List Of Essential Medicines Research Articles

Prescription pattern of antimicrobial agents prescribed in outpatient department of dermatology in a tertiary care hospital in India

Background: Skin diseases contribute largely to global disease burden. Antimicrobial agents are used for treatment of various skin diseases of microbial aetiology caused by fungi, bacteria, viruses and ectoparasites. The primary objective of this study was to study the prescription pattern of antimicrobial agents in dermatology, to provide insights into the disease patterns, profile of the drugs used and their rationality. Methods: Cross-sectional observational study was conducted in dermatology outpatient department of T. N. M. C. and B. Y. L. Nair Charitable Hospital, Mumbai for period of 6 months. 372 prescriptions containing an antimicrobial agent (AMA) were analysed. Demographic data, disease pattern, associated comorbidities and prescription details were recorded after taking written informed consent. Results: Fungal infections were the most common (48%) followed by bacterial infections (31%). The most encountered condition was dermatophytosis. Average number of AMA per prescription was 2.33±0.73. Percentage of AMA prescribed by generic name was 48%. Percentage of AMA prescribed from National list of essential medicines 2015 (NLEM) was 32.60%. 87.9% of AMA were prescribed as combination therapy and 12.10% were prescribed as monotherapy. The commonest prescribed drugs were antifungals followed by antibiotics. Topical creams were the commonest prescribed dosage form. Conclusions: The most common class of antimicrobial agents prescribed was antifungal agents. Prescribing combination of oral antimicrobials with topical antimicrobials was found to be high. This study provides a framework for continuous prescription audit of antimicrobials in an outpatient setting and thus can help in rational use of antimicrobials in dermatological prescribing.

H15 A treatment for leprosy developed on the edge of Europe: Vincent Barry (1908–1975)

Abstract Leprosy is the prototype of a biblical disease. Without an effective cure, it was deemed a ‘curse’ for millennia. It is an infection caused by Mycobacterium leprae and Mycobacterium lepromatosis. With an affinity for peripheral skin (due to lower temperatures), a rash is a common presenting feature. A tropism to infiltrate neural tissue causes a reduction in sensation leading to repeated injury, infection and disfigurement. Affected individuals were often shunned from society and sent to leper colonies. Treatment for leprosy only became effective in the mid-20th century. Initial treatment for leprosy was with promin and dapsone. Clofazimine and rifampicin were later added in the 1960s–70s. Treatment for leprosy consists of a multidrug therapy regime of rifampicin, dapsone and clofazimine for 6–12 months. This was first recommended by the World Health Organization (WHO) in 1981 and remains the recommended treatment. Clofazimine was developed in a laboratory in Trinity College Dublin by Vincent Barry and his scientific team. Vincent Barry was born in Cork, Ireland, and later graduated in chemistry from University College Dublin. He became associate professor of chemistry in Galway where he lectured bilingually in Irish and English and co-authored the first Irish-language textbook for chemistry (Ceimic). Barry spent time working in and observing leper colonies in both Zimbabwe and India. In 1943, he was given a fellowship by the Medical Research Council of Ireland to carry out research on the chemotherapy of tuberculosis (TB). However, as TB became more curable, he focused his attention on leprosy. His team were given laboratory space in Trinity College Dublin, and in 1957, they developed compound B663, clofazimine. Intended as an anti-TB medication, clofazimine showed more effectiveness against leprosy. The product was launched in 1969 after several clinical trials in Nigeria. In 1974, they devoted the patents of the drug to India to allow it to be produced in a more cost-effective manner. The team was not interested in fame or fortune; their goal was simply to make the drug available in the developing world. They received the Boyle Award from the Royal Dublin Society in 1969, and the UNESCO Science prize in 1980 ‘for their work on the synthesis of an anti-leprosy agent, B-633’. The achievements of Mr Barry and his team, seldom discussed, have led to millions of lives being saved. Clofazimine is part of the WHO Model list of Essential Medicines.

Registration of essential medicines in Kenya, Tanzania and Uganda: a retrospective analysis.

