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Bronchitis Symptoms, Causes, Diagnosis and Treatment

Bronchitis Symptoms, Causes, Diagnosis and Treatment

Chronic Bronchitis and COPD

Chronic Bronchitis and COPD

Overview

Chronic bronchitis and COPD is a common pulmonary disorder amongst the Indian population. We see smokers, non-smokers and females, with prolonged complaints of dyspnoea on exertion, while walking into our outpatient department. A simple history and clinical examination can establish the diagnosis easily. What follows next are the facts, which a must for even anyone to know about this peculiar disorder.

Bronchitis can be called inflammation of the linings of bronchial tubes. These are the small tubes that pass air to your lungs and carry air from it. Individuals who have bronchitis frequently suffer from a cough along with the release of thick mucus. They are likely to suffer wheezing, chest pain and shortness of breath. There are two types of Bronchitis – acute and chronic.

Acute bronchitis may result from cold or other respiratory issues but improves within a couple of days without creating further discomfort. Chronic bronchitis is a more threatening condition, which develops progressively instead of striking all of a sudden. It can be described as recurrent episodes of bronchitis which tend to last for a long time. The constant inflammation of the airways results in an increased amount of sticky mucus present in the airways. And, this creates a hurdle when the air is passing in and out of the lungs. The blockage in the wind stream deteriorates after some time, bringing about breathing challenges and generates more mucus in the lungs.

Causes of Bronchitis

Chronic bronchitis disease occurs when the coating of the bronchial tubes become inflamed and irritated constantly. The constant disturbance and swelling can harm the airways and cause the development of sticky mucus, making it troublesome for air to travel through the lungs. This prompts breathing challenges that continuously escalate and cause discomfort. The inflammation is likely to harm the cilia, which are the hair-like structures that assist in keeping the air passage free of irritants. When the cilia don’t perform appropriately, the airways turn into a breeding ground for bacterial and viral contaminations.

Contaminations normally trigger the underlying aggravation and swelling that leads to acute bronchitis. Chronic bronchitis is, however, mostly caused by cigarette smoking. In reality, more than 90 percent of those with the infection may have been smokers or have a history of smoking. Breathing in tobacco smoke also temporarily affects the cilia, so continuous smoking for a long period of time can cause serious damage to the cilia. Chronic bronchitis may worsen over a period of time due to these habits.

Second-hand smoke can also add to the cause of chronic bronchitis. Other causes incorporate long term exposure to air pollution, chemical and industrial dust and toxins and dangerous gases. Chronic lung diseases may further harm the lungs and aggravate constant bronchitis symptoms.

Signs of a COPD Exacerbation

After an extensive period of aggravation and disturbance in the bronchial tubes, chronic bronchitis can result in several symptoms and it includes a relentless and heavy cough that releases mucus from the lungs. As time passes, the production of mucus increases gradually and it starts building up in the bronchial tubes creating discomfort in the air flow, which leads to causing more difficulty in breathing.

Being aware of the signs of a COPD exacerbation can go a long way in preventing the disease from worsening, and can also decrease the life-threatening risks that occur with a sudden onset of COPD symptoms.

A lung infection caused by a virus or bacteria, such as a cold or some other illness, can lead to COPD exacerbations. COPD symptoms can also suddenly worsen due to constant exposure to these harmful pollutants.

Warning signs of a COPD exacerbation may include:

  • Shortness of breath: A person experiencing a COPD exacerbation may feel breathlessness or shortage of air. If this feeling worsens even when at rest or with little physical activity, you may need to see a doctor.
  • Noisy breathing: With a COPD exacerbation, wheezing, whistling, gurgling, or rattling sounds may accompany breathing. Wheezing suggests partial obstruction of the airways by mucous, pus, or other inflammatory material. Gurgling or rattling sounds during breathing may indicate an accumulation of fluid in the lungs or mucous being present in the airways.
  • Increased anxiety: Oxygen is vital for everyone. If you feel like you are not getting enough oxygen and start to panic, being or becoming anxious can also aggravate your breathing ability as you may be anxiety.
  • Chest breathing: During a COPD exacerbation, a person may breathe from the chest instead of the abdomen, which causes your breathing to become more irregular, which causes your chest to move up and down more quickly.
  • A cough: A COPD exacerbation can result in a cough, which is more severe or frequent than usual. The coughing may increase while you are lying down or trying to sleep. Sitting in a chair instead of lying down, may help you breathe more comfortably, as lying down may aggravate it even further. A dry cough may also bring up phlegm that is bloody, green or yellow in colour.
  • Changes in skin or nail colour: During an exacerbation, there may be noticeable changes in the colour around the lips, which may appear as a bluish tint. Nails may also become blue or purple, or the skin may take on a sallow or grey tone and appearance.
  • Difficulty sleeping and lack of appetite: The increased symptoms with a COPD exacerbation may interfere with the ability to sleep or eat.
  • Lack of speech: If a person experiences severe breathing difficulty, it might impair his ability to speak and tell others what is happening. He might be able to communicate only through hand gestures that he is in distress.
  • Early morning headaches: COPD causes a build-up of carbon dioxide in the blood due to low levels of oxygen. This can result in morning headaches. If morning headaches are a new symptom, it could be a sign of a COPD exacerbation.
  • Swelling in the ankles or legs or abdominal pain: Swelling and abdominal pain are common COPD symptoms. They are associated with heart complications or irregularities caused by damage to the lungs. If these symptoms are new, or if they increase suddenly, it could be a sign of an exacerbation.

When to See a Doctor?

Many individuals do not bother about the symptoms of chronic bronchitis and misunderstand by thinking it as smoker’s cough. Nonetheless, it’s essential to contact your specialist immediately on the off chance that you have even the slightest doubt about having bronchitis. Neglecting the symptoms and treatment for chronic bronchitis significantly raises the danger of serious lung damage, which can prompt respiratory issues or heart failure.

  • Visit your doctor right away if you are persistently coughing
  • If a cough still persists for more than three weeks
  • Cough is not letting you sleep or is causing disturbance
  • If you still have a high fever above 100.4 (degree F) and continuous cough
  • Releasing discoloured mucus or blood
  • Causing shortness of breath

Treatment of Chronic Bronchitis

COPD treatments may vary, but no matter your stage, the goal of COPD treatment is to:

  • Relieve symptoms
  • Prevent complications and worsening of an illness
  • Improve health and exercise tolerance

Guidelines for treating COPD are set out in the Global Initiative for Chronic Interstitial Lung Disorder(GOLD).  COPD treatment includes:  

  • Smoking cessation: Stopping smoking can help slow down the decline in lung function.
  • Oxygen therapy: When the lungs cannot function well, inhaled oxygen is still insufficient to provide the right amount of oxygen into the blood to meet the body’s needs.
  • Nutrition: COPD can make a person lose weight and subsequently lead to loss of muscle mass. An underweight person with COPD usually experiences greater difficulty and discomfort while trying to breathe.
  • Bronchodilators: These medications relieve symptoms, and improve airway obstructions and exercise capacity. They work by opening up the air passages while making it easier to breathe. There are many different kinds of bronchodilators. Atrovent, for example, is short-acting, so it’s used for the immediate relief of symptoms.  Spiriva, by contrast, is long-acting, and its used to keep airways open day to day.
  • Corticosteroids: These drugs, such as prednisone or budesonide, are used to reduce inflammation and to treat symptoms, especially symptoms of an exacerbation. These medications may help slow the progression of occupational lung disease.
  • Vaccines: COPD can flare up and worsen when you get sick, so it’s important to get the flu shot and the pneumonia shot.
  • Surgery: When medications prove ineffective, several surgeries, including lung transplantation, can reduce symptoms and hence improve a person’s quality of life.
  • Antibiotics: Antibiotics treat bacterial infections and are used primarily during an exacerbation.

According to Schechter, oxygen therapy is effective in prolonging life. Patients with COPD need to monitor levels at home, especially at night, and not solely rely on a test at the doctor’s office to determine if they may require oxygen therapy.

Understanding and Treating COPD

Rehabilitation is beneficial: People with COPD can also benefit from rehabilitation therapy, which includes being aware of COPD and the right diet to follow. Schechter says rehabilitation therapy should also involve physical activity and exercise training

“The physical conditioning is geared to people who have lung disease, and it can improve the patient’s endurance. Even though lung function may not improve, the person with COPD is able to be more physically active,” says Schechter.

Depression and denial are common: “Some patients may be embarrassed about having COPD, which leads to depression and denial,” says Schechter. “Many feel duped by cigarette companies and feel that they brought the problem (COPD) on themselves.”

Schechter urges patients with COPD who smoked to stop worrying. “Smokers are not self-destructive, lazy or unmotivated.”  People smoke because they are addicted to nicotine, he says.

It is important to keep in mind that the more you know about COPD, the easier it is to control it.

Autism

Autism

Asthma

Asthma

Arthritis

Arthritis

Overview

Arthritis by definition is the inflammation of one, two or more joints. When one joint is involved, it is called monoarthritis. When two or three joints are involved it is called oligoarthritis. When four or more joints are involved it is called polyarthritis. There are more than 100 types of arthritis, but the most common type is osteoarthritis (OA) and rheumatoid arthritis (RA). Osteoarthritis (OA) is a progressive, painful joint disease that usually involves the neck, lower back, hips, knees or small joints of the hands.

The prevalence of osteoarthritis (OA) rises with age and as the world’s population continues to age, it is estimated that degenerative joint disorders such as osteoarthritis will impact at least 130 million individuals around the globe by the year 2050. Fifteen percent of individuals over the age of 60 are believed to suffer from this disorder. Women are more prone to osteoarthritis than men.

Osteoarthritis is thought to be the most prevalent of all musculoskeletal pathologies, affecting an estimated 10 percent of the world’s population over the age of sixty. Osteoarthritis ranks fifth among all forms of disability worldwide. Women are more prone to osteoarthritis than men. One in twenty men and one in twelve women will develop an inflammatory autoimmune rheumatic disease during their lifetime.

