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RVHT has become increasingly recognized as an important cause of clinically atypical hypertension and chronic kidney diseasethe latter by virtue of renal ischemia. The coexistence of renal arterial vascular ie, renovascular disease and hypertension roughly defines this type of nonessential hypertension. More specific diagnoses are made retrospectively when hypertension is improved after intravascular intervention.
Endocrine causes account for 1-2% and include exogenous or endogenous hormonal imbalances. Exogenous causes include administration of steroids. The most common form of secondary hypertension is a renal cause although the true prevalence of hyperaldosteronism is not clear.
Another common cause is endocrine: oral contraceptive use. Activation of the renin-angiotensin-aldosterone system RAAS is the likely mechanism, because hepatic synthesis of angiotensinogen is induced by the estrogen component of oral contraceptives. Approximately 5% of women taking oral contraceptives may develop hypertension, which abates within 6 months after discontinuation. The risk factors for oral contraceptiveassociated hypertension include mild renal disease, familial history of essential hypertension, age older than 35 years, and obesity. It would be better to group oral contraceptives and steroids with drug-induced hypertension see Table 1, below.
Exogenous administration of the other steroids used for therapeutic purposes also increases blood pressure BP, especially in susceptible individuals, mainly by volume expansion. Nonsteroidal anti-inflammatory drugs NSAIDs may also have adverse effects on BP. NSAIDs block both cyclooxygenase-1 COX-1 and COX-2 enzymes. The inhibition of COX-2 can inhibit its natriuretic effect, which, in turn, increases sodium retention. NSAIDs also inhibit the vasodilating effects of prostaglandins and the production of vasoconstricting factorsnamely, endothelin-1. These effects can contribute to the induction of hypertension in a normotensive or controlled hypertensive patient.
Obstructive sleep apnea OSA is a common but frequently undiagnosed sleep-related breathing disorder defined as an average of at least 10 apneic and hypopenic episodes per sleep hour, which leads to excessive daytime sleepiness. Multiple studies have shown OSA to be an independent risk factor for the development of essential hypertension, even after adjusting for age, gender, and degree of obesity.
Approximately half of individuals with hypertension have OSA, and approximately half with OSA have hypertension. Ambulatory BP monitoring normally reveals a dip in BP of at least 10% during sleep. However, if a patient is a nondipper, the chances that the patient has OSA is increased. Nondipping is thought to be caused by frequent apneic/hypopneic episodes that end with arousals associated with marked spikes in BP that last for several seconds.
Numerous studies have shown that treatment of OSA by continuous positive airway pressure CPAP or position therapy lowers the awake and 24-hour blood pressure levels. Unfortunately, most cases of OSA go undiagnosed. Improved physician awareness and screening for this reversible cause of hypertension is likely to lead to great improvements in quality of life and a reduced incidence of cardiovascular complications.
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Caverta can be considered as a boon to men who are suffering from erectile dysfunctions. It is used to treat erectile dysfunctions in men. Caverta is known to improve the erotic capabilities of men and bring their sexual life back on track. The main component of Caverta is a chemical called Sildenafil citrate. Caverta comes in tablet form and it is approved by FDA, which speaks volumes about its quality. This drug treats ED by increasing the blood flow to the penis. This enables erection during the sexual intercourse and makes it possible to give perfect sexual performance.
Caverta should not be taken without medical assistance. Using Caverta without consulting your doctor might pose some major health problems. Your physician will prescribe you the dose after inspecting your medical conditions and asking you a few questions about it. Do not alter with it. Doctors usually start with 50mg Caverta. Your doctor may sometimes make changes to your dose after going through the effects of the Caverta on you. Caverta is effective only when it is taken on sexual simulation. It should not be consumed more than once in 24 hours time. Swallow the pill wholly with water without breaking or crushing it. It would not produce the desired results if broken or crushed. Caverta pill should be consumed prior to the sexual intercourse.
Although Caverta is a prescribed drug, like any other drug, it still has chances of developing side effects. It has some mild as well as serious side effects. Some of the less serious side effects of Caverta include stomach upset, dizziness, diarrhea, headache, nausea, back pain, nasal congestion etc. These conditions go away in a short time. If they dont, seek medical assistance as soon as possible. Caverta has some serious side effects too. It can cause heart problems like heart attack and stroke. Some other troublesome side effects of Caverta include hearing loss, chest pain etc. It is advisable to take Caverta under proper medical guidance to avoid these side effects and allergic reactions like rashes one skin, hives etc.
A proper storage is essential for Caverta. It should be stored in a secure place. Caverta must be stored in an air tight container to avoid any interaction with air. It should be stored under the temperature of around 15-30 degree Celsius else it can be ruined. It should be kept in a safe place where children or anyone else cannot reach easily. Heat, light and dampness ruin Caverta and render it unusable. Hence it should be kept far away from these sources. It should be kept away from bathroom and kitchen too for the same reason. If Caverta has passed its expiry date, it should be disposed immediately.
Caverta should be consumed only under proper medical supervision. This will help to prevent the side effects. Consuming Caverta without seeking prescription from your doctor can lead to health issues. Before taking Caverta, confirm with your doctor and make sure that you are not allergic to its basic ingredient: Sildenafil. Caverta should never be taken with Nitrates. It causes some serious health problems. Dont take Caverta if you are already taking nitrate for some other reason. It is also advisable not to take Caverta with alcohol since it causes drowsiness. Caverta can cause dizziness. Therefore, you should avoid driving or using any other machines. Caverta is used to treat only ED and impotence and nothing else and you should not depend on it for every sexual act.
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Manufactured by Scilla Biotechnologies in India, Cialis Super Active is a brand of super fast acting Tadalafil delivered through gelatin soft gels. It is used to treat erectile issue with men. Because of the quick delivery gelatin capsule the erection is achievable in a fraction of the time of traditional pills. Long lasting erections are guaranteed!
You should take one dose with a glass of water about 15 to 20 minutes before you expect sexual activity to take place. Do not take more than one Cialis Super Active per day. If you do suspect you may have taken an overdose, contact an emergency room or a poison control center immediately.
Before you take Cialis Super Active, tell your doctor if you have:
an allergy to Tadalafil, or other medicinal ingredients
If your erection lasts longer than 4 hours or begins to become painful, contact your doctor immediately. To prevent permanent damage, this should be treated as soon as possible.
Do not consume large amounts of alcohol while taking Cialis Super Active. The chances of adverse health effects, like low blood pressure, increased heart beat, dizziness or extreme headaches go up dramatically when a Tadalafil product is consumed with alcohol.
If you do begin to feel nauseous, dizzy, get chest or arm pain after you begin sexual activity, you should stop immediately and call a doctor as soon as possible.
If you start to have vision issues while taking this medication, call your doctor as soon as possible. If you actually lose your sign in one or more of your eyes, which is extremely rare, stop using this medicine immediately.
As always, Cialis Super Active does not protect you or your partner against STDs, like AIDS or HIV.
If you experience any of the following on a regular basis, contact your doctor for advice:
If you experience any of the following issues, you should contact your doctor as soon as possible. These are not normal and should be treated seriously:
If you are taking any of the following medications, you may experience adverse reactions:
rifabutin, rifampin or rifapentine
Store at room temperature, away from direct sunlight. Keep in a tightly sealed container.
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When buying medicines nowadays, we are commonly confronted with a choice on two seemingly different but really similar products: branded and generic medicines. Before we go into what distinguishes generic from branded drugs, let us first find out some of the things that separate them.
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I use 10mg, and its more than enough for a healthy guy. 25mg is overkill for anyone without some type of existing ED.
Big doses can lead to some nasty sides you may not be aware of. It will tend to relax the soft muscle in the lining of your digestive system, and acid reflux can/will become a problem, especially with consistant use.
I use 10mg, and its more than enough for a healthy guy. 25mg is overkill for anyone without some type of existing ED.
Big doses can lead to some nasty sides you may not be aware of. It will tend to relax the soft muscle in the lining of your digestive system, and acid reflux can/will become a problem, especially with consistant use.
Good to know The stuff I have is 25 mg/ml so I just assumed that was standard, as Ive seen a lot of guys taking that much.
i did wonder why i felt a bit shitty when i did 100mg, had excellent boers for several days lol
please mang, i drop 100mg like its going out of style-no sweats
The max FDA approved dosage is 20mg.
I use 10mg, and its more than enough for a healthy guy. 25mg is overkill for anyone without some type of existing ED.
Maybe this depends on what you want to do with it.
I like to be able to go again more quickly, although to be honest Cialis might not be the best choice for that situation.
I took 100mg when I was drunk once and just got a headache.
If I go over 20mg I feel like shit sinus problems, headache, malaise.
If I go over 20mg I feel like shit sinus problems, headache, malaise.
I get stuffy nose and puffy eyes. A little swelling under the eyes and hard to breathe thru the nose so I counter that with Afrin
Very high doses can cause damage on the penis but im on Hormone Replacement Therapy HRT and my doc told me and showed me a paper on Cialis written by the manufacterer and it says if you dont suffer from erectile dysfunction you dont get any effect from Cialis, and that dosent supprise me i know alot of people that have used cialis or viagra and they dont get anything from it maybe thats why.
