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How to cite get diflucan prescription online this article:Singh OP. Mental health in diverse India. Need for get diflucan prescription online advocacy.

Indian J Psychiatry 2021;63:315-6”Unity in diversity” - That is the theme of India which we are quite proud of. We have diversity in terms of get diflucan prescription online geography – From the Himalayas to the deserts to the seas. Every region has its own distinct culture and food.

There are so many varieties of dress and language. There is huge difference between the states in terms of development, attitude toward women, health infrastructure, child mortality, and other sociodemographic get diflucan prescription online development indexes. There is now ample evidence that sociocultural factors influence mental health.

Compton and Shim[1] have get diflucan prescription online described in their model of gene environment interaction how public policies and social norms act on the distribution of opportunity leading to social inequality, exclusion, poor environment, discrimination, and unemployment. This in turn leads to reduced options, poor choices, and high-risk behavior. Combining genetic vulnerability and early brain insult with low access to health care leads to poor mental health, disease, get diflucan prescription online and morbidity.When we come to the field of mental health, we find huge differences between different states of India.

The prevalence of psychiatric disorders was markedly different while it was 5.8 and 5.1 for Assam and Uttar Pradesh at the lower end of the spectrum, it was 13.9 and 14.1 for Madhya Pradesh and Maharashtra at the higher end of the spectrum. There was also a huge difference between the rural areas and metros, particularly in terms of psychosis and bipolar disorders.[2] The difference was distinct not only in the prevalence but also in the type of psychiatric disorders. While the more developed southern states had higher prevalence of adult-onset disorders such as depression get diflucan prescription online and anxiety, the less developed northern states had more of childhood onset disorders.

This may be due to lead toxicity, nutritional status, and perinatal issues. Higher rates of get diflucan prescription online depression and anxiety were found in females. Apart from the genetic and hormonal factors, increase was attributed to gender discrimination, violence, sexual abuse, and adverse sociocultural norms.

Marriage was get diflucan prescription online found to be a negative prognostic indicator contrary to the western norms.[3]Cultural influences on the presentation of psychiatric disorders are apparent. Being in recessive position in the family is one of the strongest predictors of psychiatric illnesses and psychosomatic disorders. The presentation of depressive and anxiety disorders with more somatic symptoms results from inability to express due to unequal power equation in the family rather than the lack of expressions.

Apart from culture bound syndromes, the role of cultural idioms of distress in manifestations of psychiatric symptoms is get diflucan prescription online well acknowledged.When we look into suicide data, suicide in lower socioeconomic strata (annual income <1 lakh) was 92,083, in annual income group of 1–5 lakhs, it was 41,197, and in higher income group, it was 4726. Among those who committed suicide, 67% were young adults, 34% had family problems, 23.4% of suicides occurred in daily laborers, 10.1% in unemployed persons, and 7.4% in farmers.[4]While there are huge regional differences in mental health issues, the challenges in mental health in India remain stigma reduction, conducting research on efficacy of early intervention, reaching the unreached, gender sensitive services, making quality mental healthcare accessible and available, suicide prevention, reduction of substance abuse, implementing insurance for mental health and reducing out-of-pocket expense, and finally, improving care for homeless mentally ill. All these require sustained advocacy aimed get diflucan prescription online at promoting rights of mentally ill persons and reducing stigma and discriminations.

It consists of various actions aimed at changing the attitudinal barriers in achieving positive mental health outcomes in the general population. Psychiatrists as Mental Health Advocates There is a debate whether psychiatrists who are overburdened with clinical care could or should be involved in the advocacy activities which require skills in other areas, and sometimes, they find themselves at the receiving end of mental health advocates. We must be involved and pathways should be to build technical evidence for mapping out the problem, cost-effective interventions, and their efficacy.Advocacy can be done at get diflucan prescription online institutional level, organizational level, and individual level.

There has been huge work done in this regard at institution level. Important research work done in this regard includes the National Mental Health Survey, National Survey on Extent and Pattern of Substance Use in get diflucan prescription online India, Global Burden of Diseases in Indian States, and Trajectory of Brain Development. Other activities include improving the infrastructure of mental hospitals, telepsychiatry services, provision of free drugs, providing training to increase the number of service providers.

Similarly, at organizational level, the Indian Psychiatric Society (IPS) has filed get diflucan prescription online a case for lacunae in Mental Health-care Act, 2017. Another case filed by the IPS lead to change of name of the film from “Mental Hai Kya” to “Judgemental Hai Kya.” In LGBT issue, the IPS statement was quoted in the final judgement on the decriminalization of homosexuality. The IPS has also started helplines at different levels and media interactions.

The Indian get diflucan prescription online Journal of Psychiatry has also come out with editorials highlighting the need of care of marginalized population such as migrant laborers and persons with dementia. At an individual level, we can be involved in ensuring quality treatment, respecting dignity and rights of the patient, sensitization of staff, working with patients and caregivers to plan services, and being involved locally in media and public awareness activities.The recent experience of Brazil is an eye opener where suicide reduction resulted from direct cash transfer pointing at the role of economic decision in suicide.[5] In India where economic inequality is increasing, male-to-female ratio is abysmal in some states (877 in Haryana to 1034 in Kerala), our actions should be sensitive to this regional variation. When the enemy is economic inequality, our weapon is research highlighting the role of these factors on mental get diflucan prescription online health.

References 1.Compton MT, Shim RS. The social determinants get diflucan prescription online of mental health. Focus 2015;13:419-25.

2.Gururaj G, Varghese M, Benegal V, Rao GN, Pathak K, Singh LK, et al. National Mental Health Survey of India, get diflucan prescription online 2015-16. Prevalence, Patterns and Outcomes.

Bengaluru. National Institute of Mental Health and Neuro Sciences, NIMHANS Publication No. 129.

2016. 3.Sagar R, Dandona R, Gururaj G, Dhaliwal RS, Singh A, Ferrari A, et al. The burden of mental disorders across the states of India.

The Global Burden of Disease Study 1990–2017. Lancet Psychiatry 2020;7:148-61. 4.National Crime Records Bureau, 2019.

Accidental Deaths and Suicides in India. 2019. Available from.

Https://ncrb.gov.in. [Last accessed on 2021 Jun 24]. 5.Machado DB, Rasella D, dos Santos DN.

Impact of income inequality and other social determinants on suicide rate in Brazil. PLoS One 2015;10:e0124934. Correspondence Address:Om Prakash SinghDepartment of Psychiatry, WBMES, Kolkata, West Bengal.

AMRI Hospitals, Kolkata, West Bengal IndiaSource of Support. None, Conflict of Interest. NoneDOI.

10.4103/indianjpsychiatry.indianjpsychiatry_635_21Abstract Sexual health, an essential component of individual's health, is influenced by many complex issues including sexual behavior, attitudes, societal, and cultural factors on the one hand and while on the other hand, biological aspects, genetic predisposition, and associated mental and physical illnesses. Sexual health is a neglected area, even though it influences mortality, morbidity, and disability. Dhat syndrome (DS), the term coined by Dr.

N. N. Wig, has been at the forefront of advancements in understanding and misunderstanding.

The concept of DS is still evolving being treated as a culture-bound syndrome in the past to a syndrome of depression and treated as “a culturally determined idiom of distress.” It is bound with myths, fallacies, prejudices, secrecy, exaggeration, and value-laden judgments. Although it has been reported from many countries, much of the literature has emanated from Asia, that too mainly from India. The research in India has ranged from the study of a few cases in the past to recent national multicentric studies concerning phenomenology and beliefs of patients.

The epidemiological studies have ranged from being hospital-based to population-based studies in rural and urban settings. There are studies on the management of individual cases by resolving sexual myths, relaxation exercises, supportive psychotherapy, anxiolytics, and antidepressants to broader and deeper research concerning cognitive behavior therapy. The presentation looks into DS as a model case highlighting the importance of exploring sexual health concerns in the Indian population in general and in particular need to reconsider DS in the light of the newly available literature.

It makes a fervent appeal for the inclusion of DS in the mainstream diagnostic categories in the upcoming revisions of the diagnostic manuals which can pave the way for a better understanding and management of DS and sexual problems.Keywords. Culture-bound syndrome, Dhat syndrome, Dhat syndrome management, Dhat syndrome prevalence, psychiatric comorbidity, sexual disordersHow to cite this article:Sathyanarayana Rao T S. History and mystery of Dhat syndrome.

A critical look at the current understanding and future directions. Indian J Psychiatry 2021;63:317-25 Introduction Mr. President, Chairpersons, my respected teachers and seniors, my professional colleagues and friends, ladies and gentlemen:I deem it a proud privilege and pleasure to receive and to deliver DLN Murti Rao Oration Award for 2020.

