Lissencephaly

Lissencephaly
Lissencephaly, the literal meaning of which is ‘smooth brain’, is an uncommon, genetically-associated brain mal-development disorder marked by nil folds or convolutions in the cerebral cortex as well as microcephaly, i.e., an unusually small head. Lissencephaly is considered as a type of cephalic disorder. Terms like “pachygyria,” i.e., wide gyri or folds, or agyria, i.e., absence of gyri, are used by medical experts to define the appearance of brain surface in patients.

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Children affected by lissencephaly typically elicit considerable developmental delays, which in turn may vary from one affected child to another as per the severity of brain deformity and regulation of seizures. The life expectancy of the patients may be shortened, often because of underlying respiratory anomalies.

Lissencephaly is a very rare condition. In the US, it affects 11.7 children in every 1 million births.

Symptoms

Most children with lissencephaly tend to have a head which is of the normal size. However, some patients may be born with an abnormally small head, and the combination of the two brain-skull abnormalities is referred to as microlissencephaly.

Some of the additional common signs and symptoms of lissencephaly are listed below:

• Feeding difficulties


• Intellectual deficits


• Failure to flourish and thrive


• Irregular appearance of the face


• Swallowing problems


• Malformed toes, fingers, and/or hands.


• Severe psychomotor retardation


• Hypotonia or muscle spasms


• Seizures

Couples with a family history of lissencephaly can check for the presence of the condition via imaging tests. The brain normally develops folds during weeks 25 to 30 of pregnancy. This is when doctors will perform an ultrasound.

 Lissencephaly Types

Advancements in the field of genetics and neuroimaging has facilitated better understanding of migration disorders, thereby allowing a better definition of the spectrum of lissencephaly. The spectrum is classified into nearly 20 different forms. Many more may be added after the respective causative factors have been discovered.

Lissencephaly is categorized as per varied systems. One of the major forms of classification is Classic/Type I vs. Cobblestone/Type II. However, certain systems and additional types cannot be added to any of these classifications.

A few types of lissencephaly are listed below, along with their OMM numbers:

1. Classic/Type I lissencephaly – 607432

• L1S1:This type of lissencephaly occurs due to mutation of PAFAH1B1 gene. It is further subdivided into:
  
  
  
  • Miller–Dieker syndrome – 247200
  
  
  • Type 1 isolated lissencephaly – 601545
  
  
  • LISX1 – 300121:This type of lissencephaly occurs due to mutation of DCX/doublecortin gene. It is further subdivided into:
    
    
    
    • Lissencephaly, isolated, type 1, without the occurrence of other known genetic errors.
    
    
    
    
  
  
  
  

2. Cobblestone/Type II lissencephaly

• Fukuyama syndrome – 253800


• Walker–Warburg syndrome, also known as HARD(E) syndrome – 236670


• MEB/Muscle-eye-brain disease – 253280

3. Other types of lissencephaly

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• Microlissencephaly, i.e., microcephaly and lissencephaly


• LIS3: TUBA1A – 611603


• LIS2: Norman-Roberts syndrome. It occurs due to RELN gene defects – 257320


• LISX2: ARX, 300215

Causes of lissencephaly

Lissencephaly is thought to be mainly caused due to certain genetic mutations. It can also occur due to inadequate blood flow to the brain of the unborn child during early pregnancy, or due to viral infections of the fetus or the uterus during the first trimester.

Any of the above listed factors can result in neural migration deficits at the time of embryo development. Neural migration is a process marked by movement of the nerve cells from their original place to the permanent area inside the gray matter of the cerebral cortex. Such migration or movement typically occurs between 12 and 14 weeks of fetal development. Lissencephaly develops because such movement of the nerve cells does not occur, eventually affecting the development of brain.

Studies have successfully found out that defects in the LIS1, DCX, 14-3-3ε, ARX, and RELN genes contribute towards the development of lissencephaly. The severity of the brain formation varies as per the type of gene that suffer from mutation.

Lissencephaly may occur on its own. It can also develop along with varied related conditions such as Walker-Warburg syndrome Miller-Dieker syndrome, isolated lissencephaly sequence, and Walker-Warburg syndrome. Specialists may be needed to differentiate between these varied disorders.

Couples at increased risk to conceiving a child with lissencephaly must go for genetic testing as well as genetic counselling before opting for parenthood.

Diagnosis

The brain surface of the fetus is usually smooth till week 25 to 30 of pregnancy. If routine complex ultrasound examinations performed after this period detect any cerebral abnormality, then doctors may recommend further testing such as NMR and genetic studies, especially if the unborn child has a family history of lissencephaly or other brain conditions, or if the doctor suspects the occurrence of brain defects. Chorionic villus sampling may also be performed to check the presence of certain variants of lissencephaly, if genetic mutations are detected.

After birth, if the baby shows signs and symptoms of brain malformation, then doctors may recommend varied diagnostic tests such as CT scans, MRI scans, and/or ultrasound. In case of lissencephaly, specialists will be needed to carefully grade the severity of brain malformation. A grade 1 lissencephaly diagnosis means that a large section of the brain is affected; it is extremely rare. Most lissencephaly patients suffer from grade 3 form of the disorder.

Treatment

Currently, there are no ways to medically correct the brain defects associated with lissencephaly. Treatment is dependent on the severity of the accompanying symptoms; it is aimed at managing the symptoms and preventing complications.

• Swallowing and feeding difficulties may need the use of a gastrostomy tube.


• Hydrocephalus is treated via shunting which helps remove excess cerebrospinal fluids.


• Seizures can be controlled with anticonvulsants and other anti-seizure medications.

Lissencephaly life expectancy

Life expectancy and prognosis of lissencephaly is dependent on the severity of the condition. The mental function in children with severe lissencephaly may not develop beyond that of a 3 to 5 months old baby. In the years gone by, such children did not live beyond 2 years. Now, the life expectancy has gone up to nearly ten years. Respiratory diseases, choking or aspiration on fluids or foods, and/or seizures are the main causes of death.

Child with mild instances of lissencephaly may feature near normal brain function and development.

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Prader-Willi Syndrome

Prader-Willi Syndrome
Prader-Willi syndrome is a rare, abnormal, congenital condition identified by the presence of mental, physical, and behavioral abnormalities, the most distinctive of which is continuous and insatiable hunger that commences after age one year and persists for the rest of the patient’s life.

Voracious and frequent eating to overcome the effects of extreme hunger pangs typically results in obesity, which then causes several obesity-linked health complications. Specialists from varied fields are required to manage and control the signs and symptoms of Prader-Willi syndrome as well as to prevent the onset of complications.

Symptoms  

The signs and symptoms of Prader-Willi syndrome are categorized into two stages, one that occurs during the first year after birth and the second that occurs between ages 1 and 4 years.

Stage 1: It is marked by:

• Unusual and easily noticeable facial features such as a mouth which droops downwards, an elongated head that tapers towards the temples, eyes shaped like almonds, and slim upper lip.


• The condition of poor muscle tone known as hypotonia. When held in one’s hands, Prader-Willi syndrome babies may feel flaccid like bean babies or rag dolls.  Floppy and extended knees and elbows may pose problems in comfortable seating and resting.


• Poor muscle tone can also cause inadequate sucking reflex, thereby causing feeding issues, inadequate gain of weight, and eventual failure to grow normally and thrive.


• Babies with Prader-Willi syndrome may show abnormal or poor response to stimulation, have difficulties in waking up after sleep, feel unusually tired and lethargic, and exhibit a weak cry.


• Lack of coordination between the eyes with regards to their movement. This can cause the eyes to meander to the sides or be cross. The ocular disorder is known as strabismus.

Stage 2: It is marked by:

• Infants with Prader-Willi syndrome suffer from poor development and growth. The feet and hands may not be as long as normal. All these factors including the presence of lowered muscle mass results in them being shorter as adults when compared with other members of their family.


• Continuous food cravings can result in rapid and considerable weight gain. The hunger pangs persist even after the intake of large meals, which cause Prader-Willi syndrome patients to eat more and at regular intervals. Eating frozen food or garbage, hoarding of food, and other abnormal food seeking behaviors may also be visible.


• Delays in motor development and achievement of developmental milestones. Sitting upright may occur in 12 months or more, while walking may occur after 2 years or more.


• The testes or ovaries may produce nil or miniscule amounts of sex hormones causing hypogonadism, immature sex organs, and stunted growth after the onset of puberty. Male Prader-Willi syndrome patients will feature voices that do not deepen completely and minimal or absent facial hair, while female patients may never menstruate or have periods only after they reach their thirties. Infertility among both sexes is common.


• There may be minor or medium levels of cognitive problems. Even those patients with no observable cognitive deficit may display some problems in learning.


• Delays in speech development. Babies may start speaking only after they become two years old. Diction impairment and other speech problems may persist.


• Several children affected by Prader-Willi syndrome may also experience abnormal curving of the spine, i.e., scoliosis.


• Sleep disorders, including sleep apnea, abnormal patterns of sleep, and disturbances in sleep cycles, etc., may be evident. Obesity can aggravate these problems.


• Varied mental problems, behavioral issues, and psychological abnormalities such as OCD marked by repetitive behaviors and actions and recurring thoughts; major aggression and temper tantrums which become more prevalent when food is not given; and rectal gouging, picking at skin, etc., ,may be observed.


