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Botox weakens muscles. They can't contract. Therefore, when Botox in small amounts is injected into the corpora cavernosa of the penis, there is vasodilation for the vital organ. The result is better, fuller, and longer lasting erections.
Isis is likely to carry out new terror attacks across Europe in the “near future” as jihadis consider car bombings, chemical weapons and other methods to maximise casualties, security services have warned.
A new report by Europol, the EU-wide law enforcement agency, found that the terrorist group was changing its modus operandi as militants are driven out of key strongholds in Syria and Iraq.
Britain is among the top targets for atrocities, with at least 12 attempted attacks foiled in the past three years, and the threat level could now be increasing with the return of defeated foreign fighters with weapons training and links to Isis commanders.
Gilles de Kerchove, the EU’s counter-terror coordinator, said the danger will last for years as battles against Isis continue in the Middle East and North Africa.
“These people are trained to use explosives and firearms and they have been indoctrinated by the jihadist ideology,” he added.
“These people are trained to use explosives and firearms and they have been indoctrinated by the jihadist ideology,” he added.
“An effective response requires a comprehensive approach and long term commitment.”
Intelligence services estimate that several dozen jihadis under Isis’ direction are already present in Europe with the capability to commit terrorist attacks, but Europol warns of the additional risk of “lone wolf” terrorists who have no direct contact with the group.
While the deadliest attacks so far, in Paris on 13 November 2015, were directed by Isis and carried out by militants deployed from its Syrian territories, the Nice attack and a succession of terrorist murders in France, Belgium and Germany were committed by extremists with no external aid or training.
Europol’s report, by the European Counter Terrorism Centre, said the vast majority of attackers in Europe have been young men with a criminal past, who feel discriminated, humiliated and marginalised in society, and may have mental health issues.
Not all are strict Muslims and may have recently converted to the religion, or solely to Isis ideology, either on their own or through terrorist recruiters.
“Religion may thus not be the initial or primary driver of the radicalisation process, but merely offering a ‘window of opportunity’ to overcome personal issues,” analysts said.
The report raised concern that Syrian refugees may be targeted by recruiters as Isis seeks to gather support for its cause by “inflaming the migration crisis to polarise the EU population and turn sections of it against those seeking asylum”.
The group uses a network of recruiters as well as a sophisticated propaganda machine churning out videos, magazines, terror manuals and websites aimed at gathering supporters and inciting attacks.
Abu Mohammad al-Adnani, the Isis propaganda chief who was killed in a drone strike in August, released a video in May calling on anyone prevented from travelling to the so-called “caliphate” to wage jihad in their home countries.
“Make examples of the crusaders, day and night, scaring them and terrorising them, until every neighbour fears his neighbour,” he urged ahead of a fresh spate of attacks in Europe.
“Know that your targeting [of] those who are called ‘civilians’ is more beloved to us and more effective, as it is more harmful, painful, and a greater deterrent to them.”
Europol warned that potential targets are difficult to predict as all countries participating in the US-led coalition’s air strikes have been singled out in propaganda videos, with a growing preference for “soft targets” like public transport that have little security and provoke “maximum fear”.
“Indiscriminate attacks have a very powerful effect on the public in general, which is one of the main goals of terrorism: to seriously intimidate a population,” the report said, adding that attacking critical infrastructure like power grids and nuclear facilities is “currently not a priority”.
Europol also says the consensus among intelligence agencies in EU member states is that “the cyber capabilities of terrorist groups are still relatively low”, but adds that “the possibility of terrorist-affiliated cyber groups engaging in cyber warfare sponsored by Nation States – those with capacities to engage in this type of attacks – should not be discounted.”
Terrorists are known to have acquired hand grenades, rocket launchers, and high-grade plastic explosives and detonators from organised crime groups in Europe, while Isis magazines contain instructions on making TATP – the homemade explosive used in the Paris and Brussels attacks, as well as the 2005 London bombings.
Europol said suicide bombings, shootings, car rammings and stabbings are likely to remain the main mean of attacks as terrorists turn to the most easily available weapons.
But its report warned that methods used in atrocities in Syria and Iraq may be exported to Europe, including car bombs, kidnappings, extortion and the possible use of chemical or biological weapons.
