It was a typical morning. My mother was getting ready; this was her usual routine: bustling around the house. When she suddenly stopped and shouted, blood was oozing from her nose. As kids, my siblings and I were terrified. We scrambled to help, but it wasn't until later that we learned the cause of that alarming moment: high blood pressure. That day was our first lesson in the silent yet powerful effects of hypertension. Nosebleeds, or epistaxis, are common, and nearly everyone experiences at least one in their lifetime.

While most are minor and often caused by dry air or irritation, some can signal underlying health concerns. One recurring question is whether high blood pressure causes nosebleeds or is merely coincidental.

Where Exactly Does a Nosebleed Occur?

The nose is covered by a rich plexus of small blood vessels, making it prone to bleeding. Most nosebleeds are anterior in origin, occurring at the front of the nose, and are relatively benign. They often occur because of irritants such as dry air, frequent nose-blowing, or trauma.

On the other hand, posterior nosebleeds are caused by a source that is located deeper within the nasal cavity. They are less common but more severe, as the blood tends to flow backward into the throat, making them more difficult to control. Common causes of posterior nosebleeds include trauma, medical conditions, or high blood pressure.

Connection Between Nosebleeds and High Blood Pressure

Hypertension is the condition whereby the pressure of blood against the arterial walls is consistently too high. Over time, this may damage the fine blood vessels in the nose, causing them to rupture more easily.

Significant studies have shown a strong relationship between hypertension and severe cases of nosebleeds necessitating urgent care. A certain study showed that patients diagnosed with high blood pressure had 2.7-fold increased chances of having nosebleeds that were not slight.

However, it should be noted that mild hypertension by itself does not cause nosebleeds. Nosebleeds are more likely to happen during a hypertensive crisis when the blood pressure suddenly rises to above 180/120. A hypertensive crisis can also have other symptoms such as a severe headache, shortness of breath, and anxiety. Therefore, it is considered a medical emergency.

Why Does Hypertension Increase the Risk?

Chronic hypertension makes the walls of blood vessels weaker and less elastic, which easily causes them to tear. In the nose, this is especially vulnerable because the blood vessels are close to the surface. Sudden surges in blood pressure, such as in a hypertensive crisis, can cause tears in these weakened vessels, resulting in nosebleeds.

While hypertension is a contributing cause, nosebleeds occur infrequently as the only manifestation of high blood pressure. This makes regular monitoring for blood pressure all the more crucial, as hypertension has the reputation of being the "silent killer" since people often do not present symptoms until the disease has run its course.

Other Causes of Nosebleeds

• Dry Air: Cold weather or house heating dries out membranes that line the nose, hence susceptible to cracking.
• Trauma: Blows in the nose, nose picking or excessive nose blowing can traumatize blood vessels.
• Intrinsic Disease: Liver disease and kidney disease and drug therapy that affect clotting such as blood thinners enhance the risk of nose bleeding.
• Foreign Bodies: Children especially tend to insert objects up their noses, which can be irritating and bleed.
• Allergies or Infections: Chronic nasal inflammation resulting from allergies or colds causes irritation to the nasal mucosa.

Managing Nosebleeds at Home

For most nosebleeds, you can manage them yourself at home:

1. Sit up and lean slightly forward to prevent swallowing blood.

2. Press your nostrils together for at least 10 minutes.

3. Use a cold compress on the bridge of your nose to constrict blood vessels.

4. If the bleeding continues, use a nasal decongestant spray.

Consult a doctor if the bleeding persists beyond 20 minutes, is heavy, or follows a head injury.

Preventing Nosebleeds

Preventive measures can decrease the incidence of nosebleeds:

• Use a humidifier to maintain moisture in the air.
• Apply saline sprays or gels to keep nasal passages hydrated.
• Avoid nasal trauma by being gentle when blowing your nose.

For patients with hypertension, managing blood pressure is the best way to minimize the risk of complications. A combination of lifestyle changes, such as maintaining a healthy diet, regular exercise, and prescribed medications, can help keep blood pressure in check.

When to Worry About Nosebleeds

Most nosebleeds are harmless, but they can sometimes be signs of an underlying health condition. In adults with high blood pressure, frequent or severe nosebleeds should never be ignored. A health provider should be consulted in order to rule out any serious conditions and ensure appropriate treatment.

Regular check-ups, a healthy lifestyle, and awareness about the relationship between nosebleeds and high blood pressure would go a long way to protect your health. Indeed, prevention is always better than cure.

Epistaxis and hypertension. Post Graduate Medical Journal. 1977

With less time and more work, chronic fatigue has become a moniker of modern society. However, this not only reduces the quality of life but also constitutes a social issue that affects work efficiency and leads to accidents. On the surface, the cause of fatigue is often attributed to not getting enough rest, but there may be another underlying issue—the lack of proper nutrition.

