Categories
Ailmemts & Remedies Pediatric

Epispadias

Definition:
An epispadias is a rare type of malformation of the penis in which the urethra ends in an opening on the upper aspect (the dorsum) of the penis. It can also develop in females when the urethra develops too far anteriorly. It occurs in around 1 in 120,000 male and 1 in 500,000 female births.

An epispadia occurs when the urethra opening is abnormally placed. In a male infant with epispadias, the urethra will be generally open on the top or side of the penis.

Click to see the picture…>…...(01).…..(2).…..(1)

Boys will suffer from a short, wide penis and widened pubic bone. In a female infant with epispadias, the urethra will generally be located between the clitoris and the labia or in the abdominal area. Girls will suffer from a widened pubic bone and an abnormal clitoris and labia. In both males and females, urine will flow into the kidney and urinary tract infections are common. It is also common for the child to have urinary incontinence, kidney damage and often infertility issues as an adult.

A doctor will perform a series of tests to diagnose epispadias, which may include blood tests, x-rays and ultrasounds. Treatment involves surgery to help with urine control and appearance.

It is also called bladder exstrophy

Symptoms:

In males:
*Abnormal opening from the joint between the pubic bones to the area above the tip of the penis
*Backward flow of urine into the kidney (reflux nephropathy)
*Short, widened penis with an abnormal curvature
*Urinary tract infections
*Widened pubic bone

In females:……..Picture
*Abnormal clitoris and labia
*Abnormal opening where the from the bladder neck to the area above the normal urethral opening
*Backward flow of urine into the kidney (reflux nephropathy)
*Widened pubic bone
*Urinary incontinence
*Urinary tract infections

Causes:
The causes of epispadias are unknown at this time. It may be related to improper development of the pubic bone.

In boys with epispadias, the urethra generally opens on the top or side of the penis rather than the tip. However, it is possible for the urethra to be open along the entire length of the penis.

In girls, the opening is usually between the clitoris and the labia, but may be in the belly area.

Epispadias can be associated with bladder exstrophy, an uncommon birth defect in which the bladder is inside out, and sticks through the abdominal wall. However, epispadias can also occur with other defects.

Epispadias is an uncommon and partial form of a spectrum of failures of abdominal and pelvic fusion in the first months of embryogenesis known as the exstrophy – epispadias complex. While epispadias is inherent in all cases of exstrophy it can also, much less frequently, appear in isolation as the least severe form of the complex spectrum. It occurs as a result of defective migration of the genital tubercle primordii to the cloacal membrane, and so malformation of the genital tubercle, at about the 5th week of gestation.

Presentation:
Most cases involve a small and bifid penis, which requires surgical closure soon after birth, often including a reconstruction of the urethra. Where it is part of a larger Exstrophy, not only the urethra but also the bladder (bladder exstrophy) or the entire perineum (cloacal exstrophy) are open and exposed on birth, requiring closure.

Relationship to other conditions:
Despite the similarity of name, an epispadias is not a type of hypospadias, and involves a problem with a different set of embryologic processes.

In women:
Women can also have this type of congenital malformation. Epispadias of the female may occur when the urethra develops too far anteriorly, exiting in the clitoris or even more forward. For females, this may not cause difficulty in urination but may cause problems with sexual satisfaction. Frequently, the clitoris is bifurcated at the site of urethral exit, and therefore clitoral sensation is less intense during sexual intercourse due to frequent stimulation during urination. However, with proper stimulation, using either manual or positional techniques, clitoral orgasm is definitely possible

Diagnosis:
•Blood test to check electrolyte levels
•Intravenous pyelogram (IVP), a special x-ray of the kidneys, bladder, and ureters
•MRI and CT scans, depending on the condition
•Pelvic x-ray
•Ultrasound of the urogenital system

Treatment:
The main treatment for isolated epispadias is a comprehensive surgical repair of the genito-urinary area usually during the first 7 years of life, including reconstruction of the urethra, closure of the penile shaft and mobilisation of the corpora. The most popular and successful technique is known as the modified Cantwell-Ransley approach. In recent decades however increasing success has been achieved with the complete penile disassembly technique despite its association with greater and more serious risk of damage

