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In mod- ern western medicine tadora 20mg line impotence vasectomy, absence of menstruation in a woman of child-bearing age might be attributable to a variety of causes (e tadora 20 mg kidney disease erectile dysfunction treatment. It might not even be deemed to merit therapeutic intervention, unless the woman desired to get pregnant. In Hippocratic and Galenic thought, ab- sence of menstruation—or rather, retention of the menses, for the waste ma- terial was almost always thought to be collecting whether it issued from the body or not—was cause for grave concern, for it meant that one of the major purgative systems of the female body was inoperative. It is for this reason that the largest percentage of prescriptions for women’s diseases in most early medi- eval medical texts (which reflected the Hippocratic tradition only) were aids for provoking the menses. Between the ages of fourteen (‘‘or a little earlier or a little later, depending on how much heat abounds in her’’)84 and thirty-five to sixty Introduction  (upped to sixty-five in the standardized ensemble), a woman should be men- struating regularly if she is to remain healthy. In overall length, the four sections on menstruation (¶¶– on the general physiology and pathology of menstruation, ¶¶– on menstrual retention, ¶¶– on paucity of the menses, and ¶¶– on excess men- struation) constitute more than one-third of the text of the original Conditions of Women. Throughout these long sections on menstruation, the author is adhering closely to his sources: the Viaticum for overall theory and basic therapeutics and the Book on Womanly Matters for supplemental recipes. In ¶, the author tells us that the menses are commonly called ‘‘the flowers’’ because just as trees without their flowers will not bear fruit, so, too, women without their ‘‘flowers’’ will be deprived of off- spring. This reference to ‘‘women’s flowers’’ has no precedent in the Viaticum (the source for the rest of this general discussion on the nature of the menses) nor in any earlier Latin gynecological texts, which refer to the menses solely as menstrua (literally, ‘‘the monthlies’’). Theterm‘‘flower’’(flos) had been used systematically throughout the Trea- tise on the Diseases of Women (the ‘‘rough draft’’ of Conditions of Women, which had employed frequent colloquialisms), and at least fourteen of the twenty- two different vernacular translations of the Trotula (including Dutch, English, French, German, Hebrew, and Italian) employ the equivalent of ‘‘flowers’’ when translating the Latin menses. But just as a tree which lacks viridity is said to be unfruitful, so, too, the woman who does not have the viridity of her flowering at the proper age is called infertile. Menstrual blood is like the flower: it must emerge before the fruit—the baby—can be born. In the Hippocratic writings themselves, although there is discussion of suffocation caused by the womb, the actual term ‘‘uterine suffocation’’ (in Greek, hysterike pnix) is never used. It was only out of loose elements of Hip- pocratic disease concepts (which were always very vaguely defined and iden- tified) that the etiological entity of uterine suffocation was created, probably sometime before the second century . Such movement was thought to be caused by retention of the menses, excessive fatigue, lack of food, lack of (hetero)sexual activity, and dryness or lightness of the womb (particu- larly in older women). When these conditions obtain, the womb ‘‘hits the liver and they go together and strike against the abdomen—for the womb rushes and goes upward towards the moisture. When the womb hits the liver, it produces sudden suffocation as it occupies the breathing passage around the belly. For example, when the womb strikes the liver or abdomen, ‘‘the woman turns up the whites of her eyes and becomes chilled; some women are livid. If the womb lingers near the liver and the abdomen, the woman dies of the suffocation. Multiple means of treat- ment were employed, including the recommendation that, when the womb moves to the hypochondria (the upper abdomen or perhaps the diaphragm), young widows or virgins be urged to marry (and preferably become preg- nant). This was premised, apparently,on the belief that thewombwas capable of sensing odors. Fetid odors (such as pitch, burnt hair, or castoreum) were applied to the nos- trils to repel the womb from the higher places to which it had strayed, while sweet-smelling substances were applied to the genitalia to coax the uterus back into its proper position. Not all the symptoms were listed every time uterine movement was men- tioned by the Hippocratic writers, nor did all cases of pnix involve uterine movement. Whenanattack occurs, sufferers from the disease collapse, show aphonia, labored breathing, a seizure of the senses, clenching of the teeth, stridor, convulsive contraction of the extremities (but sometimes only weakness), upper abdominal distention, retraction of the uterus, swelling of the thorax, bulging of the network of ves- sels of the face. The whole body is cool, covered with perspiration, the pulse stops or is very small. Critical to his views, and to all contemporary criticisms of the ‘‘wandering womb’’ (in- cluding Galen’s, as we shall see in a moment) were the anatomical discover- ies made at Alexandria in the third century . The womb ‘‘does not issue forth like a wild animal from the lair’’ but is instead ‘‘drawn together because of the stricture caused by the inflammation’’ of these uterine ligaments. Soranus also adamantly rejected the Hippocratic odoriferous therapy, or at least the part of it that employed foul- smelling substances. Yet for all his modifi- cations, Soranus never questioned the disease category itself. On the contrary, his thorough engagement with it was to help render it canonical in almost all later gynecological texts up through the Renaissance. Galen, active only a generation after Soranus, was more accommodating of traditional Hippocratic perspectives.

