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Urinary tract infections in menUrinary tract infections are most commonly seen in the bladder in men. The symptoms include: Pain or burning during urination The urge to urinate often Pain in the lower abdomen Urine that is cloudy or foul-smelling Fever with chills and vomiting If the infection has spread to the kidneys, there may be pain in the back in the region of the kidney along with high grade fever, nausea and vomiting. UTI occurs very commonly and is not a medical emergency, but it is advisable to see the doctor immediately to avoid further complications. Elderly people and people suffering from diabetes should report instantly as they are at a higher risk for complications. The main risk is of the infection spreading up and affecting the kidneys. This could result in severe damage to the kidney and in people already suffering from any kidney disease, it could mean even kidney failure. There is also a small chance of the bacteria entering the blood stream and reaching other organs. Risk Factors for developing UTI: Not drinking enough water Holding in urine for long Kidney stones Taking frequent baths These factors may increase your chances of developing UTI A urine test is the only way to diagnose UTI. It not only checks for bacteria in the urine but also for abnormal cells like pus cells and red blood cells. Dipsticks are accurate. Home test kits are also available but they do not boast of 100% accuracy. Stealth or Asymptomatic UTI is the same as UTI, except that the symptoms are not seen. The bacterial infection is revealed in a routine urine test. This is serious and since it affects elderly people and immune-compromised people, needs immediate treatment. UTI is treated symptomatically. Specific antibiotics are prescribed for killing the bacteria. Symptomatic treatment is offered for the fever and pain if present. Along with this you will be recommended to drink plenty of water and fluids and regularly empty your bladder. Men with diabetes need to take special care due to several reasons. Since their immune system is weak, they are prone to infection easily. The high amount of sugar in the blood and urine may encourage the bacteria to flourish. Also, the diabetic neuropathy affects the nerves of the bladder and there may be no proper signals for emptying the bladder fully. All these add up as potential risk factors for UTI. Urinary Tract Infections are easily preventable. Here's how: Drink Plenty of water Empty your bladder at regular intervals Take showers instead of baths Visit the toilet before and after sex Avoid strong smelling soaps and washes to wash the genitals Wash from front to back.
What causes male balding?They say there are 3 types of men: the ones that go bald at the top are thinkers, the ones who go bald at the back are lovers, and the ones who grow bald at both places... only think they are lovers. If pregnancy and menstruation are a female's burden, then baldness is a great inconvenience to men. Some men lose their hair in their youth and thus lose their confidence along with their hair. So what is with baldness and men? Men start having a receding hairline by the time they hit 30, though it could begin in their 20s as well. The most common type of baldness is the mid-frontal type resembling a horseshoe. Earlier it was thought that baldness is caused only by genetic factors, but apparently emotions, lifestyle and diseases also contribute largely to hair loss and baldness. This hair loss can be temporary or permanent. Some medications like anticoagulants, antidepressants, antifungal medicines, chemotherapy etc can cause baldness. Certain diseases like thyroid disease, Crohn's disease, lupus can cause hair loss and baldness. Poor nutrition is an important factor in hair loss. Vitamin and mineral deficiencies along with poor nutrition can pave the path sooner than most other things. Then there are some conditions like Alopecia Areata which cause baldness in patches -- on the head or beard. It is temporary and the hair grow back in about 6 months to 1 year. Corticosteroid injections are used to treat the condition. Air and water pollutants, environmental toxins, conventional styling products have the potential to build up on the scalp. These affect hair cuticle, cause dryness, and weaken the hair causing them to easily break off before their natural lifecycle has ended. If you notice your hairline receding more than usual, then check if you are getting enough nutrition. Exercises like the headstand and handstand send the blood rushing to the scalp and can help with hair growth. Massaging the head with warm oil helps to increase blood circulation as well. Use a shampoo that suits your hair along with a conditioner. Oil your hair overnight at least thrice a week. Keep yourself well hydrated and try vitamin C which can help arrest hair fall. Use a clean comb and ensure that you sun your scalp, as vitamin D is an essential tonic for skin, bones, teeth and even hair.    
