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.

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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.

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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.
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  • 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”

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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.

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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.

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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)

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    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.

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    *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.

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    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.

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    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.

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    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)

    WHEN CANCER ATTACKS THE OVARIES

    The ovaries consist of different cell types, performing different functions. Any of these cells can develop into cancer

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    Ovarian cancer is the leading cause of death from gynecological cancers in the UK and USA. It is the 5th most common cause of cancer deaths in women (after lung, breast, colorectal and pancreatic cancers). Up to 20,000 new cases are diagnosed yearly in the US. The peak incidence is in women aged 75 – 84 years, but it can occur in younger women, and even (rarely) in prepubescent girls too.

     

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    CLASSIFICATION 

    The ovaries consist of different cell types, performing different functions. Any of these cells can develop into cancer, but 90% arise from the epithelial (outermost) cells. Ovarian cancers are classified based on the cluster of cells they originate from:

    • Epithelial
    • Sex cord-stromal
    • Germ cells

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    Different subclasses have been described and each has similar features but different growth behavior and response to treatment.

    RISK FACTORS

    Like most cancers, direct causal factors are largely unknown, but various risk factors have been identified:

    • Nulliparity (no previous viable pregnancy)
    • Early menarche (age at onset of menstruation <11 years)
    • Late menopause (age at cessation of menstruation >52 years)
    • Family history of ovarian, breast or colorectal (bowel) cancers
    • Family history of genetic mutations ( BRCA1, BRCA2, and HNPCC)
    • Previous history of ovarian, breast, endometrial and colorectal cancers (treated)

     SCREENING FOR OVARIAN CANCER

    Not routinely done unless one has strong risk factors.

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    SIGNS AND SYMPTOMS

    Ovarian cancer is a great mimicker as it doesn’t show any specific sign until an advanced stage as been reached. Early symptoms are no different from those attributable to other common diseases. These are:

    • Abdominal pain
    • Abdominal distension and bloating
    • Loss of appetite
    • Constipation or diarrhea (or alternation of both)
    • Abnormal menses or vaginal bleeding

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    Late Symptoms include;

     

    • Abdominal/pelvic mass – detected by palpation and confirmed by radiological tests
    • Significant weight loss
    • Difficulty in passing urine
    • Significant abdominal distension (ascites or solid mass)
    • Generalized body swelling (edema or anasarca)
    • Signs of spread to distant organs – uterus and tubes, urinary tract, bowel, stomach, lymph nodes, etc.

     

    INVESTIGATIONS

    After taking a full history and physical examination, specific tests must be done to confirm the diagnosis, determine the extent of the disease and work up for definitive treatment.

    • Full blood count
    • Kidney function test
    • Liver function test
    • Tumor markers – CA125, CEA, CA19.9, etc.
    • Imaging: ultrasound, CT scan, MRI, chest x-ray, etc

     

    MANAGEMENT 

    1. SURGERY: This is both diagnostic and therapeutic. In early stages, the ovaries, uterus, tubes and adjacent lymph nodes will be removed at once. In advanced stages, initial surgery is done to “stage” cancer (to know what stage it is). Subsequent operations may be needed depending on the result of the first surgery and response or recurrence.
    2. CHEMOTHERAPY: The different combination of anti-cancer drugs are available depending on the cell types involved. The platinum-based therapy is given in up to 6 cycles every 3 weeks. Side effects of the drugs include severe vomiting, hair loss, kidney damage, diarrhea etc. These can also be managed and ameliorated.
    3. NOVEL AGENTS: New drugs are being investigated through clinical trials. These include antibodies against cancer-promoting factors in the body (VEGF, EGFR and TKI’s)
    4. SUPPORTIVE TREATMENT: These are palliative measures put in place to alleviate the excruciating pain and suffering associated with advanced ovarian cancer. Such as drainage of ascites, painkillers (strong opioids usually, morphine), emotional support, hospice care, etc.

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    FOLLOW UP IS OFTEN CONTINUED LIFELONG.

