Smoking is the largest cause of preventable death in the world. Smoking causes 90% of all deaths from lung cancer and chronic obstructive pulmonary disease (COPD). It increases the risk of coronary heart disease, stroke, several types of cancer, infertility, stillbirth, sudden infant death syndrome (SIDS), osteoporosis, and premature skin ageing (wrinkles). Even second-hand smoke is dangerous for health.

Cigarette smoking can cause infertility.

If you are a smoker and are trying to get pregnant, stop smoking now. Quitting may be one of the best things you can do for your health, for family and for your fertility.

Smokers are more likely to have fertility problems than non smokers. If you smoke for many years, or smoke many cigarettes per day, your risk for fertility problems is increased. When you smoke, more than 7000 chemicals spread throughout your entire body and all of your organs.

In females smoking can lead to fertility problems, including the following:

Ovulation problems
Genetic issues
Damage to your reproductive organs
Damage to eggs or premature menopause
Increased risk of cancer and increased risk of miscarriage

Detailed information about male and female infertility treatments, causes and symptoms is available at http://www.rupalhospital.com/infertilitytreatmentformaleandfemale.html

In males Men that smoke are at an increased risk for the following male fertility problems:

Lower sperm count and sperm motility problems
Hormonal issues
Erectile dysfunction - trouble getting or maintaining an erection

In addition, smokers that try fertility treatments tend to take long time to conceive. If you are trying to get pregnant without success and your partner smokes, encourage him to quit. The sooner he quits, the sooner you may be able to conceive.
Here are the few important questions and answers that need to be considered and understood by the persons smoking.

"The best way to protect your fertility is to give up smoking."

Can smoking affect my ability to have a child?

Most people understand that smoking increases the risk for heart, vascular, and lung disease. Many do not realise that smoking can also lead to problems with fertility in both men and women. Sperm count, Erectile dysfunction and pregnancy complication rates increases with smoking.

Will smoking affect my eggs or sperm?

Chemicals (such as nicotine, cyanide, and carbon monoxide) in cigarette smoke speed up the loss rate of eggs. Unfortunately, once eggs die off, they cannot be regenerated or replaced. This means that menopause occurs 1 to 4 years earlier in women who smoke (compared with non-smokers). Male smokers can suffer decreased sperm quality with lower counts (numbers of sperm) and motility (spermÕs ability to move) and increased numbers of abnormally shaped sperm. Smoking might also decrease the spermÕs ability to fertilize eggs.

How can smoking impact my ability to conceive?

Women who smoke do not conceive as efficiently as non smokers. Infertility rates in both male and female smokers are about twice the rate of infertility found in non smokers. The risk for fertility problems increases with the number of cigarettes smoked daily. Even fertility treatments such as IVF may not be able to fully overcome smoking effects on fertility. Female smokers need more ovary-stimulating medications during IVF and still have fewer eggs at retrieval time and have 30% lower pregnancy rates compared with IVF patients who do not smoke.

Does second hand smoke of partner have effect on fertility?

Second-hand smoke can affect your fertility. If you live with a smoker, encourage your loved one to stop. Second-hand smoke exposes you to poisonous chemicals, affecting your fertility. In fact, fertility experts say that second hand smoke is almost as damaging to your fertility as if you were smoking yourself! Exposure to cigarette smoke for even just a few days can affect your health and your fertility. Second-hand smoke is also a known cause of Sudden Infant Death Syndrome (SIDS). If you do become pregnant, you and your partner must stop smoking to protect the health of your baby.

If I stop smoking, will my chances for conceiving and having a healthy pregnancy improve?

Yes. Quitting smoking can improve fertility though the decrease of the egg supply cannot be reversed. The rate of pregnancy complications due to smoking decreases, the longer a person has not smoked.

Can smoking affect my children?

Men whose mothers smoked half a pack of cigarettes (or more) a day had lower sperm counts. Smoking during pregnancy also can lead to growth restriction of the baby before birth. Children born with lower-than expected birth weights are at higher risk for medical problems later in life (such as diabetes, obesity, and cardiovascular disease). Children whose parents smoke are at increased risk for sudden infant death syndrome (SIDS) and for developing asthma.

