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New York how to get zithromax over the counter Gov. Andrew Cuomo will cash in on his book about leadership how to get zithromax over the counter during the buy antibiotics zithromax to the tune of more than $5 million. Cuomo, who has drawn criticism for patting his administration on the back by writing the book during the height of the outbreak, disclosed that he was paid a how to get zithromax over the counter $3.1 million advance to write âAmerican Crisis. Leadership Lessons from the buy antibiotics zithromax,â and will pocket another $2 million over the next two years on the book.Cuomo, who has come under fire for underreporting buy antibiotics deaths how to get zithromax over the counter in nursing homes and then attempting to have his administration cover it up, had his book pulled by his publisher amid the controversy, has faced constant criticism since his memoir was published last fall.

Cuomo had previously declined to how to get zithromax over the counter say how much money he made by writing the book, with his announcement coming only as his mandatory financial disclosures were scheduled to be sent to a state ethics agency. Cuomoâs tax returns were also released on Monday, May 17.According to a Cuomo spokesperson, the governor net approximately $1.5 million from the book deal after taxes and expenses. Of that profit, $500,000 was donated to the United Way of New York how to get zithromax over the counter State and the rest was put into a trust for his three daughters. From the how to get zithromax over the counter time Cuomo's book came out he was criticized for penning a book touting his performance while the crisis was ongoing.

Since then he's drawn more criticism over the involvement of some of his top staff members in prepping the book for publication on time.It is unclear if the aides were paid for their contributions to the book, with the governor and his administration stating that any work put in was on a volunteer basis.In April, the New York State Comptroller Thomas DiNapoli, authorized New York Attorney General Letitia James to investigate the role some of Cuomo's aides played in âdrafting, editing, sale and promotionâ of the book.NPD BookScan has reporting that Cuomoâs book has sold nearly 50,000 physical copies, though it was unclear how many digital copies may have been purchased.According to reports, Cuomo was allegedly approached by Crown about writing the book during the zithromax, with one of the publishing companyâs editors how to get zithromax over the counter saying that âthey thought they had identified another political star.ââCuomoâs top advisers successfully pushed state health officials to strip a public report of data showing that more nursing-home residents had died of buy antibiotics than the administration had acknowledged,â the Wall Street Journal reported in March.New York Times reporters published a similar story, saying that âThe extraordinary interventionâ¦came just as Mr. Cuomo was how to get zithromax over the counter starting to write a book on his zithromax achievements.â Click here to sign up for Daily Voice's free daily emails and news alerts.A 73-year-old Hudson Valley man was found dead, apparently of natural causes, in the vicinity of a hiking trail in the area.The resident of Philipstown, in Putnam County, was found on Monday, May 17 at the Schunnemunk State Park, located in Orange County, in the Town of Cornwall, said NYS Parks officials. State Park Police, NYS Park Forest Rangers, Orange County Medical Examinerâs Office, Town of Cornwall Police, Salisbury Mills FD, Cornwall FD, DEC forest rangers, and local EMS all responded to the scene.The incident remains under investigation. Click here to sign up for Daily Voice's free daily emails and news alerts.Accused serial killer Robert Durst may have had a helping hand in covering up the disappearance of his first wife, according to new reports.Durst - whose life and case was made famous by the HBO miniseries âThe Jinxâ - how to get zithromax over the counter has been accused of killing his first wife, Kathleen âKathieâ Durst after she suddenly disappeared at their home in New York, in Westchester County, in 1982.

Her body has how to get zithromax over the counter never been located.With Durstâs murder trial resuming after a 14-month delay due to buy antibiotics, lawyers are now saying that the real estate heirâs brother and father may have assisted him in making her disappear. Cathy Russon, an executive producer for the Law & how to get zithromax over the counter. Crime Network, tweeted that attorneys representing the family of Kathleen Durst are alleging that his brother, Douglas, and father, how to get zithromax over the counter Seymour, aided in the cover-up of her disappearance and murder. In a statement, the Durst family said it was âappalledâ by the claim from Robert Abrams, the attorney for Kathleen Durstâs family.â¨âMr.

Abrams is a how to get zithromax over the counter member of the cottage industry that seeks to personally profit off of Robertâs victims, even if it involves disrupting the prosecution of the murder of Susan Berman,â Jason Barowitz, a spokesman for the family, told the New York Post.âThe truth is that the Durst family is appalled by Robertâs actions and has cooperated with authorities to help ensure justice is served,â Barowitz continued. ÂThese allegations are false and have been repeatedly debunked.â Durst was not in the courtroom on Monday, May 17, after he how to get zithromax over the counter reportedly refused to get in the jail transport to take him to court. Heâs reportedly being treated for bladder cancer and his attorneys allege that he is in need of âurgentâ hospitalization.Durst, age 78, has been jailed since 2015 on charges he shot and killed his friend Susan Berman in her Los Angeles home in 2000.Kathleen "Kathie" Durst, who graduated from Western Connecticut State with a nursing degree in 1978, disappeared from the couple's Northern Westchester home, located in South Salem, how to get zithromax over the counter after an argument in 1982 and according to New York State Police investigator Joseph C. Becerra, both his division and the Westchester District Attorney's office are still looking into her disappearance, The New York Times reported.Durst married Kathie McCormack in 1972 when he was 27 how to get zithromax over the counter and she was only 19.Durst, a Scarsdale High School graduate, remains in prison in Los Angeles on murder charges.

He has also been linked to several other murders, outside of his first wife. Since his arrest, he has repeatedly denied the how to get zithromax over the counter charges. Click here to sign up for Daily Voice's free daily emails and news alerts.A woman was taken to an how to get zithromax over the counter area hospital after jumping into the sea lion tank at the Long Island Aquarium.The incident took place around 2 p.m. Monday, May 17 in Suffolk County.Officers were called to the aquarium in Riverhead after the woman jumped into the tank.The woman who was taken into custody was taken to an area hospital for evaluation, how to get zithromax over the counter the Riverhead Police said.Police said an arrest was not made as of Monday afternoon.Aquarium officials could not be immediately reached.

Click here to sign up for Daily Voice's free daily emails and news alerts.A Hudson Valley man died following a single-vehicle crash in Northern Westchester.Dutchess County resident Gary Malstrom Sr., age 67, of East Fishkill, was killed around 6:40 p.m., Saturday, May 15 on the Bear Moutain Parkway in the town of Cortlandt, said New York State Police Trooper AJ Hicks.A preliminary investigation indicates Malstrom, who was how to get zithromax over the counter driving a 2019 Harley-Davidson motorcycle, was traveling eastbound on the parkway when he lost control of his motorcycle and struck a guide rail, Hicks said.Malstrom was transported to Westchester Medical Center by Mohegan Emergency Medical Services where he was pronounced dead by the attending physician.Mohegan Fire Department was also on scene rendering aid.The investigation remains ongoing. Click here to sign up for Daily Voice's free daily emails and news alerts..

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Disclaimer Renova best buy zithromax skin rash. This document does not constitute legislation. In the zithromax skin rash event of any inconsistency or conflict between the legislation and this document, the legislation takes precedence. This document is an administrative document that is intended to facilitate compliance by the regulated party with the legislation and the applicable administrative policies.Date approved. November 8, zithromax skin rash 2021Effective date.

November 27, 2021On this page IntroductionThe Interim Order respecting drug shortages (safeguarding the drug supply) took effect on November 27, 2020. The interim order (IO) allowed Health Canada to compel a market authorization holder (MAH) or drug establishment zithromax skin rash licence (DEL) holder to provide information on an actual or anticipated drug shortage. The provisions of that 1-year IO have been made permanent through amendments to the Food and Drug Regulations. These provisions, contained in section C.01.014.12 of the zithromax skin rash Food and Drug Regulations (FDR), come into force on November 27, 2021. This date follows the day on which the IO ceases to have effect.

Health Canada is responsible for helping the people of Canada zithromax skin rash maintain and improve their health. This is done, in part, by our commitment and actions to help protect the Canadian drug supply, thus ensuring that people in Canada have access to the drugs they need when they need them. Health Canada works with stakeholders across the drug supply chain to. Determine the details and status of an actual or anticipated drug shortage coordinate information-sharing between parties identify mitigation strategiesMitigation strategies include exploring access to international supply and facilitating efforts by companies, whenever possible and appropriate, to make additional supply available zithromax skin rash to Canadians. For more information on drug shortages and the roles of various parties in addressing them, refer to the drug shortages in Canada page.

Purpose and scope PurposeThis guidance document is meant to zithromax skin rash help regulated parties understand how to comply with the regulations. It also provides guidance to Health Canada staff, so that the rules are enforced fairly, consistently and effectively. This guidance document will help you understand section C.01.014.12 of the FDR zithromax skin rash by outlining. The circumstances where it is mandatory for MAHs or DEL holders to provide information to Health Canada the manner in which Health Canada would require information to be providedScope InclusionsSection C.01.014.12 of the FDR applies to the following drugs for human use that have a Canadian drug identification number. Drugs that may be sold without zithromax skin rash a prescription, but are administered only under a practitionerâs supervision also known as âethicalâ drugs (for example, hemodialysis solutions, pre-filled syringes with epinephrine for severe allergic reactions, MRI contrast agents) drugs on the Prescription Drug List drugs listed in Schedules C and D of the Food and Drugs Act drugs listed in Schedules I, II, III, IV or V of the Controlled Drugs and Substances ActExclusionsNatural health products, over-the-counter drugs and drugs for veterinary use are excluded from the scope of these provisions.Responsibilities of MAHs/DEL holders and Health CanadaSection C.01.014.12 of the FDR applies to MAHs and DEL holders.

For more information on when DELs are required and how to obtain one, refer to the Guidance on drug establishment licences (GUI-0002).Responsibilities of MAHs and DEL holdersMAHs and DEL holders are responsible for providing the needed information on an actual or anticipated drug shortage to Health Canada in the format and time limit indicated by Health Canada. Responsibilities of Health CanadaHealth Canada determines the drugs zithromax skin rash for which information is needed in order to prevent or mitigate a drug shortage. Health Canada will provide MAHs and DEL holders with a reasonable amount of time to provide the information. As per laws governing the use of information, Health Canada will use the information only for the purpose for which it zithromax skin rash was collected. Health Canada may take compliance and enforcement actions for failure to meet the requirements of these regulations.

Consult our compliance and enforcement policy for health products (POL-0001).The regulations In the section below, the exact text from the FDR (section C.02.014.12) is provided first, followed by an interpretation.Text on providing informationRegulatory textThe Minister may request that the manufacturer to whom a document was issued under subsection C.01.014.2(1) that sets out the drug identification number assigned for a drug, or any person who holds an establishment licence in respect of a drug, provide the Minister with information that is in their control if the Minister has reasonable grounds to believe that. There is a zithromax skin rash shortage or risk of shortage of the drug. the information is necessary to establish or assess the existence of a shortage or risk of shortage of the drug, the reason for a shortage or risk of shortage of the drug, the effects or potential effects on human health of a shortage of the drug, or measures that could be taken to prevent or alleviate a shortage of the drug. And the manufacturer or licensee zithromax skin rash will not provide the information without a legal obligation to do so. (section C.01.014.12 (1)) InterpretationA person is an individual or an organization as defined in section 2 of the Criminal Code.Health Canada will act on behalf of the Minister in assuming the responsibilities mentioned above.Three conditions must be met for Health Canada to require you to provide information on an actual or anticipated drug shortage.

Health Canada must zithromax skin rash have reasonable grounds to believe that. Thereâs a shortage of the drug or the drug is at risk of going into shortage the information is necessary to establish or assess one or more of the following. the existence of a drug shortage or risk of shortage for the drug the reasons for a drug shortage or risk of shortage for the drug the effects or potential effects on human health of a shortage of the drug measures that could be taken to prevent or alleviate a shortage of the drug the MAH or DEL holder will not provide the information without a legal zithromax skin rash obligation to do soHealth Canada considers a number of factors when determining whether to collect information on a drug and when assessing the type of information to be provided. These include. Mandatory drug zithromax skin rash shortage reports environmental scans inspection reports or reports covering other quality issues information from within the federal government or from external sources such as patients, health care professionals, provincial and territorial partners, and international regulatory agencies media reports consultations with clinicians academic literature past experience or knowledgeNote.

