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What is Brain Hemorrhage?

What is Brain Hemorrhage?

A brain hemorrhage is a type of stroke. It’s caused by an artery in the brain bursting and causing localized bleeding in the surrounding tissues. This bleeding kills brain cells.

Many people who experience a brain hemorrhage have symptoms as though they are having a stroke, and can develop weakness on one side of their body, difficulty speaking, or a sense of numbness. Difficulty performing usual activities, including problems with walking or even falling, are not uncommon symptoms. About 13% of all strokes are hemorrhagic strokes, or caused by bleeding into the brain.

Bleeding within the skull but outside of the brain tissue

The brain has three membranes layers (called meninges) that lay between the bony skull and the actual brain tissue. The purpose of the meninges is to cover and protect the brain. Bleeding can occur anywhere between these three membranes. The three membranes are called the dura mater, arachnoid, and pia mater.

Epidural bleed (hemorrhage): This bleed happens between the skull bone and the utermost membrane layer, the dura mater.

Subdural bleed (hemorrhage): This bleed happens between the dura mater and the arachnoid membrane.

Subarachnoid bleed (hemorrhage): This bleed happens between the arachnoid membrane and the pia mater.

Bleeding inside the brain tissue

Two types of brain bleeds can occur inside the brain tissue itself – intracerebral hemorrhage (also called cerebral hemorrhage and hemorrhagic stroke) and intraventicular hemorrhage.

  • Intracerebral hemorrhage:This bleeding occurs in the lobes, pons and cerebellum of the brain (bleeding anywhere within the brain tissue itself including the brainstem).
  • Intraventricular hemorrhage:This bleeding occurs in the brain’s ventricles, which are specific areas of the brain (cavities) where cerebrospinal fluid is produced.

Causes of Brain Hemorrhage

The most common cause of a brain hemorrhage is elevated blood pressure. Over time, high blood pressure can weaken arterial walls and lead to rupture. When this occurs, blood collects in the brain leading to symptoms of a stroke. Other causes of hemorrhage include aneurysm — a weak spot in the wall of an artery — which then balloons out and may break open. Arteriovenous malformations (AVM) are abnormal connections between arteries and veins and are usually present from birth and can cause brain hemorrhage later in life. In some cases, people with cancer who develop distant spread of their original cancer to their brain (metastatic disease) can develop brain hemorrhages in the areas of brain where the cancer has spread. In elderly individuals, amyloid protein deposits along the blood vessels can cause the vessel wall to weaken leading to a hemorrhagic stroke. Cocaine or drug abuse can weaken blood vessels and lead to bleeding in the brain. Some prescription drugs can also increase the risk of brain hemorrhage.

Symptoms of a brain hemorrhage depend on the area of the brain involved. In general, symptoms of brain bleeds can include:

  • Sudden tingling, weakness, numbness, or paralysis of the face, arm, or leg, particularly on one side of the body
  • Headache (Sudden, severe “thunderclap” headache occurs with subarachnoid hemorrhage)
  • Nausea and vomiting
  • Confusion
  • Dizziness
  • Seizures
  • Difficulty swallowing
  • Loss of vision or difficulty seeing
  • Loss of balance or coordination
  • Stiff neck and sensitivity to light
  • Abnormal or slurred speech
  • Difficulty reading, writing, or understanding speech
  • Change in level of consciousness or alertness, lack of energy, sleepiness, or coma
  • Trouble breathing and abnormal heart rate (if bleed is located in brainstem)

Treatment:

Treatment for bleeding in the brain depends on the location, cause, and extent of the hemorrhage. Surgery may be needed to alleviate swelling and prevent bleeding. Certain medications may also be prescribed. These include painkillers, corticosteroids, or osmotics to reduce swelling, and anticonvulsants to control seizures.

 

What are the different types of jaundice?

Jaundice happens when too much bilirubin builds up in your blood. This makes your skin and the whites of your eyes look strikingly yellowish.

Bilirubin is a yellowish pigment created as hemoglobin — a component of red blood cells — is broken down.

Normally, bilirubin is delivered from the bloodstream into your liver. Then, it passes through tubes called bile ducts. These ducts carry a substance called bile into your small intestine. Eventually, bilirubin is passed out of your body through urine or stool.

