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Saturday, April 27, 2024
Tuberculosis

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Colorectal cancer is the second most common cause of cancer-related death in the United States.

The incidence of EO-CRC, which refers to when people under 50 years of age develop the condition, has increased markedly in several wealthy countries.

One 2020 article in CA: A Cancer Journal for Clinicians suggested that over the course of the year, about 150,000 U.S. individuals would receive a diagnosis of colorectal cancer and about 53,200 would die as a result.

The authors also predicted about 18,000 cases of individuals younger than 50 years of age receiving a diagnosis of colorectal cancer, with 3,640 forecasted deaths in this population.

Compared with adults born in the U.S. around 1950, those born around 1990 have twice the risk of developing colon cancer and four times the risk of developing rectal cancer.

A new study in the journal Gut links drinking two or more SSBs per day in adulthood with a doubling in the risk of bowel cancer before the age of 50 years.

Researchers found that each daily SSB serving among adult women may be associated with a 16% higher risk of developing EO-CRC.

Also, the study found that each additional SSB serving per day among individuals aged 13–18 years may be linked to a 32% increase in the risk of developing EO-CRC.

Examples of SSBs include soft drinks, pre-packaged fruit drinks, energy drinks, and sports drinks. Sugary drinks are the leading source of added sugars in the American diet.

In fact, from 1977 to 2001, energy intake from SSBs increased by a whopping 135%.

Unique epidemiologic evidence

For this study, the researchers used data from 95,464 participants in the Nurses’ Health Study II. This is an ongoing monitoring study of 116,430 U.S. registered nurses, all women, who were aged 25–42 years when they enrolled in 1989.

Every 4 years beginning in 1991, the women in the study reported on what they ate and drank using validated food frequency questionnaires.

In 1998, researchers asked the participants to recall their health status and lifestyle habits as teenagers.

Also, 41,272 of the women reported on what they typically ate and drank as well as on the quantities of these items between 1960 and 1982. They were aged 13–18 years at this point.

The participants also gave information on potentially influential factors, including their family history of bowel cancer, their lifestyle habits, and any regular use of aspirin, nonsteroidal anti-inflammatory drugs, or vitamin supplements.

Over 24 years of monitoring, 109 women developed bowel cancer before the age of 50 years.

The study authors write that their findings “add unique epidemiologic evidence that SSB intake may partly contribute to the rapid increase of CRC in younger adults.”

Notes on the study

It is important for researchers to understand what is behind this increase, said study co-author Dr. Jeffrey Meyerhardt. He is the clinical director of the Gastrointestinal Cancer Center at the Dana-Farber Cancer Institute in Boston, MA.

“It is presumed that exposures early in life are contributing to this rise,” Dr. Meyerhardt told Medical News Today. “Studying exposures that can be prevented is [essential] to getting control of this rising health issue.”

Substituting SSBs with reduced-fat milk or whole milk appears to be beneficial, according to study co-author Dr. Yin Cao. She is an associate professor of surgery at the Washington University School of Medicine in St. Louis, MO.

“In this study,” she told us, “we showed [that] replacing one daily serving (8 oz) of SSBs with an equivalent amount of reduced-fat milk or total milk was associated with a 35–36% lower risk of EO-CRC.”

“During the second half of the 20th century, for which average U.S. per capita soft drink consumption has dramatically increased by ~500%, milk consumption has declined by half. Milk is a good source of calcium, a mineral found to be protective of colorectal cancer.”

“We postulate [that] low milk consumption could be plausibly linked with the increased risk of EO-CRC, and further research on this topic is in the pipeline.”

The researchers point to several limitations of their study. First, they caution that this was an observational study, which can only establish correlation, not cause. They also note that the majority of the participants were white women, so the findings may not apply to men or other ethnic groups.

Even so, the study provides insight into possible actions that public health leaders might take, Dr. Cao explained.

“Particularly in adolescence,” she wrote, “the immature and rapidly growing organs could be more susceptible to exposures that could lead to cancer development.”

“Campaigns, education programs, and interventions targeting the young population to reduce SSB intake and/or replace SSBs with other healthier beverages could help reduce the accrual of time at risk and convert this window of increased susceptibility into an opportunity for better health outcomes later in life.”

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An estimated 1.5 million people living in the United States alone have RA, an autoimmune disease that causes joint pain, swelling, and eventually damage.

Researchers continue to look for new ways to diagnose RA, especially in its early stages. That is because the earlier a person receives a proper diagnosis of and treatment for RA, the better their chances of good outcomes, such as limiting joint damage and functional loss.

Researchers also remain uncertain as to what exactly causes RA to develop, although it seems to depend on a mix of genetic and environmental factors.

