Present day life style of moving in air conditioned cars and remaining confined to AC rooms has been associated with increased incidence of cardiac diseases. It has also been seen that there is increase in cardiovascular events during the winter, particularly so, in the regions located in the high latitudes. Now researchers have found out that, these people have low vitamin D level in their blood; and correlated it to the increased incidence of heart diseases, asthma and many more diseases.
Vitamin D is synthesized in the skin by the activity of ultraviolet rays received from sun. Recent day life style leaves a little room for sun exposure. So there is low level of this vitamin in blood. Over protected children, not engaged in outdoor activity also get less exposure to sun and consequently a low vitamin D level in blood. Low vitamin D level decreases endothelial function. This decrease causes insulin resistance in type II diabetics and worsens diabetes status. It helps in formation of atheroma; a plaque composed of bad fat, calcium and some blood components; which may get deposited in the inner cell layer, the endothelium of coronary arteries. There is increase in blood pressure due to increase vascular resistance. All these factors combined together may be responsible for heart attack; whose incidence rises, particularly in the winter days in the region of high latitude.
Sometimes cases are noticed, where drug treatment is started straight in the first visit of a newly diagnosed patient of hypertension. I, somehow could not digest this. If it is too high when first noticed drug treatment may be started but with mild to moderate rise in pressure, some other things should be tried first. Researchers also agree to it. It may have a cause to be designated as secondary hypertension. When a cause is not found it is termed as idiopathic or primary hypertension. However many theories are advanced to explain it.
Atherosclerosis is the main contributing factor. Here fat plaques form on the inner layer of the blood vessels, thereby narrowing the lumen. That gives resistance to flow of blood and the pumping force of heart has to increase to maintain adequate flow. So, the result is increased pressure.
Stress and strain induces a variety of endocrine hormones such as corticosteroids and adrenaline play a major role in sustaing it.
Rennin, angiotensin and aldosterone axis also plays a major role.
Obesity is a major cause of it. It is measured by what is called body mass index (BMI), which is arrived at by the formula body weight in kgs/body surface in square meter. If it is more than 30 the person is obese. And around 25 is normal
Blood pressure has two components namely systolic and diastolic. Systolic is the pressure when the heart pumps blood and diastolic is the pressure when the heart receives blood from vein and getting filled. Normally systolic blood pressure ranges from 90 mm. to 130 mm. of mercury and diastolic pressure ranges from 60 mm. to 90 mm. of mercury. When its value exceeds 130/90 mm. it is termed as hypertension. However, the patient should not be stamped as hypertensive right in the first visit, because simple tension of being examined may raise the blood pressure of a person. We usually take three recordings in three different occasions to confirm the disease.
Relevant investigations for diabetes mellitus, lipid profile, ECG, ultrasonogram, kidney profile and urine examination are to be done to exclude any other cause for it or to find out associated diseases. If no specific cause is found it is termed as idiopathic and presumed to be due to atherosclerosis.
The hierarchy of treatment should be as follows.
Life style modification. Patients leading a sedentary life should be encouraged to go for physical exercise. That will give relaxation, reduce weight, mobilize fat and keep the arteries clean from the deposits of atheromatous plaques. That will streamline blood flow and reduce hypertension.
Restriction of salt intake will go a long way in reducing the hypertension influencing the rennin-angiotensin-aldosterone axis.
Meditation will give relaxation and reduce stress which in turn will reduce the steroid hormone level to facilitate reduction of blood pressure.
Taking a few petals of garlic is said to have positive health benefits,as well as Yogic practices.
Thereafter, comes the role of drugs and first being a diuretic. And there is a long list of drugs which are to be prescribed by the expert physician.
Therefore, hypertension should be treated in a planned way. If pre-drug treatment practices are followed a number of patients may not require medications at all.
My senior colleague was treating a patient for penile infection since some days but there is no regression of the ulcer .To-day he appeared before me to tell that he urinated somewhere and caught the infection and subsequently the ulceration of penis.This man was in his fifties.This is the usual statement of a patient .I do not understand the rationality.Anyway this patient does not know his diabetic status and my collegue neither bothered to go for that.Several patient with a undiagnosed diabetes mellitus present with with ulceration of penis.The infection of glans and prepuce combined called balanoprosthitis.Now I have ordered for fasting and post-lunch blood sugar estimation.A culture and sensitivity test of pus as well as a routine and and microscopic test of urine also has been ordered.Even somebody not being a frank diabetic might be suffering from a pre-diabetic state called an impaired glucose tolerant.Here the blood sugar levels are more than prescribed limit but not sufficient to stamp as diabetic.The blood sugar level is something like below.There are several values prescribed by different diabetic associations.
