Erect Penis Display: Safe Situations for Exhibitionism

Starting at an early age, a guy tends to be pretty proud of his erect penis and the tricks that it can do. For some men, this pride may take the form of exhibitionism: displaying the penis (erect or flaccid) to another person or persons, often in public or semi-public situations. (Hopefully, men understand that an erect penis isn’t enough for praise; maintaining good penis health can help make one’s penis something worthy of being displayed.) Exhibitionism becomes a problem when a man prominently exposes his penis in a situation in which such an action is not desired – or, in many cases, is not legal.

Many men practice their exhibitionism in a safe way, which means not encroaching upon the rights and feelings of other people. The following are a few of the situations in which phallic display can be considered safe.

– In the locker room. Being in the changing room, shower room or sauna at a gym naturally affords a man the opportunity to walk around without clothing, so the locker room can be a great place for an exhibitionist to let it all hang out. It’s also not uncommon for friends in a locker room to focus attention on and comment about (usually in a mock-derogatory manner) each other’s equipment, which can be a plus for many exhibitionists. However, it’s important to remember that even in this setting, some exhibitionist practices (such as masturbating or displaying in a coercive manner) are not appropriate.

– At a nudist beach or resort. Clearly, clothing-optional beaches or nudist resorts are natural places for a man to exhibit his wares. However, a guy needs to realize that neither of these situations may be appropriate for a man with a raging hard-on. While some degree of erection is considered acceptable in these locations, in general it’s expected that such a state will be of limited duration. Men who become hard and flaunt the fact or who masturbate are not generally welcome.

– In booths at adult book stores. Many adult book stores feature booths where patrons can view explicit videos. Not surprisingly, most men engage in self-gratification while in these booths. Sometimes, patrons have cut peepholes between the booths in order to watch their neighbors; some booths even come equipped with plastic walls that enable consenting patrons in separate booths to watch each other as they masturbate.

– By skinny-dipping. Swimming naked gives many people a wonderful sense of freedom and liberation. If one has a private swimming area or can find a safely secluded spot, skinny-dipping with a partner or group of friends can be a wonderful experience.

– Jack and Jill parties. Many cities have private organizations that hold meetings specifically for their members to masturbate. When open to both sexes, it is generally referred to as a Jack and Jill club. Most such clubs have rules for cleanliness and hygiene, as well as about what is and is not allowed in terms of behavior.

– Role playing. Couples who are into exhibitionism can explore role playing as an option. This is especially useful for men with a desire to be exposed in a risky public situation. The couple creates a scenario that would be illegal in public and acts it out in the privacy of their own home. The power of imagination and fantasy cannot be underestimated.

Some exhibitionism of an erect penis is normal for a man, with many guys fulfilling this desire through simple one-on-one sexual contact. Whether putting the package on display for one partner or for a group, however, it pays to regularly use a top-drawer penis health creme (health professionals recommend Man1 Man Oil) to help maintain the organ in its best shape. A penis with adequately hydrated skin is going to have a nice glow and, more importantly, will lack dry, flaky patches that mar its otherwise impressive appearance. A crème that contains the high-end emollient Shea butter can be a superb way of providing moisturization to any member. Many penises often also feature broken capillaries as a result of rough handling. A crème that contains L-arginine should be used to help with this issue and restore the tool to its eye-catching appearance.

Reverse Heart Muscle Damage Naturally – A Case Study

Did you know that heart muscle damage can be reversed naturally? I am walking, talking, living proof, and this article is a case study profiling that proof.

Case History of Reversing Heart Muscle Damage

Five years ago I underwent surgery to replace a congenitally-faulty aortic valve in my heart. The valve didn’t shut properly and leaked with every heart beat, making my heart less efficient. I had lived with this valve for 67 years without realizing that it was faulty. I suffered from symptoms of this congenital defect but never realized the reason.

For instance, although I have always had great physical strength, I have never been able to perform exercise that required prolonged cardiovascular stamina. I always wondered how people could jog and talk at the same time, since I could hardly run half a mile without being totally winded.

After the surgery, I was able to do aerobic exercises that I had never been able to do before. I could easily run for 30 minutes without being winded. However, my physician informed me that my echocardiogram results indicated that my heart muscle was enlarged and somewhat damaged from a lifetime of overwork. She told me that this kind of enlargement could never be reversed, and that I would have to treat my heart with care for the rest of my life.

I appreciated her concern, but being a doctor of Chinese Medicine I did not believe that the situation could not be reversed. In Chinese Medicine it is believed that any condition can be healed.

Natural Supplement Therapy

After surgery my cardiologist prescribed coumadin to prevent any blood from clotting on the artificial aortic valve. I had serious side effects from taking coumadin so I switched to a natural blood regulator called nattokinase, which has been used by Asians for centuries to dissolve and prevent blood clots. In addition, I increased my intake of coenzyme Q10 from 30 mg to 180 mg. I had taken coenzyme Q10 for years as a natural form of support for my heart, and since I knew it had healing properties for the heart muscle, I increased my intake to therapeutic levels.

Echocardiogram Test Results

I get an echocardiogram once a year to ensure that my artificial heart valve is functioning properly and to check the general health of my heart. Three years ago, the results from my annual echocardiogram astonished my physician. She called me and asked me what I had been doing for my heart. I told her, and then asked her why. She replied that my heart muscle was no longer enlarged and that the heart wall was no longer thickened. This surprised her greatly since she had never seen a reversal of this kind in her practice.

I am pleased that my heart muscle has recovered from the stresses of a lifetime of overwork, and gratified that the Chinese Medicine point of view, where healing is always possible, has proven true in my case. I hope these results will inspire others with “chronic conditions” to realize that any condition can be healed, and that natural supplementation is always an option to consider.

How to Lower Triglycerides – The Best Things You Can Do to Bring Down High Triglycerides

Sometimes, triglyceride readings can be so high that it scares us. I first started researching how to lower triglycerides when my doctor’s nurse called and told me that my triglycerides were at 750, which was higher than she had ever seen. She was almost in a panic.

It turns out that others in her office had seen triglycerides that high, but it was still an issue of concern for both of us.

What I found out as I looked into it is that lowering triglycerides is really not that difficult to accomplish. You see, triglyceride readings fluctuate widely and can often be brought down relatively quickly with a few minor changes in your diet.

So what kind of dietary changes will you need to make. A diet that contains large quantities of empty carbohydrates such as sugar, white rice and potatoes is a recipe for disaster. These carbs are quickly converted into triglycerides soon after we have eaten. If you had had a meal like this the night before your blood test, that will explain much of the problem.

If you want to improve your lipid profile on a long-term basis, you will need to find good substitutes for these types of foods. For the time being, it is best to completely eliminate sugar from your diet. Find good substitutes for carbohydrates like white rice and potatoes. I personally found the brown rice was more satisfying, had more flavor, and kept my hunger at bay much longer.

Another thing to understand about how to lower triglycerides is that a cholesterol-lowering diet will also be effective at lowering triglycerides. Begin to increase the amounts of fruits, vegetables and whole grains that you consume on a daily basis.

