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Hypogonadism in Men & Woman: Causes, Symptoms & Treatments

Hypogonadism occurs when your sex glands produce little or no sex hormones. The sex glands, also called gonads, are primarily the testes in men and the ovaries in women. Sex hormones help control secondary sex characteristics, such as breast development in women, testicular development in men, and pubic hair growth. Sex hormones also play a role in the menstrual cycle and sperm production.

Hypogonadism may also be known as gonad deficiency. It may be called low serum testosterone or andropause when it happens in males.

Most cases of this disorder respond well to appropriate medical treatment.

What Are the Types of Hypogonadism?

There two types of hypogonadism are primary and central hypogonadism.

Primary Hypogonadism

Primary hypogonadism means that you don’t have enough sex hormones in your body due to a problem in your gonads. Your gonads are still receiving the message to produce hormones from your brain, but they aren’t able to produce them.

Central Hypogonadism (Secondary Hypogonadism)

In central hypogonadism, the problem lies in your brain. The hypothalamus and pituitary gland in your brain, which control your gonads, aren’t working properly.

What Are the Causes of Hypogonadism?

The causes of primary hypogonadism include:

  • autoimmune disorders, such as Addison’s disease and hypoparathyroidism
  • genetic disorders, such as Turner syndrome and Klinefelter syndrome
  • severe infections
  • liver and kidney diseases
  • undescended testes
  • hemochromatosis, which happens when your body absorbs too much iron
  • radiation exposure
  • surgery on your sex organs

Central, or secondary, hypogonadism may be due to:

  • genetic disorders, such as Kallmann syndrome (abnormal hypothalamic development)
  • infections, including HIV and AIDS
  • pituitary disorders
  • inflammatory diseases, including sarcoidosis, tuberculosis, and histiocytosis
  • obesity
  • rapid weight loss
  • nutritional deficiencies
  • use of steroids or opiates (especially long-term usage)
  • brain surgery
  • radiation exposure
  • injury to your pituitary gland or hypothalamus
  • a tumor in or near your pituitary gland
What Are the Symptoms of Hypogonadism?

Symptoms that may affect females include:

  • lack of menstruation
  • slow or absent breast growth
  • hot flashes
  • loss of body hair
  • low or absent sex drive
  • milky discharge from your breasts

Symptoms that may affect males include:

  • loss of body hair
  • muscle loss
  • abnormal breast growth
  • reduced growth of penis and testicles
  • erectile dysfunction
  • osteoporosis
  • low or absent sex drive
  • infertility
  • fatigue
  • hot flashes
  • difficulty concentrating
How Is Hypogonadism Diagnosed?

Your doctor will conduct a physical exam to confirm that your sexual development is at the proper level for your age. They may examine your muscle mass, body hair, and your sexual organs.

Hormone Tests

If your doctor thinks you might have hypogonadism, the first round of testing will involve checking your sex hormone levels. You’ll need a blood test to check your level of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Your pituitary gland makes these reproductive hormones.

You’ll have your estrogen level tested if you’re female. You’ll have your testosterone level tested if you’re male. These tests are usually drawn in the morning, which is when your hormone levels are highest. If you’re male, your doctor may also order a semen analysis to check your sperm count. Hypogonadism can reduce your sperm count.

Your doctor may order more blood tests to help confirm the diagnosis of hypogonadism and rule out any underlying causes.

Iron levels can affect your sex hormones. For this reason, your doctor may test for anemia, or iron deficiency. Your doctor may also wish to measure your prolactin levels. Prolactin is a hormone that promotes breast development and breast milk production in women, but it’s present in both genders. Your doctor may also check your thyroid hormone levels because thyroid problems can cause symptoms similar to hypogonadism.

Imaging Tests

Imaging tests can also be useful in diagnosis. An ultrasound of the ovaries uses sound waves to create an image of the ovaries and check for any problems, including ovarian cysts and polycystic ovarian syndrome (PCOS). Your doctor may order MRI scans or CT scans to check for tumors in your pituitary gland.

What Are the Treatments for Hypogonadism?

Treatment for Hypogonadism in Women

Your treatment will involve increasing the amount of female sex hormones in your body if you’re a woman.

Your first line of treatment will probably be estrogen therapy if you’ve had a hysterectomy. Either a patch or pill can administer the supplemental estrogen hormone.

Because increased estrogen levels can increase your risk of endometrial cancer, you’ll be given a combination of estrogen and progesterone if women who haven’t had a hysterectomy. Progesterone can lower your risk of endometrial cancer if you’re taking estrogen.

Other treatments can target specific symptoms. If you’re a woman and you have a decreased sex drive, you may receive low doses of testosterone. If you have menstrual irregularities or trouble conceiving, you may receive injections of the hormone human choriogonadotropin (hCG) or pills containing FSH to trigger ovulation.

