Saturday, 26 May 2018

‘Low-Calorie Sweeteners Promote Fat Accumulation’


By Chioma Umeha
Low-calorie, artificial sweeteners appear to play havoc with the body’s metabolism, and large consumption of these sugar substitutes could promote fat accumulation, especially in people who are already obese, preliminary research suggests.
The study results will be presented Monday at ENDO 2017, the Endocrine Society’s 99th annual meeting in Orlando, Fla.
“Many health-conscious individuals like to consume low-calorie sweeteners as an alternative to sugar. However, there is increasing scientific evidence that these sweeteners promote metabolic dysfunction,” said Sabyasachi Sen, an Associate Professor of Medicine and Endocrinology at George Washington University in Washington, D.C., and the study’s principal investigator.
Sen and his colleagues tested sucralose, a popular low-calorie sweetener, on stem cells- cells that could change into mature fat, muscle, cartilage or bone cells – taken from human fat tissue. They placed these cells in Petri dishes for 12 days in media that promotes fat production. At a 0.2-millimolar sucralose dose similar to the concentration found in the blood of people with high consumption of low-calorie sweeteners – equal to four cans of diet soda per day – the researchers said they observed increased expression of genes that are markers of fat production and inflammation. There also was increased accumulation of fat droplets in cells, particularly at a larger dose (1 millimolar), Sen reported.
With this evidence, the investigators then conducted a separate experiment. They analyzed biopsy samples of abdominal fat obtained from eight subjects who said they consumed low-calorie sweeteners (mainly sucralose and a trace of aspartame, and/or acesulfame potassium). Four of the subjects were healthy weight, and four were obese. According to Sen, they saw evidence of increased glucose (sugar) transport into cells and overexpression of known fat-producing genes, compared with fat biopsy samples from subjects who did not consume low-calorie sweeteners.
Additionally, he noted that subjects who consumed low-calorie sweeteners, which are several-fold sweeter than sugar, showed an overexpression of sweet taste receptors in their fat tissue; this overexpression was up to 2.5-fold higher than in subjects without history of consumption of these sweeteners. Overexpression of sweet taste receptors in the abdominal fat, he said, may play a role in allowing glucose to enter cells, from which the body absorbs it into the bloodstream.
All these findings are signs of metabolic dysregulation in which the cellular mechanisms are changing to make more fat, he explained. Of concern, Sen said, these effects were most apparent in the obese individuals who consumed low-calorie sweeteners, rather than individuals of normal weight. He added that the observed increased uptake of glucose into the cells is also concerning for consumers who have diabetes and prediabetes, “who already have more sugar in their blood,” compared to their counterparts who do not have diabetes.
More studies are necessary in larger numbers of people with diabetes and obesity to confirm these findings, he stressed.
“However, from our study,” Sen stated, “we believe that low-calorie sweeteners promote additional fat formation by allowing more glucose to enter the cells, and promotes inflammation, which may be more detrimental in obese individuals.”



