SICKLE CELL DISEASE

This is one of the sickle cell disorders. It is the commonest in this part of the World. It is estimated that approximately 25% of the population have the sickle cell trait (AS). In Nigeria, it is estimated that about 100,000 babies are delivered yearly with sickle cell anaemia. Sickle cell anaemia occurs when two individuals with haemoglobin type AS get married. The outcome of this is that anytime the woman is pregnant, there is a 25% chance that the baby is going to have Haemoglobin type SS.

Sickle cell anaemia is a problem of the blood where an individual is born with Haemoglobin type SS. Haemoglobin is the substance in blood responsible for the transfer of oxygen from one part of the body to the other. Individuals with sickle cell anaemia cannot transport oxygen properly in blood. The haemoglobin forms crystals whenever oxygen concentration drops in the blood. This then leads to sickling of the red blood cells, hence the name sickle cell anaemia. The sickled cells then block blood vessels leading poor blood flow to vital parts of the body. The organs become ischaemic and may become infarcted.

The earliest sign of sickle cell anaemia is swelling of the hands and feet in the first year of life. This usually occurs from the age of 6 months. The children are also prone to recurrent bone pains as well as body pains. They will be weak and get fatigued easily as a result of the anaemia. The anaemia results from the excessive destruction of the sickled cells by the spleen. The children will also have jaundice which is a yellowish discolouration of the eyes. More severe complications include stroke, priapism, kidney problems and leg ulcers among others.

 

It is important that a child should get to start seeing a specialist once the diagnosis of sickle cell is made. This will prevent some of this problems. Prevention is for individuals who are Haemoglobin type AS to refrain from getting married.

LABORATORY DIAGNOSIS OF SICKLE CELL DISEASE

There are several techniques which include: – Full Blood Count (FBC)/ Film Reading – Haemoglobin Electrophoresis – Use of amniotic fluid for prenatal diagnosis (Amniocentesis) – Sickling test – Solubility test  The routinely carried out techniques at St Nicholas Hospital laboratory are Electrophoresis, FBC and blood film appearances. In electrophoresis there is migration of different haemoglobin variants in an electrically charged field. This separates the haemoglobin variants and they are identified accordingly. FBC reveals anaemia,i.e. the low level of patient’s packed cell volume (PCV), increased WBC count etc.The blood film will show the red cell morphology which is sickled in shape (i.e. crescent), nucleated RBC and target cells with distortion in sizes and shapes of the RBCs. It is advocated that sickle cell carriers should seek to marry non-sickle cell carriers  to avoid increased population of individuals with the sickle cell disease. 

Is Second Hand Smoke as unsafe as Smoking?

Most people, even smokers, have become aware that smoking is bad for the health.
In reality, most of the smoke from a burning cigarette doesn’t get sucked down into a smoker’s lungs – it escapes into the air, where it can be inhaled by anyone unfortunate enough to be nearby.

Second Hand Smoke (SHS) or Passive smoking is the inhalation of smoke or environmental tobacco smoke (ETS), by persons other than the intended “active” smoker.

Most exposure to second hand smoke occurs in homes and workplaces. Second hand smoke exposure also continues to occur in public places such as restaurants, bars, and casinos, as well as in vehicles.

Nathan’s Story

Nathan, 54, Idaho; diagnosed with severe lung damage from second hand smoke exposure

Nathan, a Native American, never smoked cigarettes.
For eleven (11) years, he worked at a casino that allowed smoking. The exposure to second hand smoke caused him to develop allergies and serious infections that triggered asthma attacks, eventually causing permanent lung damage called bronchiectasis. “The casino was filled with smoke from so many people smoking,” he said. Breathing in other people’s smoke on a daily basis made his health so bad that he had to leave that job.
Nathan used to be active and athletic. He served in the Marines. He loved to participate in tribal dances. After getting sick, dancing just a few steps wore him out. Nathan hoped that sharing his story would help others understand how dangerous exposure to second hand smoke really is. Nathan’s lung damage led to his death on October 17, 2013. He was 54.

