56 thoughts on “Hello world!”

  1. ID!OT FANS OF DINGDONG & MARIAN ARE BEHIND METAL BARRICADES?……”Fans and spectators behind metal barricades cheered and waved frantically when celebrities stepped out of luxury vehicles”. Idiot fans must learn to embrace the reality and move on. Don’t allow yourselves to be fooled by actors and celebrities anymore. Fans love their idols so much but look what your idols have done to you? All of you are not invited. Hangang metal barricades lang kayo. Gets nyo?

  2. The safest way to reduce this risk is to use a condom. This protects against HIV and many other infections. If your girlfriend sometimes sleeps with her husband, it sound unlikely that you know whether her husband also sleeps with other people. You can only know about your own health by going for an HIV test yourself.

  3. Since the nineteen nineties, there was growing recognition that erectile dysfunction (ED) is a standard downside.
    Growing consciousness of efficient therapy methods
    on behalf of patients, efficient promoting by drug corporations,
    and acknowledgement by well being care suppliers that screening could
    assist establish cardiovascular and different medical dangers have led to increased charges of reporting, analysis, and remedy of ED.

    Erectile dysfunction is the lack to develop and
    maintain an erection for passable sexual intercourse or exercise within the absence of an ejaculatory disorder resembling premature ejaculation. Erectile dysfunction is the popular time period fairly than impotence.
    There aren’t any universally agreed standards for a way
    constant the issue needs to be and for what duration it must be current to meet the definition. A interval of persistence of longer than three months has been urged
    as an affordable clinical guideline.

    Several research have seemed on the prevalence of ED. The Massachusetts Male Aging
    Study1 reported a prevalence of fifty two%. The research demonstrated that ED
    is more and more prevalent with age. At age forty, roughly
    forty% of males are affected. The speed will increase to almost 70% in males aged 70 years.
    The prevalence of full ED will increase from 5% to 15% as age will increase from forty to 70 years.1 Age
    was the variable most strongly related to ED.

    Following adjustment for age, the next chance was famous in patients with coronary heart illness, hypertension, diabetes, and people taking related medications.
    Cigarette smoking on this research didn’t correlate with a higher chance of full ED.
    Nevertheless, when it was related to coronary heart illness
    and hypertension, a better chance of ED was famous.

    Incidence estimates have been printed utilizing knowledge compiled from the Massachusetts Male Aging Examine.2
    Incidence knowledge are essential to evaluate danger
    and plan remedy and prevention methods. The Massachusetts examine knowledge counsel there can be roughly 17,781 new circumstances of
    ED in Massachusetts and 617,715 within the United States yearly.

    A bigger nationwide examine, the Nationwide Well being
    and Social Life Survey, checked out sexual operate
    in women and men.Three This examine surveyed 1410 males
    aged 18 to fifty nine years, and it additionally documented
    a rise in ED with age. Moreover, the research discovered a lower in sexual need with growing age.
    Males within the oldest cohort (these aged 50-fifty nine years) have been greater than three instances as prone to expertise erection issues and to report low sexual want in comparison with males aged 18 to 29 years.
    Expertise of sexual dysfunction was extra seemingly amongst males in poor bodily and emotional well being.

    It was additionally concluded that sexual dysfunction is a vital
    public well being concern and added that emotional points are
    prone to contribute to the expertise of those issues.

    The improvement of an erection is a fancy occasion involving integration of psychologic,
    neurologic, endocrine, vascular, and native anatomic methods.
    Positron emission tomography (PET) scanning studies4 have prompt that sexual arousal is activated in larger cortical centers which then stimulate the medial preoptic and paraventricular nuclei of the hypothalamus.
    These indicators finally descend by means of a fancy neural community involving the parasympathetic nervous system and ultimately activate parasympathetic nerves within the sacral space
    (S2 to S4).

