Jun 26, 2010

Post Polio Syndrome % Symtoms, Cause , Diagnosis, Prognosis

Post-polio syndrome can affect polio survivors many years after recovering from an initial acute attack of the poliovirus. This syndrome is characterized by new muscle pain, worsening of existing weakness, and new weakness or paralysis. The cause is unknown, and there is currently no cure. Treatment is focused on relieving the symptoms. Researchers estimate that this syndrome affects 25 to 50 percent of polio survivors in the United States.
                 Post-Polio Syndrome
                Cause of Post-Polio Syndrome
                Symptoms of Post-Polio Syndrome
                Post-Polio Syndrome Diagnosis
                Post-Polio Syndrome Treatment
                Post-Polio Syndrome Prognosis
                Post-Polio Syndrome Research
                Preventing Post-Polio Syndrome
                Post-Polio Syndrome and Exercise
Post-polio syndrome is a condition that affects some polio survivors many years after recovery from an initial acute attack of the poliovirus. Decades later, 25 percent to 40 percent of people who contracted paralytic poliomyelitis in childhood will develop:
               New muscle pain
               Worsening of existing weakness
               New weakness or paralysis.
Post-polio syndrome is not an infectious disease, and people who are experiencing it do not shed poliovirus.
What Causes It?
The cause of this condition is not known. However, research scientists believe the new weakness seen in post-polio syndrome is related to the damage of individual nerve terminals in the motor units that remain after the initial poliovirus infection.
 Risk Factors for Post-Polio Syndrome
While risk factors do not cause post-polio syndrome, certain factors can increase a person's risk for developing the condition. Risk factors include:
   Increasing length of time since acute poliovirus infection
Presence of permanent disability after recovery from the original polio virus infection
Being female.
Symptoms

The symptoms of post-polio syndrome can vary in number and severity between different people with the condition. Some patients experience only minor symptoms of post-polio syndrome, while others develop more severe symptoms.
             
Common post-polio syndrome symptoms can include:

               Slowly progressive muscle weakness
               Loss of muscle
               Unaccustomed fatigue
               Joint pain
               Increasing skeletal deformities such as scoliosis.
Diagnosing Post-Polio Syndrome

In order to make a diagnosis of post-poliosyndrome, the doctor will ask the patient a number of questions, perform a physical exam, and recommend certain tests looking for signs and symptoms of post-polio syndrome. Some of these tests may include:

  Magnetic resonance imaging (MRI)
                                  Computed tomography (CT)
                                  Neuroimaging tests
                                  Electromyography (EMG).
               
These tests can help diagnose post-poliosyndrome (or even another medical condition), but they do not identify survivors at greatest risk for new progression of muscle weakness.

Before making a diagnosis, the doctor will also consider other medical conditions that can share similar symptoms with post-polio syndrome. Some of these conditions include:

            Amyotrophic lateral sclerosis (ALS), also called Lou Gehrig's disease
             Depression
            Chronic fatigue syndrome.
Treatment Options

Currently, there is no cure for post-polio syndrome. Therefore, treatment is focused on relieving the symptoms. Some treatment options for this condition include lifestyle changes and support. Research scientists continue to actively look for other post-polio treatment options.


Post-Polio Syndrome and Exercise

Post-polio syndrome symptoms of pain, weakness, and fatigue can result from the overuse and misuse of muscles and joints. These same symptoms can also result from disuse of muscles and joints. This fact has caused a misunderstanding about whether to encourage or discourage exercise for polio survivors or individuals who already have post-polio syndrome.


(Click Post-Polio Syndrome and Exercise for more information.)
The Prognosis

Post-polio syndrome is a very slow, progressive condition marked by long periods of stability.

The severity of post-polio syndrome will depend on the degree of the weakness and disability that remained after an individual had the original polio attack. People who had only minimal polio symptoms from the original attack and subsequently develop post-polio syndrome will most likely experience only mild symptoms. People who were originally hit hard by thepoliovirus and were left with severe weakness may develop a more severe case of post-polio syndrome with a greater loss of muscle function, difficulty in swallowing, and more periods of fatigue.

(Click Post-Polio Syndrome Prognosis for more information.)


How Common Is Post-Polio Syndrome?

According to estimates by the National Center for Health Statistics, more than 440,000 polio survivors in the United States may be at risk for post-polio syndrome. Researchers are unable to establish a firm prevalence rate, but they estimate that this condition affects 25 percent to 50 percent of these survivors, or possibly as many as 60 percent.

¿Qué es Poliomielitis?