Preimplantation Of Genetics Screening Reduces Miscarriage Rate – Bueno


Monique Bonavita Bueno is an embryologist from Brazil who visited Nigeria recently. In this interview with CHIOMA UMEHA, Bueno speaks on s
perm washing and freezing, preimplantation of genetics diagnosis and screening (PGD/PGS), their implication in fertility treatment.
What is the job of Embryologist?
Well we work with the garments, basically with the garments of the patients. We do ovary stimulation and IVF treatment. So we work with eggs and sperms and embryos. The sperm and eggs are placed into incubators and examined carefully at intervals to ensure that fertilization and cell division have taken place, after which the fertilized eggs are then known as embryos. Two to five days after egg retrieval, embryos are ready to be placed in the woman’s uterus.
What is the difference between sperm washing and sperm freezing?
Sperm washing is the process in which individual sperms are separated from the semen. Washed sperm is used in artificial insemination using the intrauterine insemination (IUI) technique and in in vitro fertilization (IVF).
Sperm washing involves removing any mucus and non-motile sperm in the semen to improve the chances of fertilization and to extract certain disease-carrying material in the semen. Sperm washing is a standard procedure in infertility treatment. Sperm washing takes place in a laboratory following sperm donation.
Sperm washing is done before sperm freezing. We take the sample of a man’s (patient’s) sperm and wash it before freezing. So we need to wash so will just keep the sperm to freeze.
How long can freezing last?
There is no limit for the freezing
What does Preimplantation of genetics diagnosis involve?
Preimplantation of genetics diagnosis (PGD) is a genetic testing used to determine the embryos that carry a specific gene mutation before the pregnancy occurs. While preimplantation genetics screening (PGS) refers to removing one or more cells from an in vitro fertilization embryo to test for chromosomal normalcy. PGS screens the embryo for normal chromosome number. We can think of PGS as chromosome disorder screening on IVF embryos. So PGS increase the chances for a healthy pregnancy.
What are the limitations?
There are no limitations, we have many good reasons to do the PGD and PGS. Actually the main benefits of PGD are to prevent the transmission of monogenic disorder by restoring the genetic quality of the embryo while the PGS will steady the chromosomical quality of the embryo and screen for equal embryo to be transferred. It would help in reducing the miscarriage rate; it will increase the implantation rate and also the chances of having a baby.
Who is qualified to do it?
Though anyone can undergo PGD and PGS, I will add that it is common mainly among patients that have advanced in maternal age. Women aged 37 and above: any IVF patient aged 37 or above may benefit from PGS, provided that they produce five or more embryos.
Patients in their mid-thirties are more likely to produce abnormal embryos so they are more likely to do the PGS that will analyse and identify abnormal chromosomal abnormality and identify an equal embryo to transfer to her uterus.
Preimplantation genetic diagnosis can benefit any couple at risk for passing on a genetic disease or condition.
The following is a list of the type of individuals who are possible candidates for PGD are: Carriers of sex-linked genetic disorders; carriers of single gene disorders; those with chromosomal disorders; women aged 35 and over. Others are: Women experiencing recurring pregnancy loss and women with more than one failed fertility treatment.
PGD has also been used for the purpose of gender selection.
However, discarding embryos based only on gender considerations is an ethical concern for many people.
What are the benefits of PGD?
The following are considered benefits of PGD: PGD can test for more than 100 different genetic conditions.
The procedure is performed before implantation thus allowing the couple to decide if they wish to continue with the pregnancy.
The procedure enables couples to pursue biological children who might not have done so otherwise.
What are the concerns of PGD?
The following are considered concerns or disadvantages associated with the use of PGD: Many people believe that because life begins at conception, the destruction of an embryo is the destruction of a person.
While PGD helps reduce the chances of conceiving a child with a genetic disorder, it cannot completely eliminate this risk. In some cases, further testing is needed during pregnancy to ascertain if a genetic factor is still possible.
Although genetically present, some diseases only generate symptoms when carriers reach middle age. The probability of disorder development should be a topic of discussion with the healthcare provider.
Keep in mind that preimplantation genetic diagnosis does not replace the recommendation for prenatal testing.
What is egg bank and sperm bank?
Sperm bank or egg bank or cryo bank in general is a facility that store human sperm, human eggs, garment in general from sperm to egg donors to use by human or couple who need donor provider garments and to achieve the pregnancy which they cannot using theirs.
Can you then define what fertility preservation is?
Fertility preservation is the process of saving eggs, sperm or embryo or ovarian tissue before they go into fertility damaging treatment like cancer treatment so the person can still use their garment to achieve pregnancy in the future. So women who want to delay motherhood can also preserve their eggs, so she is able to use her eggs to have her own biological child when she is ready.
A woman’s egg was preserved at 30 and now she is 40. How would you describe the success rate, how viable is it?
And as an experienced embryologist, you should be sure of doing it in a perfect way so the patient can come at 30-years-old, then returns when she is 40. If so, her egg will continue to be exactly the same quality.
How is the preservation done?
Currently we have a technique called cryopreservation, and vitrification. Cryopreservation and vitrification are methods used for preserving human germ cells. Thanks to them, germ cells may be preserved in our cryobank for as long as several decades. The preservation period depends on the agreement with the client.
The difference between cryopreservation and vitrification is in the cell freezing rate.
Cryopreservation is a technique that utilises a special medium to allow preservation in liquid nitrogen at a temperature of -196°C.
Vitrification is a modern technique that rapidly freezes reproductive cells to a temperature of -196°C, literally within seconds. A special medium containing cryoprotectants is used during the process to protect the cells against damage.
Vitrification is rapid freezing of eggs or embryos. So it is very quick with successful rate of eggs and embryos. The success is higher than slow freezing that anything that was done before now.


Benzoic Is Universal Food, Drink Preservatives, Not Harmful – NIFST



By
Chioma Umeha
It was Hippocrates, the ancient Greek Physician who became known as the founder of medicine that said: “Let food be thy medicine and medicine be thy food.” Hippocrates aligns with the axiom which says – ‘Health is wealth.’ Therefore, the controversies trailing the safety of Benzoic preservatives in foods and beverages in the country did not come as a surprise.
As the saying goes, “Those who think they have no time for healthy eating will sooner or later have to find time for illness.” This explains why many Nigerians are still worried and confused about safe consumption of foods and beverages with Benzoic preservatives.
However, the Nigerian Institute of Food Science and Technology (NIFST) has finally dismissed the idea of carcinogenicity of consuming carbonated beverages together with Vitamin C, which have been reported to be poisonous.
Speaking with the media weekend in Lagos, the first Vice National President, NIFST, Dr. Oluwole Toye said the use of benzoic acid as food and beverage additives is internationally acceptable.
Toye, said that the chances of forming benzene, a poisonous chemical, upon consuming soft drinks together with Vitamin C were slim.
He said that it required an ultra-violet light as well as high temperature to convert Vitamin C and benzoic acid, an additive found in soft drink, to poison.
The first Vice National President said that the temperature must be above 60 degrees Celsius before any reaction with Vitamin C could take place in the body.
He said: “It is true that if you mix benzoic acid and ascorbic acid over time you will have benzene formation, but two conditions must be meant for this interaction to take place. One, the temperature must be above 60 degrees Celsius and there must be ultra-violet light.
“Moreover, in Nigeria even peak Maiduguri heat is below 45 degree Celsius and we hardly get ultra-violet light out there. So, it is not likely, but that does not make it impossible. But in the event that these conditions are available, there is another preventive condition that will ensure that benzene formation does not occur. The moment sugar is available in the mixture, benzene formation is neutralised.
“And we know that sugar is one of the highest solid materials in soft drinks. This shows that there are preventive conditions entrenched in soft drink processing and production to ensure that we do not take poison. And as a scientist, I affirm that consuming soft drink and vitamin C is not poisonous.”
Toye, who also spoke about the importance of proper education of the public on the matter, also said: “The use of Benzoates which include benzoic acid, sodium benzoate, potassium benzoate and calcium benzoate as food addictive is internationally acceptable. The WHO/FAO joint Expert Committee on Food Addictives (JECFA) in 1997 adopted an Average Daily Intake (ADI) of 0.5mg/kg body weight for benzoates. Sodium benzoate is used globally as preservative in drinks and scientifically established as safe.”
He further stressed that “benozic acid is globally certified by CODEX as a safe preservative used generally in food and beverage products around the world, that the Nigerian Industrial Standards for benzoic preservative for soft drink is 250mg/kg is within the international CODEX standard of 600mg/kg and that Nigeria and the UK, like every other country, are at liberty to set their respective national standards referencing the CODEX standard and taking into consideration their peculiar environmental realities.”
He said Codex Committee on Food Activities in 2004 adopted the maximum use level for sodium, potassium, calcium benzoates and benzoic acid at the level of 600ppm for food category which comprises water based drinks, adding that this was the acceptable regulatory standard and serves as a global baseline.
He said it was within the specification level from Codex that Nigeria (National Agency for Food and Drugs Administration and Control (NAFDAC), Standard Organisation of Nigeria (SON), industry and other relevant stakeholders) adopted 250mg/kg as its level for these additives for the category of products. This level was an action to cope with our environmental situation, since these products were not thermally treated, hence requires a level of acidity to keep them safe.
“So Nigeria’s approval of 250mg/kg of these additives is within the internationally permitted maximum of 600mg/kg and it is reasonable within our climatic conditions. Therefore the products are considered to be safe for consumption within Nigerian population.
“In 2014, the 48th session of the Codex Committee on Food Additives lowered the maximum level for these additives in the stated food category from 600mg/kg to 250mg/kg as a result of an exposure estimate on benzoate conducted by Joint Export Committee on Food Additives (JECFA),” he noted.
According to him, this level can in no way cause harm to Nigerians who take foods and drinks with such additives.
The nutritionist therefore commended NAFDAC for its proactive measure in ensuring that all guidelines for production of foods and drugs in the country were adhered to.


