Im Drgomez89 Im internal medicine Specialist and i have been receiving more young patients with erectile dysfunction.

I wanted to share real medical information with their respective sources. Maybe it can help someone with this everyday more common problem.

• Erectile dysfunction (ED) is defined as a consistent or recurrent inability to attain and/or maintain penile erection sufficient for sexual satisfaction.

McCabe MP, Sharlip ID, Atalla E, Balon R, Fisher AD, Laumann E, Lee SW, Lewis R, Segraves RT
J Sex Med. 2016 Feb; 13(2):135-43.

• In a recent study conducted in a Urology Clinic, it has been observed that one out of four men seeking medical care for ED was younger than 40 years
  

Capogrosso P, Colicchia M, Ventimiglia E, Castagna G, Clementi MC, Suardi N, Castiglione F, Briganti A, Cantiello F, Damiano R, Montorsi F, Salonia A
J Sex Med. 2013 Jul; 10(7):1833-41.

• ED has been for long time considered a problem mainly related to psychological conditions and distress. Accordingly, until phosphodiesterase type 5 inhibitors (PDE5i) were introduced, psychoanalysis and cognitive-behavioural therapy were the only option for ED
  
• In the last few decades, ED has been recognized as a clinical consequence of several different organic diseases and the importance of vascular health in erectile function has been so emphasized that ED is now considered not only the result of vascular impairment, but also a harbinger of forthcoming cardiovascular (CV) events
  

Corona G, Monami M, Boddi V, Cameron-Smith M, Lotti F, de Vita G, Melani C, Balzi D, Sforza A, Forti G, Mannucci E, Maggi M
J Sex Med. 2010 May; 7(5):1918-27.


The Sexual Medicine and Andrology Unit of the University of Florence for sexual dysfunction, the first tertile of age (n=1,873 subjects) represents younger subjects (18–44 years) And the most common cause of erectyle dysfunction ing young patients are Organic pathologies (not psycological causes)

Corona G, Ricca V, Bandini E, Rastrelli G, Casale H, Jannini EA, Sforza A, Forti G, Mannucci E, Maggi M
J Sex Med. 2012 Aug; 9( 8 ):2017-26.

Erectile Dysfunction AS Cardiovascular RISK

• Young patients are often reassured without any further medical investigations, including physical exam. However, organic disorders, as well as relational and psychological or psychiatric conditions, can be meaningful in determining ED in younger men
  
• according to Montorsi’s hypothesis , impairment of penile artery blood flow occurs before that of coronary or carotid arteries, whose diameter is greater and needs longer time to acquire a clinically relevant damage. The clinical consequence of this pathological event is that ED often manifests earlier than myocardial infarction or stroke. In particular, it has been demonstrated that ED occurs on average three years before the first major adverse CV event (MACE)
  

Montorsi P, Ravagnani PM, Galli S, Rotatori F, Veglia F, Briganti A, Salonia A, Dehò F, Rigatti P, Montorsi F, Fiorentini C
Eur Heart J. 2006 Nov; 27(22):2632-9.

Endocrine Causes or erectile Dysfunction

• This is the case of adrenal insufficiency, whose treatment with glucocorticoid and mineralocorticoid replacement is able to improve erectile function

Granata A, Tirabassi G, Pugni V, Arnaldi G, Boscaro M, Carani C, Balercia G
J Sex Med. 2013 Aug; 10(:2036-43.

• An adequate control of thyroid function in hyper- and hypothyroid patients is associated with an improvement in ED

Carani C, Isidori AM, Granata A, Carosa E, Maggi M, Lenzi A, Jannini EA
J Clin Endocrinol Metab. 2005 Dec; 90(12):6472-9.

• testosterone (T) deficiency is frequently found in subjects with ED

Maseroli E, Corona G, Rastrelli G, Lotti F, Cipriani S, Forti G, Mannucci E, Maggi M
J Sex Med. 2015 Apr; 12(4):956-65.


