Nizar Muhammad

Dr. Nizar Muhammad (Pharm-D, R.Ph.) working as a hospital pharmacist since 2014. Currently, he is working in Ayub Teaching Hospital Abbottabad as shift Incharge in Accident and Emergency Department Pharmacy.

Top 9 Safest & Best Natural Adderall Alternatives

Are there any “over the counter best Adderall alternatives”? Can you buy them legally? Find out more in this article.  Adderall is the brand name for the combination of two prescription drugs, dextroamphetamine, and amphetamine. It is one of the most commonly used cognitive enhancers in the world. Many students use it to enhance their studying power during exams. Adderall is a prescription drug approved by the Food and Drug Administration (FDA) to treat Attention Deficit Hyperactivity Disorders (ADHD) and Narcolepsy. Attention Deficit Hyperactivity Disorder (ADHD) is a neurological problem that may affect children’s and young adults’ school learning and sports activities. While narcolepsy may affect job-related attention-seeking activities in adults, to address these problems, Adderall is used, which is a Prescription only medication (POM) containing four salts of amphetamine. It is also used in sports activities for enhancing performance, as a recreational drug at parties, and as an aphrodisiac (off-label). In addition, Adderall increases cognitive abilities and causes specific other emotional effects, e.g., euphoria, increase libido, etc. Students in colleges and universities most commonly use Adderall for wakefulness in exam preparation and score improvement. Please remember that, It’s illegal and can’t be used without a doctor’s prescription…!! Composition of Adderall/ generic formula Adderall is a combination of four salts of amphetamine, including Amphetamine aspartate monohydrate=25%, Amphetamine sulfate= 25%, Dextro-amphetamine saccharate=25%, Dextro-amphetamine sulfate= 25% They are all central nervous system stimulants and belong to the phenethylamine class, available in the market as Adderall, Adderall XR, and Mydayis. Amphetamines are legal stimulant that is only available with a doctor’s prescription. There are other legal stimulants like Nicotine and caffeine. However, caffeine is one of the world’s most commonly used legal stimulants. How does Adderall work? Adderall increases the activity of the neurotransmitters norepinephrine and dopamine in the brain, which interacts with specific brain receptors and, in turn, alleviates the symptoms of ADHD and narcolepsy. If you are looking for natural Adderall alternatives, you should buy a supplement that can increase dopamine or norepinephrine activity. [Note: We have included a list of best over-the-counter Adderall alternatives below, so keep reading] Why is Adderall used so much in the USA? According to studies, Adderall was the 45th most prescribed medication in the United States. In addition, the illegal use of Adderall and other products like Ritalin and Ice for recreational purposes and sports doping in larger doses increases its demand and consumption. What are the side effects of Adderall? Adderall is a controlled medicine and should be used only when prescribed by a doctor. The side effects vary from person to person, commonly including sleep loss, dry mouth, and appetite loss. At normal small doses for ADHD or other labeled indications, Adderall has a very low tendency for addiction. However, large doses or illegal use may lead to addiction and impair cognitive control, causing muscle breakdown rapidly, which can induce delusions and paranoia. The illegal use of large doses of Adderall for recreational purposes may pose serious addiction problems and cravings. Therefore the illicit use of Adderall must be demotivated. Can Adderall be replaced with other prescription medications? Adderall can be replaced with other nerve stimulants to treat ADHD and narcolepsy under registered medical practitioners’ directions. The products that can be used as an alternative to Adderall are, Ritalin —contains methylphenidate as a nerve stimulant. Other products include Concerta, Daytrana, Adhansia, etc., available as POM in the USA, but all of these stimulants have the same effect as addictive adverse effects. The non-addictive alternatives for Adderall include Strattera (atomoxetine) can be used for ADHD. Antihypertensive medications like Tenex (guanfacine), Catapres (clonidine), and the narcolepsy medication Progvil (modafinil) can be used in adults who don’t respond to standard stimulant-based