India's contribution on "Guillain-Barre syndrome": Mapping of 40 years research
Correspondence Address: Source of Support: None, Conflict of Interest: None DOI: 10.4103/0028-3886.117612
Source of Support: None, Conflict of Interest: None
Objective: Guillain-Barre Syndrome (GBS) is an acute inflammatory polyradiculoneuropathy causing limb weaknesses. The mortality is around 8%, with about 20% of patients remaining disabled. The purpose of this study is to examine the performance of Indian Medical Scientists in the area of GBS over a period of 40 years. India's contribution to GBS has been examined based on the global publication output and share, growth rate, citation impact, publication share in various field, highly cited papers and their impact, most productive authors and their citation impact and collaboration of research on GBS with the international community. Materials and Methods: The data for this study has been taken from Scopus, a multidisciplinary database using keywords GBS and Miller Fisher Syndrome. The contribution of India on GBS has been compared with different countries for its publication and citation count during a period of 40 years (1973-2012). Results: It is found that there were 10,633 publications available from global medical research covering the various aspects of GBS. India's share is 2.92% of global output and holds 10 th rank in overall publication output on GBS, whereas United States topped the rank with the highest number of publications. Sanjay Gandhi Post-graduate Institute of Medical Research, Lucknow is the most productive institutions while Tally AB from the National Institute of Mental Health and Neurosciences, Bangalore is the most productive author who has contributed the highest number of papers on GBS. Conclusion: India is far behind in GBS research as compared to other countries like USA, as there might be a low case report of GBS in Indian population. Still the research focusing this disease is quite prominent and needs a careful medical attention through research capacity building in order to look for better treatment of the disease in Indian cases. This study shall be helpful in enhancing the awareness of the GBS by Indian scientists.
Keywords: Bibliometric analysis, Guillain-Barre syndrome, Indian research output, Miller Fisher syndrome, neural disorder, polyneuropathy
Guillain-Barre Syndrome (GBS) is an acute immune-mediated acute polyradiculoneuropathy disorder. The syndrome is named after the French physicians Georges Guillain and Jean Alexandre Barre, who described it in 1916. GBS can cause life-threatening complications if the respiratory muscles are affected or if autonomic nervous system is involved. The weakness reaches its nadir in 2-4 weeks. About 5% of the patients die and more patients are left with a disabling motor deficit and/or fatigue.  GBS is a heterogeneous disorder.  Epidemiology suggests annual incidence of 1.55/100,000 and incidence increases from 0.8/100,000 in patients younger than 35 to 4.67/100,000 in patients older than 75 years. Men are affected approximately 1.5 times more than women.  There are no incidence studies of GBS in Indian population, but some case based studies have been reported. , The major predisposing causes include infections: Campylobacter jejuni, cytomegalovirus, Epstein-Barr virus and Mycoplasma pneumonia.  Some cases of GBS have been reported following influenza virus infection.  The treatment of GBS is multidisciplinary and both plasma exchange and high dose intravenous immunoglobulin are effective in reducing both the severity of the disease and the residual deficits. 
There are different Bibliometric studies reported involving publication analysis on different diseases such as acquired immunodeficiency syndrome (AIDS), ,,,, neuroscience,  cancer,  malaria, ,, tuberculosis,  diabetes,  diarrhea  and antioxidant.  Some of the Bibliometric studies highlighting the contribution of India on Immunology  and contribution of Brazil on Immunology,  Indian Dental Science Research  and Cholera research in India.  The study on "Syndrome," other than AIDS, only one Bibliometric analysis on "Severe Acute Respiratory Syndrome"  has been reported. On the other hand, as far as GBS is concerned there is no incidence of literature analysis or Bibliometric analysis has been reported so far by any author from India or any other country. Hence, this study aimed to analyze the current status of research output on GBS by Indian scientists. This study shall help in understanding the current stand of India's contribution on GBS and hence help in highlighting the research potential and in-turn helping stakeholders in decision making.
