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SICKLE CELL DISEASE AND COVID-19

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“What do I need to do (or know) as a person with Sickle cell disease?” The enquirer is health care student. In response I came across nice piece written by Nitin et al published in the Pan African Medical Journal (Vol 36, May -Aug 2020). The World Health Organization (WHO) has identified sickle cell disease (SCD) as a major concern of public health significance. It has been estimated that around 5% of the global population carry Sickle Cell Trait genes. About two-thirds of the sickle cell disease patients of the global burden reside in sub-Saharan Africa. COVID-19 Pandemic caused by Corona virus 2 (SARS COV2) is having a devastating effect on socioeconomic and health indicators in counties worldwide. The additional financial burden of supporting health care management system in tackling COVID-19 impact at the same time preventing mortality rate of COVID-19 deaths is a matter of great concern to all.

The pathogenesis of the sickle cell disease is attributed to the polymerization of the deoxygenated haemoglobin S(HbS). The polymerization leads to alteration in the normal biconcave shape of the red blood cells making them rigid and more prone for intravascular haemolysis. As a consequence of repeated hypoxia driven polymerization of HbS there is development of cyclic cascade leading to blood cell adhesion, vaso-occlusive crisis and ischaemic reperfusion injury. SCD patients may develop complications such as Acute Chest Syndrome, pulmonary embolism and stroke 

About two thirds of new borns born with SCD worldwide are found in sub-Saharan Africa. The sickle cell gene HbSS is commonly identified in Africa in SCD while HbSC and HbS/ beta+thalassemia has been observed in West Africa. SCD had led to the death of about 50-90% of the affected as the disease remained undiagnosed during the childhood. The various studies done in Africa were found that SCD patients have higher mortality rates.  In Ghana-the programme to enhance health care for sickle cell disease is a big relief.

The development of knowledge of understanding the pathology and management protocol of SCD has been helpful in management of the disease. The presence of malaria, undernutrition and other infectious diseases also contribute towards mortality rate in Africa. Of late it has been seen that because of the devoted and dedicated health care services provided by the health personnel the mortality rates are declining and this life-threatening disease of children is now progressing to chronic disease of the adult. 

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It has been observed that pulmonary functions are decreased in SCD. Lung functions are compromised in patients of sickle cell disease and Sickle Cell Trait (SCT). Repeated chest infections in SCD and SCT lead to alteration in geometry of lung parenchyma and physical properties of elastic and collagen fibres thus decreasing pulmonary function parameters such as Forced Vital Capacity, Forced Expiratory Volume and Forced Expiratory Volume 1%. Moreover the pulmonary vasculature is highly sensitive to hypoxia (absence of enough oxygen) driven micro-occlusion of pulmonary vasculature which along with cell adhesive changes may cause pulmonary hypertension and further compromise lung functions]. Persons with SCD have an increased susceptibility to infection. The impaired leucocyte function and humoral and cell-mediated immunity loss have been reported to account for the immunocompromised state in patients with sickle cell disease. The SCD patients being immune compromised are more prone for recurrent chest infections. The major cause of mortality in patients of SCD is acute chest syndrome, pneumonia and acute respiratory distress syndrome.

COVID-19 is the acronym for corona virus disease 19 and has been termed as SARS-COV-2 by International Committee of Taxonomy on Virus (ICTV). The common clinical manifestations observed in patients of sickle cell disease include cough, fever, shortness of breath, loss of smell perception and loss of taste sensation. Most of the patients of COVID-19 may have a mild course of disease while few may develop severe clinical manifestations. The clinical manifestation of severity in COVID-19 patient includes Acute Respiratory Distress Syndrome (ARDS), Pneumonia, Multiple Organ Failure, Septic Shock and Sepsis. The severity of pneumonia manifests with dyspnoea (difficulty or laboured breathing) and tachypnoea (abnormally rapid breathing) 

COVID-19 infection can worsen the pulmonary manifestation in SCD patients especially in those having pulmonary complications such as Acute Chest Syndrome, Pulmonary Hypertension and ARDS. COVID-19 infections in SCD can also increase morbidity and mortality risk in these patients.

