Dec 26, 2012

The global battle to wipe out polio has come closer than ever to success

Washington Post: Playing with fire
The Washington Post
| The Salt Lake Tribune
First Published Dec 25 2012 05:54 pm • Last Updated Dec 25 2012 05:57 pm
The global battle to wipe out polio has come closer than ever to success, but obstacles remain. The hurdles are not only the highly infectious nature of the disease but also war, corruption, weak public health systems and failing states. Last week added another obstacle to that list: obscene acts of violence. In Pakistan, nine unarmed vaccination workers were killed by gunfire while distributing medicine that could save the lives of countless children. Six of the victims were female, including three teenagers.
The attacks were unprecedented. In their wake the United Nations suspended a vaccination drive aimed at high-risk areas of the country and the young people who are most susceptible to the polio virus, which affects the nervous system and can lead to paralysis. The perpetrators are unknown, and no one claimed responsibility, but they are believed to be the Pakistan Taliban. The Taliban has denied it, but the Associated Press reported that suspicion has fallen on the terrorist organization because of its past opposition to the campaign and because of claims by some extremists that the vaccine could make children sterile — not true — or that the workers are spies for the United States. This is not true either but may be lingering blowback from the CIA’s use of a doctor in Pakistan and a fake vaccination campaign in the hunt for Osama bin Laden.
Huge strides have been made toward eradicating polio since the effort was launched in 1988. Then, the disease was endemic in 125 countries; today, only in three: Pakistan, Afghanistan and Nigeria. Last year, there were 650 cases globally; this year, as of last week, 214. In the 1980s the disease annually killed or paralyzed more than 350,000 children. The member states of the World Health Organization declared a "programmatic emergency" in May to galvanize efforts toward a final eradication, an exceedingly difficult task that has been achieved with only one other disease, smallpox.
Pakistan’s progress is notable but fragile. This year there have been only 56 polio cases in the country, less than a third of the 175 last year. Yet the virus can spread rapidly and unexpectedly, especially where hygiene and sanitation are poor. This is why vaccination is so important; if enough children are immunized, the virus can’t find susceptible children to infect and dies out. By shooting the vaccine teams in Pakistan, the assailants are playing with fire. They have not only snuffed out the lives of humanitarian workers but blasted open a pathway for the disease to spread among children not immunized. It is hard to contemplate an ideology that would deliberately put so many people at risk.
The government of Pakistan has rightly condemned the shootings, as have the United Nations and the WHO. The gunmen cannot be allowed to shut down a vital public health campaign. Perhaps the workers will need to be better protected, but the vaccination effort must go on.

