Gout vs Pseudogout :Risk Factors,Causes, and Symptoms


Gout is a common form of arthritis. It is also a painful condition that usually involving the joints. It is caused by high levels of uric acid in the blood. Uric acid is formed when the body breaks down purines. The purines can be found in the body and certain foods. When symptoms get worse, it is known as flares. When there are no symptoms, it is known as remissions.

Risk Factors

There are many risk factors for gout.Gout generally develops in men between age 30 to 45 and women age 55 to 70.

Increased Risk for Developing Gout:

  1. Obesity.
  2. High Blood Pressure.
  3. Injury or recent surgery.
  4. Fasting or overeating.
  5. Consuming an excessive amount of alcohol regularly.
  6. Diet high in meat, shellfish, and beverages sweetened with high-fructose corn syrup.
  7. Taking medications that can increase blood levels of uric acid.


Gout occurs when there is an excess of uric acid in the body. The body makes uric acid when it breaks down purines. Purines are found in the body and the foods we eat. Usually, uric acid crystals can build up in joints, fluids, and tissues within the body when there is an excess of uric acid in the body. Hyperuricemia does not always cause gout. In addition, hyperuricemia without gout symptoms does not need to be treated. The sharp, needle-like crystals cause gout. 


  1. Intense joint pain: can occur at any joint but usually affects the big toe.
  2. Inflammation and redness: joint is usually swollen, warm, and red.
  3. Limited movement: not able to move joint normally.
  4. Lingering discomfort: last from few days to a few weeks.

Symptoms develop quite rapidly. It can last for three to ten days. Usually, the symptoms and signs affect a single joint. Gout attacks are very painful. It can happen quite suddenly, often overnight. The pain is typically severe. So, it shows the severity of inflammation in the joint. The medical term for excessive fluid in a joint is a “joint effusion”.


  1. Nonsteroidal anti-inflammatory drugs (NSAIDs) – reduce swelling and pain. It is used as first-line treatment.
  2. Colchicine – people who cannot tolerate NSAIDs usually take  colchicine.
  3. Steroids (prednisone) – used in people who cannot take NSAIDs or colchicine. Prednisone is linked with an increased risk of a recurrent gout attack.


Pseudogout also is a form of arthritis that causes sudden joint pain and swelling. It is caused by calcium pyrophosphate dihydrate crystals (CPPD). 

The sudden attacks of joint pain, swelling, and warmth can occur when you have pseudogout. It can last for days to weeks. It can affect the ankles, feet, shoulders, elbows, wrists, or hands but it mostly affects the knee.

Risk Factors

Besides older age, several other factors also increase the risk for developing pseudogout :

  • Joint trauma due to injury or surgery.
  • Genetics: some people tend to develop pseudogout and more likely to have symptoms at an earlier age.
  • Excess iron: people with a genetic disorder that causes the body to store excess iron.
  • Other disorders: some disorders that affect metabolism or endocrine glands are likely to develop pseudogout.


Pseudogout occurs when calcium pyrophosphate crystals form in the synovial fluid in the joints. Crystals can also deposit in the cartilage and can cause damage. The formation of crystal in the joint fluid results in swollen joints and acute pain. Older people have higher possibilities of getting pseudogout compared to younger people. In addition, the genetic condition can cause pseudogout because it always occurs in families.

In addition, other factors may include :

  • Low activity of the thyroid gland.
  • Parathyroid glands create too much parathyroid hormone.
  • Excess iron in the blood.
  • High calcium levels in the blood.
  • Lack of magnesium.


Pseudogout most often affects the knees. In addition, it also affects the ankles, wrists, and elbows.

General symptoms may include:

  1. Bouts of joint pain
  2. Swelling of the affected joint
  3. Fluid build up around the joint
  4. Chronic inflammation


Until now, no treatment can completely remove or prevent the formation of calcium pyrophosphate dehydrate crystals. Therefore, treatment is generally focused on reducing pain and swelling.

  • Joint injection: insert a needle into the affected joint and take off the fluid. So, the crystals, pressure, and pain will be relieved. Injection of a steroid into the joint can decrease the amount of inflammation present.
  • Oral medications such as NSAIDs, prednisone, and colchicine can decrease inflammation and pain.
  • Joint immobilization: avoid lifting heavy objects if it involve the legs.


Nur Ayuni Mohd Ruduan

Nur Ayuni Mohd Ruduan

Nur Ayuni Mohd Ruduan, Bachelor of Science (Hons) Pharmacology, is staff officer of Mayflax, one of the nation’s leading healthcare and marketing company.

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Osteoporosis in women increase risk of Parkinson’s disease

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Osteoporosis in women increase risk of Parkinson's disease

senior women with osteoporosis picture

According to a recent study, a women that suffered osteoporosis are more likely to develop Parkinson’s disease (PD).

Estrogen plays an important role to maintain bone strength. Therefore,  women that has menopause their levels of  estrogen will decrease. Hence, the rate of bone loss increases for approximately 8 to 10 years before returning to premenopausal rates. Its may lead to this disease.

“Risk of patients with early-stage PD can reduce the bone-mineral density levels and osteoporosis and PD always linked together (co-occur),” the authors said.

Taiwan’s National Health Insurance Research Database is using retrospective cohort study to test this hypothesis. In the osteoporosis group, between 2002 and 2006 the investigator enrolled 23,495 patients with osteoporosis aged 50 to 80 years and approximately 23,495 patients without osteoporosis in the comparison group.

