11/18/2013

Global Polio Study Begins


NEW YORK, Nov. 18, 2013 /PRNewswire/ -- An unprecedented surveillance study launches today to contribute to global polio eradication efforts.  Recent outbreaks of Polio in Israel, Syria, Kenya, South Sudan, and Somalia have once again placed the virus at the forefront of Public Health Officials' concerns.
Jeffrey Modell FoundationJeffrey Modell Foundation
The Jeffrey Modell Foundation's surveillance study will focus on patients with Primary Immunodeficiencies (PI) who have either received the Oral Polio Vaccine (OPV), a live-weakened form of the virus, or have been exposed to it. Due to little or no immune system, when a patient with PI receives OPV, he or she is unable to create an immune response and therefore, cannot clear the intestinal vaccine virus infection, which is typically excreted within six to eight weeks by individuals with healthy immune systems. 
After prolonged periods of time, the virus may no longer be the same as the original vaccine-virus as it can genetically alter. This is called Vaccine Derived Poliovirus (VDPV). Although rare, it is expected that patients with PI are at risk of developing Vaccine Associated Paralytic Poliomyelitis (VAPP) and VDPV excretion, which could lead to possible exposure to the community.  The surveillance of these patients will shed light on important questions about vaccine-derived polioviruses throughout the globe. 
This study will include 25 sites across a wide geographical range.  The Jeffrey Modell Centers Network makes it possible to find a large patient population for this surveillance.  JMF Centers in Argentina, Brazil, Colombia, Mexico, China, Hong Kong, India, Israel, Iran, Kuwait, Russia, Poland, Turkey and Tunisia will participate.   JMF will work alongside the World Health Organization (WHO), The Centers for Disease Control and Prevention (CDC), Task Force for Global Health (TFGH), and the Bill & Melinda Gates Foundation. 
Vicki Modell, Co-Founder of JMF, says, "We are excited to begin such a meaningful and crucial surveillance project in so many regions of the world.  We are optimistic and hope to bring our energy, our commitment, and our compassion to this program."   
Once wild poliovirus is eradicated globally, vaccine-viruses will be the only type of live poliovirus in the community and could potentially lead to an outbreak.  In order to prevent this occurrence, the Polio Antivirals Initiative (PAI), an essential part of the TFGH's Polio Eradication effort, aims to create an efficient and inexpensive antiviral.
About Jeffrey Modell FoundationVicki and Fred Modell established the Jeffrey Modell Foundation in 1987, in memory of their son Jeffrey, who died at the age of fifteen from complications of Primary Immunodeficiency – a genetic condition that is chronic, serious, and often fatal.  JMF is a global nonprofit organization dedicated to early diagnosis, meaningful treatments and, ultimately, cures through research, physician education, public awareness, advocacy, patient support, and newborn screening.  The Jeffrey Modell Centers Network (JMCN) includes 556 physicians at 234 academic institutions in 196 cities and 78 countries spanning 6 continents.  For more information about PI, visit www.info4pi.org or email the Jeffrey Modell Foundation at info4pi@jmfworld.org
Post Polio Litaff, Association A.C _APPLAC Mexico

The Polio Crusade

THE POLIO CRUSADE IN AMERICAN EXPERIENCE A GOOD VIDEO THE STORY OF THE POLIO CRUSADE pays tribute to a time when Americans banded together to conquer a terrible disease. The medical breakthrough saved countless lives and had a pervasive impact on American philanthropy that ... Continue reading..http://www.pbs.org/wgbh/americanexperience/polio/

Erradicación de La poliomielitis

Polio Tricisilla Adaptada

March Of Dimes Polio History

Dr. Bruno

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A 41-year-old man developed an acute illness at the age of 9 months during which, following a viral illness with headache, he developed severe weakness and wasting of the limbs of the left side. After several months he began to recover, such that he was able to walk at the age of 2 years and later was able to run, although he was never very good at sports. He had stable function until the age of 18 when he began to notice greater than usual difficulty lifting heavy objects. By the age of 25 he was noticing progressive difficulty walking due to weakness of both legs, and he noticed that the right calf had become larger. The symptoms became more noticeable over the course of the next 10 years and ultimately both upper as well as both lower limbs had become noticeably weaker.

On examination there was wasting of the muscles of upper and lower limbs on the left, and massively hypertrophied gastrocnemius, soleus and tensor fascia late on the right. The calf circumference on the right exceeded that on the left by 10 cm (figure1). The right shoulder girdle, triceps, thenar eminence and small muscles of the hand were wasted and there was winging of both scapulae. The right quadriceps was also wasted. The wasted muscles were also weak but the hypertrophied right ankle plantar flexors had normal power. The tendon reflexes were absent in the lower limbs and present in the upper limbs, although the right triceps was reduced. The remainder of the examination was normal.

Figure 1

The patient's legs, showing massive enlargement of the right calf and wasting on the left

Questions

1
What is that nature of the acute illness in infancy?
2
What is the nature of the subsequent deterioration?
3
What investigations should be performed?
4
What is the differential diagnosis of the cause of the progressive calf hypertrophy?

Answers

QUESTION 1

An acute paralytic illness which follows symptoms of a viral infection with or without signs of meningitis is typical of poliomyelitis. Usually caused by one of the three polio viruses, it may also occur following vaccination and following infections with other enteroviruses.1 Other disorders which would cause a similar syndrome but with upper motor neurone signs would include acute vascular lesions, meningoencephalitis and acute disseminated encephalomyelitis.

QUESTION 2

A progressive functional deterioration many years after paralytic poliomyelitis is well known, although its pathogenesis is not fully understood.2 It is a diagnosis of exclusion; a careful search for alternative causes, for example, orthopaedic deformities such as osteoarthritis or worsening scoliosis, superimposed neurological disorders such as entrapment neuropathies or coincidental muscle disease or neuropathy, and general medical causes such as respiratory complications and endocrinopathies.3

QUESTION 3

Investigations revealed normal blood count and erythrocyte sedimentation rate and normal biochemistry apart from a raised creatine kinase at 330 IU/l (normal range 60–120 IU/l), which is commonly seen in cases of ongoing denervation. Electromyography showed evidence of denervation in the right APB and FDI with polyphasic motor units and complex repetitive discharges, no spontaneous activity in the left calf and large polyphasic units in the right calf consistent with chronic partial denervation. Motor and sensory conduction velocities were normal. A lumbar myelogram was normal. Magnetic resonance imaging (MRI) scan of the calves is shown in figure2.

Figure 2

Axial T1 weighted MRI scan (TR 588 ms, TE 15 ms) of the calves, showing gross muscle atrophy and replacement by adipose tissue on the left, and hypertrophy of the muscles on the right, with only minor adipose tissue deposition

QUESTION 4

The differential diagnosis of the progressive calf hypertrophy is given in the box.

Causes of calf muscle hypertrophy

Chronic partial denervation

  • radiculopathy

  • peripheral neuropathy

  • hereditary motor and sensory neuropathy

  • spinal muscular atrophy

  • following paralytic poliomyelitis

    Neuromyotonia and myokymia

  • Isaac's syndrome

  • generalised myokymia

  • neurotonia

  • continuous muscle fibre activity due to: chronic inflammatory demyelinating polyradiculopathy, Guillain Barre syndrome, myasthenia gravis, thymoma, thyrotoxicosis, thyroiditis

    Muscular dystrophies

    Myositis

    Infiltration

  • tumours

  • amyloidosis

  • cysticercosis

    Link here