DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS OF POLIOMYELITIS—The Management of Patients in the Hospital Admitting Room

Because of the great variety of early symptoms of poliomyelitis and their similarity to the symptoms of a number of other diseases, in times of epidemic many patients are admitted to hospital on suspicion of poliomyelitis. At such times the prime purpose of the hospital admitting room staff is to distinguish between patients with poliomyelitis (or other diseases requiring immediate treatment) and those who may be referred into other channels.This presentation (1) points out the superficial similarities of the clinically observable signs and symptoms and of laboratory data in poliomyelitis and in other diseases, and (2) discusses the more occult dissimilarities which aid in differentiation.     

Enteroviruses in the XX and XXI centuries

The modern view of the role of enteroviruses in the eradication of poliomyelitis is presented. Enteroviruses were discovered in the XX century. In the 1950s they caused great epidemics of poliomyelitis and serous meningitis in many countries of the world. The introduction of oral poliomyelitis vaccine (OPV) into medical practice made it possible to eliminate the epidemics of poliomyelitis in a short time. Poliomyelitis morbidity was reduced to sporadic cases and in a number of regions disappeared. OPV produced non-specific influence also on the epidemics of serous meningitis, as well as on a case incidence. The eradication of poliomyelitis viruses and the cessation of immunization with OPV will not result in eradication of paralytic diseases. Paralytogenic viruses of 20 serotypes circulate in nature, and some of these viruses are capable of causing the outbreaks of severe paralytic diseases. The authors propose either to retain immunization with OVP as tour immunizations with monovaccine of type 2, or to create new live enterovirus vaccines on the basis of avirulent enterovirus strains.     

Poliomyelitis in pregnancy

Acute poliomyelitis occurs in all trimesters of pregnancy. At one time there were six women in the poliomyelitis ward at Children's Hospital, five of whom were either pregnant or recently delivered. Poliomyelitis is an important entity in the differential diagnosis of diseases complicating pregnancy. Once diagnosed, treatment is directed primarily toward the symptoms of poliomyelitis, secondarily toward pregnancy. Effort should be made to maintain adequately high oxygen tension in the maternal blood stream to protect the fetus. The prognosis of the disease when it occurs during pregnancy may be less predictable, but it is generally good for both mother and infant. Although the incidence of abortion is relatively high, if the pregnancy goes to term parturition is expected to be normal. The number of cases reported is not sufficient to establish the significance of the suspected selective occurrence of poliomyelitis in pregnancy.     

POLIOMYELITIS IN PREGNANCY

Acute poliomyelitis occurs in all trimesters of pregnancy. At one time there were six women in the poliomyelitis ward at Children''s Hospital, five of whom were either pregnant or recently delivered. Poliomyelitis is an important entity in the differential diagnosis of diseases complicating pregnancy. Once diagnosed, treatment is directed primarily toward the symptoms of poliomyelitis, secondarily toward pregnancy. Effort should be made to maintain adequately high oxygen tension in the maternal blood stream to protect the fetus. The prognosis of the disease when it occurs during pregnancy may be less predictable, but it is generally good for both mother and infant. Although the incidence of abortion is relatively high, if the pregnancy goes to term parturition is expected to be normal. The number of cases reported is not sufficient to establish the significance of the suspected selective occurrence of poliomyelitis in pregnancy.     

Incidence of poliomyelitis; the effect of tonsillectomy and other operations on the nose and throat

A statistical survey was made of all the cases of poliomyelitis occurring in all of Los Angeles County during the three years of 1949, 1950 and 1951 in an attempt to determine the effect of operations on the nose and throat on the incidence of poliomyelitis. Tonsillectomy and adenoidectomy were the only operations noted with any degree of frequency. Yet, in the total of 3,601 cases of poliomyelitis that occurred in this three-year period there were only 20 (0.55 per cent) in which the patient had had recent tonsillectomy and adenoidectomy. The incidence of this disease in patients who had had tonsillectomy and adenoidectomy was compared with the "expected" incidence as determined from the incidence in other patients, in the same age group. There was no significant difference between actual and expected incidence even during the summer months when most cases of poliomyelitis occurred. The same was true with regard to recently tonsillectomized patients in the epidemic months of July through October. In a separate survey of 675 patients with poliomyelitis, it was noted that only 30 per cent ever had had tonsillectomy or adenoidectomy. Inasmuch as it is estimated that one of every three persons in the general young population nowadays has had tonsillectomy and adenoidectomy, this figure is no more or less than could be expected.     