Health Canada will continue to work with companies, provinces and territories and stakeholders from across the supply chain to address actual or anticipated shortages. Sharing information voluntarily helps mitigate shortages. This regulatory zithromax skin rash power will only be used where the criteria for requiring the information have been met and the information is not voluntarily provided by the MAH/DEL holder. Types of information that must be providedHealth Canada can only use the authority under these regulations to obtain from an MAH or a person who holds a DEL information that is within their control. Process for providing informationHealth Canada will zithromax skin rash provide the MAH or DEL holder with a set of instructions for providing the information.

The MAH or DEL holder will also receive a written reason for why this information is required. This allows for more transparent zithromax skin rash decision-making.A request for required information will include. The name of the MAH or DEL holder the regulatory authority being relied upon the drug(s) in question a description of the information in the person's control that the Minister has reasonable grounds to believe is necessary to determine if. the product is at risk of a drug shortage and the drug shortage presents a risk to human health or the information could help prevent or alleviate the drug shortage the timeframe for providing the information the format for submitting zithromax skin rash the informationThe information must be submitted by the deadline in the format specified.Health Canada may follow up with more questions should the need arise.Contact us For questions about drug shortage and discontinuation regulations, contact us at [email protected] Actual shortage. a manufacturer's current supply cannot meet current demand in Canada (pÃ©nurie rÃ©elle) (refer to "Shortage") Anticipated shortage.

a manufacturer's future zithromax skin rash supply cannot meet projected demand in Canada (pÃ©nurie anticipÃ©e) (refer to "Shortage") Drug. any of the following drugs for human use. drugs included in Schedule I, II, III, IV or V zithromax skin rash to the Controlled Drugs and Substances Act. Prescription drugs. Drugs that are listed in Schedule C or D to the Act.

And drugs that are zithromax skin rash permitted to be sold without a prescription but that are to be administered only under the supervision of a practitioner. (drogue) (FDR, C.01.014.8) For clarity, prescription drugs are found on the Prescription Drug List. Drug zithromax skin rash establishment licence (DEL). a licence issued to a person in Canada pursuant to Division 1A of the FDR to conduct licensable activities in a building which has been inspected and assessed as being in compliance with the requirements of Divisions 2 to 4 of the Food and Drug Regulations (Licence d'Ã©tablissement de produits pharmaceutiques (LEPP)) Drug identification number (DIN). an 8-digit numerical code assigned by Health Canada to each drug product marketed under the Food and Drugs Act zithromax skin rash and Regulations A DIN uniquely identifies the following product characteristics.

Manufacturer, brand name, medicinal ingredient(s), strength of medicinal ingredients(s), pharmaceutical form, route of administration (numÃ©ro dâidentification dâun mÃ©dicament) Establishment licence. Refer to Drug Establishment Licence above Manufacturer. a person, including an association or partnership, who under their own name, or under a trade, design or word mark, trade name or other name, word, or mark controlled by them, sells a food or drug (fabricant) (FDR, A.01.010) Market authorization holder (MAH). the legal entity that holds the notice of compliance, the drug identification number (DIN), the medical device licence, the product licence or that has received authorization to import and sell a drug for the purpose of a clinical trial (dÃ©tenteurs d'une autorisation de mise sur le marchÃ© (DAMM)) Person. an individual or an organization as defined in section 2 of the Criminal Code (personne) (FDA, section 2) Shortage.

in respect of a drug, a situation in which the manufacturer to whom a document was issued under subsection C.01.014.2(1) that sets out the drug identification number assigned for the drug is unable to meet the demand for the drug in Canada (pÃ©nurie) (FDR, C.01.014.8 (2))References Legislation and regulations Policies and Guides Web pages/Associated documents ContactsHealth Canada Drug Shortages Division [email protected] linksLegislation and regulations Guidance on drug shortages.

Disclaimer. This document does not constitute legislation. In the event of any inconsistency or conflict between the legislation and this document, the legislation takes precedence.

This document is an administrative document that is intended to facilitate compliance by the regulated party with the legislation and the applicable administrative policies.Date approved. November 8, 2021Effective date. November 27, 2021On this page IntroductionThe Interim Order respecting drug shortages (safeguarding the drug supply) took effect on November 27, 2020.

The interim order (IO) allowed Health Canada to compel a market authorization holder (MAH) or drug establishment licence (DEL) holder to provide information on an actual or anticipated drug shortage. The provisions of that 1-year IO have been made permanent through amendments to the Food and Drug Regulations. These provisions, contained in section C.01.014.12 of the Food and Drug Regulations (FDR), come into force on November 27, 2021.

This date follows the day on which the IO ceases to have effect. Health Canada is responsible for helping the people of Canada maintain and improve their health. This is done, in part, by our commitment and actions to help protect the Canadian drug supply, thus ensuring that people in Canada have access to the drugs they need when they need them.

Health Canada works with stakeholders across the drug supply chain to. Determine the details and status of an actual or anticipated drug shortage coordinate information-sharing between parties identify mitigation strategiesMitigation strategies include exploring access to international supply and facilitating efforts by companies, whenever possible and appropriate, to make additional supply available to Canadians. For more information on drug shortages and the roles of various parties in addressing them, refer to the drug shortages in Canada page.

Purpose and scope PurposeThis guidance document is meant to help regulated parties understand how to comply with the regulations. It also provides guidance to Health Canada staff, so that the rules are enforced fairly, consistently and effectively. This guidance document will help you understand section C.01.014.12 of the FDR by outlining.

The circumstances where it is mandatory for MAHs or DEL holders to provide information to Health Canada the manner in which Health Canada would require information to be providedScope InclusionsSection C.01.014.12 of the FDR applies to the following drugs for human use that have a Canadian drug identification number. Drugs that may be sold without a prescription, but are administered only under a practitionerâs supervision also known as âethicalâ drugs (for example, hemodialysis solutions, pre-filled syringes with epinephrine for severe allergic reactions, MRI contrast agents) drugs on the Prescription Drug List drugs listed in Schedules C and D of the Food and Drugs Act drugs listed in Schedules I, II, III, IV or V of the Controlled Drugs and Substances ActExclusionsNatural health products, over-the-counter drugs and drugs for veterinary use are excluded from the scope of these provisions.Responsibilities of MAHs/DEL holders and Health CanadaSection C.01.014.12 of the FDR applies to MAHs and DEL holders. For more information on when DELs are required and how to obtain one, refer to the Guidance on drug establishment licences (GUI-0002).Responsibilities of MAHs and DEL holdersMAHs and DEL holders are responsible for providing the needed information on an actual or anticipated drug shortage to Health Canada in the format and time limit indicated by Health Canada.

Responsibilities of Health CanadaHealth Canada determines the drugs for which information is needed in order to prevent or mitigate a drug shortage. Health Canada will provide MAHs and DEL holders with a reasonable amount of time to provide the information. As per laws governing the use of information, Health Canada will use the information only for the purpose for which it was collected.

Health Canada may take compliance and enforcement actions for failure to meet the requirements of these regulations. Consult our compliance and enforcement policy for health products (POL-0001).The regulations In the section below, the exact text from the FDR (section C.02.014.12) is provided first, followed by an interpretation.Text on providing informationRegulatory textThe Minister may request that the manufacturer to whom a document was issued under subsection C.01.014.2(1) that sets out the drug identification number assigned for a drug, or any person who holds an establishment licence in respect of a drug, provide the Minister with information that is in their control if the Minister has reasonable grounds to believe that. There is a shortage or risk of shortage of the drug.

the information is necessary to establish or assess the existence of a shortage or risk of shortage of the drug, the reason for a shortage or risk of shortage of the drug, the effects or potential effects on human health of a shortage of the drug, or measures that could be taken to prevent or alleviate a shortage of the drug. And the manufacturer or licensee will not provide the information without a legal obligation to do so. (section C.01.014.12 (1)) InterpretationA person is an individual or an organization as defined in section 2 of the Criminal Code.Health Canada will act on behalf of the Minister in assuming the responsibilities mentioned above.Three conditions must be met for Health Canada to require you to provide information on an actual or anticipated drug shortage.

Health Canada must have reasonable grounds to believe that. Thereâs a shortage of the drug or the drug is at risk of going into shortage the information is necessary to establish or assess one or more of the following. the existence of a drug shortage or risk of shortage for the drug the reasons for a drug shortage or risk of shortage for the drug the effects or potential effects on human health of a shortage of the drug measures that could be taken to prevent or alleviate a shortage of the drug the MAH or DEL holder will not provide the information without a legal obligation to do soHealth Canada considers a number of factors when determining whether to collect information on a drug and when assessing the type of information to be provided.

These include. Mandatory drug shortage reports environmental scans inspection reports or reports covering other quality issues information from within the federal government or from external sources such as patients, health care professionals, provincial and territorial partners, and international regulatory agencies media reports consultations with clinicians academic literature past experience or knowledgeNote. Health Canada will continue to work with companies, provinces and territories and stakeholders from across the supply chain to address actual or anticipated shortages.

Sharing information voluntarily helps mitigate shortages. This regulatory power will only be used where the criteria for requiring the information have been met and the information is not voluntarily provided by the MAH/DEL holder. Types of information that must be providedHealth Canada can only use the authority under these regulations to obtain from an MAH or a person who holds a DEL information that is within their control.

Process for providing informationHealth Canada will provide the MAH or DEL holder with a set of instructions for providing the information. The MAH or DEL holder will also receive a written reason for why this information is required. This allows for more transparent decision-making.A request for required information will include.

The name of the MAH or DEL holder the regulatory authority being relied upon the drug(s) in question a description of the information in the person's control that the Minister has reasonable grounds to believe is necessary to determine if. the product is at risk of a drug shortage and the drug shortage presents a risk to human health or the information could help prevent or alleviate the drug shortage the timeframe for providing the information the format for submitting the informationThe information must be submitted by the deadline in the format specified.Health Canada may follow up with more questions should the need arise.Contact us For questions about drug shortage and discontinuation regulations, contact us at [email protected] Actual shortage. a manufacturer's current supply cannot meet current demand in Canada (pÃ©nurie rÃ©elle) (refer to "Shortage") Anticipated shortage.

a manufacturer's future supply cannot meet projected demand in Canada (pÃ©nurie anticipÃ©e) (refer to "Shortage") Drug. any of the following drugs for human use. drugs included in Schedule I, II, III, IV or V to the Controlled Drugs and Substances Act.

Prescription drugs. Drugs that are listed in Schedule C or D to the Act. And drugs that are permitted to be sold without a prescription but that are to be administered only under the supervision of a practitioner.

(drogue) (FDR, C.01.014.8) For clarity, prescription drugs are found on the Prescription Drug List. Drug establishment licence (DEL). a licence issued to a person in Canada pursuant to Division 1A of the FDR to conduct licensable activities in a building which has been inspected and assessed as being in compliance with the requirements of Divisions 2 to 4 of the Food and Drug Regulations (Licence d'Ã©tablissement de produits pharmaceutiques (LEPP)) Drug identification number (DIN).

an 8-digit numerical code assigned by Health Canada to each drug product marketed under the Food and Drugs Act and Regulations A DIN uniquely identifies the following product characteristics. Manufacturer, brand name, medicinal ingredient(s), strength of medicinal ingredients(s), pharmaceutical form, route of administration (numÃ©ro dâidentification dâun mÃ©dicament) Establishment licence. Refer to Drug Establishment Licence above Manufacturer.

a person, including an association or partnership, who under their own name, or under a trade, design or word mark, trade name or other name, word, or mark controlled by them, sells a food or drug (fabricant) (FDR, A.01.010) Market authorization holder (MAH). the legal entity that holds the notice of compliance, the drug identification number (DIN), the medical device licence, the product licence or that has received authorization to import and sell a drug for the purpose of a clinical trial (dÃ©tenteurs d'une autorisation de mise sur le marchÃ© (DAMM)) Person. an individual or an organization as defined in section 2 of the Criminal Code (personne) (FDA, section 2) Shortage.

