Inside Diagnostics Spring 2013 (01/2013) by nal von minden GmbH

new art laboratories

Inside Diagnostics Spring 2013

Crystal Meth The most deadly drug in the world

dengue FEVer

The tropical disease reaches Europe

HIV hOME TESTInG H

Home testing CHor3 professional help?

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Laboratory Service Constulting & Service

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Inside Diagnostics Vorwort

new art laboratories

Your expert for in vitro diagnostics

We help you care! For over 30 years, high product quality and an excellent service have been the main charactersitics of our enterprise. Hospitals, clinics, pharmacies, prisons and doctors across Europe rely on our expertise. Our wide and innovative portfolio covers everything you need for drug analysis and medical diagnostics. nal von minden GmbH Tel.: 0941 29010-0 info@nal-vonminden.com www.nal-vonminden.com Seite 2

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Inside Diagnostics

Forward

Dear Reader, For 30 years nal von minden has successfully met the needs of its customers and is a trusted expert in the production and distribution of in vitro diagnostic products and point of care tests. Through regular customer contact and regular participation in conferences and trade fairs, we understand the needs and interest of our customers. In this magazine we wish to offer our customers exciting articles focusing on various areas of our expertise and product spectrum.

In this issue, our focus theme is Crystal Meth and the current developments surrounding this dangerous drug as it continues to spread across Europe. Also included are articles on Dengue Fever and the controversial topic of HIV home testing. Should you have any questions or suggestions surrounding any of the articles enclosed then please do not hesitate to contact us.

Philipp StrauĂ&#x; Editor in Chief

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Subscribe to our magazine for FREE today Write to us: inside-diagnostics@nal-vonminden.com Contact Inside Diagnostics Philipp StrauĂ&#x; Tel.: 0941 29010-36 inside-diagnostics@nal-vonminden.com

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Inside Diagnostics Contents

Contents Themes What is Crystal Meth? �� 5 How Dengue-Fever has reached Europe �� 6 Legal Highs �� 7 Fentanyl – The Deadly Drug �� 8 Home testing or trust the professionals? �� 10 nvm Inside New logistics centre in Moers �� 12 Short News �� 14 Conference Calendar 2013 �� 15

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Imprint CH3

Crystal Meth | Page 5

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Many complications including skin inflammation, tooth decay, panic attacks, aggression and anxiety can occur quickly after the initial dose.

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Inside Diagnostics nal von minden GmbH Customer Magazine Contact Person: nal von minden GmbH Philipp Strauß Friedenstraße 32 93053 Regensburg Editors: Philipp Strauß, Kristina Sambs, Raffaela Seiband, Lukas Eder, Torsten Winkler, Thomas Schott, Anne Kaiser, Christopher Beiderbeck, Frederica Swaine inside-diagnostics@nal-vonminden.com Production: Martina Kastenmaier, Kasia Orlowska

Rapid Tests Crystal Meth

Crystal Meth is on the rise across Europe What is Crystal Meth? Methamphetamine has its origins in the Second World War. Here ´Pervi- tin´ otherwise known as ´Tank Chocolate´ was administered to soldiers to increase performance and concentration. The semi-synthetic drug is addictive and can be smoked, swallowed or ingested nasally. The drug reduces the need for sleep and suppresses feelings of hunger and thirst. After consuming a high dosage, hallucinations, dizziness, and problems with blood pressure and circulation can also occur. In addition many further complications can occur quickly after the first dosage such as chronic skin inflammation, tooth decay, panic attacks, aggression and anxiety. A further side effect can be problems with concentration, where those concerned can barely remember dates and standard information.

Whilst consumption of the drug still remains low in the UK compared with other substances, Crystal Meth still has a prominent appeal on the dance scene. Unsurprisingly Crystal Meth´s ability to surpress the need for sleep, food and drink, make it popular in such markets. In addition to this, widespread consumption of the drug abroad and its current rise in Europe, makes the potential for consumption to rise in the UK much more likely.

