Meloxicam – an overview | ScienceDirect Topics

Ketorolac

Ketorolac, until recently, was the only parenteral NSAID available in the United States and was therefore used quite extensively in the perioperative period. Pharmacologically, it is a member of the pyrrolo-pyrrole group and is avidly protein bound, resulting in a low volume of distribution. Ketorolac is extensively conjugated in the liver and then excreted in the urine. Time to measurable effect is about 30 minutes, with a peak effect noted at 1 to 2 hours and a duration of action of 4 to 6 hours.

In the management of postoperative pain, ketorolac has proven very useful, with an opioid-sparing effect and efficacy similar to morphine in the treatment of moderate pain.^39,40 Concerns exist regarding the renal safety profile of ketorolac in the perioperative setting that have necessitated modifications of dosing guidelines. Previously, the drug was administered at a 60-mg initial dose followed by 30 mg every 4 hours, and cases of acute tubular necrosis were reported. Gastrointestinal bleeding and operative site bleeding have also been reported and are mostly associated with advanced patient age, duration of therapy beyond 5 days, and higher dosing regimens.⁴¹ Subsequently, dosing recommendations were decreased by more than 50%. The ketorolac product labeling now advises the following intravenous dosing protocol: for a single dose, 30 mg intravenously or 15 mg if patient age is greater than 65 year or body weight less than 50 kg; for multiple dosing, patients should be commenced on 30 mg every 6 hours, not to exceed 120 mg in a 24-hour period; in those older than 65 years or weighing less than 50 kg, the dosing should be 15 mg every 6 hours, not to exceed 60 mg in 24 hours.⁴² In no circumstance should dosing go beyond 5 days of therapy, and ketorolac is best avoided in patients with a history of peptic ulcer disease or renal impairment.

Acetaminophen

Acetaminophen, while strictly speaking is not an NSAID, is generally grouped in this therapeutic class and plays a major role in analgesic therapy. Acetaminophen is a para-aminophenol derivative with analgesic and antipyretic properties similar to aspirin. The very useful antipyretic effect is thought to be a direct effect on the hypothalamic heat-regulating centers via inhibiting action of endogenous pyrogens. Recent reports suggest that acetaminophen acts via serotonergic pathways, COX-3 inhibition, and/or endogenous cannabinoid potentiation to provide analgesia, but its mechanism of action remains poorly understood.^43–45 Although equipotent to aspirin in inhibiting central prostaglandin synthesis, acetaminophen has no significant peripheral prostaglandin synthetase inhibition and is therefore less useful than NSAIDs for painful inflammatory disorders.

Acetaminophen has few side effects in the usual dosage range; unlike NSAIDs, no significant gastrointestinal toxicity or platelet function inhibition occur. Acetaminophen has, however, been associated with the development of hypertension but has not yet been associated with increased cardiovascular risk. ⁴⁶ Nephrotoxicity also can occur with acetaminophen but less frequently than it occurs with NSAIDs.⁴⁷

Acetaminophen is completely and rapidly absorbed following oral administration, and peak serum concentrations are achieved within 2 hours. About 90% of acetaminophen is hepatically metabolized to sulfate and glucuronide conjugates for renal excretion with a small amount secreted unchanged in the urine. Minor metabolites are responsible for the hepatotoxicity seen in overdose.⁴⁸ CYP 450 enzyme system induction in the liver by any agent, including ethanol, increases the formation of toxic free radial metabolites and thereby increases hepatotoxicity. In the healthy individual, daily doses of 2.6 to 3.2 g are generally considered safe, but acetaminophen dosing should not exceed 4 g/day.^49,50 In patients with a history of ethanol abuse or liver disease, acetaminophen should generally be avoided.

The bioavailability of rectal acetaminophen is variable and is approximately 80% of that following oral administration. The rate of rectal absorption is slower, with maximum plasma concentration occurring 2 to 3 hours after administration. Doses of 40 to 60 mg/kg of rectal acetaminophen have been shown to have an opioid-sparing effect in the management of postoperative pain.⁵¹ In Europe, an intravenous prodrug form of acetaminophen, propacetamol, and intravenous acetaminophen are available for clinical use and have been shown to reduce postoperative opioid consumption.^52,53 In 2011, an intravenous form of acetaminophen was introduced in the United States for the parenteral management of pain and fever.⁵⁴ Intravenous acetaminophen (1 g every 4 hours for 24 hours) was well tolerated, improved pain reporting, and decreased morphine consumption after orthopedic surgery.⁵⁵

Meloxicam Drug Information – Indications, Dosage, Side Effects and Precautions

Generic Name : Meloxicam

Pronunciation : mel-OX-i-kam

Latest prescription information about Meloxicam. Learn how to pronounce the drug’s name, its indications, dosage, how to take, when to take, when not to take, side effects, special precautions, warnings and its storage instructions . Also listed are the International and Indian trade name(s) of the drug and its price list.

ICD Code : Y45.3 |

Therapeutic Classification : Analgesics

This medication is a non-steroidal anti-inflammatory drug (NSAID), prescribed for pain, swelling, and stiffness caused by breakdown of joints. It is also used in children 2 years of age and older for juvenile rheumatoid arthritis (a type of arthritis that affects children). It prevents the production of certain chemicals that cause pain and inflammation in the body. 

Hypersensitivity to this medication, aspirin or other NSAIDs; severe liver impairment; bleeding disorders; kidney failure without dialysis. Rectal administration is contraindicated in patients with inflammation of the anus and the rectum, hemorrhoids (swelling and inflammation of the veins in the rectal and anus) or rectal bleeding, perioperative pain in patients who have undergone coronary artery bypass graft.

Oral/Rectal- Ankylosing spondylitis; Rheumatoid arthritis- 15 mg once daily.

Patients with increased risk of adverse effects- Initial: 7.5 mg.

Acute exacerbations of osteoarthritis- 7.5 mg once daily. Max: 15 mg once daily.

It comes as a tablet and suspension (liquid) to take by mouth. It is usually taken once a day with or without food.

Caution must be exercised in patients with history of GI disease, asthma, hypertension, heart disease, fluid retention or heart failure, elderly, during pregnancy and breastfeeding.

Monitor patients with advanced renal disease.

It may cause dizziness, lightheadedness or fainting. Do not drive a car or operate machineries while taking this medication.

