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What Exactly Is Staphylococcus…. by Peju Adeniran

Let me first say, that today’s story is not entirely mine.

The people I’m talking about today were not my patients directly.

It was a colleague of mine, who had been treating this couple for infertility, for about three months, who told me their story.

They had undergone tests and there was no medical evidence of any kind that would make fertility a problem.

One day they came into his office as usual and the woman had passed him a note on the sly indicating that she wanted to see him privately without her husband present.

My friend made her know that it was okay and a while later, she returned alone and told my friend she knew the cause of their infertility.

“Doctor, promise that you won’t tell my husband, but I know the reason why I can’t bear my husband a child. It is because of my staphylococcus and I have been treating it without his knowledge for a long time. If he knows that the fault is from me, he will most likely divorce me.”

She told him that she had been diagnosed  at a herbal clinic where she had gone complaining of waist-pain and sleeplessness.

My colleague was understandably depressed after she left and as we sat in the doctor’s lounge that day, he wondered.

“What is it that makes some people comfortable with the idea of  spreading wrong information just to make money from gullible people? It’s this kind of mis-information that makes the doctor’s job doubly difficult.”

My colleague was right. There is a lot f mis-information about Staphylococcus.

Staphylococcus is one of the most “popular”  bacteria in Nigeria today. Not just because it is common in incidence, but because it has been publicized as being the root cause of many diseases like “barrenness”, “waist-pain”, “moving sensation around the body”,  “genital discharge and itching”, “tiredness”, “heat inside the body”, “watery sperm” and a multitude of other “diseases”.

This mis-information started a few years ago. It was spread by some practitioners of “alternative medicine” and has remained a source of angst for practicing physicians in Nigeria.

Many times, patients come into the consulting room and tell you that they are infected with Staphylococcus. They then ask for treatment, instead of asking to be diagnosed for what their problem might be. Most of the time, they are wrong, and their problems have nothing whatsoever to do with Staphylococcus.

Staphylococcus is a common bacteria, especially in the tropical region. There are over thirty different species of the bacteria and not all infect humans; many of them in fact, prefer other animals, and each is responsible for a specific ailment.

This bacteria is usually found on the skin, clothes, around the face, and body environment of children, adults and the aged. While it can be responsible for some diseases, it simply isn’t true that it is responsible for all that is being claimed in its name.

These bacteria can live harmlessly on the surface of the skin, especially around the nose, mouth, genitals, and anus. But when the skin is punctured or broken for any reason, the staphylococcus bacteria can enter the wound and cause an infection.

Most of the time, they are minor skin infections which are more exaggerated in people with skin problems like burns or eczema.

Staphylococcus. Aureus, one of the most common of the lot, causes skin infections like folliculitis, (infected hair follicles) boils (furuncles),  impetigo, and cellulitis which are limited to a small area of a person’s skin. S. aureus can also release toxins (poisons) that may lead to illnesses like food poisoning or toxic shock syndrome

It is possible, but rare, to get infected through contaminated objects, because the bacteria is often spread through skin-to-skin contact, and can also be spread from person to person among those who live close together in group situations (such as in school hostels ). Usually this happens when people with skin infections share things like bed linens, towels, or clothing.

Warm, humid environments can contribute to staphylococcus  infections, so excessive sweating can increase someone’s chances of developing an infection.

Although it’s very rare, infections caused by S. aureus can occasionally become serious. This happens when the bacteria move from a break in the skin into the bloodstream. This can lead to infections in other parts of the body, such as the lungs, bones, joints, heart, blood, and central nervous system.

This is more likely in people whose immune systems have been weakened by another disease — or by certain medications, like chemotherapy for cancer.

Occasionally patients having surgery may get more serious types of staphylococcal infections.

Like we saw from the patient above, many myths surround Staphylococcus. Next week, I will show you some of the most common myths that surround this popular bacteria.

What Exactly Is Staphylococcus       Peju Adeniran

Let me first say, that today’s story is not entirely mine.

The people I’m talking about today were not my patients directly.

It was a colleague of mine, who had been treating this couple for infertility, for about three months, who told me their story.

They had undergone tests and there was no medical evidence of any kind that would make fertility a problem.

One day they came into his office as usual and the woman had passed him a note on the sly indicating that she wanted to see him privately without her husband present.

My friend made her know that it was okay and a while later, she returned alone and told my friend she knew the cause of their infertility.

“Doctor, promise that you won’t tell my husband, but I know the reason why I can’t bear my husband a child. It is because of my staphylococcus and I have been treating it without his knowledge for a long time. If he knows that the fault is from me, he will most likely divorce me.”

She told him that she had been diagnosed  at a herbal clinic where she had gone complaining of waist-pain and sleeplessness.

My colleague was understandably depressed after she left and as we sat in the doctor’s lounge that day, he wondered.

