3/16/2016

Human Achievement of the Day: Polio Eradication


Polio used to be a parent’s worst nightmare. The virus mostly affects children, and hampers the brain’s ability to communicate with muscles. While its effects are usually temporary, polio can lead to permanent paralysis and even death. If the paralysis reaches the respiratory system, victims will be unable to breathe on their own, which led to the depressing sight of hospital wards filled with rows and rows of iron lungs (pictured below). Polio can also cause permanent muscle atrophy, making walking difficult long after the disease runs its course. It has no cure, so once a child catches it, they can only hope their case is a mild one.
Then, in the 1950s, Jonas Salk invented the polio vaccine—a human achievement that continues to improve millions of lives even today. Within just a few years, polio completely disappeared in the United States. Parents all over America no longer had to fear that the virus would rob their children of the ability to walk. Children no longer had to avoid their friends who might have infected them, and did not have to dread the possibility of spending two weeks inside an iron lung.
The developing world has been less fortunate. But more and more, some of the world’s poorest people are able to share in what the economist Julian Simon called “our victory against death.” Polio has been gone from the U.S. for decades, but it wasn’t until the 1980s that a global campaign to eradicate the disease began in earnest. Even in the current decade, regions of Africa continued to grapple with polio and its human costs—until now.
New York Times story recently celebrated the fact that the entire continent of Africa has not had a single case of polio for more than a year. That’s 1.1 billion people, polio-free. Millions of childhoods are safer than they have ever been from a disease that has been a scourge for thousands of years.
What made this human achievement possible? Jonas Salk’s vaccine, most obviously. But the root cause is what economist and historian Deirdre McCloskey calls the “Great Enrichment.” As more and more people come around to the types of values that Human Achievement Hour celebrates—progress, dynamism, openness, and a general pro-human outlook—the world gets ever richer. And nowhere are those values having a greater impact than in the developing world. The more that people celebrate and honor human achievement, the more of it there will be.
Thanks to that ethos, more people today actually have lights that they can leave on, or turn off, as they wish. And when they do turn out those lights for the night, they can sleep well, knowing that thanks to people like Jonas Salk and his many successors who are working on cures for malaria, HIV/AIDS, and other diseases, their children will grow up to be healthier and wealthier than they were.

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