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SICKLE CELL DISEASE AND COVID-19

“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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Features

What booze can do to you

Sikaman Palava
Sikaman Palava

Ethanol, the chemical compound present in most alcoholic drinks, is a neurotoxin, that is, a sub­stance that can damage or destroy the nervous system. Someone who is drunk is, in fact, suffering from a form of poisoning.

In large quantities, ethanol caus­es coma and death. For instance, among students in Japan, the prac­tice of ‘ikkinomi, or alcohol chug­ging, causes deaths every year.

The body is able to convert eth­anol into harmless substances, but this is not accomplished immediate­ly. If alcohol is consumed at a faster rate than the body can handle, ethanol builds up in the system and begins to interfere noticeably with brain function. In what way?

Speech, vision, coordination, thought, and behaviour are all connected with an incredibly com­plex series of chemical reactions in the brains neurons, or key cells. The presence of ethanol modifies those reactions, suppressing or enhancing the role of certain neutrontransmit­ters chemicals that relay signals from neuron to neuron.

The stream of information in the brain is thus altered, preventing the brain from functioning normally. That is why when a person drinks too much, he or she develops slurred speech, blurred vision, sluggish movement, and weakened be­havioural restraints and inhibitions, all common symptoms of intoxica­tion.

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Prolonged exposure to alcohol damages the liver

EXPOSURE

With prolonged exposure to alcohol, brain chemistry adapts to counter the poisonous effect of eth­anol and to maintain normal nerve function. This leads to tolerance, whereby the same amount of alcohol has less of an effect than it would have had previously.

Dependence occurs when the brain has adapted so much to the presence of alcohol that it cannot operate properly without it. The body craves alcohol to maintain the chemical balance.

When a person is deprived of alcohol, his brain chemistry is totally destabilised and withdrawal symp­toms, such as anxiety, trembling, or even seizures, set in.

Besides causing modifications of brain chemistry, alcohol abuse can lead to cell atrophy and destruction, altering the brain’s very structure. While partial recovery is possible with abstinence, some of this damage seems to be irreversible.

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Neurons that die are apparently never replaced, further affecting memory and other cognitive func­tions.

Damage to the brain is not just the result of long term exposure to alcohol.

Research seems to indicate that even relatively short periods of alco­hol abuse can be harmful.

LIVER DISEASE

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AND CANCER

The liver plays a vital role in me­tabolising food, combating infection, regulating blood flow and removing toxic substances, including alcohol, from the body.

Prolonged exposure to alcohol damages the liver in three stages. During the first state, the breaking down of ethanol slows the digestion of fats, causing them to build up in the liver.

This is called steatohepatitis, or fatty liver. In time, chronic inflam­mation of the liver, or hepatitis, sets in. While alcohol can cause hepatitis directly, it also appears to lower the body’s resistance to Hepatitis B and Hepatitis C viruses.

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If unchecked, inflammation causes cells to burst and die. Compounding this damage, alcohol seems to trigger the natural system of programmed cells death called apoptosis.

This final stage is cirrhosis. The vicious cycle of continuous inflamma­tion and cell destruction causes irre­versible scarring. Eventually, the liver becomes humpy, instead of remaining spongy.

Finally, scar tissue prevents blood from flowing normally, leading to liver failure and death.

Alcohol’s effect on the liver has another insidious side effect -the liver is less capable of playing its defensive role in counteracting the effect of cancer-forming agents.

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In addition to favouring the devel­opment of cancer of the liver, alcohol greatly increases the risk of cancer of the mouth, the pharynx, the larynx, and the oesophagus.

What is more, alcohol makes the mucous membranes in the mouth more easily penetrated by cancerous substances in tobacco, elevating the risk for smokers.

Women who drink daily are at greater risk of breast cancer. Accord­ing to one study, the risk for those who drank three or more alcoholic beverages per day was 69 per cent higher than that of nondrinkers.

POISONED BABIES

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A particularly tragic outcome of alcohol abuse is its effect on the unborn. “Alcohol is far worse for the developing fetus than any other abused drug,” reported by the ‘Inter­national Herald Tribune.’

When a pregnant woman drinks, her developing chin also drinks and the toxic effect of alcohol is espe­cial, devastating at this format stage of the fetus.

Alcohol causes irreversible damage to its central nervous system. Neurons do not form properly. Cells are killed off. Other cells end up located in the wrong place.

The result, fetal alcohol syndrome (FAS), is the foremost cause of mental retardation in newborns. Difficulties encountered by FAS children include intellectual impairment, language problems, developmental delay, be­havioural dysfunction or deficit, slow growth, hyper activity, and hearing and sight disorders. Many babies are also born with characteristic facial deformities.-Credit: AWAKE

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This article was first published on Saturday, November 5, 2005

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Islamic Position on Illicit Drugs (Part 2)

• Imam Alhaji Saeed Abdulai, the Author
• Imam Alhaji Saeed Abdulai, the Author

In Ghana, the Narcotics Control Commission Act, 2020 (Act 1019), prohibits the possession, use, trade, or cultivation of narcotic drugs without lawful authorisation.