Age, sex, comorbid conditions, and socioeconomic status is included in this study. It will be use to rate the tendency scores.

Furthermore, about 31% in the osteoporosis group is likely to develop PD than the comparison group. Thus, patients with osteoporosis is significantly having lower PD-free survival rate compare to the comparison group (p<0.001).

In a gender-based analysis, women with osteoporosis is facing higher risk of developing Parkinson’s disease than men.

According to the author, “patients with osteoporosis is at high risk of developing Parkinson’s disease, and the risk appears to be greater in women.”

However, further research need to investigate the mechanisms underlying findings.


Obesity and Overweight Can Affect Health Problems

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Obesity and Overweight Can Affect Health Problems

Obesity is a medical condition that occurs when a person carries excess weight that might affect their health!

What are obesity and overweight?

Obesity and overweight are defined as abnormal so, excessive fat accumulation that may impair health.

Furthermore, when people eat more calories than usual over and over again, so their bodies will store the extra calories. For instance, fat may build up in their bodies.

Eventually, fat can harm the health of a person. In addition, The term “overweight” or “obese” actually has a higher chance of developing weight-related health problems. It can lead to other diseases like high blood pressure, high cholesterol, type 2 diabetes, heart disease, and sleep apnea. However, weight can come from muscle, bone, fat, or body water.

Above all, these diseases give a bad impact to our body. For instance, people with severe obesity are more likely to have other diseases.

Facts about overweight and obesity

The global WHO estimates, in 2016, therefore, more than 1.9 billion adults above 18 years and older were  overweight in and more than 650 million adults are obese.

Eventually a large number of the world’s population lives in countries where overweight so, their death number of obesity is however more than underweight people.

Body Mass Index (BMI)

Body mass index (BMI) is a simple index of weight-for-height. Therefore, It is used to define whether an individual is considered underweight, healthy, overweight and obesity. In addition, often all doctors use BMI to check patient weight at all routine check-ups.

BMIWeight status
Below 18.5 Underweight
30.0 and aboveObese

Health problems of being overweight and obesity

Obesity is when your body weight is abnormal. Therefore, it can lead to other diseases like high blood pressure, high cholesterol, type 2 diabetes, heart disease, sleep apnea, and many more. In other words, these diseases may affect a poor quality of life, disability, or life threatening.

1. Hypertension

Obesity is the one that cause of high blood pressure. But, also known as hypertension. For instance, about three out of four patients with high blood pressure are obesity. Similarly, high blood pressure increases the risk of other conditions such as heart disease like congestive heart failure (CHF) in addition, so it can also cause stroke, and kidney disease.

2. Respiratory Disorders

Obesity and overweight are at higher risk for lung infections, asthma, and other respiratory disorders. In addition, people with obesity, around 50% to 60% therefore, have obstructive sleep apnea (OSA). Because, obstructive sleep apnea (OSA) is a very serious breathing disorder and it block air passageways during sleep. Above all, this blockage causes you to stop breathing for a while.

Mostly, it may attack during your sleep at the night. However, it reduced the amount of oxygen in blood. Because, obstructive sleep apnea can cause sudden cardiac death and stroke because apnea will disrupt the normal sleep cycle, and may cause restless sleep. In addition, fatigue and drowsiness occured.

3. Heart Disease

Heart attack is a higher risk with people that have severe obesity. For instance, it increases the risk of heart failure. However, obesity in addition can associated with arrhythmias that is irregular heartbeats.

4. Diabetes

Obesity is a major cause of Type 2 diabetes. Similarly, when blood sugar is too high in your body and difficult to control, because of high blood sugar. So, type 2 diabetes can risk to death.

There can lead to:

  • Amputations (loss of limbs)
  • Heart disease
  • Stroke
  • Blindness
  • Kidney disease
  • High blood pressure
  • Nerve damage and numbness
  • Hard-to-heal infections
  • Impotence

5. Gastroesophageal Reflux Disease (GERD)

Obesity has been associated with higher risk of GERD. In addition, Gastroesophageal Reflux Disease (GERD), and heartburn, because of stomach acid or intestinal secretions lead to oesophagus damage. In other words, heartburn, indigestion, vomiting, coughing especially at night, hoarseness, and belching is the common symptoms.

6. Bone and Joint Damage

Above all, bone and joint damage may affected if you are obesity. However, it can increase the risk of personal injury and accidents. In addition,  joint diseases (arthritis), disc herniation, spinal disorders,  back pain, pseudotumor cerebri, a condition that increase the pressure in the brain and associated with confusion similarly disorientation, headache, and visual problems might occur.


As body mass index (BMI) increases, so the risk of cancer and death from cancer might be increased.

These cancers include:

  • Endometrial cancer

  • Cervical cancer

  • Ovarian cancer

  • Postmenopausal breast cancer

  • Colorectal cancer

  • Esophageal cancer

  • Pancreatic cancer

  • Gallbladder cancer

  • Liver cancer

  • Kidney cancer

  • Thyroid cancer

  • Prostate cancer
  • Non-Hodgkin’s lymphoma
  • Multiple myeloma
  • Leukemia

Above all, for people with severe obesity, the percentage of death increases for all types of cancer. So, the death rate is men is 52% and for women is 62% higher.

Other Conditions

Kidney Disease: High blood pressure, Type 2 diabetes and congestive heart failure are major causes of kidney disease and kidney failure. In addition, these conditions are even worse with people that have obesity.

Liver Disease: Obesity is the major cause for fatty liver. For instance, most people with severe obesity have fatty liver disease so, It can cause scarring at the liver, resulting in liver damage. In addition, can lead to cirrhosis.

