Alertas sanitarias de productos médicos subestándares, falsificados y no registrados al inicio de la pandemia de COVID-19 en las Américas / Health alerts for substandard, falsified, and unregistered medical products at the onset of the COVID-19 pandemic in the Americas / Alertas de saúde para produtos médicos abaixo do padrão, falsificados e não registrados no início da pandemia de COVID-19 nas Américas

RESUMEN Objetivo. Identificar y analizar los incidentes de productos médicos subestándares, falsificados, no registrados y robados al inicio de la pandemia de COVID-19. Métodos. Búsqueda detallada en los sitios web de las autoridades reguladoras de las Américas. Identificación de los incidentes de medicamentos y dispositivos médicos (incluidos los de diagnóstico in vitro) subestándares falsificados, no registrados y robados. Se determinaron los tipos de productos, las etapas de la cadena de suministro en las que se detectaron y las medidas tomadas por las autoridades. Resultados. Se identificaron 1 273 incidentes en 15 países (1 087 productos subestándares, 44 falsificados, 123 no registrados y 19 robados). La mayor cantidad de incidentes corresponden a dispositivos médicos, desinfectantes y antisépticos. El punto en la cadena de suministro con mayor frecuencia de informes fue la adquisición a través de internet. Las medidas tomadas por las autoridades reguladoras corresponden en su mayoría a: alerta, prohibición de uso, prohibición de publicidad y fabricación, retiro del mercado y seguimiento de eventos adversos. Conclusiones. Se evidenció un número destacable de incidentes de productos médicos subestándares, falsificados, no registrados y robados al inicio de la pandemia por COVID-19. La escasez de insumos, la flexibilización en los requisitos regulatorios y el aumento de la demanda son factores que pueden favorecer el incremento del número de incidentes. Las autoridades reguladoras nacionales de referencia presentaron mayores frecuencias de detección de incidentes y de aplicación de medidas sanitarias. Se observó que se debe abordar el canal de venta por internet con alguna estrategia reguladora para garantizar la distribución segura de productos médicos.

ABSTRACT Objective. Identify and analyze incidents of substandard, falsified, unregistered, and stolen medical products at the onset of the COVID-19 pandemic. Methods. Detailed search of the websites of regulatory authorities in the Americas. Identification of incidents of substandard, falsified, unregistered, and stolen medicines and medical devices (including in vitro diagnostics). The types of products were determined, as were the stages in the supply chain where they were detected, and the actions taken by authorities. Results. A total of 1 273 incidents were identified in 15 countries (1 087 substandard, 44 falsified, 123 unregistered, and 19 stolen products). The largest number of incidents involved medical devices, disinfectants, and antiseptics. The most frequently reported point in the supply chain was online purchasing. The principal measures taken by the regulatory authorities were: alerts, prohibition of use, prohibition of advertising and manufacture, recall, and monitoring of adverse events. Conclusions. A substantial number of incidents involving substandard, falsified, unregistered, and stolen medical products at the onset of the COVID-19 pandemic were identified. Shortages of supplies, easing of regulatory requirements, and increased demand are factors that may have led to an increase in the number of incidents. The national regulatory authorities of reference reported more frequent detection of incidents and more frequent application of health measures. A regulatory strategy is needed in order to address online sales and ensure the safe distribution of medical products.

RESUMO Objetivo. Identificar e analisar incidentes de produtos médicos abaixo do padrão, falsificados, não registrados e roubados no início da pandemia de COVID-19. Métodos. Foi realizada uma busca detalhada nos sites das autoridades reguladoras das Américas. Foram identificados incidentes envolvendo medicamentos e dispositivos médicos (incluindo para diagnóstico in vitro) abaixo do padrão, falsificados, não registrados e roubados. Foram determinados os tipos de produtos, os estágios da cadeia de abastecimento em que foram detectados e as medidas tomadas pelas autoridades. Resultados. Foram identificados 1 273 incidentes em 15 países (1 087 produtos abaixo do padrão, 44 falsificados, 123 não registrados e 19 roubados). O maior número de incidentes estava relacionado a dispositivos médicos, desinfetantes e antissépticos. O ponto na cadeia de abastecimento com a maior frequência de relatos foi a de aquisição pela internet. As medidas tomadas pelas autoridades reguladoras foram principalmente alertas, proibições de uso, proibições de publicidade e fabricação, recolhimento de produtos do mercado e monitoramento de eventos adversos. Conclusões. Houve um número significativo de incidentes envolvendo produtos médicos abaixo do padrão falsificados, não registrados e roubados no início da pandemia de COVID-19. A escassez de insumos, a flexibilização das exigências regulatórias e o aumento da demanda são fatores que podem levar a um maior número de incidentes. As autoridades reguladoras nacionais de referência informaram um aumento na frequência de detecção de incidentes e implementação de medidas sanitárias. O canal de vendas pela internet precisa ser abordado com alguma estratégia regulatória para garantir a distribuição segura de produtos médicos.

