This document discusses poliomyelitis (polio), including its causes, clinical presentation, complications, management, and prognosis. Polio is caused by infection with the poliovirus, which destroys motor neurons and can cause flaccid paralysis. It primarily affects children under 5 years old and presents as aseptic meningitis or flaccid paralysis that is usually asymmetric. Long-term complications include deformities of the limbs from muscle imbalances. Management involves vaccination to prevent transmission and treatment of complications through bracing, therapy, or surgery. Prognosis depends on the initial severity and extent of paralysis.
A spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent changes in its function. Symptoms may include loss of muscle function, sensation, or autonomic function in the parts of the body served by the spinal cord below the level of the injury.
A spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent changes in its function. Symptoms may include loss of muscle function, sensation, or autonomic function in the parts of the body served by the spinal cord below the level of the injury.
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..
ANKLE FRACTURES
Pott’s fracture
A Pott’s fracture is a type of ankle fracture that is characterized by a break in one or more bony prominences on the sides of the ankle known as the malleoli.
Also known as Broken Ankle, Ankle Fracture and malleolar fracture.
Pott’s fracture often occurs in combination with other injuries such as a sprained ankle or other fractures of the foot, ankle or lower leg.
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..
ANKLE FRACTURES
Pott’s fracture
A Pott’s fracture is a type of ankle fracture that is characterized by a break in one or more bony prominences on the sides of the ankle known as the malleoli.
Also known as Broken Ankle, Ankle Fracture and malleolar fracture.
Pott’s fracture often occurs in combination with other injuries such as a sprained ankle or other fractures of the foot, ankle or lower leg.
https://www.biomedscidirect.com/2829/an-overview-of-coronavirus-disease-covid-19?utm=articles
An overview of coronavirus disease (covid-19)
Authors:Emy Jancy Rani J.
Int J Biol Med Res. 2023; 14(4): 7687-7691 | Abstract | PDF File
juliet Nnaji Review of Case study 2Top of FormEpisodicFoc.docxLaticiaGrissomzz
juliet Nnaji
Review of Case study 2
Top of Form
Episodic/Focused SOAP Note
Patient Information:
JO, 46-year-old female, African American
S.
CC: Pain in both ankles, but more concerned about her right ankle.
HPI: The patient is a 46-year-old African American female who presents to the clinic with complaint of bilateral ankle pain, but more concerned about her right ankle. Patient reports that she heard a pop come from her right ankle while playing soccer 3 days ago over the weekend, and ever since her right ankle has become increasingly uncomfortable. She is able to bear weight but it is uncomfortable when standing or walking. Patient described the pain as a dull uncomfortable pain and she rates the pain as 7/10 to the right ankle and 3/10 to the left ankle. She believes that the right ankle is bruised and swollen. She reports that she takes Ibuprofen and Tylenol alternately for pain and swelling and it makes it tolerable. Pain is aggravated whenever she puts weight on it to stand or walk but feels better when she is seated with her right foot raised.
Current Medications:
Ibuprofen 600mg every 8 hours as needed for the pain
Tylenol 1000mg every 4 hours as needed for pain
One-A-Day Women’s Multivitamins one tablet daily
Ferrous Sulfate 325mg once daily
Allergies: Denies any drug, food, latex or seasonal allergies
PMHx: Osteoarthritis (diagnosed 7 years ago), Type 11 DM and HTN (diagnosed 3 years ago). Right total knee replacement (3 years ago). Received influenza vaccine this season, Current on Covid and other vaccines. Last Tdap 11/25/2020. No recent hospitalizations
A.
Differential Diagnoses
1)Primary Diagnosis is Ankle Sprain:
An ankle sprain is an injury to one or more ligaments in the ankle with symptoms such as pain, swelling, soreness, bruising, limited range of motion and joint stiffness (Dains, Baumann, & Scheibel, 2019). It is an inversion-type twisting of the foot, followed by pain and swelling (Young, 2019). This type of injury is often associated with physical activities or sports. Sports injuries occur when running, cutting, landing from a jump, or from direct contact which can produce an audible tear or pop causing pain and swelling that are immediate, but ecchymosis may lag a day or two behind (American Orthopedic Foot & Ankle Society, 2021). JO has most of these symptoms and is able to bear weight which rules out a more complex structural injury or fracture.
