HEPATITIS B

Hepatitis B infection (HBV)

I will start by explaining what hepatitis means. Literally it means inflammation of the Liver. Hepatitis is therefore a disease characterised by the inflammation of the liver.

I assume we all know what the Liver is and how important it is. For the benefit of those who have forgotten their biology, the liver is a vital organ located on the upper part of the right side of your abdomen. The liver is just one and it serves as the function of the factory of your body. It has loads of very vital roles including the clearing of your blood of toxins, drugs, alcohol etc. It also produces the bile that help in fat digestion, stores glycogen (storage form of glucose) for use when we lack glucose in our blood. It also produces products needed for clotting of blood, among other functions.

What causes of Hepatitis:

Hepatitis is caused by several things but the most common ones are

* Viruses
* alcohol
* drugs like paracetamol, oral contraceptives, non steroidals like ibuprofen among others
* other infections and diseases

For the purposes of this article I will focus on the viral causes.

There are five types of viruses known to cause hepatitis as follows:
Hepatitis A, B,C,D and E viruses.

Hepatitis B and C are the most virulent and dangerous.

For now let me concentrate on Hepatitis B virus (HBV )

Facts about HBV infection

* About 2 billion suffer from it worldwide. This shows how quick this disease spreads
* about 350 million people suffer from the chronic form of the disease known as chronic HBV
* the bad news is that it has no cure
* the good news is that it is preventable
* though it has no cure there are medications available to help the sufferer from progressing to the severe forms.
* it is the 10th leading cause of death worldwide
* it usually takes between 40 days to 160 days for symptoms to develop after exposure to the virus
* Several sufferers show no symptom at all, yet they can still infect others.
* most of the symptoms are non specific and can be mistaken for malaria, flu, typhoid etc.

How is HBV spread

* sexually : both vaginal and anal

* through transfusion of contaminated blood or blood products

* vertical transmission being from a woman to her baby during child birth

* reuse of contaminated needles and syringes

* there are also evidence that it can be passed through kissing and breast feeding.

What is the fate of someone who contacts the virus?

There are different scenarios and some of them are as follows :

* you may show no symptoms and after a few months infection clears completely
* you may show no symptoms but infection stays quiet in the liver . This is known as silent or anicteric hepatitis B infection. Though you don't show symptoms you can infect others.
* you may develop acute hepatitis B infection. What does this mean?
This is when the infection stays in your body from when you contact it to about 3 months.
* this acute hepatitis may gradually clear over the 3 months period and you get well completely or you may develop any or some of the following:

A very severe form of acute hepatitis known as a fulminant liver failure . This means your liver has failed and may require a liver transplant to live or you may die.
Chronic hepatitis which means you have carried this infection for up to 6 months and beyond . This Chronic Hepatitis B infection can also progress to very hopeless conditions like cirrhosis where your liver is scarred or even cancer of the liver known as hepatocellular cancer.

Part 2 to follow, watch out.

Thanks for reading

Dr Chin Akano
26/09/2012

CERVIX CANCER PART 2

CANCER OF THE CERVIX PART 2

In this series we shall be looking at the symptoms of cancer of the cervix

Like I highlighted in the previous article on this topic, cancer of cervix is the second commonest cancer in women and it is a major killer. The good news is that if diagnosed early it can be treated with excellent outcomes. Cervical screening is a good way of identifying cells that will turn into cancer and if detected early these cells can be destroyed so they don't become cancerous.
It is therefore crucial that every woman especially those between 20 and 65 years go for cervical screening ( pap /cervical smear).

What are the symptoms of this killer disease?

It may show no symptom until it becomes advanced at which stage it may be incurable. It is therefore essential that early diagnosis is made, hence the need to go for cervical screening.

There are however some symptoms that are associated with this disease . These include the following:

• The commonest symptom is abnormal vaginal bleeding. By this I mean vaginal bleeding that is not the normal menstrual bleeding.

Examples are

* coital and post-coital bleeding: This is vaginal bleeding during and after sexual intercourse.

* Intermenstrual bleeding:
This is bleeding in between your normal periods

* Post menopausal bleeding
This is bleeding in women who have attained menopause ( means they have normally stopped seeing their periods)

* Contact bleeding:
This is bleeding for example while you are douching or when your vagina is being examined with fingers or speculum by your doctor or nurse.

Before I become a scare monger, I must stress that not all cases of abnormal vaginal bleeding is due to cancer of the cervix. There are several other causes.

Apart from abnormal vaginal bleeding, other symptoms of cervical cancer are

• Painful sex (dyspareunia):
I am also not saying that every woman that experiences discomfort or pain during sex has cancer of the cervix. As always there are other possible causes of painful sex ranging from simple reasons lack of sexual lubrication in the woman, the male partner having an oversized penis, to vaginal infection and so on and so forth.

• Vaginal discharge which is often foul smelling :

Like we know there are other causes of offensive vaginal discharge like bacterial vaginosis (BV) etc.

• Pelvic pain

• Dysuria ( pain or burning sensation during urination)

My advice is that any woman who experiences abnormal vaginal bleeding , vaginal discharge etc must go and see her doctor as a matter of urgency.

