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    Default Med Q & A 6..

    Is there any risk to my pregnancy?



    Q. I am a 30 years old pregnant lady. At 18 weeks of pregnancy, I underwent triple test and the results are as follows: AFP - 21 ng/ml, beta-HCG in serum was 5150 miu/ml, B-estradiol - 1200 pg/ml. I would like to know whether my results indicate any risk to my baby or not?

    A. The information you have provided is not adequate to conclude anything. This is not like some tests where absolute readings help us make a diagnosis. This is a screening test and an abnormal test only means you need more tests and normal is reassuring and you can avoid more tests. That means you may have normal tests and yet an abnormal baby and vice versa. So it requires a fair degree of expertise and care to interpret these tests.

    There are two types of tests in clinical medicine we use these days. One is to diagnose diseases, which have a linear or predictable correlation, like if you have a blood sugar which is higher than a particular level (200 mg) you have diabetes, irrespective of any other factor. Most tests these days are not as clear and require very careful interpretation. For example you may have high cholesterol and still live a long life free of heart disease and may have an early heart disease despite a normal cholesterol, though the risk is higher if the cholesterol is high. Abnormalities and the triple test is even more complicated as it does not have a cause effect relationship with abnormal fetus, instead it is what we call a population based test. That means that to say whether it is normal or abnormal one has to have a baseline (median) reading of a large population. The test reading in mol/ml or IU / ml is converted to multiples of Median (MoM) which is then put on complex software to interpret and work out a statistical risk of abnormality in a fetus. That means for each lab we need to know the median for each of the three tests which are worked out after a large population at the same stage of pregnancy is tested using the kits this lab is using and then put on a dedicated software to work out a risk.

    There fore the information you have provided is inadequate to tell you whether your test is normal or not. You need to give us the Multiples of Median (MoMs) of each of the three tests and we will be able to say whether the test is grossly normal or not. I must add that with MoMs also it is the best that the risk is worked out on the software of the individual lab itself, and your lab is best placed to give you the exact risk. From the information you have provided all I can say at this stage is that the beta HCG seems low and the serum estriol and Alpha Fetoproteins quite normal (based on the levels generally seen in Indian populations but you need to be careful when you interpret these. Normality or abnormality of this test may affect your whole life and that of the family so please do not be in a hurry to take any decisions. And even if the tests are abnormal it does not mean your baby is abnormal it only means you need further tests like an amniocentesis to reach a final diagnosis. These tests are easily available in any large city of India now.

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    Why is there a discrepancy in calculating my pregnancy days?


    Q. I am a 33 years old woman in the seventh month of my pregnancy, which is about 26 weeks. But my scan report shows it to be about 28 weeks and this change of two weeks growth is from the beginning itself. My BP and other parameters are in normal condition and the baby's movement is also adequate. Is there any problem in this case?

    A. I am not sure why ultrasound (US) was done at 6 months. It is rarely required at this stage, so please ask your doctor if any specific complication was expected and why Ultrasound was ordered. I also want you to understand that US does not tell you how many weeks your pregnancy is. That is calculated according to the day of conception, which depends on things like your date of last period and the length of your menstrual cycle. US merely estimates the size of the parts of the fetus in millimetres and this is analysed by a software to approximately calculate the age of the fetus. All these calculations are at best estimates and not very accurate. If there is a discrepancy of over 4 weeks between the age calculated by dates and that by US do we need to consider it abnormal. And we are more worried if the baby is too small rather than too big. Anyway the commonest cause of this kind of discrepancy by a week of two is error in calculations. First the dates should be definitely known, and then when we convert months to weeks there should be no error. For example: 6 months are for 26 weeks not 24, i.e. each month has 4 weeks plus 2 or 3 days (except February) and these need to be accounted for in the calculation of age in weeks. More over we calculate the age in weeks from the first day of the last period recorded assuming it is a 28 day cycle. So, for example, the age is one week more in women with 21 days cycle and one less in a woman with a 35 days cycle. Once you have been careful and excluded all these possible errors, if the baby is still larger you need to consider conditions in which the fetal growth is more than expected. That is also mostly due to genetic and racial factors (both parents are above average in height and weight). If that is also not the case, the major factor to be ruled out is a high blood sugar level/diabetes. Even blood sugars considered normal for a non-pregnant adult may be a problem in pregnancy. So you need a blood sugar estimation (fasting and one hour after each meal) to see that your blood sugars are not high. If that is normal as well just see your doctor and the commonest problem is wrong dates. Anyway if the discrepancy has been there since early pregnancy it is unlikely that it is due to a medical cause and it must be because of a calculation error and you do not have to worry at all. Besides, the problem is only if there is a discrepancy of 4 weeks or more.

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    Why does my husband's skin get cut?


    Q. My 34 years old husband feels too much of pain after sex and sometimes the skin also gets cut. Is there any problem?

    A. It appears he has phimosis. In this condition the opening of the prepuce is tight. On erection, the diameter of penis increases. As a result of this, during coitus, prepuce cannot slide back easily. When forced there is pain and the prepuce cracks at the margin. This may be since childhood or may result from repeated inflammation. Many a times conservative treatment helps. In others surgery may be required. Consult your Dermatologist.

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    How can I check my HIV status?


    Q. I am a 24 years old man and got my blood tested after 60 days of my last exposure wherein the result came as Not Detected for the HIV Proviral DNA by PCR test. Now it has been 6 months completed since the last exposure. Which test should I get done? I have few symptoms like my body becomes very hot and my thighs burn when I sit and my back too burns. Could these symptoms be because of HIV infection?

