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By Prof. Moses Galukande

It is fairly well known now that when blood clots in our blood vessels, it is a potentially life threatening condition. And many people have lost their lives on the account of clots formation in the blood vessels. For the most part this can be prevented.

How common is it?

Whereas in the past it was thought to be less common in Africa, we have lately seen a surge. Clots are more likely in Africa in people who have just had surgery, child birth and pregnancy. Globally it is estimated that up to 2 million people annually will develop this potentially life threatening condition.

What are they?

Blood is a thick fluid that has several components that would be prone to getting stuck inside our vessels but through complex well-coordinated mechanisms including naturally occurring blood thinners it is able to flow seamlessly through the vessels back and fro, up and down.

Clotting is a useful process designed to prevent one from bleeding to death should a blood vessel get opened up.

How do clots form?

Blood clots form when blood loses its fluidity and tends towards a partially solid state (gel-like) and gets stuck in parts of veins or arteries or plugs them.

There are three factors that contribute to clot formation. One, the fluidity of the blood, the thicker it gets the more likely to clot, and a number of things can lead to this. Two, the vessels through which the blood flows, damage to the vessel walls trigger clots formation, for example uncontrolled high blood pressure damages vessel walls. Three, the speed with which the blood flows in the vessels, with sluggish flow the risk goes up, as in when one stays in one place for a long time without moving.

Where do clots form and move to?

The more deadly forms of clots are those that form in the deep veins of the legs, dislodge and move to the lungs (medical term is Pulmonary Embolism (PE).   In the lung, these clots block arteries and prevent oxygen delivery to vital organs. Clots may plug a vessel in the brain (stroke), the intestines (causing part of the intestines to die off), the kidneys and limbs.

How deadly are clots?

When clots form inside the vessels the body often attempts to dissolve them naturally, they only become dangerous when the natural dissolution fails or delays. Clots plug vessels partially or completely and restrict blood flow, decrease oxygen levels in the blood, and spark off a whole cascade of events. Large or multiple blood clots can be fatal.

How do you know you got a clot in the lungs?

Sudden shortness of breath that isn’t caused by exercise, chest pain, palpitations (rapid heart rate).

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By Prof. Moses Galukande

What is it?

Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorder. Functional, means in this case that the physical disorder in which the symptoms have no known or detectable organic basis. Organic means, without clearly defined physical cause or structural change in the organ in question.

In a consensus meeting by numerous global experts in the field called ‘Rome IV criteria’, IBS was characterized by as repeated abdominal pain, on an average of at least 1 day a week in the last 3 months, associated with two or more of the following: related to defecation, association with a change in frequency of stool or association with a change in form (appearance) of stool.

Are there types of Irritable bowel syndrome (IBS)?

For the purpose of treatment, IBS can be divided into three types, based on your symptoms: one; constipation which is predominant, two; diarrhea is predominant or three a mix of the two.

How common is it?

From the available community surveys, it goes as high as 1 in 10 people, though it varies from community to community. Not much work has been documented in most African countries about IBS.

How is it diagnosed?

With the above criteria and the absence of organic cause a diagnosis is made. The absence of organic cause is after a whole lot of investigations are done. These investigations include but not limited to lab tests, imaging tests and endoscopy. It is a diagnosis of exclusion, i.e. after all else has been ruled out.

Diagnostic procedures can include:

Colonoscopy. A small, flexible tube with a powerful light at the end of it, is used to examine the entire length of the colon.

X-ray or CT scan. These tests produce images of your abdomen and pelvis that might allow a health worker to rule out other causes of your symptoms, especially if you have abdominal pain. We might also investigate the large intestine by pushing in a “dye’ (barium) to make any problems more visible on X-ray. This barium test is sometimes called a lower GI series.

Upper endoscopy. A long, flexible tube is inserted down your throat and into the tube connecting your mouth and stomach (esophagus). A camera on the end of the tube allows us to inspect your upper digestive tract and obtain a tissue sample (biopsy) from your small intestine and fluid to look for overgrowth of bacteria.

Laboratory tests can include:

Lactose intolerance tests. Lactase is an enzyme you need to digest the sugar found in dairy products. If you don’t produce lactase, you may have problems similar to those caused by IBS, including abdominal pain, gas and diarrhea. A breath or blood test confirms lactose intolerance or if you remove milk and milk products from your diet for several weeks and the problem goes away it is another way of proving it.

Breath test for bacterial overgrowth. A breath test can also determine if you have bacterial overgrowth in your small intestine. Bacterial overgrowth is more common among people who have had bowel surgery or who have diabetes or some other disease that slows down digestion.

Stool tests. Your stool might be examined for bacteria or parasites, or a digestive liquid produced in your liver (bile acid), if you have chronic diarrhea.

Who gets it?

Early studies have suggested a low prevalence (occurrence) of IBS in developing countries, but more recent research has shown an increasing prevalence in newly developed and developing economies as they become more ‘westernized’. Westernized, means taking on a lifestyle as in the west, not limited to adoption of the western diets.

