General Topics

Symptoms of Bone health and Osteoporosis | Endocrinology

What is osteoporosis?

Osteoporosis is a condition that affects the bones. Its name comes from the Latin “porous bones”. The inside of a healthy bone has tiny holes like a honeycomb. Osteoporosis increases the size of these areas, causing loss of strength and bone density. Also, the outside of the bone becomes weak and thin.

Osteoporosis can occur at any age, but it is more common in adults, especially women. More than 53 million people in the United States have or are at risk of developing osteoporosis. People with osteoporosis are at risk for fractures or fractures when they perform normal activities such as standing or walking.  The most commonly affected bones are the ribs, hips, and bones of the wrist and spine.

Bone is biological tissue that is constantly being degraded and replaced. Osteoporosis occurs when the creation of new bone does not sustain the loss of old bone. Osteoporosis affects men and women of all races. But white and Asian women, especially older menopausal women, are at the highest risk. Medications, a healthy diet, and exercise with weights can help prevent bone loss or strengthen already weak bones.

What can I do to keep my bones healthy?

You can take some simple steps to prevent or delay bone loss. For example:

Include a lot of calcium in your diet. For adults ages, 19 to 50 and for men ages, 51 to 70, the recommended daily allowance (RDA) is 1,000 milligrams (mg) of calcium per day. The recommended dose is 1200 mg per day for women over 50 and men over 70.

Good sources of calcium are dairy products, soy products like almonds, broccoli, kale, canned salmon, sardines, and tofu. If you find it difficult to get enough calcium from your diet, ask your doctor about supplements.

Take care of vitamin D Your body needs vitamin D to absorb calcium. For adults ages 19 to 70, the RDA for vitamin D is 600 international units (IU) per day. For adults 71 and older, this recommendation increases to 800 IU per day.

Good sources of vitamin D are fatty fish such as salmon, trout, white fish, and tuna. Also, mushrooms, eggs, and fortified foods such as milk and whole grains are good sources of vitamin D. Sunlight also contributes to the body’s production of vitamin D.

Include physical activity in your daily routine. Weight-bearing exercises, such as walking, jogging, and stair climbing, can help you build strong bones and decrease bone loss.

Stay away from drug abuse. Do not smoke. If you are a woman, have no more than one drink a day. If you are a man, avoid drinking more than two drinks a day.

Importance of bone health

Your bones are constantly changing: new bone is forming and old bone is breaking. As a child, your body makes new bone faster than it breaks down old bone and increases your bone mass. Most people reach bone mass in their 30s. After that, the bone reconstruction will continue, but you will lose a little more bone mass than you gained.

A condition that causes bones to become weak and brittle (how likely you are to develop osteoporosis) depends on how much bone mass you gain when you reach your 30s and how quickly you lose it after that. At your peak bone mass, you have more bone on the “bank” and are less likely to develop osteoporosis as you age.

Does it affect bone health?

Bone health is affected by many factors. For example:

The amount of calcium in your diet. A diet low in calcium contributes to a decrease in bone density, a risk of early bone loss and fractures.

Physical activity: Those who are physically inactive are at a higher risk of developing osteoporosis than their active counterparts.

Tobacco and alcohol: Research suggests that tobacco use contributes to weak bones. Similarly, more than one alcoholic drink a day for women on a regular basis or two alcoholic drinks a day for men increases the risk of osteoporosis.

Gender: If you are a woman, you are at risk of developing osteoporosis because women have less bone tissue than men.

Size: If you are very thin (with a body mass index of 19 or less) or have a small body frame, you are at risk because your bone mass is lower than your age.

Years: As you get older, your bones become thinner and weaker.

Ethnic and family history: If you are white or of Asian descent, you are at risk of developing osteoporosis. Also, having parents or siblings with osteoporosis puts you at higher risk, especially if you also have a family history of fractures.

Hormone levels: Too much thyroid hormone can cause bone loss. In women, decreasing estrogen levels can significantly increase bone loss at menopause. The absence of premenopausal amenorrhea also increases the risk of osteoporosis. In men, low testosterone levels lead to loss of bone mass.

Eating disorders and other conditions: People with anorexia or bulimia are at risk for bone loss. Also, conditions such as stomach surgery (gastrectomy), weight loss surgery, and Crohn’s disease, celiac disease, and Cushing’s disease can affect the body’s ability to absorb calcium.

Some drugs: Long-term use of corticosteroid medications such as prednisone, cortisone, prednisolone, and dexamethasone can cause bone damage. Other medications that increase the risk of osteoporosis include aromatase inhibitors, selective serotonin reuptake inhibitors, methotrexate, phenytoin (Dilantin), and some anti-seizure medications such as phenobarbital and proton pump inhibitors to treat breast cancer.

Symptoms of osteoporosis

In general, there are no symptoms of osteoporosis. This is why it is sometimes called a silent disease. However, you should look for the following:

  • Loss of height (decrease of an inch or more)
  • Change of posture (stooping or leaning forward)
  • Piri of respiration (capacity of the small lungs due to compressed discs)
  • Bone fractures
  • Pain in the lower back

Causes of osteoporosis

Your bones are in a constant state of restoration: new bone is formed and old bone is broken. When you are a child, your body makes your bone faster than it breaks an old bone, and your bone mass increases. This process slows down in their early 20s, and most people reach their peak bone mass in their 30s. As people age, bone mass is lost faster than it was created.

How likely you are to develop osteoporosis depends on the amount of bone mass you have achieved as a youth. Peak bone mass is inherited in some way and the species group also varies. At your peak bone mass, you have more bone on the “bank” and are less likely to develop osteoporosis as you age.

Risk factors of osteoporosis

There are many risk factors that increase your chances of developing osteoporosis, two of which are sex and age.

Osteoporosis is a disorder that affects more and more people. However, women over the age of 50 or postmenopausal women are at higher risk of osteoporosis. During the first 10 years after menopause, women experience a rapid loss of bone mass because menopause reduces the production of a hormone called estrogen, which protects against excessive loss of bone mass.

Age and osteoporosis affect men too. You might be surprised that men over the age of 50 are more likely to develop osteoporosis-induced fractures than those with prostate cancer. An estimated 80,000 men a year break their hips and women are more likely to die in the year following a hip fracture.

The risk of developing osteoporosis is also related to race. Caucasian and Asian women are more likely to develop osteoporosis. However, African American and Hispanic women are still at risk. In fact, African American women are more likely than white women to die after a hip fracture.

Another factor is bone structure and body weight. Small and thin people are at higher risk of developing osteoporosis because they lose less bone than people with higher body weight and larger frames. Family history also influences the risk of osteoporosis. If your parents or grandparents have signs of osteoporosis, such as a broken hip after a minor fall, you are at risk for the disease.

Finally, certain medical conditions and medications can increase your risk. If you have any of the following conditions, some of which are related to irregular hormone levels, you and your healthcare provider may want to consider screening for osteoporosis.

  • An overactive thyroid, parathyroid, or adrenal glands.
  • History of bariatric surgery (weight loss) or organ transplantation.
  • History of hormone therapy or missed periods due to breast or prostate cancer.
  • Celiac disease or inflammatory bowel disease.
  • Blood diseases such as multiple myeloma.

Some medications can cause side effects that can damage bones and lead to osteoporosis. These include steroids, breast cancer treatments, and medications to treat seizures. You should talk to your healthcare provider or pharmacist about the bone effect of your medication.

Each risk factor may seem related to something beyond your control, but it is not. You have control over some of the risk factors for osteoporosis. You can discuss drug-related problems with your healthcare provider. And you are responsible for:

Eating habits: If your body does not have enough calcium and vitamin D, you are more likely to develop osteoporosis. Although eating disorders such as bulimia or anorexia are risk factors, they can be treated.

Lifestyle: People who lead a sedentary (inactive) lifestyle are at risk of developing osteoporosis.

Tobacco use: Smoking increases the risk of cracking.

Alcohol consumption: having two drinks (or more) a day increases the risk of osteoporosis. 

Treatment for osteoporosis

If your test reveals that you have osteoporosis, your doctor will work with you to create a treatment plan. Your doctor can also prescribe medications and lifestyle changes. These lifestyle changes can increase your intake of calcium and vitamin D, as well as get adequate exercise.

There is no cure for osteoporosis, but proper treatment can help protect and strengthen your bones. These treatments can help slow bone breakdown in your body, and some treatments can increase the growth of new bone.

Medications for osteoporosis: The most common medicine used to treat osteoporosis is called bisphosphonates. Bisphosphonates are used to prevent bone loss. They can be taken orally or by injection. Among them are:

  • Alendronate (Fosamax)
  • Ibandronate (Boniva)
  • Rhysdronate (octonel)
  • Zoledronic acid (regeneration)
  • Other medications can be used to prevent bone loss or to stimulate bone growth. Among them are:
  • Testosterone
  • In men, testosterone treatment can help increase bone density.

Hormonal therapy: For women, the estrogen used during and after menopause can help reduce bone density. Unfortunately, estrogen therapy also increases the risk of blood clots, heart disease, and some types of cancer.