Not true, unless the dose causes you to have a boner for more than 4 hours. THAT can cause damage to the penis.
Last edited by GymLift; 05-29-2007 at 09:07 AM.
Yes, many of us here can vouch for that.
Definitely not true. Harder, longer-lasting erections, and shorter refractory periods are the benefits Ive experienced.
Heck, there are high school aged kids using the shyt nowadays. I doubt any of them are experiencing any form of ED.
u should be fine, just drink a ton of water to flush it out as fast as possible. u may have a headach the size of texas and maybe feel sick, but thats about it.
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Cialis, the brand name of the medication tadalafil, can treat erectile dysfunction in men. It works by relaxing the muscles and increasing blood flow to certain areas of the body. Like any medication, it is possible to overdose on this medication if taken in excess. Cialis overdose symptoms may include chest pain, irregular heartbeat, lightheadedness, fainting or nausea, according to Individuals experiencing these overdose symptoms should seek emergency medical attention. Anyone taking Cialis should take certain precautions not to take too much of the medication.
Tadalafil, or any of its ingredients. Call your healthcare provider or get help right away if you experience any symptoms of an allergic reaction, such as rash, hives, swelling of the lips, tongue or throat, or difficulty breathing or swallowing
After taking a single tablet, some of the active ingredient of CIALIS remains in your body for more than 2 days. The active ingredient can remain longer if you have problems with your kidneys or liver, or you are taking certain other medications.
Stop sexual activity and get medical help right away if you get symptoms such as chest pain, dizziness, or nausea during sex. Sexual activity can put an extra strain on your heart, especially if your heart is already weak from a heart attack or heart disease.
What Should I Tell My Healthcare Provider Before Taking CIALIS?
CIALIS is not right for everyone. Only your healthcare provider and you can decide if CIALIS is right for you. Ask your healthcare provider if your heart is healthy enough for you to have sexual activity. You should not take CIALIS if your healthcare provider has told you not to have sexual activity because of your health problems. Before taking CIALIS, tell your healthcare provider about all your medical problems, particularly if you have or ever had:
heart problems such as chest pain angina, heart failure, irregular heartbeats, or have had a heart attack
retinitis pigmentosa, a rare genetic runs in families eye disease
severe vision loss, including a condition called NAION
blood cell problems such as sickle cell anemia, multiple myeloma, or leukemia
Can Other Medicines Affect CIALIS?
some types of antibiotics such as clarithromycin, telithromycin, erythromycin several brand names exist, please contact your healthcare provider to determine if you are taking this medicine
CIALIS is also marketed as ADCIRCA for the treatment of pulmonary arterial hypertension. Do not take both CIALIS and ADCIRCA. Do not take sildenafil citrate Revatio
What Should I Avoid While Taking CIALIS?
Do not use other ED medicines or ED treatments while taking CIALIS.
Do not drink too much alcohol when taking CIALIS for example, 5 glasses of wine or 5 shots of whiskey. Drinking too much alcohol can increase your chances of getting a headache or getting dizzy, increasing your heart rate, or lowering your blood pressure.
What Are The Possible Side Effects Of CIALIS?
The most common side effects with CIALIS are : headache, indigestion, back pain, muscle aches, flushing, and stuffy or runny nose. These side effects usually go away after a few hours. Men who get back pain and muscle aches usually get it 12 to 24 hours after taking CIALIS. Back pain and muscle aches usually go away within 2 days. Call your healthcare provider if you get any side effect that bothers you or one that does not go away.
An erection that wont go away: If you get an erection lasting more than 4 hours, seek immediate medical help to avoid long-term injury.
In rare instances, men taking prescription ED tablets, including CIALIS, reported a sudden decrease or loss of vision or hearing sometimes with ringing in the ears and dizziness. Its not possible to determine if these events are related directly to the ED tablets or to other factors. If you have a sudden decrease or loss of vision or hearing, stop taking any ED tablet, including CIALIS and call a healthcare provider right away.
Based on their pharmacology, phosphodiesterase-5 PDE5 inhibitors may conceivably potentiate the hypotensive effect of antihypertensive medications. These agents inhibit PDE5-mediated degradation of cyclic guanosine monophosphate cGMP, which in vascular smooth muscles can cause peripheral vasodilation. However, clinical pharmacology studies of tadalafil administered as a 10 mg dose except in studies with angiotensin II receptor AR blockers and amlodipine, which used a dose of 20 mg have demonstrated no clinically significant interaction with various antihypertensive drugs from major classes including calcium channel blockers, ACE inhibitors, beta blockers, thiazide diuretics, and AR blockers. Tadalafil 10 mg and 20 mg also had no clinically significant effect on blood pressure changes due to tamsulosin, an alpha-1a blocker. In addition, analysis of data from Phase 3 clinical trials showed no difference in adverse events in patients taking tadalafil with or without antihypertensive medications. In patients receiving concomitant antihypertensive medications, tadalafil 20 mg may induce a blood pressure decrease that is, in general, minor and not likely to be clinically relevant. In a clinical study of healthy male subjects 45 to 78 years of age, administration of silodosin with a single 20 mg dose of tadalafil resulted in increased frequency of positive orthostatic test results during a 12-hour period following concomitant dosing compared to administration with placebo. No events of symptomatic orthostasis or dizziness were reported in subjects receiving silodosin with tadalafil. Nevertheless, patients should be advised of the potential for interaction and to contact their doctor if they experience symptoms of hypotension such as dizziness, lightheadedness, or fainting.
The classifications below are a guideline only. The relevance of a particular drug interaction to a specific patient is difficult to determine using this tool alone given the large number of variables that may apply.
Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Do not stop taking any medications without consulting your healthcare provider.
Disclaimer: Every effort has been made to ensure that the information provided by Multum is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. Multums information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill, knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective, or appropriate for any given patient. Multum Information Services, Inc. does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. Copyright 2000-2014 Multum Information Services, Inc.
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Caverta Sildenafil is an oral pill recommended for the treatment of erectile dysfunction ED or male impotence. This is sexual condition usually experienced by men during their step into their middle age. Thus some of the basic symptoms of erectile dysfunction are inability by men to attain erection while making love and also when they are unable to maintain erection until climax for long hours during sexual intercourse. This sexual difficulty is due to various health complications which can be physiological, psychological or both. But the main underlying cause to impotence in men is deficiency of blood into the male organ. This gives out loose erections in men which makes them difficult to have sexual intercourse with its partner.
Edegra. Lovegra. Intagra. Aurogra. Eriacta. Vigora. Filagra. Femalegra. Caverta. Suhagra. Sildigra. Penegra. Silagra. Zenegra.
Silagra assist men in maintaining and achieving long-lasting erections: The medication of Silagra danged actively impedes the working of PDE5 species which is key important in bringing sterile erections. Thus, it brings not at home efficiently flow of blood into the virile process that gives absent from erections that is sturdier, harder and firmer pro reproductive intercourse. This gives allows men to attain the apex remarkably easily as the erection stays dream of on the side of four hours in men.
Because of limited clinical experience in patients with mild to moderate hepatic cirrhosis Child-Pugh Class A or B, consider a starting dose of Adcirca 20 mg once daily. Patients with severe hepatic cirrhosis Child-Pugh Class C have not been studied, thus avoid use of Adcirca in such patients see Dosage and Administration 2.2, Warnings and Precautions 5.4 and Clinical Pharmacology 12.3.
Single doses up to 500 mg have been given to healthy male subjects, and multiple daily doses up to 100 mg have been given to male patients with erectile dysfunction. Adverse reactions were similar to those seen at lower doses. Doses greater than 40 mg have not been studied in patients with pulmonary arterial hypertension. In cases of overdose, standard supportive measures should be adopted as needed. Hemodialysis contributes negligibly to tadalafil elimination.
Adcirca tadalafil, an oral treatment for pulmonary arterial hypertension, is a selective inhibitor of cyclic guanosine monophosphate cGMP specific phosphodiesterase type 5 PDE5. Tadalafil has the empirical formula C 22 H 19 N 3 O 4 representing a molecular weight of 389.41. The structural formula is:
The chemical designation is pyrazino1,2 :1, 6pyrido3, 4 bindole-1, 4-dione, 6-1, 3-benzodioxol-5-yl-2, 3, 6, 7, 12, 12a-hexahydro-2-methyl-, 6R, 12aR-. It is a crystalline solid that is practically insoluble in water and very slightly soluble in ethanol.
Adcirca is available as orange, film coated, almond shaped tablets for oral administration. Each tablet contains 20 mg of tadalafil and the following inactive ingredients: croscarmellose sodium, hydroxypropyl cellulose, hypromellose, iron oxide, lactose monohydrate, magnesium stearate, microcrystalline cellulose, sodium lauryl sulfate, talc, titanium dioxide, and triacetin.
