Adetunji Memorial Hospital

01/01/2016

May our blessings increase abundantly this year. Happy New Year to our esteem clients.

15/12/2015

Why Fever Does Not Always Mean Malaria'
Posted: 15/Dec/2015


The head case management branch of the National Malaria elimination programme, Dr Godwin Ntadom has advised people to desist from always thinking of malaria alone when they have fever.

Fever means having an abnormally high body temperature or when you body temperatures rises above its normal range and could be accompanied with headache, or shivering.

He stated this while commenting on the World Malaria Report 2015, released last week by the World Health Organisation. According to the report, there is a significant increase in the number of countries moving towards malaria elimination, with prevention efforts saving millions of dollars in healthcare costs over the past 14 years in many African countries.

The report says two countries, Nigeria and Democratic Republic of Congo, account for more than 35% of global malaria deaths in 2015.

Ntadom said deaths due to malaria has reduced significantly in the country and why we have really not seen this is because of our mentality that fever must be malaria or always be malaria.

"When people go to do test, they say 'Oh I did the test and it was negative, I think that the test is not good.' But the fact is that they don't have malaria. Once you do a test and it is negative, know that you don't have malaria. Some people just find it difficult to believe or swallow and would say how can I have fever and you are telling me that it is not malaria? We don't just have this challenge with individuals but even health care providers. You see doctors do test and it is negative and they still insist on giving anti-malaria medicine because they don't believe in themselves and the test," he explained.

He said now is the period of the year when there is the lowest incidence of malaria because rain is no longer falling, with no breeding spaces or mosquitoes buzzing around, adding that tests done from December to April have a higher chance of being negative for malaria, and the peak transmission season is usually during the rainy season in our environment.

He advised that when people have fever and cough now they should also think that there are other diseases that can cause it.

He said: "Now the weather is changing, we are moving from dry season to rainy season, a lot of dust and bacteria, all these cause fever too. It is not only malaria that causes fever, it could be a viral infection, or bacterial infection but definately it is not malaria when your test is negative to it. And when the test is positive, go for treatment immediately with anti-malaria."

He said Nigeria and Democratic Republic of Congo, feature often in malaria deaths because of their huge populations and not because they are not doing anything about it.

According to him, Nigeria has achieved so much in its malaria control efforts in the past few years and has moved down from hyper endemic, that is a situation where about 50% of the population at any time will be tested positive when they have fever, to a meso endemic nature, that is the level that you test about 100 people and less than 25 are positive especially in most urban areas.

Ntadom said although we still have pockets of places in the country that are still highly endemic generally the malaria situation in the country has gone down.

He added that Nigeria still has a lot to do because the target is to get to a point where in every 100 less than five will be positive before achieving a complete elimination in the country.

Some interventions against malaria in the country, he said includes the Seasonal Malaria Chemoprevention (SMC), integrated community case management and awareness creation.

He added that the bulk of resources from this interventions are from Global Fund, UKAID, and USAID among others.

By: Ojoma Akor
Daily Trust News

19/07/2015

HAND WASHING

Frequent hand-washing is one of the best ways to avoid getting sick and spreading illness. Hand-washing requires only soap and water or an alcohol-based hand sanitizer - a cleanser that doesn't require water.

WHEN TO WASH YOUR HANDS:-

As you touch people, surfaces and objects throughout the day, you accumulate germs on your hands. In turn, you can infect yourself with these germs by touching your eyes, nose or mouth. Although it's impossible to keep your hands germ-free, washing your hands frequently can help limit the transfer of bacteria, viruses and other microbes.

Always wash your hands before:

Preparing food or eating
Treating wounds, giving medicine, or caring for a sick or injured person
Inserting or removing contact lenses

Always wash your hands after:

Preparing food, especially raw meat or poultry
Using the toilet or changing a diaper
Touching an animal or animal toys, leashes or waste
Blowing your nose, coughing or sneezing into your hands
Treating wounds or caring for a sick or injured person
Handling garbage, household or garden chemicals, or anything that could be contaminated — such as a cleaning cloth or soiled shoes
Shaking hands with others
In addition, wash your hands whenever they look dirty.

