Historia ya upasuaji wa moyo

Mapinduzi na maendeleo makubwa katika tiba ya upasuaji wa moyo duniani yanaanzia mwaka 1944 wakati kwa mara ya kwanza duniani katika Hospitali ya John Hopkins nchini Marekani ilifanyika operesheni ya kwanza ya upasuaji wa moyo na kufanikiwa kwa mtoto aliyekuwa na tatizo la moyo la kuzaliwa nalo lililokuwa linasababisha watoto watoto kufa kwa kukosa hewa safi ya oksijeni katika mzunguko wa damu mwilini.

Operesheni hii ilifanywa na Dkt. Alfred Blalock na wanafunzi wake wa upasuaji akiwemo Dkt. Denton A. Cooley (Mwalimu wangu na mwanzilishi wa Texas Heart Institute ya Marekani) baada ya kuombwa na daktari wa watoto, Dkt. Hellen Taussing kujaribu kuokoa maisha ya watoto hao waliokuwa wanakufa bila ya kujua jinsi ya kuwasaidia.

Lakini la muhimu kutambua ni kuwa, operesheni hii ya kwanza duniani ilifanikishwa na kijana Mmarekani mweusi (African-American), Vivien Thomas aliyekuwa msaidizi wa Dkt. Alfred Blalock kwa majaribio ya kisayansi aliyewezesha kufanyika kwa operesheni hii na akafikia kupewa Udaktari wa Heshima (Honorary Doctor of Medicine) na kufundisha madaktari wengi wa upasuaji wa moyo waliopitia katika Hospitali ya John Hopkins. Hivyo operesheni hii huitwa ‘Blalock-Taussing Shunt’. Lakini historia itamkumbuka Dkt. Vivien Thomas kwa mchango wake.

Operesheni hii ilikuwa ni ya kuunganisha baadhi ya mishipa ya damu ili kuwezesha mwili wa mtoto kupata hewa safi. Ingawa operesheni hii ilikuwa si ya kufungua moyo moja kwa moja lakini ilisaidia kutoa mwanga kuwa inawezekana kuufanyia moyo upasuaji na kurekebisha kasoro zilizo ndani ya moyo.

Hivyo madaktari na wanasayansi waliendelea na majaribio mbalimbali kwa kutumia wanyama na hadi baada ya vita ya Pili ya Dunia ambapo baadaye Dkt. John Gibbon na mkewe Mary Gibbon katika chuo kikuu cha Minnesota mjini Minneapolis nchini Marekani walipofanikiwa kugundua mashine ya

Ultrasound ni chombo ambacho kimekuwa kikitumiwa na madaktari wengi sehemu mbalimbali duniani kwa ajili ya kuchunguza matatizo mbali mbali yaliyo ndani ya mwili wa mgonjwa.

Mojawapo ya matumizi maarufu ya chombo hiki kwa wanawake ni utambuzi wa jinsi mtoto alivyokaa tumboni mwa mama mjamzito,kuchunguza umbo la mfuko wa uzazi, matatizo katika mfumo wa uzazi na pia kuangalia iwapo kiumbe kilichopo ndani ya tumbo la mama mjamzito ni hai ama la.

Hivi karibuni huko nchini Uingereza, madaktari wamebuni kipimo cha Ultrasound kinachoweza kugundua kansa ya mfuko wa kizazi mapema kabla ya hata dalili hazijaanza kujitokeza kwa mgonjwa. Kipimo hicho kina uwezo wa kugundua kansa ya mfuko wa uzazi kwa mwanamke ikiwa katika hatua za awali kabisa kabla hata ya dalili zake kuanza kujitokeza rasmi.

Watafiti hao wamesema kwamba hii ni hatua kubwa katika kukabiliana na Ugonjwa wa kansa ya mfuko wa kizazi kwa kina mama katika nchi zinazoendelea, na wanatarajia kwamba chombo hiki kinaweza kuanza kutumika muda si mrefu hasa katika nchi zinazoendelea.

Watafiti hao wamedai kuwa ni matarajio yao kuwa chombo hiki kitakapoanza kutumika, kitakuwa ni miongoni mwa vipimo vya lazima kabisa ambavyo mgonjwa anatakiwa kufanyiwa (Routine) wakati wa kuwafanyia kina mama uchunguzi wa afya zao.

Kuna wastani wa wagonjwa wapya 60,000 wa kansa ya mfuko wa kizazi kila mwaka wengi wao wakiwa kwenye umri wa miaka 60. Aidha kwenye nchi zilizoendelea, ugonjwa huu husababisha wastani wa vifo 1,700 kila mwaka. Tangu mwaka 1970, idadi ya wagonjwa wa kansa ya mfuko wa kizazi imeongezeka kwa asilimia 50, huku wataalamu wa afya wakisema imetokana na wanawake wengi kupenda kuzaa watoto kidogo  pamoja na kuongezeka uzito (Obesity).

Watafiti hao kutoka chuo Kikuu cha London, nchini Uingereza wamesema kipimo hicho cha ultrasound (Ultrasound specialist test) kina uwezo wa kupima unene wa mfuko wa uzazi hivyo kutoa picha zinazowezesha kugundulika kwa kansa mapema.

