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Sep29
Achlasia Cardia
Introduction
Achalasia is an esophageal disorder of unknown cause characterized by apertistalsis of the esophageal body and non-relaxation of the lower esophageal sphincter (LES). First description is found in 1674, by Sir Thomas Willis. A sponge tipped whale bone was used by a patient to push food down after each meal. The term achalasia was coined by Hurst and Rake (1929) and is Latin for “Failure to relax”, though Von Mikulicz had suggested cardiospasm as the cause in 1981.

Achalasia is an uncommon disease occurring in 5-10 per 100,000 population. Most commonly adults are affected with mean age being 40-50 years. Idiopathic achalasia, found in the northern America closely mimics “Chagas Disease of the esophagus” occurring in South America.




Pathophysiology
Anatomic alterations
Abnormalities in all neuromuscular components of the esophagus and its central nervous connection have been described but a pathogonomic defect remains elusive. Vagal and Doral Motor Nerve Center degeneration is thought to be secondary phenomenon. Most consistently present is the inflammatory reaction with destruction of ganglionic cells in the myenteric plexus in the esophageal wall. There is progressive decrease in number of ganglionic cells with a more advanced disease indicating the loss may later in disease. There is smooth muscle hypertrophy with fibrosis and liquifactive necrosis is thought to be secondary, as is chronic mucosal changes due to irritation by the retained food in the distal esophagus. These changes result in increase incidence of SCC in patients with achalasia.

Physiologic alterations
In healthy esophagus the smooth muscle contraction and resting LES tone is maintained by excitatory cholinergic innervation. To allow peristalsis inhibitory NO/VIP mediated smooth muscle inhibition is generated in response to swallow. The key abnormality in achalasia is impairment of the post- ganglionic neurons to the smooth circular muscle.




Etiology
Genetic theory
86 families have been described but accounts for 1-2% of all patients.

Infectious theory
Possibly a neuro-trophic infectious cause. Herpes virus seems to be most plausible except that they are not uniformly identified. In Chagas disease the cause is Trypanosoma cruzi.

Autoimmune theory
50% patients have anti-bodies and the inflammatory response seen in the esophageal wall is T-cell mediated.

Degenerative theory
some suggestion that in a small percentage of patients, especially the elderly, achalasia is a result of degenerative neurological disorder.




Clinical Presentation
Overview
Mean duration of symptoms is 4.6 Yrs (1mth to 67Yrs)

Patients adapt to slowly worsening symptomatology and present late in the disease progression
Delay in diagnosis due to lack of physician understanding of esophageal motility disorders exacerbates the late presentation
This is frequently confused with GERD and treated as such for a long period of time prior to presentation



Common Symptoms
Dysphagia: This is the most frequent complaint. Liquids are often worse than solids. Usually slowly progressive with weight loss only in advanced disease. Often the patient presents with a history of being the last to finish a meal. Frequently patients report having to use a Valsalva maneuver to force food into the stomach.
Regurgitation: Presents in 75% of patients. Patients can often tell what is regurgitated as the food is undigested. There is a history of chronic saliva, mucous spitting, and drooling on the pillow at night.
Chest pain: Presents in 40% of patients. Patients are often younger with a poor and unpredictable response to dilation or surgical therapy.
Heartburn: Presents in approximately 33% of patients. This is due to undigested food and/or in situ production from fermentation of an uncleared food bolus. This is unresponsive to acid suppression usually hours after eating.
Weight loss: 50-60% of patients show a slight weight loss usually late in the disease progression. If weight loss if significant, malignancy should be suspected.
Megaesophagus: 6 cm dilation of the esophagus with tortuosity.



Diagnostic Testing
Upright Chest X-ray: Widened mediastinum, air-fluid level in the mediastinum, absence of a gastric air bubble
Barium Swallow (with fluoroscopy): this is the single best diagnostic test
No peristalsis, possible simultaneous contractions
Poor clearance (normal < 1 minute)
Bird beak tapering of the LES (smooth narrowing)
Irregular shadow on the top of the barium level: due to food and liquid in the esophagus
Esophageal dilation (sigmoid esophagus in late stages)
Esophageal Manometry: this it the gold standard for diagnosis
Aperistalsis of the esophageal body (especially in the distal 2 channels), also called simultaneous waves/non-propulsive waves
Body pressure usually less than 40 mmHg. If > 40 mmHg then this is called "vigorous achalasia"
Hypertensive non-relaxing LES
Esophageal pressurization (the baseline does not return to below gastric zero level after the catheter has been withdrawn into the esophagus). This is due to retained food and fluid in the esophagus
Inability to advance catheter into the stomach with the possibility of needing an EGD to advance the catheter
Endoscopy: This is always done to rule out other causes of the patients symptomatology (e.g. malignancy)
Dilated fluid-filled esophagus
Tortuosity
Thickened mucosa with friability
Difficult to negotiate LES
Normal LES on retroflexion view
EUS/CT Scan: used to rule out pseudo-achalasia



Treatment Options
The goal of treatment is to improve esophageal clearance.

Medical Therapy
Nitrates and Calcium channel blockers. These are used to relax a hypertensive LES

Botulinum Toxin
BTX administration to the esophagus results in paralysis of the LES with a decreased resistance and increased clearance

Technique: 100 U (4 divided doses) injected intramuscularly in the LES (1 cm above the squamo-columnar junction)
75-90% first time response
50% effect after 6 months
Repeat injections are possible but progressively less helpful
Repeat injections are reserved for those unfit or unwilling to undergo surgery
Use in pseudo-achalasia to differentiate from classical achalasia
Reports of increased risk for mucosal perforation if myotomy is required later
Pneumatic Dilation
This is the oldest known therapy and was first introduced in 1898.

Technique: Rigiflex dilator (3.0, 3.5, 4.0 cm sizes) done under fluoroscopy
2-3% full thickness perforation
50-85% symptom control at 5 years
Frequent need for repeat dilations
Progressive decrease in symptom control over longer periods
Surgical Cardiomyotomy (Heller myotomy)
First described by Heller in 1913 as trans-thoracic double myotomy (anterior and posterior), and subsequently modified to single long anterior-lateral myotomy by Zajjer (1923) has remained the standard of surgical intervention till mid 1990’s.


Pelligrini has been a pioneer in applying minimally invasive technique to the procedure and has evolved the extent of myotomy and need for fundoplication since 1990’s to now.
First reported change was use of left VATS (thoracoscopic) (1992) while maintaining a long esophageal myotomy with only minimal extension (0.5cm) on to the stomach. Reports of 80% relief of dysphagia with 42% GERD symptoms.


To decrease dysphagia the myotomy needed to be extended more on to the stomach. Hence conversion to trans-abdominal (laparoscopic) method. Initially 1.5-2 cm on to the stomach with a Dor fundoplication (1994) to prevent reflux (also the anterior fundoplication helps protect the mucosa). Since then this group has further changed to extend the myotomy 3 cm on to the stomach and use a Toupet fundoplication (1998) for anti-reflux. 95-90% relief with 13% GERD.

If Megaesophagus is encountered, treatment is either via a Heller myotomy (some have reported poor surgical outcomes) or an esophagectomy at experienced centers.

