For Women and some Men

Skin Whitening Creams - 
to -for women and some Men 

Lightening skin tone is an ancient and well‐documented practice, and remains common practice among many cultures specially in Asian and African region. Specially women since the early days have been very considerate about the skin care and skin color had become a parameter of beauty!!! 

Skin color is due to the melanin pigments present in our skin and more melanin less fairer you look. So most of the women try to look fair by trying out different cosmetic and pharmaceutical products. 

Owing to the very high demand, Currently in the market there are numerous skin whitening products with different purposes for different body parts in diverse dosage form such as creams, gels, ointments, capsules, tablets lotions and many more. 

Whitening agents such as corticosteroids, tretinoin and hydroquinone are medically applied to effectively lighten the skin tone of hyperpigmented lesions. 
However, when these agents are used cosmetically, they are associated with a variety of side‐effect.

These products may or may not be pharmaceutical products and in Sri Lanka most of the cosmetics are not registered as borderline products. Given the loop-hall in the laws and the acts there are numerous skin care products claiming skin fairness. 

Most of these products are synthetic chemicals in proportions harmful to the skin and lack of proper regulation has created a huge market for the skin whitening products which are sold under different names and prices with no any quality standards and assurance. These are promoted as the only solution for suffering women through various media including TV channels, social media and even newspapers. 

Not all products that purport to lighten the skin are illegal and unsuitable for use,in fact there are several quality herbal preparations with proven effect,  but many creams and other dosage forms contain chemicals banned under safety regulations. These include mercury and hydroquinone. over the last 50 years hydroquinone had been the key component in skin whitening products and it acts by reducing the production of melonocytes - melanin producing cells. The prolonged use of synthetic hydroquinone is linked with 

• poisoning, 
• skin damage 
• liver and kidney malfunction 
• skin rashes 
• skin irritation
•  Death  

Also  misuse of corticosteroid creams is associated with thinning of the skin, an increased chance of skin cancer and, even with darkening of the skin. 

What you should know? 

- For all the skin problems including hyper pigmentation there are skin clinics in hospitals and specialized doctors to help you out 
- Pharmaceutical products should always be taken under a prescription 
- you should strictly follow the directions of the physicians or the pharmacists when using skin care products.  
- when buying any other fairness cream 

• check whether the product is registered in Sri Lanka 
• look for the composition of ingredients
• get the help of your pharmacists if it is sold in the pharmacy   
• check whether the directions been given properly and clearly 
• always check for the authenticity of the product.    
• avoid over night solutions !! 

Most of the products in the market could be very much misleading and they may not even mention about the composition of the products in such cases its best to avoid such preparations or seek help.  

Simply because your salon, favourite actress, or your friend recomend dont use whitening products. 

what can you do? 

Well becoming fair is a real struggle unless you are not born with it. Specially we being Asian women we do know that skin color is a parameter of beauty which is very unfair in certain circumstances. This will always make you want to apply more creams and skin care products with low quality and more side effects after all we all love to look beautiful and radiant. Rather than trying out all bleaching products and thousands of creams recommended by your salons and actresses we can simply follow these too .. 

Dearest Women and Some men, 

• Drink more water 
• Eat fresh fruits and vegetables 
• Eat balanced healthy diet 
• Avoid artificial food flavors,colors and fast food 
• Keep your skin clean  
• Avoid sunlight as much as possible 

these will give you a better glowing healthier skin. 

Its always good to have a healthier glowing skin even if you are dark!!!!!!!!!! 

Well have a look 

Miss Universe 2019

reference - 

Overview of skin whitening agents with an insight into the illegal cosmetic market in Europe B. Desmedt P. Courselle

Piumishh - (B. Pharm)

So many Pills - Yet so Ill

So many Pills - Yet so Ill 

This is quite a complain we all have heard all our lives and even we might have thought the same when we are ill or when one of our dearest people has fallen ill. 

Not being well despite been under medication is a common scenario most patients face and this could be due to many reasons and the top most out of all is the lack of "Compliance" and Non - Adherence

Compliance and adherence have very subtle difference and in very simple terms it is the extent to which the patients behavior matches the recommendation of the prescriber, which means patients should take 

• right medicine, 
• in right dose, 
• at right time, 
• for the right duration and 
• in the right route. 