I am humbled at this great honor and remain grateful to the Indian Psychiatric Society (IPS) in general and the awards committee in particular. I would like to begin my presentation with my homage to Professor DLN Murti Rao, who was a Doyen of Psychiatry.[1] I have a special connection to the name as Dr. Doddaballapura Laxmi Narasimha Murti Rao, apart from a family name, obtained his medical degree from Mysore Medical College, Mysuru, India, the same city where I have served last 33 years in JSS Medical College and JSS Academy of Higher Education and Research.

His name carries the reverence in the corridors of the current National Institute of Mental Health and Neuro Sciences (NIMHANS) at Bangalore which was All India Institute of Mental Health, when he served as Head and the Medical Superintendent. Another coincidence was his untimely demise in 1962, the same year another Doyen Dr. Wig[2],[3] published the article on a common but peculiar syndrome in the Indian context and gave the name Dhat syndrome (DS).

Even though Dr. Wig is no more, his legacy of profound contribution to psychiatry and psychiatric education in general and service to the society and Mental Health, in particular, is well documented. His keen observation and study culminated in synthesizing many aspects and developments in DS.I would also like to place on record my humble pranams to my teachers from Christian Medical College, Vellore – Dr.

Abraham Varghese, the first Editor of the Indian Journal of Psychological Medicine and Dr. K. Kuruvilla, Past Editor of Indian Journal of Psychiatry whose legacies I carried forward for both the journals.

I must place on record that my journey in the field of Sexual Medicine was sown by Dr. K. Kuruvilla and subsequent influence of Dr.

Ajit Avasthi from Postgraduate Institute of Medical Education and Research from Chandigarh as my role model in the field. There are many more who have shaped and nurtured my interest in the field of sex and sexuality.The term “Dhat” was taken from the Sanskrit language, which is an important word “Dhatu” and has known several meanings such as “metal,” a “medicinal constituent,” which can be considered as most powerful material within the human body.[4] The Dhat disorder is mainly known for “loss of semen”, and the DS is a well-known “culture-bound syndrome (CBS).”[4] The DS leads to several psychosexual disorders such as physical weakness, tiredness, anxiety, appetite loss, and guilt related to the loss of semen through nocturnal emission, in urine and by masturbation as mentioned in many studies.[4],[5],[6] Conventionally, Charaka Samhita mentions “waste of bodily humors” being linked to the “loss of Dhatus.”[5] Semen has even been mentioned by Aristotle as a “soul substance” and weakness associated with its loss.[6] This has led to a plethora of beliefs about “food-blood-semen” relationship where the loss of semen is considered to reduce vitality, potency, and psychophysiological strength. People have variously attributed DS to excessive masturbation, premarital sex, promiscuity, and nocturnal emissions.

Several past studies have emphasized that CBS leads to “anxiety for loss of semen” is not only prevalent in the Indian subcontinent but also a global phenomenon.[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20]It is important to note that DS manifestation and the psychosexual features are based on the impact of culture, demographic profiles, and the socioeconomic status of the patients.[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20] According to Leff,[21] culture depends upon norms, values, and myths, based on a specific area, and is also shared by the indigenous individuals of that area. Tiwari et al.[22] mentioned in their study that “culture is closely associated with mental disorders through social and psychological activities.” With this background, the paper attempts to highlight the multidimensional construct of DS for a better clinical understanding in routine practice. Dhat Syndrome.

A Separate Entity or a “Cultural Variant” of Depression Even though DS has been studied for years now, a consensus on the definition is yet to be achieved. It has mostly been conceptualized as a multidimensional psychosomatic entity consisting of anxiety, depressive, somatic, and sexual phenomenology. Most importantly, abnormal and erroneous attributions are considered to be responsible for the genesis of DS.

The most important debate is, however, related to the nosological status of DS. Although considered to a CBS unique to India, it has also been increasingly reported in China, Europe, Japan, Malaysia, Russia, and America.[11] The consistency and validity of its diagnosis have been consistently debated, and one of the most vital questions that emerged was. Can there be another way to conceptualize DS?.

There is no single answer to that question. Apart from an independent entity, the diagnostic validity of which has been limited in longitudinal studies,[23] it has also been a cultural variant of depressive and somatization disorders. Mumford[11] in his study of Asian patients with DS found a significant association with depressed mood, anxiety, and fatigue.

Around the same time, another study by Chadha[24] reported comorbidities in DS at a rate of 50%, 32%, and 18% related to depression, somatoform disorders, and anxiety, respectively. Depression continued to be reported as the most common association of DS in many studies.[25],[26] This “cause-effect” dilemma can never be fully resolved. Whether “loss of semen” and the cultural attributions to it leads to the affective symptoms or whether low mood and neuroticism can lead to DS in appropriate cultural context are two sides of the argument.

However, the cognitive biases resulting in the attributional errors of DS and the subsequently maintained attitudes with relation to sexuality can be explained by the depressive cognitions and concepts of learned helplessness. Balhara[27] has argued that since DS is not really culture specific as thought of earlier, it should not be solely categorized as a functional somatic syndrome, as that can have detrimental effects on its understanding and management. He also mentions that the underlying “emotional distress and cultural contexts” are not unique to DS but can be related to any psychiatric syndrome for that matter.

On the contrary, other researchers have warned that subsuming DS and other CBS under the broader rubric of “mood disorders” can lead to neglect and reductionism in disorder like DS that can have unique cultural connotations.[28] Over the years, there have been multiple propositions to relook and relabel CBS like DS. Considering it as a variant of depression or somatization can make it a “cultural phenotype” of these disorders in certain regions, thus making it easier for the classificatory systems. This dichotomous debate seems never-ending, but clinically, it is always better to err on over-diagnosing and over-treating depression and anxiety in DS, which can improve the well-being of the distressed patients.

Why Discuss Dhat Syndrome. Implications in Clinical Practice DS might occur independently or associated with multiple comorbidities. It has been a widely recognized clinical condition in various parts of the world, though considered specific to the Indian subcontinent.

The presentation can often be polymorphic with symptom clusters of affective, somatic, behavioral, and cognitive manifestations.[29] Being common in rural areas, the first contacts of the patients are frequently traditional faith healers and less often, the general practitioners. A psychiatric referral occurs much later, if at all. This leads to underdetection and faulty treatments, which can strengthen the already existing misattributions and misinformation responsible for maintaining the disorder.

Furthermore, depression and sexual dysfunction can be the important comorbidities that if untreated, lead to significant psychosocial dysfunction and impaired quality of life.[30] Besides many patients of DS believe that their symptoms are due to failure of interpersonal relationships, s, and heredity, which might cause early death and infertility. This contributes to the vicious cycle of fear and panic.[31] Doctor shopping is another challenge and failure to detect and address the concern of DS might lead to dropping out from the care.[15] Rao[17] in their epidemiological study reported 12.5% prevalence in the general population, with 20.5% and 50% suffering from comorbid depression and sexual disorders. The authors stressed upon the importance of early detection of DS for the psychosexual and social well-being.

Most importantly, the multidimensional presentation of DS can at certain times be a facade overshadowing underlying neurotic disorders (anxiety, depression, somatoform, hypochondriasis, and phobias), obsessive-compulsive spectrum disorders and body dysmorphic disorders, delusional disorders, sexual disorders (premature ejaculation and erectile dysfunction) and infectious disorders (urinary tract s, sexually transmitted diseases), and even stress-related manifestations in otherwise healthy individuals.[4],[14],[15] This significant overlap of symptomatology, increased prevalence, and marked comorbidity make it all the more important for physicians to make sense out of the construct of DS. That can facilitate prompt detection and management of DS in routine clinical practice.In an earlier review study, it was observed that few studies are undertaken to update the research works from published articles as an updated review, systemic review, world literature review, etc., on DS and its management approach.[29],[32],[33],[34],[35] The present paper attempts to compile the evidence till date on DS related to its nosology, critique, manifestations, and management plan. The various empirical studies on DS all over the world will be briefly discussed along with the implications and importance of the syndrome.

The Construct of Dhat Syndrome. Summary of Current Evidence DS is a well-known CBS, which is defined as undue concern about the weakening effects after the passage of semen in urine or through nocturnal emission that has been stated by the International Statistical Classification of Diseases and Related Health Problems (ICD-10).[36] It is also known as “semen loss syndrome” by Shakya,[20] which is prevalent mainly in the Indian subcontinent[37] and has also been reported in the South-Eastern and western population.[15],[16],[20],[32],[38],[39],[40],[41] Individuals with “semen loss anxiety” suffer from a myriad of psychosexual symptoms, which have been attributed to “loss of vital essence through semen” (common in South Asia).[7],[15],[16],[17],[32],[37],[41],[42],[43] The various studies related to attributes of DS and their findings are summarized further.Prakash et al.[5] studied 100 DS patients through 139 symptoms of the Associated Symptoms Scale. They studied sociodemographic profile, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Mini-International Neuropsychiatric Interview, and Postgraduate Institute Neuroticism Scale.

