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Getting Frequent Urination, Burning Sensation In Leg And Kidney Stone. Any Treatment?

Posted on Sat, 15 Dec 2012

Question: puss cells 4 - 6 hpf
RBC 1 - 2 HPF

right kindey has small 1mm stone
burning sensation in leg ( which no one is ready to listen but it only happens whe
frequent urination

ultra sound impression
---------------------------

rt. renal calculus
post-void residual urine volume increased (180ml)

since 20days i keep geting better for 2 - 3 days then back to same problem

Answered by Dr. G.Srinivasan (44 minutes later)

Hi,

Welcome to XXXXXXX

The small renal calculus needs the following---

1. Plenty of oral fluids (water, fruit juices, tender coconut water) upto 4 litres daily. The secret is to drink before thirst occurs.
2. Restriction of red meat - if you happen to take.
3. Restriction of alcohol - if you happen to take.

Frequency of micturition---

1. Look for urinary infection and get treated if so.
2. If symptoms persist after that, you need treatment for OVERACTIVE BLADDER.

High residual urine

1. Need uroflowmetry test.
2. If the flow is less , need cystoscopy to look for obstruction to the urine path.
Unfortunately, there is no scientific explanation between urination and leg burning and thats why there is no proper response from your consultants till now.
B complex supplements for a moth should work for the burning pain. If no response by that time, a neurology consult is worthwhile.

Get well soon.
Regards
DR GS

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. G.Srinivasan (7 minutes later)

can i call you please ? what is your mobile number
because i need to explain waht happens
one hemeopathy doctor told me its because of lambar veins/nerves or something

only when i dont go uring for 30mins the burning sensation starts
and why do i have blood in my urine
isnt puss cell and RBC count a proof of UTI ?

i was told UTI is causing flow problem
i get well for 2-3days and then it back to the same problem
and what is the treatment for overactive bladder ?
yes i can see the flow is less compared to 20days ago before i had this problem
but i was told its the UTI which is making the flow less, isnt it ?
no doctors are able to answer this but i was told by a hemeopathic doctor because the bladder is connected to the lumbar region vein or something pelase let me know

Answered by Dr. G.Srinivasan (2 hours later)

Hi,

Welcome back.
Most organs in the body are connected directly or indirectly - but that does not explain your symptoms.
Yes, UTI can cause reduced flow and hence it is wise to check uroflow once the UTI is completely treated.
Pus cells and RBC alone are not enough to prove UTI, urine culture test is necessary to confirm UTI.
Over active bladder needs treatment for about 3 to 6 months and it is curable.
It is just a sensitive bladder that wants to empty as soon as it fills to a limit.

Regards
DR GS

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. G.Srinivasan (7 minutes later)

urine complete analysis was done and thats how they found RBC and puss!
is urine complete analysis not same as Urine Culture test ? let me know so i can go and get this test done today.

But i am suffering i am going to toilet every 30 - 45mins with little urine and no flow. but when i drink a lot of water the flow is good.

i am going to drink 4 liters of water as you said but since 3rd october i am suffering and between these days only 4 days may be i had relief and then back again to the same problem.

please help and advise what do you think could be the most likely problem ?

I had this probelm when i was 19 but then recently i had a long meeting nad i was holding my urine for 2 hrs and since then i hv this problem, so definitely it some kind of infection dont you think ? but if its not UTI then what is it , which is making me go to toilet every 1hr

I go swimming every day, after swim i go once and then i have relief for 2 hrs XXXXXXX and then it starts again.
please dont forget i have suffered this when i was 19 till 21 then it was mild frequenly urination every 3-4 hrs which was ok and now recently because i hold my urine

now the thing is i think if any urine is build i get burning sensation through my arms, top of my hands, legs and my top of my feet
4 days ago i was just perfect without any burning etc. and now again the same burning thing
its comes and goes and i am really tired

I am treating it with lot of water, cranberry, XXXXXXX tea and it helps
can i have your phone number to call or can you call me to discuss this ?

Answered by Dr. G.Srinivasan (2 hours later)

Hi XXXXXXX

WELCOME BACK.
We are nit supposed to give contact nos.
Urine culture is different and done to know the bacteria ad the appropriate medicine that will act.
If that is negative, then you need treatment for overactive bladder, as i mentioned earlier.
Holding urine does not produce any of the symptoms.
Other symptoms are not related to urination.
If your urologist is not able to solve the issue, you need counselling by a psychiatrist.

