3/23/2010

El presidente estadounidense Barack Obama promulgó el martes una reforma



Barack Obama promulga reforma de la salud que abre "nueva era en EEUU"
WASHINGTON — El presidente estadounidense Barack Obama promulgó el martes una reforma del sistema de salud que busca extender la cobertura a 32 millones de estadounidenses adicionales, señalando que la nueva legislación abre una "nueva era en Estados Unidos".
"La ley que estoy firmando pondrá en marcha reformas por las que pelearon y marcharon generaciones de estadounidenses", dijo Obama en medio de aplausos y vítores de parlamentarios demócratas y miembros de su administración.
"Junto con la llegada de la primavera, saludamos el advenimiento de una nueva era en Estados Unidos", declaró Obama.
En un homenaje a sus colaboradores y legisladores que aprobaron el domingo el texto, después de un año de arduos debates, Obama hizo referencia a sus predecesores que en vano intentaron que se aprobara la reforma del sistema de salud, desde Theodore Roosevelt hasta Bill Clinton, cuya esposa, Hillary Clinton es secretaria de Estado del actual gobierno.
Obama contó con emoción que en el momento en que ratificaba la ley, pensaba en su difunta madre, "quien peleaba con las compañías de seguros mientras moría de cáncer", así como en varias víctimas de abusos de las aseguradoras, las que nombró.
El discurso de Obama cobró un tono de campaña cuando evocó las disposiciones del texto que entraban en vigencia a partir de este año, en el que para noviembre también se perfilan elecciones legislativas cruciales.
"No somos un país que reduce sus aspiraciones (...) Somos un país que enfrenta las dificultades y acepta sus responsabilidades (...) Forjamos nuestro propio destino", estimó el presidente.
"Y ahora, vamos a asentar la idea fundamental de que todo el mundo debería beneficiarse de una seguridad básica en el rubro de la salud", añadió.
No obstante, incluso antes de entrar en vigor, la ley ya era cuestionada tanto en el plano jurídico como político.
Los republicanos estiman que la reforma, aprobada el domingo por la Cámara de Representantes, implica un costo demasiado elevado y una toma de control del sistema de salud por parte del Estado.
La oposición pretente usar este argumento para llevar a cabo su campaña de cara a las elecciones legislativas de noviembre, en las que se renovará la Cámara de Representantes y un tercio del Senado, ambos controlados por los demócratas.
El jueves, Obama viajará a Iowa (centro) donde intentará convencer a los estadounidenses de los beneficios de esta ley que ha perdido popularidad, en un intento por impedir que los republicanos acaparen los medios de comunicación.
Además, 13 estados redactaron una demanda judicial contra la reforma de salud, que tildan de inconstitucional al obligar a los estadounidenses a suscribir un seguro de salud, lo que estiman que atenta contra los derechos constitucionales de los ciudadanos.
"Esta demanda judicial informará al gobierno federal que Florida (sureste) no permitirá que se ignoren o menosprecien los derechos constitucionales de nuestros ciudadanos ni la soberanía de nuestro estado", declaró el fiscal general de Florida Bill McCollum.
El portavoz de la Casa Blanca, Robert Gibbs, estimó normales estas reacciones cuando se trata de cambios legislativos de "grandes proporciones", y añadió que la Casa Blanca no cree que los opositores a esta reforma "tengan mucho éxito".
Otros 34 estados ya presentaron una demanda o anunciaron que tienen la intención de hacerlo, señaló la Conferencia Nacional de Legislaturas Estatales (National Conference of State Legislatures).http://www.google.com/hostednews/afp/article/ALeqM5hf6JfL_679rn5xiMvRgem8Z05WQQ


The Polio Crusade

THE POLIO CRUSADE IN AMERICAN EXPERIENCE A GOOD VIDEO THE STORY OF THE POLIO CRUSADE pays tribute to a time when Americans banded together to conquer a terrible disease. The medical breakthrough saved countless lives and had a pervasive impact on American philanthropy that ... Continue reading..http://www.pbs.org/wgbh/americanexperience/polio/

