Tuesday, October 28, 2014
PICTURES ILLUSTRATING GEOGRAPHIC TONGUE
HARMLESS BUT DISTURBING PICTURE OF GEOGRAPHIC
GEOGRAPHIC TONGUE
Tuesday, October 21, 2014
Managing dog bites (2)
In
the first part of this piece, it was said that a large percentage of
dog bite victims are children and it was emphasised that it is
appropriate to begin prevention education with children and parents.
Infants and children should, therefore, be evaluated after a dog bite.
History
After
confirming that the victim is medically stable, the doctor will begin
primary assessment by obtaining information that can help determine the
patient’s risk of infection, including the time of the injury, whether
the animal was provoked or unprovoked. This will help to establish
whether or not the dog has rabies.
The doctor will also ascertain if the dog has been biting other people concurrently, which may suggest that it has rabies.
Physical examination
The
measurement and classification of the wound and the range of motion of
the affected part and adjacent areas should be documented. Nerve,
vascular and motor function must be recorded.
A
general examination of all the systems should be done also, and the
doctor should use this information to allay the fears of the patient.
The
doctor may take photographs that are useful, especially in situations
where the wounds present as irregular, or where there are signs of
infection. He may also take photographs in cases that may involve
litigation, such as a wound inflicted by an unleashed dog.
Treatment
The
wound must be rinsed with normal saline or Ringer’s lactate solution in
order to reduce the rate of possible infection. Some dead tissues must
also be cut off. Patients who have been bitten by a dog should be
instructed to elevate and immobilise the area involved.
Most
bite wounds should be re-examined in 24 to 48 hours, especially bites
to the hands. Wound suturing and closure should be delayed in an
infected person, and also in wounds that are more than 24 hours old.
Radiographs (X-Rays) may be obtained, especially with puncture wounds near a joint or bone.
Plastic
surgery, general surgery or maxillofacial surgery may be necessary for
deep wounds involving the face. Orthopaedic consultation may also be
considered for wounds that directly involve the joints or other bony
structures.
Antibiotics
Treatment
with prophylactic antibiotics for five to seven days is appropriate for
dog bite wounds, unless the risk of infection is low or if the wound is
superficial. A 10-14-day course of oral antibiotic treatment is more
appropriate.
Prevention of rabies
The
patient’s risk of infection with the rabies virus must be addressed
immediately. Because of the serious risk a rabid animal on the loose
poses to the public, it is important to document the conditions
surrounding the attack.
Patients with
a bite from an unprovoked dog should be considered being at higher risk
for rabies infection than patients with a bite from a provoked dog. If
the dog owner is reliable and can confirm that the animal’s vaccination
against rabies virus is current, the dog may be observed at the owner’s
home.
Observation by a vet doctor is
appropriate when the vaccination status of the animal is unknown. The
animal should be quarantined for 10-14 days.
Exposure
to a rabid animal does not always result in rabies if treatment is
initiated promptly following an exposure to rabies. And that’s why we
say rabies can be prevented. If an exposure to rabies is not treated and
a person develops clinical signs of rabies (headache, irritability,
photophobia, barking), the disease almost always results in death.
Rabies
immunisation consists of an active immune response with a vaccine and a
passive immune response with rabies immune globulin (RIG). Once the
vaccine series has begun, it is usually completed with the same vaccine
type. Vaccine is administered on days 0, 3, 7, 14, 28 and 90.
Rabies
immunisation should begin within 48 hours after the bite, but it can be
subsequently discontinued if the animal is certified free of the rabies
virus.
Tetanus immunisation
Victims of dog bites should be immediately covered with tetanus immunisation once their immunisation status is known.
Preventing dog bites
An
older dog should not be introduced into a household with children
because the dog’s behaviour cannot be predicted. Prospective dog owners
should obtain breed-specific information before getting a new dog. This
is because some breeds of dogs are more likely to attack, despite
training.