The study found a wide range of physical, anxiety, depression, sexual, and cognitive symptoms. Most commonly associated symptoms were found as per score ≥1. This study reported several parameters such as the “sense of being unhealthy” (99%), worry (99%), feeling “no improvement despite treatment” (97%), tension (97%), tiredness (95%), fatigue (95%), weakness (95%), and anxiety (95%).

The common sexual disorders were observed as loss of masculinity (83%), erectile dysfunction (54%), and premature ejaculation (53%). Majority of patients had faced mild or moderate level of symptoms in which 47% of the patients reported severe weakness. Overall distress and dysfunction were observed as 64% and 81% in the studied subjects, respectively.A study in Taiwan involved 87 participants from a Urology clinic.

Most of them have sexual neurosis (Shen-K'uei syndrome).[7] More than one-third of the patients belonged to lower social class and symptoms of depression, somatization, anxiety, masturbation, and nocturnal emissions. Other bodily complaints as reported were sleep disturbances, fatigue, dizziness, backache, and weakness. Nearly 80% of them considered that all of their problems were due to masturbatory practices.De Silva and Dissanayake[8] investigated several manifestations on semen loss syndrome in the psychiatric clinic of Colombo General Hospital, Sri Lanka.

Beliefs regarding effects of semen loss and help-seeking sought for DS were explored. 38 patients were studied after psychiatrically ill individuals and those with organic disorders were excluded. Duration of semen loss varied from 1 to 20 years.

Every participant reported excessive loss of semen and was preoccupied with it. The common forms of semen loss were through nocturnal emission, masturbation, urinary loss, and through sexual activities. Most of them reported multiple modes of semen loss.

Masturbatory frequency and that of nocturnal emissions varied significantly. More than half of the patients reported all types of complaints (psychological, sexual, somatic, and genital).In the study by Chadda and Ahuja,[9] 52 psychiatric patients (mostly adolescents and young adults) complained of passing “Dhat” in urine. They were assessed for a period of 6 months.

More than 80% of them complained of body weakness, aches, and pains. More than 50% of the patients suffered from depression and anxiety. All the participants felt that their symptoms were due to loss of “dhat” in urine, attributed to excessive masturbation, extramarital and premarital sex.

Half of those who faced sexual dysfunctions attributed them to semen loss.Mumford[11] proposed a controversial explanation of DS arguing that it might be a part of other psychiatric disorders, like depression. A total of 1000 literate patients were recruited from a medical outdoor in a public sector hospital in Lahore, Pakistan. About 600 educated patients were included as per Bradford Somatic Inventory (BSI).

Men with DS reported greater symptoms on BSI than those without DS. 60 psychiatric patients were also recruited from the same hospital and diagnosed using Diagnostic and Statistical Manual (DSM)-III-R. Among them, 33% of the patients qualified for “Dhat” items on BSI.

The symptoms persisted for more than 15 days. It was observed that symptoms of DS highly correlated with BSI items, namely erectile dysfunction, burning sensation during urination, fatigue, energy loss, and weakness. This comparative study indicated that patients with DS suffered more from depressive disorders than without DS and the age group affected by DS was mostly the young.Grover et al.[15] conducted a study on 780 male patients aged >16 years in five centers (Chandigarh, Jaipur, Faridkot, Mewat, and New Delhi) of Northern India, 4 centers (2 from Kolkata, 1 each in Kalyani and Bhubaneswar) of Eastern India, 2 centers (Agra and Lucknow) of Central India, 2 centers (Ahmedabad and Wardha) of Western India, and 2 centers of Southern India (both located at Mysore) spread across the country by using DS questionnaire.

Nearly one-third of the patients were passing “Dhat” multiple times a week. Among them, nearly 60% passed almost a spoonful of “Dhat” each time during a loss. This work on sexual disorders reported that the passage of “Dhat” was mostly attributed to masturbation (55.1%), dreams on sex (47.3%), sexual desire (42.8%), and high energy foods consumption (36.7%).

Mostly, the participants experienced passage of Dhat as “night falls” (60.1%) and “while passing stools” (59.5%). About 75.6% showed weakness in sexual ability as a common consequence of the “loss of Dhat.” The associated symptoms were depression, hopelessness, feeling low, decreased energy levels, weakness, and lack of pleasure. Erectile problems and premature ejaculation were also present.Rao[17] in his first epidemiological study done in Karnataka, India, showed the prevalence rate of DS in general male population as 12.5%.

It was found that 57.5% were suffering either from comorbid depression or anxiety disorders. The prevalence of psychiatric and sexual disorders was about three times higher with DS compared to non-DS subjects. One-third of the cases (32.8%) had no comorbidity in hospital (urban).

One-fifth (20.5%) and 50% subjects (51.3%) had comorbid depressive disorders and sexual dysfunction. The psychosexual symptoms were found among 113 patients who had DS. The most common psychological symptoms reported by the subjects with DS were low self-esteem (100%), loss of interest in any activity (95.60%), feeling of guilt (92.00%), and decreased social interaction (90.30%).

In case of sexual disorders, beliefs were held commonly about testes becoming smaller (92.00%), thinness of semen (86.70%), decreased sexual capabilities (83.20%), and tilting of penis (70.80%).Shakya[20] studied a clinicodemographic profile of DS patients in psychiatry outpatient clinic of B. P. Koirala Institute of Health Sciences, Dharan, Nepal.

A total of 50 subjects were included in this study, and the psychiatric diagnoses as well as comorbidities were investigated as per the ICD-10 criteria. Among the subjects, most of the cases had symptoms of depression and anxiety, and all the subjects were worried about semen loss. Somehow these subjects had heard or read that semen loss or masturbation is unhealthy practice.

The view of participants was that semen is very “precious,” needs preservation, and masturbation is a malpractice. Beside DS, two-thirds of the subjects had comorbid depression.In another Indian study, Chadda et al.[24] compared patients with DS with those affected with neurotic/depressive disorders. Among 100 patients, 50%, 32%, and 18% reported depression, somatic problems, and anxiety, respectively.

The authors argued that cases of DS have similar symptom dimensions as mood and anxiety disorders.Dhikav et al.[31] examined prevalence and management depression comorbid with DS. DSM-IV and Hamilton Depression Rating Scale were used for assessments. About 66% of the patients met the DSM-IV diagnostic criteria of depression.

They concluded that depression was a frequent comorbidity in DS patients.In a study by Perme et al.[37] from South India that included 32 DS patients, the control group consisted of 33 people from the same clinic without DS, depression, and anxiety. The researchers followed the guidelines of Bhatia and Malik's for the assessment of primary complaints of semen loss through “nocturnal emissions, masturbation, sexual intercourse, and passing of semen before and after urine.” The assessment was done based on several indices, namely “Somatization Screening Index, Illness Behavior Questionnaire, Somatosensory Amplification Scale, Whitley Index, and Revised Chalder Fatigue Scale.” Several complaints such as somatic complaints, hypochondriacal beliefs, and fatigue were observed to be significantly higher among patients with DS compared to the control group.A study conducted in South Hall (an industrial area in the borough of Middlesex, London) included Indian and Pakistani immigrants. Young men living separately from their wives reported promiscuity, some being infected with gonorrhea and syphilis.

Like other studies, nocturnal emission, weakness, and impotency were the other reported complaints. Semen was considered to be responsible for strength and vigor by most patients. Compared to the sexual problems of Indians, the British residents complained of pelvic issues and backache.In another work, Bhatia et al.[42] undertook a study on culture-bound syndromes and reported that 76.7% of the sample had DS followed by possession syndrome and Koro (a genital-related anxiety among males in South-East Asia).

Priyadarshi and Verma[43] performed a study in Urology Department of S M S Hospital, Jaipur, India. They conducted the study among 110 male patients who complained of DS and majority of them were living alone (54.5%) or in nuclear family (30%) as compared to joint family. Furthermore, 60% of them reported of never having experienced sex.Nakra et al.[44] investigated incidence and clinical features of 150 consecutive patients who presented with potency complaints in their clinic.

Clinical assessments were done apart from detailed sexual history. The patients were 15–50 years of age, educated up to mid-school and mostly from a rural background. Most of them were married and reported premarital sexual practices, while nearly 67% of them practiced masturbation from early age.

