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Immune Thrombocytopenia (ITP) Treatment | Nplate® (romiplostim)

COPD Inhaler | ANORO ELLIPTA (umeclidinium and vilanterol inhalation powder)
Prescribing Info: http://bit.ly/2zUiw6Q. Prescription ANORO is used long term to treat COPD, including chronic bronchitis, emphysema, or both. ANORO is not used to relieve sudden symptoms of COPD, won't replace a rescue inhaler, and is not for asthma. IMPORTANT SAFETY INFORMATION • Do not use ANORO to treat sudden symptoms of chronic obstructive pulmonary disease (COPD). Always have a rescue inhaler with you to treat sudden symptoms. • Do not use ANORO if you have a severe allergy to milk proteins or are allergic to any of the ingredients in ANORO. Ask your healthcare provider if you are not sure. • Do not use ANORO if you have asthma. • Do not use ANORO more often than prescribed. • Do not take ANORO with other medicines that contain a long-acting beta2-adrenergic agonist (LABA) or an anticholinergic for any reason. Tell your healthcare provider about all your medical conditions and about all the medicines you take. • Call your healthcare provider or get medical care right away if your breathing problems get worse, if you need to use your rescue inhaler more often than usual, or if your rescue inhaler does not work as well to relieve your symptoms. • ANORO can cause serious side effects, including: − COPD symptoms that get worse over time. If this happens, do not increase your dose of ANORO; instead, call your healthcare provider. − symptoms of using too much of a LABA medicine, including: chest pain; increased blood pressure; fast or irregular heartbeat; headache; tremor; nervousness. − sudden breathing problems immediately after inhaling your medicine. If you experience this, stop using ANORO and call your healthcare provider right away. − serious allergic reactions. Call your healthcare provider or get emergency medical care if you get any of the following symptoms: rash; swelling of your face, mouth, and tongue; hives; breathing problems. − effects on heart: increased blood pressure; chest pain; a fast or irregular heartbeat, awareness of heartbeat. − effects on nervous system: tremor; nervousness. − new or worsened eye problems, including acute narrow-angle glaucoma that can cause permanent loss of vision if not treated. Symptoms may include: eye pain or discomfort; nausea or vomiting; blurred vision; seeing halos or bright colors around lights; red eyes. If you have these symptoms, call your healthcare provider right away before taking another dose. − urinary retention. People who take ANORO may develop new or worse urinary retention. Symptoms may include: difficulty urinating; painful urination; urinating frequently; urination in a weak stream or drips. If you have these symptoms, stop taking ANORO and call your healthcare provider right away before taking another dose. − changes in laboratory blood levels, including high levels of blood sugar and low levels of potassium. • Common side effects of ANORO include: sore throat; sinus infection; lower respiratory infection; common cold symptoms; constipation; diarrhea; pain in your arms or legs; muscle spasms; neck pain; chest pain. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. Talk to your doctor about ANORO. Please see full Prescribing Information, including Patient Information, for ANORO at http://bit.ly/2zUiw6Q. Visit https://www.anoro.com or call 1-844-44-ANORO to learn more. Sponsored by GSK. For US audiences only. ANORO ELLIPTA was developed in collaboration with INNOVIVA Trademarks are owned by or licensed by GSK. ©2019 GSK or licensor. UCVOGM190014 November 2019 Produced in USA.

