➥ 本文描述搶救一名感染SARS-CoV-2早產嬰兒經過(27週，出院時健康狀況良好，8週時回院急診，父母及4歲手足為無症狀感染者)。


嬰兒感染SARS-CoV-2所受到的影像似乎比年齡較大的兒童大，呼吸道疾病的嚴重程度，與成人類似，似乎與宿主肺部的發炎反應有關，而非病毒量。


建議對兒科患者密切監測其發炎反應，適時的調控可能是有效的治療方式。(「財團法人國家衛生研究院」莊淑鈞博士 摘要整理 ➥http://forum.nhri.org.tw/covid19/virus/j_translate/j1096/)


📋 Horizontal transmission of severe acute respiratory syndrome coronavirus 2 to a premature infant: multiple organ injury and association with markers of inflammation (2020/05/19)+中文摘要轉譯
■ Author：
James Cook, Katharine Harman, Bogdana Zoica, et al.
■ Link：
(The Lancet) https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30166-8/fulltext


🔔豐富的學術文獻資料都在【論壇COVID-19學術專區】
■ http://forum.nhri.org.tw/covid19/


#2019COVID19Academic
衛生福利部
疾病管制署 - 1922防疫達人
疾病管制署
國家衛生研究院-論壇

繼上一篇的 #早洩 自我診斷之後

接下來要進入大家最在乎的地方

如果有 #早洩的問題該如何自救呢？

圖文網誌好讀版：

https://drbirdscience.blogspot.com/2020/03/blog-post_23.html

其實自救的方法可以簡單分成

#口服藥物類治療
#非口服藥物治療

在這裡我們先討論口服藥物的使用

懶得看下去的話可以參考圖片懶人包：

我舉一個最近門診的案例：

一位約30歲的年輕工程師

之前沒有任何不良習慣

體型算是中廣型，BMI大概27左右

最近剛交第一個女朋友

是一個大學剛畢業的年輕妹子

覺得好不容易可以脱離母胎處男了🎉🎉🎉

選在一個美好的夜晚到內湖的知名摩鐵

結果竟然才愛撫一下就........身寸了😱😱😱

本來以為第一次太緊張造成的

後來又試了幾次

也只是插入動兩下就忍不住了......

最長只有10秒.......

導致他的女朋友最它越來越冷漠，眼看這段感情岌岌可危...💔

這種狀況

我們稱之為原發性早洩 / 終身早洩 / 先天性早洩

(life long premature ejaculation )

在確定沒有次發性早洩的問題之後

(acquired premature ejaculation)

就可以開始第一步的治療，其中最常使用的藥物是：

🔴短效的血清素再吸收抑制劑--必利勁

(selective serotonin re-uptake inhibitor, SSRI )

from 中國附醫藥劑部

這個藥的學名叫做 #Dapoxetine

[英文發音像是"#打砲神器"]

商品名：Priligy, 中文：#必利勁

這個藥的主要功用在增加腦內的血清素濃度來延長射精的時

使用的方式為：#性行為前一小時 服用同時配合喝大量的水分

到底多有效呢？

根據一個大型研究收錄了2,614位先天性早洩的病患

他們平均的射精時間約54秒⏰

分成三組人使用安慰劑、必利勁30毫克、必利勁60毫克

最有效的是吃60毫克這組

他們的射精時間延長了三倍變成3.32分鐘

30毫克這一組延長了約兩倍變成2.78分鐘

所以使用必利勁之後....

#延長兩到三倍的時間，#平均約三分鐘左右

比較有趣的是安慰劑這一組也有效果

延長到1.78分鐘

所以其實男人很多都是 #缺乏自信心 ＸＤＤ

給一點自信就會表現變好......(給點掌聲吧～姐妹們)👏👏👏

但是相對來說會有的 #副作用 包含了

#噁心、#頭暈、#頭痛、#腹瀉 發生率大約3~20%不等

吃越高劑量的發生機率越高，好處是代謝快不殘留

目前這是唯一有早洩適應證的藥物

都作為先天性早洩的第一線藥物

但是價格不菲，據我所知大約落在三顆$1000台幣左右

『#春宵一顆值千金』(誤)💸💸💸

我想應該就是這個意思

除了必利勁之外也可使用

🔴長效的血清素再吸收抑制劑或抗憂鬱劑

#Fluoxetine
中文名稱：百憂解(其中一種商品名)
使用方式：每天20~40mg或性交前3~6小時
#Paroxetine
中文名：克憂果(其中一種商品名)
使用方式：每天10~40mg或20mg性交前3~4小時
#Clomipramine
中文名：可必安(其中一種商品名)
使用方式：每天25~50mg或25mg性交前3~4小時

在 #必利勁 發明之前泌尿科醫師主要都是開立這些藥物

但是其實這些藥當初開發的目的是為了治療憂鬱症

所以藥效的作用會相對緩慢許多而且需要長期服用

一般來說需要使用1到兩週才會有效果

而且使用半年以上可能會有藥效減退的問題

其他副作用包含：

#性慾減退、#高潮減退、#性功能障礙

使用在18歲以下病患可能會提高 #自殺風險 等等

所以現在臨床上並不是最佳選擇

壯陽藥也可以治早洩！？

🔴常見治療勃起功能障礙的藥物對早洩其實也有效果

研究發現治療效果竟然跟必利勁差不多

平均可以延長2.4分鐘

臨床上如果是早洩同時合併有勃起問題的話

有些病患在勃起功能治療好之後早洩的問題就會獲得改善

但是神奇就在即使病人沒有軟屌的問題也有效!!👍

究其原因

我覺得可能是安慰劑效應

或是其實讓GG更硬了一點也可以減少早洩情形的發生吧！

那如果把威而鋼和必利勁加在一起吃

會不會效果最好？

確實也是如此

這兩種要加在一起會比單吃任何一種效果還好

但是並沒有增加太多(比起單用多一分鐘左右)

