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Latest Heart News WEDNESDAY, July 21, 2021 (HealthDay News) Eating beef, lamb, where can you get cipro pork and processed meats spells trouble for your heart, and the more you eat, the worse it gets, new research warns. The meta-analysis -- an overview of data from a large number of studies -- included more than 1.4 million people who were followed for 30 years. It found that for each 1.75 ounces of beef, lamb and pork where can you get cipro consumed, the risk of heart disease rose 9%, CNN reported. Processed meats were even worse.

For each 1.75 ounces of processed meats such as bacon, ham or sausage consumed, the risk rose 18%, according to the study published July 21 in the journal Critical Reviews in Food Science and Nutrition. A recommended serving of meat is about 3 where can you get cipro ounces, the size of a bar of soap or deck of cards, according to the American Cancer Society. "Processed meat appears to be worse for coronary heart disease," study co-author Anika Knüppel, a nutritional epidemiologist in the department of population health at the University of Oxford, in England, told CNN. "This is in line with what has been found for bowel [colon] cancer, where processed meat has been shown to be associated with higher increase in risk than red meat," Knüppel added.

The good news from the study where can you get cipro is that pouy — such as chicken and turkey — don't appear to increase the risk of heart disease, CNN reported. Considered lean meats, most types of pouy do not contain the levels of saturated fat as found in red meat, nor the high levels of sodium that are part of processed meats. Saturated fat contributes to the development of plaque on your artery walls, which can create dangerous blockages. Meanwhile, sodium raises blood pressure, restricting the flow of blood to where can you get cipro the heart.

More information Visit the U.S. Department of Agriculture for more on healthy where can you get cipro eating. SOURCE. CNN Robert Preidt Copyright © 2021 HealthDay.

All rights where can you get cipro reserved. SLIDESHOW Heart Disease. Causes of a Heart Attack See SlideshowLatest antibiotics News By Cara Murez HealthDay ReporterWEDNESDAY, July 21, 2021 (HealthDay News) Coffee delivers the boost that many people need to start their day. Now, new research suggests this breakfast powerhouse may also provide some protection against buy antibiotics where can you get cipro.

Consuming vegetables and having been breastfed might also reduce your buy antibiotics risk, according to the new study from Northwestern University in Chicago. Conversely, processed meats may increase your susceptibility to the antibiotics. Other foods studied — where can you get cipro including fruit, tea and red meat — had no impact. "We know that buy antibiotics is an infectious disease, similar to pneumonia or other kinds of respiratory s.

We know that immunity plays an important role where can you get cipro in our ability to combat some of these infectious diseases," said study co-author Marilyn Cornelis. "I was interested in seeing how nutrition could play a role [in buy antibiotics] because we know that nutrition impacts immunity," added Cornelis, an associate professor of preventive medicine at Northwestern University School of Medicine. Other research has focused on individual health issues in terms of buy antibiotics , including the impact of conditions such as diabetes. Less attention has been given to modifiable risk factors, other than weight, Cornelis where can you get cipro said.

For the study, the researchers used UK Biobank data to examine an association between dietary behaviors from 2006 to 2010 and buy antibiotics s from March through November 2020 in the same people. The investigators looked specifically at foods shown to affect the immune system in earlier human and animal studies. The study included where can you get cipro nearly 38,000 participants who had received a buy antibiotics test. About 17% tested positive for the cipro.

The team found that nutrition might confer a modest degree of protection. For example, consuming one or more cups of coffee a day was associated with a 10% decrease in risk of buy antibiotics when where can you get cipro compared to consuming less than one cup daily. Consuming at least two-thirds of a serving of cooked or raw vegetables daily (excluding potatoes) was also linked with reduced risk. However, even eating where can you get cipro less than half a serving of processed meat daily — think hot dogs and deli meat — was associated with higher risk.

Like coffee, being breastfed as an infant was associated with a 10% reduced risk. Why these dietary factors might make a difference is not yet known, and it's important to note that the study cannot prove a direct cause-and-effect relationship. The reason why coffee where can you get cipro seems protective while tea is not could be the greater amount of caffeine in coffee, Cornelis suggested. "Alternatively, it could be other constituents of coffee that are unique and make it distinct from tea.

For example, tea is often rich in flavonoids. Whereas with coffee, it's more polyphenols, specifically chlorogenic acid, which is actually a relatively unique constituent of coffee," Cornelis where can you get cipro said. "It has been implicated in other diseases not related to buy antibiotics but might also be driving this relationship." In a similar juxtaposition, red meat consumption did not appear to boost risk for contracting buy antibiotics, but processed meats did. "The relationship may not necessarily be related to meats all, but it could be the actual processing of these foods.

These are just hypotheses, but because buy antibiotics is so new, obviously more research where can you get cipro is needed," Cornelis said. Consuming a lot of veggies appeared to be good, in terms of risk, she said, though whether specific vegetables with certain nutrient profiles make a bigger difference is unknown. "Some of these findings, they just are indicators of good eating where can you get cipro habits. I think it just speaks to the importance of good nutrition, not only for buy antibiotics, but just for overall health," Cornelis said.

Not a substitute for treatment Certainly, coffee and veggies are not substitutes for the buy antibiotics treatment and other recommended preventive measures, experts say. The U.S where can you get cipro. Centers for Disease Control and Prevention says everyone age 12 and older should get a treatment. treatments are not yet available for younger children.

Dr. Karen Studer is program director for the preventive medicine residency program at Loma Linda University in California. She said the study findings are similar to the teachings of lifestyle medicine and the idea that food is medicine. QUESTION According to the USDA, there is no difference between a “portion” and a “serving.” See Answer "The benefits of a whole food, plant-based diet — which is mostly fruits and vegetables and grains — will protect you from a lot of diseases.

This is exciting because it looks like it's true for infectious disease such as buy antibiotics, too," Studer said. Other studies have also found benefits in coffee, including increased longevity, Studer said. Small lifestyle changes can have a big impact on health, Studer added. That might include giving up tobacco, alcohol or sugar-sweetened beverages.

If nutrition is challenging, you could focus on other lifestyle changes, such as improving sleep or managing stress, she said. "My advice to my patients is, the degree at which you want to see change happen is the degree you're going to have to change your behavior," Studer said. "Look for your low-hanging fruit and then do small steps and really try to make changes over time to benefit your health long-term." The findings were published online recently in the journal Nutrients. More information The U.S.

Centers for Disease Control and Prevention has tips on eating for a healthy weight. SOURCES. Marilyn Cornelis, PhD, associate professor, preventive medicine (nutrition), Northwestern University Feinberg School of Medicine, Chicago. Karen Studer, MD, MPH, MBA, program director, preventive medicine residency program and assistant professor, preventive medicine, School of Medicine, and assistant professor, School of Public Health, Loma Linda University, Loma Linda, Calif..

Nutrients, June 20, 2021, online Copyright © 2021 HealthDay. All rights reserved. From Nutrition and Healthy Eating Resources Featured Centers Health Solutions From Our SponsorsLatest Diabetes News WEDNESDAY, July 21, 2021 (American Heart Association News) There are many reasons to avoid getting diabetes, or to keep it controlled if you already have it. Higher risks for heart disease, stroke and for having a foot or leg amputation.

But here's another one. It's a major risk factor for dementia. While researchers are still investigating what causes that increased risk, one thing they do know is it's linked to highs – and lows – in the body's blood sugar levels. "Whether it's Type 1 or Type 2 diabetes, glycemic control is very important" for maintaining good brain health, said Rachel Whitmer, chief of the division of epidemiology at University of California, Davis and associate director of the school's Alzheimer's Disease Research Center.

"This is another motivation to have good control." Good management of blood glucose levels is one of seven lifestyle changes people can make to support better heart and brain health, called Life's Simple 7 by the American Heart Association. It's a step that could potentially help more than 34.2 million people in the U.S. Living with diabetes. According to the Centers for Disease Control and Prevention, the vast majority of people with diabetes have Type 2, which becomes more prevalent as people get older, as does dementia.