Treatment for Hypogonadism in Men

Testosterone is a male sex hormone. Testosterone replacement therapy (TRT) is a widely used treatment for hypogonadism in males. You can get testosterone replacement therapy by:

  • injection
  • patch
  • gel
  • lozenge

Injections of a gonadotropin-releasing hormone may trigger puberty or increase your sperm production.

Treatment for Hypogonadism in Men and Women

Treatment for males and females is similar if the hypogonadism is due to a tumor on the pituitary gland. Treatment may include radiation, medication, or surgery to shrink or remove the tumor.

Hypogonadism is a chronic condition that requires lifelong treatment. Your sex hormone level will probably decrease if you stop treatment.

Seeking support through therapy or support groups can help you before, during, and after treatment.

Pulmonary Edema: Causes, Symptoms & Treatments

Pulmonary edema definition and facts

  • Pulmonary edema is typically caused by filling of alveoli in the lungs by fluid leaking out of the blood.
  • Pulmonary edema may be caused by a number of cardiac or non-cardiac conditions.
  • Breathing difficulty is the main manifestation of pulmonary edema.
  • Treatment of the underlying cause of pulmonary edema is an essential step in the management of pulmonary edema.

What is pulmonary edema?

Edema, in general, means swelling. This typically occurs when fluid from inside blood vessels seeps outside the blood vessel into the surrounding tissues, causing swelling. This can happen either because of too much pressure in the blood vessels or not enough proteins in the bloodstream to hold on to the fluid in the plasma (the part of the blood that does not contain any blood cells).

Pulmonary edema is the term used when edema happens in the lungs. The immediate area outside of the small blood vessels in the lungs is occupied by very tiny air sacs called the alveoli. This is where oxygen from the air is picked up by the blood passing by, and carbon dioxide in the blood is passed into the alveoli to be exhaled out. Alveoli normally have a thin wall that allows for this air exchange, and fluids are usually kept out of the alveoli unless these walls lose their integrity.

Picture of the alveoli and lung

Picture of the alveoli and lung

Pulmonary edema occurs when the alveoli fill up with excess fluid seeped out of the blood vessels in the lung instead of air. This can cause problems with the exchange of gas (oxygen and carbon dioxide), resulting in breathing difficulty and poor oxygenation of blood. Sometimes, this can be referred to as “water in the lungs” when describing the condition to patients.

Pulmonary edema can be caused by many different factors. It can be related to heart failure, called cardiogenic pulmonary edema, or related to other causes, referred to as non-cardiogenic pulmonary edema.

What are the symptoms of pulmonary edema?

The most common symptom of pulmonary edema is shortness of breath or breathlessness. This may be of gradual onset if the process slowly develops, or it can have a sudden onset in the case of acute pulmonary edema.

Other common symptoms may include easy fatigue, more rapidly developing shortness of breath than normal with usual activity (dyspnea on exertion), rapid breathing (tachypnea), dizziness, or weakness.

Low blood oxygen level (hypoxia) may be detected in patients with pulmonary edema. Furthermore, upon examination of the lungs with a stethoscope, the doctor may listen for abnormal lung sounds, such as rales or crackles (discontinuous short bubbling sounds corresponding to the splashing of the fluid in the alveoli during breathing).

What are the risk factors?

The risk factors for pulmonary edema are essentially the underlying causes of the condition. There isn’t any specific risk factor for pulmonary edema other than risk factors for the causative conditions.

What causes pulmonary edema?

As mentioned earlier, pulmonary edema can be broadly divided into cardiogenic and non-cardiogenic causes. Some of the common causes are listed below.

Cardiogenic causes of pulmonary edema

Cardiogenic causes of pulmonary edema results from high pressure in the blood vessels of the lung due to poor heart function. Congestive heart failure due to poor heart pumping function (arising from various causes such as arrhythmias and diseases or weakness of the heart muscle), heart attacks, or abnormal heart valves can lead to accumulation of more than the usual amount of blood in the blood vessels of the lungs. This can, in turn, cause the fluid from the blood vessels to be pushed out to the alveoli as the pressure builds up.

What is the treatment for pulmonary edema?

The treatment of pulmonary edema largely depends on its cause and severity.

Most cases of cardiac pulmonary edema are treated by using diuretics (water pills) along with other medications for heart failure. In some situations, appropriate treatment can be achieved as an outpatient by taking oral medications. If the pulmonary edema is more severe or it is not responsive to oral medications, then hospitalization and the use of intravenous diuretic medications may be necessary.

