As in Incident command...

IC established!
We'll have several different sections reporting in - recent research, local topics, or highlighting areas of the Sponsor Hospital Council of Greater Bridgeport protocols.

*** Keep in mind - this website does not replace your protocols, and these posts do not reflect SHCGB or Bridgeport Hospital policies. This is a place to discuss research, controversies, or discuss possible future protocols. When in doubt, check your current protocols through the official source.

Sunday, April 20, 2014

Part 2: Does Cyanokit save lives in cardiac arrest?

In the last post I reviewed some key facts about hydroxocobalamin (HCB), otherwise known by its brand name Cyanokit. However, paramedics and firefighters aren't really concerned with the animal studies - they want to know if it saves human lives! 

And according to some flashy headlines, many people believe this stuff works when nothing else can.


Source
Source
Source
But these are news reports and press releases - what does the medical evidence show? 


Does HCB help in cardiac arrest due to smoke?
This is the tough hurdle for studying any toxicologic antidote, and it's especially hard to do research in this area. The events are rare, and it's usually an emergency when these poisoning occur. For these reasons, and more, there have only been a few studies of HCB in humans.

Four studies have looked at the use of HCB in smoke-exposed patients. Interestingly, 3 of them were done in France, mostly in Paris.


Just for fun, Google "Paris" and "burning."

Study #1 - All smoke exposure patients who got HCB  

The authors of the first study looked at all the patients treated with HCB over an 8-year period  for "suspected cyanide poisoning" after a smoke inhalation, usually from a house fire. It's important to understand that there was no comparison group so it is impossible to know whether the drug helped, hurt, or did nothing.

With that in mind, all 101 patients got HCB, and all were from residential house fires; about 1/3 of those were in cardiac arrest. Forty two patients died, 30 survived, and the status of 29 patients was "unknown.



How about patients found in cardiac arrest? Of the 38 patients who where found in arrest, 21 of those had prehospital ROSC - pretty encouraging. Unfortunately,  the majority of those (19/21) subsequently died in the ICU.

This might be encouraging if we were givne some data about those 2 out of 38 patients who survived. For instance, did they get the HCB before, during, or after their cardiac arrest? Unfortunately, there are no further details

Study #2 - All cyanide exposures who got HCB

Just like the study above, the authors of study #2 included patients with smoke inhalation or cyanide ingestion who were treated with HCB by EMS. Since this was written by the same authors as study #1 above,  and covers mostly the same period (1995-2008), it is likely that many of these patients overlap with those in the prior study.
Out of the 161 patients studied, 61 were found in cardiac arrest. Most of these died in the field, or ended up dying in the hospital, but 5 patients lived after getting HCB from EMS!



 
That's an 8% save rate, which seems very promising, but the authors note that most of these "saves" didn't actually get HCB before they had ROSC. As they point out (my emphasis):
"Among the 61 patients in [cardiac] arrest, 5 survived without sequelae and, in particular, without neurological sequelae. Four of the 5 patients were ... discovered in cardiac arrest by the fire brigade, and spontaneous cardiac activity was obtained after cardiac massage and oxygen therapy. ...
[H]ydroxocobalamin was not responsible for the recovery of spontaneous cardiac activity in these patients."
I'll point out that the 5th cardiac arrest survivor had his age only listed as "adult," suggesting that the EMS records were incomplete, at the least... 


Study #3 - All smoke exposures, who got HCB, and who made it alive to the ICU
The last study adopted a slightly different approach. The authors performed a retrospective "observational case series" of all of the patients who who had smoke exposure, received HCB in the field, and were subsequently admitted to the ICU

A total of 69 patients were enrolled. Of these, 15 patients had been in cardiac arrest when EMS found them. Of these 15 patients, only 2 survived.



Hey, 2/15 is a 13% save rate, which might be really promising. Or might not be - we can't tell from the study design.

Study #4 - All smoke exposure patients who got HCB - in Texas! 
You might not have thought that Paris and Houston would have a lot in common!

You can skip Googling "Paris" and "Houston"
As it turns out, both Parisians and Texans have been using HCB for years, and a just-published abstract describes the experience of the FD in Houston. Unfortunately, the study wasn't "Texas-sized," and was actually smaller than those done in Paris.