  Heart:
Chest pain, abnormal heart rhythm, cardiac failure, hypertension, heart attack, fast heart rate, risk of blood clots and stroke.


  Central Nervous System:
Headache, dizziness, sleeplessness, abnormal dreaming, anxiety, confusion, convulsions, depression, fatigue, increased appetite, nervousness, general discomfort, drowsiness, tremor and vertigo.


  Skin:
Rash, itching, hair loss, swelling of the skin, skin eruption, increased sweating, photosensitivity reaction, redness of the skin and multiforme(allergic reaction that occurs in response to medications).


  Eye and ENT:
Inflammation of pharynx, abnormal vision, inflammation of conjunctiva, taste perversion and abnormal noise in the ear.


  Gastrointestinal:
Indigestion, diarrhea, nausea, abdominal pain, constipation, flatulence, vomiting, dry mouth, duodenal ulcer, eructation, difficult and painful swallowing, gastric ulcer, heart burn, GI bleeding and blood vomiting.


  Genitourinary:
Urinary tract infection, frequent urination, albumin in urine, increased BUN(Blood, Urea, Nitrogen) and creatinine, blood in urine and kidney failure.


  Blood:
Anemia, decrease in white blood cells, platelets and easy bruising.


  Liver:
Increased liver enzymes, bilirubinemia, inflammation of liver and liver failure.


  Metabolic:
Dehydration, weight loss or gain.

  Musculoskeletal:
Muscle pain, back pain, joint-related signs and symptoms.


  Respiratory:
Upper respiratory tract infection, coughing, asthma and shortness of breath.


  Miscellaneous:
Influenza-like symptoms, swelling of leg, household accidents, allergic reaction, face edema, fever and hot flushes.

What Does It Look Like? Can It Kill?

Can you overdose on Meloxicam? Yes, it is possible. For the most part, Meloxicam is safe to consume for treatment, granted that the patient sticks to their prescription. However, if they don’t use it as their prescription states, they could potentially overdose on it. The symptoms of an OD may appear suddenly, which is why it’s important that the patient has all the necessary information about ODs and knows what to look out for, so their life can be saved as fast as possible.

Can You Overdose on Meloxicam?

Mobic isn’t the standard run-of-the-mill pain-killing medication or opioid, making it slightly safer for health than most drugs. But that doesn’t mean that it’s entirely safe for health to consume without bounds.

This drug, like other NSAIDs, might be less potent than an opioid. However, it’s still potent enough to help patients deal with pain. Since it’s an anti-inflammatory drug, it is still possible that the patient can OD if they aren’t careful when they’re taking it. They should have information about the drug’s safety and information about overdoses while using the medicine.

Although there are still minimal studies and information on Mobic NSAIDs overdoses, they are possible. Four cases have been recorded so far where the patient had taken more of the drug than they were prescribed, and although only one of them was in a severe condition, they had all suffered damage to the GI tract; however, they all recovered.

However, they all received medical attention fairly quickly, so the OD symptoms could be controlled, and they could be nursed back to health. That may not be the case for someone that doesn’t manage to get medical attention right away. Even though the medication appears as a “harmless” anti-inflammatory drug, things can worsen significantly if the prescription isn’t followed.

Meloxicam Overdose Amount

Physicians tend to prescribe a person Meloxicam medication at the lowest dose possible that yields effective results in alleviating the individual’s pain and inflammation. In most cases, this would be a daily use of 5-7.5 mg dosage of the drugs. It reduces the risk of OD.

When the individual does not experience significant help in relieving pain or the other symptoms they’ve been dealing with, the physician may increase the drug to a maximum of 15 mg.

The maximum daily dose of Meloxicam for adult patients is 15 mg. However, it is possible that the patient ends up experiencing an NSAIDs OD without everyday use or one-time use of 15 mg of drugs; the amount of this drug the patient can safely consume depends on their body composition and their tolerance. Effects of an OD because of the drugs may appear unexpectedly too.

That is because Meloxicam can end up affecting the heart, regardless of whether they have pre-existing heart conditions. It may still cause heart failure or GI tract problems such as intestinal bleeding even if they had no prior history of the disease. The risk is higher for patients with pre-existing heart conditions or who are predisposed to GI problems. That is why the physician in charge will try to get them alternative medication first, but if they have to use Mobic, they should be monitored closely for any overdose symptoms.

Mobic Overdose Symptoms

It is important to consider the symptoms presented in a patient when they have taken a Meloxicam overdose amount (anywhere over 15 mg). First, it is crucial to understand the effects that the drug has on the body can be significantly elevated. For example, NSAIDs like Mobic can raise blood pressure, and those with pre-existing hypertension may experience an unhealthy spike in their blood pressure levels.

Another factor to be taken into account is drug interactions Meloxicam has been associated with. Taking Mobic together with those drugs can cause even more severe symptoms to develop.

In the Majority of Cases, When an Individual Overdoses on Mobic, They Would Experience the Following Symptoms:

• Nausea
• Vomiting
• Drowsiness
• Epigastric pain
• Lethargy

There are some cases where symptoms can become more severe. Some patients may experience gastrointestinal bleeding.

In a Patient Who Develops Poisoning as a Result of the Mobic Overdose, the Following Symptoms May Also Develop:

• Acute renal failure
• Coma
• Convulsions
• Respiratory depression
• Hepatic dysfunction
• Hypertension
• Cardiovascular collapse
• Cardiac arrest

The half-life of Meloxicam also needs to be taken into account here to consider how long it would take the body to expose the medication. The half-life of the drug is considered to be 20 hours on average.

Individuals who think that a glass of wine is okay with Meloxicam should understand that alcohol is not advisable when this particular drug is used, especially when taking more than the initial amount of Mobic. Such a combination can significantly aggravate the Meloxicam side effects. It’s essential to seek help immediately when any of the OD symptoms appear to have the lowest risk of death possible.

Meloxicam Overdose Death

Since Meloxicam overdose is linked with cardiovascular and extreme GI tract complications, the FDA has added a black box warning to the drug. Even if the patient wasn’t predisposed to cardiovascular or GI tract conditions, they could still experience fatal effects while using this drug. That is why it’s recommended that a close eye is kept while the patient is using the medicine. The lowest dose should be used for the shortest amount of time possible.