Other conditions that could become life-threatening:  Therefore, pregnancy women that diagnosed with obesity will increases the chance of having a miscarriage, gallbladder disease, pancreatitis, and others.

What causes it?

The following picture shows causes of obesity.

Causes of obesity

How can overweight and obesity be reduced?

However, overweight and obesity as well as unrelated diseases associated with it, are largely preventable.

People can reduced by:

  • Limit the energy intake of total fats and sugars.
  • Increase diet fruit and vegetables, legumes, whole grains and nuts.
  • Do regular physical activity everyday, In other words, at least 1 hour a day for children and 2 hours a week for adults.
  • Limit screen time.
  • Get enough good quality sleep. Because, it can  increase your productivity to burn fats.
Picture of obesity prevention

Benefits of being healthy weight

In addition, to reducing the risk of health conditions and maintain a healthy weight provides other benefits:


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Raihan Ridzuan

Raihan Ridzuan, Bachelor of Science (Hons) Pharmacology, is staff officer of Mayflax, one of the nation’s leading healthcare and marketing company.


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High Cholesterol : Types, Tests, Risk, Prevention, Treatments.

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High Cholesterol :Types, Tests, Risk, Prevention, Treatments

Picture of level cholesterol

What is cholesterol?

Cholesterol actually is good for health. Our body needs cholesterol to perform and supports the normal function of cell membranes, hormone levels, and others. Moreover, if cholesterol level in your blood increased can lead to hyperlipidemia, hypercholesterolemia, or high blood cholesterol. 

Besides, if the human body having more cholesterol in the blood, it will build up inside the walls of blood vessels. This buildup is called plaque, or atherosclerosisPlaque will blocks the blood flow and cause a:

Cholesterol can be either good or bad. Furthermore, cholesterol is an oil-based substance. It does not mix with the blood, which is water-based and travels around the body in lipoproteins.

Moreover, cholesterol can be found in egg yolks, meat, and cheese and others.

Types of cholesterol

There are three types of cholesterol:

  • Low-density lipoproteins (LDL): Also known as “bad” cholesterol. High levels of LDL cholesterol may risk of heart disease and stroke.
  • High-density lipoproteins (HDL): Also known as “good” cholesterol, it carries cholesterol back to the liver. Then, the liver flushes it from the body. High levels of HDL cholesterol can lower the risk of heart disease and stroke.
  • Very-low-density lipoproteins (VLDL) are particles in the blood that carry triglycerides. VLDL stands for very low-density lipoprotein.  VLDL also called as “bad” cholesterol because it buildup of plaque in arteries. However, VLDL and LDL are different which is VLDL carries triglycerides and LDL carries cholesterol.

Levels and ranges

Therefore, cholesterol is measured in milligrams per deciliter (mg/dL). The target range for cholesterol levels are (Centers for Disease Control and Prevention [CDC], 2020):

Lipid Profile Normal Range
Total cholesterol< 200 mg/dL
LDL (“bad”) cholesterol < 100 mg/dL
HDL (“good”) cholesterol≥ 60 mg/dL
Triglycerides< 150 mg/dL

Test to measures cholesterol

Cholesterol levels must measured at least once every five years, possibly as early as age 20 years.

Furthermore, high cholesterol usually has no signs or symptoms. You may also not know you are having a bad cholesterol levels in your body until sudden heart attack or stroke happen. So, it so important to check your cholesterol levels at least every 5 years.

The cholesterol screening, requires a blood sample. Therefore, before do cholesterol test, need to fasting for about 8 to 12 hours. Usually people will fast at night and do the test on the next morning.

The cholesterol test checks the levels of:

  • Low-density lipoprotein (LDL). 
  • High-density lipoprotein (HDL). 
  • Triglycerides is a type of fat in your blood that your body uses for energy. The combination of high levels of triglycerides with low HDL cholesterol or high LDL cholesterol levels can increase your risk for heart attack and stroke.
  • Total cholesterol is the total amount of cholesterol in the blood based on your HDL, LDL, and triglycerides numbers.

What risk factors affect cholesterol levels?

Risk factors that may raise your high cholesterol:

Age:  When get older, the cholesterol levels may rise. However, young people, such as children and teenagers also tend to have high cholesterol.

Heredity: High blood cholesterol can run in families.

Weight: Being overweight or obese also increases your cholesterol level.

Race: Some races may have an increased risk of high cholesterol. For instance, African Americans have higher HDL and LDL cholesterol levels than whites.

Diet: Saturated fat, trans fat in the food, will increase cholesterol levels. Saturated fats can make your cholesterol numbers higher, so better choose  diet that are lower in saturated fats. For instance,  red meat, butter, and cheese, have a lot of saturated fats.


Avoid tobacco: Stop smoking. Frankly, it may reduce the number of good cholesterol in your body.

Diet: Reduce the number of trans fats and saturated fat. Eat heart-healthy foods like fruits, vegetables, poultry, fish, and whole grains.  Limit red meat, sugary products, and dairy products made with whole milk.

Harvard Health has identified 11 cholesterol-lowering foods that can lower cholesterol levels:

  • oats
  • barley and whole grains
  • beans
  • eggplant and okra
  • nuts
  • vegetable oil like canola and sunflower
  • fruits such as apples, grapes, strawberries, and citrus
  • soy and soy-based foods
  • fatty fish like salmon, tuna, and sardines
  • foods rich in fiber

Exercise regularly: Try to exercise about 30 minutes per day, 3 times a week.