Moroccan authorities dismantled an Isis cell planning attacks potentially involving chemical weapons in February, discovering biological agents among a cache of weapons from Libya to foil a “catastrophic” attack.
Libya, which remains locked in a continuing civil war following the British-backed ousting of Muammar Gaddafi, threatens to become “a second springboard” for Isis attacks on Europe, Europol’s report warned.
Militants are losing ground in their stronghold of Sirte, but the country is still a major destination for foreign fighters, bolstered by a free flow of weapons and “unlimited places in which jihadists could be trained for future terrorist attacks”.
The report also warned that Isis was not the only group with the intent and capability to carry out atrocities in the West, with al-Qaeda and its former affiliate Jabhat al-Nusra continuing to inspire attacks including the Charlie Hebdo massacre.
Rob Wainwright, the director of Europol, said police and security services were intensifying cooperation to combat the threat, causing an increase in terror arrests and the foiling of several plots.
“This shows that the increased cooperation and exchange of data between all relevant services across Europe is a successful means to mitigate the threat posed by Isis,” he added.
“Nevertheless, this report shows that the threat is still high and includes diverse components which can be only tackled by even better collaboration.”
The report concluded that the scale, frequency and impact of terror attacks was rising in the EU and that new attempts are “likely to take place in the near future”, adding: “As long as Isis remains a factor in Syria and Iraq, and even if they are defeated there, they will continue with their attempts to encourage and organise terrorist attacks in the EU.”
For white supremacists, or men who just want to get the upper hand again, uneducated migrants from Third World countries are the best useful idiots they can get. Open the borders!
KUALA LUMPUR, Feb 26 — Demand for designer vagina procedures in Malaysia skyrocketed in comparison to other plastic surgery treatments, a report by private healthcare search engine WhatClinic.com has indicated.
In explaining the triple digit growth of almost 200 per cent in interest for the laser vaginal rejuvenation procedure, the report highlighted the relatively fuss-free nature of the treatment to tighten the vagina.
“The treatment is relatively pain free and the patient can return to a normal day to day routine very soon after,” the clinic comparison site’s annual global report said.
In its analysis of 10,290 email enquiries to over 100 Malaysian clinics made through the online clinic directory site over the past two years, WhatClinic.com’s data showed a whopping 191 per cent jump in interest in the laser vaginal rejuvenation procedure in Malaysia with a leap from 103 enquiries in 2015 to 300 in 2016.
At an average starting price of RM2,575 based on last year’s figures, laser vaginal rejuvenation is also the cheapest among the country’s top 10 plastic surgery treatments WhatClinic.com users enquired about.
Based on both enquiries locally and from abroad, liposuction which removes excess body fat attracted the greatest interest with 1,201 enquiries alone last year, while eyelid surgery and the procedure to shift body fat to another part of the body were also in the top three list last year at 577 and 563 enquiries respectively.
In terms of percentage, however, interest in seven out of the top 10 treatments sought by patients fell at an average rate of 20.8 per cent when compared against the previous year, including liposuction and eyelid surgery which fell by 32 per cent and 19 per cent, as well as breast implants (-26 per cent) and rhinoplasty to reshape the nose (-24 per cent).
It is unclear how big a role pricing plays in these trends, as the average starting price last year for the seven treatments that experienced a fall in interest mostly fall in the range of RM7,833 to RM17,874 with only one of them at RM4,400 (eyelid surgery).
Two of the three treatments in the list showing growing popularity had average starting prices of RM8,723 (gynecomastia or treatment to correct enlarged male breasts) and RM8,736 (fat transfer) as compared to rising star laser vaginal rejuvenation at RM2,575.
Weighing in on the interest levels in Malaysia’s plastic surgery services, WhatClinic.com said: “We haven’t seen a huge increase overall, in fact there was a 4 per cent decrease in interest in plastic surgery when we compared the past three months to the same period one year ago—however there has been growth from overseas in some treatments.”
The young ones
Out of the 4,777 email enquiries last year for local plastic surgery services, the bulk of them came from those in the younger age groups of 25 to 34 at 43 per cent and 35 to 44 at 20 per cent respectively, with demand gradually decreasing from these two age groups onwards. Those in the 18 to 24 age group represent the third largest group by accounting for 18 per cent of the enquiries.
