Apr 29, 2016

This Brazilian Supermodel Bonded With Mothers In India For An Important Cause


Part 4 of our "World Immunization Week" series

April 24-30 is World Immunization Week and we at A Plus are proud to present a five-part series that celebrates the incredible impact vaccines have had on global health.
Most people know Isabeli Fontana as the gorgeous Brazilian supermodel who has been the face of some of the biggest names in fashion, including Ralph Lauren, Oscar de la Renta, Versace, and countless others. But Fontana is more than just a pretty face in the pages of Victoria's Secret or Vogue, she's a mother who is dedicated to keeping her children healthy through the use of vaccines. This dedication led her to become an international advocate for vaccines and helping mothers around the world protect their children as well. 
Fontana's journey to advocacy happened by chance when she was taking her son to get his booster shot. It was there that she met representatives from Rotary International, who asked her if she'd like to become an ambassador. Because vaccines were important to her as a mother, she decided to give it a shot. Though she had always been in favor of vaccines in general, she was about to get an education about polio that would be completely life-changing. 
This ambassadorship with Rotary took her to India, where she helped administer the oral polio vaccine to children, spoke with people in the communities, and toured hospitals that treated people who injured by polio. Polio was no longer an abstract concept; the undeniable effects of the disease were right in front of her.
Isabeli Fontana giving the oral polio vaccine during an ambassador trip to India for Rotary International.
Isabeli Fontana giving the oral polio vaccine during an ambassador trip to India for Rotary International. JEAN-MARC GIBOUX FOR ROTARY INTERNATIONAL 
"It was very deep for me to go to the hospital and see people who had polio," Fontana told A Plus. "I cried all the time. I was facing the problem. It is very serious."
Though polio has been eradicated in India, the disease is still endemic in neighboring Pakistan. If vaccination rates in India don't remain high, the disease could make a resurgence. 
Fontana admits that the reality she saw while on the trip is quite unlike her day-to-day life as one of the world's fashion elites. Yet, during her trip to India, she met women who were very much like her in the most important sense: mothers who wanted nothing more than to keep their children safe.
She said there was one woman in particular who made a deep impression on her. Though she showed up with her children to receive the polio drops, she refused to leave until the children received immunizations against a number of other diseases as well.
"She was really concerned because she knows the place that she lives in," Fontana recalled. "She knew she needed to get all of the shots done before she left."
Isabeli indicating the world is "this close" to eradicating polio, thanks to the efforts of Rotary International and its partners. 
Isabeli indicating the world is "this close" to eradicating polio, thanks to the efforts of Rotary International and its partners.  JEAN-MARC GIBOUX FOR ROTARY INTERNATIONAL
Like many of the parents Fontana met while in India, she views vaccines as a no-brainer and has no interest in debating with the idea of opposing vaccines.
"Kids deserve to be happy and healthy. I don't know what to say. I have children and I am very concerned about that," she stated emphatically. "Of course, everyone wants to be natural, but the thing is, this is very serious. This is not just, 'Oh well, I don't believe in vaccination, so I'm not going to immunize my children.'" 
Fontana knows first hand that it is truly a small world and disease can spread easily when given the chance. Brazil hosted the World Cup in 2014, bringing soccer fans from all over the world right to her doorstep. Because the country eradicated polio in 1989, it was unsettling for health officials to discover that a tourist from Africa carried the poliovirus to Brazil.
Thankfully it didn't spread, but the summer Olympics hosted in Rio this year could threaten the health of tourists and citizens of Brazil if vaccination rates are not kept high.
"It's something that can come back if we're not careful," she cautioned. 
Isabeli meeting a patient who has been affected by polio during her ambassador trip to Delhi, India.
Isabeli meeting a patient who has been affected by polio during her ambassador trip to Delhi, India. JEAN-MARC GIBOUX FOR ROTARY INTERNATIONAL
Moving forward, Fontana plans to continue using her voice as an ambassador for Rotary and give every mother on the planet the opportunity to protect their own children from infectious disease.
"If something happens to your children [because of disease], nothing can repair the problem. Everyone's children deserve to be healthy in this world. We all need to do our best for our children so we can live healthy," she stated.
Join Isabeli Fontana's fight to eradicate polio by donating to Rotary International here. For every dollar that comes in, the Bill & Melinda Gates Foundation will donate $2, which triples the power of the contribution. 
Cover image: JEAN-MARC GIBOUX FOR ROTARY INTERNATIONAL





















































Post Polio Litaff, Association A.C _APPLAC Mexico

Post polio unilateral Psoas atrophy

Post polio unilateral Psoas atrophy
Incidental finding in MRI Lumbar spine of a 30 year old male complaining of mild low backache. He is a known case of poliomyelitis involving left lower limb during childhood. On neurological examination left lower limb wasting, hypotonia and areflexia.  
MRI Lumbar spine axial sections show severe atrophy of left side Psoas consistent with past history of Poliomyelitis.

