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- [The fight against polio: a social-medical alliance, Buenos Aires, 1943]. [English Abstract, Journal Article]
- Salud Colect 2012 Dec; 8(3):299-314.
The present article analyzes the emergence of a volunteer-based social assistance organization that played an active role in the health care provided for poliomyelitis in Argentina: Asociación para la Lucha contra la Parálisis Infantil (Association for the Fight against Child Paralysis). This institution was created in Buenos Aires in 1943 by a group of women from upper and middle class social sectors. In a context of biomedical uncertainty, the organization mobilized material and symbolic resources to respond to the need for rehabilitation of the permanent physical conditions the disease provoked in its victims. Using as a source the institutional memories of the organization, the article demonstrates how doctors and philanthropists formed a social-medical alliance and developed a fundamental interest in practicing a form of treatment sustained in a framework that united Christian ideas with medical and rehabilitative innovations.
- Real-time Polymerase Chain Reaction Analysis of Sewage Samples to Determine Oral Polio Vaccine Circulation Duration and Mutation After Mexican National Immunization Weeks. [JOURNAL ARTICLE]
- J Pediatric Infect Dis Soc 2012 Sep; 1(3):223-229.
Oral polio vaccine (OPV) can mutate and cause outbreaks of paralytic poliomyelitis with prolonged replication. After poliovirus eradication, global use of inactivated polio vaccine (IPV) may be needed until all OPV stops circulating. Mexico, where children receive routine IPV but where OPV is given only during biannual national immunization weeks (NIWs), provides a natural setting to study duration of OPV circulation in a community primarily vaccinated with IPV.One-liter sewage samples from four separate arroyos (creeks) near Orizaba, Mexico, were collected monthly for 12 months. Concentrated sewage underwent RNA extraction, reverse transcription, and real-time polymerase chain reaction (PCR) to detect OPV serotypes 1, 2, and 3 and their variants containing the serotype-specific point mutation in the 5' untranslated region associated with neurovirulence.OPV was detected 3, 4, 5, and 7 months after the May 2010 NIW, but was not detected at 6 or 8 months. A second and third NIW occurred in February 2011 and May 2011, and OPV was detected in the sewage monthly after both of these NIW through July 2011 when collection stopped. The OPV detected was primarily serotype 2 and predominantly contained the point mutations in the 5' untranslated region associated with increased neurovirulence.OPV was detected in sewage as late as 7 months after an NIW in a Mexican community primarily vaccinated with IPV, but was not detected at 8 months, suggesting that OPV circulation may have ceased. These data suggest that in communities with high vaccination rates, 1 or 2 years of IPV administration after OPV cessation could be sufficient to prevent outbreaks of paralytic poliomyelitis from vaccine-derived strains.
- Vaccine Poliovirus Shedding and Immune Response to Oral Polio Vaccine in HIV-Infected and Uninfected Zimbabwean Infants. [JOURNAL ARTICLE]
- J Infect Dis 2013 May 14.
Background.With prolonged replication, attenuated polioviruses used in oral polio vaccine (OPV) can mutate into vaccine-derived poliovirus (VDPV) and cause poliomyelitis outbreaks. Individuals with primary humoral immunodeficiencies can become chronically infected with vaccine poliovirus, allowing it to mutate into immunodeficiency-associated VDPV (iVDPV). It is unclear if children perinatally infected with the human immunodeficiency virus (HIV), who have humoral as well as cellular immunodeficiencies, might be sources of iVDPV.Methods. Prospective study collecting stool and blood samples at multiple time points from Zimbabwean infants receiving OPV according to the national schedule. Nucleic acid extracted from stool was analyzed by real time PCR for OPV serotypes.
Results.We analyzed 825 stool samples: 285 samples from 92 HIV-infected children and 540 from 251 uninfected children. Poliovirus shedding was similar after 0-2 OPV doses, but significantly higher in the HIV-infected versus uninfected children after ≥3 OPV doses, particularly within 42 days of an OPV dose, independent of seroconversion status. HIV infection was not associated with prolonged or persistent poliovirus shedding. HIV infection was associated with significantly lower polio seroconversion rates.
Conclusions.HIV infection is associated with decreased mucosal and humoral immune responses to OPV, but not the prolonged viral shedding required to form iVDPV.
