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When the http://cz.keimfarben.de/cheap-kamagra-uk/ erectile dysfunction treatment kamagra buy kamagra tablets struck, many IT leaders shadowed clinical staff to view first-hand the support those clinicians needed on the front lines. And often they learned some valuable lessons.Meanwhile, while healthcare organizations and their IT teams focused on fighting the erectile dysfunction treatment crisis, hackers in the wild were not taking a break from their cyberattacks on the buy kamagra tablets healthcare organizations. The kamagra showed the importance of strategically investing in a secure and integrated foundation of digital tools, offering the ability to scale up existing offerings to respond to the demand for digital care. But what buy kamagra tablets comes next?. In this final installment in Healthcare IT News' feature story series, Health IT Lessons Learned in the erectile dysfunction treatment Era, several IT leaders discuss the lessons they've learned over the buy kamagra tablets past 18 months.

They are:David Higginson, executive vice president and chief innovation officer at Phoenix Children's Hospital in Arizona. (@PhxChildrens)Emily Kagan-Trenchard, vice president of digital and innovation buy kamagra tablets strategy, digital patient experience, at Northwell Health, based in New Hyde Park, New York. (@NorthwellHealth)Dr. Paul Testa, chief medical information officer at buy kamagra tablets NYU Langone Health in New York City. (@nyulangone)Scott Waters, chief information and technology officer at Overlake Medical Center & buy kamagra tablets.

Clinics in Bellevue, Washington. (@OverlakeHMC)(Click here to visit the special portal containing all 12 feature stories in this series.)Clinical informatics at the point of careTesta and his team at NYU Langone Health quickly learned over the past year that clinical informatics done right has to be done at the point buy kamagra tablets of care."At the start of the kamagra, we walked the halls and partnered with our clinical staff to see first-hand what kind of support they needed on the front lines," he recalled. "Working side by side with clinicians as they took care of patients allowed us to literally see the writing on the wall, as seen in the photo texted to us from a senior leader and tweeted by a colleague researcher." [Photo above.]Clinicians needed erectile dysfunction treatment-specific data, which they took to writing on glass doors of care rooms to keep track of patients' oxygen levels and reduce the number of room entries of each erectile dysfunction treatment patient."At the start of the kamagra, we walked the halls and partnered with our clinical staff to see first-hand what kind of support they needed on the front lines."Dr. Paul Testa, NYU Langone HealthWatching frontline staff improvise and problem-solve on the fly gave the IT team insight into what was most important for them in dealing with the crisis bedside."We knew we buy kamagra tablets could get them the same specific, real-time data in a more accurate way that respected their need for mobility," Testa said. "Informaticists cross-walked the writing on the wall with discrete data points in the EHR and we rapidly configured real-time digital reports that display erectile dysfunction treatment-specific patient data for clinicians to access buy kamagra tablets on both desktop and mobile devices."These reports serve them up data in the way they need to care for our patients," he continued.

"These solutions were only able to be successfully developed because of the emphasis we place on partnership between the clinical systems and IT teams."Testa and his team will continue to partner with clinicians at the point of care and listen carefully to what they need – and keep reading the writing on the walls."Being present at the bedside gives us better and more actionable insights into what is and isn't working for our clinicians," he noted. "We develop digital solutions for various uses across our system, but seeing them used in practice is the best way to know what changes and improvements need to be made."Partnership and collaboration are core tenants of our IT department, and work side by side at the bedside with our clinicians to provide the tools they need buy kamagra tablets to provide the highest quality care for our patients," he added.Bolstering cyber defensesOn a different front, Waters of Overlake Medical Center &. Clinics learned along with other healthcare organizations that while the organizations may have a singular focus to fight the erectile dysfunction treatment crisis, the bad actors out there were not going to buy kamagra tablets take a break from their cyberattacks."In fact, they capitalized on an industry that has been working to vaccinate and treat people impacted by erectile dysfunction treatment for over a year without rest," he said. "The rate of cyberattacks has increased significantly and the sophistication keeps increasing. So many health systems fell victim to phishing attacks and ransomware in 2020, which created another burden on a workforce that is already stretched thin."We also saw the attackers going after the tools buy kamagra tablets that we use to detect and defend against attacks such as was the case with the Solarwinds and now the Kaseya attacks," he added."We realize we can't solely rely on one or even two tools to protect us.

We need to have several layers of tools from different vendors in some cases."Scott Waters, Overlake Medical Center &. ClinicsOverlake Medical buy kamagra tablets Center &. Clinics has bolstered its approach to defense buy kamagra tablets in depth."We realize we can't solely rely on one or even two tools to protect us," he explained. "We need to have several layers of tools from different vendors in some cases. We also realized there is value in consolidating to single-vendor ecosystems in other cases buy kamagra tablets.

The basic idea is to have a flexible security program that can pivot, not if, but when the landscape changes because it changes constantly."Zero trust – or as close to that as we can get and still effectively provide patient care – is a journey everyone needs to be on at this point," he asserted. "We have to continue to educate our staff so that they buy kamagra tablets can be good 'human firewalls' for the organization. Investing resources in user awareness education is something we have been committed to and are looking to increase in the coming years."Integrated foundation of digital toolsThe erectile dysfunction treatment kamagra showed Testa the importance of strategically investing in an buy kamagra tablets integrated foundation of digital tools for both patients and clinicians."When the kamagra hit, we were able to scale up our existing offerings to respond to the demand for digital care, rather than some forced pivot or buy some standalone third-party solutions," he recalled. "At NYU Langone Health, we made the choice to commit to integrated systems that prioritize the patient and clinician digital experience."Rather than use several niche systems across our organization, we have fewer, but more strategic systems in place that are integrated with one another."With this in mind, the organization has committed to a single-app experience for patients, which allowed staff to respond quickly and stay connected to them when the kamagra began."Through our NYU Langone Health app, patients can book appointments, access test results, conduct a video visit and securely chat with providers all in one place, rather than being sent to multiple locations," Testa explained. "While this approach requires more integration and feature implementation, it buy kamagra tablets paid dividends and allowed for the rapid acceleration of digital engagement with patients over the past year."Our telemedicine capabilities were offered through our app before the kamagra and grew exponentially to connect with patients where they live," he continued.

"With a strong foundation of technology already in place, we were able to quickly scale up from approximately 1,000 appointments per month to more than 160,000 at the height of erectile dysfunction treatment."NYU Langone Health will continue to buy kamagra tablets strengthen its foundation of digital tools and put the patient and clinician experience at the center of all it does."The reason we were able to successfully scale and stay connected to patients during the kamagra was because we thoughtfully designed our capabilities to benefit both patients and clinicians, not one at the expense of the other," he said. "Our telemedicine offerings allow care to be brought more conveniently to patients in their homes, but also offer our clinicians more flexibility around where and when they can offer that care."We will continue to work with both groups to ensure that the tools we create are allowing them to provide and receive the highest quality care, even in the most unforeseen circumstances," he added.Modernizing and maturing texting practicesVery early on in the kamagra, it became clear that text messages were going to be required at Northwell Health to accomplish many of the communications and coordination efforts that it was trying to deliver."However, our health system's policy around using text messages had been written in another era," said Kagan-Trenchard of Northwell Health. "We were only allowed to send notices about upcoming appointments with so little detail that a patient found it buy kamagra tablets hard to understand who this appointment was with or for."Any other texting use-case outside of appointment confirmation was considered too risky to even be considered," she continued. "Our legal team's perspective on the safe use of SMS texting had not been updated to reflect the ubiquity of, and consumer demand for, text message communications, nor had the privacy standards governing the content of these messages been updated to reflect current best practices.""We worked with legal very, very closely to not only adjust our text messaging policies for the short-term crisis management but update our larger texting consent management framework in order to ensure that SMS could be an active channel for patient communications in the long term."Emily Kagan-Trenchard, Northwell HealthFurthermore, the texting utilities the organization did use were not communicating back to appropriate source systems when patients opted out of these texting campaigns, resulting in a confusing jumble of text message consent data that rendered it nearly useless for other applications."We worked with legal very, very closely to not only adjust our text messaging policies for the short-term crisis management but update our larger texting consent management framework in order to ensure that SMS could be an active channel for patient communications in the long term," she explained."With these new legal standards in hand, we now had to coordinate implementation between all of the teams currently using text messaging, as well as those setting up to do so in the near future," she said. "We needed to coordinate like never before on everything from how we would manage opt-outs on various short codes, to ensuring that cell phone information buy kamagra tablets was up to date, to aligning on timing, content and message triggers."This required staff to not only implement tools that could send automated and conditional logic messages, but even transition the conversation to a live person for a real-time reply in certain circumstances.Rapid custom app developmentKagan-Trenchard also learned something that she said the kamagra made clear.

Health systems cannot simply outsource their own digital flexibility."Custom software and application development is a muscle all health systems need to have, to some extent, within their own workforce," buy kamagra tablets she said. "This skill set needs to be one that can both build scaled enterprise utilities, as well as custom, rapid response tools as was often called for during the kamagra."This means we not only need to look at the talent we employ, but also the server environments, the code repos, development frameworks, data and API management architecture, along with our design capabilities, user experience strategy, microcopy and much more," she said.This is not a set of skills that Northwell Health had built exclusively for use during the kamagra, but during this crisis it became abundantly clear why it was not just a need for one-time special projects, she said. It is a critical capability of a health system's IT response to unexpected circumstances, she added."Custom applications were used for basic coordination of people and appointment logistics, erectile dysfunction treatment testing, managing vaccination rollout populations and scheduling, and rapidly activating pop-up buy kamagra tablets locations as directed by the state," she said. "During the kamagra, the digital patient experience team and IT custom software development groups leaned on their existing agile development and design practices to pivot their resources and get to work, sometimes turning around tools in as little as 48 hours."Some areas of the business turned to platforms such as Salesforce to stand up their own custom email and campaign pages for certain things. But even with those WYSIWYG utilities, there is buy kamagra tablets still a need to consider the product and experience design components, she said."Everything from the field typed, form flow and validation practices to experience integration, accessibility and health literacy issues cropped up," she noted.

"Many areas of the business didn't know they needed these skills until there was a fire that needed to be put out."So it is not only the engineering side of custom application development that is important to cultivate – it also is the design strategy and user experience components that make for a successful rapid application development team," she added.Super-speedThe predominant lesson Higginson of buy kamagra tablets Phoenix Children's Hospital learned over the past year has been that his team can get things done quickly – very quickly.In normal times, new projects and initiatives take some time to get off the ground, but necessity is the mother of invention, and the kamagra expedited work to find solutions to new problems, he said."An example of this was our work to place cameras in every patient room," he said. "We had installed cameras in our NICU a few years earlier and wanted to do this across the hospital, but erectile dysfunction treatment pushed this initiative to the top of the list."So we innovated our own solution. We purchased cameras from a company called Axis and created our own HL7 ADT solution that automates buy kamagra tablets the patient-family connection throughout the hospital experience."David Higginson, Phoenix Children's Hospital"Like other health systems, our visitor restrictions were very strict, only allowing one parent or caregiver in the room at a time," he continued. "We knew this would be difficult for families – parents, grandparents and other loved ones were anxious to see these children – and we were eager to provide a solution and put families' needs first."Of course, purchasing this particular type of camera for every patient room can be expensive. In addition, boxed vendor solutions are imperfect in many ways, he said."Beyond the expense, the cameras require regular involvement from buy kamagra tablets clinicians including manually disconnecting each family from the system when their patient is discharged or transferred," he explained.

"This creates too many opportunities for error, especially buy kamagra tablets for providers who are already managing many details for complex patients."So we innovated our own solution. We purchased cameras from a company called Axis and created our own HL7 ADT solution that automates the patient-family connection throughout the hospital experience," he continued. "It also disengages the family once the patient is discharged or transferred, eliminating the possibility of human error."Staff also designed and sourced a unique buy kamagra tablets gooseneck with medical-grade coating that attaches directly to the camera and allows parents and clinicians to adjust the angle – aiming the lens at a child's face and away from a wound or surgical site, for example."Another feature of our solution was a light ring around the lens that would change colors anytime a camera was accessed," he added. "This provided a visual cue to clinicians that families were actively utilizing the technology and could see the patient."The IT team worked with Phoenix Children's Hospital Foundation to cover the cost of this project, which amounted to about $600 for each room (compared to $7,000-$8,000 for a vendor solution), buy kamagra tablets Higginson said. They also got their solution implemented in about three weeks' time, while a boxed product would have taken considerably longer to implement, he added."More importantly, we know that it made a difference for families," he said.

"On average, parents and other loved ones accessed the cameras roughly 20 times a day for just a few minutes at a time buy kamagra tablets. The opportunity to see their children virtually was the next-best thing to in-person visitation."More than just video conferencingWaters discovered that as an organization, Overlake Medical Center &. Clinics needed a virtual communications platform that would deliver more than just video conferencing functionality."Like many other health systems prior to the kamagra, Overlake was already using audio and video conferencing solutions for some of our meetings, but there buy kamagra tablets was a significant preference to meet in person for almost everything," he noted. "Being at the epicenter of the erectile dysfunction treatment outbreak in the U.S., we had to shift our preferences of in-person meetings to the practical and safer approach of meeting virtually and we had to make this shift quickly."They discovered that their solutions at that time for video conferencing did not allow for robust communications among project and committee teams."Functionality such as chat that could persist after the meeting ended, being able to set up virtual spaces for collaboration on documents in real time and asynchronously, and of course video buy kamagra tablets conferencing with screen sharing was of critical need," Waters said. "We implemented Microsoft Teams and it was a game-changer when it came to streamlining our communication needs during the kamagra, but what we have found is that it has really become a significant enterprise tool that will persist into the future."Overlake Medical Center &.

Clinics has invested more deeply in Microsoft Teams as an enterprise communication buy kamagra tablets platform."One example of how we are investing is our deployment of the Microsoft Teams Family Connect application we are preparing to go live with," he noted. "This application will allow for a more cohesive consultation experience, involving the provider, patient and their families, creating a more holistic approach to care planning."Our expectations that meetings have to be in-person have changed as an organization," he continued. "At the same time, the expectations of our staff to be able buy kamagra tablets to work remotely have also become stronger and more vocal. This has to be a cultural shift at Overlake that has taken some time to get used to but across all of our productivity metrics we have shown it to be a successful transition."There will always be situations where buy kamagra tablets a virtual meeting just cannot replace the face-to-face interaction of in-person, but there is a permanent place for virtual work at Overlake for certain roles."The biggest lesson with this shift has been that flexible thinking is our greatest attribute at Overlake," he concluded. "We pride ourselves on being a forward-thinking healthcare organization that can meet and anticipate the needs of our patients, staff and community."Twitter.

