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This article contains affiliate links Going Here to products buy flagyl for dogs. Discover may receive a commission for purchases made through these links.Shedding unwanted fat is often easier said than done. Tired of having love handles or belly fat buy flagyl for dogs that just won't go away?.

If you’ve tried diet and exercise and aren’t getting the results you want, you may want to consider adding a supplement to your daily routine. With a high quality fat burner supplement designed for women, you can finally see a positive change on the scale and in the mirror.A quick Google search will show you that there’s buy flagyl for dogs no shortage of fat burner supplements for women. There are hundreds of products to choose from, to include capsules, gummies, and even drops.

So how do buy flagyl for dogs you pick a supplement that will actually give you the results you want?. The fact is that there are tons of worthwhile fat burners out there, but there are also low-grade ones that don’t work and may even be dangerous. To save our readers time and effort, we’ve come up with a list of the top 5 fat burners that all women should try.Whether you want to lose 5lbs or 50lbs, these effective fat burners will move you in the right buy flagyl for dogs direction towards being leaner, fitter, and healthier.Our Top Picks for Fat Burners for Women1.

Elm &. Rye Fat Burner2. Verma Farm’s buy flagyl for dogs Energy CBD Oil3.

Powher Fat Burner4. Trimtone5. NLA for Her Shred Her1.

Elm &. Rye Fat BurnerElm &. Rye Fat Burner is one of the best supplements on the market, especially for women.

If you’re looking for serious weight loss, this is a product worth trying. It works by boosting the metabolism so that your body can burn fat for energy instead of storing it. Elm &.

Rye Fat Burner uses all natural ingredients that have shown to be effective in increasing metabolic rate while also increasing body temperatures. Some of the ingredients may even block the absorption of carbs, which decreases the types of calories that the body can store as fat.This supplement has pages of positive reviews. Most customers say that Fat Burner helps keep them feeling full and satisfied, while also allowing them to look and feel thinner, leaner, healthier, and younger!.

Benefits● Increases energy● Boosts the metabolism● Uses sustainably sourced ingredients● Suppresses the appetite● Tested by a third-party labIngredientsNiacin (Vitamin B3) - Boosts energy levels and may reduce abdominal fat accumulationVitamin B6 (Pyridoxine HCI) - Regulates the production of serotonin and melatonin to boost brain health, immunity, and metabolic processes.Vitamin B12 (as Cyanocobalamin - Alleviates fatigue while improving energy levels. Assists in converting fat into protein to facilitate effective fat burning.Caffeine Anhydrous - Stimulant that improves energy levels and focus. Also triggers thermogenesis.L-Theanine - Increases focus on alertness.

May also increase production of mood-boosting hormones like dopamine and serotonin.Green Coffee Extract - A stimulant that contains caffeine. It keeps energy levels high and improves thermogenesis fat burn.Green Tea Extract - Packed with antioxidants, which improve the body's abilty to burn fat by activating norepinephrine. Also reduces fat storage throughout the body and provides an energy boost.Ashwagandha - Decreases inflammation and helps in burning fat stored throughout the body.

Also helps with managing stress and anxiety that may lead to excessive eating.Rhodiola Extract - Boosts energy levels, reduces mental fatigue and stress, and also helps with more efficient fat burning.Coleus Forskoli - Creates lipase and adenylate cyclase, which promote fat loss without impacting lean muscle mass.Price● $84.99 for 30 day supply2.Verma Farm’s Energy CBD OilLooking for a fat burning supplement that will work with the keto diet?. Verma Farm’s Energy CBD Oil is designed for women on keto. This supplement will give your body the extra push it needs to get into ketosis and to remain there for as long as needed.Verma Farm’s Energy CBD Oil is made with a unique blend of ingredients that promote weight loss and fat burning.

If you're dreaming of a flat tummy, this supplement can help you finally get rid of those stubborn areas of fat that never seem to go away.Price● $109.99 for one month supply3. Powher Fat BurnerIf you're looking for a fat burner supplement that uses natural stimulants, plant extracts, and essential vitamins and minerals to boost weight loss and metabolism, Powher is definitely a top contender.Powher Fat Burner is a unique weight loss supplement that not only uses high quality, all natural ingredients, but it's formulated to offer the best doses of these ingredients to maximize fat loss. This supplement doesn't contain any fad ingredients or pointless compounds that don't contribute to losing weight and boosting the metabolism.Powher also reduces fatigue and tiredness.

We all know how hard it can be to get to the gym or to be physically active. This supplement will keep you energized and well-fueled so that you can stay on track to losing weight and slimming down.Benefits● Boosts metabolism with natural caffeine● Keeps bad cravings at bay● Supports greater weight loss● Specifically formulated for women● Money-back guaranteeIngredientsMagnesium - An essential mineral that makes you feel more energized throughout the day by reducing tiredness and lethargy.Selenium - Plays an important role in normal thyroid function. The thyroid is responsible for hormonal balance and function.Chromium - Essential trace element that improves the body's ability to metabolize calories from fat, carbs, and protein.

Also helps to maintain balanced glucose levels.Iron - Needed to metabolize and regulate energy production. Also boosts immunity.Konjac Root - Known as glucomannan, this is a form of dietary fiber that helps to regulate bowel movement and lower cholesterol and blood glucose levels. Also keeps you feeling fuller for longer, which reduces the risk of overeating.Choline - Nutrient that enables the body to more effectively metabolize lipid fat so that it's burned for energy instead of stored for fat.Natural caffeine - Effective stimulant that increases energy levels and boosts mental focus and concentration.Price● $65 for one bottle● $129 for two bottles● $195 for 3 bottles (+ one free bottle)4.

TrimtoneTrimtone is another fat burner supplement that is uniquely formulated for women. It's marketed towards women who are always on the go, but can be taken by anyone who wants to lose weight. This supplement is best combined with an active lifestyle in order to get the fastest results.Trimtone is made with all natural ingredients that stimulate the metabolism.

By taking one capsule in the morning, your body will naturally and efficiently burn fat all day long. It also uses ingredients that effectively suppress the appetite and speed up thermogenesis.Unlike other supplements, Trimtone offers all the benefits you need in a single capsule. This makes it one of the most convenient fat burners for women.Benefits● All natural ingredients● Small dose (just one capsule)● Boosts the metabolism● Improves fat burnIngredientsCaffeine - Promotes fat burning by increasing thermogenesis and lipolysis.

Also boosts performance and keeps energy levels high.Green Coffee - Contains chlorogenic acid that reduces the amount of fat absorbed by the digestive system. Also lowers insulin levels and boosts metabolism. Offers natural caffeine as well.Green Tea - Offers all sorts of compounds that increase metabolism and hormones that instruct cells to break down fat.

May also decrease the amount of carbohydrates that the body absorbs.Grains of Paradise - Part of the ginger family that revs up brown adipose tissue. This type of fat regulates blood sugar levels and burns more readily and quickly than white fat.Glucomannan - Dietary fiber that expands in the stomach, providing feelings of fullness and satiety that last for hours.Price● $49.95 for one month supply● $99.90 for two months supply (+ free month)● 149.85 for three months supply (+ 2 free months)5. NLA for Her Shred HerWith Shred Her, you can finally say goodbye to stubborn fat.

This fat burner is an ua-potent thermogenic fat burner that is designed for women who are serious about losing weight and burning fat. Shred Her contains an innovative, concentrated blend of ingredients that are effective in breaking down fat and kicking the metabolism into high gear.Shred Her will help you along your journey to not only lose fat, but to tone your body. Proper diet, exercise, and supplementation will give you the abs and skinny waist that you’ve always wanted!.

Stick with your routine, stay consistent, and you’re sure to see results.Benefits● Potent ingredients● Thermogenic● Increases fat burn● Helps to tone the bodyIngredientsRauwolscine - Alpha-receptor antagonist that inhibits the receptors that stop the breakdown of fat. Also burns fat, increases digestion, and promotes lean muscle gain.Caffeine - Decreases muscle fatigue, increases muscle strength, and improves muscle endurance. Also a natural stimulant that promotes focus and healthy energy levels.Dynamine - Alpha-receptor antagonist that blocks the receptors that stop the breakdown of fat.

Also burns fat, increases digestion, and promotes lean muscle gain.Green Tea - Full of antioxidants and caffeine that boosts the body's ability to burn fat. Also reduces the amount of fat stored in the body.Conjugated Linoleic Acid - Type of fat that may reduce body fat levels by reducing food intake, stimulating fat breakdown, increasing fat burning, and inhibiting fat production.Acetyl-L-carnitine - Boosts brain power, improves endurance, decreases muscle soreness, and speeds up red blood cell production by keeping oxygen freely flowing to the muscles and other parts of the body.TeaCrine - Patented ingredient that improves mental focus, increases energy production, and boosts mood and motivation.Raspberry Ketones - Helps the body to break down and burn fat more quickly and efficiently. Also boosts the metabolism.Hordenine HCL - Boosts energy levels and increases focus as well as brain function.Konjac Root - A natural fiber that reduces cravings, suppresses the appetite, and promotes healthy blood sugar levels as well as healthy cholesterol levels.

Bioperine (Black Pepper Extract) - Has antioxidant and anti-inflammatory properties. May also improve blood sugar regulation, cholesterol levels, and brain and gut health.Price● $42.99 for one month supply (one-time purchase)● $34.39 for one month supply (Subscribe &. Save)How Fat Burners WorkFat burners can work in three main ways.

Appetite suppression, boosting the metabolism, and thermogenesis. It’s not uncommon for a fat burner to include ingredients that promote a few of these methods to help users burn fat and reach their weight loss goals. Here’s what you need to know about each of them.Appetite SuppressionWomen typically have strong cravings, especially around that time of the month.

Cravings alone can make it extremely hard for women to not only lose weight, but to keep it off for good. This is why so many fat burner supplements use ingredients that suppress the appetite in order to keep cravings at bay.More often than not, women gain weight because of food cravings. Eating too many calories on a routine basis, especially without proper exercise, will cause you to pack on the pounds.

While your body needs calories to use as energy, excess calories turn into fat and are stored in various areas of the body.Supplements that suppress the appetite can work in many different ways. Some ingredients, like certain types of fiber, take up physical space in the digestive system. This provides a sense of fullness.

Other supplements use ingredients that affect neurotransmitters in order to keep hunger hormones, like ghrelin, in check.Some of the top ingredients that are used for appetite suppression include:● Glucomannan● CBD● 5-HTP● Fenugreek● Green tea extract● Garcinia cambogiaIf you’re interested in finally curbing your cravings in order to decrease your caloric intake, be sure to look for a fat burner that contains at least one of these effective appetite suppressing ingredients.Boosting the MetabolismThe metabolism can be quite a fickle body function. When working in an optimal state, the metabolism turns food into energy that is then used by the body. Supplements that are designed to boost the metabolism cause the body to expel calories instead of storing them as fat.Metabolism boosting fat burners work in many ways.

Some use stimulants, such as caffeine, in order to slightly increase the heart rate, which gets the metabolism revved up and working more efficiently. Other supplements use vitamins and minerals to correct any deficiencies that may be negatively impacting metabolic function.When taking a supplement that’s designed to boost the metabolism, pay close attention to the ingredients. Some women have a low tolerance to stimulants and may experience negative side effects.

If you’ve had a bad experience with caffeine or other stimulants, look for a product that contains L-Carnitine or vitamin B6 to naturally kick your metabolism up a notch.ThermogenesisFat burners that use thermogenesis increase the body’s heat production, which in turn burns fat. These products typically contain natural ingredients that have thermogenic properties. Some of the most commonly used compounds include:● Turmeric● Capsaicin● Green tea extract● CaffeineThese ingredients work by stimulating the body to produce more heat.

In turn, the body must produce more energy while also burning fat simultaneously. Many thermogenic ingredients also have a healthy impact on the metabolism.Fat burners that work by promoting thermogenesis often cause you to sweat more than normal. You may also have difficulty sleeping, so be mindful of how much you take and when you take these types of supplements.Potential Side Effects to be Aware ofAs with any supplement, there’s always the risk of side effects.

While most fat burners, especially those that contain all natural ingredients, rarely cause adverse side effects, it’s important to know what you could experience.Some of the most commonly reported side effects of fat burners include:● Diarrhea● Bloating● Gastrointestinal discomfort● Jitters● AnxietyIf you experience any of these symptoms, it’s best to stop taking the supplement. When restarting, try taking a lower dosage. You may also want to consider switching to a new product altogether.Fat burners that contain stimulants are most likely to cause anxiety and jitters.

These side effects can be remedied by using a non-stimulant fat burner or taking a lower dose so that the effects aren’t as strong.The best way to avoid adverse side effects when taking a fat burner supplement is to always follow the dosage instructions. Never take more than the recommended dosage. Otherwise you risk these side effects and potentially more serious ones.If you’re unsure if a fat burner will cause you to experience adverse side effects, discuss with your doctor or a medical professional first.Are Fat Burners Safe?.

One of the most common questions that women have about fat burners is whether or not these supplements are safe or not. For the most part, fat burner supplements are safe, assuming they’re made with quality ingredients that are tested for potency, quality, and safety.Of course, we all know that low quality and even potentially dangerous fat burners are sold under the guise of quick weight loss. With that said, there are some ingredients you’ll want to avoid, as they have shown to be dangerous and even deadly.

If you come across a fat burner that contains any of these ingredients, don’t buy it!. Three harmful ingredients that have been banned or are widely discouraged from being used include:● Ephedra ● Synephrine, to include M-synephrine, O-synephrine, and P-synephrine● 2,4 Dinitrophenol (DNP)These ingredients have been linked to heart attack, stroke, and other cardiac issues. Some have even been potentially linked to several deaths.By avoiding these ingredients altogether, you’re less likely to spend money on a low quality product.

Aside from the ingredients that a supplement is made with, there are other factors to consider when choosing a high quality supplement.Consider who is selling the fat burner. Is it a brand you’ve heard of before?. Is the brand reputable?.

Does the website look legitimate?. Buying from a reputable brand is a must. Trusted names in the weight loss supplement industry will be transparent, open, and honest with consumers.You’ll also want to review customer testimonials.

This is the best way to learn the truth behind a supplement. If a fat burner is safe and effective, you’ll see that these positive words are captured in customer reviews of the product.At the end of the day, even though there are dangerous supplements on the market that are advertised as fat burners, the fact is that with proper research, you can avoid these products entirely. Pay close attention to the ingredients used in a supplement, as well as brand reputation and customer feelings about the product.ConclusionWho says that weight gain is just part of life?.

While weight gain is common as we get older, being overweight doesn’t have to be your reality. If you’re serious about burning fat and improving your overall health by losing weight, there are tons of supplements out there to help you reach these goals.With the right fat burner supplement for women, losing weight has never been easier. No matter which fat burner you choose, the key is to stay consistent and to make other healthy lifestyle choices.While not all fat burners require you to diet and exercise, you’ll get best results by embracing these lifestyle choices.

The healthier you eat and the more calories you burn through exercise, the quicker you’ll shed those unwanted pounds.Thirty percent of unvaccinated American adults say they’re waiting for the buy antibiotics treatments currently authorized for emergency use to be officially approved by the U.S. Food and Drug Administration. The FDA has since granted that approval for those age 16 and older for the Pfizer-BioNTech treatment on Aug.

23, 2021. What had to happen for the FDA to advance from emergency use authorization, or EUA, to full approval?. I’m a pharmacist who trains other pharmacists, health care providers and students on why, when and how to administer treatments.

Emergency use authorization, while streamlining the regulatory process so the treatment is more quickly available to the public, still follows a rigorous process the FDA requires to ensure treatment safety and effectiveness. The difference is that more time has passed and more data is available for review when a company applies for full approval.[embedded content]EUA and Full Approval Share Similar First StepsFor both emergency authorization and full approval, for buy antibiotics treatments, the FDA first requires initial safety studies on a small number of people. Here, researchers document potential adverse events, or side effects, that the treatment may cause.

Researchers also determine the safest and most effective dose of the treatment.Once the treatment is determined to be safe and an optimal dose identified, researchers will create larger studies to ascertain how well it works in a controlled setting where some people are given the treatment while others are given a placebo.It is important to note that the number of people who participated in the initial buy antibiotics safety studies was similar to that in the safety studies of other commonly used treatments, including treatments for tetanus, diphtheria, whooping cough and meningitis. Over 43,000 adults participated in the early phases of the Pfizer-BioNTech clinical trial, over 30,400 in Moderna’s and over 44,000 in Johnson and Johnson’s. Half the participants in each study were given a treatment, while the other half were given a placebo.Where EUA and Full Approval DifferFrom this point on, emergency use authorization and full FDA approval for buy antibiotics treatments follow different clinical study requirements.For the emergency use authorization, the FDA requires at least half of the participants of the original studies to be followed for at least two months post-vaccination.

This is because the vast majority of treatment-related side effects occur right after vaccination.Full FDA approval, on the other hand, requires participants in the original studies to be followed for at least six months. Reviewers look at data from the same study participants but collected over a longer period of time. All adverse events are examined.

The manufacturer must also provide more detailed manufacturing plans and processes, as well as a higher level of oversight and inspections. All of this adds significantly more time to the review process.Full FDA approval involves reviewing more data after a longer observational period. (Credit.

SOPA Images/LightRocket via Getty Images)Both Pfizer and Moderna began their rolling submission for approval in the FDA’s “Fast Track” process, designed to speed up review. This allows the companies to submit portions of their approval application to the FDA for review as they’re completed.Full FDA approval will initially apply to only the same age groups that were tested in the original emergency use authorization. This means that the treatment has been approved first for people ages 16 and up for Pfizer, and will likely be approved for those 18 and up for Moderna.

Rolling submission will allow approval of the treatment for younger groups as more data becomes available.Different Timelines, Same Rigorous RequirementsFull FDA approval is a milestone that may help build confidence among the treatment hesitant about the safety of the treatments. But the true test of the treatment came when it first gained emergency use authorization. Then, researchers identified the majority of its potential side effects and proved its ability to protect against severe disease.Article updated on Aug.

23, 2021 to reflect FDA approval of Pfizer BioNTech treatment for those ages 16 and older.Jennifer Girotto is an associate clinical professor of pharmacy practice ar the University of Connecticut is a clinical physician and assistant professor at the University of Virginia. This article is republished from The Conversation under a Creative Commons license. Read the original article.This article contains affiliate links to products.

Discover may receive a commission for purchases made through these links.Even with a healthy diet and making healthy lifestyle choices, many people still have vitamin and nutrient deficiencies. And whether you’re deficient or just want to ensure that your levels are at a proper range, it never hurts to supplement.These days, there are thousands of different supplements to choose with, along with hundreds of different brands to choose from. And while variety is nice, it can make things a little more difficult for consumers who are looking for a supplement that is safe and effective.Elm &.

Rye is one of the newest supplement brands to enter the industry, but in just a year alone, the company has experienced immense success and customer satisfaction. Unlike other supplement brands on the market, Elm &. Rye uses pure, sustainability sourced ingredients.

From ingredient sourcing to product packaging, all products are made in a way that takes the environmental and social impact into consideration.Not only are Elm &. Rye supplements made with quality, sustainable ingredients, this is confirmed by 3rd party testing. Each supplement is tested by an independent lab to assure purity and potency.

This shows just how customer-focused and transparent Elm &. Rye is.So whether you want to boost brain health or gut health, or if you want to shed stubborn fat, you’re sure to find just the supplement you need from Elm &. Rye.

Most Popular Elm &. Rye ProductsAs mentioned above, Elm &. Rye doesn’t provide just one type of supplement.

Instead, the brand has formulated a variety of different products that are designed to meet your specific nutrient and lifestyle needs.Want to improve your sleep quality and quantity?. Consider the delicious Melatonin Gummies. Want to boost your cognitive health so that you can be more productive?.

The brand’s Nootropics supplement may be what you’re missing.Here is some in-depth information about some of Elm &. Rye’s top selling products.Testosterone SupportTestosterone Support can be used for men who want to lose fat and gain muscle. It can also be used for those who have low testosterone levels.

While this condition is typically treated with testosterone injections, some prefer a more natural option.Older men, such as those 40 and older, are at an increased risk of low testosterone. As men get older, the body produces less testosterone, which eventually causes levels to drop below the healthy range. Low testosterone does more than impact a man's libido and sexual performance.

Men with low T are also more likely to experience:● Weight gain● Muscle loss● Reduced bone mass● FatigueWhile low testosterone levels are a natural part of aging, this doesn’t mean that men should simply accept it and move on. This is one of the many conditions that can benefit from Testosterone supplement from Elm &. Rye.This supplement is formulated with 6 highly effective ingredients that are designed to increase testosterone production and levels.

These ingredients include:● Tribulus Terrestris Powder (Tribulus Terrestris)● Chrysin 99%● Diindolylmethane (DIM)● Long Jack Eurycoma Root (Eurycoma Longifolia)● Gamma Oryzanol Powder● Calcium (as Calcium Carbonate)Here’s how each of these ingredients work to promote healthy testosterone production, which in turn boosts testosterone levels.Tribulus Terrestris Powder (Tribulus Terrestris)This ingredient contains chemical compounds that increase many hormone levels in the body, including testosterone. Tribulus Terrestris has also shown to be an effective treatment for low libido and poor sexual performance.Chrysin 99%Chrysin is a naturally occurring flavonoid that can be harvested from many different plants, including passionflower. Studies have found that this flavonoid can benefit men who want to gain muscle mass.

