HEPATITIS B

 KEY FACTS

* Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease.

* The virus is transmitted through contact with the blood or other body fluids of an infected person.

* An estimated 240 million people are chronically infected with hepatitis B (defined as hepatitis B surface antigen positive for at least 6 months).

* More than 686 000 people die every year due to complications of hepatitis B, including cirrhosis and liver cancer 1.

* Hepatitis B is an important occupational hazard for health workers.

* However, it can be prevented by currently available safe and effective vaccine.

Hepatitis B is a potentially life-threatening liver infection caused by the hepatitis B virus. It is a major global health problem. It can cause chronic infection and puts people at high risk of death from cirrhosis and liver cancer.

A vaccine against hepatitis B has been available since 1982. The vaccine is 95% effective in preventing infection and the development of chronic disease and liver cancer due to hepatitis B.

Geographical distribution

Hepatitis B prevalence is highest in sub-Saharan Africa and East Asia, where between 5–10% of the adult population is chronically infected. High rates of chronic infections are also found in the Amazon and the southern parts of eastern and central Europe. In the Middle East and the Indian subcontinent, an estimated 2–5% of the general population is chronically infected. Less than 1% of the population of Western Europe and North America is chronically infected.

Transmission

The hepatitis B virus can survive outside the body for at least 7 days. During this time, the virus can still cause infection if it enters the body of a person who is not protected by the vaccine. The incubation period of the hepatitis B virus is 75 days on average, but can vary from 30 to 180 days. The virus may be detected within 30 to 60 days after infection and can persist and develop into chronic hepatitis B.

In highly endemic areas, hepatitis B is most commonly spread from mother to child at birth (perinatal transmission), or through horizontal transmission (exposure to infected blood), especially from an infected child to an uninfected child during the first 5 years of life. The development of chronic infection is very common in infants infected from their mothers or before the age of 5 years.

Hepatitis B is also spread by percutaneous or mucosal exposure to infected blood and various body fluids, as well as through saliva, menstrual, vaginal, and seminal fluids. Sexual transmission of hepatitis B may occur, particularly in unvaccinated men who have sex with men and heterosexual persons with multiple sex partners or contact with sex workers. Infection in adulthood leads to chronic hepatitis in less than 5% of cases. Transmission of the virus may also occur through the reuse of needles and syringes either in health-care settings or among persons who inject drugs. In addition, infection can occur during medical, surgical and dental procedures, through tattooing, or through the use of razors and similar objects that are contaminated with infected blood.

Symptoms

Most people do not experience any symptoms during the acute infection phase. However, some people have acute illness with symptoms that last several weeks, including yellowing of the skin and eyes (jaundice), dark urine, extreme fatigue, nausea, vomiting and abdominal pain. A small subset of persons with acute hepatitis can develop acute liver failure which can lead to death.

In some people, the hepatitis B virus can also cause a chronic liver infection that can later develop into cirrhosis of the liver or liver cancer.

Who is at risk for chronic disease?

The likelihood that infection becomes chronic depends upon the age at which a person becomes infected. Children less than 6 years of age who become infected with the hepatitis B virus are the most likely to develop chronic infections.

In infants and children:

80–90% of infants infected during the first year of life develop chronic infections; and

30–50% of children infected before the age of 6 years develop chronic infections.

In adults:

less than 5% of otherwise healthy persons who are infected as adults will develop chronic infection; and

20–30% of adults who are chronically infected will develop cirrhosis and/or liver cancer.

Diagnosis

It is not possible, on clinical grounds, to differentiate hepatitis B from hepatitis caused by other viral agents and, hence, laboratory confirmation of the diagnosis is essential. A number of blood tests are available to diagnose and monitor people with hepatitis B. They can be used to distinguish acute and chronic infections.

Laboratory diagnosis of hepatitis B infection focuses on the detection of the hepatitis B surface antigen HBsAg. WHO recommends that all blood donations be tested for hepatitis B to ensure blood safety and avoid accidental transmission to people who receive blood products.

Acute HBV infection is characterized by the presence of HBsAg and immunoglobulin M (IgM) antibody to the core antigen, HBcAg. During the initial phase of infection, patients are also seropositive for hepatitis B e antigen (HBeAg). HBeAg is usually a marker of high levels of replication of the virus. The presence of HBeAg indicates that the blood and body fluids of the infected individual are highly contagious.

Chronic infection is characterized by the persistence of HBsAg for at least 6 months (with or without concurrent HBeAg). Persistence of HBsAg is the principal marker of risk for developing chronic liver disease and liver cancer (hepatocellular carcinoma) later in life.

Treatment

There is no specific treatment for acute hepatitis B. Therefore, care is aimed at maintaining comfort and adequate nutritional balance, including replacement of fluids lost from vomiting and diarrhoea.

Chronic hepatitis B infection can be treated with drugs, including oral antiviral agents. Treatment can slow the progression of cirrhosis, reduce incidence of liver cancer and improve long term survival.