• Some individuals with Prader-Willi syndrome may exhibit symptoms such increased tolerance capacity for pain, nearsightedness, and pale skin.

Causes

• Prader-Willi syndrome is a hereditary condition caused due to genetic defects or errors. Doctors are not aware of the exact gene that has the errors, but research indicates that the defective gene may be present in a particular section of chromosome 15.


• All genes, excluding the gender genes, are passed on from the parents in pairs wherein one copy comes from the mother and the other from the father. Each copy of most genes is active, while some genes may continue functioning even when just one copy is expressed or active.


• Prader-Willi syndrome is caused when the copy of a gene passed from the father does not get expressed; its expression is essential to proper functioning. This genetic anomaly may arise due to:
  
  
  
  • Paternal copy of chromosome 15 is absent.
  
  
  • Presence of defects, errors, or mutations in paternal copy of chromosome 15.
  
  
  • Inheritance of 2 maternal copies of chromosome 15, while none from the father.
  
  
  • The genetic anomaly that causes Prader-Willi syndrome also affects the functioning of the hypothalamus. This part of the brain is responsible for regulation of hunger, thirst, and other important body functions as well as controlling the production of hormones responsible for growth and development. Thus, dysfunction of hypothalamus is what eventually causes stunted growth, insatiable hunger, sexual problems, and other deficits associated with Prader-Willi syndrome.
  
  
  
  

Treatment

There is no cure for correcting the genetic mutation associated with Prader-Willi syndrome. Treatment is aimed at managing the symptoms and preventing complications.

• Feeding problems and subsequent weight gain issues can be overcome with a high-calorie diet given to affected babies. Older children then need to be given a calorie-controlled diet to avoid obesity.


• Growth hormone therapy can help improve metabolic activities, lower body fat, aid growth, and enhance muscle mass and tone.


• Mental health problems can be corrected with medications and psychological therapies. Speech issues can be corrected with speech therapy, cognitive issues can be corrected with behavioral cognitive therapy, while occupational therapy can help cope with the daily routine and work life.


• Hormone replacement therapy can help increase the levels of sex hormones.

Prader-Willi Syndrome life expectancy

Prader-Willi syndrome does not come with any standard or specific life expectancy. Patients who can efficiently control their diet and hunger pangs can completely avoid the onset of obesity and related complications such as lung failure or cardiac diseases. This will not only prolong the life of such patients but will also result in a better overall quality of life. Specialized care and supervision may be needed for some patients across their lifespan.

Prader-Willi Syndrome pictures

The hypothalamus location

Warts on Tongue

Warts on Tongue Warts are small lesions or bumps that can develop anywhere in the body and even inside the mouth. It can develop on the lips and tongue also but often they are painless and harmless. Tongue warts occur either as single or in groups. They are irregular in shape, size and texture. Warts are tiny and discrete bumps which are rough in shape and white or red in color. Warts on tongue are caused by viral infection and often they are transmitted through oral sex. Treatment is available in various forms from topical creams to laser therapy.

Risk Factors :

Oral warts are at high risk of developing in people who have sexually transmitted diseases. People with weak immunity are more prone to develop warts on tongue than others. Certain ethnic groups like Asians and black people are at high risk of developing oral warts. Those who are involved in meat industry like handling and processing meat are at high risk of developing oral warts. Oral warts are common in any age group but are high in young adults.

Causes :

It is the HPV virus that causes warts on tongue. There are hundreds of strains of human papilloma virus causing oral warts and genital warts. Among them HPV2, HPV13 and HPV32 are identified causing warts on tongue. The main method of spreading is through kissing the genitals. A person having poor genital hygiene can easily transmit the virus to their partners.

Symptoms :

When a person develops warts on tongue he would develop irritation while eating food and there can be difficulty in chewing food. It can cause painful sores on the tongue varying in shape and size. The presence of warts on tongue can cause discomfort and pain to the person. Some people will have problems in speaking due to irritation and discomfort. Warts appear as lesions or raised tiny section on the tongue.

Diagnosis :

No special test is required for detecting oral warts. It can be identified on physical exam.

Treatment :

Treatment of warts on tongue can be difficult due to its tiny size and location on the tongue. Topical creams and antiviral ointments can be applied on the warts which would destroy the virus and prevent further development of warts. Oral medications are given for managing pain and irritation. Some people believe that applying tea tree oil with cotton swab on the wart will destroy the virus gradually. Similarly you can get remedy by rubbing the banana peel or crushed potatoes on the warts for getting relief from irritation. Garlic is considered to have antiseptic properties and hence you can smash some garlic or use garlic paste on the warts to destroy them.

Surgical methods of removing warts include cryotherapy (by freezing the wart with liquid nitrogen), laser therapy (destroying it with laser beam), and injection (by injecting interpheron alpha) and gently cutting and removing it using specially sterilized instruments. Often the warts on tongue would recur on the same person. Avoid pricking or cutting the warts on your own since this can lead to complications of bleeding. Eat only soft and crushed foods that are soothing to the tongue.

Prevention :

You can prevent developing warts on tongue by wearing condoms while doing oral sex. Alternatively you can apply dental dams to prevent such infection. But even the above methods cannot guarantee total protection. You need to avoid having any type of sexual contact with the person having infection.

Excessive Burping

Excessive Burping Belching is the process of expelling air through the mouth. It occurs normally for all people irrespective of their age and health condition. But for some people it occurs repeatedly in the same day causing embarrassment. When a person swallows too much of air unintentionally the stomach expands for accumulating the air. Eventually excess of air is sent out from the stomach through the mouth causing belching or burping.

Causes :

Number of factors can cause excessive belching. Some people may swallow more air particles while eating quickly or drinking fast. Taking too much of carbonated drinks can also cause belching. Sometimes anxiety can trigger belching when too much of gas is released from the stomach. Newborns and infants are allowed to burp shortly after they finished with feeding since they always drink quickly taking in large amounts of air. They feel comfortable only after expelling excess of air from the stomach.

Some people belch frequently as a habit. For some people it can be due to medical issues like inflammation of the stomach or due to Gastro Esophageal Reflux Disorder (GERD). There are various factors and medical conditions that cause excessive belching. Aerophagia is the process of taking in lots of air involuntarily. Without their knowledge some people swallow excess of air while eating or drinking.

People who talk frequently while eating are prone to more belching than others. People who use chewing gum or candy regularly are likely to swallow excess of air. Drinking beverages that contain carbon, smoking, ill fit dentures and anxiety attack can trigger excessive belching. Having too much of alcohol, carbonated drinks, sugary foods, items rich in starch or fiber can also produce excess of gas causing belching.

Certain foods like cabbage, bananas, broccoli, peas, beans, onions, garlic and cauliflower can cause more gas. Certain drugs given for Type 2 diabetes like acarbose, pain killers like Ibuprofen or naproxen or aspirin and laxatives like sorbitol can cause more gas leading to belching. Certain medical conditions like gastroparesis, gastritis, peptic ulcer, malabsorption, lactose intolerance and certain stomach infections can cause gas and belching. Helicobacter pylori are the bacterium causing inflammation of the soft lining of the stomach which can irritate the cells causing more gas formation. Any ulcers or sores on the stomach or intestine, or on the throat can cause gas.

When to see a doctor? :

Belching is a normal process if it happens occasionally. But people who belch or burp frequently due to heartburn accompanied with abdominal pain should seek medical guidance.

Diagnosis :

Your doctor would order some testing procedures based on your symptoms. If there is abdominal pain while belching he may ask you to undergo ultrasound scan of the stomach and intestine. He would analyze the cause for excessive belching and accordingly proceed with testing process. He may request for abdominal scan, X-ray and CT/MRI scan if necessary to rule out any anomalies.

Treatment :

Your doctor will consider factors like your age, health and list of medications you are currently taking before treating excessive belching. The method of treatment depends on the underlying medical cause or other factors.

Home Remedies :

• You should start eating and drinking slowly. Don’t talk while eating.


• A small walk after eating can help you to expel air easily.


• Lying on your side can help to relieve the excess of gas from the stomach.


• Sit down by bending your knees together and keeping it close to your chest. This position will help you to expel the gas with ease.


• Avoid using chewing gum or candies frequently.

Medical Treatment :

Your doctor will ask you series of questions about your symptoms, eating habits and drinking. He would ask you to maintain a food chart for few days to know the exact reason. If certain foods are causing excessive belching you will have to avoid it in future. If drinking alcohol is the major cause for belching try to reduce your intake. In case if there is inflammation of the stomach he would prescribe suitable medications to treat swelling.

For occasional belching and acidity over the counter antacids can give relief. But for repeated belching you can consult your doctor. If the cause is due to GERD suitable drugs are to be taken regularly and you will be instructed to avoid certain foods that are more acidic. Prolonged belching can affect the normal functions of your digestive system and intestine. Hence you need to know the reason and triggering factors for belching.

