Psychological Erectile Dysfunction

27 December, 2015 (23:27) | Erectile Dysfunction | By: Health news

No one is secured from this. It could face everyone. But anyone can deal with it. Psychological impotence is so terrible that its causes are rooted in man’s head and there is no medicine to cope with this problem.
Depression, stress, fatigue, scandals at home and work, and even poor school grade of your beloved child – all this can get out in the most crucial moment. These are the first and main causes of psychological impotence. He just cannot turn his attention to something else or relax.

However, there are a number of reasons that can cause this type of impotence. Circumstances of intimacy can be uncomfortable or even unsuitable for the partner. For example, if he knows that at any moment someone can come in, or if he feels uncomfortable in the position in which he is having sex. Psychological impotence can be caused even by the smell or appearance of woman. Sometimes, that the man is sexually weak only with one particular female partner.

Although sometimes vice versa – a partner is going well with only one woman in bed. In the first case he is bored with monotony and he is looking for something new, in the second case he is scared to look for something new. He was accustomed to one woman, her touches, structure and anatomy of her body.

Often the causes of psychological impotence are quarrels and scandals. The discrepancy between sexual tastes, preferences and desires, can also be the reasons of psychological impotence.

This type of impotence entails an obsessive fear of unintended pregnancy or infection of any sexually transmitted diseases. It is important to protect your health.

However, the use of condoms during sexual intercourse can be a stressful situation. But then you can select another kind of contraception.

Certainly, psychological impotence can occur when a man makes love to a woman for the first time. He is afraid not to make a proper impression on her.

The reason for psychological impotence lies in the innate low sex drive of man and his low self-esteem. It happens that a man is not able to be excited because of the fact that he has not decided on his sexual orientation yet. The reason for this type of impotence may be the psychological trauma especially in adolescence: depravity and sexual humiliation. In this case, the man should visit sex therapist and psychologist.

Basically psychological impotence occurs suddenly while spontaneous erections in the morning and at night exist.
Psychological impotence is diagnosed by collecting information about the sexual life of men. The doctor asks about the duration of impotence, frequency of sexual intercourse and about the sex life before this.

To cope with this problem will help masturbation, stimulation by visual images, and, of course, a healthy lifestyle: maximum of vitamins and mineral substances, minimum of alcohol, nicotine, and drugs.

By the way, female partners also should be careful with their men: careful attitude to a partner and achievement of harmony in the relationship will help to cure any disease.

Canadian Health&Care Mall: Safety, Quality and Care

12 October, 2015 (22:16) | Health Care, Canadian pharmacy | By: Health news

To replace an expensive journey to their local drugstore with a more convenient and, what is more important, far thriftier alternative – this is what people that choose online pharmacies want. So those who choose Canadian Health&Care Mall want to buy meds online with absolute confidence. Since having been in the business for more than five years already, the company developed into a reliable and well-known international distributor. Today, after years of arduous work, it is the name that speaks for itself and the company that really cares.

Canadian Health&Care Mall: What Makes It Competitive

It’s not one peculiar feature that distinguishes the drugstore and makes it worth dealing with but the right combination of all the features that appeal to customers and enable the drugstore to remain active and highly competitive on the contemporary pharmaceutical market:

  • Its product database comprises the widest selection of both essential medicines and health care products. All the medications dispensed are high quality generics manufactured by time-tested brands that work in strict conformity with the highest standards of safety and quality.
  • Close and effective cooperation with highly regarded manufacturers and the pharmacy’s own fair pricing policy established from the very outset has enabled it to charge markedly low prices, which are far lower than the respective ones quoted by other online pharmacies.
  • No extensive product selection and no low prices will appeal if a customer cannot get his/her medications ASAP. Making deliveries just as promised, both inside and outside Canada, the pharmacy has built up a reputation as a reliable supplier delivering products on time.
  • Highly knowledgeable staff and top notch personal service are two more features that appeal to all the customers of Canadian Health&Care Pharmacy – www.canadianhealthcaremalll.com. People like to be informed well and on time and like to be treated the way they deserve.
  • All pharmacy’s customers highly appreciate the safe and secure shopping it ensures. The strictest privacy policy protects personal information of each and every customer, while the highest level of SSL encryption protects the transmission of personal/financial data.

Canadian Health&Care Mall www.canadianhealthcaremalll.com: What Makes It Special

Such a conventional and at the same time innovative approach to do business per se is enough for placing the pharmacy on the TOP list. However, the drugstore has chosen not to restrict itself to everything that is reliable and solid but too official. That’s where a great variety of special offers comes up as both incentives and benefits. Thus, all loyal customers are active participants of the pharmacy’s loyalty program that stipulates such specials like free shipping and insurance, personalized discounts and free bonus pills added to each and every order placed. If you’re a newcomer, you’re welcome to use a promo code whatever your order is; this can be just the way that will eventually lead you to all the benefits of the pharmacy’s loyalty program.