Katika utafiti wao, kati ya wanawake 96 waliopimwa kwa kutumia chombo hicho, asilimia 80 waligundulika kuwa na kansa ya mfuko wa uzazi kwa usahihi kabisa hata kabla hawajaanza kuonesha dalili kama za kutoka damu kwa wingi kwenye sehemu zao za siri.

Watafiti hao bado wanaendelea kuwapima kina mama zaidi ili kujua uhakika wa kipimo chao katika kugundua kansa katika hatua za awali. Kwa kawaida iwapo kansa itagundulika mapema, mgonjwa ana nafasi kubwa ya kuishi iwapo atapata tiba mapema kabla hata kansa haijasambaa au kuenea mwilini.

Kansa ya mfuko wa kizazi huwapata kina mama ambao wameshafikia ukomo wa kupata hedhi kila mwezi na ambao wana umri kati ya miaka  60 hadi 69. Aidha wanawake wanakuwa katika hatari kubwa zaidi iwapo kiwango cha homoni aina ya oestrogen kitakuwa juu kuliko kawaida.

Kwa kawaida homoni hii ya oestrogen huwa katika kiwango cha chini sana wakati wa ujauzito, na wanawake wenye watoto wachache huwa na kiwango kikubwa cha homoni hii hivyo kuwa kwenye hatari ya kupata kansa hii ya mfuko wa uzazi.

Wanawake wanene (Obese) nao wapo kwenye hatari ya kupata aina hii ya kansa kwa vile wengi wao huwa na kiwango cha juu sana cha homoni hii ya oestrogen kwa vile mafuta yaliyolundikana mwilini hubadilisha homoni za aina nyingine kuwa oestrogen.

Ian Jacobs, mtafiti mkuu katika utafiti huo uliochapishwa katika jarida maarufu la afya la The Lancet amesema, “Miaka kadhaa ijayo, wanawake wanene, waliozaa mara chache, na wenye matatizo ya ugonjwa wa shinikizo la damu wanastahili kufanyiwa uchunguzi wa mifuko yao ya uzazi mapema kwa kutumia kipimo hicho ili kutambua kama wana kansa hii ya mfuko wa kizazi au la”.

Mkurugenzi wa kitengo cha utafiti wa kansa nchini Uingereza, ambao ndio waliofadhili utafiti huo, Bi. Kate Law, amesema matokeo ya utafiti huo yameonesha kuwa kipimo cha Ultrasound kinaweza kutumika na madaktari katika kuwawezesha kugundua aina ya kansa hiyo mapema.

Aina mbili ya chembe chembe za asilia za mwanadamu (genes) zinazohusishwa na kansa hii zimegundulika, ambazo pia huongeza hatari ya ugonjwa mwingine wa mfuko wa uzazi unaoitwa  Endometriosis kwa asilimia 20.

Ugunduzi huo ni hatua muhimu katika utengenezaji wa dawa ya kutibu kiini cha kansa hiyo na pia unafungua njia katika kubuni vipimo vya damu vya kugundua kansa hii kwa haraka. Chembe chembe hizo za asili (genes) zinahusika katika utengenezaji wa ukuta wa mfuko wa uzazi pamoja na kutengeza homoni za  aina nyingi, watafiti hao wamesema.

Ugonjwa huu wa Endometriosis ambao husababisha matatizo ya uzazi, hutokea baada ya ukuta wa mfuko wa uzazi kuanza kuota katika sehemu nyingine za mwili wa mwanadamu.

Inatarajiwa kwamba pindi utafiti huu utakapokamilika, kipimo hiki kitaanza kutumika muda si mrefu katika nchi nyingi duniani ili kuokoa vifo vya kina mama wengi duniani.

For children under five (5) years of age

Introduction: Taking care of your child’s oral health is important and should start at an early age. Parents and care givers should start caring for their Child’s mouth from birth.

A closer look at the child’s mouth: The mouth is made up of different parts all working together for normal function of the body. It’s used for speaking, singing, eating, swallowing and showing emotions.

The parts that make up the mouth are:- Teeth, Gums, Tongue and Lips. Children start getting their first teeth around six month of age , and by three years of age all 20 teeth should have appeared in the mouth- 10 at the upper and 10 at the lower jaw. These teeth are at times called milk or primary teeth.

Introduction

Bahi district is one amongst six districts that make up Dodoma region. It extends between latitude 4o and 8o South and between longitude35o and 37o East. The district has an area of 5948 square km, and borders Kondoa district to the north, Manyoni to the west, Dodoma municipal to the south west and Chamwino district to the East. The district is divided into 4 divisions of Chipanga, Bahi, Mundemu and Mwitikila. The four divisions have a total of 21 wards, 56 villages and 1559 hamlets. The 2002 national census projected a population density of about 238,951 (District Council profile, 2010).

Health care facilities

Bahi district council has no district hospital, however, it has a total number of 35 health care facilities. Among these heath care facilities, six are health centers and 29 are dispensaries. There are 27 health care providers who have been trained to manage mental illnesses.

Background on Mental Health

The WHO defines health as a state of complete physical, psychological and social well being, and not just the absence of disease or infirmity.