Athar Muniruddin Siddiqui Spinal Surgeon
This 70 year old male patient presented to us with Acute on chronic progressive bilateral leg paraparesis. His history of weakness spans over a year that was progressively getting worse. On top of it he had a fall 4 months ago following which his leg movements completely stopped bilaterally, with just sensation below D7 level. When we met him in OPD, his MRI scan shows traumatic cord compression at D7/8 Level on a background of infective erosion of vertebral Body and disc space most likely TB. He was been given 10-20% chance of neurological recovery following surgery, however the surgery was performed to clear infection, stabilise spine and prevent further kyphotic deformity for his rehabilitation in future. Following surgery by the grace of GOD his legs started moving and eventually at 6 weeks mark as his wound completely heeled, his spine stabilised and power in his key myotomes in lower limbs improved to 4+/5 BILATERALLY in L2/L3/L4/L5/S1 from almost 1/5. This is an excellent recovery and a case report in its own. Further transpired that timely intervention can change patient situation with right treatment in expert and trained hands. Dr. Athar Muniruddin Siddiqui is a UK trained Spinal Surgeon. He has been working in NHS England for last 15 years. Dr. Siddiqui did his fellowship training in spinal surgery at Great Ormond Street Hospital London and Guy’s and St Thomas’s Hospital NHS Trusts London. His NHS base is Guys & St Thomas’s NHS Trust and Stepping Hill Hospital NHS Trust, where he works as a consultant spinal surgeon. Apart from being lead clinician for AO Hospital Karachi Spine Directorate. Also he represents Complex Spine London in Pakistan which is the largest dedicated spinal surgery, pain and therapy group in the UK. https://www.complexspine.london/athar-muniruddin-siddiqui/ ☎️To schedule your appointment Call or Whatsapp on KARACHI:0333-3135181 & 0333-5222510 LAHORE: 0333-3135181 #SpinalSurgeon #AMSspineandOrthopaedics #AOHospital #CervicalPain #SpinalCord #CriticalStenosis #Sciatica #SpinalInjection

HealthSalus
THE COUGH THAT NEVER CEASES. SEVEN IMPORTANT CAUSES. We refer to a cough that lasts more than three weeks and that never ceases to end. The cough is a reflex that that our body uses as a defence mechanism to expel or clean foreign bodies from our airways. If the cough becomes a chronic cough, it would not be normal and it would be warning us that there is something wrong. The cough can present itself as part of acute pathologies that would be generally infectious and of a short duration. We will be analysing the persistent and chronic cough within this article, as it is a symptom of many pathologies that need to be diagnosed as soon as possible. CAUSES OF THE CHRONIC COUGH 1. ASTHMA Asthma is a disease that produces an inflammation and reversible obstruction of the bronchial tubes. It is characterised by the presence of a certain type of cough that is predominantly dry, nightly and accompanied by respiratory difficulties. It is usually produced by an allergy to pollen, fungi, animal hairs, foods, vasomotor alterations, etc. 2. CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) Chronic obstructive pulmonary disease covers three types of pathologies and they are: chronic bronchitis, emphysema and long-term asthma in people that have been smokers. This disease is due to the permanent and irreversible inflammation of the bronchial tubes. It is usually caused by tobacco and produces a cough every morning and different amounts of sputum. 3. GASTROESOPHAGEAL REFLUX Gastroesophageal reflux is the way in which gastric contents travel through the oesophagus and produce a feeling of heartburn or burning in the throat, mouth or retrosternal. This acid usually produces laryngeal irritation that causes a commonly dry and persistent cough. Gastroesophageal reflux can only present this cough as an only symptom without being aware that the reflux is present. 4. POSTNASAL DRIP Postnasal dripping is the constant presence of mucus within the throat. This dripping is caused by inflammatory processes in the nose (Rhinitis) and in the mucous membrane that surrounds the sinuses (Sinusitis). 5. CHRONIC LARYNGITIS Inflammation of the larynx that lasts more than three weeks, results in a dry cough that is usually accompanied by hoarseness, that is commonly due to the misuse of the voice, the presence of nodules on the vocal chords or irritants such as tobacco, alcohol, gastroesophageal reflux. 6. TUBERCULOSIS Tuberculosis is a pulmonary infection that is produced by Koch’s bacillus and which the main symptoms are: a chronic cough with sputum of blood, fever, tiredness, night sweats, etc. 7. LUNG CANCER Lung cancer usually does not have any initial symptoms, but a recent cough that lasts more than three weeks, or an existing cough that changes intensity or tone, or that simply has the presence of blood in the sputum, would alert us of this pathology. OTHERS Cystic fibrosis, bronchiectasis, cardiac failure, parasites such as worms and pharmaceuticals to treat hypertension such as captopril, etc. are other pathologies that will produce a cough that is not as frequent. Lastly, we want to remind people that when faced with the presence of a cough that lasts for more than three weeks, then medical assistance should be sought out in order to obtain a diagnosis as quickly as possible. Dr. J. Hurtado Martínez Medical Director of HealthSalus

