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Sorato MM, Davari M, Kebriaeezadeh A. Improving access to medicines to reduce marketing and use of substandard and falsified medicines in Africa: Scoping review. THE JOURNAL OF MEDICINE ACCESS 2024; 8:27550834241236598. [PMID: 38476401 PMCID: PMC10929061 DOI: 10.1177/27550834241236598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 02/15/2024] [Indexed: 03/14/2024]
Abstract
Background Both constrained access to essential medicines and combatting marketing of substandard and falsified (SF) medicines are unmet health sector goals in Africa. Objective To answer the question of how improved access can reduce the continuous surge of SF medicines in Africa. Design We conducted a scoping review based on standard protocol. Methods We searched articles published in the English language from PubMed/Medline, Cochrane Library, Embase, Scopus, Web of Science, and Google Scholar by using a systematic search query. Results Seventy-one articles were included in this review. Access to quality essential medicines is still a major problem in developing countries in Africa and will continue as a threat for the next decade of health care. Ensuring access to quality medicines and preventing SF medicines in Africa need a systematic approach to address their underlying causes. Failure to ensure access to medicines is the major reason for the availability of SF medicines. Improving access to quality medicines can reduce SF medicine marketing and use. Manipulating the entire supply chain for efficiency, avoiding trade agreements that could reduce access, using compulsory licensing provisions, and pharmaceutical price control, providing incentives for drug development, and promoting rational use of medicines can improve access. Conclusion Ensuring access to medicines and preventing SF medicine marketing cannot be achieved in the planned period in developing countries in Africa unless a comprehensive strategy is used. Improving access to quality medicines can reduce SF medicine marketing and use, that is, ensuring access through uninterrupted supply, improved efficiency, enhanced local production, preventing SF medicine entry, improved medication use system, and improved affordability. Therefore, it is essential to improve supply chain capability, address challenges of the supply chain, improve leadership and governance, establish country-specific anti-counterfeiting and anti-substandardization committees, and collaborate with all relevant stakeholders.
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Affiliation(s)
- Mende Mensa Sorato
- Department of Pharmacy, College of Medicine, Komar University of Science and Technology, Sulaimaniyah, Iraq
| | - Majid Davari
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Kebriaeezadeh
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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Sakira AK, Ouattara MSMJ, Yabre M, Bande M, Some TI. Contribution to the Detection of Poor Quality Sildenafil Drugs in Burkina Faso Using High-Performance Thin-Layer Chromatography. JOURNAL OF ANALYTICAL METHODS IN CHEMISTRY 2021; 2021:4093859. [PMID: 34691802 PMCID: PMC8528628 DOI: 10.1155/2021/4093859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/18/2021] [Accepted: 09/25/2021] [Indexed: 06/13/2023]
Abstract
In substandard drugs enforcement, there is a need to develop reliable, fast, and inexpensive analytical methods. Due to its very characteristics, HPTLC offers opportunities for the development of methods that meet these requirements. This technique was used to develop and validate a method for the determination of sildenafil in pharmaceutical formulations from the licit and illicit supply chain in Burkina Faso. Taking into account optimization parameters such as measurement wavelength and mobile phase composition, the best elution quality is found at the maximum signals of spots on silica plates at 305 nm, using a mixture of dichloromethane-methanol mixture 9 : 1 (v/v) proportions. The method developed under these conditions was validated using the accuracy profile as a decision tool. The establishment of the response function curves allowed the choice of the polynomial function applied to the peak areas. This mathematical model provides a validity range between 0.4 and 0.6 mg/mL. The application of the developed and validated method to collected samples allowed the detection of two substandard drugs and confirmed the poor quality of drugs in the illicit market. More data using this approach in a variety of drug molecules could lead to the establishment of databases of counterfeit drugs in Burkina Faso.