Epidemiological, clinical, and pathomorphological characteristics of epidemic poliomyelitis-like disease caused by enterovirus 71.

In May-September, 1975, an outbreak of epidemic disease clinically and pathomorphologically simulating nearly all known forms of poliomyelitis occurred predominantly among young infants in Bulgaria. Most cases presented benign aseptic meningitis, sometimes with a short period of general cerebra- symptoms. Paralytic forms, such as bulbar polioencephalitis, anterior poliomyelitis, isolated pareses of the facial nerve, occasional cases of encephalomyocarditis, etc., were observed in about 21% of all cases. Over one-fourth of the paralytic cases with bulbar symptoms ended fatally. In March, 1976 another sporadic fatal case of this disease was examined. No new cases occurred in 1977. Histopathological examinations in all fatal cases regularly revealed lesions in the grey matter of the medulla and spinal cord typical of acute anterior poliomyelitis and bulbar polioencephalitis, with some peculiar features of localization and depth of the involvement of the brain stem. The similarity to poliomyelitis and precariously rapid increase in the incidence led to the decision to urgently vaccinate the entire human population with Sabin's live poliovirus vaccine simultaneously in the whole country in order to produce interference with the circulating agent. This aim appeared to have been achieved partially because soon the number of new cases of the disease began to decrease; however, no sharp and complete break in the curve of the incidence occurred. By the time of mass vaccination, the results of virological examinations started before were not yet available. Later, comprehensive complete evidence was obtained that over 25 fatal and many other typical cases of the disease were associated with an enterovirus proved to be antigenically related to enterovirus 71. The diseases in Bulgaria, 1975, differ considerably in the frequency of paralytic forms and in severity from the epidemics caused by enterovirus 71 in Sweden, 1973, Australia, 1972--1973, USA, 1969--1972, and Japan, 1972--1973.     

The molecular epidemiology of poliomyelitis: the characteristics of the strains isolated from patients in Moscow in 1973-1986

Eleven virus strains isolated from poliomyelitis patients in Moscow in 1973-1986 were analyzed by the method of oligonucleotide mapping of RNA. The genome of the isolates showed considerable similarity to the genomes of Sabin's vaccine strains and mainly to the vaccine strain of antigenic type 2. The conclusion was made that the sporadic cases of poliomyelitis registered in this region were etiologically linked with the vaccine strains of poliomyelitis virus. Only in one case the disease appeared in the recipient of the vaccine, in all other cases the patients were infected through contacts.     

Clinical Manifestation of Depression after Stroke: Is It Different from Depression in Other Patient Populations?

Background

Despite ample research on depression after stroke, the debate continues regarding whether symptoms such as sleep disturbances, loss of energy, changes in appetite and diminished concentration should be considered to be consequences of stroke or general symptoms of depression. By comparing symptoms in depressed and non-depressed stroke patients with patients in general practice and patients with symptomatic atherosclerotic diseases, we aim to further clarify similarities and distinctions of depression after stroke and depression in other patient populations. Based on this, it is possible to determine if somatic symptoms should be evaluated in stroke patients in diagnosing depression after stroke.

Methods

An observational multicenter study is conducted in three hospitals and seven general practices including 382 stroke patients admitted to hospital with a clinical diagnosis of intracerebral hemorrhage or ischemic infarction, 1160 patients in general practice (PREDICT-NL), and 530 patients with symptomatic atherosclerotic diseases (SMART-Medea).