It may also increase testosterone production.Diindolylmethane (DIM)Diindolylmethane supports free testosterone levels by inhibiting aromatase. This is an enzyme that converts testosterone to estrogen. When men have high estrogen levels, testosterone levels decrease.

So by preventing the conversion of testosterone to estrogen, T levels can more readily increase.Long Jack Eurycoma Root (Eurycoma Longifolia)Research shows that Long Jack Eurycoma Root is effective in elevating serum testosterone while also improving muscle strength. The ingredient has strong antioxidant properties, which protect the body from free radicals that cause cellular damage.Gamma Oryzanol PowderGamma Oryzanol Powder increases testosterone and human growth hormone levels. It may also be effective at improving strength, especially in men who lift weights or partake in any other kind of resistance training.Calcium (as Calcium Carbonate)Calcium does more than build strong bones!.

Studies have found that calcium channels may influence testosterone levels. It’s thought that men with higher levels of calcium are more likely to have high testosterone levels as well.Fat BurnerLosing weight isn’t easy. And after spending weeks dieting and exercising, you may find that you still aren’t happy with the number on the scale or what you see in the mirror.

Fat Burner from Elm &. Rye is the gold standard fat burning supplement. It’s designed to boost metabolism, increase calorie burn, and give you an energy boost so that you can power through those tough workouts.This fat burning supplement contains all natural ingredients that work to rev up your metabolism, ensuring that your body is in optimal fat burning mode.

It also contains energy-boosting ingredients that will keep you energized and focused.Each Fat Burner capsule contains:● Niacin (Vitamin B3)● Vitamin B6 (Pyridoxine HCI)● Vitamin B12 (as Cyanocobalamin)● Caffeine Anhydrous ● L-Theanine● Green Coffee Extract● Green Tea Extract● Ashwagandha● Rhodiola Extract ● Coleus ForskohliiWhen combined with diet and exercise, this supplement can help you lose that stubborn fat so that you can finally reach your weight loss goal. Here’s how each of these ingredients contribute to helping you burn fat.B VitaminsFat Burner contains vitamin B3, B6, and B12. These B vitamins are needed for focus and energy.

They also work with the metabolism to convert food into energy. When calories are burned for energy, they aren’t stored as excess fat.Caffeine AnhydrousCaffeine is a stimulant that increases metabolic rate. This means that your body is able to more effectively and efficiently use excess body fat for energy.

Caffeine is one of the most commonly used ingredients in fat burner products. Our products have about 270mg of caffeine per serving, which is about the same amount of caffeine you will find in a Tall Starbucks coffee. Mayo Clinic recommends healthy adults avoid going over 400mg of caffeine a day, so that is something to keep in mind when taking any supplements containing caffeine.

L-TheanineL-Theanine is known for its ability to encourage relaxation and focus. It stimulates GABA production, which is a neurotransmitter. L-Theanine can also counteract some of the side effects of caffeine, such as an energy spike and the subsequent crash.Green Coffee ExtractGreen coffee is unroasted coffee beans that act like fiber when ingested.

This ingredient is effective in reducing appetite while also stabilizing blood sugar levels. It may also slow the absorption of carbohydrates.Green Tea ExtractGreen tea is one of the most effective, natural fat burners. It increases fat oxidation by up to 17%!.

Green tea also packs a powerful antioxidant punch. It contains catechins, to include EGCG, which boosts metabolism.AshwagandhaAshwagandha benefits the body in many different ways. It reduces inflammation throughout the body, which means less aches and pains.

It also reduces cortisol levels, which are often elevated due to stress and anxiety.Rhodiola Extract Rhodiola is an adaptogen herb that is commonly known as the “golden root.” It’s widely used in alternative medicine to decrease stress and anxiety levels while also improving the body’s resistance to stress. Since stress can be counterproductive to weight loss, this ingredient is quite beneficial.Coleus ForskohliiColeus Forskohlii activates an enzyme known as cAMP. This enzyme increases lipolysis and targets fat stored in the cells.

This increases and may even speed up the rate of fat loss.Daily ProbioticProbiotics are living microorganisms that are needed for a healthy digestive system. Probiotics promote a healthy balance of gut bacteria, which minimizes the risk of many different diseases. When the digestive system has a healthy balance of good bacteria, you're less likely to experience digestive issues, obesity, and even mental health problems.Daily Probiotic from Elm &.

Rye is formulated to promote a balanced, healthy gut while also boosting the immune system. Unlike other supplements, Daily Probiotic contains just one active ingredient. Lactobacillus acidophilus.This is one of the most common types of probiotics.

It can be found in yogurt and cheese, as well as fermented foods, and of course in supplements. Lactobacillus acidophilus produces lactic acid by producing the enzyme lactase. Lactase breaks down lactose, into lactic acid.So how does Lactobacillus acidophilus improve digestive health as well as overall health?.

Some of the most widely researched benefits include:● Promotes weight loss● Prevents and reduces cold and flu symptoms● Improves symptoms of Irritable Bowel Syndrome (IBS)● Prevents and reduces allergy symptoms● Reduces high cholesterol levels, including LDL cholesterol● May prevent or reduce diarrhea● Can treat and prevent vaginal sBy taking Daily Probiotic as the name intends, you’ll notice a huge impact on your overall health and well-being.NootropicsDo you commonly experience a condition known as brain fog?. Do you have days where you find it hard to focus and concentrate?. Productivity relies on your overall cognitive health to be in good shape, but if you’re like most people, you could use a little boost for your memory, focus, and cognition.While there are all sorts of vitamins and minerals you can take individually to improve your cognition and brain health, there is a better option.

Nootropics from Elm &. Rye contains all of the vitamins, minerals, and other compounds that will give you the cognitive boost you need.Each serving contains nutrients that your brain is sure to love, including:● Niacin (Vitamin B3)● Vitamin B6 (Pyridoxine HCI)● Caffeine Anhydrous● Gamma-Aminobutyric● Bacopa Monnieri Extract● Alpha GPC● L-Theanine● Phosphatidylserine extract● L-Tyrosine● Huperzine-A 1%Each of these ingredients benefits the brain and cognitive function in different ways. For example, studies have found that Niacin, also known as vitamin B3, not only improves cognitive function, but may even be able to prevent cognitive decline.

Gamma-Aminobutyric (GABA), is a neurotransmitter that, when at optimal levels, supports perceptual and attentional functioning as well as superior cognitive performance.With this combination of nootropic ingredients, you’ll think more sharply and clearly. You’ll also find that it's much easier to concentrate and focus, which will be a huge boost to your productivity levels at work and at home. While nootropics protect the brain against cognitive decline, especially in adults and seniors, you’re never too young to benefit from this type of supplement.Elderberry GummiesWhether it’s cold and flu season or if you simply want to give your immune system the support it needs, taking the right supplement can make a world of a difference.

And while there are many vitamins and minerals, such as zinc and vitamin C, that are well-known for boosting and supporting the immune system, there are other highly effective options as well.Elderberry is one of the most widely used medicinal plants throughout the world due to its high antioxidant content. Dating back to the time of the Egyptians, elderberry was used to heal burns and to improve complexion. The flowers and leaves have also been used to treat swelling, inflammation, and for pain relief.Today, elderberries are used as a supplement for treating cold and flu symptoms.

Studies have shown that elderberry extract may be able to minimize common symptoms such as:● Cough● Sore throat● Runny or stuffy nose● Headache● Muscle and body achesIf you want to try elderberry, one of the best supplements on the market is Elderberry Gummies from Elm &. Rye. These flavorful gummies offer a fun, tasty way to give your immune system a healthy boost.

They’re also a great alternative for those who dislike or can’t take traditional capsules.Just one gummy a day supports a healthy immune system and a healthy heart. And if you happen to get sick, these elderberry gummies can relieve cold and flu symptoms so that you can get back to feeling your best sooner.Melatonin GummiesHow often do you wake up feeling refreshed and rejuvenated?. Chances are that you’re like most people and instead wake up feeling tired, maybe even like you never slept at all.

Sleep problems are more common than ever before. A growing number of people experience sleep disturbances or difficulty falling or staying asleep.Because of this, there have been a growing number of over-the-counter sleep aids that are designed to promote better sleep. There are also all-natural supplements, such as Melatonin Gummies from Elm &.

Rye, that use natural ingredients to improve sleep quality and quantity.Whether you have issues falling asleep or staying asleep, Melatonin Gummies can help you get the sound rest that you need. When taken as directed, this supplement not only promotes better sleep, but also improves morning alertness. It can even help reduce the side effects caused by jet lag.Melatonin Gummies contain simple ingredients, including melatonin, sugar, and pectin.

They’re flavored with natural flavors and are colored with vegetable juice. These gummies even contain spirulina extract, which has powerful antioxidant and anti-inflammatory properties.So what exactly is melatonin?. Melatonin is a hormone made by the pineal gland, which is located in the middle of the brain.

The hormone helps your body know when to sleep and when to wake up, a cycle known as the circadian rhythm.At night, your body naturally produces more melatonin. Levels drop during the day, and increase in the evening as the sun starts to set. Light, along with your internal body clock, dictate how much melatonin your body makes.If you don't have proper melatonin levels in the evening, you may find it hard to fall asleep or stay asleep.

A melatonin supplement can also benefit those who have insomnia or delayed sleep phase disorder.CollagenCollagen is a protein that accounts for about a third of all of the protein in your body along with three quarters of your skin. It plays a large role in ensuring that your joints are healthy and that your skin is elastic. Collagen can be found in your muscles, bones, and in your blood.As we get older, collagen breaks down, and the body isn’t able to produce it as readily.

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This supplement contains 1000 mg of hydrolyzed collagen as well as 90 mg of vitamin C. The combination of these two ingredients will ensure that your bones, joints, hair, skin, and nails are healthier than ever before.MagnesiumMagnesium is an extremely important mineral. It’s needed to maintain bone and muscle health and helps to improve muscle function while also promoting faster recovery.

Magnesium also supports other processes, including:● Regulating blood sugar levels● Regulating blood pressure● Regulating muscle and nerve function● Creating protein, bone, and DNAMagnesium deficiency is one of the most common deficiencies. While less than 2% of Americans have been diagnosed with a deficiency, studies suggest that around 75% of Americans aren't meeting the recommended daily intake. Magnesium deficiency only presents noticeable symptoms when levels are severely low, which is why most people are deficient and don't know it.Low magnesium levels have been associated with many health issues, including chronic diarrhea, diabetes, and poor nutrient absorption.

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While most people who eat a healthy diet get plenty of magnesium, it never hurts to supplement.Fish OilThere are tons of fish oil supplements on the market, but if you're looking for one that's made with potent, high quality ingredients, Elm &. Rye is the brand for you. This company uses sustainable ingredients, and each supplement is lab tested to ensure potency and quality.And while you’ve likely heard about fish oil many times, not many people know about the benefits of taking fish oil supplements.

Fish oil is high in omega-3 fatty acids as well as vitamin A and D, all of which can benefit your overall health.If you don’t eat fatty fish once or twice a week, it’s a great idea to supplement with omega-3s. Taking omega-3s regularly offers all sorts of health benefits, including:● Reduces inflammation● Improves heart health● Supports muscle and joint health● Reduces symptoms from mental disorders● Improves eye health● Supports healthy skinWhat’s nice about Elm &. Rye Fish Oil supplement is that each serving contains a whopping 1000 mg of high quality fish oil.

Taking this supplement each day can help with daily aches and pain caused by inflammation. You will also notice that your skin feels healthier and that you overall just feel better!. Final ThoughtsThere is no shortage of supplements on the market, but what if you could buy all of the nutrients you need from a single, high quality brand?.

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Flagyl 500 tablet

	Flagyl	Vantin	Minocin	Cefzil	Zyvox	Sumycin
Male dosage	Drugstore on the corner	Online Pharmacy	At walgreens	At walmart	Online Drugstore	At walgreens
Daily dosage	Online	Yes	No	Yes	No	Yes
Buy with mastercard	200mg	Ask your Doctor	100mg	Ask your Doctor	600mg	500mg
Price	Yes	No	No	No	No	Online
Can women take	Cheap	200mg	Yes	No	No	No
How fast does work	400mg	100mg	Canadian pharmacy only	250mg	Canadian pharmacy only	Register first

SOBRE NOTICIAS EN ESPAÑOLNoticias en flagyl 500 tablet español es una sección de Kaiser Health News que contiene traducciones de artículos de gran interés para la comunidad hispanohablante, y contenido original enfocado en la población hispana que vive en los Estados Unidos. Use Nuestro Contenido Este contenido puede flagyl 500 tablet usarse de manera gratuita (detalles). La temporada de influenza se verá diferente este año, ya que los Estados Unidos se enfrentan a una pandemia de antibiotics que ya ha matado a más de 176.000 personas.Muchos estadounidenses son reacios a ir al médico y los funcionarios de salud pública temen que las personas eviten vacunarse.

Aunque a veces se considera incorrectamente como un resfriado, la gripe también mata flagyl 500 tablet a decenas de miles de personas en el país cada año. Los más vulnerables son los niños pequeños, los adultos mayores y las personas con enfermedades subyacentes. Cuando se combina con los efectos de buy antibiotics, los expertos en salud pública dicen que es más importante que nunca vacunarse contra la gripe.Si una cantidad suficiente de la población se vacuna, más del 45% lo hizo la temporada de gripe pasada, podría ayudar a evitar un escenario de pesadilla este invierno, con hospitales llenos de pacientes con buy antibiotics y los que sufren los efectos graves de la influenza.Además de la posible carga para los hospitales, existe la posibilidad de que las personas contraigan ambos flagyl y “nadie sabe qué sucede si se contrae influenza y buy antibiotics simultáneamente flagyl 500 tablet porque nunca sucedió antes”, dijo la doctora Rachel Levine, secretaria de Salud de Pennsylvania, a reporteros.En respuesta, este año los fabricantes están produciendo más suministros de vacunas, entre 194 y 198 millones de dosis, unas 20 millones más de las que se distribuyeron la temporada pasada, según los Centros para el Control y Prevención de Enfermedades (CDC).Mientras se acerca la temporada de gripe, aquí hay algunas respuestas a preguntas frecuentes:P.

¿Cuándo debo vacunarme contra la gripe?. La publicidad ya ha comenzado y algunas flagyl 500 tablet farmacias y clínicas ya tienen sus suministros. Pero, debido a que la efectividad de la vacuna puede disminuir con el tiempo, los CDC recomiendan no recibir la dosis en agosto.Muchas farmacias y clínicas comenzarán las inmunizaciones a principios de septiembre.

Generalmente, los flagyl de la influenza comienzan a circular a mediados o fines de octubre, pero se expanden masivamente más tarde, en flagyl 500 tablet el invierno. Se necesitan aproximadamente dos semanas después de recibir la inyección para que los anticuerpos, que circulan en la sangre y frustran las infecciones, se acumulen.“Las personas jóvenes y sanas pueden comenzar a vacunarse contra la gripe en septiembre, y las personas mayores y otras poblaciones vulnerables pueden hacerlo en octubre”, dijo el doctor Steve Miller, director clínico de la aseguradora Cigna.Los CDC recomiendan que las personas “se vacunen contra la influenza a fines de octubre”, pero señalaron que se puede recibir la vacuna más tarde porque “aún puede ser beneficiosas y la vacunación debe ofrecerse a lo largo de toda la temporada de influenza”.Aun así, algunos expertos recomiendan no esperar demasiado este año, no solo por buy antibiotics, sino también en caso de que haya escasez debido a la abrumadora demanda.P. ¿Cuáles son las razones por las flagyl 500 tablet que las que debería ofrecer mi brazo para vacunarme?.

Hay que vacunarse porque brinda protección contra la gripe y, por lo tanto, contra la propagación a otras personas, lo que puede ayudar a disminuir la carga para los hospitales y el personal médico.Y hay otro mensaje que puede resonar en estos tiempos extraños.“Le da a la gente la sensación de que hay algunas cosas que pueden controlar”, dijo Eduardo Sánchez, director médico de prevención de la American Heart Association.Si bien una vacuna contra la gripe no evitará buy antibiotics, recibirla podría ayudar al médico a diferenciar entre las dos enfermedades si se desarrolla algún síntoma (fiebre, tos, dolor de garganta) que ambas infecciones comparten, explicó Sánchez.Y aunque las vacunas contra la gripe no evitarán todos los casos de gripe, vacunarse puede reducir la gravedad si la persona se enferma, dijo.Todas las personas elegibles, especialmente los trabajadores esenciales, los que sufren de afecciones subyacentes y aquellos en mayor riesgo, incluidos los niños muy pequeños y las mujeres embarazadas, deben buscar protección, dijeron los CDC. La entidad recomienda la vacunación a partir de los 6 flagyl 500 tablet meses.P. ¿Qué sabemos flagyl 500 tablet sobre la efectividad de la vacuna de este año?.

Se deben producir nuevas vacunas contra la gripe cada año, porque el flagyl muta y la efectividad de la vacuna varía, dependiendo de qué tan bien coincida con el flagyl circulante.Se calculó que la formulación del año pasado tuvo una eficacia de aproximadamente un 45% para prevenir la gripe en general, con una efectividad de aproximadamente un 55% en los niños. Las vacunas disponibles en el país este año tienen como objetivo prevenir al menos tres cepas diferentes del flagyl, y la mayoría cubre cuatro.Todavía no se sabe qué tan bien coincidirá el suministro de este año con las cepas que circularán flagyl 500 tablet en los Estados Unidos. Las primeras indicaciones del hemisferio sur, que atraviesa su temporada de gripe durante nuestro verano, son alentadoras.

Allí, las personas practicaron el distanciamiento social, usaron máscaras y se vacunaron en mayor número este flagyl 500 tablet año, y los niveles mundiales de gripe son más bajos de lo esperado. Sin embargo, expertos advierten que no se debe contar con una temporada igual de suave en los Estados Unidos, en parte porque los esfuerzos por usar mascara facial y de distanciamiento social varían ampliamente.P. ¿Qué están haciendo flagyl 500 tablet diferente los seguros y sistemas de salud este año?.

Las aseguradoras y los sistemas de salud contactados por KHN dicen que seguirán las pautas de los CDC, que exigen limitar y espaciar la cantidad de personas que esperan en las filas y las áreas de vacunación. Algunos están programando citas para vacunas contra la gripe para ayudar a controlar el flujo.Health Fitness Concepts, una compañía que trabaja con UnitedHealth Group y otras empresas para establecer clínicas de vacunación contra la gripe en el noreste del país, dijo que está “fomentando eventos más pequeños y frecuentes para apoyar el distanciamiento social” y “exigiendo que se completen todos los formularios y arremangarse las camisas antes de entrar al área de vacunación contra la influenza”.Se requerirá que todos usen máscaras.Además, a nivel nacional, algunos grupos médicos contratados por UnitedHealth instalarán carpas, para que las inyecciones se puedan administrar al aire libre, dijo un vocero.Kaiser Permanente planifica las vacunas directamente en autos en algunos de sus centros médicos y está probando los procedimientos de detección y registro sin contacto en algunos lugares.Geisinger Health, un proveedor de salud regional en Pennsylvania y Nueva Jersey, flagyl 500 tablet dijo que también tendría programas de vacunación contra la influenza al aire libre en sus instalaciones.Además, “Geisinger exige que todos los empleados reciban la vacuna contra la influenza este año”, dijo Mark Shelly, director de prevención y control de infecciones del sistema. €œAl dar este paso, esperamos transmitir a nuestros vecinos la importancia de la vacuna contra la influenza para todos”.P.

Por lo general, me flagyl 500 tablet vacunan contra la gripe en el trabajo. ¿Seguirá siendo una opción este año?. Con el objetivo de evitar riesgosas reuniones en interiores, muchos empleadores se muestran reacios a patrocinar las clínicas de gripe en oficinas como flagyl 500 tablet han ofrecido en años anteriores.

Y con tanta gente que sigue trabajando desde casa, hay menos necesidad de llevar las vacunas contra la gripe al lugar de trabajo. En cambio, muchos empleadores están alentando a los trabajadores a que reciban vacunas de sus médicos de atención primaria, en farmacias flagyl 500 tablet u otros entornos comunitarios. El seguro generalmente cubrirá el costo de la vacuna.Algunos empleadores están considerando ofrecer cupones para vacunas contra la gripe a sus trabajadores sin seguro o a aquellos que no participan en el plan médico de la compañía, dijo Julie Stone, directora general de salud y beneficios de Willis Towers Watson, una firma consultora.Estos cupones podrían, por ejemplo, permitir a los trabajadores obtener la vacuna en un laboratorio en particular sin costo.Algunos empleadores están comenzando a pensar en cómo podrían usar sus estacionamientos para administrar vacunas contra la gripe enlos autos, dijo el doctor David Zieg, líder de servicios clínicos para el consultor de beneficios Mercer.Aunque la flagyl 500 tablet ley federal permite a los empleadores exigir a los empleados que se vacunen contra la gripe, ese paso generalmente lo toman solo los centros de atención médica y algunas universidades donde las personas viven y trabajan en estrecha colaboración, dijo Zieg.Pero sucede.

