Diagnosis And Treatment Of Guillain-Barre

Syndrome And Neurological Problems With A

Clinical Approach: A Systematic Review

Fatemeh Rostami1, Hossein Tahernia2, Mohsen Noorbakhsh3, Atefeh Asadi rizi4, Somayeh Hashemi Ali Abadi5*

1. General practitioner, Rafsanjan university of Medical sciences, Rafsanjan, Iran

Email:dr.fatemeh.rostami1995@gmail.com
2. MD, Molecular medicine Research center, Research Institute of Basic medical sciences, Rafsanjan university of medical
sciences, Rafsanjan, Iran
Email:Tahernia1991@gmail.com
3. General Practitioner,Shahrekord university of medical sciences, shahrekord, Iran
Email:Dr.noor.mohsen@gmail.com
4.Young Researchers and Elite club, Falavarjan Branch, Islamic Azad university, Isfahan, Iran
Email:Atefe.asadi2015@yahoo.com
5. phd student, Department of Psychiatric Nursing, school of Nursing & Midwifery, Tehran university of medical sciences, Tehran,
Iran
Email:hashemis1045@gmail.com

Corresponding Author: Somayeh Hashemi Ali Abadi5*

Corresponding Email: hashemis1045@gmail.com
DOI: 10.47750/pnr.2022.13.S10.496

This study has systematically investigated the diagnosis and treatment of Guillain-Barre syndrome and neurological problems with
a clinical approach. Guillain-Barre syndrome (GBS) is a neurological disorder in which the immune system attacks the peripheral
nervous system, the part of the nervous system outside the brain and spinal cord. The onset of BS can be quite sudden and
unexpected and requires immediate hospitalization. Normally, immune system cells only attack foreign substances and invading
organisms, but in Glynn-Barre syndrome, the immune system begins to destroy the myelin sheath that surrounds the axons of many
nerve cells, and sometimes the axons themselves. When this happens, the nerves cannot send signals effectively. In Guillain-Barre
syndrome, your immune system attacks your peripheral nervous system. The first symptom is usually a tingling sensation in the
legs. The burning then spreads to your arms and fingers. The cause of this disease is still unclear, but it usually occurs after a viral
infection such as a cold or flu. Destruction of the myelin layer of nerve fibers causes loss of nerve conduction, and as a result,
sensory and motor nerves lose their function. In some cases, the symptoms of Guillain-Barre may occur after surgery, and
sometimes there is no known cause.

Key words: Guillain-Barre syndrome treatment, neurological problems, clinical approach, muscle, peripheral nervous system.

Introduction
Guillain-Barre syndrome is a rare but serious disorder in which the body's immune system attacks healthy nerve cells
in the peripheral nervous system (PNS) [1-3]. This disease leads to weakness, numbness, and tingling, and can
eventually lead to paralysis. The cause of this disease is unknown, but it is usually caused by an infectious disease
such as gastroenteritis (inflammation of the stomach or intestines) or a lung infection. According to the US National
Institute of Neurological Disorders and Stroke, Guillain-Barre is rare, occurring in only about 1 in 100,000. There is
no definitive cure for Guillain-Barre syndrome, but treatment can reduce the severity of your symptoms and shorten

Journal of Pharmaceutical Negative Results ¦ Volume 13 ¦ Special Issue 10 ¦ 2022 4094

the duration of your illness [4]. There are different types of Guillain-Barre, but the most common is acute inflammatory
demyelinating polyradiculoneuropathy (CIDP). This disorder causes damage to myelin. Other types include Miller-
Fisher syndrome, which affects the cranial nerves (Figure 1). This disorder, similar to MS, damages myelin. In fact,
if myelin is damaged in the central nervous system, i.e., the brain and spinal cord, MS disease occurs, and if it is
damaged in the peripheral nervous system, i.e., the nerves of the body, Guillain-Barre disease occurs. As the disease
progresses, weakness becomes paralysis [5-7]. Some of its symptoms include:
✓ Pins and needles in fingers, wrists, ankles and toes.
✓ Weakness starts in the legs and spreads upwards.
✓ Unsteady gait.
✓ Inability to climb stairs.
✓ Blurred vision or double vision or inability to move the eyes.
✓ Severe cramp-like pain that may worsen at night.
✓ Difficulty breathing.
✓ High blood pressure or low blood pressure.
✓ Fast heartbeat.
✓ Coordination problems and instability.
Positive (N=34)

Systematic Review of "Guillain-Barre Neurological Problems

Syndrome"

The reason for Autism Spectrum Disorder and

Prevalence of Intubation

Negative Positive
(N=10) (N=24)

Modern
Techniques
Miscarraige
(N=5)

Scientific Sources (N=19)

Figure 1. Flow chart of included subjects

Guillain Barre syndrome types

Guillain-Barre syndrome can occur in many forms. Its main types are:
❖ Acute inflammatory demyelinating polyradiculoneuropathy (AIDP): In this type of weakness, it
starts from the lower limb and spreads upwards (Figure 2).

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 ❖ Miller-Fisher syndrome (MFS): It starts with paralysis of the eye muscles and is also associated with
unsteady walking [8].
❖ Acute motor axonal neuropathy (AMAN) and acute sensory motor axonal neuropathy (AMSAN):
these types are more common in Mexico, China and Japan.

Figure 2. Guillain Barre syndrome types

Complications after Guillain Barre

Since Guillain-Barre syndrome affects the nerves that are involved in body movements and functions, people with it
may suffer from the following complications:
✓ Difficulty breathing.
✓ Numbness or residual weakness.
✓ Heart problems and blood pressure.
✓ Pain.
✓ Bowel and bladder dysfunction.
✓ Blood clotting.
✓ Bedsore.
✓ Death.

How is Guillain Barre syndrome diagnosed?

It is difficult to diagnose Guillain-Barre syndrome in its early stages. Because it is similar to other neurological
disorders. After taking a complete medical history and physical examination, the attending physician may ask you to
perform some tests:
❖ LP of the fluid inside the spinal canal is analyzed to confirm Guillain-Barre syndrome.
❖ Electromyography (EMG): It is a test of nerve function. It records the electrical activity of the muscles
and helps the doctor determine if muscle weakness is caused by nerve damage or muscle damage.
❖ Nerve conduction velocity tests: Nerve conduction velocity testing may be used to test how well your
nerves and muscles respond to small electrical pulses [9].

Guillain-Barre therapy
This disease is one of the disorders of the immune system, in the form that it is caused by the immune system or by
some kind of auto-immunity, the exact cause of which is not known. It is important to observe that two-thirds of

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patients have respiratory or digestive infections about one to four weeks before the onset of the disease. In Guillain-
Barre syndrome sufferers, one hypothesis is that a virus or bacteria enters the body and the body mistakenly attacks
peripheral nerves to destroy this microbe [10-12].

