NETGURUMALI

If your visit to the washroom has become abnormally frequent and it causes immense pain to urinate then, it is time for you to get cautious about those signs. To your surprise, the symptoms which you had been ignoring for a quite a while can be some early warning signs of kidney stone.

A stone in the kidney occurs when a small piece of calcium from the urine forms in the kidney or the ureter. When other minerals stick to it they together form a stone.
Although the symptoms of kidney stone can be seen quite soon but, knowing these early signs can help you stay alert about its formation.

Pain while Urinating

If you have been experiencing the urge to urinate a lot more frequently than ever, you must get checked for a stone in the kidney. Also, if urinating is accompanied with pain, your symptoms are clear. The pain occurs when the stone moves from the bladder to the urethra. This movement also leads to urinary tract infection (UTI).
Pain in the Back

Severe pain in the back especially, in the side and the back below the ribs where the kidneys are located indicates a stone trouble. The pain may also shift from lower abdomen to the groin.
Blood with Urine
People who suffer from kidney stones, often experience pink, red, or brown urine. As the stone grows in size, it blocks the urethra and you will notice dash of blood with your urine.
Vomiting

The feeling of nausea due to kidney stones is so strong that you will almost end throwing up. Vomiting takes place due the immense amount of pain which is caused by the stone. Vomiting also takes place because the body wants to get rid of the waste accumulated due to the blockage by stones. To vomit out is be the only way to remove all the toxins from the body.

When you have a stone in the kidney, discoloration of your urine starts taking place. Along with this, the urine also starts having a foul smell which is caused by the toxins that stay in the body due to blockage. It is these chemicals which crystallize and form the stone.
Difficulty in Sitting Comfortable Position

When the stone becomes large in size, the pain becomes intolerable. This causes pressure in the area when the patient sits down or tries to lie down in a comfortable position.
To eliminate the problem completely, you must know its symptoms. If you are encountering any of these troubles, it will help you take early consultation from the doctor which will save you from the trouble in future.

Hair loss is surprisingly common in women, affecting more than 30 million in the U.S., according to the American Academy of Dermatology. It can start as early as puberty or much later in life. In fact, 38 percent of women 70 and older experience hair loss, in part because hair thickness decreases with age, especially after menopause. The condition often leads to low self-esteem, social anxiety, and self-imposed isolation.

Female pattern hair loss (FPHL) is characterized by thinning over the top of the scalp and sometimes the sides. In men, a male hormone known as an androgen is primarily responsible for hair loss, but the main cause of FPHL appears to be less clear-cut. Women normally produce male hormones too, and in some cases the condition is associated with excessive androgen levels. Other types of hair shedding in women may be related to estrogen loss or significant changes in estrogen levels, as in the postpartum period or in menopause. Hair loss can also result from breakage during hair treatments and styling, certain medication—including hormones—and conditions like iron deficiency, severe dieting, thyroid disease, lupus, and even stress.

Finasteride (Propecia) is approved by the Food and Drug Administration to treat male pattern hair loss (also called androgenetic alopecia). At higher doses, it's also approved to reduce the symptoms of enlarged prostate in men. It works by blocking the enzyme that is responsible for the conversion of testosterone to dihydrotestosterone, the androgen that causes the prostate to enlarge. It also reduces dihydrotestosterone levels in the scalp, which slows hair loss and even increases hair growth. Because finasteride has been effective in controlling male pattern hair loss, it has been used to treat female pattern hair loss, although it has not gained FDA approval for that purpose. Medication prescribed to treat a condition that does not have FDA approval for that use is known as "off-label." Doctors can legally prescribe any medication they deem appropriate for treatment.

"If a woman has female pattern hair loss and elevated androgen levels that we can document, then she is likely to respond to treatments that block or decrease androgens, and finasteride is an option," says Elise A. Olsen, M.D
., a professor of dermatology and oncology and director of the Hair Disorders Research and Treatment Center at Duke University Medical Center. "But often we will try it even in women who don't have elevated androgen levels because other treatment options are very limited, and these women may have sensitivity to androgens at the cellular level of the hair follicle that we can't document."
What is the evidence?