El mes pasado, el sistema de la Universidad de California emitió una orden ejecutiva que requiere que todos los estudiantes, profesores y personal se vacunen contra la gripe antes del 1 de noviembre, con limitadas excepciones.P. ¿Qué están haciendo las flagyl 500 tablet farmacias para alentar a las personas a vacunarse contra la gripe?. Algunas farmacias están haciendo un esfuerzo adicional para salir a la comunidad y ofrecer vacunas contra la gripe.Walgreens, que tiene casi 9,100 farmacias en todo el país, continúa una asociación iniciada en 2015 con organizaciones comunitarias, iglesias y empleadores que ha ofrecido alrededor de 150,000 clínicas de gripe móviles hasta la fecha.El programa pone especial énfasis en trabajar con poblaciones vulnerables y en áreas desatendidas, dijo el doctor Kevin Ban, director médico de la cadena de farmacias.Walgreens comenzó a ofrecer vacunas contra la gripe a mediados de agosto y está animando a las personas a no demorar en vacunarse.Tanto Walgreens como CVS están estimulando a las personas a programar citas y hacer trámites en línea este año para minimizar el tiempo que pasan en los locales.En los CVS MinuteClinic, una vez que los pacientes se han registrado para recibir la vacuna contra la gripe, deben esperar afuera o en su automóvil, ya que las áreas de espera interiores ahora están cerradas.“No tenemos un arsenal contra buy antibiotics”, dijo Ban, de Walgreens.

€œPero quitar flagyl 500 tablet la presión del sistema de atención médica proporcionando vacunas por adelantado es algo que sí podemos hacer”. Julie Appleby. jappleby@kff.org, @Julie_Appleby Michelle flagyl 500 tablet Andrews.

andrews.khn@gmail.com, @mandrews110 Related Topics Insurance Noticias En Español Public Health buy antibiotics Insurers treatmentsThis story was produced in partnership with PolitiFact. This story can be republished for free (details). President Donald Trump accepted the Republican Party’s nomination for president in a 70-minute speech from the South Lawn of the White House on Thursday night.Speaking to a friendly crowd that didn’t appear to be observing social distancing conventions, and with flagyl 500 tablet few participants wearing masks, he touched on a range of topics, including many related to the buy antibiotics flagyl and health care in general.Throughout, the partisan crowd applauded and chanted “Four more years!. € And, even as the nation’s buy antibiotics death toll exceeded 180,000, Trump was upbeat.

€œIn recent months, our nation and the entire planet flagyl 500 tablet has been struck by a new and powerful invisible enemy,” he said. €œLike those brave Americans before us, we are meeting this challenge.”At the end of the event, there were fireworks.Our partners at PolitiFact did an in-depth fact check on Trump’s entire acceptance speech. Here are the highlights related to the administration’s buy antibiotics response and other health policy issues:“We developed, flagyl 500 tablet from scratch, the largest and most advanced testing system in the world.” This is partially right, but it needs context.It’s accurate that the U.S.

Developed its buy antibiotics testing system from scratch, because the government didn’t accept the World Health Organization’s testing recipe. But whether the system is flagyl 500 tablet the “largest” or “most advanced” is subject to debate.The U.S. Has tested more flagyl 500 tablet individuals than any other country.

But experts told us a more meaningful metric would be the percentage of positive tests out of all tests, indicating that not only sick people were getting tested. Another useful metric would be the percentage of the population that flagyl 500 tablet has been tested. The U.S.

Is one of the most populous flagyl 500 tablet countries but has tested a lower percentage of its population than other countries. Don't Miss A Story Subscribe to KHN’s free Weekly Edition newsletter. The U.S flagyl 500 tablet.

Was also slower than other countries in rolling out tests and amping up testing capacity. Even now, many states are experiencing delays in reporting test results to positive individuals.As for flagyl 500 tablet “the most advanced,” Trump may be referring to new testing investments and systems, like Abbott’s recently announced $5, 15-minute rapid antigen test, which the company says will be about the size of a credit card, needs no instrumentation and comes with a phone app through which people can view their results. But Trump’s comment makes it sound as if these testing systems are already in place when they haven’t been distributed to the public.“The United States has among the lowest [buy antibiotics] case fatality rates of any major country in the world.

The European Union’s case fatality rate is nearly three times higher than ours.”The case fatality rate measures the known flagyl 500 tablet number of cases against the known number of deaths. The European Union has a rate that’s about 2½ times greater than the United States.But the source of that data, Oxford University’s Our World in Data project, reports that “during an outbreak of a flagyl, the case fatality rate is a poor measure of the mortality risk of the disease.”A better way to measure the threat of the flagyl, experts say, is to look at the number of deaths per 100,000 residents. Viewed that flagyl 500 tablet way, the U.S.

Has the 10th-highest death rate in the world.“We will produce a treatment before the end of the year, or maybe even sooner.”It’s far from guaranteed that a antibiotics treatment will be ready before the end of the year.While researchers are making rapid strides, flagyl 500 tablet it’s not yet known precisely when the treatment will be available to the public, which is what’s most important. Six treatments are in the third phase of testing, which involves thousands of patients. Like earlier phases, this one looks at the safety of a treatment but also examines its effectiveness and collects more data on flagyl 500 tablet side effects.

Results of the third phase will be submitted to the Food and Drug Administration for approval.The government website Operation Warp Speed seems less optimistic than Trump, announcing it “aims to deliver 300 million doses of a safe, effective treatment for buy antibiotics by January 2021.”And federal health officials and other experts have generally predicted a treatment will be available in early 2021. Federal committees are working flagyl 500 tablet on recommendations for treatment distribution, including which groups should get it first. €œFrom everything we’ve seen now — in the animal data, as well as the human data — we feel cautiously optimistic that we will have a treatment by the end of this year and as we go into 2021,” said Dr.

Anthony Fauci, the nation’s top infectious diseases flagyl 500 tablet expert. €œI don’t think it’s dreaming.”“Last month, I took on Big Pharma. You think flagyl 500 tablet that is easy?.

I signed orders that would massively lower the cost of your prescription drugs.”Quite misleading. Trump signed four flagyl 500 tablet executive orders on July 24 aimed at lowering prescription drug prices. But those orders haven’t taken effect yet — the text of one hasn’t even been made publicly available — and experts told us that, if implemented, the measures would be unlikely to result in significant drug price reductions for the majority of Americans.“We will always and very strongly protect patients with preexisting conditions, and that is a pledge from the entire Republican Party.”Trump’s pledge is undermined by his efforts to overturn the Affordable Care Act, the only law that guarantees people with preexisting conditions both receive health coverage and do not have to pay more for it than others do.

In 2017, Trump supported flagyl 500 tablet congressional efforts to repeal the ACA. The Trump administration is now backing GOP-led efforts to overturn the ACA through a court case. And Trump has also expanded short-term health plans that don’t have to comply with the ACA.“Joe Biden recently raised his hand on the debate stage and promised he was going to give it away, your health care dollars to flagyl 500 tablet illegal immigrants, which is going to bring a massive number of immigrants into our country.”This is misleading.

During a flagyl 500 tablet June 2019 Democratic primary debate, candidates were asked. €œRaise your hand if your government plan would provide coverage for undocumented immigrants.” All candidates on stage, including Biden, raised their hands. They were flagyl 500 tablet not asked if that coverage would be free or subsidized.Biden supports extending health care access to all immigrants, regardless of immigration status.

A task force recommended that he allow immigrants who are in the country illegally to buy health insurance, without federal subsidies.“Joe Biden claims he has empathy for the vulnerable, yet the party he leads supports the extreme late-term abortion of defenseless babies right up to the moment of birth.”This mischaracterizes the Democratic Party’s stance on abortion and Biden’s position.Biden has said he would codify the Supreme Court’s ruling in Roe v. Wade and flagyl 500 tablet related precedents. This would generally limit abortions to the first 20 to 24 weeks of gestation.

States are allowed under court rulings to ban abortion after the point at which a fetus can sustain life, usually considered to be between flagyl 500 tablet 24 and 28 weeks from the mother’s last menstrual period — and 43 states do. But the rulings require states to make exceptions “to preserve the life or health of the mother.” Late-term abortions are very rare, about 1%.The Democratic Party platform holds that “every woman should have access to quality reproductive health care services, including safe and legal abortion — regardless of where she lives, how much money she makes, or how she is insured.” It does not address late-term abortion.PolitiFact’s Daniel Funke, Jon Greenberg, Louis Jacobson, Noah Y. Kim, Bill McCarthy, Samantha Putterman, Amy Sherman, Miriam Valverde and KHN reporter Victoria Knight flagyl 500 tablet contributed to this report.

Related Topics Elections Health Industry Pharmaceuticals Public Health The Health Law Abortion buy antibiotics Immigrants KHN &. PolitiFact HealthCheck Preexisting Conditions Trump Administration treatmentsThis story also ran on CNN. This story can be republished for free (details). Flu season will look different this year, as the country grapples with a antibiotics flagyl that flagyl 500 tablet has killed more than 172,000 people. Many Americans are reluctant to visit a doctor’s office and public health officials worry people will shy away from being immunized.Although sometimes incorrectly regarded as just another bad cold, flu also kills tens of thousands of people in the U.S.

Each year, with the very young, the elderly and those with underlying conditions flagyl 500 tablet the most vulnerable. When coupled with the effects of buy antibiotics, public health experts say it’s more important than ever to get a flu shot.If enough of the U.S. Population gets vaccinated — more than the 45% who did last flu season — it could help head off a nightmare scenario in the coming winter of hospitals stuffed with both buy antibiotics patients and those suffering from severe effects of influenza.Aside from the potential burden on hospitals, there’s the possibility people could get both flagyles — and “no one knows what happens if you get influenza and buy antibiotics [simultaneously] because it’s never flagyl 500 tablet happened before,” Dr.

Rachel Levine, Pennsylvania’s flagyl 500 tablet secretary of health, told reporters this month.In response, manufacturers are producing more treatment supply this year, between 194 million and 198 million doses, or about 20 million more than they distributed last season, according to the Centers for Disease Control and Prevention. Email Sign-Up Subscribe to KHN’s free Morning Briefing. As flu season approaches, here are flagyl 500 tablet some answers to a few common questions:Q.

When should I get my flu shot?. Advertising has already begun, and some pharmacies and clinics have their flagyl 500 tablet supplies now. But, because the effectiveness of the treatment can wane over time, the CDC recommends against a shot in August.Many pharmacies and clinics will start immunizations in early September.

Generally, influenza flagyles flagyl 500 tablet start circulating in mid- to late October but become more widespread later, in the winter. It takes about two weeks after getting a shot for antibodies — which circulate in the blood and thwart s — to build up. €œYoung, healthy people can begin getting their flu shots in September, and elderly people and other vulnerable populations can flagyl 500 tablet begin in October,” said Dr.

Steve Miller, chief clinical officer for insurer Cigna.The CDC has recommended that people “get a flu treatment by the end of October,” but noted it’s not too late to get one after that because shots “can still be beneficial and vaccination should be offered throughout the flu season.”Even so, some experts say not to wait too long this year — not only because of buy antibiotics, but also in case a shortage develops because of overwhelming demand.Q. What are the flagyl 500 tablet reasons I should roll up my sleeve for this?. Get a shot because it protects you from catching the flu and spreading it to others, which may help lessen the burden on hospitals and medical staffs.And there’s another message that may resonate in this strange time.“It gives people a sense that there are some things you can control,” said Eduardo Sanchez, chief medical officer for prevention at the American Heart Association.While a flu shot won’t prevent buy antibiotics, he said, getting one could help your doctors differentiate between the diseases if you develop any symptoms — fever, cough, sore throat — they share.And even though flu shots won’t prevent all cases of the flu, getting vaccinated can lessen the severity if you do fall ill, he said.You cannot get influenza from having a flu treatment.All eligible people, especially essential workers, those with underlying conditions and those at higher risk — including very young children and pregnant women — should seek protection, the CDC said.

It recommends that children flagyl 500 tablet over 6 months old get vaccinated.Q. What do we know about the effectiveness of this year’s treatment?. Flu treatments — flagyl 500 tablet which must be developed anew each year because influenza flagyles mutate — range in effectiveness annually, depending on how well they match the circulating flagyl.

Last year’s formulation was flagyl 500 tablet estimated to be about 45% effective in preventing the flu overall, with about a 55% effectiveness in children. The treatments available in the U.S. This year are aimed at preventing at least three flagyl 500 tablet strains of the flagyl, and most cover four.It isn’t yet known how well this year’s supply will match the strains that will circulate in the U.S.

Early indications from the Southern Hemisphere, which goes through its flu season during our summer, are encouraging. There, people practiced social distancing, wore masks and got vaccinated in greater numbers this year — and global flu flagyl 500 tablet levels are lower than expected. Experts caution, however, not to count on a similarly mild season in the U.S., in part because masking and social distancing efforts vary widely.Q.

What are flagyl 500 tablet insurance plans and health systems doing differently this year?. Insurers and health systems contacted by KHN say they will follow CDC guidelines, which call for limiting and spacing out the number of people waiting in lines and vaccination areas. Some are setting appointments for flu shots to help manage the flow.Health Fitness Concepts, a company that works with UnitedHealth Group and other businesses to set up flu shot clinics in the Northeast, said it is “encouraging smaller, more frequent events to support social distancing” and “requiring all forms to be completed and shirtsleeves rolled up before entering the flu shot area.” Everyone will be required to wear masks.Also, nationally, some physician groups contracted with UnitedHealth will set up tent areas so shots can be given outdoors, flagyl 500 tablet a spokesperson said.Kaiser Permanente plans drive-thru vaccinations at some of its medical facilities and is testing touch-free screening and check-in procedures at some locations.

(KHN is not affiliated with Kaiser Permanente.)Geisinger Health, a regional health provider in Pennsylvania and New Jersey, said it, too, would have outdoor flu vaccination programs at its facilities.Additionally, “Geisinger is making it mandatory for all employees to receive the flu treatment this year,” said Mark Shelly, the system’s director of prevention and control. €œBy taking this step, we hope to convey to our neighbors the importance of the flu treatment flagyl 500 tablet for everyone.”Q. Usually I get a flu shot at work.

Will that be an option this flagyl 500 tablet year?. Aiming to avoid risky indoor gatherings, many employers are reluctant to sponsor the flagyl 500 tablet on-site flu clinics they’ve offered in years past. And with so many people continuing to work from home, there’s less need to bring flu shots to employees on the job.

Instead, many employers are encouraging workers to get shots from their primary care doctors, at pharmacies or in other community flagyl 500 tablet settings. Insurance will generally cover the cost of the treatment.Some employers are considering offering vouchers for flu shots to their uninsured workers or those who don’t participate in the company plan, said Julie Stone, managing director for health and benefits at Willis Towers Watson, a consulting firm. The vouchers could flagyl 500 tablet allow workers to get the shot at a particular lab at no cost, for example.Some employers are starting to think about how they might use their parking lots for administering drive-thru flu shots, said Dr.

David Zieg, clinical services leader for benefits consultant Mercer.Although federal law allows employers to require employees to get flu shots, that step is typically taken only by health care facilities and some universities where people live and work closely together, Zieg said.Q. What are flagyl 500 tablet pharmacies doing to encourage people to get flu shots?. Some pharmacies are making an extra push to get out into the community to offer flu shots.Walgreens, which has nearly 9,100 pharmacies nationwide, is continuing a partnership begun in 2015 with community organizations, churches and employers that has offered about 150,000 off-site and mobile flu clinics to date.The program places a special emphasis on working with vulnerable populations and in underserved areas, said Dr.

Kevin Ban, chief medical officer for the drugstore chain.Walgreens began offering flu shots in mid-August and is encouraging people flagyl 500 tablet not to delay getting vaccinated.Both Walgreens and CVS are encouraging people to schedule appointments and do paperwork online this year to minimize time spent in the stores.At CVS MinuteClinic locations, once patients have checked in for their flu shot, they must wait outside or in their car, since the indoor waiting areas are now closed.“We don’t have tons of arrows in our quiver against buy antibiotics,” Walgreens’ Ban said. €œTaking pressure off the health care system by providing treatments in advance is one thing we can do.” Julie Appleby. jappleby@kff.org, @Julie_Appleby flagyl 500 tablet Michelle Andrews.

andrews.khn@gmail.com, @mandrews110 Related Topics Insurance Public Health buy antibiotics Insurers treatmentsUse Our Content This story can be republished for free (details). As the smoke thickened near her home in Santa Cruz, California, last week, Amanda Smith kept asking herself the same questions. Should we flagyl 500 tablet leave?. And where would we go?.

The wildfire evacuation zone, at the time, ended a few blocks from her flagyl 500 tablet house. But she worried about flagyl 500 tablet what the air quality — which had reached the second-highest warning level, purple for “very unhealthy” — would do to her children’s lungs. Her 4-year-old twins had spent time in the neonatal intensive care unit.

One was later diagnosed with asthma, and last year was hospitalized with pneumonia.By Tuesday, said Smith, flagyl 500 tablet “we all had headaches, the kids were coughing a little bit, and it was raining ash.” The family had been conscientiously isolating at home because of the buy antibiotics flagyl, and leaving meant potential exposures. But on Wednesday, Smith said, “I looked at my partner and said, maybe we should leave.”She called a friend in Orange County, about 380 miles south, who offered her parents’ empty condo. But the next day, the friend’s child spiked a fever — a possible case of buy antibiotics — and the plan fell through amid the distraction.Amanda Smith takes a selfie of herself and flagyl 500 tablet her twin children in Santa Cruz, California, in April.

(Amanda Smith)So Smith looked on Airbnb, careful to seek out hosts who detailed their buy antibiotics precautions, and found an apartment in San Bruno, about an hour’s drive north. She stuffed photos and documents flagyl 500 tablet into a suitcase, grabbed the go-bags, and her family headed out.“It’s coming out of our savings to stay here,” Smith said from the safety of her apartment rental, which runs about $1,150 a week. €œIt was a really fraught decision to leave, but as soon as we got over the hill and the sky was blue, I took a big sigh of relief and knew that it had been a good decision.”As the twin disasters of buy antibiotics and fire season sweep through California, thousands of residents like Smith are weighing difficult options, pitting risk against risk as they decide where to evacuate, whether from imminent flames or the toxic air.

Amid a virulent flagyl 500 tablet flagyl, which is safest?. Doubling up at a friend’s home?. A flagyl 500 tablet hotel?.

An evacuation center?. And when do the risks of smoke inhalation outweigh the risk of a deadly flagyl 500 tablet ?. €œObviously the most important thing is for people to do what they can to protect their lives, not only from the fire, but also from buy antibiotics,” said Detective Rosemerry Blankswade, public information officer for the San Mateo County Sheriff’s Office, which is helping coordinate response to the massive CZU Lightning Complex fires.“You have to evaluate the big picture here.

If fire is your most imminent danger, flagyl 500 tablet maybe take the buy antibiotics risk. But if you flagyl 500 tablet can avoid both of them, that’s obviously going to be the best option. It’s kind of a little bit of triage that we’re asking for people to do in their own lives right now.” Email Sign-Up Subscribe to KHN’s free Morning Briefing.

In flagyl 500 tablet San Mateo, one of two counties where the CZU Lightning Complex fires are blazing, officials are advising people to head to an evacuation center, where county workers will assist them in finding a hotel room. Meanwhile, in neighboring Santa Cruz, where tens of thousands of residents have evacuated and shelters have limited space, officials are asking those under orders to leave to stay with family and friends whenever possible.What’s the right choice when all options pose additional risks?. We spoke with several experts to help guide your thought process.You have to flagyl 500 tablet evacuate.

Where should you go?. If your region flagyl 500 tablet is under an evacuation order, do not hesitate. Leave immediately.

If you can afford it, booking a room flagyl 500 tablet at a hotel or motel outside the evacuation zones may be the best option, said Dr. Michael Wilkes, a professor at the University of California-Davis School of Medicine. They almost always flagyl 500 tablet have air-conditioning units, which help filter the air from both smoke and flagyl.

Many hotels are implementing new cleaning processes. Ask staffers to detail what they’re doing to sanitize rooms, and consider skipping the daily cleaning service during your stay flagyl 500 tablet. You might also check review sites such as TripAdvisor to see what other guests report.

When possible, avoid the lobby and other shared flagyl 500 tablet spaces, and opt for contactless check-in.Amanda Smith at home in Santa Cruz, California, with her twin children. Smith and her family decided to voluntarily evacuate their home on Aug flagyl 500 tablet. 20, due to heavy smoke in the area from the CZU Lightning Complex fires in the nearby Santa Cruz Mountains.

(Anna Maria Barry-Jester/KHN)With so many people in Northern California fleeing the fires, many hotels are already full, especially in more flagyl 500 tablet remote areas. So what about staying with family or friends?. After months of being shut in and avoiding close contact beyond immediate family, flagyl 500 tablet moving into someone else’s home means a host of potential exposures.

Consider whether you or anyone else in the home is at high risk from buy antibiotics because of age or a preexisting condition.“If so, that’s a reason to think twice before going to someone’s home,” said Dr. Gina Solomon, a program director at the Oakland-based Public Health Institute.Consider, too, what precautions your friends or flagyl 500 tablet family have been taking. Sheltering with someone whose job brings them into frequent contact with other people may not be as safe as sheltering with people who largely have been staying home.

