Oct 22, 2010

Polio nears eradication: WHO


Mumbai, Oct 22 : India is well on its way to eradicate the polio virus, as per the latest World Health Organisation (WHO)data, which cites a sharp drop in the number of cases this year as compared to last year as an indication.

Largely because of effective surveillance of migrant population and vaccination drive, so far this year only 39 cases have been reported against 395 at the same time (Sept) last year. For the first time, UP has not reported even a single case of type1 polio so far. 

The only hurdle so far is the inability to break transmission of type-1 polio in the country despite reducing it to very low level.

Since January, two national immunization rounds have been held, and high-risk areas in the country have received two additional vaccination rounds.

The Indian Academy of Paediatrics (IAP), the premier association of Pediatricians in India, has lauded eradication efforts by the govt and recommended a judicious use of Oral Polio Vaccine (OPV) and Injectable Polio Vaccine (IPV) in the pre-eradication phase before singly introducing IPV in the post eradication era. 

As of now, IPV has never been used during current polio-eradication program in the country although GoI and India Expert Advisory Group (IEAG) has recommended studies on feasibility of using IPV during the pre-eradication phase on several occasions.

According to Dr Deepak Ugra, President, IAP, "In the current phase of pre-eradication, IPV can be a valuable tool if used in campaign mode in the endemic states to hasten the interruption of wild polio virus transmission. States that are polio-free and not contiguous with Uttar Pradesh or Bihar like the southern states need to introduce IPV in the Expanded Programme on Immunisation (EPI) schedule and restrict OPV only for three annual pulse campaigns instead of 2 as practiced now.

"Once UP and Bihar also qualify for introduction of IPV, the whole nation can use IPV in EPI and OPV by pulses, until clear evidence emerges of the total absence of wild polio virus. Thereafter OPV may no longer be needed."

Oral polio vaccine (OPV) has been the choice for routine immunization in India since 1995. However this hasn't helped the country to control the disease as many children have contracted the disease despite taking multiple doses of the vaccine.

According to T Jacob John, Member, Global Advisory Polio Eradication Committee, WHO and former Head of Clinical Virology at the Christian Medical College in Vellore, "A strategy shift from OPV to IPV will avoid inevitable problems associated with OPV such as vaccine associated polio, risk of polio in immunocompromised children and risk of vaccine derived polio outbreaks that have occurred in few countries even after successful eradication of wild polio."

OPV is a live but weakened virus given as drops to children. This is the most common mode of polio vaccination in India. However, most developed countries have already switched to IPV which contains killed or inactivated virus. Today, over 50 polio-free countries are already using IPV and/or combination vaccines with IPV.

According to the WHO, a nation cannot be declared polio-free unless there are no fresh cases reported for 3 consecutive years. The polio eradication deadline has already been extended thrice by over 8 years.

Polio is one of the leading causes of disability leading to permanent paralysis. Out of 197 countries in the world, in only 4 countries polio is still endemic. Nigeria, Pakistan and Afghanistan are the other three countries in the list.

According to Ugra, the last pockets of the virus remain the toughest to eradicate due to very high force of transmission of wild poliovirus mainly type-1 and 3, sub-optimal efficacy of trivalent OPV, extremely poor state of routine immunization, high incidences of diarrhea and malnutrition amongst young children and interference by non-polio enteroviruses in the gut.

Energizante, vertiginosa, ostentosa y cosmopolita, son algunos de los calificativos que recibe Mumbai, la ciudad más grande de la India y capital del estado de Maharashtra, y que se encuentra situada en una estrecha franja de terreno que surge de la costa pantanosa de Maharashtra y se adentra en el Mar Arábigo. 

Originalmente fue un conglomerado de islas que pertenecieron en el siglo XVI a los portugueses y que en el siglo XVII pasaron a control británico. Con el paso del tiempo estas islas se fueron uniendo para dar origen a la isla-ciudad de Bombay.

La ciudad cuenta con 17 millones de habitantes, lo que la convierte en una de las ciudades más grandes del mundo. Igualmente está considerada como la ciudad más congestionada de la India, pues los barrios bajos continúan creciendo y los asentamientos han invadido tierras públicas y privadas, venciendo todos los intentos por proporcionar de servicios a estas zonas.  http://www.viajes-exoticos.info/mumbai-india.php

México a la vanguardia en el Síndrome de Post Polio

Oct 20, 2010

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México a la vanguardia en el Síndrome de Post Polio

Oct 19, 2010

Immunization and surveillance gaps pose risks:WHO

The World Health Organization (WHO) has warned that goals to eliminate measles and reduce hepatitis B infections by 2012 and maintaining a polio-free status are at risk due to the immunization and surveillance gaps in the Western Pacific region.

