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Bellanti R, Rinaldi S. Guillain-Barré syndrome: a comprehensive review. Eur J Neurol 2024; 31:e16365. [PMID: 38813755 PMCID: PMC11235944 DOI: 10.1111/ene.16365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/12/2024] [Accepted: 05/13/2024] [Indexed: 05/31/2024]
Abstract
Guillain-Barré syndrome (GBS) is a potentially devastating yet treatable disorder. A classically postinfectious, immune-mediated, monophasic polyradiculoneuropathy, it is the leading global cause of acquired neuromuscular paralysis. In most cases, the immunopathological process driving nerve injury is ill-defined. Diagnosis of GBS relies on clinical features, supported by laboratory findings and electrophysiology. Although previously divided into primary demyelinating or axonal variants, this dichotomy is increasingly challenged, and is not endorsed by the recent European Academy of Neurology (EAN)/Peripheral Nerve Society (PNS) guidelines. Intravenous immunoglobulin and plasma exchange remain the primary modalities of treatment, regardless of the electrophysiological subtype. Most patients recover, but approximately one-third require mechanical ventilation, and 5% die. Disease activity and treatment response are currently monitored through interval neurological examination and outcome measures, and the potential role of fluid biomarkers is under ongoing scrutiny. Novel potential therapies for GBS are being explored but none have yet modified clinical practice. This review provides a comprehensive update on the pathological and clinical aspects of GBS for clinicians and scientists.
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Affiliation(s)
- Roberto Bellanti
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Simon Rinaldi
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
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Rougereau G, Hollier-Larousse B, Bauer T, Genêt F, Salga M, Cale F. Anterior-approach total hip arthroplasty in patients with poliomyelitis: Long-term outcomes. Orthop Traumatol Surg Res 2024:103964. [PMID: 39074552 DOI: 10.1016/j.otsr.2024.103964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 09/04/2023] [Accepted: 10/16/2023] [Indexed: 07/31/2024]
Abstract
OBJECTIVE In patients with residual poliomyelitis-related impairments, total hip arthroplasty (THA) is challenging due to the high frequency of risk factors such as hip dysplasia, dislocation, muscle weakness, and fracture. The objective of this study was to assess the long-term functional and radiographic outcomes of anterior-approach THA with a ceramic-ceramic, dual-mobility, or constrained implant in patients with poliomyelitis sequelae. HYPOTHESIS THA via the anterior approach with a ceramic-ceramic, dual-mobility, or constrained implant is a reliable technique that is not associated with excess risks of instability or aseptic loosening. MATERIAL AND METHODS This single-centre retrospective study included consecutive patients with poliomyelitis sequelae who underwent THA between January 1998 and September 2019 via the anterior approach, with implantation of a ceramic-ceramic, dual-mobility, or constrained implant. The Harris Hip Score (HHS), implant position, and complications (e.g., infection and loosening) were collected during the most recent in-person visit. RESULTS The study included 19 patients (23 hips). Mean follow-up was 5.2 ± 4.2 years (range, 2.0-10.6 years). Only six of the 23 procedures were done on the side with greater muscle weakness. The mean HHS at last follow-up was 80.4 ± 10.4. A single procedure (1/23, 4%) was followed by a complication, consisting in intra-prosthetic dislocation 2 years after implantation of a dual-mobility cup. At last follow-up, the HHS was not associated with psoas and gluteus muscle strength (rs = 0.35, p = 0.11 and rs = 0.37, p = 0.09, respectively) and was not significantly different between the weaker vs. stronger side (82.7 ± 8.0 vs. 79.5 ± 11.3, respectively; p = 0.53). Cup position was more horizontal, thereby optimising function, when the procedure was done on the weaker vs. the stronger side (39.9° ± 4.3 vs. 45.0° ± 6.8, respectively; p = 0.02). CONCLUSION THA is a good option for improving function in patients with poliomyelitis sequelae. THA via the anterior approach with a ceramic-ceramic, dual-mobility, or constrained implant is a reliable method that is not associated with an excess risk of instability or loosening. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Grégoire Rougereau
- Département de chirurgie orthopédique et traumatologique, Hôpital Raymond-Poincaré, APHP, Garches, France; Département de chirurgie orthopédique et traumatologique, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France.
| | - Bernard Hollier-Larousse
- Département de chirurgie orthopédique et traumatologique, Hôpital Raymond-Poincaré, APHP, Garches, France
| | - Thomas Bauer
- Département de chirurgie orthopédique et traumatologique, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France
| | - François Genêt
- UPOH (Unité Péri Opératoire du Handicap, Perioperative Disability Unit), PMR Department, Raymond-Poincaré Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Garches, France; Université Versailles Saint-Quentin-en-Yvelines (UVSQ), UFR Simone Veil - Santé, END: ICAP, Inserm U1179, Montigny-le-Bretonneux, France; Garches Neuro-Orthopaedics Research Group (GRENOG), Garches, France
| | - Marjorie Salga
- UPOH (Unité Péri Opératoire du Handicap, Perioperative Disability Unit), PMR Department, Raymond-Poincaré Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Garches, France; Université Versailles Saint-Quentin-en-Yvelines (UVSQ), UFR Simone Veil - Santé, END: ICAP, Inserm U1179, Montigny-le-Bretonneux, France; Garches Neuro-Orthopaedics Research Group (GRENOG), Garches, France
| | - Fabien Cale
- Département de chirurgie orthopédique et traumatologique, Hôpital Raymond-Poincaré, APHP, Garches, France
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Izquierdo-Condoy JS, Vásconez-Gonzáles J, Morales-Lapo E, Tello-De-la-Torre A, Naranjo-Lara P, Fernández R, Hidalgo MR, Escobar A, Yépez VH, Díaz AM, Oliva C, Ortiz-Prado E. Beyond the acute phase: a comprehensive literature review of long-term sequelae resulting from infectious diseases. Front Cell Infect Microbiol 2024; 14:1293782. [PMID: 38357446 PMCID: PMC10864624 DOI: 10.3389/fcimb.2024.1293782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/16/2024] [Indexed: 02/16/2024] Open
Abstract
Infectious diseases have consistently served as pivotal influences on numerous civilizations, inducing morbidity, mortality, and consequently redirecting the course of history. Their impact extends far beyond the acute phase, characterized by the majority of symptom presentations, to a multitude of adverse events and sequelae that follow viral, parasitic, fungal, or bacterial infections. In this context, myriad sequelae related to various infectious diseases have been identified, spanning short to long-term durations. Although these sequelae are known to affect thousands of individuals individually, a comprehensive evaluation of all potential long-term effects of infectious diseases has yet to be undertaken. We present a comprehensive literature review delineating the primary sequelae attributable to major infectious diseases, categorized by systems, symptoms, and duration. This compilation serves as a crucial resource, illuminating the long-term ramifications of infectious diseases for healthcare professionals worldwide. Moreover, this review highlights the substantial burden that these sequelae impose on global health and economies, a facet often overshadowed by the predominant focus on the acute phase. Patients are frequently discharged following the resolution of the acute phase, with minimal long-term follow-up to comprehend and address potential sequelae. This emphasizes the pressing need for sustained vigilance, thorough patient monitoring, strategic health management, and rigorous research to understand and mitigate the lasting economic and health impacts of infectious diseases more fully.
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Njoh AA, Josue Kedakse TSN, Eric Mboke E, Nembot R, Collins LYP, Amani A, Bachire HB, Gulma KA, De Kiev LC. Polio outbreaks in Cameroon following the COVID-19 pandemic. Pan Afr Med J 2023; 45:90. [PMID: 37663631 PMCID: PMC10474802 DOI: 10.11604/pamj.2023.45.90.35332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/09/2023] [Indexed: 09/05/2023] Open
Abstract
Polio is an infectious and disabling life-threatening disease caused by the poliovirus. This disease is prevented through vaccination. Though this viral infection has been eliminated in most parts of the world, a few countries are still endemic to wild poliovirus. In 2020, the World Health Organization (WHO) African Region, including Cameroon, was certified free of wild poliovirus. Some countries recurrently report circulating vaccine-derived poliovirus cases (cVDPV) despite recorded achievements. Also, the risk of importing poliovirus from endemic settings remains, particularly in the context of coronavirus disease (COVID-19). This study aimed to assess the state of polio in Cameroon and identify the situation during COVID-19. A data review was conducted from February to March 2023. Data on polio cases and vaccination coverage per region of Cameroon were reviewed from 2014 to 2022. Data were analyzed with Microsoft Excel, and the results were presented as proportions. The last wild poliovirus was reported in Cameroon in 2014, and the country benefitted from a response. No case of poliovirus was detected in the country from 2015 to 2018. After that, an increasing number of type two cVDPV were reported across 50% of the country's regions from 2019 to 2022. The outbreaks benefitted from responses with various oral polio vaccines, including the type two novel oral polio vaccine (nOPV-2). Though wild polioviruses have been eliminated in most countries, including Cameroon, cVDPV remains a significant problem. There is an urgent need to strengthen disease surveillance and vaccination to prevent cVDPV-2 in this country, particularly in the COVID-19 context.
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Affiliation(s)
- Andreas Ateke Njoh
- Expanded Program on Immunization, Ministry of Public Health, Yaoundé, Cameroon
- School of Global Health and Bioethics, Euclid University, Bangui, Central African Republic
| | | | - Ekoum Eric Mboke
- Expanded Program on Immunization, Ministry of Public Health, Yaoundé, Cameroon
| | - Raoul Nembot
- Expanded Program on Immunization, Ministry of Public Health, Yaoundé, Cameroon
| | | | | | | | - Kabiru Abubakar Gulma
- School of Global Health and Bioethics, Euclid University, Bangui, Central African Republic
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Karczewski D, Siljander MP, Larson DR, Taunton MJ, Lewallen DG, Abdel MP. Primary total knee arthroplasty in patients with post-polio syndrome. Bone Joint J 2023; 105-B:635-640. [PMID: 37259562 DOI: 10.1302/0301-620x.105b6.bjj-2022-0988.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Aims Knowledge on total knee arthroplasties (TKAs) in patients with a history of poliomyelitis is limited. This study compared implant survivorship and clinical outcomes among affected and unaffected limbs in patients with sequelae of poliomyelitis undergoing TKAs. Methods A retrospective review of our total joint registry identified 94 patients with post-polio syndrome undergoing 116 primary TKAs between January 2000 and December 2019. The mean age was 70 years (33 to 86) with 56% males (n = 65) and a mean BMI of 31 kg/m2 (18 to 49). Rotating hinge TKAs were used in 14 of 63 affected limbs (22%), but not in any of the 53 unaffected limbs. Kaplan-Meier survivorship analyses were completed. The mean follow-up was eight years (2 to 19). Results The ten-year survivorship free from revision was 91% (95% confidence interval (CI) 81 to 100) in affected and 84% (95% CI 68 to 100) in unaffected limbs. There were six revisions in affected limbs: three for periprosthetic femoral fractures and one each for periprosthetic joint infection (PJI), patellar clunk syndrome, and instability. Unaffected limbs were revised in four cases: two for instability and one each for PJI and tibial component loosening. The ten-year survivorship free from any reoperation was 86% (95% CI 75 to 97) and 80% (95% CI 64 to 99) in affected and unaffected limbs, respectively. There were three additional reoperations among affected and two in unaffected limbs. There were 12 nonoperative complications, including four periprosthetic fractures. Arthrofibrosis occurred in five affected (8%) and two unaffected limbs (4%). Postoperative range of motion decreased with 31% achieving less than 90° knee flexion by five years. Conclusion TKAs in post-polio patients are complex cases associated with instability, and one in four require constraint on the affected side. Periprosthetic fracture was the main mode of failure. Arthrofibrosis rates were high and twice as frequent in affected limbs.
