Jan 20, 2020

Polio cases in the Philippines now 14, say WHO, UNICEF





With the highly contagious disease, the World Health Organisation (WHO) and UN Children’s Fund (UNICEF) said on Wednesday.
The patients, children under five, were from provinces in the southern region of Mindanao, according to a situation report by the two international bodies.
“The risk for further polio transmission continues to be assessed as high at the national level, because of chronically sub-optimal immunisation coverage and poor sanitation and hygiene conditions,’’ the report said.
The WHO and UNICEF said they had dispatched nearly 40 consultants to work with Philippines health officials and support an immunisation campaign in Mindanao and metro Manila.
The Philippines was declared free of polio 19 years ago but in September 2019, the  announced that a three-year-old-girl from the southern province of Lanao del Sur was found to have the disease, which is caused by the poliovirus and can cause paralysis.
Since then, the Department of Health has been conducting a vaccination campaign targeting all children below five years of age in Manila and Mindanao.
It has scheduled new rounds of immunisation drives until April.
The report said three cases of polio were also reported in Sabah, , which is near Mindanao.
The cases were found to be genetically linked to a case in the southern Philippines province of Basilan. 
(dpa/NAN)


Post Polio Litaff, Association A.C _APPLAC Mexico

Jan 19, 2020

The 5 Worst Foods for Arthritis and Joint Pain



Most people have no idea that eating the wrong foods can cause arthritis pain flare-ups.
Including a certain kind of vegetable that can make your arthritis pain worse and make you feel 5-10 years older.
Click To See The 5 Worst Arthritis Foods >>>
Whether you’ve been diagnosed with arthritis or if you just have occasional achy joints, in just a few minutes, you’ll know how to steer clear of the 5 biggest “food landmines” that can sabotage your health and make your joint pain worse. 
What you’re about to discover will probably be quite surprising. 
But more importantly, it will show you how to take control of your arthritis instead of having it take control of you.
Click To See The 5 Worst Arthritis Foods >>>
Plus, I won’t just show you the worst foods to avoid. You’ll also see what happens inside your body when you eat them.

And that’s not all.
In addition to walking you through the “5 Worst Foods,” we’re also going to cover other facts you need to know like:
  • The real culprit behind your arthritis pain. (Less than 1 in 10,000 people know this.)
  • The discovery of a little known New York doctor that will give you a HUGE advantage in your fight against arthritis.
  • The reason that traditional “painkillers” make things worse.
  • I’ll reveal the “trouble making” vegetable that can actually make your arthritis pain worse.
  • What special type of “super food” can actually counteract the damage of arthritis itself.
So let's get started…
References:
Adler A, Holub B. Effect of garlic and fish-oil supplementation on serum lipid and lipoprotein concentrations in hypercholesterolemic men. American Journal of Clinical Nutrition. 1997 Feb;65(2):445-50.
NIAMS, NIH, Bethesda, Maryland 20892, USA. Arthritis & Rheumatology (Impact Factor: 7.87).06 / 1998; 41(5):778-99. DOI: 10.1002 / 1529-0131(199805)41:5 <778::AID-ART4> 3.0.CO;2-V Source: PubMed
Hürlimann, David, Frank Enseleit, and Priv-Doz Dr Frank Ruschitzka. “Rheumatoide arthritis, inflammation und atherosklerose.” Herz 29.8 (2004): 760-768.
Schett, Georg. “Rheumatoid arthritis: inflammation and bone loss.” Wiener Medizinische Wochenschrift 156.1-2 (2006): 34-41.
*Results will vary based on how long and how closely you follow the information presented, as well as other individual biological factors.





















































Post Polio Litaff, Association A.C _APPLAC Mexico

Jan 10, 2020

Abnormal Movements in Sleep as a Post-Polio Sequelae


                                                         By: Richard L. Bruno, 

Published in: American Journal of Physical Medicine and Rehabilitation, 1998; 77: 1-6.