@SiwickiHealthITEmail the writer buy kamagra tablets. Bsiwicki@himss.orgHealthcare IT News is a HIMSS Media buy kamagra tablets publication.Amazon Web Services this week introduced AWS for Health, a range of services aimed at helping healthcare and life science organizations reach their goals. "AWS for Health provides proven and easily accessible capabilities that help organizations increase the pace of innovation, unlock the potential of health data, and develop more personalized approaches to therapeutic development and care," wrote Patrick Combes, director, head of technology – healthcare and life sciences at AWS, in a blog post Thursday. "AWS for Health simplifies the process for healthcare buy kamagra tablets and life-science enterprises and innovative startups to identify industry-leading, cloud-based solutions across 16 critical solution areas in healthcare, genomics, and biopharma," Combes continued.WHY IT MATTERSWhen it comes to healthcare specifically, Amazon says AWS will allow organizations to accelerate the digitalization and utilization of their data.The tools are aimed at addressing a range of needs, including clinical systems, analytics and AI/ML, patient and clinician experience, medical research, finance and operations, and core health IT. For example, Amazon's Epic on AWS solution allows users to migrate electronic health record workloads to the cloud, with a goal of increasing performance and automating many traditional IT tasks.

Of particular interest is Amazon HealthLake, which buy kamagra tablets is available in select regions as of this week. The HIPAA-eligible service uses machine learning to extract meaningful information from unstructured data, then organize, index and store that information in chronological order.By leveraging the Fast Healthcare Interoperability Resources industry standard format, the software enables interoperability, allows users to analyze the newly structured data, and makes it easier for organizations, researchers buy kamagra tablets and practitioners to collaborate. The company first announced HealthLake in December 2020, joining a host of other software giants in offering data management and analysis tools. HealthLake is available in eastern buy kamagra tablets and western U.S. Regions, with more availability coming soon."More and more of our customers in the healthcare and life-sciences space are looking to organize and make sense of their reams of data, but are finding this process challenging and cumbersome," said Swami Sivasubramanian, vice president of Amazon Machine Learning for AWS, in a statement."We built Amazon HealthLake to remove this heavy lifting for healthcare organizations, so they can transform health data in the cloud in minutes and begin analyzing that information securely at scale.

"Alongside AWS for Health, we’re excited about how Amazon HealthLake can help medical providers, health insurers and pharmaceutical companies provide patients and populations with data-driven, personalized and predictive care," buy kamagra tablets Sivasubramanian added. THE LARGER TRENDAlthough AWS for Health as a curated offering is new, many of the company's health-focused buy kamagra tablets solutions have been available to customers for some time.For instance, the Boston-area health system Wellforce made headlines just this past week when it announced it would be migrating its Epic infrastructure to AWS cloud, following in the footsteps of other systems such as Piedmont Athens Regional in Georgia.And in March, Change Healthcare announced that it would offer data science-as-a-service in collaboration with AWS, aimed at helping health systems and life-sciences organizations boost care plan design effectiveness.ON THE RECORD "Healthcare and life-science organizations are moving towards digital transformation to decrease the cost of care, improve collaboration, make data-driven clinical and operational decisions, and enable faster development of new therapeutics and treatment paths," wrote Combes in the AWS blog post."Identifying the right cloud technology to reach these goals can be challenging, and many organizations lack the internal resourcing and expertise to assess, build, and deploy their own solutions," he added. Kat Jercich is senior editor of Healthcare IT News.Twitter. @kjercichEmail. Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication.Abu Dhabi’s Department of Health (DoH) has revealed it is working towards “securely and effectively” reducing cyber threats with the introduction of a new policy.Unveiled earlier this week, the “Abu Dhabi Healthcare Information Security Strategy”– said to be the first of its kind in the region's healthcare sector – will focus on improving its information infrastructure to protect it from the current increase of cyberattacks taking place globally.The strategy will include digital transformation through “enabling technology, innovation, and artificial intelligence adoption in the healthcare sector of the emirate,” the DoH said.THE LARGER CONTEXTScheduled to come into effect “immediately”, the new strategy takes on six areas of focus.

Cybersecurity governance, cybersecurity resilience, cybersecurity capabilities, cybersecurity partnerships, cybersecurity maturity, and cybersecurity innovation. All healthcare facilities and professionals – including insurance providers, service providers, vendors, and authorised parties who have access to patient healthcare data – are required to adopt the new policy.Jamal Mohammed Al Kaabi, undersecretary of DoH, stated. €œAt DoH, we take pride in adopting a proactive approach that is inspired by the vision of our wise leadership in order to continue to strive for excellence and provide world class innovative services through technology.“Our approach to tackling cybersecurity includes implementing a host of processes and proactive measures that help mitigate associated risks and ensures full readiness to effectively and safely respond to any digital threats or attacks.”The announcement of the new strategy comes as the United Arab Emirates (UAE) capital prepares to enter another partial lockdown ahead of the Eid Al-Adha holidays.Beginning 17 July, all Abu Dhabi residents are required to stay at home from midnight until 5am, unless they have prior permission in the form of an approved police permit. New capacity limits for public places have also been announced.Furthermore, those travelling to the emirate – including those fully vaccinated – are required to present either a negative PCR test result taken within 48 hours, or a DPI test taken within 24 hours.ON THE RECORD“We intend to work alongside our partners for the roll out of the updated strategy and take secure steps to support and contribute to the enhancement of the healthcare sectors’ digital transformation journey,” Al Kaabi added. €œ[It is] with the aim of continuing to provide high healthcare service quality to all members of the community.”The United States, along with much of the world, finds itself battling two kamagras.

The erectile dysfunction treatment crisis, of course, but also the cyber kamagra that has also proliferated across the globe.In the healthcare industry, some hospitals have been hobbled for weeks at a time – and at least one patient has died – because of the scourge of ransomware.The cyberattacks have become so frequent and commonplace that it's worth asking whether ransomware, like many suspect is already happening with erectile dysfunction, is already moving from kamagra to endemic status."Ransomware, I think, has become the greatest challenge for most organizations," said retired Admiral Michael Rogers, former director of the National Security Agency and the former commander of U.S. Cyber Command in a recent interview with Healthcare IT News."Healthcare [is] an incredibly attractive target in the middle of a kamagra," said Rogers, who will be speaking next month at HIMSS21 in Las Vegas. "And criminals are aware. That's one reason why you've seen a massive uptick, particularly focused on healthcare in the past 18 months from a ransomware activity perspective."Indeed, since the early days of the kamagra – not counting the vanishingly small window when the prospect of a hacker "ceasefire" was dangled – the bad guys have been hard at work, targeting the World Health Organization and erectile dysfunction treatment testing sites, academic research facilities and treatment distribution supply chains.Their targets have also included hospitals and health systems of all shapes and sizes. Meanwhile, the size of the ransom demands is climbing skyward."It's gotten worse," said Rogers, who served under Presidents Barack Obama and Donald Trump.

Rogers served at NSA and U.S. Cyber Command concurrently for four years before retiring in 2018."For a couple of reasons. Number one, the criminal segment has become much more aggressive," he said. "Why?. There's a lot of money.

There's a lot of money for criminal groups to be made. I may not want to pay the ransom, but I can't afford interruption or degradation of my services or operating ability to help in the middle of a kamagra. I've got to keep going."Number two?. "In the last three years since I left, nation states' risk calculus has become even more aggressive. They are willing to take even greater risks."That's not just with ransomware.

Recent headlines have shown just how far foreign cyber crooks have been willing and able to intrude upon U.S.-based information networks – not just the DNC and the RNC, or Sony, but a wide array of federal agencies and private companies large and small.Rogers points specifically to the SolarWinds and Microsoft Exchange server exploits, which stunned even seasoned cybersecurity professionals in their sheer size, scope and brazenness.Meanwhile, ransomware seizures such as the Colonial Pipeline hack have helped bring the threat into sharp focus.Finally, the president and Congress are paying attention, and federal security agencies seem willing to give as good as they get. "On the positive side, there is clearly a sense that we are not where we need to be, and that it's going in the wrong direction," said Rogers.But he says he is frustrated that the cybersecurity problems are not only persisting, but worsening.A big reason for that is the current state of incident prevention and response – especially when it comes to interrelation of the public and private sectors – "has failed to deliver for over a decade," said Rogers. "I only speak for myself. But my frustration is. Why do we keep doing the same things and expect a different result?.

"Sure, there are valuable organizations such as H-ISAC, the Health Information Sharing and Analysis Center, which specializes in "crowdsourced" cybersecurity, sharing threat intelligence and other best practices for protection and risk mitigation. And yes, the CISA, FBI, HHS and other agencies are good about getting out alerts and warnings to the healthcare stakeholders that need to hear them. But too often, "the government will do its thing, the private sector will do its thing," said Rogers. "As we see things we think might be of interest to the other, as we have the time, and as we have the inclination, we'll share those insights."Everyone is so busy, quite frankly. Most organizations don't have time to think about it.

They are just trying to defend their own systems, their own intellectual property, their own data."To truly measure up against the scope of the cyber threat to healthcare and all industries, "I just think we've got to have a different model," he said."It's not about collaboration," Rogers explained. "To me, it's about integration. We've got the government and the private sector. We've got to team together 24 hours a day, seven days a week."He acknowledged, "You can't do this at scale across every business within the private sector. But can't we start with a few sectors where the risks to our economy, to the safety and wellbeing of our citizens, to the security of our nation–?.

Let's pick a few areas, and do some test cases, and see if a different model might produce a different result."There are some "great examples out there where we have applied a government and private-sector model and achieved some amazing results," said Rogers.Aviation safetyFor instance, he said, "We decided as a society that the potential loss of literally hundreds of people in an aviation accident represented such a risk that we needed to do something different," he said."So we created mechanisms. Every time there is an aviation accident, the federal government steps in. It partners with the airplane manufacturer, the airline that operated the aircraft, the union, et cetera. It pores over all the maintenance records. It pores over the production history of the aircraft.

It looks at all the software and the hardware. It looks at how it was operated. It determines the cause of the crash."And then it goes a step further," he added. "It mandates that we're going to change maintenance. Sometimes we're going to change production.

We're going to change the way we do software, we're going to change how the aircraft is operating."The net impact is we are flying more aircraft with more people than we ever have, and yet aviation safety has actually been very strong. While we have aviation accidents, they tend not to be recurring patterns, the same cause over and over."Compare that with cybersecurity, where we've been seeing the same techniques used by the bad guys "working over and over and over," he said."We have got to get to a point where the pain of one leads to the benefit of the many," said Rogers. "And yet what is happening now?. The pain of the one is not shared. We don't learn from it.

And so it is repeated over and over and over again. We have got to change that dynamic."Admiral Michael S. Rogers will offer more insights at HIMSS21 as a participant in the keynote panel discussion, “Healthcare Cybersecurity Resilience in the Face of Adversity.” It’s scheduled for Tuesday, August 10 from 8:30-9:30 a.m. In Venetian, Palazzo Ballroom. Twitter.

@MikeMiliardHITNEmail the writer. Mike.miliard@himssmedia.comHealthcare IT News is a HIMSS publication.The South Korean Ministry of Science and Information and Communications Technology is planning a 30 billion won ($26.2 million) investment in a research programme to develop digital treatments for depression.WHY IT MATTERSBased on a news report by Seoul-based news agency Yonhap, the number of South Koreans with depression in 2019 went up to 800,000. The figure was projected to continue rising due to the impact of restrictions mounted against the erectile dysfunction treatment kamagra.The research programme will see the development of a digital service offering personalised depression diagnoses based on the real-time collection and analysis of patient data.The service will also provide preventive measures against mental illness by utilising smartphones and other mobile devices. Potential digital treatments include games and virtual reality.The report noted that the Science and ICT Ministry already set aside 14 billion won ($12.3 million) over the next four years for the said research programme, while the private sector also made a 14.9 billion won ($13 million) investment.It was also reported that Naver Cloud of South Korean internet giant Naver Corp. Was tapped to build a cloud infrastructure for the programme's digital platforms.THE LARGER TRENDDigitally enabled treatments are seen as alternatives to conventional methods of treating mental health conditions.Last month, South Korean telecommunications firm KT Corporation entered into a strategic partnership with US-based bioelectronics developer NeuroSigma to jointly develop and market new electronic therapies for neurological and neuropsychological disorders, such as ADHD, depression and epilepsy.A year ago in July, Orexo unveiled its latest digital treatment called deprexis for treating symptoms of depression.

Another digital health company, UpLift Health, created a mobile app that uses cognitive behavioural therapy to help people dealing with depression. It provides 12 rounds of a 45-minute chatbot-guided session where users can answer questions, take mental health exercises and receive feedback and guidance.Meanwhile, a subsidiary of Google's parent Alphabet, X, disclosed in November that it was working on a project called Amber to spot biomarkers of depression..

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Latest Heart News By Amy Norton HealthDay ReporterFRIDAY, kamagra oral jelly uk sales June 25, 2021 A steady lunch routine of cheeseburgers and fries may shorten your life, but loading your dinner plate click to read with vegetables could do the opposite. Those are among the findings of a new study looking at the potential health effects of not only what people eat, but when. Researchers found that U.S kamagra oral jelly uk sales.

Adults who favored a "Western" lunch — heavy in cheese, processed meat, refined grains, fat and sugar — were at heightened risk of premature death from heart disease. The same was true of people who had a penchant for potato chips and other "starchy" snacks between meals. On the opposite end of the spectrum were folks who got plenty of vegetables kamagra oral jelly uk sales — specifically at dinnertime.

They were nearly one-third less likely to die during the study period, versus people whose dinner plates rarely hosted vegetables. Yet people who ate the most vegetables at lunch showed no such benefit. Study author Wei Wei and kamagra oral jelly uk sales colleagues, from Harbin Medical University in China, said the findings point to the potential importance of timing in food choices.

Other experts, though, stressed that it's overall diet quality that matters. "That is one of the findings of this study," said Lauri Wright, an assistant professor of nutrition and dietetics at the University of North Florida. "It still kamagra oral jelly uk sales comes back to diet quality." The fact that unhealthy lunches, specifically, were tied to ill effects does not mean those foods are fine at dinner, said Wright, who is also a spokesperson for the Academy of Nutrition and Dietetics.

So-called Western lunches could be a marker of many other things, she said, including a busy, stressful daily routine that involves a lot of grab-and-go eating. Similarly, Wright said, vegetable-filled dinners could signify other things about people. They might have more time for meal planning, kamagra oral jelly uk sales for instance.

There's no reason, Wright added, that a veggie-rich lunch habit wouldn't be healthy. The findings do raise "some interesting questions" about the timing of certain types of meals and snacks, according to Dr. Anne Thorndike, kamagra oral jelly uk sales an associate professor at Harvard Medical School in Boston.

For example, she said, it's possible that having a veggie-rich meal is more beneficial in the evening than at midday. Or maybe people tend to eat "more diverse and nutrient-rich" vegetables at dinner, Thorndike said. But those are research questions, according to kamagra oral jelly uk sales Thorndike, who is also chair of the American Heart Association's nutrition committee.

She stressed that this study "is not meant to be a guideline for healthy eating," and agreed that people should focus on overall diet quality. "Having two to three servings of vegetables at any time of day — in addition to two to three servings of fruit — remains the priority," Thorndike said. The findings, published June 23 in the kamagra oral jelly uk sales Journal of the American Heart Association, are based on 21,500 U.S.

