Every man wants to be successful in life, including sexual sphere. But when relationship with partner becomes more intimate, many representatives of the stronger sex lose courage and acquire some stiffness because of tormenting fears. Psychological problems often become a big problem, causing erectile dysfunction.
What is Cholera
Cholera (Lat. «cholera») is an acute intestinal anthroponotic infection caused by bacteria species Vibrio cholerae; characterized by fecal-oral infection mechanism, small bowel lesion, watery diarrhea, vomiting, rapid body fluid and electrolytes loss accompanied with varying degrees of dehydration up to hematogenic shock and death.
Cholera (http://www.nhs.uk/Conditions/Cholera/Pages/Definition.aspx) usually spreads as epidemy. Endemic regions are located in Africa, Latin America, India (South East Asia).
There are more than 140 serogroups of Vibrio cholerae; they are divided into:
- agglutinated by typical cholera O1 serum (V. cholerae O1);
- not agglutinated by typical cholera O1 serum (V. cholerae non 01).
«Classical» cholera is caused by cholera vibrios of O1 serogroup (Vibrio cholerae O1). There are two biovars (biotypes) of this serogroup:
- classical (Vibrio cholerae biovar cholerae);
- El Tor (Vibrio cholerae biovar eltor).
According to morphological, cultural and serologic characteristics they are similar: short curved motile rods with flagellum, gram-negative aerobes, well tingible with aniline dyes, do not form spores and capsules, grow in alkaline environment (pH 7,6-9,2) at 10- 40 ° C. Cholera vibrios El Tor, unlike classical, are able to hemolyze sheep red blood cells (not always).
Each of these biotypes according to O-antigen (somatic) are subdivided into serotypes. Inaba serotype contains C fraction, Ogawa serotype – B fraction and Hikojima serotype – B and C fractions. Cholera vibrios H-antigen (flagellar) is common for all serotypes. Cholera vibrios form cholera toxin (CTX) – protein enterotoxin.
Vibrio cholerae non-01 cause choleriform diarrhea of various severity, which can also be fatal.
Infection portal of entry is gastrointestinal tract. Cholera vibrios are often die in stomach due to chlorohydric acid. The disease develops only when they pass through gastric barrier and reach small bowel, where they rapidly multiply and release exotoxin. Experiments with human volunteers showed that large cholera vibrios dose (10″ microbial cells) at some individuals caused disease and after preliminary gastric chlorohydric acid neutralization the disease could be cause after administration of 106 vibrios (i. e. 100 000 times less dose).
Cholera syndrome occurrence is connected to two substances present at vibrio:
- protein enterotoxin – choleragen (exotoxin);
Choleragen binds with specific enterocytes receptor – ganglioside.
Neuraminidase, degrading acetylneuraminic acid residues, forms specific receptor, enhancing choleragen effect, out of ganglioside. Complex choleragen-specific receptor activates adenylate cyclase, which, together with and by means of prostaglandin stimulatory effect increases cyclic adenosine monophosphate formation (AMP). AMP regulates water and electrolytes secretion from cells into intestinal lumen through ion pump. As a result of this mechanism activation, small bowel mucous membrane begins to secrete a huge amount of isotonic fluid, which can’t be absorbed by large bowel, thus causing isotonic fluid intractable diarrhea.
Severe morphological epithelial cells changes at patients with cholera are not identified (during biopsy). Cholera toxin was determined neither in lymph nor in blood in vessels extending from small bowel. In this regard, there is no evidence that this toxin affects any other organs except small bowel. Secreted by small bowel fluid is characterized with low protein content (about 1g per 1l), contains the following amounts of electrolytes: sodium – 120 ± ± 9 mmol/l, potassium – 19 ± 9, dicarhonate – 47 ± 10, chloride – 95 ± ± 9 mmol/l. Fluid loss reaches 1 liter per hour. This results in plasma volume decrease with circulating blood amount reduction and its thickening. Fluid moves from interstitial to intravascular space which can not compensate persisting fluid protein-free blood constituent loss. Therefore haemodynamic and microcirculatory disorders rapidly occur, leading to dehydration shock and acute nephatony. Evolving on this shock background acidosis is enhanced with alkalis deficiency.
