Guillain-Barré Syndrome (GBS) | Causes, Pathophysiology, Signs & Symptoms, Diagnosis, Treatment

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  • Опубликовано: 31 май 2024
  • Guillain-Barré Syndrome (GBS) | Causes, Pathophysiology, Signs & Symptoms, Diagnosis, Treatment
    Guillain-Barré Syndrome is a auto-immune demyelinating condition involving ascending weakness and paralysis. Guillain Barre Syndrome most often occurs after resolution of an infection (ex. campylobacter jejuni), but other causes/risk factors include influenza vaccination and surgery. In this lesson, we also discuss a variety of Guillain Barre Syndrome variants, methods of diagnosing Guillain Barre Syndrome and ways to treat it.
    I hope you find this lesson helpful. If you do, please consider liking, subscribing and clicking the notification bell to help support this channel and stay up-to-date on future lessons!
    REFERENCES:
    Guillain-Barre Syndrome, StatPearls
    www.ncbi.nlm.nih.gov/books/NB...
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Комментарии • 163

  • @vickieturner1249
    @vickieturner1249 3 месяца назад +5

    Diagnosis in 1989 @ 33, head to toe, I am 68 female. Case study 113 in the USA, at that time. The symptoms were severe and hospitalized for months in Atlanta. My recovery was painful and slow. God was with me every step. I started with paralyzed legs and my speech was jumbled mess. I now when tired show signs but currently working hard on gut health, exercise (rebounder), vitamins clean. My spinal tab did not come until 2 weeks after hospitalized. I had a brilliant doctor who started with a visual of my inability to continuously walk and my nails. I started in denial mode as a fit 33 year old female no health issues. Today, still minor issues but you would never know in appearance. I thank God for the journey
    ❤.

    • @paulacuartas1536
      @paulacuartas1536 Месяц назад

      God bless you allow God to use you to bring strength through this diagnosis

  • @nataraju3002
    @nataraju3002 2 года назад +2

    Thankyou so much for explaining it in an easy manner✨!🤞

  • @dailydoseofmedicinee
    @dailydoseofmedicinee 3 года назад +48

    After the first signs and symptoms, the condition tends to progressively worsen for about two weeks. Symptoms reach a plateau within four weeks. Recovery begins, usually lasting six to 12 months, though for some people it could take as long as three years.

    • @butterflyflyaway7862
      @butterflyflyaway7862 2 года назад +1

      Death possibility?

    • @jeffreyb3238
      @jeffreyb3238 2 года назад

      @@butterflyflyaway7862 There is a small mortality rate.

    • @jeffreyb3238
      @jeffreyb3238 2 года назад +7

      Yes, I had GBS in 1983-1984, hospitalised for nine weeks, three of which were in ICU. In my case this was preceded by a headache which lasted two weeks. I made a full recovery.🦘

    • @jeffreyb3238
      @jeffreyb3238 2 года назад

      @@butterflyflyaway7862 Yes

  • @HugsXO
    @HugsXO 2 года назад +12

    Soooo this started in Aug 2019 with the flu shot. I was then hospitalized in Oct with upper respiratory virus however they were unable to identify. Within 4 weeks I woke up with numbness, tingling and burning hands and feet. The swelling was horrible too. Went through EMG and the Doctor had to test the leads on himself to see if it was working. Spinal tap done along with MRI and tons of bloodwork. I couldn't use my hands at all, thank God for my husband. Came down with Bell's Palsey a 2nd time. Hands resolved however I still have burning, swelling and excruciating pain in my feet. Not going to risk any further vaccines especially the Covid vaccine.

    • @mokhles703
      @mokhles703 2 года назад +2

      Thanks for sharing your experience

  • @chandanabasnayake
    @chandanabasnayake 2 года назад +2

    Nicely explained
    Good for quick refreshing the knowledge.

  • @armi4276
    @armi4276 2 года назад +2

    Thank you so much for sharing your knowledge.

  • @saharhaider1908
    @saharhaider1908 2 года назад

    very good presentation thank you very much

  • @sinclair657
    @sinclair657 Год назад +1

    Thank you interesting information about the clinical variants.

  • @lenushpopa
    @lenushpopa 6 месяцев назад

    Thank you for this amaizing video!