Adults who took part in a federal study between 2003 and 2014. In general, people eating more plant foods had a lower risk of dying during the study period, while those who favored meat, cheese and processed foods had a higher risk. But timing kamagra oral jelly uk sales seemed to matter.

The one-quarter of people who ate the most Western lunches were 44% more likely to die of heart disease, versus the one-quarter with the least Western lunch patterns. In contrast, people who ate a lot of fruit for lunch were one-third less likely to die of heart disease than those who passed on fruit at their midday meal, the findings showed. Meanwhile, the one-quarter who kamagra oral jelly uk sales ranked highest in the "vegetable" dinner pattern were 23% less likely to die of heart trouble, and 31% less likely to die of any cause.

Those people ate a range of vegetables, as well as beans. There was one habit that seemed bad at any time of day. Eating starchy snacks like kamagra oral jelly uk sales potato chips and pretzels.

People who downed those foods after any meal were over 50% more likely to die of heart ills or other causes, versus those who ate the fewest starchy snacks. Cutting back on those foods throughout the day is wise, Thorndike said. And while night snacking gets a kamagra oral jelly uk sales bad rap, she noted, there's nothing inherently wrong with that timing.

It's just that people often go for starchy or sweet treats. Wright agreed. "People who kamagra oral jelly uk sales snack at night usually don't choose celery," she said.

More information The American Heart Association has advice on healthy eating. SOURCES. Anne Thorndike, MD, MPH, associate professor, medicine, Harvard Medical School, Boston, and chair, nutrition kamagra oral jelly uk sales committee, American Heart Association, Dallas.

Lauri Wright, PhD, RDN, assistant professor, nutrition and dietetics, University of North Florida, Jacksonville, Fla.. Journal of the American Heart Association, June 23, 2021, online Copyright © 2021 HealthDay. All rights kamagra oral jelly uk sales reserved.

SLIDESHOW Heart Disease. Causes of a Heart Attack See SlideshowLatest Heart News THURSDAY, June 24, 2021 (American Heart Association News) Jesse Shea felt a little cloudy when he got up for work on a Monday. He chalked it up to being out later than usual to kamagra oral jelly uk sales watch football with friends.

Jesse drove to the dock in Cape May, New Jersey, where he worked on a tugboat for a salvage operation. It was a demanding job, mentally and physically. But at kamagra oral jelly uk sales 26, Jesse, a former college soccer player, was in the best shape of his life.

He lifted weights daily at his local gym and watched what he ate. He had a bachelor's degree in nutritional science. On the drive to kamagra oral jelly uk sales work, his head felt heavy.

When a friend called, he tried to speak but couldn't. It must be morning throat, he thought. He hadn't spoken to anyone yet that day kamagra oral jelly uk sales.

At work, Jesse went to put on his waterproof overalls. Except, he struggled to walk to where they were hanging. Then it took longer than it should've to put his legs in each side kamagra oral jelly uk sales.

He went to untie the tugboat, but couldn't remember what to do. A co-worker on another boat nearby noticed and shouted, "What's going on?. " Jesse had no kamagra oral jelly uk sales idea.

He took a gulp of water, but it dribbled out of his mouth. He couldn't ignore the signs any longer. "I think I'm stroking out," he texted his kamagra oral jelly uk sales co-worker on the nearby boat.

Jesse didn't even know what that meant, but it was the only explanation that came to mind. He took a few photos of his face and looked at them. His right side kamagra oral jelly uk sales drooped.

Then he realized he couldn't raise his right arm. In a panic, he managed to call his father, but could only cry. In the emergency room of the closest hospital, doctors surrounded Jesse, asking him basic questions kamagra oral jelly uk sales.

"What's your name?. What year is it?. Who kamagra oral jelly uk sales is the president?.

" He didn't know the answers. Tests confirmed a blood clot in his brain. But they kamagra oral jelly uk sales didn't know what caused the stroke.

They gave him medication to try clearing the clot and monitored the response. That night, Jesse could barely move his right arm and couldn't move his fingers at all. Luckily he is left-handed kamagra oral jelly uk sales.

He could swallow only if he concentrated. He had some movement in his right leg and could walk with assistance. A few days later, his older sister, Alex Shea, was on her way to the hospital when she called to see if her parents or other two siblings – all of whom kamagra oral jelly uk sales were spending long hours by Jesse's side – needed anything.

"I was expecting to hear water or coffee," Alex said, "but Jesse had been saying the word 'basketball' for hours." She stopped at a store and bought three sizes. "Jesse took the small one and spent the next eight hours trying over and over to pick it up and throw it," she said. "At first, he couldn't even grasp kamagra oral jelly uk sales it.

By the end of the night, he was throwing it." Jesse's parents had him transferred to a more specialized hospital in hopes of finding the source of the stroke. They couldn't. About 1 in 4 clot-caused strokes in kamagra oral jelly uk sales the U.S.

Are classified as "cryptogenic," meaning no known cause can be identified. Jesse received physical, speech and occupational therapy for a few months. He did much more on kamagra oral jelly uk sales his own.

"A couple days out of the hospital, I was begging someone to bring me to the gym," Jesse said. "For the first six months, if I was awake, I was rehabbing." The owner of his gym let Jesse work out for free. A fellow gym member, Jerry Griffin, kamagra oral jelly uk sales heard about Jesse and wanted to help because he'd been through a similar ordeal.

He helped Jesse learn to walk again and how to do things like swing his arms when he walks. For all his progress, Jesse couldn't return to his kamagra oral jelly uk sales job. He also struggled to regulate his emotions, often feeling either too emotional or not emotional enough.

He had daily headaches and occasionally had symptoms that mimicked a stroke, sending him back to the hospital for days at a time. The swings kamagra oral jelly uk sales affected his motivation. Then he met his new best friend.

Sampson, an English mastiff, the same breed his family had when Jesse was a kid. "I never had my own dog or puppy," he said kamagra oral jelly uk sales. "Suddenly I had to take the dog out every 20 minutes.

That got me going." Jesse also found inspiration from David Goggins, a former Navy Seal turned endurance athlete and motivational speaker. "His message is, kamagra oral jelly uk sales you can always come back from something. Everyone goes through bad times," Jesse said.

He no longer had the fine motor skills he needed for soccer, so he turned to distance running. This past November, only one year after his stroke, he ran a virtual half-marathon and raised kamagra oral jelly uk sales more than $10,000 for the American Stroke Association. Dozens of friends cheered him on, with a party at the finish line.

QUESTION What is a stroke?. See Answer A few months after running 13.1 kamagra oral jelly uk sales miles, Jesse completed a challenge that required running 4 miles every four hours for 48 hours – a total of 48 miles over two days. Despite these impressive feats, Jesse is hesitant to declare himself recovered.

He knows he's not the same person he was before the stroke. "I had a general sharpness and now I'm just kamagra oral jelly uk sales not as crisp," he said. "But I feel like I'm improving every day." American Heart Association News covers heart and brain health.

Not all views expressed in this story reflect the official position of the American Heart Association. Copyright is owned or held by the American Heart Association, Inc., and all rights are kamagra oral jelly uk sales reserved. If you have questions or comments about this story, please email [email protected].

By Diane Daniel American Heart Association News Copyright © 2021 HealthDay. All rights kamagra oral jelly uk sales reserved. From Healthy Resources Featured Centers Health Solutions From Our SponsorsLatest Sexual Health News FRIDAY, June 25, 2021 (HealthDay News) Think the sex lives of Americans took a hit during the kamagra?.

Think again. New research kamagra oral jelly uk sales finds there's been a jump in sales of erectile dysfunction (ED) drugs, especially Cialis (tadalafil), in the United States over the past year. "We saw a huge spike in sales of daily use erectile dysfunction drugs, which suggests that some people were having more spontaneous sex than ever -- with their partners at home, they wanted to always be ready," said senior study author Dr.

Benjamin Davies, a professor of urology at the University of Pittsburgh's School of Medicine. His team compared sales of ED kamagra oral jelly uk sales drugs before March 2020 and during the initial months of the kamagra, March to December 2020. To account for other factors that might influence the sale of the drugs -- such as access to pharmacies -- the study authors also analyzed the sales of other urological drugs, which didn't change in the months after the kamagra was declared.

There was a short decrease in ED medication sales in March and April 2020, but sales of the drugs have steadily risen since then, according to the findings outlined in a research letter published June 25 in the Journal of Internal Medicine. In particular, sales of Cialis (tadalafil) -- a longer-acting drug that's taken daily to kamagra oral jelly uk sales help with more spontaneous sexual activity -- nearly doubled between February and December of 2020, the researchers found. "Changes in sales of erectile dysfunction drugs can indicate important problems and point out issues in people's general well-being," Davies said in a university news release.

"People's sexual lives contribute to the psychosocial fabric of society." Davies also directs the Urologic Oncology Program at Hillman Cancer Center, which is part of the University of Pittsburgh Medical Center. More information Harvard Medical School has more on erectile kamagra oral jelly uk sales dysfunction drugs. SOURCE.

University of Pittsburgh, news release, June 25, 2021 Robert Preidt Copyright © 2021 HealthDay. All rights reserved kamagra oral jelly uk sales. QUESTION Erectile dysfunction (ED) is… See AnswerLatest erectile dysfunction News FRIDAY, June 25, 2021 (HealthDay News) The first case of erectile dysfunction treatment may have occurred in China weeks earlier than previously thought, a new study claims.

The first officially identified case occurred in early December 2019, but increasing evidence suggests the original case may have emerged earlier. In this study, British kamagra oral jelly uk sales researchers conducted a new analysis and concluded that the first case of erectile dysfunction treatment arose between early October and mid-November of 2019 in China, with the most likely date of origin being Nov. 17.

"The method we used was originally developed by me and a colleague to date extinctions, however, here we use it to date the origination and spread of erectile dysfunction treatment," said study author David Roberts, from the University of Kent, in the United Kingdom. "This novel application within the field of epidemiology offers a new opportunity to understand the emergence and spread of diseases as it only requires a small amount kamagra oral jelly uk sales of data," Roberts explained. For the study, his team repurposed a mathematical model originally developed by conservation scientists to determine the date of extinction of a species, based on recorded sightings of the species.

They reversed the method to determine the date when erectile dysfunction treatment most likely originated, based on when some of the earliest known cases occurred in 203 countries. Along with pushing back the likely kamagra oral jelly uk sales date of the first case, the findings suggest that the kamagra spread more quickly than what's officially accepted, the study authors added. For example, the new analysis estimates that the first case outside of China occurred in Japan on Jan.

3, 2020, the first case in Europe occurred in Spain on Jan. 12, 2020, kamagra oral jelly uk sales and the first case in North America occurred in the United States on Jan. 16, 2020.

The findings were published online June 24 in the journal PLOS Pathogens. Learning more about of the origins of erectile dysfunction treatment could improve understanding of its continued spread, Roberts said in kamagra oral jelly uk sales a journal news release. The approach used in this study could be applied to better understand the spread of other infectious diseases in the future, he added.

More information The U.S. Centers for Disease Control and Prevention has more on erectile dysfunction treatment kamagra oral jelly uk sales. SOURCE.

PLOS Pathogens, news release, June 24, 2021 Robert Preidt Copyright © 2021 HealthDay. All rights reserved.Latest Mental Health News FRIDAY, June kamagra oral jelly uk sales 25, 2021 (HealthDay News) U.S. High school seniors say marijuana was significantly harder to come by during the kamagra — yet their use of the drug continued at rates similar to those before school closures began, a new study finds.

Their binge-drinking also continued at similar rates, according to the U.S. National Institute on Drug kamagra oral jelly uk sales Abuse (NIDA). "Last year brought dramatic changes to adolescents' lives, as many teens remained home with parents and other family members full time," said NIDA director Dr.

Nora Volkow. "It is striking that despite this monumental shift and teens' perceived decreases in availability of marijuana and alcohol, usage rates held steady kamagra oral jelly uk sales for these substances. This indicates that teens were able to obtain them despite barriers caused by the kamagra and despite not being of age to legally purchase them." For the study, lead author Richard Miech of the University of Michigan in Ann Arbor and colleagues used an annual survey of substance use behaviors and attitudes among U.S.

Teens to assess the kamagra's impact. The spring 2020 survey gathered responses from 3,770 students between mid-February and mid-March, but was stopped early because of kamagra oral jelly uk sales school closures. A summer survey that could be completed outside school followed up with 582 students between mid-July and mid-August 2020.

The teens reported the largest year-to-year decreases in perceived availability of marijuana and alcohol in the survey's 46 years. For marijuana, the percentage of students who reported "fairly" or "very" easy access dropped 17 points — from 76% kamagra oral jelly uk sales in the spring before the kamagra to 59%. For alcohol, it dropped 24 points, from 86% to 62%.

Even with lower perceived availability, about 20% of students said they had used marijuana in the past month, compared with 23% before the kamagra. And 13% reported binge drinking in the past two weeks during the kamagra compared with kamagra oral jelly uk sales 17% before. The authors cited the wide availability of alcohol and marijuana as a factor in the continued use of these substances.

One behavior that did decline substantially was vaping, the study authors noted. Before the kamagra, 24% of respondents said they had vaped nicotine in the kamagra oral jelly uk sales past month, compared with 17% during the kamagra. In all, 73% said they could "fairly" or "very" easily obtain a vaping device before the kamagra, compared with 63% during the kamagra, the findings showed.

The legal purchase age is 21 for nicotine products and alcohol in all states, and for cannabis in states that have legalized recreational use, the researchers noted in a NIDA news release. The decline in vaping dovetailed with a 2020 change in the kamagra oral jelly uk sales federal minimum age for tobacco product purchases, including vaping devices and liquids. The new minimum age is 21 years.

"These findings suggest that reducing adolescent substance use through attempts to restrict supply alone would be a difficult undertaking," said Miech, of the Monitoring the Future study. "The best strategy is likely to be one that combines approaches to limit the supply of these substances with efforts to decrease demand, through educational and kamagra oral jelly uk sales public health campaigns." The survey results were published online June 24 in Drug and Alcohol Dependence. More information The U.S.

Centers for Disease Control and Prevention has more on teen substance use and risks. SOURCE. U.S.

National Institute on Drug Abuse, news release, June 24, 2021 Cara Murez Copyright © 2021 HealthDay. All rights reserved. QUESTION What are opioids used to treat?.

Latest Heart News By Amy Norton HealthDay ReporterFRIDAY, June 25, 2021 A steady lunch routine of cheeseburgers and fries may shorten your http://markgrigsby.com/buy-seroquel-online-cheap life, buy kamagra tablets but loading your dinner plate with vegetables could do the opposite. Those are among the findings of a new study looking at the potential health effects of not only what people eat, but when. Researchers found buy kamagra tablets that U.S. Adults who favored a "Western" lunch — heavy in cheese, processed meat, refined grains, fat and sugar — were at heightened risk of premature death from heart disease.

The same was true of people who had a penchant for potato chips and other "starchy" snacks between meals. On the opposite end of the spectrum were folks who got buy kamagra tablets plenty of vegetables — specifically at dinnertime. They were nearly one-third less likely to die during the study period, versus people whose dinner plates rarely hosted vegetables. Yet people who ate the most vegetables at lunch showed no such benefit.

