Aug 31, 2019

Pakistan reports 5 more polio cases, Global total now 71

By NewsDesk  @infectiousdiseasenews
Five additional wild polioviruses type 1 (WPV1) cases were reported in the past week in Pakistan. According to the Global Polio Eradication Initiative, one case each was reported from Hangu, Bannu, and North Waziristan districts, Khyber Pakhtunkhwa province; and, two from Hyderabad district, Sindh province.
This brings Pakistan’s total to 58 this year and the global total to 71.
Pakistan only reported 12 cases all of last year.
In addition, seven more circulating vaccine-derived poliovirus type 2 (cVDPV2) cases were reported, six in the Democratic Republic of the Congo and one in Nigeria. To date, 59 cases have been reported in Africa and Asia this year.


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Aug 28, 2019

Cannabis for fibromyalgia

Cannabis has been used as an all-purpose homeopathic remedy for centuries. Over time, evidence suggests that the plant was an herbal remedy for psycho-neurological disordersbreast cancerrheumatism sexual disorders, and painful complications related to childbirth. Now, this ancient tool has a new, modern application. A cannabis patch is now available for patients with fibromyalgia and diabetic nerve pain.

Cannabis for fibromyalgia & nerve pain

Fibromyalgia and diabetic neuropathy have a couple of things in common. Both conditions involve seemingly unexplainable pain, tingling, and can drastically reduce your quality of life.
Early research suggests that cannabis may have powerful therapeutic effects for both conditions, and this new pain patch offers a novel new approach for conditions that are incredibly difficult to treat.
2014 survey from the National Pain Foundations found that cannabis was considered the most effective pain medication by fibromyalgia patients who were willing to experiment with the herb.
Not all survey respondents had consumed cannabis. However, those that had suggested that the herb worked better at managing pain than the leading prescriptions for fibromyalgia, including Savella, Cymbalta, and Lyrica.
Small human trials of cannabis for diabetic neuropathy have also been successful. A study of 16 patients with diabetic neuropathy of the feet found the herb successfully reduced pain symptoms in a dose-dependant manner. The cannabis plant has successfully reduced nerve pain associated with conditions like multiple sclerosis as well.
While expensive cannabis-based pharmaceuticals are already available in some countries for the treatment of nervous disorders, most canna-curious patients are stuck with topical creams and oral cannabis options, which can be a little strong for the daytime.
Now, one innovative company, Cannabis Science, has released a revolutionary new topical application of cannabis medicines.

Cannabis Science designs an infused pain patch

Cannabis Science, Inc. is a pharmaceutical research company that works to develop innovative new cannabis medicines. In November of 2016, they announced their most recent project, a transdermal patch that delivers powerful pain-fighting medicine through the skin and into the bloodstream.
The company has two new patches in mind, one for fibromyalgia and one for diabetic neuropathy. While both of these patches will contain cannabinoids, each formulation and delivery method will be designed to most effectively manage symptoms of the respective illness.
In a press release announcing the new pain patch, Cannabis Science CEO Raymond Dabney explains,
The development of these two new pharmaceutical medicinal applications are just the tip of the iceberg for what we see as the future for Cannabis Science.
While we strive to increase our land capacity for growth and facilities to produce our own product to supply our scientists with proprietary materials to make these formulations, we are also busy researching more potential needs for Cannabis related medical applications and developing the methods for delivery of these medications.
Earlier in 2016, Cannabis Science began recruiting for a study on inhaled cannabis preparations for patients with asthma and lung diseases like COPD.
Cannabis Science is also not the first company to look into the transdermal applications of cannabis. Mary’s Medicinals got there first, offering cannabis-infused pain patches to medical cannabis patients in Colorado, Arizona, Nevada, Washington, Michigan, and Oregon. The company also hopes to offer their patches in California soon.
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Aug 23, 2019

Polio Videos

Post Polio Litaff, Association A.C _APPLAC Mexico

Aug 22, 2019

Original Report Vitality Among Patients With Postpolio

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. DesignMulti-centre study.

