Inexpensive Medicines Research Articles

Amentoflavone from Selaginella tamariscina inhibits SARS-CoV-2 RNA-dependent RNA polymerase

The SARS-CoV-2 pandemic caused millions of deaths due to its prominent infectivity and mortality. Although the vaccines and medicines for SARS-CoV-2 are on the market, new coronavirus variants like influenza are expected to reemerge continuously. Therefore, effective and inexpensive medicines will be required to respond to SARS-CoV-2 variants. Here, we used herbal plant extracts to search for effective compounds that can interfere with SARS-CoV-2 RNA-dependent RNA polymerase (RdRp) and found that Selaginella tamariscina extract (STE) can reduce SARS-CoV-2 RdRp activity. The HCoV-OC43 beta coronavirus model was used to examine whether STE treatment could inhibit coronavirus replication and reduce coronavirus-induced cytotoxicity. Next, we searched the active compound of STE and found that amentoflavone is the main active compound of STE. Finally, we demonstrated that amentoflavone inhibits SARS-CoV-2 RdRp and coronavirus replication. Our results collectively indicate that amentoflavone from STE is possibly beneficial in responding to coronavirus-related diseases, including SARS-CoV-2.

Cyanobacteria - promising objects of biotechnology and medicine

Cyanobacteria are the oldest microorganisms capable of photosynthesis and nitrogen fixation. The wide prevalence and high adaptability of cyanobacteria is provided by secondary metabolites of various chemical nature. Among them are polyketides, non-ribosomal peptides, non-protein amino acids, lipopolysaccharides, alkaloids, terpenoids and others with a wide range of biological activity. Cyanobacteria have a huge potential for discovering new natural molecules, studying the ways of their biosynthesis, developing new pharmaceuticals, and their clinical application. The advantage of cyanobacteria as a microbial source for drug discovery is the economy of their cultivation using simple inorganic nutrients compared to other microorganisms. Unlocking the potential of cyanobacteria requires the use of advanced methods of biotechnology and synthetic biology, which is associated with the need to modify the secondary metabolites of cyanobacteria to obtain a wide range of valuable compounds. Biological treatment using microalgae is one of the most promising areas of biotechnology for wastewater treatment, characterized by high efficiency, simplicity, and environmental friendliness. The problem remains to obtain strains that are tolerant to high concentrations of carbon dioxide and eutopic cultivation conditions in cattle-breeding effluents. Integration of cyanobacterial-based biotechnologies into the cycle of purification and processing of animal waste is also a challenge. Work in this direction is currently ongoing. The use of modern biotechnology methods will allow the use of cyanobacteria for the biodegradation of pollutants, including animal waste, the production of effective non-toxic and relatively inexpensive medicines capable of overcoming drug resistance and improving the effectiveness of treatment, as well as nanoparticles, molecular hydrogen, and solving other practical problems of ecology, biotechnology, medicine.

Advancing African Medicines Agency through Global Health Diplomacy for an Equitable Pan-African Universal Health Coverage: A Scoping Review.

The African continent is home to 15% of the world’s population and suffers from a disease burden of more than 25% globally. In this COVID-19 era, the high burden and mortality are further worsened due to inequities, inequalities such as inadequate health systems, scarce financial and human resources, as well as unavailability of inexpensive medicines of good quality, safety, and efficacy. The Universal Health Coverage ensures that people have access to high-quality essential health services, secure, reliable, and affordable essential medicines and vaccines, as well as financial security. This paper aimed at addressing the critical need for a continental African Medicines Agency (AMA) in addressing the inequities and the role of global health diplomacy in building consensus to support the ratification of the Treaty of AMA. A literature review was done in Scopus, Web of Science, MEDLINE/PubMed, and Google Scholar search engine to identify the critical literature in the context of study objectives. All the articles published after 2015 till 2021 in the context of AMA were included. African Health Strategy 2016–2030 highlighted the importance of an African regulatory mechanism for medicines and medical products. Through global health diplomacy (GHD), the African Union and its partners can negotiate and cooperate in providing infrastructural, administrative, and regulatory support for establishing the AMA. The paper emphasizes the South–South cooperation and highlights the contributions of India and China in the supply of medicines and vaccines to Africa. A strong AMA created through GHD can be a vital instrument in utilizing Trade-Related Aspects of Intellectual Property Rights (TRIPS) flexibilities extension and an ideal partner for European and other regional regulatory authorities seeking to stem the tide of counterfeit, sub-standard, or fake products.

