Jun 12, 2010

Tajik Polio Outbreak Strains Relations With Russia

Moscow and Dushanbe fall out over restrictions to prevent disease spreading.
Moscow’s tough response to an outbreak of polio in Tajikistan has created some tension between the two nations, as Dushanbe ask for restrictions to be lifted.
The outbreak was spotted in April after doctors recorded an unusually high number of cases of with acute flaccid paralysis, a loss of muscle tone which is a symptom of the poliomyelitus virus. By May 16, the Tajik health ministry said there were 83 confirmed cases of polio, including one death. The following day, the World Health Organisation, WHO, gave a higher figure of 129 confirmed cases. The outbreak is concentrated in and around the capital Dushanbe and in the southern Katlon oblast in the south-western part of the country.
This is the first outbreak of the disease in Tajikistan since the last case was registered in 1997.
Poliomyelitis is a highly contagious disease affecting the nervous system and sometimes resulting in paralysis. It mainly affects children and is transmitted through contaminated food, drinking water and faeces.
The WHO said two rounds of a nationwide vaccination campaign for children under six had been completed, with a third due to take place in the first five days of June.
Concerned at the prospect of transmission via imported food or the hundreds of thousands of Tajik nationals who travel to Russia for work, Moscow took action at the beginning of May.
On May 2, it banned imports of Tajik nuts and dried fruit. The Russian consumer and health agency Rospotrebnadzor said these food items were a particular concern since they are consumed without being cooked. 
Four days later, Moscow it introduced a travel ban for children from Tajikistan under the age of six until the end of the immunisation campaign. Rospotrebnadzor head Gennady Onitschenko said the ban became necessary after a nine-month-old baby who arrived from Tajikistan to the Siberian city of Irkutsk wsa diagnosed with polio.
For Tajikistan, the food ban was a particular blow as dried fruit and nuts are an important export.  
On May 6, Tajik Foreign Minister Hamrokhon Zarifi handed Russian ambassador Yury Popov a note requesting an end to the import restrictions. The Tajik authorities argue that the nuts and fruit are safe as they come from the northern Soghd region, where no cases of polio have been recorded.
Dushanbe and Moscow also disagreed publicly over a decision to bring Russian children home until the danger had passed. Most of them are the children of personnel stationed at a permanent Russian military base in Tajikistan.
In an interview to a Russian radio station on May 11, Onitschenko said his agency had asked the Tajik authorities to provide every possible assistance to allow the children to leave swiftly. But he said obstructions had been placed in the way, and suggested that this was an attempt by the Tajiks to get the food ban lifted.
Tajik foreign ministry spokesman Davlat Nazriev denied the allegation, saying there were no obstacles to anyone leaving the country.
The Russian embassy in Dushanbe, meanwhile, tried to calm troubled waters by saying any travel problems were due not to obstructionism, but to the May 8-10 public holiday in Tajikistan commemorating the end of the Second World War.
The acrimonous exchanges over how to respond to the polio outbreak reflect wider frustrations in Tajikistan’s relationship with Moscow.
Political analysts in Tajikistan interviewed by IWPR suggested the Russians had ulterior motives for coming down hard over the polio issue. They believed it might have something to do with the ongoing construction of the giant Roghun hydroelectric dam. Russian companies withdrew from the project two years ago following contractual disagreements, and Uzbekistan has more recently been urging Moscow to back its own opposition to the plan, which it fears will deprive the region of water.
Dodojon Atovulloev, a Tajik opposition member in exile, drew comparisons with other instances in which Russia has imposed bans on former Soviet states when political relations deteriorate. As examples he cited wine from Georgia and Moldova and milk from Belarus.
Arkady Dubnov, a journalist in Moscow who specialises in Central Asian affairs, dismisses such suggestions, arguing that relations between Russia and Tajikistan are in fairly good shape. He believes the problems stemmed from an overreaction by Onitschenko, who should not be seen as a mouthpiece for the Kremlin.
Jumaboy Sanginov, who heads the parliamentary faction of  the governing People’s Democratic Party of Tajikistan, agreed that Moscow should not be accused of politicising the matter. A doctor by profession, Sanginov said Tajikistan should own up to its own failure to do enough to prevent the polio outbreak.
“The reason it has spread in Tajikistan is that in the past, not all residents of this country have been vaccinated,” he said.
Firuz Saidov, a researcher at the Centre for Strategic Studies, linked to the Tajik president’s office, added, “We did indeed fail to spot the spread of the polio virus in Tajikistan, and that’s a minus point for our healthcare system.”
Jahongir Boboev is a pseudonym for journalist in Tajikistan.
This article was produced jointly under two IWPR projects: Building Central Asian Human Rights Protection & Education Through the Media, funded by the European Commission; and the Human Rights Reporting, Confidence Building and Conflict Information Programme, funded by the Foreign Ministry of Norway.
The contents of this article are the sole responsibility of IWPR and can in no way be taken to reflect the views of either the European Union or the Foreign Ministry of Norway.

