May 5, 2012

Could Hig RCP and High CK be related to PPS?

Tips and Techniques for Polio Survivors by Dr. Richard L. Bruno
Recently I had a fever with muscle and chest pain. The only abnormal blood tests showed high C-reactive protein and high creatine kinase. My blood pressure and cholesterol are normal, I have never smoked, and I'm thin. Because of the chest pain I had an angiogram, which was normal. Could high CRP and high CK be related to PPS?

C-reactive protein is a blood marker for inflammation somewhere in the body. High CRP can be seen with type 2 diabetes, autoimmune diseases and cancers.Could inflammation somewhere in your body, as indicated by your elevated CRP, be related to PPS? Fifty consecutive patients evaluated at The Post-Polio Institute had CRP measured. The patients were on average 59 years old and 55% were women. Thirteen percent had an elevated CRP, 66% of  whom were men. CRP was on average nearly three times the normal value. However, there was no significant difference between those with high and normal CRP on self-ratings of daily fatigue, difficulty with self-care or ability to perform activities inside or outside of the home. So, there is no evidence that elevated CRP or inflammation is related to PPS, either to post-polio fatigue or difficulty in functioning.

Recent studies have found that elevated CRP is related to having a heart attack or stroke. The theory is that a bacterial or viral infection (although definitely not a poliovirus infection) somehow inflames arteries and causes them to clog. Our 1985 National Survey found no more heart disease or high blood pressure in polio survivors than in the general population. But two studies found that 5% more male post-polio patients had abnormally elevated cholesterol as compared to the general population. In one of the studies, only 33% of those with high cholesterol had been given a cholesterol screening test by their doctor and not even 25% were on cholesterol-lowering medications, like the statin drugs such as Lipitor, Pravachol and Zocor. This is not good, since reducing cholesterol reduces heart attack risk. What's more, research has shown that taking statins to reduce cholesterol can also lower CRP and may thereby increase survival even after having a first heart attack.

Statin drugs provide a connection between CRP and CK--in polio survivors. CK is an enzyme released when muscle is damaged. One half of one percent of anyone taking a statin develops muscle breakdown, which causes muscle
pain (especially in the calves), muscle weakness and an increase in CK. Even without muscle breakdown or an elevated CK, some polio survivors report muscle pain or weakness when taking a statin, usually one of the older statins like Lipitor. And polio survivors can have an elevated CK without taking a statin. Two studies found that 40% of polio survivors had abnormally elevated CK, with men having significantly higher CK than did women. In one study, CK increased with the number of steps polio survivors walked in a day. In our fifty Post-Polio Institute patients, 21% had abnormally elevated CK levels (on average about 33% higher than normal) with men also having higher CK than did women. But, as with CRP, there was no significant difference between those with high and normal CK on self-ratings
of daily fatigue, difficulty with self-care or the ability to perform activities inside or outside of the home. However, an elevated CK may mean that polio survivors are making their muscles work too hard and are causing them to break down.

So, neither CRP nor CK is related to fatigue or loss of functional abilities in polio survivors. However, all polio survivors need to have their cholesterol and CRP measured to assess heart disease risk. And since an elevated CK indicates muscle breakdown, either from taking a statin or from muscle overuse, polio survivors should have CK measured before taking a statin. If you are worried about possible muscle weakness or breakdown with the statins, or the newer cholesterol-lowering drugs like Zetia and Vytorin, ask your doctor about using older medications like slow-acting niacin or bile acid sequestrants. Besides medication, polio survivors need to eat high fiber foods, reduce saturated fat, treat high blood pressure and stop smoking to keep their tickers ticking.

