Poliomyelitis Patients Research Articles

Survivorship of total knee arthroplasty in poliomyelitis patients: long-term results from the R.I.P.O. registry and single-institution retrospective study.

The survival of total knee arthroplasty (TKA) in patients with poliomyelitis remains a debated topic due to the high recurrence of postoperative genu recurvatum. This study aims to report the long-term survival of TKA in patients with poliomyelitis, using data from the Italian Register of Prosthetic Implantology. A registry-based population study was conducted, utilizing data from the Emilia Romagna orthopedic arthroplasty implants registry (RIPO - Registro Implantologia Protesica Ortopedica). The cohort consisted of 71 patients with poliomyelitis-related arthritis who underwent TKA. The study assessed and analyzed demographic data, implant type, fixation method, insert type, and level of constraint. Additionally, variations in preoperative and postoperative both clinical and functional Knee Society Scores (KSS) were collected. Eight implants required revision surgery (16%), and three patients died (6.1%), resulting in a 10-year survival rate of 86.6% and a 15-year survival rate of 53.9%. Aseptic loosening was the primary cause of revision, accounting for 37.5% of failures, followed by insert wear (25%). No statistically significant correlation was found between the level of constraint and implant survival (p=0.0887, log-rank). Both the clinical and functional KSS improved postoperatively. TKA is a viable alternative to knee arthrodesis and, in properly selected patients, might represent the first-choice treatment for articular degeneration due to its high survivorship. Despite the complexity of these cases, TKA can effectively alleviate articular pain, instability, and angular deviation, thereby preserving knee functionality.

Total Hip Arthroplasty in the Nonparalytic Limb of Residual Poliomyelitis Patients: A Propensity Score Matched Study.

Poliomyelitis is a rare neuromuscular disease that can cause hip osteoarthritis on the contralateral side due to an abnormal mechanical weight-bearing state, making some residual poliomyelitis patients candidates for total hip arthroplasty (THA). The aim of this study was to investigate the clinical outcome of THA in the nonparalytic limbs of these patients compared with those of non-poliomyelitis patients. Patients treated between January 2007 and May 2021 were retrospectively identified in a single center arthroplasty database. Eight residual poliomyelitis cases that met the inclusion criteria were matched to non-poliomyelitis cases in a ratio of 1:2 based on age, sex, body mass index (BMI), age-adjusted Charlson comorbidity index (aCCI), surgeon, and operation date. The hip function, health-related quality of life, radiographic outcomes, and complications were analyzed with unpaired Student's t test, Mann-Whitney test, Fisher's exact test or analysis of covariance (ANCOVA). Survivorship analysis was determined using the Kaplan-Meier estimator analysis and Gehan-Breslow-Wilcoxon test. After a mean follow-up of about 5 years, patients with residual poliomyelitis had worse postoperative mobility outcomes(P < 0.05), but there was no difference in total modified Harris hip score (mHHS) or European quality of life-visual analogue scale (EQ-VAS) between the two groups (P > 0.05). There was no difference in radiographic outcomes or complications between the two groups, and patients had similar postoperative satisfaction (P > 0.05). No readmission or reoperation occurred in the poliomyelitis group (P > 0.05), but the postoperative limb length discrepancy (LLD) in the residual poliomyelitis group was greater than that in the control group (P < 0.05). Functional outcomes, health-related quality of life improvement were similarly significantly improved in the nonparalytic limb of residual poliomyelitis patients after THA compared with conventional osteoarthritis patients. However, the residual LLD and weak muscle strength of the affected side will still influence mobility, so residual poliomyelitis patients should be fully informed of this outcome before surgery.

Total knee replacements using rotating hinge implants in polio patients: clinical and functional outcomes.