Recurrent Symptoms after previous myotomy
Previous thoracic myotomy
Recurrent dysphagia with or without GERD

Dilated distal esophagus
Perform an extended myotomy onto the stomach with fundoplication if dysphagia is the primary symptom
Esophagectomy a good option, but trans-thoracic mobilization might be needed
Previous Laparoscopic myotomy
Due to either an incomplete myotomy, refibrosis, or obstruction due to fundoplication
Redo Heller myotomy with fundoplication is treatment of choice
If needed a transhiatal esophagectomy is also a good option



References
1. VaeziMF,RichterJE.CurrentTherapiesforAchalasia:Comparisonand efficacy. J Cli Gastroenterolo 1998;27:21-35.
2. Richter JE. Achalasia. The Esophagus 4th ed. Lippincot, Williams and Wilkins. Eds. Castell, Richter.
3, Oelschlager BK, Eubanks TR, Pelligrini CA. Surgery for esophageal motor disorders. The Esophagus 4th ed. Lippincot, Williams and Wilkins. Eds. Castell, Richter.


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Sep28
Power struggle!
Getting out from the departmental store with my shopping bag, i was loading them in my car when i noticed a motorbike parked nearby. A crow was sitting on the petrol tank of the bike, and with a surreptitious look around, he delved into a pouch that was fixed on the bike and pulled out a goodie; a pistachio shell!. He looked around again, noticed another crow nearby, and quickly put the nutshell back again and nonchalantly started to look elsewhere. I am almost sure he also caught my eye!. With another look at the other crow, he seemed to be debating what to do, and then decided to carry the war right into the enemy camp. He flew to the place the other crow was sitting, and chased it away. The poor chap did not know what was happening and with a furious caw, flew away, probably cursing the chaser but deciding to leave the battle scene!.
I did not stop to see whether the crow came back for the nut shell (ironic isn’t it, all this was for not even the nut, just the shell!), but was thinking about how we humans and crows are so similar in our interpersonal relationships. I have seen this happening so often in the corporate jungle. People vie with each other for positions and power, and very often than not, the rules of the game are not followed; if they at all are, they are conveniently bent to suit the needs of the few who know how to win. The winning is all that matters. So these games are played out, in board rooms, in conferences, at meetings, and in cabins behind closed doors. The chase is subtle but it is persuasive. The victim either decides, like the crow in our story, to leave the scene but carries with it anger and resentment and even feelings of being victimised and being a scapegoat. Or he decides to give it a fight, and then the real battle ensues.
These feelings, if not handled constructively, become the emotional baggage that the person carries; and this feeling of having lost out may permeate into his other areas of living, sometimes making relationships also very dysfunctional. See the whirlpool effect?
I think it all boils down to fighting right: even in personal relationships. Squirrels have to bury food: so they do. But it is not seen as ‘hiding’ it away. It is acting in character to its species. But on second thoughts, i think the crow also acted in its nature? Don’t they say crows are supposed to thieve?? But do we humans act in our true nature? Are we not essentially supposed to be ‘good’ ? Then why do we deliberately push down, degrade other fellow beings, all for money, power, position? If we let go of the need for greed for power and control, i think a lot of our interpersonal conflicts can also resolve itself. Most of them start with power struggle: If the need for being in control: of others, not of self, is examined, and saturated not by controlling another human being, but by renouncing the need by itself, then i am sure life would be so much more fulfilling.
Mohana Narayanan


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Sep28
A PROSPECTIVE STUDY OF ALLERGIC RHINITIS IN CHILDREN & ITS HOMOEOPATHIC MANAGEMENT
ABSTRACT:
Allergic rhinitis is one of the most commonly diagnosed health disorders among children. AR affects up to 20 percent of children. Boys are twice as likely to get allergic rhinitis as girls. The median age of onset of the condition is 10 years old, meaning that equal numbers of children develop the condition before and after age 10. Half of children develop the condition before age 10, and half after that time. Allergic rhinitis is the most common chronic disease in children. About one in five children has symptoms by the age of 2 or 3 years .A study in found that 42% of children were diagnosed with allergic rhinitis by the age of six. Commonly called hay fever. Allergy symptoms can have a profound effect on a child’s health, behavior and ability to learn. Left untreated, allergic rhinitis also can lead to a host of other serious conditions, including asthma, recurrent middle-ear infections, sinusitis, sleep disorders and chronic cough.
The present study is undertaken to study the efficacy of Homoeopathic remedies in the treatment of allergic rhinitis in children. 100 cases were studied. Out of which 55% recovered ; 35 % improved & 10 % did not improve.

INTRODUCTION:
Allergic Rhinitis presents with the following symptoms:
1. Nasal allergies typically feature a clear nasal discharge with sneezing.
2. There may be itchy, watery eyes & / a dry cough.
3. Parents often notice a “rabbit nose” – A child crinkling her nose to relieve the itchy sensation inside.
4. “Allergic shiners” – dark circles under the eyes, have long been associated with allergies, but are less predictive than the other symptoms.
5. “ Allergic Salute” – A common habit of children which consists of rubbing their nose upwards. This is usually because the nose is itchy & this practice can lead to a small crease in the skin of the lower part of the nose.
6. Mouth breathing often leads to dryness & cracking of the lips & children are often very thirsty & may wake at night for a drink of water.

Types Of Allergic Rhinitis:
The two categories of allergic rhinitis include:
1. Seasonal - occurs particularly during pollen seasons. Seasonal allergic rhinitis does not usually develop until after four years of age.
2. Perennial – occurs throughout the year. This type of allergic rhinitis is commonly seen in younger children.
NEED FOR THE STUDY:
• Allergic Rhinitis in children is a commonly prevalent condition all over the world.
• Every year millions of people use over the counter (OTC) products to relieve nasal stuffiness & conditions like sneezing, running nose, sore throat & cough. The common causes of these symptoms include allergic rhinitis (Hay fever).
• Allergic rhinitis, which occurs during a specific season, is called “Seasonal allergic rhinitis”. When it occurs throughout the year, it is called “Perennial Allergic Rhinitis”.
• Allergic rhinitis in children is a common clinical condition we encounter in our OPD & the fact is that, Homoeopathy can deal with this state effectively.
• In such a common clinical condition, the conventional system of medicine has a limited scope & treat this clinical condition with antihistamines, decongestants, topical & systemic steroids, which in addition to sedation, can produce dizziness, tinnitus, blurred vision, tremors, dry mouth & poor concentration. Occasionally blood dyscracias have been reported & sensitization can occur with urticaria & eczema.
• Allergic rhinitis in children if left untreated may lead to chronic sinusitis, otitis media, allergic bronchitis etc.
• Homoeopathic medicines have been found to be having good scope in the treatment of allergic rhinitis in children. Hence there is a need for a systematic & scientific study.

Aims and Objectives: The present study was undertaken to fulfill the following objectives:
• To study the pattern of presentation of allergic rhinitis in children.
• To study the miasmatic background and its implication on allergic rhinitis in children.
• To study the Homoeopathic management of allergic rhinitis in children.
• To study the efficacy of Homoeopathic remedies in the treatment of allergic rhinitis in children.

Material and Methods:
7.1 SOURCES OF DATA
The subject for this study were taken from A.M. Shaikh Homoeopathic Medical College and Hospital, OPD/IPD and village health camps.