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Affiliation(s)
- Abdoul Karim Sakira
- Laboratoire de Toxicologie, Environnement et Santé (LATES), Ecole Doctorale des Sciences de La Santé (ED2S), Université Joseph KI-ZERBO, 03 BP 7021 03, Ouagadougou, Burkina Faso
| | - Mitéhélé Sandrine Marie Josiane Ouattara
- Laboratoire de Toxicologie, Environnement et Santé (LATES), Ecole Doctorale des Sciences de La Santé (ED2S), Université Joseph KI-ZERBO, 03 BP 7021 03, Ouagadougou, Burkina Faso
| | - Moussa Yabre
- Laboratoire de Toxicologie, Environnement et Santé (LATES), Ecole Doctorale des Sciences de La Santé (ED2S), Université Joseph KI-ZERBO, 03 BP 7021 03, Ouagadougou, Burkina Faso
| | - Moumouni Bande
- Laboratoire de Toxicologie, Environnement et Santé (LATES), Ecole Doctorale des Sciences de La Santé (ED2S), Université Joseph KI-ZERBO, 03 BP 7021 03, Ouagadougou, Burkina Faso
| | - Touridomon Issa Some
- Laboratoire de Toxicologie, Environnement et Santé (LATES), Ecole Doctorale des Sciences de La Santé (ED2S), Université Joseph KI-ZERBO, 03 BP 7021 03, Ouagadougou, Burkina Faso
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3
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McManus D, Naughton BD. A systematic review of substandard, falsified, unlicensed and unregistered medicine sampling studies: a focus on context, prevalence, and quality. BMJ Glob Health 2021; 5:bmjgh-2020-002393. [PMID: 32859648 PMCID: PMC7454198 DOI: 10.1136/bmjgh-2020-002393] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 02/06/2023] Open
Abstract
Substandard and falsified (SF) medicines are a global issue contributing to antimicrobial resistance and causing economic and humanitarian harm. To direct law enforcement efficiently, halt the spread of SF medicines and antimicrobial resistance, academics, NGOs and government organisations use medicine quality sampling studies to estimate the prevalence of the problem. A systematic review of medicine quality studies was conducted to estimate how the methodological quality of these studies and SF prevalence has changed between 2013 and 2018. We also aimed to critique medicine sampling study methodologies, and the systematic review process which generates prevalence estimates. Based on 33 studies, the overall estimated median (Q1-Q3) prevalence of SF medicines appears to have remained high at 25% (7.7%-34%) compared with 28.5% in 2013. Furthermore, the methodological quality of prevalence studies has improved over the last 25 years. Definitive conclusions regarding the prevalence of SF medicines cannot be drawn due to the variability in sample sizes, consistency of design methods, and a lack of information concerning contextual factors affecting medicine quality studies. We contend that studies which present cumulative average prevalence figures are useful in a broad sense but could be improved to create more reliable estimates. We propose that medicine quality studies record the context of the study environment to allow systematic reviewers to compare like with like. Although, the academic rigour of medicine quality studies is improving, medicine sampling study limitations still exist. These limitations inhibit the accurate estimation of SF medicine prevalence which is needed to support detailed policy changes.
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Affiliation(s)
- Dominic McManus
- School of Pharmacy (Formerly of), University College London, London, UK
| | - Bernard David Naughton
- Saïd Business School, University of Oxford, Oxford, UK .,Pharmacy Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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4
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Eiben H, Hala L, Slipchuk V. The current state of the pharmaceutical market of Ukraine, quality assurance and falfication of medicines. PHARMACIA 2021. [DOI: 10.3897/pharmacia.68.e64723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The aim of our article was the study of the current state of the pharmaceutical market of Ukraine in the context of the quality assurance of medicines and preventing the spread of falsified medicines (FM), the identification of the main problems in the field of circulation of medicines and the ways to solve them. It is established that the dynamic development of the pharmaceutical market and its high profitability cause problem of drug quality, increasing threats to the spread of FM in circulation and require the implementation of effective mechanisms for regulation of quality and safety of medicines. Analysis the annual official statistics of the State Service of Ukraine on Medicines and Drug Control for the period of 2008–2019 on the number of detected FM in circulation showed a steady trend of increasing FM and insufficient implementation of effective measures to combat them. The creation of effective quality assurance system of drugs and preventing the spread of FM need to improve the organization of state control of drug quality, strengthening criminal liability for falsification of drugs and optimization of the system of their detection.
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Bakker-'t Hart IME, Ohana D, Venhuis BJ. Current challenges in the detection and analysis of falsified medicines. J Pharm Biomed Anal 2021; 197:113948. [PMID: 33582458 DOI: 10.1016/j.jpba.2021.113948] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/28/2021] [Accepted: 01/31/2021] [Indexed: 10/22/2022]
Abstract
Falsified medicines affect public health all around the globe. Complex distribution routes, illegal online webshops and reuse of packaging materials make them hard to detect. In order to tackle this problem, detection methods for the recognition of suspicious medicines and subsequent confirmation of falsification by analytical techniques is required. In this review, we focus on the developments and challenges that existed in the last five years (2015-2020) in the detection and analysis of falsified medicines. These challenges might have not been solved yet or arisen with new types of falsifications, new analytical techniques or detection strategies. Detection of suspicious medicines starts with visual inspection of packaging materials. However, re-use of packaging materials and high-quality imitations complicate visual inspection. Recent developments in the analysis of packaging by microscopic and spectroscopic techniques such as optical microscopy, X-ray fluorescence, infrared spectroscopy and Raman spectroscopy or microscopy, in combination with multivariate analysis show promising results in the detection of falsified medicines. An ongoing big challenge in the analysis of falsified medicines is the affordability of analytical devices. Yet, recent reports showed that lower cost devices, such as Counterfeit Drug Indicator or Counterfeit Detection device version 3 show promising use in the detection of falsified medicines. Furthermore, combining the outcomes of different low-cost analytical techniques, such as Minilab, colorimetry and Counterfeit Drug Indicator significantly increased selectivity and sensitivity in the detection of falsified medicines. Also, recent developments make it possible to link a low-cost technique, such as TLC, to mobile phones. Proper training of personnel has shown room for improvement and remains a challenge, even for relatively simple techniques. With an increased use of analytical fingerprints, an upcoming challenge is the accessibility of the growing pool of data. There is also the need of validated reference libraries on both national and international levels. Developments of the last few years bring us a step closer in the fight against falsified medicines, however challenges remain in the worldwide accessibility of affordable, easily operable and sensitive techniques.