México a la vanguardia en el Síndrome de Post Polio

May 4, 2012

Hundreds of doctors and survivors of polio virus

Hundreds of doctors and survivors of polio virus Thursday morning marched through the streets of Abuja in efforts to "renew vigour" in a fight to break transmission of wild polio virus in Nigeria.
At least 23 cases of the virus were reported last April, up from 14 in March.
Niger and Sokoto states recorded their first cases this year, three and two respectively.
President of Nigeria Medical Association, Dr Omede Idris, said doctors would continue
everything possible to stop further transmission of the virus.
"It is important that we renew vigour to eradicate polio," said Dr Idris.
 "We are interested as medical practitioners" to ensure a break in transmission.
Executive director of the National Primary Health Care Development Agency,
Dr Muhammad Ado, said the "issue of wild polio virus has become a war.
"There is no reason whatsoever for any Nigerian child to go down with paralysis," he said.
A group of survivors of polio virus joined doctors in the walk from the
Federal Secretariat at 6.30 early .
Thursday morning.
"Each and every case of a Nigerian child paralysed
is embarrassing and, to us, that cannot continue,"said Ado.
He noted a crippled child compromised "our ability as a country to meet our economic expectation."
The walk was a clear message to doctors to give their support in ensuring to child goes down with 
paralysis, he said.
Nigerian Medical Association has insisted the country's polio case is untenable when it does not
 have pockets of war as do Pakistan and Afghanistan, only two still polio-endemic countries.
India, which left the league of four endemic countries this year, is also thought to have more pressing environmental and poverty challenges.
Omede insisted there was "nothing against the use of polio vaccine," referring to objections to
 the vaccine.
"It does not cause any deformity. It is important that parents allow their children be vaccinated,
" he noted.
A fresh round of nationwide vaccination is scheduled for this month.
"If we do that, we would have done one good thing for many generations of our country."
Not left behind
Parents are still "rejecting polio vaccination, despite the fact that we are living with it
," says Lawan Didi, president of The Association of Polio Survivors of Nigeria, who was struck
 by the virus as a child.
Children struck by polio-induced paralysis end up in wheelchairs or roller skates as adults.
And their biggest problem is movement, says Didi, who was moved piggyback by relatives 
up until he was 18. "Wherever we go, we must look for assistance to get there."
He and other survivors of polio joined the walk on rollers because, he said,
 "We should not left behind.
"As polio survivors, we know where it pinches. We wear the shoes."
México a la vanguardia en el Síndrome de Post Polio

May 3, 2012

Polio this week - As of 18 April 2012

       Polio this week As of 18 April 2012

  • Nigeria only country to report cases this week: Six new cases have been reported in northern Nigeria, including one case of infection with wild polio virus type 3. This raises the concern that too many children continue to be missed during immunization activities. In some areas of Nigeria, notably inBorno, Kano, Sokoto and Yobe, more than one-third of all children remain under-immunized. A continued surge in cases in northern Nigeria poses the risk of renewed spread of the virus to other nations in west Africa. In the past, polio virus has spread from northern Nigeria to Niger, then on into Burkina Faso and Mali. The risk is further magnified given the security situation in Mali. 

Wild Poliovirus (WPV) cases

Total cases
Year-to-date 2012
Year-to-date 2011
Total in 2011* 
- in endemic countries
- in non-endemic countries

Case breakdown by country HERE
Data in WHO as of 19 Apr 2011 for 2011 data and 17 Apr 2012 for 2012 data.

Poliomyelitis Mayo Foundation

Poliomyelitis Mayo Foundation for Medical Education and Research (MFMER)