    The neurovascular occasions that in the end happen end result within the
    inhibition of adrenergic tone and the discharge of the nonadrenergic, noncholinergic (NANC) neurotransmitter nitric oxide.
    Nitric oxide is believed to be launched from NANC nerves and endothelial
    cells. It subsequently stimulates the guanylate cyclase enzyme system in penile
    clean muscle. This ends in elevated ranges of cyclic guanosine monophosphate (GMP) and in the end in clean muscle relaxation, enhancement of arterial
    inflow, and veno-occlusion, producing ample firmness for sexual exercise.

    Recognized danger components for ED embrace cardiovascular illness (hypertension, atherosclerosis, and hyperlipidemia), diabetes, depression, alcohol use, smoking,
    pelvic/perineal surgical procedure or trauma, neurologic illness,
    obesity, pelvic radiation, and Peyronie illness. Examples of frequent neurologic situations that may result in ED embrace cerebral vascular accident,
    a number of sclerosis, Parkinson illness, and spinal cord damage.
    Extra generally, vascular illness and diabetes can produce neurovascular
    abnormalities leading to ED. Surgical procedure for cancers of the prostate, bladder,
    and colon could disrupt each neural and vascular pathways, leading to ED.

    Hormone deficiency or hypogonadism, whether or not major or
    secondary, can lead to ED. Hormone deficiency, nevertheless, is much less typically the reason for ED than is
    diabetes or vascular illness. How typically ED is attributable to hormone deficiency stays considerably controversial, however estimates of roughly three% to
    5% of instances are affordable. Medications and recreational medicine also can produce erectile dysfunction by numerous poorly understood mechanisms.

    Some well being questionnaires assist display screen for
    and consider erectile dysfunction5 and will assist
    in the first care setting. It’s important, nonetheless, to acknowledge that abbreviated
    questionnaires may not consider particular
    areas of the sexual cycle, equivalent to sexual need, ejaculation, and orgasm.

    Nonetheless, they are often helpful in serving to patients talk about the issue and in signaling the necessity for an analysis.

    If it is set that ED is an issue, an in depth sexual and medical historical past ought to be taken and
    a bodily examination needs to be achieved to guage the affected person. Specifically, it will be important to judge the ED and
    to rule out premature ejaculation, which can also be a typical sexual dysfunction.6

    A variety of particular questions referring to sexual operate
    may help the clinician consider the complaint of ED. Questions
    ought to concentrate on the next:

    Once questions associated to the precise erectile complaint have been reviewed, extra questions regarding medical and psychosocial elements must be
    evaluated. Particularly, these embody the next: signs suggesting the presence of diabetes, peripheral vascular illness,
    neurologic illness, or chronic liver or kidney illness; a whole checklist of medications and recreational medicine, together with alcohol, and questions about cigarette smoking; historical past of surgical procedure or radiation therapy, significantly procedures associated to genitourinary or gastrointestinal malignancy; a historical past
    of pelvic genital, perineal, or spinal cord trauma; and the standard of the
    marital or companion relationship and expectations of each affected person and companion.

    Following a overview of the medical historical past, the salient
    options of the bodily examination ought to embody the next:

    Once an entire sexual and medical historical past has
    been accomplished, acceptable laboratory research ought
    to be carried out. Within the preliminary analysis of ED, refined laboratory testing isn’t
    needed. For instance, when historical past or bodily examination directs, it could also be acceptable to incorporate hormonal
    analysis to exclude a analysis of hypogonadism (low testosterone and prolactin ranges) or hypothyroidism (low thyroid stimulating hormone [TSH] ranges)
    or to display for diabetes if the affected person just isn’t recognized to be diabetic (hemoglobin A1c or glucose
    tolerance testing). A primary metabolic panel and/or urinalysis could establish patients in danger for liver
    or kidney illness. A lipid panel might even be warranted as a display for cardiac danger
    components.

    In most circumstances, a tentative prognosis could be established with a
    whole sexual and medical historical past, bodily examination, and restricted laboratory testing.

    In lots of circumstances, the prognosis stays considerably ambiguous.
    Nevertheless, with the availability of oral medicine for remedy of ED that’s secure and has minimal
    or tolerable negative effects, extra diagnostic testing might be
    pointless or might be delayed till a therapeutic trial of oral remedy has proved ineffective.