“What is it that makes some people comfortable with the idea of  spreading wrong information just to make money from gullible people? It’s this kind of mis-information that makes the doctor’s job doubly difficult.”

My colleague was right. There is a lot f mis-information about Staphylococcus.

Staphylococcus is one of the most “popular”  bacteria in Nigeria today. Not just because it is common in incidence, but because it has been publicized as being the root cause of many diseases like “barrenness”, “waist-pain”, “moving sensation around the body”,  “genital discharge and itching”, “tiredness”, “heat inside the body”, “watery sperm” and a multitude of other “diseases”.

This mis-information started a few years ago. It was spread by some practitioners of “alternative medicine” and has remained a source of angst for practicing physicians in Nigeria.

Many times, patients come into the consulting room and tell you that they are infected with Staphylococcus. They then ask for treatment, instead of asking to be diagnosed for what their problem might be. Most of the time, they are wrong, and their problems have nothing whatsoever to do with Staphylococcus.

Staphylococcus is a common bacteria, especially in the tropical region. There are over thirty different species of the bacteria and not all infect humans; many of them in fact, prefer other animals, and each is responsible for a specific ailment.

This bacteria is usually found on the skin, clothes, around the face, and body environment of children, adults and the aged. While it can be responsible for some diseases, it simply isn’t true that it is responsible for all that is being claimed in its name.

These bacteria can live harmlessly on the surface of the skin, especially around the nose, mouth, genitals, and anus. But when the skin is punctured or broken for any reason, the staphylococcus bacteria can enter the wound and cause an infection.

Most of the time, they are minor skin infections which are more exaggerated in people with skin problems like burns or eczema.

Staphylococcus. Aureus, one of the most common of the lot, causes skin infections like folliculitis, (infected hair follicles) boils (furuncles),  impetigo, and cellulitis which are limited to a small area of a person’s skin. S. aureus can also release toxins (poisons) that may lead to illnesses like food poisoning or toxic shock syndrome

It is possible, but rare, to get infected through contaminated objects, because the bacteria is often spread through skin-to-skin contact, and can also be spread from person to person among those who live close together in group situations (such as in school hostels ). Usually this happens when people with skin infections share things like bed linens, towels, or clothing.

Warm, humid environments can contribute to staphylococcus  infections, so excessive sweating can increase someone’s chances of developing an infection.

Although it’s very rare, infections caused by S. aureus can occasionally become serious. This happens when the bacteria move from a break in the skin into the bloodstream. This can lead to infections in other parts of the body, such as the lungs, bones, joints, heart, blood, and central nervous system.

This is more likely in people whose immune systems have been weakened by another disease — or by certain medications, like chemotherapy for cancer.

Occasionally patients having surgery may get more serious types of staphylococcal infections.

Like we saw from the patient above, many myths surround Staphylococcus. Next week, I will show you some of the most common myths that surround this popular bacteria.

Man, Know Thy Teeth ….By Peju Adeniran

Life as a medical student was hard; there were books to read, lecturers to impress, patients to attend to, and a social life to try and fit into the mix.

The perks were therefore few and far between, but I’ll let you in n a little secret; one of the advantages was that as a young doctor, you could get access to free diagnosis, consultation, and even free medication when possible.

It was under one of these of F-O-C arrangements a few years ago, that I had a colleague take a professional look at my teeth.

Like most people, I consider myself to posses a good enough set of teeth; there were no obvious cases of tooth decay, I had not had any tooth pain or bad breath, so I figured I had nothing to worry about.

As I sat draped in the dental chair, I was handed a dental mirror that would allow me take a look at the back and sides of my teeth, I took it confidently and looked in, but to my horror, I discovered something shocking.

At the back and sides of my mouth were unsettling evidence of plaque and tartar that had left dark marks all round on the areas close to the gum line.

I was mightily appalled. “How had I let this happen?” I thought to myself.

Teeth are normally very resistant; they are often preserved even in skeletons and you can tell someone’s diet, even when they have been long dead, just by looking at the state of their teeth.

The top layer, called the enamel is whiter, like milk in primary teeth in children, and darker and stronger by the time the secondary teeth appear in adults. Enamel is very strong and can usually withstand a lot of pressure in order to protect the living tissue it encases.

But, enamel is not foolproof.

It can be worn down by eating too-hard foods for those who chew on hard bone frequently. It can be broken, if you use your teeth to open bottle tops for example or bite into a stone in your food or chip it against a hard object like the floor if you fall.

Enamel is also quickly decalcified (the calcium, which makes it hard, is removed) by acids, and these acids come from the sugars that we eat which are broken down into acid by the normal bacteria in our mouths.

Brushing twice daily, or at least about eight hours apart, or even rinsing the mouth by swishing water around after eating sweets for instance will help to reverse this reaction.

Brush for at least two minutes; recite the alphabet thrice while you brush to help you keep time.

Don’t forget to brush the tongue, in about 20 firm strokes, to remove bacteria.

