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Postpoliomyelitis Syndrome and Reversal With Sugammadex: A Case Report | AANA | PubMed.

[Open Access] [October 2020  Vol. 88, No. 5]

Abstract.

Postpolio syndrome (PPS) is a disabling process characterized by progressive muscle weakness and atrophy that typically emerges decades after an initial poliomyelitis infection. Although the exact incidence of PPS is unknown, it is estimated that 25% to 40% of all poliomyelitis survivors are affected. Patients with PPS may have increased sensitivity to numerous anesthetic agents including neuromuscular blocking drugs. A case report of a patient with PPS undergoing general anesthesia for a cystoscopy procedure is presented. Because of a previous general anesthetic using traditional muscle relaxant reversal of neostigmine, which resulted in prolonged paralysis (6-8 hours) and an intensive care unit admission, sugammadex was used in the cystoscopy procedure. Excellent results were achieved. Following extubation, the patient sustained adequate respiratory effort demonstrated by respiratory rate, end-tidal carbon dioxide, and oxygen saturation within normal limits. Sugammadex administration led to a markedly improved outcome for a patient with a disabling muscle-weakening neurologic disorder. Use of this medication may be of value to other anesthesia providers caring for patients with PPS in an operative setting.

Free (at the time of writing) full text PDF: https://www.aana.com/docs/default-source/aana-journal-web-documents-1/20-oct-marshall.pdf


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UK: Scotland: Rotarians in Monklands won't let Covid-19 stop fight against polio | The Daily Record.

[15 OCT 2020]

Organisation backing End Polio campaign and World Polio Day later this month.


Coatbridge, Airdrie and Monklands Rotary Club has previously held fundraisers like a ten-bowling competition (pictured) to back good causes.

Ian Bunting writes:

COATBRIDGE, Airdrie and Monklands Rotary Club is not letting Covid-19 prevent it from continuing to do its bit in the fight against polio.

Even though the organisation’s meetings are now held in a virtual setting, the generous Rotarians are still managing to fundraise for its chosen great causes.

https://www.dailyrecord.co.uk/news/local-news/monklands-rotarians-collect-toiletries-donate-22756220

A spokesperson for the club said: “Rotary is an international community that brings together leaders who step up to take on the world’s toughest challenges, locally and globally.

“The eradication of polio is one of our longest standing and most significant efforts.

“Along with our partners, we have helped immunise more than 2.5 billion children against polio in 122 countries.

“We have reduced polio cases by 99.9 percent worldwide and we won’t stop until we end the disease for good.

“Our club has been involved in the End Polio campaign since 1979 in various ways, from donating to the Rotary Foundation charity every year to additional fundraising via the Purple Crocus initiative over the past five years.

“The work continues, although the Covid-19 pandemic has resulted in our meetings now being held virually online.

“We will be marking World Polio Day on Saturday, October 24, and continue to join the global fight against the disease.”

Information about the Monklands club’s work can be found at https://coatbridgeairdriemonklandsrotary.webs.com/; visit https://www.endpolio.org/ for further details on the End Polio campaign.


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Ted Chaiban, UNICEF MENA Regional Director's speech to WHO EMRO Regional Committee | ReliefWeb.

[News and Press Release] [Source: UNICEF] [Posted: 15 Oct 2020] [Originally Published: 15 Oct 2020] [Origin: View original]

Thank you for the opportunity to be with you all today.

The COVID-19 pandemic is taking a heavy toll on countries in the Region and particularly its most vulnerable – children and women.

With information fatigue coupled especially with decreasing risk perceptions in countries there is a major need for COVID-19 prevention efforts to be adjusted and accelerated for sustained practice of risk-reduction behaviours.

Simultaneously, several countries are witnessing significant reductions in intake of health and social services.

