Disease Information

It was Monday morning, and as usual Doctor Emeka was looking dapper in his ward coat. He was about adjusting his glasses when a frantic knock at the door interrupted his hands midway. “Come in,”  Emeka said, inviting a huge middle-aged woman, who  gingerly made her way into the office and occupied one of the two chairs across from the Physician’s desk. “Good morning,” Emeka, being his usual jovial self, greeted Mrs. Ade. “E karo oo! Doctor (Good morning, Doctor)”, Mrs. Ade replied, leaning forward in her seat. Mrs. Ade was recently diagnosed with type 2 diabetes and she had come for her routine medical check-up. “How are you feeling today?” Dr. Emeka asked, peering at her through his round-framed eyeglasses. “Ah! Doctor! Throughout the night, I couldn’t sleep, oh!! She exclaimed, waving her hands for emphasis she continued; “I was waking up every 30 mins to urinate…. the worst part is I don’t know if the headache I have is due to lack of sleep or is something more serious. Because, Doc, my head is pounding!” After a brief pause to see if Doctor Emeka was listening, she continued excitedly as she could see she had his rapt attention. “Even today, when I went to open my shop,  ..you know, so I could sell some fabrics before coming here, the headache still continued and I felt very tired” Suddenly, she pointed at him angrily saying; “You people said I have diabetes. Ehn? Doctor? What kind of sickness is this? I have heard of this diabetes before but I don’t know what it is.” Mrs Ade said, gesticulating heavily. “Okay, so first of all”, Doc Emeka said in a way to calm her down, “I’ll prescribe some drugs for you so you can feel better”. “Now, to your question: Diabetes is a disease in which the glucose …that’s like sugar- that is gotten from the food that you eat cannot be properly processed and used by your body.” Leaning forward over his desk, he continued, “You see, Mrs Ade, when you eat food, your body breaks it down to glucose and this glucose enters your blood. From there, a hormone, called insulin, produced by the pancreas, acts like a key that opens your cells for the glucose in your blood to enter the cells where it is used to make energy for living” He paused to ask if she understood, Dr Emeka continued following an affirmative nod from Mrs. Ade. “In type 1 diabetes, this insulin is not produced at all. Therefore, patients having this type of diabetes have to depend on insulin injections, but in type 2 diabetes, the insulin produced in your body is not sufficient or the body cells have become resistant to it. In both types, your blood sugar level is usually higher than normal. This is called hyperglycemia,“. “Okay. Thank you, Doctor. So why did you give me that injection to be using? Er…insu..insult..in…” “Insulin?” “Ehen! Omo mi (my child)! Olorun bukun fun o (God bless you)! Insulin, dear.” “I placed you on insulin therapy because from the tests conducted, your body does not produce enough insulin.” “Ah! But, Doctor! Me, tapping her chest, I cry like omokekere (small child) when I see needle oh! I don’t like injections at all! Arranging the oral medicines on one side and the Insulin Injector on the other, she continued; “Ah! I will be taking only those drugs that you gave me oh, and keep this injection one side,” Mrs. Ade looked away, pouting. “Those drugs that I placed you on are only to boost your insulin sensitivity so that your body can make energy. But insulin therapy is necessary because your body does not make enough insulin.” “But, wo! Is this how I will die, Doctor? I heard that diabetes kills people well well. Me, I don’t want to die and leave my children for another woman to take care of, oh!“, Mrs. Ade said, shaking her legs vigorously and almost crying. “No, ma’am. The disease is not a death sentence. It can be managed. You’ll be fine,” Doctor Emeka consoled her. “ “I know you are upset and a bit scared of needles, but you must know that the insulin injectors come in various forms, like; he went along to name some of them, “…the insulin pens and pumps, all of them come with micro-sized needles…very tiny needles, the doctor, makes a gesture with his index finger and thumb so that they touch at the tips, “insulin is meant to be injected underneath the skin, that is subcutaneously, as such the needles are small and the prick almost painless!” …Okay…Doc, you know best, so I’ll just try this insulin and see how it goes…Mrs. Ade reluctantly agrees. Just before the doctor could speak, she continued as though it was the same sentence, “But must it be in the Fridge, …you know as light is in this country..” “You have to keep it in a cool place, and the refrigerator is best to keep it at an ideal temperature, to maintain its effectiveness.”  