    Oral Therapy

    Although there are quite a few choices for nonsurgical remedy, oral phosphodiesterase-5 (PDE5) inhibitors needs to be provided as first-line remedy of patients with ED until contraindicated.7 A abstract of the
    three oral PDE5 medicine accredited to be used by the U.S.
    Meals and Drug Administration (FDA) is present in Desk 1.

    Tready 1. FDA-Authorized Phosphodiesterase Inhibitors for Erectile Dysfunction

    All three medicine reversibly inhibit penile-particular PDE5 and improve the nitric oxide-cyclic GMP pathways of cavernous easy muscle relaxation;
    that’s, all three stop the breakdown of cyclic GMP by PDE5.

    According to a evaluation of all randomized, managed trials evaluating sildenafil
    by the American Urological Affiliation (AUA) Consensus
    Panel on Erectile Dysfunction, 36% to 76% of patients receiving the drug have
    been “ready to realize intercourse” throughout therapy.
    For tadalafil, a smaller quantity (four) of randomized managed trials revealed that eleven% to forty seven% of
    patients have been “in a position to realize intercourse” (dose-dependant).
    Related efficacy has been noticed with vardenafil, though research are fewer.7

    The success price of all three medicine is decreased in some affected person teams.
    For instance, efficacy in diabetic patients might be nearer
    to 50% to 60%, with demonstrated effectiveness for these with sort 1 or 2 diabetes.
    Though patients who’ve had a radical prostatectomy would possibly reply to any of those medication, one
    of the best response happens in patients whose process was bilateral
    nerve sparing. In these patients, success charges
    differ however method 70% in some collection.
    Nevertheless, if a single nerve was spared, success is diminished and, if no nerves have been spared,
    outcomes are typically poor, with successful price of lower than 15%.

    All three medication require sexual stimulation to be efficient.
    The standard dose of sildenafil is 50 mg or one hundred
    mg taken roughly 1 hour earlier than intercourse, on an empty stomach.

    Vardenafil can be taken 1 hour earlier than intercourse, with a regular dose of 10 mg or 20 mg.
    Vardenafil could also be much less affected by meals
    intake, however absorption could also be delayed if a excessive-fats meal has not too long ago been ingested.
    Tadalafil could also be taken 2 hours earlier than intercourse, however its longer half-life (17.5 hours) permits larger affected person flexibility in deciding when to provoke intercourse
    (eg, 6, eight, or maybe 12 hours earlier than). Tadalafil could also be taken with out regard
    to meals intake.

    All three medicine are usually nicely tolerated.
    Unwanted side effects embrace headache, flushing, dyspepsia, and nasal congestion. Visible abnormalities are
    encountered with sildenafil, however are unlikely with vardenafil and tadalafil.
    Again ache and myalgia can happen with tadalafil, however are unusual with
    sildenafil or vardenafil. Patients deemed to be of highest cardiovascular threat shouldn’t be handled for ED till their
    cardiac situation has been stabilized. These situations embrace unstable/refractory
    angina, myocardial infarction/cerebrovascular accident (MI/CVA) inside the previous 2
    weeks, uncontrolled hypertension, NYHA Class III-IV congestive coronary heart failure,
    excessive-threat arrhythmias, hypertrophic obstructive cardiomyopathies, and
    average-to-extreme valvular illness.Eight As well as, all three
    medicine are contraindicated in patients who
    use nitroglycerin or nitrate-containing compounds.9,10 Combining any of those three medication with nitroglycerin or nitrates
    can lead to important hypotension. Vardenafil is contraindicated in patients utilizing doxazosin, terazosin, or tamsulosin. Tadalafil is contraindicated in patients utilizing doxazosin or terazosin.
    It could also be safely taken with tamsulosin on the zero.Four-mg dose.
    In patients who take 50 mg of sildenafil or extra and use alpha blockers, sildenafil dosing needs to be prevented for a minimum of
    four hours after the dose of the alpha blocker.
    In patients who take 25 mg of sildenafil, use of any of the alpha blockers is taken into account secure.
    These medicine are sometimes used for the remedy of benign prostatic hypertrophy and
    maybe much less typically for hypertension.