Let me also quickly add that at advanced stages cancer of the cervix may show other symptoms especially when it has spread to other organs. Some of those symptoms include

• Loss of appetite
• Weight loss
• Tiredness/lethargy
• Constipation
• Bone pain
• Change in bowel and bladder habits
• Leg swelling
• Passing blood in urine (haematuria)
• Urinary incontinence
• Several others

Watch out for a follow up article discussing how to diagnose cancer of the cervix, treatment etc.

Thanks for reading
Dr Chin Akano

THE ROLE OF MULTIPLE SEX PARTNER IN CERVICAL CANCER

Contacting Cancer through sexual intercourse!!!!!

Do women know that they can develop a cancer through sexual intercourse?

If they are not aware, cervical cancer ( cancer of the cervix) can develop as a result of a sexually transmitted disease known as human papilloma virus. ( HPV).

This virus is passed by men to their female sex partners but the irony is that the male carrier usually show no symptom and therefore not even aware that they are harbouring such a disease.

Before I go any further let me refresh our memory that the cervix is the neck of the womb. It is the area linking the vagina and the womb ( uterus).

Cancer of the cervix is the second commonest cancer in women ( breast cancer is the commonest) and it is quite deadly.

Is there hope for the women?

Yes there is hope. Every sexually active woman should go for a cervical smear , often known as pap smear.

What is this?

This is a screening test that detects changes in the cervix. It is not a test for cancer but one that can reveal if your cervix has undergone changes that can lead to cancer.

If these changes are detected early, they can be treated completely and successfully preventing the development of the cancer.

How is this smear done?

Your doctor or nurse will pass an instrument called speculum through your vagina to reveal the cervix and use another known as spatula to sweep around your cervix and collect cells . These cells are checked out in the laboratory for pre-cancerous cells.

Advanced countries like UK have a robust cervical screening programme for women between the ages of 25 and 64 years where they are invited for screening every 3 to 5 years, depending on their age.
In the UK this programme has been quite successful in reducing the incidence of cervical cancer.
There has also been plan to involve also women 20 years and above now in this screening programme.

So the message is that every woman within this age category of 20 to 64 years should go for a cervical smear immediately and if the results are normal, to repeat it every 3 to 5 years.

If however the result is abnormal they should see a good gynaecologist or oncologist immediately.

Apart from the cervical smear, there is also available vaccination against this virus (HPV). I am therefore advising young women who are sexually active to take advantage of this vaccination to prevent them contracting this infection that can cause cancer of the cervix.

Of course another advice is to avoid multiple sexual partners and most importantly always use a condom.

More on cancer of the cervix to follow.

Thanks for reading

Dr Chin Akano

BREAST CANCER PART 2

BREAST CANCER PART 2

This is a continuation of my series on Breast Cancer. Like we already know it is the commonest cancer in women and the commonest cause of cancer death in women.

We also already know that both men and women can suffer from this dreaded disease but it is 100 times commoner in women. Furthermore we have been told that breast cancer at the early stage may not have symptoms and the commonest symptom is painless lump in the breast. Other symptoms include pain in the breast, nipple discharge, lump in the armpit, nipple changes, rashes, ulcer etc.

I have also told you in part 1 that anyone who has had cancer in one breast has an extremely high risk of developing it in the other breast. Similarly those with a close family history of breast cancer, those who have had cancer in other parts of their body, obese people, smokers etc are at high risk of developing breast cancer.

In this part i shall be looking at how to detect breast cancer.

It is so important to detect breast cancer early because the earlier it is detected and treated, the better the outcome.

So how can Breast Cancer be detected???

* I advise people to examine their breasts regularly for lumps, rashes, ulcer, pain and some changes. If you are twenty and above, i advise that you become familiar with how your breasts feel and look normally, so that you can easily tell when there are changes.

* Report these changes to your doctor immediately

* Screening of the breast using a special x-ray equipment called mammogram detects early stages of breast cancer. In advanced world like UK, there is a screening programme for all women between 50 and 70 years where they are invited for a free mammography. If you are in Nigeria and you belong to this age group or have a significant risk please find a good centre and undergo a mammography.

* MRI :
The breast can also be screened for early stages of cancer using an MRI. I believe this is a lot more expensive than mammography.

Having discussed how to screen or detect early cancers, i will now look into how to diagnose breast cancer.

If for example you notice a breast changes and you go see your doctor, depending in the part of the world you live, i expect that you will be referred to see a breast specialist or cancer specialist who should undertake the following:

a) Talk to you and take a history of your symptoms

b)Examine your breasts including your arm pits and your lymph node areas

c) Conduct the following diagnostic procedures as follows:

* mammogram

* Breast ultrasound ( ultrasound of the breast)

* Fine needle aspiration ( a needle is used by a doctor to withdraw some cells from the breast lump into a syringe under ultrasound guidance and this sample is sent to the lab to check for cancer)

* biopsy ( a small part of the lump or tissue is removed surgically or by suction or other means and taken to the lab for examination by the pathologist)

* Lymph node ultrasound and fine needle aspiration ( ultrasound of any suspicious lymph node and needle aspiration like as described above)

Following these procedures the doctor will be able to confirm for sure if actually you are suffering from breast cancer.


One big question is this: Are all breast lumps or breast pain or rash etc breast cancer?? The answer is a capital NO. There are other possible causes which I shall be discussing in part 3 of this series.