The post-delivery bluesA baby being born is cause for celebration. Especially in a country like India, where the family ties tend to be close, there is a festive atmosphere at home. However, sometimes the mothers may not share the same enthusiasm. This wave of negative emotions in the middle of what is clearly a happy occasion can be confusing for the new mother. Interestingly these feelings are not abnormal, as many new moms face postpartum depression, which is also called baby blues. It is an emotional reaction that begins a few days after delivery and lasts not more than 2 weeks. What are the symptoms of postpartum depression? Feelings of anger or irritability. Lack of interest in the baby. Lack of appetite and sleep disturbance. Crying and sadness. Irritability or hypersensitivity. Feelings of guilt, shame or hopelessness. Loss of interest, joy or pleasure in the things you used to enjoy. Possible thoughts of harming the baby or yourself. What are the causes of postpartum depression? Postpartum depression can occur due to a combination of factors. Hormonal changes: Changes in the level of hormones can leave you feeling tired, sluggish and depressed. Changes in your blood volume, blood pressure, immune system and metabolism can contribute to fatigue and mood swings. Emotional factors: Feeling overwhelmed with the new arrival in the family, and taking care of the baby day and night, may leave you sleep deprived, overexerted, and anxious. New mothers also feel that they look less attractive after pregnancy. You may feel that people around you are concerned with the baby more than you, and that you are being neglected. All these emotional factors may lead to postpartum depression. Other factors: Issues like breast feeding, financial strain, and relationship troubles can also contribute to postpartum depression. How does one deal with postpartum depression? Take complete rest and sleep for sufficient hours Spend quality time with your husband Go for healthy diet Take morning or evening walk for fresh air Try to follow yoga or other exercises Share your feelings with your husband or friends Do not overexert Join some groups for new moms Go for individual therapy or counsellors Remember, postpartum depression is not an incurable problem. It is just a temporary state of mind, which can be overcome if you are sufficiently aware of the problem.                
Perfect partners in crime - Midlife crisis and dementiaThe responses we have to common stressful events in our daily lives have a lasting impact on our brain structure. The effects of a stressful event last a very long time, though apparently we seem to have recovered from it. Researchers say that the stress hormones keep circulating in our body long after the stress has passed. According to a recent Swedish research study, our response to common life events may trigger long-lasting physiological changes in the brain. These interestingly shocking findings come from the Prospective Population Study of Women in Gothenburg, a long term study on 800 women that lasted for almost forty years. The women who were a part of this study were all born before 1930, and underwent regular neuropsychiatric tests. The study started in 1968 assessed women for any baseline stressors like workplace problems, widowhood, alcoholism and illness in the family. Women who had serious issues at the start of the study had a 21% higher risk of developing Alzheimer's Disease and 15% higher risk of developing dementia later on in life. Interestingly, having to take care of a mentally ill family member like a sibling or mother, was found to be a major cause for development of dementia later on in life. The findings of this study show that accumulated stress from common life events has severe physiological and psychological consequences. These physiological consequences include adverse effects on the central nervous, cardiovascular and endocrine and immune systems. There have been several studies that state that the effects of stressful events like earthquakes, cyclones and floods can have a lasting impact on life and often shape the person's personality. What makes this study interesting is its finding that daily stressors accumulated over a period of time and often left unresolved, have a lasting impact that shows up in later stages of life!