- Distal Femoral Fractures in Post-poliomyelitis Patients Treated with Locking Compression Plates. [Journal Article]
- Orthop Surg 2013 May; 5(2):118-23.
Treatment of distal femoral fracture in post-polio patients is difficult because the bone is usually osteopenic, small and deformed. This retrospective study aimed to investigate the outcomes of distal femoral fracture in post-polio patients treated by locking compression plates (LCP).The medical records of 19 post-polio patients (mean age 49 years at time of surgery) were reviewed and intraoperative data retrieved. Fracture union and callus formation were evaluated on radiographs taken at each postoperative visit. Functional outcome assessments included range of motion and Hospital for Special Surgery (HSS) score of the ipsilateral knee joint.Sixteen femoral fractures occurred in the poliomyelitis-affected limbs. The mean duration of operation was 86 min and mean blood loss 120 mL. All fractures healed (mean, four months) but union was delayed in one. At the final follow-up 2 yrs after surgery, the mean range of knee flexion was 105° (range, 90°-130°), and mean HSS score 76 points (range, 60-93). There were no cases of nonunion, implant cutout, or other complications.LCP provides stable fixation of distal femoral fractures in post-polio patients. Bony union and good functional outcomes are achieved, but delayed union and minimal callus may occur.
- Evaluating the acute flaccid paralysis surveillance system in South Africa, 2005-2009 - an analysis of secondary data. [Journal Article]
- Pan Afr Med J 2013.:86.
Acute Flaccid Paralysis (AFP) surveillance was adopted by World Health Organization (WHO) to monitor progress towards poliomyelitis eradication. South Africa Department of Health (DoH) routinely collects AFP surveillance data but has no documented evidence of its epidemiological use. The study discusses the epidemiology of AFP in South Africa from 2005-9, evaluates performance of the AFP surveillance system, and identifies components that require strengthening.A retrospective descriptive analysis was conducted on secondary AFP surveillance data for South Africa for the period 2005-2009, consisting of all children.South Africa reported 1501 AFP cases between 2005 and 2009. Of these, 67.2% were <5years of age, and 54.3% were male. None of the cases were confirmed poliomyelitis, and ten (0.7%) were classified as polio-compatible. The national annualized non-polio AFP detection rate increased from 1.6 in 2005 to 2.1 non-polio AFP cases/100,000 children <15years in 2008-9. All performance indicators met the WHO-specified targets except two. Between 2007 and 2009, 51.5%, 55.3% and 65% of specimens, respectively, reached the laboratory within 72hours of being sent (WHO target is ≥80%). Proportion of stool specimens where non-polio enterovirus was isolated decreased from 22.5% in 2006 to <1% in 2008 and 2009 (WHO target is ≥10%).The AFP surveillance system met most WHO-specified epidemiological and laboratory performance standards. The surveillance programme needs to address problems of delayed specimen arrival to the laboratory and incomplete documentation of laboratory findings in the national AFP surveillance database.
- The EV71 strain 1095 structures of procapsid and mature virion. [JOURNAL ARTICLE]
- J Virol 2013 May 1.
Enterovirus 71 (EV71) is an important emerging human pathogen with a global distribution and presents a disease pattern resembling poliomyelitis with seasonal epidemics that include cases of severe neurological complications such as acute flaccid paralysis. EV71 is a member of the Picornaviridae family, which consists of icosahedral, non-enveloped, single-stranded RNA viruses. Here we report structures derived from X-ray crystallography and cryo-electron microscopy (cryo-EM) for the 1095 strain of EV71, including a putative precursor in virus assembly, the procapsid, and the mature virus capsid. The cryo-EM map of the procapsid provides new structural information on portions of capsid proteins VP0 and VP1 that are disordered in the higher resolution crystal structures. Our structures solved from virus particles in solution are largely in agreement with those from prior X-ray crystallographic studies, however, we observe small but significant structural differences for the 1095 procapsid compared to a structure solved by Wang et al, 2012, for a different strain of EV71. For both EV71 strains, the procapsid is significantly larger in diameter than mature capsid, unlike any other picornavirus. Nonetheless, our results demonstrate that picornavirus capsid expansion is possible without RNA encapsidation and that picornavirus assembly may involve an inward radial collapse of the procapsid to yield the native virion.
