Sometimes, when it comes to problems in the abdominal area, an ultrasound is not clear enough for a diagnosis. In such cases, an Endoscopic Retrograde Cholangiopancreatography (ERCP) may be performed. This procedure gives the doctor a clear view of the duodenum, bile duct, pancreatic ducts, gallbladder and papilla of Vater.

This procedure is usually performed under intravenous sedation without general anesthesia. This procedure involves the use of a duodenoscope, which can be described as a thin, long, flexible tube with a camera at one end. It also has a fiber optic bundle that transmits lights to the camera and a chip to transmit video images to a TV screen.

This is inserted through the patient s mouth and sent down the throat through the food pipe to the stomach and duodenum while the patient is lying on his or her back. The air pipe is left undisturbed so as to not interfere with the patient s breathing. Since the patient is not under general anesthesia, he or she can move and turn according to the doctor s needs. The papilla of Vater is a small nipple like structure with an opening to the bile duct and pancreatic duct. Once this has been identified, a small plastic catheter is passed through the duodenoscope into the bile duct or pancreatic duct through the papilla. Dye is then injected into the area and X-rays are taken of the bile ducts and pancreatic duct. In cases where a biopsy is needed, other instruments can also be passed through the endoscope. Plastic or metal stents can also be passed through this to relieve obstructions in the bile ducts and pancreatic ducts.

ERCP can be used to diagnose and treat a number of conditions in the liver, bile ducts, gall bladder, pancreas and papilla of Vater. These include:

  Blockage of the bile duct by gallstones, cancer, scars, tumors or compression from adjacent organs.

  Jaundice due to an obstructed bile duct. This can also cause light stools and dark urine.

  Persistent upper abdominal pain

  Unexplained weight loss and loss of appetite

  Diagnosing a Dysfunctioning Sphincter of Oddi within the Papilla of Vater

ERCP can also be used to confirm pancreatic cancer and cancer of the bile duct. Once the diagnosis is confirmed, the doctors can customize treatment according to the patient s needs.

Endoscopic Retrograde Cholangiopancreatography - Procedure and Results

4 Things to Know Before You Lose Your Virginity

Losing your virginity can be a big experience and can be exciting as well as nerve-wrecking at the same time. Its significance is different for everyone and there are no wrong or right ways to lose your virginity. Making your first time a memorable experience is easy if you know and remember these 4 things:

1. Relax

You might be conscious about your body or nervous about pain or pleasing your partner, but you need not be. It is natural to feel insecure and nervous, but communicating your reservations with your partner will clear the air between both of you, helping you level your expectations and relax. Your first time is about exploring each other's body and pleasuring each other as well as an understanding partner will help you relax and forget your insecurities.

2. It might hurt a bit

If you are a woman, intercourse for the first time might hurt a bit if your vagina is not well lubricated before you have sex. Also, you might feel some pain and/or bleed if your hymen tears, but it will not be excruciating pain. Worrying about the pain is a lot scarier than the actual pain. Some women may not experience any pain at all. However, you should make sure you are well lubricated. Foreplay is a great way to get ready for intercourse and if it is still painful you could use additional lubricants to minimize discomfort and pain.

3. Go slow

If you are a man, help your partner be comfortable by going slow in accordance to their wish. Going too fast may hurt your partner if they are not comfortable and make your first time a traumatic experience. Try to gauge your partner's reactions and proceed in a way pleasurable to both of you. Penetrating too soon might cause you to ejaculate too quickly before your partner has climaxed. Indulge in foreplay so that both of you are ready. If your partner ejaculates too fast or is unable to hold his erection, do not feel rejected or angry, support him and help him get aroused again, as it is just an effect of nervousness and excitement.

4. Use protection

There is no truth in the saying that you cannot get an STD on your first time. It is completely possible and the only way to prevent that is to use condoms or not have penetrative sex. Women can get pregnant during unprotected sex and unless you plan to become pregnant, panicking about being pregnant for days after your first time will ruin your first time and peace of mind. Use birth control and/or condoms to prevent unwanted pregnancy after your first time, and both your partner and you will be able to enjoy losing your virginity without any worries.



4 Things to Know Before You Lose Your Virginity

Spread of HIV infection from a woman who has transmits HIV to her child during pregnancy, childbirth (labor and delivery), or breastfeeding (breast milk) is called as  Mother to child  transmission (MTCT) of HIV. It is also termed as the perinatal transmission of the HIV infection or  vertical  transmission. In the absence of medical intervention, perinatal transmission rates are very high, between 20-45% in different parts of the world. In various regions of the African subcontinent a large number of HIV infected children are present. It is a major cause of deaths in teens and adolescents in that region. 

