PNEUMONIA IN CHILDREN

Pneumonia means an infection of the lungs. In the early 1900's pneumonia was responsible for many deaths even in children. Fortunately, with the invention of antibiotics and certain vaccines, pneumonia occurs less commonly today and can be effectively treated in most cases.
CAUSES OF PNEUMONIA
There are several types of germs that can cause an infection of the lungs; bacterial and viral. Although there are many different types of bacteria and viruses,fungi that can cause pneumonia, there tend to be related to age and other circumstances. For example the bacteria that cause pneumonia in newborns differ than those that cause the same infection in older children.
Signs and Symptoms......Symptoms of pneumonia vary, depending on the age of the child and the cause of the pneumonia. Common symptoms include:
• fever
• chills
• cough
• unusually rapid breathing
• breathing with grunting or wheezing sounds
• labored breathing that makes a child's rib muscles retract (when muscles under the rib cage or between ribs draw inward with each breath)
• vomiting
• chest pain
• abdominal pain
• decreased activity
• loss of appetite (in older kids) or poor feeding (in infants)
• in extreme cases, bluish or gray color of the lips and fingernails
When pneumonia is caused by bacteria, an infected child usually becomes sick relatively quickly and experiences the sudden onset of high fever and unusually rapid breathing. When pneumonia is caused by viruses, symptoms tend to appear more gradually and are often less severe than in bacterial pneumonia. Wheezing may be more common in viral pneumonia.
Some types of pneumonia cause symptoms that give important clues about which germ is causing the illness. For example, in older kids and adolescents, pneumonia due to Mycoplasma is notorious for causing a sore throat and headache in addition to the usual symptoms of pneumonia.N.B.....some children persistent high fever (more than 4 days) can be the only sign of pneumonia
INVESTIGATIONS
Although the doctor can sometimes hear specific noises with stethoscopes, that suggest pneumonia, the diagnosis is confirmed by a chest x-ray. After the full treatment course, children usually fully recover and there is no need to repeat the chest X-ray. However if the child was very ill, had a large or severe pneumonia, a repeat chest x ray may be recommended to make sure the pneumonia has cleared. If this is the case, a repeat X ray is performed 4- 6 weeks after treatmants.
TREATMENT OF PNEUMONIA
Viral pneumonia..........No treatment, although in most cases the doctor cannot tell if the cause is viral and will treat all pneumonias with antibiotics.
Bacterial Pneumonia .....treated by complete dose of antibiotics for 7-10 days.Children less than 3 months of age with pneumonia are admitted to hospital for intravenous antibiotics, oxygen treatment and rehydration.
Children with weakened immune systems are usually hospitalized and may need different(stronger) antibiotics than the children with normal immune systems.

After the full treatment course, children usually fully recover and there is no need to repeat the chest X-ray. However if the child was very ill, had a large or severe pneumonia, a repeat chest x ray may be recommended to make sure the pneumonia has cleared. If this is the case, a repeat X ray is performed 6-8 weeks later.
PREVENTION OF PNEUMONIA..........People who has cough should be treated,Avoid close contact with someone coughing,Those coughing should protect mouth and nose from with handkerchiefs when coughing or sneezing,Hand washing in people with cough or cold,Exclusive breastfeeeding in the first 4-6 months protects children from pneumonia,Balanced diet for older children,Avoid overcrowding,Vaccination..vaccines are available to protect pneumonia.