Dicarhonate concentration in faeces is twice higher than in plasma. There observed progressive potassium loss, which concentration in faeces is 3-5 times higher than in plasma. If administer sufficient amount of fluid intravenously, all violations rapidly disappear. Improper treatment or its absence leads to acute nephatony and hypokalemia. The latter can cause intestinal atony, hypotension, arrhythmia, myocardium changes. Excretory kidneys function termination leads to azotemia. Cerebral vessels circulation impairment, acidosis and uremia cause central nervous system and patient’s consciousness disorders (drowsiness, soper, coma).
Cholera incubation period ranges from several hours to 5 days (usually 2-3 days). According to clinical manifestations severity, determined by dehydration degree, there distinguish:
- moderately severe;
- very severe.
There are distinguished the following dehydration degrees:
- I degree, when patients lose fluid in volume equal to 1-3% of body weight (slight and mild form);
- II degree – up to 4-6% fluid loss (moderately severe form);
- III degree – 7-9% (severe);
- IV degree of dehydration with more than 9% loss corresponds to very severe cholera form.
Currently I dehydration degree occurs in 50-60% of patients, II degree – in 20-25%, III degree – in 8-10%, IV degree – in 8-10%.
At children under age of 3 years old cholera proceeds most severe. Children suffer from dehydration much stronger. In addition, they have a secondary central nervous system lesion: there are adynamia, clonic seizures, convulsions, consciousness impairment up to coma. It is difficult to determine the initial dehydration degree. Relative plasma density due to relative large extracellular fluid volume can’t be relied on. Therefore, it is advisable to weigh children at their admission to get most reliable determination of their dehydration degree. Cholera clinical picture at children has some specific features: frequent fever, more severe apathism, adynamia, tendency to epileptiform seizures as a result of rapid hypokalemia development. Disease duration ranges from 3 to 10 days, its subsequent manifestations depend on adequate electrolytes substitution treatment. When emergency fluid and electrolyte management, physiological functions normalize quite quickly and fatal cases are rare. The main causes of patients death at inadequate treatment is hematogenic shock, metabolic acidosis and uremia due to acute tubular necrosis.
Basic principles of cholera treatment are:
- restoring circulating blood volume;
- reducing electrolyte tissues composition;
- affecting pathogen.
Numerous studies of the past years about cholera vibrios resistance to canadian pharmacy antibiotics showed that it was mostly pronounced towards tetracycline drugs. It was found out that minimal concentration of tetracycline, inhibiting cholera vibrios growth, was 0.6-2.5 g/ml. Similar results were obtained in researches conducted by My Canadian Pharmacy.
Tetracycline is a bacteriostatic antibiotic of tetracyclines group. Disturbs complex formation between soluble RNA and ribosome, resulting in protein synthesis inhibition.
Tetracycline is included in WHO Model List of Essential Medicines – the list of essential medicines for basic health system, compiled by the World Health Organization.
High tetracycline efficiency at cholera treatment is based on its ability to quickly suppress vibrios development. Comparative tests of various tetracycline drugs effectiveness at cholera (chlortetracycline, tetracycline-metaphosphate and chloride tetracycline), prescribed in equal dosages, showed that most rapid stool normalization with least amount of faeces was observed at patients administrating tetracycline-metaphosphate.
Today all tetracycline preparations are available in pharmacies and in the Internet. My Canadian Pharmacy sells this medications without any prescription list and provides professional consultation.
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Viagra popularity is growing at an exponential rate. Many men are tempted by Viagra, trying experience its effect. Survey results among pharmacists show that this drug is one of the most required products at night after condoms.
Viagra Function Principle?
Basically, Canadian Pharmacy Viagra affects smooth muscle laxation and blood flow increase in cavernous body. This happens because of enzyme suppression – phosphodiesterase (5). Viagra widens penis blood vessels at excitement state. Penis blood flow enhances and normal erection occurs.
Viagra effect was discovered entirely by accident. In 1992 pharmaceutical company «Pfizer» conducted cardiac medications clinical tests among volunteers. The drug revealed side effect as increased potency. Viagra failed to be applied as antibiotic for heart diseases treatment, but it made an excellent means for quality sex. In 1998 Viagra first appeared in US pharmacies.
