Canadian Health&Care Mall is one the most convenient and customer-friendly online service for buying drugs. The e-store claims to have safety and quality of all medications as their priority. Apart from that, the company is licensed, has affordable prices, live professional assistance, numerous bonuses, discounts and promotions.

As for the Canadian Health&Care Mall’s history, I did not find any information about the company’s experience at this field either that the fact that they started as an actual pharmacy retailing business. This fact indeed gives them a head start on a deeper understanding of customers’ needs.

The benefits of purchasing medication from this pharmaceutical service are numerous. At Canadian Health&Care Mall website www.canadahealthcaremall.com, customers get a chance to obtain the drugs for a wide variety of health issues, including the conditions that affect stomach, skin, heart, lungs, eyes, blood, sexual function, and many others. Regardless of the indications, all the drugs are manufactured by the authorized pharmaceutical producers that have a spotless reputation. The medications are made in accordance with all the safety regulations, and you can be confident that you always get what you’ve ordered.

Having said that, it seems that the main e-store’s focus is on the oral erectile dysfunction treatment such as so-called PDE5 inhibitors, Viagra, Cialis and Levitra as well as the vast range of their generics. To win the user’s trust on generic products, the company offers a lot of information and articles in order to explain the differences in quality and prices.

At the company, they accept the payments performed using Visa, Master Card, American Express, and eCheck. While using you credit card with the help of SSL, any information you enter is protected from unauthorized access.

At Canadian Health&Care Mall, they use the following delivery companies: Regular Airmail and Express Courier. When it comes to Regular Airmail, they work with this company to ensure international shipping while Express Courier is perfect for delivering the drugs to the US residents. The waiting period for delivery of drugs by Regular Airmail is two to three weeks, but the medications can be delivered faster. The waiting period of Express Courier is approximately 8-14 business days. Their customers have an opportunity to track their drugs, which helps them feel confident that the drugs are on their way.

When it comes to the duration of delivery, it depends on the shipping method that you choose. With the help of Express Courier, you are expected to get the drugs in 8 to 14 days. If you go for Regular Airmail, the maximum waiting period is 21 days. Obviously, the majority of orders take less time to arrive. After you get the confirmation from the company, your drugs will be shipped within 10 days. You will get a notification to your email that your drugs have been shipped. It should be noted that shipping is performed only on business days.

They follow the Personal Information Protections and Electronic Documents Act (PIPEDA). The personal details that you enter on the website are encrypted with the help of SSL. Your information is viewed only by the authorized representatives of the company, which is necessary to finish your order.

Canadian Health&Care Mall Feedbacks

In total, I counted less than 20 feedbacks from the clients, all mostly positive, highlighting excellent prices and custom service efficiency. There were some negative moments about a stolen account. Some of the reviews did not look very natural to me though. Here are some of them below:

ENJOY THE SERVICE

★★★★☆

Just a few months back I was scared of online shopping for medications, though my fear disappeared the moment I opened the page of CHCM. The assistive customer support team helped me choose all the necessary medications, correct dose and strength, gave me recommendations and tips concerning the processes of ordering, payment and delivery and provided me with hot deals. I do not remember my last time purchasing medications from a land-based drugstore, really.

– Clarence Jackson, 39 Years old

10% DISCOUNTS

★★★★★

I am extremely thankful for everything you did for me: for the saved time and money, your support and assistance, fast services and big discounts. I have been your customer for 2 years already, and you have never failed me!

– Sean, Alabama

POSITIVE EXPERINCE

★★★★☆

Ordering medications from Canadian Health and Care Mall is in general a positive experience, but what happened afterwards was horrible. Someone simply stole my email account and other private information. During a couple of weeks I was receiving spam messages with a link to CHCM. Besides, it seemed impossible to keep in touch with the customer support team or other workers. However, fortunately, I have managed to get in touch with technical support that fixed this problem fast and easily.

– James, 37 years old

More Canadian Health and Care Mall reviews here: https://www.canadahealthcaremall.com/reviews-and-testimonials

Conclusion

The website looks very user-friendly and trustworthy, you can see Canadian Health and Care Mall does care about its image and clients. I believe you can shop safely there, however, I would try working with them for a while to see if their words match with reality.

