POLIO ERADICATION (POLIOMYELITIS)

In the early 80s infants mortality due to polio infection was very high, secondary to lack of health education, poor hygiene and unavailability of polio vaccine, but with public health awareness and vaccination, mortality due to infectious diseases have reduced drastically.  A study conducted by WHO showed  that Polio cases have decreased by over 99% since 1988, from an estimated 350 000 cases in more than 125 endemic countries then, to 74 reported cases in 2015.

Despite this huge achievement, the world is practically not safe until polio is totally eradicated. There are pockets of polio cases in developing countries like ours despite the huge funds already spent to eradicate polio, and the most recent outbreak in Nigeria is linked to the Insurgency in the North eastern part of Nigeria, which has denied several people in that area access to quality health care.

Poliomyelitis (polio) is a highly infectious viral disease, which mainly affects young children. The virus is transmitted by person-to-person spread mainly through the fecal-oral route or, less frequently, by a common vehicle (e.g. Contaminated water or food) and multiplies in the intestine, from where it can invade the nervous system and can cause paralysis. Polio mainly affects children under 5 years of age. There is no cure for polio, it can only be prevented. Polio vaccine, given multiple times, can protect a child for life.

Initial symptoms of polio include fever, fatigue, headache, vomiting, stiffness in the neck, and pain in the limbs. In a small proportion of cases, the disease causes paralysis, which is often permanent. There is no cure for polio, it can only be prevented by immunization.

There are two types of vaccine that protect against polio: inactivated poliovirus vaccine (IPV) and oral poliovirus vaccine (OPV). IPV is given as an injection in the leg or arm, depending on the patient's age. Polio vaccine may be given at the same time as other vaccines. Most people should get polio vaccine when they are children. Children get 4 doses of IPV at these ages: 2 months, 4 months, 6-18 months, and a booster dose at 4-6 years.

Considering the extent of damage caused by the polio virus evidenced by the attached pictures, Its important to ensure that our children get vaccinated to avoid the associated physical disability and eventually reduce the global financial burden as it was estimated that once global polio eradication is achieved a net gain of  40-50 billion dollar would be saved.

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Maternal and Child Health Receives Boost in Northern Nigeria

Minister of State for Health Dr. Muhammad Ali Pate has said that   maternal and child health in Northern Nigeria will received a boost as the Nigerian Union of Road Transport Workers (NURTW) and Partnership for Reviving Routine Immunization in Northern Nigeria and Maternal and Newborn and Child Health (PRRINN-MNCH) collaborated to provide emergency services to pregnant women in the rural areas in the Northern Nigeria.

The Minister made this known over the weekend, in Abuja in a keynote address at the signing of Memorandum of Understanding (MOU) between the PRRINN-MNCH and NURTW on how to accelerate provision of Transport Service to pregnant women on emergency.

The Minister said that the partnership between the two organizations will complement Federal Government effort in providing maternal and child healthcare service in the rural area.

He said that there are socio-economic disparities between rural and urban duelers in Nigeria adding that women in the rural areas have the highest risk of dying during child birth than those living in the urban centres.

However, the Minister said that the Federal Government has deployed Midwives and community health workers to the rural areas across the country to assist pregnant women.

Earlier, the President, National Union of Road Transport Workers Union (NURTW) Alh. Najeem Usman said that studies have shown that one of the barrier that delay women from getting to health facility in the rural area is lack of transport.

To bridge the gap, he said the NURTW and PRRINN-MNCH in collaboration with the Jigawa, Katsina, Yobe and Zamfara  state governments decided to set up an Emergency Transport Scheme (ETS) to ease the suffering of women and minimize maternal complication caused through delay in reaching health facility.

Alhaji Usman also noted that MOU was to expand the Emergency Transport Services (ETS) initiative to the entire rural communities in the country.

To achieve the overall goal of reducing the high maternal mortality ratio in Nigeria, the ETS need to be scaled up beyond the four states”, he said.

Brain Injury Doesn't Raise Dementia Risk for Most: Study But likelihood of re-injury does increase

 Having a traumatic brain injury at some time in your life doesn't raise the risk of dementia in old age, but it does increase the odds of re-injury, a new study finds.

"There is a lot of fear among people who have sustained a brain injury that they are going to have these horrible outcomes when they get older," said senior author Kristen Dams-O'Connor, assistant professor of rehabilitation medicine at the Icahn School of Medicine at Mount Sinai Medical Center in New York City.

