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Oct 25

Penyelidikan: Masaalah Mati Pucuk Atau Lemah Tenaga Batin Lelaki

Maksud mati pucuk atau biasa juga dipanggil lemah tenaga batin ialah ketidakupayaan dalam memperolehi dan mengekalkan ketegangan zakar yang cukup lama untuk mencapai kepuasan hubungan seks. Kajian epidemologi di Malaysia (1997/98) menunjukkan 1.7 juta lelaki berumur 40 tahun ke atas mengalami masalah mati pucuk.

Sebab-sebab mati pucuk:

  • Masalah perubatan seperti diabetes dan tekanan darah tinggi yang boleh menyempitkan saluran darah (arteriosclerosis)
  • Penyakit mental seperti kemurungan dan kebimbangan
  • Kecederaan pada otak dan saraf tunjang
  • Masalah hormon seperti kekurangan paras testosterone yang rendah
  • Kegagalan hati dan buah pinggang
  • Penyakit Parkinson
  • Angin ahmar
  • Komplikasi pembedahan kelenjar prostat atau pundi kencing (jarang berlaku)
  • Kesan sampingan ubat-ubatan
  • Mati pucuk juga berkaitan dengan tabiat merokok, minum alkohol, stres, kegemukan (obesiti) dan kurang aktiviti fizikal.

Simptom

Ketidakupayaan untuk memperolehi dan mengekalkan ketegangan
Ketegangan tidak mencukupi untuk penetrasi dalam hubungan seks
Ketidakupayaan dalam mengekalkan ketegangan selepas penetrasi untuk mencapai kepuasan hubungan seks
Komplikasi

    • Kemurungan
    • Kebimbangan semasa hubungan
      Masalah perkahwinan
    • Rasa rendah diri
    • Kualiti hidup rendah / kurang

Rawatan

Rawatan Bukan Ubat

Mengamalkan cara hidup sihat boleh membantu sesetengah lelaki dalam masalah ini seperti:

Mengamalkan pemakanan tambahan atau suplemen
Berhenti Merokok
Mengurangkan berat badan yang berlebihan
Meningkatkan aktiviti fizikal
Masalah mati pucuk akan bertambah baik jika penyakit diabetes atau tekanan darah tinggi terkawal.
Pengurusan stres
Rawatan Ubat-ubatan

__________________________________________________________________________________

Mengenai Jus Delima Bio Emas TM 

Jus Delima Bio Emas ialah Minuman Herba Campuran.

  • Khasiat semua buah-buah yang terkandung dalam produk Delima Bio EmasTM telah melalui kajian klinikal dan saintifik yang telah dijalankan oleh pelbagai pehak dari serata dunia dan boleh dirujuk di laman web National Institutes of Health – NIH.
  • NIH memuatkan journal-journal serta artikel-artikel berkaitan penyelidikan atau penemuan berhubung dengan dunia perubatan dan menjadi rujukan kepada para pengamal perubatan, penyelidik, pesakit, penuntut dan profesional seluruh dunia.
  • Journal-journal serta artikel yang memuatkan hasil kajian saintifik ke atas bahan-bahan yang digunakan sebagai formulasi dalam JusDelima Bio Emas TMiaitu Ekstrak Delima, Anggur, Zaitun, Kurma, Aprikot, Manna dan Madu boleh semak di sini.
  • Sumber rujukan ini diterbitkan oleh National Institutes of Health – NIH, Amerika Syarikat dan Kanada dan juga universiti-universiti dan pusat penyelidikan yang berkenaan.

Dengan adanya sumber maklumat yang berwibawa mengenai bahan-bahan yang digunakan dalam Jus Delima Bio Emas, diharap ianya memberi panduan dan boleh menggunakanya mengikut tujuan yang bersuaian. Jus Delima Bio Emas juga mempunyai Sijil Pengesahan HALAL JAKIM.