Subjects: One hundred and forty-three patients with post- polio syndrome.

MethodsInventories 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 88 Stockholm, 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 vitality
ISSN 1650-1977J Rehabil Med 40
Neuropsychiatry, Neuropsychology, & Behavioral Neurology:

A Neuropsychological Study of the Postpolio Syndrome: Support for Depression Without Neuropsychological Impairment

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)
Neuropsiquiatría, Neuropsicología, Neurología y del Comportamiento:

Un estudio neuropsicológico del síndrome postpolio: Apoyo a la depresión sin deterioro neuropsicológico

Hazendonk, MBBSc Kim;. Crowe, Simon F. Ph D..


Objetivo: El presente estudio tuvo como objetivo examinar el funcionamiento cognitivo en el síndrome postpolio (SPP) después de controlar por los efectos de la depresión y el comportamiento de la enfermedad.
Antecedentes: Pocos estudios han investigado las posibles secuelas cognitivas del SPP, a pesar de amplia documentado quejas subjetivas de "fatiga mental".
Método: Un total de 23 enfermos de PPS, 20 supervivientes de la polio sin PPS, y 22 controles emparejados se compararon mediante el Inventario de Depresión de Beck-II, la enfermedad Cuestionario de Comportamiento, un síndrome de fatiga crónica lista de síntomas, y varias medidas de la memoria, la atención y concentración, incluyendo la tarea de Brown-Petersen, prueba de Stroop, Laberinto de Austin, California Verbal Learning Test, Trail Making Test, controlada oral Palabra Test de Asociación, y el símbolo dígitos Modalidades de prueba.
Resultados: En los participantes con un diagnóstico médico confirmado de PPS, hubo un nivel significativamente mayor de depresión y sintomatología hipocondríaca, en comparación con los otros dos grupos. Sin embargo, no existen diferencias significativas entre los tres grupos en las medidas neuropsicológicas.
Conclusiones: Estos resultados indican que las dificultades de atención y la memoria reportado por las víctimas del PPS puede estar relacionado con las manifestaciones físicas o psicológicas de la enfermedad en lugar de decrementos objetivo en el rendimiento cognitivo. (NNBN 2000, 13:112-118)

Editor (s): 

Post Polio Litaff, Association A.C _APPLAC Mexico

Aug 21, 2019

DVT: How We Treat These Blood Clots and Tips to Prevent Them

Deep vein thrombosis (DVT) is a condition in which a blood clot forms in one or more deep veins in your body—most often in the legs and sometimes in the arms. People who have DVT in the lower extremities often experience:
  • A hot burning sensation in the legs
  • New pain or intense cramping while walking
  • Swelling in an extremity
DVT affects as many as 900,000 Americans each year. People often develop DVT because they have a known or undiagnosed bleeding disorder, recently had an invasive surgery, or have been temporarily immobile due to a long plane ride or bed rest.
Our team successfully identifies and treats people with DVT every day. Recently, we saw a patient who frequently flew all around the world for work. After her flight landed in Washington, D.C., the patient experienced a swollen, painful leg. Under our care, the patient was seen and diagnosed with DVT. We were able to perform minimally invasive rapid clot removal for her and also identified the reason for her DVT—a central venous compressive syndrome called May-Thurner Syndrome—which we were able to treat with a stent. The patient returned home that night and was back at work the next day.
LISTEN: Dr. Abramowitz discusses DVT treatment and prevention in the Medical Intel podcast.