Types of arthritis

Osteoarthritis

It is the most common type of arthritis. It is most often seen in adults over 40s or older. It is more common in women and people with family history of this disorder. However, it can occur at any age, due to injury or due to any other joint-related conditions, such as rheumatoid arthritis or gout. In osteoarthritis, the smooth cartilage lining of the joint is primarily affected. Due to which movement becomes more difficult leading to pain and stiffness. Once the cartilage lining begins to thin out and roughen, the tendons and ligaments need to work harder. Due to which swelling and the formation of bony spurs occur. Severe damage to cartilage leads to bone rubbing on bone, changing the shape of the joint and making the bones out of their normal position. The most commonly affected joints are spine, hands, hips and knees.

Rheumatoid arthritis

It usually starts when a person is between the ages of 40 and 50 years. Women are three times more prone than men. Rheumatoid and osteoarthritis are entirely two different disorders. Rheumatoid arthritis happens when the body’s immune system targets affected joints causing pain and swelling. The outer covering (synovium) of the joint is affected first. Then the disease spreads across the joint, leading to further swelling & change in the joint’s shape. This causes cartilage and the bone to break down. The tissues and organs in the body are also affected by rheumatoid arthritis

Other types of arthritis and related conditions

  • Ankylosing spondylitis: This is a long-term inflammatory condition causing stiffness and joint fusion. The bones, muscles and ligaments of the spine are affected. It can also affect eyes and larger joints.
  • Cervical spondylosis: is a degenerative osteoarthritis that affects the joints and bones in the neck causing pain and stiffness.
  • Fibromyalgia: The body’s muscles, ligaments and tendons become painful.
  • Gout: Excessive uric acid in the body causes Gout. This uric acid in joints (especially the big toe) causes intense pain, swelling and redness.
  • Psoriatic arthritis: This is an inflammatory joint arthritis which affects people with psoriasis.
  • Enteropathic arthritis:  Individuals with inflammatory bowel disease (IBD), ulcerative colitis and Crohn’s disease develop this form of inflammatory and chronic arthritis. Enteropathic arthritis is seen among one in five people with Crohn’s or ulcerative colitis. The peripheral limb joints and the spine are the most common areas affected by inflammation.
  • Reactive arthritis: It occurs after an infection of the genital tract, bowel, or throat. It presents as inflammation of the eyes, joints and urethra.
  • Secondary arthritis: Arthritis which develops after injury to a joint after several years of injury.
  • Polymyalgia rheumatic: This is a condition that affects people over 50 years of age. The immune system leads to muscle stiffness and pain and joint inflammation.

Causes

The cause of arthritis depends on the type of arthritis. Common causes include

  • Injuries
  • Hereditary factors
  • Metabolic abnormalities like gout and pseudogout
  • The direct & indirect effect of infections (viral and bacterial)

RA and SLE are due to immune system dysfunction. Genetic markers increase the risk of developing RA.

Most types of arthritis are a result of a combination of factors. Some people are genetically more prone to certain arthritic conditions. Additional factors like infection, smoking, previous injuries and physically demanding occupations, interact with genes to increase the risk of arthritis.

Diet and nutrition play a very important role in the treatment of arthritis. Foods which increase inflammation like refined sugar and animal-derived foods can make symptoms worse.

Gout is a type of arthritis which is linked to diet and is caused by elevated levels of uric acid. High-purine foods like red wine, seafood and meat, increase the gout symptoms.

Symptoms of arthritis

Arthritis limits the functions of the affected joints. Arthritis causes joint inflammation and results in swellingjoint stiffness, pain, redness, and warmth. The inflamed joint can be tender with or without pain. When large joints like knee joints are involved, there is a limitation of movement due to cartilage loss and joint damage. When smaller joints in the fingers are affected by arthritis, there will be loss of strength of hand grip.

Rheumatic disease is not limited to the joints. It can affect various other organs of the body. Symptoms can include gland swelling (swollen lymph nodes), feverfatigueweight loss, feeling unwell, and abnormalities of organs like the heart, lungs,  or kidneys.

Risk factors

Certain risk factors have been linked with arthritis. Some of these are modifiable while others are not.

Non-modifiable risk factors for arthritis

  • Age: The risk of arthritis increases with age.
  • Sex: Most forms of arthritis are more common in females than men. Gout is common in males than in females.
  • Genetic factors:  Certain types of arthritis like rheumatoid arthritis (RA), Ankylosing spondylitis and systemic lupus erythematosus (SLE) are associated with specific genes.

Modifiable risk factors for arthritis

  • Obesity: Overweight and obesity hastens the onset and advancement of osteoarthritis.
  • Joint injuries: Damage to a joint can enhance osteoarthritis in the joint.
  • Infections: Germs that infect joints can enhance various types of arthritis.
  • Occupation: Professions that involve repetitive bending and squatting can lead to osteoarthritis of the knee.

Diagnosis

During a physical examination, the doctor examines all joints for pain, redness, swelling, warmth and movements. Depending on the type of arthritis suspected by the doctor, the following tests may be suggested.

Laboratory tests

The analysis of body fluids helps pinpoint the type of arthritis you may have. Fluids commonly analyzed include blood, urine and joint fluid. To obtain a sample of your joint fluid, your doctor will cleanse and numb the area before inserting a needle in your joint space to withdraw some fluid (aspiration).

Imaging studies

These types of tests detect problems within the joint which cause the symptoms. Examples include:

X-rays are used to see bone, cartilage loss, bone spurs and bone damage. X-rays do not detect early arthritic damage, but help to see the progress of the disease.

Computerized tomography (CT) scan takes X-rays from various angles and combines them to produce cross-sectional views of internal structures. In CTs both bone and the surrounding soft tissues are noted.

Magnetic resonance imaging (MRI) combined radio waves along with strong magnetic field to produce cross-sectional images to view details of soft tissues of tendons, cartilage and ligaments.

Ultrasound is used to produce images of cartilage, soft tissues, and fluid-filled structures like bursae. Needle placement for joint aspirations and injections can also be guided by ultrasound.

Treatment

Arthritis treatment focuses on relieving the symptoms and also improvement of the joint function. Arthritis can be treated with several different methods, or can be treated by combinations of different treatment modalities.

Medications

The medications vary depending on type of arthritis. Common medications used for arthritis include:

  • Analgesics: These medications relieve pain, but have no effect on inflammation. Examples of analgesic are paracetamol, narcotics like oxycodone, tramadol or hydrocodone.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs not only reduce pain but even decrease inflammation. NSAIDs like ibuprofen and naproxen sodium are used to treat arthritis. Oral NSAIDs are known to cause stomach irritation. Some can also increase the risk of heart attack or stroke. Some NSAIDs in the form of creams or gels can be rubbed on joints.
  • Counterirritants: The creams and ointments containing capsaicin or menthol are used as a rub on the skin over the aching joint. These counterirritants are known to interfere with the pain signals transmitted from the joint and thus relieving the pain.
  • Disease-modifying antirheumatic drugs (DMARDs): DMARDs slow or stop the immune system and prevent attacks on the joints. Examples include hydroxychloroquine and methotrexate.
  • Biologic response modifiers: These are typically used in combination with DMARDs. They are genetically engineered drugs which target various protein molecules involved in the immune response. Examples include infliximab and etanercept.
  • Corticosteroids:  Prednisone and Cortisone are the steroids which are used to reduce inflammation and suppress immune system. Corticosteroids are taken orally and can be injected into the painful joint directly.

Therapy

Physical therapy is useful for many types of arthritis. Exercises are used to improve the range of motion and strengthen the muscles that surround the joints. In some cases, splints or braces may be necessary.

Surgery

If conservative measures don’t show any improvement the doctor would suggest surgery.

  • Joint repair: In this surgery, joint surfaces are smoothened and realigned to decrease pain and improve function. These procedures are done arthroscopically, with the help of small incisions over the joint.
  • Joint replacement: This procedure replaces the damaged joint with an artificial one. Examples are hips and knees.
  • Joint fusion: Smaller joints, like fingers, wrist, and ankle are treated by joint fusion. The ends of the two bones are removed in the joint and locked together until they heal into one unit.

Prevention

  • Arthritis is not always preventable. Healthy habits can reduce the risk of developing painful joints as a person gets older.
  • Healthy polyunsaturated fats like omega-3 fatty acids are found in certain fish and are known to reduce inflammation in the body. Rheumatoid arthritis is lower in individuals who eat fish rich in omega-3 fatty acids like mackerel, trout, salmon, and sardines twice a week.
  • Overweight women are four times more prone to knee osteoarthritis than healthy weight women. Diet and exercise can play an important role in bringing the weight into a healthier range.
  • Exercise reduces excess weight and strengthens the muscles around the joints. This protects them from wear and tear. Aerobic activities like swimming or walking are strengthening exercises. Stretching exercises maintain flexibility and range of movements.
  • Over time, joints begin to wear out. When an injury occurs to the joints, like during an accident or sports, they damage the cartilage and cause them to wear more quickly. Use proper safety equipment during playing sports, and learn the correct exercise techniques to avoid injury.
  • Correct techniques during working, sitting and lifting will protect the joints. For example, carrying items close to the body will not put too much strain on the person’s wrists. If the person has to sit for long periods at work, the legs, back, and arms have to be well supported.
  • Women, who drink moderate amounts of alcohol, may have a lower risk of rheumatoid arthritis.

FAQs

  1. What is Arthritis?

Arthritis by is inflammation of one, two or more joints and cause pain and swelling.

  1. What are the most common types of arthritis?

Types of arthritis are osteoarthritis, rheumatoid arthritis, ankylosing spondylitis and reactive arthritis.