Alpha 1 Antitrypsin Deficiency

Alpha 1 Antitrypsin Deficiency Alpha 1 antitrypsin is a type of protein produced in the liver and deficiency of this protein can cause liver problems and lung disease. A1AD is a genetic disorder inherited by birth. Any deficiency of this protein can damage the alveolar walls of the lungs. Normal serum level of A1A is about 20-60 umol/L and it can cause lung damage if the level goes below 15. Children having COPD (Chronic Obstructive Pulmonary Disease) should be checked for A1AT deficiency to prevent liver and lungs damage. A1AT is common disorder in white people and more particular in North western European countries.

A1AT is a under-diagnosed disorder and young children having frequent episodes of congestion may have this deficiency. About 10-15% of adults having A1AT disorder are likely to develop liver problems. There is no cure for A1AT but with early diagnosis symptoms can be managed and possible liver damage can be prevented. A1AT is also known as genetic emphysema, Alpha 1 emphysema and hereditary pulmonary emphysema.

Symptoms :

Initial signs of A1AT can appear even before 20 years. Some of the common symptoms include shortness of breath, wheezing, breathlessness while doing exercise, loss of weight, repeated respiratory infections, rapid heartbeat and extreme tiredness. The symptoms will increase steadily as the person smokes causing more damage to the lungs.

Some people may develop emphysema having symptoms of persistent cough, difficulty in breathing and barrel shaped chest. If the disease has progressed to cause liver damage the person may show symptoms like swollen legs or feet, swollen abdomen and yellow coloration of the skin.

Causes :

A1AT is an inherited disorder and the defective genes are passed on to the children. A genetic mutation in SERPINA1 gene is likely to cause A1AT disorder. This gene is responsible for producing antitrypsin protein which protects the body from neutrophil elastase. Actually elastase enzyme is meant for fighting infection, but if the level of A1AT is too low this enzyme can attack and destroy the lung walls called alveoli. This can lead to emphysema, a life threatening lung damage.

The defective gene of SERPINA1 is inherited by autosomal codominant method. People with two copies of M allele version will not develop A1AT deficiency. People having S allele version will have reduced production of antitrypsin enzyme and people with Z allele will have almost no enzyme secretion and they are prone to develop this disorder. Some people may have combination of version like SZ or SM or MZ and smoking considerably increases the risk of lung disorders. It is not true that every person with A1AT disorder would develop liver problem. Those having ZZ version are more likely to develop lungs and liver problems.

Tests :

Children with a history of A1AT disorder should be screened for serum levels frequently. The doctor will complete the physical exam and the symptoms. He would listen to the wheezing sound or shortness of breath using a stethoscope. He may order for blood test to identify Alpha 1 genotype, Alpha 1 antitrypsin test to find out the level of this protein serum in your blood. He may also order for imaging tests like chest X-ray to check how far the damage has been done. If he suspects liver problems he may conduct liver biopsy and liver function test.

Treatment :

A1AT disorder cannot be treated but the symptoms can be controlled. People with low levels of antitrypsin should be watched for symptoms. Such people will be advised to quit smoking to prevent early lung damage. Method of treatment varies with that of individual’s symptoms. Your doctor would prescribe suitable bronchodilators to control respiratory tract infection. People with COPD are given pulmonary rehabilitation. Such people can benefit by taking yearly shots of influenza vaccines. In severe cases lung surgery and transplantation is done. Liver problems can be managed by effective medications and specific diet. In extreme cases of liver failure, liver transplant is done.

Prognosis :

Those who are diagnosed with A1AT disorder in early stages (through screening tests before symptoms have developed) have better prognosis. Individuals diagnosed with COPD are likely to have Alpha 1 deficiency. A1AT is the top most risk factor causing emphysema. Hence everyone with COPD should be screened for Alpha 1.

Amblyopia

Amblyopia Amblyopia also known as lazy eye is abnormal vision seen in infancy and childhood. Lazy vision is reduced vision that can affect the visual perception of the child. Actually amblyopia is seen in only one eye, but left untreated it can affect total vision also. Amblyopia can cause loss of vision from mild to severe. It is caused due to reduced neuromuscular communication between the brain and the eyes. The brain receives signal from only one eye and reduced weak signal from the other eye. It ignores the weak signal of the affected eye causing lazy eye. Amblyopia can be corrected with eye patches, eyeglasses or lenses. About 2-3% of American children have amblyopia.

Symptoms :

Since amblyopia begins in infancy or childhood, it is difficult to identify. The baby may have wandering eye that moves either inward or outward. If you grab the attention of the infant by showing some objects, the eyes may not focus together. The baby may have reduced perception in one eye.

If you observe any of the above symptoms in your baby you need to consult your doctor immediately. The child may have blurred vision or turned out vision due to crossed eyes. If there is wandering of eyes after few weeks of birth, you can report it to your primary care physician.

Causes :

The major cause of amblyopia is strabismus or crossed eyes. Babies or children having crossed eyes are likely to develop amblyopia. Misalignment of eyes or reduced communication between the brain and eye muscles can be the cause of amblyopia. Imbalanced muscle would prevent the eyes to track the object together.

You can detect this problem by simply closing one eye of the baby with your hand and check if he/she is comfortable in indentifying favorite toy. If the child cries or fusses and not able to complete the task it can be due to amblyopia. Hereditary is another factor for amblyopia which tends to run in families. Deprivation can block the clear vision of the child causing cloudy or blurred vision. Some children can have astigmatism right from birth which is a refractive error. This can cause vision problems.

Risk Factors :

Children born to parents with vision problems are more prone to develop amblyopia than others. Children with low birth weight and those with a family history of vision problem can develop lazy eye. Amblyopia should be treated without any delay; else it can cause permanent loss of vision.

Diagnosis :

Routine physical exam at primary health care center would reveal any abnormality in the eyes of the infant. Wandering eyes is the strong indication of amblyopia. Your ophthalmologist will examine the baby’s eye through a special device or test his eyes by red reflex test. She would check whether the child has strabismus or crossed eyes. Depending on the age of your child, your doctor may conduct suitable test. Infants are tested using moving object, toddlers by reflex test and preschoolers will be asked to read some letters and identify pictures.

Treatment :

Treatment for amblyopia or lazy eye should begin in early childhood depending on the intensity of the problem. For mild vision abnormality, your doctor may suggest corrective eyewear like eyeglasses or contact lenses, if the problem is due to astigmatism. For some children the doctor may recommend eye patches. The child will have to cover the normal (strong) eye with a patch so that weak eye would outgrow the problem of reduced vision gradually. Children above 4 or 5 years can use this method of treatment.

Eye-drops like atropine can be applied on the strong eye which can cause temporary blurring of vision. The weak eye will be stimulated eventually to focus the object correctly. In severe cases, surgery has to be done for correcting lazy eye or amblyopia. Children having cataracts or droopy eyelid are to be surgically operated for correcting the vision. In some cases, combination of two methods would give the best output in few weeks. Any type of treatment will yield positive results, if started in early childhood.

Avascular Necrosis

Avascular Necrosis Necrosis is the term used for denoting tissue death in the body. Death of tissue can occur due to insufficient blood supply or complete cut-off from blood supply. It can occur due to radiation, sudden injury and exposure to chemicals. The damage caused by necrosis is irreversible. If the tissue death occurs in the bone it is known as Avascular necrosis. It can cause tiny fractures inside the bone which may eventually cause bone collapse.

Blood supply to particular section of a bone would stop leading to avascular necrosis. In some cases the joint of particular bone gets dislocated causing necrosis. This can occur due to prolonged use of steroids and alcoholism. Often, the hip joint is affected by avascular necrosis and sometimes it can affect the upper leg, upper arm or knee bones. Bone needs continuous blood supply since it is a living tissue. Any interruption of blood can cause death of bone tissue. Avascualr necrosis is also called as osteonecrosis or aseptic necrosis.

Symptoms :

Pain in the joint is the only symptom of avascular necrosis. In the initial stages there will not be any sign, but as the disease progresses, the joint may get affected causing intense pain while making movements. Avascular necrosis does not occur overnight. It is a process that happens gradually causing tissue death in the bone. It might take months together or sometimes even a year for tissue death on the bone. It can affect hip joints, shoulder, upper arm or leg and even your foot. Severe pain is felt in the groin or thighs and you can feel the pain in both sides of the body.

Causes :

When normal blood supply to the bone is restricted or slowed down it can cause avascular necrosis. This can happen due to sudden trauma or injury and due to dislocation of joint. People who undergo hip joint surgery are prone to develop avascular necrosis. People who are taking chemo therapy for cancer can develop avascular necrosis since radiation can weaken the bones and joints interrupting regular blood supply.

Chronic (long term) use of corticosteroids is likely to cause avascular necrosis. Over consumption of alcohol can deposit fat particles into the blood vessels thus restricting normal blood flow to the bones. Inflammation on the arteries and blood clots inside can restrict blood supply to the bone leading to avascular necrosis. Certain medical conditions like Gaucher’s disease, pancreatitis, HIV infection and other autoimmune disorders can cause necrosis in bones.

Risk Factors :

Anyone can develop avascular necrosis, but is common in age group of 30-50 years. People who are alcoholic or involved in binge drinking, people who use steroid drugs for long duration and those who take osteoporosis medications like biphosphonates are prone to develop avascular necrosis. Certain medical issues like lupus, HIV, diabetes and autoimmune diseases can trigger avascular necrosis. Undergoing cancer treatment, undergoing dialysis and kidney transplant surgery makes you prone to avascular necrosis.

