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Archive for June 2017

World Sickle Cell Day

19  JUNE SICKLE CELL DAY by Dr. Rabia Sardar
Sickle-cell disease (SCD) is a group of blood disorder . The most common type is known as sickle-cell anaemia (SCA). It results in an abnormality in the oxygen-carrying protein haemoglobin  (hemoglobin S) found in red blood cells. This leads to a rigid, sickle shape under certain circumstances. sickle cell disease typically begin around 5 to 6 months of age. A number of health problems may develop, such as attacks of pain (“sickle-cell crisis”),anemia, swelling in hand and feet, bacterial infections and stroke .Long term pain may develop as patient get older.
Sickle-cell disease occurs when a person inherits two abnormal copies of the hemoglobin gene, one from each parent. This gene occurs in chromosome 1. Several subtypes exist, depending on the exact mutation in each haemoglobin gene. An attack can be set off by temperature changes, stress,dehydration, and high altitude.A person with a single abnormal copy does not usually have symptoms and is said to have sickle cell trait. Such people are also referred to as carriers. Diagnosis is by a blood test and some countries test all babies at birth for the disease. Diagnosis is also possible during pregnancy.The care of people with sickle-cell disease may include infection prevention with vaccination and antibiotics , high fluid intake , folic acid supplementation, and pain medication. Other measures may include blood transfusion, and the medication hydroxycarbamide (hydroxyurea)A small proportion of people can be cured by transplant of bone marrow.
Sickle Cell Disease is one of the most frequent genetic disease worldwide. It is present on four continents: in sub-Saharan Africa , in Asia (Middle-East, Arabic peninsula, India,Pakistan), in the Americas, on the North (USA), centre (Guatemala, Caribbean islands), and on the South (Brazil,Surinam, Guiana), in Southern Europe (Southern Italy and Sicily, Greece, Turkey). It is estimated that 500.000 are born every year with this severe and invalidating condition and that 50% of them will die before the age of 5 years..
DIAGNOSIS
Abnormal haemoglobin forms can be detected on haemoglobin electrophoresis. Sickle-cell haemoglobin (HgbS) and haemoglobin C with sickling (HgbSC) the two most common forms . The diagnosis can be confirmed with high performance liquid chromatography ,Genetic testing, are highly specific for HbS and HbC .An acute sickle-cell crisis is often precipitated by infection. Therefore, a urinalysis to detect an occult urinary tract infection, and chest X-ray to look for occult pneumonia should be routinely performed.People who are known carriers of the disease often undergo genetic counseling, before they have a child. A test to see if an unborn child has the disease takes either a blood sample from the fetus or a sample of amniotic fluid. Since taking a blood sample from a fetus has greater risks, the latter test is usually used. Neonatal screening provides a better method of early detection for individuals with sickle-cell disease
SIGN AND SYMPTOMS

Sickle-cell crisis

The terms “sickle-cell crisis” or “sickling crisis” may be used to describe several independent acute conditions occurring in patients with SCD. SCD results in anemia and crises that could be of many types including the vaso occlusive crisis,aplastic crisis, sequestration crisis, haemolytic crisis, and others. “Although infection, dehydration, and acidosis (all of which favor sickling) can act as triggers, in most instances, no predisposing cause is identified
Vaso-occlusive crisis

Painful crises are treated with hydration, analgesics , and blood transfusion, pain management requires opoids administration at regular intervals until the crisis has settled. For milder crises, a subgroup of patients manage on (NSAIDs) such as diclofenac and naproxen. For more severe crises, most patients require inpatient management for intravenous opioids devices are commonly used.

Splenic sequestration crisis

Because of its narrow vessels and function in clearing defective red blood cells, the spleen is frequently affected.It is usually Infarcted before the end of childhood in individuals suffering from sickle-cell anemia. This spleen damage increases the risk of infection from encapsulated organism. preventive antibiotics and vaccinations are recommended.Splenic sequestration crises are acute, painful enlargements of the spleen, caused by intrasplenic trapping of red cells and resulting in a precipitous fall in hemoglobin levels with the potential for hypovolemic shock. Sequestration crises are considered an emergency. If not treated, patients may die within 1–2 hours due to circulatory failure. Management is supportive, sometimes with blood transfusion. These crises are transient, they continue for 3–4 hours and may last for one day

Acute chest syndrome

(ACS) is defined by at least two of the following signs or symptoms: chest pain, fever, pulmonary infiltrate or focal abnormality, respiratory symptoms

Aplastic crisis

Aplastic crises are acute worsenings of the patient’s baseline anaemia, producing palor ,increased heart rate and fatigue. This crisis is normally triggered by parvovirus B19, which directly affects production of red blood cells by invading the red cell precursors and multiplying in and destroying them. Parvovirus infection almost completely prevents red blood cell production for two to three days. In normal individuals, this is of little consequence, but the shortened red cell life of SCD patients results in an abrupt, life-threatening situation.Reticulocyte counts drop dramatically during the disease (reticulopenia), and the rapid turnover of red cells leads to the drop in haemoglobin. This crisis takes 4 days to one week to disappear. Most patients can be managed supportively; some need blood transfusion.

