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Tag: clinical

  • Clinical psychologist, Pamela Udoka, joins Qed.ng

    Clinical psychologist, Pamela Udoka, joins Qed.ng

    Certified clinical psychologist and theatre artist, Pamela Udoka, has joined Qed.ng as a columnist beginning from Friday, January 5. 2018.

    Her weekly column, known as ‘Talk with Pamela,’ will draw from her specialty as a marital conflict, relationship and sex therapist.

    Mrs Udoka holds a BA (Hons) in theatre arts from the University of Ibadan and an MSc in psychology with emphasis on life-span developmental psychology, childhood disorders and clinical intervention from the University of Lagos. She is undergoing an M.Phil/ Ph.D. in clinical psychology at the University of Ibadan with emphasis on causes of relationship/marital conflicts, depression, posttraumatic stress disorder and interventions.

    Pamela who has been married for 26 years to renowned theatre director, Dr. Arnold Udoka is a member of the National Association of Nigerian Theatre Arts Practitioners (NANTAP), president of the Nigerian Centre of International Association of Theatres for Children and Young People (ASSITEJ Nigeria) and an elected member of the executive committee of ASSITEJ International.

    A public speaker, she is a member of both the Nigerian Psychological Association (NPA) and the Nigerian Association of Clinical Psychologists (NACP).

    “We are excited to have Pamela Udoka on our team,” Editor-in-Chief of Qed.ng, Olumide Iyanda said.

    “Her expertise and passion for mental and emotional health are quite infectious. This is indeed a good way to start the New Year.”

  • Clinical radiographers demand separate department in hospitals

    The struggle for recognition by the various professional groups in the health sector is not likely to end soon.

    Clinical radiographers, critical players in health service, has also joined the fray as they are demanding for a separate department in health facilities.

    They claimed that they  did not find the current arrangment of keeping them in the same department with medical doctors  comfortable.

    The practice, they said, has relegated them to the background with no voice in the scheme of things.

    The group, therefore, demanded a separate department for practitioners in public and private health facility, which should be headed by one of their own.

    According to Mr Okoye Neirus, a deputy director with the National Hospital, Abuja, radiographers should not be lumped together with medical doctors in the same department.

    He said there was a need to create an autonomous department for them as it is a different and unique discipline, urging all radiographers to challenge the ugly trend whether as a clinical or academic radiographer.

    Neirus, who spoke in Abuja during the 2017 World Radiography Day organised by the Medical Imagine Society of Nigeria (MISON), in conjunction with General Electronics (GE), with the theme: “Awakening the spirit of radiographers in Nigeria”, said: “While we celebrate our past glory an ugly present and future are starring us in the face in clinical sector. We need to achieve the same feat we achieved in the academic sector in our clinical sector. department of radiography needs to be autonomous just as department of radiography in the universities are autonomous. We should have our own separate department in the clinical sector, which must be headed by a radiographer.”

    He continued:“To me, it does not matter which  name we will call it. What will matter is that it is for radiographers and headed by radiographers. If we look at the present management structure in the clinical sector, department is the smallest official unit of communication, but very sadly as presently constituted, radiographers are joined with doctors in one department, which is headed by only doctors. Radiographers have no opportunity toward the department. It is exclusively made for doctors. We must take our future in on hands and rise up to this challenge. This ugly trend must be challenged by all radiographers, irrespective of whether you are in the academic or clinical sector.”

    MISON Federal Capital Teritory (FCT), Abuja Chairman Emma Ngwu said the 2017 celebration was to create awareness on radiography as the fastest-growing field/discipline in medicine, engender harmony among radiographers/medical imaging practitioners, and promote international best practices.

    He added: “As  shining beacon  of this profession, radiography, a fast evolving and dynamic discipline that have outlived its initial name-radiography, birthed in 1895, whatever name we chose to call ourselves in Nigeria. Whatever name is globally acceptable, one thing is certain, this profession is and remains the cynosure of all in the field of patient care.”

    He, therefore, urged members to  guard it jealousy and protect it from the prying eyes of quacks and “ensure that any patient encountered, will go home feeling fulfilled, encouraged, safe and finds both physical (medical) and physiological healing. “After all, we care about their safety,”he said.

     

  • Breast cancer: Clinical anatomy and breast self-examination

    Breast cancer: Clinical anatomy and breast self-examination

    Causes of  breast cancer in women

    Though, a constellation of factors operate to cause the disease, it is relevant to note that the normal growth of breast tissue depends on certain hormones such as Thyroxin, Prolactin, Estrogen (ducts) Progesterone (glands), Growth hormones, HCG (Human Chorionic Gonadotropin) and HPL (Human placental lactogen)  amongst others.