Anger management for your teenaged daughter - Handling difficult teenage times If one fine day you find your daughter suddenly reacting differently to a particular situation, do not be surprised, especially if she is in her teens. The outburst is beyond her control and she herself is confused by her own behavior, at times. It's important rather than scolding her for her misbehavior, one must wait for her to calm down and then speak to her regarding the incident when she is in a jolly mood. It is impossible to forgive such behavior if it repeats regularly, though. Here are some ways to deal with your daughter if she strays the limits of accepted norm for a behavior. You can seek the help of a counselor and understand why this is happening and solve her queries so that she could handle them better in the future. Why do Teenage Girls Lose Temper?By the time, the girls enter their teens they would have become aware about the social etiquettes, importance of looks, acting in an acceptable manner in social scenarios and creating a 'cool' image about themselves when they are outside their homes. So, even if they are hurt, or are angry at something, they do not let it go public, lest their 'cool' image gets shattered. However, the same anger becomes bottled up and vents itself out when they reach home. It's much like the workplace anger showing up at home. This is the place where they can behave wildly and still expect forgiveness. However, that does not mean that you should let your daughter get away with such kind of madness. After she has cooled down, you need to talk to her to find out what is bothering her or making her behave in such a manner. Probably, she may not accept that she has a problem, but you will have to find a way to reach to the root of the issue. More often girls want to be like someone in their college or peer group. They want to fit into a particular group and being unable to do so makes them nervous and distraught. Teach your daughter to believe in herself. Make her understand that she is a unique person on her own and do not need to convert herself into someone else. It may take consistent effort on your part to imbibe all these things into her mind, but you have to work hard to make her understand. Self-Control is the KeyMany young girls do not know how to solve a particular problem when they are faced with it. Apart from taking her to a good counselor, you can discuss problem solving techniques with her. Ask her to understand the situation first, put a foot backwards, relax, and then find a solution to the problem. This habit will make her probe into the problem in a better way and she will be able to handle similar situations when they occur again. You can ask her to write down the problems that are bothering her and ponder over them. You can assist her initially, but as she matures she will find her own solutions depending on her past experiences. Adolescent girls have sometimes trouble keeping their anger, rage, and fear under control and hence their problems should be handled patiently. Brainstorming SolutionsOnce she has ripped apart every aspect of the problem and has come to a brainstorming solution, advise her to write down the plan of action. For example, if she is disturbed due to a particular teacher who does not seem to like her grades, she may do well seeking help through friends who are better in that subject, or for that matter, a bad remark by someone in a group might unsettle her, thereby venting her anger at home. With restraint on your part, make her understand that anger will only block her process to think or find a solution. If you teach her to find answers for the problems in a calm manner, your teenage daughter will surely learn to control her anger and behave normally as she grows into an adult.
Cranky kids in a diner? dealing with them made a bit easy!This has happened to many a parent. They make a reservation at a fine dining restaurant, perhaps with friends and relatives. But their kid screams, and cries,disturbing the entire restaurant, and spoiling the general mood. For this reason, many parents avoid going out altogether, especially to fancy places. But there are ways in which you can handle the toddler when you are at a restaurant. We will show you how. Carry toys Restaurant may be boring at times for toddlers. That's why they turn peevish and may start playing with forks, spoons or knife. So carry some toys, crayons, notebooks, or even a story book, which will keep them busy and you can have a good time. Order something yummy and healthy for the kid A hungry kid is an angry kid. So, order something which is your kid's favorite and also healthy at the same time. Or you can carry something along with you like fruits breads, cherries or other nutritious treats. Keep responding to what kid says The best way to keep childrenwell behavedis to talk to them and respond whenever the child speaks. Don't avoid them or get too engrossed with other people. They get cranky when they don't get a response from you. Take a round with your kid When the kid becomes difficult to handle, just pick him in your arms and take a mini tour of the restaurant or walk outside. This will distract him and relieve his boredom. Don't tolerate any bad behavior If the bad behavior of the kids is intolerable, then firmly tell them that they need to adopt good manners if they want to visit restaurants again. Disturbing other diners is not acceptable. But it doesn't mean that you punish them.You just have to remove them to a place where they don't bother anyone. Make your outing relaxed and enjoyable Above all, don't forget to have fun and make it an enjoyable evening. Don't get too carried away disciplining the kid. You can afford to be a bit silly and enjoy the time with your child.
Mood disordersMood disorder is a category of mental health problems, and it includes all types of depression and bipolar disorder. The cause of mood disorder is not well known. Endorphins in brain are responsible for positive moods. The neurotransmitters regulate endorphins. Depression and other mood disorders are caused by a chemical imbalance in the brain. Life events such as unwanted changes in life may also contribute to a depressed mood. Mood disorders are inherited. Children, adolescents, or adults who have a parent with a mood disorder have a greater chance of also having a mood disorder. Symptoms: Prolonged feeling of sadness Helpless feeling Low self-esteem Intense guilt Suicidal thoughts Loss of interest in daily activities Difficulty with relationships Disturbed sleep Change in appetite or weight Low energy Inability in concentrating Inability to make decisions Frequent physical complaints (i.e., headache, stomach ache, fatigue) Threats of running away from home Hypersensitivity to failure or rejection Irritability Aggressive behaviour Hostility In mood disorders, these feelings appear more intense than what a person may normally feel from time to time. Treatment Psychotherapy: It is focused on changing the individual's distorted views of themselves and the environment around them, working through difficult relationships, and identifying stress triggers in their environment and how to avoid them. Family therapy: Families play a vital supportive role in any treatment process. Antidepressant medications: Medications in combination with psychotherapy has shown to be very effective in the treatment of depression.