An impressive response has been mounted by countries in the region and I want to acknowledge the leadership Your Excellencies, Ministers of Health, have shown in your respective countries adopting an RCCE approach to promote COVID-19 prevention as you continue to seek ways to ensure continuity of health and nutrition services according to your country’s context and the needs of the community.

UNICEF will continue to support on-ground outreach and community engagement efforts particularly at the sub-national level as well as mobilization of local leaders, networks and key influencers.

We see recovery in immunization services and utilization of primary health care services in some countries. I reiterate UNICEF’s support to ensure that this is sustained and that mothers and children are able to access other essential services such as Antenatal Care, safe deliveries and treatment for severe acute malnutrition among children while ensuring that frontline health workers are supported through capacity building for Infection Prevention and Control and availability of Personal Protective Equipment.

In this regard, the strength and trust in immunization and Primary Health Care (PHC) services will be key as WHO and UNICEF work together on the COVAX facility to ensure timely deployment of COVID-19 vaccines. We will again need to work together on community engagement so that the vaccine is accepted and shore up the cold chain.

Strengthening PHC resilience and its capacity to deliver front line response including under COVID, we will alleviate the burden on tertiary health care, and strengthen the national health systems’ capacity in continuing to provide health care for the needy and respond to COVID.

Even as we come together on the response to COVID pandemic let us not forget that the region continues to be at risk of polio with new outbreaks of vaccine-derived poliovirus in Sudan and Yemen. WHO and UNICEF are fully committed and engaged in the battle to rid the world of this debilitating disease and immediate immunization response is required to stop circulation of virus in both countries. UNICEF has brought in vaccines to support the response. It is important that access is provided to vaccination teams to vaccinate all children living in outbreak zones.

Together, we will be able to protect our communities and frontline PHC workers from COVID and restore communities’ trust in the public health system so that families can seek services with full assurance of safety and quality.

Together, we can support tens of thousands of children to survive and be healthy across our region.

Media Contacts Juliette Touma Regional Chief of Communications UNICEF Middle East and North Africa Regional Office Tel: 00962798674628


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UK: How Halifax is going 'Purple for Polio' - from head shaves to lighting up landmarks | Halifax Courier.

[Thursday, 15th October 2020]

Abigail Kellett writes:

Ramesh Mistry and Ken Robertshaw of the Rotary Club of Halifax have dyed their hair and beards purple to bring attention to the campaign and on October 24 as part of the World Polio Day events there will be on a stall at the Piece Hall, Halifax where they will be publicly shaved of their beards and locks.

The stall will be in Halifax from 10am to 8pm and residents are invited to attend, with social distancing, to witness this event and to learn more about the campaign and Rotary Club activities.

Ramesh Mistry and Ken Robertshaw of the Rotary Club of Halifax have dyed their hair and beards purple
Ramesh Mistry and Ken Robertshaw of the Rotary Club of Halifax have dyed their hair and beards purple.

A site has been set up to receive donations in support of their efforts which can be accessed at uk.virginmoneygiving.com/purpleNshaveAlso at The Piece Hall on Friday, October 23, the landmark will light up purple to show its support for the campaign.

The Bandstand and Piece Hall lights will be turned purple at around 6.15pm.

Wainhouse Tower will also light up purple in aid of World Polio Day.

In 1985 there were over 1000 cases of Polio being recorded in the World every day paralyzing, and killing, many of the victims.

Rotary International pledged that they would fight this disease and launched what has now become the Global Polio Eradication Initiative, an alliance with the World Health Organisation and the Bill and Melinda Gates Foundation.

This has led to a reduction from that awful headline figure to less than 100 in the last 12 months.

The fight goes on to wipe out this disease and Rotary Clubs are still at the forefront. Recently the whole of Africa was declared Polio free and there are only two countries left to become fully clear; Afghanistan and Pakistan.

Volunteers continue to work to reach the children of these countries and vaccinate them and prevent polio taking hold and affecting them, despite the many obstacles and dangers they face.

As each child is treated they have their little fingers dyed purple to indicate that they have been treated.


