Male Infertility

Management Team

Male Infertility

Overview

Male infertility refers to the inability of males to conceive a child owing to issues with sperm production, function, or delivery.

Genetic factors, hormonal imbalances, lifestyle factors, and medical conditions affecting the reproductive system.

difficulty conceiving despite regular, unprotected intercourse. Please consult a doctor if you have been trying to conceive for a year without success through regular, unprotected intercourse.

Semen analysis for sperm count evaluation, motility, and morphology, as well as hormonal tests and imaging studies.

Depends on the underlying causative factors and may involve lifestyle changes, medications to improve sperm production, or surgical interventions to address structural problems. Assisted reproductive techniques like in vitro fertilisation (IVF) can also help achieve pregnancy.

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Sleep Study

Management Team

Sleep Study

Overview

A sleep study, also known as polysomnography, is a comprehensive test used to diagnose sleep disorders. It records the brain waves, oxygen levels in the blood, heart rate, breathing, as well as eye and leg movements during sleep. It also measures eye and leg movements.

The test is usually performed at night. However, it may be done during the day for shift workers who usually sleep in the daytime. In addition to diagnosis, a sleep study might help determine a treatment plan in case of a sleep disorder diagnosis. It also might be used to adjust treatment.

  • Sleep apnoea or another sleep-related breathing disorder: In this condition, breathing stops and starts repeatedly during sleep.
  • Periodic limb movement disorder: People with this sleep disorder flex and extend their legs while sleeping. This condition is sometimes linked to restless legs syndrome. Restless legs syndrome causes an uncontrollable urge to move the legs while awake, usually in the evenings or at bedtime.
  • Narcolepsy: People with narcolepsy experience overwhelming daytime drowsiness. They can fall asleep suddenly.
  • Rapid eye movement (REM) sleep behaviour disorder: This sleep disorder involves acting out dreams during sleep.
  • Unusual behaviours during sleep: This includes walking, moving around, or rhythmic movements during sleep.
  • Unexplained long-lasting insomnia: People with insomnia have trouble falling asleep or staying asleep

  • Diagnose Sleep Disorders like sleep apnoea, narcolepsy, restless legs syndrome, insomnia.
  • Investigate Sleep-Related Behavioural disorders like sleepwalking, night terrors and other unusual activities during sleep.
  • Evaluate Treatment Efficacy, i.e., how well the treatment for a sleep disorder is working, which includes titration sleep study.

  • Polysomnography (PSG): It is the most common sleep study. PSG requires the patient to sleep overnight in a sleep disorder clinic (i.e., Level 1 sleep study). Levels 2, 3 and 4 include home-based sleep studies. The number of monitoring parameters reduces as the level of sleep study increases.
  • Multiple Sleep Latency Test (MSLT): This test measures how quickly you fall asleep in a quiet environment during the day.
  • Maintenance of Wakefulness Test (MWT): This test evaluates your ability to stay awake during the day.

  • Avoid caffeine
  • Follow specific instructions regarding medication use

  • Setup: Sensors are placed on the scalp, face, chest, limbs, and a finger.
  • Monitoring: The equipment monitors sleep stages and cycles, heart rate, breathing, oxygen levels and movements.
  • Environment: Measurements are taken in a comfortable, quiet room for overnight studies.

A specialist will analyse the data. A follow-up appointment will be scheduled to discuss the results and potential treatments.

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6-Minute Walk Test (6MWT)

Management Team

6-Minute Walk Test (6MWT)

Overview

The 6-Minute Walk Test (6MWT) is a simple and practical test used to assess a person's aerobic capacity and endurance. It measures the distance an individual can walk quickly on a flat, hard surface in six minutes.

  • Check oxygen desaturation while walking.
  • Evaluate functional capacity.
  • Assess exercise tolerance.
  • Monitor the response to medical interventions.
  • Predict morbidity and mortality.