It happens when the body can't properly use the insulin it makes to control blood sugar levels. It develops over many years and is often associated with being overweight or obese. Type 1 diabetes is an autoimmune disease in which the body stops making insulin. Most of the research on the diabetes-dementia link involves Type 2 diabetes, which studies show roughly doubles the dementia risk and may cause it to develop a few years earlier.

For people with Type 1 diabetes, treatment advances have led to longer lifespans, allowing researchers to begin delving into how the disease affects their cognitive abilities as they age. "They are now living to ages to be at risk for diseases that happen later in life," said Whitmer, who is also an adjunct investigator at the Division of Research for Kaiser Permanente Northern California. Whitmer led a study for Kaiser that showed older adults with Type 1 diabetes who were hospitalized for just one blood sugar extreme were at higher risk for dementia – and those who were hospitalized for both highs and lows were six times more likely to later develop dementia. Shannon Macauley, an assistant professor of gerontology and geriatric medicine at Wake Forest School of Medicine, studies the relationship between Type 2 diabetes and Alzheimer's disease in her lab in Winston-Salem, North Carolina.

"Glucose is unbelievably important for the brain," Macauley said. Though it makes up just 2% of the body's weight, the brain uses 20%-30% of circulating blood glucose. "People don't appreciate how much the brain sucks glucose out of the blood. It's a big user of your glucose supply." QUESTION ______________ is another term for type 2 diabetes.

See Answer Unlike other organs, the brain can't store excess glucose, she said. That makes it vulnerable to highs and lows. "It needs it on demand in a rapid fashion but that puts the brain at excess risk when glucose levels hit one extreme or another." Macauley's research in mice suggests too much glucose may be causing rapid production of beta-amyloid, proteins that clump together to form amyloid plaques in the brain. Beta-amyloid has been implicated in the development of Alzheimer's disease.

When the brain suddenly produces excess beta-amyloid, it's "like throwing a Jersey barrier out onto I-95," Macauley said. "All the cars have to figure out how to get around it. The cells can't get to where they need to go, they can't communicate properly with other cells and lose their efficiency." Conversely, too little glucose in the brain robs it of the energy it needs to perform tasks, she said. "You need energy on hand for every task – to talk, think, button your shirt.

Energy also goes to keeping the cells and brain alive. If you go low, you are starving the brain, and it can't do what it needs to do." Preventing dementia isn't the only way good blood glucose control helps the brain, Whitmer said. "It also helps to prevent stroke," she said. "There are lots of blood vessels in the brain.

Good glycemic control equates with good blood vessel health. What's good for your heart is good for your brain." Whether a person has Type 1 or Type 2 diabetes, there are many steps they can take to keep blood sugar levels on an even keel. First, it's important to know your numbers. Even blood sugar levels slightly higher than normal – a condition known as prediabetes – can start to do damage, Macauley said.

To be in the healthy range, levels should be lower than 100 mg/dl, with measurements from 100-125 mg/dl considered prediabetes. "If you are in that realm, there are clues you are becoming unhealthy," Macauley said. A person may be overweight, eating an unhealthy diet, smoking or not getting enough sleep or physical exercise. "Exercise causes you to use that extra glucose." If diet and exercise don't help enough, medication may be needed, she said.

People with Type 1 diabetes need to check blood sugar levels throughout the day because what they eat and how much physical activity they get can cause levels to rise or fall. Health experts recommend they keep supplies such as hard candy, fruit juice or glucose tablets with them to boost levels should they get too low. As people with Type 1 live longer, Whitmer said, researchers need to focus on other ways to ensure their years are healthy ones. "We really need to step back and think about how we can increase this patient population's chances of successful aging." American Heart Association News covers heart and brain health.

Not all views expressed in this story reflect the official position of the American Heart Association. Copyright is owned or held by the American Heart Association, Inc., and all rights are reserved. If you have questions or comments about this story, please email [email protected] By Laura Williamson American Heart Association News Copyright © 2021 HealthDay. All rights reserved.Latest antibiotics News WEDNESDAY, July 21, 2021 (HealthDay News) The Pfizer buy antibiotics treatment will be produced for the first time in Africa by a South African firm, Pfizer announced Wednesday.

The Biovac Institute in Cape Town will produce the treatment for distribution across Africa, which is in desperate need of more buy antibiotics treatments as cases surge, the Associated Press reported. Biovac will receive large-batch ingredients for the treatment from Europe and will blend the components, put them in vials and package them for distribution. The company will begin production in 2022, and the objective is to make more than 100 million doses a year. This is "a critical step" in increasing Africans' access to an effective buy antibiotics treatment, according to Biovac CEO Dr.

Morena Makhoana, the AP reported. The Johnson &. Johnson buy antibiotics treatment is already being made in South Africa and being distributed across Africa, the wire service said. Plans are to deliver 200 million J&J doses across the continent, the AP reported.

South Africa is relying on the Pfizer treatment in its mass vaccination drive. It has purchased 40 million doses of the Pfizer treatment, which are arriving in weekly deliveries. More than 5.5 million of South Africa's 60 million people have received at least one jab, with more than 1.4 million fully vaccinated, according to official figures released Wednesday, the AP reported. South Africa's goal is to vaccinate about 67% of its population by February 2022.

Across Africa, vaccination levels are still low, with less than 2% of the continent's population of 1.3 billion having received at least one shot, according to the Africa Centers for Disease Control and Prevention. More information Visit the U.S. Centers for Disease Control and Prevention for more on buy antibiotics treatments. SOURCE.

Associated Press Robert Preidt Copyright © 2021 HealthDay. All rights reserved.Latest Migraine News By Denise Mann HealthDay ReporterTHURSDAY, July 22, 2021 (HealthDay News) Roller coasters race up, down, over and back again at breakneck speeds, but if you are one of the millions of people who get migraines, the risks may not be worth the thrill. A new study by German researchers shows that folks who get migraines will more likely feel motion sickness and dizziness after a virtual roller coaster ride, compared with people who don't get these blinding headaches. These symptoms correlated directly with changes in key brain areas, the researchers said, and those insights could further research into easing the headaches.

"Migraine patients reported more dizziness and motion sickness, as well as longer symptom duration and intensity in a virtual roller coaster ride, and the brain of migraine patients reacted differently," said study author Dr. Arne May, a professor of neurology at the University of Hamburg. "We found differences not just in [symptoms], but also in specific activations of areas within the brain's cerebellum and the frontal gyrus." The brain's cerebellum helps regulate balance and the frontal gyrus is responsible for visual processing. More than just a cautionary tale about the risks of roller coaster rides for people with a history of migraines, the new findings add to the understanding of migraine as a sensory disorder and may pave the way toward treatments that address those symptoms.

For the study, 20 people with a history of migraine and 20 people without such a history watched videos to experience a virtual roller coaster ride while researchers used functional MRI scans to track brain activity. No one experienced a migraine during the virtual ride, but 65% of people with migraine experienced dizziness compared to 30% of those without a history of these headaches. What's more, people with migraine also experienced symptoms for longer periods of time than their counterparts without migraine, an average of 1 minute 19 seconds compared to 27 seconds, respectively. People with migraines also reported more intense motion sickness, the study showed.

People with migraine had increased activity in five areas of the brain that correlated with migraine disability and motion sickness scores, May said. "Migraine patients process visual input differently than other people do and activate a specific brain network when this occurs," May explained. Dizziness and motion sickness are often neglected by doctors who treat migraines, even though they are part of the spectrum of symptoms with this disease. "If we can explain such symptoms and show that a specific brain area is activated during attacks, they will be better accepted," May said.