Jun 11, 2010

Con la erradicación de la poliomielitis, el síndrome de Guillain-Barré se transformó en la principal causa de parálisis neuromuscular

Síndrome de Guillain-Barré  
http://www.elcisne.org/ampliada.php?id=87
Con la erradicación de la poliomielitis, el síndrome de Guillain-Barré se transformó en la principal causa de parálisis neuromuscular en occidente. Se trata de un trastorno a partir del cual el sistema inmunológico del cuerpo ataca a parte del sistema nervioso periférico. Los síntomas inmediatos del síndrome incluyen distintos grados de debilidad o sensaciones de cosquilleo en las piernas, que se pueden propagar luego a los brazos y al torso. Estos síntomas pueden aumentar en intensidad hasta que los músculos no pueden utilizarse en absoluto y la persona afectada queda casi totalmente paralizada.
 
El síndrome de Guillain Barré constituye la causa más frecuente de parálisis aguda generalizada y ocasionalmente fatal en el que el sistema inmunológico del cuerpo ataca a parte del sistema nervioso periférico. Los síntomas iniciales contienen distintos grados de debilidad o sensaciones de cosquilleo en las piernas, pero los mismos pueden aumentar en intensidad y frecuencia hasta que los músculos pierden su funcionalidad y la persona afectada queda prácticamente paralizada, poniendo en peligro su vida. Se trata en realidad de un conjunto de síntomas de etiología autoinmune con características clínicas, fisiopatológicas, electrofisiológicas con pronóstico y evolución diferentes. La primera mención referente a un cuadro similar con entumecimiento, debilidad, corta evolución y recuperación espontánea data de comienzos de siglo XIX; en 1859 Octave Landry de Thézila describe la forma desmielinizante y a finales del siglo XIX Guillain Barré y Strohl recopilan más casos, describen y profundizan otras características y realizan la primera electromiografía. Luego, a lo largo del siglo XX otros investigadores seguirían analizando las distintas variantes del SGB, agregando nuevos conceptos relacionados con su patogénesis y el espectro clínico. Profundizando específicamente en este conjunto de síntomas se los describe como una poliradiculoneuropatía inflamatoria aguda, rápidamente progresiva y cuya etiología no está claramente establecida. De todos modos se la acepta como un mecanismo que actúa dando una respuesta inmune dirigida contra los antígenos (antigangliosidos) sobre la mielina o el axón. La gran mayoría de los casos de SGB son de tipo desmielinizante, aunque también existen variantes ligadas a la infección por campylobacter jejuni, u otros tipos de infecciones gastrointestinales o respiratorias, y también a otros factores como inmunizaciones, cirugía, anestesia o trauma. El muy notable el carácter clínico inicial del SGB, con una duración menor a 12 semanas, reconociéndose síntomas ya mencionados como sensaciones extrañas en las extremidades inferiores asociadas a debilidad ascendente y variable que más tarde puede comprometer seriamente la musculatura respiratoria y de pares craneales por un periodo de 1 a 3 semanas. Luego, los síntomas del SGB entran en un periodo de meseta para finalmente desenvolver la fase quizá más crítica de la enfermedad, un 90% de los pacientes están en esta etapa en su punto de mayor debilidad. Allí pueden aparecer síntomas como debilidad muscular simétrica progresiva, dolor también es frecuente, arritmias cardíacas, labilidad en la regulación de la presión arterial, disfunción pupilar, diaforesis, retención urinaria por compromiso de esfínter externo uretral y disfunción gastrointestinal.

