National Essential Drug List Research Articles

Landscape assessment of the availability of medical abortion medicines in India

BackgroundMedical abortion with mifepristone and misoprostol can be provided up to 63 days’ gestation in India. This accounts for 67.5 percent of all abortions in the country. We conducted an assessment to determine the availability of medical abortion medicines, specifically the combi-pack, in India.MethodsWe applied the World Health Organization landscape assessment protocol at the national level. The assessment protocol included a five-step adaptation of an existing availability framework, including online data collection, desk review, country-level key informant interviews, and an analysis to identify barriers and opportunities to improve medical abortion availability. The assessment was conducted between August and March 2021.ResultsMedicines for medical abortion are included in the national essential drug list and available with prescription in India. The assessment identified 42 combi-pack products developed by 35 manufacturers. The quality of medical abortion medicines is regulated by national authorities; but as health is devolved to states, there are significant inter-state variations. This is seen across financing, procurement, manufacturing, and monitoring mechanisms for quality assurance of medical abortion medicines prior to distribution. There is a need to strengthen supply chain systems, ensure consistent availability of trained providers and build community awareness on use of medical abortion medicines for early abortions, at the time of the assessment.ConclusionOpportunities to improve availability and quality of medical abortion medicines exist. For example, uniform implementation of regulatory standards, greater emphasis on quality-assurance during manufacturing, and standardizing of procurement and supply chain systems across states. Regular in-service training of providers on medical abortion is required. Finally, innovations in evidence dissemination and community engagement about the recently amended abortion law are needed.

Consequences of Gamma Irradiation on Triphala’s Phytochemical Compositions, Microbial Burden and Antioxidant Properties

Triphala, a renowned polyherbal blend comprising three fruits, Phyllanthus emblica Linn., Terminalia chebula Retz., and Terminalia bellirica (Gaertn.) Roxb., in equal proportions, holds a rich historical lineage in both Ayurvedic and Thai traditional medicine. Triphala has been reputed as the indigenous medicine in the Thailand National List of Essential Drugs: List of Herbal Medicinal Products which has been widely used as a natural remedy for relieving cough and phlegm. However, the inherent challenge of microbial contamination in herbal remedies necessitates effective interventions. Gamma () irradiation emerges as a pivotal method to mitigate the microbial burden in medicinal plants, albeit with potential repercussions on their chemical composition and biological properties. This study investigated the impact of -irradiation doses of 5, 10, and 25 kGy exposed to Triphala and the microbial contamination along with antioxidant activity, total phenolic content (TPC), gallic acid (GA), and chebulagic acid (CA) contents. The TPC and antioxidant activity of non-irradiated and irradiated Triphala were determined by using the Folin-Ciocalteu method and DPPH assay, while the GA and CA contents were quantified by HPLC analysis. The results demonstrated the efficacy of radiation doses (5-25 kGy) in diminishing microbial loads without significantly altering TPC or DPPH scavenging activity. Intriguingly, irradiation at 5 and 10 kGy, resulted in a notable increase in GA contents and CA contents (p< 0.05). Thus, the -irradiation emerges as a promising avenue for preserving Triphala quality and antioxidant properties amidst microbial contamination challenges.

Availability of essential, generic medicines before and during COVID-19 at selected public pharmaceutical supply agencies in Ethiopia: a comparative cross-sectional study

ObjectivesLockdowns and border closures impacted medicine availability during the COVID-19 pandemic. This study aimed to assess the availability of essential, generic medicines for chronic diseases at public pharmaceutical supply agencies...

Study on prescription pattern in acute myocardial infarction in a tertiary care teaching hospital

Background: Prescription pattern monitoring studies refer to drug utilization studies that primarily examine the prescribing, dispensing, and administration of medications to promote the rational use of drugs. Aims and Objectives: The present study aimed to examine the prescription patterns among patients with acute myocardial infarction (MI) who were admitted to intensive care unit of a tertiary care center. Materials and Methods: This was a prospective, cross-sectional study carried out in 201 acute MI patients. Patients’ demographics, clinical history, laboratory and imaging findings, the name of the drug (brand name or generic name), dosage form, and percentage of drugs prescribed from the WHO and National Essential Medicine List were noted. Results: In the present study, the majority of the study participants (73.14%) belonged to the age group of 41–65 years, with male predominance (60.20%). Most patients reported having a mixed diet (49.26%) and were from rural areas (63.68%). Aspirin, clopidogrel, and atorvastatin were prescribed to all the patients, followed by pentazocine (70.42%) and streptokinase. Percentage of drugs prescribed by generic name was 62%, while percentage of drugs prescribed from the WHO Model List of Essential Medicines (2021) and National Essential Drugs List (2022) was 70% and 68%, respectively. Conclusion: The present study findings revealed that the majority of patients belonged to the age group of 41–65 years, with male predominance. The present study revealed a low percentage of prescriptions with generic names, indicating a pressing need to revise the prescription standards in tertiary care hospitals.