DIARRHOEA IN CHILDREN

Diarrhoea is the condition of having frequent loose or liquid bowel movements. It is the passing of watery stools more than three times a day. It is often a symptom of an infection or acute/long-term condition.
Diarrhoea can either be:
• acute: diarrhoea that comes on suddenly, and lasts for five to 10 days, or
• chronic: diarrhoea that lasts for more than two weeks.
Acute diarrhea is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause severe dehydration which is one cause of death in diarrhea sufferers. Along with water, sufferers also lose dangerous amounts of important salts, electrolytes, and other nutrients.
What causes diarrhoea?
Acute diarrhoea is usually caused by a viral or bacterial infection and affects almost everyone from time to time.
Rotavirus is the major cause of paediatric severe diarrhoea worldwide. Live attenuated vaccines, shown to be highly effective where they have been so far trialed, are increasingly being implemented within universal infant immunization schedules.
How common is it?
Diarrhoea and vomiting is very common, especially in children. A baby or toddler will probably have diarrhoea and vomiting two or three times a year.
How serious is it?
Diarrhoea usually clears up in a couple of days and is not serious. However, it can be serious in babies and the elderly because of the risk of dehydration.
If diarrhoea is persistent or there are other symptoms, such as bleeding, see your General Practitioner
If your child is between three months and one year old, diarrhoea should last no longer than 48 hours.
Symptomatic treatment for diarrhea involves the patient consuming adequate amounts of water to replace that loss, preferably mixed with electrolytes to provide essential salts and some amount of nutrients. For many people, further treatment is Symptomatic treatment for diarrhea involves the patient consuming adequate amounts of water to replace that loss, preferably mixed with electrolytes to provide essential salts and some amount of nutrients. For many people, further treatment is unnecessary.
The following types of diarrhea indicate medical supervision is require
• Diarrhea in institutions such as hospitals, child care centers, or geriatric and convalescent homes.
• Diarrhea in infants
• Moderate or severe diarrhea in young children;
• Diarrhea associated with blood
• Diarrhea that continues for more than two days;
• Diarrhea that is associated with more general illness such as non-cramping abdominal pain, fever, weight loss, etc;
In many cases of diarrhea, replacing lost fluid and salts is the only treatment needed. This is usually by mouth – oral rehydration therapy – or, in very severe cases, intravenouslyi.e through the vein.

FIRST WORLD PNEUMONIA DAY

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GENITAL WARTS

Genital warts, also known as venereal warts or condylomata acuminata, are one of the most common types of sexually transmitted diseases (STD’s). As the name suggests, genital warts affect the moist tissues of the genital area. They may look like small, flesh-colored bumps or have a cauliflower-like appearance. Genital warts may be very small, or they may multiply into large clusters. Although genital warts can be treated with medications and surgery, they are a serious health concern. The virus that causes genital warts — the human papillomavirus (HPV) — has been associated with cervical cancer. It has also been linked with other types of genital cancers.
CAUSES:Like warts that appear on other areas of your skin, genital warts are caused by a virus — HPV — that infects the top layers of your skin. There are more than 100 different types of HPV, but only a few can cause genital warts. These strains of the virus are highly contagious and spread through sexual contact with an infected person. About two-thirds of people who have sexual contact with someone who has genital warts develop the condition — usually within three months of contact, but in some cases not for years.
RISK FACTORS OF BECOMING INFECTED WITH HPV INCLUDE:Having unprotected sex with multiple partners,Having had another sexually transmitted disease ,Having sex with a partner whose sexual history you don't know ,Becoming sexually active at a young age
COMPLICATIONS :HPV infection ,Adolescent girls most at risk of getting an STD Sexually transmitted diseases (STDs) Cancer..Cervical cancer has been closely linked with HPV infection. Certain types of HPV also are associated with cancer of the vulva, cancer of the anus and cancer of the penis. Human papillomavirus infection doesn't always lead to cancer, but it's still important for women, particularly if you've been infected with certain higher risk types of HPV, to have regular Pap tests.
PROBLEMS DURING PREGNANCY. Genital warts may cause problems during pregnancy. Warts could enlarge, making it difficult to urinate. Warts on the vaginal wall may reduce the ability of vaginal tissues to stretch during childbirth. may need surgery to prevent airway obstruction.
TESTS AND DIAGNOSIS
• DETECTING GENITAL WARTS :Because it's often difficult to detect genital warts, your doctor may apply an acetic acid solution to your genitals to whiten any warts. Then, he or she may view them through a special microscope called a colposcope.
• THE IMPORTANCE OF PAP TESTS: For women, it's important to have regular pelvic exams and Pap tests, which can help detect vaginal and cervical changes caused by genital warts or the early signs of cervical cancer — a possible complication of HPV infection.

TREATMENTS

Up to 30 percent of genital warts go away without treatment. If your warts are not causing discomfort, you may not need treatment. However, if your symptoms include itching, burning and pain or if visible warts are causing emotional distress, your doctor can help you clear an outbreak with medications or surgical treatments. The underlying virus is never completely eliminated, however, and genital warts may reappear even after treatment. Genital warts treatments that can be applied directly to your skin include: Podophyllin and podofilox (Condylox),Trichloroacetic acid (TCA). This chemical treatment burns off genital warts. They must always be applied by a doctor. Don't try to treat genital warts with over-the-counter medications. These medications aren't intended for use in the moist tissues of the genital area. Using over-the-counter medications for this purpose can cause even more pain and irritation. Surgery may also be used to remove the Warts.