ABSTRACT


Nearly two-thirds of polio survivors report abnormal movements in sleep (AMS), with 52% reporting that their sleep is disturbed by AMS. Sleep studies were performed in seven polio survivors to objectively document AMS. Two patients demonstrated Generalized Random Myoclonus (GRM), brief contractions and even ballistic movements of the arms and legs, slow repeated grasping movements of the hands, slow flexion of the arms and contraction of the shoulder and pectoral muscles. Two other patients demonstrated Periodic Movements in Sleep (PMS) with muscle contractions and ballistic movements of the legs, two had PMS plus Restless Leg Syndrome (RLS) and one had sleep starts involving only contraction of the arm muscles. AMS occurred in Stage II sleep in all patients, in Stage I in some, and could significantly disturb sleep architecture even though patients were totally unaware of muscle contractions. Poliovirus-induced damage to the spinal cord and brain is presented as a possible cause of AMS. The diagnosis of post-polio fatigue, evaluation AMS and management of AMS using benzodiazepines or dopamimetic agents is described.

Despite numerous late-onset symptoms reported by polio survivors -- fatigue, muscle weakness, pain, cold intolerance, swallowing and breathing difficulties -- one symptom was totally unexpected: abnormal movements in sleep (AMS). As early as 1984 our post-polio patients were reporting muscle contractions as they fell asleep. The 1985 National Post Polio Survey included two questions about AMS: "Do your muscles twitch or jump as you fall asleep?" and "Is you sleep disturbed by muscle twitching?" (1) It was surprising that 63% of the 676 respondents reported that their muscles did twitch and jump during sleep and that 52% -- a third of the entire sample -- said that their sleep was disturbed by twitching.

These percentages are markedly elevated as compared to the incidence of AMS in the general population. In one survey only 29% of those without neurological disease who were at least 50 years old reported AMS, versus 63% of surveyed polio survivors who were 52 years old on average. (2) In another survey only 34% of those older than 64 reported AMS, slightly more than half the incidence of AMS in the younger post-polio sample. (3) Given the apparent increased prevalence of AMS in polio survivors, and with daytime fatigue the most commonly reported Post-Polio Sequelae (PPS), we were interested in objectively documenting AMS, relating them to possible disturbances in sleep architecture and identifying an effective treatment for AMS. (1)

METHODS

Subjects. Seven polio survivors were referred for sleep studies to a sleep disorders center. This was a sample of convenience, in that the subjects were patients presenting with PPS who themselves knew (three patients) or whose bed mates knew (four patients) that AMS were occurring. Patients were on average 54 years old and 44 years post acute polio which occurred at age 10. The patients had had AMS for a mean of eight years which was on average 35 years post acute polio. Patients reported moderate-to-severe difficulty sleeping at night and moderate-to-severe daytime fatigue that did not respond to the treatments of choice for post-polio fatigue (i.e., pacing of activities, daytime rest periods, energy conservation and use of appropriate assistive devices. (4) In addition to fatigue, patients reported an average of two limbs having late-onset muscle weakness.
Procedure. Patients underwent a standard polysomnographic evaluation with EEG and facial EMG recorded for sleep staging. (5) Blood oxygen saturation, measured using a finger pulse oxymeter, chest and abdominal wall excursion and nasal air temperature were also recorded; video monitoring of sleep was also performed. Surface EMG was recorded from patients' legs as well as from limbs in which AMS were reported.

RESULTS Read more
México a la vanguardia en el Síndrome de Post Polio

Jan 9, 2020

Polio: Vaccinated British man shed virus for 30 years


Human poliovirus particle
Image copyrightSCIENCE PHOTO LIBRARY

He had an immune disorder that mean the weakened polio virus used to vaccinate him in childhood survived in his body. 
Over time it has mutated into a form of the virus that can cause paralysis and he had no idea the jab had not worked. 
Polio is only endemic in Pakistan, Afghanistan and Nigeria although Nigeria has now gone more than a year without a case. 
The discovery was made by a team from the National Institute for Biological Standards and Control in Potters Bar, Hertfordshire.
They now warn that similar cases could trigger new outbreaks and hamper efforts to eradicate the disease. 
They wrote in the journal PLOS Pathogens: "While maintaining high immunisation coverage will likely confer protection against paralytic disease caused by these viruses, significant changes in immunisation strategies might be required to effectively stop their occurrence and potential widespread transmission."
The man had a full course of polio vaccinations, including three doses of weakened live virus at five, seven and 12 months old, followed by a booster when he was about seven.
He was later diagnosed with a condition that suppresses the immune system, affecting its ability to kill viruses in the gut.
His stool samples contained high levels of polio virus - the researchers estimated the man had been shedding live polio in his stools for as long as 28 years.
The virus had also mutated dramatically and were no longer the weakened, or "attenuated", versions of the virus which are used in the vaccinations.
The infection was neutralised by using blood plasma taken from people with healthy immune systems who had been immunised against polio.