    A. The complaints you describe do not point to HIV. Normally the test you had 60 days after your risk exposure should be adequate to convince you that you were lucky and did not acquire HIV infection. If you still have some doubt, please go to a reliable laboratory, such as the government testing and counselling centre and get an ELISA test done. If it is negative, please stop worrying about the previous exposure. Please ensure that you do not expose yourself to risk again so that you avoid all the worry and tension you have been through. However if the test comes positive, do not believe the result until it is repeated. If the second test is negative, stop worrying -- you do not have HIV infection. If the second test is also positive, then you need to see your doctor.

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    Can low haemoglobin cause hearing loss?


    Q. I am a 37 years old woman having sensory neural hearing loss (SNHL), which was diagnosed 6 months back but I have been having difficulties for several years now. I have had an MRI and it was normal. I had a complete placental abruption, which caused disseminated intravascular coagulation 5 years ago. At the lowest point, my blood pressure was 55/35 mm/Hg and haemoglobin was 4. I do not know how long this lasted for before it was corrected. I was wondering whether or not low levels of haemoglobin during this episode could possibly have caused hearing loss. Are there any documented cases of disseminated intravascular coagulation causing hearing loss?

    A. Disseminated intravascular coagulation (DIC) by itself causes SNHL, at least I am not aware of this relationship but the conditions in, which DIC occurs definitely can cause vestibular insufficiency leading to giddiness and deafness. Less of oxygen called hypoxia is also one of the commonest causes of SNHL.

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    How can I control my sugar level?


    Q. I am a 24 years old man suffering from chronic pancreatitis from the past 3 years and due to this, I have also developed diabetes. I am neither alcoholic nor have any family history of this disease. The cause for my condition is not known. I have lost weight and often feel tired and drained out. I take my breakfast, lunch and dinner on time but in small quantity as advised by the doctor. My sugar level shoots up even after light meals and I often find it difficult to control them. Please suggest.

    A. As you have mentioned chronic pancreatitis is not always alcohol related, there are several associations with this disorder. What happens is that the pancreatic gland which produces digestive enzymes as well as insulin to control our blood sugar, gradually gets damaged to a varying degree. It is the most important gland in the body to digest the various food we ingest and this helps in the utilisation of the various food elements needed by the body and the rest is excreted. So, when the enzyme production from the pancreas is low or absent it needs to be supplied to help digestion and you need to consult a specialist to prescribe you with regular daily pancreatic supplements as their absence will lead to regular increase in bowel movements of undigested food. Similarly diabetes, which is because of lack or absence of insulin from the pancreas, needs daily replacement as injections and your specialist will advise you on that as well. As you would have experienced most people get pain in the abdomen in varying degrees and this would also need to be treated with appropriate analgesics.

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    Is my son's nystagmus curable?


    Q. My 5 years old son is having a problem of nystagmus since birth. We have recently consulted an ophthalmologist and he said that it is a case of retinal degeneration. His far vision is 6/24 and there was no improvement after using spectacles. He has no problem in his near vision. Is there a possibility of progressive loss in vision or will it remain stable? Is there any treatment available to treat this condition?

    A. Nystagmus can be central or ocular in origin, which means it could have originated from brain or from eyes. As he has retinal degeneration, it could be the second reason. Being married within the relation could be another reason. Ask your son to wear glasses regularly. Sometimes, it improves with time. It is unlikely to worsen. The vision depends upon whether the degeneration is going to worsen or not. Ask your doctor if there is a null point, and if it is present, it can be improved by surgery

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    Can a young child learn more than 2 languages?


    Q. My daughter is 2 years old and our mother tongue is Telugu. I would like to know whether we should speak to her in English or Telugu or Tamil. Because I feel if she starts communicating in a language other than English after going to school, she will face difficulty in understanding others. Kindly advise me if a kid can learn more than 2 languages at an early stage.

    A. Usually most of the children are capable of picking up 2 or more languages if the exposure to the languages begins early. But it is, to a certain extent, dependant on child's language proficiency too. You can talk to her in your mother tongue initially but if you are residing in another state (e.g. Tamil Nadu) where the only exposure your child will get outside home is Tamil, then you should teach her Tamil. However when children go to school none of them are well versed with English and the primary teachers are aware of that, so don't worry about that.

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    Do I have a urinary infection?


    Q. I am a 23 years old male and took a urine test for urinary infection. The results are: albumin nil, sugar - nil. Deposits RBCs - occ cells seen/hpf. Pus cells-2-3 cells seen/hpf. Epithelial cells - 2-3 cells seen/hpf. Do these results indicate any urinary infection?

    A. Most of patients with urine infection have told tales of urinary voiding symptoms, with pyuria (urine having pus cells more than 5-10 per hpf or more than 10 pus cells per microliter). Urine infection is unlikely with the given urine findings if you do not have symptoms and have not been drinking water heavily to dilute urine substantially. You do have occasional red blood cell, which could be normal, but needs to be verified with subsequent urine examinations, and investigated if the finding persists in the future.

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    Can low PSA level cause problems?


    Q. My 66 years old father got his prostate specific antigen (PSA) test done. The result came 0.010 ng/ml, which was below the normal range (0.22-6.16ng/ml). Last year, his result was 0.02 ng/ml. He is a diabetic but it is very much under control. He also has the problem of burning feet (which has increased now) and constipation. He has tried isabgol but it doesn't help him much. Is the lower PSA a cause of worry?

    A. Very low or zero PSA is usually seen only after Prostate gland has been removed completely as after surgical radical prostatectomy for cancer, or after castration leading to atrophy of prostate. If your father has not undergone such surgery then most common cause of such low PSA could be a lab error and a repeat test would prove it. You may put your anxiety to rest since there is no known disease condition causing a low PSA level.

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