treatment. Over the counter, Adderall/ OTC Adderall, is that a reality? Most consumers who use Adderall for recreational, enhancing memory, sports doping, increased responsiveness, or addiction purposes always search to obtain the medication without a prescription or struggle for such substances, which may cope with a craving for Adderall. As mentioned above, Adderall contains nerve-stimulant ingredients and is used in ADHD and narcolepsy as Prescription Only Medicine (POM). However, the recreational use of Adderall may produce significant health risks; therefore, possession and sale of this medication are dealt with strictly worldwide. If you are looking for over-the-counter stimulants similar to Adderall in the market, stop wasting your time because Adderall contains synthetic constituents known as racemic amphetamine and cannot be sold without a proper prescription from any pharmacy or store. But if you are looking for a natural Adderall alternative, keep reading this, as we will discuss some of the best-selling and high-quality substitutes for Adderall. What could be a legal non-prescription Adderall substitute? If you are looking for an alternative to this drug that contains the same ingredients as Adderall and should be OTC or obtained without a prescription, consider this a myth because there is no such thing as “natural Adderall” or “over-the-counter Adderall.” It is not Adderall, but it is the formula of Adderall, which requires the legal prescription of a doctor, and any other same product will also need the same procedure. If you are not suffering from ADHD and narcolepsy, you still want it to enhance your brain power, focus, and concentration. In that case, many such products are available in the market, which can boost your energy levels, enhance your sports performances, increase your response time, boost your memory, and regulate your sleep-wake cycles. In this article, we have compiled many over-the-counter stimulants similar to Adderall that can be obtained legally without a prescription. Let’s look at some natural substances that can be used as an alternative to the above prescription drug. Nutritional substances used Adderall replacement. Adderall enhances dopamine and norepinephrine levels in the brain; therefore, certain nutritional substances can produce the same effects approximately with no or less adverse results. Moreover, the neuronal levels of serotonin and choline can also affect brain performance. There are certain supplements for Adderall replacement, but that doesn’t mean it is

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10 Best Thermometer For Babies (2024 Updated Buyer Guide)

Nothing can best observe a baby’s uneasiness but a mother’s lap. There is nothing as powerful as a mother’s love and nothing as healing as a child’s soul. Concerning the health of your baby or growing child is a part of parenting, and it ascends when you feel that your kiddy is not feeling well because a baby cannot express their condition. A pediatrician can best find the problems concerned. Still, it’s necessary to know how to assess your baby’s situation and deal with health emergencies at home by using an emergency health kit. Remember that your health kit is incomplete without a thermometer; therefore, this article will provide you with a review of some of the advanced, precise, accurate, and easy-to-use thermometers concerning their properties, pros, and cons, making it easy for you to select the best out of the available thermometers in the market. Do you know? Normal body temperature= 97.0 ⁰F – 99.5 ⁰F, (36.1 ⁰C– 37.5 ⁰C) Slightly high temperature= 99.5 ⁰F – 101.1 ⁰F, (37.5 ⁰C– 38.4 ⁰C) High body temperature = 101.1 ⁰F and above (38.4 ⁰C and above) 10 Best Thermometers For Babies Considering all the pros and cons, we recommend the best digital thermometer for babies available on the market. iProven Medical Digital Ear Thermometer with Temporal Forehead Function Why do we recommend this?  