GUNAKAN JUS DELIMA BIO EMAS TANPA WAS-WAS

 _________________________________________________________________________________

 

Ubat-ubatan boleh didapati untuk mengubati mati pucuk dalam bentuk pil dan suntikan. Dalam keadaan di mana ubat tidak berkesan atau tidak boleh digunakan, alat vakum khas dan pembedahan implan mungkin berguna. (Anda perlu mendapatkan nasihat doktor sebelum menggunakan kaedah-kaedah rawatan tersebut)

Pencegahan

Berhenti Merokok dan pengambilan alkohol
Pengawalan penyakit darah tinggi dan diabetes secara optima
Cara hidup yang sihat
Rehabilitasi

KAJIAN KLINIKAL KEBERKESANAN JUS DELIMA

Satu kajian klinikal mengenai keberkesanan jus delima dalam membantu meningkatkan kembali masaalah lemah tenaga batin dikalangan lelaki berumur 40 tahun ke atas telah dilakukan oleh tiga penyelidik daripada The Male Clinic, Beverly Hills California dan David Geffen School of Medicine at University of California, Los Angeles, CA, Amerika Syarikat.

Penyelidik tersebut ialah C P Forest1, H Padma-Nathan1 and H R Liker. Hasil kajian mereka yang diterbitkan pada 14 Jun 2007 dan boleh dicapai di http://www.nature.com/ijir/journal/v19/n6/full/3901570a.html#aff1.

Dalam kajian tersebut mereka menggunakan 53 orang yang berumur 40han yang mengalami masaalah mati pucuk. Kesemua 53 orang subjek ini menjalani proses kajian sehingga tamat selama 28 dengan di berikan jus delima.

Hasil kajian ini merumuskan bahawa jus delima mempunyai potensi besar untuk menangani kes mati pucuk lelaki ( Further studies are warranted to clarify the efficacy and clinical role of POM on male ED.)

Baca artikel penuh di bawah:

Efficacy and safety of pomegranate juice on improvement of erectile dysfunction in male patients with mild to moderate erectile dysfunction: a randomized, placebo-controlled, double-blind, crossover study

by: C P Forest1, H Padma-Nathan1 and H R Liker2

International Journal of Impotence Research (2007) 19, 564–567; doi:10.1038/sj.ijir.3901570; published online 14 June 2007

Abstract

This randomized-controlled trial examined the efficacy of wonderful variety pomegranate juice versus placebo in improving erections in 53 completed subjects with mild to moderate erectile dysfunction. The crossover design consisted of two 4-week treatment periods separated by a 2-week washout. Efficacy was assessed using International Index of Erectile Function (IIEF) and Global Assessment Questionnaires (GAQ). Of the 42 subjects who demonstrated improvement in GAQ scores after beverage consumption, 25 reported improvement after drinking pomegranate juice. Further, 17 subjects showed preference of one beverage to the other. Subjects were more likely to have improved scores when pomegranate juice was consumed (P=0.058). Although overall statistical significance was not achieved, this pilot study suggests the possibility that larger cohorts and longer treatment periods may achieve statistical significance.

Introduction

Pomegranate juice (POM) a potent antioxidant, enhances endothelial nitric oxide (NO) levels and directly impacts atherosclerotic changes associated with erectile dysfunction (ED). The juice from pomegranates contains potent polyphenolic flavonoid antioxidants known as anthocyanins. Studies demonstrate that POM has more polyphenol antioxidants than any other fruit juice tested for antioxidant activity. It has also been demonstrated to have greater antioxidant activity than green tea or wine. POM contains approximately 1.5% flavonoids, polyphenols, pectin and ascorbic acid by weight.1

Antioxidants, such as those in POM, enhance the bioavailability of NO and offer protection against atherosclerosis.1 Recent laboratory tests revealed that POM consumption in atherosclerotic apolipoprotein E-deficient mice reduced the size of atherosclerotic lesions by 44% and decreased low-density lipoprotein (LDL) susceptibility to aggregation and retention in humans.2 The protective effects of NO on atherosclerosis and oxidative destruction are attributed to its ability to prevent adhesion and aggregation of blood cells and platelets, inhibit vascular smooth muscle cell proliferation, and prevent oxidation of LDL cholesterol.2 LDL cholesterol that has been oxidized is much more likely to become arterial plaque, therefore, by reducing LDL oxidation in mice, POM reduces arterial plaque. One study in humans demonstrated that POM consumption significantly reduced common carotid intima-media thickness associated with carotid artery stenosis, along with concomitant lowering of blood pressure and inhibition of lipid peroxidation in serum and in LDL.3

Because erectile tumescence and rigidity require significant dilatation of the penile arteries, NO deficiency may manifest itself as ED, the first clinical manifestation of atherosclerotic disease.4, 5 Owing to its effect on NO, antioxidants may play a role in smooth muscle relaxation as well. Studies demonstrate that POM, improves erectile function and decreases fibrosis in animal models.6 POM, with its inherent antioxidant properties, has potential benefit for ED due to its ability to decrease fibrosis, increase NO bioavailability and reduce atherosclerotic plaque.