  • Raloxifene (Evista)
  • Although there is still a risk of blood clots, these drugs have been found to provide the benefits of estrogen without much risk.
  • Denosumab (Prolia)
  • This injection is given by injection and is more promising than bisphosphonates in reducing bone loss.
  • Teriparatide (Forteo)
  • This medicine is also given by injection and stimulates bone growth.
  • Calcitonin Salmon (Fortical and Miocalcin)
  • This medicine is taken as a nasal spray and reduces bone resorption. Talk to your doctor about the risk of cancer with this drug.
  • Romosozumab (evidence)

The drug was approved by the FDA in April 2019 to treat women experiencing menopause and at risk of fractures.

12 medications are given under the skin in two injections (in one session) once a month for 12 months or less. It has a “black box” warning because it increases the risk of heart attack or stroke, so it is not recommended for people with a history.

Natural remedies for osteoporosis: Since osteoporosis medications can cause side effects, you can try other treatments instead of medications. Many supplements such as red clover, soy, and black cohosh can be used to help promote bone health.

However, before using these supplements, be sure to speak with your doctor or pharmacist. This is for two main reasons. There are very few studies to support the use of these substances in the treatment of osteoporosis. As a result, we have no evidence that they work.

These medications can cause side effects in addition to interacting with the medications you are taking. You need to make sure you know what side effects are occurring and if you are taking medications that can interact with the supplement.

All of them report good results with natural treatments.

Exercises for osteoporosis: What you can do to help keep your bones healthy is not the right thing to do. Exercise is very important, especially exercises with weights.

Weight-bearing exercises involve placing your feet or hands on the floor or another surface. Examples:

  • Climbing stairs
  • Leg presses
  • Squats
  • Lizards
  • Resistance bands
  • Dumbbells
  • Heavy-duty exercise machines

These exercises help because they make your muscles push and pull on your bones. This action tells your body to form new bone tissue, which makes your bones stronger.

This isn’t your only benefit from exercise, however. In addition to its many positive effects on weight and heart health, exercise can also improve your balance and coordination, which can help you avoid falls.

Prevention of osteoporosis

Your bones need good nutrition and regular exercise to stay healthy throughout your life.

Protein: Protein is one of the building blocks of bones. However, there is conflicting evidence on the effect of protein intake on bone density. Most people eat a lot of protein in their diet, but some don’t. Vegetarians and vegans can deliberately get enough protein in their diet if they want adequate sources such as soy, nuts, legumes, seeds for vegetarians and vegans, and dairy and eggs for vegetarians.

Older people can eat less protein for a number of reasons. If you think you are not getting enough protein, ask your doctor if supplementation is an option.

Bodyweight: Being underweight increases your risk of bone loss and fractures. Being overweight now increases your risk of arm and wrist fractures. Therefore, maintaining appropriate body weight is good for your bones, as well as your overall health.

Calcium: Women between the ages of 18 and 50 need 1,000 milligrams of calcium per day. This daily increase to 1,200 milligrams when women turn 50 and men turn 70.

  • Good sources of calcium
  • Low-fat dairy products
  • Dark green leafy vegetables
  • Canned salmon or sardines with bones
  • Soy products like tofu
  • Calcium-fortified whole grains and orange juice

If you find it difficult to get enough calcium from your diet, consider taking calcium supplements. However, too much calcium is associated with kidney stones. Although it is not yet clear, some experts suggest that calcium may increase the risk of heart disease, especially in supplements.

The Department of Health and Medicine of the National Academy of Sciences, Engineering, and Medicine (formerly Institute of Medicine) recommends that total calcium intake, including supplements and diet, should not exceed 2,000 milligrams per day for those over 50 years.

Vitamin D: Vitamin D improves your body’s ability to absorb calcium and improves bone health in other ways. People can get some of their vitamin D from sunlight, but it is not a good source if you live in high latitude, are at home, or use sunscreen regularly, or avoid the sun due to the risk of skin cancer.

To get enough vitamin D to maintain bone health, it is recommended that adults ages 51 to 70 take 600 international units (IU) and 800 IU after age 70 through diet or supplements. Those who have no other sources of vitamin D and especially those with limited sunlight need supplementation. Most multivitamin products contain 600 to 800 IU of vitamin D. Up to 4,000 IU of vitamin D per day is safe for most people.

Exercise: Exercise can help you build strong bones and slow them down. Exercise can benefit your bones when you start out, but there are many benefits to you if you start exercising regularly as a child and continue to exercise throughout your life.

Combine strength training exercises with weight lifting and balance exercises. Strength training can help strengthen the muscles and bones in your arms and upper spine. Weight-bearing exercises (walking, jogging, running, stair climbing, rope skiing, skiing, and impact sports) primarily affect the legs, hips, and backbones.

Balance exercises like tai chi reduce the risk of falls, especially as you age. Swimming, cycling, and exercising on machines like ellipticals provide good cardiovascular exercise, but they do not improve bone health.

General Topics

Symptoms of Thyroid Diseases in Women | Endocrinology

What is the thyroid?

Thyroid disease affects the thyroid gland, a small butterfly-shaped gland at the base of your neck, below Adam’s apple. This gland produces thyroid hormone that travels in your blood to all parts of your body. Thyroid hormone panels your body’s metabolism in many ways, including how fast you burn calories and how fast your heartbeats.

How does thyroid disease affect women?

Women are more probable than men to have thyroid disease. One in eight women will develop thyroid problems in her lifetime. In women, thyroid disease can cause:

  • Problems with your menstrual period. Your thyroid helps control your menstrual cycle. Too ample or too little thyroid hormone can make your periods very light, heavy, or irregular. Thyroid disease can also cause your periods to stop for numerous months or more, a condition called amenorrhea. If your body’s immune system causes thyroid disease, other glands, with the ovaries, may be involved. This can main to early menopause (before age 40).
  • Trouble receiving pregnancy When thyroid disease affects the menstrual cycle, it also affects ovulation. This can make it difficult for you to get pregnant.
  • Problems during pregnancy. Thyroid problems during pregnancy can cause health glitches for mother and baby.
  • Sometimes the symptoms of thyroid problems are confused with those of menopause. Thyroid disease, especially hypothyroidism, is more probable to develop after menopause.

Causes of thyroid disease in women

All types of hyperthyroidism are due to an overproduction of thyroid hormones, but the condition can occur in a number of ways:

Graves’ disease: Production of too much thyroid hormone.

Toxic adenomas: Nodules develop in the thyroid gland and begin to secrete thyroid hormones, upsetting the chemical balance of the body, some goiters may contain several of these nodules.

Subacute thyroiditis: Inflammation of the thyroid causes the gland to “lose” excess hormones, resulting in temporary hyperthyroidism that usually lasts for a few weeks but can persist for months.

Malfunction of the pituitary gland or cancerous growths in the thyroid gland: Although rare, hyperthyroidism can also develop from these causes.

Hypothyroidism, on the other hand, is due to an underproduction of thyroid hormones. Since your body’s energy production requires certain amounts of thyroid hormones, a decrease in hormone production leads to lower energy levels. The causes of hypothyroidism include:

Hashimoto’s thyroiditis: In this autoimmune disorder, the body attacks the thyroid tissue. The tissue eventually dies and stops producing hormones.

Thyroid gland removal: The thyroid may have been surgically removed or chemically destroyed.

Exposure to excessive quantities of iodide: Cold and sinus medications, heart medication amiodarone, or certain contrast dyes given before some X-rays can expose you to too much iodine. You may have a higher risk of developing hypothyroidism if you have had thyroid problems in the past.

Lithium: This drug has also been concerned as a cause of hypothyroidism.

Symptoms of thyroid disease in women

There are a variety of symptoms that you might experience if you have thyroid disease. Unfortunately, the symptoms of a thyroid condition are often very similar to the signs of other medical conditions and stages of life. This can make it difficult to know if your symptoms are related to a thyroid problem or something else entirely.

For the most part, the symptoms of thyroid disease can be alienated into two groups, those related to having too much thyroid hormone (hyperthyroidism) and those related to having too little thyroid hormone (hypothyroidism).

Symptoms of an overactive thyroid (hyperthyroidism) can include:

  • Experiencing anxiety, irritability, and nervousness
  • Having trouble sleeping
  • Lose weight
  • Have an enlarged thyroid gland or goiter
  • Have muscle weakness and tremors
  • Having irregular menstrual periods or stopping your menstrual cycle
  • The sensation of sensitivity to heat
  • Have vision problems or eye irritation

Symptoms of an underactive thyroid (hypothyroidism) can include:

  • Feeling tired (fatigue)
  • Winning weight.
  • Experience oblivion
  • Have frequent and heavy menstrual periods
  • Have dry and rough hair
  • Have a hoarse voice
  • Experiencing intolerance to low temperatures

Who is affected by thyroid disease?

Thyroid disease can affect anyone. Men, women, infants, adolescents, and the elderly. It can be present at birth (typically hypothyroidism) and can mature with age (often after menopause in women).

Thyroid disease is very common, and an assessed 20 million people in the United States have some type of thyroid disorder. A woman is five to eight times more likely to be diagnosed with thyroid disease than a man.