Regulación de la venta de productos médicos por Internet: experiencias y estrategias para Latinoamérica / Regulation of the online sale of medical products: experiences and strategies for Latin America / Regulamentação da venda de produtos médicos pela internet: experiências e estratégias para a América Latina

RESUMEN El objetivo de este informe especial es presentar los avances en Latinoamérica sobre la regulación de la venta de productos médicos a través de internet y ofrecer orientación a las Autoridades Reguladoras Nacionales (ARN) en la planificación y ejecución de estrategias para la regulación y fiscalización del comercio electrónico de productos médicos. Se presentan los avances regulatorios y de programas, e iniciativas efectuadas por cuatro países de América Latina para el control de la venta de productos médicos a través de Internet, incluyendo revisiones complementarias de la literatura y de programas para el control del comercio electrónico de agencias de referencia. A partir de esta revisión, se proponen las siguientes líneas estratégicas: fortalecimiento del marco regulatorio y normativo; fortalecimiento de la capacidad fiscalizadora; colaboración con autoridades y otros actores clave nacionales e internacionales; y comunicación y sensibilización con la comunidad y los profesionales de salud. Cada una de estas estrategias deben ir acompañadas con acciones específicas, que pueden servir como orientaciones para las ARN de las Américas, y de países con contextos similares para el fortalecimiento de sus marcos regulatorios y la protección de los pacientes y consumidores.

ABSTRACT The objective of this special report is to present the advances in Latin America on regulation of the online sale of medical products and to offer guidance to national regulatory authorities (NRAs) on planning and implementing strategies to regulate and oversee the e-commerce of medical products. The regulatory advances and the programs and initiatives implemented in four Latin American countries to control the online sale of medical products are presented, including complementary reviews of the literature and reviews of e-commerce control programs of agencies of reference. Based on this review, the following strategies are proposed: strengthening the regulatory and policy framework; strengthening the capacity for oversight; collaboration with national and international authorities and other key players; and communication and awareness-raising with the community and health care professionals. Each of these strategies should be accompanied by specific actions that can serve as guidelines for NRAs in the Americas and in countries with similar contexts, to strengthen their regulatory frameworks and patient and consumer protections.

RESUMO O objetivo deste relatório especial é apresentar os avanços na regulamentação da comercialização de produtos médicos pela internet na América Latina e oferecer orientações às Autoridades Reguladoras Nacionais (ARN) sobre planejamento e execução de estratégias de regulamentação e fiscalização do comércio eletrônico de produtos médicos. São apresentados avanços regulatórios e programáticos, bem como iniciativas realizadas por quatro países latino-americanos para controlar a venda de produtos médicos pela internet, incluindo revisões complementares da literatura e programas de controle do comércio eletrônico por agências reguladoras de referência. Com base nesta revisão, propõem-se as seguintes linhas estratégicas: fortalecimento do marco regulatório e normativo; fortalecimento da capacidade de fiscalização; colaboração com autoridades e outros atores-chave nacionais e internacionais; e comunicação e sensibilização da comunidade em geral e dos profissionais de saúde. Cada uma dessas estratégias deve ser acompanhada de ações específicas, que podem servir de diretrizes para as ARN das Américas - e de países com contextos semelhantes - para fortalecer seus marcos regulatórios e a proteção de pacientes e consumidores.

Vigilância e controle de medicamentos abaixo do padrão, falsificados e não registrados: revisão integrativa / Market surveillance and control of substandard, falsified and unregistered medicines: integrative review / Vigilancia y control de medicamentos subestándar, falsificados y no registrados: una revisión integral

RESUMO 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.

