Is the Quad screen not the same as my usual Ante-natal test?The screen is essentially the same as other medical screening tests that look for other relevant substances, except the likelihood of identifying pregnancies at risk for Down syndrome is higher through the evaluation of Inhibin-A levels. Inhibin-A: inhibin-A is a protein produced by the placenta and ovaries. The Quad test determines a mother’s risk for having a baby with Down syndrome.

The Quad screen test measures levels of four substances in pregnant women’s blood:

• Alpha-fetoprotein (AFP) (a protein made by the developing baby)
• Human chorionic gonadotropin (HCG) (a hormone made by the placenta)
• Estriol (a hormone made by the placenta and the baby’s liver)
• Inhibin A, (another hormone made by the placenta)

The test is done between weeks 15 and up to week 22.

Why is the Quad screen done?

The quad screen evaluates your chance of carrying a baby who has any of the following conditions:

• Down syndrome (trisomy 21). Down syndrome is a chromosomal disorder that causes lifelong intellectual disability and developmental delays and, in some people, health problems.
• Trisomy 18. This is a chromosomal disorder that causes severe developmental delays and abnormalities in the structure of the body. Trisomy 18 is often fatal by age 1.
• Spina bifida. Spina bifida is a birth defect that occurs when a portion of the neural tube fails to develop or close properly, causing defects in the spinal cord and in the bones of the spine.
• Abdominal wall defects. In these birth defects, the baby’s intestines or other abdominal organs stick through the belly button.

The quad screen has traditionally been one of the most commonly used screenings in the second trimester. It was generally used if prenatal care began during the second trimester or if first trimester screening, which involves a blood test and an ultrasound exam, wasn’t available.

A negative quad screen doesn’t guarantee that the baby won’t have a chromosomal abnormality, single-gene disorder or certain birth defects. If your screening test is positive, your doctor will recommend additional testing to make a diagnosis.

Before the screening, think about what the results mean to you. Consider whether the screening will be worth any anxiety it might cause, or whether you’ll handle your pregnancy differently depending on the results.

When should a Quad screen be done?

The Quad screen may be offered to the expectant mother by the obstetrician/gynaecologist between 15 and 20 weeks of pregnancy, counting from the first day of the last menstrual period.

How is a Quad screen  it done?

You can eat and drink normally before the test.

During the Quad screen test, a sample of blood is taken from the woman’s vein. The blood sample is sent to a lab for analysis.

You can return to your usual activities immediately.

Substances in the blood sample are measured to screen for:

• Problems in the development of the fetus’ brain, spinal cord and other neural tissues of the central nervous system (neural tube). Problems with neural tube development can occur as spina bifida or anencephaly (absence of all or part of the brain). Neural tube defects occur in 1 or 2 out of every 1000 births. The quad marker screen can detect approximately 75% of open neural tube defects.
• Genetic disorders such as Down syndrome, a chromosomal abnormality. Approximately 1 in 720 babies is born with Down syndrome. The quad marker screen can detect approximately 75% of Down syndrome cases in women under age 35 and 85 to 90% of Down syndrome cases in women age 35 years and older.

Do I need to have the Quad screen test?

All pregnant women are recommended to have a quad marker screen, but it is your decision whether or not to have the test. However, if you have any of the following risk factors, you may want to strongly consider having the test:

• You are age 35 or older when the baby is due.
• Your family has a history of birth defects.
• You’ve had a child with a previous birth defect.
• You have had insulin-dependent (type 1) diabetes prior to your pregnancy.

If you have any questions or concerns about this test, please talk with your healthcare provider.

Risks

The quad screen is a routine prenatal screening test. The test poses no risk of miscarriage or other pregnancy complications.

Results

Your age and results of the quad screen will be used at the estimated time of delivery to evaluate your chance of carrying a baby who has certain chromosomal conditions, neural tube defects or abdominal wall defects.

