NIGERIAN NATIONAL BIOETHICS COMMITTEE (NNBC) by DR. IZUAGBA KELECHI .U.

EMMANUEL ONWUBIKO'S COLUMN GENERAL NEWS HEALTH AND WELLBEING HUMAN ANGLES OPINION

MY REVIEW …

INTRODUCTION:

  • A human activity involving an interaction between the counselor and the client where the counselor helps the client to navigate through and cope with the challenges encountered by him or her in the journey of life.
  • The General ethical rule states that your actions must not weaken thye mental or physical state of any human being.

SCOPE OF CHALLENGES:

  1. Developmental
  2. Educational
  3. Career issues
  4. Coping with chronic illnesses both mental and physical ailments
  5. Stigma and discrimination
  6. Bereavement and loss
  7. Major life decisions
  8. Interpersonal relationship issues
  9. Socio-economic issues
  10. Performance and achievement issues. E.g. sexual and successes in life.

STRATEGIES: STRATEGY 1

  1. Communication dimensions
  2. Unconditioned positive regards (Rogers)
  3. Unconditioned without preconditions, without regards to race, socioeconomic status, color, etc.
  4. Positive regards – accept and value the client for what he/she is and not what you want him/her to be.
  5. Positive attitude, warm greeting, good eye contact and friendly tone of voice.
  6. Listening sills
  7. This is very crucial
  8. It conveys to the client that you are listening
  9. He/she need to feel that you care and are listening otherwise they may clam up.
  10. During counseling/therapeutic sessions, handle silence and don’t feel uncomfortable about it.
  • Process variables:
  • Empathy

Empathy vs. Sympathy definition (Rogers, 1957)

  • The ability to perceive the internal frame of reference of another with accuracy and with pertain thereto; as if one were the other person, without losing the “as if” condition.
  • Truax (1961) added another aspect of communicating. This understanding to the client.
  • Be authentic; do not pretend
  • Empathy should be adequate

STRATEGY 2

  1. Communication dimensions
  2. Non-verbal communication
  3. This often conveys acceptance or rejection.
  4. This is by facial expressions, gestures, tone of voice.
  5. Body language as a therapist may convey a barrier between you and the client therefore try to be conscious of it. Sensitive clients may pick these and refuse to co-operate.
  6. Arrangement of furniture in the counseling room may unwillingly create barriers between the counselor and the therapist.
  • Process variable
  • Transference
  • This is an unconscious phenomenon where the client transfers emotions he/she feels towards a significant person in his/her life to the therapist.
  • Counter transference
  • Reciprocation of the emotion by the therapist unconsciously.
  • Defence mechanisms
  • Resistance
  • Denial

ADVOCACY OBJECTIVES

  1. Promotion of human rights of persons with mental illness.
  2. Monitoring of life conditions
  3. Parity of care needs to be assured in all health schemes.
  4. Informing and motivating the decision makers
  5. Empower families
  6. Work with NGOs
  7. Create appropriate lobbying bodies
  8. Elaborate with electronic and print media

ELEMENTS OF ADVOCACY

  1. Political support
  2. Policy change
  3. Persuasive communications
  4. Visits, letters, fliers, etc.

EXPECTED OUTCOME

  1. Support from policy makers
  2. Increased awareness
  3. Increased involvement of Nigerians
  4. Increased media participation and support
  5. Enactment and Amendment of legislation
  6. Better resource allocations
  7. Policy change

PROCESS OF ADVOCACY

  1. Obtain scientific facts on various illness
  2. Know how to reach target audience
  3. Form team of competent/committed persons
  4. Be equipped with facts and advocacy kits e.g. purposeful designed file jackets, car stickers, key holders, badges, face-cap, t-shirts, fliers, books, table calendars, etc.
  5. Book an appointment
  6. Confirm the appointment
  7. Arrive early
  8. Introduce team
  9. Accurately/precisely state the mission in order of:
    1. Objectives
    1. Successes recorded in the past
    1. Current challenges
    1. Support needed
  10. Deliver advocacy materials
  11. Create opportunity for response
  12. Closing remark

N/B: Use the agreement reached for publicity.

4 Principles of medical ethics

  1. Autonomy
  2. Non-maleficence
  3. Beneficence
  4. Justice

HEALTH CORNER

TOPIC – HIV/AIDS

BY: DR. IZUAGBA KELECHI .U.