Study author Wei Wei and colleagues, from Harbin Medical University in China, said the findings point to the potential importance of timing in buy kamagra tablets food choices. Other experts, though, stressed that it's overall diet quality that matters. "That is one of the findings of this study," said Lauri Wright, an assistant professor of nutrition and dietetics at the University of North Florida. "It still comes back to diet quality." buy kamagra tablets The fact that unhealthy lunches, specifically, were tied to ill effects does not mean those foods are fine at dinner, said Wright, who is also a spokesperson for the Academy of Nutrition and Dietetics.

So-called Western lunches could be a marker of many other things, she said, including a busy, stressful daily routine that involves a lot of grab-and-go eating. Similarly, Wright said, vegetable-filled dinners could signify other things about people. They might have more time for meal planning, for buy kamagra tablets instance. There's no reason, Wright added, that a veggie-rich lunch habit wouldn't be healthy.

The findings do raise "some interesting questions" about the timing of certain types of meals and snacks, according to Dr. Anne Thorndike, an buy kamagra tablets associate professor at Harvard Medical School in Boston. For example, she said, it's possible that having a veggie-rich meal is more beneficial in the evening than at midday. Or maybe people tend to eat "more diverse and nutrient-rich" vegetables at dinner, Thorndike said.

But those are research questions, according to Thorndike, who buy kamagra tablets is also chair of the American Heart Association's nutrition committee. She stressed that this study "is not meant to be a guideline for healthy eating," and agreed that people should focus on overall diet quality. "Having two to three servings of vegetables at any time of day — in addition to two to three servings of fruit — remains the priority," Thorndike said. The findings, published June 23 in the Journal buy kamagra tablets of the American Heart Association, are based on 21,500 U.S.

Adults who took part in a federal study between 2003 and 2014. In general, people eating more plant foods had a lower risk of dying during the study period, while those who favored meat, cheese and processed foods had a higher risk. But timing buy kamagra tablets seemed to matter. The one-quarter of people who ate the most Western lunches were 44% more likely to die of heart disease, versus the one-quarter with the least Western lunch patterns.

In contrast, people who ate a lot of fruit for lunch were one-third less likely to die of heart disease than those who passed on fruit at their midday meal, the findings showed. Meanwhile, the one-quarter who ranked highest in the "vegetable" dinner pattern were 23% less likely to die of buy kamagra tablets heart trouble, and 31% less likely to die of any cause. Those people ate a range of vegetables, as well as beans. There was one habit that seemed bad at any time of day.

Eating starchy snacks buy kamagra tablets like potato chips and pretzels. People who downed those foods after any meal were over 50% more likely to die of heart ills or other causes, versus those who ate the fewest starchy snacks. Cutting back on those foods throughout the day is wise, Thorndike said. And while night snacking gets a bad rap, she noted, there's nothing inherently wrong with that buy kamagra tablets timing.

It's just that people often go for starchy or sweet treats. Wright agreed. "People who snack at buy kamagra tablets night usually don't choose celery," she said. More information The American Heart Association has advice on healthy eating.

SOURCES. Anne Thorndike, MD, MPH, associate professor, buy kamagra tablets medicine, Harvard Medical School, Boston, and chair, nutrition committee, American Heart Association, Dallas. Lauri Wright, PhD, RDN, assistant professor, nutrition and dietetics, University of North Florida, Jacksonville, Fla.. Journal of the American Heart Association, June 23, 2021, online Copyright © 2021 HealthDay.

All rights reserved buy kamagra tablets. SLIDESHOW Heart Disease. Causes of a Heart Attack See SlideshowLatest Heart News THURSDAY, June 24, 2021 (American Heart Association News) Jesse Shea felt a little cloudy when he got up for work on a Monday. He chalked it up to being out later than usual to watch buy kamagra tablets football with friends.

Jesse drove to the dock in Cape May, New Jersey, where he worked on a tugboat for a salvage operation. It was a demanding job, mentally and physically. But at 26, Jesse, a former college soccer player, was in the best shape buy kamagra tablets of his life. He lifted weights daily at his local gym and watched what he ate.

He had a bachelor's degree in nutritional science. On the drive to buy kamagra tablets work, his head felt heavy. When a friend called, he tried to speak but couldn't. It must be morning throat, he thought.

He hadn't spoken to buy kamagra tablets anyone yet that day. At work, Jesse went to put on his waterproof overalls. Except, he struggled to walk to where they were hanging. Then it took longer than it buy kamagra tablets should've to put his legs in each side.

He went to untie the tugboat, but couldn't remember what to do. A co-worker on another boat nearby noticed and shouted, "What's going on?. " Jesse buy kamagra tablets had no idea. He took a gulp of water, but it dribbled out of his mouth.

He couldn't ignore the signs any longer. "I think I'm stroking out," he texted his co-worker on buy kamagra tablets the nearby boat. Jesse didn't even know what that meant, but it was the only explanation that came to mind. He took a few photos of his face and looked at them.

His right buy kamagra tablets side drooped. Then he realized he couldn't raise his right arm. In a panic, he managed to call his father, but could only cry. In the emergency room of buy kamagra tablets the closest hospital, doctors surrounded Jesse, asking him basic questions.

"What's your name?. What year is it?. Who buy kamagra tablets is the president?. " He didn't know the answers.

Tests confirmed a blood clot in his brain. But they didn't know what caused the stroke buy kamagra tablets. They gave him medication to try clearing the clot and monitored the response. That night, Jesse could barely move his right arm and couldn't move his fingers at all.

Luckily he buy kamagra tablets is left-handed. He could swallow only if he concentrated. He had some movement in his right leg and could walk with assistance. A few days later, his older sister, Alex Shea, buy kamagra tablets was on her way to the hospital when she called to see if her parents or other two siblings – all of whom were spending long hours by Jesse's side – needed anything.

"I was expecting to hear water or coffee," Alex said, "but Jesse had been saying the word 'basketball' for hours." She stopped at a store and bought three sizes. "Jesse took the small one and spent the next eight hours trying over and over to pick it up and throw it," she said. "At first, buy kamagra tablets he couldn't even grasp it. By the end of the night, he was throwing it." Jesse's parents had him transferred to a more specialized hospital in hopes of finding the source of the stroke.

They couldn't. About 1 in 4 clot-caused strokes buy kamagra tablets in the U.S. Are classified as "cryptogenic," meaning no known cause can be identified. Jesse received physical, speech and occupational therapy for a few months.

He did much buy kamagra tablets more on his own. "A couple days out of the hospital, I was begging someone to bring me to the gym," Jesse said. "For the first six months, if I was awake, I was rehabbing." The owner of his gym let Jesse work out for free. A fellow gym member, Jerry Griffin, heard about Jesse and wanted to help because he'd been through a similar buy kamagra tablets ordeal.

He helped Jesse learn to walk again and how to do things like swing his arms when he walks. For all his progress, Jesse couldn't return to his buy kamagra tablets job. He also struggled to regulate his emotions, often feeling either too emotional or not emotional enough. He had daily headaches and occasionally had symptoms that mimicked a stroke, sending him back to the hospital for days at a time.

The swings buy kamagra tablets affected his motivation. Then he met his new best friend. Sampson, an English mastiff, the same breed his family had when Jesse was a kid. "I never buy kamagra tablets had my own dog or puppy," he said.

"Suddenly I had to take the dog out every 20 minutes. That got me going." Jesse also found inspiration from David Goggins, a former Navy Seal turned endurance athlete and motivational speaker. "His message is, buy kamagra tablets you can always come back from something. Everyone goes through bad times," Jesse said.

He no longer had the fine motor skills he needed for soccer, so he turned to distance running. This past November, only one year after buy kamagra tablets his stroke, he ran a virtual half-marathon and raised more than $10,000 for the American Stroke Association. Dozens of friends cheered him on, with a party at the finish line. QUESTION What is a stroke?.

See Answer A few months after running 13.1 miles, Jesse completed a challenge that required running buy kamagra tablets 4 miles every four hours for 48 hours – a total of 48 miles over two days. Despite these impressive feats, Jesse is hesitant to declare himself recovered. He knows he's not the same person he was before the stroke. "I had a general sharpness and now I'm just not buy kamagra tablets as crisp," he said.

"But I feel like I'm improving every day." American Heart Association News covers heart and brain health. Not all views expressed in this story reflect the official position of the American Heart Association. Copyright is owned or held by the American Heart buy kamagra tablets Association, Inc., and all rights are reserved. If you have questions or comments about this story, please email [email protected].

By Diane Daniel American Heart Association News Copyright © 2021 HealthDay. All rights buy kamagra tablets reserved. From Healthy Resources Featured Centers Health Solutions From Our SponsorsLatest Sexual Health News FRIDAY, June 25, 2021 (HealthDay News) Think the sex lives of Americans took a hit during the kamagra?. Think again.

New research finds there's been a jump in sales of erectile dysfunction (ED) drugs, especially Cialis (tadalafil), in the United States over the buy kamagra tablets past year. "We saw a huge spike in sales of daily use erectile dysfunction drugs, which suggests that some people were having more spontaneous sex than ever -- with their partners at home, they wanted to always be ready," said senior study author Dr. Benjamin Davies, a professor of urology at the University of Pittsburgh's School of Medicine. His team compared sales of ED drugs before March 2020 buy kamagra tablets and during the initial months of the kamagra, March to December 2020.

To account for other factors that might influence the sale of the drugs -- such as access to pharmacies -- the study authors also analyzed the sales of other urological drugs, which didn't change in the months after the kamagra was declared. There was a short decrease in ED medication sales in March and April 2020, but sales of the drugs have steadily risen since then, according to the findings outlined in a research letter published June 25 in the Journal of Internal Medicine. In particular, sales of Cialis (tadalafil) -- a longer-acting drug that's taken daily to buy kamagra tablets help with more spontaneous sexual activity -- nearly doubled between February and December of 2020, the researchers found. "Changes in sales of erectile dysfunction drugs can indicate important problems and point out issues in people's general well-being," Davies said in a university news release.

"People's sexual lives contribute to the psychosocial fabric of society." Davies also directs the Urologic Oncology Program at Hillman Cancer Center, which is part of the University of Pittsburgh Medical Center. More information Harvard buy kamagra tablets Medical School has more on erectile dysfunction drugs. SOURCE. University of Pittsburgh, news release, June 25, 2021 Robert Preidt Copyright © 2021 HealthDay.

All rights buy kamagra tablets reserved. QUESTION Erectile dysfunction (ED) is… See AnswerLatest erectile dysfunction News FRIDAY, June 25, 2021 (HealthDay News) The first case of erectile dysfunction treatment may have occurred in China weeks earlier than previously thought, a new study claims. The first officially identified case occurred in early December 2019, but increasing evidence suggests the original case may have emerged earlier. In this study, British researchers conducted a new buy kamagra tablets analysis and concluded that the first case of erectile dysfunction treatment arose between early October and mid-November of 2019 in China, with the most likely date of origin being Nov.

17. "The method we used was originally developed by me and a colleague to date extinctions, however, here we use it to date the origination and spread of erectile dysfunction treatment," said study author David Roberts, from the University of Kent, in the United Kingdom. "This novel buy kamagra tablets application within the field of epidemiology offers a new opportunity to understand the emergence and spread of diseases as it only requires a small amount of data," Roberts explained. For the study, his team repurposed a mathematical model originally developed by conservation scientists to determine the date of extinction of a species, based on recorded sightings of the species.

They reversed the method to determine the date when erectile dysfunction treatment most likely originated, based on when some of the earliest known cases occurred in 203 countries. Along with pushing back the likely date of the first case, the findings suggest that the kamagra spread more quickly than what's officially buy kamagra tablets accepted, the study authors added. For example, the new analysis estimates that the first case outside of China occurred in Japan on Jan. 3, 2020, the first case in Europe occurred in Spain on Jan.

12, 2020, and the first case in North America occurred in buy kamagra tablets the United States on Jan. 16, 2020. The findings were published online June 24 in the journal PLOS Pathogens. Learning more about of the origins of erectile dysfunction treatment could buy kamagra tablets improve understanding of its continued spread, Roberts said in a journal news release.

The approach used in this study could be applied to better understand the spread of other infectious diseases in the future, he added. More information The U.S. Centers for buy kamagra tablets Disease Control and Prevention has more on erectile dysfunction treatment. SOURCE.

PLOS Pathogens, news release, June 24, 2021 Robert Preidt Copyright © 2021 HealthDay. All rights reserved.Latest Mental Health buy kamagra tablets News FRIDAY, June 25, 2021 (HealthDay News) U.S. High school seniors say marijuana was significantly harder to come by during the kamagra — yet their use of the drug continued at rates similar to those before school closures began, a new study finds. Their binge-drinking also continued at similar rates, according to the U.S.

National Institute on Drug Abuse buy kamagra tablets (NIDA). "Last year brought dramatic changes to adolescents' lives, as many teens remained home with parents and other family members full time," said NIDA director Dr. Nora Volkow. "It is striking that despite this monumental shift and teens' buy kamagra tablets perceived decreases in availability of marijuana and alcohol, usage rates held steady for these substances.

This indicates that teens were able to obtain them despite barriers caused by the kamagra and despite not being of age to legally purchase them." For the study, lead author Richard Miech of the University of Michigan in Ann Arbor and colleagues used an annual survey of substance use behaviors and attitudes among U.S. Teens to assess the kamagra's impact. The spring 2020 survey gathered responses from 3,770 students between mid-February and mid-March, but buy kamagra tablets was stopped early because of school closures. A summer survey that could be completed outside school followed up with 582 students between mid-July and mid-August 2020.

The teens reported the largest year-to-year decreases in perceived availability of marijuana and alcohol in the survey's 46 years. For marijuana, the percentage of students who reported "fairly" or "very" easy access dropped 17 points — buy kamagra tablets from 76% in the spring before the kamagra to 59%. For alcohol, it dropped 24 points, from 86% to 62%. Even with lower perceived availability, about 20% of students said they had used marijuana in the past month, compared with 23% before the kamagra.

And 13% reported binge drinking in the past two weeks during buy kamagra tablets the kamagra compared with 17% before. The authors cited the wide availability of alcohol and marijuana as a factor in the continued use of these substances. One behavior that did decline substantially was vaping, the study authors noted. Before the kamagra, 24% of respondents said they had vaped nicotine in the past month, compared with 17% during buy kamagra tablets the kamagra.

In all, 73% said they could "fairly" or "very" easily obtain a vaping device before the kamagra, compared with 63% during the kamagra, the findings showed. The legal purchase age is 21 for nicotine products and alcohol in all states, and for cannabis in states that have legalized recreational use, the researchers noted in a NIDA news release. The decline in vaping dovetailed with a 2020 change in the federal minimum age for tobacco product purchases, buy kamagra tablets including vaping devices and liquids. The new minimum age is 21 years.

