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Management of Surrogacy
Caesarean Section Procedure
Treatment of Gynae Problems
Gynecology Laparoscopy Procedures
Treatment Of Female Sexual Problems
Treatment Of Menopause Related Issues
Treatment Of Menstrual Problems
Treatment of Mirena (Hormonal Iud)
Pap Smear Procedure
Polycystic Ovary Syndrome Treatment
Treatment of Uterine Bleeding
Antenatal And Postnatal Exercise
Management of Postnatal Care
Adiana System Treatment
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A girl aged 29 years having problem with white vaginal discharges since last two years, presently she feel a considerable weakness and discomfort and backache. I need your support and guideline to get treatment.
The amount of emotional upheaval that periods, or no periods (for that matter) can cause, is something that every woman is aware of. It's normal to miss your period for different reasons occasionally, but it is a matter of concern if this absence persists over a period of time. The condition is then termed as a case of secondary amenorrhea. Although most people are quick to consider pregnancy while dealing with the various reasons for missed periods, there are a number of possibilities which are seldom mulled over, but should be considered in order to take effective precautions and seek proper medical care:
- Weight: Body weight is responsible for affecting hypothalamus and this may, in turn, upset your menstrual cycle. BMI level under 18-19 may result in triggering irregularities since enough estrogen will not be created. This is also why underweight women, who suffer from bulimia or anorexia, tend to miss their periods frequently. On the other hand, overweight women may stop ovulating due to increase in the production of estrogen and therefore, have heavy, infrequent periods. Therefore, it is essential that body weight be regulated to avoid any disappointment at 'the time of the month.'
- Stress: Any type of physical or emotional stress is bound to affect your cycle. This is because, the production of stress hormones in the body increases and an elevated level of adrenaline and cortisol may impair the functioning of the reproductive system. Under stressful situations, the body employs its amino acids to assist the neurotransmitters to produce stress hormones over sex hormones. As a consequence, the chances of missing your periods increase.
- Exercising Too Much: While regular workout is indispensable for battling a sedentary lifestyle, overdoing it might cause your body to produce lesser estrogen and delay your periods. Women, who are into athletics and gymnastics, are more likely to suffer from amenorrhea. In fact, other aspects of over-exercising, like sleeping less, fasting, and infections also contribute to such irregularities.
- Breastfeeding: Prolactin is the hormone that aids in milk production and may also repress ovulation for a while. Many breastfeeding moms may not get their periods for a month or more as a result. But this doesn't do away with your chances of getting pregnant. A span of three months is expected to pass before the abnormalities are done away with.
- Food Allergies: Celiac disease or untreated gluten allergy can directly harm hormone production. They are directly related to your gut health and your adrenal glands which is why they can influence the sex hormone creation.
New path to blood sugar control
Most dm drugs make pancrea to increase insulin other act on liver other act on body cell
To date, two of these new drugs have been approved by the u. S. Food and drug administration for treating type 2 diabetes. The first, canagliflozin (invokana®), was cleared last march; the second, dapagliflozin (farxiga®), was approved just this week.
Both drugs are so-called sglt2 inhibitors that act by blocking the kidneys’ reabsorption of sugar, or glucose. The result is that more glucose is released in the urine and the patient’s blood glucose level goes down — a major goal of diabetes treatment.
Most other available drugs for diabetes work by targeting the liver, pancreas or gut to improve insulin sensitivity, reduce insulin resistance or stimulate insulin secretion. In contrast, sglt2 inhibitors work completely independent of insulin.
The two new medications, which are taken by mouth in pill form, are approved for use as stand-alone drug therapy, in addition to changes in diet and increased exercise, or in combination with other drugs for diabetes. Their approvals were based on multiple clinical studies — nine for canagliflozin and 16 for dapagliflozin — showing that they effectively lowered hemoglobin a1c, a measure of average blood sugar level over the previous three months.
A surprise effect on the waistline
An added benefit is that sglt2 inhibitors are associated with modest weight loss. For instance, patients shed from 2.8 percent to 5.7 percent of body weight in clinical studies of canagliflozin.
“The weight loss is an appealing side effect of sglt2 inhibitors, especially in the growing population of obese individuals with type 2 diabetes,” says cleveland clinic endocrinologist mary vouyiouklis, md. “aside from metformin, which occasionally results in modest weight loss, other oral drugs used to treat type 2 diabetes are weight-neutral or can cause weight gain.”
Safety profile: keeping an eye on heart effects
Another potential benefit is also a potential adverse effect: the fact that sglt2 inhibitors have a mild diuretic effect (i. E, tend to increase urination). This results in lowering of blood pressure, which can be good for some patients who have high blood pressure but can also cause lightheadedness, dizziness or even fainting in other individuals. Dr. Vouyiouklis says caution is needed before these drugs are started in any patients at particular risk of the latter effects, such as the elderly or patients taking diuretics or multiple drugs for blood pressure.
The drugs’ other most common side effects in clinical trials — genital yeast infections and urinary tract infections — are also related to the fact that they act via the kidneys. Both drugs posed a low risk of hypoglycemia, the dangerously low blood sugar episodes associated with some diabetes therapies.
However, the new drugs were found to modestly increase levels of ldl (“bad”) cholesterol, which could be a concern because patients with diabetes are already at increased risk of heart disease. The potential for increased rates of heart attack, stroke and other cardiac events is being specifically monitored in large ongoing studies of both canagliflozin and dapagliflozin, but full results are not expected for several years.
Ongoing bladder safety scrutiny with dapagliflozin
Additionally, patients taking dapagliflozin in clinical trials showed a small increase in bladder cancer diagnoses compared with control patients. In fact, dapagliflozin was rejected for approval by the fda two years ago because of concerns over bladder cancer and liver toxicity.
The agency’s concerns about these risks were eased by additional data from dapagliflozin’s manufacturer this time around, but the drug’s approval included a requirement that it be studied for bladder cancer risk in patients in ongoing trials as well as in new animal studies looking specifically at effects on the bladder.
Canagliflozin does not appear to be associated with bladder cancer or liver toxicity, the fda concluded.
More agents in the pipeline
Several other sglt2 inhibitors may soon be available as well. One of them, empagliflozin, is in late-stage studies, and the fda is expected to decide on its approval by the end of march.
Who should get these drugs, and when?
Dr. Vouyiouklis says obese patients with type 2 diabetes and normal kidney function stand to benefit most from sglt2 inhibitors. In general, these drugs seem to be best tolerated by patients with normal kidney function and less well tolerated by those with moderate kidney disease (they should not be used by patients with severe kidney disease). They are not approved for use by pregnant women, patients under 18 or individuals with type 1 diabetes.
“Although sglt2 inhibitors are approved for use as single drug therapy, metformin remains my choice for first-line oral therapy,” says Dr. Vouyiouklis. “Because sglt2 inhibitors are relatively new and their long-term effects are not yet known, I prefer to reserve them for use as add-on therapy. I believe they will be a useful addition, especially in obese patients who are seeking to lose weight.”