However, despite these effects consumption of the drug is on the rise across Europe. This is due particularly to the prevalence of the drug in the Czech Republic, and the subsequent trade channels into neighboring countries. Areas of Germany bordering the Czech Republic, in particular the Eastern regions of Bavaria, have thus seen a growth in the consumption of the dangerous drug.

Sample material: Urine Cut-off: 1000 ng/ml, 500 ng/ml or 300 ng/ml Detection Time: 4-6 hours after consumption for up to 1-5 days Test Format: Test strip and Test cassette, Integrated into a multi test

In addition, nowadays the internet is host to numerous tutorials detailing how Crystal Meth can be produced at home in the kitchen. Worrying is all that can sometimes be required to produce Crystal Meth is a 2 litre bottle, a cold remedy and an ice pack. Of course such methods bring many dangers. For example, there is a high risk of the mixture suddenly exploding during the manufacturing process. Yet such sites highlight the demand for such information from the consumer.

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nal von minden Test nal von minden Drug-Screen® rapid tests deliver reliable results within 5 minutes and detect the presence of the drug within a patient sample. Contact us for more information!

Sample material: Saliva Cut-off: 50 ng/ml Detection Time: 10 min after consumption for up to 72 hours Test Format: Test cassette, Integrated in diverse Multi test combinations Sample material: Blood Cut-off: 50 ng/ml Detection Time: 1 hour after consumption for up to 24 hours Test Format: Test cassette, Integrated in Multi-8 Test combination PS, FS

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Tropical Medicine Dengue Fever

Tropical diseases are spreading

How Dengue-Fever has reached Europe Anyone planning a holiday to the tropics this summer will have certainly researched the risks concerning tropical diseases and taken the appropriate preventative action. Yet, who considers the same risks when travelling to Southern Europe? As tropical diseases spread further the risks must be understood more. Tropical diseases can now threaten to ruin your experience in more and more regions, as Dengue Fever has made its way to Europe. Around half a century ago, Dengue Fever was only common in Asia. Here the body aches associated with Dengue Fever were characteristic of the disease known better as ´Break Bone Fever.´ In 1970 Dengue fever was reported in only nine countries in the world. Despite this however the disease affected people from over 100 countries and as a result began to spread rapidly. According to the WHO, Dengue is the most rapidly spread viral mosquito- borne disease, where 50 million new cases of the infection are estimated annually. The culprit is the spread of the mosquitoes which carry the disease, in particular the Asian tiger mosquito. Through globalisation and international transportation of goods, the bloodsuckers have quickly become world travelers. In addition, through climate change there are now more and more regions in which these creatures feel at home and thus multiply. No longer is the risk of Dengue Fever confined only to the Tropics. Cases of the disease are now reported in Southern France, Greece, Italy and Croatia. In Madeira, there was even an epidemic, where more than 800 cases were reported. As global warming continues to threaten, a further spread of infected mosquitoes to other countries is a constant possibility. Unfortunately, there is no primary vaccination or effective medication against the infection. Instead only the symptoms of the disease can be reduced. Initial prevention is therefore the only option, and systematic mosquito repellent is recommended as the most effective preventative method.

The variety of possible pathogens and the non-specific symptoms complicate the diagnosis of Dengue Fever further. In around 90 percent of cases, symptoms are flu like, where fever, chills, fatigue and severe limb, joint and muscle pain are common characteristics. After around 5 days, the renewed fever will cause a notable rash and swelling of the lymph nodes is likely. In additional vomiting and nausea can occur. The subsequent recovery period can take weeks. In severe cases the disease can even cause internal bleeding and the potentially fatal ´dengue hemorrhagic fever.´ These flu like symptoms complicate diagnosis of the disease especially in countries where the disease is not traditionally present. Doctors are often not familiar with symptoms and characteristics in a suspected sufferer, and can thus sometimes fail to correctly diagnose the condition. This said, antibodies for the disease can be detected in the blood five days after infection, and between the fourth and seventh days Dengue Fever can be sensitive to molecular biological tests. In cases of suspected Dengue Fever nal von minden Rapid Tests offer a fast and cost effective diagnostic aid. For laboratory diagnostics, results can also be gained through the use of nal von minden ELISA kits. In additional to our test for Dengue Fever, we offer our customers other rapid and laboratory tests for a range of tropical infections, including Malaria, CCA, Chagas, Chikungunya, Cholera and Cryptosporidium. If you require further information, please just ask.