Practical aspects of palliative care & palliative radiotherapy in incurable cervical cancer.

Cervical cancer is the most common cause of cancer-related deaths among economically disadvantaged women. The symptoms of pain, discharge, constipation, foul smell, insomnia and depression can be controlled with inexpensive medicines such as oral morphine, maintenance oral metronidazole, antidepressants and laxatives. These medications should be prescribed according to the palliative care guidelines and titrated to the individual patient’s clinical response, pathophysiology, and metabolic parameters. A hypothetical clinical scenario illustrates some aspects of pain and symptom management, inter-disciplinary palliative care, medical ethics and communication needs in low-resource settings. Palliative radiotherapy is a cost-effective intervention to reduce vaginal discharge, bleeding, pressure effects and nociceptive or neuropathic pain caused by pelvic and para-aortic disease. The role of palliative radiotherapy in patients with malignant fistulae is discussed and the literature on hypo-fractionated pelvic radiotherapy is briefly reviewed.

Palliative care and symptom relief for people affected by multidrug-resistant tuberculosis.

The World Health Organization (WHO) defines palliative care as the prevention and relief of the physical, psychological, social and spiritual suffering of adults and children with life-threatening illnesses and psycho-social support for their families. Palliative care and symptom relief (PCSR) also addresses suffering in nonlife-threatening situations such as after cure. PCSR should never be considered a substitute for tuberculosis (TB) prevention and treatment, but should be accessible by everyone in need. PCSR can reduce suffering and improve quality of life of patients with end-stage chronic illnesses while reducing costs for health care systems and providing financial risk protection for patients' families. It also may help enable patients to adhere to long and noxious treatments and thereby reduce mortality and help protect public health. Basic PCSR can be taught easily to TB specialists as well as primary care clinicians and delivered in hospitals, clinics or patients' homes combined with infection control. For these reasons, integration of PCSR into multidrug-resistant (MDR) and extensively drug-resistant TB (XDR-TB) treatment programs is medically and morally imperative. We propose an essential package of PCSR for people with M/XDR-TB that includes a set of safe, effective and inexpensive medicines and equipment, social supports for patients and caregivers living in extreme poverty, and necessary human resources. The package aligns with WHO guidance on programmatic management of drug-resistant (DR) TB and should be universally accessible by people affected by M/XDR-TB. We also describe the ethical practice of PCSR for people with M/XDR-TB and identify needed areas of research in PCSR for people with M/XDR-TB.

Stock Market Responses to Unethical Behavior in Organizations: An Organizational Context Model

We develop and test a model that extends the understanding of how people react to news of organizational unethical behavior and how such reactions impact stock performance. We do so by taking into account the interplay between the features of specific unethical acts and the features of the organizational context within which unethical acts occur. We propose a two-stage model in which the first stage predicts that unethical acts that benefit the organization are judged less harshly than are unethical acts that benefit the actor, when the organization is seen as pursuing a moral goal (e.g., producing inexpensive medicine rather than tobacco products). In such cases, the motives behind the unethical act are construed as an individual’s intentions to pursue a moral end. The second stage of our model connects moral judgment to action against the organization as a whole. We propose that moral judgments of an unethical act are more likely to translate into negative economic consequences for the organization when the unethical act is seen as benefiting the organization, because in such cases the organization is construed as an accomplice. Study 1 is an event study of stock market reactions to organizational unethical behavior in which the features of organizational unethical behavior were operationalized by coding media coverage of unethical acts. Study 2 is an experiment that used news stories to manipulate features of unethical behavior and measured participants’ estimates of stock performance, while incentivizing participants for accuracy. Both studies found support for our model. The online appendix is available at https://doi.org/10.1287/orsc.2018.1244 .