Other than the four extreme cases mentioned above, there haven’t been many studies that study the possibility of death because of Meloxicam in humans, although limited testing has been done on animals to check the safety.

Studies testing the drug’s safety in humans have found that as long as the patient gets medical treatment to stop the overdose symptoms, Meloxicam overdose death can be avoided.

Meloxicam Overdose Treatment

Without prompt treatment, the development of poisoning can rarely lead to a Meloxicam overdose death. Even though patients might think it’s okay to take more of the anti-inflammatory drug than stated in the prescription, it isn’t. That is why individuals are advised to understand how an overdose on the medication should be treated. If a patient takes more medicine than prescribed and any OD symptoms appear, a call to the emergency is the right step to take.

If the prescribed dose doesn’t seem to be effective anymore, a patient should call their physician, explain that the prescribed dose does not seem to be working for them, and ask permission to increase the daily amount.

Can Meloxicam Overdose be Managed at Home?

Home-based treatment, apart from supportive care while awaiting a medical team, is not advised. Gastric lavage is the preferred initial treatment for an overdose on Meloxicam. Once gastric lavage has been performed, the patient should be provided with activated charcoal. It is essential to seek medical assistance soon after the overdose occurs.

In cases where the drug has already entered the person’s bloodstream, a dose of Cholestyramine may be advisable. This medication has been shown to cause the Meloxicam chemical to be expelled from the body faster than usual. Overdose can be dangerous, and if it happens, professional Mobic withdrawal assistance is advised. If one noticed any signs of abusing Meloxicam, an OD happened, it is necessary to look for drug addiction treatment at a professional rehabilitation facility.

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Page Sources

1. Zeidler, H. , Kaltwasser, J. P., Leonard, J. P., Kohlmann, T., Sigmund, R., Degner, F., & Hettich, M. (2002). Prescription and tolerability of Meloxicam in day-to-day practice: postmarketing observational cohort study of 13,307 patients in Germany. Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases, 8(6), 305–315. https://pubmed.ncbi.nlm.nih.gov/17041399/
2. United States Food and Drug Administration. Mobic. Prescribing Information https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/020938s022lbl.pdf
3. Howes L. G. (2007). Selective COX-2 inhibitors, NSAIDs and cardiovascular events – is celecoxib the safest choice?. Therapeutics and clinical risk management, 3(5), 831–845. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2376081/
4. Bergese, S. D., Melson, T. I., Candiotti, K. A., Ayad, S. S., Mack, R. J., McCallum, S. W., Du, W., Gomez, A., & Marcet, J. E. (2019). A Phase 3, Randomized, Placebo-Controlled Evaluation of the Safety of Intravenous Meloxicam Following Major Surgery. Clinical pharmacology in drug development, 8(8), 1062–1072. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6899482/
5. Lehr, T., Staab, A., Tillmann, C., Trommeshauser, D., Schaefer, H. G., & Kloft, C. (2009). A quantitative enterohepatic circulation model: development and evaluation with tesofensine and Meloxicam. Clinical pharmacokinetics, 48(8), 529–542. https://pubmed.ncbi.nlm.nih.gov/19705923/

Published on: May 14th, 2019

Updated on: August 3rd, 2021

Dr. Ahmed Zayed is a Bachelor of Medicine and Surgery. He is graduated from the University of Alexandria, Egypt. Dr. Ahmed Zayed has a passion for writing medical and health care articles and focuses on providing engaging and trustworthy information to readers.

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.

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Meloxicam Tablets 7.5 Mobic — Boehringer Ingelheim | 2000-05-29 | AHC Media: Continuing Medical Education Publishing | Relias Media

Pharmacology Update

By William T. Elliott, MD, FACP and James Chan, PharmD, PhD

Given the popularity of the new cox-2 inhibitors, the introduction of a new nonsteroidal anti-inflammatory drug (NSAID) seems positively old fashioned, but that is exactly what Boehringer Ingelheim has done. Meloxicam is a new NSAID that was recently approved by the FDA for marketing. It is an oxicam nonsteroidal anti-inflammatory agent chemically similar to piroxicam (Feldene). In contrast to the recently introduced selective cyclooxygenase (COX)-2 inhibitors such as celecoxib (Celebrex) and rofecoxib (Vioxx) which are primarily inhibitors of COX-2, meloxicam has as preferential cyclooxygenase-2 selectivity. ¹ Meloxicam will be marketed in this country by Boehringer Ingelheim and Abbott Laboratories.

Indications

Meloxicam is indicated for the relief of signs and symptoms of osteoarthritis (OA).

Dosage

The recommended starting and maintenance dose of meloxicam is 7.5 mg with a maximum dose of 15 mg/d.² It may be taken without regard to meals or antacids. The drug is supplied as 7.5-mg tablets.

Potential Advantages

Meloxicam has a long elimination half-life (about 20 h) and is dosed once daily. No dosage adjustment is required in patients with mild to moderate renal or hepatic impairment. Meloxicam does not appear to affect the pharmacokinetics and the average anticoagulant effect of warfarin as determined by prothrombin time. However, monitoring is recommended, particularly in the first few days after initiating or changing meloxicam therapy in patients taking warfarin. ²

Potential Disadvantages

Similar to other NSAIDs, gastrointestinal (GI) adverse events were the most frequently reported events in the clinical trials.² GI side effects may be more frequent than originally expected as, after the product was launched in the United Kingdom, the product labeling had to be updated to include stronger warnings for GI side effects and skin reactions. Forty-one percent of suspected adverse reactions reported (1330 in the first 21 months) were GI-related, including 18% perforations, ulcerations, and bleeding. Fourteen percent were dermatological side effects.^5,8 Meloxicam is only approved for use in OA.

