Poliomyelitis, commonly known as polio, is a viral disease that may cause paralysis. It is caused by the poliovirus, which targets motor neurons in the spinal cord. While most polio infections are asymptomatic, symptomatic cases can present as abortive polio, non-paralytic aseptic meningitis, or paralytic poliomyelitis. Paralytic polio is further classified as spinal, bulbar, or bulbo-spinal depending on the areas of the spinal cord and brainstem affected. Diagnosis involves testing stool, cerebrospinal fluid, or serum samples. Treatment focuses on symptom relief through rest, pain management, physical therapy, and supportive measures like ventilation or
In this presentation you will find summary for poliomyelitis. what is polio ? what are the causes ? and what will be the prevention?
here you'll also find about the rehabilitation program for polio as well..
Encephalitis is a rare yet serious disease that can be life-threatening.
Encephalitis is an inflammation of the brain tissue.
The most common cause is viral infections.
In rare cases it can be caused by bacteria or even fungi.
Encephalitis is an inflammation of the brain tissue.
Primary encephalitis- It occurs when a virus directly infects the brain and spinal cord.
Secondary encephalitis- It occurs when an infection starts elsewhere in the body and then travels to your brain.
Older adults
Children under the age of 1 year
People with weak immune systems
Primary (infectious) encephalitis
Common viruses, including HSV (herpes simplex virus) and EBV (Epstein-Barr virus)
Childhood viruses, including measles and mumps
Arboviruses (spread by mosquitoes, ticks, and other insects), including Japanese encephalitis, West Nile encephalitis, and tick-borne encephalitis
Secondary encephalitis: could be caused by a complication of a viral infection.
Brief and easily understandable description on measles along with images for undergraduate students. this presentation would help in picturising what measles is.
In this presentation you will find summary for poliomyelitis. what is polio ? what are the causes ? and what will be the prevention?
here you'll also find about the rehabilitation program for polio as well..
Encephalitis is a rare yet serious disease that can be life-threatening.
Encephalitis is an inflammation of the brain tissue.
The most common cause is viral infections.
In rare cases it can be caused by bacteria or even fungi.
Encephalitis is an inflammation of the brain tissue.
Primary encephalitis- It occurs when a virus directly infects the brain and spinal cord.
Secondary encephalitis- It occurs when an infection starts elsewhere in the body and then travels to your brain.
Older adults
Children under the age of 1 year
People with weak immune systems
Primary (infectious) encephalitis
Common viruses, including HSV (herpes simplex virus) and EBV (Epstein-Barr virus)
Childhood viruses, including measles and mumps
Arboviruses (spread by mosquitoes, ticks, and other insects), including Japanese encephalitis, West Nile encephalitis, and tick-borne encephalitis
Secondary encephalitis: could be caused by a complication of a viral infection.
Brief and easily understandable description on measles along with images for undergraduate students. this presentation would help in picturising what measles is.
Tetanus Presentation
77 slides
Including drip rates of muscle relaxants
PDF : http://www.mediafire.com/download/k00ciibf73d7y6p/
For more, visit www.medicalgeek.com
Chikungunya is an epidemic disease, broke out in Bangladesh in 2017. It was first identified in Tanzania 1953. From then it continuously rose as an epidemic disease after some interval in Asia, Africa and even in America.
Tetanus Presentation
77 slides
Including drip rates of muscle relaxants
PDF : http://www.mediafire.com/download/k00ciibf73d7y6p/
For more, visit www.medicalgeek.com
Chikungunya is an epidemic disease, broke out in Bangladesh in 2017. It was first identified in Tanzania 1953. From then it continuously rose as an epidemic disease after some interval in Asia, Africa and even in America.
Polio or poliomyelitis is first known to have occurred nearly 6,000 years ago, as evidenced by the withered and deformed limbs of certain Egyptian mummies.
Polio was epidemic in the United States and the world in the 20th century, especially in the 1940s and 1950s.
Poliomyelitis is a highly infectious viral disease, which mostly affects young children; the virus is transmitted by person-to-person spread mainly through the fecal-oral route, or, less frequently, by a common vehicle (e.g. contaminated food or water) and multiplies in the intestine, from where it can invade the nervous system and can cause paralysis.
Initial symptoms of polio include fever, fatigue, headache, vomiting, stiffness in the neck, and pain in the limbs.
Etiology
Polioviruses are enteroviruses within the Picornaviridae family.
Direct contact. Poliovirus can be transmitted through direct contact with someone infected with the virus.
Ingestion. Less commonly, it can be transmitted through contaminated food and water.
Clinical Manifestations
Most patients infected with poliovirus develop inapparent infections and are frequently asymptomatic.
Nonspecific symptoms. Fever, headache, nausea, vomiting, abdominal pain, and oropharyngeal hyperemia are observed in mild cases and usually resolve within a few days.