There was significant guilt associated with nocturnal emissions and masturbation. Nearly 27% of the cases reported DS-like symptoms attributing their health problems to semen loss.Behere and Nataraj[45] reported that majority of the patients with DS presented with comorbidities of physical weakness, anxiety, headache, sad mood, loss of appetite, impotence, and premature ejaculation. The authors stated that DS in India is a symptom complex commonly found in younger age groups (16–23 years).

The study subjects presented with complaints of whitish discharge in urine and believed that the loss of semen through masturbation was the reason for DS and weakness.Singh et al.[46] studied 50 cases with DS and sexual problems (premature ejaculation and impotence) from Punjab, India, after exclusion of those who were psychiatrically ill. It was assumed in the study that semen loss is considered synonymous to “loss of something precious”, hence its loss would be associated with low mood and grief. Impotency (24%), premature ejaculation (14%), and “Dhat” in urine (40%) were the common complaints observed.

Patients reported variety of symptoms including anxiety, depression, appetite loss, sleep problems, bodily pains, and headache. More than half of the patients were independently diagnosed with depression, and hence, the authors argued that DS may be a manifestation of depressive disorders.Bhatia and Malik[47] reported that the most common complaints associated with DS were physical weakness, fatigue and palpitation, insomnia, sad mood, headache, guilt feeling and suicidal ideation, impotence, and premature ejaculation. Psychiatric disorders were found in 69% of the patients, out of which the most common was depression followed by anxiety, psychosis, and phobia.

About 15% of the patients were found to have premature ejaculation and 8% had impotence.Bhatia et al.[48] examined several biological variables of DS after enrolment of 40 patients in a psychosexual clinic in Delhi. Patients had a history of impotence, premature ejaculation, and loss of semen (after exclusion of substance abuse and other psychiatric disorders). Twenty years was the mean age of onset and semen loss was mainly through masturbation and sexual intercourse.

67.5% and 75% of them reported sexual disorders and psychiatric comorbidity while 25%, 12.5%, and 37.5% were recorded to suffer from ejaculatory impotence, premature ejaculation, and depression (with anxiety), respectively.Bhatia[49] conducted a study on CBS among 60 patients attending psychiatric outdoor in a teaching hospital. The study revealed that among all patients with CBSs, DS was the most common (76.7%) followed by possession syndrome (13.3%) and Koro (5%). Hypochondriasis, sexually transmitted diseases, and depression were the associated comorbidities.

Morrone et al.[50] studied 18 male patients with DS in the Dermatology department who were from Bangladesh and India. The symptoms observed were mainly fatigue and nonspecific somatic symptoms. DS patients manifested several symptoms in psychosocial, religious, somatic, and other domains.

The reasons provided by the patients for semen loss were urinary loss, nocturnal emission, and masturbation. Dhat Syndrome. The Epidemiology The typical demographic profile of a DS patient has been reported to be a less educated, young male from lower socioeconomic status and usually from rural areas.

In the earlier Indian studies by Carstairs,[51],[52],[53] it was observed that majority of the cases (52%–66.7%) were from rural areas, belonged to “conservative families and posed rigid views about sex” (69%-73%). De Silva and Dissanayake[8] in their study on semen loss syndrome reported the average age of onset of DS to be 25 years with most of them from lower-middle socioeconomic class. Chadda and Ahuja[9] studied young psychiatric patients who complained of semen loss.

They were mainly manual laborers, farmers, and clerks from low socioeconomic status. More than half were married and mostly uneducated. Khan[13] studied DS patients in Pakistan and reported that majority of the patients visited Hakims (50%) and Homeopaths (24%) for treatment.

The age range was wide between 12 and 65 years with an average age of 24 years. Among those studied, majority were unmarried (75%), literacy was up to matriculation and they belonged to lower socioeconomic class. Grover et al.[15] in their study of 780 male subjects showed the average age of onset to be 28.14 years and the age ranged between 21 and 30 years (55.3%).

The subjects were single or unmarried (51.0%) and married (46.7%). About 23.5% of the subjects had graduated and most were unemployed (73.5%). Majority of subjects were lower-middle class (34%) and had lower incomes.

Rao[17] studied 907 subjects, in which majority were from 18 to 30 years (44.5%). About 45.80% of the study subjects were illiterates and very few had completed postgraduation. The subjects were both married and single.

Majority of the subjects were residing in nuclear family (61.30%) and only 0.30% subjects were residing alone. Most of the patients did not have comorbid addictive disorders. The subjects were mainly engaged in agriculture (43.40%).

Majority of the subjects were from lower middle and upper lower socioeconomic class.Shakya[20] had studied the sociodemographic profile of 50 patients with DS. The average age of the studied patients was 25.4 years. The age ranges in decreasing order of frequency were 16–20 years (34%) followed by 21–25 years (28%), greater than 30 years (26%), 26–30 years (10%), and 11–15 years (2%).

Further, the subjects were mostly students (50%) and rest were in service (26%), farmers (14%), laborers (6%), and business (4%), respectively. Dhikav et al.[31] conducted a study on 30 patients who had attended the Psychiatry Outpatient Clinic of a tertiary care hospital with complaints of frequently passing semen in urine. In the studied patients, the age ranged between 20 and 40 years with an average age of 29 years and average age of onset of 19 years.

The average duration of illness was that of 11 months. Most of the studied patients were unmarried (64.2%) and educated till middle or high school (70%). Priyadarshi and Verma[43] performed a study in 110 male patients with DS.

The average age of the patients was 23.53 years and it ranged between 15 and 68 years. The most affected age group of patients was of 18–25 years, which comprised about 60% of patients. On the other hand, about 25% ranged between 25 and 35 years, 10% were lesser than 18 years of age, and 5.5% patients were aged >35 years.

Higher percentage of the patients were unmarried (70%). Interestingly, high prevalence of DS was found in educated patients and about 50% of patients were graduate or above but most of the patients were either unemployed or student (49.1%). About 55% and 24.5% patients showed monthly family income of <10,000 and 5000 Indian Rupees (INR), respectively.

Two-third patients belonged to rural areas of residence. Behere and Nataraj[45] found majority of the patients with DS (68%) to be between 16 and 25 years age. About 52% patients were married while 48% were unmarried and from lower socioeconomic strata.

The duration of DS symptoms varied widely. Singh[46] studied patients those who reported with DS, impotence, and premature ejaculation and reported the average age of the affected to be 21.8 years with a younger age of onset. Only a few patients received higher education.

Bhatia and Malik[47] as mentioned earlier reported that age at the time of onset of DS ranged from 16 to 24 years. More than half of them were single. It was observed that most patients had some territorial education (91.67%) but few (8.33%) had postgraduate education or professional training.

Finally, Bhatia et al.[48] studied cases of sexual dysfunctions and reported an average age of 21.6 years among the affected, majority being unmarried (80%). Most of those who had comorbid DS symptoms received minimal formal education. Management.

A Multimodal Approach As mentioned before, individuals affected with DS often seek initial treatment with traditional healers, practitioners of alternative medicine, and local quacks. As a consequence, varied treatment strategies have been popularized. Dietary supplements, protein and iron-rich diet, Vitamin B and C-complexes, antibiotics, multivitamin injections, herbal “supplements,” etc., have all been used in the treatment though scientific evidence related to them is sparse.[33] Frequent change of doctors, irregular compliance to treatment, and high dropout from health care are the major challenges, as the attributional beliefs toward DS persist in the majority even after repeated reassurance.[54] A multidisciplinary approach (involving psychiatrists, clinical psychologists, psychiatric social workers) is recommended and close liaison with the general physicians, the Ayurveda, Yoga, Unani, Siddha, Homeopathy practitioners, dermatologists, venereologists, and neurologists often help.

The role of faith healers and local counselors is vital, and it is important to integrate them into the care of DS patients, rather than side-tracking them from the system. Community awareness needs to be increased especially in primary health care for early detection and appropriate referrals. Follow-up data show two-thirds of patients affected with DS recovering with psychoeducation and low-dose sedatives.[45] Bhatia[49] studied 60 cases of DS and reported better response to anti-anxiety and antidepressant medications compared to psychotherapy alone.

Classically, the correction of attributional biases through empathy, reflective, and nonjudgmental approaches has been proposed.[38] Over the years, sex education, psychotherapy, psychoeducation, relaxation techniques, and medications have been advocated in the management of DS.[9],[55] In psychotherapy, cognitive behavioral and brief solution-focused approaches are useful to target the dysfunctional assumptions and beliefs in DS. The role of sex education is vital involving the basic understanding of sexual anatomy and physiology of sexuality. This needs to be tailored to the local terminology and beliefs.