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The need for precision in does zithromax treat urinary tract s go to my blog scientific communication is long established. In genetics, one area in which it is particularly important that information be communicated accurately is the reporting of DNA variants. Over the past 2âyears, a working group convened by the Human Variome Project has considered what requirements might reasonably be made of authors to verify that descriptions of variants submitted for publication comply with a widely accepted standard.Two journals undertook a pilot study to test the feasibility of a requirement that authors verify compliance of their variant descriptions to Human Genome Variation Society (HGVS) standards through the use of a standard tool such as Mutalyzer or â¦.

The need for how to get zithromax over the counter precision in scientific communication Buy lasix pill is long established. In genetics, one area in which it is particularly important that information be communicated accurately is the reporting of DNA variants. Over the past 2âyears, a working group convened by the Human Variome Project has considered what requirements might reasonably be made of authors to verify that descriptions of variants submitted for publication comply with a widely accepted standard.Two journals undertook a pilot study to test the feasibility of a requirement that authors verify compliance of their variant descriptions to Human Genome Variation Society (HGVS) standards through the use of a standard tool such as Mutalyzer or â¦.

Zithromax and pregnancy

How to cite this article:Singh zithromax and pregnancy OP. Mental health in diverse India. Need for zithromax and pregnancy advocacy.

Indian J Psychiatry 2021;63:315-6âUnity in diversityâ - That is the theme of India which we are quite proud of. We have diversity zithromax and pregnancy in terms of geography â From the Himalayas to the deserts to the seas. Every region has its own distinct culture and food.

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

Compton and Shim[1] zithromax and pregnancy have described in their model of gene environment interaction how public policies and social norms act on the distribution of opportunity leading to social inequality, exclusion, poor environment, discrimination, and unemployment. This in turn leads to reduced options, poor choices, and high-risk behavior. Combining genetic vulnerability and early brain insult with low access to health care leads to poor mental health, disease, and morbidity.When we come to the field of mental health, we find huge differences between different states of zithromax and pregnancy 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 zithromax and pregnancy 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 zithromax and pregnancy and anxiety were found in females. Apart from the genetic and hormonal factors, increase was attributed to gender discrimination, violence, sexual abuse, and adverse sociocultural norms.

Marriage was found to be a negative prognostic indicator contrary to the western norms.[3]Cultural influences on the presentation of psychiatric disorders zithromax and pregnancy 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 lakh) was 92,083, in annual income group zithromax and pregnancy of 1â5 lakhs, it was 41,197, and in higher income group, it was 4726. Among those who committed suicide, 67% were young adults, 34% had family problems, 23.4% of suicides occurred in daily laborers, 10.1% in unemployed persons, and 7.4% in farmers.[4]While there are huge regional differences in mental health issues, the challenges in mental health in India remain stigma reduction, conducting research on efficacy of early intervention, reaching the unreached, gender sensitive services, making quality mental healthcare accessible and available, suicide prevention, reduction of substance abuse, implementing insurance for mental health and reducing out-of-pocket expense, and finally, improving care for homeless mentally ill. All these require sustained advocacy aimed at promoting rights of zithromax and pregnancy mentally ill persons and reducing stigma and discriminations.

It consists of various actions aimed at changing the attitudinal barriers in achieving positive mental health outcomes in the general population. Psychiatrists as Mental Health Advocates There is a debate whether psychiatrists who are overburdened with clinical care could or should be involved in the advocacy activities which require skills in other areas, and sometimes, they find themselves at the receiving end of mental health advocates. We must be involved and pathways should be to build technical evidence for mapping out the problem, cost-effective interventions, and their efficacy.Advocacy can be done at institutional zithromax and pregnancy 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 zithromax and pregnancy 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, zithromax and pregnancy the Indian Psychiatric Society (IPS) has filed 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 âMental Hai Kyaâ to âJudgemental Hai Kya.â 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 zithromax and pregnancy editorials highlighting the need of care of marginalized population such as migrant laborers and persons with dementia. At an individual level, we can be involved in ensuring quality treatment, respecting dignity and rights of the patient, sensitization of staff, working with patients and caregivers to plan services, and being involved locally in media and public awareness activities.The recent experience of Brazil is an eye opener where suicide reduction resulted from direct cash transfer pointing at the role of economic decision in suicide.[5] In India where economic inequality is increasing, male-to-female ratio is abysmal in some states (877 in Haryana to 1034 in Kerala), our actions should be sensitive to this regional variation. When the enemy is economic inequality, our weapon is zithromax and pregnancy research highlighting the role of these factors on mental health.

References 1.Compton MT, Shim RS. The social determinants of zithromax and pregnancy 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 zithromax and pregnancy 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 1990â2017. 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 âa culturally determined idiom of distress.â 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 â 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.

Several past studies have emphasized that CBS leads to âanxiety for loss of semenâ 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 âculture is closely associated with mental disorders through social and psychological activities.â 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 âCultural Variantâ 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?.

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 âcause-effectâ dilemma can never be fully resolved. Whether âloss of semenâ 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 âemotional distress and cultural contextsâ 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 âmood disordersâ 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 âcultural phenotypeâ 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.

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 âsemen loss syndromeâ 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 âsemen loss anxietyâ suffer from a myriad of psychosexual symptoms, which have been attributed to âloss of vital essence through semenâ (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 â¥1. This study reported several parameters such as the âsense of being unhealthyâ (99%), worry (99%), feeling âno improvement despite treatmentâ (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 âDhatâ 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 âdhatâ 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 âDhatâ 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 âDhatâ multiple times a week. Among them, nearly 60% passed almost a spoonful of âDhatâ each time during a loss. This work on sexual disorders reported that the passage of âDhatâ 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 ânight fallsâ (60.1%) and âwhile passing stoolsâ (59.5%). About 75.6% showed weakness in sexual ability as a common consequence of the âloss of Dhat.â 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 âprecious,â 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 ânocturnal emissions, masturbation, sexual intercourse, and passing of semen before and after urine.â The assessment was done based on several indices, namely âSomatization Screening Index, Illness Behavior Questionnaire, Somatosensory Amplification Scale, Whitley Index, and Revised Chalder Fatigue Scale.â 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 15â50 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 (16â23 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 âloss of something preciousâ, hence its loss would be associated with low mood and grief. Impotency (24%), premature ejaculation (14%), and âDhatâ 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%â66.7%) were from rural areas, belonged to âconservative families and posed rigid views about sexâ (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 16â20 years (34%) followed by 21â25 years (28%), greater than 30 years (26%), 26â30 years (10%), and 11â15 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 18â25 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.

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 âsupplements,â 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.

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 Â± 3.5 years and concluded that the âpureâ 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 âplaceâ 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 âother nonpsychotic mental disordersâ (F48), DSM-V mentions it only in appendix section as âcultural concepts of distressâ 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 âtrue syndrome.â[27] Over decades, various schools of thought have considered DS either to be a global phenomenon or a cultural âidiomâ 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 ânicheâ of DS in the near future.

It will be interesting to see whether it retains its diagnostic independence or gets subsumed under the broader ânarrativeâ 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 âconstructâ 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 âseparateâ 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 âbird's eyeâ 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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'Dhat' syndrome â A useful clinical entity. Indian J Dermatol 1989;34:32-41. 26.Dewaraja R, Sasaki Y.

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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.

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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.

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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.

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

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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.

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

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

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

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

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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 how to get zithromax over the counter cite this article:Singh OP. Mental health in diverse India. Need for how to get zithromax over the counter advocacy. Indian J Psychiatry 2021;63:315-6âUnity in diversityâ - That is the theme of India which we are quite proud of.

We have diversity in terms of geography â From the Himalayas how to get zithromax over the counter 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 how to get zithromax over the counter huge difference between the states in terms of development, attitude toward women, health infrastructure, child 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 how to get zithromax over the counter 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 how to get zithromax over the counter 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 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, the less how to get zithromax over the counter 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 how to get zithromax over the counter found in females. Apart from the genetic and hormonal factors, increase was attributed to gender discrimination, violence, sexual abuse, and adverse sociocultural norms. Marriage was found how to get zithromax over the counter to be a negative prognostic indicator contrary to the western norms.[3]Cultural influences on the presentation of psychiatric disorders are apparent. Being in recessive position in the family is one of the strongest predictors of psychiatric illnesses and psychosomatic disorders.

The presentation of depressive and anxiety disorders with more somatic symptoms results from inability to express due to unequal power equation in the family rather than the lack of expressions. Apart from culture bound syndromes, the role of cultural idioms of distress in manifestations of psychiatric symptoms is well acknowledged.When we look into suicide data, how to get zithromax over the counter suicide in lower socioeconomic strata (annual income <1 lakh) was 92,083, in annual income group of 1â5 lakhs, it was 41,197, and in higher income group, it was 4726. Among those who committed suicide, 67% were young adults, 34% had family problems, 23.4% of suicides occurred in daily laborers, 10.1% in unemployed persons, and 7.4% in farmers.[4]While there are huge regional differences in mental health issues, the challenges in mental health in India remain stigma reduction, conducting research on efficacy of early intervention, reaching the unreached, gender sensitive services, making quality mental healthcare accessible and available, suicide prevention, reduction of substance abuse, implementing insurance for mental health and reducing out-of-pocket expense, and finally, improving care for homeless mentally ill. All these require sustained advocacy aimed at promoting rights of mentally ill persons how to get zithromax over the counter 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 how to get zithromax over the counter 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, how to get zithromax over the counter Global Burden of Diseases in Indian States, and Trajectory of Brain Development. Other activities include improving the infrastructure of mental hospitals, telepsychiatry services, provision of free drugs, providing training to increase the number of service providers. Similarly, at organizational level, the Indian Psychiatric Society (IPS) has filed a how to get zithromax over the counter case for lacunae in Mental Health-care Act, 2017. Another case filed by the IPS lead to change of name of the film from âMental Hai Kyaâ to âJudgemental Hai Kya.â 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 how to get zithromax over the counter migrant laborers and persons with dementia. At an individual level, we can be involved in ensuring quality treatment, respecting dignity and rights of the patient, sensitization of staff, working with patients and caregivers to plan services, and being involved locally in media and public awareness activities.The recent experience of Brazil is an eye opener where suicide reduction resulted from direct cash transfer pointing at the role of economic decision in suicide.[5] In India where economic inequality is increasing, male-to-female ratio is abysmal in some states (877 in Haryana to 1034 in Kerala), our actions should be sensitive to this regional variation. When the enemy is economic inequality, our weapon is research highlighting the role of these factors on how to get zithromax over the counter mental health.

References 1.Compton MT, Shim RS. The social how to get zithromax over the counter 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 how to get zithromax over the counter 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 1990â2017. 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 âa culturally determined idiom of distress.â 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.

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.

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 â 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 âDhatâ was taken from the Sanskrit language, which is an important word âDhatuâ and has known several meanings such as âmetal,â a âmedicinal constituent,â which can be considered as most powerful material within the human body.[4] The Dhat disorder is mainly known for âloss of semenâ, and the DS is a well-known âculture-bound syndrome (CBS).â[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 âwaste of bodily humorsâ being linked to the âloss of Dhatus.â[5] Semen has even been mentioned by Aristotle as a âsoul substanceâ and weakness associated with its loss.[6] This has led to a plethora of beliefs about âfood-blood-semenâ 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 âanxiety for loss of semenâ 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 âculture is closely associated with mental disorders through social and psychological activities.â 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 âCultural Variantâ 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 âcause-effectâ dilemma can never be fully resolved. Whether âloss of semenâ 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 âemotional distress and cultural contextsâ 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 âmood disordersâ 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 âcultural phenotypeâ 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.