  1. What is the risk for arthritis?

Age, Sex, Genetic factors, Obesity, Joint injuries, Infection, Occupation

Appendicitis

Appendicitis

In this blog, you will get an insight into the causes & symptoms of Appendicitis. Also, learn about the best Appendicitis treatment in India.

Overview

The appendicitis is an inflammation of the appendix. An appendix is a small, worm-shaped pouch present at the beginning of the large intestine. It is usually 5 to 10 cm long. The function of the appendix is unknown but some scientists say that it acts as a storehouse for good bacteria. Others believe that it is a useless remnant from human evolution. The position of the appendix varies between individuals.

Appendicitis is a medical emergency that requires immediate attention. It is also the most common cause of abdominal surgery. Appendicitis can occur at any age and equally affects both the men and women. However, it is slightly more prevalent in men who are 15 to 25 years old. Recent studies have shown a reduction of the number of cases of appendicitis in western countries. The incidence in Asian and African countries may be lower. But actual figures from these countries are not available. The prevalence of appendicitis is low in cultures where a high-fiber diet is consumed regularly.

Appendicitis occurs when a blockage of the appendix causes it to be infected and inflamed. The appendix becomes swollen, infected and painful in this situation. The inflammation can also spread to the body structures surrounding the appendix.

The resulting pain and symptoms can mimic other conditions like urinary tract infection or stomach ulcer. However, appendicitis is an emergency condition that requires immediate treatment. Diagnosis of appendicitis relies heavily on the experience of the doctor. The diagnosis is made from the physical signs of the patient and investigations. Pain in the right lower region of the abdomen is the most common symptom associated with appendicitis. Investigations like ultrasound and laboratory tests are carried out for further evaluation and for clear observation of appendicitis. Treatment of appendicitis involves medications to control the infection and removal of the appendix by surgery. Surgical removal of the appendix is called an appendectomy. If appendicitis treatment is delayed, then the patient may develop complications like perforation, abscess and peritonitis.

Causes

  • The exact reason why some individuals develop appendicitis is actually unknown. Several factors like blockage of appendix, infections, diet and family history are known to contribute.
  • Appendicitis usually results from an obstruction of the appendix by fecal mass, stricture (narrowing), foreign objects, and worms, enlargement of lymphoid tissue, infections, injuries, and tumors.
  • The presence of fecal mass, foreign body or viral infection causes swelling and irritation in the appendix. The blockage in the appendix causes increased the mucus production which exerts greater pressure on the walls of the appendix. The high pressure on the luminal wall of the appendix causes thrombosis (formation of blood clot) of the small blood vessels.
  • The inner lining of the appendix normally contains several lymphoid tissues. These are collections of immune cells called as lymphocytes. These lymphoid tissues can become enlarged in diseases of the intestine like inflammatory bowel disease, measles, amoebiasis and viral infections. This can also cause blockage of the appendix.
  • Parasites like thread worms and flukes can also cause blockage of the appendix. Blockage of the appendix has also been shown in injuries like shotgun wounds to the abdomen and by a misplaced intrauterine contraceptive device like CuT. Infections like tuberculosis and cancers can also result in appendicitis.
  • The increasing pressure reduces blood flow to the tissue. Adequate blood supply is required for the cells to remain healthy. Lack of blood supply causes cell death and necrosis of the appendix. When this happens, bacteria can multiply within the tube of the blocked appendix. As the bacteria multiply, immune and inflammatory cells like white blood cells (WBC) accumulate at the site of the infection and the whole process results in an inflammation.
  • The inflammation can cause the appendix to swell and become painful. It can also spread to the tissue and structures immediately surrounding the appendix and cause infection, thrombosis, and necrosis.
  • If left untreated, the infected or inflamed appendix will burst (perforate) spilling the infectious material into the abdominal cavity and result in peritonitis. Sometimes a pus-filled abscess (a pocket of pus built up in the tissues) is formed outside the inflamed appendix. Due to these complications, appendicitis is an emergency condition requiring immediate surgical removal of the appendix.

Symptoms

Appendicitis symptoms form a classic triad of stomach pain, vomiting and fever. But this typical presentation may not be presented in all cases.

Abdominal pain is the most common symptom of appendicitis. Typically, the pain starts in the middle of the abdomen and later shifts to the lower right side, where the appendix is usually located. The pain may worsen if the area where the appendix is located is pressed or while coughing or walking. In acute appendicitis, the affected individual experiences excruciating pain that causes him to bend his body by folding his legs to the chest.

The anatomic position of the appendix varies considerably between individuals. The location of the pain associated with appendicitis and the associated symptoms can also vary accordingly. An inflamed appendix near the urinary bladder may irritate the bladder and cause painful urination. If the appendix extends behind, inflammation can irritate the nerves and muscles behind and cause difficulty in walking.

Others symptoms of appendicitis are

  • Fever
  • Nausea and vomiting
  • Loss of appetite
  • Pain around the navel
  • Bloating
  • Frequent and painful urination

Appendicitis symptoms vary among different individuals and according to the duration of the inflammation. Depending on the duration of symptoms and the presence of complications appendicitis may be classified as acute, chronic, recurrent or complicated appendicitis.

Acute appendicitis

Acute appendicitis occurs when symptoms appear suddenly and with a severe intensity. It lasts for 24 to 48 hours. This is the most common reasons for abdominal surgery in appendicitis.

Chronic appendicitis

It occurs when the inflammation of the appendix remains undiagnosed and the symptoms last for up to 3 weeks. The symptoms may appear and disappear. Usually, chronic appendicitis is diagnosed when the intensity of pain increases and the patient presents like acute appendicitis.

Recurrent Appendicitis

It is diagnosed when a patient has multiple episodes of lower abdominal pain due to appendicitis.

Complicated appendicitis

If left untreated, the infected or inflamed appendix will either burst or perforate spilling the infectious material in the abdominal cavity. Complicated appendicitis occurs when an appendix bursts due to increased pressure within it or when the appendix loses all its blood supply and becomes gangrenous. An appendicular abscess is formed when pus collects within a sac in the region near the appendix.

An appendix with abscess can also perforate or explode. The infectious material can spread within the abdominal cavity and cause peritonitis (inflammation inner wall of the abdomen).

The symptoms of appendicitis may be mimicked by a few conditions. These include

  • Infections of the uterus and the surrounding structures
  • Stones in the urinary tract
  • Urinary tract infections
  • Endometriosis
  • Infection of the intestines
  • Gallbladder stone and infection

Risk Factors

  • Age: The risk of appendicitis is more in adolescents and young adults (15 to 25 years).
  • Gender: Male have a greater risk than female
  • Infection: Gastrointestinal infection increases the risk of appendicitis
  • Trauma: Internal injury to appendix increased the risk of appendicitis
  • Low fiber diet: A low fiber diet causes constipation and causes some of the fecal matter to become lodged in the appendix leading to appendicitis.

Diagnosis

Appendicitis is diagnosed by a doctor by taking a patient’s history, physical examination and by conducting investigations.

Physical examination

During the physical examination, the doctor checks the vital signs such as blood pressure, body temperature, rate of respiration and heartbeat. The doctor would also conduct a detailed examination of the abdomen and locate the site of pain. Patients with appendicitis have fever, increased heart rate, pain in the right lower abdomen, and reduced movement of the intestines.

Laboratory test

  • Blood test: The blood is tested to determine the white blood cell (WBC) count. Increase in WBC count is a common indication of infection.
  • Other laboratory tests may be required to eliminate diseases of abdominal organs like liver and kidney or detect complications. These tests include
  • CRP or C-reactive protein is elevated in complicated appendicitis
  • The urine test is performed to detect urinary tract infections and kidney stones. These can also mimic symptoms of appendicitis. Pus cells can appear in the urine in some cases of appendicitis.
  • Liver function tests
  • Amylase test to detect diseases of the pancreas which can imitate appendicitis
  • A pregnancy test is recommended in women because the symptoms of appendicitis can be imitated by ectopic pregnancy.

Imaging test

  • Abdominal ultrasound: The ultrasound is the initial investigation of choice in patients suspected with appendicitis. A sonologist uses an ultrasound machine to view the appendix and presence of complications.
  • CT Scan: A CT scan is more sensitive than an ultrasound. It can detect appendicitis in patients who present will atypical symptoms and whom the appendix is located behind the large intestine
  • X-ray (barium enema): It helps the doctor to examine the patient’s rectum, large intestine and the lower part of the small intestine. A fluid called barium is given to the patient in the form of a rectal enema. Then an X-ray of the abdomen is performed to examine the abdomen, obstruction in the appendix and to detect non -filling appendix. This test is not widely performed now.

Treatment

Medications

Medications are prescribed to patients with mild appendicitis. Some of the medications, which your doctor may prescribe you if you have mild appendicitis, are:

  • Antibiotics: To reduce the bacterial infection
  • Pain killers: To reduce the severity of pain

Surgery

Appendicitis treatment primarily consists of surgical removal of the appendix (appendectomy). The surgeon will remove the appendix by using one of the two methods: open or laparoscopic surgery.

a) Open appendectomy

During an open appendectomy, a single incision is made in the lower right area of the abdomen to remove the appendix. However, this technique has been widely replaced by laparoscopic surgery.

b) Laparoscopic appendectomy

Laparoscopic surgery requires smaller incisions and is less invasive. The surgeon makes three small incisions (each 1/4 – 1/2 inch) and inserts a laparoscope (a tiny telescope connected to a video camera) through a cannula into one of the incision. It helps the surgeon to have a magnified view the internal organs on a television monitor. Several other cannulas are inserted through the other incisions and the appendix is removed. Laparoscopic surgery nvolves smaller incisions and the recovery period is shorter.

Pain medications and antibiotics may be prescribed after the surgery.

Advantages of laparoscopic appendectomy
  • Shorter hospital stay
  • Decreased incidence of wound infection
  • Smaller scars
  • Complications of appendectomy:
  • Bleeding
  • Wound infection
  • Injury to organs close to appendix

What a patient has to do before undergoing appendectomy?