Types of jaundice are categorized by where they happen within the liver’s process of taking in and filtering out bilirubin

There are three main types of jaundice:

Hepatocellular jaundice occurs as a result of liver disease or injury.

Hemolytic jaundice occurs as a result of hemolysis, or an accelerated breakdown of red blood cells, leading to an increase in the production of bilirubin.

Obstructive jaundice occurs as a result of an obstruction in the bile duct. This prevents bilirubin from leaving the liver

Common symptoms of jaundice include:

  • a yellow tinge to the skin and the whites of the eyes, normally starting at the head and spreading down the body
  • pale stools
  • dark urine
  • itchiness

Accompanying symptoms of jaundice resulting from low bilirubin levels include:

  • fatigue
  • abdominal pain
  • weight loss
  • vomiting
  • fever
  • pale stools
  • dark urine

Levels of Bilirubin

The level of bilirubin is defined in a blood test called a bilirubin test. This measures unconjugated, or indirect, bilirubin levels. These are responsible for the onset of jaundice.

Bilirubin levels are measured in milligrams per decilitre (mg/dL). Adults and older children should have a level of between 0.3 and 0.6 mg/dL. Around 97 percent of infants born after 9 months of pregnancy have levels lower than 13 mg/dL. If they show higher levels than this, they are usually referred for further investigation.

These ranges may differ between laboratories. How far above the normal range a person’s levels are will set out a course of treatment.

Are you really pregnant?

The signs of early pregnancy can vary from woman to woman. You may feel your body making changes quickly (within the first month of pregnancy) or you may not notice any symptoms at all. Symptoms of early pregnancy can include a missed period, an increased need to urinate, swollen and tender breasts, fatigue, and morning sickness.

Classic pregnancy signs and symptoms

The most common early signs and symptoms of pregnancy might include:

  • Missed period. If you’re in your childbearing years and a week or more has passed without the start of an expected menstrual cycle, you might be pregnant. However, this symptom can be misleading if you have an irregular menstrual cycle.
  • Tender, swollen breasts. Early in pregnancy hormonal changes might make your breasts sensitive and sore. The discomfort will likely decrease after a few weeks as your body adjusts to hormonal changes.
  • Nausea with or without vomiting. Morning sickness, which can strike at any time of the day or night, often begins one month after you become pregnant. However, some women feel nausea earlier and some never experience it. While the cause of nausea during pregnancy isn’t clear, pregnancy hormones likely play a role.
  • Increased urination. You might find yourself urinating more often than usual. The amount of blood in your body increases during pregnancy, causing your kidneys to process extra fluid that ends up in your bladder.
  • Fatigue also ranks high among early symptoms of pregnancy. During early pregnancy, levels of the hormone progesterone soar — which might make you feel sleepy.

Other pregnancy signs and symptoms

Other less obvious signs and symptoms of pregnancy that you might experience during the first trimester include:

  • The flood of hormones in your body in early pregnancy can make you unusually emotional and weepy. Mood swings also are common.
  • Hormonal changes during early pregnancy can cause you to feel bloated, similar to how you might feel at the start of a menstrual period.
  • Light spotting. Sometimes a small amount of light spotting is one of the first signs of pregnancy. Known as implantation bleeding, it happens when the fertilized egg attaches to the lining of the uterus — about 10 to 14 days after conception. Implantation bleeding occurs around the time of a menstrual period. However, not all women have it.
  • Some women experience mild uterine cramping early in pregnancy.
  • Hormonal changes cause your digestive system to slow down, which can lead to constipation.
  • Food aversions. When you’re pregnant, you might become more sensitive to certain odors and your sense of taste might change. Like most other symptoms of pregnancy, these food preferences can be chalked up to hormonal changes.
  • Nasal congestion. Increasing hormone levels and blood production can cause the mucous membranes in your nose to swell, dry out and bleed easily. This might cause you to have a stuffy or runny nose.

What is Tonsillitis?

Tonsillitis is inflammation of the tonsils, two oval-shaped pads of tissue at the back of the throat — one tonsil on each side. Signs and symptoms of tonsillitis include swollen tonsils, sore throat, difficulty swallowing and tender lymph nodes on the sides of the neck.

Most cases of tonsillitis are caused by infection with a common virus, but bacterial infections also may cause tonsillitis.