Most commonly associated symptoms were found as per score â¥1. This study reported several parameters such as the âsense of being unhealthyâ (99%), worry (99%), feeling âno improvement despite treatmentâ (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.

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 âDhatâ 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 âdhatâ in urine, attributed to excessive masturbation, extramarital and premarital sex.

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

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.

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 ânocturnal emissions, masturbation, sexual intercourse, and passing of semen before and after urine.â The assessment was done based on several indices, namely âSomatization Screening Index, Illness Behavior Questionnaire, Somatosensory Amplification Scale, Whitley Index, and Revised Chalder Fatigue Scale.â 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.

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 15â50 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 (16â23 years).

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.

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%â66.7%) were from rural areas, belonged to âconservative families and posed rigid views about sexâ (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.

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%).

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 18â25 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.

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 âsupplements,â 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 Â± 3.5 years and concluded that the âpureâ 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 âplaceâ 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.

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 âconstructâ 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 âseparateâ 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 âbird's eyeâ 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.

Sathyanarayana Rao TS, Tandon A, editors. Psychiatry in India. Training and Training Centres. 2nd ed.

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Zithromax classification

The government-backed Digital Health Cooperative Research Centre has launched a A$1 million (above $700,000) research project that intends to empower accurate prescription of medications for patients dealing with kidney failure.WHAT IT'S ABOUTThe research institute, in tandem with the Northern Territory Health and the University of South Australia, will develop this clinical decision support tool for healthcare professionals that will be delivered as a standalone service via an application program interface, making it easy to integrate with existing prescribing or dispensing software systems.After analysing the context of medicine prescription and dispensing in the first research phase, they will create a renal dosage calculator algorithm zithromax classification based on NT Health's clinical data sets and other available medicine knowledge databases. In the second phase, they zithromax classification will simulate the impact of the tool in the urban and rural primacy clinics in NT and South Australia. The final research phase involves a clinical pilot in NT's urban and remote primary health care centres and community pharmacy settings.

WHY IT MATTERSInaccurate medicine selection and dosing for people with impaired kidneys zithromax classification is a "common and preventable issue," according to the UniSA research team. They noted that about a quarter of patients receive "inappropriate" medications, which in turn contribute to up to a tenth of adverse reactions that could lead to hospital admissions."A digital solution targeting this problem has the potential to prevent 25,000 medication-related admissions annually," said Libby Roughead, a professor at UniSA who also leads the university's research team. Moreover, medication-related problems account for over 250,000 yearly hospital admissions, costing A$1.4 billion ($1 billion) each year, noted Dr Terry Sweeney, CEO of DHCRC.About 700,000 Australians over the age of 65 with renal function problems, as well as Aboriginal and Torres Strait Islander peoples, are targeted beneficiaries of the project, according to the DHCRC zithromax classification.

It was mentioned that seven in 10 hospitalisations from chronic kidney disease occur among senior Australians while one in five indigenous Australians has shown signs of the disease.The research project, said Bhavini Patel, executive director of Medicines Management at NT Health, will "ensure safer prescribing and dispensing of medications for people living with kidney disease and reduce the risk of medication associated renal problems".THE LARGER TRENDLast month, the DHCRC set up a $2.1 million research project that will improve clinical decision support tools across regional and metropolitan hospitals settings in the country. The three-year zithromax classification project aims to enhance the fit between decision support technologies and their users. To achieve this, it will make use of Alcidion's Miya Precision system to point out priority areas where decision support tools will add value.

In September, the research firm also launched a project, together with UniSA and SA Health, to create zithromax classification a digital analytics tool that predicts the risk of adverse events in hospitals. It was said that the tool will be used to develop a visual programme that will provide clinicians and administrators with real-time insights describing a hospital's risk exposure. The project ultimately intends to resolve patient safety issues, such as ramping, suicide prevention, medication zithromax classification and falls incidents.The U.S.

Cybersecurity and Infrastructure Security Agency and the Federal Bureau of Investigation issued a reminder this week to critical infrastructure partners that bad actors are unlikely to take a break for the holiday season. Although neither CISA nor FBI have identified specific threats zithromax classification looming, they noted that previous incidents over U.S. Holidays have set a concerning precedent.

"Recent history tells us that this could be zithromax classification a time when these persistent cyber actors halfway across the world are looking for ways â big and small â to disrupt the critical networks and systems belonging to organizations, businesses and critical infrastructure," said the agencies in a joint bulletin. WHY IT MATTERS As CISA and the FBI pointed out, holidays such as Thanksgiving often mean offices are closed, and security professionals may be less attentive. Still, they said, organizations can take zithromax classification several actions to try and proactively protect against cyberattacks.

They recommended that all entities, especially critical infrastructure partners, to implement best practices, including. Identifying IT security employees for weekends and holidays who would be available to surge during these times in the event of zithromax classification an incident Implementing multi-factor authentication for remote access and administrative accounts Mandating strong passwords and ensuring they are not reused across multiple accountsEnsuring remote desktop protocol is secure and monitoredReminding employees not to click on suspicious links, and conducting exercises to raise awareness The agencies also urged organizations to stay vigilant against known cybercrime techniques, such as phishing scams, fraudulent sites spoofing reputable businesses and unencrypted financial transactions. "Finally â to reduce the risk of severe business/functional degradation should your organization fall victim to a ransomware attack â review and, if needed, update your incident response and communication plans," said the agencies, directing organizations to ransomware awareness resources regarding holidays and weekends.

"These plans should list actions zithromax classification to take â and contacts to reach out to â should your organization be impacted by a ransomware incident." THE LARGER TRENDThis isn't the first time CISA and the FBI have issued a holiday ransomware warning. Before Labor Day weekend, the agencies raised similar concerns, pointing to attacks on critical infrastructure on Mother's Day, Memorial Day and Independence Day. It also seems, however, zithromax classification that hackers need no special occasion to cause a ruckus.

This year has seen a rise in cyber attacks and data breaches in the healthcare sector, with more than 40 million patient records compromised by incidents reported to the federal government in 2021. ON THE RECORD "As Americans prepare zithromax classification to hit the highways and airports this Thanksgiving holiday, CISA and the FBI are reminding critical infrastructure partners that malicious cyber actors arenât making the same holiday plans as you," said the agencies in the bulletin. Kat Jercich is senior editor of Healthcare IT News.Twitter.

@kjercichEmail. [email protected] IT News is a HIMSS Media publication.Apple announced this week that it was suing NSO Group, an Israeli surveillance technology company, in federal court for allegedly accessing users' devices without authorization. In addition to damages, the tech giant is seeking to block NSO Group from accessing or using any Apple products, or developing spyware that could be used on Apple products in the future.

"State-sponsored actors like the NSO Group spend millions of dollars on sophisticated surveillance technologies without effective accountability," said Craig Federighi, Appleâs senior vice president of software engineering, in a statement. "That needs to change." Apple devices are "the most secure consumer hardware on the market," he contended, but "private companies developing state-sponsored spyware have become even more dangerous. "While these cybersecurity threats only impact a very small number of our customers, we take any attack on our users very seriously, and weâre constantly working to strengthen the security and privacy protections in iOS to keep all our users safe," Federighi added.

NSO Group offered a statement to Healthcare IT News in response to requests for comment. "Thousands of lives were saved around the world thanks to NSO Group's technologies used by its customers," said NSO Group representatives. "Pedophiles and terrorists can freely operate in technological safe-havens, and we provide governments the lawful tools to fight it.

NSO Group will continue to advocate for the truth." WHY IT MATTERS NSO Group says its surveillance technology is used by government intelligence and law enforcement agencies to track criminals. But as Apple outlines in its complaint, the company's spyware has reportedly been used against journalists, human rights activists, dissidents, public officials and others.This month, the U.S. Department of Commerce included the NSO Group in its Entity List for "engaging in activities that are contrary to the national security or foreign policy interests of the United States." Specifically, the agency said that NSO Group had enabled foreign governments, via its spyware, to "maliciously target" individuals such as embassy workers and academics and to "conduct transnational repression." In its complaint, Apple zeroed in on "FORCEDENTRY," an exploit for a vulnerability used to break into a victim's device and install NSO Group's Pegasus spyware product.

The company accused attackers of creating Apple IDs to send malicious data to a victim's device, which then allowed NSO Group or its clients to surreptitiously deliver Pegasus. "On information and belief, Defendants provide consulting and expert services to their clients, assist them with their deployment and use of Pegasus, and participate in their attacks on Apple devices, servers and users," according to the complaint. Although Apple has not observed any evidence of successful remote attacks against devices running iOS 15 or later, it said that each attack carries substantial costs for the company, including the necessity to redirect resources.

"In the meantime, on information and belief, Defendants continue with their pernicious efforts to target and harm Apple and its customers by infecting, exploiting, and misusing Apple devices and software," said the complaint. The company also announced that it would be contributing any damages from the lawsuit, plus an extra $10 million, to organizations pursuing cybersurveillance research and advocacy. "At Apple, we are always working to defend our users against even the most complex cyberattacks," said Ivan KrstiÄ, head of Apple Security Engineering and Architecture, in a statement.

"The steps weâre taking today will send a clear message. In a free society, it is unacceptable to weaponize powerful state-sponsored spyware against those who seek to make the world a better place." THE LARGER TRENDNation-states have increasingly relied on sophisticated software to carry out governmental objectives. As Errol Weiss, H-ISAC chief security officer, pointed out in an interview with Healthcare IT News earlier this month, cyber-offensive capabilities have now become the norm, not the exception."A few years ago, you could count maybe a few dozen countries that had a decent, offensive cyber capability.

And now it's probably the opposite," he said. The U.S. Government has raised the alarm about these developments, most recently regarding an Iran-sponsored hacker group targeting healthcare.ON THE RECORD "Our threat intelligence and engineering teams work around the clock to analyze new threats, rapidly patch vulnerabilities, and develop industry-leading new protections in our software and silicon," said Apple's KrstiÄ in a statement."Apple runs one of the most sophisticated security engineering operations in the world, and we will continue to work tirelessly to protect our users from abusive state-sponsored actors like NSO Group," he said.

Kat Jercich is senior editor of Healthcare IT News.Twitter. @kjercichEmail. [email protected] IT News is a HIMSS Media publication.The six partners of EIT Health met earlier this month in Vienna, ahead of the planned launch of Austriaâs new EIT Health Regional Innovation Hub in early 2022.They discussed how the hub is going to operate across Austria and how it is going to be linked into the European network of EIT Health.WHATâS THE IMPACTThe six partners who will jointly establish the regional EIT Health network in Austria are:The Austrian Institute of Technology (AIT)Boehringer Ingelheim RCVThe startup SanusX of the UNIQA insurance groupKapsch BusinessComthe Wild Groupand the Viennese startup service INiTS.From January 2022, the new hub based in Vienna, together with other network partners, aims to drive forward innovative digital health products and solutions while also supporting startups and small and medium-sized enterprises (SMEs).The EIT Health Regional Innovation Hub is funded by the Austrian Federal Ministry of Digital Affairs and Economy, the Federal Ministry of Social Affairs, Health, Care and Consumer Protection, the Vienna Chamber of Commerce as well as Wirtschaftsagentur Wien.THE LARGER TRENDWith the new Austrian hub, EIT Health intends to capitalise on the opportunities of the region and to strengthen its multidisciplinary network.The European Institute of Innovation and Technology (EIT) is an independent EU Body that seeks to innovate European sectors by promoting and supporting ideas and entrepreneurial spirit around technology.

EIT Health is the designated body for healthcare to this end.In February 2021, EIT Health funded two startups from Germany and Spain with â¬1.5 million for a period of two years as part of the Wild Card innovation programme.In December 2020, EIT Health launched the Catapult Competition and funded nine winning startups from the digital health, biotech and medtech sectors with a total of â¬1 million.ON THE RECORDDirk Holste, Research Manager and Deputy Head of the AIT Center for Health &. Bioresources and Coordinator of EIT Health Austria, commented. ÂWe are excited to be in our new premises today and conduct the first official partner meeting for the new EIT Health Regional Innovation Hub.âHe continued.