You may be at higher risk of developing thyroid disease if:

  • You have family antiquity of thyroid disease
  • You have a medical condition (which may include pernicious anemia, type 1 diabetes, primary adrenal insufficiency, lupus, rheumatoid arthritis, Sjögren’s syndrome, and Turner’s syndrome)
  • Take medicine that is high in iodine (amiodarone)
  • They are over 60 years old, especially in women
  • You have had treatment for a thyroid condition or cancer in the past (thyroidectomy or radiation)

Risk factors of thyroid disease in women

Risk factors include:

  • Family history: Having a family member with autoimmune thyroid disease
  • Age: Hypothyroidism can start at any age, but the risk continues to increase as people age
  • Gender: Hypothyroidism is more common in women than in men. It is much more communal in new women than young men, but as men get older, they start to catch up
  • Race: Hypothyroidism is common in Caucasians and Asians. African Americans are at lower risk
  • Presence of other autoimmune disorders
  • Down syndrome or Turner syndrome

Thyroid disease after pregnancy

  • Up to 1 in 10 women develop postpartum thyroiditis, an inflammation of the thyroid several months after giving birth.
  • When the thyroid becomes inflamed, it can leak hormones, making it slightly hyperthyroid (when the gland overproduces thyroid hormone).
  • Then when you run out of thyroid hormone, you can develop hypothyroidism until your gland heals.
  • The symptoms can be very subtle. Some women lose weight; others feel anxious.
  • You could blame these things on being a new mom. But if the diagnosis is missed, it is generally not critical. If it’s really mild, just look at it. In most women, it all resolves in several months.
  • If it’s severe, you may need treatment for symptoms.
  • In most women, the hyperthyroid and hypothyroid phases last for several weeks.
  • But not all women experience both phases. About 5% of women will be left-hand with permanent hypothyroidism.
  • It tends to recur in later pregnancies and is also more common in women with autoimmune diseases.

Treatment for thyroid disease

You take a synthetic version of thyroid hormone in a pill to replace what your body doesn’t make.

Diagnosis of thyroid disease

In addition to a complete medical history and physical exam, specialized tests are used to diagnose thyroid disorders. Blood tests are usually done to measure the levels of thyroid hormones and TSH. Your doctor may also order blood tests to identify antibodies against thyroid tissue, such as antithyroglobulin, anti thyroperoxidase, or TSH receptor stimulant antibody titers.

Imaging tests are commonly used when there are thyroid nodules or enlargement. Ultrasound can visualize the constancy of the tissue within the gland and can often reveal cysts or calcifications. Ultrasound examination cannot distinguish a benign process from a malignant one.

Radioactive iodine scans of the thyroid are often done to evaluate the function of thyroid nodules. The thyroid is the only place in the body that absorbs iodine, so when radiolabelled iodine is administered, it is absorbed by the thyroid gland. An imaging test typically shows radioactive iodine uptake by normal thyroid tissue.

Areas or nodules that produce excess hormones (known as hyperfunction) will show increased absorption of iodine. These are known as nodules or “hot” areas. In contrast, so-called “cold” nodules represent areas with decreased iodine uptake. The “cold” nodules do not produce excess hormones and can sometimes represent cancer.

Fine needle aspiration and biopsy are techniques that remove a taster of cells or tissue from the thyroid gland for inspection and diagnosis by a pathologist, who is a physician trained in the diagnosis of conditions based on tissue samples. Fine needle aspiration (FNA) uses a long, thin needle to remove a sample of cells from the thyroid. FNA can be done in the doctor’s office. Sometimes ultrasound images are used to guide the FNA procedure. A biopsy is the surgical sampling of tissue.


Preparation of Slit Lamp Exam | Procedure | Ophthalmology

What is the slit lamp exam?

The slit lamp examination is a standard diagnostic procedure, also known as biomicroscopy. A slit lamp combines a microscope with very bright light. The slit lamp exam is usually part of a comprehensive eye exam. The individual will sit in a chair in front of the slit lamp with the chin and forehead supported by a support.

The doctor can use this instrument to observe the eyes in detail and determine if there are any abnormalities. They will be able to discuss the results with the person right away.

Uses of slit lamp examination

Doctors use the slit lamp as part of a comprehensive eye exam to better look at the structures within a person’s eyes. These include the following:

  • Conjunctiva: The conjunctiva is a thin, transparent membrane that covers the white of the eye. It also includes the membranous surface of the inner lids.
  • Cornea: The cornea is the transparent cover of the iris and pupil. It protects the eye and also helps send light through the pupil to the retina at the back of the eye.
  • Eyelids: The eyelids help protect the eyeball from debris or injury. Blinking helps lubricate the eye and prevent it from drying out.
  • Iris: the iris is the coloured portion of the eye. It controls the quantity of light that arrives in the eye by contracting and dilating the pupil.
  • Pupil: The pupil is the black spot in the middle of the eye. It occupancies light to enter the eye and travel to the retina.
  • Lens: The lens is placed behind the iris and focuses light on the retina.
  • Sclera: The sclera is the white portion of the eye. It consists of relatively strong fibrous tissue that helps provide structure and protection to the rest of the eye.
  • Retina: The retina is the tissue in the eye that contains cells that detect light. These cells join nerves that eventually join to form the optic nerve.

Process undergoing slit lamp examination

After the first look into your eyes, your doctor may apply a special dye called fluorescein to make the exam easier. It will be given as an eye drop or on a small, thin strip of paper that touches the white of the eye. The doctor will then manage a series of eye drops that will dilate the pupils. Enlargement will make it easier for the doctor to see the other structures in the eye. The drops take about 20 minutes to work.

Once the person has dilated pupils, the doctor will repeat the eye exam. This period they will grip a particular lens close to the eye.
The procedure does not hurt, although there may be a brief sting during the application of the eye drops. Dilated pupils develop very large, which can make the eyes sensitive to light. This can make driving or outlay time outside painful. However, the eye drops should garb off within a combine of hours, and wearing sunglasses should help during this period.

Slit lamp exam preparation

There is no special preparation for this test. If the doctor plans to dilate the pupils, the person may want to wear sunglasses and arrange a trip home after the test.

Risk factors in the slit lamp exam

A slit lamp exam is generally very safe, although medications that dilate the pupils carry some risks. They can increase eye pressure, causing nausea and eye pain. Anyone experiencing these symptoms should inform a doctor immediately.

Types of slit lamp exam

Other common eye exams include:

Wood’s lamp examination

Wood’s lamp projects ultraviolet light into the eye to reveal any abrasions or scratches on the cornea. Doctors can use this if a slit lamp is not available.

Fundus examination

During a fundus exam, the doctor will use an ophthalmoscope to look inside the eye. Some will use a direct ophthalmoscope, which is a small hand-held instrument with a light on. However, most doctors will use an indirect ophthalmoscope, as they can wear it on the head and it gives them a wider field of view for the exam. The patient will be asked to look into the distance while using the device to examine the internal structures of the eye.


For this process, the doctor will first administer numbing eye drops. The person will sit with their head supported by the slit lamp microscope, and the doctor will place a special contact lens directly over the eyeball. Happens during a slit lamp exam.

You do not need to prepare in advance for a slit lamp exam. Once you are in the exam chair, the doctor will place an instrument in front of you to support your chin and forehead. This helps stabilize the head for the exam. Your ophthalmologist may put drops in your eyes to make any abnormalities on the corneal surface more visible. The drops contain a yellow dye called fluorescein, which washes away tears. Additional drops may also be put in your eyes to allow your pupils to dilate or enlarge.

The doctor will use a low-power microscope, along with a slit lamp, which is a high-intensity light. They will look you in the eye closely. The slit lamp has different strainers to get different views of the eyes. Some doctor’s offices may have devices that detention digital images to track variations in the eyes over time.

Throughout the test, the doctor will examine all areas of your eye, including:

  • Eyelids
  • Conjunctiva
  • Iris
  • Lens
  • Sclera
  • Cornea
  • Retina
  • Optic nerve

Diagnosis in the test

A slit lamp exam can help diagnose the following circumstances:

  • Macular degeneration, a chronic condition that affects the part of the eye responsible for central vision.
  • Detached retina, a condition in which the retina, which is a main layer of tissue at the back of the eye, is shed from its base.
  • Cataracts, a clouding of the lens that damagingly affects the ability to see images visibly.
  • Corneal injury, an injury to one of the tissues that cover the surface of the eye.
  • Retinal vessel obstructions, obstructions in the blood vessels of the eye that can cause a sudden or gradual loss of vision.

Ask your doctor what you are looking for during the exam and what eye conditions you may be at risk for. This test usually has no major side effects. Your eyes may be sensitive to light for a time afterwards, especially if your pupils were dilated. If you start to feel nauseous or have pain in your eyes, return to your doctor’s office as soon as possible. These may be symptoms of increased fluid pressure in the eye, which can be a medical emergency. While the risk of this is small, eye drops used to dilate the eye can rarely cause this to occur.

Abnormal results mean

If the results of your slit lamp exam are abnormal, there can be a variety of conditions, including:

  • Infection
  • Inflammation
  • Increased pressure in the eye
  • Degeneration of the arteries or veins of the eye

For example, if macular degeneration is occurring, the doctor may find drusen, which are yellow deposits that can form in the macula at the beginning of age-related macular degeneration. If your doctor suspects a particular cause of vision problems, she may recommend more tests to get a more definitive diagnosis.