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Affiliation(s)
- Daniel Karczewski
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Dirk R Larson
- Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Taunton
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - David G Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Liu KB, Guan J, Zang JC, Hua QK, Qin SH. The epidemiological characteristics of neurogenic limb deformity disorder in China: a national-based study from Qin Sihe orthopedic center. BMC Public Health 2023; 23:567. [PMID: 36973707 PMCID: PMC10041791 DOI: 10.1186/s12889-023-15470-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/18/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Neurogenic limb deformity disorder (NLDD) refers to limb deformity disorders caused by various neurogenic disorders. However, there are no studies to systematically summarize and analyze these diseases in China, and we first proposed the concept of NLDD. We describe the epidemiological characteristics of NLDD in China based on the largest case database of limb orthopedics in China. METHODS This study analyzed parameters from the Qin Sihe Orthopedic Surgery Case Data (QSHOSCD). The database is based on the Rehabilitation Hospital affiliated to National Research Center for Rehabilitation, which has collected nearly 37,000 patients to date and includes a wide variety of limb deformities. The types of diseases are summarized and classified for all patients studied. Statistical analysis was based on the type of etiology, age, regional distribution, and historical surgical volume. Partial outcomes were statistically analyzed separately by common diseases (polio and cerebral palsy) and rare diseases (37 other diseases). RESULTS From 1979 to 2019, 30,194 patients with NLDD were treated surgically for 39 neurogenic disorders. The male to female ratio was 1.48:1, the mean age was 19.65 years, and most patients (82.38%) were aged between 6 and 30 years. Patients included from 32 provinces and cities across China, mainly concentrated in populous central provinces and Heilongjiang Province. The peak of annual surgical procedures was from 1988 to 1994, and the number of annual surgical procedures for common diseases gradually decreased from 1994 onwards, but the trending is opposite for rare diseases. CONCLUSIONS This study is the first to demonstrate the disease types, population characteristics and incidence trends of NLDD in China. It suggests that the prevention and treatment of NLDD should focus on the adolescent population and enhance the treatment of neurogenic diseases that cause limb deformities. The growth and adaption of the Ilizarov technique and its practice in Chinese orthopedic benefits the treatment of neurogenic limb deformity disorders.
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Affiliation(s)
- Kai-Bing Liu
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jack Guan
- Bay Area Foot and Ankle Medical Clinic, San Jose, USA
| | - Jian-Cheng Zang
- Department of Orthopaedics, Rehabilitation hospital, National Research Center For Rehabilitation, Beijing, China
- Key Laboratory of Intelligent Control and Rehabilitation Technology, Ministry of Civil Affairs, Beijing, China
| | - Qi-Kai Hua
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
| | - Si-He Qin
- Department of Orthopaedics, Rehabilitation hospital, National Research Center For Rehabilitation, Beijing, China.
- Key Laboratory of Intelligent Control and Rehabilitation Technology, Ministry of Civil Affairs, Beijing, China.
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Shi L, Che G, Huang Y, Yi M, Kang P. Outcomes of total hip arthroplasty with a standard prosthesis for the affected hip in patients with poliomyelitis sequelae: a mid-term retrospective follow-up study. J Orthop Surg Res 2023; 18:195. [PMID: 36915109 PMCID: PMC10009972 DOI: 10.1186/s13018-023-03697-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 03/09/2023] [Indexed: 03/14/2023] Open
Abstract
INTRODUCTION Total hip arthroplasty for poliomyelitis sequelae could be a technical challenge due to the higher risk for prosthetic dislocation and degenerative changes in the affected limbs. This study aimed to analyse the mid-term outcomes of primary total hip arthroplasty on the affected hip with standard prosthesis. MATERIALS AND METHODS From January 2008 to January 2018, 32 patients with poliomyelitis sequelae underwent total hip arthroplasty on the affected hip with standard prosthesis. Clinical and radiographical outcomes, complications, and prosthesis survival rates were evaluated. RESULTS After a mean follow-up of 7.9 (4.4-13.1) years, the Harris Hip Score, University of California Los Angeles activity level rating, and 12-item Short Form Health Survey Questionnaire scale score significantly improved. The abduction and flexion motions of the hip joint improved dramatically, and the visual analogue scale pain score decreased significantly. The leg length discrepancy was effectively corrected. During the follow-up, one patient experienced prosthetic dislocation, one underwent revision surgery due to acetabular component loosening, two had osteolysis, four had heterotopic ossification, two experienced transient sciatic nerve palsy, and one had intermuscular vein thrombosis. The prosthesis survival rate was 96.9% at 5 years postoperatively. No periprosthetic infection occurred. CONCLUSION Total hip arthroplasty with standard prosthesis could be an effective treatment for hip arthropathy on the affected hip of patients with poliomyelitis sequelae, resulting in good clinical outcomes and few complications. Constrained liner and dual mobility articulation are not recommended unless the hip muscle strength of the abductor is < III.
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Affiliation(s)
- Lihan Shi
- Department of Orthopaedics Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-qiao Road, Chengdu, 610036, Sichuan Province, People's Republic of China
| | - Guangwei Che
- Department of Orthopaedics Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-qiao Road, Chengdu, 610036, Sichuan Province, People's Republic of China
| | - Yong Huang
- Department of Orthopaedics Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-qiao Road, Chengdu, 610036, Sichuan Province, People's Republic of China
| | - Min Yi
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Pengde Kang
- Department of Orthopaedics Surgery, West China Hospital, Sichuan University, 37# Wainan Guoxue Road, Chengdu, 610041, Sichuan Province, People's Republic of China.
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Li S, Chen X, Li S, Weng X, Lin J, Jin J, Qian W. Total Hip Arthroplasty in the Nonparalytic Limb of Residual Poliomyelitis Patients: A Propensity Score Matched Study. Orthop Surg 2023; 15:1037-1044. [PMID: 36810876 PMCID: PMC10102314 DOI: 10.1111/os.13685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE Poliomyelitis is a rare neuromuscular disease that can cause hip osteoarthritis on the contralateral side due to an abnormal mechanical weight-bearing state, making some residual poliomyelitis patients candidates for total hip arthroplasty (THA). The aim of this study was to investigate the clinical outcome of THA in the nonparalytic limbs of these patients compared with those of non-poliomyelitis patients. METHODS Patients treated between January 2007 and May 2021 were retrospectively identified in a single center arthroplasty database. Eight residual poliomyelitis cases that met the inclusion criteria were matched to non-poliomyelitis cases in a ratio of 1:2 based on age, sex, body mass index (BMI), age-adjusted Charlson comorbidity index (aCCI), surgeon, and operation date. The hip function, health-related quality of life, radiographic outcomes, and complications were analyzed with unpaired Student's t test, Mann-Whitney test, Fisher's exact test or analysis of covariance (ANCOVA). Survivorship analysis was determined using the Kaplan-Meier estimator analysis and Gehan-Breslow-Wilcoxon test. RESULTS After a mean follow-up of about 5 years, patients with residual poliomyelitis had worse postoperative mobility outcomes(P < 0.05), but there was no difference in total modified Harris hip score (mHHS) or European quality of life-visual analogue scale (EQ-VAS) between the two groups (P > 0.05). There was no difference in radiographic outcomes or complications between the two groups, and patients had similar postoperative satisfaction (P > 0.05). No readmission or reoperation occurred in the poliomyelitis group (P > 0.05), but the postoperative limb length discrepancy (LLD) in the residual poliomyelitis group was greater than that in the control group (P < 0.05). CONCLUSION Functional outcomes, health-related quality of life improvement were similarly significantly improved in the nonparalytic limb of residual poliomyelitis patients after THA compared with conventional osteoarthritis patients. However, the residual LLD and weak muscle strength of the affected side will still influence mobility, so residual poliomyelitis patients should be fully informed of this outcome before surgery.
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Affiliation(s)
- Songlin Li
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chineses Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xi Chen
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shanni Li
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chineses Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xisheng Weng
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chineses Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jin Lin
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chineses Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jin Jin
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chineses Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenwei Qian
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chineses Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Wang X, Ren R, Ma B, Xie J, Ma Y, Luo H, Guo Y, Ding L, Zhang L, Zhang M, Wang T, Shuang Z, Zhu X. Comparative Study on MNVT of OPV Type I and III Reference Products in Different Periods. Diseases 2023; 11:diseases11010028. [PMID: 36810542 PMCID: PMC9944487 DOI: 10.3390/diseases11010028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 02/10/2023] Open
Abstract
Widespread vaccination using the oral live attenuated polio vaccine (OPV) and Sabin strain inactivated vaccine (sIPV) have greatly reduced the incidence of polio worldwide. In the period post-polio, the virulence of reversion of the Sabin strain makes the use of OPV gradually becoming one of the major safety hazards. The verification and release of OPV has become the top priority. The monkey neurovirulence test (MNVT) is the gold standard for detecting whether OPV meets the criteria, which are recommended by the WHO and Chinese Pharmacopoeia. Therefore, we statistically analyzed the MNVT results of type I and III OPV at different stages: 1996-2002 and 2016-2022. The results show that the upper and lower limits and C value of the qualification standard of type I reference products in 2016-2022 have decreased compared with the corresponding scores in the 1996-2002 period. The upper and lower limit and C value of the qualified standard of type III reference products were basically the same as the corresponding scores in the 1996-2002. We also found significant differences in the pathogenicity of the type I and III in the cervical spine and brain, with the decreasing trend in the diffusion index of the type I and type III in the cervical spine and brain. Finally, two evaluation criteria were used to judge the OPV test vaccines from 2016 to 2022. The vaccines all met the test requirements under the evaluation criteria of the above two stages. Based on the characteristics of OPV, data monitoring was one of the most intuitive methods to judge changes in virulence.
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Bravar G, Luchesa Smith A, Siddiqui A, Lim M. Acute Myelopathy in Childhood. CHILDREN (BASEL, SWITZERLAND) 2021; 8:1055. [PMID: 34828768 PMCID: PMC8618498 DOI: 10.3390/children8111055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/04/2021] [Accepted: 11/11/2021] [Indexed: 12/13/2022]
Abstract
Acute myelopathy presenting in childhood can be clinically classified based on the location of injury (with resulting spinal syndrome) or the cause (broadly traumatic or non-traumatic). Types of nontraumatic myelopathy include ischaemic, infectious, inflammatory, nutritional, and metabolic causes, some of which may be part of a systemic illness such as systemic lupus erythematosus or a demyelinating disease such as multiple sclerosis. Nonaccidental injury is an important consideration in cases of traumatic myelopathy, which may often be associated with other injuries. Assessment should include neuroimaging of the brain and spinal cord, with further investigations targeted based on the most likely differential diagnoses; for example, a child with suspected demyelinating disease may require specialist cerebrospinal fluid and serological testing. Management also will differ based on the cause of the myelopathy, with several of these treatments more efficacious with earlier initiation, necessitating prompt recognition, diagnosis, and treatment of children presenting with symptoms of a myelopathy. Important components of holistic care may include physiotherapy and occupational therapy, with multidisciplinary team involvement as required (for example psychological support or specialist bowel and bladder teams).