Read about the factors affecting fertility and infertility in men and women of fertile age at https://rupalhospital.wordpress.com/

Quitting smoking can be very, very difficult but studies show that the chance for success is much higher if you work with your health-care provider and/or a support group. Sometimes, temporary use of a nicotine replacement (such as nicotine gum or patch) and/or prescription medication can improve quitting smoking rates, and you can use these while trying to conceive, if needed. Though it generally isnÕt advised to use these during pregnancy, you and your health-care provider might consider their use during pregnancy after weighing the risks and benefits.

The facts about smoking and fertility

Smokers take longer to conceive than non-smokers and are more likely to have fertility problems. While smoking can lead to some long-term fertility damage, studies have also shown that fertility rates can improve after one year of quitting.

Some women may be tempted to keep smoking until they get pregnant. However, it's best for you and your future baby if you quit before you achieve pregnancy. It'll improve your chances of conceiving, be easier on your body, healthier for your baby, and lower the risk of miscarrying the pregnancy before you've even had a chance to give up smoking. The take-home message for young women is that smoking irreversibly damages an irreplaceable population of ovarian cells. Numerous studies had identified specific effects of maternal smoking during pregnancy, including foetal growth retardation, neonatal deaths, pregnancy complications, premature delivery and possible effects on lactation and long-term effects on surviving children.
Further, there have been indications that smoking decreases fertility in women increases the frequency of menstrual abnormalities and decreases the age of spontaneous menopause. In males, it has been suggested that cigarette smoking negatively affects every system involved in the reproductive process. Spermatozoa from smokers have reduced fertilising capacity, and embryos display lower implantation rates.

If your partner is also a smoker, it's best to quit together, and there are many good reasons to do so. Dropping the habit together will increase your chances of successfully quitting, too.

Fertility often improves for women after they stop smoking. Studies show that female smokers can increase their chances of conceiving by quitting at least two months before trying to get pregnant. Quit smoking and you may just find it easier to get pregnant. In conclusion, although smokers as a group may not experience reduced fertility, males with marginal semen quality may benefit from quitting smoking. Also, smokers should quit smoking for the sense of responsibility for their future generation as tobacco smoke contains numerous mutagenic substances.

The best way to protect your fertility is to give up smoking. Despite these warnings, millions of women of childbearing age still continue to smoke. By doing so, they risk their own health and the health of their babies and put the family building at stake.

Its in the interest of the family that couple makes healthy choices for themselves, their partners, and their future children. Rupal Hospital is dedicated to provide the highest quality of services in womenÕs health. It is the result of years of experience, knowledge, understanding and constant updating and effort that has made the Rupal Hospital the best amongst all. Doctors at Rupal Hospital take keen interest in public health education. We believe that preventive interventions are equally important as curative medicine, and prevention always requires awareness and educations. We conduct several workshops and seminars that will improve the health being of couples and in turn will help them to attain pregnancy.

Get Awesome Facts on pregnancy and and benefit of our expertise on Infertility Treatment, male and Female infertility symptoms and solutions at http://www.rupalhospital.com or you can contact us on 91-261-2599128-9

बाइपोलर डिसऑर्डर (द्विध्रुवी विकार) मूड डिसऑर्डर के अंतर्गत अन्य वाले मानसिक विकारों की श्रेणी में आता है, जिसमे प्रभावित व्यक्ति की मनोदशा, स्वभाव और ऊर्जा के स्तर में नाटकीय परिवर्तन देखने को मिलते है.

Bipolar disorder is in a class of mood disorders that is marked by dramatic changes in mood, energy and behavior. The key characteristic of people with bipolar disorder is alternating between episodes of mania (extreme elevated mood) and depression (extreme sadness). These episodes can last from hours to months.

स्वाभाव में होने वाले इन परिवर्तनों के परिणामस्वरूप व्यक्ति की दैनिक क्षमता एवं कार्यशीलता भी प्रभावित हो जाती है.जब व्यक्ति मेनिया के दौर में आता है तब वह वास्तविकता एवं यथार्थ से कट जाता है एवं अत्यधिक जोश,उत्साह का अनुभव करते हुए कई बार खतरनाक परिस्थितियों में सम्मिलित हो जाता है.