The treatment for noncardiac causes of pulmonary edema varies depending on the cause. For example, severe infection (sepsis) is treated with antibiotics and other supportive measures, or kidney failure needs to be properly evaluated and managed.

Oxygen supplementation is necessary if the measured oxygen level in the blood is too low. In serious conditions, such as ARDS, placing a patient on a mechanical breathing machine is necessary to support their breathing while other measures are taken to treat pulmonary edema and its underlying cause.

When should I seek medical care for pulmonary edema?

Medical attention should be sought for anyone who is diagnosed with pulmonary edema of any cause. Many causes of pulmonary edema require hospitalization, especially if they are caused acutely. In some cases of chronic (long term) pulmonary edema, for example, with congestive heart failure, routine follow-up visits with the treating doctor may be recommended.

Most cases of pulmonary edema are treated by internal medicine doctors (internists), heart specialists (cardiologists), or lung doctors (pulmonologists).

How can pulmonary edema be prevented?

In terms of preventive measures, depending on the cause of pulmonary edema, some steps can be taken. Long-term prevention of heart disease and heart attacks, slow elevation to high altitudes, or avoidance of drug overdose can be considered preventive.

On the other hand, some causes may not completely avoidable or preventable, such as ARDS due to an overwhelming infection or a trauma.


Proteinuria : Causes, Symptoms & Treatments

People with proteinuria have urine containing an abnormal amount of protein. The condition is often a sign of kidney disease.Healthy kidneys do not allow a significant amount of protein to pass through their filters. But filters damaged by kidney disease may let proteins such as albumin leak from the blood into the urine.Proteinuria can also be a result of overproduction of proteins by the body.Kidney disease often has no early symptoms. One of its first signs may be proteinuria that’s discovered by a urine test done during a routine physical exam.  Blood tests will then be done to see how well the kidneys are working.

Risk Factors for Proteinuria

The two most common risk factors for proteinuria are:

  • Diabetes
  • High blood pressure (hypertension)

Both diabetes and high blood pressure can cause damage to the kidneys, which leads to proteinuria.

Other types of kidney disease unrelated to diabetes or high blood pressure can also cause protein to leak into the urine. Examples of other causes include:

  • Medications
  • Trauma
  • Toxins
  • Infections
  • Immune system disorders
Increased production of proteins in the body can lead to proteinuria. Examples include multiple myeloma and amyloidosis.Other risk factors include:

  • Obesity
  • Age over 65
  • Family history of kidney disease
  • Preeclampsia (high blood pressure and proteinuria in pregnancy)
  • Race and ethnicity: high blood pressure and develop kidney disease and proteinuria.

Some people get more protein into urine while standing than while lying down. That is known as orthostatic proteinuria.

Treatment of Proteinuria

Proteinuria is not a specific disease. So its treatment depends on identifying and managing its underlying cause. If that cause is kidney disease, appropriate medical management is essential.

Untreated chronic kidney disease can lead to kidney failure.

In mild or temporary proteinuria, no treatment may be necessary.

Drugs are sometimes prescribed, especially in people with diabetes and/or high blood pressure. These may come from two classes of drugs:

  • ACE inhibitors (angiotensin-converting enzyme inhibitors)
  • ARBs (angiotensin receptor blockers)

Proper treatment — especially in patients with chronic disease such as diabetes and high blood pressure — is essential to prevent the progressive kidney damage that is causing the proteinuria.

Vasectomy: Procedure & complications

What is a vasectomy?

A vasectomy is a permanent method of birth control for males. In this method, the tubes that carry sperms from the testes to the penis called vas are divided by an operation. This prevents sperm from being released in the semen during ejaculation. It can be offered to any man who wishes to be sterilized permanently. Although vasectomy can be reversed, the reversal may not work always.

How is the procedure performed?

The consent of the couple is taken. The doctor numbs each side of the scrotum with a local anaesthetic (numbing medicine). The operation is usually done through a small cut in the scrotum. The vas deferens (the tubes that carry the sperms) is pulled out and a part of it is removed or interrupted by various methods. The two cut ends of the vas deferens are sealed and placed back in the scrotum. The cuts in the skin are closed with stitches.
The whole procedure usually takes 15 to 20 minutes. The patient can go home after the procedure is completed. There may be some pain in the groin for 3 or 4 days after the operation. Some blood or yellow fluid may come out from the cuts on the skin. The area around the cuts may swell a bit. Pain relieving medicines and ice packs can be used to help with pain and discomfort. In some cases, a procedure called no-scalpel vasectomy is performed. In this the size of the skin cut is so small as to be barely noticeable.

How effective is the procedure?

A vasectomy is usually 100% effective in preventing pregnancy. However, during the first few weeks following the procedure another form of birth control method must always be used until the doctor confirms that the ejaculate does not contain sperm. Vasectomy does not protect against sexually transmitted diseases.