Comments

Meloxicam is an oxicam NSAID with greater activity against the inducible isoform of COX-2 than the constitutive COX-1. Its efficacy is reported to be similar to other NSAIDs, such as piroxicam, diclofenac, or naproxen,^1,2,6 but early clinical trials suggest that meloxicam had improved gastrointestinal tolerability compared to piroxicam, diclofenac, or naproxen. ^1,3,4,7 Meloxicam in doses of 7.5 mg-15 mg/d was compared to piroxicam 20 mg/d, diclofenac 100 mg/d, or naproxen 750 mg/d. A meta-analysis of meloxicam studies (10 randomized trials, n > 20,000, duration up to 24 weeks) suggests that it causes fewer GI adverse events than non-COX-2 selective NSAIDs, including less dypepsia, fewer PUBs, and less frequent withdrawal of NSAIDs because of adverse events.³ However, the postmarketing experience in the United Kingdom suggests that GI events may be higher than suggested by these trials. A possible explanation of this difference may be the dose. The two largest trials—the Meloxicam Large-scale International Study Safety Assessment (MELISSA, n = 9323) and Safety and Efficacy Large-scale Evaluation of COX-Inhibiting Therapies (SELECT, n = 8656), were conducted with the lower, 7.5-mg dose. Thus, the preponderance of the safety evidence is based on this dose. Some patients may need a higher dose as there was some evidence that meloxicam may be less efficacious than other NSAIDs. In the MELISSA trial, there were more patients who discontinued meloxicam (7.5 mg/d) because of lack of efficacy compared than to diclofenac (100 mg/d) (odds ratio 1.66; 95% CI: 1.16-2.38).⁴ Meloxicam in low doses may have less effect on platelet aggregation than non-COX-2 selective NSAIDs such as diclofenac or indomethacin.^9,10

The product labeling for meloxicam, unlike the selective COX-2 inhibitors, did not mention reduced GI events with meloxicam and other NSAIDs.² Meloxicam (7.5 mg) costs about $2 per day, which is lower than celecoxib and rofecoxib, which are about $2.50 per day.

Clinical Implications

It is not clear if meloxicam offers any clear advantage over non-COX-2 selective NSAIDs. There have been no published comparative trials between meloxicam and COX-2 preferential inhibitors, such as nabumetone or etodolac, or COX-2 selective agents, such as celcoxib and rofecoxib.

References

1. Noble S, Balfour JA. Drugs 1996;51(3):424-430.

2. Mobic Product Labeling. Boehringer Ingelheim. April 1999.

3. Schoefeld P. Am J Med 1999;107(6A):48S-54S.

4. Hawkey C, et al. Br J Rheumatol 1998;37(9):937-945.

5. FDC Report. The Pink Sheet 1998;60(51):5.

6. Lipscomb GR, et al. Br J Clin Pharmacol 1998;46:133-137.

7. Dequeker J, et al. Br J Rheum 1998;37:946-951.

8. FDC Report. The Pink Sheet 1998;60(37):13.

9. Tegeder I, et al. Clin Pharmacol Ther 1999;65(5):533-544.

10. de Meijer A, et al. Clin Pharmacol Ther 1999;66(4): 425-430.

Meloxicam Withdrawal & Detox – The Recovery Village Drug and Alcohol Rehab

Meloxicam is a prescription non-steroidal anti-inflammatory drug (NSAID), otherwise known as an anti-inflammatory medication. Although it is not a narcotic medication and does not provide people a high, it is occasionally abused by people seeking to fuel their substance use disorder. However, for those who are taking meloxicam, there information about the medication and its effects that are important to know prior to stopping the medication.

Meloxicam Withdrawal

Withdrawal from meloxicam is generally not difficult, and the drug may be safely stopped without any tapering. However, there may be some symptoms that are unmasked by stopping the drug, and it may be wise for people to take precautions to avoid any discomfort. An awareness of meloxicam helps people anticipate any potential problems, but it is always wise to discuss medications with a healthcare provider when considering discontinuing any drug.

Meloxicam Withdrawal Symptoms

There are no withdrawal symptoms from meloxicam, as there is from alcohol, opioids or stimulants. This characteristic is because meloxicam is not psychoactive, meaning that it does not readily cross the blood-brain barrier and affect the brain’s chemistry.

Although meloxicam does not cause a withdrawal syndrome, because meloxicam is used for the treatment of pain and inflammation anyone who suddenly stops taking the medication may experience the return of their pain or inflammation. This return would include the symptoms of inflammation such as stiffness, swelling, redness, and heat. Stopping meloxicam does not require tapering, although the dose may be gradually lowered prior to people who do not require the urgent cessation of the drug.

How Long Does Meloxicam Withdrawal Last

The elimination half-life — the length of time it takes the body to metabolize and get rid of half of the drug in your system — of meloxicam is 15-20 hours. There is no known “rebound” worsening of symptoms after stopping meloxicam, so the only effect of stopping meloxicam will be the unmasking of symptoms that were suppressed by the drug. The return of any symptoms will last as long as the condition causing them is active, and does not depend on the medication itself. As mentioned, meloxicam has no withdrawal symptoms.

Meloxicam Withdrawal Medications

There are no specific safety concerns about withdrawing from meloxicam, such as there are with alcohol withdrawal, so there is no direct requirement to use any withdrawal medication. However, to prevent the return of the pain or inflammation that the meloxicam was suppressing, a health care provider may want to prescribe another treatment to help with the symptoms. Other treatments could be other inflammation-suppressing medications (such as prednisone, other NSAIDs, or anti-rheumatics), pain medication (such as other NSAIDs, or acetaminophen) or physical anti-inflammatory and pain treatments (such as physical therapy, acupuncture, ice, elevation, compression and rest).

Meloxicam Withdrawal Deaths

Although meloxicam itself can cause side effects that are potentially fatal (such as bleeding in the stomach, or kidney problems), meloxicam withdrawal itself is not known to carry a risk of death. As such, withdrawing from the medication can be done safely at home, without any tapering. However, discussing the discontinuation of any drug with a healthcare provider is necessary. A physician may advise the use of another medication to ease the unmasking of any symptoms that the meloxicam may have been managing.

Meloxicam Withdrawal Cold Turkey

If a person must stop taking meloxicam, there are no specific dangers to their health from stopping the medication cold turkey. However, a person may wish to taper the medication or use an alternative to ease the return of the pain and inflammation symptoms for which they were taking the medication.

Meloxicam Withdrawal Tips

Someone that is planning to stop taking meloxicam should do so in consultation with their doctor. If they were taking meloxicam that wasn’t theirs or taking more than the prescribed dose they should be honest with their doctor about that behavior. They can also discuss what, if any, of their pain or inflammation symptoms, may return after stopping the medication, and whether an alternative treatment may be needed.