Hope you learned a thing or two from this. Thanks for reading

Dr Chin Akano

BREAST CANCER PART 1 With Dr. Chin Akano

BREAST CANCER PART 1

In this series i shall be looking at the breast cancer, some facts about it, risk factors, signs and symptoms, prevention, diagnosis, treatment and prognosis

I will start by saying that breast cancer is the cancer originating from breast tissue and is the commonest cancer in women and commonest cause of cancer death in women as well.

WHO CAN SUFFER FROM BREAST CANCER??

Both men and women can suffer from breast cancer, though it is 100 times commoner in women.
However due to delay in diagnosis of breast cancer in men, the outcome is a lot poorer in men than in women.

Furthermore any body who has reached puberty can suffer from breast cancer but it is commoner in women over 50 years and also kills more women over that age.

WHAT CAUSES BREAST CANCER ?

No one knows what causes it but there are certain factors that put someone at a higher risk of developing it. These are known as the risk factors and among them are:

* If a close relative has suffered from cancer of the breast

* If you have cancer in one breast already

* if you are a woman

* If you have developed any other cancer in any other part of your body

* If you are a smoker

* If you are obese

* If you are over 50 years

* Those who refused to breast feed

* Commoner in white women

* Those taking Hormone replacement therapy (HRT)

* Over exposure to radiation eg during x-rays

* Excessive alcohol consumption

* Several others like taking of combined pills ( oral contraceptive, early menstruation, late menopause )

HOW CAN BREAST CANCER BE RECOGNISED?


Please note that you may have no symptom at all especially at the early stage of the cancer

If you do have symptoms yy far the commonest symptom is painless lump in the breast. This lump does not disappear after your period in women.

Other possible symptoms are as follows:

* Pain in the breast

* Discharge from the nipple : the discharge could be clear, bloody and coloured.

* swelling in the armpit

* dimpling of the nipple

* nipple retraction

* nipple redness

* Rash on or around the nipple

* Itching of the nipple

*Ulcer of the nipple

*Burning sensation to the nipple

* change in colour and size of breast [s]

Part 2 to follow: Watch out

Thanks for reading


Dr Chin Akano

STROKE PART 1 by Dr. Chin Akano

STROKE Part 1

Today we shall be discussing a very serious medical condition known as stroke. Like we already know stroke is a major killer and one of the major causes of disability in the population.

What is stroke?

Stroke is that medical emergency used to be known as a Cerebro-Vascular accident (CVA) . The term CVA has now being dropped for STROKE. Stroke occurs when the blood supply to the brain or part of the brain is restricted or cut off . Like all organs, the brain needs oxygen and nutrients provided by blood to function properly and when the blood supply is compromised the brain cells begin to die eventually leading to brain damage and eventually brain death if the compromise is not arrested. The brain tissue ceases to function if deprived of oxygen for more than 60 to 90 seconds and after approximately three hours it will suffer irreversible injury possibly leading to death of the tissue. This death of the tissue is known as infarction.

If a blood vessel supplying blood and oxygen to the brain is blocked , for example by a blood clot preventing any blood reaching a part of the brain a stroke will occur. This type of stroke is known as ischaemic stroke and this constitutes more than 80% of all cases of stroke. There is also the other type of stoke which constitutes about 20% of all cases of stroke which occurs when a blood vessel is damaged and blood leaks out into the brain tissue. This is known as the haemorrhagic stroke

There are other important facts about stroke that i want us to be aware of as follows:

Prompt treatment is crucial and essential

The sooner a person receives treatment for a stroke, the less damage is likely to happen.

Stroke is currently the second leading cause of death in the western world ranking after heart disease

It causes 10% of deaths worldwide.

Evidence shows that stroke will soon become the commonest cause of death worldwide

It is the greatest single cause of severe disability in most countries of the world
Anybody can suffer a stroke irrespective of age, sex or race

The incidence of stroke increases rapidly from 30 years of age
95% of strokes occur in people age 45 and older
Two-thirds of strokes occur in those over the age of 65
A person's risk of dying if he or she does have a stroke also increases with age.
if you have a first-degree relative who had a stroke at an early age (under 50) you're at higher risk
Having had a stroke in the past greatly increases one's risk of future strokes.
Men are 25% more likely to suffer strokes than women
60% of deaths from stroke occur in women.
The risk of stroke is higher in Africans, Carribeans and Asians


Moving forward, let us look at who is at risk of developing stroke.

* Those suffering from blood pressure (hypertension) are more liable to developing stroke. Infact hypertension causes about 35-50% cases of strokes
* Smokers are also at increased risk of developing stroke
* Those suffering from Diabetes Mellitus (Diabetes) have 2-3 fold increased risk of stroke.
* Those whose cholesterol level is high has a two fold risk of developing stroke.
* Those who have problem with their heart rhythm problem known as Atrial Fibrillation (AF) have a very high risk of developing stroke
* Those suffering from Sickle cell disease also have are at risk of developing stroke. About 10-15% of children with this disease suffer stroke.
* childbirth also puts women at risk of developing stroke
*Menopause also puts women at risk of developing stroke, the risk is increased in those on hormonal replacement therapy (HRT)
* Those who have suffered a previous stroke or transient ischaemic attack (TIA) are also more liable to developing stroke
* Old Age-- The older one gets the more liable he/she is to developing stroke.