The nutrition and fiber found in these foods will have a positive long-term impact on both your cholesterol and triglyceride readings. I encourage you to visit my website to learn more about lowering triglycerides without having to resort to medication.

Four Ways to Make Your Penis Bigger

Instead of boring you with a bunch of theoretical nonsense or scientific mumbo-jumbo, I am going to go ahead and cut to the chase with this article and fill you in on four ways to make your penis bigger. All four ways are suitable for rookies and they are great for making your penis longer as well as making your penis thicker:

1. Arginine Supplementation. If whey protein is the must-have supplement for bodybuilders, arginine is the must-have supplement for making your penis bigger. It is a vasodilator and will allow your penis to become more engorged with blood when you get hard. This will result in a bigger, firmer, stronger erection.

If your erection quality is significantly below your body’s potential right now, this method alone can add over a half-inch to your erect size. The best kind of arginine is called AAKG, and you can pick it up at Wal-Mart or any health food store for under twenty bucks for a big bottle.

2. Penis Stretches. Make sure you heat your penis up first using a hot washcloth, then take about ten minutes to stretch your penis out as far in front of you as it will. Start out with ten second sets and work your way up to thirty. Do this for about ten minutes. It will slowly lengthen your ligaments and expand your blood vessels, both of which are key determinants of erection size.

3. Jelqs. One of the best ways to make your penis bigger, especially for rookies. Get your penis half-erect, apply lubrication, and grip it tightly at the base using the thumb and forefinger of one hand. Slowly slide that hand up the shaft to the tip, then repeat with the other hand. Go back and forth for at least five minutes, preferably ten, and try to feel yourself pushing blood into your penis with each stroke.

4. Ulis. This is a great rookie method for increasing girth and head size. It is easy too. Get your penis fully erect and grip it very tightly at the base using a reverse “OK” grip with one hand. You should see and feel your penis become engorged with blood and the head get big and shiny. Be careful, don’t squeeze too hard, but be firm. Start with ten seconds and work your way up to thirty.

Take your arginine daily and do the three listed exercises at least three times per week and you should be able to gain an inch in six weeks. I would be surprised if you didn’t. You will be well on your way to a bigger, healthier, more satisfying penis!

How to Cure From Indigestion

Indigestion is a condition that is frequently caused by eating too fast, especially by eating high-fat foods quickly.

Indigestion takes the form of gas, bloating, heartburn and abdominal pain and can cause a great deal of discomfort for the sufferer.

Avoiding the foods and situations that seem to cause indigestion is the most successful way to treat it. Excess stomach acid does not cause or result from indigestion, so antacids are not an appropriate treatment, although some people report that they do help. Smokers can help relieve their indigestion by quitting smoking, or at least not smoking right before eating. Exercising with a full stomach may cause indigestion, so scheduling exercise before a meal or at least an hour afterward might help.

Patients with the esophagitis type of indigestion are often treated with H2 antagonists. H2 antagonists are drugs that block the secretion of stomach acid. They include ranitidine (Zantac) and famotidine (Pepcid).
Patients with motility disorders may be given prokinetic drugs. Prokinetic medications speed up the emptying of the stomach and increase intestinal motility. They include metoclopramide (Reglan) and cisapride (Propulsid). These drugs relieve symptoms in 60-80% of patients.

Smokers may be advised to quit smoking or avoid smoking before meals. Also, exercising after a meal can be a cause of indigestion, so scheduling exercise before a meal, or waiting at least an hour after eating, can also help prevent indigestion.

Practitioners of Chinese traditional herbal medicine might recommend medicines derived from peony (Paeonia lactiflora), hibiscus (Hibiscus sabdariffa), or hare’s ear (Bupleurum chinense) to treat indigestion. Western herbalists are likely to prescribe fennel (Foeniculum vulgare), lemon balm (Melissa officinalis), or peppermint (Mentha piperita) to relieve stomach cramps and heartburn.

If you experience indigestion frequently, see your doctor, who will try to determine when your indigestion occurs, what foods and drinks seem to trigger it, in what part of the abdomen the discomfort is strongest, and how long it typically last. Your physician also may want to run a series of tests to make sure that your indigestion is not being caused by a more serious condition, such as gastroesophageal reflux disease, colon cancer, stomach ulcer, gastritis, pancreatic disease, or irritable bowel syndrome. A barium X-ray, endoscopic examination of the digestive tract, or stool sample may be necessary. In order to rule out disorders of the pancreas, liver, or gallbladder, your doctor also may recommend an ultrasound examination of those organs.

If over-the-counter products do not offer relief, your physician may prescribe cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), or omeprazole (Prilosec) to block acid production in the stomach. A medication that increases the strength of the lower esophageal sphincter, such as metocopramide or bethanechol, also may be prescribed.

For heartburn symptoms that occur at night, it may help to sleep in a slightly more upright position, because the action of gravity reduces reflux. To help prevent indigestion, the best advice is to eat regular meals and a balanced diet, so that you maintain a healthy weight. Don’t smoke or drink alcohol in large amounts.

Any factors listed above (like smoking and alcohol), as well as the incorrect use of any drugs, should be stopped if possible. Non-ulcer dyspepsia often starts at a time of stress. Stress cannot be easily avoided, but there are many ways that you can deal with it. Avoiding deadlines (especially the self-imposed ones) is important. Delegating more responsibility should be tried, if at all possible. Learn to say No a little more often, and make sure that there are proper evening and weekend breaks. Regular exercise and the distraction of a hobby may be useful. Above all, problems should be discussed openly. Bottled-up feelings and worries are a big cause of stress.

Breathe Easy: The Free and Easy Way to Lower High Blood Pressure Using Slow Breathing With Music

Slow breathing is a genuine breakthrough in natural blood pressure treatment. Yet despite impressive clinical trials and glowing endorsements from leading medical institutions such as The Mayo Clinic and The American Heart Association, it still hasn’t gained widespread use among the public. This is unfortunate because slow breathing holds enormous potential to improve the lives of countless millions suffering not only hypertension but also from many forms of stress and anxiety disorders.

Could the whopping $300 price tag on the market-leading slow breathing device be a reason for sitting on the fence? They say you can’t put a price tag on your health (it’s usually the ones selling the product or service doing the talking!) but high prices surely don’t help to break down skepticism! Even though there’s now an enjoyable and much more affordable alternative available, a rightly skeptical public still needs some convincing.

So what if I told you that slow breathing doesn’t have to cost you a penny? Sure, any of the new products can and do make learning the method faster and easier. But you should ignore commercially motivated claims that it’s too difficult to do on your own. The fact is, with very little effort, the benefits of slow breathing are freely available to all!

You can also forget about complicated or mysterious practices you may have heard about before. Most breathing instruction is way off the mark. Like most things in life that really work, slow breathing is actually very simple and practical and all it takes is 15 minutes a day. Here’s exactly how you do it. I call it the Breatheasy system:

What you’ll need:

  • A quiet and comfortable place (your favorite recliner?) and a time when you have at least 15 minutes free of noise and distraction.
  • If at all possible, a piece of music that is very gentle and slow tempo. Classical adagios or larghettos are often ideal (but watch out for those numbers that suddenly explode into the 1812 Overture – you’re out to lower your blood pressure!).

