Search

Background: In recent years, a significant understanding of delivering optimal aerosol therapy and the availability of various drugs and devices have led to an increase in its use in clinical practice. There are only a few studies available regarding their use in critically ill patients from a few parts of the world. We aimed to study the practice pattern of aerosol therapy in critically ill patients from Indian intensive care units (ICUs). Methods: After ethical approval, this multi-centric prospective observational study was performed over a study period of four weeks. Newly admitted adult patients considered who had an artificial airway and/or ventilation (including non-invasive). Patients were followed up for the next 14 days or until ICU discharge/death (whichever came first) for details of each aerosol therapy, including ongoing respiratory support, drug type, and aerosol-generating device. Results: From the nine participating centers across India, 218 patients were enrolled. Of 218 enrolled patients, 72.48% received 4884 aerosols with 30.91 ± 27.15 (95%CI: 26.6-35.1) aerosols per patient over 1108 patient days. Approximately 62.7% during IMV, 30.2% during NIV, 2.3% in spontaneously breathing patients with an artificial airway during weaning, and 4.7% were given without an artificial airway after weaning or decannulation. In 59%, a single drug was used, and bronchodilators were the most frequent. The jet nebulizer was the most common, followed by the ultrasonic and vibrating mesh aerosol generator. The ventilator setting was changed in only 6.6% of the aerosol sessions with IMV and none with NIV. Conclusion: Aerosol therapy is frequently used with a wide variation in practices; bronchodilators are the most commonly used drugs, and jet nebulizers are the most widely used. [ABSTRACT FROM AUTHOR]

Essential medicines or drugs are recognized as highly cost-effective components within contemporary healthcare, demonstrating significant potential for improving health outcomes. The provision of essential medicines directly impacts the functioning of healthcare facilities, resulting in financial hardship. This review aims to fill knowledge gaps by examining obstacles hindering access and utilization of essential medicines in India. This study conducted a comprehensive evidence synthesis, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, to analyse articles on the availability and utilization of essential medicines in India. The search strategy included various databases and keywords. Published, peer-reviewed articles focusing on the National/State List of Essential Medicines and meeting specific criteria were considered. Data items included essential medicines, drug availability, utilization, and challenges. Data was extracted, synthesized, and analysed using thematic framework analysis. Out of 1,129 articles, 11 were selected for review. Studies consistently highlighted the inadequate availability of essential medicines in different Indian states. Availability of essential medicines varies in the range of 17-51 percent across major states of India. Stock-outs of medicines vary from 4 to 14 weeks. Governance issues including differential procurement mechanisms across states of India, hinder seamless availability of essential medicines. Other challenges included distribution and purchasing system inefficiencies, governance-related issues, and facility/user-level challenges impacting drug utilization. Disruptions in utilization were observed due to improper prescription practices and non-availability of affordable options. Accessibility and affordability also affected drug utilization. Issues with supply chain management and conflicting guidelines further contributed to the obstacles faced in ensuring availability and utilization of essential medicines in India. Ensuring the availability, accessibility, and affordability of essential medicines is of utmost importance. The public health system needs to strengthen its procurement and distribution management. Strengthening the logistics support for an efficient supply of essential medicines will reduce the time lag in receipt of drugs. Guidelines on essential drugs prepared by the National Health System Resource Centre need to be strictly adhered to and monitored in inventory management system. There is an urgent need to develop a sustainable model for achieving uniformity in the availability and utilization of essential medicines in India. [ABSTRACT FROM AUTHOR]