Aggregated N-of-1 trials for unlicensed medicines for small populations: an assessment of a trial with ephedrine for myasthenia gravis

BackgroundInexpensive medicines with a long history of use may currently be prescribed off-label for rare indications. Reimbursement is at the discretion of health insurance companies, and may be unpredictable. The example addressed was ephedrine as add-on treatment for myasthenia gravis. Stakeholders from academia, a patient organization, the Dutch National Health Care Institute (NHCI) and Dutch Medicines Evaluation Board (MEB) advised on the trial design. The NHCI and MEB agreed to provide scientific advice on the suitability of the evidence generated by the trial, for regulatory decisions. This paper describes the feasibility of the trial and the utility of its aggregated results.ResultsThe trialists experienced the trial as feasible. Retrospective interviews showed that the trial as performed was acceptable to patients. The treatment effect in the primary outcome measure, muscle strength, was statistically significant when inferred to the population level, though the effect size was modest. Secondary outcomes were statistically significant in a preplanned, fixed effects analysis within the four patients. The NHCI advised that it could potentially make reimbursement decisions based on the Fitting Evidence framework, should the trialists decide to apply for reimbursement. The MEB advised that for a licensing decision, the N-of-1 design is a last-resort option for demonstrating treatment benefit in a rare disease. N-of-1 trials alone do not provide enough evidence on potential risk. The MEB found the current trial inconclusive. It suggested doing a 2-armed trial of longer duration, possibly with a different outcome measure (postponement of corticosteroid use). It suggested engaging a consultancy or commercial sponsor, should the trialists decide to seek market authorization of the drug.ConclusionsIn theory, evidence from aggregated N-of-1 trials is suitable for use in licensing and reimbursement decisions. The current example illustrates differences in interpretation of N-of-1 results by health authorities. In the era of personalized medicine, consensus is required on the interpretation of data from study designs geared to small groups. Demonstrating effectiveness of inexpensive medicines in small populations may require involvement of non-commercial parties, to preserve affordability.

Efficacy of Omega-3 in Treatment of Recurrent Aphthous Stomatitis: A Randomised, Double-blind, Placebo-controlled Study.

To evaluate the potential of omega-3 polyunsaturated fatty acid supplement as an effective, safe and inexpensive medicine for the treatment of recurrent aphthous stomatitis. In this double-blind clinical trial, 50 patients with recurrent aphthous stomatitis were randomly divided into the omega-3 group and placebo group. Patients in the omega-3 group received 1000 mg omega-3 group capsules (Daroupakhsh Company, Tehran, Iran) for 6 months; while those in the placebo group received placebo capsules with the same instructions. The pain, size, duration and recurrence rate of ulcers were recorded in each follow-up phase. Follow-up was done weekly in the first month of drug prescriptions and then monthly in the next 5 months. The data were analysed with SPSS-20 through the Mann-Whitney test to compare the groups with respect to each variable and the Wilcoxon and Friedman tests to compare the groups over time. Values were significant at P < 0.05. In the omega-3 group, pain was lessened from 4.96 to 3.04, irritation was reduced from 5.88 to 4.00 (P = 0.0627) and the size of ulcers was decreased from 2.30 to 1.48 mm (P = 0.062). No significant change was observed in the aforementioned variables in the placebo group. Moreover, the number of ulcers indicated a significant reduction in the fourth, fifth and sixth months in comparison with the placebo group (P = 0.00). The recurrence of ulcers in the omega-3 group showed a significant decrease in the fifth and sixth months compared with the placebo group (P < 0.05). The current study indicated that omega-3 consumption decreased the symptoms of recurrent aphthous stomatitis.

A framework for unbiased, robust and system-wide characterization of MHC-bound peptides and epitopes (APP5P.111)

Abstract Vaccines are the most inexpensive medicine in the long run, yet developing them remains a slow process. A major challenge is to identify proteins efficiently processed by the host and presented on major histocompatibility complexes (MHCs). Furthermore, the extreme polymorphism of the MHCs means that candidate antigens must be tested across many genotypes. Immunopeptidomics, the study of all peptides presented by the host’s immune system, holds promise but is limited by informatics:standard approaches result in high error rates for these samples. We describe here an experimentally validated informatic treatment of mass spectrometric data from peptides eluted from the surface of antigen-presenting cells that can identify epitopes bound by specific MHCs, predict their core binding regions, and reveal consensus binding motifs of MHC alleles. Our approach avoids the biases inherent with MHC immunopurification or prior consensus motifs and enables rational vaccine design by allowing rapid and sensitive screening of individual immunopeptidomes.