    Although vardenafil doesn’t appear to supply important clinical QT prolongation, it has
    been steered that it’s averted in patients who’ve congenital QT prolongation abnormalities and in patients utilizing class I antiarrhythmic medication, reminiscent of quinidine and procainamide.
    It is usually finest to keep away from using vardenafil with Class III antiarrhythmic medication,
    resembling amiodarone or sotalol.

    Dose-adjustment is beneficial in patients with hepatic failure and with co-administration of medication additionally metabolized by the cytochrome p450 enzymes.

    Withdrawal of Offending Medications

    It is extraordinarily essential to take a whole
    drug historical past, significantly with regard to antihypertensive medications
    and medicine used for cardiovascular illness, anxiety, depression, or
    psychosis in any affected person complaining of ED (Desk 2).
    Antihypertensive medication, comparable to diuretics and beta blockers, could also be related to ED and maybe might be discontinued or switched to different medication, corresponding to angiotensin-changing enzyme inhibitors or calcium channel blockers (eg, diltiazem, nifedipine, amlodipine), which could trigger
    much less of an issue. The newer angiotensin II receptor antagonists might even be much less problematic, however extra lengthy-time period
    knowledge are wanted to affirm this.

    Tready 2. Medication and Drug Lessons Reported to Have an effect on Erectile Operate*

    * This listing is certainly not complete

    © 2004 The Cleveland Clinic Basis.

    Of the medicine used for depression, tricyclic antidepressants could also be related to erectile issues and
    different medicine could also be substituted to stop this complication. Presently accessible substitutes embody
    bupropion, nefazodone, and trazodone. The selective serotonin reuptake inhibitors (eg,
    fluoxetine, sertraline, paroxetine, citalopram) may also trigger difficulties with ED, however they may additionally produce other
    vital sexual uncomfortable side effects, together
    with decreased libido and anorgasmia.

    Clinical expertise in switching medications has general been disappointing, and
    enchancment doesn’t usually appear to happen.
    Nonetheless, you will need to attempt to discontinue attainable offending medications earlier than proceeding to
    extra invasive choices. Oral therapy has modified the
    ways in which clinicians discontinue medications in patients with ED, and has improved the strategy.
    For instance, a affected person may develop erectile dysfunction on a
    thiazide diuretic. The drug could also be withdrawn, however a trial of oral ED therapy may
    be initiated throughout the remark interval whereas the affected person is ready to see whether
    or not any spontaneous enchancment in erectile perform happens after drug withdrawal.
    Alternatively, if diuretic therapy is efficient, effectively
    tolerated, and controlling the blood stress, oral ED therapy can be utilized to deal with the sexual unintended effects on an ongoing foundation.

    If a trial of oral therapy and withdrawal of offending medications
    show to be ineffective in restoring erectile perform, it might be applicable for many major care practitioners to think about referral to a specialist for
    added analysis and dialogue of other therapy choices.
    These embrace intracavernous injection therapy,
    vacuum constriction gadgets, intraurethral therapy, and doable surgical procedure.

    Vacuum Constriction Units

    As famous, if a trial of oral therapy and withdrawal of offending medications don’t restore erectile operate,
    most main care practitioners ought to consider referring the affected person to a specialist for added
    analysis and dialogue of different remedy choices.
    Nevertheless, some main care practitioners could advocate vacuum constriction units.
    Two remedy tips have urged that such units are a primary-line therapy modality.Eleven,12

    The machine consists of an acrylic cylinder positioned over the penis
    that makes use of a lubricant to attain a great seal between the penile physique and cylinder.
    An erection is then achieved by making a vacuum contained in the cylinder with a pump related to the cylinder.
    As soon as an erection is achieved, a constriction band is
    utilized to the bottom of the penis to take care of the erection. The cylinder can then be
    eliminated and the affected person can interact in intercourse with the constriction band(s) at the bottom of the penis sustaining the erection. The bands can stay on for roughly half-hour after which should be eliminated.
    The erection produced by the machine differs from a traditional erection seemingly due to venous occlusion from the
    constriction band leading to generalized swelling of
    all the penis, with possible preservation of arterial inflow.