Post polio unilateral Psoas atrophy 

Cause of the muscle atrophy in Polio is still not completely clear, likely due to the premature degeneration of surviving motor neurons. Poliovirus has a predilection for the motor neurons of the anterior horns of the spinal cord, cell death followed by distal wallerian degeneration, denervation of muscles resulting in muscle weakness and atrophy.

Relevant investigations:  Detection of Oligoclonal immunoglobulin G and M bands in Csf  and demonstration of Poliovirus like RNA sequences in Csf  by Polymerase chain reaction.

DDx: other causes of unilateral psoas atrophy with associated atrophy of other para spinal muscles need to be excluded like scoliosis,  neoplasms, spondylosis with spinal stenosis. In normal or asymptomatic individuals, mild asymmetry of Psoas is a common finding appears to be a benign anatomical variant.

Rx :  No specific and successful treatment. Steroids, human growth hormone, pyridostigmine, Modafanil and bromocriptine all have been disappointing. Role of subcutaneous insulinlike growth factor-1  and IV immunoglobulin is doubtful.

References:  
The late effects of Polio: Information For Health Care Providers, Commonwealth Department of Community Services and Health. ISBN 1-875412-05-0. Archived from the original on June 25, 2008. Retrieved 2008-08-23.
Post-poliomyelitis Syndrome: Case Report and Review of the Literature, KH Lin,  YW Lim,
W. Michael Scheld, Richard J. Whitley, Christina M. Marra..Infections of the Central Nervous System .
Gonzalez H, Sunnerhagen KS, Sjoberg I, Kaponides G, Olsson T, Borg K. Intravenous immunoglobulin for post-polio syndrome: a randomised controlled trial. Lancet Neurol. Jun 2006;5(6):493-500.


Post Polio Litaff, Association A.C _APPLAC Mexico

Apr 26, 2016

Polio: Off-label use of IPV vaccine to tide over shortage

IPV vaccine
THE MANUFACTURERS HAVE CONFIRMED THAT THEY WILL NOT RAISE OBJECTIONS TO THE USE OF IPV OFF-LABEL FOR INTRADERMAL USE.
Due to shortage of Inactivated Polio Vaccine (IPV) globally, India and a few other countries are stretching the supply of the vaccine to cover all children. The IPV vaccine was introduced into the routine immunization programme in India from November 30, 2015.
To tide over the shortage, children in Puducherry and seven States (Andhra Pradesh, Karnataka, Kerala, Maharashtra, Odisha, Tamil Nadu and Telangana) will get two doses of 0.1 ml each at 6 and 14 weeks and administered intradermally. Children in the rest of the country will get 0.5 ml of the vaccine at 14 weeks administered intramuscular.
The vaccine has been licensed by the manufacturers only for intramuscular use and not for intradermal administration. The Global Polio Eradication Initiative (GPEI) has, however, permitted the use of the vaccine intradermally as only one-fifth of the vaccine will be required to vaccinate a child.
“The manufacturers have confirmed that they will not raise objections to use of their product off-label. The final decision, however, on the use of IPV intradermally will need to be made by each country and its respective regulatory agencies,” says an April 7 Information Note of GPEI. Both the companies have been “requested to fast-track their efforts to file for a licence revision to include a provision for intradermal use.”
The February 26, 2016 meeting of the mini India Expert Advisory Group (IEAG) recommended that in the absence of sufficient IPV supply, the Government of India “should consider implementing a routine immunisation schedule of two fractional doses [of 0.1 ml each] of IPV, administered at 6 weeks and 14 weeks, in six or seven of the high performing States/Union Territories”. The main objective of IEAG in using IPV intradermally was to ensure administration of IPV to all infants.
As of February 2016, Gavi has assured 28.14 million doses of IPV. Domestic procurement from the Hyderabad-based Shantha Biotechnics for the period October 2016 to March 2018 will provide another 24 million doses, leaving a shortfall of 23.42 million doses, notes the IEAG.
“India has no shortage of IPV vaccine but it is a hand-to-mouth supply,” said Dr. Pradeep Haldar, Deputy Commissioner – Immunisation, Ministry of Health and Family Welfare, Government of India. “The supply has to be managed properly till March 2018 by making sure that all 27,000 cold-chain points [across the country] have only one month’s supply”.
The “rapid scale-up of IPV production required has encountered multiple challenges, leading to a global shortage”, according to the Global Polio Eradication Initiative. As a result, about 20 countries that are at low risk for type 2 VDPV will get their first shipment only in the fourth quarter of 2017. And nearly 25 countries that have already introduced IPV and considered at low risk for type 2 VDPV outbreak will not receive additional supply before the fourth quarter of 2017.
The IEAG has recommended reassessment of the use of fractional dose of IPV in seven States and Puducherry after one year and take a decision to either continue in these States and Puducherry or expand it to more States based on the “lessons learnt from the experience and the supply position at that point in time.” It has also asked for studies to be carried out to understand the immunogenicity and protection conferred by two doses of 0.1 ml vaccine in the Indian setting and to guide future continuation or expansion of the use of fractional dose of IPV.