"These findings suggest that reducing adolescent substance use through attempts to restrict supply alone would be a difficult undertaking," said Miech, of the Monitoring the Future study. "The best strategy is likely to be one that combines buy kamagra tablets approaches to limit the supply of these substances with efforts to decrease demand, through educational and public health campaigns." The survey results were published online June 24 in Drug and Alcohol Dependence. More information The U.S. Centers for Disease Control and Prevention has more on teen substance use and risks.

SOURCE. U.S. National Institute on Drug Abuse, news release, June 24, 2021 Cara Murez Copyright © 2021 HealthDay. All rights reserved.

QUESTION What are opioids used to treat?. See Answer.

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Keep out of reach of children. Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Throw away any unused medicine after the expiration date.

How to spot fake kamagra

TTHealthWatch is a weekly How much seroquel cost podcast how to spot fake kamagra from Texas Tech. In it, Elizabeth Tracey, director of electronic media for Johns Hopkins Medicine, and Rick Lange, MD, president of the Texas Tech University Health Sciences Center in El Paso, look at the top medical stories of the week. A transcript of the podcast is below the summary.This week's topics include revascularization in how to spot fake kamagra people with both MI and shock, a new targeted therapy for some thyroid and lung cancers, remdesivir in moderate erectile dysfunction treatment disease, and the risk of erectile dysfunction treatment for those with cancer.Program notes:0:37 Cancer and erectile dysfunction treatment risk1:37 Specific type of cancer2:33 Individualized risk category3:33 Individual numbers were small4:03 Use of remdesivir in moderate disease5:03 Used an ordinal scale to assess6:03 New targeted agent selpercatinib7:03 Overall 2% of cancers8:12 Valuable addition for this mutation9:06 Effective, durable and minimal side effects10:02 Identify the pathway and target10:26 Heart attack, shock and revascularization11:26 CATH-PCI registry12:09 May need additional procedures later13:14 EndTranscript:Elizabeth Tracey. How does erectile dysfunction treatment affect people with cancer?. Rick Lange.

Best coronary interventions in people with heart attacks and how to spot fake kamagra shock.Elizabeth. A new targeted agent for some types of thyroid and lung cancers.Rick. And remdesivir in people with moderate erectile dysfunction treatment -- helpful or not?. Elizabeth. That's what we're talking about this week on TT HealthWatch, your weekly look at the medical headlines from Texas Tech University Health Sciences Center in El Paso.

I'm Elizabeth Tracey, a Baltimore-based medical journalist.Rick. And I'm Rick Lange, President of Texas Tech University Health Sciences Center in El Paso and Dean of the Paul L. Foster School of Medicine.Elizabeth. Rick, how about if we start with the erectile dysfunction treatment ones first and then we can move on to the ones that are not erectile dysfunction treatment?. This week, we have 50/50.

The first one I'd like to talk about is the one that's in Lancet Oncology. It's taking a look at erectile dysfunction treatment and how does that impact on people with various types of cancer?. Their a priori hypothesis -- and I think many of us would have thought this also -- is that folks who have cancer probably are at higher likelihood of having more severe disease and poor outcomes.In the UK, they did a registry that's called the UK erectile dysfunction Cancer Monitoring Project. In this study, they looked between March 18th and May 8th. They had adult patients with cancer enrolled in this and then they also had a parallel non-erectile dysfunction treatment UK cancer control population.319 of their 1,044 patients in this cohort died and 92.5% of those had a cause of death recorded as due to erectile dysfunction treatment.

So the numbers compress, of course, and when they take a look at specific types of cancers, they find that it's the patients with leukemia who showed a significantly increased case fatality rate. They corrected, of course, for age and sex, and those hematologic malignancies, especially among those who had recently had chemotherapy, had an increased risk of death relative to erectile dysfunction treatment admission.Rick. Obviously, there are a number of risk factors for having severe disease and death -- age, obesity, diabetes, hypertension, lung disease, kidney disease -- and people have assumed that cancer also increases your risk of having severe or life-threatening erectile dysfunction treatment .This study allowed the investigators to look at all types of cancers and what they found particularly was that the presence of a solid tumor cancer -- something like a kidney cancer, or a GI cancer, or even lung cancer -- did not increase the risk of having severe erectile dysfunction treatment or dying from erectile dysfunction treatment . It was just the hematologic malignancies that you mentioned. Now, what this allows them to do is to have an individualized risk categorization for each of the patients.

When you're taking care of a patient with lung cancer, do you have to be more or less concerned and therefore change your chemotherapy?. People have shortened radiotherapy, they've switched from IV to oral chemotherapy regimens, and they've also modified immunotherapy. It suggests that, in fact, in people with solid tumors that's probably not necessary.Elizabeth. I think all of this is good news because, of course, people have been extremely reluctant to come to medical centers and continue treatment because they've been concerned about erectile dysfunction treatment. As we've noted before, I feel substantially safer in the hospital than I feel anywhere else in town, so that concern, at least, is something I would probably put to rest.I think one thing that was somewhat disappointing about this study and that I would like to see confirmed is the numbers because, as we've talked about before, when you start to parse those into the various types of malignancies, I'd sure like to see much bigger numbers so that I could feel more comfortable with the outcomes.Rick.

Yep. Either individual numbers of pancreatic cancer, and prostate cancer, and lung cancer were all small. But, again, they were able to take a large group -- solid tumors versus hematologic malignancies like leukemia, lymphoma, multiple myeloma -- and those large categories were able to determine that it was the latter that had the increased risk. I agree, but these are the largest numbers we have to date.Elizabeth. Let's talk about your erectile dysfunction treatment one.

That's in the Journal of the American Medical Association, "How early should we be using remdesivir?. " That's what I'll call it.Rick. Even, should we at all?. Now you say, "Well, of course we should be. We've already had those studies and proven that." The studies that showed that remdesivir were helpful were those that had severe erectile dysfunction treatment .

They were hospitalized and they had a decrease in their blood oxygen content, hypoxia, or hypoxemia.In a large trial of over 1,000 people sponsored by the NIH, it showed that remdesivir, if done early, can actually decrease the hospital stay by 4 days, -- from 15 days to 11 days -- but there was no change in the mortality. That's the severe erectile dysfunction treatment-infected. What about those that have moderate erectile dysfunction treatment ?. There were about 600 individuals. You have evidence of erectile dysfunction treatment , you have pulmonary infiltrates -- they could see it on your lungs -- but you don't require oxygen.

Those 600 people got randomized to either have 5 days of remdesivir, 10 days of remdesivir, or just standard care.Those that received 10 days versus those that received standard care, their outcome was essentially the same. Those that received 5 days of remdesivir appeared to do a little bit better, but the clinical significance of it really isn't very clear because they used what's called an ordinal scale that ranged from everything from, "Did the patient need hospitalization?. " to "Were they dead?. "Each of those things wasn't similarly affected by remdesivir and some are more significant than others. For example, dying is a much more significant event than going to be hospitalized or needing to be put on nasal oxygen.

The authors were really kind of muted. They said, "Well, it looks like it could be beneficial." But clinical significance, really not very evident.Elizabeth. And it's kind of expensive, so putting people on that stuff if they don't really need it doesn't make any sense to me. Remind me again about the side effect profile.Rick. Relatively minor side effects.

Now, it's interesting because only about three-fourths of the individuals actually completed the 5-day course. Only about 40% completed the 10-day course because they left the hospital earlier, which made it even a little bit more complicated. I think that the studies show for people with severe , it can shorten your hospital stay. But in those with moderate , I'd say the jury's still out.Elizabeth. Leaving our erectile dysfunction treatment things then, let's turn to the New England Journal of Medicine, back to cancer, a new targeted agent called selpercatinib, which takes aim at specific mutations that are called RET -- that's capital R-E-T- -- altered cancers.

There are two studies that are in here, one taking a look at thyroid cancers and the other taking a look at non-small cell lung cancers.It turns out that with regard to the thyroid cancers, more than 50% of sporadic medullary thyroid cancers have this particular RET mutation and 10% to 20% of papillary thyroid cancers. [There are] much smaller percentages of non-small cell lung cancers in the second study, but also colorectal, breast, and other cancers.This particular mutation generates docking sites for downstream signaling adapters and that activates multiple key cancer effectors, so that's how this thing works. And when you take a look overall among a group of diverse cancers, these aberrations have been identified in approximately 2% of the cases of cancer.In the thyroid cancers, they had 55 patients with the medullary thyroid cancer previously treated. Sixty-nine percent had a response to the agent with 82% progression-free survival at one year. Among 88 patients who had the same mutation and medullary thyroid cancer not previously treated, only 73% -- which I think is a little curious -- had a response to selpercatinib, while 92% had progression-free survival at one year.

Finally, in 15 of 19 patients with previously treated RET fusion-positive thyroid cancer, 79% had a response.With regard to non-small cell lung cancer, they had 105 patients with this mutation, previously been treated with platinum-based chemotherapy, 64% response, and 39 previously untreated patients, 85% had a response. And finally, in 10 of 11 patients with central nervous system metastases had an intracranial response to the agent.This looks like a valuable addition for that 2% of total cancers that express this particular mutation and suggests to me that something we've asserted many times about cancer, that clinically we call it cancer -- but actually, if we take a look at really what this disease is, it's a multitude of different diseases.Rick. Elizabeth, and I'm glad you brought that point up because this therapy was effective in lung cancer and thyroid cancer. You say, "Well, those are two different organs." But the mechanism for the growth of the cancer was the same in both these of types of cancers.As you mentioned, it's the RET protein. That RET protein typically signals growth of cells.

When it mutates or fuses, there's uncontrolled growth of these cells. That's what causes cancer. So what we're moving from is an organ-specific therapy to the molecular mechanisms behind it so we can get really specific targeted therapies.This particular RET therapy was effective, it was durable, and importantly, the side effects were really minimal. Only 2% to 3% percent of individuals that were taking the medication had to stop it because of the side effects. It's one of several different targeted therapies that's now available.Elizabeth.

Right. I guess one of my concerns is a) the expense of developing these targeted therapies and getting them to market, and b) the fact that overall 2% of cancers manifest this particular mutation. So does that mean we're going to peck away at all of these different mutations in order to develop that entire armamentarium of targeted agents that are going to help everybody with cancer?. Rick. That's a great question.

I can foresee a time we look at those individual pathways that we know, and although this one may account for less than 2% of cancers, another one may be 5%, another one be 4% or 3%. So in toto, what we should be able to do is identify the pathways that are activated in a particular cancer and have specific therapies towards that. I think that's the future. It's targeted therapy towards the molecular mechanism, not targeted towards the organ.Elizabeth. Well, I'm just going to say that what I'm hoping for the future is that we're going to develop blood tests that are specific for this, be able to catch the things super early before they even start to manifest as any particular tumor type.

Let's turn to your final one in JAMA Internal Medicine.Rick. Elizabeth, we're going to talk about individuals who have heart attacks -- then after that, or as a result of that, have shock, and their mortality's been very high, as high as 50%.Now, we know that when someone's having a heart attack, if you open their artery up, restore blood flow, you improve their overall outcome. But 70% to 80% of these people that have heart attacks and shock have more than one blood vessel involved. Only one has the clot that's caused the acute heart attack, but there are other blood vessels with blockages or stenosis.The question is when you're taking pictures and you identify that, do you just open the one artery or should you open all the arteries to improve overall outcome?. That's what this study addressed.

Do we do just the culprit vessel or do all vessels to do this?. This is a follow-up on a randomized controlled trial.Now, you say, "Well, why would you want to do this after a randomized controlled trial that showed that only doing the culprit vessel was the best way to do it?. " Well, because it's a very selected population and sometimes it's not a real-world experience. To address whether this applies in the real world, they used results from the CathPCI Registry. That's a registry of everybody that has a cardiac catheterization.There were over 64,000 patients at over 1,600 hospitals that had a heart attack and shock.

Some of those individuals had all the blood vessels opened, about a third of them did, and about two-thirds just had that single blood vessel opened.Doing the single blood vessel ended up with a better outcome. If you opened all blood vessels, you had a higher risk of dying and a higher risk of having complications as a result of the procedure as well.Elizabeth. A couple of other things that they mentioned in this study. One is that when you only have the culprit vessel done, you were at higher risk for subsequent ... Requiring additional revascularization or readmission for heart failure down the road.Rick.

You may need to have additional procedures in some patients down the road, but the thing is they live through the hospitalization. You don't kill them during the hospitalization [because] of complication.Here's why this is particularly important. When people present with a heart attack and don't have shock but have multi-vessel disease, studies have shown they do better if you open all their blood vessels up.Ten years ago I helped write those guidelines. We would have said, "Oh, my goodness. When you're having an acute heart attack, don't open all the blood vessels.

When you're having shock, open them all up." Now what the studies have shown is just the opposite.Elizabeth. That's so fascinating and so tell me, how often do shock and MI occur together?. Rick. That's a great question. It's obviously more likely to occur in people that have either had a previous heart attack or [are] older.

I would say it's probably in the neighborhood of about 10% or 15%. Most people with acute heart attack don't have shock. But those that do, the mortality is very high.Elizabeth. Good information, then. On that note, that's a look at this week's medical headlines from Texas Tech.

I'm Elizabeth Tracey.Rick. I'm Rick Lange. Y'all listen up and make healthy choices. Last Updated August 28, 2020.

TTHealthWatch is a buy kamagra tablets weekly podcast from Texas Tech. In it, Elizabeth Tracey, director of electronic media for Johns Hopkins Medicine, and Rick Lange, MD, president of the Texas Tech University Health Sciences Center in El Paso, look at the top medical stories of the week. A transcript of the podcast is below the summary.This week's topics include revascularization in people with both MI and shock, a new targeted therapy for some thyroid and lung cancers, remdesivir in moderate erectile dysfunction treatment disease, and the risk of erectile dysfunction treatment for those with cancer.Program notes:0:37 Cancer and erectile dysfunction treatment risk1:37 Specific type of cancer2:33 Individualized risk category3:33 Individual numbers were small4:03 Use of remdesivir in moderate disease5:03 Used an ordinal scale to assess6:03 New targeted agent selpercatinib7:03 Overall 2% of cancers8:12 Valuable addition for this mutation9:06 Effective, durable and minimal side buy kamagra tablets effects10:02 Identify the pathway and target10:26 Heart attack, shock and revascularization11:26 CATH-PCI registry12:09 May need additional procedures later13:14 EndTranscript:Elizabeth Tracey. How does erectile dysfunction treatment affect people with cancer?.

Rick Lange. Best coronary interventions in people with heart attacks and buy kamagra tablets shock.Elizabeth. A new targeted agent for some types of thyroid and lung cancers.Rick. And remdesivir in people with moderate erectile dysfunction treatment -- helpful or not?.

Elizabeth. That's what we're talking about this week on TT HealthWatch, your weekly look at the medical headlines from Texas Tech University Health Sciences Center in El Paso. I'm Elizabeth Tracey, a Baltimore-based medical journalist.Rick. And I'm Rick Lange, President of Texas Tech University Health Sciences Center in El Paso and Dean of the Paul L.