After explaining the procedure in detail, the baseline vitals of the patients are noted. Then, the patient is asked to walk on a flat surface and his/her pulse and oxygen saturation are monitored simultaneously. The patient can take a break/stop if he/she feels tired and/or breathless. Once six minutes are completed, the patients’ vitals are checked again and the total distance walked is measured.

  • The total distance walked is compared with normative data based on age, sex, and health status.
  • A shorter distance walked may indicate reduced functional capacity, which could be due to various conditions, such as cardiovascular or pulmonary diseases, musculoskeletal problems, or general deconditioning.
  • A fall in the oxygen level usually indicates a lung pathology.
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Thoracoscopy/Pleuroscopy

Management Team

Thoracoscopy/Pleuroscopy

Overview

Thoracoscopy is a minimally invasive procedure that allows access to the pleural space (space between chest wall and lungs), using a combination of viewing and working instruments. It has become the second most important endoscopic procedure in respiratory medicine after bronchoscopy.

  1. Rigid Pleuroscope
  2. Semi-rigid Pleuroscope (similar to video bronchoscope)

  • Work-up and diagnosis of indeterminate pleural fluid (effusion)
  • Staging of lung cancer
  • Site-directed biopsy of parietal pleura
  • Staging of mesothelioma (pleural malignancy)

Absolute: Lack of pleural space

  • Refractory cough
  • Severe hypoxemia (low O2 saturation)
  • Coagulopathy including low platelet counts
  • Unstable comorbidities or hemodynamic status
  • Pulmonary arterial hypertension

  • Bleeding after a parietal pleura biopsy
  • Lung perforation and air leak
  • Infection in the pleural space

  • Fasting is required for 6‒8 hours
  • Stop blood thinners 3‒5 days before the procedure (after confirmation from the doctor)
  • Patient has to be admitted to the hospital for 3‒5 days
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T

Klinefelter Syndrome

Management Team

Klinefelter Syndrome

Overview

Klinefelter syndrome is a genetic condition in males caused by an extra X chromosome. Many men with Klinefelter syndrome are not diagnosed with infertility until they realise they are unable to father a child.

Reduced muscle mass, enlarged breast tissue, infertility, and learning difficulties.

Genetic testing and evaluating physical and developmental symptoms.

Testosterone replacement therapy to address hormonal deficiencies, physical therapy to improve muscle strength, speech and educational support, and fertility treatments if desired. Early diagnosis and intervention are important to address developmental and health challenges, enabling individuals with Klinefelter syndrome to lead healthy and productive lives.

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K

Advanced Airway Procedures

Management Team

Advanced Airway Procedures

Overview

  • Thermal Ablative Therapy: This therapy is used for removing or debulking the tumours that are blocking the main airways and causing bleeding or difficulty in breathing. Electrocautery, argon plasma coagulation (APC), laser therapy and cryotherapy are the various modalities that enable us to achieve this.
  • Airway dilatation/Balloon bronchoplasty: A surgeon inserts a deflated balloon into a section of abnormally narrowed airway. By inflating the balloon with water, the airway is expanded, potentially relieving the symptoms. Balloon bronchoplasty may be performed prior to airway stent placement to help expand the bronchus.
  • Airway stenting (bronchial stent): Advanced cancer or certain other conditions like tuberculosis can constrict or compress an airway tube (bronchus). When the bronchus becomes blocked, it causes difficulty in breathing, cough and pneumonia. Using a bronchoscope, a surgeon can insert a wire-mesh stent into a narrowed airway. Expanding the stent can open a bronchus and relieve symptoms caused by the constriction.
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A

Rigid Bronchoscopy

Management Team

Rigid Bronchoscopy

Overview

In rigid bronchoscopy, a long metal tube (rigid bronchoscope) is inserted into the patient’s windpipe and main airways. The rigid bronchoscope’s larger diameter allows the doctor to use more sophisticated surgical tools and techniques.

Rigid bronchoscopy is performed under general anaesthesia (unconsciousness with assisted breathing), like a surgical procedure. It is imperative to undergo evaluation by the physician as well as the anaesthesiologist prior to the procedure; this allows the discussion of risks and benefits and correction of any reversible contraindication. After general anaesthesia is administered, the patient is intubated with the rigid bronchoscope and attached to the ventilator.