Results

The prevalence of major depressive disorder according to DSM-IV criteria was 14.1% (95% CI 11.0%-18.0%) in the stroke cohort, 5.4% (95% CI 3.8%-7.9%) in the symptomatic atherosclerotic diseases cohort and 12.9% (95% CI 11.1%-15.0%) in the general practice cohorts. Comparing depressed patients of the three cohorts demonstrated broadly similar symptom profiles, as well as comparable levels of individual symptom prevalence. However, the stroke patients suffered more severely from these symptoms than patients in the other populations.

Conclusions

The findings suggest that depression after stroke is not a different type of depression. This finding indicates that all depressive symptoms should be evaluated in stroke patients, including somatic symptoms.     

Circadian Variation in the Occurrence of Paroxysmal Supraventricular Tachycardia in Clinically Healthy Subjects

The purpose of this study was to assess prospectively the circadian distribution of spontaneous paroxysmal Supraventricular tachycardia (PSVT) in drug-free subjects with no previous history or symptoms and signs of concomitant heart or lung disease. Of 112,424 presumably diurnally active patients admitted to the Emergency Department of a city hospital during a 2-year period (1990-1991), a total of 185 patients were screened with these characteristics. Time of symptom onset was exactly recordable in 177 (75 men and 102 women). Analysis of variance documented a higher incidence in the morning-afternoon hours. Cosinor analysis, although not a perfect method for the time series analysis, verified circadian rhythmicity with afternoon peak times. Our findings suggest that a circadian pattern in intrinsic electrical instability of the heart conduction system exists irrespective of the circadian fluctuations in the pathophysiologic mechanisms of the cardiovascular or lung diseases most frequently associated with PSVT itself.     

Local replication of simian immunodeficiency virus in the breast milk compartment of chronically-infected, lactating rhesus monkeys

Retroviruses have been linked to a variety of diseases such as neoplastic and immunodeficiency disorders and neurologic and respiratory diseases. Recently, a novel infectious human retrovirus, the xenotropic murine leukemia virus-related virus (XMRV), has been identified in cohorts of patients with either a familial type of prostate cancer or chronic fatigue syndrome. The apparent unrelatedness of these diseases raised the question of the potential involvement of XMRV in other diseases. Here, we investigated the presence of XMRV in a selection of pediatric idiopathic infectious diseases with symptoms that are suggestive of a retroviral infection, as well as in children with respiratory diseases and in adult patients with spondyloarthritis (SpA). Using a XMRV env-nested PCR, we screened 72 DNA samples obtained from 62 children hospitalized in the Montpellier university hospital (France) for hematological, neurological or inflammatory pathologies, 80 DNA samples from nasopharyngeal aspirates from children with respiratory diseases and 19 DNA samples from SpA. None of the samples tested was positive for XMRV or MLV-like env sequences, indicating that XMRV is not involved in these pathologies.     

长期住院精神障碍患者现况调查

目的:探讨长期住院精神障碍患者的现况及其影响因素。方法:采用自制调查问卷对2013年1月1日至7月1日我院慢性病科住院治疗2年以上的473例精神障碍患者进行调查分析。结果:长期住院患者中,男性比例高于女性,以精神分裂症患者居多,婚姻状况以未婚者居多;合并躯体疾病315例(66.60%),合并1种疾病者145例(30.66%),合并2种以上疾病者170例(35.94%),年龄与合并躯体疾病有关,70岁以上发生率最高;因精神病性症状反复发作滞留医院131例(27.70%),因家属无法对患者进行日常照顾、家属无法管理患者,担心危害、家庭经济困难、无接收对象而仍然滞留在医院342例(72.30%)。结论:精神障碍患者滞留医院除了因为病情慢性化,也有家庭、社会、经济等因素。发展社区精神卫生防治康复工作既能降低医疗成本,也有助于改善康复期患者的生活质量。     

Virus survival as a seasonal factor in influenza and poliomyelitis

Summary The influence of temperature and humidity on the survival of airborne viruses was studied in a static system. Preliminary experiments with a bacteriophage showed that relative humidity was more important than temperature and absolute humidity. The effect of relative humidity was not dependent on the composition of the medium surrounding the virus particles. The survival of influenza and poliomyelitis virus are sharply influenced by relative humidity but in an opposite way. Influenza virus survives much better at lower humidities, poliomyelitis virus at higher humidities. In countries with moderate climates the period of increasing morbility for influenza, in winter, coincides with indoor conditions of relative humidity which are optimal to virus survival. For poliomyelitis the same is true during summer (Fig. 7). Indoor relative humidity is considered an important “seasonal factor” in the epidemiology of poliomyelitis and influenza and probably of other diseases.     