This warning comes despite the regions substantial progress in controlling vaccine-preventable diseases. WHO adds that some member states within the region continue to have inadequate coverage of routine or supplementary immunizations to eliminate these diseases.

Dr. Shin Young-soo WHO Regional Director for the Western Pacific told a meeting of WHO Regional Committee members that countries need to make available additional human and financial resources to fully implement the established strategies against vaccines-preventable diseases.

Dr. Shin added that preventing the potential spread of imported wild poliovirus by reducing immunization and surveillance gaps in countries is far more cost effective than bringing a polio outbreak under control.

Statistics show that the annual number of measles deaths within the Western Pacific region is currently less than 2000a and an estimated 27 countries and area, comprising 88% of the region’s population are likely to achieve the interim milestone of reducing chronic hepatitis B infection to less than 2% among 5 year old children in 2012.

By Repeka Nasiko 

Oct 17, 2010

Spinal Cord Injury, Spasms, and Serotonin

For release: Monday, September 20, 2010
A model of the vertebrae that protect the spinal cord.
When people think of spinal cord injury, they tend to think of paralysis.  But a spinal cord injury can also cause debilitating muscle spasms.  Although the drug baclofen can control these spasms, many patients cannot tolerate its side effects, which include general sedation and dizziness.  A new study sheds light on how a spinal cord injury leads to spasms, and on the promise of more precisely targeted drugs with fewer side effects.
The study focuses on what happens to muscle-controlling nerve cells (motor neurons) after a spinal cord injury.  In an intact spinal cord, these neurons are under the command of signals from the brain.  Some signals tell the motor neurons to fire, which causes their associated muscles to contract.  Other signals silence the motor neurons and cause muscle relaxation.
After a spinal cord injury, both kinds of signals are interrupted.  The motor neurons are not under the brain’s control anymore, but they continue to fire spontaneously, leading to spasms.  The new study explains how this spontaneous activity occurs.
The research was led by David Bennett, Ph.D., and Karim Fouad, Ph.D., neuroscientists at the University of Alberta in Canada.  Partial funding came from the National Institute of Neurological Disorders and Stroke.  Dr. Bennett’s lab has a novel system for studying spinal cord injuries in rats; it is the only system in the world that enables researchers to precisely control the environment surrounding the injured spinal cord and simultaneously record the electrical activity of individual spinal neurons.
The researchers theorized that after an injury, spasticity could occur because a small number of intact fibers in the spinal cord continue to produce serotonin – a brain-derived chemical that excites motor neurons.  Yet, in rats with spinal cord injury, there was no evidence of residual serotonin.  Instead, the motor neurons below the injury began producing higher levels of a serotonin receptor that is persistently “on,” even in the absence of serotonin.
“A receptor is supposed to receive by definition,” said Dr. Bennett in an interview with Nature Medicine,* where the study was published.  “The analogy would be a telephone starting to talk without anyone talking into it,” he said.
The research comes full circle with prior clinical studies of cyproheptadine, a drug that blocks many different types of serotonin receptors.  Years ago, cyproheptadine was found to reduce spasticity in patients with spinal cord injury, but it can also lead to overeating and obesity.  Plus, until now, no one understood how it worked.
Dr. Bennett and his colleagues tested cyproheptadine in their rat model of spinal cord injury, and found that it reduces spontaneous motor neuron activity.  They also tested cyproheptadine in several people with spinal cord injury.  By monitoring spasms in the patients’ leg muscles using electromyography (EMG), the team confirmed that the drug acts through the same mechanism in humans as it does in rats.
The experimental drug SB206553, which is more specific than cyproheptadine for the subtype of serotonin receptors found on motor neurons, also reduced spasms in rats.  A drug like SB206553 might be the answer to the side effects observed with cyproheptadine and baclofen, Dr. Bennett said.
SB206553 must be injected directly into the spinal cord, and has not yet been tested in humans. 
And there is another important cautionary note.  Researchers have long recognized that the spontaneous neuronal activity and spasms that follow a spinal cord injury are not uniformly harmful.  For people with partial spinal cord injuries, these changes can actually help maintain muscle tone and support limited movements.  Dr. Bennett and his team confirmed that when rats with a partial spinal cord injury received a high dose of SB206553, they had poor locomotor recovery compared to injured but untreated rats.  This means that careful dosing will be just as important as finding a drug that hits the right target.
-By Daniel Stimson, Ph.D.
*Murray KC et al.  “Recovery of motoneuron and locomotor function after spinal cord injury depends on constitutive activity in 5-HT2C receptors.”  Nature Medicine, June 2010, Vol. 16, pp. 694-701.
Date Last Modified: Monday, September 20, 2010

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