Category Archives : HEALTH

The term “Neonatal Jaundice” (NNJ) refers to the yellow discolouration that appears in the eyes and/or skin of a baby anytime within the first month of life. It is due to an excessive amount of BILIRUBIN in the blood. Bilirubin is a pigment formed when the red cells (RBCs) in the blood die or are destroyed. Normally it is acted upon in the liver and passed out of the body through the intestines so that its concentration in the blood is very small. If however, red blood cells are destroyed too rapidly or in excessive amounts, or if the liver is not functioning properly, or if the intestine is blocked, preventing bilirubin from leaving the body, its blood concentration may rise and jaundice results.

We worry about Neonatal Jaundice because sometimes, bilirubin (especially when the blood concentration is very high, and before it has been acted upon in the liver) can enter the brain of the baby, causing severe brain damage or even death. The importance of preventing these very distressing events is therefore obvious.

What causes Neonatal Jaundice?

Sometimes jaundice is in fact “normal” in a newborn baby. It usually appears on the third day of life. It is only mild and does not persist for more than a week. Jaundice appearing within the first 48 hours, or rising above a certain bilirubin level, or present beyond the second week of life, is not normal and, therefore, requires investigation. The cause is not always found, but the most frequent causes in our environment include:

1.            Blood incompatibility:

Sometimes a baby’s blood does not “agree” with that of his mother. During her pregnancy, substances called ANTIBODIES then form in her blood and cross the placenta into the baby’s blood. These antibodies are harmful to the baby’s red blood cells, which they “attack” and destroy in excessive amount leading to Jaundice.

2.            G6PD Deficiency:

G6PD is a substance normally present in red blood cells. It protects them from being destroyed too easily. In some babies (usually boys) G6PD is deficient and the red blood cells are unduly fragile. If such babies are exposed to certain chemicals such as camphor often used in preserving the baby’s clothes, the fragile red blood cells are destroyed, and jaundice results. The camphor is absorbed through the baby’s skin. Some ointments and powders used commonly in dressing the baby’s cord and navel contain menthol and have the same effect.

3.            Infections:

Newborn babies are very prone to infections because they have little or no resistance. Some of these infections may cause neonatal jaundice. Certain infections such as syphilis or German measles (Rubella) affecting the mother during pregnancy may be passed onto her unborn child and cause neonatal jaundice. Newborn babies may also suffer from hepatitis, just like adults, and become jaundiced s a result of inflammation of the liver.

4.            Prematurity:

If a baby is born before the usual nine (9) months , the liver may not yet have developed enough to cope with the bilirubin formed in the blood. Consequently, premature babies develop neonatal jaundice very easily.

 

IRREGULAR MENSTRUATION. Yemi, an 18 –year old clerk has not had a period since her last D & C (standard abortion procurement) six months earlier, her fourth D& C since the age of 15 years. Each was done after she had missed her by about seven to ten days. No prior clinical examination of pregnancy test was done or even suggested. No counselling was given. We later found that Yemi had Asherman’s syndrome- a complication of D & C that may make her infertile. Was Yemi ever pregnant or not?

Menstruation is the outward manifestation of very complex series of chemical, hormonal and physical changes which occur in the female in anticipation of and preparation for normal pregnancy. If conception fails to occur, the lining of the womb is shed.

This shedding is menstruation. It is therefore described as the weeping of a disappointed womb. Pregnancy is thus the commonest cause of a missed period. HOWEVER THERE ARE OTHER CAUSES OF MISSED PERIOD especially in adolescence – I have emphasised this because many young girls like Yemi have gone to “procure abortion” or have been encouraged to “procure an abortion” by all sorts of practitioners in the country, simply because they missed their period. The need to confirm pregnancy before a decision to keep or terminate it cannot be over-emphasised. This, will definitely save many a young lady tremendous agony and misery in later life.

Menstruation is only one of the many changes that occur in adolescence. Adolescence is characterised not only by the magnitude and rapidity of physical changes of sexual maturation but also by an important process of psychic maturation. There are qualitative and quantitative changes in the sexual drive, affecting the behaviour of the adolescent. A change in role from dependent child to independent autonomous adult slowly occurs.

Psychological factors also have significant influence on the rhythm of menstruation. The normal menstrual cycle that is from the first day of the period to the first day of the next period is 28days plus or minus seven days (i.e. a range of 21 to 35 days). There is significant person to person variation in the length of the cycle and sometimes there is variation in cycle length in the same individual in the absence of disease or pregnancy. Irregular menstruation may present as infrequent menstruation (Oligomenorrhoea) where the length of the cycle is increased or as very frequent menstruation in which case the cycle length is shortened (Polymenorrhoea). In the adolescent age group, other abnormalities of menstruation worthy of mention would include: – excessive menstrual bleeding menorrhagia delay in onset or failure to start menstruation, and painful menstruation. Due to the very complex nature of the control of menstruation and the other factors which affect it, including emotional factors, the early periods may be very irregular and many of them are not associated with ovulation. It is not unusual for a young girl to have her menarche (first period) and not have another for months. It becomes regular after two to three years and would have regularised in most people by the age 18 years. In a small number of people, the periods however will remain infrequent even after the age of 20.