Ugonjwa wa kisukari ni tatizo ambalo siku hizi husababishwa na mfumo wa maisha tunayoishi hasa vijana, tafiti zilizowahi kufanywa zinaonesha kuwa vijana wapo kwenye hatari kubwa ya kupata kisukari kwa sababu ya mfumo usio sahihi wa maisha wanayoishi vijana.

Kutokufanya mazoezi, kukosa muda wa kupumzika na kutokula mlo sahihi,unywaji wa pombe na uvutaji sigara wa kupitiliza, hizi ni sababu chache zinazochangia vijana kuishi katika mfumo wa maisha hatarishi wa kupata maradhi ya kisukari.

Leo tunaangalia suala zima la chakula kwa watu mwenye maradhi ya kisukari,madaktari wapo wengi sana kwenye hospitali zetu pamoja na majumbani mwetu lakini wewe mwenye ugonjwa wa  kisukari ndiyo daktari namba moja katika kutibu afya yako.

Kitu muhimu kwa mgonjwa wa kisukari ni  kufahamu ya kwamba  ana uwanja mpana  sana wa vyakula anavyoruhusiwa kula tofauti na  na mazoea yaliyojengeka miongoni mwetu kuwa mtu anayeuugua maradhi haya basi ana  vyakula vyake vya kipekee kabisa. Maisha ya mtu mwenye kisukari yanatakiwa kuendelea kama kawaida, na unaruhusiwa kula aina zote za vyakula isipokuwa tu vile venye sukari.

Katika sehemu hii ya pili ya muendelezo wa makala ya magonjwa ya zinaa nitazungumzia kuhusu ugonjwa wa Chlamydia.

Chlamydia ni nini?

Chlamydia ni aina ya ugonjwa wa zinaa unaosababishwa na bakteria aina ya Chlamydia trachomatis ambao wanaweza kuathiri viungo vya uzazi na pia kusababisha ugonjwa wa homa ya mapafu unaojulikana kama typical pneumonia. Kati ya magonjwa ya zinaa yanayosababishwa na bakteria, Chlamydia ndio ugonjwa unaoongoza kwa maambukizi duniani ambapo kwa nchi ya Marekani pekee inakisiwa watu milioni 4 huambukizwa kila mwaka .

Bawasiri ni mojawapo ya tatizo ambalo mara nyingi linapotokea humfanya mtu kuwa na aibu kuelezea au kwenda hospitali ili kupata tiba sahihi. Bawasiri au hemorrhoids husababishwa na kuvimba kwa mishipa ya damu aina ya vena katika eneo la mfereji wa haja kubwa.

Kuna aina mbili za Bawasiri

Nje

Aina hii ya bawasiri hutokea katika eneo la mwisho kabisa la mfereji wa haja kubwa, na huweza kuambatana na maumivu, pamoja na kuwashwa kwa ngozi katika eneo hilo. Mara nyingine mishipa hiyo ya damu (vena) hupasuka na damu huganda na kusababisha aina kitaalamu inaitwa Thrombosed hemorrhoid.

Ndani

Aina hii ya bawasiri hutokea ndani ya mfereji wa haja kubwa. Na huwa haimbatani na maumivu na wengi huwa hawatambui kuwa wanatatizo hili. Aina hii imegawanyika katika mainisho yafuatayo
Daraja I- Bawasiri kutotoka katika mahali pake pa kawaida
Daraja II- Bawasiri kutoka wakati wa haja kubwa na kurudi yenyewe baada ya tukio hilo.
Daraja III- Bawasiri kutoka wakati wa haja kubwa na mtu kuweza kuirudisha mwenyewe baada ya tukio hilo.
Daraja IV- Bawasiri kutoka wakati wa haja kubwa na vigumu mtu kuirudisha baada ya tukio hilo.

Je bawasiri husababishwa na nini?

Ini ni kiungo muhimu sana katika mwili wa binadamu. Ndicho kiungo kikubwa kilichopo ndani ya mwili. Ugonjwa wa cirrhosis ni ugonjwa wa 12 duniani kati ya magonjwa yanayosababisha vifo vitokanavyo na  maradhi. Cirrhosis husababishwa na unywaji pombe kupindukia, ugonjwa wa hepatitis B, C, na ugonjwa wa fatty liver disease. Kwa wagonjwa wengine chanzo halisi cha ugonjwa huu hakijulikani. Kabla ya kuangalia ugonjwa wa cirhosis  (tamka sirosis kwa kiswahili), kwanza tuangalie kazi ya ini kwenye mwili wa binadamu.

Ini linahusika na

• Kushughulikia chakula kilichosagwa kutoka kwenye utumbo mdogo (small intestine)
• Hulinda mwili dhidhi ya magonjwa
• Kutengeneza  nyongo (bile)
• Hudhibiti kiwango cha mafuta, sukari na chembechembe zijulikanazo kama amino acids kwenye damu
• Huhifadhi vitamini, madini ya chuma na kemikali nyengine muhimu
• Huvunjavunja chakula na kutengeneza energy inayohitajika mwilini
• Ini hutengeneza chembechembe zinazozuia damu kuganda mwilini kama fibrinogen, prothrombin, factor V, VII, IX, X  na X, protini C na S, antithrombin na nk.
• Huharibu sumu na madawa ambayo yameingia mwilini.
• Hutengeneza homoni aina ya angiotensinogen  ambayo inahusika kupandisha presha ya damu mwilini wakati inapokutana na enzyme ya renin, enzyme hii ya renin hutolewa na figo wakati figo inapohisi presha imeshuka mwilini.
• Husafisha damu kutokana na chembechembe  mbaya na bakteria.
• Hutengeneza enzyme na protini ambazo zinahitajika mwilini kwenye shughuli nyingi na hata kurekebisha tishu zilizoharibika.