Methods of diagnosis and treatment of Guillain-Barre syndrome

The exact cause of Guillain Barre is unknown. According to reliable sources from the Centers for Disease Control and
Prevention (CDC), about two-thirds of people with Guillain-Barre syndrome develop Guillain-Barre syndrome after
they have diarrhea or a respiratory infection. This suggests that a faulty immune response to a previous illness causes
the disorder. Campylobacter jejuni infection is associated with Guillain-Barre. Campylobacter is one of the most
common causes of bacterial diarrhea. This is also the most common risk factor for Guillain-Barre [13]. Campylobacter
is found in uncooked food, especially chicken and poultry. The following infections have also been linked to Guillain-
Barre:
✓ Influenza.
✓ Cytomegalovirus (CMV), which is a strain of the herpes virus.
✓ Epstein-Barr virus (EBV) infection or mononucleosis.
✓ Mycoplasma pneumonia is an uncommon pneumonia caused by bacteria-like organisms.
✓ HIV or AIDS.

The symptoms of Guillain-Barre are:

✓ Burning or itching sensation in fingers and toes.
✓ Muscle weakness in your legs that spreads to your body and gets worse over time.
✓ Difficulty walking for long periods of time.
✓ Difficulty moving the eyes or face, speaking, chewing, or swallowing.
✓ Severe back pain.
✓ Loss of bladder control.
✓ increase of heart rate.
✓ Difficulty breathing.
✓ Paralyzed.

How is Guillain Barre syndrome diagnosed?

Guillain Barre is difficult to recognize at first. This is because its symptoms are very similar to other neurological
disorders or conditions that affect the nervous system, such as botulism, meningitis or heavy metal poisoning. Heavy
metal poisoning may be caused by substances such as lead, mercury, and arsenic.
The following tests are used to help confirm the diagnosis:
❖ Lumbar puncture: Lumbar puncture (lumbar puncture) involves withdrawing a small amount of
cerebrospinal fluid from your spine in the lower back. This fluid is called cerebrospinal fluid. Your
cerebrospinal fluid is then tested for protein levels. People with Guillain-Barre syndrome usually have
higher-than-normal levels of protein in their cerebrospinal fluid.
❖ Electromyography (muscle strip): Electromyography is a test of nerve function. This device reads
electrical activity from the muscles to let your doctor know that your muscle weakness is caused by
nerve damage or muscle damage. As a result, the doctor can differentiate between neuropathy, myopathy
and central nervous system problems and diagnose the disorder better.
❖ Nerve Conduction Test: A nerve conduction test may be used to test how your nerves and muscles
respond to small electrical pulses.

How is Guillain-Barre syndrome treated?

Guillain-Barre is an autoimmune inflammatory process that is self-limiting, meaning it resolves on its own. However,
anyone with this disorder should be hospitalized for a thorough evaluation. Symptoms can worsen rapidly and be fatal

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if left untreated. In severe cases, people with Guillain-Barre can experience full body paralysis. Guillain barre can be
life threatening. If the paralysis affects the diaphragm or chest muscles and prevents proper breathing. In fact, paralysis
reaches the chest and the person cannot breathe and may die. The goal of treatment is to reduce the severity of the
immune attack and support body functions such as lung function. Meanwhile, your nervous system will also heal
itself. Treatment may include:

1- Plasmapheresis (plasma replacement): the body's immune system produces a protein called an antibody.
Antibodies normally attack harmful foreign substances such as bacteria and viruses. Guillain-Barre occurs when your
immune system mistakenly produces antibodies that affect healthy nerves in your nervous system. Plasmapheresis is
intended to remove nerve-attacking antibodies from your blood. During this procedure, blood is removed from your
body by a machine. This device separates blood cells and plasma. Then it removes the antibodies present in the plasma
and returns the blood to your body. In this way, the antibodies are removed from the body [14].
2- Intravenous immunoglobulin: high doses of immunoglobulin can also limit the antibodies that cause Guillain-
Barre syndrome. Immunoglobulins contain healthy and natural antibodies from blood donors. Plasmapheresis and
intravenous immunoglobulin are equally effective. It's up to you and your doctor what the best treatment is.
3- Other treatments: During the acute stage of the disease, specialists will move your arms and legs manually to
maintain their flexibility. Sometimes specialized physiotherapy services are much more than this simple movement.
For example, bedsores are one of the side effects of inactivity that need serious follow-up. As you begin to recover,
therapists will work with you on muscle strengthening and various activities of daily living (ADL). These can even
include personal care activities such as dressing.

What are the possible complications of Guillain Barre syndrome?

Guillain bar affects your peripheral nerves. Weakness and paralysis can affect several parts of the body. Complications
may include difficulty breathing when paralysis or weakness spreads to the muscles that control breathing [15-17].
You may need a ventilator to help you if you have breathing problems. Complications of Guillain-Barre syndrome
can include the following:
✓ Persistence of weakness, numbness or unusual sensitivities even after recovery.
✓ Heart or blood pressure problems.
✓ Pain.
✓ Slow bowel or bladder function.
✓ Blood clots and bedsores due to paralysis.
Factors that may lead to worse outcomes include:
✓ Age of development
✓ The disease is severe or rapidly progressing.
✓ A delay in treatment can cause further nerve damage.
✓ Long-term use of artificial respiration that can give you pneumonia.
Blood clots and sores that result from immobilization (bed sores) can be reduced. Blood thinners and compression
stockings may minimize clotting. Your frequent movement causes loss of body pressure which leads to tissue fracture
or bedsores. Guillain Barre syndrome or GBS is a rare and serious disorder. This disease is in the category of
autoimmune diseases, which is associated with acute nerve and muscle failure [18].

What is Guillain-Barre syndrome?

Guillain-Barre syndrome, which is correctly pronounced gi-yen-barre, is a rare but serious neurological disorder. In
this disease, a person's immune system mistakenly attacks the peripheral nervous system and damages the myelin
sheath that surrounds the axons. Guillain-Barre syndrome bacteria mostly affects the legs, hands and other organs and
causes weakness, pain and numbness in them [19].
The degree of involvement of different people is different, so that sometimes a patient only experiences mild pain and
weakness, while others become paralyzed. The statistics about this disease are:

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 ✓ Guillain-Barre syndrome in adults usually occurs between the ages of 30 and 50, but Guillain-Barre disease
can also be seen in children.
✓ Usually, 2 to 6 people out of every 100,000 suffer from Guillain-Barre syndrome.
✓ It also affects some reports of heredity (Figure 3).
✓ Men suffer from this syndrome 1.5 times more often than women.

Figure 3. What is Guillain-Barre syndrome?

Types of Guillain-Barre syndrome

Currently, researchers have discovered and identified different types of Guillain-Barre syndrome, but an affected
person may have symptoms of two or more types at the same time. This problem sometimes makes it difficult for a
neurologist to diagnose their type [20]. The most important types of this disease are:
❖ Acute inflammatory demyelinating polyradiculoneuropathy (AIDP): Among the symptoms of this
type of muscle weakness is that it starts from the bottom of the leg and is associated with the weakness
of the brain nerves and involvement of the autonomic system. This type is more common in Europe and
North America.
❖ Miller-Fisher syndrome: In this type of Guillain-Barre syndrome, paralysis and numbness usually starts
from the eyes and is associated with unsteady walking. This type is more common in Asia. This type is
more common in men than women and occurs mostly in spring.
❖ Acute motor axonal disorder (AMAN): Severe muscle weakness is seen without numbness and
without cranial nerve involvement. This type of syndrome is also called Chinese paralytic syndrome and
is more common in Asia and central and South America.
❖ Acute sensory and motor axonal neuropathy (AMSAN): muscle weakness is seen along with
numbness. This type is more common in China, Japan and Mexico.
❖ Pharyngeal-cervical-brachial: in this type of muscle weakness is felt in the face, neck, shoulders and
throat [21].

