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Patients’ evaluation was done interictally, 1) Medical, neurological, endocrinological, psychiatric, vascular and urological history and examination: Seizure variables included age at onset, precipitating factors, duration of illness, type, frequency, family history of epilepsy, type of utilized AED(s) (monotherapy or polytherapy), duration of treatment, degree of patients’ control on AED(s) and side effects from medications.

The frequencies of seizures were defined as described before [20] into: a) very frequent: occuring several times a day or at intervals shorter than 7 days, b)

frequent

Regarding the degree of control on AEDs, patients were considered controlled on AEDs treatment, when seizure free for ?1 year, partially controlled when seizure frequencies were occasional and uncontrolled when seizures were frequent or very frequent. Physical and urological examinations included examination for the presence of secondary sexual character, genitalia, other tissues of the penis and pelvic region, rectal and prostate examination and examination of perianal and penile sensation. Bulbocavernosal reflex was done to test the integrity of the sacral arc, performed by squeezing the glans (head) of the penis, which immediately cause the anus to contract if nerve function is normal.

The latency between squeeze and contraction was assessed by observing the anal sphincter or by filling it with a gloved finger inserted past the anus. All patients underwent standard electroencephalography (EEG) and neuroimaging [as computed tomography (CT) or magnetic resonance imaging (MRI)]. 2) Assessment of erectile function: Assessment of erectile function was done using the Arabic translated version [21] of International Index of Erectile Function questionnaire 5-items version or IIEF-5 [22].

Each item of IIEF-5 is scored from 0 to 5 on 4 items and 1 to 5 on 1 item.

The 4 of the 6 items includes questions regarding maintenance ability, erection confidence, maintenance frequency, and erection firmness, while the single item includes question about intercourse satisfaction and overall satisfaction.

A cutoff value of 21 is chosen so that patients with IIEF-5 scores of ?21 are classified as having ED while scores >21 are not. According to this scale, ED is classified into four categories: severe ED (1–7), moderate ED (8–11), mild-to-moderate ED (12–16), mild (17–21), and no ED (22–25).

3) Psychiatric evaluation: Standardized psychiatric interview was done by applying the Diagnostic and Statistical Manual of Mental Health Disorders, fourth edition (DSM–IV) criteria for the diagnosis of depression and anxiety [23]. A standardized psychiatric interview was chosen as the primary method for obtaining data. A differentiation between behavioral disorders and behavioral symptoms was made throughout the work. In patients with coexisting symptoms, assessment of the severity of the symptoms was undertaken by an experienced psychologist using the Arabic translated versions of Beck Depression Inventory (2nd edition) (BDI-II) [24, 25] and Hamilton Anxiety Rating Scale (HAM-A) [26,27]. BDI-II is the revised version of the original BDI (1st edition) [28]. In BDI-II, the items reflecting somatic disease and consequences of a medical illness which overlap with depressive symptoms were eliminated (as fatigue, work disability, weight loss, loss of energy, sleep loss, appetite loss, changes in body image, and somatic preoccupation).

The BDI–II consists of 21 items to assess the intensity of depression.

Each of the 21 items corresponding to a symptom of depression is summed to give a single score for the BDI-II.

According to summation of scores from all 21 parameters, the score of 0-13 is considered minimal range, 14-19 is mild, 20-28 is moderate, and 29-63 is severe.

The HAM-A consists of 14 items to measure the severity of a patients’ anxiety. Each of the 14 items is scored on a 5-point scale, ranging from 0 = not present to 4 = severe. According to summation of scores from all 14 parameters, the total score of 14-17 is considered as mild in range 18-24 as moderate while 25-30 as severe. 15-20 minutes to complete the interview and score the result. 4) Laboratory investigations: Standard laboratory tests included: complete blood count (CBC), measurement of serum creatinine, liver enzymes and fasting blood glucose level. For analysis of serum free testosterone, prolactin, free thyroxin (FT4), thyroid stimulating hormone (TSH) and sex hormone binding globulin (

SHBG

postictal

The concentrations of serum prolactin, FT4 and TSH were measured by IMMULITE reproductive hormone assays from Diagnostic Product Cooperation (Los Angeles, USA). The concentrations of free testosterone were measured by enzyme immunoassay method (ELISA) (BioSource Europe S.A. Rue de I`Industrie, 8 – B-1400 Nivelles – Belgium) and SHBG concentrations were measured by ELISA kits (IBL international GMBH, Hamburg, Germany).

For confirmation, the serum hormone levels were obtained and assessed twice at two different days.