Lagos Worries Over Increasing Suicide Rate



..Will Soon Commence Depression Treatment In 57 PHCs

By Chioma Umeha
Worried about the increasing rate of suicide in the state, the Lagos State Government has rolled out new plans to tackle the menace, even as it said that the current recession has made mental condition a public health concern.
Announcing this to journalists on Friday was Dr. Jide Idris, the Commissioner of Health, who also said the State Government will soon start treatment of depression and other common mental health disorders in all 57 flagship primary healthcare (PHC) centres.
He spoke at the press conference to mark the World Health Day, with the theme: “Depression: Let’s Talk.”
Idris stressed that the growing cases of suicide in Lagos was worrisome and that efforts must be made to nip it in the bud.
“As evidenced by the recent disturbing news of suicide and suicidal attempts, a densely populated and metropolitan city- state like Lagos is not exempt from the challenges associated with increasing prevalence of depression and other mental health issues. The current recession even makes the experience in Nigeria a public health concern at a time when joblessness, homelessness, and hopelessness affect so many with the current economic downturn,” he stated.
Depression, a mental disorder is a major cause of suicide.
Statistics released by the World Health Organisation (WHO) shows that 300 million people are now living with depression, an increase of more than 18 per cent between 2005 and 2015.
Depression is chacterised by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, feelings of tiredness, and poor concentration.
Similarly, depression is a leading cause of disability worldwide and a major contributor to overall burden of disease.
In view of the growing and worrisome suicide events that have occurred, the State Government considers it necessary to inform the populace about suicide and the common causes with depression being the first on the list, “So, we must talk,” Idris emphasised.
To this effect, the State has opened two help lines – 08058820777 and 09030000741 – through which residents can ask questions, make enquiries and seek help from professionals early enough to allow for appropriate intervention, the Lagos State Health boss announced.
“I must stress that there are people available to help. So, “Let’s Talk” …if you are a student, “Let’s Talk”, if you are parent, “Let’s Talk”, You feel alone in the world,” Let’s Talk.” Please be assured that Lagos State is committed to ensure the Public Health safety of all its residents and we are working to ensure that we live safe and healthy lives, as we chase our dreams and work towards self-actualisation,” he restated.
“Suicide is a major public health concern, but preventable. It does not discriminate, thus affecting people of all ages, genders and ethnicities. Main risk factors include depression, other mental disorders including substance abuse disorder.
“Many suicides occur in moments of crisis with a breakdown in the ability to deal with life stresses such as financial problems, relationship breakup or chronic pain and illness.
“In addition, experiencing conflict, disaster, violence, abuse or loss and a sense of isolation are strongly associated with suicidal behaviour. Suicide rates are also high among vulnerable groups who experience discrimination, such as refugees and migrants and prisoners,” he added.
The Commissioner added: “Depression can impair an individual’s ability to function at work or school or cope with daily life. In its most severe form, depression can lead to suicide.
However, Idris restated that depression can be prevented or managed.
According to him, the current situation calls for a change in the attitudes that perpetuate stigma and discrimination that have isolated people in the past. ”
“The cases of suicide in the state have further substantiated that mental health deserves much higher strategic priority and it is a signal with an articulate and unified voice behind it.”
On mental health, the commissioner said the ministry had established a Mental Health Advisory/Stakeholders’ Group to conduct a situation analysis, proffer innovative solutions and map out an implementation plan for reducing the burden of mental health problems in Lagos.
He said the group was made up of academics, policy makers, NGOs, researchers, clinicians and service users, with the department of Behavioural Medicine, LASUCOM forming the core of the think – tank team to bridge the gap.
“Following this, the Ministry of Health in collaboration with the Department of Behavioural Medicine, Ministry of Youth and Social Development and the Ministry of Justice are working on repealing and replacing the existing Mental Health Law to meet current global realities.
“We now have a draft of the new Mental Health Bill. This bill is presently at an advanced stage, with renewed efforts, the law should be presented as an executive bill to the Lagos State House of Assembly soon.”
On his part, a Consultant Psychiatrist at the Lagos State University Teaching Hospital, LASUTH, Prof. Abiodun Adewuya said: “Per week in Lagos State University Teaching Hospital, LASUTH, we have nothing less than 2 to 3 mentally ill destitute that are picked from the streets, treated free. “For suicides, the rate seems to be high and there is focus on it now and the methodology is bizarre,” he added.