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Rapid Tests Legal Highs

Deceptive Bath Sales

Legal Highs

Since our autumn 2011 issue, the United Nations has responded to the latest developments. In its latest drug report, the UN pointed out the great dangers posed by ´designer drugs.´ However, despite increasing recognition of the problem, the number of consumers and those offering such products continues to rise rapidly across Europe and the world. Desired and undesired effects of legal highs Legal Highs can be categorised into two groups: ´Downers´ with sedative effects and Úppers´ with stimulant effects. For example Synthetic Cannabis products cause relaxing effects whereas Mephedrone or other synthetic cathinone derivatives mimic sensations associated with Cocaine or Amphetamine. The drugs are sold in a variety of forms including herbs, tablets, power and capsules. In general imitation cannabis products are sold under the name of íncense´ or ´herbal highs´ and the stimulant substances are represented as ´Bath salts´ or ćleaners.´ However in principle all possible terms are conceivable. Experienced users of the óriginal drugs´ report similar effects but not the same effects from using these designer drugs. Furthermore, due to variations in manufacturing, the final dose received is constantly problematic. Due to unprofessional production, the final ingredient composition is difficult to assess. The drug concentration can therefore vary significantly from batch to batch or from pack to pack. Due to these production variances, it is also incredibly difficult to assess the predicted risks to the customer. In many circumstances these drugs can be fatal, and such risks are often not realised until it is too late. Long Term Consequences Just as the immediate risks are difficult to determine, as good as nothing is known about the long term effects of these designer drugs. Unlike with ćonventional´ illegal drugs, there are no long term scientific studies focusing on the possible outcomes and consequences of regular consumption.

It must therefore be assumed that you are exposed to considerable health risks through consuming such substances both short term and long term. Target Group Worryingly the number of consumers continues to increase despite the obvious risks. The reason for the consumption of legal highs is diverse but many consumers may feel secured by the implied legality of the substances. Consumers with prior drug experience can also often try to stay negative in drug screen tests through use of legal highs. Others see the substances as a cost effective alternative to more expensive hard drugs such as Cocaine. For some however it is just curiosity combined with the appealing presentation of legal highs and the ready availability on the internet. As a result there is a wide prevalence of young users, many of who are under 30 years old. Legality: Why are these drugs actually ´legal´? According to the Narcotics Act only clearly known substances can be banned. Thus it often takes time for a substance to gain in popularity and prevalence before it can be considered dangerous enough to be removed from the market. In 2011 alone the EU early warning system reported 49 new psychoactive substances. The manufacturers therefore usually have months to sell the goods before legislation has an impact. In addition, new and alternative chemical compositions are often developed which enable a substance to remain classified as legal. As a result the legal-illegal game of cat and mouse continues. The term ´Legal Highs´ is misleading. The branding automatically suggests something non harmful due to the legal status. Yet this is definitely not the case! Although these substances are at the moment not forbidden, illegal substance can sometimes make their way into these ´legal highs.´ In some circumstances consumers of legal highs have thus be charged with violation of narcotic laws anyway. Legal highs therefore continue to be both a serious health and legal risk.

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Rapid Tests Fentanyl

Addicts target throw away pain patches

The Deadly Drug Fentanyl What is Fentanyl?

Fentanyl is a highly potent synthetic Opioid with strong analgesic and sedative effects. It is usually administered as anesthesia and for severe chronic pain. For this reason it functions regularly in cancer pain relief prescriptions due to its function as one of the strongest painkillers. Fentanyl has the same characteristics as Morphine, but is about 100 times stronger. It is controlled regularly by narcotics laws where all Fentanyl containing products must be prescribed. Fentanyl is traditionally prescribed in patch form, through which the drug´s is absorbed into the body. However due to the drugs composition, even after use of a patch, 70% of the active ingredient from the initial dosage still remains in the patch.

respiratory arrest as well as death by asphyxiation. Shockingly, more people die through Fentanyl related deaths than Heroin or Cocaine. The black market is booming Drug addicts are developing new ways and possibilities to access Fentanyl. A popular way is through the so called ´Doctor hopping.´ Addicts and black market dealers regularly contact new doctors, bringing an old medication box with them to an appointment in an attempt to obtain new Fentanyl patches. With various excuses, such as moving areas, the dealers and addicts try again and again to get access to the patches. On the black market the medication packs can be sold at values 100% above the original resale value.