The only randomized, double-blind, placebo-controlled trial on this subject involved 137 postmenopausal women with low androgen levels and hair thinning at the front of their scalp. After 12 months, there were no significant differences in hair count between the patients receiving finasteride or a placebo, and both groups continued to lose hair. The authors concluded that finasteride was well-tolerated but did not reduce hair loss in these women.

Another group of researchers studied 48 premenopausal women with FPHL and elevated androgen levels: 36 subjects were randomized to treatment with one of three drugs with anti-androgen effects, including finasteride, and 12 subjects declined treatment but were observed. The study wasn't blinded, meaning that patients and researchers knew which medication was received. After a year, those taking finasteride continued to lose hair.

In contrast, two studies reported some success with finasteride, but neither was randomized, blinded or placebo-controlled. In one, 37 premenopausal women with FPHL but without androgen excess received finasteride along with an oral contraceptive. After 12 months, most of them showed improved hair density, although the contraceptive contained drospirenone, which has anti-androgen actions and may have contributed to that effect. And in a 2010 study, 86 pre- and postmenopausal Asian women with FPHL and normal androgen levels were treated with finasteride for 12 months, resulting in slight increases in hair density for 57 women, moderate increases in 10 women, and more substantial increases for four women. Anecdotal reports and small, uncontrolled trials have also noted beneficial results with hair loss in pre- and postmenopausal women with or without increased androgen levels.

With the exception of herpes simplex and varicella-zoster encephalitis, the viral forms of encephalitis are not treatable. The primary objective is to diagnose the patient as soon as possible so they receive the right medicines to treat the symptoms. It is very important to lower fever and ease the pressure caused by swelling of the brain.

Patients with very severe encephalitis are at risk for body-wide (systemic) complications including shock, low oxygen, low blood pressure, and low sodium levels. Any potentially life-threatening complication should be addressed immediately with the appropriate treatments.
Treating Probable Causes of Encephalitis

Since it is difficult to determine the cause of encephalitis, and rapid treatment is essential, clinical guidelines recommend immediately administering intravenously the antiviral drug acyclovir without waiting to determine the cause of the illness.

Once the doctor receives results from diagnostic tests, drug treatment depends on the cause of the encephalitis. Antiviral drug treatments for specific causes of encephalitis include:

    Herpes Simplex Virus . Acyclovir is recommended.
    Varicella-Zoster Virus . Acyclovir is recommended. Ganciclovir or adjunctive corticosteroids may also be considered.
    Cytomegalovirus . Combination of ganciclovir plus foscarnet.
    Epstein-Barr Virus . Corticosteroids may be used, although risks may outweigh benefits. (Acyclovir is not recommended.)
    Human Herpesvirus 6. Ganciclovir or foscarnet are recommended for immunocompromised patients.
    Measles. Ribavirin may be considered.
    ADEM. High-dose intravenous corticosteroids.
    St. Louis Encephalitis . Interferon alfa-2a may be considered.

For bacterial meningitis, antibiotics (not antiviral drugs) are used.
Additional Treatments

Other encephalitis treatments are aimed at reducing symptoms.

    Seizures may be prevented by using oral anticonvulsant drugs.or intravenous lorazepam (Ativan).
    Sedatives may be prescribed for irritability or restlessness.
    Simple pain relievers may be used for fever and headache.
    In patients who are otherwise stable, the only other treatment measures are to keep the head elevated and monitor the patient's status.

Investigational Treatments

No specific drugs have been effective for treating arboviruses, including West Nile virus, although a number of drugs used to treat other virus infections are being investigated. They include interferon alfa 2a (Roferon-A) and other interferons.

The goal of treating impotence is to enable a man to achieve and maintain an erection so that he can have sexual intercourse. Depending upon the cause of impotence, treatment may include one or more of the following.