Of all gynaecological malignancies ovarian cancer carries the worst prognosis and it is estimated to be the ninth most common cancer and fifth most common cancer related mortality. Most of them are diagnosed in advanced stages of III and IV with a five year survival rate of less than 28%. Only 15% of ovarian cancers are diagnosed in early stage with a five year survival rate of 94%. This suggests that early detection will improve prognosis. Early diagnosis is often difficult due to lack of specific symptoms and also ovaries are inaccessible for direct inspection and palpation. Despite the significant disease burden ovarian cancer is relatively rare in general population with an estimated age adjusted incidence of 13 per 100,000 women. The age standardized incidence rate (ASR) varies widely; as low as 0.06 per 100,000 in China to as high as 16.3 in Switzerland. In India during the period 2004-5 proportion of ovarian cancer varied from 1.7% to 8.7% of all cancers affecting women as reported by various urban and rural population based cancer registries operating under the network of National Cancer Registry Programme of the Indian Council of Medical Research.4 Screening tests lack specificity and there is no single effective screening test for ovarian cancer. Main strategies for screening include biochemical markers and transvaginal ultrasound (TVS).

Screening
Low risk women

Use of tumour marker CA-125 and TVS has been evaluated for screening asymptomatic low risk women. These proved to be ineffective because of low prevalence of epithelial cancer which is reported to be approximately 1 case for 2,500 women per year. It is estimated that a test with 100% sensitivity and 99% specificity would have a positive predictive value of only 4.8% which means 20 out of 21 women undergoing surgery for suspected ovarian cancer will not have the disease.

High risk women

The definite risk factor known to increase the risk of ovarian cancer include an identified BRCA gene mutation and a family history of cancer which is suggestive of ovarian cancer syndrome. Women with these conditions should be referred for genetic testing for proper assessment of the risk of developing ovarian cancer. Women with BRCA-1 mutation have a life time risk of 63% for developing ovarian cancer before the age of 70 years and breast cancer risk is 85%. Risk of developing ovarian and breast cancer are 27% and 84% respectively among women who show BRCA-2 mutations before the age of 70 years.

Women with Lynch syndrome/hereditary non-polyposis colorectal cancer(HNPCC) caused by DNA mismatch repair genes carry the risk of developing endometrial cancer in 42-60%, ovarian cancer in 9-12% by the age of 70 years and also have 40-60% life time risk of developing colorectal cancer.

The strongest known risk factor is a family history of the disease which is present in about 10-15% of women with ovarian cancer. Women with a single family member affected by epithelial ovarian cancer have a risk of 4-5%, while with two affected family members the risk is 7%. Women with hereditary ovarian cancer syndrome defined as having at least two first degree relatives with epithelial ovarian cancer have a life time probability as high as 13- 55% to develop epithelial ovarian cancer. Know more about ovarian cancer here: canadianhealthmall.com.

Other risk factors

1. Age-Incidence increases with age; median age at diagnosis is 63.
2. Obesity
3. Hormone replacement therapy (HRT)
4. Early menarche and late menopause
5. Endometriosis
6. Smoking (stop smoking with Canadian Health Care Mall – watch here)
7. Association between ovulation induction and ovarian carcinoma Infertility alone is an independent risk factor. Nulliparous women have a higher risk of ovarian cancer irrespective of usage of fertility drugs. A 2013 Cochrane review concluded that there may be an increased risk of borderline ovarian tumours in sub-fertile women but no convincing evidence of increase in the risk of invasive epithelial ovarian cancer with fertility drug usage.

Screening methods

ACOG recommends that the best way to detect ovarian cancer is for both the patient and her clinician to have a high index of suspicion of the diagnosis in symptomatic women. But there are no tests that could reliably detect ovarian cancer in its earliest and most curable stage and so educating women and practitioners about symptoms and prompt initiating work up helps in timely diagnosis and treatment.

Symptoms and signs are usually present 3-6 months at least before diagnosis, these include increased distension or bloating, abdominal or pelvic pain, feeling full quickly or difficulty in eating etc. These symptoms and signs should be evaluated with suspicion of ovarian cancer, with pelvic examination, TVS and CA-125. Though a thorough bimanual pelvic examination is cost effective, it is not cost sensitive to detect ovarian cancer in asymptomatic women.