Introduction: The drugs approved by the Food and Drug Administration (FDA) in 2022, for the first time for any indication or under any brand, were studied under the contexts of indications, mechanism of action, and side effects. Primary care practitioners with considering patients as a composite whole will benefit by acquainting themselves with these drugs and their indications and adverse effects. Observations: The drugs were approved in all, 11 for the management of neoplasia, and 5 each for hematological, neurological, and dermatological conditions. 11 of the approved drugs are monoclonal antibodies and six are small molecule inhibitors. Conclusion: Although the FDA’s expedited approval program allows rapid market availability of drugs for difficult to treat conditions, a quarter of the globe does not have access to essential medicines, primarily due to cost. In light of this, approval agencies must reorient approval processes to improve accessibility. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease (CKD), a leading public health problem, has potential risks and serious implications on the health of individuals and society at large. Few studies explored the factors that influence access to CKD care at the community level in rural areas of West Bengal. A qualitative study was planned among key stakeholders to explore their views and experiences and to identify the barriers and potential facilitators that influence access to CKD care at the primary care level. Methods: Total 23 stakeholders participated in the study. Seventeen in-depth interviews (IDIs) were conducted on a purposive sample of stakeholders (CKD patients, healthcare providers (HCPs) and health planners) and one focus group discussion (FGD) among six community health workers. The audio-recorded interviews were transcribed verbatim. The Lévesque's framework for access to care as modified by Jodie Bailie et al. was employed to construct interview guides and structure the initial codes. Thematic analysis was undertaken using QSR NVivo version 11 using both inductive and deductive approaches. Results: The major barriers to CKD care at patient level were poor knowledge and awareness of CKD and at the health system level was shortage of skilled staffs, diagnostics and medicines and fragmented referrals. The potential facilitators identified were educational activities to increase the awareness of CKD among HCPs and patients; provision of CKD-related supplies and a system-level approach to care coordination along with m-health-based care. Conclusions: Targeted CKD screening programs and CKD specific trainings may improve awareness of CKD. Additionally, stronger primary care infrastructure, availability of essential drugs and diagnostics and creating an efficient referral process for the quality CKD care are the need of the hour. [ABSTRACT FROM AUTHOR]

Topical route of administration is very important and the most commonly used method of drug delivery for treatment of ocular diseases. However, due to unique anatomical and physiological barriers of eye, it is difficult to achieve the therapeutic concentration in the targeted tissue within the eye. To overcome the effect of these barriers in absorption and to provide targeted and sustained drug delivery, various advances have been made in developing safe and efficient drug delivery systems. Various formulation strategies for ocular drug delivery are used, like basic formulation techniques for improving availability of drugs, viscosity enhancers, and use of mucoadhesives for drug retention and penetration enhancers to promote drug transport to the eye. In this review, we present a summary of the current literature to understand the anatomical and physiological limitations in achieving adequate ocular bioavailability and targeted drug delivery of topically applied drugs and use of new techniques in formulating dosage forms in overcoming these limitations. The recent and future advances in nanocarrier-mediated drug delivery may have the potential to provide patient-friendly and noninvasive techniques for the treatment of diseases related to the anterior and posterior segments of the eye. [ABSTRACT FROM AUTHOR]

Int J Med Public Health 2015;5:71-6. 3 Laing R, Waning B, Gray A, Ford N, 't Hoen E. 25 years of the WHO essential medicines lists: Progress and challenges. While NLEM 2015 contained 376 medicines, NLEM 2022 contained 384 medicines. Out of the included medicines, 342 belong to one therapeutic category, 41 medicines appear in two therapeutic categories, 11 medicines appear in three therapeutic categories, and 4 medicines appear in four categoriesIn NLEM, medicines are divided by health-care setups into primary (P), secondary (S), and tertiary (T) health-care facilities. [Extracted from the article]

Background: Over-the-counter (OTC) sale of medical abortion (MA) inducing drugs is a common practice. Exploring its impact on women's health and the barriers to avail free MA services at hospital by these women is essential to improve upon policy decision. Methods: A prospective observational study included 112 women following ingestion of MA drugs from nonformal providers. Demography, clinical details, and reasons for not availing free abortion services at hospital were recorded. Results: Among 112 women, mean age was 28.63 (SD 4.7) years. Seventy one (63.39%) women were from rural region; 70.54% were educated below high school; 44 (39.28%) had prior induced abortion; 62.5% had never used any contraception. Majority (101; 90%) took two drugs (Mifepristone and Misoprostol), 28 (25%) used correct dosage. Drugs were consumed beyond 9 weeks of gestation by 25 (22.4%) women. Abnormal vaginal bleeding was commonest 105 (93.75%) presentation. Haemorrhagic shock was noted in 21 (18.75%) women, while 21 (18.7%) women required blood transfusion. "Easy and quick availability of these drugs OTC" was the commonest statement for not attending hospital. Conclusion: Easy and quick availability of OTC drugs, distance to hospital were major barriers. Incorrect dosage and lack of gestational age calculation were two most common errors in the risk assessment protocol. Expanding provider base, by training midlevel providers, can overcome these and unmask the full potential of MA to make abortion safer. [ABSTRACT FROM AUTHOR]