“The demographics are consistent with global trends of recent. Digitally connected millennials are bombarded with more and more ‘versions’ of beauty by brands and their peers. This causes pressure to achieve the best possible look,” Philip Boyle, WhatClinic’s Head of Consumer Matters, told Malay Mail Online.
Although women continued to dominate last year in terms of number of enquiries made for plastic surgery services in Malaysia at 70 per cent, WhatClinic.com noted that the number of men seeking such treatments has seen a “sharp increase” over the past few years, predicting that the balance will shift in the future.
US and Australia loving it
Medical tourists from Australia, US and the UK showed growing interest in plastic surgery services in Malaysia, with an annual growth last year of 10 per cent, 32 per cent and 6 per cent respectively, while the two other countries in the top five list — neighbours Singapore and Indonesia — showed lesser demand with a fall of 21 per cent and 34 per cent respectively.
Boyle cited “currency advantages” for Malaysia’s popularity among visitors from Australia and the US, while WhatClinic.com predicted that the strong growth figures from Australia meant the trend from that country was likely to continue.
“The US is Malaysia’s fastest growing medical tourism market, growing 32 per cent in the past 12 months. This has no doubt been influenced by the weakening ringgit (MYR) against the dollar (USD),” the report said.
WhatClinic.com also attributed Malaysia’s popularity for plastic surgery to government initiatives to promote the country as a medical tourism destination, as well as the improved quality and reputation of Malaysian plastic surgeons.
As for the plastic surgery treatment in Malaysia favoured by medical tourists, liposuction was the firm favourite last year with its 409 enquiries. This is almost twice as many as the second on the list, rhinoplasty at 209 enquiries.
This was followed by breast implants, fat transfer and eyelid surgery, with the latter showing a marked decline of 28 per cent from 221 enquiries in 2015 to 160 enquiries last year.
“Fat transfer appears to be the treatment of the year, experiencing 2.2x growth in the 12 months to January 2017,” the report said, referring to the growth of 120 per cent from 89 enquiries in 2015 to 196 enquiries last year.
What is ‘beauty’ now?
Boyle said the treatment trends reflect consumer interest, with more showing a preference for safer treatments such as fat transfer — which is less risky due to the use of the patients’ own cells.
For the star treatments of laser vaginal rejuvenation and fat transfer, Boyle cited “increased availability, increased awareness, word of mouth” as factors driving the demand for these procedures in Malaysia.
Commenting on the decline in demand for some treatments such as liposuction, eyelid surgery and rhinoplasty, Boyle said: “There are now more non-surgical options than ever before—fat freezing and the non-surgical nose jobs are now available as less invasive, and more affordable options.”
Boyle also told Malay Mail Online that the change in demand for certain types of plastic surgery procedures is linked to both affordability and a change in the sense of beauty.
“We have seen global trends for butt implants and fuller thicker eyebrows (which many have attributed to popular celebrities and models) We have also seen in the UK, smaller breast implants, as more and more women become interested in fitness. Laser hair removal has become extremely popular.
“We have also seen growth in demand for eyelid and chin surgeries.
“All of these are linked to changes in what ‘beauty’ means. Not to mention the medical aesthetic market, which is bringing out things like vampire facials and fat freezing to consumers,” he said.
(A vampire facial is where a person’s own platelet rich plasma is injected into her face to help the skin renew and rejuvenate.)
The next big hit?
“Hair transplant is overtaking breast augmentation as the fastest growing plastic surgery procedure. It’s also being used to repair eyebrows, and fill patchy beards!” Boyle said.
95 percent of the victims of violence are men. Because women are natural cowards who send men to handle things when they are dangerous.
Men are our competitors. We want less of those around. Women are our prey. We want them poor and helpless.
Aug 18th, 2016 - Snopes
An international kerfuffle after Turkey's failed 2016 coup led to reports that the age of consent in that country had been lowered to age 12. Turkish officials deny the claim.
In August 2016, numerous social media posts and news articles reported that after a failed military coup in Turkey, the age of consent in that country has been lowered from 18 to 12. For example, Sweden’s Minister of Foreign Affairs, Margot Wallström, published a tweet affirmatively stating the age of consent in Turkey had been lowered precipitously.