To audit national drug registers (NDRs) in Kenya, United Republic of Tanzania and Uganda with respect to national Essential Medicine Lists (EMLs) and to conduct an analysis of highly registered products including a sub-analysis of highly registered antimicrobial products. Retrospective analysis of registration of essential medicines and medicinal products on NDRs as of February 2018. Not applicable. None. Registration status of essential medicines by country, essential medicine status of registered products by country and medicines with more than 50 registrations across all three countries. A high proportion of essential medicines are not registered: Kenya 28% (175/632), United Republic of Tanzania 50% (400/797) and Uganda 40% (266/663). Of registered products on the NDRs, more than half are not essential: Kenya 71% (4350/6151), United Republic of Tanzania 64% (2278/3590) and Uganda 58% (2268/3896). When the three NDRs were combined, there were 42 medicines with over 50 registered products, accounting for 30% (4153/13637) of products, many of which were non-essential. Non-registration of essential medicines is a barrier to availability. Over-registration of medicines, particularly non-essential medicines, diverts regulatory resources towards registering non-priority and, sometimes, clinically sub-optimal medicines. The East African Community Medicines Registration Harmonization Project has the potential to improve access to key medicines if registration of essential medicines is prioritised and registration of non-essential medicines is restricted.

Monoclonal antibody usage pattern in a tertiary care center: A retrospective study

Abstract Background: Monoclonal antibodies (mAbs) are agents that are clones of homogenous parent B cells used in managing and diagnosing multiple conditions. They are used for individualized therapy for patients due to their high specificity for an antigen/epitope. Much needs to be understood about their utilization patterns in a developing country like India, where accessibility and cost play a major role in patient care. Objectives: The objectives of this study were to evaluate the drug prescribing patterns and indications for use of mAbs and compare their availability, with the essential drug list of the World Health Organization (WHO) and the National list of essential medicines in India (NLEM). Materials and Methods: This is a retrospective cross-sectional study conducted from July to December 2021. Data were collected from 237 patients who have visited the tertiary care center or been admitted and have received mAbs. Demographic data, department of admission, diagnosis on admission, and mAbs used during treatment were recorded and analyzed. Results: Out of the 237 patients, who were eligible for this study, 61.6% of them were males and 38.4% were females. The department of ophthalmology used mAbs most commonly (65.8%). Ranibizumab was the most used mAb in this department and overall. Conclusion: Out of the mAbs being used in the tertiary care center, only rituximab was part of the NLEM (India) essential drug list, and six more drugs were present in the WHO essential drug list. The advent of biosimilars is expected to bring costs down significantly for the patient and have better treatment outcomes.

Prostatic issues and Homoeopathic Approach

The current piece deals with the issue of non cancerous obstructive uropathy. It hampers the quality of life in males above 45 years of age. An enlarged prostate gland or Benign Prostatic Hyperplasia (BPH) is a leading cause of obstructive uropathy in men. In India, prevalence of BPH is around 50% of men by the age of 60 years. The reader will get an idea of the problem of prostatic issues at global & national level through the eyes of clinical health in the beginning sections before delving in to the Homoeopathic system of the AYUSH platform. Currently, the AYUSH platform has regained its value in the era of the current pandemic. The pandemic has further escalated the prostatic issues further. In the absence of effective therapy in the modern medicine, the article peeps through what homoeopathy can offer to deal with prostatic issues that fulfil the triad criteria of essential medicines as per the National List of Essential Medicines (NLEM). The criteria is that these medicines need to be effective clinically, safe clinically and should be without side effects.