Nonparalytic poliomyelitis. Nonparalytic poliomyelitis is characterized by the symptoms described above in addition to the following: nuchal rigidity, more severe headache, back, and lower extremity pain, and meningitis with lymphocytic pleocytosis (usually).
Assessment and Diagnostic Findings
To confirm the diagnosis, a sample of throat secretions, stool or a colorless fluid that surrounds your brain and spinal cord (cerebrospinal fluid) is checked for poliovirus.
Viral cultures. Obtain specimens from the cerebrospinal fluid (CSF), stool, and throat for viral cultures in patients with suspected poliomyelitis infection.
Serum antibody. Obtain acute and convalescent serum for antibody concentrations against the 3 polioviruses.
IG titer. A 4-fold increase in the immunoglobulin G (IgG) antibody titers or a positive anti-immunoglobulin M (IgM) titer during the acute stage is diagnostic.
Medical Management
The treatment of poliomyelitis is mainly supportive.
Physical therapy. Physical therapy is indicated in cases of paralytic disease; in paralytic disease, it provide frequent mobilization to avoid the development of chronic decubitus ulcerations; active and passive motion exercises are indicated during the convalescent stage.
Total hip arthroplasty. Total hip arthroplasty is a surgical therapeutic option for patients with paralytic sequelae of poliomyelitis who develop hip dysplasia and degenerative disease.
Diet. Because patients with poliomyelitis are prone to develop constipation, a diet rich in fiber is usually indicated.
Pharmacologic Management
No antiviral agents are effective against poliovirus.
THESE SLIDES ARE PREPAREED TO UNDERSTAND about communicable diseases IN EASY WAY Important links- NOTES- https://mynursingstudents.blogspot.com/ youtube channel https://www.youtube.com/c/MYSTUDENTSU... CHANEL PLAYLIST- ANATOMY AND PHYSIOLOGY-https://www.youtube.com/playlist?list=PL93S13oM2gAPM3VTGVUXIeswKJ3XGaD2p COMMUNITY HEALTH NURSING- https://www.youtube.com/playlist?list=PL93S13oM2gAPyslPNdIJoVjiXEDTVEDzs CHILD HEALTH NURSING- https://www.youtube.com/playlist?list=PL93S13oM2gANcslmv0DXg6BWmWN359Gvg FIRST AID- https://www.youtube.com/playlist?list=PL93S13oM2gAMvGqeqH2ZTklzFAZhOrvgP HCM- https://www.youtube.com/playlist?list=PL93S13oM2gAM7mZ1vZhQBHWbdLnLb-cH9 FUNDAMENTALS OF NURSING- https://www.youtube.com/playlist?list=PL93S13oM2gAPFxu78NDLpGPaxEmK1fTao COMMUNICABLE DISEASES- https://www.youtube.com/playlist?list=PL93S13oM2gAOWo4IwNjLU_LCuhRN0ZLeb ENVIRONMENTAL HEALTH- https://www.youtube.com/playlist?list=PL93S13oM2gAPkI6LvfS8Zu1nm6mZi9FK6 MSN- https://www.youtube.com/playlist?list=PL93S13oM2gAOdyoHnDLAoR_o8M6ccqYBm HINDI ONLY- https://www.youtube.com/playlist?list=PL93S13oM2gAN4L-FJ3s_IEXgZCijGUA1A ENGLISH ONLY- https://www.youtube.com/playlist?list=PL93S13oM2gAMYv2a1hFcq4W1nBjTnRkHP facebook profile- https://www.facebook.com/suresh.kr.lrhs/ FACEBOOK PAGE- https://www.facebook.com/My-Student-S... facebook group NURSING NOTES- https://www.facebook.com/groups/24139... FOR MAKING EASY NOTES YOU CAN ALSO VISIT MY BLOG – BLOGGER- https://mynursingstudents.blogspot.com/ Instagram- https://www.instagram.com/mystudentsu... Twitter- https://twitter.com/student_system?s=08 #PEM, #polio,#communicablediseases,#ASSESSMENT, #APPEARENCE,#PULSE,#GRIMACE,#REFLEX,#RESPIRATION,#RESUSCITATION,#NEWBORN,#BABY,#VIRGINIA, #CHILD, #OXYGEN,#CYANOSIS,#OPTICNERVE, #SARACHNA,#MYSTUDENTSUPPORTSYSTEM, #rashes,#nursingclasses, #communityhealthnursing,#ANM, #GNM, #BSCNURING,#NURSINGSTUDENTS, #WHO,#NURSINGINSTITUTION,#COLLEGEOFNURSING,#nursingofficer,#COMMUNITYHEALTHOFFICE,#HEALTHPROBLEMS
Poliovirus is a picornaviridae. it has 3 wildtypes, Wildtype 2 has been eradicated from the world. All countries have been declared polio free except Pakistan, Afghanistan and Nigeria. Global Polio Eradication Initiative has been discussed.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
1. SUBMITTED TO: SUBMITTED BY:
MRS. VINAY KUMARI AMANDEEP KAUR
Associate professor(HOD) M.Sc. (N) 2nd Year
Medical-Sugical Nursing Deptt. Roll No. 11915703
SUBMITTED ON:- 17.04.2017
2. INTRODUCTION
A viral disease which may affect the spinal cord causing
muscle weakness and paralysis.
