I came across this nice article about viagra cialis online pharmacy pharmacy health care from a local newspaper that is worth sharing.
The penis is easily a man's most guarded and revered appendage. As such, the penis commands a level of care and respect. Let's review some of the tips on penis health care that will keep you rising happily each morning
Washing
Penis is a sensitive organ, a point that should always be kept in mind during penis health care. For some odd reasons, many men feel the need to vigorously scrub their units with powerful soaps or disinfectants to keep clean. In fact, simple washing with warm water and a mild soap or non-soap cleanser is more than satisfactory.
Uncircumcised men should slide the foreskin back and wash with warm water, not soap. Then, be sure to dry the area very well. Both infrequent and too frequent washing have been associated with balanitis. If you do notice irritation, avoid scented soaps or shower gels and try warm salt water instead. New clothes or even new laundry detergents can also cause irritation
Self Examination
Particularly when sexually active, men should regularly perform genital self examination to identify testicular cancer or any sexually transmitted infections (STIs) that present themselves visibly. For testicular cancer, experts recommended that men practise it one a month after taking a bath. Not only is regular testicular examination a good way to catch testicular cancer early, but it also provides an opportunity to examine the penis and testicles for signs of an STI.
Red Flags
There are many red flags for STIs. Some of the major signs and symptoms of common STIs that you should be on the lookout for:
- Discharge from penis: The drip could be thick and yellow or it could be watery and very slight
- Change in smell or colour of semen
- Blood in the semen or urine
- Pain during sex or during urinating or ejaculating
- Pain in the pelvic area
- Flesh coloured or reddish bumps, sores or blisters on the skin of the genitals that may or may not itch
- Small blisters that turn into scabs on the genital area
- Soft, flesh coloured, cauliflower like warts around the genital area
Like it or not, your penis is with you until the end. As a source of procreation and pleasure, the penis commands proper care. So, take care of it properly.
terça-feira, 1 de novembro de 2011
Penis Health Care
sábado, 29 de outubro de 2011
A call for peer-reviewed lectures in Academic EM journal
In an interesting announcement this week, Academic Emergency Medicine announced that it will be publishing Peer-Reviewed Lectures (PeRL) in video format. The journal has had success with its Dynamic Emergency online pharmacy viagra video section, and it appears that it is now looking to branch out. The PeRL videos will really shatter the old-school model of journals traditionally focusing on original hypothesis-driven research. This is the first that I've heard of a journal thinking "outside the box" and publishing peer-reviewed lectures in addition to traditional research.
According to the SAEM Facebook page announcement:
"Prospective authors should consider contacting the PeRLs editorial board (through John Burton, MD, Senior Associate Editor) for a discussion before starting on video production of a lecture for a determination of topic suitability. Videos can be complex to produce, and given the effort involved, having a discussion with an editor either by e-mail or phone before producing it, is recommended."
terça-feira, 3 de maio de 2011
Goodbye to Electrical Cardioversion for Atrial Fibrillation?
Goodbye to Electrical Cardioversion for Atrial Fibrillation?
The field of clinical medicine is littered with the bodies of sacred cows. Recent examples include the demise of vagotomy and pyloroplasty as a standard treatment for peptic ulcers and the absolute contraindication of beta blockers in the treatment of heart failure. I would like to suggest that the next sacred cow to be dispensed with is the routine use of electrical cardioversion in the treatment of atrial fibrillation, despite its inclusion as a therapeutic option in the National Institute for Health and Clinical Excellence (NICE) atrial fibrillation guidelines.[1]
Direct electrical cardioversion has been a mainstay of therapy for the treatment of atrial fibrillation for many years. The theory underpinning its utilisation has some face validity, that by restoring sinus rhythm any problems associated with atrial fbrillation will be ameliorated. This, however, does not take into account the underlying cause of the arrhythmia, with the majority of atrial fbrillation caused by ischaemic heart disease. It is only relatively recently, however, that evidence for the ineffectiveness of cardioversion has begun to emerge. Paradoxically this evidence has derived from trials designed to prove the effectiveness of the procedure.
The Evidence
The utility of cardioversion was originally explored in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study,[2] which recruited over 4,000 patients aged 65 and over with atrial fbrillation and one additional risk factor for stroke. Patients were randomised to either rhythm control, using electrical cardioversion and purchase cialis as necessary, or to rate control using drugs, such as beta blockers or digoxin. To the surprise of the investigators the primary outcome, mortality, was worse in the rhythm control group, as were secondary outcomes such as hospitalisation and serious arrhythmias. Importantly, oral anticoagulation could be stopped at the clinician's discretion following cardioversion.