Immune Thrombocytopenia (ITP) Treatment | Nplate® (romiplostim)
With ITP, managing platelets is very important. Setting goals can help. IMPORTANT SAFETY INFORMATION. What is the most important information I should know about Nplate®? Nplate® can cause serious side effects, including: Worsening of a precancerous blood condition to a blood cancer (leukemia): Nplate® is not for use in people with a precancerous condition called myelodysplastic syndromes (MDS), or for any condition other than immune thrombocytopenia (ITP). If you have MDS and receive Nplate®, your MDS condition may worsen and become an acute leukemia. If MDS worsens to become acute leukemia you may die sooner from the acute leukemia. • Higher risk for blood clots: - You may have a higher risk of getting a blood clot if your platelet count becomes high during treatment with Nplate®. You may have severe complications or die from some forms of blood clots, such as clots that spread to the lungs or that cause heart attacks or strokes. - If you have a chronic liver disease, you may get blood clots in the veins of your liver. This may affect your liver function. • What are the possible side effects of Nplate®? - Nplate® may cause serious side effects. See “What is the most important information I should know about Nplate®?” - The most common side effects of Nplate® in adults include: -- headache -- joint pain -- dizziness -- trouble sleeping -- muscle tenderness or weakness -- pain in arms and legs -- stomach (abdomen) pain -- shoulder pain -- indigestion -- tingling or numbness in hands and feet -- bronchitis -- inflammation of the sinuses (sinusitis) -- vomiting -- diarrhea -- upper respiratory tract infection -- cough -- nausea -- pain in mouth and throat (oropharyngeal pain) - The most common side effects of Nplate® in children 1 year of age and older include: -- bruising -- upper respiratory tract infection -- pain in mouth and throat (oropharyngeal pain) - People who take Nplate® may have an increased risk of developing new or worsening changes in the bone marrow called “increased reticulin.” These changes may improve if you stop taking Nplate®. Your healthcare provider may need to check your bone marrow for this problem during treatment with Nplate®. - These are not all the possible side effects of Nplate®. Tell your healthcare provider if you have any side effect that bothers you or that does not go away. For more information, ask your healthcare provider or pharmacist. - If you have any questions about this information, be sure to discuss with your doctor. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088. How will I receive Nplate®? Nplate® is given as an injection under the skin (subcutaneous) one time each week by your healthcare provider. Your healthcare provider will check your platelet count every week and change your dose of Nplate® as needed. This will continue until your healthcare provider decides that your dose of Nplate® can stay the same. After that, you will need to get blood tests every month. When you stop receiving Nplate®, you will need blood tests for at least 2 weeks to check if your platelet count drops too low. APPROVED USES Nplate® is a prescription medicine used to treat low blood platelet counts (thrombocytopenia) in: • adults with immune thrombocytopenia (ITP) when certain medicines or surgery to remove your spleen have not worked well enough. • children 1 year of age and older with ITP for at least 6 months when certain medicines or surgery to remove your spleen have not worked well enough. Nplate® is not for use in people with a precancerous condition called myelodysplastic syndrome (MDS), or low platelet count caused by any condition other than immune thrombocytopenia (ITP). Nplate® is only used if your low platelet count and medical condition increase your risk of bleeding. Nplate® is used to try to keep your platelet count about 50,000 per microliter in order to lower the risk for bleeding. Nplate® is not used to make your platelet count normal. It is not known i

