Featured

EVERYBODY IS ANGRY!

A moment of patience in a moment of anger saves a thousand moments of regret; Anger begins with madness and ends in regret.

Advertisements

Anger is an intense emotional response that involves a strong uncomfortable and hostile response to a perceived provocation, hurt or threat. Anger can occur when a person feels their personal boundaries are being or are going to be violated.

There is a sharp distinction between anger and aggression (verbal or physical, direct or indirect) even though they mutually influence each other. While anger can activate aggression or increase its probability or intensity, it is neither a necessary nor a sufficient condition for aggression.

There is a part of the brain responsible for identifying threats to our well-being. Part of this responsibility is sending out alarms when a threat is identified and the body responds in many ways depending on how we have wired ourselves.

For those who are impulsive, in an effort to protect themselves, their reactions override the part of the brain responsible for thought and judgment. In other words, although the brain is wired in such a way as to influence us to act before we can properly consider the consequences of our actions, we also have the option and control of processing our reactions.

Anger instigates physiological responses such as increased heart rate, elevated blood pressure, and increased levels of adrenaline and noradrenaline which are stress hormones that our body secrete as a fight or flight response. Also, expression of anger can be found in facial expressions eg clenching of the jaw, body language like clenching of the fist,  and at times subtle acts like the eyes becoming red or even a wry sardonic laugh.

Modern psychologists view anger as a primary, natural, and mature emotion experienced by virtually all humans at times, and as something that has functional value for survival. Uncontrolled anger can, however, negatively affect personal or social well-being and impact negatively on those around them. It is equally challenging to be around an angry person and the impact can also cause psychological/emotional trauma if not dealt with.

Characteristics of Anger

Passive anger

  • Dispassion, such as giving someone the cold shoulder; Evasiveness, such as turning one’s back in a crisis, avoiding conflict; Defeatism, such as setting yourself and others up for failure; Obsessive behavior, such as needing to be inordinately clean and tidy, making a habit of constantly checking things; Psychological manipulation, such as provoking people to aggression and then patronizing them, provoking aggression but staying on the sidelines, emotional blackmail, false tearfulness, feigning illness; Secretive behavior, such as stockpiling resentments that are expressed behind people’s backs, giving the silent treatment or under the breath mutterings, avoiding eye contact; Self-blame, such as apologizing too often, being overly critical, inviting criticism.

Aggressive anger

  • Bullying, such as threatening people directly; Destructiveness, such as destroying objects as in vandalism, harming animals, child abuse, destroying a relationship, reckless driving, substance abuse; Grandiosity, such as showing off; Hurtfulness, such as violence, including sexual abuse and rape, verbal abuse; Manic behavior, such as speaking too fast, walking too fast, driving too fast, reckless spending; Selfishness, such as ignoring others’ needs, not responding to requests for help, queue jumping; Threats, such as frightening people by saying how one could harm them; Unjust blaming, such as accusing other people for one’s own mistakes; Unpredictability, such as explosive rages over minor frustrations, attacking indiscriminately; Vengeance, such as being over-punitive. This differs from retributive justice.

Assertive anger

  • Blame, Punishment, and Sternness, such as making them feel bad repeatedly and depriving them of some things you see as comforts and calling out a person on their behavior, with voice raised with utter disapproval/disappointment.

ANGER MANAGEMENT

  1.  Identify what initially triggered the anger
  2. Reflect on how you related to the triggering situation e.g., what did you say to yourself about it.
  3. Identify all of the specific emotional and behavioral responses that followed.

Enhanced Personal Awareness

In order to stay less angry, you must have a clear sense of your anger and other people’s anger

Where and when does the anger occur? Why does anger occur (what events or situations lead to the anger)? What kinds of memories or images trigger the anger? How do you feel when you become angry (emotionally and physically)? What are you thinking when you are angry? How do you handle the situation that made you angry? Do you always behave the same way? If not, why not? What do others do when you become angry?

Anger Disruption by Avoidance and Removal

These techniques lead to interruption of anger by removing you, mentally or physically, from the situation.

Create simple strategies that can disrupt anger and give yourself time and distance to calm down, then approach the situation differently, at a later time. This enhances your self-awareness. Drinking water has a good therapeutic effect and in the Islamic religion, performing ablution is recommended as a remedy.