Dogs have the tendency to
chase a moving object. Therefore, children need to learn to avoid
running and screaming in the presence of a dog. Educate children and
adults to remain calm when threatened by a dog. Direct eye contact
should be avoided, because the dog may interpret that as aggression. If a
dog perceives no movement, it will lose interest and go away.
Still on Omonigho
Meanwhile,
Omonigho, the four-year-old victim of a dog bite mentioned in the first
part of this piece, whose scalp was torn by two dogs, is now stable and
communicates freely with the parents. However, he is still on admission
at the surgical ward.
A special appeal for the boy and his brothers who were also injured is still open to the public.
Omonigho’s dad’s account details:
Name: Abraham Odia
Email: abraham.odia@gmail.com
A/C Number: 2057755102
Bank: UBA
Tel: 07061833256
10 WAYS TO PREVENT DOG BITE IN THE NEIGBOURHOOD
10 WAYS TO PREVENT DOG BITE IN THE NEIGBOURHOOD
1. Children need to learn to avoid running and screaming in the presence of a dog. Dogs have a tendency to chase a moving object
2.
Children
should avoid unknown dogs. If they see a dog they don’t know and wandering
around loose and unsupervised, they should avoid the dog and consider leaving
the area.
3. An older dog should not be introduced into a household
with children because the dog's behaviour cannot be predicted. 4. Educate children to remain calm when threatened by a dog. Direct eye contact should be avoided because the dog may interpret that as aggression.
5. Teach Children not to hug or kiss a dog on the face. Hugging the family dog or face-to-face contact are common causes of bites to the face.
6. Children should not pet a dog without asking first, when the owner is with their dog, children should ask the owner for permission to pet their dog.
7. Teach
children to confidently, quietly walk away if they’re confronted by an
aggressive dog. Instruct them to stand still if a dog goes after them and then
take a defensive position. It often helps to tell them to “be a tree:”
8.
Teach
children never to tease dogs by taking their toys, food or treats, or by
pretending to hit or kick.
9. Teach children never to disturb
a dog that’s sleeping, eating or protecting something.
10. Children should be Supervised at all time. If visiting children are bothering the dog, put the dog away or send the children home.
10. Children should be Supervised at all time. If visiting children are bothering the dog, put the dog away or send the children home.
Finally,
Parent should report stray dogs or dogs that frequently get loose in your neighbourhood.
Monday, October 13, 2014
MEDICAL MANAGEMENT OF DOG BITE
Managing dog bite 1
On August 26, 2014, The PUNCH newspaper
reported that a 14-year-old boy died from dog bite. James Musa and his
teenage friends were playing football. Things went awry when Musa
allegedly touched the dog during the match.
Jerry, the dog, was said to have jumped
on him, mauling the boy just under his right eye. Unknown to its owners
and neighbours, the huge Alsatian dog was not done with its deadly
mission. Without provocation, it bit another victim, 21-year-old Aishat
Opakunle, on her right palm on the night of the same day it attacked
Musa.
Musa hid the news of the dog bite from
his aunt and her husband, telling lies about the real cause of the
scratch just below his right eye.
Musa, Jerry the dog and Aishat all died
within a month. Musa was said to have complained of headache and fever,
while Aishat was said to be barking like a dog before her death.
This confirmed the suspicion of the people that the dog was rabid.
Last week, again as reported by The PUNCH,
four-year-old Omonigho Abraham and his brothers were chased into their
apartment by tow wild dogs. But while Omonigho’s brothers escaped from
the dogs, he wasn’t as lucky, as the dogs pounced on him and ate off his
scalp! He is currently battling for his life at the Lagos State
University Teaching Hospital, Ikeja.
The dogs chewed the skin and exposed the victim’s skull during the attack last Thursday.
The two dogs have been kept in police custody in order to prevent further attacks on others.
The immediate elder brother of the
victim, seven-year-old Osemudiamen, and another brother who is 11 years
old, were said to have jumped down from the balcony of their two-storey
building in their bid to escape from the dogs, with one of them
sustaining fracture in the process.