We recommend this device because it is advanced and utilizes the latest innovative infrared lens technology, DMT-489, for better accuracy. It is effortless to use and provides proven accurate reading; having this gadget at your home or clinic can minimize the associated hazards of other conventional thermometers with mercury and glass. This device is convenient and feasible for anyone to use. No skill or specialty is required for the operation of this device. Description: This Professional and best digital Thermometer for babies uses innovative infrared lens technology DMT-489 for better accuracy. It can be used equally for all age groups and is provided with specifications like power storage, memory recall, LED display, etc. It is one of the most users trusted devices available in the market. It can be used to record the body and ambient temperature, which is beneficial for use in the home and hospital. Available in gray color, have two buttons for the forehead and ear. An extra pouch is provided for safe carriage and storage. Pros: Warrantied accuracy Very simple to use and understand Uses ⁰C and ⁰F as dual-mode Safety is assured compared to conventional devices. Recommended by the consumers Provided with a pouch HD wide and easy-to-read display Fast action: 1second time for ear and 3-sec forehead Easy to clean due to the smart design Dual-mode function for ear and forehead Backlight option for use in the dark Approved and clinically tested Alarm and fever, indicating ability through colors. Records 20 readings 100 days money back warranty Cons: Less accurate compared to digital thermometers for rectal use clinically These are expensive and often provide inaccurate readings if the ear contains wax. Need a battery cell to operate Expensive device. Scurry Baby thermometer, Ear and Forehead Thermometer Why do we recommend this?  It provides multiple functions, including a rapid response time of about 1 sec, accuracy assurance, multimode functions, CE certification, FDA approval, and ease of use. The white light LED display makes it easy to use in the dark and can be used indoors and outdoors for multiple purposes. Reliable and advanced technology is used in this device. The device records the temperature from the ear and forehead, a non-invasive technique that is easy to apply to your kiddies. These features make it one of the best Thermometers for babies. Description: This device records the body temperature of babies, kids, and adults. It can be used for body, room, and object temperature measurements. Novel features like light indicators in three warning colors (green, orange, red) make it superior to the other competitive products—green color normal, orange slight fever, and red high fever. Pros: White light LED makes it easy to use even in the dark Ear mode, forehead mode Auto shut down for 30 seconds Up to 32 temperature record history Trusted, clinically proven Alarm and sound mute option Better than mercury thermometers in accuracy and safety Warrantied Best Digital Thermometer for baby Also, The multimode feature makes it able to be used in every age of people FDA approved CE certified Interchangeable in ⁰F, ⁰C Three-color warning indication Cons: These are expensive and often provide inaccurate readings if the ear contains wax. Less accurate compared to digital thermometers for rectal use clinically We need a battery cell to operate.     Mosen Thermometer for Fever Why do we recommend this?  We care for you and your family’s health. For the same reason, we recommend this state of the art and one of the best devices unique concerning many features, including its magnetic cap, easy operability at night time. The product is provided with a tri-color indicator for fever. Description: It is certified and approved by the FDA and, a digital electronic device with up to the mark accuracy and fastness, to measure body temperature. It is the best ear thermometer for babies because it Uses the most innovative and advanced infrared technology to record temperature through the eardrum and the surrounding tissues of the ear and forehead, switching to the respective mode just by pressing the given button. Anyone can use it for all age groups at home and hospital. Pros: They offer a warranty Up to 40 temperature record Trusted, clinically proven Three color warning indication The multimode feature makes it able to use in every age people Interchangeable in ⁰F, ⁰C FDA approved The best forehead thermometer for babies, also, Ear mode CE certified Better than mercury thermometers in accuracy and safety Backlight wide LED makes it easy to use even in the dark Auto shut down 30 seconds Alarm and sound mute option 1 second response time Cons: Less accurate compared to digital thermometers for rectal use clinically

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10 Best Baby Formulas For Breastfed Babies [Pharmacist Guide]