PREVENTION
 Use a condom. HPV can spread through skin-to-skin contact with any infected part of your body — but using a condom every time you have sex can significantly reduce your risk of contracting HPV.
 Avoid sexual contact. If warts are visible on your genital area or your partner's, avoid sexual contact until the warts are treated. If you've developed genital warts for the first time, inform your sexual partner so that he or she can be screened for infection and, if necessary, receive treatment.
 Consider vaccination. While it won't completely prevent genital warts or cervical cancer, a vaccine known as HPV Vaccine protects against the two strains of HPV that cause 70 percent of cervical cancers and the two strains that cause 90 percent of genital warts. The national Advisory Committee on Immunization Practices recommends routine vaccination for girls ages 11 and 12, as well as girls and women ages 13 to 26 if they haven't received the vaccine already. The vaccine is most effective if given to girls before they become sexually active.

COMMUNITY SERVICE.... A SELFLESS SERVICE

A CROSS SECTION OF ADULTS BEEN ATTENDED TO BY DR ADESANYA AND THE MEDICAL TEAM IN IDOWA TOWN ODOGBOLU LGA OGUN STATE,NIGERIA,WEST AFRICA

DR ADESANYA COUNSEL AN ELDERLY MAN IN THE COMMUNITY ON HOW TO PREVENT HYPERTENSION.
















THE KABIYESI ALSO LEADS BY EXAMPLE AS HE IS BEING CHECKED BY DR ROTIMI ADESANYA.

HERNIA

A hernia is when an internal part of the body, such as an organ, pushes through a weakness in the muscle or surrounding tissue wall. Usually your muscles are strong and tight enough to keep your intestines and organs in place, but sometimes they are not, thereby causing a hernia.

TYPES OF HERNIA
a hernia can occur anywhere in the abdomen region. The most common types are:

• Inguinal hernia this occurs when tissue (usually part of the intestines) pokes through your lower abdomen. Inguinal hernias these are the most common type of hernia. In reported cases, 98% occur in men. Inguinal hernias can occur at any age, but they are primarily an age-related condition. The older you get, the more likely you are to develop one.

• Femoral hernia this occurs when tissue pokes through into your groin, or the top of your inner thigh. Femoral hernias these are less common than inguinal hernias, around three quarters of cases of femoral hernias occur in women.

• Incisional hernia this occurs when tissue pokes through a surgical wound or incision that has not fully healed. Incisional hernias these develop as a complication of abdominal surgery. The chance of an incisional hernia developing after surgery can vary from between 0.5-10%, depending on the type of surgery involved.
• Umbilical hernia this occurs when tissue pokes through the part of the abdomen near to the navel (belly button).Umbilical hernias these are very common in young children, with as many as one in six children being affected. Black children are 10 times more likely to develop an umbilical hernia than white children. The reasons for this are unclear. In most cases, an umbilical hernia will resolve as a child grows older, without the need for treatment.
• Other types are hiatus hernia, epigastric hernia and spingelian hernias.

SIGNS AND SYMPTOMS………….Some are asmptomatic, Swelling, pain, constipation, vomiting, something bulging out of the body, scrotal swelling.

CAUSES

• Congenital weakness of certain muscles…commonest cause is in children
• Chronic cough
• Those doing heavy works i.e carrying heavy loads are at risk labourers, farmers fall into this category.
• Children with certain congenital abnormalities

COMPLICATIONS…….these are medical emergencies that require urgent medical/surgical intervention. Obstruction in the bowel leading to Strangulation of affected organs and interruption of the blood supply to the intestines.

TREATMENT……….Due to the potential risks of these complications, surgery is usually recommended to repair the hernia. The surgery called herniorapphy or herniotomy.The only exception is umbilical hernias, as the risks of complications are thought too small to justify surgery.