WORLD AIDS DAY

  • 1st OF DECEMBER YEARLY
  • 2019 THEME = “KNOW YOUR STATUS”
  1. INTRODUCTION:
  2. HIV stands for human immune deficiency virus.
  3. HIV belongs to human retrovirus (retroviridae) and the subfamily of lentivirus.
  4. It is the virus that causes HIV infection and AIDS – the most advanced stage of HIV infection.
  5. There are 2 strains of HIV – HIV1 and HIV 2
  6. The HIV 1 is the most common cause of HIV world-wide and was 1st recognized in 1981 while the HIV 2 is most common in West Africa and was 1st reported in 1986 in Nigeria (Lagos state).
  7. The number of people living with HIV/AIDS (PLWHAS) has increased and most marked in sub-Saharan Africa.
  8. In Nigeria, the prevalence varies within states.
  9. Mainly by heterosexual, perinatal and transfusion of blood and blood products which pose great concern
  10. HIV attacks and destroys the infection-fighting CD4 cells of the immune system, thereby causing inability of the body’s immune system to fight diseases and infections.
  11. Each year, 1.5 million women living with HIV become pregnant and without Anti-retroviral.
  12. There’s a 15-45% chance that their baby will also become infected.
  13. Among pregnant women who take Anti-retroviral to prevent mother-to-child-transmission (PMTCT), the risk of transmission is reduced by <3%
  • MODE OF TRANSMISSION:
  • Sexual contact with an infected person i.e. unprotected sex with homosexuals, heterosexuals etc.
  • Sharing of contaminated sharp objects e.g. needles, pins, razor blades etc.
  • Mother-to-child transmission or vertical transmission
  • Intravenous drug use (by IV drug users)
  • CLINICAL PRESENTATIONS:
  • Presentation depends on the stage of the disease.
  • At the initial stage, it is an acute infection with no signs and symptoms
  • Incubation period is variable and could be up to 10 years or more
  • Seroconversion normally occurs during 2 to 12 weeks after infection.
  • There are basically 4 stages of HIV infection according to WHO.
  • At stage 1, patient can be Asymptomatic with normal activity. CD4+ count of >500/ul. There may be generalized Lymph node enlargement.
  • At stage 2, patient can be Symptomatic with normal activity. There’s presence of mild symptoms e.g. mucocutaneous manifestations or changes e.g. skin, hair, nail changes. There are also current upper respiratory tract infections with moderate/unexplained weight loss. CD4+ count of <500/ul.
  • At stage 3, patient can have advanced symptoms e.g. unexplained diarrhea for >1 month, unexplained prolonged fever > 1month, opportunistic infections e.g. oral candidiasis, pulmonary tuberculosis, oral leukoplakia with severe weight loss. CD4+ count of <350/ul.
  • At stage 4, this is the HIV – wasting syndrome stage or stage of full-blown AIDS. Patient presents with severe symptoms e.g. severe weight loss with chronic diarrhea, prolonged fever, opportunistic infections e.g. Kaposi sarcoma, Toxoplasmosis of the brain etc. CD4+ count of <200/ul.
  • BREASTFEEDING IN HIV
  • For most babies, breastfeeding is the best way to be fed.
  • About 5-20% of babies infected through mother-to-child-transmission acquire it through breast feeding.
  • It is still not understood ho HIV becomes present in breast milk; but HIV infected CD4+ cells have greater capacity to replicate in breast milk than in blood.
  • Once the infant ingests this HIV – infected milk, it is believed that the virus enters the body through breeches in the infant’s mucous membrane.
  • Exclusive breast feeding is advocated (i.e. 1st 6-months of life) and not mixed feeding; for HIV+ve mothers who choose to breastfeed but must provide infants with once daily nevirapine for 6 weeks.
  • Then give complementary feeds and wean baby at 12 months.