HOW TO WASH YOUR HANDS:-

It's generally best to wash your hands with soap and water. Follow these simple steps:

Wet your hands with running water — either warm or cold.
Apply liquid, bar or powder soap.
Lather well.
Rub your hands vigorously for at least 20 seconds. Remember to scrub all surfaces, including the backs of your hands, wrists, between your fingers and under your fingernails.
Rinse well.
Dry your hands with a clean or disposable towel or air dryer.
If possible, use a towel or your elbow to turn off the faucet.
Keep in mind that antibacterial soap is no more effective at killing germs than is regular soap. Using antibacterial soap might even lead to the development of bacteria that are resistant to the product's antimicrobial agents — making it harder to kill these germs in the future.

HOW TO USE AN ALCOHOL-BASED HAND SANITIZER:-

Alcohol-based hand sanitizers, which don't require water, are an acceptable alternative when soap and water aren't available. If you use a hand sanitizer, make sure the product contains at least 60 percent alcohol. Then follow these simple steps:

Apply enough of the product to the palm of your hand to wet your hands completely.
Rub your hands together, covering all surfaces, until your hands are dry.
Antimicrobial wipes or towelettes are another effective option. Again, look for a product that contains a high percentage of alcohol. If your hands are visibly dirty, however, wash with soap and water.

KIDS NEED CLEAN HANDS, TOO

Help children stay healthy by encouraging them to wash their hands properly and frequently. Wash your hands with your child to show him or her how it's done. To prevent rushing, suggest washing hands for as long as it takes to sing the "Happy Birthday" song twice. If your child can't reach the sink on his or her own, keep a step stool handy.

Alcohol-based hand sanitizers are OK for children and adolescents, especially when soap and water aren't available. However, be sure to supervise young children using alcohol-based hand sanitizers. Remind your child to make sure the sanitizer completely dries before he or she touches anything. Store the container safely away after use.

Hand hygiene is especially important for children in child care settings. Young children cared for in groups outside the home are at greater risk of respiratory and gastrointestinal diseases, which can easily spread to family members and other contacts.

Be sure your child care provider promotes frequent hand-washing or use of alcohol-based hand sanitizers. Ask whether the children are required to wash their hands several times a day — not just before meals. Note, too, whether diapering areas are cleaned after each use and whether eating and diapering areas are well-separated.

GLOBAL HAND WASHING DAY

Due to the importance of Hand Washing, the WHO has set aside a day as the Global Hand Washing Day which 15th October of every year. This day is dedicated to advocacy(teaching about the importance and need) of hand washing. This will involve educating people about hand washing on the radio, TV, schools etc.

A SIMPLE WAY TO STAY HEALTHY

Hand-washing doesn't take much time or effort, but it offers great rewards in terms of preventing illness. Adopting this simple habit can play a major role in protecting your health.

07/07/2015

The Quantum Resonance Magnetic Spectrometry is Chinese based technology that studies magnetic field around object "hair in man" to determine it's molecular make-up and hence believed to assess possible presence of disease state in the body.
Due to prevailing economic situation and the struggle for survival, it has been bastardized especially in Nigeria where this machine is been carried everywhere: on the road, in the market, to offices....and giving tђǝ impression that it scans tђǝ whole body from just holding a probe in tђǝ palm.
An important thing to note is that no matter how many times a person does tђǝ scan and on whoever tђǝ test in done on, there is always a disease condition that will necessitate buy one or more of tђǝ "supplements"

THEY ARE ALL LIES !!!!!!!!!

Pls check tђǝ link below for further detailed scientific prove.

http://blogs.discovermagazine.com/neuroskeptic/2015/01/31/quantum-resonance-spectrometry-work/ #.VZvos7SCN8U

Does Quantum Resonance Spectrometry Work? neuroskeptic

07/07/2015

NASAL CONGESTION

Nasal congestion is the blockage of the nasal passages usually due to membranes lining the nose becoming swollen from inflamed blood vessels. It is also known as nasal blockage, nasal obstruction, blocked nose, stuffy nose, or plugged nose.
Nasal congestion has many causes and can range from a mild annoyance to a life-threatening condition. The newborn infant prefers to breathe through the nose referred to as "obligate nose breathers".
Nasal congestion can cause mild facial and head pain, and a degree of discomfort, often from allergies or the common cold.