ABSTRACT Objective. To identify the strategies employed by regulatory systems for the market surveillance and control of substandard, falsified, and unregistered medicines at the regional-global levels, especially regarding drug recall procedures. Method. An integrative literature review was performed. Searches were performed in MEDLINE via PubMed, Embase, and SciELO to select articles published from 2007 to 2019 in English, Portuguese, and Spanish, covering national regulatory system initiatives, with a focus on the recall of substandard, falsified, and unregistered medicines. Results. Of 483 articles initially identified, 21 global, regional, or national scope studies were selected. Prevention, detection, and response strategies, including drug recall, were grouped according to two broad market surveillance and control models (passive-reactive and proactive) used by regulatory systems. These models seem to combine passive and proactive, complementary or concurring actions that varied according to country development level and regulatory capacity. Although considered the most effective response for protection of populations, medicine recall was not implemented in a uniform manner in different regulatory systems as indicated by the studies. Conclusions. Addressing the complexity and magnitude of the problem of substandard, falsified, and unregistered medicines will demand effort, investment, and profound changes in the approaches, processes, and capacity of regulatory systems, with market surveillance and control strategies possibly converging toward a hybrid, multisectoral, multidisciplinary, global, and systemic model of human health protection.

RESUMEN Objetivo. Identificar las estrategias de actuación de los sistemas regulatorios en la vigilancia y control de los medicamentos subestándar, falsificados y no registrados a nivel regional-mundial, especialmente en lo que se refiere a los procesos de retirada de medicamentos del mercado (recall). Métodos. Se realizó una revisión bibliográfica integral en las bases de datos de MEDLINE a través de PubMed, Embase y SciELO. Se seleccionaron los estudios publicados entre 2007 y 2019, en inglés, portugués y español, en los que se abordaban las estrategias elaboradas por los sistemas regulatorios de los países, con énfasis en la retirada de los medicamentos subestándar, falsificados y no registrados. Resultados. De los 483 estudios identificados inicialmente, se incluyeron 21 publicaciones de ámbito nacional, regional o mundial. Las estrategias de prevención, detección y respuesta, incluida la retirada de medicamentos, se agruparon en dos modelos de actuación (pasivo-reactivo y proactivo) de los sistemas de regulación en la vigilancia y el control de los medicamentos. Estos modelos parecen combinar estrategias pasivas y proactivas, complementarias o concurrentes, que varían según el nivel de desarrollo de los países y su capacidad de regulación. Aunque la retirada de productos se considera la respuesta más eficaz para proteger a la población, según los estudios esta no se ha aplicado de manera uniforme en los sistemas de regulación. Conclusiones. La complejidad y la magnitud del problema de los medicamentos subestándar, falsificados y no registrados exigen esfuerzos, inversiones y cambios profundos en el enfoque, los procesos y las capacidades de los sistemas de regulación; y las estrategias de vigilancia y control del mercado pueden converger hacia un modelo híbrido, multisectorial, multidisciplinar, mundial y sistémico de protección de la salud humana.

Regulación de la venta de medicamentos por procedimientos telemáticos en España: riesgos y ventajas en situaciones excepcionales / Regulation of the sale of medicines for human use through telematic procedures in Spain / Regulamentação da venda de medicamentos por procedimentos telemáticos em Espanha: riscos e vantagens em situações excepcionais

RESUMEN Objetivo: Analizar la regulación de la venta de medicamentos por procedimientos telemáticos en España, así como los riesgos y ventajas que esta presenta. Metodología: Se analizó e interpretó la legislación en materia de regulación de venta de medicamentos de uso humano a través de Internet en el ordenamiento jurídico español. Resultados: Dicha regulación se encuentra en el Real Decreto 870/2013, de 8 de noviembre, por el que se regula la venta a distancia al público, a través de sitios web, de medicamentos de uso humano no sujetos a prescripción médica. Este Real Decreto limita la venta de medicamentos a través de Internet a aquellos que no requieran prescripción médica, ya que en Internet se pueden vender medicamentos ilegalmente, lo cual supone una amenaza para la salud pública. No obstante, también existen ventajas de dicha actividad como es la garantía de acceso a los medicamentos por parte de la población. En la presente contribución se analiza el caso de las nuevas condiciones de dispensación establecidas durante la pandemia provocada por el nuevo coronavirus SARS-CoV-2. Conclusiones: Para garantizar la seguridad de los pacientes se limita la venta de medicamentos vía online, no obstante, en situaciones especiales, como la crisis sanitaria generada por el nuevo coronavirus se amplió el marco normativo para garantizar el acceso de la población a los medicamentos.