  • If the mother chooses to do replacement feeding which is the only 100% effective way to prevent mother-to-child transmission “after” birth, then she must meet up with the WHO criteria for replacement feeding which includes: Acceptability, Feasibility, Affordability, Sustainability, and safety.
  • It is either Exclusive breast feeding or Replacement feeding but never mixed feeding (i.e. combination of both).
  • Mothers who choose replacement feeding must be supported by teaching them how to properly prepare the food and in correct dilusion using clean feeding bottles and utensils.
  • TREATMENT MODALITIES IN HIV:
  • Treatment of Acute bacterial infections.
  • Prophylaxis and treatment of opportunistic infections e.g. Pnemocystic Jiroveci or Pneumocystic carinii pneumonia (using COTRIMOXAZOLE)
  • Anti-retroviral therapy – (ART) using zidovudine, Lamivudine, Efavirenz)
  • Maintenance of good nutrition
  • Immunization
  • Management of AIDS defining illnesses.
  • Psychological support from the family
  • Palliative care for terminally ill-patients
  • Monitor the toxicity of the ARV drugs
  • PREVENTION OF HIV:
  • General health promotion measures:
  • Practice safe sex
  • Be faithful to your partners.
  • Avoid unwanted pregnancy for HIV-infected women through family planning and counseling services to prevent mother-to-child-transmission.
  • Safe delivery methods, use of anti-retrovirals among HIV-infected women and safer infant
  • Feeding options to increase child health and survival
  • Health education:
  • Use sterile or new sharps like needles, razor blades, etc.
  • Avoid illicit drug use (in IV drug users) because they are harmful to health.
  • Good personal hygiene e.g. avoid unnecessary injuries, treat wounds to avoid contamination, etc.
  • Universal precaution and specific protection:
  • Always use screened blood for blood transfusion.
  • Give post exposure prophylaxis (PEP) to vulnerable individuals who may be exposed to HIV-infections e.g. rape victims/sexual assault victims. This is also applicable to any health worker who may accidentally get pricked by the needle while managing a HIV – infected patient. N/B: Post exposure prophylaxis (PEP) is therefore NOT recommended as a prevention of HIV following casual consensual sexual intercourse due to toxicity of the drugs.
  • Early diagnosis and treatment:
  • By voluntary HIV screening and counseling.
  • Ensure HIV testing of every pregnant woman with prompt intervention of effective Anti-retroviral therapy
  • Support and care for HIV+ve infected women and their families
  • Strict adherence to therapy to reduce the viral load
  • Follow-up.
  • CONCLUSION:
  • HIV/AIDS is a very deadly disease in our environment and therefore requires precautionary measures.
  • Nigeria is an enormous country with a very high number of people living with HIV.
  • The HIV epidemic in Nigeria is concentrated mainly among heterosexuals (accounting for over 80% by route of transmission). Yet the trend is now shifting towards “most-at-risk” in the population.
  • Enhanced and more strengthened surveillance system targeting the whole population and with special attention to the “most-at-risk” need to be implemented.
  • More prevention campaigns should be planned and carried out while the monitoring system of HIV/AIDS in Nigeria require improvement in terms of data complement and integration in order to allow for for better assessment of the epidemic.
  • Efforts should also be made towards effective sexual transmission infection programming, proper integration of HIV/AIDS and sexual and reproductive health services and also fostering of gender equality at the population level.
  • Finally, encouraging HIV testing among the Nigerian population to ensure everyone knows their HIV status together with efficient linkage to care for newly diagnosed HIV cases is key to mitigate new infections and provide HIV treatment to all.