The AFFIRM investigators conducted a post hoc on-treatment analysis that did show some survival advantage if sinus rhythm was maintained.[3] The caveat to this was that use of anti-arrhythmic drugs was associated with increased mortality and, in fact, the main predictor of survival was use of warfarin. This left even the AFFIRM investigators to conclude that any advantage from maintaining sinus rhythm through use of anti-arrhythmic agents was offset by their toxicity.
Despite the fact that these findings have been repeated in further studies[4,5] and the problems associated with ensuring adequate oral anticoagulation prior to undertaking the intervention, cardioversion has remained a common intervention in patients with atrial fibrillation, particularly if there is associated co-morbidity such as heart failure.
A recent paper also seems to lay this issue to rest. Roy and colleagues[6] in trying to establish the efficacy of cardioversion for patients with atrial fibrillation and heart failure (defined as left ventricular ejection fraction of 35% or less, or symptoms of congestive heart failure) recruited 1,376 patients who were randomised to rhythm control, comprising cardioversion within six weeks of randomisation with additional cardioversions as necessary, or rate control with adjusted doses of beta blockers with digoxin. There was no significant difference in primary outcome of death from cardiovascular causes, nor any significant differences in secondary outcomes including death from any cause, stroke, or worsening heart failure. The authors concluded that "in patients with atrial fibrillation and congestive heart failure, a routine strategy of rhythm control does not reduce the rate of death from cardiovascular causes as compared with a rate-control strategy".
Where Does This Leave Us?
If cardioversion therefore has no place in the routine treatment of atrial fibrillation, nor in the treatment of high-risk patients, for example those with heart failure, where does this leave us? To my mind, cardioversion should no longer be offered routinely to patients with atrial fibrillation. The only clinical scenarios where it may be a useful intervention are for patients presenting acutely, within 24 hours of onset, or for patients who are very symptomatic despite medical therapy. Even in these instances, oral anticoagulation should be considered long term because of the high rate of recurrence
References
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Agel FIT - Appetite Suppressant & Fat Inhibitor
Agel FIT - Appetite Suppressant & Fat Inhibitor
Agel FIT is a wonderful component of the initial line-up of Agel products. This weight management aid will be a huge help to those who struggle with “the battle of the bulge.” And, because it is formulated as a gel preparation, it can easily be taken when it is most effective (see below).We all know that being overweight is a common, frustrating problem for people in all parts of the world, and it would be wonderful if there were a magic pill that would melt away the extra pounds without any physical effort. Unfortunately, there is no “magic bullet”. Let’s face it; losing weight involves a simple equation; the calories expended must exceed those that are consumed. In other words, we have to ‘eat a little less’ and ‘move a little more’. Now, this equation sounds easy, but the execution of a reasonable diet combined with a regular exercise program maintained over the long-term is sometimes not an easy process. Therefore, many people trying to lose weight will benefit from supplemental support as they face the inevitable obstacles along the way.
So let’s talk about Agel FIT. This great tasting gel can help play a role in this frustrating struggle, without the harmful effects of stimulants. The active ingredient in Agel FIT is a well studied, patent pending form of HCA (hydroxycitric acid), called Super CitriMax™. It comes from the extract of the fruit and rind of Garcinia combogia, and it has been shown in clinical trials to decrease body weight by reducing appetite and inhibiting fat synthesis without stimulating the central nervous system. There are other products on the market that use HCA for weight management, but not all of them contain Super CitriMax™. What makes this form of HCA so good is that it is bound to calcium and potassium, which maximizes its solubility, thereby, increasing its bioavailability. Add that to the fact that it is now suspended in a gel formulation and we have the makings of an awesome weight management aid.
Research has shown that HCA potency, bioavailability, timing of ingestion, and dosage are the essential requirements for optimal results. According to the studies, the Super CitriMax™ works best if it is ingested 30 to 60 minutes prior to eating meals, three times each day. This will allow time for the absorption of the HCA and suppression of appetite. With the convenience of a gel pack, timing the ingestion of this product in the 30 to 60 minute window will be a breeze.