Biofeedback has also been proposed as a treatment modality.[4] Individual stress factors that might have precipitated DS need to be addressed. A detailed outline of assessment, evaluation, and management of DS is beyond the scope of this article and has already been reported in the IPS Clinical Practice Guidelines.[56] The readers are referred to these important guidelines for a comprehensive read on management. Probably, the most important factor is to understand and resolve the sociocultural contexts in the genesis of DS in each individual.

Adequate debunking of the myths related to sexuality and culturally appropriate sexual education is vital both for the prevention and treatment of DS.[56] Adequate treatment of comorbidities such as depression and anxiety often helps in reduction of symptoms, more so when the DS is considered to be a manifestation of the same. Future of Dhat Syndrome. The Way Forward Classifications in psychiatry have always been fraught with debates and discussion such as categorical versus dimensional, biological versus evolutionary.

CBS like DS forms a major area of this nosological controversy. Longitudinal stability of a diagnosis is considered to be an important part of its independent categorization. Sameer et al.[23] followed up DS patients for 6.0 ± 3.5 years and concluded that the “pure” variety of DS is not a stable diagnostic entity.

The authors rather proposed DS as a variant of somatoform disorder, with cultural explanations. The right “place” for DS in classification systems has mostly been debated and theoretically fluctuant.[14] Sridhar et al.[57] mentioned the importance of reclassifying DS from a clinically, phenomenologically, psycho-pathologically, and diagnostically valid standpoint. Although both ICD and DSM have been culturally sensitive to classification, their approach to DS has been different.

While ICD-10 considers DS under “other nonpsychotic mental disorders” (F48), DSM-V mentions it only in appendix section as “cultural concepts of distress” not assigning the condition any particular number.[12],[58] Fundamental questions have actually been raised about its separate existence altogether,[35] which further puts its diagnostic position in doubt. As discussed in the earlier sections, an alternate hypothesization of DS is a cultural variant of depression, rather than a “true syndrome.”[27] Over decades, various schools of thought have considered DS either to be a global phenomenon or a cultural “idiom” of distress in specific geographical regions or a manifestation of other primary psychiatric disorders.[59] Qualitative studies in doctors have led to marked discordance in their opinion about the validity and classificatory area of DS.[60] The upcoming ICD-11 targets to pay more importance to cultural contexts for a valid and reliable classification. However, separating the phenomenological boundaries of diseases might lead to subsetting the cultural and contextual variants in broader rubrics.[61],[62] In that way, ICD-11 might propose alternate models for distinction of CBS like DS at nosological levels.[62] It is evident that various factors include socioeconomics, acceptability, and sustainability influence global classificatory systems, and this might influence the “niche” of DS in the near future.

It will be interesting to see whether it retains its diagnostic independence or gets subsumed under the broader “narrative” of depression. In any case, uniformity of diagnosing this culturally relevant yet distressing and highly prevalent condition will remain a major area related to psychiatric research and treatment. Conclusion DS is a multidimensional psychiatric “construct” which is equally interesting and controversial.

Historically relevant and symptomatically mysterious, this disorder provides unique insights into cultural contexts of human behavior and the role of misattributions, beliefs, and misinformation in sexuality. Beyond the traditional debate about its “separate” existence, the high prevalence of DS, associated comorbidities, and resultant dysfunction make it relevant for emotional and psychosexual health. It is also treatable, and hence, the detection, understanding, and awareness become vital to its management.

This oration attempts a “bird's eye” view of this CBS taking into account a holistic perspective of the available evidence so far. The clinical manifestations, diagnostic and epidemiological attributes, management, and nosological controversies are highlighted to provide a comprehensive account of DS and its relevance to mental health. More systematic and mixed methods research are warranted to unravel the enigma of this controversial yet distressing psychiatric disorder.AcknowledgmentI sincerely thank Dr.

Debanjan Banerjee (Senior Resident, Department of Psychiatry, NIMHANS, Bangalore) for his constant selfless support, rich academic discourse, and continued collaboration that helped me condense years of research and ideas into this paper.Financial support and sponsorshipNil.Conflicts of interestThere are no conflicts of interest. References 1.2.3.Srinivasa Murthy R, Wig NN. A man ahead of his time.

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When compared with suxamethonium, rocuronium was associated with a delayed initiation and reduced dose of postintubation sedation.emergency care systems.

AbstractA short cut review was carried out to establish the diagnostic get diflucan prescription online characteristics of alveolar dead space fraction (AVDSf) in the diagnosis of pulmonary embolism (PE). This is calculated from the arterial and end-tidal CO2. Three papers get diflucan prescription online were selected to answer the clinical question.

The author, study type, relevant outcomes, results and weaknesses are tabulated. It is concluded that there is good evidence to support the use of AVDSf within a clinical prediction model to exclude a PE in patients when there is a low pretest probability. However, the specificity is not sufficient to support it as a ‘rule in’ test.AbstractA short cut review was conducted to assess if the use of rocuronium get diflucan prescription online in the ED was associated with a decrease in the provision of postintubation sedation.

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When compared with suxamethonium, rocuronium was associated with a delayed initiation and reduced dose of postintubation sedation.emergency care systems.

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Insurance plans that pay higher commissions to brokers usually have another name for diflucan higher premiums, which is contributing to rising healthcare costs, according to a new study.Researchers from Johns Hopkins University said Wednesday that brokerages operating under fee-based models, as well as those that have no middleman purchasers, offer the most value for businesses of all sizes. Under the current system, smaller plans often have higher commission-to-premium another name for diflucan ratios than larger health plans, researchers said. They found a $1,000 increase in premiums correlated with an approximately $30 commission hike for the insurance broker. Dr.

Marty Makary, who led the study, said the study's results quantify the conflict of interest facing many brokers across the U.S., since agents can be paid a bonus by insurers for selling a more pricey policy, even if it's not in the employer's best interest."This is one of the fundamental areas of healthcare waste in America, the way in which health insurance and pharmacy benefits are sold on the market," Makary said. While most large employers hire benefit consultants to navigate their self-insured health plans, smaller companies often use insurance brokers to help them choose a plan for their employees. Those brokers are primarily paid through insurer commissions, which are tacked onto the final price of the policy. That cost ultimately comes out of workers' pockets, the study said."The average American utility worker, food service worker, postal worker will have approximately $4,000 of their earnings go to their company's broker to put him in a (pharmacy benefit manager) or health insurance plan," Makary said.Researchers reviewed public Form 5500s filed with the Internal Revenue Service by more than 23,600 companies and found brokers received an average commission of $178 per enrollee for fully insured health plans, or $89,000 paid to brokers for a company with 500 employees.

Businesses with fewer employees generally paid a higher commission per enrollee to brokers, according to the study.The Johns Hopkins analysis, which was published in the "Medical Care Research and Review" journal, does not include any bonuses brokers received from insurance companies for selling their plan, employer retention bonuses, acquisition bonuses, or other "kickbacks," Makary said. Because of this, he noted brokers can receive even more incentives for pushing pricier policies."The benefits advisor should be paid for their work," he said. "But the way in which they are paid distorts their fiduciary role, and the result is we have bloated [pharmacy benefit managers] and insurance domination in the marketplace."He said the study underscores the need for employers' interests to be aligned with their brokerage's interests.Congress could fix some of the incentive issues, he said. In May 2019, the U.S.

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Insurance plans that pay higher commissions to brokers usually have higher premiums, which is contributing get diflucan prescription online to rising healthcare costs, according to a new study.Researchers from Johns Hopkins University said Wednesday that brokerages operating under fee-based models, as well as those that have no middleman https://eingrext.at/kulinarik-tulln-23-26-maerz-2017/ purchasers, offer the most value for businesses of all sizes. Under the current get diflucan prescription online system, smaller plans often have higher commission-to-premium ratios than larger health plans, researchers said. They found a $1,000 increase in premiums correlated with an approximately $30 commission hike for the insurance broker.

Dr. Marty Makary, who led the study, said the study's results quantify the conflict of interest facing many brokers across the U.S., since agents can be paid a bonus by insurers for selling a more pricey policy, even if it's not in the employer's best interest."This is one of the fundamental areas of healthcare waste in America, the way in which health insurance and pharmacy benefits are sold on the market," Makary said. While most large employers hire benefit consultants to navigate their self-insured health plans, smaller companies often use insurance brokers to help them choose a plan for their employees.