Plant Molecular Pharming for the Treatment of Chronic and Infectious Diseases

Plant molecular pharming has emerged as a niche technology for the manufacture of pharmaceutical products indicated for chronic and infectious diseases, particularly for products that do not fit into the current industry-favored model of fermenter-based production campaigns. In this review, we explore the areas where molecular pharming can make the greatest impact, including the production of pharmaceuticals that have novel glycan structures or that cannot be produced efficiently in microbes or mammalian cells because they are insoluble or toxic. We also explore the market dynamics that encourage the use of molecular pharming, particularly for pharmaceuticals that are required in small amounts (such as personalized medicines) or large amounts (on a multi-ton scale, such as blood products and microbicides) and those that are needed in response to emergency situations (pandemics and bioterrorism). The impact of molecular pharming will increase as the platforms become standardized and optimized through adoption of good manufacturing practice (GMP) standards for clinical development, offering a new opportunity to produce inexpensive medicines in regional markets that are typically excluded under current business models.

“Access to Inexpensive Medicine Is a Right of the People”: An Interview With “Gypsy Pharmacist” Krisana Kraisintu

Asian Politics & PolicyVolume 3, Issue 3 p. 461-474 “Access to Inexpensive Medicine Is a Right of the People”: An Interview With “Gypsy Pharmacist” Krisana Kraisintu First published: 05 July 2011 https://doi.org/10.1111/j.1943-0787.2011.01280.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume3, Issue3July 2011Pages 461-474 RelatedInformation

Optimism, persistence, and our collective crystal ball.

Thank you indeed to Christopher Plowe for the very generous introduction—I think it was perhaps too generous. Chris showed the list of fellows and students who have worked with me at National Institutes of Health (NIH), and great credit really goes to them. I have been fortunate and privileged to have been surrounded by the brilliance of all of these individuals and their accomplishments through the years. Also, Chris did not name himself in the photographs with our Malian colleagues, instead referring to himself only as one of the “less talented” fellows. Not at all! In fact, Chris was overly generous to me when he spoke of our field work in Mali on chloroquine resistance. It really was Chris' project with Abdoulaye Djimde while I was collaborating on much of that work. So I return the credit for that to Chris, with the comment that it was particularly rewarding to see the impact on health in the villages where we collaborated with our Malian colleagues to deliver relatively inexpensive medicines that worked wonders. Tonight marks the end of a wonderful experience for me as your ASTMH President. The period has left me with lasting memories, new colleagues, and friends. And it is a great satisfaction to say that this extraordinary Society continues to grow in strength and collective voice as the leading international organization of scientists and clinicians dedicated to tropical medicine and global health. ASTMH is alive with an abundance of positive spirit and teamwork in our membership. This year we have held our largest and most successful Annual Meeting ever, with over 3,400 registrants. We have also seen excellent progress in areas of membership, policy and advocacy, media communications, and awards program funding. Time does not allow me to thank by name everyone who made this progress possible. However, I would like to express my gratitude to some individuals in particular: • To Sally Finney, our Executive Director, for her initiative and careful attention to our ASTMH activities this year. These have included the Policy and Advocacy work with Kent Campbell, the upcoming ASTMH Constitution and Bylaws revisions, the launch of our Public Relations Committee, the media relations contract with the MWW Group, and the coordination of our Executive Committee and Council meetings; • To Judy DeAcetis, Lyn Maddox, Matthew Lesh, and their Sherwood Group Colleagues for their attentive care to this year's operations including the meeting arrangements, the drive to boost membership, and the wide-ranging administrative needs of our Society. • To Chris King and the approximately 100 members of our Scientific Program Committee for their contributions of time, thought, and effort putting together a terrific Meeting Agenda this year. • To the members of the ASTMH Council, especially Josh Berman, Peter Weller, Jim Kazura, Ed Ryan, Claire Panosian, Joe Vinetz, Steve Higgs, plus so many other Society members I have not named—thank you all for your generous service to ASTMH this year. • Finally, to my wife Marilyn, daughter Dianne, and sons Alex and Nick and their wives Lauren and Alysen: your love and unaffected eloquence in our family have meant everything to me over the years; and thank you very much for your support through a busy and eventful 2009.