SUMMARY Aim: To analyze the regulation of the sale of medicines by telematic procedures in Spain, as well as the risks and advantages that it presents. Methodology: The legislation on the regulation of the sale of medicines for human use through the Internet in the Spanish legal system was analysed and interpreted. Results: Said regulation is found in Royal Decree 870/2013, of November 8, which regulates the distance sale to the public, through websites, of medicines for human use not subject to medical prescription. This Royal Decree limits the sale of medicines through the Internet to those that do not require a medical prescription, since medicines can be sold illegally on the Internet, which poses a threat to public health. However, there are also advantages of this activity, such as the guarantee of access to medicines by the population. This contribution analyses the case of the new dispensing conditions established during the pandemic caused by the new SARS-CoV-2 coronavirus. Conclusions: To guarantee the safety of patients, the sale of medicines online is limited, however, in special situations, such as the health crisis generated by the new coronavirus, the regulatory framework was expanded to guarantee the population's access to medicines.

RESUMO Objetivo: Analisar a regulamentação da comercialização de medicamentos por procedimentos telemáticos em Espanha, bem como os riscos e vantagens que apresenta. Metodologia: A legislação foi analisada e interpretada sobre a regulamentação da comercialização de medicamentos de uso humano pela Internet no ordenamento jurídico espanhol. Resultados: O referido regulamento consta do Real Decreto 870/2013, de 8 de novembro, que regulamenta a venda à distância ao público, através de websites, de medicamentos para uso humano não sujeitos a receita médica. Este Decreto Real limita a venda de medicamentos pela Internet aos que não necessitem de receita médica, uma vez que os medicamentos podem ser comercializados ilegalmente na Internet, o que representa uma ameaça para a saúde pública. Porém, também há vantagens dessa atividade, como a garantia de acesso a medicamentos por parte da população. Esta contribuição analisa o caso das novas condições de dispensação estabelecidas durante a pandemia causada pelo novo coro-navírus SARS-CoV-2. Conclusões: Para garantir a segurança dos pacientes, a venda de medicamentos online é limitada, porém, em situações especiais, como a crise de saúde gerada pelo novo coronavírus, o marco regulatório foi ampliado para garantir o acesso da população aos medicamentos.

Study on Main Changes of Counterfeit and Inferior Drugs ’Relevant Provisions in the Newly Revised Drug Administration Law and Their Impact on Law Enforcement / 中国药房

OBJECTIVE：To provide reference for further clarifying the definition of counterfeit and inferior drugs and law enforcement for revelent departments ，and guaranteeing the safety of drug use and legitimate right for the public. METHODS ： Through comparative research ，literature research and interpretation of the new law ，comprehensive analysis and research was conducted for the relevant provisions of counterfeit and inferior drugs in the newly revised Drug Administration Law in respect of the definition ，penalty rules and identification basis of counterfeit and inferior drugs. The challenges and impacts of these changes on drug law enforcement were put forward from the perspective of drug law enforcement practice. RESULTS & CONCLUSIONS ： In terms of definition ，the newly revised Drug Administration Law redefined the counterfeit and inferior drugs ，which was reduced from 15 cases before the amendment to 11 kinds，but the content was more abundant. It cancelled the concept of punishing counterfeit and inferior drugs ；increased the prohibition of the use of counterfeit and inferior drugs ；punished violation behavior of drug administration order not according to counterfeit and inferior drugs ；removed two items that being punished as counterfeit drugs；adjusted the definition of contaminated drugs from counterfeit drugs to inferior drugs ；clarified the definition of excipients. In terms of penalty provisions ，the provisions of legal liability for counterfeit and inferior drugs in the newly revised Drug Administration Law comprehensively used a variety of punishment measures ，greatly increased the amount of fine ；differentiated the situation of production ，wholesale and retail of inferior drugs ，and set different punishment ranges ；appropriately reduced the punishment range of producing and selling TCM decoction pieces that did not meet the drug standards ；increased the punishment for the violation of drug management order ，and the scope of punishment was similar to that of counterfeit and inferior @qq.com drugs. The “double penalty system ”was implemented for serious illegal acts and punished to individuals. The punishment for drug users who used counterfeit and inferior drugs was clarified. The situation of heavier punishment for producing and selling counterfeit and inferior drugs was increased ，and the first responsibility system and punitive compensation were added to protect the legitimate rights and interests of consumers. In terms of identification basis ，the newly revised Drug Administration Law had deleted the provisions that specific situation of quality inspection conclusion may not be specified ，and only provided the principle provisions. The challenges and impacts of the newly revised Drug Administration Law on law enforcement included how to understand the “ingredients”in the definition of counterfeit drugs；how to distinguish between deteriorated drugs and contaminated drugs ；how to investigate and deal with unauthorized acts ； whether drug inspection reports were required in all cases of counterfeit and inferior drugs ；how to understand the situation that did not affect the safety and effectiveness ，and connecting administrative law enforcement with criminal justice for counterfeit and inferior drugs ，etc. It is suggested to further strengthen the law popularization ，and introduce the interpretation of the newly revised Drug Administration Law as soon as possible ，clarify the legislative intent ，and guide the grassroots law enforcement ；issue Amendment Ⅺ to the Criminal Law of the People ’s Republic of China as soon as possible ，increase the charges of illegal acts against the order of drug administration ，do a good job in connecting administrative law enforcement with criminal justice and crack down on the illegal and criminal acts in the field of drugs ，and further promote the administration according to law.