Another question flagyl 500 tablet is how crowded the home is. If you have your own room and, preferably, your own bathroom, that makes staying with friends a better option. If a separate bedroom is not available and smoky skies are not a problem, you might consider pitching a tent in their backyard.For those with an RV or tent, camping can present another good option — flagyl 500 tablet although, with hundreds of wildfires burning across California, it may be challenging to drive far enough away to avoid fire and smoke.

If you do camp, try to find a site away from wooded areas. And think flagyl 500 tablet twice before using group bathrooms.Is an evacuation center safe?. Many counties have implemented new precautions at emergency shelters to prevent the spread flagyl 500 tablet of the antibiotics.

In Santa Cruz, for example, officials are scaling back the capacity in each shelter to allow for social distancing, providing tents for people to use as shielding inside and allowing camping in the parking lots.Still, staying in a shelter should probably not be your first choice. In terms of flagyl 500 tablet buy antibiotics risk, deciding between a hotel and a friend’s house is “nipping at the edges,” said Dr. John Swartzberg, a clinical professor emeritus at the UC-Berkeley School of Public Health, while “being in a congregate setting is only better than being completely exposed to the elements.”If an evacuation shelter is your best immediate option, again, do not hesitate.

€œYou have these standards you want to practice for yourselves,” Swartzberg flagyl 500 tablet said, “but when something worse comes along, it trumps how careful we can be with buy antibiotics because the need for shelter is greater.” You can lower your risk of by wearing a mask, washing hands frequently and sanitizing surfaces.Smith’s partner, Grant Whipple, walks with their children in Big Sur on March 7. That was their last camping trip before the buy antibiotics flagyl hit, Smith says. That area flagyl 500 tablet is now under threat from wildfire.

(Amanda Smith)If you aren’t in a fire zone, should you invite friends and family to stay with you?. Deciding whether to open your home to friends who are evacuating is an intensely personal decision and may depend on whether anyone in your flagyl 500 tablet family has a preexisting condition.“I guess it depends on how good a friend they are and how desperate they are,” said Swartzberg. It may also depend on how much space you have.

If your guests can have their own bedroom flagyl 500 tablet and bathroom, it might be safer.If you do offer your home, experts advise against simply considering yourself a new pod with your guests. Instead, take steps to lower your chances of .“It might not be pleasant, but wearing a mask anytime you’re not in your own bedroom is the safest way to go,” said Solomon. Stay outside as flagyl 500 tablet much as possible, she added, and consider eating meals outdoors or eating in shifts to avoid being maskless with those outside your family unit.

Sanitize surfaces and wash hands frequently. If air quality permits, keep the windows open to improve airflow.If you’re in a region flagyl 500 tablet with hazardous smoke conditions, should you leave?. If your area has dense smoke but no imminent fire risk, the thought of heading flagyl 500 tablet somewhere else may be appealing, especially if you have respiratory issues.

But in most cases, Wilkes said, it would be safer not to leave your buy antibiotics bubble. And given the expanse of California’s fires, anywhere you flee could end up having lousy air quality by the time you arrive.“The better part of rationality,” Wilkes said, “would be to stay at home, not exercise [outdoors], stay inside as much as you can, turn on the air conditioning.”California Healthline senior correspondent flagyl 500 tablet Anna Maria Barry-Jester contributed to this report. Jenny Gold.

jgold@kff.org, @JennyAGold Related Topics California Public Health States buy antibiotics Environmental Health Natural DisastersIn the 2014 elections, Republicans rode a wave of anti-Affordable Care Act sentiment to pick up nine flagyl 500 tablet Senate seats, the largest gain for either party since 1980. Newly elected Republicans such as Cory Gardner in Colorado and Steve Daines in Montana had hammered their Democratic opponents over the health care law during the campaign and promised to repeal it.Six years later, those senators are up for reelection. Not only is the law still around, but it’s gaining in flagyl 500 tablet popularity.

What was once a winning strategy has become a political liability.Public sentiment about the ACA, also known as Obamacare, has shifted considerably during the Trump administration after Republicans tried but failed to repeal it. Now, in the midst of the buy antibiotics flagyl and the ensuing flagyl 500 tablet economic crisis, which has led to the loss of jobs and health insurance for millions of people, health care again looks poised to be a key issue for voters this election. Don't Miss A Story Subscribe to KHN’s free Weekly Edition newsletter.

With competitive races in Colorado, Montana, Arizona, North Carolina and Iowa pitting Republican incumbents who voted to repeal the ACA against Democratic challengers promising to flagyl 500 tablet protect it, attitudes surrounding the health law could help determine control of the Senate. Republicans hold a slim three-vote majority in the Senate but are defending 23 seats in the Nov. 3 election flagyl 500 tablet.

Only one Democratic Senate seat — in Alabama, where incumbent Doug Jones is up against former Auburn University football coach Tommy Tuberville — is considered in play for Republicans.“The fall election will significantly revolve around people’s belief about what [candidates] will do for their health coverage,” said Dr. Daniel Derksen, a professor of public health at the University of Arizona.The flagyl 500 tablet Affordable Care Act has been a wedge issue since it was signed into law in 2010. Because it then took four years to enact, its opponents talked for years about how bad the not-yet-created marketplace for insurance would be, said Joe Hanel, spokesperson for the Colorado Health Institute, flagyl 500 tablet a nonpartisan nonprofit focused on health policy analysis.

And they continued to attack the law as it took full effect in 2014.Gardner, for example, ran numerous campaign ads that year criticizing the ACA and, in particular, President Barack Obama’s assertion that “if you like your health care plan, you’ll be able to keep your health care plan.”But now, Hanel said, the ACA’s policies have become much more popular in Colorado as the costs of health exchange plans have dropped. Thus, political messaging has changed, flagyl 500 tablet too.“This time it’s the opposite,” Hanel said. €œThe people bringing up the Affordable Care Act are the Democrats.”Despite Gardner’s multiple votes to repeal the ACA, he has largely avoided talking about the measure during the 2020 campaign.

He even removed his pro-repeal position from his campaign website.Democratic attack ads in July blasted Gardner for repeatedly dodging questions in an interview with Colorado Public Radio about his stance on a lawsuit challenging the ACA.His opponent, Democrat John Hickenlooper, fully embraced flagyl 500 tablet the law when he was Colorado governor, using the measure to expand Medicaid eligibility to more low-income people and to create a state health insurance exchange. Now, he’s campaigning on that record, with promises to expand health care access even further.Polling DataPolling conducted by KFF for the past 10 years shows a shift in public opinion has occurred nationwide. (KHN is an editorially independent program flagyl 500 tablet of KFF, the Kaiser Family Foundation.)“Since Trump won the election in 2016, we now have consistently found that a larger share of the public holds favorable views” of the health law, said Ashley Kirzinger, associate director of public opinion and survey research for the foundation.

€œThis really solidified in 2017 after the failed repeal in the Senate.”The foundation’s polling found that, in July 2014, 55% of voters opposed the law, while 36% favored it. By July 2020, that had flipped, with 51% flagyl 500 tablet favoring the law and 38% opposing it. A shift was seen across all political groups, though 74% of Republicans still viewed it unfavorably in the latest poll.Public support for individual provisions of the ACA — such as protections for people with preexisting conditions or allowing young adults to stay on their parents’ health plans until age 26 — have proved even more popular than the law as a whole.

And the provision that consistently polled unfavorably — the mandate that those without insurance must pay a fine — was eliminated in 2017.“We’re 10 years along and the sky hasn’t caved in,” said Sabrina Corlette, a health policy professor at Georgetown University.Political MessagingFollowing the passage of the ACA, Democrats didn’t reference the law in their campaigns, said Erika Franklin Fowler, a government professor at Wesleyan University and the director of the Wesleyan Media Project, which tracks political advertising.“They ran on any other issue they could find,” Fowler said.Republicans, she said, kept promising to “repeal and replace” but weren’t able to do so.Then, in the 2018 election, Democrats flagyl 500 tablet seized on the shift in public opinion, touting the effects of the law and criticizing Republicans for their attempts to overturn it.“In the decade I have been tracking political advertising, there wasn’t a single-issue topic that was as prominent as health care was in 2018,” she said.As the global health crisis rages, health care concerns again dominate political ads in the 2020 races, Fowler said, although most ads haven’t explicitly focused on the ACA. Many highlight Republicans’ support for the lawsuit challenging preexisting condition protections or specific provisions of the ACA that their votes would have overturned. Republicans say they, too, will protect people with preexisting conditions but otherwise have largely flagyl 500 tablet avoided talking about the ACA.“Cory Gardner has been running a lot on his environmental bills and conservation funding,” Fowler said.

€œIt’s not difficult to figure out why he’s doing that. It’s easier for him to tout that in a state like Colorado flagyl 500 tablet than it is to talk about health care.”Similar dynamics are playing out in other key Senate races. In Arizona, flagyl 500 tablet Republican Sen.

Martha McSally was one of the more vocal advocates of repealing the ACA while she served in the House of Representatives. She publicly acknowledged those votes may have hurt her 2018 Senate bid.“I did vote to flagyl 500 tablet repeal and replace Obamacare,” McSally said on conservative pundit Sean Hannity’s radio show during the 2018 campaign. €œI’m getting my ass kicked for it right now.”She indeed lost but was appointed to fill the seat of Sen.

Jon Kyl after he resigned at the end of 2018 flagyl 500 tablet. Now McSally is in a tight race with Democratic challenger Mark Kelly, an astronaut and the husband of former Rep. Gabby Giffords.“Kelly doesn’t have a track record flagyl 500 tablet of voting one way or another, but certainly in his campaign this is one of his top speaking points.

What he would do to expand coverage and reassure people that coverage won’t be taken away,” said Derksen, the University of Arizona professor.The ACA has proved a stumbling block for Republican Sens. Thom Tillis of North Carolina and flagyl 500 tablet Joni Ernst of Iowa. In Maine, GOP Sen.

Susan Collins cast a key vote that prevented the repeal of flagyl 500 tablet the law but cast other votes that weakened it. She now also appears vulnerable — but more for her vote to confirm Brett Kavanaugh’s nomination to the Supreme Court and for not doing more to oppose President Donald Trump.In Montana, Daines, who voted to repeal the ACA, is trying to hold on to his seat against Democratic Gov. Steve Bullock, who used flagyl 500 tablet the law to expand the state’s Medicaid enrollment in 2015.

At its peak, nearly 1 in 10 Montanans were covered through the expansion.As more Montanans now face the high cost of paying flagyl 500 tablet for health care on their own amid flagyl-related job losses, Montana State University political science professor David Parker said he expects Democrats to talk about Daines’ votes to repeal cost-saving provisions of the ACA.“People are losing jobs, and their jobs bring health care with them,” Parker said. €œI don’t think it’s a good space for Daines to be right now.” Markian Hawryluk. MarkianH@kff.org, @MarkianHawryluk Related Topics Elections Health Care Costs Health Care Reform Insurance States Arizona flagyl 500 tablet Colorado Montana North Carolina Obamacare PlansLatest Prevention &.

Wellness News FRIDAY, Aug. 28, 2020 (HealthDay News) -- A warning about alcohol-based hand sanitizers in flagyl 500 tablet packaging that looks like food or drink has been issued by the U.S. Food and Drug Administration."The agency has discovered that some hand sanitizers are being packaged in beer cans, children's food pouches, water bottles, juice bottles and vodka bottles," according to an FDA a news release.

"Additionally, the FDA has found hand sanitizers that contain food flavors, such as chocolate or raspberry."Reports received by the FDA include a person who bought what they believed was drinking water but was actually hand sanitizer, and a hand flagyl 500 tablet sanitizer using children's cartoons in marketing and sold in a pouch that resembled a snack, CNN reported."I am increasingly concerned about hand sanitizer being packaged to appear to be consumable products, such as baby food or beverages. These products could confuse consumers into accidentally ingesting a potentially deadly product. It's dangerous to add scents flagyl 500 tablet with food flavors to hand sanitizers which children could think smells like food, eat and get alcohol poisoning," FDA Commissioner Dr.

Stephen Hahn said in the release.Copyright © 2019 HealthDay. All rights reserved flagyl 500 tablet. QUESTION According to the USDA, there is no difference between a “portion” and a “serving.” See AnswerLatest Cancer News By Steven ReinbergHealthDay ReporterTHURSDAY, Aug.

27, 2020 (HealthDay News)Cancer patients who need radiation therapy shouldn't let fear of buy antibiotics delay their treatment, one hospital study suggests.Over six days in May, during the height of the flagyl in New Jersey, surfaces in the radiation oncology department at Robert Wood Johnson University Hospital in New Brunswick, N.J., were tested for buy antibiotics before cleaning.Of 128 samples taken in patient and staff areas and from equipment, flagyl 500 tablet including objects used by a patient with buy antibiotics, not one was positive for antibiotics, the flagyl that causes buy antibiotics, the study found.Patients can be reassured that surface contamination is minimal and necessary cancer treatment can go forward safely, said lead researcher Dr. Bruce Haffty, chairman of radiation oncology at Rutgers Cancer Institute in New Brunswick."Cancer care should and must continue in a buy antibiotics flagyl, and it can be delivered safely and effectively with minimal risk of acquiring a buy antibiotics from the radiation oncology environment, provided routine measures like mask-wearing, hand-washing, distancing and screening are in place and adhered to," Haffty said.The study does have some limitations. Because of the nature of environmental sampling, 100% of a surface could not be swabbed flagyl 500 tablet for analysis.

And no flagyl 500 tablet air samples were taken. But Haffty said that because no flagyl was found on surfaces, it's doubtful that any flagyl was present in the air."An important thing is that we did this testing before cleaning crews came in at the end of the day when there had been all kinds of traffic with patients and staff moving back and forth," he said.Patients and staff routinely wore masks, maintained social distance and washed their hands often, which is probably why no flagyl was found, Haffty said.Patients also were screened on arrival with temperature checks and questioned about flagyl symptoms, he added.Dr. Anthony D'Amico is chief of radiation oncology flagyl 500 tablet at Brigham and Women's Hospital in Boston.

He said, "This study corroborates what we have found."Overall, his hospital's rate is 2%, while that in the community next to the hospital is 9%, D'Amico said. But where there are people with lots of underlying conditions and less access to health care, the rate is 33%, he said."Hospitals seem to be safer flagyl 500 tablet right now than public settings -- protocols that people are using are working," D'Amico said.The takeaway. Patients need not put off treatment out of concern that they could be infected in the hospital."We have told patients not to delay radiation because of buy antibiotics, because cancer can be more life-threatening than buy antibiotics," he said.D'Amico's hospital treats patients diagnosed with buy antibiotics who need radiation before other patients arrive in the morning.

The department is cleaned after they leave flagyl 500 tablet and at the end of the day after all other patients have gone, he said.Patients with buy antibiotics symptoms must test negative before undergoing screening tests like mammography and colonoscopy, D'Amico added.In the waiting room, patients and staff wear masks and maintain distancing. Patients' temperatures are taken and they are asked about any symptoms, he said."Patients should feel safe that the person sitting next to them in a waiting room has been properly screened," D'Amico said.The findings were published online Aug. 27 in JAMA Oncology.Copyright © 2020 flagyl 500 tablet HealthDay.

All rights reserved. SLIDESHOW flagyl 500 tablet Skin Cancer Symptoms, Types, Images See Slideshow References SOURCES. Bruce Haffty, MD, associate vice chancellor, cancer programs, and chair, radiation oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, N.J..

Anthony D'Amico, MD, PhD, professor, radiation oncology, Harvard Medical School, and chief, flagyl 500 tablet genitourinary radiation oncology, Brigham and Woman's Hospital, Boston. JAMA Oncology, Aug. 27, 2020, flagyl 500 tablet onlineLatest Heart News THURSDAY, Aug.

27, 2020 (HealthDay News)Heart flagyl 500 tablet attack survivors are more likely to lose weight if their spouses join them in shedding excess pounds, new research shows."Lifestyle improvement after a heart attack is a crucial part of preventing repeat events," said study author Lotte Verweij, a registered nurse and Ph.D. Student at Amsterdam University of Applied Sciences, in the Netherlands. "Our study shows that when spouses join the effort to change habits, patients have a better chance of becoming healthier -- particularly when it comes to losing weight."The study included 411 heart attack survivors who, along with receiving usual care, were referred to up to three lifestyle change programs for weight loss, increased physical activity and quitting smoking.The patients' partners could attend the programs for free and flagyl 500 tablet were encouraged by nurses to take part.

Nearly half (48%) of the patients' partners participated, which was defined as attending at least once.Compared to those without a partner, patients with a participating partner were more than twice as likely to improve in at least one of the three areas (weight loss, exercise, smoking cessation) within a year, the findings showed.When the influence of partners was analyzed in the three areas separately, patients with a participating partner were more successful in shedding weight compared to patients without a partner, according to the study presented Thursday at a virtual meeting of the European Society of Cardiology. Such research is considered preliminary until published in a peer-reviewed journal.But partner participation did not improve heart attack survivors' likelihood of quitting smoking or becoming more physically active, according to the report."Patients with partners who joined the weight-loss program lost more weight compared to patients with a partner who did not join the program," Verweij said in a society news flagyl 500 tablet release."Couples often have comparable lifestyles, and changing habits is difficult when only one person is making the effort. Practical issues come into play, such as grocery shopping, but also psychological challenges, where a supportive partner may help maintain motivation," she explained.-- Robert PreidtCopyright © 2020 HealthDay.

All rights flagyl 500 tablet reserved. QUESTION In the U.S., 1 in every 4 deaths is caused by heart disease. See Answer References flagyl 500 tablet SOURCE.

European Society of Cardiology, news release, Aug. 27, 2020Latest Healthy Kids News THURSDAY, flagyl 500 tablet Aug. 27, 2020 (HealthDay News)If your child will be doing online learning this school year, you need to take steps to protect them from eye strain, the American Academy of Ophthalmology says."I really have seen a marked increase in kids suffering from eye strain because of increased screen time.

Good news is most symptoms can be avoided by taking a few simple steps," flagyl 500 tablet pediatric ophthalmologist Dr. Stephen Lipsky, a clinical spokesperson for the academy, said in an academy news release.Here he offers these remote-learning recommendations to protect your child's vision:Set a timer to remind your child to take a break every 20 minutes. Alternate reading flagyl 500 tablet on an e-book with a real book.

Encourage children to look up and out the window every two chapters or to shut their eyes for 20 flagyl 500 tablet seconds.Mark books with paperclips every few chapters. When they reach a paper clip, it will remind them look up. On an flagyl 500 tablet e-book, use the bookmark function for the same effect.Make sure children use laptops at arm's length (about 18 to 24 inches) from where they're sitting.

Ideally, they should have a monitor positioned at eye level, directly in front of the body. Tablets should also be held at arm's length.To reduce glare, position the light flagyl 500 tablet source behind the child's back, not behind the screen. Adjust the brightness and contrast on the screen so that it feels comfortable for children.

Don't use a flagyl 500 tablet device outside or in brightly lit areas. The glare on the screen can cause eye strain.Children shouldn't use a device in a dark room. As the pupil expands to adjust to the darkness, the brightness flagyl 500 tablet of the screen can aggravate after-images and cause discomfort.Children should stop using devices 30 to 60 minutes before bedtime.

Blue light may disrupt sleep. If teens don't want to do this, have them switch to night mode or a similar mode to reduce blue light exposure.When study time is over, make sure children flagyl 500 tablet spend time outdoors. Several studies suggest that spending time outdoors, especially in early childhood, can slow the progression of nearsightedness.-- Robert PreidtCopyright © 2020 HealthDay.

All rights reserved flagyl 500 tablet. QUESTION What causes dry flagyl 500 tablet eyes?. See Answer References SOURCE.

American Academy of flagyl 500 tablet Ophthalmology, news release, Aug. 13, 2020Latest Heart News THURSDAY, Aug. 27, 2020 flagyl 500 tablet (American Heart Association News)"Something's not right," Marranda Edwards told her aunt in San Antonio.

"I'm coming there."Edwards, who lives outside of Atlanta, had been worried for several days. Her mother, Alvis Whitlow, hadn't been calling as often flagyl 500 tablet as usual, which could easily be five times a day. And when they did speak, Whitlow sounded confused and weak.In late March, a call from Edwards' aunt added to her suspicions.

The aunt reported that Whitlow had gastrointestinal problems and couldn't walk to the bathroom without assistance flagyl 500 tablet. That's when Edwards knew she needed to act.Edwards took the first flight she could find, with her husband staying home to take care of their three children and six foster children.On the way to Texas, Edwards thought about the last time she sensed something was seriously wrong with her mom. It was in 2003, when she too lived in San Antonio.Someone from the beauty shop where Whitlow was getting her hair done called to say her mother had thrown up and felt flagyl 500 tablet weak.

This stood out because for much of that week, her mom complained of having a headache, which was unusual."Something's not right," Edwards told the woman at the beauty shop. "I'm coming there."Edwards called an ambulance to check flagyl 500 tablet on her mom. As paramedics examined Whitlow, her heart stopped.At the hospital, doctors determined that an aneurysm burst in her brain, leading to bleeding.

