PATERNITY TESTING

A story that touches the heart was featured by the punch newspaper on the valentine day, It was the story of a middle aged Nigerian man who discovered that a young man he raised from birth and who is now 32 years old is not his biological son.

The Nigerian man who resides in the United Kingdom, Mr. Oscar, was forced to arrange for a DNA test to determine the paternity of his erstwhile son, Valentine, when his wife allegedly told their presumed son that Oscar was not likely to be Valentine’s biological father.

Valentine had dragged his supposed dad, Oscar, to a DNA test centre in Britain after his mother informed him a month earlier that the man who had brought him up for the last 32 years may not actually be his dad. It was reported that Mr Oscar took Valentine to England from Nigeria and put him through school till graduation in the University of Britian. The result of the DNA test was read to Oscar who wailed in agony as the results said there was “zero per cent chance” he and Valentine were biologically related.

DEOXYRIBONUCLEIC ACID (DNA)

The DNA is like an instruction manual for how to build a person. Most DNA is basically the same in everyone - two eyes, two ears, one nose, etc - but there is enough variation in certain parts of the DNA that everyone turns out slightly different from everyone else. Because of this, DNA can be used to identify individuals. Human DNA can be extracted from many types of body fluid or tissue (saliva, semen, blood, hair, nails etc.) Also DNA can be extracted from an item that is contaminated with body fluids (such as chewing gum, cigarette butts, sanitary towels etc.)

DNA paternity testing is the use of DNA profiling (known as genetic fingerprinting) to determine whether two individuals are biologically parent and child. A paternity test establishes genetic proof whether a man is the biological father of an individual, and a maternity test establishes whether a woman is the biological mother of an individual. Tests can also determine the likelihood of someone being a biological grandparent to a grandchild.

In the case of a paternity test, for example, if we test a child and its mother, we can compare where the two match. This tells us which parts of the DNA have come from the mother. The remaining parts must therefore have come from the father. If we look at a man's DNA and it matches those remaining points, the man is the father. If the parts don't match, the man could not have supplied the child's DNA and is therefore not the father.

DNA can also establish relationships between siblings and more distant relatives as they all will have common DNA inherited from an ancestor.

The testing is performed by collecting buccal cells found on the inside of a person's cheek using a buccal swab or cheek swab. The buccal cells are then sent to a laboratory for testing. For paternity testing, samples from the alleged father and child would be needed. For maternity testing, samples from the alleged mother and child would be needed.

Consent is required for DNA testing

If the child is under the age of 18 years, both parents must consent to parentage testing for the result to have legal standing. All persons being tested must complete a form proving consent on the day of testing.

Accuracy of DNA Tests

DNA paternity testing has the highest likelihood of excluding a falsely assumed father. A man who does not match the child's paternal DNA type can be excluded with 100% certainty. If the man is not excluded, then with DNA testing, the probability of him being the father can be determined up to 99.999%.

Results

In the interest of the parties being tested, when the results are ready, the written reports are forwarded to a medical or legal professional as nominated by the applicant. Counselling before and after the test is also mandatory. This ensures confidentiality of the test results as well as professional supervision of the circumstances of the DNA test.

Peace of Mind DNA testing  

Questions about paternity and simple relationships can be answered by taking a Peace of Mind DNA tests. The sample collection processes for Peace of Mind testing are not admissible for legal purposes. Testing can determine paternity, maternity, common paternal lineage (along the male line), siblingship between 2 sisters (mother's sample is required) and twin testing. Prenatal paternity testing is performed by using samples of the unborn child either by chorionic villi, obtained by the CVS procedure (from 10 weeks gestation) or amniotic fluid, obtained by amniocentesis (from 14-16 weeks gestation).

Prevention of Typhoid Fever

Recently, there has been a lot of public outcry over repeated cases of misdiagnosis of typhoid fever. Nigerians deserve to know what this disease is all about; how it can be detected, treated and prevented.