Little evidences are available in the literature concerning the outcomes of total knee replacement (TKR) in poliomyelitis patients with severe knee deformities or degeneration. Encouraging results have been reported concerning the use of constrained implants, i.e., rotating hinge knee prosthesis (RHK), compared to less constrained ones. The purpose of this paper is to report our experience with rotating hinge total knee replacement, using only RHK prosthesis, to determine functional results, complications, and survival of TKR in poliomyelitis patients. We performed a retrospective chart review of 14 patients with a history of knee osteoarthritis following poliomyelitis that underwent primary TKR, for a total of 15 surgical procedure (one bilateral case). Preoperative and postoperative clinical measurements have been conducted for all patients using the Knee Society Score (KSS). Hip-knee angle, recurvatum knee angle, and Insall-Salvati index were evaluated with full weight-bearing panoramic view X-ray preoperatively and postoperatively. The 2-year postoperative clinical KSS significantly improved from the preoperative scores. The average clinical KSS improved from 32,9 (range 3-48) preoperatively to 77,4 (range 60-88) postoperatively (P value < 0.005). The average functional KSS improved from 32,5 (range 10-60) preoperatively to 59,4 (range 30-95) postoperatively (P value < 0.005). TKR is a successful treatment in improving knee function and patient's quality of life. Using constrained implants, especially rotating hinge implants in polio patients with a quadriceps muscle weakness, could be a good alternative to maintain a physiological kinematics and reducing the revision rate due to knee instability.

Survivorship of Total Knee Arthroplasty in Poliomyelitis Patients: Long-Term Results from the R.I.P.O Registry and Single-Institution Retrospective Study

Survivorship of Total Knee Arthroplasty in Poliomyelitis Patients: Long-Term Results from the R.I.P.O Registry and Single-Institution Retrospective Study

Polio Environmental Surveillance and Its Application to SARS-CoV-2 Detection

The polio eradication program, launched in 1988, has successfully decreased the number of poliomyelitis patients worldwide. However, in areas with immunization gaps where oral polio vaccine coverage has dropped, outbreaks of more virulent vaccine-derived polioviruses (VDPVs) have become a threat to public health. In Japan, inactivated polio vaccine replaced oral polio vaccine as the routine immunization in 2012. Polio environmental surveillance (ES) has been conducted nationwide since 2013 to efficiently monitor the wild type poliovirus or VDPV, which may be imported from overseas. ES may also be utilized to detect other viruses in stool samples. We propose a method of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection based on the polio ES network, and establish a procedure to detect fragments of SARS-CoV-2 genome in wastewater solids. Our findings suggest that polio ES can be used to simultaneously monitor SARS-CoV-2 RNA fragments in sewage waters.

Enigmatic Neural Pathways: Potentiating Viral Neuroinvasion Into the CNS.

Enigmatic Neural Pathways: Potentiating Viral Neuroinvasion Into the CNS.

Complications of Halo Vest Orthosis: A Narrative Study

Background and Aim: Perry and Nickel introduced the halo vest in 1959. It is the most common immobilization device for the unstable cervical spine. In the literature review, most articles review the beneficial effects of the halo vest, and a few report its complications. This study aims to evaluate the complications associated with halo orthosis. Methods and Materials/Patients: This is a narrative study about halo vest complications. To provide up-to-date information, we reviewed the articles written about halo complications. All relevant articles were retrieved from Google Scholar, Medline, PubMed, etc., using the keywords of “halo vest orthosis”, “unstable cervical spine fracture”, “halo vest complications”, “halo vest immobilization”, “pin-site-related complications”, and “vest-related complications”. Afterward, we reviewed and critically analyzed the articles. Results: At first, the halo vest was used for postoperative paralyzed poliomyelitis patients, and later, it was also used for traumatic injury of the cervical spine or postoperatively in cervical spine reconstructive surgery. Compared to other orthoses, the halo vest provides a more effective external fixation and maintains normal anatomic alignment of the cervical spine without impacting jaw motion and resulting in eating problems. However, it has many temporary complications. To prevent halo vest complications, experienced people should apply it, and the patients should be regularly followed up for early detection and treatment of complications. Conclusion: Our review is the starting point for the evaluation and investigation of halo vest complications. Because of the high incidence of pin loosening and infection, it is better to evaluate the design and application of halo pin. Since the initial design of the halo vest, only its superstructure has been redesigned without any significant change in other parts of it.

Outcomes of total knee arthroplasty in a patient with poliomyelitis and distal femur malunited fracture

Severe deformity of the distal femur due to malunited fracture in a poliomyelitis patient is a rare entity. No reports are available in the literature about the results of total knee arthroplasty (TKA) in such cases. We report a 4-year follow-up of TKA in a 52-year-old woman who had postpoliomyelitis syndrome with malunited distal femur fracture associated with severe deformity and degenerative arthritis. TKA in poliomyelitis patients could reveal a good short-term functional improvement. We aim to demonstrate that even with the presence of deformity from previous trauma in polio cases, TKA would improve functional abilities. However, long-term follow-up is needed for similar cases.