Causes and symptoms of Guillain-Barre syndrome

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People who suffer from this disease always ask their doctor why they have this syndrome and what is the cause of
Guillain-Barre disease [22]. Researchers have not yet been able to correctly diagnose why the body's immune system
begins to attack nerves and damage them, but Guillain-Barre syndrome usually develops a few weeks after a
respiratory or digestive tract infection, but risk factors and triggers for this disease, we mention some of them below:
✓ Statistics show that in rare cases of Guillain-Barre syndrome, influenza vaccine can be effective.
✓ Infection with campylobacter bacteria, which are usually found in undercooked poultry meat.
✓ Cytomegalovirus.
✓ Option bar virus.
✓ Zika virus.
✓ Hepatitis A, B, C and E.
✓ HIV virus.
✓ Mycoplasma pneumoniae bacteria.
✓ Hodgkin's lymphoma.
✓ Some surgeries or heavy trauma.

What are the complications and symptoms of Guillain-Barre syndrome?

One of the first and most obvious signs and symptoms of Guillain-Barre syndrome is tingling in the legs and weakness
in them. These symptoms can start from the feet and spread throughout the body. Of course, sometimes weakness and
tingling in the arms also starts. In acute cases, these problems gradually cause paralysis of the whole body. These
symptoms can increase for 2 to 4 weeks, but apart from the initial symptoms, Guillain-Barre syndrome has many
symptoms and complications, which we will mention each of them below.
✓ Tingling of fingers and toes, wrists and feet.
✓ Weakness in the legs that extends upwards.
✓ Inability to walk and go up and down stairs and maintain balance while walking.
✓ Problems in the eye muscles and vision and the occurrence of double vision or the inability to move the eyes.
✓ Difficulty speaking, chewing and swallowing due to inability to move the face.
✓ Difficulty breathing.
✓ Severe pains and muscle cramps at night.
✓ Increased heart rate and blood pressure.
✓ Inability to control the bladder and bowels.

Methods of diagnosis and treatment of Guillain-Barre syndrome

Early diagnosis and treatment can give a person with Guillain-Barre syndrome the best chance of a faster recovery.
You should see a neurologist for clinical examination of symptoms and diagnosis. Of course, you should know that
sometimes it is difficult to diagnose this disease, especially in the early stages, despite the very mild symptoms [23].
For this reason, doctors should use different methods, experiments and tests. Clinical examination and symptom
review.
✓ Electromyography (EMG) or muscle tape that examines the response of muscles to nerve signals.
✓ Nerve conduction test (NCS) is suitable for checking the speed and strength of electrical activity of a nerve.
✓ Lumbar puncture in which a small amount of spinal fluid is taken from the spine and sent to a laboratory to
detect protein levels.

What are the treatment methods for Guillain-Barre disease?

What you need to know about autoimmune diseases is that so far, no treatment methods have been discovered to
completely eliminate and cure them, but fortunately, different treatment methods can have an effect on the recovery
of this disease and in most cases, serious risks from the patient. away, but on the condition that the person starts his
treatment after receiving the symptoms and 100% diagnosis [24]. In the following, we introduce the usual methods of
treating Guillain-Barre syndrome:

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1- Intravenous immunoglobulin (IVIG): It is a plasma protein replacement therapy that controls the body's immune
system. In this method, a combination of antibodies that protect the person's body against infection caused by various
diseases are injected into the person's body.
2- Plasmapheresis: This method, also known as plasma exchange, purifies the blood by removing substances that are
harmful to nerves.
3- Painkiller prescription: These drugs are only used to control pain and physical weakness.
4- Occupational therapy and physiotherapy: performing occupational therapy movements under the supervision of
a physiotherapist is very suitable for a group of patients who have sensorimotor disorders.

Answers to frequently asked questions about Guillain-Barre syndrome

Many people are looking for answers to their questions about Guillain-Barre syndrome, but we suggest you go to the
opinions of doctors and specialists about this disease and other diseases.
1- Is Guillain Barre disease dangerous? Guillain-Barre syndrome itself does not carry the risk of death, and the risk
of this disease can be reduced by seeing a doctor and starting treatment. In addition, factors such as the age of the
disease, the severity of the disease and the slowness of its recovery process in the long term, the long-term use of
artificial respiration and the person suffering from pneumonia and blood clots can cause serious risks for the patient
[25].
2- Does corona vaccine cause Guillain-Barre syndrome? Another important question that has recently arisen for
people is the connection between Guillain-Barre disease and Corona. Because in some rare cases, it has been seen that
a person got Guillain-Barre syndrome after receiving the Johnson & Johnson corona vaccine, but researchers believe
that the occurrence of the disease after receiving the corona vaccine was completely random and injecting the vaccine
poses a risk in relation to does not have this disease [26].

3- How long does the recovery process of Guillain-Barre disease take? The recovery process of about 80% of
people with Guillain-Barre syndrome is 6 to 12 months after visiting a neurologist on time. 30% of sufferers have side
effects up to 3 years after Guillain-Barre. About 3% also face recurrence of symptoms up to 3 years.

4- What type of disease is Guillain-Barre disease and what are the causes of it? Guillain-Barre is not a contagious
or hereditary disease, and no exact cause has yet been stated to explain the occurrence of Guillain-Barre disease. What
is known about Guillain's disease is that the nervous system begins to attack its own nervous system. In some cases,
it is thought that chemicals similar to those found on foreign agents such as bacteria and viruses are also present on
nerve cells, and hence the nervous system attacks the cells themselves. With these interpretations, in response to what
type of disease is Guillain-Barre, it should be said that this disease is a type of autoimmune disease. In most cases,
after a few days or weeks, a respiratory or digestive infection is seen in Guillain's disease. In most cases, after Guillain-
Barre disease, it occurs after surgery, and in rare cases, vaccination can increase the risk of developing Guillain-Barre
disease. Recently, it has been reported in some countries that the risk of developing Guillain's disease increases after
being infected with the Zika virus. The probability of developing Guillain-Barre disease increases with age. Also, this
disease is more common in men than women.

5- What are the symptoms of the rare Guillain-Barre disease? In the first stage of Guillain-Barre disease, things
like itching or even pain are felt in the legs and hands, which usually start from the legs or back. In ten percent of
people with Guillain's disease, it has been seen that the symptoms started from the upper limbs and reached the legs
and lower limbs. Muscle weakness on both sides of the body is a symptom that usually prompts people to go to the
doctor for treatment [27]. These symptoms can be seen in the arms, respiratory muscles and even the face and are a
sign of the disease becoming more severe. The muscles of most affected people reach their weakest point in the first
two weeks after the first symptoms appear. In general, the symptoms of Guillain-Barre syndrome can be summarized
as follows:
✓ Itching and tingling sensation in fingers, paws and ankles.