Literature has shown that policies that seek to strengthen families are essential in addressing the substance abuse problem buy discount tadora 20mg on-line erectile dysfunction injection. In South Africa buy 20mg tadora overnight delivery erectile dysfunction treatment after radical prostatectomy, one single most important initiative that seeks to address a family unit as key to building an individual is the 26 Green Paper on Families. It deals with how to promote family life, and how to strengthen families and what family strengthening programmes can be pursued. Societal/Community level and Drug use campaigns At the level of society or community, interventions should ideally focus on reducing youth’s access to drugs, and modifying societal norms that promote indulgence in these substances. Regulations and stricter enforcement of laws play a key role in reducing drug abuse. Harker, at al (2008) also recommends:  Community mobilization to counter the sale of legal and illegal drugs. In 2003 the Department of Social development launched the campaign “Ke moja, I’m fine without drugs”. In line with the National Drug Master Plan, “Ke moja I’m fine without drugs” main focus is on the primary prevention. The programme further works towards the protection and upliftment of all people and communities by promoting well-being and encouraging and supporting people to take pro- health decisions. In 2010, the Department of Social Development launched an Anti-substance abuse campaign popularized through the name ‘No place for drugs in my community’. The campaign focused on awareness raising and promoting rehabilitation amongst those affected. One of the objectives of the campaign was to promote debate and action around drug abuse. The last of these was launched by the minister in 2015 under the banner ‘Vulnerable populations in emergencies’. Many of these seasonal campaigns are often overshadowed by many others from different stakeholders – which are aimed specifically at alcohol abuse. As a result of this, substance abuse, other than alcohol does not get the desired prominence. Recently, the government launched a national campaign, known as Operation Fiela/Reclaim. Operation Fiela-Reclaim is a multidisciplinary interdepartmental operation aimed at eliminating criminality and general lawlessness in communities. The ultimate objective of the 27 operation is to create a safe and secure environment for all in South Africa through the prevention and combating of various crime types and addressing the safety concerns of the citizens of the country. Although no formal evaluation of the campaign has been conducted – there is anecdotal evidence of success particularly in its other areas of focus such as confiscating counterfeit goods and unlicensed fire arms. Its focus in dealing with the criminal aspect of possession, with no specific education is another limitation. Through the ‘Be Alert’ campaign, drug awareness has been prioritized – giving information on different drugs, their effects and dangers of addiction. Several civil society organizations have also developed and implemented drug abuse related campaigns. National Youth Development Agencies has been involved in Anti-drug awareness campaign. At community level, these organizations tend to mushroom in high drug use communities, many of them emphasizing harm reduction – through promoting rehabilitation programmes. Whilst these tend to have some microsomal success – they often lack adequate support from law enforcement and exist in isolation from those aimed at addressing supply of drugs. Indeed, they are often overwhelmed by the continued supply of the drugs, resulting in addiction relapses. The program has not been formally evaluated but continues to inspire private sector involvement in the fight against drugs. On a daily basis, these prosecutors noticed that many of the young people filtering through the criminal justice system shared this history and were in trouble as a direct result of it. They embarked on a carefully structured campaign, which addressed substance abuse and revealed how children were being led into a life of crime due to addiction. They are a safe place for children between the ages of 14 and 17 who are in conflict with the law.