Those brokers are primarily paid through insurer commissions, which are tacked onto the final price of the policy. That cost ultimately comes out of workers' pockets, the study said."The average American utility worker, food service worker, postal worker will have approximately $4,000 of their earnings go to their company's broker to put him in a (pharmacy benefit manager) or health insurance plan," Makary said.Researchers reviewed public Form 5500s filed with the Internal Revenue Service by more than 23,600 companies and found brokers received an average commission of $178 per enrollee for fully insured health plans, or $89,000 paid to brokers for a company with 500 employees. Businesses with fewer employees generally paid a higher commission per enrollee to brokers, according to the study.The Johns Hopkins analysis, which was published in the "Medical Care Research and Review" journal, does not include any bonuses brokers received from insurance companies for selling their plan, employer retention bonuses, acquisition bonuses, or other "kickbacks," Makary said.

Because of this, he noted brokers can receive even more incentives for pushing pricier policies."The benefits advisor should be paid for their work," he said. "But the way in which they are paid distorts their fiduciary role, and the result is we have bloated [pharmacy benefit managers] and insurance domination in the marketplace."He said the study underscores the need for employers' interests to be aligned with their brokerage's interests.Congress could fix some of the incentive issues, he said. In May 2019, the U.S.

Senate Committee on Health, Education, Labor and Pensions introduced The Lower Health Care Cost Act, which would require health insurance brokers to disclose all compensation associated with plan selection and enrollment before the contract is finalized. Businesses can also choose to work with brokerages that are paid with a flat fee. Makary recommended brokers who have received "Health Rosetta" certification, which he said means they adhere to strict principles regarding commissions, bonuses, kickbacks and other options for their employees.

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Latest antifungals 3 doses of diflucan News THURSDAY, Sept. 2, 2021 (HealthDay News) At least 15 million doses of antifungal medication treatments have been thrown away in the United States since March 1, government data shows. That's a far greater amount than previously known, but it is still just a small fraction of the total doses administered in this country, according to NBC 3 doses of diflucan News. The data is self-reported by pharmacies, states and other treatment providers, but does not include some states and federal providers, and it also does not explain the reasons doses were thrown away, NBC News reported. Four national pharmacy chains each reported more than 1 million wasted doses, led by Walgreens with 2.6 million, the most of any pharmacy, state or other treatment provider, followed by CVS (2.3 million), Walmart (1.6 million) and Rite Aid (1.1 million), NBC News reported.

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"It's really 3 doses of diflucan tragic that we have a situation where treatments are being wasted while lots of African countries have not had even 5% of their populations vaccinated," Sharifah Sekalala, an associate professor of global health law at England's University of Warwick who studies health care inequalities in infectious diseases, told NBC News. But Kristen Nordlund, a spokeswoman for the U.S. Centers for Disease Control and Prevention, said the portion of wasted doses " remains extremely low." "As access to antifungal medication treatment has increased, it is important for providers to not miss any opportunity to vaccinate every eligible person who presents at treatment clinics, even if it may increase the likelihood of leaving unused doses in a vial," Nordlund told NBC News. More information 3 doses of diflucan Visit the U.S. Food and Drug Administration for more on antifungal medication treatments.

SOURCE. NBC News Robin 3 doses of diflucan Foster and Robert Preidt Copyright © 2021 HealthDay. All rights reserved.Latest antifungals News THURSDAY, Sept. 2, 2021 In a finding that should reassure Americans who have already lined up to get their antifungals shots, a new study shows the risk of long antifungal medication is halved in fully vaccinated adults if they do get a breakthrough . Researchers analyzed 3 doses of diflucan data from people who provided information for a antifungal medication symptom study in the U.K.

Between Dec. 8, 2020, and July 4, 2021, including 1.2 million who'd received one treatment dose and more than 971,000 who'd received two doses (fully 3 doses of diflucan vaccinated). Fully vaccinated adults had a 49% reduced risk of long antifungal medication, a 73% reduced risk of hospitalization and a 31% reduced risk of acute symptoms, the study showed. The most common symptoms among fully vaccinated adults were similar to those in unvaccinated people. Loss of 3 doses of diflucan smell, cough, fever, headaches, and fatigue.

But compared to the unvaccinated, fully vaccinated adults had milder and fewer symptoms, and were half as likely to have multiple symptoms in the first week of illness. Sneezing was the only common symptom that occurred more often in vaccinated adults, according to the study published Sept. 1 in The Lancet Infectious Diseases 3 doses of diflucan journal. It also found that people who lived in the poorest areas had a greater risk of after a single shot. People with frailty and other health conditions that limited their independence were up to two times more more likely to get antifungal medication after vaccination, and of getting 3 doses of diflucan sick.

"In terms of the burden of long antifungal medication, it's good news that our research has found that having a double vaccination significantly reduces the risk of both catching the diflucan and, if you do, developing longstanding symptoms. However, among our frail, older adults and those living in deprived areas, the risk is still significant and they should be urgently prioritized for second and booster vaccinations," said lead researcher Claire Steves, from Kings College London. "Vaccinations are 3 doses of diflucan massively reducing the chances of people getting Long antifungal medication in two ways. Firstly, by reducing the risk of any symptoms by 8 to 10 fold and then by halving the chances of any turning into long antifungal medication, if it does happen," said Tim Spector, lead investigator of the antifungal medication symptom study. "Whatever the duration of symptoms we are seeing that s after two vaccinations are also much milder, so treatments are really changing the disease and for the better," he said in a Kings College news release.

"We are 3 doses of diflucan encouraging people to get their 2nd jab as soon as they can." British Health and Social Care Secretary Sajid Javid said the new findings are encouraging. "This research is encouraging, suggesting treatments are not only preventing deaths but could also help prevent some of the longer lasting symptoms," he said in the news release. "It is clear treatments are building a wall of defense against the diflucan and are the best way to protect people from serious illness." More information The U.S. Centers for Disease Control and Prevention has more on post-antifungal medication 3 doses of diflucan symptoms. SOURCES.

Kings College London, news release, Sept 3 doses of diflucan. 1, 2021 Robert Preidt Copyright © 2021 HealthDay. All rights reserved.Latest Neurology News By Denise Mann HealthDay ReporterTHURSDAY, Sept. 2, 2021 (HealthDay News) Depression and multiple sclerosis (MS) tend to travel together, new research finds, and when they do the chances of dying during the next decade can be up to five times greater than it is for those with neither condition 3 doses of diflucan. Exactly why the combination is so lethal is not fully understood, but several factors may be at play, explained study author Dr.

Raffaele Palladino, a research associate at Imperial College London. For starters, depression is associated with inflammation and other brain changes that 3 doses of diflucan increase stroke risk. "People with psychiatric disorders may not have their cardiovascular risk factors managed as well, and depression is associated with poorer health behaviors [diet, physical activity] which can negatively affect MS as well as other aspects of health," Palladino said. Affecting nearly 1 million people in the United States, MS occurs when the immune system misfires against the central nervous system, which is made up of the brain, spinal cord and optic nerves. Symptoms range from mild to severe and may include numbness, fatigue, bladder issues, 3 doses of diflucan walking difficulties, and problems with thinking and memory.

Fully 20% of people with MS also experience depression, Palladino said. For the study, researchers reviewed the medical records of nearly 85,000 people with 3 doses of diflucan and without MS. They tracked who developed vascular disease or died over a 10-year period. At the start of the study, 21% of the people with MS were depressed, as were 9% of those folks without MS. People with MS and depression were more than five times as likely to die of 3 doses of diflucan any cause during the next decade when compared to people with neither condition after researchers controlled for other factors that could affect the risk of dying such as smoking and diabetes.

People with both conditions were also more than three times as likely to develop vascular disease as folks with neither condition, the study showed. Having either a history of MS or depression also affected risk of dying during the next 10 years. Folks with MS without depression were nearly four times more likely to die than people with neither condition, 3 doses of diflucan and people with depression without MS were nearly twice as likely to die, the study showed. It's too early to say whether treating depression in people with MS will help improve vascular risk factors such as inflammation in the brain and lower the chances of dying. Awareness about the 3 doses of diflucan symptoms of depression in MS and family support are critical, Palladino said.

Common symptoms of depression may include feelings of sadness, tearfulness. Irritability. Loss of interest in 3 doses of diflucan normal activities. Sleep disturbance. Fatigue.

Changes in 3 doses of diflucan appetite. Feelings of guilt. Trouble thinking, and frequent thoughts of death, he said. "Appropriate mental health screening followed 3 doses of diflucan by timely, effective intervention is an essential step to mitigate [depression's] burden," Palladino said. The study appears in the Sept.

1 issue of 3 doses of diflucan Neurology. Two experts who were not part of the study stressed the importance of recognizing the signs of depression and vascular disease in people with MS and treating it appropriately. This study identifies the relationship between MS and depression "and highlights the impact of this combination on incident vascular risk and all-cause mortality," said Dr. Emily Pharr, an assistant professor of neurology at Wake Forest 3 doses of diflucan Baptist Medical Center in Winston-Salem, N.C. "These findings emphasize the importance of close monitoring of symptoms of depression and vascular risk factors in our patients living with MS." SLIDESHOW What Is Multiple Sclerosis?.

