PhD defence N. (Nowshin) Papri

Below is a brief summary of the dissertation:

Guillain-Barré Syndrome (GBS) is a rare but serious disorder where the immune system attacks the peripheral nerves causing sudden weakness, including paralysis of the legs and arms and breathing difficulties. While GBS has been well studied in high-income countries, little is known about how it affects people in low- and middle-income countries (LMICs). The studies in the thesis aim to improve understanding of GBS in Bangladesh by examining its clinical presentation, current treatment, and course. The research is based on over two decades of collaboration between the icddr,b in Bangladesh and Erasmus MC in The Netherlands.

The studies show that patients in Bangladesh, more often have a severe and axonal GBS, and higher mortality compared to high-income countries. Diagnosis and treatment are challenging in Bangladesh due to limited hospital resources, high treatment costs, and shortages of intensive care and rehabilitation. Prognostic tools used in Western countries to predict disease severity were tested in Bangladesh. They were found useful but needed adjustment to better reflect local conditions. Tools measuring disability and fatigue were also evaluated in an international GBS cohort, including Bangladesh. While generally reliable, some questions did not perform well across different cultures and need refinement. Finally, long-term impact of GBS in Bangladesh was studies, showing that many patients continue to experience pain, disability, and reduced quality of life months after illness.

Overall, these results highlight the urgent need for affordable treatments, better diagnostic tools, and stronger healthcare systems to improve outcomes for patients with GBS in low-resource settings.