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Official websites use. Share sensitive information only on official, secure websites. Mohamed elham. To treat anal fissure, internal anal sphincterotomy may be associated with surgical risks and incidence of incontinence. Botulinum toxin injection into the anal sphincter is invasive and expensive. Headache and hypotension hindered topical treatment with glyceryl trinitrate. Greater patient compliance, potentiated efficacy, reduced side effects, and lower cost are the major advantages offered by the combination therapy. Therefore, combination topical gels of nifedipine NIF , lidocaine hydrochloride LDH and betamethasone valerate BMV were prepared and evaluated regarding viscosity, pH, drug content, and in vitro release. Compatibility study of drug—drug and drug-excipient mixtures preceded the formulation. Stability study was performed. A prospective randomized clinical trial was conducted for six weeks to assess the efficacy of the optimized formula in the treatment of anal fissure either acute AAF, 37 patients or chronic CAF, 34 patients in comparison with three single drug market products. The gels showed acceptable viscosity ranges, tolerated pH values, and drugs content limits complying with the pharmacopeial limit. Keywords: Nifedipine, lidocaine hydrochloride, betamethasone valerate, anal fissure, combination topical therapy. Anal fissure is one of the most painful anal disorders that inversely affect the life quality of the patients. Internal anal sphincterotomy has been used to heal the anal fissures through lowering the resting anal pressure. Yet, surgical risks and late permanent incidence of incontinence are the main complications during the post-operative period Haq et al. Hence, alternative therapy regimens are necessary for the treatment of anal fissure. Chemical sphincterotomy has been induced by different agents including botulinum toxin, glyceryl trinitrate, and calcium channel blockers, such as diltiazem and nifedipine NIF Perrotti et al. Factors that limit the use of topical nitrates are infrequent with CCBs making them an attractive alternative therapy. The use of either oral or topical NIF significantly improved the healing rates in patients with anal fissures providing comparable efficacy Agrawal et al. Topical NIF at concentrations of 0. Fixed-dose combination drugs are formulations of two or more active ingredients in a single dose. Such combination is beneficial when the active ingredients are incorporated in the intended doses and in such way that the combination is safe and effective for a significant population of patients. Fixed combination therapy offers some advantages over concurrent administration of different single active ingredient preparations Shenfield Among these improved patient compliance, enhanced efficacy, reduced side effects, and lower cost. Fixed combination topical preparations containing a corticosteroid and a local anesthetic are extensively used to alleviate symptoms and improve the life quality of patients with inflammatory anal diseases. Local anesthetics provide immediate relief of pain and itching after application. Therefore, an additive or synergistic effect in the fixed combinations of corticosteroids and local anesthetics is obtained Havlickova According to the Anatomical Therapeutic Chemical classification system developed by the World Health Organization, betamethasone is classified as a potent corticosteroid Havlickova Subsequently, lidocaine has been commonly used in combination products with different corticosteroids including betamethasone 0. As well, combination products of NIF 0. In the light of the above-mentioned facts, it was worth to prepare, evaluate, and optimize a combination topical gel containing NIF, LDH, and betamethasone valerate BMV. In addition, a prospective randomized clinical trial was performed to investigate the efficacy of the optimized combination formula in the treatment of AAF and CAF. Nifedipine NIF was kindly supplied by E. O pharmaceutical Co. Other chemicals were of fine analytical grade. The mobile phase was filtered 0. Separation was carried out isocratically at a flow rate of 1. All assays were performed at ambient temperature. Serial dilutions were made to obtain concentration ranges of 8—80, 80—, and 1. The standard calibration curve of each drug was constructed by plotting its concentrations in the prepared solutions versus the corresponding peak areas recorded. Titanium dioxide has been employed as a photostabilizer Yang et al. Temperature calibration was performed using indium To prevent any loss of material, the glass rod was broken and left inside the vial. The controls were mixtures without added water and stored in refrigerator. To detect the physical instability, organoleptic parameters of samples, such as color and odor, were observed at the end of the test. To identify the chemical instability, each sample was divided into two parts at the end of the fourth week. Samples were analyzed quantitatively using the previously described HPLC method in triplicate. The second part was used to record FT-IR spectrum. The gel was carefully spread to give a layer as homogenous as possible with a suitable thickness. The first gel formulation F1 was prepared by dispersing CP 1. NIF 0. The pH was adjusted to 5. The supernatant was filtered through 0. PH measurement was accomplished using a calibrated digital pH meter Beckman Instruments Fullerton, CA , Krefeld, Germany in triplicate and the average values were calculated. The viscosity