INTRAPSYCHIC Causes

• ED, depression is significantly associated with a greater severity of the impairment in erectile function

Corona G, Ricca V, Bandini E, Mannucci E, Petrone L, Fisher AD, Lotti F, Balercia G, Faravelli C, Forti G, Maggi M
J Sex Med. 2008 Feb; 5(2):458-68.

• However, the relationship seems to be bidirectional, as also ED has been associated with the occurrence of depression . In addition, treatment with PDE5i is related with an improvement in depressive symptoms

McCabe MP, Althof SE
J Sex Med. 2014 Feb; 11(2):347-63

[/list]

In fact, young men reporting ED risk being dismissed without any specific medical assessment, including medical history or physical exam, owing to the assumption that ED in younger is a self-limiting condition, without any clinical consequence.

IF you have any question you can DM

Ur right Aveatrex im sorry.

Well to talk about Social Anxiety disorder and his medication is important to know the symptoms ur having.
Usually we dont use Xanax for Social Anxiety is well know the first line treatment are Sertraline and paroxetine. They have the best outcomes in clinical trials.
https://www.ncbi.nlm.nih.gov/pubmed?term=15699296

But Remember Psycotherapy it the most important treatment with better results in time.

This is a very important TOOL i recommend u its called  Liebowitz Social Anxiety Scale [LSAS]
https://nationalsocialanxietycenter.com/liebowitz-sa-scale/
Pliz do the test and send me the result DM
ANd your whole medication. BEcause not every patient get better with only 1 medication. And if you tell me the whole story DM would be perfect.

And secondly
The nootropics
I will share with u this article talks very important stuff we all should know about Nootropics there are not magic pills specially in healthy patients. They are not goin to make u get better grades. Are like Pre work out and as u know pre work out can hurt u more than the benefit that they are goin to get u

https://digitalrepository.trincoll.edu/cgi/viewcontent.cgi?article=1060&context=fypapers

Well let me tell you something  about these topic is very interesting
in the last 20 years theres have been a raise in Erectyle disfunction among young people the incidence is almost 20 % so... there are  a lot of young people around us with this problem..

Erectyle disfunction is not only to get your penis hard.. its having problems to get it hard enough and for enough time to be able to perform the whole sexual intercourse

we can use this calculator to measure our erectile function.

https://qxmd.com/calculate/calculator_377/international-index-of-erectile-function-iief-5

There are some theories  and some of the talks about the abuse of porn. That make us more hard to please
but everyone should be checked  almost 85% of causes are reversible.

it would be nice if he DM me and talk more about this
But let him know 1 of 5 guys under 30 year have this problem so he is not alone.

About the Vitamin C use with medical benefits in the last years have been some meta analysis like this
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5000725/
Who show its really really hard to find benefit in the use of this suplement.
Somme studies show little very little benefit, another one dont show  real benefit.
And the studies that show real benefit the are open label, observational. What im trying to say is we need more studies with better methodological design


And https://www.ncbi.nlm.nih.gov/pubmed?term=24566474 in this Last review of the literature there isnt enough evidence to recommend the use of vitamin C.

did you see this kind of post those are good advices but they does not have  any bibliography  once a patient started metrotexate because his neighbour told him it was a good treatment for psoriasis. ( its true ) but the details are importante. the neighbour told him the dose was 5 mg every day. she took it for 2 months... and his bone marrow stopped working because the dose she was taking was excessive.

 Thats why when i was writing about the relation between autism behavior and the cow milk consumption  i pointed out the weak points of the studies PETA used and compare with another article with a more solid design

the most important thing about medicine articles its about the study design and if the statistical tools they use are the right ones. Even in the most prestigious journal we can find studies with a weak design. and they are published there. 

If u guys want. We also can talk about critical reading

Aveatrex Pliz forgive me im dinning with my parents.. i promise you i will give you a proper answer when i get home

 Hi gercinci im jose rodriguez coul u help me to make a logo to a proyect
im a doctor and the proyect its called Hang over Relief its about goin to the patient home and give them intravenous hidratation and medication for the headache and nausea.