Foster School of Medicine.Elizabeth. Rick, how about if we start with the erectile dysfunction treatment ones first and then we can move on to the ones that are not erectile dysfunction treatment?. This week, we have 50/50. The first one I'd like to talk about is the one that's in Lancet Oncology.

It's taking a look at erectile dysfunction treatment and how does that impact on people with various types of cancer?. Their a priori hypothesis -- and I think many of us would have thought this also -- is that folks who have cancer probably are at higher likelihood of having more severe disease and poor outcomes.In the UK, they did a registry that's called the UK erectile dysfunction Cancer Monitoring Project. In this study, they looked between March 18th and May 8th. They had adult patients with cancer enrolled in this and then they also had a parallel non-erectile dysfunction treatment UK cancer control population.319 of their 1,044 patients in this cohort died and 92.5% of those had a cause of death recorded as due to erectile dysfunction treatment.

So the numbers compress, of course, and when they take a look at specific types of cancers, they find that it's the patients with leukemia who showed a significantly increased case fatality rate. They corrected, of course, for age and sex, and those hematologic malignancies, especially among those who had recently had chemotherapy, had an increased risk of death relative to erectile dysfunction treatment admission.Rick. Obviously, there are a number of risk factors for having severe disease and death -- age, obesity, diabetes, hypertension, lung disease, kidney disease -- and people have assumed that cancer also increases your risk of having severe or life-threatening erectile dysfunction treatment .This study allowed the investigators to look at all types of cancers and what they found particularly was that the presence of a solid tumor cancer -- something like a kidney cancer, or a GI cancer, or even lung cancer -- did not increase the risk of having severe erectile dysfunction treatment or dying from erectile dysfunction treatment . It was just the hematologic malignancies that you mentioned.

Now, what this allows them to do is to have an individualized risk categorization for each of the patients. When you're taking care of a patient with lung cancer, do you have to be more or less concerned and therefore change your chemotherapy?. People have shortened radiotherapy, they've switched from IV to oral chemotherapy regimens, and they've also modified immunotherapy. It suggests that, in fact, in people with solid tumors that's probably not necessary.Elizabeth.

I think all of this is good news because, of course, people have been extremely reluctant to come to medical centers and continue treatment because they've been concerned about erectile dysfunction treatment. As we've noted before, I feel substantially safer in the hospital than I feel anywhere else in town, so that concern, at least, is something I would probably put to rest.I think one thing that was somewhat disappointing about this study and that I would like to see confirmed is the numbers because, as we've talked about before, when you start to parse those into the various types of malignancies, I'd sure like to see much bigger numbers so that I could feel more comfortable with the outcomes.Rick. Yep. Either individual numbers of pancreatic cancer, and prostate cancer, and lung cancer were all small.

But, again, they were able to take a large group -- solid tumors versus hematologic malignancies like leukemia, lymphoma, multiple myeloma -- and those large categories were able to determine that it was the latter that had the increased risk. I agree, but these are the largest numbers we have to date.Elizabeth. Let's talk about your erectile dysfunction treatment one. That's in the Journal of the American Medical Association, "How early should we be using remdesivir?.

" That's what I'll call it.Rick. Even, should we at all?. Now you say, "Well, of course we should be. We've already had those studies and proven that." The studies that showed that remdesivir were helpful were those that had severe erectile dysfunction treatment .

They were hospitalized and they had a decrease in their blood oxygen content, hypoxia, or hypoxemia.In a large trial of over 1,000 people sponsored by the NIH, it showed that remdesivir, if done early, can actually decrease the hospital stay by 4 days, -- from 15 days to 11 days -- but there was no change in the mortality. That's the severe erectile dysfunction treatment-infected. What about those that have moderate erectile dysfunction treatment ?. There were about 600 individuals.

You have evidence of erectile dysfunction treatment , you have pulmonary infiltrates -- they could see it on your lungs -- but you don't require oxygen. Those 600 people got randomized to either have 5 days of remdesivir, 10 days of remdesivir, or just standard care.Those that received 10 days versus those that received standard care, their outcome was essentially the same. Those that received 5 days of remdesivir appeared to do a little bit better, but the clinical significance of it really isn't very clear because they used what's called an ordinal scale that ranged from everything from, "Did the patient need hospitalization?. " to "Were they dead?.

"Each of those things wasn't similarly affected by remdesivir and some are more significant than others. For example, dying is a much more significant event than going to be hospitalized or needing to be put on nasal oxygen. The authors were really kind of muted. They said, "Well, it looks like it could be beneficial." But clinical significance, really not very evident.Elizabeth.

And it's kind of expensive, so putting people on that stuff if they don't really need it doesn't make any sense to me. Remind me again about the side effect profile.Rick. Relatively minor side effects. Now, it's interesting because only about three-fourths of the individuals actually completed the 5-day course.

Only about 40% completed the 10-day course because they left the hospital earlier, which made it even a little bit more complicated. I think that the studies show for people with severe , it can shorten your hospital stay. But in those with moderate , I'd say the jury's still out.Elizabeth. Leaving our erectile dysfunction treatment things then, let's turn to the New England Journal of Medicine, back to cancer, a new targeted agent called selpercatinib, which takes aim at specific mutations that are called RET -- that's capital R-E-T- -- altered cancers.

There are two studies that are in here, one taking a look at thyroid cancers and the other taking a look at non-small cell lung cancers.It turns out that with regard to the thyroid cancers, more than 50% of sporadic medullary thyroid cancers have this particular RET mutation and 10% to 20% of papillary thyroid cancers. [There are] much smaller percentages of non-small cell lung cancers in the second study, but also colorectal, breast, and other cancers.This particular mutation generates docking sites for downstream signaling adapters and that activates multiple key cancer effectors, so that's how this thing works. And when you take a look overall among a group of diverse cancers, these aberrations have been identified in approximately 2% of the cases of cancer.In the thyroid cancers, they had 55 patients with the medullary thyroid cancer previously treated. Sixty-nine percent had a response to the agent with 82% progression-free survival at one year.

Among 88 patients who had the same mutation and medullary thyroid cancer not previously treated, only 73% -- which I think is a little curious -- had a response to selpercatinib, while 92% had progression-free survival at one year. Finally, in 15 of 19 patients with previously treated RET fusion-positive thyroid cancer, 79% had a response.With regard to non-small cell lung cancer, they had 105 patients with this mutation, previously been treated with platinum-based chemotherapy, 64% response, and 39 previously untreated patients, 85% had a response. And finally, in 10 of 11 patients with central nervous system metastases had an intracranial response to the agent.This looks like a valuable addition for that 2% of total cancers that express this particular mutation and suggests to me that something we've asserted many times about cancer, that clinically we call it cancer -- but actually, if we take a look at really what this disease is, it's a multitude of different diseases.Rick. Elizabeth, and I'm glad you brought that point up because this therapy was effective in lung cancer and thyroid cancer.

You say, "Well, those are two different organs." But the mechanism for the growth of the cancer was the same in both these of types of cancers.As you mentioned, it's the RET protein. That RET protein typically signals growth of cells. When it mutates or fuses, there's uncontrolled growth of these cells. That's what causes cancer.

So what we're moving from is an organ-specific therapy to the molecular mechanisms behind it so we can get really specific targeted therapies.This particular RET therapy was effective, it was durable, and importantly, the side effects were really minimal. Only 2% to 3% percent of individuals that were taking the medication had to stop it because of the side effects. It's one of several different targeted therapies that's now available.Elizabeth. Right.

I guess one of my concerns is a) the expense of developing these targeted therapies and getting them to market, and b) the fact that overall 2% of cancers manifest this particular mutation. So does that mean we're going to peck away at all of these different mutations in order to develop that entire armamentarium of targeted agents that are going to help everybody with cancer?. Rick. That's a great question.

I can foresee a time we look at those individual pathways that we know, and although this one may account for less than 2% of cancers, another one may be 5%, another one be 4% or 3%. So in toto, what we should be able to do is identify the pathways that are activated in a particular cancer and have specific therapies towards that. I think that's the future. It's targeted therapy towards the molecular mechanism, not targeted towards the organ.Elizabeth.

Well, I'm just going to say that what I'm hoping for the future is that we're going to develop blood tests that are specific for this, be able to catch the things super early before they even start to manifest as any particular tumor type. Let's turn to your final one in JAMA Internal Medicine.Rick. Elizabeth, we're going to talk about individuals who have heart attacks -- then after that, or as a result of that, have shock, and their mortality's been very high, as high as 50%.Now, we know that when someone's having a heart attack, if you open their artery up, restore blood flow, you improve their overall outcome. But 70% to 80% of these people that have heart attacks and shock have more than one blood vessel involved.

Only one has the clot that's caused the acute heart attack, but there are other blood vessels with blockages or stenosis.The question is when you're taking pictures and you identify that, do you just open the one artery or should you open all the arteries to improve overall outcome?. That's what this study addressed. Do we do just the culprit vessel or do all vessels to do this?. This is a follow-up on a randomized controlled trial.Now, you say, "Well, why would you want to do this after a randomized controlled trial that showed that only doing the culprit vessel was the best way to do it?.

" Well, because it's a very selected population and sometimes it's not a real-world experience. To address whether this applies in the real world, they used results from the CathPCI Registry. That's a registry of everybody that has a cardiac catheterization.There were over 64,000 patients at over 1,600 hospitals that had a heart attack and shock. Some of those individuals had all the blood vessels opened, about a third of them did, and about two-thirds just had that single blood vessel opened.Doing the single blood vessel ended up with a better outcome.

If you opened all blood vessels, you had a higher risk of dying and a higher risk of having complications as a result of the procedure as well.Elizabeth. A couple of other things that they mentioned in this study. One is that when you only have the culprit vessel done, you were at higher risk for subsequent ... Requiring additional revascularization or readmission for heart failure down the road.Rick.

You may need to have additional procedures in some patients down the road, but the thing is they live through the hospitalization. You don't kill them during the hospitalization [because] of complication.Here's why this is particularly important. When people present with a heart attack and don't have shock but have multi-vessel disease, studies have shown they do better if you open all their blood vessels up.Ten years ago I helped write those guidelines. We would have said, "Oh, my goodness.

When you're having an acute heart attack, don't open all the blood vessels. When you're having shock, open them all up." Now what the studies have shown is just the opposite.Elizabeth. That's so fascinating and so tell me, how often do shock and MI occur together?. Rick.

That's a great question. It's obviously more likely to occur in people that have either had a previous heart attack or [are] older. I would say it's probably in the neighborhood of about 10% or 15%. Most people with acute heart attack don't have shock.

But those that do, the mortality is very high.Elizabeth. Good information, then. On that note, that's a look at this week's medical headlines from Texas Tech. I'm Elizabeth Tracey.Rick.

I'm Rick Lange. Y'all listen up and make healthy choices. Last Updated August 28, 2020.

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High burden kamagra oral jelly female of antibiotic-resistant Mycoplasma genitalium in symptomatic urethritisMycoplasma genitalium is an aetiological agent http://www.ec-exen-pire-schiltigheim.ac-strasbourg.fr/?page_id=295 of sexually transmitted urethritis. A cohort study investigated M. Genitalium prevalence, antibiotic resistance and association with previous macrolide exposure among 1816 Chinese kamagra oral jelly female men who presented with symptomatic urethritis between 2011 and 2015. was diagnosed by PCR, and sequencing was used to detect mutations that confer resistance to macrolides and fluoroquinolones. In 11% kamagra oral jelly female of men, M.

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Doi:10.1093/cid/ciz294.A new entry inhibitor offers promise for treatment-experienced kamagra oral jelly female patients with multidrug-resistant HIVFostemsavir, the prodrug of temsavir, is an attachment inhibitor. By targeting the gp120 protein on the HIV-1 envelope, it prevents viral interaction with the CD4 receptor. No cross-resistance has been described with other antiretroviral agents, including those that target viral entry by other kamagra oral jelly female modalities. In the phase III BRIGHTE trial, 371 highly treatment-experienced patients who had exhausted ≥4 classes of antiretrovirals received fostemsavir with an optimised regimen. After 48 kamagra oral jelly female weeks, 54% of those with 1–2 additional active drugs achieved viral load suppression <40 copies/mL.

Response rates were 38% among patients lacking other active agents. Drug-related adverse events included nausea (4%) and diarrhoea (3%). As gp120 substitutions reduced fostemsavir susceptibility in up to 70% of patients with virological failure, fostemsavir offers the most valuable salvage option in partnership with other active kamagra oral jelly female drugs.Kozal M, Aberg J, Pialoux G, et al. Fostemsavir in adults with multidrug-resistant HIV-1 . N Engl J Med 2020;382:1232–43 kamagra oral jelly female.

Doi. 10.1056/NEJMoa1902493Novel tools to aid identification of hepatitis C in primary careHepatitis C can now be cured with oral antiviral treatment, and improving diagnosis is a key element of kamagra oral jelly female elimination strategies.1 A cluster randomised controlled trial in South West England tested performance and cost-effectiveness of an electronic algorithm that identified at-risk patients in primary care according to national recommendations,2 coupled with educational activities and interventions to increase patients’ awareness. Outcomes were testing uptake, diagnosis and referral to specialist care. Practices in the intervention arm had an increase in all outcome measures, with adjusted risk ratios of 1.59 (1.21–2.08) for uptake, 2.24 kamagra oral jelly female (1.47–3.42) for diagnosis and 5.78 (1.60–21.6) for referral. The intervention was highly cost-effective.

Electronic algorithms applied to practice systems could enhance testing and diagnosis of hepatitis C in primary care, contributing to global elimination goals.Roberts K, Macleod J, Metcalfe C, et al. Cost-effectiveness of an intervention to increase uptake of hepatitis C kamagra oral jelly female kamagra testing and treatment (HepCATT). Cluster randomised controlled trial in primary care. BMJ 2020;368:m322 kamagra oral jelly female. Doi:10.1136/bmj.m322Low completion rates for antiretroviral postexposure prophylaxis (PEP) after sexual assaultA 4-week course of triple-agent postexposure prophylaxis (PEP) is recommended following a high-risk sexual assault.3 4 A retrospective study in Barcelona identified 1695 victims attending an emergency room (ER) between 2006 and 2015.

Overall, 883 (52%) kamagra oral jelly female started prophylaxis in ER, which was mostly (43%) lopinavir/ritonavir based. Follow-up appointments were arranged for those living in Catalonia (631, 71.5%), and of these, only 183 (29%) completed treatment. Loss to kamagra oral jelly female follow-up was more prevalent in those residing outside Barcelona. PEP non-completion was associated with a low perceived risk, previous assaults, a known aggressor and a positive cocaine test. Side effects kamagra oral jelly female were common, occurring in up to 65% of those taking lopinavir/ritonavir and accounting for 15% of all discontinuations.

More tolerable PEP regimens, accessible follow-up and provision of 1-month supply may improve completion rates.Inciarte A, Leal L, Masfarre L, et al. Postexposure prophylaxis for HIV in sexual assault victims. HIV Med kamagra oral jelly female 2020;21:43–52. Doi:10.1111/hiv.12797.Effective antiretroviral therapy reduces anal high-risk HPV and cancer riskAmong people with HIV, effective antiretroviral therapy (ART) is expected to improve control of anal with high-risk human papillomakamagra (HR-HPV) and reduce the progression of HPV-associated anal lesions. The magnitude of the effect is kamagra oral jelly female not well established.