Relaxation Coping Skills

Anger is often marked by increased emotional and physical excitement. Relaxation coping skills target this excitement and can help you calm down when angered.

Relaxation skills include slow deep breathing, slowly repeating a calming word or phrase, picturing a personal relaxation image, or focusing on muscle tension and consciously letting it go.

Attitude and Cognitive Change

When angry, people often make bad situations worse by the way they think about them. For example, angry individuals tend to demand that things should be, ought to be, or have to be, their way—rather than just wanting or preferring them to be a certain way. Often, they call other people insulting, sometimes obscene, names. The problem situation is often seen as awful or catastrophic, rather than simply difficult, frustrating, or truly disappointing. By thinking about bad situations in this way, natural

Things should not, ought not, or have to be your way. You shouldn’t call other people insulting, sometimes obscene, names. Don’t see a problematic situation as awful or catastrophic, rather, see it as a salvageable task. By thinking about bad situations in this way, natural frustrations, hurts, and disappointments that seem much larger and lead to increased in anger can be dealth with objectively.

Acceptance and Forgiveness

Many things that others do simply can not be helped. For example, children spill drinks;  Spouses sometimes forget about issues that are important to their partners.

Thinking that others have intentionally set out to cause problems is almost always wrong. Thinking that they could have acted differently, if they really wanted to, ignores other causes of behavior. Thinking that the bad behavior of others is always intentional just increases anger and does little to solve problems. Understanding that some behaviors are caused by biology or genetics, or normal development, or economic stressors, is more realistic.

Communication Skill 

Some people experience anger because they do not have the necessary skills to negotiate common interpersonal hassles and conflicts.

Fighting with a spouse, for example, may occur when one partner has a poor negotiating skill and because such persons may also not know how to communicate well about family budgets and many other things, they resort to unconventional methods that may be provocative or aggressive over time. The Anger here has escalated because of insufficient skill at resolving the situation.

Featured

Cervical Cancer

Cervical Cancer has been attributed to infection with HUMAN PAPILLOMA VIRUS (HPV). HPV infection is usually transmitted sexually.

…..to her, she was doing this to help her only child whom she gave birth to while in the penultimate year of secondary school.  Regrettably, she said, ‘ i had aborted a couple of pregnancies and had sex with several men while in secondary school and by then i was seventeen because i had to fend for myself as an orphan who had no one to help me, but this child just could not be aborted’.     … that is the result the doctor said. She has stage III cervical cancer at age forty-five…

Overview

Womanhood is a world on its own and it takes patience, knowledge, and pity sometimes for one to dabble into such world. They have their own peculiarities in every sphere of life. In the medical world, as cancer remains one monster to deal with, peculiar to women are some cancers like breast, cervical cancer. In this article, I would focus on cervical cancer which from my own little experience most women don’t know about until they come down with it.

Cervical Cancer

The cervix ( pronounced: saviks) is the neck or narrow portion of the uterus(womb) where it joins with the vagina. Cancer is simply when cells of a particular tissue undergo uncontrolled (and often rapid) growth. Thus cervical cancer is the cancer of the cervix.

Cervical cancer is the second commonest malignancy after cancer of the breast in women in developing countries ( Nigeria inclusive) and it remains the leading cause of death in these countries but the third commonest cancer in women in the world. Peak age when women present in Nigeria is 45 to 55 years. However, it is diagnosed in any woman of reproductive age group.

AFRO-IG-480x339

The causes have been attributed to

  • Genital infection with human papilloma virus
  • Sex at a young age
  • Multiple sexual partners
  • Promiscus male partners
  • One who had or has a sexually transmitted infections. It is important to point out that HIV infection is associated with a very high increase in risk of cervical cancer.
  • Also, a patient with cervical intra-epithelial neoplasia can progress to cervical cancer

What makes the Doctor think A patient has it

*Though, there are some that may not have any symptom but will come to the hospital with abnormal Papanicolaou (Pap smear) result. This is in those that do screening

* abnormal bleeding from the vagina, majorly after sex

* bleeding from the vagina between menstrual period or after menopause

*offensive vaginal discharge which is characteristic

*pain on pelvic side

For those women that present late, they may have in addition

  • Backache
  • Leg pain/ swelling
  • Blood in the urine or bloody urine

Or the doctor investigates by looking at the cervix called colposcopy

How does the Gynaecologist treat

The treatment modality depends on the stage of cancer the patient presents with.