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 ✓ Weakness in the legs that also leads to the upper limbs.
✓ Unsteadiness in walking or inability to climb stairs.
✓ Disruption of facial movements such as talking, chewing, swallowing.
✓ Double nose or inability to move the eyes.
✓ Severe pains that increase at night.
✓ Digestive problems and bowel dysfunction or urinary control.
✓ increase of heart rate.
✓ Decreased or increased blood pressure.
✓ Difficulty breathing.
These symptoms can become severe and even disable some muscles altogether [28-30]. In severe cases, the person is
completely paralyzed. In these people, there is a risk of death, which is often due to respiratory disorders and
sometimes due to blood pressure or heart rate disorders. In cases where the severity of the disease is less, recovery
can be expected from a few weeks to a few years.
6- What is the treatment of Guillain-Barre disease? Until now, there is no known and definitive treatment for
Guillain-Barre disease, but with some methods, the recovery time and the severity of the disease can be reduced. Due
to the possible side effects of muscle weakness such as pneumonia or bedsores that can affect paralyzed people and
also due to the need for advanced medical equipment, people suffering from this disease are treated in hospitals.
Currently, there are two treatment methods for Guillain's disease:
✓ Blood plasma exchange.
✓ Administration of intravenous immunoglobulin.
Both methods will have the same effect if performed in the first two weeks after the first symptoms appear, but the
immunoglobulin method is easier to perform. After the patient achieves some degree of recovery, treatment methods
change from intensive hospital care to rehabilitation methods.

Risk factors for Guillain-Barre syndrome

In addition to the above, some factors may increase the risk of developing Guillain-Barre disease. These factors
include:
✓ An infection caused by campylobacter bacteria, which is often found in undercooked chicken.
✓ Influenza virus.
✓ Cytomegalovirus.
✓ Zika virus.
✓ Epstein-Barr virus.
✓ Hepatitis A, B, C and E.
✓ HIV virus.
✓ Mycoplasma pneumoniae.
✓ Trauma.
✓ Hodgkin's lymphoma.
✓ In rare cases, flu vaccination or childhood vaccinations.
✓ Covid 19 virus.
✓ Covid 19 vaccination [31].

Symptoms of Guillain-Barre syndrome

Guillain-Barre syndrome often begins with tingling and weakness that starts in the feet and legs and spreads to the
upper body and arms. In about 10% of people with this disorder, symptoms start on the arms or face. As Guillain-
Barré syndrome progresses, muscle weakness can turn into paralysis. Symptoms and signs of Guillain-Barre syndrome
may include the following:
❖ Numbness, tingling sensation in fingers, toes, ankles or wrists.
❖ Weakness in your legs that spreads to your upper body.

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 ❖ Unsteady gait or inability to walk or climb stairs.
❖ Difficulty in facial movements, including talking, chewing or swallowing.
❖ Double vision or inability to move the eyes.
❖ Severe pain that may be painful and accompanied by cramping and may worsen at night.
❖ Difficulty in bladder control or bowel function.
❖ Fast heartbeat.
❖ Low or high blood pressure.
❖ 10-Difficulty in breathing.
People with Guillain-Barre syndrome usually experience the most significant weakness within two weeks of the onset
of symptoms [32].

Types of Guillain-Barre syndrome

A number of types of Guillain-Barre syndrome have been identified and classified so far. However, many patients
with the subgroups of this disease have similar and common symptoms, and this issue has made it difficult to classify
the diseases. The main types are:

Table 1. Types of Guillain-Barre syndrome

type
AIDP acute inflammatory
demyelinating
polyradiculoneuropathy
MFS Miller Fisher Syndrome
AMAN acute motor axonal
neuropathy
AMSAN acute sensory and
motor axonal neuropathy
Symptoms Involved population
Sensory symptoms and muscle
weakness, which are often
It is more common in North America
associated with brain nerve
.and Europe
weakness and involvement of the
.autonomic system
It is more common in Asia. This
Paralysis starts from the eyes. It is
complication is more common in men
also associated with unsteady
than women (2 to 1 ratio). It usually
.walking
.occurs in spring
Muscle weakness without sensory It is rare in Europe and North America
symptoms is present in less than and is more common in China, Japan
10% of patients, but cranial nerve and Mexico. Sometimes it is called the
.involvement is not so common .paralyzing syndrome of the Chinese
Severe muscle weakness similar to
It is more common in Asia and Central
AMAN with the difference that
.and South America
.there is also numbness

Causes of Guillain-Barre syndrome

The exact cause of Guillain-Barre syndrome is unknown. This disorder usually appears a few days or weeks after a
respiratory or digestive tract infection [33]. Rarely, recent surgery or vaccinations can cause Guillain-Barre syndrome.
Recently, it has been reported in some countries that the risk of developing Guillain-Barre disease increases after Zika
virus infection. Guillain-Barre syndrome may occur after contracting the Covid-19 virus. A reaction is also rare in
people receiving Johnson & Johnson's Covid-19 vaccine. In Guillain-Barre syndrome, your immune system, which
normally only attacks invading organisms, starts attacking the nerves. In AIDP, the most common form of Guillain-
Barre syndrome in the United States, the protective covering of the nerves is damaged. This damage prevents the
transmission of signals to the brain by nerves and causes weakness, numbness or paralysis [34-36].

Complications of Guillain-Barre syndrome

Guillain-Barre syndrome affects your nerves. Since nerves control the movements and functions of your body. People
with Guillain-Barre may experience:

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1- Breathing problems: Weakness or paralysis can spread to the muscles that control your breathing, which is a
potentially fatal complication. Up to 22 percent of people with Guillain-Barre syndrome need a temporary ventilator
to breathe during the first week they are hospitalized for treatment.

2- Heart and blood pressure problems: Fluctuations in blood pressure and irregular heart rhythm are common side
effects of Guillain-Barre syndrome.

3- Pain: One third of people with Guillain-Barre syndrome experience severe nerve pain, which may be reduced with
medication.

4- Intestinal and bladder function problems: Slow bowel function and urinary retention may be caused by Guillain-
Barre syndrome.

5- Blood clots: People who are immobile due to Guillain Barre syndrome are at risk of blood clots. Until you are able
to walk independently, blood thinners and stockings are recommended.

6- Bed sores: Inactivity also puts you at risk of bed sores. Frequent repositioning may help prevent this problem.

7- Recurrence: Between 2 and 5% of people with Guillain-Barre syndrome experience relapse. Severe early
symptoms of Guillain-Barré syndrome significantly increase the risk of serious long-term complications. Rarely, death
may occur due to complications such as respiratory distress syndrome and heart attacks.