2) Bursitis: Bursitis can be described as the acute or chronic inflammation of a bursa that results in localized pain, tenderness, and swelling over the bursa (Maffulli, et al, 2018). Other symptoms that are associated with this condition is low-grade temperature, the warmth of overlying skin, and a palpable bump over heel (Maffulli et al., 2018).
3) Plantar fasciitis: This affects women twice as often as men. It is caused by chronic weight-bearing stress when laxity of the foot structures allows the talus to slide forward and.
The CDC estimates that AFM affects about 100 people each year. It is most common among children and young adults, although anyone can get it. People of all ages can develop AFM after being exposed to viruses, including enteroviruses (EV-D68, poliovirus), coxsackievirus, and rhinovirus. EV-D68 has been the main cause of AFM since 2018.
The coronavirus disease outbreak has proven to be a major health crisis affecting virtually every facets of our lives.
Coronavirus disease is an ongoing pandemic disease. The disease which is caused by a new type of virus, known as severe
acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Many patients hospitalized with COVID-19 will develop muscle
weakness particularly those admitted in intensive care unit (ICU). Studies have shown that muscle weakness is one of the
direct consequences of critical illness. We systematically reviewed literature that quantified changes in muscle strength and it
relationship with COVID- 19 in Intensive care unit in humans.
My little case study and a brief discussion about Pneumonia in general.
Constructive criticisms and reactions are welcomed. I'm still a nursing student, so I would like to thank you guys in advance for helping me to learn more.
:)
Transverse myelitis is a pathology, whose etiology is associated with autoimmune or infectious diseases, which directly affects the spinal cord, coursing with motor, sensory and acute or subacute dysfunction9. We report a case of a 32-year-old multiparous woman who, after the first postpartum day, reported pain and paresthesia in the lumbar and lower limbs with progressive worsening. Patient started clinical investigation, with orthopedic causes ruled out, together with the neurology and neurosurgery team. She underwent magnetic resonance imaging of the thoracic and lumbar spine where infectious neuropathy was evidenced at L4-L5. Patient was transferred to a referral hospital where Mycobacterium tuberculosis was evidenced as the cause and, when performing a rapid test for SARS-CoV-2, it was positive.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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.
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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.
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
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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
1. POLIOMYELITIS
AND ITS
MANAGEMENT
Dr. Arojuraye S. A
(MBBS, FWACS, FMCOrtho)
Consultant Orthopaedic & Trauma Surgeon
National Orthopaedic Hospital, Dala - Kano
Refresher Course in Orthopaedic Nursing, June 2019.
doctoraroju@yahoo.com
3. Introduction
Poliomyelitis: Acute infectious viral disease
spread by the oropharyngeal route.
Major cause of morbidity & mortality until
1960s
Large epidemics in 1940s & 1950s in
developed world
Refresher Course in Orthopaedic Nursing, June 2019.
doctoraroju@yahoo.com
4. Introduction…
Only 10% of patients exhibit any symptoms
CNS involvement occurs in < 1%
“Silent circulation”
Many may be infected prior to the development of
a single case of paralysis
WHO:
a single confirmed case of polio in an area of low
occurrence is an epidemic
Refresher Course in Orthopaedic Nursing, June 2019.
doctoraroju@yahoo.com
5. Introduction…
Effects:
Anterior horn cells of the spinal cord & brainstem
Flaccid paralysis of the affected muscle groups
Rare disease (1988):
Due to vaccination
Effects of previous dx are still with us
Refresher Course in Orthopaedic Nursing, June
2019. doctoraroju@yahoo.com
6. Introduction…
Affects any age & Sex
Most common in children (<5yrs)
M:F = 3:1
Immunity
Maternal immunity disappear during the first six
month of the life.
Immunity after the infection is life long but
reinjection
No cross immunity: types I, II & III
Refresher Course in Orthopaedic Nursing, June 2019.
doctoraroju@yahoo.com
7. Introduction…
3 countries are endemic (2014):
Pakistan
Nigeria
Afghanistan
WHO (25/09/2015):
Nigeria out of polio - endemic list
Sporadic cases occur in many others
Refresher Course in Orthopaedic Nursing, June 2019.
doctoraroju@yahoo.com
8. Introduction…
Patients with polio sequelae:
Still abundant
They are not infectious
They are crippled & outcast in modern society
The role of Orthopedic surgeon & nurses is not
during acute phase, but to effectively treat its
sequelae to help these people lead a more
normal life
Refresher Course in Orthopaedic Nursing, June 2019.