How can stroke be recognised? By this i mean the signs and symptoms of stroke.
The functions of the different parts of the body are controlled by different parts of the brain, so the symptoms vary depending on

* The part of the brain affected
* The size of the brain affected
* Duration in which the brain part is starved of oxygen and blood.

To be continued……

Thanks for reading

Dr Chin Akano

DEPRESSION PART 1 By Dr. Chin Akano

DEPRESSION PART 1

This series shall be looking at the most common psychiatric illness of our time, Depression. This illness is often so serious that a lot of people suffering from it have a lot of physical and psychiatric symptoms. This disease is also so important to talk about because it is the commonest cause of suicide worldwide. About 1 million people commit suicide every year so this disease is an epidemic. Apart from being the most common mental illness, depression is ranked as the fourth among all diseases by WHO.

In this part 1, i shall be explaining what depression is, the causes, the risk factors and the symptoms.

I will begin by asking us who we think can suffer from depression? is it the disease of only women, or the elderly? No, depression can affect men, women and adolescents and occasionally children. However it is commoner in women and those aged between 30 and 40 years followed by those aged between 50 and 60 years.

The next thing is to know what causes depression. Do we know how people become depressed? The answer is that the exact cause of depression is not known, however some experts believe that depression is caused by a combination of biological, psychological, and social factors. Though no one knows the exact cause, there are however some factors and conditions that make some people more liable to developing depression than others. These are known as the RISK FACTORS.

So what are these risk factors for depression?

▪ Loneliness

▪ Lack of social support

▪ Recent stressful life experiences like bereavement, rape, serious accidents,
redundancy etc

▪ Family history of depression

▪ Marital or relationship problems

▪ Financial strain

▪ Early childhood trauma or abuse

▪ Alcohol or drug abuse

▪ Unemployment or underemployment

▪ Health problems or chronic pain

▪ female gender

▪ past history of depression

▪ other mental health problems like dementia



What are the symptoms of depression?

I like to say at this point that feeling down from time to time is a normal part of life and is not classed as depression. This is just temporary blues. Similarly it is normal for one to be sad from time to time that is also not depression.

For someone to be depressed, emptiness and despair must take hold of the person and refuse to go away making it very difficult for them to function and enjoy like they once did.

Hobbies and friends don’t interest them like they used to; they are exhausted all the time; and just getting through the day can be overwhelming and tasking to them.

For one to be diagnosed with depression: there must be at least these 2 cardinal symptoms
* The person must have a low mood for most of the times for at least 2 weeks
* The person must loose interest in things he used to enjoy. This again must be for most of the times for at least 2 weeks.
These symptoms should have been present persistently for at least 2 weeks and must have caused clinically significant distress and impairment for one to be said to be clinically depressed. It is also important to mention that these above symptoms must not be due to physical or organic reasons.
In addition to the above 2 cardinal symptoms, depressed patients may experience some or all of the following symptoms:
* Feeling tired so easily
* Appetite problems usually poor appetite but sometimes over eating
* Loss of concentration
* Loss of libido
* Erectile dysfunction in men
* sleep problems usually disturbed sleep. The classical pattern is early morning wakefulness where the patient wakes up quite early in the morning after struggling to fall asleep and then staying awake till morning. However some depressed patients may also suffer from over sleeping (hypersomnia)

* feeling hopeless
* feeling helpless
* Some may be agitated while others may become so slow and sluggish
* Some are unable to control their negative thoughts, no matter how much they try
*Some are quite irritable, short-tempered or more aggressive than usual
* Some drink more alcohol than normal and often engage in reckless behaviour.
* Some believe that life is not worth living
* Having a lot of physical complaints such as headaches, back pain, aching muscles, and stomach pain.
▪ * Having very strong feelings of worthlessness or guilt criticizing themselves for perceived faults and mistakes.

* Some feel so miserable and sad

*some feel as if even the smallest tasks are sometimes impossible.

▪ *Some don't want to see people or are scared to be left alone. Social activity may feel hard or impossible.

▪ *Some find it difficult to think clearly.

▪ *Some feel that they are a burden to others.

▪ *Some indulge in self harm

▪ * Some take their lives (Completed suicide)


▪ Some signs that can tell you that one is depressed:

* Looking sad

* Unkempt

* dishevelled

* Always blaming themselves

* feeling that they are the worst

* Always lacking confidence

* avoiding eye contacts

* Talks in low tone and frequency

* Slow movements

* drinking a lot of alcohol to feel better

* Not sleeping at night or sleeping a lot

* Always tired

* isolating themselves

Stay tuned for Part 2, coming your way shortly

Thanks

INFERTILITY PART 2 By Dr. Chin Akano

WHAT CAUSES INFERTILITY IN WOMEN


Let us first discuss some basic facts that will help us understand this topic.

For a woman to think of conceiving, first she needs to have normal reproductive anatomy.

What do I mean?

I am trying to say that she needs to be born with the following:

* a vagina ( Note that some women are born without one while some have issues with theirs)

* Womb (uterus)

* Fallopian tubes (tubes) left and right (2)

* Ovary (ovaries) left and right (2)

Even when she is born with all of these organs, they have to be normal and functional.

In a nutshell any problem with vagina, or womb or tubes or ovaries could lead to infertility.

