How can a man know that he is having azoospermia?

Unfortunately, in most of the cases, the men are not aware that he is having azoospermia. However, if you have any problems in genital organs since birth, any operations (particularly hernia), infections (mumps, tuberculosis, STI), injury, then he should be alert. Men treated for cancers (by chemotherapy), taking anabolic steroids, having problems in pituitary gland or liver diseases are at high risk. Men, having inadequate body hair, sexual dysfunction and varicocele should also discuss this issue with their doctor.

The semen test shows no sperm. What should I do?

A single report is not conclusive. This is, because, sperm production requires 3 months and it needs cool temperature than rest of the body. This is why, men have their testes hanging outside the body in the scrotum. Thus, today's semen analysis reflects a man's health 3 months before. Again, the results can vary from one laboratory to another.

So, we usually advise repeating the test after few days, preferably from a second laboratory. Sometimes, careful examination may reveal few sperms, that can be used for ICSI.

The repeat test also showed azoospermia. What is the next step?

The next step is to find out the cause. Your doctor may ask you some questions and with your permission, may check your body areas (hair growth, breast development, penis, scrotum, testicular size etc). Doctor can advise you some tests like ultrasound of your testes, or sometimes of your prostate gland. Some hormonal tests are advised (blood tests- LH, FSH, Testosterone, prolactin etc) and in some occasions, karyotyping and Y chromosome Microdelection (chromosomal analysis).

What is Fallopian Tube(s)?
Fallopian tubes (commonly called “the tubes�) are the structures that are connected to the both sides of the uterus. Inside the tube, the sperms and the egg meet (“fertilization�) to form the embryo, which then travels down the tubes into the uterus and then the pregnancy starts. Tubal factor accounts for 20-25% cases of female infertility. It’s more common in secondary infertility (women who conceived earlier).

What are the reasons for tubal blockage?
Often, the exact cause is not known. Infection is the commonest cause. The infections may be due to sexually transmitted infection (STI), particularly Chlamydia infection or infection from bowel or appendix. Tuberculosis is very common in our country and can affect the tubes, silently, without affecting any other parts (not even the lungs) of the body. Endometriosis is also a common reason for tubal blockage. Any pelvic surgery (surgery in ovaries, tubes, uterus, even appendix) can block the tubes by “adhesion�. This means the tube may be open but attached to the bowel or rotated on itself, so that the tube cannot pick up the eggs from the ovaries. Sometimes fibroid of uterus can compress the tube and cause blockage. Women, with previous history of ectopic pregnancy, are at risk. Uncommonly, some abnormalities, present since birth can block the tubes.

Thoughts in the Time of Corona


It is hard to live peacefully for the so-called modern human civilization. Everyday we are earning fresh problems regarding social, political, economic and various other sectors. Along with this, nature is also organising natural surgical strikes and making the whole situation imbalanced. In that list, the latest addition is Corona virus. Falling behind all the known nightmares like, racism, wars, recession etc. this extremely infectious disease snatches the international headline. At present the global public health emergency is COVID-19.