What are the complications after the procedure?

In rare cases, there can be infection or a haematoma, which is a collection of blood, in the area where surgery was performed.
What are the benefits of this procedure?

Vasectomy is a very effective and permanent method of birth control. There are no pills to take or devices to insert, and there is no interruption of sex. One is only required to use condoms or some other birth control methods for the first 20 ejaculations or for 3 months after the procedure. There are no apparent long-term health risks involved during or after the procedure.

Acid lipase diseases: causes, symptoms & treatments

Digestive system in the human body needs several important enzymes that break down the eaten foods into their basic ingredients. Similarly, when a specific type of enzyme called lysosomal acid lipase, that is essential for breaking fat in the foods are lacking in the digestive system, the fat turns into toxic chemicals harmful for the body, and then deposits in the cells and tissues. These fatty deposits contain oil, cholesterol and waxes, which create many adverse effects in the body including in several organs. This is when Acid Lipase Disease or Lysosomal Acid Lipase Deficiency occurs.

What is Acid Lipase Disease or Lysosomal Acid Lipase Deficiency?

Acid Lipase disease or Lysosomal acid lipase deficiency (LAL deficiency) occurs when the body doesn’t create enough lysosomal acid lipase enzymes. Infants, children, and adults are equally susceptible to this disease. Acid Lipase Disease or Lysosomal Acid Lipase Deficiency may cause a number of problems in the body as fatty materials are stored in the major organs like liver, spleen, blood vessels, etc.

Types of Acid Lipase Disease or Lysosomal Acid Lipase Deficiency

There are two categories of Acid Lipase Disease or Lysosomal Acid Lipase Deficiency known to the medical practitioners

  • Wolman’s Disease: It is a rare genetic disorder in which the genetic mutations that causes Acid Lipase Disease or Lysosomal Acid Lipase Deficiency. The symptoms of this disease are generally apparent shortly after birth. Wolman’s disease is caused due to mutations in the LAL genes. This is inherited from the ancestors as an autosomal recessive trait.
  • Cholesteryl Ester Storage Disease (CESD): It is also a rare genetic disorder in which the digestive system does not supply lysosomal acid lipase in sufficient quantities. In many patients, CESD is not detected till adulthood. This disease is also caused due to mutations in the LAL genes, which is inherited from the ancestors as an autosomal recessive trait.

Symptoms of Acid Lipase Disease or Lysosomal Acid Lipase Deficiency

To understand the symptoms of Acid Lipase Disease or Lysosomal Acid Lipase Deficiency, it is necessary to understand the symptoms of Wolman’s disease and Cholesteryl ester Storage Disease.

  • Symptoms of Wolman’s Disease: The symptoms in this form of Acid Lipase Disease or Lysosomal Acid Lipase Deficiency are visible within a few days or weeks of birth. Affected infants may have the following symptoms:
    • Bloating or swelling of the stomach.
    • Significant enlargement of liver and spleen.
    • Fibrosis of liver.
    • Accumulation of fluid in the abdominal cavity.
    • Persistent vomiting.
    • Frequent diarrhea and fatty stools.
    • Hardening of adrenal gland.
    • Lack of coordination of muscles.

If not treated in time, the symptoms worsen further leading to liver dysfunction, lower levels of RBCs in the blood, and several other life threatening issues.

  • Symptoms of Cholesteryl Ester Storage Disease: The symptoms of cholesteryl ester storage disease vary widely. Some patients develop symptoms of CESD in early childhood, and others may have few undetectable symptoms in childhood. The later cases remain undiagnosed till adulthood. Following are the major symptoms of CESD:
    • Abnormal fat deposits in many organs.
    • Fatty lever.
    • Abnormal blood lipoprotein profile.
    • Hepatomegaly leading to fibrosis of liver.
    • Hardening of adrenal gland.

In Acid Lipase Disease or Lysosomal Acid Lipase Deficiency, the liver function gets severely damaged if not diagnosed or treated in time.

Epidemiology of Acid Lipase Disease or Lysosomal Acid Lipase Deficiency

Acid Lipase Disease or Lysosomal Acid Lipase Deficiency affects males and females alike. Till today, the disease is considered very rare one; however, the researchers think that perfect records are not available. Prevalence of CESD and Wolman’s disease is estimated at 1 in 40000.

Prognosis of Acid Lipase Disease or Lysosomal Acid Lipase Deficiency

It is necessary to understand the prognosis of acid lipase disease in its two different forms of the disease:

  • Wolman’s Disease: This is a rare disease characterized by autosomal recessive disorder. It leads to diseases like jaundice, enlarged liver, anemia, problems in GI tract, etc.
  • Cholesteryl Ester Storage Disease: This is exceptionally rare and often known as another form of Wolman’s disease. If remained undetected it may lead to jaundice, enlargement of liver, several disorders in circulatory system, and hardening of adrenal gland.