It can be used in women eligible for oral con- Hypertrophy of the sebaceous glands and connective tis- traceptives buy tadora 20 mg without prescription erectile dysfunction icd 0. Thesearevery r Topical treatments using antibiotic gels discount tadora 20 mg fast delivery erectile dysfunction toys, such as effective with 80% of patients achieving long-term re- metronidazole, are used for at least 4–6 weeks. However, r Systemic treatments are used in refractory cases and retinoids are highly teratogenic causing spontaneous in patients with ocular symptoms. Prolonged courses abortions and severe life-threatening congenital mal- of metronidazole, tetracycline, oxytetracycline or ery- formations. Women require a pregnancy test prior thromycin are generally used, which is changed to to starting therapy and should ideally use both an aretinoid if symptoms remain. See section Acne oral contraceptive and a barrier contraceptive during Vulgaris for details regarding the use and safety of and for 1 month after treatment. Prognosis Rosacea is a chronic condition, and topical metronida- zole may be required to maintain remission. Rosacea Definition Achronic inflammatory facial dermatosis affecting the Hair and nail disorders central face characterised by vascular dilation, erythema and pustules. Alopecia is defined as hair loss; it is classified into diffuse and localised, scarring and non-scarring. Sex Aetiology/pathophysiology F > M The growth of hair from follicles passes through a cycle (see Fig. Aetiology/pathophysiology There is dilation of dermal blood vessels, hyperplasia of Clinical features and management sebaceous glands but normal excretion of sebum. The r Androgenic alopecia has a genetic tendency and is cause is unknown but it is more common in individu- androgen-dependent. Some females, starting from late teens increasing in inci- evidence suggests a role for hair follicle mites. In males the hairline recedes initially in the temporal regions before hair loss at the Clinical features Symptoms begin with recurrent flushing of the face, which worsens on exposure to hot drinks, alcohol, stress Table9. Thismayprecede,byyears,erythemaofthe Diffuse non-scarring Androgenic alopecia, metabolic, nose and cheeks. Scarring Discoid lupus, burns, radiation, foreign body in the eye, telangiectasia and inflammation lichen planus. Chapter 9: Hair and nail disorders 397 Anagen, Growth phase lasts two to three years. Catagen, Release of hair shaft involutional phase lasts two to three weeks Telogen, resting phase, lasts three to four months Figure 9. Topical minoxidil produces some response in up Idiopathic Possible steroidogenic abnormality to 30% of cases. Finasteride is also used in androgenic Iatrogenic Danzol, some oral contraceptive pills alopecia in males. Pituitary Hyperprolacinaemia r Telogen effluvium occurs when the normally asyn- Adrenal Congenital adrenal hyperplasia, Cushing’s chronous cycles in follicles synchronises after child- syndrome Ovarian Polycystic ovaries, hyperthecosis, some tumours birth, surgery or severe illness. Hir- develop well-demarcated circular patches of hair loss, sutism is caused by increased androgen production or, which may coalesce causing alopecia totalis. Pathog- more rarely, increased sensitivity of hair follicles to an- nomonic is the presence of exclamation mark hairs, drogens (see Table 9. Women with a normal menstrual cycle are unlikely to Hirsutism have an endocrine cause. Other features may include Definition acne, seborrhoea, androgenic alopecia, deepening of the Hirsutism is the androgen-dependent growth of hair in voice and clitoromegaly. The abdomen should be exam- awoman, which is in the same distribution as in males. Increased incidence Systemic illness Hypothyroidism, anorexia nervosa, of impetigo is seen in conditions damaging the integrity malnutrition, porphyria cutanea of skin such as eczema, and its spread is facilitated by tarda overcrowding and poor hygiene. Paraneoplastic syndrome Clinical features Impetigo appears as erythematous erosions with a char- Investigations acteristic golden brown crusting. There may be associ- Dependent on the level of virilisation and menstrual ated localised lymphadenopathy. Bullous impetigo de- anomaliesfound;hormoneprofileandabdominalimag- scribes punched-out blistering lesions with crusting due ing may be required. Management Management r Any underlying cause for excess androgen production Swabs should be taken. Of- r Physical methods of hair removal include shaving, ten the condition requires treatment with oral penicillin chemical depilatories, bleaching, electrolysis and laser (Streptococcus) and flucloxacillin (Staphylococcus).

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