Tumour markers

CA-125 is the most extensively studied tumour marker in ovarian carcinoma. Ca-125 is a glycoprotein produced by majority of epithelial ovarian cancer (EOC). It is elevated in 61-95% of symptomatic patients with EOC and in 29- 75% of those with stage I disease. Normal value is 30- 35 U/ml, it is influenced by menopausal status. In premenopausal women the sensitivity is decreased. It also can be elevated in other cancers like endometrial, breast, lung, lymphoma, colorectal cancer etc. It is also elevated in certain benign conditions like endometriosis, uterine leiomyoma, pregnancy, PID etc. It is not specific for ovarian cancer. In malignancy serial measurements show increase in value. Screening using a single CA-125 measurement is not specific with low sensitivity. Serial measurements combined with TVS improves sensitivity and specificity.

Trans vaginal sonography

It has been found to be safe and effective means visualizing ovaries. The earlier studies mainly focused on ovarian volume, normal premenopausal ovarian volume established to be >20 ml and for post menopausal women the cut off value is 8-10 ml. Risk Malignancy Index (RMI) is the most widely used index to diagnose ovarian cancer in suspected cases. It combines three pre-surgical features: serum CA-125, menopausal status (M) and Ultrasound score (U).
RMI: U x M x CA-125

U: One point for each of these morphological criteria- multilocular cysts, solid areas, bilateral lesion, metastases, ascites

M: Menopausal status is scored as 1 for premenopausal and 3 for postmenopausal status.

RMI score of 200 indicates high degree of suspicion of ovarian malignancy, sensitivity of 78% and specificity of 87%.The routine use of CT/MRI for assessment of ovarian masses does not improve sensitivity and specificity obtained by TVS in the detection of ovarian malignancies. What is needed is a multimodal screening using CA-125 and ultrasound. Patient should be referred to a specialist if four or more of the following indicators are present.

1. Premenopausal (< 50 Years)

A. CA-125 > 200 U/ml
B. Ascites
C. Evidence of abdominal/distant metastases by
scan or imaging studies.
D. Family history of breast or ovarian carcinoma
(first degree relatives)

2. Post menopausal women (≥ 50 years)

A. Elevated CA-125 > 35 U/ml
B. Ascites
C. Nodular or fixed pelvic mass
D. Abdominal or distant metastases
E. Family history of breast or ovarian carcinoma
(first degree relatives)

In this study 240 patients were male as compared to female 140 female patients. Age of the patients varies between 17-58 years with average age being 26.5 years. Most common presentation in this study was ureteric colic (70%) followed by burning micturition (50%) followed by vomiting (40%) and fixed renal pain in 30% cases. Most common sign was haematuria (80%).

A stone in the ureter usually arises in the kidney and enters in to the ureter subsequently. Most calculi are small and pass spontaneously. Typically most patients present with sudden onset of agonizing pain, which may radiate to the groin, sacrum, labia, scrotum and the anterior surface of thigh. Presence of stone in ureter does not necessitate the surgical intervention.

Important factors that decide spontaneous passage of stones are its size, location and degree of obstruction at the initial presentation. Conservative treatment or medical treatment is probably most effective for stone size of 3- 10mm.

Overall incidence of stone passage with medical treatment is >65%. Many randomized trials prove the efficacy of conservative or medical treatment and helps in reducing the pain and helps in stone passage. Thus overall rate of surgical intervention is reduced with medical treatment. Conservative treatment using medical therapy is found to be cost-effective before embarking upon surgical option.

Most stone that will pass spontaneously with conservative management, will pass within 4-6 weeks. According to meta-analysis done by Marlene Busko conclude that all patients with stone size up to 1 cm who are candidate for observation should be offered trial of medical therapy. Conservative or medical management should not be offered to patients with >1cm size stone, high grade obstruction or patients in sepsis.

According to Pak et al, high fluid intake in such ways that urine output remains above 3 liters per day, has shown that there is reduction in saturation of calcium phosphate, calcium oxalate thus decreasing the chances of stone formation. High fluid intake is associated with increase in inhibitory activity of Tamm-Horsfall protein.

Diuretics like Dicontin–K inhibits the sodium-potassium chloride channel in the ascending limb of loop of henle. It increases the urine output. Calcium channel blockers and α-blockers have been found to be associated with antegrade propulsion of stone by inhibiting ureteral spasm.