Pliz help me

Hi madfet

Its important to know when u started smoking and how many cigarettes do you smoke every day
you can calculate your pack- year relation
https://shouldiscreen.com/English/pack-year-calculator

Over 10 you are un moderate risk of developing COPD (Chronic Obstructive Pulmonary Disease)
and over 20 you are at high risk
And over 30 you need to be check for LUNG cancer with a  low dose radiation CAT scan
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4849359/

Important things to know

• cigarette smoking is thought to be causal in 85 to 90 percent of all lung cancer https://www.ncbi.nlm.nih.gov/pubmed?term=12527563
• Chest radiograph screening does not reduce mortality from lung cancer, although there are limited data in women. thats why for screening you need a Low dose radiation Cat Scan
• The majority of patients with lung cancer have advanced disease at clinical presentation
  This may reflect the aggressive biology of the disease and the frequent absence of symptoms until locally advanced or metastatic disease is present https://www.ncbi.nlm.nih.gov/pubmed?term=26811226
• Chest pain — Chest pain is present in approximately 20 to 40 percent of patients presenting with lung cancer and is more common in younger compared with older patients https://www.ncbi.nlm.nih.gov/pubmed?term=2992757

Its unlikely for you to have lung cancer or lung failure right now unless you have any genetic mutation.
Its important to know characteristic about the pain :
Like if the pains is always there? or only when you deep breath
or if it was only i time u felt it.
if you have any more question u can easily DM and i will be pleased to help you.

This kind of pain are named Gout flares. Its important to know when was the alst time you checked your uric acid levels.
If they are over 6.8 mg/dl the uric acid easly precipitates and becomes crystal. And those are the one who causes the pain. https://www.ncbi.nlm.nih.gov/pubmed?term=5027604
Long-term success in achieving and maintaining subsaturating serum urate levels ( <6.0 mg/dl) is attended by clinical benefits that include cessation of gout flares, resolution of tophi, and improvement in patient physical function and health-related quality of life.

Important things to know
1 Gout can lead to

• Recurrent flares of inflammatory arthritis (gout flare)
• A chronic arthropathy
• Accumulation of urate crystals in the form of tophaceous deposits
• Uric acid nephrolithiasis
• A chronic nephropathy that, in gouty patients, is most often due to comorbid states

2 About the alcohol intake

• In patients with established gout maintaining goal range serum urate levels(<6.0 mg dl) on pharmacologic urate-lowering therapy, small amounts of alcohol intake are unlikely to trigger flares or promote disease progression.
• Beer, liquor, and wine were all associated with an increased risk of gout flare in patients with established gout and at least one gout flare in the prior year BUT A significant dose-response relationship was found between the amount of alcohol (beer, liquor, or wine) the bigger the dose the higher the risk
• Some studies suggest Wne has lower risk to develop gout flares but the best thing its to avoid it until your serum urate level  reach 6.0 mg/dl

About Hypertension medication

• Hidrochlorothiazide raises serum urate levels with doses over 25 mg a day
• Losartan Lowers serum urate levels with 50 mg or more a day
• calcium-channel blockers have been found to decrease both urate levels and incident gout risk https://www.ncbi.nlm.nih.gov/pubmed?term=22240117

About Diet
 Dietary purine restriction has proven to be an impractical means to manage gout, despite urate being the end product of purine metabolism. Furthermore, with the availability of potent antihyperuricemic drugs, this dietary approach is rarely necessary and infrequently employed, except in individuals with severe renal insufficiency or intolerance of pharmacologic therapy.