Factors that can affect the substances measured by a quad screen include:

• A miscalculation of how long you’ve been pregnant
• Maternal race
• Maternal weight
• Carrying more than one baby during a pregnancy
• Diabetes
• In vitro fertilization
• Smoking during pregnancy

The quad screen correctly identifies about 80 percent of women who are carrying a baby who has Down syndrome. The quad screen only indicates your overall chance of carrying a baby who has certain chromosomal conditions, neural tube defects or abdominal wall defects. A decreased chance (negative screen result) doesn’t guarantee that your baby won’t have one of these conditions. Likewise, an increased chance (positive screen result) doesn’t guarantee that your baby will be born with one of these conditions.The doctor will help you understand your test results and what the results might mean for your pregnancy.

Quick Facts:

What it looks for

• Down syndrome
• Trisomy 18 (Edwards Syndrome)
• Open Neural Tube Defects (ONTD)

When to do it

• 15 weeks, 1 day to 21 weeks, 6 days gestation

Why this test

• Stand-alone second trimester screen
• Screens for open neural tube defects
• Screen for Down syndrome issues

References

https://my.clevelandclinic.org

https://www.mayoclinic.org

https://www.ntd.eurofins.com

American Pregnancy Association Home

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General measures such as oxygen and intravenous fluids are also recommended. Attempts to decontaminate the stomach, with activated charcoal or other means, has not been shown to be useful. While there is a theoretical risk of health care workers taking care of a poisoned person becoming poisoned themselves, the degree of risk appears to be very small.

TREATMENT: Treatment begins with decontamination. Airway control and oxygenation are paramount. The mainstays of pharmacological therapy include atropine, pralidoxime, and benzodiazepines (eg, diazepam). Initial management must focus on adequate use of atropine. Optimizing oxygenation prior to the use of atropine is recommended to minimize the potential for dysrhythmias.

SIGNS AND SYMPTOMS: Signs and symptoms of OP poisoning can be divided into three broad categories: (1) Muscarinic effects, (2) Nicotinic effects, and (3) Central Nervous System (CNS) effects. Symptoms of exposure which typically appear within 30 to 90 minutes after exposures are due to the continuous stimulation of the muscarinic and nicotinic receptors. 

Muscarinic symptoms include excessive secretion from mucus membranes, increased pulmonary and oropharnygeal secretions, pupillary constriction manifesting as diarrhoea, excessive urination, miosis, bronchorrhea, bradycardia, emesis, lacrimation and salivation, commonly tagged with the mnemonic ‘DUMBBELS’. Adrenal medulla activity manifest as increased sweating and garlic smell because of vicarious excretion, bradycardia, abdominal cramping and intestinal hypermotility.

Nicotinic activity results in autonomic nervous system stimulation manifesting as tachycardia, hypertension, sweating and rarely dilated pupil. Nicotinic overstimulation at the neuromuscular junction causes muscle weakness, fasciculation, fatigue and paralysis

OP toxicity is a clinical diagnosis. Diagnosis is typically based on the symptoms and can be confirmed by measuring butyrylcholinesterase activity in the blood; but typically, these results are not readily available.

PATHOPHYSIOLOGY: The underlying mechanism involves the inhibition of acetylcholinesterase (ACHE), leading to the buildup of acetylcholine (ACh) in the body. AChE is an enzyme that degrades the neurotransmitter acetylcholine (ACh) into choline and acetic acid. ACh is found in the central and peripheral nervous system, neuromuscular junctions, and red blood cells (RBCs).

OP can be absorbed cutaneously, ingested, inhaled, or injected. Although most patients rapidly become symptomatic, the onset and severity of symptoms depend on the specific compound, amount, route of exposure, and rate of metabolic degradation.

 MANAGEMENT OF OP POISONING DECONTAMINATION: The first step in the management of patients with organophosphate poisoning is putting on personal protective equipment. These patients may still have the compound on them, and you must protect yourself from exposure. Health care providers must avoid contaminating themselves while handling patients. Use personal protective equipment, such as neoprene gloves and gowns, when decontaminating patients because hydrocarbons can penetrate nonpolar substances such as latex and vinyl. Use charcoal cartridge masks for respiratory protection when decontaminating patients who are significantly contaminated.

Secondly, you must decontaminate the patient. This means removing and destroying all clothing because it may be contaminated even after washing. Gently cleanse patients suspected of organophosphate exposure with soap and water because organophosphates are hydrolyzed readily in aqueous solutions with a high pH.