How We Diagnose and Treat DVT

To diagnose DVT, we typically begin with taking patient’s history to identify potential provoking risk factors and perform a physical exam. We’ll often perform an ultrasound to detect any blood clots. The ultrasound is a considerably quick test that’s usually done at the bedside and doesn’t require patients to experience radiation exposure.
Most people with DVT are treated with an anticoagulation agent, also known as a blood thinner. Anticoagulation agents are effective because they reduce the chances of additional blood clots forming while patients’ bodies naturally break down the blood clot. The body’s own process can take three to six months to dissolve the clot. For some patients with extensive blood clot formation, we can use minimally invasive techniques to remove the clot using a catheter (a plastic tube or hose). This allows us to directly remove the clot in a procedure called mechanical thrombectomy, which removes the clot using retrieval devices, such as a vacuum suction. We use clot-busting medication to assist with this process.
The risk of leaving DVT untreated depends on where in the body the DVT is and how long it’s left untreated.  Blood clots below the knee usually cause swelling short-term but don’t necessarily result in long-term damage to the leg. However, blood clots above the knee, especially those that extend above the groin and into the veins in your belly and pelvis, can lead to long-term drainage problems from the leg. These issues sometimes result in post-thrombotic syndrome, or long-term swelling, wounds on the legs and pain. Untreated DVT can also result in clots breaking free. Once in circulation, clots can travel to the lungs and causing a pulmonary embolism, a potentially fatal condition in which one or more arteries in the lungs become blocked.

Can DVT Be a Sign of a More Serious Condition?

While DVT is a condition in and of itself, it’s important to determine what caused a patient’s blood clots to ensure they don’t recur and identify any serious underlying medical conditions. DVT can be caused by genetic conditions, inflammatory autoimmune disorders, or even be the first sign that someone has cancer.
#DVT, or #bloodclots in the deep veins, can be linked to other medical conditions. Vascular surgeons work to not only treat blood clots but also attempt to identify what caused them. via @MedStarWHC

Tips to Prevent DVT

The best thing people can do to prevent DVT is to get up and move around. If you travel long distances by car, train, or airplane, or if you sit at a desk during work for long hours every day, make sure you stand up and move every hour or so. If you’re immobile due to surgery or another health condition, keep your blood circulating by doing exercises, such as ankle flexes or leg lifts, to activate the muscles in your legs.
Our team at MedStar Washington Hospital Center offers the latest, most effective techniques for treating DVT. And after treating DVT, we make sure we identify the reason you developed it in the first place. Make sure to reach out to a doctor if you’re experiencing symptoms of DVT—we’re here to help.

Post Polio Litaff, Association A.C _APPLAC Mexico

Aug 17, 2019

Biochemical Pain in Post Polio Syndrome.

Pain in Post-Polio Syndrome

Anne C. Gawne, MD, Roosevelt Warm Springs Institute for Rehabilitation, Post-Polio Clinic, Warm Springs, Georgia

Anne Carrington Gawne, MD received her medical training at the Uniformed Services University in Bethesda, Maryland, and did her residency at the National Rehabilitation Hospital in Washington, DC.
Before moving to Roosevelt Warm Springs Institute for Rehabilitation in Warm Springs, Georgia, Dr. Gawne treated polio survivors at National Rehabilitation Hospital for nine years. She co-authored Post-Polio Syndrome: Pathophysiology and Clinical Management with Lauro S. Halstead, MD, National Rehabilitation Hospital, which was published in Critical Reviews in Physical Medicine and Rehabilitation, Vol. 7, Issue 2, pages 147-188.