In this article I'm going to discuss about the prophylactic scope of Homoeopathy. Though the efficacy of homoeopathic prophylactic remedies for various conditions has not been proved by controlled studies and statistical records, yet homoeopathy has reportedly been used for prevention during the epidemics of Cholera, Spanish Influenza, Yellow fever, Plague, Scarlet fever, Diphtheria, Typhoid etc. Sutherland writes, "If the Homoeopathic school is to put up an effective opposition to the growing demand for modern preventive medicine, it must be able to search for and present facts which will constitute irrefutable proof of the arguments we present."
In case of epidemics, the best prophylactic will be the remedy (Genus Epidemicus) obtained by examining typical symptoms from the accurate observations of the first few cases. To find the exact genus epidemicus we have to observe the cases and accumulate the proper symptomatology of the patients. Epidemic diseases are so called contagious in nature and they come with fixed group of symptoms. Dr. Kanjilal giving two alternative says, "It goes without saying that, the best prophylactic remedy is the constitutional similimum of the individual. It is proved by experience that persons strictly following the homoeopathic line in their medical measures, rarely fall victims to any epidemic disease. The next line of defense is the similimum of a particular epidemic - the so called Genus Epidemicus." Dr. Kanjilal clearly clarifies that to approach an epidemic with the homoeopathic concept of individualization and to approach with a genus epidemicus are completely two different paths. They both can't be fitted in the same bracket. So, in a nutshell our goal is to form the antibody. Which is induced by homoeopathic drugs. The drug that most closely simulates the disease in all its clinical aspects is more likely to be a prophylactic than one less similar.
The subject of Nosodes provides a most interesting study to the homoeopath and yet, strangely, the Nosodes seem to have received much less attention that they deserve, in spite of their great utility and efficacy when indicated in practice. Nosodes are most abused, unused, and misused of all the remedies in the homoeopathic Materia Medica. Some physicians use when routinely, others use them rarely or not at all. I personally believe that Nosodes are going to play a very significant role to combat against COVID-19.
Nosodes have been compared to vaccines and even called oral vaccines. Pierre Schmidt writes, a Nosode is "a medicine derived from pathological tissue or secretions containing the specific virus of the sickness." Boger writes : "When our late confrere, Dr. H.C. Allen, pointed to the nosodes as the most important of remedies in arousing reaction, he did the greatest thing of his busy life."
Now, the most important part is that - to fight against COVID-19 homoeopaths have the immense opportunity to discover an Autogenous Nosode from the secretions of the patient. For instance, Green reports a case of eczema which was cured by a potency made from the discharge itself, after Graph., Petr., Mez., Sulph., etc., had failed. Why it is not applicable for Corona virus now? What will be the best prophylactic remedy than that? The effectivity of the nosodes in preventing infectious diseases seems to have been established. Samuel Swan has reported a number of instances where the administration of Variolinum has apparently prevented the onset of smallpox. Wheeler has conducted scientific experiments with potencies of Diptherotoxin and has shown that the drug in potency has the power of altering the Schick reaction. Hering, Swan, Burnett, and others did much along this line. Hering proposed the employment of the diluted saliva of a rabid dog for hydrophobia in 1833, antedating Pasteur. Swan antedated Koch in the discovery of Tuberculinum. Koch introduced Tuberculin in 1890. Burnett began his work with this remedy (under the name of Bacillinum) in 1885 and obtained results never dreamed of by Koch. Various other reports are also to be found in the literature which seem to prove that the various nosodes have prevented specified diseases. Of course in some cases, a drug which has produced a similar symptom picture also appears to have acted as a prophylactic, but between the two, the similar drug and the nosode, the nosode is apparently preferred, because of its greater similarity and easier selection. So, in COVID-19, the nosode prepared from COVID-19 will seems to have a very definite effect in producing prophylaxis. Incidentally, the preventive virtues of nosode of COVID-19 will seems to be safer too. (Literature provides the same prophylactic example in between tuberculosis and Tuberculinum. On the contrary though BCG is claimed absolutely safe, in the British Medical Journal, there are instances of children who were adversely affected by BCG vaccination.) Yingling writes long time ago, "What shall we say of the Nosodes, remedies derived from morbid tissues and secretions containing the specific virus of diseases? Some twenty of the animal and four of the vegetable nosodes are now used with success. The list may be extended largely. We, of this society, all know and appreciate their use and value. It would be impossible today to get along without them. Our usefulness would be wonderfully curtailed and menaced."
