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Brief Summary of Polycystic Ovarian Syndrome

Gynaecology Comments Off

Sep 032012

Polycystic ovary syndrome (PCOS) is one of the most common female endocrine disorders.These patients have a steady state of relatively high estrogen, androgen and LH levels rather than the fluctuating levels seen in ovulating women.

Definition

There are two definitions or diagnostic criteria that are commonly used:

In 1990 a consensus workshop sponsored by the NIH(National Institutes of Health)/NICHD(National Institute of Child Health and Human Disease) suggested that a patient has PCOS if she has all of the following:

Oligoovulation
Signs of androgen excess (clinical or biochemical)
Other entities are excluded that can result in menstrual irregularity and hyperandrogenism.

In 2003 a consensus workshop sponsored by ESHRE(European Society for Human Reproduction and Embryology)/ASRM(American Society for Reproductive Medicine) in Rotterdam indicated PCOS to be present if any 2 out of 3 criteria are met.

Oligoovulation and/or anovualation manifested as oligomenorrhea or amenorrhea
Excess androgen activity (clinical or biochemical evidence)
polycystic ovaries (as seen on gynecologic ultrasound)

Pathophysiology

Increased level of estrogen comes from obesity due to conversion of ovarian and adrenal androgen to estrone in body fat. High estrogen level suppresses FSH and causes relative increase in LH. Constant LH stimulation of ovary results in anovulation, multiple cysts and theca cell hyperplasia with excess androgen production.

Clinical Presentation

A patient with polycystic ovary syndrome presents with following clinical features:

Hirsutism (male pattern of hair growth).
Obesity
Virilization (development of male-like characteristics).
Amenorrhea (no menstrual periods).
Abnormal uterine bleeding.
Insulin resistance and hyperinsulinemia with increased risk of type II diabetes.
Infertility (This generally results directly from lack of ovulation)
Increased risk of cancer of breast and endometrium due to unopposed estrogen production. Continue reading »

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Treatment For Cystic Fibrosis

General Medicine, Pediatrics Comments Off

Sep 012012

Cystic fibrosis is a genetic disorder that is inherited in an autosomal recessive pattern and is characterized bya defective transport of chloride and sodium across the epithelium that causes thick, sticky mucus to build up in the lungs, digestive tract, and other areas of the body. It is one of the most common chronic lung diseases in children and young adults.

Some of the treatment options are discussed briefly here:

Physiotherapy

Daily chest percussion and physiotherapy with postural drainage reduces respiratory exacerbations

Antibiotics

Early high dose , broad spectrum , long duration (minimum 2-3 weeks) antibiotics helps minimize lung damage in infective exacerbations. Oral or intravenous fluroquinolones combined with nebulized antibiotic is often the initial choice; resistance and chronic carriage needs intravenous combinations. Prophylactic antibiotics are also increasingly used.

Bronchodilators

These are helpful for symptomatic relief.

DNase- alpha mucolytics

These are administered as areosol spray. Mechanism of action is that it interferes with sputum neutrophil DNA, helping to liquefy sputum and encourage expectoration, thus helps in reducing cough.

Pancreatic enzyme replacement

Since patients with cystic fibrosis have pancreatic enzyme deficiency therefore enzyme replacement helps avoid malabsorption.

Immunization

Routine pneumococcal and influenza vaccination are recommended for patients with cystic fibrosis. Continue reading »

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Introduction To Ankylosing Spondylitis

General Medicine Comments Off

Aug 312012

This is a chronic inflammatory arthritis especially affecting sacroiliac joints and spine and characterized by progressive stiffening and fusion of the axial skeleton. It is one of the seronegative spondyloarthropathies.

Incidence

It is most commonly seen in the age range of 20 to 30 years and male to female ratio is 4: 1 . More than 90% of affected persons carry the histocompatibilty antigenHLA B27

Clinical Signs and Symptoms

Onset is usually insidious. There are recurring episodes of low back pain and stiffness sometimes radiating to the buttocks or thigh. Pain is worse in early morning and after inactivity.

Some patients complian of chest pain aggravated by breathing that is due to involvement of costovertebral joints. There is occasionally heel pain due to plantar fasciitis .

On examination there is failure to obliterate lumbar lordosis on forward flexion. There is pain on sacroilliac compression and tenderness over bony prominenece such as illiac crest, ischial tuberosity and greater trochanter.

There is restriction of movement of lumbar spines in all directions. As the disease progresses stiffness increases throughout the spine.

Associated Clinical findings

Iritis occurs in about 25% of patients.
Aortic regurgitation, heart blocks and anterior uveitis
Pulmonary fibrosis of the upper lobes with progression to cavitation mimicking tuberculosis.

Investigations

ESR is often raised.
RA factor is absent.
HLA B 27 seen in 90% of cases

X Ray Lumbar spine

The sacroilliac joints are eroded with irregular margins and sclerosis of adjacent bone. As the disease advances , the sacroilliac joints may fuse. Continue reading »

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