The study appears in the July 21 issue of Neurology, Headache specialists said that the findings enhance the understanding and burden of migraine. "It really confirms the dizziness and motion sensitivity that migraine sufferers experience, and broadens our perception of migraine as a sensory disorder," said Dr. Teshamae Monteith. She is an associate professor of clinical neurology and chief of the headache division at the University of Miami Miller School of Medicine.

Monteith is also a fellow of the American Academy of Neurology. "Migraine is an invisible disorder, but these imaging findings validate the dizziness and motion sensitivity and make us think about treatment outcomes other than headache," said Monteith. "These symptoms can be disabling and may also occur when playing virtual-reality video games." "Dizziness is a common symptom reported by people impacted by migraine," agreed Dr. Brian Grosberg, director of the Hartford HealthCare Headache Center in Connecticut.

"The findings in this study substantiate this experience and implicate areas of the brain involved in its processing." More information SLIDESHOW 16 Surprising Headache Triggers and Tips for Pain Relief See Slideshow Learn more about migraines and how they are treated at the American Academy of Neurology. SOURCES. Arne May, MD, PhD, professor, neurology, University of Hamburg, Germany. Teshamae Monteith, MD, associate professor, clinical neurology, and chief, headache division, University of Miami Miller School of Medicine.

Brian Grosberg, MD, director, Hartford HealthCare Headache Center, Hartford, Conn.. Neurology, July 21, 2021 Copyright © 2021 HealthDay. All rights reserved. From Migraines and Headaches Resources Featured Centers Health Solutions From Our Sponsors.

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AdvertisementContinue reading the main storySupported byContinue reading the main storyHow Food May Improve Your MoodThe sugar-laden, high-fat foods we often crave when we are stressed or depressed, as comforting as they are, may be the least likely to benefit our mental health.Credit...Rocio EgioMay 6, 2021, 5:00 low cost cipro a.m. ETAs people across the globe grappled with higher levels of stress, depression and anxiety this past year, many turned to their favorite comfort foods. Ice cream, low cost cipro pastries, pizza, hamburgers.

But studies in recent years suggest that the sugar-laden and high-fat foods we often crave when we are stressed or depressed, as comforting as they may seem, are the least likely to benefit our mental health. Instead, whole foods such as vegetables, fruit, fish, eggs, nuts and seeds, beans and legumes and fermented foods like yogurt may be a better bet.The findings stem from an emerging field of research known low cost cipro as nutritional psychiatry, which looks at the relationship between diet and mental wellness. The idea that eating certain foods could promote brain health, much the way it can promote heart health, might seem like common sense.

But historically, nutrition research has focused largely on how the foods we eat affect our physical health, rather than our mental health. For a long time, the potential influence of food on happiness and mental well-being, as one team of researchers recently put it, was “virtually ignored.”But over the years, a growing body of research has provided intriguing hints about the ways in which foods may affect low cost cipro our moods. A healthy diet promotes a healthy gut, which communicates with the brain through what is known as the gut-brain axis.

Microbes in the gut produce neurotransmitters like serotonin and dopamine, which regulate our mood and emotions, and the gut low cost cipro microbiome has been implicated in mental health outcomes. €œA growing body of literature shows that the gut microbiome plays a shaping role in a variety of psychiatric disorders, including major depressive disorder,” a team of scientists wrote in the Harvard Review of Psychiatry last year.Large population studies, too, have found that people who eat a lot of nutrient-dense foods report less depression and greater levels of happiness and mental well-being. One such study, from 2016, that followed 12,400 people for about seven years low cost cipro found that those who increased their consumption of fruits and vegetables during the study period rated themselves substantially higher on questionnaires about their general levels of happiness and life satisfaction.Large observational studies, however, can show only correlations, not causation, which raises the question.

Which comes first?. Do anxiety and depression drive people to choose unhealthy foods, or vice versa?. Are people low cost cipro who are happy and optimistic more motivated to consume nutritious foods?.

Or does a healthy diet directly brighten their moods?. The first low cost cipro major trial to shed light on the food-mood connection was published in 2017. A team of researchers wanted to know whether dietary changes would help alleviate depression, so they recruited 67 people who were clinically depressed and split them into groups.

One group went to meetings with a dietitian who taught them to follow a traditional Mediterranean-style diet. The other group, serving as the control, met regularly with a research low cost cipro assistant who provided social support but no dietary advice.At the start of the study, both groups consumed a lot of sugary foods, processed meats and salty snacks, and very little fiber, lean proteins or fruits and vegetables. But the diet group made big changes.

They replaced candy, fast food and pastries with whole low cost cipro foods such as nuts, beans, fruits and legumes. They switched from white bread to whole grain and sourdough bread. They gave up sugary low cost cipro cereals and ate muesli and oatmeal.

Instead of pizza, they ate vegetable stir-fries. And they replaced highly processed meats like ham, sausages and bacon with seafood and small amounts of lean red meats.Importantly, both groups were counseled to continue taking any antidepressants or other medications they were prescribed. The goal of the study was not to see if a healthier diet could replace medication, but whether it could provide additional benefits like exercise, good sleep and other lifestyle behaviors.After 12 weeks, average depression scores improved in both groups, which might be expected for anyone entering a clinical trial that provided additional support, low cost cipro regardless of which group you were in.

But depression scores improved to a far greater extent in the group that followed the healthy diet. Roughly a third of those people were no longer classified as depressed, compared to 8 percent low cost cipro of people in the control group.The results were striking for a number of reasons. The diet benefited mental health even though the participants did not lose any weight.

People also saved money by eating the more nutritious foods, demonstrating that a healthy diet can be economical. Before the study, the participants spent low cost cipro on average $138 per week on food. Those who switched to the healthy diet lowered their food costs to $112 per week.The recommended foods were relatively inexpensive and available at most grocery stores.

They included things like canned beans and lentils, low cost cipro canned salmon, tuna and sardines, and frozen and conventional produce, said Felice Jacka, the lead author of the study.“Mental health is complex,” said Dr. Jacka, the director of the Food &. Mood Centre at Deakin low cost cipro University in Australia and the president of the International Society for Nutritional Psychiatry Research.

€œEating a salad is not going to cure depression. But there’s a lot you can do to lift your mood and improve your mental health, and it can be as simple as increasing your intake of plants and healthy foods.”A number of randomized trials have reported similar findings. In one study of 150 adults with depression that was published last year, researchers found that people assigned to follow a Mediterranean diet supplemented with fish oil for three months had greater reductions in symptoms low cost cipro of depression, stress and anxiety after three months compared to a control group.Still, not every study has had positive results.

A large, yearlong trial published in JAMA in 2019, for example, found that a Mediterranean diet reduced anxiety but did not prevent depression in a group of people at high risk. Taking supplements such low cost cipro as vitamin D, selenium and omega-3 fatty acids had no impact on either depression or anxiety.Most psychiatric professional groups have not adopted dietary recommendations, in part because experts say that more research is needed before they can prescribe a specific diet for mental health. But public health experts in countries around the world have started encouraging people to adopt lifestyle behaviors like exercise, sound sleep, a heart-healthy diet and avoiding smoking that may reduce inflammation and have benefits for the brain.

The Royal Australian and New Zealand College of Psychiatrists issued clinical practice guidelines encouraging clinicians to address diet, exercise and smoking before starting patients on medication or psychotherapy.Individual clinicians, too, are already incorporating nutrition into their work with patients. Dr. Drew Ramsey, a psychiatrist and assistant clinical professor at the Columbia University College of Physicians and Surgeons in New York, begins his sessions with new patients by taking their psychiatric history and then exploring their diet.

He asks what they eat, learns their favorite foods, and finds out if foods that he deems important for the gut-brain connection are missing from their diets, such as plants, seafood and fermented foods.Dr. Ramsey published a book in March, “Eat to Beat Depression and Anxiety,” and founded the Brain Food Clinic in New York to help people struggling with mood disorders improve their diets. He often recites a jingle so people can remember the basics of his dietary advice.