Let me give some examples

* Vagina: absent vagina, or blocked vagina etc would lead to infertility

* Tubes: excessively long or blocked or diseased tubes could lead to infertility

* Ovaries: ovaries riddled with cysts, or not producing eggs or diseased are likely to lead to infertility
* Uterus: abnormally shaped or narrowed womb or one with abnormal linings or muscles or riddled with fibroids, masses or even diseased may lead to infertility.

Let me now go ahead and explain the importance of these reproductive organs


Vagina: This is the organ necessary for sexual intercourse to occur. Following intercourse the man deposits semen into the vagina and it swims through the vagina to the fallopian tube.

What is semen?
This is the fluid deposited by a man following ejaculation or masturbation. It contains spermatozoa (sperm), prostatic fluid, pre-ejaculate, fructose, amino acid , etc. Lesson to take away is that a man may produce semen without sperm in it and his semen will therefore be unable to fertilize the eggs ( ova). That a man ejaculated and produced semen does not mean the semen contains sperm or potent or enough sperm to fertilise the egg(s)
So for a man’s semen to be fertile, it must contact spermatozoa and other necessary components.

After semen is deposited in the vagina, the sperm swims through and gets to the fallopian tube and meet with the eggs waiting there and then fertilization occurs and an embryo is formed. This embryo then undergoes all necessary changes in the womb to become the baby we wish for.

Ovaries:

Every woman should have 2 ovaries, one on the left and another on the right. It is the ovary that produces the eggs (ova) and this happens once every month. This process is known as ovulation.
Both ovaries take their turn to produce eggs every month. So a woman does not need both ovaries to conceive but for obvious reason having both ovaries increase your chance of conceiving.
Ovulation usually takes place on the 14th day of a woman’s cycle if she has a regular cycle of 28 days. For those with cycles longer or irregular, it is difficult to time their ovulation.


Many women know when they ovulate as their cycle is like a clock and therefore easily predictable, however many women have irregular cycles and unpredictable ovulation.

So how can a woman know that she is ovulating?

There are a few features that can help a woman know when she is ovulating. They include the following

* marginal rise in base body temperature

* some vaginal discharge

* sharp one sided abdominal pain

* increased craving to have sex

* abdominal bloating

* breast engorgement among others



Fallopian tubes ( 2 in number)

After ovulation, egg(s) also known as ovum(ova) are released and they find their way to the fallopian tube to be fertilized by a sperm (champion sperm).

After ovulation, the next thing is fertilisation. What is this?

This is the process where a sperm and egg join together to form an embryo.

Where does it take place? In the fallopian tube

So the gist is that after ovulation the eggs move from the ovaries to the fallopian tube while the sperm migrates from the vagina to the tube as well to fuse with the egg to form the baby.

After fertilization in the fallopian tube, the fertilized egg or embryo stays there for a few days and then gradually finds its way into the womb ( uterus). If for any reason the embryo is not able to find its way into the womb, the baby starts developing in the tube. This is known as ectopic pregnancy. As the tube is not suited to accommodate the growing baby, after a while the tube burst causing some of the fatal emergencies associated with ectopic pregnancy.
In essence ectopic pregnancy means a pregnancy developing outside the womb. Please note that it is not only in the fallopian tube that ectopic pregnancy can occur, it can also occur in the ovaries, the cervix and even the abdomen.

Womb (Uterus)

When the fertilized egg (embryo) succeeds to get into the womb, it then gets attached to the lining of the womb. This process is known as implantation.
After implantation the embryo stays in the womb and undergo all necessary changes until the baby is born.

In conclusion for a woman to be fertile, first she has to anatomically normal and all the necessary reproductive organs have to be functional and normal.

Furthermore anything that affects the reproductive cycle ranging from depositing of the semen in the vagina, to the migration of the sperm to the fallopian tube, to ovulation, to migration of eggs to the tube, to fertilization, to movement of the fertilized egg to the womb, to implantation of the fertilized egg to the development of the baby in the womb would lead to infertility in a woman.

INFERTILITY PART 1 by Dr. Chin

INFERTILITY PART 1

What does infertility mean? In simple terms infertility is defined as inability to make a baby.

Both a man and woman can be infertile. In a third of the cases of infertility , the problem is from the woman, another third is from the man or both may have a problem or the problem may be unknown.

Infertility is very common and it is seen in about 1 in every 7 couples worldwide.

At the moment let us focus on infertility in women:

A woman under 35 years of age would be said to be infertile if she is unable to conceive even though she is having regular unprotected sex for up to 12 months and has no known problem with her reproductive system .
For women older than 35 years, they will be deemed infertile if they are unable to conceive after 6 months of regular unprotected sex rather than 12 months in younger women.
For women over 35 years, time is of essence so after 6 months she needs to be investigated and treatment started if necessary.
A woman can also be described as being sub fertile if she has tried unsuccessfully to have a child after a period less than the prescribed 12 months in under 35 year olds and less than 6 months in older women. This means that she is less fertile than women of her age.

In the UK infertility is defined as a failure to conceive after regular unprotected sexual intercourse for 2 years in the absence of known reproductive pathology. So a woman will not be entitled to free NHS investigation for infertility unless they have been having regular unprotected sexual intercourse for 2 years or more and yet did not conceive.

What does regular sexual intercourse mean?