Best regards
DR GS

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. G.Srinivasan (7 hours later)

with the above symptoms is it good to masturbate twice a day ?
i read its healthy and i am not married
i have gf who i every 3 months and then we have sex atleast 10 times a week
now i hv come back from swim and drank 450ml of 40mins ago and no urge to urinate.
is it that i hv a blockage to urinate ?
HERE IS MY ULTRA SOUND. please now tell me why do i have so much urine left after i visit the toilet they scanned it right away

Parenchymal echogenicity normal.
cortico-medullary demarcation is normal in both kindeys
Pelvi-calyceal system not dilated . Ureters are not dilated.
Urinary baldder is distended and shows no evidence of calculus
U.bladder wall and prostrate are normal
post-void residual urine volume is 180ml
RETROPERITONEUM - no enlarged nodes seen
PERITONEUM - no free fluid noted. No Abnormal bowerl loops noted.
Liver not enlarged
gall bladder is of normal size and shows no evidence of calculus or sludge. walls not thickened.
pancreas - no obvious lesion noted.

Answered by Dr. G.Srinivasan (9 hours later)

Hi,

Welcome to XXXXXXX and thanks for your reply.

High residual urine means either there is block in the urine passage or the bladder is not contracting enough.
We have already concluded that this is probably due to UTI. So, it is wise to wait till the infection is completely treated to get uroflowmetry test done.
Depending on the cause, the treatment is to be undertaken.
Otherwise the scan report is normal.

Wishing you best health,
Regards
DR GS

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. G.Srinivasan (1 minute later)

i have been with this infection since 26th September with may be 10 days of relief

from 26th sept. till now i had on and off infection.

what do you suggest me to do ?
how long should i wait ?
tomorrow I will be going for a routine urine test

Answered by Dr. G.Srinivasan (23 minutes later)

Hi,

Welcome back.

It is good to know that you are so active.

Masturbation is not known to cause any physical harm, as long as you do not have the guilt feel and it does not affect your daily work.
A urine routine as well as culture tests would be a wise decision.
Get a uroflowmetry test to look for and rule out obstruction, once the infection is treated.

Best regards
DR GS

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. G.Srinivasan (1 hour later)

Yes i am getting a culture urine test tomorrow and it result will be ready in 3 days they said . so I will write you again on Thursday or friday with the results and details of the Urine finding.

but why do you think i had RBC in my blood ? is this serious UTI ? if you see my report above it says puss and rbc in urine...you haven't explained me this and details of this . if its UTI then why RBC and PUSS ?

I am actually confused, because earlier you said its UTI and tahts causing the blockage and ultrasound is normal so why a urine flow test ?

thx

Answered by Dr. G.Srinivasan (1 hour later)

Hi,

Welcome back.
RBC and WBC in urine are suggestive of UTI. This has to be confirmed with urine culture test.
I have explained to you already.
UTI does not lead to block, but can affect the flow test value due to poor contraction of the bladder as a temporary phenomenon.
So i suggested to do a flow test later once the infection settles.

Regards
DR GS

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. G.Srinivasan (8 hours later)

also i was thinking to ask you one question that no one is saying to me is that the small stone in my kidney can also cause block to urine ?

or the block of urine with stone can only happen if the stone in the bladder and not in kidney ?

Answered by Dr. G.Srinivasan (5 minutes later)

Hi,

Welcome to XXXXXXX
If the stone in the kidney comes down, it can block the ureter to cause pain in the back radiating to the front of the abdomen.
If a stone in the bladder migrates down, it can cause urine block and urinary retention.

Regards
DR GS

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. G.Srinivasan (14 minutes later)

when the ultra sound was performed and the 180cc urine was there the stone was in the kidney and i am not sure if the radiologist checked the position of the stone after i passed the urine and came back to him when he found residual urine.

today i wokeup after 6hrs of sleep with bruning in back and urge to urinate with hot burning feeling inside teh whole below area and back so went to toilet with little urine but after passing urine a lot of inside pain burning back etc. i laid in bed and after 3 hrs i am ok now but pain is still there a little bit in my back and front below abdomen.

teh feeling of burnuing is that someone put very hot vicks or balm inside my stomach

drinking lots of water like you said and later go for culture urine test and will let you the findings by thursday or friday when i have the results.

Answered by Dr. G.Srinivasan (1 hour later)

Hi
Welcome bacK.
The stone 1 mm is too small to cause any pain.
pls get back with the urine reports,

Regards
DR GS

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. G.Srinivasan (2 hours later)

just got my report for routine the results are :

Urine sugar - 0
RBC Urine - NIL / hpf
Pus Cells - 0-1 / hpf
Epithelial Cells - 0-1 / HPF

The cultural test they said will be ready in 3 days so when i get that i will send you

Answered by Dr. G.Srinivasan (6 hours later)

Hi

The urine routine is normal.
Let await the culture report.

