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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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Prostitution in Sikaman -1

• Prostitution is more pliable on mobile phones and E-mails
• Prostitution is more pliable on mobile phones and E-mails

Apart from money-based church business and armed robbery, prostitution must be the next most lucrative private enterprise in Sikaman. It is normal­ly organised as a sole proprietor­ship and not as a limited liability company.

In some cases, it is a partnership between a prostitute and a pimp who knows he is destined for hell, anyway.

Sikaman Palava
Sikaman Palava

‘Sikaman Palava’ investigations have lots to reveal about the flesh trade. Contrary to opinions that the business is dying out, it is rath­er booming and mobile phones and E- mail services are making it more pliable.

It all points to the fact that some prostitutes are in a class of their own. The clients are top shots and expatriates who have ‘dough’, executives who want the service in style, with all the champagne airs, a little perversity here, a bit of sadism there to intensify sexual gratification.

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The fact is that some of the big guns are tired of having sex with their wives. Some claim the women are not what they used to be. After one or two children, they simply bloat, develop flabby breasts, and lose the shape that used to turn their husbands crazy. So there must be a search for new cargo. But the big man cannot go after ‘meat’ in the streets. He must distinguish himself in the sinful venture, and if that means going to hell, so be it.

It has come to the realisation of some high profile prostitutes that their peculiar brand of prostitution is in high demand by high paying clients. So they make themselves available on ‘mobile. The client only has to dial a number and she is booked.

“You can’t get me before 9pm. I’ll fix you for 9:30 pm till thy kingdom come. I’ve got a new style to outdoor tonight I hope you don’t get a heart attack. As you know, it can be quite hectic sometimes.”

“See you at 9:30 then. I’m al­ready getting a hard-on.”

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CANDLELIGHT

Some prostitutes indeed deliver in style. They can cook the best of meals and serve in the glow of can­dlelight, light music floating from the back ground. The romantic atmosphere is quite irresistible and the client is delighted. He laughs like a fool.

In a more elaborate setting, he must submit to a lather bath and massage with health-oils. When he is through, he is relaxed. A glass of champagne loosens his appetite. Two tots of Alomo heightens his libido, but he must be patient. In the hands of an experienced pros­titute, you indeed must be patient, lest you stumble and fall.

The sex act itself can vary de­pending on the taste of the client, his orientation, his occupation, level of intelligence or stupidity. Everything counts. Other factors to consider is the weirdness of the character of the particular client. Is he perverse? What about unnat­ural sex; sodomy? Fellatio and cun­ninlingus? Very frightening terms. Sadism or masochism?

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A whole successful businessman worth millions of dollars is seen naked with a chain around his neck like a licensed dog.

He is dragged about in a room by a lousy prostitute who gives him orders to bark “Wow! Wow! Wow!”

It is all part of the sexual gim­mick. Sometimes, the man is flogged with a belt; that’s the only way he can become aroused. And when he is through after satisfy­ing himself sexually, he pants for breath. “Jesus Christ! Deliver me!”

The bill is outrageously high. A quick cheque settles it though and the client is led to his car. At home, he tells his wife, “The meeting today was very hectic. They just wouldn’t understand my point of view, I had to leave pant­ing at the end of it.’

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EXPERIENCE

A prostitute who handles high-profile clients are normally trained overseas where they also gain experience. When they are getting older, they come back home and set up. They are still attractive, curvy, not too bad vital statistics.

They have their own houses, cars and a houseboy who knows how to shut his beak. Occasionally, he is given a sexual treat by Madam and he wonders whether heaven is not right here on earth.

The next class of prostitutes are the freelancers. They may look gaudy, boosy and wandering. They may target motorists. After a lift and a nice chat, they can offer to give the wealthy-looking driver some manipulation of his organ while he is still driving, quite a dangerous undertaking.

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If the driver doesn’t end up in a ditch or hits an electric pole when climaxing, then he is likely to wind up in the sea. Often, nothing hap­pens, though. The lady is dropped off, the man gets home and rea­lises that his wallet full of foreign currency and cedis is nowhere to be found. It is a lesson to be learnt the hard way.

This kind of prostitute may even take a client to a hotel. She chats and drinks with the wealthy client who wants to go and ‘wee wee’. In his absence the prostitute drops a little something in his drink. He is back, takes a long one down his throat. In 15 minutes, he can be seen lying prostrate, snoring pow­erfully.

The prostitute dresses up quick­ly, takes the loot from the man’s brief- case and exits. Thousands of dollars and pound sterling together with travellers’ cheques gone for good. These types are in town. Get wary of them, till we meet next week for the sequel.

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The Prophet part 4

Antobam woke up with a terri­ble headache. He checked the time on his mobile phone, 2:30 am. “What! Where is the money?” He asked aloud. “Where are those girls? Why did I drink so much of that whisky? What were those two girls up to?” He sat up on the bed and noticed a bulge close to the pillow.

