Free Medication Research Articles

Implementing a pilot primary care program: Armenia’s steps toward universal health coverage

Abstract Problem Armenia has struggled to transform its ineffective primary healthcare (PHC) system into one that can address the non-communicable disease burden, which causes 93% of mortality. To address this issue, Armenia aims to establish universal health coverage and invest in high-quality primary care. Description In 2023, the Armenian Ministry of Health signed a multisectoral policy to implement a pilot primary care program to trial a multitude of reforms related to diabetes (DM) and hypertension (HTN). Pilot interventions include pathways for screening/diagnosis, provider training, free medications and diagnostics, and new provider financial incentives. The key question to be answered is if these pilot interventions cause DM and HTN health outcomes to improve. Beginning in 2024, the program is being piloted in a primary care clinic in Dsegh. Results As a result of the 2023 Ministerial policy, multisectoral stakeholders designed and implemented this pilot program. Baseline focus groups found that the pilot addresses the financial barriers that community members noted lead to delays in seeking care and that providers perceive the pilot to be beneficial to their patients. Although final results are not yet available, the pilot has already positively changed features in the national EMR and brought together stakeholders in a way never done before. Lessons The pilot’s innovation comes from it being the first time that hypertension and cholesterol medications are provided by the government for free, provider bonuses are based on outcome indicators, indicator targets are set this high, a point-of-care A1c machine is utilized, and a robust monitoring and evaluation (M&E) plan is implemented, all of which are currently shaping discussions on national policy. For countries similarly working on strengthening primary care, it is recommended to pilot specific reforms and establish mechanisms through M&E systems that allow pilots to inform evidence-based decision making. Key messages • To move towards universal health coverage, pilot programs designed with multi-sectoral stakeholders are needed to trial suggested healthcare reforms. • It is essential to invest in monitoring and evaluations systems to generate the data necessary to develop evidence-based policies.

Accessibility to Health Care Services and Treatment for People with Noncommunicable Diseases in Northwest Syria.

We assessed the accessibility to health care services and treatment for people with noncommunicable diseases (NCDs) in Northwest Syria after more than eleven years of the worst humanitarian crisis in Syria. Included in this cross-sectional study were people with one or more of cardiovascular diseases, diabetes, cancer, or chronic obstructive pulmonary diseases; people from both Aleppo and Idleb governorates; and residents from both inside and outside the camp. Data were collected in November 2022 via face-to-face interviews. The findings were obtained from 674 respondents (52.8% female). Respondents in Idleb were 6.5 times more likely to access health care services than Aleppo (p = 0000). In-camp residents were 1.5 times more likely to access outreach health services (p = 0.020). Respondents with higher income were three times more likely to access health care services compared to respondents with lower income (p = 0.000). Having any of the surveyed NCDs made the respondents less likely to get the required services. The study findings added more evidence about the inequity in terms of accessing health care services in Northwest Syria and identified the barriers. It was clear that a perceived group of people with NCDs do not have access to the health care services, including outreach health services and free medications.

Microfluidic aerosol-assisted synthesis of gefitinib anticancer drug nanocarrier based on chitosan natural polymer

An aerosol-assisted approach was devised to synthesize gefitinib anticancer drug-loaded chitosan nanocarriers (GefNCs). The nanocarrier synthesis involves mixing and interacting gefitinib molecules with chitosan natural polymer within a microfluidic chip. The combination was nebulized with an on-chip integrated micropneumatic nebulizer with N2 as the nebulizer gas. The aerosol was collected in a beaker containing a glutaraldehyde cross-linking agent while magnetically stirring. The chip was created by CO2 laser engraving on polymethyl methacrylate sheets. The synthesized GefNCs were characterized using FTIR, DLS, FESEM, and TEM. The FESEM images revealed a nanoparticle size distribution of 18.5 ± 4.6 nm. After adjusting numerous experimental parameters such as chip design, polymer concentration, solution flow rate, and nebulizer gas flow rate, the synthesized nanocarrier's release mechanism was investigated using various kinetic models. The results demonstrated that the release behavior of GefNCs is pH-sensitive and greater at acidic pH values than physiological pH, making the synthesized nanocarrier a potential for targeted gefitinib delivery to cancer cells. Furthermore, the kinetic studies revealed that the drug's release mechanism best matches Fick's diffusion rule. Under optimal conditions, the encapsulation efficiency was 77.8 %. The cytotoxicity of the produced nanocarrier was investigated on the A549 non-small cell lung carcinoma. The MTT test revealed that the produced nanocarrier had a lower IC50 than the free medication. Furthermore, cytotoxicity experiments on empty nanocarriers revealed that the materials utilized to synthesize nanocarriers have no appreciable cytotoxicity. The developed microfluidic-assisted approach provides a quicker synthesis procedure with a high encapsulation efficiency.

