Poor-quality medicines: a global threat to health / Lao Medical Journal

@#Poor quality medicines have been described as a global pandemic that threatens the lives of millions of people. The problem is much more severe in poor-resource countries where pharmaceutical legislation and regulation are limited. Poor quality medicines are divided into three categories: substandard, degraded and falsified and the countermeasures vary according to each category. The use of poor quality medicine leads from minimal to severe complications (including death) for the individuals but also harms the community. Furthermore, they lead to a loss of confidence of the patients in essential medicines, in manufacturers and in health system and they increase the work burden for health workers, customs and police. To detect them, different techniques have been developed, each with advantages and limits. This article describes these aspects of poor quality medicines and also presents the factors that contribute to the existence and spread of poor quality medicines. A section of the article is devoted to the issue of poor quality medicine in Laos.

Evaluation of the quality of recovery and the postoperative health status after elective surgery / Avaliação da qualidade da recuperação e do estado de saúde no pós-operatório de cirurgias eletivas

Abstract Purpose: Postoperative recovery is a complex process with physiologic, functional, and psychologic dimensions. Postoperative quality of recovery is considered as a crucial outcome following surgery and anesthesia. The objective of this study was to assess and compare the quality of postoperative recovery and health status before and after surgery, in patients undergoing elective surgery. Methods: This observational, prospective study was conducted on patients proposed for elective surgery. Evaluation of postoperative recovery was performed using the Postoperative Quality of Recovery Scale and health status was assessed by applying the EuroQol assessing problems in five dimensions: mobility, personal care, usual activities, pain/discomfort, and anxiety/depression, and the World Health Organization Disability Assessment Schedule 2.0. Poor quality of recovery was defined as recovery in fewer than two domains at postoperative Day 1 in the Postoperative Quality of Recovery Scale. Results: Before surgery (D0), patients with poor quality of recovery had median Visual Analog Scale scores in EuroQol similar to those of patients without poor quality of recovery, but they had more problems in the mobility, usual activities, pain/discomfort, and anxiety/depression dimensions. At 3 months after surgery, patients with poor quality of recovery had median Visual Analog Scale scores in EuroQol similar to those of patients without poor quality of recovery, but they maintained more problems in the pain/discomfort dimension. Patients with poor quality of recovery scored significantly higher on the World Health Organization Disability Assessment Schedule 2.0 scale at baseline, although the results were similar at 3 months. Conclusions: Patients with poor quality of recovery had the worst health status at D0. Evaluation at 3 months indicated similar rates of problems in EuroQol (except for pain/discomfort) and World Health Organization Disability Assessment Schedule 2.0 scores were similar.

Resumo Objetivo: A recuperação pós-operatória é um processo complexo com dimensões fisiológicas, funcionais e psicológicas. A qualidade da recuperação pós-operatória é considerada um resultado crucial após cirurgia e anestesia. O objetivo deste estudo foi avaliar e comparar a qualidade da recuperação pós-operatória e o estado de saúde antes e depois da cirurgia em pacientes submetidos à cirurgia eletiva. Métodos: Este estudo observacional prospectivo foi feito com pacientes agendados para cirurgia eletiva. A avaliação da recuperação pós-operatória foi feita com a Escala de Qualidade da Recuperação Pós-Operatória (Postoperative Quality of Recovery Scale) e o estado de saúde foi avaliado com a aplicação do EuroQol, que analisa problemas em cinco dimensões (mobilidade, cuidados pessoais, atividades habituais, dor/desconforto e ansiedade/depressão) e a ferramenta para medida de incapacidade desenvolvida pela Organização Mundial da Saúde (World Health Organization Disability Assessment Schedule 2.0). Má qualidade de recuperação foi definida como uma recuperação em menos de dois domínios da Escala de Qualidade da Recuperação Pós-Operatória no primeiro dia (D1) de pós-operatório. Resultados: Antes da cirurgia (D0), os pacientes com má qualidade de recuperação apresentaram escores medianos na escala visual analógica semelhantes aos dos pacientes sem má qualidade de recuperação, mas apresentaram mais problemas nas dimensões mobilidade, atividades habituais, dor/desconforto e ansiedade/depressão. No terceiro mês após a cirurgia, os pacientes com má qualidade de recuperação apresentaram escores na escala visual analógica medianos no EuroQol semelhantes aos dos pacientes sem má qualidade de recuperação, mas apresentaram mais problemas na dimensão dor/desconforto. Os escores World Health Organization Disability Assessment Schedule 2.0 dos pacientes com má qualidade de recuperação foram significativamente maiores no início do estudo, embora os resultados tenham sido semelhantes no terceiro mês. Conclusões: Os pacientes com má qualidade de recuperação apresentaram o pior estado de saúde no D0. A avaliação no terceiro mês indicou taxas semelhantes de problemas no EuroQol (exceto dor/desconforto) e escores semelhantes no World Health Organization Disability Assessment Schedule 2.0.