7.2 METHOD OF COLLECTION OF DATA (INCLUDING SAMPLING PROCEDURE, (IF ANY)

Following is the inclusion criteria fixed for the study:
Subjects from 0-12 years and of both the sexes irrespective of socioeconomic status.
Following is the exclusion criteria fixed for the study:
• Subjects with active treatment for any other chronic disease.
• Subjects with worm infestations having high eosinophil count.
Patients were selected on the basis of inclusion & exclusion criterias. A detailed case history was taken with clinical presentation.
Patients were reviewed on every seventh day for the first two months and later every 15 days for the remaining period of study.
No sampling procedure was adapted.
All the cases of allergic rhinitis were taken for the study, between the periods of December 2005 to 30th June 2008. (No new cases were taken up for the study after June 2008). Total Number of cases = 100.

CRITERIA OF BASIC ASSESSMENT OF RESPONSE:
(A) Subjective: General condition; Appetite; Thirst; Bowels; Sleep; Itching.
(B) Objective: Sneezing; Nasal discharge; Nasal obstruction.


Conclusion: The following valid conclusion can be drawn from the study.
1. The maximum incidence of the patients suffering from allergic rhinitis is in the age group of 2-10 years.
2. Males were found to be more prone to allergic rhinitis compared to females in this study.
3. The constitutional remedies which gave maximum benefit to the patients were mainly Ars Album, Nux Vom, Pulsatilla, Sulphur, Nat Mur, Kali mur, Silicea, Calc carb, Natrum sulph & Kali bich.
4. The constitutional remedies gave maximum relief to the patients. The patient improved faster after the administration of constitutional remedies.
5. The miasmatic and constitutional approach of treatment was only successful when they were integrated. This study gave me a better idea in my attempt to treat cases of Allergic rhinitis.
6. Homoeopathic Management of Allergic rhinitis is able to annihilate the disease and helps to reduce the intensity and frequency of the episode of Allergic rhinitis.
7. There is a better scope in Homoeopathic for the treatment of Allergic rhinitis, since the treatment is based on holistic and individualistic approach.
8. Homoeopathic remedies not only annihilate the disease but also prevents the complications associated with it. However further studies need to be carried out to understand the finer menaces of the disease.
9. This was a modest effort on my part to find the role of Homoeopathic medicines in the treatment of different types of Allergic rhinitis and the response in this study is quite satisfactory. Dr. Nahida M.Mulla.M.D.
Vice Principal.
Professor of Repertory & PG Guide.
HOD Paediatric OPD.
A.M.Shaikh Homoeopathic Medical College & Hospital,Nehru Nagar, Belgaum – 590010.
Mobile – 9448814660.


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Sep27
GLOBAL STRESS THE POSSIBLE ROLE OF NAMASMARAN IN TOTAL STRESS MANAGEMENT
GLOBAL STRESS
THE
POSSIBLE
ROLE
OF
NAMASMARAN
IN
TOTAL
STRESS MANAGEMENT

DR.SHRINIWAS KASHALIKAR
The ascent of our petty self and its merger into the true self i.e. cosmic self is hypothesized to be possible through the practice of NAMASMARAN.

The term cosmic self refers to the source of cosmic conscience, thoughts, ideas and their execution.

The entanglement in the petty self leads to total inertia or perverted and fanatic activities. This is characterized by indiscriminate violence, destruction of nature and brazen exploitation of others. This may be termed TAMAS.

The entanglement in the petty self; can also lead to intelligent, skilled, but sectarian and hence selfish activity aimed at the petty gains of few. This is characterized by subtle, disguised and cunning exploitation, deception, cheating, frauds, lies, hypes, through a variety of tactics and technologically advanced means. The cruelty is concealed and hence majority fall prey to it; willingly or unknowingly but readily!
This may be termed RAJAS.

The entanglement of petty self may also lead to otherwise innocuous, harmless, egalitarian activities such as involvement in the study (though inadequate) of various sciences, arts, and technology. This self contented attitude associated with kindness (though insufficient and restricted to personal favors and certain philanthropic activities) is SATVA.

More practice of NAMASMARAN by more people; is hypothesized to help more people; in the ascent of petty self and merging with the cosmic self (The source of the holistic perspective, ideas, feelings and actions i.e. superliving); and lead to commensurate rectification of everything governed by the TAMAS, RAJAS and SATVA and achieve Total Stress Management!


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Sep27
STRESS ALCOHOL AND TOBACCO
STRESS
ALCOHOL
AND
TOBACCO


DR.
SHRINIWAS
KASHALIKAR

One of the hallmarks of STRESS in our life; is discrepancy, dysrhythmia and discord within our own selves!

There is always a discrepancy, dysrhythmia and discord; between our imagination, thoughts, feelings, instincts, physical requirements and our habits! They are almost never identical or even in sequence, order or harmony. They may be not merely dissimilar; but often are; contradictory.

Thus we may not think the same; as what we imagine and we may not feel the same; as what we think (and talk and write). Our instinctual cravings also may not in tune with our emotions. Thus instinctual needs may force us to indulge in something that makes us sad and repent!

Hence even if we fantasize a utopia of some heaven on the earth, intellectually it may be inconceivable. Even if there is intellectual argument about good and bad feelings; it may not be valid in day to day emotional interactions. Even if there are deep sentiments about morality pertaining to passions; they may not match with our instinctual actions such as sexual behavior! Similarly irrespective of what we think and feel about our habits or addictions; many of us helplessly continue to indulge in them.

This is also why; spiritual perceptions occupy only a small corner of our thinking and intellectual debates occupy a small fraction of our literature and art.

In fact; adolescent and often illicit sex, voyeurism, crimes such as kleptomania, and habits such as smoking, drinking etc. form a romanticized and conspicuous part of our cinematic and dramatic creations.

On this background it should be easy to understand; why habits such as tobacco and alcohol in different forms; are popular amongst many of us; irrespective of age, sex, occupation, economic status, nationality, race, religion etc.

This continues to be so inspite of their well publicized risks for health; and their condemnation by the ministries of information and broadcast of different countries and several philanthropic organizations; in the world.

Whether the alcohol and tobacco are the culprits or whether our vulnerability to addiction; are responsible for the sway these things hold on our life; is a moot question.

Moreover; our nature also seems to vacillate between elation in hedonistic pleasures and some kind of fantasizing of austerity!
One question that tends to bother us; is; what are we going to gain by “sacrificing our pleasures and/or excitement of indulgence; while facing the reality of life; especially when no one can guarantee sound physical health and sound financial status; by abstinence?”

It is in this context that the ancient wisdom, which is valid today; guides us!

The seers of the past such as Sadguru Shri Gondavlekar Maharaj; comprehended all these and many more complexities of our nature; and provided us with; the eternally benevolent guidance.

Thus; our problem is of inadequate emergence of our consciousness, which is entrapped in pettiness of perspective, policy making, motivation and actions, inevitably associated with excitement of petty gains and misery of petty failures!

Hence; even if we are not addicted to tobacco, alcohol or anything else, (and may take pride in it); we still can be destructive to self and the others.

Hence they did not indulge in fanatic and inconsiderate condemnation or blatant encouragement of our vulnerability and weakness. In stead; they provided us with the means of empowerment and enlightenment to rise above and grow out of the vulnerability, weakness, weariness and pettiness! They enabled us to overcome the attitude of delirious justification and pride; as well as the incapacitating sense of guilt about our addictions and habits!