Canadian Health&Care Mall website: http://www.canadianhealthcaremalll.com

My Canadian Pharmacy RX: Health Control

7 October, 2015 (19:41) | Health Care | By: Health news

Data collection procedures for in-depth telephone interviews and in-person focus groups, including informed consent, were approved by the University of Florida Institutional Review Board.

Instrument Development

Instrument development for the focus groups and interviews was guided by definitions of health as articulated by Wolinsky and Zusman and WHO, as well as constructs within theories of health behavior derived from the Health Belief Model and the Theory of Planned Behavior. The goal of this research was to capture beneficiary sentiments and opinions about what health means to them and their ability to “control” their health. Wording and content were refined after conducting an initial pilot focus group with Medicaid beneficiaries. During the pilot focus group, it was noted whether the participants misinterpreted questions, and they were asked to suggest alternative language and make recommendations for additional questions. An iterative process, typical of qualitative research, was used to continuously revise the instrument based on participant responses, interviewers’ observations, and team analyses of data.

Participant Recruitment and Data Collection

Focus groups and individual in-depth telephone interviews were conducted with adults and parents of children who were enrolled in the Medicaid program in the state of Florida. Community liaisons posted flyers and used personal contacts to recruit participants to focus groups. The focus groups lasted approximately 45 to 60 minutes and each participant received a $20 gift card.

Eligibility files from the Florida Medicaid program were used to identify individuals for telephone interviews. Recruitment letters were mailed to randomly selected beneficiaries. The letters were followed up with phone calls to schedule telephone interviews. After the completion of each interview, participants were mailed a $10 gift card. Respondents were recruited and interviewed until it was determined that a point was reached where no new information was being collected. Interviews and focus groups were audio recorded and transcribed verbatim. All participants provided verbal informed consent prior to participation in the study.

There were 32 participants for individual interviews, and 57 individuals participated in 7 focus groups.

Coding and Thematic Development

Using the instrument as a guide, an initial set of codes was developed. Based on an iterative process, these codes were refined and descriptive sub-codes were developed in order to best catalog the essence of the data. Then, for each general code and sub-code, each study team member (authors) utilized Atlas Ti 5.0 to aggregate quotes and statements. Team meetings were used to gain consensus on codes and themes and to generate study findings and conclusions.

FINDINGS

Beneficiaries framed health and control of health in a number ways, and several content areas were identified, including a general understanding of health, health as a life experience, health as a function or action, health defined based on the healthcare system, dimensions of health, and the ability to control health.

General Understanding of Health

Beneficiaries’ general understanding of health was based on their descriptions of what they considered to be healthy and not healthy. Healthy was defined as “life” and productivity to some, while others defined it as not having to go to the doctor and having no need for medications. An example of how participants typically noted their concept of being healthy follows:
Health means, it’s your life, when you hear the word health you are talking about your life. If I am healthy enough to live, a healthy human being, am I healthy enough to be productive to the world.

Descriptions of what it is like not to be healthy include the following statement:

You have poor health you become confused, you’re crazy, you do crazy stuff, you know, you are not productive to the world if you don’t have health.

Health as a life experience

Health was often defined according to a condition experienced throughout life. One example of how someone described health as a part of their life experience is illustrated below:

Something I’ve never had in my life. Only for the first 6 months of my life, I was a healthy baby, and after 6 months, I’ve been sick all my life. The word health in my life is nothing that I’ve never had.

Health as a Function or Action

Health was also defined according to functions or actions that individuals could do or not do. For example, “health means being able to take care of yourself,” “for my child…health is doing exercise, walking, playing around,” and “it means that I can get around and do things for myself continuously and not have to depend on nobody to come and take care of me” were some of the functional descriptions individuals used to describe health. One individual described health in terms of a social life: it would be something like walking on the beach with a six pack … a nice chick [woman] walking with me you know.

Health Care System

When talking about health, some individuals framed their comments in terms of the healthcare system. They did this by discussing the role their clinician or the healthcare system played in their health. Clinicians were viewed as key sources of information and instrumental in keeping the beneficiaries healthy by making suggestions and checking their health status. For example, “good health means to me that I see a psychiatrist that keeps me balanced and centered and on track” was one statement used to relate health and health care.

Dimensions of Health

The interview protocol specifically included probes focused on the specific spiritual, physical, and mental aspects of health. Physical health was defined by beneficiaries primarily in terms of activity level. As an example, these individuals responded that physical “health is doing exercise, walking, playing around” or that “you can do just about anything you want to do.” Individuals defined being mentally healthy as being happy as in the following quote: “being mentally happy is not worrying and being able to figure things out for myself.”