If a patient is scheduled for an appendectomy, he or she has to follow these suggestions to prevent complications:

  • Avoid eating or drinking anything 8 hours before the surgery.
  • Give complete information about your past health to the surgeon.
  • Inform the surgeon if you have the sensitivity to any medication or latex.
  • Inform the surgeon about all the medications and supplements that you are taking.
  • Inform the surgeon, if you are taking aspirin or anticoagulant medications, as they affect blood clotting. The surgeon may ask you to stop taking the medication before the surgery.

What should the patient do after discharge?

  • The patient should take proper care after being discharged from the hospital. It helps to prevent infections and helps in early recovery.
  • Avoid tiring activity.
  • Keep the incision clean and dry.
  • Take adequate rest until the doctor advises the patient to return to work and to normal activities.
  • Consult the doctor immediately if the patient has fever, vomiting, pain, and redness at the site of incision or any other symptoms.

Prevention

  • High-fiber diet: Including food rich in fiber such as sweet potatoes, flax seeds, raw almonds, mushrooms and so on will help to prevent appendicitis. Diet rich in fiber content helps prevent the obstruction of the appendix by fecal matter.
  • Immediate medical care: In case of symptoms which may suggest appendicitis, approaching a doctor and following medical advice can prevent complications of appendicitis from developing.
  • Dietary fiber is said to reduce the blockage of the appendix by fecal matter.

FAQs

  1. What are the long-term consequences of an appendectomy?

No long-term complications are associated with an appendectomy. You can resume your work 2 to 6 weeks after the surgery. However, it is important to follow a healthy lifestyle for a good health.

  1. Is surgery the only method to treat appendicitis?

No. Mild appendicitis can be treated with antibiotics and painkillers. However, patients with severe appendicitis need surgical removal of the appendix to prevent further complications and infections.

  1. Which doctor should I consult for appendicitis?

You should consult a physician, a general surgeon, or a gastroenterologist for appendicitis.

  1. Can appendicitis occur during pregnancy? If yes, what is the treatment?

Appendicitis may happen around second or third trimester of pregnancy. It may cause a fetal loss due to exposure to infectious fluids. The diagnosis and treatment remain the same for a pregnant patient and any other patient. However, additional care will be required. The surgeon, general physician, and gynecologist will closely monitor the patient.

  1. Which conditions can cause similar symptoms as that of Appendicitis?

Meckel’s diverticulitis, pelvic inflammatory disease (PID), inflammatory diseases of the right upper abdomen, right-sided diverticulitis, kidney diseases, and ectopic pregnancy are some of the conditions that mimic the symptoms of appendicitis.

Acquired immunodeficiency syndrome (AIDS)

Acquired immunodeficiency syndrome (AIDS)

Overview

Acquired Immuno Deficiency Syndrome (AIDS) is a disease caused by human immunodeficiency virus (HIV). HIV damages the immune system and decreases the ability of your body to fight against infections and diseases.

In the early 1980s, doctors described unusual infections and cancers among gay men. These men developed unusual pneumonia caused by Pneumocystis carinii and cancers like Kaposi sarcoma and died due to a severe deficiency in their body’s immune defenses. By September 1982, CDC had named this condition as AIDS or acquired immune deficiency syndrome and proposed that it causes a defect in the cell-mediated immunity of the body. Later, the disease was also shown to affect intravenous drug abusers and patients suffering from hemophilia. In 1984, the human immunodeficiency virus was discovered as the cause of AIDS by scientists Luc Montagnier and Robert Gallo.

Clinically, HIV infection progresses through 3 stages, namely, acute primary infection, stage of clinical latency and AIDS. Throughout these stages, the immunity of the individual progressively decreases, and the number of immune cells present reduces.

When the immunity of the individual infected with HIV becomes extremely weak, specific immune cells in his body known as CD4 cells decrease below 200 cells/mm3, and he develops AIDS. AIDS is the most serious phase of HIV infection. In this phase, the patient suffers AIDS symptoms like severe, life-threatening infections, cancers and neurological complications of AIDS.

HIV infection is diagnosed by testing for antibodies against HIV in the blood of the patient. A few tests which detect the presence of viral DNA and CD4 cell counts are used to guide AIDS treatment.

According to worldwide the statistics published by the World Health Organisation, by the end of 2016, 36.7 million people were infected with HIV. Additionally, 1.6 million deaths occurred due to causes related to AIDS. The African continent has the highest number of people affected. Currently, AIDS is described as a pandemic, a disease which has spread across continents. People in developing countries are most affected, as HIV infection increases the chances of acquiring infections like tuberculosis and dying due to AIDS-related complications.

AIDS also affects the economy of the country because a majority of the individuals affected are in the productive age group. Studies have reported that ninety-five percent of individuals with HIV infection live in developing countries. Poverty, the presence of other severe illnesses, unavailability of appropriate medical care and ignorance aggravates the burden of AIDS in these nations.

Due to the modes of transmission, individuals who are at risk of developing AIDS or HIV infection are

  • Men who have sex with men
  • Commercial sex workers
  • Individuals who have multiple partners and involve in unprotected sex
  • Illicit drug users who share needles
  • Individuals who have concurrent sexually transmitted diseases

Causes

AIDS is caused by the human immunodeficiency virus (HIV). These viruses are called retroviruses and belong to a genus called Lentivirus. There are two types of HIV: HIV-1and HIV-2.

HIV-1 is the most common virus present worldwide. It accounts for 95% of all the infections. HIV-1 has several subgroups, M, N, O, and P. Among these, subgroup M is the most widely prevalent.

HIV- 2 is less commonly prevalent. It has been reported from Western Africa, European countries like Portugal and France and India. It causes disease which progresses slower than that caused by HIV-1.

These viruses are transmitted by any of the following routes

  • Unprotected sex with an infected person.
  • Sharing of infected needles between illicit drug users.
  • Transfusion of infected blood to an uninfected person
  • Mother to child during pregnancy or breastfeeding.

When these viruses enter the human body, they attach to immune cells called as CD4 T-cells. The virus has certain spikes called glycoproteins on its surface which interact with receptors on the surface of CD4 T-cells. CD4 T-cells are a type of white blood cells, which play an important role in the immune system. They attack harmful microorganisms and protect us from infections and disease.

The attached viruses enter into the CD4 cells and multiply within these cells. These cells become damaged by the multiplying virus. Therefore, the number of CD4 T-cells progressively decline to result in weakening of the immune system.

A strong immune system is required for defending the human body against infections. AIDS occurs when the infecting HIV causes the immunity of the body to be deficient. Consequently, AIDS symptoms include several infections which are otherwise not found in healthy individuals. These infections are called opportunistic infections. The degree to which the immune cells are destroyed also determines the risk of developing opportunistic infections.

The immune system also protects the body against cancers by eliminating mutated cells which can multiply indefinitely. The defense against cancer is also weakened in AIDS, and the patient suffers from several cancers.

The virus can also enter the brain very early on in the infection and multiply within the immune cells in the brain. These immune cells, the macrophages and monocytes of the brain, act as reservoirs for HIV infection and can cause progressive neurological damage.

Symptoms

In the initial stages, infection with HIV may not show any symptoms. As the immunity of the body progressively declines, symptoms of HIV infection begin to appear. It takes several years for the progression of the disease from initial infection to full-blown AIDS.

Symptoms of HIV infection depend on the stage of illness and the CD4 count of the individuals. There are three stages of HIV infection, which include:

Stage 1

Acute primary infection is the earliest stage of HIV infection. It usually develops within 2 to 4 weeks after the person is infected with HIV. During this stage, the virus multiplies rapidly and spreads throughout the body. The risk of spreading the disease is highest during this stage. Individuals may experience flu-like symptoms such as fever, headache, and rash during this stage.

Stage 2

Stage of clinical latency is the second stage of HIV infection. It is also called as asymptomatic HIV infection or chronic HIV infection. In this stage, the virus continues to multiply slowly, but the patient does not have any specific signs or symptoms. Some individuals may have persistent swelling of their lymph nodes. If no proper treatment is received during this stage, the infection may progress to AIDS. This stage may last up to 10 years in patients not receiving any treatment.

Stage 3

AIDS is the most severe stage of HIV infection. During this stage, the immune system is severely damaged. An HIV positive person is said to have AIDS when he or she has an AIDS-defining illness or a CD4 cell count less than 200 cells/mm3.

An AIDS-defining illness is a critical illness that occurs in HIV infected individuals. A significant drop in the immune cells that defend the body against infections and cancers occur in this stage. These may be opportunistic infections or cancers that occur due to reduced immunity.

Opportunistic infections are those infections that occur at a higher frequency in patients with the defective immune system.

Examples include

  • Candidiasis of mouth, esophagus and vagina
  • Tuberculosis
  • Atypical mycobacterial infections
  • Cryptococcal meningitis
  • Cryptosporidiosis
  • Salmonella infection of the blood
  • Cytomegalovirus infection of the eye
  • Toxoplasmosis
  • Pneumocystis pneumonia
  • Histoplasmosis
  • Coccidiomycosis
  • Herpes simplex virus infection
  • Oral hairy leukoplakia

Certain cancers also occur at a high frequency among individuals with AIDS. These include

Apart from this AIDS can also cause wasting syndrome. Patients experience prolonged diarrhea, fever and drastic weight loss.

AIDS dementia complex is a group of neurological complications of AIDS. It results in mental changes like confusion, forgetfulness and changes in physical activity like abnormalities of walking.

If no proper treatment is received during this stage, the patients typically survive for not more than 3 years.

Risk Factors

Lack of adequate knowledge about HIV and its modes of transmission is the primary factor that increases the chances of exposure to HIV. Infection with HIV can occur in any individual regardless of their sexual orientation, race, gender, occupation or social status. However, certain practices and lifestyle behaviors may increase the likelihood of acquiring HIV infection. These practices are called as risk factors because they increase the risk of HIV infection.