Regards
DR GS

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. G.Srinivasan (1 minute later)

today i am so much better though i went a lot to the toilet but felt like i was able to clean my bladder with high stream of urine....

so today is 29th i hope the next 2 weeks i am going to be fine, i will continue to take URICOL, himalaya, cystone, drink lots of water,cranberry XXXXXXX tea. and see the results and keep you posted.

Answered by Dr. G.Srinivasan (4 minutes later)

Hi

Sure.

DR GS

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. G.Srinivasan (16 hours later)

if i drink 2 litres of water how many times in a day i should go to the toilet to urinate to be declared as a healthy man with a healthy Urinary tract system
today I am going to urine every 10mins with non-pressure urine at all just normal urine
its very frustrating....every 10mins i press my stomach and i see there is urine to go
which means i still hv lots of urine left and in 10mins urine builts and then i get the urge to go :(
i just went again in less than 10mins and had half of urine i usually pass when i am healthy and the pressure was increasing and decreasing i could see it as i know the normal pressure of my urine but it is never the normal pressure i have when i go to void.

yesterday i had that pressure of full void but not today at all :(

please help, reports should be ready on Wednesday
also one new thign i am noticing that if i dont go to toilet now every 20 - 30mins my lower back burns as if i can see my kidneys burning....pls help

Answered by Dr. G.Srinivasan (13 hours later)

Hi,

WELCOME BACK.
There is no scientific relation between the two.
If the problem persists, kindly get counselled by a psychologist or a psychiatrist.

Regards
DR GS

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. G.Srinivasan (2 minutes later)

i am suffering and going to toilet every 10 - 20mins ,can u tell me what does a psychiatrist have to do with this ?

Answered by Dr. G.Srinivasan (4 minutes later)

Counseling for the back pain in relation to urination and not frequency - my dear.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. G.Srinivasan (2 minutes later)

i read symptons on many sites the dribling, waiting for 10 seconds to start to pass urine, urent frequency all symptoms of prostratitis ...
i know my ultrasound scan shows its perfect size but i am thinking what if its infected and thats why i have the same symptoms, please advise

Answered by Dr. G.Srinivasan (5 hours later)

Hi,

Prostatitis does not show up on scan. It is a clinical diagnosis, based on the symptom complex and supplemented by urine culture, semen culture and culture of expressed prostatic secretions.
If your urologist thinks it is prostatitis, antibiotics are usually prescribed for a month.
In addition, group of medicines called alpha blockers may give you symptomatic relief.
If the frequency does not change,anti-cholinergics will be added.
This is not a easy disease to treat. We need to try out various combinations and see what works for you.

We can only guide or suggest and the actual treatment needs to be done by your attending doctor.

Regards
DR GS

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. G.Srinivasan (29 hours later)

i got my lab test for CULTURE and everything is normal no bacteria found the lab reports syas

so what now ??
i have same frequent urination, dribbling, in one urine session fast and slow stream and dribbling of urine
please help

Answered by Dr. G.Srinivasan (6 hours later)

Hi,

We have already discussed the possible causes.
Chronic prostatitis/ OAB - overactive bladder.
Kindly get examined and get treated by a urologist.

Regards
DR GS

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. G.Srinivasan (14 hours later)

well sometimes i am better for few days and then back to the same time so how can my bladder and prostratitis cure

is chronic prostratitis XXXXXXX ???

i am now taking saw palmetto tables ....

Answered by Dr. G.Srinivasan (9 hours later)

Hi,

Chronic prostatitis is not a life threatening disease. It is manageable with life style changes and medicines.

Lets give a try with what you are taking now and decide based on your progress.

Regards
DR GS

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. G.Srinivasan (13 hours later)

what about the urine in my bladder ?

Answered by Dr. G.Srinivasan (1 hour later)

Hi,

Residual urine is part of the problem. It needs to be checked after giving you a course of treatment.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. G.Srinivasan (16 minutes later)

but i am taking saw palmetto which i read on the internet is the best herb to take for the problem.

you saying i have chronic prostratitis, the scan radiologist measured my prostrate size and he said its normal size and you only 30 years old and prostrate is only for people above 40 or 50+
so can you tell me if my size of the prostrate is normal how can you say i have prostratitis but ofcourse i have the symptoms very equal to that.