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Affiliation(s)
- Ingrid M E Bakker-'t Hart
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Antonie Van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, the Netherlands
| | - Dana Ohana
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Antonie Van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, the Netherlands
| | - Bastiaan J Venhuis
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Antonie Van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, the Netherlands.
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Tesfaye W, Abrha S, Sinnollareddy M, Arnold B, Brown A, Matthew C, Oguoma VM, Peterson GM, Thomas J. How Do We Combat Bogus Medicines in the Age of the COVID-19 Pandemic? Am J Trop Med Hyg 2020; 103:1360-1363. [PMID: 32815510 PMCID: PMC7543841 DOI: 10.4269/ajtmh.20-0903] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 08/08/2020] [Indexed: 12/15/2022] Open
Abstract
The COVID-19 pandemic has brought concurrent challenges. The increased incidence of fake and falsified product distribution is one of these problems with tremendous impact, especially in low- and middle-income countries. Up to a tenth of medicines including antibiotics and antimalarial drugs in the African market are considered falsified. Pandemics make this worse by creating an ecosystem of confusion, distraction, and vulnerability stemming from the pandemic as health systems become more stressed and the workload of individuals increased. These environments create opportunities for substandard and falsified medicines to be more easily introduced into the marketplace by unscrupulous operators. In this work we discuss some of the challenges with fake or falsified product distribution in the context of COVID-19 and proposed strategies to best manage this problem.
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Affiliation(s)
- Wubshet Tesfaye
- Health Research Institute, University of Canberra, Canberra, Australia
| | - Solomon Abrha
- University of Canberra, Canberra, Australia
- Mekelle University, Mek’ele, Ethiopia
| | | | - Bruce Arnold
- Canberra Law School, University of Canberra, Canberra, Australia
| | - Andrew Brown
- IntraHealth International, Durham, North Carolina
| | | | - Victor M. Oguoma
- Health Research Institute, University of Canberra, Canberra, Australia
| | - Gregory M. Peterson
- University of Canberra, Canberra, Australia
- University of Tasmania, Hobart, Australia
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Fisher AC, Viehmann A, Ashtiani M, Friedman RL, Buhse L, Kopcha M, Woodcock J. Quality Testing of Difficult-to-Make Prescription Pharmaceutical Products Marketed in the US. JAMA Netw Open 2020; 3:e2013920. [PMID: 32833019 PMCID: PMC7445591 DOI: 10.1001/jamanetworkopen.2020.13920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Health care practitioners and patients must have information to support their confidence in the quality of prescription pharmaceuticals. OBJECTIVE To determine whether there were clear and substantive differences in major quality attributes between difficult-to-make solid oral dosage form pharmaceutical products marketed in the US. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study analyzed US Food and Drug Administration-collected samples of 252 drug products marketed in the US and manufactured in the US, Canada, Europe, India, and the rest of Asia. These drug products were immediate-release solid oral dosage forms considered difficult to make on the basis of product quality history. This sampling included 35 innovator and 217 generic drug samples manufactured by 46 different firms containing 17 different active ingredients. Statistical analysis was performed from February to November 2019. MAIN OUTCOMES AND MEASURES All products were tested within their shelf life on the basis of the legally recognized tests of the US Pharmacopeia for the major quality attributes of dosage unit uniformity and dissolution. These tests measure dosage consistency and drug release, respectively. The consistency of either attribute was used to calculate a process performance index to describe the variability in manufacturing. RESULTS All 252 drug product samples met the US market standards for dosage unit uniformity and dissolution, although the process performance index (Ppk) for dissolution fell below the level of 4-sigma capability (ie, <1 error per 1600) for 11 different manufacturers and for generics in 4 of 5 regions, including the US. As part of a retrospective analysis, manufacturers performing above the median Ppk for either dissolution or dosage unit uniformity submitted fewer product quality defect reports (mean field alert reports of 0.22 and 0.63, respectively) than those falling at or below the median Ppk for these attributes (mean field alert reports of 2.1 and 1.7, respectively). CONCLUSIONS AND RELEVANCE All samples met the US market standards for dosage unit uniformity and dissolution, indicating acceptability for use by patients regardless of manufacturer or region. To our knowledge, this is the largest sampling study of pharmaceutical manufacturers for the US market and these data provide objective insight into the quality of prescription drugs with high manufacturing risks.