The experience of mania can be very frightening and lead to impulsive behavior that has serious consequences for the person and the family.

इसके ठीक विपरीत जब यही व्यक्ति डिप्रेशन के दौर में होता है तब अत्यधिक हताश, निराश प्रतीत होता है, साथ ही अन्य समस्याएं जैसी भूख काम लगना, नींद नहीं आना, चिड़चिड़ापन आदि भी होने लगती है.

Treatment of Bipolar Disorder depends upon the nature, severity and progression of signs n symptoms.


Dr. Pooja Pathak
@swavalambanrehab

नामस्मरण आणि गांजा: डॉ. श्रीनिवास जनार्दन कशाळीकर

विद्यार्थी: कुंभ मेळ्यामध्ये पुष्कळ गांजा ओढला जातो, त्याबद्दल तुमचे काय मत आहे?

शिक्षक: गांजा असो वा अन्य मादक पदार्थ; त्यांच्याबद्दल; आपल्या मनात एक प्रकारची दहशत असते. तसेच; तिटकाराही असतो. पण साधूंच्या बद्दल; आदरयुक्त दबदबा आणि एक प्रकारचे कुतुहूलमिश्रित गूढ आपल्या मनात असल्यामुळे आपण त्यांच्याबद्दल फटकळपणे बोलत नाही आणि त्यांच्याविरोधी टोकाची भूमिका घेत नाही.
पण सर्वच मादक पदार्थ सारखेच नसतात. काही मादक पदार्थ मन भडकवू शकतात आणि त्यामुळे हिंसक गुन्हे घडू शकतात. पण काही मादक पदार्थ मनाची खळबळ, अशांती, अस्वस्थता, उन्माद वगैरे कमी करतात. असे म्हणतात की; काही मादक पदार्थामुळे लैंगिक वासना दबली जाते व वीर्यस्खलन वा शीघ्रपतन होत नाही. अध्यात्मिक प्रगतीसाठी वीर्यस्खलन होऊ न देणे महत्वाचे आहे असे काहीजण मानत असल्यामुळे लैंगिक वासना दाबून अध्यात्मिक प्रगती साधता यावी म्हणून ते मादक पदार्थांचे सेवन करत असू शकतात! त्यामुळे; गांजा ओढणे हे सर्व सामान्यांच्या कसोटीला उतरत नसले तरी तो गंभीर गुन्हा मानला जात नसावा.

विद्यार्थी: पण हे योग्य आहे?

शिक्षक: आपण व्यक्तिगत जीवनात कसे वागावे, काय खावे-प्यावे; आपला दिनक्रम कसा असावा; ह्याबद्दल जबरदस्ती वा सक्ती असावी का? कुणी ब्रह्मचारी असावे की गृहस्थाश्रमी ह्याचे स्वातंत्र्य ज्याचे त्याला हवे की नको? कुणी कोणते कपडे घालावे हे कुणी ठरवायचे?
त्यामुळे मला वाटते; इतरांना नावे ठेवण्यापेक्षा; आपले आचरण तपासून पाहावे. काळजीपूर्वक तपासल्यानंतर; आपले आचरण आपल्या स्वत:ला थोडे जरी खुपत किंवा सलत असले; किंवा लोकांना हानिकारक होत असले, तर ते प्रयत्नपूर्वक सुधारणे आवश्यक आहे. त्यासाठी नामस्मरण हाच उत्तम उपाय आहे असेच सर्व संतांचे सांगणे आहे.

विद्यार्थी: इतरांना नावे ठेवण्यापेक्षा; स्वत:कडे त्रयस्थ दृष्टीने पाहणे फार महत्वाचे आहे, कठीण आहे! तसेच; स्वत:मधले दोष दूर व्हावे असे वाटणे आहे, देखील कठीण आहे! नामस्मरणाने जर हे शक्य होत असेल असेल तर मी जास्तीत जास्त नामस्मरण करण्याचा अगदी मनापासून प्रयत्न करीन.