The main cause of concern in patients of SCD is that these patients are immunocompromised and may suffer from both acute and chronic complications which require hospitalization and close contact with the medical system. There is overlap in clinical manifestations of fever and lung disease in COVID-19 and SCD. The increased complications will amplify health care utilization-e diagnostic, management and logistic challenges. In view of the above facts it is necessary for health care workers to educate SCD patient registered in their areas regarding care and precautions to be taken during COVID-19 pandemic to prevent getting affected with COVID-19 infection. Although the education applies to everyone, there should be more emphasis for persons with SCD.

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All persons with SCD need to be educated regarding COVID-19 signs, symptoms and mode of spread. They should be explained regarding the increased risk of contracting COVID-19 infections in them due to their immunocompromised state. All patients of SCD should be advised to strictly adhere to social distancing, isolation polices, use of face mask, and frequent hand washing with soap to prevent COVID-19 infections. They should keep adequate medication of SCD such as analgesic and antipyretic drugs, hydroxyurea.  They can be advised regarding use of clinical thermometer at home as fever is common sign in SCD patient and thereby these persons can take appropriate precautions and medication after seeking telephonic consultation with their health care providers. They can use pharmacy home delivery services in case they require medication during emergency situations.

Until then regularly/daily consume polyphenol-rich cocoa. It is been useful for persons with SCD.

DR. EDWARD O. AMPORFUL

CHIEF PHARMACIST

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COCOA CLINIC 

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The eye is indeed the lamp of the body

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There is a scripture that is found in Matthew 6:22 which says that the lamp of the body is the eye and therefore the eye must see well to enable the body to get to its destination.  

What most people do not know is that behind the scenes, there is a strong interaction between the eyes and the brain before a picture becomes clear.  The state of mind therefore is crucial to the eye seeing clearly to enable the body to process accurately the information the eyes are feeding it for proper identification of what the eyes see. 

This is similar to how a person behaves i.e. what informs the decisions that forms in the mind that results in the actions that a person performs.  The actions of a person does not therefore just happen but is as a result of things that went on in the mind, which in most cases resulted from information passed on to it by the eyes either consciously or unconsciously.

There are so many issues that affect our society which makes one wonder, whether the people who displayed such acts were created by someone or something other than God. 

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How can a person see a beach created by God with beautiful beaches and fresh air blowing all around, decides to defecate at such places, and therefore desecrate the environment?  lt is simply mind boggling? 

When other people in other countries who dwell on the coast are using their beaches for tourist attraction purposes as a means of livelihood and also to promote environmental health, some people living around our beaches, have turned them into rubbish dumping sites and toilets. 

It is a very sad situation and the earlier we did something about it the better.  It is a national emergency that must engage the attention, first of the government and then the citizenry, where religious bodies and NGOs must play a critical role.

The things we focus on in this country, needs to be addressed.  Our minds which processes the info the eyes send to the brain, must be disciplined.  There are certain behaviours that a disciplined mind can ignore even when the eye has provided info to the brain.  One of the things a disciplined mind does, is the avoidance of a second look, which is critical for every person who wants to avoid adultery or fornication. 

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Once a person is not blind, he will see things.  The boobs, the ‘shankus’, the coca cola shapes, the light complexioned, the dark complexioned etc. the eyes will definitely see and report same to the brain.  What the brain or the mind decides to do or instructs the eye to do is the issue. 

It can decide to instruct the eye to take a second look and let the mind drool over it or say ignore it and that will be the end.

If the mind becomes trained to focus on environmental issues like clean environment, the eyes will automatically be reporting on insanitary conditions to the brain as and when it sees them.  The mind will pay attention to such data and begin to process them and to identify solutions to deal with the reported insanitary conditions. 

There is the need to encourage citizens to train the mind to focus on the right thing so that in tandem with the eyes, focus will be maintained.  When the mind is so trained, it communicates with the eye to also focus on hood things that helps in both are spiritual life and our secular lives, for indeed the eyes are the lamp of the body.  God bless.