The Budget Impact Analysis of Adopting Direct Oral Anticoagulants for Stroke Prevention in Nonvalvular Atrial Fibrillation Patients in Malawi

ObjectivesThis study aimed to estimate the budget impact of adopting direct oral anticoagulants (DOACs) for stroke prevention in patients with nonvalvular atrial fibrillation in Malawi after the inclusion of DOACs in the World Health Organization’s essential medicine list. MethodsA model was developed in Microsoft Excel. An eligible population of 201 491 was adjusted with 0.05 % incidence rate and mortality rates yearly according to the treatments. The model estimated the implication of supplementing rivaroxaban or apixaban to the standard treatment mix (also the comparator), thus warfarin and aspirin. The current market share of 43% aspirin and 57% warfarin was adjusted proportionally with 10% DOAC uptake in the first year and 5% annually over the subsequent 4 years. Clinical events of stroke and major bleeding from the ROCKET-AF and ARISTOTLE trials were used because health outcome indicators affect resource utilization. The analysis was conducted solely from the Malawi Ministry of Health perspective and it considered direct costs over 5 years. The sensitivity analysis involved varying drug costs, population, and care costs from both public and private sectors. ResultsThe research suggests that despite potential savings of $6 644 141 to $6 930 812 in stroke care because of fewer stroke events, the total Ministry of Health healthcare budget (approximately $260 400 000) may increase by between $42 488 342 to $101 633 644 in 5 years because drug acquisition costs are greater than savings. ConclusionsWith a fixed budget and current DOACs prices, Malawi can consider using DOACs in patients at the highest risk while waiting for cheaper generic versions.

Dehydration of Niclosamide Monohydrate Polymorphs: Different Mechanistic Pathways to the Same Product.

Many active pharmaceutical ingredients (APIs) can crystallize as hydrates or anhydrates, the relative stability of which depends on their internal structures as well as the external environment. Hydrates may dehydrate unexpectedly or intentionally, though the molecular-level mechanisms by which such transformations occur are difficult to predict a priori. Niclosamide is an anthelmintic drug on the World Health Organization's "List of Essential Medicines" that crystallizes in two monohydrate forms: HA and HB. Through complementary time-resolved synchrotron powder X-ray diffraction and thermogravimetric kinetic studies, we demonstrate that the two monohydrates dehydrate via distinctly different solid state pathways yet yield the same final anhydrate phase. Water loss from HA via diffusion yields an isomorphous desolvate intermediate which can rearrange to at least two different polymorphs, only one of which exhibits long-term stability. In contrast, dehydration of HB proceeds via a surface nucleation process where simultaneous water loss and product formation occur with no detectable crystalline intermediates. Comparative analysis of the two systems serves to highlight the complex relationship between lattice structure and solid state dehydration processes.

Availability of cytotoxic medicines in the WHO essential medicine list used in treating childhood malignancies in low-income and lower-middle-income countries: a systematic review protocol

IntroductionCancer is a leading cause of death globally with childhood cancers accounting for around 5% of the total incidence. Almost 90% of childhood cancers are recorded from low-income and lower-middle-income...

The National List of Essential Medicines of India 2022 (NLEM 2022): Tommy, Toe the Line.

India recently released its fifth National List of Essential Medicines 2022 (NLEM 2022). A critical analysis of the list was performed and was compared with the WHO 22nd Model List of Essential Medicines published in 2021. The Standing National Committee, since its inception, have taken four years to finalise a list. The analysis identified that all the available formulations and strengths of the selected drugs are included in the list, which must be avoided. Furthermore, the antibacterial agents are not categorised as access, watch and reserve (AWaRe) and this list is not aligned with the national programs, standard treatment guidelines and nomenclature. There are a few factual errors and some typographic errors. These problems in the list need to be rectified immediately so that the document would be able to serve the community more effectively as a true model list.

The somatic mutation profile of breast cancer in Uganda.