Almost 90% of all HIV infected children live in the sub-Saharan Africa. In some districts of AP, Karnataka, Maharashtra and TN that were highly HIV-prone, we have several HIV infected children and adolescents. The virus replicates in the body and affects the immune system. Due to decreased immunity, various opportunistic infections enter the body and cause AIDS related symptoms. Prevention of HIV infection in infants and young children is now a high priority and has been the rallying point for enhanced prevention efforts. MTCT HIV infection can be prevented with adequate measures by way of Anti-retroviral treatment (ART). All expecting mothers who are HIV infected should have access to the preventive medical services throughout the gestation period, during labor and also during breastfeeding. 



Proper provision of resources with skilled staff and awareness programs can help in avoiding new infection cases. Breastfeeding is the primary source of transmission of infection from mother to child. Basically, once ART is started in an HIV infected pregnant woman that should continue forever. With proper ART course, chances of MTCT are near Zero. At the Unison Medicare & Research Centre; which is India s first fully comprehensive clinic for HIV Care and infectious Diseases, during last decade, not a single MTCT has occurred after treating more than 160 such HIV infected mothers. Even prior to that MTCT rate was lower than 1%. Our motto has been making the mothers virally suppressed commensurate with the global principle of  Undetectable = Untransmittable ! In fact now more and more HIV infected couples have been coming forward for an elective pregnancy. Even HIV un-infected children orphaned by AIDS or living with sick caregivers are at the great risk of emotional and physical abuse, which in turn increases the child s vulnerability to HIV infection. 

Reduction of risks to these vulnerable children is of great importance and various programs are being implemented for the welfare of orphans and vulnerable children. Various risk factors that are implicated in the transmission of HIV infection from mother to child are as follows: 

Increased viral load 
Genital tract viral load 
Reduced CD4 cell count 
Unprotected sexual intercourse with infected partner 
Smoking, Substance and drug abuse 
Deficiency of Vitamin A and other essential nutrients 
Presence of other Sexually transmitted diseases (STDs) 
Pre-term delivery 
Placental disruption 
Invasive monitoring of the fetus 
Breast feeding In most cases, HIV will not cross through the placenta from mother to baby. 
In an otherwise healthy mother, risk of child getting infected is low. Prenatal visits shouldn t be increased until a complication arises. The physician should observe symptoms of AIDS and pregnancy-related complications on a regular basis. HIV may be the direct cause or a marker of a complex interaction of related medical and social conditions that affect pregnancy. Most HIV positive women are usually asymptomatic and have no major obstetrical problems during their gestation period. They should receive similar obstetric antenatal care as the HIV-negative women, unless indicated by the need to provide specific treatment for HIV related conditions. There is no evidence of a need to increase the number of antenatal visits, provided there are no complications of the HIV infection, although additional counseling sessions may be required to reassure the mother and family. 

Care of the HIV positive woman during pregnancy should include ongoing counseling and support as an integral part of the management. Invasive diagnostic procedures, such as chorionic villus sampling, amniocentesis or cordo-centesis should be avoided wherever possible, due to a possible risk of infection of the fetus. In case you have a concern or query you can always consult an expert & get answers to your questions!

How Can We Achieve HIV-Free Generation?

Irritable bowel syndrome is a disorder that is diagnosed on the basis of its symptoms. It is characterised by intense abdominal pain, discomfort, bloating and change in bowel habits. One of the primary symptoms of IBS is abdominal pain. It may also be accompanied with frequent diarrhoea or constipation. There might also be a feeling of partial or incomplete evacuation. The symptoms are sometimes relieved by the proper bowel movement. Other symptoms, in this case, include depression and anxiety. In rare cases, there is also a possibility of sexual dysfunction and a reduced libido.

Causes of Irritable Bowel Syndrome 

The exact reason behind the occurrence of IBS is not known. It is a disruption of the brain-gut axis that is known to cause the problem. It is also caused due to small intestinal bacterial overgrowth.

Triggering factors 

IBS is intensified or triggered by the following factors:

Foods: Edibles like chocolate, milk and alcohol might lead to constipation or diarrhoea. One must also avoid carbonated beverages and some fruits and vegetables. These might lead to bloating and discomfort.

Stress: The condition gets worse with any type of stress.

Hormones: In women, the symptoms occur as a result of the hormones during menstrual periods.

Complications: It is not associated with any fatal condition. But it can lead to diarrhoea and constipation and aggravate hemorrhoids.

Adverse Impacts of the Disease-

IBS has an adverse impact on your lifestyle. It will limit your ability to get social or carry out your daily professional activities. You will find it difficult to cope up with the symptoms while living away from your comfort zone or home. You will not have a good sex life. You will get depressed and may even feel suicidal in extreme cases.

Treatment of Irritable Bowel Syndrome-

IBS is treated broadly by bringing in certain changes in the lifestyle. To begin with, you are advised to check your diet. Include fibre in your diet, if you are suffering from constipation. Also, avoid oily, spicy and hot food items. Besides, you are prescribed medicines such as stool softeners and laxatives and antispasmodic drugs and proton pump inhibitors.