The words polio (grey) and myelin (marrow, indicating
the spinal cord) are derived from the Greek.
Poliomyelitis is a disease of the anterior horn motor
neurons of the spinal cord and brain stem caused by
poliovirus.
Poliomyelitis, literally meaning “grey spinal cord
inflammation
It is a viral infection
3. INTRODUCTION
Virus localized in the anterior horn cells of the spinal cord
and certain brain steam motor nuclei.
It is contagious: usually spread from person to person.
Only harmful to humans
The virus enters the body through the mouth, usually from
hands contaminated of an infected person.
3 types: Spinal, Bulbar and Bulbo-spinal
Disease is more common in the summer/rainy season.
It is primarily an intestinal infection that causes paralysis
in less than 1% of cases
4. Historical Background
Sir Walter Scott(1771–1832) may have had the earliest
recorded case of polio.
First described by Michael Underwood in 1789
Initially thought to be due to trauma
Became known as the Heine-Medin disease due to the
work of Dr. Jakob Heine and Dr. Karl Oskar Medin.
Later called infantile paralysis, based on its propensity
to affect children.
3rd human disease targeted for eradication.
6. Cont…
Americans believed that the Italians brought it over since
immigrants are “dirty” and live in the slums.
25% of polio deaths came in the first 24 hours…85% of
deaths occurred during a victim’s first 20 days in the
hospital.
Polio patients whose muscles were paralyzed faced
months, perhaps years, of burdensome physical therapy to
strengthen weakened muscles.
Patients were often placed in iron lungs to help with
breathing regulation.
7. Immune system
In immune individuals, IgA anti bodies against poliovirus are
present in the tonsils and gastrointestinal tract, and are able to
block virus replication; IgGand IgM antibodies against PV can
prevent the spread of the virus to motor neurons of the central
nervous system.
Infection or vaccination with one serotype of poliovirus does
not provide immunity against the other serotypes, and full
immunity requires exposure to each serotype.
A rare condition with a similar presentation, nonpoliovirus
poliomyelitis, may result from infections with nonpoliovirus
enteroviruses.
8. Census
India was rated for 40,000 cases of polio in 1980s and
until 2002. The state of Uttar Pradesh alone was
accounted for 2/3rd of the world’s polio cases.
No polio case reported since 2011.
9th Annual Plan By The Planning Commission Of India
a) Started the PPP: Dec 1995
b) Original Target of eradication: 2000
c) Revised Target of eradication: 2002
d) Further Revised Target of eradication: 2007
9. DEFINITION
It is an acute viral infectious disease caused by
enterovirus.
The word ‘myletis’ means an inflammation in the spinal
cord, which often targets insulating material covering
nerve cell fibers (myelin).
Greek word:-
“polios”-grey
“Myelos” –spinal cord
Route:- feco-oral
10. Epidemiology
Incidence
(2011)India :- 5cases-
1wild polio, 4
VAPP(Vaccine-
Associated Paralytic
Poliomyelitis)
(2010)42 confirmed
cases
Last case detected in
Goa in 1997
11. Agent
GENUS: Enterovirus
SPECIES: poliovirus
STRUCTURE: ssRNA enclosed in a protein capsid.
TYPES: Three Types: - PV1, PV2, PV3. differentiated by
the type of capsid protein.
SIZE: 30nm in diameter with icosahedral symmetry
PV1 is most common encountered form & the one most
commonly associated with the paralysis.
12. Resistance
In feces :- for months at 4oC & years at 20oC
Inactivated by heat and chlorination.
Host range :- natural infection occurs only in humans.
Mode of transmission
Feco-oral route
In early stage of disease, through inhalation or entry
through conjunctiva of droplets of respiratory secretions
of patient.
13. Period of communicability
7-10 years before & after the onset of symptoms.
Age :- most vulnerable from 6months to 3 years.
Seasonal :- most common
during rainy season, peak season
from July to September.
Environmental source
of infection:-
Contaminated water and food
Flies
Overcrowding and poor sanitation.