  • @slocoast5
    @slocoast5 Год назад +14

    It’s amazing! I wish i had known all this information back in 2003. I’ve gone through so much with GBS it’s horrible. And no it didn’t just last two years. I still have residual symptoms I’m still dealing with.

  • @sherlockwatson101
    @sherlockwatson101 Год назад +7

    I lost the ability to walk and spent time in the hospital for 3 weeks. Changed my life forever, I got a stomach flu and literally couldn’t eat or drink anything, after a week I was numb on my arms and numb up to my tummy. I could barely walk. I’d take 3 steps and feel like I was going to faint. I took an Uber to the clinic and collapsed the minute I got there. I had no control, my body felt like it was failing- I actually thought I would die … I was 26. I also couldnt sleep because of the pain in my toes - even in the hospital I cried myself to sleep half the time.
    Im still in physical therapy for my ataxia … it’s been a year… I fear I’ll never fully recover.
    I wouldn’t wish this on my worst enemy

    • @trewilliams3453
      @trewilliams3453 Год назад +1

      Keep fighting im a 22 year old survivor

    • @Kwildcat13
      @Kwildcat13 4 месяца назад

      Have you tried also changing your diet to carnivore I hope your doing better

  • @ZahidHussain-ht4tw
    @ZahidHussain-ht4tw 10 месяцев назад

    Thank you so much sir 👍👍... informative video 💐💐💐

  • @NS-jt4kg
    @NS-jt4kg Год назад

    2 of my family members have (had) this one of them is still in the hospital because of it. It has been over a year now and he gets better and deteriorates again, but at the moment they are sure he will never breath on his own again.

  • @KarenGerstman
    @KarenGerstman Год назад +2

    I had GBS in 1983. How familiar this all sounds to me! I was hospitalized at NYU Medical Ctr/Rusk in NYC for over 2 months back then. It's a relief to know the treatment has changed drastically. I was treated with steroids back in 1983, which resulted in avascular necrosis (AVN) of both hips and shoulders, though in 1996 I underwent core decompressions of both hips, arthroscopic surgery to my left shoulder in 2004, and ultimately a complete left hip replacement in September of 2010. The right hip is hanging in there!

  • @DomSamui
    @DomSamui 2 месяца назад +1

    I am 11 and have GBS for more than a year. I am working hard and hope to be walking again soon. Good luck everyone

  • @olusolape5850
    @olusolape5850 3 года назад +1

    Thank you

  • @roosirachmakemala994
    @roosirachmakemala994 3 года назад +2

    Thankyou so much

  • @charlesdavis7461
    @charlesdavis7461 2 года назад +8

    Thank you, it was even easy for me to understand. Not that I understood all of the medical terms , you did an excellent presentation. Probably because my wife after my months of therapy is still trying to get to her past walking ability. One thing I believe is that GBS is more common than Doctors know.

    • @raindrops1047
      @raindrops1047 2 года назад +2

      Try homeopathic medicine. I am taking Natura Plus from Italy by Sabir. I am not their sales person nor I want to advertise here but homeopathic medicine helped me along with lots and lots of prayers to God. Take the advice if you like it.

    • @jdmmg4904
      @jdmmg4904 2 года назад +1

      @@raindrops1047 homeopathy doesn't work besides the placebo effect. I'm not writing this to convince you as I don't believe it will but for others not to fall for it. Homeopathic treatment is nothing more than highly diluted substances to the point that there is nothing (!!) left from the original substance. So you're mostly having sugar in your mouth as they taste sweet. The idea that something gets more potent the more diluted it gets just goes about everything we know about how this world works. So do yourselves a favor and put your money in something that works.
      Plus, remember: if you're concerned about "big pharma" making loss of money... There's rarely something where you can make money so easily than with homeopathy. These companies and "doctors" earn a lot of money as well with giving out little sugar pills. Don't let yourself ve fooled just because they take more time listening to your medical issues. Yes, normal doctors often do this too little but this doesn't make the homeopathic treatment effective.

    • @charlesdavis7461
      @charlesdavis7461 11 месяцев назад

      @@raindrops1047 Thank you.

  • @tamb7587
    @tamb7587 Год назад +2

    Other sites say that it can move in reverse starting at the top moving to the bottom and it’s NOT always symmetrical.. Please don’t tell people these things because some drs won’t even consider the problem being GBS if it’s not moving just as u stated. I’ve watch multiple videos and it is NOT always ascending nor is it always symmetrical..