Incidence of Diabetes Mellitus in the Kyrgyz Republic and the World. Factors Influencing Its Course

In recent years, large-scale studies based on data from administrative databases have reported changes in diabetes incidence over time. Different countries show various trends: stable incidence, decreases, and increases. High-income countries have seen a decline in diabetes incidence, possibly linked to changes in diagnosis and screening practices. The number of children and adolescents with diabetes, particularly type 2, is increasing, significantly impacting society. Diabetes is a cause of premature mortality and disability, negatively affecting the economy. In the USA, premature mortality is estimated to cost 19.9 billion dollars annually. In Kyrgyzstan, the burden of non-communicable diseases, including type 2 diabetes, is growing. Measures to combat diabetes in the country include free provision of insulin and medications, the approval of clinical guidelines and protocols, and the implementation of national prevention and control programs. The State Guarantee Program ensures free medication assistance for diabetes patients. Despite these efforts, issues with funding and resource efficiency remain. Improving the quality of medical care, intersectoral cooperation, and increasing accountability for public health are necessary. Enhancing the quality of pharmaceutical care and the efficient use of public funds are also priorities for improving the diabetes situation in Kyrgyzstan. Early diagnosis and treatment of diabetes complications, as well as the implementation of new prevention strategies, are crucial for reducing incidence and improving the quality of life for patients.

Barriers to access to cancer care for patients from the conflict-affected region of the Nagorno-Karabakh Republic: A qualitative study.

Access to essential health services is a basic human right, yet many cancer patients living in conflict-affected regions face multiple obstacles to service use. The (former) Nagorno-Karabakh Republic was a conflict-affected region in the South Caucasus populated predominantly by ethnic Armenians. Multiple acute armed conflicts, the recent military occupation of the region, and the prolonged military blockade of the Lachin Corridor (a humanitarian corridor connecting Nagorno-Karabakh to Armenia) exacerbated existing social, health, economic, and political fragilities in this region. As a result, cancer services were disrupted, with limited clarity on how the ongoing military blockade of a humanitarian corridor affected cancer patients' experiences of accessing cancer care locally and in bordering Armenia. Our study aimed to describe the experiences of patients from Nagorno-Karabakh in accessing the cancer care services they needed. We conducted remote semi-structured interviews with adult (aged ≥18 years) cancer patients receiving cancer care from three university hospitals in Armenia and face-to-face interviews with cancer care professionals from these hospitals. Interviews were conducted during the blockade of the Lachin Corridor between March and May 2023. Data were analysed thematically using a deductive approach. Twelve adult cancer patients (9 women) and 12 cancer care professionals participated. A key barrier to accessing cancer services was attributed to the Azerbaijani military occupation of the region and the blockade of a major roadway connecting Nagorno-Karabakh to Armenia. Patients talked in length about the challenges of finding transport and travelling long distances to reach essential cancer services in Armenia. Policies of free anti-cancer medication provision and decentralised medication supply were paused because of the military occupation, affecting patients' timely access to anti-cancer medication. Out-of-pocket expenses for treatment, anti-cancer medication, travel, and temporary accommodation in Armenia placed a significant financial burden on cancer patients, exacerbated by the humanitarian crisis. Conflict-affected regions blockaded by military forces lack the capacity and targeted support to sustain their essential health services and provide care to those in need of life-saving treatments. Coordinated action from national and international organisations and governments is urgently needed to enhance humanitarian assistance and healthcare support to patients, their families and wider communities affected by military blockades and armed conflicts.