This article is especially for you if you are searching for the best formula for breastfed babies and searching for an honest review.   Experts and pediatricians worldwide recommend exclusive breastfeeding for the initial 06-12 months of a baby’s life. [1] Unfortunately, there might be some unfavorable circumstances in which breastfeeding may not be possible, so the only option is for mothers to have formula milk. Many formula milk brands are available, and if you are confused about which one will be the best alternative to breast milk, follow this article until the end. Here, we have compiled a list of the best baby formula for breastfed babies available on the market. What is a baby formula? As clarified from the name, infant formula or baby formula is a highly processed dry food in powder form or a liquid concentrate form, ready to be reconstituted/diluted with purified water.  You can also use it as directed by the manufacturer, or it may be available in a ready-to-use form and is required to meet the dietary needs of infants.  The formula can also be mixed with breast milk to correct your baby’s nutritional deficiencies. 10 Best Baby Formulas For Breastfed Babies After days of researching different brands and reading many of the best baby formula reviews, we recommend the following formulas among all the available products in the market. 1. Similac Advance Infant Formula ⇒(Our Top Pick) Infants below the age of 12 months grow rapidly, so their parents care more than anything to provide the best nutritional support. They can quickly be supplied through breastfeeding, but if there is a problem with breastfeeding, then the best among all the available formulas in the market shall be chosen. The best formula baby formula for breastfed babies is one that contains all the nutrients required for the rapid growth of your baby. It is one of the best baby formulas for breastfed babies because it contains multivitamins and minerals in sufficient quantity. It also has probiotics and prebiotics to help build a strong immune system to fight germs and diseases. We are reviewing this product, which is the best alternative to breast milk. Features: The product is designed for babies of 0-12 months of age. The product is available in three packs, each with 36 OZ (1.02kg) of dry powder. Pros This baby formula milk contains Human Milk Oligosaccharides (HMO), which makes it the closest formula to breast milk. An exclusive blend of nutrients in the form of optiGRO is a specification of Abbott’s Similac formula, making it one of the best formulas for baby growth and development. The product does not contain any artificial growth hormones. The product contains iron for infants’ better oxygenation and cellular growth. The product comprises prebiotics, which will help to make the immune system healthy. DHA, Lutein, and vitamin E will help improve brain, visual, and body growth. Non-GMO certified It can be used alone or mixed with breast milk, but it may be prepared separately in purified water and added to the breast milk. It is one of the trusted formulae highly recommended by moms. Cons Being in the powder form, the formula may need some effort to be prepared with purified water. Mixing the dry powder with pumped breast milk requires particular directions and is not easy. This product is not suitable to be used by babies with galactosemia. This product is not eligible for lactose intolerance.   2. Baby’s Only Lacto-Relief Toddler Formula ⇒ (Lactose-Free) Many infants cannot digest lactose, a carbohydrate present in breast milk, and milk-based formulas, which results in diarrhea and growth retardation. For such types of patients, unique formulas that do not contain lactose are used. It will be best if a particular formula is of organic origin and NON-GMO certified. This is the best baby formula for breastfed babies because of its benefits. We are providing our review of this product as follows in terms of pros and cons; Features: It’s the best baby formula for newborns 0-12 months. The size per serving is four fl. oz (120ml); servings per container is about 21. This product is available in dry powder form and a pack of 6. Pros Infants with lactose intolerance can use this product. This is the best organic baby formula that contains DHA & ARA obtained organically from egg phospholipids. It is a NON-GMO product, with no corn syrup, palm oil, or fungal or algae oils. It is free from bleach or acids. The product has no genetically engineered products present. It is the best formula for developing the nervous system, eye, and brain. Hexane is a free product concerning DHA & ARA. It is also gluten-free and has no egg allergens. This formula is BPA-Free and packaging-certified. OU Kosher is certified and contains eggs, dairy, soy, and coconut. Cons Not for use in infants with galactosemia. Mixing the dry powder with pumped breast milk requires particular directions and is not easy. It cannot be used in babies with protein allergies.   