Materia Medica Malaysiana

March 15, 2004


Filed under: Uncategorized — malaysianmedicine @ 7:14 am

WoMan: A precious gift of health

THREE years ago, Datuk Seri Endon Mahmood expressed a dream — of a clinic that will provide health screenings as well as educate women in preventive diseases. Specialists would provide the services free of charge, or at a very affordable cost. “We need to keep women informed about their health and educate them on proper measures against all kinds of diseases. We need a wellness centre which provides information as well as services that are accessible to women and their families,” said Endon. Last Thursday, her dream came true. The First Lady launched the Kelinik Nur Sejahtera at the National Population And Family Planning Board (LPPKN), in Jalan Raja Laut, Kuala Lumpur, with Woman and Family Development Minister Datuk Seri Shahrizat Abdul Jalil.

“This is our gift from us to you,” said Shahrizat at the opening. The clinic focuses on prevention of diseases through periodical health screenings for diseases. Nur Sejahtera will also organise talks, seminars and workshops to raise public awareness and also educate people on health care and medicines on the prevention of diseases. It will also advocate maintaining a healthy lifestyle. Shahrizat said there are six packages available for screening — general women’s health, cancer, treatment for menopause, family planning, weight management and general health for men. She said the packages came either with free consultation or a low fee, and would be handled by seven specialist doctors who have offered their services on a part-time basis. These doctors are prominent specialists in the country and experts in various in various disciplines. They are Dr Nor Ashikin Ahmad Mokhtar (obstetrics and gynaecology), Prof Madya Dr Aminuddin Ahmad (gastroenterology), Prof Dr Raman Subramaniam (obstetrics and gynaecology), Datuk Dr Tan Hui Meng (urology), Prof Dr Yip Cheng Har (surgery), Dr Tee E Siong (nutrition) and Dr Salina Low Abdullah (psychology).

Besides these doctors, there are also a few specialists who are willing to offer their services in cardiology, endocrinology and other fields of medicine. “I want to make sure cost concerns don’t keep a woman from getting these life-saving screenings,” said Shahrizat. “We have asked other private clinics to offer their expertise as well. Right now, Pantai Medical Centre has agreed to set a minimum price of RM90 a year for mammograms for women with lower incomes. “We will try to get the services at even lower rates, hopefully,” she added.

Urging the people to make use of the facilities, Shahrizat said: “The preventive concept is suitable and timely, especially these days when cancer is becoming a common occurrence. We should use this opportunity to enhance our health.

She was also concerned about women neglecting their health after menopause. Regular medical exams are just as important to a woman’s health after menopause as they are before. Some women still mistakenly believe that because they no longer menstruate, some of the screenings they used to take — mammograms and pap smears — are no longer needed. “With education and the right information, it will be possible for us to prevent these diseases as well as to cure them at the early stages. Hence, free health talks will also be held at the clinic every month,” she said. Similar programmes all over the world have screened hundreds of thousands of women for early detection and successful treatment of both breast and cervical cancers. Breast cancer is most curable when detected in its earliest stages and cervical cancer is nearly 100 per cent preventable with regular Pap smears. A Pap smear can find cervical cancer long before signs and symptoms show up.

But why do significant numbers of women still die of one of the most preventable and best-understood malignancies? This is definitely because of the lack of effective screening programmes, especially for those medically underserved, explained Shahrizat. Women’s health is a matter of global concern. Women are becoming increasingly affected by cancer, HIV/AIDS, and heart diseases. The Malaysian health care system has achieved some degree of success, and it is reputed to be among the best in the Asia-Pacific region. And yet there are still so many out there who have not had a Pap smear or breast check even once. “Before you take the woman you love shopping for a gift, before you take her anywhere at all to celebrate her birthday, take her to the clinic. That would be the best gift you can give the woman you love — the gift of health,” Endon said.


Filed under: Uncategorized — malaysianmedicine @ 7:13 am

Realising a dream to prevent a nightmare

The recent launch of the first Nur Sejahtera clinic is, as Datuk Seri Endon Mahmood says, the result of “hard work and determination of the Ministry of Women and Family Development (KPWK), in demonstrating its awareness towards a crucial basic need of women and family.” “I am honoured to officiate another realisation of the KPWK’s dream,” she continued, having been there three years ago to launch the ministry’s budding vision.