€œSeafood, greens, nuts and beans — and a little dark chocolate.”Dr. Ramsey said these foods help to promote compounds like brain-derived neurotrophic factor, or BDNF, a protein that stimulates the growth of new neurons and helps protect existing ones. They also contain large amounts of fiber, unsaturated fat, antioxidants, omega-3 fatty acids and other nutrients that have been shown to improve gut and metabolic health and reduce inflammation, all of which can affect the brain.Dr.

Ramsey said he does not want people to think that the only factor involved in brain health is food. €œLots of people get their food exactly right, live very active lives, and still have significant troubles with their mental health,” he said.But he also teaches people that food can be empowering. €œWe can’t control our genes, who our parents were, or if random acts of trauma or violence happen to us,” he said.

€œBut we can control how we eat, and that gives people actionable things that they can do to take care of their brain health on a daily basis.”AdvertisementContinue reading the main story.

AdvertisementContinue reading the main storySupported byContinue reading the main storyHow Food May Improve Your MoodThe sugar-laden, high-fat foods we often crave when we are stressed or depressed, as comforting as they are, may be the https://vahybridloan.org/cheap-generic-levitra/ least likely to where can you get cipro benefit our mental health.Credit...Rocio EgioMay 6, 2021, 5:00 a.m. ETAs people across the globe grappled with higher levels of stress, depression and anxiety this past year, many turned to their favorite comfort foods. Ice cream, pastries, pizza, hamburgers where can you get cipro.

But studies in recent years suggest that the sugar-laden and high-fat foods we often crave when we are stressed or depressed, as comforting as they may seem, are the least likely to benefit our mental health. Instead, whole foods such as where can you get cipro vegetables, fruit, fish, eggs, nuts and seeds, beans and legumes and fermented foods like yogurt may be a better bet.The findings stem from an emerging field of research known as nutritional psychiatry, which looks at the relationship between diet and mental wellness. The idea that eating certain foods could promote brain health, much the way it can promote heart health, might seem like common sense.

But historically, nutrition research has focused largely on how the foods we eat affect our physical health, rather than our mental health. For a long time, the potential influence of food on happiness and mental well-being, as one team of researchers recently put it, was “virtually ignored.”But over the years, a growing body of research where can you get cipro has provided intriguing hints about the ways in which foods may affect our moods. A healthy diet promotes a healthy gut, which communicates with the brain through what is known as the gut-brain axis.

Microbes in the gut produce neurotransmitters like serotonin and dopamine, which regulate our where can you get cipro mood and emotions, and the gut microbiome has been implicated in mental health outcomes. €œA growing body of literature shows that the gut microbiome plays a shaping role in a variety of psychiatric disorders, including major depressive disorder,” a team of scientists wrote in the Harvard Review of Psychiatry last year.Large population studies, too, have found that people who eat a lot of nutrient-dense foods report less depression and greater levels of happiness and mental well-being. One such study, from 2016, that followed 12,400 people for about seven years found that those who increased their consumption of fruits and where can you get cipro vegetables during the study period rated themselves substantially higher on questionnaires about their general levels of happiness and life satisfaction.Large observational studies, however, can show only correlations, not causation, which raises the question.

Which comes first?. Do anxiety and depression drive people to choose unhealthy foods, or vice versa?. Are where can you get cipro people who are happy and optimistic more motivated to consume nutritious foods?.

Or does a healthy diet directly brighten their moods?. The first major trial to where can you get cipro shed light on the food-mood connection was published in 2017. A team of researchers wanted to know whether dietary changes would help alleviate depression, so they recruited 67 people who were clinically depressed and split them into groups.

One group went to meetings with a dietitian who taught them to follow a traditional Mediterranean-style diet. The other group, serving as the control, met regularly with a research assistant who provided where can you get cipro social support but no dietary advice.At the start of the study, both groups consumed a lot of sugary foods, processed meats and salty snacks, and very little fiber, lean proteins or fruits and vegetables. But the diet group made big changes.

They replaced candy, fast food and pastries with whole foods where can you get cipro such as nuts, beans, fruits and legumes. They switched from white bread to whole grain and sourdough bread. They gave up sugary where can you get cipro cereals and ate muesli and oatmeal.

Instead of pizza, they ate vegetable stir-fries. And they replaced highly processed meats like ham, sausages and bacon with seafood and small amounts of lean red meats.Importantly, both groups were counseled to continue taking any antidepressants or other medications they were prescribed. The goal of the study was not to see if a healthier diet could replace medication, but whether it could provide additional benefits like exercise, good sleep and other lifestyle behaviors.After 12 weeks, average depression scores improved in both groups, which might be expected for anyone entering a clinical trial that provided additional support, where can you get cipro regardless of which group you were in.

But depression scores improved to a far greater extent in the group that followed the healthy diet. Roughly a third of those people were where can you get cipro no longer classified as depressed, compared to 8 percent of people in the control group.The results were striking for a number of reasons. The diet benefited mental health even though the participants did not lose any weight.

People also saved money by eating the more nutritious foods, demonstrating that a healthy diet can be economical. Before the study, the where can you get cipro participants spent on average $138 per week on food. Those who switched to the healthy diet lowered their food costs to $112 per week.The recommended foods were relatively inexpensive and available at most grocery stores.

They included things like canned beans and lentils, canned salmon, tuna and sardines, and frozen and conventional produce, said Felice Jacka, the lead author of where can you get cipro the study.“Mental health is complex,” said Dr. Jacka, the director of the Food &. Mood Centre at Deakin University in Australia and the where can you get cipro president of the International Society for Nutritional Psychiatry Research.

€œEating a salad is not going to cure depression. But there’s a lot you can do to lift your mood and improve your mental health, and it can be as simple as increasing your intake of plants and healthy foods.”A number of randomized trials have reported similar findings. In one study of 150 adults with depression that was published last year, researchers found that people assigned to follow a Mediterranean diet supplemented with fish oil for three months had greater reductions in symptoms of depression, stress and anxiety after three months compared where can you get cipro to a control group.Still, not every study has had positive results.

A large, yearlong trial published in JAMA in 2019, for example, found that a Mediterranean diet reduced anxiety but did not prevent depression in a group of people at high risk. Taking supplements such as vitamin D, selenium and omega-3 fatty acids had no impact where can you get cipro on either depression or anxiety.Most psychiatric professional groups have not adopted dietary recommendations, in part because experts say that more research is needed before they can prescribe a specific diet for mental health. But public health experts in countries around the world have started encouraging people to adopt lifestyle behaviors like exercise, sound sleep, a heart-healthy diet and avoiding smoking that may reduce inflammation and have benefits for the brain.

The Royal Australian and New Zealand College of Psychiatrists issued clinical practice guidelines encouraging clinicians to address diet, exercise and smoking before starting patients on medication or psychotherapy.Individual clinicians, too, are already incorporating nutrition into their work with patients. Dr. Drew Ramsey, a psychiatrist and assistant clinical professor at the Columbia University College of Physicians and Surgeons in New York, begins his sessions with new patients by taking their psychiatric history and then exploring their diet.

He asks what they eat, learns their favorite foods, and finds out if foods that he deems important for the gut-brain connection are missing from their diets, such as plants, seafood and fermented foods.Dr. Ramsey published a book in March, “Eat to Beat Depression and Anxiety,” and founded the Brain Food Clinic in New York to help people struggling with mood disorders improve their diets. He often recites a jingle so people can remember the basics of his dietary advice.

€œSeafood, greens, nuts and beans — and a little dark chocolate.”Dr. Ramsey said these foods help to promote compounds like brain-derived neurotrophic factor, or BDNF, a protein that stimulates the growth of new neurons and helps protect existing ones. They also contain large amounts of fiber, unsaturated fat, antioxidants, omega-3 fatty acids and other nutrients that have been shown to improve gut and metabolic health and reduce inflammation, all of which can affect the brain.Dr.