शिक्षक: हा संकल्प सर्वश्रेष्ठ पण तो तेवढाच कठीण देखील आहे. कारण; आपण जे पाहतो, जे ऐकतो, जे अनुभवतो, ते सारे आपल्या संकुचित आणि सदोष नजरेतून पाहत असल्यामुळे; आपल्याला नेहमीच नामस्मरणापासून विचलित करू शकते! म्हणजे; नामस्मरणाच्या आड आपले आपणच येत असतो! पण तरीही नाम, गुरु, ईश्वर म्हणजेच आपला अंतरात्मा; आपल्याकडून नामस्मरण करून घेतो!

APPROACH TO ANAEMIA IN GENERAL PRACTICE
DR.S.ABBAS ALI
MD DNB MNAMS
Fellowship in cardiology
PGDCC (ultrasonography)
PGDCC(Echocardiogram)
FCGP,MCCP (Cardiology)
Lecturer, department of medicine
KD MEDICAL COLLEGE, MATHURA

Anaemia is usually defined clinically as a reduction of the haemoglobin concentration to less than 13g/dl (males) or less than 12g/dl (females). Haemoglobin constitutes about 1% of total body weight. It is a common problem in general practice.
Degree of Anaemia: Anaemia is often classified as mild degree (9-11 gm %), moderate
(7-9 gms %), severe (4-7 gm %) and very severe (<4gm %). It is also classified according to Haematocrit (PCV) %.
While evaluating of the patient with anemia and making of specific diagnosis requires a clinical assessment and laboratory investigations. The two must be put together for a comprehensive diagnosis.
Clinical assessment requires careful history and physical examination.
A careful evaluation of medical history often gives vital clues to the cause of anemia. The acuity of anemia, association with other symptoms & history of any chronic illness are important. Some important points
History Comments
Age Iron def. rare before 6 months
Neonatal anemia with reticulocytosis suggests blood loss or Hemolysis.
B-thal. sickle cell anemia appear by 4-8 mths. of age

Genetic & family history X-linked: G-6-PD def
Autosomal dominant: Spherocytosis
Autosomal recessive: Sickle cell anemia, Fanconi
Family member with h/o early cholecystectomy/ biliary calculus
Race & Ethnicity

Nutrition Cows milk & iron deficiency
Strict vegetarian: B12 deficiency
Goat’s milk: Folate def.
Pica, Plumbism & iron def.

Drugs G-6-PD def
Immune mediated hemolysis (Penicillin)
Bone marrow suppression
Phenytoin & folate def.

Diarrhea Malabsorption of iron, B12 &E
Inflammatory bowel disease
Milk protein allergy- chronic blood loss
Intestinal resection & B12 def

Infection Giardia- iron def
Intestinal bacterialovergrowth- blind loop & B12
Epstein barr, CMV & Parvo virus- Bone marrow suppression
Malaria, Kalazar, Chronic infection


Nutritional history related to drugs or alcohol intake and family history of anemia should always be assessed. Certain geographic backgrounds and ethnic origins are associated with an increased likelihood of an inherited disorder of the hemoglobin molecule or intermediary metabolism. Glucose-6-phosphate dehydrogenase (G6PD) deficiency and certain hemoglobinopathies are seen more commonly in those of Middle Eastern or African origin, including African Americans who have a high frequency of G6PD deficiency. Other information that may be useful includes exposure to certain toxic agents or drugs and symptoms related to other disorders commonly associated with anemia.
Physical Examination
 General appearance of child & assessment of growth parameters helps decide the acuity or chronicity of anemia & other associated illnesses.
 Look for signs of trauma
 Presence of petecie, bruising & ecchymosis
 Lymphadenopathy, Hepato-spleenomegaly & abdominal mass. Splenomegaly and lymphadenopathy suggest an underlying lymphoproliferative disease,
 Prominent cheek bones, frontal bossing indicates hemolytic anemia
 Associated congenital malformations- Fanconi anemia.
 Tell tale signs of any chronic illness e.g. hypertension, short stature, arthritis, cluubing, cyanosis etc.
 petechiae suggest platelet dysfunction
 blood in the stool
 In the anemic patient, physical examination may demonstrate a forceful heartbeat, strong peripheral pulses, and a systolic "flow" murmur. The skin and mucous membranes may be pale if the hemoglobin is <80–100 g/L (8–10 g/dL). This part of the physical examination should focus on areas where vessels are close to the surface such as the mucous membranes, nail beds, and palmar creases. If the palmar creases are lighter in color than the surrounding skin when the hand is hyperextended, the hemoglobin level is usually <80 g/L
Laboratory Evaluation: Initial Laboratoryy workup of anemia requires