The Irritable bowel syndrome (IBS) is more common in women in their 20 to 40s.

Is it curable?

Because IBS is a chronic condition, it may not go away completely. However, medication and lifestyle changes can help you manage the condition and reduce the frequency of attacks.

Does it worsen as we grow older?

Although seniors may feel that IBS is an inevitable part of aging, the opposite is actually true. While sensitivity of the nerves within the digestive system may increase with age, there are ways to help reduce the overall risk or alleviate the symptoms.

Are there triggers of IBS?

There is psychological stress and there is irritation caused by particular foods and drinks, and this may vary from person to person, the idea here is to be careful to note what food provokes your intestines, then withdraw from it, if relief comes, introduce it again at some point, if the symptoms return, there is your confirmation. However, there are food allergy tests that can be done by taking a blood sample to check incompatibility with your system.

How can I control it?

Try a high fiber diet. Fiber helps reduce constipation but also can worsen gas and cramping.

Avoid problem foods. Eliminate foods that trigger your symptoms.

Eat at regular times. Don’t skip meals, and try to eat at about the same time each day to help regulate bowel function.

Exercise regularly.

Deal with mental stress, relax, worry less, socialize, and talk to a counsellor or clinical psychologist.

Does IBS lead to cancer?

No, it doesn’t, though cancer can develop independent of it. Generally, after the age of 45 in Uganda, we recommended a regular colonoscopy, regular is every 2-3 years.

When should you worry?

If the following or any of the following is happening, you need a full assessment to be sure nothing sinister is going on.

  • Onset of signs and symptoms after age 45
  • Unintentional weight loss
  • Rectal bleeding
  • Fever
  • Nausea or recurrent vomiting
  • Abdominal pain, especially if it’s not related to a bowel movement, or occurs at night
  • Diarrhea that is persistent or awakens you from sleep
  • Anemia related to low iron

How is it treated?

Treatment of IBS focuses on relieving symptoms so that you can live as normally as possible. Some mood modifying drugs may be deem necessary to add to other measures.

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By Prof. Moses Galukande

What commonly goes wrong with the Gall bladder?

To start with, the gall bladder is a sac like organ, found beneath and attached to the liver. Its primary job is to store bile manufactured from the liver to be used in the digestion of fat. Upon ingestion of fat, the gallbladder releases the bile in it through an adjoining duct (tube) into the small intestines, specifically a part of the small intestines called the duodenum. The bile mixes with the fat, cuts it down into bits that the rest of the intestines can absorb into the body for use.

One of the commonest afflictions of the gallbladder is the formation of stones in it. These stones are a mix of salts and other debris that is filtered through the liver. When these stones sit in the gall bladder, they rub into its wall (inner lining) and induce inflammation. Inflammation translates into pain in the upper part of the abdomen just below the rib cage on the right. Tissue inflammation consists of swelling, congestion, heat and redness, all these happen on the inside of the abdomen in the gall bladder. Once the inflammation sets in, each time after a meal is ingested, the action of releasing bile from the gall bladder will induce intense pain. Avoiding fatty meals rests the gall bladder and therefore reduces the pain attacks. This inflammation may be made worse by a bacterial infection superimposing on the presence of stones. Occasionally, it is also possible to have inflammation with no stones.

The risks for developing gall stones include, but are not limited to the female gender, commoner among women, mostly in their forties, women who have had children and are overweight. Men are not exempted, though. The other associated risk factors are an excess of fat in the blood commonly known as cholesterol. To find out if you have high cholesterol is by doing a laboratory test called a lipid profile.

What a patient with gallstones is likely to complain about, is pain in the upper abdomen, worsened by taking a fatty meal. Though often most mistake these symptoms for ‘ulcers’ and therefore would have ‘eaten’ a lot of antacids before an ultrasound reveals the presence of gallstones; because occasionally ‘ulcers’ co-exist with gall bladder diseases, an endoscopy is performed to exclude  this possibility. Endoscopy is a specialized gadget used to inspect the inside of the food pipe, stomach and intestines.

Once present and symptomatic (causing trouble), the permanent solution is to take out the entire gallbladder with the stones. Removing only the stones without the gall bladder will certainly end up in a recurrence (stones forming again).

Now days, there are two options of removing the gallbladder with its stones, the open method where a large incision is made on the tummy, up to 10-15cm and option two is  keyhole also called minimally invasive or laparoscopic surgery, where a couple of tiny 1cm each stab incisions are used.

For the majority of patients, the surgery goes well and all symptoms resolve and life goes back to normal. Both options the open and keyhole are ably done in Uganda. There is now sufficient expertise and equipment in several hospitals.

 

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26th May 2022

To our est​​eemed clients,

International Medical Group is undergoing a name change and is being rebranded to “C-Care”, and as our trusted and reliable client in our endeavours, I wanted to keep you apprised of the exciting proceedings.