18. Entero viruses
The Nomenclature has given Numbers
1. Polio virus types 1 to 3.
2. Coxsasackie virus Group A. 1- 24.
3. Coxsasackie virus Group B. 1-6.
4. Echo virus type 1-33.
5. Entero virus type 68-71.
19. Life cycle of polio virus
Poliovirus, the causative agent of
poliomyelitis, is a human
enterovirus and member of the
family of Picornaviridae.
Poliovirus is composed of a RNA
genome and a protein capsid.
The genome is single-stranded
positive-sense RNA
20. Life cycle of polio virus
Enters through mouth
Intestine if the virus finds a cell with the correct receptor in
the intestine
Infection begins
The polio virus genoma (RNA) enters the intestinal cell
21. The viral RNA takes over the cell
Replicates (RNA) in intestinal cell
New RNA+ new capsids (shells) = new polio virus
Thousands of polio virus burst out of cell and enters the
blood stream
34. CLINICAL FEATURES/ TYPES
Infection may occur in two forms:-
1. Inapparent/ asymptomatic(90-95%)
Accounts for approximately 95% of cases
Virus stays in intestinal tract and does not attack the nerves
Virus is shed in the stool so infected individual is still able to
infect others
2. Apparent/ symptomatic (5-10%)
Abortive polio
Non-paralytic aseptic meningitis
Paralytic poliomyelitis
Polio encephalitis
35. Abortive polio
4-8% infections
Does not lead to paralysis
Minor illness
Symptoms :-
Low grade fever
Sore throat
Vomiting
Abdominal pain
Loss of appetite
Malaise
Recovery:- complete, most recover in <1 week , no paralysis.
36. Non-paralytic aseptic meningitis
Occurs in 1-2% of polio infections
Symptoms :-
Headache
Nausea
Vomiting
Pain and stiffness of neck, back and legs.
Complete recovery after 2-10 days of symptoms.
38. Signs
Kiss the knee test
Method:- knees kept
down, child ask to kiss his
knees.
Observation:- cannot do
the maneuver due to
stiffness spine may draw
up the knees sharply.
39. Head drop sign
Method:- hand placed
under patient’s shoulder
and trunk is raised.
Observation:- head lags
behind limply.
40. Neck rigidity
Method:- in
uncooperative
child- place child’s
head beyond the
edges of table.
Observation:- true
involuntary neck
rigidity persists,
voluntary stiffening
of muscles
disappears.
41. Paralytic poliomyelitis
0.5-1% of of those infected develop this type.
2 phases-
Minor- same as abortive polio
Major- muscle pain, spasm and return of fever
Followed by rapid onset flaccid paralysis, complete within
72hrs.
It is of three types:-
1. Spinal paralytic poliomyelitis
2. Bulbar poliomyelitis
3. Bulbo-spinal poliomyelitis
42. 1. Spinal paralytic poliomyelitis
Attacks motor neurons in the spinal cord and
causes paralysis in arms and legs and breathing
problems.
Most common 79-80% of cases
Results from lower motor neuron lesion of
anterior horn cells of spinal cord
Affects muscles of legs, arms and trunk.
Severe cases- quadriplegia, paralysis of trunk,
abdominal and thoracic muscles.
43. Cont…
Paralysis- asymmetrical (legs> arms) , descending paralysis,
Children <5 years most likely to become paralyzed in
one leg
Adults are most commonly paralyzed in both arms and
legs
Muscles- floppy
Reflexes- diminished, Deep tendon reflex lost before onset of
paralysis
Sensation- normal
Residual paralysis- after 60 days.
44. 2. Bulbar poliomyelitis
Affects neurons responsible for sight, vision, taste,
swallowing, and breathing
Accounts for 2% of paralytic polio
Life threatening
Virus attacks motor neurons in brainstem
Affects cranial nerve function
Cranial nerve lesion- vagus
Primarily inhibits ability to breathe, speak, and swallow
effectively
Facial asymmetry present
45. Symptoms
Nasal twang and hoarseness of voice
Nasal regurgitation
Dyspnea(difficult or laboured breathing.)
Dysphagia (difficulty or discomfort in swallowing)
Child refuses to feed
Secretions accumulate in pharynx- aspiration
Involvement of
Respiratory centre- shallow, irregular respiration
Vasomotor centre- BP rises then fall
Pulse- rapid, weak thread
Skin- dusky and mottoled
Restless, confused and comatose
46. 3. Bulbo-spinal poliomyelitis
Accounts for 19% of paralytic cases.
Affects extremities and cranial nerves.
Leads to severe respiratory involvement.
Combination of spinal paralytic and bulbar polio.
47. Polio encephalitis
Occurs in rare cases
Causes inflammation of gray matter of brain
Autonomic dysfunction is common and it has a high
mortality
Signs & Symptoms:-
Agitation,
Confusion,
Stupor
coma
Irritability
Delirium
48. Disorientation
Tremors
Convulsions
Paralysis of upper motor neuron type
Residual paralysis
Acute phase of illness lasts for 0-4 weeks
Recovery- variable
At 60 days mild to severe residual paresis
Maximum recovery up to first 6 months
Slow recovery up to 2 years.