Spiritual health was defined in somewhat abstract terms as “being in tune with the world,” “finding answers to life,” and “having faith in God.” Some discussed their current spiritual health in different ways which generally consisted of the following description:

My spiritual health, oh my goodness, is good… I have found all the answers to life as far as I’m concerned because of my faith….Well I know there is a God. He took it away.

Ability to Control Health

Respondents were asked about whether they thought they were able to “control” their health or if they knew what actions were necessary to control their health. Individuals identified five primary factors that facilitate control of health: their individual ability, the role of others, such as family and friends, the role of clinicians and the medical care system, money and resources, and God and prayer.

Individual Ability. Individuals regarded control of health as their personal responsibility. Some respondents were generally empowered to control their own health and spoke of examples where they changed their lifestyle or behavior, including, “I am the best one to judge of what I want and who I want . . . what I need,” and the following:

I am going to give you an example of controlling my health. I used to smoke. I smoked cigarettes for 8 years . . . woke up in December of last year and I told myself I am going to quit smoking cigarettes and I quit smoking cigarettes.

While control of health is regarded as personal and individualistic, many acknowledged that it is very difficult to do and that they lacked the ability. In some ways, their comments could be thought of as fatalistic, as illustrated by the following exchange:

Interviewer: Do you have control over your health personally?
Respondent: No.
Interviewer: Why is that?
Respondent: Not now I don’t.
Interviewer: Have you had in the past, do you think?
Respondent: Maybe when I was younger, if I had lost weight, knew more than I know now. Change my living and eating habits.
Interviewer: You don’t think you can do these things now?
Respondent: Well, the damage is already done, so you can’t undo what’s already done.

Role of Others Such as Family and Friends. While some individuals did not indicate the degree to which their own health is controlled by factors other than themselves, many did recognize that they may need help and so seek information to gain control of their health. It is at this point that individuals rely on others, including their physicians, nurses, family members, and friends, to provide information and encouragement. Individuals also expressed the need to control themselves: “I try to control it myself, but if I can’t control it, I see if I can get help.” Other comments regarding control of health included the following: “someone was helping me . . . encouraging me to eat the right food and stuff . . . like somebody to push me. If I try to do it on my own, it is not working.”

Money and Resources. Money, or lack of money, affects the ability to control health in several ways, including the purchasing of healthy foods, going to the doctor, and buying medications. The high cost of purchasing healthy foods was cited as the main effect of lack of money on the ability to control health.

To eat healthy it cost more than just going to buy a bag of potato chips or going to McDonalds. You know they got the dollar menu but when you got to eat healthy is like you have to spend more money to eat healthy.

Beyond having enough money to purchase healthy foods, going to the doctor, and purchasing medications, many individuals were simply overwhelmed with the cost of living in general. Worry about paying bills ultimately affected their mental health status.

If I got a bunch of money I wouldn’t have to worry about my losing my house and that I think would, instead of taking all this medication I take, it might calm me down you know, and make me feel better about myself . . .
God, Prayer, and State of Mind. Although control of health is regarded as very individualistic, faith in God had a profound impact on an individual’s perceived ability to control their own health. Some individuals considered themselves subject to God and His will for them, and had faith that God would take care of them. Other individuals who described themselves as being sick or ill noted that being unhealthy or unwell is a “state of mind.” These individuals indicated that they were not going to worry about their illness and that they were going to live their lives as best as possible. For example: but I am not going to let my weakness and my sickness bother me because I stay walking and I stay going, you know, stay going everywhere, but the pains just come and go. And I am not going to let my pains bother me.

This “state of mind” view of health has a spiritual dimension as many participants indicated that faith in God through prayer enabled them to maintain positive attitudes: “I’m fine, I’m fine, and it’s in the hands of God.”
Strategies for Remaining Healthy or Regaining Health.

Individuals also identified strategies for remaining healthy or regaining health. Overwhelmingly, when asked about strategies to remain healthy or to regain good health, beneficiaries focused on the role of various actions such as changing nutrition and diet, taking medications and going to the doctor, and, to some extent, physical activity and exercise. Many of the phrases used to define health reflect actions to maintain health including having breakfast, going to the doctor, exercising, and eating well.

Article by My Canadian pharmacy Team: http://www.mycanadianpharmacyrx.com

Want to Stop Acne?

8 June, 2010 (21:13) | Acne | By: Health news

If there’s one thing that you need to know about acne, it’s the fact that it’s treatable. It means that you can spend the rest of your life bidding good-bye to it. It’s also fortunate that there are different types of acne treatments that you can take advantage of:

  • Antibiotics
  • There are usually the drugs that are given by doctors to cure more severe acne. By then, your pustules could already be large, red, and swollen; and they could no longer be treated by topical creams and other mild medications. Antibiotics would normally target the bacteria that cause the inflammation or the infection.