After three months, your brush is full of the recommended limit of bacteria, and should be replaced.

What about getting the perfect, white smile?

Even though the teeth may look clean and perfect, like I thought mine were, not taking the time to clean the hard-to-reach spots at the back and sides can lead to plaque formation.

Dental Plaque is present in just about everybody’s mouths. If not gotten rid of, plaque will harden to form calculus, which leads to other problems such as gum/periodontal disease, which manifest as bleeding gums and bad breath.

Habits and daily routine such as cigarette smoking, coffee drinking and tea will leave stains on your teeth. Also taking too long between brushing sessions will allow food remnants leave permanent stains on the teeth.

Flossing is easy, and essential. Bits of food stuck between teeth, especially left for a long time can contribute to gum disease and decay.

With the right brushing and flossing technique Dental Plaque may be easily removed.

Calculus and Stains require a visit to your dentist’s office to be professionally cleaned off  nevertheless prevention is always better than cure.

Some long – term medications, like some anti-depressants, could contribute to gum disease; ask your doctor for help if you are taking any of them.

It is important not to ignore any sign or symptom of gum disease, as this can progress to irreversible stages of advanced gum disease (periodontitis).

When you know you have the perfect, healthy teeth smiling comes a whole lot easier!

Let me tell you a little secret (Tuberculosis Word) ….Peju Adeniran

It is hard to be brave as a doctor. It takes a lot of practice to act like you can cope with everything, and even then sometimes you cannot always win.

I remember the morning that I held my new born niece, just hours old, as she was about to be immunized.

Imagine this; she had just been through hours of squeezing and pushing through the birth canal, entering this new place that was noisy and bright, and the next thing her skin was being pierced by a painful long needle and bits of a virus was being pushed into her blood.

She wailed. Her mother wailed. I wailed too. But in spite of the fact that it was a painful thing to do and watch, we had no choice; my little niece had been born into a world that had Tuberculosis in it, and like the millions of babies born everyday, we had to do this to help save her live.

The Tuberculosis infection is one of those, that we refer to as a multi-system disease because instead of being restricted only to the lungs and manifesting as a cough, (which many seem to know about) Tuberculosis can actually be present in various parts of the body.

It is commonly transmitted though, through the lungs, when one inhales infected droplets. The organism that causes Tuberculosis likes to live in the lungs of an infected carrier. When this person coughs and releases droplets into the air, an infected, un-immunized person that breathes this in runs a high risk of contracting the disease.

An infected person can then develop symptoms that range from chronic cough, productive of blood or bloody sputum, weight loss, fever, wasting away of muscles, weakness, bone infection, and even sometimes invasion of the spinal cord.

Tuberculosis is therefore of great concern and cases of infection are treated with utmost urgency and seriousness. This was a fact that was brought home to me in my last three months as a medical intern.

“Engineer” was a man in his fifties who presented to the hospital where I worked as a case of TB infection. He was not a new case, in fact he had been diagnosed a year earlier.

Most patients with TB are often given what we call “DOT” or “Direct Observation Therapy.” This means the patient has to report at the hospital every day, for about 6 out of his 9 month treatment period to take his drugs under the watchful eye of the physician. This is to ensure that the patients take their drugs and do not pass on the infection to others.

This did not go down well with “Engineer” so by the time he was forcibly brought by his family to our hospital, he had defaulted in treatment several times, at previous hospitals and was already very frustrated.

“I will sign, I will sign!” he shouted. “I will sign that I’ll take these drugs at home everyday!, Im tired of coming to hospital like this!”

We felt pity for him, but unfortunately, we still could not release him to go home and risk being a bank of infection to everyone.

If you are infected like “Engineer” and you do not want to report to the hospital daily, please, please, please:

Be very careful of how close you stand to people

  • Cover your mouth when you cough
  • If you live in the same house with other people please ensure that the windows are open all the time and the rooms are well ventilated also.
  • Make sure to boil your clothes and bedding or those of an infected person in very hot water  (100 degrees) while washing, to rid it of bacteria
  • Tuberculosis infection is difficult within a healthy immune system. Always boost your immunity with proper nutrition and exercise
  • Stay away from children, especially those children in the first months of their lives, especially un-immunized ones. Please don’t carry them.

* As we celebrate world Tuberculosis day, remember that TB is a disease of community importance and for cases of suspected infection, the relevant health authorities in the community should be notified.

Toju’s Curious Case Of Tuberculosis!!! ….Eghosa Imasuen

I was a twenty-six year old doctor, had just finished NYSC and was working in a private hospital near Agboju on the FESTAC axis of Lagos. A mother brought in her son, Toju1 who she complained had not been thriving for the last few months.

Not thriving? If there ever was an understatement, that was it.