Stress, Depression Have No Link With Genes – Study


By Chioma Umeha
A recent study published in PLOS One led by Washington University School of Medicine in St. Louis has dismissed the result of an influential 2003 study about the interaction of genes, environment and depression.
The new study said that the 2003 study “may have missed the mark.”
Since publication of the study in Science, that original paper has been cited by other researchers more than 4,000 times, and some 100 other studies have been published about links between a serotonin-related gene, stressful life events and depression risk.
It indicated that people with a particular variant of the serotonin transporter gene were not as well-equipped to deal with stressful life events and, when encountering significant stress, were more likely to develop depression.
Such conclusions were widely accepted, mainly because antidepressant drugs called selective serotonin reuptake inhibitors (SSRIs) help relieve depression for a significant percentage of clinically depressed individuals, so many researchers thought it logical that differences in a gene affecting serotonin might be linked to depression risk.
But in this new study, the Washington University researchers looked again at data from the many studies that delved into the issue since the original publication in 2003, analyzing information from more than 40,000 people, and found that the previously reported connection between the serotonin gene, depression and stress wasn’t evident.
The new results are published on Tuesday, in the journal Molecular Psychiatry.
“Our goal was to get everyone who had gathered data about this relationship to come together and take another look, with each research team using the same tools to analyze data the same way,” said the study’s first author, Robert C. Culverhouse, PhD, an assistant professor of medicine and of biostatistics. “We all ran exactly the same statistical analyses, and after combining all the results, we found no evidence that this gene alters the impact stress has on depression.”
Over the years, dozens of research groups had studied DNA and life experiences involving stress and depression in the more than 40,000 people revisited in this study. Some previous research indicated that those with the gene variant were more likely to develop depression when stressed, while others didn’t see a connection. So for almost two decades, scientists have debated the issue, and thousands of hours of research have been conducted. By getting all these groups to work together to reanalyze the data, this study should put the questions to rest, according to the researchers.
“The idea that differences in the serotonin gene could make people more prone to depression when stressed was a very reasonable hypothesis,” said senior investigator Laura Jean Bierut, MD, the Alumni Endowed Professor of Psychiatry at Washington University.”
But when all of the groups came together and looked at the data the same way, we came to a consensus. We still know that stress is related to depression, and we know that genetics is related to depression, but we now know that this particular gene is not.”


Japan Donates US$3.5m To WFP For Emergency Needs In Northeast


By Chioma Umeha
The United Nations World Food Programme (WFP) today welcomed a US $3.5 million contribution from the Government of Japan to provide desperately needed food assistance to tens of thousands of internally displaced people in Northeast Nigeria.
The funding allows WFP to deliver food to more than 160,000 people in Borno and Yobe States, where the Boko Haram insurgency has left many people severely food insecure, and experts warn of a credible risk of famine in some places.
“We commend the Government and people of Japan for their continued contributions to WFP’s operations in Northeast Nigeria,” said Ronald Sibanda, WFP Country Director and Representative ad interim in Nigeria. “This generous contribution from Japan will help WFP continue scaling up its response to reach more families in the region with food and nutrition support.”
Currently, some 4.7 million people are in dire need of food assistance in the three most conflict-affected states – Borno, Yobe and Adamawa – a figure that is expected to rise to 5.1 million by June.
“This new assistance is part of Japan’s pledge made at the Oslo Humanitarian Conference on Northeast Nigeria and Lake Chad Region held between 23-24 February 2017 for humanitarian assistance in the region, and newly additional funding from the Emergency Grant Aid as a swift response to United Nations Secretary-General Antonio Guterres’s call for emergency humanitarian support,” said Sadanobu Kusaoke, Ambassador of Japan to Nigeria.
“The government of Japan is committed to ensure that millions of people in dire need of food in northeast Nigeria do not go hungry,” he added. “It is expected that this funding will, in the interim, assuage the suffering of people in the affected states who are in a near-famine situation.”
For four consecutive months, WFP has reached more one million vulnerable in northeastern Nigeria with cash-based transfers, food distributions and nutritional assistance targeting children under five, along with pregnant and nursing women. Indeed, WFP’s assistance increased in March to reach nearly 1.2 million beneficiaries, with plans to gradually scale up to reach 1.8 million people monthly during the coming lean season.