In more recent years, RA researchers have been exploring the link between ERA, people at risk of RA, and the changes in their oral and intestinal microbiota, or community of microbes.

It seems people with ERA and at risk of RA have abnormal levels of certain bacteria in the mucus that lines the mouth and intestines. They also seem to be more likely than other people to have periodontal disease, or gum disease.

What is more, some research indicates RA may begin in the oral cavity.

That is why a team of researchers from the Academic Centre for Dentistry of Amsterdam (ACTA) set out to analyze the microbial populations and periodontal condition of people with ERA, those at risk of RA, and a control group of people without these conditions for comparison.

Their study appears in the journal Arthritis & Rheumatology.

The oral microbiome and RA

Researchers have long speculated that autoimmune diseases, such as RA, are triggered or caused by microorganisms.

For quite some time, researchers have been aware there are links between periodontal disease, changes in the oral and intestinal microbiome, and RA.

Several studies seem to show that oral microbes — in particular anaerobic bacteria, which do not require oxygen — may play a role in the development of RA.

A 2009 study highlights three types of anaerobic bacteria occurring in the oral cavity that have been identified in joint fluid from people with RA. Several studies show that antibodies for certain types of anaerobic bacteria associated with periodontal disease may play a role in the development of RA.

Some researchers think these bacteria may cause an RA-associated immune response by producing proteins that trigger the formation of anti-citrullinated protein antibodies (ACPAs).

These compounds appear to promote inflammatory responses in different types of cells, including bone cells. Some studies have shown that this response ACPAs promote may be involved in the mediation of bone damage in the joints of people with RA.

For these and other reasons, the detection of ACPAs is now considered the most specific biomarker for RA in serum, which is the fluid component of blood.

The detection of ACPAs in serum also seems to help predict RA development several years before a person has clinical RA or experiences symptoms and receives an RA diagnosis.

That is why several research teams, including the team involved in the current study, have been exploring how changes in the composition and other components of the oral microbiome may relate to the onset of RA.

Oral microbiome changes and RA risk

In the new study, researchers analyzed the oral microbiome and periodontal status of three groups of 50 people.

People in the first group had ERA, and the second group included people at risk of RA (people with serum ACPAs or arthralgia). People in the third group did not have RA and were not at risk, did not have autoimmune conditions, and were generally healthy.

Each participant was examined by a dentist to assess their periodontal condition. Dentists checked whether their gums bled with probing, the inflamed gum surface area, and how deep into the gum line dental tools could probe.

They also examined how many teeth each participant had, how many of their teeth were missing, decayed, or filled, and whether a person wore a removable denture. They also asked each participant about the last time they brushed their teeth and what their regular oral hygiene measures were.

In addition, the scientists collected from each participant samples of the tongue coating or film, saliva, and subgingival dental plaque, which is found below the gum.

After using devices to amplify the DNA present in the samples, they collected, analyzed, and quantified the microbial populations within the samples. They then compared microbial differences between the three groups.

The team identified no difference in periodontal conditions between the groups. There was also no difference in dental plaque samples.

Yet differences did exist between the oral saliva and tongue coating of people with ERA and at risk of RA compared with the control group.

Levels of bacteria belonging to the genera Prevotella and Veillonella were higher in saliva samples from people with ERA and at risk of RA compared with the control group. Veillonella bacterial levels were also higher in the tongue coatings of the RA groups than in those of people in the control group.

According to the authors, these findings suggest that a possible link between the oral microbe and RA may truly exist.

This also suggests that bacteria from these two genera, as well as some others already reported to be involved in RA onset, could help trigger immune responses that influence the development of RA.

The authors explain that these findings correspond to those of previous studies showing that people with new-onset RA and established RA had increased levels of oral Prevotella bacteria. The results also support research that found increased levels of Prevotella bacteria in the gut microbiome of people at risk of RA or with ERA.

The authors write that some strains of Prevotella can cause chronic inflammation, which can trigger immune cells to be released throughout the body. They add that in some cases, microbial dysbiosis, or microbial imbalances, partially resolves with RA treatment.

The wider picture

Medical News Today spoke with Dr. Vanessa L. Kronzer, who cowrote a recent review on the etiology of RA. She said:

“This is an interesting study that, in my mind, achieves two goals. First, it provides further support for the mucosal origin hypothesis for RA. And second, it suggests that dysbiosis occurs even before disease onset and thus may play a role in RA disease pathogenesis.”

Dr. Kronzer believes this research is “an important step in a long path to understanding the etiology of this important disease.”