Fruit diet can be dangerousFruits are healthy and provide lots of nutrition, vitamins, antioxidants, carbohydrates, fibre and bioflavanoids to the body.These things together protect your body from different health conditions and heart disease. However if you only eat fruit, you miss many other essential nutrients such as fats and protein. This can upset your stomach and lead to indigestion. Hence it is very important to take a well-balanced diet to remain healthy. Check out why you should not rely solely on fruits for living. Fruits do not provide protein Protein is highly important for your growth and development. By eating only fruits, you are restricting your intake of proteins that can stop your overall development process. Your body requires calories and energy on a regular basis. Each cell of your body contains protein. To keep your body cells in top working condition it is important that you include protein-rich foods such as lentils, soy products,  nuts and beans in your regular diet. You can also consume low-fat dairy, lean meat, fish and skinless poultry to provide required amount of protein to your body. Fruits do not provide fat Although excess of fat is not good for health, it is essential that your body requires on daily basis to ensure smooth functioning of your immune system and also to help your body absorb various minerals and vitamins provided by other foods like fruit. If you continue being a fruitarian for long duration, the chances of stroke due to brain haemorrhage increases. According to health experts, you should get around 20 to 35 percent of your daily calories from fat. To provide your body with good fats you should include soybean, sunflower, olive or canola oil in your diet. Fish and poultry also provide good amount of healthy fats to the body. Too much of fruits can lead to digestive problems Fruits provide fibres to the body in large amounts. Although your body needs fibre as it is one of the essential nutrients, getting too much of fibre can lead to side effects. Fibre works as broom to clear of your abdomen and aid in the digestion process. However, too much of fibre leads to stomach problems and cause symptoms such as gas, cramps and bloating. Sometimes it may also lead to chronic diarrhoea, dehydration and loose stools. On a regular basis, a woman requires only 22 to 28 gm of fiber per day and a man needs 34 to 38 gm. Apart from fruits, seeds, vegetables and whole grains also provide fibre to the body. Other considerations If you limit your intake to fruits, you may not get enough calories required for producing the required amount of energy. Consuming calories less than 1100 per day can lead to lot of side-effects such as intolerance to cold, gallstones, hair loss and fatigue. So although fruits taste wonderful and are very tempting, being a fruitarian is not the best thing for your health. Your body needs all the nutrients for carrying out its different activities and hence you should include variety of foods in your diet.  
Diet to help manage stressYou cannot avoid stress, as it has now become an integral part of modern lifestyle. Children are worried about their exams and performances in the cultural events, teenagers are stressed out about their looks and body shape, adults take stress owing to competition at work, and so on. One thing is sure that you cannot stay away from stress. So, how can you avoid the side effects caused due to stress? You can include certain foods in your diet that help manage your level of stress. Researchers are already on to it, studying the effects of various foods on the stress levels. It is always better to choose from the organically harvested nuts, veggies, fruits, and fish for better health benefits. Nori Sushi nori is a type of seaweed that is rich in magnesium that contains anxiety-fighting properties. Magnesium is also known for stress reducing abilities. Apart from this, it also carries other essential health nutrients that are necessary for the overall development of health. Vitamin C Foods Cantaloupe is composed of vitamin C that is a renowned stress buster. Another great stress busting food is orange. When you are under stress, adrenal glands in your body start producing cortisol that lowers your immune system's capacity. This leads to breaking down of muscle tissue. Vitamin C in oranges have the ability to return the high blood pressure to normal level. Moreover, when you are stressed there are chances of this vitamin getting used up and hence the need to increase your intake of vitamin C rich foods. Another popular vitamin C enriched food is blueberries that are also packed with lots of antioxidants which relieve stress. Almonds Almond is a treasure trove of essential nutrients such as vitamin E, B2, zinc, and magnesium. Although they are high in fat, they provide your body with all these essential nutrients. You can easily have a handful of almonds every day and still feel less guilty about.  Apart from the fat, energy, and the essential nutrients, almonds give the brain and its memory a shot in the arm. Broccoli Broccoli is rich in vitamin B and folic acid, both proven stress busters that helps in giving you relief from panic, anxiety, stress, and depression. Bananas Bananas contain one of the most important amino acids - tryptophan that gets transformed into serotonin which is a stress-busting hormone that is known to induce a feeling of well being. This makes you happier and gives you relief from stress. Banana is also rich in potassium. Potassium regulates the heart due to which the blood pressure can be kept under control. That is why many health experts recommend inclusion of a potassium-rich diet, as it normalizes your heart rate and help you calm down in stressful situations. This makes banana an essential food addition to your diet. Chocolate The dark chocolates are bitter and give you a feeling of satiation despite the little amount you devour. Due to this feeling, you eat less, but you still enjoy the flavor of the chocolate, much more than the milk chocolate varieties. When you are under stress, most of your body organs are vulnerable to damage. The antioxidants polyphenols that are present in the dark chocolate slow down the damage and also contribute in its repair. Studies have also revealed that 40 grams of dark chocolate per day helps reduce stress-causing hormones such as catecholamine and cortisol. Increasing the intake of stress busting foods in your daily diet can help control diabetes and hypertension.