582 Background: Breast cancer, the most common cancer in sub-Saharan Africa (SSA), is characterized by poor survival compared with resource-rich regions. A variety of factors are responsible for this disparity and include late stage at presentation, limited diagnostic and therapeutic options, and potentially biologically more aggressive disease. The application of next generation sequencing to cancer specimens in resource-rich regions has identified new molecular mechanisms. However, such molecular testing has generally not been applied to tumors from SSA where the aggressive nature and younger age of women with breast cancer argues for the potential for novel pathogenic mechanisms. Here, we describe the somatic mutation profile of breast cancer in Uganda. Methods: We enrolled 100 consecutive women with a new diagnosis of invasive breast cancer at the Uganda Cancer Institute (UCI) in Kampala - the primary cancer center of Uganda and neighboring countries. Histopathologic classification was performed at the UCI and revaluated in a blinded fashion at the Fred Hutchinson Cancer Center (Seattle, WA). Demographic and clinical data were obtained. A biopsy specimen of the tumor tissue was obtained, snap frozen, processed using standard protocols to obtain DNA, and sequenced using the clinically-validated UW-OncoPlex assay, identifying all classes of variants and mutations. Results: We analyzed data from 100 women with a histologically-confirmed diagnosis of breast cancer between the ages of 35 and 65 - the vast majority of whom presented with either stage 3 or stage 4 (92%). All 100 tumor specimens were successfully sequenced, with, 96 (96%) demonstrating somatic mutations. The most commonly altered gene was TP53, with mutations in 65% of patients, with identified variant classes including truncations (18), missense (19), and copy loss (33). PIK3CA mutations were identified in 36% of patients, while copy gain or amplification were identified in MYC (50%), CCND1 (31%), FGFR1 (26%). EGFR (9%), and ERRB2 (24%). Nearly half of the women had either a mutation in BRCA1 (24%) or BRCA2 (24%); 6 (6%) of the tumors expressed mutations in both BRCA1 and BRCA2. Conclusions: We identified a diverse landscape of somatic mutations - the prevalence of BRCA1, BRCA2, and PIK3CA mutations are considerably higher than in other documented populations. A better understanding of the mutational profile can provide biological insights, inform prognosis, and serve as a predictive biomarker. As mutations in BRCA1/2 and PIK3CA can potentially be treated with targeted therapies (e.g. PARP inhibitor, PI3K inhibitor), such data can inform policymakers, allow for inclusion of these therapeutics in the formulary and in the WHO Model List of Essential Medicines, and reduce health disparities. Notably, all cases were successfully sequenced, with 96% of cases demonstrated somatic mutations, even without employing specific enrichment strategies commonly used in high-income countries.

Variations in global prices of chemotherapy for childhood cancer: a descriptive analysis.

The stark disparity in survival for children with cancer across the world has inspired a global call to expand chemotherapy access in low and middle income countries. Among the numerous barriers to success, a paucity of reliable information regarding chemotherapy pricing hinders the ability of governments and other key stakeholders to make informed budget decisions or negotiate lower medication prices. The aim of this study was to generate comparative price information on both individual chemotherapy agents and comprehensive treatment regimens for common childhood cancers using real-world data. Chemotherapy agents were selected based on their inclusion in the World Health Organization (WHO) Essential Medicines List for Children (EMLc) and their use in frontline regimens for the tracer cancer types prioritized by the WHO's Global Initiative for Childhood Cancer (GICC). Sources included IQVIA MIDAS data, obtained under license from IQVIA, and publicly available data from Management Sciences for Health (MSH). Data on chemotherapy prices and purchase volumes spanning 2012-2019 were aggregated according to WHO region and World Bank (WB) income classification. Cumulative chemotherapy prices for treatment regimens were compared across WB income classification. Data representing an estimated 1.1 billion doses of chemotherapy were obtained for 97 countries: 43 high income countries (HICs), 28 upper middle income countries (UMICs), and 26 low and lower middle income countries (LLMICs). Median drug prices in HICs were 0.9-20.4 times those of UMICs and 0.9-15.5 times those of LMICs. Regimen prices were generally higher for HICs, hematologic malignancies, non-adapted protocols, and higher risk stratification or stage, albeit with notable exceptions. This study represents the largest price analysis to date of chemotherapy agents used globally in childhood cancer therapy. The findings of this study form a basis for future cost-effectiveness analysis in pediatric cancer and should inform efforts of governments and stakeholders to negotiate drug prices and develop pooled purchasing strategies. NB received funding support from the American Lebanese Syrian Associated Charities and Cancer Center Support grant (CA21765) from the National Cancer Institute through the National Institutes of Health. TA received funding through the University of North Carolina Oncology K12 (K12CA120780) and the University Cancer Research Fund from the UNC Lineberger Comprehensive Cancer Center.