    5-year survival rate ranges from 90% to less than 20% depending on the stage of cancer before treatment is commenced.
    PREVENTION 

    It is said that the only way to not have cancer is not to be born. Ovarian cancer can not be predicted 100% but individuals with strong risk factors can be followed closely so as to detect the disease early. They can also opt for prophylactic oophorectomy (removal of the ovaries) after completing their reproductive career (cf. Angelina Jolie). For younger women, eggs can be harvested, frozen and used for IVF when they’re ready to get pregnant later.

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    General healthy lifestyle helps to prevent cancer among other things – healthy diet, regular exercise, quitting alcohol and smoking, etc.

    Childhood Cancers

    To nurse one child in Nigeria with cancer, you need about N2 million on the average in a period of about two years

    By Drs. Azeezah Shopeyin and Ajayi Abass 

    Childhood cancers occur in children less than 15 years. They are devastating not only to the children but their entire family. In Nigeria, it creates a huge financial burden on the family as there is no supportive treatment plan for children and the cost of treatment is very high.

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    Cancer leads to abandonment of treatment and consequently death of children. Hence, prevention of childhood cancers cannot be over emphasized. It’s important to note that in most fields of medicine, pediatrics have been found to be of significant challenge, because of communication challenges, and caregiver support.

    Burden to public health

    The international agency for research on cancer stated in 2004 that worldwide 160,000 children under 15 years get childhood cancers and 90,000 will die from it every year. In 2007, 71.2 of every 1 million Nigerian children below 15 years had childhood cancers.

    Due to the lack of data in Nigeria, and the paucity of studies on childhood cancers, it is not easy to appreciate the burden of childhood cancers, this might be due to the preoccupation with infectious diseases which are said to cause about 25% of childhood deaths.

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    In an 11year retrospective study conducted in northern Nigeria, by A. Mohammed and A.U Aliyu, it was noticed that childhood cancers were 8.44% of cancers diagnosed within that period. A male: female ratio of 1.5:1.

    In 2014, Consultant Paediatrician, Oncology/Haematology Unit of the Lagos University Teaching Hospital, LUTH, Dr. Adebola Akinsulirie, said about four or five cases of childhood cancer are seen monthly at the LUTH. That will give you about 50 children in a year. That is big as far as cancer in children is concerned in Nigeria. To nurse one child with cancer, you need about N2 million on the average in a period of about two years.

    Types of childhood cancers

    The most common childhood cancers accounting for childhood deaths in Lagos  include kidney cancer (nephroblastoma) and blood cancer (Acute lymphoblastic leukemia and Acute myeloid leukemia)

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    Lymphomas (solid cancer of white blood cells) are also quite common childhood malignancies and neuroblastoma (cancer of nerve cells), others include leukemias, bone and muscle tumors.

    Causal or pre-disposing factors

    The cause of most childhood cancers are unknown in about 75-90% of cases, 5-15% are due to familial and genetic factors( intrauterine viral infections, parental occupational/ radiation exposures, war-torn regions and disasters, elderly maternal age above 35, parental especially maternal smoking and alcohol consumption.

     

    and <5-10 % are due to known environmental exposures and exogenous factors (food, radiation, dyes, infections like intrauterine viral infection Epstein-Barr virus and leukemias/ lymphomas etc). It’s important though to note that cancers generally are caused by a variety of factors and are not limited to a single causative agent.

    How to recognize childhood cancers early

    Complaints about any of the following that does not go away in a child:

    • Feeling of an unusual lump or swelling
    • Unexpected paleness and loss of energy
    • Easy Bruising
    • An ongoing pain in one area of the body
    • Limping
    • Unexplained fever or illness that doesn’t go away
    • Frequent headaches, often with vomiting
    • Sudden eye or vision changes
    • Sudden unexplained weight loss

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    Prevention of childhood cancers

    1. Avoidance of chewing or smoking tobacco.
    2. Protection from sunlight.
    3. Limiting fats in diet
    4. A healthy diet with at least 5 portions of fruits and vegetables per day.

    Management of childhood cancers

    Childhood cancers are managed by a team of specialized pediatric cancer care specialists, including pediatric oncologists, pathologists, radiologists, surgeons, radiotherapists, nurses and support staff include the nutritionist, social workers, pharmacists and other medical specialists. First, a correct diagnosis is made; depending on the stage of the disease from Investigations carried out, the child is given drugs,  and surgical intervention or radiation therapy may be necessary.