Ugonjwa wa cirrhosis ni nini?

Cirrhosis ni matokeo ya ugonjwa sugu wa ini ambao  hubadilisha tishu za kawaida za ini kwa njia ya fibrosis, scar tishu, matezi (regenerative nodules),  kuziba damu kuingia kwenye ini  na hivyo kufanya ini kushindwa  kufanya kazi yake vizuri.

Visababishi vya ugonjwa huu

Cirhosis husababishwa na mjumuiko wa magonjwa mengi ambayo ni

Ugonjwa wa ini unaosababishwa na unywaji wa pombe kupindukia kwa muda mrefu ( alcoholic liver disease) . Inakadiriwa asilimia 10 – 20 ya wanywaji pombe kupindukia kwa miaka 10 au zaidi  ndio wanaopata ugonjwa huu. Yule anayekunywa pombe kwa muda mrefu huwa na asilimia kubwa ya kupata ugonjwa huu kutokana na kiwango cha pombe kuongezeka au kuwa kingi kwenye mwili wake. Pombe huharibu ini na kusababisha lishindwe kufanya kazi yake dhidhi ya mafuta, protini, na wanga (carbohydrates).

Ugonjwa huu wa ini unaotokana na unywaji pombe kwa muda mrefu (alcoholic liver disease) hauathiri wanywaji pombe wote na si lazima uwe mnywaji pombe ili upate ugonjwa huu.

Wanywaji pombe kupindukia pia wanaweza kupata tatizo la utapia mlo (malnutrition) kutokana na pombe kukosa virutubisho muhimu vinavyohitajika  mwilini, kupungua kwa hamu ya kula, na kupungua kwa ufyonzwaji wa virutubisho  vya chakula  kwenye utumbo. Utapia mlo pia husababisha ugonjwa wa ini.

Unywaji wa pombe kupindukia huweza kusababisha ugonjwa aina ya alcoholic hepatitis ambao huambatana na homa, manjano kwenye mboni au ndani ya macho na kwenye ngozi, kuongeza ukubwa wa ini (hepatomegaly) na kudhoofika  kwa mgonjwa (anorexia). Alcoholic hepatitis ni hatari sana kwani unaweza kusababisha kifo.

Non alcoholic steatohepatitis (NASH)  ama Non alcoholic liver cirrhosis   – Mafuta hujikusanya kwa wingi kwenye ini na kusababisha huharibifu wa tishu za ini (scar tishu). Ugonjwa huu unahusishwa na kisukari, unene uliopitiliza, utapia mlo wa protini (protein malnutrition), baadhi ya magonjwa ya moyo na baadhi ya madawa aina ya corticosteroids. Mgonjwa hapa hana historia ya unywaji pombe.

Ugonjwa aina ya hepatitis B, C, na D, ambayo husababishwa na virusi vya hepatitis. Hepatitis B ndio chanzo kikuu cha ugonjwa wa cirhosis kati ya hepatitis zote duniani. Hepatitis C ndio sababu kuu ya wagonjwa wengi kuhitaji ini la kupandikizwa (liver transplant) duniani.

• Autoimmune hepatitis – Husababishwa na mfumo wa kinga mwilini ambao huathiri ini na kuharibu chembechembe au seli za ini na hivyo kusababisha ugonjwa wa cirrhosis.
• Magonjwa ya kurithi kama cystic fibrosis, wilson’s  disease, galactosemia, alpha 1 antitrypsin deficiency, hemochromatosis na glycogen storage disease. Watu wenye tatizo la ukosaji wa alpha  - 1  -antitrypsin  ambayo inakuwa kwenye mapafu ya binadamu na husaidia kukinga tishu zisiharibiwe na enzyme za seli za uhabirifu hasa nuetrophil elastase, wanaweza kupata mjumuiko wa magonjwa yanayoathiri mfumo wa upumuaji  (COPD)  kama watakuwa na historia ya uvutaji sigara.
• Cardiac  cirrhosis  - Hutokana na ugonjwa sugu wa moyo unaoathiri  sehemu ya kulia ya moyo na hivyo kuufanya moyo kushindwa kufanya kazi yake vizuri na hatimaye kulileletea madhara ini. Husababishwa na tatizo kwenye kizibo cha moyo (valve problem), kuathiriwa kwa moyo na maradhi ya bakteria au virusi, uvutaji sigara na nk.
• Madawa na sumu  zinazoharibu na kudhuru ini
• Ugonjwa wa kichocho (schistosomiasis)
• Magonjwa yanayojulikana kama  primary biliary cirrhosis na primary  sclerosing  cholangitis

Dalili na viashiria vya ugonjwa wa cirrhosis

Wagonjwa wengi wa cirrhosis hawaonyeshi dalili zozote kwenye hatua za awali za ugonjwa huu. Dalili zinatokana na

