Learn about Erectile Dysfunction and Sildenafil Citrate Online

Have you ever wondered how sildenafil acts within your body to help you solve your problems with erectile dysfunction?  Thanks to the instant availability of the Internet and computer devices, you will now be able to learn about ED and sildenafil citrate online right at your fingertips.

If you are curious as to how PDE5 inhibitors such as sildenafil work inside your body, then you can browse on search engines by simply typing in the search box the words sildenafil citrate online.  When you read about the mechanics of the action of sildenafil citrate online, you will learn that it helps protect the enzyme cGMP (short for cyclic guanosine monophosphate) from being degraded by the cGMP-specific PDE5 (short for phosphodiesterase type 5 enzyme) which are evidently located in the penile corpus cavernosum of men.  The free radical NO (short for nitric oxide) found in the penile corpus cavernosum adheres itself to what are called the guanylate cyclase receptors, which then results to the occurrence of elevated amounts of cGMP, thereby leading to the vasodilation or relaxation of the smooth muscles of the inner lining cushions of the helicine arteries (tendril-like arteries of the penis importantly involved in the process of its erection).  Once the smooth muscles relax, it will result to vasodilation and therefore there will be an increased supply of blood flowing into the penile spongy tissue, and the end result would be a successful penile erection.

Additionally, what you would also learn about sildenafil citrate online is that its special molecular makeup is somewhat similar to cGMP (located in the penile corpus cavernosum as well) and functions as an aggressive binding element of PDE5 in the penile corpus cavernosum, which results to more concentrations of cGMP and even better occurrences of erections. Avery important information that men will learn through reading about sildenafil citrate online is that sildenafil will be rendered useless without the introduction of one or more sexual stimuli, since only a sexual stimulus will be the only factor that can initiate the activation of the nitric oxide and cGMP inside a man’s body. Read more…

What's in the news: May 29 -- Chalk River closed for 3 months or longer

Chalk River shutdown to last "at least three months"
Revised upwards from earlier estimates, the Chalk River shutdown will last "at least three months," said the chief nuclear officer of Atomic Energy of Canada Limited (AECL). Nuclear medicine experts in Canada and the US have expressed grave concerns about what now appears to be an inevitable shortage of radioisotopes, which are needed for the contrast materials used in diagnostic imaging.

Asked by a Globe and Mail reporter whether the nuclear plant might be shut down indefinitely, Natural Resources Minister Lisa Raitt said, "The answer is, we don't know." [Globe and Mail]

Health Minister Leona Aglukkaq said she is working to coordinate with foreign providers but, in a shockingly bad stroke of luck, three of the four other reactors worldwide that produce similar radioisotopes are also shut down at the moment.

Linda Keen, the former president of the Canadian Nuclear Safety Commission, said the current crisis is even worse than the 2007 one that got her fired. (In 2007, Ms Keen required Chalk River to shut down for safety repairs, but when a radioisotope shortage appeared to be imminent the government convened to pass emergency legislation overruling her, leading to her dismissal.)

Quebec pathologists raise spectre of breast cancer testing errors
A small study by the Quebec association of pathologists revealed disturbingly high rates of errors, prompting calls for mass re-testing. "There are thousands of patients who have cancer and who received treatment. Did they get the good treatment?” said Health Minister Dr Yves Bolduc. “Some people perhaps didn't get treatment and should have received it." Quebec does not have a quality-assurance process to verify its pathology results. [Globe and Mail]

After years of scrutiny and painful discoveries of wrongdoing and cover-ups of breast-cancer pathology test errors in Newfoundland, the news that Quebec might have some of the same problems distressed many people. In a release issued Friday, the Canadian Breast Cancer Network called for "huge system change." "Given the errors in Newfoundland and Labrador and now in Quebec, it is evident that this is not a regional problem – it is a national one," said CBCN president Diana Ermel. "CBCN therefore calls for urgent action to implement systemic changes, with the establishment of uniform standards in Canada as a necessary first step to begin to restore confidence in the medical system in this country by women diagnosed with breast cancer and their families. We know that Canadian pathologists are working diligently to advance national laboratory standards and we applaud their efforts."