Meningitis Deadly, Be Alert, Ensure Hygiene – Lagos Tells Residents


By Chioma Umeha

The Lagos State Government has alerted residents on the dangers of Cerebro Spinal Meningitis and urged them to observe high standards of personal and environmental hygiene as preventive measures against Cerebrospinal Meningitis (CSM).
Idris in a statement on Monday signed by the Director, Public Affairs, Lagos State Ministry of Health, Mrs Adeola Salako, warned that the decease is deadly.
The commissioner said that no case of CSM had been recorded in the state contrary to what had been published
“However as a responsive government, we deem it fit to alert the public, “ he said.
Idris said preventive measures should include washing of hands with soap and water frequently.
“It is strongly advised for people to avoid overcrowding in living quarters, provide cross-ventilation in sleeping and work-rooms and other places where many people come together.
“People should also get vaccinated with CSM vaccine when you are travelling to areas where meningitis outbreaks have been reported, “ he said.
The commissioner said CSM is a dangerous and a life threatening disease that affects the thin layers of the tissue around the brain and spinal cord of an infected human person and is caused by bacteria.
He said that CSM is an epidemic-prone disease that spreads from person to person through contact with discharges or droplets from nose and throat of an infected person.
“It can also be transmitted through kissing, sneezing and coughing, especially amongst people living in close quarters, hotels, refugee camp, barracks, public transportation and areas with poor ventilation or overcrowded places, “ Idris said.
He said that though seasonal meningitis outbreak usually affects mainly the Northern States that fall within the meningitis belt of the country, it is not impossible that outbreaks could occur in any part of the country.
While urging residents to take responsibility for their health and report persons with the above symptoms to the nearest public health facility or the Ministry of Health, the Commissioner stated that the State Government had put in place all the above measures towards avoidance and prevention of outbreak of CSM in Lagos State.
Idris advised the general public to remain calm and report suspected cases to the nearest public health facility or contact Disease Surveillance Officers of the Ministry of Heath on the following GSM numbers: 08037170614, 09087106072, 08023169485, 08052817243, 08026441681.
The commissioner said that health workers in the state in all the 57 Local Governments and Local Council Development Areas had been placed on high alert.
According to him, the disease surveillance and monitoring activities have since been intensified.
“Health workers are also advised to avoid close contact with suspected and probable cases of CSM based on the case definition distributed and ensure proper disposal of respiratory and throats secretions of cases.
“They are also to report suspected or probable cases, observe universal safety precautionary measures and make use of personal protective equipment when in contact with such cases as highlighted in the Fact-Sheets earlier forwarded to them, “ he said.
He urged residents to take responsibility for their health and report persons with the above symptoms to the nearest public health facility or the Ministry of Health.


Misdiagnosis Bane Of Improper Endometriosis Treatment – Zurawin


Dr. Robert K Zurawin, is an Associate Professor at the Baylor College of Medicine in the United States(US). In this interview with CHIOMA UMEHA, Zurawi   spoke on endometriosis in adolescent girls, its symptoms, health implication and treatment.

What is endometriosis?
Endometriosis is a medical condition that occurs when the lining of the uterus, called the endometrium, grows in other places, such as the fallopian tubes, ovaries or along the pelvis. When that lining breaks down, like the regular lining in the uterus that produces the menstruation, it has nowhere to go. This causes cysts, heavy periods, severe cramps and even infertility.
Can you explain the symptoms of endometriosis?
The symptoms include, painful periods, dysmenorrhoea which is pain usually in the pelvis or lower abdomen. The second symptom is severe crippling pain especially while having sexual intercourse; these are the two major symptoms.
So, the third is infertility. If a woman has painful periods and she is unable to conceive, those are the three main warning signs of endometriosis. The rest that women should look out for are nausea, fatigue, and all these things can vary in different conditions, but those I mentioned earlier are the top three.
What is the situation in USA and how do you compare it to Nigeria’s situation?
Surprisingly, in the United State we have similar problem of under diagnosis, for failure to diagnose endometriosis not only in adult, especially in the young women. I have personally seen endometriosis in teenagers of 12 and 13; of course before they turn 19 they have reached the severe stage three or four of endometriosis.
The problem even in the United State is that they have been sent from doctor to doctor, gastroenterologist to pain specialist to psychiatrists to general surgeons without the real diagnosis. So how it relates to Nigeria is that fibroid is a lot of problem strictly among the Nigerian populace, especially in older women. However, in the younger women you do not see fibroids of course it takes a while to develop, you see more of endometriosis. The way that we encourage people both in the United States and Nigeria is same. We tell them to beware of endometriosis. It occurs in girls who have severe menstrual pains that are not responding to certain therapy like oral contraceptives; in such situation it is most likely to be endometriosis.
So both in the United States and in Nigeria, the simple way is to screen women, give them a three month treatment, if they respond it means it is not endometriosis. If they don’t respond in three months you recommend further examination like laparoscopy. Even in the United States 50 per cent of young women who don’t respond to treatment and laparoscopy are found to have endometriosis.
In summary, I think   both countries have the problem of awareness that endometriosis exists. In addition to that is the education of the doctors. We need to educate women especially, mothers of young women or the young women themselves in schools that if they have symptoms that are suggesting that they have endometriosis to seek care. Also, they should be aware of the need to go to the right consultant. They shouldn’t have to go to six or eight doctors before diagnosis.
Is it right for a woman who has endometriosis to take her daughter that is not of menstruating age to a doctor for its treatment?
We do know that endometriosis has a tendency to run in family, but if a woman has children, especially if she had them when she was younger, it doesn’t mean that her children are going to have endometriosis.
However, I will recommend that a mother should let her daughter be aware that there is a possibility of having endometriosis. If she has the symptoms that suggest endometriosis, then she should be checked.
That doesn’t mean that if she is feeling fine, she should be taken to the doctor, but at least let her be aware that there is potential of having the problem in the future.
Can you compare the response of people that present with the symptoms and management of endometriosis in the US and Nigeria?
Amazingly, it is similar between US and Nigeria because there is no diagnosis except for the understanding of the proper treatment of endometriosis. Not everybody who treats it does the right thing. For instance, if you suspect endometriosis and then have a laparoscopy, there is   a proper way of removing   endometriosis and that reduces the chances of it causing problems.
Not everybody does the right surgery, not even in the United States. They may do incomplete surgery and the symptoms will remain there.
So, just like in the US, if the doctors here in Nigeria are not well trained on the treatment of endometriosis that is mostly surgery, such doctor will do whatever he likes to the patient, the symptoms will still be there. But, if the doctor is well trained, he will be able to carry it out. That is why we commend Dr. Abayomi Ajayi of Nordica, he has done a good job in endometriosis awareness here in Nigeria.
What are the methods that can be deployed to train doctors without awareness of endometriosis?
I think endometriosis should be an important part of the curriculum in residency training and as diagnosis becomes more common, young gynaecologists will learn from the senior doctors during their residency training.
So the awareness can come in form of training. The doctors should be trained to understand that endometriosis is a problem and correct ways of treating it. There are certain centres in Nigeria that are already doing a good work, but I think there is more work to be done for the future. Government should help to establish training centres. I think it is one of the investments that government can do. In the United States, government supports doctors to create awareness in endometriosis.   If the   Nigerian government can help to establish and support   training centres, the country will have well trained doctors that can treat the disease and that will stop Nigerians from travelling abroad to treat endometriosis.
You said that women with endometriosis suffer infertility, pains during menstrual period and sexual intercourse. In treatment, which of the problems do you prioritise; do you focus on the pain or infertility?
We have to separate the issue of pains from infertility. Now there is a reproductive technology as we have here in Nordica that can be used to assist women who are finding it difficult to get pregnant, so you can still have endometriosis and have children. This may require IVF or other procedures that allow you have the baby even if you have endometriosis.
The issue of treatment is a matter of the patient’s choice; the patient has to decide. Does the patient want to get pregnant now or later or never? If she never wants to get pregnant then the proper treatment for endometriosis has to be recommended – which is mainly surgery. And when the surgery is done properly, the endometriosis won’t come back.
However, if you want to get pregnant with endometriosis, then you have to go to fertility specialist. So that’s the point.