Las Enfermedades Infecciosas

La Poliomielitis (Polio)

¿Qué es la poliomielitis (polio)?
La poliomielitis es una enfermedad muy contagiosa causada por tres tipos de poliovirus. 
El poliovirus es un virus reconocido principalmente por destruir el sistema nervioso causando parálisis.
 Sin embargo, la mayoría de personas infectadas con polio, no tienen síntomas y algunas tienen 
síntomas leves. De todas las personas que tienen la infección, el 2 por ciento o menos pueden desarrollar
 una enfermedad paralítica. Desde la llegada de la vacuna contra la polio durante los primeros años de la 
década de 1950, las infecciones por el poliovirus han sido casi erradicadas. En países pobres, 
subdesarrollados y que no tienen acceso a la vacuna, la polio todavía es una preocupación principalmente
 para bebés y niños pequeños. La Organización Mundial de la Salud (su sigla en inglés es WHO) continúa esforzándose por erradicar el virus a nivel mundial.

 Los bebés y los niños pequeños forman el grupo de mayor riesgo.

Las infecciones por poliovirus son más comunes durante las estaciones de verano y otoño.

El riesgo de desarrollar parálisis por el virus aumenta con la edad.
¿Cómo se transmite el poliovirus?
La transmisión del poliovirus se produce más frecuentemente por la vía fecal oral. Usualmente ocurre debido al lavado de manos inadecuado o por el consumo de alimentos o agua contaminados. Las secreciones respiratorias también diseminan el poliovirus. Las personas infectadas con el virus pueden excretarlos en sus heces durante varias semanas. Los individuos son más contagiosos inmediatamente antes de que aparezcan los síntomas y poco tiempo después.
¿Cuáles son los síntomas de la poliomielitis?

Las infecciones por poliovirus pueden mostrar síntomas en varios grados de severidad. La mayoría de individuos (del 90 al 95 por ciento) no tienen síntoma alguno, lo cual se conoce como infección inaparente. Las otras tres categorías serán descritas más adelante.

A continuación, se enumeran los síntomas más comunes de la poliomielitis. Sin embargo, cada individuo puede experimentar los síntomas de una forma diferente. Los síntomas pueden incluir los siguientes:
La Poliomielitis abortiva
Un curso corto y leve de la enfermedad con uno o más de los síntomas siguientes:

Fiebre (hasta 103°F ó 39.5°C).

Apetito disminuido.

Náusea, vómito o ambos.

Dolor de garganta.

Malestar general.

Estreñimiento.

Dolor abdominal.
La Poliomielitis no paralítica

Los síntomas de la poliomielitis no paralítica son iguales a los de la poliomielitis abortiva, pero el dolor de cabeza, la náusea y el vómito pueden ser peores. Además, pueden ocurrir los siguientes síntomas:

El niño puede sentirse mal durante un par de días, luego parece mejorar y después vuelve a sentirse mal con los síntomas siguientes:

Dolor de los músculos del cuello, el tronco, los brazos y las piernas.

Rigidez del cuello y de la columna vertebral.

La Poliomielitis paralítica
Los síntomas de la poliomielitis paralítica son iguales a los de la poliomielitis no paralítica y la abortiva. Además, pueden ocurrir los siguientes síntomas:

Debilidad generalizada en los músculos.

Estreñimiento severo.

Músculos desgastados.

Respiración debilitada.

Dificultad para tragar.

Tos débil.

Piel ruborizada o manchada.

Voz ronca.

Parálisis de la vejiga.

Parálisis de los músculos.
¿Cómo se diagnostica la poliomielitis?

Además del examen y la historia médica completa, los procedimientos para diagnosticar la poliomielitis pueden incluir los siguientes exámenes:

Cultivos de la garganta, orina y heces.

Punción lumbar o espinal.

El recuento de que el niño no recibió la vacuna contra el polio o que no completó las series de vacunas contra dicha enfermedad.

Tratamiento de la poliomielitis:
El tratamiento específico para la poliomielitis será determinado por su médico basándose en lo siguiente:

Su estado general de salud y su historia médica.

Que tan avanzada está la enfermedad.

Su tolerancia a determinados medicamentos, procedimientos o terapias.

Sus expectativas para la trayectoria de la enfermedad.

Su opinión o preferencia.
Aunque existe prevención contra la poliomielitis, no existe cura para los individuos infectados. El tratamiento es de apoyo, que significa que los síntomas pueden tratarse para mejorar la comodidad y recuperación del paciente.
Tratamiento del dolor con analgésicos (como el acetaminofén).

Reposo en cama hasta que la fiebre disminuya.