DO NOT STIGMATIZE OR DISCRIMINATE.

                                                             THANKS…..

TOPIC: BREASTFEEDING AND ITS BENEFITS

BY: DR IZUAGBA KELECHI .U.

INTERNATIONAL BREAST FEEDING WEEK           1ST -7TH August Yearly

  1. INTRODUCTION:
  2. Breastfeeding is the feeding of an infant with breast milk directly from the female breast.
  3. The optimal feeding recommended by WHO invoilves – Exclusive breastfeeding for the 1st – 6months of life followed by adequate complementary feeding while still breastfeeding until the child is at least 2 years.
  4. This will supply the macro and micro nutrients in adequate amount for optimal growth and development of the child.
  5. The physiology of breast flow is linked to response to stimuli of the anterior and posterior pituitary gland to release prolactin and oxytocin respectively when a baby suckles at the breast. This carries sensory impulses from the nipple to the brain cause MILK LET-DOWN (milk let-down reflex)
  6. Oxytocin release is responsible for the milk let down reflex. It can further be stimulated by pleasant conditions in the parturient mother.
  7. Pain, worry, doubt can hinder the reflex and can stop the breast milk from flowing temporarily
  • TYPES OF FEEDING IN INFANTS:
  • Exclusive breastfeeding: as defined by WHO is the feeding of an infant for the 1st – 6months of life with no other food, drink or water but allows the infant to receive ORS (oral rehydration solutions), drops, syrups consisting of vitamins, minerals and other supplements when medically prescribed.
  • Complementary feeding:
  • This is the transition from exclusive breast feeding to family feeds i.e. giving a baby other foods in addition to breast feeding.
  • At 6 months, an infant’s need for energy and nutrient starts to exceed what is provided by the breast milk alone therefore, complementary feeds are necessary to meet those needs to avoid growth faltering.
  • Complementary feeds must be given in the most acceptable and digestible forms for the growth and development of the child
  • It should be responsive and food should be safe for consumption
  • Increase the consistency and frequency gradually
  • Supplementary Feeding:
  • This is feeding that substitutes breastfeeding
  • They are feeds given to a baby under 6months to supplement his intake of breast milk where it is insufficient
  • Predominant Feeding:
  • This simply means that the infant’s pre-dorminant source of nourishment is breast milk. However, the infant may have also received liquids and other drinks not medically prescribed.
  • COMPOSITION OF BREAST MILK
  • COLOSTRUM:
  • This is the 1st milk produced in the 1st few days after delivery
  • It is usually small in volume
  • It has more protein, antibodies, anti-infective proteins, vitamin A than the mature milk
  • It has less fat than mature milk
  • It is regarded as the 1st immunization against diseases a baby will receive after delivery
  • It has mild laxative effect which helps the baby to evacuate meconium. This helps clear bilirubin in the gut thereby preventing neonatal jaundice
  • There are presence of growth factors which helps the baby’s immature intestine to develop thereby preventing baby from developing allergies
  • TRANSITION MILK:
  • This is the milk that replaces colostrum
  • It is secreted 5-15days after delivery
  • MATURE MILK:
  • This replaces transitional milk
  • It contains less protein but more fat
  • Comprises of foremilk (greyish milk) produced in large quantity, contains more water than the hind milk
  • Also the hind milk (yellowish) contains more fat for satiety
  • It is important that baby feeds on one breast per feed thereby taking the fore milk and hind milk
  • This will supply all the nutrients and adequate calories needed for growth and development
  • OTHERS:
  • Carbohydrates e.g. lactose
  • Proteins e.g. lacto-albumin, cysteine needed for brain development
  • Lipids e.g. polyunsaturated fatty acids, TGS
  • Vitamins e.g. vitamin A,C,E but low in D,K,B12
  • Minerals/electrolytes e.g. potassium, calcium
  • Trace elements – low in iron
  • BENEFITS OF BREASTFEEDING
  • To the baby:
  • Confers immunity and protects against infections (immunologic function)
  • Contains right balance of nutrients needed for optimal growth and development
  • Reduces the risk of allergies e.g. juvenile asthma
  • As a mild laxative, meconium is easily evacuated and less risk of neonatal jaundice
  • Increases the IQ i.e. intelligent children. The taurine and cystein in breast milk help in brain development
  • Nutrients are easily absorbable
  • Helps in language, cognitive and perceptual development
  • To the mother:
  • Mother-to-child bonding
  • Enhances child spacing(lactational Amenorrhea)
  • Decreases the risk of ovarian, breast cancers
  • Helps to fasten involution of the uterus
  • Lowers the risk of post-partum hemorrhage
  • Gives personal satisfaction and fulfillment of motherhood
  • Saves time
  • Convenient and economical
  • Reduces pain by releasing oxytocin
  • Decreases the risk of maternal and infant mortality
  • Decreases the risk of osteoporosis and rheumatoid arthritis
  • To the family and community:
  • Saves cost
  • Safe for the environment e.g. no littering of cans
  • MISCONCEPTIONS ABOUT BREASTFEEDING
  • That breast milk is not enough for a growing child
  • If breast size is small, milk output will be small
  • That colostrum is a dirty milk and should not be given to the baby
  • That breast may sag as a result of breastfeeding
  • That it causes loss of sexual appeal
  • That it hinders sexual activity during lactation
  • PROBLEMS ASSOCIATED WITH BREASTFEEDING
  • It may be embarrassing outside the home especially in public places
  • Transmission of infections e.g. HIV, Hepatitis B is higher
  • Drug transmission e.g. cancer drugs and alcohol
  • Breast milk jaundice
  • Hemorrhagic disease of the newborn can occur since there’s low vitamin K in breast milk
  • CONCLUSION
  • Breastfeeding is the most natural way to feed a baby
  • The breast milk provides the ideal nutrition for the infant and are more easily digested than infant formular
  • Breastfeeding lowers the baby’s risk of having asthma and other allergies, reduces respiratory infections and bouts of diarrhea among other benefits
  • The best breastfeeding position is the one you and your baby are both comfortable and relaxed with. The best position is the “cradle” position. Therefore, positioning is very important
  • There are some common challenges with breastfeeding such as breast engorgement which is breast fullness that causes pain due to congestion of the blood vessels in the breast
  • Also inverted nipples, cracked nipples, sore nipples, breast infection (mastitis) are other challenges encountered during breastfeeding
  • Call your doctor if your breasts become unusually red, swollen, hard or sore; and
  • If you have bleeding from your nipples, unusual discharge etc.
  • The GOAL of breastfeeding is to achieve a healthy baby. Therefore, every mother should endeavor to exclusively breastfeed her baby.