Evaluation of the Pharmaceutical Quality of Different Brands of Ranitidine Tablets Manufactured in Bangladesh: A Pharmaceutical and Public Health Prospective.

Drug counterfeiting and production of substandard drug is a global problem. Substandard or counterfeit drugs are threat for the effective treatment of diseases and highly worsen the quality of life of patients. This study was aimed to assess the pharmaceutical quality of ranitidine hydrochloride tablets manufactured in Bangladesh. Tablets were collected from different parts of Bangladesh and quality parameters were evaluated according to the United States Pharmacopoeia and the British Pharmacopoeial methods. The potency of tablets was measured spectrophotometrically. Weight variation and disintegration time were performed according to pharmaceutical monographs. Among 43 brands tested, 8 failed to comply with the USP specification (active ingredient: 90±10%) due to containing of less amount of ranitidine of which 6 brands were spurious and 2 were substandard in nature. Two brands did not comply with the specification for weight variation of tablets whereas all brands passed disintegration time test. The findings clearly demonstrate the production of substandard ranitidine tablets in Bangladesh. The drug control authority of Bangladesh should take effective steps to prevent the production of substandard drugs to secure public health.

Empirical Analysis on Characteristics and Trend of Illegal Circulation of Counterfeit Drugs and Its Moni-toring Countermeasures in China / 中国药房

OBJECTIVE:To investigate the characteristics and trends of illegal circulation of counterfeit drugs in China,and to put forward monitoring countermeasures. METHODS:In empirical study,3 typical cases of counterfeit drugs manufacturing and selling in China were analyzed (including Jiangsu Wuxi Internet transnational counterfeit drugs manufacturing and selling case, Shanghai Avastin eye drug case,Sichuan Dazhou counterfeit drugs case),to compare the sources of counterfeit drug and illegal cir-culation pathway,thus find out the monitoring problems. RESULTS & CONCLUSIONS:Main reasons for illegal circulation of counterfeit drugs in China are as follows as drug circulation regulation absence of foreign-funded medical institutions,the existence of hidden drug circulation monitoring holes in urban medical institutions,under-developed and weak ability of distinguishing talse drug information internet counterfeit drugs sales regulatory means. It is suggested to establish drug management norms for for-eign-funded medical institutions,improve drug circulation monitoring in primary medical institutions,establish pharmaceutical logis-tics(transportation)licensing system and strengthen online fake drug sale information monitoring and information publication.

Factors Associated with Drug Counterfeit in Nigeria: A Twelve Year Review.

Background: Drug counterfeiting poses a great danger to every society. The actual prevalence of counterfeit drugs is difficult to ascertain presently but just like other crimes, drug counterfeiting is an underground business that often comes to light mostly when death occurs. About 10% of drugs circulating worldwide are fake drugs with enormous associated health risk. Preventing the problem is a primary duty of every responsible nation in order to save lives. Objective: This paper aims at studying the factors associated with drug counterfeiting, its consequences and possible solutions. Methods: This article reviews relevant literatures published from 2004 to 2015 from medical journals, health survey reports, books, Google search and health-related websites such as World Health Organization. Results: Several researchers have identified corruption and conflict of interest, poor health seeking behavior of Nigerians, high prices of locally manufactured drugs due to high taxes and tariffs, inadequate legislation, unordered drug distribution system, inadequate cooperation from government agencies and discriminatory regulation by exporting countries as the major factors associated with drug counterfeiting in Nigeria. Conclusion/ Recommendations: Drug counterfeiting is one of the greatest atrocities of our time and it affects both developing and developed countries. There is an urgent need for the government as well as professional bodies to ensure massive public enlightenment and the effective enforcement of the existing drug laws in Nigeria.

Counterfeit drugs in India: significance and impact on pharmacovigilance.