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    The challenges in pediatric cancer are numerous but surmountable if there is the will. These are

    1. Recognition of symptoms by parents
    2. Time of presentation/ late presentation
    3. Lack of funds by caregivers
    4. Limited diagnostic equipment/ facilities
    5. High cost of diagnostic investigations
    6. High cost of treatment
    7. Effects of cytotoxic drugs/radiation therapy
    8. Lack of political standing of their own as such children are forgotten in most policies.

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    The above challenges can be solved if

    1. Adequate awareness is provided about childhood cancers
    2. Children are exclusively included in the NHIS
    3. Funding is provided for research into childhood cancers
    4. Facilities for diagnosis and treatment are provided.
    5. Provision of psychological support and social welfare services.

    In summary

    Childhood cancers are a source of significant burden to the child, parents, and caregivers; as such a lot of support is needed; financial, psychological, and spiritual. The distress from the disease, the financial implications, and stress of accessing treatment including the toxicity of the cytotoxic agents is of significant concern, however, children are more likely to recover from cancers when they are detected early and commenced on therapy as quick as possible.

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    Dr. Azeezah Shopeyin graduated from the University of Lagos, college of medicine.With several years experience, she also has a master degree in public health. She’s interested in health education and promotion. She’s a wife and mother of two kids and she enjoys making people happy,

    Dr. Ajayi Abass Oluwaseyi graduated from Ahmadu Bello University in Zaria. Also known as Juggernaut bn Yusuf, he is also a writer, an aspiring Neurosurgeon, and a Farmer. He currently works at the federal teaching hospital in Gombe.

    ENGAGING CANCER

    Cancer starts from errors in coding as a result of mutations which could occur naturally by heredity when cells are multiplying or induced by an external agent

    Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. Not all tumors are cancerous and benign tumors do not spread to other parts of the body.

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    Today, millions of people will march all over the world to commemorate the world cancer day. Irrespective of our religion, tribe, nation and political views, this is the day we highlight to fight this menace that has claimed the lives of millions and shattered the hope of many families.

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    To explain cancer in simpler terms, biology has taught us all living things are made up of cells, be it unicellular (one) as the case of some microorganisms and multicellular (plenty) as the case of humans. The cell is the basic unit of life. Our cells contain the genetic material “genes” located in the DNA. These genes are made up of simple coding which defines the function of the cell.

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     The interactions of these gene replaces cells when they are damaged or need to grow. These lead to the formation and functionality of tissues, organs and different systems in our body. Just like a computer, made up with various coding and algorithms which help different softwares to work and at the long run function in tandem as a computer.

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    Cancer starts from errors in these coding as a result of mutations which could occur naturally by heredity when cells are multiplying or induced by an external agent. Basically, these mutations could occur in genes that control the way cells grow; tumour suppressor genes (TSG) and oncogenes (ONC).

    Tumour suppressor genes function like a break system in a car, it halts the growing of cells while oncogenes function like the accelerator of a car, maintaining the speed or rate at which cells multiply. When either of TSG and ONC is affected, what will happen is either cells multiplying at an abnormal speed leading to the formation of tumour in an organ. This occur due to the inability of TSG ‘brakes’ to reduce the speed or cells multiplying excessively due to much pressure on the accelerator, the ONC.

    Causes of cancer

    Some cancers develop when an individual inherits a bad gene with mutations, an oncogene or a tumour suppressor gene from parents. As the person grows, the mutations increase and finally cancer develops at a particular stage in life. It is like buying a bad computer which eventually develops fault during use.

    Some viruses induce mutations in the coding in these genes leading to cancer. Similar to the way viruses attack our computers leading to the deletion of some important files on the desktop leading to software malfunction and sometimes might affect the hardware.

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    Carcinogens, chemical agents like benzene that can cause cancer when inhaled or consumed can also induce mutations. It is like using a computer to visit bad websites with malwares, installing fake applications or software that is incompatible with your computer. Also, some environmental factors like exposure to radiation can lead to cancer.