Like the French studies, the Houston authors looked retrospectively at all the patients who had received HCB for "possible cyanide poisoning." Over a period of 4 years, 22 patients got the drug. Half of those were found in cardiac arrest, and 8/11 had ROSC "after administration of HCB."

So, awesome, right? Unlike study #2 above, the patients in cardiac arrest actually got HCB before ROSC, not after. Is this proof that HCB, given in arrest, can produce ROSC rates in almost 75% of cases? 

 Limitations of these "case series"studies
Unfortunately, we still can't say.  All of these studies were basically case series. It is very low-quality evidence, ranking just above expert opinion. You can think of such a study design as just a fancy doctor phrase meaning "a bunch of cool stories."




Why? Because there is no comparison group in any of them. Since the drug was never actually tested against another drug, let alone a placebo, we don't know if HCB helped, or did nothing

Heck, for all we know, it may have even hurt patients. We just don't know.

 So, what can we do with this data?
By itself, not much. HCB is a new therapy, with potential, but no solid human evidence to support when we should use it. Of course, we don't always wait for perfect evidence to come along before using drugs and therapies.

With that in mind, what should you and your teammates do the next time FD drags a patient in cardiac arrest out of a fire? Or what if one of your firefighter teammates collapses next to you during a fire?

The next post will offer some suggestions, based on better evidence, of techniques and therapies that have been shown to lives.

35 comments:

  1. Brooks,

    I am in the process of writing a more detailed response that I plan to post tomorrow. In the meantime, my answer is yes. I would administer the Cyanokit to a patient in cardiac arrest that has been removed from a burning building. I would also administer it to a patient that is not in cardiac arrest but 1) is presenting with signs of cyanide toxicity in conjunction and 2) has a lactate greater than 6mmol.

    As for a firefighter, this is a different story. If they collapse during a fire, I don't presume the etiology is from cyanide toxicity. Traditional therapies here. If they are found with either a broken mask or not wearing their mask at all, I would then add it to their treatment.

    Regardless, more to follow.

    -Bobby

    ReplyDelete
  2. I'll await your longer response! Thanks for reading.

    ReplyDelete
  3. My post is too long...and the footnotes got all messed up in the copy/paste process. Email instead?

    ReplyDelete
    Replies
    1. Brooks.walsh_at_gmail. Looking forward to this mega-response!

      Delete
  4. WIth such goodies as acrolein, cyanide, phosgene and others, both as gasses/vapors and adsorbed onto micro-particles of soot (which reach alveoli and are phagocytized) even in "common" household fires, this should be studied properly. My respects to the French, but they tend to announce too early. (mycrofft)

    ReplyDelete
  5. I am bold enough among many others to state that there is now a potent cure to this sickness but many are unaware of it. I discovered that I was infected with the virus 3 months ago, after a medical check-up. My doctor told me and I was shocked, confused and felt like my world has crumbled. I was dying slowly due to the announcement of my medical practitioner but he assured me that I could leave a normal life if I took my medications (as there was no medically known cure to Herpes). I went from churches to churches but soon found that my case needed urgent attention as I was growing lean due to fear of dying anytime soon. In a bid to look for a lasting solution to my predicament, I sought for solutions from the herbal world. I went online and searched for every powerful trado-medical practitioner that I could severe, cos I heard that the African Herbs had a cure to the Herpes syndrome. It was after a little time searching the web that I came across one Dr Itua(A powerful African Herbal Doctor), who offered to help me at a monetary fee. I had to comply as this was my final bus-stop to receiving a perfect healing. My last resolve was to take my life by myself, should this plan fail. At last it worked out well. He gave me some steps to follow and I meticulously carried out all his instructions. Last month, to be precise, I went back to the hospital to conduct another test and to my amazement, the results showed that negative,Dr Itua Can As Well Cure The Following Desease…Cancer,Hiv,Herpes, Hepatitis B,Liver Inflammatory,Diabetis,Fribroid, Dercum,Get Your Ex Back, You can free yourself of this Herpes virus by consulting this great African Herbal Doctor via this e-mail: drituaherbalcenter@gmail.com or call and whatsapp him on +2348149277967 He will help you and his herb medication is sure. he has the cure on all disease .You can talk to me on INSTAGRAM..tashamoore219....