WHO recommends the use of oral treatments - tenofovir or entecavir, because these are the most potent drugs to suppress hepatitis B virus. They rarely lead to drug resistance as compared with other drugs, are simple to take (1 pill a day), and have few side effects so require only limited monitoring.

In most people, however, the treatment does not cure hepatitis B infection, but only suppresses the replication of the virus. Therefore, most people who start hepatitis B treatment must continue it for life.

Treatment using interferon injections may be considered in some people in certain high-income settings, as this may shorten treatment duration, but its use is less feasible in low-resource settings due to high cost and significant adverse effects requiring careful monitoring.

There is still limited access to diagnosis and treatment of hepatitis B in many resource-constrained settings, and many people are diagnosed only when they already have advanced liver disease. Liver cancer progresses rapidly, and since treatment options are limited, the outcome is in general poor. In low-income settings, most people with liver cancer die within months of diagnosis. In high-income countries, surgery and chemotherapy can prolong life for up to a few years. Liver transplantation is sometimes used in people with cirrhosis in high income countries, with varying success.

Prevention

The hepatitis B vaccine is the mainstay of hepatitis B prevention. WHO recommends that all infants receive the hepatitis B vaccine as soon as possible after birth, preferably within 24 hours. The birth dose should be followed by 2 or 3 doses to complete the primary series. In most cases, 1 of the following 2 options is considered appropriate:

a 3-dose schedule of hepatitis B vaccine, with the first dose (monovalent) being given at birth and the second and third (monovalent or combined vaccine) given at the same time as the first and third doses of diphtheria, pertussis (whooping cough), and tetanus – (DTP) vaccine; or a 4-dose schedule, where a monovalent birth dose is followed by three monovalent or combined vaccine doses, usually given with other routine infant vaccines.

The complete vaccine series induces protective antibody levels in more than 95% of infants, children and young adults. Protection lasts at least 20 years and is probably lifelong. Thus, WHO does not recommend booster vaccination for persons who have completed the 3 dose vaccination schedule.

All children and adolescents younger than 18 years-old and not previously vaccinated should receive the vaccine if they live in countries where there is low or intermediate endemicity. In those settings it is possible that more people in high-risk groups may acquire the infection and they should also be vaccinated. They include:

* people who frequently require blood or blood products, dialysis patients, recipients of solid organ transplantations;

* people interned in prisons;

* persons who inject drugs;

* household and sexual contacts of people with chronic HBV infection;

* people with multiple sexual partners;

* health-care workers and others who may be exposed to blood and blood products through their work; and

* travelers who have not completed their hepatitis B

* vaccination series, who should be offered the vaccine before leaving for endemic areas.

The vaccine has an excellent record of safety and effectiveness. Since 1982, over 1 billion doses of hepatitis B vaccine have been used worldwide. In many countries where between 8–15% of children used to become chronically infected with the hepatitis B virus, vaccination has reduced the rate of chronic infection to less than 1% among immunized children.

As of 2014, 184 Member States vaccinate infants against hepatitis B as part of their vaccination schedules and 82% of children in these states received the hepatitis B vaccine. This is a major increase compared with 31 countries in 1992, the year that the World Health Assembly passed a resolution to recommend global vaccination against hepatitis B. Furthermore, as of 2014, 96 Member States have introduced the hepatitis B birth dose vaccine.

In addition, implementing of blood safety strategies, including quality-assured screening of all donated blood and blood components used for transfusion, can prevent transmission of HBV. Safe injection practices, eliminating unnecessary and unsafe injections, can be effective strategies to protect against HBV transmission. Furthermore, safer sex practices, including minimizing the number of partners and using barrier protective measures (condoms), also protect against transmission.

WHO response

In March 2015, WHO launched its first "Guidelines for the prevention, care and treatment of persons living with chronic hepatitis B infection". The recommendations:

1. Promote the use of simple, non-invasive diagnostic tests to assess the stage of liver disease and eligibility for treatment;

2. Prioritize treatment for those with most advanced liver disease and at greatest risk of mortality; and

3. Recommend the preferred use of the nucleos(t)ide analogues with a high barrier to drug resistance (tenofovir and entecavir, and entecavir in children aged between 2–11 years) for first- and second-line treatment.

These guidelines also recommend lifelong treatment in those with cirrhosis; and regular monitoring for disease progression, toxicity of drugs and early detection of liver cancer.

In May 2016, The World Health Assembly adopted the first “Global Health Sector Strategy on Viral Hepatitis, 2016-2021”. The strategy highlights the critical role of Universal Health Coverage and the targets of the strategy are aligned with those of the Sustainable Development Goals. The strategy has a vision of eliminating viral hepatitis as a public health problem and this is encapsulated in the global targets of reducing new viral hepatitis infections by 90% and reducing deaths due to viral hepatitis by 65% by 2030. Actions to be taken by countries and WHO Secretariat to reach these targets are outlined in the strategy.