Various explanation have been offered to prove that nosodes are not isopathic remedies. It has been suggested that potentization alters the nature of the original substance so that the resulting product becomes similar and not identical. But the correct reasoning seems to be that the nosode represents a product of disease in a particular individual, animal or plant. Each disease-product is the result of an interaction between a particular individual and a particular pathogenetic agent. Since these two factors and the resulting reaction cannot be exactly duplicated, the resulting product can never be identically same for any other case of disease, though the outward disease-manifestations and the disease-label may be the same. For instance, in virus diseases, it is known that the virus may mutate from time to time. The virus of the Asian Influenza epidemic of 1956 was different from the virus of the Influenza epidemic of 1918-20. The manifestation of symptomatology were also different. The mortality rate was different.
Some of the Influenzinums marked by Nelson's of London are as follows :
1. Influenzinum (the 1918 epidemic), 2. Influenza virus A Asia/57, 3. Influenza virus A England/42/72, 4. Influenza virus B Hong Kong 5/72, 5. Influenza virus A/Port Chalmers/1/73, 6. Influenza virus A (Asian) 1954, 7. Influenza virus B (Asian) 1954, 8. Bacillus Influenza 1918, 9. Influenza virus Az Hong Kong 1968, 10. Influenza virus Ar 1967, 11. Influenza virus B, 12. Influenza Co. (Combination of Az to 1918), 13. Influenza virus a1.
Similarly, when bacteria are attacked by antibiotics, these organisms are found to develop different strains which are resistant to the drugs. These are instances to show the variability in the nature of the invading organisms. No two individuals in the world are exactly alike and the reaction of each individual to a specific circumstances or agent is bound to be different from that of any other individual, however, much the reactions may appear to the alike. So, a Nosode product developed from the disease tissue of one individual will probably vary in nature and indications from the nosode product developed from the diseased tissue of another individual, though the disease entity affecting both persons may be the same. When the same nosode is prepared from the different persons, each preparation may fall under a different group; with the result, we may have a Medorrhinum of the 8th group, one of the 7th group and so on. If we were to prepare the nosode from different sick individuals, the enormous implications of this discovery can't be imagined! This is a question about the homoeopathic concept of individualization. I personally have no explanation of this last part but I'm always eager to be enlightened about that and I'm also very hopeful from my homeopathic society.
Regarding homoeopathic prophylactics the potencies to be used, and the frequency of repetition, very little authoritative information is available. Gibson states, "There is no hard and fast method for the use of potencies in prevention and the length of time protection may last is, of course, difficult to estimate. One plan is to give three doses of a 30C potency spread over a period of 24 hours. Repetition in the event of continuing danger of infection should be under the guidance of a homoeopathic physician." Wheeler and Kenyon write that a dose of the 30th potency of the prophylactic remedy will protect at least for a fortnight. Others advise one dose of the 30th once a week or the 200th once a fortnight till the epidemic passes. Grimmer considers that one dose of the 10M potency affords protection throughout an epidemic. The higher potencies seems to afford protection for longer periods as evidenced by the experiments of Dr. Paul Chavanon (under Diphtheria.)
At last there is a positive side of this Corona episode. As influenza virus had played a major role to stag the great World War One, at present Corona virus also came as a preventive medicine for our planet which is violently diseased. Obviously it's an exaggeration. But after detection of COVID-19, the display of patients, empathy, and administrative excellence shown by the government of India and other countries, we must acknowledge that. We hope that, we and our planet will be completely safe under their supervision. During this global threat over human civilization by COVID-19, causes multilayered panic among the population, the only way to cease it, if we could germinate this hope. Then we shall overcome.