    There are clinical and demographic overlaps, but in general, a woman’s risk of developing Breast Cancer has been linked, to a number of factors which include in order of clinical surgical importance.

    1. Female gender: It occurs mostly in women 99.9% as opposed to men 0.1%
    2. Age: It is the 2nd most important risk factor. Breast Cancer is rare before 20, but can occur in any age group. It is common in women between 30 60 years olds. More than 50% of Breast Cancer occur in women 65 years and older. PABC (Pregnancy associated Breast Cancer) appears to occur  most commonly in younger age groups.
    3. Family History: Striking family history of Breast Cancer is characterized by the presence of multiple first degree relatives

    – Mothers

    – Grand mothers

    – Aunts

    – First cousins with pre menopausal Breast Cancer

    – Bilateral disease

    – Family history of Ovarian Cancer

    1. Presence of Precursor lesions on Prior biopsy:

    90%of breast lumps are not breast cancer, but all breast lumps are presumed to be cancer until otherwise proven

    1. Women with fertility problems: These are often diagnosed with high doses of ovarian stimulating hormones
    2. Those achieving first Pregnancy and child birth beyond age 30 years and above.
    3. Genetic factors:

    Breast Cancer 1 (BRCA) gene and in males Breast Cancer 2 (BRCA1), RAP 80 and newer genes have been implicated. Population studies have demonstrated two (2) base pair deletions at position 185 and a single base pair insertion at position 5382 of BRCA2. For BRCA1, single base pair deletions at 6174 have been documented. These constitute most of the mutant alleles in AshKenazi Jews.

    Experts believe that in some cases,mutation in the genes controlling proliferation and apoptosis (programmed cell death) are responsible for Cancer. Mutations in the BRCA at 17 q 21 and BRCA2 13 q 12 Oncogenes have given support to the argument that cancer is a genetic disease, Estrogen and to a lesser extent Progesterone acting via the agency of heredity to promote neoplasia  in concert with other trigger factors.

    The P53 tumor suppressor gene(a transcription factor) operates by loss of function when activated, and is inherited in a recessive pattern, where as the oncogenes which are associated with dominant pattern of inheritance operate by gain of function when activated(proliferation)  ;others are bcl-gene associated with apoptosis and the metastasis gene for which the nm23 is a candidate gene. They are believed to operate in concert with growth factors in controlling activities of thyrosine kinase at the presynthetic(G1/S) and premitotic(G2/M) phases of the cell cycle

    1. Breastfeeding: Those who chose not to breast feed or whose husbands refuse to separate sexual breasts from reproductive breasts, are on their own at risk. Breast Cancer  having been observed to be relatively uncommon in primate and sub primate mammals, research indicates that breast feeding for about 36 months, throughout a woman’s reproductive life, offers some degree of protection against breast cancer. E3 (estriol) as opposed to E2 (estradiol) is protective,from the period of first term pregnancy and parturition throughout life. Women with gonadal dysgenesis (born without normal organs of sex/reproduction)may also enjoy protection which perhaps further implicates the ovarian factor in the concert of major events leading to breast cancer in women, as explained further hereunder,

    * The ovary do not secrete estrogen in experimental hyper prolactinemia.

    * Prolactin appears to affect granulosa cell function in vitro(in the living), by inhibiting synthesis of progesterone. It also alters the normal Testosterone: Dihydrotestosterone ratio.  In this way, it decreases aromatizable substrate(amount of cholesterol /derivatives available in adipose and other tissues convertible to estrogen) and increases local concentration of anti estrogen.

    In non breast feeding women, there is a mean delay before the first ovulation of about 45 days.

    * The development of estrogen receptor at puberty is largely prolatin dependent(good and     bad sides of baby fat).

    * The nexus of paracrine interaction between the gonadotrophs and lactotrophs estrogen, ultimately impact on the breast.

    1. Blood group, Nutrition and breast cancer( Blood group A, AB,)

    Recent and ongoing research aimed at characterization of diseases has demonstrated increasing frequency of Breast Cancer among individuals in blood group A, and AB, though no blood group is totally immune

    1. Previous breast lumps
    2. Early menarche and late menopause : these leave the system awash with hormones

    Android obesity significantly and Gynoid obesity less so, lower the threshold for early menarche ,similarly, high levels of post menopausal Estrone (E) produced by aromatization, can lead to neoplastic changes

    1. HIV/AIDS and Breast Cancer

    Viral peptides have been found in tissue biopsies, from patients with early breast cancer. Studies have shown that retroviruses including HIV are capable of acting as cellular gene transcription factors. Even the presence of viral particles of HIV in the vicinity of Human T-lymphocytes have been known to produce transformed lymphocytes which apart from becoming the targets for Natural Killer CD 8 lymphocytes also become oncogenes. Some retroviruses (ART) encode MAP (membrane associated proteins). It is interesting to note that young T- lymphocytes are more prone to HIV induced transformation.