Ramsey said he does not want people to think that the only factor involved in brain health is food. €œLots of people get their food exactly right, live very active lives, and still have significant troubles with their mental health,” he said.But he also teaches people that food can be empowering. €œWe can’t control our genes, who our parents were, or if random acts of trauma or violence happen to us,” he said.

€œBut we can control how we eat, and that gives people actionable things that they can do to take care of their brain health on a daily basis.”AdvertisementContinue reading the main story.

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How to cite this where can i buy cipro article:Singh cipro documents OP. Mental health in diverse India. Need for cipro documents 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 geography – From the cipro documents 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, cipro documents and other sociodemographic development indexes. There is now ample evidence that sociocultural factors influence mental health. Compton and Shim[1] have cipro documents 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 cipro documents access to health care leads to poor mental health, disease, 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 cipro documents developed southern states had higher prevalence of adult-onset disorders such as depression 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 depression and anxiety were found in cipro documents females. Apart from the genetic and hormonal factors, increase was attributed to gender discrimination, violence, sexual abuse, and adverse sociocultural norms. Marriage was found to be a negative prognostic indicator contrary to the western norms.[3]Cultural influences on cipro documents 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 well acknowledged.When we look into suicide data, suicide in lower socioeconomic strata (annual income <1 cipro documents 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 cipro documents require sustained advocacy aimed 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 cipro documents for mapping out the problem, cost-effective interventions, and their efficacy.Advocacy can be done at 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 India, Global Burden of Diseases in Indian States, cipro documents 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 a case for lacunae in cipro documents 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 Journal of Psychiatry has also come out with editorials highlighting the need of care of marginalized population such as migrant cipro documents 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 cipro documents enemy is economic inequality, our weapon is research highlighting the role of these factors on mental health. References 1.Compton MT, Shim RS. The social determinants of mental cipro documents health. Focus 2015;13:419-25. 2.Gururaj G, Varghese M, Benegal V, Rao GN, Pathak K, Singh LK, et al.

National Mental cipro documents Health Survey of India, 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. In. Sathyanarayana Rao TS, Tandon A, editors.

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A sex neurosis of the Indian subcontinent. Br J Psychiatry 1990;156:577-9. 10.Rao TS, Rao VS, Rajendra PN, Mohammed A. A retrospective comparative study of teaching hospital and private clinic clients with sexual problems. Indian J Behav Sci 1995;5:58-63.

11.Mumford DB. The 'Dhat syndrome'. A culturally determined symptom of depression?. Acta Psychiatr Scand 1996;94:163-7. 12.Sumathipala A, Siribaddana SH, Bhugra D.

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Indian J Psychiatry 2005;47:54-57. [Full text] 14.Prakash O, Kar SK, Sathyanarayana Rao TS. Indian story on semen loss and related Dhat syndrome. Indian J Psychiatry 2014;56:377-82. [PUBMED] [Full text] 15.Grover S, Avasthi A, Gupta S, Dan A, Neogi R, Behere PB, et al.

Phenomenology and beliefs of patients with Dhat syndrome. A nationwide multicentric study. Int J Soc Psychiatry 2016;62:57-66. 16.MacFarland AS, Al-Maashani M, Al Busaidi Q, Al-Naamani A, El-Bouri M, Al-Adawi S. Culture-specific pathogenicity of Dhat (semen loss) Syndrome in an Arab/Islamic Society, Oman.

Oman Med J 2017;32:251-5. 17.Rao TS. Comprehensive Study of Prevalence Rates, Symptom Profile, Comorbidity and Management of Dhat Syndrome in Rural and Urban Communities. PhD Thesis. Department of Psychiatry, Jagadguru Sri Shivarathreeshwara Medical College, JSS University, Shivarathreeshwara Nagar Mysore, Karnataka, India.

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[Full text] 19.Kuchhal AK, Kumar S, Pardal PK, Aggarwal G. Effect of Dhat syndrome on body and mind. Int J Contemp Med Res 2019;6:H7-10. 20.Shakya DR. Dhat syndrome.

Study of clinical presentations in a teaching institute of eastern Nepal. J Psychosexual Health 2019;1:143-8. 21.Leff JP. Culture and the differentiation of emotional states. Br J Psychiatry 1973;123:299-306.

22.Tiwari SC, Katiyar M, Sethi BB. Culture and mental disorders. An overview. J Soc Psychiatry 1986;2:403-25. 23.Sameer M, Menon V, Chandrasekaran R.

Is 'Pure' Dhat syndrome a stable diagnostic entity?. A naturalistic long term follow up study from a tertiary care centre. J Clin Diagn Res 2015;9:C01-3. 24.Chadda RK. Dhat syndrome.

Is it a distinct clinical entity?. A study of illness behaviour characteristics. Acta Psychiatr Scand 1995;91:136-9. 25.Bhatia MS, Bohra N, Malik SC. 'Dhat' syndrome – A useful clinical entity.

Indian J Dermatol 1989;34:32-41. 26.Dewaraja R, Sasaki Y. Semen-loss syndrome. A comparison between Sri Lanka and Japan. American J Psychotherapy 1991;45:14-20.

27.Balhara YP. Culture-bound syndrome. Has it found its right niche?. Indian J Psychol Med 2011;33:210-5. [PUBMED] [Full text] 28.Prakash, S, Mandal P.

Is Dhat syndrome indeed a culturally determined form of depression?. Indian J Psychol Med 2015;37:107-9. 29.Prakash O, Kar SK. Dhat syndrome. A review and update.

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31.Dhikav V, Aggarwal N, Gupta S, Jadhavi R, Singh K. Depression in Dhat syndrome. J Sex Med 2008;5:841-4. 32.Paris A. Dhat syndrome.

A review. Transcult Psychiatry Rev 1992;29:109-18. 33.Deb KS, Balhara YP. Dhat syndrome. A review of the world literature.

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35.Kar SK, Sarkar S. Dhat syndrome. Evolution of concept, current understanding, and need of an integrated approach. J Hum Reprod Sci 2015;8:130-4. [PUBMED] [Full text] 36.World Health Organisation.

The ICD-10, Classification of Mental and Behavioural Disorders. Diagnostic Criteria for Research. Geneva. World Health Organisation. 1992.

37.Perme B, Ranjith G, Mohan R, Chandrasekaran R. Dhat (semen loss) syndrome. A functional somatic syndrome of the Indian subcontinent?. Gen Hosp Psychiatry 2005;27:215-7. 38.Wig NN.

Problem of mental health in India. J Clin Soc Psychiatry 1960;17:48-53. 39.Clyne MB. Indian patients. Practitioner 1964;193:195-9.

40.Yap PM. The culture bound reactive syndrome. In. Caudil W, Lin T, editors. Mental Health Research in Asia and the Pacific.

Honolulu. East West Center Press. 1969. 41.Rao TS, Rao VS, Arif M, Rajendra PN, Murthy KA, Gangadhar TK, et al. Problems in medical practice.

A study on its prevalence in an outpatient setting. Indian J Psychiatry 1997:Suppl 39:53. 42.Bhatia MS, Thakkur KN, Chadda RK, Shome S. Koro in Dhat syndrome. Indian J Soc Psychiatry 1992;8:74-5.

43.Priyadarshi S, Verma A. Dhat syndrome and its social impact. Urol Androl Open J 2015;1:6-11. 44.Nakra BR, Wig NN, Verma VK. A study of male potency disorders.

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[PUBMED] [Full text] 46.Singh G. Dhat syndrome revisited. Indian J Psychiatry 1985;27:119-22. [PUBMED] [Full text] 47.Bhatia MS, Malik SC. Dhat syndrome – A useful diagnostic entity in Indian culture.

Br J Psychiatry 1991;159:691-5. 48.Bhatia MS, Choudhry S, Shome S. Dhat syndrome - Is it a syndrome of Dhat only?. J Ment Health Hum Behav1997;2:17-22. 49.Bhatia MS.