After 2 years post polio residual paralysis persists
50. Stool examination
The laboratory diagnosis of polio is confirmed by isolation
of virus by cultures, from the stool or throat swab or
cerebrospinal fluid (rare). In an infected person, the virus
is most likely to be cultured in stool cultures.
Collection of sample:-
2 samples 24hr apart
Within 14 days of onset of paralysis
8-10 grams or thumb size
Collection in a clean wide mouth bottle- plastic or glass
with screw cap
51. Cont…
Sample stored below 8oC
No dessication or leakage till received at WHO accredited
lab
If paralysis detected after 2 weeks sample taken up to
60days after onset.
Contact sampling:-
Done when child has died without adequate stool
sampling,
5 children in close contact with the child are taken
Single stool sample collected
52. CSF examination
Infection with polio virus may cause an increased number
of white blood cells and a mildly elevated protein level in
cerebrospinal fluid
Sr. no. Characteristics Observation
1. Appearance Clear/slightly turbid
2.
Cells 0-5 cells/µL (< 2
polymorphonucleocytes)
Leukocytosis (mainly
lymphocytes)
3. Proteins < 45 of serum protein
Normal/slightly raised
100-300 mg/dL
4. Glucose >60% of serum glucose Normal
53. Serological tests
Acute and convalescent serum sample may be tested for
rise in antibody titer (antibodies to the poliovirus), but the
report can be difficult to interpret as in many cases, the
rise in titer may occur prior to paralysis.
Three types of antibodies
Neutralizing antibodies (IgG)
Antibodies to C antigen (IgM)
Anti –D antibodies
54. Complement fixation test:-
Detects IgM and anti D antibodies
Identifies exposure to poliovirus not for type- specific
diagnosis
Less often employed
56. TREATMENT
Symptomatic and supportive
The goal of the treatment is to control symptoms while
the infection runs its course as there is no specific
treatment for the viral infection.
Treatment may includes :
Hospitalization (may be required for those individuals who
develop paralytic poliomyelitis).
If the respiratory is involved, LONG-TERM VENTILATION
is necessary.
57. Cont…
Catheterization of distended bladder may be
necessary.
Antibiotic for urinary tract infection.
Moist heat to reduce pain and muscle spasm
Pain killer to reduce muscle pain, headache (such
as acetaminophen).
Physical therapy, braces or corrective shoes, or
orthopedic surgery to help recover muscle strength &
function
58. Bed rest
Essential during acute phase:- physical activity and trauma
increases risk of paralytic polio
Posture to be changed every 2-3hrs.
Child to be placed on stomach for short period each day,
to prevent pneumonia
Optimum position for limbs
Hip- slight flexion
Knee- 5o flexion
Foot- 90o support against the sole
59. Pain relief
Sister Kenny’s treatment:- hot moist packs applied to the
muscles to relieve pain and spasm.
Analgesics
Physiotherapy
Method
Joints and paralysed muscles- moved passively through full
range for 10min., 2-3times/day
Benefits
Prevents deformities and contracture
Promote development of muscle power in paralysed muscles.
60. Physiotherapy
Method
Joints and paralysed
muscles- moved passively
through full range for
10min., 2-3times/day.
Benefits
Prevents deformities and
contracture
Promote development of
muscle power in paralysed
muscles.
61. Good nursing
Team approach is
essential
Nursing staff is an
important part in patient
care.
62. Diet
Nutritious, balanced and wholesome
In non-paralytic polio- normal diet
In paralytic polio- fed by naso-gastric tube, calories/kg
body weight.
In dysphasia patients nursed in prone position with foot
end raised- gravity drainage of
pooled secretions in pharynx.
Or intermittent suction
Tracheostomy
Respiratory failure- assisted respiration
with mechanical ventilator.
63. Indications for hospitalization
Paralysis of upper limbs <3 days duration
Progression of paralysis
Bulbar involvement
Respiratory distress
Marked drowsiness
Complications
64. Rehabilitation
Physical
Physical therapy is recommended for full recovery.
Passive stretching exercises and wedging casts can be used for
mild to moderate contractures.
Surgical release of tight fascia and muscle aponeuroses and
lengthening of tendons may be necessary for contractures
persisting longer than 6 months.
Orthoses should be used until no further recovery is anticipated.
Static joint instability can be controlled by Orthoses.
Dynamic joint instability result in a fixed deformity that
cannot be controlled by Orthoses.
65.
66. Emotional and
psychological: It is
mainly emotional
support to the child
helps prepare himself
for better adjustment
in life despite the
handicap.