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Ending Covid-19 via herd immunity is 'a dangerous fallacy' | The Guardian.

[Wed 14 Oct 2020 23.30 BST]

Prominent scientists sign open letter saying strategy is 'unsupported by evidence'.

Sarah Boseley, Health editor, writes:

The concept of ending the Covid pandemic through herd immunity is “a dangerous fallacy unsupported by scientific evidence”, say 80 researchers in a warning letter published by a leading medical journal.

The international signatories of the open letter in the Lancet say the interest in herd immunity comes from “widespread demoralisation and diminishing trust” as a result of restrictions being reimposed in many countries because of surging infections in a second wave.

The suggestion that the way out is by protecting the vulnerable and allowing the virus to transmit among those less at risk is flawed, they say. “Uncontrolled transmission in younger people risks significant morbidity and mortality across the whole population. In addition to the human cost, this would impact the workforce as a whole and overwhelm the ability of healthcare systems to provide acute and routine care.”

The signatories have expertise spanning public health, epidemiology, medicine, paediatrics, sociology, virology, infectious disease, health systems, psychology, psychiatry, health policy, and mathematical modelling. They include a number of scientists who sit on the breakaway Independent Sage group in the UK, such as former chief scientist Sir David King, former WHO director Anthony Costello, virologist Prof Deenan Pillay, behavioural scientist Prof Susan Michie and professor of European public health Martin McKee.

There is no evidence that immunity after recovering from Covid-19 lasts, they say, adding that people who are vulnerable would be at risk for the indefinite future and cannot be kept safe.

“Prolonged isolation of large swathes of the population is practically impossible and highly unethical,” they say, calling for action to suppress the levels of virus in the population.

“It is critical to act decisively and urgently,” they say. “Effective measures that suppress and control transmission need to be implemented widely, and they must be supported by financial and social programmes that encourage community responses and address the inequities that have been amplified by the pandemic.”

Those restrictions will be needed “to reduce transmission and fix ineffective pandemic response systems, in order to prevent future lockdowns”. If the numbers of infections can be pushed down to a low level, it will be possible to keep the virus suppressed through “an efficient and comprehensive” test, trace, isolate and support system, “so life can return to near-normal without the need for generalised restrictions. Protecting our economies is inextricably tied to controlling Covid-19. We must protect our workforce and avoid long-term uncertainty.”

There are success stories – among them Japan, Vietnam and New Zealand, they say.

“The evidence is very clear: controlling community spread of Covid-19 is the best way to protect our societies and economies until safe and effective vaccines and therapeutics arrive within the coming months. We cannot afford distractions that undermine an effective response; it is essential that we act urgently based on the evidence.”

Other signatories to the letter from the UK include epidemiologist Prof David Hunter, cancer researcher Prof Charles Swanton of the Crick Institute and global health professor Devi Sridhar. Those from the US include global health professor Gavin Yamey of Duke University, Prof Rochelle P Walensky from Harvard medical school and Dr Ali Nouri of the Federation of American Scientists. Researchers from Italy, Israel, Malaysia, Spain, Ireland, Germany, France, Australia, the Netherlands, Switzerland and Canada have also signed.


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Afghanistan: Regional COVID-19 mission to Afghanistan concludes | ReliefWeb.

[News and Press Release] [Source: WHO] [Posted: 15 Oct 2020] [Originally Published: 14 Oct 2020] [Origin: View original]

14 October 2020: A multidisciplinary team from WHO’s Regional Office for the Eastern Mediterranean has concluded a mission to Afghanistan to review the ongoing response to COVID-19, identify gaps and potential risks, and provide recommendations for strengthening response and control measures.

Despite insecurity, natural disasters and other ongoing challenges, the Government of Afghanistan has shown commitment to prioritize and address the COVID-19 epidemic from the very beginning of the crisis.