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Affiliation(s)
- Adam C. Fisher
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Alex Viehmann
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Melika Ashtiani
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Richard L. Friedman
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Lucinda Buhse
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Michael Kopcha
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Janet Woodcock
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
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8
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Hodges S, Garnett E. The ghost in the data: Evidence gaps and the problem of fake drugs in global health research. Glob Public Health 2020; 15:1103-1118. [PMID: 32228359 PMCID: PMC7446034 DOI: 10.1080/17441692.2020.1744678] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 02/09/2020] [Indexed: 10/31/2022]
Abstract
For the past several decades, global health research and policy have raised the alarm about the growing threat of counterfeit and low-quality drugs (henceforth 'fakes'). These high-profile and regularly-repeated claims about 'fake drugs' pepper scholarly publications, grey literature, and popular writing. We reviewed much of this work and found that it shares two characteristics that sit awkwardly alongside one another. First, it asserts that fake drugs constitute an urgent threat to lives. Second, it reports trouble with 'gaps' in the evidence on which their claims are based; that data is weaker and less conclusive than anticipated. Given the ubiquity of and urgency with these claims are made, we found this juxtaposition perplexing. To understand this juxtaposition better, we undertook a close reading of the strategies authors employed to negotiate and overcome data and evidence 'gaps' and asked questions about the cultures of scholarly publishing in global health research. We argue that a scholarly commitment to studying fakes despite--rather than because of-the evidence functions to support the continuation of similar research. It also works against asking different questions-for instance regarding the lack of easy access to pharmacological data that might make it possible to know fakes differently.
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Affiliation(s)
- Sarah Hodges
- Department of History, University of Warwick, Coventry, UK
| | - Emma Garnett
- School of Population Health and Environmental Sciences, King’s College London, London, UK
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Ozawa S, Higgins CR, Yemeke TT, Nwokike JI, Evans L, Hajjou M, Pribluda VS. Importance of medicine quality in achieving universal health coverage. PLoS One 2020; 15:e0232966. [PMID: 32645019 PMCID: PMC7347121 DOI: 10.1371/journal.pone.0232966] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/24/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To assess the importance of ensuring medicine quality in order to achieve universal health coverage (UHC). METHODS We developed a systems map connecting medicines quality assurance systems with UHC goals to illustrate the ensuing impact of quality-assured medicines in the implementation of UHC. The association between UHC and medicine quality was further examined in the context of essential medicines in low- and middle-income countries (LMICs) by analyzing data on reported prevalence of substandard and falsified essential medicines and established indicators for UHC. Finally, we examined the health and economic savings of improving antimalarial quality in four countries in sub-Saharan Africa: the Democratic Republic of the Congo (DRC), Nigeria, Uganda, and Zambia. FINDINGS A systems perspective demonstrates how quality assurance of medicines supports dimensions of UHC. Across 63 LMICs, the reported prevalence of substandard and falsified essential medicines was found to be negatively associated with both an indicator for coverage of essential services (p = 0.05) and with an indicator for government effectiveness (p = 0.04). We estimated that investing in improving the quality of antimalarials by 10% would result in annual savings of $8.3 million in Zambia, $14 million in Uganda, $79 million in two DRC regions, and $598 million in Nigeria, and was more impactful compared to other potential investments we examined. Costs of substandard and falsified antimalarials per malaria case ranged from $7 to $86, while costs per death due to poor-quality antimalarials ranged from $14,000 to $72,000. CONCLUSION Medicines quality assurance systems play a critical role in reaching UHC goals. By ensuring the quality of essential medicines, they help deliver effective treatments that lead to less illness and result in health care savings that can be reinvested towards UHC.