Sewage samples

According to the scientific team, several highly mutated polio strains, originating from vaccines, had recently been isolated from sewage samples in Slovakia, Finland, Estonia and Israel.
All bore the molecular fingerprints of "iVDPVs" - vaccine-derived polio viruses from immunodeficient individuals.
The researchers are calling for enhanced surveillance including sewage sampling and stool surveys to search for the presence of iVDPV strains.
They also suggest the development of efficient anti-viral treatments to interrupt virus replication in people who deficiencies in their immune system.


Post Polio Litaff, Association A.C _APPLAC Mexico

Jan 7, 2020

Trump touted a new antidepressant as a solution for veterans. Only 15 have been treated


In August, President Trump proudly proclaimed that he had directed the Department of Veterans Affairs to buy “a lot” of a drug known as esketamine, the first new major depression treatment with a novel mechanism to hit the U.S. market in decades.
“Its results are incredible,” Trump said at a veterans convention in Kentucky. “I’ve instructed the top officials to go out and get as much of it as you can.”
As of mid-December, the VA had treated just 15 veterans across the country with the drug. The nasal spray, which was developed by Janssen and named Spravato, was only available at seven of the agency’s facilities — out of more than 1,200. The VA treated its first patient with Spravato in June.

Experts disagree on whether the VA’s rollout has been slower than is reasonable. Some have raised safety and efficacy concerns about the treatment, and the effort to get it covered and administered in the private health care system has been rocky. But there is little doubt that the VA’s moves to make Spravato accessible stand in sharp contrast with Trump’s claims that the drug could deliver widespread relief for veterans struggling with depression.
“This was supposed to be a big game-changer,” said Dr. Erick Turner, a psychiatrist at Oregon Health and Science University. But the data on the drug was “nothing to write home about,” he added.
Esketamine is similar to ketamine, an anesthetic that is sometimes misused recreationally but that has also been used off-label for depression. The VA said it initially limited its launch of the new drug only to clinics that had experience with ketamine.
“The roll-out of the drug has been successful due to VA’s implementation plan, which used existing facility expertise to launch at sites with previous experience using ketamine treatment for mental health,” said Susan Carter, a VA spokesperson.
In June, the agency’s medical advisory board declined to approve widespread coverage of Spravato for all veterans, instead restricting the drug’s use to patients who haven’t responded to other treatments and requiring an authorization before it can be prescribed. The drug must be administered under the supervision of a physician and patients must be monitored for two hours after each dose. The monitoring requirements are similar to the process for providing ketamine. The VA turned to clinics with experience in those protocols for the initial use of Spravato.
The VA’s limited rollout mirrors the cautious approach that some in the psychiatric community have taken toward esketamine. That hesitation, in part, stems from looming questions about the data on the drug. Johnson & Johnson, which owns Janssen, submitted five studies in its application to the FDA, only two of which were positive. One of those was a maintenance-of-effect study, which historically has not counted toward the two positive studies the FDA typically wants to see for approval. In particular, experts have questioned whether there is enough data to show the medication is effective in patients age 65 and over, given that many VA patients are in that population.
“[The studies] are not robust. They’re not strong results. You pull one thread and the whole thing unravels,” said Turner.
But some experts expressed surprise that only 15 patients had been treated in the six months since Spravato was made available to veterans and that only a smattering of clinics could provide the drug.
“If you’re going to make a treatment available, make sure there is ease of access to the treatment,” said M. David Rudd, a psychologist who co-founded the National Center for Veterans Studies at the University of Utah and is now the president of the University of Memphis.
Other experts said the agency’s implementation of Spravato has actually been much faster than the drug’s rollout in private clinics and hospital systems, which have struggled to secure preauthorization from insurers to administer the drug or reimbursement for the monitoring required to provide it.
“My take would be they have already implemented across [several] facilities,” said Dr. Cristina Cusin, co-director of a ketamine clinic at Massachusetts General Hospital. Cusin served as a site leader for an esketamine trial sponsored by Janssen.
Cusin said her clinic has not been able to treat a single patient with esketamine since the drug was approved. Some insurers won’t cover the drug. Others won’t pay for the staff to monitor a patient after each dose. Some have said they are working on a bundled insurance code for the drug and monitoring, but Cusin said it’s not clear what reimbursement under such a code would look like. Meanwhile, she said, the clinic is flooded with calls from patients asking about Spravato.
Because the VA doesn’t have to deal with a dozen different insurers like a private hospital system might, Spravato coverage has been more straightforward for the agency, she said.
“It’s been relatively rapid compared to private systems,” she said. Janssen said in a statement that it is working with a variety of appropriate treatment centers to increase the number of locations certified to administer Spravato.
Beyond pushing for the VA to embrace the drug, Trump also made a point in August of saying he hoped the government was “getting [Spravato] at a very good cost.”