Non-adherence refers to unfilled prescriptions, incorrect dosing intervals, skipped dosages or premature cessation of medication. 

Why not adhere? 

There could be several reasons as to why patients do not adhere to the medication and this could be both intentional and unintentional 

 Intentional 

• bad side effects 
• lack of knowledge in proper administration technique - inhalers 
• high cost of medicines 
• not feeling well   

Unintentional  

• forgetful 
• careless 

How to improve compliance 

•  talk to the doctor or your pharmacist about side effects and they will help you  with the side effects. 

•  talk to your pharmacist regarding administration techniques  he may always help with demonstrations, leaflets, diagrams or even videos  

• there are so many brands and generics  available for the same drug and switching as instructed by the pharmacist can help you with the cost  

• drugs are no Magic beans!!!! please continue medicine as you have been instructed for the right duration ....  stopping medication as and when you want will do no good !!!  

• use your smart phone to make reminders about your medication it will always be helpful. you may also use drug charts , pill boxes  

reference - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2203247/

Piumish - B.pharm - (USJ)

HPV Vaccine

HPV Vaccine - Vaccine for the girl child  

HPV vaccine is for the prevention of Cervical cancers and the genital warts caused by the Human Papiloma Virus and currently this is been given for the girls of age 12 - 14 years old under the recommendation of the Ministry of Health, Sri Lanka.        

(previous article - https://maesterofdrugs.blogspot.com/2019/ )

Why Girls? 

HPV vaccine is currently given for girls to prevent the cervical cancers but it also has the potential to prevent penile cancers and oral cancers of males too. But in Sri Lanka priority is given to the girls and many western countries including US has recommended vaccinating the boys too.

Why  Age specificity? 

Human Papiloma Virus spreads through sexual contact and HPV vaccine is only a preventive medication for the HPV associated cervical cancers and this doesn't mean that it has a therapeutic benefit if you are already infected. Therefore it is important to select an age group who are not sexually active thus the age of 12 - 14 years.

But in  a country like Sri Lanka with much social boundaries for  girls this age group could be extended to early 20 s as in the case of most of the girls.  

Who else can get HPV vaccine? 

HPV vaccination is also recommended for everyone through age 26 years, if not vaccinated already.

Vaccination is not recommended for everyone older than age 26 years. However, some adults age 27 through 45 years who are not already vaccinated may decide to get HPV vaccine after speaking with their doctor about their risk for new HPV infections and the possible benefits of vaccination. HPV vaccination in this age range provides less benefit, as more people have already been exposed to HPV. 

Concerns prior to vaccination  

before getting the vaccine to yourself or your teen daughter , 

• inform if you have any allergies to your doctor 
• inform the doctor if you are on any long term medication for any disease
• inform about any alternative or herbal medication that you are using  
• inform if you have a weakened immune system, for example due to a genetic defect, HIV infection or medicines that affect the immune system.

Side effects of the vaccine 

According to the CDC report  July 2014 

 most common events reported (for both male and female patients) 

1. fainting-common after needle injections, especially in pre-teens and teens
2.  pain and redness in the site of injection
3. dizziness;
4. nausea;
5. headache.  

serious adverse events ( Adverse events are considered serious if it is life threatening, or results in death, permanent disability, abnormal conditions at birth, hospitalization or prolonged administration.)

1. Death 
2. Immobility  

according to the manufacturers of the HPV vaccine the side effects could be - 

• Very commonly (more than 1 in 10 patients), side effects found at the injection site include: pain, swelling and redness. Headache was also seen. 
• Commonly (more than 1 in 100 patients), side effects found at the injection site include: bruising, itching, pain in extremity. 
• Rarely (less than 1 in 1000 patients): hives (urticaria).
• Very rarely (less than 1 in 10,000 patients), difficulty breathing (bronchospasm) has been reported.  

As of any medication the HPV vaccine has its own pros and cons and what is really important is to make sure that the parents as well as the children are properly made aware of why it is given and what measures to be taken if any side effect is experienced. 

Also once the parents are properly educated they must be allowed to make the decision whether or not their daughter needs the vaccination, thus the parental consent must be obtained before the girls are being vaccinated.  

Reference - 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4708146/ 

https://www.cdc.gov/hpv/parents/vaccine.html

Piumish (B.pharm - USJ)

HPV vaccine - for your Girl Child

HPV vaccine - For the GIRL CHILD  

What is HPV? 