Some of the common risk factors that may make you vulnerable to AIDS are discussed below

Unsafe Sex

Unsafe or unprotected sex means any sexual activity without the use of condoms. Unsafe sex is the leading risk factor for acquiring HIV infection. When you involve in unsafe vaginal, oral, or anal intercourse with an infected person, exchange of body fluids that contain HIV occurs. The virus enters your body from the sexual fluids.

Multiple Sex Partners

The risk of AIDS is very high in an individual who has multiple sex partners as it increases the probability of having intercourse with an infected individual. Monogamous relationship with an uninfected individual protects you from acquiring HIV infection.

Sexually Transmitted Infection

Presence of sexually transmitted diseases (STD) such as syphilis, herpes, and gonorrhea increases the risk of contracting HIV as it causes changes in genital tissues and increases the susceptibility of HIV transmission. Individuals who have other sexually transmitted diseases like gonorrhea are more likely to have HIV infection

Unsafe Injection Practices

Unsafe injection practices involve using the same syringe, needle or injection vial for several individuals, re-using single-use syringes, and improper disposal of used needles and sharp instruments. According to World Health Organization (WHO), nearly 5% of HIV infections took place due to unsafe injection practices. Using contaminated syringes and needles increase the risk of transmission of HIV from an infected person to a healthy individual.

Drug Abuse

Individuals who inject illicit drugs are more likely to share their needles. Studies have shown that individuals who inject drugs are 28 times more likely to develop HIV infection. The needles used by infected individuals, for injecting drugs, are hollow and can carry a significant amount of infected blood.  When an uninfected individual uses the same needle, the virus is injected into the body along with the infected blood.

Unhygienic Medical Practice

Unhygienic medical practices such as handling blood and body fluid samples without wearing personal protective equipment, reusing syringes and needles, inadequate disinfection techniques and improper waste management increase the risk of HIV infection among patients, and healthcare professionals.

On the contrary, HIV is not spread through the following methods

  • Living in the same house as someone who is HIV positive
  • Kissing, shaking hands and hugging
  • Insect bites, animal bites and human bites
  • Sharing food with an infected person
  • Sharing articles such as utensils and clothes

Diagnosis

Serological tests are the most common methods to diagnose HIV infection. In this test, the pathologist looks for the presence of antibodies to the virus in the infected person’s blood. It is important to undergo early testing if you have been exposed to HIV.

The antibodies to HIV usually develop 3 to 12 weeks after exposure to the virus. Early testing helps the affected individual to seek proper treatment and minimize the risk of transmission of HIV to healthy individuals by avoiding high-risk behaviors.

Serological tests for diagnosing HIV infection are

HIV-ELISA Test

Enzyme-linked immunosorbent assay (HIV-ELISA) is a test used to detect HIV infection. HIV-ELISA detects antibodies in the blood to HIV. The pathologist will put a small amount from your blood sample to the ELISA plate and then adds an enzyme to it. Then he or she will observe how your blood and the antigen react. If your blood has HIV antibodies then the color of the ELISA plate changes. The intensity of the color change depends on the number of antibodies present in your blood sample.

HIV-ELISA is categorized into 1st, 2nd, 3rd, and 4th generations according to the advancements at each stage. Currently, 3rd and 4th generation HIV- ELISAs are most widely used. Fourth-generation HIV-ELISA can detect both antibodies and antigens. Therefore, they may detect the infection at an earlier stage.

HIV Card Test

HIV card tests are used for quick detection of the antibodies in the blood. These are rapid and give results within 20 minutes. They are easy to perform and can be used in field situations.

HIV-CLIA

HIV- Chemiluminescent assay is a variation HIV-ELISA and is performed using automated instruments. These tests are highly sensitive and use the principle of chemiluminescence.

Western Blot Test

It is a blood test used to detect multiple HIV antibodies in the blood. The procedure for the western blot test requires a strip containing a series of proteins on a specialized blotting paper. The blood sample is made to react with the paper strip. An enzyme is used to cause color change and detect antibodies. If the person is HIV infected, several colored bands appear on a strip.

Viral Load Test

It is used to monitor the treatment progress or detect early HIV infection. It measures the amount of HIV present in your blood. It can be done using methods that detect the genetic material of the virus. These include reverse transcription-polymerase chain reaction (PCR), branched DNA assay (bDNA) and nucleic acid sequence-based amplification assays (NASBA).

Window Period

Window period of HIV is the period that immediately follows the initial infection with HIV during which the infection is not detected by the tests used. During the window period, the patient is highly infected but the tests for HIV are negative. Most people develop antibodies to HIV between 3 to 12 weeks of infection. For fourth-generation ELISA, the window period is usually 4 weeks. Viral load tests may detect HIV nucleic acid by an average of 14 days. Due to the window period, if the test for HIV is initially negative following exposure, the test must be repeated after 2-3 months.

Treatment

Although there is no cure for AIDS/ HIV, medications can reduce the multiplication of the virus and treat the complications of HIV. The medications used in AIDS are known as antiretroviral therapy. They decrease the number of virus in the body, improve your immune system and treat the complications associated with AIDS.

The doctor will check your viral load and CD4 cell count before prescribing the treatment. During the treatment, the viral load is checked every 3 months and CD4 count is monitored every 3 to 6 months to evaluate the effectiveness of the treatment.

Some of the medications used for the treatment of AIDS are listed below

  • Reverse transcriptase inhibitors: Examples include Lamivudine, Zidovudine, Didanosine, Nevirapine, and Tenofovir
  • Protease inhibitors: Examples include Indinavir, Ritonavir, and Nelfinavir
  • Fusion inhibitors: Example Enfuvirtide

Individuals who are infected with HIV have to take combinations of several anti-retroviral medications. A minimum of three drugs belonging to different classes is used. These combinations are called HAART or highly active antiretroviral therapy.

These drugs may also be used to prevent the transmission of HIV infection from an infected pregnant mother to the baby. For this reason, the WHO advises all pregnant women to be tested for HIV.  Additionally, ART is also used to reduce the chances of HIV infection in healthcare workers following an accidental prick with an infected needle.

Common side effects associated with Anti-HIV medications are

  • Weakness
  • Nausea
  • Fever
  • Rash
  • Diarrhea
  • Vomiting
  • Dizziness
  • Insomnia
  • Sore throat
  • Sweating
  • Headache
  • Drowsiness
  • Flatulence
  • Indigestion
  • Constipation
  • Stomach pain
  • Loss of appetite
  • Throat irritation
  • Change in sense of taste
  • Burning sensation in the hands and feet

Serious-effects include

  • Damage to pancreas
  • Changes in body fat
  • Onset or worsening of diabetes
  • High sugar and fat levels in the blood
  • Increased bleeding in patients with hemophilia

Other complications associated with anti-HIV drugs are

Drug Interactions

Anti-HIV medications can interact with others. These drug interactions can cause unwanted effects on your body so inform your physician if you are taking any other medications.

Drug Resistance

Sometimes HIV undergoes mutation while multiplying in the body and develops resistance to the medications. In such condition, the HIV medications which previously controlled HIV may not be effective and the person may need new drugs to control the propagation of HIV in the body. Poor patient adherence to HIV medications also increases the risk of drug resistance and causes treatment failure.

Prevention

There is no vaccine against HIV infection. You can minimize the chances of acquiring HIV infection or AIDS by following these suggestions:

  • Avoid unsafe sex: Use condoms every time you have vaginal, anal, or oral sex.
  • Avoid multiple sexual partners: Avoid having more than one sexual partner as it increases the risk of acquiring HIV.
  • Know your partner’s HIV status:  Discuss with your partner about HIV testing and get him or her tested for HIV before you have sex.
  • Avoid drug abuse: Avoid drug abuse as it can increase the risk of HIV
  • Use sterile injections: Avoid using contaminated needles as it can spread infections. Use sterile injections and never share your equipment with others.
  • Receive immediate treatment: Pregnant women with HIV should take proper and immediate treatment to protect their baby from HIV.

FAQs

  1. Does staying in the same house with an HIV infected individual spread AIDS?

No. HIV is spread through the exchange of body fluids as in sexual contact, sharing needles, and blood transfusions or from mother to child during child birth. Staying in the same house as an HIV infected individual does not spread AIDS.

  1. Can I get HIV infection from mosquito bites?

No. HIV is not transmitted by the bite of a mosquito or any other insects.

  1. When should I take HIV test?

If you had unprotected sex, shared an injection, or suspect an exposure, then you should take the test.

  1. When should I start taking anti-HIV medications?

Anti-HIV medications should be taken soon after a positive HIV test. However, consult your doctor and follow his or her instructions

to receive safe and proper treatment.

ACNE

Acne

Overview

Acne is a skin condition that many people experience during their lifetime. It is commonly known as “acne vulgaris.” It is often seen in teenagers and younger adults due to hormonal imbalance. About 70 – 85% of the people affected by acne fall under the age group of 10-32 years. It affects girls (during 13 to 17 years of age) more than boys ( during 15-20 years of age). It usually disappears in the mid-twenties and may be present on and off for several years.

It occurs when hair follicles in your skin get clogged with dead skin cells, oil, and dust. It causes oily skin, spots and sometimes sore skin that is painful to touch and hot skin. It usually develops in different areas of the body such as:

  • Face (cheeks, nose, and forehead) – Majority of the people have acne on face.
  • Back – More than half the people with acne have acne on the back,
  • Chest – 10 -15% of people have acne on the chest
  • Shoulders

Acne typically appears on your face, shoulders and upper back because these areas have sebaceous glands that produce excessive oil. It can be persistent and troubling. The acne can be of various types such as blackheads, whiteheads, pimples, papules, pustules, nodules, and cystic lesions.