 En una cuarta etapa se manifiesta una recuperación, la misma puede ocurrir de 2 a 4 semanas después, pero con recaídas impredecibles. Si bien la mayoría de los pacientes se recuperan, aun los casos más severos, algunos continúan teniendo un cierto grado de debilidad. Llevándolo a términos sencillos podríamos resumir que en el SGB el sistema inmunológico del cuerpo comienza a atacar al propio cuerpo, destruyendo la cobertura de mielina que rodea a los axones (extensiones delgadas y largas de las células nerviosas que transmiten las señales nerviosas) de muchos nervios periféricos, o incluso a los propios axones. En la actualidad se reconocen cuatro formas fisiopatológicas: - Polineuropatía sensitivo-motora desmielinizante. - Neuropatía motora axonal aguda. - Neuropatía sensitivo-motora axonal aguda. - Síndrome de Miller Fisher. Incidencia y diagnóstico El misterioso síndrome de Guillain-Barré puede afectar a cualquier persona de cualquier edad y sexo. Su incidencia de 1 cada 100,000 personas, lo que le da el carácter de enfermedad rara. Según Minsalud se reportaron en Colombia 35 pacientes con diagnóstico de síndrome de Guillain Barré durante el año 2000. El SGB puede ocurrir en un breve lapso de tiempo posterior a que el paciente haya sufrido síntomas de una infección viral respiratoria o gastrointestinal. También se han reportado casos luego de una cirugía o una vacuna.

 Esto quedaría confirmado en un estudio realizado recientemente en Francia donde se llegó a la conclusión que un 40% de los pacientes con SGB muestra por lo menos un agente causal conocido, entre los cuales los más frecuentes son el Campylobacter
 jejuni y el citomegalovirus. Los casos sin agente causal conocido son más comunes durante el invierno, y usualmente la aparición de los síntomas es precedida por un cuadro gripal, respiratorio o gastrointestinal. Los cuadros que confirman el diagnóstico, entre otros, son: - Progresión a lo largo de días o semanas. - Debilidad Motora progresiva de más de un miembro. - Arreflexia o hiporreflexia marcada. - Relativa simetría. - Pérdida leve de la sensibilidad. - Comienzo con dolor o malestar de una extremidad. - Compromiso de nervios craneanos. - Comienzo de la recuperación a las 2-4 semanas luego de detenerse la progresión. - Trastorno funcional autonómico. - Ausencia de fiebre al comienzo de la evolución. - Aumento en el nivel de las proteínas del LCR una semana después de la aparición de los síntomas. - Electrodiagnóstico con conducción más lenta u ondas F. Enigmas y tratamiento Lo cierto es que se desconoce aún por qué el síndrome de Guillain-Barré ataca a algunas personas y a otras no, como también se desconoce las causas totales y precisas que desencadenan la enfermedad. Sumado a ello, el manejo del paciente con SGB puede resultar intimidante por su evolución impredecible y a la potencialidad de muerte. Se ha demostrado que el SGB infantil presenta una evolución bastante más benigna que en los adultos, presentando una tasa de recuperación más acelerada y un menor riesgo de discapacidad.
Si bien no existe una cura conocida para el síndrome de Guillain-Barré, existen terapias que reducen la gravedad de la enfermedad y aceleran la recuperación en la mayoría de los pacientes, como también existen varias vías para tratar las complicaciones derivadas de la enfermedad: - Intercambio del plasma: También conocido como plasmapheresis. Esta terapia quita sangre del paciente, separa las células rojas y blancas de la sangre del plasma, y después devuelve las células rojas y blancas. Deben producirse cuatro o cinco tratamientos del intercambio del plasma, uno por día. El intercambio del plasma es relativamente seguro, pero puede ser un tratamiento precipitado para algún paciente del GBS; también es costoso y sólo está disponible en centros con equipos adecuados. - Inmunoglobulina intravenosa: La immunoglobina intravenoso (IVIG) es un poco arriesgado, fácil de administrar el tratamiento para el GBS. Esta terapia implica altas dosis intravenosas de las proteínas que el cuerpo utiliza normalmente en dosis pequeñas.