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Affiliation(s)
- Giulia Bravar
- Department of Paediatrics, Hospital Santa Maria della Misericordia, 33100 Udine, Italy;
| | | | - Ata Siddiqui
- Children’s Neurosciences, Evelina London Children’s Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London SE1 7EH, UK;
- Department of Neuroradiology, King’s College Hospital, London SE5 9RS, UK
| | - Ming Lim
- Children’s Neurosciences, Evelina London Children’s Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London SE1 7EH, UK;
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London SE5 9NU, UK
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Outcomes of dual mobility articulation total hip arthroplasty in ipsilateral residual poliomyelitis. INTERNATIONAL ORTHOPAEDICS 2021; 46:489-496. [PMID: 34580745 DOI: 10.1007/s00264-021-05222-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/14/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patients with poliomyelitis underwent total hip arthroplasty (THA) are known to be at higher risk of dislocation on account of muscular atrophy. This study aimed to investigate clinical outcomes, radiographic outcomes, complication rates, and survivorship of dual mobility THA in displaced femoral neck fractures of elderly with poliomyelitis. MATERIALS AND METHODS We retrospectively included 17 patients (17 hips) with residual poliomyelitis who underwent THA with dual mobility articulation. Clinical outcomes were assessed with the visual analog scale (VAS) pain score, Oxford hip score, and University of California Los Angeles activity (UCLA) score. Radiographic outcomes were examined by radiographs. Complications and re-operations following THA were recorded. RESULTS The mean follow-up period was 77.05 months. The mean VAS, Oxford hip score, and UCLA score were improved significantly. In all but one patient, no complications were occurred. Re-operation was carried out in one patient due to posterior dislocation. The Kaplan-Meier survivorship with an end point of re-operation for any reason was 94.1%. CONCLUSIONS THA with dual mobility system is proved to be effective in strengthening stability and reducing the risk of dislocation, which is suitable for patients with neuromuscular disease. Hence, in elderly with residual poliomyelitis, dual mobility THA is a valid choice as a treatment for displaced femoral neck fractures.
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Arnold WD, Severyn S, Zhao S, Kline D, Linsenmayer M, Kelly K, Tellez M, Bartlett A, Heintzman S, Reynolds J, Sterling G, Weaver T, Rajneesh K, Burghes AHM, Kolb SJ, Elsheikh B. Persistent neuromuscular junction transmission defects in adults with spinal muscular atrophy treated with nusinersen. BMJ Neurol Open 2021; 3:e000164. [PMID: 34466806 PMCID: PMC8362737 DOI: 10.1136/bmjno-2021-000164] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/26/2021] [Indexed: 12/12/2022] Open
Abstract
Objective Spinal muscular atrophy (SMA) is a motor neuron disease caused by low levels of survival motor neuron (SMN) protein. Prior work in models and patients has demonstrated electrophysiological and morphological defects at the neuromuscular junction (NMJ). Therapeutic development has resulted in clinically available therapies to increase SMN protein levels in patients and improve muscle function. Here we aimed to investigate the effect of SMN restoration (via nusinersen) on NMJ transmission in adults with SMA. Methods Participants undergoing nusinersen treatment underwent 3 Hz repetitive nerve stimulation (RNS) of the spinal accessory nerve to assess compound muscle action potential amplitude decrement. Maximum voluntary isometric contraction (MVICT), Revised Upper Limb Module (RULM), and 6 min walk test (6MWT) were assessed for correlations with decrement. Results Data from 13 ambulatory (7 men/6 women, mean age 40±11 years) and 11 non-ambulatory (3 men/8 women, mean age 38±12 years) participants were analysed. Cross-sectional analyses of RNS decrement were similar at 14 months of nusinersen (−14.2%±11.5%, n=17) vs baseline (−11.9%±8.3%, n=15) (unpaired t-test, p=0.5202). Longitudinal comparison of decrement in eight participants showed no change at 14 months (−13.9%±6.7%) vs baseline (−16.9%±13.4%) (paired t-test, p=0.5863). Decrement showed strong correlations with measures of MVICT, RULM and 6MWT but not age or disease duration. Conclusion Adults with SMA had significant NMJ transmission defects that were not corrected with 14 months of nusinersen treatment. NMJ defects were negatively associated with physical function, and thus may represent a promising target for additive or combinatorial treatments.
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Affiliation(s)
- W David Arnold
- Neurology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Steven Severyn
- Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Songzhu Zhao
- Biomedical Informatics and Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA
| | - David Kline
- Biomedical Informatics and Center for Biostatistics, The Ohio State University, Columbus, Ohio, USA
| | - Matthew Linsenmayer
- Assistive Technology Department, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Kristina Kelly
- Neurology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Marco Tellez
- Neurology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Amy Bartlett
- Neurology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Sarah Heintzman
- Neurology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jerry Reynolds
- Neurology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Gary Sterling
- Neurology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Tristan Weaver
- Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Kiran Rajneesh
- Neurology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Arthur H M Burghes
- Department of Biological Chemistry and Pharmacology, The Ohio State University, Columbus, Ohio, USA
| | - Stephen J Kolb
- Neurology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Department of Biological Chemistry and Pharmacology, The Ohio State University, Columbus, Ohio, USA
| | - Bakri Elsheikh
- Neurology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Treatment with L-Citrulline in patients with post-polio syndrome: A single center, randomized, double blind, placebo-controlled trial. Neuromuscul Disord 2021; 31:1136-1143. [PMID: 34711479 DOI: 10.1016/j.nmd.2021.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 08/15/2021] [Accepted: 08/18/2021] [Indexed: 11/23/2022]
Abstract
This single-centered, randomized, double-blind, placebo-controlled study reports the results of L-Citrulline treatment for 24 weeks in patients with post-polio syndrome (PPS). Twenty-nine patients were randomized and assigned into receiving a treatment of 15 g L-Citrulline or placebo. The primary endpoint was the change of the 6 min walking distance test. Secondary endpoints included motor function measure, quantitative muscle strength, quantitative MRI and self-reported impairment questionnaires. Patients receiving L-Citrulline walked 17.5 longer in the 6 min walking distance test when compared to placebo group, however not statistically significant (95% CI = -14.69; 49.68, p = 0.298). None of the secondary endpoints showed a statistically significant change in the L-Citrulline group when compared to placebo group. The motor function measure showed a change of -0.78 (95% CI= [-3.39; 1.83] p = 0.563). Muscle degeneration of leg muscles assessed with quantitative MRI indicated no significant change (estimate= -0.01, 95% CI =-0.13; 0.11, p = 0.869). L-Citrulline was safe and well tolerated. In conclusion, administration of 15 g L-Citrulline daily for 24 weeks to patients with PPS showed no beneficial treatment effect in timed muscle function.
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14
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de Lira CAB, Santos DAT, Viana RB, Guimarães JM, Oliveira JNS, Sousa BS, de Santana MG, Vancini RL, Andrade MS, Nikolaidis P, Rosemann T, Knechtle B. Knowledge of healthcare professionals about poliomyelitis and postpoliomyelitis: a cross-sectional study. SAO PAULO MED J 2021; 139:464-475. [PMID: 34378735 PMCID: PMC9632530 DOI: 10.1590/1516-3180.2020.0617.16032021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 03/16/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Postpoliomyelitis syndrome is a clinical condition that can affect poliomyelitis survivors. OBJECTIVE Our aim was to evaluate knowledge of poliomyelitis and postpoliomyelitis syndrome among Brazilian healthcare professionals. DESIGN AND SETTING Cross-sectional study conducted at a Brazilian public higher education institution located in the state of Goiás. METHODS The participants (n = 578) were Brazilian physicians, physical therapists, nurses, nutritionists and psychologists. A self-administered questionnaire (30 questions) was designed to probe knowledge about poliomyelitis and postpoliomyelitis syndrome. From the questionnaire, we created a structured test to objectively evaluate the knowledge of these professionals. The test was composed of 20 questions and was scored over a range from 0 (totally ill-informed) to 20 (totally well-informed). RESULTS In general, the physicians, physical therapists and nurses demonstrated better understanding of poliomyelitis and postpoliomyelitis syndrome. The healthcare professionals who had received previous information about poliomyelitis and postpoliomyelitis syndrome had significantly higher scores than those who had never received information (P < 0.001). On average, this difference was approximately 28.6%. CONCLUSIONS The findings from the present study indicate that there is a critical need for improvement of knowledge about postpoliomyelitis syndrome among Brazilian healthcare professionals. The services provided by these professionals may therefore become compromised. Furthermore, public healthcare initiatives should be implemented to improve knowledge among healthcare professionals.
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Affiliation(s)
- Claudio Andre Barbosa de Lira
- BSc, PhD. Associate Professor, Faculdade de Educação Física e Dança (FEFD), Universidade Federal de Goiás (UFG), Goiânia (GO), Brazil.
| | - Douglas Assis Teles Santos
- BSc, MSc. Assistent Professor, Colegiado de Educação Física, Universidade do Estado da Bahia (UNEB), Teixeira de Freitas (BA), Brazil.
| | - Ricardo Borges Viana
- BSc, PhD. Professor, Escola Superior de Educação Física e Fisioterapia do Estado de Goiás (ESEFFEGO), Universidade Estadual de Goiás (UEG), Goiânia (GO), Brazil.
| | - Juliana Moreira Guimarães
- BSc. Nurse, Unidade Acadêmica Especial de Ciências da Saúde, Universidade Federal de Jataí (UFJ), Jataí (GO), Brazil.
| | - Jéssica Nathalia Soares Oliveira
- BSc. Biomedic, Unidade Acadêmica Especial de Ciências da Saúde (UA-CISAU), Universidade Federal de Jataí (UFJ), Jataí (GO), Brazil.
| | - Bolivar Saldanha Sousa
- MD, PhD. Physician, Hospital Israelita Albert Einstein, São Paulo-Brazil, São Paulo (SP), Brazil.
| | - Marcos Gonçalves de Santana
- BSc, PhD. Associate Professor, Unidade Acadêmica Especial de Ciências da Saúde (UA-CISAU), Universidade Federal de Jataí (UFJ), Jataí (GO), Brazil.
| | - Rodrigo Luiz Vancini
- BSc, PhD. Adjunct Professor, Centro de Educação Física e Desportos, Universidade Federal do Espírito Santo (UFES), Vitória (ES), Brazil.
| | - Marília Santos Andrade
- PhD. Physical Therapist and Associate Professor, Department of Physiology, Universidade Federal de São Paulo (USP), São Paulo (SP), Brazil.
