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Edmond K, Clark A, Korczak VS, Sanderson C, Griffiths UK, Rudan I. Global and regional risk of disabling sequelae from bacterial meningitis: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2010; 10:317-28. [PMID: 20417414 DOI: 10.1016/s1473-3099(10)70048-7] [Citation(s) in RCA: 379] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Few data sources are available to assess the global and regional risk of sequelae from bacterial meningitis. We aimed to estimate the risks of major and minor sequelae caused by bacterial meningitis, estimate the distribution of the different types of sequelae, and compare risk by region and income. We systematically reviewed published papers from 1980 to 2008. Standard global burden of disease categories (cognitive deficit, bilateral hearing loss, motor deficit, seizures, visual impairment, hydrocephalus) were labelled as major sequelae. Less severe, minor sequelae (behavioural problems, learning difficulties, unilateral hearing loss, hypotonia, diplopia), and multiple impairments were also included. 132 papers were selected for inclusion. The median (IQR) risk of at least one major or minor sequela after hospital discharge was 19.9% (12.3-35.3%). The risk of at least one major sequela was 12.8% (7.2-21.1%) and of at least one minor sequela was 8.6% (4.4-15.3%). The median (IQR) risk of at least one major sequela was 24.7% (16.2-35.3%) in pneumococcal meningitis; 9.5% (7.1-15.3%) in Haemophilus influenzae type b (Hib), and 7.2% (4.3-11.2%) in meningococcal meningitis. The most common major sequela was hearing loss (33.9%), and 19.7% had multiple impairments. In the random-effects meta-analysis, all-cause risk of a major sequela was twice as high in the African (pooled risk estimate 25.1% [95% CI 18.9-32.0%]) and southeast Asian regions (21.6% [95% CI 13.1-31.5%]) as in the European region (9.4% [95% CI 7.0-12.3%]; overall I(2)=89.5%, p<0.0001). Risks of long-term disabling sequelae were highest in low-income countries, where the burden of bacterial meningitis is greatest. Most reported sequelae could have been averted by vaccination with Hib, pneumococcal, and meningococcal vaccines.
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Affiliation(s)
- Karen Edmond
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
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152
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Identification of counterfeit medicines for erectile dysfunction from an illegal supply chain. Arh Hig Rada Toksikol 2010; 61:69-75. [PMID: 20338870 DOI: 10.2478/10004-1254-61-2010-1953] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The appearance of counterfeit medicines in supply chains is a global public health problem that may seriously affect patients. Counterfeit drugs do not meet quality standards and do not declare their real composition and/or source for the purposes of fraud. They may be generic or innovative, they may contain genuine constituents in a fake packaging, or wrong ingredients, or inactive ingredients, or an incorrect quantity of the active substance. In Croatia, no cases of counterfeit medicines have been detected so far, but the Agency for Medicinal Products and Medical Devices has received 34 samples of medicines and other products for testing from Zagreb City Police. The samples included medicines for erectile dysfunction: sildenafil, tadalafil, and vardenafil. Twenty-three samples of tablets without marketing authorisation in Croatia were tested with high-performance liquid chromatography (HPLC) for the declared sildenafil and tadalafil content. Samples labelled 1 (batch T/33), 3 (batch T/33), 5 (batch 4), 6 (batch M0016J), 10 (batch T-070235), 12 (batch T-070544), 15 (batch 314833201), 16 (batch 832718474), and 17 (batch 504830028) containing sildenafil and samples labelled 20 (batch 070356), 21 (batch 05668), and 22 (batch T 378 5) containing tadalafil did not contain the active substance within the acceptable 95 % to 105 % margin of deviation from the declared content. While most samples cannot be described as fake with a reasonable amount of certainty, there is still a suspicion of counterfeit. A correct conclusion can be drawn only with the assistance of the manufacturers and by conducting additional laboratory tests.
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153
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Newton PN, Green MD, Fernández FM. Impact of poor-quality medicines in the 'developing' world. Trends Pharmacol Sci 2010; 31:99-101. [PMID: 20117849 PMCID: PMC2845817 DOI: 10.1016/j.tips.2009.11.005] [Citation(s) in RCA: 132] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 11/24/2009] [Accepted: 11/24/2009] [Indexed: 11/24/2022]
Abstract
Since our ancestors began trading several millennia ago, counterfeit and substandard medicines have been a recurring problem, with history punctuated by crises in the supply of anti-microbials, such as fake cinchona bark in the 1600s and fake quinine in the 1800s. Unfortunately this problem persists, in particular afflicting unsuspecting patients in ‘developing’ countries. Poor-quality drugs are a vital (but neglected) public health problem. They contribute to a ‘crevasse’ between the enormous effort in therapeutic research and policy decisions and implementation of good-quality medicines.
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Affiliation(s)
- Paul N Newton
- Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.
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154
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Dionisio D, Racalbuto V, Messeri D. Designing ARVs Patent Pool Up to Trade & Policy Evolutionary Dynamics. Open AIDS J 2010; 4:70-5. [PMID: 20200604 PMCID: PMC2831190 DOI: 10.2174/1874613601004020070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Revised: 07/01/2009] [Accepted: 10/12/2009] [Indexed: 11/22/2022] Open
Abstract
Patent pools for second and third-line Fixed Dose Combination (FDC) antiretroviral drugs (ARVs) should not be delayed as they are instrumental to urgent public health needs in the under-served markets. Nonetheless, multinational originator companies still seem to perceive patent pooling for ARVs as a minefield that would offer the generic competitors lots of deeply exploitable opportunities, to the detriment of patent owner’s rights. This paper analyses the brand industry concerns, while looking for a strategy up to a really equitable and free world market, without any discrimination between end-users in wealthy and resource-limited countries. This strategy would urge partnerships between originator companies first to make newer FDC ARVs quickly available and allow patent pool agreements with generic counterparts to be negotiated straight afterwards. The patent pool strategy highlighted in this paper would assert the primacy of health over for-profit policies, while aligning with the 61st WHO’s Assembly recommendations and G7, G8 and World Trade Organisation’s warnings and pledges against trade protectionism.