Irrigate the eyes of patients who have had ocular exposure using isotonic sodium chloride solution or lactated Ringer’s solution.

In the case of ingestion, vomiting and diarrhea may limit the amount of substance absorbed but should never be induced. Activated charcoal can be given if the patient presents within 1 hour of ingestion, but studies have not shown a benefit. 

MEDICAL CARE: Airway control and adequate oxygenation are paramount in organophosphate (op) poisonings. Intubation may be necessary in cases of respiratory distress due to laryngospasm, bronchospasm, bronchorrhea, or seizures. Immediate aggressive use of atropine may eliminate the need for intubation. Succinylcholine should be avoided because it is degraded by plasma cholinesterase and may result in prolonged paralysis. In addition to atropine, pralidoxime and benzodiazepines (e.g. diazepam) are mainstays of medical therapy .   The definitive treatment for organophosphate poisoning is atropine, which competes with acetylcholine at the muscarinic receptors. The initial dose for adults is 2 to 5 mg IV or 0.05 mg/kg IV for children until reaching the adult dose. If the patient does not respond to the treatment, double the dose every 3 to 5 minutes until respiratory secretions have cleared and there is no bronchoconstriction. In patients with severe poisoning, it may take hundreds of milligrams of atropine given in bolus or continuous infusion over several days before the patient improves.

Pralidoxime also should be given to affect the nicotinic receptors since atropine only works on muscarinic receptors. Atropine must be given before pralidoxime to avoid worsening of muscarinic-mediated symptoms. A bolus of at least 30 mg/kg in adults or 20 to 50 mg/kg for children should be given over 30 minutes. Rapid administration can cause cardiac arrest. After the bolus, a continuous infusion of at least 8 mg/kg/hr for adults and 10 to 20 mg/kg/hr for children should be started and may be needed for several days. Central venous access and arterial lines may be needed to treat the patient with organophosphate toxicity who requires multiple medications and blood-gas measurements.   Continuous cardiac monitoring and pulse oximetry should be established; an electrocardiogram (ECG) should be performed. Torsades de pointes should be treated in the standard manner. The use of intravenous magnesium sulfate has been reported as beneficial for organophosphate toxicity. The mechanism of action may involve acetylcholine antagonism or ventricular membrane stabilization.

SURGICAL CARE: Patients with trauma or blast injury should be treated according to standard advanced trauma life support (ATLS) protocol. Patient decontamination should always be considered to prevent medical personnel poisoning.

INPATIENT CARE: Because of risks of respiratory compromise or recurrent symptoms, hospitalizing all symptomatic patients for at least 48 hours in a high acuity setting is recommended. Patients who are asymptomatic 12 hours after organophosphate exposure can be discharged since symptom onset should usually occur within this time frame.   Optimal recommendations are made on a case-by-case scenario.   Following occupational exposure, patients should not be allowed to return to work with organophosphates until serum cholinesterase activity returns to 75% of the known baseline level. Also, establishing baseline cholinesterase levels for workers with known organophosphate exposure is recommended

It is vital that health care providers working at primary and secondary level facilities should be informed of the hazards, clinical presentation of accidental organophosphate poisoning in children, and the key steps in its management.

REFERENCE

The post Organophosphate Poisoning 2: Prevention, Treatment and Care appeared first on St. Nicholas Hospital.

1. Beans.

You’ve probably never heard of cholecystokinin, but it’s one of your best weight-loss pals. This digestive hormone is a natural appetite suppressant. So how do you get more cholecystokinin? One way, report researchers at the University of California at Davis, is by eating beans: A study of eight men found that their levels of the hormone (which may work by keeping food in your stomach longer) were twice as high after a meal containing beans than after a low-fiber meal containing rice and dry milk.

2. Salad. 

Do you tend to stuff yourself at meals? Control that calorie intake by starting with a large salad (but hold the creamy dressing.) A study published in the Journal of the American Dietetic Association found that people who ate one salad a day with dressing had higher levels of vitamins C and E, folic acid, lycopene, and carotenoids-all disease fighters-than those who didn’t add salad to their daily menu.