What is Computed Tomography (CT Scan) | Endocrinology

What is computed tomography (CT Scan)?

Computed tomography (CT) is an imaging procedure that uses specialized x-ray equipment to create detailed images or scans of areas inside the body. This is sometimes called a computed tomography or computerized axial tomography (CT) scan.

The word tomography comes from the Greek words tomes (a cut, slice, or section) and graphene (to write or record). Each image created by the CT procedure shows organs, bones, and other tissues in a thin “piece” of the body. All pieces of images produced in CT are like slices of bread – you can view each slice individually (two-dimensional images) or you can view the entire bar (three-dimensional image). Computer programs are used to create both types of images.

Modern CT machines take continuous images in a helical (or spiral) fashion rather than taking a series of images of individual parts of the body, just like the original CT machines. Helical City (also known as Spiral City) has several advantages over older City techniques: it is faster, produces quality 3D images of areas of the body, and can better detect minor abnormalities.

In addition to its use in cancer, CT is widely used in the diagnosis of diseases and conditions of the circulatory (blood) system such as coronary artery disease (atherosclerosis), vascular aneurysms, and blood clots; Spinal conditions; Stones in the kidneys and bladder; Bulbs Inflammatory diseases such as ulcerative colitis and sinusitis.

And injuries to the head, skeletal system, and internal organs. Computed tomography is also used to detect abnormal brain function or deposits in adult patients with cognitive impairment who are being evaluated for Alzheimer’s disease and other causes of cognitive impairment.

Uses of computed tomography

It is useful for:

  • Soft fabric
  • Pelvis
  • Blood vessels
  • Light
  • Abdomen
  • Bones
  • CT is often the preferred way to diagnose many cancers such as liver, lung, and pancreas.

The image allows the doctor to determine the presence and location of the tumor, its size, and how much nearby tissue is affected. A head scan provides important information about the brain, such as whether there is bleeding, arterial swelling, or a tumor.

The CT scan reveals a tumor in the abdomen and any swelling or inflammation in nearby internal organs. It shows the layers of the spleen, kidneys, or liver. Because a CT scan detects abnormal tissue, it can be used to plan for radiation therapy and biopsy, and it provides valuable data on blood flow and other vascular conditions.

It helps the doctor to assess bone diseases, bone density, and the condition of the patient’s spine. It also provides important data on injuries to the patient’s arms, legs, and other skeletal structures. Small bones are also clearly visible, as is the tissue around them.

Risk Factors of CT Scan (computed tomography)

A CT scan contains a small dose of targeted radiation. This level of radiation has not been shown to be harmful even in people who have had multiple scans. The risk of cancer as a result of a CT scan is estimated to be less than 1 in 2,000. The amount of radiation to which a person is exposed is estimated to be equivalent to several months and several years of natural exposure in the environment.

The scan is done only if there is a clear medical reason to do it. The results lead to treatment for serious conditions. By deciding to have a scan, doctors make sure the benefits outweigh any risks. Problems that arise from radiation exposure include cancer and thyroid problems.

It is very rare in adults and not even in children. However, it is more prone to the effects of radiation. This does not mean that health problems occur, but any CT scan should be noted in the child’s medical record. In some cases, a CT scan will only show the required results. For some conditions, an ultrasound or MRI scan may be done.

CT scan is during pregnancy?

Any woman who suspects that she is pregnant should inform her doctor in advance, as there is a risk that the X-rays will harm the fetus. Citing the American College of Radiography, the American Pregnancy Association (APA) states that “radiation dose should not be included in any diagnostic radiograph until it has adverse effects on the fetus or developing fetus.”

However, the APA states that CT scans are not recommended for pregnant women, “unless the benefits clearly outweigh the risk.”

Breastfeeding after CT scan

If breastfeeding requires an iodinated intravenous dye instead of breastfeeding, you should avoid breastfeeding for about 24 hours while the mother is breastfeeding.

Differences between CT Scan and MRI are

  • The CT scan uses X-rays, but an MRI uses magnets and radio waves.
  • Unlike an MRI, a CT scan does not show tendons or ligaments.
  • MRI is good for examining the spinal cord.
  • CT scan is well suited to cancer, pneumonia, abnormal chest x-rays, bleeding in the brain, especially after an injury.
  • The brain tumor is more clearly visible on MRI.
  • CT scan shows organ tears and injuries more quickly, so it is more suitable for injury cases.
  • On a CT scan, the broken bones and vertebrae are more clearly visible.
  • CT scans provide a better image of the lungs and organs in the chest cavity between the lungs.

Preparation of CT scan

When you schedule your CT scan, the hospital or center staff will tell you how to prepare.

What to eat: The staff may instruct you to drink only clear liquids starting at midnight before your appointment. They may also tell you not to eat or drink for at least 4 hours before the scan. For the scans of certain parts of the body, it is better to eat and drink at any time before. Ask your healthcare team for specific instructions for your test.

What to wear: Wear loose-fitting clothing without zippers or metal buttons. All clothing that contains metal and affects the examination should be removed. This includes shirts, bras, and glasses with belts, earrings, snaps, or zippers. If you cannot wear your clothes during the scan, you can wear a hospital gown.

If you need a contrast medium for the scan: You may need a contrast medium when scanning. If so, your doctor may ask you to have a blood test to monitor your kidney function. You can always have a blood test a few weeks before the scan.

Personal medical history or concerns: Be prepared to talk to your healthcare team about these things:

  • All the medications you are taking.
  • If you have a medical problem such as diabetes.
  • Do you have any drug or food allergies?
  • Any allergic reaction to iodine you may have had in the past.
  • Should you take your usual medication on the day of the scan?
  • You may be breastfeeding or pregnant. A CT scan puts the baby at risk.
  • If you have a problem with the test.

Insurance, expenses, and compliance: If you are concerned about the cost of your CT scan, find out ahead of time what your insurance provider will cover. Ask how much you will have to pay. Once you arrive at the doctor’s office or hospital, the staff will ask you to sign a consent form. This form indicates that you understand the advantages and disadvantages of the scan and that you agree to have it.

During the CT scan

  • The patient must lie on a motorized examination table that slides into a donut-shaped CT scanner.
  • In most cases, the patient lies on his back and on his back. But sometimes they have to lie on their stomach or side.
  • After an X-ray image, the bed is moved slightly and then the machine takes another image and. The patient must lie a lot for the best results.
  • During the examination, everyone except the patient leaves the room. The intercom allows two-way communication between the radiographer and the patient.
  • If the patient is a child, parents or adults can stand or sit nearby but should wear a lead apron to avoid radiation exposure.

After a CT scan

If a contrast dye is used in your procedure, it will be monitored over a period of time for side effects or adverse reactions, such as itching, swelling, a rash, or trouble breathing. If you notice any pain, redness, and/or swelling at the IV site after returning home from your procedure, you should inform your doctor as it may indicate an infection or other type of reaction.

Generally, no special care is required after a CT scan. You can resume your normal diet and activities unless your doctor tells you otherwise. Your doctor may give you additional or alternative instructions after the procedure, depending on your specific situation.


Why the Applanation Tonometry is done? | Ophthalmology

What is applanation tonometry?

Applanation Tonometry test measures the amount of pressure it takes to flatten a part of the cornea. Pressure readings help your doctor diagnose and track glaucoma. He will give you drops to numb your eye, then press lightly with a tool called a tonometer.

Why is applanation tonometry done?

Your eyes are full of different fluids that keep them healthy. New fluid is constantly being produced and the old fluid is drained. But if this drainage system becomes clogged, fluids build up. This increases the pressure inside the eyes.

Sometimes the pressure is due to an eye injury or trauma. Once your eye heals, everything will return to normal. But some people have a drainage system that doesn’t work the way it should.

Over time, the high pressure inside your eye can damage your optic nerve, which sends images from your eyes to your brain. If left untreated, it can cause glaucoma.

Since the disease usually has no symptoms, it is a good idea to have regular eye exams. Your ophthalmologist will monitor your eye pressure using a tonometry test. You can also track pressure changes over time.

Anyone can get glaucoma, but your chances are higher if:

  • You are over 40
  • You have a family member with glaucoma
  • Are African, Hispanic, or Asian
  • You have had an eye injury
  • You have hyperopia or myopia
  • You have been told that your corneas are thin in the middle
  • Do you have diabetes?
  • You have migraines
  • You have circulation problems (blood flow)

When applanation tonometry is done?

A normal test result means that the pressure in your eye is within the normal range and that you do not have glaucoma or other pressure-related eye problems. Conferring to the Glaucoma Research Substance, the normal pressure range is 12 to 22 mm Hg. The measurement “mmHg” stands for “millimetres of mercury”, which are the units used to record eye pressure.

If your test comes back with a pressure reading greater than 20 mm Hg, you may have glaucoma or pre-glaucoma. This is not always the case. Your test result may also show high blood pressure if you have had an eye injury or if you have bleeding in the front of the eye caused by blood vessel problems, inflammation, or other problems. Your doctor will discuss treatment options with you if you are diagnosed with glaucoma or pre-glaucoma.