67. Occupational Therapy
Occupational therapy (OT) provides purposeful activities
or interventions in order to promote function, health, and
wellness and to prevent further injury or disability.
The goal is to assist survivors in achieving
their maximum level of independence.
To be seen by an occupational therapist, a referral by a
physician is usually required.
68. Recreational Therapy
Patients may attend leisure activities to reduce stress and
learn how to get involved in group activities
69. Speech Therapy
Patients with cranial nerve involvement may develop
swallowing dysfunction. To protect the airway and prevent
aspiration pneumonia, a speech therapist needs to be
involved early to perform an evaluation of the safety of
swallowing.
Decisions on the appropriate consistency of oral foods and
use of various strategies/techniques greatly reduce the risk
of aspiration.
Periodic follow up of patient status can be performed with
serial video swallow testing.
71. NURSING MANAGEMENT
Nursing Diagnosis
Imbalanced Nutrition: Less Than Body Requirements
related to anorexia, nausea and vomiting
Ineffective Thermoregulation related to the infection
process
Ineffective Airway Clearance related to muscle paralysis
Ineffective Breathing Pattern related to muscle paralysis
Acute pain related to the infection that attacks the nerve
Impaired physical mobility related to paralysis
Anxiety: in children and families related to disease
conditions.
72. 1. Imbalanced Nutrition: Less Than Body Requirements
related to anorexia, nausea and vomiting
Nursing intervention
Encourage frequent small meals to promote nutritional and
fluid intake.
Maintain naso-gastric tube feeding, if ordered.
Hyper alimentation may be necessary to ensure adequate
nutrition.
Eliminate unpleasant stimuli and odors from the environment
during meals.
Monitor skin turgor every shift.
Involve a nutritionist in planning a diet for the child that
includes favorite foods.
73. 2. Ineffective Thermoregulation related to the infection
process
Nursing Intervention
Reduce or eliminate the sources of heat loss in infants:
When a shower, prepare a warm environment.
Avoid the flow of air (air conditioning, ceiling fan,
open vent)
Warm all the goods for care (stethoscope, scales,
hand care givers, clothes, bed linen)
Place the baby swing bed away from the wall
(outside) or window if possible.
74. Monitor the baby's body temperature
If the temperature is below normal
Use with two blankets
Wear headgear
Assess the environmental sources for heat loss
If hypothermia settled more than 1 hour, refer to the more
expert.
Review of the complications of cold stress, hypoxia,
respiratory acidosis, hypoglycemia, fluid and electrolyte
imbalance, weight loss.
75. If the temperature is above normal
Remove the blanket
Remove the headgear, when worn
Assess the environmental temperature again
If the temperature hyperthermia settled more than 1
hour, report the physician.
Teach caregivers why babies are vulnerable to temperature
(hot and cold)
Demonstrate how to save heat during the bath.
76. 3.Ineffective Airway Clearance related to muscle paralysis.
Nursing Interventions
Assess respiratory rate, depth, rythm, effort, and breath
sounds.
Position: HOB elevated.
Promote o ptimum level of activity for best possible lung
expansion, Ambulate.
Suction per: Nasal, Oral, Tracheal
77. 4. Acute pain related to the infection that attacks the nerve
Nursing Interventions
Analgesic Administration
Pain Management
Patient-Controlled Analgesia Assistance
78. 5. Impaired physical mobility related to paralysis
Nursing Interventions
Exercise Therapy: Ambulation
Joint Mobility
Fall Precautions
Positioning
Bed Rest Care
79. PROGNOSIS
Non paralytic cases- complete recovery
Paralytic polio- permanent weakness in 2/3rd cases
Worse- older children , sudden onset of illness with high
fever.
80. POST POLIO SYNDROME
Observed in people who had polio during their childhood,
having complete recovery but may develop signs of polio
in later stage.
Affects about 25-50% of the polio survivors.
More common in females.
81. Common signs and symptoms:
Progressive muscle or joint weakness and pain
General fatigue and exhaustion after minimal activity
Muscle atrophy
Breathing or swallowing problems
Sleep-related breathing disorders, such as sleep apnea
Decreased tolerance of cold temperatures
Cognitive problems, such as concentration and memory
difficulties
Depression or mood swings
82. PREVENTION
The best preventive measure for poliomyelitis is ensuring
hygiene and encouraging good sanitation practices. But,
polio prevention begins with polio vaccination. Polio
vaccine has been developed against all 3 subtypes of the
poliovirus and is very effective in producing protective
antibodies that induces immunity against the poliovirus and
provides protection from paralytic polio.
83. Cont…
Global Polio Eradication Initiative launched in 1988.
Polio cases have decreased by over 99% since 1988, from
an estimated 3,50,000 cases then, to 1,604 reported cases
in 2009.