NASAL OBSTRUCTION:- Nasal obstruction characterized by insufficient airflow through the nose can be a subjective sensation or the result of objective pathology. It is difficult to quantify by subjective complaints or clinical examinations alone, hence both clinicians and researchers depend both on concurrent subjective assessment and on objective measurement of the nasal airway. Often a doctor's assessment of a perfectly patent nasal airway might differ with a patient's complaint of an obstructed nose.

CAUSES

*Allergies
*Common cold or influenza
*Deviated septum
*Hay fever (allergic reaction to pollen or grass)
*Reaction to medication (e.g. Flomax)
*Rhinitis medicamentosa {a condition of rebound nasal congestion brought on by extended use of topical decongestants (e.g., oxymetazoline, phenylephrine, xylometazoline, and naphazoline nasal sprays)}.
*Sinusitis or sinus infection (Infection may cause blood vessels in the nasal passage to inflame.)
*Pregnancy may cause women to suffer from nasal congestion due to the increased amount of blood flowing through the body.
*Nasal polyps
*Co**ha bullosa
*Empty nose syndrome
*Gastroesophageal reflux disease (theorized to cause chronic rhinosinusitis- the "airway reflux paradigm")

TREATMENT

The treatment of nasal congestion frequently depends on the underlying cause.
# Alpha-adrenergic agonists are the first treatment of choice. They relieve congestion by constricting the blood vessels in the nasal cavity, thus resulting in relieved symptoms. Examples include oxymetazoline and phenylephrine.
# Both influenza and the common cold are self-limiting conditions that improve with time; however, drugs such as acetaminophen (paracetamol), aspirin, and ibuprofen may help with the discomfort.
# A cause of nasal congestion may also be due to an allergic reaction caused by hay fever, so avoiding allergens is a common remedy if this becomes a confirmed diagnosis. Antihistamines and decongestants can provide significant symptom relief although they do not cure hay fever. Antihistamines may be given continuously during pollen season for optimum control of symptoms. Topical decongestants should only be used by patients for a maximum of 3 days in a row, because rebound congestion may occur in the form of rhinitis medicamentosa.
# Nasal decongestants target the discomfort directly. These come as nasal sprays like naphazoline (Privine), oxymetazoline (Afrin, Dristan, Duramist), as inhalers, or phenylephrine (Neo-Synephrine, Sinex, Rhinall) or as oral pills (Bronkaid, Sudafed, Actifed, Neo-Synephrine, Sinex, Rhinall). Oral decongestants may be used for up to a week without consulting a doctor, with the exception of Bronkaid and Sudafed, which can be taken as long as needed, but nasal sprays could worsen the congestion if taken for many days; therefore, you should only take nasal sprays when discomfort cannot be remedied by other methods, and never for more than three days.
# If an infant is unable to breathe because of a plugged nose, a nasal aspirator (e.g bulb sucker) may be useful to remove the mucus. The mucus might be thick and sticky, making it difficult to expel from the nostril.

COMPLICATION

- Nasal congestion in an infant in the first few months of life can interfere with breastfeeding and cause life-threatening respiratory distress.
- In older children and adolescents it is often just an annoyance but can cause other difficulties.
- Nasal congestion can interfere with the hearing and speech.
- Significant congestion may interfere with sleep, cause snoring, and can be associated with sleep apnea.
- In children, nasal congestion from enlarged adenoids has caused chronic sleep apnea with insufficient oxygen levels and hypoxia, as well as right-sided heart failure. The problem usually resolves after surgery to remove the adenoids and tonsils.

28/06/2015

DIARRHEA

Diarrhea(diarrhoea), is the condition of having at least three loose stool each day (a.k.a. Purging in colloquial speaking). It often lasts for a few days and can result in dehydration due to fluid loss. Diarrhea alone is often referred to as Enteritis and if accompanied with vomiting, it's called Gastroenteritis. If there is blood in tђǝ stool, it's called Dysentery.