| | - Pantelis Nikolaidis
- BSc, PhD. Professor, School of Health and Caring Sciences, University of West Attica, Athens, Greece.
| | - Thomas Rosemann
- MD, PhD. Physician and Professor, Institute of Primary Care, University of Zurich, Zurich, Switzerland.
| | - Beat Knechtle
- MD, PhD. Physician and Scientific Assistant, Institute of Primary Care, University of Zurich, Zurich, Switzerland; and Researcher, Medbase St. Gallen Am Vadianplatz, St. Gallen, Switzerland
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15
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Valerio F, Whitehouse DP, Menon DK, Newcombe VFJ. The neurological sequelae of pandemics and epidemics. J Neurol 2021; 268:2629-2655. [PMID: 33106890 PMCID: PMC7587542 DOI: 10.1007/s00415-020-10261-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/03/2020] [Accepted: 10/07/2020] [Indexed: 12/11/2022]
Abstract
Neurological manifestations in pandemics frequently cause short and long-term consequences which are frequently overlooked. Despite advances in the treatment of infectious diseases, nervous system involvement remains a challenge, with limited treatments often available. The under-recognition of neurological manifestations may lead to an increase in the burden of acute disease as well as secondary complications with long-term consequences. Nervous system infection or dysfunction during pandemics is common and its enduring consequences, especially among vulnerable populations, are frequently forgotten. An improved understanding the possible mechanisms of neurological damage during epidemics, and increased recognition of the possible manifestations is fundamental to bring insights when dealing with future outbreaks. To reverse this gap in knowledge, we reviewed all the pandemics, large and important epidemics of human history in which neurological manifestations are evident, and described the possible physiological processes that leads to the adverse sequelae caused or triggered by those pathogens.
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Affiliation(s)
- Fernanda Valerio
- University Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge, Box 93, Hills Road, Cambridge, CB2 0QQ, UK.
| | - Daniel P Whitehouse
- University Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge, Box 93, Hills Road, Cambridge, CB2 0QQ, UK
| | - David K Menon
- University Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge, Box 93, Hills Road, Cambridge, CB2 0QQ, UK
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - Virginia F J Newcombe
- University Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge, Box 93, Hills Road, Cambridge, CB2 0QQ, UK
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
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16
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Total Hip Arthroplasty in Patients With Postpolio Residual Paralysis: A Systematic Review. J Arthroplasty 2021; 36:2239-2247. [PMID: 33593623 DOI: 10.1016/j.arth.2021.01.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/25/2020] [Accepted: 01/18/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Patients with postpolio residual paralysis can develop disabling hip arthritis in paralytic as well as a nonparalytic limb, warranting total hip arthroplasty (THA). Limited literature is available on the results of THA among these patients in the form of small series or case reports. We have undertaken a systematic review to evaluate the clinical outcome of THA in patients with poliomyelitis with hip pathologies. METHODS A systematic search of electronic databases of PubMed, Scopus, and Web of Science pertaining to English literature was undertaken from 1945 to August 2020 to assess the results of THA in patients with poliomyelitis. Information was gathered about demographics, indication, clinical course, complications, functional outcome, survival, and need for any revision surgery in these patients. RESULTS The literature search revealed 81 articles. Finally, after deduplication and manual selection, 16 relevant articles (128 hips) were included for evaluation. There is a paucity of literature evaluating THA in patients with poliomyelitis over the last 2 decades. The principal reason for arthroplasty was osteoarthritis of the hip in the ipsilateral (paralyzed) limb. A combination of cemented, uncemented, and hybrid implant fixation system was found to be used by surgeons. Addressing instability and perioperative management of limb length discrepancy were found to be challenging propositions. CONCLUSION THA remains an effective intervention to relieve pain and improve quality of life in patients of poliomyelitis afflicted with either primary or secondary arthritis of the hip. The use of uncemented nonconstrained hip implant designs appears to demonstrate better results than constrained implants.
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Albanese CV, Reddy S. The Current State: Epidemiology and Working Toward Eradication. Phys Med Rehabil Clin N Am 2021; 32:467-476. [PMID: 34175007 DOI: 10.1016/j.pmr.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Acute polio, once epidemic and a significant source of paralysis and disability, has been dramatically reduced through global vaccination programs. Although vaccination efforts have experienced a setback because of COVID-19, resulting in increased number of vaccine-associated and wild virus infections, polio eradication is still a realistic goal that will result in significant cost savings. The secondary health issues related to aging with the residual effects of polio, including postpolio syndrome, will persist for many years posteradication. Continued education of medical professionals is essential to ensure provision of the necessary care to this population.
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Affiliation(s)
- Carol Vandenakker Albanese
- Department of Physical Medicine and Rehabilitation, UC Davis School of Medicine, 4860 Y Street, Suite 3850, Sacramento, CA 95817, USA.
| | - Shailesh Reddy
- Department of Physical Medicine and Rehabilitation, UC Davis Health, 4860 Y Street, Suite 3850, Sacramento, CA 95817, USA
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18
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A Systematic Review of Total Knee Arthroplasty in Neurologic Conditions: Survivorship, Complications, and Surgical Considerations. J Arthroplasty 2020; 35:3383-3392. [PMID: 32873450 DOI: 10.1016/j.arth.2020.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/27/2020] [Accepted: 08/04/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Patients with neurologic disorders present a unique set of challenges for knee surgeons because of contractures, muscle weakness, spasticity, and ligament instability. The primary purpose of this review was to report the outcomes of total knee arthroplasty (TKA) in these patients, including survivorship, complications, and surgical considerations. METHODS We performed a systematic review of articles using PubMed, Cochrane Central, EMBASE, and Google Scholar. All studies reporting outcomes of TKA in patients with Parkinson disease, multiple sclerosis, poliomyelitis, Charcot joint, spina bifida, stroke, and cerebral palsy were included. RESULTS In total 38 studies were included: 22 studies (461 patients) reported patient-reported outcome measures and 24 studies (510 patients) reported survivorship. All 38 studies reported complication rates. TKA resulted in an improvement in functional outcome in all series. Complication rate was higher in patients with neurologic conditions. Of studies reporting survivorship, mean follow-up ranged from 1 to 12 years with survivorship from 66% to 100%. All levels of implant constraint were reported without consensus. Limited rehabilitative data exist. CONCLUSION TKA in patients with neurologic disorders improves symptoms and function but carries significant risk. This review helps surgeons preoperatively counsel their patients in an informed manner. Careful planning, perioperative care, and appropriate implant selection may mitigate risk of complication.
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19
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Curtis A, Lee JS, Kaltsakas G, Auyeung V, Shaw S, Hart N, Steier J. The value of a post-polio syndrome self-management programme. J Thorac Dis 2020; 12:S153-S162. [PMID: 33214920 PMCID: PMC7642628 DOI: 10.21037/jtd-cus-2020-009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Post-polio syndrome is characterised by symptoms of fatigue, pain and new-onset neuromuscular weakness, and emerges decades after the initial poliovirus infection. We sought to evaluate the only post-polio syndrome specific self-management programme in the United Kingdom. Methods This was a retrospective study of patients who had completed a residential self-management programme led by a multi-disciplinary clinical team. Following a confirmed diagnosis of post-polio syndrome by rehabilitation and neurology specialists, patients were offered to participate in the programme. Although group-based, patients also received individually tailored support on physical exercise and fatigue management. Physical effects, physical function, psychosocial well-being measures were assessed at baseline and 6 months follow-up. Knowledge was tested at baseline and immediately following the programme. Statistical comparisons were made using paired t-test and Wilcoxon signed rank test according to the data distribution. Results Over a period of 17 years, 214 participants (median age 61.3 years old, 63% female) attended 31 programmes. At 6 months the following post-polio syndrome specific symptoms improved significantly: fatigue, as measured by the Multidimensional Assessment of Fatigue scale [37.6 (7.1) vs. 34.2 (9.3), P=0.005]; and pain [15.0 (6.1) vs. 13.1 (6.7), P=0.001], atrophy [10.0 (8.0–12.0) vs. 9.0 (7.0–11.0), P=0.002] and bulbar symptoms [3.0 (1.0–5.0) vs. 2.0 (0–4.0), P=0.003] as measured by the Index of Post-polio Sequelae scale. Knowledge related to post-polio syndrome also significantly increased [14.0 (11.0–16.0) vs. 17.0 (16.0–19.0), P=0.001]. Participants were able to walk at a faster speed over 10 meters [0.77 (0.59–1.00) vs. 0.83 (0.67–1.10) m/s, P=0.003] and walked longer distances during the 2-minute walk test [76.9 (31.7) vs. 82.0 (38.4) m, P=0.029]. Depression and anxiety scores did not change over time [PHQ-9, 2.0 (0.3–10.8) vs. 2.0 (0.3–6.8), P=0.450; GAD-7, 2.0 (0–7.0) vs. 1.0 (0–3.0), P=0.460] nor was there change in self-reported quality of life {60 [50–70] vs. 60 [55–70], P=0.200}. Conclusions This study suggests that a post-polio syndrome self-management programme led to improvement in symptoms, knowledge and walking speed, but not quality of life. Anxiety and depression scores remained low.
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Affiliation(s)
| | - Jeong Su Lee
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Georgios Kaltsakas
- Guy's and St Thomas' NHS Foundation Trust, London, UK.,Faculty of Life Sciences and Medicine, King's College, London, UK
| | - Vivian Auyeung
- Faculty of Life Sciences and Medicine, King's College, London, UK
| | - Simon Shaw
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nicholas Hart
- Guy's and St Thomas' NHS Foundation Trust, London, UK.,Faculty of Life Sciences and Medicine, King's College, London, UK
| | - Joerg Steier
- Guy's and St Thomas' NHS Foundation Trust, London, UK.,Faculty of Life Sciences and Medicine, King's College, London, UK
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20
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Ganesh GS, Marwah D, Punyal S, Gupta S. Physical activity and quality of life predictors among university students with polio in India: A cross-sectional study. J Clin Transl Res 2020; 6:71-80. [PMID: 33426356 PMCID: PMC7790500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/15/2020] [Accepted: 07/01/2020] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Quality of life (QoL) assessments measure the overall well-being of a person. Available data suggest an estimated 10-20 million polio survivors worldwide. Few studies have investigated the physical activity and the QoL of these patients in India. AIM The present cross-sectional study attempted to measure the physical activity and QoL of polio survivors and to evaluate the relationship between physical activity and QoL, among other factors. METHODS The study was conducted in 96 students (64 women and 32 men with a mean age of 22.1±3.7 years). QoL, physical activity, fatigue, and pain were measured by the World Health Organization QoL measure - abbreviated version (WHOQOL-BREF), physical activity scale for individuals with physical disabilities (PASIPD), multidimensional fatigue symptom inventory-short form (MFSI-SF), and numerical rating scale. RESULTS The mean metabolic equivalent score was 27.10 h/day. Low mean scores were observed for the physical health, psychological well-being, social relationships, and environmental domains of QoL (25.2±3.3, 21.8±3.0, 12.0±1.8, and 23.0±4.3, respectively). There was a weak negative association between physical activity levels and the physical health domain of QoL (P<0.05), whereas no associations were identified between physical activity levels and other QoL domains (P>0.05). Regression analysis identified female gender, fatigue, and physical activity as predictors of the physical health domain, and female gender, number of sites affected, and assistive devices used as predictors of the psychological health domain of QoL. CONCLUSIONS Low physical activity levels and QoL were noted among students with poliomyelitis in Uttar Pradesh, India. RELEVANCE FOR PATIENTS Considering the inverse relationship between physical activity and QoL, physical activities should be modified or protected in polio survivors. Female polio survivors may be referred to psychological counseling to learn coping strategies, even during periods of relative stability.