Acne appears on the skin as

  • Blackheads or whiteheads: Commonly known as comedones.
  • Pimples: Small or big tender red bumps on the skin
  • Pustules: Bumps that contain pus
  • Cysts: They are boils or deep pimples.

Certain conditions can aggravate acne such as

  • Manipulation (poking/pricking/squeezing) of acne lesions unnecessarily,
  • Hormonal imbalance and fluctuation during menstruation,
  • Blocking the pores of the skin by wearing hats, sports helmet and hats,
  • Air pollution
  • Extreme weather conditions especially high humidity.

Acne can vary from mild to severe forms. It can be divided into the following categories depending on its severity.

Mild Acne: People with this acne have comedones (whiteheads or blackheads). They are caused due to clogging of pores in the skin. Blackheads have skin pigment melanin that reacts with oxygen present in the air and hence looks black (it does not contain dirt).  Whiteheads have a white or yellowish head and are closed pores. The acne will increase when more oil or sebum is produced in the skin and bacteria will multiply and lead to the inflammatory type of acne.  If someone only has a few pimples, then it is considered as “mild acne.”

Moderate Acne: People with this type of acne have noticeably more pimples on their skin. When these pimples inflame, they are called papules or pustules. Papules are small bumps, and pustules are pimples filled with yellow pus.

Severe Acne: People with this type of acne has a lot of pustules or papules on the skin along with nodules and scars on their skin. These nodules are often painful and reddish.

Many effective treatments are available for acne. The bumps and pimples on skin heal slowly and may or may not leave a scar behind. Recurrence of acne is a major problem. The risk of problems caused by acne can be lowered by starting an early treatment. Severe cases of acne can cause emotional distress and depression in few patients.

Causes

Four main factors cause acne are

  • Excessive oil and sebum production,
  • Hair follicles clogged with oil, dead skin cells, and bacteria,
  • Excessive activity of androgens (hormones).

Other causes are

  • P. acnes: Acne is usually caused by a harmless skin bacterium known as P. acnes. Abnormal sebum is produced in large amounts by some glands present on the skin due to hormonal changes. When this sebum is in large amounts, the harmless skin bacteria become aggressive and cause inflammation of the skin and pus. The blockage of the pores is seen at the opening of the hair follicles as these hormones also cause the thickening of the inner lining of the hair follicle.
  • Familial Tendency: Acne is also known to have a familial tendency (runs in the families). You can have acne if your parents have acne now or when they were young.
  • Hormonal Imbalance: It is usually seen during menstrual cycle and pregnancy in women. Episodes of acne are often observed in women. Androgens are hormones that are present more in boys. They produce excessive sebum due to the enlargement of the sebaceous gland. Use of oral contraceptives also can affect the production of sebum.
  • Diet: Some studies have indicated that certain dietary foods such as chips, bagels, chocolate, and bread can aggravate and worsen acne.
  • Medications: Certain drugs such as testosterone, corticosteroids, and lithium may also aggravate acne.
  • Stress: Stress can worsen acne in many people.
  • Hygiene: Poor hygiene or dirty skin does not cause acne. In fact, cleansing the skin with harsh soaps, scrubbing the skin too hard or applying chemicals that irritates the skin may cause acne to worsen.
  • Greasy Foods: Eating greasy or fatty foods do not cause acne. Exposure of skin to oil particles in the air such as working in kitchens can cause the clogging of the pores of the skin and worsen acne.
  • Cosmetics: Not all cosmetics cause acne or worsen it. Non-comedogenic cosmetics that are oil and fragrance-free can be used to prevent the clogging of pores that causes acne. Make-up must be removed on a regular basis and daily before going to sleep.

Symptoms

Acne can present itself as six main types of spots:

  • Blackheads – The pores on the skin are plugged with bacteria and oil. These clog the pores and turn brown when exposed to air. Small yellowish or black bumps develop on the skin.
  • Whiteheads – The pores on the skin are closed and plugged. They appear similar to blackheads, and when squeezed, they do not empty.
  • Pimples – They are usually pustules with pus at their tips.
  • Papules – Small, red and tender bumps are seen on the skin. They have a white tip in the center.
  • Nodules – Solid, large and painful bumps or lumps present beneath the surface of the skin.
  • Cystic Lesions – They are pus-filled lumps present beneath the surface of the skin and are painful. They cause permanent scarring and look similar to boils.

You can take the advice of your doctor if you have any of the following symptoms:

  • If you are feeling unhappy or feeling depressed due to your acne,
  • If you cannot control the acne (pimples, spots, and scars) with over the counter medications available,
  • If you develop cysts or nodules that are visible and painful,
  • If your skin is red, inflamed and hot to touch.
  • If your skin is excessively dry or skin peeling is seen.

Scarring can be seen in acne if it is severe. The wounds caused by acne are commonly found in the deeper layers of the skin. Some people have apparently visible indented scars (pockmarks) on their face while others only have small, flat scars that are hardly noticeable on their face.

Acne scars can be divided as follows:

  1. Hypertrophic Scars: This type of acne scar is less commonly seen. They are usually found in people with severe acne. These scars can be seen on your back, chest, and shoulders. During the process of healing of the wound production of excessive connective tissue causes hypertrophic scars.
  2. Atrophic Scars: It is found in people who do not squeeze their pimples, and they are less likely to get scars. During the process of healing of the wound, when it does not heal properly, the connective tissue is not produced in sufficient amounts. Hence a scar forms beneath the surrounding skin, creating a dent in the skin.
  3. Keloid scars: It is a very rare type of acne scarring. They are bigger than the original inflamed area unlike in the hypertrophic scars. These scars also occur when excessive connective tissue is produced.

Some other skin conditions that may mimic acne are

  • Rosacea: It affects people in their thirties and forties. It occurs in the middle third of the face, along with redness. Flushing and superficial blood vessels are also seen in few cases. Pimples characterize this condition in the middle third of the face, but they do not have comedones.
  • Folliculitis: They are inflamed follicles and not acne. Doctors may prescribe oral antibiotics, generally not the same ones used for the treatment of acne.
  • Pseudofolliculitis: When the hair on the skin is shaved they may produce small tender bumps known as “razor rash or bumps.” In such cases, treatment involves growing beard, shaving less often and laser hair removal.
  • Gram-negative folliculitis: Some people develop pustules filled with bacteria on their skin that are resistant to antibiotics. It is commonly seen in patients who are treated with oral antibiotics for long periods of time. Bacterial cultures are helpful in such kind of cases.

Risk Factors

  • Age: Young adults and teenagers are more prone to acne. But it can affect people of all age groups.
  • Hormonal Changes: Hormonal imbalance is often seen in girls and women during the menstrual cycle and pregnancy.
  • Medications: Certain drugs that contain corticosteroids, lithium and androgens are high-risk factors for acne.
  • Family History: Genetics often play a role in acne. If your parents have acne, then you have the risk of developing acne too.
  • The Friction of your Skin: This friction on the skin is usually caused by cellphones, telephones, helmets, backpacks and tight collars.

Diagnosis

Your physician can diagnose acne by:

  • Examination of the skin of face, chest, the abdomen, and the back,
  • For the different types of a spot (such as blackheads or whiteheads, red nodules, pimples).
  • How many spots you have and whether they are painful or not.
  • History can be asked about conditions like PCOS. (In adult women, condition like PCOS – Polycystic Ovarian Syndrome can cause hormonal imbalance that can cause acne).
  • Four grades can be used to measure the severity of acne. This is important in planning your type of treatment. The grades are:
  • Mild – grade 1:  Acne is mostly confined to blackheads and whiteheads, with just a few pustules and papules.
  • Moderate – grade 2: There are multiple pustules and papules, which mostly occur on the face.
  • Moderately severe – grade 3: A large number of pustules and papules are seen on the back and chest, as well as the occasional inflamed nodule can be seen.
  • Severe – grade 4: A large number of painful pustules and nodules can be observed on the skin.

Prevention

Acne can be prevented by taking simple measures such as:

  • Keep your face clean: It is important to wash your face twice daily. Impurities, dead skin cells and extra oil can be removed from your skin’s surface.
  • Moisturize: Always use a moisturizer that minimizes dryness and peeling of skin as many acne products contain ingredients that may cause dryness of the skin.
  • Use makeup sparingly: During a breakout of acne, avoid wearing foundation, face powder, or blush. Non-comedogenic products can be preferred.
  • Over-the-counter acne product: Try an over-the-counter acne product such as salicylic acid, benzoyl peroxide, glycolic acid to reduce acne.
  • Avoid too much touching of your skin: Avoid touching your chin, face as you can irritate the already inflamed facial skin and spread bacteria. Do not pop the pimples.
  • Avoid Sunlight: The sun’s UV rays (ultraviolet rays) can increase redness and inflammation of the skin and can cause post-inflammatory hyperpigmentation.
  • Hair Products: Avoid using oils, fragrances, or gels on your hair that may aggravate your acne.
  • Skin Care: Eating healthy fruits and vegetables can prevent acne breakouts.
  • Exercise: Regular exercise is good for your body, including your skin.
  • Stress & Depression: Avoid stress and stress relating factors that may aggravate your acne as much as possible.

Treatment

The treatment of acne is a slow process and may take from months to years. Topical treatments may take up to three months to start working, but they have good results after they start working. Three medications that are proven to be effective on acne are benzoyl peroxide, retinoids, and also antibiotics. These medications target the acne by acting on different factors. In most of the patients, two of the below drugs can be used as an effective treatment for acne.

1) Benzoyl peroxide: It targets surface bacteria, P. acnes that often aggravate acne. Dryness or Irritation of skin is a common side effect. If it is not used as per the instructions or excessive application on the skin can cause peeling of the skin.

It must be used in wash formulations or lower concentrations. It is available as a face wash or leave-on gel. Few products that contain benzoyl peroxide (in low concentrations) may be advised by your doctor to treat acne.