    ReplyDelete
  6. 6 months ago I was diagnosed with COPD with 55-60% lung capacity. My doctor just said all the crying , stomping your feet will not change it so just accept it and basically patted me on the back and sent me home to die. I was devastated and was afraid to do anything. I stopped riding my bike, I was afraid to do anything that would cause any exertion. It consumed my thoughts with every breath and the fear of what to expect was almost more than I could deal with. So I couldn't get myself all time I decided to find a herbal cure online and I came acrose Doctor Itua on how he cure several people suffering from Hiv, and Herpes I gave him a call on this Number +2348149277967 also chat on whatsapp he gave me all the details about the cure i paid him for the medicine after 5 working days i receieve my herbal medicine ,I use it for two weeks that is how I get Cured and today I'm living healthy and fine I give him thanks also promise him to testify about his work,He Can also cure the following deseases..Copd,Herpes,Hiv,Hepatitis,diabetes,
    Contact...drituaherbalcenter@gmail.com

    ReplyDelete
  7. next part is divided for the entertainment of the candidates. The formation of the part and best ideas is empowered for the flow of the firs. The routine is depicted for the flow of the offers for the movement of the chances for the humans.

    ReplyDelete
  8. part two of the new motivation is inducted for the approach of the students. It has been marked for the flow of the
    http://www.radiologyfellowship.net/radiology-fellowship-eras-registration-tips/ for all strong and fit men of the area. The improvement of the term is done for the good and all elements for the humans.

    ReplyDelete
  9. part two of the whole of the scheme is welcomed for the individuals. All the issues of the part and visits of the http://www.residencyprograms.biz/list-of-img-friendly-surgery-residency-programs/ are changed for the humans. The types have been inducted for the formation of the better slots for the humans in the midst of the elements.

    ReplyDelete
  10. Excellent post,Each kind of the contaminations isn't extraordinary and people need to continue with a sound life but you can visit http://www.road2residency.com/medical-school-personal-statement-services/ to manage your task. Regardless, we live in the overall population in which people need to go up against different kinds of afflictions which increase well ordered. In this article, you talk about only a solitary contamination anyway you have to think about more diseases.

    ReplyDelete
  11. All the medical students try to reach their goal but sometimes they were misguided. Here http://www.rheumatologyfellowship.com/about-our-help-with-personal-statement-for-rheumatology-fellowship/ our writers share their knowledge of this specialty and combined with their writing experience. You will find your way to success here.

    ReplyDelete
  12. It is no secret that I have a very deep and personal relationship with God. I have pushed and resisted that relationship this past year through all the bullshit I have had to go through living with Herpes but once again, God is bigger than my stubbornness and broke through that outbreak cold sore and all I had Genital Herpes. For me personally, hearing over and over how I am not good enough has really invaded my mind in the worst way possible. I completely shut down and I was just waking up like is this how life going to end this temporary herpes outbreak “fuck everybody with herpes if you know what I mean” but let's be honest here...
    It is a cowardly to say no to herbal medicine. It is fear based. And it is dishonest to what my heart wants. Don't build a wall around yourself because you are afraid of herbals made or taking a bold step especially when it's come to health issues and getting cure. So many young men/ women tell me over and over that Dr Itua is going to scam me but I give him a try to today I feel like no one will ever convince me about herbal medicine I accept Dr Itua herbal medicine because it's cure my herpes just two weeks of drinking it and i have been living for a year and months now I experience outbreak no more, You can contact him if you need his herbal medicine for any such diseases like, Herpes, Schizophrenia,Cancer,Scoliosis,Fibromyalgia,Fluoroquinolone Toxicity Syndrome Fibrodysplasia Ossificans Progressiva.Fatal Familial Insomnia Factor V Leiden Mutation ,Epilepsy Dupuytren's disease,Desmoplastic,Diabetes ,Coeliac disease,Creutzfeldt–Jakob,,Lyme Disease,Epilepsy, ,ALS,Hepatitis,Copd,Parkinson disease.Genetic disease,Fibrodysplasia disease,Fibrodysplasia Ossificans Men/Woman infertility, bowel disease ,Huntington's disease ,Diabetes,Fibroid. disease,Lupus,Lipoid Storage diseases( Gauchers disease),Polycystic Disease.,Cerebral Amyloid Angiopathy, Ataxia,Cirrhosis of Liver,Arthritis,Amyotrophic Lateral Sclerosis,Alzheimer's disease,Adrenocortical carcinoma.Asthma,Allergic,HIV, Epilepsy, Infertility, Love Spell,. Email..drituaherbalcenter@gmail.com then what's app.+2348149277967.... My advice to any sick men/women out there is simple... Be Always an open book. Be gut wrenching honest about yourself, your situation, and what you are all about. Don't hold anything back. Holding back will get you nowhere...maybe a one way ticket to lonelyville and that is NOT somewhere you want to be. So my final truth...and I'm just starting to grasp this one..