"It's not true," she said. "But we did find a risk for re-injury."

The 16-year study of more than 4,000 older adults also found that a recent traumatic brain injury with unconsciousness raised the odds of death from any cause in subsequent years.

Those at greatest risk for re-injury were people who had their brain injury after age 55, Dams-O'Connor said. "This suggests that there are some age-related biological vulnerabilities that come into play in terms of re-injury risk," she said.

Dams-O'Connor said doctors need to look out for health issues among older patients who have had a traumatic brain injury. These patients should try to avoid another head injury by watching their balance and taking care of their overall health, she said.

To investigate the consequences of a traumatic brain injury in older adults, the researchers collected data on participants in the Adult Changes in Thought study, conducted in the Seattle area between 1994 and 2010. The participants' average age was 75.

At the start of the study, which was published recently in the Journal of Neurology, Neurosurgery & Psychiatry, none of the participants suffered from dementia. Over 16 years of follow-up, the researchers found that those who had suffered a traumatic brain injury with loss of consciousness at any time in their lives did not increase their risk for developing Alzheimer's or other forms of dementia.

The risk of another traumatic brain injury, however, more than doubled if the first injury occurred before age 25 and almost quadrupled if the injury happened after age 55. Similarly, a recent traumatic brain injury more than doubled the odds of death from any cause, the study found.

Dams-O'Connor's group plans to look at risk factors to try to understand why some people have poor long-term prognosis after a brain injury.

One expert said genetics may play a role. "My guess is that the risk for post-traumatic-brain-injury Alzheimer's disease has a genetic component with some genes increasing risk and others offering protection," said Dr. Sam Gandy, associate director of the Mount Sinai Alzheimer's Disease Research Center in New York City.

These findings should not be confused with those regarding athletes who suffer brain injuries, Gandy said.

"The dramatic examples of former [National Football League] players, hockey players and wrestlers who have an unusual illness, marked by depression, agitation and psychosis are quite different from Alzheimer's disease patients who tend to be apathetic," he said.

"Much remains to be discovered about the role of lifelong traumatic brain injury history, including severity and nature of torque and other physical factors, and late-life mental decline," Gandy said.

Another expert, Dr. Danny Liang, a neurosurgeon at North Shore-LIJ Cushing Neuroscience Institute in Manhasset, N.Y., thinks these findings are too narrow to say much about the risk of dementia as a result of traumatic brain injury.

"The study is restricted to a limited population so it's hard to extrapolate these findings to other populations," he said. "It is also possible that there were people who had traumatic brain injury who did develop dementia before age 65, so they were not included in the study," Liang said.

There also was no data on injury severity or duration of unconsciousness, he said. Brain injuries differ, and knowing the severity is important to determine the ultimate outcome, he said.

Doctor-Patient Communication Key to Sticking With Meds

Ineffective communication is a major player when patients don't properly take medication as prescribed, a new study finds.

"Communication matters. Thirty percent of people [in the study] were not necessarily taking their medications the way their doctors thought they were," study lead author Dr. Neda Ratanawongsa, an assistant professor in the department of medicine at University of California, San Francisco, said in a university news release.

"Rates for non-adherence were 4 to 6 percent lower for patients who felt their doctors listened to them, involved them in decisions and gained their trust. By supporting doctors in developing meaningful relationships with their patients, we could help patients take better care of themselves," she added.

The study authors reached their conclusions after giving questionnaires to more than 9,000 patients who took drugs to lower their blood sugar, blood pressure or cholesterol. They completed items on how they communicated with their doctors, and the researchers checked their prescription records to see if they were properly taking their medications.

Andrew Karter, a senior research scientist with the Kaiser Permanente research division who assisted with the study, pointed out what was unique about the findings. "We found that medication adherence is better if the physician has established a trusting relationship with the patient and prioritizes the quality of communication, even if that communication is not specifically focused on medication adherence," he said in the news release.

Weight-Loss Surgery Is New Diabetes Foe

Though it began as a treatment for something else entirely, gastric bypass surgery -- which involves shrinking the stomach as a way to lose weight -- has proven to be the latest and possibly most effective treatment for some people with type 2 diabetes.

Just days after the surgery, even before they start to lose weight, people with type 2 diabetes see sudden improvement in their blood sugar levels. Many are able to quickly come off their diabetes medications.