Essential role of autophagy in restricting poliovirus infection revealed by identification of an ATG7 defect in a poliomyelitis patient

ABSTRACT Paralytic poliomyelitis is a rare disease manifestation following poliovirus (PV) infection. The disease determinants remain largely unknown. We used whole exome sequencing to uncover possible contributions of host genetics to the development of disease outcome in humans with poliomyelitis. We identified a patient with a variant in ATG7, an important regulatory gene in the macroautophagy/autophagy pathway. PV infection did not induce a prominent type I interferon response, but rather activated autophagy in neuronal-like cells, and this was essential for viral control. Importantly, virus-induced autophagy was impaired in patient fibroblasts and associated with increased viral burden and enhanced cell death following infection. Lack of ATG7 prevented control of infection in neuronal-like cells, and reconstitution of patient cells with wild-type ATG7 reestablished autophagy-mediated control of infection. Collectively, these data suggest that ATG7 defect contributes to host susceptibility to PV infection and propose autophagy as an unappreciated antiviral effector in viral infection in humans.

Ultrasonographic evaluation of the distal femoral and talar cartilage thicknesses in patients with poliomyelitis: a cross-sectional observational study.

Sequelae of poliomyelitis, coupled with asymmetric impairment and weight-bearing, typically alter walking biomechanics which can be associated with the knee and ankle osteoarthritis. We aimed to investigate whether the distal femoral and talar cartilage thicknesses were different in patients with poliomyelitis. Cross-sectional observational study. Outpatients, tertiary care center. Thirty-six patients (12 males, 24 females) with a history of poliomyelitis and 36 age, gender and body mass index similar healthy subjects (11 males, 25 females) were enrolled. Mean values for age, body mass index and age of the poliomyelitis onset were 70.2±4.6 years, 27.2±5.7 kg/m2, and 3.6±2.4 years. Visual Analogue Scale (VAS) was used to assess pain. Lower limb muscle strengths were measured by manual muscle testing. The more affected side was identified according to the lower limb manual muscle testing. Bilateral distal femoral cartilage from the lateral femoral condyle, intercondylar area, medial femoral condyle and talar cartilage thicknesses were measured using ultrasound imaging. Among patients, the onset of poliomyelitis was at 3.6±2.4 years of age, and Functional Ambulation Category scores were 5 (3-5). VAS scores were similar between the sides affected more and less by poliomyelitis. All cartilage thicknesses (except the talar cartilage) of the patients were found to be thinner on the more affected side than the less affected side (all P<0.001). The thickness of talar cartilage was thinner compared to control subjects (P<0.001). Among the patients, quadriceps muscle strength was positively correlated with medial condyle (r=0.377, P=0.024), intercondylar area (r=0.399, P=0.016) and lateral condyle (r=0.363, P=0.030) thicknesses. Knee VAS scores were negatively correlated with talar cartilage thicknesses (r=-0.393, P=0.018). We found a thinning of the distal femoral condyle in the more affected paretic sides of poliomyelitis patients as compared to both those of less affected sides and those of healthy controls. Talar cartilages on both sides of the patients were thinner compared to control subjects. Our preliminary findings may contribute to the long-term management of patients with long-term poliomyelitis sequelae.

Thoracolumbar curve and Cobb angle in determining spread of spinal anesthesia in Scoliosis. An observational prospective pilot study.

Background and Aims:Disparity in spread of spinal anesthesia is a known complication in scoliosis patients. Our primary aim was to compare this disparity based on Cobb Angle and thorocolumbar spine curvature. Secondary aim was to calculate the appropriate lateral angulation of the spinal needle from midline for successful lumbar puncture.Materials and Methods:All poliomyelitis patients with scoliosis posted for lower limb orthopedic contracture release surgeries were enrolled into Group A (Cobb Angle <50°), Group B (Cobb Angle >50°), and on thoracolumbar curve into Group R (Right), Group L (Left). Group A, B, R, and L were studied for bilateral spread of spinal anaesthesia. Lateral angle of the spinal needle from midline was noted with Goniometer in groups A and B. Statistical analysis was done using unpaired t test and Chi-square test.Results:Failures in subarachnoid block (SAB) (unilateral anaesthesia/inadequate/patchy block) was significant in Group B (P = 0.033). Segmental disparity in bilateral spread of spinal anaesthesia was significant in Group R with P value of 0.042. Approximate lateral angle for needle in Group A was (4.1 ± 2.45) and in Group B was (9.14 ± 2.45).Conclusions:The study showed that there was a strong correlation between right-sided thoracolumbar curve and the spread of spinal anesthesia

Host Genetics, Innate Immune Responses, and Cellular Death Pathways in Poliomyelitis Patients.