    Some of them are not over-the-counter medicines. This means you need to have the doctor’s prescription. Moreover, since these medications are more powerful, you need to follow the advice of your doctor as well as the instructions in taking the prescription. This is to lessen their possible side effects. You may also have to protect yourself against the sun, since some of them can make your skin sensitive.

  • Benzoyl Peroxide
  • This component is normally found in medications that are for acne. There are a lot of benefits you can get out of it. First, it can unclog your pores. It can also kill the bacteria that can cause further inflammation or infection. It may also speed up the healing of your acne.

    Unlike antibiotics, this one is much milder and safer to use. Nevertheless, you still need to follow directions. Usually, you are going to apply this once a day, after cleaning your face and going to bed. This way, you will give your body and medication to heal your acne. You may also experience slight burning sensation or itchiness on the area where you add the medication. However, these should not make you worry. It only means that the medication is working, but if the feelings persist for a much longer time or worsen, you need to see a doctor.

  • Herbal Treatments
  • If you have gone through alternative medicine, then your acne treatments would definitely be herbal lotions, creams, and supplements. They are all made of natural ingredients such as citruline, red clover, and aloe vera. Some of the herbs used contain anti-inflammatory and bacterial properties, which would eventually help in reducing the appearance of acne-blackheads, whiteheads, and pustules-on your skin. They can also possess certain nutrients that can enrich the condition of your skin, allowing it to repair wounds and regain its smoothness. If you’re scared of the side effects of medications, you can use this product as an alternative.

  • Laser Treatment
  • This is more ideal for those who are in a hurry of getting rid of their acne. It can get rid of acne in just few weeks, as well as reduce acne scars. The only downside is that it’s going to be really costly.

    Before you consider any of these treatments, though, make sure that you’ve already consulted a physician, particularly a dermatologist. He or she can come up with a treatment plan that suits the severity of your acne.

    Buy Cialis Online in Canadian Pharmacy

    14 August, 2015 (16:32) | Canadian pharmacy, Canadian Cialis | By: Health news

    History

    Cialis is a highly popular drug in the modern world. Sold in many different versions, colors, forms, and doses, Cialis is also known under many names, one of which is Tadalafil. When it was created, Cialis was hailed as a great development for both the medical field and the sphere of adult sexuality. It is still one of the top contenders in the field of sexual enhancement drugs, along with Viagra and Levitra. Cialis was developed in the 1990’s and first saw the light in 2003 when it was approved for use by the FDA. A team of researchers from Glaxo Wellcome and ICOS worked on the drug, hoping to create a better alternative to the then-existing Viagra. In some ways, they succeeded, as Cialis has a much longer effect and half-life in comparison with Viagra, with up to 36 hours of use to Viagra’s 17.5.

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    Cialis: How it Works

    Cialis is a drug mainly used to treat male erectile dysfunction (ED). ED is a condition when a man is unable to achieve or maintain an erection during sexual activity. This condition occurs for a number of reasons and in the presence of various factors, including cardiovascular disease, side effects from certain drugs, diabetes and certain psychological issues and illnesses. Erectile dysfunction is also most commonly associated with aging. Thankfully, developers of drugs like Cialis have found a way to counteract this problem, giving hope, confidence, and happiness to millions of men all over the world. Cialis belongs to a class of drugs known as PDE5 inhibitors, all of which are used to treat erectile dysfunction. The drug works in the following way: first, it is taken orally in a dose determined by physicians. Within an hour of administration, the drug should begin exhibiting an effect. This medication sets off a biological chain reaction in which cGMP (a nucleotide) is released and smooth muscles of the penis relax, causing increased blood flow and subsequent erection. This effect is known to last for many hours.

    Other Uses

    While Cialis is stereotypically referred to as a drug for male sexuality, it actually has some additional uses that have been confirmed and promoted in the medical trade. First and foremost is pulmonary hypertension. This is a rare disease that produces an increase in blood pressure of pulmonary arteries, veins, and capillaries. This, in turn, causes fainting, shortness of breath, dizziness and leg swelling. Cialis has been shown to increase artery vasodilatation, lower blood pressure and vascular resistance. Another condition Cialis is believed to alleviate is benign prostatic hyperplasia, also known as enlarged prostate. The drug does not counteract the condition, but it does temporarily remove some of its signs and symptoms. Furthermore, Cialis is sometimes taken by women to increase blood flow to the genital region which improves their sexual response.

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    Cialis can be purchased by adult men and women, but some countries require a prescription to obtain it. It is widely available in most pharmacies all over the world, but sometimes it can be difficult to get it if it’s out of stock, or the nearest such pharmacy is very far away. In such circumstances, it can be very convenient to buy the drug online. With the popularization of the internet, thousands of online drug stores have appeared, including those that specialize in drugs like Cialis. All of them have different prices, assortments and shipping conditions. Thus, if you want to obtain Canadian Cialis, you can benefit by finding a localized online store. When choosing a web-based Canadian pharmacy, make sure that it has a good sales record and trustworthy policies for the customer.