3. Enfamil PREMIUM (Pack of 4) (best baby formula for gas) Uneasiness and crying are some common problems that you may feel in your baby. There are multiple reasons for these symptoms, but the most common are gas and abdominal colic. Therefore, the particular type of formula is designed to meet the nutritional needs of infants and reduce fussiness, gas, and crying. Enfamil PREMIUM is the best formula for colic babies, having the following pros and cons. Features: It is a specially designed milk-based dry powder, the best formula milk for babies 0-6 months. It can also be used for up to 12 months. It is the closest formula to breast milk and is the best formula for reflux and gas. The net weight is 21.5 OZ (610g), containing 33 servings, each serving equal to 4 fl. oz (18g) per container. The product comes with refills and a reusable tub. Pros Relieves symptoms of fussiness, gas, and crying within 24hrs It contains iron, which is

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10 Best Multivitamins For Teen Boys (2024 Helpful Review)

If you have trouble getting the recommended daily doses of nutrients through food, taking the best multivitamins for teen boys and girls may be your best course of action. Have you ever noticed that your child may have a deficiency of specific vitamins? If not, then it’s an opportunity for you to take our guidance and correctly resolve the issue of vitamin deficiency in your child, if any. However, convincing a teenager is always a difficult task, but it’s the responsibility of parents to take care of and provide essential vitamins and nutrients to them. Our body produces many chemical substances to balance the internal body processes and keep us healthy and robust. However, there are still certain vital chemical substances that our body cannot produce and need to be taken from the outside environment, mainly from a balanced diet and proper nutrition. These critical chemicals are called vitamins and nutrients. Types of vitamins and their functions: Vitamins are of two types: water-soluble (Vitamin C and Vitamin B1 through Vitamin B12) and fat-soluble (Vitamin A, D, E, and Vitamin K). Vitamins have different chemical natures and thus play other vital roles inside our body to maintain our body’s vitality, growth, functions, and strength by boosting specific metabolic and enzymatic processes. Vitamin deficiency in teenage boys: Vitamin D: Vitamin D is essential for calcium absorption. This is mainly obtained from dairy products and synthesized inside our bodies in sunlight. Vitamin D deficiency causes problems in all age groups, but its impact on teenage boys’ growth, height, and weight are significant to be addressed on time. Vitamin D deficiency in teenagers may cause rickets, a bone disease in which bones beneath the knee joint form a curved lateral convex shape, and with time, it causes stunted growth and low stature and height. It is also evident that vitamin D plus calcium deficiency causes osteomalacia, a disease in which bones become weak, soften and don’t have enough strength to absorb excessive physical stress, which may lead to fractures during sports and other exercises. Slipped capital femoral epiphysis in teenage boys is another prevalent problem, which involves the upper neck of the developing femur bone in the hip joint and is an excruciating condition. This can be due to vitamin D and calcium deficiency. These indications make it one of the best vitamins for teens, boys, and girls. Vitamin A: This fat-soluble vitamin is essential for growth, normal vision, gene expression, immune response, and development of sexual characteristics in teenagers (age 14-18 years). Deficiency of vitamin A in teenagers is a significant health problem worldwide. [1] Lack of vitamin A causes a condition known as night blindness, in which a person cannot visualize things in low light or dark places. During puberty, deficiency of the vitamin can lead to less developed sexual characteristics, including the expression of secondary sexual characteristics like the development of genitalia, changes in voice, and the appearance of facial and groin hairs. Vitamin B6: Since vitamin B6 plays a vital role in the metabolism and synthesis of amino acids, building blocks of protein, its deficiency may cause growth retardation in teenagers. [2] Besides this, vitamin B6 is also required for the synthesis of heme, which is needed for the synthesis of hemoglobin and, thus, Red blood cells. Folic acid (folate)/ vitamin B9: This vitamin functions as a coenzyme and is required for the endogenous synthesis and metabolism of amino acids and nucleic acids, providing an essential role in cell division and growth. Higher levels can result in better academic achievements.  