MY
REVIEW …
INTRODUCTION:
Ø 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.
Ø 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
a)
Unconditioned positive regards (Rogers)
Ø Unconditioned
without preconditions, without regards to race, socioeconomic status, color,
etc.
Ø Positive
regards – accept and value the client for what he/she is and not what you want
him/her to be.
Ø Positive
attitude, warm greeting, good eye contact and friendly tone of voice.
b)
Listening sills
Ø This
is very crucial
Ø It
conveys to the client that you are listening
Ø He/she
need to feel that you care and are listening otherwise they may clam up.
Ø During
counseling/therapeutic sessions, handle silence and don’t feel uncomfortable
about it.
2.
Process variables:
a.
Empathy
Empathy
vs. Sympathy definition (Rogers, 1957)
Ø 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.
Ø Truax
(1961) added another aspect of communicating. This understanding to the client.
v Be
authentic; do not pretend
v Empathy
should be adequate
STRATEGY 2
1.
Communication dimensions
a)
Non-verbal communication
Ø This
often conveys acceptance or rejection.
Ø This
is by facial expressions, gestures, tone of voice.
Ø 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.
Ø Arrangement
of furniture in the counseling room may unwillingly create barriers between the
counselor and the therapist.
2.
Process variable
a)
Transference
Ø This
is an unconscious phenomenon where the client transfers emotions he/she feels
towards a significant person in his/her life to the therapist.
b)
Counter transference
Ø Reciprocation
of the emotion by the therapist unconsciously.
c)
Defence mechanisms
Ø Resistance
Ø 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
Ø 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
a)
Accurately/precisely state the mission in order
of:
Ø Objectives
Ø Successes
recorded in the past
Ø Current
challenges
Ø Support
needed
b)
Deliver advocacy materials
c)
Create opportunity for response
d)
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
Ø 1st
OF DECEMBER YEARLY
Ø 2019
THEME = “KNOW YOUR STATUS”
1.
INTRODUCTION:
Ø HIV
stands for human immune deficiency virus.
Ø HIV belongs
to human retrovirus (retroviridae) and the subfamily of lentivirus.
Ø It is the
virus that causes HIV infection and AIDS – the most advanced stage of HIV
infection.
Ø There
are 2 strains of HIV – HIV1 and HIV 2
Ø 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).
Ø The
number of people living with HIV/AIDS (PLWHAS) has increased and most marked in
sub-Saharan Africa.
Ø In Nigeria,
the prevalence varies within states.
Ø Mainly
by heterosexual, perinatal and transfusion of blood and blood products which
pose great concern
Ø 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.
Ø Each
year, 1.5 million women living with HIV become pregnant and without
Anti-retroviral.
Ø There’s
a 15-45% chance that their baby will also become infected.
Ø Among
pregnant women who take Anti-retroviral to prevent mother-to-child-transmission
(PMTCT), the risk of transmission is reduced by <3%
2.
MODE OF TRANSMISSION:
a)
Sexual contact with an infected person i.e.
unprotected sex with homosexuals, heterosexuals etc.
b)
Sharing of contaminated sharp objects e.g.
needles, pins, razor blades etc.
c)
Mother-to-child transmission or vertical
transmission
d)
Intravenous drug use (by IV drug users)
3.
CLINICAL PRESENTATIONS:
Ø Presentation
depends on the stage of the disease.
Ø At the
initial stage, it is an acute infection with no signs and symptoms
Ø Incubation
period is variable and could be up to 10 years or more
Ø Seroconversion
normally occurs during 2 to 12 weeks after infection.
Ø There
are basically 4 stages of HIV infection according to WHO.
Ø At
stage 1, patient can be Asymptomatic with normal activity. CD4+
count of >500/ul. There may be generalized Lymph node enlargement.
Ø 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.
Ø 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.
Ø 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.
4.
BREASTFEEDING IN HIV
Ø For
most babies, breastfeeding is the best way to be fed.
Ø About
5-20% of babies infected through mother-to-child-transmission acquire it
through breast feeding.
Ø 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.
Ø 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.
Ø 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.
Ø Then
give complementary feeds and wean baby at 12 months.
Ø 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.
Ø It is
either Exclusive breast feeding or Replacement feeding but never mixed feeding
(i.e. combination of both).
Ø 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.
5.