• Kushindwa kufanya kazi kwa ini kadri ugonjwa unavyoongezeka
• Kuharibika kwa umbile na ukubwa wa ini kutokana na kitu tunachoita kitaalamu kama scarring

Dalili za cirrhosis ni

• Uchovu
• Ulegevu
• Kichefuchefu
• Kupungua hamu ya kula hatimaye kupungua uzito
• Kupungua hamu ya kufanya mapenzi

Hata hivyo, dalili na viashiria vingi vinaweza visitokee hadi mtu atakapopata madhara ya cirrhosis. Dalili na viashiria hivyo ambavyo hutokea baada ya madhara kutokea ni kama zifuatavyo;

• Kuwa rangi ya manjano kwenye macho na ngozi kutokana na ukusanywaji  wa bilirubin kwa wingi kwenye viungo hivi.
• Kutapika
• Homa
• Kuharisha
• Maumivu ya tumbo kutokana kuongezeka ukubwa wa ini au kutokana na vijiwe kwenye gall bladder (gallstones)
• Kuwashwa mwili  kutokana na bile salts iliyopo kwenye ngozi
• Tumbo kuwa kubwa au kuvimbiwa kutokana na maji kujikusanya sehemu ya tumbo (ascites)
• Kuongezeka uzito kwa sababu ya ukusanywaji wa maji mwilini
• Kutoka damu kwenye fizi au pua, husababishwa na kutokuwepo na chembechembe zinazozuia damu kuganda
• Kuvimba kwa miguu
• Kupumua kwa shida
• Kupungua nyama mwilini (Loss of muscle mass)
• Kwa wanawake, kuwa na hedhi isiyokuwa ya kawaida kutokana kupungua kwa utolewaji wa homoni zinazosaidia wakati wa hedhi.
• Damu kwenye matapishi au haja kubwa kutokana kuharibika mfumo wa kuzuia damu kuganda.
• Spider angiomata – Kutokea kwa mabaka yanayofanana na utandu wa buibui ambao katikati yake kuna rangi nyekundu. Hii inatokana na mishipa ya damu inayoonekana kwa sababu ya kuongezeka  kiwango cha estradiol.
• Kuongezeka mikunjo ya kwenye viganja vya mikono (palmar erythema) husababishwa na kupungua kwa homoni za mapenzi (sex hormone)
• Kuongezeka kwa matiti kwa wanaume (gynecomastia) kutokana na kuzidi kwa kiwango cha homoni aina ya estradiol mwilini, hutokea kwa asilimia 66 ya wagonjwa wa cirrhosis.
• Kupungua kwa korodani  kwa sababu ya kushindwa kufanya kazi vizuri kwa hypothalamus na pitituary gland. Hii husababisha uume kushindwa kusimama (kusimika),  kushindwa kutia mimba mwanamke (infertility), na kupungua hamu ya kufanya mapenzi.
• Mabadiliko ya kucha – Kucha zinaweza kuwa na mistari (Muehrcke’s lines), au kuwa za rangi nyeupe pembezoni mwake na rangi nyekundu kwa mbele (terry’s nails) au kujikunja kwa kucha pembeni (finger clubbing).
• Bandama kuongezeka ukubwa (splenomegaly)
• Kuongezeka unene  na kufupika kwa ngozi ya viganja vya mikono na hivyo kusababisha vidole na viganja kuwa kwenye umbile la kujikunja (dupuytren’s contracture)
• Ini linaweza kuongezeka ukubwa, kupungua au kuwa la kawaida.
• Kuonekana kwa mishipa ya damu sehemu ya tumbo (caput medusa)
• Mgonjwa kuwa na harufu kali kama ya maiti kwenye pumzi kutokana na kuongezeka kwa dimethyl sulfide
• Cruveilhier   Bumgarten murmur – Sauti fulani ambayo daktari anaweza kuisikia  wakati akimpima mgonjwa kutumia stethoscope  maeneo ya tumboni.
• Mapigo ya moyo kwenda haraka mtu anapojaribu kusimama
• Kusikia kiu sana
• Mdomo kuwa mkavu au kukauka mate
• Asterixis

Vipimo vya uchunguzi

• Vipimo vya damu (Complete blood count) – Upungufu wa damu (anaemia),  kupungua kwa chembechembe bapa  za damu au platelets (thrombocytopenia), kupungua chembechembe nyeupe za damu (leukopenia) na chembechembe aina ya neutrophils (neutropenia) na kupungua kwa madini aina ya sodium.
• Kipimo cha ufanyaji kazi wa  ini (Liver function test) – Kupungua kwa albumin, kuongezeka kwa aminotraferases AST na ALT (AST > ALT), alkaline phosphatase, bilirubin, gamma glutamyl transferase. Kuongezeka kwa protini aina ya globulin.
• Kipimo cha kuangalia chembechembe za kuzuia damu kuganda (coagulation test)
• Liver biopsy
• Vipimo vya damu kuangalia kiwango cha immunoglobulins (IgG, IgM, na IgA), Alpha 1 antitrypsin, ferritin na  transferrin saturation, copper na ceruloplasmin.
• Serology for hepatitis virus, autoantibodies
• Kipimo cha wingi wa mafuta aina ya cholestrol na sukari                                                                            
• Vipimo vya mionzi

• Kipimo cha ultrasound – Inaweza kugundua saratani ya ini, portal hypertension nk.
• CT scan ya tumbo ili kutofautisha na magonjwa mengine kama saratani aina mbalimbali, magonjwa ya kongosho (pancrease), ini, figo nk.
• Liver/bileduct MRI
• Gastroscopy – Kipimo cha kuangalia mpira wa kupitishia chakula kwenda kwenye tumbo, tumbo na sehemu ya duedonum ili kuhakikisha kama kuna oesophagus varices na kuzitibu ikiwezekana.