He lifted the mattress and picked up the newspaper wrappers with the neatly arranged notes. He saw the neatly written record of the value of the notes. No, those girls are not thieves.

“It was my mistake. If I hadn’t drank myself to sleep they would be here in bed with me, giving me the time of my life. Pretty girls, those two. And so loyal and honest. Tomorrow will be different.”

“I will not drink any whisky, and I will show them that I am a real man. Just then he heard the whis­pers. Very soon it will be time, they seemed to be saying. This is an important day.”

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The gold dealer will bring lots of money. Give him some of the liquid to drink, and we will prepare him. He will do very big business, and he will give you anything you ask for. There will be more miracles and testimonies today.

Antobam smiled to himself. “I am going to be a very rich man in only a few days man. Money, power, and women. Wow! Antobam got to the grounds at 5, but there were quite a number of people waiting.

Mr Kwame Dofu was among them. He greeted them all, and they came around to shake his hand. “My brothers and sisters, I assure you that whatever your problem is, you will not go home without a solu­tion.” Shouts of “Amen” “thank” you Osofo and “you are a true man of God” responded.

“Please take your seats, and start talking to the great one about what­ever bothers you. Before the service is over, there will be a solution.” He waved Mr Dofu over, and went with him to the wooden structure that serves as a temporary office.

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“My brother, I have done quite a lot of work on the issue you came to see me about. I have prepared a special, powerful package for you. Take this, drink it, and go back to your business. I want to see you in two weeks.”

Beaming with smiles, Mr Dofu drank the foul smelling liquid in two gulps, said a big thank you to Anto­bam and took his leave. “I believe you, Papa Osofo. And I assure you that I will reward you, big time.”

Just when Osofo Antubam finished with Mr Dofu, Mary and Suzzie went over to him. “Good Morning ladies. I am very sorry about yesterday. I drank too much of the stuff you gave me. Today will be different, I assure you.”

“Don’t worry, Osofo. Since you are now setting things up, our main concern now is to help you to put things in place, and to make you comfortable. We are always there to serve you. This morning, Osofo, we want to go and clean up your place, and prepare something nice for you when you close.

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And before coming to church, we will pass by the bank and collect the forms. After you have signed them, the account will be open. You can check the payments anytime and, of course, issue cheques whenever you need money.”

“Suzzie and Mary, I am happy I picked the two of you from the very start. Listen, I will take good care of you, okay? Here is some money. Buy whatever you need for the errands you have mentioned.

And here is the key. Please come back as early as you can. You know I need you here.” The service was very lively. The lively singing of praise songs was followed by one and a half hours of testimonies.

Most of them related to money – big sales, new jobs and overdue debts paid. But there were also testimonies about healing. Barren women had taken seed, and, of course, several men who had lost their bedroom authority had re­gained them, to the delight of their partners.

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As he had promised, Antobam preached for only 30 minutes, ex­horting the congregation to attend church regularly, pay their tithes and offerings, and strictly follow his ‘directions’ for securing solutions to their problems.

After another round of prais­es during which the congregation danced to the floor to drop their offering, he closed the service, grabbed the big bowl which was full to the brim with money, and moved to his desk. A long queue was quick­ly formed at the desk.

Meanwhile, Mary and Suzzie had gone to give Antobam’s place quite a decent look. A new bedsheet and pillows, a secondhand carpet and four plastic chairs placed in the verandah had done the trick.

They also prepared two fish and chicken stews. After all these, they rushed to the National Savings Bank and collected application forms for opening current and savings ac­counts.

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They joined the service a few min­utes before the main session closed. Antobam looked round and saw, to his relief, Mary and Suzzie moving towards him. “Hello ladies. What have you been up to?” “Quite a bit, Osofo. We’ve just collected your drink. Here you are. We’ve made a few changes at your place. I think you will like it. You will also have something nice to eat. Now, here are the forms for the savings and current accounts.

If you will sign them, the bank will open the account. From today, we can pay all monies direct into the account.” ‘How can I thank you, ladies?” “You don’t need to thank us,” Suzzie said. “It is our duty to help a man of God succeed.” “Okay, my ladies, please take the offerings and count them as you did yester­day.

You can add the payments made after the consultations. Will it be possible to pay them into the account today?” “Yes,” Mary said. “The bank closes at four. If we leave here at three, we would be there just in time.”

The two friends started counting, as Osofo Antobam gave his clients his directions for solving their prob­lems. On quite a few occasions he closed his eyes as if he was receiv­ing direction from above on what to do.

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But as the fetish priest at the Nana Kofi Broni shrine and the dwarfs had assured him, the solu­tions would certainly be provided. Having heard the huge testimonies earlier in the day, the clients parted with substantial sums of money in expectation.

By Ekow de Heer

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