CAUSES:

Loose but non watery stools in babies who are being breastfed, may be normal. It is called breastmilk stool and need no treatment. It looks like egusi(melon) soup - small, loose & yellowish. It can be passed ranging from: once in 7days to 7times in one day. No fever, no dehydration & child sucks well.

However, apart from this breastmilk stool, The most common cause of diarrhea is an infection of the intestines most commonly by a virus. Others include bacteria, or parasite. These infections are often acquired from food or water that has been contaminated by stool, or directly from another person who is infected.

A number of non-infectious causes may also result in diarrhea, including hyperthyroidism, lactose intolerance, inflammatory bowel disease, a number of medications, and irritable bowel syndrome. Most common cause encountered in our clinics is diarrhea due to Food irritation such as large consumption of spicey food or undigested food & vegetables.

DISEASE BURDEN:

About 1.7 to 5 billion cases of diarrhea occur per year. It is most common in developing countries, where young children get diarrhea on average three times a year. Total deaths from diarrhea are estimated at 1.26 million in 2013 – down from 2.58 million in 1990. In 2012, it is the second most common cause of deaths in children younger than five (0.76 million or 11%). Frequent episodes of diarrhea are also a common cause of malnutrition and the most common cause in those younger than five years of age. Other long term problems that can result include stunted growth and poor intellectual development.

EFFECTS:

Immediate & commonest effect of diarrhea is Dehydration. Signs of dehydration often begin with loss of the normal skin elasticity and changes in personality. This can progress to decreased urination, loss of skin color, a fast heart rate, and a decrease in responsiveness & convulsion as it becomes more severe. Then coma & death if not addressed. Fever & abdominal distension are other possible aftermath.

TREATMENT:

Oral rehydration solution (ORS), which is clean water with modest amounts of salts and sugar, is the main treatment of choice. Zinc tablets are also recommended especially in children. These treatments have been estimated to have saved 50 million children in the past 25 years.

It is recommended that patient having diarrhea continue to eat healthy food and babies continue to breastfeed. If commercial ORS are not available, homemade solutions may be used such as Garri water, Rice water, pap or Coke. In those with severe dehydration, intravenous fluids may be required. Most cases; however, can be managed well with fluids by mouth.
ANTIBIOTICS IS RARELY NEEDED. But it may be recommended in a few cases such as those who have bloody diarrhea and a high fever, those with severe diarrhea following traveling, and those who grow specific bacteria or parasites in their stool. Loperamide may help decrease the number of bowel movement but is not recommended in those with severe disease. LET US LEAVE THIS DECISION TO OUR DOCTORS.

PREVENTION:

Prevention of infectious diarrhea is by improved sanitation, clean drinking water, and hand washing with soap. Breastfeeding for at least six months is also recommended and vaccination against rotavirus is helpful.

Open defecation is a leading cause of infectious diarrhea leading to death.

Poverty is a good indicator of the rate of infectious diarrhea in a population. This association does not stem from poverty itself, but rather from the conditions under which impoverished people live. The absence of certain resources compromises the ability of the poor to defend themselves against infectious diarrhea. "Poverty is associated with poor housing, crowding, dirt floors, lack of access to clean water or to sanitary disposal of f***l waste (sanitation), cohabitation with domestic animals that may carry human pathogens, and a lack of refrigerated storage for food, all of which increase the frequency of diarrhea... Poverty also restricts the ability to provide age-appropriate, nutritionally balanced diets or to modify diets when diarrhea develops so as to mitigate and repair nutrient losses. The impact is exacerbated by the lack of adequate, available, and affordable medical care."

Water
One of the most common causes of infectious diarrhea, is a lack of clean water. Often, improper f***l disposal leads to contamination of groundwater. This can lead to widespread infection among a population, especially in the absence of water filtration or purification. Human f***s contains a variety of potentially harmful human pathogens. E.g Makoko, Ijora, Ajegunle areas of Lagos.

