to the severity of weakness at onset, and BI to an older age. CONCLUSIONS:This study underscores that the functional recovery of GBS patients in Colombia is influenced not only by the natural course of the disease but also by socioeconomic factors, emphasizing the crucial role of social determinants of health.

We aimed to investigate the association of emerging infectious disorders with Guillain-Barré syndrome (GBS) in Colombia following the 2015–2016 Zika outbreak.

To characterize the epidemiological, clinical, and laboratory features of cases of encephalitis of unknown etiology included in the NEAS cohort.

Fragile X syndrome is caused by the expansion of CGG triplets in the FMR1 gene, which generates epigenetic changes that silence its expression. The absence of the protein coded by this gene, FMRP, causes cellular dysfunction, leading to impaired brain development and functional abnormalities. The physical and neurologic manifestations of the disease appear early in life and may suggest the diagnosis. However, it must be confirmed by molecular tests. It affects multiple areas of daily living and greatly burdens the affected individuals and their families. Fragile X syndrome is the most common monogenic cause of intellectual disability and autism spectrum disorder; the diagnosis should be suspected in every patient with neurodevelopmental delay. Early interventions could improve the functional prognosis of patients with Fragile X syndrome, significantly impacting their quality of life and daily functioning. Therefore, healthcare for children with Fragile X syndrome should include a multidisciplinary approach.

To evaluate clinical, laboratory, and epidemiological features of acute neuroinflammatory disorders (ANIDs) that followed the 2016 Zika epidemic in Colombia.

Background: The first-line interventions in immune thrombocytopenia (ITP) include intravenous polyclonal immunoglobulins (IVIg), corticosteroids and anti-D immunoglobulin (anti-D). Objective: We aimed to compare the effectiveness and safety of first line treatments for newlydiagnosed primary ITP in children to increase the platelet count. Methods: We searched MEDLINE, EMBASE, LILACS and the Cochrane Central register of Controlled Trials (CENTRAL); and included the clinical trials. We performed the statistical analysis in R. Results: We included 12 studies for meta-analysis. Compared with IVIG 2g/kg, response rates were lower for prednisone 2mg/kg at 72 hours [RR 0.04 (95% CI 0.0 to 0.68)] and at 7 days [RR 0.23 (95% CI 0.08 to 0.67)]; at 48 hours, methylprednisolone 30mg/kg also showed lower response rates [RR 0.72 (95% CI 0.52 to 0.99)]. IVIG 2g/kg and 2.5g/kg had less adverse effects than Anti- D, methylprednisolone and IVIG 0.8g/kg. For rising platelet count, no statistical differences were found at 24 hours or in 7 days; at 48 hours, IVIG 2g/kg showed better results than Anti-D 75μg/kg [MD -58.84 (95% CI -87.02 to -25.66)]. After a month, platelet count with IVIG 2g/kg was higher than Anti-D 50 and 75μg/kg [-82.03 (95% CI -102.60 to -61.46) and -78.77 (95% CI -97.80 to - 59.74), respectively], but lower than methylprednisolone 50mg/kg [MD 118 (95% CI 3.88 to 232.12)]. Conclusion: The total platelet count rises higher in early and late phases with IVIG than Anti-D, but in long term it is higher with methylprednisolone. Additionally, IVIG causes less adverse effects than Anti-D and corticosteroids.