Tiba ya ugonjwa wa cirrhosis inahusisha

• Kuacha kunywa pombe kabisa kwa kupata ushauri nasaha pamoja na mgonjwa kuhudhuria programu za kusaidia kuacha kunywa pombe (rehabilitation center). Kama ugonjwa wa cirrhosis  bado haujatokea, mgonjwa akiacha pombe ini linaweza kupona.
• Kutibu tatizo la utapia mlo kwa kutumia vitamini na folic acid.
• Kutibu  chanzo cha ugonjwa wa  cirrhosis
• Kuzuia uhabirifu zaidi wa ini kwa kuzuia utumiaji wa dawa aina ya paracetamol pamoja na pombe.
• Chanjo dhidhi ya hepatitis B na C
• Mgonjwa kupewa dawa za kuongeza damu na kama upungufu wa damu mwilini ni mkubwa basi atahitaji kupewa damu
• Kuzuia madhara ya cirrhosis kwa

• Kuzuia utumiaji wa chumvi kwenye chakula
• Kupunguza vyakula venye protini nyingi
• Kutumia dawa za antibiotics ambazo daktari atakushauri
• Kutumia dawa aina ya lactulose ili kupunguza madhara ya heptic encephalopathy kwa kupunguza kiwango cha ammonia mwilini na pia husaidia mgonjwa kupata choo laini.

Madhara ya cirrhosis ni yapi?

Madhara ya cirrhosis ni kama yafuatayo

• Saratani ya ini ambayo husababisha vifo vingi sana
• Kuvimba kwa tumbo kwa sababu ya kujaa maji
• Kuwashwa mwili mzima
• Kuwa wa manjano kwenye macho na ngozi
• Kudhurika rahisi na madawa
• Kutoka damu kwenye fizi, puani na nk.
• Kuongezeka kwa mifupa ya kwenye mikono na miguu na hivyo kusababisha maumivu makali sana, kukakamaa na kuvimba miguu.
• Esophageal varices
• Portal hypertension
• Hepatic encephalopathy – Hali ya kuchanganyikiwa, kupungua kwa umakini, kusahau haraka, kuwa na hasira, kupungua uwezo wa kujiamulia, mgonjwa kutojali muonekano wake,  kubadilika badilika hisia, kuona watu au vitu ambavyo haviko (hallucination), matatizo ya kulala, hii inatokana na kuongezeka kwa ammonia ndani ya damu ambayo hupelekwa kwenye ubongo.

Madhara ya cirrhosis yakishindwa kudhibitiwa au kama ini litashindwa kufanya kazi kabisa, basi mgonjwa atahitaji kupandikizwa ini jingine.

Chandarua hutoa kinga dhidi ya mbu, nzi na wadudu mbali mbali wasambazao magonjwa, hivyo kuzuia magonjwa kama malaria, homa ya dengue na homa ya manjano.

Ufanisi wa kazi wa chandarua huwa maradufu kinapowekwa dawa ya kuua wadudu.

Vyandarua vilianza kutumika lini?

Vyandarua vilianza kutumika kuanzia katikati ya karne ya kumi na nane (mid-18th century), inasadikiwa kuwa hata yule malkia maarufu wa Misri Cleopatra alitumia chandarua. Vilevile vyandarua vilitumika wakati wa ujenzi wa mfereji wa suez baada ya malaria kutishia umaliziaji wa ujenzi wa mfereji huo.

Chandarua hutengenezwa kwa kutumia: pamba, polyester, polyethylene au nylon

Vyandarua vyenye dawa

Vyandarua vyenye dawa vilianza kutumika miaka ya 1980 kwa ajili ya kuzuia malaria. Na hadi sasa vyandarua hivi vinaanza kutumiwa kama mmbadala wa vyandarua vya zamani katika nchi nyingi, Tanzania ikiwa ni mojawapo ya nchi hizo.
Inaaminika kuwa vyandarua vyenye dawa vinafanyakazi maradufu ya vyandarua visivyo na dawa. Chandarua hutoa kinga ya asilimia 70 dhidhi ya malaria kulinganisha na kulala bila chandarua.

Katika tafiti iliyofanywa na Deswal na wenzake iliyochapishwa September 2004, katika kambi za jeshi katika mji wa Allahad, nchini India waligundua kuwa maambukizi ya malaria yalipungua kwa kiasi kikubwa baada ya kutumia vyandarua vyenye dawa, na mbu aina ya Anophiline walipungua kwa asilimia 67.8 wakati culex walipungua kwa asilimia 49. Na watumiaji hawakupata madhara yoyote. Na hivyo walithibitisha kuwa matumizi ya vyandarua vyenye dawa husaidia kupunguza malaria kwa kiasi kikubwa.

