Gallbladder is the organ which plays a major role in in the digestive system.This organ is located in t the right side of the abdomen, and hidden under the liver. Gall bladder stores the bile that is produced by the liver to help break down fats in the small intestine.

If the bile stored in the gallbladder contains too much cholesterol, then it may contribute to the development of gall stones. This condition may leads to the inflammation of the gall bladder. You can treat signs of gallstones naturally in your home itself. This does not even involve too much of costs.

Let me share with you the most effective natural remedies for gallbladder inflammation that you can try at home.

1) Pears: You can treat inflammation in gallbladder by eating pears. Even consuming pear juice a couple of times in the day will help you get relief from signs of gallstones. Even symptoms of painful bile duct can be avoided.

2) Beets: It is very effective to consume beet juice for cleaning the gallbladder. This helps even those who suffer from an obstructed bile duct. It is advisable to consume about 100 ml beet juice two times a day. This will relieve you of inflammation to a great extent.

3) Olive Oil: Naturally extracted olive oil is very effective in treating gallstones. The patient must be given about 30 ml olive oil as soon as he gets up at dawn. This should be followed with the same quantity of grapefruit or lemon juice. To cure of all indications of gallstones, this cocktail should be consumed for several weeks every morning.

4) Sunflower Oil: One of the other important natural remedies for gallbladder inflammation is the sunflower oil. The important thing being the oil must be unrefined and raw. You have to take the same quantity of sunflower oil as mentioned above for olive oil.

5) Dandelion: You can even try this remedy. Drink about 125 ml dandelion juice every day. This will prevent symptoms of bile duct cancer. Suppose the patient develops gallbladder polyps and other symptoms, then he must be given dandelion juice that is mixed with watercress. This will really help.

6) Chicory: You can grind and consume chicory roots, flowers and seeds as a natural remedy to treat gallbladder inflammation. This is very effective for all organs that are related with secreting bile including liver. If you have symptoms of bile duct cancer then you should consume chicory on a daily basis.

7) Carrots: Carrots act like cleansing agents for the gallbladder. They are beneficial even when the patient suffers from a bile duct blocking. The patient must consume about 100 ml carrot juice two times in a day. This will relieve from the inflammation in the gallbladder.

Enema with Warm water: Enema with warm water is effective in removing fecal unwanted material that could be responsible for an obstructed bile duct.

9) Exercise: It is important to exercise everyday. A proper exercise regimen must be adopted and followed diligently. This helps circulation and prevents any kind of blockages.

10) Hot packs: You could place hot packs on the areas that are affected due to gallbladder polyps. This will relieve the pain considerably. You can apply them to the upper abdomen and back.

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Grandson’s Favorite Cake

Before my oldest grandson was three, he decided the best cake in the world was carrot cake topped with cream cheese frosting. Each grandchild gets to choose what cake is baked or purchased for their birthdays. We all know when my grandson’s birthday comes along, the recipe below will be on the menu!

Carrot cake is not only delicious, it provides fiber and protein, as well as vegetables and fruit to picky eaters. Even children who do not like vegetables will eat this cake. I hope you enjoy this homemade cake as much as we all do.

My Grandson’s Favorite Cake!

2 cups sugar

1 ½ cups oil

3 eggs

2 tsp vanilla extract

2 cups flour

2 tsp soda

2 tsp cinnamon

1 tsp salt

2 cups grated carrots

1-8oz can crushed pineapple

2 cups chopped pecans

1 cup grated coconut, optional–I leave it out.

Combine sugar, oil, eggs, and vanilla in bowl; mix well. Stir in sifted dry ingredients. Add carrots, pineapple, pecans and coconut; mix well. Pour into prepared 8×13 inch baking pan. Bake at 350 degrees for 45-50 minutes or until cake tests done. Use buttermilk frosting or a cream cheese frosting.

The perfect cream cheese icing for your carrot cake!

1 8oz package of cream cheese

½ box powdered sugar

½ stick margarine

2 tsp vanilla

Mix ingredients stir until smooth, and spread over cake while hot. Sprinkle pecans and or coconut on top of icing. If desired for carrot cake, purchase orange and green icing in a tube and decorate cake with icing carrots.

