Dec 16, 2011

The basic management principles for individuals with postpolio syndrome


Rehabilitation Program

Physical Therapy

The basic management principles for individuals with postpolio syndrome include energy conservation and pacing one's activities. Although basic, these activity modifications may be difficult for some patients to accept. Psychological interventions, such as cognitive behavior therapy, may also be initiated to help reduce fatigue.[7]
Reports on exercises are conflicting, but the key factor seems to be exercise intensity. Strengthening exercises should be nonfatiguing. A specific suggestion is to exercise every other day, and the perceived rate of exertion should be less than "very hard." Loads should be held for only 4-5 seconds, and there should be a 10-second rest between bouts and a 5-minute rest between sets. The patient should perform about 3 sets of 5-10 repetitions.[8]
In addition to specifying exercises for those body areas experiencing the deleterious effects of disuse, the exercise prescription also should consider how to protect (1) muscles and joints that are experiencing the adverse effects of overuse and (2) body areas with very significant chronic weakness (generally, areas where the muscles have less than antigravity strength on manual muscle testing).
Results of these exercises vary. Strengthening programs performed as described show a 60% increase on isokinetic strength, improved cardiorespiratory status, no decline in strength in 6-12 months, and 5% increase in isometric strength.
Electrical stimulation has been used to strengthen weakened muscles or to reeducate muscles weakened through disuse, as well as to decrease pain.
For myofascial pain, consider heat, electrical stimulation, trigger point injections, stretching exercises, biofeedback, muscle relaxation exercises, or static magnetic fields for trigger points.
For gait disturbances, assistive devices can be used, but sometimes patients refuse because of the philosophy of "not giving in." Treatment also can involve limitation of ambulation to shorter distances and the use of orthotics for joint protection.

Occupational Therapy

Patients with postpolio syndrome usually benefit from different adaptive techniques and equipment to perform any activities of daily living, as well as education and energy conservation techniques.

Speech Therapy

Speech evaluation in persons with postpolio syndrome usually is recommended with any suggestion of swallowing problems. The therapist teaches the patient about different techniques to improve his/her swallowing function.

Consultations

  • Pulmonologists
    • When the patient with postpolio syndrome reports respiratory problems, a full pulmonary evaluation may be required.
    • Sometimes, the patient may even need mechanical respiratory support.
    • A sleep evaluation may be necessary for suspected sleep apnea.
  • Orthopedists - The patient may present with various joint deformities that may require orthoses and sometimes even surgery.

Medication Summary

Medications, most of which address fatigue, have been used with only partial success in patients with postpolio syndrome. Contradictory information is reported on the use of antivirals. Some authors have found no significant improvement with antivirals as compared with placebo. Amantadine may act to release dopamine from dopaminergic terminals and other central sites. Corticosteroids have been studied, but with no good results.

Nov 8, 2011

OPV Oral Vaccine what is it?

What Is the Oral Polio Vaccine (OPV)?

Oral polio vaccine (OPV) is a vaccine that contains live but weakened poliovirus. OPV is highly effective in polio prevention. However, because of the risk of a rare but serious condition called vaccine-associated paralytic poliomyelitis, OPV use in the United States was discontinued in 2000.

History of Polio and OPV

A 1916 polio epidemic in the United States killed 6,000 people and paralyzed 27,000 more. In the early 1950s, there were more than 20,000 cases of polio each year.
The first polio vaccine was licensed in 1955. This polio vaccine was an inactivated polio vaccine (IPV), meaning it did not contain any live poliovirus. By 1960, the number of cases had dropped to about 3,000. In 1961, an oral polio vaccine was licensed. As the number of cases ofpolio disease continued to drop after its introduction, it became the vaccine of choice in the United States and most other countries of the world.
In 1979, the last cases of paralytic poliomyelitis caused by wild poliovirus in the United States occurred. The success of polio vaccination in the United States and other countries sparked a worldwide effort to eliminate polio.
In 1998, an enhanced-potency inactivated polio vaccine became available. Because OPV can cause a rare but serious reaction called vaccine-associated paralytic poliomyelitis, it was recommended that OPV not be used. In 2000, the use of OPV in the Unites States was discontinued.