MNT also contacted Johanna Kroese from ACTA, the corresponding author of the study. She explained:

“Our results indicate a possible role for oral bacteria in triggering the onset of RA. Targeting these bacteria might lower the risk of developing RA. Future research can focus on strategies to target these bacteria and improving oral health, and might eventually lead to the development of measures for RA disease prevention.”

Some limitations

While the study had many strengths, it also had some notable flaws.

People within the ERA group were receiving treatment for RA, while people at risk of RA and those in the control group were not. The researchers also did not collect information on some factors that may influence dental plaque, such as diet.

To confirm their findings, the authors say future studies must collect multiple datasets over longer periods of time, ideally using large groups of people and consistent collection methods.

Nevertheless, these findings may have uncovered yet another stepping stone in the complex, elusive development process of RA. This could be good news for the millions of people living with RA, and the healthcare professionals trying to diagnose and treat them.

As Johanna Kroese explained to MNT, although further research is needed, “improving oral health is relevant for the entire population, and it wouldn’t hurt to already pay attention to oral health in persons at risk of developing RA.”

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1178747478 Image credit: SCIENCE PHOTO LIBRARY / Getty Images.

A retrospective, observational study has found that people who received the BCG vaccination — which prevents tuberculosis — were less likely to report symptoms of COVID-19 and less likely to have antibodies against the infection in their blood.

Scientists developed the BCG (bacillus Calmette-Guérin) vaccine more than 100 years ago to protect against the bacterial infection tuberculosis (TB).

According to the World Health Organization (WHO), by 2004, around 100 million children a year were receiving the vaccine.

In the United States, BCG is approved for people at high risk of developing TB and for treating some forms of bladder cancer.

But research also suggests that BCG vaccination early in life can reduce child mortality by up to 45%, mainly through reduced susceptibility to sepsis (blood poisoning) in babies, respiratory infections, and fever.

In adolescents and older people, there is also some evidence that BCG protects against viral respiratory infections.

Scientists believe the vaccine primes the “innate” immune system, the body’s first line of defense against viruses and other invading organisms. Unlike adaptive immunity, innate immunity rarely targets specific pathogens that the body has encountered in the past.

Researchers at the Cedars-Sinai Medical Center in Los Angeles, CA, wondered whether BCG might reduce susceptibility to SARS-CoV-2, the virus that causes COVID-19.

“We were interested in studying the BCG vaccine because it has long been known to have a general protective effect against a range of bacterial and viral diseases other than TB, including neonatal sepsis and respiratory infections,” says co-senior author Dr. Moshe Arditi, director of the Pediatric and Infectious Diseases and Immunology Division at Cedars-Sinai.

The team has reported their results online in The Journal of Clinical Investigation.

COVID-19 symptoms and antibodies

Between May 11 and June 18, 2020, 6,201 healthcare workers gave blood samples and answered questions about their medical history, including whether they had received BCG and vaccines against two other bacterial infections and influenza.

In total, 1,836 said they had received the BCG vaccination, 4,275 said they had not received it, and 90 were unsure.

Those with the vaccination were less likely to report experiencing symptoms of COVID-19 at any time in the past 6 months.

Overall, 3.5% of the entire cohort tested positive for SARS-CoV-2 antibodies.

Among those who reported receiving the BCG vaccine, 2.7% tested positive, while among those who said they hadn’t received it, 3.8% tested positive.

“It appears that BCG-vaccinated individuals either may have been less sick and therefore produced fewer anti-SARS-CoV-2 antibodies, or they may have mounted a more efficient cellular immune response against the virus,” says Dr. Arditi.

After adjusting for age and sex, BCG vaccination — but none of the other vaccinations — was still associated with a reduced likelihood of testing positive for SARS-CoV-2 antibodies.

In their paper, the researchers write:

“Taken together, these results indicate that a history of BCG vaccination confers a nonspecific protective effect against infection with SARS-CoV-2 and decreases the presence of self-reported COVID-19 symptoms. This appears to be specific to BCG, as [other vaccinations] […] are not associated with similar protection against infection with SARS-CoV-2.”

Self-reported vaccination history

One of the study’s limitations was that it relied on participants’ recollection of which vaccines they had received, and whether they had experienced typical COVID-19 symptoms in the previous 6 months.

In addition, the numbers in each group who developed symptoms or tested positive were relatively small, which limited the statistical power of the study and the reliability of its findings.

However, it is interesting to note that those who reported receiving the BCG vaccination were older on average. They were also more likely to have diabetes, hypertension, cardiovascular disease, and chronic obstructive pulmonary disease.

These are all factors that increase a person’s chances of developing a severe COVID-19 infection.