    Clinical research have urged that these gadgets are efficient and acceptable to a
    lot of patients with ED of various causes, together with psychogenic erectile failure.
    The preliminary general response charge is roughly eighty% to ninety%.

    Nonetheless, satisfaction with this remedy modality sometimes wanes with time,
    as patients report dissatisfaction with how cumbersome or unnatural the gadgets are to make use
    of, hinging or buckling of the erection with thrusting, and dissatisfaction with the truth that
    the erection is ischemic (and due to this fact chilly) which might be off-placing to the companion.

    Tlisted here are comparatively few contraindications
    to using vacuum units. Some situations can predispose to priapism or maybe bleeding with
    constriction, reminiscent of sickle cell illness, polycythemia, and different blood dyscrasias.
    Patients taking anticoagulants (warfarin) can safely use vacuum constriction gadgets however want to simply accept a better threat of bleeding (ecchymosis).

    Good guide dexterity can also be wanted to make
    use of the machine; if handbook dexterity is impaired,
    a keen sexual accomplice can study to use the
    machine.

    Complications from using a vacuum constriction system are comparatively minor.
    They embody the event of petechiae or ecchymosis, numbness or coolness of the penis, trapping of the ejaculate, and pivoting of the penis at the bottom.

    Intraurethral and Intracorporeal Alprostadil

    Alprostadil (also called prostaglandin E1 [PGE1]) is the outstanding
    recognized clean-muscle dilator of the corpus cavernosum.
    Its mechanism of motion is believed to be the promotion intracellular accumulation of cAMP, thereby inflicting decreased intracellular accumulation of calcium and ensuing easy muscle relaxation. Alprostadil will be delivered to the erectile tissue both through an intraurethral
    suppository that’s massaged after which absorbed throughout
    the corpus spongiosum of the urethra to the corpora cavernosa,
    or instantly injected into the corpora cavernosa.
    When administered urethrally, doses are roughly 10 instances greater than when straight injected (125 mcg to 250 mcg intraurethral in contrast with 2.5 mcg to 25
    mcg intracavernosal).

    Side results embody feeling gentle-headed, fainting,
    priapism, urethral bleeding (intraurethral), dyspareunia in accomplice (intraurethral), hematoma (intracavernosal) or penile curvature secondary to scar (intracavernosal).
    Efficacy of intraurethral alprostadil has been demonstrated to be round 50% (“in a position to have intercourse”) in randomized managed trials.Thirteen,14 For intracorporeal injection, usually alprostadil is tried
    alone, or compounded with papaverine (nonspecific phosphodiesterase inhibitor that will increase intracellular cAMP
    and cGMP) and/or phentolamine (aggressive, non-selective alpha1- and alpha2-adrenoreceptor
    blocker).

    An in depth evaluate of the advantages and drawbacks of
    the mixtures of those medication is past the scope of this chapter, however could be
    discovered within the assessment by Pinsky et al.15 Given the excessive threat of priapism throughout escalation of therapy for intracorporeal injection, it is strongly recommended that the medication be administered in a supervised workplace go to initially and that the affected person be
    given a nicely-articulated plan for remedy of priapism if it happens.
    Escalation tips for alprostadil alone fluctuate, however a basic guideline
    is to start out at 2.5 mcg and improve by 2.5 mcg to a dose of 5
    mcg after which in increments of 5 mcg to 10 mcg till an erection ample for penetration, not lasting
    greater than 1 hour, is achieved. If there isn’t a response to the preliminary 2.5-mcg dose,
    escalation dosing might be barely extra liberal.
    A European potential four-12 months trial of the drug additionally evaluated success of PGE1 alone and demonstrated charges starting from 89% to
    ninety seven%.Sixteen

    Other Nonsurgical Remedies for Erectile Dysfunction

    Several therapies have been promoted within the pre-PGE1, pre-prostaglandin period, together with yohimbine, trazodone, testosterone, and varied natural cures.
    None of those is at the moment beneficial beneath the up to date AUA Pointers
    for the Therapy of Erectile Dysfunction. Testosterone supplementation is just advisable for males with low testosterone
    ranges. One small randomized trial of Korean purple ginseng has been published17 which demonstrated modest enhancements in Worldwide Index of Erectile
    Perform (IIEF) and RigiScan scores in contrast with placebo.