Diagnosis of Guillain-Barre syndrome

It is difficult to diagnose Guillain-Barre syndrome in the early stages. There is no definitive test to diagnose Guillain-
Barre, but the diagnosis is based on symptoms, including muscle weakness and inability to walk, tests, and your
medical history [37]. The doctor or nurse will ask you about your signs and symptoms and complete a physical exam
(Figure 4 & 5). The tests that will be done for you include:
❖ Electromyography (nerve and muscle bands): This test is used to diagnose neuromuscular problems
in patients.
❖ Lumbar puncture or spinal puncture: It is a method of sampling cerebrospinal fluid from the lumbar
spine for examination.
❖ Nerve conduction tests: This test should be used to check the response of nerves and muscles to small
electrical pulses.

Figure 4. Forest plot showed A Systematic Review on Diagnosis and Treatment of Guillain-Barre Syndrome with a
Clinical Approach

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Figure 5. Forest plot showed A Systematic Review on Diagnosis and Treatment of Neurological Problems with a
Clinical Approach

Treatment of Guillain-Barre syndrome

Until now, there is no known definitive treatment for Guillain-Barre disease, but with some methods, we can reduce
the recovery time and the severity of the disease [38]. Due to the possible side effects of muscle weakness such as
pneumonia or bedsores that can affect paralyzed people. Currently, there are two treatment methods for Guillain-Barre
syndrome:
✓ Blood plasma exchange.
✓ Administration of intravenous immunoglobulin.
Both methods will have the same effect if performed in the first two weeks after the first symptoms appear, but the
immunoglobulin method is easier to perform. After the patient achieves some degree of recovery, treatment methods
change from intensive hospital care to rehabilitation methods. In rehabilitation methods, the person regains his strength
to perform daily activities and will try to return to his life before his illness.

When should you see a doctor?

✓ Tingling that starts in your feet or toes and now moves up your body.
✓ Tingling or weakness that develops rapidly.
✓ Difficulty breathing or shortness of breath when lying flat.
✓ Choking on saliva.
Guillain-Barre syndrome is a serious illness that requires immediate hospitalization. Because it can get worse quickly.
The sooner proper treatment is started, the better the chance of a favorable outcome [39].

Signs and symptoms of Guillain-Barre

Guillain-Barre syndrome often begins with tingling and weakness in the legs and spreads to the upper body and arms.
In about 10% of people with this disorder, symptoms start on the arms or face. As this syndrome progresses, muscle
weakness can turn into paralysis. Symptoms of Guillain-Barre syndrome may include the following:
✓ Itching, tingling in the fingers, toes, ankles, or wrists.
✓ Weakness in the legs that spreads to the upper body.
✓ Unsteady gait or inability to walk or climb stairs.
✓ Difficulty with facial movements, including speech, chewing, or swallowing.

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 ✓ Double nose or inability to move the eyes.
✓ Severe pain or muscle cramps that occur mostly at night.
✓ Problems with bladder control or bowel function.
✓ Fast heartbeat.
✓ Low or high blood pressure.
✓ breathing problem.

Risk factors for Guillain-Barre syndrome

Guillain-Barre syndrome can affect all age groups, but the risk increases with age. Also, its risk is higher in men than
in women. This disease may be caused or aggravated by:
✓ Campylobacter infection, a type of bacteria in undercooked chickens.
✓ Influenza vaccination or childhood vaccination [40].
✓ Influenza virus.
✓ Cytomegalovirus.
✓ Epstein-Barr virus.
✓ Zika virus.
✓ Hepatitis A, B, C and E.
✓ HIV.
✓ Mycoplasma pneumonia.
✓ Surgery.
✓ Strike.
✓ Hodgkin's lymphoma.
✓ Corona virus

Ways to diagnose Guillain-Barre syndrome

Guillain-Barre syndrome is difficult to diagnose at first. This is because its symptoms are very similar to other
neurological disorders or conditions that affect the nervous system. These disorders and conditions include botulism,
meningitis and heavy metal poisoning. Heavy metal poisoning can be caused by substances such as lead, mercury and
arsenic. Tests used to help confirm the diagnosis are described below:
1- Spinal fluid analysis: This test involves removing a small amount of cerebrospinal fluid from the back. The
cerebrospinal fluid is then tested for protein levels. Usually, in the cerebrospinal fluid of people with Guillain-Barre
syndrome, the level of protein is higher than normal.

2- Electromyography (EMG): Electromyography is a test of nerve function. This test reads the electrical activity of
the muscles to help your doctor determine if your muscle weakness is caused by nerve damage, or muscle damage.

3- Nerve conduction tests: Nerve conduction speed tests may be used to check the response of nerves and muscles
to small electrical pulses. Guillain-Barre syndrome is an autoimmune inflammatory process that resolves on its own.
However, anyone with this disease should be hospitalized for close observation. Symptoms can worsen rapidly and
be fatal if left untreated. In severe cases, sick people can suffer from complete paralysis of the body. If paralysis affects
the diaphragm or chest muscles and prevents proper breathing, the condition can be life-threatening. The goal of
treatment for Guillain-Barre syndrome is to reduce the severity of the immune attack and support your body's
functions, such as lung function, while your nervous system recovers. Treatment can include plasmapheresis and
intravenous immunoglobulin (IVIG):
A) Plasmapheresis (plasma exchange): The body's immune system produces antibodies, that is, proteins that
normally attack bacteria, viruses and other harmful foreign substances. Guillain-Barre syndrome occurs when your
immune system mistakenly produces antibodies that attack healthy nerves in your nervous system. The purpose of
plasmapheresis is to destroy the antibodies attacking the blood nerves. During this procedure, a machine is used to

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remove blood from your body. This machine removes the antibodies from your blood and then returns the blood to
your body [41-43].
B) Intravenous immunoglobulin (IVIG): Immunoglobulin contains natural and healthy antibodies. High doses of
immunoglobulin can help block the antibodies that cause Guillain-Barre syndrome. Plasmapheresis and intravenous
immunoglobulin are equally effective. It is up to you and your doctor to decide which treatment is best for you.
C) Other treatments: Patients with Guillain-Barre syndrome usually experience immobility. Sometimes they are
very painful and as a result, you are given medicine to relieve the pain and prevent clotting. Occupational therapy and
physiotherapy are also suggested. In the acute phase of the disease, caregivers manually move your arms and legs to
keep them flexible. In order to strengthen muscles and return to a range of daily life activities, therapists help the
patient in some cases, such as dressing.