GSKPro for Healthcare Professionals
Prescribing Info: http://bit.ly/2zUiw6Q. Prescription ANORO is used long term to treat COPD, including chronic bronchitis, emphysema, or both. ANORO is not used to relieve sudden symptoms of COPD, won't replace a rescue inhaler, and is not for asthma. IMPORTANT SAFETY INFORMATION • Do not use ANORO to treat sudden symptoms of chronic obstructive pulmonary disease (COPD). Always have a rescue inhaler with you to treat sudden symptoms. • Do not use ANORO if you have a severe allergy to milk proteins or are allergic to any of the ingredients in ANORO. Ask your healthcare provider if you are not sure. • Do not use ANORO if you have asthma. • Do not use ANORO more often than prescribed. • Do not take ANORO with other medicines that contain a long-acting beta2-adrenergic agonist (LABA) or an anticholinergic for any reason. Tell your healthcare provider about all your medical conditions and about all the medicines you take. • Call your healthcare provider or get medical care right away if your breathing problems get worse, if you need to use your rescue inhaler more often than usual, or if your rescue inhaler does not work as well to relieve your symptoms. • ANORO can cause serious side effects, including: − COPD symptoms that get worse over time. If this happens, do not increase your dose of ANORO; instead, call your healthcare provider. − symptoms of using too much of a LABA medicine, including: chest pain; increased blood pressure; fast or irregular heartbeat; headache; tremor; nervousness. − sudden breathing problems immediately after inhaling your medicine. If you experience this, stop using ANORO and call your healthcare provider right away. − serious allergic reactions. Call your healthcare provider or get emergency medical care if you get any of the following symptoms: rash; swelling of your face, mouth, and tongue; hives; breathing problems. − effects on heart: increased blood pressure; chest pain; a fast or irregular heartbeat, awareness of heartbeat. − effects on nervous system: tremor; nervousness. − new or worsened eye problems, including acute narrow-angle glaucoma that can cause permanent loss of vision if not treated. Symptoms may include: eye pain or discomfort; nausea or vomiting; blurred vision; seeing halos or bright colors around lights; red eyes. If you have these symptoms, call your healthcare provider right away before taking another dose. − urinary retention. People who take ANORO may develop new or worse urinary retention. Symptoms may include: difficulty urinating; painful urination; urinating frequently; urination in a weak stream or drips. If you have these symptoms, stop taking ANORO and call your healthcare provider right away before taking another dose. − changes in laboratory blood levels, including high levels of blood sugar and low levels of potassium. • Common side effects of ANORO include: sore throat; sinus infection; lower respiratory infection; common cold symptoms; constipation; diarrhea; pain in your arms or legs; muscle spasms; neck pain; chest pain. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. Talk to your doctor about ANORO. Please see full Prescribing Information, including Patient Information, for ANORO at http://bit.ly/2zUiw6Q. Visit https://www.anoro.com or call 1-844-44-ANORO to learn more. Sponsored by GSK. For US audiences only. ANORO ELLIPTA was developed in collaboration with INNOVIVA Trademarks are owned by or licensed by GSK. ©2019 GSK or licensor. UCVOGM190014 November 2019 Produced in USA.

U.S. Food and Drug Administration
For over 10 years, making a difference in the lives of people like Lib has been our inspiration. Full Prescribing Info: https://bit.ly/2pkdv0D Important Safety Info: What is the most important information I should know about Nplate®? Nplate® can cause serious side effects, including: • Worsening of a precancerous blood condition to a blood cancer (leukemia): Nplate® is not for use in people with a precancerous condition called myelodysplastic syndromes (MDS) or for any condition other than chronic (lasting a long time) immune thrombocytopenia (ITP). If you have MDS and receive Nplate®, your MDS condition may worsen and become an acute leukemia. If MDS worsens to become acute leukemia you may die sooner from the acute leukemia. • Higher risk for blood clots: - You may have a higher risk of getting a blood clot if your platelet count becomes high during treatment with Nplate®. You may have severe complications or die from some forms of blood clots, such as clots that spread to the lungs or that cause heart attacks or strokes. - If you have a chronic liver disease, you may get blood clots in the veins of your liver. This may affect your liver function. • What are the possible side effects of Nplate®? - Nplate® may cause serious side effects. See "What is the most important information I should know about Nplate®?" - The most common side effects of Nplate® in adults include: -- headache -- joint pain -- dizziness -- trouble sleeping -- muscle tenderness or weakness -- pain in arms and legs -- stomach (abdomen) pain -- shoulder pain -- indigestion -- tingling or numbness in hands and feet - The most common side effects of Nplate® in children 1 year of age and older include: -- inflammation of the passages in the nose and throat -- upper respiratory tract infection -- itchy, runny, or blocked nose -- sore throat and discomfort with swallowing -- inflammation of the eye -- ear infection -- inflammation in the lining of the intestines -- inflammation of the sinuses -- cough -- pain in mouth and throat -- upper stomach (abdomen) pain -- diarrhea -- rash -- bleeding beneath the surface of the skin or bruising under the skin -- itchy rash -- fever -- swelling in the limbs/hands/feet -- bruising - People who take Nplate® may have an increased risk of developing new or worsening changes in the bone marrow called “increased reticulin.” These changes may improve if you stop taking Nplate®. Your healthcare provider may need to check your bone marrow for this problem during treatment with Nplate®. - These are not all the possible side effects of Nplate®. Tell your healthcare provider if you have any side effect that bothers you or that does not go away. For more information, ask your healthcare provider or pharmacist. - If you have any questions about this information, be sure to discuss with your doctor. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088. How will I receive Nplate®? Nplate® is given under the skin (subcutaneous injection) one time each week by your healthcare provider. Your healthcare provider will check your platelet count every week and change your dose of Nplate® as needed. This will continue until your healthcare provider decides that your dose of Nplate® can stay the same. After that, you will need to get blood tests every month. When you stop receiving Nplate®, you will need blood tests for at least 2 weeks to check if your platelet count drops too low. Pregnancy Surveillance Program: Women who become pregnant during Nplate® treatment are encoura