  • @rutanaal-douh4295
    @rutanaal-douh4295 3 года назад

    thanks

  • @WalkerStevensFineArt4U
    @WalkerStevensFineArt4U 3 года назад +4

    I was diagnosed with 'Pure' Parkinson's Disease, but in the past three weeks, I feel like my symptoms are ALL related to GBS. Is it possible?

  • @treffitt1983
    @treffitt1983 2 года назад +2

    My daughter went into GBS after surgary for bloodclot removel.she is still fightening it.

  • @florabraswell9744
    @florabraswell9744 Год назад +1

    Can someone have GBS and recuperate on their own “ like having the symptoms but not bad enough too cause hospitalization? Thank you in advance for your reply “ God Bless You”❤

  • @epeyserah6727
    @epeyserah6727 7 дней назад

    Thanks for the video, please can someone recovery fully from the plateau stage by using the kenesitherapy?

  • @Sho-mh4pe
    @Sho-mh4pe Год назад

    more than one limb= bilateral=symmetric *
    thank you, good explanation

  • @snehabhayaje6250
    @snehabhayaje6250 3 года назад +2

    Thank you so much

  • @luvaquad
    @luvaquad 5 месяцев назад

    We should consider the manufacture’s inserts & review history .
    Today, knowledge that the medications , vac’s do indeed cross into the uterine lining ( recent years of testing afterbirth contents ) .
    The push to vac pregnant women when past documentation states the newborn will have the mothers antibodies ( immunity).. for the first 3 years of a child’s life … why are we experimenting after we were told children were immune to what they now are inoculating moms , infants & children for .

  • @RayvenTheNight
    @RayvenTheNight Год назад +1

    Question? So when I was a child I got the flu vaccine and maybe 30 minutes after while walking home with my mother, I completely lost all feeling below my waist and this lasted for about 45 minutes to 1 hour. Could that lead to this year's later ?

  • @komalgaikwad8934
    @komalgaikwad8934 2 года назад

    Plz upload more videos

  • @aadam1
    @aadam1 4 месяца назад

    عاشت ايدك دكتور

  • @drabdirahmansaladibrahim4602
    @drabdirahmansaladibrahim4602 5 месяцев назад

    Lipopolysacchride on outer membrane of campylobacter resembling gangliosides of peripheral nerve membranes …. There used to be go u just answered my question

  • @luvaquad
    @luvaquad 5 месяцев назад

    In 1976, concerns in the United States about a possible influenza pandemic involving a virus similar to the deadly 1918 pandemic strain resulted in a large-scale vaccination program for the entire country. Approximately 45 million people were vaccinated in 10 weeks with what became known as the “swine flu vaccine” [16]. The US government abruptly stopped the vaccination program when no swine flu cases were detected outside the military base where the disease originated and when an unexpectedly high number of cases of Guillain-Barré syndrome were reported in vaccinated individuals. The vaccine was estimated to have caused approximately one Guillain-Barré syndrome case per 100,000 persons vaccinated [17], resulting in 53 deaths [18]. As a result of the association between the 1976 swine flu vaccine and Guillain-Barré syndrome, this condition is closely monitored every influenza season as part of the influenza vaccine safety monitoring in the United States.

  • @venkybly
    @venkybly 2 года назад

    Tq

  • @DizzyMotoz
    @DizzyMotoz Год назад +2

    I had a stomach flu i dont get sick often and i got better within 4 days it was painful thought took medicene and what not got better then my calfs felt sore like if i walked like forrest gump haha i was like its ok ill stretch week later stretching didnt help and i had pain in my calfs i again said its ok ill stretch it out then it went to my thighs thats when i said this aint normal at all. Tried another week going almost a month then boom my ligaments on my thighs couldnt hold my body weight i would collapse. Ended up breaking my middle finger trying to catch myslef from feeling discombobed falling catching yourself. I told myself i should just go to emergency, i retaliated and told myself ill be ok, my girlfriend that knew what was happening took extra notice to see whats happening noticed my legs were getting swollen. She told my mom and they forced me to go to the hospital. I utteredto myself i should go to thehospital im retaining water. Went to the ER and yea diagnosed with it they asked about vaccines i had none but what caused it was the stomach virus. I can walk now i had no balance still cant move my thumbs. Go to the hospital my doctors said i could of died because my legs were getting blood clots. God is good

  • @armi4276
    @armi4276 2 года назад

    Actually it was Miller Fisher Syndrome , a variant of GBS.