    Life style, practices such as smoking can contribute to the induction most cancers. This is similar to personal choices you make with your computer at your own risk, removing a flash drive inappropriately, shutting down your computer unexpectedly or using your computer in an environment where liquids could spill on it. These practices can crash your computer just as a smoker is liable to die young either by lung cancer or other respiratory disorders.

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    Another key risk factor that could initiate cancer is aging. The processes that control cell reproduction malfunctions. This lead to accumulation of toxic reactive oxygen species that damage mitochondria (cell engine). For example, reactive oxygen species above normal levels can oxidize our DNA.

    The cure, Our Hope

    Although we have been blessed with an immune system that could detect and destroy cancer cells, many cancer cells are well equipped to survive and evade these cells. Scientists are left with the option of finding cures for cancer, however, every cancer seems to be different, making it difficult to cure all cancers with one drug. Also, cancers can be well-managed and prevented, telling us cancer is not a death sentence.

    Early detection, you can revive a computer which is dragging or slow as a result of malware or viruses. Install an antivirus as quick as possible, there you go. Taking your car to a mechanic when it flashes check engine, when you notice the grip of the brake has reduced or when the clutch smells will definitely prevent a sudden disaster when driving.

    As well, early detection of cancers will significantly increase the chances of survival. Doctors would administer different form of therapies just like an antivirus in a computer. Cancerous cells would die and in many cases total remission could occur. However, successfully scanning and deleting the virus on your computer does not assure you your computer can not be infected again, hence, Cancer patients who are in remission can also have reoccurrence.

    Some cancers are gender specific, some are age specific, like prostrate cancer and there are recommendations for when to start detecting them.

    Positive lifestyle, practices such as eating fruits and vegetables, exercising, quitting smoking, maintaining a clean environment and avoiding junks can reduce the risk of cancer. Recent studies have discovered that processed meats, canned foods, over cooking food such as brown bread could cause cancer.

    The Future, Cancer will one day be treated like any other disease with significantly reduced mortality rate. The approach to getting a cure is like traffic rules, using camera speed checkers on the road to prevent excessive speeding of cars and arrest those who over-sped by giving them a surprise ticket when they get home. We would one day detect and arrest rouge cells before the progression of cancers. The use of bumps on roads to prevent over-speeding and also slow down drivers, we are already slowing down the rate at which ONC drive our cells to induce cancer. In the nearest future, our immune system will boosted and trained to apprehend bad drivers of our genes.

    Mahmud Abdullah Opekitan attended Obafemi Awolowo University, Ile-Ife, Osun state, Nigeria between 2008 and 2011 bagging a B.Sc Hons Microbiology with a Second Class, Upper Division. He Also has a Master of Biomedical Science degree in Biomolecular Science- With Distinction. He’s currently wrapping up his Phd in Cancer Biology from Strathclyde Institute Of Pharmacy And Biomedical Sciences. 

    Depression

    You can’t love others if you don’t love yourself and you are selfish if you love yourself too much because few would embrace you. If you don’t love yourself at all, you need help, not death.

    “Since the robbery, I have cried all day and night, I can’t believe I have lost it all, ahh! I am so sad, in fact, I am depressed, she said”

    DEPRESSION IS NOT SADNESS

    Sadness, like excitement, is a normal reaction to an unpleasant situation or life difficulties. Often times, however, ‘I am depressed as used in the story above is used synonymously with I am sad. By extension reducing the reality of the illness to just a mood- sadness. This misconception is what birth statements like “snap out of it”, “man up”, “you are just making a big deal out of it”.

    Depression is a mental illness, associated with low mood, decreased energy, low self-esteem, loss of interest in previously exciting activities, appetite disorder (loss or excessive), a feeling of guilt, thoughts of death and disturbed sleep. Depression is way beyond sadness.

    Signs and Symptoms of Depression

    “It started with my being unable to sleep, but it soon got worse. I lost weight drastically and started experiencing somatization- chronic physical pains in various parts of my body, making me very weak and low-spirited, but no one at the time understood what I was talking about”.  