To support countries in moving towards achieving the global hepatitis goals under the Sustainable Development Agenda 2030, WHO is working in the following areas:

* Raising awareness, promoting partnerships and mobilizing resources;

* Formulating evidence-based policy and data for action;

preventing transmission; and

* Scaling up screening, care and treatment services.

RECTAL BLEEDING

There are many causes of rectal bleeding. The severity can vary from mild bleeding (common) to a severe life-threatening bleeding (uncommon). If the bleeding is heavy or if you have black stools (faeces) - older blood due to a bleed from high up in the gut - then see a doctor immediately or call an ambulance. However, it is often a mild bleed. In this situation, make an appointment with your doctor so that the cause can be found.

What is rectal bleeding?

The term rectal bleeding is used by doctors to mean any blood that is passed out when you go to the toilet to pass stools (faeces). However, not all bleeding that is passed out actually comes from the back passage (rectum). The blood can come from anywhere in the gut. The more correct term is gastrointestinal tract bleeding, often abbreviated to GI bleeding. There are many causes of rectal bleeding (GI bleeding) which are discussed later.

What is the gut?

The gut (gastrointestinal tract) starts at the mouth and ends at the anus. When we eat or drink, the food and liquid travel down the gullet (oesophagus) into the stomach. The stomach starts to break up the food and then passes it into the small intestine.

The small intestine (sometimes called the small bowel) is several metres long and is where food is digested and absorbed. Undigested food, water and waste products are then passed into the large intestine (sometimes called the large bowel). The main part of the large intestine is called the colon, which is about 150 cm long. This is split into four sections: the ascending, transverse, descending and sigmoid colon. Some water and salts are absorbed into the body from the colon. The colon leads into the back passage (rectum) which is about 15 cm long. The rectum stores stools (faeces) before they are passed out from the anus.

Types of rectal bleeding/GI tract bleeding.

When you have GI bleeding, the things that a doctor needs to assess include the following:

How bad (severe) the bleeding is?

Bleeding can range from a mild trickle to a massive life-threatening severe bleed (haemorrhage). In most cases the bleed is mild and intermittent. In this situation, any tests that need to be done can be done as an outpatient. There is no immediate risk to life with mild, intermittent GI bleeding. However, always report to a doctor if you have a large amount of bleeding, as a lot of blood loss needs urgent treatment.

Sometimes bleeding from a condition in the gut (GI tract) is so mild (like a slight trickle) that you do not notice any actual bleeding and it is not enough to change the colour of your stools (faeces). However, a test of your faeces can detect even small amounts of blood. This test may be done in various situations (described later).

Where the bleeding is coming from?

Bleeding can come from anywhere in the GI tract. As a general rule:

• Bleeding from the anus or low down in the back passage (rectum) - the blood tends to be bright red and fresh. It may not be mixed in with faeces but instead you may notice blood after passing faeces, or streaks of blood covering faeces. For example, bleeding from an anal tear (fissure) or from haemorrhoids (described later).

• Bleeding from the colon - often the blood is mixed up with faeces. The blood may be a darker red. For example, bleeding from colitis, diverticular disease, or from a bowel tumour. However, sometimes, if the bleeding is brisk then you may still get bright red blood not mixed up too much with faeces. For example, if you have a sudden large bleed from a diverticulum (described later).

• Bleeding from the stomach or small intestine - the blood has far to travel along the gut before it is passed out. During the time it takes to do this the blood becomes altered and dark and mixes with faeces. This can make your faeces turn a black or plum colour - this is called melaena. For example, this may occur due to a bleeding stomach or duodenal ulcer. Note: if you have melaena it is a medical emergency, as it usually indicates a lot of bleeding that is coming from the stomach or duodenum. You should tell a doctor immediately if you suspect that you have melaena.

The cause of the bleeding:

A doctor may ask various questions to get an idea as to the main possible causes of the bleeding. So, for example, you may be asked about possible symptoms. You may be asked about:

• Whether you have any pain.

• If you have any pain, where it is and what type of pain it is.

• Any itching around your bottom.

• Any change in your bowels, such as diarrhoea or constipation.

• Any weight loss.

• Any history in your family of bowel disease.

The doctor is then likely to examine you. This may include examining your back passage (anus and rectum) by inserting a gloved finger into your anus. Sometimes they may use an instrument called a proctoscope to look a little way inside your back passage. Sometimes, a diagnosis can be made after this. For example, of an anal fissure or pile (haemorrhoid). However, further tests are commonly needed to clarify the cause. This is because the examining finger or the proctoscope can only go a short way up your GI tract. If no cause is found, the bleeding may be coming from higher up.

What are the causes of rectal bleeding/GI tract bleeding?