Abuse by Drug Addicts Drug addicts use precisely this opportunity to feed their addiction. They may search through the waste from clinics, nursing homes and doctors to find disposed of Fentanyl patches. These patches are then cooked by addicts in order to extract the active substance to be injected intravenously. An alternative is to chew the patch in the mouth in order to extract the active ingredient and consume it orally. Dependence on Fentanyl in this way is highly dangerous, where both addicts and experts report on the dangers of overdose through misuse. In particular, the border between a normal dose and a lethal dose is difficult to predict. Intoxication through Fentanyl also increases the risk of heart and

The following advice is recommended before prescribing

3 Detailed history of the patient 3 Performance of Rapid Test to determine suspected substance misuse

3 Prescription of only the smallest package sizes 3 Receipt of used patches and safe disposal PS

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Inside Diagnostics Vorwort

new art laboratories

nal von minden Drug-Screen® Spice/K2 Rapid test Rapid test for detection of drugs in urine analysis, Cut-off: 50 ng/ml

NEW JWH-018, a Synthetic Cannabinoid, is also commonly referred to as ‘spice’. Initial studies of the metabolism of JWH have highlighted metabolic processes such as ring and alkyl substituent hydroxylation, carboxylation and glucuronidation. A number of countries in Europe, as well as in the US and Canada have banned the use of these substances.

and therapeutic treatments offered by physicians. The visual in vitro diagnostic rapid test is designed for professional use to provide a preliminary qualitative and analytical result. A more specific chemical method must be used for the confirmation of results. Gas chromatography/mass spectrometry (GC/MS) or Liquid chromatography/mass spectrometry (LC/MS) are the preferred methods. Clinical The nal von minden Drug-Screen® Spice/K2 Test is and professional judgement should be exercised a immuno-chromatography based rapid test for the when interpreting any substance of abuse test requalitative determination of JWH-018 and JWH-73’s sult, particularly when the preliminary test result is major metabolites in human urine at a cut-off value positive. of 50 ng/ml. It can be used as an aid to the diagnosis Rapid Tests

can also be integrated into a multi drug test

Laboratory Diagnostic Laboratory Service Consulting & Service

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Infectology HIV Hometesting

HIV Rapid Test

Home Testing or trust the professionals? According to statistics from the Robert Koch institute, the fight against AIDS hit a major setback in 2012. Here statistics show that the number of new infections has risen to a record high, where a worrying percentage is still unaware of their condition. Two thirds of those affected are still homosexual and bisexual men, where this group still represents the largest risk category. The number of undetected infections makes the disease increasingly difficult to contain – because these people can unknowingly pass on the virus. Fear, lack of knowledge and the dislike of condoms means that the disease can spread easily, and it can sometimes take years before a diagnosis is made. In the moment it is often difficult to act rationally and protect oneself. So how can you be sure or can you never be sure? Since 2012, the company OraSure has offered the first FDA approved home test for end users in the USA. The test is performed by obtaining a smear of liquid from the gums, and costs less than 20€. The person tests themselves and a test result can be interpreted after only 20 minutes. Developers see the advantage to be the private and confidential environment which the test can be carried out in. This factor could result in a rise in the number of detected infections as consent to take the test and to be tested could increase. In addition one could potentially test a new sexual partner before the first sexual contact. However it is also made clear that the test is not 100% accurate and contact with a doctor especially after contact with an infected person is still recommended. In addition positive results should be confirmed by a professional. Negative results should also be confirmed again after 3 months to account for the diagnostic window period where in general this time period is 3-6 months. Clinical studies have also revealed that the OraSure test recognises only 92% of HIV cases: “That is that one in every twelve