TREATMENT MODALITIES IN HIV:
a)
Treatment of Acute bacterial infections.
b)
Prophylaxis and treatment of opportunistic
infections e.g. Pnemocystic Jiroveci or Pneumocystic carinii pneumonia (using
COTRIMOXAZOLE)
c)
Anti-retroviral therapy – (ART) using
zidovudine, Lamivudine, Efavirenz)
d)
Maintenance of good nutrition
e)
Immunization
f)
Management of AIDS defining illnesses.
g)
Psychological support from the family
h)
Palliative care for terminally ill-patients
i)
Monitor the toxicity of the ARV drugs
6.
PREVENTION OF HIV:
a)
General health promotion measures:
Ø Practice
safe sex
Ø Be
faithful to your partners.
Ø Avoid
unwanted pregnancy for HIV-infected women through family planning and
counseling services to prevent mother-to-child-transmission.
Ø Safe
delivery methods, use of anti-retrovirals among HIV-infected women and safer
infant
Ø Feeding
options to increase child health and survival
b)
Health education:
Ø Use
sterile or new sharps like needles, razor blades, etc.
Ø Avoid
illicit drug use (in IV drug users) because they are harmful to health.
Ø Good
personal hygiene e.g. avoid unnecessary injuries, treat wounds to avoid
contamination, etc.
c)
Universal precaution and specific protection:
Ø Always
use screened blood for blood transfusion.
Ø 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.
d)
Early diagnosis and treatment:
Ø By
voluntary HIV screening and counseling.
Ø Ensure
HIV testing of every pregnant woman with prompt intervention of effective
Anti-retroviral therapy
Ø Support
and care for HIV+ve infected women and their families
Ø Strict
adherence to therapy to reduce the viral load
Ø Follow-up.
7. CONCLUSION:
Ø HIV/AIDS
is a very deadly disease in our environment and therefore requires
precautionary measures.
Ø Nigeria
is an enormous country with a very high number of people living with HIV.
Ø 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.
Ø Enhanced
and more strengthened surveillance system targeting the whole population and
with special attention to the “most-at-risk” need to be implemented.
Ø 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.
Ø 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.
Ø 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:
Ø Breastfeeding
is the feeding of an infant with breast milk directly from the female breast.
Ø 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.
Ø This
will supply the macro and micro nutrients in adequate amount for optimal growth
and development of the child.
Ø 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)
Ø Oxytocin
release is responsible for the milk let down reflex. It can further be
stimulated by pleasant conditions in the parturient mother.
Ø Pain,
worry, doubt can hinder the reflex and can stop the breast milk from flowing
temporarily
2. TYPES
OF FEEDING IN INFANTS:
a)
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.
b)
Complementary feeding:
Ø This
is the transition from exclusive breast feeding to family feeds i.e. giving a
baby other foods in addition to breast feeding.
Ø 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.
Ø Complementary
feeds must be given in the most acceptable and digestible forms for the growth
and development of the child
Ø It
should be responsive and food should be safe for consumption
Ø Increase
the consistency and frequency gradually
c)
Supplementary Feeding:
Ø This
is feeding that substitutes breastfeeding
Ø They
are feeds given to a baby under 6months to supplement his intake of breast milk
where it is insufficient
d)
Predominant Feeding:
Ø 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.
3. COMPOSITION
OF BREAST MILK
a)
COLOSTRUM:
Ø This
is the 1st milk produced in the 1st few days after
delivery
Ø It is usually
small in volume
Ø It has
more protein, antibodies, anti-infective proteins, vitamin A than the mature
milk
Ø It has
less fat than mature milk
Ø It is
regarded as the 1st immunization against diseases a baby will
receive after delivery
Ø It has
mild laxative effect which helps the baby to evacuate meconium. This helps
clear bilirubin in the gut thereby preventing neonatal jaundice
Ø There
are presence of growth factors which helps the baby’s immature intestine to develop
thereby preventing baby from developing allergies
b)
TRANSITION MILK:
Ø This
is the milk that replaces colostrum
Ø It is
secreted 5-15days after delivery
c)
MATURE MILK:
Ø This
replaces transitional milk
Ø It
contains less protein but more fat
Ø Comprises
of foremilk (greyish milk) produced in large quantity, contains more water than
the hind milk
Ø Also
the hind milk (yellowish) contains more fat for satiety
Ø It is
important that baby feeds on one breast per feed thereby taking the fore milk
and hind milk
Ø This
will supply all the nutrients and adequate calories needed for growth and
development
d)
OTHERS:
Ø Carbohydrates
e.g. lactose
Ø Proteins
e.g. lacto-albumin, cysteine needed for brain development
Ø Lipids
e.g. polyunsaturated fatty acids, TGS
Ø Vitamins
e.g. vitamin A,C,E but low in D,K,B12
Ø Minerals/electrolytes
e.g. potassium, calcium
Ø Trace
elements – low in iron
4. BENEFITS
OF BREASTFEEDING
a.