- History of the Department of Neurosurgery at Thomas Jefferson University Hospital. [JOURNAL ARTICLE]
- Neurosurgery 2013 Apr 25.
The Neurosurgical tradition at Jefferson Medical College began in the 19th century with Samuel Gross. In his textbook entitled A System of Surgery, Gross revealed his knowledge in the disorders of the nervous system at a time when innovations were practically inexistent. Gross's work paved the way for William Williams Keen, "America's first brain surgeon". In 1887, Keen became the first surgeon in the nation to successfully remove a primary brain tumor. In 1893, Keen operated secretly on President Grover Cleveland for removal of an intraoral sarcoma and later served as a consultant to Franklin Roosevelt after he contracted poliomyelitis. The neurosurgery division was established in 1943 by J. Rudolph Jaeger. It was Philip Gordy who created a distinct Department of Neurosurgery in 1969. Jewell L. Osterholm became Chairman of the Department of Neurosurgery in 1974. Since 2004, Robert Rosenwasser has served as chairman, and the Department of Neurosurgery at Jefferson has grown to include 26 faculty members. The residency has expanded to include three residents per academic year since 2007.
- Vaccine coverage of healthcare students in hospitals of the Paris region in 2009: The Studyvax Survey. [JOURNAL ARTICLE]
- Vaccine 2013 Apr 24.
INTRODUCTION:Healthcare students should comply with the same vaccination recommendations as employed healthcare professionals. Vaccination coverage data for healthcare students are lacking
MATERIALS AND METHODS:This cross-sectional survey was carried out on medical, nursing and midwifery students in 15 hospitals of the Assistance Publique - Hôpitaux de Paris with a maternity ward. All midwifery students were surveyed, and a subset of medical and nursing students were selected from 10 hospitals by three-stage random sampling. Data were collected by face-to-face interviews and verified from health records.
RESULTS:A total of 432 students were included in the study (178 medical, 147 nursing, 107 midwifery), of whom 376 (87%) had proof of vaccination. The confirmed coverage for compulsory vaccinations was 96.9% for the booster dose of diphtheria-tetanus-poliomyelitis vaccine, 93.6% for BCG and 91.8% for at least three doses of hepatitis B. The coverage for recommended vaccinations confirmed by a vaccine booklet was 44% for pertussis (booster at 11-13 or 16-18 years of age), and 79.3% and 49.6% for the first and second doses of measles, respectively. The rate for influenza vaccination was 39.6%, based on self-reported information. Of the 27 students without any history of varicella infection, six had been vaccinated.
DISCUSSION:Vaccination coverage of healthcare students is high for compulsory vaccinations, but largely insufficient for recommended vaccinations. Increased awareness regarding the required vaccinations is necessary in this population, as well as stronger enforcement prior to initiating clinical work.
- Poliomyelitis in Pakistan: time for the Muslim world to step in. [Journal Article]
- Lancet 2013 May 4; 381(9877):1521-3.
- Inflammatory, vascular, and infectious myelopathies in children. [Journal Article]
- Handb Clin Neurol 2013.:999-1017.
Acute nontraumatic myelopathies of childhood include inflammatory, infectious, and vascular etiologies. Inflammatory immune-mediated disorders of the spinal cord can be categorized as idiopathic isolated transverse myelitis, neuromyelitis optica, and multiple sclerosis. In recent years, human T-cell lymphotropic virus type 1, West Nile virus, enterovirus-71, and Lyme disease have been increasingly recognized as infectious etiologies of myelopathy, and poliomyelitis remains an important etiology in world regions where vaccination programs have not been universally available. Vascular etiologies include vasculopathies (systemic lupus erythematosus, small vessel primary angiitis of the central nervous system), arteriovenous malformations, and spinal cord infarction (fibrocartilaginous embolism, diffuse hypoxic ischemia-mediated infarction). Vascular myelopathies are less common than inflammatory and infectious myelopathies, but are more likely to lead to devastating clinical deficits. Current therapeutic strategies include acute anti-inflammatory treatment and rehabilitation. Stem cell transplantation, nerve graft implantation, and stimulation of endogenous repair mechanisms represent promising strategies for spinal cord repair.