Doctor Emeka, smiled his famous megawatts grin before saying; “don’t worry you can get an ice pack from the Pharmacy for those times when there are power outages” “The Pharmacist will also show you how to use and refill the insulin Pen.” “Don’t use more than the dose I prescribed, even if you missed a dose, take it as soon as you remember…unless it’s closer to the next dose” “If you take too much insulin, your blood sugar level may drop too low and this could have serious effects like extreme tiredness, lack of coordination and even loss of consciousness….even normal doses of insulin have side effects too like bloating, and weight gain. If you notice any other changes, please inform me.” “Ah! Ese oh, Doctor!(Thank you, Doctor) Olorun bukun fun o fun mi (God bless you for me)! Eeni jiya laye o(You will never suffer in life),” Mrs. Ade pronounced as she

World AIDS Day remains a time to reassess the efforts we are making in the fight against the virus. This year focuses on continually building resilient care services around the globe in the light of the recent Corona virus pandemic including accessing individual country progress. Going over the basics of the disease is surely a good idea as information remains a potent tool to improve public awareness and guide individual decisions. HIV stands for human immunodeficiency virus which causes the HIV infection. The most advanced stage of this infection is AIDS which occurs when an HIV positive individual does not receive treatment; AIDS means Acquired immune deficiency syndrome; Immune deficiency has to do with a weakness in the immune system that helps to fight diseases thus people with AIDS are prone to many other diseases example tuberculosis. How is it spread? HIV is found in body fluids such as blood, semen, pre seminal fluids, vagina fluids, breast milk and rectal fluid. Common ways in which the virus can be spread – Having unprotected sex this include Vagina, Oral and anal sex and also engaging in unsafe sexual practices with an HIV positive individual or persons -By sharing needles with someone who has the virus, now this can be seen in drug abusers. -The virus can also be spread from a pregnant woman who is HIV positive to her child, it’s also spread through, child birth and during breast feeding. – Sharing tattoo equipment without sterilization between use -Through exposure to the blood of someone living with HIV such as through a needle stick. Health workers are prone to needle stick injuries -Through blood transfusion of blood that was not properly screened. HIV is not found in sweat, saliva, tears and therefore the virus cannot be spread through hugging an individual or having casual contact with one. The virus cannot be spread by sharing a toilet, towels or bedding with an HIV positive individual or through a mosquito or insect bite. Symptoms of HIV Early symptoms include fever, chills, skin rash, sore throat, body pains, swollen lymph node. Other symptoms occur when the immune system has been severely weakened. These include rapid weight loss , recurrent fever and night sweats, sores on the mouths , anus and genitals, bruises and bleeding that can’t be explained , recurrent or chronic diarrhea , bumps or legions on the skin. There is also a presence of opportunistic infections (occur in persons with weakened immunity) like pneumonia, tuberculosis and other sexually transmitted diseases. You can’t rely on symptoms to know if you have HIV or AIDS, the best way is to get tested. Fortunately there are a large variety of do-it-yourself kits in the market, all you need do is visit the nearest pharmacy. How can the risk of getting HIV be reduced? 1) Practicing safe sex using condoms 2) Limiting the number of sexual partners 3) Avoid sharing injection and other piercing instruments 4)The use of PREP and PEP Treatment HIV has no cure but it can be managed by using medicines that helps prevent HIV from progressing to AIDS and it can be prevented also by using PrEP or PEP. Pre exposure prophylaxis (PREP) is taken by individuals who are at risk of getting HIV and hence are taken at points where there is a risk of infection and Post exposure prophylaxis (PEP) is for those who may have been exposed to the virus and it is usually taken within 72 hours of exposure. The management of HIV and the use of PEP and PREP has made it possible for an HIV positive mother to give birth to a HIV negative baby. Interestingly, an HIV negative partner may have sexual intercourse with his HIV positive partner without the fear of transmission provided the negative partner adheres to the PrEP strictly. PEP is also useful in cases of rape or sexual assault; the victims are given PEP to prevent getting infected by the virus. Talk to your health care provider and stay safe. Pharm. Emmanuel Bosco Otite  