FOLIC ACID ...A WONDER DRUG

Folic acid also called folate; folacin or vitamin b9 is needed to make healthy new cells in our body. Lack of folic acid in the body may lead to a condition called anaemia which is shortage of red blood cells.
Folic acid and you
Folic acid is needed for normal cell growth. This vitamin helps to
• Build healthy blood cells.
• Prevent neural tube defects of the brain and spinal cord.
• Reduces levels of a blood chemical (homocysteine) that may increase your risk of heart disease.
Sources of folic acid
When you think of the word folic acid think of the word foliage. Plants are good source and the main food source of folic acid. some good sources includes dark green leafy vegetables such as spinach,lettuce,and other vegetables available in our environment, black beans, dried beans,avocados,oranges,orange juice, wheat germs, whole wheat products fortified with folic acids such as cereals,pasta,bread,rice etc.
Why use folic acid
Taking folic acids helps prevent serious health problems such as Births defects, Heart disease, Alcoholics Pre –conception, Infertility, Those of childbearing age,
Sicklers,Those on anticonvulsant (antiepileptic drugs) Those with low blood level.

Conditions that cause increase body need for folic acid.
anemia,diarrhea,prolonged fever,haemodialysis,long term illness, intestinal disease, liver disuse, long time stres,surgical removal of stomachc,breastfedinfants,pre term babies
signs and symptoms of folic acid deficiency
poor growth, graying of hairs, inflammation of the tongue, glossitis, mouth ulcers, peptic ulcer and diarrhea.it may also lead to certain types of anaemiea, congenital abnormality like neural birth defects.
TIPS
• eat healthy diet to provide all the nutrients your body need
• those having these signs and symptoms should take high dose of folic acids
• in those with deficiency the body stores are replenished after few weeks of therapy, your doctor is the best judge to decide the duration for which you should take the drugs.
• Those with sickle cell disease will take the drug for life.
• choose a supplement that provides 400-800mcg of folic acid
• store the supplement in cool dry place away from the sun and heat
• check the expiry date,the recommended daily values is 400mcg
• folic acid supplementation does not have side effects as the drugs is water soluble vitamins and excreted in the body.

IS Premature Ejaculation (PE) A PROBLEM?

Premature ejaculation (PE) means coming too quickly, and it's one of the commonest of all sexual problems in men. It’s almost impossible to get an accurate definition of premature ejaculation.what some couples consider a satisfactory length of intercourse would be very inadequate for others.

It is commoner in younger men; there is a distinct tendency for it to improve with age. Men generally get better controls as they grow older.Good treatments are available. On the average, most men may take 7-10minutes before ejaculation. The average lasting time of men with premature ejaculation (PE) was 2minutes.
From our own clinical experience, there are plenty of couples who would regard intercourse that lasts under 20 minutes as less than satisfactory, and would feel that any ejaculation in less than 10 minutes is premature. As a working definition, if either you or your partner feels that orgasm is happening too soon, then there probably is some degree of premature ejaculation (PE).

RESULTS OF PREMATURE EJACULATION

In most cases premature ejaculation does matter, because it makes people unhappy and frustrated. And in severe cases Premature ejaculation (PE) can threaten or even ruin a marriage - simply because it spoils the sex lives of both partners.
Sometimes, the condition is so bad the man can't have sex because he ejaculates before he can get into the vagina. This can be devastating for a man's self-confidence. And it can be hugely frustrating and annoying for his partner – especially if she wants to get pregnant.

TREATMENT
MILD CASES – for instance, you can last five minutes but would like to last 10, there's probably no point in going to a doctor.the treatments options are listed below

• Distraction Technique…you should be able to improve matters by simple distraction techniques.This means turning your mind to something else when you sense that climax is near. For example, you can think about something totally unconcerned with sex or pinch yourself.
• Local anaesthetic gel..this no longer recommended because it causes numbness, irritations and soreness in the vagina of the partner.
• Long love condoms…this is a special type of condom,It's called the 'longlove condom’ and it contains a local anaesthetic (benzocaine) inside it.

SEVERE CASES……If Premature ejaculation (PE) is causing you significant problems, it is best to consult an expert for treatment. These are the treatment options

• The Masters-Johnson method
  This method cures the vast majority of men, provided that both partners are keen to co-operate (which isn't always the case). It is based on a special 'penis grip' developed by the American therapists Masters and Johnson.
  he finger-grip abolishes the desire to climax, so if, under careful instruction, the couple use it over a period of weeks, they can usually re-train the man so he can last much longer.