Hypertension and Vitamin DVitamin D is one of the essential vitamins that are required for strong and healthy bones. The body synthesizes it in the skin from cholesterol when there is adequate exposure to sunlight. Over the past decade, vitamin D has been intriguing medical researchers the world over. Several studies were conducted and interesting results found. One of them being that vitamin D may be implicated in influencing blood pressure levels. As per studies conducted, it was found that low levels of vitamin D lead to high blood pressure levels. People living in high altitudes where sunlight is at a minimum level were found to be hypertensive. Also, the winter season showed an increase in hypertension cases which was again attributed to the low sunlight levels. What exactly does vitamin D do to affect the blood pressure? Renin is an enzyme secreted by the kidneys that constricts the blood vessels and increases the blood pressure. Vitamin D acts by inhibiting this renin. Insulin resistance causes high blood pressure, which is why hypertension often has co-morbidity with diabetes mellitus. Vitamin D helps in improving the body's sensitivity to insulin. Calcium deposits on the arterial walls harden them and make them lose their elasticity leading to an increase in the pressure of blood flowing through them. Vitamin D helps the body to better absorb and metabolize the calcium. The role of vitamin D in strengthening bones is very clear. Though the studies have shown that people having deficiency in vitamin D tend to develop hypertension, the role of vitamin D in this case is still not very clear. Also, whether vitamin D supplements help in lowering blood pressure levels is still to be found out! But all said and done, the research findings cannot be ignored. Moreover, a morning walk is beneficial in many other ways as well! So, get up early, put on your walking shoes and say Hello to the sun! Vitamin D alone will not help you control your BP. You need to keep taking the medications along with the other dietary and life-style changes! An early morning walk is a blessing for the whole day!
Dos and don s during heat crampsHeat cramps can affect people who exercise or work in the heat. It could be due to dehydration, so if you are going to be active in the heat then you need to drink a lot of water even if you are not thirsty. Before going out, find out what the temperature is and do not exercise outdoors in the heat. Heat cramps may not be as serious as heat exhaustion or heat stroke, but the condition needs to be treated with the same urgency. People who are on low-sodium diets may be affected more than others. Heat cramps may seem mild, but they can be the first sign of heat exhaustion, so pay attention and stop all activity, and rest. Here is what you can do and what you should avoid if you suffer from heat cramps: Dos : If you have muscle spasms and the muscles are unable to function properly, then immediately stop all activity. Get inside a room or go into the shade and take some rest. Raise the feet to 12 inches above the body. Gently massage and stretch the muscles. Wet a paper towel or handkerchief and drape it around your face, at the back of your neck and underarms. Drink a clear natural juice or a sports drink to get the electrolyte balance back. Do not go out in the sun again even if the spasms have subsided. If the cramps last more than an hour then go to a doctor. If you are on a low-sodium diet then tell the doctor about it. Don s : Don take any painkillers or fever tablets as they could cause harm. Avoid caffeine, alcohol, and sugary soda drinks. Don rub alcohol on the muscles. Don drink ice cold drinks as they can cause stomach cramping. Don take salt tablets unless the doctor has prescribed them. Don do your full quota of exercises if the heat is getting on to you. Don stop drinking water even if you do not feel thirsty. Don resume any strenuous activity for several hours after a heat cramp. Prevention:Prevention is always better, so it’s a good idea to reduce exercise in the summer, especially when it is extremely hot. If people are working outside, like construction workers, then they must take more breaks, keep their heads covered and sip on water after every 10 minutes to prevent heat cramps. Always plan ahead and get acclimatized if you know you have to do a physical activity in the heat that could cause sweating. If you are an athlete, then do take a mix of sports drink, water, and juices to maintain the electrolyte balance. Always carry water with you if you are playing any sport in the heat. All events must be planned at a time when the heat is bearable and not when it is too hot. Keep a close watch on the person if there are signs of vomiting and nausea along with flushed skin. Rush them to the hospital.