The deficiency of this vitamin may lead to growth plus mental health abnormalities. Vitamin B12:  This vitamin also works as a coenzyme and helps to metabolize proteins and fats. Its role is vital in developing the myelin sheet of the nerves and, ultimately, for the development of mental health. Deficiency may cause loss of sensory characteristics, growth retardation, and mental health weaknesses. Vitamin C: This water-soluble vitamin is essential and one of the best for teens, as it is often deficient in teenage boys and girls. Vitamin C is vital for developing and strengthening muscles and plays its role in synthesizing collagen, carnitine, and neurotransmitters. Vitamin C is famous for its antioxidant role, which is essential for immunity and stopping spontaneous cell death. Vitamin C plays its part in iron absorption; deficiency may lead to iron deficiency anaemia. Its lack causes scurvy, a disease of gums and an oral cavity. Vitamin E: Vitamin E is one of the most critical vitamins concerning its antioxidant effect. It is used in a blood disorder (beta-thalassemia) in teenagers to cope with the deficiency of haemoglobin,, this one is also the best vitaminvitamin for teens. It is also used in teenagers with G6PD deficiency. Dietary sources of vitamins: Due to their different chemical nature, vitamins have multiple sources, ranging from cereals to nuts, eggs, vegetables, fresh fruits, seafood, dairy products, animal fats, liver, and meat. That’s why it is hard to fulfil the need for the daily required amount of every vitamin from food because achieving such a balanced diet is a challenging task. To quickly provide sufficient vitamins for teenage boys (age group 13-19 years), the following products are recommended that are readily available in the market. Best multivitamins for teen boys (Products): Luckily, we have compiled this list of the best multivitamins for teen boys; some can be used for girls. 1. A Day VitaCraves Teen For Him Multivitamin Gummies Teenagers of pre-pubertal and post-pubertal age need an excessive amount of nutrition due to their high energy consumption in various sports and physical activities. The same is required for their educational, mind-starving purposes. Besides these, teenagers have rapid growth and cell division, for which a balanced diet is essential. Sometimes, due to malnutrition or lack of a balanced diet, teenagers develop specific issues regarding their health, ultimately affecting their physique and intellect. This may be due to a deficiency of vitamins and minerals and can only be overcome by providing a balanced diet or the right multivitamin

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An evidence based approach to treat “Dyslipidemia”

Identification and treatment of dyslipidemia is necessary to reduce the rate of atherosclerosis and the subsequent cardiovascular events, including coronary artery disease (CAD), which may be pharmacologic or non pharmacologic. Patients with abnormal lipid profiles (dyslipidemia) shall be identified and treated on the basis of patients’ risk profiles. Important points regarding the diagnosis of dyslipidemia: From the age of 20 everyone shall be screened for dyslipidemia every 5 years including those who have a normal lipid profile. But those who are obese and having other risk factors including positive family history for dyslipidemia and those with CAD, should perform annual screening. Fasting serum lipid profile is normally preferred. Subject shall be screened for the metabolic causes of dyslipidemia, including diabetes mellitus (DM), liver diseases, hypothyroidism, and nephrotic syndrome. Patient medication history shall also be assessed, because medications containing progestins, corticosteroids, or anabolic steroids can lead to dyslipidemia. Risk Assessment? Patients with established coronary heart disease  (CHD) and those with a risk of developing CHD must be considered for lipid-lowering therapy CHD or equivalent patients (>20%) with a 10 – year risk of CHD, having DM or Peripheral Vascular Disease or abdominal aortic aneurysm, or CAD.  