ÂAustria has many healthcare innovation strengths including a well-developed healthcare system with widely accepted and implemented electronic health record (ELGA).âThe newly created EIT Health Austria will integrate well into the already vast and vibrant network, and we look forward to addressing the health challenges facing Europe through synergistic and collaborative working with our EIT Health peers.âJan-Philipp Beck, CEO of EIT Health, said. ÂWe look forward to fruitful collaborations that can improve the lives of patients and citizens across Europe.â.

The government-backed Digital how to get zithromax over the counter Health Cooperative Research Centre has launched a A$1 million (above $700,000) research project that intends to empower accurate prescription of medications for patients dealing with kidney failure.WHAT IT'S ABOUTThe research institute, in tandem with the Northern Territory Health and the University of South Australia, will develop this clinical decision support tool for healthcare professionals that will be delivered as a standalone service via an application program interface, making it easy to integrate with existing prescribing or dispensing software systems.After analysing the context http://nms.langschlag.at/begegnungszonen/ of medicine prescription and dispensing in the first research phase, they will create a renal dosage calculator algorithm based on NT Health's clinical data sets and other available medicine knowledge databases. In the second phase, they will simulate the impact of the tool in the urban and rural primacy clinics how to get zithromax over the counter in NT and South Australia. The final research phase involves a clinical pilot in NT's urban and remote primary health care centres and community pharmacy settings. WHY IT MATTERSInaccurate medicine selection and dosing for people with impaired kidneys is a "common and preventable issue," according to the UniSA research team how to get zithromax over the counter. They noted that about a quarter of patients receive "inappropriate" medications, which in turn contribute to up to a tenth of adverse reactions that could lead to hospital admissions."A digital solution targeting this problem has the potential to prevent 25,000 medication-related admissions annually," said Libby Roughead, a professor at UniSA who also leads the university's research team.

Moreover, medication-related problems account for over 250,000 yearly hospital admissions, costing A$1.4 billion ($1 billion) each year, noted Dr Terry Sweeney, CEO of DHCRC.About 700,000 Australians over the age of 65 with renal function problems, as well as Aboriginal and Torres Strait Islander peoples, are targeted beneficiaries of the project, according to the how to get zithromax over the counter DHCRC. It was mentioned that seven in 10 hospitalisations from chronic kidney disease occur among senior Australians while one in five indigenous Australians has shown signs of the disease.The research project, said Bhavini Patel, executive director of Medicines Management at NT Health, will "ensure safer prescribing and dispensing of medications for people living with kidney disease and reduce the risk of medication associated renal problems".THE LARGER TRENDLast month, the DHCRC set up a $2.1 million research project that will improve clinical decision support tools across regional and metropolitan hospitals settings in the country. The three-year project how to get zithromax over the counter aims to enhance the fit between decision support technologies and their users. To achieve this, it will make use of Alcidion's Miya Precision system to point out priority areas where decision support tools will add value. In September, the research firm also launched a how to get zithromax over the counter project, together with UniSA and SA Health, to create a digital analytics tool that predicts the risk of adverse events in hospitals.

It was said that the tool will be used to develop a visual programme that will provide clinicians and administrators with real-time insights describing a hospital's risk exposure. The project ultimately intends to resolve patient safety issues, such as ramping, suicide prevention, medication and how to get zithromax over the counter falls incidents.The U.S. Cybersecurity and Infrastructure Security Agency and the Federal Bureau of Investigation issued a reminder this week to critical infrastructure partners that bad actors are unlikely to take a break for the holiday season. Although how to get zithromax over the counter neither CISA nor FBI have identified specific threats looming, they noted that previous incidents over U.S. Holidays have set a concerning precedent.

"Recent history tells us that this could be a time when these persistent cyber actors halfway across the how to get zithromax over the counter world are looking for ways â big and small â to disrupt the critical networks and systems belonging to organizations, businesses and critical infrastructure," said the agencies in a joint bulletin. WHY IT MATTERS As CISA and the FBI pointed out, holidays such as Thanksgiving often mean offices are closed, and security professionals may be less attentive. Still, they said, how to get zithromax over the counter organizations can take several actions to try and proactively protect against cyberattacks. They recommended that all entities, especially critical infrastructure partners, to implement best practices, including. Identifying IT security employees for weekends and holidays who would be available to surge during these times in the event of an incident Implementing multi-factor authentication for remote access and administrative accounts Mandating how to get zithromax over the counter strong passwords and ensuring they are not reused across multiple accountsEnsuring remote desktop protocol is secure and monitoredReminding employees not to click on suspicious links, and conducting exercises to raise awareness The agencies also urged organizations to stay vigilant against known cybercrime techniques, such as phishing scams, fraudulent sites spoofing reputable businesses and unencrypted financial transactions.

"Finally â to reduce the risk of severe business/functional degradation should your organization fall victim to a ransomware attack â review and, if needed, update your incident response and communication plans," said the agencies, directing organizations to ransomware awareness resources regarding holidays and weekends. "These plans should list actions to take â and contacts to reach out to â should your organization be impacted by a ransomware incident." THE LARGER TRENDThis isn't the first time CISA and the FBI have issued a holiday how to get zithromax over the counter ransomware warning. Before Labor Day weekend, the agencies raised similar concerns, pointing to attacks on critical infrastructure on Mother's Day, Memorial Day and Independence Day. It also seems, however, that hackers need no special occasion to cause a how to get zithromax over the counter ruckus. This year has seen a rise in cyber attacks and data breaches in the healthcare sector, with more than 40 million patient records compromised by incidents reported to the federal government in 2021.

ON THE RECORD "As Americans prepare to hit the highways and airports this Thanksgiving holiday, CISA and the FBI are reminding critical how to get zithromax over the counter infrastructure partners that malicious cyber actors arenât making the same holiday plans as you," said the agencies in the bulletin. Kat Jercich is senior editor of Healthcare IT News.Twitter. @kjercichEmail. [email protected] IT News is a HIMSS Media publication.Apple announced this week that it was suing NSO Group, an Israeli surveillance technology company, in federal court for allegedly accessing users' devices without authorization. In addition to damages, the tech giant is seeking to block NSO Group from accessing or using any Apple products, or developing spyware that could be used on Apple products in the future.

"Pedophiles and terrorists can freely operate in technological safe-havens, and we provide governments the lawful tools to fight it. NSO Group will continue to advocate for the truth." WHY IT MATTERS NSO Group says its surveillance technology is used by government intelligence and law enforcement agencies to track criminals. But as Apple outlines in its complaint, the company's spyware has reportedly been used against journalists, human rights activists, dissidents, public officials and others.This month, the U.S. Department of Commerce included the NSO Group in its Entity List for "engaging in activities that are contrary to the national security or foreign policy interests of the United States." Specifically, the agency said that NSO Group had enabled foreign governments, via its spyware, to "maliciously target" individuals such as embassy workers and academics and to "conduct transnational repression." In its complaint, Apple zeroed in on "FORCEDENTRY," an exploit for a vulnerability used to break into a victim's device and install NSO Group's Pegasus spyware product. The company accused attackers of creating Apple IDs to send malicious data to a victim's device, which then allowed NSO Group or its clients to surreptitiously deliver Pegasus.

"On information and belief, Defendants provide consulting and expert services to their clients, assist them with their deployment and use of Pegasus, and participate in their attacks on Apple devices, servers and users," according to the complaint. Although Apple has not observed any evidence of successful remote attacks against devices running iOS 15 or later, it said that each attack carries substantial costs for the company, including the necessity to redirect resources. "In the meantime, on information and belief, Defendants continue with their pernicious efforts to target and harm Apple and its customers by infecting, exploiting, and misusing Apple devices and software," said the complaint. The company also announced that it would be contributing any damages from the lawsuit, plus an extra $10 million, to organizations pursuing cybersurveillance research and advocacy. "At Apple, we are always working to defend our users against even the most complex cyberattacks," said Ivan KrstiÄ, head of Apple Security Engineering and Architecture, in a statement.

Government has raised the alarm about these developments, most recently regarding an Iran-sponsored hacker group targeting healthcare.ON THE RECORD "Our threat intelligence and engineering teams work around the clock to analyze new threats, rapidly patch vulnerabilities, and develop industry-leading new protections in our software and silicon," said Apple's KrstiÄ in a statement."Apple runs one of the most sophisticated security engineering operations in the world, and we will continue to work tirelessly to protect our users from abusive state-sponsored actors like NSO Group," he said. Kat Jercich is senior editor of Healthcare IT News.Twitter. @kjercichEmail. [email protected] IT News is a HIMSS Media publication.The six partners of EIT Health met earlier this month in Vienna, ahead of the planned launch of Austriaâs new EIT Health Regional Innovation Hub in early 2022.They discussed how the hub is going to operate across Austria and how it is going to be linked into the European network of EIT Health.WHATâS THE IMPACTThe six partners who will jointly establish the regional EIT Health network in Austria are:The Austrian Institute of Technology (AIT)Boehringer Ingelheim RCVThe startup SanusX of the UNIQA insurance groupKapsch BusinessComthe Wild Groupand the Viennese startup service INiTS.From January 2022, the new hub based in Vienna, together with other network partners, aims to drive forward innovative digital health products and solutions while also supporting startups and small and medium-sized enterprises (SMEs).The EIT Health Regional Innovation Hub is funded by the Austrian Federal Ministry of Digital Affairs and Economy, the Federal Ministry of Social Affairs, Health, Care and Consumer Protection, the Vienna Chamber of Commerce as well as Wirtschaftsagentur Wien.THE LARGER TRENDWith the new Austrian hub, EIT Health intends to capitalise on the opportunities of the region and to strengthen its multidisciplinary network.The European Institute of Innovation and Technology (EIT) is an independent EU Body that seeks to innovate European sectors by promoting and supporting ideas and entrepreneurial spirit around technology. EIT Health is the designated body for healthcare to this end.In February 2021, EIT Health funded two startups from Germany and Spain with â¬1.5 million for a period of two years as part of the Wild Card innovation programme.In December 2020, EIT Health launched the Catapult Competition and funded nine winning startups from the digital health, biotech and medtech sectors with a total of â¬1 million.ON THE RECORDDirk Holste, Research Manager and Deputy Head of the AIT Center for Health &.

Bioresources and Coordinator of EIT Health Austria, commented. ÂWe are excited to be in our new premises today and conduct the first official partner meeting for the new EIT Health Regional Innovation Hub.âHe continued. ÂAustria has many healthcare innovation strengths including a well-developed healthcare system with widely accepted and implemented electronic health record (ELGA).âThe newly created EIT Health Austria will integrate well into the already vast and vibrant network, and we look forward to addressing the health challenges facing Europe through synergistic and collaborative working with our EIT Health peers.âJan-Philipp Beck, CEO of EIT Health, said. ÂWe look forward to fruitful collaborations that can improve the lives of patients and citizens across Europe.â.

Zithromax for eye

Letters to zithromax for eye the Editor is a periodic feature http://photobycox.com/where-can-you-buy-levitra-over-the-counter/. We welcome all comments and will publish a selection. We edit zithromax for eye for length and clarity and require full names. A Concerned Taxpayer Takes Stock of treatment Efforts Your recent article âNovavaxâs Effort to Vaccinate the World, From Zero to Not Quite Warp Speedâ (July 19) seems to reveal Maryland-based Novavax as a corporation that is misusing a vast amount of taxpayersâ money so its CEO (and other officers) can make a killing selling stocks. Novavax has contracted with many foreign countries (Spain, India and Japan, etc.) to produce treatments (or components) meant to treat world populations in need of a means to arrest the widespread scourge of buy antibiotics.