"This is not a silver bullet," said Dr. Vadim Sherman, medical director of bariatric and metabolic surgery at the Methodist Hospital in Houston. "The silver bullet is lifestyle changes, but gastric bypass is a tool that can help you get there."

The surgery has risks, it isn't an appropriate treatment for everyone with type 2 diabetes and achieving the desired result still entails lifestyle changes.

"The surgery is an effective option for obese people with type 2 diabetes, but it's a very big step," said Dr. Michael Williams, an endocrinologist affiliated with the Swedish Medical Center in Seattle. "It allows them to lose a huge amount of weight and mimics what happens when people make lifestyle changes. But, the improvement in glucose control is far more than we'd expect just from the weight loss."

Almost 26 million Americans have type 2 diabetes, according to the American Diabetes Association. Being overweight is a significant risk factor for type 2 diabetes, but not everyone who has the disease is overweight. Type 2 occurs when the body stops using the hormone insulin effectively. Insulin helps glucose enter the body's cells to provide energy.

Lifestyle changes, such as losing 5 to 10 percent of body weight and exercising regularly, are often the first treatments suggested. Many people find it difficult to make permanent lifestyle changes on their own, however. Oral medications are also available, but these often fail to control type 2 diabetes adequately. Injected insulin can also be given as a treatment.

Surgeons first noted that gastric bypass surgeries had an effect on blood sugar control more than 50 years ago, according to a review article in a recent issue ofThe Lancet. At that time, though, weight-loss surgeries were significantly riskier for the patient. But as techniques in bariatric surgery improved and the surgical complication rates came down, experts began to re-examine the effect the surgery was having on type 2 diabetes.

In 2003, a study in the Annals of Surgery reported that 83 percent of people with type 2 diabetes who underwent the weight-loss surgery known as Roux-en-Y gastric bypass saw a resolution of their diabetes after surgery. That means they no longer needed to take oral medications or insulin in most cases.

In Roux-en-Y surgery, the anatomy of the digestive system is rearranged, Sherman explained. A small portion of the stomach is attached directly to the small intestine, bypassing the rest of the stomach, duodenum and upper intestine. This not only restricts how much food the person can eat -- as do other weight-loss surgeries, such as gastric banding -- but it changes the hormones in the digestive system.

"When food or nutrients enter the mid or hind intestine, the body releases a hormone called GLP1 and other hormones that tell the brain to stop eating," Sherman said. After gastric bypass surgery, however, "you're getting this effect earlier in a meal, and it results in less cravings, too," he said. "It's unclear exactly where the mechanism for this change is right now, though some suspect the duodenum."

Wherever the change occurs, it happens soon after the surgery. "There's a change in blood glucose almost immediately, often before people even leave the hospital," he said.

Sherman noted that weight-loss surgery that involves banding doesn't have the same effect on diabetes. Once people lose weight, their blood sugar control may improve, he said, but it's not as dramatic as what occurs after bypass surgery.

Potential risks of gastric bypass include those that exist for most surgeries, including the possibility of excessive bleeding, blood clots and infection, according to the U.S. National Institute of Diabetes and Digestive and Kidney Diseases. But, these risks are often heightened in people who are obese.

Afterwards, people who've had the surgery may not absorb nutrients as well as they used to, and doctors often recommend taking certain supplements. Also, food can tend to move from the stomach to the small intestine too quickly, before it's fully digested. Called dumping syndrome, this side effect often develops after eating foods high in carbohydrates, according to Sherman. Symptoms may include abdominal pain and diarrhea.

And, despite its promise, not everyone with diabetes is an ideal candidate for gastric bypass.

It's currently recommended only for those with a body mass index (BMI) above 40 and those who have a BMI over 35 and a medical condition such as type 2 diabetes, high blood pressure or heart disease.

Type 1 diabetes, though, is not on the list. Williams noted that bariatric surgery won't help with blood sugar control in people with type 1 diabetes because type 1 is an autoimmune condition in which insulin-producing cells in the pancreas are destroyed by the immune system. In type 2, Sherman said, the problem is not in the pancreas to begin with.

Gastric bypass surgery is also best for those who haven't had type 2 diabetes for a long time, and for those who don't have to use insulin to control their blood sugar.

"Bariatric surgery is not an easy fix," Williams said. "There's a lot of prep that goes into bariatric surgery, and then it's a lifelong lifestyle adjustment. Dietary intake is restricted for life, and people have to avoid high-sugar foods. But, it's a really good option for the right person."