This study is undertaken to analyze the patterns of Indian GBS research output with the emphasis on: (i) Indian research output growth, rank and global publications' share and impact; (ii) The India's international collaboration with collaborative partners; (iii) The productivity of Indian institutions and their impact; (iv) The most productive Indian authors and their citation impact; (v) Most popular and highly cited Indian papers and (v) The patterns of research communication in the most productive journals.
This study is undertaken on the publications on GBS by Indian research community. The data is collected from Scopus multidisciplinary bibliographic database available over http://www.scopus.com/home.url. Two phrases "GBS" and "Miller Fisher Syndrome" available in the article title, abstract and keywords, has been used to retrieve bibliographic data and "India" word is used for the country of affiliation of the author using following string.
(TITLE-ABS-KEY("GBS") OR TITLE-ABS-KEY("Miller Fisher Syndrome")) AND PUBYEAR > 1972 AND PUBYEAR < 2013 (TITLE-ABS-KEY("GBS") OR TITLE-ABS-KEY("Miller Fisher Syndrome") AND AFFIL (India)) AND PUBYEAR > 1972 AND PUBYEAR < 2013.
The citation count for the study has been taken as the number of citation received by the articles since it was published. For the international collaboration, each articles published from India is manually analyzed to see the collaboration by Indian authors with International authors. In combination with the above string, separate search strategies have been adopted to retrieve the data for individual, institutional and journal output. Thus, the data obtained using the different search strategies has been subjected to data analysis and interpretation of results.
Global publication share and rank
The Scopus database yielded a total of 10,633 records from the world and 310 records by Indian scientists on GBS. [Table 1] presents the distribution of 10 most productive countries on GBS. The global publication ranges from 2.92% to 22.48%, where United States holds top rank with the highest number of publications (2390 papers), which is 22.48% share of total publication. United Kingdom ranked second (9.15% share), Japan third (9.25%) share while Germany, France, Italy, The Netherlands, Spain and Canada have contributed handsomely and their share ranges between 3.15% and 7.84% of global share. India holds the 10 th rank with 310 publications, which shares 2.92% publication of global output.
The overall publication output shown an increasing trends, but for few countries, decline in their publication share can be observed from 1973 to 2012. USA has shown a decline in publication share of 3.55% from 1983-1992 to 1993-2002. Japan, Germany, Netherland and Spain have shown a decline in publication share of 0.46% to from 1993-2002 to 2003-2012. France has shown continued decline in publication share from 1973-82 to 1993-02 and a marginal increase of 0.05% from 1993-2002 to 2003-2012. India's publication share increased progressively from 1973 to 2012 and highest progress has been a gain in the period 2003-2012 (4.34%) and the overall growth rate of 2.92%.
From [Table 2], we can find that there are six countries, which have average citation per paper (ACPP) higher than world ACPP (12.74). The Netherlands hold the top position on ACPP (28.80) followed by United Kingdom (24.15) and Canada (22.03). The other three countries are USA (17.67), Japan (14.90) and Germany (13.35). For four countries, the ACPP lower than world ACPP and these are Italy (12.15), France (10.67), Spain 6.57) and India (5.27).
India's contribution on GBS
India holds the 10 th position in overall publication output on GBS with a cumulative total of 310 papers during 1973-2012. The overall Indian publication appears in six different document types, which consists of 206 articles (66.45% share), 42 letters (13.55% share), 25 reviews (8.06% share), 6 conference papers (1.94%), 5 editorial (1.61%), 4 note items (1.29%) and 3 short surveys (0.97%). The cumulative growth of the Indian output increased from 16 papers in 1973-82 to 215 in 2003-12, which is a 1243.75% growth. As for as the citation impact is concerned, the Indian papers receive 5.27 citations per paper. The ACPP is highest in the year ranging 1993-02 (11.28). Out of 310 papers of Indian origin, 200 (64.52%) papers have been cited by others [Table 3].