    On the other hand weakened and reduced T  lymphocyte population can hardly mount formidable viral attack. How ever, Breast Cancer is not listed by the CDC as one of the recognised  opportunistic infections (OIS) disease conditions

    1. Patients on HRT (Hormone Replacement therapy).

    The biochemical commonality between the female gonadal steroids and environmental carcinogens is the benzene ring. These agents which are being abused by women with fertility issues undergoing treatment from Herbalists can induce cancer any where in the body, either directly or through the intermediates  produced when they are metabolized,

    . Others

    Uncontrolled exposure to X-rays, use of breast firming creams, Alcohol recycled vegetable oil, Tobacco, flavouring and colouring agents in fast foods are all potential carcinogens depending on genetic constitution of the individual.

    Some symptoms and signs?

    Symptoms and signs of breast cancer may be concealed, masked or obvious . They  can also  be generalized or specific, depending on the stage of the tumor, location and extent of spread. Pain, yellow eyes, malaise, lethargy, thirst and weight loss are some of the non specific or generalized symptoms.

    Grave signs that should require serious action include

    1)            Painless breast lump

    2)            Breast oedema

    3)            Skin ulceration (not dimples) seen to be coming from a solid breast lump

    4)            Fixation of tumor to the chest wall muscles and even beyond

    5)            Presence of matted axillary lumph nodes or even a single axillary (Armpit) lymph node more than 2.5cm (larger than the breadth of an adult finger)

    6)            Arm oedema (pitting or non pitting) swelling of the Arm of the side where breast has a problem.

    7)            Sudden appearance of a painful hard lump in pregnancy is serious, more so if  unilateral (in one side).

    The most important single fact about the clinical features of breast cancer is that it is not like tooth ache or wound in the tongue; it can be silent at the onset and at any other time like partially extinguished fire only to come out stronger and deadlier.

  • Overcoming depression: Clinical psychotherapy

    The diversity of human experiences and views of life makes the efficacy of clinical psychotherapy unpredictable. The diversity of manifestation of depression is also a challenge for clinical psychotherapy. Depression could be transient or stable, acute or chronic, mild or severe, treatable or untreatable, etc. It happens to people of all ages, cultures, religions, ideologies, professions, and walks of life. Overall, the summary of preventive psychotherapy is that if one wants to remain healthy, one needs to learn to cope with “the world”. Therefore, clinical psychotherapy of established depression also teaches coping skills.

    Therapists differ in their philosophies and therapeutic approaches. Psychoanalytic techniques are used by some practitioners to treat major depression. Psychotherapy aims at resolving personal problems through a special outlet provided for the patient through talking in a prepared setting of safety, confidentiality, and acceptance that conveys concern and allows a patient to better explore and resolve issues. Psychodynamic psychotherapy uses psychoanalysis with more social and interpersonal focus. “Psychodynamic therapy is based on the assumption that a person is depressed because of unresolved, generally unconscious conflicts, often stemming from childhood” (WebMD, http://www.webmd.com/depression/psychotherapy-treat-depression).

    Clinically, psychotherapy may be delivered, “to individuals, groups, or families by mental health professionals, including psychotherapists, psychiatrists, psychologists, clinical social workers, counselors, and suitably trained psychiatric nurses. With more complex and chronic forms of depression, a combination of medication and psychotherapy may be used” Young people are sometimes clinically diagnosed to have depression. For children and adolescents, cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) are preferred therapies for depression.

    Cognitive behavioral therapy is used to teach the subjects to challenge self-defeating. It deals with the ways of thinking (cognitions) and helps people to change counter-productive behaviors. “Several variables predict success for cognitive behavioral therapy in adolescents: higher levels of rational thoughts, less hopelessness, fewer negative thoughts, and fewer cognitive distortions. CBT is particularly beneficial in preventing relapse. Several variants of cognitive behavior therapy have been used in depressed patients, the most notable being rational emotive behavior therapy, and more recently mindfulness-based cognitive therapy “ (Wikipedia).