NOTE:
An inoculation designed to prevent POLIO. The killed virus vaccine (IPV) is currently recommended for almost all children in the United States. Until recently, the live oral polio vaccine (OPV) was recommended for most children. While both vaccines provide immunity to polio, OPV was better at keeping the disease from spreading to other people. However, for a few people (about one in 2.4 million), OPV actually caused polio. Since the risk of getting polio in the United States is now virtually gone, experts believe that using oral polio vaccine is no longer worth the slight risk. The killed virus polio shot (IPV) never causes polio.
México a la vanguardia en el Síndrome de Post Polio

Nov 5, 2011

The First Oral Treatment for MS

The First Oral Treatment for MS
STANFORD, CA (Ivanhoe Newswire) – 


Multiple sclerosis is a disease that affects about 400 thousand Americans. The body's immune system turns on itself and attacks the brain. Until now, patients had to rely on injections for help. Now,  the very first oral medication for MS has patients talking.

"It’s every step you take, you feel the pain," Lisa Adams told Ivanhoe.

"I could be in a wheelchair. I could go blind," Lizette Garcia said.

Lisa Adams and Lizette Garcia were both diagnosed with MS  in the prime of their lives. It’s a disease that slowly robs patients of their ability to walk, see and even think clearly.

"I feel like it's unstoppable all of a sudden," Lisa said.

For years, the only treatments for patients with MS had to be injected. Now, the FDA has approved the first oral treatment called Gilenya.

"Patients are excited about that because it is an oral product. We have never had that before,"Jeffrey Dunn, M.D.,  a clinical neuro-immunologist at Stanford School of Medicine, said.

In MS, the body's immune system attacks myelin, a substance that protects nerves. Gilenya works by holding certain immune cells in the lymph nodes so they can't reach the myelin. In clinical studies, Gilenya reduced MS relapses by 54% compared to a placebo and by 52% compared to another common injectable drug. But some say doctors should be cautious when prescribing the oral medication.  

"What we don't know is what can happen long-term, and we don't know that until we have a lot more patients on the drug," Melissa Ortega, M.D., a clinical instructor and MS specialist at the University of Miami said.

Gilenya can also cause serious side effects like slowed heart rate, liver problems, headaches and a build-up of fluid in the eye. Still,  lisa says she'd give it a try.

"I’m so excited to think about maybe not having to go back to injections," Lisa said.
Lizette has been taking the oral drug. So far, so good.
"I’ve had no side effects. I have more energy, and I feel so good, and I’m happy about that," Lizette said.

Currently, there are four other oral medications in the final phase of clinical trial testing that could become FDA approved soon. One interesting fact about MS, doctor Dunn says the closer you live to the equator, the less at risk you are for the disease. Your chances greatly increase the further away you live.


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The First Oral Treatment for MS -- In Depth Doctor's Interview
Jeffrey Dunn, MD, a clinical neuro-immunologist at Stanford School of Medicine talks about a new oral option for MS patients
Are you seeing more MS patients now than before and why?
Dr. Dunn: I think so. One of the biggest differences has been the patients that we are seeing MS in, traditionally in the past MS has been thought of as a disease of Northern Europeans and Scandinavian those of that sort of ethnic heritage, the Northern European, Scandinavian heritage. As with any autoimmune disease females more than males, three to one ratio. But classically MS has been seen as a disease of Caucasians, light skinned, light eyed, light haired young adults. But increasingly in this area we’re seeing that MS affects not just folks of that ethic heritage but those of Indian ethnic heritage, those of Asian ethnic heritage, Hispanic and African American as well. Historically in the past these sort of have been described as nonconventional groups, the not classical case of MS. It’s been thought that MS in those individuals, the non-white individuals has been rare in the past. In fact we know now that’s not true MS affects all races and our ability and our awareness of the frequency with which it’s affecting these non-traditional groups is absolutely increasing.

There are more white people than Indian or other ethnic people is that the reason that we haven’t seen as much? http://www.ivanhoe.com/channels/p_channelstory.cfm?storyid=28179
México a la vanguardia en el Síndrome de Post Polio

Oct 30, 2011

New Funding For Polio - Potential For The Infectious Disease To Make A Comeback Published: Sunday | October 30, 20110 Comments