Because appropriate treatment for tonsillitis depends on the cause, it’s important to get a prompt and accurate diagnosis. Surgery to remove tonsils, once a common procedure to treat tonsillitis, is usually performed only when tonsillitis occurs frequently, doesn’t respond to other treatments or causes serious complications.

There are three types:

Acute tonsillitis. These symptoms usually last 3 or 4 days but can last up to 2 weeks.

Recurrent tonsillitis. This is when you get tonsillitis several times in a year.

Chronic tonsillitis. This is when you have a long-term tonsil infection.

Tonsillitis symptoms

Possible symptoms of tonsillitis include:

Tonsillitis Symptoms in Children

In very young children, you may also notice increased irritability, poor appetite, or excessive drooling.

In children, symptoms may also include:

  • Upset stomach
  • Vomiting
  • Stomach pain
  • Drooling
  • Not wanting to eat or swallow

When to see a doctor

You should see a doctor if you experience the following symptoms:

  • fever that’s higher than 103°F (39.5°C)
  • muscle weakness
  • neck stiffness
  • a sore throat that doesn’t go away after 2 days

In rare cases, tonsillitis can cause the throat to swell so much that it causes trouble breathing. If this happens, seek immediate medical attention.

While some tonsillitis episodes go away on their own, some may require other treatments.

What is Fistula?

A fistula is an abnormal connection or passageway that connects two organs or vessels that do not usually connect. They can develop anywhere between an intestine and the skin, between the vagina and the rectum, and other places. The most common location for a fistula is around the anus.

TYPES OF FISTULAS:

ANAL FISTULAS/PERIANAL FISTULAS.

Abnormal connection between the epithelialized surface of the anal canal and the perianal skin.

Anorectal Fistula occurs between the anal canal and the skin around the anal opening.

Rectovaginal or Anovaginal Fistula occurs when a hole develops between the rectum or anus and the vagina.

Colovaginal Fistula occurs between the colon and the vagina.

URINARY TRACT FISTULAS.

Abnormal openings within a urinary tract organ or an abnormal connection between a urinary tract organ and another organ.

Vesicouterine fistula occurs between the bladder and the uterus.

Vesicovaginal fistula is where a hole develops between the bladder and the vagina.

Urethrovaginal fistula is between the urethra and the vagina.

OTHER TYPES.

Enteroenteral fistula occurs between two parts of the intestine.

Enterocutaneous or Colocutaneous fistula occurs between the small intestine and the skin or the colon and the skin respectively.

Left untreated, fistulas can be traumatic, debilitating, and can do additional harm to your body. Nerve damage, infection, and kidney failure are associated with fistulas.

WHAT CAUSES A FISTULA?

The most common cause of fistulas is childbirth and obstructed labor that is left unrelieved.  While the incidence of fistulas due to complicated births, other causes can create this troublesome condition. Crohn’s disease and diverticular disease are well known to cause fistula formation. In addition, those who are undergoing radiation therapy are at greater risk for a variety of fistulas.

 WHAT ARE THE SYMPTOMS OF FISTULAS?

Depending on the type of fistula, here are some telltale sign

  • Constant urine leakage from the vagina
  • Irritation in the external female genital organs
  • Frequent urinary tract infections (UTIs)
  • Leakage of gas and/or feces into the vagina
  • Fluid drainage from the vagina
  • Nausea
  • Vomiting
  • Diarrhea
  • Abdominal pain

If you have one or more of these symptoms, be sure to promptly discuss them with a healthcare provider.

What is Testicular Cancer?

Testicular cancer occurs in the testicles (testes), which are located inside the scrotum, a loose bag of skin underneath the penis. The testicles produce male sex hormones and sperm for reproduction.

Compared with other types of cancer, testicular cancer is rare. But testicular cancer is the most common cancer in males between the ages of 15 and 35.

Testicular cancer is highly treatable, even when cancer has spread beyond the testicle. Depending on the type and stage of testicular cancer, you may receive one of several treatments or a combination.

Signs of a testicular tumor are:

  • A painless lump in the testicle (the most common sign)
  • Swelling of the testicle (with or without pain) or a feeling of weight in the scrotum
  • Pain or a dull ache in the testicle, scrotum, or groin
  • Tenderness or changes in the male breast tissue

If you find any lump or firm part of the testicle, you should see a doctor find out if it is a tumor. Very few men who have testicular cancer felt pain at first.