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    Canadian Pharmacy Encourages Healthy Diet for COPD Breathing Relief

    24 June, 2015 (23:00) | Canadian pharmacy | By: Health news

    Preserving a healthier diet regime does have several benefits like sustaining the proper weight to sustain easy breathing irrespective of age. An estimated 13.5 million individuals in USA are known to have chronic obstructive pulmonary disease (COPD), which is already counted amongst the 4 major causes of death. Breathing difficulty arises due to continuous mucus formation or collapse of air sacs in the lungs.

    Our Canadian pharmacy consequently encourages individuals to indulge in a wholesome diet plan comprising of fruits and vegetables to be capable to breathe effortlessly when suffering from complex illnesses like COPD. Weight handle is essential when suffering from respiratory ailments. Obesity leads to improper functioning of the lungs and heart. In both situations, breathing difficulty is experienced. Attacks can be serious and frequent in people suffering from COPD.

    Workout Can Aid Avert Asthma
    Indulging in normal workout is one way of keeping body weight beneath control. Lifestyles have changed. Youngsters and adults are much less dependent on exercise or activity and rely on technology to lessen workload. The trend has invariably led to elevated obesity across the globe top to asthma. It has now turn out to be important to sustain a normal workout regimen in order to keep good health.

    Nevertheless, our Canadian pharmacy points out after asthma sets in, exercise leads to bronchial tube inflammation. People involved in rigorous exercise are most likely to have much more asthmatic attacks. Men and women often acquire Combivent inhalers to avoid exercising-induced bronchospasm. The medication has encouraged sportspersons to indulge in rigorous workout with greater preparation and preventive measures. Even though causes of asthma are nevertheless unknown, alterations in way of life might aid in the extended run. A nutritious diet plan will support individuals who can’t exercising often.

    Properly Balanced Diet regime Can Be Tasty As Effectively

    Folks prefer fruits to vegetables simply simply because they taste better and can be eaten without having cooking. Raw vegetables may not be as tasty but lend enough nutritional worth and must be included in everyday diet. Changing menu assists create a taste for healthy meals. For instance, white or brown rice, entire grain cereals, and brown bread can be eaten at diverse instances to keep away from monotony. They all include essential minerals and vitamins required to sustain physique balance.

    Meat eaters opt for poultry, seafood, lean pork or beef. Lack of vitamin D and calcium can influence bone well being. Folks have a tendency to steer clear of certain variety of foods to decrease cooking time. Such men and women can always preserve canned meals like tuna, which can be effortlessly added to rice, cheese, and frozen vegetables that can be speedily steamed. The Internet has provided straightforward access to a wide range of scrumptious recipes.

    Specific sort of foods capable of making gas like carbonated beverages, cabbage, broccoli, or beans must be avoided on a everyday basis, especially by individuals who get frequent attacks. Spices and herbs can be employed for seasoning rather of excess salt. Our Canadian pharmacy encourages healthier meals and successful drugs like generic Combivent not only to steer clear of medical complications but also to effectively handle weight when suffering from asthma and other respiratory diseases.
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    Read also about canadian pharmacy viagra: http://www.canadianhealthcaremalll.com/canadian-viagra-and-viagra-types

    Chemotherapy in the management of prostate cancer

    22 April, 2015 (13:59) | Prostate cancer | By: Health news

    Despite this interpretation of the early experience, another generation has passed since the NPCP trials were initiated, without cytotoxic therapy earning a place in the routine management of patients with metastatic prostate cancer. Recent modification of chemotherapy and the introduction of prostate-specific antigen (PSA) testing that permits efficient assessment of ‘response’ have changed this perception.

    It is instructive to consider some of the factors contributing to this perception. First, evaluation of clinical response has been difficult. Second, the fact that even patients with disseminated prostate cancer are commonly managed exclusively by urologists has attenuated the experience of medical oncologists in this disease, and very likely has contributed to the slow development of cytotoxic paradigms. Third, there has been an ironic distraction produced by the advent of medical testicular suppression. For some time, clinical research in advanced prostate cancer has seen disproportionate resources expended on randomizing many thousands of patients to variants of hormonal therapies.

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    More than a decade of such experience has demonstrated that no matter how complex or expensive we make androgen deprivation, its therapeutic impact is still limited. Finally, the palliative impact of cytotoxic drugs is underappreciated. As pointed out by Slack and Murphy in the quotation above, cytotoxic therapy carefully applied can often provide symptom relief with less morbidity than that associated with narcotics or other palliative
    interventions.