Begun in 2001, Nur Sejahtera’s primary aim was to create and increase health awareness among women and family. In almost 15 years of experience in women’s health, programme co-chairman Dr Nor Ashikin Mokhtar has seen much ignorance shown by even professional women as regards women’s health.

Targeted principally at the poor, Dr Nor Ashikin says the three years of Nur Sejahtera road shows, lectures and seminars have reached “hundreds of thousands of women all over the nation.” According to her, after each event, LPPKN would get requests for more like programmes, “and that’s when we knew that we needed somewhere for them to keep coming back to for more information.” The Nur Sejahtera wellness clinic and information centre, situated in the LPPKN building in Kuala Lumpur, will now serve as the first permanent base of the Nur Sejahtera programme.

Chief among the parties responsible for the materialising of the clinic, says Dr Nor Ashikin, is Datuk Seri Shahrizat Abdul Jalil, the Minister of Women and Family Development.

“She actually stayed the whole day and sat through the seminar I gave,” says Dr Nor Ashikin of the minister, in reference to the inaugural seminar held after the 2001 launch of the Nur Sejahtera: Sihat dan Segak programme.

“She keeps her promises,” Dr Nor Ashikin added, explaining that when the idea was first proposed to Shahrizat, the minister saw it as a “value programme.” Since then, Dr Nor Ashikin has seen all plans approved and efficiently implemented.

Shahrizat in turn expresses gratitude to the Prime Minister’s wife for being the inspiration in her ministry’s project.

“Datin Seri’s strength and bravery in facing her own predicament inspired me to push the project through,” says the minister. “We talked about how important health is and how important doctors are,” adding also that from experience, Endon couldn’t emphasise enough how important the surrounding is for a patient’s well-being.

This aspect motivated Shahrizat to press for clinic aesthetics, on top of equipment and staffing, making Klinik Nur Sejahtera truly a one-of-a-kind, one-stop family wellness and information centre.

LPPKN director-general Fatimah Saad calls Shahrizat, “a breath of fresh air,” as the latter has introduced new approaches to the concept of wellness, which includes making the clinic premises as beautiful as the limited budget allows.

Now LPPKN is able to narrow healthcare inequalities between the rich and the poor from all angles.

“This clinic is the ministry’s gift to Datin Seri and the nation’s women,” says Shahrizat. Based on the concept of prevention and early intervention, Nur Sejahtera clinic provides comprehensive health screening and laboratory testing services. It is well equipped in terms of both facilities and expertise.

Apart from permanent staff of trained clinical personnel and doctors, Nur Sejahtera canvassed for, and got, the volunteer services of specialists in various fields from various establishments.

The list of prominent doctors includes Dr Nor Ashikin herself, a gynaecologist with Pantai Medical Centre. Not content with serving on Nur Sejahtera’s Perubatan dan Saintifik advisory panel, Dr Nor Ahsikin is one of about 15 volunteer specialists who will be working at least once a month on a rotational basis.

Some of the specialists confirmed so far are Dr Zain Al Rashid of Pantai Medical Centre, Professor S.P. Chan of Universiti Malaya, Professor Dr Muhammad Abdul Jamil Mohd Yassin of Universiti Kebangsaan Malaysia, Datuk Dr Haron Ahmad of Damansara Specialist Hospital, Dr Suniza Sufian of Universiti Kebangsaan Malaysia and Dr Norlaila Mustafa of Universiti Kebangsaan Malaysia.

For Institut Jantung Negara consultant cardiologist Dr Azhari Rosman, it is a small service to offer in view of Dr Nor Ashikin and Shahrizat’s dedication to promoting family health.

“I have worked with Dr Nor Ashikin on many projects before on men’s health,” and in the name of common interest, he volunteered his expertise. “Datuk Seri Shahrizat has also worked with us on health programmes,” Dr Azhari gave another good reason for joining the panel, “and for Nur Sejahtera, I felt honoured that she took the trouble to write me a personal invitation.” Dr Azhari finds Shahrizat “easy to work with and she prioritises family health as an important asset.” He therefore considers one day a month “not too much”, even with his tight regular schedule at IJN. Pantai Hospital as a group has also offered a much appreciated discount programme for mammograms conducted on patients referred to them by Klinik Nur Sejahtera. For one year, Pantai CEO Datuk Dr Ridzwan Bakar has agreed to reduce mammogram charges from RM150 to RM90 for Nur Sejahtera referrals.