In 2010, only four countries in the world remain polio-
endemic, down from more than 125 in 1988. The
remaining countries are Afghanistan, India, Nigeria and
Pakistan.
84. Core strategies of GPEI (Global Polio
Eradication Initiative)
1. High infant immunization coverage with four doses of oral
poliovirus vaccine (OPV) in the first year of life
2. Supplementary doses of OPV to all children under five
years of age during PPI.
3. AFP (acute flaccid paralysis) surveillance among children
under fifteen years of age.
4. Targeted “mop-up” campaigns once wild poliovirus
transmission is limited to a specific focal area.
85. The best preventive measure for poliomyelitis is ensuring
hygiene and encouraging good sanitation practices. But,
polio prevention begins with polio vaccination. Polio vaccine
has been developed against all 3 subtypes of the poliovirus
and is very effective in producing protective antibodies that
induces immunity against the poliovirus and provides
protection from paralytic polio.
Two types of vaccine are available:
An inactivated (killed) polio vaccine (IPV) and
A live attenuated (weakened) oral polio vaccine (OPV).
86. Type of vaccine ADVANTAGES DISADVANTAGES
Inactivated Polio
Vaccine
• It is inactivated, so it cannot
replicate, and cannot be shed in
the stool of a vaccinated person.
• It cannot cause vaccine associated
paralysis, and is safe to use in
immune-deficient persons or in
household contacts of immune-
deficient persons.
• Requires injection
• More expensive
• Produces less local
gastrointestinal
immunity
• Recipients could
become infected with
wild polio virus
Oral Polio Vaccine • It is very easy to administer
• Less expensive
• Produces excellent intestinal
immunity which helps.
• Prevent infection with wild virus
• May cause vaccine-
associated paralytic
polio
87. GUIDE ON POLIOMYELITIS IMMUNIZATION
Rationale for IPV
use
- Lowers the risk of reemergence of type 2 wild and vaccine-derived poliovirus and
facilitates control and interruption of reintroduced type 2 polioviruses in
conjunction with targeted use of monovalent OPV.
Type of vaccine - Inactivated (killed) vaccine with types 1,2,&3 antigens
- Antigen dose 40-8-32 for each vaccine type
Route of adm. - Intramuscular or subcutaneous injection
Immunization
Schedule
-WHO recommends 1 dose of IPV with DTP3 and OPV3 which is typically
recommended at 14 weeks or at 4 months, based on country EPI schedules and
SAGE recommendations.
Volume per dose - Each dose is 0.5 ml
Storage conditions:
heat & freeze
sensitivity
- Store at 2°C to 8°C. DO NOT FREEZE
- DISCARD opened vial at the end of the vaccination session or after 6 hours
whichever comes first—do not return open vial to refrigerator.
Presentation & vial
size
- WHO prequalified in stand-alone 1 and 10 dose vials (5-dose vials anticipated in
the second half of 2014)
Package volume per
dose
- 1-dose presentation: 1, 10, & 50 vial cartons with volume per dose (cm3) of 101.4,
26.8, and 12.9 respectively
- 5-dose presentations (volume information pending)
- 10-dose presentation: 10 vials cartons with volume per dose (cm3) of 2.46
Co-administration
with other vaccines
-Can be co-administered with other injectable vaccines but with separate syringe in
a separate injection site (at least 2.5 cm apart)
- IPV can be co-administered with OPV in the same session.
88. (OPV)
Route Oral
Site Mouth
Number of Dose 3 doses
Age at First Dose 6 weeks after birth
Minimum Intervals between Doses 4 weeks
Dosage 2 drops
Storage Temperature -15 to -25 °C
89. Polio Vaccine Adverse Reactions
Rare local reactions (IPV)
No serious reactions to IPV have been documented
Paralytic poliomyelitis (OPV)
Polio Vaccine Contraindications and Precautions
Severe allergic reaction to a vaccine component or
following a prior dose of vaccine
Moderate or severe acute illness
90. Vaccine-Associated Paralytic Polio
Mutation of the vaccine inside the body may cause lose of attenuation
(itself brought on by reversion) leads to paralytic polio
Increased risk in persons >18 years & those with immunodeficiency
(B cell)
No procedure available for identifying persons at risk of paralytic disease
5-10 cases per year with exclusive use of OPV
2005 in India: Wild case: 66; VAPP 180,
Many countries switched to sequential IPV-OPV and then only IPV
schedules once the number of VAPP cases exceeded wild polio cases.
91. POLIO & ITS PREVENTION IN INDIA
India was one of the four countries with wild polio virus in
2010.
Most cases were reported from Bihar & UP
Cases seen in various states of north India were due to
import from their 2 states
2010 – 42 cases
Last case of type 2 in 1999
Last WPV3 Oct 2010
Last WPV1 Jan 2011
Polio free country – Jan 2014
92. Celebrity Engagement For a Public Cause
Celebrity endorsement is a technique of brand / advertising
campaign that involves a famous person using their fame to
help them in promoting a product /service .