Causes of Acid Lipase Disease or Lysosomal Acid Lipase Deficiency

Acid Lipase Disease or Lysosomal Acid Lipase Deficiency is caused due to mutations in the LIPA gene. This gene contains specific instructions for producing lysosomal acid lipase enzyme. Due to mutations, the gene loses that genetic instruction and the digestive system does not get the enzyme to digest fat present in a food. Thus, the disease occurs.

Diagnosis of Acid Lipase Disease or Lysosomal Acid Lipase Deficiency

Diagnosis of Acid Lipase Disease or Lysosomal Acid Lipase Deficiency largely depends on the identification of characteristic symptoms. In newborn babies, Wolman’s disease is detected by observing and testing enlarged liver and different gastrointestinal problems. In adult people, CESD is initially suspected in the similar process. Later, the physician confirms the disease through clinical investigation, patient’s history, patient’s family history, and some specialized tests that detect the levels of lysosomal lipase acid in the body. For more confirmation, many doctors also undertake molecular genetic testing to detect mutations in the LIPA gene.

Treatment and Management of Acid Lipase Disease or Lysosomal Acid Lipase Deficiency

There is no one specific treatment for acid lipase disease. Certain drugs are given to support adrenal gland production. It is also essential that infants detected with Acid Lipase Disease or Lysosomal Acid Lipase Deficiency are fed intravenously. Doctors, often advise to follow certain diet chart and certain lifestyle to stay fit.

Several researches are still going on to develop newer and surer treatment procedures for Acid Lipase Disease or Lysosomal Acid Lipase Deficiency. Sebelipase alfa is now used to treat Acid Lipase Disease or Lysosomal Acid Lipase Deficiency. This is a recombinant form of lysosomal acid lipase enzyme. It is given once every week intravenously to the people having Acid Lipase Disease or Lysosomal Acid Lipase Deficiency at higher levels. For those patients with less severe case, it is administered once in every fortnight.

Gene therapy treatment for Acid Lipase Disease or Lysosomal Acid Lipase Deficiency is still underway with some significant development. In this process, the defective gene in a patient’s body is replaced by a normal gene to form the enzyme in the body.

Lower back pain: Treatments

The lumbar spine, or low back, is a remarkably well-engineered structure of interconnecting bones, joints, nerves, ligaments, and muscles all working together to provide support, strength, and flexibility. However, this complex structure also leaves the low back susceptible to injury and pain.

The low back supports the weight of the upper body and provides mobility for everyday motions such as bending and twisting. Muscles in the low back are responsible for flexing and rotating the hips while walking, as well as supporting the spinal column. Nerves in the low back supply sensation and power the muscles in the pelvis, legs, and feet.

Most acute low back pain results from injury to the muscles, ligaments, joints, or discs. The body also reacts to injury by mobilizing an inflammatory healing response. While inflammation sounds minor, it can cause severe pain.

There is a significant overlap of nerve supply to many of the discs, muscles, ligaments, and other spinal structures, and it can be difficult for the brain to accurately sense which is the cause of the pain. For example, a degenerated or torn lumbar disc can feel the same as a pulled muscle – both creating inflammation and painful muscle spasm in the same area. Muscles and ligaments heal rapidly, while a torn disc may or may not. The time course of pain helps determine the cause.

Coccydynia, commonly called tailbone pain or coccyx pain. Compressed spinal canal.

Images of Tailbone pain(1) & compressed spinal canal(2)

Types of Low Back Pain

There are many ways to categorize low back pain – two common types include

Mechanical pain. By far the most common cause of lower back pain, mechanical pain (axial pain) is pain primarily from the muscles, ligaments, joints (facet joints, sacroiliac joints), or bones in and around the spine. This type of pain tends to be localized to the lower back, buttocks, and sometimes the top of the legs. It is usually influenced by loading the spine and may feel different based on motion (forward/backward/twisting), activity, standing, sitting, or resting.

Radicular pain. This type of pain can occur if a spinal nerve root becomes impinged or inflamed. Radicular pain may follow a nerve root pattern or dermatome down into the buttock and/or leg. Its specific sensation is sharp, electric, burning-type pain and can be associated with numbness or weakness (sciatica). It is typically felt on only one side of the body.

There are many additional sources of pain, including claudication pain (from stenosis) myelopathic pain, neuropathic pain, deformity, tumors, infections, pain from inflammatory conditions (such as rheumatoid arthritis or ankylosing spondylitis), and pain that originates from another part of the body and presents in the lower back (such as kidney stones, or ulcerative colitis).