Family Traditions

In our family, it is now traditional to have carrot cake with cream cheese icing at my oldest son’s birthday bash. These kinds of traditions have helped strengthen families for generations. Whether it is carrot cake, your grandmother’s banana pudding, or mom’s yeast break, family food favorites can become traditional fare that provides memories for years to come. If you don’t have family food favorites, consider starting your own family traditions with this cake recipe.

Linda Pogue is the webmaster of http://www.momsredkitchen.com where she regularly posts information about kitchen products, reviews cookbooks, and shares family recipes. She is also the lensmaster of http://www.squidoo.com/grammas-favorite-dessert-recipes, where this and other family favorite dessert recipes can be found. Article Source: http://EzineArticles.com/?expert=Linda_Pogue

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Just in case you visit a doctor to report conditions that may suggest the presence of STD; chances are, your doctor will perform a genital exam to further understand your real medical condition. Such examinations will give your doctor the chance to better recognize the symptoms that you are experience, while at the same time gathering information to clearly establish the disease. Keep in mind that genital exam is different for male and female hence you cannot expect that you will have the same experience with your boyfriend the time when he had his own exam.

Female Genital Exam

For female, this involves the process of pelvic exam in order to check the internal and external reproductive organs so as to further observe some signs of a disease. More often than not, the pelvic exam is as always accompanied by a pap smear. For some obvious reasons, it is highly advised that women must schedule their pelvic exam to fall during those times when she is not having her periods. On the other hand, when the condition is accompanied by worrisome symptoms like burning sensation during urination or abnormal discharge then the pelvic exam must be scheduled the soonest.

Be reminded that for pelvic exam to take place properly, the woman should not douche or even make use of vaginal spray and powder. Also, one should not insert something into the vagina even with the case of the penis for at least 24 hours before the examination. Then the examination will be done at the clinic.

Male Genital Exam

For the male, the doctor will have to do a visual and manual examination to the penis, spermatic cord, epididymis, testicles, and vas deferens. If needed, the doctor will have to examine the rectum or the anal and including the prostate gland. It is vital for every patient to tell the doctor if he is having sores or ulcers, some pain within the area, unusual discharge, and other symptom so that the doctor will know what to look for during the examination. The process may cause due uncomfort to men though there is never a time when patient would complain that they are feeling pain towards the whole process.

Understanding Genital Exam

The importance of genital exam is that doctors will have a clear picture of what is really happening within the body of the patient. Although it is somewhat uncomfortable to remove your clothing in front of your doctor, it is highly advised that patients should not be discouraged just because of the process given the fact that a simple exam like this can in fact create a big help in saving your life.

Afterwards, the doctor will give his findings and in case there is the present of a problem, he will have to advise the necessary treatments possible in order to fully eradicate the trouble. Furthermore, any fluids or tissue collected will require laboratory analysis in order to rule out the possibility of cancer or other serious diseases.

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Disclaimer: If you are unsure if or how you should use a cold application, please consult with a medical professional who can take into consideration your personal health history.

We have all felt the pain of sprains, strains or bruises, but did you know that a cold hydrotherapy application can do more than control pain? These applications enhance the effects of treatment and can be used by clients at home. It is important, though, to know how to use cold applications properly.

Inflammation is known as a “non-specific” response to injury, and is a physiological process which begins immediately after injury. Inflammation serves the purpose of isolating and immobilizing the injured area. When an injury occurs, whether it is a sprain, strain, contusion etc, a cascade of events is set in motion:

• vasoconstriction (contraction of the blood vessels) occurs immediately, followed shortly by vasodilation (expansion of the blood vessels). Vasodilation results from the release of chemicals such as histamine, increasing the size and permeability of capillaries and arterioles
• This increase in size and permeability increases blood flow to area (resulting in warmth and redness) and the leaking of fluid (exudate) from capillaries (resulting in swelling and pain)
• with increased blood flow, white blood cells migrate to area – the presence of white blood cells will inhibit infection
• At this point, further loss of blood and fluid is prevented due to clotting by proteins

Even though inflammation does serve a purpose, it can be very painful. This is where cold hydrotherapy applications come in handy, as they help control pain and bruising of injured tissue.