How Eggs, Sperm Preservation Can Rescue Infertile Couples


By
Chioma Umeha
Ask Mrs. Precious Bassey, she will tell you that her greatest regret in life is wasting her reproductive years instead of settling down early for marriage.
Mrs Bassey said: “I was thirty-six, and was dating a lot. I was more interested in meeting up with groups of friends for after-work drinks and lingering over dinners at the latest hot spots than I was in nesting at home with one man or starting a family.
“Getting serious in a relationship that would lead to marriage was in the back of my mind, but I was in no rush,” she added.
Thank goodness, she finally tied the nuptial knot with Mr. Bassey, one of her numerous male admirers in October 2013. Formerly Miss Precious Obong, now became Mrs. Precious Bassey.
Now that she is in her early 40, she has another huddle to cross. Getting pregnant has become a herculean task to achieve.
“As I speak to you there is pressure on my husband to throw me out and get another wife. My husband’s people are all on my neck. All their eyes are on me to see me with a ‘protruding belly.’ Unfortunately, that hasn’t been possible.
But, I know there’s nothing God cannot do. Perhaps, if I had known about egg storing, I wouldn’t find myself in this mess. All the doctors who have handled our case came with one conclusion, ‘Woman you need help as your eggs were not as fertile as before,” Mrs. Bassey lamented to Independent.
She was told that the only option to get pregnant was through donor eggs.
Of course, this greatly reminded her mother’s words, which she often found disgusting then. “I never took my mother’s advice seriously as a young undergraduate. She always sang it like a song on my ears.
What is the song? You may ask – ‘Women have time, women are like flowers, it’s the person that has ears that would hear, there’s time for everything,” Mrs. Bassey regretfully recalls.
Unfortunately, many women are in the same shoes with Mrs. Bassey who could have saved their eggs at their youthful age, while they rock their lives until they are ready to start having babies.
Like the popular adage, make hay while the sun shines, Florence Anthony, has not forgiven herself for being blindfolded with ’America love.’
Many called her names, for being ‘stupid’ to waiting more than 10 years for a man when so many other well to do young men were coming for her hand in marriage.
“Before Chuka travelled to America, he promised doing everything for me, including dying for me. He told me it’s a matter of two years; he will come for me. Unfortunately, I am still here today, Chuka is no longer calling me on phone,” Florence told Independent, sobbing.
Now she is in the middle of her 40s full of regrets. “As a single mother I am trying to have at least one or two babies because I can take care of them. But, it has not been possible as I was told my eggs are no longer fertile.
Fortunately, respite has come the way of young men and women who are too busy to settle down for marriage due to one reason or the other, according to experts.
The rise in infertility and its attendant effects on marriages, including the psychological and emotional trauma couples go through when they have no child has become the bane of many societies, especially in Africa.
To tackle growing cases of infertility and increase the chances of individuals or couples having their own children, experts have introduced sperm and egg banks through the process of cryo preservation and vitrification to preserve fertility.
Cryopreservation or cryoconservation is a process where organelles, cells, tissues, extracellular matrix, organs or any other biological constructs susceptible to damage caused by unregulated chemical kinetics are preserved by cooling to very low temperatures.
Explaining, Monique Bonavita Bueno, a Brazilian Embrologist, said the fertility preservation technology involves sperm, egg and ovarian tissue preservation. The method can be used to store an egg or sperm for future use.
Giving details, Bueno said a sperm and egg bank, is a facility that collects and stores human sperms and eggs, from sperm and egg donors, used by women, men or couples who need them to achieve pregnancy.
Monique further explained that fertility preservation is a process of saving eggs, sperm or embryo or ovarian tissue before undergoing a fertility damaging treatment like cancer so the person can still use them later to achieve pregnancy in the future.
Women who want to postpone motherhood can preserve their eggs and still have their own biological child whenever they are ready.
Describing cryo preservation as the future of fertility all over the world, Monique said vitrification is the latest technology and it freezes eggs faster and quicker.
Vitrification, is a cutting edge technology for cryopreservation (freezing) of embryos and eggs. Patients who undergo In Vitro Fertilization (IVF) may have several eggs collected. The eggs are then fertilized with a sperm and checked for fertilization. Fertilized eggs are called embryos.
On how long the egg can last when kept, she said: “Survival rates of the eggs will be much higher than slow freezing that was done before.”
A senior embrologist at Nordica fertility centre, Adedamilola Atiba stressed there is a biological clock that ticks for a woman.
“Once it has passed, there is nothing anybody can do. Many people find it hard to take donor eggs,” she said,
Atiba identified many reasons why people delay having children, which she said includes, career, social, medical and other reasons.
Similarly, she explained that the process could be done because of a disease such as cancer and the person plans to take medications which could affect his or fertility. “So such a person could store his or her eggs or sperm in the bank, go for the treatment of whatever the medical condition is, and when the person is through, return to the bank for the stored egg/sperm.”
“As a woman, no one knows when menopause will set in, maybe earlier or later, it is better if the eggs are kept in the bank, just like we store our money in the bank. By the time she is 40 or 50, and she has banked her eggs in her 20s or 30s, she can still achieve pregnancy with her eggs,” Atiba added.
The Nigerian-based Embrologist, Atiba likened cryo preservation to a special food kept in a good deep freezer which can last for a long time as far as there is constant stable power supply, while giving assurance that whenever it is brought out, the quality is still the same.
Atiba stressed; “There are many women of advanced age who are still able to have children except if she has some underlying medical conditions such as fibroids. What matters in fertility for a woman is the egg quality. If we are able to preserve that, we are preserving a huge chunk of the fertility and every other thing can fall in place. If she is 40 or 50 years when she is ready for motherhood, she has no issues because her eggs are still young, maybe 20 or 30,” she said.
The Managing Director of Nordica Fertility Clinic, Dr Abayomi Ajayi also said whoever does not want to have a sexual relationship with the opposite sex can go to the bank to get a sperm for her eggs, if that is what the person wants.
On the need for assurance by some that it is the same eggs or sperm they are donating now that they get whenever they are ready, Ajayi said: “They can always verify with different technology including a DNA to ascertain if their own eggs were given to them.”
“If 100 eggs are frozen, we may not get the whole 100 in the best of conditions, but 80 to 90 percent of the eggs will still be in good condition and the quality will still be exactly the same,” he said.
Emphasising the need for an increase in awareness of this latest technology, Ajayi insisted it will be better for a woman to store her eggs when young.
“Eggs is something that if you don’t store it, it will waste every month. Whether you like it or not, as we grow older, our body is going to get rid of the eggs. Why not store them so they can be of use in the future, rather than wait till you are 40 or above and all that is available is a donor egg?” he queried rhetorically.