El IVIG es tan eficaz como el intercambio del plasma y se recomienda para los adultos con los síntomas más graves. La eficacia del IVIG todavía no se ha probado en niños y en pacientes con síntomas leves. Se ha probado también el uso de hormonas esteroides como forma de reducir la gravedad de Guillain-Barré, pero los estudios clínicos controlados han demostrado que este tratamiento no sólo no es eficaz, sino que puede incluso tener un efecto perjudicial sobre la enfermedad. El punto más crítico del tratamiento de SGB radica en mantener el cuerpo del paciente funcionando durante la recuperación del sistema nervioso. Esto puede requerir a veces colocar al paciente en un respirador, un monitor del ritmo cardíaco u otras máquinas que ayudan a la función corporal. El periodo de recuperación varía con cada paciente y el grado de compromiso general que haya ocasionado el SGB. Puede variar entre unas cuantas semanas o algunos cuantos años. Un 30% apro-ximadamente de quienes han padecido un episodio de SGB sufren una considerable debilidad residual después de 3 años de la enfermedad; y un 3% puede, incluso, sufrir una recaída de debilidad muscular o sensaciones de hormigueo durante muchos años después del ataque inicial. Como métodos alternativos de recuperación se plantean actualmente hidroterapias, ejercicios en piscinas que pueden realizar hasta los pacientes que han quedado en silla de ruedas. Los especialistas están enfocados en dar con nuevos tratamientos y en perfeccionar los ya existentes. Como también examinar más profundamente el funcionamiento del sistema inmunológico para identificar a las células que podrían ser las responsables de iniciar y emprender el ataque contra el propio sistema nervioso. Del mismo modo también se emprenden investigaciones para lograr nuevas drogas para el tratamiento de este complejo síndrome.

 Pero por sobre todo instan a los familiares a brindar toda la contención posible y el apoyo en las terapias rehabilitantes, dado el carácter repentino y discapacitante del SGB, que muchas veces deja a los pacientes en un estado de profunda depresión. En la actualidad existen muchos grupos de familiares construyendo redes de ayuda y contención, donde comparten testimonios y luchan por el avance de los tratamientos existentes. Fuentes: - “Guías de manejo del síndrome de Guillain Barre en niños. Basadas en la evidencia. Instituto de Ortopedia Infantil Roosevelt”. - “Síndrome de Guillain Barre. Experiencia de 3 años en un hospital de tercer nivel”. Dr. Marco Antonio Canedo Q., Dr. Sergio A. Rodríguez Q. - “What's New in Guillain-Barré Syndrome?”, Pritchard J. Foro de familias: http://www.gbspain.com/foro/ http://www.gbs.org.uk/index2.shtml