1. Complete blood count (CBC) and it is the single most important investigation in anaemia. It
should include Hb, Hct, WBC, platelet count and RBC indices viz. RBC count, MCV, MCH, and RDW. The components of the CBC also help in the classification of anemia. Microcytosis is reflected by a lower than normal MCV (<80), whereas high values (>100) reflect macrocytosis. The MCH and MCHC reflect defects in hemoglobin synthesis (hypochromia). Automated cell counters describe the red cell volume distribution width (RDW).
2. Peripheral blood smear examination: A careful evaluation of the peripheral blood smear is important, and clinical laboratories often provide a description of both the red and white cells, a white cell differential count, and the platelet count. In patients with severe anemia and abnormalities in red blood cell morphology and/or low reticulocyte counts, a bone marrow aspirate or biopsy can assist in the diagnosis. The peripheral blood smear also provides important information about defects in red cell production. As a complement to the red cell indices, the blood smear also reveals variations in cell size (anisocytosis) and shape (poikilocytosis).
3. Reticulocyte count: An accurate reticulocyte count is key to the initial classification of anemia. Normally, reticulocytes are red cells that have been recently released from the bone marrow. Normally, the reticulocyte count ranges from 1 to 2% and reflects the daily replacement of 0.8–1.0% of the circulating red cell population.