Turkey’s Deputy Prime Minister angrily denied Wallström’s statement on Twitter as well, terming the claim “stupid”.
A British tabloid detailed the origins of the claim, noting that a recent court decision had struck down a law defining sex acts with children under the age of 15 as “sexual abuse”:
The decision by the country’s constitutional court removes a legal provision that all sexual acts against children under the age of 15 are “sexual abuse”. Children aged 12, 13 and 14 will no longer receive automatic protection as a minor, according to the ruling, but will be expected to offer or decline consent in sexual activity. Experts say this is a green light for sex with “consenting” minors as young as 12.
The Guardian provided a more nuanced take on the developments that led to the rumor, reporting that “Turkey has summoned Sweden’s envoy in an escalating row after Stockholm accused Ankara of legalising sex with children” and stating that the age of consent in Turkey had not been affected by an unrelated July 2016 ruling pertaining to the adjudication of child abuse cases:
“It is a scandal for a foreign minister to post such a tweet based on false news or speculation,” the Turkish foreign minister, Mevlüt Çavu?o?lu, said in televised comments, adding the Swedish ambassador to Ankara had been summoned to his ministry. However, the Swedish foreign ministry said it was the chargé d’affaires who was summoned by Ankara, as the ambassador was still on vacation. Çavu?o?lu blasted the “unacceptable” tweet, saying Wallström should have acted responsibly.
“A foreign minister should not tell lies and should not adopt an approach accusing Turkey,” he said. “Yes to criticism but this is a slander, a lie.” Turkey’s constitutional court in July annulled a criminal code provision punishing as “sexual abuse” all sexual acts involving children under the age of 15, responding to a petition brought by a lower court. The court has given a six-month period for parliament to draw up a new law based on its ruling.
The Guardian affirmed the age of consent in Turkey remained at 18 and was unaffected by the court ruling in question:
The lower court that brought the petition was worried there was no distinction between cases of sexual acts involving a young teenager or a toddler. The legal age of consent in Turkey remains 18 and was not affected by the ruling. But it drew a furious response from activists worried it would open the way for unpunished child sexual abuse.
In a lengthy statement, Turkey’s Minister of Foreign Affairs blamed a “falsified headline” published by a “discredited newspaper” and displayed on a prominent news ticker in Vienna for the rumors:
A falsified headline, claiming that abuse of children under the age of 15 is allowed in Turkey, was displayed on an electronic news ticker of “Kronen Zeitung” newspaper at the passenger lounge of the Vienna International Airport on 13 August 2016. This headline does not reflect the truth at all. Another headline reading that “Through vacation in Turkey you only support Erdo?an” was intentionally displayed on the same ticker in the near past. We deplore and strongly condemn that an international airport, which is located in the centre of Europe and intensely used by passengers from different countries, is abused by a discredited newspaper to spread its irresponsible, distorted and falsified messages in order to defame a friendly country and its nation.
The Ministry of Foreign Affairs took the necessary steps through the Austrian Embassy in Ankara and the Turkish Embassy in Vienna also conveyed its reaction about the matter on the same day.
Turkey is a state that always aims at protecting and improving the universal human rights and is committed itself to the international conventions in the field of child rights and their additional protocols both verbally and spiritually, as an esteemed member of the international community. Turkey is aware of its responsibilities and duties in this field.
A country in a position of the rising centre of racism and xenophobia ever increasing in Europe should focus on healing these diseases through its politicians, media and society. Instead, some irresponsible media may falsify and reflect even judicial decisions in another country to feed their hateful and hostile discourses against a society and we consider it as a manifestation of these diseases.
Unfortunately, the statements of some Austrian politicians and officials against Turkey and EU membership of Turkey encourage such defamatory news.
This tendency damages social harmony and peace in Austria where more than 300 thousand people of Turkish origin live. Although a copy of the ruling pertaining to the sexual abuse law is not readily available, officials in Turkey have maintained that the rumor is a misinterpretation of that judicial decision and that the age of consent remains at 18 in Turkey, not 12.
If you are still invested in the real estate of European cities, get out! A terrorist attack with chemical weapons will happen. There will be hoards of people who won't want to live in urban centers.