Post Polio Litaff, Association A.C _APPLAC Mexico

Dec 12, 2012

Cronic Fatigue

Chronic fatigue syndrome refers to long-standing severe and disabling fatigue without a proven physical or psychologic cause.
  • Unexplained fatigue lasts for 6 months or longer.
  • Sometimes symptoms begin with a coldlike illness.
  • No treatments have proved to be effective, but symptoms may lessen over time.
Chronic fatigue syndrome may occur in up to 38 of 100,000 people in the United States. However, a recent telephone survey found the prevalence to be many times higher. Chronic fatigue syndrome affects people primarily between the ages of 20 and 50 and is about 1½ times more common among women than men.
Despite considerable research, the cause of chronic fatigue syndrome remains unknown. Controversy exists as to whether there is a single cause or many causes and whether the cause is physical or psychologic.
Some studies have suggested infection with the Epstein-Barr virus, rubella, herpesvirus, or human immunodeficiency virus (HIV) as a possible cause of chronic fatigue syndrome. However, current research indicates that these viral infections probably do not cause this syndrome. It is unclear whether other infections are related to the syndrome.
Some evidence suggests abnormalities of the immune system as possible causes. Other suggested causes include allergies (about 65% of people with chronic fatigue syndrome report previous allergies), hormonal abnormalities, decreased blood flow to the brain, and lack of certain nutrients in the diet.
Chronic fatigue syndrome seems to run in families, which may support an infectious agent as a cause. Alternatively, members of the same family may respond similarly to physical and psychosocial stress.
Some researchers have suggested that prolonged bedrest during convalescence from an illness may play a role in causing this disorder.
Some researchers believe the syndrome ultimately will prove to have multiple causes, including genetic predisposition and exposure to microbes, toxins, and other physical and emotional factors.
Symptoms and Diagnosis
The main symptom is fatigue, usually lasting at least 6 months, that is severe enough to interfere with daily activities. Severe fatigue is present even on awakening and persists throughout the day. The fatigue often worsens with physical exertion or psychologic stress. However, evidence of muscle weakness or of joint or nerve abnormalities is rare. Symptoms may begin after a coldlike illness that involves swollen lymph nodes that are tender or painful. In these people, extreme fatigue may begin with a fever and runny nose. However, in many people, fatigue begins without any preceding coldlike illness. Other symptoms that may occur are difficulty in concentrating and sleeping, sore throat, headache, joint pains, muscle pains, and abdominal pain.
No laboratory tests are available to confirm a diagnosis of chronic fatigue syndrome. Doctors therefore must rule out other diseases that may cause similar symptoms, such as thyroid disease, psychologic problems, alcoholism, or the early stage of a liver, inflammatory, or kidney disorder. The diagnosis of chronic fatigue syndrome is made only if no other cause, including side effects of drugs, is found to explain the fatigue.
Diagnosis of Chronic Fatigue Syndrome
According to the Centers for Disease Control and Prevention, a diagnosis of chronic fatigue syndrome requires the following:
  1. Medically unexplained persistent or recurring fatigue of at least 6 months' duration that is new or has a definite beginning; is not due to exercise; is not substantially relieved by rest; and substantially interferes with work-related, educational, social, or personal activities.
  2. At least four of the following symptoms for at least 6 months:
    • Poor short-term memory or reduced concentration severe enough to interfere with work-related, educational, social, or personal activities
    • Sore throat
    • Low-grade fever
    • Tender lymph nodes in the neck or armpits
    • Muscle pain
    • Abdominal pain
    • Pain in more than one joint without joint swelling or tenderness
    • Headaches that differ from previous headaches in terms of type, pattern, or severity
    • Unrefreshing sleep
    • Persistent feeling of illness for at least 24 hours after exercise
These symptoms must have been present persistently or recurrently during, but not before, the period of fatigue.
However, not all doctors agree that these criteria should be applied strictly with every person. The criteria are more useful as a common definition in research studies.
In most cases, symptoms of chronic fatigue syndrome lessen over time.
Excessive periods of prolonged rest cause deconditioning and may worsen symptoms of chronic fatigue syndrome. Gradual introduction of regular aerobic exercise, such as walking, swimming, cycling, or jogging, under close medical supervision may reduce fatigue and improve physical function. Formal, structured physical rehabilitation programs may be best. Psychotherapy, including individual and group behavior therapy, may be helpful as well.
Many different drugs and alternative therapies have been tried. Although many treatments, such as antidepressant and corticosteroid drugs, seem to make a few people feel better, none are clearly effective for all. It is hard for people and doctors to tell what treatments work because symptoms are different in different people and because symptoms may come and go on their own. Controlled clinical trials are the best way to test therapies, and no drug therapy has been shown to be effective in controlled trials. A number of treatments directed at possible causes, including use of interferons, intravenous injections of immune globulin, and antiviral drugs, have been mostly disappointing. Dietary supplements, such as evening primrose oil, fish oil supplements, and high-dose vitamins, are commonly used, but their benefits remain unproved. Other alternative treatments (for example, essential fatty acids, animal liver extracts, exclusion diets, and removal of dental fillings) also have been ineffective.
Last full review/revision December 2008 by Margaret-Mary G. Wilson, MD
Buscando el bien de nuestros semejantes, encontramos el nuestro.