STAY HEALTHY!!!

KEEP A HEALTHY BABY!!! THANKS …

TOPIC – CERVICAL CANCER

CERVICAL CANCER

BY: DR IZUAGBA KELECHI .U.

  1. INTRODUCTION:
  2. Cervical cancer is the commonest reproductive cancer found in women and the 2nd commonest cancer after breast cancer
  3. It is due to abnormal growth of cells that have the ability to invade or spread to other parts of the body
  4. It is highly preventable and can lead to untimely death in extreme cases
  5. It can be prevented by PAP smear screening and HPV vaccine
  6. The high mortality rate globally can be reduced through early diagnosis, prevention, effective screening and treatment programmes
  7. Screening aims to detect precancerous changes which if left untreated, may lead to cancer
  • CAUSES:
  • The cause of cervical cancer is “unknown” but has been linked to HPV (Human Papilloma Virus) which is a sexually transmitted infection
  • SYMPTOMS / COMMON PRESENTATIONS
  • Post coital/sexual bleeding
  • Inter-menstrual bleeding
  • Foul smelling vaginal discharge
  • Dyspareunia (pain during sexual intercourse)
  • Pelvic pain
  • Weight loss
  • RISK FACTORS:
  • Early sexual activity (coitarche) before the age of 16
  • Unprotected sexual intercourse with multiple sexual partners
  • Genetic/family history of cervical cancer
  • Smoking cigrattes – this is associated with squamous cell cervical cancer
  • Use of cocaine
  • Multiple pregnancies (high parity) – having many pregnancies is associated with an increased risk of cervical cancer. Among HPV infected women, those who have had seven or more full term pregnancies have four times risk compared to women with no pregnancies.
  • TYPES OF CERVICAL CANCERS:
  • Squamous cell carcimona (commonest type)
  • Adenocarcinoma
  • Adenosquamous carcinoma (rare)
  • Undifferentiated type (very rare)
  • IMMEDIATE  CAUSE OF DEATH IN PATIENTS
  • Haemorrhage (excessive bleeding)
  • Cancer spread to the kidneys causing uremia
  • Infections in the system caused by the cancer cells
  • PREVENTION OF CERVICAL CANCER
  • Be faithful to your patner
  • Play safe by practicing protected sex
  • Avoid smoking of cigrattes
  • Do not abuse drugs like cocaine
  • Get vaccinated immediately!!!
  • The vaccine called GARDASIL is a very potent vaccine and it is very important that every woman of reproductive age group must get it
  • The vaccine prevents the HPV (Human Papilloma Virus) from causing cervical cancer in future
  • Visit the hospital for PAP smear screening
  • TREATMENT
  • Treatment is so diverse and involves the use of chemotheraphy, radiotheraphy and surgery
  • Treatment basicallky depends on the stage of the disease
  • CONCLUSION
  • The survival rate of cervical cancer decreases as the disease gets worse
  • The peak age of cervical cancer is from 50 years but can occur after 30 years
  • Every woman must take precautious measures by all means and if sexually active, she must get vaccinated against the virus that cause this deadly disease.
  • Women who are found to have abnormalities on screening need follow-up, diagnosis and treatment in order to prevent the development of this cancer and also to treat it at the early stage
  • Screening should be performed at least once for every woman in the target group (30-50 years)when it is most beneficial
  • HPV testing, cytology, VIA (Visual Inspection with acetic acid) are all recommended screening tests
  • “Screen and treat” and “screen, diagnosis and treat” are both valuable approaches
  • PREVENTION THEY SAY IS BETTER THAN CURE. GO FOR SCREENING AND GET VACCINATED TODAY!!!

THANKS…

TOPIC: SYSTEMATIC HYPERTENTION

BY: DR IZUAGBA KELECHI .U.