To the baby:
Ø Confers
immunity and protects against infections (immunologic function)
Ø Contains
right balance of nutrients needed for optimal growth and development
Ø Reduces
the risk of allergies e.g. juvenile asthma
Ø As a
mild laxative, meconium is easily evacuated and less risk of neonatal jaundice
Ø Increases
the IQ i.e. intelligent children. The taurine and cystein in breast milk help
in brain development
Ø Nutrients
are easily absorbable
Ø Helps
in language, cognitive and perceptual development
b.
To the mother:
Ø Mother-to-child
bonding
Ø Enhances
child spacing(lactational Amenorrhea)
Ø Decreases
the risk of ovarian, breast cancers
Ø Helps
to fasten involution of the uterus
Ø Lowers
the risk of post-partum hemorrhage
Ø Gives personal
satisfaction and fulfillment of motherhood
Ø Saves
time
Ø Convenient
and economical
Ø Reduces
pain by releasing oxytocin
Ø Decreases
the risk of maternal and infant mortality
Ø Decreases
the risk of osteoporosis and rheumatoid arthritis
c.
To the family and community:
Ø Saves
cost
Ø Safe
for the environment e.g. no littering of cans
5. MISCONCEPTIONS
ABOUT BREASTFEEDING
a)
That breast milk is not enough for a growing
child
b)
If breast size is small, milk output will be small
c)
That colostrum is a dirty milk and should not
be given to the baby
d)
That breast may sag as a result of
breastfeeding
e)
That it causes loss of sexual appeal
f)
That it hinders sexual activity during
lactation
6. PROBLEMS
ASSOCIATED WITH BREASTFEEDING
Ø It may
be embarrassing outside the home especially in public places
Ø Transmission
of infections e.g. HIV, Hepatitis B is higher
Ø Drug
transmission e.g. cancer drugs and alcohol
Ø Breast
milk jaundice
Ø Hemorrhagic
disease of the newborn can occur since there’s low vitamin K in breast milk
7. CONCLUSION
Ø Breastfeeding
is the most natural way to feed a baby
Ø The
breast milk provides the ideal nutrition for the infant and are more easily
digested than infant formular
Ø Breastfeeding
lowers the baby’s risk of having asthma and other allergies, reduces respiratory
infections and bouts of diarrhea among other benefits
Ø 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
Ø 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
Ø Also inverted
nipples, cracked nipples, sore nipples, breast infection (mastitis) are other
challenges encountered during breastfeeding
Ø Call
your doctor if your breasts become unusually red, swollen, hard or sore; and
Ø If you
have bleeding from your nipples, unusual discharge etc.
Ø 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
BY: DR IZUAGBA KELECHI
.U.
1.
INTRODUCTION:
Ø Cervical
cancer is the commonest reproductive cancer found in women and the 2nd
commonest cancer after breast cancer
Ø It is
due to abnormal growth of cells that have the ability to invade or spread to
other parts of the body
Ø It is
highly preventable and can lead to untimely death in extreme cases
Ø It can
be prevented by PAP smear screening and HPV vaccine
Ø The
high mortality rate globally can be reduced through early diagnosis,
prevention, effective screening and treatment programmes
Ø Screening
aims to detect precancerous changes which if left untreated, may lead to cancer
2.
CAUSES:
Ø The
cause of cervical cancer is “unknown” but has been linked to HPV (Human
Papilloma Virus) which is a sexually transmitted infection
3.
SYMPTOMS / COMMON PRESENTATIONS
a.
Post coital/sexual bleeding
b.
Inter-menstrual bleeding
c.
Foul smelling vaginal discharge
d.
Dyspareunia (pain during sexual intercourse)
e.