March 14, 2004


Filed under: Uncategorized — malaysianmedicine @ 2:00 pm

Q is for quit

Want to say tak nak and quit smoking? There are 300 quit-smoking clinics based in hospitals and government health clinics all over Malaysia. All you need to do is make the effort, writes TEE SHIAO EEK.

RAMESH Muniandy has lit up more than 10,000 cigarettes in his lifetime. When he started smoking at the age of 13, he only had three or four cigarettes a day. By the time he entered university, he had graduated to at least 30 cigarettes a day.

Today, he doesn’t smoke anymore, and urges other smokers to quit as well.

Dr Sallehudin bin Abu Bakar…’Tobacco dependence is a disease.’
“Quitting smoking improves symptoms of bronchitis, asthma, emphysema and other chronic obstructive pulmonary diseases (COPD). If a smoker stops before middle age, his health risks are reduced to the level of a non-smoker,” says Dr Sallehudin bin Abu Bakar, Deputy Director of the Wilayah Persekutuan Health Department.

“Approximately 15 to 20 years after a smoker quits, the risk of lung disease and coronary heart disease will be almost as low as that of a non-smoker. The risks take a long time to reduce (because) the damage to your organs is almost permanent,” he adds.

Two decades may seem impossibly long, but one cannot expect the toxic effect of cigarettes to disappear overnight. There are, after all, more than 4,000 chemicals in cigarette smoke, including hydrogen cyanide, butane, acetone, ammonia and cadmium. It is these chemicals that cause smoking to be a risk factor for 25 types of diseases.

“Smoking causes 90% of all cancers. It is a major cause of throat cancer, stroke, coronary heart disease and erectile dysfunction,” says Dr Kuppusamy Iyawoo, Head of the Institute of Respiratory Medicine.

“Smoking is also dangerous to family and friends. About 75% of cigarette smoke is released into the environment as second-hand smoke, which increases the risk of lung cancer,” he adds.

It was a picture of blackened, diseased lungs that finally drove the point home for Muniandy. The shocking revelation that he was putting himself and his loved ones in danger made him decide to quit.

In this day and age, it’s safe to say that only a few people do not know about the consequences of smoking. Despite that, the nicotine addiction is still strong, with five million adult smokers in Malaysia.

[abbreviated – read more at the link above]

There are 300 quit-smoking clinics based in general hospitals and government health clinics all over Malaysia. Klinik Q is situated in the Institute of Respiratory Medicine (before Hospital Tawakal), Jalan Pahang. It is open on Tuesdays (2.30-4.00pm) and Saturdays (8.30am-12.00pm). If you wish to register, you can walk in or call 03-4023 2966 to make an appointment. Treatment is absolutely free.