Four-year survey of the quality of antimicrobial medicines in Cambodia / 国際保健医療

Background and Objectives  Falsified or substandard antimicrobials present a health hazard to patients, and may promote antimicrobials resistance. We conducted a four-year study to evaluate the quality of selected antimicrobials and to examine the prevalence of falsified or substandard antimicrobials in Cambodia, aiming to promote efforts to improve the quality of medicines in Cambodia.Methods   We collected samples of clarithromycin, sulfamethoxazole/trimethoprim, ceftriaxone, cefuroxime, levofloxacin, gentamicin, ciprofloxacin, fluconazole, nalidixic acid, ofloxacin, phenoxymethyl penicillin and roxithromycin products from several different types of drug outlets in five provinces (rural areas) and Phnom Penh (an urban area), during 2011 to 2014. The authenticity of the collected medicines was investigated, and the medicines were analyzed to determine whether they met the appropriate pharmacopoeial standards.Results   We collected 647 samples, produced by 179 manufacturers, from 353 outlets. Only 51 (15%) of the outlets were air-conditioned. We found different-coloured packaging of the same brand (different lots) of products from some manufacturers. The insert information of one sample was different from the package information. Twelve (1.9%) samples were not officially registered with Department of Drug and Food (DDF). In authenticity investigation, 43 of 179 manufacturers replied and confirmed the authenticity of 154 samples (out of 647); also, 18 out of 40 Medicine Regulatory Authority (MRA) replied to enquiries about whether products were licensed or not (one was not). Among the samples, 424 (80.4%), 406 (86%) and 533 (90.6%) passed in dissolution, content uniformity and quantity tests, respectively. Samples of cefuroxime and roxithromycin that failed were significantly cheaper than those that passed.Conclusion  Poor-quality antimicrobials were found in Cambodian markets, though no falsified medicines were detected. Result of samples were not confirmed in authenticity, so it was possible to include falsified medicines. Manufacturers should be encouraged to improve GMP implementation. Storage conditions in the distribution chain may also need to be improved. Continuous efforts by stakeholders are needed to ensure that medicines are properly licensed.

Comparative study of osseointegration of 4 different surfaced implants in the tibia of dogs

PURPOSE: This study was performed in order to compare the osseointegration of 4 different surfaced implants in the dog's tibia which has thick dense cortical bone and loose marrow space. MATERIALS AND METHODS: Four mongrel dogs and four different surface types of implants, smooth surfaced AVANA implants, RBM surfaced AVANA implants, HA-coated Steri-Oss implants and SLA Bicon implants, were used in this study. The animals were divided into 4 groups on the basis of implant surface characteristics: Control group, RBM group, HA group, and SLA group. Three implants of each group were installed into the metaphysis of tibia of adult dogs. The animals were sacrificed at 8 weeks after implantation. The undecalcified specimens were prepared for histological examination and histomorphometric analysis of implant-bone contact ratios. RESULTS: Radiographically and histologically good osseointegration of implant was observed in the dense cortical bone, but poor osseointegration was observed in the marrow space. Histologically more bone apposition to implant surface was found in rough surfaced groups than the smooth surfaced, Control group. In histomorphometric findings of cortical bone the average bone-implant contact ratios of HA group (95.4%, p<0.01), RBM group (87.1%, p<0.05), and SLA group (86.0%, p<0.05) were significantly higher than that of Control group (75.9%). In marrow space the average bone-implant contact ratios of HA group (76.1%, p<0.01) and SLA group (45.4%, p<0.05) were significantly higher than that of Control group (29.6%). The ratio of RBM group was higher than that of Control group but there was no significantly difference between RBM group and Control group. CONCLUSION: These results suggest that the rough surfaced implants can obtain the better osseointegration than the smooth surfaced implant in the cortical and marrow space and that HA-coated implants can obtain the best osseointegration in the marrow space among them.

Effect of implant surface characteristics on osseointegration in the ilium of dogs