In August 2020, Medical News Today reported another observational study, which suggested countries with mandatory BCG vaccination had a degree of “herd immunity” against the disease.

There are 22 clinical trials currently investigating BCG’s potential to prevent or treat COVID-19, which should provide more definitive evidence. Dr. Arditi and Cedars-Sinai are involved in one of the studies.

No-one believes BCG will be more effective than specific vaccines for COVID-19, Dr. Arditi explains. But if the trials prove its worth, as a well-established vaccine, BCG could be quickly approved and rolled out for this application.

“It is a potentially important bridge that could offer some benefit until we have the most effective and safe COVID-19 vaccines made widely available,” he says.

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Chevron has revealed that it is spending over $5 million (about N1.9 billion) to support the federal government’s fight against tuberculosis, malaria and HIV in the country since 2017.

Chairman and managing director, Chevron Nigeria Limited, Jeff Ewing, who disclosed this, lauded the 12-year partnership between Chevron and the Global Fund in the fight against the infectious diseases and building of resilient health system in Nigeria.

The Global Fund is an international financing and partnership organisation whose aim is to attract, leverage and invest additional resources to end the epidemics of HIV/AIDS, tuberculosis and malaria to support the attainment of the Sustainable Development Goals of the United Nations on good health and well-being.

Jeff in a statement made available to LEADERSHIP yesterday explained that the partnership between Chevron and Global Fund is an example of how Chevron is contributing strategically to the development of Nigeria by helping to improve the health of its people.

He affirmed that Chevron has been one of the largest Global Fund corporate partners and its partnership focuses on capacity development initiatives, joint advocacy and communications campaigns, and other local initiatives. “Chevron also encourages its staff to share their skills with the local programmes to help improve grant reach and performance,” he added.

He stated that Chevron’s $5 million investment from October 2017 has supported the national HIV and TB programmes in Nigeria.

Chevron’s intervention since 2019 has supported more than one million people living with HIV on antiretroviral therapy and over 42,000 HIV-positive pregnant women have received antiretroviral therapy during pregnancy to prevent passing the virus to their babies.

He said in addition more than one million HIV-positive patients were screened for TB in HIV care or treatment settings and over seven million people tested for HIV and received their results, during the period.

“More than 2.8 million pregnant women knew their HIV status from the intervention fund,” the Chevron chairman said.

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Medical experts have warned that non-communicable diseases (NCDs) such as hypertension, diabetes, cancer, cardiovascular diseases are responsible for the majority of Coronavirus disease (COVID-19) deaths in the country.

President, NCD Alliance Nigeria, Olorogun Dr. Sonny F. Kuku, in his opening remarks during a webinar on, “Non-communicable Diseases and COVID-19 in Nigeria – The response”, held Tuesday, July 21, 2020, said: “… We are only seeing the tip of the iceberg and unfortunately, people with NCDs are at greater risk. It is impacting the poorest people and most vulnerable. People with hypertension, diabetes and heart disease are the most vulnerable. We are now seeing stroke as symptom. This means COVID-19, which is an infectious disease is manifesting as an NCD in the form of stroke…”

Vice President, Scientific Affairs, NCDs Alliance Nigeria, Dr. Kingsley Akinroye, has said blamed the situation on the nation’s years of lack of commitment to the course of NCDs. The cardiologist said NCDs account for 29 per cent of deaths in Nigeria.

Akinroye, at the launch of the New Civil Society Solidarity Fund on NCDs in response to COVID-19, harped on the need to strengthen the healthcare system, intensify awareness, increase access to care and treatment, and vote more money for NCDs care and management.

However, the NCD Alliance Nigeria and 19 other global and national NCD Alliances have been awarded $300,000.

Akinroye added that regional and national NCD Alliance including NCD Alliance Nigeria would get $15,000 to address the critical needs of people living with NCDs during the pandemic through advocacy and communication activities that would support stronger organisational stability and resilience

According to the cardiologist, COVID-19 shows many connections between it and NCDs stating that people living with NCDs are more vulnerable to COVID-19 with a substantially higher risk o becoming severely ill or dying from the virus.

The expert said that actions taken to control NCDs in Nigeria include the launch o the First Multi-Sectoral Action Plan or Prevention and Control o NCDs by the Federal Ministry of Health (FMoH) and the NCD Alliance Nigeria Publication of the Handbook on Civil Society Organisation in NCDs.

“Activities in Nigeria will include the development of a database of people living with NCDs in Lagos, Osun, and Federal Capital Territory and by NCD area of focus. Also, establishment and support for people living with NCDs with skills and knowledge, and connect them to NCD Alliance Nigeria, federal Ministry o Health, World Health Organisation and State Ministry of Health in the four states,” he added.