Homeopathic medicines-IBS requires prolonged treatment. Homoeopathy works best to get you relief from the symptoms and cures it, from the roots. Here are certain homeopathic remedies that are helpful in treating the disorder.

Argentum nitricum

Asafoetida

Colocynthis

Lilium tigrinum

Lycopodium

Natrum carbonicum

Nux vomica

Podophyllum

Sulphur

Aloe

It has to be kept in mind that these are just basic remedies. There are over 150 Homeopathic medicines that can be used for treating IBS. Thus, consult your doctor for the best remedy for you as per the symptoms.  

Treating Irritable Bowel Syndrome With Homeopathy

When you experience any kind of bone and joint pain, you may be wondering what the best remedy might be to get relief. Some people ignore the pain, and it worsens, while others take over-the-counter medicines. However, the best remedy for bone and joint pain is to visit a pain management specialist. The field of pain management has evolved over the last twenty years. Nowadays, there are dedicated pain management specialists who are experts in treating bone and joint pain.

Here are 3 reasons to consult a pain management specialist for bone and joint pain:
1. Pain management specialists are trained especially for understanding any kind of bone or joint pain. They undergo special training based on bone and joint pain management and thus know how best to recognize and treat such pains.

2. Pain management specialists have a multidisciplinary approach towards treating bone and joint pain. The aim of pain management is to provide overall treatment and pain management specialists know about the best ways to take care of joint and bone pains. Pain management involves interventional procedures, psychological therapies, medication management and physical therapies. Pain management specialists also provide you with lifestyle modification remedies and assign you exercise schedules and diet plans. Alternative medicines like acupuncture and massage therapies are also provided by pain management specialists.

3. Pain management specialists cooperate with you and come up with the best solution for your bone and joint pain. Pain is such an aspect, which has no fixed cure and the remedy varies from person to person and depends on the nature and severity of the pain. Thus everyone should receive a personalized treatment, which is most suitable to cure the pain that has occurred to them. Pain management specialists work with patients, discuss a lot and come up with the best treatment procedure, which would complement the patient. For example, a neurostimulation device can be prescribed to a patient who suffers from complex regional pain syndrome and did not have success with other treatment procedures. In many patients with a shattered spinal disc, pain management specialists prescribe injections, which work effectively to give relief and treat the condition.

A pain management specialist can make the best assessments on bone and joint pain. Being trained especially in bone and joint pain management, you can bank upon pain management specialists to receive the best treatment for your bone or joint pain.

3 Reasons to See a Pain Management Specialist for Bone and Joint Pain

There are different types of heart problems like coronary artery disease, congenital heart failure and cardiomyopathy, but their warning signs are the same i.e. shortness of breath. This is the reason why shortness of breath should never be taken lightly and should always be investigated for heart diseases.

Why does shortness of breath happen?
You may not be able to get in enough air while experiencing shortness of breath. Known medically as dyspnea, shortness of breath is often described as an intense tightening in the chest and a feeling of suffocation. This is one of the most frightening conditions experienced by a patient. You can experience dyspnea without any serious medical problems in these conditions

After strenuous exercise
In extreme temperatures
Due to obesity and
In high altitudes
But if you are not in any of these conditions, then shortness of breath is a sign of a serious medical problem usually involving your heart or lungs. These two vital organs transport oxygen to the rest of your body and remove carbon dioxide; hence problems with either of these organs can affect your breathing. Shortness of breath that comes on suddenly called acute, can be due to other causes too like:

Asthma
Excess fluid around the heart
Low BP
Heart failure
Blood clot in an artery in the lung
Collapsed lung
Pneumonia
If you have had shortness of breath that has lasted for weeks, then we call it chronic and its causes can be various diseases of the heart apart from asthma and COPD. There is no doubt that your heart may be in trouble, if you have chronic shortness of breath. You may be suffering from these heart conditions:

Cardiomyopathy or problems with the heart muscle cause symptoms like shortness of breath after physical exertion as well as fatigue, and swelling of legs and abdomen. Patients suffering from cardiomyopathy are at risk of sudden death due to cardiac arrest.
Heart arrhythmias is also called irregular heartbeat, and can cause slow or fast heartbeats. These also have symptoms like shortness of breath. Arrhythmias can cause strokes, heart failure and cardiac arrest.
Heart failure occurs when the heart is unable to pump blood efficiently to meet the needs of the body. This is a potentially fatal condition. One of the most common symptom is shortness of breath with exercise and while lying down. Fatigue is another common symptom.
Pericarditis or swelling of membranes around the heart is also characterised by shortness of breath.
Treatment of breathlessness can start after you are referred to a heart specialist for further tests to confirm the likely cause.

Shortness in Breath - Can Your Heart Be In Danger?

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