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R

Male Hypogonadism

Management Team

Male Hypogonadism

Overview

Male hypogonadism refers to a condition wherein insufficient amounts of testosterone (hormone responsible for male sexual development and reproductive function) are produced by the testes. It can be congenital or acquired due to injury, infection, or other medical conditions.

Reduced muscle mass, fatigue, decreased libido, and infertility.

Measuring testosterone levels through blood tests and assessing symptoms and medical history.

Testosterone replacement therapy to restore normal levels, which can improve symptoms and overall quality of life. If fertility is a concern, additional treatments like gonadotropin injections may be used to stimulate sperm production.

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M

Pulmonary Function Tests (PFTs)

Management Team

Pulmonary Function Tests (PFTs)

Overview

A complete pulmonary function test (PFT) is a thorough assessment used to evaluate lung function across various parameters. Conducted in a specialised pulmonary function laboratory, the test involves specific equipment, such as spirometers, body plethysmographs (for lung volumes) and devices for diffusion capacity (DLCO) measurements.

Before the test, patients are advised to avoid smoking, heavy meals, and strenuous exercise, with medication adjustments as needed under medical guidance.

The procedure includes several tests performed sequentially.

  • Spirometry is typically the first, measuring how much air a person can inhale and exhale and how quickly they can do so. This test helps diagnose conditions like asthma and COPD based on airflow limitations.
  • Following spirometry, lung volumes are assessed using a body plethysmograph or gas dilution techniques. This part of the test determines parameters such as Total Lung Capacity (TLC) and Residual Volume (RV), which are crucial for distinguishing between obstructive and restrictive lung diseases.
  • Next, a DLCO test is used to evaluate the efficiency of gas exchange in the lungs by measuring the uptake of carbon monoxide during a breath-hold manoeuvre. This is essential for diagnosing conditions affecting the alveolar capillary membrane, such as emphysema and pulmonary fibrosis.
  • Depending on clinical indications, bronchodilator response testing may also be performed to assess for reversible airflow obstruction.

Once baseline lung function measurements are established through PFTs, they provide a critical reference point for monitoring disease progression over time. Regular follow-up tests allow the pulmonologist to detect changes in lung function parameters, which may indicate worsening of conditions like COPD, pulmonary fibrosis, or asthma flare-ups. This monitoring aspect of PFTs is essential for predicting long-term outcomes and prognosis for patients, informing healthcare teams about the effectiveness of current treatments or the need for adjustments.

Moreover, based on specific diagnoses derived from PFT data (such as obstructive versus restrictive lung disease), healthcare providers can select appropriate medications like bronchodilators to alleviate airway obstruction or corticosteroids to manage inflammation effectively. Furthermore, measurements from PFTs, particularly DLCO, aid in determining the necessity and optimal dosage of supplemental oxygen therapy. For patients with severe conditions, such as advanced COPD, PFT results may also influence considerations for surgical interventions like lung volume reduction surgery or even lung transplant surgery in end-stage lung disease treatment.

Additionally, PFTs contribute to the design of pulmonary rehabilitation programmes aimed at improving exercise tolerance, optimising lung function and enhancing the overall quality of life for patients.

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Primary Ovarian Insufficiency

Management Team

Primary Ovarian Insufficiency

Overview

Primary ovarian insufficiency arises when the ovaries cease to function properly before the age of 40 years.

  • Genetic factors
  • Autoimmune diseases
  • Unknown reasons.

  • Hot flashes
  • Night sweats
  • Irregular menstrual cycle
  • Dry eyes
  • Vaginal dryness

Assessment of symptoms and hormone levels and sometimes genetic testing.

Hormone replacement therapy to manage symptoms and support bone and heart health. Fertility treatments or assisted reproductive technologies may be needed for women who wish to conceive. Emotional support and counselling can help cope with the psychological impact of primary ovarian insufficiency, improving overall well-being.

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