An analysis of 60 cases of culture bound syndromes. Indian J Med Sci 1999;53:149-52. [PUBMED] [Full text] 50.Morrone A, Nosotti L, Tumiati Mc, Cianconi P, Casadei F, Franco G. Dhat Syndrome. An Analysis of 18 Cases.

Paper Presented in 11th Congress of the European Academy of Dermatology &. Venerology. Prague. Czech. 2002.

51.Carstairs GM. Hinjra and jiryan. Two derivatives of Hindu attitudes to sexuality. Br J Med Psychol 1956;29:128-38. 52.Carstairs GM.

The Twice Born. Bloomington. Indiana University Press. 1961. 53.Carstairs GM.

Psychiatric problems of developing countries. Based on the Morison lecture delivered at the Royal College of Physicians of Edinburgh, on 25 May 1972. Br J Psychiatry 1973;123:271-7. 54.Sathyanarayana Rao TS. Some thoughts on sexualities and research in India.

Indian J Psychiatry 2004;46:3-4. [PUBMED] [Full text] 55.Prakash O, Rao TS. Sexuality research in India. An update. Indian J Psychiatry 2010;52:S260-3.

56.Avasthi A, Grover S, Rao TS. Clinical practice guidelines for management of sexual dysfunction. Indian J Psychiatry 2017;59 Suppl 1:S91-115. 57.Kavanoor Sridhar V, Subramanian K, Menon V. Current nosology of Dhat syndrome and state of evidence.

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DC. American Psychological Association. 2013. 59.Yasir Arafat SM. Dhat syndrome.

Culture bound, separate entity, or removed. J Behav Health 2017;6:147-50. 60.Prakash S, Sharan P, Sood M. A qualitative study on psychopathology of dhat syndrome in men. Implications for classification of disorders.

Asian J Psychiatr 2018;35:79-88. 61.Lewis-Fernández R, Aggarwal NK. Culture and psychiatric diagnosis. Adv Psychosom Med 2013;33:15-30. 62.Sharan P, Keeley J.

Cultural perspectives related to international classification of diseases-11. Indian J Soc Psychiatry 2018;34 Suppl S1:1-4. Correspondence Address:T S Sathyanarayana RaoDepartment of Psychiatry, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysore - 570 004, Karnataka IndiaSource of Support. None, Conflict of Interest. NoneDOI.

10.4103/psychiatry.IndianJPsychiatry_791_20.

How to cite this http://www.em-centre-bischheim.ac-strasbourg.fr/event/semaine-europeenne-de-la-reduction-des-dechets/ article:Singh where can you get cipro OP. Mental health in diverse India. Need for where can you get cipro 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 geography – From the Himalayas to where can you get cipro 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 where can you get cipro mortality, and other sociodemographic development indexes. There is now ample evidence that sociocultural factors influence mental health.

Compton and Shim[1] have described in their model of gene environment interaction how public policies and social norms act on the distribution where can you get cipro 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, and morbidity.When we come to the field of mental health, we find huge differences where can you get cipro 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 and anxiety, where can you get cipro 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 depression and anxiety were found in females where can you get cipro. Apart from the genetic and hormonal factors, increase was attributed to gender discrimination, violence, sexual abuse, and adverse sociocultural norms.

Marriage was found to be a negative prognostic indicator contrary to the western norms.[3]Cultural influences on the presentation of psychiatric disorders are where can you get cipro 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 well acknowledged.When we look into suicide data, suicide in lower where can you get cipro 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 where can you get cipro require sustained advocacy aimed 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 where can you get cipro done at 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 India, Global Burden of Diseases in where can you get cipro 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 where can you get cipro 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 Journal of Psychiatry has also come out with editorials highlighting the need of care of where can you get cipro 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, where can you get cipro our weapon is research highlighting the role of these factors on mental health.

References 1.Compton MT, Shim RS. The social where can you get cipro determinants 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 where can you get cipro of India, 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 buy generic cipro online 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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[Full text] 19.Kuchhal AK, Kumar S, Pardal PK, Aggarwal G. Effect of Dhat syndrome on body and mind. Int J Contemp Med Res 2019;6:H7-10.

20.Shakya DR. Dhat syndrome. Study of clinical presentations in a teaching institute of eastern Nepal.

J Psychosexual Health 2019;1:143-8. 21.Leff JP. Culture and the differentiation of emotional states.

Br J Psychiatry 1973;123:299-306. 22.Tiwari SC, Katiyar M, Sethi BB. Culture and mental disorders.

An overview. J Soc Psychiatry 1986;2:403-25. 23.Sameer M, Menon V, Chandrasekaran R.

Is 'Pure' Dhat syndrome a stable diagnostic entity?. A naturalistic long term follow up study from a tertiary care centre. J Clin Diagn Res 2015;9:C01-3.

24.Chadda RK. Dhat syndrome. Is it a distinct clinical entity?.

A study of illness behaviour characteristics. Acta Psychiatr Scand 1995;91:136-9. 25.Bhatia MS, Bohra N, Malik SC.

'Dhat' syndrome – A useful clinical entity. Indian J Dermatol 1989;34:32-41. 26.Dewaraja R, Sasaki Y.

Semen-loss syndrome. A comparison between Sri Lanka and Japan. American J Psychotherapy 1991;45:14-20.

27.Balhara YP. Culture-bound syndrome. Has it found its right niche?.

Indian J Psychol Med 2011;33:210-5. [PUBMED] [Full text] 28.Prakash, S, Mandal P. Is Dhat syndrome indeed a culturally determined form of depression?.

Indian J Psychol Med 2015;37:107-9. 29.Prakash O, Kar SK. Dhat syndrome.

A review and update. J Psychosexual Health 2019;1:241-5. 30.Grover S, Avasthi A, Gupta S, Dan A, Neogi R, Behere PB, et al.

Comorbidity in patients with Dhat syndrome. A nationwide multicentric study. J Sex Med 2015;12:1398-401.

31.Dhikav V, Aggarwal N, Gupta S, Jadhavi R, Singh K. Depression in Dhat syndrome. J Sex Med 2008;5:841-4.

Transcult Psychiatry Rev 1992;29:109-18. 33.Deb KS, Balhara YP. Dhat syndrome.

A review of the world literature. Indian J Psychol Med 2013;35:326-31. [PUBMED] [Full text] 34.Udina M, Foulon H, Valdés M, Bhattacharyya S, Martín-Santos R.

Dhat syndrome. A systematic review. Psychosomatics 2013;54:212-8.

35.Kar SK, Sarkar S. Dhat syndrome. Evolution of concept, current understanding, and need of an integrated approach.

J Hum Reprod Sci 2015;8:130-4. [PUBMED] [Full text] 36.World Health Organisation. The ICD-10, Classification of Mental and Behavioural Disorders.

Diagnostic Criteria for Research. Geneva. World Health Organisation.

1992. 37.Perme B, Ranjith G, Mohan R, Chandrasekaran R. Dhat (semen loss) syndrome.

A functional somatic syndrome of the Indian subcontinent?. Gen Hosp Psychiatry 2005;27:215-7. 38.Wig NN.

Problem of mental health in India. J Clin Soc Psychiatry 1960;17:48-53. 39.Clyne MB.

Indian patients. Practitioner 1964;193:195-9. 40.Yap PM.

The culture bound reactive syndrome. In. Caudil W, Lin T, editors.

Mental Health Research in Asia and the Pacific. Honolulu. East West Center Press.

1969. 41.Rao TS, Rao VS, Arif M, Rajendra PN, Murthy KA, Gangadhar TK, et al. Problems in medical practice.

A study on its prevalence in an outpatient setting. Indian J Psychiatry 1997:Suppl 39:53. 42.Bhatia MS, Thakkur KN, Chadda RK, Shome S.

Koro in Dhat syndrome. Indian J Soc Psychiatry 1992;8:74-5. 43.Priyadarshi S, Verma A.