Pelvic pain
f.
Weight loss
4.
RISK FACTORS:
a)
Early sexual activity (coitarche) before the
age of 16
b)
Unprotected sexual intercourse with multiple
sexual partners
c)
Genetic/family history of cervical cancer
d)
Smoking cigrattes – this is associated with
squamous cell cervical cancer
e)
Use of cocaine
f)
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.
5.
TYPES OF CERVICAL CANCERS:
a)
Squamous cell carcimona (commonest type)
b)
Adenocarcinoma
c)
Adenosquamous carcinoma (rare)
d)
Undifferentiated type (very rare)
6.
IMMEDIATE
CAUSE OF DEATH IN PATIENTS
a)
Haemorrhage (excessive bleeding)
b)
Cancer spread to the kidneys causing uremia
c)
Infections in the system caused by the cancer
cells
7.
PREVENTION OF CERVICAL CANCER
a)
Be faithful to your patner
b)
Play safe by practicing protected sex
c)
Avoid smoking of cigrattes
d)
Do not abuse drugs like cocaine
e)
Get vaccinated immediately!!!
Ø The
vaccine called GARDASIL is a very potent vaccine and it is very important that
every woman of reproductive age group must get it
Ø The
vaccine prevents the HPV (Human Papilloma Virus) from causing cervical cancer
in future
f)
Visit the hospital for PAP smear screening
8.
TREATMENT
Ø Treatment
is so diverse and involves the use of chemotheraphy, radiotheraphy and surgery
Ø Treatment
basicallky depends on the stage of the disease
9.
CONCLUSION
Ø The
survival rate of cervical cancer decreases as the disease gets worse
Ø The
peak age of cervical cancer is from 50 years but can occur after 30 years
Ø 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.
Ø 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
Ø Screening
should be performed at least once for every woman in the target group (30-50
years)when it is most beneficial
Ø HPV
testing, cytology, VIA (Visual Inspection with acetic acid) are all recommended
screening tests
Ø “Screen
and treat” and “screen, diagnosis and treat” are both valuable approaches
Ø 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:
Ø 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)
Ø 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.
Ø 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.
Ø 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”.
Ø Higher
in both extremes of socio-economic groups.
Ø Commoner
in blacks/black population
Ø Prevalence
in Nigeria is 11.2% in adults
Ø 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
Ø Effective
BP control is possible and can be achieved
2.
CLASSIFICATION OF HYPERTENSION
Ø Based
on JNC-7 classification, it can be
a)
Normal BP = <120/<80 mmHg
b)
Optimum BP = 120/80 mmHg
c)
Pre-hypertension = 120-139/80-89 mmHg
d)
Stage 1 hypertension = 140-159/90-99 mmHg
e)
Stage 2 hypertension = >or=160/>or =100
mmHg
Ø Based
on the cause / aetiology:
a)
Primary hypertension / essential /
idiopathic(unknown)
b)
Secondary hypertension
Ø The primary/essential
hypertension is the “commonest” accounting for 95% of cases
Ø Because
the cause is unknown, it is non-curable; and treatment is for life
Ø The
primary hypertension is likely due to interplay between factors (risk factors)
which maybe different among individuals
Ø The
secondary hypertension accounts for the remaining 5% of cases.
3.
RISK FACTORS OF HYPERTENSION (PRIMARY TYPE)
a)
Hereditary/generic factors i.e. family history
b)
Advancing age (45years and above)
c)
Obesity
d)
Dietary factors e.g. excessive salt intake, low
k+ , low
vegetables/fresh fruits, saturated fats (hyperlipidemia)
e)
Excessive alcohol consumption
f)
Physical inactivity
g)
Smoking
h)
Socio-economic status (both high and low)
i)
Gender factor – less in pre-menopausal women,
more in men (oestrogen is protective)
j)
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.
4.
FACTORS THAT TRANSIENTLY INCREASE BP:
a)
Anxiety
b)
Cold
c)
Sexual orgasm
d)
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.
5.
COMMON PRESENTATIONS OF HYPERTENSION
a)
Asymptomatic (i.e. no symptoms hence called a
“silent killer”)
b)
Occasional symptoms e.g.
Ø Headache
Ø Dizziness
Ø Palpitations
(awareness of one’s heart beat)
6.