They believed it was flagyl 500 tablet caused by undiagnosed hypertension. She needed to undergo a procedure to stop the bleeding. The chance of survival was 20%, doctors told Edwards.The procedure worked.

And the damage wasn't as severe as feared.After two months of rehabilitation, Whitlow returned to work. She retired four years later, in 2007, at age 53, after nearly three decades with the San Antonio school system.Since then, Whitlow remained active and healthy, spending time with friends, family and church activities. She also visited Edwards and her family several times a year.Having arrived in San Antonio for the urgent visit, the first thing Edwards noticed was how weak her mother seemed.Whitlow also was coughing.

By the next day, it sounded like wheezing."I thought it might be bronchitis, but it started sounding worse," Edwards said.When a trip from the living room to the bedroom left Whitlow out of breath, Edwards called 911.Paramedics measured her temperature at 102 and her blood oxygen level at 87% instead of in the usual high 90s."Then I just knew it," Edwards said. "She's got it. She's got the antibiotics."Edwards followed the ambulance to the hospital but wasn't allowed inside.

The next day, the doctor called, confirming Whitlow had buy antibiotics and saying she was on a ventilator. He said she'd also need to be transferred to a hospital set up for buy antibiotics patients."I need you to prepare," the doctor told Edwards. "The patients we've seen with her age and history and how she presented, she only has a 20% chance of living."Edwards thought.

"Here it was again. A 20% chance."Whitlow spent more than two weeks on a ventilator. Doctors tried to remove her from the ventilator twice, but each time she needed the mechanical help again within eight hours."You have to make a serious decision," doctors told Edwards.The options.

Insert a breathing tube, perhaps permanently, and go to a long-term acute care facility, or stay in the hospital – but when the ventilator is removed, it won't be put back in place.Edwards drove to the hospital, sat on the curb to be as close to her mother as possible. Then she began praying."What do I do?. " she thought.

"What do I do?. "Edwards called the hospital with her decision.Put in the tube.Whitlow was transferred to a hospital that specializes in weaning patients off ventilators. Although Edwards still couldn't be with her mom, they could smile, wave and blow kisses through a window.

After her breathing tube was removed, they could again talk on the phone.On May 11, after 27 days of acute care and a total of 24 days on a ventilator, Whitlow went home. Leaving the hospital, she refused a wheelchair, allowing her to walk into Edwards' waiting arms for their first hug in six weeks. Hospital staffers surrounded them, cheering their reunion."I didn't expect all that applause," Whitlow said.

"It made me feel really good, just blessed."The next day, a parade of more than 100 family, sorority and church members drove by to celebrate her recovery.Edwards, who is an assistant principal at a middle school, brought Whitlow back with her to Georgia. She arrived to more fanfare – a huge yard sign and cheering family members."God blessed me to be alive and to have someone here like Marranda to take care of me," Whitlow said. "Without her, I don't know what I would have done."American Heart Association News covers heart and brain health.

Not all views expressed in this story reflect the official position of the American Heart Association. Copyright is owned or held by the American Heart Association, Inc., and all rights are reserved. SLIDESHOW Stroke Causes, Symptoms, and Recovery See Slideshow.

SOBRE NOTICIAS EN ESPAÑOLNoticias en español es una sección de Kaiser Health News que buy flagyl for dogs contiene traducciones de artículos de gran interés para la comunidad hispanohablante, y contenido original enfocado en la población hispana que vive en los Estados like it Unidos. Use Nuestro buy flagyl for dogs Contenido Este contenido puede usarse de manera gratuita (detalles). La temporada de influenza se verá diferente este año, ya que los Estados Unidos se enfrentan a una pandemia de antibiotics que ya ha matado a más de 176.000 personas.Muchos estadounidenses son reacios a ir al médico y los funcionarios de salud pública temen que las personas eviten vacunarse. Aunque a veces se considera incorrectamente como un resfriado, la gripe buy flagyl for dogs también mata a decenas de miles de personas en el país cada año. Los más vulnerables son los niños pequeños, los adultos mayores y las personas con enfermedades subyacentes.

Cuando se combina con los efectos de buy antibiotics, los expertos en salud pública dicen que es más importante que nunca vacunarse contra la gripe.Si una cantidad suficiente de la población se vacuna, más del 45% lo hizo la temporada de gripe pasada, buy flagyl for dogs podría ayudar a evitar un escenario de pesadilla este invierno, con hospitales llenos de pacientes con buy antibiotics y los que sufren los efectos graves de la influenza.Además de la posible carga para los hospitales, existe la posibilidad de que las personas contraigan ambos flagyl y “nadie sabe qué sucede si se contrae influenza y buy antibiotics simultáneamente porque nunca sucedió antes”, dijo la doctora Rachel Levine, secretaria de Salud de Pennsylvania, a reporteros.En respuesta, este año los fabricantes están produciendo más suministros de vacunas, entre 194 y 198 millones de dosis, unas 20 millones más de las que se distribuyeron la temporada pasada, según los Centros para el Control y Prevención de Enfermedades (CDC).Mientras se acerca la temporada de gripe, aquí hay algunas respuestas a preguntas frecuentes:P. ¿Cuándo debo vacunarme contra la gripe?. La publicidad ya ha comenzado y algunas farmacias buy flagyl for dogs y clínicas ya tienen sus suministros. Pero, debido a que la efectividad de la vacuna puede disminuir con el tiempo, los CDC recomiendan no recibir la dosis en agosto.Muchas farmacias y clínicas comenzarán las inmunizaciones a principios de septiembre. Generalmente, los flagyl de la influenza comienzan a buy flagyl for dogs circular a mediados o fines de octubre, pero se expanden masivamente más tarde, en el invierno.

Se necesitan aproximadamente dos semanas después de recibir la inyección para que los anticuerpos, que circulan en la sangre y frustran las infecciones, se acumulen.“Las personas jóvenes y sanas pueden comenzar a vacunarse contra la gripe en septiembre, y las personas mayores y otras poblaciones vulnerables pueden hacerlo en octubre”, dijo el doctor Steve Miller, director clínico de la aseguradora Cigna.Los CDC recomiendan que las personas “se vacunen contra la influenza a fines de octubre”, pero señalaron que se puede recibir la vacuna más tarde porque “aún puede ser beneficiosas y la vacunación debe ofrecerse a lo largo de toda la temporada de influenza”.Aun así, algunos expertos recomiendan no esperar demasiado este año, no solo por buy antibiotics, sino también en caso de que haya escasez debido a la abrumadora demanda.P. ¿Cuáles son las razones por las que las que debería ofrecer mi buy flagyl for dogs brazo para vacunarme?. Hay que vacunarse porque brinda protección contra la gripe y, por lo tanto, contra la propagación a otras personas, lo que puede ayudar a disminuir la carga para los hospitales y el personal médico.Y hay otro mensaje que puede resonar en estos tiempos extraños.“Le da a la gente la sensación de que hay algunas cosas que pueden controlar”, dijo Eduardo Sánchez, director médico de prevención de la American Heart Association.Si bien una vacuna contra la gripe no evitará buy antibiotics, recibirla podría ayudar al médico a diferenciar entre las dos enfermedades si se desarrolla algún síntoma (fiebre, tos, dolor de garganta) que ambas infecciones comparten, explicó Sánchez.Y aunque las vacunas contra la gripe no evitarán todos los casos de gripe, vacunarse puede reducir la gravedad si la persona se enferma, dijo.Todas las personas elegibles, especialmente los trabajadores esenciales, los que sufren de afecciones subyacentes y aquellos en mayor riesgo, incluidos los niños muy pequeños y las mujeres embarazadas, deben buscar protección, dijeron los CDC. La entidad recomienda la vacunación a partir de los 6 meses.P buy flagyl for dogs. ¿Qué sabemos sobre la buy flagyl for dogs efectividad de la vacuna de este año?.

Se deben producir nuevas vacunas contra la gripe cada año, porque el flagyl muta y la efectividad de la vacuna varía, dependiendo de qué tan bien coincida con el flagyl circulante.Se calculó que la formulación del año pasado tuvo una eficacia de aproximadamente un 45% para prevenir la gripe en general, con una efectividad de aproximadamente un 55% en los niños. Las vacunas disponibles en el país este año tienen como objetivo prevenir al menos buy flagyl for dogs tres cepas diferentes del flagyl, y la mayoría cubre cuatro.Todavía no se sabe qué tan bien coincidirá el suministro de este año con las cepas que circularán en los Estados Unidos. Las primeras indicaciones del hemisferio sur, que atraviesa su temporada de gripe durante nuestro verano, son alentadoras. Allí, las personas practicaron el distanciamiento social, usaron máscaras y buy flagyl for dogs se vacunaron en mayor número este año, y los niveles mundiales de gripe son más bajos de lo esperado. Sin embargo, expertos advierten que no se debe contar con una temporada igual de suave en los Estados Unidos, en parte porque los esfuerzos por usar mascara facial y de distanciamiento social varían ampliamente.P.

¿Qué están haciendo diferente los seguros y sistemas buy flagyl for dogs de salud este año?. Las aseguradoras y los sistemas de salud contactados por KHN dicen que seguirán las pautas de los CDC, que exigen limitar y espaciar la cantidad de personas que esperan en las filas y las áreas de vacunación. Algunos están programando citas para vacunas contra la gripe para ayudar a controlar el flujo.Health Fitness Concepts, una compañía que trabaja con UnitedHealth Group y otras empresas para establecer clínicas de vacunación contra la gripe en el noreste del país, dijo que está “fomentando eventos más pequeños y frecuentes para apoyar el distanciamiento social” y “exigiendo que se completen todos los formularios y arremangarse las camisas antes de entrar al área de vacunación contra la influenza”.Se requerirá que todos usen máscaras.Además, a nivel nacional, algunos grupos médicos contratados por UnitedHealth instalarán carpas, para buy flagyl for dogs que las inyecciones se puedan administrar al aire libre, dijo un vocero.Kaiser Permanente planifica las vacunas directamente en autos en algunos de sus centros médicos y está probando los procedimientos de detección y registro sin contacto en algunos lugares.Geisinger Health, un proveedor de salud regional en Pennsylvania y Nueva Jersey, dijo que también tendría programas de vacunación contra la influenza al aire libre en sus instalaciones.Además, “Geisinger exige que todos los empleados reciban la vacuna contra la influenza este año”, dijo Mark Shelly, director de prevención y control de infecciones del sistema. €œAl dar este paso, esperamos transmitir a nuestros vecinos la importancia de la vacuna contra la influenza para todos”.P. Por lo general, me vacunan contra la gripe buy flagyl for dogs en el trabajo.

¿Seguirá siendo una opción este año?. Con el objetivo de buy flagyl for dogs evitar riesgosas reuniones en interiores, muchos empleadores se muestran reacios a patrocinar las clínicas de gripe en oficinas como han ofrecido en años anteriores. Y con tanta gente que sigue trabajando desde casa, hay menos necesidad de llevar las vacunas contra la gripe al lugar de trabajo. En cambio, muchos empleadores buy flagyl for dogs están alentando a los trabajadores a que reciban vacunas de sus médicos de atención primaria, en farmacias u otros entornos comunitarios. El seguro generalmente cubrirá el costo de la vacuna.Algunos empleadores están considerando ofrecer cupones para vacunas contra la buy flagyl for dogs gripe a sus trabajadores sin seguro o a aquellos que no participan en el plan médico de la compañía, dijo Julie Stone, directora general de salud y beneficios de Willis Towers Watson, una firma consultora.Estos cupones podrían, por ejemplo, permitir a los trabajadores obtener la vacuna en un laboratorio en particular sin costo.Algunos empleadores están comenzando a pensar en cómo podrían usar sus estacionamientos para administrar vacunas contra la gripe enlos autos, dijo el doctor David Zieg, líder de servicios clínicos para el consultor de beneficios Mercer.Aunque la ley federal permite a los empleadores exigir a los empleados que se vacunen contra la gripe, ese paso generalmente lo toman solo los centros de atención médica y algunas universidades donde las personas viven y trabajan en estrecha colaboración, dijo Zieg.Pero sucede.

El mes pasado, el sistema de la Universidad de California emitió una orden ejecutiva que requiere que todos los estudiantes, profesores y personal se vacunen contra la gripe antes del 1 de noviembre, con limitadas excepciones.P. ¿Qué están haciendo las farmacias para buy flagyl for dogs alentar a las personas a vacunarse contra la gripe?. Algunas farmacias están haciendo un esfuerzo adicional para salir a la comunidad y ofrecer vacunas contra la gripe.Walgreens, que tiene casi 9,100 farmacias en todo el país, continúa una asociación iniciada en 2015 con organizaciones comunitarias, iglesias y empleadores que ha ofrecido alrededor de 150,000 clínicas de gripe móviles hasta la fecha.El programa pone especial énfasis en trabajar con poblaciones vulnerables y en áreas desatendidas, dijo el doctor Kevin Ban, director médico de la cadena de farmacias.Walgreens comenzó a ofrecer vacunas contra la gripe a mediados de agosto y está animando a las personas a no demorar en vacunarse.Tanto Walgreens como CVS están estimulando a las personas a programar citas y hacer trámites en línea este año para minimizar el tiempo que pasan en los locales.En los CVS MinuteClinic, una vez que los pacientes se han registrado para recibir la vacuna contra la gripe, deben esperar afuera o en su automóvil, ya que las áreas de espera interiores ahora están cerradas.“No tenemos un arsenal contra buy antibiotics”, dijo Ban, de Walgreens. €œPero quitar la presión del sistema de atención médica proporcionando vacunas por adelantado es algo buy flagyl for dogs que sí podemos hacer”. Julie Appleby.

jappleby@kff.org, buy flagyl for dogs @Julie_Appleby Michelle Andrews. andrews.khn@gmail.com, @mandrews110 Related Topics Insurance Noticias En Español Public Health buy antibiotics Insurers treatmentsThis story was produced in partnership with PolitiFact. This story can be republished for free (details). President Donald Trump accepted the Republican Party’s nomination for president in a 70-minute speech from the South Lawn of the White House on Thursday night.Speaking to a friendly crowd that didn’t appear to be observing social distancing conventions, and with few participants wearing masks, he touched on a range of topics, including many related to the buy antibiotics flagyl and health care in general.Throughout, the partisan crowd buy flagyl for dogs applauded and chanted “Four more years!. € And, even as the nation’s buy antibiotics death toll exceeded 180,000, Trump was upbeat. €œIn recent months, our nation and the entire planet has been struck by a new and powerful invisible enemy,” he said buy flagyl for dogs.

€œLike those brave Americans before us, we are meeting this challenge.”At the end of the event, there were fireworks.Our partners at PolitiFact did an in-depth fact check on Trump’s entire acceptance speech. Here are the highlights related to the administration’s buy antibiotics response and other health policy issues:“We developed, from scratch, the largest and most advanced testing system in the world.” This is partially buy flagyl for dogs right, but it needs context.It’s accurate that the U.S. Developed its buy antibiotics testing system from scratch, because the government didn’t accept the World Health Organization’s testing recipe. But whether the system is the “largest” or “most advanced” is buy flagyl for dogs subject to debate.The U.S. Has tested more individuals than any other buy flagyl for dogs country.

But experts told us a more meaningful metric would be the percentage of positive tests out of all tests, indicating that not only sick people were getting tested. Another useful metric would be the buy flagyl for dogs percentage of the population that has been tested. The U.S. Is one of the most populous countries but buy flagyl for dogs has tested a lower percentage of its population than other countries. Don't Miss A Story Subscribe to KHN’s free Weekly Edition newsletter.

The buy flagyl for dogs U.S. Was also slower than other countries in rolling out tests and amping up testing capacity. Even now, many states are experiencing delays in reporting test results to positive individuals.As for “the most advanced,” Trump may be referring to new testing investments and systems, like Abbott’s recently announced $5, 15-minute rapid antigen test, which the company says will be buy flagyl for dogs about the size of a credit card, needs no instrumentation and comes with a phone app through which people can view their results. But Trump’s comment makes it sound as if these testing systems are already in place when they haven’t been distributed to the public.“The United States has among the lowest [buy antibiotics] case fatality rates of any major country in the world. The European Union’s case fatality rate is nearly three times higher than ours.”The case fatality rate measures the known number of cases against the known number buy flagyl for dogs of deaths.

The European Union has a rate that’s about 2½ times greater than the United States.But the source of that data, Oxford University’s Our World in Data project, reports that “during an outbreak of a flagyl, the case fatality rate is a poor measure of the mortality risk of the disease.”A better way to measure the threat of the flagyl, experts say, is to look at the number of deaths per 100,000 residents. Viewed that buy flagyl for dogs way, the U.S. Has the 10th-highest death rate in the world.“We will produce a treatment before the end of the year, buy flagyl for dogs or maybe even sooner.”It’s far from guaranteed that a antibiotics treatment will be ready before the end of the year.While researchers are making rapid strides, it’s not yet known precisely when the treatment will be available to the public, which is what’s most important. Six treatments are in the third phase of testing, which involves thousands of patients. Like earlier phases, this one looks at the safety of a treatment but also examines its buy flagyl for dogs effectiveness and collects more data on side effects.

Results of the third phase will be submitted to the Food and Drug Administration for approval.The government website Operation Warp Speed seems less optimistic than Trump, announcing it “aims to deliver 300 million doses of a safe, effective treatment for buy antibiotics by January 2021.”And federal health officials and other experts have generally predicted a treatment will be available in early 2021. Federal committees are working on recommendations for treatment distribution, including which groups should get it buy flagyl for dogs first. €œFrom everything we’ve seen now — in the animal data, as well as the human data — we feel cautiously optimistic that we will have a treatment by the end of this year and as we go into 2021,” said Dr. Anthony Fauci, the buy flagyl for dogs nation’s top infectious diseases expert. €œI don’t think it’s dreaming.”“Last month, I took on Big Pharma.

You think buy flagyl for dogs that is easy?. I signed orders that would massively lower the cost of your prescription drugs.”Quite misleading. Trump signed four executive orders on July 24 aimed at lowering prescription buy flagyl for dogs drug prices. But those orders haven’t taken effect yet — the text of one hasn’t even been made publicly available — and experts told us that, if implemented, the measures would be unlikely to result in significant drug price reductions for the majority of Americans.“We will always and very strongly protect patients with preexisting conditions, and that is a pledge from the entire Republican Party.”Trump’s pledge is undermined by his efforts to overturn the Affordable Care Act, the only law that guarantees people with preexisting conditions both receive health coverage and do not have to pay more for it than others do. In 2017, Trump supported congressional efforts to buy flagyl for dogs repeal the ACA.

The Trump administration is now backing GOP-led efforts to overturn the ACA through a court case. And Trump has also buy flagyl for dogs expanded short-term health plans that don’t have to comply with the ACA.“Joe Biden recently raised his hand on the debate stage and promised he was going to give it away, your health care dollars to illegal immigrants, which is going to bring a massive number of immigrants into our country.”This is misleading. During a June 2019 Democratic primary debate, candidates buy flagyl for dogs were asked. €œRaise your hand if your government plan would provide coverage for undocumented immigrants.” All candidates on stage, including Biden, raised their hands. They were not asked if that coverage would be free or subsidized.Biden supports extending buy flagyl for dogs health care access to all immigrants, regardless of immigration status.

A task force recommended that he allow immigrants who are in the country illegally to buy health insurance, without federal subsidies.“Joe Biden claims he has empathy for the vulnerable, yet the party he leads supports the extreme late-term abortion of defenseless babies right up to the moment of birth.”This mischaracterizes the Democratic Party’s stance on abortion and Biden’s position.Biden has said he would codify the Supreme Court’s ruling in Roe v. Wade and buy flagyl for dogs related precedents. This would generally limit abortions to the first 20 to 24 weeks of gestation. States are allowed buy flagyl for dogs under court rulings to ban abortion after the point at which a fetus can sustain life, usually considered to be between 24 and 28 weeks from the mother’s last menstrual period — and 43 states do. But the rulings require states to make exceptions “to preserve the life or health of the mother.” Late-term abortions are very rare, about 1%.The Democratic Party platform holds that “every woman should have access to quality reproductive health care services, including safe and legal abortion — regardless of where she lives, how much money she makes, or how she is insured.” It does not address late-term abortion.PolitiFact’s Daniel Funke, Jon Greenberg, Louis Jacobson, Noah Y.

Kim, Bill buy flagyl for dogs McCarthy, Samantha Putterman, Amy Sherman, Miriam Valverde and KHN reporter Victoria Knight contributed to this report. Related Topics Elections Health Industry Pharmaceuticals Public Health The Health Law Abortion buy antibiotics Immigrants KHN &. PolitiFact HealthCheck buy flagyl for dogs Preexisting Conditions Trump Administration treatmentsThis story also ran on CNN. This story can be republished for free (details). Flu season will look different this year, as the country grapples with a antibiotics flagyl that has killed more than 172,000 people. Many Americans are reluctant to visit a doctor’s office and public health officials worry people will shy away from being immunized.Although sometimes incorrectly regarded as just another bad cold, flu also kills tens of thousands of people in the U.S. Each year, with the very young, the buy flagyl for dogs elderly and those with underlying conditions the most vulnerable.