Toju was supposed to be sixteen but looked twelve. He had a swollen tummy, a trait that belied the fact that elsewhere he was all bones. He had also been suffering from anorexia (a technical term for loss of appetite; the better known condition mostly suffered by young girls is a psychiatric condition named anorexia nervosa.) Toju suffered from a low-grade fever, something which could only be guessed at from his history of suffering from night sweats, i.e., at around three every morning, he would break out in a profuse sweat, wetting his beddings. He had been to hospital, to church, and his mother had brought him to us because the resident doctors at the teaching hospital were on strike.

When I examined him, I found him to be small for his age; he was skinny, showed signs of recent weight loss, and was at the bottom percentile of weight and height for his age. He was pale. His tummy was indeed bloated, and from my examination full of  fluid; peritoneal fluid, i.e., fluid in the spaces between the intestines.

My diagnostic cap on, I recalled advice I had received from a consultant back in school. We were told that TB was the great imitator. It was more than a lung disease and could take on any form, present as any syndrome. In our peculiar environment—tropical, urban, poor—any odd longstanding illness had to have Tuberculosis as one of its differential diagnoses. So, from the moment I heard that the boy had been “somewhat ill” for upwards of a year, with multiple visits to many hospitals, I feared tuberculosis. Other symptoms that pointed in this direction were the night sweats and the pallor, the anaemia, and the weight loss. But he didn’t have the bloody cough, he didn’t have any cough. That should have taken my mind of TB, you say. Wrong. Tuberculosis usually attacks the lungs but can also affect other parts of the body. It affects the skin, the lymph nodes around the neck causing swellings called scrofula, and the spine, causing a potentially crippling condition called Pott’s Disease. You see, Tuberculosis is an infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis in humans. It is mostly spread via the air, moving from person to person in coughed-up air droplets and spittle. Mostly, I said. They are odder ways in which it is spread, one being via unpasteurised milk from an infected cow.

I told the mother what I thought he had. She said, that cannot be, Toju is not coughing blood. I said, I know. I will need to take a sample. I produced a needle and syringe, noted the surprise on the mother’s face when I swabbed her child’s belly instead of some vein on his arm and plunged the needle into his tummy. I aspirated some fluid. Immediately I knew that my suspicions had been correct. Even before they were sent to the lab, I knew what the child had. You see the fluid that filled his belly was of a golden hue, the classic straw-coloured peritoneal aspirate. The young man had abdominal tuberculosis.

I sent him for an x-ray, for a skin tuberculin test and for a sputum examination, and sent the aspirate for a microscopic examination (the Ziehl-Neelsen stain) and culture (using the Löwenstein-Jensen media.) Did I wait for the results to come before I began treatment? Of course, not. This is a common misconception; I blame the otherwise laudable campaigns by my colleagues in the medical laboratories. Yes, lab tests are important, invaluable, but they are principally a tool that only doctors are qualified to use; and lab tests were made to aid diagnosis, not be diagnosis in themselves. Your primary concern is the patient in front of you; you can either leave the patient to die and say you were waiting for a lab result, or you can begin treatment. The patient’s response to a line of therapy will also aid your diagnosis. So, I started the young man on first line Anti-TB medication and asked the mother to bring him back in a fortnight for a review of the results of the investigations.

The next time I saw Toju, the change set my heart aglow. It had only been two weeks but his cheeks had already started filling out, the swelling in his belly was down, and there was a spring in his step. I had heard that miracles of therapy came after a correct diagnosis but had never experienced anything this dramatic. The results proved that he had Tuberculosis. I transferred him to the health centre in his local government headquarters to continue DOTS (Directly Observed Therapy, Short Course.) I did not hear from them again—this was in 2003—but I imagine that today, he is healthy, finishing university somewhere, and has a sweet girlfriend that he plans to marry soon.

C’est la vie.

[1] Not his real name

Obstructive Sleep Apnoea and Snoring….by Eghosa Imasuen

We all know the relative or roommate or spouse who snores, who keeps us awake at night with generator and construction-worksite-like noises. And a few of us suspect that those who snore are blissfully unaware that they disturb us, that they might be affecting our health. But we do not suspect the health implications associated with snoring.

One of my anaesthesiology professors once asked me, during an operation he was covering, what the major sign of respiratory obstruction was. I racked my brain, reeling off highfalutin answers to this seven-worded query. Big answers to a little question. The real answer was little too. He told me: noisy breathing. One of the obvious signs that someone is having trouble breathing is noisy breathing. We already know this from the asthmatic wheeze, from the stridor of infantile epiglottitis and crackles of pneumonia. This is also true with snoring.

With snoring, the person suffers from a structural predisposition to obstruction. Whether from overweight, or from faulty anatomy, the person’s upper airways—i.e., the part of the breathing apparatus above the lungs, the throat, pharynx, and mouth—are prone to collapse during the deep sleep. This person normally doesn’t have any problems when awake as the muscles that keep the airways patent are working. But when they fall asleep, that is when the problems arise.