    ReplyDelete
  13. WITH THE HELP OF  DR PERFECT ENLARGEMENT CREAM MY PENIS GROW  FROM 3 INCHES TO 9 INCHES YOU CAN ON EMAIL AT SOLUTIONTOALLPROBLEMS1@GMAIL.COM

    Hello everyone I have to give my testimony about a herbal doctor called Dr Perfect. I was heartbroken because I had a very small penis not good enough to satisfy a woman, I have been in so many relationships but they were cut off because of my situation, I have used so many products prescribed by the doctor but none could render me the help I was looking for, so I decided to search online for solution and I saw a lot of comments about this specialist called Dr Perfect on how he helped people with small penis, cancer and others so I decided to give his herbal product a try, I messaged him on WhatsApp and replied me back, he gave me some comforting words we talked on how i can receive the product and he sent me his herbal product for penis enlargement, within 1 week of using it I began to feel the enlargement of my penis, now it just two weeks of me using his products my penis is about 9 inches longer, and I settle things with my girlfriend I was surprised when she said that she is satisfied with my performance in bed and am happy that i have a big penis now all thanks to Dr Perfect feel free to contact Dr Perfect at solutiontoallproblems1@gmail.com or WhatsApp him +1(256)251-3614 and get your enlargement cream     

    ReplyDelete
  14. WITH THE HELP OF  DR PERFECT ENLARGEMENT CREAM MY PENIS GROW  FROM 3 INCHES TO 9 INCHES YOU CAN ON EMAIL AT SOLUTIONTOALLPROBLEMS1@GMAIL.COM

    Hello everyone I have to give my testimony about a herbal doctor called Dr Perfect. I was heartbroken because I had a very small penis not good enough to satisfy a woman, I have been in so many relationships but they were cut off because of my situation, I have used so many products prescribed by the doctor but none could render me the help I was looking for, so I decided to search online for solution and I saw a lot of comments about this specialist called Dr Perfect on how he helped people with small penis, cancer and others so I decided to give his herbal product a try, I messaged him on WhatsApp and replied me back, he gave me some comforting words we talked on how i can receive the product and he sent me his herbal product for penis enlargement, within 1 week of using it I began to feel the enlargement of my penis, now it just two weeks of me using his products my penis is about 9 inches longer, and I settle things with my girlfriend I was surprised when she said that she is satisfied with my performance in bed and am happy that i have a big penis now all thanks to Dr Perfect feel free to contact Dr Perfect at solutiontoallproblems1@gmail.com or WhatsApp him +1(256)251-3614 and get your enlargement cream     

    ReplyDelete
  15. I want to thank Dr Emu a very powerful spell caster who help me to bring my husband back to me, few month ago i have a serious problem with my husband, to the extend that he left the house, and he started dating another woman and he stayed with the woman, i tried all i can to bring him back, but all my effort was useless until the day my friend came to my house and i told her every thing that had happened between me and my husband, then she told me of a powerful spell caster who help her when she was in the same problem I then contact Dr Emu and told him every thing and he told me not to worry my self again that my husband will come back to me after he has cast a spell on him, i thought it was a joke, after he had finish casting the spell, he told me that he had just finish casting the spell, to my greatest surprise within 48 hours, my husband really came back begging me to forgive him, if you need his help you can contact him with via email: Emutemple@gmail.com or add him up on his whatsapp +2347012841542 is willing to help any body that need his help.