They showed us the way of fulfillment of our life. They actually showed us the immortal and sublimely romantic culmination of the essence of our perspective, imagination, thoughts, feelings, instincts, needs and also our habits! They gave us a holistic solution to evolve a sublimely meaningful life, instead of nagging or pampering us; about our habits in isolation!!

Hence; in stead of going into the domestic, economic, medical, cultural and other angles and issues involved in the habits/addictions (including those of tobacco and alcohol); with a fragmented approach; we should (at least provisionally) unhesitatingly accept and verify the scope and limitations of the holistic solution provided by the seers!

Which is this holistic solution?

This holistic solution is; a really universal practice of NAMASMARAN that endows the enlightenment and empowerment on us; irrespective of our age, sex, occupation, religion, race, nationality etc; to blossom all inclusively and experience the ultimate fulfillment in life!

In fact; the benevolence of NAMASMARAN does not limit to helping us to conquer alcohol and tobacco; but it reveals to us; the individual and global blossoming embodied in Total Stress Management; which is the mega synthesis or mega reunion of philosophy and science, spiritualism and materialism; and theism and atheism!


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Sep27
STRESS RESERVATIONS AND COMMUNALISM
STRESS
RESERVATIONS
AND
COMMUNALISM


DR.
SHRINIWAS
KASHALIKAR

Merely belonging to different castes, different religions or merely following certain customs, which are running through the generations in a family and a community etc. do not make us discriminatory, unjust, prejudiced and communal; and does not produce STRESS of communalism!

According to the world book dictionary, communalism refers to self-governance of a commune or communes and this is a kind of federalism. Communal means related to commune.

In Sanskrit there is a SUBHASHITA

PINDE PINDE MATIH BHINNAH
KUNDE KUNDE NAVAM PAYAH
JATO JATO NAVACHARAH
NAVA VANEE MUKHE MUKHE

The meaning of this SUBHASHITA is simple and enlightening. It boosts the spirit of tolerance.

It implies, every individual has different intellectual capacity, every source of water contains water with different characteristics and composition, every community has different tradition; and different linguistic expression is present in every individual mouth!

But in India this word has different connotation. In India, communalism implies disproportionate pride, concern about one’s caste, tribe, religion or any such group and disproportionate contempt, hatred and prejudice about those of others.

This is almost always associated with practices harmful to others. Communalism has become an everyday problem. It has infiltrated every walk and every stratum of life; like a cancer. Thus political parties, a variety of unions, various organizations etc and associations are diseased with communalism. Similarly, policies regarding employment, promotions, admission to different educational careers, competitive examinations in almost every sphere of life have been infiltrated by communalism.

To understand and overcome the menace of communalism and bring about harmony and justice in society effectively; we have to understand the caste system and the caste specific job distribution that has come into existence and remained for centuries and the emergence of religions and their impact on social life. In this article; we will consider the development of caste system.

In my view, (my theory of the emergence of caste system that disapproves the conspiracy and exploitation theories) the caste system in India was based on the physiological principle of homeostasis where many different type of cells perform different functions so as to maintain constancy of internal environment and thereby health of the organism.

Secondly it was based on the principle of variety, complementarity and harmony in nature. Thus the emergence of caste system was based on the observation that neither in body nor in nature the individual components perform the same work or job. In fact this kind of “equality” is dangerous. Complementarity of components is important and conducive to health. This entailed distribution of different jobs. This distribution of the jobs initially depended on the capacity.

However the distribution of jobs gradually became independent of the capacity and started depending on one’s caste. How could have this happened?

Firstly, it appears to me that this took place because of the observation; that the tissues performing a particular function in body; give rise to the cells with the same functions.

Secondly; there is heredity in nature. The mango tree gives mango fruits, banana tree gives banana and coconut tree gives coconuts. The offspring of a tiger is tiger and offspring of a cat is a cat.

Thus the fact the tissues give rise to daughter cells performing the same function and the plants and animals reproduce their own replicas; was probably extrapolated to the human society.

It must have been thought that such heredity must be working in human beings also. In fact, such extrapolation must have been buttressed by the observations that children do carry the traits of their parents which may include, from mathematical talents to musical skills, besides physical constitution and looks. In fact even today we use expressions such as “There is music in his blood”, “There is acting in his blood” “There is business in his blood” and so on. These expressions are based on observations of centuries. So every community was seen or perceived as a particular organ or tissue, which would give rise to specific type of cells; and subserve the homeostasis in the organism viz. holistic welfare or blossoming of the mankind!

The second reason for this change must have been due one of the most prevalent concepts viz. KARMA PHALA SIDDHANTA. In Marathi this is expressed as KARAVE TASE BHARAVE. In English this is expressed through “As you sow, so you reap”.

This concept gives a basis for why a particular child is born in a particular community or caste. This led to the notion that those who are born in a particular caste are born according their deeds in the past life. This lent a conceptual foundation for the stability and continuance of the caste dependent job distribution. So every individual in a particular community, caste, subcaste; was conceived as a particular individual cell in a tissue.
Now it can be appreciated why there were restrictions on all the communities (analogous to organs or tissues) to do a particular job.

Obviously this was to achieve social homeostasis (analogous to homeostasis in an organism). Clearly this was to avoid competition based on petty selfishness and unabated personal ambitions, which could, jeopardize the welfare of a society (analogous to endangering the homeostasis and life of an organism because of different tissues competing to perform the same functions).

The caste system also had one more and important aspect and that was punishment at local level. This punishment depended on the nature of “crime” or “sin” and the verdict of the traditional beliefs, conventions and consensus. This particular system included the punishment of outcasting.

Outcasting means; removing out of the community. The person or a family could not live in; and get any facilities from their community. There was total noncooperation. This was a kind of imposition of sanctions.

It is well known in India that the father and mother of the world famous saint of 12th century, saint Dnyaneshwar were outcasted and forced to commit suicide; for their “crime” of going against the then prevalent conventions.

Those who were outcasted were condemned to live as the outcaste. This system of giving “justice” by consensus; apparently did not have any provision for the upward traffic of the outcasted “lower” castes, who actually were not merely the conquered people or slaves. They included the “upper” castes individuals and families, which had to enter into “lower” castes because of what was then considered a “crime”.

However one does not know with certainty whether there were any ways of absolving from those so called “crimes” and promoting to “upper castes”.

Today most of these “crimes” may not be considered as crimes, blunders or even mistakes; because of the individualism, superficiality, pettiness as well as ideas of (right as well as wrong) freedom.

It appears that these castes, which were forced to live outside the villages, were declared untouchable. Due to the same notion of heredity, which consolidated caste system, their progeny was also considered inferior and forced to stay out of the village border, was made to accept dirty jobs and were declared untouchable. This is why; many villages in India used to have and still have; in many regions, the formerly untouchable people staying beyond the boundaries of the villages.

The caste system has been primarily a result of all that has been said above and NOT A CONSPIRACY; though it became unjust and perverted; through the subsequent influence of other factors such as vested interests, misuse of cultural superiority and authority, emotional blackmailing, exploitation of gullibility, religious persecutions, outright sadism, brutality, foreign invasions, forcible conversions, fear of the unknown, fear of the society, etc.