We were at the airport trying to board a flight back home to Akure, Ondo state, Nigeria. My dad has been missing for some days now and no one seemed to know his whereabouts. I had been so caught up with work, school and my family that I totally forgot to check up on my parents. On getting home after an eighteen-hour flight from Australia, I decided to rest and search for my dad the next day but before I could retire to my room, a heavy knock was heard on the door. My mum looked at me wondering if I was expecting someone, we got to the door and there was my dad looking so pale and weak. I screamed and rushed to hug him but he pushed me away. I and mom were shocked. I said, “Baba Wunmi, it’s me your only daughter Wunmi”. He replied, “leave my house, I have no child”. I cried all night because I have never seen daddy this cold. It didn’t take long before the doctor diagnosed him with a condition called Senile Dementia also known as Alzheimer’s Disease. This year, the theme of World Alzheimer’s day is “Lets talk about Dementia” as a way of opening up a conversation about the experiences of persons with this condition. A lot of people are not aware of this particular disease condition and because of this the patients are not cared for properly. Although, the exact cause of Alzheimer’s disease is not fully understood it is caused by a combination of genetic, lifestyle and environmental factors. Quick Facts About Alzheimer’s Disease It is a progressive disease that causes the brain cells to degenerate and die leading to loss of memory and other important brain functions. It can’t be cured but can be managed It requires medical diagnosis It can be a lifelong condition Symptoms of Alzheimer’s Disease Memory Loss: This can be observed when the individual repeats his statements and questions, gets lost in familiar places, forgets names of family members. They find it difficult to concentrate & think about abstract concept such as numbers and managing finances. Behavioral changes: Their personality and behavior start to change. They become depressed, apathetic, aggressive, easily irritated, delusional, and distrust people easily. At the last stage of the disease, the brain changes begin to affect balance, bowel and bladder movement. Risk Factors Age – It doesn’t affect kids, mostly people >65 years old Family history and genetics (when a relative has the condition) Down Syndrome Sex – It’s usually more common in females than in males. Past head trauma Poor sleeping patterns Lifestyle and Health: Lack of exercise, obesity, smoking, high blood pressure, high cholesterol, poorly controlled type 2 diabetes. Prevention Alzheimer’s disease is not a preventable condition. However, a number of the lifestyle risk factors mentioned above can be modified by Exercise regularly. Eat a healthy diet Manage high blood pressure, high cholesterol and diabetes properly. Quit smoking and drinking Engaging in mentally stimulating activities and games have been reported to be helpful. Now you can understand why Baba Wunmi couldn’t recognize his only daughter. Family members of persons with Alzheimer’s Disease deal with such regularly and its really important we create more awareness about the condition and the struggles around it. Anyanwu Tobechi Innocentia Pharmacist in Training at the University of Port- Harcourt

Hemorrhoids are blood vessels that are located in the muscles of the walls of the rectum and anus. They are located at the junction where small arteries merge into veins.  Now, hemorrhoids become an issue when they begin to swell, cause itching, pain and/or bleeding. This condition is referred to as hemorrhoidal crises or hemorrhoidal disease (commonly called pile). Causes of Hemorrhoidal Disease It usually develops due to increased pressure in the lower rectum and this can be due to:  Straining while stooling. Sitting for too long  Chronic diarrhea or constipation Obesity Pregnancy Anal sex Regular heavy lifting Colon cancer  Previous kidney surgery Alcohol, fat or spicy foods Risk factors Age – The older one gets, the more predisposed they are because of weakening of the tissues supporting the veins in the rectum and anus. Family history – When a family member had the condition. There are different types of hemorrhoids and they are classified based on their location to the pectinate line(this is the dividing point between the upper 2/3 and lower 1/3 of the anus). They include:  Internal hemorrhoids: These are located above the pectinate line and are covered with same cells as those that line the intestine. There