Evaluation of prescribing patterns using WHO core drug use indicators in a pediatric hospital of Kabul Afghanistan: A prospective cross-sectional study

BackgroundThe global issue of irrational drug use, particularly concerning pediatric patients, is a significant concern. Notably, there has been a lack of studies assessing rational drug prescribing for pediatric patients within Afghanistan's healthcare system. This investigation aimed to address this gap by examining drug prescribing patterns at the Indira Gandhi Pediatric Health Institute (IPHI) in Kabul, Afghanistan. MethodsA prospective cross-sectional analysis was conducted to evaluate the prevailing drug prescribing practices at the outpatient department of IPHI in Kabul, Afghanistan. A systematic random sampling method was employed to select 600 outpatient prescriptions from the institute, following the World Health Organization (WHO) guidelines for investigating drug utilization in healthcare facilities. ResultsThe average age of patients was 4 years, and the average number of drugs per prescription was 2.9. Notably, 84% of prescriptions included one or more antibiotics, surpassing the WHO standard of <30%. Furthermore, 67% of the prescribed drugs were listed on Afghanistan's national essential drugs list (EDL), falling below the standard value of 100%. Only 35.1% of the prescribed drugs were in generic form, also lower than the recommended 100%. Moreover, 5.7% of all prescriptions included injections, the ideal value is <20%. The most frequently prescribed drug groups were anti-microbials (25.7%), followed by non-steroidal anti-inflammatory drugs (NSAIDs), (21.4%), gastrointestinal drugs (17.3%), and vitamins (7.8%). ConclusionThe study's findings indicate that, on average, a higher number of drugs were prescribed per patient visit at IPHI compared to recommended standards. Additionally, there was a lower utilization of generic drugs and drugs from Afghanistan's national essential drugs list (EDL), with an over-prescription of antibiotics.

Strategies for Removal of Barriers to Hepatitis C Elimination in Sub-Saharan Africa.

Hepatitis C virus (HCV) infection is a major global health threat, with serious consequences including liver cirrhosis and cancer. Despite efforts to combat HCV, an estimated 1.5 million new infections occur each year and HCV was the sixth leading cause of death in 2017. Nevertheless, political leaders are increasingly interested in the fight against HCV, and the achievements of countries such as Rwanda, Egypt, India, Mongolia, Pakistan, Georgia, and Ukraine have given hope that the elimination plan to reduce new infections to 90% and mortality to 65% by 2030 is possible. It is true that some African countries can attest to the difficulty of operationalizing the HCV program with expensive testing platforms and HCV drugs that few could afford in the past, let alone the logistics involved, given that active case detection is an asset for HCV elimination. The inability to add direct-acting antivirals (DAAs) to the national essential drug list and negotiate DAA cost subsidies remains a major challenge in Africa. The lessons learned from implementing and scaling up the human immunodeficiency virus program can provide a strong framework to deliver comprehensive HCV services. We present the strategies used by some African countries to move toward HCV elimination, describe the challenges they have faced, and suggest realistic solutions.

Sensible Factors that Need Strategic Change to Improve the Medical Drug Availability across Healthcare Institutions in Sri Lanka

Abstract : Access to medicines remains a major obstacle for people across the world to maintain their health at a desired level. Ensuring an adequate supply of safe and effective drugs of acceptable quality is an integral part of the health policy of Sri Lanka. The medical supplies division is the sole organization responsible for providing all pharmaceuticals, surgical items, laboratory items, radioactive items, and printed materials for government sector healthcare institutions. The establishment of an independent drug regulation authority, the Declaration of a national essential drug list, the establishment of a separate drug procurement entity, Pooled procurement, digitalization of drug management, and expansion of drug storage capacity are key strategies that have been implemented by the Ministry of Health to minimize the drug shortages across the healthcare institutions of Sri Lanka. Despite the implemented strategies drug shortage continue to evolve from time to time as a public outcry in the media. This case study describes the critical issues that need to look at more strategically to improve drug availability.