Post Polio Litaff, Association A.C _APPLAC Mexico

Why dietary supplements are suspect

Fuente Harvard Women’s Health Watch

Supplements aren’t held to the same standards as FDA-approved drugs. Evidence indicates that few are effective, many are useless, and others may be harmful.

herbs-supplements-vitamins
Image: Thinkstock
Dietary supplements—including herbs, vitamins, minerals, and other products—are a $37-billion industry in the United States, and 60% of women are taking them regularly. At the same time, mounting research is suggesting that supplements—even mainstays like calcium—may be harmful at high doses.
The use of supplements and other alternatives to standard treatments is centuries old, but Dr. David Eisenberg, adjunct associate professor at the Harvard T.H. Chan School of Public Health, was the first to document the widespread use of alternative therapies in the United States. In a 1993 article in The New England Journal of Medicine, Dr. Eisenberg and colleagues reported that more than a third of Americans were using unconventional therapies, largely for chronic conditions, and most were doing so without letting their clinicians know. That report covered acupuncture, spinal manipulation, massage, and yoga, but it also focused public attention on all unconventional treatments, including the growing use of herbal remedies and other dietary supplements. In 1998, the Office of Alternative Medicine in the National Institutes of Health (NIH) was revamped as the National Center for Complementary and Alternative Medicine and charged with funding rigorous studies into the safety and effectiveness of alternative physical treatments as well as popular dietary supplements and herbs.

The evidence for herbs

The traditional practice of herbal medicine involves combining different herbs and using them in a variety of preparations. Herbal remedies marketed today are usually powders or extracts derived from plant leaves, stems, or roots. Several studies, largely NIH-funded, have put some remedies often recommended for women to the test. The results are summarized below.
Black cohosh. A plant long used as a home remedy for arthritis, black cohosh has been recommended for hot flashes, night sweats, vaginal dryness, and other menopausal symptoms. Studies of its effectiveness have had mixed results. However, there are more than 50 reports of liver damage in people taking it, although it is unknown whether black cohosh or another substance in the preparation triggered the reactions.
Chamomile. This herb appears to be effective in relieving anxiety. Although less potent than prescription drugs, a cup of chamomile tea may soothe your nerves. Because chamomile is related to ragweed, marigolds, chrysanthemums, and daisies, it may trigger an allergic reaction if you have asthma or are allergic to these plants.
Echinacea. There is no conclusive evidence that echinacea either prevents colds or reduces cold symptoms. It may trigger reactions in people who are allergic to ragweed, marigolds, chrysanthemums, or daisies.
Ginseng. Although ginseng has been touted as a remedy for everything from colds to fatigue to forgetfulness, there isn’t strong evidence from clinical trials that it has any of those properties. Ginseng may also interact with aspirin and the anti-clotting agent warfarin (Coumadin).
Ginkgo biloba. Extracts from the leaves of the ginkgo tree are promoted for improving memory and preventing and treating dementia. However, in the Ginkgo Evaluation of Memory study of 3,000 men and women over age 75, ginkgo didn’t slow cognitive decline or reduce the incidence of dementia over a six-year period. Ginkgo may also increase bleeding risk.
Milk thistle. Laboratory studies indicated that this herb, also known as silymarin, had a protective effect on liver cells, but clinical trials haven’t validated any benefit. Don’t count on milk thistle to compensate for the effects of a few extra glasses of wine.
St. John’s wort. A few early studies indicated that St. John’s wort might alleviate depression, but larger trials failed to confirm those results. St. John’s wort also interacts with a large number of prescription medications.