This randomized-controlled trial explores the clinical efficacy of POM for the management of ED. The primary hypothesis is that treatment of ED patients with POM Wonderful POM would produce statistically significant positive Global Assessment Questionnaire (GAQ) scores when compared to placebo-controlled patients. The GAQ elicits the patient’s self-evaluation of study beverage effect on erectile activity during that period. The secondary hypothesis is that treatment of ED patients with POM Wonderful POM would produce changes in the erectile function domain of the International Index of Erectile Function (IIEF) as well as the remaining IIEF domains (intercourse satisfaction, overall satisfaction, orgasm and desire domains) when these values are compared with baseline and between the two treatment groups. The IIEF is a validated questionnaire whose erectile function domain score has been demonstrated to correlate with ED intensity.7, 8Other domains of the IIEF were evaluated as secondary end points.

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Materials and methods

Study design and entrance criteria

This randomized, double-blind, placebo-controlled clinical trial utilized a crossover design to compare the efficacy of POM to placebo. Sixty sexually active, healthy males aged 21–70 years with a history of ED for at least 3 months duration were recruited at a single site. To qualify, subjects were required to have mild to moderate ED as indicated by an erectile function domain score of 17–25 on the IIEF Questionnaire.8 Inclusion criteria included being in a stable, monogamous relationship with a consenting female partner and being willing to attempt sexual intercourse on at least one occasion per week during each study period. Subjects were excluded from entrance into the study for the following reasons: ED caused by untreated endocrine disease, significant penile pathology, clinically significant hepatic, renal or neurological disease, a recent history of myocardial infarction, diabetes mellitus or an HbA1cgreater than or equal to7.0, history of prostate cancer or prostate surgery other than a transurethral resection of the prostate, a history of alcoholism within the previous 2 years, or the current consumption of three or more alcoholic drinks per day. Any subject currently on ED therapy (prescription medications, over-the-counter medications, herbal preparations or medical devices) was required to discontinue therapy during the screening period and for the duration of the study.

Study event timeline

The study was designed to incorporate a screening period for verification of eligibility followed by two 28-day treatment periods and a 14-day washout after period 1. At visit 1, before all screening procedures, the subject completed the IRB approved informed consent process. A general medical and ED history was obtained, a physical exam and laboratory evaluations were performed, and the IIEF questionnaire was administered. Once it was determined that a subject met inclusion criteria for entrance into the study, he was scheduled to return for randomization.

At visit 2, immediately before randomization, the subject was dosed with a sample containing 4 ounces of each beverage to verify tolerance. The subject was subsequently randomized to either placebo juice or POM for period 1. Subjects were instructed to consume the entire 8 ounces of beverage on a daily basis with their evening meal or shortly after. The quantity of beverage required was based upon human research, which indicated that 1.5 mmol of total polyphenols is the optimal dose per day.2 At the end of 28 days of daily consumption the subject returned for visit 3, where the GAQ and IIEF were administered to assess the effect of the period 1 study beverage on the subject’s erectile function. A 2-week washout period ensued during which time the subject did not consume any study beverage nor utilize any treatment for ED. The subject was provided with the opposite study beverage during study period 2 as per the crossover design of the study. Upon completion of 28 days of consumption of the study beverage, the subject returned for his final visit, where GAQ and IIEF questionnaires were administered again to assess the study beverage effect during the second study period.