Socio-Demographic and Health Profile of Scheduled Tribes of Six Integrated Tribal Development Agency Spots in Kurnool District

Introduction: A tribe is a self-contained, homogeneous group that exists independently of any hierarchical system. According to the 2011 census, 10.42 crore Indians are identified as ‘Scheduled Tribes’, comprising 8.6% of the country’s total population and 11.3% of the rural population. Tribal habitations are scattered across vast areas with limited access to basic health necessities, rendering them vulnerable to various health hazards. This article focuses on demographic profiles such as age, gender, caste, religion, marital status, educational status, occupation, dietary habits, and addiction, enabling an assessment of the socio-economic and health status of tribal groups in the specified area. Objectives: The main objectives of the study were to conduct a socio-demographic survey, promote knowledge on disease prevention, and provide healthcare and free medication facilities through Unani medicine via mobile medical camps. Methodology: The study was conducted in six Integrated Tribal Development Agency (ITDA) spots inhabited by the Sugali or Lambada tribe of Kurnool District, Andhra Pradesh, characterized by low socio-economic status. Data was collected through door-to-door surveys and a pre-designed questionnaire provided by CCRUM. Results: A total of 3755 individuals were screened, of which 450 were selected for data collection. Among the 450 individuals, the majority were males (253 i.e., 56.22%) belonging to the Hindu religion, with 98.44% being Scheduled Tribes. Educational status was average, with 63.33% being illiterate. More than half of the individuals (51.55%) were married, and the majority (52.66%) were agricultural laborers, with almost all being non-vegetarians. Additionally, 26% of individuals were addicted to smoking. Conclusion: Common challenges faced by the Sugali tribes of Kurnool district include lack of resources, industrialization, and socio-economic factors such as illiteracy. These factors contribute to poverty, malnutrition, and various physical and psychological disorders among tribal communities.

#347 Long-term effectiveness of a village doctor-led multifaceted strategy on blood pressure control: a cluster randomized trial

Abstract Background and Aims We tested the effectiveness of a village doctor-led multifaceted strategy on blood pressure (BP) control over 36 months among patients with hypertension in rural China. Village doctors are community health workers who provide basic primary health care in rural China. Method 326 villages were randomly assigned to the village doctor-led intervention or usual care. Individuals aged ≥40 years with an untreated mean BP ≥140/90 mmHg (≥130/80 mmHg in individuals with clinical cardiovascular disease) or treated BP ≥130/80 mmHg were recruited. The trained village doctors initiated and titrated antihypertensive medications according to a simple stepped-care protocol with supervision from primary care physicians. They also delivered discounted and free medications to patients and conducted health coaching on lifestyle change, medication adherence, and home BP monitoring. Intention to treat analysis was conducted. Results At baseline, mean age (62.8 vs. 63.2 years), percentage of women (60.9% vs. 61.6%), mean systolic BP (157.0 vs. 155.5 mmHg), and diastolic BP (88.1 vs. 87.3 mmHg) were comparable between intervention and control groups. At 36 months, 72.5% patients in the intervention group and 11.7% patients in the control group had a BP of less than 130/80 mmHg, with a group difference of 60.8% (95% CI 59.4 to 62.2%; p<0.0001). Mean systolic BP decreased by –30.8 mmHg (95% CI –31.7 to –29.9) from baseline to 36 months in the intervention group and by –7.6 mmHg (–8.5 to –6.8) in the control group, with a group difference of –23.1 mmHg (95% CI –24.4 to –21.9 mmHg; p<0.0001). Mean diastolic BP decreased by –14.8 mmHg (–15.3 to –14.3) from baseline to 36 months in the intervention group and by –4.9 mmHg (–5.3 to –4.4) in the control group, with a group difference of –9.9 mmHg (–10.6 to –9.3 mmHg; p<0.0001). No treatment-related serious adverse events were reported in either group. Conclusion In rural China, the village doctor-led multifaceted strategy significantly reduced BP over 36 months in patients with hypertension. This proven-effective and sustainable implementation strategy could be scaled up throughout rural China and in other low- and middle-income countries for hypertension control.