  • It may be surgery if it is at the early stage or
  • The use of radiation and chemotherapy for the more advanced cases
  • Or the use of chemotherapy or radiation for palliation for cases that have developed other things from it

Survival

There is a similar 5-year survival rates for radiotherapy or surgery for someone with the cancer. This survival also depends on the stage of the cancer. If stage I there is 70-80% survival rate but stage IV has 18% survival rate.

What is in this for YOU! 

The major cause of this disease has been attributed to infection with HUMAN PAPILLOMA VIRUS (HPV). HPV infection is usually transmitted sexually. Condom use may not prevent the transmission. The HPV 16 and 18 are the major serotypes of the cause. Thus, a lady or woman who has been introduced to sex life should get screened two years into sex life and every 3-5 years. In essence, those who should have PAP SMEAR done are

  • Ladies who have started having sex
  • Or above age 21

The American Cancer Society, American College of Obstetricians and Gynaecologist recommend that

  • 21-29 years should have pap smear alone every 3 years
  • 30- 65 years pap smear every 3 years or HPV and cytology testing every 5 years
  • Greater than 65 years no screening recommended
  • Less than 25 no screening recommended because women aged 21-24 are at low risk for invasive cervical cancer but they are at high risk for HPV exposure and associated lesions.

Any Vaccine.

The joy here is that, one could be vaccinated against the Human Papilloma Virus (which is not only for girls but also available for boys) but for girls majorly. The vaccine is useful in those who have not had the disease and no usefulness in one who already had it. The two HPV vaccines approved in the United States of America are Gardasil and Cervarix.

0115_W2_I_Cervical

THE GIST HERE is, please go and get PAP SMEAR done today and tell others about it. It is for your future, in other to live a meaningful life insha Allaah. So please present YOURSELF at any Government health care facility for details.

…. her sex partners were no longer patronizing her since they got to know about her disease as she even was no longer interested in that. She was no more lively, seems no hope for her. Her Chemotherapy drug has made her loose her hair, no beauty to display any longer. The radiotherapy also played it own part on the pelvis. At last, she gave up the ghost with a repentant soul. Don’t ask me if God would accept such repentance.  I leave YOU TO JUDGE…. this woman, this cervical cancer.

I.O Dada (Haniif ibn Toyin)

Featured

Medical Help At Your Fingertips

Our team can help you learn more about the treatment and procedure options available to you for different health problems and diseases

Do you have any health concerns? Are you finding it difficult to reach a doctor right away? Are unsure of what to do or you need information and assistance for someone you care about? Our team of experts are ready to give you the support you need.

What Kind of Assistance Can You Get From Us?

  • Advice
  • Help on understanding various medical conditions
  • Information about maternal and child care
  • Health and wellness information
  • Psychological, Sexual and Family Consult
  • Preventive Health Guidelines

Making The Right Decision

Our team can help you learn more about the treatment and procedure options available to you for different health problems and diseases.They’ll also give you information to discuss with your doctor when deciding what kind of treatment is best for you.

Our goal is to get your medical questions answered and getting qualified opinions from certified Doctors through seamless and personalized interaction.

Please check in regularly for updated info and exciting articles and downloadables that will make you healthier.

INDUCTION OF LABOUR 

About 10% of pregnancies need to be induced in order to expedite vaginal delivery. This happens when the benefits of delivering the baby outweighs the risks  of continuing the pregnancy or awaiting spontaneous labour. 
*What are the indications for induction of labour? 
-Placenta insufficiency : when the placenta is diseased and no longer capable of supporting the foetus
-‎Prolonged pregnancy : beyond 41 weeks of gestation 
-Intrauterine growth restriction (IUGR) : when the foetus fails to gain weight, or loses weight due to constitutional, maternal or placental disease
– Premature rupture of membranes : when the “bag of water” breaks without any sign of labour after 24 hours (to avoid infection to the baby) 
– Intrauterine fetal death – to prevent the risk of toxicity or infection to the mother 
– Intrauterine infection (Chorioamnionitis) 
– Unexplained antepartum hemorrhage 
– Potential or presumed fetal macrosomia : increasing growth beyond 4kg, especially in diabetic mothers
– Medical diseases in the mother : such as severe hypertension, uncontrolled diabetes, cardiac or renal diseases, cancers, etc. 
*What are the methods for inducing labour? 
Before induction of labour, it is important to assess the cervix to determine its “ripeness”, ie. to predict whether induction is likely to succeed or fail. Predictors of a successful induction includes advanced gestational age (above 37weeks) and multiparity (having delivered by vagina in the past). 
The cervix can be ripened through medical and non-medical methods. There is limited evidence to support the efficacy of non-medical methods (eg. Sexual intercourse, nipple stimulation, herbal mixtures, dates, castor oil, etc.) 
The medical methods of ripening are :