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Ageism is pest of rich countries. If you are old you have no value. In poor countries, value depends on wealth. That is much better than value depending on youth because wealth can become more with advancing years. This is why rich men have every reason to invest in destruction. Plain math.
Slow brain waves reveal precisely when a patient loses awareness while under anesthesia, and could prevent the small percentage of cases in which patients are "awake" during surgery.
Being aware of what's happening during surgery and even feeling the pain seems like an unthinkable nightmare. Isn't that what anesthesia is for?
But it does happen in up to one percent of surgeries involving high-risk patients, according to research published in 2011, and affects between 20,000 and 40,000 patients annually in the U.S. alone. Now, scientists from the University of Oxford in the U.K. believe they've found a way to put an end to this disturbing statistic.
Using EEG brain monitoring and MRI imaging scans, the researchers discovered that people lost awareness when low-frequency electrical waves, also called “slow waves,” enveloped the brain. When the waves reached a plateau, sensory signals no longer reached the thalamocortical regions, which are the parts of the brain linked to conscious awareness.
“Awareness in anesthesia is a 'never event'—it isn't good enough for it to be rare,” Roisin Ní Mhuircheartaigh, one of the researchers, told Healthline. “Our goal is to allow anesthesiologists to look at a patient's brain activity and know with confidence that [he or she] is safely asleep.”
The researchers have applied for a patent on their findings and are looking into developing better monitoring equipment for patients under anesthesia. They are the second group of scientists this year to do so. Earlier this year, researchers from the Massachusetts Institute of Technology and Boston University published their findings on slow waves and unconsciousness.
“They looked at EEG, too, but have focused on the relationship between slow waves and alpha activity,” Catherine Warnaby, another Oxford researcher, told Healthline. “A key difference is that we have looked at slow wave saturation and have the FMRI evidence to support that this state represents a state of perception loss.” Changing the Standards for Anesthesia
Warnaby stressed that anesthesia is very safe, but little is known about how it works in the brain. In patients with severe health problems, too much anesthesia can adversely affect their heart or lungs. Elderly patients may experience severe confusion after an operation if given too much anesthesia.
“We think that this has great potential to become an individualized marker for delivering anesthesia during surgery,” Warnaby said. “If we can prove further that this saturation relates to the point where people lose awareness of the outside world, it may change the way that anesthetics are delivered worldwide. Anesthesiologists would be able to give anesthetics to achieve this saturation level and know that they were giving each individual just the right amount of the drug.”
Learn About the Risks and Benefits of Anesthesia During Delivery »
The research could also help resolve other riddles of the brain, Warnaby added. "Our findings could have implications for all sorts of altered states and disorders of consciousness, such as locked-in syndrome or persistent vegetative state."
In both the Oxford and U.S. research, scientists experimented with the common anesthetic, propofol.
There are EEG monitors available to assess the depth of anesthesia, although there isn't much evidence that these methods are better than traditional monitoring at reducing awareness during surgery, Warnaby said.
The next step is to perform further experiments to recreate a surgical setting. Researchers will look at how other drugs used during surgery—such as painkillers—affect slow waves during anesthesia.
“Depending on the operation, anesthesiologists have to give drugs that block muscle function, 'paralyzing drugs,'” Mhuircheartaigh said. “If inadequate anesthetic drugs are given while the patient can't move to let us know they're awake, awareness can occur.”
Like Warnaby, Mhuircheartaigh stressed the rarity of these cases, especially in healthy people. “However, rare isn't good enough,” she told Healthline. “We hope that by looking at this key process in the brain we can be sure that the patient can't perceive any surgery.”
Judge: Rape facilitates a natural society where men are protectors
Gayle Nicholas Scott, PharmD
DISCLOSURES October 26, 2015
"Herbal Viagra" has been in the news recently. Are these products safe and/or effective?
Gayle Nicholas Scott, PharmD Assistant Professor, Eastern Virginia Medical School, Norfolk, Virginia
Remedies for male sexual enhancement have been available for millennia. The Ebers Papyrus, dating back to around 1600 BC, recommended topical application of baby crocodile hearts mixed with wood oil. A Sanskrit text written six centuries earlier suggested a man could visit 100 women after consuming a mixture of goat testes boiled in milk, sesame seeds, and the lard of a porpoise. Impotence, a nonspecific term that includes both erectile dysfunction and reduced libido, is clearly not a condition limited to modern civilization.
