APOLINARIO MABINI ANG TUNAY NA SANHI NG KANYANG PAGKALUMPO

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APOLINARIO MABINI: ANG TUNAY NA SANHI NG KANYANG PAGKALUMPO :

APOLINARIO MABINI: ANG TUNAY NA SANHI NG KANYANG PAGKALUMPO Batangas City Convention Center July 7, 2014

Patient’s Profile :

Patient’s Profile Name of Patient: Apolinario Mabini Address: Tanawan , Batangas Age: 31 years old Gender: Male Marital Status: Single Religion: Roman Catholic Date of admission: October 1896 Hospital: San Juan de Dios, Intramuros , Maynila

Medical History (incomplete):

Medical History (incomplete) “In the absence of medical records and with the scarcity of materials about his illness, we had to rely on the few documents I gathered on the subject. “

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CHIEF COMPLAINT: weakness in waist and legs HISTORY OF ILLNESS: The patient was apparently well until 9 months prior to admission, the patient was brought to the prisoner’s ward at San Juan de Dios Hospital due to weakness in waist and legs with no other symptoms noted. “Since January, 1896, I cannot stand because of weakness in my waist and legs. I do not suffer any other ache and I look as if I were not sick. The physicians however say that I will never recover my health; but I do not despair because I am still able to do something good for my country.”

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FAMILY HISTORY: No records available REVIEW OF SYSTEMS: No records available PHYSICAL EXAMINATION: Not done PHYSICAL EXAMINATION: [N/A] (based on historical account) cannot stand [no motor] LABORATORY AND DIAGNOSTIC STUDIES: not available

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PAST MEDICAL HISTORY: Diosdado G. Capino Nahulog sa kabayo Atty . Jose Oliveros I recall stories I heard as a boy from old folks in Tanauan that Mabini became paralytic because he and his sweetheart were caught in flagranti (act) by the father of the latter. Mabini jumped out of the window so he would not be forced to marry the girl and in the process broke his leg.

ATTENDING PHYSICIANS :

ATTENDING PHYSICIANS 1. Ariston l. Bautista

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2. Isodoro de los Santos

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3. Santiago R. Barcelona

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4. Lucino Almeida

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5. Trinidad Pardo de Tavera

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On (June) July 5, 1897, Apolinario Mabini was released from his imprisonment in San Juan de Dios Hospital.

IMPRESSION: :

IMPRESSION: 1. Stroke   A stroke, sometimes referred to as a cerebrovascular accident (CVA ), or colloquially brain attack is the loss of brain function due to a disturbance in the blood supply to the brain. This disturbance is due to either ischemia (lack of blood flow) or hemorrhage.

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Depending on the part of the brain affected, the defect in the brain is usually on the opposite side of the body .

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In most cases, the symptoms affect only one side of the body (unilateral).

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2. Syphilis Syphilis is a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum subspecies pallidum . The primary route of transmission is through sexual contact; it may also be transmitted from mother to fetus during pregnancy or at birth, resulting in congenital syphilis.

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Ambeth Ocampo's "Looking Back" column gives us the following information: "Syphilis as the cause of Mabini's paralysis originated from detractors who claimed the black spot on Mabini's back was proof that he was receiving syphilis treatment. Arsenic or Salvarsan , which was a syphilis cure, was manufactured in Germany in 1907 and couldn't have been available in the Philippines at the time of Mabini's death in 1903.

Black Spot :

Black Spot   Bed sores, also known as pressure ulcers, pressure sores or decubitus ulcers are skin lesions which can be caused by friction, humidity, temperature, continence, medication, shearing forces, age and unrelieved pressure.