СТРУКТУРНЫЙ АНАЛИЗ И ОЦЕНКА РАЦИОНАЛЬНОСТИ НАЗНАЧЕНИЙ ЛЕКАРСТВЕННЫХ ПРЕПАРАТОВ В ПЕДИАТРИЧЕСКОЙ ПРАКТИКЕ

This article discusses the problems of providing drug care to children. The aim of the work was to identify the prerequisites for the creation of a Russian indicative list of medicines for children based on the assessment of rationality and structural analysis of drug prescriptions in pediatric practice. The study used the methods of content analysis, statistical analysis, graphical method. The sample consisted of 2,900 prescriptions for drugs and other pharmacy products made by doctors of various profiles to children aged 0 to 17 years. The study showed that 92% were medicines (MP), the rest - other pharmacy products (biologically active additives, cosmetics, medical products, etc.). An analysis was also carried out by the frequency of prescriptions, by dosage forms, by anatomical-therapeutic-chemical (ATC) classification and by prescriptions outside the instructions (off-label, in our study, we attributed to off-label those cases when drugs were prescribed to children aged , not officially permitted in the instructions for medical use). Nurofen for children (Ibuprofen) oral suspension was the most frequently prescribed medication in the study sample. When analyzing according to the first level of the ATC classification, the largest percentage of prescriptions fell on group R - "Respiratory system". From the sample studied by us, most often children were prescribed drugs in liquid dosage forms, namely, drops for oral administration, in off-label prescriptions, for the most part, solid dosage forms (tablets) were found. It was found that in most cases drugs were prescribed outside the instructions for children aged 1 to 3 years - 39% of all off-label prescriptions. In our opinion, to improve the pharmaceutical care provided to children, it is necessary to create a Russian indicative list of essential medicines for children, which should be periodically reviewed and republished in order to contain only relevant and reliable information.

Drug Utilization Pattern and Potentially Inappropriate Medications among Elderly Inpatients in a Tertiary Care Hospital in Western Nepal

Introduction: Drug utilization research deals with the quality of care focusing on potentially inappropriate medication (PIM), The objectives of the study were to assess the drug utilization pattern (class of drugs used, average number of drugs per prescription per encounter, number of drug prescribed in generic name and antibiotics in prescription) and potentially inappropriate medications and their categories among elderly inpatients.
 Methods: It was a prospective observational study carried out in the medical department of Western Regional Hospital, one of the tertiary level public referral hospital in Pokhara, Nepal. One hundred and two patients of both sexes, age above 65 years and who were hospitalized in medical department were selected. The patients were followed until their discharge to obtain complete information about the drugs being used. Patient data collection form and Updated 2012 Beers Criteria were used to assess drug utilization patterns and determine PIM respectively.
 Results: Most of the patients were in the age group of 65-70 (37.25%) followed by 71-75 (27.45%) and 76-80 (18.62%). Out of 102 patients, 53 (51.97%) were male and 49 (48.03 %) were female. Antimicrobials were the most prescribed medicines (16.73%). Average number of drugs per prescription per encounters, number of drug prescribed in generic name and number of antibiotics in prescription were 7.26, 9.6% and 21% respectively. About 57% of medicines were prescribed from the national essential medicine list. Among them, 20 (3.91%) of all drugs had at least one PIM. There were 27 drugs in Beers criteria A, one drug in Beers criteria B, and no drug in Beers criteria C.
 Conclusion: Antibiotic prescription was found within the optimal values whereas values of other prescribing indicators were out of the optimal values in comparing earlier studies. PIM was observed in prescriptions that suggest irrational practice and the need for interventions.