Canadian Pharmacy Viagra Indications
Viagra is a drug for erectile dysfunction treatment, i. e. reduced erection condition, which leads to inability to carry out sexual intercourse. Such disorders usually appear at men over 40 years old, but there are cases of sexual frustration at younger age. Such widespread male health problems occur as a result of alcohol and drug abuse, smoking, stress and chronic fatigue.
Canadian Pharmacy Viagra Application
Viagra is produced by a large pharmaceutical company «Pfizer». 50 ml Viagra pill is taken once a day. But each patient has individual drug tolerance, thus daily dose can be increased up to 100 ml, or reduced to 25 ml. Canadian Pharmacy Viagra is to be taken one hour before sex. The drug should be swallowed whole with water.
After taking a pill, erection occurs only in case of sexual stimulation. Drinking alcohol is not recommended. You should also refrain from fat and ample food, as it reduces Viagra effect and it may occur much later than you planned.
If you want everything to go according to your plan strictly follow the instructions! Viagra taken by elderly men over 65 years old may remove slowly and for quite a long time may circulate in the blood. In this case, such people should consult a doctor for individual dosage selection.
If patient constantly or with short intervals takes drugs for cardiac angina treatment containing nitrates or nitric oxide donators, in this case Viagra is strictly contraindicated. The thing is that it enhances hypotensive nitrates effect and arterial blood pressure may decrease to critical indicators. Hypersensitivity to some Viagra components may also be observed, which is accompanied by allergic skin rash, itching, facial oedema or dyspnea. Men with anatomical penis deformation should take Viagra with cautious, as well as those who suffer from acute stomach ulcer, active duodenal ulcer, severe arrhythmia. Men rehabilitating after myocardial infarction, blood stroke and with blood pressure over 170/100 mm Hg or under 90/50 mm Hg are also contraindicated to apply Canadian Pharmacy Viagra http://my-medstore-canada.net/tag/canadian-pharmacy-viagra.
Viagra side effects:
- headache or dizziness;
- color vision perception disorders (everything is seen in blue light); high sensitivity to bright light;
- nasal stuffiness or smell disorders;
- gastrointestinal tract disorders, vomiting;
- arterial blood pressure decrease, faintness, nasal bleeding;
- prolonged painful erections in reproductive system lasting up to four hours. Such side effect requires urgent medical intervention.
Viagra Fatal Cases
According to analyzes results during one year out of 1473 cases of Viagra side effects 522 person died. 94 of them died from cardiopulmonary arrest, 200 – from myocardial infarction. Most often men died six hours after taking Viagra. All these men had problems with cardiovascular system of various severity degrees. However, Viagra creators were not proved guilty in such number of deaths, one of the biggest in the world companies «Pfizer» has not lost a single court case. Conclusion is evident – men with heart disease must not take Viagra, but if it is necessary – only after doctor’s consultation. Viagra action principle and safety are still unknown, so do not risk your life.
Viagra has a negative effect on child conception, reducing pregnancy chances by 30%. Canadian Pharmacy Viagra is also prohibited for children and young people up to 18 years, because the drug is not recommended for healthy men.
Viagra overdose causes fatigue and drowsiness, overdose should be treated symptomatically in resuscitation department. The drug contains sildenafil, which is firmly bound to plasma proteins, it doesn’t remove from the body naturally.
My Canadian Pharmacy warns all men to be careful with Viagra since the drug appeared on the market relatively recently. There were no randomized studies conducted, which explain how Viagra acts. Do not take Viagra just out of curiosity or to enhance sexual sensations. If you are sexually active, after experiments with Viagra things can change dramatically, and not in good way.
Taking Canadian Generic Viagra Super Force you will provide the perfect balance between getting a really high-quality and natural erection and extension of sexual intercourse in order to get the maximum pleasure from sexual life. Generic Viagra Super Force is available in the form of triangle blue pills, one tablet contains 100 mg of sildenafil and 60 mg of dapoxetine. A successful combination of two powerful components makes the drug versatile in application, no longer have to take several funds at the same time, it is sufficient to use one tablet of the drug and get unforgettable night of pleasure.