Meloxicam Detox

When meloxicam is taken, most of it is metabolized and removed from the body in less than a day, so there is no prolonged detoxification involved with stopping meloxicam use. Because there are no withdrawal symptoms associated with meloxicam, the detox process is not challenging like an opioid’s detox process is. Always consult with your doctor before changing your medicinal regimen in any way.

Meloxicam Detox at Home

It’s safe to withdraw from meloxicam at home, so long as it’s approved by a doctor. It may be wise to plan a quiet, restful day with someone nearby to help in case pain and inflammation symptoms return and cause discomfort or limited mobility. Involving friends and family in the process is usually helpful as they can provide comfort and support that an individual would not have if they were on their own.

Helping Someone Withdrawing or Detoxing from Meloxicam

Being informed is the best way to help someone who is planning to stop taking meloxicam. By understanding the drug and its effects and available alternatives to the drug, a person can plan their safe withdrawal with confidence. As with any drug, consulting a physician prior to discontinuation is wise.

Finding a Meloxicam Withdrawal and Detox Center

It generally isn’t necessary to attend a drug withdrawal and detox center to withdraw from meloxicam. However, if meloxicam is part of a larger trend of substance misuse, contact The Recovery Village to speak with a representative about how substance use disorder treatment can work for you. Using individualized treatment plans that address addiction and any co-occurring mental health disorders, The Recovery Village provides each patient with the treatment that will work best for their individual needs. Take a step toward a healthier future by calling today.

Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.

best use of medicine in pregnancy

(Date: March 2019. Version: 3)

This factsheet has been written for members of the public by the UK Teratology Information Service (UKTIS). UKTIS is a not-for-profit organisation funded by Public Health England on behalf of UK Health Departments. UKTIS has been providing scientific information to health care providers since 1983 on the effects that medicines, recreational drugs and chemicals may have on the developing baby during pregnancy.

What is it?

Meloxicam is a type of painkiller that your doctor may prescribe to treat rheumatic pain and inflammation. It belongs to a class of drug called non-steroidal anti-inflammatory drugs (NSAIDs). This leaflet summarises the scientific studies relating to the effects of meloxicam on a baby in the womb.

Use of meloxicam during pregnancy is not advised unless prescribed by your doctor, especially if you are 30 or more weeks pregnant. Paracetamol is usually recommended to control pain or fever during pregnancy. If paracetamol does not control your pain it is important that you ask your doctor for advice before taking meloxicam or any other NSAID. Meloxicam may be prescribed during pregnancy for some women with certain illnesses; women who need to take meloxicam after 30 weeks of pregnancy will be monitored by a fetal medicine specialist.

What if I have already taken meloxicam during pregnancy?

Taking meloxicam before week 30 of pregnancy is unlikely to harm a baby in the womb. However, if you have taken or are taking any medicines it is always a good idea to let your doctor know that you are pregnant so that you can decide together whether you still need medication.

If you have taken meloxicam after week 30 of pregnancy it is important that you let your doctor or midwife know as soon as possible.

Can taking meloxicam in pregnancy cause miscarriage?

It is unclear whether taking meloxicam in early pregnancy could increase the chance of miscarriage. No studies have investigated the likelihood of miscarriage in women specifically taking meloxicam. Some studies have, however, shown that women who take any type of NSAID during pregnancy are more likely to have a miscarriage than women who do not.

Can taking meloxicam in pregnancy cause my baby to be born with birth defects?

A baby’s body and most internal organs are formed during the first 12 weeks of pregnancy. It is mainly during this time that some medicines are known to cause birth defects.

No studies have assessed the chance of birth defects in babies born to women who specifically took meloxicam in early pregnancy. Current information does not raise alarm that birth defects are caused by general use of NSAIDs in pregnancy, although ongoing research is needed.

What problems can taking meloxicam after 30 weeks of pregnancy cause in my baby?

Premature closure of the ductus arteriosus
Before birth, a blood vessel in the baby called the ductus arteriosus needs to stay open to supply the baby in the womb with nutrients and oxygen from the mother. The ductus arteriosus closes after birth. ‘Premature closure of the ductus arteriosus’ is the medical term used to describe this blood vessel closing before it is supposed to.

Taking meloxicam or another NSAID after 30 weeks of pregnancy can cause the ductus arteriosus to close while the baby is in the womb. It is important to contact your doctor or midwife straight away if you have taken an NSAID after 30 weeks of pregnancy, especially if you have taken several doses, or more than the recommended dose.

Persistent pulmonary hypertension of the newborn (PPHN)
PPHN occurs when a newborn baby’s lungs do not adapt to breathing outside the womb. It is thought to be linked, in some cases, to early closure of the ductus arteriosus (see above). PPHN is generally rare but it can be serious.

Although two small studies have shown a link between PPHN and taking NSAIDs during pregnancy, another larger study did not show a link. Further research is required to assess the chance of PPHN following exposure in the womb to NSAIDs and specifically to meloxicam.

Oligohydramnios (reduced fluid around the baby)
Use of meloxicam or other NSAIDs after 30 weeks of pregnancy may result in oligohydramnios (where there is too little amniotic fluid in the sac around the baby).

Meloxicam should only be taken after week 30 of pregnancy under medical supervision. If you have taken meloxicam after 30 weeks of pregnancy your obstetrician may wish to check the baby (and amniotic fluid levels) by ultrasound scan.

Can taking meloxicam in pregnancy cause stillbirth?

No studies have investigated the chance of stillbirth specifically following use of meloxicam in pregnancy. Two studies of women taking any NSAID in pregnancy do not show a link with stillbirth. While this is reassuring, further research is required to separately analyse pregnancy outcomes in women taking meloxicam.

Can taking meloxicam in pregnancy cause preterm birth or my baby to be small at birth (low birth weight)?

There is no evidence that use of any NSAID in pregnancy causes preterm delivery or low infant birth weight.

Can taking meloxicam in pregnancy cause learning or behavioural problems in the child?

A baby’s brain continues to develop right up until the end of pregnancy. It is therefore possible that taking certain medicines at any stage of pregnancy could have a lasting effect on a child’s learning or behaviour.

No studies have assessed learning and behaviour in children exposed in the womb to meloxicam.

Will my baby need extra monitoring during pregnancy?