1. Mechanical methods –  this includes using the finger to “stretch and sweep” the cervix and/or insertion of a catheter into the cervical canal. 
2. Pharmacological methods – use of chemical agents (prostaglandins and oxytocin) 
**********
Certain parameters are used by the midwives/physicians to “score” the ripeness of the cervix. After satisfactory ripening, induction of labour proper begins. This can be done in one of two ways – 
~Artificial rupture of membranes – Deliberately breaking the “bag of water”, which stimulates the process of active labour through the release of prostaglandins.
~Induction/Augmentation of labour using oxytocin infusion – Oxytocin is released normally by the brain at the time of labour. This process can be augmented by infusion of controlled amount of oxytocin (Syntocinon®) through dedicated intravenous infusion pumps. 
*Note that induction of labour MUST be done in a hospital where adequate feto-maternal monitoring and standard obstetric care are available. This will ensure that any complication in the course of induction can be identified promptly and treated appropriately. 
It is also better to have standby facilities for Caeserean section in case of complications during, or failure of induction of labour. 
Wishing all expectant mothers safe delivery! 

Monkeypox Outbreak

Monkeypox is a viral disease similar to smallpox and chickenpox transmitted majorly by rodents. The virus can spread both from animal to human and from human to human.

On the 22nd of September, 2017, the Nigeria Centre for Disease Control (NCDC) was notified of a case of suspected Monkeypox.

The case was identified in an 11-year-old male patient who was presented to the Niger Delta University Teaching Hospital (NDUTH) in Yenagoa, Bayelsa State in Nigeria.

Subsequently, 11 other cases were identified. All the cases are currently receiving appropriate medical care. All the patients are improving clinically and there have been no deaths.

A medical doctor and 10 persons who came down with the monkeypox had been quarantined in an isolation centre at the Niger Delta University Teaching Hospital, Okolobiri, in Yenagoa Local Government Area of the state.

As at 1st October 2017, 32 close contacts of the cases have been identified, advised appropriately and are being monitored.

Infection from animal to human can occur via an animal bite or by direct contact with an infected animal’s bodily fluids. The virus can spread from human to human by both respiratory (airborne) contact and contact with infected person’s bodily fluids.

Risk factors for transmission

  • close contact with infected persons eg- sharing a bed, room
  • using the same utensils as an infected person
  • Eating inadequately cooked meat of infected animals
  • Anything that favors the introduction of the virus to the oral mucosa.

Incubation period

It takes about 5-21 days but ideally it is 10–14 days. symptoms of monkeypox are similar to smallpox, although it is often milder.

figure1_lg

Signs and symptoms

A distinctive feature of monkeypox compared to other similar diseases is that some patients develop severe lymphadenopathy (swollen lymph nodes) before the appearance of the rash.

The infection can be divided into two periods:

  • The invasion period (0-5 days) characterized by fever, intense headache, lymphadenopathy (swelling of the lymph node), back pain, myalgia (muscle ache) and an intense asthenia (lack of energy);
  • The skin eruption period (within 1-3 days after the appearance of fever) where the various stages of the rash appear.

Rash often begins

  • on the face and then spreading elsewhere on the body.
  • The face (in 95% of cases), and palms of the hands and soles of the feet (75%) are most affected.
  • Evolution of the rash begins with lesions with a flat base to vesicles (small fluid-filled blisters), pustules, followed by crusts occurs in approximately 10 days. Three weeks might be necessary before the complete disappearance of the crusts.
  • Rash can also affect oral mucous membranes (in 70% of cases), genitalia (30%), and conjunctivae (eyelid) (20%)

Severe cases occur more commonly among children and are related to the extent of virus exposure, patient health status and severity of complications.