    ReplyDelete
  16. Am Lucy Morgan from Atlanta Georgia  i was suffering from genital herpes, oral herpes, shingles. Before I came in contact with dr. Kham It is no longer news that the Acquired immune deficiency syndrome Herpes Virus is increasing by the day, The fear is that many people living with the sickness are scared of saying it because of the stigma that comes along with it.I am bold enough among many others to state that there is now a potent cure to this sickness but many are unaware of it.I discovered that I was infected with the virus 3 months ago, after a medical check-up. My doctor told me and I was shocked, confused and felt like my world had crumbled. I was dying slowly due to the announcement of my medical practitioner but he assured me that I could live a normal life if I took my medications, In a bid to look for a lasting solution to my predicament, I sought for solutions from the voodoo world. I went online and searched for every powerful trado-medical practitioner that I could severe, because I heard that the African Voodoo Priests had a cure for Herpes syndrome. It was after a little time searching the web that I came across one Dr. Kham website who offered to help me, He gave me some steps to follow and I meticulously carried out all his instructions. Two days ago to be precise, I went back to the hospital to conduct another test and to my amazement, the results showed that " I am NEGATIVE" You can free yourself of this Herpes virus by consulting this great African Voodoo Priest via this EMAIL dr.khamcaregiver@gmail.com or dr.khamcaregiver@outlook.com]  WHATSAPP NUMBER +2348159922297, You can Also Visit his website to know more about him at > https://drkhamherbalhealingcenter.wordpress.com/    

    HE CONFIDENTLY TOLD ME HE CAN ALSO SOLVE THE FOLLOWING PROBLEMS WITH ANY DELAY IN TIME

    PREGNANCY spell

    EPILEPSY cure spell

    GENPILENCI

    HIV AIDS.

    PREGNANCY

    DIABETICS

    STROKE.

    EXPANDS OF PENIS BREAST

    H.P.V TYPE 1 TYPE 2 TYPE 3 AND TYPE 4. TYPE 5.

    HUMAN PAPILLOMAVIRUS

    HERPES.

    SYPHILIS.

    CANCER.

    HEPATITIS A B and C.

    HIGH BLOOD PRESSURES AND BODY BOILS.

    ReplyDelete
  17. get your ex back with a love spell that works fast.
    Dr.Jumba has helped thousands of women get their Ex boyfriends back using his real effective love Spell. After my boyfriend of one year broke up with me, I could barely speak without crying. I felt blindsided and didn't know what to do. I didn't know if I could get him back and the anxiety was unbearable. I needed him back desperately because I loved him so much. So I contacted this great spell caster for help. He helped me cast a return love spell on him and just within 11 hours my boyfriend came back to me crying and begging for my forgiveness. Dr. Jumba released him to know how much I loved and wanted him. And He also opened his eyes to picture how much love we have shared together. As I am writing this testimony right now I am the happiest woman on earth. I want to recommend this great spell caster to anyone that truly needs an urgent solution to a love break up. Email him at wiccalovespelltools@yahoo.com or wiccalovespelltools@gmail.com or Call/WhatsApp him: +19085174108 "I'm so grateful and can say that if you have been broken up with and want to get that person back, Dr.Jumba is the best! I'll never forget how much he helped me
    WEBSITE : drjumbaspellhome.wordpress.com , blog : https://wiccaspelltools.blogspot.com/

    ReplyDelete
  18. Please share as you read okay you may save a soul today, natural herbs
    are really great, I was cured from HSV by a doctor called DR Okiti from West Africa, now I believe that natural herbs and roots has their own way of working, based on medical report I was told that HSV has no cure even when I saw a post about Dr Okiti how he cured many people with his herbal medicine I doubted it at first but just decided to give it a try because I was so desperately trying to get rid of my problems not knowing it was going to be the end of this deadly virus in my body, please if you have anyone with this same virus or diseases like this contact Dr Okiti via email drokitiherbalhome100@gmail.com or whatsapp +234 705 067 0365. I'm a living testimony of his herbal medicine and don't forget to share as you read okay, please save a soul today.