    Again, sadness is not depression, sadness could for some is only a small part of depression and some others may not feel sadness at all. Depression has many other symptoms, including physical ones. If you have been experiencing any of the following signs and symptoms for at least 2 weeks, you may be suffering from depression:

    • Decreased energy, fatigue, being “slowed down”
    • Difficulty concentrating, remembering, making decisions
    • Persistent sad, anxious, or “empty” mood
    • Feelings of hopelessness, pessimism
    • Feelings of guilt, worthlessness, hopelessness
    • Loss of interest or pleasure in hobbies and activities
    • Difficulty sleeping, early-morning awakening, or oversleeping
    • Appetite and/or weight changes
    • Thoughts of death or suicide, suicide attempts
    • Restlessness, irritability
    • Persistent physical symptoms, e.g. diarrhea

    Types

    There are different types of depressive disorders and based on symptom severity, depression can range from mild to severe to very severe condition

    Major depression

    Major depression is sometimes referred to as clinical depression, unipolar depression or major depressive disorder. It involves low mood and/or loss of interest and pleasure in usual activities, as well as other symptoms for at least two weeks. Symptoms of depression interfere with individual’s daily life and normal functioning. Depression can be described as mild, moderate or severe; melancholic or psychotic (see below).

    Melancholia

    This is the term used to describe a severe form of depression where many of the physical symptoms of depression are present particularly slow movement. It is also characterized by complete loss of pleasure in everything or almost everything.

    Psychotic depression

    Sometimes a depressive disorder can be accompanied by loss \of touch with reality and experience psychosis. This can involve hallucinations (seeing or hearing things that aren’t there) or delusions (false beliefs that aren’t shared by others), such as believing they are divinities, prophets or evil, or that they’re being watched or followed. They can also be paranoid, feeling as though everyone is against them or that they are bad omens.

    Antenatal and postnatal depression

    In the days or weeks following birth, many women experience ‘baby blues’ which is a common condition related to hormonal changes and affects up to 80 percent of women. The ‘baby blues’, are common experiences, but are different from depression and tend to decrease within a week or two. Depression is longer lasting and can affect not only the mother but her relationship with her child, the child’s care and development, the mother’s relationship with her partner and other members of the family. Almost 10 percent of women will experience depression during pregnancy. This increases to 16 percent in the first three months after having a baby.

    Bipolar disorder

    In bipolar disorder, the person experiences periods of depression and periods of mania, with periods of normal mood in between. Mania is the opposite of depression, characterized by extremely “high” moods, energized behavior, having racing thoughts, little need for sleep, difficulty concentrating and feeling frustrated and irritable. It may sometimes affect the person’s touch with reality and has episodes hallucinations (seeing or hearing something that is not there) or having delusions (e.g. the person believing he or she has divine powers).

    Bipolar disorder tends to run in families. Stress and conflict can trigger episodes for people with this condition and it is common for bipolar disorder to be misdiagnosed as depression, alcohol or drug abuse, attention deficit hyperactivity disorder (ADHD) or schizophrenia. A mild form of bipolar disorder is cyclothymic disorder

    Seasonal affective disorder (SAD)

    SAD is a mood disorder that has a seasonal pattern. The cause of the disorder is unclear, but it’s thought to be related to the variation in light exposure (Sunlight) in different seasons. Depression which starts in winter and subsides when the season ends is the most common.

    Causes

    “Mopelola was noticed in September in the year 2014 to be unduly withdrawn from people including keeping away from her friends on the ground that nobody loves her; almost at the same time, she has also been seen not to be participating in some of the church activities that were known to be pleasurable to her. Within a month of the onset of the condition, she has been observed to have reduced appetite for food as she claims that she has a need to engage in fasting and prayers to combat some negative thoughts that were running through her mind, such thoughts according to her include but not limited to thoughts of not “good enough, being worthless and useless and that there was nothing good about her future”. Consequently, she felt unhappy all the times and sometimes got angry at others around him. This condition has affected her ability to concentrate on her JAMB coaching class and her level of concentration has dropped significantly. Her parents in their state of being bewildered to have made many spiritual attempts to ameliorate the problem, only minimal improvement was noticed”

    The thought that depression is mood-sadness, and sufferers being individuals “who can’t just get over it” consequently make the misconstrued cause of depression to be Weakness. Religious affirmations that link spiritual weakness to depression further make appropriate treatment less sought.