McPherse Thompson, Assistant Business Editor
Perth, Western Australia:The Australian government and the Bill Gates Foundation have announced just over US$93 million in new funding to help eradicate polio-myelitis, a debilitating disease that continues to strike the most vulnerable people, especially children.
Prime Minister Julia Gillard said Australia will provide $50 million (US$53.3 million) over four years to the Global Polio Eradication Initiative to help purchase vaccines, monitor outbreaks, and respond when and where needed.
Australia's support will help take the final steps to achieve worldwide polio eradication, Gillard told a news conference at the Commonwealth Heads of Government Meeting at the Perth Convention and Exhibition Centre on Saturday.
She was joined by British Prime Minister David Cameron, Nigerian President Goodluck Jonathan, Canadian Prime Minister Stephen Harper and Pakistan Prime Minister Yousaf Raza Gilani to make the announcement.
Microsoft chairman Bill Gates joined the leaders via video link - recorded and shown to the press conference - to announce a US$40 million contribution to the eradication programme on behalf of the Gates Foundation and in support of the Commonwealth commitments.
The conference heard that since the eradication initiative was launched in the two decades since 1988, significant global progress has been made to reduce the number of polio cases.
The disease has now been estimated to have been eradicated by up to 99 per cent, and remains endemic in only four countries - Afghanistan and three members of the Commonwealth, namely India, Nigeria, and Pakistan.
strong partnerships
The Australian prime minister has applauded the leadership shown by India, Nigeria and Pakistan in their ongoing efforts to eradicate the disease.
"We welcome global progress and encourage Commonwealth members to remain committed to overcome the final hurdles in polio eradication," Gillard said.
"The importance of strong partnerships between affected countries, donors and organisations like the Gates Foundation, Rotary International and the Global Poverty Project, in achieving eradication must also be recognised," said the prime minister.
Also documented as vital to the elimination of the disease have been the continued work of the Gates Foundation and Rotary International, as well as the personal contributions of many Australians, including Sir Clem Renouf, who in the 1970s, as Rotary president, led the international campaign to vaccinate every child against polio.
Jamaica reported the last case of polio in 1982 and saw the declaration of the region of the Americas as polio-free in 1994. However, indications of the potential for the infectious disease to make a comeback was realised in 2000 when neighbouring Dominican Republic and Haiti saw a resurgence of polio cases.
Last year, the Jamaica National Building Society donated US$2,500 to the Rotary Club of St Andrew North, US$2,000 of which was earmarked for the global polio eradication programme.
The Global Polio Eradication Initiative is a public-private partnership led by national governments in collaboration with the World Health Organisation, Rotary International, the US Centers for Disease Control and Prevention, and the United Nations Children's Fund, with support from the Bill and Melinda Gates Foundation.
Australia's contribution to polio eradication is part of its broader commitment to saving the lives of children and women in developing countries and its $1.6-billion commitment to maternal and child health over the five years to 2015, according to a bulletin from the prime minister's office.
It said increasing routine immunisation around the world has helped reduce the number of child deaths from 12.4 million in 1990 to 7.6 million in 2010.
mcpherse.thompson@gleanerjm.com
Full Caption
From left: The president of Nigeria, His Excellency Goodluck Jonathon; the prime minister of Canada, the Right Honourable Stephen Harper; polio survivor Ramesh Ferris; the prime minister of The United Kingdom, the Right Honourable David Cameron; the prime minister of Pakistan, His Excellency Syed Yousuf Raza Gilani; and Australian Prime Minister Julia Gillard, announce initiatives on polio at the Perth Convention and Exhibition Centre yesterday. Contributed http://jamaica-gleaner.com/gleaner/20111030/lead/lead8.html

Canada pledges more money toward fight against polio

 

 


Canada's Prime Minister Stephen Harper gives a speech during the concluding session at a pre-summit business forum ahead of the Commonwealth Heads of Government meeting (CHOGM) in Perth October 27, 2011. CHOGM will be opened by Britain's Queen Elizabeth on Friday. http://www.canada.com/news/canada-in-afghanistan/Canada+pledges+more+money+toward+fight+against+polio/5628087/story.html