It can be clearly understood from the foregoing that the caste system in India which deteriorated into increasingly unjust and grave perversion; was to start with; NOT A CONSPIRACY; as is made out to be by many misguided individuals.

The theory that it was a conspiracy; can prejudice and mislead; the young and innocent people; and can create division, hatred and strife; amongst different castes. But since it does not go to the root cause; it can not solve the burning problems of the billions. In fact this has been vindicated by the history of many ad hoc measures; such as; reservations and other caste-caste interactions in India in last several decades.

The fact that the caste system did not develop as conspiracy can be clearly evident if following points are considered.

1) Caste system to be the conspiracy has not primarily been a result of political wars or religious wars also. The subsequent influence of such factors; however; can not be entirely denied.

2) Political, dictatorial, oppressive, exploitative reasons appear too simplistic to explain the phenomenon of casteism and untouchability, which has spread all over India and in every nook and corner of even the interior most aspects of country (which were ruled by extremely different rulers with extremely diverse backgrounds).

3) Caste system to be a conspiracy has not been primarily a result of winner-loser relationship. If that had been the case then there would not have been as many restrictions on certain “upper” castes as have been there in India.

4) If there had been winner loser relationship between two groups then one would have found fairly uniform characteristics amongst “upper” and “lower” castes. This is not so. Everyone would agree that there are people with very low capacity in so called “upper” castes and there are people with far greater capacity in so called “lower” castes. In fact almost all types of people are seen in all the castes. This applies not only to capacity but also to morality and social commitment.

5) The skin complexion of the individuals from “upper” castes and “lower” castes is also not uniform. Thus brahmins are not uniformly fair in complexion and the “lower castes” are not uniformly dark in complexion.

6) Caste system was not based on equality. But it was basically and to start with not based on inequality, injustice and exploitation also. It was based on; as is said earlier; the interpretation of homeostasis, heredity and complementarity, and its extrapolation to society, social harmony, social stability, social order and optimal social blossoming in holistic health.

7) In the ancient times; most of the rulers and great scholars were NOT brahmins and the scriptures were the products of consensus and any particular community.

It has to be appreciated that because of this, even as most of the saints did not practice caste discrimination, religious discrimination or any kind of discrimination for that matter, they did not condemn or allege the Indian scriptures with malicious and vicious intentions.

These scriptures (MANU SMRUTI, PARASHAR SMRUTI, VASISHTHA SMRUTI, NARADA SMRUTI, YAJNAVALKYA SMRUTI) were codes of conduct for different age groups, different professionals, different members of the family etc; such as and so on.

This was because they knew that by condemning them, the old wisdom of social homeostasis would be lost and by supporting and practicing it; the exploitative, coercive and inhuman element would be justified and would continue.

For this reason they chose the middle way. The saints did not make any disruptive and provoking statements; because they knew that this was not the solution to the evils of caste system. They knew that the solution to the evils of caste system lied in the opening of the floodgates of enlightenment and empowerment for one and all.

This is why, without making any stunts and gimmicks they spent their lives in trying to open the floodgates of enlightenment and empowerment for one and all.

They suffered during their lifetime because of the harassment from callous, rigid, orthodox and inhuman conservative elements; and centuries after their death; still continue to be misunderstood, misquoted, condemned and ridiculed by many misguided elements.
From the work of the saints it appears that the saints had diagnosed the flaw in the caste system; and hence foreseen and predicted; the end of caste system (without losing the essential concept of social homeostasis) through generalized enlightenment and empowerment; irrespective of caste, religion, region etc, which is of paramount importance and inevitable and indispensable (but neglected) in really annihilating the castes even today.

The major flaw; in the caste system that rendered it extremely exploitative, coercive and inhuman; is the omission or ignorance of i) Human beings are different from tissue cells; by virtue of greater freedom and flexibility ii) mango, coconut, tiger and cat do not have the choice and freedom to transcend their mango-ness, coconut-ness, tiger-ness and cat-ness. In contrast human beings have this potential and hence must get choice and freedom to transcend their caste characteristics, the process which is called enlightenment or self-realization.

The saints seem to have realized that the children are not of the parents (to get exactly the same characteristics or to be blamed for the “sins” of their parents), but they come through the parents.

The saints also seem to have realized that it is a great fallacy to condemn some one as sinful; merely because of being born in a particular caste; and punish him/her for the so called sins/crimes of the past generations or past lives.

The purpose of this article is not to glorify or to condemn anybody, or to describe the detailed history of caste system but only to i) conceptualize the theory of the mergence of caste system based on the understanding physiology and ii) having gone to the root of the caste system and the main determinants of the caste system; take it to its logical end by blossoming everybody; at individual and global levels in every possible way!

This implies that everything coercive in caste system would come to an end and the wisdom of harmony and complementary would continue.

This is because, we must remember that while evolving out of the caste system, and annihilating it; mankind has already begun to be plagued by and suffer from; individualism, pettiness and superficiality.

Those, who attribute all the evils to the caste system in India; must be explained; that; in rest of the world; where there was no caste system like that in India, individualism, pettiness and superficiality are playing havoc and proving to be malignant and fatal!
We must learn from the saints; the importance of opening the floodgates of self realization to people irrespective of caste, creed, race, religion, nations and study, practice and promote; the Total Stress Management (the core of which is NAMASMARAN), which embodies holistic perspective, policies, plans, programs and actions; for individual and global blossoming; through international laws, rules and conventions; in holistic healthcare, holistic productive education, and every field of life!

As and when this begins, everybody would become self reliant, independent, empowered, self sufficient, and enlightened; and the ad-hoc steps such as reservation policy, free education, concessions, free food, subsidies, loan wavers etc; would become redundant and unnecessary. Moreover; majority would begin to realize that in absence of this; even 100 percent reservations in parliaments, assemblies, jobs and everywhere; for that matter; would NOT solve the problems of the suffering billions.


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Sep26
Pathology made easy fpr medical students & PG aspirants
Dear medical students & friends,

Hi, I am Dr. Nitin Chawla, Assistant Professor in department of Pathology in SGRR medical college, dehradun. As you all know that based on new MCI curriculum, it is mandatory to ask 20% of questions in university exams in
MCQs format. At times students find it
difficult where to get chapter wise MCQs to assess the study of the topic.
Keeping this in mind, I have written an explanatory MCQ book in pathology “REVIEW OF PATHOLOGY” which contains
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entrance guides as it gives chapter wise MCQs from the syllabus and gives
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entire subject. So, if you really crave to score more marks in second MBBS
university examinations, you can visit the website of the book which is as
follows:

www.reviewofpathology.com

and book your copy.

Note-Kindly tell all your MBBS friends about it.