MS Symptoms, Causes, Diagnosis See Slideshow Julie Fiol, associate vice president of health care access at the National MS Society, agreed. "The immediate clinical implications of these findings are the importance of screening 3 doses of diflucan for and treating depression in MS," she said. Depression in MS is not just a reaction to living with a chronic illness, Fiol noted. "It's also something biological that is happening outside of the person's control," she said. "Left untreated, depression reduces quality of life, makes other MS symptoms 3 doses of diflucan -- including fatigue, pain, cognitive changes -- feel worse, and may be life-threatening." More information Learn more about depression and MS at the National MS Society.

SOURCES. Raffaele Palladino, MD, 3 doses of diflucan PhD, research associate, Imperial College London, United Kingdom. Emily Pharr, MD, assistant professor, neurology, Wake Forest Baptist Medical Center, Winston-Salem, N.C.. Julie Fiol, associate vice president, health care access, National MS Society, New York City. Neurology, Sept.1, 2021 Copyright © 3 doses of diflucan 2021 HealthDay.

All rights reserved. From Healthy Resources Featured Centers Health Solutions From Our SponsorsLatest antifungals News By Ernie Mundell HealthDay ReporterTHURSDAY, Sept. 2, 2021 (HealthDay News) A new study of more than 19,000 San Diego health care workers finds that 3 doses of diflucan antifungal medication vaccination may have lost some of its power to ward off "breakthrough" s. But that's no reason to lose faith in the treatments. In the study, the rate of antifungal medication in July among unvaccinated workers was nearly triple that of people who had gotten their shots.

Still, the study found a "dramatic change in treatment effectiveness between June and July," according to researchers led by Dr 3 doses of diflucan. Francesca Torriani, of University of California San Diego (UCSD) Health. Her team calculated that "treatment effectiveness exceeded 90% from March through June, but fell to 65.5% in July." In June, one-third of diagnosed cases of antifungal medication occurred among fully vaccinated health care 3 doses of diflucan workers. But just one month later, 3 of every 4 cases occurred among the vaccinated. Because more than 83% of all workers in at UCSD Health are now vaccinated, some kind of rise in the number of breakthrough cases was expected.

But the sudden, sharp uptick between June and July was 3 doses of diflucan still striking. It "is likely to be due to both the emergence of the Delta variant and waning immunity over time," Torriani and her colleagues said in a report published Sept. 1 in the New England Journal of Medicine. Risks of 3 doses of diflucan in July were also "compounded by the end of masking requirements in California and the resulting greater risk of exposure in the community," the authors added. Overall, regular testing of just over 19,000 UCSD health workers uncovered 125 cases of symptomatic antifungal medication in July, up from just 13 cases in May and 15 in June.

Only one case was severe enough that the individual 3 doses of diflucan required hospital care, and that case occurred in an unvaccinated worker, the researchers said. No one died. And although 94 of the 125 cases reported in July occurred in vaccinated workers, the key number to look at is what the researchers call the "attack rate." According to the study, in July there were about 5.7 cases of antifungal medication per every 1,000 vaccinated workers at UCSD Health. Compare that to the attack rate among the 3 doses of diflucan unvaccinated. 16.4 cases of antifungal medication per every 1,000 workers.

That means that an unvaccinated person was nearly three times more likely to contract antifungal medication compared to a fully vaccinated person. As for symptoms, in a tally of cases occurring among UCSD health workers from March through July, "symptoms were present in 109 of the 130 fully vaccinated workers [83.8%] and in 80 of the 90 unvaccinated workers [88.9%]," the 3 doses of diflucan study found. The new study represents a detailed look at antifungal medication rates, because UCSD Health "has a low threshold for antifungals testing, which is triggered by the presence of at least one symptom during daily screening or by an identified exposure, regardless of vaccination status," the authors noted. Dr. Amesh Adalja is an expert in infectious disease and senior scholar at the 3 doses of diflucan Johns Hopkins Center for Health Security in Baltimore.

Reading over the findings, he said that they support the effectiveness and necessity of getting vaccinated against the new antifungals. "treatments aren't force fields -- breakthrough s will occur, especially as people get back to their activities in 3 doses of diflucan the midst of the more contagious Delta variant," Adalja said. "The breakthroughs were all mild, with no one hospitalized," he added. "To me, that shows the treatments are doing what they were designed to. Taming the diflucan." More information 3 doses of diflucan.

For more on antifungal medication vaccination, see the U.S. Centers for Disease Control and Prevention. SOURCES. Amesh Adalja, MD, senior scholar, Johns Hopkins Center for Health Security, New England Journal of Medicine, Sept.1, 2021 Copyright © 2021 HealthDay. All rights reserved..

Latest antifungals you could look here News THURSDAY, Sept get diflucan prescription online. 2, 2021 (HealthDay News) At least 15 million doses of antifungal medication treatments have been thrown away in the United States since March 1, government data shows. That's a far greater amount than previously known, but it is still just get diflucan prescription online a small fraction of the total doses administered in this country, according to NBC News. The data is self-reported by pharmacies, states and other treatment providers, but does not include some states and federal providers, and it also does not explain the reasons doses were thrown away, NBC News reported.

Four national pharmacy chains each reported more than 1 million wasted doses, led by Walgreens with 2.6 million, the most of any pharmacy, state or other treatment provider, followed by CVS (2.3 million), Walmart (1.6 million) and Rite Aid (1.1 million), NBC News reported. There are numerous reasons why doses may be marked as wasted, from a cracked vial or an error diluting the treatment to a freezer malfunction to more doses in a vial than people who want them get diflucan prescription online. A wastage report can also happen when a vial contains fewer doses than it should, NBC News said. As of Tuesday, 438 million doses have been distributed in the United States, while an additional 111.7 million doses have been sent to other countries since Aug.

3, NBC News reported get diflucan prescription online. The data was released as many countries struggle to get antifungal medication treatments. "It's really tragic that we have a situation where treatments are being wasted while lots of African countries have not had even 5% of get diflucan prescription online their populations vaccinated," Sharifah Sekalala, an associate professor of global health law at England's University of Warwick who studies health care inequalities in infectious diseases, told NBC News. But Kristen Nordlund, a spokeswoman for the U.S.

Centers for Disease Control and Prevention, said the portion of wasted doses " remains extremely low." "As access to antifungal medication treatment has increased, it is important for providers to not miss any opportunity to vaccinate every eligible person who presents at treatment clinics, even if it may increase the likelihood of leaving unused doses in a vial," Nordlund told NBC News. More information get diflucan prescription online Visit the U.S. Food and Drug Administration for more on antifungal medication treatments. SOURCE.

NBC News Robin Foster and Robert Preidt Copyright © 2021 get diflucan prescription online HealthDay. All rights reserved.Latest antifungals News THURSDAY, Sept. 2, 2021 In a finding that should reassure Americans who have already lined up to get their antifungals shots, a new study shows the risk of long antifungal medication is halved in fully vaccinated adults if they do get a breakthrough . Researchers analyzed data from people who get diflucan prescription online provided information for a antifungal medication symptom study in the U.K.

Between Dec. 8, 2020, get diflucan prescription online and July 4, 2021, including 1.2 million who'd received one treatment dose and more than 971,000 who'd received two doses (fully vaccinated). Fully vaccinated adults had a 49% reduced risk of long antifungal medication, a 73% reduced risk of hospitalization and a 31% reduced risk of acute symptoms, the study showed. The most common symptoms among fully vaccinated adults were similar to those in unvaccinated people.

Loss of smell, get diflucan prescription online cough, fever, headaches, and fatigue. But compared to the unvaccinated, fully vaccinated adults had milder and fewer symptoms, and were half as likely to have multiple symptoms in the first week of illness. Sneezing was the only common symptom that occurred more often in vaccinated adults, according to the study published Sept. 1 in The get diflucan prescription online Lancet Infectious Diseases journal.

It also found that people who lived in the poorest areas had a greater risk of after a single shot. People with frailty and other health conditions that get diflucan prescription online limited their independence were up to two times more more likely to get antifungal medication after vaccination, and of getting sick. "In terms of the burden of long antifungal medication, it's good news that our research has found that having a double vaccination significantly reduces the risk of both catching the diflucan and, if you do, developing longstanding symptoms. However, among our frail, older adults and those living in deprived areas, the risk is still significant and they should be urgently prioritized for second and booster vaccinations," said lead researcher Claire Steves, from Kings College London.