The hormonal levels were combined with the cross sectional assessment while clinical evaluation and interviewing with patients and control subjects. Compliance to antiepileptic medications was confirmed by assessment of the serum drug level at least once during the period of the study.

The serum levels of AEDs were determined in the Therapeutic Drug Monitoring (TDM) lab, Assiut University Hospital, Assiut, Egypt, using fluorescence polarization immunoassay system of Abbott (EPIA), TDxFLX apparatus (Abbott Lab, Wiesbaden, Germany) as described before [29]. The serum levels of AEDs were measured as part of the investigation in batched assays. The approximated therapeutic serum level of CBZ is 4-10 ?g/ ml and that of VPA is 50-100 ?g/ml. Calculations were done with the statistical package SPSS, version 12.0.

Data were presented as mean ± SD (standard deviation) when normally distributed and mean (quartiles) when not normally distributed.

Kolmogorov-Simirnov test was used to test the parameter distributed. Unpaired two-sided Student’s t test was used for comparison of mean of normally distributed parameters. In all other cases Mann-Whitney U test was used for comparison.

Correlations must be assessed using Pearson’s for normally distributed data and Spearman’s methods for non-normally distributed data.

What was once acknowledged solely as impotence and smilingly mentioned barely behind closed doors has within the recent years gained immense recognition for the most part partially to the microscopic blue pill created for this?

It absolutely was within the late '90s and was the speak the city thus to talk.

Anyone laid low with it wished it and folks who didn't grasp what it absolutely shortly did.

There was even a brand

new

Not solely have these medications helped millions, however they need additionally created their revered manufacturing firms a bigger quantity of cash than the common person would ever even win in an exceeding lottery.

Thus it's not too stunning to ascertain that there's analysis occurring for a subsequent generation or a minimum of a new product which will be marketed. Two such medications within the works are that of Vidalista 40 and Kamagra Gold or Zydena®.

Sildenafil is AN experimental medication that has shown nice promise, particularly within the speed within which it claims to figure.

The manufacturers are oral communication that it starts operating in as very little as quarter-hour once taking it and this might undoubtedly spell competition for different current products on the market. Quarter-hour is concerning 0.5 the time that presently prescribed Kamagra Oral Jelly 100mg impotence treatments begin to figure once being taken.

Thus there undoubtedly may well be a marketplace for such a pill if it ever becomes offered.

But what abundant even be observed is that there's a once each day Cialis that may negate such a fast-acting medication. different problems to stay in mind but are facet effects, The other medication within the works is called Udenafil or proprietary name is Zydena®.

This medication is truly presently being prescribed in each Chosen and Russia as a once each day formula. One needs to surprise if it's solely a matter of your time before it involves North America and Europe.

It will but ought to be approved by the FDA before ever coming back to the USA and Dong-A Partech Co, its producer is running tests within the USA to do to prove its effectiveness and safety to sometime create a debut in the US.

Is there an area for these medications within the world market?

I'd say affirmative, the prescriptions that are written or refilled day by day for this condition are staggering and it is sensible that some new ones on the market would undoubtedly succeed on some level.

However can this happen, solely time can tell and if it will the speculation on what medication will take high spot within the market is smooth out.

Nothing works for my Erectile Dysfunction; am I currently cursed with this condition for life?

Quite merely, the solution to the present is an unequivocal no. In today's world, with a good vary of treatment strategies offered, nobody ought to ever feel that there's no answer for his or her own specific variety of dysfunction. In younger men, it will typically be that their performance anxiety is thus entrenched that even giant doses of Cenforce drug, Malegra , or Vilitra won't offer a cure. However, for these men, there are six ways that they'll adopt that, with a small amount of following, will yield terribly satisfactory results.

Wherever this is often impractical, there are different, lesser-known medications that will induce a satisfactory erection regardless of however anxious they'll be. The situation will be terribly similar in older men. Let's say in post-prostatectomy cases, Cenforce 150 drug and similar medication can rarely work.

However, these men can also have the benefit of various medications within the kind of gels or via painless injections. This additionally applies to men with neural structure injury, advanced induration, Parkinson's sickness, and stroke or artery sickness.

The main message here is that despite your natural and, utterly intelligible issues, there's invariably an answer and everyone that's needed is that the right specialist with a dedication and a disposition to assist you to discover the correct one for you. You want to totally perceive your own dysfunction and what's inflicting it and this is often wherever a specialist skilled comes in.