2) Retinoids: Most of the patients are suitable candidates for retinoid therapy. They are vitamin A derivatives which act by breaking up of comedones (both whiteheads and blackheads). They help in preventing the formation of first lesions of acne and thus help prevent the clogging of pores. To prevent the formation of new bumps of acne, they must be applied to the entire affected area of the skin. The common side effects of this therapy are excessive dryness of the.

Isotretinoin: It is usually prescribed as an oral retinoid. It is used in patients with severe scarring or acne. This helps in shrinking of the size of oil glands (the anatomic origin of the acne). The acne diminishes if the oil glands are inactive. The course usually is given for five to six months. The common side effects are skin dryness; patients can also have elevated liver enzymes or blood lipids. Risk of the devastating birth defect is usually seen when given to pregnant women or women of childbearing age (women planning to get pregnant).

3) Hormone Therapy: It is helpful especially for those women with acne which flare up during menstruation cycle.  The hormone therapy consists of

A medication that blocks the effect of male hormones (at the level of oil glands and hair follicle) known as spironolactone

Low-dose progesterone and estrogen (usually seen in birth control pills)

4) Antibiotics: Topical or oral antibiotics are used to treat acne. Erythromycin and clindamycin are applied on the skin or taken orally to prevent the accumulation of surface bacteria on the skin and often the inflammation of the skin is reduced. Antibiotics are most effective when used in combination with retinoids or benzoyl peroxide. It helps in preventing antibiotic resistance.

Antibiotic creams: If acne is caused by bacteria, it may be treated with stronger antibiotic creams advised by your doctor. Acne present on the back and chest is usually of bacterial origin.

Oral antibiotics: Tetracyclines are effective in treating acne. Other oral antibiotics that are useful in the treatment of acne are Amoxicillin, cefadroxil, and other sulfa drugs. Doxycycline can cause esophagitis (irritation of the esophagus) and an increased tendency to sunburn. Long-term use of tetracyclines can cause induce bacterial resistance and weaken the immune system.

5) Oral contraceptives: Low dose oral contraceptives can treat acne.

6) Spironolactone: This drug blocks hormone receptors such as androgen hormone receptors. It can cause menstrual irregularities, breast tenderness, and increased potassium levels in the bloodstream. It is generally well-tolerated in young women and in women with resistant acne.

7) Cortisone Injections:  Doctors inject a form of cortisone to make large cysts and pimples to flatten out fast.

8) Light Treatments: Special lights and devices are used in the treatment of acne alone or in conjunction with photosensitizing dyes. These treatments can be effective and are safe. The best option is laser treatment of acne and is considered as an adjunct to conventional therapy.

9) Chemical Peels: Chemical peels (such as the superficial peels with glycolic acid) have supportive benefit. They do not substitute for regular therapy.

10) Treatment of Acne Scars: In some patients, acne leaves them with permanent scarring on the skin. Surgical procedures to elevate deep acne scars can be done. Smoothing out of shallow acne scars can be done by laser resurfacing.

11) Self-Care Measures: Many self-care measures can prevent acne and are helpful in having better skin.

  • Do not attempt to squeeze or prick the acne spots, this can lead to permanent damage of the skin and severe scarring is often seen.
  • Frequent washing of skin can make the symptoms worse. Do not wash the affected areas of skin many times (more than twice a day).
  • Very cold or hot water can worsen acne. The affected area can be washed with a mild cleanser or soap and lukewarm water.
  • Do not try to squeeze spots or “clean out” blackheads. This can make the acne worse and may also result in permanent scarring on the skin.
  • Several over the counter creams or lotions are available that reduce the spots.
  • Use a water-based, fragrance-free skin emollient if your skin is too dry.
  • Make-up must be removed completely before going to bed.
  • Avoid using too many cosmetics and too much make-up. Use the product that is less likely to clog the pores in your skin such as water-based, non-comedogenic cosmetics.
  • Wash your hair regularly, and this may prevent, falling of hair on your face.

12) Exercise: Regular exercise may not improve acne. But it can improve your self-esteem and boost your mood. Take a shower after the exercise as sweat can also clog the pores and worsen your acne.

FAQs

1) What is acne?

Acne is a disorder of the follicle. It is evolving from the buildup of bacteria, dead skin cells, and the increasing amounts of sebum or oil that blocks up the pores

2) What causes acne-prone skin?

Acne prone skin is caused mainly due to two factors such as heredity and hormones. The dead cells on the skin build up on the follicle wall, clogging the follicle causing the skin to be acne prone.

3) What role does oiliness play in the development of acne lesions on the skin?

The oil glands in the skin are “switched on” by hormones. This explains both the development of acne during puberty, as well as hormone-related acne flares associated with menstrual and pre-menstrual breakouts. Sebum or oil “coats over” the dead cells of the skin, forming plugs in the lower part of hair follicle called microcomedones.

4) What role does stress play in acne and acne flares?

Stress actually can cause hormone fluctuations. They can cause sudden surges of oil and inflammation of follicles that can lead to sudden breakouts of acne-causing acne flares.

5) Do greasy foods, pizza, and chocolate cause or make acne problems worse?

The role of food in acne is relatively minimal. It is essential to have a balanced diet. Greasy food as such does cause acne.

Dr. Indira Hinduja

Dr. Indira Hinduja

Designation:

Honorary Gynaecologist (IVF and Infertility specialist)

Areas Of Expertise:

Infertility, Assisted Reproductive Technologies, Embryology and Stem cells

Edu. Qualification:

M.D., Ph.D., D.G.O., D.F.P.


E-Mail: 
info@hindujahospital.com

Telephone: (+91) 24447831 / 24447832 / 24451515 / 24447000 / 24447500

For Appointments: 022-39818181/67668181

Professional Experience and Training

Teaching Experience:

Undergraduates and postgraduate teaching experience for 25 years at King Edwards Memorial Hospital (KEM Hospital) and Seth G.S. Medical Hospital and College. Examiner for M.B.B.S., M.D. for several times in Maharashtra, Goa.

Professional Commitments:

Guide for M.Sc and Ph.D. in Applied Biology, University of Bombay.
Editorial Board: The National Medical Journal of India.

Professional Appointments:

Hinduja IVF Centre
P.D.Hinduja National Hospital and Medical Research Centre
Veer Savarkar Marg,
Mahim, Mumbai-400 016 India. 
Tel. : (+91) 24447831 / 24447832 / 24451515 / 24447000 / 24447500
Appointments: (+91) 39818181 / 67668181
For any enquiry, email us at info@hindujahospital.com

Honorary Obstetrician and Gynaecologist
Breach Candy Hospital,
Nepeansea Road. Mumbai

Honorary Obstetrician and Gynaecologist
Department of Obstetrics & Gynaecology.
Jaslok Hospital & Research Centre 
15. Dr. G. Deshmukh Marg, 
Mumbai-400 026 
Phone No. 24933333/ 24939595.

  • House Physician(June 1967 to November 1967), Department of Pediatrics, BYL Nair Charitable Hospital, Topiwala National Medical(TNM) College, Bombay.
  • House Surgeon (December 1967 to May 1968), Department of Obstetrics And Gynaecology, BYL Nair Charitable Hospital, TNM College, Bombay.
  • Registrar ,(June 1968 to November 1968), Department of Chest Diseases and Tuberculosis, BYL Nair Charitable Hospital, TNM College, Bombay.
  • Registrar, (December 1968 to November 1969),Preventive and Social Medicine, BYL Nair Charitable Hospital, TNM College, Bombay.
  • Registrar, (December 1969 to June 1972) Department of Obstetrics and Gynaecology, BYL Nair Charitable Hospital, TNM College, Bombay.
  • Senior Registrar (June 1972 to November 1973) Department of Obstetrics and Gynaecology King Edward Memorial (KEM)Hospital and Seth GS Medical College, Bombay.
  • Tutor (December 1973 to March 1976) Department of Obstetrics and Gynaecology, KEM Hospital and Seth GS Medical College, Bombay. During this period was promoted as Assistant Professor for 9 months in leave vacancy of Assistant Professor in Department of Obst. and Gynaec of KEM Hospital & Seth GS Medical College, Bombay.
  • Reader (Assistant Professor) (1st April 1976 to 20th August 1987). Department Of Obstetrics. & Gynaecology of KEM Hospital, Seth GS Medical College, Bombay.
  • As a Reader In-Charge of Department of Post Partum Programme from March 1977 to March 1979. During this period organised number of female sterilisation camps all over Maharashtra, Gujarat, Goa and Madhya Pradesh. I was awarded by Bombay Municipal Corporation for excellent work in the field of Family Welfare.
  • Professor ( 20th August, 1987 till 14th July, 1991) Department of Obstetrics and Gynaecology, KEM Hospital, Seth GS Medical College Bombay.
  • HONORARY OBSTETRICIAN AND GYNAECOLOGIST (15th July 1991-till date.) Department of Obstetrics and Gynaecology, Jaslok Hospital and Research Centre.

Research Projects Completed:

  • Development of Reproductive Technologies- IVF-ET, GIFT,ZIFT,ICSI,PGD.
  • Established for the first time in India the technique of In Vitro Fertilization and Embryo Transfer as a Collaborative efforts between King Edwards Memorial Hospital and Institute of Research in Reproduction (ICMR).
  • These efforts resulted in a birth of India’s first scientifically documented IVF baby (Test-tube baby) on 6th August 1986.
  • Gamete Intrafallopian Transfer (GIFT) technique was developed successfully and India’s GIFT baby was born on 4th January 1988.
  • Oocyte donation programme in cases of premature ovarian failure. First baby was born on 24th Janaury, 1991.
  • Cytogenetic study in couple having unexplained infertility, male infertility-Bad obstetric history.
  • Human chorionic villous sampling in high risk pregnancy with history of genetic disorders in past or family history of congenital anomalies.
  • Study of chromosomal anomalies in couples belonging to cases having H/O repeated fetal losses or susceptible to fetal loss. Cytogenital study was supported by Research Society of KEM Hospital.
  • Induction of Ovulation. 