THE PRECIPITATION OF CLINICAL POLIOMYELITIS BY INJECTIONS

In records of 1,321 cases of poliomyelitis in the city of Los Angeles in 1948, notation was made as to whether or not the patient had been vaccinated against smallpox or had received an injection of one kind or another in the period preceding the onset of poliomyelitis.In children under 12 years of age, the incidence of poliomyelitis was slightly higher among those who had had recent vaccination or injection than among those who had not, and the incidence of paralysis was slightly greater also. However, the disparities were not considered statistically significant. They were not wide enough to warrant withholding immunization against other serious diseases on the strength of the possibility that in so doing a slight reduction in the incidence of crippling poliomyelitis might be effected.     

Value of outpatient follow-up after curative surgery for carcinoma of the large bowel.

The records were reviewed of 406 patients with carcinoma of the large bowel who had been treated at the Middlesex Hospital during 1958-62. Of these patients, 180 were followed up regularly in this hospital after radical surgery, and from six months to 15 years after operation they were seen 2319 times; 71 developed a recurrent carcinoma but, of these, 41 recurrences (58%) were diagnosed at times other than those of the patients'' routine outpatient appointments, although they were being regularly reviewed. Only one patient with recurrence appeared to have been cured by further surgery. For the present, adequate education of patients in the symptoms of early recurrence, with instruction to return if any of these develop, is likely to be more effective than the unsatisfactory and time-consuming routine follow-up still used in many hospitals.     

泰安市维持无脊髓灰质炎状态的策略与效果分析

目的调查泰安市保持无脊髓灰质炎(简称无脊灰)状态所采取的策略和取得的效果,为证实无脊灰提供依据,并为其他疫苗针对传染病的控制与消除提供借鉴。方法采用描述流行病学研究方法,对该市2001—2011年保持无脊灰状态所采取的策略和效果进行回顾性分析。结果证实泰安市2001年实现无脊灰以来,始终正确地实施脊髓灰质炎疫苗免疫策略,加强对急性弛缓性麻痹病例监测,完善免疫规划科学管理,巩固了自1991年5月以来无脊髓灰质炎野病毒感染病例发生的成果。结论持续做好免疫、监测、管理三大策略对维持无脊髓灰质炎状态至关重要,并为其他疫苗针对疾病的控制提供了理论借鉴。     

Major Operations on Patients with Poliomyelitic Impairment

Pertinent data on operations (other than orthopedic) carried out in 39 patients who had residual impairment from poliomyelitis were reviewed with a view to appraising what additional operative risk there may be for such patients.For a large proportion of the patients, equipment to aid respiration was needed and a large proportion of the operations were urologic procedures as might be expected in a group with generally restricted physical activity. Also, the occurrence of complications was higher than for an ordinary surgical service. Even so, the experience indicated that residual impairment from poliomyelitis ought not be considered a contraindication even of elective, let alone emergency operations.     

Eradicating Helicobacter pylori and symptoms of non-ulcer dyspepsia.