Dec 7, 2012

Neuropsychiatry, Neuropsychology, & Behavioral Neurology

Neuropsychiatry, Neuropsychology, &  amp; Behavioral Neurology:



Hazendonk, Kim M. B.BSc.; Crowe, Simon F. Ph.D.

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Objective: This study aimed to examine cognitive functioning in postpolio syndrome (PPS) after controlling for the effects of depression and illness behavior.
Background: Few studies have investigated the possible cognitive sequelae of PPS, despite widespread documented subjective complaints of "mental fatigue."
Method: A total of 23 PPS sufferers, 20 polio survivors without PPS, and 22 matched controls were compared using the Beck Depression Inventory-II; the Illness Behaviour Questionnaire; a chronic fatigue syndrome symptom checklist; and several measures of memory, attention, and concentration, including the Brown-Petersen Task, Stroop Test, Austin Maze, California Verbal Learning Test, Trail Making Test, Controlled Oral Word Association Test, and Symbol-Digit Modalities Test.
Results: In those participants with a medically confirmed diagnosis of PPS, there was a significantly higher level of depressive and hypochondriacal symptomatology as compared with the other two groups. Nevertheless, no significant differences existed between the three groups on neuropsychological measures.
Conclusions: These results indicate that the attention and memory difficulties reported by PPS sufferers may be linked to the physical or psychological manifestations of the illness rather than to objective decrements in cognitive performance. (NNBN 2000;13:112-118)

The Post-Polio Syndrome As an 

Evolved Clinical Entity
Definition and Clinical Description
Article first published online: 17 DEC 2006

Post-polio syndrome (PPS) refers to the new neuromuscular symptoms that occur at least 15 years after stability in patients with prior acute paralytic poliomyelitis. They include: (1) new muscle weakness and atrophy in the limbs, the bulbar or the respiratory muscles [post-poliomyelitis muscular atrophy (PPMA)] and (2) excessive muscle fatigue and diminished physical endurance. PPS is a clinical diagnosis that requires exclusion of all other medical, neurological, orthopedic or psychiatric diseases that could explain the cause of the new symptoms. Routine electromyography is useful to confirm chronic and ongoing denervation and exclude neuropathies. Muscle biopsy, single fiber electromyography (EMG), macro-EMG, serum antibody titers to polio virus, and spinal fluid studies are very useful research tools but they are rarely needed to establish the clinical diagnosis. PPS is a slowly progressive phenomenon with periods of stability that vary from 3 to 10 years. Current evidence indicates that PPS is the evolution of a subclinically ongoing motor neuron dysfunction that begins after the time of the acute polio. It is clinically manifested as PPS when the well-compensated reinnervating process crosses a critical threshold beyond which the remaining motor neurons cannot maintain the innervation to all the muscle fibers within their motor unit territory.




Bruno RL, Galski T, DeLuca J. The neuropsychology of post-polio fatigue.

 Archives of Physical Medicine and Rehabilitation, 1993; 74: 1061-1065.

J Rehabil Med 2008; 40: 709–714
Gunilla Östlund, MSci1, Åke Wahlin, PhD2, Katharina S. Sunnerhagen, MD, PhD3,4 and Kristian Borg, MD, PhD1
From the 1Divison of Rehabilitation Medicine, Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital, 2Department of Psychology, Stockholm University, Stockholm, 3Institute for Neuroscience and Physiology, Section for Clinical Neuroscience and Rehabilitation, Göteborg University, Göteborg, Sweden and 4Sunnaas Rehabilitation Hospital, Faculty of Medicine, University of Oslo, Oslo, Norway
Objective: To evaluate vitality and fatigue in post-polio pa- tients, and the relative contributions of physiological and psychological parameters to the level of vitality. Design: Multi-centre study.