Diclofenac sodium inhibits the formation of prostaglandins and helps in relieving pain of stone colic. In addition to anti-inflammatory action, Diclofenac sodium interferes with auto-regulatory response by reducing renal blood flow and does not affects the renal function in normal kidney. Calcium channel blockers are smooth muscle relaxant. Few small prospective studies show that it facilitates spontaneous passage of stone if it is combined with prednisolone which is strong anti-inflammatory drug.

In this study, there was a male preponderance (60%) and median age of presentation was 26.5 years with age varies between 18-75 years. Ureteric stone was more common on right side as compared to left side (60% vs. 40%) in this study.

Most common presentation was ureteric colic in 280 patients (70%), followed by burning micturition in 200(50%) followed by vomiting (40%) and fixed renal pain in 30% cases. Most common sign was haematuria in 290 (80%) followed by urinary tract infection in 230(60%) of patients. Absence of haematuria does not rule out present the stone. According to one study, 67% of patients with ureteric stone had more than 5 RBC per high power field and 89% of patients had more than 0 RBC/hpf on urine microscopic examination.

Total number of patients with stone up to 4mm size were 210(52.5%), 5-6mm were 40(10%) and 7-10mm were 150(37.5%). Patients with stone size up to 4mm were offered regime 1 out of 210 ,120 patients had passed stone with regime 1& 30 patients were referred for surgery because of high grade obstruction they develop. Remaining 60 patients were switch over to regime 2, out of those 48 (80%) patients had passed stone.

Those patients of 5-6mm and 7-10 mm were offered regime 2.out of 190 patients,114 patients had passed stone with success rate of 60%.comparing the efficacy of regime 1 to 2, regime 2 was found to be more effective for upper 1/3rd(P:0.011) and lower 1/3rd (p=0.000). For middle 1/3rd, there was no statistical significant difference was found (p:=0.676).Overall success rate with regime 2 was 80%.

Stone passage rate was highest in the lower ureter 1/3rd (80%) followed by middle 1/3rd (45%) and upper 1/3rd (40%). According to Ueno et al, width is a critical determinant of spontaneous passage of stone. So we considered width as a parameter for patient’s selection. We found that stones measuring 5 mm or smaller in size will usually pass spontaneously in 80% cases, while stones measuring 6mm or larger in size will pass spontaneously in 60% cases.

Though Stone size and location is very important predictor of stone passage, many other factors decide the fate of stone. It is known that the larger the stone lower the probability of spontaneous passage. With regard to the location of stone, our study showed that if a stone was present in the upper 1/3rd of ureter at the time of diagnosis, the overall frequency of spontaneous passage was 40%. The frequency of spontaneous passage of stones in the distal 1/3rd of ureter was significantly higher than that of stones in the upper 1/3rd (80%).

A review of the literature published by Hubner et al in 1993 included 2,704 cases derived from six studies; they reported frequencies of spontaneous passage of 12% for proximal ureteral stones, 22% for mid ureteral stones, and 45% for distal ureteral stones. Review by Singh et al show that medical treatment using either α-blockers or calcium channel blockers improve the stone passage rate for moderately sized distal ureteral stones. Adverse drug reactions were noted in 4% of those taking α-blockers and in 15.2% of those taking calcium channel blockers.

Meta-analysis by Hollingsworth et al also concludes that medical therapy with either calcium channel blockers or α- blockers may increase the chance of spontaneous passage of stone. Steroid has also found to important in the conservative management of ureteric stone. Addition of steroid to α blocker has been found to shorten the time for spontaneous passage.

Overall success rate is 70.5% in this study for stone up to 10 mm in size (282 patients have passed stone out of 400) In our study, higher stone clearance rate was noted with regime 2. Those patients who were not responded to regime-1 were switch over to regime-2 and responded very well (80%). There was a statistically significant difference was noted with regime 2 for at least lower 1/3rd (p=0.000) and upper 1/3rd calculus (p=0.011). Better response rate was probably because of addition of calcium channel blockers and steroids.

Only those patients who required intervention were admitted to the hospital. All other patients were managed at home by medical treatment. No patients in our study showed any significant side effects associated with drugs.

Medical expulsive therapy using calcium channel blocker and steroid is a rational approach for management of ureteric calculi. It is cost effective and patients can be treated on outpatients’ basis. Patients can carry out his day to day work with medical expulsive therapy without significant side effect.