Typhoid fever is an acute illness associated with fever caused by the Salmonella typhi bacteria. It can also be caused by Salmonella paratyphi, a related bacterium that usually causes a less severe illness. The bacteria are deposited in water or food by a human carrier and are then spread to other people in the area.

Transmission

Typhoid fever is contracted by drinking or eating the bacteria in contaminated food or water. People with acute illness can contaminate the surrounding water supply through stool, which contains a high concentration of the bacteria. Contamination of the water supply can, in turn, taint the food supply. The bacteria can survive for weeks in water or dried sewage.

Diagnosis

After the ingestion of contaminated food or water, the Salmonella bacteria invade the small intestine and enter the bloodstream temporarily. The bacteria are carried by white blood cells in the liver, spleen, and bone marrow, where they multiply and re-enter the bloodstream. If a test result isn’t clear, blood samples will be taken to make a diagnosis.

The Widal test may suggest infection with Salmonella typhi. But they are not diagnostic because of the number of false-positive and false-negative. Isolation of Salmonella  bacteria that causes typhoid) from cultures of stool, blood, urine, or bone marrow are necessary to confirm the diagnosis of typhoid fever.

Symptoms

The incubation period is usually one to two weeks, and the duration of the illness is about three to four weeks. Symptoms include: Poor appetite, headaches , generalised aches and pains, fever, lethargy, diarrhea and chest congestion may develop some, and abdominal pain and discomfort are common. The fever becomes constant. Improvement occurs in the third and fourth week in those without complications. About 10 per cent of people have recurrent symptoms after feeling better for one to two weeks. Relapses are actually more common in individuals treated with inappropriate dosing of antibiotics.

Treatment

Typhoid fever is treated with antibiotics which kill the Salmonella bacteria. Prior to the use of antibiotics, the fatality rate was 20 per cent. Death occurred from overwhelming infection, pneumonia, intestinal bleeding, or intestinal perforation. With antibiotics and supportive care, mortality has been reduced. With appropriate antibiotic therapy, there is usually improvement within one to two days and recovery within seven to 10 days.

Several antibiotics are effective for the treatment of typhoid fever. Chloramphenicol was the original drug of choice for many years. Because of side effects, chloramphenicol has been replaced by other effective antibiotics. Those who become chronically ill (about three to five per cent of those infected), can be treated with prolonged antibiotics. Often, removal of the gallbladder, the site of chronic infection, will provide a cure.

Prevention

Prevention is the best way to protect the child against typhoid fever. Some simple steps to reduce chances of catching this infection are listed below:

Drink pure or bottle water

Contaminated drinking water is a common source of the infection. Boil your water and allow it to cool before drinking or stick to purified water .

Hand washing

Teach children to wash hands frequently. Wash with warm, soapy water before eating food. Also wash after using the toilet. Public education campaigns encouraging people to wash their hands after defecating and before handling food are an important component in controlling spread of the disease. Alcohol-based hand sanitiser can kill germs when water is not available.

Wash fruits and vegetables thoroughly

Raw fruit or vegetables may have been washed in contaminated water. There is the need to rewash the fruits and vegetables thoroughly.

Typhoid immunisation / vaccination

Typhoid vaccine is readily available and can be used in children from two years of age. Adults can also be given the typhoid vaccination to prevent them from typhoid fever. For those travelling to high-risk areas, vaccines are now available.

Managing meningitis in children

The Nigeria Centre for Disease Control, NCDC, has confirmed the outbreak of Cerebro Spinal Meningitis, CSM, in the northern part of the country with at least 324 deaths related to the disease.

Over 2,900 suspected cases have been recorded while 109 have been confirmed and are being treated.

Cerebrospinal Meningitis is the medical term for inflammation of the tissues (meninges) that surround the brain and spinal cord. The inflammation is most commonly caused by a virus or a bacterium, which travels from an infection in another part of the body through the bloodstream to the meninges (brain).