Introduction: Scorpion envenomation is a life-threatening condition, particularly for children. Therefore, it is essential for primary care health providers to suspect, identify, and manage this condition early to prevent death and minimize morbidity. Objective: To identify the key epidemiological characteristics of scorpion envenomation and update the primary care health workers regarding the latest management practices of scorpion envenomation. Methodology: A non-systematic review was performed by searching the key terms on databases such as PubMed, Medline, Scopus, Google Scholar, and ResearchGate. Results: Worldwide, over 2.5 billion people are living at risk of scorpion stings. Every year, over 1.2 million are stung by scorpions leading to the death of at least 3,250 people globally. The most vulnerable group includes farmers, laborers, and those living in rural areas. Adults are most frequently stung but envenomation is more severe among children. Prazosin is a key drug to prevent death due to cardiovascular complications. Conclusion: Most of these stings and deaths could be preventable with proper awareness, safety precautions, and timely access to treatment. Government and local hospitals should ensure the availability of key drugs such as prazosin. [ABSTRACT FROM AUTHOR]

Context: The prevalence of oral mucosal lesions across various countries varies from 4.9% to 64.7%. The cost barrier is an important factor that prevents people in low-middle income countries from seeking professional help for dental problems. Aims: The present study aims to analyze the costs of medicines and oral care products prescribed for common oral lesions and to find the most expensive and the most economic brands. Methods and Material: The list of medicines and oral care products prescribed for the management of four oral conditions namely, recurrent aphthous stomatitis, oral candidiasis, oral herpes, and gingivitis were taken and their median retail prices, cost variation percentages were calculated from the current Indian market brands. The median retail prices were compared with their corresponding Jan Aushadhi prices. Also, the availability of the drugs and oral care products were evaluated across the state drug procurement lists of Tamil Nadu, Rajasthan, Uttar Pradesh, Telangana, and Bihar. Results: Wide cost variations were seen in most of the drugs and oral care products. The Jan Aushadhi prices of included drugs were very economical compared to the median market prices. However, the availability of the drugs was less in the Jan Aushadhi list and also in the state medical commission lists. Conclusions: The availability of such commonly used drugs in oral conditions has to be ensured in state and central departments by the policy makers. Price regulations of drugs routinely prescribed by dentists will help reduce the overall treatment costs for dental care. [ABSTRACT FROM AUTHOR]

Context: Available information indicates that substance abuse poses a major political, social, and health challenge worldwide. Availability of drugs, negative peer pressure, poverty, and frustration are among the factors that increase the burden of substance abuse. Urine drug testing (UDT) is a reliable laboratory method of analyzing substances of abuse because many drugs and their metabolites remain detectable in the urine for longer periods. Aims: To detect the laboratory pattern of substance abuse among youths in North-Western Nigeria and to make recommendations based on the overall pattern to curtail the effect on society. Settings and Design: A retrospective cross-sectional survey of secondary data of patients who presented to a clinical laboratory for urine drug tests. Methods and Material: Trained personnel carried out a supervised collection of fresh urine samples, which were analyzed using a qualitative immunoassay technique. The presence of a drug was determined by reaching the drug's limit of detection. Statistical Analysis Used: Data were analyzed using a Statistical Package for the Social Science (SPSS) version 2 software. Results: The screen prevalence of substance abuse was 60.9%. Among those who tested positive, 97% were males, whereas 3% were females. The majority of participants were youths below 30 years of age. The observed pattern revealed a few of the participants (26.48%) had only one drug substance present in their urine, whereas 73.53% tested positive for multiple substances ranging from two to five drugs in a urine sample. Conclusion: A high prevalence of substance abuse was observed and most of the participants were multidrug users. [ABSTRACT FROM AUTHOR]