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Affiliation(s)
- G. Shankar Ganesh
- 1Department of Physiotherapy, Composite Regional Centre for Skill Development, Rehabilitation, and Empowerment of Persons with Disabilities, Lucknow, Uttar Pradesh, India,Corresponding author: G. Shankar Ganesh Department of Physiotherapy, Composite Regional Centre for Skill Development, Rehabilitation, and Empowerment of Persons with Disabilities, Mohaan Road,Lucknow - 226 017, Uttar Pradesh, India
| | | | - Sukriti Punyal
- 3Safdarjung Hospital, Ansari Nagar East, New Delhi, India
| | - Sachin Gupta
- 4Jamia Hamdard University, Hamdard Nagar, New Delhi, India
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Majer A, McGreevy A, Booth TF. Molecular Pathogenicity of Enteroviruses Causing Neurological Disease. Front Microbiol 2020; 11:540. [PMID: 32328043 PMCID: PMC7161091 DOI: 10.3389/fmicb.2020.00540] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/12/2020] [Indexed: 12/12/2022] Open
Abstract
Enteroviruses are single-stranded positive-sense RNA viruses that primarily cause self-limiting gastrointestinal or respiratory illness. In some cases, these viruses can invade the central nervous system, causing life-threatening neurological diseases including encephalitis, meningitis and acute flaccid paralysis (AFP). As we near the global eradication of poliovirus, formerly the major cause of AFP, the number of AFP cases have not diminished implying a non-poliovirus etiology. As the number of enteroviruses linked with neurological disease is expanding, of which many had previously little clinical significance, these viruses are becoming increasingly important to public health. Our current understanding of these non-polio enteroviruses is limited, especially with regards to their neurovirulence. Elucidating the molecular pathogenesis of these viruses is paramount for the development of effective therapeutic strategies. This review summarizes the clinical diseases associated with neurotropic enteroviruses and discusses recent advances in the understanding of viral invasion of the central nervous system, cell tropism and molecular pathogenesis as it correlates with host responses.
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Affiliation(s)
- Anna Majer
- Viral Diseases Division, National Microbiology Laboratory, Winnipeg, MB, Canada
| | - Alan McGreevy
- Viral Diseases Division, National Microbiology Laboratory, Winnipeg, MB, Canada.,Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada.,Department of Biology, University of Winnipeg, Winnipeg, MB, Canada
| | - Timothy F Booth
- Viral Diseases Division, National Microbiology Laboratory, Winnipeg, MB, Canada.,Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
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22
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Le Guennec L. Manifestazioni neurologiche delle infezioni. Neurologia 2020. [DOI: 10.1016/s1634-7072(20)43298-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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23
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Shakeel SI, Brown M, Sethi S, Mackey TK. Achieving the end game: employing "vaccine diplomacy" to eradicate polio in Pakistan. BMC Public Health 2019; 19:79. [PMID: 30654797 PMCID: PMC6337835 DOI: 10.1186/s12889-019-6393-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 01/03/2019] [Indexed: 11/21/2022] Open
Abstract
Background On April 28, 2014, the World Health Organization (WHO) declared polio a “Public Health Emergency of International Concern” (PHIC) under the authority of the International Health Regulations. Although polio has been eradicated from nearly every nation on earth, Pakistan is one of three countries where wild polio and vaccine-derived polio strains remain, thwarting global eradication efforts. Aims Polio eradication progress is complicated by security and conflict issues at the border area between Pakistan and Afghanistan. In addition to security issues, other critical challenges, such as maintaining cold supply chain for vaccines, active and sentinel surveillance, false beliefs about vaccines, distrust of healthcare workers, and accessibility to conflict areas due to terrorist activities, all play a role in the continued persistence of Polio. In response to these challenges, we assess the local and international policy environment and its impact on polio eradication in Pakistan. Findings Based on our analysis of existing barriers and challenges associated with polio eradication in Pakistan, this study discusses why employing “vaccine diplomacy” represents a key policy and advocacy strategic approach to achieve the overall end game of polio eradication. Specifically, we identify a set of concrete public health, international development, and diplomatic and policy recommendations that can act synergistically under the umbrella of health and vaccine diplomacy to finally put an end to polio.
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Affiliation(s)
- Shahella Idrees Shakeel
- Joint Master's Program in Health Policy and Law, University of California, San Diego School of Medicine - California Western School of Law, San Diego, CA, USA
| | - Matthew Brown
- National Institutes of Health, National Cancer Institute, U.S. Embassy, China Office, Beijing, China
| | | | - Tim K Mackey
- Department of Anesthesiology and Division of Infectious Diseases and Global Public Health, University of California, San Diego School of Medicine, San Diego, CA, USA. .,Global Health Policy Institute, 8950 Villa La Jolla Drive, A124, La Jolla, San Diego, CA, 92037, USA.
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Li J, Hu Z, Tseng C, Zhao Z, Yuan Y, Zhu Z, Qiu Y, Liu Z. Radiographic and Clinical Outcomes of Surgical Correction of Poliomyelitis-Related Spinal Deformities: A Comparison Among Three Types of Pelvic Instrumentations. World Neurosurg 2018; 122:e1111-e1119. [PMID: 30439526 DOI: 10.1016/j.wneu.2018.10.238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 10/29/2018] [Accepted: 10/31/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND We compared the clinical and radiographic outcomes of corrective surgery in patients with poliomyelitis-related spinal deformity (PSD) using 3 types of pelvic fixation and investigated the incidence and risk factors for complications. METHODS We reviewed the data from 42 patients with PSD who had undergone spinopelvic reconstruction at a single institution from 2000 to 2016. Of the 42 patients, 15 had been treated with the Galveston technique, 13 with iliac screw fixation, and 14 with S2-alar-iliac (S2AI) screw fixation. Demographic data, radiographic parameters, and complications were analyzed. Health-related quality of life was determined using Scoliosis Research Society (SRS) 22-item questionnaires and the Oswestry Disability Index scores. RESULTS After surgery, the correction rate of the main curve was 51.7%, 57.8%, and 52.1% in the 3 groups, with significant improvement in regional kyphosis, coronal balance, and pelvic obliquity (PO) (P < 0.05). The correction of PO was similar among the 3 types of pelvic fixation; however, the patients treated with S2AI fixation required significantly less operative time (P < 0.05) and blood loss (P < 0.006). The overall complication rate was 40.5%, with a major complication rate of 23.8%. Age at surgery (P = 0.006) and grade >2 SRS-Schwab osteotomy (P = 0.036) were significant risk factors for complications. Significant improvement was found in the SRS-22 and Oswestry Disability Index scores at the final follow-up examination in the 3 groups. CONCLUSIONS The present study showed satisfactory correction of spinopelvic deformity for 42 patients with PSD. Compared with the Galveston technique and iliac screw fixation, the use of S2AI significantly decrease the operative time and estimated blood loss and obtained similar correction of PO. Patient age at surgery and grade >2 SRS-Schwab osteotomy were significant risk factors for complications.
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Affiliation(s)
- Jie Li
- Department of Spine Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Zongshan Hu
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Hong Kong, China
| | - Changchun Tseng
- Department of Spine Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhihui Zhao
- Department of Spine Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yiwen Yuan
- Department of Spine Surgery, Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Zezhang Zhu
- Department of Spine Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yong Qiu
- Department of Spine Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhen Liu
- Department of Spine Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
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Singh N, Ray S, Srivastava A. Clinical Mimickers of Amyotrophic Lateral Sclerosis-Conditions We Cannot Afford to Miss. Ann Indian Acad Neurol 2018; 21:173-178. [PMID: 30258257 PMCID: PMC6137639 DOI: 10.4103/aian.aian_491_17] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Giving a diagnosis of amyotrophic lateral sclerosis to a patient is akin to handing out a death certificate. However, not all patients presenting with the classical dysphagia, wasting, and weakness may have motor neuron diseases. In these cases, it is extremely important not to miss little cues which can suggest an alternative diagnosis and in many cases a lease of life in terms of a treatment option. In this review, we consider some clinical scenarios that can present with the same symptom complex as diseases involving motor neurons but have a different anatomical or etiopathological basis and in many cases even a therapeutic option.
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Affiliation(s)
- Nishita Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Sucharita Ray
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Achal Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Keck F, Kortchak S, Bakovic A, Roberts B, Agrawal N, Narayanan A. Direct and indirect pro-inflammatory cytokine response resulting from TC-83 infection of glial cells. Virulence 2018; 9:1403-1421. [PMID: 30101649 PMCID: PMC6141141 DOI: 10.1080/21505594.2018.1509668] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 07/31/2018] [Indexed: 12/16/2022] Open
Abstract
Venezuelan equine encephalitis virus (VEEV) is a neurotropic arbovirus that is highly infectious as an aerosol and can result in an encephalitic phenotype in infected individuals. VEEV infections are known to be associated with robust inflammation that eventually contributes to neurodegenerative phenotypes. In this study, we utilize the TC-83 strain of VEEV, which is known to induce the expression of IL-6, IL-8, and other pro-inflammatory cytokines. We had previously demonstrated that TC-83 infection resulted in changes in mitochondrial function, eventually resulting in mitophagy. In this manuscript, we provide data that links upstream mitochondrial dysfunction with downstream pro-inflammatory cytokine production in the context of microglia and astrocytoma cells. We also provide data on the role of bystander cells, which significantly contribute to the overall inflammatory load. Use of a mitochondrial-targeted antioxidant, mitoquinone mesylate, greatly reduced the inflammatory cytokine load and ameliorated bystander cell inflammatory responses more significantly than a broad-spectrum anti-inflammatory compound (BAY 11-7082). Our data suggest that the inflammatory mediators, especially IL-1β, may prime naïve cells to infection and lead to increased infection rates in microglial and astrocytoma cells. Cumulatively, our data suggest that the interplay between mitochondrial dysfunction and inflammatory events elicited in a neuronal microenvironment during a TC-83 infection may contribute to the spread of infection.