March 12, 2004


Filed under: Uncategorized — malaysianmedicine @ 7:40 pm

RM75 mil biogenerics plan

Two years ago, the Malaysian government quietly invested RM75 million in a biotech venture to make “biogenerics” or off-patent biotech drugs. The company, a wholly owned subsidiary of the Ministry of Finance, is Inno Biologics Sdn Bhd. However, up until now, the government has still not made a formal announcement on the investment.
This lack of information on Inno Biologics has drawn much criticism. Some believe the company failed in its first attempt at making insulin. Others reckon that Inno Biologics spent too much money paying hefty licence fees for access to certain process technologies.
Yet others question the appropriateness of the deal – how did the Science Adviser (Tan Sri Datuk Dr Ahmad Zaharudin Idrus) to the Prime Minister end up as Inno Biologics’ chairman?
But in an interview with netv@lue2.0, Ahmad Zaharudin explains that the main reason for the low-key nature of Inno Biologics’ formation is purely strategic. “We didn’t want our neighbouring countries to know early on what we were planning as many are getting into the biotech space as well.”
He also denies failed attempts at making insulin, saying that since the company was set up in December 2002, it has been busy designing its plant and enhancing and pilot-testing the process technologies involved in the making of biogenerics.
Ahmad Zaharudin says there is no conflict of interest in his position as both Science Adviser and chairman of Inno Biologics. Apart from being a government representative to oversee the development of the company, he says there is so much to be done in science and technology that conflict of interest is not relevant in this case.
He adds that he does not earn any money from Inno Biologics or ask for special favours from the government to help the company. “We could have asked the Ministry of Health for an exclusive contract to buy insulin from us but we did not,” he stresses.
The raison d’ztre for Inno Biologics is to kick-start the country’s manufacturing foray into the biotech arena, Ahmad Zaharudin says. “This company represents the business content aspect of the country’s plans to embrace biotechnology while the three institutions in the BioValley are focused on research.”
(The three institutions are the Agro-Biotechnology Institute, the Pharmaceutical and Nutraceutical Institute and the Genomic and Molecular Biology Institute.)
The bulk of the RM75 million investment will go towards the design and building of a plant, which includes a bioreactor – a container in which a biological reaction or biological activity takes place for the production of biotech drugs. A Europe-based consulting firm designed the plant according to European standards at a cost of RM1 million. At the time of writing, Inno Biologics was preparing to open a tender for the building of the plant, likely to be done in Europe. The plant will be shipped to Malaysia after passing necessary tests for such certification as GMP (good manufacturing practice) and US FDA (Food and Drug Administration) approval, explains Ahmad Zaharudin. However, he declined to reveal the estimated cost of the plant, which is expected to start operations in 2006 at the Nilai Science and Technology Park. It will have the capacity to produce 1,000 litres of mammalian cell culture, which will be used to produce biogenerics. (The large-scale culturing of mammalian cells allows for the production of biogenerics such as proteins that are otherwise difficult or expensive to extract from living organisms.)
Although Ahmad Zaharudin specified that the plant will be producing insulin and erythropoietin (a hormone normally produced by the kidney that stimulates red blood cell production), Inno Biologics’ chief executive Dr Mohd Nazlee Kamal says those are just examples of the kind of biogeneric drugs that the company can produce.
The plant will also be able to produce monoclonal antibodies and be used as a facility to make drugs for companies that are conducting clinical trials for their drugs, adds Nazlee.
Inno Biologics has hired five Malaysian PhDs, including Nazlee, a qualified engineer in bio processing who was previously with Amersham Biosciences (as business area manager), Sartorius (business development manager) and B.braun biotech (sales manager). Prior to that, he had spent 10 years as a lecturer in bio processing engineering at Universiti Teknologi Malaysia. Inno Biologics’ chief technology officer is Professor Dr Mohd Sanusi Jangi, a microbiologist who was a professor at Open University Malaysia and Universiti Kebangsaan Malaysia before that.
Apart from making biogenerics, the company also plans to offer contract research and manufacturing services. In the pipeline for Inno Biologics is a much larger plant, with the capacity to produce 10,000 litres of mammalian cells. It is unclear how much Phase 2 will cost and how Inno Biologics will raise the additional funding. What is clear is that Inno Biologics has started work on the design of the plant in Phase 2 and that it will be located within the BioValley.
Ahmad Zaharudin does not rule out more funding from the government (for Phase 2) but adds that they will look at other options too, such as the capital market.

Will Inno Biologics survive?
Large government-funded projects like Inno Biologics typically face criticism that they are not viable. Otherwise, why wouldn’t private investors fund the project? And the typical response to such criticism is that a project like Inno Biologics is driven by national interest, not the profit motive.
In this case, the rationale for the investment is not only capacity-building (an oft-used justification these days in government-funded science and technology projects) but also that it is an opportunity that promises good returns in the long run, according to Ahmad Zaharudin.
“The government was pleased because there was a bunch of competent people who were gung-ho enough to take the risk and propose the project. There is no profit motivation from the people and we cut all costs to a minimum,” he says.
Nevertheless, Ahmad Zaharudin is confident the company will break even in five years and become a RM100 million company in terms of revenue by then. It will first target the domestic market and then venture into regional markets such as Thailand and the Philippines to sell its drugs.
The competitive edge that Ahmad Zaharudin hopes will spur its success is the simple, high-quality, low-priced model. “We are doing things very cheaply yet we have the necessary scientific brain power to ensure our products are of high quality.”
But it can be argued that this is the same model that others in the region are toying with. Even at home, Inno Biologics will possibly face competition from an insulin plant being built in Penang. In June last year, it was announced that a US$34-million (RM129.2 million) human insulin plant will come onstream by mid-2005 in that state. The project is a joint venture between the Penang Development Corporation and London-based GeneMedix plc. The latter was founded by well-known Malaysian biotechnologist Dr Kim Tan. GeneMedix will license its insulin-making technology to the Penang plant, which will then manufacture and commercialise human insulin.
Inno Biologics would have passed its final test when it is able to market enough of its biogenerics and other services to see it break even in its fifth year, and report the RM100-million turnover its chairman is confident of.