PurposePoliovirus (PV) is one of the most studied viruses. Despite efforts to understand PV infection within the host, fundamental questions remain unanswered. These include the mechanisms determining the progression to viremia, the pathogenesis of neuronal infection and paralysis in only a minority of patients. Because of the rare disease phenotype of paralytic poliomyelitis (PPM), we hypothesize that a genetic etiology may contribute to the disease course and outcome.MethodsWe used whole-exome sequencing (WES) to investigate the genetic profile of 18 patients with PPM. Functional analyses were performed on peripheral blood mononuclear cells (PBMCs) and monocyte-derived macrophages (MdMs).ResultsWe identified rare variants in host genes involved in interferon signaling, viral replication, apoptosis, and autophagy. Upon PV infection of MdMs, we observed a tendency toward increased viral burden in patients compared to controls, suggesting reduced control of PV infection. In MdMs from patients, the IFNβ response correlated with the viral burden.ConclusionWe suggest that genetic variants in innate immune defenses and cell death pathways contribute to the clinical presentation of PV infection. Importantly, this study is the first to uncover the genetic profile in patients with PPM combined with investigations of immune responses and viral burden in primary cells.

Outcome of femoral fractures in poliomyelitis patients.

As patients who were afflicted with poliomyelitis during the outbreaks in the past are aging, lower extremity osteoporotic fractures are becoming more frequent. Fixation in deformed, porotic bone, coupled with muscle weakness and imbalance creates a unique challenge when treating these fractures as does their reduced rehabilitation potential. The aim of this study was to investigate the outcome of femoral fractures in surviving poliomyelitis patients. Sixty-five patients with 74 femoral fractures were treated between 1990 and 2014. Clinical outcome was assessed using the Parkland and Palmer mobility score, and quality-of-life was assessed using the SF-12® score. Some 84% of the fractures were a result of low-energy mechanisms and occurred in the polio-affected limbs, but nonaffected limbs were also injured owing to low-energy mechanisms in all cases. Fifty-seven fractures were treated operatively. There were nine re-operations (16%), including implant removals, nonunion, peri-implant fractures, and malunion. Some 60% of the patients did not regain their previous ambulatory capacity. Post-operative weight-bearing status did not correlate with the final functional outcome. Polio patients with femoral fractures have a guarded prognosis for regaining their pre-injury ambulatory capacity. A higher re-operation rate than that with "normal" osteoporotic fractures is expected.

Subarachnoid block in kyphoscoliosis: A reliable technique?

Subarachnoid block in patients with kyphoscoliosis always present a unique challenge to the anesthesiologist owing to the deformity of spine. The asymmetry in bilateral spread of local anesthetic has been reported earlier. We present a case report of poliomyelitis patient with fracture femur (left) with thoracolumbar kyphoscoliosis posted for open reduction internal fixation. Anesthesia planned in this patient was subarachnoid block with modified paramedian approach which resulted in unilateral sensory block.

Restless Legs Syndrome and Poliomyelitis: New Evidences of an Old Observation?

Restless Legs Syndrome and Poliomyelitis: New Evidences of an Old Observation?

Tibial lengthening with ankle arthrodesis in poliomyelitic patients with unilateral dysfunction of both knee extension and ankle dorsiflexion.