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Affiliation(s)
- Forrest Keck
- National Center for Biodefense and Infectious Diseases, George Mason University, Manassas, VA, USA
| | - Stephanie Kortchak
- National Center for Biodefense and Infectious Diseases, George Mason University, Manassas, VA, USA
| | - Allison Bakovic
- National Center for Biodefense and Infectious Diseases, George Mason University, Manassas, VA, USA
| | | | - Nitin Agrawal
- Krasnow Institute for Advanced Study, George Mason University, Fairfax, VA, USA
| | - Aarthi Narayanan
- National Center for Biodefense and Infectious Diseases, George Mason University, Manassas, VA, USA
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Atwal A, Duncan H, Queally C, Cedar SH. Polio survivors perceptions of a multi-disciplinary rehabilitation programme. Disabil Rehabil 2017; 41:150-157. [PMID: 28974103 DOI: 10.1080/09638288.2017.1381184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE Post-polio syndrome refers to a late complication of the poliovirus infection. Management of post-polio syndrome is complex due to the extensive symptomology. European and United Kingdom guidelines have advised the use of rehabilitation programmes to manage post-polio syndrome. There is a paucity of research in relation to the effectiveness of rehabilitation interventions. The objective of this study is to explore polio survivor's perceptions of an in-patient multi-disciplinary rehabilitation programme. METHODS Semi-structured interviews of community dwelling polio survivors who attended in-patient rehabilitation programme in the United Kingdom. Thematic analysis was used to describe and interpret interview data. RESULTS Participants' experiences were influenced by past experiences of polio and their self-concept. Participants generally had a positive experience and valued being with other polio survivors. Positive strategies, such as pacing and reflection changed their mind-sets into their lives after the programme, though they still faced challenges in daily living. Some participants supported others with post-polio syndrome after completing the programme. CONCLUSIONS Our research identified that participants experienced long term positive benefits from attending a rehabilitation programme. Strategies that users found helpful that explored the effectiveness of interventions to manage polio are not cited within a Cochrane review. If we are to recognise the lived experience and service user empowerment within a model of co- production it is essential that patient preferences are evaluated and used as evidence to justify service provision. Further research is required with polio survivors to explore how best rehabilitation programmes can adopt the principles of co-production. Implications for Rehabilitation The patients' expertise and lived experience must be at the centre of a rehabilitation programme. Strategies such as pacing and reflection are perceived as important strategies to enable self-management of polio and post-polio syndrome despite the limited evidence base to support these interventions. Polio rehabilitation programmes should not be time limited and commissioners and therapists need to ensure that follow up support is provided. When measuring outcomes patient preferences and views must be evaluated.
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Affiliation(s)
- Anita Atwal
- a School of Health and Social Care , London Southbank University , London , UK
| | - Helen Duncan
- b School of Health and Social Care , Brunel University , London , UK
| | - Claire Queally
- b School of Health and Social Care , Brunel University , London , UK
| | - S H Cedar
- a School of Health and Social Care , London Southbank University , London , UK
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Eichel T, Dreux ML. Negative or Positive? The Iron Lung and Poliomyelitis—Zurich, 1951. Anaesth Intensive Care 2017; 45:13-20. [DOI: 10.1177/0310057x170450s103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
During the poliomyelitis epidemics of the last century hospitals were inundated with patients in acute respiratory failure. Between 1946 and 1949, Nandor (Ferdinand) Eichel documented the use of the iron lung in children with acute poliomyelitis at the University Children's Hospital, Zurich. The aim was to assess the effectiveness of the Iron lung and negative pressure respiratory support for this indication and to establish its role in the context of other existing therapies at the time. Eichel produced his review and data as the Inaugural Dissertation towards his medical degree from the the University of Zurich, published in 1951. The dissertation was written in German and first translated into English in 2014. The current paper explores the findings of the dissertation and explains why there has been the transition to techniques of respiratory support today. It includes a biography of Dr F. N. Eichel and an update on the current status of poliomyelitis. The original dissertation was found in the home of Nandor's son and was of great interest to the current authors, Nandor's granddaughter and her colleague.
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Affiliation(s)
- T. Eichel
- St George Hospital, Sydney, New South Wales
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Garg N, Park SB, Vucic S, Yiannikas C, Spies J, Howells J, Huynh W, Matamala JM, Krishnan AV, Pollard JD, Cornblath DR, Reilly MM, Kiernan MC. Differentiating lower motor neuron syndromes. J Neurol Neurosurg Psychiatry 2017; 88:474-483. [PMID: 28003344 PMCID: PMC5529975 DOI: 10.1136/jnnp-2016-313526] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 11/21/2016] [Indexed: 12/12/2022]
Abstract
Lower motor neuron (LMN) syndromes typically present with muscle wasting and weakness and may arise from pathology affecting the distal motor nerve up to the level of the anterior horn cell. A variety of hereditary causes are recognised, including spinal muscular atrophy, distal hereditary motor neuropathy and LMN variants of familial motor neuron disease. Recent genetic advances have resulted in the identification of a variety of disease-causing mutations. Immune-mediated disorders, including multifocal motor neuropathy and variants of chronic inflammatory demyelinating polyneuropathy, account for a proportion of LMN presentations and are important to recognise, as effective treatments are available. The present review will outline the spectrum of LMN syndromes that may develop in adulthood and provide a framework for the clinician assessing a patient presenting with predominantly LMN features.
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Affiliation(s)
- Nidhi Garg
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Susanna B Park
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Steve Vucic
- Departments of Neurology and Neurophysiology, Westmead Hospital, The University of Sydney, Sydney, New South Wales, Australia
| | - Con Yiannikas
- Department of Neurology, Concord and Royal North Shore Hospitals, The University of Sydney, Sydney, New South Wales, Australia
| | - Judy Spies
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - James Howells
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - William Huynh
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - José M Matamala
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Arun V Krishnan
- Prince of Wales Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - John D Pollard
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - David R Cornblath
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Mary M Reilly
- MRC Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, UK
| | - Matthew C Kiernan
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Abstract
INTRODUCTION The outcomes of total hip replacement in patients suffering from residual poliomyelitis are poorly covered in the literature. In this retrospective study we posed the question of whether total hip replacement performed for degenerative hip diseases in limbs with residual poliomyelitis could determine satisfactory mid-term clinical and radiographic results, with a reasonable complication rate. METHODS A retrospective study was carried out to assess the results of 14 total hip replacements performed on 14 patients with residual poliomyelitis on the involved limb from June 1999 to September 2011. Average age at the time of surgery was 51 years (range 26-66 years). Mean duration of follow-up was 92 months (range 52-156 months). Surgery was performed through a direct lateral approach on all hips. All but one were cementless implants. RESULTS 2 implants failed, 1 due to traumatic acetabular fracture 6 days after surgery, and 1 due to aseptic cup loosening 13 years after surgery. Surgery was uneventful in all patients except 1 (7%), who experienced a transient sensory sciatic nerve palsy. At the latest follow up Harris Hip Score was 83.3 (range 72-91) with a marked improvement when compared to preoperative score (average 52, range 32-78). No dislocations had occurred. CONCLUSIONS Total hip replacement can be considered a feasible option for hip osteoarthritis in patients with limbs affected by residual poliomyelitis. Longer follow-up studies are needed to assess the effectiveness of unconstrained total hip replacement in polio patients.
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Schmidt S, Gocheva V, Zumbrunn T, Rubino-Nacht D, Bonati U, Fischer D, Hafner P. Treatment with L-citrulline in patients with post-polio syndrome: study protocol for a single-center, randomised, placebo-controlled, double-blind trial. Trials 2017; 18:116. [PMID: 28274276 PMCID: PMC5343398 DOI: 10.1186/s13063-017-1829-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 02/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Post-polio syndrome (PPS) is a condition that affects polio survivors years after recovery from an initial acute infection by the Poliomyelitis virus. Most often, patients who suffered from polio start to experience gradual new weakening in muscles, a gradual decrease in the size of muscles (muscle atrophy) and fatigue years after the acute illness. L-citrulline is known to change muscular metabolism synthesis by raising nitric oxide (NO) levels and increasing protein synthesis. This investigator-initiated, randomised, placebo-controlled, double-blind, trial aims to demonstrate that L-citrulline positively influences muscle function and increases muscular energy production in patients with PPS. METHODS/DESIGN Thirty ambulant PPS patients will be recruited in Switzerland. Patients will be randomly allocated to one of the two arms of the study (placebo:verum 1:1). After a 24-week run-in phase to observe natural disease history and progression, participants will be treated either with L-citrulline or placebo for 24 weeks. The primary endpoint is change in the 6-min Walking Distance Test. Secondary endpoints will include motor function measure, quantitative muscle force, quantitative muscle magnetic resonance imaging and magnetic resonance spectroscopy and serum biomarker laboratory analysis DISCUSSION: The aim of this phase IIa trial is to determine if treatment with L-citrulline shows a positive effect on clinical function and paraclinical biomarkers in PPS. If treatment with L-citrulline shows positive effects, this might represent a cost-efficient symptomatic therapy for PPS patients. TRIAL REGISTRATION ClinicalTrial.gov, ID: NCT02801071 . Registered on 6 June 2016.
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Affiliation(s)
- Simone Schmidt
- Division of Neuropediatrics, University of Basel Children’s Hospital, Spitalstrasse 33, Postfach 4031 Basel, Switzerland
- Division of Neurology, University Hospital Basel, Basel, Switzerland
| | - Vanya Gocheva
- Division of Neuropediatrics, University of Basel Children’s Hospital, Spitalstrasse 33, Postfach 4031 Basel, Switzerland
| | - Thomas Zumbrunn
- Department of Clinical Research, Clinical Trial Unit, University Hospital Basel, Basel, Switzerland
| | - Daniela Rubino-Nacht
- Division of Neuropediatrics, University of Basel Children’s Hospital, Spitalstrasse 33, Postfach 4031 Basel, Switzerland
| | - Ulrike Bonati
- Division of Neuropediatrics, University of Basel Children’s Hospital, Spitalstrasse 33, Postfach 4031 Basel, Switzerland
- Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Dirk Fischer
- Division of Neuropediatrics, University of Basel Children’s Hospital, Spitalstrasse 33, Postfach 4031 Basel, Switzerland
- Division of Neurology, University Hospital Basel, Basel, Switzerland
- Division of Neurology, Medical University Clinic, Kantonsspital Baselland, Bruderholz, Switzerland
| | - Patricia Hafner
- Division of Neuropediatrics, University of Basel Children’s Hospital, Spitalstrasse 33, Postfach 4031 Basel, Switzerland
- Division of Neurology, Medical University Clinic, Kantonsspital Baselland, Bruderholz, Switzerland
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Abstract
Weakness is a common complaint in the emergency department, and a most challenging one, because before the emergency physician can proceed with an evaluation, the complaint of weakness must be fully clarified to determine about what the patient is actually complaining. This article will focus on causes of acute generalized nontraumatic bilateral weakness. Evaluation begins with the history and physical examination, followed by diagnostic testing in some cases.
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Affiliation(s)
- Latha Ganti
- University of Central Florida College of Medicine, 6850 Lake Nona Blvd, Orlando, FL 32827, USA.
| | - Vaibhav Rastogi
- Department of Internal Medicine, North Florida Regional Medical Center, 6500 W Newberry Road, Gainesville, FL, USA
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Changchien CH, Chen WC, Su YM. Free anterolateral thigh flap harvesting from paralytic limbs in post-polio syndrome. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2016; 3:50-5. [PMID: 27583272 PMCID: PMC4996063 DOI: 10.1080/23320885.2016.1200978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 05/22/2016] [Indexed: 11/25/2022]
Abstract
We report two cases of poliomyelitis in which an anterolateral thigh myocutaneous free flap was harvested from the paralytic limb for oral reconstruction. We observed a decrease in the pedicle diameter of the anterolateral thigh flap, but the blood supply to the skin paddle was adequate.