Classical is my personal preference but other types of music that can work equally well are new age or ambient. You could even use chants or an ocean wave CD, anything relaxing with a slow and regular tempo.

It is possible to do it without music but the right music offers important advantages, as I will explain below.

  • If you have headphones I recommend using them. They focus the music and help insulate you from distracting noises. If you don’t have them don’t worry as you will still get good results.
  • A timer (optional) – only to signal the end of 15 minutes (not to count with).

Here’s what you do:

1. Start the music and get as comfortable and relaxed as possible.

Slow breathing requires relaxation to be effective. The more relaxed you are, the greater the benefits.

2. Breathe slowly and deeply but keep to a comfortable rate. A short pause between phases is normal.

If you’ve practiced abdominal breathing and are comfortable with it that’s fine. But slow breathing to lower blood pressure does not require any special form of breathing. Just breathe in the way that’s most comfortable for you.

Don’t confuse deep with strenuous. You don’t have to fill your lungs. That will only lead to hyperventilation and will actually raise your blood pressure.

3. Gradually extend your exhale phase until it’s approximately twice the length of your inhale. For example, breathe in for 2 seconds, pause, then exhale for 4 seconds. Take your time with it. Don’t rush any of these steps.

DON’T COUNT your breathing or use any form of timekeeper. The example is strictly to illustrate the right pattern. This is where most forms of breathing instruction go wrong. You can’t relax while counting or focusing on time. If you plant the inhale/exhale ratio of 1 to 2 firmly in your mind you will end up in the right ballpark.

4. Once you are used to this pattern, gradually slow your rate of breathing. Do not slow to a point of discomfort. If you feel any strain at all you need to back off. Remember you must stay relaxed in order to get the benefits.

Now is when using music pays off. The music itself will act as a regulator and your breathing will unconsciously adjust itself to the beat, helping to keep it smooth and regular.

5. Continue for 15 minutes. Repeat the session 4 or 5 times a week. That’s all it takes.

TO REVIEW: Relax to the music, extend exhale to twice the length of inhale, slow your breathing as much as comfortable, relax and continue for 15 minutes.

It’s bound to feel awkward at first but with a little practice it will soon become second nature. Better yet, many come to find it so enjoyable as to be almost addictive!

Your breathing will gradually become more regular and slower each time you do this. Although you should never count you may want to briefly check your rate at the end of a session now and then. The ideal rate to shoot for is 6 or 7 breaths per minute. But take your time – it usually takes several weeks to reach this rate comfortably.

But you don’t even need to go that far to get the benefits: Clinical trials reveal that breathing slowly in the way described above at a rate of less than 10 breaths per minute leads to significant reductions in blood pressure. Even more amazingly, the results are cumulative and begin to last around the clock in 4 to 6 weeks: a real and lasting drop in blood pressure!

You may also find that it reduces general levels stress and anxiety and can even improve your sleep. It can be useful on a second level too: those who suffer from stress or anxiety attacks can apply slow breathing as a tool for fast, on-the-spot relief.

My personal experience confirms these findings. After trying nearly every natural remedy imaginable, none of which worked, I finally solved my high blood pressure problem with slow breathing – on my own, exactly as described – and I’ve since witnessed many others enjoy even more dramatic results.

So what’s stopping you now? Give it a try. All it takes is 15 minutes a day.

The Basics of the Lymphatic System, Lymphatic Drainage

The lymphatic system is one of the most important systems in our body. The proper functioning of the lymphatic system is critical to our body’s ability to detoxify, nourish and regenerate tissue, filter out metabolic waste and inorganic material and maintain a healthy immune system.

The lymphatic system runs parallel to the circulatory system. Unlike the circulatory system in which the heart acts as a pump to circulate blood, the lymphatic system does not have a pump to circulate lymph. Instead, lymph vessels contain tiny muscles, or lymphangions (little hearts), which contract consecutive sections of the vessels to contribute to movement of lymph through the vessels via a peristaltic effect (peristaltic motion – waves of involuntary contraction passing along the walls of a hollow structure such as the esophagus or intestine and moving the contents forward).

A well-functioning lymphatic system is important to our health and well-being. The lymph circulates white blood cells which fight infection and contribute to the production of antibodies – crucial elements in supporting the immune system. In addition to white blood cells, hormones are also carried throughout the body via lymph.

Fatigue, stress, inactivity and/or trauma inhibit lymph flow. This compromises cellular functioning, metabolic waste (“toxins”) accumulates, and we become vulnerable to the possible development of illness.

Lymphatic drainage is a light, rhythmic, manual therapy employed to increase lymph circulation throughout the body. This subtle technique uses a repetitive pumping motion which in part, moves the skin in the direction of lymph flow (the majority of the lymphatic system is just below the skin). Stretching the skin stimulates the lymphangions to contract more often, improving lymph circulation. Lymphatic drainage is performed in a precise manner to activate lymphatic flow, which, in turn, decreases tissue congestion and stimulates the immune system. Lymph circulation can be increased six to ten times the standard rate as a result of a single session of lymphatic drainage.

This technique has been used since the early 1930s and is a standard practice in Europe. Now gaining recognition in the US, it is regularly prescribed for women following mastectomies to minimize lymphedema and is reimbursed by many insurance companies. Lymphatic drainage is an excellent complement to any surgery, as it reduces swelling (sometimes within minutes of a treatment), decreases healing time (increases circulation and brings more of the necessary healing ingredients to the incision site), and improves proper scar formation. Lymphatic drainage can be performed just 24 hours after surgery.

In addition to lymphatic drainage, drinking plenty of water, eating a healthy diet, deep abdominal breathing and exercise are all ways to support lymphatic circulation. Every time we contract a muscle, the muscle rubs against numerous lymph vessels, stimulating them to contract. Yet another reason exercise is so good for us!

Edema vs. Lymphedema

Edema is swelling due to excess fluid in the affected tissue. Edema is common at the site of physical trauma (e.g. sprained ankle), among pregnant women and people who stand for a large part of their work day. Edema of the feet or legs usually improves once the person sits down and raises their feet.

The initial symptoms of lymphedema are similar to regular edema. However, lymphedema is a condition whereby protein-rich fluid collects in tissue. Normally, protein molecules leave arterioles and enter the interstitial spaces (space between the cells). The protein molecules are too large to be re-absorbed by venules and in a healthy lymphatic system, this protein-rich fluid is reabsorbed by lymphatic vessels and circulated through the lymphatic system, filtered by lymph nodes and eventually the lymph fluid returns to the circulatory system. However, a compromised lymphatic system may be unable to reabsorb this fluid. Protein attracts water, so the longer it takes for the lymphatic system to “pump out” this protein rich fluid… the more fluid is attracted to the protein and more swelling occurs.