Most women will be offered a scan at around 20 weeks of pregnancy to look for birth defects as part of their routine antenatal care. Taking meloxicam before 30 weeks of pregnancy would not normally require extra monitoring of your baby.

If you have taken meloxicam after 30 weeks of pregnancy, extra scans to monitor the wellbeing of your baby are likely to be needed. Discuss this with your midwife/obstetrician.

Are there any risks to my baby if the father has taken meloxicam?

We would not expect any increased risk to your baby if the father took meloxicam before or around the time your baby was conceived.

Who can I talk to if I have questions?

If you have any questions regarding the information in this leaflet please discuss them with your health care provider. They can access more detailed medical and scientific information from www.uktis.org.

Feedback request 

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General information 

Up to 1 out of every 5 pregnancies ends in a miscarriage, and 1 in 40 babies are born with a birth defect. These are referred to as the background population risks.  They describe the chance of these events happening for any pregnancy before taking factors such as the mother’s health during pregnancy, her lifestyle, medicines she takes and the genetic make up of her and the baby’s father into account.

Medicines use in pregnancy

Most medicines used by the mother will cross the placenta and reach the baby. Sometimes this may have beneficial effects for the baby.  There are, however, some medicines that can harm a baby’s normal development.  How a medicine affects a baby may depend on the stage of pregnancy when the medicine is taken. If you are on regular medication you should discuss these effects with your doctor/health care team before becoming pregnant.

If a new medicine is suggested for you during pregnancy, please ensure the doctor or health care professional treating you is aware of your pregnancy.

When deciding whether or not to use a medicine in pregnancy you need to weigh up how the medicine might improve your and/or your unborn baby’s health against any possible problems that the drug may cause. Our bumps leaflets are written to provide you with a summary of what is known about use of a specific medicine in pregnancy so that you can decide together with your health care provider what is best for you and your baby.   

Every pregnancy is unique. The decision to start, stop, continue or change a prescribed medicine before or during pregnancy should be made in consultation with your health care provider. It is very helpful if you can record all your medication taken in pregnancy in your hand held maternity records.

www.medicinesinpregnancy.org

Mobic, Mobic Side Effects, Mobic Information

PUBG MOBILE: Arcane

on the App Store

Royale Pass M5: Mirror World
Survive merciless battles on the Mirror Island

The official version of PLAYERUNKNOWN’S BATTLEGROUNDS specially for mobile devices.
Intense firefights and quick wins.

• THE BIGGEST “BATTLE ROYAL”
Free and with many new events. Take first place and shoot your fill at the same time! PUBG MOBILE is the first “Battle Royale” for smartphones and at the same time – the peak of the genre.

• PLAY FOR FREE ANYWHERE, ANYWHERE.
PUBG MOBILE will easily cheer you up! The most enjoyable and optimized firefights are completely free!

• INTENSE BATTLES AND RAPID VICTORIES
Grab your weapons and get ready for battle: free matches in PUBG MOBILE are calling!

• EXCITING NEW MODES
Collaboration with ARCANE begins! Visit Mirror Island, transform into ARCANE heroes, unlock new skills and tactical items, and navigate hotspots on Erangel, Livik and Sanuk! You have never seen such battles!

• HUGE CARDS AND LOTS OF BATTLES
PUBG MOBILE excites blood with many dangers and opportunities.Can you survive on the maps of this world? Call your friends and play new modes together! Shoot everything you see!

• DESIGNED SPECIALLY FOR MOBILE DEVICES
Features customizable controls, workout modes and voice chat with friends. The most elaborate controls and the most realistic weapons among mobile shooters.

PUBG MOBILE offers a variety of items and high definition graphics. Everything you need is here. Try out an incredible arsenal of free weapons and keep checking back often for new items, maps and modes to be added all the time!

PUBG MOBILE is the most addicting free online shooter for mobile devices.Enter the game, equip and challenge other players. Engage in epic 100-man combat and play modes such as Payload, 4v4 Team Deathmatch, and Zombies. The last survivor will win. Fire until the end!

* A stable network connection is required.

Follow us:
Facebook: https://www.facebook.com/PUBGMOBILE
Twitter: https://twitter.com/PUBGMobile
Reddit: https://www.reddit.com/r/PUBGMobile/
Discord: https: // discord.gg / pubgm

If you have any questions, please contact our support team at [email protected].

Osmo Mobile 2 – Product Information

New corporate information protection and management features in Outlook Mobile

Three years ago, we launched Outlook Mobile, which was designed not only to provide customers with the most convenient email and calendar experience, but also to provide enterprise-grade security.With a growing number of telecommuting and mobile workers in businesses today, Outlook Mobile is coming soon with advanced features such as support for Microsoft Information Protection’s built-in tagging and improved mobile device management. Plus, new features like featured notifications and Microsoft Teams integration help keep your workforce in the loop. We are confident that these new features, as well as the premium user experience that we are constantly improving, make Outlook Mobile worthy of your choice.

Designed specifically for mobile devices, Outlook for iOS and Android offers new ways to communicate and organize your work so you can focus on what matters. Over the years, we’ve deepened our Office 365 integration and added a variety of AI-powered capabilities that anticipate your needs. We’ve also redesigned Outlook Mobile to bring it to the Microsoft Cloud and added a wide range of compliance and corporate governance features, including FedRAMP, modern hybrid authentication, and policy support to help you manage and protect sensitive information.

Outlook Mobile is used on over 100 million devices today, including clients such as Adventist Health System and Razer:

“Microsoft Intune and mobile email powered by Exchange Online have resulted in significant support savings for us. In the past, employees had to frequently unregister and re-register devices, and the support team was inundated with requests to re-sync email accounts. But thanks to Intune, employees are now downloading the Microsoft Outlook mobile app, we’re applying the right policies, and you’re done! ”
– Tony Qualls, Director of Corporate Technical Services at Adventist Health System

“With Outlook Mobile and the Teams mobile app, you can access everything that’s built in, including PowerPoint, Excel, OneDrive files, conversations, or calendar events.Thanks to these applications, you can quickly and efficiently solve any problem from your phone. ”
– Tom Moss, Senior Vice President, Mobile, Razer

We are proud that customers rate Outlook Mobile highly and hope that today’s announcements will build your trust.