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Results

Of the 74 subjects who entered the screening process, 61 were enrolled and 53 completed the study. Subjects with mild to moderate ED were randomized into two cohorts, 31 subjects in cohort 1 and 30 in cohort 2. During period 1, subjects in cohort 1 received the study beverage while those in cohort 2 received placebo. Beverage assignments were reversed during period 2 per crossover design. At least 87% of subjects in each cohort consumed the study beverage a minimum of 21 days during each 28-day study period. Four subjects in cohort 1 and three subjects in cohort 2 were lost to follow-up; one subject discontinued for reasons not related to the study. The mean age for each cohort was 46 years old (46.39 in cohort 1; 45.97 in cohort 2) and the mean IIEF score was 21 (20.84 in cohort 1; 20.73 in cohort 2). No serious adverse events occurred during the study and no subjects discontinued due to adverse events. The most commonly reported adverse events were upper respiratory infections and pharyngitis (8% for POM; 4% for placebo). The following adverse events were reported while on POM: diarrhea (2%), flatulence (2%), hyperlipidemia (2%), nasal congestion (2%) and hypertension (2%). One patient (2%) reported anxiety while on placebo.

Of the 55 subjects who drank the placebo beverage, 53 also drank POM. A total of 42 subjects demonstrated improvement in GAQ score after beverage consumption, 25 after drinking POM. In total, 17 subjects showed preference of one beverage to the other in GAQ scores. Of the 17 subjects, 8 from cohort 1 and 5 from cohort 2 preferred POM to placebo while 2 subjects from each cohort preferred placebo to POM. It was observed that subjects were more likely to have improved scores if they drank POM (P=0.058). It was noted that a higher proportion of subjects showed improved GAQ scores in cohort 1 (56 and 33%) than in cohort 2 (38 and 29%). Beverage preferred statistical analyses were performed for the overall beverage comparisons without controlling for age group. They utilized the Mainland-Gart test for phase or beverage preference, considering both cohort and period. Beverage preferred is defined as POM when the GAQ response was improved following the POM beverage phase, but not after placebo beverage phase and similarly for placebo (Table 1). Subjects with missing or the same response for both phases were not considered to have a preference (Table 2).

 

 

Secondary efficacy end points did not reach clinical significance. The meanplusminuss.d. of change from baseline in IIEF erectile function domain score was -0.13plusminus6.08 for POM and -0.02plusminus5.04 for placebo (P=0.72). The meanplusminuss.d. of change from baseline in IIEF of other domains was 1.40plusminus7.88 for POM and 1.64plusminus6.88 for placebo.

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Discussion

Endothelial dysfunction has been closely associated with atherosclerotic disease and compromises the availability of NO in the penile tissues necessary to cause smooth muscle relaxation and the resultant tumescence and rigidity. Increasing the availability of endothelium-derived NO is believed to increase ultimately erectile response. PDE5 inhibitors, first-line therapy for ED, prevent the breakdown of cyclic GMP (cGMP) while appearing to facilitate local NO release in the tissues with resultant erectile response. POM has been demonstrated to contain the highest potency of antioxidants when compared to other beverages, enhancing the action of NO by vascular endothelial cells. This study explored whether the known antioxidant activity of POM translates into clinical efficacy in healthy male subjects with mild or mild-to-moderate ED.

This study observed trends toward increased erectile function based on self-administered questionnaires, although overall statistical significance was not achieved (P=0.058). Cohort 1 subjects performed differently from cohort 2 even though they shared similar demographic and baseline characteristics (except remaining IIEF domain score). Why subjects from cohort 1 were more likely to have improved GAQ scores is unclear.

While improved scores on GAQ approached statistical significance, the scores on the IIEF questionnaire did not. It is important to note that the GAQ is an assessment of the final result of 4 weeks of beverage consumption, while the IIEF takes into consideration all sexual activity during the previous 4 weeks. If the POM required as much as 2 weeks of consumption before demonstrating a response based upon recent studies,2 then the IIEF would not be as sensitive to recognizing an improvement in erectile function as the GAQ. The use of a subject sexual encounter diary would have been useful in this situation to demonstrate if there was progressive improvement in erectile function during each treatment period.