  1. INTRODUCTION:
  2. Hypertension also known as high blood pressure is a medical condition in which there’s persistently elevated systolic and diastolic blood pressure of > or = 140/90 mmHg in adults (WHO)
  3. It is a non-communicable disease, very common and can be “Asymptomatic” and if it is not detected and controlled, it can often lead to lethal complications.
  4. The prevalence of hypertension increases with advancing age and it is a major risk factor for coronary artery diseases, heart failure, stroke and renal insufficiency.
  5. Because hypertension is almost without symptoms except for headaches in some people, it hides without knowing it and is therefore referred to as a “SILENT KILLER”.
  6. Higher in both extremes of socio-economic groups.
  7. Commoner in blacks/black population
  8. Prevalence in Nigeria is 11.2% in adults
  9. Increasing awareness and early diagnosis will improve the control of high blood pressure. This will help to reduce cardiovascular complications which can lead to morbidity and mortality
  10. Effective BP control is possible and can be achieved
  • CLASSIFICATION OF HYPERTENSION
  • Based on JNC-7 classification, it can be
  • Normal BP = <120/<80 mmHg
  • Optimum BP = 120/80 mmHg
  • Pre-hypertension = 120-139/80-89 mmHg
  • Stage 1 hypertension = 140-159/90-99 mmHg
  • Stage 2 hypertension = >or=160/>or =100 mmHg
  • Based on the cause / aetiology:
  • Primary hypertension / essential / idiopathic(unknown)
  • Secondary hypertension
  • The primary/essential hypertension is the “commonest” accounting for 95% of cases
  • Because the cause is unknown, it is non-curable; and treatment is for life
  • The primary hypertension is likely due to interplay between factors (risk factors) which maybe different among individuals
  • The secondary hypertension accounts for the remaining 5% of cases.
  • RISK FACTORS OF HYPERTENSION (PRIMARY TYPE)
  • Hereditary/generic factors i.e. family history
  • Advancing age (45years and above)
  • Obesity
  • Dietary factors e.g. excessive salt intake, low k+ , low vegetables/fresh fruits, saturated fats (hyperlipidemia)
  • Excessive alcohol consumption
  • Physical inactivity
  • Smoking
  • Socio-economic status (both high and low)
  • Gender factor – less in pre-menopausal women, more in men (oestrogen is protective)
  • Geographical factors e.g. in KOMA people of Nigeria, high blood pressure is virtually non-existent and there’s no rise with age than in western organized societies.
  • FACTORS THAT TRANSIENTLY INCREASE BP:
  • Anxiety
  • Cold
  • Sexual orgasm
  • Exercise (brisk rise in systolic BP)

N/B: The secondary types are usually due to underlying systematic diseases e.g. renal, endocrine, neurological and exogenous factors and are not the focus of discussion.

  • COMMON PRESENTATIONS OF HYPERTENSION
  • Asymptomatic (i.e. no symptoms hence called a “silent killer”)
  • Occasional symptoms e.g.
  • Headache
  • Dizziness
  • Palpitations (awareness of one’s heart beat)
  • TREATMENT
  • Non-medical treatment: lifestyle modification e.g.
  • Weight reduction
  • Exercise
  • Reduced salt and alcohol intake
  • Stop smoking
  • Dietary approach e.g. take more fruits and vegetables
  • Reduce intake of refined sugar
  • Medical treatment:
  • The use of drugs (anti-hypertensives) e.g. Thiazides (hydrochlorothiazide), calcium channel blockers (Amlodipine), etc.

N/B: Always adhere to your medications with lifestyle modifications. This will help reduce the blood pressure and will prevent fatal complications of the disease.

  • CONCLUSION:
  • Hypertension is a very common disorder in aged people and it is associated with higher risk of cardiovascular morbidity and mortality
  • Effective blood pressure control can be achieved with strict adherence to medications and life style changes
  • Every adult must “routinely” check his/her blood pressure at least 2 times weekly if “undiagnosed” as this disease does not show or give clues hence referred to a silent killer
  • For the “diagnosed” patients, they must have a personal BP apparatus with the assistance of a medical personnel (nurses) to always check their blood pressure daily to control the BP in addition to strictly adhering to their daily medications and lifestyle modifications
  • Visit your doctor if there are complaints
  • Early diagnosis and prompt intervention are key to management of hypertension

GO CHECK YOUR BLOOD PRESSURE TODAY!!!

THANKS…

TOPIC: SICKLE CELL ANAEMIA…

BY: DR IZUAGBA KELECHI .U.