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Disliked by Congress, Apolinario Mabini’s appointment as chief justice by Emilio Aguinaldo was questioned. During the time Mabini had the full confidence of President Aguinaldo, his detractors could not find any hint of corruption or dishonesty on him, so they concocted the rumor that he lost the use of his legs because of syphilis. The rumor was spread by the wealthy mestizos around Aguinaldo who wanted Mabini's ethical and ideological influence cut off . --- Ambeth Ocampo

Pujalte’s Report:

Pujalte’s Report Syphilis in its advanced stages makes the victim suffer from epileptic seizures, blindness or insanity, none of which was true of Mabini , whose brilliant mind was functioning where he learned English, wrote his La Revolucion Filipina and his version of Balagtas's Florante at Laura, all the while refusing to swear allegiance to the United States. His mind was lucid until his death. X-rays did not show the thickened skull of a person with syphilis.

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3. Pott’s disease Pott's disease or Pott disease is a presentation of extrapulmonary tuberculosis whereby disease is seen in the spinal vertebrae.

Pujalte’s Report:

Pujalte’s Report

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4. Poliomyelitis Poliomyelitis (Polio ) Poliomyelitis often called polio or infantile paralysis, is an acute, viral, infectious disease spread from person to person, primarily via the fecal-oral route.   Major polio epidemics started to appear in the late 19th century in Europe and soon after the United States, and it became one of the most dreaded childhood diseases of the 20th century .  

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Poliomyelitis was first recognized as a distinct condition by Jakob Heine in 1840.

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Polio had existed for thousands of years in certain areas, with depictions of the disease  in ancient art.

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 Early symptoms of paralytic polio include high fever, headache, stiffness in the back and neck, asymmetrical* weakness of various muscles, sensitivity to touch, difficulty swallowing, muscle pain, loss of superficial and deep reflexes, paresthesia (pins and needles), irritability, constipation, or difficulty urinating. *asymmetrical (having no balance or symmetry)

Controversy about Mabini's paralysis :

Controversy about Mabini's paralysis Even during his lifetime, there were controversial rumors regarding the cause of Mabini's paralysis. Infighting among members of the Malolos congress led to the spread of rumors saying that Mabini's paralysis had by caused by venereal disease - specifically, syphilis. This was debunked only in 1980, when Mabini's bones were exhumed and the autopsy proved once and for all that the cause of his paralysis was Polio. In 1980, Apolinario Mabini’s remains were exhumed and studied by a group of orthopedic doctors led by Dr. Jose M. Pujalte who put to rest the rumor that the “Sublime Paralytic” lost the use of his legs due to syphilis.

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  Postmortem examination done by a group of orthopedic doctors led by Dr. Jose M. Pujalte came to conclusion after careful reconstruction, X-ray and analysis that Mabini’s paralysis was not caused by syphilis, as some people would like to believe, but it was the result of adult polio .   "Though polio is a disease associated with children and Mabini was paralyzed at 31,this was not surprising, since other leaders like Franklin D Roosevelt caught polio at 39. Despite his paralysis, Mabini had sensation in the affected part of his body. With all the other possibilities ruled out, our medical sleuths (a team of doctors formed in 1980 and led by Dr. Jose Pujalte , then director of the National Orthopedic Hospital) were left with only one conclusion - Mabini's paralysis was caused by polio .“ Fortunately, not everything is open ended. In 1980, Apolinario Mabini’s remains were exhumed and studied by a group of orthopedic doctors led by Dr. Jose M. Pujalte who put to rest the rumor that the “Sublime Paralytic” lost the use of his legs due to syphilis. No scandal there: Mabini was afflicted by polio.------By Ambeth Ocampo

THE PUJALTE REPORT :

THE PUJALTE REPORT

Dr. Jose Pujalte :

Dr. Jose Pujalte

Dr. Andres Borromeo :

Dr. Andres Borromeo

Dr. Franklin Dizon, Jr. :

Dr. Franklin Dizon , Jr.

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Wrong interpretation:

Wrong interpretation

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No Polio affliction was evident either in his bones from waist down.

Treatment:

Treatment Hot Spring

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Soaking in a hot mineral spring is a form of hydrothermal therapy, used to improve health and treat disease and injury since ancient times .