Post Polio Litaff, Association A.C _APPLAC Mexico

Dec 21, 2019

Polio Outbreaks Confirmed in 14 African Countries



December 15th, 2019 – The US Centers for Disease Control and Prevention (CDC) increased the polio outbreak Travel Alert for 14 African countries.
The CDC said in a new Level 2 Travel Alert published on December 11, 2019, that ‘there are confirmed polio outbreaks in various countries primarily located in central and eastern Africa.’
Additionally, the Global Polio Eradication Initiative (GPEI) reported ‘polio-endemic countries, which have never stopped the transmission of indigenous wild poliovirus, can also be affected by outbreaks of circulating vaccine-derived poliovirus.’
This ‘Practice Enhanced Precaution’ Travel Alert is an important reminder to all travelers visiting the African countries listed below, to ensure they have previously completed the full polio vaccination series.
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The CDC and the World Health Organization (WHO) both recommend visitors to infected areas for more than 4 weeks should receive an additional dose of oral polio vaccine (OPV) or inactivated polio vaccine (IPV) within 4 weeks to 12 months of travel.
And, adults should discuss with a healthcare provider if it’s appropriate to receive a single booster dose of the polio vaccine.
The CDC and the GPEI have reported the following outbreak information for these 14 African countries:  
  • Angola - There are 71 cVDPV2 cases from seven outbreaks reported in 2019.
  • Benin - There are six cVDPV2 cases in 2019 linked to the Jigawa outbreak in Nigeria.
  • Cameroon - Affected by circulating vaccine-derived poliovirus type 2 (cVDPV2).
  • Central African Republic - There are 16 reported cases in 2019 from six different outbreaks of cVDPV2 in 2019.
  • Chad - There is one cVDPV2 case in the country linked to the Jigawa outbreak in Nigeria.
  • Democratic Republic of the Congo - There are 53 cVDPV2 cases in 2019 and 20 in 2018.
  • Ethiopia - Five cVDPV2 cases reported in Ethiopia in 2019, four of them are linked to the outbreak in neighboring Somalia and the fifth case is part of a newly reported Ethiopian outbreak this week.
  • Ghana - Nine cVDPV2 cases in 2019 linked to the Jigawa outbreak in Nigeria.
  • Mozambique - Circulation of cVDPV2 has been confirmed in Mozambique.
  • Niger - There are nine cVDPV2 cases in 2019 linked to the Jigawa outbreak in Nigeria.
  •  Nigeria - There are 18 cVDPV2 cases reported in 2019. There were 34 cVDPV2 cases in 2018.
  • Somalia - A total of 15 cVDPV cases (eight type 2, six type 3 and one co-infection of both type 2 and type 3) since the beginning of the outbreaks.  
  • Togo - There are three cVDPV2 cases in 2019 in the country linked to Jigawa outbreak in Nigeria.
  • Zambia - There is one cVDPV2 case from the first outbreak in the country.
According to the CDC, the United States has been polio-free since 1979, and the IPV has been the only polio vaccine offered in the USA since 2000. 
IPV is given by a shot in the leg or arm, at 4 different times, depending on the patient’s age. IPV vaccination has not been known to cause serious problems, but side effects are a potential risk, says the CDC.
In the USA, there are various IPV vaccines available, such as Kinrix and Pediarix.
Once vaccinated, your doctor should provide you with an International Certificate of Vaccination or Prophylaxis yellow card. This will serve as your official documentation of polio vaccination.
Polio is a crippling and potentially deadly disease that affects the nervous system. Because the virus lives in the feces of an infected person, people infected with the disease can spread it to others when they do not wash their hands well after defecating. 
People can also be infected with polio if they drink water or eat food contaminated with infected feces.
In rare cases, polio can be fatal if the muscles used for breathing are paralyzed or if there is an infection of the brain, says the CDC.
Recently, there was some good news regarding the elimination of 2 out of 3 polio types.
An independent commission of experts concluded during October 2019, that wild poliovirus type 3 (WPV3) has been ‘eradicated’ around the world. This announcement follows the earlier eradication of wild poliovirus type 2 during 2015.
Additionally, global leaders affirm their commitment to eradicate polio and pledge $2.6 billion on November 19, 2019, as part of the 1st phase of the funding needed to implement the Global Polio Eradication Initiative’s Polio Endgame Strategy 2019-2023.
Prior to traveling abroad, medication and vaccine counseling appointments can be scheduled with a travel specialist at Vax-Before-Travel.
Polio vaccine news published by Vax-Before-Travel.