Kwa sasa vyandarua vingi huwekewa dawa aina zifuatazo: Deltamethrin na Permethrin. Kwa ufanisi mzuri wa chandarua chenye dawa, ni vyema kila baada ya miezi sita kukiwekea tena dawa,ili kiweze kufanya kazi vizuri.

Kwanini watu wengi hawatumii vyandarua vyenye dawa?

Tafiti mbalimbali zimeshafanyika kuhusiana na kwanini watu wengi hawatumii vyandarua vyenye dawa hata kama watapewa bure na serikali. Katika utafiti uliofanyika pembezoni mwa mto Imo, Nigeria iliyochapishwa machi 2010 “kuhusiana na mtazamo wa matumizi ya vyandarua vyenye dawa na athari yake katika kuzuia malaria kwa wakina mama wajawazito” uliofanywa na chukwuocha UM na wenzake waligundua kuwa mtazamo wa wananchi kuhusu malaria kuwa wanawake wajawazito na watoto wapo kwenye hatari zaidi ya kupata malaria kuliko wanaume na wanawake ambao hawana watoto kabisa kwa sababu miili yao ni dhaifu. Vilevile walipata sababu za kutotumia vyandarua vyenye dawa kuwa ni:

• Gharama na upatikanaji wake
• Vilevile wanaamini kemikali za dawa zinazowekwa zinamadhara kwa watu wazima,watoto na wanawake wajawawazito
• Wengi walipata matangazo kuhusu umuhimu wa vyandarua vyenye dawa
• Wengi waliamini dawa hizo zitumikazo kwenye vyadarua huleta madhara yafuatayo:
  • huathiri upumuaji hasa kwa wakina mama wajawazito na kama zinaua mbu basi zinaweza kuua hata binadamu.
  • Wapo pia watumiaji wengi walioripoti kuhisi joto kali na kukosa hewa ya kutosha wakiwa wamelala usiku.

Nini mtazamo wa matumizi ya vyandarua vyenye dawa katika nchi nyingi za afrika?

Kwa ujumla kuna imani na mitazamo mbalimbali kuhusiana na matumizi ya vyandarua vyenye dawa kikubwa kikiwa kuhusishwa na kupunguza nguvu za kiume na kuaminini kuwa zinaweza kuleta madhara makubwa kwa binadamu.

Hitimisho

Kutokana na tafiti mbalimbali zilizofanywa zinathibitisha kuwa Hamna madhara kwa binadamu na matumizi mazuri ya vyandarua vyenye dawa hupunguza maambukizi ya malaria kwa kiasi kikubwa.

Nikisema matumizi mazuri namaanisha kuwa uhakikishe umelala katikati hamna ngozi inayogusa chandarua hasa kwa vile ambavyo havina dawa maana mbu huweza kukuuma, na kuhakikisha hakija chanika na kimechomekwa vizuri. Na kutosahau kukiwekea dawa tena baada ya miezi sita.

What is Basic life support?

Basic life support (BLS) is the provision of initial care for an illness or injury, commonly known as first aid. First aid is usually performed by a non-expert person to a sick or injured person until definitive medical treatment can be accessed. Certain self-limiting illnesses or minor injuries may not require further medical care past the first aid intervention. First aid generally consists of a series of simple and in some cases, potentially life-saving techniques that an individual can be trained to perform with minimal equipment.

Why do we provide initial care for illness or injury?

The key aims of first aid can be summarized in three key points:

• Preserve life - the overriding aim of all medical care, including first aid, is to save lives
• Prevent further harm - also sometimes called prevent the condition from worsening, this covers both external factors, such as moving a patient away from any cause of harm, and applying first aid techniques to prevent worsening of the condition, such as applying pressure to stop a bleed becoming dangerous.
• Promote recovery - first aid also involves trying to start the recovery process from the illness or injury, and in some cases might involve completing a treatment, such as in the case of applying a plaster to a small wound

Do you require any skills to perform BLS?

Yes. However you don’t have to go to the medical school to know these skills. Any person can be trained and perform these skills. Certain skills are considered essential to the provision of first aid and are taught ubiquitously. Particularly the "ABC"s of Cardiopulmonary resuscitation (CPR), which focuses on critical life-saving intervention, must be rendered before treatment of less serious injuries. ABC stands for Airway, Breathing, and Circulation. In other school of thought there is an addition of fourth step of "D" for Deadly bleeding or Defibrillation, while others consider this as part of the Circulation step. Variations on techniques to evaluate and maintain the ABCs depend on the skill level of the first aider. Once the ABCs are secured, first aiders can begin additional treatments, as required.

What is CPR?

CPR stands for cardiopulmonary resuscitation (cardio- means heart, pulmonary means lungs), is an emergency procedure which is attempted in an effort to return life to a person in cardiac arrest (cessation of normal circulation of the blood due to failure of the heart to contract effectively). It is indicated in those who are unresponsive with no breathing or only gasps. It may be attempted both in and outside of a hospital.

CPR involves chest compressions at a rate of at least 100 per minute in an effort to create artificial circulation by manually pumping blood to the heart, brain and other vital organs. In addition the rescuer may provide breaths by either exhaling into their mouth (mouth-to-mouth breathing) or utilizing a device (mouth piece) that pushes air into the lungs. The process of externally providing ventilation is termed artificial respiration. Mouth-to-mouth breathing is a quick, effective way to provide oxygen to the victim.