Prognosis:
Even with successful surgery, patients may have long-term problems with:
*incontinence, where serious usually treated with some form of continent urinary diversion such as the Mitrofanoff
*depression and psycho-social complications
*sexual dysfunction

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://www.nlm.nih.gov/medlineplus/ency/article/001285.htm
http://en.wikipedia.org/wiki/Epispadias
http://health.stateuniversity.com/pages/794/Hypospadias-Epispadias.html
http://www.wikidoc.org/index.php/Epispadias
http://www.eclips.consult.com/eclips/article/Pediatrics/S0084-3954(07)70134-3

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Categories
Ailmemts & Remedies Pediatric

Hypospadias

Definition:
Hypospadias is a birth defect found in boys in which the penile meatus is not at the tip of the penis. The meatus is the term for the opening of the penis through which urine normally exits the bladder. The incidence is reported to be 1 in 300 live male births. There is some family risk of hypospadias, as familial tendencies have been noted. Up to 14% of male siblings are affected.

Hypospadias is usually classified according to the location of the opening. As the defect increases in severity, the opening to the penis will be found further back on the penis. The most severe types can have openings at the region of the scrotum and even in the perineum (the region between the anus and scrotum).

Click for picture

In some men with hypospadias, there’s another abnormality called chordee, in which the penis curves downwards and the foreskin only covers the front of it.In the most severe forms of hypospadias, the urethral opening is so far back it’s almost in the scrotum. The scrotum itself may be small and the testes may not have descended (that is, they’re still deep in the abdomen). When babies are born like this, it can be difficult to work out which sex they are without further tests.

click tom see the picture

Both hypospadias and chordee must be repaired so that a child can have normal urinary and reproductive health.

Symptoms:
Hypospadias is a structural abnormality that doesn’t progress or put the man at risk of any other serious illness. However, as with any abnormalities of the urinary system, there may be an increased risk of urinary infection in more severe cases.

Hypospadias may cause emotional turmoil when a boy realises he’s different from his friends. It can also cause practical problems with passing urine (those with the condition usually have to sit down to pee) and later with sexual intercourse, which may be embarrassing or difficult to cope with. Hypospadias may cause general worries about sexuality and fertility.

Signs and symptoms of hypospadias may include:

*Opening of the urethra at a location other than the tip of the penis
*Downward curve of the penis (chordee)
*Hooded appearance of the penis because only the top half of the penis is covered by foreskin
*Abnormal spraying during urination

Causes:
Hypospadias is present at birth (congenital). The exact reason this defect occurs is unknown. Sometimes hypospadias is inherited.

As the penis develops in a male fetus, certain hormones stimulate the formation of the urethra and foreskin. Hypospadias results when a malfunction occurs in the action of these hormones, causing the urethra to develop abnormally.

As a boy is developing in utero, the penis begins to form in the sixth week of fetal life. Two folds of tissue join each other in the middle and a hollow tube is formed in the middle of the future penis. This tube is the urethra and its opening is called the penile meatus. As the skin folds develop to form the penis, any interruption in this process leads to the meatus being located in a location further from the end of the penis. The exact etiology for this premature cessation of urethral formation is poorly understood. In addition, the etiology of the often-associated abnormal downward curvature (chordee) is also poorly understood.

Risk Factors:
This condition is more common in infants with a family history of hypospadias.

Some research suggests that there may be an increased risk of hypospadias in infant males born to women of an advanced age or those who used in vitro fertilization (IVF) to conceive. The connection to IVF may be due to the mother’s exposure to progesterone, a natural hormone, or to progestin, a synthetic form of progesterone, administered during the IVF process. Other research, however, hasn’t confirmed a link between IVF and hypospadias, but did find an association between a mother’s exposure to pesticides and hypospadias.

Diagnosis:
A physical examination can diagnose this condition. Imaging tests may be needed to look for other congenital defects.

Treatment
The treatment of hypospadias is always surgical. Initially when the child is born and hypospadias is identified, it is important to delay any thoughts of circumcision until seen by a urologist. This is because the foreskin can provide essential additional skin needed to reconstruct the urethra.