    ReplyDelete
  19. I was diagnosed of herpes virus in 2015, I have tried all possible means to get cure but all my effort proved abortive, until a friend of mine introduced me to a herbal doctor called Dr Onokun  who prepare herbal medicine to cure all kind of diseases including herpes virus (Hsv), when i contacted this herbal doctor via his email, he sent me herpes virus herbal medicine via courier service, when i received the herbal medicine he gave me step by step instructions on how to apply it, when i applied it as instructed i was totally cured from the virus within 2 weeks of usage. Contact this great herbal doctor today to get your cure.
    Via Email : Dronokunherbalcure@gmail.com

    ReplyDelete
  20. Hi viewers online, I'm Alfonso Vázquez from Mexico. I'm here to share my testimony about how i was helped to get my wife back. I was a cheat and my wife caught me several times. I tried fixing myself and each time i ended up cheating over and over again. I guess i didn't realise what she meant to me until she had left me alone. I began to find a way to get her back but nothing seems to work out perfectly till i came across an article about Lord Zakuza who helped a lot of people globally to get their relationships back. I made contact with him on his WhatsApp number via +1 740-573-9483 and he assured me that my wife will come back to me within 48 hours with his powerful magics and i paid 410 Euros for the materials needed for the work. Surprisingly, my wife came back home after 2 days saying that she still loves me and i swore never to cheat on her anymore. All thanks to Lord Zakuza. Email him via ( lordzakuza7@gmail.com ) or WhatsApp number via +1 740-573-9483.

    ReplyDelete
  21. My husband changed dramatically towards me, doesn’t communicate anymore.He disrespects me and accuses me falsely of infidelity because of wicked gossip …but I’m simply AMAZED at the results of Dr. Todd who did reunion love spell for me. Everything is going so well and EXACTLY how he said it would be. Even though it took 3 days to fully progress, it was so worth it because things are just about at perfection! How he took my situation and completely turned it around to give me exactly what I wanted is beyond me, but something I will never question and just be completely grateful, God Bless Dr.Todd for turning sorrow happiness. Dr.Todd's contact; manifestspellcast @ gmail. com
    WhatsApp:+1 604 901 9747

    ReplyDelete
  22. I was cured of HIV with the use of natural herbs. My name is Alandre and I'm from Texas. I love herbs so much. Most times, injection and drugs are just a waste of time. I was cured, I suffered from HIV for 13 years but with the help of Dr. Mark herbal medicine, I was cured within a few weeks of drinking the herbs he sent to me through courier delivery service. This same doctor also cured my Aunty from herpes, as soon as I heard she had herpes, I quickly refer her to Dr.Mark and she was cured too after drinking his herbs.I have referred a lot of people to Dr. Mark and they were all cured from their various illness. Have you taken herbs before?. You have spent so much money on drugs,injections,surgeries etc and yet you have no good result to show for it. Contact Dr. Mark now, he is a herbalist doctor, Dr. Mark has herbs that cures Hiv, Herpes, diabetics, asthma, hepatitis, STD, cancer, chronic, etc. Contact Dr Mark through his Email address on: blessedlovetemple@gmail.com Please share the good news to other people once you are cured

    ReplyDelete
  23. I am very happy today to share this amazing testimony on how Dr. AFRID the herbal doctor was able to cure me from my Herpes Virus with his herbal medicine. I have been a herpes patient for almost 8 months now and have tried different methods of treatment to ensure that I am cured of this terrible disease, but none worked for me, so I had to leave everything to God to handle as I was a Christian who had faith that one day God would intervene in my life, yet I felt so sad and desperate as I was losing almost everaything due to my illness, A few months ago while I was surfing the internet I saw different recommendation about Dr AFRID on how he have been using his herbal Medicine to treat and cure people, these people advice we contact Dr. AFRID for any problem that would help immediately, I contacted Dr AFRID and I told him how I got his contact and also about my disease, after some time Dr. AFRID told me to have faith that he would prepare for me a medication of herbal herbs, he told me I would take this medicine for a few weeks and also asked my home for home address so as possible for him to submit the drug for me, so my good friends after all the process and everything Dr AFRID actually sent me the medicine, I took it as I was directed by Dr. AFRID, after a few weeks passed, while on Dr. AFRID medication I began to experience changes in my body, I had to call my doctor at the hospital for some blood test, after test my hospital doctor told me that I was no longer with the herpes virus and my blood is pretty good, I can not even believe this, Friends well today i am Herpes Free and i want everyone to know that there is a cure for herpes for those who will contact Dr AFRID after reading my testimony, you can kindly contact Dr. AFRID in (DRAFRIDHERBALHOME@GMAIL.C OM) or whatsApp him +2349057260738, God bless you all  

