Brief Answer:
Fatty liver has several causes, obesity is the most likely cause here.

Detailed Answer:
Hello Ms. XXXXXXX

Thanks for posting your query.

I have gone through the sonogram report. The fatty changes in the liver are only mild. They can be due to several causes, but, obesity is the most likely cause here in addition to usage of analgesics.

These changes are mostly benign and respond rapidly when the underlying cause, say, obesity or insulin resistance, is treated. Maintenance of a healthy diet, healthy weight and regular follow up suffice.

The cause of the recent development of irregular cycles and appearance of polycystic ovaries in the sonogram points to a recent disturbance in the hormone balance. This could be due to the ATT, sudden weight gain, stress, which obviously you are experiencing, inflammatory changes and so on.

The appearance of multiple follicles does not mean that TB is spreading to the ovaries, you would have different symptoms in that case. You need to have a complete hormone profile to assess the management protocol to be followed.

Regular exercise, healthy weight and healthy but not fatty diet, help in most cases of PCOD to regularize the cycles. If you did not achieve withdrawal bleeding with adequate doses of Meprate, further investigation is necessary to assess the uterine response. If you have developed insulin resistance, use of Metformin will help to achieve ovulation; it also helps in the management of the fatty liver.

Hope your query has been answered. Please feel free to contact for further information. I will be happy to help.

regards,
Shanti.V.

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Brief Answer:
Insulin resistance can be related to type II or latent diabetes.

Detailed Answer:
Hi,

Thanks for writing back.

The hormone profile I would suggest includes FSH, LH, serum DHEAS levels, progesterone and estrogen levels, serum Prolactin, Thyroid profile, tests for insulin resistance, AMH levels apart from routine blood counts. Based on the output, one can decide the necessary hormone supplements and further investigations needed.

Insulin resistance means the cells of the body fail to respond to the normal dose of insulin produced by the body in natural circumstances. This causes high blood sugar as the insulin is not used effectively by the cells. This in turn leads to excess production of insulin by the pancreas. This process continues and may result in detection of Type II diabetes or latent autoimmune diabetes of adults.

Inflammatory changes relate to specific localized infections, general infections, tissue reaction to allergens and so on. They can be detected depending upon the cause.

Hope your queries have been clarified. Please get back if you need any more help.

regards,
Shanti.V.

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Brief Answer:
Detailed below.

Detailed Answer:
Hi,

Thanks for your query.

Here are your answers-

1. Sepsis---The symptoms start from fever, raised respiratory rate and heart rate, high blood sugar, confirmed or probable infection, and as the condition progresses, there is decreased urinary output, abnormal platelet count, difficulty in breathing, confusion, abdominal pain and abnormal heart pumping. Septic shock includes symptoms of severe sepsis along with very low blood pressure.

2. Neuropathy---Symptoms depend on whether it is sensory, motor or autonomic neuropathy.
sensory-tingling and numbness, abnormal pain perception, loss of sensation to temperature changes, coordination, pins and needles, shooting pains, changes in the skin, nails and hair, ulcers, wounds and gangrene etc.
motor-muscle twitching, cramps, weakness, wasting and paralysis.
autonomic-unable to tolerate heat, reduction of sweating, incontinence of bowel, bladder, sudden blood pressure changes leading to fainting, racing heart etc.

If the conjunctivitis has subsided, you need to have regular follow up with the ophthalmologist until declared free of infection. Systemic symptoms are usually not so troublesome and can be easily controlled with symptomatic treatment using analgesics. If needed, please see a physician.

Your doctor could be trying to combine progesterone with anti-insulin medication to attain uterine response. This usually works when progesterone alone fails to induce a period.

Hope all your queries have been answered. Take care.

regards,
Shanti.V.

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Brief Answer:
Estrogen metabolism may be increased by Rifampicin.

Detailed Answer:
Hi,

Thanks for your queries.

Here are your answers.

1. Progynova is an estrogen which may have been prescribed to enhance endometrial growth. The metabolism is increased when used along with Rifampicin. The medication itself can cause water logging and hence, bloating.

I am giving you a link which contains the properties, uses and precautions for Progynova in detail. Please go through that and your doubts will be clarified.

http://www.medicines.org.uk/emc/medicine/6442/SPC/Progynova+2mg

2. Pyridoxine in amounts greater than 200 mg. is not considered safe. Neuropathies are caused with toxicity. Since B-Long contains lesser amount of vitamin, you need not worry. Yet, use only one preparation.

3. Sepsis usually causes high fever, above 101 degrees or it can also cause subnormal temperatures.

4. The time taken for a viral infection to subside depends on the type of virus. There are viruses which give relief within a couple of days to those slow viruses which take weeks and months to give relief.

5. Fatty liver along with raised enzymes calls for periodic check up to look for progress. Though the changes are reversible in many cases, check should always be done to detect progress.

6. Inflammatory changes and tissue reaction can be measured by several tests and these depend on the type of inflammation suspected. You can consult an infectious disease specialist or an immunologist for these.

Hope this helps.

regards,
Shanti.V.

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Brief Answer:
Endometriosis does not cause missed periods.

Detailed Answer:
Hello,

Thanks for posting your query.

Endometriosis does not cause missed periods. In fact, it causes heavy and painful periods, infertility, painful intercourse etc. I am providing you a link below with complete patient information about the disease process and management. Please go through it.

https://www.asrm.org/BOOKLET_Endometriosis/#top

Healing is delayed whenever there is much of intervening adipose tissue. ATT means anti-tuberculous treatment. It cannot show flaring up and down since it is not a medical condition. If you are referring to the disease process, well, if the drugs are apt to the situation, relapse is rare. B-Long, does not interfere with the drug action as it is not overdose; I have already clarified this earlier.

I have given in one of the earlier threads, the several methods available to test for drug resistance. They include culture methods, genetic tests including DNA content analysis and tissue biopsy. If diagnostic laparoscopy is needed, it can be done with proper precautions.

Hope this helps.

regards,
Shanti.V.

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Brief Answer:
Detailed below.

Detailed Answer:
Hi,

Thanks for writing.

Here are your answers:
--I mentioned that the metabolism of the drug is enhanced when used in combination with Rifampicin, not that the metabolism of the body in general is increased when the drug is used. I have also given you a link for the properties of the medication earlier. Please go through it.

---Bloating is a side effect of the medication. Sweating and constipation are likely to be unrelated.

---some of the genetic tests used to detect MDR are line probe assays and direct sequencing.

---pre-operative precautions require avoidance of eating and drinking from midnight prior to the day of the procedure.

Hope this helps.

regards,
Shanti.V.

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