Counterfeit drugs have emerged as a major global problem. This issue has been brought to the centre of the Indian media due to the death of 15 women attending a sterilization camp in Chhattisgarh. India’s pharmaceutical industry exports drugs worth 15 billion dollars, which means a high prevalence of counterfeiting in India’s drug industry has global repercussions. However, accurate figures on the extent of counterfeit drugs in India are not available. The scientific literature as well as media reports often quotes figures of 10-35%, though studies done by the Indian Government dispute this. Counterfeit drug numbers have been known to be under represented by Governments due to fear of undermining their economy and health systems. On the other hand, rival companies in other countries may have an incentive to over hype India’s counterfeit problem to dent India’s growing status as the leading global supplier of generic medicines. Lack of clear definitions and differences between laws of countries further complicate reporting. A high prevalence of counterfeit drugs has a large impact on both health and economic indicators. Additionally, counterfeit drugs provide significant challenges to Pharmacovigilance programmes. Hence, here we discuss the significance of use of counterfeit drugs in India and challenges faced by Pharmacovigilance due to the extensive use of counterfeit drugs.

Identification of Norvasc and counterfeit drugs based on Raman spectra of phar-maceutical excipients / 药学实践杂志

Objective To build an identification method for Norvascand its counterfeit drugs based on the differences of their pharmaceutical excipients with the original and generic Amlodipine besylatetablets as tools .Methods Raman spectra of pharmaceutical excipients which were usually used in tablets were collected .Similarity algorithm and characteristic Raman bands were used to search the excipients contained in the tablets .If the excipients was not the same as excipients contained in Nor-vasc ,the tablet was judged as counterfeit drugs .Otherwise ,principal component analysis was used to identify counterfeit and generic .Results and conclusion The method based on Raman spectra of pharmaceutical excipients could identify Norvasc and counterfeit drugs efficiently and accurately .

Substance use and sexual risk among at-risk adolescents in Juiz de Fora, Minas Gerais State, Brazil / O uso de substâncias e o risco sexual entre adolescentes em situação de risco social em Juiz de Fora, Minas Gerais, Brasil / Consumo de sustancias estupefacientes y riesgo sexual entre adolescentes en situaciones de riesgo en Juiz de Fora, Minas Gerais, Brasil

We examined the difference in prevalence of substance use and sexual risk behaviors among at-risk youth participants in programs offered by community-based organizations in Juiz de Fora, Minas Gerais State, Brazil, by gender and organization type (governmental vs. non-governmental). 388 adolescents were recruited from 25 intervention-based organizations servicing at-risk youth between the ages of 12 and 17 in Juiz de Fora. Participants completed a 15-item survey assessing substance use and sexual risk behaviors, along with socio-demographic predictors of these behaviors. Males were more likely to report drug and alcohol use associated with homelessness and abandonment. Females were more likely to report sexual risk taking associated with neighborhood crime. Participants from non-governmental organizations were less likely to engage in all measured risk behaviors. The present analysis points to the need to understand how Brazil’s Child and Adolescent Act is being applied and the implications this has for intervention and the promotion of positive health outcomes for young people.

Examinou-se a diferença na prevalência do uso de drogas e comportamento sexual de risco entre os jovens de alto risco em programas oferecidos por organizações localizadas na comunidade de Juiz de Fora, Minas Gerais, Brasil .Foram recrutados 388 adolescentes de 25 organizações de intervenções preventivas que servem jovens de alto risco entre as idades de 12-17. Participantes completaram um questionário com 15 perguntas que avalia o uso de substâncias e o comportamento sexual de alto risco, juntamente com indicadores sociodemográficos. Os adolescentes do sexo masculino foram mais propensos a relacionar o uso de drogas e álcool com a falta de moradia e abandono. As adolescentes do sexo feminino foram mais propensas a reportar comportamentos sexuais de alto risco em associação com o crime comum. Participantes de ONGs foram menos propensos a se envolver nos comportamentos de alto risco pesquisados. A presente análise aponta para a necessidade de se entender as implicações que isso tem para a intervenção preventiva e a promoção de resultados positivos na saúde dos jovens.

Examinamos las diferencias en la prevalencia de uso de sustancias estupefacientes y el riesgo sexual entre los jóvenes participantes de los programas ofrecidos por las organizaciones de base comunitaria en Juiz de Fora, Minas Gerais, Brasil. Se incorporaron 388 adolescentes de 25 organizaciones de apoyo e intervención a la juventud, que atienden a chicos de entre de 12-17 años en Juiz de Fora. Los participantes completaron un estudio con 15-ítems para evaluar el consumo de sustancias estupefacientes y el riesgo sexual, junto a aspectos socio-demográficos predictores de estos comportamientos. Los varones tenían más probabilidades de uso de drogas y alcohol, asociado al desamparo y abandono. Las mujeres tenían más probabilidades de riesgos sexuales, relacionados con la delincuencia del barrio. Los participantes de las organizaciones no gubernamentales tenían menos probabilidades de comportamientos de riesgo. El presente análisis apunta la necesidad de entender cómo se está aplicando la ley del niño y del adolescente y las consecuencias que tiene para la intervención y la promoción de los resultados positivos para la salud.