About the Gout flare
The treatment of a gout flare is based on 4  key aspects

• serum urate lowering drug (allopurinol or febuxostat)
• Colchicine 0.6 mg twice its important to prevent gout flares can be taken up to 6 months
• Nsaids Like indometacin 50 mg every 8 hours helps inflamation and pain relief
• Hidratation

https://www.ncbi.nlm.nih.gov/pubmed?term=23098865


If u need more information u can easly contact me by DM
I really like doing this.. or you can just give me some merit or something lol i really enjoyed this

i hope this can really help u in something

IF u want we can talk about the information ONLINE.
PETA.org  https://www.peta.org/features/got-autism-learn-link-dairy-products-disease/

They talk about the relationship between a cow milks protein named casein and his relationship with
AUTISM autistic behavior and the cite this 2 articles (Article 1)https://www.ncbi.nlm.nih.gov/pubmed?uid=8869369&cmd=showdetailview&indexed=google and Article 2 https://www.ncbi.nlm.nih.gov/pubmed/12168688 and they talk about those articles like they are stadistically solid. But if you go through them and analyze them

• they were only 20 patients in every group (if u want the full articles i can send them to you)
• the methodological design of those studies they dont explain if the studies are blind or double blind
• the ages of the patients (this is particularly important because the development of the brain of everyone changes with age)

,   
the number of participant are very low to have enough statistic and interpretative power and also be able to  extrapolate their results. But in the article they talk about the articles as if they are rock solid truths.



We can search for some new meta Analysis like this one https://www.ncbi.nlm.nih.gov/pubmed/28612113 and we can see the search criteria which they use they can get almos 220 patients and they identify most of the studies which show differences are related to parents tools to measure their children behavior.

And if u have a family member with  autism spectrum disorder. Im sure you have heard about those diet interventions.... even some medical doctor protect those beliefs. (because there are not solid rock results)

We can talk also about Cross fit and pregnancy, insulin use and the risk of going blind (this may surprise you).
Im at your services guys and also i can get those articles for you.

 
I will thank @ciprianpt he was the first in help me through BT world. He even donate me a GPS im always thankful for his kindness.

Im Jose Im and internal Medicine Specialist Doctor
Im on vacation 15 Days and i noticed my fourth year students had personal question about basic medicine subjects and they were embarrassed to ask because the thought people will mock them. Thats why i implemented and anonymous system of papers with questions in a BOX.

You dont have idea how many questions did I get. 

Then i writing this post to let you guys know u can ask me anything u want.
Its amazing the huge amount of LIES internet says about medicine subjects

 Im here for you guys and if you have a question for yourself or anyone you care about.
For only $5 valued ETHER or Bitcoin i can give u a full answer with their respective bibliography to prove its truthfulness .

My specialties

• Drug interactions
• Obesity
• Heart disease
• Lung disease
• Sleep problems
• social Anxiety
• Depression

Just PM And if u guys want we can open a thread to share information about a topic every week. By you deciding the topic with a Survey.
 

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yeah instead of thinking he wasted those bitcoin it was their best investment ever.. he give it a real usage in the real world..,. and thats the most dificult par in the crypto assets.. give them a real world value.. other wise those token would be have those $41 price or even lower because anybode want them the most funny part is what  did tho the seller of the pizza with those bitcoins.

I hope it does because with muy investment money i am not able to do good trading Right now. When it gets below 150 again I'm going to get inti the game again. Right now with the price skyrocketing a Lot of new investor are going to come. So we have to learn to treat them well AND teach them how not to he scammed to not going back

yeah men all this thread its just.. incomplete.. if i have to promise me something it would be dont make a work partnership with a gambling addict. i have bad experiences with that.. and its worst when the addict its part of your family.. they even rob u to feed their addiction... and cant take seriously other commitment... i think easy money does not last much... that should be our main goal.. even now with our now bitcoin investors.

i dont see tombola.game in the list .. it was one of my first investments in the crypto world 2 years ago.. they promsied that they will share theor profits with the share holders and promised to pay them with ether not their own token TBL.. it lasted 2 months but i supposed its dificult to grow in the bear market.. even if the idea is good.

we are in buyinh buying buying time. the  bear market last less than i expected thats why we dont have to listen to speculator even if they call themselves. Experts.. an expeculation is alway that even if they come from experts or telegram channels or whatever. the market is like that it has their own rhythm

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