Opinion of medical and pharmaceutical professionals on the quality of pharmaceutical care for patients with diabetes mellitus in the Novosibirsk region: a comparative sociological study

Relevance. Patients with diabetes mellitus (DM) in the Russian Federation have the right to receive free medications. Despite this, some patients with DM experiencing difficulties at various stages of preferential treatment are forced to purchase medications at their own expense. Medical workers (MW) who receive patients and pharmaceutical workers (PW) of preferential dispensing points (PDP), who dispense drugs on preferential terms and provide pharmaceutical information (PI) to patients, are of considerable interest as competent sources of opinion about the quality of the organization of drug provision.Objective. To conduct a comparative sociological study of the organization of PDP for patients with DM in the Novosibirsk region (NSR) using the method of questioning MW and PW.Materials and methods. The materials used were the MW and PW questionnaires developed by the authors. During the study, the following methods were used: sociological survey (questioning), content analysis, comparative analysis, induction, and logical method.Results and discussion. 71% of MW must deal with various difficulties when issuing preferential prescriptions for drugs. These include: absence of drugs in the preferential list (29%), funding limit (29%), and absence of drugs in the PDP (35%). An average level of compliance in taking medications by patients with DM according to the MW was revealed, with a low interest in PI according to PDP workers. 45% of PW experience difficulties when conducting PI of patients with DM. The majority of PW (88%) consider the range of PDP in which they work to be rich in international nonproprietary names, trade names, and release forms of both oral hypoglycemic drugs and insulins.Conclusions. The results obtained allow us to conclude that the drug provision system for patients with DM in the NSR needs to be optimized. Based on the results of the survey, the main directions of optimization can be identified: increasing the availability of drugs in the PDP and increasing the competence of the PDP’s PW through the development of additional training materials and activities.

Development of a Medication Refill System - A Collaboration Between Telemedicine and Pharmacy Departments

Background: The Saturday Clinic for the Uninsured (SCU) has an on-site dispensary that provides free medications to patients. Many patients request urgent refills when they run out leaving them without medications prior to their appointments. A prior study showed a reminder phone call can effectively assist with medication refills.1 However, little data exists for how to develop such a system at a free clinic. Our team implemented this methodology utilizing a system where patients were contacted before their medications ran out to arrange refills and analyzed its effectiveness. Methods: All clinic patients receiving medications from the on-site dispensary had their expected refill date logged. Patients 3 weeks away from needing a refill had their chart reviewed to determine if they should be contacted. When indicated, patients were contacted one time via telephone by students to assess their needs and schedule refills. System outcomes were gathered over 18 weeks and analyzed to determine the number of potential medication gaps prevented and system success rate. Results: 131 patient charts were reviewed for potential follow-up. 58 patients were contacted, of which 32 patients were reached and spoken with resulting in 32 refills scheduled. The system prevented 24.4% of potential medication gaps with a system success rate of 55.2%. Conclusion: This system successfully reduced medication gaps among patients. The most and least effective methods for scheduling refills were by directly speaking with patients and leaving voicemails respectively. A trend observed was a decrease in urgent patient calls regarding medication gaps. Future directions include making multiple contact attempts, using multiple contact methods including texts and emails, and evaluating adherence.

Community as a classroom: Perception of an Indian medical graduate on family adoption program

BackgroundThe Family Adoption Program is recommended by the National Medical Commission (Undergraduate Medical Education Board) of India under Competency-Based Medical Education under the MBBS curriculum. It begins from their 1st Professional Year and continues till their 3rd Professional Year as a part of the curriculum of Community Medicine. The program aims to provide experimental learning opportunity to Indian Medical Graduate towards community-based health care and the program is expected to improve the communication skills of the students which helps in their professional growth, learning to be humane and empathize with the family they adopted. ObjectiveTo know the perception of an Indian Medical Graduate on the Family Adoption Program. MethodologyA Google form was shared among the students to fill upon consent. All the students who have adopted at least one family during their professional course were included. ResultsMore than 97 % of the students have explained the purpose of the visit to the family. Nearly 90 % of the families were co-operative. One of the students quoted the reason for noncooperation as “according to the locals, after collection of information by the students, no action was taken by the concerned authorities to curb the health issues of the families such as free medication or consultation” while other student said, “Language barrier and trust”. More than 25 % of the students stated that one of the primary reasons as an obstacle to collect complete data was families lack of interest. The majority feel empathetic towards the family.