Tadalafil is an inhibitor of phosphodiesterase type 5 PDE5, the enzyme responsible for the degradation of cyclic guanosine monophosphate cGMP. Pulmonary arterial hypertension is associated with impaired release of nitric oxide by the vascular endothelium and consequent reduction of cGMP concentrations in the pulmonary vascular smooth muscle. PDE5 is the predominant phosphodiesterase in the pulmonary vasculature. Inhibition of PDE5 by tadalafil increases the concentrations of cGMP resulting in relaxation of pulmonary vascular smooth muscle cells and vasodilation of the pulmonary vascular bed.
Studies in vitro have demonstrated that tadalafil is a selective inhibitor of PDE5. PDE5 is found in pulmonary vascular smooth muscle, visceral smooth muscle, corpus cavernosum, skeletal muscle, platelets, kidney, lung, cerebellum, and pancreas.
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En juillet 1999, laccord de paix de Lomé a été signé par le Président Kabbah et Foday Sankoh. Cet accord prévoyait une immunité générale contre les poursuites. La MONUSIL, une mission dobservation des Nations-Unies établie dès juillet 1998 pour veiller au désarmement des anciens combattants et à la bonne exécution de laction humanitaire, a été remplacé en octobre 1999 par une opération de maintien de la paix plus importante, la MINUSIL Mission des Nations unies en Sierra Leone. Cette force onusienne devait superviser la mise en uvre de laccord de Lomé, notamment sur la question du désarmement. Plusieurs mois après le début de la mission le 5 mai 2000, 500 casques bleus ont été pris en otage par le RUF libérés le 25 mai 2000. Après cette attaque, condamnée par la société civile sierra léonaise et par la communauté internationale, le gouvernement de Sierra Léone a obtenu des Nations-Unies lautorisation de création dun tribunal spécial chargée de juger les atrocités commises depuis 1991 résolution 1315, 14 août 2000. Dès juillet 2000, les Nations-Unies avaient déjà imposées un embargo sur le trafic de diamants sierra léonais, visant principalement le trafic du RUF résolution 1306. En janvier 2002, après la reddition denviron 45000 rebelles du RUF, des milices Kamajor et de gangs armés, le commandant de la MINUSIL 14 janvier et le Président Kabbah 18 janvier ont officiellement annoncé la fin de la guerre civile au Sierra Léone.
Dans le même temps, le 16 janvier 2002, le gouvernement et lONU ont signé un accord établissant la Tribunal Spécial pour la Sierra Leone chargé de juger les responsables de crimes de guerre et de crimes contre lhumanité commis en Sierra Léone après le 30 novembre 1996 date des accords dAbidjan. Neuf des onze personnes inculpées pour crimes de guerre, crimes contre lhumanité et autres violations du droit international humanitaire sont dans les prisons du TSSL. En juillet 2007, deux dentre eux, Alex Tamba Brima et Santigie Borbor Kanu, ont notamment été condamnés à une peine de 50 ans de prison pour plus de détails voir: Tribunal Spécial pour la Sierra Léone et fiches Trial Watch Sierra Léone.
Durant les 10 années de la guerre civile, 2, 5 millions de personnes soit environ un tiers de la population sont ont été obligées de fuir le pays ou leur région, 100000 à 200000 personnes ont été tuées ans des milliers volontairement mutilées dans le but de les empêcher de travailler. De plus, de nombreux enfants ont été kidnappés et utilisées comme enfants-soldats ou esclaves sexuels.
La Commission Vérité et Réconciliation CVR pour la Sierra Léone est une initiative des parties au conflit décidée lors de laccord de paix de Lomé de 1999. Il avait été décidé que la CVR serait mise en place dans les 90 jours suivant la signature de laccord. Toutefois, il a fallu attendre 2002 pour finalement voir sa réelle mise en place, malgré sa création par un acte du Parlement voté en février 2000 Truth and Reconciliation Commission Act 2000.
Keep vitamin K in the emergency kit so that it can be given when appropriate for markedly elevated INRs.
Consider using a protocol for managing anticoagulant dosing. Many facilities have arrangements with their contracted pharmacies or their physician groups Coumadin clinics to provide appropriate prescribing and monitoring orders in response to lab results.
Make patients and families aware of the risks of anticoagulant usage, which include increased bleeding, and document informed consent to their use. Patients can have adverse events even with INRs that are within therapeutic range.
Most of us are well aware that anticoagulant drugs, especially warfarin, are among the greatest sources of serious medication-related adverse events and medical errors.
The cases mentioned here are not uncommon. When a patient has a bad outcome and there is evidence of repeated abnormally elevated lab values INRs without appropriate action, it is difficult to defend a lawsuit as it should be, considering that multiple entities have had an opportunity to intervene: laboratory, pharmacy, nursing, and physicians or other practitioners. Keep in mind that risks of bleeding are increased when multiple drugs are used including aspirin and other antiplatelet agents clopidogrel, prasugrel, ticlopidine, NSAIDs, and heparin and heparinoid drugs.
We need to be sure we have reasonably consistent practices with respect to 1 changing a warfarin dose, 2 rechecking the INR, 3 how long to keep a patient on warfarin and other blood thinners, and 4 what to do when starting antibiotics or other drugs that are likely to interact with warfarin. All these considerations are on top of ensuring that we have obtained informed consent and that the patient or family is aware of the risks associated with bleeding.
There are good protocols that we can use, but in my experience they are very conservative and take a long time to get warfarin to a therapeutic dosage. That delay frequently necessitates prolonged bridging therapy.
New drugs are in the pipeline that will not require monitoring of labs, but it will probably be years before they are in the mainstream. So in the meantime, be vigilant and be sure you have processes in place to provide checks and balances when a patient is receiving warfarin or other anticoagulants.
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September is National Pain Awareness Month and Atrial Fibrillation Awareness Month, and AMDA has tools that support both initiatives and can help practitioners and their teams increase awareness of and improve care for these conditions in postacute and long-term care PA/LTC settings.
AMDA is the only national organization guided exclusively by the needs and issues affecting long term care medicine. For a full array of benefits and services exclusively for LTC professionals, click here to join today!
Cytochrome P450 Inducers Studies have shown that drugs that induce CYP3A4 can decrease tadalafil exposure.
CYP3A4, Rifampin Rifampin 600 mg daily, a CYP3A4 inducer, reduced tadalafil 10-mg single-dose exposure AUC by 88% and C max by 46%, relative to the values for tadalafil 10 mg alone. Although specific interactions have not been studied, other CYP3A4 inducers, such as carbamazepine, phenytoin, and phenobarbital, would likely decrease tadalafil exposure. No dose adjustment is warranted. The reduced exposure of tadalafil with the coadministration of rifampin or other CYP3A4 inducers can be anticipated to decrease the efficacy of Cialis for once daily use; the magnitude of decreased efficacy is unknown.
Aspirin Tadalafil did not potentiate the increase in bleeding time caused by aspirin.
Cytochrome P450 Substrates Cialis is not expected to cause clinically significant inhibition or induction of the clearance of drugs metabolized by cytochrome P450 CYP isoforms. Studies have shown that tadalafil does not inhibit or induce P450 isoforms CYP1A2, CYP3A4, CYP2C9, CYP2C19, CYP2D6, and CYP2E1.
CYP1A2 Theophylline Tadalafil had no significant effect on the pharmacokinetics of theophylline. When tadalafil was administered to subjects taking theophylline, a small augmentation 3 beats per minute of the increase in heart rate associated with theophylline was observed.
CYP2C9 Warfarin Tadalafil had no significant effect on exposure AUC to S-warfarin or R-warfarin, nor did tadalafil affect changes in prothrombin time induced by warfarin.
CYP3A4 Midazolam or Lovastatin Tadalafil had no significant effect on exposure AUC to midazolam or lovastatin.
P-glycoprotein Digoxin Coadministration of tadalafil 40 mg once per day for 10 days did not have a significant effect on the steady-state pharmacokinetics of digoxin 0.25 mg/day in healthy subjects.
Pregnancy Category B Cialis tadalafil is not indicated for use in women. There are no adequate and well controlled studies of Cialis use in pregnant women.
Risk Summary Based on animal data, Cialis is not predicted to increase the risk of adverse developmental abnormalities in humans.
Animal Data Animal reproduction studies showed no evidence of teratogenicity, embryotoxicity, or fetotoxicity when tadalafil was given to pregnant rats or mice at exposures up to 11 times the maximum recommended human dose MRHD of 20 mg/day during organogenesis. In one of two perinatal/postnatal developmental studies in rats, postnatal pup survival decreased following maternal exposure to tadalafil doses greater than 10 times the MRHD based on AUC. Signs of maternal toxicity occurred at doses greater than 16 times the MRHD based on AUC. Surviving offspring had normal development and reproductive performance.
In a rat prenatal and postnatal development study at doses of 60, 200, and 1000 mg/kg, a reduction in postnatal survival of pups was observed. The no observed effect level NOEL for maternal toxicity was 200 mg/kg/day and for developmental toxicity was 30 mg/kg/day. This gives approximately 16 and 10 fold exposure multiples, respectively, of the human AUC for the MRHD of 20 mg.