Many men do not tell their health care provider about these signs. On average, men wait for about five months before saying anything. Since the tumor can spread during that time, it is vital to reach out to a urologist if you notice any of these signs. This is especially true if a sign lasts for more than two weeks. The urologist will want to test if cancer is growing or if there’s some other issue, like:

Epididymitis: swelling of the epididymis. Often treated with antibiotics.

Testicular torsion: Twisting of the testicles. Often treated with surgery.

Inguinal hernia: when part of the intestine pokes through a weak part of the stomach muscles near the groin. Often treated with surgery.

Hydrocele: when fluid builds up in the scrotum. This often goes away without treatment.

Causes of Testicular Cancer

It’s not clear what causes testicular cancer in most cases.

Doctors know that testicular cancer occurs when healthy cells in a testicle become altered. Healthy cells grow and divide in an orderly way to keep your body functioning normally. But sometimes some cells develop abnormalities, causing this growth to get out of control — these cancer cells continue dividing even when new cells aren’t needed. The accumulating cells form a mass in the testicle.

Nearly all testicular cancers begin in the germ cells — the cells in the testicles that produce immature sperm. What causes germ cells to become abnormal and develop into cancer isn’t known.

Prevention

 There’s no way to prevent testicular cancer.

Some doctors recommend regular testicle self-examinations to identify testicular cancer at its earliest stage. But not all doctors agree. Discuss testicular self-examination with your doctor if you’re unsure about whether it’s right for you.

Is Tobacco protective against COVID-19 Pneumonia? The Underdog went on loose!!!

Smoking

Tobacco usage is one of the major concerns of preventable mortality and morbidity worldwide. Tobacco epidemic has always been one of the biggest public health threats leading to mortality of 80 lakh people a year around the world. Among them 12.5% are the result of non smokers being being exposed to second hand smoke. The smokeless tobacco is on the rise in recent years accounting 300 million people which in turn is highly addictive.

Impact of pandemic on tobacco consumption

The Pandemic and the countermeasures ordered in response to it, have had social and economic consequences with additional negative effects in the form of temporary or definitive unemployment. This has led to the worrisome rise in the tobacco consumption and smoking relapses. The crisis to access to usual care owing to fear of nosocomial or nosohusial infections, and sudden divergence of healthcare resources to COVID19 had a dramatic negative impact on the smoking rehabilitation.

Is Tobacco protective against COVID19 Pneumonia?

Smokers are generally at increased risk of infectious diseases, whereas in contrary some studies have suggested tobacco may be protective against COVID19 and the world’s media outlets gave a extensive coverage to these. These were based on several hypothesis. Lets breakdown the myth,

1) These emerged from hospitalised studies. Indeed the prevalence of smoking among among hospitalised patients was typically lower than the general population.

2) Smoking status is generally poorly documented in hospital medical records leading to classification bias, moreover data on current smokers, period of abstinence, level of tobacco use may not have been recorded (reverse causality bias).

3) Various confounders have been not excluded.

4) Active smoking may affect the nasopharyngeal viral load decreasing the RT-PCR sensitivity.

5) In addition, owing to the vague symptom of chronic cough, smokers are more likely to be tested than non smokers.

6) Smokers may have fewer social relationships than non smokers.

Tobacco – prognostic factor for COVID19 pneumonia

The largest meta analysis included 47 studies with a total of 32849 hospitalised COVID19 patients (Reddy et al.2020), confirmed that current smokers had increased risk of severe COVID19. History of smoking was assessed and found to have been associated with severe or critical covid, progression and need for ventilation, and in-hospital mortality. Each association had significant P value

Smoking also up-regulates the angiotension converting enzyme 2 receptors, which are potential targets for COVID19 (Brake et al. 2020)

Underdog went on loose!!!

During COVID19 pandemic, tobacco control is a greater challenge than ever for health policy makers, healthcare providers. World tobacco day 2021 is to remind us the need for vigilant public health measure and not to compromise the combatting smoking WHO 2000-2024. Healthcare providers should provide evidence based pharmacological treatment and behavioural smoking cessation therapies with remote support. Smokers helpline should offer their services to all smokers including asymptomatic and symptomatic COVID19 patients. Over 80% of the tobacco consumers live in low to middle income group according to WHO, warranting the interventions to be targeted in these groups in particular since they are at high risk for COVID19. Public health campaigns held in response to pandemic should reference the importance of tobacco prevention and cessation. The current crisis within crisis must be tackled with the combined efforts health policy makers and healthcare providers.