How does the application of cryotherapy affect an injury?

When cold is applied, the sensation which is felt is Cold, then Burning, Aching and Numb. (CBAN) The general rule when applying cold to an acute injury is to leave the application on until the area is numb, or for 10 minutes, whichever comes first. This duration of application, which is considered to be a “long” duration, will have the following effects on tissue:

• slowdown metabolism of the affected cells, meaning less oxygen is required for cellular process
• cold will constrict the blood vessels and decrease blood flow, thereby reducing hematoma and contusion formation
• the exudate (fluid) formation will be reduced at the site; less fluid puts less pressure on the pain receptors – therefore, it is less pain
• This effect will last up to 20 minutes after the application has been removed
• pain decreases for 2 reasons: waste products (cellular debris) is being absorbed and cold has a numbing effect on the nerves (pain receptors or nociceptors)

Cold hydrotherapy applications during this phase of injury may also decrease the amount of scar tissue formed, as the migration of fibroblasts to the injury site is reduced.

Why is there a time limit on how long I can leave a cold application on?

The time limit which is placed on a cold application is there to maintain the health of the tissue. If cold is left on an area for too long (12-15 minutes or longer), Hunting Response is activated to prevent tissue damage from prolonged cold.

Hunting Response is a cycle of vasoconstriction (decreased blood flow), then vasodilation (increased blood flow), and will occur if cold is left on for too long, or when tissue is cooled excessively. The increased blood flow occurs for 2 reasons:

1) to prevent damage to tissue that is peripheral to the injury site and

2) to help remove waste products,such as histamine, which occur in response to the injury and to the cold.

Hunting Response is essential to tissue health as it maintains the cellular metabolism at a rate which assists in healing the injury and surrounding tissue, and ensures that blood, supplying oxygen and nutrients, is delivered in adequate amounts to the cells.

If Hunting Response is allowed to occur from a prolonged application of cold, it can be painful as blood is forced into the area via a process known as “active derivation”.

How do I use a frozen gel-pack on my injury?

Gel packs are just one of several cryotherapy applications, and are a convenient way to address an acute injury. Here are some tips, precautions and contraindications for using cryotherapy:

1. Any application is contraindicated over an open wound, as it may introduce infection to the area.
2. Cold applications should be left until after your massage therapy treatment, and can be used between visits.
3. Cold should never be applied “proximal” to an injury. (proximal is an anatomical term which refers to how close an area on a limb is to the trunk of the body. For example. the elbow is proximal to the hand.) Circulation is diverted away from the application site, and blood may pool in the already injured area.
4. Cold is contraindicated if you have had a previous poor reaction to cold, have nerve damage, poor circulation (such as in diabetes or Raynaud’s Disease), fragile skin, plates, pins or wires.
5. Your gel pack should always be wrapped in a damp cloth or towel, and not applied directly to the skin. (you can damage your skin this way)
6. The gel pack can be used in cycles of 10-10-10 – 10 minutes on, 10 off, 10 on again. Then, give your body a rest and leave it off for up to an hour, then repeat.
7. You should never lie on your gel pack.

For further information on hydrotherapy, the book I used as a reference for this article is An Introduction to Heat and Cold as Therapy by Laurel Fowlie (paperback 2006).

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Cervicitis is the name of a disease of the cervix which can be very dangerous to women as it can affect pregnant women by creating miscarriages, or giving your newborn baby unwanted infections. There are cases related to premature birth also related to cervicitis.

Diagnosing cervicitis is not so easy, as this infection affects women of all ages and the symptoms are very similar to other kinds of infections. Of course, your doctor can always run proper test to make sure you are not suffering from cervicitis; however, you should not ignore any kind of symptoms related to this kind of disease especially if you are pregnant, as you may be risking the life of your baby.

In cervicitis, the lower part of the uterus or the cervix gets infected. This infection can slowly spread to other parts of the reproductive organs. Causes for this infection vary from person to person, however the most common ones can be from some kind of injury during intercourse or some kind of irritation.

Contraceptives, especially those which are implanted can also cause this to become a major problem and sometimes even the most simple and stupid of all things like leaving a tampon and forgetting about it for some time can create a big havoc to the whole system.