Nutrition
Proper nutrition is important for health and functioning, including the prevention of infectious diarrhea. It is especially important to young children who do not have a fully developed immune system. Zinc deficiency, a condition often found in children in developing countries can, even in mild cases, have a significant impact on the development and proper functioning of the human immune system. Indeed, this relationship between zinc deficiency reduced immune functioning corresponds with an increased severity of infectious diarrhea. Children who have lowered levels of zinc have a greater number of instances of diarrhea, severe diarrhea, and diarrhea associated with fever. Hence tђǝ need for supplemental Zinc during diarrhea illness. Similarly, vitamin A deficiency can cause an increase in the severity of diarrheal episodes, however there is some discrepancy when it comes to the impact of vitamin A deficiency on the rate of disease. While some argue that a relationship does not exist between the rate of disease and vitamin A status, others suggest an increase in the rate associated with deficiency. Given that estimates suggest 127 million preschool children worldwide are vitamin A deficient, this population has the potential for increased risk of disease contraction. This is one of reason for continue feeding during illness.

BAD HABIT:

Pls Note: A bad practice of our people is to immediately start Flagyl & Tetracycline when there is a loose stool in adult and Flagyl + Ampicillin/Septrin/Amoxil in children ± Diastop in children. Many also uses pican/teething powder/Gripe water. This are uncalled for. They may cause more harm than good. There is risk of Pseudomembranous colitis from this. Let's desist from these bad habits.

12/06/2015

Constipation

Constipation is an acute or chronic condition in which bowel movements occur less often than usual or consist of hard, dry stools that are painful or difficult to pass. Bowel habits vary, but an adult who has not had a bowel movement in three days or a child who has not had a bowel movement in four days is considered constipated.

Constipation is one of the most frequent gastrointestinal complaints in the out-patient clinics. There are at least 2.5 million doctor visits for constipation in the USA each year and hundreds of millions of dollars are spent for laxatives yearly. No standard record for our environment for many cases are not reported.

Causes of constipation:
Constipation most commonly occurs when the waste (stool) that forms after food is digested, moves too slowly (slow transit) as it passes through the digestive tract. Dehydration, changes in diet and activity, and certain drugs are frequently to blame to slow transit of stool. When stool moves slowly, too much water is absorbed from the stool, and it becomes hard and dry. Gradual enlargement of the re**um and poor coordination of the pelvic and a**l muscles sometimes contribute to or cause constipation. Sometimes a combination of these processes occurs.
Another cause is bowel obstruction (blockage), it is serious but uncommon.

Diagnosis:
A doctor usually relies on the person's account of constipation when making a diagnosis. The doctor also examines the re**um with a gloved finger and, if stool is present, determines the amount and consistency. The stool is tested for occult (hidden) blood. The person's symptoms and examinations are often all that are needed to confirm a diagnosis of constipation and to determine the likely cause.
When the cause remains unclear, tests may be done. The doctor may recommend an examination with a flexible viewing tube, either of just the lower part of the large intestine (sigmoidoscopy) or of the entire large intestine (colonoscopy). This examination is important if the constipation developed suddenly or if it is worsening noticeably.
Occasionally, other tests are needed to determine the cause. An abdominal x-ray may show evidence of bowel obstruction or suggest another cause.
Another test involves swallowing several capsules containing tiny rings that can be seen on x-rays. An x-ray is taken several days later. Finally, emptying of the re**um can be tested in the laboratory or with special x-rays.