You would like to own the precise reason for your distinctive impotence pinpointed and solely a doctor with a specialist interest and coaching during this subject will try this for you. Understanding your own erection issues is a component of the cure and designation the cause is central to correct treatment. Erection may be a sexual state that corresponds to the enlargement of pennies in males.

The easy reason for an erection purchase viagra no prescription is taken into account to be the enhanced blood flow within the pennies that creates it grow giant and thence get erected. The complete method of erection is de facto vital for a person to own a contented sexual life.

Allow us to currently perceive the varied aspects of male erection downside. The primary players that management the complete erection method embrace the male internal secretion androgen, the pituitary body, and also the prostate. Currently, the blood enters the erectile organ space into the hollow structures that are parallel to the penis on each side, referred to as corpora cavernous. This enhanced blood flow will be a result of psychological input. Once the erection reaches its extreme the seed is ejaculated via a tube, corpus spongiosum, out of the erectile organ. The correct functioning of the erectile organ is important to urge a correct erection.

If thanks to any physical reason the blood flow isn't optimum to cause an erection the state are termed as erection pathology.

Erection difficulties are ordinarily seen in those people who have unhealthy habits like alcoholism and chain-smoking.

Medical science has developed a cure for dysfunction.

Dysfunction or impotence will be treated to some extent with the employment of medical aid medication offered within the market. They're being taken and prescribed as traditional health pills Cenforce 200 . These medications will undoubtedly facilitate a male in obtaining the desired quantity of erection for a selected amount of your time.

The time of erection depends on the number and kind of drug in taking Sildamax .

The primary operation of those medications is to stimulate the nerves encompassing the erectile organ and at last end in enhanced blood flow within the penis to cause a penal erection.

Several times who are on these medications for long have rumored satisfactory results. They acclaim to regain the boldness in their sex lives and additionally convey the manufacturers of those medications for saving their married life that depends on intimacy and sexual activity.

Some of the foremost common impotence medications embrace Super P Force , Viagra, Cialis, and Levitra.

Well, there are some facet effects of those medications.

Therefore it's not suggested for patients laid low with cardiovascular disease, diabetes, high steroid alcohol levels, eye issues, and chain-smoking.

Patients on top of fifty years old-time are suggested to remain far from any artificial medication treatment because it will adversely have an effect on their body.

The danger of erection issues arises if you're seriously overweight or extremely diabetic. Therefore if you'll manage your weight and sugar levels you can keep one's eyes off from these disorders. The largest rum concerning dysfunction is that it cannot be cured. However, as a matter of truth impotence is totally curable if diagnosed at AN early stage of life.

Therefore it suggested to all or any the people that if you're feeling any symptoms of erectile organ malfunction then have it diagnosed as early as doable. is an innovative drug delivery company engaged in the research, development and commercialization of technologies and products intended to address safe use of medications. We have discovered and developed three proprietary platform technologies which can be used to develop multiple products. Our LIMITX ™ Technology is intended to minimize

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The server encountered an internal error or misconfiguration and was unable to complete your request.

Please contact the server administrator, webmaster@alahalygate.altagamoa.com and inform them of the time the error occurred, and anything you might have done that may have caused the error. More information about this error may be

available

Additionally, a 500 Internal Server Error error was encountered while trying to use an ErrorDocument to handle the request. Erection problems often occur as men get

older

Physical causes may include older age, diabetes, heart disease, taking certain types of HIV medication and how long you have taken these medications. Sexual wellbeing is an important part of your overall health and problems in this area can have an impact on how you feel about yourself. Help is available from healthcare professionals if you are struggling with erectile dysfunction.

Having sexual problems may also indicate that there are other areas of your physical and psychological health that need to be attended to.

Erectile dysfunction (or impotence) is when you cannot get or keep an erection

that

Occasional problems are not necessarily a cause for concern, but ongoing erectile dysfunction should be investigated by a doctor. It is one form of male sexual dysfunction, which also includes problems ejaculating and reduced sexual desire or satisfaction. Erectile dysfunction often affects men as they get older.

It is also more common in men with HIV than in the general population, although it has been difficult to estimate how many men with HIV are affected.

Research suggests that around 40 to 60% of men with HIV may have some degree of erectile dysfunction.

Erectile dysfunction has various physical and psychological causes. It is often associated with conditions that affect blood flow in the penis, including diabetes, high cholesterol, high blood pressure, cigarette smoking, obesity and heart disease. Other factors commonly linked to erectile dysfunction include older age, low testosterone levels, alcohol or drug use, anxiety and depression. It is important to consider both the physical and the psychological reasons behind sexual problems. If you

have

Your anxiety around sexual performance may add to an existing physical cause and worsen the problem.

