5/26/2010

Health Leaders Discuss Polio, Alcohol, Childhood Obesity At WHA


From the 63rd World Health Assembly (WHA) in Geneva, the Associated Press reports on what some "describe as a new strategy to get rid of" poliothat focuses on developing solutions to "problems in each country, provides more WHO monitoring, like more teleconferences, and holds governments more accountable." The plans also provide "[n]ew [polio] outbreak response plans," according to the AP.
Some "say there is little new [in this strategy] and that if this effort fails ... serious questions about whether to continue the campaign should be raised," the news service reports.

"Since WHO, the U.S. Centers for Disease Control and Prevention, UNICEF and Rotary International set out to eradicate polio in 1988, they have come tantalizingly close," the news service writes. "By 2003, cases had dropped by more than 99 percent. But progress has stalled since and several deadlines have been missed."
Despite eradication efforts, polio remains "entrenched" in Afghanistan, India, Nigeria and Pakistan. "Experts worry that as the effort enters its 22nd year, donors' patience and wallets are running thin. Sustaining the effort costs about $750 million every year," the AP reports.
According to the AP, the Bill & Melinda Gates Foundation "said the next three years are 'critically important' [to fight polio]. The foundation said their polio donations are reconsidered every year."
The piece also includes comments from current and former heads of the WHO's polio programs, who reflect on the new strategy and express concerns over what will happen if the WHO's polio program is abandoned (Cheng, 5/20).
In related news, the AP reports the WHO's 193 member states endorsed a "global strategy to reduce alcohol abuse ... Harmful drinking is the third leading risk factor for disability and premature death in the world, with 2.5 million deaths each year linked to alcohol, WHO said," the news service writes. "That figure includes 320,000 people between 15 and 29, and [WHO] said many others are sickened with heart and liver diseases, cancer and even HIV/AIDS because of alcohol abuse," according to the AP (Klapper, 5/20).
Also at the WHA, leaders "agreed on Thursday to try to reduce children's consumption of junk food and soft drinks by asking member states to restrict advertising and marketing," Reuters reports. According to the WHO, some "42 million children under the age of five are overweight, 35 million of them in developing countries," the news service writes (Nebehay, 5/20).

U.S. Surgeon-General Regina Benjamin welcomed WHO's childhood obesity plan during the WHA.
"The United States thanks the WHO for its work on the global strategy for the prevention and control of non-communicable diseases," Benjamin said, in remarksprepared for delivery during the meeting. "Because non-communicable diseases are a significant public health issue that affect both developing and developed countries, we continue to support the WHO's Action Plan for implementing the global strategy, such as the inclusion of all stakeholders in that work, as the reduction of non-communicable diseases is a shared responsibility" (5/20).

WHO Faces Questions Of Handling of H1N1
In related news, the BBC reports on how the topic of the WHO's handling of the H1N1 (swine flu) pandemic remains high on the agenda at the WHA. The piece reflects on health experts' skepticism that the virus outbreak was classified as a pandemic.

"The WHO has struggled to offer clear answers on the question of its definition of a pandemic, partly because of its policy of keeping the identity and the deliberations of its pandemic emergency advisory committee secret," the BBC writes. "The lack of transparency in its decision making process, together with the WHO's advice to countries to begin widespread vaccination against swine flu, has led some observers to suspect undue influence from the pharmaceutical industry" (Foulkes, 5/20).

Meanwhile, "[a]n expert panel investigating the World Health Organization's response to last year's swine flu outbreak said Wednesday it wants to see confidential exchanges between the U.N. body and drug companies," theAP/Washington Post reports. Committee chairman and U.S. Institute of Medicine President Harvey Fineberg said the panel plans to seek documents of correspondence between the groups before and after the WHO declared H1N1 to be a pandemic, according to the news service.

"The documents include 'contractual or letters of understanding' between the pharmaceutical industry and WHO, [Fineberg] said. 'Some of the agreements with industry that we would like to examine have been considered confidential,' but so far all of the panel's requests have been met, he said" (Jordans, 5/19).
This information was reprinted from globalhealth.kff.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Global Health Policy Report, search the archives and sign up for email delivery atglobalhealth.kff.org.
 Henry J. Kaiser Family Foundation.



Clasificación Internacional de Enfermedades Codifico al Síndrome de Post Polio con el Código G14 Síndrome Postpolio   Incluye :  Síndrome postpoliomielítico  Excluyéndolo del código B91Secuelas de poliomielitis

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

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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