Treatment
When stool is impacted, tap water enemas or soap water enema(enema saponis) are commonly used. Usually people are positioned on their left side, with knees flexed. About 5 to 10 ounces of tap or soap water at body temperature are gently instilled into the re**um and sigmoid colon. When the water is emptied, the impacted stool is passed with it. Nonprescription prepackaged enemas can be used in place of tap water. If enemas fail to work, a health care practitioner may need to remove the stool manually using a gloved finger. The person is then sometimes asked to drink a solution containing dissolved salts and polyethylene glycol, which cleanses the digestive tract.
After the impaction has been removed, the person may be told to add fiber to the diet or to use laxatives to prevent constipation. Laxatives may be used every two to three days if a bowel movement does not occur naturally.
If the stool is not impacted, several options are available for treating constipation. Increasing the intake of fluids and fiber is often the first step. Vegetables, fruit (especially prunes), whole-grain breads, and high-fiber cereals are excellent sources of fiber. Bran is an alternative source. To work well, fiber should be consumed with plenty of fluids.
Laxatives and stool softeners are sometimes needed if changes in diet are insufficient. Most laxatives are safe for long-term uses, if used appropriately.
Bulking agents, such as psyllium and methylcellulose, are laxatives that help hold water in the stool and add bulk to it. The increased bulk stimulates the natural contractions of the large intestine. Bulkier stools are softer and easier to pass. Bulking agents act slowly and gently. These agents generally are taken in small amounts at first. The dose is increased gradually until regularity is achieved.
Osmotic agents are laxatives that keep large amounts of water in the large intestine, making the stool soft and loose. These laxatives consist of salts or sugars that are poorly absorbed. Some contain magnesium and phosphate, which can be partially absorbed resulting in harm to people with kidney failure.
Stimulant laxatives contain substances that directly stimulate the walls of the large intestine (such as senna and bisacodyl), causing them to contract. Taken by mouth, stimulant laxatives generally cause a bowel movement in six to eight hours. Some are available as suppositories. When taken as suppositories, these laxatives often work in 15 to 60 minutes. Stimulant laxatives are best used for brief periods. If longer use is needed, they should be used no more often than every third day and under a doctor's supervision.
Occasionally, a problem with coordination of pelvic floor and anorectal muscles may be identified. This can be treated with biofeedback or muscle retraining exercises; such treatments are performed only in centers which specialize in this area and upon referral by a doctor.

Prevention A combination of an adequate intake of fluids, adequate exercise, and a high-fiber diet may prevent constipation.
Laxatives are sometimes a helpful addition to these measures. For example, when a person needs to take a potentially constipating drug, a stimulant laxative along with increased intake of dietary fiber and fluids helps prevent constipation.

Source: American College of Gastroenterology (http://patients.gi.org/)

Colorectal cancer (CRC) is the 2nd leading cause of cancer deaths in the U.S. but also one of the most preventable. Visit ACG's CRC Health Center to learn more

30/05/2015

Hello Nigeria, happy democrazy season, compliments. We are all welcome to a new dawn.

25/05/2015

24/05/2015

Sickle cell disease (SCD)

Sickle-cell disease (SCD), also known as sickle-cell anaemia (SCA) and drepanocytosis, is a hereditary blood disorder, characterized by an abnormality in the oxygen-carrying haemoglobin molecule in red blood cells. This leads to a propensity for the cells to assume an abnormal, rigid, sickle-like shape (sickle cell) under certain circumstances.

The first modern report of sickle-cell disease may have been in 1846 but the abnormal characteristics of the red blood cells, which later lent their name to the condition, was first described in 1910 by Ernest Edward Irons (1877–1959), an intern to the Chicago cardiologist and professor of medicine James B. Herrick (1861–1954). Herrick made the first description in the medical literature. In the 1940s and 1950s contributions by Nobel prize-winner Linus Pauling made it the first disease where the exact genetic and molecular defect was elucidated.
In 1954, the introduction of haemoglobin electrophoresis allowed the discovery of a particular subtypes "SC" disease different from the original "SS" disease.

GENETICs
Normally, humans have haemoglobin A, which consists of two alpha and two beta chains, haemoglobin A2, which consists of two alpha and two delta chains, and haemoglobin F, consisting of two alpha and two gamma chains in their bodies. Of these, haemoglobin F dominates until about 6 weeks of age then A dominates throughout life.

The sickle-cell hemoglobin occurs when the sixth amino acid (glutamic acid) in the A chain, is replaced by valine to change its structure and function; as such, sickle-cell anemia is also known as E6V. Valine is hydrophobic, causing the haemoglobin to collapse on itself occasionally.