Answered by Dr. G.Srinivasan (16 minutes later)

I have already answered this question.
Prostatitis does not show up on scan. It is only a clinical diagnosis based on your symptoms and clinical examination.
Also, our answers without physical examination provide you only guidance for the possible cause and probable solution. The examining doctor is the best person to talk about the details.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. G.Srinivasan (58 minutes later)

what life style changes should i bring ? please tell me

Answered by Dr. G.Srinivasan (9 hours later)

Hi

Welcome to XXXXXXX Thanks for your reply.

It is VERY RELEVANT QUESTION.

1. Avoid constipation.
2. Empty the bladder at bed time religiously.
3. Muscle relaxants - orally.
4. Anti- anxiety agents.
5. Frequent sex/ masturbation.
6. Oral fluids not more than 3 liters a day.

DR GS

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. G.Srinivasan (3 hours later)

i read that i shud avoid orange,lemon juice is this true ?
also says avoid wheat,milk,egg
so thinking what shud i eat cos i live very healthy

breakfast - always cereal wholegrain with milk and banana

lunch - caned tuna fish or soup usually

dinner - salmon fish / chicken / noodles etc.

I live very healthy and swim everyday 6 months a year .

1. i am taking natural tablets to avoid consitpation
2. i dont know what u mean by religiously
3. can u please advise healthy muscle relaxants to take
4. please prescribe Anti anxiety natural tablets
5. I am single but hv a girlfriend who i see every 3 months or so with twice a day atleast sex session ;-)
6. i will ensure i dont take more than that

now when i pee i get pain on the left hand side of the stomach feels like a cramp. why is that ?

how frequently shud I masturbate while i am not with my gf ? 2 times day ?

thought i should tell you , I also ejaculate very quickly one i penetrate the vagina but if i have daily sex for 7 days then i go for 10 - 15mins. is that Normal ?

please answer all my above question as they are important for me to understand the whole problem i am going through :(

Answered by Dr. G.Srinivasan (1 hour later)

Hi

welcome back.

1. Your diet pattern looks ok and there is no need to restrict, as the problem is not related to diet ( you can take all that you have mentioned).
2. Medicines whatever it be, cannot be prescribed online due to ethical practices.
3. Masturbation - two three times a week is ok.
4. Empty the bladder at bed time for sure (that is what i meant by religious).
5. Pain in the abdomen while urinating needs to be evaluated by your doctor by checking you physically. I cant answer this. Sorry.
6. Your ejaculation time is ok if you have daily sex. Occasional sex can lead to early ejaculation and i cant comment unless you practice sex on a regular basis.

Take care---
DR GS

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. G.Srinivasan (11 hours later)

today the symptoms are on and off, sometimes i am going every 2 - 3 hrs and sometimes every 20mins

i am worried i hv a stone in my prostrate or signs of prostrate cancer as per this article here --> WWW.WWWW.WW
please advise

Answered by Dr. G.Srinivasan (6 hours later)

Hi

Welcome back.
Your problem is mainly worry, as i said earlier.
Prostate cancer is a disease of old age.
Stones in the prostate are not heard of, but calcifications are.
Even if so, calcifications would be seen in the scan and no specific treatment is not needed for this.

So you mainly need reassurance and counselling.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. G.Srinivasan (9 days later)

i am reading about carrot and XXXXXXX juice helps to fight my situation with prostratitis, is that true ??

so will carrtot, parsley help me ?

will taking 3 tables at day for zinc help me ?

Answered by Dr. G.Srinivasan (4 hours later)

Hi
Welcome back.
They are of course good for general health as well, even though there are no numbers ( Statistics)
Zinc definitely helps.
Regards
DR GS

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. G.Srinivasan (1 hour later)

i am back again suffering the same again, was good for the last 6 - 7 days .

now since yesterday again the same thing, i hv been eating lots of pumpkin seeds, zinc tablets and saw palmetto 2 capsules everyday one morning and evening

how can i get immediate relief

so since 24th september until now i am have been good only 3 weeks and the rest of the time i have been suffering, please help

Answered by Dr. G.Srinivasan (57 minutes later)

Hi,

Welcome back.

I think you are taking enough medications.
In my opinion, you need counseling, lifestyle changes and medicines.
You need to check with the doctor physically to get immediate relief.

Regards
DR GS

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. G.Srinivasan (2 minutes later)

i did get checkedup physically, he said i have residual urine etc. and thats it

Answered by Dr. G.Srinivasan (54 minutes later)

Hi,

When you met the doc, what was his suggestion?
Kindly follow that, to get better.
You need to give time----

Regards
DR GS

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. G.Srinivasan (35 minutes later)

when i met him i had infection so he said take this that Cystone and Cifran and it will go in 3 days and now its more than 1 month but its on and off as i said earlier.

so how long do you think i should be on all this medications etc ?

what i dont understand is while I am still on the medicine i get back to the frequent urination.

do you think I should take some medicine instead of this herbal natural capsules etc. ?