• Antidepressant drugs
  In recent years, it has also proved possible to treat PE with antidepressant drugs taken a few hours before intercourse. delaying male climax is a well-known side-effect of certain antidepressants. For most men, that side-effect is unwanted. But for young men with premature ejaculation, it's desirable.
• Cognitive behaviour treatment (stop-start technique)
  The CBT method also aims to alter the man’s behaviour: he is encouraged to masturbate using the stop-start technique to gain more control over his responses and his urge to ejaculate quickly.

This piece has been written by the author for the purpose of education only. No self medication please.

Infertility in men

Infertility is defined as inability of a couple to achieve conception after a year of unprotected, adequate regular sexual intercourse. Adequate sexual intercourse means 2-3 times of sexual intercourse. This is only possible in couple co-habiting. Sexual techniques too are very important consideration.

Infertility affects 1 in every 10-12 couples in Nigeria. Diagnosis requires a thorough assessment of both partners. There are numerous causes of infertility. It is only after the cause has been established/identified that treatment will be effective. It is a wasteful venture to treat or provide solution to cases of infertility without knowing the cause.

CAUSES

The causes of infertility can be broken into 4 broad groups

• Male factor only……………occurs in 33% of people with infertility
• Female factor………………occurs in 33% of people with infertility
• Both male and female factor occurs in 33% of people with infertility
• Unexplained factors ……….occurs in less than 1% of people with infertility
• Male factor this is due to conditions/problems in man.
• Female factor. This is due to conditions/problems in woman.
• Both male and female factor…this are due to problems/conditions in women.
• Unexplained/unidentified factors. In threes group of people no cause is identified after investigations .this occurs in very few people less than 1%.

SPECIFIC CAUSES

• Congenital factors …..Chromosomal abnormality, Klinefelters syndrome, congenital albescence of testiclec, Undescensed testes, Hypoplastic testes abnormal formation of the vas and epipydymis
• Acquired factors…..Trauma to the pelvis, to the scrotum.Surgeries like prostratectomy, neurologic dysfunction, Orchidectomy, Radiotherapy to the perineum, chemotherapy (anticancer drugs), and bilateral testicular lesion.
• Infections…. Mumps orchitis, Gonococcal infection, Chlamydia infection, staphylococcus.
• Chronic illness…like chronic renal failure, diabetes.neurologic dysfunction.
• Endocrine ….Hyperaldorenalism, Hypopituitarism, Hyperprolactinaemia.
• Physiological …Extreme temperature to the testicles e.g. nylon underwear’s
• Varicocoele ….also increase scrotal temperature. This is the anatomic abnormality found in the male resulting from abnormal dilation of vein.

MANAGEMENT

History

History of infection with mumps in childhood, history of groin surgery, history of gonococcal infection and other STDS, history of undescended testes, history of cancer, history of radiotherapy and chemotherapy.

Examination for gyneacomastia, smooth face due to low testosterone, feminine voice, absent hair distribution in the pubic area, truncal obesity.

Testicles are examined, scrotum also examined for varicoeceles, epidydimis also examined

Examined the phallus size not important and check the urethral meatus to see if they are present

INVESTIGATION

Seminal fluid analysis this is one of the most important test in investigation of men for infertility. The following had to be followed when doing seminal fluid analysis:

Abstain from sexual intercourse3-5 days before the test, Collection better by masturbation, Collect sample in a tight container, Deliver sample to the lab 10-15 minutes.

Things like sperm count, sperm motility, viability, sperm antibody are checked semen may also be examined for any form of infection.

Normal seminal fluid analysis

• Volume….2-6 mls
• Color….normal/cream colored
• Microscopic….1-3 WBC/hpf
• Ph……7-8
• Sperm count above 20 million/ML
• Sperm morphology….normal above60%
• Sperm motility …above 50 %( 1-3hrs)
• Sperm antibody…..also checked.

Other test like urinary MCS or urethral swab test will have to be done to check for infection like staphylococcus, Chlamydia and gonococci infection

Hormonal analysis…hormones like prolactin, testosterone are checked

Treatment will depend on the cause of the infertility.

Questions/ clarifications will be entertained by the author…..08037202050