The limitations of this pilot study include cohort size, treatment period duration, and compliance issues. Considering that the P-value nearly achieved statistical significance (0.058) for those who preferred POM, it is possible that statistical significance could have been achieved with either larger cohorts of subjects or extended treatment periods. It was proposed at the onset of the study that the clinical effect of POM on ED could be observed as quickly as within a week, yet this may not have been long enough time to allow for a clinical response. Extended treatment periods could provide the time necessary to observe improved clinical response and thus improved GAQ and IIEF scores. Study visit compliance among many subjects was difficult and required multiple telephone contacts to insure maintenance of visits within windows. This was anticipated since compliance issues are common in clinical trials involving young healthy men (study mean age of 46). This is largely related to the commitment and activity levels in this age group. A potential limitation of the study is that POM has a distinct appearance and taste. This was minimized for the study by taste and color matching the placebo beverage as well as providing a 2-week washout so that it would be difficult for subjects to discern any subtle difference in taste or appearance between the study beverages. To minimize bias, patients were asked not to attempt to speculate which month’s beverage had the active ingredient.

Although the results of this pilot study did not achieve statistical significance, a trend was demonstrated toward benefit of erectile function in men with mild and mild-to-moderate ED based upon results from self-administered GAQ. Modifying the design of the study to incorporate a larger cohort of subjects and longer treatment periods could possibly demonstrate statistical significance. As a powerful antioxidant, enhancing the actions of NO in vascular endothelial cells, POM has great potential in the management of ED. Of interest would be the use of this POM in conjunction with medications that depend heavily on NO activity such as PDE5 inhibitors.9 Further studies are warranted to clarify the efficacy and clinical role of POM on male ED.

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References

  1. Ignarro LJ, Byrns RE, Sumi D, de Nigris F, Napoli C. Pomegranate juice protects nitric oxide against oxidative destruction and enhances the biological actions of nitric oxide. Nitric Oxide 2006; 15: 93–102. | Article | PubMed | ISI | ChemPort |
  2. Aviram M, Dornfeld L, Rosenblat M, Volkova N, Kaplan M, Coleman R et al. Pomegranate juice consumption reduces oxidative stress, atherogenic modifications to LDL, and platelet aggregation: studies in human and in atherosclerotic apolipoprotein E-deficient mice. Am J Clin Nutr 2000; 71: 1062–1076. | PubMed | ISI | ChemPort |
  3. Aviram M, Rosenblat M, Gaitini D, Nitecki S, Hoffman A, Dornfeld L et al. Pomegranate juice consumption for 3 years by patients with carotid artery stenosis reduces common carotid intima-media thickness, blood pressure and LDL oxidation. Clin Nutr 2004; 23: 423–433. | Article | PubMed | ISI | ChemPort |
  4. Kaiser DR, Billups K, Mason C, Wetterling R, Lundberg JL, Bank AJ. Impaired brachial artery endothelium-dependent and -independent vasodilation in men with erectile dysfunction and no other clinical cardiovascular disease. J Am Coll Cardiol 2004; 43: 179–184. | Article | PubMed | ISI |
  5. Ganz P. Erectile dysfunction: pathophysiologic mechanisms pointing to underlying cardiovascular disease. Am J Cardiol 2005; 96 (Suppl): 8M–12M. | Article | PubMed | ISI | ChemPort |
  6. Azadzoi KM, Schulman RL, Aviram M, Siroky MB. Oxidative stress in arteriogenic erectile dysfunction: prophylactic role of antioxidants. J Urol 2005; 174: 386–393. | Article | PubMed | ISI | ChemPort |
  7. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997; 49: 822–830. | Article | PubMed | ISI | ChemPort |
  8. Cappelleri JC, Rosen RC, Smith MD, Mishra A, Osterloh IH. Diagnostic evaluation of the erectile function domain of the International Index of Erectile Function. Urology 1999; 54: 346–351. | Article | PubMed | ISI | ChemPort |
  9. Agarwal A, Nandipati KC, Sharma RK, Zippe CD, Raina R. Role of oxidative stress in the pathophysiological mechanism of erectile dysfunction. Review. J Androl 2006; 27: 335–347. | Article | PubMed | ISI | ChemPort |

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Acknowledgements

We thank Karen Edwards for her assistance throughout this clinical trial. This study was financially supported by POM Wonderful, LLC.

Nota:

Jus Delima Bio Emas mempunyai ekstrak delima sebagai bahan utama.

Kredit: http://www.nature.com/



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