ADQ health critic Eric Caire blamed the governing Liberals for dragging their feet on responding to the current allegations and for failing to prevent the errors by fixing the system sooner. [ADQ news release]

Hugh Short attempted murder charge dropped
Canadian officials have dropped a charge of attempted murder against James Kopp in the case of the 1995 shooting of Ancaster, Ontario, physician and abortion provider Hugh Short. Mr Kopp is currently serving a life sentence after being convicted of killing an abortion provider in New York.

Need bariatric surgery? Get in line
A new national survey measured bariatric surgery wait times across Canada and found the average wait time is five years. "The waiting times for bariatric surgery are the longest of any surgically treated condition," concluded study authors Drs Nicolas Christou and Evangelos Efthimiou. "Given the significant reduction in the relative risk of death with bariatric surgery (40%–89% depending on the study), the current waiting times for the procedure in Canada are unacceptable." [ (PDF)]

Earlier this week, the government of Ontario announced it will spend $12.6 million over the next three years to increase the province's capacity to provide patients with bariatric surgery by 750% and to fund obesity research and prevention projects. [Ontario Ministry of Health and Long Term Care news release]

More wait times woes
Speaking of wait times, here's an incredible story: Adult thalassemia and sickle cell disease patients in Toronto can't access adult services at Toronto General Hospital until one of the 99 current patients dies and a spot opens up. 150 patients are left without help beyond the blood transfusions they require. [Anemia Institute for Research and Education news release]

Pay parity
Higher pay for specialists in Quebec is unfair, charged the provincial association of general practitioners. "Numbers don't lie: general practitioners' compensation is not competitive," said Dr Louis Godin, the president of the Fédération des médecins omnipractitiens du Québec, in a release. "The ever-widening compensation gap between general practitioners and medical specialists in Quebec is becoming disproportionately lopsided and unjustifiable when one considers the current crisis in family medicine." [FMOQ news release]

Wonky news
The latest Health Wonk Review is up.

What's in the news: May 27 -- Morgentaler suit against New Brunswick moves forward

Morgentaler v New Brunswick suit to go ahead
The New Brunswick government was rebuffed in its efforts to have a legal challenge against its restrictions on publicly funded abortions, brought by Dr Henry Morgentaler (right), thrown out. The government had argued that Dr Morgentaler had no legal standing to challenge the government on abortion funding because he is not a woman, but the Court of Appeal has now ruled, in a unanimous decision, that the suit can go ahead.

"With respect," wrote Chief Justice Ernest Drapeau in dismissing the government's appeal and ordering them to pay Dr Morgentaler's legal costs, "neither the Province’s primary nor its alternative contention comes close to passing muster." [Morgentaler v New Brunswick decision, Court of Appeal of New Brunswick (PDF)]

New Brunswick Justice Minister TJ Burke has said that his government may appeal to the province's Supreme Court to overturn the Court of Appeal's decision to uphold the initial ruling. Peggy Cooke, an employee at Dr Morgentaler's only clinic in the province, in Fredericton, told CBC News she suspected the government of attempting to drag out the process until Dr Morgentaler dies, in order to avoid going to trial.

H1N1 pandemic fears recede
The worst of the H1N1 flu outbreak is over for the time being, according to Dr David Butler-Jones, Canada's chief public health officer.

"It looks at this point like we're over the worst of it in Canada for this season," he said. "But, again, I'm going to hedge my bets on that because we're watching very closely and it's still within the incubation period of previous cases, so you could see a second spike."

NB trauma system can't find a boss
New Brunswick is still struggling through its year-and-a-half-long search for someone to head the province's trauma system, after senior trauma care leader Dr Andrew Trenholm bowed out of the running and another candidate accepted a job in Quebec. A third candidate has been identified, however, and is supposed to be interviewed this Thursday.

No helicopters, no outrage?
Dr Edward J Harvey, the co-editor of the Canadian Journal of Surgery, penned an impassioned editorial that appears in next month's issue lamenting the absence of Canadian criticism about the death of actress Natasha Richardson after a fall at Mont-Tremblant ski resort.

Ms Richardson was taken by ambulance -- the provincial government doesn't have a helicopter for emergency medical transfers -- from a hospital in the Laurentians to a trauma centre in Montreal but died several days later.