Attracting users
Put life into the cause
Build awareness
Influence behavior
Positioning
93. The Major Campaign
“Do Boond Zindagi Ki”
Translated meaning : “Two drops of Life”.
Meaning: This meant two drops that had the power to
decide whether a child will walk , limp or die .
94. Polio Vaccination under UIP (universal immunization
programme)
Age Vaccine
Birth OPV0
6 wks OPV1
10 wks OPV2
14 wks OPV3
16-24 Months OPV4
Two drops of OPV is used
Nose should not be pinched
Instead apply pressure to both side of mouth
Breast feeding is not contraindicated
Hot liquids to be avoided for ½ hr after OPV
95. Pulse Polio Immunization (PPI)
The supplementary immunization activities (SIAs) in India
launched in 1995
Irrespective of the immunisation status
Usually Dec & Jan – Peak transmission
Providing additional OPV doses to every child aged <5 years at
intervals of 4-6 weeks during National Immunization Days
(NIDs) & sub-National Immunization Days (SNID's)
It “Flood” the community with OPV within a very short period
of time, thereby interrupting transmission of virus throughout
the community.
Intensification - house-to-house “search and vaccinate”
component.
The number of PPI rounds is determined by the extent of
poliovirus transmission in the country.
96. Vaccine Vial Monitoring
The vaccine vial monitor is a
small thermo chromic sticker on
the vaccine vial and changes
colour as the vaccine is exposed
to heat.
The colour of the sticker tells
whether the vaccine must be
discarded due to excessive heat
exposure.
It reduces uncertainty and waste.
97. Feelings of a child with polio-Addie Flowers Vance,
Charlotte, Mecklenburg County, 1996
"I won’t ever forget the feeling in my legs when I lost the
use of them. It was just such a weird feeling. It was just
like it went through me, just a surge went through my
body. I can feel it right now just thinking about it. It
was very frightening for a little 14-year-old girl to
think, gosh, my life’s gone, you know?”
98. PROGNOSIS
The outlook depends on the form of the disease (subclinical or
paralytic) and the body area affected. Most of the time, complete
recovery is likely if the spinal cord and brain are not involved.
Brain or spinal cord involvement is a medical emergency that may
result in paralysis or death (usually from respiratory problems).
Disability is more common than death. Infection that is located high
in the spinal cord or in the brain increases the risk of breathing
problems .
99. Case Study: Polio
Polio has been around for thousands of years, but it had
generally been a mild disease. When sanitation techniques
improved at the end of the 19th century, people stopped getting
the mild form of polio when they were babies. Instead, older
children and adults got a more serious illness that was
extremely contagious, and yet no one knew how it was
transmitted.
Animal research was crucial to identifying what caused polio
and finding a vaccine. In 1908 Drs. Karl Landsteiner and Erwin
Popper proved that polio was an infectious disease by showing
that monkeys injected with tissue from a person who died of
polio would become ill with the disease. We now know that
polio is transmitted when bodily wastes from a person who has
the disease contaminate food or water, which then is ingested
by another person.
100. Polio was difficult to stop because it is caused by a virus.
Antibiotics such as penicillin were considered "wonder drugs" in
the 1940s because they could cure bacterial infections, but they
were useless against polio. Viruses are also harder to isolate than
bacteria. In 1949 Drs. John Enders, Frederick Robbins, and
Thomas Weller made a breakthrough when they figured out how
to grow the polio virus in cell cultures. This achievement earned
them a Nobel Prize.
During the 1950s, Drs. Jonas Salk and Albert Sabin developed
two different polio vaccines. These vaccines "teach" the immune
system how to defend itself against polio by exposure to the virus
in a killed or weakened form. The vaccines were tested in
animals to make sure that they were safe and effective before
they were used in people.
Today polio has been virtually eradicated in the industrialized
world, but it remains a problem in some developing countries.
101. BIBLIOGRAPHY
O.P. Ghai et al. Essential Pediatric. CBS Publishers & distributors; 2009.
Park JE Textbook of preventive and social medicine ; a treatise on
community health. Banarsidas Bhanot; 1972.
Fauci AS, Eugene B, M.D SLH, M.D DLL, JJ, Joseph L. Harrison’s
principles of internal medicine. McGraw- Hill; 2008.
Bradford, Mak, Carrie Palmer, and Fiona Kouyoumdjian. "Vaccine
Strategies." N.p. Brown.edu. N.d. Web. 27 Apr. 2011.
Wilson, Daniel J. Living with Polio: The Epidemic and Its Survivors.
Chicago: University of Chicago, 2005. Print.
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