The dogs reportedly dragged Omonigho
through the compound for more than one hour before help arrived. His
mother, Mrs. Helen Abraham, who was warned by the police and neighbours
not to venture inside the compound, refused to listen and ran in to
rescue her traumatised child.
She narrated, “One of the dogs emerged
from the corridor with blood stains in its mouth. I ran inside. The
other dog, on sighting me, pounced on me, but I fought back. It later
ran away. I called on people who joined me to take Omonigho to the
hospital. This has been a nightmare I want to wake up from.”
I spoke with Omonigho’s dad a few days
after the gory event. He said, “When I got home, I saw parts of my son’s
scalp on the floor. The dogs dragged him through the compound for about
one and a half hours but nobody moved near them. His face was also
affected, but thankfully, it did not get to his eyes.”
Truth about dog bite
Almost one half of all dog bites involve
an animal owned by the victim’s family or neighbours. A large percentage
of dog bite victims are children. And although some breeds of dogs have
been identified as being more aggressive than others, any dog may
attack when threatened.
Health workers and schools should educate parents and children on ways to prevent dog bite.
Again, doctors can also educate parents
and children on ways to prevent dog bite; and when dog bites do occur,
the physician must be knowledgeable about how to treat the victim
effectively.
Many fatalities related to dog bites
occur each year in this country, many are unreported; and most of the
victims are children. In certain parts of Nigeria, the population has
been taught about dog bite, what to do, the first aid and not to hide.
While I was practising up north, I
discovered that whenever a dog bit anyone, the community or relations of
the victim would quickly kill the dog and then bring the owner to the
hospital to say what he knew about his dog.
Some owners would come with the
certificate of vaccination from the animal public health department to
prove that the offending dog was not rabid. This would not help matter
in any way, however.
The narrative of the victim was one of
the things that would enable the doctor to guess whether or not the dog
had rabies. The victims will immediately tell you whether they provoked
the dogs or the dogs were unprovoked. This will help the doctor in a
way.
Again, the victim might be able to tell you how many people have been bitten by the dog in the community.
Although most dog bite attacks are not
provoked, there are several measures that adults and children can take
to decrease the possibility of being bitten. Most dogs don’t bite
humans; however, under certain circumstances, any dog is capable of
inflicting harm. The most common victims of dog bites are children,
especially in incidents that prove fatal.
Several dog breeds, especially the wild
ones, have been identified for their role in fatal dog bite attacks,
including pit bull breeds, Rottweiler, huskies, German shepherds and
wolf hybrids.
Assessment for the risk of tetanus and
rabies virus infection, and subsequent selection of prophylactic
antibiotics, are essential in the management of dog bites.
Save Omonigho
Omonigho, the four-year-old victim of the
recent dog bite is alive in the intensive care unit of LASUTH and he is
now more stable and communicates with the parent. The father said he
was worried and hoped that his brain is not affected.
Here’s a special appeal for Omonigho and
his brothers who were also injured and a prayer for the family as they
pass through this post-traumatic stress disorder.
I have also given my own widow’s mite on
behalf of my family. So, let’s be our brother’s keeper by donating
towards this child’ medical treatment, which may take some time and
consume much money.
Omonigho’s dad’s account details are as follows:
Name: Abraham Odia
Email: abraham.odia@gmail.com
A/C Number: 2057755102
Bank: UBA
Tel: 07061833256
Let us save this boy’s life.
Tuesday, October 7, 2014
Protecting Pupils from Ebola Virus Disease
A survey conducted by The PUNCH online to find out whether it was safe for primary and secondary schools in the country to resume on September 22 when the Ebola Virus Disease has not been totally resolved revealed 18 per cent of the voters saying it is safe, while 82 per cent of the voters said it wasn’t.