The revolutionary gel technology used to deliver this formulation not only improves the bioavailability of Super CitriMax™, but also offers a convenience factor that can maximize the timing of its ingestion. Although nothing can replace a healthy diet and regular physical activity, Agel FIT will be an excellent addition to a successful weight management program.
J. Todd Nilson, M.D.
Director, Professional Advisory Team
Active Ingredients: Garcinia combogia, apple cider vinegar, powedered cellulos
More information:
| Article: | FIT Ingredients and Supplemental Facts (PDF) |
| Article: | Agel FIT Ingredients |
| Video: | Brent Long - Weight Loss with FIT - Broadband (2 min) |
| Video: | Brent Long - Weight Loss with FIT - Dial Up (2 min) |
| Audio: | Agel Professional Advisory Board: March 1, 2006 Agel FIT - Audio | Slides (PDF) |
Agel FIT Benefits
Agel’s FIT™ gel is a key component in your weight-loss and weight-maintenance goals. Nearly everyone wants to lose weight, reduce body fat and contour arms, abdomen, chest, and legs.The Opportunity
“I want to lose weight. Now.” “I want my 6-pack abdomen back.” “I want to look good in my swim suit.” “I’ve got to get fit now!!” Ever hear yourself or someone make these comments. Our busy lives often “force” us to eat poorly. No balanced diet. Only processed foods. Eating on the run. These choices have led to an overweight and obesity pandemic that now rivals chronic diseases.Statistics in the USA are an indicator of problems stemming from overweight and obesity. The prevalence of human overweight and obesity has increased over the years in both genders, for all age groups, for all racial groups and all educational levels. Astonishing overweight and obesity statistics abound for USA citizens. USA males overweight = 69% and females overweight = 62% should be surprising. The percentage of obese adults (BMI = 30): males 28% and females 33%. Surprising? It is still on the rise.
Overweight (BMI > 25.0-29.9) statistics have shown that the 20-34 year old range has been impacted the most in the past 20 years. Males 20-34 years old in the overweight classification increased 139%, while females increased 189%.
Even more alarming over the past 20 years are the increases in obesity (BMI = 30.0) among adults, with male obesity increased 217% and female obesity increased 195%.
The cost of lost productivity related to obesity (BMI = 30) among Americans ages 17-64 is $3.9 billion. Workdays lost related to obesity = 39.3 million, physician office visits related to obesity = 62.7 million workdays, restricted activity days related to obesity: 239.0 million workdays.
The Solution
Agel FIT™ gel and the Agel FIT Switch™ Program can help you, your family, your friends, and your neighbors succeed with weight-loss and physical fitness. FIT contains active levels of (-)hydroxycitric acid (HCA). (-)Hydroxycitric acid acts to turn off two important biochemical “switches” - fatty acid synthesis/storage and glycogen breakdown.There are hundreds of biological switches functioning every second within your body chemistry. Switches may be flipped “OFF” when there is abundant product concentration from a biochemical reaction. Conversely, a BioSwitch may be turn “ON” when there is abundant starting material for the reaction. These BioSwitches center around the activity of enzymes. Enzymes are helpful proteins that allow biochemical reactions to take place with the lowest input of energy.
Agel FIT Program GelBenefits
- Helps curb your appetite
- Helps you reduce food intake
- Increases fat burning
- Inhibits fat synthesis & storage
- Supports body weight-loss
- Helps balance emotional feelings
- Is 3-times more effective than diet and exercise alone
- Maintains healthy cholesterol levels within already normal levels
- Reduces Body Mass Index (BMI) to healthier levels
The FIT Program
- Agel FIT 30-60 minutes before meals (2-4 times/day)
- Helps reduce your appetite
- Supports fat metabolism
- Long-lasting effects
- Set caloric limits (2000 kcal/day)
- Key to weight loss
- Choose foods you like
- Eat more Walk more
- Eat 5-7 small meals
- Helps maintain feeling of fullness
- Minimizes glucose swings
- Keep a daily journal
- Records you feelings
- Tracks your success
- Balances your emotions
- Get 30 minutes of walking each day
- Burns more calories
- Helps you socialize
- Increases fitness
- Eat more Walk more
- Drink more water (carbonated soft drinks do not count)
- Aids digestions
- Supports energy levels
- Helps feel satisfied
Agel’s FIT Features:
- Gelceutical™ enhanced bioactive technology
- Exclusive FIT BioSwitch™ Technology
- Patent pending Super Citrimax® HCA
- Carry-anywhere Agel pouch