Symptoms of post-polio syndrome include fatigue, new weakness and pain in muscle and joints. Chronic pain is the second most prevalent symptom reported and frequently is the most difficult to treat. Improvement in the evaluation and treatment of pain can significantly improve comfort and restore function. The differential diagnosis is extensive, but many of the problems appear to be related to overuse of weak muscles along with abnormal joint and limb biomechanics.
To facilitate the diagnosis and treatment of pain, a classification that divides the pain syndromes into three classes has been developed:
  1. post-polio muscle pain;POST-POLIO MUSCLE PAIN occurs only in muscles affected by polio. It is described as either a deep or superficial aching pain, which many survivors say is similar to the muscle pain they experienced during their acute illness. Characterized by muscle cramps, fasciculations or a crawling sensation, it typically occurs at night or the end of the day when one tries to relax. It is exacerbated by physical activity and stress, and cold temperatures.
OVERUSE PAIN includes injuries to soft tissue, muscle, tendons, bursa and ligaments. Common examples are rotator cuff tendinitis, deltoid bursitis and myofascial pain. Myofascial pain in post-polio is similar to that in others. It occurs most frequently in the muscle of the upper back and shoulders and is characterized by bands of taut muscles and discrete trigger points that elicit a jump response when palpated. These occur due to poor posture or improper body biomechanics.
Fibromyalgia with its associated symptoms is another cause of muscle pain that has been recognized by other investigators and has similar symptoms, but is distinctly different from post-polio muscle pain. The classic tender points are uncommon with post-polio muscle pain.

BIOMECHANICAL PAIN presents as a degenerative joint disease (DJD), low back pain or pain from nerve compression syndromes. Weakness induced by polio-affected muscles, as well as poor body mechanics, makes the joints more susceptible to the development of DJD. Survivors who walk develop degenerative joint disease in the lower extremities because years of ambulating on unstable joints and supporting tissue increase the chance of developing further pain and deformity. Those who use wheelchairs or assistive devices such as canes, crutches or walkers are prone to DJD, or overuse syndromes, in their upper extremities, especially the wrist and shoulders. The joint pains are only rarely accompanied by swelling and/or inflammation, but do demonstrate tenderness and abnormal range of motion. X-rays of painful, weight-bearing joints may show degenerative changes proportional with the amount of stress the joints have sustained.
Nerve compression syndromes, including carpal tunnel syndrome (CTS), ulnar mononeuropathy at the wrist or elbow, brachial plexopathy and cervical or lumbosacral radiculopathy, are syndromes that can cause pain as well as neurological deficits in the post-polio individual. Risk factors for the development of focal neuropathies of the median and ulnar nerves include use of an assistive device such as a cane, crutch or wheelchair. These neuropathies can be detected on electrodiagnostic tests (EMG/NCS) before the individual has the characteristic symptoms of CTS.
The evaluation of post-polio individuals with pain requires careful investigation of all aspects of their pain. Among the questions asked are typical ones such as "What makes the pain better?" and "What makes it worse?" The way pain interferes with the survivors' ability to sleep and work is noted. Which treatments are helpful and by whom they are given is also documented.
Pain management in post-polio is based on a few basic principles, supplemented by class-specific recommendations. These basic principles include efforts to:
  1. improve abnormal body mechanics;
  2. correct and minimize postural and gait deviations mechanically;
  3. relieve or support weakened muscles and joints;
  4. promote lifestyle modifications;
  5. decrease the abnormally high work load of muscles relative to their limited capacity.
TREATMENT FOR POST-POLIO MUSCLE PAIN includes decreasing activity throughout the day, applying heat, and stretching. Stretching has a role in maintaining the extensibility of muscle and connective tissue; however, it must be performed judiciously because there are situations in which a polio survivor may derive greater functional benefit and be safer with tighter tendons and reduced joint range of motion.
A variety of medications are used to treat post-polio muscle pain, but the most common ones - such as nonsteroidal anti-inflammatories (NSAIDS), Tylenol, benzodiazepams, and narcotics - are of little use. The use of tricyclic antidepressants (TCAs), especially amitriptyline, can help with pain and also with fatigue.

TREATMENT FOR OVERUSE PAIN includes modification of extremity use, followed by modalities such as ice, heat or ultrasound, transcutaneous electrical nerve stimulation (TENS), and occasionally NSAID medications. Treatment for myofascial pain consists of myofascial release techniques, including spray and stretch and trigger-point injections. Often rest is not possible since many rely on upper extremities for both locomotion and self care. In rare cases, steroid injections or surgery may be needed.


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