Applanation tonometry procedure

Before the tonometry test, your ophthalmologist will put numbing drops in your eyes so you don’t feel like anything is touching them. Once your eye is numb, your doctor may touch the surface of the eye with a small, thin strip of paper that contains orange dye to tint it. This helps increase the accuracy of the test.

Then your doctor will place a machine called a “slit lamp” in front of you. It will support your chin and forehead on the supports provided. The lamp will then move towards your eyes until only the tip of the tonometer probe touches your cornea. By slightly flattening the cornea, the instrument can detect pressure in the eye. Your ophthalmologist will adjust the tension until you get an adequate reading.

Because your eyes are numb, you will not feel pain during the procedure. Tonometry is extremely safe. However, there is minimal risk that your cornea will be scratched when the tonometer touches your eye. However, even if this happens, it will usually heal in just a few days.

Complications of applanation tonometry

Corneal abrasion, aggravation of ocular globe rupture, the transmission of infections, and reaction to ocular drugs are possible complications of tonometry. The risk of these complications is considerably low (less than 1%).

Risk factors

Accurate and precise IOP readings are imperative to assess a patient’s risk of progressive optic nerve damage. Inaccurate or inconsistent IOP measurements prevent the clinician from making accurate decisions about treatment and management and can put the patient at risk for visual field loss.


Dexamethasone Suppression Test (DST) | Endocrinology

What is the Dexamethasone Suppression Test (DST)?

The dexamethasone suppression test measures the response of the adrenal glands to ACTH. Dexamethasone is given and cortisol levels are measured. Cortisol levels should decrease in response to dexamethasone administration. This test measures cortisol before and after dexamethasone to see if your cortisol levels are under normal physical control. In normal individuals, cortisol levels must be suppressed in a “post” pattern.

There are no dietary requirements for this test. You must make an appointment. To find your closest Collection Center and to make an appointment, please refer to your request form, visit our Collection Center locations or visit Telephone Patient Assistance at 1300 732 030.

You must report to the exam at the Collection Center at 9 am for two consecutive hours. If your doctor does not prescribe a dose, you will be given two tablets (1 mg dexamethasone) on the first day at 11 pm. The tablets should be stored in a cool, dark place until taken. If you take the tablets at 11 a.m. On the second day, the collector will certify with you if necessary.

Why do the dexamethasone suppression test?

This test is done when excessive cortisol production is suspected. Low-dose tests can help differentiate healthy people from those who produce more cortisol. An overdose test can help detect abnormalities in the pituitary gland (Cushing’s disease).

ACTH secretion from the pituitary gland is usually regulated by the level of cortisol in the blood plasma. ACTH stimulates the adrenal cortex to produce cortisol. As plasma cortisol levels rise, ACTH secretion is suppressed. ACTH increases as cortisol levels decrease.

Dexamethasone is a synthetic cortisol-like steroid that suppresses ACTH secretion in the general population. Therefore, giving dexamethasone lowers ACTH levels, resulting in lower cortisol levels. People with pituitary glands that produce high levels of ACTH have an abnormal response to a low dose test but have a normal response to a high dose.

Common values:

Low dose:

  • Overnight: 8 a.m. Plasma cortisol <5 mcg / dl
  • Dose: Day 3 <10 mcg / day Urine free cortisol


  • Overnight:> 50% reduction in plasma cortisol
  • Criterion:> 90% reduction in urinary free cortisol

Normal value ranges may vary slightly in different laboratories.

When is a high-dose dexamethasone suppression test needed?

With the occasional pituitary form of Cushing’s disease, cortisol does not suppress blood levels (because the negative feedback loop is more resistant to the effects of synthetic cortisol). Therefore, a dexamethasone overdose (high dose dexamethasone suppression test) is required to overcome this resistance and demonstrate a negative feedback approach.

Cushing’s disease caused by an adrenal gland tumor is resistant to the effects of low and high doses of dexamethasone. Therefore, the decrease in blood cortisol levels after the use of low and high doses of dexamethasone suppression test may support the adrenal origin of Cushing’s disease.

In summary, if cortisol levels are reduced 4 and / or 8 hours after the dose of dexamethasone, we have identified Cushing’s disease of pituitary origin. If the levels do not deviate from the high values ​​of the pre-injection sample, then the diagnosis is of adrenal origin. 

Preparation for the dexamethasone suppression test

Before the dexamethasone suppression test, your doctor will instruct you to stop taking certain prescriptions that can affect the results. In addition to:

  • Birth control pills
  • Barbiturates
  • Phenytoin, which is used to treat seizures.
  • Corticosteroids
  • Estrogens
  • Spironolactone, which is used to treat circulatory cirrhosis, ascites, or kidney problems.
  • Tetracycline, which is an antibiotic.

How is the dexamethasone suppression test performed?

Two variants of the dexamethasone suppression test are the low-dose test and the high-dose test. Both forms of testing can be done overnight or over a three-day period. The standard test for both is a three-day trial. During both forms of testing, your healthcare provider will administer a certain amount of dexamethasone and then measure your cortisol levels. A blood sample is also required.

Blood sample

Blood is drawn from a vein on the inside of the lower arm or on the back of the hand. First, your healthcare provider will clean the site with disinfectant. They wrap an elastic band around your upper arm to make the vein fill with blood, making it more visible. Next, your healthcare provider will insert a fine needle into the vein and collect a blood sample in a tube attached to the needle. The band is removed and gauze is applied to the site to prevent further bleeding.

Low-dose night test

  • Your doctor will give you 1 milligram of dexamethasone at 11 p.m.
  • A blood sample will be taken at 8 am the next morning to test your cortisol levels.
  • Low-dose standard test
  • Collects urine samples in three days and stores them in collection bottles 24 hours a day.
  • On the second day, your doctor will give you 48 mg of oral dexamethasone every six hours for 48 hours.

Night overdose test

  • Your healthcare provider’s test measures your cortisol levels in the morning.
  • You will be given 8 milligrams of dexamethasone at 11 PM.
  • Your healthcare provider will take a blood sample at 8 a.m. to measure your cortisol levels.

Standard overdose test

  • Collects urine samples in three days and stores them in containers for 24 hours.
  • On the second day, your healthcare provider will give you 2 milligrams of oral dexamethasone every 6 hours for 48 hours.

Understand the results of the dexamethasone suppression test

An abnormal low-dose test result indicates that you are experiencing excessive cortisol release. This is called Cushing’s syndrome. This disorder produces ACTH due to an adrenal tumor, a pituitary tumor, or a tumor in another part of the body. The results of overdose tests can help isolate the cause of Cushing’s syndrome.

High cortisol levels can also be caused by other conditions, including:

  • Heart attack
  • Heart failure
  • Poor diet
  • Septicemia
  • The most active thyroid gland
  • Anorexia nervosa
  • Disappointment
  • Untreated diabetes
  • Alcoholism

What are the risk factors of the dexamethasone suppression test?

As with any blood draw, there is a risk of minor injury at the injection site. In rare cases, the vein may swell after blood is drawn. This condition, called phlebitis, can be treated with warm compresses several times a day. Ongoing bleeding can be a problem if you have a bleeding defect or are taking blood thinners such as warfarin (a staple product) or aspirin.


Oral Glucose Tolerance Test (OGTT) | Endocrinology

What is the Oral Glucose Tolerance Test (OGTT)?

  • The oral glucose tolerance test (OGTT) is the gold standard for diagnosing type 2 diabetes.
  • During pregnancy, it is still used to diagnose gestational diabetes.
  • With an oral glucose tolerance test, the person fasts overnight (at least 8 hours, but no more than 16 hours).
  • The next morning, fasting plasma glucose is tested.
  • After this test, the person receives a dose of oral glucose (the dose depends on the duration of the test).
  • There are several methods obstetricians use to perform this test, but what is described here is standard.
  • Generally, glucose is present in the sweetened liquid that a person drinks.
  • Blood samples are taken four times at different times after taking sugar to measure the blood glucose.

Types of oral glucose tolerance test

The oral glucose tolerance test approach varies significantly depending on the objectives of the test. The ratio varies depending on the oral glucose solution and the time required and the number of blood draws. There are also variations in which a low carb diet is recommended.

There are two standard variations for screening and diagnostic purposes:

  • The two-hour OGTT with two blood draws is used to diagnose diabetes/prediabetes in non-pregnant adults and children.
  • A three-hour OGTT with four blood draws is used to evaluate gestational diabetes.

Pregnancy recommendations

The American College of Obstetricians and Gynecologists (ACOG) recommends routine testing for gestational diabetes in pregnant women at 24 and 28 weeks’ gestation.

That said, instead of going straight to a three-hour OGTT, doctors recommend a one-hour glucose test that does not require fasting. If you have these delays, have a family history of diabetes, have polycystic ovarian syndrome (PCOS), or have had gestational diabetes before, you can request the glucose challenge one hour before 24 weeks. The test is unusual: blood glucose values ​​are more than 140 milligrams per deciliter (mg / dL) or more; you go to a full three hour OGTT. Some doctors have determined that the intake is less than 130 mg / dL.

Advantages and disadvantages of oral glucose tolerance test

The oral glucose tolerance test fast is much more sensitive than the plasma glucose test (FPG) and is often ordered when diabetes is suspected but the FPG gives a normal result. 6 Its ability to detect weakness early means that people with prediabetes can often treat their condition with diet and exercise rather than medication. The oral glucose tolerance test is also the only test that can accurately diagnose IGT.