Phosphodiesterase-5 inhibitors — Phosphodiesterase-5 (PDE-5) inhibitors work by increasing chemicals that allow the penis to become and remain erect. They help a man to achieve an erection after sexual stimulation, but the medication does not increase sexual desire.

PDE-5 inhibitors are effective in restoring potency in about 70 percent of men. They work best in men with psychogenic impotence, though can be used in men with other types of impotence as well. In men with conditions that affect the blood vessels (such as diabetes), PDE-5 inhibitors are effective in about 55 to 60 percent of cases. The success rate in men who have undergone prostate cancer surgery is between 25 and 30 percent.

Sildenafil — Sildenafil (Viagra®) should be taken one hour before planned sexual intercourse. Its effect lasts for about four hours; this refers to the time frame that erection is possible if sexual stimulation occurs, not the duration of the erection. The recommended dose is 50 mg for most men; men over the age of 65 should start with 25 mg. The dose may be increased up to 100 mg if the erection was unsatisfactory or decreased to 25 mg if there are bothersome side effects. Only one dose should be taken per 24 hours.

Vardenafil and tadalafil — Vardenafil (Levitra®) and tadalafil (Cialis®) are also PDE-5 inhibitors used to treat ED. Like sildenafil, men who take vardenafil may have an erection (in response to sexual stimulation) as soon as 30 minutes and for up to four hours after taking a vardenafil tablet (this refers to the time frame that erection is possible if sexual stimulation occurs, not the duration of erection). The recommended dose is 10 mg for most men; men over 65 years should start with 5 mg. The dose may be increased to 20 mg or decreased to 2.5 mg as needed. No more than one dose should be taken per 24 hours.

Men who take tadalafil may have an erection within 16 minutes (in response to sexual stimulation) and may be able to experience an erection (in response to sexual stimulation) up to 36 hours after each dose (this refers to the time frame that erection is possible, not the duration of erection). The recommended starting dose is 10 mg for most men. The dose may be increased to 20 mg or decreased to 5 mg as needed. No more than one dose should be taken every 24 hours. Tadalafil can also be taken every day as a low dose pill.

Use of PDE-5 inhibitors

Side effects — Side effects of PDE-5 inhibitors include headache, flushed (red) skin, indigestion, and dizziness. Sildenafil may cause distorted (blue-tinged) vision. Side effects are generally short-lived and resolve spontaneously.
Drug interactions — Men who use nitrates (nitroglycerin) in any form, either on a regular basis or only as needed for chest pain, should never use PDE-5 inhibitors. Taking PDE-5 inhibitors and nitrates can lead to dangerously low blood pressure. PDE-5 inhibitors do not cause heart attacks.
A man who has used a PDE-5 inhibitor and then develops cardiac problems and requires nitrate medications should NOT use the PDE-5 inhibitor in the future. Men who develop chest pain should contact their healthcare provider or go to an emergency department immediately.

Certain medications (including erythromycin, ketoconazole, protease inhibitors, rifampin, phenytoin, and grapefruit juice) can alter the duration of time that sildenafil, vardenafil, and tadalafil remain in the blood stream, which can cause additional side effects. A healthcare provider or pharmacist can provide specific information.

Medications such as doxazosin (Cardura®) and terazosin (Hytrin®), used to treat frequent urination and other urinary symptoms caused by an enlarged prostate (called benign prostatic hyperplasia or BPH), should not be taken with any of the PDE-5 inhibitors; the combination of drugs can cause very low blood pressure. However, tamsulosin (Flomax®), also prescribed for bothersome urinary symptoms caused by BPH, is safe to take with tadalafil as it does not cause a dangerous decline in blood pressure. It is not known if tamsulosin is safe to take with sildenafil or vardenafil. (See "Patient information: Benign prostatic hyperplasia (BPH) (Beyond the Basics)".)