A prospective study on direct out-of-pocket expenses of hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease in a Philippine tertiary care center

Chronic obstructive pulmonary disease (COPD) is a frequent cause of morbidity and mortality in the Philippines and majority of the economic burden lies in hospitalizations during an exacerbation. Despite coverage of hospitalization cost with the national health insurance system (Phil-Health) for COPD exacerbations, patients often pay out-of-pocket. This study aimed to determine the demographic characteristics of COPD admissions at a Philippine tertiary care center, Philippine General Hospital, and assess mean cost of hospitalization, and identify predictors of prolonged hospitalization and cost > 20,000 Philippine pesos (Php). A prospective cross-sectional study was conducted for 6 months by chart review. Patients were categorized as charity service patients, that is, with no charged professional fees and free medications and private service patients who pay for their health care services. A total of 43 COPD admissions were included. The average daily cost of hospitalization (at peso-dollar rate of 56) for service patients was at $ 75.89 compared to private service patients at $ 285.71. Demographic characteristics and type of accommodation were not significant predictors of prolonged hospital stay nor hospitalization cost of ≥ $ 357. Accommodation cost and professional fees accounted for majority or 61.6% of the overall cost for private patients, while medications and diagnostic tests were the major or 76.01% contributor to the overall cost for charity patients. Despite existence of Phil-health, in-patient coverage for COPD remain insufficient. Measures for maximizing COPD control in the out-patient setting could potentially reduce total cost for this disease.

Impact of Insurance Status on Clinical Management and Outcomes of Patients with ST-Segment Elevation Myocardial Infarction: Findings from the Kuwait Catheterization Laboratory Project Registry

Background: Emerging evidence from various countries suggests that ST-segment elevation myocardial infarction (STEMI) patients with differing health-care insurance types experience discrepancies in clinical management and outcomes. Kuwait government provides free essential treatments and medications to noninsured patients with certain emergency conditions. We aimed to compare differences in clinical management and in-hospital and 30-day outcomes in STEMI patients with different insurance types in Kuwait. Methods: Data were derived from Kuwait Catheterization Laboratory Project (Kuwait CLAP) registry. Adult patients (≥18 years) diagnosed with STEMI were enrolled in Kuwait CLAP registry between February 2020 and February 2021. Patients were categorized into insured and noninsured. The coprimary outcomes were the in-hospital and 30-day mortality in insured versus noninsured patients with STEMI. In-hospital and 30-day adverse cardiac outcomes were also compared. Results: Of 668 patients with STEMI, 116 (17%) were insured and 552 (83%) were not insured. Three (2.6%) of the insured and 9 (1.6%) of the noninsured patients suffered in-hospital mortality, while no patients in the insured group and four patients (0.7%) patients in the noninsured group suffered 30-day mortality, with no significant difference between the two groups (P = 0.447 and P = 1, respectively). The rates of in-hospital complications and 30-day adverse events were similar between the two groups. Conclusions: Our findings suggest no differences in acute or short-term outcomes among patients with different insurance status in Kuwait. These findings are reassuring knowing that the free essential services provided by Kuwait government for STEMI patients did not compromise the outcomes of noninsured compared to insured patients.

The burden of HCV among prevalent hemodialysis patients after the National Egyptian HCV Eradication program

In the first phase of its treatment program, Egypt aimed to treat 250,000 people annually until 2020, thereby reducing the number of viremic patients and limiting hepatitis C virus (HCV) transmission. Egypt strives to eradicate HCV and HCV-associated morbidity by 2030. This study aimed to determine the prevalence of HCV infection among end-stage renal disease patients and the reasons for non-treatment among those offered free medication. This multi-center cross-sectional study was conducted during the period from November 2022 to April 2023. The study included 500 patients receiving hemodialysis (HD) sessions on a regular basis for more than three months in Dakahlia Governorate. According to patients` medical history, we found that 23.4% of patients had previous HCV infection. Of these, 12.6% received treatment, and 10.8% did not receive treatment due to a variety of reasons. For instance, some patients were unaware of the drug’s availability, five patients (1%) feared side effects, 43 patients (8.6%) did not require treatment, and five patients (1%) had other causes as contraindications of drugs, noncompliance and deterioration of health status. In addition, 20.4% of patients were reported to have fully recovered, while 0.8% had a recurrence. After investigations, 1% of patients had positive hepatitis B surface antigen (HbsAg), 23.4% positive HCV Ab, and 4.2% positive HCV by the polymerase chain reaction. In conclusion, the low prevalence of HCV among HD patients confirms that HCV infection is not currently a significant health concern among patients on maintenance HD.