There are two main types of meningitis — the viral and bacterial meningitis

Bacterial meningitis: There are many types of bacteria that can cause bacterial meningitis. The most likely type depends upon the child’s age, history of vaccinations, current or past medical problems. The common causes of bacterial meningitis in older infants and children are Streptococcus pneumonia, Haemophilus influenzae type b (Hib) and Neisseria meningitides. Bacterial meningitis is a medical emergency that must be treated quickly to minimise the risk of serious illness or even death.

Certain factors can increase a child’s risk of developing bacterial meningitis, including recent exposure to someone with bacterial meningitis, recent infection of the ear or sinus infection, travel to areas where bacterial meningitis is common such as sub-Saharan Africa, serious head injury, problems with the immune system, cochlear implants, and certain anatomic abnormalities.

Viral meningitis: The most common cause of viral meningitis is a family of viruses called enterovirus. Other viruses that cause meningitis can be transmitted airborne, by direct contact with an infected animal.

Signs and symptoms

Although bacterial meningitis is usually more severe, the signs and symptoms of bacterial and viral meningitis can be similar.

Newborn: They may develop a fever accompanied by non-specific symptoms (e.g, poor feeding, vomiting, diarrhoea, rash). The infant may have a stiff neck or bulging fontanel (soft spot on the skull) and may be irritable, restless, or lethargic.

Older children: They may develop a sudden fever, headache, nausea, vomiting, confusion, stiff neck, and complain that light bothers their eyes (photophobia). Meningitis can cause seizures, and decreased level of awareness. Certain types of bacterial meningitis may be associated with petechiae and purpura rash.

Diagnosis

Bacterial meningitis is a medical emergency that must be treated promptly. The following tests are generally recommended, and are usually performed in a hospital emergency department:

A blood culture – A sample of blood is cultured in the laboratory to determine if there are bacteria present (normally, no bacteria should be present in the blood). The results of the blood culture can also help determine which antibiotic is best.

Lumbar puncture – During a lumbar puncture, also known as a spinal tap, a clinician uses a needle to remove a sample of spinal fluid from the area around the spinal cord in the low back. Several tests are done on the cerebrospinal fluid to determine if a bacterial infection is present, and if so, which antibiotic treatment is best. The CSF may also be sent for viral cultures and/or molecular tests (called “PCR”) for enteroviruses.

CT scan may be recommended when and where the facility is available.

Treatment

The treatment for meningitis depends upon whether the meningitis is caused by a virus or a bacterium. However, this distinction may not be clear until the culture results are available (usually 48 to 72 hours after they are obtained).

In many cases, children are treated as if they have bacterial meningitis until bacterial meningitis is definitively excluded. The reason for this is that there is a significant risk of serious illness or even death if the child has bacterial meningitis and treatment is delayed for a prolonged period of time.

Bacterial meningitis is a life-threatening illness that requires hospitalisation and treatment with intravenous antibiotics. Depending upon the severity of the illness, the child may also need supportive treatments to aid breathing, oxygen support, maintain blood pressure, prevent excessive bleeding, and keep the child hydrated.

However, even with proper treatment, meningitis can damage the brain and cause long-term complications, including deafness, developmental delay or learning disabilities, spastic or paralysed muscles, coma and seizures. Complications are more common in children who live in developing and endemic regions.

Prevention 

Vaccines: Several routine childhood vaccines reduce the risk of developing bacterial meningitis, including the pneumococcal, meningococcal, and Haemophilus influenzae type b (Hib) vaccines. Vaccines are also available to prevent certain types of viral infections that may cause meningitis or other central nervous system infections, including polio, influenza, varicella, measles and mumps.) Preventive antibiotics are recommended for close contacts of anyone infected with meningococcal infection, even if the contact was previously vaccinated.

Families of children with meningitis should take care of them and avoid becoming infected. This includes washing hands after touching the child or changing diapers and before eating or preparing food. Utensils and cups should not be shared, the child’s mouth should be covered during a cough, and the child should not be kissed on the mouth.

Any parent who suspects that their child could have meningitis should seek medical attention immediately with their child physician. Meningitis affects all ages (the young and elderly).