Current recommendations place emphasis on high quality chest compressions over artificial respirations and a method involving only chest compressions is recommended for untrained rescuers. The victim should be laid on a hard surface for maximum efficiency of chest compressions. Compression-ventilation ratio for the lone rescue should be 30 compressions to 2 breaths.

Two rescuers should use a ratio of 15 compressions to 2 breaths for both adults and infants.

If the victim becomes responsive, s/he should be laid on recovery position.

Besides provision of basic life support to unresponsive victim, there are other conditions which require first aid. These include Choking, Bleeding, Fever, Burns, Snake /poisonous bites and fractures.

What is chocking?

Chocking occurs when there is a foreign-body airway obstruction. Early recognition of airway obstruction is the key to successful outcome. The signs of airway obstruction may range from weak ineffective cough, high-pitched noise, increased respiratory difficulty, unable to speak and unable to move air. The public should use the universal sign to indicate the need for help when chocking and this involves clutching the neck with the thumb and fingers.

Relief of chocking involves the use of abdominal thrusts commonly known as the Heimlich maneuver.

This can be used in both adults and children. However the Heimlich maneuver is not used to relieve choking in infants. The relief of chocking in infants is done by back slaps and chest thrust as shown in the figure below.

If the chocking individual becomes unresponsive, the rescuer should perform CPR.

What is bleeding and its first aid?

Bleeding occurs when there is loss of certain amount of blood. Severe bleeding refers when there is large volume of blood lost. Bleeding can be caused by many things, for instance cuts, injuries like scalp wound, tooth extraction, accidents/falls etc.

The first aid for a bleeding person, depending on the type and site of bleeding, involves resting/lying down, slightly elevate legs, if possible elevate the affected area, remove any visible debris and using a clean cloth, apply a direct pressure on the wound/bleeding site. Apply pressure continuously for about 20 minutes and seek medical attention.

What are burns?

Burns can result from dry heat (fire), moist heat (steam, hot liquids), electricity, chemicals, or from radiation, including sunlight. The longer the skin is exposed to the burn source, the worse the burn can be.

Classification of burns

First-degree burns affect only the outer skin layer. The skin area appears dry, red, and mildly swollen. First-degree burns are painful and sensitive to touch. They should feel better in 1 to 2 days. They heal in about a week.

Second-degree burns affect the skin's outer and lower layers. The skin is painful, swollen, red, and has blisters. The skin also has a weepy, watery surface.

Third-degree burns affect the outer and deeper skin layers and organs below the skin. The skin appears black-and-white and charred. It swells. Tissue under the skin is often exposed. Third-degree burns may have less pain than first-degree or second-degree burns. Why? No pain is felt where nerve endings are destroyed. Pain may be felt around the margin of the burn, though.

For Severe Burns before Emergency Care
Remove the person from the source of heat. Keep the person's airway open. Remove hot or burned clothes that come off easily, not if they are stuck to the skin. Cover the burns loosely with clean cloths. Use direct pressure to control bleeding. Don't rub.

For First-Degree and Second-Degree Burns
Use cold water or cloths soaked in cold water on burned areas for 15 minutes or until the pain subsides. Do not use ice at all. Doing this could result in frostbite.

Cover the area loosely with a dry clean cloth, such as sterile gauze. Hold it in place by taping only the edges of the gauze. Don't use ointments. Aloe vera can be applied over closed skin 3 to 4 times a day. Don't break blisters. If they break on their own, apply an antibacterial spray or ointment or treatment prescribed by your doctor. Keep the area loosely covered with a sterile dressing.

Snake / poisonous bites

If someone is bitten by a poisonous snake, the bitten area should be immobilized and the victim transported to a hospital as quickly as possible. The bitten area should be washed with soap and water. A wide constriction bandage (tourniquet) may be applied two to four inches upstream of the bitten area (if on an extremity) so long as the pressure is not too tight (one or two fingers should be able to slide under the band). Overly tight tourniquets should never be used as these can block arterial blood flow to the affected area and worsen tissue damage.

Incising (cutting) and suctioning the bite area has not been shown to be beneficial, but a venom extractor (found in commercial snake bite kits) may be helpful if it is applied to the area within five minutes of the bite and left in place for 30 minutes. Ice or cooling packs should never be applied to the area as these may result in greater harm, and incisions of the bitten area are also potentially harmful and have no benefit.

Most importantly, any victim of a venomous snake bite should be evaluated in an emergency medical care facility as soon as possible.

What is fever and its first aid?

Fever means a state of higher-than-normal body temperature. The normal body temperature is 37.0ºC. Fever indicates abnormal process in the body and when it is high, it can be life threatening, requiring more attention. Fever can be confirmed by the use of thermometer although sometimes feeling ones temperature by use of the hand can be applied. Causes of fever can be bacterial and viral infections, dehydration, childhood immunization etc. In most of the areas in Tanzania, the term ‘fever’ is misunderstood and used synonymously to mean malaria disease.

Although there are medications which usually lower the fever, there are other measures there can be taken so as reduce the body temperature of the victim. These include removing the excess clothing on the victim, sponging the body by luke warm water and provision of plenty of drinking fluids.