Safety — It is not yet proven that sildenafil is safe for these groups:

Men who have had a heart attack, stroke, or life-threatening irregular heartbeats (called arrhythmia) within the last six months
Men with untreated low or high blood pressure
Men with retinitis pigmentosa, a progressive eye disorder that can lead to blindness
Resuming sexual activity after a prolonged period of inactivity is similar to beginning a new exercise routine. Men considering a PDE-5 medication should be able to participate in an activity that is approximately equal to the energy required for sex (eg, walking two to four miles per hour on a flat surface). The healthcare provider may recommend exercise treadmill testing to ensure that sexual activity will be safe.

Nonarteritic ischemic optic neuropathy or NAION, a condition associated with loss of vision, has been reported in a few men who have taken sildenafil and tadalafil. Most of these cases occurred in men with underlying nerve or blood vessel disease.

Purchasing medications for erectile dysfunction — A number of sources claim to sell medications such as Viagra®, Cialis®, Levitra®, or herbal supplements for erectile dysfunction through the internet or by mail for a reduced cost, often without a prescription. These sources are not known to be safe or reliable, and it is not possible to know whether the pills from these sources contain the actual drug or are counterfeit. Consumers are strongly cautioned to avoid potentially unreliable sources for any medication. Community pharmacies or reputable web-based pharmacies are the most reliable source for all types of medications.

Penile self-injection — With penile self-injection, the patient injects a medication (alprostadil or papaverine) into the corpora cavernosa (the two chambers of the penis that are filled with spongy tissue). This causes an erection by allowing the blood vessels within the penis to expand so that the penis first swells and then stiffens to create a fully rigid erection (figure 1). The erection created by penile injection occurs without sexual stimulation (different from the erection that occurs after sildenafil, vardenafil or tadalafil).

It takes a lot of training for men to feel comfortable with this type of therapy. Under the guidance of urologists, men are shown how to make the skin on the penis sterile and how to inject the medication properly (figure 2). Although this treatment works well for erections, many men eventually stop using it because of discomfort from the injections.

Side effects — Pain is the most common side effect. Men often say that this is the reason they discontinue this type of treatment.
There is also a small risk that the penis will remain erect after intercourse. This occurs in 6 percent of men who use alprostadil and about 11 percent of those who use papaverine. Prolonged erection, called priapism, that lasts longer than four to six hours is a medical emergency. A healthcare provider should be contacted immediately. An emergency procedure must be done as soon as possible to empty the blood that is trapped in the penis. An erection that lasts longer than 48 hours often results in scarring of the tissue inside the penis.

Intraurethral alprostadil (MUSE) — This treatment uses the same medication (alprostadil) as penile self-injection. Instead of injecting it, the man inserts a device with an alprostadil pellet into the urethra. The urethra is the opening in the center of the penis from which urine flows. The alprostadil is then absorbed into the erectile bodies (corpus cavernosum) to create an erection.

Side effects — Side effects include pain as the blood vessels in the penis widen and swell to create the erection. Problems like prolonged erection and scarring on the outside of the penis are less common than with self-injection therapy.
Vacuum-assisted erection devices — There are several products on the market that use vacuum pressure to draw blood into the penis. A rigid ring is placed at the base of the penis (near the body) to hold the blood inside the penis, allowing it to remain erect. Vacuum devices successfully create erections in as many as 67 percent of patients. Satisfaction with vacuum-assisted erections varies between 25 and 49 percent.

Vacuum-assisted devices require that a man be able to hold and pump the unit. It may take a week or more for the device to work effectively. After a man is accustomed to using the device, he can usually create an erection that is rigid enough for penetration and sexual intercourse. He will not be able to ejaculate because the ring that holds blood in the penis also compresses the urethra, preventing semen from exiting. The ability to have an orgasm is not affected by the ring.

Penile prostheses — A penile prosthesis is a device that is surgically implanted and inflates to allow the penis to become erect (figure 3). Penile prostheses are used less frequently because of the popularity of PDE-5 inhibitors and penile injection therapies. For men who do not respond to these therapies or who find vacuum erection therapy distasteful, penile prostheses are an option.