Lymphedema is a disease and if not treated, has a serious negative impact on health. Left unchecked, the swelling due to lymphedema increases, producing elephantine limbs. Eventually the swollen tissue turns fibrotic, i.e. hardens, further reducing lymphatic functioning. In extreme cases, doctors have suggested amputation of the affected limb.

The accepted treatment for lymphedema is Complete Decongestive Therapy (also referred to as Complex Decongestive Therapy) which consists of lymphatic drainage, bandaging of the affected limb, exercise and impeccable skin care.

A lymphatic drainage session always begins at the neck. There is a high concentration of lymph nodes in the neck and the largest lymphatic vessels are nearby in the chest area. Thus we always start by treating the neck & shoulders – to stimulate the lymph nodes and the right and left lymphatic vessels. After the neck, the session would generally move on to the affected area, most often the limbs with lymphedema. A series of light strokes are done with the movement in the direction the lymph should flow. Lymphatic drainage always starts closest to the trunk of the body and works out along the limb (proximal to distal), using an “uncorking” process. Uncorking stimulates the lymph vessels closest to the body to begin clearing. As treatment moves away from the body, vessels initially treated are better able to handle more fluid movement from the vessels farther down the limb.

When lymphatic drainage is complete, the affected limb is bandaged with short stretch bandages. These bandages differ from the common “Ace” bandage which applies constant pressure. Ace bandages should never be used when treating lymphedema. Short stretch bandages have an active as well as a resting phase, so they do not apply continuous pressure like the Ace bandage. The resting phase is important to healthy circulation.

Bandaging is a vital part of treatment. Once the area has been treated with lymphatic drainage, some fluid has been moved out and swelling is somewhat reduced. Bandages apply pressure on the tissue to help prevent further fluid accumulation and to aid in the re-absorption of existing fluid. These bandages are left on at a minimum overnight and ideally until the next visit to the therapist. If possible, clients learn to bandage themselves and can reapply the bandages after a shower or bath. If left un-bandaged, the risk is great that swelling will return to pre-treatment stage. Consistent bandaging alone can help to reduce swelling from lymphedema.

Clients must participate in their own therapy by doing some simple movement exercises. Lifting the affected limb, doing easy circles with the arm or leg, bending at the knee or elbow are all simple but affective “exercises” for stimulating lymph flow. Deep diaphragmatic breathing is also important. In addition, clients must take special care with their skin. The skin of lymphedema clients can be very sensitive and prone to infection and wounds. Great care must be used to protect the skin. Important skin care includes a hypoallergenic moisturizer.

In severe cases, such as those left untreated for an extended period, lymphedema clients must see a lymphatic therapist 5 days a week for lymphatic drainage and bandaging. In Europe, clients are seen twice a day.

With continued care and good client compliance, lymphedema can be effectively treated and reduced.

Medical Negligence and How it Affects Your Life

Medical malpractice and negligence impact hundreds of thousands of American lives every year. The Journal of the American Medical Association (JAMA) reports that 250,000 people die every year as a result of medical malpractice and negligence.

If you have been a victim of medical negligence or malpractice, you know the experience has affected every aspect of your life and your life will never be the same. Being a victim of medical malpractice or negligence affects every aspect of your life, physically, emotionally, mentally and financially.

The five diseases or medical conditions most involved in medical malpractice and negligence allegations and claims include, but are not limited to:

  • Breast cancer
  • Lung cancer
  • Colorectal cancer
  • Mmyocardial infarction (heart attack)
  • Appendicitis.

Misdiagnosis was the major accusation in these instances, resulting in delayed treatments, the wrong treatments or no treatments. Unnecessary surgeries, inappropriate surgeries, medication mistakes, and life-threatening infections contracted while being treated for another condition are also commonly cited in medical malpractice and medical negligence cases.

How Common is Misdiagnosis in Medical Negligence Cases?

  • Medical negligence or malpractice most often involves misdiagnosis, delayed diagnosis or failure to diagnose
  • Over 50% of emergency room malpractice claims involve misdiagnosis, delayed diagnosis or failure to diagnose
  • Over 5600 medical malpractice and negligence payments were made because of diagnostic related errors

A victim of medical malpractice or medical negligence, or the survivors in the case of a death, must show the medical malpractice or medical negligence caused damages and the damages can be assessed a value. Since each case is different, the amount of damages can only be determined after an investigation of the facts and circumstances by an experienced medical malpractice and medical negligence attorney.

Compensation in these cases can and does include payment for medical expenses, loss of income, loss of future earning potential, rehabilitation costs, long term care expenses, pain and suffering and final expenses in the case of a death, and survivor entitlements.

What Do the Best Formal Dining Room Sets Have in Common?

Whether you are newlyweds, or a family who has just moved into a new house, or someone whose house needs updating, there is nothing more fulfilling and satisfying that being able to decorate or vamp up your own place. They say that there is no place like home, and of course, home can only truly feel like one if it makes you feel secure, comfortable, and at peace.

Obviously, this implies that your interiors have to make you feel like you belong. No matter how ostentatious your house designs are, if they don’t feel like YOU, you can never be completely happy and at home. Your choice of interiors and furniture can definitely go a long way when it comes to determining the level of comfort and happiness you’ll feel in your very own home. Furniture, in particular, can really set the mood or the atmosphere in a room. Your choice of style, color, and material can either do damage to or light up the entire room.

Let’s talk about dining room furniture. The dining room is one of the most important parts of the house. This is the place where people dine together and convene as a family or a group of friends, and strengthen relationships and bonding through meals or casual get-togethers. Therefore, your choice of dining room furniture is very important.

Formal dining room sets, in particular, are great for entertaining guests for smarter, dress-up type occasions. Whether it’s a graduation party, or an intimate gathering that makes use of formal utensils and table settings, choosing the right formal dining room sets does a lot to set the right mood within the group. This is also where place settings take their cues from. In fact, you could say that they form the foundation of a great-looking dining room setting. If all is in place with your tables and chairs, then your guests should have no problem feeling comfortable when they come over.

There are different kinds of dining room furniture, which is basically a dining room table, complete with the chairs and the entire set-up. For more formal occasions, a dining room table is best to purchase, which can be installed right in your main dining area. Choose a brand that is made of wood for durability and longevity. For a more casual take on dining and mealtime moments, kitchen tables are best. These come in various shapes and sizes, and can be customized according the number of people you would like to seat. For smaller groups, you can consider going for pub tables.

Criteria for Buying

Now, let’s talk about the general criteria to consider when it comes to buying specifically formal dining room sets.

The first factor is design. Now while a lot of people are antsy or fussy about designs, keep in mind that it is not always best to choose designs that are ostentatious and eye-catching. Remember that your dining tables have to fit right into the space you are placing them into, and not stick out like a sore thumb. Less is more, so keep it simple. The best way to choose the right design for your home should be based on the type of mood you want to set, relative to the mood the rest of your house already sets.