Tadalafil and/or its metabolites cross the placenta, resulting in fetal exposure in rats.
Cialis is not indicated for use in women.
Tadalafil and/or its metabolites were secreted into the milk in lactating rats at concentrations approximately 2.4-fold greater than found in the plasma.
Like a scientist trying to prove an established hypothesis, a pharmaceutical marketer can make the case for just about any social media strategy if they look long enough. Before conducting any type of online listening or social media research, a marketer could have already decided that Facebook is the perfect platform. With this decision already made, the process of finding supporting research is a selective exercise. The research that supports the conclusion is pulled to the front and the rest is simply glossed over.
Its reasonable to walk into pharmaceutical social media planning with a hypothesis. The danger arises when you are unwilling to change your conclusion based on the research at hand. Social media demands an open mind. The way people interact, the functions of community and the social currency are all unique. A social media marketer needs to research, listen and observe and allow that to shape strategynot the other way around.
On the flip side, there can be a tendency to get so lost in the research and data that you never emerge with a conclusion. You can spend months rehashing the same information without forming a cohesive strategy. While a willingness to follow research is important, decisiveness is equally important. Its that whole yin and yang thing againyou need balance.
Online listening is a critical step to developing a social media strategy. It helps to inform the strategies and tactics that will best serve your audience. Use the information gleaned from social media listening to build a social media strategy that ties directly to the patient need. But dont use the mountains of information as a crutch. Dont use it as an excuse to continue stalling engagement.
Be thoughtful. Be flexible. But be decisive.
There is an odd balancing act when it comes to risk tolerance at pharmaceutical companies. On the one hand, the industry is incredibly risk averse. Whether its because of the heavy regulations, steep consequences or the overall culture, most pharma companies avoid and mitigate risk at all costs. On the other hand, the pharmaceutical industry is based on a series of large bets in the clinical research pipeline. These are bets that would make any poker shark fold without hesitation.
It is this balancing act that contributes to some of the difficulties in getting pharmaceutical social media programs off the ground. Many companies lack a solid grasp of exactly what their risk quotient is when it comes to social media. And to complicate matters, a successful social media strategy needs to incorporate stakeholders from several functional areas including: legal, regulatory, safety, IT, marketing and PR. Its likely that your legal team is going to have a different tolerance for risk than your marketing team.
You can see the obvious source of conflict herewhen you get a bunch of people around the table with different priorities, reaching an action plan is a challenge. Its okay to have competing interests at the table. In fact, its encouraged. However, the problem lies in the fact that people rarely acknowledge when competing interests are present. Instead, meetings get derailed by the inevitable stalemate when each functional area fights relentlessly for their own cause.
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2013 Lung LLC. All rights reserved. ADCIRCA and Cialis are registered trademarks of Eli Lilly and Company, 2013.
All other trademarks and registered trademarks are the property of their respective owners and are not affiliated with and do not endorse Eli Lilly and Company or its products.
Do not take ADCIRCA if you take any medications that contain nitrates often used for chest pain, as the combination could cause a sudden, unsafe drop in blood pressure
If you experience chest pain after taking ADCIRCA, contact your healthcare provider
ADCIRCA is a type of medication called a phosphodiesterase 5 inhibitor PDE-5i. PDE-5is can cause blood vessels to widen, which may result in a decrease in blood pressure. If you have heart-disease or any problems with low blood pressure, tell your healthcare provider before taking ADCIRCA, as these conditions may be affected by the action of ADCIRCA
If you have ever had blockage in the veins of your lungs, known as pulmonary veno-occlusive disease PVOD, ADCIRCA is not recommended for you
Taking ADCIRCA with alcohol, or blood pressure medications, such as alpha-blockers, may lower blood pressure and cause hypotension light-headedness or fainting
Do not take ADCIRCA if you are taking rifampin an antibiotic for certain bacterial infections, or antifungal medications, such as ketoconazole and itraconazole. If you require treatment with both ADCIRCA and ritonavir Norvir
at the same time, your dose of ADCIRCA will need to be adjusted. Inform your healthcare provider if you have kidney or liver problems before taking ADCIRCA
which is used to treat erectile dysfunction ED, impotence and the signs and symptoms of benign prostatic hyperplasia BPH, enlarged prostate. If you are taking ADCIRCA, do not take Cialis or other PDE-5is
In rare cases, patients reported side effects such as decreased eyesight or loss of vision in one or both eyes NAION, or sudden decrease or loss of hearing, sometimes with ringing in the ears and dizziness. If you experience any of these side effects after taking ADCIRCA, seek medical attention right away
In rare cases, men taking PDE-5is including tadalafil for erectile dysfunction reported side effects such as an erection lasting more than four hours. If you experience a prolonged erection, seek medical attention right away
The most common side effects of ADCIRCA are headache, muscle pain, getting red or hot in the face flushing, nausea, pain in the arms, legs or back, upset stomach, stuffy or congested nose
Thomas A Gieseke - 3 illustrations for Adcirca: pillbox with empty Sunday compartment, isolated dog and isolated pedometer. Indefinite buyout of rights for use in print and electronic media iPad presentation for use by Adcirca only - Copyright Clearance Center - Wolters Kluwer Health, Circulation, Nazzareno Galie, Bruce H. Brundage, Hossein A. Ghofrani, Ronald J. Oudiz, Gerald Simmonneau, Zeenat Safdar, Shelley, Tadalafil Therapy for Pulmonary Arterial Hypertension, License No: 3177700012726 - Nicholais Photography - Unlimited use of photos in print, digital, web for pro and consumer in the US - Bella Agency - Victoria Gardner, unlimited use in print, digital and web
WEDNESDAY, Oct. 29 HealthDay News - - Cialis tadalafil, a drug used to treat erectile dysfunction, appears effective in treating pulmonary hypertension, researchers report.
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Strategically misguided, and a humanitarian disaster.
Author Adam Garfinkle s succinct summary about Obama s policy also uses two words I have used, on more than one occasion: feckless and incoherent.
Recognizing this doesn t require penetrating insight. Just an ability and perhaps more importantly, a willingness to recognize the obvious.
And it is only getting worse. The debacle unfolding in Montreux is so comical in a tragic way that it seems befitting, given the town s most famous resident, Charlie Chaplin. Psst. Don t tell the Russians and the Iranians about the Freddie Mercury statue. Putin will try to outlaw it as gay propaganda and the Iranians will try to hang it.
After years of wending through to what is to an American an incomprehensible legislative process that involves a three body problem the trialogue of the Commission, the EU Parliament, and member states, Europe has agreed on its version of the trade execution portion of Frankendodd: Mifid II. The clearing and OTC collateralization equivalents are covered under a different law, EMIR. A good summary is here.
FISHKILL, NY - Rombout Fire Company presents Pizza Night on every Friday during Lent from 4:00 PM to 8:00 PM at Rombout Station One at 901 Main Street, Fishkill near I-84 exit 12. Rombout will be selling 16 cheese pizza for 10, New England clam chowder with crackers for 5 a quart and Macaroni Cheese. All food will be available starting February 15, 22, March 1, 8, 15, 22, and 29 for pick up at Station One or firefighters will deliver to residents in the Rombout Fire District. To place your order, call 845-896-8620 between 4 and 7:30 that day. Rombout appreciates your support.
It is with deep regret and sorrow that the Officers and Members of the Rombout Fire Company announce the passing of Rombout Fire District Commissioner Terry Tag Muller on Friday, January 19th 2013. Tag was a Life Member of Fire Company having joined in 1974 and was serving as a Commissioner of the Rombout Fire District. Tag had served as Chairman of the Board of Fire Commissioners for 2012.
The wake will be on Sunday January 20, from 16:00 to 20:00 at McHoul s Funeral Home, Fishkill, NY. Rombout Fire Company will hold a memorial Service at 20:00 hours. The funeral will be Monday January 21, at 11:00 at McHoul s Funeral home, with Burial at Fishkill Rural Cemetery. Refreshments will follow at Rombout Station 1.
Our thoughts and prayers are with the Muller Family in this difficult time.
Rombout Fire Company will be hosting two benefit pancake breakfasts for the Breezy Point Volunteer Fire Company on Sunday, November 25, and December 23. The benefit breakfast is from 8:00 to 11:00 AM at Rombout Station One at 901 Main Street, Fishkill near I-84 exit 12. All proceeds from the events will be donated to the Point Breeze Volunteer Fire Company. In addition we will be offering 5050 raffle tickets with half of the proceeds going to the Point Breeze Volunteer Fire Department and the other half to one lucky winner. Tickets will be available at both breakfasts and the big 50/50 drawing will be at 10:45 AM on December 23rd. Please join us for two delicious breakfasts for a great cause. Our firefighter chefs will be serving hot pancakes, eggs, sausage, bacon, hash browns and toast with piping hot coffee and tea and orange juice. Plus the omelet chef will be making omelets just the way you want in a cheery family setting. The price for adults is 8, senior citizens are 7, 5 to 12 is 6 and kids under 5 are free. For more info phone 845-896-8620 or visit our website at or Facebook page at Rombout Fire Company Inc.