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Affiliation(s)
- Daniele Dionisio
- "Access to Drugs: International Policies" - CLIA (Italian Network for International Fight against AIDS), Italian Society for Infectious and Tropical Diseases (SIMIT), Division of Infectious Diseases, Pistoia Hospital, Pistoia, Italy
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157
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Counterfeit drugs and other products and substances: Review of drugs for influenza prevention and treatment including pandemic influenza A(H1N1) 2009. VOJNOSANIT PREGL 2010; 67:501-6. [DOI: 10.2298/vsp1006501j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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158
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Sengaloundeth S, Green MD, Fernández FM, Manolin O, Phommavong K, Insixiengmay V, Hampton CY, Nyadong L, Mildenhall DC, Hostetler D, Khounsaknalath L, Vongsack L, Phompida S, Vanisaveth V, Syhakhang L, Newton PN. A stratified random survey of the proportion of poor quality oral artesunate sold at medicine outlets in the Lao PDR - implications for therapeutic failure and drug resistance. Malar J 2009; 8:172. [PMID: 19638225 PMCID: PMC2734859 DOI: 10.1186/1475-2875-8-172] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Accepted: 07/28/2009] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Counterfeit oral artesunate has been a major public health problem in mainland SE Asia, impeding malaria control. A countrywide stratified random survey was performed to determine the availability and quality of oral artesunate in pharmacies and outlets (shops selling medicines) in the Lao PDR (Laos). METHODS In 2003, 'mystery' shoppers were asked to buy artesunate tablets from 180 outlets in 12 of the 18 Lao provinces. Outlets were selected using stratified random sampling by investigators not involved in sampling. Samples were analysed for packaging characteristics, by the Fast Red Dye test, high-performance liquid chromatography (HPLC), mass spectrometry (MS), X-ray diffractometry and pollen analysis. RESULTS Of 180 outlets sampled, 25 (13.9%) sold oral artesunate. Outlets selling artesunate were more commonly found in the more malarious southern Laos. Of the 25 outlets, 22 (88%; 95%CI 68-97%) sold counterfeit artesunate, as defined by packaging and chemistry. No artesunate was detected in the counterfeits by any of the chemical analysis techniques and analysis of the packaging demonstrated seven different counterfeit types. There was complete agreement between the Fast Red dye test, HPLC and MS analysis. A wide variety of wrong active ingredients were found by MS. Of great concern, 4/27 (14.8%) fakes contained detectable amounts of artemisinin (0.26-115.7 mg/tablet). CONCLUSION This random survey confirms results from previous convenience surveys that counterfeit artesunate is a severe public health problem. The presence of artemisinin in counterfeits may encourage malaria resistance to artemisinin derivatives. With increasing accessibility of artemisinin-derivative combination therapy (ACT) in Laos, the removal of artesunate monotherapy from pharmacies may be an effective intervention.
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Affiliation(s)
- Sivong Sengaloundeth
- Food and Drug Department, Ministry of Health, Government of the Lao PDR, Vientiane, Lao PDR
| | - Michael D Green
- Division of Parasitic Diseases, US Centres for Disease Control and Prevention, Atlanta, USA
| | - Facundo M Fernández
- School of Chemistry & Biochemistry, Georgia Institute of Technology, Atlanta, GA, USA
| | - Ot Manolin
- Food and Drug Quality Control Centre, Ministry of Health, Government of the Lao PDR, Vientiane, Lao PDR
| | - Khamlieng Phommavong
- Food and Drug Department, Ministry of Health, Government of the Lao PDR, Vientiane, Lao PDR
| | | | - Christina Y Hampton
- School of Chemistry & Biochemistry, Georgia Institute of Technology, Atlanta, GA, USA
| | - Leonard Nyadong
- School of Chemistry & Biochemistry, Georgia Institute of Technology, Atlanta, GA, USA
| | | | - Dana Hostetler
- School of Chemistry & Biochemistry, Georgia Institute of Technology, Atlanta, GA, USA
| | - Lamphet Khounsaknalath
- Food and Drug Quality Control Centre, Ministry of Health, Government of the Lao PDR, Vientiane, Lao PDR
| | - Latsamy Vongsack
- Food and Drug Quality Control Centre, Ministry of Health, Government of the Lao PDR, Vientiane, Lao PDR
| | - Samlane Phompida
- Centre for Malariology, Parasitology & Entomology, Government of the Lao PDR, Vientiane, Lao PDR
| | - Viengxay Vanisaveth
- Centre for Malariology, Parasitology & Entomology, Government of the Lao PDR, Vientiane, Lao PDR
| | - Lamphone Syhakhang
- Food and Drug Department, Ministry of Health, Government of the Lao PDR, Vientiane, Lao PDR
| | - Paul N Newton
- Wellcome Trust – Mahosot Hospital – Oxford Tropical Medicine Research Collaboration, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Center for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, University of Oxford, Oxford, UK
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