Despite these advantages, the oral glucose tolerance test has its limitations:

  • The oral glucose tolerance testis a time-consuming test that requires an extensive pre-test fast and a long period of testing and waiting.
  • Test results can be affected by stress, illness, or medications.
  • Blood is less stable after collection, which means that results can sometimes be distorted as a result of improper handling or storage of the sample.
  • In terms of precision, OGTT has a sensitivity of between 81 and 93 per cent (percentage of optimal positive test results). It is much better than FGP with a sensitivity of between 45% and 54%.

Risk factors for oral glucose tolerance test

OGTT is a safe and minimally invasive test that requires two to four blood draws. Infection is rare but can occur. However, some may have a reaction to the oral glucose solution, usually nausea or vomiting. If vomiting occurs during the test, the test may not be complete.

They will monitor and treat you if necessary, but be aware that some people experience hypoglycemia during an oral glucose tolerance test.

Do not oral glucose tolerance test if it is:

  • Diabetes has already been diagnosed
  • You have an allergy to sugar or dextrose.
  • Recovering from surgery, injury, or infection
  • They are subject to severe psychological stress.
  • Have you ever experienced hypokalemic paralysis?

Before the oral glucose tolerance test

If you are sick or have a recent illness, even if it is as common as a cold, you may not be tested. If you are not sure, call the laboratory or your doctor.


Since you have to come to the lab when you are fasting, OGTTs are usually scheduled in the morning. You should be prepared to allocate three to four hours, depending on whether you are taking a two or three-hour test.

Since stress and anxiety can affect your blood sugar levels, arrive at least 30 minutes before your appointment so that you have time to calm down and relax.


Oral glucose tolerance test can be done in the doctor’s office, clinic, hospital, or an independent laboratory.

What to wear

Because it is necessary to draw blood, wear short sleeves or a blouse that allows you to easily wrap your sleeves.

Food and drink

You should stop eating and drinking eight to 12 hours before the test (time spent sleeping); Follow your doctor’s advice. You can take an occasional sip of water if you like.

If you smoke, you must suspend the day of your appointment until the test is over. Smoking not only increases insulin production but also weakens glucose tolerance and increases blood pressure.


Inform your doctor about the medications you are taking, their prescription, over-the-counter, nutritional, homoeopathic, traditional, or recreational. Some medications affect blood glucose and may need to be temporarily stopped.

These may include:

  • Blood thinners such as Topamax (Topiramate) or Depocoat (Valproate)
  • Different antipsychotics such as clozaril (clozapine) or serocquel (cutiapine)
  • Corticosteroids such as prednisone or medrol (methylprednisolone)
  • Urination
  • Quinolone antibiotics such as cipro (ciprofloxacin) or levaquin (levofloxacin)
  • Statin medications such as Crester (rosuvastatin) and lipids (atorvastatin)
  • Salicylates including aspirin
  • Tricyclic antidepressants such as anafranil (clomipramine) or tofranil (imipramine)

You should never stop taking chronic medications without first consulting your doctor.

What Brig

In addition to your ID and health insurance cards, you may have to sit for a few hours between blood drawings, so you may want to bring something to read. Some headphones and relaxing music to listen to.

However, avoid video games or anything that exaggerates you. This is especially true if your child is being tested. Instead, bring a storybook or toys or download a video to your laptop or tablet. You may want to bring a protein bar or snack to eat after you’re done, especially if you have a long drive home.

Cost and medical insurance

The test may be covered in whole or in part by your health insurance. Prior authorization is generally not required, but to be safe, check with your insurance company ahead of time to verify and estimate what your copay or coins will cost.

If you are not insured, buy at the best price. Independent laboratories have the best prices compared to doctor’s offices or hospitals. You should also ask if there is a patient support program in the lab that provides tire structure or monthly payments. This can be very helpful if you think there should be lab tests in progress.

During the oral glucose tolerance test

Unlike a fasting glucose test, it only tests your blood in the fasted state, with fasting OGTT and non-fasting results. Testing procedures may vary depending on whether you are an adult, a child, or if you are pregnant.


On the day of the test, after registering and verifying your insurance information, you will be taken to the test room, where your height and weight will be recorded. Your temperature and blood pressure can also be taken.

At this point, you will be asked to lift your sleeve for a blood draw. To do this, the phytotomist places an elastic tourniquet around the upper arm.

Throughout the test

Select the vein on the curve of your arm or wrist and wipe it with an antiseptic wipe. The butterfly needle is then inserted and 2 millilitres (ml) of blood is drawn to obtain the initial fasting result.

After the needle is removed and the puncture wound is bandaged, you or your baby will be given a solution of sugar and glucose to drink. The formulation used varies as follows:

  • For two hours of OGTT in adults: 8 ounce solution containing 75 grams of sugar
  • For the two-hour OGTT in children: the dose is 1.75 grams of sugar per kilogram of body weight (1.75 g / kg), with a maximum dose of 75 grams.
  • For three hours OGTT: 8-ounce solution with 100 grams of sugar
  • After drinking the solution, you will return to the reception area for the indicated waiting time; In general, you cannot leave.
  • If you are an adult or child tested for diabetes or prediabetes, wait two hours after drinking the solution and return to the testing room for another blood draw (for a total of two blood draws).
  • If you are being tested for gestational diabetes, take blood samples one, two, and three hours after drinking the solution (for a total of four blood samples).
  • You will be monitored throughout the test to make sure your glucose levels are not too low. Consult a nurse or phlebotomist if you experience any signs of hypoglycemia, such as weakness, sweating, anxiety, chills, pale skin, or irregular appetite.
  • After obtaining the necessary samples, you can return home and resume your normal activities and diet. If you feel light-headed or dizzy, the medical team may ask you to get some rest before leaving.

After the oral glucose tolerance test

Although the side effects are unusual, some people experience bloating, nausea, abdominal pain, and diarrhea as a result of the oral solution. These can be alleviated with an over-the-counter antidiarrheal by drinking ginger tea or chewing peppermint gum. Some may also experience pain, swelling, or bruising at the site of the blood draw.

Call your doctor if you experience any unusual pain, swelling or excessive bleeding at the puncture site, or symptoms of infection such as high fever, chills, rapid heart rate, fast breathing, or shortness of breath.

Explaining the results of oral glucose tolerance test

Your doctor should get the test results in two to three days. The results are accompanied by reference ranges with higher and lower numerical values. Any value between high and low values ​​is considered normal. Anything outside the reference range is considered abnormally high (often indicated by the letter “H”) or abnormally low (indicated by “L”).

The two-hour OGTT results for adults or children are described below:

  • Normal: less than 140 mg / dL
  • Prediabetes or IgT: 140 and 199 mg / dL
  • Diabetes (reversible): 200 mg / dL and more

If the blood glucose value is above 200 mg / dL, the doctor will repeat the test or use another test to confirm the diagnosis of diabetes. If both tests are positive, the diagnosis is considered conclusive.

The three-hour OGTT results are interpreted differently. To do this, a preliminary diagnosis is made based on one or more high glucose values ​​in one or more of the four blood draws. Abnormal values ​​should be verified with a repeat oral glucose tolerance test.

Typical forecast ranges for three-hour OGTT are as follows:

  • Common fasting: less than 95 mg / dL
  • Normal after one hour: less than 180 mg / dL
  • Normal after two hours: less than 155 mg / dL
  • Normal after three hours: less than 140 mg / dL

If any of these values ​​are higher, the test is repeated in four weeks. After the second test, if two or more values ​​increase, gestational diabetes is definitely diagnosed.


Bietti’s Crystalline Dystrophy (BCD) | Diagnosis | Ophthalmology

What is Bietti’s crystalline dystrophy?

Bietti’s crystalline dystrophy (BCD) is a hereditary eye disease named after Dr G. B. Bietti, an Italian ophthalmologist, who labelled three patients with alike symptoms in 1937. This disease is also called Bietti’s crystalline chorioretinal dystrophy.

What causes Bietti’s crystalline dystrophy (BCD)?

Bietti’s crystalline dystrophy is produced by mutations in the CYP4V2 gene. This gene provides instructions for making a member of the cytochrome P450 family of enzymes. These enzymes are involved in the formation and breakdown of various molecules and chemicals within cells. The CYP4V2 enzyme is involved in a multi-step process called fatty acid oxidation in which lipids are wrecked down and converted into energy, but the enzyme’s specific function is not well understood.

CYP4V2 gene mutations that cause Bietti’s crystalline dystrophy damage or eliminate the function of this enzyme and are believed to affect lipid breakdown. Though, it is unknown how they lead to the exact signs and symptoms of Bietti’s crystalline dystrophy. For unknown reasons, the severity of the signs and symptoms differs significantly among individuals with the same CYP4V2 gene mutation. Bietti’s crystalline dystrophy patients and on the causes of the condition.

What are the symptoms of Bietti’s crystalline dystrophy (BCD)?

Symptoms of Bietti’s crystalline dystrophy comprise crystals in the cornea (the clear covering of the eye); bright yellow deposits on the retina; and broadminded atrophy of the retina, choriocapillaris, and choroids (the posterior layers of the eye). This tends to cause progressive night blindness and constriction of the visual field. BCD is a rare disease and appears to be more common in people of Asian descent.