Hypospadias is often repaired  before a child is one year of age. This way, the boy is in diapers and management of dressings are made easier. However, the exact age of repair can vary according to the size of the penis and severity of the defect. It can be repaired in most of the  cases with a single operation, but on occasion, a second operation may be needed. The operation is performed under general anesthesia with the child completely asleep. Most of the boys will have a small tube exiting the tip of their new meatus. This “stent” will protect the new urethra and allow for adequate healing. Most patients leave the hospital the same day or the following day. However, more complex repairs for the more severe types of hypospadias can require longer hospital stays due to the need for bedrest and immobilization in the immediate post-operative setting.


Click for the picture

The exact type of operation employed varies according to the severity of the defect. For the more distal defects that have openings closer to the normal position at the end of the penis, a new tube can be created from the surrounding skin. This creation of a tube is known as a Thiersch-Duplay repair. For more severe defects, the options range. Additional hairless skin is often needed to recreate the urethral tube when longer defects are seen. Here, the subdermal skin of the foreskin can be used. For the most severe defects, we can remove mucosal skin from the inside of the cheek or use subdermal skin from other hairless parts of the body. It is important to use hairless skin as future hair growth in the neourethra can present multiple problems.

Complications:
The usual risks of surgery are present at the time of performing  hypospadias repairs. Risk of infection is controlled with use of antibiotics with the surgery and in the post-operative setting. Bleeding is well controlled by using a penile tourniquet during the operation. This limits the blood loss to a very minimal amount, while allowing for good visualization of the tissues for the surgeon.

By using good surgical techniques   the longer-term complications of the surgery are minimised. The most common problems that present are fistula and stricture. A fistula occurs if a hole develops along the pathway of the repair proximal to the tip of the penis. In other words, a hole can develop along the underside of the penis allowing for leakage of urine. Additionally, a stricture is a scar that can form causing a narrowing in the urethra. If either of these complications occur, an additional repair will be needed usually 6 months later

Prognosis:
Results after surgery are typically good. In some cases, more surgery is needed to correct fistulas or a return of the abnormal penis curve.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/hypospadias.shtml
http://www.nlm.nih.gov/medlineplus/ency/article/001286.htm
http://www.mayoclinic.com/health/hypospadias/DS00884
http://www.cornellurology.com/pediatrics/hypospadias.shtml

http://www.medindia.net/patients/paediatrics/Hypospadias.htm

http://www.surgeryencyclopedia.com/Fi-La/Hypospadias-Repair.html

http://www.adhb.govt.nz/newborn/Guidelines/Anomalies/Hypospadias.htm

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Categories
Diagnonistic Test

Cystourethrogram

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Definition:
A cystourethrogram is an X-ray test that takes pictures of your bladder and urethra while your bladder is full and while you are urinating. A thin flexible tube (urinary catheter) is inserted through your urethra into your bladder. A liquid material that shows up well on an X-ray picture (contrast material) is injected into your bladder through the catheter, then X-rays are taken with the contrast material in your bladder. More X-rays may be taken while urine flows out of your bladder, in which case the test is called a voiding cystourethrogram (VCUG).

CLICK & SEE

By filling your bladder with a liquid dye that shows up on x-rays, your doctor can watch the motion of your bladder as it fills and empties and can see if your urine splashes backwards toward your kidneys as the bladder muscle squeezes. This kind of test can help your doctor to better understand problems with repeated urinary-tract infections or problems involving damage to the kidneys. It can also be useful for evaluating urine leakage problems.

If X-rays are taken while contrast material is being injected into the urethra, the test is called a retrograde cystourethrogram because the contrast material flows into the bladder opposite the usual direction of urine flow.

Why It Is Done
A cystourethrogram is done to:

*Find the cause of repeated urinary tract infections.
*Look for injuries to the bladder or urethra.
*Find the cause of urinary incontinence.
*Check for structural problems of the bladder and urethra.
*Look for enlargement (hypertrophy) of the prostate or narrowing (stricture) of the urethra in men.
*Find out if urinary reflux is present. See a picture of abnormal backflow of urine.
*Look more carefully at abnormalities first found by intravenous pyelography.