Human Papiloma Virus (HPV) is a common virus which transfers from person to person from skin to skin contact during sexual activities. HPV infections are common in late teens and early 20s and most go unnoticed with no symptoms. among the 40 different types of HPV about 20 may cause cervical cancers in women and also cancers associated with vulva, anus, penis and oropharynx in both genders. 

Every year, about 12,000 women are diagnosed with cervical cancer and 4,000 women die from this disease in the U.S. 

Cervical cancer is the second common cause of cancer deaths causing nearly 80% of deaths in developing countries. It has been globally estimated that almost 12% of all female cancers are cervical cancers. 

In Sri Lanka, it is estimated that 7.52 million are at risk of developing cervical cancer, 1395 cases with 11.8 age specific standardized rates and 814 deaths (International Agency for Research on Cancer). 

How to prevent HPV related cancer? 

there are basically two ways to prevent the HPV related cervical cancer 

1. Screeneing for HPV cancer 

 this is also called the pap smear test and is recomended for the women of age 21 - 65 and in Sri Lanka test has been conducted in women for the past two decades. All women at the age of 35 years (or above) are offered one time screening at the well women clinics conducted by Medical Officers of Health and the tests should be done once in 3-5 years. 


2. Getting the HPV vaccination  

 The primary target population is likely to be girls within the age range of 10 to 13 years who are not sexually active by the time of the vaccination.  

 Vaccination of secondary target populations of older adolescent females or young women is recommended only if this is feasible, affordable, cost effective, and does not divert resources from vaccinating the primary target population or effective cervical cancer screening programmes, and if a significant proportion of the secondary target population is likely to be naive to vaccine-related HPV types.

The most important point to be remembered is the vaccine doesnot provide any therapeutic benefit if you are already infected or diagnosed with cervical cancer. 

HPV vaccination in Sri Lanka. 

Who - 

            Girls of grade  7 and 8 island wide no boys at current status. 

how many -

              2 doses 6 months apart 

before - 

               girls become 14 years old. 

vacccination handled by -  

                Medical Officers of Health (MOOH) and Public Health Inspectors (PHII) 

reference -
http://www.epid.gov.lk/web/index.php?option=com_content&view=article&id=208&Itemid=517&lang=en
https://www.cdc.gov


piumish - (Bpharm - USJ)

Let the Pharmacist HELP

                                                      Let the Pharmacist HELP

Me - Hello
Friend - Hello , I need help
Me - yes What Is it?
Friend - I was given an inhaler
Me - so?
Friend - How to use it?
Me - Did not your Pharmacist explain?
Friend - I was in a hurry. I Came

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Above is a part of a telephone conversation I very recently had with a friend of mine. Being a student and now a graduate I have faced similar situation a lot and It was good this was at least a phone call once I was asked about a suppository through a text message !!!!!

Use of certain Medical Devices such as Inhalers, Insulin pens and certain dosage forms such as suppositories, Pessaries, Eye drops and ear drops need practice and prior demonstrations in most of the cases. When ever you visit your Pharmacist with a prescription of a medical device he or she may try to explain you how to use it. You may be in a hurry, you may think you know, and you may even assume that you can Call your pharmacist friend and take their advice But it is very important that you listen to your pharmacist and  I am positive there is no way you can learn the proper technique of using an inhaler over the phone and not to mention the varieties of inhalers currently available.

Now what you should focus on ,

- How to use / administer
- When to use 
- Where and How to store 
- How to carry your device with you 
- How to clean your device  
- When to discard and get a new one 

Yes above may differ according to the device but is true for most of them.

Your pharmacist will explain all the above in detail and it is essential for you to remember at least what I have listed.

Why you think your pharmacist make you wait and explain all these even when you yourself don't want to hear half the stuff he explains.

 Because it

- ensure proper use of device 
- improves patient compliance
- minimizes potential adverse events
- reduces side effects
- avoids misuse and abuse 

So it is for your own good and he wastes his own time to make sure you get
   Right Drug, 
                     Dose, 
                     Time, 
                     Route  


Also one step forward your pharmacist may also provide you with leaflets, pictograms and any other material for further reference if you are in doubt.

Know your Rights 

All Pharmacists may not be ready to waste time on counselling when they have long queues waiting for them ....

