Dear Fellow countrymen

 

It is our constitutional right to know the health of our President. It is a moral prerogative to be concerned about our President’s health. The physical and mental well-being of most presidents in the world are usually not shrouded in secrecy because details of  the health of current and past presidents in the developed world are in the public domain. Speculations about the health of some of our leaders should not be subject to benign or malignant analyses by medically qualified and non-medically qualified pundits.

 

Permit me to congratulate the photographer who took the picture of President Muhammadu Buhari that was published in The Guardian newspaper of Friday, February 24, 2017. This photograph  showed the face of the President and the back of both of his hands. It is a universally acceptable and common exercise in medical education to use such photos in arriving at a preliminary clinical diagnosis albeit subject to clinical history, more laboratory tests and clinical examination.

As a board certified physician in internal medicine and a board certified physician in Anatomic pathology from London and Ireland, I hereby venture to throw some light on this invaluable photograph that may allay the fears of all the concerned citizens of this nation and in the Diaspora.

 

My negative findings, based on this single photograph are as follows:

 

1) The President is not dehydrated;

 

2) The President is not clinically anaemic;

 

3) The President is not clinically jaundiced;

 

4) For his age, there are no wrinkles on his forehead indicative of good preservation and nutrition; and

 

5) The national costume does not permit a superficial assessment of whether he has lost weight or not.

 

My positive findings based on this single snapshot are as follows:

 

1) The photograph shows some degree of clubbing of the fingers;

 

2) the photo shows a small nodule on the lateral aspect of two fingers and one of these bumps has a hyper-pigmented  rim  suggestive of an infective aetiology (cause) in the recent past;

 

3) there is mild reduplication  of skin over the knuckles (not enough for elastosis);

 

4) there are multiple transverse opacities on the nails particularly of the left hand suggestive of an infection, viral or other infections.

 

The summary of these positive findings suggest that if the clubbing of the fingers are not congenital, the President may have a disease associated with finger clubbing, some of which are not serious and some of which are serious and cannot be speculated upon. The most serious of these is cancer somewhere.

 

One relevant question to ask is whether the President smoked cigarettes at some point in his life. Furthermore, the multiple opacities in the nails suggest some infective pathologies at different times as these opacities appear layered in disposition. The little bump on the finger with a hyper-pigmented rim is benign and suggests a previous infection or even an insect bite. In my opinion, there may be no cause for alarm if the finger clubbing is something he was born with. If not, there may be cause for alarm if the underlying cause is a serious disease and there are many to consider.  The significance of his past history of an ear infection is worthy of further investigation as head and neck cancers may masquerade in a number of ways.

 

 It will be in the best interest of all concerned for more information to be released as extended requests for sick leave make the prognosis to be suspect. For those who may wish to be more enlightened on finger clubbing, there are several references on the Internet and textbooks of medicine.

 

Finally, I may be wrong as this synopsis is based on a newspaper snapshot which is presumed to be of recent vintage. In that case, this is not meant to mislead the public but to fill a huge void in the absence of reliable information.

 

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Written by Prof. Femi. Williams. M.A., M.D., F.R C P (Lond) F R C Path (Lond)

 

Founder, African Cancer Centre, Lagos