Dieta adecuada.

Esfuerzo y ejercicio mínimo.

Compresas calientes o almohadillas calientes para el dolor en los músculos.

La hospitalización puede ser necesaria para las personas que desarrollan poliomielitis paralítica.

Las complicaciones de poliomielitis paralítica pueden incluir parálisis permanente de ciertos grupos musculares, incluyendo los músculos respiratorios y los de las piernas.

Prevención de la poliomielitis:
Higiene adecuada y lavarse bien las manos.

La inmunización contra el poliovirus: en Estados Unidos, se recomienda administrar la vacuna contra la polio a las edades siguientes:

2 meses.

4 meses.

Entre 6 y 18 meses.

Entre 4 y 6 años.

Pueden administrarse dos versiones de la vacuna:

IPV - Vacuna Inactivada contra la Polio que se administra por inyección (pinchazo).

La vacuna se administra completamente en las cuatro visitas. La administración de la IPV no puede causar polio y se puede usar en forma segura para individuos con sistemas inmunes debilitados.
OPV - Vacuna Oral contra la Polio que se administra por la boca.

En casos raros se ha conocido que la OPV cause poliomielitis paralítica asociada con la vacuna (su sigla en inglés es VAPP).

En enero del 2000, los Centros para la Prevención y el Control de las Enfermedades 
(Centers for Disease Control and Prevention, su sigla en inglés es CDC), el Comité Asesor para las Práctica de Inmunización (Advisory Committee on Immunization Practices, su sigla en inglés es ACIP), y la Academia Americana de Pediatría (American Academy of Pediatrics, su sigla en inglés es AAP) recomendaron que no se administre rutinariamente la OPV y que únicamente se administre IPV. Existen situaciones en las que es necesario que su hijo reciba la OPV, por ejemplo cuando viaje a países en los que puede transmitirse el poliovirus infeccioso o "silvestre".

La Vacuna Oral contra la Polio NO debe administrarse a los niños que:
tienen sistemas inmunológicos debilitados.

Toman esteroides a largo plazo.

 tienen cáncer.

tienen infección por VIH o SIDA.

tienen alergia a la neomicina, estreptomicina o polimixina B.

Editors of Canadian Medical Association Journal warn polio outbreak in Tajikistan could spread