CHD risk factors Family history of developing CAD (age <55 for men, <65 for women), or low serum high density lipoprotein  HDL (age <45 for men, <55 for women), or hypertension, or smoking, or age( >45 for men, <55 for women). Initiation of therapy and the ideal goal for LDL and non-HDL levels: The ideal LDL goal for CAD or equivalent patients, shall be <100 (or <70) and the non-HDL goal shall be <130 while initiation of the therapy shall be regardless of LDL level in the body. Patients having 0-1 risk factors for developing CHD will have an ideal goal for LDL as ( <160), and non-HDL as (<190) while for initiation of the therapy the LDL level must be >190. Patients having 2+ risk factors for developing CHD will have an ideal goal for LDL as ( <130), and non-HDL as (<160) while for initiation of the therapy the patient must have a 10-year risk and 10-20% LDL as >130 or a 10year risk and <10%LDL as >160 Life style changes required for therapy: life style modifications, as described below, are advised to be followed, for at least 6 weeks, before initiating pharmacotheraphy. <7% of Calories shall be obtained from saturated fat on a daily maintenance basis Out of the total calories not more than 25-35% must be obtained from total fat Intake of monounsaturated fats and polyunsaturated fats must be increased. monounsaturated fats up to 10 % of the total caloric intake polyunsaturated fats up to 20 % of the total caloric intake total daily cholesterol shall not be consumed more than 200mg exercise and weight loss may be beneficial up to some extent health diet containing plant sterols, Omega-3 fatty acids, and a viscous fiber shall be consumed Pharmacotherapy: HMG-CoA reductase inhibitors (statins): can lower LDL by 18-55% and Triglycerides by 7-30% can increase HDL by 15% check baseline LFTs  three months after initiating therapy , discontinue therapy if LFTs>3 times the upper limit of normal keep in view the ADRs and efficacy of every agent BileAcid Sequestrants: decrease LDL by 15-30% increase HDL by 3-5% lower or no effect on TGs GI upset and decrease absorption of other medications are ADRs Nicotinic Acid: decrease LDL by 5-25% increase HDL by 15-35% decrease TGs by 20-50% contraindicated in gout, CLD, or diabetes relatively Fibrates: decrease LDL by 5-20% increase HDL by 10-35% decrease TGs by 20-50% dyspepsia, myopathy etc are the ADRs Ezatimibe: decrease LDL by 18-20% increase HDL by 1-5% decrease TGs by 5-11% contraindicated in liver diseases Omega-3 fatty acids: reduce hepatic production of TGs modestly reduce LDL and increase HDL associated with increased risk of bleeding and decrease in glucose control Approach to treatment: Therapy depends on the LDL goal as shown in the figure below once LDL goal is achieved then HDL and TGs levels can be considered. statins are the first line drugs, treatment shall be started with a low dose (10-20mg) to assess lipid-lowering effect and tolerability, then shall be titrated gradually. a second agent may be added if lipid goal is not achieved even with a maximum dose Complimentary and Alternative Therapies: Plant sterols/stenols reduce LDL but not TGs, HDL. Soluble fibers has modest lowering effect on Total Cholesterol (TC), LDL. Soy protein has modest effect on lowering of TC, LDL, TGs. Guggul has also been shown to reduce TC, LDL, TGs. Note: all of the above supplements can cause GI upsets Red yeast rice, both in capsules and extract form, reduce TC and LDL with no known significant adverse effects Clinical Pearls: LDL shall be treated first before considering secondary goals. Patients with CHD can take more benefit from statins Patients with acute MI shall early start statins regardless of the LDL levels Different statins shall be started before switching to or adding other agents Patient profile of creatinine phosphokinase shall only be obtained when muscles pain is experienced Pre-medication with aspirin and gradual titration of the dose is advised to improve the effects of Niacin  If TG>1000 hospitalize the patient and start fibrate urgently References: A Practical Approach to Cardiovascular Medicine, First Edition. Edited by Reza Ardehali, Marco Perez, Paul Wang. @2011Blafkwell Publishing Ltd. Published 2011by Blackwell Publishing Ltd.