Subject coverage of GBS papers published from India
Indian contribution on GBS appeared in eight broad subject categories (Scopus classification of journal's subject). The highest publications are available in the subject category Medicine (281 publications, 90.65% share). The other subject categories are Neuroscience (76 publications, 24.52% share), Immunology and Microbiology (25 publications, 8.06% share) and Biochemistry, Genetics and Molecular Biology (17 publications, 5.48% share). The subject with less than 5% shares is Pharmacology, Toxicology and Pharmaceutics (9 publications, 2.90% share) and Psychology (6 publications, 1.94% share). Health professions and Veterinary science have shared two publications each with 0.65% share [Table 4].
Considering the citation quality impact of GBS on various subject categories, it is found that two subject category Immunology and Microbiology and Biochemistry; Genetics and Molecular Biology have highest citation impact (10.28 and 10.82 respectively). The other two subject, which have higher citation than average Indian ACPP (5.27) are Psychology (8.50 citation per paper) and Neuroscience (6.07 citation per paper). Though the Medical field has the highest number of publications and the highest number of citations, but the citation impact is only 5.10 citations per paper.
Research contribution of Indian institutions on GBS
In this study, it is found that there are eleven Indian institutes, which have published five and more papers on GBS during 1973-2012. The publication performance of these 11 Indian institutions and their citation impact along with h-index value  is given in [Table 5].
Unlike other Bibliometric measures, the h-index is another very important parameter to account the lifetime achievement of a scholar's work and h-index can give fairer measure of an academic's overall impact. , It is found that these 11 institutes have contributed 51.94% of total Indian publication on GBS. The contribution came as 14 papers per institutions and 7 institutes have more publication then average while 5 have less paper than average. "Sanjay Gandhi Post-graduate Institute of Medical Science (SGPGIMS), Lucknow" topped the rank with 31 (10%) publications. It has obtained 333 citations on an average citation rate of 10.74 citations per paper and h-index of 11. After Sanjay SGPGIMS, Post-graduate Institute of Medical Education and Research and All India Institute of Medical Science have contributed 20 publication (97 citations; 4.85 citation per paper; h-index value 5) followed by National Institute of Mental Health and Neuroscience (NIMHANS) have 19 publications (171 citations; 9 citations per paper; h-index value 8). The others have publication counts ranges between 5 and 15 and their citation count ranges between 6 and 75 and average citation per pages ranges from 0.35 to 9.20 citations per paper.
Most productive Indian authors on GBS and their impact
310 papers published by 159 Indian authors either singly or jointly. [Table 6] presents the status of 21 most productive Indian authors and their citation impact who have published more than 5 papers during 1973-2012. It is found that these 21 authors belongs to 7 institutes of India and of which 7 authors are associated with SGPGIMS, Lucknow, 4 authors are associated with Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, 3 each from Chhatrapati Shahuji Maharaj Medical University, Lucknow and NIMHANS, Bangalore, 2 from Post-Graduate Institute of Medical Education and Research, Chandigarh and one each from Care Hospital, Hyderabad and Kasturba Medical College, Manipal.
These 21 authors have contributed 142 papers, which is 45.81% share of cumulative total Indian output. Eleven authors have published higher number of papers than the group average (6.76 papers), of which the most productive author is A.B. Tally from NIMHANS, Bangalore with the maximum number of publications (15 papers), followed by 12 papers by K. N. Prasad, 9 papers by S. Prabhkar and 8 papers each by K K. Nayati and J. Kalita. Seven papers each were published by each by four authors, 6 papers each by two authors and 5 papers each by 10 authors.
Seeing the quality of papers based on citation impact, it is found that 12 authors have more than Indian ACPP (5.52) while 9 authors have lower citation impact. The highest citation impact is received by S. Pradhan (10.29 citations per paper) of SGPGIMS, Lucknow, who have published 7 papers and obtained 72 citations during 1973-2012 followed by J. Kalita (8 papers, 78 citations and 9.75 citations per paper) and K.N. Prasad (12 papers, 89 citations and 7.42 citations per paper). Though A.B. Tally has published the maximum number of papers received only 84 citations (4.27 citations per paper).