Lose weight: Hence, losing about 10% of your body weight can make a difference in your cholesterol levels. Get advice from your healthcare provider about the safe ways to lose weight.

Avoid negative emotions: Learn how to deal with anger, stress, and other negative emotions in your life even though is hard.

Control blood sugar and blood pressure: Make sure to follow your healthcare provider’s guidelines for blood sugar levels, especially if you have diabetes, to keep your blood pressure healthy.



There are ways to treat high cholesterol:-

Lipid-lowering therapy

Drug treatment for people with high cholesterol depends on their level of cholesterol and other risk factors.

Healthcare practitioners usually will advise to start with diet and exercise first, but people with a higher risk of a heart attack may need to take statins or other medications to treat their disease.

Statins are the leading group of cholesterol-lowering drugs. The statins available on prescription in Malaysia include:

  • Atorvastatin (Lipitor®).
  • Fluvastatin (Lescol®).
  • Lovastatin (Mevacor®).
  • Pravastatin (Pravachol®).
  • Rosuvastatin (Crestor®).
  • Simvastatin (Zocor®).

Statin medications are one of the most well-known categories of cholesterol drugs. Thus, statin work by reducing the amount of cholesterol produced by the liver. Furthermore, statins work to decrease blood cholesterol and may help reduce the risk of heart attacks and stroke.

Other drugs:-

Apart from statins, a doctor may prescribe:

1. Selective cholesterol absorption inhibitors

2. Niacin is a B vitamin that affects the production of fats in the liver.

3. Bile acid sequestrants are another class of drugs used to treat high cholesterol levels. Drugs, also called resins, are attached to bile acid, which cannot be used for digestion. In response, the liver makes more bile by using more cholesterol. These drugs shall include:

  • Cholestyramine (Questran®, Questran® Light).
  • Colestipol (Colestid®).
  • ColesevelamHcl (WelChol®).

4. Fibrates are also called as fibric acid derivatives. They are more effective at reducing triglyceride levels than LDL cholesterol. It  also helps to boost the levels of HDL cholesterol. These drugs include:

  • Fenofibrate (Antara®, Tricor®, Fenoglide®, Fibricor®, Lipidil®, Lipofen®, Trilipix® and Triglide®)
  • Gemfibrozil (Lopid®)

5. Omega-3 fatty acid medications derived from fish oils work to lower high triglyceride levels.

Apart from a healthy lifestyle, some medication helps to reduce the cholesterol level in our bodies. At mayflax, we provide pharmaceutical products to the customer. Cholesterol medication is also available like Crestor® and other drug brands. If you want to deal with us, you can contact us or sign up here for more info.


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Raihan Ridzuan

Raihan Ridzuan, Bachelor of Science (Hons) Pharmacology, is staff officer of Mayflax, one of the nation’s leading healthcare and marketing company.


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Factors That Affect Blood Pressure

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     High blood pressure is also known as hypertension. It is abnormally high blood pressure in the arteries, which are the blood vessels that carries blood from the heart to the whole body.

     In about 95 percent of cases, the cause of hypertension is unknown and affects many individuals who do not know they have the condition. These cases are classified as essential hypertension. However, high blood pressure is the main risk factor for heart disease, stroke, kidney failure, and eye problems. When blood pressure level is increased, the heart and arteries have to work harder than normal to pump blood through the body. Thus, overload may lead to thickens the muscles of the heart and arteries or damages artery walls.

     As a result, damage to the heart caused by the extra work and a lack of oxygen causes heart disease.  When blood pressure is high, the artery and blood vessel walls may be damaged over time. This leads to dangerous complications and life-threatening.

   Besides, many factors such as genes, kidney disease, some medications, and lifestyle can affect blood pressure. Lifestyle factors play a key role in balancing our blood pressure.

However, there are some known key factors that increase your risk:

1. Age

Age is one of the factors that contribute to high blood pressure. Our arteries are stiffening with age. Sixty percent of people above 60 years of age likely to have high blood pressure.

2. Exercise

Physical activity elevated the cardiac output and therefore the blood pressure. The recommended, resting after exercises is about 20 to 30 minutes for the following exercise to reduce it. 

3. Stress

Stress will stimulate the sympathetic nervous system which increases the cardiac output and vasoconstriction of the arterioles, thus, increasing the blood pressure reading.

4. Sex

Usually, after puberty, females have a lower blood pressure than males of the same age.

These differences are thought to be caused by hormonal variation. Women in general after menopause have a high blood pressure than in the past.

5. Medication

When, medications or drug that alter one or more of the previous prescription it can be one of the factors that changed blood pressure, including caffeine, diuretics that reduce blood volume, narcotics, analgesia and specific antihypertensive agents.

6. Obesity

Hypertension may be predisposed to childhood and adult obesity. Also, obesity increases the risk of developing high blood pressure by 6% over the next four years. The greatest risk is extra body fat.

7. Inheritance

Hypertension tends to occur in families. You are at higher risk of having high blood pressure if you have a close relative. In some families, genetics are strong for both parents who have high blood pressure. However, the inheritance pattern is unknown.

8. Drinking Alcohol

Researchers have concluded that there is a strong link between binge drinking alcohol and high blood pressure. Regular heavy or binge drinking can also cause significant increases in blood pressure, sometimes extreme enough to cause a stroke. However, alcohol may also have an impact on the efficacy of blood pressure-lowering drugs.