What’s new in corporate information protection and deployment

We know that protecting confidential information is a top priority for many of our customers, so today we are introducing new features that will help keep that information safe while making it easier to deploy and manage Outlook Mobile.We are committed to delivering best-in-class corporate governance and security capabilities as well as ease of use and speed.

Simple application of privacy labels to messages

Customers will soon be able to categorize and tag messages in Outlook Mobile to ensure that sensitive information is handled in accordance with company policies. Outlook for iOS and Android now includes built-in Microsoft Information Protection flagging to help enforce the same set of protection policies and actions across all Microsoft 365 apps.For example, administrators can set custom sensitivity labels such as “General” or “Company only” and appropriate actions, such as adding a footer to messages or encrypting them. Users will then be able to add the “Company Employee Only” label to messages so that only recipients who can decrypt the message can open them. In addition, an administrator can configure a policy to allow users to change the label as needed, specifying the rationale for doing so for tracking and compliance purposes.Our goal is to begin rolling out a preview of this capability to commercial Outlook Mobile users by the end of the year.

Simplify Outlook Mobile deployment and administration

We’ve added new configuration options for Outlook Mobile to help your employees quickly set up this solution.

• Support for adding only corporate accounts to Outlook Mobile : We recently added a new setting to reduce the risk of using personal accounts on corporate devices.For example, administrators can specify which corporate email and OneDrive for Business accounts are allowed in Outlook Mobile.

Administrators will be able to prevent adding personal accounts to corporate devices

In addition, the following features will be available in commercial versions of Outlook Mobile in the coming months:

• Scale deployment and ensure consistency : Administrators will be able to force certain Outlook mobile app settings to be sent to users to enable or disable sync or save contacts, use biometrics such as Touch ID, block external images, prompts, and mail settings including sorting options.By standardizing these settings, you can simplify and scale your Outlook Mobile deployment while maintaining consistency.
• Speed ​​up account setup : In the near future, administrators will be able to force Outlook Mobile account configurations to be sent to accounts that support Modern Authentication. This will enable employees to get up and running with Outlook Mobile in no time by using the correct data for their work training records.To set up, just enter your password, which means that the number of calls to technical support will be reduced, and you can quickly and easily protect mobile workers. This capability is already available for Basic-authenticated accounts in on-premises Exchange deployments.
• New App Tuning Policy interface in Microsoft Intune : This interface will natively support push configuration data for accounts in an on-premises Exchange environment with basic authentication.In the coming months, we plan to improve the policies in this interface so that they can be used to manage Outlook Mobile features, including saving or syncing contacts.

New ways to communicate and organize your daily work

To help you work and communicate with colleagues while away from the office, Outlook Mobile will soon include new features based on Microsoft Teams and enhanced Office Lens integration, featured notifications, and improved calendar features.

Create and join Teams meetings in Outlook Mobile

More companies are using Teams for collaboration, so we’re excited to announce the integration of Teams meetings with Outlook. Soon you will be able to add online meetings to your calendar events and join them right from Outlook. We plan to implement this feature in Outlook in early 2019.

New Office Lens in Outlook Mobile

Have you ever had to sort through numerous business cards after a conference for a long time? Now all you need to do is take a picture of the card in Office Mobile, and Office Lens will automatically save the contact information to Outlook.Plus, you can be sure that your images will be used in accordance with your company-defined application protection policies and that your device’s camera settings will be respected. Customers with Outlook for Android will be able to take advantage of this feature in the coming months.

Selected notifications

For some people – a boss, a husband or wife, a child – it is desirable to answer as soon as possible. Soon you will be able to turn on Favorite mode for notifications so that you only receive them when you receive messages or calendar events from such people.Featured notifications will appear in Outlook Mobile in the coming months.

Calendar share and search

• Enhanced sharing : Now it’s easier for you to share your schedule with colleagues and manage room reservations or delegated calendars. All you need to do is add a new calendar from the menu in Outlook Calendar. Just select Add shared calendars and find people, rooms or mailboxes.You can add and view a colleague’s shared calendar or even a meeting room booking calendar. We are already rolling out this capability to commercial users.

Easily add shared calendars with colleagues or even rooms directly from Outlook Mobile

• Calendar Search : Soon you will be able to find not only the contacts, reservations, packages and files you want, but also calendar events. Searching in Outlook Mobile makes this quick and easy.This opportunity will be implemented in the coming months.

We are delighted to present these innovative features in Outlook Mobile, and we hope they meet and exceed your expectations. Email us if you have comments or suggestions. Thank you for trusting us!

ViPNet Client Mobile 2 | Virtual Private Networks, Secure Communications

Use Cases

Safe work with corporate resources through secure channels

Traffic encryption using the GOST 28147-89 algorithm (key length 256 bits) enables users to securely work over the Internet with any internal resources of the organization.The transmitted data is not accessible to outsiders.

Protected user communication (available in some modifications)

The ViPNet Client product can work successfully with another Infotecs solution – the ViPNet Connect application. It is intended for secure communication of corporate users (calls, chat, file exchange).

Safe work on the Internet with centralized traffic cleaning (available in some modifications)

The ViPNet Client application allows you to use a configuration that blocks direct access to the Internet even when the device is outside the corporate network.At the same time, the device can access the Internet only through the corporate traffic cleansing center: proxy servers, firewalls and other filtering tools.

This approach provides multi-layered protection for a mobile device and allows corporate information security mechanisms to be applied to tablets and smartphones in the same way as to ordinary work computers in the office. Users no longer need to install specialized versions of traffic control tools on mobile devices.

Filtering traffic on the device (available in some modifications)

ViPNet Client protects a mobile device from network attacks using a built-in firewall, which is centrally controlled by the administrator of the protected network.

NBA LIVE Mobile Pack Reward Chances

Players should be able to get the most out of their game, so we strive to provide as much information as possible that can be helpful in making decisions in the game.After the start of the new season NBA LIVE Mobile , you will be able to see the odds of earning rewards from the packages you purchased.

The NBA LIVE Mobile store can now check the odds of earning rewards for most packages. To do this, just touch them. The odds of getting rewards from packs are grouped by OVR and rarity. Since sets may contain unique items, all items are grouped by category. Often, for bundles timed to specific promotions, the likelihood of receiving items participating in this promotion will be indicated.