所以目前比較少醫師會建議病人一起使用

但是如果價錢不是你的考量點

在和醫師商量過後可以以適應症外使用(off-label use)的方式服用

目前有藥商正在進行這類的Combo藥物試驗

相信不久的將來就會看到這種 『威而勁』的藥物出現了

其實很多網友都知道必利勁這個藥物

也都有使用經驗

但是長期要吃藥不但會擔心傷身，也是一筆不小的開銷

那有沒有吃藥以外的方法呢？

請見下回分享了

#泌尿科 #台北泌尿科 #北醫 #割包皮 #台北割包皮 #泌尿科推薦 #性功能治療 #性功能 #持久 #壯陽

[政府違法扼殺民主, 讓世界再度看見台灣]
.
事情已經鬧上國際, 中選會, 蔡英文政府, 你們還要對年輕生命的犧牲不聞不問嗎?!
.
國際知名環保人士支持以核養綠, 聲援黃士修絕食要求政府依法行政
請蔡英文政府讓人民能公投決定自己想要的能源政策, 而不是政府黑箱決定執行非核家園, 結果只是讓台灣成為排碳家園, 空污家園, 漲價家園
.
https://www.facebook.com/michael.shellenberger1/posts/10155378934741895
.

Taiwanese Government Sparks Hunger Strike After Rejecting Signatures For Pro-Nuclear Referendum

This is urgent — please share!
——————————

The Taiwanese government is being accused of violating election law after rejecting more than 24,000 signatures gathered by the former president and environmentalists seeking a popular vote on nuclear energy this November.

“I am not asking people to support nuclear power,” said a Shih-Hsiu Huang, 31, the co-founder of Nuclear Myth-Busters, who began a hunger strike in front of the government Central Election Commission (CEC) last Thursday after it rejected the signatures. “I am asking the Taiwanese government to let the people choose.”

In August, Taiwan’s former president, Ma Ying-jeou, endorsed the referendum and joined pro-nuclear environmentalists in the streets of Taipei to gather signatures, drawing new support for the initiative and triggering widespread media coverage.

"Opposing nuclear energy is now an outdated trend," Ma said. "What has become a trend is how to reduce emissions of carbon dioxide to tackle global warming."

The referendum on nuclear power could still qualify for the ballot. Organizers say they had delivered 315,000 signatures on September 6 — more than the 282,000 that the law required.

But the activists say that their odds declined when the government rejected an additional 24,000 signatures that they attempted to deliver on September 13.

“This is malfeasance,” said Tsung-Kuang Yeh, a professor of nuclear engineering at National Tsing Hua University. “First, they kept moving up the deadline — from September 14 to September 10 and then to September 6. Then, they rejected our signatures on September 13.”

Organizers say they delivered additional signatures to increase their chance of qualifying and were rejected on a technicality.

In a statement, the government commission said, “There is very little flexibility in each stage. To follow this stage-by-stage procedure, it is therefore not possible for the CEC to accept a second submittal.”

But Huang says a representative of the government told him by phone, which he video-recorded, on September 12, that she would accept the group’s additional signatures, and even told him which door in the building to enter in order to meet her.

“Twenty-four hours later the CEC changed its mind and slammed the door on us,” said Professor Yeh.

Huang said their signature-gathering benefited from widespread opposition to the current anti-nuclear government. With an approval rating of just 33% , President Tsai Ing-wen saw her popularity decline when half of all households suffered electricity outages last summer due, in part, to the nuclear phase-out.

The rejection of signatures wasn’t the first time Taiwan’s government took actions which the pro-nuclear activists say were designed to thwart their efforts.

Taiwanese law requires that petitioners have at least six months to gather signatures after delivering an initial 2,000 signatures in order to gain permission for the larger signature-gathering effort.

Though they delivered the initial signatures in March, the government only allowed signature-gathering to begin in July.

Solar & wind provide less than 5% of Taiwan’s electricity despite years of large government subsidies.EP

Nuclear power in Taiwan derives its support from environmentalists concerned about land use and climate change and from those concerned about the island-nation’s heavy dependence on energy imports. Taiwan imports 97% of its energy from abroad.

Solar and wind combined provide less than five percent of Taiwan’s electricity last year despite years of heavy government subsidies, while nuclear energy provided 13 percent — and would have provided 23% had Taiwan been operating all of its reactors.

Earlier this year the Tsai government approved a new coal plant, despite recent reports documenting 1,000 premature deaths annually from air pollution from Taiwanese coal plants.

Last October, the climate scientist James Hansen and dozens of other leading environmental scientists and scholars urged President Tsai (致蔡英文總統公開信中文翻譯) to return to nuclear. “Taiwan would need to build 617 solar farms the size of its largest proposed solar farm at a cost of $71 billion just to replace its nuclear reactors.”

Tuesday marks the 125th hour mark of the fast, and Yeh said Huang is becoming fatigued from lack of food. Another pro-nuclear leader, Yen-Peng Liao, said he would continue the fast if Huang is hospitalized.

“This hunger strike is not for myself and not for the public referendum,” said Huang, “it is for the democracy and the order of law in Taiwan.”