Diagnosis

The differential diagnoses that must be considered include other rash illnesses, such as, smallpox, chickenpox, measles, bacterial skin infections, scabies, syphilis, and medication-associated allergies. Lymphadenopathy during the prodromal stage of illness can be a clinical feature to distinguish it from smallpox.

Monkeypox can only be diagnosed definitively in the laboratory where the virus can be identified by a number of different tests:

  • enzyme-linked immunosorbent assay (ELISA)
  • antigen detection tests
  • polymerase chain reaction (PCR) assay
  • virus isolation by cell culture

Treatment and vaccine

There are no specific treatments or vaccines available for monkeypox infection, but outbreaks can be controlled.

4dcce2d151976e7ea344e19572428432005bfc2b7da67492152a4601af28412b

Vaccination against smallpox is assumed to provide protection against human monkeypox infection however routine smallpox vaccination was discontinued following the apparent eradication of smallpox.

Prevention

Any human that might have come into contact with an infected animal/human should be quarantined, handled with standard precautions and observed for monkeypox symptoms for 30 days.

Reducing the risk of infection in people

During human monkeypox outbreaks, close contact with other patients is the most significant risk factor for monkeypox virus infection. In the absence of specific treatment or vaccine, the only way to reduce infection in people is by raising awareness of the risk factors and educating people about the measures they can take to reduce exposure to the virus. Surveillance measures and rapid identification of new cases is critical for outbreak containment.

  •  Gloves and protective equipment should be worn when taking care of ill people. Regular hand washing should be carried out after caring for or visiting sick people.
  • Reducing the risk of animal-to-human transmission. Efforts to prevent transmission in endemic regions should focus on thoroughly cooking all animal products (blood, meat) before eating. Gloves and other appropriate protective clothing should be worn while handling sick animals or their infected tissues, and during slaughtering procedures.
  • hand-washing-250px
  • Health-care workers caring for patients with suspected or confirmed monkeypox virus infection, or handling specimens from them, should implement standard infection control precautions.
  • Healthcare workers and those treating or exposed to patients with monkeypox or their samples should consider being immunized against smallpox via their national health authorities. Older smallpox vaccines should not be administered to people with comprised immune systems.
  • Samples taken from people and animals with suspected monkeypox virus infection should be handled by trained staff working in suitably equipped laboratories.
"Mad cow, deer tick, monkey pox, what's next?"
“Mad cow, deer tick, monkey pox, what’s next?”

Continue reading “Monkeypox Outbreak”

​PERINEAL TEAR: THE PRICE OF ‘PUSHING’ 

Vaginal delivery remains the better option than C-section; unless there’s a medical indication for the latter. But nothing comes without its own downside. One of the downsides of vaginal birth is the higher risk of genital tract injuries: ranging from slight bruising to various degrees of tear.

Episiotomy is the surgical cut made in the vaginal wall and peri-anal (perineal) muscles which is sometimes necessary to widen the space for the passage of the baby and to prevent irregular lacerations during delivery (which are more difficult to treat).

When a woman is given an episiotomy or she sustained genital laceration during childbirth, a proper repair must be done by a trained personnel (midwife or doctor). Failure to repair promptly and skillfully can result in immediate and longterm complications.

The steps involved in repairing perineal tear and episiotomy are essentially similar:
*The doctor will examine your vagina and anus to visualize the extent of injury, check if the anus is involved and decide whether the repair should be done in the labour room or operating theater.

*You will be given an injection at the site of the wound to numb the pain. You shouldn’t feel anything during the stitching and a few hours thereafter.

*The cut will be stitched layer-by-layer, ie. Vaginal wall, muscles, then skin. Absorbable sutures are widely used nowadays, so need to go back for removal of stitches.

*If the deep anal sphincters (special muscles controlling the anus) are involved, the procedure should be done in an operating theater, by a specialist doctor, under anesthesia.

After the repair, care must be taken to ensure proper healing of the wound. Painkillers, antibiotics and stool softening medications must be taken for at least 2 weeks. Sitz bath (immersing the perineum in lukewarm water) should be done twice daily until full healing. Long-term contraception is advised to reduce the risk of wound breakdown during the next delivery. Next pregnancy and childbirth should be hospital-supervised, taking into consideration the past events.