In this group of people in whom spontaneous conversion to regular cycles does not occur, a number of them would present later as sub fertile (or infertile) patients and would require treatment to have regular periods. There are also some abnormal conditions or diseases that may occasionally be the cause of irregular periods in the adolescent. It is therefore advised that if a girl has not established normal menstruation after the age of 16 years, she should see a gynaecologist. Most gynaecologists would normally and appropriately not start active treatment immediately unless an obvious abnormality is present.

However counselling will be done. If the condition persists after the age of 18 in the absence of any abnormality the patient is usually treated with contraceptive pills for about four cycles. Menstruation is regular when the oral contraceptive is used properly and after withdrawal of the pill, many of the patients would revert to a regular rhythm. If this fails a D & C (Dilation and Curettage) may be done. An additional number of patients would revert to a regular rhythm at this stage.  For those who haven’t hormone therapy using the pill may be repeated. Where this fails further treatment may be deferred until pregnancy is desired when ovulation may be induced and cycles regularised with the use of fertility drugs.

It cannot be over-emphasised that irregularity of periods especially in the adolescent should be managed by a competent and well trained doctor. It is even more important in our environment as there is an association with future fertility and this society still places so much weight on reproductive ability.

HIV, Exercise & Diet              

Introduction: ever since the dreaded HIV Virus was made known. It has been panic all the way. In this edition we shall take a careful look at useful hints on how to manage the dreaded Virus through exercise, relaxation and diet intake.

 

KNEE REPLACEMENT FOR THE ELDERLY

Her name is Josephine Fejokwu, a sixty year old widow from Delta State who resides in Lagos. History was made some years back in the Lagos State healthcare delivery system when she benefited from the first total knee replacement surgery done by a team of local surgeons at the Lagos State University Teaching Hospital, LASUTH, Ikeja. Consultant orthopaedic surgeon Dr. Ladipo Olawale led the team of surgeons from LASUTH and National Orthopaedic Hospital, Igbobi, in the operation that lasted for two and half hours. The sixty year old woman confided in Truhealth that her knee problem which medical experts called osteoarthritis of the knee started ten years ago.

Mrs Fejokwu explained how she became the first beneficiary of the free knee surgery. “I went for treatment at National Orthopaedic Hospital, Igbobi. I was told I needed to go for surgery for which I would pay about eight hundred thousand naira. At first I ran away. Later a doctor at Igbobi told me to go to Lagos State University Teaching Hospital. When I got there, the doctors examined me and asked me to report daily for treatment. One day, I was told there is a free surgery for knee problems. I could not believe it myself that the Lagos State would treat me free. It is unbelievable; so I thank God and I am very happy”. The Commissioner of Health, Dr. Jide Idris, said the surgery seeks to help elderly patients that cannot be accommodated in the major programme of limb deformity and corrective surgery started by the last administration. He said the state periodically sorts out cases who are adults with arthritis who require mobility aids but could not do operation .

He said “we decided to support the project when the recommendation was made for many reasons. We are equipping the facility in this teaching hospital which is supposed to provide specialized care for the patients. Secondly as a teaching hospital we are supposed to be training staff. So, this is another avenue to build capacity along other specialty. Thirdly, this is a crippling disease and some of the patients we have seen are very poor people who can also benefit from the free health programme. The Commissioner of Health further explained that this knee surgery was a pilot of programme which is a partnership between the state Ministry of Health and the company, Smith and Nephew who provided the instrumentation based on the fact that a number of implant of the knees were purchased from them.

Meanwhile, Dr. Ladipo Adewole who led the team of surgeons said the old lady was diagnosed for osteoarthritis which is a disease characterized by irreversible erosion of the cartilage which covers the ends of bones where they are approximated from joints. He added that the knee joint is formed where the lower end of the thigh bone (tibia) join. The knee cap (patella) is placed in front of this joint. Dr. Adewole explained that osteoarthritis is caused by localized pressure on the cartilage structure as a result of deformity or obesity, weakened cartilage structure due to rheumatic diseases and weakening of bone supporting the joint cartilage as is seen in sickle cell disease. He stated that the symptoms include pain, swelling, deformity and instability of the knee and the diagnosis is confirmed by x-rays.

In the past, medical experts treated osteoarthritis by administering pain relievers and anti-inflammatory drugs as well as physiotherapy, weight control, and waking aids. Results from this kind of treatment were largely unsatisfactory because of persistent pain and difficulty due to decreased mobility. By this bold step, Lagos state is poised to retain its place as the premier state in the provision of healthcare in Nigeria.

The prototype of the instrumentation for total knee replacement as it is known today was designed by an English man living in New York as far back as 1972. Presently 150,000 total knee replacements are performed in the USA annually.

POLIOMYELITIS (POLIO)

POLIOMYELITIS is an acute infectious disease that may result in severe physical handicap (paralysis). It has probably been recognized for centuries but first appeared in a medical textbook “disease of children” by Michael Underwood in the late eighteen century. The causative organism was discovered by Landsteiner in 1908. The virus is excreted in the faeces of affected person and is acquired through the mouth (faeces oral route) by faecal contamination of water, food and by direct handling.