The tragedy of Super storm Sandy has had a catastrophic impact on the entire tri-state region; however, the community of Breezy Point, Queens in particular has been completely devastated. This close-knit community of hard working blue-collar workers is no stranger to tragedy in the past. In the wake of 9/11, the community mourned the loss of 37 of its own in the tragedy at the Twin Towers. A few months later an airliner departing from JFK airport crashed in the community.
In patients receiving an SSRI in combination with a monoamine oxidase inhibitor MAOI, there have been reports of serious, sometimes fatal, reactions including hyperthermia, rigidity, myoclonus, autonomic instability with possible rapid fluctuations of vital signs, and mental status changes that include extreme agitation progressing to delirium and coma. These reactions have also been reported in patients who have recently discontinued an SSRI and have been started on an MAOI. Some cases presented with features resembling neuroleptic malignant syndrome. Animal data on the effects of combined use of an SSRI and MAOIs suggest that these medicinal products may act synergistically to elevate blood pressure and evoke behavioural excitation. Therefore, dapoxetine should not be used in combination with an MAOI, or within 14 days of discontinuing treatment with an MAOI. Similarly, an MAOI should not be administered within 7 days after dapoxetine has been discontinued.
Thioridazine administration alone produces prolongation of the QTc interval, which is associated with serious ventricular arrhythmias. Medicinal products such as dapoxetine that inhibit the CYP2D6 isoenzyme appear to inhibit the metabolism of thioridazine and the resulting elevated levels of thioridazine are expected to augment the prolongation of the QTc interval. Dapoxetine should not be used in combination with thioridazine or within 14 days of discontinuing treatment with thioridazine. Similarly, thioridazine should not be administered within 7 days after dapoxetine has been discontinued.
As with other SSRIs, co-administration with serotonergic medicinal/herbal products including MAOIs, L-tryptophan, triptans, tramadol, linezolid, SSRIs, SNRIs, lithium and St. Johns WortHypericum perforatum preparations may lead to an incidence of serotonin associated effects. Dapoxetine should not be used in combination with other SSRIs, MAOIs or other serotonergic medicinal/herbal products or within 14 days of discontinuing treatment with these medicinal/herbal products. Similarly, these medicinal/herbal products should not be administered within 7 days after dapoxetine has been discontinued.
The use of dapoxetine in combination with CNS active medicinal products has not been systematically evaluated in patients with premature ejaculation. Consequently, caution is advised if the concomitant administration of dapoxetine and such medicinal products is required.
In vitro studies in human liver, kidney, and intestinal microsomes indicate dapoxetine is metabolized primarily by CYP2D6, CYP3A4 and flavin monooxygenase 1 FMO1. Therefore, inhibitors of these enzymes may reduce dapoxetine clearance.
Potent CYP3A4 inhibitors - Administration of ketoconazole 200 mg twice daily for 7 days increased the C-max and AUCinf of dapoxetine 60 mg single dose by 35% and 99%, respectively. Considering the contribution of both unbound dapoxetine and desmethyldapoxetine, the Cmax of the active fraction may be increased by approximately 25% and the AUC of the active fraction may be doubled if taken with potent CYP3A4 inhibitors. The increases in the Cmax and AUC of the active fraction may be markedly increased in a part of the population which lack a functional CYP2D6 enzyme, , CYP2D6 poor metabolizers, or in combination with potent inhibitors of CYP2D6.
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Magnetic hard drives are the workhorses of mass storage. Virtually every computer has a hard drive. There are dozens of hard drive manufacturers worldwide. So its not surprising that competition, along with technology improvements, has driven hard drive prices to all-time record lows. Thats good news. But are cheap hard drives truly a bargain? Read on
Is the money you save when buying a cheap hard drive lost due to lower performance and/or shorter lifespan? The answer is yes and no; but mostly, no. Sure, there are manufacturers who cut corners to sell at the very lowest prices, and their hard drives may be lacking. But most of the drop in hard drive prices has not come at the expense of quality.
In 1990, hard drive storage cost about US10 per megabyte. By 2000, the price was about one CENT per megabyte. And in the past ten years, prices have come down again by a factor of 100X. To put that in perspective, the 500GB of hard drive stoage that costs about 50 today would have cost 5, 000, 000 twenty years ago. Its true that modern operating systems and software applications gobble up hard drive space like candy, but hard drives today look mighty cheap when compared to just a few years ago.
If you want a larger, less expensive, and higher quality hard drive, it seems the best thing to do is wait. But if you need a hard drive today, the news is still good. Cheap hard drives from well-known manufacturers really are much better today than they were five years ago. Quantum leaps in magnetic storage technology allow many times more data to be packed into every square inch of a disk. Consequently, a hard drive of a given capacity can be made smaller, and smaller costs less. Reliability is the sine qua non in hard drives, so great improvements have been made in that department as manufacturers compete for consumers trust. The ever growing market for mass storage enables economies of manufacturing scale, and that drives prices down too.
Before starting to use kamagra oral jelly to enhance your potency, it is strongly recommendable to consult with your physician and maybe even carry out a thorough medical examination to see how your heart is functioning, check the condition of your vessels etc. This is important for, like any other impotence enhancing medication, kamagra oral jelly has direct impact on the work of your heart. If there is any heart condition that you do not know about, taking kamagra or any other potency enhancing oral jellies can cause serious complications. Try to get all possible information on the side effects of taking kamagra-type medications, before you buy this drug! If you feel shy about asking your doctor these questions, there are many informative and precise articles about kamagra oral jelly and its analogues on the Web. Do read them through before you make up your mind to buy kamagra jelly meds!
The meds like kamagra oral jelly are very easy to use and have a very short response time. You can take kamagra just 15 or 20 minutes before the sex act. This oral jelly is easy to swallow and tastes pretty good. You can even choose the oral jelly flavor to your liking: kamagra oral jelly is available in several fruit flavors.
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Erectile dysfunction is, unfortunately, a common problem for millions of middle-aged men all over the world. At the same time, this is also a very delicate issue that not all people feel comfortable discussing with their partners or even doctors. The latest researches and studies show that this condition is getting younger with time and can now affect men in their early 30s. There can be various reasons why erectile dysfunction appears: some relate it to increasingly stressful lifestyles of modern men, others believe it has much to do with taking medications. Whatever causes the problem, erectile dysfunction is obviously not something you can easily ignore. All of us understand the consequences of mens inability to perform at their best sexually: ruined marriages, tension between partners, stress and eventually depression.
Children whose families are committed to each other in 20 minutes of food four times a week, weigh much less than those who left the table after 15 to 17 minutes. Eventually, those extra minutes add the food and get really powerful, said study author Barbara Fiese, director of family stability at the University of Illinois, in a news release from the university.
History in the fire: Islamic extremists set fire to a library of ancient manuscripts of Timbuktu, reports The Guardian.
What is special about the National Ethics Committee of Emergency Medicine?
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I like Jon discuss marketing tips, consultants helps expand marketing, personnel, management, products, etc. Renato Saltz, MD
In addition to unique content and emphasis of the course, the pool is especially effective teachers who teach. Each teacher has a great experience at a conference in CME courses in general medicine and has some experience in teaching the course NEMBR. Everyone understands the purpose of the course is intended to provide a presentation, focused, energetic and engaging. Each brings their own unique style to the course, while providing a standardized course directors organized presentation.
See question: We have a 13-year-old with ADHD. This is something that can grow?
January 7, 2013, sleep and study memory in Melbourne, Australia
Once again, I thank you for the work you do, I learned a lot and I m slowly trying to implement here in the clinic. I feel much more confident in myself when making calls and scheduling patients. S Not that I have no Trust only did not phones. I have no experience what so ever in sales. After the first 15-20 minutes of your workout it clicked in my brain after being told not to individuals, but to the people very powerful for me. Anyway, just wanted to let you know that. And the team has done a fabulous job on Saturday, as you know.
This Germy world out there, and as a mom, you must take precautions. Always carry a bottle of alcohol-based hand sanitizer with you and use it often, especially before handling food. When you travel, trying to stop their children to get their fingers in the eyes or mouth.
Factors that increase the risk of obesity in children from poor families are included: being a single parent, having a mother with a low level of education and who live in areas without access to healthy food.
Claims, Fortune 500 companies
Aggression Charming: Seeing something beautiful can cause aggressive behavior, according to Popular Science. In one study, photos of super-cute animals generated excited responses like It s so soft I want to die! Another study allowed respondents pop bubble wrap, while watching the beautiful pictures. Cute animals, a more aggressive response, and the most bubbles popped.
Endowmax Oil is a male enhancement lubricant that is advertised as giving menrock hard erections within seconds, as well as increasing sexual pleasure and
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Exophthalmos is a normal condition in brachycephalic short nosed dog breeds because of the shallow orbit. However, it can lead to keratitis secondary to exposure of the cornea.