If perineal tears are left unattended for a long time after delivery, severe bleeding can occur; necessitating blood transfusion. Other complications include:

*infection

*poor wound healing

*constipation

*chronic pain

*faecal incontinence (inability to control flow of stool)

*flatulence (uncontrollable farting)

*fecal fistulae (abnormal connection between anus and vagina – soiling the vagina with feaces)

*sexual dissatisfaction and other sexual dysfunctions

*difficulty in subsequent deliveries

*low self esteem

Genital tract injuries can be prevented by allowing the baby to descend gradually, with controlled pushing, guarding of the perineum by the midwives, doing episiotomy when needed or planned caesarean section when the fetal weight is estimated to be above 4kg.

Blood Cancer: The Leukemias

Just like any other cancer which is basically an abnormal, uncontrolled cell growth, the human blood is not left out of this inferno. Blood cancer is literarily a condition whereby blood cells continue to proliferate uncontrollably.

Leukemia Symptoms, Types, Causes, Diagnosis, Treatments, Prevention, Nutritions, Cure (1)

What is Leukemia?

Leukemias are a heterogeneous group of malignant disorders which is characterized by uncontrolled clonal (single cell) proliferation of blast cells in the bone marrow and body tissues. To put it simply, imagine a pregnant woman delivering 100 premature babies every year whenever she gets pregnant!

Blast cells are immature blood cells. Blood cells go through about 5 stages before they become mature and are able to perform their functions. In leukemia, immature cells accumulate and are unable to reach their full matured state.

hqdefault

Blood cells produced in the bone marrow (the soft spongy center of long bones of the arms and legs) include; The Red Cells, White Cells, and Platelets.

While the red cells are responsible for carrying oxygen, providing nutrients to body cells and tissues to ensure their survivals as well as transporting waste products away from those same cells,

The white cells act as defense mechanisms of the body to fight and guard against infections. They are basically the B (The Myeloid cell line) and T cells (The Lymphoid cell line).

Platelets are responsible for the formation of blood clots at sites of injury.

Stages of Blood Cells Production.

Leukemia can be Acute- (of short, quick and fatal onset) or Chronic- (continues over an extended period of time) while it is being managed.

ABIM-USMLE-Step-3-Leukemia-CLL-AML-CML-ALL

 

ACUTE LEUKEMIAS

Characterized by 20% or more of blast cells in the bone marrow. It is of abrupt onset and is rapidly fatal. The survival rate is <6 months without treatment. The more recent WHO classification of acute leukemia relates it with other Chromosomal Abnormalities E.g. Down Syndrome.

Acute Lymphoblastic Leukemia (ALL) is the most common Leukemia in children falling off by 10 years with a secondary rise after the age of 40 years. Its incidence is highest at 3 to 7 years while Acute Myeloid Leukemia is most common in adults.

Causes of Leukemias

There is no exact known cause but several risk factors of leukemia just like every other cancer, however, for Acute Leukemias;

  • The first event is thought to occur in the fetus in utero due to environmental exposure during pregnancy.
  • It may arise as a postnatal (after birth) mutation in early lymphoid cells in the bone marrow.
  • The secondary event is precipitated by infection in childhood due to the mechanism of abnormal response of the child’s immune system to infection.

It is of utmost importance to exclusively breastfeed babies for the first six months of life this boosts the child’s immune system and the introduction of a balanced diet in complementary feeding.

Furthermore, children with high level of social activity like those attending day care have reduced incidence of ALL because of exposure to common infections boosting their immune system

Symptoms and Features of Acute Leukemia include:

  • Fever
  • features of mouth, throat, skin and respiratory infections
  • Marked cervical lymphadenopathy
  • Testicular swelling
  • Spontaneous bruises, purpura and bleeding gums.

Leukemia-symptoms

 Laboratory Diagnosis

1. Bone marrow infiltration checked with bone marrow biopsy

  • Anemia (Reduced Blood hemoglobin concentration)
  • Leucopenia (Reduced white cells count)
  • Thrombocytopenia (Reduced platelet count)
  • Hypercellular bone marrow with >20% blast cells.
  • Infiltration of organs Liver, Spleen and lymph nodes.

2. Cerebrospinal fluid examination contains blast cells (CSF is meant to be a clear colorless fluid which cushions the brain)

3. Increase uric acid as a result of bone degradation with deranges Liver and renal function tests

4. Radiography may include lytic bone lesions

5. Other tests like a CT scan which may be needed for staging as well as other investigations depending on the salient signs

Treatment

Supportive Therapy: Prompt treatment of any episode of fever, blood and blood products support.