Jun 10, 2010

Expert delivers answers for those inflicted with polio

   Rebuilding Lives, Empowering People and Preventing Injuries

An internationally known Post Polio Syndrome expert from the US will give a much-needed insight into the illness during Post Polio Awareness Week (3-9 August).
Dr William DeMayo, Medical Director of the comprehensive Post Polio Clinic at the John P Murtha Neuroscience and Pain Institute in Philadelphia, will share his vast knowledge about Post Polio Syndrome, including its symptoms, side effects and pain management techniques, via a video conference at the Spinal Injuries Association’s Woolloongabba office next Wednesday (5 August).
His talk will centre on the theme, Comprehensive Post Polio Assessment Clinics – do we really need them?
“As Post Polio Syndrome becomes more recognised in both medical circles and in the general community, an increasing amount of people worldwide are being diagnosed with the condition,” Dr DeMayo said.
“I’m looking forward to sharing what I know about the syndrome with a Queensland audience, as I’m aware there are six Post Polio Support Groups operating in regions throughout the state.
“By providing the audience with practical information about the condition, I hope to make a difference in their lives that will assist in easing the disability and pain of Post Polio Syndrome.”
Like most five-year-olds, Varsity Lakes resident Lyn Glover was full of energy, but when she was struck with polio in 1958, she spent a month of solitude while quarantined in hospital recovering from the insidious illness.
Polio did not really feature in Lyn’s life again for many years, until she broke her foot in 2006 and began experiencing the late effects of polio.
To highlight Post Polio Awareness Week (3-9 August), Lyn explains that polio is a viral disease that attacks the spinal cord and causes permanent or temporary paralysis.
“The nerves that were killed or damaged at the time of the initial virus attack when I was young were replaced by the development of compensatory nerves, which resulted in partial recovery,” she said.
“What is now believed to be happening is that those compensatory nerves are dying as the result of over use of muscles and joints and a return for many elderly people with polio to the wheelchairs, calipers and walking canes that many had long discarded.
“Many post polio sufferers are now experiencing considerable pain as the result of this reversal. The condition is called Post Polio Syndrome or known as experiencing the late effects of polio.”
Symptoms are varied but include muscle weakness, extreme fatigue, sleep and breathing difficulties.
The Gold Coast Post Polio Support Group formed in 2007 and Lyn is convenor of the group, which meets monthly to discuss issues ranging from healthcare advice to accessibility issues in the community.
Spinal Injuries Association CEO Mark Henley said it was a real coup for the organization to host the live video conference with Dr DeMayo.
“Because Post Polio Syndrome and the late effects of polio are still relatively unknown, there are many people in the community with misconceptions, or who may not realise they have one of these conditions,” Mr Henley said.
“Dr DeMayo’s insight into Post Polio Syndrome will answer a lot of questions for many people.”
For more information on Post Polio Syndrome or your local Member Networks group, please visit www.spinal.com.au.
Issued 28 July.

Polio gone, but its impact on Albany Creek resident continues.

 Creek’s Dr Margaret Peel will later this month attend an international conference on polio survivors in Warm Springs, Georgia – the place where former US President Franklin D Roosevelt, who famously had polio throughout his presidential term, spent a lot of time rehabilitating and passed away in 1945.

The Post Polio Health 10th International Conference: Living with polio in the 21st century, will draw approximately 400 people from around the world.

Delegates will include those such as Dr Peel who has Post Polio Syndrome (PPS), people experiencing the late effects of polio and medical practitioners from a range of health fields.

Diagnosed with polio as a child when the epidemic struck in 1951, Dr Peel spent many years working as a microbiologist and travelling extensively with manageable side effects from her childhood affliction until 10 years ago, when she was diagnosed with PPS.“The side effects are different for everyone but can include progressive loss of muscle strength, joint and muscle pain, unaccustomed fatigue, cramping and in some instances, trouble swallowing and breathing,” Dr Peel said.

Increased sensitivity to cold temperatures, difficulty sleeping and a decline in the ability to perform basic daily activities are other symptoms of PPS.