The odds of earning NBA LIVE Mobile rewards have been set to ensure that every package you buy is guaranteed to give you something of value. This means that with a specified value of 100% in a particular category, you are guaranteed to receive an item from that category. The description of each package from the NBA LIVE Mobile store also lists the total number of items you will receive.

Shows the probability for a specific set only – the probability values ​​are not added.This means that the opening of each set is a separate event, and even if several identical sets are opened, the probability of getting one or another item remains the same.

The odds of winning NBA LIVE Mobile are calculated mathematically. The probability values ​​are then checked by simulating the opening of a very large number of sets. The number of sets opened during a simulation depends on the rarity of the set, but is always sufficient to obtain statistically representative data.

NBA LIVE Mobile is a live game that is constantly evolving, just like the packages we offer you. New packages will appear in the game from time to time – especially during new programs and during the off-season. The chances of earning rewards from these packs may differ from previously released packs. However, you can always find out the odds of earning rewards from a package before purchasing by simply tapping it.

The changes related to the display of the likelihood of getting bundles in the game is another step towards transparency and openness.We strive to provide as much important information as possible to enable you to decide how to play and what investments to make. It is important for us that players always have a choice, and that NBA LIVE Mobile remains fun and exciting.

eGov mobile app | Electronic government of the Republic of Kazakhstan

E-government mobile application eGov mobile is available for download on Google Play (required Android version – 5.0 or later), AppGallery, AppStore (Requires iOS version 11.3 or later).

You can log in to the application with an EDS or one-time password *.

The eGov mobile application allows you to use EDS as conveniently as possible:

• Issue an EDS from the mobile application itself in a matter of minutes without the need to visit the PSC
• Bind your existing digital signature to a 4-digit PIN code and built-in biometrics of your device (Face ID, Touch ID) and you can no longer be distracted by choosing a digital signature and entering a password every time you authorize and receive services.

On the main page of the application are presented:

Brief instructions for the user to work with the application. The instructions are in the form of stories familiar to users on social networks.

QR Scanner. QR scan available:

• Authorization and signing of services on the egov.kz website by scanning the QR code in the application.
• Payment of the state fee for the provision of services to the PSC
• Also, by scanning the QR code, access to viewing a third party document in the “Digital Documents” service can be obtained.eGov mobile, by calling the services of the state bodies of the Republic of Kazakhstan, downloads the document to which access has been allocated.

For a user who provides access to their digital documents, it is enough to enter “Digital Documents”, open the required document and click on the “Open Access” button, after which a unique QR code is generated, available for one-time scanning by a third party.

Section “Popular services” displays the most popular information, the full list of services can be found by clicking on the link “All services” or in section “Catalog of services” .

In the Service Catalog services are grouped according to their respective categories. In section “Order history” , you can view the status of the request and the result of the service. You can easily save the received document to your smartphone or share it via mail or messenger.

Section “Services” contains:

• “Digital Documents” is a service for storing personal electronic documents in the eGov Mobile application.Also, the service provides an opportunity for a citizen, upon his agreement, to provide third parties with access to documents.
• “Electronic Labor Exchange” – a single digital platform for employment, providing an opportunity to find a job. Through this service you can:

– create a resume, receive invitations for interviews from employers, apply for a vacancy or refuse an invitation;
– create a subscription to vacancies according to the specified parameters and receive notifications by e-mail.
– pass vocational guidance testing, having received the result to determine the professions that are closest to you.

• “Health Passport” allows you to obtain a clinical document that stores structured information about the patient’s health, as well as data of attachment to a medical organization, dispensary registration, stationary data, laboratory results, etc. with the ability to upload a document to the Health program on iOS.
• “Pension Calculator” allows you to calculate the estimated amount of your future retirement benefits.

In the “Notifications” section, you can view all notifications about changes in the status of services and informational messages.

The “Profile” displays personal information from various state databases about the family, personal documents, social status, information about participation in a legal entity, information about cars and real estate, etc. Also available information about the validity of the digital signature.

In the “My Cards” section of the Profile, you can link a payment card to pay government fees.

* One-time password – SMS notification with a verification code, which is sent to the user’s mobile phone after sending the request. To use a one-time password, the user must be registered in the Mobile Citizens Database.

Scan the QR and download the app now!

Play Market, Android AppStore iOS App Gallery, Huawei
(Android)

Stream Mobile People Talks | Listen to podcast episodes online for free on SoundCloud

Podcast

Mobile People Talks is a podcast about mobile development.And everything else.
So if you are not a mobile developer, do not rush to close the page – different issues have different levels of immersion and will be of interest to developers with different experience and degree of mobility).
Hopefully, the podcast becomes a regular resource to help you create better apps and market them more effectively, as there is always room for growing expertise in mobile development given the complex nature of the industry.

The hosts of the podcast are developers with extensive experience and experience, each of whom represents their own area of ​​mobile development:

Alexander Denisov, organizer of GDG Moscow, creator of the FlutterRussia channel, Co-Head of Flutter Competency in EPAM
Flutter and Dart GDE (Google Developer Expert)
Twitter: https: // twitter.com / shuregdenisov
Telegram: t.me/aleksandr_denisov (group: t.me/FlutterRussia)
Email: [email protected]

Vladimir Ivanov, active speaker, member of the Mobius program committee
Twitter: twitter.com/vvsevolodovich
Telegram: t.me/vvsevolodovich

Danis Tazetdinov, EPAM mobile community driver, evangelist of Apple platforms, author of a channel about news in the world of iOS development
Telegram: t.me/edeniska (channel: t.me/AppleDevNews)
Twitter: twitter.com/edeniska
Email: [email protected]

The podcast has its own channel: t.me / MobilePeopleTalks, and you can also write to us by mail [email protected]

Mobile People Talks’s tracks

published on 2021-12-02T16: 53: 41Z
published on 2021-11-30T16: 20: 56Z
published on 2021-11-17T07: 41: 18Z
published on 2021-11-12T07: 41: 31Z
published on 2021-11-03T07: 10: 28Z
published on 2021-10-20T05: 25: 56Z
published on 2021-10-06T07: 22: 49Z
published on 2021-09-22T07: 30: 48Z
published on 2021-09-08T07: 30: 30Z
published on 2021-08-04T05: 33: 40Z .