It means having sexual intercourse at least every 2-3 days.

Irrespective of how infertility is defined, it is usually grouped into 2 categories as follows:

Primary infertility is when a woman has never conceived ( become pregnant) after at least 1 year of unprotected sex (intercourse). while

Secondary infertility refers to when a woman has been pregnant at least once, but never again.

Some important facts about infertility:

* A woman is at the peak of her fertility in her earlier 20s
* At age 35 ( and especially 40), the chances of getting pregnant drops considerably
* Adequate sexual intercourse is necessary for pregnancy to occur
* For a healthy woman under the age of 30 who has sex regularly, the chance of getting pregnant is about 25 - 30% per month.
* A woman can increase her chances of becoming pregnant each month by having sex at least every 3 days before and during ovulation.
* It is especially important to do so 72 hours before ovulation begins.
* Note that ovulation occurs about 2 weeks before the next menstrual cycle (period) starts.
*If a woman sees her period every 28 days, she should have sex at least every 3 days between the 10th and 18th day after the period starts.
* Also note that sperm can survive in the female reproductive tract for up to 72 hours (3 days) after it was deposited
* An egg (ovum) can survive and be fertilized for up to 24 hours after being released from the ovaries ( ovulation).
* 84% of women who are less than 35 years and have regular unprotected intercourse ( every 2-3 days) will become pregnant within 12 months
* 92% of them will get pregnant within 2 years of having regular unprotected sex
* For women older than 35 years 94% will get pregnant after 3 years of regular unprotected sex while those aged 38, only 77% will do so
*For couples who have been trying to conceive for more than three years without success, the likelihood of pregnancy occurring within the next year is 25% or less.

What is required for a woman to get pregnant

* her ovaries must be able to produce eggs or ova (ovulation)
* After the ovulation, the eggs must be able to move to the tube where they get fertilised by sperm
* When the egg is fertilised to form the embryo, the embryo should be able to move into the womb. If not then the pregnancy becomes ectopic one
* when the embryo ( fertilised egg) gets into the womb, it must be able to attach to the lining of the womb (implantation) *
When it implants, it must be able to survive
Failure of any of these stages will lead to inability of the woman to be pregnant or stay pregnant.

HIV/AIDS PART 2 BY DR. CHIN AKANO

SIGNS AND SYMPTOMS OF HIV INFECTION

Before i discuss this in detail, i will like to state that HIV infected individuals may have only a few or no symptom at all for several years even up to 20 years before they show any. So it is advisable for individuals to run routine HIV tests to ascertain their status.
This is the wise thing to do because the earlier one discovers that they are infected, the sooner they start treatment and better the outcome.
HIV infection goes through three stages in an individual between when they contact the infection to when they develop the full blown late or advanced stage of the infection otherwise referred to as AIDS.

These stages are as follows:

a] Acute infection
b] Latent phase
c] AIDS

* Acute infection phase
This is the phase immediately after exposure to the HIV infection. Often people have no symptoms at all till about 2-4 weeks following the exposure often . This is often referred to as sero-conversion.
Then they may experience symptoms which appear like flu illness or can even be mistaken for malaria or typhoid fever. When these symptoms develop, they may last for several weeks before they disappear and the individual becomes free of them.
The patient is much more infectious during this period and as such it is important that the disease is diagnosed at this stage.
The message is that if any one comes down with the under listed symptoms, it is advisable for them to take an HIV test because this stage is when the person is highly infectious and also for the person to seek correct management

The symptoms are usually as follows:

High temperature (fever)
sore throat (pharyngitis)
Rashes in the body and face
muscle and joint pain
feeling tired and generally unwell
mouth sores
sores in the oesophagus [gullet]
swollen lymph glands (lymphadenopathy)
headache
nausea
vomiting
weight loss
thrush



* LATENCY PHASE or chronic or quiet phase

Following the acute phase, the individual develops a strong immunity against the HIV infection and this leads to the development of this quiet phase where the individual may have only very few or no symptoms at all. This can last anywhere from two weeks to even over 20 years depending on the individual.
This stage is dangerous as the sufferer may not know that he/she is carrying this infection and could transmit it to others.
The common symptom at this stage is lymph glands become persistently swollen. It is so important to identify the HIV infection at this stage because initiation of anti-retroviral treatment significantly improves survival

* Late or advanced stage formerly known as AIDS

AIDS, the final stage of HIV infection when the immunity is almost fully compromised. At this stage the CD4+ T cell numbers decline below a critical level of 200 cells per µL.
At this stage the individual becomes quite ill and comes down with various infections, cancers and other diseases.
Some of the common diseases that the infected individual suffer at this stage are as follows:

unexplained weight loss
recurrent respiratory tract infections like throat infection (pharyngitis) sinus infections, chronic cough, ear infection (otitis media), chest infections
mouth/tongue ulcers
oesophageal ulcers
Skin rashes
thrush [ candidiasis eg vaginal, oral ]
staph aureus, some streptococcal infection
Very serious and fatal pneumonia caused by fungus pneumocystis carinii pneumonia
mycobacterium tuberculosis (TB)
Shingles
Herpes infections
Certain cancers like Kaposi's sarcoma and some lymphomas

Watch out for part 2

Should pregnant women go for scan? (Part II) by Dr. Chin Akano.