 

References: http://www.cdc.gov/tobacco/quit_smoking/

PEEK

A new smart phone based system, known as PEEK (Portable Eye Examination Kit) has been developed by a team of experts in the fields of eye care, research, and mobile technology.

PEEK is designed to be a comprehensive eye examination tool that leverages mobile phone technology to extend the availability of ophthalmic diagnostic tests beyond expensive treatment centres to anywhere in the world, no matter how remote.

According to The World Health Organization (WHO), 285 million people are estimated to be visually impaired worldwide. Out of which, 39 million are blind and 246 million have low vision. Moreover, 90% of the world’s visually impaired live in developing countries; a staggering statistic, considering that 80% of all visual impairment can be avoided or cured (WHO).

Currently, PEEK has the following applications:

• Patient record with Geo-tagging
• Visual Acuity
• Visual field testing
• Colour Vision Testing
• Contrast Sensitivity Testing
• Lens imaging for cataract
• Retinal Imaging
• Image grading

The ultimate vision of PEEK developers is to create an affordable and portable device that empowers general health workers and eye care practitioners to diagnose eye diseases and provide a means for managing and monitoring the treatment of patients, anywhere in the world.

MATERNAL, NEW BORN, AND CHILD HEALTH IN NIGERIA

Every single day, Nigeria loses about 2,300 under-five year olds and 145 women of childbearing age. This makes the country the second largest contributor to the under–five and maternal mortality rate in the world – UNICEF

Such an alarming rate of deaths occurring in the country every single day is unacceptable. Consequently, there is an immediate need to identify practices that have been successful in other countries, distilling the pertinent information and hopefully adapting it in such a way that the country’s mortality and morbidity rates for mother and infant alike are significantly reduced

CONTRIBUTING FACTORS

There are several factors that cause high rates maternal and infant mortality in Nigeria. For the sake of brevity they will be listed as follows:

1. Lack antenatal care
2. Absence of skilled midwives/birth attendants
3. Delay in treatment of pregnancy complications
4. Malnutrition, particularly in the case of post-neonatal mortality
5. Indirect factors such as:
   1. Socio-economic status (i.e. poverty)
   2. Maternal education level
   3. Cultural practices

THE WAY FORWARD

The first step that must be taken in order to improve Nigeria’s abysmal Maternal, New born and Child Health (MNCH) status is to extrapolate good practices seen in other parts of the world, particularly other parts of Africa and adapting them to facilitate the desired change.

A comprehensive MNCH report presented by the African Union Commission (AUC) offers evidenced based practices form different parts of Africa that have been helpful in improving reproductive and maternal, new born, and child health outcomes. For example the initiatives discussed for maternal health are:

1. Midwifery education and professional development
2. Creation of midwifery database
3. Maternity waiting homes
4. Community based approach to increase utilization of maternal health services
5. Civil society engagement in prevention of obstetric fistula
6. Reforming laws and expanding access to safe abortion services

Each of the aforementioned initiatives is not intended to be implemented by one individual or organisation, but in tandem with several implementation partners and collaborators.

St. Nicholas House Fire Incident

PRESS RELEASE

For Immediate release: February 3, 2014

 

Feb. 3, 2014, 9:00 a.m. WST – At approximately 5:55 p.m. on Sunday, Feb. 2, 2014, there was a fire on the 9^th floor of St. Nicholas House.   The appropriate agencies were alerted and a combined effort ensured the fire was promptly extinguished and the site was secured. 

No other floors or buildings were affected.  Contrary to reports, there were neither injuries sustained nor loss of life.

St. Nicholas House, where the incident occurred, is a 14-story office building adjacent to St. Nicholas Hospital Lagos and is a considerable distance from the patient wards. As a result an evacuation was unnecessary and there were no patient or staff casualties of any kind. Furthermore, there was no damage to the hospital itself.