    • Administration of Clomiphene Citrates, human menopausal gonadotropin, pure follicular stimulation hormone and human chorionic gonadotropins in different combination and dose regime.
    • Effect of oral contraceptives prior to ovarian stimulation its effect on follicular response to stimulation protocol.
    • Influence of Gonadotropin Releasing Hormone on stimulation of multiple Follicles.
    • Varying time interval of gonadotropin administration and its effect on oocyte maturation and fertilization in vitro.
  • Human Oocyte.

    • Ultrastructure of immature, mature, atretic, normally fertilized and abnormally fertilized oocyte.
    • Correlation between steroid hormones and protein contents of follicular fluid and maturation of oocyte.
    • Protein synthesis by granulosa cells surrounding oocyte and fertilizing ability of oocyte.
    • Constituents of oocyte environment, study of the follicular fluid for the presence of gonadotropin, steroid hormones, glycosaminoglycans, total protein and glucose.
    • Inhibin in follicular fluid and its correlation with maturation, fertilizing ability of oocyte.
    • Intraovarian factors contributing follicular maturation, fertilization and atresia.
    • Effect of injection of purified human follicular fluid on mice follicles.
  • Male Infertility

    • Ultrastructure of sperm in infertile male
    • Decondensation of sperm in vitro in infertile male
    • Study of fertilising potential of sperm. Hypoosmotic test, acrydine orange test, zona free hamster egg penetration with human capacited sperms.
  • Cytogenetic Study of Oligospermia
  • Unexplained Infertility- Immunological factors responsible of infertility by reducing fertilization potential of gametes.
  • Intra Uterine Insemination of washed spermatozoa and its outcome in terms of pregnancy.
  • Early Pregnancy Factor.

    • Presence of early pregnancy factor in culture fluid and serum as a marker for early embryo implantation.
    • Early diagnosis and prognosis of choriocarcinoma and vesicular mole by estimating early pregnancy factor in serum.
  • Vitamin Carrier Protein.

    • Riboflavin-carrier protein (RCP) in follicular fluid and its correlation with oocyte maturation.
    • Presence RCP in fallopian tube in different phases of menstrual cycle.
  • Testing of efficacy of ZK 98.299 as a synthetic progesterone antagonist.
  • Micromanipulation of Gametes.

    • Microfertilization by injecting a sperm in perivitalline space of oocyte ooplasm.
    • Intracytoplasmic sperm injection.
    • Microbiopsy of mice embryo.
    • Prevention of sex linked diseases.
  • Inhibin in endometrium during various phases of the ovarian cycle.
  • Hypertrophy of Pituitary during different phases of menstrual cycle.
  • Pituitary size and its correlation with follicular size and levels of gonadotropins and steroid hormones.
  • Molecular studies on defects in human sperm. Jaslok Hospital & Research Centre.
  • Genetic evaluation of male infertility (Y deletion). Jaslok Hospital & Research Centre

Ongoing Research Projects:

  • Microdeletion of Y chromosomes in males (collaboration with TIFR)
  • Sperm function tests and fertilization in vitro.
  • Role of Centrosome in fertilizing potential of the sperm. (collaboration with IRR, ICMR).
  • Receptive genes in endometrium useful for implantation. (collaboration with IRR, ICMR).
  • To establish human embryonic stem (HES) cell lines without mouse embryonic fibroblast feeder layer and to identify factors secreted by MEF layer that prevents differentiation of HES cells in-vitro. National Institute for Research and Reproduction.
  • Purification and characterization of human sperm adhesion molecular identified by polyclonal /monoclonal antibodies and their role in infertility.
  • Factors regulating endometrial receptivity in nonhuman primate

List of Publications:

  • Hinduja, I. N., Asgaokar V.S. (1969) Single dose of Chloramphenicol in treatment of Enteric Fever. Current Medical Journal., 4, 102-105.
  • Hinduja, I. N., Shah S.K. (1969) Ovarian Tomours. Current Medical Journal., 4, 311-314.
  • Hinduja, I. N., Thakur S.S. (1971) Septic Abortion (Criminal Abortions). Indian Journal of Obstet. and Gynaecol., 21, 251.
  • Hinduja, I. N., Joglekar, S.J. (1974) The comparative study of Coagulation Mechanism in Mid-trimenster Abortions Induced by Prostaglandins and Hypertonic Saline. Indian Journal of Obstet. & Gynaec. 24, 432.
  • Hinduja, I. N., Mehta, A.P. (1976) Anaerobic Infections in Obstetrics and Gynaecology. Proceeding of the Third All India Congress of Medical Microbiologists, pp. 323.
    Click here to read the complete list

Contribution to the Books

  • Critical appraised of tubal surgery in infertility.’ Zaveri K. L., Hinduja I. N. In: ‘Progress in infertility & transvaginal sonography’ (eds.S.Desai & G. Allahbadia) CBS Publishers & Distributors N. Delhi. pp.243-248 (1996)
  • Intrauterine & intratubal insemination. Zaveri K. L., Hinduja I. N. In: ”Infertility & Transvaginal sonography current concepts.”: (eds. S. Desai & G. Allahbadia). Jaypee Brothers. pp. 170-176 (1995).
  • The role of transvaginal colour Doppler sonography in Assisted Reproductive Techniques. Zaveri K. L., Hinduja I. N.,” Transvaginal sonography in infertility’ (ed. G. Allahbadia) pp. 48-52 (1998) Rotunda Medical Technologies Pvt. Ltd. Role of transvaginal Sonography in IVF.
  • Transvaginal Sonography in Assisted Reproductive Techniques (ART) “Transvaginal sonography in infertility’ Hinduja I. N., Zaveri K.L. (ed. G. Allahbadia) pp. 491-495. Rotunda Medical Technologie Pvt.Ltd. Role of transvaginal Sonography in IVF.
    Click here to read the complete list

Edited Book

Editor of The Book “Assisted Reproductive Technologies, Current Methods and Future Directions” by Oxford University Press, New Delhi, 2001.
On editorial Board “The National Medical Journal Of India”.

Conferences and Seminars

  • Anaerobic infections and their management in Obstetrics and Gynaecology. Hinduja, I.N, Seminar on Non Spore Bearing infections in Obstetrics and Gynaecology-held at Ahmedabad, organised by Medical Practitioners of Ahmedababd in 1980.
  • Anaerobic in Obstetrics and Gynaecology VIIth All Gujarat Obstetrics and Gynaecology Congress, Hinduja I.N, Mehta AP, 1980.
  • Role of Anaerobes in infection of the female genital tract. Hinduja, I.N., Mehta AP. 3rd All India Annual Congress of Medical Microbiologists, 24th and 25th November, 1980.
  • 4. Place of Laparoscopic Sterilization via fallope rings in Camps. Hinduja I.N., Purandare VN. 1st National Congress on Gynaecological Endoscopy. 14th, 15th ,16th March 1979.
    Click here to read the complete list

Invited Lectures and Seminars

  • In vitro fertilization and embryo transfer and gamete intra fallopian transfer. Annual Meeting of Obstetrics and Gynaecology Society of Trivandrum, Guest Lecture, 26th June, 1987.
  • Jaipur University guest lecture in IVF-ET and other assisted reproductive technologies 30th December, 1987.
  • In vitro fertilization and embryo transfer following different ovarian stimulation protocols. 1st National Meeting of Indian Society for the study of Reproduction and Fertility 4th November, 1988.
  • Role of LHRH Agonists in Obstetrics in Obstetrics and Gynaecology. Recent Advances in Obstetrics and Gynaecology. An Update. November, 1989.
  • Role of assisted reproductive technologies in management of infertility. Obstetrics and Gynaecology Society of Ahmedabad. Guest Lecture 17th November, 1989.
  • Embryo: Diagnosis and treatment. 18th Annual Conference of the Bombay Obstetrics and Gynaecology Society. 7th April 1990. 
    Click here to read the complete list

Affiliations to Professional Bodies

  • Life member, Bombay Obstetrics and Gynaecological Society.
  • Life member, Indian Association of Gynaecological Endoscopists.
  • Life member, Indian Association of Sex Educators, Counsellors and Therapists.
  • Life member, Indian Fertility Sterility Society.
  • Life member, Indian Society for the study of reproduction and fertility.
  • Life member, Federation of Obstetrics and Gynaecological Societies of India.
  • Life member, Society of Assisted Reproduction and Infertility.
  • Life member, Endocrine Society of India.
  • Life member, Association of Medical Consultants.
  • Life member, National Association for Voluntary Sterilization of India.
  • Member, National Academy of Juvenile and Adolescent Obstetrics and Gynaecology.
  • Member, European Society of Human Reproduction and Embryology.
  • Member, American Society for Reproductive Medicine.
  • Member, Indian Medical Association.
  • Member, Indian Association of Medical Women.

Awards and Honours

  • Bombay Municipal Commissioner for excellent work in the field of family welfare in 1976.
  • Felicitated by Municipal Commissioner, Dean, Seth G.S.Medical Collage and KEM hospital on the founders day in 1987.
  • Mayor’s award of Greater Bombay in September 1986.
  • Outstanding Citizens Award by Jaycees of South Bombay on 26th September 1986.
  • Young Indian Award 1987.
  • Outstanding Lady Citizen of Maharashtra State Jaycee Award 1987.
  • Quoted in Limca Book of Record 1990- page. 88.
  • Rotary International Public Voccassional Excellence Trophy 1994 for successfully pioneering the birth of the first test tube baby.
  • Bharat Nirman Award 1994 for Talented Ladies for their outstanding contribution.
  • International woman’s day Award (8th March 1995) by the Mayor of Bombay.
    Click here to read the complete list