In part 1 Isaid that in normal pregnancies women are expected to undertake only 2 scan sessions being

;

• dating or booking scan at between 6 to 15 weeks 
and 
anomaly scan at 20-22 weeks



In this part I shall be talking about reasons why a pregnant woman may be asked to undertake more than 2 scan sessions.

 Like I said when there are problems in the pregnancy, the woman may undergo further ultrasound scans. Some of the possible reasons for this are as follows:



• Suspected ectopic pregnancy



Ectopic pregnancy is any pregnancy growing outside the uterus (womb).
 Without ultrasound there is no way it can be diagnosed with precision. If a woman is pregnant confirmed with a urine and blood test and then suddenly develops a low abdominal pain, bleeding through the vagina or feeling faint among other symptoms, they are referred for scan to rule out ectopic pregnancy. It is a very serious condition that needs to be diagnosed promptly and with precision.



• Miscarriages
 

It is only with a scan that a Doctor can tell a woman with absoluteness that she has miscarried. Your doctor may suspect that a you are miscarrying based on symptoms but confirmation must be through an ultrasound scan. It is even more crucial for those women who suffer missed miscarriage where there baby has died in the womb. There is no other way of confirming this except with an ultrasound scan.



• Any case of bleeding and severe abdominal pain in pregnancy


 It is through scan that a doctor can confirm if the bleeding or pain in pregnancy is related to the pregnancy or not



• Elderly pregnant women to check for downs syndrome and other genetic abnormalities in their babies


We already know that the older a woman is, the more likely she is to give birth to children with downs syndrome and other genetic disorders. In good centres, a scan known as Nuchal Translucency is done around 15 weeks to check if the baby is likely to have these disorders.

• 
Growth scan


If the baby seems not be to growing well or bigger than expected, a growth scan is done to confirm the growth of the foetus (baby). There is no need to undertake this in normally progressing pregnancy



• Placental localisation

I am sure most of us know about placenta often referred to as the after birth. This organ is for the nourishment of the baby while in the womb. Sometimes it lies in a position that obstructs the birth canal and prevent normal vaginal delivery. This is known as placenta praevia. So a scan is done to check the location of the placenta .If the placenta is found to be this low lying, the woman will be planned for a routine Caesarian Section (CS) . If this diagnosis is not known before the woman goes in labour, of course the labour will be obstructed, the baby can't come out through the vagina and an emergency CS is called for. This obviously may affect the well-being of both the mother and baby



• Foetal (fetal) distress


This is when the baby is in distress in the womb and in serious danger. In addition to other tests, an ultrasound scan with a doppler facility can correctly diagnose the cause of the distress



• The presentation and lie of the baby


The obstetrician and midwife need to know the presentation and lie of the baby in the womb. Presentation means how the baby is coming towards the birth canal. If the baby is coming with the head, this is normal and it is known as cephalic presentation. Sometimes the baby comes with the buttocks,this is known as breech presentation. Women are unable to deliver a baby with breech presentation through the vagina without help or intervention. In some cases the baby even presents with the legs etc .
So knowing how the baby is presenting is crucial in planning how the woman will deliver her baby.
The lie on the other hand is how the baby is lying in the womb. The normal lie is what we call longitudinal lie where the long axis of baby is longitudinal and parallel to that of the mother.Sometimes babies lie in awkward positions like obliquely, transversely etc. The obstetrician and midwife need this information to plan the delivery for the woman



• Fetal well being scan for women with serious medical problems


Women who suffer from serious medical conditions that can affect their babies and impact on planning of their delivery eg diabetes, hypertension in pregnancy, Pre- ecclampsia etc would need to have regular scans as prescribed by their obstetrician to assess the well being and growth of the baby



• What of the gender of the baby?

Ideally this is not a reason for a scan since there is no difference in the outcome of the pregnancy and planning for delivery for different sexes.However some women want to know the gender of their baby(babies) for whatever reason. It is often possible to confirm this from about 15 weeks of pregnancy and beyond. It must be emphasized that it is not always possible to see the gender of the baby and it is therefore subject to errors at times. 




Dr Chin Akano

Should pregnant women go for scan? Find out in this well written article titled Ultrasound by Dr. Chin Akano.

ULTRASOUND

Today's topic is about ultrasound scan for pregnant women. I want to explain what ultrasound is, how it works, the safety, why and when it should be done and also to possibly correct some myths about it.



WHAT DOES ULTRASOUND MEAN?



Ultrasound is a sound of high frequency that one cannot hear and is emitted and received by the special machine known as ultrasound machine.These sound waves create images of organs and structures inside your body which the scan machine picks up. Ultrasound is used for both diagnosis and treatment.In diagnosis, it is used in various spheres of medicine including obstetrics, gynaecology, surgical, medical, foetal (new born babies), musculo-skeletal, cardiac, neurological etc etc.
Today i shall focus on obstetric scans which applies to pregnant women only.


WHAT IS REQUIRED FOR THE PROCEDURE:


* an air conditioned room to reduce heating from the machine
* an ultrasound machine
* a couch where the woman will lie
* a gel 
* a light dimmer to dim the light before the procedure takes place
* Paper towels to clean the woman after the procedure and also to protect her clothings from being soiled by the gel



WHAT IS THE USE OF ULTRASOUND IN PREGNANCY?