‘Adopt Cleaner Lagos Initiative To Spend Less On Disease Treatment’


By Chioma Umeha
By Dada Jackson
Iya Loja General of Nigeria, Chief Folashade Tinubu-Ojo has urged market men and women and the people to support the Cleaner Lagos Initiative (CLI) of the Lagos State Government, saying that the programme is in the best interest of Lago
sians.
Speaking with reporters at the commissioning of network of roads, Link Bridge and health centre in Alimosho area of the State, the market leader said there was no question about the good intention of government with the initiative, revealing that when fully implemented, the people would spend less on treating all kinds of diseases.
Tinubu-Ojo, who described the initiative as timely and necessary, noted that the Governor deserved to be commended for the huge plan to massively address the issue of cleanliness of the environment.
Her words: “The initiative is very good and it is a welcome development. There is no question about the fact that we need to keep our environment very clean even for our own health.
“An adage says cleanliness is next to godliness and health is wealth. When our environment is clean, everything will be positively affected even our food intake. Everything will be fine and we spend less on treatment of all kinds of diseases.
“So, I want to commend Governor Ambode for coming up with this bold and highly timely initiative to ensure our environment is clean.”
The market leader also counselled the people, especially market men and women to always keep their environment clean and abide by all rules and regulations concerning the environment.
She added: “I have always been saying it to our people that our markets should always be kept clean and trading on the road is prohibited and against the law and even the rules of market association. “So, I will like to urge our market men and women to support and cooperate with government in its bid to achieve a very clean environment because this new initiative is definitely for our own good.”