When coupled with the effects of buy antibiotics, public health experts say it’s more important than ever to get a flu shot.If enough of the U.S. Population gets vaccinated — more than the 45% who did last flu season — it could help head off a nightmare scenario in the coming winter of hospitals stuffed with both buy antibiotics patients and those suffering from buy flagyl for dogs severe effects of influenza.Aside from the potential burden on hospitals, there’s the possibility people could get both flagyles — and “no one knows what happens if you get influenza and buy antibiotics [simultaneously] because it’s never happened before,” Dr. Rachel Levine, Pennsylvania’s secretary of health, told reporters this month.In response, manufacturers are producing more treatment supply this year, between 194 million and 198 million doses, or about 20 million more than they buy flagyl for dogs distributed last season, according to the Centers for Disease Control and Prevention. Email Sign-Up Subscribe to KHN’s free Morning Briefing. As flu season approaches, here are buy flagyl for dogs some answers to a few common questions:Q.

When should I get my flu shot?. Advertising has already begun, and some pharmacies buy flagyl for dogs and clinics have their supplies now. But, because the effectiveness of the treatment can wane over time, the CDC recommends against a shot in August.Many pharmacies and clinics will start immunizations in early September. Generally, influenza flagyles start circulating buy flagyl for dogs in mid- to late October but become more widespread later, in the winter. It takes about two weeks after getting a shot for antibodies — which circulate in the blood and thwart s — to build up.

€œYoung, healthy people can begin getting their flu shots in September, and elderly people and buy flagyl for dogs other vulnerable populations can begin in October,” said Dr. Steve Miller, chief clinical officer for insurer Cigna.The CDC has recommended that people “get a flu treatment by the end of October,” but noted it’s not too late to get one after that because shots “can still be beneficial and vaccination should be offered throughout the flu season.”Even so, some experts say not to wait too long this year — not only because of buy antibiotics, but also in case a shortage develops because of overwhelming demand.Q. What are buy flagyl for dogs the reasons I should roll up my sleeve for this?. Get a shot because it protects you from catching the flu and spreading it to others, which may help lessen the burden on hospitals and medical staffs.And there’s another message that may resonate in this strange time.“It gives people a sense that there are some things you can control,” said Eduardo Sanchez, chief medical officer for prevention at the American Heart Association.While a flu shot won’t prevent buy antibiotics, he said, getting one could help your doctors differentiate between the diseases if you develop any symptoms — fever, cough, sore throat — they share.And even though flu shots won’t prevent all cases of the flu, getting vaccinated can lessen the severity if you do fall ill, he said.You cannot get influenza from having a flu treatment.All eligible people, especially essential workers, those with underlying conditions and those at higher risk — including very young children and pregnant women — should seek protection, the CDC said. It recommends that buy flagyl for dogs children over 6 months old get vaccinated.Q.

What do we know about the effectiveness of this year’s treatment?. Flu treatments — which must be developed anew each year buy flagyl for dogs because influenza flagyles mutate — range in effectiveness annually, depending on how well they match the circulating flagyl. Last year’s formulation was estimated to be about 45% buy flagyl for dogs effective in preventing the flu overall, with about a 55% effectiveness in children. The treatments available in the U.S. This year are aimed at preventing at least three strains of the flagyl, and most buy flagyl for dogs cover four.It isn’t yet known how well this year’s supply will match the strains that will circulate in the U.S.

Early indications from the Southern Hemisphere, which goes through its flu season during our summer, are encouraging. There, people practiced social distancing, wore masks and got vaccinated in greater numbers this year — and global buy flagyl for dogs flu levels are lower than expected. Experts caution, however, not to count on a similarly mild season in the U.S., in part because masking and social distancing efforts vary widely.Q. What are insurance plans and health systems buy flagyl for dogs doing differently this year?. Insurers and health systems contacted by KHN say they will follow CDC guidelines, which call for limiting and spacing out the number of people waiting in lines and vaccination areas.

Some are setting appointments for flu shots to help manage the flow.Health Fitness buy flagyl for dogs Concepts, a company that works with UnitedHealth Group and other businesses to set up flu shot clinics in the Northeast, said it is “encouraging smaller, more frequent events to support social distancing” and “requiring all forms to be completed and shirtsleeves rolled up before entering the flu shot area.” Everyone will be required to wear masks.Also, nationally, some physician groups contracted with UnitedHealth will set up tent areas so shots can be given outdoors, a spokesperson said.Kaiser Permanente plans drive-thru vaccinations at some of its medical facilities and is testing touch-free screening and check-in procedures at some locations. (KHN is not affiliated with Kaiser Permanente.)Geisinger Health, a regional health provider in Pennsylvania and New Jersey, said it, too, would have outdoor flu vaccination programs at its facilities.Additionally, “Geisinger is making it mandatory for all employees to receive the flu treatment this year,” said Mark Shelly, the system’s director of prevention and control. €œBy taking this step, we hope to convey to our neighbors the importance of the flu treatment for buy flagyl for dogs everyone.”Q. Usually I get a flu shot at work. Will that be buy flagyl for dogs an option this year?.

Aiming to avoid risky buy flagyl for dogs indoor gatherings, many employers are reluctant to sponsor the on-site flu clinics they’ve offered in years past. And with so many people continuing to work from home, there’s less need to bring flu shots to employees on the job. Instead, many employers are encouraging workers to get buy flagyl for dogs shots from their primary care doctors, at pharmacies or in other community settings. Insurance will generally cover the cost of the treatment.Some employers are considering offering vouchers for flu shots to their uninsured workers or those who don’t participate in the company plan, said Julie Stone, managing director for health and benefits at Willis Towers Watson, a consulting firm. The vouchers could allow workers to get the shot at a particular lab at no cost, buy flagyl for dogs for example.Some employers are starting to think about how they might use their parking lots for administering drive-thru flu shots, said Dr.

David Zieg, clinical services leader for benefits consultant Mercer.Although federal law allows employers to require employees to get flu shots, that step is typically taken only by health care facilities and some universities where people live and work closely together, Zieg said.Q. What are pharmacies doing to encourage people to get buy flagyl for dogs flu shots?. Some pharmacies are making an extra push to get out into the community to offer flu shots.Walgreens, which has nearly 9,100 pharmacies nationwide, is continuing a partnership begun in 2015 with community organizations, churches and employers that has offered about 150,000 off-site and mobile flu clinics to date.The program places a special emphasis on working with vulnerable populations and in underserved areas, said Dr. Kevin Ban, chief medical officer for the drugstore chain.Walgreens began offering flu shots in mid-August and is encouraging people not to delay getting vaccinated.Both Walgreens and CVS are encouraging people to schedule appointments and do paperwork online this year to minimize time spent in the stores.At CVS MinuteClinic locations, once patients have checked in for their flu shot, they must wait outside or in their car, since the indoor waiting areas are buy flagyl for dogs now closed.“We don’t have tons of arrows in our quiver against buy antibiotics,” Walgreens’ Ban said. €œTaking pressure off the health care system by providing treatments in advance is one thing we can do.” Julie Appleby.

jappleby@kff.org, @Julie_Appleby buy flagyl for dogs Michelle Andrews. andrews.khn@gmail.com, @mandrews110 Related Topics Insurance Public Health buy antibiotics Insurers treatmentsUse Our Content This story can be republished for free (details). As the smoke thickened near her home in Santa Cruz, California, last week, Amanda Smith kept asking herself the same questions. Should we buy flagyl for dogs leave?. And where would we go?. The wildfire buy flagyl for dogs evacuation zone, at the time, ended a few blocks from her house.

But she worried about what the air quality — which had reached the second-highest warning level, purple for “very unhealthy” — would do to her children’s lungs buy flagyl for dogs. Her 4-year-old twins had spent time in the neonatal intensive care unit. One was later diagnosed with asthma, and last year buy flagyl for dogs was hospitalized with pneumonia.By Tuesday, said Smith, “we all had headaches, the kids were coughing a little bit, and it was raining ash.” The family had been conscientiously isolating at home because of the buy antibiotics flagyl, and leaving meant potential exposures. But on Wednesday, Smith said, “I looked at my partner and said, maybe we should leave.”She called a friend in Orange County, about 380 miles south, who offered her parents’ empty condo. But the next day, the friend’s child spiked a fever — a possible case of buy antibiotics — and the plan fell through amid the distraction.Amanda Smith takes buy flagyl for dogs a selfie of herself and her twin children in Santa Cruz, California, in April.

(Amanda Smith)So Smith looked on Airbnb, careful to seek out hosts who detailed their buy antibiotics precautions, and found an apartment in San Bruno, about an hour’s drive north. She stuffed photos and documents into a suitcase, grabbed the go-bags, and her family headed out.“It’s coming out of our savings to stay here,” Smith buy flagyl for dogs said from the safety of her apartment rental, which runs about $1,150 a week. €œIt was a really fraught decision to leave, but as soon as we got over the hill and the sky was blue, I took a big sigh of relief and knew that it had been a good decision.”As the twin disasters of buy antibiotics and fire season sweep through California, thousands of residents like Smith are weighing difficult options, pitting risk against risk as they decide where to evacuate, whether from imminent flames or the toxic air. Amid a virulent flagyl, which is safest? buy flagyl for dogs. Doubling up at a friend’s home?.

A buy flagyl for dogs hotel?. An evacuation center?. And when do the risks of smoke inhalation outweigh the risk of buy flagyl for dogs a deadly ?. €œObviously the most important thing is for people to do what they can to protect their lives, not only from the fire, but also from buy antibiotics,” said Detective Rosemerry Blankswade, public information officer for the San Mateo County Sheriff’s Office, which is helping coordinate response to the massive CZU Lightning Complex fires.“You have to evaluate the big picture here. If fire is buy flagyl for dogs your most imminent danger, maybe take the buy antibiotics risk.

But if you can avoid both of them, that’s obviously going to be the buy flagyl for dogs best option. It’s kind of a little bit of triage that we’re asking for people to do in their own lives right now.” Email Sign-Up Subscribe to KHN’s free Morning Briefing. In buy flagyl for dogs San Mateo, one of two counties where the CZU Lightning Complex fires are blazing, officials are advising people to head to an evacuation center, where county workers will assist them in finding a hotel room. Meanwhile, in neighboring Santa Cruz, where tens of thousands of residents have evacuated and shelters have limited space, officials are asking those under orders to leave to stay with family and friends whenever possible.What’s the right choice when all options pose additional risks?. We spoke with several experts to help guide your thought process.You buy flagyl for dogs have to evacuate.

Where should you go?. If your buy flagyl for dogs region is under an evacuation order, do not hesitate. Leave immediately. If you can afford it, booking a room at a hotel or motel buy flagyl for dogs outside the evacuation zones may be the best option, said Dr. Michael Wilkes, a professor at the University of California-Davis School of Medicine.

They almost always have air-conditioning units, which buy flagyl for dogs help filter the air from both smoke and flagyl. Many hotels are implementing new cleaning processes. Ask staffers to detail what they’re doing to sanitize rooms, and consider skipping the daily cleaning service during your stay buy flagyl for dogs. You might also check review sites such as TripAdvisor to see what other guests report. When possible, avoid the lobby and other shared spaces, and opt for contactless check-in.Amanda Smith at home in Santa Cruz, California, with her twin buy flagyl for dogs children.

Smith and her family decided to voluntarily buy flagyl for dogs evacuate their home on Aug. 20, due to heavy smoke in the area from the CZU Lightning Complex fires in the nearby Santa Cruz Mountains. (Anna Maria Barry-Jester/KHN)With so many people in Northern California fleeing the fires, many hotels buy flagyl for dogs are already full, especially in more remote areas. So what about staying with family or friends?. After months of being shut in and avoiding close contact beyond immediate family, moving into someone buy flagyl for dogs else’s home means a host of potential exposures.

Consider whether you or anyone else in the home is at high risk from buy antibiotics because of age or a preexisting condition.“If so, that’s a reason to think twice before going to someone’s home,” said Dr. Gina Solomon, a buy flagyl for dogs program director at how to order flagyl online the Oakland-based Public Health Institute.Consider, too, what precautions your friends or family have been taking. Sheltering with someone whose job brings them into frequent contact with other people may not be as safe as sheltering with people who largely have been staying home. Another question is how crowded the buy flagyl for dogs home is. If you have your own room and, preferably, your own bathroom, that makes staying with friends a better option.

If a separate bedroom is not available and smoky skies are not a problem, you might consider pitching a tent in their backyard.For those with an RV or tent, camping can present buy flagyl for dogs another good option — although, with hundreds of wildfires burning across California, it may be challenging to drive far enough away to avoid fire and smoke. If you do camp, try to find a site away from wooded areas. And think twice before using buy flagyl for dogs group bathrooms.Is an evacuation center safe?. Many counties have implemented new precautions at emergency shelters to prevent the spread of the buy flagyl for dogs antibiotics. In Santa Cruz, for example, officials are scaling back the capacity in each shelter to allow for social distancing, providing tents for people to use as shielding inside and allowing camping in the parking lots.Still, staying in a shelter should probably not be your first choice.

In terms of buy antibiotics risk, deciding between a hotel and a friend’s house is “nipping at the edges,” buy flagyl for dogs said Dr. John Swartzberg, a clinical professor emeritus at the UC-Berkeley School of Public Health, while “being in a congregate setting is only better than being completely exposed to the elements.”If an evacuation shelter is your best immediate option, again, do not hesitate. €œYou have these standards you want to practice for yourselves,” Swartzberg said, “but when something worse comes along, it trumps how careful we can be with buy antibiotics because the need for shelter is greater.” You can lower your risk of by wearing a mask, washing hands frequently and sanitizing surfaces.Smith’s partner, Grant Whipple, buy flagyl for dogs walks with their children in Big Sur on March 7. That was their last camping trip before the buy antibiotics flagyl hit, Smith says. That area is now under threat buy flagyl for dogs from wildfire.

(Amanda Smith)If you aren’t in a fire zone, should you invite friends and family to stay with you?. Deciding whether to open your home to friends who are evacuating is an intensely personal decision and may depend on whether anyone in your family has a preexisting condition.“I guess it depends on buy flagyl for dogs how good a friend they are and how desperate they are,” said Swartzberg. It may also depend on how much space you have. If your guests can have their own buy flagyl for dogs bedroom and bathroom, it might be safer.If you do offer your home, experts advise against simply considering yourself a new pod with your guests. Instead, take steps to lower your chances of .“It might not be pleasant, but wearing a mask anytime you’re not in your own bedroom is the safest way to go,” said Solomon.

Stay outside as much as possible, she added, and consider eating meals outdoors or eating in shifts to avoid being maskless with those buy flagyl for dogs outside your family unit. Sanitize surfaces and wash hands frequently. If air quality permits, keep the windows open to improve airflow.If you’re in a region with hazardous buy flagyl for dogs smoke conditions, should you leave?. If your area has dense buy flagyl for dogs smoke but no imminent fire risk, the thought of heading somewhere else may be appealing, especially if you have respiratory issues. But in most cases, Wilkes said, it would be safer not to leave your buy antibiotics bubble.

And given buy flagyl for dogs the expanse of California’s fires, anywhere you flee could end up having lousy air quality by the time you arrive.“The better part of rationality,” Wilkes said, “would be to stay at home, not exercise [outdoors], stay inside as much as you can, turn on the air conditioning.”California Healthline senior correspondent Anna Maria Barry-Jester contributed to this report. Jenny Gold. jgold@kff.org, @JennyAGold Related Topics California Public Health States buy antibiotics Environmental Health Natural DisastersIn buy flagyl for dogs the 2014 elections, Republicans rode a wave of anti-Affordable Care Act sentiment to pick up nine Senate seats, the largest gain for either party since 1980. Newly elected Republicans such as Cory Gardner in Colorado and Steve Daines in Montana had hammered their Democratic opponents over the health care law during the campaign and promised to repeal it.Six years later, those senators are up for reelection. Not only is the law still around, but it’s gaining buy flagyl for dogs in popularity.

What was once a winning strategy has become a political liability.Public sentiment about the ACA, also known as Obamacare, has shifted considerably during the Trump administration after Republicans tried but failed to repeal it. Now, in the midst of the buy antibiotics flagyl and the ensuing economic crisis, which has led to the loss of jobs and health insurance for millions of people, health care again looks poised to be a key issue for buy flagyl for dogs voters this election. Don't Miss A Story Subscribe to KHN’s free Weekly Edition newsletter. With competitive races in Colorado, Montana, Arizona, North Carolina and Iowa pitting Republican incumbents who voted to repeal the ACA against Democratic buy flagyl for dogs challengers promising to protect it, attitudes surrounding the health law could help determine control of the Senate. Republicans hold a slim three-vote majority in the Senate but are defending 23 seats in the Nov.

3 election buy flagyl for dogs. Only one Democratic Senate seat — in Alabama, where incumbent Doug Jones is up against former Auburn University football coach Tommy Tuberville — is considered in play for Republicans.“The fall election will significantly revolve around people’s belief about what [candidates] will do for their health coverage,” said Dr. Daniel Derksen, a professor of public health at the University of Arizona.The Affordable Care Act has been a wedge issue since it was signed into law buy flagyl for dogs in 2010. Because it then took four years to enact, its opponents talked for years about how bad the not-yet-created marketplace for insurance would be, said Joe Hanel, spokesperson for the buy flagyl for dogs Colorado Health Institute, a nonpartisan nonprofit focused on health policy analysis. And they continued to attack the law as it took full effect in 2014.Gardner, for example, ran numerous campaign ads that year criticizing the ACA and, in particular, President Barack Obama’s assertion that “if you like your health care plan, you’ll be able to keep your health care plan.”But now, Hanel said, the ACA’s policies have become much more popular in Colorado as the costs of health exchange plans have dropped.

Thus, political messaging has changed, too.“This time it’s the opposite,” Hanel buy flagyl for dogs said. €œThe people bringing up the Affordable Care Act are the Democrats.”Despite Gardner’s multiple votes to repeal the ACA, he has largely avoided talking about the measure during the 2020 campaign. He even removed his pro-repeal position buy flagyl for dogs from his campaign website.Democratic attack ads in July blasted Gardner for repeatedly dodging questions in an interview with Colorado Public Radio about his stance on a lawsuit challenging the ACA.His opponent, Democrat John Hickenlooper, fully embraced the law when he was Colorado governor, using the measure to expand Medicaid eligibility to more low-income people and to create a state health insurance exchange. Now, he’s campaigning on that record, with promises to expand health care access even further.Polling DataPolling conducted by KFF for the past 10 years shows a shift in public opinion has occurred nationwide. (KHN is an editorially independent program of KFF, the Kaiser Family Foundation.)“Since Trump buy flagyl for dogs won the election in 2016, we now have consistently found that a larger share of the public holds favorable views” of the health law, said Ashley Kirzinger, associate director of public opinion and survey research for the foundation.

€œThis really solidified in 2017 after the failed repeal in the Senate.”The foundation’s polling found that, in July 2014, 55% of voters opposed the law, while 36% favored it. By July 2020, that had buy flagyl for dogs flipped, with 51% favoring the law and 38% opposing it. A shift was seen across all political groups, though 74% of Republicans still viewed it unfavorably in the latest poll.Public support for individual provisions of the ACA — such as protections for people with preexisting conditions or allowing young adults to stay on their parents’ health plans until age 26 — have proved even more popular than the law as a whole. And the provision that consistently polled unfavorably — the mandate that those buy flagyl for dogs without insurance must pay a fine — was eliminated in 2017.“We’re 10 years along and the sky hasn’t caved in,” said Sabrina Corlette, a health policy professor at Georgetown University.Political MessagingFollowing the passage of the ACA, Democrats didn’t reference the law in their campaigns, said Erika Franklin Fowler, a government professor at Wesleyan University and the director of the Wesleyan Media Project, which tracks political advertising.“They ran on any other issue they could find,” Fowler said.Republicans, she said, kept promising to “repeal and replace” but weren’t able to do so.Then, in the 2018 election, Democrats seized on the shift in public opinion, touting the effects of the law and criticizing Republicans for their attempts to overturn it.“In the decade I have been tracking political advertising, there wasn’t a single-issue topic that was as prominent as health care was in 2018,” she said.As the global health crisis rages, health care concerns again dominate political ads in the 2020 races, Fowler said, although most ads haven’t explicitly focused on the ACA. Many highlight Republicans’ support for the lawsuit challenging preexisting condition protections or specific provisions of the ACA that their votes would have overturned.

Republicans say they, too, will protect buy flagyl for dogs people with preexisting conditions but otherwise have largely avoided talking about the ACA.“Cory Gardner has been running a lot on his environmental bills and conservation funding,” Fowler said. €œIt’s not difficult to figure out why he’s doing that. It’s easier for him to tout that in a state like Colorado than it is to talk about health care.”Similar dynamics are playing out in buy flagyl for dogs other key Senate races. In Arizona, Republican buy flagyl for dogs Sen. Martha McSally was one of the more vocal advocates of repealing the ACA while she served in the House of Representatives.

She publicly acknowledged those votes may have hurt her 2018 Senate bid.“I did vote to repeal and replace Obamacare,” McSally said on conservative pundit Sean Hannity’s radio buy flagyl for dogs show during the 2018 campaign. €œI’m getting my ass kicked for it right now.”She indeed lost but was appointed to fill the seat of Sen. Jon Kyl after he resigned at the end of 2018 buy flagyl for dogs. Now McSally is in a tight race with Democratic challenger Mark Kelly, an astronaut and the husband of former Rep. Gabby Giffords.“Kelly doesn’t have a track record of voting one way buy flagyl for dogs or another, but certainly in his campaign this is one of his top speaking points.