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Affiliation(s)
- Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States of America
- Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America
| | - Colleen R. Higgins
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States of America
| | - Tatenda T. Yemeke
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States of America
| | - Jude I. Nwokike
- Promoting the Quality of Medicines (PQM) Program, United States Pharmacopeial Convention (USP), Rockville, MD, United States of America
| | - Lawrence Evans
- Promoting the Quality of Medicines (PQM) Program, United States Pharmacopeial Convention (USP), Rockville, MD, United States of America
| | - Mustapha Hajjou
- Promoting the Quality of Medicines (PQM) Program, United States Pharmacopeial Convention (USP), Rockville, MD, United States of America
| | - Victor S. Pribluda
- Promoting the Quality of Medicines (PQM) Program, United States Pharmacopeial Convention (USP), Rockville, MD, United States of America
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Ashrafizadeh M, Zarrabi A, Hashemi F, Moghadam ER, Hashemi F, Entezari M, Hushmandi K, Mohammadinejad R, Najafi M. Curcumin in cancer therapy: A novel adjunct for combination chemotherapy with paclitaxel and alleviation of its adverse effects. Life Sci 2020; 256:117984. [PMID: 32593707 DOI: 10.1016/j.lfs.2020.117984] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/14/2020] [Accepted: 06/15/2020] [Indexed: 12/15/2022]
Abstract
Dealing with cancer is of importance due to enhanced incidence rate of this life-threatening disorder. Chemotherapy is an ideal candidate in overcoming and eradication of cancer. To date, various chemotherapeutic agents have been applied in cancer therapy and paclitaxel (PTX) is one of them. PTX is a key member of taxane family with potential anti-tumor activity against different cancers. Notably, PTX has demonstrated excellent proficiency in elimination of cancer in clinical trials. This chemotherapeutic agent is isolated from Taxus brevifolia, and is a tricyclic diterpenoid. However, resistance of cancer cells into PTX chemotherapy has endangered its efficacy. Besides, administration of PTX is associated with a number of side effects such as neurotoxicity, hepatotoxicity, cardiotoxicity and so on, demanding novel strategies in obviating PTX issues. Curcumin is a pharmacological compound with diverse therapeutic effects including anti-tumor, anti-oxidant, anti-inflammatory, anti-diabetic and so on. In the current review, we demonstrate that curcumin, a naturally occurring nutraceutical compound is able to enhance anti-tumor activity of PTX against different cancers. Besides, curcumin administration reduces adverse effects of PTX due to its excellent pharmacological activities. These topics are discussed with an emphasis on molecular pathways to provide direction for further studies in revealing other signaling networks.
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Affiliation(s)
- Milad Ashrafizadeh
- Department of Basic Science, Faculty of Veterinary Medicine, University of Tabriz, Tabriz, Iran
| | - Ali Zarrabi
- Sabanci University Nanotechnology Research and Application Center (SUNUM), Tuzla 34956, Istanbul, Turkey; Center of Excellence for Functional Surfaces and Interfaces (EFSUN), Faculty of Engineering and Natural Sciences, Sabanci University, Tuzia, Istanbul 34956, Turkey
| | - Farid Hashemi
- DVM, Graduated, Young Researcher and Elite Club, Kazerun Branch, Islamic Azad University, Kazeroon, Iran
| | - Ebrahim Rahmani Moghadam
- Department of Anatomical Sciences, School of Medicine, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fardin Hashemi
- Student Research Committee, Department of Physiotherapy, Faculty of Rehabilitation, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maliheh Entezari
- Department of Genetics, Faculty of Advanced Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Kiavash Hushmandi
- Department of Food Hygiene and Quality Control, Division of Epidemiology & Zoonoses, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Reza Mohammadinejad
- Pharmaceutics Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Masoud Najafi
- Radiology and Nuclear Medicine Department, School of Paramedical Sciences, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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11
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Rasheed H, Hoellein L, Bukhari KS, Holzgrabe U. Regulatory framework in Pakistan: situation analysis of medicine quality and future recommendations. J Pharm Policy Pract 2019; 12:23. [PMID: 31528352 PMCID: PMC6737614 DOI: 10.1186/s40545-019-0184-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 06/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quality issues in pharmaceuticals are identified as a huge global and public health problem, especially with reference to low- and middle-income countries like Pakistan. The 2011 "Fake Drug Crisis" acted as a driving force to reform the regulatory structures of the country and for establishing the autonomous "Drug Regulatory Authority of Pakistan". Despite the fact that Pakistan possesses a huge pharmaceutical industry, there is a severe dearth of published literature and scientific evidence for the country regarding medicine quality and the prevalence of counterfeit and low-quality products, respectively. AIMS AND OBJECTIVES This narrative review covers relevant features of the regulatory framework for pharmaceuticals in Pakistan, its national pharmaceutical industry, as well as a compilation and analysis of published literature for documentation of the country's situation regarding the overall quality of medicines. METHODS Available data including scientific publications on the quality of pharmaceuticals in peer reviewed journals, research reports, notifications, and alerts issued by the World Health Organization and other agencies were accessed and compiled. Post graduate dissertations were used to represent unpublished research data and drug safety alerts issued from the local Pakistan authority were analysed to assess the type and number of quality failures reported for pharmaceuticals. RESULTS It could be clearly shown that there is negligible scientific data available on the issue of medicine quality in Pakistan. The anticipated number of 40-50% of poor-quality drugs in Pakistan cannot be defended by data available from the literature. Accessible technologies and strategies used in recent years at global level, especially in developing countries, were also reviewed and recommendations are devised for Pakistan to combat the fight against poor-quality medicines. CONCLUSION The case reports, investigations, and general data listed for Pakistan suggest the need of strengthening regulatory systems for premises and GMP inspections, analytical laboratories, as well as an overall capacity building in the field of unravelling and controlling substandard and falsified medicines. It is proposed that well-planned and properly funded studies need to be carried out for collecting critical statistics regarding the prevalence of substandard and falsified medicines in Pakistan.