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Avoid starting any new medicines without first consulting your doctor. If Staxyn is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Staxyn with the following: alfuzosin, doxazosin, tamsulosin, arrhythmia medicines such as amiodarone, procainamide, quinidine, sotalol, clarithromycin, erythromycin, HIV medicines called protease inhibitors such as atazanavir, indinavir, ritonavir, saquinavir, nitroglycerin, itraconazole, ketoconazole, or recreational drugs called poppers such as amyl nitrate and butyl nitrate. Side effects cannot be anticipated. If any develop or change in intensity, tell your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking this drug. Side effects may include: back pain, dizziness, flushing, headache, indigestion, runny/stuffy nose, upset stomach
Staxyn is not for use in women. Staxyn is not for regular use. Take it only before sexual activity. Do not take more than one tablet in 24 hours. Store at room temperature. Our 10-week newsletter series, written by a pharmacist, will help you learn about your medication.
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Common Side Effects of Antidepressants Find out about common and not-so-common side effects of antidepressants and how to manage them.
How Drugs Can Lower Cholesterol Discover how cholesterol-lowering medications work in your body to bring your cholesterol numbers down to ideal levels.
Do Over-the-Counter Proton-Pump Inhibitors Work? You might wonder why you need a prescription for GERD if many PPIs are available over the counter. Get the answers to this and other questions about OTC PPIs.
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Staxyn is a medicine, containing vardenafil, taken by mouth for the treatment of erectile dysfunction ED in men. Staxyn may help a man with ED get and keep an erection when he is sexually excited. Staxyn can cause your blood pressure to drop suddenly to an unsafe level if it is taken with certain other medicines. With a sudden drop in blood pressure, you could get dizzy, faint, or have a heart attack or stroke. Medicines called alpha-blockers, which are used to treat high blood pressure and prostate problems, may significantly lower blood pressure when used with Staxyn. You should not start Staxyn if you take alpha-blockers.
Jim Hightower is the ninth winner of the prestigious award. Twice elected Texas agriculture commissioner, Hightower was praised for nurturing organic production, promoting alternative crops, regulating pesticides and monitoring groundwater. A New York Times bestselling author, he has written seven books, including his most recent, written with longtime partner Susan DeMarco, Swim Against the Current. Á¨Á¨An advocate for everyday people whose voices are seldom heard in Washington or on Wall Street, Hightower believes that Ápolitics isnt about left versus right; its about top versus bottom. Á He broadcasts daily radio commentaries, which are on more than 150 stations across the country, on subjects ranging from public healthcare to Hamid Karzai. Each month, Hightower publishes a populist political newsletter, The Hightower Lowdown, exposing hypocrisy in Congress and targeting the abuses of corporations. With more than 135, 000 subscribers, the Lowdown has received both the Alternative Press Award and the Independent Press Association Award for best national newsletter.
The 9th annual Puffin/Nation prize carries a 100, 000 cash award and is given annually to one who has challenged the status quo Áthrough distinctive, courageous, imaginative, socially responsible work of significance. Á It is awarded jointly by the Puffin Foundation Ltd. of New Jersey and The Nation Institute. Recipients are chosen by a panel of four judges whose identities are not disclosed. The prize has previously been awarded to Van Jones, environmental activist and presidential advisor; Michael Ratner, civil rights lawyer and founder of the Center for Constitutional Rights; Democracy Now! host Amy Goodman; Robert Moses, celebrated civil rights advocate and founder of the Algebra Project; Dolores Huerta, co-founder with Cesar Chavez of the United Farm Workers Union; David Protess, anti-death penalty advocate and co-founder of the Innocence Project; Barbara Ehrenreich, journalist and author of the bestselling book Nickle and Dimed: On Not Getting By in America; and Jonathan Kozol, renowned educator and author of The Shame of the Nation: The Restoration of Apartheid Schooling in America.
Click here for more information about Jim Hightower or The Nation Institute.
2014 The Puffin Foundation, Ltd.
Generic indicates using a different name for the same ingredients. The contents of the pills in our generic version and the branded analogue are identical.
Why is the price of your product low?
Due to several reasons. We do not pay anything for marketing, there are no taxes to be paid as theegi arrival of unregistered product is tax free, the manufacturer is located in an offshore zone and the production costs are much lower. Child labor is not used.
Why are the name on the pill and the branded one different?
The name printed on the pill indicates the active ingredient used here. The contents of the generic pills are identical with the contents of the branded versions. Only the names differ. The use of the brand names on pharmaceuticals by the manufacturers of generic drugs would be the breach of copyright though using the well known ingredients is legal.
Cialis Soft Tabs Tadalafil is an oral drug, used to treat erectile dysfunction in men and to provide an erection. Cialis Soft Tabs has longer effect then Viagra and the quickest start time 15 minutes. Sexual stimulation is required. You will not get an erection just by taking Generic Cialis without sexual stimulation.
In Charnins analysis of exit poll data, we can say with a 95% confidence level that means in 95 out of 100 elections that the exit polls will fall within a statistically predictable margin of error. Charnin looked at 300 presidential state exit polls from 1988 to 2008, 15 state elections would be expected to fall outside the margin of error. Shockingly, 137 of the 300 state presidential exit polls fell outside the margin of error.
What is the probability of this happening?
One in one million trillion trillion trlllion trillion trillion trillion, said Charnin.
More statistical proof of Republican operatives, zealots and sympathizers tampering with the vote is found in the fact that 132 of the elections fell outside the margin in favor of the GOP. We would expect eight.
Say you have a fair coin to flip. We would expect that if we flip that coin there would be an even split between heads and tails or in this case, Republicans and Democrats. Election results falling outside the margin of error should be equally split between both parties. Yet, only five times, less than expected, did the extra votes fall in the direction of the Democratic Party.
So what are the odds? According to Charnin, of 132 out of 300 state presidential elections exceeding the margin of error in the direction of the Republicans one in 600 trillion trillion trillion trillion trillion trillion trillion trillion trillion.
The corporate-owned media does not want to mention that the problems with the exit polls began with the ascendancy of the former CIA Director George Herbert Walker Bush to the presidency in 1988. It is also that year when the non-transparent push-and-pray voting machines were introduced in the New Hampshire primary by Bush ally John Sununu. Bush, who rigged elections for the CIA throughout the Third World did unexpectedly well where the voting machines were brought in.
In any other election outside the, the State Department would condemn the use of the these highly riggable machines based on the discrepancy in the exit polls. Its predictable what would happen if an KGB agent in some former Soviet Central Asian republic picked up an unexplained 5% of the votes at odds with the exit polls. A new election would be called for, as it was in the Ukraine in 2004. We would not have accepted the reported vote from the corrupt intelligence officer.
The CIA Directors son wins with laughable exit poll discrepancies in 2000 and 2004 and the mainstream media sees no evil. The medias perspective is to discredit the exit polls, which they sponsor, and call any who points to the unadjusted, or actual, polls conspiracy theorists.
In 2004, 22 states had a red shift to the CIA Directors son, George W. Bush. Usually such improbably results are signs of a Banana Republic. Now we have a too-close-to-call neck and neck recall race in Wisconsin that show an obvious red shift for a right-wing red governor. Nobody wants to look at the non-transparent black box machines. Electronic election rigging has prospered. Democracy is dead. Long live the adjusted vote totals.
Bob Fitrakis has a in political science and a He is an election law attorney, professor, and has written four books on election integrity.
How do you review a performance that hasnÁt ended yet? In fact, as I am typing this, the 50-hour Improvathon isnÁt even halfway through. Divided into two-hour slots, performers from the London Jam and friends take on this incredible challenge; ÁDo
Contact your doctor or seek emergency medical attention if your erection is painful or lasts longer than 4 hours. A prolonged erection priapism can damage the penis.
Stop using this medicine and get emergency medical help if you have sudden vision loss.
You should not take Cialis if you are allergic to tadalafil.
Do not take Cialis if you are also using a nitrate drug for chest pain or heart problems. This includes nitroglycerin, isosorbide dinitrate, and isosorbide mononitrate. Nitrates are also found in some recreational drugs such as amyl nitrate or nitrite poppers. Taking Cialis with a nitrate medicine can cause a sudden and serious decrease in blood pressure.
To make sure Cialis is safe for you, tell your doctor if you have any of these other conditions:
heart disease or heart rhythm problems, coronary artery disease;
a recent heart attack within the past 90 days;
a recent history in the past 6 months of a stroke, or congestive heart failure;
angina chest pain, high or low blood pressure;
liver or kidney disease or if you are on dialysis;
a blood cell disorder such as sickle cell anemia, multiple myeloma, or leukemia;
a bleeding disorder such as hemophilia;
retinitis pigmentosa an inherited condition of the eye;
a physical deformity of the penis such as Peyronies disease; or
if you have been told you should not have sexual intercourse for health reasons.
Cialis can decrease blood flow to the optic nerve of the eye, causing sudden vision loss. This has occurred in a small number of people taking Cialis, most of whom also had heart disease, diabetes, high blood pressure, high cholesterol, or certain pre-existing eye problems, and in those who smoke or are over 50 years old. Stop using Cialis and get emergency medical help if you have sudden vision loss.