  • @KaylaofBunnys
    @KaylaofBunnys 3 года назад +7

    Would you say in the aftermath of it could cause mast cell activation disorder and
    Dysautonomia ? My wife had GBS after a flu shot in her 20's it was 20 years ago but she still so unwell
    Thanks

    • @teacherkat7005
      @teacherkat7005 2 года назад

      How is your wife feeling now?

    • @anaurcan2062
      @anaurcan2062 5 месяцев назад

      My Dad is sick GBS him have 3 cardiac stent .I hope God help him

  • @khushboorajpoot625
    @khushboorajpoot625 4 месяца назад

    Can u suggest for m from gbs

  • @jenjenirica2785
    @jenjenirica2785 3 года назад +2

    My husband was gbs survivor 1 year from now and miller fisher syndrome, he recovered because of ivig treatment, now he's back to work, but sometimes he felt numbness in his face, and fatigue. Is it normal?

  • @abrormuhammad7803
    @abrormuhammad7803 3 года назад +2

    Why lower limb? Can anyone explain please?

  • @himanshuambilkar4160
    @himanshuambilkar4160 3 года назад +20

    Gillian Barre syndrome
    Ganglioside antibody
    Autoimmune demyelination
    Acroparesthesia
    Neurological emergency
    Bicker encephalitis
    Miller Fisher syndrome
    Acute inflammatory demyelination polyneuropathy
    Pharyngeal cervical brachial vibrant
    Aman acute motor axonal neuropathy
    Amsan acute motor sensory axonal neuropathy
    Lumbar puncture albuminocytologic dissociation
    Intravenous IMG
    Avoid steroids

  • @armi4276
    @armi4276 2 года назад +17

    Will the pfizer covid 19 vaccine trigger GBS? I got my shot last july 6 and I'm experiencing fatigue and tingling on my fingers and weakness on my thighs.

    • @jacywilson
      @jacywilson 2 года назад +5

      My friend got the Pfizer vaccine in March and got GBS from it. Still stuck in his bed now July 28th. I HOPE YOU ALL HAVE A MILD REACTION LIKE ERIC CLAPTON. HE ONLY LOST HIS HANDS

    • @jacywilson
      @jacywilson 2 года назад +7

      @@NotSoFinalGirl1996 Hi, you don't have to let anyone put anything into your body that you don't want.. Your body, your choice

    • @6odmode
      @6odmode 2 года назад +4

      @@jacywilson wtf do u mean he only lost his hands, permanently? like they announced they would never work again ? paralized? pls answer my moms been in the hosp ever since astrazenca and ive done research and ended up here

    • @jacywilson
      @jacywilson 2 года назад +3

      @@6odmode Clapton's neuropathy was just temporary, but many others who have taken the vaccine have experienced much more serious injuries from the vaccine. You might think what happened to him was "minor".. but just losing your hands for a day can have severe consequences in a person's life. Yes, the neuropathy was temporary but there could be severe long term effects from it..

    • @jeffreyb3238
      @jeffreyb3238 2 года назад +1

      Absolutely not. It was the first question that I asked of my GP, as I'd had GBS. Certainly can never have the flu vaccination as that could trigger a repeat.

  • @donnanugent705
    @donnanugent705 2 года назад +6

    Actually, as a survivor of GBS and have spoken to many other survivors, it can and does reoccur.

    • @teacherkat7005
      @teacherkat7005 2 года назад

      How long did you suffer from GBS? and what are your symptoms?

    • @donnanugent705
      @donnanugent705 2 года назад +4

      It was back in 1979 and I was 27 years old.
      Started with numbness in extremities and continued until inability to use arms and legs... paralyzed in that had no ability to move. Facial paralysis/droopy face. Double vision.
      Lots of therapy. Today you would never know. Interesting journey for sure.
      Total hospital/rehab time about 2 months.

    • @teacherkat7005
      @teacherkat7005 2 года назад

      @@donnanugent705 thanks God you overcome such difficult challenge 🙏🏼
      Just wanna ask, if you can still remember, how long did you suffer from the symptoms before it was diagnosed as GBS?