3. Green tea. 

The slimming ingredient isn’t caffeine. Antioxidants called catechins are what help speed metabolism and fat burning. In a recent Japanese study, 35 men who drank a bottle of oolong tea mixed with green tea catechins lost weight, boosted their metabolism, and had a significant drop in their body mass index. Health bonus: The participants also lowered their (bad) LDL cholesterol.

4. Olive oil. 

Fight off middle-age pounds with extra virgin olive oil. A monounsaturated fat, it’ll help you burn calories. In an Australian study, 12 postmenopausal women (ages 57 to 73) were given a breakfast cereal dressed either with a mixture of cream and skim milk or half an ounce of olive oil and skim milk. The women who ate the oil-laced muesli boosted their metabolism.

5. Grapefruit.

 It’s back! A  2006 study of 91 obese people conducted at the Nutrition and Metabolic Research Center at Scripps Clinic found that eating half a grapefruit before each meal or drinking a serving of the juice three times a day helped people drop more than three pounds over 12 weeks. The fruit’s phytochemicals reduce insulin levels, a process that may force your body to convert calories into energy rather than flab.

Summarily:

• When making choices within food groups, select fresh instead of canned foods
• Become a label reader to determine which foods are high in sodium
• Use low sodium versions of soups and other packaged foods
• Eat plenty of fresh fruits and vegetable
• Choose whole-grain rice, pastas, cereals and breads
• Keep in mind that sodium occurs naturally in some foods, like breads and dairy products
• Avoid processed meats, like cold cuts
• Avoid high-sodium condiments like soy sauce, pickles, and olives
• Limit the amount of salt you add during cooking
• Taste your food before salting it
• Use herbs, spices, vinegars, fruits, and vegetables to add extra flavor to your food so you won’t miss the salt

source: WebMd.

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While most often the exposure occurs from an agricultural pesticide, there are household items, such as ant and roach spray, that also contain organophosphate compounds. Organophosphate pesticides are one of the top causes of poisoning worldwide, with an annual incidence of poisonings among agricultural workers varying from 3-10% per country.

Organophosphate insecticides are common household products in Nigeria, where they are used mainly to control mosquitoes and other household pests such as cockroaches and bed bugs. More than 80% of the reported toxic exposures to insecticides are attributable to organophosphates.

The prevalence of accidental childhood poisoning across different countries ranges from 0.74% – 7.2% of paediatric admissions with organophosphate poisoning accounting for 7.5%-34.6% of cases of accidental childhood poisoning in Nigeria.

The World Health Organization (WHO) noted that pesticide poisoning is now the most common method of suicide worldwide. About two million people attempt suicide and one million accidental poisoning cases occur each year worldwide.

In Nigeria, suicide is traditionally a taboo. However, the recent report of cases of intentional poisoning is probably as a result of media influence or breakdown of our traditional social fabric. A ten-year retrospective study of childhood poisoning in Warri, South-south Nigeria, noted that intentional poisoning occurred in the adolescent age group and mainly involved female teenagers. Organophosphates were observed to be the sole agent for intentional poisoning in the retrospective review of cases seen in North-central Nigeria and these were adolescent females.

WHAT IS ORGANOPHOSPHATES (OP)? Organophosphate (OP) compounds are a diverse group of chemicals used in both domestic and industrial settings. They are often constituents of pesticides and insecticides. Some of these products are produced in an unregulated manner and sold by unregistered vendors on the streets and in market places in sub-Saharan Africa. When purchased, and improperly stored, children may easily have access to, and inadvertently consume them. Indeed, globally, organophosphate poisoning is the most significant cause of severe toxicity and mortality resulting from acute poisoning. 

Examples of organophosphates include the following: Insecticides – Malathion, parathion, diazinon, fenthion, dichlorvos, chlorpyrifos, ethion. Nerve gases – Soman, sarin, tabun, VX. Ophthalmic agents – Echothiophate, isoflurophate. Antihelmintics – Trichlorfon. Herbicides – Tribufos (DEF), merphos. Industrial chemical (plasticizer) – Tricresyl phosphate.