Tests :

Your doctor will check the affected joint by gently applying pressure over it. He would look for tenderness of joint. He may order for imaging tests like X-ray or bone scanning to get clear picture of tissue death in the bone.

Treatment :

Bone loss that has already occurred cannot be reversed, but by giving timely treatment, you can prevent further damage to the affected joint and bone. Your doctor may prescribe NSAIDs like Aleve or Advil to get quick relief from joint pain and inflammation. Osteoporosis drugs like Fosamax or Binosto can be given to reduce bone loss. Cholesterol controlling medications is given to prevent blood clots in the blood vessels.

• Surgery :

For severe cases surgical procedures like bone transplantation, core decompression or osteotomy can be done. This method is effective in strengthening the affected bone. For some people, joint replacement surgery is done using plastic parts.

Home Remedies :

Your doctor may advice you to take complete rest if you have avascular necrosis. You should avoid putting extra pressure on the affected bone or joint to prevent further damage. Practice certain stretching exercises recommended by your therapist to improve the joint motion. Electrical current can be given on the affected bone to promote fresh bone growth.

Prevention :

One cannot prevent avascular necrosis but can reduce the risk factors like drinking excess of alcohol and reducing weight.

Peritonitis

Peritonitis Peritonitis is a type of fungal infection of the abdominal wall caused by swelling of peritoneum (a soft membrane lining of the stomach). It would cause bloated feeling and abdominal cramps. Peritonitis needs to be treated immediately failing which it can cause complications like organ failure and even death. To prevent any serious complications, it should be treated promptly. It can be treated and controlled by antibiotics and in severe cases it has to be surgically operated.

Symptoms :

Some of the common signs of peritonitis are moderate to severe abdominal pain, tenderness, nausea, vomiting, fever, bloating sensation, diarrhea or inability to pass stool and extreme tiredness. For people who are doing peritoneal dialysis it can cause cloudy fluid and white strands of fibrin during dialysis. If you have severe abdominal pain with problems in passing urine or stool, then you need to seek immediate medical advice.

Causes :

• Any sudden perforation (rupture) of the abdominal wall can cause peritonitis. The soft membrane of the abdomen peritoneum can get broken due to several factors.


• Certain type of medical procedures like peritoneal dialysis can cause perforation in peritoneum. Using poor hygienic instruments during dialysis can cause infection of peritoneum leading to peritonitis.


• It can occur during the process of gastrointestinal surgery.


• Bacteria can easily enter into the peritoneum during the above procedures.


• Pancreatitis can also lead to peritonitis if the bacteria could migrate outside pancreas.


• Any infection in the digestive tract can cause rupture of the abdominal wall causing peritonitis. Any sudden injury to the stomach can cause this condition.


• Certain types of liver disease can cause peritonitis.


• Primary peritonitis is caused by liver cirrhosis and kidney failure.


• Secondary peritonitis can be caused due to pelvic inflammatory disease, Crohn’s disease, diverticulitis, any surgical procedure and trauma.

Risk Factors :

Peritonitis infection can occur to people who undergo peritoneal dialysis. Hence it is necessary to use sterile surgical instruments during dialysis. If left untreated, it can cause sepsis (internal infection) which can lead to organ failure.

Diagnosis :

Your doctor will complete the physical exam and look for the above symptoms. He will collect your medical history and check for cloudy fluid during dialysis in case you are a patient of dialysis therapy. He may order for series of tests including blood profile, peritoneal fluid analysis, and imaging tests like X-ray or CT scan to check the condition of your abdomen.

Treatment :

• Depending on the condition of the patient, he/she may be hospitalized for treating peritonitis infection.


• The doctor will start Intravenous fluids and give suitable antibiotics to prevent the bacterial infection.


• If the condition is critical surgery is done to remove the infected or dead tissue from the abdomen.


• For people who undergo peritoneal dialysis extreme care should be taken to prevent any infection.


• Until the infection heals completely, the dialysis therapy is given through alternative methods.

Prevention :

Take enough steps while doing peritoneal dialysis to maintain proper hygiene. The nurse and surgeon should thoroughly wash their hands before using any catheters. The skin area around the catheter should be cleaned with antiseptic solution. The entire team should use proper sterile instruments during the procedure. It is necessary to take antibiotics prescribed by your doctor in case you have spontaneous peritonitis before due to underlying medical conditions.

Chlamydia

Chlamydia Chlamydia is the most common type of sexual disease transmitted by sex partners. It can cause vaginal discharge and burning sensation while passing urine. This infection is common for both men and women and this bacterial infection is transmitted through sexual intercourse from affected partner. Chlamydia can be treated fully with effective antibiotics.

Symptoms :

You may not have any symptom as soon as you receive the Chlamydia infection. It might take a week or even more for you to notice some symptoms. It can cause pain in genitals while having sex, burning pain while urination, vaginal discharge in women and pain in testicles in men. It can also cause abdominal pain, bleeding between periods, itching sensation on the genitals, mild fever and painful urination. In men the tip of the penis develops swelling and it can cause cloudy discharge.

Causes :

Chlamydia is a bacterial infection that spreads through sex. You can receive the infection while having oral sex or anal sex also. In rare cases, the pregnant mother can transmit this infection to the fetus during delivery.

Who are at risk?

People who have multiple sex partners, who start with having sex in early ages, and those employed as sex workers have increased risk of getting Chlamydia. Often Chlamydia does not cause any complications but sometimes it can cause pelvic inflammation in women and prostate gland infection in men. In rare cases it can cause infertility in women. If left untreated, Chlamydia can lead to ectopic pregnancy for women.

Tests :

The centre for prevention and control of disease in the USA recommends yearly screening for Chlamydia for all sexually active people of young ages and pregnant women to avoid any complications. Men and women with multiple sex partners have high risk of getting Chlamydia infection even with using condoms.

Your doctor would do a swab test obtained from the discharge of vagina to test it on the lab. For men discharge from the penis is collected or sample is taken from urethra for testing. A simple urine test can also be done to diagnose Chlamydia infection.

Treatment :

Antibiotics are given in suitable doses for Chlamydia. Your doctor will give instructions about continuing antibiotics for few days or even weeks. Avoid having sex while you are diagnosed with infection since you can pass on the infection to your sex partner. Even if you don’t have any symptoms given above there is still the chance of spreading the infection to others while having sex.

Prevention :

• Have always safe sex by using condoms.


• Avoid having sex with multiple partners.


• Go for regular screening tests if you are sexually active with many partners, even if you don’t have any symptoms.


• Women should avoid douching since cleaning the vagina very often can increase the risk of getting infected.

Neurosarcoidosis

Neurosarcoidosis Sarcoidosis is described as a peculiar inflammatory disorder affecting the lungs and it occurs mostly between 20-40 years. It can affect many organs in the body since it is caused due to deposits of plaque like substance in the nervous system. Neuro-sarcoidosis is the term given to sarcoidosis that affects the nervous system. Often it affects the facial nerves and cranial nerves like pituitary gland and the hypothalamus.

People who have sarcoidosis have increased risk for developing neurosarcoidosis. Initial symptom of this disease is the Bell’s palsy causing weakness of optical (pertaining to eye) and auditory (ear) nerves. It can develop suddenly and also a slow process. Swelling of nerves can occur in any part of the body like brain or spinal cord or any other part of the nerves. The effects of this disease can be managed by taking corticosteroid drugs.

Causes :

Neurosarcoidosis is a chronic (long term) disorder affecting many organs and system of the body. It can affect particular area of nerves or the spinal cord as a whole. This disease develops due to the deposit of dead cells in the nerves thus disrupting its normal function.

Symptoms :

Muscle weakness in your face is the first symptom of neurosarcoidosis. The nerves of the face muscles can get affected causing intense pain or numbness in these areas. It can cause reduced vision, trouble in hearing and loss of smell and taste if the auditory and optical nerves gets affected. In case if the nervous system of the pituitary gland gets affected it can cause symptoms like excess of thirst, extreme tiredness, changes in menstrual cycle (for women) and increased urine output.

For some people it can cause symptoms like confusion, loss of memory, delirium, dizziness, blurred vision, headache, loss of taste or smell, seizures and stroke. If the peripheral nerves get affected due to this disorder, it can cause loss of sensation or abnormal sensation and reduced movement in particular part of the body.

Diagnosis :

Your doctor will complete physical exam after listening to your symptoms. He may then gather complete medical information and order for series of tests like blood profile, imaging tests like X-ray, CT or MRI scan of the brain. He may also perform lumbar puncture to collect cerebrospinal fluid inside and testing it in the lab. In case of inflammation of nerves the results would show increased levels of angiotensin converting enzyme.

Treatment :

• No clear treatment is available for neurosarcoidosis. The intensity of symptoms can be managed by effective drugs and therapies.


• Drugs that contain corticosteroid are prescribed for controlling swelling of nerves.


• Immunosuppressant drugs are also given for managing the symptoms.


• For people who have muscle weakness in particular part like hands or legs, physiotherapy is given for muscle relaxation.