doctoraroju@yahoo.com
9. Aetiopathogenesis
Infection is caused by poliomyelitis virus:
Group: Enterovirus
Family: Picornavirus
Single-stranded RNA
3 different strains of virus: type I, II, III
No cross immunity
Polio virus can survive for long periods in the
external environment
4 months in water & 6 months in faeces
Refresher Course in Orthopaedic Nursing, June 2019.
doctoraroju@yahoo.com
10. Aetiopathogenesis…
Polio is more likely:
During rainy season
Overcrowding
Poor sanitation
Source of infection are contaminated:
Water
Food
Flies
Refresher Course in Orthopaedic Nursing, June 2019.
doctoraroju@yahoo.com
11. Aetiopathogenesis…
Route:
Oral route
Multiplies in intestine (may manifest as diarrhea)
Reaches the nervous system via bloodstream
Incubation period: 7 – 14 days
Affinity:
Some brainstem nuclei
Anterior horn cells of the spinal cord
(lumbar & cervical enlargements of the cord)
Refresher Course in Orthopaedic Nursing, June 2019.
doctoraroju@yahoo.com
12. Aetiopathogenesis…
Effects:
Flaccid paralysis
The proportion of motor
units destroyed is
variable & the resultant
weakness depends on
the % of motor units that
have been destroyed
Refresher Course in Orthopaedic Nursing, June 2019.
doctoraroju@yahoo.com
14. Clinical Spectrum
Polio passes through several clinical phases:
Acute illness
Paralysis
Convalescence
Residual paralysis
Refresher Course in Orthopaedic Nursing, June 2019.
doctoraroju@yahoo.com
15. Clinical Spectrum (Acute illness)
Prodromal symptoms (1/3):
Sore throat
Mild headache
Slight pyrexia
Diarrhea
With increase in severity:
Neck stiffness (like in meningitis)
Joints flexed; the muscles are painful & tender
Passive stretching provokes painful spasms
Refresher Course in Orthopaedic Nursing, June 2019.
doctoraroju@yahoo.com
16. Clinical Spectrum
(Paralysis)
Muscle weakness appears:
It reaches a peak in 2–3 days
May give rise to dyspnea & dysphagia
May die or survive
If the patient does not succumb:
Pain and pyrexia subside after 7–10
Patient is infective for at least 4 weeks
Refresher Course in Orthopaedic Nursing, June 2019.
doctoraroju@yahoo.com
18. Clinical Spectrum
(Recovery & Convalescence)
Return of muscle power:
Most noticeable within the first 6 months
There may be continuing improvement:
For up to 2 years.
Refresher Course in Orthopaedic Nursing, June 2019.
doctoraroju@yahoo.com
19. Clinical spectrum
(Residual paralysis)
Incomplete recovery:
Asymmetric flaccid (LMN) paralysis
Unbalanced muscle weakness
Joint deformities and growth defects
Although sensation is intact
Refresher Course in Orthopaedic Nursing, June 2019.
doctoraroju@yahoo.com
21. Clinical Spectrum
(Post-polio Syndrome)
Reactivation of the virus (50% of cases):
Progressive muscle weakness
Unaccustomed fatigue
Diagnosis:
Patients with a confirmed history of poliomyelitis
Period of neurological stability of at least 15 years
Diagnosis of exclusion
Refresher Course in Orthopaedic Nursing, June 2019.
doctoraroju@yahoo.com
22. Differential diagnosis
Diagnosis of polio must be considered in
endemic areas whenever a child presents
with acute flaccid paralysis
Differentials:
Guillain-Barré syndrome
Acute transverse myelitis
Traumatic paraplegia
Myopathy, Neuropathy
Spinal dysraphism
Refresher Course in Orthopaedic Nursing, June 2019.
doctoraroju@yahoo.com
23. Differential diagnosis
Guillain-Barre
syndrome
Ascending symmetrical myelopathy that occurs later in life.
Facial nerve palsy can be seen. Most cases have complete
recovery
Acute transverse
myelitis
Acute sensory & motor paralysis below a particular level at
which the vascular supply to cord has been interrupted
Traumatic
paraplegia
History of trauma & radiograph may show the fracture.
Neuropathy Both motor & sensory loss. Generally bilateral. Treating the
cause may lead to improvement.