People with BCD have crystals in some of their white blood cells (lymphocytes) that can be seen with an electron microscope. Researchers have not been able to determine exactly what substance forms these crystalline deposits. Its presence does not appear to harm the patient in any other way, except to affect vision.

Bietti’s crystalline dystrophy (BCD) treatment

There is no cure or treatment for Bietti’s crystalline dystrophy. Scientists hope to apply the findings of genetic research to develop an effective therapy.

Risk factor’s

Asians, especially those of Chinese ethnicity, have been found to have a relatively higher incidence of BCD.

Diagnosis of Bietti’s crystalline dystrophy (BCD)

The diagnosis of BCD is based on the ophthalmic evaluation of numerous small yellowish-white retinal crystalline deposits in the retina with or without crystalline deposits in the cornea, atrophy of the RPE, and sclerosis of the choroidal vessels. Corneal crystals are usually isolated in the anterior and subepithelial stroma of the peripheral cornea.

YP4V2 is only moderately expressed in the cornea and conjunctiva; therefore, ocular surface findings are not necessary for diagnosis. Diagnostic tools include electroretinography to assess the degree of rod and cone dysfunction, Humphrey visual field test for visual field deficits, spectral-domain OCT to identify reflective spots, in vivo confocal microscopy, and specular microscopy. If the clinical features are ambiguous, the disease can be confirmed by identifying pathologic variants in CYP4V2 using molecular genetic testing.

Clinical presentation

Typically, Bietti’s crystalline dystrophy patients begin to notice symptoms between the second and third decades of life. Patients experience a progressive discount in visual acuity, nyctalopia, and visual field loss. Colour vision can sometimes be exaggerated as well. Visual deficits can progress at different speeds in each eye, and the severity and speed of progression vary widely among affected people. Over time, patients, especially in their fifth or sixth decade, can become legally blind.

Differential diagnosis

The differential diagnosis of Bietti’s crystalline dystrophy includes other diseases that involve crystalline deposits in the retina such as:

  • Retinitis pigmentosa
  • Type 1 and type 2 primary hyperoxaluria
  • Cystinosis
  • Infectious crystalline keratopathy
  • Sjogren-Larsson syndrome
  • Drug toxicity of agents such as tamoxifen, talc retinopathy, methoxyflurane, and canthaxanthin.

Hypocalcemia | Preventive Measures | Endocrinology

What is hypocalcemia?

Hypocalcemia is an electrolyte inequity and is indicated by a low level of calcium in the blood. The normal adult worth for calcium is 4.5-5.5 mEq/L.

Calcium is significant for healthy bones and teeth, as well as for normal muscle and nerve function. Usual blood calcium levels are maintained through the actions of parathyroid hormone (PTH), your kidneys, and intestines. If your blood test fallouts show hypocalcemia, your doctor may check your albumin level as well. If your albumin is low, your calcium level must be corrected for this. A modified calcium level will be higher if the albumin is low.

Signs and symptoms of hypocalcemia

Hypocalcemia is usually asymptomatic

The attendance of hypoparathyroidism may be suggested by the clinical manifestations of the original disorder (e.g., short stature, rounded facies, intellectual disability, calcification of the basal ganglia in type Ia pseudohypoparathyroidism; vitiligo with autoimmune hypoparathyroidism).

The main clinical manifestations of hypocalcemia are due to alterations in the cell membrane potential, which causes neuromuscular irritability.

Neurological manifestations

Muscle cramps that affect the back and legs are common. Sinister hypocalcemia can cause mild diffuse encephalopathy and should be suspected in patients with mysterious dementia, depression, or psychosis.

Papilledema occurs occasionally

Severe hypocalcemia with serum calcium <7 mg/dl (<1.75 mmol / l) can cause hyperreflexia, tetany, laryngospasm, or generalized seizures. Tetany is usually the result of severe hypocalcemia but may be due to a reduction in the ionized fraction of serum calcium without marked hypocalcemia, as occurs in severe alkalosis. Tetany is characterized by the following:

  • Sensory symptoms consisting of paresthesias of the lips, tongue, fingers, and feet.
  • Carpopedal spasm, which can be prolonged and painful.
  • Generalized muscle pain
  • Spasm of facial muscles

Tetany can be manifest with spontaneous or latent symptoms and require provocation tests for its appearance. Latent tetany generally occurs with less severely decreased serum calcium concentrations: 7 to 8 mg / dL (1.75 to 2.20 mmol / L). Chvostek and Trousseau signs are easily obtained at the bedside to identify latent tetany. Chvostek’s sign is an involuntary contraction of the facial muscles caused by a light tapping of the facial nerve just before the outer auditory meatus. It is present in ≤ 10% of healthy people and most people with acute hypocalcemia but is often absent in chronic hypocalcemia.

Trousseau’s sign is the precipitation of carpal spasm by the reduced blood supply to the hand with a tourniquet or blood pressure cuff inflated to 20 mm Hg above systolic blood pressure applied to the forearm for 3 minutes. Trousseau’s sign also occurs in alkalosis, hypomagnesemia, hypokalemia, and hyperkalemia, and approximately 6% of people without identifiable electrolyte disturbances.

Other manifestations

Many other abnormalities can occur in patients with chronic hypocalcemia, such as dry and flaky skin, brittle nails, and coarse hair. Candida infections occasionally occur in hypocalcemia, but occur more frequently in patients with idiopathic hypoparathyroidism. Cataracts occasionally occur with long-lasting hypocalcemia and are not reversible by correction of serum calcium.

Hypocalcemia causes

Hypocalcemia most often occurs when too much calcium is lost in the urine or when not enough calcium is transferred from the bones to the blood. Causes of hypocalcemia include the following:

  • A low level of parathyroid hormone (hypoparathyroidism), such as can occur when the parathyroid glands are damaged during thyroid gland surgery.
  • Lack of response to a normal level of parathyroid hormone (pseudohypoparathyroidism)
  • Absence of parathyroid glands at birth (for example, in DiGeorge syndrome)
  • A low level of magnesium (hypomagnesemia), which reduces the activity of the parathyroid hormone.
  • Vitamin D deficiency (due to inadequate intake or inadequate exposure to sunlight)
  • Kidney dysfunction, which results in increased excretion of calcium in the urine and makes the kidneys less able to activate vitamin D
  • Inadequate calcium intake
  • Disorders that decrease calcium absorption
  • Pancreatitis

Certain medications, including rifampicin (an antibiotic), anticonvulsants (such as phenytoin and phenobarbital), bisphosphonates (such as alendronate, ibandronate, risedronate, and zoledronic acid), calcitonin, chloroquine, corticosteroids, and plicamycin.

Diagnosis of hypocalcemia

The first step in diagnosis is a blood test to determine your calcium levels. Your doctor may also use mental and physical exams to look for signs of hypocalcemia. A physical exam may include a study of your:

  • Hair
  • Skin
  • Muscles

A mental exam may include tests to:

  • Dementia
  • Hallucinations
  • Confusion
  • Irritability
  • Convulsions

Your doctor may also test for the signs of Chvostek and Trousseau, both of which are related to hypocalcemia. Chvostek’s sign is a spasm response when a set of facial nerves is touched. Trousseau’s sign is a spasm in the hands or feet that comes from ischemia or a restriction in the blood supply to the tissues. Contractions or spasms are considered positive responses to these tests and suggest neuromuscular excitability due to hypocalcemia.

Treatment of hypocalcemia

  • Calcium supplements
  • Sometimes vitamin D

Calcium supplements, taken by mouth, are often all that is needed to treat hypocalcemia. If a cause is identified, treating the disorder causing hypocalcemia or changing medications can restore the calcium level. Once symptoms appear, calcium is usually given intravenously. Taking vitamin D supplements helps increase calcium absorption from the digestive tract. Sometimes people with hypoparathyroidism are given a synthetic form of parathyroid hormone.

Risk factors for hypocalcemia

Some risk factors can increase your potential for developing hypoglycemia.

Certain populations

Children with type 1 diabetes, the elderly, and people who are unfamiliar with hypoglycemia are at increased risk of developing hypoglycemia. Lack of awareness of hypoglycemia can occur if you experience low blood sugar frequently, which can make your body insensitive to symptoms. The inability to feel symptoms such as sweating, shaking, increased heart rate, anxiety, or hunger is dangerous because it can lead to loss of consciousness or even death.

Complications of hypocalcemia

Untreated hypoglycemia can lead to:

  • Seizure
  • Loss of consciousness
  • Death
  • Hypoglycemia can also contribute to the following:
  • Dizziness and weakness
  • Falls
  • Injuries
  • Motor vehicle accidents
  • Increased risk of dementia in older adults
  • Ignorance of hypoglycemia

Over time, repeated episodes of hypoglycemia can make hypoglycemia unaware. The body and brain no longer produce signs and symptoms that warn of low blood sugar, such as tremors or irregular heartbeats. When this happens, the risk of severe and life-threatening hypoglycemia increases.

If you have diabetes, recurring episodes of hypoglycemia, and lack of knowledge of hypoglycemia, your doctor may modify your treatment, raise your blood sugar goals, and recommend blood glucose awareness training.