- Yes you can always ask for your Pharmacist to Explain or Demonstrate the use of a medical device no matter how long the queue is
-  You may feel free to ask for a language of your preference
-  If you are not comfortable being counselled in public ask for privacy!!
- Ask for an emergency contact number if available

In an ideal set up the privacy of the patient should be regarded with greater importance by the pharmacist and should have a separate area for counselling!!
Pharmacists are bound by a code of ethic and you can always trust your pharmacists with your health problems and expect them to respect privacy.

So the next time you walk in with a prescription of a Medical Device make sure you are willing to spend few minutes to be counselled for your own good and please do note that ignoring what your pharmacist got to say and ending up with consequences will be a Bitter Pill To Swallow....... Its always good to let your pharmacist help you with your medical devices than asking your friends family or googling.



Let Him HELP!!!!!!!!!!


Piumish (B.Pharm USJP)

Social Media and Healthcare

Being the e - Generation most of us have become so dependent on internet for all most all our needs. From a song of your favorite artist to what you can cook from bread left overs, from sari designs to fashions of tribal people, from origami air crafts to rocket science and the list may go on, is just a touch away.
Google is excellent,  a total savior, a fixer, a friend in need, a mind reader, and a teacher ....

With the advancement of the technology use of Internet has become an inseparable thing in human life and it has made the most simplest daily chores easier by leaps and bounds. People use internet for Everything and this is true when they fall ill as well.

Back in the days when someone fell ill it was either self medication, visit to the doctor and sometimes we may get the help of a friend. Now this " friend" is replaced with social media and google.

Being public about private life has become a fashion in social media and this is no exception when people are sick.

A Knight in Armour for the Damsel in Distress !!!!!!!!

Social Media is of help -

- It provides access to medical assistance or advice to millions of people who complain of their ailments in different groups where medical professionals provide advice.
- There are professional forums which provides support for Mental Health to people who are either embarrassed or not in a position to obtain a direct medical advice
- It provides a platform for Public Health Education where people are made aware of diseases, prevention strategies, novel discoveries in health care sector.
- It provides patient counselling on medications, indications, side effects and proper usage
- It is an excellent place for people to develop their own interests on Healthcare Sector.
- Further Social media can  be used to establish very basic healthcare practices very effectively among both young and old.

Ex - Proper use of contraceptive methods
     -  Importance of vaccination


So the social media is of immense help for mothers with sick kids, students with stress needing medical assistance and also for people who are interested in living healthy !

But all the people who go on giving Medical advice are they all professional?

The biggest problem with social media is the users tend to Trust.
This applies to healthcare as well. Giving wrong advice for the wrong patient by a wrong personnel can lead to various complications, serious adverse events such as hospitalization or even death.

The Social Media has only replaced your "friend" but Not your Doctor and the Healthcare team. It is fine to get advice but people should meet the doctor as well.

One of the worst cases of Social Media is people trying for Self Medication this ranges from Home remedies to Self prescribing Antibiotics!!!!

Similarly there are millions of cosmetic products, whitening creams, weight gain products, weight loss products and many borderline products being advertised and sold through Social Media. These should be regulated to ensure the quality safety and efficacy of these products.
Not everything in social media is reliable information and every person giving medical related information may not be a Health Care Professional (HCP). This leaves a huge responsibility on Policy Makers and HCPs in using and regulating what and what not to be posted and shared in Social Media and as well as to streamline who says what!!

So next time when you seek help in social media for your ailments or regarding your medication you can always check for the reliability of information and keep in mind its always best to meet a doctor when ill and meet a pharmacists to know about all the borderline products such as Ayurveda medication and cosmetics.

Social Media Cannot  Replace the Health Care Team !!!!!!!!!!!!!! 

Piumish (B.Pharm USJP)

If I pay Why not sell?

If I Pay Why not sell? 

"Health is Wealth" yet we fall ill, some very often and some rarely and some of us may be on life time medication for chronic diseases such as diabetes or high blood pressure. As I have seen there are different types of people when think of illness..

- Type I - People who rush to the nearest doctor as soon as they feel ill .... be it real or not they end up meeting their prescriber!!! 

- Type II -  Self Medication Type  Who try home remedies be it herbal preparations, OTC products or the medication they have previously used for the same kind of illness .. 

