May 9, 2012

Does the polio scare really exist today?

México a la vanguardia en el Síndrome de Post Polio

May 8, 2012

Post-poliomyelitis syndrome or Post-polio syndrome (PPS)


Post-poliomyelitis syndrome or Post-polio syndrome (PPS) is the commonly accepted term to describe the neuromuscular symptoms that may develop many years after acute paralytic poliomyelitis. The prevalence estimates of late onset neuromuscular symptoms in prior polio patients vary between 25 and 74%. PPS patients are diagnosed on the basis of a confirmed history of paralytic poliomyelitis, followed by partial to fairly complete neurological recovery and functional stability for at least 15 years. After this recovery period, new or increased muscle weakness or abnormal muscle fatigability (decreased endurance), with or without generalized fatigue, muscle atrophy, or muscle and joint pain, appear usually gradually. PPS diagnosis is made by exclusion. Laboratory tests are used to show evidence of prior polio and to exclude other diseases: electromyography (EMG) displays signs of reinnervation and denervation both in symptomatic and non-symptomatic muscles. Muscle biopsy findings include type-grouping of muscle fibres as the result of reinnervation, and hypertrophy of muscle fibres as a compensation for the loss of muscle fibres. No curative treatment is available for PPS. Management is preferably multidisciplinary and aims both at reducing muscle overuse and rebalancing muscular capacities and demands. It consists of exercise, assistive devices and life style changes. The etiology of PPS is still unclear. It is currently hypothesized that muscle fibres undergo denervation again due to distal degeneration of axons of enlarged motor units.

Expert reviewer(s)

  • Dr F. [Frans] NOLLET

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

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