How To Prepare
Tell your doctor before the test if:.

*You are or might be pregnant.
*You have symptoms of a urinary tract infection.
*You are allergic to the iodine dye used in the contrast material or any other substance that contains iodine. Also tell your doctor if you have asthma, are allergic to any medicines, or have ever had a serious allergic reaction (anaphylaxis), such as after being stung by a bee or from eating shellfish.

*Within the past 4 days, you have had an X-ray test using barium contrast material, such as a barium enema, or have taken a medicine (such as Pepto-Bismol) that contains bismuth. Barium and bismuth can interfere with test results.

*You have an intrauterine device (IUD) in place.

You may be asked to sign a consent form authorizing this procedure. Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results may mean. To help you understand the importance of this test, fill out the medical test information form (What is a PDF document?) .

If you are breast-feeding, give your baby formula for 1 to 2 days after the test.

How It Is Done

A cystourethrogram is done by a urologist or a radiologist. The doctor may be assisted by an X-ray technologist. You usually will not have to be admitted to the hospital.

You will need to take off all or most of your clothes, and you will be given a cloth or paper covering to use during the test. You will be asked to urinate just before the test begins.
You will be asked to wear a hospital gown and  lie on your back on an X-ray table. Your genital area will be cleaned and draped with sterile towels. Men may be given a lead shield that covers their genitals to protect them from radiation. But women’s ovaries cannot be shielded without blocking the view of the bladder.

A part of your genital area is cleaned with soap on a cotton swab. Then a soft, bendable rubber tube called a urinary catheter is inserted into your bladder, usually by a nurse. The tube is first coated with a slippery jelly and then pushed gently through the opening of the urethra (at the end of the penis for men and near the opening of the vagina for women).

CLICK & SEE

A sterile flexible cystoscope in an operating theatre

A catheter will be placed through your urethra and into your bladder. Contrast material will then slowly be injected through the catheter until your bladder is full.

You will feel some pressure while the tube slides into the urethra. Once it is in place, a tiny balloon on the end of the tube is filled with air to hold it in position. The other end (about 6 inches of tubing) hangs outside of your vagina or penis. The doctor uses this tube to fill your bladder with fluid containing a dye that shows up on x-rays. You will feel pressure in your bladder as it begins to expand.

To create a clear picture, your bladder needs to be filled with as much fluid as it can hold. You will probably feel a very strong urge to urinate. A few pictures are taken with the bladder completely full, and then the balloon is emptied and the tube is pulled out. You are given a urinal container or a bedpan and asked to urinate while you are still on the table under the x-ray camera. Several pictures are taken while your bladder is emptying. Many patients find this part of the test embarrassing, but it is routine and the doctor thinks nothing of it.

X-rays will be taken when you are standing up and sitting and lying down. The catheter is removed and more X-rays will be taken while you are urinating. You may be asked to stop urinating, change positions, and begin urinating again. If you are unable to urinate in one position, you may be asked to try it from another position.

After the test is over, drink lots of fluids to help wash the contrast material out of your bladder and to reduce any burning on urination.

This test usually takes 30 to 45 minutes.

How It Feels
You will feel no discomfort from the X-rays. The X-ray table may feel hard and the room may be cool. You may find that the positions you need to hold are uncomfortable or painful.

You will feel a strong urge to urinate at times during the test. You may also find it somewhat uncomfortable when the catheter is inserted and left in place. You will have a feeling of fullness in your bladder and an urge to urinate when the contrast material is injected. You may be sore afterward. If so, soaking in a warm tub bath may help.

You may feel embarrassed at having to urinate in front of other people. This procedure is quite routine for the X-ray staff. If you find yourself feeling embarrassed, take deep, slow breaths and try to relax.

During and after the test you may feel a burning sensation when you urinate. You may need to urinate frequently for several days after the test. You may also notice some burning during and after urination. Drink lots of fluids to help decrease the burning and to help prevent a urinary tract infection.

Risks Factors:
A cystourethrogram does not usually cause problems. Occasionally this test may lead to a urinary tract infection. If the contrast material is injected with too much pressure, there is some chance of damage to the bladder or urethra.