This simply shows that many parents are not in agreement with the resumption of primary and secondary schools on the said date, despite the health ministry saying there’s currently no confirmed new case of Ebola in Nigeria, as it has been contained.
I spoke to a mom who is a banker and she said she and her colleagues had made up their minds not to allow their children to resume on September 22 for fear of Ebola.
A particular said, “I just received a mail confirming that schools would re-open on September 22, 2014. After reading it, I felt compelled to put on paper my thoughts since the announcement of same by the Federal Government.
“One thing that struck me is that I am yet to receive information about confirmed nationwide measures that have been put in place to ensure the safety of our children from the Ebola virus upon resumption at school in two weeks.
“It is understandable that we want our children educated, but we need to be reminded that we can only educate the healthy and living. How do we tell them not to play with their friends as they are used to? Or not to show concern if one of them gets hurt and is bleeding?
“How can we really be sure that our three to 16-year-olds would be safe from Ebola in a place where we cannot control who they come in contact with; a place where they share toilets, eat and play with others? How many infrared thermometers have been distributed across these schools in Nigeria?”
This and many other issues were raised by this mom.
Solutions
I will like to reassure parents that if all the preventive measures are put in place by the schools, we will not have a single case of Ebola among the pupils when the schools resume.
There are documented cases from Kikwit, Democratic Republic of Congo, of an Ebola outbreak in a village that had the custom of children never touching a sick adult. Even children who live in small, one-room huts with parents who died from Ebola did not get infected.
The U.S. embassy also made a press release at the beginning of the Ebola epidemic that “There’s no medical reason to stop flights, close borders, restrict travel or close embassies, businesses or schools.” It called on residents of affected countries to always practice good hand washing techniques.
The fight against Ebola needs collective and concerted efforts by all: government, health workers, parents, care givers, school owners, teachers, organisations and the public.
Government should provide potable water for private and public schools, while those in the villages may be assisted with water storage tanks. Soap should also be provided for schools.
There should also be sensitisation exercise on the Ebola virus for principals and head teachers of public primary and secondary schools, and for proprietors of private schools.
Health workers should volunteer to assist the schools in their localities through health education on prevention of epidemic.
The basic universal precaution of frequently washing hands in the fight against diseases is important for nannies and care givers in order to prevent spread of infections.
Parents and school teachers are to teach the pupils to properly wash their hands as often as possible. Messages should be sent to the parents on the precautionary steps to take to ensure the safety of their children.
Private organisations must donate soaps, sanitisers, hand gloves and non contact infrared thermometers, hand dryers, disposable tissues/towels, etc. to schools. On their part, pupils should avoid putting hands in their mouths and avoid shaking or having body contact with sick pupils.
They must wash their hands regularly, since they are prone to putting their hands into their mouths or rubbing their eyes.
Schools must send teachers on training on how to prevent and manage Ebola Virus Disease. These teachers would, in turn, train other teachers on the same. They should organise staff seminars and parents’ forum so as to educate parents on what they need to do to complement the efforts of the schools.
Provision of hand sanitisers can come in handy, especially when one doesn’t have access to water. Everyone would have to wash their hands before entering the school, and there would be regular hand washing and use of hand sanitisers because it would be difficult controlling children from touching one another.
Schools should also delegate people to take the temperature of everyone entering their premises through non contact thermometers. Those with high fevers should be put aside for medical attention.
Schools should provides sickbays where children who developed fever in school will be isolated and nursed before the parents will arrive for onward transfer to the hospital.
Such children will have a questionnaire on risk of Ebola Virus disease administered and exempted from school to allow for full recovery.
A medical report will be required on resumption from sick leave of such children.
Tackling Vaginal Discharge in Children
Case 1
A nursing mother once ran to our clinic to be treated for sexually transmitted disease because she thought her two-month old baby girl acquired STD from her. The baby girl was having a whitish vaginal discharge. The mother was checked and tested for evidence of STD at her request. The test was normal. She was reassured that the vaginal discharge her baby was having was not STD but it was as a result of hormonal withdrawal. This does not require treatment, as it will cease after a period.