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 Arming the Sikaman journalists to the teeth

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THE relationship between New Times Corporation (NTC) and African Concrete Productions (ACP) is based entirely on matters of the stomach. Each depends on the other in a dietary symbiosis, reinforced by the close proximity of each other

At lunchtime, you’d see a particular set of Times workers marching regimentally to ACP to face the wall. You’d think they are soldiers. It has long been declared that the company manufactures the best kokonte in the Greater Accra Region. ACP is, therefore, a culinary haven for those NTC kokonte fans, both male and female.

As the NTC kokonte warriors cross the border to ACP, you’d see some ACP banku fanatics dancing joyously to NTC. They are lucky folks because they do not have to obtain visa to enter into ‘Times’ to attack the balls of banku with precision and accuracy. They also claim that the lightsoup at ‘Times’ is arguably the best in West Africa.

So the relationship between the two entities was quite cordial and based practically on stomach palaver, until ACP workers staged an industrial revolution, whereupon the managing director, accountant and estate manager were allegedly stripped naked and locked up in a room. An insurgency had began in earnest.

An ACP worker came to ‘Times’, this time not to eat banku and okro. He had come to inform newsmen that juicy stuff awaited them at ACP. It could make a front page lead story.

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A camerawoman and a female reporter were accordingly dispatched to go and bring back news, juicy news as juicy as kokonte and groundnut soup.

Sikaman Palava
Sikaman Palava

I was driving to work when I espied the familiar camerawoman clicking away outside the ACP premises. I didn’t see any ‘Times’ reporter but angry workers who were on the verge of getting violent. I slowed down and the driver behind blew his horn at me like a lunatic. I drove on.

Later, I heard the reporter and camerawoman were harassed and brutalised. The report came,. “The camerawoman, Mrs Salome Adonu-Agbottah and reporter Mrs Doreen Allotey, in an attempt to retrieve the camera which the workers had seized from them were severely beaten. They were manhandled and almost pushed into a big gutter opposite the company’s premises.

BRUISES

“….The camerawoman had bruises on her body, her hand bag was destroyed and the money in it stolen. Mrs Allotey’s watch was also snatched and her feet stamped on.”

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Luckily, it was not her nose that was trampled upon. She has a beautiful nose.

The bad news was received with extreme sorrow. If the victims had been men, it would not have seemed too bad. But to brutalise women is just unacceptable. The New Times Corporation has not stopped mourning the incident which has been condemned in many circles.

Some people keep asking me why Times sent females to cover a potentially violent demonstration. I tell them they might as well ask why CNN’s amazon, Christina Amanpour, is assigned to cover the carnage in Bosnia-Herzegovina and Rwanda. She is always on the frontline in jeans and jacket.

Journalism is a potentially hazardous profession, and once you accept to study and practise the trade, you might as well bone up to face any assignment as long as your superiors feel you are capable of handling it or you have demonstrated the capacity to handle it. Both males and females can be assigned anywhere, anytime just like policemen and women are assigned.

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The only difference between cops and pressmen is that the latter are armed only with a pen and the former with a gun. The question is should newsmen also arm themselves so that in any event of an assault they would not be found wanting in self-defence? They can’t adequately defend themselves with a pen and a jotter. A pen cannot even disfigure an opponent’s upper lip.

Photo-journalists have particularly suffered violence. Spectator ace-cameraman Vincent Dzatse was severely assaulted by AMA men when he attempted to take pictures of their indiscretions.

Sports cameraman, P. K. Arthur has been beaten more than once at the sports stadium when riots errupted and he wanted to capture it on his lenses.

Some sports journalists have been banned from entering the Accra Sports Stadium by supporters because in their comments, they didn’t write “sense”. Some supporters once nearly lynched Christian Abbew, Spectator Sports Editor, near a courtroom. He was stoned like the biblical Stephen. He had gone to defend a contempt charge.

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I think it is time journalists met and discussed how best to defend themselves in any event of an attack by individuals or mobs. In the pursuance of their duty, they must be free from harassment and assault.

Some journalists go to work and return home with a black-eye or a double fore-head. It is just not right. Something has to be done about it. I think journalists should be armed. But first we must be trained in the use of firearms so that our warning shot do not hit below the belt. What about training in Kung Fu?

This article was first published on Saturday, October 17, 1998.

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