Dhat syndrome and its social impact. Urol Androl Open J 2015;1:6-11. 44.Nakra BR, Wig NN, Verma VK.

A study of male potency disorders. Indian J Psychiatry 1977;19:13-8. [Full text] 45.Behere PB, Natraj GS.

Dhat syndrome. The phenomenology of a culture bound sex neurosis of the orient. Indian J Psychiatry 1984;26:76-8.

[PUBMED] [Full text] 46.Singh G. Dhat syndrome revisited. Indian J Psychiatry 1985;27:119-22.

[PUBMED] [Full text] 47.Bhatia MS, Malik SC. Dhat syndrome – A useful diagnostic entity in Indian culture. Br J Psychiatry 1991;159:691-5.

48.Bhatia MS, Choudhry S, Shome S. Dhat syndrome - Is it a syndrome of Dhat only?. J Ment Health Hum Behav1997;2:17-22.

49.Bhatia MS. An analysis of 60 cases of culture bound syndromes. Indian J Med Sci 1999;53:149-52.

[PUBMED] [Full text] 50.Morrone A, Nosotti L, Tumiati Mc, Cianconi P, Casadei F, Franco G. Dhat Syndrome. An Analysis of 18 Cases.

Paper Presented in 11th Congress of the European Academy of Dermatology &. Venerology. Prague.

Hinjra and jiryan. Two derivatives of Hindu attitudes to sexuality. Br J Med Psychol 1956;29:128-38.

52.Carstairs GM. The Twice Born. Bloomington.

Indiana University Press. 1961. 53.Carstairs GM.

Psychiatric problems of developing countries. Based on the Morison lecture delivered at the Royal College of Physicians of Edinburgh, on 25 May 1972. Br J Psychiatry 1973;123:271-7.

54.Sathyanarayana Rao TS. Some thoughts on sexualities and research in India. Indian J Psychiatry 2004;46:3-4.

[PUBMED] [Full text] 55.Prakash O, Rao TS. Sexuality research in India. An update.

Indian J Psychiatry 2010;52:S260-3. 56.Avasthi A, Grover S, Rao TS. Clinical practice guidelines for management of sexual dysfunction.

Indian J Psychiatry 2017;59 Suppl 1:S91-115. 57.Kavanoor Sridhar V, Subramanian K, Menon V. Current nosology of Dhat syndrome and state of evidence.

Indian J Health Sex Cult 2018;4:8-14. 58.APA (American Psychological Association). Diagnostic and Statistical Manual of Mental Disorders.

American Psychological Association. 2013. 59.Yasir Arafat SM.

Dhat syndrome. Culture bound, separate entity, or removed. J Behav Health 2017;6:147-50.

60.Prakash S, Sharan P, Sood M. A qualitative study on psychopathology of dhat syndrome in men. Implications for classification of disorders.

Asian J Psychiatr 2018;35:79-88. 61.Lewis-Fernández R, Aggarwal NK. Culture and psychiatric diagnosis.

Adv Psychosom Med 2013;33:15-30. 62.Sharan P, Keeley J. Cultural perspectives related to international classification of diseases-11.

Indian J Soc Psychiatry 2018;34 Suppl S1:1-4. Correspondence Address:T S Sathyanarayana RaoDepartment of Psychiatry, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysore - 570 004, Karnataka IndiaSource of Support. None, Conflict of Interest.

NoneDOI. 10.4103/psychiatry.IndianJPsychiatry_791_20.

Amiodarone and cipro

Regular use of an antibacterial mouthwash does not prevent oropharyngeal gonococcal The double-blind Oral Mouthwash amiodarone and cipro use to Eradicate GonorrhoeA (OMEGA) trial randomised men who have sex with men to rinse and gargle at least once daily for 60 s with either an antibacterial mouthwash (Listerine. N=219) or a mouth lubricant amiodarone and cipro as control (Biotène. N=227) for a total of 12 weeks.1 2 Oropharyngeal swabs were collected 6-weekly and saliva 3-weekly. The number of incident cases of oropharyngeal gonorrhoea was 15 (7%) in the Listerine group and 10 (4%) in the Biotène group amiodarone and cipro. At week 12, the adjusted risk difference in the cumulative incidence of oropharyngeal gonorrhoea between the two groups was 3.1% (95% CI −1.4 amiodarone and cipro to 7.7).

While the large CI indicates the need for further data, these initial findings do not support a protective effect of Listerine against oropharyngeal gonorrhoea.Transient impact of buy antibiotics on HIV care in four African countriesInvestigators analysed data from the African Cohort Study, which prospectively collects information from 12 clinics across 5 HIV care programmes in Tanzania, Uganda, Kenya and Nigeria.3 Parameters including HIV clinic visit adherence, virological suppression and food security were compared between the periods January 2019–March 2020 (precipro phase) and May 2020–February 2021 (cipro phase). After adjusting for age, amiodarone and cipro sex and HIV care programme, both attendance of scheduled clinic visits and food security were significantly reduced in the early cipro phase, but not after 7 September 2020. There were no detrimental effects on treatment adherence and amiodarone and cipro virological suppression rates. The findings provide reassurance, although they are not fully representative of the general HIV population across Africa. There remains a need to investigate the impact of the buy antibiotics cipro on HIV care globally.Expedited partner therapy does not improve eradication of Chlamydia trachomatis before deliveryExpedited partner therapy (EPT) enables providers to prescribe treatment for partners of patients diagnosed with an STI, without the partner having to establish direct care.4 This cohort study evaluated a prenatal amiodarone and cipro EPT programme in Dallas, Texas, a high Chlamydia trachomatis (CT) prevalence area.

Investigators evaluated the effect of EPT on rates amiodarone and cipro of CT before delivery compared with the traditional partner referral, testing and treatment approach used the year before. The rate of was 15% (61 of 419) with EPT vs 13% (60 of 471) with the standard approach (OR 0.86. 95% CI 0.58 amiodarone and cipro to 1.26). EPT on its own is unlikely to be enough to amiodarone and cipro successfully eradicate CT before delivery.Homelessness and housing instability increase the risk of HIV and hepatitis C cipro among people who inject drugsPeople who inject drugs (PWID) are at increased risk of HIV and hepatitis C cipro (HCV) and have high levels of homelessness and unstable housing.5 This systematic review and meta-analysis included studies published between 2017 and 2020 that estimated HIV or HCV incidence, or both, among community-recruited PWID. In the pooled estimates, recent homelessness or unstable housing (current or within 1 year) increased the risk of acquiring HIV and HCV compared with stable housing, with an adjusted relative risk of 1.39 (95% CI 1.06 to 1.84.

P=0.019) for HIV and 1.64 (95% CI 1.43 amiodarone and cipro to 1.89. P<0.0001) for HCV amiodarone and cipro. Risk reduction for PWID must include interventions to support housing stability.Unrecognised oral and anal shedding of Treponema pallidum in MSM with early syphilisMouth, anus, urethra and semen samples were systematically collected in 200 men who have sex with men (MSM) (31% living with HIV) to investigate Treponema pallidum shedding from asymptomatic sites relative to lesion sites.6 Across all stages of early syphilis, comprising primary, secondary and early latent, 91%, 74% and 8%, respectively, had T. Pallidum at any site, and 20%, 26% and 0% had detection at two or more sites, amiodarone and cipro with the highest detection in the mouth (24%) and anus (23%). Oral and amiodarone and cipro anal shedding of T.