There are many possible causes. Below is a brief overview of the more common causes:

Piles (haemorrhoids):

Haemorrhoids are swellings that can occur in the anus and lower back passage (lower rectum). There is a network of small blood vessels (veins) within the inside lining of the anus and lower rectum. These veins sometimes become wider and filled with more blood than usual. These swollen (engorged) veins and the overlying tissue may then form into one or more small swellings called haemorrhoids. Haemorrhoids are very common and many people develop one or more haemorrhoids at some stage. Small haemorrhoids are usually painless. The most common symptom is bleeding after going to the toilet. Larger haemorrhoids may cause a mucous discharge, some pain, irritation and itch.

Anal fissure:

An anal fissure is a small tear of the skin of the anus. Although the tear of an anal fissure is usually small (usually less than a centimetre), it can be very painful because the anus is very sensitive. Often an anal fissure will bleed a little. You may notice blood after you pass stools (faeces). The blood is usually bright red and stains the toilet tissue but soon stops.

Diverticula:

A diverticulum is a small pouch with a narrow neck that sticks out from the wall of the gut (intestines). Diverticula is the word used for more than one diverticulum. They can develop on any part of the gut but usually occur in the colon. Several diverticula may develop over time. A diverticulum may occasionally bleed and you may pass some blood via your anus. The bleeding is usually abrupt and painless. The bleeding is due to a burst blood vessel that sometimes occurs in the wall of a diverticulum and so the amount of blood loss can be heavy. Diverticula can cause other symptoms such as tummy pains and changes in the normal bowel habit.

Crohn's disease:

Crohn's disease is a condition which causes inflammation in the gut. The disease flares up from time to time. Symptoms vary, depending on the part of the gut affected and the severity of the condition. Common symptoms include bloody diarrhoea, tummy (abdominal) pain and feeling unwell.

Ulcerative colitis and other forms of colitis:

Ulcerative colitis (UC) is a disease where inflammation develops in the colon and rectum. A common symptom when the disease flares up is diarrhoea mixed with blood. The blood comes from ulcers that develop on the inner wall of the inflamed gut. There are other rare causes of inflammation of the colon (colitis) or inflammation of the rectum (proctitis) that can cause rectal bleeding.

Polyps:

A bowel polyp is a small growth that sometimes forms on the inside lining of the colon or rectum. Most develop in older people. Polyps are non-cancerous (benign) and usually cause no problems. However, sometimes a polyp bleeds and sometimes a polyp can turn cancerous.

Cancer:

Cancer of the colon and rectum are common cancers in older people. They sometimes affect younger people. Rectal bleeding is one symptom that may occur. Bleeding is often not visible (occult - see later) and other symptoms are often present before visible bleeding occurs. For example, weight loss, tiredness due to blood loss (anaemia), diarrhoea or constipation. Cancers of other parts of the gut higher up from the colon sometimes cause rectal bleeding but these are uncommon.

Angiodysplasia:

Angiodysplasia is a condition where you develop a number of enlarged blood vessels within the inner lining of the colon. Angiodysplasia most commonly develops in the ascending (right) colon, but they can develop anywhere in the colon. The cause is unknown but they occur most commonly in older people. Bleeding from an angiodysplasia is painless. The blood seen can range from bright red brisk bleeding, to dark blood mixed with faeces, to black- or plum-coloured faeces (melaena). An angiodysplasia may also cause non-visible (occult) blood loss.

Abnormalities of the gut:

Various abnormalities of the gut or the gut wall may cause rectal bleeding in young children. Examples include:

• Volvulus - a twisting of the gut.

• Intussusception - one part of the gut is sucked into another, creating a blockage.

• Meckel's diverticulum - an extra bulge or pouch in the small intestine, present from birth (congenital).

• Hirschsprung's disease - a condition where a part of the lower bowel does not function as it should. The muscles of the bowel wall are unable to squeeze along the faeces as they should do.

• Abnormal blood vessel development.

Stomach and duodenal ulcers:

An ulcer in the stomach or duodenum may bleed. This can cause melaena - where your faeces turn black- or plum-coloured as described earlier.

Some gut infections:

These may cause bloody diarrhoea due to inflammation of the gut, caused by some infections. There are various other rarer causes:

What should I do if I have rectal bleeding?

See a doctor. If the bleeding is heavy, or if you have black- or plum-coloured stools (faeces) - called melaena (described above), see a doctor immediately or call an ambulance. If you feel dizzy, collapse or feel generally unwell then consider calling an ambulance, as this might indicate a heavy bleed. However, often the bleeding is mild. In this situation, make an appointment with your doctor soon. Some people assume that their rectal bleeding is due to piles (haemorrhoids) and do not get it checked out. Haemorrhoids are perhaps the most common cause of rectal bleeding. However, you should not assume the bleeding is coming from a haemorrhoid unless you have been properly assessed by a doctor.

What tests might be advised?