Post Polio Litaff, Association A.C _APPLAC Mexico

Eradicating polio includes preparing for its possible return




If poliovirus were detected in your country, what actions would be taken to prevent its spread? Who would inform the public and coordinate a campaign to vaccinate vulnerable children? How many vaccine doses would be needed? How would they be procured and stored?
These questions and many more were part of polio outbreak simulation exercises (POSEs) conducted in the past month in Albania and Ukraine to review the countries’ national polio outbreak response plans and identify any gaps in preparedness.
Dr Oleksandr Zaika, Manager of Ukraine’s National Immunization Programme, explained: “This is an important and timely exercise. Critical review of the plan by experts from the Ministry of Health, the Public Health Centre, academia, and other institutions from national and oblast levels with facilitation by WHO/Europe is crucial in ensuring the preparedness of the country to a potential polio outbreak.”

The WHO European Region is polio free – why simulate an outbreak?

In October 2019, wild poliovirus type 3 was declared eradicated. This global milestone signified that, of the three wild strains, only poliovirus type 1 continues to spread anywhere in the world. However, the number of cases caused by this remaining wild strain in Afghanistan and Pakistan has increased sharply in the past year – from 33 in 2018 to 117 in 2019, as of 11 December.
A second concern is the increased detection of circulating vaccine-derived poliovirus (cVDPV) globally, with 216 human cases detected in 16 countries as of 11 December this year (up from 104 cases in 7 countries in 2018). This global trend underlines the urgency of ensuring that countries in all parts of the world are alert and ready to respond if needed.
The Global Polio Eradication Initiative’s standard operating procedures for responding to a poliovirus event or outbreak call for all countries to plan for the eventuality of a poliovirus importation or local detection. They also encourage countries to develop a preparedness plan and test it in a polio outbreak simulation exercise to ensure that public health personnel and emergency systems are prepared to react quickly and effectively if any poliovirus isolate is detected.

Lessons learned in Ukraine

The need for quick action to prevent the re-establishment of polio in Ukraine, and thereby the European Region as a whole, was demonstrated with the detection of 2 cases of cVDPV in Ukraine in 2015. The lessons learned in responding to that outbreak, which was stopped within 6 months with no further cases detected, were a main focus of the POSE conducted in Kyiv on 9–11 December 2019.
Many of the participants responsible for disease surveillance, immunization, outbreak response, vaccine regulation, communication or laboratory services were part of the response in 2015–2016 and could share valuable insights with their colleagues while reviewing the current preparedness plan.
Based on a proposed (fictitious) polio outbreak scenario, participants identified the plan’s strengths and gaps and tested its alignment with international standards. The outcome is a compilation of proposed revisions as well as a timeline and action points for their incorporation into the updated national document.