The world moves at a hectic pace these days. If you feel like you're constantly running on empty, you're not alone. Many people say that they just don't have the energy they need to accomplish all they need to. Sometimes the cause of fatigue is obvious — for example, getting over the flu or falling short on sleep. Sometimes a vitamin deficiency is part of the problem. It might be worth asking your doctor to check a few vitamin levels, such as the three we've listed below.

Key Nutrient Deficiencies That Can Cause Fatigue

- Iron

Anemia occurs when there aren't enough red blood cells to meet the body's need for oxygen, or when these cells don't carry enough of an important protein called hemoglobin. Fatigue is usually the first sign of anemia. A blood test to measure the number of red blood cells and the amount of hemoglobin can tell if you have anemia. The first step in shoring up your body's iron supply is with iron-rich foods (such as red meat, eggs, rice, and beans) or, with your doctor's okay, over-the-counter supplements.

- Vitamin B12

Your body needs sufficient vitamin B12 in order to produce healthy red blood cells. So a deficiency in this vitamin can also cause anemia. The main sources of B12 are meat and dairy products, so many people get enough through diet alone. However, it becomes harder for the body to absorb B12 as you get older, and some illnesses (for example, inflammatory bowel disease) can also impair absorption. Many vegetarians and vegans become deficient in B12 because they don't eat meat or dairy. When B12 deficiency is diet-related, oral supplements and dietary changes to increase B12 intake usually do the trick. Other causes of B12 deficiency are usually treated with regular injections of vitamin B12.

- Vitamin D

A deficit of this vitamin can sap bone and muscle strength. This vitamin is unique in that your body can produce it when your skin is exposed to sunlight, but there also aren't many natural food sources of it. You can find it in some types of fish (such as tuna and salmon) and in fortified products such as milk, orange juice, and breakfast cereals. Supplements are another way to ensure you're getting enough vitamin D (note that the D3 form is easier to absorb than other forms of vitamin D).

What Does Research Say?

Taking this into account, a research group led by Professor Hiroaki Kanouchi at Osaka Metropolitan University's Graduate School of Human Life and Ecology focused on nutritional status and water-soluble vitamin deficiencies found in unbalanced diets. The team hypothesized that a lack of folate (B9) and vitamin B12 may be related to fatigue, and centered their research around homocysteine (Hcy), a biomarker known to increase when these deficiencies are present.

Blood concentrations of Hcy, folate, and vitamin B12 in approximately 600 healthy Japanese participants were measured. Participants' fatigue and motivation were assessed using the Chalder Fatigue Scale questionnaire and the Visual Analog Scale. The initial results showed that individuals with higher blood Hcy levels had lower levels of vitamin B12 and folate, regardless of sex.

The Link Between Homocysteine and Fatigue

The researchers then examined the relationship between homocysteine levels and fatigue separately for men and women. In their analysis, factors that may influence fatigue, such as age, sleep duration, workload, and dietary habits, were simultaneously accounted for.

The results revealed that higher Hcy levels were associated with greater physical fatigue in men, while higher levels were associated with decreased motivation in women.

(Dr Alex Mathew, Senior Consultant – Internal Medicine, Max Super Speciality Hospital, Patparganj)

Advances in hematology, oncology, and blood and marrow transplantation (BMT) have transformed patient outcomes over the past two decades. However, alongside these achievements lies a persistent and often underappreciated threat—Invasive Fungal Infections (IFIs).

Despite significant improvements in diagnostics and antifungal therapies, IFIs continue to contribute substantially to morbidity, mortality, prolonged hospitalization, and healthcare costs among immunocompromised patients. Fungal infections in patients with blood cancers and blood disorders are neither rare nor unpredictable. And yet they continue to be diagnosed too late, too often.

What Happens To The Immune System During Treatment?

The treatments that have transformed the outlook for leukemia, lymphoma, myeloma, and serious bone marrow disorders are genuinely remarkable. Intensive chemotherapy, bone marrow transplantation, and the newer targeted therapies have extended and saved lives in ways that were not imaginable a generation ago. But each of them does something to the immune system that creates a serious risk.

Chemotherapy depletes neutrophils, the white blood cells specifically responsible for recognizing and destroying fungal organisms. A transplant requires conditioning that leaves patients with almost no immune defenses for an extended period. Prolonged neutropenia, mucosal barrier injury, corticosteroid exposure, graft-versus-host disease, and the increasing use of targeted therapies collectively create an environment where opportunistic fungal pathogens can thrive. Some of the most effective modern therapies in hematology work by modifying immune pathways, leaving patients vulnerable to fungal disease for months after treatment ends. This window can last weeks, sometimes much longer.

