Hazardous properties and toxicological update of mercury: From fish food to human health safety perspective

The mercury (Hg) poisoning of Minamata Bay of Japan widely activated a global attention to Hg toxicity and its potential consequences to the aquatic ecosystem and human health. This has resulted to an increased need for a dynamic assembly, contextualization, and quantification of both the current state-of-the-art and approaches for understanding the cause-and-effect relationships of Hg exposure. Thus, the objective of this present review is to provide both hazardous toxic properties and toxicological update of Hg, focusing on how it ultimately affects the aquatic biota to potentially produce human health effects. Primarily, we discussed processes that relate to Hg exposure, including immunological aspects and risk assessment, vulnerability, toxicokinetics, and toxicodynamics, using edible fish, swordfish (Xiphias gladius), as a model. In addition, we summarized available information about Hg concentration limits set by different governmental agencies, as recognized by national and international standardization authorities.

Harmonization of regulatory approaches for evaluating therapeutic equivalence and interchangeability of multisource drug products: workshop summary report

Regulatory approaches for evaluating therapeutic equivalence of multisource (or generic) drug products vary among different countries and/or regions. Harmonization of these approaches may decrease the number of in vivo bioequivalence studies and avoid unnecessary drug exposure to humans. Global harmonization for regulatory requirements may be promoted by a better understanding of factors underlying product performance and expectations from different regulatory authorities. This workshop provided an opportunity for pharmaceutical scientists from academia, industry and regulatory agencies to have open discussions on current regulatory issues and industry practices, facilitating harmonization of regulatory approaches for establishing therapeutic equivalence and interchangeability of multisource drug products.

Aflatoxin M1 in milk does not contribute substantially to global liver cancer incidence

BACKGROUND

For 60 y, it has been known that aflatoxin B1 (AFB1), a mycotoxin produced by Aspergillus fungi in certain food and feed crops, causes hepatocellular carcinoma (liver cancer; HCC) in humans. The annual global burden of AFB1-related HCC has been estimated. However, much less is known about the potential carcinogenic impact of a metabolite of AFB1 called aflatoxin M1 (AFM1), which is secreted in milk when dairy animals consume AFB1-contaminated feed. The cancer risk of AFM1 to humans from milk consumption has not yet been evaluated.

OBJECTIVES

We sought to estimate the global risk of AFM1-related liver cancer through liquid milk consumption, accounting for possible synergies between AFM1 and chronic infection with hepatitis B virus (HBV) in increasing cancer risk.

METHODS

We conducted a quantitative cancer risk assessment by analyzing extensive datasets of national population sizes, dairy consumption patterns, AFM1 concentrations in milk in 40 nations, and chronic HBV prevalence. Two separate cancer risk assessments were conducted: assuming a possible synergy between AFM1 and HBV in increasing cancer risk in a manner similar to that of AFB1 and HBV, and assuming no such synergy.

RESULTS

If there is no synergy between AFM1 and HBV, AFM1 may contribute ∼0.001% of total annual HCC cases globally. If there is synergy between AFM1 and HBV infection, AFM1 may contribute ∼0.003% of all HCC cases worldwide. In each case, the total expected AFM1-attributable cancer cases are ∼13-32 worldwide.

CONCLUSION

AFM1 exposure through liquid milk consumption does not substantially increase liver cancer risk in humans. Policymakers should consider this low risk against the nutritional benefits of milk consumption, particularly to children, in a current global situation of milk being discarded because of AFM1 concentrations exceeding regulatory standards.

Systematic Review of Platelet-Rich Plasma in Medical and Surgical Specialties: Quality, Evaluation, Evidence, and Enforcement