It is also possible for low back pain to develop with no definitive cause. When this happens, the primary focus is on treating the symptoms (rather than the cause of the symptoms) and the patient’s overall health.

For subacute and chronic lower back pain, a thorough diagnosis is important to lay the foundation for appropriate treatment and rehabilitation. Lower back pain treatment reduces the likelihood of recurrent back pain flare-ups and helps prevent the development of chronic lower back pain.


  1. Lumbar surgeries
  2. Lumbar decompression surgeries

A decompression surgery removes whatever is pressing on a nerve root from the spinal column, which might include a herniated portion of a disc or a bone spur. There are two primary types of decompression for low back pain.

  • Microdiscectomy is a minimally invasive procedure for patients with a lumbar herniated disc causing radicular leg pain (sciatica).
  • Laminectomy removes part of the layer of the bone or soft tissue that is compressing a nerve or multiple nerve roots. A laminectomy will typically be performed for someone with leg pain and/or weakness from spinal stenosis caused by changes in the facet joints, discs, or bone spurs.

A decompression surgery can be performed with open or minimally invasive techniques with relatively small incisions, and minimal discomfort and recovery before returning to work or other activities. Most of these procedures are now being done as day surgery or with one overnight stay.

3. Fusion surgeries(lumbar spinal fusion)

Lacunar Stroke: Causes, Symptoms & Treatments

A stroke occurs when blood flow to the brain is interrupted or blocked. Strokes that are caused by blockages in blood vessels within the brain are called ischemic strokes. Lacunar stroke is a type of ischemic stroke that occurs when blood flow to one of the small arteries deep within the brain becomes blocked. Any type of stroke is dangerous because brain cells are deprived of oxygen and begin to die within minutes.
What are the symptoms of lacunar stroke?

Symptoms of stroke usually come on suddenly and without warning. Signs of lacunar stroke can include:

  • slurred speech
  • inability to raise one arm
  • one side of the face appearing droopy
  • numbness, often on only one side of the body
  • difficulty walking or moving the arms
  • confusion
  • memory problems
  • struggle to speak or understand spoken language
  • headache
  • loss of consciousness or coma

As brains cells die, functions controlled by that area of the brain are affected. These symptoms can vary depending on the location of the stroke.

What causes lacunar stroke?

Lacunar stroke is caused by lack of blood flow in smaller arteries that supply deep brain structures. The most important risk factor for the development of lacunar stroke is chronic high blood pressure. The condition can cause the arteries to narrow. This makes it easier for cholesterol plaques or blood clots to block blood flow to the deep brain tissues.

Who is at risk for lacunar stroke?

Risk of lacunar stroke increases with age. Those at risk include people with chronic high blood pressure, heart disorders, or diabetes. People with a family history of stroke are also at a higher risk than other groups.

Other factors that increase the likelihood of lacunar stroke include:

  • smoking or exposure to secondhand smoke
  • alcohol
  • drug abuse
  • pregnancy
  • use of birth control pills
  • sedentary lifestyle
  • poor diet
  • high cholesterol
  • obstructive sleep apnea

Annual physical examinations are important to screen for various health issues, including high cholesterol and obstructive sleep apnea.

What is the treatment for lacunar stroke?

If you have a lacunar stroke, early treatment increases your chance of survival and may prevent further damage. Once you arrive at the emergency room, you’ll likely be given aspirin. This reduces the risk of having another stroke.

Supportive measures may be needed to assist your breathing and heart function. You may receive oral or intravenous clot-busting drugs. In extreme circumstances a doctor can deliver medications directly into the brain.

Lacunar stroke can result in some brain damage. Depending how badly the underlying structures are damaged, you may not be able to care for yourself following a stroke. Recovery varies for each person and depends on the severity of the stroke.

Some lacunar stroke patients transition from the hospital to a rehabilitation center or nursing home, at least for a short period of time. Because of brain damage, stroke patients often have to re-learn skills and regain their strength. This can take weeks, months, or years.

Most stroke patients require long-term treatment. This can include medication to treat high blood pressure, diabetes, or high cholesterol. After a lacunar stroke, some patients also require:

  • physical therapy to restore function
  • occupational therapy to improve skills needed for everyday living
  • speech therapy to improve language skills

PCOS: Causes, symptoms & Risks

What is Polycystic Ovary Syndrome?

Polycystic ovary syndrome (PCOS), is a type of hormonal disorder causing enlarged ovaries with cyst formation on the outer layer. The symptom is caused due to raised male hormone (androgen) in the woman’s body. PCOS causes a problem with women’s menstrual cycle, fertility, and appearance. PCOS is the most common disorder among women between age group 18-44. It has no definite cure, and only weight management and exercise can bring about noticeable changes.