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tests results in a false negative result” reported the FDA. ´False negatives´ mean that the test records no HIV infection, although it is present. 5,800 participants were included in this study and on average the test failed to identify 7 out of 100 HIV positive samples. These individuals were thus presented as HIV negative when they were in fact HIV positive. Whilst the reason for this was most likely application error, the results are still worrying. In additional, ´False positive´ results also emerged in the study. German Aids Help reported that “If 10 000 people performed the home test, around 20 users would report a false positive result.” Again the results of such studies are not reassuring. In Europe a HIV home test for end users is not yet approved. HIV rapid tests must therefore be performed by doctors, public health officials or counseling centres by trained professionals. The reasons for this are obvious. Significantly, often the diagnostic window period is not considered thus causing potential risks to public and individual safety and health. In addition individual consumers are inexperienced with use of the test, and incorrect results under certain circumstances can occur. Yet, the most important aspect should concern psychological care and counseling – which is absent in a home test. What do you do if the test is positive? Although the package insert states that the test should only be considered as ´the first step´ and does not confirm a HIV infection - does this really calm someone sitting alone at the kitchen table? HIV/AIDS is still incurable. In Europe it is therefore assumed that a test result, whether positive or negative, should not be performed without specialised personnel with a professional background. Counseling services are especially important in

Infectology HIV Hometesting

dealing with such a situation. Sometimes it can help to contact others in the same situation, and others may wish to seek information on antiretroviral therapy as soon as possible. For others it may help them to realise that living with HIV today no longer a death sentence. Opinions continue to differ on whether a HIV home test should be considered as progress or critical. Yet, despite these discussions the FDA still considers the home test as an improvement in HIV diagnostics.

discussion. So far a HIV Home test is not approved in Europe. Therefore nal von minden only offers the OraQuick HIV test to professional users only, alongside its comprehensive range of other professional HIV diagnostic kits. We will report in due cause should further developments in legislation surrounding HIV home testing occur.

Armin Schafberger (German AIDS Help) however discusses openly the disadvantages surrounding such a device. He believes that â&#x20AC;&#x153;The approval of the HIV home test shows the helplessness and even despair in the USA surrounding the ever growing epidemic. Millions of people in the USA do not have access to a basic healthcare system and targeted HIV testing services, based on consultation and voluntary participation are scarce. Instead the responsibility is simply put in the hands of the individual, giving him an unreliable and expensive device, and sparing him from any professional advice. That is third class medicineâ&#x20AC;&#x153; concludes Schafberger. Certainly the topic of HIV home testing has a lot of room for

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nvm Inside New Logistics Centre

Bigger, Faster & Modern

New logistics centre in Moers Increased productivity and capacity The new logistics centre in Moers is designed to meet the ever growing demands of the nal von minden business. The complex includes modern offices, a 500 m2 warehouse and delivery area. The new warehouse with 460 palette locations, 72 shelving units each with six levels, enables the capacity to store 28,800 boxes, with 25 channels for a further 4,250 box capacity. Temperature sensitive products are stored in the large cooling room. Storage Strategy FIFO (First In First Out) In order to ensure efficient logistics, a system of ABC analysis is applied. Those products selected most frequently are stored at a closer distance to the packing stations. The packing station consists of two packing tables. To assist with shipping, there are two pallet jacks and a fork lift truck. KS

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nvm Inside New Logistics Centre

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Inside Diagnostics Short News

nal von minden

Short News Bowel Cancer in the UK

Bowel Cancer is now the second most common cause of cancer death in the UK. Yet, when detected early bowel cancer is a very treatable disease. However lack of knowledge and possible embarrassment means that sadly, the often treatable cancer has one of the highest mortality rates. These observations are worrying. The World Health Organisation (WHO) recommends early screening for bowel cancer and encouragingly the NHS is taking action. The National Bowel Cancer Screening Programme for all over 60’s is now fully rolled out across the UK to help prevent further increases. A Pilot Scheme for ´bowel scope screening´ those over 55 was also initiated in March 2013 by the NHS, as further effort to reduce mortality rates. Fecal Occult Blood Tests (FOB Tests), used widely by the NHS are useful aids in the detection of bowel cancer. These tests indicate early the need for further investigations, thus resulting in early diagnosis and treatment of bowel cancer when present. FS