Insights of Healthcare Workers and Community Members on Mental Health Perception and Practices in Meru County, Kenya

Mental health is a neglected field in many low and middle-income countries, such as Kenya, where information on the prevalence of mental health conditions is scarce. This problem is aggravated by an uneven distribution of mental health service providers and widespread ignorance and stigma around mental illness in the general population. The study in Meru County, Kenya, aimed to assess the knowledge, attitudes, and practices of healthcare workers and community members regarding mental health. The study, a descriptive cross-sectional survey, involved 535 community members and 109 healthcare workers, employing both qualitative and quantitative methods. Data was collected through household surveys, key informant interviews, and focus group discussions and analysed using univariate frequencies, descriptive statistics, and thematic analysis. The study revealed that 39% of community members had a family member with a mental health condition, while 68% of HCWs had been diagnosed with such conditions. Mental illness was often attributed to supernatural causes, genetics, substance abuse, and socio-economic pressures. A significant gap was found in the availability of counselling services in health facilities, with only 29.4% of HCWs reporting their presence. The perception of the affordability and accessibility of mental health services varied greatly between HCWs and community members. Additionally, while HCWs reported the availability of free medication, community members experienced shortages. The study also noted differing attitudes towards patients with mental illness in terms of respect and dignity and highlighted the use of traditional healers and religious leaders for mental health issues. This study contributes valuable insights into the state of mental health in Kenya, highlighting the high burden of mental illness, limited availability of services, and prevalent myths and misconceptions. It underscores the need for improved healthcare worker training, public awareness, and stronger health systems to address mental health issues effectively in Kenya and similar rural environments

Mapping the Therapeutic Options for Multiple Sclerosis in Brazil: A Comprehensive Analysis

Multiple sclerosis is an autoimmune disease that affects the central nervous system. In Brazil, there are currently several therapeutic options for the treatment of this condition, with some being distributed free of charge, while others are not included in the list of free medications. The objective of this article is to provide a pharmacoepidemiological analysis of the available medications in the country, covering their mechanisms of action, the historical context of approval and free distribution within the healthcare system, and their geographical distribution of application. Additionally, we discuss the impact of the inclusion of these medications on hospitalization and mortality rates in the country. We hope that this work serves as a resource for healthcare professionals to better understand pharmacoepidemiology and for health policymakers seeking data for the planning of public policies aimed at the treatment of multiple sclerosis.

Non-communicable disease care in Sierra Leone: a mixed-methods study of the drivers and barriers to retention in care for hypertension

ObjectiveTo retrospectively analyse routinely collected data on the drivers and barriers to retention in chronic care for patients with hypertension in the Kono District of Sierra Leone.DesignConvergent mixed-methods study.SettingKoidu Government...

NC MedAssist: Dispensing Hope throughout North Carolina.

By providing free medications to those who are uninsured and who have low income, organizations like NC MedAssist are able alleviate this barrier for thousands of North Carolinians each year. This article will describe the history and benefits of NC MedAssist.

СПЕЦИАЛИЗИРОВАННАЯ МЕДИЦИНСКАЯ ПОМОЩЬ ПАЦИЕНТАМ С СЕРДЕЧНО-СОСУДИСТЫМИ ЗАБОЛЕВАНИЯМИ: ОТДЕЛЬНЫЕ АСПЕКТЫ

Significance. Diseases of the circulatory system are a class of diseases of high social importance and a reservoir for reducing mortality and increasing life expectancy, primarily through improving specialized medical care for working-age patients. The purpose of this study is to assess the results of improving specialized medical care for cardiovascular patients under the federal project “Fight against cardiovascular diseases”. Material and Methods. The analysis is based on data from statistical collections of the Federal Research Institute for Health Organization and Informatics of the Ministry of Health of the Russian Federation, and was focused on evaluating target and actual indicators of the federal project “Fight against cardiovascular diseases”. The content analysis of normative legal documents regulating provision of medical care to patients with cardiovascular diseases has been undertaken. Results. Results of the federal project implemented from October 1st, 2018 to December 31st, 2023, are as follows: 374 regional vascular centers and primary vascular departments were re-equipped (retrofitted); more than 310,000 therapeutic X-ray endovascular interventions were performed; 95.5% of patients who underwent through major cardiovascular surgery are provided with free medications; more than 70% of patients with a high risk of acute cardiovascular event are under medical follow-up and received medical care; hospital mortality from myocardial infarction is under 10%, and hospital mortality from acute cerebrovascular accidents is under16.2%. The standardized mortality rate from diseases of the circulatory system in Russia as a whole decreased by 6.0% in 2022 compared to 2018 and equaled to 408.8 per 100,000population. Conclusion. Implementation of the federal project “Fight against cardiovascular diseases” has made it possible to increase effectiveness of specialized medical care delivery in the Russian Federation primarily due to improved material and technical resources of health care facilities. Coverage of cardiovascular patients with quality clinical follow-up is a hard-to-implement component of the overall process of care delivery to such patients, requiring on-going improvements in the implementation approaches. Progress towards this target is the lowest. In order to achieve quality results in reducing morbidity and mortality from cardiovascular diseases, it is important to timely improve the regulatory framework rather than only develop the resource component.