- Type III -  Who CALL their Doctor friend and get a list of medicines. 

Now all these Three types happen to end up in the pharmacy and will be treated very differently.  

How Pharamcist may react 

A - will provide medication

B - pharmacist will Refuse 

C - will give an OTC medication single dose depending on patients condition and refer to a medical officer  

If you go to your pharmacy with a legal prescription issued by 

            - Registered Medical Practitioner (RMP)

           -  Registered Dental Practitioner 

           -  Registered Veterinary Practitioner  

pharmacist will issue the drugs without trouble. 

In  Sri Lankan set up there are several laws governing the dispensing without prescriptions as well as pharmacists are bound to adhere with Good Pharmacy Practice as well. According to the law of Sri Lanka Pharmacist cannot prescribe medication for any ailment unless the patient is in a critical condition needing immediate medical assistance. 

According to the NMRA (National Medicine Regulatory Authority) of Sri Lanka there are 3 types of drugs in the pharmacy. 

Schedule I - Drugs which can be sold without a license. 

These are available in any good store not necessarily in a pharmacy. Paracetamol, herbal preparations, some Traditional medicines used for the common ailments such as herbal balms and creams. 

Schedule II - This is subdivided as Schedule II - A and Schedule II - B 

Schedule II A - These are Non Prescription drugs or OTC ( Over The Counter) medication.  OTC medicines are available to treat an expanding range of ailments. 

Ex -  Some analgesics, dermatologic products, anti-diarrheals, laxatives, antiemetics, antacids, anti-allergics etc  

Schedule II B - Drugs which can be sold only under prescription. 

Theses include All Antibiotics, anti diabetic medication anti hypertensives, anti psychotics and so on. 

   

Shedule III - These drugs are dispensed only with a prescription from a RMP. These are addictive drugs of abuse and should only be dispensed with a prescription not exceeding 3 days. 

Ex- Morphine , Diamorphine tablets. 

Now going back to type II and type III,  

 When you ask for a self prescribed medication which cannot be dispensed ( Schedule II B , III) without a legal prescription your pharmacist has every right to refuse giving you the medication.  

The list you got from your doctor friend isn't a Legal Prescription. 

  

He just sells. If I pay Why not sell? 

This is the attitude of patients who can't take NO for an answer. 

Why the Refusal????  

- it is illegal to sell prescription only drugs without a legal prescription - Ex  antibiotics 

- patient may be in need of medical assistance rather than self medication 

- self medication for symptomatic relief is not a good practice 

- there can always be allergies, interactions with other food and drug the patient may be taking so dispensing without a history can be harmful. 

- certain medications are contraindicated for special patients groups such as pregnant women and kids.  

- when the pharmacist is unaware of quality, safety and efficacy of certain products. 

 Now when you all go to the drug store with no prescription you are asking for something illegal and unethical to be done. 

Pharmacy is no ordinary store with business goals only. Pharmacists are bound with a code of ethic and laws from which they are restricted to sell anything and everything as and when they want and patients request.

"No " doesn't make him a bad, non supportive person with lack of customer care. It is natural to feel irritated and angry about your pharmacist in a situation as such when you happen to go to the drug store amidst the busy schedule only to be told that you cant get your medicines. Being human most of you will make a mental note to "avoid" the particular drug store for the rest of your lives owing to the refusal since you all don't have the slightest idea that the  pharmacist had been doing the righteous thing and had been concerned about your health more than a pharmacist who runs a business for profit motive only. 

Yes there are Pharmacists who will "Sell" anything and everything no matter what. 

Not All People are Ethical.....   

So next time when the pharmacist say NO just keep in mind he must be having a Good enough reason for that. 

Nobody will lose a Customer with No Good Reason !!!!!!!!!!!!!!!!!!!  

And instead of avoiding the "NO Pharmacy" avoid "Sell Pharmacy" for your own good. 

Generic Vs Brands

                                                             
                                           


 Generics Vs Brands  

We all might have visited the drug store at least once in our life time and ever wondered what are the  Brands and Generic of Drugs and did we even know such types of drugs exist? 