9. Smoking

Whether you smoke or people close to you do, the effects can be damage to the heart. Your heart will not work properly as before. Moreover, smoking causes your blood vessels to shrink which making your heart work even harder.

10. Too much salt

Salt, or sodium chloride, has been used to flavor and preserve foods for thousands of years and is also found in a wide variety of foods.

When sodium increases in our blood, the blood vessels will retain water and try to balance the sodium concentration. As a result, this extra water increases the volume of blood in vessels that cause high blood pressure.

Taking too much salt can cause high blood pressure. The maximum recommended intake of salt is less than 6 grams per day.

Tips to help improve blood pressure

Figure 1. Tips to improve blood pressure.

  • Reduce salt intake
  • Consume a balanced diet

  • Maintain a healthy body weight

  • Be physically active

  • Limit alcohol intake

  • Don’t smoke

What Is the Blood Pressure Range?

A blood pressure reading is 120/80. The top number “120” is called the systolic, and bottom number “80”  is called the diastolic. The ranges are:

  • Normal: Less than 120 over 80 (120/80)
  • Elevated: 120-129/less than 80
  • Stage 1 high blood pressure: 130-139/80-89
  • Stage 2 high blood pressure: 140 and above/90 and above
  • Hypertension crisis: higher than 180/higher than 120  

Steps to measuring blood pressure

Picture of steps checking BP

Figure 2. Steps to measuring blood pressure

In summary, hypertension is one of the main risk factors for the development of heart disease and stroke. Our blood pressure is influenced by several factors. So, we need to stop smoking, stay active, eat balance diet and limit the intakes of salt and alcohol to reduce the risk of high blood pressure. Not just all that, medication also important to treat who are diagnosed with this disease.

At mayflax, we provide pharmaceutical products to a clinic and hospital. We also serve hypertension medications. Thus, by dealing with us, you will be able to enjoy a large selection of pharmaceutical products at affordable prices.

If you want to know more about us, you can contact us or sign up here.

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Raihan Ridzuan

Raihan Ridzuan, Bachelor of Science (Hons) Pharmacology, is staff officer of Mayflax, one of the nation’s leading healthcare and marketing company.

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Improper Inhaler Technique: Affect Asthma Control

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Improper Inhaler Technique: Affect Asthma Control

Healthcare professionals can support patients in optimizing their technique by examining the effects of the sub-optimal inhaler.

Inhalers used to treat asthma and chronic obstructive pulmonary disease (COPD). Thus, inhalation techniques play a major role in improving drug adherence.

About 92% people with asthma use their device incorrectly. Improper inhaler have been reported in children and adults, including experienced inhaler users

Moreover, improper inhaler technique can prevent drugs from reaching to lungs. It can be effective if the patient used in correct ways. Good inhalation techniques are very important to maximize the benefits of these drugs.

Hence, the correct technique depends on what type of inhaler. Some inhaler steps differ according to the type  of inhaler.

Besides, healthcare professionals must be proficient in how to use correctly of each inhaler device and need to be aware of common mistakes so they can confidently demonstrate in front of patients.

However, you can purchase the inhaler with doctor’s prescription at any pharmacy, and healthcare professional can buy from any pharmaceutical company such as Mayflax.

Types of Asthma Devices

    Common inhaler are used to deliver asthma and chronic obstructive pulmonary disease (COPD) medications which are metered dose inhalers (MDIs), dry powder inhalers (DPIs), and soft mist inhalers (SMIs).

Meanwhile, each type of inhaler has advantages and disadvantages. Below,  the various types and technique of inhaler medical device :-

1. Pressurised metered dose inhaler (PMDI)


  • Drug is stored under pressure in the metal canister
  • A fine mist of medication is released upon pressing the canister that can be inhaled into the lungs
  • Works well with a valved holding chamber (VHC) or spacer.

How to use?

  1. First, need to remove cap.
  2. Second, hold inhaler upright and shake well.
  3. Third, breathe out gently and away from inhaler.
  4. Fourth, put mouthpiece between teeth without bite and close lips to form a good seal.
  5. Start to breathe in slowly and deeply. At the same time, press the inhaler device.
  6. Hence, hold breath for 5 to 10 seconds.
  7. While holding breath, remove inhaler from mouth.
  8. Breathe out gently and away from the inhaler.
  9. Repeat dose if needed and replace cap.
  10. Lastly, clean device if necessary after use.
Picture of metered dose inhaler

Available Brand in Malaysia

  • Ventolin® MDI (Salbutamol)
  • Flixotide MDI (Fluticasone)
  • Flutiform® MDI (Fluticasone/Formoterol)
  • Foster®  MDI (Beclometasone/Formoterol)
  • Alvesco® MDI (Ciclesonide)

2. Tuberhaler


  • Dry powder inhaler (DPI)
  • No coordination required
  • Device dispenses a small amount of very fine powder directly into the lungs
  • Comes with a dose indicator

How to use?

  1. First, need to unscrew and remove cover.
  2. Second, check dose counter.
  3. Third,  keep inhaler upright while twisting grip at the base.
  4. Twist around and then back until click is heard.
  5. Then, breathe out gently, and away from the inhaler.
  6. Fourth, put mouthpiece between teeth without bite and close lips to form good seal
  7. Do not cover the air vents.
  8. Breathe in strongly and deeply.
  9. Fifth, hold breath about 5 to 10 seconds.
  10. Hence, remove the device before breathing out fully.
  11. If more than one dose is needed, repeat all steps starting from step 3.
  12. Lastly, replace cover and clean the device if necessary.
PIcture of taking tuberhaler

Available Brand in Malaysia

  • Symbicort® Turbuhaler (Budesonide/Formoterol)
  • Pulmicort® Turbuhaler (Budesonide)
  • Bricanyl® Turbuhaler (Terbutaline)

3. Respimat soft mist inhaler


  • Dispenses fine and easy to inhale droplets directly deep into the lungs.
  • Requires very less effort during inhalation
  • Comes with a dose indicator

 How to use?