• TNF alpha inhibitors are given to reduce inflammation of arthritis is effective in treating neurosarcoidosis.

Prognosis :

The outlook of this disease varies from one person to another. Age, health condition and intensity of nerves affected determine the prognosis. For some people the symptoms can be managed with effective doses of medications but for others the disease may progress repeatedly. For severe cases, it can cause permanent disability and even death. With progressive damage done to the brain nerves, there would be increased complications that can be serious.

Prevention :

You cannot totally prevent getting neurosarcoidosis. But if you are diagnosed with sarcoidosis, you need to get intense treatment for the disease so that it does not affect your nerves anymore.

Trigeminal Neuralgia

Trigeminal Neuralgia Trigeminal nerve is a group of nerves that is responsible for chewing and production of saliva. It is present on either side of the ear and trigeminal nerve is also known as fifth cranial nerve. It runs from the brain and passes through your face near the ear. The main nerve separates into three nerve endings and hence called as Tri (three) geminal nerve. Since the nerve goes to your scalp through forehead, cheeks and jaw sharp pain is felt on these areas.

Trigeminal neuralgia can cause chronic (long term) pain on your face giving bouts of excruciating pain. The pain is felt largely while touching your face like applying makeup or brushing your teeth etc. Even a small stimulation of the face can trigger this pain. The pain can be recurring and can cause mild attacks on your face. Trigeminal neuralgia affects elderly people largely and is more on women than men. The pain can be controlled by effective treatment and medications. Trigeminal neuralgia is a rare type of pain affecting people who are above 60 years and about 1 in every million people are affected.

Symptoms :

Trigeminal neuralgia can cause sudden episodes of shooting pain on your face that it can be felt as electric shock. The pain can be felt spontaneous when you touch the face. The pain would last for few seconds only but it may return again. For some people it can cause mild pain occasionally. Pain is triggered while you are touching the face for anything or for brushing your teeth. Many people describe the pain as though someone is stabbing with a knife on their face and piercing the skin.

The areas like cheeks, in and around the ears and jaws are worst affected with pain since the nerve passes through these areas. Pain is usually felt on one side of your face. For some people pain is focused in only one part like jaw or cheeks but for others it would spread widely. If not treated promptly, staggering pain is felt frequently and intensely over time.

Causes :

Intense sudden pain of trigeminal neuralgia occurs when the function of the trigeminal nerve gets disturbed. When the artery or vein gets in touch with the trigeminal nerve accidentally, it gets disrupted causing stabbing pain. Occasional contact of the artery with the nerve can put extra pressure on it thus interfering with its normal function. Aging is another factor that can cause trigeminal neuralgia. Having multiple sclerosis can also damage the myelin sheath covering of the trigeminal nerves causing intense pain. In rare cases formation of tumor on the trigeminal nerve can cause pain.

Risk Factors :

Old age is the primary risk factor for developing trigeminal neuralgia. For reasons unknown, women are more prone to get TN than men. The first attack or episode of pain comes without warning and may lasts for few seconds. The frequency of further attacks differs widely from one person to another. The pain may come and go on the same day or it can occur suddenly after a month or so. Nobody can predict when the next attack of pain would come back.

Complications :

As such trigeminal neuralgia would not cause any complications. However throbbing pain can interfere with your daily routine to large extent. You may ignore brushing your teeth or applying cream on your face due to the fear of pain. Hence you should not delay in taking treatment for trigeminal neuralgia.

Tests :

Your doctor can detect trigeminal neuralgia on listening to your symptoms. He may touch your face to verify where exactly pain has started. Further he may request for reflex test and neurological examination to know which branch of the nerve has been affected. To eliminate the possibility of multiple sclerosis he may order for imaging tests like CT/MRI scan.

Treatment :

For most of the people, trigeminal neuralgia pain can be managed by medications. But it can cause some adverse effect over long periods. In rare cases surgery is done for treating TN. Anticonvulsant medications like carbamazepine are prescribed for trigeminal neuralgia. After some years you may feel the pain again and your doctor may increase the dosage of the drug. These drugs can cause side effects like drowsiness and confusion.

Some doctors may prescribe muscle relaxing drugs like Gablofen or Lioresal for treating trigeminal neuralgia. In severe cases surgery is to be done to release the compression on the nerve. Microvascular decompressing surgery is done to remove the blood vessel from the trigeminal nerve region. A small incision is made behind the ear and a small hole is drilled on the skull. Your surgeon will remove any artery or vein that compresses the trigeminal nerve branch. This surgery can cause facial numbness or double vision or any other complications.

Another procedure called Gamma knife radioactive therapy is done wherein radiation is passed directly on the trigeminal nerve so that pain is not felt anymore on your face. This option is more effective and safe than surgery. If the patient gets back the pain again the same procedure is repeated. Your doctor may give you a shot of glycerol to damage the trigeminal nerve and blocking the pain. A small needle is sent into the base of skull through your face and sterile glycerol is injected directly on the nerve.

Balloon compression is another method for treating trigeminal neuralgia. A thin catheter is sent through the skull to locate the trigeminal nerve. A balloon is inserted to one end of the catheter which is then inflated to cause pressure on the trigeminal nerve to block the signals of pain. Now alternative therapies like acupuncture, vitamin or nutritional therapy and electrical stimulation are available for treating trigeminal neuralgia.

Rectal Pain

Rectal Pain Anus or rectum is the area through which feces are expelled from your body. Having rectal pain occasionally is not a matter of concern since it would resolve within few minutes. Many factors like anal fissure, fistulas and chronic constipation can cause rectal pain. If there is rectal bleeding accompanied with severe pain you need to get medical advice. Rectal pain can be managed by effective therapy or medical treatment depending on the cause.

Causes :

Number of factors given below can cause rectal pain :

• Development of fissure on the anal canal can trigger rectal pain. It can tear off the soft lining of the anal canal causing pain. Having anal sex or having frequent constipation can weaken the area inducing pain.


• Fistulae can develop on the anal region triggering pain.


• Some serious medical conditions like rectal cancer, colon cancer, Crohn’s disease, and rectal ulcer can cause pain with other symptoms also.


• Hemorrhoids can cause inflammation of veins in the anus region causing rectal pain. If the nerve endings of the rectum gets damaged it causes severe pain.


• Perianal hematoma and perianal abscess and itching can cause rectal pain.


• Sometimes, the sphincter muscles of the anal region can develop spasms causing fleeting pain on the bottom.

Symptoms :

Rectal or anal pain can range from mild to severe. Getting spasm on the anal sphincter muscles can cause sudden fleeting pain. The pain would last for few minutes only but it can be stabbing pain on the rectum. Some people would feel tight pressure building up on the rectal region. This can be due to levator ani syndrome. The pain is felt while you are sitting and it improves while standing.

Hemorrhoids can cause mild pain and discomfort on the rectum. But if there is hemorrhoid thrombosis (blood clot) it can cause throbbing pain. Developing anal fissure can cause acute intense pain as though someone is tearing your bottom with knife. The pain may range from mild to severe. It is often accompanied with bleeding from the rectum. The pain would be more intense while passing stool since the bowel would have to tear off the skin for coming out of the rectum. If you have rectal pain with other symptoms like bleeding you can seek medical advice.

Tests :

Your doctor will listen to the symptoms and perform rectal examination using special instrument. Anal fissure or hemorrhoids can become evident during physical exam. If required, he may order for imaging tests.

Treatment :

If you have mild recta pain it can be due to spasm of anal sphincter muscle. You can wait for few minutes to check if the pain has reduced. You can try home remedies like sitting in hot water bath for few minutes. Gently massage the anal muscles so that the muscle spasm gets reduced. Over the counter painkillers like Advil or Ibuprofen can provide immediate relief.

For pain due to hemorrhoids, you can apply creams that contain hydrocortisone. Eat soft foods and include lot of fiber content so that your stool gets soft and passes quickly. Drink plenty of water. Sitting in lukewarm water for 20 minutes can reduce the pain and discomfort caused by hemorrhoids. Your doctor would prescribe anti-inflammatory drugs and medications for relaxing the muscle to manage rectal pain caused by Levator Ani syndrome.

For severe cases of hemorrhoids on the rectum, your doctor may surgically remove it after giving a shot of anesthetic on the rectal region. For treating severe cases of anal fissure, sphincterectomy is done. This would reduce the muscle tone thereby decreasing the spasms.

Prevention :

Most of the rectal pain are mild and can be managed by taking plenty of fiber and water in your diet. By eating soft foods your bowel movement becomes easy causing no trauma to the rectum. Avoid constipation by eating more fiber foods and drinking water. If you have constant constipation you need to consult your doctor.

Brown Vaginal Discharge

Brown Vaginal Discharge It is quite normal for every woman to have vaginal discharge in between the menstrual cycle. Vaginal discharge is the mucus like fluid that comes out of your vagina. The color of the fluid can be white or light brown. This fluid is nothing but collection of mucus produced by the cervix and vaginal walls. It gets released through vagina whenever there is excess of fluid collection.

Having brown vaginal discharge on occasions indicates that you are healthy. Actually vagina produces this fluid to cleanse itself and keep the inner environment clean. Dead cells inside the vagina and unwanted bacteria are removed through vaginal discharge. This process helps in keeping your vagina clean and disease-free.