By meta-analysis, people on established ART (vs ART-naive) had a 35% lower prevalence of HR-HPV , and those with undetectable viral load (vs detectable viral load) had a 27% and 16% reduced risk of low and high-grade anal lesions, respectively. Sustained virological kamagra oral jelly female suppression on ART reduced by 44% the risk of anal cancer. The role of effective ART in reducing anal HR-HPV and cancer risks is especially salient given current limitations in anal cancer screening, high rates of anal lesion recurrence and access to vaccination.Kelly H, Chikandiwa A, Alemany Vilches L, et al. Association of antiretroviral therapy with kamagra oral jelly female anal high-risk human papillomakamagra, anal intraepithelial neoplasia and anal cancer in people living with HIV. A systematic review and meta-analysis.

Lancet HIV kamagra oral jelly female. 2020;7:e262–78. Doi:10.1016/S2352-3018(19)30434-5.The impact of sex work laws and stigma on HIV prevention among female sex workersSex work laws and stigma have been established as structural risk factors for HIV acquisition among female sex workers (FSWs). However, individual-level data assessing these kamagra oral jelly female relationships are limited. A study examined individual-level data collected in 2011–2018 from 7259 FSWs across 10 sub-Saharan African countries.

An association emerged between HIV prevalence and increasingly punitive and non-protective laws kamagra oral jelly female. HIV prevalence among FSWs was 11.6%, 19.6% and 39.4% in contexts where sex work was partly legalised, not recognised or criminalised, respectively. Stigma measures such as kamagra oral jelly female fear of seeking health services, mistreatment in healthcare settings, lack of police protection, blackmail and violence were associated with higher HIV prevalence and more punitive settings. Sex work laws that protect sex workers and reduce structural risks are needed.Lyons CE, Schwartz SR, Murray SM, et al. The role of sex work laws and stigmas in increasing HIV kamagra oral jelly female risks among sex workers.

Nat Commun 2020;11:773. Doi:10.1038/s41467-020-14593-6..

High burden of buy kamagra tablets antibiotic-resistant Mycoplasma http://bestnaturalblends.com/products.php genitalium in symptomatic urethritisMycoplasma genitalium is an aetiological agent of sexually transmitted urethritis. A cohort study investigated M. Genitalium prevalence, antibiotic resistance and association with previous macrolide exposure among 1816 Chinese men who presented with symptomatic urethritis between buy kamagra tablets 2011 and 2015.

was diagnosed by PCR, and sequencing was used to detect mutations that confer resistance to macrolides and fluoroquinolones. In 11% of buy kamagra tablets men, M. Genitalium was the sole pathogen identified.

Nearly 90% of s were resistant to buy kamagra tablets macrolides and fluoroquinolones. Previous macrolide exposure was associated with higher prevalence of resistance (97%). The findings point to the need for routine screening for M buy kamagra tablets.

Genitalium in symptomatic men with urethritis. Treatment strategies to overcome antibiotic resistance in M. Genitalium are needed.Yang L, buy kamagra tablets Xiaohong S, Wenjing L, et al.

Mycoplasma genitalium in symptomatic male urethritis. Macrolide use is associated with increased resistance buy kamagra tablets. Clin Infect Dis 2020;5:805–10.

Doi:10.1093/cid/ciz294.A new entry inhibitor offers promise for treatment-experienced patients with multidrug-resistant HIVFostemsavir, the buy kamagra tablets prodrug of temsavir, is an attachment inhibitor. By targeting the gp120 protein on the HIV-1 envelope, it prevents viral interaction with the CD4 receptor. No cross-resistance has been described with other antiretroviral agents, including those that target viral entry by buy kamagra tablets other modalities.

In the phase III BRIGHTE trial, 371 highly treatment-experienced patients who had exhausted ≥4 classes of antiretrovirals received fostemsavir with an optimised regimen. After 48 weeks, 54% of those with 1–2 additional active drugs achieved viral load suppression <40 copies/mL buy kamagra tablets. Response rates were 38% among patients lacking other active agents.

Drug-related adverse events included nausea (4%) and diarrhoea (3%). As gp120 substitutions reduced fostemsavir susceptibility in up to buy kamagra tablets 70% of patients with virological failure, fostemsavir offers the most valuable salvage option in partnership with other active drugs.Kozal M, Aberg J, Pialoux G, et al. Fostemsavir in adults with multidrug-resistant HIV-1 .

N Engl buy kamagra tablets J Med 2020;382:1232–43. Doi. 10.1056/NEJMoa1902493Novel tools to aid identification of hepatitis C in primary careHepatitis C can now be cured with oral antiviral treatment, and improving diagnosis is buy kamagra tablets a key element of elimination strategies.1 A cluster randomised controlled trial in South West England tested performance and cost-effectiveness of an electronic algorithm that identified at-risk patients in primary care according to national recommendations,2 coupled with educational activities and interventions to increase patients’ awareness.

Outcomes were testing uptake, diagnosis and referral to specialist care. Practices in the intervention arm had an increase in all outcome measures, with adjusted buy kamagra tablets risk ratios of 1.59 (1.21–2.08) for uptake, 2.24 (1.47–3.42) for diagnosis and 5.78 (1.60–21.6) for referral. The intervention was highly cost-effective.

Electronic algorithms applied to practice systems could enhance testing and diagnosis of hepatitis C in primary care, contributing to global elimination goals.Roberts K, Macleod J, Metcalfe C, et al. Cost-effectiveness of an intervention to increase uptake of hepatitis C kamagra buy kamagra tablets testing and treatment (HepCATT). Cluster randomised controlled trial in primary care.

BMJ 2020;368:m322 buy kamagra tablets. Doi:10.1136/bmj.m322Low completion rates for antiretroviral postexposure prophylaxis (PEP) after sexual assaultA 4-week course of triple-agent postexposure prophylaxis (PEP) is recommended following a high-risk sexual assault.3 4 A retrospective study in Barcelona identified 1695 victims attending an emergency room (ER) between 2006 and 2015. Overall, 883 (52%) started prophylaxis in ER, which was buy kamagra tablets mostly (43%) lopinavir/ritonavir based.

Follow-up appointments were arranged for those living in Catalonia (631, 71.5%), and of these, only 183 (29%) completed treatment. Loss to follow-up was more buy kamagra tablets prevalent in those residing outside Barcelona. PEP non-completion was associated with a low perceived risk, previous assaults, a known aggressor and a positive cocaine test.

Side effects were common, occurring in up to buy kamagra tablets 65% of those taking lopinavir/ritonavir and accounting for 15% of all discontinuations. More tolerable PEP regimens, accessible follow-up and provision of 1-month supply may improve completion rates.Inciarte A, Leal L, Masfarre L, et al. Postexposure prophylaxis for HIV in sexual assault victims.

HIV Med 2020;21:43–52 buy kamagra tablets. Doi:10.1111/hiv.12797.Effective antiretroviral therapy reduces anal high-risk HPV and cancer riskAmong people with HIV, effective antiretroviral therapy (ART) is expected to improve control of anal with high-risk human papillomakamagra (HR-HPV) and reduce the progression of HPV-associated anal lesions. The magnitude of buy kamagra tablets the effect is not well established.

By meta-analysis, people on established ART (vs ART-naive) had a 35% lower prevalence of HR-HPV , and those with undetectable viral load (vs detectable viral load) had a 27% and 16% reduced risk of low and high-grade anal lesions, respectively. Sustained virological suppression on ART reduced by 44% the risk of buy kamagra tablets anal cancer. The role of effective ART in reducing anal HR-HPV and cancer risks is especially salient given current limitations in anal cancer screening, high rates of anal lesion recurrence and access to vaccination.Kelly H, Chikandiwa A, Alemany Vilches L, et al.

Association of buy kamagra tablets antiretroviral therapy with anal high-risk human papillomakamagra, anal intraepithelial neoplasia and anal cancer in people living with HIV. A systematic review and meta-analysis. Lancet HIV buy kamagra tablets.

2020;7:e262–78. Doi:10.1016/S2352-3018(19)30434-5.The impact of sex work laws and stigma on HIV prevention among female sex workersSex work laws and stigma have been established as structural risk factors for HIV acquisition among female sex workers (FSWs). However, individual-level data assessing these relationships are buy kamagra tablets limited.

A study examined individual-level data collected in 2011–2018 from 7259 FSWs across 10 sub-Saharan African countries. An association emerged between HIV buy kamagra tablets prevalence and increasingly punitive and non-protective laws. HIV prevalence among FSWs was 11.6%, 19.6% and 39.4% in contexts where sex work was partly legalised, not recognised or criminalised, respectively.

Stigma measures such as fear of seeking buy kamagra tablets health services, mistreatment in healthcare settings, lack of police protection, blackmail and violence were associated with higher HIV prevalence and more punitive settings. Sex work laws that protect sex workers and reduce structural risks are needed.Lyons CE, Schwartz SR, Murray SM, et al. The role of sex work laws and stigmas in buy kamagra tablets increasing HIV risks among sex workers.

Nat Commun 2020;11:773. Doi:10.1038/s41467-020-14593-6..

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High burden of antibiotic-resistant Mycoplasma genitalium in symptomatic generic kamagra online urethritisMycoplasma kamagra 100mg oral jelly review genitalium is an aetiological agent of sexually transmitted urethritis. A cohort study investigated M. Genitalium prevalence, antibiotic resistance and association with previous macrolide exposure kamagra 100mg oral jelly review among 1816 Chinese men who presented with symptomatic urethritis between 2011 and 2015. was diagnosed by PCR, and sequencing was used to detect mutations that confer resistance to macrolides and fluoroquinolones.

In 11% of kamagra 100mg oral jelly review men, M. Genitalium was the sole pathogen identified. Nearly 90% kamagra 100mg oral jelly review of s were resistant to macrolides and fluoroquinolones. Previous macrolide exposure was associated with higher prevalence of resistance (97%).

The findings kamagra 100mg oral jelly review point to the need for routine screening for M. Genitalium in symptomatic men with urethritis. Treatment strategies kamagra 100mg oral jelly review to overcome antibiotic resistance in M. Genitalium are needed.Yang L, Xiaohong S, Wenjing L, et al.

Mycoplasma genitalium kamagra 100mg oral jelly review in symptomatic male urethritis. Macrolide use is associated with increased resistance. Clin Infect Dis 2020;5:805–10. Doi:10.1093/cid/ciz294.A new entry inhibitor offers promise for treatment-experienced patients with multidrug-resistant HIVFostemsavir, the prodrug of temsavir, is kamagra 100mg oral jelly review an attachment inhibitor.

By targeting the gp120 protein on the HIV-1 envelope, it prevents viral interaction with the CD4 receptor. No cross-resistance has been described kamagra 100mg oral jelly review with other antiretroviral agents, including those that target viral entry by other modalities. In the phase III BRIGHTE trial, 371 highly treatment-experienced patients who had exhausted ≥4 classes of antiretrovirals received fostemsavir with an optimised regimen. After 48 weeks, 54% of kamagra 100mg oral jelly review those with 1–2 additional active drugs achieved viral load suppression <40 copies/mL.

Response rates were 38% among patients lacking other active agents. Drug-related adverse kamagra 100mg oral jelly review events included nausea (4%) and diarrhoea (3%). As gp120 substitutions reduced fostemsavir susceptibility in up to 70% of patients with virological failure, fostemsavir offers the most valuable salvage option in partnership with other active drugs.Kozal M, Aberg J, Pialoux G, et al. Fostemsavir in adults kamagra 100mg oral jelly review with multidrug-resistant HIV-1 .

N Engl J Med 2020;382:1232–43. Doi. 10.1056/NEJMoa1902493Novel tools to aid identification of hepatitis C in primary careHepatitis C can now be cured with oral antiviral treatment, and improving diagnosis is a key element of elimination strategies.1 A cluster randomised controlled trial in South West England tested performance and cost-effectiveness of an electronic algorithm that identified at-risk patients in primary care according to national recommendations,2 coupled with educational activities and interventions to increase patients’ awareness. Outcomes were testing uptake, diagnosis and referral to specialist care.

Practices in the intervention arm had an increase in all outcome measures, with adjusted risk ratios of 1.59 (1.21–2.08) for uptake, 2.24 (1.47–3.42) for diagnosis and 5.78 (1.60–21.6) for referral. The intervention was highly cost-effective. Electronic algorithms applied to practice systems could enhance testing and diagnosis of hepatitis C in primary care, contributing to global elimination goals.Roberts K, Macleod J, Metcalfe C, et al. Cost-effectiveness of an intervention to increase uptake of hepatitis C kamagra testing and treatment (HepCATT).

Cluster randomised controlled trial in primary care. BMJ 2020;368:m322. Doi:10.1136/bmj.m322Low completion rates for antiretroviral postexposure prophylaxis (PEP) after sexual assaultA 4-week course of triple-agent postexposure prophylaxis (PEP) is recommended following a high-risk sexual assault.3 4 A retrospective study in Barcelona identified 1695 victims attending an emergency room (ER) between 2006 and 2015. Overall, 883 (52%) started prophylaxis in ER, which was mostly (43%) lopinavir/ritonavir based.

Follow-up appointments were arranged for those living in Catalonia (631, 71.5%), and of these, only 183 (29%) completed treatment. Loss to follow-up was more prevalent in those residing outside Barcelona. PEP non-completion was associated with a low perceived risk, previous assaults, a known aggressor and a positive cocaine test. Side effects were common, occurring in up to 65% of those taking lopinavir/ritonavir and accounting for 15% of all discontinuations.

More tolerable PEP regimens, accessible follow-up and provision of 1-month supply may improve completion rates.Inciarte A, Leal L, Masfarre L, et al. Postexposure prophylaxis for HIV in sexual assault victims. HIV Med 2020;21:43–52. Doi:10.1111/hiv.12797.Effective antiretroviral therapy reduces anal high-risk HPV and cancer riskAmong people with HIV, effective antiretroviral therapy (ART) is expected to http://www.ayersappliancerepair.net/2010/08/testimony-lear/ improve control of anal with high-risk human papillomakamagra (HR-HPV) and reduce the progression of HPV-associated anal lesions.

The magnitude of the effect is not well established. By meta-analysis, people on established ART (vs ART-naive) had a 35% lower prevalence of HR-HPV , and those with undetectable viral load (vs detectable viral load) had a 27% and 16% reduced risk of low and high-grade anal lesions, respectively. Sustained virological suppression on ART reduced by 44% the risk of anal cancer. The role of effective ART in reducing anal HR-HPV and cancer risks is especially salient given current limitations in anal cancer screening, high rates of anal lesion recurrence and access to vaccination.Kelly H, Chikandiwa A, Alemany Vilches L, et al.

Association of antiretroviral therapy with anal high-risk human papillomakamagra, anal intraepithelial neoplasia and anal cancer in people living with HIV. A systematic review and meta-analysis. Lancet HIV. 2020;7:e262–78.