Self‐Assembled Double‐Shelled Ferrihydrite Hollow Spheres with a Tunable Aperture

Novel double-shelled hierarchical ferrihydrite hollow spheres (Fe(10)O(14)(OH)(2).4H(2)O) were successfully synthesized on a large scale by using a facile medicine-inspired solution-phase approach. Sodium nitroprusside (SNP), an ordinary and inexpensive medicine for expanding blood vessels, served as both a ferric source and an in situ formed gas-bubble template with the presence of sodium dihydrogen phosphate as a pH regulator, coordinator, and stabilizer. A twice-gas-bubble template model has been proposed for the formation of the double-shelled hollow spheres to take advantage of the dissociation and hydrolyzation of the two kinds of ligands in the SNP precursor. The size of the double-shelled ferrihydrite hollow spheres can be tuned by varying the experimental parameters. As-obtained ferrihydrite is highly sensitive to ethanol gas, which indicates potential applications in the field of sensing devices.

Assessing the performance, practices and roles of drug sellers/dispensers and mothers'/guardians' behaviour for common childhood conditions in Kibaha district, Tanzania

In most third world countries, self-medication is common and pharmacies, drug stores and drug shops are important providers of health advice and inexpensive medicines. We used exit interviews to assess drug sellers'/dispensers' roles and consumers' behaviour in Kibaha district, Coast region, Tanzania. Exit interviews with mothers/guardians reported the following childhood conditions treated with or without prescriptions at drug shops: respiratory infections (34%), fever (21%), a combination of diarrhoea, acute respiratory infection (ARI) and fever (14%), diarrhoea alone (13%) and other conditions (17%). The majority of drug sellers/dispensers prescribed or dispensed branded drugs (85%) for most mothers/guardians who visited these drug shops. In addition, antibiotics in total were prescribed for 31% of the mothers/guardians. Of the antibiotics dispensed, 38% were not prescribed by clinicians. In total, oral rehydration salts (ORSs) (3%), antimalarials (sulphadoxine/pyrimethamine) (24%) and antipyretics (11%), were prescribed in 20% but were bought by only 9%; multivitamins (6%), cough mixtures (4%) and other drugs (2%) (antihelminthics, benzylbenzoate emulsions, ear and eye drops) were also purchased from these facilities. Of the diarrhoea case histories presented by simulated clients at the drug shops, only 35% of the bloody diarrhoea scenarios were accurately diagnosed for getting antibiotics as compared with 44% for watery diarrhoea for which the use of antibiotics were wrongly advised (P<0.01). Furthermore, drug sellers/dispensers in these drug shops recommended use of ORS less frequently (3%) for a combination of diarrhoea, ARI and fever, and 2% for ARI alone than for watery (29%) and bloody diarrhoea (32%), respectively, for children under five years of age (P<0.001). Antimicrobial agents were advised for ARI (38%), watery diarrhoea (44%) and bloody diarrhoea (35%), respectively, with no significant difference among the three common childhood conditions. Antipyretics were advised in almost all childhood conditions but were least in watery (2%) and bloody diarrhoea (4%). This study demonstrates that antibiotics are overused in both the urban and rural settings of Kibaha district and that this is due to both clinicians'and drug sellers'prescribing practices in public and private facilities. The use of branded drugs was more common than that of generic drugs in private pharmacies, drug stores and ordinary shops. It is hereby proposed that any intervention should focus on training both facilities in the district on selectively prescribing and rational use of antibiotics for ARI and diarrhoea, and also to prescribe and dispense generic drugs so that it costs patients less when they buy drugs in shops. There is a need to increase awareness in recommending the use of ORS for clients to manage watery and bloody diarrhoea, and ARI in children under five years of age.

An Inexpensive Medicine Ball for Strength, Conditioning, and Rehabilitation Programs

An Inexpensive Medicine Ball for Strength, Conditioning, and Rehabilitation Programs