The symptoms of cervicitis include irritation and itchiness, bleeding or vaginal discharge after your periods and pain during intercourse. Burning while passing urine can also be another symptom and in some cases lower back pain also.

A mild case of cervicitis may not be noticed at all and the discomforts may be ignored by many, however once this infection and inflammation gets out of control, you will have more severe effects like fever and nausea. cervicitis can also lead to infertility as the sperm will get infected before it reaches the ovum and therefore it will contradict the whole process of reproduction.

Cervicitis during pregnancy is the most risky infection that you may have as it may lead to miscarriage or to infections of the new born which may include eye infections or other infections of the skin and even it can cause blindness in some babies.

Therefore, please make sure you do not ignore any symptoms of pain or discomfort in your vaginal area and consult your doctor immediately and get the proper tests done to find out the causes of the problem. Any kind of infection of the reproductive organs such as the cervix or the uterus or the fallopian tubes can also create similar symptoms and knowing what is really wrong and taking the proper treatment can be very important for you and your reproductive health.

Your doctor will be able to give you the proper diagnosis and treatment for cervicitis. If for some reason there is an unusual inflammation of the cervix or around the area, the doctor may also prescribe a biopsy to rule out any other problems or further complications.

Deep is a Physician and Blogs about current health events and current health articles Article Source: http://EzineArticles.com/?expert=Deep_Gajiwala

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Although you will never hear most medical professionals say it, a DHA omega 3 fish oil cholesterol lowering formula may be just as helpful in getting your cholesterol levels down as any of the prescription formulas available. A quality n-3 fatty acid formula even offers you benefits that you simply can’t get from a pharmaceutical designed to only do one thing. There are virtually no side effects related to the use of omega 3 formulas either.

The cardiovascular benefits that you will receive in addition to lowering your triglyceride levels include lowered blood pressure, clot prevention, a reduced risk of heart irregularities and arrhythmias, less chances of developing varicose veins and Raynaud’s disease, the increased breakdown of fibrin, and slowed heart rate. How many products would the pharmaceutical companies sell you in order to treat all of that?

The only danger that comes with taking an omega 3 fatty acid supplement stems from its effectiveness as an anticoagulant. The anti-clotting effect and improved circulation you get when consuming fish oil cholesterol regularly have the potential to cause you to suffer internal bleeding. The potential is only there when extremely high doses of fish oil are regularly consumed, so by staying within the advised limits of 2,000mg to 4,000mg per day will keep you safe.

When it comes to cholesterol lowering drugs there are quite a few more negative side effects that people regularly experience even when taking the recommended safe dosage. These negative side effects include headache, infections, muscle pain, joint pain, diarrhea, and inflammation of the sinuses. There are other common side effects from using these drugs as well.

How would you like to experience unexplained rash, abdominal pain, weakness, flu-like symptoms, back pain, constipation, and sore throat? You always need to look seriously at these symptoms when they occur. Some of these symptoms could indicate liver damage, kidney problems, and severe muscle breakdown. There is absolutely no chance of any of the side effects that I have listed here occurring with an omega 3 fish oil cholesterol formula.

Then there are the signs to look for that signal an allergic reaction to your medication, like a rash, itching, hives, wheezing, difficulty breathing, and swelling of the mouth, tongue, or throat. Some of the more rare effects that users have suffered include intestinal ulcers, hepatitis, asthma, and memory loss, hair loss, ringing in the ears, fainting, hearing loss, high blood pressure, and gout.

How can something that is simply supposed to lower your cholesterol cause such a wide variety of problems? Take it from me when I say that if you have a choice in the matter it is better to go with an all natural DHA omega 3 fish oil cholesterol formula. This type of product will treat not only a variety of cardiovascular problems, but will prevent or treat all forms of inflammatory diseases as well.

Don’t put yourself at risk of experiencing the many negative effects that prescription medications can potentially inflict on you unless you absolutely have too. A quality DHA omega 3 fish oil cholesterol formula should always be your first choice.

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How are your knees doing? Are they “killing” you?