What he would do to expand coverage and reassure people that coverage won’t be taken away,” said Derksen, the University of Arizona professor.The ACA has proved a stumbling block for Republican Sens. Thom Tillis of North buy flagyl for dogs Carolina and Joni Ernst of Iowa. In Maine, GOP Sen. Susan Collins cast a key vote that buy flagyl for dogs prevented the repeal of the law but cast other votes that weakened it. She now also appears vulnerable — but more for her vote to confirm Brett Kavanaugh’s nomination to the Supreme Court and for not doing more to oppose President Donald Trump.In Montana, Daines, who voted to repeal the ACA, is trying to hold on to his seat against Democratic Gov.

Steve Bullock, who used the buy flagyl for dogs law to expand the state’s Medicaid enrollment in 2015. At its peak, nearly 1 in 10 Montanans were covered through the expansion.As more Montanans now face the buy flagyl for dogs high cost of paying for health care on their own amid flagyl-related job losses, Montana State University political science professor David Parker said he expects Democrats to talk about Daines’ votes to repeal cost-saving provisions of the ACA.“People are losing jobs, and their jobs bring health care with them,” Parker said. €œI don’t think it’s a good space for Daines to be right now.” Markian Hawryluk. MarkianH@kff.org, @MarkianHawryluk Related Topics Elections Health Care Costs Health Care Reform Insurance States Arizona Colorado Montana North Carolina Obamacare PlansLatest Prevention buy flagyl for dogs &. Wellness News FRIDAY, Aug.

28, 2020 (HealthDay News) -- A warning about alcohol-based hand sanitizers in packaging that looks like food or drink has been issued by the buy flagyl for dogs U.S. Food and Drug Administration."The agency has discovered that some hand sanitizers are being packaged in beer cans, children's food pouches, water bottles, juice bottles and vodka bottles," according to an FDA a news release. "Additionally, the FDA has found hand sanitizers that contain food flavors, such as chocolate or raspberry."Reports received by the FDA include a person who bought what they believed buy flagyl for dogs was drinking water but was actually hand sanitizer, and a hand sanitizer using children's cartoons in marketing and sold in a pouch that resembled a snack, CNN reported."I am increasingly concerned about hand sanitizer being packaged to appear to be consumable products, such as baby food or beverages. These products could confuse consumers into accidentally ingesting a potentially deadly product. It's dangerous to add scents with food flavors to hand sanitizers which children could think smells like food, eat and get buy flagyl for dogs alcohol poisoning," FDA Commissioner Dr.

Stephen Hahn said in the release.Copyright © 2019 HealthDay. All rights reserved buy flagyl for dogs. QUESTION According to the USDA, there is no difference between a “portion” and a “serving.” See AnswerLatest Cancer News By Steven ReinbergHealthDay ReporterTHURSDAY, Aug. 27, 2020 (HealthDay News)Cancer patients who need radiation therapy shouldn't let fear of buy antibiotics delay their treatment, one hospital study suggests.Over six days in May, during the height of the flagyl in New Jersey, surfaces in the radiation oncology department at Robert Wood Johnson University Hospital in New Brunswick, N.J., were tested for buy antibiotics before cleaning.Of 128 samples taken buy flagyl for dogs in patient and staff areas and from equipment, including objects used by a patient with buy antibiotics, not one was positive for antibiotics, the flagyl that causes buy antibiotics, the study found.Patients can be reassured that surface contamination is minimal and necessary cancer treatment can go forward safely, said lead researcher Dr. Bruce Haffty, chairman of radiation oncology at Rutgers Cancer Institute in New Brunswick."Cancer care should and must continue in a buy antibiotics flagyl, and it can be delivered safely and effectively with minimal risk of acquiring a buy antibiotics from the radiation oncology environment, provided routine measures like mask-wearing, hand-washing, distancing and screening are in place and adhered to," Haffty said.The study does have some limitations.

Because of the nature of environmental sampling, 100% of a surface could not be buy flagyl for dogs swabbed for analysis. And no buy flagyl for dogs air samples were taken. But Haffty said that because no flagyl was found on surfaces, it's doubtful that any flagyl was present in the air."An important thing is that we did this testing before cleaning crews came in at the end of the day when there had been all kinds of traffic with patients and staff moving back and forth," he said.Patients and staff routinely wore masks, maintained social distance and washed their hands often, which is probably why no flagyl was found, Haffty said.Patients also were screened on arrival with temperature checks and questioned about flagyl symptoms, he added.Dr. Anthony D'Amico is chief of buy flagyl for dogs radiation oncology at Brigham and Women's Hospital in Boston. He said, "This study corroborates what we have found."Overall, his hospital's rate is 2%, while that in the community next to the hospital is 9%, D'Amico said.

But where there are people with lots of underlying conditions and less access to health care, the rate is 33%, he said."Hospitals seem to be safer right now than buy flagyl for dogs public settings -- protocols that people are using are working," D'Amico said.The takeaway. Patients need not put off treatment out of concern that they could be infected in the hospital."We have told patients not to delay radiation because of buy antibiotics, because cancer can be more life-threatening than buy antibiotics," he said.D'Amico's hospital treats patients diagnosed with buy antibiotics who need radiation before other patients arrive in the morning. The department is cleaned after they leave and at buy flagyl for dogs the end of the day after all other patients have gone, he said.Patients with buy antibiotics symptoms must test negative before undergoing screening tests like mammography and colonoscopy, D'Amico added.In the waiting room, patients and staff wear masks and maintain distancing. Patients' temperatures are taken and they are asked about any symptoms, he said."Patients should feel safe that the person sitting next to them in a waiting room has been properly screened," D'Amico said.The findings were published online Aug. 27 in JAMA Oncology.Copyright © 2020 HealthDay buy flagyl for dogs.

All rights reserved. SLIDESHOW Skin Cancer Symptoms, Types, Images See Slideshow References buy flagyl for dogs SOURCES. Bruce Haffty, MD, associate vice chancellor, cancer programs, and chair, radiation oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, N.J.. Anthony D'Amico, buy flagyl for dogs MD, PhD, professor, radiation oncology, Harvard Medical School, and chief, genitourinary radiation oncology, Brigham and Woman's Hospital, Boston. JAMA Oncology, Aug.

27, 2020, buy flagyl for dogs onlineLatest Heart News THURSDAY, Aug. 27, 2020 (HealthDay News)Heart attack survivors are more likely to lose weight if their spouses join them in shedding excess pounds, new research shows."Lifestyle improvement after a heart attack is a crucial part of preventing repeat events," said study author Lotte Verweij, a buy flagyl for dogs registered nurse and Ph.D. Student at Amsterdam University of Applied Sciences, in the Netherlands. "Our study buy flagyl for dogs shows that when spouses join the effort to change habits, patients have a better chance of becoming healthier -- particularly when it comes to losing weight."The study included 411 heart attack survivors who, along with receiving usual care, were referred to up to three lifestyle change programs for weight loss, increased physical activity and quitting smoking.The patients' partners could attend the programs for free and were encouraged by nurses to take part. Nearly half (48%) of the patients' partners participated, which was defined as attending at least once.Compared to those without a partner, patients with a participating partner were more than twice as likely to improve in at least one of the three areas (weight loss, exercise, smoking cessation) within a year, the findings showed.When the influence of partners was analyzed in the three areas separately, patients with a participating partner were more successful in shedding weight compared to patients without a partner, according to the study presented Thursday at a virtual meeting of the European Society of Cardiology.

Such research is considered preliminary until published in a peer-reviewed journal.But partner participation did not improve heart attack survivors' buy flagyl for dogs likelihood of quitting smoking or becoming more physically active, according to the report."Patients with partners who joined the weight-loss program lost more weight compared to patients with a partner who did not join the program," Verweij said in a society news release."Couples often have comparable lifestyles, and changing habits is difficult when only one person is making the effort. Practical issues come into play, such as grocery shopping, but also psychological challenges, where a supportive partner may help maintain motivation," she explained.-- Robert PreidtCopyright © 2020 HealthDay. All rights buy flagyl for dogs reserved. QUESTION In the U.S., 1 in every 4 deaths is caused by heart disease. See Answer References SOURCE buy flagyl for dogs.

European Society of Cardiology, news release, Aug. 27, 2020Latest Healthy Kids News THURSDAY, Aug buy flagyl for dogs. 27, 2020 (HealthDay News)If your child will be doing online learning this school year, you need to take steps to protect them from eye strain, the American Academy of Ophthalmology says."I really have seen a marked increase in kids suffering from eye strain because of increased screen time. Good news is most symptoms can be avoided by taking a few simple steps," pediatric ophthalmologist buy flagyl for dogs Dr. Stephen Lipsky, a clinical spokesperson for the academy, said in an academy news release.Here he offers these remote-learning recommendations to protect your child's vision:Set a timer to remind your child to take a break every 20 minutes.

Alternate reading on an e-book with a buy flagyl for dogs real book. Encourage children to look up and out the window buy flagyl for dogs every two chapters or to shut their eyes for 20 seconds.Mark books with paperclips every few chapters. When they reach a paper clip, it will remind them look up. On an e-book, use the bookmark function buy flagyl for dogs for the same effect.Make sure children use laptops at arm's length (about 18 to 24 inches) from where they're sitting. Ideally, they should have a monitor positioned at eye level, directly in front of the body.

Tablets should also buy flagyl for dogs be held at arm's length.To reduce glare, position the light source behind the child's back, not behind the screen. Adjust the brightness and contrast on the screen so that it feels comfortable for children. Don't use a device outside or in buy flagyl for dogs brightly lit areas. The glare on the screen can cause eye strain.Children shouldn't use a device in a dark room. As the pupil expands to adjust to the darkness, the brightness of the screen can buy flagyl for dogs aggravate after-images and cause discomfort.Children should stop using devices 30 to 60 minutes before bedtime.

Blue light may disrupt sleep. If teens don't want to do this, have them switch buy flagyl for dogs to night mode or a similar mode to reduce blue light exposure.When study time is over, make sure children spend time outdoors. Several studies suggest that spending time outdoors, especially in early childhood, can slow the progression of nearsightedness.-- Robert PreidtCopyright © 2020 HealthDay. All rights buy flagyl for dogs reserved. QUESTION buy flagyl for dogs What causes dry eyes?.

See Answer References SOURCE. American Academy of Ophthalmology, news buy flagyl for dogs release, Aug. 13, 2020Latest Heart News THURSDAY, Aug. 27, 2020 (American Heart Association News)"Something's buy flagyl for dogs not right," Marranda Edwards told her aunt in San Antonio. "I'm coming there."Edwards, who lives outside of Atlanta, had been worried for several days.

Her mother, Alvis Whitlow, buy flagyl for dogs hadn't been calling as often as usual, which could easily be five times a day. And when they did speak, Whitlow sounded confused and weak.In late March, a call from Edwards' aunt added to her suspicions. The aunt reported that buy flagyl for dogs Whitlow had gastrointestinal problems and couldn't walk to the bathroom without assistance. That's when Edwards knew she needed to act.Edwards took the first flight she could find, with her husband staying home to take care of their three children and six foster children.On the way to Texas, Edwards thought about the last time she sensed something was seriously wrong with her mom. It was in 2003, buy flagyl for dogs when she too lived in San Antonio.Someone from the beauty shop where Whitlow was getting her hair done called to say her mother had thrown up and felt weak.

This stood out because for much of that week, her mom complained of having a headache, which was unusual."Something's not right," Edwards told the woman at the beauty shop. "I'm coming there."Edwards called buy flagyl for dogs an ambulance to check on her mom. As paramedics examined Whitlow, her heart stopped.At the hospital, doctors determined that an aneurysm burst in her brain, leading to bleeding. They believed it was caused buy flagyl for dogs by undiagnosed hypertension. She needed to undergo a procedure to stop the buy flagyl for dogs bleeding.

The chance of survival was 20%, doctors told Edwards.The procedure worked. And the damage wasn't as severe as feared.After buy flagyl for dogs two months of rehabilitation, Whitlow returned to work. She retired four years later, in 2007, at age 53, after nearly three decades with the San Antonio school system.Since then, Whitlow remained active and healthy, spending time with friends, family and church activities. She also visited Edwards and her family several times a year.Having arrived in San Antonio for buy flagyl for dogs the urgent visit, the first thing Edwards noticed was how weak her mother seemed.Whitlow also was coughing. By the next day, it sounded like wheezing."I thought it might be bronchitis, but it started sounding worse," Edwards said.When a trip from the living room to the bedroom left Whitlow out of breath, Edwards called 911.Paramedics measured her temperature at 102 and her blood oxygen level at 87% instead of in the usual high 90s."Then I just knew it," Edwards said.

"She's got buy flagyl for dogs it. She's got the antibiotics."Edwards followed the ambulance to the hospital but wasn't allowed inside. The next day, the doctor called, confirming Whitlow had buy antibiotics buy flagyl for dogs and saying she was on a ventilator. He said she'd also need to be transferred to a hospital set up for buy antibiotics patients."I need you to prepare," the doctor told Edwards. "The patients we've buy flagyl for dogs seen with her age and history and how she presented, she only has a 20% chance of living."Edwards thought.

"Here it was again. A 20% chance."Whitlow spent buy flagyl for dogs more than two weeks on a ventilator. Doctors tried to remove her from the ventilator twice, but each time she needed the mechanical help again within eight hours."You have to make a serious decision," doctors told Edwards.The options. Insert a breathing tube, perhaps permanently, and go to a long-term acute care facility, or stay in the hospital – but when the ventilator is removed, it won't be put back in place.Edwards drove to the buy flagyl for dogs hospital, sat on the curb to be as close to her mother as possible. Then she buy flagyl for dogs began praying."What do I do?.

" she thought. "What do buy flagyl for dogs I do?. "Edwards called the hospital with her decision.Put in the tube.Whitlow was transferred to a hospital that specializes in weaning patients off ventilators. Although Edwards still couldn't be with her mom, they could smile, wave and blow kisses through a window. After her breathing tube was removed, they could again talk on the phone.On May 11, after 27 days of acute care and a total of 24 days on a ventilator, Whitlow went home.

Leaving the hospital, she refused a wheelchair, allowing her to walk into Edwards' waiting arms for their first hug in six weeks. Hospital staffers surrounded them, cheering their reunion."I didn't expect all that applause," Whitlow said. "It made me feel really good, just blessed."The next day, a parade of more than 100 family, sorority and church members drove by to celebrate her recovery.Edwards, who is an assistant principal at a middle school, brought Whitlow back with her to Georgia. She arrived to more fanfare – a huge yard sign and cheering family members."God blessed me to be alive and to have someone here like Marranda to take care of me," Whitlow said. "Without her, I don't know what I would have done."American Heart Association News covers heart and brain health.

Not all views expressed in this story reflect the official position of the American Heart Association. Copyright is owned or held by the American Heart Association, Inc., and all rights are reserved. SLIDESHOW Stroke Causes, Symptoms, and Recovery See Slideshow.

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About This TrackerThis tracker provides the number of confirmed cases and deaths from novel antibiotics by country, the trend in confirmed http://buyingtitles.co.uk/buying-titles-art/ case and flagyl for lichen planus death counts by country, and a global map showing which countries have confirmed cases and deaths. The data are drawn from the Johns Hopkins University (JHU) antibiotics Resource Center’s buy antibiotics Map and the World Health Organization’s (WHO) antibiotics Disease (buy antibiotics-2019) situation reports.This tracker will be updated regularly, as new data are released.Related flagyl for lichen planus Content. About buy antibiotics antibioticsIn late 2019, a new antibiotics emerged in central China to cause disease in humans. Cases of this disease, known as buy antibiotics, flagyl for lichen planus have since been reported across around the globe. On January 30, 2020, the World Health Organization (WHO) declared the flagyl represents a public health emergency of international concern, and on January 31, 2020, the U.S.

Department of Health and Human Services declared it to be a health emergency flagyl for lichen planus for the United States.With schools nationwide preparing for fall and the federal government encouraging in-person classes, key concerns for school officials, teachers and parents include the risks that antibiotics poses to children and their role in transmission of the disease.A new KFF brief examines the latest available data and evidence about the issues around buy antibiotics and children and what they suggest about the risks posed for reopening classrooms. The review concludes that while children are flagyl for lichen planus much less likely than adults to become severely ill, they can transmit the flagyl. Key findings include:Disease severity is significantly less in children, though rarely some do get very sick. Children under age 18 account for 22% of the population but flagyl for lichen planus account for just 7% of the more than 4 million buy antibiotics cases and less than 1% of deaths.The evidence is mixed about whether children are less likely than adults to become infected when exposed. While one prominent study estimates children and teenagers are half as likely as adults over age 20 to catch the flagyl, other studies find children and adults are about equally likely to have antibodies that develop after a buy antibiotics .While children do transmit to others, more evidence is needed on the frequency and extent of that transmission.

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About This TrackerThis tracker provides the number of confirmed http://santabarbarakoi.net/?p=1 cases and deaths from novel antibiotics by country, the trend in confirmed case and death counts by country, and a buy flagyl for dogs global map showing which countries have confirmed cases and deaths. The data are drawn from the Johns Hopkins University (JHU) antibiotics Resource Center’s buy antibiotics Map and the World Health Organization’s (WHO) antibiotics Disease (buy antibiotics-2019) buy flagyl for dogs situation reports.This tracker will be updated regularly, as new data are released.Related Content. About buy antibiotics antibioticsIn late 2019, a new antibiotics emerged in central China to cause disease in humans. Cases of this buy flagyl for dogs disease, known as buy antibiotics, have since been reported across around the globe.

On January 30, 2020, the World Health Organization (WHO) declared the flagyl represents a public health emergency of international concern, and on January 31, 2020, the U.S. Department of Health and Human Services declared it to be a health emergency for the United States.With schools nationwide preparing for fall and the federal government encouraging in-person classes, key concerns for school officials, teachers and parents include the risks that antibiotics poses buy flagyl for dogs to children and their role in transmission of the disease.A new KFF brief examines the latest available data and evidence about the issues around buy antibiotics and children and what they suggest about the risks posed for reopening classrooms. The review concludes that while children are much less likely than adults to become severely ill, they can transmit the flagyl buy flagyl for dogs. Key findings include:Disease severity is significantly less in children, though rarely some do get very sick.

Children under age 18 account for 22% of the population but account for just 7% of the more than 4 million buy antibiotics cases and less than 1% of deaths.The evidence is mixed about buy flagyl for dogs whether children are less likely than adults to become infected when exposed. While one prominent study estimates children and teenagers are half as likely as adults over age 20 to catch the flagyl, other studies find children and adults are about equally likely to have antibodies that develop after a buy antibiotics .While children do transmit to others, more evidence is needed on the frequency and extent of that transmission. A number of studies find children are less likely than adults to be the source of buy flagyl for dogs s in households and other settings, though this could occur because of differences in testing, the severity of the disease, and the impact of earlier school closures.Most countries that have reopened schools have not experienced outbreaks, but almost all had significantly lower rates of community transmission. Some countries, including Canada, Chile, France, and Israel did experience school-based outbreaks, sometimes significant ones, that required schools to close a second time.The analysis concludes that there is a risk of spread associated with reopening schools, particularly in states and communities where there is already widespread community transmission, that should be weighed carefully against the benefits of in-person education..

Trichomoniasis flagyl

Abstract 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, trichomoniasis flagyl 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 trichomoniasis flagyl by Dr. N.

N. Wig, has been at the forefront of advancements in understanding and misunderstanding. The concept of DS is still evolving being treated as a culture-bound syndrome in the past to a syndrome of depression and treated as “a culturally determined idiom of distress.” It is bound with myths, fallacies, prejudices, secrecy, exaggeration, and value-laden judgments. Although it has been reported from many countries, much of the literature has emanated from Asia, that too mainly from India.

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

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

Indian J Psychiatry 2021;63:317-25 Introduction Mr. President, Chairpersons, my respected teachers and seniors, my professional colleagues and friends, ladies and gentlemen:I deem it a proud privilege and pleasure to receive and to deliver DLN Murti Rao Oration Award for 2020. I am humbled at this great honor and remain grateful to the Indian Psychiatric Society (IPS) in general and the awards committee in particular. I would like to begin my presentation with my homage to Professor DLN Murti Rao, who was a Doyen of Psychiatry.[1] I have a special connection to the name as Dr.

Doddaballapura Laxmi Narasimha Murti Rao, apart from a family name, obtained his medical degree from Mysore Medical College, Mysuru, India, the same city where I have served last 33 years in JSS Medical College and JSS Academy of Higher Education and Research. His name carries the reverence in the corridors of the current National Institute of Mental Health and Neuro Sciences (NIMHANS) at Bangalore which was All India Institute of Mental Health, when he served as Head and the Medical Superintendent. Another coincidence was his untimely demise in 1962, the same year another Doyen Dr. Wig[2],[3] published the article on a common but peculiar syndrome in the Indian context and gave the name Dhat syndrome (DS).

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

K. Kuruvilla, Past Editor of Indian Journal of Psychiatry whose legacies I carried forward for both the journals. I must place on record that my journey in the field of Sexual Medicine was sown by Dr. K.