Dr Saravana Bharathy, Consultant, Internal Medicine,                             Dr Mehta’s Hospitals

Cataract

The ability to see the world clearly and in all its glory is to be appreciated and taken care of.

Blindness due to cataract presents an enormous problem not only in terms of human morbidity but also in terms of economic loss and social burden.

Month of June is observed as ‘cataract Awareness month’to educate people on the world’s leading cause of preventable blindness – Cataract

The natural lens present in the human eye is normally transparent and works similar to the lens in a camera, focusing light entering the eye on to the retina leading to clear vision. It also adjusts eye’s focus, letting us see both near and far off objects clearly. A cataract is a cloudy or opaque area which develops in the normally clear lens of the eye. Depending upon its size and location it can interfere with normal vision.

Most cataracts occur in people over the age of 55 , its called senile cataract. Occasionally it can also occur in newborn babies, children and adults less than 55 years of age.

Age related breakdown of lens protein is the commonest cause  senile cataract. Certain other factors like prolonged exposure to ultra violet radiation from sunlight or other sources, systemic disease like diabetes, personal habits like smoking , alcohol certain medications, previous eye injuries, eye disease are considered to be risk factors for developing cataract. certain genetic disease and congenital infections can cause cataract in newborn babies.

To begin with cataracts are subtle and not bothersome. it progresses through various stages before the entire lens becomes opacified leading to a profound loss of vision

Though its difficult to predict how quickly a cataract will progress, generally age related cataract progress slowly over years whereas those  due to other reasons progresses more rapidly.

In the early stages impact of cataract on vision can be subtle and  includes one or more of the following symptoms

vision becomes blurry, cloudy, hazy or dim especially in low light

Sensitivity to bright light,halos around the light and glare.

Oncoming headlights causes more glare than before and night driving becomes difficult, colours may appear faded

As the cataract progresses vision diminishes further and gradually until it leads to total blindness in advanced stage if left untreated. Earlier the diagnosis,earlier the treatment better is the visual prognosis.

Hence consult an ophthalmologist as soon as you develop any  symptoms of early cataract.

Cataract is diagnosed after a comprehensive eye check up by an ophthalmologist using simple painless techniques

Once cataract is diagnosed treatment depends on the stage of cataract,amount of visual impairment caused and the visual need of the patient.

In the early stages symptoms may be alleviated by simple measures like wearing correct eyeglasses, using sunglasses to minimize exposure to ultra violet rays,having better lighting for reading, controlling systemic illness like diabetes if any.

In the later stages,when there is gradual diminution of vision leading to difficulty in carrying out daily activities surgery may be considered. An advanced or late stage cataract can be more difficult to treat, so it is considered ideal to intervene before this stage is reached.

Cataract surgery is a common, fast healing, safe and highly successful  day care procedure and restores the vision completely

Phacoemulsification is the most widely used surgical technique  which uses ultrasonic energy to emulsify the cataract which is subsequently aspirated and a artificial intra ocular lens is placed inside the eye.The intra ocular lens requires no special care postoperatively and remains inside the eye thereafter.this procedure is commonly referred to as ‘LASER surgery by the common man.

Though there are no clinically proven approaches to prevent development of cataract,  certain strategies can slow down the progression of cataract which includes

Regular eye checkup with an ophthalmologist beyond 40 years of age

Reducing exposure to sunlight through uv blocking lenses

Avoiding smoking and alcohol

Treatment of coexisting systemic illness like diabetes

Including healthy diet plan

Though cataract still remains as one of the leading cause of blindness,early diagnosis and effective treatment can avert vision loss.

Dr Vinitha Sathish, Consultant Pediatric Ophthalmologist MBBS, DO, FICO, FRCS

 

What you need to know on COVID Vaccine?