C-Care” is a multi-national healthcare group based in Mauritius and listed on the

Mauritian Stock Exchange that is part of a multi-sector company, Ciel Ltd, operating across Africa and Asia.

Accordingly, all of our subsidiaries will be rebranded under:

  1. International Hospital Kampala will become C-Care IHK

  1. International Medical Centre will become C-Care IMC

We are pleased to add the following brands to our growing portfolio

  1. C-Labs.

  1. C-Pharma.

We are augmenting our capacity to deliver quality healthcare services by expanding and improving our facilities, programs and services. It is my sincerest hope that you will embrace the exciting upcoming changes as we launch “C-Care” and remain the dependable client you have always been. Your continued collaboration is as important to us now as ever before. Thank you for your support and we take the next step in revolutionising medical care in the region.

Yours faithfully,

Sukhmeet Sandhu

CEO

 

C-Care

Tel: +256 (0) 312 200 400

Fax: +256 414 345 768

P.0 Box 8177, Kampala, Uganda

Plot 4686, St. Barnabas Road, Kisugu- Namuwongo

 

 

 



 

By Prof. Moses Galukande

Beverage simply means a drink other than water. Although there are several, tea and coffee are most popular nonalcoholic beverage globally.

After water, tea is the most popular drink in the world. Tea is made by pouring hot water over cured tea leaves. This popular beverage can be enjoyed hot or cold, and can bring different health benefits. Tea plants mostly grow in Asia, but tea is enjoyed in many countries around the world.

There are over 3000 varieties of tea, each with its own specific characteristics. The naming and growing of teas is in many ways similar to wine. Just as Bordeaux wine is named after the Bordeaux region in France many teas are also named after the area they are grown in.

The other popular hot beverage is coffee, though Ugandans do more tea than coffee.

Some history of the most popular nonalcoholic beverages

Tea: The history of tea dates back to ancient China, almost 5,000 years ago. According to legend, in 2732 B.C. Emperor Shen Nung discovered tea when leaves from a wild tree blew into his pot of boiling water. He was immediately interested in the pleasant scent of the resulting brew, and drank some.

Coffee: The history of coffee begins in legend. According to one legend, ancestors of today’s Oromo people in a region of Jimma in Ethiopia were the first to recognize the energizing effect of the coffee plant. A one Kaldi in Ethiopia in  the 9th-century discovered the stimulating effect of coffee when he noticed how excited his goats became after eating the beans from a coffee plant goes another legend, probably both of doubtful authenticity, although widely circulated as being true.

Is there any danger of taking hot beverages?

Yes , danger number one ; Whether you are preparing, serving, or drinking a hot beverage, scalds can occur as a function of exposure time and temperature of the liquid.

When I was growing up tea was served hot, and if not piping hot the older family members would ask for it to be rewarmed or rather re- boiled.

In some countries including China, Iran and those in South America, where teas such as the bitter herbal infusion mate are traditionally drunk at extremely high temperatures — above 65 or 70 degrees Celsius.

Danger number two; There is also some evidence that longstanding consumption of “very hot” beverages (60 degrees Celsius and above may increase the risk of esophageal cancer. Oesophageal cancer is cancer of the food pipe. It is one of the cancers the difficult cancers to successfully treat.  Whereas hot beverages are not the number one risk factor, it should be avoided. In 2016, the World Health Organization issued a report that found; drinking “very hot” beverages of any kind could potentially raise the cancer risk, and it classified them as “probably carcinogenic” to humans.

Advice on hot beverages

While there are plenty of reasons to enjoy drinking tea or any other beverage, you may want to let that piping hot beverage cool down a bit before you take a sip.

How do I know it is that hotter than recommended without dipping a thermometer in my cup at table?

In general, hot water is 54 Celsius or above. Warm water is 32 to 43C. Cold water is generally between 15 and 27 C.

If you want to form a very rough idea of whether water is cold, lukewarm, or hot, first hold your hand above the water. If you feel heat radiate off of the water, it is hotter than recommended and may burn you. If you feel no heat, the water will either be room-temperature or cold.

What are the advantages of taking acceptably hot tea or water?

Drinking water, hot or cold, keeps your body healthy and hydrated. Some people claim that warm water specifically can help improve digestion, relieve congestion, and even promote relaxation, compared with drinking cold water.

How hot are the beverages when served?

Often times, in commercial places or even homes hot beverages are served at temperatures near their brewing temperature; far hotter than recommended.

A more rationale practice is to let them sit for a while to cool before serving them.

What to do after hot beverages are served?

Mixing very hot beverages with cooler beverages. Even small amounts of mixing can have significant effects. For instance, cooled coffee could be mixed into a hot, freshly brewed coffee to reduce temperature without dilution. Alternatively, milk, creamer, or other cooler liquids could be added as appropriate.

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