It depends on the possible causes of the bleeding. This will be determined by a doctor talking to you (your history) and an examination. Usually one of the following tests is suggested:

• Sigmoidoscopy.

• Colonoscopy.

• A virtual colonoscopy (CT colonography).

What is a colonoscopy?

A colonoscopy is a test where an operator (a doctor or nurse) looks into your colon. Normally you are not put to sleep for this test; however, you will be given an injection to make you drowsy (a sedative).

A colonoscope is a thin, flexible telescope. It is about as thick as a little finger. It is passed through the anus and into the colon. It can be pushed all the way along the inside of the colon as far as where the small and large intestines meet (the caecum).

The colonoscope contains fibre-optic channels which allow light to shine down so the operator can see inside your colon. This is done either by looking down the colonoscope or by attaching the colonoscope to a TV monitor.

The colonoscope also has a side channel down which devices can pass. These can be manipulated by the operator. For example, the operator may take a small sample (biopsy) from the inside lining of the colon by using a thin grabbing instrument which is passed down a side channel.

What is a sigmoidoscopy?

The sigmoid colon is the final portion of the bowel that is joined to the rectum. A sigmoidoscope is like a small telescope with an attached light source about the thickness of your finger. It is similar to a colonoscope but much shorter. A sigmoidoscopy is easier to do than a colonoscopy. It may be done instead of a colonoscopy if the bleeding is suspected to be coming from the lower colon or rectum. A doctor or nurse inserts the sigmoidoscope into the anus and pushes it slowly into the rectum and sigmoid colon. This allows the doctor or nurse to see the lining of the rectum and sigmoid colon. The procedure is not usually painful but it may be a little uncomfortable.

What is a virtual colonoscopy?

A virtual colonoscopy (also called CT colonography) is a newer test. It allows the doctor to get a good view of the colon without passing the tube right up inside it. A tube is passed into the back passage (rectum) but does not have to go further up. With this tube, a gas is pushed into the bowel to open it up. A CT scan is then done of the bowel. This test is less uncomfortable and better tolerated than the traditional colonoscopy. It is usually used for people who are more frail and cannot tolerate a colonoscopy. However it is not available in all areas.

What is a faecal occult blood (FOB) test?

The FOB test detects small amounts of blood in your stools (faeces) which you would not normally see or be aware of.

When and why is the FOB test done?

As discussed, there are several disorders which may cause bleeding into the gut. These may cause rectal bleeding which you can see. However, some of these disorders in some people may only bleed with a trickle of blood. If you only have a small amount of blood in your faeces then the faeces look normal. However, the FOB test will detect the blood. So, the test may be done if you have other symptoms that may suggest a gut problem. For example, persistent tummy (abdominal) pain, weight loss, etc. It may also be done to screen for bowel cancer before any symptoms develop (see below).

Note: the FOB test can only say that you are bleeding from somewhere in the gut. It cannot tell from which part. If the test is positive then further tests will usually be arranged to find the source of the bleeding. For example, colonoscopy.

How is the FOB test done?

A small sample of faeces is smeared on to a piece of card. You obtain a sample by using a small scraper to scrape some faeces off toilet tissue which you have just used after going to the toilet. The sample is tested by adding a chemical to the sample on the card. If there is a change in colour after adding the chemical, it indicates that some blood is present.

Usually two or three FOB tests are done on two or three separate samples of faeces, obtained on different days. This is because a bleeding disorder of the gut may only bleed now and then. So, not every sample may contain blood. A series of two or three samples done on several days may be more accurate in detecting a bleeding gut disorder.

Screening for bowel cancer:

Screening means looking for early signs of a particular disease in otherwise healthy people who do not have any symptoms and when treatment is likely to be curative. Bowel cancer (colorectal cancer) screening aims to detect colorectal cancer at an early stage when there is a good chance that treatment will cure the cancer.

In the Nigeria there is a screening programme for certain age groups. This involves testing three samples of your faeces for blood. The age group is slightly different in different parts of the Nigeria. If you are in the relevant age groups, you will automatically be sent an invitation and then your FOB screening kit, so you can do the test at home. After your first screening test, you will then be sent another invitation and screening kit every two years until you reach the maximum age. You can then request further kits if you would like to continue to be included in the screening programme.

THIS IS THE OFFICIAL NUMBER OF CASUALTIES AS REPORTED BY THE NIGERIA MEDICAL ASSOCIATION.

On behalf of all the Medical and Dental Practitioners under the auspices of the Nigerian Medical Association(MMA), Akwa Ibom State branch, I wish to commiserate with all the families of those who lost their loved ones during and after the collapse of the Reigners Bible Church building on 10th December 2016.

I also share in the grief, pains, frustrations and suffering of all the survivors who had incurred one form of injury or the other.
Indeed this is a very trying and difficult moment for all of us as our state has never been faced by a disaster of this magnitude with attendant huge casualties.