There are several stages of sleep. The initial phases in which there are varying levels of arousability—here the muscles are still under conscious control, even if they are unaware of this—and REM (Rapid Eye Movement or Dream) sleep. When we fall into REM sleep, our muscles are at their most relaxed state. The throat collapses, and if there was a pre-existing tendency to obstruction, the person snores. Now, as in all things in life, there is a spectrum of severity ranging from the small cute whistling snore, to the bring-down-the-house generator-noise type.

This brings us to the most common form of Obstructive Sleep Apnoea, OSA, and its consequences. In some cases of snoring, the obstruction becomes complete, the airways fully blocked off, and the patient stops breathing. We have observed this in relatives and friends. Some mischievous ones call this “changing gear.” When this happens, carbon dioxide levels in the blood rise and “awaken” the person. Conscious control of the airways is achieved and for a short while the snoring stops, and starts again. This cycle is repeated throughout the night. The end effect of this is that the patient does not sleep well. For years, the person’s brain has not been reaching its full resting state. There is associated morbidity with this: from increased somnolence (i.e., the tendency to drop off into sleep during the waking hours); to tiredness and irritability; structural defects in the brain’s blood circulatory architecture, we call this Cerebro-vascular Disease (CVD); increased predisposition to strokes, to the small-small strokes that doctors call lacuna infarcts that can lead to multi-infarct dementia; to a type of heart failure called cor pulmonale.

During the investigations in hospital of a patient with OSA, a sleep study is carried out by the ENT (ear, nose, and throat) surgical department. A multidisciplinary approach is advocated for OSA management. There are treatments. There is first the advice that the person loses weight. There is advice on sleeping positions; lie prone or on your side, the back sleeping position worsens snoring, and OSA. There is a machine called the continuous positive airway pressure (C-PAP) machine. This comes with a mask, or nasal canellas that are worn during sleep. Its name is self-explanatory. Models designed for the peculiarities of our environment come with rechargeable batteries. There are also surgical options for therapy. The option chosen by your doctor will depend on the results of your consultation and the subsequent investigations.

So, if you know a relative who snores, who seems to stop breathing during the night, whom you have to nudge repeatedly to stop the snoring; or you have been told by friends and relatives that you snore really badly and you find yourself increasingly tired during the day? Then go and see your doctor. It might be a sign of impending morbidity. There is no better evidence of the truth in the statement that a stitch in time saves nine.

Febrile Seizures……By Eghosa Imasuen

Full disclosure: I suffered febrile convulsions as a child.

A Febrile seizure is a convulsion that is associated with a significant rise in body temperature in children aged from six months to five years. Families in Africa can tell an episode is on when the child suddenly goes into a fit when he/she has a fever caused by malaria, or other culprits like respiratory infections, ear infections, urinary tract infections etc.

This is what happens: The child suddenly goes stiff, the limbs start twitching and the eyes roll back in the head. A typical episode lasts for less than a minute, a period when the mother’s terror makes it seem like hours, ages even. The child may poo or pee, may breathe irregularly, and turn darker. There is almost no sequela after an episode. And most children will outgrow these episodes before they reach the age of five.

And because of the peculiarities of our environment—malaria, viral infections, bacterial sepsis, genetics—we have children who are exceptionally prone to these.

One sign in African adults who suffered febrile seizures as children are the “fever marks”—small facial scarifications. You must have seen them in friends; two small vertical lines, a few centimetres long, on either cheek. Thankfully incidence of these facial marks are declining as more and more parents become educated about what to do when a child convulses during a fever.

My mom tells me stories about my episodes. Of how, on the day of my first birthday party, I went swiftly from a fever to a fit as I had done a few months before, and she and Dad rushed me to the hospital. But as soon as I was in the car, with the wind rushing in and the lulling drone of the engine I suddenly relaxed and slept the rest of the way to the clinic. They had a hard time convincing the doctor of what had just happened. She says the doctor gave me paracetamol syrup, told her to continue the chloroquine she had already started giving me and the birthday went ahead as planned.

She recalls how she had to fight off my granny who wanted me to receive the facial marks, so that the convulsions would stop. She also remembers the old wives tales and other supposed remedies: palm kernel oil applied all over the child’s body will stop the convulsion immediately. Put the child’s feet in the fire, that will drive the demons away. Swathe the child in warm blankets so he can sweat the convulsion away.

None of those treatments work, and may actually worsen things. You see, no one knows what really causes febrile convulsions are. There is a genetic link, as having a first degree relative—parent, sibling—who suffered from febrile convulsions predisposes one to it. The only thing doctors are sure of is that the parent or care-giver must endeavour to bring down the temperature of the child. This can be via physical methods—tepid sponging, i.e., using slightly-above-room-temperature water to douse the child—or via oral doses of paracetamol or ibuprofen syrup.