  1. INTRODUCTION:
  2. Population genetic studies are recent important expression in the field of genetic and the knowledge thus acquired can be of practical value in preventive medicine in the form commonly referred to as “genetic counseling”. This is practically important as it is at present in Africa where sickle cell anaemia has incidence of nearly 2% and maybe responsible for childhood mortality of approximately 5 per 1000.
  3. Genetic counseling is essential for prospective couples. It informs them about the genetic risks after having ascertained their genotypes. This adjudges the most effective control measures as most of our people and our laws are restrictive on abortion issues.
  4. The distribution of the sickle cell gene previously thought to be confined to the black race is now known to be worldwide. However, the greatest disease burden is still found in tropical Africa
  5. Nigeria, the most populous black nation has the largest number of persons with sickle cell disease in the world and it is estimated that 2% of all children in Nigeria are born with sickle cell disease.
  6. The term “sickle cell disease” is different from “sickle cell anaemia”. Sickle cell diseases is a group of blood disorders in which the sickle gene is present with another abnormal gene affecting the hemoglobin production (quantity) or structure (quality)
  7. The most common type of sickle cell disease is the “sickle cell anaemia” which is the topic of discussion; “while sickle cell trait” are carriers with an abnormal gene and a normal gene e.g. AS, AC, etc.
  8. The inheritance of sickle Hb conforms to an autosomal recessive pattern. When an individual inherits two abnormal Hb genes, one of which is HbS, sickle cell disease results. Where the two abnormal genes inherited are the s-type i.e. (HbSS), sickle cell anaemia results.
  9. Preconception counseling for women can be defined as specialized form of counseling for women of reproductive age before the onset of pregnancy to detect, counsel about pre-existing conditions that may militate against safe motherhood and delivery of a healthy baby. The need for preconception counseling cannot be over emphasized especially in patients with sickle cell disease.
  • COMMON PRESENTATIONS OF SICKLE CELL ANAEMIA
  • Stable state / pain-free period
  • Vaso-occlussive crisis (VOC)
  • Sequestration crisis / Acute sequestration crisis
  • Haemolytic crisis
  • Aplastic crisis
  • Megaloblastic crisis
  • Sickle cell anaemia patients are known to experience a chronic haemolytic state which is punctuated by recurrent acute episodes known as “crisis”, often precipitated by infections and adverse environmental conditions
  • Haemolytic crisis may develop over 2-4 months of life as the fetal haemoglobin (HbF) disappears. Patients usually present with pallor, jaundice and are precipitated by infections e.g. malaria, upper respiratory tract infections, osteomyelitis etc. treating the underlying infection and blood transfusion can help in managing the haemolytic crisis
  • The vaso-occlusive crisis (VOC) is due to occlusion of the blood vessels by the sickled cells causing tissue ischemia. Pain is the commonest symptom here and can last for 4-7 days. Acute-sickle dactylitis presenting as hard-foot syndrome which is usually the first presentation evidenced by symmetrical painful swelling of the hands and feet is due to ischaemic necrosis of the small bones of the extremities due to “choking off” of their blood supply as a result of a rapidly expanding bone marrow
  • Acute painful episodes are the most frequent manifestations and tend to affect mainly the limbs in younger children and head, chest and abdomen in older patients.
  • In vaso-occlusive crisis, it is pertinent to hydrate the patient, treat the underlying infection e.g. malaria, give analgesics e.g. paracetamol
  • Acute splenic sequestration is a distinct and episodic entity seen in infants and young children with SCA and usually following an acute febrile illness. For reasons not fully understood, large volume of blood becomes acutely pooled in the spleen which becomes massively enlarged (splenomegaly) with signs of circulatory failure/shock. Young children with sickle cell anaemia develop splenomegaly with hypersplenism and with resultant anaemia. Resuscitating, ventilating and transfusing blood can help in managing such patients.
  • Aplastic anaemia with life-threatening decrease in Hb (haemoglobin) can occur following parvo-virus B19 infection of the bone marrow. Patients present with signs of weakness, pallor and decrease in Hb concentration. This crisis can be self-limiting and can reverse within 2-3 hours. Hydrate patient and treat underlying infections if crisis persist.
  • Megaloblastic crisis occurs due to increased turnover of red blood cells, recurrent infections, malaria infestation and folate deficiency.
  • CLINICAL FEATURES OF SICKLE CELL ANAEMIA

(COMMON FEATURES)