Hemolytic crisis

Hemolytic crises are acute accelerated drops in haemoglobin level. The red blood cells break down at a faster rate. This is particularly common in patients with coexistent G6DP deficiency. Management is supportive, sometimes with blood transfusion.
The World Health Organization (WHO) has started work to promote a world wide agenda to address hemoglobin dysfunctions.
WHO has made a commitment to:
·         Recognize that sickle cell disease is a major health issue.
·         Increase awareness of the world community regarding sickle cell disease.
·         Eliminate harmful and wrong prejudices associated with sickle cell disease.
·         Urges member countries where sickle cell disease is a public health problem to establish health programs at the national level and operate specialized centers for sickle cell disease and facilitate access to treatment.
·         Promote satisfactory access to medical services to people affected with sickle cell disease.
·         Provide technical support to all countries to prevent and manage sickle cell disease.
·         Promote and help research to improve the lives of people affected with sickle cell
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CHAP Accreditation: First in the UAE & in the MIDDLE EAST

FLORIDA HOME CARE takes pride on its recent achievement of ZERO DEFICIENCY in the Accreditation conducted by the Community Health Accreditation Partner (CHAP) – the Globally Recognized US Based Accrediting Body.
We are delighted to be the FIRST in the UAE & in the MIDDLE EAST. This accomplishment sets us as one of the BEST in the healthcare industry.

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Announcement: CHAP Accreditation

Florida Home Care is proud to announce and takes pride on its recent achievement of “ZERO DEFICIENCY” in the accreditation conducted by the Community Health Accreditation Partner (CHAP) – the Globally Recognized US Based Accrediting Body.
We are delighted to be the FIRST in the UAE & in the MIDDLE EAST. This accomplishment sets us as one of the BEST in the healthcare industry.

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Potential health complication and remedies during Ramadan

Heartburn (indigestion)
Those who are on regular medication for indigestion, such as antacids (eg Gaviscon), antihistamines (eg Zantac) or proton pump inhibitors (eg Losec, Zoton or Nexium) are advised to continue taking them, at the pre-dawn meal for instance. The control of heartburn or belching can be aided by eating in moderation and avoiding oily, deep-fried or very spicy food. Reducing your caffeine intake and/or stopping smoking can also be of benefit, if relevant. Sleeping with your head raised on a few pillows and long-term weight loss may also help prevent heartburn.

Headache
This is a common problem and has many causes. Headaches during a fast could commonly be due to dehydration or hunger, inadequate rest, or the absence of addictive substances such as caffeine or nicotine. A moderate and balanced diet, especially not missing the pre-dawn meal, consuming adequate quantities of fluid and if necessary taking a dose of painkillers such as paracetamol, may all go a long way towards either preventing or reducing the risk of developing a disabling headache.

Dehydration
Prevention is always better than cure. However, if you do not adequately rehydrate before a fast, your risk of dehydration is increased. This risk is higher in the elderly and in those taking tablets such as diuretics. Depending on the severity of the dehydration, you may experience a general feeling of being unwell, lethargy, muscle cramps, dizziness, disorientation and even collapse or fainting

Constipation
Constipation could be a very irritating problem for someone undertaking a fast. Maintaining good hydration outside the fast, eating healthly, with lots of fruit and vegetables in your diet, increasing the fibre content of your food using bran, and being active all help to keep your bowel motions as regular as would otherwise be expected. If the problem persists, a short course of bulk laxatives may help.

Poor control of diabetes
Those injecting insulin are advised not to fast, as the potential risk to health, both in the short and long term, of not taking insulin is too great. People who have their diabetes under control using tablets should ensure that they visit their GP prior to Ramadan, in order to discuss any possible changes to their drug regime which would facilitate a safe fast. If not, such patients are at risk of poor control of their diabetes during and outside the fasting times. Regular self-monitoring of your blood glucose is strongly advised. Low blood sugar levels (a ‘hypo’) are dangerous, and if untreated may lead to fainting or fits, and hence must be strictly avoided. Feeling dizzy, sweaty and disorientated may all suggest a hypo. If this is suspected, you should immediately have a sugary drink.

– Dr. Rabia Sardar

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World Blood Donors Day

June 14 is World Blood Donor’s Day.
World Blood Donor Day (WHO) is celebrated on 14 June annually all around the world for safe blood and blood products awareness. It also encourages people to donate blood and save a life. Everyone has a life-saving gift which is Blood.
The blood you donate gives someone another chance at life. One day that someone may be a close relative, a friend, a loved one—or even you.

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Foods that are beneficial during fasting

Foods that are beneficial during fasting:

Complex carbohydrates will help release energy slowly during the hours of fasting. They are found in grains and seeds such as barley, wheat, oats, semolina, beans, lentils and basmati rice

Fibre-rich foods are also digested slowly. These include bran, cereals, whole wheat, grains and seeds, potatoes with the skin, vegetables such as green beans and almost all fruit including apricots, prunes and figs.

Foods to avoid, Heavily processed, fast-burning foods containing refined carbohydrates in the form of sugar and white flour. Too much fatty food should also be avoided, cakes, biscuits, chocolates and sweets. The drinks such as tea, coffee and cola could also be avoided because of their caffeine content.

Suhoor – the pre-dawn meal This should be a wholesome, moderate meal that is filling and provides enough energy for many hours. It is very important to include slowly-digested foods. iftar – the meal that breaks the day’s fast, This could include dates or fruit juices to provide a refreshing burst of energy.

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