FDA pregnancy category B. Cialis is not expected to harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment with Adcirca.
It is not known whether tadalafil passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.
Cialis is usually taken only once per day. Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.
Cialis can be taken with or without food.
For erectile dysfunction, take the dose just before sexual activity but not more than once per day.
Cialis can help achieve an erection when sexual stimulation occurs. An erection will not occur just by taking a pill. Follow your doctors instructions.
During sexual activity, if you become dizzy or nauseated, or have pain, numbness, or tingling in your chest, arms, neck, or jaw, stop and call your doctor right away. You could be having a serious side effect.
Do not break or split a tablet. Swallow it whole.
Do not take Cialis for erectile dysfunction if you are taking Adcirca for pulmonary arterial hypertension.
Store at room temperature away from moisture and heat.
If Cialis is used as needed, you are not likely to be on a dosing schedule.
If you take Cialis every day and you miss a dose, take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
Four strengths of almond-shaped tablets are available in different sizes and different shades of yellow, and supplied in the following package sizes:
Store at 25 C 77 F; excursions permitted to 15-30 C 59-86 F see USP Controlled Room Temperature.
Keep out of reach of children.
Physicians should discuss with patients the contraindication of Cialis with regular and/or intermittent use of organic nitrates. Patients should be counseled that concomitant use of Cialis with nitrates could cause blood pressure to suddenly drop to an unsafe level, resulting in dizziness, syncope, or even heart attack or stroke.
Physicians should discuss with patients the appropriate action in the event that they experience anginal chest pain requiring nitroglycerin following intake of Cialis. In such a patient, who has taken Cialis, where nitrate administration is deemed medically necessary for a life-threatening situation, at least 48 hours should have elapsed after the last dose of Cialis before nitrate administration is considered. In such circumstances, nitrates should still only be administered under close medical supervision with appropriate hemodynamic monitoring. Therefore, patients who experience anginal chest pain after taking Cialis should seek immediate medical attention see Contraindications 4.1 and Warnings and Precautions 5.1.
Physicians should consider the potential cardiac risk of sexual activity in patients with preexisting cardiovascular disease. Physicians should advise patients who experience symptoms upon initiation of sexual activity to refrain from further sexual activity and seek immediate medical attention see Warnings and Precautions 5.1.
Physicians should discuss with patients the potential for Cialis to augment the blood-pressure-lowering effect of alpha-blockers and antihypertensive medications see Warnings and Precautions 5.6, Drug Interactions 7.1, and Clinical Pharmacology 12.2.
Physicians should discuss with patients the clinical implications of continuous exposure to tadalafil when prescribing Cialis for once daily use, especially the potential for interactions with medications, nitrates, alpha-blockers, antihypertensives and potent inhibitors of cytochrome P450 3A4 and with substantial consumption of alcohol. see Dosage and Administration 2.7, Warnings and Precautions 5.6, Drug Interactions 7.1, 7.2, Clinical Pharmacology 12.2, and Clinical Studies 14.2.
There have been rare reports of prolonged erections greater than 4 hours and priapism painful erections greater than 6 hours in duration for this class of compounds. Priapism, if not treated promptly, can result in irreversible damage to the erectile tissue. Physicians should advise patients who have an erection lasting greater than 4 hours, whether painful or not, to seek emergency medical attention.
Membrane Integrity Factor has HGHR, in its real form - and is one of the most talked about and researched, anti-aging formulas on the European market. Good news, it has finally arrived in the US, creating a bit of a stir with consumers looking to boost their youth factor. Weve all heard about the anti-aging and health benefits of HGH and maybe thought them beyond our reach due to cost. But Dr. Hans Neiper, the developer behind this formula, has taken HGHR replenishing technology out of the lab and made it accessible to everyone. Membrane Integrity Factor infuses the body with HGHR to kick start your pituitary gland into high gear. Enhanced production may translate into feeling more energetic, sexual, and virile, while allowing you to gain muscle mass and lose weight more easily. Hands down Membrane Integrity Factor has done amazingly well with consumers looking to get their vitality back! When you read the Blog posts, and we suggest you do, youll see for yourself what this formula can deliver. Learn More, Read the Full review of Membrane Integrity Factor here.
Youve probably heard about it, or seen it on all the major media outlets? Deer Antler Plus is the top-performing nutritional supplement made to support and maintain muscle health and strength exclusively for men. This supplement is for those guys who want to grow faster, define better and have bigger muscles. We think Deer Antler Plus will be especially beneficial to those who, lead an active life or who spend a lot of time at the gym already. The contained formula in Deer Antler Plus is unlike any other weve seen and will work to help with both muscle building and muscle recovery. Overall, we feel Deer Antler Plus is the perfect dietary supplement for men who are concerned about their strength, and want to start seeing real results from their workouts. Finally, this could be the last muscle support supplement youll ever need! Learn More, Read the Full review of Deer Antler Plus here.
You can say goodbye to male patterned baldness with Profollica! This 2-step product is the only natural hair loss system weve seen, that may actually provide men with what they want - a reversal of hair loss and a promotion of hair growth! The powerful formula was scientifically developed to disable the internal hormones that begin the hair loss process. Profollica is backed by science and is even doctor recommended. It contains ingredients proven in clinical research to slow down and stop hair loss. It has even been shown to re-activate hair follicles that have been producing for some time. There is no question, if you are serious about taking charge of your image, Profollica is the only way to go when it comes to combatting hair loss. Learn More, Read the Full review of Profollica here.
While Endowmax uses the most potent ingredients that definitely battling erection problems, We strongly advise those who have heart disease, diabetes and hypertension to stay away from Endowmax as the side effects of long term use of Endowmax may bring nasty side effects.
Endowmax is relatively new comer in male enlargement industries and its not proven yet. We advise our readers to do a bit of research before you buy any male supplements. we recommend our readers to check out the following 2 products before you decide to buy EndowMax.
2 capsules daily after meals.
Soft Cant Even Penetrate?.
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Unable To Satisfy You Partner the Way She WANTs?
If youre having one or more of the following sexual problems and youve been looking for a natural solution to these problems and are confused about which male enhancers to buy, then this information could literally save you hundreds of dollars from being scammed by male enhancement manufacturers!
The widespread use of sexual enhancing drugs is of concern because they can cause heart attack.
The possibility of heart attacks is one reason why Viagra is a prescription drug rather than an over-the-counter drug like aspirin. A doctor needs to understand your medical history and make sure that Viagra wont cause a heart attack. Occasional patients who take Viagra get painful, long-lasting erections and have to see a doctor to solve the problem.
This might show up as cardiomyopathy with exercise intolerance heart failure.
Finally, there is some concern that some men, especially younger men who take Viagra recreationally and who dont really need it for physical reasons, may end up with a dependency on the drug. That is, they may become unable to maintain an erection without taking Viagra.
The ONLY way to make sure you wont get any nasty side effects like heart attack while increasing your sexual performance is to avoid taking drugs at all cost.
Natural male enhancement is a popular solution for sexual dysfunction in men of all ages, and there is a lot of information put on the Internet. With hundreds of companies trying to get your money, how do you know which products actually work?
Before you purchase a male enhancer, you should research the available options carefully and ignore the hype.
A lot of male enhancement products make false advertising claims about their effectiveness - no product can make you gain inches, and herbal male enhancers are not manufactured to work immediately like prescription ED drugs such as Viagra, Cialis, and Levitra.
Natural male enhancers work with your body over a time period of a few days to a few weeks to gradually enhance what you have, safely and naturally. They are virtually side effect-free, unlike prescription ED drugs.
With little information available about the effectiveness of male enhancement products, weve done the research and reviewed various male enhancers available on the market to show you what to look for.
What Is Considered A Quality Male Supplements?!
With so many arthritis and joint pain supplements out there in the market all claiming to be able to eliminate your arthritis and joint pain permanently, I know it is hard to tell which supplement really work.
Back pain or myalgia was reported at incidence rates described in Tables 1 through 4. In tadalafil clinical pharmacology trials, back pain or myalgia generally occurred 12 to 24 hours after dosing and typically resolved within 48 hours. The back pain/myalgia associated with tadalafil treatment was characterized by diffuse bilateral lower lumbar, gluteal, thigh, or thoracolumbar muscular discomfort and was exacerbated by recumbency. In general, pain was reported as mild or moderate in severity and resolved without medical treatment, but severe back pain was reported with a low frequency 5% of all reports. When medical treatment was necessary, acetaminophen or non-steroidal anti-inflammatory drugs were generally effective; however, in a small percentage of subjects who required treatment, a mild narcotic, codeine was used. Overall, approximately 0.5% of all subjects treated with Cialis for on demand use discontinued treatment as a consequence of back pain/myalgia. In the 1-year open label extension study, back pain and myalgia were reported in 5.5% and 1.3% of patients, respectively. Diagnostic testing, including measures for inflammation, muscle injury, or renal damage revealed no evidence of medically significant underlying pathology. Incidence rates for Cialis for once daily use for ED, BPH and BPH/ED are described in Tables 2, 3 and 4. In studies of Cialis for once daily use, adverse reactions of back pain and myalgia were generally mild or moderate with a discontinuation rate of 1% across all indications.