  1. Hold inhaler upright with the cap closed.
  2. Then, turn base in direction of arrows on label until it clicks. Half a turn.
  3. Open the cap until it snaps fully open.
  4. Breathe out gently, and away from inhaler.
  5. Moreover, put mouthpiece in mouth and close lips to form a good seal.
  6. After that, start to breathe in slowly and deeply through mouth;
  7. And at the same time, press down on the dose button.
  8. Continue to breathe in slowly and deeply.
  9. Hold breath for 5 to 10 seconds.
  10. While holding breath, remove inhaler from mouth.
  11. Breathe out gently, away from mouthpiece.
  12. Close cover to click shut.
  13.  If you need two doses, repeat from step 1 to get the full dose.
Picture of taking Respimat soft mist inhaler

Available Brand in Malaysia

  • Spriva Respimat® (Tiotropium)

4. Accuhaler


  • Dry powder inhaler (DPI)
  • No coordination required
  • Device dispenses a small amount of very fine powder directly into the lungs
  • Comes with a dose indicator

How to use?

  1. Check dose counter.
  2. Open cover using thumb grip.
  3. Load dose.
  4. Keep device horizontal or upright while sliding lever until it clicks and do not shake.
  5. Then, breathe out gently but not into device.
  6. Put mouthpiece in mouth, without biting and close lips to form a good seal. 
  7. Breathe in quickly and deeply.
  8. After that, hold breath for a count of ten.
  9. While holding breath, remove inhaler from mouth.
  10. Slowly breathe out.
  11. If more than one dose is needed, repeat all steps starting from step 3.
  12. Close cover to click shut.
  13. Clean device if necessary after use.
Picture of Accuhaler

Available Brand in Malaysia

  • Seretide® Accuhaler (Salmeterol/Fluticasone)

5. Ellipta


  • Medication is stored under pressure in the metal canister
  • A fine mist of medication is released upon pressing the canister that can be inhaled into the lungs
  • Works well with a valved holding chamber (VHC) or spacer.

How to use?

  1. First, check dose counter and do not shake.
  2. Second, slide cover down until click is heard.
  3. Third, breathe out away from inhaler.
  4. Fourth, put mouthpiece in mouth and close lips to form a good seal;
  5. And do not block air vent with fingers.
  6. Then, breathe in steadily and deeply.
  7. Fifth, hold breath about 5 to 10 seconds.
  8. While holding breath, remove inhaler from mouth.
  9. After that, breathe out gently, and away from inhaler.
  10. Slide the cover upwards as far as it will go, to cover the mouthpiece.
  11. Lastly, rinse your mouth with water and spit it out for a steroid-containing inhaler.

Available Brand in Malaysia

  • Ventolin® MDI (Salbutamol)
  • Flixotide MDI (Fluticasone)
  • Flutiform® MDI (Fluticasone/Formoterol)
  • Foster®  MDI (Beclometasone/Formoterol)
  • Alvesco® MDI (Ciclesonide)
Picture of taking ellipta

Common Errors with Inhaler Technique

  • Not breathing with the proper way.
  • Breathing in too early and too late when pressing the inhaler canister.
  • Forget to shake the inhaler before use.
  • Not waiting for the next puff. Some inhalers, need to wait at least 30 to 60 seconds before taking the next puff.
  • Hence, not breathing out before using the inhaler and does not have  a tight lip seal.
  • Not lifting your chin slightly before breathing in. 
  • Furthermore, not holding your breath after taking the inhaler;
  • As well as, not using a spacer when needed.

Guidance of How To Use Your Asthma Devices?

This video shown how to use different types of inhalers. 

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Author picture.Mayflax

Raihan Ridzuan

Raihan Ridzuan, Bachelor of Science (Hons) Pharmacology, is staff officer of Mayflax, one of the nation’s leading healthcare and marketing company.


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COVID-19: Can vitamin C help boost your immune system?


COVID-19: Can vitamin C help boost your immune system?


Coronavirus disease 2019 (COVID-19) is an infectious disease caused by Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2). It happened in December 2019 in Wuhan, China, and spread globally, resulting in an ongoing pandemic.

The COVID-19 pandemic was confirmed as a global pandemic by the World Health Organization.

Thus, it continued to spread and a vaccine is urgent for immunization and a cure. Meanwhile, waiting for the production of vaccine done, taking precautions action is considered the best approach.

This disease is asymptomatic and the severity of covid-19 may lead to severe respiratory tract infections and become deadly.

Furthermore, according to the Centers for Disease Control and Prevention (CDC), these factors related to immunity such as age and underlying conditions determine the risk of infection.

Therefore, individuals who are at higher risk of having covid-19 complications is a person that having a pre-existing illness like type 2 diabetes, liver disease, hypertension, cardiovascular disease, and respiratory issues.

It also increases with age as the general immunity reduces when you getting older.

Besides, immune factors play a major role to protect our bodies, with this variety factor which indicates the influence the severity of the disease.

Does Vitamin C help boost your immunity and keep you from COVID-19-free?