Considering h-index as a factor of qualitative analysis, it is found that none of the authors have achieved the average h-index of all authors taken together. The highest h-index was achieved by two authors and these are K.N. Prasad and J. Kalita with h-index of 6 each. Two authors have h-index 5 each, six authors have h-index 4 each, six authors have h-index 3 each, two authors have h-index 2 each and three authors have h-index 1 each.
Out of 310 papers, forty six papers have international collaboration for research in GBS. The most of the international collaborative papers appeared in last 10 years. As far as the collaborative country is concerned, India has collaborated with 22 countries of the world and most number of papers appears in collaboration with United States (9). France (5) and United Kingdom (4) are other two countries with whom Indian authors have worked on GBS. Thirteen countries have at least one collaborative paper with Indian authors [Table 7].
Most productive journals publishing Indian GBS research
The Indian authored papers appeared in 125 national and international journals. [Table 8] presents the status of top 14 journals, which have published 163 papers on GBS which is 53.97% of total Indian publications. As far as the Impact Factor (IF) is concerned, the Indian authors have published four papers in "Lancet" journal which has its IF 38.278 (JCR 2011). Six papers have been published in "Journal of Neurology, Neurosurgery and Psychiatry," which have IF of 4.764.
Highly cited Indian papers on GBS during 1973-2012
Out of 310 papers published from India, 200 (64.52%) papers received at least one citation during 1973-2012 with a cumulative total of 1633 citations. There are 17 papers, which have received 20 or more citations since their publication until 2012 and can be referred as highly cited publications. These all 17 papers appeared in different national and international journals. Of these 17 papers, four papers appeared as internationally collaborated and other 13 papers published as zero-international collaboration. Out of these 17 most cited Indian papers, only one paper have the citation between 80 and 100, two papers have 60-80 citations, four papers have citations range between 40 and 60 and 10 papers have citations ranges between 20 and 40. These 17 papers collectively received 666 citations with an average citation of 39.18 citations per paper, which is about 40.78% of overall citations of Indian publications [Table 9].
The Bibliometric analysis of literatures on GBS available through Scopus database during 1973-2012, reveals that the research on GBS is being conducted throughout the world and the most number of literatures on GBS came from United States (22.48% of global share). As far as India is concerned, it is ranked 10 th in overall publication. The Indian authors have contributed 310 papers on GBS, which is 10 th ranked in global output with 2.92% share. The overall citation impact of the Indian publication is found to be 5.27 citations per paper during 1973-2012. Sanjay Gandhi Post-graduate Institute of Medical Research, Lucknow is found to be the most productive Indian institutes with 31 publications. The most of the papers have been collaborated with United States (19.57% share) and 21 other countries of the world. The 310 publications appeared from Indian institutes have been published in 125 national and international journals. "Neurology India" is the most productive journal (41 papers; IF - 0.956) and 4 papers in "Lancet" journal, which have highest IF of 37.278.
About 64.52% Indian papers have been cited by others and the top 17 articles are found to be most frequently cited papers with 20 or more citations. The most cited papers have average citation rate of 39.18 citations per paper. A.B. Tally of NIMHANS, Bangalore is most productive authors and published 15 papers on GBS with the cumulative total of 64 citations (4.92 citations per paper). The most cited Indian authors are S Pradhan and J. Kalita who have scored 10.29 and 9.75 citations per paper respectively.
The Bibliometric analysis of GBS, which is a rare disease and less frequent occurrence, help in understanding the nature of research being conducted throughout the globe specially with reference to India. The number of cases of GBS increased following vaccination with the A76NJ 1976 influenza vaccine. , This has created a need of heightened awareness of GBS. In Indian scenario, this disease is spreading and occurring quite often, which can be understood by the literatures of Indian case studies published after 2003 onward. This study shall be able to enhance the awareness of the GBS, its nature of publications and growth of the literature world-wide and opens the door for further research.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]