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Sep26
THE COLLOID CRYSTALLOID WAR
There is a longstanding and eternal debate concerning the type of fluid (crystalloid or colloid) that is most appropriate for volume resuscitation. Each fluid has its army of loyalists who passionately defend the merits of their fluid. It was believed that a major consequence of acute blood loss was an interstitial fluid deficit and that replenishing this deficit with a crystalloid fluid will reduce mortality. Thus crystalloid fluids were popularized for volume resuscitation because of their ability to add volume to the interstitial fluids. Later studies using more sensitive measures of interstitial fluid revealed that the interstitial fluid deficit in acute blood loss is small and is unlikely to play a major role in determining the outcome from acute hemorrhage. This refuted the importance of filling the interstitial compartment with crystalloids, yet its popularity did not wane.
The most convincing argument in favor of colloids for volume resuscitation is their superiority over crystalloid fluids for expanding the plasma volume. Colloid fluids will achieve a given increment in plasma volume with only one quarter to one third the volume required of crystalloids. This is an important consideration in patients with brisk bleeding or severe hypovolumia, where rapid volume resuscitation is desirable . Crystalloids can also achieve the same increment in plasma volume as colloids but then three to four times more volume is required to achieve this goal !This adds fluid to the interstitial space and can cause unwanted edema. THE PRINCIPLE EFFECT OF CRYSTALLOID INFUSIONS IS TO EXPAND FLUID VOLUME, NOT THE PLASMA VOLUME. Since the goal of fluid resuscitation is to support the intravascular volume , colloids fluids are the logical choice over crystalloids.
FILLING A BUCKET- The following example illustrates the problem with using crystalloids to expand the plasma volume. Assume that you have two buckets, each representing the intravacular compartment, and each bucket is connected by a clamped hose to an overhanging reservior that contains fluid. One reservior contains a colloid fluid in the same volume as the bucket, and the other reservior contains a crystalloid fluid in a volume that is three to four times greater than the colloid volume. Now release the clamp on each hose and empty the reserviors; both buckets will fill with fluid, but most of the crystalloid fluid will spill over on to the floor. Now ask yourself which method is better suited for filling the buckets; the colloid method with the right amount of fluid and no spillage, or the crystalloid method with too much fluid, most of which spills on to the floor.The biggest disadvantage of colloid resuscitation is the higher cost of these fluids.
Thus there is too much chatter about which type of resuscitation is most appropriate in critically ill patients , because it is unlikely that one type of fluid is best for all patients. A more logical approach is to select the type of fluid that is best designed to correct a specific problem with fluid balance. For example, crystalloid fluids are designed to fill the extracellular space(interstitial space plus intravascular space) and would be appropriate for use in patients with dehydration. Colloids on the other hand are designed to expand plasma volume and are appropriate for patients with hypovolumia due to blood loss, while albumin containing colloid fluids are appropriate for patients with hypovolumia associated with hypoalbuminemia. Tailoring fluid therapy to specific problems of fluid imbalance is the best approach to volume resuscitation !


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Sep25
RECENT ADVANCES IN TREATMENT OF AIDS /HIV PATIENTS
RECENT ADVANCES IN TREATMENT OF HIV/AIDS PATIENTS
-----DR.D.R.NAKIPURIA
AIDS is acquired immunodeficiency syndrome comprises of many symptoms and signs (different complains of patients and many thing evaluated by Doctor on examination)of Patient suffering from HIV,Hunam Immunedeficiency Virus.AS THE NAME SUGGEST OUR DEFENCE SYSTEM or Immune system is paralysed or made less responsive(measured in this infection by determining CD4 Count from Blood examination as a type of Lymphocyte fighting with invasion of HIV in our Body) whenever any infection of Bacteria,Virus,Fungus or parasite invade our body as a result infection can occur in any part of our body and as primary resistance from our Body System is weak,infection spreads more and more resulting in further growth of invading microbes and this HIV virus too(measured by Viral Load as Copies of Virus in Blood and susceptibility to drugs by sensitivity test).Therefore development of Anti Retro Virus (as HIV is Retrovirus) medicines has developed which once started raise immune system CD4 count by checking further growth of HIV virus and prevent infection by other Microbes(Oppurtinistic Infections) but as we know more and more about these medicines and their side effects and different Oppurtinistic Infections,WHO put some best guidelines when to start these medicines in HIV patients as in Year 2006 ART was to be started if CD4 count is below or 200 but in 2010 it is upto 350 But Amercan Journal suggest it upto 500 when patient is symptomatic or in stage I and II as per WHO staging(Patients with less grade of infections)but in stageIII and Stage IV patients or patients with severe form of disease or seriously ill as suffering from TB,Meningitis,Kidney or Cardiomyopathy,Chest or GI tract infections does not require any estimation of CD4 count as this is presumed and fact that their CD4 count is below 350 or 200 and ART or Better called HAART Medicines immediately.In case of TB patients ATT should be started after start of ART generally within 2-8 wks to avoid IRIS or any adverse reaction,those on HAART developing TB ,ART should be started immediately(with efavirenz except children below 03 yrs of age and first trimester pregnancy).In case of Pregnant Patient same module is practised ,in patients suffering with Hepatitis B or C patients,like TB, ART should be started immediately without any staging or delay of 2-8 wks.In case of Childrens too now same strategy is applied but here CD4 count varies according to age groups,we can start ART immediately in stage III and IV in infant or children upto 12 yrs of age but in Infants and children up to 2yrs of age no need of checking CD4 count start ART if patient is sytomatic or is diagnosed as HIV patients,even in infants now ART may be started if we strongly clinically suspect HIV (As Mother strongly positive or both parents positive or breast fed positive mother children etc) but in early age from 2-5 yrs reduction of CD4 count up to 750 or % of CD4 count below 25 but above 05 yrs criteria is 350 for stage I and II . In Developed countries Art is being started CD4 count upto 500 or less above 05 yrs and adult.CD4 count was previously estimated every 06 months but now at every 03 months and if it is not raising considered as immunological failure and Viral load to be done before starting therapy and also at 3-6 months to see copies below 5000/ml it is raising then drug sensitivity test is done and if not possible then IInd Line drug is started,if IInd line drug started then now a days IIIrd line drug is started.In pregnancy either mother exposed to AER earlier or not ART started in first trimester(avoiding Efavirez) with drug regime and is continued life long unlike nevirapine during labor or Zidovudine regime only,Zidovudine and Nevirapine found good in CD4 count between 250-350.
Now HAART medicines has been slightly modified,Two NRTIs and one NNRTIs is still practised to check drug resistance by Virus mutation but instead of dT4(Stavudine 30 or 40 as per wt above or below 60kg causing severe lididolysis or peripheral neuropathy,pancreatitis ) now3TC(Lamivudine)+AZT/ZDV(Zadivudine causing severe anaemia or neutropenia ) or 3TC + TDF(Tedofil,causing nephropathy and calcinosis ) or TDF + FTC (Emcritabine),AZT+ FTC(causing hepatitis) so 3TC+ AZT+NVP(causing hepatitis and stevenson Zhonson syndrome) or 3TC+AZT+EFV (Efavirenz)or 3TC+TDF+NVP(Nevirapine) or EFV is preferred ,even Simple FTC+NVP or FTC+ EFV is preferred.here Abacavir (ABC) or Diadanosine (ddi) is also used as NRTIS but combination like Stavudine+Zaduvidine,3TC+FTC or AZT+TDF or dt4+Abacavir is not used . Incase of Tuberculosis patients,Efavirenz is given not NVP except when patient is child below 03 yrs or Ist trimester pregnant or under Psychotic condition or medicines.If possible and patient can afford Rifabutine may be started in ATT instead of Rifampcin but mostly if patient is not renal compromised or under hepatic pathology simple ATT is good.In Resistant cases(increase in viral load,less cd4 count or drug resistance)IInd line drug of 03 drugs combination is started here one protease inhibitor(Liponavir(LPV) / Squanavir(SQR)/ Indinavir(IDV) /Atazanavir(ATV) /Fosamprenavir(FPV) / Darunavir(DRV) /Etarvine(ETV) with boosted Ritonavir(r)or plain Ritonavir(RTV) is used and along with this in TB patients with Rifampcin dose of protease inhibitor like Lopinavir+ boosted ritonavir(LPV/r) or Squanavir +Boosted Ritonavir or Indinavir + boosted Ritonavir is increased but with Rifabutine no dose adjustment is done.Instead of using NRTIS used in past as for dt4 or 3TC ,AZT + TDF or TDF + FTC or simply replacing 3TC by TDF or FTC or ABC or ddi is done,if any drug produce complication or side effect as mentioned above it is also replaced.In case of Hepatitis B TDF +3TC is used with NNRTIS or Protease Inhibitor.Revebrine and Pregylated Interferon is used with ART in Hepatits C patients.If after IInd line treatment CD4 count is increased third line treatment using one NNRTIS ,one Protease inhibitor as newly added ATV,DRVor FPV with Integrase inhibitor Raltegravir(RAL) is used.
Cotrimoxazole is added to prophylaxis below 350 to prevent malaria,bacterial,PNeumocystis Jivorecii or Campylobacter Diarrhoea and Toxoplasmosis.STD clinic for any sexual inflicted persons like commercial or flying sex worker (counselling and promoting use of condom )and treatment and screening of suspected highly prone patients like IDUs,drug users,(not sharing needle)migratory labours,Truck drivers etc., at target Intervention clinic is backbone to control it and every suspect should be submitted for HIV screening ,Similiarly every TB patient and in ICTC every Blood donor and PTCT pregnant mother is screened for HIV.Proper counselling of these patients with advise and regular follow up of these persons at primary or semi primary or assisting ART centre is must by doing off and on viral load and CD4 count examination. Every oppurtunistic infection should be controlled and here medicines shold be contined for a long time to prevent recurrence and continuation of ART medicine of great importance.Adhrence,compliance and continued taking medicines with proper counselling during IRIS or any other drug reaction is most important of HIV treatment.