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Affiliation(s)
- Huma Rasheed
- Institute of Pharmacy and Food Chemistry, University of Wuerzburg, am Hubland, 97074 Wuerzburg, Germany
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Ludwig Hoellein
- Institute of Pharmacy and Food Chemistry, University of Wuerzburg, am Hubland, 97074 Wuerzburg, Germany
| | - Khalid Saeed Bukhari
- USP Promoting the Quality of Medicines (PQM) Program, U.S. Pharmacopeial Convention, 12601 Twinbrook Parkway, Rockville, MD 20852-1790 USA
| | - Ulrike Holzgrabe
- Institute of Pharmacy and Food Chemistry, University of Wuerzburg, am Hubland, 97074 Wuerzburg, Germany
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12
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Ndichu ET, Ohiri K, Sekoni O, Makinde O, Schulman K. Evaluating the quality of antihypertensive drugs in Lagos State, Nigeria. PLoS One 2019; 14:e0211567. [PMID: 30759124 PMCID: PMC6373917 DOI: 10.1371/journal.pone.0211567] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 01/14/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND As the burden of noncommunicable diseases grows, access to safe medical therapy is increasing in importance. The aim of this study was to develop a method for evaluating the quality of antihypertensive drugs and to examine whether this prevalence varies by socioeconomic variables. METHODS We conducted a cross-sectional survey of registered pharmacies in 6 local government areas (LGAs) in Lagos State, Nigeria. In each LGA, we sampled 17 pharmacies from a list of all registered pharmacies derived from the Pharmacists Council of Nigeria. We assessed drug quality based on (1) the level of active pharmaceutical ingredients (APIs), which identified falsely labeled drug samples; and (2) the amount of impurities, which revealed substandard drug samples in accordance with the international pharmacopoeia guidelines. Good-quality drugs met specifications for both API and impurity. RESULTS Of the 102 drug samples collected, 30 (29.3%) were falsely labeled, 76 (74.5%) were substandard,78 (76.5%) were of poor quality and 24 (23.5%) were of good quality.Among the falsely labeled drugs, 2 samples met standards set for purity while 28 did not. Among the 76 substandard drug samples, 28 were also falsely labeled. Of the falsely labeled drugs, 17 (56.7%) came from LGAs with low socioeconomic status, and 40 (52.6%) of the substandard drug samples came from LGAs with high socioeconomic status. Most of the good-quality drug samples, 14 (58.3%), were from LGAs with low socioeconomic status. Eighteen (60%) of the falsely labeled samples, 37 (48.7%) of the substandard samples, and 15 (62.5%) of the good-quality drug samples were from manufacturers based in Asia. The average price was 375.67 Nigerian naira (NGN) for falsely labeled drugs, 383.33 NGN for substandard drugs, and 375.67 NGN for good-quality drugs. The prevalence of falsely labeled and substandard drug samples did not differ by LGA-level socioeconomic status (P = .39) or region of manufacturer (P = .24); however, there was a trend for a difference by price (P = .06). CONCLUSION The prevalence of falsely labeled and substandard drug samples was high in Lagos. Treatment of noncommunicable diseases in this setting will require efforts to monitor and assure drug quality.
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Affiliation(s)
| | - Kelechi Ohiri
- Health Strategy and Delivery Foundation, Lagos, Nigeria
| | | | | | - Kevin Schulman
- Clinical Excellence Research Center, Department of Medicine, Stanford University, Stanford, California, United States of America
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Rahman MS, Yoshida N, Tsuboi H, Tomizu N, Endo J, Miyu O, Akimoto Y, Kimura K. The health consequences of falsified medicines- A study of the published literature. Trop Med Int Health 2018; 23:1294-1303. [PMID: 30291683 DOI: 10.1111/tmi.13161] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To analyse and present the literature describing the health consequences of falsified medicines, focusing on mortality and morbidity, as well as the scale of the issue, the geographic extent, the medicines affected, and the harm caused at both the individual and population levels. METHODS We searched for articles in PubMed, using pre-optimized keywords '(counterfeit OR fake OR bogus OR falsified OR spurious) AND (medicine OR drug)'. Searches up to February 2017 yielded 2006 hits, of which 1791 were full-length articles in English. Among them, we found 81 papers that qualitatively or quantitatively described 48 incidents in which falsified medicines caused patients to suffer serious adverse effects, injury, symptoms or death. RESULTS The distribution of incidents was examined according to the economic status of the countries involved, regional location in the world, therapeutic category of the medicines, number of incidents and victims by year, and characteristics of the falsified medicines. Among the 48 reported incidents, 27 (56.3%) occurred in developing countries and 21 (43.7%) in developed countries. These incidents involved a total of approximately 7200 casualties including 3604 deaths. CONCLUSIONS Despite the poor quality of much of the reported data, the results of this study indicate that all types of medications have been targeted for falsification, and falsified medicines have had a serious impact on the health of both adults and children worldwide, with similar numbers of incidents in developing and developed countries.