Hormonal imbalance is another factor contributing to PCOS. This indirectly affects development and release of eggs during ovulation cycle. Excess insulin (the hormone which converts sugars into starch) also cause high androgen levels.

Polycystic Ovarian Syndrome (PCOS) Symptoms & Treatment


Symptoms of PCOS starts right from the stage when women start menstruating. However, the severity may vary leading to irregular menstrual cycles. Due to decreased levels of female hormone, women start developing some male-like characteristics (unwanted hair growth, decreased breast size, change of voice, hair loss, and thinning). Other important symptoms that mark the disease are:

  • Acne.
  • Unwanted weight gain.
  • Pelvic and abdominal pain.
  • An episode of unexpected anxiety, depression, and anger.
  • Infertility due to lack of ovulation.


The causes of PCOS are not very clear and understood, but few of the major factors could include:

  • Genetics: PCOS runs in families, so anyone who has a family history is at greater risk of being affected.
  • Hormonal imbalance: It is another factor contributing to PCOS. Excessive production of a male hormone in will cause changes in the women body leading to PCOS. This indirectly affects development and release of eggs during ovulation cycle.
  • Excess insulin(hormone which converts sugars into starch): It also causes high androgen levels


The main risk factors include:

  • High blood pressure, high cholesterol, and lipid profiles.
  • Metabolic Syndrome —signs that indicate increased the risk of cardiovascular disease.
  • Nonalcoholic steatohepatitis —liver inflammation caused by fat accumulation in the liver.
  • Infertility.
  • Sleep apnea (state when a person stops breathing periodically during sleep).
  • Depression and anxiety.
  • Abnormal uterine/menstrual bleeding.
  • Cancer of the uterine lining (endometrial cancer).
  • Gestational diabetes or pregnancy-induced high blood pressure.
  • Breast cancer.

Excessive Sweating: One of Many Possible Signs <b>of PCOS</b>


The disease cannot be completely prevented, but early treatment and diagnosis will help prevent long-term complications such as:

  • Diabetes.
  • Obesity.
  • Metabolic syndrome.
  • Infertility.

Scleral Buckling :Procedure details

Scleral buckling surgery is a common way to treat retinal detachment. It is a method of closing breaks and flattening the retina.

A scleral buckle is a piece of silicone sponge, rubber, or semi-hard plastic that your eye doctor (ophthalmologist) places on the outside of the eye(the sclera, or the white of the eye). The material is sewn to the eye to keep it in place. The buckling element is usually left in place permanently.

The element pushes in, or “buckles,” the sclera toward the middle of the eye. This buckling effect on the sclera relieves the pull (traction) on the retina, allowing the retinal tear to settle against the wall of the eye. The buckle effect may cover only the area behind the detachment, or it may encircle the eyeball like a ring.

By itself, the buckle does not prevent a retinal break from opening again. Usually extreme cold (cryopexy) or, less commonly, heat (diathermy) or light (laser photocoagulation) is used to scar the retina and hold it in place until a seal forms between the retina and the layer beneath it. The seal holds the layers of the eye together and keeps fluid from getting between them.

Other facts about the surgery

  • The surgery takes place in an operating room, usually on an outpatient basis (you go home the same day).
  • Local or general anesthesia may be used.
  • Before the surgery, your eye doctor may patch both of your eyes and have you stay in bed to keep the detachment from spreading. Right before surgery, he or she will use eyedrops to dilate your pupils and may trim your eyelashes to keep them out of the way.
  • A first-time surgery usually lasts 1 to 2 hours. Repeat surgeries or more complex detachments may take longer.

What To Expect After Surgery

You may have some pain for a few days after the surgery. Your eye may be swollen, red, or tender for several weeks. Your eye doctor may put drops in your eye that prevent infection and keep the pupil from opening wide (dilating) or closing (constricting). You may have to wear a patch over the eye for a day or more.

Contact your doctor right away if you notice any signs of complications after surgery, such as:

  • Decreasing vision.
  • Increasing pain.
  • Increasing redness.
  • Swelling around the eye.
  • Any discharge from the eye.
  • Any new floaters, flashes of light, or changes in your field of vision.

Why It Is Done

Scleral buckling is effective in supporting a tear, hole, or break in the retina that has caused the detachment. It is rarely helpful on its own when scar tissue tugging on the retina has caused the detachment (traction detachment).