Myopathy LMN paralysis with no sensory loss. Mostly genetic. The pattern
is predictable & generally symmetrical. Paralysis tends to
worsen over time. Muscle biopsy may provide the diagnosis
Spinal dysraphism Tuft of hair or swelling at the back. There may be both motor &
sensory loss & the paralysis may deteriorate with growth
Refresher Course in Orthopaedic Nursing, June 2019.
doctoraroju@yahoo.com
24. Orthopaedic complications
Distribution
Lower limb: 92 %
Trunk + LL: 4 %
LL + UL: 1.33 %
Bilateral UL: 0.67 %
Trunk + UL + LL: 2 %
Reasons :
Some muscles have short columns of cells in the
spinal cord while some have long columns
Short column muscles develop complete paralysis
Refresher Course in Orthopaedic Nursing, June 2019.
doctoraroju@yahoo.com
25. Orthopaedic Complications
In the lower limb:
Most common partially paralyzed muscle is
quadriceps femoris
Most common completely paralyzed muscle is
tibialis anterior
In the upper limb:
Most commonly involved muscle is deltoid
Hand muscles are rarely involved
Most common: opponens pollicis
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31. Orthopaedic Complications
Causes of progressive deformities
Muscle Imbalance
Unrelieved Muscle Spasm
Growth
Gravity And Posture
Bony Deformities
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32. Management (Prevention)
Prevention:
Oral polio vaccine (OPV)
Inactivated polio vaccine (IPV)
Even if a patient has had an attack of polio;
he should be immunized as there are 3 strains of
the virus and no cross immunity
Refresher Course in Orthopaedic Nursing, June 2019.
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34. Management (Treatment)
Depends on the phase of the dx.
Acute phase:
Symptomatic as the disease run its course
Bed rest & splintage of paralyzed limbs
Active movements are avoided
Ventilatory support for resp. paralysis
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35. Management (Treatment)…
Convalescent phase:
Joints are splinted to reduce pain
Joint mobilization exercises are begun
Paralysis:
Limit the resultant deformities
Refresher Course in Orthopaedic Nursing, June 2019.
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36. Management (Treatment)…
PPRP
Correct the deformities
To provide maximum attainable function
Nonoperative: splints and traction
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38. Prognosis
Depends on 2 factors:
Severity of initial paralysis
Diffuseness of its regional distribution.
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39. Prognosis…
Generally:
If total paralysis persists beyond the 2nd month,
significant recovery is unlikely.
If the initial paralysis is partial, prognosis is better
The more extensive the paralysis in the first 10
days of illness the more severe the ultimate
disability
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40. References
WHO Fact sheet on Poliomyelitis, March 1 2019.
https://www.who.int/news-room/fact-sheets/detail/poliomyelitis.
Deborah E. Poliomyelitis In: Apleys GA, Solomon L. Apleys System
of Orthopaedics & Trauma; Neuromuscular disorders. CRC Press,
2018; Chp 10: 261 – 265.
Mukul M, Jitesh JK. Poliomyelitis In: Fundamentals of
Orthopaedics; Neuromuscular disorders. Jaypee Brothers Medical
Publishers, 2016; Chp 8: 311 – 314.
Refresher Course in Orthopaedic Nursing, June 2019.
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Editor's Notes
MUSCLE IMBALANCE –
• Flaccid paralysis is the main cause of
functional loss and muscle imbalance .
• when a muscle or a group of muscle is
paralysed,the opponent strong muscle pull the
joints to their side.
UNRELIEVED MUSCLE SPASM
• Muscle spasm,” a principal manifestation of
poliomyelitis in its early stages, is
characterized by protective contraction of the
muscles to prevent a potentially painful
movement
• This can be prevented by passive stretching
and splinting.
GROWTH
• Bony growth depends upon the stimulus by
active healthy stretching around the growth
plate , which is lacking in case of polio affected
childrens causing limb length inequality ,
attenuation of blood vessels and reduced
blood supply leading to reduced growth of the
bone.
GRAVITY AND POSTURE
• Gravity plays an important role in maintaining
the posture and deformity.
• Paralysed group of muscles are not in a
position to maintain posture.
• Bony Deformities
• Apart from deformities due to soft tissue
stretching and contracture, bony deformities
duly occur in polio patients over a period of
time.
• eg:, genu valgus due to persistent iliotibial
band contracture which subsequently lead to
subluxation at the knee