Pallidum was most frequent during secondary syphilis and often occurred in the absence of overt syphilis lesions, independently of HIV status. Studies are needed to demonstrate bacteria viability from asymptomatic shedding sites and whether its detection might improve syphilis control.Published in Sexually Transmitted s amiodarone and cipro - The Editor’s Choice. The combination of dolutegravir/rilpivirine used in HIV amiodarone and cipro and neuropsychiatric adverse effectsPooling data from 20 randomised trials with a minimum duration of 48 weeks, this meta-analysis investigated the risk of neurotoxicity (defined as the occurrence of depression, anxiety, insomnia, dizziness or suicidal behaviour) in adults treated with rilpivirine, dolutegravir or the combination dolutegravir/rilpivirine versus comparator regimens.7 Twelve trials were in treatment-naive and eight in treatment-experienced participants, totalling 10 998 individuals. Depression was the most common neuropsychiatric event, whereas suicidal behaviour was the least common. The relative risk (RR) of depression was not different with dolutegravir or rilpivirine versus amiodarone and cipro comparator.

In contrast, dolutegravir/rilpivirine showed a synergistic effect on depression, with an amiodarone and cipro RR of 2.82 (95% CI 1.12 to 7.10. P=0.03), although no study directly compared dolutegravir/rilpivirine with efavirenz. While further studies are needed, the occurrence of depression should be monitored during dolutegravir/rilpivirine therapy.IntroductionIt has long been understood that increased exposure to a specialty is associated with increased likelihood of applying to that specialty training programme.1 Medical amiodarone and cipro students often have few timetabled sexual health and HIV clinics in their undergraduate training and have been found to lack accurate factual knowledge.2 In England, 2020, genitourinary medicine (GUM) saw only 0.58 applicants per training position, the lowest of all 43 ST3-level programmes listed by Health Education England and one of only four with a competition ratio <1.0.3 Many oversubscribed specialties such as psychiatry and obstetrics and gynaecology have dedicated associations for medical students and/or pre-specialty trainees interested in these fields.The Student and Trainee Association for Sexual Health and HIV (STASHH) was founded in spring 2021 by Dr Hannah Church, Eleanor Cochrane and Dr Eleanor Crook with support from the BASHH. Its overarching aim is to ….

Regular use of an antibacterial mouthwash does not prevent oropharyngeal gonococcal The double-blind Oral Mouthwash use to Eradicate GonorrhoeA (OMEGA) trial where can you get cipro randomised men who have sex with men to rinse and gargle at least once daily for useful reference 60 s with either an antibacterial mouthwash (Listerine. N=219) or where can you get cipro a mouth lubricant as control (Biotène. N=227) for a total of 12 weeks.1 2 Oropharyngeal swabs were collected 6-weekly and saliva 3-weekly.

The number of incident cases of oropharyngeal gonorrhoea was where can you get cipro 15 (7%) in the Listerine group and 10 (4%) in the Biotène group. At week 12, the adjusted risk difference in the cumulative incidence of oropharyngeal gonorrhoea between the two groups where can you get cipro was 3.1% (95% CI −1.4 to 7.7). While the large CI indicates the need for further data, these initial findings do not support a protective effect of Listerine against oropharyngeal gonorrhoea.Transient impact of buy antibiotics on HIV care in four African countriesInvestigators analysed data from the African Cohort Study, which prospectively collects information from 12 clinics across 5 HIV care programmes in Tanzania, Uganda, Kenya and Nigeria.3 Parameters including HIV clinic visit adherence, virological suppression and food security were compared between the periods January 2019–March 2020 (precipro phase) and May 2020–February 2021 (cipro phase).

After adjusting for age, sex and HIV care programme, both attendance of scheduled clinic visits and food security were where can you get cipro significantly reduced in the early cipro phase, but not after 7 September 2020. There were no detrimental effects on treatment where can you get cipro adherence and virological suppression rates. The findings provide reassurance, although they are not fully representative of the general HIV population across Africa.

There remains a need to investigate the impact of the buy antibiotics cipro on HIV care globally.Expedited partner therapy does not improve eradication of Chlamydia trachomatis before deliveryExpedited partner therapy (EPT) enables providers to prescribe treatment for partners of patients diagnosed with an STI, without the partner having to establish direct care.4 This cohort study evaluated a prenatal EPT programme in Dallas, Texas, a where can you get cipro high Chlamydia trachomatis (CT) prevalence area. Investigators evaluated the effect of EPT on rates of CT before delivery compared with the traditional partner where can you get cipro referral, testing and treatment approach used the year before. The rate of was 15% (61 of 419) with EPT vs 13% (60 of 471) with the standard approach (OR 0.86.

95% CI 0.58 to where can you get cipro 1.26). EPT on its own is unlikely to be enough to successfully eradicate CT before delivery.Homelessness and housing instability increase the risk of where can you get cipro HIV and hepatitis C cipro among people who inject drugsPeople who inject drugs (PWID) are at increased risk of HIV and hepatitis C cipro (HCV) and have high levels of homelessness and unstable housing.5 This systematic review and meta-analysis included studies published between 2017 and 2020 that estimated HIV or HCV incidence, or both, among community-recruited PWID. In the pooled estimates, recent homelessness or unstable housing (current or within 1 year) increased the risk of acquiring HIV and HCV compared with stable housing, with an adjusted relative risk of 1.39 (95% CI 1.06 to 1.84.

P=0.019) for HIV and 1.64 (95% CI where can you get cipro 1.43 to 1.89. P<0.0001) for HCV where can you get cipro. Risk reduction for PWID must include interventions to support housing stability.Unrecognised oral and anal shedding of Treponema pallidum in MSM with early syphilisMouth, anus, urethra and semen samples were systematically collected in 200 men who have sex with men (MSM) (31% living with HIV) to investigate Treponema pallidum shedding from asymptomatic sites relative to lesion sites.6 Across all stages of early syphilis, comprising primary, secondary and early latent, 91%, 74% and 8%, respectively, had T.

Pallidum at any site, and 20%, 26% and 0% had detection at two or more sites, with the highest detection where can you get cipro in the mouth (24%) and anus (23%). Oral and anal where can you get cipro shedding of T. Pallidum was most frequent during secondary syphilis and often occurred in the absence of overt syphilis lesions, independently of HIV status.

Studies are needed to demonstrate where can you get cipro bacteria viability from asymptomatic shedding sites and whether its detection might improve syphilis control.Published in Sexually Transmitted s - The Editor’s Choice. The combination of dolutegravir/rilpivirine used in HIV and neuropsychiatric adverse effectsPooling data from 20 randomised trials with a minimum duration of 48 weeks, this meta-analysis investigated the risk of neurotoxicity (defined as where can you get cipro the occurrence of depression, anxiety, insomnia, dizziness or suicidal behaviour) in adults treated with rilpivirine, dolutegravir or the combination dolutegravir/rilpivirine versus comparator regimens.7 Twelve trials were in treatment-naive and eight in treatment-experienced participants, totalling 10 998 individuals. Depression was the most common neuropsychiatric event, whereas suicidal behaviour was the least common.

The relative risk (RR) of depression was not different with dolutegravir where can you get cipro or rilpivirine versus comparator. In contrast, dolutegravir/rilpivirine showed a synergistic effect on depression, with an RR of where can you get cipro 2.82 (95% CI 1.12 to 7.10. P=0.03), although no study directly compared dolutegravir/rilpivirine with efavirenz.

While further studies are needed, the occurrence of depression should be monitored during dolutegravir/rilpivirine therapy.IntroductionIt has long been understood that increased exposure to a specialty is associated with increased likelihood of applying to that specialty training programme.1 Medical students often have few timetabled sexual health and HIV clinics in their undergraduate training and have been found to lack accurate factual knowledge.2 In England, 2020, genitourinary medicine (GUM) saw only 0.58 applicants per training position, the lowest of all 43 ST3-level programmes listed by Health Education England and one of only four with a competition ratio <1.0.3 Many oversubscribed specialties such as psychiatry and obstetrics and gynaecology have dedicated associations for medical students and/or pre-specialty trainees interested in these fields.The Student and Trainee Association for Sexual Health and HIV (STASHH) was founded in spring 2021 by Dr Hannah Church, Eleanor Cochrane and Dr Eleanor Crook where can you get cipro with support from the BASHH. Its overarching aim is to ….

;