Dr Harvey writes that while governments have been reluctant to pay for the expensive helicopter services, it has been empirically shown that they can save lives. "Why does it take the death of a famous actress to raise the question of why we do not have regionally appropriate health care policies? Why is the death and suffering of our population at large not enough to change policies? The obvious answer in this and other cases of nonhomogeneous health care delivery is that these policies are not political flashpoints. Until an election is won or lost on health care inadequacies, there will continue to be nonentities in the political landscape. We as physicians should no longer sit idly by as governmental policies set by largely noninformed bureaucrats cause such deficiencies in health care." [ (PDF)]

Blood sugar in pregnancy predicts diabetes later
Mildly abnormal blood sugar levels in pregnant women, even levels below those required to make a diagnosis of gestational diabetes, are a sign that the women are at higher risk of developing type 2 diabetes, according to a new study by the Institute for Clinical Evaluative Sciences, in Toronto.

"Although we already know that women who've had gestational diabetes need to be monitored, the study suggests that even women with mild glucose abnormalities might benefit from diabetes prevention and detection strategies," Sunnybrook researcher Baiju Shah said.

Aglukkaq signs Brazil pact
Health Minister Leona Aglukkaq signed a memorandum of understanding with her Brazilian counterpart, Dr Jose Gomes Temporão, to establish more cooperation between our two countries on issues like pandemic preparedness and healthcare for indigenous people. [Health Canada news release]

Nunavut's historian health minister
As though Nunavut doesn't have enough healthcare problems to keep Health Minister Tagak Curley occupied, he has thrown himself into the centre of another, totally unrelated controversy: did the Inuit on Sir John Franklin's ill-fated 19th-century exploration of the Northwest Passage resort to murder and cannibalism? Mr Curley spoke at the National Maritime Museum, in Greenwich, England, to refute those claims.

A doctor's story of arrival
Dr Zardasht Gaf described how he came to leave the Kurdish region of Iraq to come to Canada, using a fraudulent passport provided by a smuggler to make his way to Ottawa in 2003 and then fighting for refugee status. Now, Dr Gaf begins a family practice residency at McMaster in July.

And a story from south of the border:
University of North Carolina-Chapel Hill health policy professor Jonathan Oberlander is interviewed by health reporter and media critic Trudy Lieberman of the Columbia Journalism Review about the role of health IT and electronic medical records in healthcare reform and the effects the US federal stimulus package is likely to have on health IT. Many of the same considerations Dr Oberlander discusses, it seems to me, apply to Canada as well. Readers of Canadian Medicine may remember Dr Oberlander, who is an expert on the similarities and differences between the American and Canadian healthcare situations, from an article published in November called "The death of convergence theory."

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Promising new book: "Right of Thirst"

Albuquerque emergency doc and novelist Frank Huyler's latest, , features as its protagonist an American cardiologist whose international medical aid mission encounters some serious setbacks.

In an essay , critic Benjamin Moser writes that Huyler's cardiologist

"...causes nothing like the havoc of Graham Greene’s Quiet American, but he does inadvertently get some people killed. Huyler, however, is far too sophisticated a writer to dismiss his idealism out of hand: at the end of a spectacularly failed 'aid' mission, it is this idealism, directed not at the entire provinces of bedraggled strangers Anderson had envisioned but at a few individuals as hapless as he is, that saves his journey from utter calamity."
It sounds as though this book might be of particular interest readers of Canadian Medicine who have in the past read about former MSF president and Canadian MD James Orbinski's harrowing overseas medical aid experiences (THE INTERVIEW: Dr James Orbinski's war), the six-month stint Toronto's Dr James Maskalyk did in Sudan (Six Months in Sudan excerpt), and leftist Montreal infectious disease specialist Dr Amir Khadir's time overseas before he was elected to the provincial legislature in Quebec (Left-wing MD elected as Quebec gives Liberals a majority).

Also: if this is your kind of thing and you want to know more about medical volunteer opportunities overseas available to Canadian doctors (which will surely prove more successful than the one in Right of Thirst), check out the for descriptions of organizations as well as advice on how to get involved.