Although investigations are on going, the cause of the fire is likely to be electrical.

We kindly request that all statements indicating any form of patient casualties and/or structural damage to St. Nicholas Hospital be regarded as false and should be ignored.

This incident has not affected the daily operations of St. Nicholas Hospital in any way and we are currently open and continue to operate at normal capacity.

For further information please contact:

ENGR BELLO

Resident Engineer

St. Nicholas House

Catholic Mission Street

Lagos

Telephone: (+234) 802 310 7306

 

Thank you.

For St Nicholas Hospital

Polio in Nigeria

According to the Global Polio Eradication Initiative, Nigeria is one of the most entrenched reservoirs of wild poliovirus (WPV) in the world. Nigeria is the only country with the on going transmission of all three serotypes of the poliovirus namely, wild poliovirus type 1 (WPV1), wild poliovirus type 3, and circulating vaccine-derived poliovirus type 2 (cVDPV2). In its weekly report, the Global Polio Eradication Initiative highlighted the north of the country as the main source of polio infection. The disease also remains endemic in Afghanistan and Pakistan.

In 2013, The Bill and Melinda Gates Foundation made wiping out Polio in the next six years its utmost priority. However, on January 21, 2014 Bill Gates warned that violence in Nigeria and Pakistan could be a major setback in achieving his goal of eradicating Polio. The Islamic insurgency, chiefly in the form of Boko Haram, is the major cause for concern as regards progress in Nigeria.

Polio This Week in Nigeria

1. No new WPV cases were reported this week. The total number of WPV cases for Nigeria 2013 remains 53 (all WPV1). The most recent WPV1 case in the country had onset of paralysis on 15 December 2013 (from Damboa, Borno).
2. No new cVDPV2 case was reported in the past week. The total number of cVDPV2 cases for 2013 remains 3. The most recent cVDPV case had onset of paralysis on 6 November 2013 (from Konduga, Borno).
3. Sub-National Immunization Days (SNIDs) were conducted in south-eastern states of Nigeria on 7-9 and 14-17 December 2013. Further National immunization days (NIDs) are planned for late January, followed by National immunization days in March.

Tips For a Better Memory

Normal age-related changes in the brain tend to slow some of our cognitive processes, making it harder to learn new things and easier to get distracted. It can also represent a loss of self as our memories make-up an internal biography of things we have done, people we love, and much more.

As a result, much research has been done on ways people, both young and old, can sharpen their minds.

From Harvard Health Publications here are a few research proven tips for a better memory:

1. Economize your brain use

Take advantage of calendars and planners, maps, shopping lists, file folders, and address books to keep routine information accessible. Designate a place at home for your glasses, keys, and other items you use frequently

2. Organize your thoughts

New information that’s broken into smaller chunks, such as the hyphenated sections of a phone or social security number, is easier to remember than a single long list, such as financial account numbers or the name of everyone in a classroom.

3. Use all your senses

The more senses you use when you learn something, the more of your brain will be involved in retaining the memory. For example, odours are famous for conjuring memories from the distant past, especially those with strong emotional content, such as visits to a cookie-baking grandparent.

4. Repeat after me

When you want to remember something you have just heard or thought about, repeat it out loud. For example, if you’ve just been told someone’s name, use it when you speak with him or her: “So John, where did you meet Paul?”

5. Space it out

Instead of repeating something many times in a short period, as if you were cramming for an exam, re-study the essentials after increasingly longer periods of time — once an hour, then every few hours, then every day. Spacing out periods of study is particularly valuable when you are trying to master complicated information

6. Make a mnemonic

Mnemonic devices are creative ways to remember lists. They can take the form of acronyms — such as the classic “Every good boy does fine,” to remember the musical notes E, G, B, D, and F on the lines of the treble clef. For older learners, a particularly helpful system is a story mnemonic — that is, a brief narrative in which each item cues you to remember the next one

7. Challenge Yourself

Engaging in activities that require you to concentrate and tax your memory will help you maintain skills as you age. Discuss books, do crossword puzzles, try new recipes, travel, and undertake projects or hobbies that require skills you aren’t familiar or comfortable with.