was estimated using a calibrated cone and plate rotary viscometer Haake Inc. Two grams of each formulation were equally spread on the cellophane membrane. The donor cells height was adjusted so that the membrane was just below the release medium surface. The cells were shaken at 25 strokes per min. One-milliliter samples were withdrawn from the receiver compartment at 0. The intercept and slope of the linear portion of the plots were derived by linear regression. The steady-state permeation flux J ss for each drug in each formula was calculated as the slope divided by the membrane surface area Das et al. In order to determine the release mechanism of drug, in vitro release data of each drug from the studied formulations were analyzed according to zero-order, first-order Martin et al. Percentage remaining of each drug in the tested optimized combination gel was plotted against time in days to determine its shelf life t 90 and half-life t 50 at each storage temperature using Sigma Plot 12 software Cranes Software International, Bangalore, India Hooda et al. The study was performed to evaluate the efficacy of the optimized topical combination gel of the investigated drugs in the treatment of acute and chronic anal fissures in comparison with three single drug topical market products. The market products were GTN cream that contains 0. Research Ethics Committee of Faculty of Pharmacy, Mansoura University, Egypt approved the study and the included informed consents of all patients. The patients were allocated into four groups: group A; with acute anal fissure AAF treated with the optimized topical combination gel F2 , group B; with AAF treated with the three single drug topical market preparations within 0. Exclusion criteria were: Presumed or confirmed pregnancy; lactating women; any history of reaction to topical agents and associated co-morbidity, such as ischemic heart disease, hypertension, diabetes mellitus, inflammatory bowel disease, HIV-related fissure, tuberculosis ulcer and leukemic ulcer; and associated complications warranting surgery abscess, fistula, hemorrhoids, and cancer as well as unwillingness of the patient to participate in the study Tsunoda et al. Anoscopy was performed at baseline and during the sixth week. Healing of anal fissure was defined at anoscopy when epithelialization or formation of a scar achieved at the sixth week of the therapy. Bleeding response, discharge, and pruritus: Patient scored the severity of their symptoms at baseline and weeks 1, 3, and 6, on numeral rating scales NRS range: 0—10 Tsunoda et al. Adverse effects of the medicines: such as itching, headache, and dizziness were recorded at every visit. The end-point of the study: it was complete healing of the fissure after treatment. Treatment was considered successful if the fissure had healed within 6-week treatment. With respect to the data of compatibility, drug release, and stability, statistical analysis was done through ANOVA one-way analysis of variance followed by Tukey—Kramer multiple comparisons test employing Graph Pad Prism-6 software Graph Pad Software Inc. Regarding the clinical study, the collected data were coded, processed, and analyzed. Mann—Whitney U test was used to compare the continuous data. Chi-square test was used to compare the categorical data of the studied groups. An excellent linearity was observed in a concentration range of 8—80, 80—, and 1. DSC thermograms of the three drugs individually, in their binary mixtures and ternary system as well as binary mixtures with each of the solid excipients are represented in Figure 1 a—e. While the larger shift in T peak of BMV can be referred to the partial dissolution of this drug in the molten mass of the other two drugs. Thus, disappearance of NIF and BMV endothermic peaks may be attributed to the dissolution in the molten excipient P, methylparaben, or propylparaben of much lower melting point Liu et al. Disappearance or shift of the drugs peaks did not confirm the incompatibility particularly there were no new peaks. FT-IR spectra of different blends of the three drugs and each of them with the excipients retained all characteristic bands of the drugs without appearance of new bands suggesting that these compounds are compatible data are not shown. As well, FT-IR spectra of stressed test samples were compared to those of corresponding control samples and only spectra that encountered changes are illustrated in Figure 1 f—h. Both individual drugs and drug—drug mixtures exhibited insignificant changes in percentage drug remained after being subjected to IST. These samples did not show any changes in the organoleptic parameters color and odor throughout the storage period. In accordance, FT-IR spectra of stressed drugs and drug—drug binary mixtures did not show a shift or a disappearance of absorption bands when compared to those of control samples. Also, no appearance of new bands was noted. This furtherly indicated the compatibility of the three drugs. There was no alteration in the organoleptic parameters of the stressed binary mixtures of the drugs with the above-mentioned excipients throughout the storage period. Accordingly, FT-IR spectra of stressed samples showed characteristic absorption bands comparable with those of control samples. In spite of the insignificantly different LDH content in the control and test samples, incompatibility of LDH with each of P, methylparaben, and propylparaben can be suggested by characteristic odor and viscous liquid observed in case of stressed binary systems with each