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Author is an HIV specialist Doctor


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Sep18
APATHY OF SEX IN MALE /FEMALE-HOW TO TREAT?
Gradually as we are more educated by Media,internet,print media,films, social interactions, books,our day to day exposure in family,friends,society to sex from our childhood till Adult period or even we are middle aged or old,Sex either comes spontaneously or otherwise due to above reasons becomes a very need of our life like Anger,fear,Greediness,Love,Hunger,Thirst,Sex is important involuntary demand of our body.
But as becomes more informed on this matter either by family /society or our exposure to different above mentioned information channels,we start asking ourselves as we are competent enough to perform Sex properly and completely qualitively and quantitavely perfect.Mostly A person or his/her are experiencing it ,that is why if partner complains (which is mostly not seen in our Indian society) a person is ofeten left to himself whether he is performing normally or not and he becomes more questening whe he reads or sees videos /stories of betters performing persons who are doing sex for much time ,much frequently and in different postures and styles ,satisfying partner with more satisfications in form of penetrations, cries,return behaviours and demands.But most of such behavioural changes are wrong as Sex performance never means deep or forceful penetrations, excessive strong rigid,fatty and thickened tight Penis or Fatty full Labia with prominent Clitoris or with excessive discharge of Male or Female before or after Coitus or making partner more demanding sex or behaving in abnormal styles,fashions and positions.If these comes in our sexual behaviour these are excess above Normal Sexual behaviour,whether this is pervertion or not is questionable but not a certainly normal behaviour.A normal sex apathy cannot be said at all if these are absent,only need is of a normal sex desire at a proper time,place with a normal partner with or without a fore play and after desire a normal erection with normal penetration,coitus , normal holding,exercise for 1-5minutes and normal discharge inside or outside of few ML of fluid only.Iind arousal may come immediately or may not come for hours it never means less strength or apathy or a partner not interested for second after first in short time.But beside this there are some gray areas where a person in normal condition without under any influence of medicine,addiction or psycho social or organic body diseases never gets sexual desire even after proper stimulation by partner or by books / stories or video and remain apathetic to sex ,these persons whether Male or Female are called Apathetic to Sex or we can say Less desire/Drive/Interst for Sex is seen among them,Mostly it is assumed that Male suffers it most and it is reflected more as Male is Active Partner in Sex but it is not true a freezed Female can damp a normally (not Hyperactive) Male too or a stimulated Female can boost up a borderline or less performing Male too also,so Importance of Both Partners exist and one can supplement and correct other by Physical or Psychosocial stimulation,some time change of partner,time,place,orientation,external stimulation,visualisation and exhibition of Normal Sex and psychosocial support corrects this Low desire so well that in most of cases mere psychosocial correction and support yields very good result needing no medicines .
That is why this article will provide us correct knowledge of Less Desire/ Drive in sex. Mostly we assume that wife is a bit concerned, but it doesn’t bother you too much because she doesn’t speak about it or mentions it. However, deep within, you want to understand how and why you have transitioned from a once energetic young chap who could satisfy his newly-wedded wife in a matter of minutes to a man who no longer yearns to play the game. Deep inside, you also realize that the longer things go on like this, the farther apart you and your wife will drift. However, time and time again, you brush the issue under the carpet.Men often don’t express their personal problems, especially those involved with relationships or sexual in nature, and, therefore, find it difficult to seek help. This eventually leads to breakdown of their relationships and causes stress, which further aggravates the problem.
What is low sex drive?
A man with decreased libido thinks less about sex, loses interest in sexual fantasy and in sexual activity. Even sexual provocation by sights, words, or touches, may fail to induce interest. The man, however, often retains the capacity to have sex. Some men, despite having no desire for sex, continue to engage in sexual activity in order to satisfy their partners. In such cases, women may find the excitement completely lacking and might start feeling that their partners are no longer interested in them.Different men have different levels of libidos. This may range from one extreme, (such as wanting sex everyday) to the other extreme (having sex only once, twice or thrice a month/year). Men also have varying levels of satisfaction with their own sex drives. Therefore, there is no normal range of sexual activity for a coupleProblems may arise when the husband’s libido is persistently low, which causes the wife to remain sexually dissatisfied or unfulfilled or when the man seems to be dissatisfied with his own level of sex drive. Compatibility between spouses, including sexual compatibility and sex drive, is essential to maintain healthy sexual life. While libido may be decreased temporarily by conditions such as fatigue or anxiety, some men experience low levels of sexual desire all their lives.
Medical causes
Low libido may be caused by many different medical conditions. One of the most frequent is low levels of testosterone in the body. Apart from erectile dysfunction and premature ejaculation, which may induce anxiety and as a result, decrease your sexual drive, other unrelated conditions (such as Physical weakness Diabetes,TB,anemia, chronic Disease of Liver,Kidney, Lung,Neurological,spinal Gi Tract,cardiovascular disease, Genitourinary diseases pain due to Bony,Skeletal or Muscular diseases,Hormonal diseases) may also lower your libido.Try to rule out all physical or organic disease possibilities for your reduced sex drive. If you have any condition that might be associated with a low libido, see your doctor. You could have a medical condition that can be easily remedied or controlled. Treating the underlying medical condition may help in improving your sex drive.
Stress
Chronic stress can interfere with the hormones involved in the sexual response. This may result in low libido. Stress may be induced due to a variety of factors such as financial, personal, work–related and so on.if by counselling or psychosocial support or some time by psychiatrist using some medicines to cut depression,fear,mania oranger,anxiety, sleeplessness and once these are corrected a normal drives come,but in most of cases of absent such diseases Less Drive is mostly due to our thinking due to our experience or influence by some incidence or videos or exposures and as these are better explained and cleared Drive comes gradually.In Female,a very orthodox bringing a belief of severe pain,bleeding,tear or shock or loss of virginity or of pregnancy create so much nervousness as she never allows any penetration or sometime even any physical exposure or stimulation,They need support from senior members or friends in Family or Partner or some time psychological counselling or medicines.sometime presence of excessive pain due to infection in Genitourinary system causes them Freezed,a proper control of infection by medicines by a good gynaecologist or Urologist or Family Physician corrects it.In amle,except for presence of infections in genitilia or urinary system mostly corrected by good psychological counselling and support ,medicines have got a little role except to correct infection or psysical diseases. Reduce stress and manage it more effectively. This can range from employing stress-relieving techniques such as prayers, meditation and yoga to delegating more responsibilities to your colleagues and peers, depending upon the cause of stress. Alternatively, have sex to reduce stress! It is a well-known fact that sex is a wonderful stress-buster.
No time for sex
Commonly seen now a days! because of our urge to be more and more busy,to earn more and more and in this race we forget our selves,some basic need of our body as we start less eating,gradually it becomes our diet ,same way no time for sex in early days lead to no sex drive in future leading to complete loss of our social and familial life .Juggling multiple responsibilities of earning and providing to your family, parenting, keeping the household afloat and discharging social responsibilities…whew! You find yourself constantly busy. Having packed schedules daily drains your energy and leaves no time for sex. A busy schedule also means a busy mind — and having a lot on your mind makes it difficult for you to relax and "get in the mood”. Sex, may, therefore, take a backseat and feel like just one more thing on your extremely-long "to-do list." All of these factors contribute to a lower libido.Remember that sex is an important part of an adult relationship. Just as we need to find time for ourselves, we also need to find time for our partners. Designate a night or two a week to spend quality, romantic time with your wife. You can make it more interesting by bringing something new to the bedroom occasionally.
Emotional causes