Physical causes of erectile dysfunction in men with HIV. In addition to the factors mentioned above, there are specific factors that are important if you are living with HIV.

These include having lived with HIV for a longer time, a lower CD4 cell count when you were first diagnosed and possibly taking certain HIV medications (see below).

If you have both HIV and hepatitis C, or suffer from body fat redistribution (lipodystrophy), you may be more likely to viagra fast delivery have difficulties getting an erection.

Many men with HIV have low testosterone levels (hypogonadism). This can be difficult to diagnose because some symptoms (such as loss of vitality, low sexual desire, low bone mineral density and loss of muscle mass) are less specific and can occur in men with HIV who have normal testosterone levels. It is important for your doctor to investigate whether this could be the cause of your impotence. Chronic illness, HIV replication, antiretroviral medications, viagra fast delivery lipodystrophy, metabolic syndrome, other co-morbidities and co-infections can contribute to low testosterone levels in people living with HIV. A feeling of unease, such as worry or fear, which can be mild or severe.

Anxiety disorders are conditions in which viagra fast delivery anxiety dominates a person’s life or is experienced in particular situations. Amyl, butyl or isobutyl

nitrite

An association means that the two variables change together, but it doesn't necessarily mean that A causes B. antiretroviral (ARV) A substance that acts against retroviruses such as HIV.

There are several classes of antiretrovirals, which are defined by what step of viral replication they target: nucleoside reverse transcriptase inhibitors; non-nucleoside reverse transcriptase inhibitors; protease inhibitors; entry inhibitors; integrase (strand transfer) inhibitors.

Usually, having spontaneous erections at night or in the morning is a good indicator of testosterone status.

It means you have enough testosterone in your blood to rule out a severe deficiency.

It would also help your doctor rule out other physical causes of impotence. As HIV is associated with increased risk of heart disease, the link between erectile dysfunction and heart disease is of particular importance for men living with HIV.

Impotence may be an early marker for undiagnosed heart disease. If you are living with HIV and having difficulty getting an erection, you should have a thorough cardiovascular risk assessment done and any risk factors for heart disease should be addressed.

As cholesterol, high blood pressure, diabetes and other health conditions can all contribute to erectile dysfunction, lifestyle changes may help. Exercise regularly: particularly activities that get the heart rate up, such as walking fast, dancing, gardening and cycling.

Do antiretrovirals and other medications cause erectile dysfunction? Some research has linked the use of protease inhibitors boosted with ritonavir ( Norvir ) to erectile dysfunction, but this hasn’t been found in all studies. Nerve damage that occurred with the use of some older antiretrovirals may also contribute, but erectile dysfunction has not been consistently linked with any particular antiretroviral class.

The length of time that you have been on certain types of medication seems to be of particular importance. Other medications can also contribute to erectile dysfunction. These include some drugs taken to treat depression, other mental health conditions and high blood pressure, as well as opioid painkillers.

If you’re concerned that your medication could be causing your difficulties getting or staying hard, it is important to discuss this with your doctor. Psychological causes of erectile dysfunction in men with HIV. Your sexual drive or performance can be affected by depression, stress or anxiety, relationship problems, embarrassment or guilt.

Psychological causes may be particularly relevant for men living with HIV as there are specific psychological stressors linked to having HIV, such as the fear of transmitting it to others, the stigma surrounding infection, concerns about discussing your status with others, and body image changes.

These can potentially affect your feelings about sex.

Living with HIV can have a negative impact on your quality of life, social wellbeing and sexual function.

Sexual difficulties may have a physical cause, but also be aggravated by psychological and emotional factors, especially in the case of a stigmatised disease such as HIV. Pressure to use condoms could also have an impact upon sexual performance.

Some men find that their penis is less sensitive to touch when using condoms, which may contribute to erectile dysfunction.

Research has linked sexual dysfunction with less condom use and risky sexual behaviour, possibly for this reason. "The recreational drug ‘poppers’ should not be used with any erectile dysfunction medications as this could result in a potentially fatal drop in blood pressure." People living with HIV who have sexual dysfunction often also experience anxiety or depression.

It’s possible that these mood problems and the medications used to treat them may both contribute to sexual dysfunction. For gay and bisexual men, sexual difficulties have been associated with low self-confidence and poor self-image. There are complex interactions between sexual dysfunction, recreational drug and alcohol use, mood disturbance, sexual risk-taking and HIV infection.

In these instances, it is important to seek out help that does not only attend to the physical causes of sexual difficulties, but also considers psychological causes and consequences.