Actual earthquake during simulated outbreak in Albania

A desktop POSE was also conducted in Tirana, Albania, on 26–27 November 2019 to draft a national polio outbreak response plan and improve understanding of the critical actions needed to respond to a polio-related event or outbreak.
Participants included national policy-makers and senior technical staff from the Ministry of Health and Institute of Public Health. Their dedication to ensuring that the country is fully prepared for a polio outbreak was profoundly demonstrated during the 2-day event, as they continued with the exercise while simultaneously responding to a 6.4-magnitude earthquake that shook the country in the early morning of 26 November.

Post Polio Litaff, Association A.C _APPLAC Mexico

Dec 16, 2019

Respiratory and Sleep problems in Post-Polio



Post-polio syndrome  [13][14]

Importance


  • Respiratory problems in PPS are an important cause of symptoms and complications, including sleep disorders.
  • They may be under-diagnosed or inadequately assessed.
  • Treatment can improve both quality of life and prognosis.

Aetiology[14]

Respiratory problems in PPS may be due

to one or more of:
  • Respiratory muscle weakness.
  • Bulbar impairment - this may affect control of the upper airway or the respiratory cycle. If the upper airway is affected, there may be obstructive sleep apnoea.
  • Skeletal deformity - scoliosis or chest wall stiffness.
  • Other pathology - eg, chronic obstructive pulmonary disease (COPD), asthma, obesity.
  • Aspiration - if swallowing is affected.
All these are likely to worsen during sleep. The pattern of respiratory impairment may be hypoventilation, obstructive sleep apnoea, or both.

Symptoms

Respiratory failure can develop insidiously - symptoms may be subtle or unnoticed. Breathlessness may not be a symptom in patients with limited mobility. Possible symptoms are:
  • Sleep disruption, eventually leading to insomnia, daytime sleepiness or fatigue.
  • Morning headaches, irritability, poor concentration, anxiety or depression.
  • Abnormal sleep movements, nocturnal confusion, vivid dreams.
  • Breathlessness which may be positional.
  • Weak cough, and chest infections.

Signs

These may be subtle - possible signs are:
  • Unexplained tachypnoea.
  • Use of accessory muscles.
  • Abdominal paradox - this is inward movement of the abdomen on inspiration while the upper chest expands.
    • May be best seen with the patient supine during a sniff manoeuvre. When upright, it can be missed, as the diaphragm passively descends at the beginning of inspiration.
  • Severe, untreated nocturnal hypoxaemia can cause pulmonary hypertension, giving signs such as raised JVP and ankle oedema.

Assessment of respiratory problems

  • Listen to the patient's story and preferences.
  • Assess:
    • Voice and cough.
    • Chest deformity.
    • Observe patients in realistic situations - eg, doing repeated tests or actions, and doing everyday actions in which they may be using the necessary breathing muscles to achieve another task.
  • Investigations:
    • Peak flow and cough peak flow.
    • Spirometry:
      • Both seated AND supine spirometry are needed.
      • A sensitive indicator of respiratory muscle weakness is reduction in maximal inspiratory pressure.
    • Oximetry (and possibly capnography).
    • Sleep study (polysomnogram).
    • ECG and CXR if appropriate.
    Full sets of lung function tests and arterial blood gases may not be helpful in this scenario, unless intrinsic lung disease is suspected.

Management of respiratory problems

There are various options - choice will depend on the patient's individual situation and preferences.
Night-time mechanical ventilation is often used. This helps by resting the respiratory muscles at night, and preventing deterioration of respiratory function during sleep. It also treats the secondary sleep disorder.

Supportive measures include:
  • Not smoking.
  • Avoiding sedatives and alcohol.
  • Optimal weight and nutrition.
  • Pneumococcal and influenza vaccination.
  • Postural support if needed.
  • Prompt treatment of chest infections.
  • Techniques such as assisted cough or glossopharyngeal breathing ('frog breathing').
  • Chest expansion exercises.
Assisted breathing options are:
  • Non-invasive ventilation (NIV), also called non-invasive intermittent positive pressure ventilation (NIPPV), is often useful - see box below.
  • Rocking bed:
    • This helps breathing by rocking a patient consecutively head up and head down. It is surprisingly effective, especially where muscle weakness is mainly diaphragmatic.
  • Pneumobelt:
    • This gives intermittent abdominal pressure ventilation and is useful for daytime assistance.
  • Negative pressure ventilation:
    • Examples are tank ventilators (iron lung), jacket ventilators (Tunnicliffe), and cuirass ventilators. The devices are cumbersome, and mainly used where NIV is not tolerated, or to provide 'respite' from NIV
  • Tracheostomy ventilation.