Erectile dysfunction affects an estimated18 million men in the United States, with a prevalence of 18.4% in men aged 20 years and older. Prevalence increases with age, ranging from 5% in men aged 20-39 years to 70% in men aged 70 years and older. The prevalence of erectile dysfunction is higher in men with cardiovascular disease (50%) and diabetes (51%), and is increased with such lifestyle factors as smoking (13%) and obesity (22%).
Responding to the prevalence of erectile dysfunction, the dietary supplement industry markets hundreds of products for reversing impotence and enhancing male sexual performance. Legally, dietary supplement labels cannot make medical claims, such as "for treatment of erectile dysfunction"; however, such claims as "to enhance sexual function" are permissible. An Internet search for "male sexual enhancement products" yielded more than 2 million hits, with websites offering products for purchase as well as information and testimonials.
Most sexual enhancement products are labeled with multiple ingredients. Commonly listed ingredients on male enhancement products include Butea superba (red kwao krua), Chlorophytum borivilianum (safed musli), Crocus sativus (saffron), dehydroepiandrosterone (DHEA), Epimedium grandiflorum (epimedium, horny goat weed), Eurycoma longifolia (tongkat ali, pasak bumi), Fadogia agrestis (fadogia), Ginkgo biloba, Lepidium meyenii (maca), Muira puama (potency wood), Panax ginseng, Pausinystalia yohimbe (yohimbe bark, not to be confused with the prescription drug yohimbine), Pinus pinaster (pycnogenol, pine bark), Serenoa repens (saw palmetto), Turnera aphrodisiaca (damiana), and Tribulus terrestris (devil's weed, goathead). Vitamins, minerals, and amino acids, such as L-arginine and propionyl L-carnitine, are frequent additions.
Many of these products have been studied only in male rats, but the few studies in men have been small or poorly designed, limiting conclusions about efficacy and safety.
Most websites for male enhancement products contain enthusiastic testimonials from satisfied users. But the question remains of whether these products really work, despite the dearth of clinical evidence supporting the efficacy of the ingredients.
Some products for sexual enhancement augment sexual activity, but the labeled ingredients may not be the source of the effect. Of the 232 drug recalls by the US Food and Drug Administration (FDA) between 2007 and 2012—all for unlabeled drug ingredients—51% were dietary supplements. Of the dietary supplement products recalled, sexual enhancement products were the most commonly recalled (40%), followed by bodybuilding (31%) and weight-loss products (27%). Of the 1560 Health Safety Alerts for dietary supplements issued by the FDA MedWatch and Health Canada between 2005 and 2013, 33% were for sexual enhancement products.
Unlabeled drugs in sexual enhancement products are frequently the prescription-only phosphodiesterase 5 (PDE5) inhibitors, such as sildenafil (Viagra®), tadalafil (Cialis®), vardenafil (Levitra®), and avanafil (Stendra®). With increasing frequency, the unlabeled drugs may be analogues of PDE5 inhibitors that have been modified slightly from the parent structures. These derivatives are not detected by routine laboratory screening, which reduces the risk for both detection by the FDA and lawsuits for patent infringement.
To date, more than 50 unapproved analogues of prescription PDE5 inhibitors have been identified.
Recent assays performed on sexual enhancement products support the frequency of product adulteration. Of 91 products analyzed, 74 (81%) contained PDE5 inhibitors, including tadalafil and/or sildenafil (n = 40) or PDE5-inhibitor analogues (n = 34). Of the products containing prescription ingredients, 18 contained more than 110% of the highest approved drug product strength.
Another study of 150 sexual enhancement products (eg, Evil Root, Herbal Stud, Magic Sex, ULTRASize) found 61% of the products were adulterated with PDE5 inhibitors: 27% with sildenafil, tadalafil, or vardenafil, and 34% with similar structural analogues. Among the adulterated products, 64% contained only one PDE5 inhibitor and 36% contained mixtures of two to four PDE5 drugs or analogues. The amounts of PDE5 inhibitor prescription medicines were higher than the maximum recommended dose in 25% of products. Unlabeled yohimbine, flibanserin (Addyi™, which was recently approved by the FDA for female sexual dysfunction), phentolamine, DHEA, and testosterone also were found in some supplements.