Dr. Swarnadip Bhattacharyya (BHMS)
West Bengal University of Health Science

CASE REPORT OF NOCTURNAL ENURESIS
ABSTRACT: Nocturnal enuresis (NE) is involuntary urination that occurs at night during sleep without any inherent suggestion of frequency of bedwetting or pathophysiology. There are a number of treatment options available for NE; such as drug therapy, bladder training, positive reinforcement, and the enuresis night alarm. It requires patience, persistence and motivation. Several behavioural approaches can be used for treatment such as enuresis night alarm therapy and various skills oriented components. A thorough homoeopathic case taking and treating with an individualised homoeopathic remedy of single dose gives an assured result. Case with marked peculiar symptom can be made basis of prescription and not all cases requires repertorization.
Keywords: Nocturnal enuresis, bedwetting, enuresis, homoeopathy, single dose, peculiar symptom.
INTRODUCTION:
Nocturnal enuresis (NE) is defined as “involuntary voiding of urine that occurs while sleeping that can happen at an inappropriate and socially unacceptable time and place� and due to which its negative impact occurs on the quality of life of the affected children and their families. It is most common in boys, with a ratio of three boys for every girl until the age of 15. Enuresis should be differentiated from continuous or intermittent incontinence or dribbling. The bed is usually soaking wet in enuresis, compared to incontinence in which there is loss of urine without normal emptying of the bladder.
More than 85% children attain complete diurnal and nocturnal control of the bladder by five years of age. The remaining 15% gain continence at approximately 15% per year, such that by adolescence only 0.5-1 % children have enuresis. Up to the eleventh year, enuresis is twice as common in boys as it is in girls; thereafter, the incidence is similar or slightly higher in girls.
Enuresis is called primary when the child has never been dry and secondary when bed wetting starts after a minimum period of six months of dryness at night.
Enuresis may be comorbid with mood and emotional disorders and also has a high level of comorbidity with attention deficit hyperactivity disorder (ADHD). Part of emotional disorder such as anxiety, expression and insomnia are experienced by persons who have elimination disorders related to distress and social stigma
Classifications
Enuresis classified on the basis of the time of occurrence into the following three subtypes:
• Nocturnal Enuresis: Passing urine during sleep.
• Diurnal Enuresis: Leakage of urine during waking hours.
• Monosymptomatic or uncomplicated NE: Normal voiding at night with absence of symptoms.
• Polysymptomatic or complicated NE: Bedwetting at day time with symptoms urgency, frequency, constipation and encopresis.
• Nocturnal and diurnal Enuresis, also known as nonmono-symptomatic enuresis.
Aetiology:
- NE is hereditary, children whose parents were not enuretic have only a 15% incidence of bedwetting and when one or both parent were enuretics, the rates increases to 44% and 77% respectively
- From the difficulty in waking up when the bladder is filled.
- excessive nocturnal urine production and nocturnal bladder hyperactivity
- Can be drinking late in the evening or not passing urine before going to sleep, resulting in excessive urine volume.
- Another cause may be a low amount of antidiuretic hormone during the night which controls the production of urine.
Goals of treatment
The following are goals of management for NE
• To stay without bedwetting on particular occasions such as sleepover at night or day.
• To decrease the frequency of wet nights.
• To decrease the impact of enuresis on the child and family.
• To avoid recurrence of bedwetting.
For achieving the above goals lifestyle and behavioural changes play an important role.

Primary management of enuresis is behavioural modification and positive reinforcement and it should be start with educating the child as well as parents about the condition, which can be achieved through :
-Behavioural Management.
-Night urine alarm therapy.
-Pajama (Under wear) Device
-Mechanism of action of Night urine Alarm Device
-Waking schedule

CASE REPORT :
A female patient of age 10 years visited our A. M. Shaikh Homoeopathic Hospital on 22/07/2019 with her father who described her case in detail with the presenting complaint of Bed wetting since 5 years.

History of presenting complaint
Patient came with the complaint of bed wetting at night and daytime as well; there is no single dry night since 5 years.At times she passes urine 2-3 times at night and once during her day/evening sleep.
No H/O Night terrors or Nightmare.
Treatment history:
Has consulted an allopathic paediatrician for the above mentioned complaint and was on treatment for 3years with no desirable improvement, so wilfully seeking homoeopathic treatment.
Past history: No H/O any major illness or any remarkable events occurred since birth.
Family history: Nothing significant. No family history of enuresis.
Milestones:
Neck holding - 4th month
Monosyllable speech – 7th month
Crawling – 9th month.
Sitting without support by 10th month.
Walking without support – 14th month.
Normal speech with meaningful words – after18 months.
Personal History:
Diet : Vegetarian,
Appetite :Not adequate, hardly eats a roti at times.
Thirst : 1 – 1.5 ltrs / day,
Micturition : D/N : 3-4/2-3,
Stools : Once/day, Regular, Soft.
Desires : Spicy food.
Life Space Investigation :
ï‚— Birth history : Full term normal hospital delivery. Mother had absolutely healthy pregnancy throughout the term. Mother was not a known case of Hypertension, Diabetes Mellitus, Hypothyroidism. No H/O any insult (injury) at birth.
 Post delivery – till date. : Patient is born and brought up in Kadoli, Belagavi. No remarkable events since birth.
ï‚— She is good in studies, mingles with people easily. She gives debate and speaks freely without fear in-front of people and she has won in almost all the debate she has participated yet she is timid. She cannot takes / tolerates the pain when other people are quarrelling (reaction sympathetic). She is that sensitive she cannot even tolerate the fight in movies and serials. If she sees any beggar on road she tends to lend her tiffin.
General Physical Examination :
Patient is moderately built and moderately nourished, No pallor, cyanosis, icterus, clubbing, oedema, lymphadenopathy, Temperature : 98.6º F. (Afebrile), Thermals : Hot, Height :129cms, Weight :26kgs, Birth Weight : 2.75kgs, Pulse rate :84 bpm, Respiratory cycle : 18cpm.
Clinical diagnosis :Primary enerusis.
Totality of symptoms :
ï‚— Bedwetting at night and daytime.
ï‚— Desires spicy food.
ï‚— She cannot tolerate when other people are quarrelling (reaction - sympathetic), She is that sensitive she cannot even tolerate the fight in movies and serials. If she sees any beggar on road she tends to lend her tiffin
ï‚— Hot patient.
Analysis of symptoms :
Common symptoms Uncommon symptoms
Bed wetting. She cannot tolerate when other people are quarrelling.
Timid but speaks in public.
Desires spicy food