Recovery of people with Guillain-Barre syndrome

The recovery period for Guillain-Barre syndrome can be long, but most people recover. Symptoms generally worsen
for 2 to 4 weeks before stabilizing. It can take anywhere from a few weeks to a few years for people to recover, but
most people recover within 6 to 12 months. About 80% of affected people can walk independently within 6 months
and 60% regain their regular muscle strength within 1 year. Of course, for some people, it takes longer to recover. A
smaller number of people with Guillain-Barre syndrome still have weakness after 3 years. About 3% who experience
more severe symptoms, have symptoms such as weakness and tingling in their body years after treatment. Guillain-
Barre syndrome is a rare disorder that occurs as a result of the body's immune system attacking the peripheral nerves,
following this attack, muscle weakness, numbness, tingling, and sometimes paralysis appear. This syndrome or disease
occurs as a result of damage to the peripheral nervous system and the mistake of the immune system and alienation of
body cells due to some infections or other unknown problems [44].
In this disease, the muscle strength of the person decreases and the natural reflexes of the muscles are disturbed, and
the feeling of tingling and tingling in the shoulders and arms or other parts of the body is evident. The nature of this
disease can be self-limiting, or progress and lead to complete paralysis. In mild types, the weakness may stop, but in
more severe types, the weakness progresses and eventually completely disables the lower limbs. The arms may also
be involved. Weakness or paralysis worsens within 24 to 48 hours and in some cases, it may start in the arm and spread
down, even in some cases the weakness and paralysis involve the arms and legs at the same time. Other symptoms of
this syndrome include numbness, tingling, and muscle pain that can be similar to crampy pain. Among the emergency
symptoms of Guillain-Barre, which require emergency intervention, it should be noted that it is difficult to swallow,
drooling, and difficulty breathing. Among other symptoms of this disease, it is possible to mention disorders in
speaking, chewing and swallowing food, as well as problems in eye movements and back pain. There is no accurate
and definitive test to diagnose Guillain-Barre, but the diagnosis is based on symptoms such as muscle weakness and
inability to walk, tests and history of the disease. The doctor or nurse asks about the signs and symptoms and performs
the necessary examinations [45]. Tests include:
1- Nerve and muscle strip.
2- Getting the lumbar fluid from the spinal canal.

There is no definitive cure for Glyn barre, but there are ways to improve symptoms, including:
A) IVIG: This drug is made of protein and protects the immune system against the attacks of invading antibodies.
B) Plasmapheresis: a device is connected to your body that draws blood into it and the antibodies that attack the
nerves are separated from the blood [46]. These antibodies are proteins that exist in the blood and cause an attack on
the body's immune system. In order for the patient to be monitored and the symptoms of the disease can be treated,
hospitalization may be required. In advanced cases of the disease, the patient may not be able to eat by mouth, so a
nasogastric tube is placed for him and food is given through the tube. The diet should be high-calorie and high-protein
to maintain and restore muscle strength. Food may be prescribed in small amounts and often. During hospitalization,
if the weakness of the respiratory muscles causes improper ventilation and breathing disorder, it may be necessary to
damage the nerve fibers in Glynn-Barre's disease, an artificial ventilator, while the patient is hospitalized, the doctor

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and nurse in order to prevent from the side effects caused by immobility, they take measures for him. Physical therapy
may be needed to help maintain muscle strength and flexibility [47]. In addition to the above, the following drugs are
used as needed and to relieve the symptoms.
✓ Coronet, which reduces inflammation and swelling of nerves.
✓ Immunosuppressant that is prescribed in the acute stage of the disease.
✓ Analgesics and pain relievers such as aspirin.
The new complication of the corona virus, which manifests itself in the form of weakness of the muscles of the hands
and feet and sometimes weakness of the respiratory muscles, so far, several cases of this complication have been
reported in the country's hospitals, and sometimes it can cause death with a sudden attack of Iranology. Some diseases
in which a person's body considers itself a stranger and the sufferings of these diseases and some common treatments
for organ weakness due to peripheral nerve conduction disorder, the speed of electrical conduction in the peripheral
nerves of our body, depends on the thickness of the nerves and the insulating coating on each nerve and is the ambient
temperature. Thicker nerves have a higher conduction speed, as well as nerves that are covered with insulation,
because in the place where insulation allows nerve messages to pass through, they have a higher conduction speed,
and the higher temperature of the body in warmer weather increases the nerve conduction speed [48].
One of the factors that determine the speed of conduction is the insulation coating that is placed on the axon membrane
and by blocking the nerve transmissions in the place where there is insulation, it provides the possibility of short-
circuiting the electrical message in places without insulation and like a person who takes steps. It takes longer, here
too, the steps of the nerve message become longer and the conduction speed increases [49].
For various reasons, this insulating sheath on the nerve may be destroyed or not formed correctly since infancy. For
example, some congenital disorders can lead to the non-formation of this sheath. In a group of diseases called
demyelinating inflammatory diseases, the immune system of the individual's body performs this demyelinating
process, that is, the individual's immune system recognizes a microbe or a virus and tries to destroy it, the same with
the individual's own body. Because the aggressive reaction of the body's defense components, or in other words, our
internal soldiers against internal components, spends their energy on useless work, which not only makes them less
powerful against the attacks of the real enemy, but also a kind of internal settlement and internal discharge. The
possibilities are also taken into account and it makes the living being incapacitated. Loss of the myelin sheath may
occur in the central nervous system or the peripheral nervous system. We have the loss of this sheath in the central
nervous system, for example, in MS and similar diseases, but the loss of this sheath in the peripheral nervous system
occurs in three important diseases: Guillain Barre, MMN (multiple motor neuronopathy) and CIDP (chronic
inflammatory demyelinating). polyradiculopathy) occurs. In Guillain-Barre disease, a person suddenly experiences
weakness of the limbs, especially the lower limbs, and this weakness may have an upward course and involve the
hands and even the respiratory system. In the case of MMN, there is involvement of different nerves in different parts
of the body, and the course of the disease is gradual and progressive, and usually there is little muscle atrophy.
In CIDP, the course of the disease is chronic and gradually progressing, and in the course of the disease, we
occasionally encounter an attack of the patient, which improves or leaves a small movement defect. In order to control
and treat these diseases, the immune system of a person, which mistakenly recognizes the body's own system as a
stranger, must be adjusted and its function reduced. So, we see that it is not always important to be active in different
parts of the body, sometimes it is more important to be less active and to regulate working and not working, activity
and inactivity, speeding up and slowing down, moving forward or backward and all this. Adjustments are necessary
for a healthy life, and if these adjustments did not work like a very accurate thermostat, pains, troubles, and diseases
would come to humans [50].
When scientists have been unable to fully control the activity of the unbridled immune system, for example, in multiple
sclerosis and have not yet achieved complete success, despite extensive research all over the world, the importance of
maintaining these coordination’s in a healthy person is understood. In the treatment of these diseases, drugs that
weaken or change the function of the immune system are used, except in the case of CIDP, coronet is used less today,
and more less complicated methods such as intravenous immunoglobulin and blood plasma exchange are used. A drug
like cortone is still used in the treatment of CIDP, and long-term treatment with cortone is effective in curing the
disease [51-53]. One of the common and relatively inexpensive treatments compared to other Guillain-Barre

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treatments is blood plasma exchange, which can remove stray antibodies that have mistakenly identified the person's
own organ. Intravenous immunoglobulin can also be used, but the cost of treatment is high, especially in Iran, in non-
governmental systems. In the treatment of MMN, instead of plasma exchange, treatments that weaken and change the
immune system, such as intravenous immunoglobulin or rituximab, which is a monoclonal antibody, are used [54].