WHO Afghanistan has been supporting Afghanistan’s Ministry of Public Health in responding to the COVID-19 emergency since January 2020. This support has been focused on nine pillars, guided by the COVID-19 ONE UN Health Response Plan.

“Afghanistan has made significant strides in containing the pandemic. After reaching a peak in cases in May/June, there has been a continuous decline in the number of cases in recent weeks,” said Richard Brennan, Regional Emergency Director and mission team lead.

“Extensive training has taken place for health workers on a range of topics. Progress has also been made to rapidly scale up the number of laboratories that are able to test for COVID-19, with 14 public and 18 private laboratories in 8 provinces currently active, and plans to expand to 34 provinces.”

There were no COVID-19 testing facilities when the epidemic started in Afghanistan. WHO has since supported the Ministry of Public Health in a rapid scale-up by establishing laboratories, training technical staff, and providing essential equipment and supplies to expand testing across the country. Given this support, the current network of laboratories can conduct up to 5500 test per day, but more needs to be done.

Extensive investment has also been made in the provision of infection prevention and control (IPC) training. More than 2000 health care workers have been trained on case management and intensive care and while more than 1300 have received training on IPC through WHO’s support. Technical support in the development of national IPC guidelines is also ongoing.

“We see a need for a more institutionalized approach to protecting health care workers through improved infection prevention and control measures, especially in light of the infections occurring in health care settings. Timely and comprehensive data-sharing is also important to allow us to better analyze the course of the pandemic and provide appropriate guidance and support to further contain transmission.”

Surveillance and contact tracing has significantly benefited from the country’s functioning disease early warning system and the polio programme’s extensive surveillance network which has been leveraged to support the response to COVID-19. To date, the polio programme has facilitated COVID-19 surveillance training for more than 98 000 health service providers (public and private), more than 47 000 polio frontline workers, nearly 36 000 members of the Polio Surveillance Network, and about 5000 government and NGO staff. However, community-based and event-based surveillance requires strengthening, and the capacity of rapid response teams remains limited even though nearly 240 have been trained on case definition, specimen collection and case investigation.

While an appropriate testing strategy is in place, the COVID-19 national laboratory network can be further strengthened by assessing laboratory capacities using WHO’s COVID-19 Laboratory Assessment Tool.

A strategic vision for risk communication and community engagement (RCCE) with an innovative approach and road map that embraces community engagement and accountability has been developed for inclusion in the existing national action plan. A comprehensive RCCE package has been finalized, including a series of well-planned Afghanistan-specific training modules targeting frontline health workers and key staff in municipalities and community development councils. WHO is co-chairing an interagency RCCE working group which is providing a collaborative platform to align messaging, coordinate tasks to avoid duplication and share lessons learnt. A functional rumour tracking system is also in place in the country, although a more systematic approach is needed to guide and inform public message development.

With the return of more than 550 000 Afghans from the Islamic Republic of Iran and Pakistan, and several porous border crossings between these countries and Afghanistan, greater effort needs to be placed on increasing cross-border collaboration between these countries to manage COVID-19, as well as other public health risks that can threaten national and regional health security.


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Obituary: Laurence L. Schmitt (Larry) | Ottumwa Daily Courier.

Laurence L. Schmitt

March 8, 1948 - September 28, 2020.

Laurence L. Schmitt (Larry), age 72, formerly of Milton, MA and Cohasset, MA, died peacefully on September 28, 2020, at his home in Charlotte, North Carolina. Larry was born on March 8, 1948 in Dubuque, Iowa to the late Helen (Lee) and Philip Schmitt. He grew up in Ottumwa, Iowa and graduated as valedictorian of his class of 600 from Ottumwa High School. He attended the Massachusetts Institute of Technology (MIT) graduating with a BS in Humanities in 1970, only the second class at MIT ever to graduate with this degree. He studied under some of the best known writers and poets in America, including Lillian Hellman, Louise Gluck, and A. R. Gurney. Larry spent most of his career as a software engineer for Lotus/IBM in the Boston/Cambridge area.