    Progress towards more routine assessment of the role of chemotherapy has been made because of a number of factors that have been addressed:

    (1) Establishment of standardized response criteria;
    (2) Closer ties between medical oncologists and urologists in ‘academic centers of
    excellence’;
    (3) Recognition of the toxicity and therapeutic limitations of androgen ablation;
    (4) Inclusion of quality-of-life end-points in clinical research.

    Evaluation and management of lower urinary tract symptoms related to benign prostate disease

    17 April, 2015 (15:17) | Critical Care | By: Health news

    Introduction

    The International Continence Society-‘Benign Prostatic Hyperplasia’ (ICS-‘BPH’) study was initiated following the First World Health Organization (WHO) Consultation on benign prostatic hyperplasia (BPH) in 2014. At this meeting, there was no formal acknowledgement of the role of urodynamics in the assessment of men presenting with lower urinary tract symptoms (LUTS), which were then typically described as ‘prostatism’ or ‘clinical BPH’, and the seven-item American Urological Association (AUA) symptom score was adopted as the International Prostate Symptom Score (IPSS).

    There were concerns that such a short symptom score did not cover the range of problematic symptoms experienced by patients, and that many urologists relied upon symptom ascertainment alone to select patients for invasive therapies, despite evidence that LUTS had poor diagnostic specificity.

    In addition, there were suggestions that urodynamic studies could be used to identify patients with obstruction who might be more suitable for invasive treatments, thus leading to better patient selection and outcome, particularly in the context of increasing diversification of technologies for the treatment of LUTS.

    In this context, the ICS-‘BPH’ study was established. A number of things have now changed. In particular, there is general consensus that the IPSS is not diagnostic, and acceptance that urodynamic studies have a role in the evaluation of men with LUTS. There has also been a marked change in the use of terminology in this area. In particular, the term ‘prostatism’ has been rejected and there is considerable care now in the use of ‘BPH’.

    BPH tends now to be reserved for histological diagnosis, with LUTS used to describe lower urinary tract symptoms, BPE (benign prostatic enlargement) an enlarged prostate found on digital or ultrasound examination, and BPO (benign prostatic obstruction) the diagnosis of obstruction confirmed by urodynamic studies.

    The title of the ICS-‘BPH’ study was thus soon outdated, and so inverted commas were used to denote the difficulties surrounding the term ‘BPH’! In the sections that follow, the methods and major findings from the ICS-‘BPH’ study are presented and their contribution evaluated.

    Methods of the ICS-‘BPH’ study

    The main aims of the ICS-‘BPH’ study were:

    (1) To investigate the relationships between the results of urodynamic studies and a wide range of urinary symptoms;
    (2) To produce a valid and reliable symptom, sexual function and quality of life questionnaire, including, if possible, a scored short form for use in clinical practice and research;
    (3) To undertake an observational study of outcome of treatments according to current clinical practice around the world;
    (4) To compare methods of pressure-flow analysis to establish the ‘optimum’ method of diagnosing bladder outlet obstruction.

    These aims were addressed in three phases:

    Phase I International, multicenter observational study collecting baseline data on LUTS and their impact on quality of life, sexual function, uroflowmetry and urodynamic studies;

    Phase II International, multicenter observational study of outcome approximately 12 months following treatment;

    Phase III Evaluation of treatments in randomized trials, e.g. CLasP study. Urologists from around the world were invited to recruit consecutive patients over 45 years of age with LUTS presumed to be of benign origin who could complete a frequency-volume chart and questionnaire and undergo uroflowmetry and urodynamics.

    Men with significant urological disease, unfit for treatment or taking medication active on the lower urinary tract were excluded.

    The ICS-‘BPH’ study questionnaire was designed to be self-completed. It was developed in English and then professionally translated into 15 other languages (Danish, Dutch, Finnish, French, French Canadian, German, Israeli, Italian, Japanese, Norwegian, Portuguese, Spanish, Swedish, Taiwanese, Turkish). Each translation was re-translated and checked by a lay advisor or national coordinator prior to use.

    In the ICSmale questionnaire, men are asked to record each urinary symptom according to one of five grades from ‘never’ through ‘occasionally’, ‘sometimes’ and ‘most of the time’ to ‘all of the time’. Immediately beneath each question concerning the prevalence of the symptom follows a question referring to the degree of problem or bother caused by each of the symptoms graded from ‘not a problem’ through ‘a bit of a problem’ or ‘quite a problem’ to ‘a serious problem’.

    The majority of symptoms are presented in this format, with the exception of the more specific items of frequency, nocturia and acute retention which are couched in terms of numbers. In addition, there are seven specific questions concerning quality of life (ICSQoL), including three fixed format questions, two global quality of life questions and two open-ended questions.