MY ASSESSMENT :

MY ASSESSMENT GUILLAIN-BARRÉ SYNDROME

Guillain-Barré Syndrome:

Guillain-Barré Syndrome is an acute inflammatory demyelinating polyneuropathy (AIDP), a disorder affecting the peripheral nervous system. It is usually triggered by an acute infectious process. The syndrome was named after the French physicians Guillain , Barré and Strohl , who were the first to describe it in 1916. It is sometimes called Landry's paralysis, after the French physician who first described a variant of it in 1859. It is included in the wider group of peripheral neuropathies.

ETIOLOGY :

ETIOLOGY The etiology of Guillain-Barré syndrome is unclear, but an autoimmune response is strongly suspected. There is a preceding event or trigger that is often an infection. Occasionally, vaccinations have been known to trigger Guillain-Barré syndrome.

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Approximately half of the people who develop Guillain - Barré syndrome have a mild febrile illness 2 to 3 weeks before the onset of symptoms. The febrile infection is usually respiratory or gastrointestinal. Approximately 25% of patients with this disease have antibodies to either cytomegalovirus or Epstein-Barr virus.

PATHOPHYSIOLOGY:

PATHOPHYSIOLOGY In Guillain-Barré syndrome, the myelin sheath surrounding the axon is lost. Demyelination is a common response of neural tissue to many agents and conditions, including physical trauma , hypoxemia, toxic chemicals, vascular insufficiency , and immunological reactions. Loss of the myelin sheath in Guillain-Barré syndrome makes nerve impulse transmission is aborted.

CLINICAL MANIFESTATIONS:

CLINICAL MANIFESTATIONS The syndrome may develop rapidly over the course of hours or days, or may take up to 3 to 4 weeks to develop. Most patients demonstrate the greatest weakness in the first weeks of the disorder. Patients are at their weakest point by the third week of the illness . In the beginning, a flaccid, ascending paralysis develops quickly . The patient is most commonly affected in a symmetrical pattern .

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The patient may first notice weakness in the lower extremities that may quickly extend to include weakness and abnormal sensations in the arms. Deep tendon reflexes are usually lost, even in the earliest stages. The trunk and cranial nerves may become involved. Respiratory muscles can become affected, resulting in respiratory compromise.

CLINICAL MANIFESTATIONS:

CLINICAL MANIFESTATIONS Autonomic disturbances such as urinary retention and orthostatic hypotension may also occur. Superficial and deep tendon reflexes may be lost. Some patients experience tenderness and pain on deep pressure or movement of some muscles.

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Sensory symptoms of paresthesias , including numbness and tingling, may occur. Pain is a complaint in a large number of patients. It is aching in nature and often compared with the feeling of muscles that have been overexerted.

CLINICAL MANIFESTATIONS:

CLINICAL MANIFESTATIONS If there is cranial nerve involvement, cranial nerve VII, the facial nerve, is most often affected. Guillain-Barré syndrome does not affect level of consciousness, pupillary function, or cerebral function.

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Symptoms may progress for several weeks. The level of paralysis may stop at any point. Motor function returns in a descending fashion. Demyelination occurs rapidly, but the rate of remyelination is approximately 1 to 2 mm per day.

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Also, nerve conduction studies record impulse transmission along the nerve fiber. Pulmonary function tests are done when Guillain-Barré syndrome is suspected to establish a baseline for comparison as the disease progresses. Declining pulmonary function capacity may indicate the need for mechanical ventilation and management in an ICU.

DIAGNOSIS:

DIAGNOSIS The history of the onset of symptoms can be revealing because symptoms of Guillain-Barré syndrome usually begin with weakness or paresthesias of the lower extremities and ascend in a symmetrical pattern. A lumbar puncture may be performed and reveal increased protein.

CLINICAL MANAGEMENT:

CLINICAL MANAGEMENT preventive measures need to be established to prevent DVT and pulmonary embolism do not develop. Heparin 5000 units subcutaneously may be given along with antiembolism stockings and sequential compression devices

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The first therapy proven to benefit patients with Guillain-Barré syndrome is plasmapheresis . This procedure mechanically removes humoral factors. Intravenous immunoglobulin (IVIG) is also useful in managing Guillain-Barré syndrome.