Structure and mutation of deoxypodophyllotoxin synthase (DPS) from Podophyllum hexandrum

Deoxypodophyllotoxin synthase (DPS) is a 2-oxoglutarate (2-OG) dependent non-heme iron (II) dioxygenase that catalyzes the stereoselective ring-closing carbon-carbon bond formation of deoxypodophyllotoxin from the aryllignan (−)-yatein. Deoxypodophyllotoxin is a precursor of topoisomerase II inhibitors, which are on the World Health Organization’s list of essential medicines. Previous work has shown that DPS can accept a range of substrates, indicating it has potential in biocatalytic processes for the formation of diverse polycyclic aryllignans. Recent X-ray structures of the enzyme reveal possible roles for amino acid side chains in substrate recognition and mechanism, although a mutational analysis of DPS was not performed. Here, we present a structure of DPS at an improved resolution of 1.41 Å, in complex with the buffer molecule, Tris, coordinated to the active site iron atom. The structure has informed a mutational analysis of DPS, which suggests a role for a D224-K187 salt bridge in maintaining substrate interactions and a catalytic role for H165, perhaps as the base for the proton abstraction at the final rearomatization step. This work improves our understanding of specific residues’ contributions to the DPS mechanism and can inform future engineering of the enzyme mechanism and substrate scope for the development of a versatile biocatalyst.

An Assessment of the Availability of Essential Medicines in Gadag Taluk, Karnataka: A Study of Primary Health Centers.

Background Essential medicines are those that meet the priority healthcare needs of most of the population and are included in the 2030 Agenda for Sustainable Development. The national list of essential medicines should be tailored to the specific needs of each nation and should always be accessible at reasonable prices and with guaranteed quality. Methods A cross-sectional study was done to assess the availability of essential medicines in primary health centers (PHCs) in Gadag Taluk. The data for the assessment of availability was collected using a checklist, which was prepared after reviewing the Karnataka list of essential medicines, surgical items, and miscellaneous items from 2021 to 2022 for PHCs. The sampling design was a universal sample of all 15 PHCs, as per health management information system data, to assess the availability of essential medicine in PHCs. Results Results indicate that theavailability of essential medicines in 15 PHCs in Gadag Taluk is 74.20%. The availability of anti-allergic drugs and drugs used in anaphylaxis was around 88%, whereas the availability of antidiabetic drugs and non-steroidal anti-inflammatory drugs was 86.88% and 86.66%, respectively. All other categories of drugs are available above 50%, except ophthalmic and ear, nose, and throat drugs. Conclusion The public sector should be strengthened by making sure that patients have access to free essential medicines and that essential medications are always available. This would help patients spend less money out of their own pockets and move India closer to achieving universal healthcare.

The knock-on effects of COVID-19 pandemic on the supply and availability of generic medicines in Ethiopia: mixed methods study

BackgroundCOVID-19 pandemic posed a major impact on the availability and affordability of essential medicines. This study aimed to assess the knock-on effects of the COVID-19 pandemic on the supply availability of non-communicable chronic disease (NCD) medicines and paracetamol products in Ethiopia.MethodsA mixed methods study was conducted to assess the supply and availability of twenty-four NCD drugs and four paracetamol products listed on the national essential medicines list for hospitals. Data were collected from twenty-six hospitals located in seven zones of Oromia region in the southwestern part of Ethiopia. We extracted data on drug availability, cost and stock out for these drugs between May 2019 and December 2020. The quantitative data were entered into Microsoft Excel and exported to statistical package software for social science (SPSS) version 22 (IBM Corporation, Armonk, NY, USA) software for analysis.ResultsThe overall mean availability of selected basket medicines was 63.4% (range 16.7% to 80.3%) during the pre-COVID-19 time. It was 46.3% (range 2.8% to 88.7) during the pandemic. There was a relative increase in the availability of two paracetamol products [paracetamol 500 mg tablet (67.5% versus 88.7%) and suppository (74.5% versus 88%)] during the pandemic. The average monthly orders fill rates for the selected products range from 43 to 85%. Pre-COVID-19, the average order fill rate was greater or equal to 70%. However, immediately after the COVID-19 case notification, the percentage of order(s) filled correctly in items and quantities began decreasing. Political instability, shortage of trained human resources, currency inflation, and limited drug financing were considered as the major challenges to medicine supply.ConclusionThe overall stock out situation in the study area has worsened during COVID-19 compared to pre-COVID-19 time. None of the surveyed chronic disease basket medicines met the ideal availability benchmark of 80% in health facilities. However, availability of paracetamol 500 mg tablet surprisingly improved during the pandemic. A range of policy frameworks and options targeting inevitable outbreaks should exist to enable governments to ensure that medicines for chronic diseases are consistently available and affordable.