Untreated diabetes

If you have diabetes, hypoglycemic episodes are uncomfortable and can be scary. Fear of hypoglycemia can cause you to take less insulin to make sure your blood sugar doesn’t drop too low. This can lead to uncontrolled diabetes. Talk to your doctor about your fear and do not change the dose of your diabetes medicine without your doctor’s permission.

Hypocalcemia prevention

  • If you have diabetes
  • Continuous glucose monitor

Follow the diabetes management plan that you and your doctor have developed. If you are taking new medications, changing your eating or medication schedules, or adding new exercises, talk with your doctor about how these changes could affect your diabetes control and your risk for hypoglycemia.

A continuous glucose monitor (CGM) is an option for some people, particularly those unfamiliar with hypoglycemia. A CGM has a tiny wire that is inserted under the skin that can send blood glucose readings to a receiver.

If your blood sugar levels are getting too low, some CGM models will alert you with an alarm. Some insulin pumps are now integrated with CGM and can stop insulin delivery when blood sugar levels are dropping too fast to help prevent hypoglycemia.

Make sure you always carry a fast-acting carbohydrate, such as glucose tablets or juice, so you can treat the drop in blood sugar before it drops dangerously low.

If you don’t have diabetes

For periodic episodes of hypoglycemia, eating frequent small meals throughout the day is a stopgap amount to help prevent blood sugar levels from dropping too low. However, this approach is not recommended as a long-term strategy. Work with your doctor to identify and treat the cause of hypoglycemia.


Albinism | Causes and Symptoms | Ophthalmology

What is albinism?

Albinism is a rare collection of genetic disorders that cause the skin, hair, or eyes to have little or no colour. Albinism is also associated with vision problems. According to the National Organization for Albinism and Hypopigmentation, approximately 1 in 18,000 to 20,000 people in the United States has a form of albinism.

Types of albinism

Different genetic defects characterize the numerous types of albinism. The types of albinism include:

Oculocutaneous albinism (OCA)

OCA affects the skin, hair, and eyes. There are several subtypes of OCA:


OCA1 is due to a flaw in the tyrosinase enzyme. There are two subtypes of OCA1:

  • OCA1a: Individuals with OCA1a have a whole absence of melanin. This is the pigment that gives colour to the skin, eyes, and hair. People with this subtype have snowy hair, very light skin, and light eyes.
  • OCA1b: People with OCA1b make some melanin. They have light-coloured skin, hair, and eyes. Their colouration may increase as they age.


OCA2 is less severe than OCA1. It is due to a defect in the OCA2 gene that results in reduced melanin production. People with OCA2 are born with fair skin and colour. Their hair can be yellow, blonde, or light brown. OCA2 is more common in people of African descent and Native Americans.


OCA3 is a defect in the TYRP1 gene. It usually affects dark-skinned people, particularly black South Africans. Persons with OCA3 consume reddish-brown skin, reddish hair, and hazel or brown eyes.


OCA4 is due to a flaw in the SLC45A2 protein. It produces minimal melanin production and usually occurs in people of East Asian descent. People with OCA4 have symptoms similar to those of people with OCA2.

Ocular albinism

Ocular albinism is the result of a genetic mutation on the X chromosome and occurs almost exclusively in men. This type of albinism only affects the eyes. People with this type have normal hair, skin, and eye colour, but no colour in the retina (the back of the eye).

Hermansky-Pudlak syndrome

This syndrome is a rare form of albinism that is due to a defect in one of the eight genes. It produces symptoms similar to those of OCA. The syndrome occurs with lung, intestinal, and bleeding disorders.

Chediak-Higashi syndrome

Chediak-Higashi syndrome is an additional rare form of albinism that is the consequence of a defect in the LYST gene. It crops symptoms similar to OCA, but may not touch all areas of the skin. Hair is usually brown or blonde with a silver sheen. The skin is usually creamy white to greyish in colour. People with this syndrome have a defect in white blood cells, which increases the risk of infections.

Griscelli syndrome

Griscelli syndrome is an extremely rare genetic disorder. It is due to a defect in one of the three genes. There have only been 60 known cases of this syndrome worldwide since 1978. It occurs with albinism (but may not affect the whole body), immune problems, and neurological problems. Griscelli syndrome usually causes death within the first decade of life.

Causes of albinism

Albinism is inherited. It’s not contagious – you can’t “catch” it from someone else. People are born with albinism because they receive an albinism gene or genes from their parents. In the most shared forms of oculocutaneous albinism, both parents must carry the albinism gene for a youngster to be born with the condition. Even if both parents transmit the gene, the chance of each of their children being born with albinism is one in four.

If just one parent has the gene and the other parent has a standard pigment gene, their broods won’t have oculocutaneous albinism. But each child will have a one in two accidental of being a “carrier” of an albinism gene. If a child who carries the gene grows up to have a baby with someone who also does, there’s a one in four accidental that their baby may have albinism. Since most people who carry an albinism gene don’t show any signs of the disorder, a baby with this disease can be born to parents whose complexion is typical for people of their ethnic group.

The most common form of ocular albinism touches only males who have inherited an albinism gene from their mothers. Some ladies can have a milder form of the illness if they have inherited this gene.

Symptoms of albinism

The main symptoms of albinism can affect skin, hair, eye colour, and vision.


The clearest sign is a lighter skin tone, but skin tone does not continually differ substantially. In some people, melanin levels rise slowly over time, darkening the skin tone as the personages. Skin is likely to burn easily in the sun. He does not usually tan.

After sun exposure, some people with this disease can develop:

  • Freckles
  • Moles, usually pink in colour due to the reduced amount of pigment
  • Lentigines, large freckle-like spots

There is also an increased risk of skin cancer. People should use sunscreen with a sun protection factor of 30 or higher and report any new moles or other skin changes to a doctor.


This can vary in colour from white to brown. Those of African or Asian ancestry tend to have yellow, brown, or reddish hair. As the separate ages, their hair colour may slowly darken.

Eye colour

This can also change with age and ranges from very light blue to brown. Low levels of melanin in the iris mean that the eyes may appear slightly translucent and, in some light, appear red or pink as the light reflects off the retina at the back of the eye. The lack of pigment prevents the iris from completely blocking sunlight. This results in sensitivity to light, known as photosensitivity.


It always affects vision. Changes in eye function can include:

  • Nystagmus: The eyes move rapidly and uncontrollably back and forth.
  • Strabismus: The eyes do not work in unison.
  • Amblyopia: Also known as “lazy eye”.
  • Nearsighted or farsighted: The person may be extremely nearsighted or farsighted.
  • Photophobia: The eyes are particularly sensitive to light.
  • Optic Nerve Hypoplasia: Visual impairment can result from an underdeveloped optic nerve.
  • Incorrect routing of the optic nerve: Nerve signals from the retina to the brain follow unusual nerve paths.
  • Astigmatism: An abnormal inflexibility of the front surface of the eye or lens causes blurred vision.

Strategies that can help include:

  • Placement of special telescopic lenses attached to glasses.
  • Using a large computer screen or high contrast media
  • Install software that converts text to speech
  • Using a brightly coloured ball when playing

Vision problems connected to albinism tend to be inferior in newborns but improve rapidly during the first 6 months of life. However, eye health problems are likely to persist.

Diagnosis of albinism

This is usually obvious from the appearance of a baby when it is born. Your baby’s hair, skin, and eyes may be examined for signs of a lack of pigment. Since it can cause several eye problems, your baby may be referred to an eye specialist (ophthalmologist) for testing. Electrodiagnostic tests are also sometimes used to help diagnose albinism. This is where tiny electrodes are attached to the scalp to test the eye’s connections to the part of the brain that controls vision.

Treatment of albinism

  • It is not curable: The emphasis of treatment is to achieve your symptoms or related conditions.
  • Surgery or glasses: They can correct strabismus or crossed eyes, which often accompany albinism. This is when your eyes are not aligned or pointed in different directions.
  • Low vision aids: Small telescopes that attach to glasses can help you see far away objects better. Microscopes or magnifying glasses do the same with closer things. Tinted glasses or contact lenses can ease your sensitivity to light.

Complications of albinism

This can contain skin and eye complications, as well as social and emotional challenges.

  • Eye complications
  • Vision problems can affect learning, employment, and the ability to drive.
  • Skin complications

People with this have skin that is very sensitive to light and sun contact. Sunburns are one of the most serious complications associated with this disease because they can increase the risk of developing skin cancer and skin thickening related to sun damage.

Social and emotional challenges

Some people may experience discrimination. Other people’s reactions to people with this disease can often hurt people with the disease. People may knowledge bullying, teasing, or questions about their appearance, glasses, or visual aids. They usually look very different from members of their own families or ethnic groups, so they may feel like strangers or be treated like strangers. These experiences can contribute to social isolation, low self-esteem, and stress.

It is preferable to use the term “person with albinism” to avoid the stigma of other terms.


If a family member has this, a genetic counsellor can help you understand the type and the chances of having a future child with this disease. She can also explain the tests available to you.

Risk factors

It is an inherited disorder that is present at birth. Children are at risk of existence born if they have parents with parentages who carry the gene for albinism.