Conclusion
In this article, we tried to explain, what is Guillain's disease and what is its type? We also reviewed the symptoms of
the disease and the available treatment methods. Guillain-Barre disease is an autoimmune disease in which the nervous
system attacks its own nerve cells. The cause of this disease is unknown, but some bacterial and viral infections can
increase the possibility of contracting this disease. The main symptom of this disease is itching and muscle weakness.
The definitive treatment method has not been known yet, but with special treatment methods and rehabilitation care,
the severity of the disease and its duration can be reduced. Symptoms generally worsen for two to four weeks before
stabilizing. After that, recovery can take from a few weeks to a few years, but usually the recovery period is between
6 and 12 months. About 80% of people with Guillain-Barre can move independently in six months and regain 60% of
their muscle strength in one year. For others, recovery takes longer. Approximately 30% of people will still have
weakness after three years. About 3% of people with Guillain-Barre experience a recurrence of their symptoms, such
as weakness and tingling, even years after the original event. In rare cases, the disease can be life-threatening,
especially if the person does not receive treatment.

References

[1]. S Parviz, Kh GH, H Esfahani, E Mohammadzadeh, E Zarei, Relationship Between Radiological and Sonographic Manifestation in
covid-19 patients with the Risk of Embolism,International Journal of Early childhood special Education,2022,14(1),2948-2959
[2]. A Nurmeksela, et al., Relationships between nursing management, nurses’ job satisfaction, patient satisfaction, and medication errors at
the unit Level: A correlational study. Research Square 2020; 1 (1): 1-22.
[3]. E Zarei, Z Joudaki, H Dinari, S Hajisadeghi, A Namazi,Computed tomography lung lesions in coronavirus disease 2019 patients:A
systematic Review and metanalysis,International journal of special Education,2022,37(3),12691-12699
[4]. E Zarei, Z Haddadian, A Rostami, E Mohammadzadeh, A Abdolhoseini,Lung imaging features in covid-19 cases:a systematic review
and metaanalusis, International journal of special Education,2022,37(3),12626-12637

[5]. E Zarei,et al.,Effectivness of pelvic ultrasonography in Diagnosis of central precocious puberty and its Diffrentiation from similar
condition,Iran J Radiol,2022,19(4),1-11
[6]. M Sadeghian, et al, Therapeutic effectiveness of green tea leaf extract on clinical symptoms in children suffering viral gastroenteritis:A
randomized clinical trial,Eur J Trans1 Myol,2022,32(3),10606,1-6
[7]. S A Hossein Moussavi Jahanabadi,et al, Examining the Principles of Oral and Dental Hygiene in Children and the Elderly with Burns
and Facial Plastics Surgery: The Original Article, Tobacco Regulatory Science (TRS),2022, 3198-3212

[8]. F Mirakhori, et al , Diagnosis and Treatment Methods in Alzheimer's Patients Based on Modern Techniques: The Orginal Article,
Journal of Pharmaceutical Negative Results, 2022, 13 (1), 1889-1907
[9]. M Sadeghian,et al,Prevalence of fatty liver and its related factors in children,Journal of Family Medicine and primary
care,2022;11:5604-5608
[10]. H Danesh, J Rahmati, M Khodabandeh, SM Hemadi,A Bahmani, Medical Evaluation of Robotic Surgery methods:A Review study,
International journal od special education,2022,37(3)
[11]. H Jahandideh, A Yarahmadi, S Rajaieh, AO Shirazi, M Milanifard, et al., Cone-beam computed tomography guidance in functional
endoscopic sinus surgery: a retrospective cohort study, J Pharm Ree Int, 2020, 31 (6), 1-7
[12]. F Jahangiri,et al,Renal Hydatid cyst or a simple cyst? Report of a Rare case,Arch pediatr Infect Dis,2019;7(2),1-4
[13]. H Mirjalili, H Amani, A Ismaili, MM Fard, A Abdolrazaghnejad, Evaluation of Drug Therapy in Non-Communicable Diseases; a
Review Study, Journal of Medicinal and Chemical Sciences, 2022, 5 (2), 204-214
[14]. H Tahernia, et al., Diagnosis and Treatment of MS in Patients Suffering from Various Degrees of the Disease with a Clinical Approach:
The Original Article, Journal of Pharmaceutical Negative Results, 2022, 13 (1), 1908-1921
[15]. Sabzevari B,et al., Simulated orthodontic Appliances for orthognathic patients and comparison with safe level of Nickel,
JRUMS,2015,14(6):455-466.
[16]. F Ahrari, et al, The effect of fluoride exposure on the load-deflection properties of superelastic nickel-titanium-based orthodontic
archwires, Australian Orthodontic Journal,2012,28(1),72-79

Journal of Pharmaceutical Negative Results ¦ Volume 13 ¦ Special Issue 10 ¦ 2022 4109