of these excipient possibly due to the acid degradation of the excipients in the acidic microenvironment provided by acid content in LDH without affecting LDH content in the binary mixtures Rowe et al. This may indicate the incompatibility between LDH and these excipients. It can be said that NIF was compatible with these excipients as clarified by insignificantly different drug content of control and stressed test mixtures Table 1 b as well as unchanged organoleptic properties on the storage. In addition, FT-IR spectra of these mixtures after storage at stress condition did not show new bands, band shift or absence of bands existing in spectra of control mixtures. BMV formed a milky liquid with P only on the storage. Yet, there was insignificant difference in BMV content in test and control mixtures with P Moreover, there were no detectable differences in FT-IR spectra of control and test mixtures. This may reflect only a physical incompatibility between BMV and P According to Figure 2 a , there was an improvement in NIF photostability on the increase in titanium dioxide concentration. The formulations possessed acceptable viscosity ranges Garg et al. Accordingly, there was insignificant difference between J ss values of these drugs in the two gel formulations Table 2 a. In vitro release of LDH from the prepared gels was comparable with that of the market gel Figure 2 c. In case of BMV, the drug permeation from these gels was superior to that seen with the market product Figure 2 d. The values of J ss for these drugs reflected such behavior Table 2 a. The data of kinetic analysis are represented in Table 2 b. The drugs release mechanism followed either zero kinetics or diffusion transport. To verify it, the release data were analyzed via Korsmeyer—Peppas equation. Non-Fickian diffusion 0. In comparison with the initial measurements, there were insignificant changes in pH 5. Generally, there was a sharp decline in t 90 and t 50 of the drugs on the elevation of storage temperature particularly with BMV. Moreover, the optimized gel preparation stored at the three storage temperatures did not encounter bacterial or fungal growth. Baseline characteristics of the study population are listed in Table 3 a. Prevalence of fissure healing, pain, bleeding, discharge, and itching among patients with AAF and CAF at first, third, and sixth weeks post-treatment are demonstrated in Table 3 b. Clinical study a Baseline characteristics of the study population. There was no significant difference in the baseline characteristics of the participated patients. The mean age of patients was Regarding the symptomatology, pain, discharge, and itching were more frequent than rectal bleeding Table 3 a. Complete healing of AAF occurred in Three patients in group D were unsatisfied and subjected to anal dilation and sphincterotomy. The effective healing of patients suffering from either AAF or CAF after treatment with the optimized combination gel F2 for six weeks is illustrated in Figure 3. Representative photographs of patients suffering from either AAF a before treatment baseline , b after treatment for six weeks with the optimized combination gel F2 or CAF, c before treatment baseline , and d after treatment for six weeks with the optimized combination gel F2. Although there were equal medians of pain baseline scale in case of group A and B patients on one side and group C and D patients on the other side Table 3 a , the severity of pain reflected by the median that became lower among groups A and C patients treated with the optimized gel in comparison with groups B and D treated with the market products Table 3 b. Regarding the basic characteristics of the population, there was a higher prevalence of rectal bleeding among patients with CAF in comparison with those with AAF. Although there was a higher severity of anal discharge and itching among AAF patients in comparison with CAF patients, equal medians of their scales were observed between groups A and B patients on one side and between groups C and D patients on the other side. In comparison with groups B and D treated with market products, the severity of rectal bleeding, anal discharge, and itching became lower among groups A and C patients treated with the optimized combination gel formulation. No patients in groups treated with optimized gel reported side effects groups A and C. While mild headache was experienced by Perianal itching was another side effect, which was reported by 9. Both headache and perianal itching were reported by 6. There was no significant difference in healing of anal fissure as well as relief of pain, rectal bleeding, anal discharge, and itching following treatment with the optimized formula among AAF patients group A in comparison with CAF patients group C. The compatibility among the three drugs and between the drugs and tested excipients was confirmed except with LDH and each of P, methylparaben, and propylparaben as well as BMV and P The gels containing compatible excipients showed acceptable viscosity and pH ranges as well as pharmacopoeial complying drugs content limits. In addition, no side effects were reported by patients treated with the optimized combination gel in contrast to those treated with the market products. As a library, NLM provides access to scientific literature. Drug Deliv. Find articles by Amgad E Salem. Find articles by Elham A Mohamed. Find articles by Hosam M Elghadban. Find articles by Galal M Abdelghani. Received Jun 5; Accepted Jul 29; Collection date Open in a new tab. Group B; with acute anal fissure AAF treated with the market topical preparations. Group D; with chronic anal fissure CAF treated with the market topical preparations. Similar articles. Add to Collections. Create a new collection. 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A large body of research that has investigated substance dependence and working memory (WM) resources, yet no prior study has used a comprehensive test.