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Affiliation(s)
- Chih-Hsuan Changchien
- Department of Plastic and Reconstructive Surgery, Chiayi Christian Hospital , Chiayi City , Taiwan
| | - Wei-Chen Chen
- Department of Plastic and Reconstructive Surgery, Chiayi Christian Hospital , Chiayi City , Taiwan
| | - Yu-Min Su
- Department of Plastic and Reconstructive Surgery, Chiayi Christian Hospital , Chiayi City , Taiwan
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Bertolasi L, Danese A, Monaco S, Turri M, Borg K, Werhagen L. Polio Patients in Northern Italy, a 50 Year Follow-up. Open Neurol J 2016; 10:77-82. [PMID: 27651845 PMCID: PMC5012079 DOI: 10.2174/1874205x01610010077] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 05/24/2016] [Accepted: 06/09/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Poliomyelitis was before the immunization an important medical problem. Nowadays polio prior patients (PP) suffer from polio sequelae or have developed post-polio-syndrome (PPS) with increasing paresis, pain and fatigue. OBJECTIVES To analyze the medical situation 50 years after acute polio. The degree of paresis was compared between the recovery 1952-1961 and 2012.The prevalence of patients fulfilling the criteria for PPS was estimated. METHOD The study was performed in Italy. Included were PP with rehabilitation after acute polio 1952-1961 and in 2012. During the years PP underwent yearly evaluation. A thorough neurological examination was performed in 2012. A telephone interview with questions concerning pain, paresis, fatigue, walking aids and concomitant diseases was performed in 2012. The patients were divided in two groups, if they fulfilled the criteria for PPS or not. RESULTS Included were 67(94%) patients receiving rehabilitation after acute poliomyelitis and 2012. 78% were walkers, half of the PPS used wheelchair. Eight out of ten suffered from pain. Four out of ten fulfilled the PPS criteria. Pain was slightly more common in PPS. CONCLUSION Female gender, fatigue and wheelchair dependency were significantly more common in PPS while pain was common in both groups.
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Affiliation(s)
- L. Bertolasi
- Section of Neurology, Department of Neurological, Neurophysiological, Morphological and Motor Sciences, University of Verona, Verona, Italy
| | - A Danese
- Section of Neurology, Department of Neurological, Neurophysiological, Morphological and Motor Sciences, University of Verona, Verona, Italy
| | - S Monaco
- Section of Neurology, Department of Neurological, Neurophysiological, Morphological and Motor Sciences, University of Verona, Verona, Italy
| | - M Turri
- Section of Neurology, Department of Neurological, Neurophysiological, Morphological and Motor Sciences, University of Verona, Verona, Italy
| | - K Borg
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institut at Danderyds Hospital, Stockholm, Sweden
| | - L Werhagen
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institut at Danderyds Hospital, Stockholm, Sweden
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Affiliation(s)
| | | | - Hadi Manji
- National Hospital for Neurology & Neurosurgery
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36
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Werthel JD, Schoch B, Sperling JW, Cofield R, Elhassan BT. Shoulder arthroplasty for sequelae of poliomyelitis. J Shoulder Elbow Surg 2016; 25:791-6. [PMID: 26700552 DOI: 10.1016/j.jse.2015.09.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 09/16/2015] [Accepted: 09/29/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Polio infection can often lead to orthopedic complications such as arthritis, osteoporosis, muscle weakness, skeletal deformation, and chronic instability of the joints. The purpose of this study was to assess the outcomes and associated complications of arthroplasty in shoulders with sequelae of poliomyelitis. METHODS Seven patients (average age, 70 years) were treated between 1976 and 2013 with shoulder arthroplasty for the sequelae of polio. One patient underwent reverse shoulder arthroplasty, 2 had a hemiarthroplasty, and 4 had total shoulder arthroplasty. Average follow-up was 87 months. Outcome measures included pain, range of motion, and postoperative modified Neer ratings. RESULTS Overall pain scores improved from 5 to 1.6 points (on a 5-point scale) after shoulder arthroplasty. Six shoulders had no or mild pain at latest follow-up, and 6 shoulders rated the result as much better or better. Mean shoulder elevation improved from 72° to 129°, and external rotation improved from 11° to 56°. Average strength in elevation decreased from 3.9 to 3.4 postoperatively, and external rotation strength decreased from 3.9 to 3.3. This, however, did not reach significance. Evidence of muscle imbalance with radiographic instability was found in 4 shoulders that demonstrated superior subluxation, anterior subluxation, or both. This remained asymptomatic. No shoulder required revision or reoperation. CONCLUSIONS Shoulder arthroplasty provides significant pain relief and improved motion in patients with sequelae of poliomyelitis. Muscle weakness may be responsible for postoperative instability, and careful selection of the patient with good upper extremity muscles must be made.
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Affiliation(s)
| | - Bradley Schoch
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - John W Sperling
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Robert Cofield
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Mifsud Bonnici D, Sanctuary T, Warren A, Murphy PB, Steier J, Marino P, Pattani H, Creagh-Brown BC, Hart N. Prospective observational cohort study of patients with weaning failure admitted to a specialist weaning, rehabilitation and home mechanical ventilation centre. BMJ Open 2016; 6:e010025. [PMID: 26956162 PMCID: PMC4785284 DOI: 10.1136/bmjopen-2015-010025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 11/09/2015] [Accepted: 11/20/2015] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES According to National Health Service England (NHSE) specialist respiratory commissioning specification for complex home ventilation, patients with weaning failure should be referred to a specialist centre. However, there are limited data reporting the clinical outcomes from such centres. SETTING Prospective observational cohort study of patients admitted to a UK specialist weaning, rehabilitation and home mechanical ventilation centre between February 2005 and July 2013. PARTICIPANTS 262 patients admitted with a median age of 64.2 years (IQR 52.6-73.2 years). 59.9% were male. RESULTS 39.7% of patients had neuromuscular and/or chest wall disease, 21% were postsurgical, 19.5% had chronic obstructive pulmonary disease (COPD), 5.3% had obesity-related respiratory failure and 14.5% had other diagnoses. 64.1% of patients were successfully weaned, with 38.2% weaned fully from ventilation, 24% weaned to nocturnal non-invasive ventilation (NIV), 1.9% weaned to nocturnal NIV with intermittent NIV during the daytime. 21.4% of patients were discharged on long-term tracheostomy ventilation. The obesity-related respiratory failure group were most likely to wean (relative risk (RR) for weaning success=1.48, 95% CI 1.35 to 1.77; p<0.001), but otherwise weaning success rates did not significantly vary by diagnostic group. The median time-to-wean was 19 days (IQR 9-33) and the median duration of stay was 31 days (IQR 16-50), with no difference observed between the groups. Weaning centre mortality was 14.5%, highest in the COPD group (RR=2.15, 95% CI 1.19 to 3.91, p=0.012) and lowest in the neuromuscular and/or chest wall disease group (RR=0.34, 95% CI 0.16 to 0.75, p=0.007). Of all patients discharged alive, survival was 71.7% at 6 months and 61.8% at 12 months postdischarge. CONCLUSIONS Following NHSE guidance, patients with weaning delay and failure should be considered for transfer to a specialist centre where available, which can demonstrate favourable short-term and long-term clinical outcomes.
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Affiliation(s)
| | - Thomas Sanctuary
- Lane Fox Respiratory Unit, Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - Alex Warren
- GKT School of Medical Education, King's College London, London, UK
| | - Patrick B Murphy
- Lane Fox Respiratory Unit, Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - Joerg Steier
- Lane Fox Respiratory Unit, Guy's and St Thomas’ NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Philip Marino
- Lane Fox Respiratory Unit, Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - Hina Pattani
- Lane Fox Respiratory Unit, Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - Ben C Creagh-Brown
- Lane Fox Respiratory Unit, Guy's and St Thomas’ NHS Foundation Trust, London, UK
- Intensive Care Unit, Royal Surrey County Hospital, Guildford, Surrey, UK
- Surrey Perioperative Anaesthesia and Critical care collaborative research group (SPACeR), Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
| | - Nicholas Hart
- Lane Fox Respiratory Unit, Guy's and St Thomas’ NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas’ NHS Foundation Trust, London, UK
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38
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Nucleobase but not Sugar Fidelity is Maintained in the Sabin I RNA-Dependent RNA Polymerase. Viruses 2015; 7:5571-86. [PMID: 26516899 PMCID: PMC4632402 DOI: 10.3390/v7102894] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/17/2015] [Accepted: 10/18/2015] [Indexed: 12/17/2022] Open
Abstract
The Sabin I poliovirus live, attenuated vaccine strain encodes for four amino acid changes (i.e., D53N, Y73H, K250E, and T362I) in the RNA-dependent RNA polymerase (RdRp). We have previously shown that the T362I substitution leads to a lower fidelity RdRp, and viruses encoding this variant are attenuated in a mouse model of poliovirus. Given these results, it was surprising that the nucleotide incorporation rate and nucleobase fidelity of the Sabin I RdRp is similar to that of wild-type enzyme, although the Sabin I RdRp is less selective against nucleotides with modified sugar groups. We suggest that the other Sabin amino acid changes (i.e., D53N, Y73H, K250E) help to re-establish nucleotide incorporation rates and nucleotide discrimination near wild-type levels, which may be a requirement for the propagation of the virus and its efficacy as a vaccine strain. These results also suggest that the nucleobase fidelity of the Sabin I RdRp likely does not contribute to viral attenuation.
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39
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Cells transplanted onto the surface of the glial scar reveal hidden potential for functional neural regeneration. Proc Natl Acad Sci U S A 2015; 112:E3431-40. [PMID: 26080415 DOI: 10.1073/pnas.1501835112] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Cell transplantation therapy has long been investigated as a therapeutic intervention for neurodegenerative disorders, including spinal cord injury, Parkinson's disease, and amyotrophic lateral sclerosis. Indeed, patients have high hopes for a cell-based therapy. However, there are numerous practical challenges for clinical translation. One major problem is that only very low numbers of donor cells survive and achieve functional integration into the host. Glial scar tissue in chronic neurodegenerative disorders strongly inhibits regeneration, and this inhibition must be overcome to accomplish successful cell transplantation. Intraneural cell transplantation is considered to be the best way to deliver cells to the host. We questioned this view with experiments in vivo on a rat glial scar model of the auditory system. Our results show that intraneural transplantation to the auditory nerve, preceded by chondroitinase ABC (ChABC)-treatment, is ineffective. There is no functional recovery, and almost all transplanted cells die within a few weeks. However, when donor cells are placed on the surface of a ChABC-treated gliotic auditory nerve, they autonomously migrate into it and recapitulate glia- and neuron-guided cell migration modes to repair the auditory pathway and recover auditory function. Surface transplantation may thus pave the way for improved functional integration of donor cells into host tissue, providing a less invasive approach to rescue clinically important neural tracts.