Across all studies with any Cialis dose, reports of changes in color vision were rare 0.1% of patients.
The following section identifies additional, less frequent events 2% reported in controlled clinical trials of Cialis for once daily use or use as needed. A causal relationship of these events to Cialis is uncertain. Excluded from this list are those events that were minor, those with no plausible relation to drug use, and reports too imprecise to be meaningful:
Body as a Whole asthenia, face edema, fatigue, pain
Cardiovascular angina pectoris, chest pain, hypotension, myocardial infarction, postural hypotension, palpitations, syncope, tachycardia
Digestive abnormal liver function tests, dry mouth, dysphagia, esophagitis, gastritis, GGTP increased, loose stools, nausea, upper abdominal pain, vomiting, gastroesophageal reflux disease, hemorrhoidal hemorrhage, rectal hemorrhage
Musculoskeletal arthralgia, neck pain
Nervous dizziness, hypesthesia, insomnia, paresthesia, somnolence, vertigo
Respiratory dyspnea, epistaxis, pharyngitis
Skin and Appendages pruritus, rash, sweating
Ophthalmologic blurred vision, changes in color vision, conjunctivitis including conjunctival hyperemia, eye pain, lacrimation increase, swelling of eyelids
Otologic sudden decrease or loss of hearing, tinnitus
Urogenital erection increased, spontaneous penile erection
The following adverse reactions have been identified during post approval use of Cialis. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. These events have been chosen for inclusion either due to their seriousness, reporting frequency, lack of clear alternative causation, or a combination of these factors.
Sexual activity may be a strain on your heart, especially if you have heart disease. If you experience chest pain during sexual activity, call your physician immediately and avoid sexual activity until you are advised otherwise by your doctor.
Tell any and all of your health care providers that you are taking Cialis. If you ever need emergency treatment for a heart problem, the health care providers who treat you will need to know the last time you took Cialis.
Do not let anyone else take your medication.
Ask your doctor about drinking grapefruit juice while taking Cialis.
pain in your back, muscles or any limb
chest pain - Cialis may cause serious side effects if you have a heart condition.
Call your doctor if you experience any other unusual problem. It may be a Cialis side effect.
In case of an overdose of Cialis, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
pain in your back, muscles or any limb
Keep all appointments with your doctor.
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.
Keep Cialis in the original container, tightly closed, and out of reach of children.
Store it at room temperature and away from excess heat and moisture. Do not store in the bathroom.
Discard any medication that is outdated or no longer needed. Talk to your pharmacist about proper disposal.
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If you have difficulties with having a good erection, there must be the time to check on different special medication. It has been many years now since the first erectile dysfunction started to be used by men.
Thanks to those mediation men can be sure that if there is a problem with erection, they will get an instance help to manage it. Thus, if you are thinking about trying special mediation, you can check on Cialis.
This medication is extremely popular among men. Cialis is not the only medication that you can use for the management of erectile dysfunction, but this medication is really worth checking out.
It is very effective for increase the blood flow to your penis and it would just be enough to use this medication hour one before starting having sex.
Depending on individual factors, you may be recommended to take this mediation in other dose than some other man. The main point here is actually to find the minimal dose of this medication for you that still would work for you.
Can Endowmax help you satisfy your partner? Women have always liked a man with a big, strong penis. Its just human nature. So before drugs like Viagra came along, what did men do? It turns out they had their own form of Viagrathe plants and herbs that grew around them. For thousands of years, men took these powerful sexual herbs to increase the size of their penis and erection.
Catuaba Bark is a very famous aphrodisiac plant found in Brazils rain forest. The Tupi Indians have been using it for centuries to increase the size and strength of their penis. Theyve written many songs praising the plants amazing sexual powers.
Maca Root used to be eaten by Incan warriors before going into battle. It gave them energy and strength. Throughout South America, this plant is still widely used to increase penis size, erection strength, and sexual stamina. If you walk through the streets of Peru today, youll see many maca products for sale, including drinks, juice, and even candy!
Epimedium Grandiflorum Extract is better known as Horny Goat Weed. For over 2, 000 years, this herb has been used in traditional Chinese medicine to cure erectile dysfunction. It contains icariin, which increases your bodys levels of nitric oxide. Nitric oxide is important because it relaxes your smooth muscles. This allows blood to flow more easily to the penis. More blood to the penis means a bigger and stronger erection.
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I ve stopped using Endowmax. I consider myself a student of natural male enhancement products, so I try to keep an open mind about things. So even though this is an Endowmax review, I ve got to be honest and say that I like another product better. Endowmax is NOT the best way to increase the size your penis. Herbs alone simply cant do this.
If you want to make your penis bigger naturally, you must do penis exercises. In my last entry I wrote about Penis Advantage, which I think is the best penis exercise program available today. I do these exercises religiously and have seen positive results.
But I havent changed my mind about one thing. I strongly believe that natural herbs can increase erection strength and prevent premature ejaculation. Ive been using a product called Zenerx for the last couple of months, and theres no question that its far superior to Endowmax.
The herbs in Zenerx are thoroughly tested for purity and strength. Of all the male enhancement pills out there, Zenerx probably has the purest ingredients. And each pill contains a very strong dose of these high-quality herbs. The results are quite powerful.
Endowmax only took me so far. But by doing penis exercises and taking Zenerx, Ive taken my sexual abilities to a higher level.
Here s an interesting video featuring genuine people they don t look like actors to me! describing how Zenerx has affected their sex lives.
If youd like to check out the Zenerx website, just go to the official website. Forget about reading all those Endowmax reviews. There s no doubt in my mind that Zenerx is just so much better than Endowmax.
This blog is mainly about Endowmax, but occasionally Ill recommend another product if its truly outstanding. Today Id like to talk about the penis enlargement program called Penis Advantage. I ve been following this program for a while and I believe it s significantly better than Endowmax for enlarging the penis naturally.
While the penis is not a muscle, it s the same as any other part of your body. Exercise will make it stronger and fitter.
The nanoparticles were tested on a total of 18 rats bred to have age-related ED. The rats were divided into three treatment groups. One group of seven rats received nanoparticles encapsulating NO. A second group of five rats received nanoparticles encapsulating NO plus an experimental ED drug called sialorphin which has a mechanism of action different from PDE5 inhibitors. A third group of six received nanoparticles encapsulating NO plus tadalafil Cialis.
Five of the seven rats treated with the NO-containing nanoparticles, and all 11 rats treated with nanoparticles encapsulating NO plus sialorphin or tadalafil showed significantly improved erectile function. None of the seven rats in a control group, which received empty nanoparticles, showed any improvement.
Most of the animals, nearly 90 percent, showed a response to treatment with the nanoparticles, says co-author Joel M. Friedman, , , professor of physiology biophysics and of medicine. Dr. Friedman developed the nanoparticles with his son Adam Friedman, , chief resident in the division of dermatology of the department of medicine at Montefiore Medical Center, The University Hospital and Academic Medical Center for Einstein.
The response time to the nanoparticles was very short, just a few minutes, which is basically what people want in an ED medication, adds Dr. Davies. In both rats and humans, it can take 30 minutes to one hour for oral ED medications to take effect.
Postmortem examination of the tissues at the site of administration showed no signs of local inflammation or toxicity. In addition, when we applied the nanoparticles at therapeutic doses, we found no indication of systemic side effects, says Dr. Friedman.
The Einstein research team will carry out safety and dosing studies in rats in the coming months. Clinical studies on humans could begin in a few years if animal studies continue to show that the nanoparticle delivery system is safe and effective. But the investigators caution that the time from a proof-of-concept trial in animals to approved use in humans may be a decade or more.
More information: The paper, Nanoparticles as a novel delivery vehicle for therapeutics targeting erectile dysfunction, is published in the September 18, 2009 online edition of the Journal of Sexual Medicine.
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A new generation of anti-impotency drugs based on nanoparticles might be coming quickly. Researchers at the Albert Einstein College of Medicine in New York presenting at the 104th Annual
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Enzyte Newer brand name Enzyte 24/7 and Extenze sometimes also known as Extenze Plus or Extenze extended release tablets pills are some of the top-rated male enhancement dietary supplements. The following article is intended to highlight some of the key differences between the two and provide an honest comparison to help you make your decision wiser, easier and safer.
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Korean Red Ginseng, Ginkgo Biloba, Grape Seed Extract, Horny Goat Weed, Muira Puama, Niacin, Zinc
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I am so happy I found Zenerx on I have been looking at local health stores for similar products with no luck. I received my package a day earlier than expected and had a great experience using this site.
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Why bother, fluoride is in your drinking water.
I think that it is necessary for you to be at least 18 years old to own a car at your own name in almost all the states of USA. If you are not 18 yet, then you have to wait for it.
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