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Don’t believe in “Myths” about rabies because it can cost high for you and your community

Food and Agriculture Organization (FAO) United Nations has issued some facts against the common folk beliefs i.e. myths about rabies which shall be known by everyone who deals with animals or residing in areas where exposure to animal bites may occur and eventually can lead to the infection. Following is a brief description of the report of FAO. Myths   MYTH #1: ” Feeding your dog well means responsible dog ownership”. Fact: Responsible dog ownership means that you register your dog with the local authorities, you annually vaccinate your dog for rabies, you keep your dogs from roaming the streets, and you feed and care for your dog in an ethically responsible manner as stated by the FAO. MYTH #2: “Rabies is transmitted only by the bite of an animal”. Fact: Transmission by the bite of a rabid animal is the most common way. Rabies can also be transmitted through a scratch inflicted by a dog or an animal if fresh saliva is on the nail that causes scratch. Airborne transmission of rabies may also occur when handling bat guano or in bat caves. Aerosol transmission has been implied in four reports of human rabies cases and documented in experimental work with animals as reported by FAO. MYTH #3: “Dog vaccines prevent your dog from getting rabies for only a few months”. Fact: According to FAO, if your dogs are vaccinated against rabies, they are protected for at least one year with each vaccine. MYTH #4: “Dog owners can choose whether or not to vaccinate their dogs against rabies”. Fact: In the light of the FAO report, this depends on the country where you live but in most of the countries in the world, as a dog owner, you are required to vaccinate your dogs against rabies every year. This protects you, your family and friends, your community, and your dogs. MYTH #5: “A Rabies vaccine for a dog is expensive”. Fact: The cost of a complete course of human vaccination plus immunoglobulins if needed, that is necessary if a person is bitten by a non-vaccinated dog or a suspected rabid animal is far more than vaccinating a dog prophylactic-ally. MYTH #6: “If a dog bites a person, it is only important to care for the person”. Fact: Actually, according to WHO, if a dog bites a person it is necessary to catch the dog and keep it in a room or cage, isolated from other animals and people for 10 days, to observe it for abnormal or rabies-like behavior, in addition to making sure the person who was bitten receives proper treatment. MYTH #7: “Rabies is not life-threatening or fatal to humans”. Fact: Rabies is ALWAYS life-threatening and can result in death if the bite wound is not washed immediately and the post-exposure vaccination is not given in a timely fashion as per the public health requirement. MYTH #8: First aid is not necessary to help a person who has been bitten or scratched by a dog or an animal suspected to be rabid. Fact: Immediate and thorough washing and cleaning of a bite wound are ESSENTIAL. Flush the wound with a strong stream of water. Wash well with soap or detergent. Next, apply a disinfectant to the wound and surrounding tissue, taking care to get it under skin flaps. Immediately afterward, take the person to the hospital or vaccination point. MYTH #9: The vaccine shots for humans who have been exposed to rabies are dangerous and can make them sick as well as affecting their memory. Fact: There were some side-effects from the old human vaccine but the new human vaccine that is currently available does not result in those side effects. However, the source and registration of a vaccine may first be confirmed from the nearby facility or hospital or a health care team where applicable. MYTH #10: “If a traditional healer treats a bite wound, there is no need to see a doctor or go to a medical center or hospital”. Fact: People with bite wounds that are only treated with traditional medicine are at greater risk of death from rabies, once a person shows clinical symptoms, death is unpreventable. MYTH #11: Rabies virus can be detected and treated by traditional medicine when traditional healers treat bite wounds. Fact: To date, there is no traditional medicine that is proven effective against the rabies virus. Therefore, even if a traditional healer treats your bite wound, you should still proceed to a medical center or hospital so the wound can be properly cleaned and disinfected, and so you can get a post-exposure rabies vaccine. MYTH #12: If I were bitten by a vaccinated dog, I do not need a post-exposure human rabies vaccine. Fact: Even if the dog is vaccinated against rabies, you should still go to the doctor for consultation. The doctor will evaluate the bite wound and advise on whether a post-exposure vaccine is necessary. If you do not seek medical care, you are risking your life. MYTH #13: Human-to-human transmission of rabies not possible. Fact: Humans are mammals. Therefore, theoretically, human-to-human rabies transmission is possible. However, there are no laboratory-tested cases to confirm that this has actually happened. MYTH #14: The only thing I can do about the rabies problem is to make sure my pets are vaccinated annually. Fact: This is important, but only a good first start. There are other ways you can assist in controlling the disease: Do not let your dogs roam outside the house or yard without a muzzle and leash, even if they are vaccinated; Cooperate with your local vet and village head to register and vaccinate your dogs annually; Educate yourself and all members of your family about rabies. In particular, warn young children never to get close to dogs and animals that appear sick or aggressive; and Call your local vet or village heads when you spot an animal that you suspect is sick or rabid.

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