Scleral buckling poses some short-term and long-term risks. Most of these complications do not happen very often. Risks include the following:

  • The most common cause of failure in surgery for retinal detachment is a type of scarring on the retina, called proliferative vitreoretinopathy (PVR), that can cause the retina to detach again. PVR usually requires additional treatment, including vitrectomy surgery.
  • Detachment of the choroid (a part of the tissue that forms the eyeball) or swelling in the retinal area may delay healing.
  • The pressure of the scleral buckle can raise the fluid pressure inside the eyeball. People with glaucoma may have a higher risk of this complication.
  • Bleeding in the eye can impair vision.
  • The eye may become infected. You may need antibiotics and corticosteroids to reduce redness or discharge from the eye and treat the infection. Sometimes it is necessary to remove the buckling implant to treat the infection.
  • The plastic or rubber of the buckling device may rub on other parts of the eye, move out of place, or become a site of infection. In some cases, the buckling device may need to be removed.

The surgery may also affect your vision in other ways:

  • Since a scleral buckle pushes in on the eye, it can change the shape of the eye. Good vision depends on the shape of the eye. The change caused by a scleral buckle may cause a refractive error that can affect vision. Vision may change for several months after scleral buckling surgery. You should have a follow-up vision exam after about 6 months to check for vision changes. You may need glasses or contact lenses (or a new prescription) to correct the changes.
  • The scleral buckle can affect the eye muscles and how well they control the movement of the eyes. This can lead to misaligned eyes (strabismus) and double vision (diplopia).

Hepatitis A, B & C: Detailed description

How can one prevent Hepatitis B and C?

We can eliminate and protect ourselves against hepatitis B with the help of excellent vaccines available in market. Three injections at regular intervals of time i.e., at 0, 1 and 6 months gives around 90-95% protection against hepatitis. For an effective management apart from vaccination, patients should be checked if they are protected after the vaccination. Hence, it is wise to check one antibody-titer (anti-HBs) after vaccination; a level of more than 10 reflects adequate protection against hepatitis B.

For hepatitis C, unfortunately, there isn’t any vaccine. As both hepatitis B and C are transmitted through blood borne infections, general precautions need to be taken. IV drug abusers are usually prone to hepatitis C. It is important to educate the masses about the dangers of sharing needles or razors with infected individuals.

Another important route of transmission of hepatitis B, and to a lesser extent hepatitis C, is from mother to child. Hence, it is necessary to thoroughly examine expectant mothers during pregnancy. HBV DNA levels should be checked for in the third trimester, and if they are very high (above 108), the expectant mother should undergo treatment. In case the mother is not treated during pregnancy, the newborn baby should be vaccinated within 12 hours of birth, administering both active (vaccine) and passive (immunoglobulin) immunization.

What is Hepatitis B? What are its effects and what precautions need to be taken? 

Hepatitis B is a viral infection caused from a small, circular, double stranded DNA virus which predominantly infects the liver in the human body. The most common modes of infection are blood borne or sexual.. Vaginal and seminal secretions contain a large amount of the hepatitis B virus. The most important mode of transmission is the vertical transmission, where the baby gets it from the mother.

Hepatitis B affects the liver, and can either be acute or chronic in nature. Acute infections are self-limiting, i.e., ≥ the disease is healed on its own in 95% of patients due to their strong immune system. Chronic infections have two forms – Chronic active hepatitis and Carrier state hepatitis, which can last for life. In some patients, it can even progress to decompensated liver disease, i.e., cirrhosis, with the end stage being hepatocellular carcinoma. Therefore, it has got a varied presentation, it can be acute/chronic, from where it can advance to form cirrhosis and liver cancer.

Hence, precautionary measures should be adhered to avoid hepatitis B. As a universal health protocol, vaccination of hepatitis B should be administered to every newborn in India. Along with vaccinations, safe sexual practices, avoiding promiscuity and not having multiple sexual partners, avoiding sharing of injections or razors can also help in preventing Hepatitis B infection.

How can liver diseases be avoided?

Liver diseases can be categorized into acute infection and chronic infection. Most of the acute infections, in the sub-continents, are hepatitis A and E. Hepatitis A and E are not blood borne infections, but are caused due to fecal-oral route through contaminated water and food. So, safe hygienic practices need to be advocated to avoid this.

For hepatitis B, vaccination is the only precaution.

For hepatitis C, unfortunately, we don’t have any vaccine available.

For alcohol liver diseases causing liver cirrhosis, alcohol is a substance abuse which has the potential to cause permanent liver damage. Avoid drinking alcohol up to a carcinogenic dose. In India, the carcinogenic cut-off level is about 40-80gms/day of alcohol for men and 20-40gms/day for women. In the absence of history of any liver disease, this should not be a potential danger. There are inherited liver diseases where are acquired through genes. One could be hemochromatosis, where the pregnant mother can undergo genetic screening. Lastly, the most common are drug induced liver injuries causing permanent hepatic failure. A proper treatment is needed for control and cure of the disease.