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

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

It has mostly been conceptualized as a multidimensional psychosomatic entity consisting of anxiety, depressive, somatic, and sexual phenomenology. Most importantly, abnormal and erroneous attributions are considered to be responsible for the genesis of DS. The most important debate is, however, related to the nosological status of DS. Although considered to a CBS unique to India, it has also been increasingly reported in China, Europe, Japan, Malaysia, Russia, and America.[11] The consistency and validity of its diagnosis have been consistently debated, and one of the most vital questions that emerged was.

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

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

Balhara[27] has argued that since DS is not really culture specific as thought of earlier, it should not be solely categorized as a functional somatic syndrome, as that can have detrimental effects on its understanding and management. He also mentions that the underlying “emotional distress and cultural contexts” are not unique to DS but can be related to any psychiatric syndrome for that matter. On the contrary, other researchers have warned that subsuming DS and other CBS under the broader rubric of “mood disorders” can lead to neglect and reductionism in disorder like DS that can have unique cultural connotations.[28] Over the years, there have been multiple propositions to relook and relabel CBS like DS. Considering it as a variant of depression or somatization can make it a “cultural phenotype” of these disorders in certain regions, thus making it easier for the classificatory systems.

This dichotomous debate seems never-ending, but clinically, it is always better to err on over-diagnosing and over-treating depression and anxiety in DS, which can improve the well-being of the distressed patients. Why Discuss Dhat Syndrome. Implications in Clinical Practice DS might occur independently or associated with multiple comorbidities. It has been a widely recognized clinical condition in various parts of the world, though considered specific to the Indian subcontinent.

The presentation can often be polymorphic with symptom clusters of affective, somatic, behavioral, and cognitive manifestations.[29] Being common in rural areas, the first contacts of the patients are frequently traditional faith healers and less often, the general practitioners. A psychiatric referral occurs much later, if at all. This leads to underdetection and faulty treatments, which can strengthen the already existing misattributions and misinformation responsible for maintaining the disorder. Furthermore, depression and sexual dysfunction can be the important comorbidities that if untreated, lead to significant psychosocial dysfunction and impaired quality of life.[30] Besides many patients of DS believe that their symptoms are due to failure of interpersonal relationships, s, and heredity, which might cause early death and infertility.

This contributes to the vicious cycle of fear and panic.[31] Doctor shopping is another challenge and failure to detect and address the concern of DS might lead to dropping out from the care.[15] Rao[17] in their epidemiological study reported 12.5% prevalence in the general population, with 20.5% and 50% suffering from comorbid depression and sexual disorders. The authors stressed upon the importance of early detection of DS for the psychosexual and social well-being. Most importantly, the multidimensional presentation of DS can at certain times be a facade overshadowing underlying neurotic disorders (anxiety, depression, somatoform, hypochondriasis, and phobias), obsessive-compulsive spectrum disorders and body dysmorphic disorders, delusional disorders, sexual disorders (premature ejaculation and erectile dysfunction) and infectious disorders (urinary tract s, sexually transmitted diseases), and even stress-related manifestations in otherwise healthy individuals.[4],[14],[15] This significant overlap of symptomatology, increased prevalence, and marked comorbidity make it all the more important for physicians to make sense out of the construct of DS. That can facilitate prompt detection and management of DS in routine clinical practice.In an earlier review study, it was observed that few studies are undertaken to update the research works from published articles as an updated review, systemic review, world literature review, etc., on DS and its management approach.[29],[32],[33],[34],[35] The present paper attempts to compile the evidence till date on DS related to its nosology, critique, manifestations, and management plan.

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

The study found a wide range of physical, anxiety, depression, sexual, and cognitive symptoms. Most commonly associated symptoms were found as per score ≥1. This study reported several parameters such as the “sense of being unhealthy” (99%), worry (99%), feeling “no improvement despite treatment” (97%), tension (97%), tiredness (95%), fatigue (95%), weakness (95%), and anxiety (95%). The common sexual disorders were observed as loss of masculinity (83%), erectile dysfunction (54%), and premature ejaculation (53%).

Majority of patients had faced mild or moderate level of symptoms in which 47% of the patients reported severe weakness. Overall distress and dysfunction were observed as 64% and 81% in the studied subjects, respectively.A study in Taiwan involved 87 participants from a Urology clinic. Most of them have sexual neurosis (Shen-K'uei syndrome).[7] More than one-third of the patients belonged to lower social class and symptoms of depression, somatization, anxiety, masturbation, and nocturnal emissions. Other bodily complaints as reported were sleep disturbances, fatigue, dizziness, backache, and weakness.

Nearly 80% of them considered that all of their problems were due to masturbatory practices.De Silva and Dissanayake[8] investigated several manifestations on semen loss syndrome in the psychiatric clinic of Colombo General Hospital, Sri Lanka. Beliefs regarding effects of semen loss and help-seeking sought for DS were explored. 38 patients were studied after psychiatrically ill individuals and those with organic disorders were excluded. Duration of semen loss varied from 1 to 20 years.

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

More than half of the patients reported all types of complaints (psychological, sexual, somatic, and genital).In the study by Chadda and Ahuja,[9] 52 psychiatric patients (mostly adolescents and young adults) complained of passing “Dhat” in urine. They were assessed for a period of 6 months. More than 80% of them complained of body weakness, aches, and pains. More than 50% of the patients suffered from depression and anxiety.

All the participants felt that their symptoms were due to loss of “dhat” in urine, attributed to excessive masturbation, extramarital and premarital sex. Half of those who faced sexual dysfunctions attributed them to semen loss.Mumford[11] proposed a controversial explanation of DS arguing that it might be a part of other psychiatric disorders, like depression. A total of 1000 literate patients were recruited from a medical outdoor in a public sector hospital in Lahore, Pakistan. About 600 educated patients were included as per Bradford Somatic Inventory (BSI).

Men with DS reported greater symptoms on BSI than those without DS. 60 psychiatric patients were also recruited from the same hospital and diagnosed using Diagnostic and Statistical Manual (DSM)-III-R. Among them, 33% of the patients qualified for “Dhat” items on BSI. The symptoms persisted for more than 15 days.

It was observed that symptoms of DS highly correlated with BSI items, namely erectile dysfunction, burning sensation during urination, fatigue, energy loss, and weakness. This comparative study indicated that patients with DS suffered more from depressive disorders than without DS and the age group affected by DS was mostly the young.Grover et al.[15] conducted a study on 780 male patients aged >16 years in five centers (Chandigarh, Jaipur, Faridkot, Mewat, and New Delhi) of Northern India, 4 centers (2 from Kolkata, 1 each in Kalyani and Bhubaneswar) of Eastern India, 2 centers (Agra and Lucknow) of Central India, 2 centers (Ahmedabad and Wardha) of Western India, and 2 centers of Southern India (both located at Mysore) spread across the country by using DS questionnaire. Nearly one-third of the patients were passing “Dhat” multiple times a week. Among them, nearly 60% passed almost a spoonful of “Dhat” each time during a loss.

This work on sexual disorders reported that the passage of “Dhat” was mostly attributed to masturbation (55.1%), dreams on sex (47.3%), sexual desire (42.8%), and high energy foods consumption (36.7%). Mostly, the participants experienced passage of Dhat as “night falls” (60.1%) and “while passing stools” (59.5%). About 75.6% showed weakness in sexual ability as a common consequence of the “loss of Dhat.” The associated symptoms were depression, hopelessness, feeling low, decreased energy levels, weakness, and lack of pleasure. Erectile problems and premature ejaculation were also present.Rao[17] in his first epidemiological study done in Karnataka, India, showed the prevalence rate of DS in general male population as 12.5%.

It was found that 57.5% were suffering either from comorbid depression or anxiety disorders. The prevalence of psychiatric and sexual disorders was about three times higher with DS compared to non-DS subjects. One-third of the cases (32.8%) had no comorbidity in hospital (urban). One-fifth (20.5%) and 50% subjects (51.3%) had comorbid depressive disorders and sexual dysfunction.

The psychosexual symptoms were found among 113 patients who had DS. The most common psychological symptoms reported by the subjects with DS were low self-esteem (100%), loss of interest in any activity (95.60%), feeling of guilt (92.00%), and decreased social interaction (90.30%). In case of sexual disorders, beliefs were held commonly about testes becoming smaller (92.00%), thinness of semen (86.70%), decreased sexual capabilities (83.20%), and tilting of penis (70.80%).Shakya[20] studied a clinicodemographic profile of DS patients in psychiatry outpatient clinic of B. P.

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

The view of participants was that semen is very “precious,” needs preservation, and masturbation is a malpractice. Beside DS, two-thirds of the subjects had comorbid depression.In another Indian study, Chadda et al.[24] compared patients with DS with those affected with neurotic/depressive disorders. Among 100 patients, 50%, 32%, and 18% reported depression, somatic problems, and anxiety, respectively. The authors argued that cases of DS have similar symptom dimensions as mood and anxiety disorders.Dhikav et al.[31] examined prevalence and management depression comorbid with DS.

DSM-IV and Hamilton Depression Rating Scale were used for assessments. About 66% of the patients met the DSM-IV diagnostic criteria of depression. They concluded that depression was a frequent comorbidity in DS patients.In a study by Perme et al.[37] from South India that included 32 DS patients, the control group consisted of 33 people from the same clinic without DS, depression, and anxiety. The researchers followed the guidelines of Bhatia and Malik's for the assessment of primary complaints of semen loss through “nocturnal emissions, masturbation, sexual intercourse, and passing of semen before and after urine.” The assessment was done based on several indices, namely “Somatization Screening Index, Illness Behavior Questionnaire, Somatosensory Amplification Scale, Whitley Index, and Revised Chalder Fatigue Scale.” Several complaints such as somatic complaints, hypochondriacal beliefs, and fatigue were observed to be significantly higher among patients with DS compared to the control group.A study conducted in South Hall (an industrial area in the borough of Middlesex, London) included Indian and Pakistani immigrants.

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

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

The patients were 15–50 years of age, educated up to mid-school and mostly from a rural background. Most of them were married and reported premarital sexual practices, while nearly 67% of them practiced masturbation from early age. There was significant guilt associated with nocturnal emissions and masturbation. Nearly 27% of the cases reported DS-like symptoms attributing their health problems to semen loss.Behere and Nataraj[45] reported that majority of the patients with DS presented with comorbidities of physical weakness, anxiety, headache, sad mood, loss of appetite, impotence, and premature ejaculation.

The authors stated that DS in India is a symptom complex commonly found in younger age groups (16–23 years). The study subjects presented with complaints of whitish discharge in urine and believed that the loss of semen through masturbation was the reason for DS and weakness.Singh et al.[46] studied 50 cases with DS and sexual problems (premature ejaculation and impotence) from Punjab, India, after exclusion of those who were psychiatrically ill. It was assumed in the study that semen loss is considered synonymous to “loss of something precious”, hence its loss would be associated with low mood and grief. Impotency (24%), premature ejaculation (14%), and “Dhat” in urine (40%) were the common complaints observed.

Patients reported variety of symptoms including anxiety, depression, appetite loss, sleep problems, bodily pains, and headache. More than half of the patients were independently diagnosed with depression, and hence, the authors argued that DS may be a manifestation of depressive disorders.Bhatia and Malik[47] reported that the most common complaints associated with DS were physical weakness, fatigue and palpitation, insomnia, sad mood, headache, guilt feeling and suicidal ideation, impotence, and premature ejaculation. Psychiatric disorders were found in 69% of the patients, out of which the most common was depression followed by anxiety, psychosis, and phobia. About 15% of the patients were found to have premature ejaculation and 8% had impotence.Bhatia et al.[48] examined several biological variables of DS after enrolment of 40 patients in a psychosexual clinic in Delhi.

Patients had a history of impotence, premature ejaculation, and loss of semen (after exclusion of substance abuse and other psychiatric disorders). Twenty years was the mean age of onset and semen loss was mainly through masturbation and sexual intercourse. 67.5% and 75% of them reported sexual disorders and psychiatric comorbidity while 25%, 12.5%, and 37.5% were recorded to suffer from ejaculatory impotence, premature ejaculation, and depression (with anxiety), respectively.Bhatia[49] conducted a study on CBS among 60 patients attending psychiatric outdoor in a teaching hospital. The study revealed that among all patients with CBSs, DS was the most common (76.7%) followed by possession syndrome (13.3%) and Koro (5%).

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

The reasons provided by the patients for semen loss were urinary loss, nocturnal emission, and masturbation. Dhat Syndrome. The Epidemiology The typical demographic profile of a DS patient has been reported to be a less educated, young male from lower socioeconomic status and usually from rural areas. In the earlier Indian studies by Carstairs,[51],[52],[53] it was observed that majority of the cases (52%–66.7%) were from rural areas, belonged to “conservative families and posed rigid views about sex” (69%-73%).

De Silva and Dissanayake[8] in their study on semen loss syndrome reported the average age of onset of DS to be 25 years with most of them from lower-middle socioeconomic class. Chadda and Ahuja[9] studied young psychiatric patients who complained of semen loss. They were mainly manual laborers, farmers, and clerks from low socioeconomic status. More than half were married and mostly uneducated.

Khan[13] studied DS patients in Pakistan and reported that majority of the patients visited Hakims (50%) and Homeopaths (24%) for treatment. The age range was wide between 12 and 65 years with an average age of 24 years. Among those studied, majority were unmarried (75%), literacy was up to matriculation and they belonged to lower socioeconomic class. Grover et al.[15] in their study of 780 male subjects showed the average age of onset to be 28.14 years and the age ranged between 21 and 30 years (55.3%).

The subjects were single or unmarried (51.0%) and married (46.7%). About 23.5% of the subjects had graduated and most were unemployed (73.5%). Majority of subjects were lower-middle class (34%) and had lower incomes. Rao[17] studied 907 subjects, in which majority were from 18 to 30 years (44.5%).

About 45.80% of the study subjects were illiterates and very few had completed postgraduation. The subjects were both married and single. Majority of the subjects were residing in nuclear family (61.30%) and only 0.30% subjects were residing alone. Most of the patients did not have comorbid addictive disorders.

The subjects were mainly engaged in agriculture (43.40%). Majority of the subjects were from lower middle and upper lower socioeconomic class.Shakya[20] had studied the sociodemographic profile of 50 patients with DS. The average age of the studied patients was 25.4 years. The age ranges in decreasing order of frequency were 16–20 years (34%) followed by 21–25 years (28%), greater than 30 years (26%), 26–30 years (10%), and 11–15 years (2%).

Further, the subjects were mostly students (50%) and rest were in service (26%), farmers (14%), laborers (6%), and business (4%), respectively. Dhikav et al.[31] conducted a study on 30 patients who had attended the Psychiatry Outpatient Clinic of a tertiary care hospital with complaints of frequently passing semen in urine. In the studied patients, the age ranged between 20 and 40 years with an average age of 29 years and average age of onset of 19 years. The average duration of illness was that of 11 months.

Most of the studied patients were unmarried (64.2%) and educated till middle or high school (70%). Priyadarshi and Verma[43] performed a study in 110 male patients with DS. The average age of the patients was 23.53 years and it ranged between 15 and 68 years. The most affected age group of patients was of 18–25 years, which comprised about 60% of patients.

On the other hand, about 25% ranged between 25 and 35 years, 10% were lesser than 18 years of age, and 5.5% patients were aged >35 years. Higher percentage of the patients were unmarried (70%). Interestingly, high prevalence of DS was found in educated patients and about 50% of patients were graduate or above but most of the patients were either unemployed or student (49.1%). About 55% and 24.5% patients showed monthly family income of <10,000 and 5000 Indian Rupees (INR), respectively.

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

Singh[46] studied patients those who reported with DS, impotence, and premature ejaculation and reported the average age of the affected to be 21.8 years with a younger age of onset. Only a few patients received higher education. Bhatia and Malik[47] as mentioned earlier reported that age at the time of onset of DS ranged from 16 to 24 years. More than half of them were single.

It was observed that most patients had some territorial education (91.67%) but few (8.33%) had postgraduate education or professional training. Finally, Bhatia et al.[48] studied cases of sexual dysfunctions and reported an average age of 21.6 years among the affected, majority being unmarried (80%). Most of those who had comorbid DS symptoms received minimal formal education. Management.

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

Community awareness needs to be increased especially in primary health care for early detection and appropriate referrals. Follow-up data show two-thirds of patients affected with DS recovering with psychoeducation and low-dose sedatives.[45] Bhatia[49] studied 60 cases of DS and reported better response to anti-anxiety and antidepressant medications compared to psychotherapy alone. Classically, the correction of attributional biases through empathy, reflective, and nonjudgmental approaches has been proposed.[38] Over the years, sex education, psychotherapy, psychoeducation, relaxation techniques, and medications have been advocated in the management of DS.[9],[55] In psychotherapy, cognitive behavioral and brief solution-focused approaches are useful to target the dysfunctional assumptions and beliefs in DS. The role of sex education is vital involving the basic understanding of sexual anatomy and physiology of sexuality.

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

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

Longitudinal stability of a diagnosis is considered to be an important part of its independent categorization. Sameer et al.[23] followed up DS patients for 6.0 ± 3.5 years and concluded that the “pure” variety of DS is not a stable diagnostic entity. The authors rather proposed DS as a variant of somatoform disorder, with cultural explanations. The right “place” for DS in classification systems has mostly been debated and theoretically fluctuant.[14] Sridhar et al.[57] mentioned the importance of reclassifying DS from a clinically, phenomenologically, psycho-pathologically, and diagnostically valid standpoint.

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

It will be interesting to see whether it retains its diagnostic independence or gets subsumed under the broader “narrative” of depression. In any case, uniformity of diagnosing this culturally relevant yet distressing and highly prevalent condition will remain a major area related to psychiatric research and treatment. Conclusion DS is a multidimensional psychiatric “construct” which is equally interesting and controversial. Historically relevant and symptomatically mysterious, this disorder provides unique insights into cultural contexts of human behavior and the role of misattributions, beliefs, and misinformation in sexuality.

Beyond the traditional debate about its “separate” existence, the high prevalence of DS, associated comorbidities, and resultant dysfunction make it relevant for emotional and psychosexual health. It is also treatable, and hence, the detection, understanding, and awareness become vital to its management. This oration attempts a “bird's eye” view of this CBS taking into account a holistic perspective of the available evidence so far. The clinical manifestations, diagnostic and epidemiological attributes, management, and nosological controversies are highlighted to provide a comprehensive account of DS and its relevance to mental health.

More systematic and mixed methods research are warranted to unravel the enigma of this controversial yet distressing psychiatric disorder.AcknowledgmentI sincerely thank Dr. Debanjan Banerjee (Senior Resident, Department of Psychiatry, NIMHANS, Bangalore) for his constant selfless support, rich academic discourse, and continued collaboration that helped me condense years of research and ideas into this paper.Financial support and sponsorshipNil.Conflicts of interestThere are no conflicts of interest. References 1.2.3.Srinivasa Murthy R, Wig NN. A man ahead of his time.

In. Sathyanarayana Rao TS, Tandon A, editors. Psychiatry in India. Training and Training Centres.

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A retrospective comparative study of teaching hospital and private clinic clients with sexual problems. Indian J Behav Sci 1995;5:58-63. 11.Mumford DB. The 'Dhat syndrome'.

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16.MacFarland AS, Al-Maashani M, Al Busaidi Q, Al-Naamani A, El-Bouri M, Al-Adawi S. Culture-specific pathogenicity of Dhat (semen loss) Syndrome in an Arab/Islamic Society, Oman. Oman Med J 2017;32:251-5. 17.Rao TS.

Comprehensive Study of Prevalence Rates, Symptom Profile, Comorbidity and Management of Dhat Syndrome in Rural and Urban Communities. PhD Thesis. Department of Psychiatry, Jagadguru Sri Shivarathreeshwara Medical College, JSS University, Shivarathreeshwara Nagar Mysore, Karnataka, India. 2017.

18.Kar SK. Treatment - emergent Dhat syndrome in a young male with obsessive-compulsive disorder. An alarm for medication nonadherence. Acta Med Int 2019;6:44-45.

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Dhat syndrome. Study of clinical presentations in a teaching institute of eastern Nepal. J Psychosexual Health 2019;1:143-8. 21.Leff JP.

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

An overview. J Soc Psychiatry 1986;2:403-25. 23.Sameer M, Menon V, Chandrasekaran R. Is 'Pure' Dhat syndrome a stable diagnostic entity?.

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

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

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

A comparison between Sri Lanka and Japan. American J Psychotherapy 1991;45:14-20. 27.Balhara YP. Culture-bound syndrome.

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

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J Sex Med 2015;12:1398-401. 31.Dhikav V, Aggarwal N, Gupta S, Jadhavi R, Singh K. Depression in Dhat syndrome. J Sex Med 2008;5:841-4.

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

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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. A study of male potency disorders.

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Dhat syndrome - Is it a syndrome of Dhat only?. J Ment Health Hum Behav1997;2:17-22. 49.Bhatia MS. An analysis of 60 cases of culture bound syndromes.

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

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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.

Abstract 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, you can try here biological aspects, buy flagyl for dogs 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 buy flagyl for dogs term coined by Dr.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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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.

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