It is simple as this we all know Biscuits lets say Chocolate Biscuits!!! 
Well when you buy Chocolate biscuits from the store its exactly same to your Generics in the drug store. One more step forward you try buying X - Chocolate biscuits ( Given - X any brand of Biscuits you prefer). Now this is more or less your brands in medicines. Now what are the differences of the two types of biscuits? May be the Packing, Labeling, Quality as you feel it But most importantly the content and the taste will be the same. This is common to medicines as well but in contrast both generics and any type of brand of a particular medicine should comply with similar quality standards. 

Now to be very specific  

Generic drugs are copies of brand-name drugs that have exactly the same dosage, intended use, effects, side effects, route of administration, risks, safety, and strength as the original drug. In other words, their pharmacological effects are exactly the same as those of their brand-name counterparts. 

The most simplest example 

Paracetamol - Generic 
Panadol - Brand name 

The main advantage of using Generics over Brands is their comparatively low cost. Most patients are having in a wrong belief that generics are of low quality due to the lower prices but it is NOT...  and they also wonder if the quality and effectiveness have been compromised to make the less expensive products. 

High cost doesn't always imply High Quality!!!! 

Actually, generic drugs are only cheaper because the manufacturers have not had the expenses of developing and marketing a new drug. When a company brings a new drug onto the market, the firm has already spent substantial money on research, development, marketing and promotion of the drug. A patent is granted that gives the company that developed the drug an exclusive right to sell the drug as long as the patent is in effect. 

Also the packing and labeling in Generics and Brands vary and most probably the appearance of the tablet or the capsule. 

Another common disbelief is that generic drugs take longer to work. Both Generics and Brands should be manufactured under exact conditions and should be manufactures as per the regulations and are being tested for quality, safety and efficacy with no discrimination. So being less effective is not likely to happen if the quality control is done as per the guidelines. 

For the same drug there can be several brands and generics available in the pharmacy with a huge price deviation according to the manufacturer. 



So next time you go to your Pharmacist you have every right to ask for either Paracetamol or Panadol!!!!!!!!!!!! 


Reference - https://www.fda.gov/home

“When religion was strong and science weak, men mistook magic for medicine; now,when science is strong and religion weak, men mistake medicine for magic.” 

Industrial Pharmacists

Pharmacists - The drug designers

 Tablets, capsules, syrups, vaccines and all the dosage forms and drug delivery methods are not god made!!!

Each and every medicine both you and I have been using ever since we were born is the hard work and years of lab studies and clinical trials conducted by the healthcare professionals throughout the world.

Today the pharmaceutical industry has become one of the largest industries in the world.

Yes we all fall sick and even the kings need medicine!!

Also it is the second largest mafia in the world !!!!!!!!

  

Role of Pharmacist in pharmaceutical industry... 

• Research and development 

A drug reaching the pharmacy is a long and lengthy process which involves years and years of hard work and hours spent in laboratories and clinical trials.

From the process of finding an active pharmaceutical ingredients pharmacists are involved.

They may use the knowledge in pharmacology,toxicology, pharmaceutics, chemistry, physiology and even bio pharmaceutics in developing a sustainable dosage form. There are no miracles in this industry ....  

• Manufacture and quality assurance 

once the clinical trials are done with and drug is good go with production it is the pharmacists who see to the process. 

Drugs are being manufactured as per the pharmacopoeia standards (BP,USP, JP, IP ) and from the manufacturing to the quality control and quality assurance pharmacists are involved.

As of all industries this is also profit oriented and pharmacists face a huge challenge in meeting the best pharmaceutical standards with an affordable cost to the patients with best safety and quality.  

• Clinical trials and post-marketing surveillance

The pharmacist has the knowledge of drugs and health care provision required to facilitate collaboration between companies, health professionals and governments in relation to clinical trials and surveillance.

Drugs are under constant monitoring once introduced to the market and all side effects, adverse events, quality complaints and customer feedback are collected around the globe and pharmacist work day and night to deliver best dosage forms to the patients. 

• Sales and marketing

The pharmacist, whose professional ethics demand a concern for the interest of patients, can make a contribution to proper marketing practices related to health care and to the provision of appropriate information to health professionals and the public .

so the medicines you get from your druggist is not Gods work its the effort of millions of pharmacists and Health care professionals working across the globe to supply you with an appealing dosage form you prefer to swallow when you are really sick!

Cheers the Heroes Behind The Scene !!!!!!!!!!!!!!! 

Piumishh - Bpharm (USJ)