are different grades of internal hemorrhoids, based on the degree of position change below the pectinate line into the anal canal. Grade 1: Here the hemorrhoid bulges into the anal canal but it doesn’t fall completely. This may bleed. Grade 2: It becomes visible outside the anus during straining but spontaneously returns to its original internal position once the straining is stopped. Grade 3: The hemorrhoid protrudes past the anus without any straining. Grade 4: Here the hemorrhoid becomes too painful to be pushed back in. External hemorrhoids: These are located below the pectinate line and are covered with cells that resemble the skin. Symptoms 1. External hemorrhoids: These can form blood clot and lead to:  Acute and throbbing pain (most common) Excess skin tags that cause difficulty with cleaning after stooling and can cause secondary skin infections Dark and clotted bleeding 2. Internal hemorrhoids: These can prolapse (move from original position) and/or form blood clots    causing: Bleeding that is usually painless (most common)  Mucus discharge which leads to irritation (burning and itching) of the skin around the anus Moderate fecal incontinence (inability of the bowel to hold feces) Pain (rarely)  Diagnosis Physical examination Anoscopy, sigmoidoscopy or colonoscopy (All examinations carried out to examine changes around the bowel and anus). Treatment Options Medications This includes pain killers like diclofenac, stool softeners, anti-diarrheal agents, other medications including suppositories to shrink the hemorrhoid. its important to be very weary of herbal medicines peddled as been effective Surgery Widely used for those who medications prove ineffective Lifestyle measures (These are quite effective for prevention as well) Increase in fiber intake and fluids Avoiding prolonged sitting/defecating position and straining Avoiding anal intercourse Regular exercise In conclusion it is important to get treated at early stages for better results if any symptoms are experienced. Seeing a physician is really important. Self medication is not the way to go. Pharm Blessing Maduelosi (B.Pharm UPH)

Hepatitis is an inflammatory (swelling) disease of the liver mainly caused by viral infection and excessive alcohol intake.  Viral hepatitis which is our focus here results from infection with any of the following viruses: Hepatitis A, B, C. D or E virus. Modes of Transmission Hepatitis A and E are contracted when  the viruses are taken in contaminated food or water while Hepatitis D infects a person with untreated Hepatitis B.  Hepatitis B and C are transmitted through infected blood, body tissue, and other body fluids such as semen. Modes of Transmission Unprotected sex Transfusion of infected blood and blood products, Injections during surgery and dental procedures Injection Drug Use (IDU)  Patient care by surgeons and dentists, and other health practitioners who come in contact with blood and body fluids. Childbirth, and from an  infected family member to infants.  In Nigeria some specific local practices have been tied to Hepatitis B and C infections and a few of them include Local  circumcision,  Drawing tribal marks Body piercing Child deliveries especially with infected mothers  Blood oaths  Local hair cutting Local manicure/pedicure.  Persons most at risk of contracting Hepatitis B and C are commercial sex workers, men having sex with men, medical practitioners, HIV patients, prisoners, persons injecting drugs, persons who have multiple sex partners.  Possible Complications Left untreated, Hepatitis B and C infections can become very severe and cause death of liver cells (cirrhosis), liver failure, and liver cancer (hepatocellular carcinoma).  Preventive Measures Hepatitis A  vaccination is available and quite effective.  Both Hepatitis A and E can aslo be prevented by Washing hands after using the restroom.  Thorough washing of food, fruits, and vegetables before consumption  Washing hands  before eating.  Prevention of Hepatitis B, C & D.  The best prevention for Hepatitis B and D is with  taking the Hepatitis B vaccines for newborns and adults. There is currently no vaccine for Hepatitis C.  Other preventive measures for Hepatitis B and Hepatitis C include: Safe injection practices in health centers Avoiding contact with unscreened blood and blood products Screening of donor before use for patients. Practicing safe sex  Signs and Symptoms Signs of chronic Hepatitis B and C infections take long to appear. Some of the symptoms  include: Abdominal pain, Dark urine, Joint pain, Jaundice (yellow color in skin or eyes),  Fatigue.  Treatment Drugs are available for treating chronic hepatitis B and for cure of hepatitis C. Treatment for hepatitis B is lifelong as it has no cure yet.  All drugs for the treatment of viral hepatitis are to be procured following a positive diagnosis at an approved health facility and with prescription from a certified physician. In general, the most affordable remedy remains prevention. Early diagnosis and proper treatment will prevent chronic disease, liver damage and other losses including death.  Emmanel Edeh Pharmacist in Training at the University of Port Harcourt