Filed under: Uncategorized — malaysianmedicine @ 7:20 pm

New therapy for dadah addicts


The Government is turning to drug substitution therapy, using methadone on
dadah addicts, under a plan to overhaul the conventional drug
rehabilitation system.

Deputy Home Minister Datuk Chor Chee Heung said a pilot study would begin next month involving 50 ex-Pusat Serenti inmates from the Klang Valley, who would be given methadone for three to six months.

Methadone suppresses the craving for the “high” obtained from drugs such as heroin, morphine and codeine.

The treatment works on the medical premise that some people may be predisposed to drug addiction because of biological deficiencies, such as their body’s inability to produce natural endorphins as a response to pain.

Notably, drug substitution therapy has also helped to curb the spread of HIV/AIDS, hepatitis and other diseases spread through needle sharing.

In Malaysia, about 80 per cent of persons with HIV/AIDS contracted the disease through needle-sharing.

The treatment could change the way drug addicts were viewed here; no longer as people with social and psychological problems but as medical patients, said Chor.

“The addict will be like a patient who can take his medication and go about living a normal life.

“He will be just like a person who requires medication for diabetes or high blood pressure,” he said. The pilot study is jointly conducted by the National Drug Agency, Universiti Malaya Medical Centre (UMMC), Universiti Sains Malaysia (USM) and Duopharma (M) Sdn Bhd, the maker and sponsor of the drug.

The Government is to decide whether the drug therapy will be adopted in its Pusat Serenti rehabilitation programmes after the pilot study.

The project is focused on ex-inmates because 75 to 80 per cent of them relapse upon release from rehabi-litation centres.

Conducted voluntarily, ex-inmates must obtain the consent of their families and moral support from their local communities or non-governmental organisations.

The idea is to make drug substitution therapy a community-based treatment, whereby an ex-addict can be treated while being an active member of society.

The Government hopes to determine the cost of treatment per person through the pilot study.

The non-monetary benefits and positive effect on society as a whole would be tremendous, said Prof Dr Muhamad Hussein Habil, UMMC’s consultant on drug addiction and a Universiti Malaya professor. “It helps the ex-addict return to a normal life by stabilising his relationships with others, thus reducing crime and allowing him to work and contribute to society,” said Hussein.

March 10, 2004


Filed under: Uncategorized — malaysianmedicine @ 11:57 am

Jactim’s donation for haemoglobin meters

Expectant mothers in rural areas can look forward to their nearest health
clinic having a haemoglobin meter, which is used to detect anaemia, thanks to a donation from the Japanese Chamber of Trade and Industry, Malaysia (Jactim) Foundation.

Jactim vice-president Datuk Masatoshi Fujiki handed over a mock cheque for RM120,000 to Deputy Health Minister Datuk Seri Dr Suleiman Mohamed today for the purchase of 44 meters. The ceremony was held at the Health Education and Communication Centre in Bangsar.

Fujiki said the donation came under Jactim Foundation’s Medical Support in Remote Areas project for 2003. “We decided to undertake this project when we heard the Health Ministry’s request for assistance.

“The foundation hopes the contribution will help promote better health management, especially among those who live in remote areas where medical facilities may be less sophisticated than those available to the urban population.” He said the haemoglobin meters were particularly effective for early detection of anaemia among expectant and nursing mothers.

Expressing his gratitude to the Jactim Foundation, Suleiman said the donation was timely as 20 per cent of health clinics in Malaysia lacked the meters.

“Anaemia, one of the leading causes of morbidity among antenatal mothers, can be easily treated if detected early. To date only 686 clinics out of the 858 health clinics in Malaysia are equipped with the meter.” The Jactim Foundation was established in 1994 to assist cultural, social and educational development in Malaysia and in the process help strengthen the mutual understanding and friendship between Malaysia and Japan.


Filed under: Uncategorized — malaysianmedicine @ 11:56 am

Welfare fund to get RM20m more

THE Government has approved an additional RM20mil – over the earlier RM5mil – to help chronic patients.