Specific Therapy: Chemotherapy, Radiotherapy, Short and intensive courses of drugs.

slide_6

The physician (Hemato-Oncologist) decides which is the best approach to treatment according to severity.

 Complications

An unfortunate complication of acute leukemia is DIC Disseminated Intravascular Coagulation

  • DIC is a disorder characterized by excessive inappropriate activation of coagulation and formation of small clots in the blood vessels. These clots block the flow of blood and are a leading cause of death in acute Leukemia.
  • The activation of clot formation is caused by road- like clumps of granular materials in leukemic cells called Auer Rods. This can as well lead to bleeding from the digestive and respiratory tracts as all platelets are used up in the formation of these clots.

CHRONIC LEUKEMIAS

Could be chronic myeloid or chronic lymphoid leukemia according to the cell line affected. It is characterized by rapid proliferation and growth of MATURED blood cells within the bone marrow.

Cll-blood-cancer-leukemia-infographic

Hypercellularity (increased amount of cells) of any of the different blood cells (eg White Blood Cell or Red Blood Cell) is a diagnostic feature. It is mostly asymptomatic and detected mostly in routine blood checks. It is nominated according to the predominantly increasing cell;

  • White cells increasing predominantly- Chronic Myeloid Leukemia or Chronic Lymphocytic Leukemia
  • Red cells increasing predominantly- Polycythemia Rubra Vera
  • If it’s the platelets increasing predominantly then we refer to as Essential Thrombocythemia

The Chronic leukemias account for about 15% of Leukemias and can occur at any stage.

Chronic Leukemia is managed appropriately at this hypercellular stage. It is stable indolent and slow progressing. All efforts by medical personnel managing the condition are aimed at not progressing from this stage into the accelerated phase where symptoms begin to manifest and ultimately to blastic transformation. (Transformation to the acute phase)

General Prevention of Leukemias

Prevention is aimed at reducing your risks of leukemia since there is no known cause for leukemia as well as other various types of cancers.

leukemia-3-728

Risk factors include;

  • Occupational exposures to certain chemicals such as benzene
  • Smoking and other uses of tobacco products
  • Exposure to large amounts of radiation
  • Down Syndrome or other types of genetic abnormalities
  • Smoking, other uses or exposure in pregnancy and in childhood to tobacco smoke (passive smoking).

TREATMENT

The treatment for cancers are quite expensive and drain resources. This is even more so when the five-year survival rates aren’t encouraging, however, new treatments are emerging that can change the outcomes into a better prognosis.

Presentación de PowerPoint

Immunotherapy is the “treatment of disease by inducing, enhancing, or suppressing an immune response”. Immunotherapies designed to elicit or amplify an immune response are classified as activation immunotherapies, while immunotherapies that reduce or suppress are classified as suppression immunotherapies.

What holds true for most blood cancers is that the earlier you detect it, the better you can reign it in.

Summary

34be04652180a0ceb50ce222d0e8b059

Mariam Mojisola Solate-Eshinlokun is a Medical Laboratory Scientist (B.MLS, AMLSCN) in Hematology and Immunohematology. She also has an M.Sc in view. She’s from Ogun state, a wife, mother and currently practice at the National blood bank, Khartoum Sudan.

 

​ABNORMAL MENSTRUAL BLEEDING

 

Most women have, at least, a rough idea of when to expect their monthly visitors – the menses. But some are not so lucky. The visitor can just decide to barge in at any time. Irregular menses can be very embarrassing, frustrating and distressing. 
I have discussed normal menstrual cycle on this blog before, read it here… http://wp.me/p72X3S-1U

Let’s look at some of the definitions of abnormal menses. 
*Menorrhagia – heavy menstrual flow, which can be described subjectively as the need to change pads more frequently than before. 
*Metrorrhagia – prolonged menses lasting for more than 9 days. 
*Menometrorrhagia – combination of heavy and prolonged menses. 
*Hypermenorrhea – cycle length shorter than 24 days. 
*Hypomenorrhea – cycle length greater than 38 days. 
*Amenorrhoea – absence of menses for 3 or more consecutive months. 
*Inter-menstrual bleeding – bleeding or spotting in between the menstrual cycles. 
*Post-coital bleeding – bleeding or spotting after sexual intercourse. 
*Post menopausal bleeding – bleeding or spotting after menopause (after at least one year of confirmed menopause) 
*Irregular menstrual cycle – more than 7-9 days of disparity in lengths of cycles. 
What are the causes of irregular menses? 