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Affiliation(s)
- Mohammad Sofiqur Rahman
- Medi-Quality Security Institute, Kanazawa University, Kanazawa, Japan.,Department of Pharmacy, University of Asia Pacific, Dhaka, Bangladesh.,Department of Drug Management & Policy, Kanazawa University, Kanazawa, Japan
| | - Naoko Yoshida
- Department of Drug Management & Policy, Kanazawa University, Kanazawa, Japan
| | - Hirohito Tsuboi
- Department of Drug Management & Policy, Kanazawa University, Kanazawa, Japan
| | - Naoki Tomizu
- Department of Drug Management & Policy, Kanazawa University, Kanazawa, Japan
| | - Jamie Endo
- Department of Drug Management & Policy, Kanazawa University, Kanazawa, Japan
| | - Onishi Miyu
- Department of Drug Management & Policy, Kanazawa University, Kanazawa, Japan
| | - Yoshio Akimoto
- Medi-Quality Security Institute, Kanazawa University, Kanazawa, Japan
| | - Kazuko Kimura
- Medi-Quality Security Institute, Kanazawa University, Kanazawa, Japan
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Janvier S, Cheyns K, Canfyn M, Goscinny S, De Spiegeleer B, Vanhee C, Deconinck E. Impurity profiling of the most frequently encountered falsified polypeptide drugs on the Belgian market. Talanta 2018; 188:795-807. [DOI: 10.1016/j.talanta.2018.06.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/06/2018] [Accepted: 06/08/2018] [Indexed: 12/29/2022]
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Lawson G, Ogwu J, Tanna S. Quantitative screening of the pharmaceutical ingredient for the rapid identification of substandard and falsified medicines using reflectance infrared spectroscopy. PLoS One 2018; 13:e0202059. [PMID: 30096202 PMCID: PMC6086453 DOI: 10.1371/journal.pone.0202059] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/26/2018] [Indexed: 01/29/2023] Open
Abstract
The World Health Organization suggests that approximately 10% of medicines worldwide are either falsified or substandard with higher figures in low and middle income countries. Such poor quality medicines can seriously harm patients and pose a threat to the economy worldwide. This study investigates attenuated total reflectance-fourier transform infrared (ATR-FTIR) spectroscopy as a simple and rapid method for determination of drug content in tablet dosage forms. Paracetamol was used as the model pharmaceutical ingredient. Spectra of standard mixtures of paracetamol with different excipients formed the basis for multivariate PLS based quantitative analysis of simulated tablet content using different selected infrared absorbance bands. Calibration methods using ATR-FTIR were compared with the ATR-FTIR and conventional ultraviolet spectroscopic analyses of real tablet samples and showed that the paracetamol/microcrystalline cellulose mixtures gave optimum results for all spectral bands tested. The quantitative data for band 1524-1493cm-1 was linear (R2 ˃ 0.98; LOQ ≥ 10%w/w tablet). Global examples of paracetamol tablets were tested using this protocol and 12% of the tablet samples examined was identified as substandard. Each sample analysis was completed in just a few minutes. ATR-FTIR can therefore be used in the rapid screening of tablet formulations. The simplicity of the proposed method makes it appropriate for use in low and middle income countries where analytical facilities are not available.
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Affiliation(s)
- Graham Lawson
- Leicester School of Pharmacy, Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom
| | - John Ogwu
- Leicester School of Pharmacy, Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom
| | - Sangeeta Tanna
- Leicester School of Pharmacy, Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom
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Lehmann A, Hofsäss M, Dressman J. Differences in drug quality between South Africa and Germany. J Pharm Pharmacol 2018; 70:1301-1314. [PMID: 30047137 DOI: 10.1111/jphp.12985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 06/27/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To examine differences in drug product quality between products marketed in developed countries and in developing countries. METHODS The quality of drug products marketed in both Germany and South Africa by the same pharmaceutical company was compared. A fixed-dose combination tablet containing amoxicillin/clavulanic acid, and mometasone furoate nasal spray were selected to represent generic medicines requiring prescriptions, while skin lightening products (legally obtained and/or confiscated) were selected to represent pharmaceutical products that are available without a prescription. Pharmacopoeial tests included assay, content uniformity, and where applicable, dissolution in addition to a visual examination of the packaging. KEY FINDINGS Some differences between the product marketed in Germany and in South Africa were detected for the amoxicillin tablet formulations, although all samples still complied with regulatory requirements. The mometasone nasal spray product marketed in South Africa delivered a higher dose than was declared on the label. The composition of the skin lightening products conformed qualitatively with labelling, but in some South African samples alarmingly high amounts of hydroquinone were found. CONCLUSIONS Important differences in quality were detected between some German and South African products. To preclude drug products of poor or doubtful quality from entering the market in South Africa, countermeasures are needed.
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Affiliation(s)
- Andreas Lehmann
- Institute of Pharmaceutical Technology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Martin Hofsäss
- Institute of Pharmaceutical Technology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Jennifer Dressman
- Institute of Pharmaceutical Technology, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
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Drug Quality in South Africa: A Field Test. J Pharm Sci 2018; 107:2720-2730. [PMID: 29936204 DOI: 10.1016/j.xphs.2018.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 06/04/2018] [Accepted: 06/12/2018] [Indexed: 11/20/2022]
Abstract
To assess drug quality and pharmaceutical care in South Africa, "mystery" (i.e., anonymous) customers collected 316 samples from July to September 2016. Solid dosage forms containing amoxicillin alone or in combination with clavulanic acid as well as analgesics containing paracetamol alone or in combination with other drugs were sampled in a randomized fashion from the formal market (pharmacies) and by convenient sampling from the informal market. Visual inspection, uniformity of dosage units, and dissolution testing were performed to evaluate adherence to pharmacopoeial quality standards and to identify counterfeit, degraded, or substandard drugs. Although no counterfeited products were identified, only 55.4% (173/312) of samples were able to fulfill all pharmacopeial requirements for quality. Most of the 139 samples that failed were unable to pass the visual inspection due to inappropriate labeling and packaging. In addition, several substandard products were identified: 17 (5.4%) samples failed dissolution testing and 15 (4.8%) failed the content uniformity test. To improve drug quality and the quality of pharmaceutical care, better education of pharmaceutical professionals and monitoring of the pharmaceutical supply chain in South Africa are needed. Further field studies are necessary to evaluate risks and quality issues for other drug classes and distribution channels.
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Are injectable illegal polypeptide drugs safe? Case report demonstrating the presence of haemolyticBacillus cereusin 2 illegal peptide drugs. Drug Test Anal 2017; 10:791-795. [DOI: 10.1002/dta.2304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/12/2017] [Accepted: 09/13/2017] [Indexed: 01/18/2023]
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Murtagh C, Wells E, Raymond EG, Coeytaux F, Winikoff B. Exploring the feasibility of obtaining mifepristone and misoprostol from the internet. Contraception 2017; 97:287-291. [PMID: 29030227 DOI: 10.1016/j.contraception.2017.09.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/27/2017] [Accepted: 09/29/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We aimed to document the experience of buying abortion pills from online vendors that do not require a prescription and to evaluate the active ingredient content of the pills received. STUDY DESIGN We searched the internet to identify a convenience sample of websites that sold mifepristone and misoprostol to purchasers in the United States and attempted to order these products. We documented price, shipping time and other aspects of ordering. We sent the samples received to a testing laboratory that measured the amount of active ingredient in individual tablets. RESULTS We identified 18 websites and ordered 22 products: 20 mifepristone-misoprostol combination products and 2 that contained only misoprostol. We received 18 combination products and the 2 misoprostol products from 16 different sites. No site required a prescription or any relevant medical information. The time between order and receipt of the 20 products ranged from 3 to 21 business days (median 9.5 days). The price for the 18 combination products ranged from $110 to $360, including shipping and fees; the products without mifepristone cost less. Chemical assays found that the 18 tablets labeled 200 mg mifepristone contained between 184.3 mg and 204.1 mg mifepristone, while the 20 tablets labeled 200 mcg misoprostol contained between 34.1 mcg and 201.4 mcg of the active ingredient. CONCLUSIONS Obtaining abortion medications from online pharmaceutical websites is feasible in the United States. The mifepristone tablets received contained within 8% of the labeled amount of active agent. The misoprostol tablets all contained that compound but usually less than labeled. IMPLICATIONS STATEMENT Given our findings, we expect that some people for whom clinic-based abortion is not easily available or acceptable may consider self-sourcing pills from the internet to be a rational option.
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Affiliation(s)
- Chloe Murtagh
- Gynuity Health Projects, 15 East 26th Street, Suite 801, New York, NY, 10010, USA
| | - Elisa Wells
- Plan C, c/o National Women's Health Network, 1413 K Street NW, 4th Floor, Washington, D.C. 20005
| | - Elizabeth G Raymond
- Gynuity Health Projects, 15 East 26th Street, Suite 801, New York, NY, 10010, USA.
| | - Francine Coeytaux
- Plan C, c/o National Women's Health Network, 1413 K Street NW, 4th Floor, Washington, D.C. 20005
| | - Beverly Winikoff
- Gynuity Health Projects, 15 East 26th Street, Suite 801, New York, NY, 10010, USA
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