Doi:10.1016/S2352-3018(19)30434-5.The impact of sex work laws and stigma on HIV prevention among female sex workersSex work laws and stigma have been established as structural risk factors for HIV acquisition among female sex workers (FSWs). However, individual-level data assessing these relationships are limited. A study examined individual-level data collected in 2011–2018 from 7259 FSWs across 10 sub-Saharan African countries. An association emerged between HIV prevalence and increasingly punitive and non-protective laws.

HIV prevalence among FSWs was 11.6%, 19.6% and 39.4% in contexts where sex work was partly legalised, not recognised or criminalised, respectively. Stigma measures such as fear of seeking health services, mistreatment in healthcare settings, lack of police protection, blackmail and violence were associated with higher HIV prevalence and more punitive settings. Sex work laws that protect sex workers and reduce structural risks are needed.Lyons CE, Schwartz SR, Murray SM, et al. The role of sex work laws and stigmas in increasing HIV risks among sex workers.

Nat Commun 2020;11:773. Doi:10.1038/s41467-020-14593-6.BackgroundCumbria Sexual Health Services (CSHS) in collaboration with Cumbria Public Health and local authorities have established a erectile dysfunction treatment contact tracing pathway for Cumbria. The local system was live 10 days prior to the national system on 18 May 2020. It was designed to interface and dovetail with the government’s track and trace programme.Our involvement in this initiative was due to a chance meeting between Professor Matt Phillips, Consultant in Sexual Health and HIV, and the Director of Public Health Cumbria, Colin Cox.

Colin knew that Cumbria needed to act fast to prevent the transmission of erectile dysfunction treatment and Matt knew that sexual health had the skills to help.ProcessDespite over 90% of the staff from CSHS being redeployed in March 2020, CSHS maintained urgent sexual healthcare for the county and a phone line for advice and guidance. As staff began to return to the service in May 2020 we had capacity to spare seven staff members, whose hours were the equivalent of four full-time staff. We had one system administrator, three healthcare assistants, one nurse, Health Advisor Helen Musker and myself.CSHS were paramount to the speed with which the local system began. Following approval from the Trust’s chief executive officer we had adapted our electronic patient records (EPR) system, developed a standard operating procedure and trained staff, using a stepwise competency model, within just 1 day.In collaboration with the local laboratories we developed methods for the input of positive erectile dysfunction treatment results into our EPR derivative.

We ensured that labs would be able to cope with the increase in testing and that testing hubs had additional capacity. Testing sites and occupational health were asked to inform patients that if they tested positive they would be contacted by our teams.This initiative involved a multiagency system including local public health (PH) teams, local authority, North Cumbria and Morecambe Bay CCGs, Public Health England (PHE) and the military. If CSHS recognise more than one positive result in the same area/organisation, they flag this with PH at the daily incident management meeting and environmental health officers (EHOs) provide advice and guidance for the organisation. We have had an active role in the contact tracing for clusters in local general practices, providing essential information to PH to enable them to initiate outbreak control and provide accurate advice to the practices.

We are an integral part in recognising cases in large organisations and ensuring prompt action is taken to stem the spread of the disease. The team have provided out-of-hours work to ensure timely and efficient action is taken for all contacts.The local contact tracing pilot has evolved and a database was established by local authorities. Our data fed directly into this from the end of May 2020. This enables the multiagency team to record data in one place, improving recognition of patterns of transmission.DiscussionCumbria is covered by three National Health Service Trusts, which meant accessing data outside of our Trust was challenging and took more time to establish.

There are two CCGs for Cumbria, which meant discussions regarding testing were needed with both North and South CCGs and variations in provision had to be accounted for. There are six boroughs in Cumbria with different teams of EHOs working in each. With so many people involved, not only is there need for large-scale frequent communication across a multisystem team, there is also inevitable duplication of work.Lockdown is easing and sexual health clinics are increasing capacity in a new world of virtual appointments and reduced face-to-face consultations. Staff within the contact tracing team are now balancing their commitments across both teams to maintain their skills and keep abreast of the rapid developments within our service due to erectile dysfunction treatment.

We are currently applying for funding from PH in order to second staff and backfill posts in sexual health.ConclusionCSHS have been able to lend our skills effectively to the local contact tracing efforts. We have expedited the contact tracing in Cumbria and provided crucial information to help contain outbreaks. It has had a positive effect on staff morale within the service and we have gained national recognition for our work. We have developed excellent relationships with our local PH team, PHE, Cumbria Council, EHOs and both CCGs.Cumbria has the infrastructure to meet the demands of a second wave of erectile dysfunction treatment.

The beauty of this model is that if we are faced with a second lockdown, sexual health staff will inevitably be available to help with the increased demand for contact tracing. Our ambition is that this model will be replicated nationally..

High burden of antibiotic-resistant Mycoplasma genitalium in symptomatic urethritisMycoplasma genitalium buy kamagra tablets click here to investigate is an aetiological agent of sexually transmitted urethritis. A cohort study investigated M. Genitalium prevalence, antibiotic resistance and association with previous macrolide exposure among 1816 Chinese men who buy kamagra tablets presented with symptomatic urethritis between 2011 and 2015.

was diagnosed by PCR, and sequencing was used to detect mutations that confer resistance to macrolides and fluoroquinolones. In 11% buy kamagra tablets of men, M. Genitalium was the sole pathogen identified.

Nearly 90% of s were resistant buy kamagra tablets to macrolides and fluoroquinolones. Previous macrolide exposure was associated with higher prevalence of resistance (97%). The findings buy kamagra tablets point to the need for routine screening for M.

Genitalium in symptomatic men with urethritis. Treatment strategies to buy kamagra tablets overcome antibiotic resistance in M. Genitalium are needed.Yang L, Xiaohong S, Wenjing L, et al.

Mycoplasma genitalium in buy kamagra tablets symptomatic male urethritis. Macrolide use is associated with increased resistance. Clin Infect Dis 2020;5:805–10.

Doi:10.1093/cid/ciz294.A new entry inhibitor offers promise for treatment-experienced patients with multidrug-resistant buy kamagra tablets HIVFostemsavir, the prodrug of temsavir, is an attachment inhibitor. By targeting the gp120 protein on the HIV-1 envelope, it prevents viral interaction with the CD4 receptor. No cross-resistance has been described with other antiretroviral agents, including buy kamagra tablets those that target viral entry by other modalities.

In the phase III BRIGHTE trial, 371 highly treatment-experienced patients who had exhausted ≥4 classes of antiretrovirals received fostemsavir with an optimised regimen. After 48 weeks, buy kamagra tablets 54% of those with 1–2 additional active drugs achieved viral load suppression <40 copies/mL. Response rates were 38% among patients lacking other active agents.

Drug-related adverse events included buy kamagra tablets nausea (4%) and diarrhoea (3%). As gp120 substitutions reduced fostemsavir susceptibility in up to 70% of patients with virological failure, fostemsavir offers the most valuable salvage option in partnership with other active drugs.Kozal M, Aberg J, Pialoux G, et al. Fostemsavir in adults with multidrug-resistant HIV-1 buy kamagra tablets.

N Engl J Med 2020;382:1232–43. Doi. 10.1056/NEJMoa1902493Novel tools to aid identification of hepatitis C in primary careHepatitis C can now be cured with oral antiviral treatment, and improving diagnosis is a key element of elimination strategies.1 A cluster randomised controlled trial in South West England tested performance and cost-effectiveness of an electronic algorithm that identified at-risk patients in primary care according to national recommendations,2 coupled with educational activities and interventions to increase patients’ awareness.

Outcomes were testing uptake, diagnosis and referral to specialist care. Practices in the intervention arm had an increase in all outcome measures, with adjusted risk ratios of 1.59 (1.21–2.08) for uptake, 2.24 (1.47–3.42) for diagnosis and 5.78 (1.60–21.6) for referral. The intervention was highly cost-effective.

Electronic algorithms applied to practice systems could enhance testing and diagnosis of hepatitis C in primary care, contributing to global elimination goals.Roberts K, Macleod J, Metcalfe C, et al. Cost-effectiveness of an intervention to increase uptake of hepatitis C kamagra testing and treatment (HepCATT). Cluster randomised controlled trial in primary care.

BMJ 2020;368:m322. Doi:10.1136/bmj.m322Low completion rates for antiretroviral postexposure prophylaxis (PEP) after sexual assaultA 4-week course of triple-agent postexposure prophylaxis (PEP) is recommended following a high-risk sexual assault.3 4 A retrospective study in Barcelona identified 1695 victims attending an emergency room (ER) between 2006 and 2015. Overall, 883 (52%) started prophylaxis in ER, which was mostly (43%) lopinavir/ritonavir based.

Follow-up appointments were arranged for those living in Catalonia (631, 71.5%), and of these, only 183 (29%) completed treatment. Loss to follow-up was more prevalent in those residing outside Barcelona. PEP non-completion was associated with a low perceived risk, previous assaults, a known aggressor and a positive cocaine test.

Side effects were common, occurring in up to 65% of those taking lopinavir/ritonavir and accounting for 15% of all discontinuations. More tolerable PEP regimens, accessible follow-up and provision of 1-month supply may improve completion rates.Inciarte A, Leal L, Masfarre L, et al. Postexposure prophylaxis for HIV in sexual assault victims.

HIV Med 2020;21:43–52. Doi:10.1111/hiv.12797.Effective antiretroviral therapy reduces anal high-risk HPV and cancer riskAmong people with HIV, effective antiretroviral therapy (ART) is expected to improve control of anal with high-risk human papillomakamagra where can i buy kamagra jelly (HR-HPV) and reduce the progression of HPV-associated anal lesions. The magnitude of the effect is not well established.

By meta-analysis, people on established ART (vs ART-naive) had a 35% lower prevalence of HR-HPV , and those with undetectable viral load (vs detectable viral load) had a 27% and 16% reduced risk of low and high-grade anal lesions, respectively. Sustained virological suppression on ART reduced by 44% the risk of anal cancer. The role of effective ART in reducing anal HR-HPV and cancer risks is especially salient given current limitations in anal cancer screening, high rates of anal lesion recurrence and access to vaccination.Kelly H, Chikandiwa A, Alemany Vilches L, et al.

Association of antiretroviral therapy with anal high-risk human papillomakamagra, anal intraepithelial neoplasia and anal cancer in people living with HIV. A systematic review and meta-analysis. Lancet HIV.

2020;7:e262–78. Doi:10.1016/S2352-3018(19)30434-5.The impact of sex work laws and stigma on HIV prevention among female sex workersSex work laws and stigma have been established as structural risk factors for HIV acquisition among female sex workers (FSWs). However, individual-level data assessing these relationships are limited.

A study examined individual-level data collected in 2011–2018 from 7259 FSWs across 10 sub-Saharan African countries. An association emerged between HIV prevalence and increasingly punitive and non-protective laws. HIV prevalence among FSWs was 11.6%, 19.6% and 39.4% in contexts where sex work was partly legalised, not recognised or criminalised, respectively.

Stigma measures such as fear of seeking health services, mistreatment in healthcare settings, lack of police protection, blackmail and violence were associated with higher HIV prevalence and more punitive settings. Sex work laws that protect sex workers and reduce structural risks are needed.Lyons CE, Schwartz SR, Murray SM, et al. The role of sex work laws and stigmas in increasing HIV risks among sex workers.

Nat Commun 2020;11:773. Doi:10.1038/s41467-020-14593-6.BackgroundCumbria Sexual Health Services (CSHS) in collaboration with Cumbria Public Health and local authorities have established a erectile dysfunction treatment contact tracing pathway for Cumbria. The local system was live 10 days prior to the national system on 18 May 2020.

It was designed to interface and dovetail with the government’s track and trace programme.Our involvement in this initiative was due to a chance meeting between Professor Matt Phillips, Consultant in Sexual Health and HIV, and the Director of Public Health Cumbria, Colin Cox. Colin knew that Cumbria needed to act fast to prevent the transmission of erectile dysfunction treatment and Matt knew that sexual health had the skills to help.ProcessDespite over 90% of the staff from CSHS being redeployed in March 2020, CSHS maintained urgent sexual healthcare for the county and a phone line for advice and guidance. As staff began to return to the service in May 2020 we had capacity to spare seven staff members, whose hours were the equivalent of four full-time staff.

We had one system administrator, three healthcare assistants, one nurse, Health Advisor Helen Musker and myself.CSHS were paramount to the speed with which the local system began. Following approval from the Trust’s chief executive officer we had adapted our electronic patient records (EPR) system, developed a standard operating procedure and trained staff, using a stepwise competency model, within just 1 day.In collaboration with the local laboratories we developed methods for the input of positive erectile dysfunction treatment results into our EPR derivative. We ensured that labs would be able to cope with the increase in testing and that testing hubs had additional capacity.

Testing sites and occupational health were asked to inform patients that if they tested positive they would be contacted by our teams.This initiative involved a multiagency system including local public health (PH) teams, local authority, North Cumbria and Morecambe Bay CCGs, Public Health England (PHE) and the military. If CSHS recognise more than one positive result in the same area/organisation, they flag this with PH at the daily incident management meeting and environmental health officers (EHOs) provide advice and guidance for the organisation. We have had an active role in the contact tracing for clusters in local general practices, providing essential information to PH to enable them to initiate outbreak control and provide accurate advice to the practices.

We are an integral part in recognising cases in large organisations and ensuring prompt action is taken to stem the spread of the disease. The team have provided out-of-hours work to ensure timely and efficient action is taken for all contacts.The local contact tracing pilot has evolved and a database was established by local authorities. Our data fed directly into this from the end of May 2020.

This enables the multiagency team to record data in one place, improving recognition of patterns of transmission.DiscussionCumbria is covered by three National Health Service Trusts, which meant accessing data outside of our Trust was challenging and took more time to establish. There are two CCGs for Cumbria, which meant discussions regarding testing were needed with both North and South CCGs and variations in provision had to be accounted for. There are six boroughs in Cumbria with different teams of EHOs working in each.

With so many people involved, not only is there need for large-scale frequent communication across a multisystem team, there is also inevitable duplication of work.Lockdown is easing and sexual health clinics are increasing capacity in a new world of virtual appointments and reduced face-to-face consultations. Staff within the contact tracing team are now balancing their commitments across both teams to maintain their skills and keep abreast of the rapid developments within our service due to erectile dysfunction treatment. We are currently applying for funding from PH in order to second staff and backfill posts in sexual health.ConclusionCSHS have been able to lend our skills effectively to the local contact tracing efforts.

We have expedited the contact tracing in Cumbria and provided crucial information to help contain outbreaks. It has had a positive effect on staff morale within the service and we have gained national recognition for our work. We have developed excellent relationships with our local PH team, PHE, Cumbria Council, EHOs and both CCGs.Cumbria has the infrastructure to meet the demands of a second wave of erectile dysfunction treatment.

The beauty of this model is that if we are faced with a second lockdown, sexual health staff will inevitably be available to help with the increased demand for contact tracing. Our ambition is that this model will be replicated nationally..