Chapter 12a: TBE-epidemiology by country – an overview

TBE is a flavivirus infection of the central nervous system (CNS), transmitted by ticks and in some instances by ingestion of unpasteurized milk. It is diagnosed in the forested belts of Northern Eurasia ranging from the UK, eastern France, The Netherlands and Norway down to Italy through central and Eastern Europe, Russia, Kazakhstan, and China to Japan. About 10,000 cases of TBE are reported annually, likely a significant underestimate as serological testing is more sporadic than complete and, in some countries, (like Japan) not even available. The European Centre for Disease Prevention and Control (ECDC) have put TBE on their list of notifiable diseases. Their case definition requires clinical symptoms of CNS infection plus virological or serological confirmation of the infection, usually by detection of specific immunoglobulins IgG and IgM. Vaccination against TBE is on the World Health Organization’s List of Essential Medicines. the safest and most effective medicines needed in a health system. Surveillance of TBE and the TBEV is incomplete. Reported incidences do not reflect actual risk since this fluctuates annually as a result of changes in exposure, vaccine uptake, intensity of case finding and reporting, climate factors, reservoir animals and ticks – just to mention the most relevant factors. For largely unknown reasons (including human behavior, improved diagnostics, or climate change) TBEV appears to be spreading north, east, west, even south and to higher altitudes to areas that were previously believed to be free of the virus.

The impact of China's zero markup drug policy on drug costs for managing Parkinson's disease and its complications: an interrupted time series analysis.

In April 2009, the Chinese government launched Zero Markup Drug Policy (ZMDP) to adjust medical institutions' revenue and expenditure structures. This study evaluated the impact of implementing ZMDP (as an intervention) on the drug costs for managing Parkinson's disease (PD) and its complications from the healthcare providers' perspective. The drug costs for managing PD and its complications per outpatient visit or inpatient stay were estimated using electronic health data from a tertiary hospital in China from January 2016 to August 2018. An interrupted time series analysis was conducted to evaluate the immediate change following the intervention (step change, β1) and the change in slope, comparing post-intervention with the pre-intervention period (trend change, β2). Subgroup analyses were conducted in outpatients within the strata of age, patients with or without health insurance, and whether drugs were listed in the national Essential Medicine List (EML). Overall, 18,158 outpatient visits and 366 inpatient stays were included. Outpatient (β1 = -201.7, 95%CI: -285.4, -117.9) and inpatient (β1 = -372.1, 95% CI: -643.6, -100.6) drug costs for managing PD significantly decreased when implementing ZMDP. However, for outpatients without health insurance, the trend change in drug costs for managing PD (β2 = 16.8, 95% CI: 8.0, 25.6) or PD complications (β2 = 12.6, 95% CI: 5.5, 19.7) significantly increased. Trend changes in outpatient drug costs for managing PD differed when stratifying drugs listed in EML (β2 = -1.4, 95% CI: -2.6, -0.2) or not (β2 = 6.3, 95%CI: 2.0, 10.7). Trend changes of outpatient drug costs for managing PD complications significantly increased in drugs listed in EML (β2 = 14.7, 95% CI 9.2, 20.3), patients without health insurance (β2 = 12.6, 95% CI 5.5, 19.7), and age under 65 (β2 = 24.3, 95% CI 17.3, 31.4). Drug costs for managing PD and its complications significantly decreased when implementing ZMDP. However, the trend in drug costs increased significantly in several subgroups, which may offset the decrease at the implementation.