A memorial service will be held at a future date.

Larry is survived by his beloved significant other of 22 years, Kay Mixon; daughter Johanna Schmitt by his first wife Mary Jane, Johanna's partner, Brian Sulkow, and grandson Will Sulkow; six siblings, Andrew, Dan, Shirley, Ed, John and David, and their spouses; many cousins, nieces, nephews, grandnieces and grandnephews as well as Kay's son, brother and sister and their spouses, children and grandchildren.

Larry's extended family will gather for a memorial service at a future date.

Larry was a brilliant man with eclectic and passionate interests, including chess, poetry, duplicate bridge, crossword puzzles, travel, Boston professional sports, music, and the arts. He seemed to excel at everything he undertook.

In his youth in Ottumwa, Iowa he could not find chess partners equal to his ability, so he taught his younger siblings, Andy, Dan and Shirley to play and would battle them blindfolded. He also played postcard chess with a man from Australia in which each game took about a year to complete. Larry was a member of the MIT chess team that won the national collegiate championship and later personally advanced to International Master. He was a longtime member of the Boylston Chess Club in Boston, serving as Treasurer for many years.

One of his poems, written while at MIT, was published in two different writing anthologies which were used in college literature curriculums. He liked to say that he was probably the most published one-poem poet in America. In later years, he was a friend of his partner Kay's Living by Heart Poetry Group of the Old Ship Church of Hingham and joined them often on their field trips to hear different poets read their work.

Larry loved solving the New York Times crossword puzzles but never worked on any puzzles before Thursday's since they were simply too easy for him. He and his step-son Arthur Meacham used to compete to see who was fastest doing the puzzle of the day. After he retired, Larry created a number of crossword puzzles himself, even submitting a few to the New York Times.

Though never published, he claimed one of his proudest moments was when Will Shortz returned one of his crosswords to him with a hand written comment, "Not bad."

Larry developed his love and extensive knowledge of baseball in his youth when he was selected to be the scorer for the Ottumwa West End Little League games. In later years one of his favorite possessions was a gift from a friend of the complete Boston Red Sox 2004 World Series Collector's Edition. He often gently, but strongly, encouraged guests to watch key moments in the all important Game 5 against the Yankees, with him commentating. In addition, he was a huge fan of the New England Patriots and Tom Brady from the beginning of their long run of successes and never missed a game. Once on vacation in Florida when the town lost all power, Larry and Kay jumped in the car and drove to where there was radio reception - this was the famous Tuck Rule/Snow Bowl game, the result of which sent the Pats on toward their first ever Super Bowl Championship.

Larry and Kay both loved travel but preferred the serendipity of skipping organized tours and making their own path. They accomplished this by trading houses with many people across the US and Europe. But the best trip of all was the weeklong history of women's suffrage driving tour planned for Kay in exquisite and loving detail by Larry.

Larry had an encyclopedic knowledge of popular music. The Beatles, Bob Dylan, Leonard Cohen, Judy Collins and The Kinks were among his favorites. In Larry's last days his beloved daughter Johanna, her partner Brian and their son Will performed many of Larry's favorite songs, with him softly joining in. The Beatle's "In My Life" was especially for Kay.

When Larry was 4, he contracted polio and for the rest of his life could only walk wearing a brace and using crutches. As a member of the Greater Boston Post-Polio Association for many years, serving as both Treasurer and President, he was an inspiration to many. At a farewell lunch two years ago with his post-polio friends they confessed that the women had once secretly voted on the most handsome man in the group - and he had won!

Larry's powerful presence and heartwarming smile will be greatly missed by all who knew him.

Memorial contributions may be made to the Rotary's End Polio Campaign. Every dollar given will be tripled by the Bill and Melinda Gates Foundation. https://www.endpolio.org/how-to-help

Published on October 14, 2020
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