  1. Leg ulcers
  2. Frontal bossing (bossing of the skull)
  3. Osteomyelitis
  4. Gnathopathy (mal-occlusion of jaw, protruded upper teeth/buck/rabbir teeth)
  5. Stunted growth
  6. Spindle-shaped thin digits
  7. Abdominal distension
  8. Barrel chest
  9. Asthenic build
  10. Chest pain
  11. Priapism in males
  12. Delayed puberty
  13. Jaundice
  14. Pallor
  15. Other advanced systemic manifestations e.g. stroke, splenomegaly, cardiomegaly etc.
  16. Impotence
  • PREVENTING CRISIS IN SICKLE CELL ANAEMIC PATIENTS
  • This will include “primary prevention” by marriage counseling for known carriers of the HbS gene to prevent having children with sickle cell anaemia
  • Vaccination: by giving the routine immunizations and other vaccines such as pneumococcal vaccine
  • Avoid dehydration and take plenty of water orally (liberal fluid intake)
  • Use / give malaria prophylaxis using daily proguanil alongside intermittent preventive treatment (IPT) for malaria
  • Folic acid should be given to prevent anaemia from folate deficiency.
  • Antibiotics – this will help prevent infections like pneumonia which increases morbidity and mortality in these patients
  • Other advanced therapies includes:
  • Hydroxyurea; the FDA approved drug treatment to prevent painful episodes. Taken daily and reduces the risk of painful crisis and need for blood transfusion. Hydroxyurea can cause serious side-effects therefore; its toxicity should be monitored.
  • TREATMENT OF SYMPTOMS OF SICKLE CELL CRISIS
  • During acute episodes/crisis e.g. vaso-occlussive crisis, haemolytic crisis, acute sequestration crisis, patient must be rushed to the hospital immediately where the following interventions can be instituted.
  • Use of analgesics e.g. ibuprotein, pentazocin, etc.
  • Use of intravenous infusions in patients with vaso-occulsive crisis
  • Use of whole blood transfusion in treatment of severe anaemia and splenic sequestration crisis.
  • Supplemental oxygen in Acute chest syndrome and other crisis as indicated
  • Treatment of infections/malaria with antibiotics and antimalanals respectively.
  • Other advanced treatments include:
  • Gene therapy: Research is looking at the possibility of inserting a normal gene into the bone marrow of these patients to enable them make normal haemoglobin
  • Nitric oxide: patients with SCA have low nitric oxide levels. This will help to maintain the patency of blood vessels resulting in reduced stickiness of their Hb and occurrence of crisis
  • Statins: usually known to reduce cholesterol levels but are recently being evaluated because they are thought to inflammation in SCA leading to enhancements of blood flow through the blood vessels
  • Surgery: in some cases of retinopathy with retinal detachment or cases of hypersplenomegally, surgery may be indicated.
  • Stem-cell transplant: This presently represents the opportunity of cure. It is usually recommended in patients with significant symptoms and problems because of some complications with the procedure.
  • CONCLUSION:
  • Genetic counseling is essentially a process of communication and involves more than mere discussion of genetic risks. The nature of the disease, efficacy of treatment, prognosis must be discussed to prospective or intending couples.
  • Various options may be open to such couples such family limitation, adoption, sterilization, artificial insemination, prenatal diagnosis with elective abortion but there is evidence that in coming to a decision, couples are influenced by psychological, social and economical problems associated with serious genetic disorder as sickle cell anaemia.
  • Preconceptional counseling for sickle cell disease couple is very important to protect them from trauma of un-willful and unsafe abortions.
  • The detection of sickle cell anaemia in utero in first and second trimesters of pregnancy is now possible through complex biochemical techniques for globin chain analysis and genetic mapping.
  • Because of these techniques, genetic counseling of patients with affected foetus are offered therapeutic abortions in developed countries though it is at present not practiced in the vast majority of developing countries where the need is greatest
  • In our sub region, some will terminate the pregnancy to avoid problems associated with managing sickle cell anaemia. On the other hand, some women would not terminate the pregnancy because of religious and moral reasons.
  • There’s need to implement a programme, to ascertain and follow-up individuals in need of counseling of this genetic disorder and to also achieve a prenatal diagnosis by creation of a genetic registry system.
  • With the new and aggressive therapy, life expectancy has increased from 14years to about 50 years currently
  • I therefore every prospective couple to

ALWAYS CHECK THEIR GENOTYPE BEFORE MARRIAGE. A STITCH IN TIME SAVES NINE.

THANKS…

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