Drug Polymeric Carrier of Aceclofenac Based on Amphiphilic Chitosan Micelles.

Amphiphilic micelles based on chitosan (CS) were applied as drug carriers of aceclofenac (ACF) as a potential method to induce its bioavailability and therapeutic efficiency. N-octyl-N,O-succinyl CS (OSCS), an amphiphilic CS derivative, was successfully synthesized and loaded physically by ACF at different pH values and using different dosages of ACF, forming ACF-loaded polymeric micelles (PMs). The obtained PMs and ACF-loaded PMs were characterized by different analytical techniques, including AFM, TEM, DLS, UV-vis spectrophotometry, 1H NMR spectroscopy, and FT-IR spectroscopy. The pH 5 sample with a 30% ACF/polymer ratio showed the highest ACF loading capacity (LC) and entrapment efficiency (EE). In vitro release behaviors of pure ACF and ACF-loaded PMs at each release point indicated that the release profile of pH-responsive PMs loaded with ACF demonstrated quicker release rates (94% after 480 min) compared to the release behavior noticed for free ACF (59.56% after 480 min). Furthermore, the release rates exhibit a notable rise when the pH is increased from 1.2 to 4.7. In the carrageenan-induced inflammation model of paw edema in rats, it has been demonstrated that the injection of ACF-loaded PMs (at a dose of 10 mg/kg) resulted in a strengthened inflammatory activity compared to the injection of free ACF at equivalent dosages as well as at time intervals. However, the use of ACF-loaded PMs for a duration of 6 h displayed a notable reduction of paw edema, with an inhibition percentage of 85.09%, in contrast to the 74.9% inhibition percentage observed for the free ACF medication.

Liposomes-The 21st Century’s Drug Delivery System: Developments in the Last Two Decade

Liposomes have been thoroughly investigated and are utilized for various illnesses for the past few decades starting from its first discovery in 1961. Since then, therapeutic efficiency of liposomes is enhanced by increasing drug absorbance while fast deterioration and adverse effects are avoided or minimized. This will extend the biological halfway life. Liposomes are more attractive for usage as drug delivery carriers with all of these characteristics and versatility to modify their surface to create additional specific functionalities. In various phases of research, there are numerous new liposomal compositions that improve the therapeutic efficiency of new and old medicines used in pre-clinical and clinical studies. Current multimodal imaging advances aimed at better diagnosing and monitoring liposome therapies as diagnostic tools. Liposomes are major possibilities for medication delivery improvement. Recent researches show that the liposomes can be taken widely in cancer treatments. The primary properties of these structures include minimal toxicity, cytocompatibility, reduced clearance rates, tissue targeting and sustained drug release. Liposomes offer a variety of benefits as shown by approval of Doxil, as compared to traditional chemotherapy with free medication treatment. There are a multitude of liposomes depending on their size, lamellar number, shape and composition. Diagnostic, therapeutic, improved vaccination are covered by clinical use of these systems. Drug and gene delivery are two therapeutic aspects, where due to their unique characteristics liposomes might be beneficial. Several illnesses have been examined with respect to the participation of liposomes, with some good results. Cancer is a life-threatening disease. These structures have been examined in this respect, both in imaging and in chemotherapy. These investigations have resulted in different liposome compositions in different clinical stages. We take this great opportunity to present various surface functionalization strategies and bio-applications of liposomes developed during the last two decades covering the notable work published from 2011 to 2021 in this review. In addition, we provide opinions on the liposome industry, its commercial market and the prospective developments in the field of liposome technology. It is anticipated that this review will serve as a valuable resource, fostering interest and engagement among scientists worldwide in the field of liposome research.