    “Interpersonal therapy focuses on the behaviors and interactions a depressed patient has with family, friends, co-workers, and other important people encountered on a day-to-day basis. The primary goal of this therapy is to improve communication skills and increase self-esteem during a short period of time. It usually lasts three to four months and works well for depression caused by loss and grief, relationship conflicts, major life events, social isolation, or role transitions (such as becoming a mother or a caregiver” (WebMD).

    Psychotherapists are trained, licensed, and regulated professionals. In the US, such therapists additionally have to undergo clinical continuing education in order to keep renewing their licenses.  Psychotherapy work is done by different types of professionals In the US, for example, psychotherapy is provided by the following amongst others:

    The Advanced Practice Psychiatric Nurse/Clinical Nurse Specialist (APRN-PSYMH/CS): Licensed as an Advanced Practice Registered Nurse (RN) with a master’s (MS, MSN, MN) or doctoral (PhD) degree in nursing and a specialization in psychiatric/mental health nursing.

    The Licensed Clinical Social Worker (LCSW): Licensed at the specialist level. An LCSW has earned a Master’s, an MSW, MSSA or MSS, from a graduate program accredited by the Council on Social Work Education.

    The Licensed Professional Counsellor (LPC): Licensed with a master’s level (e.g., MA, MEd, MS, MDiv), specialist (EdS), and/or doctoral (PhD, PsychD, EdD) degree, primarily with counselling in content and including a minimum 300 hours practicum from an institution accredited by a regional body recognized by the Council on Post-Secondary Accreditation.

    The Licensed Marriage And Family Therapist (LMFT): Licensed at the master’s or doctoral level in marriage and family therapy or a related field from a program accredited by the Commission on Accreditation for Marriage and Family Therapy, a program that meets the curriculum/practicum criteria established by the Board of Examiners or a post-degree training program accepted by the Board.

    The Psychiatrist or aMedical License: Licensed as a physician following completion of a medical degree (MD or DO) from an approved medical school.

    The Licensed Psychologist: Licensed at the doctoral level (PhD, PsyD, EdD) from a graduate program in applied psychology (clinical/counselling, school, or industrial/organizational) with accompanying American Psychological Association (APA) accredited doctoral internship

    In countries with less developed medical systems, faith and cultural organizations and services tend to take over psychotherapy roles and may help to alleviate or consolidate depressive episodes depending on the oversight of these organizations, themselves.

    Dr. ’Bola John is a biomedical scientist based in Nigeria and in the USA. For any comments or questions on this column, please Email bolajohnwritings@yahoo.com or call 07028338910

     

  • Disappointing results in malaria vaccine clinical trials

    The latest clinical trial of the world’s leading malaria vaccine candidates produced disappointing results on Friday. The infants it was given to had only about a third fewer infections than a control group.

    But researchers said they wanted to press on, assuming they keep getting financial support, because the number of children who die of malaria is so great that even an inefficient vaccine can save thousands of lives.

    Three shots of the vaccine, known as RTS, S or Mosquirix and produced by GlaxoSmithKline, gave babies fewer than 12 weeks old 31 percent protection against detectable malaria and 37 percent protection against severe malaria, according to an announcement by the company at a vaccines conference in Cape Town.

    Last year, in a trial in children up to 17 months old, the same vaccine gave 55 percent protection against detectable malaria and 47 percent against severe malaria.

    The new trial “is less than we’d hoped for,” Moncef Slaoui, Glaxo’s chairman of research and development said in a telephone interview. “But if a million babies were vaccinated, we would prevent 260,000 cases of malaria a year. This is a disease that kills 655,000 babies a year — 31 percent of that is a very large number.”

    The company, which has already spent more than $300 million on the vaccine, wants to keep forging ahead, he said, “but it is not just our decision.”

    It also depends on the PATH Malaria Vaccine Initiative, which has put more than $200 million of its Bill and Melinda Gates Foundation financing into the vaccine, and on the World Health Organisation, which has helped talk seven African countries into allowing the vaccine to be tested on their children.

    The Gates Foundation declined to say how much money it was ultimately prepared to spend on an imperfect vaccine; this set of trials is set to go into 2014.

    “The efficacy came back lower than we had hoped, but developing a vaccine against a parasite is a very hard thing to do,” Bill Gates said in a prepared statement. “The trial is continuing, and we look forward to getting more data to help determine whether and how to deploy this vaccine.”

    All the families in the trial were given insecticide-impregnated mosquito nets and encouraged to use them; 86 percent did, so the vaccine worked despite other anti-malaria measures.