México a la vanguardia en el Síndrome de Post Polio

Sep 20, 2011

OCTOBER 24 Th. MANIFEST (World Day against polio) - Signature Collection Online





A Health Authorities and people who have had polio worldwide. As you are aware since October 1985 following the intervention of Rotary International (RI) in cooperation with the World Health Organization (WHO) and held 40 years of the founding of the United Nations (UN) was established on October 24 as World Day against polio. This year marks the twenty-sixth day of the WORLD DAY AGAINST POLIO where, will be discussed achievements in the past year, although presented a positive balance, the proposed goals will not achieve the expected results, we know that polio is still endemic in some countries and that their have been cases of imported polio in countries where it was considered eradicated. We are aware of the great efforts made by governments, global institutions and health organizations with altruistic in providing financial resources for the elimination of this terrible disease. However, as at other times it will change again due date eradication, as the financial, political, religious, geographical and cultural will remain the major impediments to achieving the dream for so many years cherished the celebration of the end of polio! It is not what has been done, but it Much remains to be done, although there are still cases of polio at an average of 1000 per year, far too many cases for the twenty-first century medicine, we hope that this scourge will disappear forever. As long as the circulation of wild poliovirus anywhere in the world, will be latent reinfection of the virus-free zones and hence the recurrence of epidemics in countries that eradicated having confidence in their people and have been declared free of wild poliovirus have lowered their rate of vaccination, allowing persisting danger of epidemics anywhere in the world. There is little to celebrate! In commemoration of World Day against polio this 2011 shortage, again, large sometimes absent from the past, survivors of the great epidemics of the last century! Those who journeyed through life even charging for fifty years or more with the aftermath left us this virus attack. 

Overlooked by doctors and medicine that due to number of cases, and what is forgotten or never studied polio because it does not appear in the books and are doing so as a curiosity, an illness now disappeared. Those who suffer multiple corrective surgeries (many of them experimental, including the affected limb amputations), forced isolation. 
Those who use heavy prosthesis, not rare that you see wrong and hurt our meats. Those who were stuck in artificial lungs for weeks or months. The major users of crutches, canes and wheelchairs. Those who have never gotten out of bed by the severity of its consequences and those who died from the virus attack. For this and other reasons:

SURVIVORS OF POLIO EXPRESS: our strongest protest against the oblivion to which we have been subjected, approximately 20 million people worldwide. That persons who suffer from polio, are not stable indefinitely, as they say they never knew or not know what the disease. That past few years begins a slow and gradual deterioration of our health and the exacerbation of our sequels, why increase our disabilities, it undermines our health and diminish our quality of life. 

The WHO and is classified and in full force this circumstance called Postpoliomyelitis Syndrome in January 2010 which states in the ICD-10 with the code G14. Forcing their compliance with all member countries. That there are multiple studies from prestigious medical institutions and universities that support without a doubt the existence of this syndrome, recent studies published in prestigious journals and multiple literature to see made available for all one that requires knowledge of the condition. That despite this, still refuses this pathological condition in most of Latin America and other European countries making patients who suffer with long journeys to hospitals and clinics cannot find answers to your discomfort or if they find apparent with the diagnosis of which is the product of his imagination denying them the care they need or sending them to work with risk to their health and physical integrity. We know that there is will and knowledge, there is little that can be do for us, on the contrary there is much that can and should do to prevent the progressive deterioration, increasing our disability and decreased quality of life. Believe it or not we are still here!

SURVIVORS OF and those with POLIO SYNDROME Postpoliomyelitis DEMAND:
The eradication of polio. Immediate implementation and unrestricted code G14 in all member countries of WHO in accordance with the Universal Charter of Human Rights. 
The immediate implementation of training programs and training for all those doctors and paramedics who ignore how to diagnose and treat this condition in the countries where it is still denied. Implementation, as soon as possible, clinical multidisciplinary care to treat wide scale of problems in these patients. The overall responsible, ethical and truthful state of current disability and the prognosis for the future, for employment purposes, people with this condition. Full respect for the laws, local, national and international protection for persons with disabilities.

SURVIVORS OF POLIO PROPOSE: Our support and active participation in actions by any authority that lead to the rapid disappearance of polio from the planet. Our full cooperation in programs that are implemented or that will be implemented to better diagnosis and treatment of our disease. Our collaboration and participation of all those serious studies which lead to better medical treatment and / or physical therapy to help improve or stabilize our quality of life. Appreciate your attention and await the answers.
To sign the manifest here