As patriots, we have to rise to the occasion by being our brothers’ keepers and lending a helping hand to those in need.

I therefore, wish to sincerely commend all the members of the NIGERIAN MEDICAL ASSOCIATION(NMA), AKWA IBOM STATE BRANCH, for heeding the call to selfless service as expressed in the prompt and timely response that has saved so many lives.
The response team led by a past Chairman of the association, DR JOHN UDOBANG,has done a good job in ensuring that victims of this very unfortunate disaster are well catered for and treated at the various health facilities in the state.

Reports from the University of Uyo Teaching Hospital(UUTH) show that 21 people were Brought In Dead(BID) , while 2 out of the 23 that were undergoing treatment died due mainly to severe bleeding( One of the victims is reported to have been transfused with 9 pints of blood).

I also wish to express our sincere gratitude to all those who have heeded our clarion call to donate blood. More blood is still needed. The number of lives your pint of blood will save can’t be underestimated.

I also call on all the survivors who had suffered any form of trauma to report to the various health facilities for proper medical examination as blunt injuries could lead to internal bleeding and avoidable deaths.

In conclusion, I assure all the members of the public, that as a responsible and proactive association, we will not rest on our oars until all the lives of the survivors are saved and they are discharged from the hospitals back to their families.

Lastly, I pray God to grant the families of all those who lost their lives the fortitude to bear the loss.

And may the souls of the faithful departed, Rest In Perfect Peace(RIP).

Amen.

DR ANIEKEME ANIEFIOK UWAH(JP)
CHAIRMAN, NMA
AKWA IBOM STATE BRANCH AND SOUTH-SOUTH ZONE

DOCTOR ACCUSES NMA OF SHIELDING CORRUPT FORMER OFFICER

A former executive member of Edo State branch of Nigerian Medical Association (NMA), Dr. Moses Ujaddughe, has accused the national body of the association of shielding one of its members accused of embezzling the association’s fund.

Ujaddughe who is also the Coordinator, Edo Central Zone of the NMA, also accused the national NMA of wrongly suspending him and the immediate past chairman of the association, Prof. Ernest Omoti, in payment for the selfless and transparent service they rendered while in office.

He also alleged that a past chairman of the association in the state, Dr. Emmanuel Ighodaro, was found guilty of several offences by the disciplinary committee of the association, including an alleged illegal withdrawal and embezzlement of N6 million which he took as an unauthorized loan from a new generation bank (name withheld) and withdrew from Edo NMA’s account after his tenure.

According to Ujaddughe, the said loan was credited to the association’s account on July 31, 2014, the same day his executive committee was dissolved, adding that “between August 1, 2014 and August 5, 2014 after his tenure, he withdrew over N6 million from the Association’s account before handing over the account.”
He also alleged that the past chairman abused his office by committing fraudulent acts for which he was indicted of by the disciplinary committee of the Association.

He mentioned the fraudulent acts to include the conversion of the association’s property for his personal use; complete absence of documentation and original receipts of expenditure throughout his tenure as chairman and embezzlement of funds generated from AGMs; Continuing Medical Education (CME) programs and from funds paid by people to use the hall in the Doctors’ House.

“The total loss of the association cannot be fully estimated because Dr. Ighodaro presumably took away all the duplicate copies of the receipts used in his time and kept absolutely no documentation of his expenditure throughout his tenure, making it impossible to verify any of his claims,” Ujaddughe alledged.
Ujaddughe who expressed dismay at his suspension, saying it is so shameful that an association as the NMA will be aiding persons who have been indicted for misappropriation and embezzlement of funds belonging to it.

“It is so shameful that an association of this kind will be giving protection to people who have misappropriated and embezzled funds belonging to the association, and association will be playing politics more than principles, it is unfortunate.

“As a statutory Vice Chairman of Edo State NMA, my executive under the chairmanship of Prof. Ernest Omoti, uncovered financial misappropriation amounting to about N163 million allegedly committed by the immediate past State Chairman, Dr. Ighodaro Emmanuel and his team.

“On the recommendation of the state branch of the association, I wrote to the Economic and Financial Crimes Commission (EFCC) for investigation. Unfortunately, this year, the leadership at the national level changed and today we have a national leadership that is in bed romancing with corruption and corrupt tendencies.

“My only crime is that I blew the whistle to expose corruption. I guess you now also understand why Prof. Omoti has been joined in the suspension spree, simply because he is perceived to be the one who created the enabling environment for the corrupt activities to be uncovered,” Ujaddughe said.

However, Dr. Emmanuel Ighodaro, in his reaction, dismissed the allegations as the handiwork of his arch-enemies and rivals who are bent on denting his image which he has built over the years as a past chairman of the state branch of the NMA.