There is a small chance of having an allergic reaction to the x-ray dye used in the test. Some patients have some temporary irritation of their urethra after the tube has been in place, and this might result in some burning during urination for a few hours afterward. Let your doctor know if burning or pain with urinating lasts longer than a day; this could mean you have developed an infection.

As with all x-rays, there is a small exposure to radiation. In large amounts, exposure to radiation can cause cancers or (in pregnant women) birth defects. The amount of radiation from x-ray tests is very small-too small to be likely to cause any harm. X-rays such as this kind in the pelvic area should be avoided in pregnant women, because the developing fetus is more sensitive to the risks from radiation.

There is always a slight chance of damage to cells or tissue from radiation, including the low levels of radiation used for this test. However, the chance of damage from the X-rays is usually very low compared with the benefits of the test.

After the procedure
It is normal for your urine to have a pinkish tinge for 1 to 2 days after the test. Contact your doctor immediately if you have:

*Blood in your urine after 2 days.
*Lower belly pain.
*Signs of a urinary tract infection. These signs include:
*Pain or burning upon urination.
*An urge to urinate frequently, but usually passing only small amounts of urine.
*Dribbling or leaking of urine.
*Urine that is reddish or pinkish, foul-smelling, or cloudy.
*Pain in the back just below the rib cage on one side of the body (flank pain).
*Fever or chills.
*Nausea or vomiting.

Results
A cystourethrogram is an X-ray test that takes pictures of your bladder and urethra while you are urinating. Some results may be available immediately after the cystourethrogram. Final results are usually available within 1 to 2 days.

Cystourethrogram  Normal:

*The bladder appears normal.

*Urine flows normally from the bladder.

*The bladder empties all the way.

*The contrast material flows evenly out of the bladder through a smooth-walled urethra.

Cystourethrogram  Abnormal:

*Bladder stones,
*tumors,
*narrowing or pouches in the wall (diverticula) of the urethra or bladder are seen in the bladder.

*If the test was done because of possible injury to the bladder, a tear is found in the bladder wall or urethra.

*Urine flows backward from the bladder into the ureters (vesicoureteral reflux).

*Contrast material leaks from the bladder.

*The bladder does not empty all the way.

*The prostate gland is enlarged.

What Affects the Test
Reasons you may not be able to have the test or why the results may not be helpful include:
*Having barium (from a previous barium enema test), gas, or stool in the bowel.
*Being unable to urinate on command because of embarrassment at having to urinate in front of other people.
*Pain caused by having the catheter into the urethra. This may also cause problems with your urinary stream. You may have a muscle spasm or not be able to fully relax the muscles that control your bladder.
*A cystourethrogram is not usually done during pregnancy because the X-rays could harm an unborn baby.
Resources:
https://www.health.harvard.edu/fhg/diagnostics/cystourethrogram.shtml
http://www.webmd.com/a-to-z-guides/cystourethrogram-16691

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Categories
Ailmemts & Remedies

Cystitis (Inflammation of the urinary Bladder)

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The term  CYSTITIS  refers to inflammation of the urinary bladder. The recurrence of cystitis may in some cases, be associated with kidney trouble.

CLICK & SEE THE PICTURES

Symptoms:
The patient complains of an almost continual urge to void and a burning sensation on passing urine. There may be feeling of pain in the pelvis and lower abdomen. The urine may become thick, dark and stringy. It may have an unpleasant smell and may contain blood or pus. Some pain in the lower back may also be felt in certain cases. In an acute stage, there may be rise in body temperature. In the chronic form of cystitis the symptoms are similar but generally less severe and longer lasting, and without a fever.

Root causes:
Cystitis may result from infection in other parts connected with or adjacent to the bladder such as the kidneys, the urethra the vagina, or the prostate gland. There may be local irritation and inflammation in the bladder if urine is retained there for an unduly long time. Cystitis may also results from acute constipation. Other conditions like an infected kidney, stones in the kidneys or bladder, or an enlarged prostate may also lead to this disorder.