    Patients in the UK also completed the generic health status instruments: Short Form 36 (SF-36) and EuroQol. Sexual function was explored using four questions (ICSsex). Each patient was also asked to keep a 7-day frequency-volume chart recording times of micturitions and incontinent episodes. An assessment was made of the patient’s prostate size by digital rectal examination (in grams) or by transrectal ultrasound (in cubic centimeters).

    Three flow rate measurements were requested for each patient, with the assessment of residual urine by ultrasound after each void. Urodynamic studies were recorded at the time of investigation by the clinician on the ICS-‘BPH’ study patient information record, and the urodynamic trace was photocopied to be analyzed centrally.

    The investigator was asked to judge whether the patient was unobstructed, had classical obstruction, questionable obstruction or another diagnosis. All data forms were returned centrally for processing and analysis using Statistical Analysis System (SAS) and Stata software.

    Critical Canadian Health: Thromboendarterectomy

    18 March, 2015 (13:27) | Critical Care | By: Health news

    Eboendarterectomy, the flow through the pulmonary arterial bed increases and right and left ventricular functions return to normal values. The effects on patients were obvious within 2 weeks of surgery and further prove the beneficial immediate effect of thromboendarterectomy. Interestingly, most patients could have their parameters assessed by transthoracic, rather than transesophageal, echocardiography.

    This technique is almost universally available as a bedside method, albeit that it is operator-dependent. Nevertheless, this technique allows us to study the direct therapeutic effects on cardiac function in patients with CTEPH more closely than before. Furthermore, its noninvasive nature makes it a very useful tool for repeated studies in patients with CTEPH, for whom the current standard is often invasive pressure assessment using right heart catheterization. This would also be beneficial for the monitoring of treatment effects in the evaluation of new therapies.

    Although the study shows the direct pathophysiologic benefit of thromboendarterectomy for patients with CTEPH, one could take this one step further and extrapolate to patients with acute PE. In a massive PE, similar changes in right ventricular dilatation, abnormal cardiac geometry, and diminished cardiac index have been demonstrated. In patients with massive PEs , there is a general consensus that thrombolysis is the therapy of choice and that echocardiography may be used to monitor the improvement of cardiac function.

    However, there is a subgroup of patients with acute PEs who have normal hemodynamic parameters but exhibit echocardiographic evidence of right ventricular dysfunction. These patients seem to have a worse prognosis than patients without echocardiographic abnormalities. Furthermore, patients who present with acute PEs and pulmonary artery pressures > 50 mm Hg are more likely to suffer from persistent pulmonary hypertension at 1 year of follow-up.

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    Hence, it seems likely that echocardiography may have a significant impact on the therapeutic management of subgroups of patients with acute PEs. There is limited evidence in the literature that echocardiography may have a role to play in the management of PE. However, there is an urgent need for prospective studies that assess the role of echocardiography in the identification of patients with PE who may benefit from thrombolytic therapy rather than heparin therapy, despite the absence of systemic hypotension or shock.

    Canadian Health and Care Mall: Symptoms Diabetes

    25 December, 2014 (10:46) | Diabetes | By: Health news

    Research by Canadian Health and Care Mall – SYMPTOMS

    My partner was very thirsty before she was found to have diabetes. What was the cause of the thirst?

    The most common signs of diabetes are thirst and loss of weight. These two symptoms are related and one leads to the other (there is more detail on weight loss in the answer to the next question). The first thing to go wrong is the increased amount of urine. Normally we pass about 1.5 litres (about 2 pints) of urine per day but people with uncontrolled diabetes may produce five times that amount. The continual loss of fluid dries out the body and the sensation of thirst is a warning that, unless they drink enough to replace the extra urine, they will soon become very dehydrated.

    Of course people who do not have diabetes may also pass large amounts of urine. Most beer drinkers know the effects of five pints of bitter. In this case it is the volume of beer that causes the extra urine, whereas in diabetes the large volume of urine causes the thirst. In the early stages, the thirst is usually mild and most people fail to realise its significance unless they have had some personal experience of diabetes. Someone with undiagnosed diabetes will often take jugs of water up to bed, wake in the night to quench their thirst and pass urine, and still not realise that something is wrong. It would be helpful if more people knew that troublesome thirst may be due to diabetes.

    I had lost quite a lot of weight before I was finally diagnosed with diabetes. Why was this?

    The main fuel for the body is glucose, which is obtained from the digestion of sugary or starchy food. People with untreated diabetes cannot use this glucose as fuel in the normal way or store it. The unused glucose builds up in their bloodstream and overflows into the urine. Someone who has uncontrolled diabetes may lose as much as 500 g (just over 1 lb) of glucose (sugar) in their urine in 24 hours. Anyone trying to lose weight knows that sugar equals calories. These calories contained in the urine are lost to the body and are a drain on its resources. The 500 g of glucose lost are equivalent to 10 currant buns (2000 calories per day).