Sep 5, 2011

Transgenic mice susceptible to poliovirus

pvr transgenic mouseYesterday I terminated the last remaining mice in my small colony, including the line of poliovirus receptor transgenic mice that we established here in 1990. Remarkably, I had never written about this animal model for poliomyelitis which has played an important role in the work done in my laboratory.
While I was still working on poliovirus as a postdoctoral fellow with David Baltimore, I became interested in how the virus causes disease. There were no convenient animal models to study poliovirus pathogenesis, so I began to think about the cellular receptor for the virus and how it could be used to make a mouse model for infection. When I moved to Columbia University Medical Center in 1982, I decided to identify the cellular gene for the poliovirus receptor. This work was carried out by the second graduate student in my lab, Cathy Mendelsohn. She identified a gene from human cells that encoded a protein which we believed to be the cellular receptor for poliovirus. When this human gene was expressed in mouse cells, it madepvr modelthem susceptible* to poliovirus infection (the mouse cells were alreadypermissive for poliovirus replication). The gene encodes a transmembrane glycoprotein (illustrated) that we called the poliovirus receptor (PVR), later renamed CD155. Over the years we worked extensively on PVR, with the goals of understanding its interaction with poliovirus during entry into the cell. In one project we collaborated with Jim Hogle, David Belnap, and Alasdair Steven to solve the structure of poliovirus bound to a soluble form of PVR. The image of that complex decorates the banner at virology blog and twiv.tv.
Figure 1
(a) Cryomicrographs of poliovirus particles complexed with (Top) and without (Bottom) sPvr. Bar = 300 Å. Image reconstructions are shown of virion + sPvr [in stereo (b)] and, for comparison, of the virion (c) (from ref. 9). The two reconstructions were overlaid in d with the respective contour levels adjusted to clarify the interaction of sPvr with the virion. Bar = 100 Å. (e) Two views of a single sPvr molecule extracted from the difference map. Domain boundaries are marked. Bar = 25 Å.
Shortly after identifying PVR as the cellular receptor for poliovirus, a new student, Ruibao Ren, joined my lab. For his project I suggested he create transgenic mice with the human gene for PVR. We already knew that synthesis of PVR in mouse cells allowed the complete poliovirus replication cycle. Together with Frank Costantini and JJ Lee, Ruibao produced PVR transgenic mice and showed that they were susceptible to poliovirus infection. The illustration at top left shows a PVR transgenic mouse with a paralyzed left hind limb after poliovirus inoculation.
Poliovirus transgenic mice were used for many years in my laboratory to study how the virus causes disease, and to identify the mutations that attenuate the neurovirulence of the Sabin vaccine strains. A good summary of this work can be found in my review, The pathogenesis of poliomyelitis: what we don't .


Source

Department of Microbiology and Neurology, School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.

Abstract

Poliomyelitis has long served as a model for studies of viral pathogenesis, but there remain many important gaps in our understanding of this disease. It is the intent of this review to highlight these residual but important questions, in light of a possible future moratorium on research with polioviruses. Salient questions include: 
(1) What cells in the gastrointestinal tract are initially infected and act as the source of excreted virus?
 (2) What is the receptor used by mouse-adapted strains of poliovirus and how can some polioviruses use both mouse and primate receptors? 
(3) What determines species differences in susceptibility of the gastrointestinal tract to polioviruses? Why cannot PVR transgenic mice be infected by the natural enteric route? 
(4) Why are neuroadapted polioviruses unable to infect nonneural cells?
 (5) What is the role of postentry blocks in replication as determinants of neurovirulence?
 (6) What route(s) does poliovirus take to enter the central nervous system and how does it cross the blood-brain barrier?
 (7) Why does poliovirus preferentially attack lower motor neurons in contrast to many other neuronal types within the central nervous system? 
(8) Does cellular immunity play any role in recovery from acute infection or in vaccine-induced protection? 
(9) In which cells does poliovirus persist in patients with gamma-globulin deficiencies? 
(10) Is there any evidence that poliovirus genomes can persist in immunocompetent hosts? 
(11) Why has type 2 poliovirus been eradicated while types 1 and 3 have not?
 (12) Can transmission of vaccine-derived polioviruses be prevented with inactivated poliovirus vaccine?
 (13) What is the best strategy to control and eliminate vaccine-derived polioviruses?
PMID:


18585526
[PubMed - indexed for MEDLINE]

Aug 30, 2011

3 Casos de Polio Post Vacunal en Peru

Lunes, 29 de Agosto 2011  |  2:24 pm


Director general de Salud asegura que no hay rebrote de polio

Lunes, 29 de Agosto 2011  |  2:24 pm
/Director afirmó que a diferencia de la polio tradicional que 
se presentaba de manera crítica, los casos de los tres niños son diferentes
 y que tienen la opción de rehabilitarse.

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