What’s up with supplements?

Vitamins, minerals, amino acids, and other compounds that are essential for good health have been marketed as supplements for decades. However, relatively few have been tested in clinical trials. Those that have been or are being subjected to scientific scrutiny include the following:
Calcium. Research has indicated that high doses of calcium from supplements don’t have much of an effect on bone density and increase the risk of heart disease and kidney stones. If you aren’t getting at least 500 to 700 milligrams (mg) of calcium in your daily diet, you may need a supplement, but it’s a good idea to limit your supplement intake to 600 mg a day.
Glucosamine and chondroitin. These substances, both components of cartilage, are used to prevent arthritis and relieve joint pain. Clinical trials have shown that they have little effect.
Melatonin. A synthetic copy of a natural hormone, melatonin is used for jet lag, sleep disturbances, and insomnia. Research has determined that it can be effective at doses as low as 0.5 mg. If you’re considering it, talk to your doctor about dosage and timing.
Vitamin D. Because most people who live in northern latitudes don’t make enough vitamin D from sun exposure, a supplement may be necessary to fill the daily requirement of 800 international units (IUs). Whether higher, 2,000-IU doses reduce the risk of heart attack, stroke, or cancer will be determined by the 25,000-person Vitamin D and Omega-3 Trial (the VITAL study), whose results will be announced in 2017.
Omega-3 fatty acids. Although studies have linked consuming foods high in omega-3s to a reduced risk of heart disease and inflammation, it’s questionable whether omega-3 supplements—available primarily in fish oil capsules—have the same effect. The VITAL study will help to answer that question, too.
Supplements for other purposes. The shelves of supplement stores abound with products that promise to make exercise easier and promote weight loss. These, too, are unproven, and some may contain stimulants that are harmful when used for extended periods.

The bottom line

The value of most herbs and supplements has been discounted or remains unproven. Few are worth the money spent on them. Moreover, there is no guarantee that the pills, capsules, or tablets contain all—or even any—of the ingredients listed on the packaging.
Most important, taking supplements can be risky. A study published in October 2015 in The New England Journal of Medicine found that the adverse effects of supplements were responsible for an average of 23,000 emergency department visits per year.
If you are concerned that your diet isn’t providing all the nutrients you need, don’t shop for supplements before talking to your doctor. If you truly need a vitamin or other dietary supplement, your clinician can suggest an appropriate product and dose. If you’re currently talking a vitamin or other supplement, let your health care team know.

Serious issues with supplements

Some non-vitamin supplements are marketed heavily in the absence of reliable evidence of efficacy or safety and may interact with prescription drugs. Moreover, some people may delay beginning proven therapies because they are relying on supplements. And some of these products are costly,” says Dr. David Eisenberg, adjunct associate professor at the Harvard T.H.Chan School of Public Health.
The supplements used in government-funded clinical studies are analyzed for purity and standardized for dose. Supplement manufacturers are required to perform such analyses and to supply the results to the FDA. Yet, according to a report aired in January 2016 by PBS’s investigative series Frontline, few of the thousands of supplement manufacturers do so, and the FDA lacks the staff and resources to analyze supplements or to compel manufacturers to comply.
As a result, the contents of a supplement capsule may not be what’s described on the label. Canadian researchers who analyzed a random sample of 44 products from 12 manufacturers reported in 2013 that 60% of the products contained substances not listed on the labels, some of which were potentially harmful contaminants. And a 2015 investigation by the New York attorney general determined that only 21% of random samples of popular house-brands supplements purchased from GNC, Target, Walgreens, and Walmart contained the ingredients in the concentrations listed on the labels. Some contained no trace of the advertised active ingredient, and others consisted primarily of “fillers,” including wheat and soy, which may trigger allergic reactions in some people. Other investigations have uncovered supplements adulterated with steroid hormones.
When it comes to dietary supplements, the ancient warning “buyer beware!” is more relevant than ever.

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