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PDF version. Kabbash: This e-mail address is being protected from spambots. You need JavaScript enabled to view it. Background : Drug abuse is a global challenge with harmful effects on health, wealth and wellbeing of nations. University students report more habitual use of marijuana, cocaine, hallucinogens and illicit drugs than noncollege students report. Aims : To identify the prevalence of tobacco use, alcohol and drug abuse and to identify some factors associated with drug abuse. Methods : A cross-sectional study recruiting students from all faculties hosted by Kafr El-Sheikh University during the academic year — Data were collected using a structured self-administered questionnaire. Results : The prevalence of current drug abuse was 8. Men reported significantly greater use of cigarettes, alcohol, tramadol, hashish and bhang than women. Students of practical colleges were found to smoke cigarettes and abuse hashish significantly more than their peers in other colleges. Risk factors associated with drug abuse were mainly related to gender and college type. Conclusion : There is a need to design and implement programmes to raise awareness and provide supportive services for prevention and management of drug abuse among university students tailored according to their needs. Keywords: alcohol consumption, Egypt, hashish, smoking, substance abuse, tranquilizers, university students, adolescent. Substance use among university students in Egypt: prevalence and correlates. East Mediterr Health J. Open Access. Some rights reserved. Substance abuse refers to the detrimental or hazardous use of psychoactive substances, as well as alcohol and illicit drugs. Psychoactive substance use can lead to dependence syndrome, which is a group of behavioural, cognitive and physiological phenomena that arise after repetitive use. This incorporates: a strong desire to take the substance; trouble with controlling its use; continued use in spite of harmful consequences; a higher priority given to substance use than to other activities, in addition to obligations; increased tolerance to the substance; and sometimes a state of physical withdrawal 1. Drug abuse by adolescents has become one of the main causes of health-related problems in several parts of the world, making some students to experience mental health problems, while some become maladjusted to school circumstances and finally drop out of school 4. Drug abusers who display symptoms of nervous tension, anxiety, depression, behavioural changes, tiredness, and loss or increase in appetite should be treated by medical specialists and counsellors to save them from fatal illness 4. Marijuana is the most broadly used, with a prevalence of 3. Other popular drugs used by students in the last 30 days were amphetamines 4. There is some evidence from American national surveys that university students are at greater risk of drug use than other young people of comparable age. The Core Alcohol and Drug Survey for demonstrated that college students reported more frequent use of marijuana, cocaine, hallucinogens and designer drugs in the last 30 days than noncollege students reported 5. Tobacco and alcohol are the most commonly used drugs among South African adolescents despite the health and social problems associated with them. This may be because they are both legal and many consider them tolerable and mild. A national survey of drug use among university students in the United Kingdom of Great Britain and Northern Ireland in found that The least commonly used drugs were heroin, methadone, crack, methamphetamine and steroids all A study among Egyptian university students in reported the lifetime prevalence of drug abuse as Multiple drug abuse is not uncommon. Among Mansoura University students in , a study of opioid-using students found that 88 reported tramadol use and 12 heroin use 9. Another study conducted at Zagazig University in reported alcohol and sedative abuse prevalence as Drug dependence is considered an important problem in Egypt that is of concern both to the community and government Peer pressure and negative life events are mentioned as the most common reasons for substance abuse. Conversely, rigorous parenting and religiosity are among the factors perceived to prevent substance use or help with cessation Different reports have indicated a progressive rise in drug abuse among Egyptian university students over time. However, only a limited number of published studies have demonstrated the magnitude of and the factors affecting this problem. No studies were conducted among Kafr El-Sheikh university students in spite of their large number. This information gap motivated us to perform the present study to identify the prevalence and correlates of drug abuse among Kafr El-Sheikh university students. We also aimed to study gender differences in the magnitude of the problem and the consequences of the problem on the students. A cross-sectional study was conducted for 3 months in the academic year — Kafr El-Sheikh University was founded in April and includes 19 faculties and 