Jun 16, 2010

Epidural steroids for back

Epidural steroids for back and leg pain: Mechanism of action and efficacy

REVIEW
CME
CREDIT
ROBERT F. McLAIN, MD
Director, Spine Fellowship Program, The Cleveland Clinic Spine Institute and The Department of Orthopaedic Surgery, The Cleveland Clinic Foundation
LEONARDO KAPURAL, MD, PhD
Department of Pain Management, The Cleveland Clinic Foundation
NAGY A. MEKHAIL, MD, PhD
Chairman, Department of Pain Management, The Cleveland Clinic Foundation

Jun 15, 2010

Acceptance Of The Existance Of Post Polio Syndrome In Mexico




It is with great honor that I am sending you the information  and invitation on Mexico's Second National Post Polio Syndrome (PPS) Symposium put on by their Department of Health with the guidance of Esther Liliana Marasco Garrido, Founder and President of LITAFF A.C. _APPLAC

It is an accredited conference and all medical professionals will be able to obtain credits by attending.  It will be open to polio survivors too.  


Mexico's Secretary of Health will have more information posted on this conference next week on the National Council for Persons with Disabilities (CONADIS) Website http://www.conadis.salud.gob.mx/ or on

Jun 14, 2010

NIGERIA: Vitamin A handouts boost polio vaccine acceptance

NIGERIA: Vitamin A handouts boost polio vaccine acceptance
14 Jun 2010 12:40:07 GMT
Source: IRIN
Reuters and AlertNet are not responsible for the content of this article or for any external internet sites. The views expressed are the author's alone.
MAIDUGURI, 14 June 2010 (IRIN) - Campaigns to distribute Vitamin A supplements to reduce high rates of child mortality and morbidity in northern Nigeria have had the unexpected side-effect of encouraging heavily stigmatized polio immunizations in the region.


Helen Keller International (HKI) started administering Vitamin A to children under five in northern Nigerian states in 2001 to protect them against river blindness, which is endemic in some states, including Borno. [http://www.irinnews.org/Report.aspx?ReportId=89167]


Vitamin A can reduce under-five deaths by 30 percent, according to the UN World Health Organization (WHO), and reduce malaria infection rates in children by one-third. [http://www.irinnews.org/Report.aspx?ReportId=85015]
As a result, the treatment tends to be welcomed by parents. Realizing this, health officials and international NGOs started to use Vitamin A to entice parents into accepting the polio vaccine. In 2007, Nigeria's National Council on Health integrated polio vaccines with the government's bi-annual Immunization Plus Days, when inoculations against measles, yellow fever, worms and Vitamin A were also administered.
"The inclusion of Vitamin A as a component of the integrated immunization campaign has helped in polio vaccine acceptance and is helping in the polio eradication drive," Susan Ojomo, UNICEF child survival and development manager in charge of 10 northern states, told IRIN.
Nigeria hopes to eradicate poliomyelitis by 2015 but resistance to the vaccine among some religious groups and traditional leaders in northern states had hampered the fight and led the infection to spread to the country's once polio-free neighbours. [http://www.irinnews.org/Report.aspx?ReportId=87407; http://www.irinnews.org/Report.aspx?ReportId=74624]
"Now almost every household brings its under-fives for polio immunization once it is accompanied by a Vitamin A supplement," local government immunization officer Mamman Isa told IRIN from the town of Biu, 200km south of Maiduguri.
Political commitment
These efforts have made a difference, said Oliver Rosenbauer, spokesman for the WHO Polio Eradication Initiative, but deeper engagement from state authorities and individual religious leaders has also increased acceptance. "We have always had strong political commitment at the national level, but this was inconsistent at the district and local level until last year," he told IRIN.
In 2009, state governors signed up to the "Abuja Commitment to Eradicate Polio." They engaged civil society leaders to ensure vaccinators were carefully selected and well-trained; polio campaigns were well-organized and had the right amount of vaccines. "This has had a real trickle-down effect," he said. [http://www.reliefweb.int/rw/rwb.nsf/db900sid/KHII-7RX9QN?OpenDocument]
At the same time, the Sultan of Sokoto state in the north formed the Traditional Northern Leaders' Forum to try to engage religious and traditional leaders in the fight.
"Resistance was never the only reason there is polio in Nigeria. Before, vaccinators didn't have maps; they didn't have the right number of vaccines; they weren't kept cold enough; and communities weren't engaged in immunizations – to get those fixed, you need this kind of local level leadership," said Rosenbauer.
The number of polio cases has plummeted by 99 percent – from 289 to three – in June 2010 versus June 2009, says WHO.
Polio campaigners must also ensure they achieve 100 percent coverage, warns Rosenbauer. Some 85 out of 700 local government areas in the north are still considered "high or very high-risk", he says; and in some areas 20 percent of children are still being missed. "The [targeting] trend is better, but needs to be built on. If we take our foot off the accelerator - this is an endemic-prone disease and it will come roaring back in no time."
aa/aj/mw

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.

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