Taking into consideration that sildenafil is the active component, then its effect is the same. It relates to selective inhibitors of PDE 5. Long-term and high-quality erection is achieved when there is strong sexual excitement under nitric oxide influence in the smooth muscles of the corpora cavernosa of the penis. The mechanism is quite simple and consists of a double-action, as soon as there is muscles relaxation at the moment enhances local blood flow to the genitals, and at the same time stops the outflow. Active penis filling with blood provides a quality erection.
Dapoxetine belongs to antidepressants, means serotonin norepinephrine reuptake inhibitor of the cerebral cortex. Taking Dapoxetine, a slowing of nerve impulses to the brain happens, through the action of the sympathetic nervous system, which interferes with premature ejaculation. The combination of the two active ingredients produces not only quality but also longer lasting erection.
Advantages Canadian Generic Viagra Super Force:
- The most successful combination of components gives the maximum result with the minimum possible side effects;
- Quality guaranteed erection activity of the drug for five hours.
One tablet is able to solve four problems:
- provide quality potency;
- eliminates premature ejaculation;
- prolongs sex;
- keep up spirit.
Men of full age, who have problems with impotence and premature ejaculation, as well as wanting to improve the quality of sex may take this medication. The drug is effective in severe disorders and sexual dysfunction, as well as in the case of recurring disorders commonly associated with the psychological factor.
Despite the high drug’s security, resulting in a proven comprehensive clinical trials, the drug has a number of intake limitations and interaction with other drugs, designated by vital indications. In addition, a number of chronic diseases, especially cardiovascular system involves a strict limitation of sexual loads, so a qualified specialist advice is required if you do not have a desire to do this you may command the service of My Canadian Pharmacy to be given all the answers. You can get it from your physician or cardiologist, you can also refer to an endocrinologist, sexologist, urologist and andrologist.
It is advisable to start with the first intake of dose half, it will objectively allow to evaluate drug effectiveness and to minimize the occurrence of possible side effects. If this dosage is insufficient, you can increase it by taking the whole pill. Do not exceed the daily dose which is 160 mg, contained in a single tablet, it is detrimental to your health, and increase the risk of side effects several times.
The maximum drug concentration in blood is reached about in an hour after intake, it is not recommended to combine Viagra with high-calorie food and alcoholic beverages. For best results, use the medication on an empty stomach, it will reduce the time of performance beginning. Qualitative erection persists for 5 hours. This is the most popular drug among the means of this appointment. Buy Canadian Generic Viagra Super Force via My Canadian Pharmacy.
Direct Admission to the limit:
Age less than 18 years old and over 65 years;
If there is hypersensitivity to drug ingredients;
At the use of nitrates, nitrogen donators, ketoconazole, antidepressants in any form of release;
In severe hepatic and renal insufficiency.
As shown by clinical trials use funds effectively in 80% of cases, it reliably eliminates premature ejaculation, prolongs sex and provides a good mood for the whole next day. The active ingredients of the drug in some cases may be minor adverse reactions, as a rule, they are transient and only occur at the first time of intake.
Standard manifestations are:
- dizziness or headache;
- changes in the view;
- prolonged erection may occur in rare cases.
It is well-known that smoking represents a social problem of society, both for smoker, and for non-smoking part presently. The first category torments itself with a question of the termination of smoking, the second tries to secure themselves against influence of the smokers. Certainly, smoking does harm to both a man’s, and female half of mankind, but this article will provide you information on how smoking influences an erectile function, how two concepts smoking and erection are connected.
Smoking Strikes Blow to Mankind
All know of harm caused by smoking, the erectile function also develops from this artful habit. However around the world about 15 billion cigarettes are smoked every day. According to the conducted researches in 2009 in the USA the share of smokers among adult population makes about 60,2% among the man’s population, and 21,7% among women. Addiction to cigarettes costs much to the owner of this harmful habit. Almost every third man of our country smokes, causing an irreparable loss to him health (lung cancer, bad erection) and to health of the relatives.