Irregular menses are commoner in pubertal girls (11-14years) and older women who are approaching menopause. Other than these, irregular or abnormal menses can be due to any of the following – 
*Psychological stress, physical exertion, or sudden change in diet, environment, etc. 

*Problems with ovulation 

*Uterine fibroids

*Adenomyosis (a condition in which the uterine lining – endometrium – grows into the wall of the uterus) 

*Use of contraceptive pills and devices 

*Miscarriage 

*Ectopic pregnancy 

*Bleeding disorders

*Hormonal imbalance 

*Infections of the genital tract including the uterus 

*Cancers of the genital tract

*Co-morbid medical conditions such as diabetes, obesity, etc. 

*Some drugs, alcohol, tobacco smoking, etc. 
Management of abnormal menstrual bleeding depends on the cause. You need to visit a doctor who will take a detailed history and carry out some tests to determine the cause. 
Some of the tests you have to do are:

*Pregnancy test

*Ultrasound scan

*Endometrial biopsy 

*Hysteroscopy

*CT scan or MRI, if indicated 

*Full blood workup

*Hormonal profile 
Of course, treatment depends on the cause or definitive diagnosis. This can be medical or surgical. Certain general measures can be used to restore normal menses; such as weight loss and stress management. 
In conclusion, menstrual disorders and irregularities are quite common. It is important to understand the mechanism of normal menses, so as to be able to detect any anomaly and seek professional advice for prompt investigation and treatment. 

ECTOPIC PREGNANCY

a rebellious embryo may decide to implant itself outside the uterus!

After the fertilization of the egg by a viable sperm, the resultant embryo travels from the fallopian tube down into the cavity of the uterus. Implantation occurs when the embryo is attached to the uterine wall and continues to develop until full term gestation.

ectopic

However, for reasons that are not fully understood, a rebellious embryo may decide to implant itself outside the uterus!

Ectopic Pregnancies (EP) account for about 11:1000 pregnancies. More than 80% of such rebels implant in the fallopian tube, hence the name “Tubal Pregnancy”, often used interchangeably with EP.

52407241-Types-of-ectopic-pregnancy-Infographics-illustration-on-isolated-background-Stock-Vector

Other recognized locations of EP are the abdominal cavity, ovaries, cervix and cesarean section scar.

Because of the limited space for growth within the tube or other ectopic sites, rupture and severe internal bleeding could occur starting from 6-8weeks. Ruptured EP is a life-threatening condition and one of the major causes of maternal mortality.

What are the risk factors for EP?

  • Previous history of EP
  • Previous history of infertility and its treatment (assisted reproductive techniques)
  • Pelvic inflammatory disease (PID)
  • Intrauterine contraceptive device use at the time of conception
  • Endometriosis (presence of the uterine lining outside of the uterus)
  • Pelvic or tubal surgery
  • Smoking

The only way to ensure prompt diagnosis and treatment of EP is to have a high index of suspicion by recognizing the telltale signs.

 

The symptoms are variable and non-specific but there is a classical triad reported by many patients:

  1. Missed period (6-8weeks)
  2. Lower abdominal pain
  3. Mild vaginal bleeding or brownish discharge. 

 Other symptoms include:Shoulder tip pain (sign of internal bleeding-ruptured EP),  Sudden collapse (due to severe blood loss)

    your-guide-to-pregnancy-abdominal-cramps-4

    A diagnosis is usually confirmed by identification via ultrasound scan, supported by the level of an early pregnancy hormone known as Human Chorionic Gonadotropin B (BHCG). The modality of treatment depends on the clinical status.

    ectopic-pregnancy-34-638

     

    *Surgical management – in ruptured EP, with acute severe blood loss, emergency surgical intervention must be done, together with blood transfusion to save the patient. 

    *Medical management – using methotrexate, in clinically stable patients who are compliant 

    *Expectant/Conservative management – in small sized EP and falling BHCG where the body is expected to get rid of the “rebel” by itself. This is reserved for a select few cases.

    Below is a summary of events in a woman with ectopic pregnancy and how the doctor chooses how best to help her.

    afp20000215p1080-f1