Psychological impotenceSex is not just physical but just as equally mentally involved. Mental stimulation and response are responsible for arousal and overall enjoyment; and therefore any sort of psychological disturbance or mental issues like stress, tension, or anxiety can lead to psychological impotence. Stress or exhaustion are most possible explanations for psychological impotence. Depression and post-traumatic stress disorder also may result in impotence. A mental trauma of sexual or physical abuse, guilt due to sexual relationship, problems amongst partners contribute too. Confusion over one's sexual identity is also a major cause for impotence. Impotence results from underlying physical disorders, especially if the people choose to stay unaware of it. Absence of knowledge of this disorder leads to anxiety and stress building up over a period of time.  So when determining factors rule out physical causes first and then go for identifying mental causes. Psychological impotence can be sometimes situational or only with a particular partner and the treatment approach differs with the cause. Counseling works wonders in the case of psychological impotence. For example, depression or anxiety may require treatment to improve condition. Post-traumatic stress disorder or abuse needs therapy on coping skills. Sometimes simply explaining underlying cause of physical condition resulting in impotence and comfort and reassurance are sufficient. So don't hold back, share to get your mojo back!!
The link between oral sex and cancerSymptoms of oral cancer: The common symptoms of oral cancer include: Red and white spots on the tongue or the lining of the mouth, inflammation of the mouth which continues well over two weeks, mouth ulcers which take over three weeks to heal, discomfort and pain during swallowing food, and lastly, sensation that something is stuck in the throat. HPV types and their nature: There are over 100 different types of HPV. Out of these, 15 have been found to cause cancer. These 15 types of HPV are called high-risk HPV. The HPV types which are found in the mouth are sexually communicable and the primary means for its transference is considered to be oral sex. It could also be carried through anal and vaginal sex, causing laryngeal cancer, anal cancer, cervical cancer, tonsil cancer, vulval and vaginal cancer, and penile cancer. Some of the HPV types get passed through skin contact. These cause warts, especially in the genital region. These types of HPV which cause the warts are less likely to escalate and cause cancer. Though there is no determinate answer as to how common the HPV mouth infection is. Advanced studies during the 21st century have put forward the role of HPV16 in new types of cancer. This was done using DNA testing. Through a medical study, it was found that the most vulnerable groups are: People in the age group of 30 to 34 and 60 to 64 years old. People who have had over 20 sexual partners in their lifetime, around 20% suffer from HPV oral infection HPV leads to cancer?: HPV does not directly cause cancer. It stimulates modifications in the cells which it has infected, like those in the mouth or cervix and due to the modifications the cell becomes cancerous. In only 10% of the cases where the patient suffers from HPV infection does cancer develop. The infection generally treats itself and is removed naturally within 2 years by the body. The chances of progression of the HPV infection into cancer is increased by smoking and drinking. Smoking injures the immune surveillance cells. Due to this injury, they are not able to fight the virus and the virus continues to persist over 2 years, leading to cancer. Vaccinations: In the United Kingdom, girls (aged 12 and 13 years old) are vaccinated against HPV. This vaccination protects the women against cervical, vulval, and vaginal cancers. Men and boys also take vaccinations against HPV, though it is not pursued as strongly as in the case of women. This leaves men who have sex with other men at a greater risk of getting oral and anal cancer. Even though the link between oral sex and cancer is not completely proven, what we do know is that oral sex causes many other infections like gonorrhea, herpes, syphilis, and chlamydia. Did you know that a very low percentage of people (only 10%) who are infected with HPV virus develop cancer? In 90% of the cases, the infection is naturally cleared by the body within two years. The natural process is, however, obstructed in those who smoke and drink.    
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