Normal level Impaired Tolerance Diabetic
Fasting 60-110 mgs/dl 110-126 mg/dl >126mg/dl
Post lunch <140mg/dl 140-180mg/dl >180mg/dl
Diabetic catch infection in skin and other parts easily.Here, as per researchers the resistance to infection decreases.The white blood cell responsible for the defense against invasion of microbes did not reach the site and there is a dysfunction .So even a trivial infection spreads quickly.
Brave & mighty rules earth.And that is also true in case of fertilizing an ovum ,of course in human.Millions of sperms rush to fertilize one ovum and one succeeds.Obviously this is an arrangement by nature to have the fittest sperm take part in reproduction.Many a times male fails to fulfill the obligation resulting in male infertility. There are a number of causes for it.There may be abnormality in sperm production,transport,fertilization and above all timing to be able to meet the ovum in female partner.The quality of sperm has certain parameters such as 1)Quantity-2-5 ml/ejaculate 2)Number-60-150 millions/ml 3)Morphology-No structural defect at least in 80-90% 4)Motility->95% motile & 5)Fructose content-150mg% 6)Liquification Time 5 minutes. .These are to be met. Deficient production may be due to testicular defects such as 1) abnormally placed testis 2) defective or
Process of Fertilization
atrophied testis etc.The testis develops inside the abdomen but come down to house in the scrotum before birth.Because it requires some sort of air-conditioned atmosphere to be able to produce sperm.And the arrangement by nature is in such a way that scrotum provides that .The scrotal temperature is less than abdominal temperature and that is favourable for working of testis.And if for some fault testis can not descend down as in undescended or impefectly descended testis the functionality decreased or abolished.This air conditioning mechanism may be defective if there is a hydrocele where fluid surrounds the testis or a varicocele where dilated blood vessels surround it resulting in bad sperm formation. .
Trauma to it,infection with mumps/syphilis or diabetes mellitus may affect sperm production.There may not be testis at all in some and may be rudimentary in some other.A careless radiation dose may damage the functionality of testis. An abnormality in the male organ must be looked into for possible cause. And last but not the least timing with ovulation in female must match .
Cross Section Of Testis In Scrotum
So in this background the person must be assessed to arrive at the cause of infertility.First of all is the semen analysis which should be performed at least after 72 hours of abstinence.If it is not within the normal parameters or no sperm in ejaculate a biopsy of testis should be performed to know the status of structural integrity of testis and vas is to be assessed for possible blockade.If semen analysis is normal the timing factor is to be looked into.Ovulation usually occurs around day fourteen of a 28days menstrual cycle.And that time is to be targeted. If all of the above found to be within standards then probably the female partner is to be assessed for..
Reeling of head is a distressing condition.In medical terminology it is called Vertigo.Here there is sensation of reeling of head or the surrounding.There are so many causes for it.It may be physiological or pathological. Mainly three systems are involved in it.The ear and related nervous system,the eyes and related nervous system or the peripheral sensory system.
The Course Of Vertebral Artery.
Physiologically this is seen while suddenly getting up from a sitting or standing position called a positional vertigo.Amongst the pathological conditions atherosclerotic hypertension is most common .Other diseases of the three system described above can give rise to vertigo.Common causes are an infection or disease of the middle ear,visual disturbances like ill fitting glasses , sensory disturbance of lower limbs and more generalized diseases like diabetes are important. Atherosclerosis causes impairment of blood flow to the brain and it’s subsections causing vertigo.Any body presenting with vertigo should be examined for atherosclerosis first.Hypertension easy to diagnose should be treated.Investigations like blood lipid profile is contributory. Ill fitting glasses easily be corrected and an ear disease is easy to diagnose and treat. The next important disease to cause vertigo is Cervical Spondylosis.Here the seven neck vertebral bones get affected commonly due to aging process.Other diseases of neck bone like Ankylosing Spondylosis also
Blood Supply
important.Here the vertebrae are deformed ,loose the flexibility and loose the natural C curve.The deformity may pose an obstruction to the blood flow in the vertebral arteries which travels through the bony processes of of neck bones.The vertebral arteries in tern could not deliver required amount of blood to the brain system and cause relative ischaemia and the consequent symptom of vertigo.This disease can also be diagnosed easily from a host of available investigations i.e. from a good quality digital X-Rays to MRI .
Adequately treated spondylosis can go a long way in relieving the symptoms. But before jumping to diagnosis of Cervical Spondylosis as cause of vertigo the more common and dangerous cause atherosclerotic hypertension should be excluded.
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