The above triad comprises the primary investigations in anaemia and can be performed
on a single EDTA blood sample.
Secondary investigations are guided by the results of the above tests in a given clinical context, and may include
1. Tests of Iron Supply and Storage: they include serum ferritin, total iron binding capacity, serum iron, serum transferring percentage. This tests reflect the availability of iron for hemoglobin synthesis. The percent transferrin saturation is derived by dividing the serum iron level (x 100) by the TIBC. The normal serum iron ranges from 9 to 27 mol/L (50–150 g/dL), while the normal TIBC is 54–64 mol/L (300–360 g/dL); the normal transferrin saturation ranges from 25 to 50%. A diurnal variation in the serum iron leads to a variation in the percent transferrin saturation. The serum ferritin is used to evaluate total body iron stores. Adult males have serum ferritin levels that average ~100 g/L, corresponding to iron stores of ~1 g. Adult females have lower serum ferritin levels averaging 30 g/L, reflecting lower iron stores (~300 mg). A serum ferritin level of 10–15 g/L represents depletion of body iron stores. However, ferritin is also an acute-phase reactant and, in the presence of acute or chronic inflammation, may rise several-fold above baseline levels. As a rule, a serum ferritin more than 200 g/L means there is at least some iron in tissue stores.
2. vitamin B12, and RBC folate levels
3. Hb electrophoresis and quantitation (Hb A2, Hb F etc)
4. Blood biochemistry for hepatic and renal functions
5. Bone-marrow aspiration
6. Trephine biopsy from bone marrow
7. Imaging studies may include X-ray chest/ skull/ other bones as warranted, ultrasound abdomen, radio-isotope studies
8. Other specialized tests include Coombs test, osmotic fragility, Ham s test, erythropoietin level, immunocytochemistry, cytogenetics etc
CLINICAL APPROACH TO A PATIENT WITH ANAEMIA
Anaemia is not a disease by itself but only a manifestation of disease. Hence, it is imperative to look for the underlying disease responsible for anaemia.
KEY ISSUES to decide in a patient with anaemia are:
1. Is it a TRUE anaemia?
2. Is the anaemia HEREDIATARY or ACQUIRED?
3. Is there any ABNORMAL BLEEDING?
4. Is there exposure to DRUGS, CHEMICALS, or TOXINS?
5. Is there a co-existing SYSTEMIC DISEASE
6. What is the nature of DIET and ETHNICITY.
CLASSIFICATION OF ANAEMIA broadly anaemia is classified in to
Hereditary : the defect often lies within the RBC. It means its Hb or- its enzyme or- its membrane. Reticulocyte count is high in hereditary anemias.
Acquired: here The defect is often extra-corpuscular
Classification Based on RETICULOCYTE INDEX Normal 0.2 – 2.0%
Reticulocyte count Very Low indicates a decreased RBC production in bone-marrow.
RETICULOCYTE COUNT Very High indicates an excessiveproduction of RBCs in bone-marrow anaemia results from either excessive destruction or excessiveloss of RBCs
RETICULOCYTE Normal (0.2- 2.0%) indicates no positive diagnostic
Classification of anaemia based on MCV (RBC Size) : MCV or mean corpuscular volume is an important parameter to classify anemia.
Microcytic (MCV <80 fl or femtolitres): it is due to inadequate Hb synthesis
Causes
1. Iron deficiency anaemia – commonest
2. Thalasmia
3. Lead toxicity
4. Anaemia of chronic disease
5. Sideroblastic anaemia
Macrocytic (MCV >100 fl)
Causes
MEGALOBLASTIC: Altered DNA synthesisleading to large & fluffy nucleus in the early RBCs
1. Usually from vitamin B12, folate deficiency, or some enzymatic involvement. Segmented nutrophils commonly associated with B12 or folate deficiency anaemia
2. Diet and drugs are the commonest culprit.
3. Increased demand may occur in haemolysis and during pregnancy & lactation
NON-MEGALOBLASTIC: DNA in red cells is normal or OK.
Causes:
1. Liver diseases
2. Alcoholism
3. Aplastic anemia
4. Hypothyroidism
Normocytic (MCV 80-100 fl) Most anaemias start as normocytic. In most diseases, it remains normocytic only
Causes
1. Anaemia of blood loss
2. Anaemia of chronic disease ( sometimes low MCV)
3. Bone marrow failure
4. Renal failure
Differential diagnosis of microcytic anaemia
IRON DIFICIENCY ANAEMIA – DIAGN0SIS THROUGH LAB INVESTIGATIONS
Hb% -- ---low
Serum ferritin ------ low
Total iron binding capacity -----very high
Serum iron ------low
MCV -----low
THALASMIA: It is due to defect in globin chain.
Hb%------normal
Serum ferritin ------normal
Total iron binding capacity------- normal
Serum iron --------normal
MCV ------low
Sideroblastic anaemia
Serum iron : increased
Serum ferritin: increased
Total iron binding capacity: normal
MCV----low
Anaemia of chronic disease:
Serum iron : low
Serum ferritin : increased
Total iron binding capacity : decreased
MCV-----low

Management
The treatment of anemia depends on the cause. Deficiency anemia can be effectively treated by therapeutic doses of the deficient mineral or vitamins. In anaemias, a right treatment may bring patient back to life whereas an inappropriate or delayed treatment may take life away

1. Journal of Pediatric Neurosciences.Volume 8/ Issue 3/ Sep-Dec 2013. Angelman syndrome in three biological siblings: Focusing on the neuropsychiatric domain.
Akhila Kumar Panda, Sujit Kumar Kar 1 , G. Gopinath.G
2. Indian Journal of Medical Specialities. 22 July 2014. Hashimoto's encephalopathy masquerading as chronic meningitis- case of a middle-aged female with review of literature. Akhila Kumar Panda, Gopinath.G, Siddharth Maheswari, Vachan Jayant Mehta,
Lomesh Bhirud
3. Journal of Neurosciences in Rural Practice | April - June 2014 | Vol 5 | Issue 2. Parry Romberg syndrome with hemimasticatory spasm in pregnancy; A dystonia mimic. Akhila Kumar Panda, Gopinath G, Shaily Singh.