    • @donnanugent705
      @donnanugent705 2 года назад

      @@teacherkat7005 It came on slowly with the numbness in my hands first. Probably a few days. Then when it affected my legs, walking was difficult... that's when I went to the ER and was diagnosed.
      It certainly was an experience. I never had to be ventilated like I see some videos show. I do remember pain...my toes felt like they were being crushed and bad headaches.

    • @tamilsportsprediction4889
      @tamilsportsprediction4889 2 года назад

      When u shaken ur hands ..when u was in icu

  • @woodman2182
    @woodman2182 2 года назад

    I was diagnosed with Guillain-barre syndrome in 2022

    • @aminech6342
      @aminech6342 2 года назад

      Did u get vaccinated? Astrazeneka ?

  • @Julia-ot3oz
    @Julia-ot3oz Год назад

    My husband died on GBS after 2 weeks of battling in hospital

  • @angelawoods5829
    @angelawoods5829 3 года назад +1

    I had that when I was 9 years old on left side of body im now 51 & having systems I have had lose in my left eye _ & seeing double... can it come back ? I had that 8 month's in the hospital' a.year of physical therapy. plz any information or fed back

    • @mokhles703
      @mokhles703 2 года назад

      You said left side. Usually GBS occurs symmetrically

  • @lindabraganza5026
    @lindabraganza5026 Год назад +1

    After flu shot. Also after vaccination

  • @aarthigirahapathisai5685
    @aarthigirahapathisai5685 3 года назад +5

    Does pins and needles in different parts of the body means GBS

    • @irishdeetalks
      @irishdeetalks 3 года назад +1

      Prior to my mum becoming paralysed due to CBS syndrome she had ‘pins & needles’ in her feet and hands. She fully recovered after a year in hospital. 20 years later she felt the pins and needles again and assumed it was coming back. Unfortunately it was cancer this time that spread and took her life just a day after her 60th birthday 🥺💜💜

    • @minchem1
      @minchem1 2 года назад +4

      @@irishdeetalks My quack knowledge tells me it was not cancer that spread, but rather the residue of inflammation that was present finally metassis into cancer. Then they tell you cancer spread but not precursor to cancer spread. Like vaccine will get into bone marrow by 4-6months from vaccine date, so does cancer. There will be 10 fold increase in cancer in next 1-5 years due to vaccines and hyperinflammation residue that are causing fatigue and other long hauler symptoms to millions. Sorry about your mum. Mainstream medicine are controlled that do not reveal truth and early cure to avoid diseases.

    • @irishdeetalks
      @irishdeetalks 2 года назад +2

      @@minchem1 Thank you for sharing your knowledge. It started with a mole (cancerous) melanoma. After the cancerous mole was removed and she got the all clear it was a year later and cancer had spread to her kidneys. I have to say I got the vaccine a few weeks ago and I’ve been extremely tired. I had a two hour drive yesterday and I pulled over as I kept falling asleep. I’ve never been so tired but I never thought of connecting it with the vaccine 😳

    • @minchem1
      @minchem1 2 года назад

      @@irishdeetalks Do you want to reverse this tiredness symptoms and be your own doctor given there is no other option?

    • @irishdeetalks
      @irishdeetalks 2 года назад

      @@minchem1 I’m will to listen. May I ask and I genuinely don’t mean to sound condescending or rude but are you a doctor? Either way, I’m still interested in your advise if you so wish to give it out 💜

  • @orangestoneface
    @orangestoneface 2 года назад +1

    In comparison with 101 other patients with severe GBS admitted to
    the intensive care unit, the patients who died were older
    and more likely to have underlying pulmonary disease. In a
    specialized center, the primary event leading to death from
    GBS was ventilator-associated pulmonary infection, predominantly in elderly patients with significant comorbidity......seems few young die....was hard to find.

  • @sikandaralikhan2447
    @sikandaralikhan2447 3 года назад

    What can we do if the eye muscles are not able to close the eyes

    • @angelawoods5829
      @angelawoods5829 3 года назад

      my right muscle in my right eye stopped working now I see double

    • @lisadowning2323
      @lisadowning2323 3 года назад

      When I had GBS 30 years ago it paralyzed the right side of my face. My doctor gave me eye drops for my eyes because I couldn't close them all the way.