Background: Platelet-rich plasma (PRP) is widely used in various medical and surgical specialties for its regenerative properties, including aesthetics (facial rejuvenation, hair restoration, and skin tightening) and orthopedics (treatment of tendinitis and osteoarthritis). However, the inconsistent literature on PRP's efficacy and safety leads to critical knowledge gaps. This systematic review evaluates quality control measures in PRP preparation and application and explores the regulatory environment governing its clinical use. Methods: Following PRISMA guidelines, a comprehensive search was conducted across multiple databases, including PubMed, EMBASE, and Web of Science, for studies published from January 2020 to April 2024. The review included randomized controlled trials (RCTs) involving human participants undergoing PRP treatment for aesthetic or regenerative purposes. Key parameters such as the PRP preparation methods, platelet concentration, and quality control measures were analyzed. The study protocol was registered with PROSPERO (ID: CRD42024557669). Results: Out of 75 RCTs involving 5726 patients, the review identified significant variability in PRP preparation methods and application techniques, including differences in centrifugation protocols and platelet concentration levels. A new evidence-based scoring system, the William-Eqram Scoring System for PRP Quality Reporting (WESS-PQR), was proposed to address these inconsistencies. Correlation analysis revealed a strong positive correlation (r = 0.79) between proper temperature control during preparation and PRP efficacy. Initial platelet count assessment showed a moderate positive correlation (r = 0.57) with efficacy. Conclusions: Standardized PRP preparation protocols and robust regulatory frameworks are urgently needed to ensure the safety and efficacy of PRP treatments. The proposed WESS-PQR scoring system can serve as a valuable tool for clinicians and researchers, promoting consistency and reliability in PRP applications.

Quality Assurance for Hepatitis C Virus Point-of-Care Diagnostics in Sub-Saharan Africa

As part of a multinational study to evaluate the Bioline Hepatitis C virus (HCV) point-of-care (POC) testing in sub-Saharan Africa (SSA), this narrative review summarises regulatory standards and quality indicators for validating and approving HCV clinical diagnostics. In addition, this review also provides a summary of their diagnostic evaluations using the REASSURED criteria as the benchmark and its implications on the WHO HCV elimination goals 2030.

Situational analysis and future directions for medicine retail outlets: compliance with pharmaceutical regulatory standards in Ethiopia

Background

Medicine regulation is essential for safeguarding the safety, efficacy, and quality of pharmaceutical products available in medicine retail outlets (MROs). It ensures that medicines, whether sourced locally or internationally, comply with stringent quality standards and regulatory protocols to protect public health. Effective regulation enhances trust in pharmaceutical markets by ensuring the availability of safe and effective medications. However, the regulatory framework within healthcare facilities, particularly in MROs where significant drug-related information is exchanged, is often underperforming. This issue is particularly pronounced in low-and middle-income countries like Ethiopia, where MROs play a critical role as the initial point of healthcare contact. This review aims to assess the level of compliance with pharmaceutical regulatory standards in medicine retail outlets (MROs) in Ethiopia and to evaluate the enforcement of these standards in the country's pharmaceutical market.

Methods

The review utilized online databases such as PubMed, and Web of Science to collect relevant studies and reports. It focused on issues of regulatory compliance in MROs in Ethiopia, identifying gaps in practice, drug quality, and adherence to national guidelines set by the Ethiopian Food and Drug Authority (EFDA).

Results

The review revealed significant regulatory compliance issues within Ethiopian MROs, leading to the distribution of poor quality medicines. It was found that drugs obtained from non-compliant outlets failed to meet quality control standards outlined in drug monographs. Many MROs and pharmacy professionals were found to be non-compliant with EFDA guidelines. Additionally, dispensing and storage practices in MROs were not in line with EFDA regulations and required improvements.

Conclusion

The review underlines the need for regulatory enforcement in Ethiopia health settings to address issues of non-compliance and the distribution of poor-quality drugs. It suggests that regulatory bodies should enhance inspection measures and provide opportunities for continued professional development for pharmacy staff and regulatory personnel. Collaboration among regulatory authorities, government, professionals, and academic researchers are pivotal to improving compliance and ensuring the availability of safe, effective, and quality medicines within medicine retail outlets and then protecting public health.

Importance of Sanitation for Stored-Product Pest Management

Sanitation is essential for the cost-effective pest management of stored-product insects. The Food, Drug and Cosmetic Act of 1938 led to the Food and Drug Administration (FDA) tightening regulatory standards, and many local surveys, courses and conferences were organized to prepare the industry for these new regulations. Sanitation removes insects and residual food, which may also provide shelter for insects, with heat treatments and insecticide applications. The number of insects removed by cleaning may be reduced as the number of available hiding places increases. Decreased sanitation negatively affects the efficacy of most other pest management practices, with means of 1.3- to 17-fold decreases in efficacy. The majority of studies quantifying the efficacy of sanitation have been performed on the farm storage of grain, but some studies have been conducted for grain elevators, food processing, and the marketing system. Results ranged from no effect of sanitation alone to very effective alone or with other methods. Sanitation can also reduce insect infestation prior to harvest. Some cost-benefit analyses have been conducted for sanitation.