    Surgical Remedies for Erectile Dysfunction

    Implantation of penile prosthesis stays an necessary choice for males in whom medical therapy of ED has failed or is in acceptable.
    Prostheses can be found as a saline-stuffed silicone system
    or a malleable gadget. The advantage of the previous is
    a extra pure look within the deflated state,
    carefully approximating the looks of a flaccid penis. The commerce-off is a better
    mechanical failure charge and better price. Satisfaction charges for patients who underwent penile prosthesis surgical procedure
    have been reported to be larger than ninety%.18 Nonetheless, in the vast majority of patients who obtain this remedy, much less invasive options have failed and due to
    this fact satisfaction with this therapy can be anticipated to be increased on this subset of
    patients. Dangers of those gadgets embody surgical and
    anesthetic threat, machine infection, and machine malfunction. Mechanical failure charges depend upon the precise system being investigated.
    Total, the share of units which can be free from mechanical failure at 5 years ranges from eighty% to ninety%.7 Infection charges
    within the period of coated gadgets and improved strategies
    are reported to be lower than 1%.19

    All gadgets which might be presently FDA accredited are thought-about protected to be
    used in a magnetic resonance imaging (MRI) surroundings.
    Nonetheless, 2 beforehand permitted gadgets-the OmniPhase and the DuraPhase penile prostheses-aren’t thought-about secure
    on this setting.

  4. For me the lion has always been a protective spirit. When I dream a lion (always a male African Savanah lion), it is fighting by my side, sleeping next to me to keep me warm, or giving me advice. But yes, I do usually dream one when I feel I have been treated unjustly.

  5. Love the fern pic. Makes me feel there. Funny how you escaped the fog and I keep on priayng for it here. I’m dying to take some misty pics. Welcome back JJ, good to have ya!

  6. My partner and I been togther for 16 yrs had hiv test for life policy done. Mine was negative and his positive. That was 14 months ago. Every 3 months after that I go test again and still I’m negative till now. How can it be possible coz we are not using protection.

  7. Mark Foote, I can sit for an hr without any pain on my ankles or knees, but I just don’t find the value or point in practice anymore, especially in an organization.

  8. Is this tablet atrovia still the same as Atripla as my didn’t tell me that is changing me to this tablet! Please I’m worried

  9. I just started using RR again to check few things. Surprise to find that command line execute to View the session report in HTML didn’t work instead it just launched RR. Is the command RapidReporter.exe –tohtml still valid? or I lost the nag of using it.

  10. I ended up using a 9×13 pan. A thin layer of batter, bake about 5 minutes until just set. I used a thicker caramel layer that I used for a previous recipe, layered according to your recipe. I spread the remaining batter with a small cookie scoop, dipped in ice water after every scoop, and carefully spread it over the caramel layer. I baked it about 20 minutes, checking with a toothpick after 15. It turned out really great, everybody loved it. I really like the idea of there brownies, I just had to get those right.

  11. I feel energyless on my feet Rebecca, and im experiencing sores on my gums and on the vagina though im taking treatment (Atroiza) appropriately. Does this mean the viral load is still going high and cd4 going down? Is this treatment really working for me and will my situation improve as time goes ?

  12. For me the lion has always been a protective spirit. When I dream a lion (always a male African Savanah lion), it is fighting by my side, sleeping next to me to keep me warm, or giving me advice. But yes, I do usually dream one when I feel I have been treated unjustly.

  13. Hi i just found out im hiv positive an im pregnant ive been given tribuss but the packet insert says dont take if pregnant im confussed what do i do? My cd4 is above 500

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