Women’s body having normal menstrual cycle will undergo plenty of changes inside with exchange of fluids and hormones. Estrogen and progesterone are two hormones involved in monthly cycle, vaginal discharge and even mood changes for women. There would be large difference in emotions before the onset of monthly periods and after it.

Vaginal discharge varies in color, quantity and texture for every woman. The chemical changes inside your body can produce large amounts of white discharge during the cycle and hot flashes. Having few light spots between your periods is not really a matter of concern. You need to worry only if you have excess of brown vaginal discharge or pain during discharge.

Causes :

Getting occasional brown vaginal discharge is absolutely normal. There are 2 major causes for getting more of vaginal discharge. One is during the initial stage of pregnancy and the other is being in pre-menopause stage. Pregnant women can get brown vaginal discharge during early stages of pregnancy. The vagina prepares itself to accommodate the fetus by clearing off the unwanted dead skin cells from the uterus. Once the egg gets fertilized by a sperm, the zygote gets itself attached to the wall of the uterus. This can cause brown vaginal discharge which may occur within 15 days of conception.

Women who are in pre-menopause stage can get yellowish brown discharge sometimes. If you get repeated discharge, you can consult your gynecologist. Some women may get brown vaginal discharge within a week after monthly periods when the old endometrial tissues are cleared off by the body. If there is brown vaginal discharge with pain and foul smell it can be due to vaginal infection or a symptom of sexually transmitted disease. Getting Chlamydia infection or gonorrhea can cause vaginal discharge between periods.

Formation of endometrial cysts can cause vaginal discharge. This can be heavy and it often occurs after intercourse. Any severe brown vaginal discharge with pain can be a sign of serious infection or disease. Infection can occur anywhere on the vagina or fallopian tubes or ovaries. If you have symptoms of pelvic pain, abdominal cramps with vaginal discharge you should consult your doctor immediately. In rare cases cervical cancer can cause brown vaginal discharge which is accompanied with other signs like loss of weight, loss of appetite, pelvic pain and extreme tiredness.

Tests :

Your doctor can easily detect the cause of brown vaginal discharge. She would ask you series of questions and perform a pelvic exam. She may also order for testing procedure like blood and urine culture and ultrasound scan of pelvic region if required.

Treatment :

Often vaginal discharge requires no treatment since it happens only for few days. It is quite natural for you to get brown discharge from the vagina if you are pregnant recently or if you are in pre-menopause stage. Treatment depends on the exact cause of the problem. If the results confirm the presence of infection, you will be prescribed antibiotics. In case of uterine polyps your doctor will consider removing it by curettage or scarring of polyps. You can prevent getting brown vaginal discharge by practicing safe sex and avoid having multiple sex partners.

Bartholin Cyst

Bartholin Cyst A pair of Bartholin glands is found on each side of the vagina which helps in keeping the vagina well lubricated. These glands are very small that you cannot feel or see it. These glands are located on the libia (folds of skin) that envelops vagina on either side. When the openings of these glands are blocked, fluid gets back into the gland accumulating to form a cyst known as Bartolin’s cyst. Often they are tiny swelling abscess around the vagina and are painless. It is quite common to develop a Bartholin cyst and it gets resolved within few days. In rare cases, surgical drainage becomes necessary.

Symptoms :

Often, Bartholin cysts go unnoticed owing to its tiny size and painless nature. You may not even notice it unless an infection develops on it. The cyst can be seen as a small lump on the lips of vagina near the opening. During infection it can cause discomfort while sitting or walking and pain while having sex. Often, these cysts occur on one side of the vagina.

Causes :

Exact cause of the formation of Bartholin’s cyst is unknown and still it is not clear why some women are getting it and others not. Bartholin’s cyst is formed when the tiny openings of the Bartholin glands get blocked. It can occur due to extra growth of the skin or due to bacterial infection like E. coli or due to sexually transmitted diseases like Chlamydia or gonorrhea. The cysts grow bigger in size while having sex since it secretes more fluid during intercourse to keep the vagina lubricated.

Tests :

Your doctor may perform a pelvic exam to detect Bartholin cyst. He may collect complete medical history and ask series of questions to check the possibility of sexual transmission. Biopsy of the tissue sample can be done for testing it on the lab to rule out any bacterial infection or cancer.

Treatment :

Bartholin cyst does not require any treatment since the abscess would drain off within few days. You need to get medical help only if it troubles you while having sex or the cyst has developed infection causing bad odor and itching. Taking Sitz baths several times a day is the best remedy for Bartholin cyst. Fill a tub with lukewarm water and sit relaxed on it for few minutes. The cysts would rupture to drain off the liquid inside. You can manage the pain by taking Advil or Motrin for some days if you have pain during intercourse.

Surgery is the choice only if the size of the cyst is large or it causes complication. Your surgeon may give a shot of local anesthesia during the procedure. He would gently make a small incision directly on the cyst to drain off the fluid inside. Subsequently a tiny catheter (rubber tubing) is placed in the region for few weeks to facilitate complete drainage. You may not be able be have sex until the catheter is removed from the area.

If your doctor suspects bacterial infection on the cyst, he would prescribe suitable antibiotics. Marsupialization is another procedure by which Bartholin’s cyst is treated. Your doctor would create a small opening on the sides of the cyst and inserts a catheter so that there is full drainage of fluid inside for some days. If the Bartholin cysts do not respond to the above methods, the glands would be removed surgically in the hospital.

Achilles Tendonitis

Achilles Tendonitis The term ‘Achilles’ refers to the bone surrounded by group of tissues connecting the muscles of the lower leg to your heel. Any injury to the tendon of Achilles can cause inflammation leading to Achilles tendonitis. It is a common phenomenon that occurs in adults who over use this tendon tissues only for a day or two of the week. There are people who play basketball or any kind of sports only on Sundays or weekends. This can cause swelling of tendon causing intense pain. Often the pain can be managed by self care methods but in severe cases the tendon may get rupture inside requiring surgery.

Causes :

• Vigorous practice of sports activities like running or jumping can cause injury of Achilles tendon muscles.


• Participating in a marathon race without any practice can cause injury to the soft muscles and tissues that surrounds the tendon.


• Using poorly fitting shoes and footwear and putting extra tension on the foot muscles can cause inflammation of Achilles tendon.


• Using certain antibiotics like ciprofloxacin can affect the tendon muscles leading to easy rupture of tendon.


• Increasing age can also contribute for Achilles tendonitis since the tendon would become weak with age.

Symptoms :

• Mild to moderate injury of Achilles tendon can cause stiffness and pain. Often the pain reduces when you start walking but sometimes the pain can increase if you perform any vigorous action involving foot muscles.


• It can cause tenderness and swelling of tendon. Palpitation can be felt on the tendon. There would be intense pain while you move the ankle joint.


• Achilles tendonitis can cause mild pain in the lower leg just above the heel portion after you have completed running or any sports activity.


• Some people can feel intense pain after climbing stairs. Morning stiffness is common with this problem which would improve after you start walking.

Who are at risk?

For reasons unknown, men are more prone to develop Achilles tendonitis than women. Elderly people, people with physical problems in their foot, obese people, people who use ill fitting shoes, people who suddenly take part in any sports events, people with certain medical issues like hypertension or diabetes and prolonged use of antibiotics like fluoroquinone can get Achilles tendonitis. In rare cases the tendon can become weak causing internal rupture leading to severe pain that demands surgical correction.

Diagnosis :

Any intense pain on the back of your heel area can be Achilles tendonitis. Your doctor will apply little pressure on the area to feel any swelling or tenderness. He may request for X-ray of tendon or imaging tests like CT/MRI scanning to get accurate picture of the tendon.

Treatment :

Mild form of Achilles tendonitis does not require any treatment. Applying hot pack on the area can give relief from pain and swelling. You can get comfort by taking pain killers like Ibuprofen or naproxen for few days. Your doctor may prescribe strong doses of anti-inflammatory agents and pain killers depending on the symptoms. Physiotherapy exercises like stretching can facilitate healing of muscles and give strength to the injured tendon. Using orthotic instruments like wedge or shoe insert can reduce inflammation of the tendon and relieve extra pressure on it.

Surgery is the option if there is rupture of tendon. Rupture/tear of tendon can occur in any age group but is more particular in old age people. Sports personalities who are taking part in football or running events can develop rupture of tendon. Any injury or sudden fall can cause sudden stretching of tendon leading to rupture. Your surgeon will repair/correct the tendon and you need to take complete rest until the injury heals.

Home Remedies :

• For managing mild pain on the tendon or lower foot area you can try any of the following techniques.


• Avoid doing any exercises for few days so that the inflammation completely heals.


• Apply ice pack on the area for few minutes and this can be repeated soon after you complete exercise or sports.


• Wearing compression bandage on your foot can reduce tension.


• Keep the foot well elevated to reduce swelling.

Prevention :

Don’t start vigorous practice on the very first day. Always increase the duration of activity gradually to prevent sudden inflammation of the tendon. Avoid running in rugged terrain and wear shoes that are comfortable to your heels giving extra cushion. Practice stretching exercises regularly to strengthen your calf muscles.