3 higher institutes. The survey included 13 faculties that were grouped into 3 strata: 1 medical faculties medicine, dentistry, pharmacy, physical and veterinary medicine ; 2 practical faculties engineering, agricultural, education, physical education, and specific education ; and 3 academic faculties commerce, arts and languages. In practical and medical faculties, students were divided into groups for practical training. In academic faculties, 1 day and 1 lecture hall were chosen randomly and all attending students in that lecture hall were included in the study sample. A total of questionnaires were distributed. A pilot study was conducted before starting data collection to test the adequacy and time needed to fill the designed questionnaire, and to determine the potential obstacles that might be met during execution of the study. Data were collected using a validated and reliable self-administered questionnaire that included items regarding the following data: sociodemographic factors; current and past history of smoking, alcohol intake and drug abuse; and problems related to drug abuse. The collected data were coded, double-checked for completeness, entered into Microsoft Excel, and analysed using SPSS version SPSS Inc. Means and standard deviations were calculated for continuous variables and frequencies for categorical variables. The c2 test was used to compare differences in the distribution of variables among suited groups. Informed consent was obtained from the participants after explanation of the study purpose and benefits, and participation was voluntary. The study included students from different faculties of Kafr El-Shiekh University, aged 17—25 years \[mean Students who ranked first among their siblings represented Students living with their parents represented Family size showed a mean of 5. Students who had ever smoked tobacco represented The most frequently abused drugs were tranquilizers 8. The second most frequently abused drug was alcohol 6. The third most frequently abused drug was hashish 6. The least frequently abused drugs included crack 0. Table 2 shows the drugs that were abused in the last month. Tranquilizers ranked first 4. Injecting drugs were ever reported by 1. Cigarette smoking was significantly more prevalent among students in practical faculties Hashish abuse was significantly more prevalent among students in practical faculties 4. Abuse of tranquilizers was more prevalent among students in theoretical faculties compared with other faculties, but the differences were not significant. Prevalence of abuse of other drugs did not differ significantly among students in different faculties. Number of abused drugs was significantly associated with male sex Table 4. Trying 1 drug was reported by Those who tried 2 drugs represented 4. The number of drugs abused was significantly associated with smoking habit. Among smokers, A significantly high percentage of medical students The highest percentage of single drug abuse Among problems related to alcohol abuse, sex without a condom 3. Drug abuse, especially among adolescents, is an important public health and social problem internationally and in Egypt. University students are at an increased risk of substances abuse. Tobacco smoking is the most commonly reported substance used by Egyptian adolescents In the present study, current i. However, it was higher than the prevalence found among medical students in the Nile Delta, which was This lower prevalence among female students can be attributed to the shameful perception of smoking among women according to community norms in Egypt Tranquilizers ranked as the most frequently abused illicit drugs ever and current abuse by 8. These results are higher than those reported among students at Zagazig University 10 and Sohag University 18 , in whom the prevalence of abuse of sedative drugs was 5. In contrast, Al-Sayed et al. Alcohol was the second most frequently ever-abused substance by our study participants 6. This is in agreement with Loffredo et al. Similar results 6. A lower prevalence of alcohol abuse 4. These results also coincide with those of Hamdi et al. The third most frequently ever-abused drug was hashish 6. This is in line with Hamdi et al. Mwaheb et al. This high percentage may have been because their study was conducted among male students only and included secondary schools and colleges. It could also be attributed to the fact that cannabis is common in Egypt with a lower price than other drugs. The most frequent currently abused substance was bhang 1. Tramadol ranked second among the most frequent currently abused drugs among study participants. A lower prevalence 0. In the current study, drug abuse was significantly associated with male students. This was also supported by a community-based study among Egyptians 20 , which concluded that male gender was significantly positively correlated with substance abuse, which may be attributed to cultural and social contexts. Similarly, Meray et al. Smoking carries a high risk of drug abuse, and our study revealed a significant association between smoking habit and the number of abused drugs. This was in agreement with the study of Amin et al. Similarly, Morrison et al. In the current study, a significantly high percentage of medical students This was consistent with the findings of Shalaby and Soliman 22 , who reported a 9. This lower prevalence of drug abuse among medical students compared to students at other colleges may be attributed to their satisfactory level of awareness regarding health