Akinroye further stated that they would build capacity for people living with NCDs on advocacy for their rights to health, prevention, access to treatment and care; provision of support and empowerment

He explained that NCD Alliance Nigeria would develop a directory and a database in the states by area of focus cardiovascular disease, diabetes, cancer, sickle cell disease, respiratory diseases and mental health and also develop advocacy communication materials targeting Lawmakers, Policymakers and opinion leaders that are persuasive and effective to improve prevention, care and access to treatment for people living with NCDs.

The expert, however, tasked the Presidential Taskforce on COVID-19 to mobilise for more testing and awareness amongst the grassroots and also provide free hypertensive and diabetic drugs or the vulnerable population.

Executive Director, NCD Alliance Nigeria, Prof. Akin Osibogun, also presented a paper on “NCDs in Nigeria and COVID-19: The Nigerian experience.”

Osibogun is a consultant public health physician/epidemiologist, a member of Lagos State COVID-19 Response Team and former Chief Medical Director (CMD), Lagos University Teaching Hospital (LUTH) Idi Araba.

Member, Nutrition Committee, Nigerian Heart Foundation (NHF) and Food Scientist, Prof. Isaac Adebayo Adeyemi, spoke on “COVID-19 and Nutrition: Gathering evidence.”

Akinroye delivered a paper on “People Living with NCDs in Nigeria and COVID-19.”

Adeyemi, who is Vice chancellor of Bells University of Technology Ota, Ogun State, and the pioneer Deputy Vice-Chancellor, Ladoke Akintola University of Technology (LAUTECH), Ogbomoso, Oyo State, said functional foods are important to boost the immune system.

Adeyemi said that a well functioning immune system is key to providing robust defence against pathogenic organisms. Adeyemi noted that mortality in people living with NCDs is likely the result of immune decline or impaired immune response.

The expert said that energy is required to fight the virus likewise, protein to produce essential antibodies.

He encouraged intake of Phytochemicals like quercetin from onions, phloretin and also Epigallocatechin gallate (EGCG) as well as conventional foods containing bioactive food compounds like vegetables, fruits, grains, dairy, fish and meat.

“Eat fresh and unprocessed food every day like fruits and vegetables, legumes and whole grains and animal products. Eat a moderate amount o fats and oils. Eat at home to reduce your rate of contact with other people,” he added.

Adeyemi urged the consumption of plant food such as grains, legumes and oilseeds, fruits and vegetables containing vitamins, minerals, fibre and phytochemicals.

He, however, stressed on the need to avoid the intake of caffeine, trans fat while also limiting the intake of salt because they are predisposing factors that contribute to morbidity o patients with COVID-19.

According to a study published in Scholars Journal of Applied Medical Sciences and titled “COVID-19 and Nutrition: Review of Available Evidence”, nutritional support is indicated for depleted patients with respiratory diseases because it provides not only supportive care, but direct intervention through improvement in respiratory and peripheral skeletal muscle function and in exercise performance.

The researchers noted: “A combination of oral nutritional supplements and exercise or anabolic stimulus appears to be the best approach to obtaining significant functional improvement. Patients responding to this treatment even demonstrated a decreased mortality. Furthermore, weight loss and malnutrition opens the door of infection reoccurrence. Poor response was related to the effects of systemic inflammation on dietary intake and catabolism.

“Dietary management of pre-existing diseases has been suggested as a strategy to minimise the potential risk of COVID-19 infection in conditions such as irritable bowel syndrome, Crohn’s and Colitis. WHO, dietetic associations and dietitians have been calling for patients with pre-existing conditions to continue abiding by their dietary advice and nutritional therapy steps received from their dietician if tested positive for COVID-19.”

Meanwhile, according to a World Health Organisation (WHO) survey, prevention and treatment services for NCDs have been severely disrupted since the COVID-19 pandemic began. The survey, which was completed by 155 countries during a three-week period in May, confirmed that the impact is global, but that low-income countries are most affected.

This situation is of significant concern because people living with NCDs are at higher risk of severe COVID-19-related illness and death.

Director-General of the WHO, Dr. Tedros Adhanom Ghebreyesus, said: “The results of this survey confirm what we have been hearing from countries for a number of weeks now.

“Many people who need treatment for diseases like cancer, cardiovascular disease and diabetes have not been receiving the health services and medicines they need since the COVID-19 pandemic began. It’s vital that countries find innovative ways to ensure that essential services for NCDs continue, even as they fight COVID-19.”