COPD Inhaler | ANORO ELLIPTA (umeclidinium and vilanterol inhalation powder)
Once-daily ANORO is a prescription medicine used long term to treat chronic obstructive pulmonary disease (COPD), including chronic bronchitis, emphysema, or both, for better breathing. ANORO is not used to treat sudden COPD symptoms and won't replace a rescue inhaler. ANORO is not for asthma. Important Safety Information •ANORO is only approved for use in COPD. ANORO is NOT approved for use in asthma. •People with asthma who take long-acting beta2-adrenergic agonist (LABA) medicines, such as vilanterol (one of the medicines in ANORO), have an increased risk of death from asthma problems. It is not known if LABA medicines increase the risk of death in people with COPD. •Call your healthcare provider if breathing problems worsen over time while using ANORO. •Get emergency medical care if your breathing worsens quickly or if use of your rescue inhaler does not relieve your breathing problems. •Do not use ANORO to treat sudden breathing problems. Always have a rescue inhaler with you to treat sudden symptoms. •It is not known if ANORO is safe and effective in people with asthma. •Do not use ANORO if you have a severe allergy to milk proteins or any of the ingredients in ANORO. Ask your healthcare provider if you are not sure. •Do not use ANORO more often than prescribed. •Do not take ANORO with other medicines that contain a LABA or an anticholinergic for any reason. Tell your healthcare provider about all the medicines you take and about all of your health conditions. •ANORO can cause serious side effects, including: - sudden breathing problems immediately after inhaling your medicine. If you experience this, stop using ANORO and call your healthcare provider right away. - serious allergic reactions. Call your healthcare provider or get emergency medical care if you get any of the following symptoms: rash; hives; swelling of your face, mouth, and tongue; breathing problems. - effects on heart: increased blood pressure; a fast or irregular heartbeat, awareness of heartbeat; chest pain - effects on nervous system: tremor; nervousness - new or worsened eye problems, including acute narrow-angle glaucoma that can cause permanent loss of vision if not treated. Symptoms may include: eye pain or discomfort; nausea or vomiting; blurred vision; seeing halos or bright colors around lights; red eyes. If you have these symptoms, call your healthcare provider right away before taking another dose. - urinary retention. People who take ANORO may develop new or worse urinary retention. Symptoms may include: difficulty urinating; painful urination; urinating frequently; urination in a weak stream or drips. If you have these symptoms, stop taking ANORO and call your healthcare provider right away before taking another dose. - changes in laboratory blood levels, including high levels of blood sugar and low levels of potassium •Common side effects of ANORO include: sore throat; sinus infection; lower respiratory infection; common cold symptoms; constipation; diarrhea; pain in your arms or legs; muscle spasms; neck pain; chest pain. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. Talk to your doctor about ANORO. Please see full Prescribing Information, including Boxed Warning and Medication Guide, for ANORO ELLIPTA at http://bit.ly/2zUiw6Q. Visit https://www.anoro.com or call 1-844-44-ANORO to learn more. Supported by GSK. For US audiences only. ANORO ELLIPTA was developed in collaboration with INNOVIVA Trademarks are owned by or licensed to the GSK group of companies. ©2018 GSK group of companies or its licensor. Produced in USA. 1009956R0 October 2018

ANTI Covid-19 Thailand

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