Prescription: Causticum200 HS 1dose
Basis of prescription : This case has been prescribed without repertorization as we found the substantial / peculiar symptom ( sensitive to emotional disturbances) for prescription while case taking.
Follow up’s : (written as it is expressed by father)
ï‚— 29/07/2019
Father said patient has passed urine only twice during her sleep since last week.
Complaints are better by 50%.
Prescribed Placebo BD for 15 days.
ï‚— 19/08/2019
Patient has passed urine during day sleep only once since past 10days.
No bedwetting at night since 10 days.
Appetite has improved, father said she herself asks and have food.
Patient is better by 75%.
Prescribed Placebo BD for 15 days.
ï‚— 03/09/2019
Bedwetting only once at day sleep and no bedwetting at night since 1 month.
Feeling generally better.
No fresh complaints.
Prescribed Placebo BD for 15 day.
Conclusion : Enuresis can be successfully treated with detailed homoeopathic case taking with individualised homoeopathic medicine along with encouragement, a positive attitude and motivation are important components of treatment to become dry. Punishment and criticism has no role to play in care. Children with enuresis get always benefit from a caring attitude of parents. A positive approach by the physician and care taker is also important role to play for putting confidence and to increase compliance.
References :
1. Ghai. O. P, BaggaArvind, Pual. V.K; Ghai essential paediatrics; 8th edition revised and enlarged; CBS Publications and distributors Pvt. Ltd.; NewDelhi; 2013, P-504.
2. Kliegman, M. Robert, Stanton, F. Bonita. Geme, St. Schor; Nelson Textbook of Paediatrics; 20th edition; ELSEVIER; Philadelphia; 2016;
3. http://dx.doi.org/10.5350/Sleep.Hypn.2019.21.0168. Sleep and hypnosis : a Journal of Clinical Neurosciences and Physiopathology.
From :
Dr Shashank H S
Dept of Paediatrics
PG Part 1
A M Shaikh Homoeopathic Medical College , PG Research Centre & Hospital, Belagavi.

Under the guidance of :
Dr Nahida M Mulla. M.D (HOM); MACH
Prof. and HOD Paediatrics
A M Shaikh Homoeopathic Medical College , PG Research Centre & Hospital, Belagavi.

In simple words, low back pain can be defined as pain experienced in the bottom region of spine (between lower margins of ribs and the gluteal folds). It may remain localised to back or radiate to the legs.

Sciatica is a term used for pain radiating down from the lower spine to the legs. Most common cause of sciatica is irritation or compression of the nerves as they exit the spine on their way to the legs. It may be accompanied by numbness, tingling and weakness in the distribution of the affected nerve.

Globally low back pain (LBP) is one of the leading causes of disability. LBP is an important cause of limitation of activities, absence from work with resultant economic implications. In industrialised countries lifetime prevalence of non-specific low back pain is estimated at 60–70%.Despite the high incidence and intensive research into this area, pain generators are not easy to identify and the diagnosis Nonspecific Low Back Pain is used commonly. This is different from situations where a specific cause such as fracture, infection, neoplasm etc. responsible for pain generation can be identified.