Case 2
Another mother brought her seven-year-old daughter who has much vaginal discharge. The mother said though she bathed the baby every day, at the end of the day, her panties were always messy with somewhat greenish tinge but without offensive smell.
The genital examination showed that the hymen was intact. A laboratory test (swab) of the discharge was sent for culture and came back positive for Eschericcha Coli, which suggested a faecal source, probably from improper toilet hygiene.
Case 3
A nine-year-old girl, accompanied by her mother, presented to the clinic with a recurrent history of green vaginal discharge. She reported no other symptoms. A thorough history and physical examination was done, including inspection of the vagina.
The genital examination showed that the hymen was not present. A test (swab of the discharge) was sent to the lab for culture and came back positive for Neisseria gonorrhea, which suggested gonorrheal infection.
Her parents were informed of the possibility of sexual transmission, but they claimed no history of such. This requires an urgent medical intervention.
Medical explanation
Baby girls who are less than three months old often have vaginal discharge and may sometimes develop vaginal spotting or bleeding. Both conditions are temporary and normal. These changes are caused by exposure to maternal estrogen, a hormone that crosses the placenta and enters the baby’s bloodstream before birth.
And because a newborn baby’s body takes longer than an adult female’s to remove this hormone, it remains after birth. The hormone has the effect of making a newborn’s body “think” that she is in puberty, and discharge and bleeding occur. As the hormone levels drop, the effects disappear. No treatment is required.
The causes of vaginal discharge in older children include irritation from bubble baths or the use of strongly scented soaps. Wearing tight-fitting nylon underwear can also result in irritation.
Again, pinworm can cause vulvo vaginitis by coming out of the rectal area. When that happens, the tiny worms can cause vaginal irritation.
Constant or repeated rubbing, pressure or abrasion in the genital area can also result in vulvo vaginitis. Examples include masturbation, frequent or prolonged contact with play equipment (saddles on play horses) or sitting in sand boxes.
If a young girl inserts a toy or other article into the vagina, this can lead to an infection, resulting in foul smelling discharge.
Infection is another cause of vulvo vaginitis. The bacteria usually come from the rectal area. It is shocking to find that some sexually-transmitted infections have been detected in young girls — an indication that sexual abuse has occurred.
Sexual abuse (rape) should be considered in children with unusual infections and recurrent episodes of unexplained vaginal discharge with no hymen. This is because the hymen is supposed to be protective against any infections.
Neisseria gonorrhoeae, the organism that causes gonorrhoea, produces gonococcal vulvo vaginitis in young girls and it is considered a sexually-transmitted disease. If lab tests confirm this diagnosis, young girls should be evaluated for sexual abuse.
Treatment
No treatment is required; both of these changes are normal in a three-month old infant. However, seek medical intervention if the amount of the discharge increases in a three-month old infant, or if the discharge becomes foul-smelling and blood-stained
The usual treatment for vaginal discharge in older girls seems fairly satisfactory, because with ordinary measures ensuring cleanliness and mild antisepsis, the condition is apt to go on its own.
Some may benefit from antibiotics, depending on the result of high vagina swab done in the laboratory.
Sexually-abused girls will need to be given psychological support, in addition to antibiotics.
Prevention
Improved perineal hygiene is necessary to help healing and to prevent future re-infection for those whose infections are caused by bacteria normally found in stool.
Young girls should be taught how to clean up after defecating. They should be taught to clean their perineal area from front to back and not vice versa. They must also be taught to wash their hands before and after using the toilet.
Sitz baths (a bath in which a person sits in water up to the hips) may be recommended. It is often helpful to allow more air to reach the genital area. Wearing cotton underwear (rather than nylon) or underwear that has a cotton lining allows greater air flow and decreases the amount of moisture in the area.
Removing underwear at bedtime may also help.