In a world where there is a lot of misinformation about epilepsy, epileptic patients are stigmatized and are also denied some human rights. It is vital to know about the disease as it is a really common occurrence. Epilepsy is a non-communicable disease (cannot be transmitted from a patient to an healthy person) in which there is abnormal brain activity. It is associated with recurrent seizure (mostly presenting as vigorous shaking) followed by unconsciousness. It is also important to know that a onetime seizure doesn’t make an individual epileptic. In fact, a significant number of individuals had slight seizures as babies mostly as a result of fever. Causes In about 50% of cases cases, the cause is unknown. However, its causes are classified as Structural – Due to head injury or a tumor Genetic – Some birth defects especially in the brain that are inherited Infectious – Infections that reach the brain Metabolic – Example low blood sugar or low blood PH Immune – when the bodies immune system attacks body cells especially in the brain Unknown Signs and symptoms Seizures are the most common symptom, they vary and the frequency is widely dependent on the severity of brain damage. Some symptoms include: Loss of consciousness Uncoordinated body movements (can lead to physical injury) Temporal lack of sensation Temporal inhibition of movement Change in mood and other cognitive functions Depression, anxiety etc. Handling an epileptic episode As a non-medical professional, the best line of action is to help the individual lie in a position where they don’t get injured due to the uncoordinated body movement. They can then be taken to the hospital, however most of such episodes end on their own after a few minutes. One commonly held belief is putting a spoon in the patient’s mouth so the upper and lower teeth don’t come together. This to believed to stop the episodes or prevent the patient from dying but this is not backed by science. Can the disease be prevented? Yes, it can. In fact, 25% of epileptic cases can be prevented or avoided through the following: Adequate prenatal care to prevent cases caused by birth injury Prevention of head injury Taking care of the cardiovascular health by reducing the risk factors of cardio vascular diseases such as diabetes, obesity, high blood pressure etc. Practicing good environmental hygiene so as to eliminate parasites that can cause some central nervous systems infection. Treatment options exist in the form of medications and surgery, it all depends on the severity and the causes. In conclusion persons with epilepsy can enjoy quality lives when they get the needed treatment. Sunday Oluchi Goodness  

Juvenile arthritis is a kind of arthritis that occurs in children below 16 years and involves swelling of the synovium (a tissue that lines the walls of the joints). It is described as an auto-immune disease meaning that the body’s immune system attacks the body cells (healthy joint tissues) instead of foreign invaders such as virus and bacteria. This leads to joint damage. Juvenile arthritis is also called Idiopathic juvenile arthritis (IJA). This means that the precise cause is not known. However various research has been able to link its occurrence to genetics, environment or certain infections. Symptoms of Juvenile Arthritis Joint stiffness, especially in the morning or after periods of inactivity Pain, swelling, and tenderness in the joints. Persistent fever Rash Weight loss Fatigue Irritability Eye redness Blurred vision Types of Juvenile Arthritis Systemic arthritis This form  can affect the entire body or many systems of the body. It is also known as Still’s disease. This type is usually associated with high fever and rash and can also affect internal organs but usually not the eyes. Boys and girls are equally affected. Oligoarthritis This affects fewer than five joints in the first six months that the child has the disease. The joints most commonly affected are the knee, ankle, and wrist. It can affect the eye, most often the iris(uveitis). It is more common in girls than in boys, and many children will outgrow it when they become adults Polyarthritis It involves five or more joints in the first six months of the disease often