OBJECTIVE--To examine the effect of eradication of Helicobacter pylori on symptoms of non-ulcer dyspepsia. DESIGN--Four week prospective study. SETTING--One hospital outpatient and endoscopy department. PATIENTS--90 adults with persistent symptoms typical of non-ulcer dyspepsia but no clinical or endoscopic evidence of other peptic, biliary, pancreatic, or malignant disease; all had histological and microbiological evidence of infection with H pylori. 83 patients completed the treatment regimen. INTERVENTION--Colloidal bismuth subcitrate 120 mg four times a day for four weeks (27 patients); metronidazole 400 mg and amoxycillin 500 mg each three times a day for one week (27); and bismuth subcitrate 120 mg four times a day for four weeks, metronidazole 400 mg three times a day for one week, plus amoxycillin 500 mg three times a day for the first week (29). MAIN OUTCOME MEASURES--Change in symptom scores determined with questionnaire; histological evidence of gastritis and microbiological evidence of presence of H pylori in biopsy specimens. RESULTS--Overall, H pylori was eradicated in 41 (49%) patients. Although gastritis scores improved significantly in only patients in whom H pylori had been eradicated (from 1.56 to 0.61, p less than 0.01 v from 1.83 to 1.07, p = 0.52) mean symptom scores after treatment were similar in patients in whom H pylori had or had not been eradicated (3.0 v 2.3, NS). Similarly the mean symptom score improved whether or not gastritis improved (2.8 v 3.1 respectively, p = 0.72). The observations were similar for treatment groups analysed individually. CONCLUSION--Antral infection with the organism does not seem to have an important aetiological role in non-ulcer dyspepsia short term.     

Long-term health status of Danish women with silicone breast implants

Long-term safety data are important in the evaluation of possible adverse health outcomes related to silicone breast implants. The authors evaluated long-term symptoms and conditions and medication use among 190 Danish women with cosmetic silicone breast implants compared with 186 women who had undergone breast reduction surgery and with 149 women from the general population. Breast implant and reduction surgeries were performed from 1973 to 1988 at one public hospital and one private plastic surgery clinic. Among women with breast implants, the average implantation time was 19 years, 60 percent (n = 114) had only one implantation, and 10 percent (n = 19) had undergone explantation before the time of study (1997 to 1998). The authors found no material differences in self-reported diseases or symptoms among study groups, except for breast pain, which was reported nearly three times as often by women with implants than by women with breast reduction (odds ratio, 2.8; 95 percent confidence interval, 1.4 to 5.3). Approximately 80 percent of women in each study group reported at least one symptom. No consistent differences were observed in the seroprevalences of antinuclear antibodies or other autoantibodies. Self-reported use of psychotropic drugs was higher among women with breast implants than among either control group. The authors conclude that long-term cosmetic breast implantation may cause capsular contracture and breast pain but does not appear to be associated with other symptoms, diseases, or autoimmune reactivity. The authors' finding of excess use of drugs for treatment of depression and anxiety among women with breast implants may warrant further investigation.     

The small hospital's role in poliomyelitis

Medical skills should be developed by the staffs of smaller hospitals for the differential study of patients with symptoms resembling those of poliomyelitis in order to provide the rudiments of care for the occasional patient with mild poliomyelitis, to recognize the indications which point to the necessity of superior technical assistance, and to decide when it is appropriate to move patients to better equipped centers. The impetuous acquisition of mechanical aids for the treatment of special problems will be effective in small communities only to the extent that this equipment is kept serviceable and is operated by persons of sufficient skill. Epidemic situations in a small community can be met only by mobilization of facilities under adequate direction and by integration of care with that provided by larger treatment centers.     

Blood Plasma Pseudocholinesterase as a Potential Biomarker of Autoimmune Diseases

We studied the blood plasma butyrylcholinesterase (BChE, pseudocholinesterase) activity as a potential marker for differentiating such autoimmune pathologies as type 1 diabetes mellitus (DM1), autoimmune thyroiditis (AIT) and rheumatoid arthritis (RA) from diseases having similar symptoms but different etiology. The blood plasma pseudocholinesterase activity was analyzed for patients with different types of diabetes mellitus. We showed its fivefold increase in DM1 compared to the control group, while in the second type of diabetes, which is metabolic pathology, it decreases two times. It was demonstrated that the activity of blood plasma BChE in patients with AIT and RA also increased fivefold compared to the group of patients without autoimmune disorders. Thus, the butyrylcholinesterase activity increases in diseases of an autoimmune nature, whereas in metabolic pathology it has the tendency to decrease; it indicates the adequacy of the selected criterion for the further development of a screening test-system that would allow differentiation of autoimmune diseases from the diseases of another origin, but with similar symptoms.