Subjects: One hundred and forty-three patients with post- polio syndrome.
Methods: Inventories of background, quality of life, fatigue and sleep quality were used. Pain was evaluated using a visual analogue scale. Descriptive statistics and correlations were used for all selected parameters. Hierarchical regres- sion models were constructed to examine predictors of varia- tions in vitality, pain, reduced activity and physical fatigue. 
Results: General fatigue accounted for 68% of the variation in vitality. Of this, 91% was accounted for by physiologi- cal indicators. After controlling for age, physiological para- meters accounted for 56.6% and 25%, if entered before and after the psychological parameters, respectively. The impact of the psychological parameters decreased after accounting for the physiological parameters. Physical fatigue, age and sleep quality were associated with variation in pain. Body mass index, pain and sleep quality accounted for differences in reduced activity and physical fatigue.
Conclusion: Vitality in post-polio patients depends on physio- logical parameters. Mental fatigue is not a prominent pre- dictor. Subgroups with or without fatigue, independent of age, need further study.
Key words: post-polio, fatigue, vitality, quality of life. J Rehabil Med 2008; 40: 709–714
Correspondence address: Gunilla Östlund, Department of Rehabilitation Medicine, Danderyd University Hospital, Building 39, 3rd Floor, SE-182 88Stockholm, Sweden. E-mail:

Submitted September 21, 2007; accepted May 29, 2008
Poliomyelitis leads to muscle weakness due to destruction of the anterior horn cells. After an initial recovery there is a phase
*This article has been fully handled by one of the Associate Editors, who has made the decision for acceptance, as it originates from the institute where the Editor-in-Chief is active.
© 2008 The Authors. doi: 10.2340/16501977-0253 Journal Compilation © 2008 Foundation of Rehabilitation Information.
of functional stability that usually lasts from 10 to 40 years. during this phase the life circumstances of polio survivors do not differ much from the general population with respect to work and family situation (1). However, after the stable phase deterioration may occur; a condition termed post-polio syndrome (PPS) (2). The most commonly reported symptoms of PPS are increased muscle weakness, fatigue and pain in the muscles and joints. The last epidemic of polio in Sweden was in 1953 when more than 5000 people contracted poliomyelitis. Today, the prevalence of polio-affected individuals in Sweden is estimated to be 186/100,000 (3). Reported estimates of polio survivors eventually developing PPS vary from 20% to 68% (2, 4). Thus, the majority of polio survivors in Sweden are now middle-aged or older, and consequently at risk of developing PPS. Risk factors for developing PPS include time since the acute polio infection (5), age at presentation of symptoms, muscle pain at exercise, recent weight gain, joint pain (6) and female gender.

During the last decade, increasing research interest has fo- cused on fatigue in patients with PPS (7). Jubelt & Agre (8) re- ported generalized fatigue as one of the most common symptoms in PPS. Mental, as well as physical, fatigue has been reported by both Bruno et al. (9) and Schanke & Stanghelle (10).
Interestingly, and related to mental fatigue, there are con- tradicting reports regarding cognitive dysfunction in patients with PPS. Difficulties with attention, word finding, maintaining wakefulness and ability to think clearly have been reported by Bruno et al. (11). However, in most other studies cognitive function is reported to be unaffected by mental fatigue (12, 13). Furthermore, fatigued polio survivors are reported to have more mental health problems than controls or polio survivors without severe fatigue (5). In a study by Conrady et al. (14) patients, both at a post polio-clinic and in a post-polio support group, experienced significantly elevated levels of psychologi- cal distress, such as somatization and depression. Gonzalez et al. (15) reported an increase in cytokines in the cerebrospinal fluid of patients with PPS, indicating an inflammatory proc- ess. The inflammatory processes were down-modulated by treatment with intravenous immunoglobulin followed by a clinical effect, especially on vitality, as evaluated by means of Short Form 36 (SF-36). This indicates that vitality has a central role in PPS that may be improved by means of phar- macological treatment. The subjective experience of vitalityISSN 1650-1977J Rehabil Med 40
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