Ultrasound is used in pregnancy to monitor the baby for well being and to plan the pregnancy . It is not used for diagnosing pregnancy . Diagnosis of pregnancy is by either urine or blood test. It is only when one has confirmed that they are pregnant that they go for scan to check out their babies.



WHEN WAS ULTRASOUND FIRST USED IN PREGNANCY MONITORING?


Early 1960s and since then it has been improved and remodelled.

IS IT SAFE?
Yes ultrasound scan is largely safe for the mother and baby. However there may be a little rise in temperature known as heating effect to the baby especially when the mother is running a temperature or when doppler scan is being used. Therefore it is advisable for pregnant women as much as possible to avoid ultrasound scan when running a temperature (fever) or for the operator not to use the doppler for a very long time on the baby.

TYPES OF SCANS IN PREGNANCY

In pregnancy a woman can be scanned in two ways as follows:
* Transabdominal scan where the procedure is done on the abdomen . This is shortened as TA
* Trans-vaginal scan where it is done through the vagina shortened as TV

Does one type have an advantage over another?
Yes TV has some advantage over TA in early pregnancies. In TV, the ultrasound probe is inserted into the vagina to release and receive ultrasound beams. So since the vagina is close to the womb and other reproductive organs, the images produced are clearer than a TA where the beam has to pass through skin, fat, muscles etc before getting to the reproductive organs. So the image seen via a TV scan is more optimum and clearer than one seen via a TA scan.
TV is therefore better than TA in early pregnancies for dating (booking) the pregnancy, in diagnosing miscarriages, ectopic pregnancies and other early pregnancy problems. It is also better in non pregnant women for gynaecological diagnosis.
However TV is not advised in virgins for obvious reasons and some women do find it unpleasant.



DOES A WOMAN NEED TO DRINK WATER BEFORE A SCAN?


In the first instance, let us understand why pregnant women are sometimes asked to drink water before being scanned. It is not to fill up her stomach but to fill up her bladder with urine.
Why does the bladder need to be filled up?
A full bladder is necessary to push the womb out of the pelvis to prevent shadows from pelvic bones. If not these shadows will prevent the visualisation of images. A full bladder also acts a window for proper visualisation of the ultrasound images
Do all pregnant women going for a scan need a full bladder?
Answer is capital NO
For a TV scan, the bladder must be completely empty. So the woman needs to empty her bladder before being scanned because urine in the bladder will affect the image quality.
For an abdominal scan in pregnancy (TA), a full bladder is not necessary in most of the cases.
A full bladder is only necessary:
1) if the pregnancy is still quite early or young. I mean pregnancies younger than about 13 weeks. After that the woman does not need a full bladder to be scanned.
2) If the reason for the scan is to check the location or position of the placenta (after birth)
In all other cases, the woman does not need to drink water or have a full bladder before being scanned.



IS ULTRASOUND SCANNING A MUST IN PREGNANCY?


Absolute yes. Sometimes i wonder how obstetricians and midwifes coped before the advent of ultrasound in diagnosis.



WHAT ARE THE REASONS FOR ULTRASOUND SCANNING IN PREGNANCY?


In normal pregnancies, the woman is expected to be scanned only twice.
When?
1) when dating or booking the pregnancy
This means assigning an age to the pregnancy known as gestational age and also estimating date of delivery known as expected date of delivery (EDD). This is known as a dating or booking scan
When should this be done?
Between 6 weeks and 15 weeks of pregnancy. Beyond 15 weeks, the dating becomes unreliable.
2) when checking the baby for anomalies or abnormalities. This is known as anomaly scan. This is a very important scan because this is when any physical abnormality in the baby can be diagnosed.
When should this be done?
This scan is done only when the baby is fully formed and the organs and parts are fully developed. This is between 20-22 weeks
. In essence for every pregnant woman, only two scans are necessary if pregnancy is normal. That is
* dating (booking)
* anomaly scan

. Dr Chin Akano

Dr Chin Akano

Dr Chin Akano is from Nkwerre Town in Nkwerre LGA of Imo state. He bagged a bachelors degree of medicine and surgery (MBBS) from the University of Benin, Benin City Nigeria.
He did his one year housemanship at the University of Port Harcourt Teaching Hospital Port Harcourt.

Subsequently he worked at the Ponyx Hospital, Port Harcourt as a resident doctor for several years before he relocated to the United Kingdom for further training.

He joined the Mid Glamorgan Psychiatry  Rotation training and also enrolled at the Cardiff University for an MSc in Psychiatry.

Subsequently he had post graduate training in General Practice ( family medicine) and  qualified in 2005.


He also undertook training as a medico-legal medicine and after qualification acted as a an expert witness and prepared several reports for the Royal Court of Justice for several years.


He is currently undertaking a MSc programme in Ultrasound diagnostics ( O&G) at the Cardiff University, UK.


He has attended about a hundred courses/seminars and conferences, made several presentations and written several articles and publications
He is a member of the Royal College of GP (RCGP) and British Medical Association (BMA)
In his spare time, he gets involved with humanitarian, charity and philantropic services
 

Dr. Chin is our in-house doctor & will be available Tuesdays to attend to our health matters. Please feel free to direct your questions/comments to abiapost@gmail.com and be rest assured he will answer them all professionally.