Plasmapheresis machine:

Plasmapheresis machine

History:

History Guillain – Barre ´ syndrome Then, in 1916, Georges Guillain (1876–1961) and Jean Alexander Barre ´ (1880–1967) described the cerebrospinal fluid findings in Landry’s ascending paralysis. Two soldiers in the French Vth Army presented with ascending paralysis, loss of deep tendon reflexes, paraesthesia and pain on deep palpation of large muscles. Andre ´ Strohl (1887– 1977), a physician-scientist who became Professeur et la chaire de Physique me´dicale a` la Faculte ´ de Me´decine de Paris in 1925, performed electromyography on the soldiers. Minor disturbances in nerve-muscle stimulation were found. Most important, their cerebrospinal fluid contained few leucocytes but a high concentration of protein. This was the opposite of the cerebrospinal fluid findings in paralytic poliomyelitis3. This constellation of findings was named Guillain – Barre ´ syndrome (GBS), after the first two authors.

Based on history and personal account :

Based on history and personal account 1) no cases of Poliomyelitis in the Philippines during that time (1896)

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2) Meningismus is common in paralytic poliomyelitis and was lacking in Mabini’s case Meningism is the triad of nuchal rigidity (neck stiffness), photophobia (intolerance of bright light) and headache. It is a sign of irritation of the meninges, such as seen in meningitis, subarachnoid hemorrhages and various other diseases. " Meningismus " is the term used when the above listed symptoms are present without actual infection or inflammation; usually it is seen in concordance with other acute illnesses in the pediatric population.

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3) Age: Yet his age and many features of the illness are more consistent with a diagnosis of Guillain – Barre ´ syndrome, an autoimmune polyneuritis . 4) Sign & Symptom probabilities for each disease were estimated from past reports of paralytic. The symptoms studied from Mabini’s case were:

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5) Franklin D. Roosevelt's paralytic illness began in 1921 at age 39, when Roosevelt got a fever after exercising heavily at a vacation in Canada. He was diagnosed with poliomyelitis two weeks after he fell ill. HOWEVER, A 2003 RETROSPECTIVE STUDY FAVORED A DIAGNOSIS OF GUILLAIN-BARRÉ SYNDROME. Goldman AS, Schmalstieg EJ, Freeman DH, Goldman DA, Schmalstieg FC (2003). "What was the cause of Franklin Delano Roosevelt's paralytic illness?" (PDF). Journal of Medical Biography (Royal Society of Medicine) 11 (4): 232–40. ISSN 0967-7720. PMID 14562158. Retrieved 2012-02-27.

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One of only three known photographs of Roosevelt in a wheelchair

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On examination by physician Robert Lovett, Roosevelt's temperature was 100°F. Both legs were paralyzed. Lovett and Bennet concluded that the diagnosis was poliomyelitis.

GUILLAIN–BARRÉ VS. POLIOMYELITIS :

GUILLAIN–BARRÉ VS. POLIOMYELITIS Bayesian analysis A peer-reviewed study published in 2003, using Bayesian analysis, found that six of eight posterior probabilities favored a diagnosis of Guillain – Barré syndrome over poliomyelitis.

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“After two long years I am returning, so to speak, completely disoriented and, what is worse, almost overcome by disease and sufferings. Nevertheless, I hope, after some time of rest and study, still to be of some use, unless I have returned to the Islands for the sole purpose of dying .”

References: :

References : Las Cartas Politicas de Mabini – T.M. Kalaw A Historical vignette : the real cause of Mabini's paralysis / Jose M. Pujalte , Franklin G. Dizon , Jr., Andres D. Borromeo . - Quezon City National Commission Concerning Disabled Persons 1982 - xi, 27 p. 23 cm. Stories of Apolinario Mabini his life, character, and teachings by Diosdado G. Capino . The hero of the Filipinos; the story of José Rizal, poet, patriot and martyr, by Charles Edward Russell and E. B. Rodriguez History of Batangas FB group

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The End