the same joints on each side of the body(symmetrical). This type affects the joints in the jaw and neck as well as those in the hands and feet. It is also more common in girls than in boys and more closely resembles the adult form of arthritis. Psoriatic Arthritis This is seen in children who have both arthritis and a fungal skin disorder called psoriasis. The child might get either the psoriasis or the arthritis years before developing the other part of the disease. Children with this type of arthritis often have pitted fingernails. Enthesitis-related arthritis This type of arthritis often affects the spine, hips, eyes, and entheses (the places where tendons attach to bones). It occurs mainly in boys older than 8 years of age. There is often a family history of arthritis of the back (called ankylosing spondylitis) among the child’s male relatives. Diagnosis/Treatment There is no single test to diagnose IJA. Instead a combination of tests are used. Medical history is taken and symptoms such as swelling, stiffness and pain are inquired about. Blood work for certain cell markers or possible infections and imaging to observe muscles and bones and bones are also necessary The goals of treatment include To relieve pain and reduce swelling To increase joint mobility and strength Prevent joint damage and other complications IJA can be managed with medications, but other than drug treatment, patients are often advised to exercise regularly and maintain healthy weight, as the disease is triggered by inactivity. Various medications are available for treatment and the physician prescribes based on the peculiarity of the patient’s symptoms and other factors. They include: NSAIDs (Non-steroidal anti-inflammatory drugs) which are painkillers such as ibuprofen, diclofenac etc. DMARDS (Disease modifying anti-rheumatic drugs) such as sulfasalazine, hydroxychloroquine, eternacept etc. Corticosteroids such as prednisolone. Antimetabolite agent such as methothrexate. Chukwu Unique Onyinyechi (B.Pharm UPH)                  

Diabetes mellitus is a lifestyle disease. It can be easily prevented but has continued to be on the increase due to poor awareness leading to late detection. It is a chronic disease (develops slowly over time) in which the pancreas no longer produces enough insulin. In some cases when insulin is produced the body cells stop responding to it. Insulin is the hormone that helps the body cells absorb the blood glucose from the food we eat. When insulin is not available or when the body cells doesn’t respond to insulin the amount of glucose in the blood becomes high and the cells are deprived of glucose. Over a period of time this disease affects many organs. If not detected early enough for treatment it can lead to other health issues such as renal failures, blindness, stroke etc. 3 Types of Diabetes exist Type 1 diabetes which was formerly known as juvenile or insulin dependent. It is the type that requires daily administration of insulin because the body produces less or no insulin. Its cause is still unknown and is rarely prevented for now. It’s very common in little children. The symptoms include excessive urination, constant hunger, weight loss, vision impairment and fatigue Type 2 diabetes previously known as adult–onset or non-insulin dependent. In this case, the body produces insulin but it is unable to use it. This type is very common especially among the obese. It is considered as the milder form among the other types because of its slow onset and can usually be controlled with diet and physical activities. Its symptoms are similar to type 1 disease including slow wound healing and extreme thirst. Gestational diabetes is the type that occurs among pregnant women but generally resolves after childbirth. After then such patients are usually at higher risk of type 2 diabetes. Lifestyle and family history plays a huge role in determine if a woman has this. Risk factors Obesity Family history of diabetes Early Detection as Your Best Shot Early detection gives an individual the best shot at beating diabetes. Diabetes (type 2 which is the most common) doesn’t develop suddenly, regular blood sugar checks help an individual detect rising blood sugars at the pre-diabetes stage. This makes it easier for management with lifestyle changes and sometimes might not require drugs at all. Prevention Type 2 diabetes is a lifestyle disease thus can be prevented. Here are a few lifestyle adjustments that can be helpful Maintain a healthy body weight Avoid sedentary lifestyle by engaging in regular fitness activity Maintain a good eating habit Avoid excessive intake of alcohol, tobacco use and foods with artificial sweeteners Sunday Oluchi Goodness