Context: Childhood diarrhea is still a major problem in developing countries, and the condition is worse in tribal areas. Aims: The study aims to assess the community perception related to diarrhea management in an aspirational district of Odisha, India. Subjects and Methods: A mixed-method study was conducted in Kandhamal, an aspirational district of Odisha, Eastern India, from June to October 2018. An in-depth interview was conducted among community health workers, and a cross-sectional survey was done for the household interview. The data were collected in a mobile-based application, Epicollect5, and in-depth interviews were recorded digitally. Statistical Analysis Used: The data were analyzed in the Statistical Package for Social Sciences (SPSS) version 22.0. Categorical variables are presented in proportions. Force-field analysis was conducted to assess the driving and restraining forces of diarrhea. Content analysis was done for the digitally recorded data. Results: Nine out of ten people were aware of the benefit of breastfeeding during diarrheal episodes in children aged under 5 years, and <50% were aware of zinc benefit. Poor sanitation, lack of safe water, poor hygiene practices, socioeconomic status, and illiteracy are the major challenges in diarrheal control in the tribal area. Conclusions: Improving the demand by creating community awareness regarding management of diarrhea, availability of essential drugs (ORS and zinc) at the community level, and capacity building of community health workers for management of diarrhea can reduce diarrhea-related morbidity and mortality in tribal areas of India. Handwashing, hygiene practices, and availability of safe water need to be promoted in the tribal region. In the long term, the socioeconomic determinants have to be addressed. [ABSTRACT FROM AUTHOR]

In the medical literature, exanthem is the name given to a widespread rash that is usually accompanied by systemic symptoms such as fever, malaise, and headache. The combination of these factors, for example, the mobility of human populations, the onset of new diseases such as COVID and the continuous availability of new drugs, make today the interpretation of the exanthems more and more difficult. In this article, we will revise briefly the conceptual problems that, during many years, have contributed to hinder its comprehension. At the end, two tables will help physicians to orientate in this field. [ABSTRACT FROM AUTHOR]

Context: Self‑medication in healthcare is becoming an increasingly important area. However, risks such as misdiagnosis, inappropriate drug dosage, extended time of use, drug interactions and polypharmacy are also associated with it. Aims: The present cross‑sectional study aims to study the prevalence of self‑medication and its associated factors among engineering students. Setting and Design: The present cross‑sectional study was conducted in an engineering college in Chennai. Materials and Methods: A total of 199 participants were studied. A pretested semi‑structured questionnaire including general information and specific questions regarding the prevalence of self‑medication and its associated factors was given to the study participants and were instructed to fill them. Statistical Analysis Used: Data were recorded and analysed in the excel spreadsheet using SPSS software version 16 and Chi‑square test was used to perform interferential statistical analysis. Results: 199 engineering students were studied, ranging from 1st year to 4th year between the age group of 17–25 years. From the data collected, 154 (77.4%) participants said they had been on self‑medications before and 45 (22.6%) participants said they have never been on self‑medication. Conclusions: From this study we come to a conclusion that the prevalence of self‑medication among the engineering students in sub‑urban Chennai is high that is 77.4%. The parameters frequently linked with self‑medication are the type of illness and the easy access to drugs. Since self‑medication is at an alarming rate, the need of the hour is to educate the youth to ensure healthy practice. [ABSTRACT FROM AUTHOR]

The inevitable surge of the accelerated approval process, especially for oncology drugs, has been a success story. However, the use of surrogate end-points and its validation has been debatable over the years. Over the years, US Food and Drug Administration has been rigorously working for the validation of these end-points to capture the real clinical benefit and appropriateness of clinical study designs. However, the high cost imposed by the manufacturer attributed to the faster drug access can be prohibitive and well undermine the whole process. We discuss issues that must be addressed and solved accordingly for managed care in oncology. [ABSTRACT FROM AUTHOR]