CRH CALLS FOR STRENGTHENING OF HIV PROGRAMMES IN THE SCHOOL

As statistics from UNAIDS revealed that a total of 180,000 Nigerians have lost their lives to HIV/AIDS pandemic, Centre for the Right To Health, CRH, has called for the reinforcement of Human Immunodeficiency Virus, HIV, in schools as part of strategies to halt the spread among adolescents.

In a chat with Vanguard during a sensitisation programme/presentation of award to outstanding healthcare workers by CRH to mark this year’s World AIDS Day in Lagos, the Programme Director, CRH, Mrs Christy Ekerete-Udofia said scaling up HIV programmes in primary, secondary schools including Universities would help the country to achieve the 90-90-90 targets for testing, treatment and viral suppression by 2030.

Ekerte-Udofia who stressed the need for government to adequately fund HIV programmes in Schools, noted that a total of 35 million people in the world have died as a result of HIV/AIDS while a total of 180,000 died in Nigeria, according to data from UNAIDS.

Admitting that Nigeria is on track as regards to the 90 -90-90 targets, she noted that the country has not done enough in terms of reducing spread of HIV among adolescents.

“In countries like South Africa, before an adolescent goes to school, packs of condoms are stuck in their bags but in Nigeria, our perception about condom use has not change.

Condom is still a taboo. Many of them out of peer pressure get initiated into sexual act very early in life and they are not able to negotiate condom use. “If we are able to curb the spread in schools we will be able to reduce HIV among adolescents”, she said.

Acknowledging that a lot of positive things have been achieved in the fight against HIV/AIDS, she said: “Being diagnosed with HIV today means something different than it was 30 years ago, HIV is no longer a death sentence but people’s attitudes can make living with HIV really hard, hence the need to end stigma.”

Ekerete- Udofi lamented the economic consequences of AIDS as it affects development, adding that in many places the stigmatisation of HIV infected individuals still adds to its devastating impact.

“CRH is currently contributing its quota to the fight against HIV through its SHiPs for MarPs Project, One stop shop, OSS, for free treatment of HIV which is fully in operation.

“At the treatment centre, individuals are counselled, tested and positive persons are placed on treatment free of charge.

“In this centre we have been able to see that 90 percent of people get tested, 90 percent tested are placed on treatment and 90 percent retain treatment. We have reduced to the barest minimum their level of viral loads. That we have been able to achieve so far.”

CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term used to describe progressive lung diseases including emphysema, chronic bronchitis, refractory (non-reversible) asthma, and some forms of bronchiectasis. This disease is characterized by increasing breathlessness.

Many people mistake their increased breathlessness and coughing as a normal part of aging. In the early stages of the disease, you may not notice the symptoms. COPD can develop for years without noticeable shortness of breath. You begin to see the symptoms in the more developed stages of the disease. That’s why it is important that you talk to your doctor as soon as you notice any of these symptoms. Ask your doctor about taking a spirometry test.

What are the signs and symptoms of COPD?

• Increased breathlessness
• Frequent coughing (with and without sputum)
• Wheezing
• Tightness in the chest
• How common is COPD?

COPD affects an estimated 200 billions in the World, and over half of them have symptoms of COPD and do not know it. Early screening can identify COPD before major loss of lung function occurs.

What are the risk factors and common causes of COPD?

Most cases of COPD are caused by inhaling pollutants; that includes smoking (cigarettes, pipes, cigars, etc.), and second-hand smoke.

Fumes, chemicals and dust found in many work environments are contributing factors for many individuals who develop COPD.

Genetics can also play a role in an individual’s development of COPD—even if the person has never smoked or has ever been exposed to strong lung irritants in the workplace.

Here is more information on the top three risk factors for developing COPD:

Smoking

COPD most often occurs in people 40 years of age and older who have a history of smoking. These may be individuals who are current or former smokers. While not everybody who smokes gets COPD, most of the individuals who have COPD (about 90% of them) have smoked.

Environmental Factors

COPD can also occur in those who have had long-term contact with harmful pollutants in the workplace. Some of these harmful lung irritants include certain chemicals, dust, or fumes. Heavy or long-term contact with secondhand smoke or other lung irritants in the home, such as organic cooking fuel, may also cause COPD.

Genetic Factors

Even if an individual has never smoked or been exposed to pollutants for an extended period of time, they can still develop COPD. Alpha-1 Antitrypsin Deficiency (AATD) is the most commonly known genetic risk factor for emphysema2. Alpha-1 Antitrypsin related COPD is caused by a deficiency of the Alpha-1 Antitrypsin protein in the bloodstream. Without the Alpha-1 Antitrypsin protein, white blood cells begin to harm the lungs and lung deterioration occurs.

The World Health Organization and the Nigeria Medical Association recommends that every individual diagnosed with COPD be tested for Alpha-1.

Because not all individuals with COPD have AATD, and because some individuals with COPD have never smoked, it is believed that there are other genetic predispositions to developing COPD.