Men generally overlook emotional causes of decreased libido such as fear, anxiety and depression. When we are afraid, anxious or depressed, sex is usually the last thing on our minds. Anxiety, fear and depression may stem from a variety of causes, be they work dilemmas, relationship issues, family woes, or money problems, but emotional experiences greatly impact our sex drive. On the contrary, fear and anxiety may occur due to sex itself. This includes the fear of contracting an STD, of making your partner pregnant or of not being able to make her conceive.
All these emotional experiences dampen our sex drive and hamper our chances of having a pleasurable sexual experience. Improving your health and immunity are the primary factors that can ensure that you are able to tackle these emotional experiences. You can manage anxiety, fear and depression by meditating, doing yoga, talking to friends or playing with your kids. When your mind is healthy, there are fewer chances of problems intruding into your bedroom. However, if you feel that these emotional experiences are overwhelming you and you cannot cope with them, seek professional help.
Boredom
After being married for few years, some couples can hardly find any sexual excitement left in their lives. You might also lose interest if your mate doesn’t take care of her looks, body and behavior.
Experiment! Bring back the excitement by trying out stuff that you had been fantasizing about for some time. Gift your wife sexy dresses, which will help bring in some spontaneity to the experience. Talk to your partner about her idea of improving the sexual relationship.

Relationship issues
Having relationship issues with your partner such as unresolved conflicts, resentment or unexpressed anger can dampen your sexual desire. You need to deal with relationship issues with your partner if you want to enjoy sex again.
Communicate. Identify the problem and try to find the solution together before issues explode into huge conflicts. If talking to each other doesn't work, seek help from a therapist.

Body Image
Some people feel unhappy about their bodies and are shy to expose them to their partners. Though, we all love and hate some aspects of our bodies, the key here is to learn to be happy with what you have and feel sexy about it.We can do away with the negative feelings by thinking about the positive aspects that you have. Even if you are overweight, you can try out ways to feel sexy by enhancing your other valuable body aspects. If you are obese, try to shed some weight by seeking professional help.
Aging
With age, men produce less testosterone, which reduces their sex drive. Other concomitant factors that may play a role in reduced libidos are age-associated fear, anxiety, and depression. Testosterone levels may be increased by taking testosterone supplements, but this should be subsequent to consultation with your doctor. Additionally, the dosage of testosterone must be carefully monitored, as high levels of this Hormone can cause depression or other side effects like prostatic or testicular cancers. Long-term safety of testosterone supplements, especially in elderly men, has also not been established. Other temporary alternatives can be the use of Viagra (Sildenafil citrate).But it corrects only erectile dysfunction not libido so it is not very useul here works or work as psycological boosting agent However, prior to initiating any medicine to boost your sex drive, it’s essential to consult your doctor.
Sexual Abuse
If you have been a victim of sexual abuse, you may find it difficult to have normal physical relations. By taking your own time to heal, being patient and getting help of friends and counselors, you can overcome this past issue and resume a normal and healthy sex life. The key here is not to pressurize yourself or get pressured from others to have sex until you are completely healed and ready.
Medication
Some common medicines such as those for high blood pressure, depression, or relieving anxiety can reduce sex drive. Depression can also lower your sex drive and so can the medicines you take to relieve it. Additionally, antidepressants can cause sexual dysfunction, such as delay in orgasm, inability to achieve orgasm or erection or ejaculation. Any of these conditions can have an adverse affect on your level of desire. Before taking any new medicine, talk to your doctor about the possible side effects on sexual activity. Also, make a list of all the medicines that you take and get to know about their side-effects. Talk to your doctor and seek alternatives to the medicines which seem to be the cause of low sex drive or sexual dysfunction. Other options may include taking drug holidays, reducing the dosage or taking antidotes. Some people may benefit from taking supplements such as Gingko biloba or switching to a different medicine. The most important thing to remember here is that you should not stop taking any medicine without first talking to your doctor.
The best approach to this problem is to try and identify the cause of low sex drive .Once we are able to do so, try to eliminate the cause or seek professional help. Remember, putting in the effort and resolving problems now will go a long way in living a sexually-fulfilling and blissful life! But most of time our belief in Less Drive/Desire is not correct as either our mental level has raises or we are under above mentioned physical or psychosocial stress and oce we get corrected it,normal desire comes but it is most true that a normal Sex must be perfomed by partners at regular interval as it increases our cohesiveness and adherance to each other and normally shapes our family and society. Neither we should be overactive or more demanding destroying our social fabrics nor we should be so much busy or shameful of performing Sex inspite of our time, space,place, age,religion,enviornment or any other social factor.
DR.D.R.NAKIPURIA
SILIGURI
09434143550
NACO TRAINED EXPERT ON HIV,SEX & VENERAL DISEASES


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