Your article mentions zithromax for eye how little yield of product has followed, given the financial investments made. I find it particularly disturbing that some of Novavaxâs corporate officers are benefiting by selling large blocks of stocks. In fact, I find it to be unconscionable, given the many who have died for lack of a remedy that has gone unfulfilled and, in this case, an initiative thatâs overfunded. I wish you would transmit your article to each and every zithromax for eye member of Congress, in the hope that those who can will investigate how the funds doled out in the name of âOperation Warp Speedâ are being misused, and unaccounted for. Â Carl Anderson, Baltimore Novavax is a great treatment, but this article shows how hard it is for a company to become a mass-treatment producer starting from a base of zero.

Https://t.co/5tKrLPY0lUâ Dr Helen MacLean (@DrHMacLean) July 19, 2021 â Dr. Helen MacLean, Melbourne, Australia Waiting in zithromax for eye Vain for a Novavax treatment?. Thank you for the article on Novavax (âNovavaxâs Effort to Vaccinate the World, From Zero to Not Quite Warp Speed,â July 19). I have been searching the web regularly to find new information on this treatment and when it might become available. Most days I zithromax for eye come up with nothing new.

Your article was thorough and informative and, although I do take exception to your statement that âAmerica is awash with treatment options,â the information provided was very enlightening. Many people are wary of the mRNA treatment technology, and Johnson &. Johnson hasnât zithromax for eye turned out to be an optimal choice, due to side effects (albeit rare) and lower efficacy. My own humble opinion is that Novavax could be of significant interest to unvaccinated Americans, depending on how the accompanying narrative is presented (e.g., tried-and-true traditional technology). Now that we have a rising surge once again in buy antibiotics, it seems like an optimal time to introduce another treatment option for Americans, but based on your excellent reporting, it sounds like it may not be Novavax.

Â Holly King, Indianapolis I would say this is to deter people from zithromax for eye going to the ER for any kind of pain. I will never go to one again. I will not pay someone to be cruel to me. I can suffer better at home than in a cold, cruel ER.â Kat Melcherð (@KatMelcher) June 29, 2021 â Kat Melcher, San Antonio A World of Difference Your most recent Bill of the Month story (âA Hospital Charged $722.50 to zithromax for eye Push Medicine Through an IV. Twice,â June 28) got me thinking about when I had to go to the hospital for almost the exact same thing.

Similar to Claire Lang-Ree, I was a college student and found myself doubled over due to sudden and exceptionally severe pain in the lower right side of my abdomen. I passed zithromax for eye out from the pain, and every time I regained consciousness, I couldnât speak and would just throw up from hurting so bad. My mom called an ambulance, and I was rushed to the hospital. While at the ER, I received an abdominal uasound, but the tech couldnât find my appendix (which is apparently normal and just happens sometimes), so they ordered an abdominal CT. The CT came back normal and ruled out appendicitis, so zithromax for eye they decided to keep me overnight for observation.

At that point, my doctors began to think the issue was gynecological. I did OK overnight, and my doctors had deduced it was likely an ovarian cyst rupture that caused the pain. My blood work was normal the next morning, so my doctors allowed me zithromax for eye to be discharged. The total cost?. Less than $500 before insurance.

The major difference between my and Claireâs zithromax for eye experiences was that I was on vacation in Budapest, Hungary, when this happened. Hungary has a public health care system. My private health insurance even ended up reimbursing us for the cost since it covered emergency visits overseas. While Hungaryâs public health care system also has its problems, excessive cost to patients isnât one zithromax for eye of them. I canât imagine having gone through that and then being slapped with a five-figure medical bill.

Sudden and severe medical emergencies are scary enough. The threat of going bankrupt for seeking treatment for them just puts salt in the wound zithromax for eye . It doesnât have to be like this. Iâm glad youâre teaching Americans how to advocate for themselves against illogical and/or erroneous billing. Keep up the good work zithromax for eye .

Â Erin Bartels, Little Rock, Arkansas â Jane Aldridge, Dallas Whereâs the âFunâ in That?. Iâm a retired federal employee with GEHA (Aetna) insurance zithromax for eye . I think the tone of your recent article about overcharging in the emergency room system at Penrose Hospital in Colorado Springs (âA Hospital Charged $722.50 to Push Medicine Through an IV. Twice.â June 28) was downright offensive. ÂFinally, make zithromax for eye it fun.

Claire and Jen made bill-fighting their mother-daughter hobby for the winter. They recommend pretzel chips and cocktails to boost the mood.â Fun?. Really? zithromax for eye . !. Trying to get justice from our broken health care system, with Big Pharma and big hospital systems raking in money while ordinary people have no recourse on outrageous bills is fun?.

!. Shame on you. Â Dr. Evelyn Hutt, Denver "Finally, make it fun. Claire and Jen made bill-fighting their mother-daughter hobby for the winter."The problem is, when you or a family member is sick, it's often difficult to impossible to find the time or energy for bill-fighting, let alone a hobby.

Https://t.co/eBgTD1lHcXâ Dania Palanker (@DaniaPal) June 28, 2021 â Dania Palanker, Washington, D.C. Iâm surprised thereâs no mention of rules based triage. At UW I know that, regardless of overt symptoms, people who are involved in a car accident >. A certain speed are automatically traumaâd. Even if they walk in to the hospital after the wreck.â Joe Lalli (@JollyJoeLalli) July 16, 2021 â Joe Lalli, Madison, Wisconsin When I was working at a hospital, we pushed strongly for a statewide "Trauma Board" to help manage the proliferation and management of trauma-related services.

Why?. More trauma centers = more expense, worse outcomes.And now. Https://t.co/N5S6Ht3rqCâ Loren Anthes (@lorenanthes) July 19, 2021 â Loren Anthes, Cleveland Another insurance company/hospital billing nightmare to be aware of. Think the worthwhile care trauma centers deliver is only possible in a US-style model where bad billing behavior is incentivized?. Not so.

The UK NHS has 27 and patients donât pay extra. Https://t.co/i6TiXweyh3â David Meuse (@JdmMeuse) July 16, 2021 â Democratic state Rep. David Meuse, Portsmouth, New Hampshire Follow the Montana Money Trail I just read the article by Andrea Halland regarding the new private medical colleges proposed in Montana (âInflux of Medical School Students Could Overwhelm Montana Resources, Program Leaders Warn,â July 15). The article was very informative except for one glaring omission. How much?.

When one of our local hospitals stepped out in an uncharacteristic way against the private new facility, my first reaction was âOMG, there must be a lot of money at stake here.â Follow the money trail, and yet Ms. Halland didnât. There is no problem confronting the training of more physicians that the private market wouldnât correct, if it is allowed to work. We face the shortages and problems we do now because there has not been a free market in medicine in a very long time. In fact, one could make the same claim about our public education system, which functions with the same kind of authoritative mindset.

Step back and get out of the way and watch great things happen if improvements are truly what are sought â¦ but if everyone is just stuffing their pockets and asserting political power, it would be great if those reporting on it would at least be honest about it. Â Evelyn Pyburn, Billings, Montana A valuable opportunity to care for the people of Montana close to home.â Amir Bastawrous, MD, MBA (@amirbastawrous) July 15, 2021 â Dr. Amir Bastawrous, Seattle A Long Shot on Long-Haulers I read the article âLittle-Known Illnesses Turning Up in buy antibiotics Long-Haulersâ (June 1) by Cindy Loose and noticed the mention of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Based on my reading, I think itâs plausible that the long-haulersâ problems are caused by the immune system in this way. Impurities in previous treatments allow retrozithromaxes to enter immune cells and stay in the DNA.

When the immune system is triggered, these retrozithromaxes may be released and do damage. Dr. Judy Mikovits in her books âPlagueâ and âPlague of Corruptionâ discusses this. For example, retrozithromax XMRV causes ME/CFS. Younger people are more susceptible because they have had more treatments.

I am not a medical doctor, but I read a lot. Â Art Gittleman, Huntington Beach, California Patients have different worldviews and very simply put believe they find help either from medical system ie doctors, science, alternative therapies or in belief of illness as means for growth. When docs and patients have different worldviews problems begin.â Tuula Saarela (@ba_tuulasaarela) June 2, 2021 â Tuula Saarela, Helsinki Connecting the Dots on POTS I read the article on the side effects that show up months after a buy antibiotics diagnosis (âLittle-Known Illnesses Turning Up in buy antibiotics Long-Haulers,â June 1). This struck a chord with me because my husband has been dealing with some strange issues for the past several months that we have just now started to determine may be postural orthostatic tachycardia syndrome (POTS), which was discussed in the article. He was seriously ill two months before buy antibiotics made its appearance in the U.S.

And went to the doctor several times. The doctor repeatedly tested him for the flu. The results were always negative and they would send him back home with instructions to rest and drink fluids and let it run its course. We believe he had a case of buy antibiotics and it wasnât known yet. He has had several new health issues come up in the year since â the most serious being a paralyzed diaphragm on one side.

Now we are dealing with a possible POTS diagnosis. I hope more doctors see what is happening and start making more of a connection between the two. We live in Kentucky and know how few specialists there are who treat POTS but are hopeful that a diagnosis and treatment will not be far off. Â Melanie Marville, Louisville â Sabine Dreher, Toronto On Opioid Addiction. A Success StoryEven as many roadblocks and red tape are being removed so that more physicians can qualify to prescribe buprenorphine, I read this sad story of this young man needlessly dying of an overdose (âHow ERs Fail Patients With Addiction.

One Patientâs Tragic Death,â July 15). He clearly was not given urgent access to recovery that included the immediate administration of buprenorphine or he would still be here today â and his parents would not have this permanent hole in their lives. Buprenorphine is that magical a drug, but itâs frustrating it remains somewhat difficult to acquire through a physician and/or pharmacy.During the 1990s until 2004, my once-disciplined self changed to acting unstable and erratic at work, my marriage failed, and I periodically acted out irresponsibly â all due to the misuse of prescription pain pills. Having had rheumatoid arthritis (RA) since age 7 (in my 50s now), I had managed my pain well with over-the-counter pain medicines. (Briefly, Iâm a white middle-class college-grad male, now on disability due to the unpredictability and ravages of the disease of RA.) However, for almost a decade and a half beginning in the early 1990s, my rheumatologists and pain management doctors routinely bombarded me with OxyContin, oxycodone, Vicoprofen, Norco and other narcotic opioid pain medicines.

The number of narcotic pain pills I was prescribed to take daily was staggering. I quickly became addicted.Upon recognizing my problem and after several unsuccessful attempts through Narcotics Anonymous and going cold turkey, I sought out an inpatient detox facility in the winter of 2003-04 at the urging of friends and family. I checked into the same facility twice within a few months for opioid recovery. At this time, it was early in opioid addiction recovery in medical settings. Likewise, the physicians assigned to my group actually gave me Uam (generic tramadol) for my RA pain, now a known opioid!.

No surprise that my attempts of recovery at the detox facility failed to keep me from abusing pain meds upon returning home â¦ until, in 2004, an RN with my employerâs health insurance passionately recommended I see a doctor in my city who was one of only a few addiction treatment physicians nationwide allowed to prescribe a then-new drug for opioid addiction treatment. Subutex (generic buprenorphine).Buprenorphine eliminates opioid cravings with no withdrawal side effects associated with the cessation of narcotic pain pills â¦ all with none of the addictive euphoric effects synonymous with narcotic opioids. Within a matter of minutes of taking my first dose, I woke up from my 15-year slumber of addiction. Quite simply, buprenorphine is an immediate on-ramp to sobriety for opioid addicts with the desire to quit. Iâve been on a daily dose to this day and, although my RA is trying to take me out (Iâve since had both shoulders and both hips replaced and both wrists reconstructed), I live a normal, clear-headed healthy life with my wife while being in the best shape of my life.