The extra allocation would also be used to set up a one-stop centre to help patients in need of aid to apply from the National Health Welfare Fund, reported Utusan Malaysia.

Health Minister Datuk Chua Jui Meng said the centre would help to speed up the application process and reduce red tape, as applicants no longer required approvals from various departments. It would be located at the ground floor of the ministry’s Block C in Jalan Cenderasari, Kuala Lumpur.

March 8, 2004


Filed under: Uncategorized — malaysianmedicine @ 1:53 pm

Doctor found drowned in car

PETALING JAYA: One of the country’s most prominent gastroenterologist was killed when the car he was driving plunged into the Klang River in PJS 7/15 here yesterday.

The body of 55-year-old Dr M. Panir Chelvam, who specialised in digestive diseases, was recovered at noon and sent to the University Malaya Medical Centre (UMMC) for a post-mortem.

Petaling Jaya Selatan Deputy OCPD Asst Comm Osman Abu Bakar said Dr Panir was believed to have lost his way in Bandar Sunway while heading home towards Bangsar Baru when the accident occurred at 2.30am.

“Post-mortem results indicated that Dr Panir had drowned and we have ruled out foul play,” he said.

ACP Osman said although the accident occurred at 2.30am, the authorities were only informed of the accident at 9.30am, when a member of the public contacted the police.

A team of policemen from the Petaling Jaya Selatan police headquarters and Sungai Way police station rushed to the scene together with a search and rescue team.

When the rescue team failed to open the car door to pull out the driver, a tow truck was called to help at about 11.30am.

Dr Panir’s black-coloured Mercedes Benz was finally pulled out of the river some 30 minutes later.

It is learnt that Dr Panir was wearing his seat belt during the incident and his car doors were locked. His cash and valuables were found intact.

Dr Panir was awarded the Kesatria Mangku Negara by the Yang di-Pertuan Agong in 1998.

He leaves behind his wife Dr Sheila Pillay and two daughters P. Alisha, 18, and P. Kavita, 16.

Condolences to the family.

March 6, 2004


Filed under: Uncategorized — malaysianmedicine @ 10:19 pm

TH Group Bhd buys Nilai Cancer Centre

TH Group Bhd said it has received approval from the Securities Commission for its proposed acquisition of Asiaprise Biotech Sdn Bhd, which owns the Nilai Cancer Institute (NCI), Malaysia’s first private oncology specialist hospital.

TH Group said it was buying Asiaprise for RM43mil to be satisfied by RM9.7mil in cash and the issuance of 30.2 million new TH Group shares at RM1.10 each.

“The acquisition of NCI marks TH Group’s entrance into the healthcare industry, making it our fourth core business,” said group managing director Lei Lin Thai in a statement. The group’s other core activities are plantation, contracting and timber extraction.

March 5, 2004


Filed under: Uncategorized — malaysianmedicine @ 5:46 pm

Merged funds make aid more accessible

THE Health Ministry’s Special Chronic Diseases Fund has been merged with the National Health Welfare Fund to make it easier for the low-income group to get medical aid, Utusan Malaysia reported.

The Government decided to merge the two funds because those seeking aid were confused by the two funds, Minister Datuk Chua Jui Meng said.

“The applicants did not know which one to apply to,” he said.

The Chronic Diseases Fund is headed by the ministry’s secretary-general and the Welfare Fund by the minister.

Chua said that with only one fund to manage, the ministry hoped to assist eligible applicants by lessening red tape.

The report said the Cabinet also agreed to do away with several conditions on applying for aid, including one that specified that applicants should not have a household income of more than RM600 and that they had to match each ringgit provided by the fund.

Chua said there was a special RM100mil fund announced in last year’s Budget and RM2mil of it was allocated to the Chronic Diseases Fund.

“However, not a sen (of the Chronic Diseases Fund) was used since the application requirements were too tight,” said Chua, adding that the allocation was withdrawn at the end of the year and not carried forward to the following year.

“A new condition agreed upon by the Cabinet is that the grant (for chronic diseases) absorbed by the Welfare Fund be not withdrawn at the end of the year,” said Chua.

He added that the Cabinet was informed that 49 applications involving RM1.677mil were approved under the Welfare Fund in 18 months

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