25. June 2010 00:48
"A large polio outbreak in Tajikistan - Europe's first in years - has the potential to further spread the dangerous virus to other regions of the world, the [editors of] the Canadian Medical Association Journal [CMAJ] warned Wednesday" in an editorial appearing in the journal, the Canadian Press reports.
The CMAJ editors "suggested the outbreak, the largest since 2005 in a country where polio is not endemic, serves as a reminder that until polio is eradicated, the risk of renewed spread remains," the news service adds (Branswell, 6/23).
"There is no cure for polio, which can cause paralysis in a small percentage of infected children and adults," the Globe and Mail writes. "But the disease is entirely preventable through vaccination, which has helped eliminate it from many countries around the world," the newspaper reports (Weeks, 6/23).
CBC News, also reporting on the CMAJ editorial, notes the progression of the polio outbreak in Tajikistan, which grew from seven polio cases confirmed in children in April to more than 560 cases, including "183 that were lab confirmed" (6/23).
"'In all countries certified as polio-free, including Canada, the Tajikistan outbreak should be clanging alarm bells,' Dr. Noni MacDonald, the journal's public health editor, and editor-in-chief Dr. Paul Hebert wrote with the journal's advisory team," the news service writes (6/23).
The outbreak reflects "growing complacency over the need to vaccinate against the highly contagious disease, Hebert said in an interview," the Globe and Mail reports in a piece that examines how dips in vaccination rates can lead diseases to become reintroduced to a population (Weeks, 6/23).
"To minimize risks worldwide, we must first control the outbreak in Tajikistan and its surrounding area. With help from WHO, sequential mass polio vaccine campaigns are already under way in Tajikistan," the authors of the editorial (.pdf) write. "Other countries need to step up their vaccination rates so the overall rates exceed 90% in all communities. Worldwide surveillance for acute flaccid paralysis should be enhanced to ensure rapid early detection of spread from Tajikistan" (MacDonald/Hebert, 6/23).
"The Tajikistan outbreak is the latest in a string of setbacks for the global polio eradication initiative, the 22-year-old campaign aimed at permanently stopping the spread of the disease," the Canadian Press continues. "The campaign, jointly run by the World Health Organization, Rotary International, the U.S. Centers for Disease Control and UNICEF, has to date spent $8 billion trying to achieve the goal." The article notes that Afghanistan, India, Nigeria and Pakistan are the "[o]nly four countries remain on the list of nations that have never interrupted spread of polio."
The article includes comments from John Spika, director general of the Public Health Agency of Canada's Centre for Immunization and Respiratory Infectious Diseases, and Bruce Aylward, head of the WHO's polio eradication team.
Meanwhile, the Russian Health and Social Affairs Ministry recently confirmed seven cases of polio that "it says likely originate from an outbreak in Tajikistan more than one month ago," Radio Free Europe/Radio Liberty reports. "They are the first cases of polio in Russia in 15 years," according to the news service (6/23).
Low-Dose Polio Injectable Polio Vaccine As Effective As Full Dose, Study Finds
"Giving just one-fifth the usual dose of the polio vaccine may protect babies against the virus nearly as well as a full dose, as long as it is injected just beneath the skin," according to a study published Thursday in the New England Journal of Medicine, Reuters reports. "The findings could bring down the cost of immunization, an important consideration in developing countries, some of which have had trouble containing the paralytic disease," according to the news service.
For the study, which involved 373 children from Oman, researchers used a needle-free jet injector device "to deliver the vaccine beneath the skin at ages 2, 4 and 6 months. Blood tests showed more than 95 percent of the infants mounted an effective immune response against polio," the news service writes. Though infants who received the lower dose of the vaccine produced fewer antibodies against polio, the response was sufficient to offer infants protection against the disease (Emery, 6/23).
"Our study shows that intradermal administration of a fractional-dose inactivated poliovirus vaccine could serve as a dose-sparing strategy
when used in a primary routine vaccination schedule in which doses are administered at 2, 4, and 6 months of age," the authors of the NEJM study write (Mohammed et al., 6/24).
"The injectable vaccine costs about $3 per dose," Reuters continues. Though "[t]he oral polio vaccine is much cheaper, at about 15 cents, … it contains a weakened virus that can mutate and sometimes cause polio in patients or when it gets into sewage," which has led health experts to "favor the injectable vaccine," according to the news service.
"With this study, we know we can use this means to lower the price," study co-author Roland Sutter of the WHO said. "If we can do one-fifth the dose, we can at least get it down to one dollar, so we are getting into the neighborhood of a price that may be affordable for developing countries in the future."
The article includes information about the global challenges to eradicating polio and the WHO's polio eradication program, a topic touched upon in an accompanying commentary piece also featured in the New England Journal of Medicine (6/23).

Jun 23, 2010

Dr. Oppenheimer


People We Know

(continued)

DECEMBER 2005
In Memoriam: Edward Anthony "Tony" Oppenheimer, MD, FCCP (1937-2005)
Dr. Oppenheimer in Japan, 2005Our readers will be saddened by news of the death of Dr. Tony Oppenheimer, who died of complications of multiple myeloma in November. Many of you knew Dr. Oppenheimer through his extensive email practice on respiratory matters related to neuromuscular disease, begun after he retired in 2000 as Chief of Pulmonary and Critical Care Medicine, Southern California Kaiser Permanente Group. Others experienced Dr. Oppenheimer firsthand as their superb physician at Kaiser, while many of us knew him as a delightfully philosophical and engaging friend, colleague and mentor.
As a member of IVUN's Medical Advisory Committee, Dr. Oppenheimer provided thoughtful and comprehensive contributions to IVUN publications and careful review of its pulmonary articles. He worked diligently, but gently, to educate ventilator users and their families, to ensure that they became accepted as equal partners in the decision-making process about the use of assisted ventilation.
Dr. Oppenheimer understood the technology and the power of the Internet early on and utilized it to the fullest to educate other health professionals about assisted ventilation. His utmost concern about quality of life issues reflected his belief that users of long-term assisted ventilation at home could live the best possible life.

"Tony epitomized the patient-physician partnership through his work with people who use ventilators longterm in the home care setting. Tony was an 'R.D.' or 'real doctor,' balancing expert medical care with humor, generosity and compassion. He was also a true advocate for ventilator users," states Judith R. Fischer, who collaborated with him on several articles for respiratory care journals and for IVUN's quarterly newsletter, Ventilator-Assisted Living.
Richard Daggett, President of the Polio Survivors Association, Downey, California, whose association enjoyed Dr. Oppenheimer's talks on post-polio respiratory problems, says, "Polio survivors have lost a good friend. Dr. Oppenheimer provided us with valuable, often life-saving information about pulmonary issues. He was always accessible and generous with his time. He will be missed, both personally and professionally."