Filed under: Infectious Diseases
Polio is a contagious viral illness that in its most severe form causes paralysis, difficulty breathing and sometimes death.
In the U.S., the last case of wild polio — polio caused naturally, not by a vaccine containing live virus — occurred in 1979. Today, despite a concerted global eradication campaign, wild poliovirus continues to affect children and adults in Afghanistan, India, Nigeria and Pakistan.
The Centers for Disease Control and Prevention (CDC) advises taking precautions to protect against polio if you're traveling anywhere there's a risk of polio. If you're a previously vaccinated adult who plans to travel to an area where polio is occurring, you should receive a booster dose of inactivated poliovirus. Immunity following a booster dose lasts a lifetime.©1998-2010 Mayo Foundation for Medical Education and Research (MFMER)
Although polio can cause paralysis and death, the vast majority of people who are infected with the poliovirus don't become sick and are never aware they've been infected with polio.
Nonparalytic polio
Some people who develop symptoms from the poliovirus contract nonparalytic polio — a type of polio that doesn't lead to paralysis (abortive poliomyelitis). This usually causes the same mild, flu-like signs and symptoms typical of other viral illnesses.
Signs and symptoms, which generally last two to 10 days, include:
                Sore throat
                Back pain or stiffness
                Neck pain or stiffness
                Pain or stiffness in the arms or legs
                Muscle spasms or tenderness
Paralytic polio
Fewer than 1 percent of people infected with poliovirus develop paralytic polio, the most serious form of the disease. Initial signs and symptoms of paralytic polio, such as fever and headache, often mimic those of nonparalytic polio. Between one and 10 days later however, signs and symptoms specific to paralytic polio appear, including:
                Loss of reflexes
                Severe muscle aches or spasms
                Loose and floppy limbs (acute flaccid paralysis), often worse on one side of the body
The onset of paralysis may be sudden.
Classifications of paralytic polio
Paralytic polio has historically been divided into several types, depending primarily on which part of the body is affected. These classifications aren't rigid, and overlap may occur among the different forms.
                Spinal polio. This most common form of paralytic polio attacks certain nerve cells (motor neurons) in your spinal cord and may cause paralysis of the muscles that control breathing and those in your arms and legs. Sometimes the neurons are only damaged, in which case you may recover some degree of muscle function. But if the neurons are completely destroyed, the paralysis is irreversible, although you still retain your sense of feeling, unlike after many spinal cord injuries.
                Bulbar polio. In this severe type of polio, the virus affects the motor neurons in your brainstem, where the centers of the cranial nerves are located. These nerves are involved in your ability to see, hear, smell, taste and swallow. They also affect the movement of muscles in your face and send signals to your heart, intestines and lungs. Bulbar polio can interfere with any of these functions but is especially likely to affect your ability to breathe, speak and swallow and can be fatal without respiratory support.
                Bulbospinal polio. A combination of both bulbar and spinal paralytic polio, this form can lead to paralysis of your arms and legs and may also affect breathing, swallowing and heart function.
Post-polio syndrome . 
Affecting some people who have recovered from polio, post-polio syndrome is a cluster of disabling signs and symptoms that appears decades — an average of 30 to 40 years — after the initial illness. Common signs and symptoms include:
                Progressive muscle or joint weakness and pain
                General fatigue and exhaustion after minimal activity
                Muscle atrophy
                Breathing or swallowing problems
                Sleep-related breathing disorders, such as sleep apnea
                Decreased tolerance of cold temperatures
When to see a doctor
Be sure to check with your doctor for polio vaccination recommendations before traveling to a part of the world where polio may still occur naturally or where oral polio vaccine (OPV) is still used, such as Central and South America, Africa and Asia. In countries that use the OPV — vaccine made with live, but weakened (attenuated) polio virus — the risk of paralytic polio to travelers is extremely low, but not zero.
Additionally, call your doctor if:
                Your child hasn't completed the series of polio vaccinations
                Your child experiences an allergic reaction after receiving polio vaccine
                Your child has problems other than a mild redness or soreness at the vaccine injection site
                You have questions about adult vaccination or other concerns about polio immunization
                You had polio years ago and are now experiencing unexplained weakness and fatigue
The poliovirus resides only in humans and enters the environment in the feces of someone who's infected. Poliovirus spreads primarily through the fecal-oral route, especially in areas where sanitation is inadequate.
Poliovirus can be transmitted through contaminated water and food or through direct contact with someone infected with the virus. Polio is so contagious that anyone living with a recently infected person is likely to become infected too. Although people carrying the poliovirus are most contagious seven to 10 days before and after signs and symptoms appear, they can spread the virus for weeks in their feces.
You're at greatest risk of polio if you haven't been immunized against the disease. In areas with poor sanitation and sporadic or nonexistent immunization programs, the most vulnerable members of the population — pregnant women, the very young and those with weakened immune systems — are especially susceptible to poliovirus.
These factors also increase your risk if you haven't been vaccinated:
                Travel to an area where polio is common or that has recently experienced an outbreak
                Living with or caring for someone who may be shedding poliovirus
                Handling laboratory specimens that contain live poliovirus
                A compromised immune system, such as occurs with HIV infection
                Having had your tonsils removed (tonsillectomy)
                Extreme stress or strenuous physical activity after being exposed to poliovirus, both of which can depress your immune system
Paralytic polio can lead to temporary or permanent muscle paralysis, disability, and deformities of the hips, ankles and feet. Although many deformities can be corrected with surgery and physical therapy, these treatments may not be options in developing nations where polio is still endemic. As a result, children who survive polio may spend their lives with severe disabilities.
Doctors often recognize polio by symptoms such as neck and back stiffness, abnormal reflexes, and difficulty swallowing and breathing. To confirm the diagnosis, a sample of throat secretions, stool or cerebrospinal fluid — a colorless fluid that surrounds your brain and spinal cord — is checked for the presence of poliovirus.
Because no cure for polio exists, the focus is on increasing comfort, speeding recovery and preventing complications. Supportive treatments include:
                Bed rest
                Antibiotics for secondary infections (none for poliovirus)
                Analgesics for pain
                Portable ventilators to assist breathing
                Moderate exercise (physiotherapy) to prevent deformity and loss of muscle function
                A nutritious diet  ©1998-2010 Mayo Foundation for Medical Education and Research (MFMER). Prevention
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