If you are coping with severe knee pain, a quick glance at the waiting room of nearly any hospital emergency room across the country would show you that you’re not alone. In fact, it is estimated that as many as one in three Americans over the age of 45 have reported experiencing some type of knee pain. Many people are surprised to learn that knee problems are not always caused by some sort of traumatic injury.

So What Causes Knee Pain?

While an injury is the most common cause of severe knee pain, there are several other potential causes of which you should be aware. Arthritis is to blame for a large number of incidents of severe knee pain problems and though most tend to think of arthritis as being reserved for ‘old people’, there is no minimum age limit. Young people are known to suffer from arthritis just as the elderly do.

Inflammation

The knee is surrounded by three major fluid filled sacs called bursae (the plural form of the term ‘bursa’). In the condition known as septic bursitis, those sacs have become infected with bacteria. The bacteria can in turn cause the bursae to inflame and thus cause the severe knee pain known as bursitis. Incidentally, this is the very same bacteria that cases staph infections on the skin (known as staphylococcus) and it can cause severe knee pain that is as bad as the pain associated with a staph infection.

Knee Braces – The Runner’s Badge of Honor

Of course there are plenty of physical traumas that can lead to severe knee pain as well. Many runners are more than happy to proudly display their scars from visits to the surgeon when they’ve had one of any number of dislocations, ligament tears and / or fractures. Even the ones who haven’t had surgery can be seeing carefully putting on their knee brace before starting out on their daily run. The knee brace is seen as a badge of honor among many diehard marathon runners.

The same can be said for nearly any other sport including the seemingly sedentary golf. That’s right; golfers are prone to severe knee pain as well! Everything from simple strains and sprains up to and including a torn meniscus is far more common among avid golfers than you might think.

Before you think that you are safe from having knee problems of your own because you aren’t involved in sports, you should know that a tremendous number of knee injuries don’t occur during sporting events at all. In fact, the condition referred to earlier in this article – knee bursitis – is also commonly referred to as housewife’s knee, roofer’s knee or carpet layer’s knee and none of those qualify as sports.

Severe knee pain can be caused by traumatic injury related to sports play or it might simply be a genetic issue that the slightest trauma may bring to your awareness. Regardless of the cause, severe knee pain should be diagnosed and treated by your physician as soon as possible to lessen the likelihood of permanent knee damage.

In the end, your knee pain is your business. You can address it as you see fit. If you have never considered using a brace, now should be the time that you take a moment to do so, for your own good. Many people refer to their braces as “pain pills”, due to the pain reduction that they can provide when you use them. – You deserve to be pain free, don’t you?

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Vasectomy reversal is a simple outpatient microsurgery that reverses the process of the vasectomy procedure. Discussing and understanding the process of the reversal vasectomy procedure requires a discussion of the vasectomy procedure too. A detailed discussion of the two processes would help you understand the outcome of the reversal procedure clearly.

Vasectomy Microsurgery

Vasectomy is a permanent form of contraception preferred by men who do not think of fathering a child at present or even in the future. The process involves cutting the tubes of the vas deferens to prevent the sperm from leaving the man’s body during ejaculation. This means that the doctor will suture and clamp the tubes to make sure that there is no feasible passageway for the semen to pass through from the testicles to the prostate glands.

The vas deferens tubes are the passageway of the semen to transport the sperm into the prostate glands. The sperm will then enter the urogenital opening of the woman’s body for possible fertilization. The word vasectomy comes from vas and ectomy. Vas is the vas deferens and ectomy is the microsurgical process. After vasectomy, the male body will still produce sperm. However, the sperm gets accumulated in the vas deferens tubes because it was already severed. The accumulated sperm in the vas deferens tubes will then produce pressure and blow up creating a blockage or scar tissue.

Reversal of Vasectomy Procedure

During the reversal of vasectomy procedure, the microsurgeon will reconnect the ends of the vas deferens tubes again. There are 2 types of techniques that the surgeon uses depending on the condition of the vas deferens.

The first technique is the vasovasostomy technique. This is a very simple technique where the surgeon attempts to reconnect the ends of the vas deferens tubes using a high-powered microscope. The objective is to create a passageway for the semen to carry the sperm from the epididymis to the prostate glands. The use of the high-powered microscope makes sure that the doctor sees the tubes clearly because it measure like the size of the smallest spaghetti. This technique is used only when the doctor finds no complications during surgery. Most men who decide to undergo the reversal vasectomy within 3 years from vasectomy procedure would likely qualify for this simple procedure.