EFFECT OF TOO MUCH SEX

EFFECT OF TOO MUCH SEX

Sex can make people feel pleasurable and apparently, you can have as many sex activities as you like. However, if you find that you are skipping meals to go for a quick romp in the sheets, you should probably be worried about having too much sex. While scientists have proved that sex can decrease anxiety and improve your moods, sex can be unhealthy if it interferes with your day to day life. Here are some problems that can be related with the effect of too much sex.

15 NEGATIVE EFFECTS OF TOO MUCH SEX

It is a little absurd to think that a pleasurable activity such as sex can end up in misery. However, it is true. Read on to find the possible negative effects of too much sex and adjust your sex life if needed.

1. Rug Burns or Bruises

This is one obvious effect of too much sex because of the rubbing during sex activities. This is especially so if you have rough sex. Rug burns make it very uncomfortable to have sex in certain positions and the bruises can be painful after you notice it. Try not to have sex on your back, knees or any other parts that might cause discomfort.

2. Soreness and Swelling

Ladies are susceptible to feeling a bit sore after a steamy session in the sheets. This is often as a result of vaginal excoriation which simply refers to the scraping of the vaginal walls during penetration. This makes it very painful to engage in any sexual activity that involves penetration. You can opt for other ways to pleasure your partner instead of penetrating.

3. Dehydration

Having sex is usually a physically involving activity that will make you sweat and lose lots of water. If you have sex too many times without staying hydrated, you could become dehydrated in no time. This is especially so if you have been taking alcohol before or while the sex. Though harmless, this is the most common effect of too much sex.

4. Urinary Tract Infection (UTI)

UTI or urinary tract infection can be very uncomfortable or even painful. Having too much sex, especially with different people, can expose women to this condition. To avoid contracting a UTI, you should take plenty of water and make sure to empty the bladder before and after sex.

5. Lower Back Pain

After a long session with heavy thrusting, you could develop lower back pain. This can make any attempt at indulging in sexual intercourse virtually impossible. You might have to try positions that do not put pressure on your back or avoid sex until you get better. This is a common effect of too much sex.

6. Injured Nerves

While the normal human being can withstand all sorts of sexual stimulation, the nerves may get a bit sore after an intense session. It is, therefore, better to pace yourself before overindulging and you could easily end up the activity for some time. Avoid too much direct stimulation of the same spot.

7. Trouble Climaxing

Men are often unable to climax after having too much sex in a short period of time. This is a perfectly normal reaction and you don't need to worry about it. This is usually down to the act that you have exhausted or considerably diminished the sperm and semen levels. The body needs time to recharge before you can get back to your randy ways.

8. Decreased Vision

While this might seem farfetched, it does actually happen to many people. This happens when blood vessels in the eyes pop during sexual activity. You need not worry too much if this happens to you as it will heal and become normal with time.

9. Strained Muscles

Like any other physical activity, sexual intercourse can cause muscle strains. This could result in pain and even immobility. You might be required to stay off sex for a while as you recover. Alternatively, you could opt for sex positions that do not put pressure on the strained muscles.

10. Exhaustion

While this is not a dangerous effect of too much sex, it can affect your quality of life. You cannot afford to go through life with tiredness. Indulging in sex several times a day will drain all your energy and leave you an exhausted feeling most of the time. During sexual activity, the body releases norepinephrine, epinephrine and cortisol which increase the heart rate and trigger the release of glucose in the blood. All this activity is tiring, especially when done frequently.

11. Hair Loss

Sexual intercourse increases the levels of Dihydrotestosterone (DHT) in the body. This hormone, in turn, leads to hair loss as DHT is known to kill hair follicles and cause male pattern baldness.

12. Weak Immunity

Your immunity can be lowered as an effect of too much sex. The prostaglandin E-2 hormone is released into the blood stream during sex. This hormone can lead to the following problems when produced in excessive amounts – weakening immunity, damaged tissues, nervous and muscular pain and lack of sexual stimulation.

13. Head Injury

This could happen if you bang your head against something during sexual intercourse. This could be the headboard or the wall as you try to push in or pull off in the similar way like porn stars' sexual routines. The severity will depend on what you hit and how hard you hit it. If you feel it is serious, see a doctor.

14. Heart Attack

While this is rare, there are situations when people suffer from a heart attack during sexual intercourse. While sex can be good for your heart as it is a cardiovascular activity like some others, you should do it with cautions if you have a history of heart problems.

15. Fracture

While the penis cannot break, it is important to know that it can suffer from a fracture. You will normally hear a popping or snapping sound followed by the loss of erection. This normally results in swelling at the base of the penis or scrotum.

So, How Much Sex Is Healthy and Normal?

There is no right or wrong answer to this. The amount of sex one should have often differs from person to person. The best way to go about this issue is to discuss it with your partner. As long as you are both comfortable with the frequency of your sexual activities, you need not worry. However, if you notice that your sexual activity is interfering with your work or day to day life, you might adjust it or see a therapist.