The law now adopts a more public health-based model, emphasising rehabilitation and education while still maintain­ing punitive measures against trafficking and illegal posses­sion.

This opens doors for religious and social actors to play key roles in prevention and heal­ing.

How the Youth and General Society Are Typically Lured into Illicit Drugs;

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One of the primary gateways to drug use is peer pressure. Many young people are intro­duced to drugs by friends who make substance use appear fashionable or as a coping mechanism for stress, bore­dom, or emotional trauma.

In urban slums and some schools, peer groups become influential in shaping be­haviour, particularly when parental supervision is weak or societal structures have collapsed.

Another contributor is media influence—with movies, music, and social media sometimes glamorising substance use. Un­employment, poverty, broken homes, academic stress, and lack of religious education also contribute significantly.

Shaykh Abd al-Rahman al-Sa‘di explains that when faith weakens, individuals seek escape in destructive behaviours. Hence, strength­ening iman (faith) is a critical defence against temptation.

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Rescuing Victims: Rehabili­tation and Social Support

Those who fall into drug addiction must not be con­demned but rather supported with compassion and care. Islam emphasises mercy and hope:

“Say, O My servants who have transgressed against themselves [by sinning], do not despair of the mercy of Allah. Indeed, Allah forgives all sins.” (Qur’an 39:53).

Rehabilitation centres, faith-based recovery programmes, community counselling, and mosque-based interventions are all vital tools.

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Imams and scholars should be equipped with basic knowl­edge in addiction counselling. Collaboration with the Nar­cotics Control Commission and health institution can create models where religious guid­ance and medical treatment go hand-in-hand.

Impact of Illicit Drugs on Society

Illicit drug use damages physical health, corrupts moral values, and leads to crime and unemployment. It depletes a nation’s human capital, as youths and adults become dependent, mentally unstable, and economically unproductive. It also leads to violence, theft, and domestic abuse.

The Qur’an declares: “And do not throw yourselves into destruction with your own hands.” Qur’an 2:195)

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Impact of Illicit Drugs in Schools

In Ghana, the increasing prevalence of drug abuse in schools has led to absentee­ism, violent behaviour, ac­ademic failure, and mental health issues.

Some school dropouts have become part of gang culture, especially in urban areas, threatening future nation­al development. These environments must be purified and protected with strong policy, parental involvement, and faith-based education.

UNICEF, Ghana Health Ser­vice, and Other Reports

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UNICEF (2019) highlight­ed the correlation between substance abuse and early childhood trauma, noting that youth exposed to abuse, neglect, or poverty are more susceptible to drug use.

The Ghana Health Service’s 2022 report showed a 17 per cent rise in mental health cas­es linked to drug abuse, with youth between 15–35 years most affected.

Narcotics Control Commis­sion Statistics

According to the 2022 Annual Report of the Narcotics Con­trol Commission, over 8,000 arrests were made for drug offenses.

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Cannabis remains the most abused drug, with growing concerns about synthetic drugs and pharmaceutical abuse, especially tramadol and cough syrups with codeine.

Islamic Law and Maqasid

al-Shari‘ah

The five universal objectives of Islamic law (maqasid al-shari‘ah)—preserving religion (deen), life (nafs), intellect (‘aql), lineage (nasl), and wealth (maal)—are all endan­gered by drug abuse.

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Any initiative that protects these objectives is not just legally encouraged but reli­giously mandated.

Imam Al-Shatibi, in al-Mu­wafaqat, asserts that laws are designed not for hardship but to preserve human dignity and collective wellbeing.

Therefore, illicit drugs threaten the very fabric of what Shari’ah seeks to pro­tect:

1. Preservation of Religion (Hifz ad-Deen) – Drug use weakens a person’s sense of religious duty. Addicts often neglect prayer, fasting, and remembrance of Allah, falling into sin and heedlessness.

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2. Preservation of Life (Hifz an-Nafs) – Drugs increase the risk of premature death through overdose, suicide, or violence. Islam strictly forbids self-harm: “And do not kill yourselves.

Indeed, Allah is to you ever Merciful” (Qur’an 4:29).

3. Preservation of Intellect (Hifz al-‘A9ql) – One of the clearest reasons intoxicants are forbidden. The mind is the seat of moral judgment. Losing one’s intellect means losing the capacity for faith and responsibility.

4. Preservation of Lineage (Hifz an-Nasl) – Drug addiction often leads to moral decay, fornication, and broken fam­ilies, harming future genera­tions.

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5. Preservation of Wealth (Hifz al-Maal) – Addicts squan­der wealth on drugs, harming families and communities. Islam commands us to be cus­todians of our resources.

These objectives guide the Islamic legal position that drug abuse is not just a sin, but a social threat that must be collectively confronted.

By Imam Saeed Abdulai

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