    • @mokhles703
      @mokhles703 2 года назад

      eye drops

  • @tessapiotrowskikristensen8058
    @tessapiotrowskikristensen8058 2 года назад

    Possible trigger: H Pylori?

  • @tamilsportsprediction4889
    @tamilsportsprediction4889 2 года назад

    Salaiva come out continuosly? When will stop

  • @KarenGerstman
    @KarenGerstman Год назад

    Oh yes....forgot this tidbit. GBS came upon me as the result of a rather banal upper respiratory ailment in 1983....

  • @lindabraganza5026
    @lindabraganza5026 Год назад +1

    My son had it and very soon a few more. I know of atleast 20 cases in my life which shows the factual info is outdated.

  • @lee-angel4610
    @lee-angel4610 3 года назад +4

    This is painful 😭😭😭

  • @noorulbasarsherazi7989
    @noorulbasarsherazi7989 2 года назад

    3 feb

  • @proteekbhattacharjee8954
    @proteekbhattacharjee8954 Месяц назад

    10:39

  • @AlyssaAbalos
    @AlyssaAbalos Год назад

    I think I got this because of dengue 😢

  • @freemanamerics3345
    @freemanamerics3345 3 года назад +2

    I had two strokes
    Living life with gb
    For 6 years zo far
    It really suks

  • @walterlynch2470
    @walterlynch2470 3 года назад +2

    Is it safe to get the covit 19 virus vaccine?

    • @jessielegera4508
      @jessielegera4508 2 года назад

      Not safe to get a vaccine if you have a history of Polyneuropathy. I'm a GBS Survivor but after my covid vaccine, GBS recured.

  • @user-uw7ms4tt2m
    @user-uw7ms4tt2m 4 месяца назад

    ❤👍

  • @emalopez4233
    @emalopez4233 2 года назад +1

    I had GBS TWICE I DIDNT HAVE THE FLU OR ANY PROBLEM W ANY INFECTION. I still have residuals from it .

  • @lasthourgaming1259
    @lasthourgaming1259 2 года назад

    I am suffering from 2020😭😭😭 Alhamdulillah

  • @alliepetty1005
    @alliepetty1005 4 месяца назад

    It was very difficult to understand what you were saying because you were speaking so quickly

  • @sikandaralikhan2447
    @sikandaralikhan2447 3 года назад

    Prolonged eyes opening will dry up the cornea

  • @johndeannuntis9291
    @johndeannuntis9291 3 года назад +20

    I had it I almost died don't sugar coat it I'm still suffering from it had to learn to walk n talk again I was I c u forever then long care rehabilitation I made it only because of GOD !!!!!!! And IT was a long time ago and i still have symptoms I KNOW all there is to KNOW about IT I should have wrote a book

    • @johndeannuntis9291
      @johndeannuntis9291 3 года назад +6

      If anyone has any questions about it friend me on Facebook and I will be glad to anser any question about it or concerns you may have

    • @Angiedisney14
      @Angiedisney14 3 года назад

      @@johndeannuntis9291 does it start with cold feet that spreads to numbness spreading symmetrical to your knees then spreads to your thighs then engulfs whole legs into lower spine. I recently had covid 28, female from uk. These symptoms went away after a couple weeks. I am assuming this can’t have been this as I don’t seem to have any permanent damage although at times my feet can still feel cold or i have strange pressing sensations on my legs. I found my legs would shake when I first started to recover and go on walks. The doctor said they believe the virus affected my sympathetic nervous system. Could I have had this but no long term damage I could even with symptoms walk fine and could feel touch it was just a numbness and paralysis feeling over legs that was very uncomfortable.

    • @atulthakur767
      @atulthakur767 3 года назад +3

      Had it in Feb 20 recovered in a month glad it was spotted early in 2nd week

    • @atulthakur767
      @atulthakur767 3 года назад +2

      It was aidp

    • @daniellovric9664
      @daniellovric9664 3 года назад

      You can write me Gbs you can heal

  • @SueT55
    @SueT55 3 года назад +2

    Cytomegalovirus causes it too, can repeat in elderly. Can take up to 2 years to resolve. Poor info.

  • @6odmode
    @6odmode 2 года назад +1

    Astrazenca vaccine

  • @nilufarkiyani7258
    @nilufarkiyani7258 3 года назад

    Thank you