TREATMENT
a)
Non-medical treatment: lifestyle modification
e.g.
Ø Weight
reduction
Ø Exercise
Ø Reduced
salt and alcohol intake
Ø Stop
smoking
Ø Dietary
approach e.g. take more fruits and vegetables
Ø Reduce
intake of refined sugar
b)
Medical treatment:
Ø 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.
7.
CONCLUSION:
Ø Hypertension
is a very common disorder in aged people and it is associated with higher risk
of cardiovascular morbidity and mortality
Ø Effective
blood pressure control can be achieved with strict adherence to medications and
life style changes
Ø 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
Ø 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
Ø Visit
your doctor if there are complaints
Ø 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:
Ø 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.
Ø 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.
Ø 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
Ø 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.
Ø 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)
Ø 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.
Ø 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.
Ø 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.
2.
COMMON PRESENTATIONS OF SICKLE CELL ANAEMIA
a)
Stable state / pain-free period
b)
Vaso-occlussive crisis (VOC)
c)
Sequestration crisis / Acute sequestration
crisis
d)
Haemolytic crisis
e)
Aplastic crisis
f)
Megaloblastic crisis
Ø 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
Ø 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
Ø 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
Ø 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.
Ø In
vaso-occlusive crisis, it is pertinent to hydrate the patient, treat the
underlying infection e.g. malaria, give analgesics e.g. paracetamol
Ø 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.
Ø 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.
Ø Megaloblastic
crisis occurs due to increased turnover of red blood cells, recurrent
infections, malaria infestation and folate deficiency.
3.
CLINICAL FEATURES OF SICKLE CELL ANAEMIA
(COMMON
FEATURES)
a)
Leg ulcers
b)
Frontal bossing (bossing of the skull)
c)
Osteomyelitis
d)
Gnathopathy (mal-occlusion of jaw, protruded
upper teeth/buck/rabbir teeth)
e)
Stunted growth
f)
Spindle-shaped thin digits
g)
Abdominal distension
h)
Barrel chest
i)
Asthenic build
j)
Chest pain
k)
Priapism in males
l)
Delayed puberty
m) Jaundice
n)
Pallor
o)
Other advanced systemic manifestations e.g.
stroke, splenomegaly, cardiomegaly etc.
p)
Impotence
4.
PREVENTING CRISIS IN SICKLE CELL ANAEMIC
PATIENTS
a)
This will include “primary prevention” by
marriage counseling for known carriers of the HbS gene to prevent having
children with sickle cell anaemia
b)
Vaccination: by giving the routine
immunizations and other vaccines such as pneumococcal vaccine
c)
Avoid dehydration and take plenty of water
orally (liberal fluid intake)
d)
Use / give malaria prophylaxis using daily
proguanil alongside intermittent preventive treatment (IPT) for malaria
e)
Folic acid should be given to prevent anaemia
from folate deficiency.
f)
Antibiotics – this will help prevent infections
like pneumonia which increases morbidity and mortality in these patients
g)
Other advanced therapies includes:
Ø 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.
5.
TREATMENT OF SYMPTOMS OF SICKLE CELL CRISIS
Ø 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.
a)
Use of analgesics e.g. ibuprotein, pentazocin,
etc.
b)
Use of intravenous infusions in patients with
vaso-occulsive crisis
c)
Use of whole blood transfusion in treatment of
severe anaemia and splenic sequestration crisis.
d)
Supplemental oxygen in Acute chest syndrome and
other crisis as indicated
e)
Treatment of infections/malaria with
antibiotics and antimalanals respectively.
f)
Other advanced treatments include:
i.
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
ii.
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
iii.
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
iv.
Surgery: in some cases of retinopathy with
retinal detachment or cases of hypersplenomegally, surgery may be indicated.
v.
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.
6.
CONCLUSION:
Ø 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.
Ø 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.
Ø Preconceptional
counseling for sickle cell disease couple is very important to protect them
from trauma of un-willful and unsafe abortions.
Ø 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.
Ø 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
Ø 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.
Ø 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.
Ø With
the new and aggressive therapy, life expectancy has increased from 14years to
about 50 years currently
Ø I
therefore every prospective couple to
ALWAYS
CHECK THEIR GENOTYPE BEFORE MARRIAGE. A STITCH IN TIME SAVES NINE.
THANKS…