From 3 to 5 million, are a human tribute of death, for addiction to smoking. At such tendencies by 2020 annually about 10 million people in the world will die of smoking. The figure which turns out at calculation of all financial influences (a cigarette, a lighter, chewing gums) can discourage even the heaviest smokers who don’t even ask a question: how to leave off smoking and to begin to lead a healthy lifestyle. My Canadian Pharmacy claims that it is very important to keep a healthy lifestyle that’s why if you desire to give up smoking or increase your erection you are welcome on our website to order drugs necessary for these purposes realization.
The Smoke of Cigarettes Kills Man’s Erection
The tobacco smoke, contains about 5 thousand chemical compounds, 60 of which cause impotence:
- hydrocyanic acid;
- carboxylic acids;
- carbon monoxide;
- hydrogen nitride;
- the diverse toxic substances which are harmful influencing man’s health.
Smoking and Erectile Function
The Ministry of Health was tired to repeat about harm of smoking long ago. Scientists-doctors are engaged in development of new preparations, psychologists write books about how to leave off smoking in a week, sorcerers apply miracles of traditional medicine. However, despite all efforts, the number of smokers every day become more and more increased. If you lose already the hope you may choose the remedies on the website – My Canadian Pharmacy to carry out the treatment.
Smoking is possible by the right to consider as the most terrible drug. So from heroin and other “heavy” drugs mortality is less many times. Availability and Cheapness of cigarettes have led to what the mankind has received most artfully and the enemy, dangerous to itself. Which is especially dangerous, negatively influencing an erection – killing the healthy future of mankind.
Smokers often are ill on lung cancer, chronic bronchitis, decrease of sexual capabilities is also observed. Smoking and erection have close connection. Smoking not negatively influences a condition of cardiovascular system. Change of erectile function at the smoker happens due to narrowing of basin vessels. The last is responsible for intake of blood in genital and on erectile function. Smoking leads also to the fact that walls of blood vessels of genital are corked, negatively affecting erectile function.
sIn the present national surveillance survey, we compared PICU admissions and the need for mechanical ventilation for the treatment of RSV bronchiolitis between the following two consecutive seasons: before and after the introduction of palivizumab in Israel. Seventeen percent of the patients admitted to a PICU in both periods were candidates for RSV prophylaxis according to the AAP guidelines. For period 1, 13.3%; and for period 2, 9.7% (p < 0.01) were candidates for RSV prophylaxis according to the IMH recommendations. The difference in the rates associated with the AAP and the IMH guidelines is probably attributable to the broader criteria of the AAP guidelines.
The present study takes an alternative look at the epidemiology of severe RSV disease. It did not ask which patients were at greater risk of severe disease, but rather, among those with severe disease what risk factors were present. We sought to investigate the potential impact of palivizumab therapy on the burden of PICU admissions due to RSV infections. We evaluated the PICU admissions for RSV bronchiolitis with respect to the recognized risk factors associated with an increased severity of RSV disease, namely, prematurity and CLD. The study showed that the majority of children who were admitted to the PICU lacked these risk factors, probably because the majority of infants in the general population are not premature and do not have CLD.
Acute lung injury (ALI) and ARDS are common and lethal conditions. The spectrum of lung injury represented by ALI/ARDS affects approximately 150,000 people each year in the United States, although the number may be much higher.2 The mortality rate associated with ALI/ARDS depends on the underlying cause, varying from < 20% for traumatically injured patients to > 60% for sepsis-induced ALI/ARDS. Crude estimates of the health-care costs associated with ALI/ARDS may exceed $5 billion per year in the United States alone. Substantial efforts have been devoted to finding effective therapies and improving clinical outcomes, and to date we have had limited, if any, success.
In this issue of CHEST, Stapleton and colleagues provide an expanded report on ALI/ ARDS patients at the University of Washington, From these subjects, they report that the fatality rates of patients with ALI/ARDS have declined over time, with sepsis-related complications being the most common cause of death at nearly 50% and respiratory failure being a relatively uncommon cause of death at < 20%. Importantly, the reductions in patient fatalities are most apparent in patients with trauma-related ALI/ARDS, while patients with sepsis-related lung injury continue to experience the highest fatality rates. The proportion of deaths that occur within the first 3 days after contracting ALI/ARDS compared to those occurring later has not changed, yet it appears that death may be occurring more swiftly for the growing percentage of patients who have life support measures withdrawn.