The main concern for your doctor is to promptly distinguish your child’s febrile convulsion from more sinister causes of seizures in children. Thus when you get to the hospital, your doctor will ask about the duration of the seizure; doctors set a benchmark of fifteen minutes as the cutoff point between simple febrile seizures and complex febrile seizures. The doctor will ask if the seizures occurred at the height of a fever. He will ask how long the child had been sick. He will ask for a description of the attack, if the whole body was involved or if only a part. He will ask for a family history of such seizures. He will ask what the child did after the seizures—did he go back to playing; did he look normal. All these questions are to confirm what is probably true—that the child suffered from a self-limiting, albeit terrifying to watch, condition.

And you? What are you supposed to do? Keep the child away from danger. Never take a small rise in body temperature for granted.  Expose the child, tepid-sponge him, give him Emcap paracetamol suspension or any other paracetamol suspension (please do this while he is still awake, not when he is fitting. And go to the hospital as soon as possible.

What should you never do? Do not rub palm kernel oil all over the child, it will cause a rise in temperature and worsen things. Do not put the child’s feet in the fire. Do not stick a spoon in the child’s mouth in a misguided attempt to prevent him from biting his tongue; you will just end up worsening things. And, finally, do not mark the child’s face.

Cholera . . . .by Eghosa Imasuen

In a previous article I ranted about the misuse of antibiotics in the treatment of diarrhoea. That was a prelude to a series of articles on the topic of diarrhoea and its many causes. This time I will talk about a specific cause of diarrhoea.
Cholera has been in the news recently. Last year, an outbreak in the northern states of Nigeria had pundits abusing our government, our health-care providers. How could they let this happen? In Naija? In 2010? Shame! For an outbreak that was quite effectively contained I feel these pundits were angry with the government for other reasons. The reaction was prompt. The drugs were delivered. Doctors are working overtime in these places. In another part of the world, Haiti’s recovery from last year’s tragic earthquake was shaken by the reaction of some of its people to the cholera outbreak there—they believe that the aid agencies brought the disease to the island.
Cholera is caused by a rod-shaped bacterium called Vibrio cholerae. It causes a severe diarrhoeal illness, with associated vomiting, severe dehydration, and abdominal pain. Symptoms may start suddenly and quickly, sometimes as little as five days after contact with contaminated food, effluent, or other patients. The diarrhoea caused by the disease is especially profuse—the classically described “rice-water stool,” so described because of the flecks of detached damaged intestinal bits that float in the stool. An untreated cholera patient may produce as much as 8-10 litres of diarrhoeal fluid in a single day. This massive efflux is the result of a toxin produced by the vibrio cholerae bacterium that compels profuse amounts of fluid from the blood supply into the small and large intestines.
The transmission of vibrio cholerae is via the faeco-oral route. This simply means that after an infected person, or a carrier stools, somehow this contaminates either food or water, and the person who drinks the water or eats the food ingests live bacteria. (Note: It doesn’t mean that someone defecated in another person’s mouth o.)
Oddly enough, cholera is rarely spread directly from person to person. And vibrio cholerae is found naturally in some shellfish and plankton, but remember that there exist toxic and non-toxic strains of these bacteria.
Now for the serious bit: although cholera can be a devastating disease, killing rapidly before treatment can even begin, its prevention is very straightforward: sanitation and common sense. Living in a country with advanced water treatment infrastructure and sewage systems helps, but so does listening to mommy when she says; wash your hands after poo-poo, boil your drinking water, etc.

  • Sterilization: All materials that come in contact with cholera patients should be sterilized by washing in hot water using chlorine bleach if possible.
  • Sewage: anti-bacterial treatment of general sewage before it enters the waterways or underground water supplies helps prevent undiagnosed patients from inadvertently spreading the disease.
  • Sources: Warnings about possible cholera contamination should be posted around contaminated water sources with directions on how to decontaminate the water (boiling, chlorination etc.) for possible use.
  • Water purification: Chlorination and boiling are often the least expensive and most effective means of halting transmission.

There is a cholera vaccine available. It is used to stop outbreaks from spreading, and to prevent spread to health workers.

Cholera treatment works on two main premises. One is to attack the disease-causing organism itself, the other is to prevent death via dehydration of the sick patient. Aha, so this is where those famous antibiotics – tetracycline, flagyl ad septrin – come in.

Cholera has traditionally been treated with tetracycline. Antibiotics shorten the duration and lessen the severity of the diarrhoea. But the mainstay of cholera treatment has always been fluid replacement. Not diarrhoeal stoppage o. FLUID REPLACEMENT. This is what saves lives. In most cases simple oral rehydration therapy with the generic proprietary brands of ORT solutions used judiciously will keep a patient alive until the disease runs its course. Where the person is very sick, we may upgrade to intravenous fluids.
Nursing care is also important. Cholera is a disease that destroys the dignity of its sufferers. You literarily shit yourself to death. I remember the sniggers in class when we were first shown a cholera bed in medical school. The bed had a hole in the middle, a funnel that emptied into a bucket. When we asked our professor why the beds needed holes he told us that the diarrhoea was so uncontrollable in the acute phase of the disease that patients did not have time to ask for toilet breaks or bed pans. And that as the epidemics worsened, nurses did not have time to respond promptly to every patient. Our professor warned us about the dignity of the patient. He punished those who sniggered at the beds with extra call duty.