Erradicación de La poliomielitis

Polio Tricisilla Adaptada

March Of Dimes Polio History

Dr. Bruno

video

movie

movie2

A 41-year-old man developed an acute illness at the age of 9 months during which, following a viral illness with headache, he developed severe weakness and wasting of the limbs of the left side. After several months he began to recover, such that he was able to walk at the age of 2 years and later was able to run, although he was never very good at sports. He had stable function until the age of 18 when he began to notice greater than usual difficulty lifting heavy objects. By the age of 25 he was noticing progressive difficulty walking due to weakness of both legs, and he noticed that the right calf had become larger. The symptoms became more noticeable over the course of the next 10 years and ultimately both upper as well as both lower limbs had become noticeably weaker.

On examination there was wasting of the muscles of upper and lower limbs on the left, and massively hypertrophied gastrocnemius, soleus and tensor fascia late on the right. The calf circumference on the right exceeded that on the left by 10 cm (figure1). The right shoulder girdle, triceps, thenar eminence and small muscles of the hand were wasted and there was winging of both scapulae. The right quadriceps was also wasted. The wasted muscles were also weak but the hypertrophied right ankle plantar flexors had normal power. The tendon reflexes were absent in the lower limbs and present in the upper limbs, although the right triceps was reduced. The remainder of the examination was normal.

Figure 1

The patient's legs, showing massive enlargement of the right calf and wasting on the left

Questions

1
What is that nature of the acute illness in infancy?
2
What is the nature of the subsequent deterioration?
3
What investigations should be performed?
4
What is the differential diagnosis of the cause of the progressive calf hypertrophy?

Answers

QUESTION 1

An acute paralytic illness which follows symptoms of a viral infection with or without signs of meningitis is typical of poliomyelitis. Usually caused by one of the three polio viruses, it may also occur following vaccination and following infections with other enteroviruses.1 Other disorders which would cause a similar syndrome but with upper motor neurone signs would include acute vascular lesions, meningoencephalitis and acute disseminated encephalomyelitis.

QUESTION 2

A progressive functional deterioration many years after paralytic poliomyelitis is well known, although its pathogenesis is not fully understood.2 It is a diagnosis of exclusion; a careful search for alternative causes, for example, orthopaedic deformities such as osteoarthritis or worsening scoliosis, superimposed neurological disorders such as entrapment neuropathies or coincidental muscle disease or neuropathy, and general medical causes such as respiratory complications and endocrinopathies.3

QUESTION 3

Investigations revealed normal blood count and erythrocyte sedimentation rate and normal biochemistry apart from a raised creatine kinase at 330 IU/l (normal range 60–120 IU/l), which is commonly seen in cases of ongoing denervation. Electromyography showed evidence of denervation in the right APB and FDI with polyphasic motor units and complex repetitive discharges, no spontaneous activity in the left calf and large polyphasic units in the right calf consistent with chronic partial denervation. Motor and sensory conduction velocities were normal. A lumbar myelogram was normal. Magnetic resonance imaging (MRI) scan of the calves is shown in figure2.

Figure 2

Axial T1 weighted MRI scan (TR 588 ms, TE 15 ms) of the calves, showing gross muscle atrophy and replacement by adipose tissue on the left, and hypertrophy of the muscles on the right, with only minor adipose tissue deposition

QUESTION 4

The differential diagnosis of the progressive calf hypertrophy is given in the box.

Causes of calf muscle hypertrophy

Chronic partial denervation

  • radiculopathy

  • peripheral neuropathy

  • hereditary motor and sensory neuropathy

  • spinal muscular atrophy

  • following paralytic poliomyelitis

    Neuromyotonia and myokymia

  • Isaac's syndrome

  • generalised myokymia

  • neurotonia

  • continuous muscle fibre activity due to: chronic inflammatory demyelinating polyradiculopathy, Guillain Barre syndrome, myasthenia gravis, thymoma, thyrotoxicosis, thyroiditis

    Muscular dystrophies

    Myositis

    Infiltration

  • tumours

  • amyloidosis

  • cysticercosis

    Link here