There are two Covid vaccines that have been currently licensed for use in India. One is a viral vector vaccine which is Covishield (serum institute – Oxford AstraZeneca). The other is inactivated vaccine which is Covaxin (Bharat biotech).The former has an efficacy of around 70% and the latter has an efficacy of around 80%. The course of the former Involves two doses space 8 to 12 weeks apart. The course of the latter involves two doses spaced four weeks apart. The common adverse effects include fever ,myalgia and pain at injection site. These symptoms hardly last for 24-48 hours. Rare occurrences of anaphylaxis and vaccine induced thrombosis with thrombocytopenia (Oxford AstraZeneca vaccine) have been reported. Both the Covid vaccines protect the most against severe Covid and Covid related mortality. They also significantly reduce the incidence of developing symptomatic Covid and of needing hospitalisation. The onset of the protective effect from the vaccines is at two weeks from the second dose of the vaccines. The vaccines are not interchangeable.

Patients with comorbidities like diabetes mellitus, hypertension, chronic diseases of the heart, lungs, liver, kidneys, malignancies and autoimmune disorders have high risk of developing severe Covid and Covid related complications and hence benefit the most from the Covid vaccines. The Covid vaccines are safe in this group of patients & usually do not require cessation or modification of the existing line of management for the above illnesses respectively.

Patients with immunodeficiency states or who are on immunosuppression for various reasons ranging from organ transplantation to autoimmune disorders may have variably reduced protective effect from the vaccine depending on the current level of immuno suppression. They require consultation with their existing physician prior to vaccination to discuss certain specific variables which could modify the vaccine’s effect.

The vaccines in India are not licensed for use in children under the age of 18 years and are also not recommended for use in pregnancy primarily due to lack of data in this population. The Vaccines have been recently recommended in lactating women also. The absolute contraindication to this vaccine includes anaphylaxis or severe allergic reaction to the Covid vaccine or to any of its components in the past.

In the event of a recent Covid infection, it is advised to defer the vaccine till 3 months from the time of symptom recovery. The rate of breakthrough infections amongst the vaccinated group in India has been reported to be 3 to 4 for 10,000 individuals. These vaccines studied thus far appear to offer near total protection against severe Covid and Covid related mortality.

Get your shot & Stay safe!

Dr.Adhiti MBBS, MD (General Medicine), Consultant Internal Medicine,                             Dr Mehta’s Hospitals

COPING WITH COVID……AN INSIGHT

Second wave of COVID 19 is spreading fast with force ,stretching healthcare system and having significant negative on various domains. Impact on mental well being was significant after relatively milder first wave.

Most common presentation, we see in adults are adjustment disorder with depressive symptoms due to multiple reasons including loss of loved ones, impact on economy and significant changes in life style. Adjustment disorders usually have good prognosis if handled with care. It usually improves as the situation improve. However we have to avoid negative coping like substance use, compromising healthy life style, taking impulsive decisions (major life decisions) on family and work front. We have to be cautious and conscious about interpersonal relationships in this situation as we commonly see significant marital discard and family problems (blaming each other) and it will have long lasting impact.

Anxiety symptoms are another common presentation during this pandemic. Anxiety symptoms are partly due to Infodemic (information available in social and mainstream media). Henceforth it is advisable to follow single reliable source for information like health bulletin from respective states and strongly advised to avoid unauthorized social media information. Hoarding behavior is another common symptom of anxiety. Hoarding behavior includes stocking excessive essentials than what is required, life saving medicines which cannot be used at home, and equipment like oxygen concentrator which cannot be used without professional help. Hoarding also results in burden to already stretched supply chain.

Anxiety can be handled with proper life style, having a lockdown routine including physical exercise, self management in cognitive and behavioral domains. Some of commonly followed cognitive strategies include, self feedback about negative coping style and cognitive errors (extreme negative thoughts and concluding that worse will happen irrespective of any safety precautions) We should listen to our mind for negative thoughts in a calm place, and should try to challenge it with facts. (for e.g. in case of fear of death, current mortality rate is 1% and 99% there is a chance of survival even when we are infected)

Lastly, we have to monitor redflags, including, persistent depression for more than 2 weeks, suicidal ideas at any point, loss of sleep, appetite, loss of routine activities (self neglect), agitation or aggressive behavior. When above said symptoms are present, it is strongly advised to take professional help.

Dr Venkateshwaran, Consultant Child and Adolescent Psychiatrist, Dr Mehta’s Hospitals