The other technique is the vasoepididymostomy where the doctor attempts to connect the vas deferens directly to the epididymis because of the presence of blockage or scar tissue. We already explained about the origin of the blockage. In reversal vasectomy, time is crucial to the formation of blockage and of the scar tissue. It is better that you decide for the reversal procedure as early as 3 years from the date of vasectomy to avoid having this type of complication. The inflammation and scarring of the vas deferens tubes develops through time. Even if the tubes were successfully reconnected, the blockage would still be there to hinder the sperm flow.

Determination of the technique to use for the procedure is possible only when the doctor opens you. The condition of the vas deferens could be determined physically. Sometimes, the doctor may perform physical scrotum examination and note if you have hardened epididymis. This is one symptom of internal blockage.

Another problem that may arise during the surgery is the length of the tubes of the vas deferens. If the length is too short then the doctor may opt for the vasoepididymostomy technique. This is not possible with physical examination. Therefore, it is essential that you prepare your funds for any changes in cost made by possible complications.

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A vasectomy (vah-SEK-tuh-mee) is a sterilization procedure that severs the vas deferens (vahs DEF-er-enz), which is the tube that transports sperm from the testicles.

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Treatment may be described under three categories. Treatment of the acute attacks; treatment in between attacks; and treatment of status asthmaticus (Severe acute asthma).

Treatment of the acute attack

Sypathomimetic drungs
Acute asthma readily responds to sympathomimetic drugs. The time-honored drug used to be adrenaline 0.5 to 1ml of 1:1000 aqueous solution given subcutaneously. It promptly relieves bronchospams, brings about expectoration, opens up the airways, and terminates the paroxysm within minutes. Adverse side effects of sympathomimetic drugs include rise in blood pressure, tachycardia, palpitation, and precipitation of angina in those with coronary artery diseases. Aquaeous adrenaline is effective for 4 hours after which the dose may have to be repeated. Oily preparations with a longer duration of action are available. Hurts’s method of administration is to deliver adrenaline subcutaneously in a does of 1 drop every minute till the bronchospasm is relieved. This helps in minimizing the dose to the optimum without causing unpleasant side effects. With the advent of safer drugs, the use of adrenaline has been reduced but still in some cases where other drugs fail, adrenaline may be necessary to give immediate relief.

Another sympathomimetic drug employed for the relief of the paroxysm is ephedrine in a dose of 25-50 mg orally every 6 hours, It is often combined with one of the xanthine derivatives. Its effect is slower but more sustained. In elderly subjects it produces urinary retention, which may precipitate prostratic symptoms. Other side effects include palpitation, excitement, and insomnia. Isoprenaline given in a dose of 20 mg subcutaneously, sublingually or as an aerosol (1/100 solution) is also effective in relieving bronchospasm during an acute attack. Sympathomimetic drugs should be used with caution in hypertensives and elderly subjects with coronary artery disease or urinary obstruction. Fatal arrhythmias may be precipitated by repeated doses of these drugs in those cases with status asthmaticus.

Beta-adrenergic agonists
Salbutamol is a selective beta-2-adrenergic agonist with less of cardiovascular side effects. It is commonly used orally in doses of 2-4 mg every 6-8 hours. It can be used parenterally in an intramuscular or intravenous dose or 500/ microgram. It is prompt in action and relatively safe. Several other beta-2-agonists such as terbutaline, isoetharine etc, are also available.