The main finding is that health services have been partially or completely disrupted in many countries. More than half (53 per cent) of the countries surveyed have partially or completely disrupted services for hypertension treatment; 49 per cent for treatment for diabetes and diabetes-related complications; 42 per cent for cancer treatment, and 31 per cent for cardiovascular emergencies.

Rehabilitation services have been disrupted in almost two-thirds (63 per cent) of countries, even though rehabilitation is key to a healthy recovery following a severe illness from COVID-19.

In the majority (94 per cent) of countries responding, ministries of health staff working in the area of NCDs were partially or fully reassigned to support COVID-19.

The postponement of public screening programmes (for example for breast and cervical cancer) was also widespread, reported by more than 50 per cent of countries. This was consistent with initial WHO recommendations to minimize non-urgent facility-based care whilst tackling the pandemic.

But the most common reasons for discontinuing or reducing services were cancellations of planned treatments, a decrease in public transport available and a lack of staff because health workers had been reassigned to support COVID19 services. In one in five countries (20 per cent) reporting disruptions, one of the main reasons for discontinuing services was a shortage of medicines, diagnostics and other technologies.

Unsurprisingly, there appears to be a correlation between levels of disruption to services for treating NCDs and the evolution of the COVID-19 outbreak in a country. Services become increasingly disrupted as a country moves from sporadic cases to community transmission of the coronavirus.

Globally, two-thirds of countries reported that they had included NCD services in their national COVID-19 preparedness and response plans; 72 per cent of high-income countries reported inclusion compared to 42 per cent of low-income countries. Services to address cardiovascular disease, cancer, diabetes and chronic respiratory disease were the most frequently included. Dental services, rehabilitation and tobacco cessation activities were not as widely included in response plans according to country reports.

Seventeen percent of countries reporting have started to allocate additional funding from the government budget to include the provision of NCD services in their national COVID-19 plan.

Encouraging findings of the survey were that alternative strategies have been established in most countries to support the people at the highest risk to continue receiving treatment for NCDs. Among the countries reporting service disruptions, globally 58 per cent of countries are now using telemedicine (advice by telephone or online means) to replace in-person consultations; in low-income countries, this figure is 42 per cent. Triaging to determine priorities has also been widely used, in two-thirds of countries reporting.

Also encouraging is that more than 70 per cent of countries reported collecting data on the number of COVID-19 patients who also have an NCD.

Director of the Department of NCDs at WHO, Dr. Bente Mikkelsen, said: “It will be some time before we know the full extent of the impact of disruptions to health care during COVID-19 on people with NCDs.

“What we know now, however, is that not only are people with NCDs more vulnerable to becoming seriously ill with the virus, but many are unable to access the treatment they need to manage their illnesses. It is very important not only that care for people living with NCDs is included in national response and preparedness plans for COVID-19 – but that innovative ways are found to implement those plans. We must be ready to ‘build back better’- strengthening health services so that they are better equipped to prevent, diagnose and provide care for NCDs in the future, in any circumstances.”

According to the WHO, NCDs kill 41 million people each year, equivalent to 71 per cent of all deaths globally. Each year, 15 million people die from an NCD between the ages of 30 and 69 years; more than 85 per cent of these “premature” deaths occur in low- and middle-income countries.

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The federal government has received $890 million as grants from the Global Fund to fight HIV/AIDS, tuberculosis and malaria.

The Minister of Health, Dr. Osagie Ehanire, said yesterday that the fund would be used to implement programmes aimed at eradicating the diseases over a three year period, from 2021 to 2023.

Ehanire said that the Global Fund also approved a grant of US$21.9 million to support Nigeria’s COVID-19 response.

He said: “The purpose of this press briefing today is to announce the receipt of a grant, made to the Federal Republic of Nigeria by The Global Fund to fight HIV/AIDS, tuberculosis and malaria, amounting to $890 million, over an implementation period of three years, beginning from 2021 to 2023.”

The minister noted that the grant, which is the largest given to any country in this funding cycle, is sequel to a successful funding request made by the Nigeria Country Coordination Mechanism (CCM).

The Global Fund for the fight against HIV/AIDS, Tuberculosis and Malaria (GF) is an innovative international financing mechanism that was established by the United Nations in 2002, with its headquarters in Geneva, Switzerland.

The fund is made up of global partnership of governments, civil societies and private donors and established for the purpose of attracting, leveraging and investing resources to fund public health interventions that would accelerate the eradication of HIV, tuberculosis and malaria in affected high burden countries to further goals of Sustainable Development Goals (SDGs).

The Global Fund has committed the sum of USD$2.586 billion since 2002 to operations in Nigeria, which are split into four program areas: HIV/AIDS, tuberculosis, malaria and the Resilient Systems Strengthening for Health, (RSSH).