David Ronfeldt agrees. "As Dr. Oppenheimer's patient since 1979, I found Dr. Oppenheimer
(I usually called him 'Chief') to be an excellent doctor, skilled at my post-polio respiratory issues, and a fine, sturdy, positive fellow to be around. He was always interested in what else was going on, and always ready with an engaging smile. He listened, he cared, he advised sensibly, he never stopped learning, and at crucial moments he took extra steps that turned out to matter."
Ismail Tsieprati, who has ALS and has used tracheostomy positive pressure since 1990, and his wife Cheryl remember "Dr. Oppenheimer's deep love for people and how he took joy and pride in the success and well-being of others. He loved to help others and never stopped giving of himself - the greatest humanitarian we have ever known. He touched our lives profoundly, and we'll always be grateful for the excellent care, the encouragement, the hope and the support he gave us throughout the years. The world has lost a great man. We have lost a dear friend."
Professionally, Dr. Oppenheimer was Associate Clinical Professor of Medicine at UCLA's School of Medicine. He was also a member of the California Thoracic Society, the American Thoracic Society and a fellow of the American College of Physicians and the American College of Chest Physicians. www.post-polio.org/ net/peo2.html

Global Polio Initiative to Build on Nigeria’s 99% Drop

Global Polio Initiative to Build on Nigeria’s 99% Drop

From Kingsley Nwezeh in Abuja, 06.21.2010
The Global Polio Eradication Initiative said weekend it was building its new polio eradication strategy on Nigeria’s successful campaign against the disease that led to 99 per cent drop in polio cases even as it said it faced a 50 per cent funding gap.
This coincided with the latest statistics that over 177,000 children under the age of five die of pneumonia in Nigeria yearly. Director, Alliances and Information, International Vaccine Access Centre, John Hopkins University, Baltimore, United States, Lois Privor-Dumm, dropped the hint in Abuja.
The Global Polio Eradication Initiative (GPEI), a coalition of national governments, World Health Organisation (WHO), Rotary International, the US Centers for Disease Control and Prevention (CDC) and the United Nations International Children’s Emergency Fund (UNICEF), which launched its 2010-2012 Strategic Plan for interrupting polio worldwide, said 10 out of the 15 previously polio-free countries re-infected in 2009 had successfully stopped their outbreaks.
“Nowhere is progress more evident than Nigeria, where case numbers have plummeted by more than 99 per cent  from 312 cases at this time last year, to three in 2010,” it said.
It said stakeholders are meeting in Geneva to build on the gains already made in 2010 and to galvanise new action on polio eradication.

“Last month, the World Health Assembly welcomed the new plan while expressing deep concern about the $1.3 billion funding shortfall out of a budget of $2.6 billion over the next three years. This financing shortfall is a serious risk to the eradication of polio.  Activities are already being cut back or postponed due to  lack of funds.
“The Ministers of Health of Nigeria, Afghanistan, Angola and Senegal, among a number of other senior health ministry officials, existing and potential funders, vaccine manufacturers and key partner organisations will attend the meeting, co-hosted by WHO Director-General, Margaret Chan and the new UNICEF Executive Director, Tony Lake, to discuss the implementation, monitoring, economics and financing of the new plan”,a statement by WHO, said.
The new plan, it said, builds on major lessons learnt to date,including findings from a major independent evaluation examining the remaining barriers to eradication. It introduces district- and area-specific strategies to target the ever-shrinking remaining reservoirs of poliovirus, exploits the game-changing bivalent oral polio vaccine to increase the impact of immunisations, and tackles health system weaknesses. The success of this plan now hinges on implementation of activities at field level and the provision of adequate financing.

Privor-Dumn, who spoke at the weekend in Abuja, on the challenge of pneumonia, described the situation as unacceptable and blamed the high morbidity rate on poor vaccine coverage of the disease in the country.
She decried the fact that a preventable and treatable disease such as pneumonia kill thousands of Nigerian children.She commended the Dr Muhammad Ali-Pate-led National Primary Health Care Development Agency (NPHDA) for sourcing for an enlarged supply of the pneumonia vaccine, but maintained that with 500 children dying of the disease daily, government must intensify its efforts in this regard.

“The World Bank, United Nations International Children’s Emergency Fund (UNICEF), World Health Organisation (WHO), National Primary Health Care Development Agency (NPHDA, and the GAVI Alliance are all working towards making the vaccine available for routine immunisation.
“But we must tell the world we need the vaccines now. This is because we must make sure the vaccines reach children, because a child being in the rural or urban area should not be a determinant to his receiving the vaccine”, she said.

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