Introduction: Substance abuse refers to the harmful or hazardous use of any psychoactive substance including licit and illicit drugs, other than when medically indicated. According to a UN report, 1 million heroin addicts are registered in India, and unofficially, there are as many as 5 million. Among all the states Punjab stood third in substance abuse and also injectable drug use. The present study was thus conducted to assess the sociodemographic profile and pattern of substance abuse among patients attending a Drug de-addiction centre. Material and Methods: A record-based analysis from March 2015 to March 2019 was done. Substance dependence was diagnosed post detailed clinical interview by a consultant psychiatrist at the center using DSM -10. For the 966 registered patients admitted in the last four years, the record was checked for completeness of data and relevant information on socio-demographic profile, substance abused, duration of hospital stays, drop out and relapse rates was extracted. Results: Of the total admitted patients (n= 966) 100% addicts were of male gender and natives of Punjab. 514 (53.21%) were married followed by 434(44.93%) never married. Maximum patients 456(47.20%) were self-employed. Heroin was the most abused drug. The injecting route of drug abuse was used by most of the abusers i.e. 51.66%. Only 173 (17.90%) patients dropped out of the treatment followed by relapse in 192 (19.88%). Conclusion: In this paper we demonstrated the vulnerability of young population towards drug addiction. Easy accessibility of drugs, peer pressure and difficult family circumstances raises the fragility to restore for substance use. However, community-based studies are imperative in order to estimate how big is the problem at the bottom. [ABSTRACT FROM AUTHOR]

The New drugs and Clinical trials rules 2019 (New rules) was introduced on 19th March 2019 by Government of India. New rules have set specific requirements for ethics committee (EC). The EC is required to follow requirements set as per New rules and to forward their report to Central Licensing Authority (CLA). This document is divided into different sections like definitions and applicable chapter & schedules for EC; changes related to registration of clinical studies and biomedical and health research; changes related to constitution, functions, proceedings, responsibility of EC for clinical trial; maintenance of records by EC; suspension and cancellation of registration of EC, post-trial access of drugs, changes and clarity related to academic clinical trials and role of ECs in compensation and medical management process. [ABSTRACT FROM AUTHOR]

Introduction: Primary Health Centers (PHCs) are intended to be the "backbone" of the Indian public health system. Yet, these do not get utilized as frontline institutions for basic curative care. As we embark on comprehensive primary health care initiatives, it is important to understand people's perceptions on PHCs; and design services that cater to their felt needs. Aim: In this paper, we examine explanations that communities give for the use or bypass of PHCs. From these perspectives, we derive some policy directions for improving basic curative care services at PHCs. Methods: This qualitative study is based on data from 14 Focus Group Discussions in a rural area in Maharashtra in the catchment area of 8 PHCs (total 91 community participants). The discussions were coded and analyzed thematically with the aid of a qualitative software. Results: PHCs were not viewed as first-access points for health care, though these were valued for specific services. The limited use of PHCs was attributed to the lack of availability of drugs/services of perceived relevance to communities; prevalent healing norms that mismatched with PHC services; doctor-patient interactions that were colored with mistrust; and widespread poor opinions of public-sector services in health. Conclusions: Currently, there seems to be little in the design of PHC services- that appeals to the "felt" needs of communities. Thus, the proposed Health and Wellness Centers (HWC) initiative resonates with people's expectations. In addition, staff at the periphery must provide "attentive" care and be prepared to contend with pre-existing poor expectations of care. [ABSTRACT FROM AUTHOR]

Mucormycosis is a rare opportunistic, aggressive, fatal fungal infection. The fungal organisms are ubiquitous and easily affect immunocompromised patients. It is spread on inhalation, inoculation and wound contamination and is more common in diabetic and other immunocompromised individuals in a population. The clinical and radiological features of Mucormycosis can overlap with other conditions for which a thorough diagnosis should be made. The rate of recurrence in Mucormycosis cases is high. This article reports one such case in which recurrence occurred twice and was controlled only with resection. The main aim of this article is to emphasize the importance of practicing aggressive resection and also on regular follow up of the patient after surgical management. Knowledge on different diagnostic and treatment methods, availability of newer drugs and regular follow up can greatly help in the management and recurrence of Mucormycosis even in immunocompromised patients in a population where diabetes is more common and mortality of rhino cerebral form is high. [ABSTRACT FROM AUTHOR]