Color coordination works sometimes, but if you want your dining table to stand out with a personality of its own, you don’t have to choose one that matches the color of your carpet exactly – just as long as it’s not too gaudy. The main focus of the dining area is the eating of the meals. Don’t let your dining room table distract your guests, family, friends, and loved ones from a wonderful meal at home.

However, while your table doesn’t necessarily have to match the colors of your walls or other items in the house, they must certainly match the chairs, servers, and cabinets. These are the more predominant areas of your dining area, and you have to make sure that even though these items are not of the same color, they must at least be a few shades close to the hue you have chosen for your dining table. Color coordination still plays a very important role in mealtimes, as the overall goal is to encourage people to do what they are supposed to do in the dining area – to eat a good meal.

A specific type of color coordination that would apply directly to woodwork is stain matching. This is simply making sure that your dining room table’s woodwork matches your existing woodwork. If you are confused about which exact color you want to get to make sure that you don’t get a shade that throws you off the original woodwork you have in your dining area, look at each stain design carefully – you should actually be able to figure out the different colors that comprise it, and you will most likely come up with brown, red, and orange, which are the most common colors. Consult your local carpenter or painter if you are still unsure.

Customization

Finally, the last criterion is customization. Now, of all these tips, this is probably one of the best to keep in mind. You see, no matter how amazing your formal dining room set may be, if it doesn’t look good in your house, it will never fit in with the rest of your furniture. Make sure you canvass different stores and brands carefully, letting your eyes do all the observing. It would be good to take raw pictures of your dining room at home without the furniture, taking close-up shots of panels, cabinets, and floors as much as possible so that you can compare products with those that you already have at home. Never be afraid to ask for help if you are unsure of which product to buy or which specs to look for. It is better to consult someone who knows what he’s doing than end up buying the wrong dining room furniture and having to return it again, therefore wasting time, energy, and resources. Learn how to take measurements to make sure that your dining room set will totally fit into your dining area.

Customization requires you to know the sizes you want for your dining area (as you can probably have it as big or as intimate as you like, depending on what you need). Never go into a furniture store without measurements, as this will be a waste of time for both yours and the store’s part. Also, do not be tempted to compromise fit for design. Understandably, some designs will appeal more to you than others, but if it doesn’t contribute to the overall feeling of belonging and comfort in the home, chances are, buying it would be a grave mistake to make. Therefore, before you make that trip to the shop, get that measuring tape out and take down notes -you’ll find that it will save you from a lot of doubting or extra trips home later, as you will be confident about the sizes you need for your home.

As each house is different, this should just be a general list that you should go through – keep your own unique standards in mind and add those along to the list, as you will have varying needs that may not be covered by those general criteria. For first-time house decorators, this task can be, while exciting, also very daunting and challenging, as the thrill usually wears off when you are halfway into the project and you start questioning whether you chose the right woodwork or the right tables and chairs to go with your dining area.

Apart from all these tips, a good idea would be to come up with a vision of your own prior to canvassing or looking around for sample tables and chairs. You should know what you would like to see in your dining room first. This eliminates a lot of prospects, and you will be able to narrow down your selection, based on your house’s specifications, your own personal needs, and your budget.

Don’t worry if you don’t find the right dining tables and chairs right away; for some people, it takes a longer time to find the perfect set. Don’t be discouraged or resort to rash decision-making and impulse buying just to appease your state of frustration -you will only end up regretting this in the end when you actually see something that you like. Instead, focus on the end goal and getting everything right and sorted before making your choice.

Anxiety Attack Treatment – How to Treat Anxiety

They come out of the blue and terrify the sufferer. But what are panic attacks? Basically, they are strong feelings of panic or anxiety that come over a person suddenly, like an attack. You might feel like you are dying, suffocating, drowning, or something similar. You may be hyperventilating,

Some might think they are going mad or they are having a heart attack. The symptoms of a panic attack are similar to the symptoms of a heart attack. The difference is, that while heart attacks may be very dangerous indeed, panic attacks are not. They are totally harmless, though they are very unpleasant. There are other differences, too.

If you think that you, or someone you know, is suffering from anxiety attacks or anxiety disorder, then you want to know something about anxiety attack treatment. It is not an imaginary disease, nor does it mean you are ‘crazy’ and need to be locked up.

The first thing you should do is talk to your family doctor and he or she will decide whether you have a medical problem that is causing these symptoms or whether it is anxiety attacks. There are some medical and psychological conditions that cause anxiety attacks as side-effects. What happens next depends on the severity of the attacks, but generally you would be referred to a specialist – a therapist or counselor.

If the condition is severe, you could be prescribed antidepressants. This is because depression is often thought to be the underlying cause of the anxiety attacks. None of these drugs can be used long term, they are prescribed to act as a kind of crutch to help the sufferer gain enough control to start with the therapy.

There are several types of therapy that are used in treating anxiety. They all try to find the root of the problem and then address it. They range from simple coping techniques to complete reprogramming.

When the anxiety attacks are relatively mild, treatment consists mostly of learning how to keep calm. There are techniques such as learning how to control your breathing, how to replace negative thoughts with positive ones, and meditating, for example, which you can use when you feel that an attack is starting. They will help to stop the attack or at least lessen its effects if you cannot stop it. A therapist or counselor will help you to learn these.

There are changes you can make to your lifestyle, too – for example, avoid food and drinks that contain a lot of caffeine, sugar and other stimulants. You should also cut down on alcohol and drugs, or cut them out completely. They don’t help you to avoid the attacks at all – in fact, they make things worse. Exercise is also recommended. This is because you breathe more deeply during exercise and the increased oxygen helps you to feel more positive and upbeat, while also helping you to stay calm. Don’t worry, this doesn’t mean pumping iron for hours on end. A stroll in the park for about half an hour a day is enough to produce feelings of calmness and well-being that last long after the exercise session has ended.

Toxic Chemicals in Skin and Hair Care Products

It is important to be careful about the chemicals that are placed on the skin with skin care products and cosmetics. Many skin products and cosmetics have dangerous chemicals as a part of there components. Our skin is not a barrier to these chemicals it acts as a transporter for these chemicals and they can end up in our blood stream and from there to the rest of our body. These chemicals will add to the toxicity of the body and will potentially add to ill health or delay the healing process.

More than 500 ingredients are used to make cosmetics products. We are unsure of the safety for the majority of these chemicals. The most common reactions to the chemicals are eczema, psoriasis and dermatitis. However, there is evidence that people who work with these chemicals (such as hairdressers and beauticians) suffer from the cumulative effects of the chemical. The studies concluded that:

  • There is an increased risk of lung, uterine, ovarian, breast, digestive and respiratory cancer.
  • Of the 169 permanent hair dyes, 150 are mutagenic (cause changes to our cells genes).
  • The use of permanent and semi-permanent hair dyes is associated with increased risk of non-Hodgkin's lymphoma, multiple myeloma, leukaemia and Hodgkin's disease.