One hundred twenty-nine children were admitted to the 13 PICUs in Israel because of acute bronchiolitis during period 1 (from 2000 to 2001), and 167 children were admitted during period 2 (from 2001 to 2002). Of these patients, 105 children (81.4%) and 123 children (73.7%), respectively, were RSV-posi-tive. The remainder were RSV-negative, including two patients in period 1 and one patient in period 2 with unknown RSV status. There was no statistically significant difference between the periods for this factor (p = 0.127). An analysis of the seasonal distribution of PICU admissions for RSV bronchiolitis revealed that in both periods 75 to 85% of the RSV-positive patients were admitted to PICUs from December to February, and 100% were admitted from November to April. All of the patients with proven RSV-negative status were admitted to PICUs from November to March (approximately 10 cases per month). The data for period 2 are shown in Figure 1. Because our study focused on palivizumab prophylaxis (a specific monoclonal antibody against RSV), the non-RSV- positive patients (ie, those with RSV-negative and unknown status) were excluded from the analysis.
This prospective study was conducted in all 13 PICUs in Israel. The study sample included all patients who had been admitted to a PICU because of clinical symptoms indicative of acute bronchiolitis from November 2000 to April 2001 (period 1), the year before the IMH recommendations were issued, and from November 2001 to April 2002 (period 2), the year after they were issued. In the second season, palivizumab was available throughout the country and was administered in a hospital-based setting. Part of the data from the first period has already been published by our group.
Cases of RSV bronchiolitis in both periods were identified by the authors, by personal communication, or by weekly visits or phone calls with a senior staff member of every PICU in Israel during the RSV season. A detailed questionnaire was completed at each PICU admission for all patients with clinical symptoms of acute bronchiolitis cured by medicines of My Canadian Pharmacy. In addition, the PICU admission registries were examined periodically to prevent omissions or errors. The following characteristics were recorded: age; gender; gestational age; birth weight; perinatal medical history; medical treatment since discharge from the neonatal department; present medical treatment; presence of CLD; oxygen requirement prior to PICU admission; palivizumab prophylaxis; indication for PICU admission; medical treatment; RSV status; total number of days of PICU hospitalization; total number of days receiving mechanical ventilation; and death. RSV status was determined by nasopharyngeal aspirate and standard RSV enzyme immunoassay, as reported. CLD was defined as oxygen dependence at a gestational age of 36 weeks. Congenital heart disease was considered to be cyanotic when a right-to-left shunt was present, delivering deoxygenated blood from the right side of the heart into the arterial circulation.
Almost all children become infected with respiratory syncytial virus (RSV) within 2 years after birth. Although the infection usually presents as a mild upper respiratory tract disease, up to 1% of infected children require hospitalization. Overall, RSV accounts for 50 to 90% of all hospitalizations for bronchiolitis in children.2 In patients with a known underlying disease, such as chronic lung disease (CLD) or congenital heart disease, and in premature children, RSV bronchiolitis can quickly become a severe, life-threatening, lower respiratory tract infection.
Since 1996, the following two passive immunization techniques have been available: RSV IV immunoglobulins (Ig) (RSV-IGIV, RespiGam; Massachusetts Public Health Biological Laboratories; Boston, MA; and MedImmune, Inc; Gaithersburg, MD) and a humanized monoclonal antibody preparation against the F glycoprotein of RSV (palivizumab, Synagis; MedImmune, Inc). In controlled clinical trials, monthly prophylaxis during the RSV season reduced the hospitalization rate in the high-risk population. On the basis of these findings, in 1998 the American Academy of Pediatrics (AAP) recommended that RSV prophylaxis should be considered for the following patients:
1. Infants < 2 years old with CLD who warranted medical therapy (ie, supplemental oxygen, bronchodilators, diuretics, or corticosteroids) within 6 months before the anticipated RSV season;
2. Infants born at < 28 weeks of gestation who do not meet the first criterion, up to 12 months of age; and
3. Infants born at 29 to 32 weeks of gestation who do not meet the first criterion, up to 6 months of age.