Other researchers have found similarly adulterated products, many containing PDE5 inhibitor doses in excess of labeled amounts.
Although dietary supplements are marketed as "all natural" with implied safety, the available research suggests caution. A recent survey indicates that cardiac symptoms were a frequent cause of emergency department visits among men aged 20-39 years taking sexual enhancement products. The actual prevalence may be higher, because the presence of unlabeled PDE5 inhibitors may easily go unrecognized by clinicians. Common adverse effects of PDE5 inhibitors, such as flushing, lightheadedness, or dyspepsia, may be attributed to niacin and yohimbe, ingredients often found in sexual enhancement products. Profound hypoglycemia after ingestion of sexual enhancement products containing sildenafil and glyburide (Micronase® and others) also has been reported.
The covert addition of analogues of PDE5 inhibitors, which are not readily detectable by chemical screens, is particularly concerning. Although these chemical cousins of PDE5 inhibitors may retain the desired pharmacologic effect, none have been clinically tested for safety and toxicologic effects.
Obtaining dietary supplement products for sexual enhancement products has several perceived advantages. The purchase can be made discreetly, conveniently, and without a visit to a prescriber. Unlike drugs, dietary supplements are not required to be labeled with adverse effect or drug interaction information. Men taking prescription drugs, such as nitrates, may perceive dietary supplements for sexual enhancement as safe alternatives to contraindicated PDE5 inhibitors.
Clinicians should maintain a high degree of awareness for the potential for adverse effects of sexual enhancement products in men with unexplained cardiovascular symptoms. Patients who express interest in sexual enhancement supplements should be referred to their healthcare provider. Explain that even though a PDE5 inhibitor is not on the label, the supplement may have these ingredients added illegally without regard to patient safety. Patients should be warned of possible changes in vision and decreases in blood pressure, and the potentially dangerous combination of PDE5 inhibitors and nitrates that require medical advice. PDE5 inhibitors are substrates of cytochrome P450 3A4 (CYP3A4). Monitoring is required to avoid an interaction with CYP3A4 inhibitor drugs, such as erythromycin, which may result in high PDE5 levels.
In summary, advise patients that dietary supplements for sexual enhancement fall into one of two categories: those that might be safe but do not work, and those that might work but are not safe.
Once islamic terror organizations will have discovered the power of arson, they will win any war. Setting cities like Lagos or Kairo on fire will drive tens of millions of refugees to Europe and undermine European culture forever.
A Chinese man had his penis freed from a tiny wrench last week after getting it stuck for nearly a day.
The 37-year-old, unnamed, was sent to hospital in eastern China's Zhejiang Province, after his trapped penis had swollen and turned purple.
Doctors and firefighters, who failed to free the man, had to call in dentists to help remove the wrench using a dental drill.
According to Huanqiu.com, an affiliation to People's Daily China, the man is a bachelor and lives in Linhai city.
He reportedly got his genitals trapped in the metal tool and was sent to the Taizhou Hospital at 9:30pm on June 2. It remains unclear why the man's penis had been stuck.
Doctors suggested that the man should undergo a surgical operation to reduce the blood flow in his penis before they could remove the tool.
It's said that the doctors tried to contact the man's parents to gain their approval for the surgery. His parents agreed to the operation, but failed to show up in the hospital to sign the consent.
As a result, the doctors had to call the Linhai Fire Brigade for help.
The firefighters arrived and brought an angle grinder.
However, the firefighters said they couldn't use the grinder. They explained that the heat generated from the grinder could pose danger to the patient.
One doctor suggested that they should find a dentist to help resolve the issue. The doctor said she had studied a similar case during a seminar.
Two dentists, Zhou Gi and Shi Gengsheng, were called. They arrived at the hospital half an hour after the man was sent in.
They brought a dental drill, a high-speed engine that rotates 200,000 to 300,000 times per minute.
'The dental engine also has a high-pressure water cooler to reduce the heat caused by the drilling,' said Zhou.
The rescue team tested the dental drill on a wrench from the firefighters' tool box before carrying out on the man.
The man was freed after a 30-minute operation by the two dentists. No further injuries were reported.
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