Nigeria has accessed $2.436 billion, which represented 94 percent of the committed amount.

The minister said the grant would complement the investment of the government of Nigeria and of other Development Partners in HIV/AIDS, tuberculosis and malaria programmes, including the Resilient and Sustainable System for Health, over the period 2021-2023.

He said the approval of the grant came following the review of the proposal that the CCM Nigeria submitted on March 23, 2020, which was adjudged to be technically sound and strategically focused by the independent Technical Review Panel of the Global Fund.

Ehanire said: “This grant will support access to malaria prevention, diagnostic and treatment services in 13 states. The States include Adamawa, Delta, Gombe, Jigawa, Kaduna, Kano, Katsina, Kwara, Niger, Ogun, Osun, Taraba and Yobe States.

“Access to HIV/AIDS and tuberculosis services across all the 36 states and the FCT; Improvements in our health system, particularly, provision of infrastructure for warehousing and distribution of health commodities, laboratory services, data management and capacity building for our healthcare providers, including support to community system.”

The minister said the implementation of the grant would specially target the poor, the most vulnerable and disadvantaged, and those at higher risk of the target diseases, to promote equity in access to health care services.

He further said: “With regard to Nigeria’s COVID-19 response effort, The Global Fund gave approval to repurpose the sum of US$6.2 million out of our on-going grants for HIV, tuberculosis and malaria to support the implementation of our initial Incident Action Plan (IAP) for COVID-19.

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To find and treat more tuberculosis cases in Nigeria, the Institute of Human Virology Nigeria (IHVN) and the National Tuberculosis and Leprosy Control Programme (NTBLCP) have launched a mobile application for screening and notifying TB cases by private healthcare providers.

Announcing this recently, the IHVN Chief Executive Officer, Dr. Patrick Dakum, said that the application, Mobile Application for Tuberculosis Screening (MATS), launched in June was a game changer in the provision of real-time and online information on progress made by private-for-profit facilities, faith-based organisation facilities, patent medicine vendors, community pharmacists, private laboratories and other TB referral entities.

He said: “The application is already being used in Edo, Delta, Cross River, Akwa Ibom, Benue, Oyo, Ondo, Osun, Ogun, Kogi, Niger, Sokoto, Plateau, Nasarawa, Kaduna, Anambra, Enugu, Rivers, Imo, and Abia states.

“Since MATS was launched on June 1st, 2020, there has been an increase in the TB screening efficiency and linkage between facility and community-based units. More than 19,000 people have been screened resulting in the identification of 1,286 TB presumptive individuals and 52 confirmed TB cases enrolled on treatment,” he said.

The IHVN CEO explained that individuals who visit private health providers in the community are screened with standard TB symptom checklist on the app.

Thereafter, appropriate referral of clients or samples for diagnosis and treatment is initiated.

“Private providers can download the app from the Google Play Store or via a web link, register as a user and start using the app once activated by a TB treatment facility. All screening data from the various referral entities can be viewed on the treatment facility’s dashboard and a summary on the mobile app,” he said.

NTBLCP Monitoring and Evaluation Manager, Dr. Obioma Chijioke- Akaniro added that the app simply shows the efforts directed towards finding tuberculosis cases. “The simplicity of MATS makes it attractive to the private sector especially as they may not oblige to filling cumbersome tools,” she said.

Dr. Chijioke-Akaniro said that MATS will be continually upgraded based on feedback from its users.

The application was developed and redesigned by PharmAccess to suit the peculiarities of private health providers in line with the national algorithm for TB screening and diagnosis.

Upgrade and deployment of the application is implemented by IHVN under the Public Private Mix (PPM) grant funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria.

“The private sector in Nigeria contributed 14% to the total national TB case notification in 2019. It is expected that the MATS app will contribute immensely to the actualization of the goal of the grant which aims to improve public private sector contribution to the national TB case notification from 11 per cent in 2017 to 35 per cent in 2020” Dr Dakum said.

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Lung cancer is the second most common type of cancer in adults in the United States. It is also the leading cause of death from cancer.

Lung cancer treatment is much more effective when the disease is in its earlier stages. However, most people with lung cancer do not experience symptoms until the disease has spread.

Some people experience subtle symptoms of early stage lung cancer, but these symptoms more often stem from other health issues or factors such as smoking.

Below, we describe early symptoms of lung cancer, as well as risk factors and when to see a doctor.

Possible signs and symptoms of early stage lung cancer

According to the American Cancer Society (ACS), most types of lung cancer do not cause symptoms until they have spread to other areas.

However, some people experience subtle symptoms during the earlier stages of the disease.