The most popular source of organophosphate insecticide/pesticide in Nigeria is the locally made variety called ‘Otapiapia’. The main active ingredient in ‘otapiapia’ is dichlorvos or 2, 2-dichlorovinyl dimethyl phosphate (DDVP), and are readily available for purchase on the streets. ‘Sniper’, which is another common variety of DDVP has a more refined packaging and is available in stores nationwide at a higher cost.

OP poisoning occurs most commonly as a suicide attempt in farming areas of the developing world and less commonly by accident.  Exposure can be from drinking, breathing in the vapors, or skin exposure.  

Cheap locally-made preparations of organophosphates are widely available and unregulated in low income settings such as in Nigeria. These preparations are stored at home in old soft drink or juice containers which attract unsuspecting children resulting in unintentional poisoning.

Sniper, is marketed in Nigeria by Swiss-Nigerian Chemical Company, as a synthetic organophosphorus but which many Nigerians have converted to an indoor insecticide. There have been cases of sniper poisonong in Nigeria; a 400-level student of the Department of English and Literary Studies, University of Nigeria, Nsukka (UNN), allegedly drank two bottles of Sniper insecticide leading to his death on Tuesday, May 14, 2019. Friends said he had a long battle with depression before his death. 

Other cases are A Niger Delta University student, who committed suicide by drinking Sniper after he discovered he had ‘carryover’ in his courses. This came shortly after two female students of University of Lagos were reported to have killed themselves using the insecticide following the accusations that they stole clothes in their hostel. Another 32-year-old banker and mother of two in Delta State, committed suicide over her husband’s alleged infidelity. She also took Sniper.

MORTALITY/MORBIDITY: Worldwide mortality studies report mortality rates from 3-25%. The compounds most frequently involved include malathion, dichlorvos, trichlorfon, and fenitrothion/malathion.   Mortality rates depend on the type of compound used, amount ingested, general health of the patient, delay in discovery and transport, insufficient respiratory management, delay in intubation, and failure in weaning off ventilatory support.   Complications include severe bronchorrhea, seizures, weakness, and neuropathy. Respiratory failure is the most common cause of death.

Written by St. Nicholas Hospital Pharmacy Department

REFERENCES

The post Management of Organophosphate Poisoning (Op)1 appeared first on St. Nicholas Hospital.

•Wash your hands often with soap and water

•Avoid contact with sick or dead wildlife such as bush meat

•Use Personal protective equipment when necessary

•Thoroughly cook all animal products before eating

Contributed by St.Nicholas Hospital Quality Assurance Unit

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Do you know that:

Ewedu is called Rama in Hausa, malukhiyah in Egypt, molohiya in Isreal, krain krain in Sierra Loene and mrenda in Kenya.Ewedu is used to produce soup (taushe) or mixed with kuli kuli (groundnut cake) to form a dish known as kwado in Hausa. Ewedu is good for weight loss because of its low calorific content and it helps strengthen the immune system, fights off stress and heart disease.

Ewedu is a folk remedy for aches and pains, dysentery, enteritis, fever, dysentery, pectoral pains, and tumors.

This green, leafy vegetable is rich in beta-carotene for good eyesight, iron for healthy red
blood cells, calcium for strong bones and teeth, and vitamin C for smooth, clear skin,
strong immune cells, and fast wound-healing. Vitamins A, C and E present in Ewedu
“sponge-up” free radicals, scooping them up before they can commit cellular sabotage.

One-half cup cooked Ewedu leaves contains: 1.3g protein, 0.3g fat, 3.1g carbohydrates,
0.4g fiber, 87.3mg calcium, 22.5mg phosphorous, 1.0mg iron, 0.02mg thiamine, 0.04mg riboflavin, 0.3mg niacin, and 10mg Ascorbic Acid or vitamin C. Ewedu has an antioxidant activity of 77%.

Contributed by Ebuka Ezeji.

