Acute Flaccid Paralysis and West Nile Virus Infection

Acute weakness associated with West Nile virus (WNV) infection has previously been attributed to a peripheral demyelinating process (Guillain-Barré syndrome); however, the exact etiology of this acute flaccid paralysis has not been systematically assessed. To thoroughly describe the clinical, laboratory, and electrodiagnostic features of this paralysis syndrome, we evaluated acute flaccid paralysis that developed in seven patients in the setting of acute WNV infection, consecutively identified in four hospitals in St. Tammany Parish and New Orleans, Louisiana, and Jackson, Mississippi. All patients had acute onset of asymmetric weakness and areflexia but no sensory abnormalities. Clinical and electrodiagnostic data suggested the involvement of spinal anterior horn cells, resulting in a poliomyelitis-like syndrome. In areas in which transmission is occurring, WNV infection should be considered in patients with acute flaccid paralysis. Recognition that such weakness may be of spinal origin may prevent inappropriate treatment and diagnostic testing

On Plica Polonica and the forgotten Joseph Romain Louis Kerckhoffs (1789-1867)

Plica Polonica (or Plica Neuropathica) is a rare hair disorder, an acute hair felting. The one who described this phenomenon thoroughly and who has been almost totally absent in history-of-medicine textbooks, is the French - Dutch physician, Joseph Romain Louis Kerckhoffs (or Kerckhove) (1789 - 1867)

Thoracopelvic assisted movement training to improve gait and balance in elderly at risk of falling: a case series

Shmuel Springer,1 Itamar Friedman,2 Avi Ohry3,4 1Department of Physical Therapy, Faculty of Health Sciences, Ariel University, Ariel, Israel; 2ProMedoss, Charlotte, NC, USA; 3Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; 4Reuth Rehabilitation and Medical Center, Tel Aviv, Israel Background: Age-related changes in coordinated movement pattern of the thorax and pelvis may be one of the factors contributing to fall risk. This report describes the feasibility of using a new thoracopelvic assisted movement device to improve gait and balance in an elderly population with increased risk for falls. Methods: In this case series, 19 older adults were recruited from an assisted living facility. All had gait difficulties (gait speed <1.0 m/s) and history of falls. Participants received 12 training sessions with the thoracopelvic assisted movement device. Functional performance was measured before, during (after 6 sessions), and after the 12 sessions. Outcomes measures were Timed Up and Go, Functional Reach Test, and the 10-meter Walk Test. Changes in outcomes were calculated for each participant in the context of minimal detectable change (MDC) values. Results: More than 25% of participants showed changes >MDC in their clinical measures after 6 treatment sessions, and more than half improved >MDC after 12 sessions. Six subjects (32%) improved their Timed Up and Go time by >4 seconds after 6 sessions, and 10 (53%) after 12 sessions. After the intervention, 4 subjects (21%) improved their 10-meter Walk Test velocity from limited community ambulation (0.4–0.8 m/s) to functional community ambulation (>0.8 m/s). Conclusion: Thoracopelvic assisted movement training that mimics normal walking pattern may have clinical implications, by improving skills that enhance balance and gait function. Additional randomized, controlled studies are required to examine the effects of this intervention on larger cohorts with a variety of subjects. Keywords: gait, balance, older adults, trainin

The Implication of Combat Stress and PTSD Trajectories in Metabolic Syndrome and Elevated C-Reactive Protein Levels: A Longitudinal Study

Objective: This study sheds light on the importance of long-term follow-up of trauma survivors, posttraumatic stress disorder (PTSD) trajectories, and early detection of health risk factors in trauma survivors. The present study prospectively assessed the following over 23 years: (1) the association of psychological and physiologic stress during captivity with elevated C-reactive protein (CRP) levels and metabolic syndrome (MetS), which includes hypertension; elevated levels of insulin, triglycerides, and fasting glucose; decreased levels of high-density lipoprotein cholesterol; and obesity and (2) the implication of PTSD trajectories in elevated CRP levels and MetS. Methods: Measurements were taken in 1991, 2003, 2008, and 2015. Participants were 116 Israeli combat veterans of the 1973 Yom Kippur War (of these, 101 were former prisoners of war [ex-POWs] and 15 were comparable controls). The medical assessments relevant for this study were body mass index, fasting blood glucose levels, and diabetes, blood pressure or a diagnosis of hypertension, high-density lipoprotein cholesterol and triglyceride levels, and medication intake. In addition, the PTSD Inventory was used to assess PTSD symptoms and trajectories over time according to DSM-IV-TR PTSD criteria. Results: Captivity-in particular, the captivity stressors of weight loss, physical suffering, psychological suffering, and humiliation-was implicated in both elevated CRP levels and MetS, significantly so with elevated CRP levels (P=.01, R-2 = 0.33). Captivity-induced PTSD, in particular chronic and delayed PTSD trajectories, was associated with elevated CRP levels and MetS, significantly so for MetS (P=.05). Conclusions: Monitoring inflammation using markers like CRP level in trauma survivors can be beneficial, particularly if PTSD is chronic or delayed. Clinicians treating trauma survivors should raise awareness of the importance of such measures in light of long-term health vulnerabilities. (C) Copyright 2017 Physicians Postgraduate Press, Inc