    Depression like all illness have factors that play a role or make an individual vulnerable. They include;

    • Traumatic events
    • Other mental health problems
    • Physical health problems e.g. chronic or life-threatening health problems
    • Genetic inheritance
    • Childhood experiences such as neglect, loss of parent(s)
    • Medication, substance and alcohol abuse.
    • Sleep, poor nutrition, and exercise

    Treatment

    Depression – even the supposed worse cases – can be treated and individuals can recover and live a productive life. Like all illness, early detection and treatment greatly affect treatment outcome. The earlier the better.

    While many may still argue that depression is caused by spiritual weakness or attack, I advise that while deliverance and other spiritual approach are being sorted, kindly visit a doctor. The goal is to be better, isn’t it? The first step to recovery is seeking help, speak to a doctor, your doctor may then refer you to a specialist after physical problems have been ruled out.

    Depression depending on the diagnosis made can be treated with medications or psychotherapy or both. Treatment is often times individualized.

    Depression can occur to anyone and at ages

    According to the World Health Organization (WHO), depression is the leading cause of disability worldwide, and at least 350 million people are affected worldwide, this could be higher considering denial and treatment abstinence based on misconceptions or ignorance could hinder diagnosis in some sufferers. Although a common illness, it affects individuals differently

    Depression in Women.

    Women with depression do not all experience same symptoms, however, symptoms of sadness, worthlessness, and guilt are typical symptoms women have.

    Depression is twice as common among women as among men. Hormonal fluctuations during puberty, menstruation, pregnancy, childbirth and menopause are probable causes amongst other factors such as genetics and abuse.

    Depression in Men

    Men although less likely than women also suffer depression and manifestations in men differ from those in women. Men are more likely to react to life difficulties with denial, anger, violence or substance and alcohol abuse. Some men may throw themselves into their work to avoid talking about their feelings or behave recklessly. Although more women attempt suicide, many more men die by suicide.

    Depression in Children

    Children are particularly thought to be free-spirited and do not “think”, hence can’t suffer depression.

    “Most studies concur that about 1% to 2% of pre-pubertal children and about 5% of adolescents suffer from clinically significant depression at any one time and by the age of 16 years 12% of girls and 7% of boys would have had a depressive disorder at some time in their lives”.

    The implication of the above is that in a primary school of about 300 children at least 3-6 of them will be depressed at any one time. Children with depression may pretend to be sick, refuse to go to school, cling to a parent or become excessively anxious. The normalcy of children makes recognition a bit difficult, however, a change in the initial behavioral or academic pattern are major red flags to watch out for.

    Depression in Teens

    As children grow into teenagers and adolescent, parental acceptance is second to peer acceptance, coupled with hormonal changes, teenage years can be tough and irritable moods are expected.

    However, depression in teenagers often presents with persistence in irritability (hostile, easily frustrated, angry outbursts), hypersomnia, increased appetite or loss of it, extreme sensitivity to rejection (criticism). Depression if left untreated may manifest fully in reckless behavior, substance abuse or school desertion.

    Unlike in adults, children and teenagers rely on adults (parents, teachers, and caregivers) in recognizing and helping them get help as ignorance of their feelings or their natural dependence may prevent them from getting help.

    Takeaway

    Prevention is better than cure, early detection and treatment will prevent disease progression

    Self-care tips and general lifestyle modifications can help manage the symptoms of many mental health problems, and may also help to prevent some problems from developing or getting worse.

    Reference

    Depression in children and adolescents, 2015 edition by; Joseph M Rey, Tolulope T Bella-Awusah & Jing Liu pg. 2

    Shadows in the Mirror by; Dr. Vivian Ikem

     

     

     

    Rukayat Ogunbiyi is a Pharmacist and Public mental health advocate, inclined towards child and adolescent psychiatry. She was trained as an intern at the Federal Neuropsychiatric Hospital, Yaba. She is currently set to resume post graduate studies in Child and Adolescent Mental health at the Center for Child and adolescent mental health in University of Ibadan.