The ingredients that you need to avoid include:

  • Foaming agents including sodium laureth sulphate (SLS), ammonium lauryl sulphate and 1,4-dioxane.
  • Artificial fragrances – many chemicals are able to gain access to our body through our olfactory system or sublingually (under the tongue). In the case of toothpaste a single fragrance can be made up of 200 chemicals which do not have to be labeled. Many fragrances are based on petroleum products and some reactions to these include dizziness, skin irritation and brown tinges to the skin. Products that are fragranced with essential oils are your safest choices.
  • Artificial colors. Things have improved since Queen Elizabeth 1 died from lead poisoning caused by her trademark white make up. However, there are still many questionable colorants. Synthetic colors are made up from coal tar containing heavy metal salts that deposit toxins into our systems.
  • Emulsifiers – these are used in just about all personal grooming products. They keep the texture uniform and stop the ingredients from separating. Eggs can be used for this but skin care companies prefer a more synthetic version. Glyceryl monostearate and stearic acid are two commonly used emulsifiers and oral care products that are known to cause side effects – in particular skin irritations. Another commonly used emulsifier is triethanolamine, a substance that is converted in living tissue into nitrosamines – some of the strongest carcinogens known. Triethanolamine causes skin irritation problems. Ethoxylates is another commonly used emulsifier which is a strongly mutagenic. It damages the DNA which increases skin aging and the risk of developing skin cancers.
  • Preservatives – These are used to slow the rate at which the products decide and therefore increase the products shelf life. Some of these that need to be avoided are:
  • Imidazolidinyl urea – formaldehyde. This is known to cause dermatitis, skin irritation, nerve damage and cancers.
  • Parabens – over 90% of cosmetics contain a conservative from the parabens family. Some of the latest research suggests that these may work as endocrine disruptors. These chemical play a role in increasing the rate of breast cancer and decreasing rates of male fertility.
  • Carrying agents – this is the ingredient that provides all the other ingredients a means to be suspended. Water is the most common carrier agent and some are derived from vegetable glycerine or seaweed. However, it is usually a petroleum derivative.
  • Porpylene glycol is commonly used and there are general warnings about it when it is in contact with the skin. It can cause brain, liver and kidney problems. Yet this is the agent that is commonly used in stick deodorants, toothpaste and most other personal care items!
  • Other ingredients to watch out for are PVP / VA copolymer, stearalkonium chloride, petrolatum and paraffin.

Skin and hair care products are used in an attempt to enhance our appearance or preserve our skin – however this is not what many of the product that are commercially available actually do. Many are far from safe and add to the toxic burden of the body. If you have been using unsafe skin and hair care products (and anyone who uses the usual commercially available products will have) then you need to detoxify your body to remove these toxic chemicals and limit the damage that they can cause.

The Problems With Diabetes And Hair Loss

The connection between diabetes and hair loss was established long ago.

Diabetes is a hormone related disorder that often leads to hair loss or thinning of the hair.

Frequent loss of hair is often considered one of the early symptoms of diabetes, which requires prompt treatment in order to avoid further complications. The growth of hair is affected by diabetes, which gradually leads to thinning of hair.

Stress is directly related to diabetes and hair loss, as the disease causes excessive anxiety, which in turn becomes the prime cause of hair loss.

Diabetes Leads To Hair Loss:

Diabetes occurs when it becomes difficult for the body to metabolize carbohydrates properly. Diabetics are highly sensitive to skin ailments, as their blood circulation and blood sugar levels are impaired.

Bruises and small wounds often take a relatively long time to heal; therefore, the recovery rate is comparatively slower and obstructs the re-growth of hair.

This causes visible hair reduction, as diabetics cannot maintain the normal cycle of re-growth process. Bacterial and fungal infections on the scalp because of diabetes could also result in hair loss, thereby making diabetes and hair loss inter-related.

Normally, a healthy person would lose around fifty to hundred strands of hair every day. Therefore, if hair loss increases rapidly, you could require medical assistance, since untreated diabetes can escalate hair loss further.

The process:

Diabetes often leads to diffused hair growth that could be a result of medical stress or side effects of certain prescribed medicines to diabetics. It usually depends on the individual’s body, as each person responds differently to specific medications. The stress caused by chronic diabetes reduces the growth of hair.

After a period of seven to eight months, hair follicles undergo a resting period and are gradually replaced with the growth of new hair. The replaced strands push the old hair to the surface of the scalp, and the hair falls out, this is known as telogen effluvium.

An autoimmune problem:

The other cause of hair loss due to diabetes is an autoimmune problem, which leads to one or more small bald patches developing on the scalp. This ailment is called alopecia areata.

Other additional autoimmune problems like a dysfunctional thyroid gland, the skin rash vitiligo, pernicious anemia, or Type 1 diabetes, often accompanies it.

Generally, Type 2 diabetes occurs when a hormonal imbalance causes polycystic ovary syndrome. Both the conditions are related to insulin resistance, which refers to the reduced ability of cells in the body to react to insulin.

Early detection and monitoring:

Diabetes often remains undetected because the symptoms at the early stage are not considered significant.

This is a major problem because early detection could slow down its harmful effects. Some of the symptoms of diabetes could be blurred vision, frequent urination, acute hunger, increased thirst, unusual weight loss, fatigue and unnecessary irritation.

Early detection of any of these symptoms, and early treatment could help in early recovery from both diabetes as well as excessive hair loss.

Careful monitoring of blood sugar levels provides relevant information that helps maintain control, which would consequently delay the development of various long-term complications.

Some of these long-term complications of diabetes could be the damage of blood vessels and nerves, loss of functioning of the kidneys, loss of sensation, heart disease and strokes.

Hair loss normally begins at the onset of diabetes and gradually becomes worse after the disease takes charge of the body.

It is very important to get the hair loss symptom diagnosed, to know the root cause of hair fall.

You need to seek a qualified doctor’s advice, so that you can avoid further problems, and to desist from using hair lotions and conditioners, which will not help to solve the problem.

Dispelling Myths About Heart Disease

Misconceptions about cardiovascular diseases — heart attacks, stroke and high blood pressure — have existed for many years and have in effect become myths. Most of them stem from factual observations during the early phase of the current global epidemic and have become deeply rooted in the minds of policymakers, health professionals and the public alike. Since these misconceptions adversely influence the allocation of resources and undermine actions to prevent and control cardiovascular diseases, they need to be firmly squashed.

Myth 1: Heart disease is a problem of developed countries

Every year, cardiovascular diseases cause around 15 million deaths in the world (30% of all deaths), and of these about two-thirds occur in developing countries. So the absolute number of deaths from these causes is twice as high in developing countries as in the industrialized world. Over twice as many deaths from stroke occur in developing countries as in industrialized countries; and the numbers of deaths due to heart attacks are equal in poor and rich countries. It is estimated that in China and India combined, which account for half the population of the developing world, between five and six million deaths are caused each year by cardiovascular diseases.