Not exactly!  It strengthens your immune system, but there is no concrete evidence that it can treat or prevent the disease caused by a SARS-CoV-2 infection. However, our body still needs vitamins to boost the immune system

Similarly, no evidence said that vitamin C supplements can help to prevent COVID-19, “Dr. William Schaffner, a professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center in Tennessee, told New York Times Parenting”.

“If there’s going to be an advantage, it’s going to be very modest,” Schaffner said.

Picture of Vitamin C

Vitamin C

Vitamin C, also known as ascorbic acid, is a water-soluble vitamin that has immune-boosting micronutrients and it is relatively easy to get such as can be found in a variety of fruits and vegetables.

Hence, low vitamin C levels are also resulting in many health problems such as poor immunity, bleeding gums, and tooth loss.

Since your body cannot produce vitamin C, it’s important to include essential nutrients in your daily diet.

Humans cannot produce vitamin C on their own, because they don’t have the specific enzyme needed. Hence, we need to get it from an exogenous source which is food that includes essential nutrients in daily diet.

In addition, vitamin C plays a role in maintaining the immune system comprehensively through its antioxidant ability to protects against damage induced by oxidative stress, collagen synthesis, or directly strengthens immune cells in the fight against infection.

 It also helps prevent the common cold.

However, you can purchase the vitamin C supplement at the pharmaceutical wholesaler if you want in a bulk quantity such as mayflax

How much your body need Vitamin C per day?

The recommended daily dosage of vitamin C follow by age and gender. As per the National Institutes of Health, the Recommended Dietary Allowances (RDAs) for vitamin C are as follows:

0–6 months40 mg40 mg
7–12 months50 mg50 mg
1–3 years15 mg15 mg
4–8 years25 mg25 mg
9–13 years45 mg45 mg
14–18 years75 mg65 mg80 mg115 mg
19+ years90 mg75 mg85 mg120 mg

Note: Individuals who smoke need more doses than non-smokers needed, which is add 35 mg per day.

Here, have five clinical stages of coronavirus disease 2019 (COVID-19) :

Table of Stages Covid-19

Figure 1: Covid-19 treatment stratification in a Malaysian public hospital setting.

Can we consume vitamin C too much ?

Vitamin C is water-soluble, meaning it absorbs and passes through your body faster. Besides that, vitamin C is eliminated when you urinate.

Taking more than 2000 milligrams per day of vitamin C can lead to unpleasant side effects such as:-

  • Stomach pain
  • Nausea
  • Diarrhoea
  • Vomiting
  • Heartburn
  • Headache
  • Insomnia

Other food sources that are high in Vitamin C

Foods rich in vitamin C include :-

  • Oranges and orange juice
  • Grapefruits
  • Strawberries
  • Kiwis
  • Broccoli
  • Brussels sprouts
  • Spinach
  • Kale
  • Red and green peppers
  • Potatoes

Immune booster to maintain body health

 There are 6 immune boosters to help you to maintain a healthy body other than vitamin C :-

Vitamin A (Beta Carotene): This vitamin helps the health of your intestines and respiratory system. Foods rich in vitamin A include carrots, sweet potato, spinach, broccoli, and red bell peppers, egg yolk, butter, milk, cheese, etc.

Picture of carrots

Vitamin E: Vitamin E can be a cancer prevention agent preventing cells from oxidative harm from free radicals. These nutrients also can neutralization of free radicals by working as an antioxidant such as vegetable oils, nuts, seeds, and avocado.

Picture of avocado

Zinc: There are many zinc-dependent enzymes in our body and their deficiency is associated with immune dysfunction. Zinc-rich foods such as beans, seeds, nuts, meat, poultry, some shellfish, legumes, whole grains, and fortified cereals.

Picture of shellfish

Selenium: Selenium is another body’s antioxidant system, that ensures the body against oxidative pressure. It a mineral that helps certain immune cells function at their best. For examples, seafood, meat, whole grains, dairy, fruits and vegetables.

Picture of whole grains

Probiotics: The function of probiotics to helps the gut to become a healthy gut because it is made up of good bacteria that help keep your body healthy and working well. Moreover, not only that, probiotics can contribute to immune function.

Picture of healthy gut

Protein: Specific amino acids can be found in protein. There are essential for T-cell function, which are cells that protect the body from pathogens. For instance, meats, poultry, seafood, eggs, beans, nuts, and all seeds which contain a lot of protein.

Picture of ham

These nutrients are proven to help your body’s immune system function most efficiently and effectively, but if you eat too much, it can be harmful.  Thus, eat these nutrients in moderation and do not overeat.

Can taking vitamin C help to prevent COVID-19?

Frankly, without a vaccine, it is important to find ways to prevent the spread of COVID-19. Again, there are many things about this virus that we still do not know because viruses keep changes through mutation, and new variants of a virus are expected to occur over time. Sometimes new variants emerge and disappear. 

Right now, vitamin C is one of the few vitamins that your body needs to do its best. Getting enough vitamins and nutrients in your diet can help in strengthening your immune system, which also can possibly help you prevent this virus.

There is nothing wrong with taking vitamin C as part of your COVID-19 prevention plan, but no evidence it is true! There is a lot of ongoing research with positive results on the use of vitamin C as a treatment.

However, there is not enough information and evidence to know for sure whether it is effective against COVID-19.