The Truth About Diarrhoea – By Eghosa Imasuen

When it comes to diarrhoea, ask any doctor what the most annoying, disturbing, and depressing misconception they have to correct amongst their friends, family, and patients is and they will tell you that it is the use of antibiotics in the treatment of diarrhoea.

Everyone I have worked with, every doctor, every nurse, every Health Extension Worker, has described how they cringe with embarrassment when seemingly educated people say things like, “Kai, bros  I wan purge die yesterday. If not for the Tetracycline/Flagyl/Septrin wey I drink, I for don die since.”

So first off, I am going to say this: Almost all cases of diarrhea are self-limiting episodes. That is if you give it time, it will stop on its own. Yes, you will feel some pain and discomfort but it will stop. Whether you took antibiotics or not, the “speedo” would still have to end on its own. ON ITS OWN! Good to get that off my chest.

You see, people, by far the most common infectious cause of diarrhoea—which is described as loose voluminous stooling, i.e., stool that takes the shape of the container  in which it finds itself—is viral. And antibiotics are used for the treatment of bacterial infections. Note that in the previous sentence I said that the most common infectious cause. The most COMMON CAUSE of diarrhoea is actually food poisoning, a two-worded entity that conjures up dreams of wicked stepmothers, and far-removed cousins, in our paranoid West African environment.

Food poisoning in this sense means getting sick from eating tainted food. What happens is that when food has been contaminated with bacteria through improper handling or poor hygiene or exposure, the bacteria thrives in it and produces certain chemicals that are consequences of its metabolism. These bacterial toxins, these by-products of the bacteria’s metabolism cause profuse diarrhea.
The irony is that diarrhoea may actually have been designed to serve a protective function. Because it causes prompt emptying of the gut, it ensures that the bacteria, in question, has minimal chance of thriving in an environment where it would otherwise be quite at home.
But the thing about nature is this: defence mechanisms have a way of actually killing what they
are supposed to protect, i.e., you. So the most dangerous complication of diarrhoea is the loss of fluids and electrolytes, the hypovolaemia and electrolyte imbalance that results is what kills people, sometimes, especially those at either extreme of the journey of life–children and the elderly–who can barely survive the assault on their delicate bodies.
By now it should be clear what the real treatment for Acute Watery Diarrhoea is: Fluid replacement in whatever guise – Oral Rehydration or IV-drips (in cases where vomiting has complicated the clinical picture.)
But, you say, where did the idea of tetracycline, septrin, and flagyl come from? First, tetracycline has saved countless lives in the fight against a major killer, cholera. The last two are used to treat the two main types of dysentery. (I should define dysentery here. Dysentery means bloody mucoid diarrhoea, sometimes painful.)

So, the point I am trying to make here is this, when you drink tetracycline or flagyl because you have diarrhea, you are doing three things; wasting time and wasting money and probably contributing to the rise of superbugs, extremely hardy multidrug-resistant strains of normally mundane gut flora.

(Brief Bio: Dr. Eghosa Imasuen, a Nigerian novelist, was born on 19 May 1976, and grew up in Warri. A medical doctor, he graduated from the University of Benin in 1999 and lives in Benin City, Nigeria, with his wife and twin sons. He is the Acting Managing Director of Royal Savings and Loans, a primary mortgage institution in Warri.)

Bowling for Boobs!

BOWLING FOR BOOBS

Abuja set to host the first ever Bowling For Boobs Competition in Africa to benefit Breast Cancer Awareness.

Stand Up To Cancer Naija is happy to announce it’s signature fundraising event for breast cancer awareness tagged “Bowling for Boobs 9ja”. The national tour event will kick off with the median edition holding at the dome entertainment centre central Area, Abuja on the 29th of January, 2011. The event which will be a bowling competition, with six teams, of eight players in each team, all competing against each other. The objective is to have fun while raising awareness and money for breast cancer project in the grassroot; prior bowling experience is not required. The event will be hosted subsequently in Lagos, Port Harcourt, and other cities in Africa.

Each bowler is to register with N20,000, after registration they will get a t-shirt and a socks complimentary. The funds generated from this event will be used to support the ongoing grassroot breast cancer projects under Stand Up To Cancer Naija. “Like a Bra our event aims to uplift and support women battling breast cancer!” said Caleb Egwuenu, Project Director of Stand Up To Cancer Naija. We are calling on everyone to take up teams or join in a team, in this incredibly colourful and outrageous social event. Raffle tickets and prizes will also be available. The Line of confirmed celebrities featuring in the event are; UTI, Waje and Uche Jumbo, many more are to be confirmed soon.