[17]. Barat-Ali Ramazanzadeh,et al, Effects of a Simulated Oral Environment,and
Sterilization on Load-deflection Properties of
Superelastic Nickel Titanium–based Orthodontic Wires, IJO,2011,22(1),13-21
[18]. B Sabzevari,et al, Microleakage under Orthodontic Metal Brackets Bonded with Three Different Bonding Techniques with/without
Thermocycling, Journal of Dental Materials and Techniques,2013,2(1),21-28
[19]. S Mostafa Moazzami, et al, The First Drinking Simulator Unit, Journal of Dental Materials and Techniques,2015,4(1),1-7
[20]. M Milanifard, G Hassanzadeha, Anthropometric study of nasal index in Hausa ethnic population of northwestern Nigeria, J Contemp
Med Sci|, 2018, 4 (1), 26-29
[21]. M Mileski, et al., The impact of nurse practitioners on hospitalizations and discharges from long-term nursing facilities: a systematic
review. Healthcare 2020; 8 (2): 114-34.
[22]. Nadieh Qaderi, Mahsa Jahanbin, Arezousadat Fatemi, Faeze Mirjalili, Ali Arayesh, Method Of Detecting Tooth Root Erosion Using Ct
Scan And Radiation After Receiving Orthodontic Treatment, Journal of Pharmaceutical Negative Results,2023,14(2), 3709-3724
[23]. Mirmohamadsadeghi H,Farimani RM,Alzwghaibi AW,Tohidkhah S,Alzamili H.Effect of Maxillary central Incisor Inclination on
palatal Bone Width.Journal of Dental school,shahid Beheshti university of medical sciences.2021;39(2):48-53.
[24]. MM Fard, Effects of Micronutrients in Improving Fatigue, Weakness and Irritability, GMJ Med. 2021, 5 (1): 391 395
[25]. SM Sajedi et al, systematic investigation of dental, heart and lung diseases in patients with covid-19 and hospitalized in ICU based on
radiology stereotypes, Journal of pharmaceutical negative result, 2023, 14 (2), 2717-2733
[26]. H Dehghani, et al, Evaluation of Alveolar Crest Bone Resorption Around Contilever Based Implants and Its Comparison with Single
Tooth Restorative Implants, Tobacco Regulatory Science (TRS),2022, 8 (1), 2385-2401
[27]. SH KHanzadeh,et al, Predictive Role of Neutrophil to Lymphocyte Ratio in Adnexal Torsion: A systematic Review and Meta-Analysis,
Hindawi mediators of Inflammation,2022(3),1-8
[28]. B Vadiati Saberi, M Afravi, D Rahi, The oral health status and oral hygiene practice of senior dental students: A cross-sectional study,
JOURNAL OF DENTOMAXILLOFACIAL RADIOLOGY, PATHOLOGY AND SURGERY,2022,11(1),1-6
[29]. Mohammad Javad Jabbari Sendi, Bardia Vadiati Saberi, Dorsa Rahi, Evaluation of microbial contamination of tooth brush and its related
factors, Journal of Dentomaxillofacial Radiology, Pathology and Surgery,11(2),7-13
[30]. M S Parsaei, et al, Scanning Electron Microscope Analysis And Investigation Of Shear Bond Strength Of Two Types Of Two-Stage
Orthodontic Adhesive With Fluoride To Human Tooth Enamel, JOURNAL OF PHARMACEUTICAL NEGATIVE
RESULTS,2022,13(7),1032-1045
[31]. SE Ahmadi, M Farzanehpour, AMM Fard, MM Fard, HEG Ghaleh, Succinct review on biological and clinical aspects of Coronavirus
disease 2019 (COVID-19), Romanian Journal of Military Medicine, 2022, 356-365
[32]. TSH Abadi, et al., Depression, stress and anxiety of nurses in COVID-19 pandemic in Nohe-Dey Hospital in Torbat-e-Heydariyeh city,
Iran. J of Military Med 2020; 22 (6): 526-33.
[33]. Y Raziani, BS Othman, Ointment therapy and prevention of cannulation-induced superficial phlebitis, Veins and Lymphatics, 2021, 10
(2)
[34]. YA Helmy, et al., The COVID-19 pandemic: a comprehensive review of taxonomy, genetics, epidemiology, diagnosis, treatment, and
control. Journal of Clinical Medicine. 2020;9(4):1225.
[35]. Z Khezerlou, D Shojaei, S Jafari, A Arabkhazaie, SHA Abadi, The Principles of Care of the Treatment Staff for the Elderly with Fracture
Problems and Corona Virus in the Special Care Unit, Tobacco Regulatory Science (TRS), 2022, 2825-2838
[36]. Z Malekpour-Dehkordi, M Nourbakhsh, M Shahidi, N Sarraf, R Sharifi. Silymarin diminishes oleic acid-induced lipid accumulation in
HepG2 cells by modulating the expression of endoplasmic reticulum stress markers. Journal of Herbal Medicine. 2022; 33:100565.
[37]. M Mahmoudinezhad, S Khosravaniardakani, L Saljoughi Badelou,et al., The integrative panel of fatty acid desaturase-2 (FADS2)
rs174583 gene polymorphism and dietary indices (DQI-I and HEI) affects cardiovascular risk factors among obese individuals, BMC
Endocrine Disorders, 2023, 23 (1), 1-12
[38]. S Khosravaniardakani, MH Anbardar, S Khodamoradi, S Peyravi, Epidemiological and Pathological Characteristics of Renal Cell
Carcinoma with Outcome Evaluation: A Single Center Study from Shiraz, Iran, International Journal of Medical Investigation, 2022,
11 (2)
[39]. S Khosravaniardakani, Vaping Products And Asthma In Youths: A Review Of The Prospective Study, International Journal of Medical
Investigation, 2022, 11 (1)
[40]. SAH Abadi, R Atbaei, M Forouhi, HG Falaverjani, R Moazamiyanfar, et al., Preventive and Therapeutic Approaches in Medical
Departments During the COVID-19 Pandemic, Kindle, 2022, 2 (1), 1-216
[41]. SA Ahadiat, M Shirazinia, S Shirazinia, S Garousi, M Mottahedi, AB Jalali, et al., Role of Telemedicine in Management of Patients
During the COVID-19 Pandemic, Kindle, 2022, 2 (1), 1-191
[42]. S Khosravaniardakani, DO Bokov, T Mahmudiono, SS Hashemi, N Nikrad, et al., Obesity accelerates leukocyte telomere length
shortening in apparently healthy adults: a meta-analysis, Frontiers in nutrition, 2022, 9
[43]. S Khosravaniardakani, The Effect of Cigarette and Its Nicotine Content on The Heart Health, International Journal of New Chemistry
9 (Spring Special), 2022, 102-107
[44]. Y Raziani, S Raziani, Evaluation of Mental Health of Chemotherapy-Treated Cancer Nurses, Journal of Medicinal and Chemical
Sciences, 2021, 4 (4), 351-363
[45]. Y Raziani, BS Othman, S Raziani, A common but unknown disease; A case series study, Annals of Medicine and Surgery, 2021, 69,
102739

Journal of Pharmaceutical Negative Results ¦ Volume 13 ¦ Special Issue 10 ¦ 2022 4110

[46]. B Vadiati Saberi,et al , Determination of frequen-cy distribution of aggressive periodontitis in dental clinic of Rasht dental school in
2016-2017, Journal of Dentomaxillofacial Radiology, Pathology and Surgery,2021,9(4),9-14
[47]. S A Hossein Moussavi Jahanabadi,et al, Examining the Principles of Oral and Dental Hygiene in Children and the Elderly with Burns
and Facial Plastics Surgery: The Original Article, Tobacco Regulatory Science (TRS),2022, 3198-3212
[48]. N Qaderi,et al, Method Of Detecting Tooth Root Erosion Using Ct Scan And Radiation After Receiving Orthodontic Treatment, Journal
of Pharmaceutical Negative Results,2023,14(2), 3709-3724
[49]. AO Shirazi, H Jahandideh, A Yarahmadi, M Milanifard, MM Delarestaghi, The effect of apple cider vinegar in the treatment of chronic
rhinosinusitis, Medical Science, 2020, 24 (104), 2467-2474
[50]. MR Khami, A Gholamhossein Zadeh, D Rahi , A cross-sectional study on COVID-19-related changes in self-medication with
antibiotics, journals.plos.org, 2022,17(6):1-9
[51]. S Margy, A Review of the Effect of Brain imaging- Short Review, Eurasian Journal of Chemical, Medicinal and Petroleum Research,
2022, 1 (3), 88-99
[52]. AA Esmaeilzadeh, S Rasoolzadegan, AR Arabi, et al., Cytotoxic study of green synthesized pure and Ag-doped α-Fe2O3 nanoparticles
on breast cancer (MCF-7) cell line, Nanomedicine Research Journal, 2022, 7 (4), 370-377
[53]. AA Esmaeilzadeh, Mohammad Ghenaat, Pisheh Sanani, et al., Study of Silybinin Plant Effective Substance for use in targeted liposomal
nanoparticles in the treatment of liver cancer, Archives of Pharmacy Practice, 2020, 11 (1), 35

[54]. H Daneste; A Sadeghzadeh; M Mokhtari; H Mohammadkhani; F Lavaee; J Moayedi; Immuno expression of p53 mutant-type in Iranian
patients with primary and recurrence oral squamous cell carcinoma, European Journal of Translational Myology, 2022

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