"Vaccinations are massively reducing the chances of people getting Long antifungal medication in get diflucan prescription online two ways. Firstly, by reducing the risk of any symptoms by 8 to 10 fold and then by halving the chances of any turning into long antifungal medication, if it does happen," said Tim Spector, lead investigator of the antifungal medication symptom study. "Whatever the duration of symptoms we are seeing that s after two vaccinations are also much milder, so treatments are really changing the disease and for the better," he said in a Kings College news release. "We are encouraging people to get their 2nd jab as soon as they can." British Health and Social Care get diflucan prescription online Secretary Sajid Javid said the new findings are encouraging.

"This research is encouraging, suggesting treatments are not only preventing deaths but could also help prevent some of the longer lasting symptoms," he said in the news release. "It is clear treatments are building a wall of defense against the diflucan and are the best way to protect people from serious illness." More information The U.S. Centers for get diflucan prescription online Disease Control and Prevention has more on post-antifungal medication symptoms. SOURCES.

Kings College get diflucan prescription online London, news release, Sept. 1, 2021 Robert Preidt Copyright © 2021 HealthDay. All rights reserved.Latest Neurology News By Denise Mann HealthDay ReporterTHURSDAY, Sept. 2, 2021 (HealthDay News) Depression and multiple sclerosis (MS) tend to travel together, new research finds, and when they do the chances of dying during the next decade can be up to five times greater than it is for get diflucan prescription online those with neither condition.

Exactly why the combination is so lethal is not fully understood, but several factors may be at play, explained study author Dr. Raffaele Palladino, a research associate at Imperial College London. For starters, depression is associated with get diflucan prescription online inflammation and other brain changes that increase stroke risk. "People with psychiatric disorders may not have their cardiovascular risk factors managed as well, and depression is associated with poorer health behaviors [diet, physical activity] which can negatively affect MS as well as other aspects of health," Palladino said.

Affecting nearly 1 million people in the United States, MS occurs when the immune system misfires against the central nervous system, which is made up of the brain, spinal cord and optic nerves. Symptoms range from mild to severe get diflucan prescription online and may include numbness, fatigue, bladder issues, walking difficulties, and problems with thinking and memory. Fully 20% of people with MS also experience depression, Palladino said. For the study, get diflucan prescription online researchers reviewed the medical records of nearly 85,000 people with and without MS.

They tracked who developed vascular disease or died over a 10-year period. At the start of the study, 21% of the people with MS were depressed, as were 9% of those folks without MS. People with MS get diflucan prescription online and depression were more than five times as likely to die of any cause during the next decade when compared to people with neither condition after researchers controlled for other factors that could affect the risk of dying such as smoking and diabetes. People with both conditions were also more than three times as likely to develop vascular disease as folks with neither condition, the study showed.

Having either a history of MS or depression also affected risk of dying during the next 10 years. Folks with MS without depression get diflucan prescription online were nearly four times more likely to die than people with neither condition, and people with depression without MS were nearly twice as likely to die, the study showed. It's too early to say whether treating depression in people with MS will help improve vascular risk factors such as inflammation in the brain and lower the chances of dying. Awareness about the symptoms of depression in MS and family support are critical, Palladino get diflucan prescription online said.

Common symptoms of depression may include feelings of sadness, tearfulness. Irritability. Loss of get diflucan prescription online interest in normal activities. Sleep disturbance.

Fatigue. Changes in get diflucan prescription online appetite. Feelings of guilt. Trouble thinking, and frequent thoughts of death, he said.

"Appropriate mental health screening followed by get diflucan prescription online timely, effective intervention is an essential step to mitigate [depression's] burden," Palladino said. The study appears in the Sept. 1 issue get diflucan prescription online of Neurology. Two experts who were not part of the study stressed the importance of recognizing the signs of depression and vascular disease in people with MS and treating it appropriately.

This study identifies the relationship between MS and depression "and highlights the impact of this combination on incident vascular risk and all-cause mortality," said Dr. Emily Pharr, an assistant professor of neurology at Wake get diflucan prescription online Forest Baptist Medical Center in Winston-Salem, N.C. "These findings emphasize the importance of close monitoring of symptoms of depression and vascular risk factors in our patients living with MS." SLIDESHOW What Is Multiple Sclerosis?. MS Symptoms, Causes, Diagnosis See Slideshow Julie Fiol, associate vice president of health care access at the National MS Society, agreed.

"The immediate clinical implications of these findings are the importance of screening for get diflucan prescription online and treating depression in MS," she said. Depression in MS is not just a reaction to living with a chronic illness, Fiol noted. "It's also something biological that is happening outside of the person's control," she said. "Left untreated, depression reduces quality of life, makes other MS symptoms -- including fatigue, pain, cognitive changes -- feel worse, and may be life-threatening." More information Learn get diflucan prescription online more about depression and MS at the National MS Society.

SOURCES. Raffaele Palladino, MD, PhD, research associate, Imperial College London, United get diflucan prescription online Kingdom. Emily Pharr, MD, assistant professor, neurology, Wake Forest Baptist Medical Center, Winston-Salem, N.C.. Julie Fiol, associate vice president, health care access, National MS Society, New York City.

Neurology, Sept.1, 2021 Copyright © 2021 HealthDay get diflucan prescription online. All rights reserved. From Healthy Resources Featured Centers Health Solutions From Our SponsorsLatest antifungals News By Ernie Mundell HealthDay ReporterTHURSDAY, Sept. 2, 2021 (HealthDay News) A new study of more than 19,000 San Diego health care workers finds that antifungal medication vaccination may have lost some of its power to ward off "breakthrough" s get diflucan prescription online.

But that's no reason to lose faith in the treatments. In the study, the rate of antifungal medication in July among unvaccinated workers was nearly triple that of people who had gotten their shots. Still, the study found a "dramatic change in treatment effectiveness between June and July," get diflucan prescription online according to researchers led by Dr. Francesca Torriani, of University of California San Diego (UCSD) Health.

Her team calculated that "treatment effectiveness exceeded 90% from March through June, but fell to 65.5% in July." In June, one-third of diagnosed cases of antifungal medication occurred among fully vaccinated health get diflucan prescription online care workers. But just one month later, 3 of every 4 cases occurred among the vaccinated. Because more than 83% of all workers in at UCSD Health are now vaccinated, some kind of rise in the number of breakthrough cases was expected. But the sudden, sharp uptick between June and July was get diflucan prescription online still striking.

It "is likely to be due to both the emergence of the Delta variant and waning immunity over time," Torriani and her colleagues said in a report published Sept. 1 in the New England Journal of Medicine. Risks of in July were also "compounded by the get diflucan prescription online end of masking requirements in California and the resulting greater risk of exposure in the community," the authors added. Overall, regular testing of just over 19,000 UCSD health workers uncovered 125 cases of symptomatic antifungal medication in July, up from just 13 cases in May and 15 in June.

Only one case was severe enough that the individual required hospital care, and that case occurred in an unvaccinated worker, the researchers get diflucan prescription online said. No one died. And although 94 of the 125 cases reported in July occurred in vaccinated workers, the key number to look at is what the researchers call the "attack rate." According to the study, in July there were about 5.7 cases of antifungal medication per every 1,000 vaccinated workers at UCSD Health. Compare that to the attack get diflucan prescription online rate among the unvaccinated.

16.4 cases of antifungal medication per every 1,000 workers. That means that an unvaccinated person was nearly three times more likely to contract antifungal medication compared to a fully vaccinated person. As for symptoms, in a tally of cases occurring among UCSD health workers from March through get diflucan prescription online July, "symptoms were present in 109 of the 130 fully vaccinated workers [83.8%] and in 80 of the 90 unvaccinated workers [88.9%]," the study found. The new study represents a detailed look at antifungal medication rates, because UCSD Health "has a low threshold for antifungals testing, which is triggered by the presence of at least one symptom during daily screening or by an identified exposure, regardless of vaccination status," the authors noted.

Dr. Amesh Adalja is an expert in infectious disease and senior scholar at the Johns Hopkins Center for Health get diflucan prescription online Security in Baltimore. Reading over the findings, he said that they support the effectiveness and necessity of getting vaccinated against the new antifungals. "treatments aren't force fields -- breakthrough s will occur, especially as people get back to their get diflucan prescription online activities in the midst of the more contagious Delta variant," Adalja said.

"The breakthroughs were all mild, with no one hospitalized," he added. "To me, that shows the treatments are doing what they were designed to. Taming the diflucan." get diflucan prescription online More information. For more on antifungal medication vaccination, see the U.S.

Centers for Disease Control and Prevention. SOURCES. Amesh Adalja, MD, senior scholar, Johns Hopkins Center for Health Security, New England Journal of Medicine, Sept.1, 2021 Copyright © 2021 HealthDay. All rights reserved..