Following surgeries with prescribed pain meds for the brief recovery process, I easily remained clean and sober with most of the pain pills left unused and properly disposed. (A side benefit of buprenorphine is that it was originally meant to fight pain, so the benefits for me are twofold.)Every ER should give buprenorphine to all opioid abusers while occupying their beds. It works within minutes once the patient is in partial withdrawal. Then the ER sends the patient directly to a doctor to treat their addiction. Buprenorphine saves lives.

It saved mine.â William Ward, Enid, Oklahoma Agree. "How ERs fail" = "How medicine fails" = "How society fails"This poor young man died 3 months after an ER visit.https://t.co/be3M61pfnAâ ðð¿ð®ðµð®ðº ðªð®ð¹ð¸ð²ð¿, ð ð (@grahamwalker) July 18, 2021 â Dr. Graham Walker, San Francisco Related Topics Contact Us Submit a Story TipDo you sometimes lose your train of thought or feel a bit more anxious than is typical for you?. Those are two of the six questions in a quiz on a website co-sponsored by the makers of Aduhelm, a controversial new Alzheimerâs drug. But even when all responses to the frequency of those experiences are ânever,â the quiz issues a âtalk to your doctorâ recommendation about the potential need for additional cognitive testing.

Facing a host of challenges, Aduhelmâs makers Biogen and its partner Eisai are taking a page right out of a classic marketing playbook. Run an educational campaign directed at the consumer, one who is already worried about whether those lost keys or a hard-to-recall name is a sign of something grave. The campaign â which also includes a detailed advertisement on The New York Timesâ website, a Facebook page and partnerships aimed at increasing the number of places where consumers can get cognitive testing â is drawing fire from critics. They say it uses misleading information to tout a drug whose effectiveness is widely questioned. ÂItâs particularly egregious because they are trying to convince people with either normal memories or normal age-related decline that they are ill and they need a drug,â said Dr.

Adriane Fugh-Berman, a pharmacology professor at Georgetown University Medical Center, who wrote about the website in an opinion piece. The websiteâs âsymptoms quizâ asks about several common concerns, such as how often a person feels depressed, struggles to come up with a word, asks the same questions over and over, or gets lost. Readers can answer ânever,â âalmost never,â âfairly oftenâ or âoften.â No matter the answers, however, it directs quiz takers to talk with their doctors about their concerns and whether additional testing is needed. EMAIL SIGN-Up Subscribe to California Healthline's free Daily Edition. While some of those concerns can be symptoms of dementia or cognitive impairment, âthis clearly does overly medicalize very common events that most adults experience in the course of daily life. Who hasnât lost oneâs train of thought or the thread of a conversation, book or movie?.

Who hasnât had trouble finding the right word for something?. Â said Dr. Jerry Avorn, a professor of medicine at Harvard Medical School who has been sharply critical of the approval. Aduhelm was approved in June by the Food and Drug Administration, but that came after an FDA advisory panel recommended against it, citing a lack of definitive evidence that it works to slow the progression of the disease. The FDA, however, granted what is called âaccelerated approval,â based on the drugâs ability to reduce a type of amyloid plaque in the brain.

That plaque has been associated with Alzheimerâs patients, but its role in the disease is still being studied. News reports also have raised questions about FDA officialsâ efforts to help Biogen get Aduhelm approved. And consumer advocates have decried the $56,000-a-year price tag that Biogen has set for the drug. On the day it was approved, Patrizia Cavazzoni, the FDAâs director of the Center for Drug Evaluation and Research, said the trial results showed it substantially reduced amyloid plaques and âis reasonably likely to result in clinical benefit.â Describing the website as part of a âdisease awareness educational program,â Biogen spokesperson Allison Parks said in an email that it is aimed at âcognitive health and the importance of early detection.â She noted that the campaign does not mention the drug by name. Earlier Thursday, in âan open letter to the Alzheimerâs disease community,â Biogenâs head of research, Dr.

Alfred Sandrock, noted the drug is the first one approved for the condition since 2003 and said it has been the subject of âextensive misinformation and misunderstanding.â Sandrock stressed a need to offer it quickly to those who have only just begun to experience symptoms so they can be treated before the disease moves âbeyond the stages at which Aduhelm should be initiated.â While the drug has critics, it is also welcomed by some patients, who see it as a glimmer of hope. The Alzheimerâs Association pushed for the approval so that patients would have a new option for treatment, although the group has objected to Biogenâs pricing and the fact that it has nine years to submit follow-up effectiveness studies. ÂWe applaud the FDAâs decision,â said Maria Carrillo, chief science officer for the association. ÂThereâs a benefit to having access to it nowâ because it is aimed at those in the early stages of dementia. Those patients want even a modest slowdown in disease progression so they have more time to do the things they want to accomplish, she said.

The drug is given by infusion every four weeks. It also requires expensive associated care. About 40% of the patients in the trials experienced brain swelling or bleeds, so regular brain imaging scans are also required, according to clinical trial results and the drugâs label. In addition, patients will likely need to be checked for amyloid protein, which is done with expensive PET scans or invasive spinal taps, according to Alzheimerâs experts. To educate more potential patients, and customers, Biogen announced it has teamed with CVS to offer cognitive testing, and with free clinics for dementia education efforts.

Biogen is also picking up some of the laboratory costs for patients who get a spinal tap. Still, the drug faces headwinds. Thereâs a congressional probe of the drugâs approval, the head of the FDA has called for an independent investigation of its review process, and thereâs pushback from policy experts and insurers over its price, which they say could seriously strain Medicareâs finances. Some medical systems, including the Cleveland Clinic and Mount Sinai, say they wonât administer it, citing efficacy and safety data. None of that is mentioned in Biogenâs campaign.

Instead, the advertisements and websites focus on what is called mild cognitive impairment, including a warning that 1 in 12 people over age 50 have that condition, which it describes as the earliest clinical stage of Alzheimerâs. On its website, Biogen doesnât cite where that statistic comes from. When asked for the source, Parks said Biogenâs researchers made some mathematical calculations based on U.S. Population data and data from a January 2018 article in the journal Neurology. Some experts say that percentage seems high, particularly on the younger end of that spectrum.

ÂI canât find any evidence to support the claim that 1 in 12 Americans over age 50 have MCI due to Alzheimerâs disease. I do not believe it is accurate,â said Dr. Matthew S. Schrag, a vascular neurologist and assistant professor of neurology at Vanderbilt University Medical Center in Nashville, Tennessee. While some people who have mild cognitive impairment progress to Alzheimerâs â about 20% over three years â most do not, said Schrag.

ÂItâs important to tell patients that a diagnosis of MCI is not the same as a diagnosis of Alzheimerâs.â Mild cognitive impairment is tricky to diagnoseâ and not something a simple six-question quiz can uncover, said Mary Sano, director of the Alzheimerâs Disease Research Center at the Icahn School of Medicine at Mount Sinai in New York. ÂThe first thing to determine is whether itâs a new memory problem or a long-standing poor memory,â said Sano, who said a physician visit can help patients suss this out. ÂIs it due to some other medical condition or a lifestyle change?. Â Carrillo, at the Alzheimerâs Association, agreed that MCI can have many causes, including poor sleep, depression or taking certain prescription medications. Based on a review of medical literature, her organization estimates that about 8% of people over age 65 have mild cognitive impairment due to the disease.

She declined to comment on the Biogen campaign but did say that early detection of Alzheimerâs is important and that patients should seek out their physicians if they have concerns, and not rely on âa take-at-home quiz.â Schrag, however, minced no words in his opinion of the campaign, saying it âfeels like an agenda to expand the diagnosis of cognitive impairment in patients because that is the group they are marketing to.â This story was produced by KHN (Kaiser Health News), a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation. Julie Appleby. [email protected], @julie_appleby Related Topics Contact Us Submit a Story Tip.

Letters to the how to get zithromax over the counter Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for how to get zithromax over the counter length and clarity and require full names.

A Concerned Taxpayer Takes Stock of treatment Efforts Your recent article âNovavaxâs Effort to Vaccinate the World, From Zero to Not Quite Warp Speedâ (July 19) seems to reveal Maryland-based Novavax as a corporation that is misusing a vast amount of taxpayersâ money so its CEO (and other officers) can make a killing selling stocks. Novavax has contracted with many foreign countries (Spain, India and Japan, etc.) to produce treatments (or components) meant to treat world populations in need of a means to arrest the widespread scourge of buy antibiotics. Your article mentions how little yield of product has followed, how to get zithromax over the counter given the financial investments made.

I find it particularly disturbing that some of Novavaxâs corporate officers are benefiting by selling large blocks of stocks. In fact, I find it to be unconscionable, given the many who have died for lack of a remedy that has gone unfulfilled and, in this case, an initiative thatâs overfunded. I wish you would transmit your article to each and every member of Congress, in the hope how to get zithromax over the counter that those who can will investigate how the funds doled out in the name of âOperation Warp Speedâ are being misused, and unaccounted for.

Â Carl Anderson, Baltimore Novavax is a great treatment, but this article shows how hard it is for a company to become a mass-treatment producer starting from a base of zero. Https://t.co/5tKrLPY0lUâ Dr Helen MacLean (@DrHMacLean) July 19, 2021 â Dr. Helen MacLean, Melbourne, Australia Waiting in how to get zithromax over the counter Vain for a Novavax treatment?.

Thank you for the article on Novavax (âNovavaxâs Effort to Vaccinate the World, From Zero to Not Quite Warp Speed,â July 19). I have been searching the web regularly to find new information on this treatment and when it might become available. Most days I come up with how to get zithromax over the counter nothing new.

My own humble opinion is that Novavax could be of significant interest to unvaccinated Americans, depending on how the accompanying narrative is presented (e.g., tried-and-true traditional technology). Now that we have a rising surge once again in buy antibiotics, it seems like an optimal time to introduce another treatment option for Americans, but based on your excellent reporting, it sounds like it may not be Novavax. Â Holly how to get zithromax over the counter King, Indianapolis I would say this is to deter people from going to the ER for any kind of pain.

I will never go to one again. I will not pay someone to be cruel to me. I can suffer better at home than in a cold, cruel ER.â Kat Melcherð (@KatMelcher) June 29, 2021 â Kat Melcher, how to get zithromax over the counter San Antonio A World of Difference Your most recent Bill of the Month story (âA Hospital Charged $722.50 to Push Medicine Through an IV.

Twice,â June 28) got me thinking about when I had to go to the hospital for almost the exact same thing. Similar to Claire Lang-Ree, I was a college student and found myself doubled over due to sudden and exceptionally severe pain in the lower right side of my abdomen. I passed how to get zithromax over the counter out from the pain, and every time I regained consciousness, I couldnât speak and would just throw up from hurting so bad.

My mom called an ambulance, and I was rushed to the hospital. While at the ER, I received an abdominal uasound, but the tech couldnât find my appendix (which is apparently normal and just happens sometimes), so they ordered an abdominal CT. The CT came back normal and ruled out appendicitis, so they decided to keep me overnight for observation how to get zithromax over the counter.

At that point, my doctors began to think the issue was gynecological. I did OK overnight, and my doctors had deduced it was likely an ovarian cyst rupture that caused the pain. My blood how to get zithromax over the counter work was normal the next morning, so my doctors allowed me to be discharged.

The total cost?. Less than $500 before insurance. The major difference between my and Claireâs experiences was that I was on vacation how to get zithromax over the counter in Budapest, Hungary, when this happened.

Hungary has a public health care system. My private health insurance even ended up reimbursing us for the cost since it covered emergency visits overseas. While Hungaryâs public health care system also has its problems, excessive cost to patients isnât one of them how to get zithromax over the counter.

I canât imagine having gone through that and then being slapped with a five-figure medical bill. Sudden and severe medical emergencies are scary enough. The threat of going bankrupt for seeking treatment for how to get zithromax over the counter them just puts salt in the wound.

It doesnât have to be like this. Iâm glad youâre teaching Americans how to advocate for themselves against illogical and/or erroneous billing. Keep up how to get zithromax over the counter the good work.