The aim of this study was to assess the results of tibial lengthening with ankle arthrodesis in poliomyelitic patients with unilateral dysfunction of both knee extension and ankle dorsiflexion. Twenty-five consecutive adult patients with poliomyelitic sequelae of unilateral dysfunction of both knee extension and ankle dorsiflexion were treated. Patients had an average shorthening of 5.4 cm (range: 4.5-6.5 cm) on the affected side. The tibia was osteotomized and lengthened with external fixators, which were then replaced with plates supplemented with bone grafting. Ankle arthrodesis was performed concomitantly. Protected weight bearing was advised until bony union was achieved. Gait function was evaluated with Functional Mobility Scale and modified Mazur Scoring System. Twenty-one patients were followed up for an average of 4.3 years (range: 2.0-8.2 years). External fixation was applied for an average of 6.2 weeks (range: 5-8 weeks). Complete bone healing was achieved in all patients and the average union time was 4 months (range: 3.5-4.5 months) after plating. At final follow-up, gait function significantly improved according to Functional Mobility Scale and modified Mazur Scoring System scores (p< 0.001 for both). The tibial lengthening with ankle arthrodesis appears to be an efficient alternative for treating poliomyelitic patients with unilateral dysfunction of both knee extension and ankle dorsiflexion.

Knowledge, attitudes and beliefs of parents towards paralytic poliomyelitis patients in Kano metropolis, Kano, Nigeria

Background: Paralytic poliomyelitis is a disabling disease known to be endemic in the northern part of Nigeria, especially Kano. Despite the WHO declaration to completely eradicate poliomyelitis globally, it has remained a challenge in this part of northern Nigeria. The persistence of the disease might be related to knowledge, attitude and beliefs of caregivers of patients with poliomyelitis. Aim : This study was conducted to determine the knowledge, attitudes and beliefs of parents and/or caregivers of children with paralytic poliomyelitis in Kano metropolis . Methods: A cross sectional survey was carried out among 96 parents/caregivers of patients with paralytic poliomyelitis. Questionnaires were administered to the participants in the selected hospitals in Kano state. Results: The result of this study showed that 55(57.3%) of the caregivers had poor knowledge, 19 (19.8%) had fair knowledge and 22 (22.9%) had good knowledge on paralytic poliomyelitis. It was equally found out that 73 (76%) of the caregivers had a positive attitude while 23 (24%) had negative attitudes towards their children with paralytic poliomyelitis. Greater number of caregivers 56 (58.3%) had positive beliefs while 40 (41.7%) had negative beliefs about the condition. Conclusion: Despite the positive attitude and beliefs parents/caregivers of patients with paralytic poliomyelitis in Kano state had, they however, had a poor knowledge about it. There is therefore the need to carryout adequate awareness programme to educate parents/caregivers of patients with paralytic poliomyelitis in Kano metropolis, Kano State, Nigeria.

Physiotherapy for poliomyelitis: a descriptive study in the Republic of Congo.

BackgroundA large poliomyelitis outbreak occurred in 2010 in the Republic of Congo. This paper describes the demographic and clinical characteristics of poliomyelitis cases and their outcomes following physiotherapy.FindingsDemographic and clinical data were collected on 126 individuals between November 23, 2010 and March 23, 2011. The male/female ratio was 2.5 and the median age was 19 years (IQR: 13.5-23). The most severe forms of the disease were more common in older patients, 81 of the 126 patients (64.3%) had multiple evaluations of muscle strength. Among patients with multiple evaluations, 38.1% had improved strength at final evaluation, 48.3% were stable and 13.6% had decreased strength.ConclusionsMost acute poliomyelitis patients receiving physiotherapy had improved or stable muscle strength at their final evaluation. These descriptive results highlight the need for further research into the potential benefits of physiotherapy in polio affected patients.

Anesthetic Management of a Parturient with Poliomyelitis Associated with Kyphoscoliosis

A 27-year-old primigravida with poliomyelitis associated with kyphoscoliosis underwent cesarean section under spinal anesthesia. Anesthesia poses a significant risk to a parturient with kyphoscoliosis and there is no single regimen that can be recommended for anesthetic management. Regional anesthesia is also challenging for anesthesiologist because the distortion of the spinous process and rotation of the vertebral column. The perioperative period was uneventful. Spinal anesthesia can be safely administered with less adverse effects in poliomyelitis patients with kyphoscoliosis. DOI: http://dx.doi.org/10.3126/njog.v9i1.11193 NJOG 2014 Jan-Jun; 2(1):67-70

Poster 284 Sarcopenic Obesity and Functional Implication in Poliomyelitis Patients

Poster 284 Sarcopenic Obesity and Functional Implication in Poliomyelitis Patients