    Lack of insulin means that the body cannot use glucose to provide energy or to build stores of starch and fat. As a result body tissues are broken down to form glucose and ketones, and this causes loss of fat and wasting of muscles.

    My vagina has been really itchy and sore. My CP says it’s to do with my diabetes. Can this be right?

    A woman whose diabetes is out of control may be troubled by itching around the vagina. The technical name for this distressing symptom is pruritus vulvae. The equivalent complaint may be seen in men when the end of the penis becomes sore (balanitis). If the foreskin is also affected, it may become thickened (phimosis), which prevents the foreskin from being pulled back and makes it difficult to keep the penis clean.

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    Current Limitations of Immunologic Testing

    17 October, 2014 (16:50) | Critical Care | By: Health news

    IgE antibodies specific to diisocyanate-HSA conjugates have been detected in 21 to 55% of cases of diisocyanate-induced OA confirmed by SIC or workplace challenge in different studies, with an assay specificity of 89 to 100%. Diisocyanate-specific IgG antibodies appear to be a good marker for recent diisocyanate exposure, rather than diisocyanate asthma, since they can be detected in a substantial buy Cialis online proportion of asymptomatic exposed workers. Active exposure to diisocyanate increases the sensitivity and specificity of specific IgE antibodies reactive with diisocyanate conjugate by RAST. The detection of diisocyanate-specific IgE antibodies fell if assayed > 30 days after the cessation of occupational exposure, with a calculated half-life of 5 to 7 months.

    The clinical data examining in vitro antigen-specific cellular immune responses to establish a diagnosis of chemical sensitizer-induced OA are limited. In vitro proliferative responses to plicatic acid-HSA antigen have been demonstrated in 24% of workers with red cedar-induced asthma, compared to 0% in exposed workers without red cedar-induced asthma. In vitro monocyte chemotactic protein-1 production by mononuclear cells cocultured with diisocyanate-HSA antigens exhibited 79% test sensitivity and 91% specificity for the diagnosis of OA compared with SIC results among 54 exposed workers.

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    Current Limitations of Immunologic Testing: There are several limitations to immunologic testing 24S for determining a patient’s sensitization to LMW chemical agents. Antigens are prepared by conjugating chemicals with a protein such as HSA; however, the chemical-protein conjugate antigens and protocols have not been standardized, and results cannot be compared between laboratories.

    Test extracts for most HMW proteins that cause OA are not commercially available and are frequently prepared differently by different investigators. Commercial extracts, if available, may not be standardized with regard to allergenic potency. The test sensitivity of in vitro specific IgE antibody assays and SPTs likely decrease after the cessation of exposure due to the half-life of the IgE antibody.

    CF Airway Inflammation Disproportionate to Infection

    14 October, 2014 (13:14) | Infections | By: Health news

    Several lines of evidence have indicated that inflammation in CF airways is excessive and sustained relative to the infectious stimulus. In vitro models of CF respiratory epithelial cells have indeed demonstrated the increased release of inflammatory mediators after exposure to inflammatory stimuli compared to cells expressing a normal CFTR, possibly mediated through dysregulation of the transcription factor NF-kB. Excessive inflammation may also result Health Pharmacy from impaired inflammatory control such that the airway response fails to cease, as evidenced from several cell model systems.

    However, this phenotype depends greatly on the model system tested. For instance, the comparison of various CF and corrected cell lines demonstrated that uncorrected CF airway epithelial cell lines inconsistently express higher IL-8 levels. Isolated primary airway epithelial cells from CF patients had greater IL-8 concentrations in culture, compared to cells isolated from non-CF patients, but only after exposure to Pseudomonas aeruginosa. However, there was no difference in IL-8 release by sham and genetically corrected CF epithelial cells that were grown in primary culture at an air-liquid interface, or in primary cultures of human cells from control and CF subjects. These studies indicate that there is considerable variability in airway epithelial cell responses to inflammatory stimuli among different cell models systems, and raise questions about the existence of a consistent hyperinflammatory CF phenotype. Better, more reproducible epithelial model systems are being developed.

    CF mice have been shown to have significantly higher concentrations of inflammatory mediators in BAL fluid and greater mortality than normal litter-mates following intrabronchial instillation of Pseudomonas-laden agar beads, despite identical bacterial burden in the lungs. However, similar to the results from in vitro models, not all murine studies have shown this relationship.

     

    Higher concentrations of neutrophils or IL-8 were found in the lungs of CF patients compared with control subjects, regardless of the pathogen recov-ered, supporting the concepts of both excessive inflammatory response and impaired inflammatory control. Reduced concentrations of antiinflammatory factors, such as IL-103 and lipoxin, were measured in BAL fluid from patients with CF.

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