Adapted from Harvard Health Publications by Ladipo Eso

A New Weapon in the Battle of Counterfeit Drugs

А counterfeit medicine is one which is deliberately and fraudulently mislabelled with respect to identity and/or source. Counterfeiting can apply to both branded and generic products and counterfeit products may include products with the correct ingredients or with the wrong ingredients, without active ingredients, with insufficient active ingredients or with fake packaging (World Health Organization)

In December 2012, following months of eviction threats, the National Agency for Food and Drug Administration (NAFDAC) officials raided “Sabon Gari” market in Kano, a well-known hub for the sale of counterfeit drugs, and forced out over 650 drug traders the Agency claimed were selling fake drugs. According to the NAFDAC website, this hard-line approach came after NAFDAC and the Kano State Government jointly destroyed N600 million worth of counterfeit drugs seized from “various illegal and clandestine pharmaceutical outlets across the State.” However, these are merely small victories in a country plagued with fake and substandard drugs.

Margaret Hamburg, Commissioner of the U.S. Food and Drug Administration stated in April 2013 at an FDA media briefing that in a recent review of 28 studies, 35% of antimalarial drugs in Sub-Saharan African in fact were substandard and 20% were counterfeit. Counterfeit drugs with little or no active ingredient can have devastating consequences to a sick and desperate malaria patient. Fake or substandard drugs with reduced dosages of active ingredients cause twice the damage, because the malaria parasite can develop a resistance to the leading anti-malarial drugs, which would be calamitous for public health.

However, a major breakthrough in the fight against counterfeit drugs presents itself in the form of the CD-3, which stands for Counterfeit Detector Device – Version 3.  According to the FDA, work on the device began in 2005 by Nicola Ranieri and Mark Witkowski of FDA’s Forensic Chemistry Center (FCC), who recognized that since substances have unique responses to light, they might be able to develop a portable tool that could identify counterfeits on the spot, even in remote locations.  The CD-3, which is set to be deployed in Ghana in 2013 and 2014, provides a way for workers in the field to quickly, easily, and cheaply identify suspicious medicine, which would prove a vital weapon in the ongoing war against counterfeit drugs.

NAFDAC is not far behind, with the introduction of Mobile Authentication Service (MAS) technology in 2011 on their regulated products. MAS is a service that enables consumers to verify the authenticity of a drug by texting a unique 10-digit code, hidden underneath a scratch-off panel that comes with the pack, to a specific number. Consumers immediately receive a response confirming whether the drug is NAFDAC approved, the company that manufactured the drug and its address, the registration and batch number of the drug, the expiry date, and a number to call to report any issues. With this new technology NAFDAC hopes to eliminate the scourge of counterfeit drugs once and for all.

Contributed by LadipoEso

A New Mosquito Repellent

Could there be a new, more effective repellent to ward off the insect responsible for millions of deaths worldwide. According to the latest estimates released by The World Health Organization (WHO) in December 2013, an estimated 627,000 died as a result of malaria in 2012.

Researchers at the University of California Riverside have a found a substance called Ethyl pyruvate that shuts down the mosquitoes receptors, which are responsible for detecting carbon dioxide from human breath as well as skin odours.

Ethyl pyruvate is already approved as a flavour agent and is present in some wines. It is already being touted as a suitable alternative to N, N-Diethyl-meta-toluamide (DEET), the leading repellent currently in use, except in malaria prone areas like in Africa and Asia due to its cost and need for consistent application on all exposed parts of the body.

Ultimately, a repellent based on Ethyl pyruvate may prove to be cheaper than DEET. The University of California researchers feel that with time they will soon discover a way to manufacture cheaper and more effective repellents to aid the ongoing fight against mosquitoes and malaria.

 

 

Contributed by Ladipo Eso

Is There a Place for Traditional/Herbal Medicine in Healthcare?