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40
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41
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Surviving polio in a post-polio world. Soc Sci Med 2014; 107:171-8. [DOI: 10.1016/j.socscimed.2014.02.024] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 02/10/2014] [Accepted: 02/13/2014] [Indexed: 12/16/2022]
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Andreoni G, Mazzola M, Perego P, Standoli CE, Manzoni S, Piccini L, Molteni F. Wearable monitoring devices for assistive technology: case studies in post-polio syndrome. SENSORS 2014; 14:2012-27. [PMID: 24469354 PMCID: PMC3958267 DOI: 10.3390/s140202012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 01/16/2014] [Accepted: 01/17/2014] [Indexed: 11/16/2022]
Abstract
The correct choice and customization of an orthosis are crucial to obtain the best comfort and efficiency. This study explored the feasibility of a multivariate quantitative assessment of the functional efficiency of lower limb orthosis through a novel wearable system. Gait basographic parameters and energetic indexes were analysed during a Six-Minute Walking Test (6-MWT) through a cost-effective, non-invasive polygraph device, with a multichannel wireless transmission, that carried out electro-cardiograph (ECG); impedance-cardiograph (ICG); and lower-limb accelerations detection. Four subjects affected by Post-Polio Syndrome (PPS) were recruited. The wearable device and the semi-automatic post-processing software provided a novel set of objective data to assess the overall efficiency of the patient-orthosis system. Despite the small number of examined subjects, the results obtained with this new approach encourage the application of the method thus enlarging the dataset to validate this promising protocol and measuring system in supporting clinical decisions and out of a laboratory environment.
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Affiliation(s)
- Giuseppe Andreoni
- Design Department, Politecnico di Milano, via G. Durando 38/A, Milan 20158, Italy.
| | - Marco Mazzola
- Design Department, Politecnico di Milano, via G. Durando 38/A, Milan 20158, Italy.
| | - Paolo Perego
- Design Department, Politecnico di Milano, via G. Durando 38/A, Milan 20158, Italy.
| | | | - Simone Manzoni
- Design Department, Politecnico di Milano, via G. Durando 38/A, Milan 20158, Italy.
| | - Luca Piccini
- SXT-Sistemi per Telemedicina s.r.l., via M. D'Oggiono 18/A, Lecco 23900, Italy.
| | - Franco Molteni
- Villa Beretta" Rehabilitation Center, Valduce Hospital, Via N.Sauro, 17 - 23845 Costa Masnaga (LC), Italy.
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43
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Lusi EA, Guarascio P. Vaccine-derived poliomyelitis and postpolio syndrome: an Italian Cutter Incident. JRSM Open 2014; 5:2042533313511241. [PMID: 25057364 PMCID: PMC4012681 DOI: 10.1177/2042533313511241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Post-polio syndrome is a condition characterized by increased muscle weakness, atrophy, fatigue and pain developing several years after the acute polio event. We describe a 52-year-old patient who experienced post-polio syndrome; he had contracted acute paralytic poliomyelitis at 12 months of age, shortly after the third dose of Salk polio vaccine.
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Affiliation(s)
- Elena Angela Lusi
- Immunology Service Central Laboratory, Italian Red Cross, Rome 00152, Italy
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44
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Liu X, Yang X, Lee CA, Moustafa IM, Smidansky ED, Lum D, Arnold JJ, Cameron CE, Boehr DD. Vaccine-derived mutation in motif D of poliovirus RNA-dependent RNA polymerase lowers nucleotide incorporation fidelity. J Biol Chem 2013; 288:32753-32765. [PMID: 24085299 DOI: 10.1074/jbc.m113.484428] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
All viral RNA-dependent RNA polymerases (RdRps) have a conserved structural element termed motif D. Studies of the RdRp from poliovirus (PV) have shown that a conformational change of motif D leads to efficient and faithful nucleotide addition by bringing Lys-359 into the active site where it serves as a general acid. The RdRp of the Sabin I vaccine strain has Thr-362 changed to Ile. Such a drastic change so close to Lys-359 might alter RdRp function and contribute in some way to the attenuated phenotype of Sabin type I. Here we present our characterization of the T362I RdRp. We find that the T362I RdRp exhibits a mutator phenotype in biochemical experiments in vitro. Using NMR, we show that this change in nucleotide incorporation fidelity correlates with a change in the structural dynamics of motif D. A recombinant PV expressing the T362I RdRp exhibits normal growth properties in cell culture but expresses a mutator phenotype in cells. For example, the T362I-containing PV is more sensitive to the mutagenic activity of ribavirin than wild-type PV. Interestingly, the T362I change was sufficient to cause a statistically significant reduction in viral virulence. Collectively, these studies suggest that residues of motif D can be targeted when changes in nucleotide incorporation fidelity are desired. Given the observation that fidelity mutants can serve as vaccine candidates, it may be possible to use engineering of motif D for this purpose.
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Affiliation(s)
| | | | - Cheri A Lee
- the Department of Biochemistry and Molecular Biology, The Pennsylvania State University, University Park, Pennsylvania 16802
| | - Ibrahim M Moustafa
- the Department of Biochemistry and Molecular Biology, The Pennsylvania State University, University Park, Pennsylvania 16802
| | - Eric D Smidansky
- the Department of Biochemistry and Molecular Biology, The Pennsylvania State University, University Park, Pennsylvania 16802
| | | | - Jamie J Arnold
- the Department of Biochemistry and Molecular Biology, The Pennsylvania State University, University Park, Pennsylvania 16802
| | - Craig E Cameron
- the Department of Biochemistry and Molecular Biology, The Pennsylvania State University, University Park, Pennsylvania 16802
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45
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Waterborne Diseases of the Ocean, Enteric Viruses. Infect Dis (Lond) 2013. [DOI: 10.1007/978-1-4614-5719-0_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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47
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Quadros AAJ, Conde MTRP, Marin LF, Silva HCA, Silva TME, Paula MBED, Pereira RDB, Ramos PE, Abe G, Oliveira ASB. Frequency and clinical manifestations of post-poliomyelitis syndrome in a brazilian tertiary care center. ARQUIVOS DE NEURO-PSIQUIATRIA 2012; 70:571-3. [DOI: 10.1590/s0004-282x2012000800002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 04/11/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: To determine the frequency and clinical manifestations of patients with post-poliomyelitis syndrome (PPS) in a Brazilian division of neuromuscular disorders. METHODS: A total of 167 patients with prior history of paralytic poliomyelitis was investigated for PPS, based on international diagnostic criteria. Other variables analyzed were: gender, race, age at poliomyelitis infection, age at PPS onset, and PPS symptoms. RESULTS: One hundred and twenty-nine patients presented PPS, corresponding to 77.2% of the studied population. 62.8% were women and 37.2% were men. Mean age of patients with PPS at onset of PPS symptoms was 39.9±9.69 years. Their main clinical manifestations were: new weakness in the previously affected limbs (69%) and in the apparently not affected limbs (31%); joint pain (79.8%); fatigue (77.5%); muscle pain (76%); and cold intolerance (69.8%). CONCLUSIONS: Most patients of our sample presented PPS. In Brazil, PPS frequency and clinical features are quite similar to those of other countries.
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48
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Abstract
In 1899, the Spanish painter Joaquín Sorolla represented, in a large canvas, a group of children probably with sequels of poliomyelitis bathing at Valencia's beach. The title of this painting was Sad Legacy. This work contributed to the international diffusion of Sorolla's artistic creation. We briefly report some facts regarding the painter and his work referring to those portraits of children and especially of sick children.
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Affiliation(s)
- Juan F Martínez-Lage
- Regional Service of Neurosurgery, Virgen de Arrixaca University Hospital, 30120 El Palmar, Murcia, Spain.
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49
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Verma R, Khanna P, Chawla S. Inactivated polio vaccine: time to introduce it in India's national immunization schedule. Hum Vaccin Immunother 2012; 8:956-8. [PMID: 22699444 DOI: 10.4161/hv.20089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Polio is a communicable disease caused by poliovirus that may attack nerve cells of the brain and spinal cord. The victims develop neurological complications, likes stiffness of the neck, muscular weakness, or paralysis of one or more limbs. In severe cases, it may be fatal due to respiratory paralysis. The world has seen tremendous gains in polio eradication over the past year. India and Nigeria saw a reduction in cases of almost 95% from 2009 to 2010, and cases of wild poliovirus type 3 (WPV3) fell by 92% globally over the same period. In fact, no case has been reported in India since February 2011, such that India may be on the verge of eradicating polio. Nevertheless, polio control experts are particularly worried about Vaccine-Derived Poliovirus (VDPV). Global surveillance efforts picked up 430 cases of VDPV from several countries between July 2009 and March 2011. In India, 7 cases of VDPV were reported during the year 2011. As long as OPV is used, virologists say that the world is at risk of VDPV causing polio in unprotected children. Achieving a polio-free world will require the "cessation of all OPV" and with it the elimination of the risk of vaccine-associated paralytic polio (VAPP) or VDPV infections. To this effect, in 2011 the Global Polio Eradication Initiative (GPEI) will produce and develop a new roadmap for VDPV Elimination. Several countries have shifted from all OPV to sequential OPV-IPV schedules and all-IPV schedules with elimination of live poliovirus. IPV will be indispensable in the post-eradication era when use of OPV has to stop but "vaccination against polio" cannot stop. IPV offers complete individual protection and has been considered as an additional tool at present for those who can afford the vaccine, and since we are nearing the eradication of polio, it is time to shift from OPV to sequential OPV-IPV schedule in India. Such a strategy will avoid inevitable problems with VAPP.
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Affiliation(s)
- Ramesh Verma
- Department of Community Medicine Pt. B.D. Sharma PGIMS, Rohtak, Haryana India.
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50
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Risk factors for post-polio syndrome among an Italian population: a case-control study. Neurol Sci 2012; 33:1271-5. [PMID: 22246456 DOI: 10.1007/s10072-012-0931-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 01/03/2012] [Indexed: 10/14/2022]
Abstract
Post-polio syndrome (PPS) is a clinical syndrome of new weakness, fatigue and musculoskeletal pain occurring in a variable proportion of polio survivors decades after acute disease. To date, several risk factors for PPS development have been reported, although the etiology of this disorder remains elusive. Using a case-control design, we aimed to assess risk indicators for PPS in a group of Italian polio survivors. Subjects with prior poliomyelitis attending the rehabilitation hospital of Malcesine, Italy, were the target population. Patients with PPS, diagnosed according to the European Federation of Neurological Societies criteria, served as cases, while patients not meeting diagnostic criteria for PPS were used as controls. All subjects were assessed through a structured questionnaire made of 82 questions and neurological examination. The association with investigated risk factors (sex, age at polio onset, age at onset of symptoms, extension and severity of polio, employment) was analyzed by the calculation of the odds ratio. A total of 161 out of 391 eligible patients met the adopted diagnostic criteria for PPS, giving a frequency of 41.2%. Symptoms most frequently complained by PPS patients were loss of muscle strength, loss of resistance, loss of muscle volume and generalized fatigue. Female gender, the presence of respiratory disturbance during the acute phase of polio and the use of orthoses and aids during the recovery and stabilization represented independent risk factors for PPS in the studied population.
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