Sickle-cell disease occurs when a person inherits two abnormal copies of the haemoglobin gene (SS or SC), one from each parent. Several subtypes exist, depending on the exact mutation in each haemoglobin gene. A person with a single abnormal copy (AS or AC) does not experience symptoms and is said to have sickle-cell trait. Such people are also referred to as carriers.

Sickle-cell conditions have an autosomal recessive pattern of inheritance from parents. The types of haemoglobin a person makes in the red blood cells depend on what haemoglobin genes are inherited from her or his parents. If one parent has sickle-cell anaemia (SS or SC) and the other has sickle-cell trait (AS or AC), then the child has a 50% chance of having sickle-cell disease (SS or SC) and a 50% chance of having sickle-cell trait (AS or AC). When both parents have sickle-cell trait, a child has a 25% chance of sickle-cell disease, 25% do not carry any sickle-cell alleles, and 50% have the heterozygous condition.

Sickle-cell gene mutation probably arose spontaneously in different geographic areas, as suggested by restriction endonuclease a**lysis. These variants are known as Cameroon, Senegal, Benin, Bantu, and Saudi-Asian. They are important because some are associated with higher HbF levels, e.g., Senegal and Saudi-Asian variants, and tend to have milder disease (less crisis).

DATA
Almost 300,000 children are born with a form of sickle-cell disease every year, mostly in sub-Saharan Africa, but also in other parts of the world such as the West Indies and in people of African origin elsewhere in the world. In 2013 it resulted in 176,000 deaths which is an increase from 113,000 deaths in 1990.

PROBLEMS
Sickle-cell disease is associated with a number of acute and chronic health problems:
Increased risk of severe bacterial infections due to loss of functioning spleen tissue (autosplenectomy) caused by encapsulated organisms such as Streptococcus pneumoniae and Haemophilus influenza.
Clogging of the blood vessels by sickled cells leading to occlusion (blockage) of the vessels and hence malfunctioning of the organs such vessel is serving. This is vaso-occlusive crisis (VOC). These includes, bone pain crisis, acute chest syndrome, mesenteric infarction, priapism, stroke etc. Further complications of this include: kidney failure, chronic leg ulcer, and necrosis of the bones (most commonly avascular necrosis ‘AVN’ of femoral head), osteomyelitis, arthritis and fracture, blindness and pregnancy loss
Other crisis include hyper hemolytic crisis (excessive blood destruction) leading to anemia and heart failure. This can also cause cholelithiasis (gall stones) and cholecystitis.
There is also Sequestration crisis in which blood pools into the spleen and Aplastic crisis in which the bone marrow suddenly fails to produce any blood cell. Severe anemia, heart failure and sepsis may result.
All these can lead to death.
Carriers (AS and AC) have symptoms only if they are deprived of oxygen (for example, while climbing a mountain) or while severely dehydrated.

TREATMENT
Children born with sickle-cell disease undergo close observation by the pediatrician and require management by a haematologist to assure they remain healthy.
They’re given FOLIC ACID daily for life.
From birth to five years of age, they may also have to take PENICILLIN daily due to the immature immune system that makes them more prone to early childhood illnesses.
They are more vulnerable to malaria hence they take malaria prophylaxis, PROGUANIL tablet daily. The malaria vaccine undergoing trials in recent time will be very helpful if found successful.
HYDROXYUREA is the first approved drug for the causative treatment of sickle-cell anaemia. It has been found to decrease the number and severity of attacks.
Other medications that generally improve health may be beneficial to them such as MULTIVITAMINS, B-COMPLEX and VIT C.
They should take WATER (can be flavored) liberally everyday to prevent dehydration.
They should avoid hash conditions such as extreme cold, sunlight, stress and maintain generally a good level of personal hygiene.
Bone marrow transplants have proven effective in children. Bone marrow transplants are the only known cure for SCD. However, bone marrow transplants are difficult to obtain because of the specific HLA typing necessary. Ideally, a twin family member (syngeneic) or close relative (allogeneic) should donate the bone marrow necessary for transplantation.

About 90% of patients survive to age 20, and close to 50% survive beyond the fifth decade.

QUESTION: Should a prospective couple each with genotypes AS or AC marry each other?