Falsificação de medicamentos no Brasil / Counterfeiting of drugs in Brazil / Falsificación de medicamentos en Brasil

OBJETIVO: Identificar os principais medicamentos falsificados apreendidos pela Polícia Federal brasileira e os estados em que houve a apreensão. MÉTODOS: Estudo retrospectivo descritivo dos laudos periciais elaborados por Peritos Criminais da Polícia Federal sobre medicamentos contrafeitos entre janeiro de 2007 e setembro de 2010. RESULTADOS: Os medicamentos com maior número de apreensões foram inibidores seletivos da fosfodiesterase 5, utilizados para tratar a disfunção erétil masculina (Cialis® e Viagra®, em média 66 por cento), seguidos por esteróides anabolizantes (Durateston® e Hemogenin®, 8,9 por cento e 5,7 por cento, respectivamente). A maior parte dos medicamentos falsos foi apreendida nos estados do Paraná, São Paulo e Santa Catarina, com incremento superior a 200 por cento no número de medicamentos inautênticos encaminhados à perícia no período. Houve aumento nas apreensões de medicamentos contrabandeados arrecadados em conjunto com os falsos; 67 por cento das apreensões incluíram no mínimo um medicamento contrabandeado. CONCLUSÕES: A falsificação de medicamentos é um grave problema de saúde pública. A identificação das classes de medicamentos falsos no País e os principais estados brasileiros com essa problemática podem facilitar ações futuras de prevenção e repressão pelos órgãos brasileiros responsáveis.

OBJECTIVE: To identify the main counterfeit drugs seized by the Brazilian Federal Police and the states where seizures have been made. METHODS: A retrospective descriptive study on expert reports produced by criminal investigators of the Federal Police between January 2007 and September 2010, in relation to counterfeit drugs, was carried out. RESULTS: The drugs with greatest numbers of seizures were selective phosphodiesterase-5 inhibitors that are used for treating male erectile dysfunction (Cialis® and Viagra®, mean = 66 percent ), followed by anabolic steroids (Durateston® and Hemogenin®: 8.9 percent and 5.7 percent, respectively). The greatest proportions of the counterfeit drugs were seized in the states of Paraná, Santa Catarina (both Southeastern Brazil) and São Paulo (Southeastern), and the number of non-authentic drugs sent for investigation increased by more than 200 percent over the study period. There were increases in seizures of smuggled drugs found together with counterfeit drugs: 67 percent of the seizures included at least one smuggled drug. CONCLUSIONS: Counterfeiting of drugs is a severe public health problem. Identification of the classes of counterfeit drugs present in Brazil and the main Brazilian states with this problem may facilitate future preventive and suppressive actions by the Brazilian bodies responsible for such actions.

OBJETIVO: Identificar los principales medicamentos falsificados incautados por la Policía Federal Brasileña y los estados donde hubo incautación. MÉTODOS: Estudio retrospectivo descriptivo de los laudos periciales elaborados por Peritos Criminales de la Policía Federal brasileña sobre medicamentos falsos entre enero de 2007 y septiembre de 2010. RESULTADOS: Los medicamentos con mayor número de incautaciones fueron los inhibidores selectivos de la fosfodiesterasa 5, utilizados para tratar la disfunción eréctil masculina (Ciallis® y Viagra®, en medio 66 por ciento), seguidos por esteroides anabolizantes (Durateston® y Hemogenin®, 8,9 por ciento y 5,7 por ciento, respectivamente). La mayor parte de los medicamentos falsos fue incautada en los estados Paraná, Sao Paulo y Santa Catarina, con incremento superior a 200 por ciento en el número de medicamentos inauténticos encaminados a la pericia en el período. Hubo aumento en las incautaciones de medicamentos contrabandeados arrecadados en conjunto con los falsos, 67 por ciento de las incautaciones incluyeron al menos un medicamento contrabandeado. CONCLUSIONES: La falsificación de medicamentos es un grave problema de salud pública. La identificación de las clases de medicamentos falsos en Brasil y los principales estados brasileños con esta problemática pueden facilitar acciones futuras de prevención y represión por los órganos brasileños responsables.