Dr Peel said she would be travelling with several other Australians to the conference and hoped to hear about the latest research being carried out and useful advice on relieving PPS symptoms.

As the secretary of the Brisbane Post Polio Support Group, Dr Peel will then share her conference findings with other members of the group.

While PPS is still quite unknown in the general community, well-known people who had polio as children include Kim Beazley, John Laws, Janet Powell and the late Kerry Packer and Joh Bjelke-Petersen.

In 1921, Franklin D Roosevelt was diagnosed with polio at the age of 39 but that did not prevent him from going on to become President of the United States.

He worked tirelessly to fundraise for a polio vaccine and raised more than $25 million for the cause during his time in office.Spinal Injuries Association CEO Mark Henley said the not-for-profit organisation had six Post Polio Support Groups (PPSG) located throughout Queensland.

“Members share their experiences and provide support to each other as they deal with the late effects of polio,” Mr Henley said.“Because the condition is still quite new as the people who had polio in the 1950s begin to age, it can be a daunting time for our members.“Having other people to talk to who are experiencing the same symptoms is reassuring and decreases feelings of isolation and helplessness.

“It’s important to remember that polio may be gone from Australia, but its impact on lives continues.”

Global polio fight to get needed funds -Bill Gates


Global polio fight to get needed funds -Bill Gates

Posted at 06/08/2010 8:16 PM | Updated as of 06/08/2010 8:16 PM

ABUJA, Nigeria - Rich nations and global donors should be able to provide the $2.6 billion in aid needed to combat polio through 2012 despite the global credit crunch, multi-billionaire philanthropist Bill Gates said on Monday.
The World Health Organisation has suggested a budget of $2.6 billion for its polio eradication efforts in 2010-2012, but says it faces a shortfall of about half of funds for that period.
"We are going to the rich world donors at a time when their budgets are tight," Gates, the founder of software giant Microsoft, told reporters during a visit to Nigeria's capital Abuja.
"But between what our foundation will do, what the others will do, I feel quite sure that we will be able to fund that fight," he added.
The Bill & Melinda Gates Foundation, which has been active in fighting child and infectious diseases in poor countries, will commit more than $150 million of its $34 billion fund this year to mass polio immunisation and surveillance programmes.
The number of worldwide cases has declined this year, most significantly in Nigeria which has recorded its lowest level of infections ever with only three so far in 2010. That is down from a total of 288 cases last year.

Key to ending polio
Nigeria, one of four countries where polio is endemic, is considered key to wiping out the virus which spread out from the northern half of the country to 17 African nations in the last few years.
Dr Bruce Aylward, director of the polio eradication initiative of WHO, said there were still many children in Nigeria that are not receiving vaccines and a large outbreak could re-occur if governments and donors become complacent.
"The reality is that it can easily explode again, where you could have thousands of children paralyzed again every single year in this country," Aylward said.
For example, polio was recently found in Tajikistan for the first time in 10 years and quickly spread, paralyzing 152 children in a few months, WHO said.
Nigeria has struggled to contain polio since some northern states imposed a year-long vaccine ban in mid-2003. Some state governors and religious leaders in the predominately Muslim north claimed the vaccines were contaminated by Western powers to spread sterility and HIV/AIDS among Muslims.
Traditional leaders throughout the country pledged in January 2009 to support immunisation campaigns, however, and are pushing parents to have their children vaccinated.
Immunisations of children in Nigeria's north rose to 71 percent this year, up from 63 percent in 2009. WHO has set a goal of 80 percent in Africa's most populous nation.
Polio, which spreads in areas with poor sanitation, attacks the nervous system and can cause irreversible paralysis within hours of infection. Children under the age of 4 are the most vulnerable to the disease that until the 1950s crippled thousands of people every year in rich nations htp://www.abs-cbnnews.com/global-filipino/world/06/08/10/global-polio-fight-get-needed-funds-bill-gates

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