PRESCRIPTION PATTERN OF ANTIEPILEPTIC DRUGS IN CHILDREN WITH EPILEPSY: A CROSS-SECTIONAL STUDY

Objective: To evaluate the pattern of prescription of antiepileptic drugs (AED) in children with epilepsy attending a tertiary care hospital in North India. Methods: An observational cross-sectional study was conducted for a duration of 1 year. Data on demographic variables including age, gender, type of epilepsy, and prescription of all AEDs and their different combinations were collected from the patients of epilepsy coming to the Department of Pediatrics, Rajindra Hospital attached to Government Medical College, Patiala, Punjab, India and analyzed using WHO core prescription indicators. Results: Out of 100 prescriptions analyzed, 55% of patients were males and 45% were females. The mean age of patients was 8.65 years (±3.80). Generalized epilepsy (78%) was the most commonly diagnosed epilepsy. 92% of patients were prescribed monotherapy, while polytherapy was used in 8% of patients. Valproate was the most common drug used in monotherapy (44.56%), followed by phenytoin (21.74%) and phenobarbitone (15.22%). In polytherapy, the most common combination used was valproate with clobazam (62.5%). 96.6% of prescriptions were based on the National List of Essential Medicines (NLEM), 2022. Conclusion: Monotherapy was the preferred modality of treatment in our hospital. Conventional drugs were favored in monotherapy, while benzodiazepines and newer drugs were more commonly used as an add-on drugs in polytherapy. Valproate was the most commonly used AED in monotherapy as well as polytherapy.

Drug shortages in China: a cross-sectional study

BackgroundDrug shortages significantly threaten public health and medical service provision worldwide. Research evidence on the complete picture of drug shortages is currently scant in China. This study aimed to provide a descriptive overview and a reference for alleviating of drug shortages in China.MethodsNational and provincial lists of drug shortages issued in China from 2018 to 2021 were collected and summarized. The information on essential medicines, medical insurance drugs, emergency drugs, and volume-based purchasing drugs was then matched with a drug shortage list to analyse the characteristics, proportion and incidence of drug shortage on each list based on the analysis of information such as dosage form, shortage frequency, and Anatomical Therapeutic Chemical (ATC) classification of the drugs in shortage.ResultsA total of 24 provinces issued drug shortages lists involving 408 drugs from 2018 to 2021. All 58 drugs in the national drug list were included on the provincial drug shortage list. Among all the drugs in shortage, the most significant shortage involved injections, accounting for 45.3% (185/408). Ninety-five drugs (23.3%) were in shortage 5 times (annual shortage > 1 time) or more in the provincial lists, and 199 drugs (48.8%) were on the shortage list only once. In terms of therapeutic property, nearly all categories of drugs had been reported in shortage, among which cardiovascular drugs, nervous system drugs, anti-tumor and immunomodulatory drugs, and blood and hematopoietic organ drugs accounted for more than 10%. There is no significant difference in drug shortage among economic regions. Comparing drugs in shortage and various lists, 81.9% (334/408), 51.0% (208/408) and 67.9% (277/408) fell on the National Medical Insurance Drug List, National Essential Medicines List, and WHO Model List of Essential Medicines, respectively, while the volume-based purchasing drugs accounted for 3.4% (14 drugs). The incidence of drug shortages on NEML, WHO Model List of Essential Medicines and medical insurance category A was significantly higher than that of medical insurance category B and volume-based purchasing drugs (P < 0.05). Of the Emergency Drugs List, 72.0% (36/50) also experienced shortages, significantly higher than all the above categories (P < 0.05).ConclusionsIn China, drug shortages were severe and complicated. Drug shortages vary among economic regions but are not significant. In comparison, the national procurement pattern of volume-based drug purchasing may be conducive to alleviating the drug shortage problem. Collaboration of all partners was recommended to ensure the supply of clinically necessary drugs.