Managing Asthma in Children -1
Mrs A.Y brought her six-year-old with symptoms and signs suggestive of asthma. She had been to two other hospitals where she was told that her son had asthma.
After I took her son’s medical history, family history of asthma and the complaints (symptoms) similar to asthma. I proceeded to examine the young boy, He was very cooperative, I ordered some blood test for infections, blood count and allergy. They all came out negative, even the chest X-ray was normal.
I explained to her that her son would have a provisional diagnosis of childhood asthma. She requested a confirmation. I explained to her that the definite diagnosis of asthma would be on result of a lung function test from a spirometer or a simple peak flow meter.
She was not pleased as she insisted on having the lung function test done. Unfortunately, after visiting other hospitals for the spirometry, she came back telling me that she was disappointed with the health care system in the country.
According to her, none of the five specialist hospitals, two children hospitals and one public teaching hospital she visited had a functioning spirometer.
A spirometer is an apparatus for measuring the volume of air inspired and expired by the lungs. A spirometer measures ventilation, the movement of air into and out of the lungs. It is used in diagnosing different types of abnormal ventilation patterns, obstructive, such as asthma and restrictive.
The test is very simple and it involves asking the patient to take in a big breath and then blow as hard and long as he or she can into a machine with a meter that reads the lung volumes.
Lack of this equipment has compromised the definite diagnosis of asthma in the nation’s hospitals. Government must look into it.
Back to Asthma. Asthma is a disease condition that occurs when there is an obstruction of the airways that carry air to and from the lungs, or when there is a swelling or an inflammation of the airways and hyper-responsiveness.
Most of the time, it is noticed in very early childhood. Asthma is not just one particular disease condition; it is a range of conditions. Cases of asthma in children between ages two and six is commonest, while the least percentage one finds is between 12 and 16 years, when the majority of them would have outgrown it.
Those who still have asthma at that teenage age are likely to have it into adulthood. About 60 per cent of children with asthma are less than six years; the remaining 40 per cent will be in children between seven years and 16 years of age.
The child should be taken to the hospital for regular check up every three to six months. That would help to ensure that the child does not suffer many of the problems resulting from asthma.
Asthma could affect the psychology and even growth of the child if not properly managed. But if managed and treated properly, the child could outgrow it. Again, the parents should comply with the drugs prescribed by the doctors.
They should not wait until the child has the symptoms before they give the medications.
Causes
Hereditary factor is also important to know if a child is susceptible to asthma. For example, if there is a family history of asthma, that is, if someone in that family is asthmatic or has reactive conditions, such as particular allergies, it could lead to asthma or what is also called hyper-reactive airway disease.
The majority of children outgrow asthma later in their teenage years.
Industrial/air pollution triggers asthma. Also, the more developed a place is, the more likely they would have a higher rate of asthma cases. Cities like Lagos would be expected to have a high rate of asthma cases.
Effluents from cars and industries have also been associated with asthma. It also depends on other factors, including hereditary and the person’s predisposition to allergies and certain conditions.
Fumes from generators used in residential areas, or smoke from firewood have all been implicated as trigger factors.
Some people can actually have it without any hereditary link, but they are in the minority.
Signs and symptoms
The child has difficulty in breathing or shortness of breath, cough, which is worse at night. It also depends on the degree of severity of the asthma. But the first signs are breathlessness and cough,
Pigeon chest – the chest may look bloated like that of a pigeon because of air congestion, the child is breathing air but cannot breathe it out.
Diagnosis
Most people who are said to be asthmatic are not. A diagnosis, which includes the lung function test, as well as spirometry, where the child is asked to take in a big breath and then blow as hard and long as he or she can into a machine, is used in making definitive diagnosis. It is especially in use for young children.
There is also the peak flow metre, used to measure how well air moves out.
There is also the six-minute walk test.
(Inhaler mage from:vhttp://www.asthmasymptoms86.com/images/Advair-inhaler-diskus.jpg)
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