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These studies helped demonstrate that handwashing can prevent spread of two of the leading killers of young children in the developing world. However, although handwashing seems outwardly simple, the habit of washing hands consistently and at the key times can be difficult to form. Additionally, handwashing does require some basic infrastructure: a water source and a hand cleanser like soap, ideally placed somewhere convenient to access during the most important times to wash hands, such as after using the toilet and before preparing or eating food. Establishing and maintaining such infrastructure may be challenging in some settings. Thus, while the type of intensive handwashing promotion used in these studies can be very effective in reducing disease, it is probably not something that can be delivered efficiently to large numbers of people. Furthermore, it is unclear whether handwashing behaviour change or health impacts are sustained after such promotion ends.

As a result, CDC began investigating models of promoting handwashing behaviour change more efficiently in developing countries. Because hygiene habits generally evolve through childhood, and large numbers of children are concentrated in schools, this strategy included studying schools as a site for handwashing promotion. In one randomized, controlled study, investigators compared absenteeism among three groups of first grade students for 5 months in China. One group was exposed to a simple, commercially-developed handwashing promotion program; a second group received the same program, plus a supply of soap for the school sinks, and one child in each classroom served as a handwashing role model for his or her peers; the third group received hygiene education that was typical for the region. Students in the group that received the handwashing promotion program, soap, and peer hygiene role models were absent substantially less than students who continued to receive standard hygiene education.

Additional research is underway to further clarify the role of school-based handwashing promotion in reducing illness among students and their families in several countries, and to explore the long-term impacts on child development of intensive handwashing promotion.

Source: http://www.cdc.gov/healthywater/hygiene/programs/handwashing-developing-world.html

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HOW CAN YOU TELL IF YOU HAVE BAD BREATH?

Some people worry too much about their breath even though they have little or no mouth odour, while others have bad breath and don’t know it. Because it’s difficult to assess how your own breath smells, ask a close friend or relative to confirm your breath questions. A simple way is to stick a clean finger in your mouth and scrape saliva from the back of your tongue. Put it on the back of your hand, wait a minute, then smell your hand. Does it smell like something you’d want to kiss? If not; don’t despair, check out these tips about causes and cures for bad breath below:

COMMON CAUSES OF BAD BREATH

• Foods: The breakdown of food particles in and around your teeth can increase bacteria and cause a foul odor. Foods such as onion, garlic, and fish can cause bad breath – even hours after you brush your teeth.
• Poor dental hygiene: If you don’t brush and floss daily, food particles remain in your mouth, causing bad breath. A colourless, sticky film of bacteria (plaque) forms on your teeth and if not brushed away, plaque can irritate your gums (gingivitis) and eventually form plaque-filled pockets between your teeth and gums (periodontitis). The uneven surface of the tongue also can trap bacteria that produce odour. And dentures that aren’t cleaned regularly or don’t fit properly can harbour odor-causing bacteria and food particles.
• Dry mouth. Saliva helps cleanse your mouth, removing particles that may cause bad odour. A condition called dry mouth — also known as xerostomia (zeer-o-STOE-me-ah) — can contribute to bad breath because production of saliva is decreased. Dry mouth naturally occurs during sleep, leading to “morning breath,” and is made worse if you sleep with your mouth open.
• Infections in the mouth. Bad breath can be caused by surgical wounds after oral surgery, such as tooth removal, or as a result of tooth decay, gum disease or mouth sores.
• Other mouth, nose and throat conditions: Bad breath can occasionally stem from small stones that form in the tonsils and are covered with bacteria that produce odorous chemicals. Infections or chronic inflammation in the nose, sinuses or throat, which can contribute to postnasal drip, also can cause bad breath.
• Bacteria:  Bacteria breed inside the mouth. These micro organisms lurk between the teeth and tongue. When bacteria become stagnate, they multiply and give off toxins and smelly odours.
• Smoking:  Any type of smoking (cigarettes, cigars, pipe etc.) or chewing tobacco can leave a really bad taste and smell in the mouth.Additionally, Smokers and oral tobacco users are also more likely to have gum disease, another source of bad breath.
• Tummy troubles. Sometimes gastrointestinal (GI) problems such as GERD or an ulcer can cause bad breath when you burp and gas is released.