Annual Report 2012 of the International Drug Control Council declares a boom in designer drugs and ´legal highs.´ At the beginning of March 2013 the international drug control council published the UN´s annual report for the year 2012. Here, new psychoactive substances were documented as an ever growing threat to public health. These designed drugs are better known under the brand ´legal highs.´ These substances are readily available on the internet and the market is in steady and constant growth. The largest drug market in the world however remains North America. An average of 1 in 20 deaths of 15-64 year olds is recorded as in connection with drug consumption. In South America the production and distribution of Cannabis is rising steadily.

France: Suspension of law requiring motorists to always travel with Alcohol Breath Test in vehicle As of now, motorists will face no fines or consequences for travelling without an alcohol breath test in their vehicle. The potential requirement to be tested, should you be in breach of this obligation, has thus also been lifted. In the middle of 2012 it was decided that the provision would be introduced as an attempt to reduce the number of road fatalities. Motorists should in an emergency have the opportunity to test themselves for alcohol and thus determine their suitability for navigating a vehicle. However from the beginning there were huge problems with the delivery and quality of tests. The French Government also had to deal with resistance and low acceptance of the population. As a result the government had little choice but temporarily override the decision. PS

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Inside Diagnostics Conference Calender

Conference Calender

Visit us at a confere n

2013 January -

February March arab lab, Stand 401 10.03.2013-13.03.2013 • Dubai, VAE APrIl DgIM, 119. Congress of German Medicine, Stand 85 06.04.2013-09.04.2013 • Wiesbaden, DE 8th Meeting of European Experts: Drug Detection/Addiction Prevention 09.04.2013 • St. Ingbert, DE XVIII. Symposium of gTFCh, Stand 11 17.04.2013-20.04.2013 • Mosbach, DE The 50th anniversary of TIaFT, Co-hosted by the lTg 26.04.2013-27.04.2013 • London, GB

May 13. Hochstadter Discussions 15.05.2013 • Hochstadt am Main, DE Secours Santé, Stand 37 15.05.2013-17.05.2013 • Bourg-enBresse, FR 18. Addiction Treatment Hamburg 21.05.2013-24.05.2013 • Hamburg, DE Préventica, Stand a39 28.05.2013-30.05.2013 • Lille, FR June Deutsches Forum on Addiction 07.06.2013-08.06.2013 • Kassel, DE 22nd South Annual Meeting & 43th Meeting of Upper Rhine Medicine 07.06.2013-08.06.2013 • Salzburg, AT 21ème Congress of SFTa 11.06.2013-13.06.2013 • Saint Malo, FR July 14. Inter disciplinary congress for Addiction Medicine

In the next issue read about:

Interlaboratory test studies 3 3 3

Who performs and takes part Which details should be considered How results are evaluated

04.07.2013-06.07.2013 • München, DE auguST

SePTeMber 51st annual TIaFT Meeting, Stand 23 02.09.2013-06.09.2013 • Madeira, PT eWTDS Conference 2013 26.09.2013-27.09.2013 • Wien, AT OcTOber

nOVeMber 57th Meeting of JIb 13.11.2013-15.11.2013 • Paris, FR Medica 20.11.2013-23.11.2013 • Düsseldorf, DE DeceMber

Summer Issue 2013

Theme Overview Methylphenidate

Workplace-Testing Food Intolerances

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Contact Details nal von minden GmbH Carl-Zeiss-Straße 12 47445 Moers Deutschland Friedenstraße 32 93053 Regensburg Deutschland CEOs: Sandra von Minden Roland Meißner Thomas Zander Tel.: +49 941 29010-0 Fax: +49 941 29010-50 info@nal-vonminden.com www.nal-vonminden.com Commerical Reg: HRB 5679 Steuer-Nr. 244/133/00130 UST-ID-Nr. DE 189 016 086

Discover our comprehensive product range! For all products and innovations please visit: www.nal-vonminden.com

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