Ways to prevent COVID-19

Furthermore,  have other ways can help to prevent the covid-19 spread. Now, you can follow easy tips to add to your “new normal” as a daily routine :-

Diagram How to avoid covid
  1. Wash your hands for 20 seconds.
  2. Apply hand sanitizer
  3. Wear a mask
  4. Social Distance
  5. Stay at home
  6. Disinfect or sanitize all the things
  7. Try not to touch your face or mouth.

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Raihan Ridzuan

Raihan Ridzuan , Bachelor of Science (Hons) Pharmacology, is  staff officer of Mayflax , one of the nation’s leading healthcare and marketing company.


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Reducing risks of osteoporosis fractures in Crohn’s disease with impact and resistance training

Cr. John Arano

Source from MIMS.com

A recent study shows that combined impact and resistance training exercises helps raise bone mineral density (BMD) and muscle function, which benefits patients with Crohn’s disease (CD) who has a high risk in developing osteoporosis and related fractures.

Researchers selected adults with stable CD (n=47, mean age=49.3 years) and were assigned to undergo an exercise intervention (n=23) or receive usual care alone (n=24) for 6 months. Usual care plus a combined impact and resistance training programme were given to the exercise group while patients underwent three 60-minutes sessions per week, with a gradual tapering of supervision to self-management.

Most of the patients had quiescent disease and none of the patients smoked. 216 months median time since the CD diagnosis and according to baseline BMD measurements, 12 patients had evidence of osteopaenia or osteoporosis at the lumbar spine and 20 at the left hip. The most common medications used for CD were immunosuppressants and biologics; none were on corticosteroids.

The bone mineral density (BMD) values were better in the exercise vs the control group at 6 months, with the difference significant at lumbar spine, but not at femoral neck nor at greater trochanter.

Even though there were three exercise-related adverse events (for instance light-headedness and nausea) the intervention yielded improvements in all muscle function outcomes and fatigue severity.

The findings highlight the intervention as a suitable model of exercise for reducing the future risk of osteoporotic fractures and physical disability in this high‐risk population, according to researchers.

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TB antibiotics in reaching targets

Cr. Simone van der Koelen

Source from Sciencedaily.com

Researchers have built up another technique that empowers them to envision how well antibiotics against tuberculosis (TB) reach at their pathogenic targets inside human hosts. The discoveries, published in the journal Science, boost understanding of how antibiotics work and could help direct the development of new antibiotics, which are truly necessary in the fight against drug-resistance.

TB treatment

TB stays as one of the world’s deadliest infectious diseases, with over a million TB-related deaths worldwide every year.

At the point when an individual is infected with Mtb (mycobacteria), their immune system attempts to clear the microorganism by calling upon specialised immune cells called as macrophages that perceive and engulf Mtb. However, the bacteria frequently discover ways to survive and duplicate, causing illness. Patients require at least four antibiotics for at six months to defeat the disease.

It was previously unknown whether antibiotics enter all the compartments of the macrophage where the Mtb hide and duplicate.

The method pioneered in this study, which consolidates three kinds of imaging (correlated light, electron and nano-scale ion microscopy), permits researchers to picture the circulation of TB drugs in Mtb-infected human macrophages at high resolution, for the first time.

A test-case TB drug

Utilizing bedaquiline as an test-case, the group contaminated human macrophages with Mtb, and following up after two days, they treated them with the medication. Their imaging results revealed that bedaquiline accumulated in various compartments of the cell, most eminently, inside lipid droplets.

The bacteria can interact with and consume these lipid droplets. Be that as it may, the group (Crick-led team) didn’t know whether bedaquiline would be moved to the bacteria, or whether the lipid droplets were retaining the antibiotic and keeping it from arriving at the bacteria. Including a chemical that kept lipid droplets from forming significantly decreased the measure of bedaquiline in Mtb, proposing that the lipid drops are responsible for moving antibiotic to the bacteria.

“Now that we can see exactly where antibiotics go once they enter macrophages, we can build up a much clearer picture of how they reach their targets, and harness these observations to design more effective treatments in the future, not only for TB but for other infectious diseases too” says Max Gutierrez, Crick group leader and senior author of the paper.

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Diabetic ketoacidosis in children equals to hypertension

Cr. Rene Bernal

Source from MIMS.com

Study has found that for children with diabetic ketoacidosis (DKA), hypertension is a common phenomenon.

Researchers gathered 1,258 patients who had sufficient haemodynamic data for the present analysis while using data from the Paediatric Emergency Care Applied Research Network. Out of these, 12.2 percent had documented hypertension at presentation.

In under 2 hours, hypertension were resolved quickly in 36 children and for 118 episodes, hypertension lasted for 2 hours. During DKA treatment, the blood pressure was normal at baseline in 196 patients but progressed to hypertension during DKA treatment. Developed at any time during DKA, the resulting overall rate of hypertension was at 27.8 percent.

The median duration of  hypertension was 4.0 hours and at presentation, correlated with more severe acidosis and stage 2 or 3 acute kidney injury. On the contrary, at baseline, lower glucose levels or glucose-corrected sodium concentrations were associated with hypertension at presentation.

Lower scores on the Glasgow Coma Scale and more severe acidosis correlated with the development of hypertension at any point during DKA. Severe acidosis, stage 2 acute kidney injury, and younger patient age are also directly correlated with hypertension severity.

The researchers stated that a central mechanism may be involved in causing abnormal haemodynamic regulation with the development of hypertension during DKA treatment and the association of hypertension with altered mental status.

They also added that it is necessary to better understand relationships of regional cerebral blood flow abnormalities during DKA is necessary and how these relate to life-threatening cerebral injuries in some children.

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