Side effects — Side effects of prosthetic devices include the possibility of infection, pain, and mechanical failure. Mechanical failure may require surgically removing the prosthesis and implanting a new one.
Testosterone replacement therapy — Testosterone therapy is prescribed if a man's testes do not make enough of the hormone testosterone. It is of no benefit in improving sexual function in men whose bodies make normal amounts of testosterone. Testosterone levels are determined with blood tests.

Men with low blood testosterone levels may have diminished libido (sex drive), erectile dysfunction (impotence), decreased muscle mass, increased fat, and are at increased risk for thinning of the bones (osteoporosis). Treatment is designed to increase a man's testosterone level, libido, erectile function, fat and muscle levels; bone density usually improve as testosterone levels return to normal.

Treatment options for testosterone deficient men include:

Testosterone injections — Testosterone injections of either testosterone cypionate (Depo-Testosterone®) or testosterone enanthate (Dela-Testryl®) increase the blood level of testosterone promptly. However, testosterone levels decline quickly; to sustain normal testosterone levels, injections must be given every one to two weeks. Pain at the injection site is the most common side effect.
Testosterone gels — Testosterone gel is applied daily to the skin surface, which allows the testosterone within the gel to be absorbed from the skin into the blood. One gel (Androgel®) is supplied as a foil packet; another (Testim ®) is in a small toothpaste-like tube. The gel is applied to the upper arms, near the shoulder, every morning. The gel dries quickly; blood testosterone levels increase within two hours and are stable for 24 hours.

Because testosterone gel applied to a man's skin surface can be transferred to a female partner's skin, men are cautioned to wear a shirt if sex is planned immediately after applying the gel. The gel is fully absorbed after two hours and the shirt precaution is not necessary after this time.
Testosterone skin patch — The testosterone patch (Androderm®) contains testosterone as well as a chemical enhancer that allows the testosterone to be absorbed through the skin into the blood. The patch is applied in the morning, usually after a shower, to the arm, or back, preferably in an area that has little to no hair (to enhance adhesion); the area where the patch is applied should be rotated. The patch must be changed every day. Side effects include skin irritation and a local rash.
Testosterone lozenge — A testosterone lozenge (Striant®) is placed in the mouth between the cheek and upper gums. It softens and forms a gel that adheres to the gums and remains in place for 12 hours; the testosterone is absorbed through the gums and into the bloodstream. It should be used twice daily and should not be chewed or swallowed. Any remaining gel should be removed before placing the next lozenge. Gum irritation and gingivitis (inflammation of the gums) occurs in a small percentage of men using this treatment.
Psychotherapy and psychoactive medications — Depression, anxiety, and distractions can cause erectile dysfunction. Often these problems can be treated using psychological counseling, antidepressant drugs, or both. Sexual therapy is sometimes needed as well.

Medications are used to treat both depression and anxiety. They are very effective, though some (especially those of the serotonin reuptake inhibitor (SSRI) class) can cause decreased sex drive and erectile dysfunction. On the other hand, some antidepressant drugs can cause delayed ejaculation, which can be helpful for men with premature ejaculation. (See "Patient information: Depression treatment options for adults (Beyond the Basics)".)

Psychological counseling or psychotherapy involves the patient talking to a therapist about his thoughts and concerns. Psychotherapy may be helpful for:

Couples, when one or both partners have a serious medical condition. Anxiety over the safety of sexual activity may be present in people who are ill and his or her partner.
Men who suddenly experience one or more erectile failures during attempted intercourse. This is called performance anxiety.
Men who are depressed. In this case, psychotherapy may be combined with an antianxiety or antidepressant medication. Almost all antidepressant medications are effective for improving symptoms of depression, but may cause sexual side effects (eg, erectile dysfunction).
Sex therapy — This type of therapy is often helpful for men who lack focus or become distracted during sex. Treatment focuses on encouraging both sexual partners to work together and uses structured home exercises to improve concentration.

Yohimbine — Yohimbine was once the only pill available to treat erectile dysfunction. It has been replaced with PDE-5 inhibitors, described above (see 'Phosphodiesterase-5 inhibitors' above).