Social Anxiety Disorder

Social Anxiety Disorder Social anxiety disorder is a problem that originates from the fear of making mistakes. The person with SA disorder will have unreasonable fear that he/she is being watched by others and will develop irrational fear of social situations. These people are always self conscious and worried about being criticized by others. People with SA disorder will often avoid being in social situations and if conditions compel them to take part in social events, they would develop an “anticipatory anxiety” probably weeks or even months before the occasion. They live in the fear of something wrong is going to happen. Many people are fully aware of their irrational fear (which is meaningless) but they don’t have the courage to overcome it.

SA disorder is called as “social phobia” which is linked with other type of mental issues like panic disorder or obsessive compulsive disorder. People with social phobia will have problems in interacting with people, and working in front of others. The fear becomes so intense that it seriously interferes with their routine activities and creates problems in relationships. These people are afraid to do even common things like using public toilet or eating in a restaurant etc. They imagine that somebody would criticize them for their behavior or mistakes and avoid such situations.

Causes :

No one factor can be limited to cause social anxiety disorder. It is caused by multiple factors like psychological, social and biological factors. For some people, SA disorder is hereditary and runs in families. It is believed to occur due to abnormal functions in the brain that is responsible for fear or stressful events.

For some people, SA disorder can develop due to embarrassing events in childhood and humiliating events in society during adolescence. Children with this disorder would have suffered and neglected by peers or bullied by others. Children who are over-protected may not have the opportunity to learn proper social skills and in later stage can develop this disorder.

Symptoms :

Some of the signs and symptoms of SA disorder are given below:-

• Developing intense anxiety while taking part in social situations


• Feeling very self conscious in front of others


• Worried and anxious about particular event even days or weeks before


• Avoid taking part in social events


• Having unreasonable fear of getting criticized


• Having hard time to maintain friendship


• Developing physiological problems like trembling, sweating and blushing, shaking while attending social situations

Social anxiety disorder is ranked 2nd in general anxiety disorders and is ranked 3rd among various types of mental disorders. More than 15 million Americans are believed to have SA disorder. It begins during early childhood or adolescence mostly, but it can develop during adulthood also. More women develop SA disorder than men.

Diagnosis :

A person is said to have SA disorder if he/she has any of the above symptoms in the past 6 months. Parents can observe the behavior of their children in social situations and detect any such activities. Your doctor may conduct some physical tests to rule out any other physical problem. He may refer your child to psychiatrist who will evaluate SA disorder based on designed interview and various assessment tools.

Treatment :

Social Anxiety disorder can be fully treated and cured. But the rate of recovery will be fast if diagnosed in early stages. Your therapist would use a specialized method called cognitive behavior therapy for treating the symptoms. The person will be able to slowly overcome the fear and anxiety with regard to social events and situations. He would create artificial conditions resembling social setup and teach different ways of overcoming his fear. The therapist will also make your child learn social skills.

Medications are recommended to treat people with intense anxiety or depression associated with SA disorder. But you cannot expect results overnight and it may take several months or years to cope with anxiety prone situations. Social phobia can also be treated with monoamine oxidase inhibitor kind of drugs. These drugs can cause side effects and hence you have to visit your doctor regularly to report any changes.

Prognosis :

The outlook for SA disorder is satisfactory. Many people are able to live normal life and take part in social situations after therapy.

Glomerulonephritis

Glomerulonephritis Glomeruli is the name of tiny filters present in the kidneys that are responsible for removing waste materials and excess of fluid from the blood. As the unwanted particles passes through these filters (glomeruli) it becomes the essential part for the function of kidney. If there is swelling of glomeruli it disrupts the normal purification function done by the kidneys thereby causing more damage to it.

Glomerulonephritis is the inflammation (swelling) of tiny filters called glomeruli of the kidneys that interrupt its normal function. There are many conditions and illness that can cause glomerulonephritis. It needs to be treated promptly failing which it can cause damage to your kidneys.

Symptoms :

Glomerulonephritis can occur suddenly (acute) or as a gradual process (chronic). If there is direct damage to the filters or glomeruli it is called as primary glomerulonephritis. In case if the functions of filters get blocked due to long-term diabetes or other illnesses, it is secondary glomerulonephritis. Signs and symptoms of this disease differ as per its type. It can cause fluid retention in your body leading to swelling of legs, face and hands.

The color of the urine may be dark brown or pink indicating presence of red blood cells in it. For some people, urine can become foamy due to proteinuria (excess of protein). It can cause increase in blood pressure and extreme tiredness. Chronic form of glomerulonephritis would proceed silently causing no symptoms. This type can also cause high blood pressure, excess of urination during night time, swelling of face, foamy urine and abdominal pain.

Causes :

For some people, exact cause of glomerulonephritis is not known, and it is idiopathic. Infectious diseases can affect the filters causing inflammation of glomeruli. People who have got strep throat infection or skin infection can develop glomerulonephritis, due to excess of antibodies produced by the immune system. Children with low immunity have chance to get streptococcal glomerulonephritis quickly.

For some people bacteria can gain entry into the blood causing heart problems like endocarditis. This problem can create inflammation of glomeruli. Glomerulonephritis can be caused due to viral infections like HIV or hepatitis B infection. Chronic inflammatory diseases like systemic lupus can affect your kidneys. Similarly, Goodpasture’s syndrome and IgA nephropathy can cause glomerulonephritis. Some kinds of vascular disorders like polyarteritis and Wegener granulomatosis can cause this problem.

Tiny filters of glomeruli can get scarred due to hypertension and prolonged diabetes also. In severe cases glomerulonephritis can cause acute kidney failure or chronic kidney problems and high blood pressuer. Too much of protein discharge in urine can lead to nephritic syndrome.

Tests :

For some people, chronic glomerulonephritis is detected during urine analysis done for other reasons. If there are signs of dark urine or frequent urination your doctor may request for complete urine test, blood test (to check the levels of creatinine), and imaging tests like X-ray or CT scan of kidneys and kidney biopsy.

Treatment :

The method of treatment differs according to the type of glomerulonephritis and severity of symptoms. Some types of glomerulonephritis caused due to strep infection would resolve without any treatment whereas other types may need antibiotics. In case high blood pressure is the root cause for the problem, your doctor would prescribe suitable diuretics and ACE inhibitors for managing it.

For managing lupus and similar chronic conditions, corticosteroids are prescribed. For treating Goodpasture’s syndrome, a special method is used for removing antibodies from the blood which is then replaced with suitable plasma from the donor. Only for final stages of kidney failure, dialysis and transplant surgery is done.

Lifestyle Changes :

For people diagnosed with glomerulonephritis, follow the instructions of your dietician with regard to salt intake. Limit the intake of potassium and protein contents in food. Manage your weight and blood pressure. Do regular exercises.

Post Traumatic Stress Disorder

Post Traumatic Stress Disorder Post traumatic stress disorder was earlier known as “shell shock” is a serious mental condition that occurs to a person who undergoes or witness a traumatic event. People who experience terrifying event in their life would take some time to overgrow the trauma. But for few people, the symptoms of helplessness, intense fear, flashbacks, nightmares, negative feelings and avoiding social life would continue for years after the event.

Actual cause of PTSD is not known clearly, since not all the people who witness traumatic events in their life are developing this disorder. It is believed to occur due to certain changes in chemical reaction in the brain. The symptoms can be managed with effective medications and therapy. Report indicates that 3.5-4% of Americans have PTSD (about 7.8 million Americans). This disorder can occur to anyone at any age and more women than men suffer from this anxiety disorder.

Symptoms :

Initial symptoms would start anytime after a person experiences traumatic event. The signs and symptoms can be broadly categorized into 4 main streams namely disturbed memories, avoidance, having negative changes in mood and finally change in emotions. Disturbed memories can cause recurrent thoughts about traumatic event, flashbacks, nightmares, upsetting dreams and intense emotional disturbance.

Symptoms of avoidance include avoiding people, avoiding certain places and avoiding thinking or talking about the stressful event. Negative changes in mood and thought can cause guilt feeling, low self esteem, hopelessness, lack of interest and inability to maintain relationships. The person may not remember certain aspects of the event and he may lose interest in important activities.

Changes in emotions can cause difficulty in sleeping, concentrating, guilt feeling, and trouble in remembering and concentrating, always expecting some danger and engaging in self destructive behavior. The person may get frightened easily even by small events. The intensity of symptoms may not be the same for all. The memories would become severe when the person is stressed or witness certain events that remind them about the past. Children with PTSD at young ages can have delayed development of motor skills.

Causes :

PTSD is classified as an anxiety disorder affecting certain people who witness terrifying event or undergo increased stress. A child who is sexually abused for prolonged period may develop PTSD. An individual who witness gruesome accident, who is in part of personal assault, who sees violent deaths of loved ones and military combat can develop this disorder.

People who are held as captives by terrorists and those who are part of natural disasters can have high risk of developing traumatic disorder. Symptoms can begin shortly within weeks but for some people it might take months or years also. PTSD is believed to occur due to inherited mental aspects of your personality and the response of your body to stressful events and changes in chemical reaction in your brain.

Who are at Risk?

• Military personnel and people facing prolonged physical or mental abuse are at high risk of developing PTSD.