Diagnosis
When cystitis is suspected, the doctor first examines a person’s abdomen and lower back, to evaluate unusual enlargements of the kidneys or swelling of the bladder. In small children, the doctor checks for fever, abdominal masses, and a swollen bladder.

The next step in diagnosis is collection of a urine sample. The procedure involves voiding into a cup, so small children may be catheterized to collect a sample. Laboratory testing of urine samples as of the early 2000s can be performed with dipsticks that indicate immune system responses to infection, as well as with microscopic analysis of samples. Normal human urine is sterile. The presence of bacteria or pus in the urine usually indicates infection. The presence of hematuria (blood in the urine) may indicate acute UTIs, kidney disease, kidney stones, inflammation of the prostate (in men), endometriosis (in women), or cancer of the urinary tract. In some cases, blood in the urine results from athletic training, particularly in runners.

Other tests
Women and children with recurrent UTIs can be given ultrasound exams of the kidneys and bladder together with a voiding cystourethrogram to test for structural abnormalities. (A cystourethrogram is an x-ray test in which an iodine dye is used to better view the urinary bladder and urethra.) In some cases, computed tomography scans (CT scans) can be used to evaluate people for possible cancers in the urinary tract.

Medications
Uncomplicated cystitis is treated with antibiotics. These include penicillin, ampicillin, and amoxicillin; sulfisoxazole or sulfamethoxazole; trimethoprim; nitrofurantoin; cephalosporins; or fluoroquinolones. (Fluoroquinolones generally are not used in children under 18 years of age.) A 2003 study showed that fluoroquinolone was preferred over amoxicillin, however, for uncomplicated cystitis in young women. Treatment for women is short-term; most women respond within three days. Men and children do not respond as well to short-term treatment and require seven to 10 days of oral antibiotics for uncomplicated UTIs.

Persons of either gender may be given phenazopyridine or flavoxate to relieve painful urination.

Trimethoprim and nitrofurantoin are preferred for treating recurrent UTIs in women.

Individuals with pyelonephritis can be treated with oral antibiotics or intramuscular doses of cephalosporins. Medications are given for ten to 14 days and sometimes longer. If the person requires hospitalization because of high fever and dehydration caused by vomiting, antibiotics can be given intravenously.

Surgery
A minority of women with complicated UTIs may require surgical treatment to prevent recurrent infections. Surgery also is used to treat reflux problems (movement of the urine backward) or other structural abnormalities in children and anatomical abnormalities in adult males.

Alternative treatment
Alternative treatment for cystitis may emphasize eliminating all sugar from the diet and drinking lots of water. Drinking unsweetened cranberry juice not only adds fluid but also is thought to help prevent cystitis by making it more difficult for bacteria to cling to the bladder wall. A variety of herbal therapies also are recommended. Generally, the recommended herbs are antimicrobials, such as garlic (Allium sativum), goldenseal (Hydrastis canadensis), and bearberry (Arctostaphylos uva-ursi); and/or demulcents that soothe and coat the urinary tract, including corn silk and marsh mallow (Althaea officinalis).Cucumber juice ,Radish Leaves ,Spinach ,Sandalwood Oil.

Diet: At the onset of acute Cystitis, it is essential to withhold all solid foods immediately. If there is fever, the patient should take only liquid food like fruit juices, soups, barley water, boiled vegetables etc. After the fever is over then patient should take non-spicy food for few days. Then gradually embark upon the all types of food.

Lifestyle : During the first three or four days of acute cystitis, when the patient is on a liquid diet, it is advisable to rest and keep warm. Pain can be relieved by immersing the pelvis in hot water. Alternatively, heat can applied to the abdomen, by using a towel wrung out in hot water and covering it with a dry towel to retain warmth. The treatment may be continued for three or four days by which time the inflammation should have subsided and the temperature returned to normal.

Regular pratice of  Yoga ,  particularly   Pranayama and Padma Asana will  give a very good result.

Homeopathic medicine also can be effective in treating cystitis. Choosing the correct remedy based on the individual’s symptoms is always key to the success of this type of treatment. Acupuncture and Chinese traditional herbal medicine can also be helpful in treating acute and chronic cases of cystitis.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.

Source:www.healthline.com and www.allayurveda.com

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