    ReplyDelete
  24. I’ve been Feeling weak and always feeling sleepy for some time which I went for a test and I was told i am diagnosed with Amyotrophic lateral sclerosis Disease (ALS DISEASE) ever since then I've followed a wide variety of medical treatments, I have even combined with different pills and antibiotics without clear results. My health was deteriorating more and more. But thanks to a Herbal Doctor's herbs method that I found on the internet which has saved so many lives and also helped me to achieve the results i wanted, i knew from the beginning that this could help me after much learning and the cure Dr sent to me and which I began to follow the method from the Herbal Doctor called (Dr Aziba) and the results were wonderful: I recommend you to get in contact with him via Email: priestazibasolutioncenter@gmail.com and on WhatsApp: +2348100368288 for ALS, HPV, HSV, HERPES, Virginal Infection Cure etc.. DR is also available to help!

    ReplyDelete
  25. I’ve been Feeling weak and always feeling sleepy for some time which I went for a test and I was told i am diagnosed with Amyotrophic lateral sclerosis Disease (ALS DISEASE) ever since then I've followed a wide variety of medical treatments, I have even combined with different pills and antibiotics without clear results. My health was deteriorating more and more. But thanks to a Herbal Doctor's herbs method that I found on the internet which has saved so many lives and also helped me to achieve the results i wanted, i knew from the beginning that this could help me after much learning and the cure Dr sent to me and which I began to follow the method from the Herbal Doctor called (Dr Aziba) and the results were wonderful: I recommend you to get in contact with him via Email: priestazibasolutioncenter@gmail.com and on WhatsApp: +2348100368288 for ALS, HPV, HSV, HERPES, Virginal Infection Cure etc.. DR is also available to help!

    ReplyDelete
  26. I’ve been Feeling weak and always feeling sleepy for some time which I went for a test and I was told i am diagnosed with Amyotrophic lateral sclerosis Disease (ALS DISEASE) ever since then I've followed a wide variety of medical treatments, I have even combined with different pills and antibiotics without clear results. My health was deteriorating more and more. But thanks to a Herbal Doctor's herbs method that I found on the internet which has saved so many lives and also helped me to achieve the results i wanted, i knew from the beginning that this could help me after much learning and the cure Dr sent to me and which I began to follow the method from the Herbal Doctor called (Dr Aziba) and the results were wonderful: I recommend you to get in contact with him via Email: priestazibasolutioncenter@gmail.com and on WhatsApp: +2348100368288 for ALS, HPV, HSV, HERPES, Virginal Infection Cure etc.. DR is also available to help!






    I’ve been Feeling weak and always feeling sleepy for some time which I went for a test and I was told i am diagnosed with Amyotrophic lateral sclerosis Disease (ALS DISEASE) ever since then I've followed a wide variety of medical treatments, I have even combined with different pills and antibiotics without clear results. My health was deteriorating more and more. But thanks to a Herbal Doctor's herbs method that I found on the internet which has saved so many lives and also helped me to achieve the results i wanted, i knew from the beginning that this could help me after much learning and the cure Dr sent to me and which I began to follow the method from the Herbal Doctor called (Dr Aziba) and the results were wonderful: I recommend you to get in contact with him via Email: priestazibasolutioncenter@gmail.com and on WhatsApp: +2348100368288 for ALS, HPV, HSV, HERPES, Virginal Infection Cure etc.. DR is also available to help!