Meningitis: Liberalise Importation Of Essential Medicines, Vaccines – PSN


By Chioma Umeha

Following the outbreak of Cerebrospinal Meningitis (CSM) which is spreading like wildfire across the country, experts have said that collaboration is critical to ensure available and affordable safe as well as effective medicines and vaccines to tackle the menace.
Stating this on Monday were pharmacists who spoke under the platform of Pharmaceutical Society of Nigeria (PSN) who regretted that the persistent fatalities from outbreak of Meningitis is a preventable one.
Specifically, PSN blamed the recurring epidemics in the country to improper medicine management and protocols especially in the area of immunisation.
According to them, a well-structured and lawfully constituted regulatory agencies involved in drug distribution would address the improper medicine management and protocols especially in the area of immunisation.
The agencies which are critical in the drug distribution network, PSN said are mainly, National Agency for Food and Drug Administration and Control (NAFDAC) and Pharmacists Council of Nigeria (PCN).
Pharm. Ahmed Yakasai, the President of PSN, in a release said that pharmacists as medicine experts have a professional responsibility to ensure the wellness of Nigerians and assure consumers of medicines that “we shall not shirk in our responsibility in this regard.”
Yakasai said: “Our observation is that the avoidable fatalities in the vicious cycle of meningitis fatality over the years are fallouts of wretched medicine management and protocols especially in the area of immunisation.
Globally, pharmacists as medicine experts are trained to handle advice and deal with all categories of medicines and biological preparations.
“Given the scenario of a well-structured and lawfully constituted regulatory agencies involved in drug distribution especially NAFDAC and PCN, the PSN submits that a more robust collaboration of efforts would ensure the availability, affordability of safe and efficacious medicines and vaccines in our nation to redress the anxiety and concerns the perennial meningitis epidemics continues to inflict on our stressed health system.”
Proposing a viable ameliorating balm experientially, the PSN called on the Federal Government to adopt routine immunisation as the panacea to the tragedy meningitis continues to epitomise in our borders.
“Since the 80s a lot of countries have adopted immunisation against haemophilus influenza Type B in their routine childhood vaccination protocols. This practically facilitates the elimination of this pathogen in such countries.
“The current epidemic is traceable to the more deadly and often times resistant Type C variety, so logically the way forward is to introduce the vaccine for meningococcus group C as it has proved clinically effective to substantially decrease this pathogen. Quadrivalent vaccines which combine four vaccines with the exception of B specie now exists with some countries even placing premium on evidence of vaccination with them as entry requirement into their country.”
Yakasai explained that the approach for prevention and control of meningococcal epidemics based on early detection followed by massive vaccination of the vulnerable population with vaccines though has shown some effectiveness especially in young people, it is still perceived as a model for product development partnership in resource limited settings. “This is the norm in Nigeria and most African nations,” he said.
“Moving forward as a fortified health system, Nigeria must change its approach to the totality of immunisation procedures by opening its borders of restrictions to permit Community Pharmacists to conduct routine immunisation against all killer childhood diseases in public interest,” the PSN said.
The PSN President observed that the resort to emergency import of vaccines every year we record epidemics is certainly not good enough, as it remains a panic measure at best.
“Government must liberalise the importation of essential medicines and vaccines which the local pharmaceutical industry has not shown proven capacity to produce. Perhaps once again the PSN must appeal to the Federal Government to follow the dictates and spirit of the PSN position paper on the implementation of the recent 20 percent Import Adjustment Tax (IAT).
“A 20 percent IAT on medicines and vaccines which are life saving only exposes consumers of medicines to avoidable death sentence. Our resolve as responsible health providers who embrace a connectivity of empathy seriously forbids jostling along this less than noble route.
“The Pharmaceutical Society of Nigeria apart from canvassing routine immunisation by community pharmacists and other competent health workers wishes to advise the public to keep faith with the reflected tips to prevent meningitis: ‘Eat only properly and well-cooked meals. Meat, fish and poultry products must be cooked at high temperature to eliminate bacteria. A balanced diet, adequate rest and sleep in addition to moderate exercise will ultimately help to maintain a strong immune system while multivitamin supplements with doses of Vitamin A, C, E and D are helpful in maintaining good health as well as reduce the chances of inflammation around the brain and spinal cord.’”
The PSN also recommended hand washing after exposure to dirt or toilets remains essential. Those who harbour or play with pets need to maintain high sanitary conditions. It also said that health workers who manage meningitis patients might consider wearing face masks to protect themselves especially if their patients are coughing or sneezing while environmental sanitation is germane to maintain germ free enclave.
The Nigerian Government has confirmed the death of over 336 people in the latest meningitis outbreak in the country.
In a statement issued on Tuesday, the Federal Government said it has also activated an Emergency Operations Centre to manage the epidemic.
The government further said that a total of $1.1 billion was needed to tackle the outbreak of Cerebrospinal Meningitis in five states of the north.
The disclosure came as the Senate President, Dr Bukola Saraki, said the Senate under his leadership, was prepared to accord government all necessary support towards tackling the disease headlong.
The amount, according to Dr Emmanuel Odu, Acting Director-General,National Primary Health Care Development Agency, NPHCDA, is needed to vaccinate an estimated 22 million people in the affected states of Zamfara, Sokoto, Kebbi, Katsina and Niger, which has resulted in the death of 336 people so far.
“As of April 3, 2017, a total of 2,997 cases with 336 deaths have been reported with 146 of cases being laboratory confirmed,” Lawal Bakare, a spokesman for NCDC said.
According to the Dr. Chikezie Ihekweazu, the Chief Executive Officer of the National Centre for Disease Control (NCDC), the most affected were Zamfara, Sokoto, Katsina and Niger states. Other states affected are Kebbi, Nassarawa, Jigawa, FCT, Gombe, Taraba, Yobe, Kano, Osun, Cross Rivers, Lagos and Plateau.
Neighbouring countries within the African Meningitis Belt that are having similar experience are Niger, Chad, Cameroun, Togo, and Burkina Faso.
Records have it that the worst CSM epidemics in the country occurred in 1996 when it claimed 11,717 lives out of 109,580 cases. And in 2003 it claimed 401 lives from the 4,130 cases reported. In 2008, it was 562 deaths out of 9,086 cases and in 2009, 9086 cases were reported out of which 562 lost their lives.
The Federal Ministry of Health source said the current the epidemic is different from the previous ones caused by Neisseria Meningitides Type ‘A’.
It said the current one is Neisseria Meningitides Type C and in epidemic proportion for the first time.



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