Methyl xanthines
Theophylline is the prototype of this group of drugs. Several later derivatives are available for oral use. Though the effects are not dramatic. Mild cases do respond to these drugs when given orally in doses of 150-200mg every 6 hours. Aminophylline is one of the ingredients of several commercial anti-asthmatic preparations along with ephedrine and phenobarbitone. The oral dose ranges from 200-300mg and it has to be given every 6 hours. The more effective route of administration of aminophylline is intravenous. The does is 240mg diluted in 20ml of 25% glucose and given intravenously over a period of 3-5 minutes. The effect is dramatic relief of the asthmatic paroxysm. This drug is particularly useful in cases unresponsive to or unsuitable for sympathomemetric drugs. It is one of the common drugs used in management of status asthmaticus. In patients with cardiovascular disease and in conditions where the possibility of left ventricular failure cannot be ruled out, this is the drug of choice. Adverse side effects are rare, but sometimes sudden vasomotor collapse or allergic manifestations may develop

Corticosteroids
These are indicated for the prompt relief of acute severe asthma and also as maintenance dosage in recurrent and chronic disease. For the acute attack, hydrocortisone,e in a dose of 100-200mg or its analogues (dexamethasone 4-8 mg or betamethasone 4-8 mg) are given intravenously as a bolus dose or in a slow drip. The effect is very obvious within 30-60 minutes. Oral preparations such as prednisolone or the other derivatives are preferred for maintenance dose. They are given for short periods to time over a period of exacerbation. The minimum effective dose is to be employed. Some cases may become steroid-dependent and the smallest dose required to be given for symptomatic relief can be determined by trial and error.

Aerosols of beclomethason are being increasingly used to abort or prevent an attack. This route of medication is convenient and the dosage can be kept to a minimum. The aerosol should be taken before bronchospasm is severe to ensure that the drug reaches the bronchi. Once severe bronchospasm develops, the patient cannot take an effective inspiration to deliver the drug at the site of action.

Anticholinergic agents
Atropine used to be given in asthma since it is effective in relieving bronchospasm but it seldom used now on account of its troublesome side effects. Another anticholinergic agent, ipratropium bromide is used at times as an aerosol with success in a dose of 36 mg 6 hours.

Prevention of recurrence
It is important to avoid known allergens which can be identified, especially in the case of some allergens like hose dust and pollen. Desensitization can be achieved by repeated challenges. Disodium cromoglycate administered as an inhalation in a dose of 20mg has the property of preventing mediator release from the mast cells. The inhalation has to be repeated every 6 hours. This drug should not be used during an acute attack since it may cause aggravation of the symptoms.

Respiration and other systemic infections should receive prompt attentions. The appropriate antibiotic should be selected based on microbiological tests. Tranquilisers, psycho-therapy or suggestion under hypnosis may be useful adjuncts in persons with prominent emotional everlay.

Management of acute severe asthma
Status asthmaticus has to be managed as a medical emergency. This condition is generally unresponsive to conventional drugs administered in the usual manner. Clinical assessment of the severity can be made from the intensity of dyspnea. Cyanosis and inability of the patient to speak uninterruptedly. Estimation of peak expiratory flow rate gives an objective assessment of the condition.

General measures:
These involve putting the patient to bed rest propped up with a back-rest; starting an intravenous infusion of normal saline. This aids in the administration of drugs and fluid replacement is essential to correct dehydration; and administering oxygen under supervision.
• Aminophylline is given as slow intravenous injection in a dose of 4-6mg/kg every 6 hours. Many cases get at least partial relief. Aminophylline can also be given as an intravenous infusion at the rate of 0.5-0.7mg/kg/hr.
• Corticosteriods should be given intravenously in high dosage. Hydrocortisone 100-300mg, betamethasone 8mg or dexamethasone 8mg are the preparations of choice. Sedatives which do not depress the respiratory centre are indicated if the patient is restless. Diazepam 5mg is suitable in most cases.

If the condition does not respond to treatment or the respiratory embarrassment is increasing, ventilation should be assisted. If the secretions are tenacious and difficult to be expectorated, throat suction or bronchoscopic aspiration may be required.

Indications for ventilatory assistance
1. Pa CO2 above 44mm Hg,
2. Pa O2 below 50mm Hg,
3. FEV1 or PEFR less than 10% of predicted value
4. extreme physical exhaustion, and
5. clouding of consciousness.

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Puberty In Male

In males the physical changes of puberty usually occurs between the ages of 11 and 14, this is slightly later than that of the females. The main male sex hormone that causes these physical changes is called testosterone.

The effect of this hormone initiate these secondary sex characteristics which are conspicuously seen in the following structure of the males’ body.

1. Effect on the distribution of hair:

Testosterone allow the distribution of hair over the pelvis, upward along the linear alba, on the chest and on the face. More-so it causes the hair over most part of the body to be prolific.