For more information on this event, please contact Caleb Egwuenu, Project Director, Stand Up To Cancer Naija on 08033626680 or the Event Publicist Bode- 07032521755

Emzor wellness walk against child abuse

With the mission of the company to promote unlimited wellness and impact the lives of our children, the Emzor Wellness club members embarked on a “Wellness Walk Against Child Abuse” to celebrate Nigeria 50th Anniversary on 29th September ,2010 at Teslim Balogun stadium Surulere, Lagos.

A total of 318 children walked round the Mainbowl of the stadium accompanied by Emzor Group representatives, representative from Lagos state government, media representative, representative from NAPTIP, representative of Proprietor & Proprietress Association in Lagos & Shagamu branch.

The key objective for the walk was to create awareness on the need to protect the rights of our future leaders and also to stop the molestation of our children.

In attendance to support the children were:

Representative of the Deputy Governor of Lagos State -Mrs Folusho Ogunlana
Representative of the First lady of Lagos State -Mrs Mosumola Jumaid
Representative of the Hon .Comm. for Women Affairs & Poverty Alleviation -Mrs O.M Shobojo
Representative of the Hon. Comm. For Health .Rep.Dr Odulana.
Special adviser to the Lagos state Governor on health matters –Mr A. U Obafemi
Secretary Proprietor/Proprietress Association (Shagamu) – Mrs Igaga.
Representatives from NAPTIP ,Mrs Kehinde
Special Adviser to Governor on health. Rep Mrs
Pharm(Mrs) Nkeiru Okoro – Executive Director (Emzor)
Pharm(Mrs) Lola Otisi – Head of Marketing & Strategy (Emzor)
Pharm.(Mrs) Chovwe Oderhohwo –Emaniru (SBUL Maternal &Child)
Mr Isaiah Osigwe (Coordinator,Emzor Wellness Club)
Pharm. (Mrs )Chinelo Umeh (Regulartory Affairs Manager)

MEDIA REPRESENTATIVE:
Emeka Anokwuru (The Sun )
Yemi Olakitan (Guardian)
Chimazor Meflaoulu (Thisday )
Onozure Dania(Vanguard)

The members of the Emzor wellness club in the following schools in Lagos state were also in attendance

1 Precious Prinx Nursery/ Primary School,Idimu
2 Smaak Children School. Iyana Ipaja
3 Playmate School. Shagamu
4 De –Paul Nursery /Primary School,Akwuwonjo
5 Govera International School,Ikotun
6 Good Heritage School.Ijesha
7 Prestige N/ P Schools Surulere
8. Anointed Feet School Surulere
9. Aunty Joke N/P School, Ijesha
10 Triple Olu Beulah N/P ,Mushin
11 Ample Gate N/P School ,Mushin
12 Jeseln Glorious Schools,Mushin
13 Young Shall Grow N/P School,Mushin
14 Kolad Kiddies Schools,Mushin
15 Davister Montessori Schools,Isolo
16 Aunty Olu N/P School,Isolo
17 Great Heritage School,Okota
18 First Foundation School,Okota
19 St.Benedict School,Okota
20 Reh Nursery & Primary School,mushin
21 Prime Global Schools,Okota
22 Kuyoru Memorial School,Surulere
23 Answer Bank Schools,Egbe

The children were addressed by the representative of the deputy governor of Lagos state, Mrs. Folusho Ogunlana in the main bowl of the stadium who is the Tutor General/Permanent Secretary education district 6.

Welcome address delivered by Pharm. (Mrs.)Chovwe Oderhohwo Emaniru SBUL (Maternal& Child) followed by a brief talk by Mrs. Kehinde Akomolafe (Head Public Enlightenment).NAPTIP

The children of Good Heritage School thrilled the audience with a Yoruba cultural dance which was followed by an Atilogu dance from children of Prestige Schools showcasing their exceptional talents

Members of the Emzor Wellness Club from Playmate Schools Shagamu presented a poem recitation to commemorate Nigeria @ 50.

There was the drama presentation by children of Prestige School on the consequence of Child Abuse and a chorography presentation by Children of Goveral International School.

The climax of the event was the presentation of the bouquet to the representative of the Deputy Governor, who had to step in as the Special Guest of Honour.

The presentations started with messages from the three major ethnic group, Igbo, Yoruba and Hausa who were fully dressed in the attire of the culture they represented. Finally was the presentation of the bouquet by the “Wellness Queen” to Mrs Ogunlana, the representative of the Deputy Governor after her message from all members of the Emzor wellness club.

Closing remark was given by Pharm.(Mrs ) Nkeiru Okoro Executive Director Operation. Appreciating our future leaders by telling them “We love you Children”

Pharm. (Mrs) Lola Otisi (Head Marketing & Strategy) said the vote of thanks after which the children took to the floor for the independence party