The early lung cancer symptoms that we describe below usually result from some other cause. However, people who experience these symptoms should consider visiting their doctors as a precautionary measure.

Sudden weight loss

The American Society of Clinical Oncology report that weight loss is often the first noticeable sign of cancer.

They estimate that 40% of people who receive a cancer diagnosis experience unexplained weight loss during that time.

Cancer can cause weight loss for many reasons, including:

  • changes to immune function
  • changes to metabolism
  • changes to hormones
  • a sudden loss of appetite
  • difficulty swallowing

Shortness of breath

Shortness of breath and wheezing can also be early symptoms of lung cancer.

Some people may experience a slight cough in addition to shortness of breath. Others may have difficulty catching their breath but have no cough.

Cough

A slight cough that does not go away can indicate early stage lung cancer. Some people assume that this cough is only a result of smoking.

A person who regularly coughs because of another lung condition may notice changes in their cough, and these can likewise indicate lung cancer.

Also, a cough that produces blood may result from lung cancer or another issue with the lungs. Anyone who experiences this symptom should see a doctor.

General fatigue

Lung cancer can cause the number of red blood cells in the body to drop. The medical term for this issue is anemia.

Because red blood cells carry oxygen, a person with anemia may not take in enough oxygen to support their body’s needs. This can result in tiredness and fatigue. Severe fatigue can make it difficult to function on a day-to-day level.

Shoulder, chest, or back pain

Most people with lung cancer do not feel pain or other symptoms during the early stages. This is because there are very few nerve endings in the lungs.

However, pain can occur when lung cancer invades the chest wall, ribs, vertebrae, or certain nerves. For example, Pancoast tumors, which form at the very top of the lungs, often invade nearby tissues, causing shoulder pain.

As a tumor develops, a person may begin to feel pain in their:

  • arms
  • chest
  • back

Hoarse voice

A person with lung cancer or another respiratory disease may develop a hoarse, raspy voice.

This can happen if a tumor presses on the laryngeal nerve, which is located within the chest. When the nerve is compressed, it can paralyze a vocal cord, causing the voice to change.

Risks

According to the Centers for Disease Control and Prevention (CDC), cigarette smoking is still the biggest risk factor for lung cancer, accounting for 80–90% of lung cancer-related deaths.

Other risk factors for lung cancer include:

  • using other tobacco products, such as cigars or pipe tobacco
  • inhaling secondhand smoke
  • being exposed to radon gas, possibly from materials within the home
  • working with dangerous chemicals, such as asbestos, arsenic, or diesel
  • living in a highly polluted area
  • having other lung conditions, such as chronic obstructive pulmonary disease
  • having a family history of lung cancer

When describing risk, organizations and experts sometimes use the term “pack-year.” A pack-year refers to the number of cigarettes smoked per day each year. So a person with a 30 pack-year smoking history may have:

  • smoked one pack per day for 30 years
  • smoked two packs per day for 15 years

The ACS recommend yearly lung cancer screenings for people aged 55–74 who:

  • currently smoke or have quit smoking in the past 15 years
  • have at least a 30 pack-year smoking history
  • currently smoke and are receiving counseling to help them quit
  • are aware of the potential benefits and harms of screening
  • have access to a facility that has experience with lung cancer screening and treatment

Screening cannot detect every instance of lung cancer, but it does lower a person’s chance of dying from the disease.

Smokers vs. nonsmokers

According to the CDC, people who smoke are 15–30 times more likely to die from lung cancer than people who do not.

Meanwhile, according to statistics from 2013–2014, about 1 in 4 people who do not smoke, including children, are exposed to secondhand smoke. This increases their risk of developing the disease.

Quitting smoking at any age can lower the risk of lung cancer.

When to see a doctor

The symptoms above usually result from issues other than lung cancer. However, anyone who experiences any of the following issues should visit a doctor:

  • a cough that lasts longer than 2–3 weeks
  • a persistent cough that worsens
  • a cough that produces blood
  • aches or pains when breathing or coughing
  • persistent shortness of breath
  • persistent tiredness or fatigue
  • recurrent chest infections
  • unexplained weight loss

Summary

Lung cancer is the second most common form of cancer. It can affect anyone but is particularly prevalent among people who smoke.

Usually, lung cancer does not cause symptoms until it has spread. As a result, it is not always possible to detect lung cancer in its earliest stages.

Nonetheless, some people experience subtle symptoms during the initial stages. It is important to recognize these because treatment is typically more effective when a person receives it early.

Anyone who experiences early symptoms of lung cancer should see a doctor. In many cases, something other than cancer is the cause. Still, it is best to seek medical advice as a precaution.

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