• People who lack good family system and grow up in neglected childhood have increased chance of getting this disorder.


• You are at risk of getting this problem if you have family history of anxiety disorder or other mental health problem.


• People who are involved in natural disasters like flood, earthquake and who witness’s accident or plane crash may develop PTSD.


• As such PTSD can cause complications like depression, anxiety and emotional disturbance if not treated. It can cause complications like developing addiction to alcohol or substance and increased suicidal thoughts.

Diagnosis :

PTSD can be detected based on symptoms. Your doctor will refer the case to a psychologist who will evaluate the disorder by asking series of questions. She would ask you about the traumatic events in your life. According to the Diagnostic and Statistical Manual of psychiatric disorders, a person is said to have PTSD if he/she has some of the above mentioned symptoms for more than a month or two. For some people it can cause great distress and make them unable to carry on with daily tasks.

Treatment :

The main purpose of treating PTSD is to help the person to overcome the stress caused by traumatic event or experience. Based on the severity of the symptoms, the person will be given psychotherapy and medications.

• Psychotherapy :

Cognitive behavior therapy can help the person to change his thought patterns and manage his feelings and emotions caused by trauma. Exposure therapy is one in which the therapist will take the person through artificially created traumatic experience and teach him to confront the fear. Many approaches like psychodynamic therapy, family and group therapy are used to change the behavior of the person effectively and to remove the distress caused by traumatic experience.

• Medications :

Antidepressants like sertraline or paroxetine are prescribed for relieving symptoms of anxiety and depression. Anti anxiety drugs can help the person to overcome stress and improve his sleeping pattern. Prazosin is an effective drug used to control nightmares and relieve the symptoms of PTSD. You need to consult your doctor about the side effects of these medications and follow his instructions and usage and dose.

Discuss with your doctor and therapist freely about PTSD. Stick on to your treatment plan even if you feel better and continue taking medications till your doctor says to stop them. Do regular exercise and eat healthy diet. Get in touch with your family and friends and share your feelings. You can also join a support group to get ideas about their coping strategies.

Many of us would confront with traumatic experience in life, but not all of us develop symptoms of PTSD. You will be able to come out of it within few days. Do not delay in getting treatment if you feel that you are not able to overcome the stress caused by traumatic experience. The more you delay the treatment, the more will be the severity of symptoms of PTSD.

Prognosis :

In most of the cases, recovery is possible but it can take some time since it is a gradual process. You cannot totally forget the event but you can manage to carry on with life with well developed coping methods.

Stuttering

Stuttering Stuttering is a disorder that affects the quality of speech. It is a speech disorder that causes significant problems with the delivery of speech. People with stuttering disorder may repeat the same word or prolong a word or phrase during their speech. Stuttering problem is common among young children when they learn to speak. With proper training it can be overgrown during the course of development.

Stammering or stuttering disorder can become chronic (lifelong) for some people and it can affect their self esteem also. Stress or anxiety can worsen the stuttering symptoms. Stuttering can be managed by speech language therapy and individual counseling and behavior therapy. Stuttering can be related to social anxiety disorder also.

Symptoms :

Children or adults affected with stuttering disorder will have difficulty in starting a word or sentence. They would repeat particular syllable or word frequently. They would prolong a word or sound for few seconds. Some people would abruptly stop while talking and others would add extra words before moving to next word. It may cause tightness of muscle on the face, facial tics, rapid blinking of eye and mild tremors on their lips. These symptoms may worsen if they are stressed or tired. Due to stuttering some people may develop anxiety while talking and avoid situations that warrant talking to strangers. Casual talking on the phone can cause significant problem for them.

Causes :

Exact cause of stuttering disorder is not known. It is believed to be caused by various factors like genetics (due to abnormalities in genes), defect in speech motor control, and certain medical conditions like stroke or trauma and due to rare mental health issues.

Risk Factors :

A person having close relatives who stutter, a child with delayed development increases the risk factor for stuttering. Males are more prone to develop stuttering than females, for reasons unknown.

Diagnosis :

Parents can observe their children while talking to check if they are stuttering. You can ask him to read aloud to detect any difference in speech. Young children would have problems in talking during the stage of learning to speak and you need to worry only if it is long term. Doctors would ask series of questions about their relationships, work and attitude for adults who stutter. They would find out if there is any mental health issues involved.

Treatment :

Combination of various methods is used for treating stuttering disorder. One method may be effective for one person and not for others. Experts would give therapy to talk slowly using controlled fluency method. You can make use of electronic devices while speaking that would help in slowing your speech to prevent stuttering. Cognitive behavior therapy CBT is helpful to change the way you think and behave. This is very useful in resolving situations of stress and anxiety.

Parents can identify which method is suitable for their child and follow it effectively to improve his speech. Encourage your child and praise him which helps in growing his self esteem. Don’t criticize your child because he stutters while talking since this would affect his overall development. You try to accept what he is and find out ways to improve his performance.

Postpartum Depression

Postpartum Depression Lot of changes happens to a woman when she becomes pregnant and subsequently gives birth to a child. In addition to physical changes, she also undergoes emotional and mental changes. Ranging from excitement to anxiety she experiences fear also. This might land up in postpartum depression. Depression arising from childbirth is known as postpartum depression. It is quite common for most of the new moms to experience mood swings for some time. But this would not continue for long.

In the case of postpartum depression, it becomes long lasting and may continue for several months or even years after childbirth. It can interrupt her daily activities and many times the mother will not even bother about her new baby due to depression. Postpartum depression has nothing to do with character of mother. It is neither weakness nor “baby blues” but it occurs as a result of bundle of hormonal changes in the brain. It is a rare and severe form of mental illness that occurs after childbirth. In extreme cases, postpartum depression develops into more severe form called postpartum psychosis which is a medical emergency. Postpartum depression can be treated but early intervention is essential for complete recovery.

Symptoms :

Prominent symptom of postpartum depression is feeling hopeless and sad each day and losing interest in pleasurable activities. Intensity of symptoms of PPD may vary from one mother to another, but these are the general signs of this disorder. A mother having “baby blues” might show symptoms of mood swings, sadness, anxiety, irritability and trouble sleeping, but these symptoms would go within few days or weeks after childbirth. The major difference in PPD is the symptoms grow intense day by day and it can significantly interfere with her daily tasks.

Loss of appetite, trouble in sleeping, increased irritation/anger, extreme tiredness, lack of interest in life/sex, severe mood swings, feeling of guilt/shame and withdrawal from family are some of the symptoms of PPD. The mother may have difficulty bonding with the child and she would completely ignore the baby, without caring to feed. Some mothers would harm their baby assuming that it is the reason for their sadness.

In severe cases they get thoughts about suicide/death. They may gain or lose weight and feel restless or sit quietly for hours together. A woman with postpartum psychosis may show symptoms of confusion, delusions and hallucinations (seeing/hearing non-existing things) and severely doubting others. She may not be able to recognize day or night and the place where she lives. Most of these symptoms may develop within few weeks after childbirth.

Causes :

Still experts cannot pinpoint the right cause of PPD and one cannot say why certain mothers develop this disorder and others not. It is believed to occur due to plenty of physical and emotional changes that happen to pregnant woman. Lots of hormonal changes occur in the body of pregnant women and after delivery there will be considerable drop in hormone levels.

It can cause dramatic changes in her metabolism, leaving her extremely tired and weak. It can also cause mood swings leading to postpartum depression. A new mother cannot sleep properly and may have trouble in handling her baby. She may feel that she is worthless and lost control. Such feelings can contribute for postpartum depression. A mother delivering stillborn baby or a child with serious illness can develop PPD.

Who are at risk?

Any woman can develop PPD after childbirth. But there are certain factors that increase the risk. Financial trouble, lack of care/love from spouse, poor support from family, increased stress and sudden death of husband are some of the factors that makes a woman prone to develop PPD.

Having a sick child, undergoing depression during pregnancy and family history of bipolar disorder increases the risk of developing this disorder. A child born for postpartum depression mother can have behavioral problems in life. If left untreated, PPD can develop further to postpartum psychosis.

Tests :

According to DSM, PPD is a kind of major depression. To be classified under PPD, a new mother should have at least 3-4 of the symptoms like depressed mood every day, lack of interest in any activity, loss of appetite, trouble in sleeping, restlessness, fatigue, difficulty to make decisions and think clearly and repeated thoughts about suicide/death.

Treatment :

Medications are given to reduce the symptom of depression and individual counseling and therapy are effective for postpartum depression. Based on your symptoms, your doctor would refer to a psychiatrist or psychologist for counseling. Family counseling is helpful in building relationships. Antidepressant drugs are prescribed with precaution for new mothers. Your psychiatrist would start with low doses since you would be breast-feeding.

If your hormone levels are imbalanced, suitable hormone therapy is given. Often, most of the symptoms of PPD go away with effective treatment, but you should follow the instructions of your doctor in taking medicines to prevent relapse. If you can afford, engage a full-time helper for your baby. Spend quality time for yourself. Eat healthy foods and do regular exercises which can help in regulating your mood.

Prevention :

You can do nothing to prevent PPD since it is not your fault. However if you have a family history of depression you can consult your doctor once you become pregnant. He might give suitable antidepressants to prevent worsening of symptoms.