TIPS TO GET RID OF BAD BREATH

1. Brush your teeth and tongue twice a day to banish bad breath. Brushing the tongue will remove smelly bacteria that cause bad breath. Most people forget to brush the tongue adequately, especially the back of the tongue.

2. Floss once a day for fresh breath. Flossing gets out hidden food particles and removes plaque, a coating of bacteria that forms around the tooth. Flossing also helps prevent periodontal disease another common cause of bad breath.

3. Gargle with peroxide to fight halitosis. An antimicrobial mouthwash is important if you have a problem with excess plaque and can also be used for fresher breath. Just ‘swish’ the product around in your mouth for 30 seconds to one minute, then spit it out. The oxygen in the hydrogen peroxide kills mouth bacteria that cause bad breath.

4. Drink adequate amount of water to avert bad breath. Lack of fluids can lead to dry mouth (xerostomia) and cause bad breath.

5. Eat yogurt for sweeter breath. According to medical experts, Yogurt replenishes the good bacteria in the gut and promotes a healthier mouth.

6.  Chewing gum makes you salivate if your mouth is dry and causing bad breath. Saliva is what washes away the bacteria in your mouth.

 7. See a dentist. At least every six months, see a dentist for teeth cleaning and an oral exam. Your dentist can check your mouth and teeth for open cavities and gum disease that cause bad breath.

If self-care tips don’t work to stop your bad breath, see your doctor. Occasionally bad breath is a sign of a more serious problem, such as an infection, chronic bronchitis, diabetes, or kidney or liver disease.

References:

St. Nicholas Hospital Quality and Safety Group, Mayoclinic.com, webmd.com.

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1.  “Be honest. If you have been prescribed medication and are not taking it regularly or at all, tell me”

• There are many reasons patients do not take their prescriptions, it could be that they decided upon another method of treatment, or only take their medication intermittently. Whatever the reason, providing complete and detailed information about your medication usage is vital to receiving accurate care.

2.  “If you are taking herbal supplements or over-the-counter drugs, or using alternative therapies, let me know”

• It is important that the use of any over-the-counter, alternative or herbal medications is disclosed to your doctor so that he/she can get an accurate idea of your health practices. This is particularly important in countries like Nigeria, where patients have easy access to a multitude of over-the-counter and herbal medications.

3.  “You need to lose weight.”

• According to a study published recently in the National Institute of Health database, in Nigeria the prevalence of overweight individuals ranges from 20.3%-35.1% while obesity ranges from 8.1%-22.2%. Obesity is a problem because it is a precondition for about 35 different health issues, such as heart disease, cancer, depression and many more.

4.  “Tell me what you’re worried about right away, not when you’re leaving.”

• It is important to make the doctor aware of the issues that bother you the most so that such issues are given the most attention. It is also advisable to ask your doctor how he prefers to work.  A recent nationwide survey of Canadian doctors showed that doctors are divided between those who prefer to hear a list of symptoms and those who prefer to approach one problem at a time.

5.  “You don’t need a prescriptionat every visit”

• Whether it is caused by past history, media, or friends; there is a tendency for patients to expect prescription medication after a doctor’s visit, otherwise they feel under-treated. A good physician knows that not all treatment methods require medication. Patients must trust their physicians to do what is best for them.

6.  “Treatment is individualistic. If a method of treatment worked for a family member or friend it doesn’t mean it will work for you”

• It is important to remember that people are different. Therefore, a one-size-fits all treatment is simply not ideal. As mentioned above, trust you doctor to provide you with a treatment regimen that works for you.

7.  “Think carefully about your symptoms before coming to the doctor’s office”

• Be as direct, concise, accurate and as prepared as you can. A full description of your symptoms allows doctors to determine the best place to start. Questions patients can ask themselves are:
• When did the pain start?
• Is it getting better?
• Where is it located?
• What makes it worse?

8.  “Please wash your hands before coming to see me“

• Washing hands is one of the first and most important steps in preventing the spread of disease causing bacteria. Washed hands and basic hygiene in general are basic requirements when going to see your doctor. However, this goes both ways so remember to ask your doctor if he has washed his hands before he touches you.

Adapted from best health magazine -10 things doctors secretly wish they could tell you.

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