Thanks

Answered by Dr. G.Srinivasan (1 hour later)

Hi,

Welcome back.

Do you think we have understood everything and not answering your questions?
In this situation, unfortunately, there are more questions than answers.
It is better to combine medicines with herbal natural capsules, due to complex nature of the problem and since it is long standing.
It is better to take these medicines for atleast one month at a stretch, if not taken earlier.

Regards
DR GS

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. G.Srinivasan (1 hour later)

I am going to take saw palmetto & Zinc for 2 months and see the results already taking it for 10 days now

on the side i am taking XXXXXXX tea, flax seed, some immunity garlic capsules and carrot juice from time to time

Answered by Dr. G.Srinivasan (20 minutes later)

Hi,

Pomegranate juice or fruit also can help.
Wishing you good health.

DR GS

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. G.Srinivasan (2 days later)

when i drink XXXXXXX tea i get better pressure when i void and i go every 15mins atleas 3 times on one cup of XXXXXXX tea

why is that ?

Answered by Dr. G.Srinivasan (4 hours later)

If you are happy with the pressure, you may continue using the same.
If the frequency worries you, you may need to reconsider taking it.
It is probably related to the increased volume intake.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. G.Srinivasan (2 hours later)

definitely not volume, i drink 350ml water and i dont get enough urine out even after 3hrs

i actaully feel relief i will tell you whathappened today i took 2 cup of tea way less than 300ml not sure exactly how much or may 250ml if two cups put together ;-)

i went two toilet 4 times but after that i didnt go to pass urine for 3 hrs which is good ;-)

so what i am trying to find out from you is what is the combination of XXXXXXX tea to prostatitis, the pressure gets very high and i pass a LOT of urine which i usually should have and it only happens after i take XXXXXXX tea

does the XXXXXXX tea pushes the urine to pass through or does it relax the prostrate and thats why i can

please explain me thisas it will help me in curing my self

Answered by Dr. G.Srinivasan (6 hours later)

Hi

Welcome back. XXXXXXX tea is a powerful anti- oxidant and that is a well known fact.
It has got effect on the urinary tract, especially bladder in reducing the inflammation.
This in turn helps to pass urine better.
See, in the long run you are the best person to decide what works well for you, especially that connected with the diet. XXXXXXX tea can be taken for as long as you want, as it is only a dietary supplement.

Regards
DR GS

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. G.Srinivasan (8 days later)

hi doctor, its me again
can you tell me why does it keep coming back
4 days i am good 5 days i am not

its on and off why ?

why is that ?

Answered by Dr. G.Srinivasan (1 hour later)

Hi
Welcome back.
Sorry to hear about you.
Unfortunately, it is the nature and course of the disease process.
Pls have faith in your doctor, see whenever necessary, get reassured, change strategies and see if things get better.
wishing you good health---

Regards
DR GS

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. G.Srinivasan (3 hours later)

hi doctor,
i am not getting treated by any doctor as per my last email, I am simply taking

pumpkin seeds
saw pametto
cranberry XXXXXXX tea

i think natural cure is the best but if you think on and off problem which i am having is not going to help then please advise me what to do as this is really started to affect my life
sometimes i am super and go toilet only every 2 - 3 hrs which is ok but sometimes i go every 15mins like yesterday i was oging every 20mins all day

Answered by Dr. G.Srinivasan (10 hours later)

Hi XXXXXXX
Welcome back.
It is good to take natural remedies and dietary supplements like what you are doing.
Since the problem is recurring, it is best to see a doctor ( GP/ family practitioner/ medical doctor/ internist), get examined and followed up on a regular basis.
As and when necessary, you may be referred to a consultant depending on the problem.
Wishing you good health
Regards
DR GS

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. G.Srinivasan (4 hours later)

i went to the doctor initially i think its waste of time and money to go to the doctor as they are just giving me antibiotics
i hv spent days and weeks reading about it and i know my only cure is natural wayor taking saw palmetto for 6 months and see the results

thxnk

Answered by Dr. G.Srinivasan (5 minutes later)

Hi,

Welcome back.
We normally do not advice self treatment.
Having started the treatment, please see how it goes and then a decision can be taken.
Wishing you best health
Regards
DR GS

Note: For further queries related to kidney problems and comprehensive renal care, talk to a Nephrologist. Click here to Book a Consultation.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar