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Dhakal N, Gyanwali P, Humagain B, Bc R, Jha N, Sah P, Pradhan A, Dhimal M, Jha AK. Assessment of quality of essential medicines in public health care facilities of Nepal: Findings of nationwide study. PLOS Glob Public Health 2023; 3:e0001841. [PMID: 37228001 DOI: 10.1371/journal.pgph.0001841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/23/2023] [Indexed: 05/27/2023]
Abstract
Essential medicines are those medicines that satisfy the primary health care needs of the citizens. Poor quality of essential medicines can have serious impact on public health. Thus, this study is aimed to assess the quality of essential medicines available in public health care facilities of Nepal. A cross sectional descriptive study was carried out in 62 health facilities across 21 districts, representing all seven provinces of Nepal and selected proportionately from all three ecological regions i.e. Terai, Hill and Mountain using lottery method. Health facilities in selected districts were chosen using random number generator. Face to face interview was taken with health facility in charge using structured questionnaire. All storage conditions information was recorded through observation checklists. Temperature and humidity were measured using a digital instrument. Similarly, 20 different generic medicines were collected for quality testing. The obtained data were entered in Epidata version 3.1, cleaned in Microsoft Excel 2007 and analyzed in SPSS version 16.0. Among 62 health facilities, only 13% of health facilities were found to follow the medicine storage guidelines, with temperature and humidity levels exceeding recommended limits. Out of 244 batches of 20 different generics of essential medicines, 37 batches were found to be substandard. These substandard medicines were- Ciprofloxacin hydrochloride eye/ear drop, Iron supplement tablets, Metformin Hydrochloric tablet, Metronidazole Tablets, Paracetamol Oral suspension, Paracetamol tablet and Povidone Iodine solution. The study recommends the urgent need for the Government of Nepal to prioritize ensuring the quality of essential medicines in the country.
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Affiliation(s)
- Neelam Dhakal
- Nepal Health Research Council, Ramshahpath, Kathmandu, Nepal
| | - Pradip Gyanwali
- Department of Pharmacology, Maharajgunj Medical Campus, Kathmandu, Nepal
| | | | - Rajendra Bc
- Nepal Health Research Council, Ramshahpath, Kathmandu, Nepal
| | - Nisha Jha
- Department of Clinical Pharmacology and Therapeutics, KIST Medical College and Teaching Hospital, Lalitpur, Nepal
| | - Phoolgen Sah
- Department of Pharmacy and Pharmacology, Janamaitri Foundation, Institute Of Health Sciences, Kathmandu, Nepal
| | - Amita Pradhan
- Department of Community Dentistry, People's Dental College and Hospital, Kathmandu, Nepal
| | - Meghnath Dhimal
- Nepal Health Research Council, Ramshahpath, Kathmandu, Nepal
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A T, Sinha S, Mohan P, Dubey S, Yadav V. A cross-sectional questionnaire based study to assess and compare knowledge of drug schedules amongst healthcare professionals in a medical college. Med J Armed Forces India 2022; 78:S172-S178. [PMID: 36147424 PMCID: PMC9485852 DOI: 10.1016/j.mjafi.2020.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 12/26/2020] [Indexed: 10/21/2022] Open
Abstract
Background Ensuring quality, safety and efficacy of all pharmaceuticals is the responsibility of drug regulators. However, healthcare workers should be aware of the legal/regulatory provisions involved. This study was planned to assess and compare the knowledge of various drugs schedules under the Drugs and Cosmetics Act, 1940 amongst medical students, post graduate residents and pharmacists. Methods A questionnaire was designed based on review of literature and was validated. After obtaining ethical clearance and consent from participants, questionnaire was administered to students undergoing internship/6 th semester/4 th semester, post graduate residents and pharmacy students. Participants' knowledge was assessed based on the percentage of correct responses and the intergroup comparison was done by applying ANOVA test. Results Overall, nearly half of the participants had poor knowledge about schedule H1. Sixth semester MBBS students had maximum knowledge followed by interns whereas pharmacy students, 4 th semester MBBS students and PG residents had poor knowledge about drug schedules. Conclusion The study clearly highlights the need for further knowledge dissemination about drug schedules. We recommend that a capsule course be developed especially for post graduate residents and final year pharmacy students.
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Affiliation(s)
- Tejus A
- Graded Specialist (Pharmacology), AFMSD, Lucknow, India
| | - Sharmila Sinha
- Professor and HoD, Dept of Pharmacology, Armed Forces Medical College, Pune 40, India
| | - Prafull Mohan
- Professor, Dept of Pharmacology, Armed Forces Medical College, Pune 40, India
| | - S. Dubey
- Demonstrator, Dept of Pharmacology, Armed Forces Medical College, Pune 40, India
| | - Vikas Yadav
- Resident, Dept of Pharmacology, Armed Forces Medical College, Pune 40, India
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Martins MAF, Scherer MDDA, Lucchese G. Vigilância e controle de medicamentos abaixo do padrão, falsificados e não registrados: revisão integrativa. Rev Panam Salud Publica 2022; 46:e36. [PMID: 35520020 PMCID: PMC9065932 DOI: 10.26633/rpsp.2022.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/30/2021] [Indexed: 11/24/2022] Open
Abstract
Objetivo. Identificar as estratégias de atuação dos sistemas regulatórios na vigilância e controle de medicamentos abaixo do padrão, falsificados e não registrados em nível regional-global, especialmente quanto aos processos de recall. Métodos. Foi realizada uma revisão integrativa da literatura nas bases de dados MEDLINE via PubMed, Embase e SciELO. Foram selecionados estudos publicados no período de 2007 a 2019, em inglês, português e espanhol, que abordavam estratégias desenvolvidas pelos sistemas regulatórios dos países, com foco no recall de medicamentos abaixo do padrão, falsificados e não registrados. Resultados. Dos 483 estudos inicialmente identificados, foram incluídas 21 publicações de alcance global, regional ou nacional. As estratégias de prevenção, detecção e resposta, incluindo o recall, foram agrupadas em dois modelos (passivo-reativo e proativo) de atuação dos sistemas regulatórios na vigilância e controle de medicamentos. Esses modelos parecem combinar estratégias passivas e proativas, complementares ou concorrentes, variando conforme o nível de desenvolvimento dos países e a capacidade regulatória. Embora seja considerado a resposta mais eficaz de proteção da população, o recall não foi implementado de forma uniforme no âmbito dos sistemas regulatórios, segundo os estudos. Conclusões. A complexidade e a magnitude do problema dos medicamentos abaixo do padrão, falsificados e não registrados exigem esforços, investimentos e mudanças profundas na abordagem, nos processos e nas capacidades dos sistemas regulatórios, podendo as estratégias de vigilância e controle do mercado convergir para um modelo híbrido, multisetorial, multidisciplinar, global e sistêmico de proteção da saúde humana.
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Affiliation(s)
| | | | - Geraldo Lucchese
- Universidade de Brasília (UnB), Departamento de Saúde Coletiva, Brasília (DF), Brasil
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Anantharamu T, Narain N, Mathur A, Roy P, Gupta A. Package inserts: Are they present to guide our patients? Med J DY Patil Vidyapeeth 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_366_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sengxeu N, Aon C, Dufat H, Boumediene F, Chan S, Ros S, Preux PM, Ratsimbazafy V, Jost J. Availability, affordability, and quality of essential anti-seizure medication in Cambodia. Epilepsia Open 2021; 6:548-558. [PMID: 34101380 PMCID: PMC8408618 DOI: 10.1002/epi4.12514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/16/2021] [Accepted: 05/30/2021] [Indexed: 01/22/2023] Open
Abstract
Objective Epilepsy is a major neurological disorder that requires long‐term medical treatment. Once epilepsy is diagnosed, people with epilepsy face many difficulties in accessing treatment (treatment gap). Our objective was to assess the situation regarding the availability, price, affordability, and quality of anti‐seizure medication (ASM), which are major determinants of access to treatment. Method A cross‐sectional study was performed in provincial/district hospitals and private pharmacies in urban and rural areas in Cambodia. Data on ASM availability and price were obtained through drug suppliers. Affordability was estimated as the number of day wages the lowest‐paid government employee must work to purchase a monthly treatment. Samples of ASM were collected, and the quality of ASM was assessed through Medicine Quality Assessment Reporting Guidelines. Results Out of 138 outlets visited, only 72 outlets (52.2% [95% CI 43.5‐60.7]) had at least one ASM available. Phenobarbital 100 mg was the most available (35.5%), followed by carbamazepine 200 mg (21.7%), phenobarbital 50 mg (11.6%), sodium valproate 500 mg (9.4%), and phenytoin 100 mg (9.4%). In provincial/district hospitals, ASM was provided free of charge. In private pharmacies, affordability for phenobarbital 50 mg and 100 mg was the best, with 0.6 and 0.5 days, respectively, compared to phenytoin 100 mg (1.8 days), and other ASM. No counterfeit ASM was found in this study. Phenytoin sample presented the worst quality (33.0%) compared to carbamazepine (27.8%), and other ASM. Significance A lack of access to affordable and effective ASM due to low availability and poor quality of ASM was identified. Our research highlights the need for future policy efforts to ensure the quality of ASM and improve their availability. This can be achieved by involving the calculation of their annual needs for these drugs and increasing the national production of ASM.
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Affiliation(s)
- Noudy Sengxeu
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France.,Faculty of Pharmacy, University of Health Sciences, Vientiane, Lao PDR
| | - Chanraksmey Aon
- Cambodian Society of Neurology, Calmette Hospital, Phnom Penh, Cambodia
| | - Hanh Dufat
- Natural Products, Analysis and Synthesis, CiTCoM (Cibles Thérapeutiques et Conception de Médicaments)-UMR 8038 CNRS/Université de Paris, Faculty of Health-Pharmacie, Université de Paris, Paris, France
| | - Farid Boumediene
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Samleng Chan
- Cambodian Society of Neurology, Calmette Hospital, Phnom Penh, Cambodia
| | - Sina Ros
- Cambodian Society of Neurology, Calmette Hospital, Phnom Penh, Cambodia
| | - Pierre-Marie Preux
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Voa Ratsimbazafy
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France.,Department of Pharmacy, CHU Limoges, Limoges, France
| | - Jeremy Jost
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France.,Department of Pharmacy, CHU Limoges, Limoges, France
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Huddart S, Singh M, Jha N, Benedetti A, Pai M. Case fatality and recurrent tuberculosis among patients managed in the private sector: A cohort study in Patna, India. PLoS One 2021; 16:e0249225. [PMID: 33770134 PMCID: PMC7996982 DOI: 10.1371/journal.pone.0249225] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/14/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A key component of the WHO End TB Strategy is quality of care, for which case fatality is a critical marker. Half of India's nearly 3 million TB patients are treated in the highly unregulated private sector, yet little is known about the outcomes of these patients. Using a retrospective cohort design, we estimated the case fatality ratio (CFR) and rate of recurrent TB among patients managed in the private healthcare sector in Patna, India. METHODS World Health Partners' Private Provider Interface Agencies (PPIA) pilot project in Patna has treated 89,906 private sector TB patients since 2013. A random sample of 4,000 patients treated from 2014 to 2016 were surveyed in 2018 for case fatality and recurrent TB. CFR is defined as the proportion of patients who die during the period of interest. Treatment CFRs, post-treatment CFRs and rates of recurrent TB were estimated. Predictors for fatality and recurrence were identified using Cox proportional hazards modelling. Survey non-response was adjusted for using inverse probability selection weighting. RESULTS The survey response rate was 56.0%. The weighted average follow-up times were 8.7 months in the treatment phase and 26.4 months in the post-treatment phase. Unobserved patients were more likely to have less than one month of treatment adherence (32.0% vs. 13.5%) and were more likely to live in rural Patna (21.9% vs. 15.0%). The adjusted treatment phase CFR was 7.27% (5.97%, 8.49%) and at 24 months post-treatment was 3.32% (2.36%, 4.42%). The adjusted 24 month post-treatment phase recurrent TB rate was 3.56% (2.54%, 4.79%). CONCLUSIONS Our cohort study provides critical estimates of TB patient outcomes in the Indian private sector, and accounts for selection bias. Patients in the private sector in Patna experienced a moderate treatment CFR but rates of recurrent TB and post-treatment fatality were low.
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Affiliation(s)
- Sophie Huddart
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- McGill International TB Centre, Montreal, Canada
- Faculty of Medicine, University of California-San Francisco, San Francisco, CA, United States of America
| | | | - Nita Jha
- World Health Partners, Patna, India
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Madhukar Pai
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- McGill International TB Centre, Montreal, Canada
- Manipal McGill Centre for Infectious Diseases, Manipal Academy of Higher Education, Manipal, India
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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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Khetan A, Zullo M, Hejjaji V, Barbhaya D, Agarwal S, Gupta R, Madan Mohan SK, Josephson R. Prevalence and pattern of cardiovascular risk factors in a population in India. Heart Asia 2017; 9:e010931. [PMID: 29469903 DOI: 10.1136/heartasia-2017-010931] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/14/2017] [Accepted: 08/18/2017] [Indexed: 11/04/2022]
Abstract
Background Cardiovascular disease is the leading cause of mortality in India. Since it is largely driven by risk factors such as hypertension, diabetes and smoking, it is important to study the treatment cascade for these conditions and identify areas for improvement. Methods This is a cross-sectional study from Project SEHAT (Study to Enhance Heart Associated Treatments), an ongoing cluster randomised controlled trial testing the hypothesis that a community health worker-led intervention can improve the control of cardiovascular risk factors in a community in West Bengal, India. For the baseline data, 3556 adults, between the ages of 35 and 70, were screened for hypertension, diabetes and smoking. For hypertension and diabetes, an elevated reading was confirmed on a repeat visit. Results 18.3% (n=650), 9.0% (n=317) and 14.1% (n=500) of adults were diagnosed with hypertension, diabetes and smoking, respectively. Overall, 35.0% (n=1242) adults had at least one of the three risk factors. 55.1% (n=358) of participants with hypertension and 40.4% (n=128) of participants with diabetes were unaware of their respective condition. 36.6% (n=238) of those with hypertension and 58.0% (n=184) of diabetics were on treatment. 8.2% (n=53) hypertensives were controlled (blood pressure <140/90 mm Hg) while 13.6% (n=43) diabetics were controlled (defined as fasting blood sugar <126 mg/dL). Less than 1% diabetics were on insulin, and average number of medications for a patient with hypertension was 1.2. Conclusions In our population in semiurban India, one in three adults have a major cardiovascular risk factor, with low control rates. There is a large burden of undiagnosed cardiovascular risk factors and a large gap between treatment and control, which may be explained by lack of treatment intensification.
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Affiliation(s)
- Aditya Khetan
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Centre, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Vittal Hejjaji
- Department of Medicine, University Hospitals Cleveland Medical Centre, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Sushil Agarwal
- Society for Enhanced Health and Access to Treatments, Dalkhola, India
| | | | - Sri Krishna Madan Mohan
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Centre, Case Western Reserve University, Cleveland, Ohio, USA
| | - Richard Josephson
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Centre, Case Western Reserve University, Cleveland, Ohio, USA
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Hamilton WL, Doyle C, Halliwell-Ewen M, Lambert G. Public health interventions to protect against falsified medicines: a systematic review of international, national and local policies. Health Policy Plan 2016; 31:1448-1466. [PMID: 27311827 DOI: 10.1093/heapol/czw062] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Falsified medicines are deliberately fraudulent drugs that pose a direct risk to patient health and undermine healthcare systems, causing global morbidity and mortality. OBJECTIVE To produce an overview of anti-falsifying public health interventions deployed at international, national and local scales in low and middle income countries (LMIC). DATA SOURCES We conducted a systematic search of the PubMed, Web of Science, Embase and Cochrane Central Register of Controlled Trials databases for healthcare or pharmaceutical policies relevant to reducing the burden of falsified medicines in LMIC. RESULTS Our initial search identified 660 unique studies, of which 203 met title/abstract inclusion criteria and were categorised according to their primary focus: international; national; local pharmacy; internet pharmacy; drug analysis tools. Eighty-four were included in the qualitative synthesis, along with 108 articles and website links retrieved through secondary searches. DISCUSSION On the international stage, we discuss the need for accessible pharmacovigilance (PV) global reporting systems, international leadership and funding incorporating multiple stakeholders (healthcare, pharmaceutical, law enforcement) and multilateral trade agreements that emphasise public health. On the national level, we explore the importance of establishing adequate medicine regulatory authorities and PV capacity, with drug screening along the supply chain. This requires interdepartmental coordination, drug certification and criminal justice legislation and enforcement that recognise the severity of medicine falsification. Local healthcare professionals can receive training on medicine quality assessments, drug registration and pharmacological testing equipment. Finally, we discuss novel technologies for drug analysis which allow rapid identification of fake medicines in low-resource settings. Innovative point-of-purchase systems like mobile phone verification allow consumers to check the authenticity of their medicines. CONCLUSIONS Combining anti-falsifying strategies targeting different levels of the pharmaceutical supply chain provides multiple barriers of protection from falsified medicines. This requires the political will to drive policy implementation; otherwise, people around the world remain at risk.
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Affiliation(s)
- William L Hamilton
- University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0SP, UK .,Wellcome Trust Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, CB10 1SA, UK
| | - Cormac Doyle
- University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0SP, UK
| | - Mycroft Halliwell-Ewen
- University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0SP, UK
| | - Gabriel Lambert
- University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0SP, UK
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