    I’ve been Feeling weak and always feeling sleepy for some time which I went for a test and I was told i am diagnosed with Amyotrophic lateral sclerosis Disease (ALS DISEASE) ever since then I've followed a wide variety of medical treatments, I have even combined with different pills and antibiotics without clear results. My health was deteriorating more and more. But thanks to a Herbal Doctor's herbs method that I found on the internet which has saved so many lives and also helped me to achieve the results i wanted, i knew from the beginning that this could help me after much learning and the cure Dr sent to me and which I began to follow the method from the Herbal Doctor called (Dr Aziba) and the results were wonderful: I recommend you to get in contact with him via Email: priestazibasolutioncenter@gmail.com and on WhatsApp: +2348100368288 for ALS, HPV, HSV, HERPES, Virginal Infection Cure etc.. DR is also available to help!

    ReplyDelete
  27. Environmental Law Assignment Help alludes to undertakings that are readied taking in to think the arrangement of rules, guidelines, and laws that oversee human communication with the indigenous habitat. These are the resolutions that depend on certain key ideas pointed toward shielding the environment from human exercises.

    ReplyDelete
  28. Herbal treatment is 100% guarantee for HSV2 cure, the reason why most people are finding it difficult to cure HSV2 is because they believe on medical report, drugs and medical treatment which is not helpful to cure HSV2. Natural roots and herbs are the best remedy which can easily eradicate herpes forever for more information about herpes cure Please write Dr.OLIHA for any health challenge email:oliha.miraclemedicine@gmail.com or WhatsApp+2349038382931. and https://olihamiraclemedicine.webs.com/ *    

    ReplyDelete
  29. Buy Herbal Product for Granuloma Annulare that encourages you to treat many skin diseases and issues, for example, scabies, rashes, eczema, psoriasis, skin break out and different diseases. Herbs Solutions by Nature uses herbal products and the skin detox formula to cure granuloma annulare naturally. If tiresome these Natural Remedies for Granuloma Annulare you feel unsavory and congenial.

    ReplyDelete
  30. I started on COPD Herbal treatment from Ultimate Health Home, the treatment worked incredibly for my lungs condition. I used the herbal treatment for almost 4 months, it reversed my COPD. My severe shortness of breath, dry cough, chest tightness gradually disappeared. Reach Ultimate Health Home via their website www.ultimatelifeclinic.com I can breath much better and It feels comfortable!

    ReplyDelete
  31. I started on COPD Herbal treatment from Ultimate Life Clinic, the treatment worked incredibly for my lungs condition. I used the herbal treatment for almost 4 months, it reversed my COPD. My severe shortness of breath, dry cough, chest tightness gradually disappeared. Reach Ultimate Life Clinic via their website www.ultimatelifeclinic.com . I can breath much better and It feels comfortable!

    ReplyDelete
  32. Assignment help services are available online which saves a lot of time. When you have less time and don't have an idea for your assignment writing, take online services and save your time and effort. As we know, it is quite important to write and submit the assignments within the stipulated time.

    ReplyDelete
  33. THERE IS CURE FOR HERPES VIRUS. This has been a great opportunity for me to speak about Doctor Ishiaku concerning his HERBAL MEDICINE for the cure of HERPES VIRUS. please visit doctor Ishiaku facebook page  
    DR ISHIAKU HERBAL HOME I am a living proof of the cure, it is not a story any more, thank God i gave him a try to cure me, i was confirm 100% negative after the usage of the herbal medicine, it is like a dream to me that Doctor Ishiaku herbal medicine could cure  herpes virus to 100% negative, before i proceed further let me quickly share his contact to the general public so anyone suffering from this virus can also have an opportunity like this to be cured. ( what - sapp + 2348180828544) .Please let every Herpes patient give herbal medicine a try. It works perfectly well. don't be deceived any more that there is no cure. This herbal medicine was shipped from Africa to me here in the United State by DHL. I am so happy to have seen my health and life back to normal. Thank you Doctor Ishiaku

    ReplyDelete
  34. Nicely done article. Everything is well polished and perfectly written. Thanks for sharing. In case you are looking expert assistance, get in touch with SourceEssay based assignment writer tea, who homework help at the lowest prices.

    ReplyDelete