Myth 2: Heart disease is a problem of the rich

All societies include “early adopters” and “late adopters” of lifestyle changes. Early in the heart disease epidemic, affluent people in developing countries had the means and the opportunity to adopt new lifestyles, involving behaviour such as choosing foods rich in fat and calories, buying cars and using tobacco. Since these goods have become affordable for mass consumption “unhealthy” behaviour of this kind has become common across all social classes. Today, affluent people, especially the urban rich, have better access to health information concerning risk factors in the media and they also possess the means to modify their behaviour in favour of a healthier lifestyle (healthy diets, leisure-time physical activity, abstinence from tobacco). They constitute the “early adopters”, while the urban poor and rural communities — with limited access to information and little time or money for “healthy foods” and “fitness clubs” — lag behind. As a result, risky behaviour develops, and risk factors increase.

Recent studies from Latin America and South-East Asia, where coronary heart disease is particularly common, indicate that many coronary risk factors are more prevalent among those with lower socioeconomic standing and that the poor are, indeed, at higher risk of heart attacks.

In industrialized countries too, where the epidemic began among the urban rich, though some decades earlier than in the developing world, cardiovascular diseases are now more common in the relatively poor. When the worldwide heart disease epidemic fully develops, the poorest countries and the poorest people within society will be the worst affected.

Myth 3: Heart disease is mostly a man’s disease

While coronary heart disease is, in general, less common in pre-menopausal women than in men, in many parts of the world it is the most common cause of death in women, even those aged under 65. Heart disease, as well as its risk factors, varies to a surprising degree between populations. For example, women aged 35-64 years in Glasgow, Scotland, and in Belfast, Northern Ireland, have higher heart attack rates than men in some parts of southern Europe, according to a recent WHO study on trends in cardiovascular diseases (the WHO MONICA Project).

Hypertension and stroke are also major problems that affect women. Given the longer life expectancy of women, they contribute increasingly to cardiovascular deaths and disability after the sixth decade. The result is that, over their entire lifespan, women and men are equally affected by heart attacks and stroke — a fact that has long been neglected by doctors and health professionals, and by women themselves. Furthermore, pregnancy-associated hypertension is an important health problem in the developing world, where it is the major cause of premature birth and perinatal death, and is also responsible for up to one-third of all maternal deaths.

Myth 4: Heart disease is a problem of old age

Atherosclerotic cardiovascular diseases (coronary heart disease and stroke) and hypertension increase with age. But research in industrialized countries shows that about one-third of heart attacks and one-quarter of strokes occur in people below the age of 65. Many of the deaths due to cardiovascular diseases also occur early, one-quarter of them below the age of 70. In the developing world, the situation is even more marked: up to half of all deaths attributable to heart diseases occur in persons younger than 70; and a great number of working-age adults suffer from these diseases. This has an enormous impact on the economic situation of individuals and families as well as on society as a whole, and hampers efforts to alleviate poverty.

Myth 5: Heart disease is not susceptible to community action

The predominant factors contributing to the risk of cardiovascular diseases appear to be acquired, and to be lifestyle-related rather than genetic. Risk factors can be modified within a “healthy environment” that supports appropriate lifestyle practices, and most cardiovascular diseases are preventable. The prevention of heart diseases in individuals calls for the active promotion of health in populations.

Programmes that combine community mobilization with governmental regulation through taxation, legislation and pricing policies have proved to be effective in controlling tobacco and encouraging healthier diets in numerous industrialized countries. From these experiences, it is clear that community, national and even global action are key elements in combating the advancing epidemic of cardiovascular diseases in the developing world. Community mobilization can best be attained through educating the public, patients, professionals and policymakers, based on the advice of health professionals.

Myth 6: Heart disease is no longer a public health issue

There is a widespread mistaken belief that the total burden of cardiovascular diseases is diminishing. Despite declining mortality, heart disease remains the dominant public health problem in industrialized countries. Eastern European countries are at present experiencing the highest mortality rates due to cardiovascular diseases. A major cause for concern is the projected rise of these diseases in developing countries in the next century. It is predicted that by 2020 the number of deaths due to heart attacks and stroke in the developing world will have doubled as compared with 1990.

The reasons for this anticipated acceleration of the epidemic are increasing life expectancy related to a decline in infant mortality, unhealthy lifestyle changes related to industrialization and urbanization, and longer periods of exposure to the risk factors of heart disease because of improved socioeconomic conditions.

The public health consequences of an uncontrolled epidemic of cardiovascular diseases in the developing world would be disastrous. Not only would millions of productive years of life be lost, but the high costs of technology-intensive management of these diseases would impose a heavy financial burden on affected individuals, their families and society as a whole. The global epidemic needs a global response now, in the form of an international effort to create awareness and stimulate action in all countries and all sectors of society.

Spanish Immigrants to the United States in the Early 1900s

We all pretty much accept that the United States is primarily a land of immigrants. And anyone educated in the United States will have read about the Spanish conquistadores in their history books. But one thing that most people aren’t aware of is that there were Spanish immigrants who came to the United States long after there were no more Spanish conquistadores. They came, like most other immigrant groups, in search of a better life.

Let’s start off by setting the stage. In the second half of the 1800s, Europe including Spain went through more than a decade of depression. The recovery began shortly after 1890. But just as the other European countries were getting back on their feet, Spain suffered a new loss. In a war with the United States in 1898, she lost the last of her colonies including Cuba, which had been one of her richest.

Coupled with this significant loss of income was an influx of Spanish colonialists returning to their mother country from the colonies she had lost. In other words, more mouths to feed and less income with which to feed them.

These economic problems were felt most acutely in the countryside. Indeed, Spain’s economy at this time was primarily rural. And in that countryside, her southern provinces and in particular the large region known as Andalucia were especially hard hit.

Thousands of country folk in Andalucia were without work and suffering from a lack of food.

Fortuitously, around the same time, in other parts of the world as diverse as Brazil, South Africa and Hawaii, there was a real need for labor, mostly manual labor. Thousands of people were needed to work on the plantations and in the mines of developing regions. These included the sugar cane and pineapple plantations of Hawaii.

Thus it came about that just a few short years after Spain lost her colonies to the United States, plantation owners on Hawaii (which had just joined the United States) came to Spain looking for farm workers.

They found them. Going to villages and towns, the labor contractors spread the word, with the result that thousands of Andalucians flocked to Gibraltar to sign three-year contracts and board ships bound for Hawaii.

Once they arrived, they were scattered among the islands and all able-bodied souls, female as well as male, from kids as young as 11 years old through adults in their 50s, were put to work. The workers were guaranteed housing and free medical care, and were paid enough to allow them the essentials of life plus, if they were very frugal, the possibility of putting aside some savings.

Their contracts also specified that they could homestead land in Hawaii after their three years were up, but since almost all of these workers were illiterate, they were unaware of this. There is no evidence that the plantation owners went any pains to explain it to them, either. The result was that once their contracts were up, they faced the decision as to whether or not to return to Spain.

Their intention had always been to leave their homeland for a few years, work hard, save up some money, and return to their native towns and villages where they could be reunited with their families and live a good life.

But during the years working on the plantations, they heard about California. They heard there was empty land available, that there was water, that the climate in California was very much like that of Andalucia so that if they had some land, they could expect to grow the same crops as they were familiar with from Spain.