The Fungi That Exploit This Window

Aspergillus is a mould found in ordinary dust and soil. In most people, it causes no harm whatsoever. In a patient with severely depleted white blood cells, it can establish a lung infection that progresses faster than most people would expect and carries a mortality rate that remains unacceptably high even with treatment. The earlier it is identified, the better the outcome. But the gap between early and late diagnosis in this context is narrow and unforgiving.

Mucormycosis is less familiar to the public but arguably more aggressive. It invades blood vessel walls directly, cutting off blood supply to surrounding tissue. Patients with blood disorders who require repeated transfusions are at particular risk because excess iron in the body accelerates their growth significantly. India has the highest burden of this infection in the world. That statistic deserves more attention than it currently receives.

Candida lives in the gut of most healthy individuals without causing any problems. When the gut lining is damaged by chemotherapy, it can cross into the bloodstream and reach the liver, spleen, and other organs, causing infections that are difficult to detect and slow to resolve.

Delayed recognition frequently results in disease progression, leading to respiratory failure, disseminated infection, and poor outcomes.

The Problem Is Underdiagnoses

None of these infections begins dramatically. The early signs are a fever that does not settle with antibiotics, a cough without an obvious cause, and breathlessness that seems proportionate to the treatment but lingers too long. In

a patient already unwell from intensive therapy, these signs often get attributed to other causes. Time passes, and the infection progresses.

Specific blood tests can indicate a fungal diagnosis before imaging shows anything definitive. They are not available everywhere in India, and that gap costs lives. Apart from the economic burden of IFIs, it can disrupt cancer treatment schedules, delaying chemotherapy or transplantation and potentially compromising long-term disease control.

What Families Should Know

Preventive antifungal therapy for high-risk patients has strong evidence behind it. Centers that have built awareness of fungal infection risk into their standard care protocols consistently see better outcomes.

For families, the most important thing is simply knowing this risk exists. Asking about it is entirely reasonable. Expecting it to be actively managed is also reasonable. In hematology and oncology, the infections that go unrecognised are the ones that do most of the damage.

Invasive fungal infections are not merely infectious complications; they are major determinants of outcomes in modern hematology and oncology practice. Recognizing the hidden burden of IFIs is the first step toward reducing their impact and improving outcomes for our most vulnerable patients.

Men have been taught for generations that they must be strong, that they are supposed to be self-sufficient, not to feel any impact, and to be emotionally strong when they face challenges.

Resilience is a good trait, but it may also make men feel disheartened about sharing their vulnerabilities or asking for assistance when they need it. Emotional distress can often be seen as a personal failure, rather than a health issue, as many grow up hearing "man up" or "be strong.”

Why Mental Health Crisis In Men Is On The Rise?

Meanwhile, there is still a high demand for men in society. Financial pressures, career expectations, family commitments, and social expectations can become a never-ending burden.

These factors can lead to feelings of loneliness, worry, and sadness, especially when combined with not having enough emotional release and wanting to turn to others for help.

Toxic Masculinity

Men are expected to be a part of the discussion, but not the central point of discussion when it comes to mental health. But the figures don't match. Almost three-fourths of the suicides in India are committed by men, which is a hidden and unaddressed issue.

One of the major issues is that there is a definition of masculinity in society. Boys are taught to be tough and independent from a young age and do not have to show feelings. The traits can both assist people in coping with difficulties and hinder them from admitting to emotional problems or seeking help when it is most necessary.

Read more: Doctors Day: From Burnout To Work Anxiety, The Mental Health Struggle Doctors Rarely Talk About

Lack Of Safe Space

A further issue is that there are not enough safe places in which men can express feelings without risk of condemnation. Stigma can be a barrier to seeking help even when there is help available. This can not only postpone treatment but also increase symptoms of loneliness and hopelessness.

The answer is more than just asking men to "speak up". We need to actively question and combat the stereotypes entrenched in society that equate vulnerability with weakness. Both families and workplaces, schools and communities all have a part to play in promoting emotional literacy and open dialogue amongst men.

Men may not be aware of or express emotional distress in traditional ways, which can be a big problem. Rather, symptoms can be manifested as irritability, withdrawal, substance abuse, or risk-taking behaviour, which can make it difficult for family members and friends to recognise when intervention is required.

It is not enough to raise awareness to solve this crisis. It is important to establish a space of normalisation for expressing emotions, to provide support for mental health and to make it part of the identity to seek help instead of looking weak. Promoting the mental health of men is not only an individual matter, but also a public health issue that can save lives.

For a genuine commitment to the prevention of suicide, mental health status of men needs to be a public health issue. Being sensitive to their challenges, to the idea of seeking assistance, and to establishing environments that are supportive of them can make the difference between life and death.

By Dr. Hamza Hussain, Head of the Department of Psychiatry and Mental Health at Ruby Hall Clinic and Bhavya Shah, Consultant Psychologist at Saifee Hospital, Mumbai