Â Erin Bartels, Little Rock, Arkansas â Jane Aldridge, Dallas Whereâs the âFunâ in That?. Iâm how to get zithromax over the counter a retired federal employee with GEHA (Aetna) insurance. I think the tone of your recent article about overcharging in the emergency room system at Penrose Hospital in Colorado Springs (âA Hospital Charged $722.50 to Push Medicine Through an IV.

Twice.â June 28) was downright offensive. ÂFinally, make it fun how to get zithromax over the counter. Claire and Jen made bill-fighting their mother-daughter hobby for the winter.

They recommend pretzel chips and cocktails to boost the mood.â Fun?. Really? how to get zithromax over the counter. !.

Trying to get justice from our broken health care system, with Big Pharma and big hospital systems raking in money while ordinary people have no recourse on outrageous bills is fun?. !. Shame on you.

Â Dr. Evelyn Hutt, Denver "Finally, make it fun. Claire and Jen made bill-fighting their mother-daughter hobby for the winter."The problem is, when you or a family member is sick, it's often difficult to impossible to find the time or energy for bill-fighting, let alone a hobby.

A certain speed are automatically traumaâd. Even if they walk in to the hospital after the wreck.â Joe Lalli (@JollyJoeLalli) July 16, 2021 â Joe Lalli, Madison, Wisconsin When I was working at a hospital, we pushed strongly for a statewide "Trauma Board" to help manage the proliferation and management of trauma-related services. Why?.

More trauma centers = more expense, worse outcomes.And now. Https://t.co/N5S6Ht3rqCâ Loren Anthes (@lorenanthes) July 19, 2021 â Loren Anthes, Cleveland Another insurance company/hospital billing nightmare to be aware of. Think the worthwhile care trauma centers deliver is only possible in a US-style model where bad billing behavior is incentivized?.

Not so. The UK NHS has 27 and patients donât pay extra. Https://t.co/i6TiXweyh3â David Meuse (@JdmMeuse) July 16, 2021 â Democratic state Rep.

David Meuse, Portsmouth, New Hampshire Follow the Montana Money Trail I just read the article by Andrea Halland regarding the new private medical colleges proposed in Montana (âInflux of Medical School Students Could Overwhelm Montana Resources, Program Leaders Warn,â July 15). The article was very informative except for one glaring omission. How much?.

We face the shortages and problems we do now because there has not been a free market in medicine in a very long time. In fact, one could make the same claim about our public education system, which functions with the same kind of authoritative mindset. Step back and get out of the way and watch great things happen if improvements are truly what are sought â¦ but if everyone is just stuffing their pockets and asserting political power, it would be great if those reporting on it would at least be honest about it.

Â Evelyn Pyburn, Billings, Montana A valuable opportunity to care for the people of Montana close to home.â Amir Bastawrous, MD, MBA (@amirbastawrous) July 15, 2021 â Dr. Amir Bastawrous, Seattle A Long Shot on Long-Haulers I read the article âLittle-Known Illnesses Turning Up in buy antibiotics Long-Haulersâ (June 1) by Cindy Loose and noticed the mention of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Based on my reading, I think itâs plausible that the long-haulersâ problems are caused by the immune system in this way.

Impurities in previous treatments allow retrozithromaxes to enter immune cells and stay in the DNA. When the immune system is triggered, these retrozithromaxes may be released and do damage. Dr.

Judy Mikovits in her books âPlagueâ and âPlague of Corruptionâ discusses this. For example, retrozithromax XMRV causes ME/CFS. Younger people are more susceptible because they have had more treatments.

This struck a chord with me because my husband has been dealing with some strange issues for the past several months that we have just now started to determine may be postural orthostatic tachycardia syndrome (POTS), which was discussed in the article. He was seriously ill two months before buy antibiotics made its appearance in the U.S. And went to the doctor several times.

The doctor repeatedly tested him for the flu. The results were always negative and they would send him back home with instructions to rest and drink fluids and let it run its course. We believe he had a case of buy antibiotics and it wasnât known yet.

He has had several new health issues come up in the year since â the most serious being a paralyzed diaphragm on one side. Now we are dealing with a possible POTS diagnosis. I hope more doctors see what is happening and start making more of a connection between the two.

We live in Kentucky and know how few specialists there are who treat POTS but are hopeful that a diagnosis and treatment will not be far off. Â Melanie Marville, Louisville â Sabine Dreher, Toronto On Opioid Addiction. A Success StoryEven as many roadblocks and red tape are being removed so that more physicians can qualify to prescribe buprenorphine, I read this sad story of this young man needlessly dying of an overdose (âHow ERs Fail Patients With Addiction.

Having had rheumatoid arthritis (RA) since age 7 (in my 50s now), I had managed my pain well with over-the-counter pain medicines. (Briefly, Iâm a white middle-class college-grad male, now on disability due to the unpredictability and ravages of the disease of RA.) However, for almost a decade and a half beginning in the early 1990s, my rheumatologists and pain management doctors routinely bombarded me with OxyContin, oxycodone, Vicoprofen, Norco and other narcotic opioid pain medicines. The number of narcotic pain pills I was prescribed to take daily was staggering.

I quickly became addicted.Upon recognizing my problem and after several unsuccessful attempts through Narcotics Anonymous and going cold turkey, I sought out an inpatient detox facility in the winter of 2003-04 at the urging of friends and family. I checked into the same facility twice within a few months for opioid recovery. At this time, it was early in opioid addiction recovery in medical settings.

Likewise, the physicians assigned to my group actually gave me Uam (generic tramadol) for my RA pain, now a known opioid!. No surprise that my attempts of recovery at the detox facility failed to keep me from abusing pain meds upon returning home â¦ until, in 2004, an RN with my employerâs health insurance passionately recommended I see a doctor in my city who was one of only a few addiction treatment physicians nationwide allowed to prescribe a then-new drug for opioid addiction treatment. Subutex (generic buprenorphine).Buprenorphine eliminates opioid cravings with no withdrawal side effects associated with the cessation of narcotic pain pills â¦ all with none of the addictive euphoric effects synonymous with narcotic opioids.

Within a matter of minutes of taking my first dose, I woke up from my 15-year slumber of addiction. Quite simply, buprenorphine is an immediate on-ramp to sobriety for opioid addicts with the desire to quit. Iâve been on a daily dose to this day and, although my RA is trying to take me out (Iâve since had both shoulders and both hips replaced and both wrists reconstructed), I live a normal, clear-headed healthy life with my wife while being in the best shape of my life.

Then the ER sends the patient directly to a doctor to treat their addiction. Buprenorphine saves lives. It saved mine.â William Ward, Enid, Oklahoma Agree.

"How ERs fail" = "How medicine fails" = "How society fails"This poor young man died 3 months after an ER visit.https://t.co/be3M61pfnAâ ðð¿ð®ðµð®ðº ðªð®ð¹ð¸ð²ð¿, ð ð (@grahamwalker) July 18, 2021 â Dr. Graham Walker, San Francisco Related Topics Contact Us Submit a Story TipDo you sometimes lose your train of thought or feel a bit more anxious than is typical for you?. Those are two of the six questions in a quiz on a website co-sponsored by the makers of Aduhelm, a controversial new Alzheimerâs drug.

But even when all responses to the frequency of those experiences are ânever,â the quiz issues a âtalk to your doctorâ recommendation about the potential need for additional cognitive testing. Facing a host of challenges, Aduhelmâs makers Biogen and its partner Eisai are taking a page right out of a classic marketing playbook. Run an educational campaign directed at the consumer, one who is already worried about whether those lost keys or a hard-to-recall name is a sign of something grave.

The campaign â which also includes a detailed advertisement on The New York Timesâ website, a Facebook page and partnerships aimed at increasing the number of places where consumers can get cognitive testing â is drawing fire from critics. They say it uses misleading information to tout a drug whose effectiveness is widely questioned. ÂItâs particularly egregious because they are trying to convince people with either normal memories or normal age-related decline that they are ill and they need a drug,â said Dr.

EMAIL SIGN-Up Subscribe to California Healthline's free Daily Edition. While some of those concerns can be symptoms of dementia or cognitive impairment, âthis clearly does overly medicalize very common events that most adults experience in the course of daily life. Who hasnât lost oneâs train of thought or the thread of a conversation, book or movie?. Who hasnât had trouble finding the right word for something?.

Â said Dr. Jerry Avorn, a professor of medicine at Harvard Medical School who has been sharply critical of the approval. Aduhelm was approved in June by the Food and Drug Administration, but that came after an FDA advisory panel recommended against it, citing a lack of definitive evidence that it works to slow the progression of the disease.

The FDA, however, granted what is called âaccelerated approval,â based on the drugâs ability to reduce a type of amyloid plaque in the brain. That plaque has been associated with Alzheimerâs patients, but its role in the disease is still being studied. News reports also have raised questions about FDA officialsâ efforts to help Biogen get Aduhelm approved.

And consumer advocates have decried the $56,000-a-year price tag that Biogen has set for the drug. On the day it was approved, Patrizia Cavazzoni, the FDAâs director of the Center for Drug Evaluation and Research, said the trial results showed it substantially reduced amyloid plaques and âis reasonably likely to result in clinical benefit.â Describing the website as part of a âdisease awareness educational program,â Biogen spokesperson Allison Parks said in an email that it is aimed at âcognitive health and the importance of early detection.â She noted that the campaign does not mention the drug by name. Earlier Thursday, in âan open letter to the Alzheimerâs disease community,â Biogenâs head of research, Dr.

ÂThereâs a benefit to having access to it nowâ because it is aimed at those in the early stages of dementia. Those patients want even a modest slowdown in disease progression so they have more time to do the things they want to accomplish, she said. The drug is given by infusion every four weeks.

It also requires expensive associated care. About 40% of the patients in the trials experienced brain swelling or bleeds, so regular brain imaging scans are also required, according to clinical trial results and the drugâs label. In addition, patients will likely need to be checked for amyloid protein, which is done with expensive PET scans or invasive spinal taps, according to Alzheimerâs experts.

To educate more potential patients, and customers, Biogen announced it has teamed with CVS to offer cognitive testing, and with free clinics for dementia education efforts. Biogen is also picking up some of the laboratory costs for patients who get a spinal tap. Still, the drug faces headwinds.

Thereâs a congressional probe of the drugâs approval, the head of the FDA has called for an independent investigation of its review process, and thereâs pushback from policy experts and insurers over its price, which they say could seriously strain Medicareâs finances. Some medical systems, including the Cleveland Clinic and Mount Sinai, say they wonât administer it, citing efficacy and safety data. None of that is mentioned in Biogenâs campaign.

Population data and data from a January 2018 article in the journal Neurology. Some experts say that percentage seems high, particularly on the younger end of that spectrum. ÂI canât find any evidence to support the claim that 1 in 12 Americans over age 50 have MCI due to Alzheimerâs disease.

I do not believe it is accurate,â said Dr. Matthew S. Schrag, a vascular neurologist and assistant professor of neurology at Vanderbilt University Medical Center in Nashville, Tennessee.

While some people who have mild cognitive impairment progress to Alzheimerâs â about 20% over three years â most do not, said Schrag. ÂItâs important to tell patients that a diagnosis of MCI is not the same as a diagnosis of Alzheimerâs.â Mild cognitive impairment is tricky to diagnoseâ and not something a simple six-question quiz can uncover, said Mary Sano, director of the Alzheimerâs Disease Research Center at the Icahn School of Medicine at Mount Sinai in New York. ÂThe first thing to determine is whether itâs a new memory problem or a long-standing poor memory,â said Sano, who said a physician visit can help patients suss this out.

ÂIs it due to some other medical condition or a lifestyle change?. Â Carrillo, at the Alzheimerâs Association, agreed that MCI can have many causes, including poor sleep, depression or taking certain prescription medications. Based on a review of medical literature, her organization estimates that about 8% of people over age 65 have mild cognitive impairment due to the disease.

Julie Appleby. [email protected], @julie_appleby Related Topics Contact Us Submit a Story Tip.