As a result, many thousands of these Spaniards ended up moving to California and settling permanently in the Sacramento delta, and in the San Francisco Bay Area. There, for the most part, they did what they had done in Hawaii (and, indeed, in Spain): they took work as farm laborers. The work of these immigrants from Spain enriched California, just as it had enriched Hawaii.

They worked hard, they saved their money, and eventually, most of them bought their own houses. They sent their children to school and became citizens.

So why were there not more of these Spanish immigrants? Because with the onset of World War I in 1914, the situation changed in Spain. Spain did not enter that war, but instead provided food and manufactured goods to the combatants. The bottom line was that with the beginning of Word War I, the economic crisis in Spain came to an end. There was work. Industries began to grow. And the Spanish government didn’t want to be losing workers, so it discouraged further immigration.

As a result of this little-known chapter of Spanish and American history, California today boasts a sizeable number of second and third generation Spanish-Americans. They continue to be concentrated in the Sacramento Delta and the San Francisco Bay Area. And these descendants of Spanish immigrants continue to be proud of their Spanish heritage.

Prospects for cureently antitubercular drugs

The inexorable rise in cases of tuberculosis worldwide, fuelledby the HIV epidemic, highlights the need for new drugs andparticularly those that can shorten the duration of treatment.Clinical trials of existing broad-spectrum agents such asthe fluoroquinolone moxifloxacin are proceeding, on thebasis of efficacy in models of infection and preliminaryclinical data. These may provide a stopgap, but the realbreakthrough will come when novel agents with potentsterilising activity are discovered. Few such novel pre-clinicaldrug candidates exist and therefore considerable effort isbeing exerted to employ new tools to identify drug targetsessential for survival of Mycobacterium tuberculosis.

According to a recent report compiled by the WorldHealth Organization (WHO), the total number of newcases of tuberculosis (TB) worldwide in 2002 had risento approximately 9 million [1]. This is despite theundoubted success of widespread implementation ofthe ‘DOTS’ (directly observed therapy, short-course)strategy, now covering 180 countries and accessible byover 70% of the world’s population. A key driver of theincrease is synergy with the HIV epidemic, which ishaving a devastating impact in some parts of the worldsuch as the WHO African Region, where 31% of new TBcases were attributable to HIV co-infection [2]. Furthermore,the emergence of strains of Mycobacterium tuberculosis(MDR-TB), resistant to all the first-line drugs iscausing serious concern in some countries [3].No new classes of drugs for TB have been developed inthe past 30 years, reflecting the inherent difficulties indiscovery and clinical testing of new agents and the lackof pharmaceutical industry research in the area [4]. TheGlobal Alliance for TB Drug Development (GATB;www.tballiance.org) was established to address this need.Its top priority is the development of a new agent that willshorten the duration of chemotherapy from the current6–8 months to two months or less, although new drugswith activity against MDR-TB and latent TB are alsoneeded [5]. There has also been considerable investmentby both the private and public sector in the developmentof new agents for the treatment of TB but fundamentaluncertainties in many aspects of the biology of the organismhave substantially hampered the ability to identifycritical targets whose inhibition would correlate withsterilising activity (Table 1). Sterilizing activity refersto the ability of a drug (such as pyrazinamide or rifampicin)to kill those organisms, known as ‘persisters’, thatsurvive treatment with agents targeting essential processesin dividing bacteria. It is only by discoveringnew agents with improved sterilising activity that ashorter treatment regimen can be developed.In this review, we discuss the drug candidates that are inclinical development and the efforts being made in preclinicalresearch to exploit alternative delivery systemsand to identify new drug targets.Clinical studiesThere have been no recent reports on the outcome ofclinical studies with truly novel antitubercular agents,reflecting the previous lack of investment in drug discoveryefforts. However, derivatives of known drugs ordrugs developed originally for other antibacterial indicationshave been tested in TB patients.RifamycinsThe most prominent of the new rifamycins is rifapentine.Its long serum half-life may permit establishment of anintermittent regimen, thus reducing the total number ofdosages to be taken under DOTS supervision. However,it does not benefit from activity against rifampicin-resistantstrains and is therefore unlikely to provide a breakthroughin therapy. In a pivotal phase III clinical study,rifapentine and isoniazid once per week was comparedwith rifampicin and isoniazid twice a week in patients who had completed two months of standard chemotherapy,that is during the continuation phase of treatment.The rifapentine regimen was found to be less effective inthat a higher rate of drug-susceptible relapse was detectedin HIV-negative patients, which correlated with theextent of cavitation [6]. In a follow-up pharmacokineticstudy, low plasma levels of isoniazid were found to beassociated with treatment failure or relapse, suggestingthat an alternative companion drug may need to beidentified for the intermittent rifapentine regimen tobe fully effective [7].Another rifamycin with a long half-life, rifalazil (previouslyknown as KRM-1648), was investigated in a PhaseII study. Patients were treated with rifalazil (10 mg or40 mg) plus isoniazid for two weeks and compared withgroups treated with isoniazid alone or isoniazid plusrifampicin. Comparable reductions in sputum bacillaryload were found, and there were few drug-related adverseevents [8].

1. World Health Organisation: Global Tuberculosis Control:Surveillance, Planning, Financing. WHO Report 2004.ISBN 92 4 156264 1. 2004. Geneva, Switzerland.2. Corbett EL, Watt CJ, Walker N, Maher D, Williams BG,Raviglione MC, Dye C: The growing burden of tuberculosis:global trends and interactions with the HIV epidemic.Arch Intern Med 2003, 163:1009-1021.3. Espinal MA: The global situation of MDR-TB. Tuberculosis 2003,83:44-51.4. O’Brien RJ, Nunn PP: The need for new drugs againsttuberculosis. Obstacles, opportunities, and next steps.Am J Respir Crit Care Med 2001, 163:1055-1058.5. Global Alliance for TB Drug Development: Tuberculosis.Scientific blueprint for tuberculosis drug development.Tuberculosis 2001, 81(Suppl 1):1–52.6. Benator D, Bhattacharya M, Bozeman L, Burman W, Cantazaro A,Chaisson R, Gordin F, Horsburgh CR, Horton J, Khan A et al.:Rifapentine and isoniazid once a week versus rifampicin andisoniazid twice a week for treatment of drug-susceptiblepulmonary tuberculosis in HIV-negative patients: arandomised clinical trial. Lancet 2002, 360:528-534.7. Weiner M, Burman W, Vernon A, Benator D, Peloquin CA,Khan A, Weis S, King B, Shah N, Hodge T et al.: Low isoniazidconcentrations and outcome of tuberculosis treatmentwith once-weekly isoniazid and rifapentine. Am J RespirCrit Care Med 2003, 167:1341-1347.8. Dietze R, Teixeira L, Rocha LM, Palaci M, Johnson JL, Wells C,Rose L, Eisenach K, Ellner JJ: Safety and bactericidal activity ofrifalazil in patients with pulmonary tuberculosis. AntimicrobAgents Chemother 2001, 45:1972-1976.