Non-invasive ventilation and 'bi-levels' explained[13][14]

NIV increases alveolar ventilation. It is provided by a portable ventilator and a tightly-fitting nasal or facial mask or nasal 'pillow'.
  • NB: NIV is NOT the same as continuous positive airway pressure (CPAP). CPAP is useful for obstructive sleep apnoea because it maintains the upper airway. It is not normally indicated for hypoventilation from respiratory muscle weakness.
People with neuromuscular disease may have difficulty breathing in, so require NIV with higher inspiratory than expiratory pressures. This can be provided using a 'bi-level' ventilator:
  • Bi-level ventilators were developed by modifying CPAP. The inspiratory positive airway pressure (IPAP) and expiratory positive airway pressure (EPAP) settings are adjusted separately.
  • The difference between IPAP and EPAP is called the span.
  • For example, a patient may require an IPAP of 14 and an EPAP of 3.
  • Sensitive flow triggers enable normal breathing to be supported. There may be a back-up control to provide ventilation if respiratory effort fails to trigger a breath.
The symptoms of post-polio syndrome are slowly progressive, with periods of stability lasting 3-10 years.
Prevention of acute polio infection is discussed elsewhere (see separate article onPoliomyelitis).

Prevention of PPS is not much discussed in the literature. Given the various known contributing factors, it seems possible that PPS problems might be reduced by:
  • Careful management of exercise and daily living activities to optimise muscle and joint use, and prevent overuse or disuse.
  • Correct maintenance of aids and prostheses.
  • Monitoring and early treatment of associated/contributing problems such as:

Further reading & references

  1. Trojan DA, Cashman NR; Post-poliomyelitis syndrome. Muscle Nerve. 2005 Jan;31(1):6-19. [abstract]
  2. EFNS guideline on diagnosis and management of post-polio syndrome; Report of an EFNS task force, European Federation of Neurological Societies (2006)
  3. Halstead LS, Silver JK; Nonparalytic polio and postpolio syndrome. Am J Phys Med Rehabil. 2000 Jan-Feb;79(1):13-8. [abstract]
  4. Howard RS; Poliomyelitis and the postpolio syndrome. BMJ. 2005 Jun 4;330(7503):1314-8.
  5. Khan F; Rehabilitation for postpolio sequelae. Aust Fam Physician. 2004 Aug;33(8):621-4. [abstract]
  6. Boone H; Problems experienced by polio survivors and suggested solutions. Presentation for occupational therapists, given at the Neurological Occupation Therapy Conference, October 2008.
  7. My Polio Life; A patient questionnaire providing baseline information and comparison charts, for use by polio survivors and their health professionals, Polio Survivors Network, 2007
  8. Boone H; When test results do not match important symptoms. Conference presentation, Post Polio Association of South Florida, Miami, 2007.
  9. Hildegunn L, Jones K, Grenstad T, et al; Perceived disability, fatigue, pain and measured isometric muscle strength in patients with post-polio symptoms. Physiother Res Int. 2007 Mar;12(1):39-49. [abstract]
  10. Davidson AC, Auyeung V, Luff R, et al; Prolonged benefit in post-polio syndrome from comprehensive rehabilitation: a pilot study. Disabil Rehabil. 2009;31(4):309-17. [abstract]
  11. Polio Outreach of Washington
  12. Lambert DA, Giannouli E, Schmidt BJ; Postpolio syndrome and anesthesia. Anesthesiology. 2005 Sep;103(3):638-44. [abstract]
  13. Howard RS, Davidson C; Long term ventilation in neurogenic respiratory failure. J Neurol Neurosurg Psychiatry. 2003 Sep;74 Suppl 3:iii24-30.
  14. Lincolnshire Post-Polio Information Newsletter. Volume 5, issue 9, June 2006. Issue covering respiratory problems.
Original Author: Dr Colin TidyCurrent Version: Dr Colin TidyPeer Reviewer: Dr John Cox

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