The second wave of COVID-19 pandemic has overwhelmed the health system across India leading to not only the loss of innumerable human lives but also exposed the various shortcomings of healthcare infrastructure. This emphasizes the need for a better preparedness of the health system across the nation to tackle the potential third wave of COVID-19 pandemic more importantly now as the cases and test positivity rate has started to show a downward trend all over India. The key areas which need to be targeted are augmenting the vaccine production and streamlining delivery mechanism, strengthening the existing pediatric emergency units and sick newborn units, expanding the oxygen production capacity in the country, ensuring the availability of drugs, strengthening of health infrastructure, logistic support and surveillance systems, expanding the free testing and diagnostic facilities, improved access to healthcare facilities, and reinforcement of COVID appropriate behavior in the community. [ABSTRACT FROM AUTHOR]

The cost of pharmaceuticals, as a percentage of total healthcare spending, has been rising worldwide. This has resulted in strained national budgets and a high proportion of people without access to essential medications. Though India has become a global hub of generic drug manufacturing, the expected benefits of cheaper drugs are not translating into savings for ordinary people. This is in part due to the rise of branded generics, which are marketed at a price point close to the innovator brands. Unbranded generic medicines are not finding their way into prescriptions due to issues of confidence and perception, though they are proven to be much cheaper and comparable in efficacy to branded medicines. The drug inventory of unbranded generic manufacturers fares reasonably when reviewed using the World Health Organization-Health Action International (WHO-HAI) tool for analysing drug availability. Also, unbranded generic medicines are much cheaper when compared to the most selling brands and they can bring down the treatment costs in primary care and family practice. We share our experience in running a community pharmacy for an urban health center in the Pathanamthitta district of Kerala State, which is run solely on generic medicines. The drug availability at the community pharmacy was 73.3% when analyzed using WHO-HAI tool and the savings for the final consumers were up to 93.1%, when compared with most-selling brand of the same formulation. [ABSTRACT FROM AUTHOR]

Targeted therapy in retinoblastoma (RB) is widely accepted as the current management tool with an aim of increasing drug availability at the tumor location. Inevitably the effect is several times higher compared to systemic delivery of chemotherapeutic drugs and carries less systemic toxicity. Despite tremendous advancement in saving life, eye salvage in advanced RB especially with active vitreous seeds remains a challenge. The hypoxic environment of the vitreous and reduced vitreous concentration of the drugs delivered makes these tumor seeds resistant to chemotherapy. Direct delivery of chemotherapeutic drugs into the vitreous cavity aids to overcome these challenges and is progressively being accepted worldwide. However, intraocular procedure in RB was abandoned due to high risk of extraocular tumor dissemination. Recently, the forbidden therapeutic technique was re-explored and modified for safe use. Although eye salvage rate has tremendously improved after intravitreal chemotherapy (IVitC), retinal toxicity, and vision salvage are yet to be validated. In our preliminary report of intravitreal melphalan in 11 eyes, we reported 100% eye salvage and 0% recurrence with an extended 15 months mean follow-up. In this review, we analyzed published reports on IVitC in RB via PubMed, Medline, and conference proceedings citation index, electronic database search, without language restriction that included case series and reports of humans and experimental animal eyes with RB receiving IVitC. [ABSTRACT FROM AUTHOR]

The article explores the uses of melatonin in humans, including its role in regulation of the circadian rhythm, various indications in anaesthesia such as hypnosis and anxiolysis, and prevention of emergence agitation and delirium. It notes the very few side effects of melatonin with virtually no serious or life-threatening complications when exogenously administered. Also noted are the high therapeutic index of melatonin, lack of life-threatening adverse effects, and ease of access.

The author reflects on the drug bioavailability and treatments for posterior ocular disease. He states that the posterior diseases including diabetic retinopathy, glaucoma, and retinitis pigmentosa causes irreversible blindness. He mentions that frequent delivery of drug from topical route to meet the therapeutic level may cause drug-related toxicities and side effects.

A response from the author of the article "Only Generics (Drugs/Names): Is India Ready?" in the 2015 issue is presented