hazards of addiction owing to their curriculum. The current study reveals a need for the development of interventions for substance abuse among university students and the increased attention of local authorities and families, in addition to implementing effective addiction counselling and prevention programmes to support university students. This study is the first report of the problem of substance abuse in Kafr El-Shiekh University. The sample size was high and reflects well the magnitude of the problem. However, the study had some limitations. First, the self-reporting nature of the drug abuse allowed recall bias. Second, the stigma associated with drug abuse among university students might have led to under-reporting and underestimation of the prevalence. This study highlighted the magnitude of drug abuse among Kafr El-Shiekh university students, the commonly abused drugs, and the factors associated with drug abuse, in addition to some consequent problems that result from it. The abused substances were mainly cigarettes, tranquilizers, alcohol and hashish. Students in academic and practical faculties are at higher risk than those in medical faculties. There are many risk factors for substance abuse but the main factors are age, sex, residence, parental educational level, and smoking habit. We would like to express our appreciation to 4th year medical students participated shared in data collection. Finally, we would like to thank all university students who participated in the study. Subscribe via RSS. Volume 30, number 8 August WHO Bulletin. Pan American Journal of Public Health. Main Search Contact. YouTube Rss feeds Twitter Facebook. Eastern Mediterranean Health Journal All issues Volume 28 Volume 28 issue 1 Substance abuse among university students in Egypt: prevalence and correlates. Substance abuse among university students in Egypt: prevalence and correlates. Keywords: alcohol consumption, Egypt, hashish, smoking, substance abuse, tranquilizers, university students, adolescent Citation: Kabbash I; Zidan O; Saied S. Methods Study design A cross-sectional study was conducted for 3 months in the academic year — Data collection and analysis Data were collected using a validated and reliable self-administered questionnaire that included items regarding the following data: sociodemographic factors; current and past history of smoking, alcohol intake and drug abuse; and problems related to drug abuse. Results The study included students from different faculties of Kafr El-Shiekh University, aged 17—25 years \[mean Discussion Drug abuse, especially among adolescents, is an important public health and social problem internationally and in Egypt. Conclusions This study highlighted the magnitude of drug abuse among Kafr El-Shiekh university students, the commonly abused drugs, and the factors associated with drug abuse, in addition to some consequent problems that result from it. Acknowledgement We would like to express our appreciation to 4th year medical students participated shared in data collection. Funding : None Competing interests : None declared. References Okpye, N. The adolescents and hard drugs: a psychological concern. The Nigerian adolescent in perspective. Nigerian Society for Education; Fourteenth report. World drug report Fareo DO. Drug abuse among Nigerian adolescents strategies for counselling. J Int Soc Res. Monitoring the future: national survey results on drug use: — Volume II: college students and adults ages 19— Soul City Institute for Social Justice. Drug use among college and university students: findings from a national survey. J Subst Use. Addressing prevalence and correlates among a sample of Egyptian university students who suffer from substance use disorders. Addict Disord Their Treat. A study of opioid dependence among Mansoura University students. Egyptian J Psych. Drug abuse in Zagazig University students, Egypt: cross sectional study, Occup Dis Environ Med. Gender differences in risks and pattern of drug abuse in Egypt. Egypt J Neurol Psychiat Neurosurg, ;47 1 —8. JRSM Open. Substance use by Egyptian youth: current patterns and potential avenues for prevention. Subst Use Misuse. Perception and practices of tobacco smoking among medical students in the Nile Delta, Egypt. Environ Sci Pollut Res Int. Women and waterpipe tobacco smoking in the eastern Mediterranean region: allure or offensiveness. Women Health ;53 1 — Sedative drug use among King Saud University medical students: a cross-sectional sampling study. Depress Res Treat. Alcohol use among college students: an international perspective. Curr Opin Psychiatry. J Forens Toxicol Medicolegal Anal. Goreishi A, Shajari Z. Sociodemographic indicators for substance use and abuse in Egypt. J Addict Prevent. Drug abuse among students in schools and colleges in Fayoum City \[thesis\]. Fayoum University; Knowledge, attitude, and practice of medical students regarding smoking and substance abuse, Cairo University, Egypt. J Egypt Public Health Assoc. Prevalence updates of substance use among Egyptian adolescents. Middle East Curr Psychiatry. Public Health Rev. Tobacco, cannabis, and other illicit drug use among Finnish adolescent twins: causal relationship or correlated liabilities?. J Stud Alcohol Drugs. Current issue Volume 30, number 8 August
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ABSTRACT Background: Drug abuse is a critical concern worldwide. Urine drug screening is a common practice applied for the detection of common drugs of.
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