What is Traditional Medicine?

Traditional medicine is the sum total of knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures that are used to maintain health, as well as to prevent, diagnose, improve or treat physical and mental illnesses.

Dr. Margaret Chan Director General of The World Health Organization (WHO), while addressing the 2008 WHO congress on traditional medicine in Beijing, Peoples Republic of China stated that the time was right to view traditional medicine as a precious resource that needs to be respected and supported as a valuable source of leads for therapeutic advances and the discovery of new classes of drugs.

A good example of a valuable medicine today is Coartem, which the FDA approved on April 8, 2009 according to the CDC. Coartem is derived from the Chinese herb artemisinin and is used in the treatment of uncomplicated Plasmodium falciparum in adults and children weighing at least five kilograms.

Another example is Nicosan (formerly known as Niprisan), which is a multiple herbal drug that has been approved in Nigeria for the treatment of sickle cell disease and is an example of a herbal drug developed by the NIPRD. In a publication by the American Chemical Society titled Nicosan: Phtomedicinal Treatment for Sickle Cell Disease, Nicosan is described as a phytomedicinal-based drug developed by traditional healers in Nigeria and has been the subject of in vitro studies and clinical trials. It is an extract mixture of four plants, Piper guineenses, Pterocarpus osun, Eugenia caryophyllum, and Sorghum bicolor, all of which grow wild or are cultivated in West Africa.

Relevance of Traditional/Herbal Medicines in Nigeria

According to Dr. Yusuf Noah of the University of Illorin, the healthcare delivery system that exists in Nigeria today is unable to meet the basic needs of many Nigerians due to the high cost of modern healthcare, its advanced technology and a high illiterate population. Furthermore, it is often the only source of medical care for those living in areas where access to advanced medical treatment is limited or non-existent

A study conducted by Oreagba, Oshikoya, and Amchree to assess the extent of use and the general knowledge of the benefits and safety of herbal medicines among urban residents in Lagos surveyed 388 participants and found that 259 (66.8%) used herbal medicines. Out of this demographic, 35% used ‘Agbo jedi-jedi’ making it the most frequently used herbal medicine preparation. ‘Agbo jedi-jedi’ is a popular herbal concoction that it is used for a wide variety of ailments, such as back ache, impotence, diarrhoea in children, fever, but most especially for the treatment of haemorrhoids.

In a related study by Okpuzor and Oloyede, a series of tests were conducted on rats using jedi  jedi  “pill” concoction, the active ingredients were found to be croton penduliflorus, cassia podocarpa and manihot esculenta and its therapeutic effect is anti- inflammatory, anti- pyretic, anti-diarrheal in young children and anti- haemorrhoid properties. Despite these properties, ‘Agbo jedi-jedi’ has not yet been approved by the National Agency for Food, Drug Administration and Control (NAFDAC).

The Future for Traditional/Herbal Medicines in Nigeria

Earlier this year, NAFDAC pledged its support to the development of traditional/herbal medicine in Nigeria. After a stakeholders meeting on the Regulation of Herbal Medicine in Nigeria, Prof. Orhii, the Director-General of the Agency, stated that his administration believes that such medicine should be supported as they are good dietary supplements and are helpful in curing ailments.

As proof of their conviction, plans were made for NAFDAC in conjunction with the Nigeria Institute of Pharmaceutical Research and Development (NIPRD), and the National Association of Nigerian Traditional Medicine Practitioners (NANTMP) to investigate the authenticity of herbal medicines that claimed to cure certain ailments. In addition, the three groups hope to conduct clinical trials for these herbal medicines, which are typically categorized as herbal supplements, so their efficacy can be determined and they can be registered as drugs.

Ultimately, the future of traditional/herbal medicines will be determined by the ability of agencies like NAFDAC to verify that whatever drugs are developed from herbal/traditional medicines are of good quality, safe, and effective.

Contributed by Ladipo Eso