A. Pubic and abdominal hair:

In most case pubic hair often appears on the males shortly after the genitalia begin to grow. The pubic hairs are usually first visible at the abdominal base of the males penis. This gradually progress until when the hairs are too many to number, and densely fill the “pubic triangle”. Finally, pubic hair spreads to the thighs and upward along the linear alba towards the navel as part of the developing abdominal hair.

B. Body and facial hair:

In the months and years following the appearance of pubic hair, other areas of the skin that are sensitive to androgen may develop androgenic hair. The usual sequence is: under arm hair, pubic hair, upper lip hair, sideburns, chest hair, and the beard area. As with most human biological processes, this specific order may vary among some individuals. Arm, leg, chest, abdominal, and back hair become heavier and more, gradually. There is a large range in amount of body hair among adult males, and significant differences in timing and quantity of hair growth among different racial groups. Facial hair is often present in late adolescence, but may not appear significantly until later. Facial hair will continue to get coarser, darker and thicker few more years after puberty.

2. Effect on baldness:

This hormone reduces the rate at which hair grows especially on the head of the male. For some other people it could result in baldness depending on the degree of secretion and responds of receptors of hair growth under the scalp or heredity factor.

3. Effect on the voice:

The larynx also referred to as Adam’s apple increases in size. Vocal chords become longer and thicker, and the voice begins to break or crack, then becomes normal. Under the influence of androgen, the voice box, grows in both sexes. This growth is far more prominent in boys, causing the male voice to drop and deepen, sometimes abruptly. Before puberty, the larynx of males and females is about equally small. Occasionally, voice change is accompanied by unsteadiness of vocalization in the early stages of untrained voices. Most of the voice change happens during middle stage of male puberty around the time of peak growth. Full adult pitch is attained at an average age of 15 years. It usually precedes the development of significant facial hair by several months to years.

4. Effect on the skin, development of acne, and Body odor:

Increasing levels of androgen can change the fatty acid composition of perspiration, resulting in a more body odor. As in females, another androgen effect is increased secretion of oil (sebum) from the skin and the resultant variable amounts of acne. Acne can not be prevented or diminished easily, but it typically fully diminishes at the end of puberty. However, on rare cases it is not unusual for a fully grown adult to suffer the occasional attack of acne, though it is normally less severe than in adolescents. Some may desire using prescription topical creams or ointments to keep acne from getting worse, or even oral medication, due to the fact that acne is emotionally difficult and can cause scarring.

5. Effect on the testicular size, function, and fertility:

For the male, testicular enlargement is the first physical manifestation of puberty. Testes in male before puberty change little in size from about 1 year of age to the onset of puberty, averaging about 2 – 3cm in length and about 1.5 – 2cm in width. Testicular size progressively increase throughout puberty, reaching maximal adult size about 6years after the onset of puberty. After the males’ testicles have enlarged and developed for about one year, the length and then the breadth of the shaft of the penis will increase and the penis’ tip will also start to enlarge to adult proportions. The average adult penile size is 18 – 20cm, besides there is wide variation in testicular size in the normal population. The testes have two primary functions: to produce hormones and to produce sperm.

It is also worth noting that during puberty a male scrotum will become larger and begin to dangle or hang below the body contrary to being up tight. This is to accommodate the production of sperm cells since the testicles need a certain temperature to be fertile.

6. Effect on male musculature, bone growth and body shape:

At the attainment of puberty, adult male have heavier bones and nearly twice as much skeletal muscle. Some of the bone growth (as in shoulder width and jaw) is disproportionately greater, resulting in noticeable differences in male and female skeletal shapes. The adult male has an average of 150% of the lean body mass of an average female, and about 50% of the body fat. Often, the fat pads of the male breast tissue and the male nipples will develop during puberty.

The muscle develops mainly during the later stages of puberty, and muscle growth can continue even after boys are biologically adult. The peak of the so-called “strength spurt”, the rate of muscle growth, is attained about one year after a male experiences his peak growth rate.

The bony structure of the males’ pelvis at puberty is also remolded from an oval shape to a narrower and triangular shape.

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