Physical profile of counterfeit tablets Viagra® and Cialis®

The profile of tablets containing an active pharmacological ingredient can be obtained using different sets of properties, including physical and chemical aspects. The first measurements carried out on tablets are the physical characteristics also called post-tabletting batch (post-TB) characteristics. These data may be valuable to assist in the detection of pharmaceutical product forgery and may also be used in a forensic intelligence perspective when inserted into databases. This work is focused on the physical characteristics of Cialis® and Viagra® tablets seized by the Brazilian Federal Police in the Rio Grande do Sul state. Using the F-test (ANOVA), all samples of counterfeit Viagra® (n = 28) and Cialis® (n = 40) were well distinguished from authentic samples by the following post-TB characteristics: length (major and minor), thickness, and mass. Using the exploratory statistical technique of Hierarchical Cluster Analysis (HCA), tablets with similar physical profiles were grouped. This result may indicate a common illicit production. We observed the validity of using post-TB properties to generate - in a fast and reliable manner and with no sample preparation - a technological profile that joins itself to the other analytical methods assisting in routine forensic detection of counterfeit Viagra® and Cialis®.

Perfil para medicamentos na forma farmacêutica comprimidos contendo uma substância ativa pode ser obtido usando diferentes conjuntos de propriedades, incluindo aspectos físicos e químicos. As primeiras medições realizadas em comprimidos são de características físicas, também chamadas características pós-compressão. Tais dados podem ser valiosos para auxiliar na detecção de falsificações de medicamentos e ser utilizados em uma perspectiva de inteligência forense, quando inseridos em bancos de dados. Este trabalho está focado nas características físicas dos comprimidos de Cialis® e Viagra® apreendidos pela Polícia Federal no Estado brasileiro do Rio Grande do Sul. Com o emprego do Teste de Fisher (ANOVA), todas as amostras falsificadas de Viagra® (n = 28) e de Cialis® (n = 40) foram diferenciadas das amostras autênticas pelas seguintes características pós-compressão: comprimento (maior e menor), espessura e massa. Utilizando-se a Análise Hierárquica de Cluster (AHC), os comprimidos com perfis físicos semelhantes foram agrupados, o que pode indicar uma produção ilícita em comum. Observou-se a validade da utilização das características pós-compressão para gerar, de um modo rápido, confiável e sem preparo de amostra, um perfil tecnológico que se una aos demais métodos analíticos utilizados na rotina forense de detecção de falsificações de Cialis® e de Viagra®.

Recent analytical approaches to counterfeit drug detection.

Counterfeiting of drugs has now become a lucrative multi-billion dollar business that threatens the effective delivery of health care services. Apart from Africa and other marginally developed parts of the world, the developed economies are equally not spared from the bane of this trade. To combat this menace, concerted efforts are needed from various facets of the community. In addition to visual inspections, sophisticated analytical tools are usually required in order to successfully distinguish counterfeits from the real stuffs. Attempt is made in this review to summarize the recent applications of these tools in keeping track with counterfeit drug flow. These are discussed under the headings of different approaches, including Near Infrared Spectroscopy, Raman Spectroscopy, Fluorescence and Phosphorescence measurements, Nuclear Magnetic Resonance imaging, X-ray and radio frequency analysis. In the quest to maintain their profit margin, the perpetrators of counterfeit pharmaceuticals will continue to develop ingenious ways to circumvent regulatory systems. Therefore, relentless efforts should continue to be deployed toward research and development in low cost, fast and efficient ways of detecting counterfeit drug at different stages of its existence.

Algorithms of Raman spectrium analysis in fast identification of counterfeit hypoglycemic agents / 第二军医大学学报

Objective: To investigate the applicability of portable Raman spectroscopy for fast identification of counterfeit hypoglycemic agents. Methods: The Raman spectra of 6 hypoglycemic agents, their corresponding reference standards and 12 common pharmaceutical excipients were detected by BW&-Tek i-Raman portable spectrometer. The spectra were analyzed by three algorithms, namely, the minimized summation of first derivative of subtraction spectra algorithm, local straight-line screening (LSLS) algorithm, and modified LSLS (MLSLS) algorithm. Results: Among the three algorithms, MLSLS algorithm showed the best performance, with the total sensitivity, specificity, accuracy and efficiency being 96.77% , 97.20% , 99.29%, and 96.02%, respectively. Conclusion: The MLSLS algorithm, which is based on infrared spectroscopy, can be adapted to identify suspected counterfeit drugs based on portable Raman spectroscopy.