Drug Utilization Pattern in Pneumonia among Pediatric Patients at a Tertiary Care Hospital

INTRODUCTION: Pneumonia remains the leading cause of hospitalization and mortality in young children in low and middle-income countries like Nepal. Antibiotics are commonly prescribed for pediatric pneumonia patients. To prevent antimicrobial resistance, antibiotics must be prescribed rationally. Therefore, the purpose of this study was to evaluate the drug utilization pattern in pediatric pneumonia patients at a tertiary care hospital by using World Health Organization (WHO) prescribing indicators. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted among pediatric pneumonia patients at Universal College of Medical Sciences, Bhairahawa, Nepal from December 2022 to May 2023. Ethical approval was taken from the Institutional Review Committee (UCMS/IRC/191/22) and the purposive sampling method was used. Data were collected from pro-forma to assess WHO prescribing indicators and analyzed in Statistical Package for Social Sciences (SPSS) version 20 program and expressed as frequency and percentage for all variables. RESULTS: A total of 1408 drugs were prescribed to 196 prescriptions or patients. The average number of drugs per prescription was 7.18. The most common 51.5% of prescriptions contain 4-5 drugs per prescription. The percentage of prescriptions with antibiotics and injections was 100% respectively. Drugs prescribed by generic name were 44.24% and those matched to the national Essential Drugs List of Nepal were 53.19%. Cephalosporins (86.7%) were the most frequently prescribed antibiotics followed by aminoglycosides (79.1%). All the antibiotics were given parenterally (100%). CONCLUSIONS: The study reported inadequate compliance with WHO prescribing indicators and recommended policy formulation and application by regulatory agencies to promote the drug utilization study.

Evaluation of Drug Prescription Pattern Using WHO Prescribing Indicators in Libya: A Cross-Sectional Study

Background and aims. The improper use of drugs due to irrational prescriptions is a common problem in Libya. This study aimed to investigate the prescribing pattern and predictors of antibiotic prescription in primary health care facilities in three districts (east, west, and south) in Libya. Methods. In this retrospective study, 484 prescriptions were examined. World Health Organization-recommended indicators for rational use were examined (WHO): e.g., the percentage of prescriptions covering antibiotics, prescription of injections, and prescription of drugs by a generic name and from a national essential drug list, as well as the average number of drugs per prescription, were all considered. Results. The average number of drugs per prescription was 4.72, with a maximum of 7 drugs in a prescription, and the percentage of prescriptions involving antibiotics and injections was 30.4% and 10.5%, respectively. There were 28.6% drugs prescribed by their generic name and 82.8% were retrieved from the essential drugs list. The most common category of medicines were 18.9% antibiotics, 18.3% antihypertensives, and 15.7% multivitamins and minerals. While the lowest consumed drugs were steroids 2.5%. Conclusion. There was some irrational drug prescribing, particularly with regard to injections and antibiotics. It is suggested that physicians participate in continuing education programs on rational prescribing for various medical indications.

Prescription Audit for WHO Prescribing Indicators and Prescription Errors in a Tertiary Care Teaching Hospital

ABSTRACT Aim: Our study aimed to audit prescriptions for the prescription indicators given by WHO and to analyze prescription errors, evaluating the frequency and types of prescription errors. Methodology: Prospective study was done in Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, under Pharmacology Department in October 2020. The prescriptions from all the OPD (outpatient departments) were collected from the pharmacy store. Prescriptions for the follow-up medication and devoid of medicine were excluded from the study. Results: Total of 1451 errors were found from 400 collected prescriptions, out of which 324 (22.3%) were errors of omission and 145 (10.0%) were errors of commission related to drugs whereas 982 (67.7%) were the error of omission other than drug details. A total of 1257 drugs were prescribed making an average of 3.14 drugs per prescription, out of which 28.72% drugs were prescribed by generic name. About 34.0% of patients were prescribed antibiotics and 2.25% of patients were prescribed injectable drugs. All the drugs were prescribed from the National Essential Drug List (NEDL). Conclusion: The prescription audit showed that there is a need to train prescribing doctors as per the standard MMC and NMC guidelines for rational prescription writing to minimize the chance of major errors like not writing the dose of the drug, not writing it in capital letters, drug-related instructions, diagnosis and so on. The prescription audit should be carried out at regular intervals to improve prescription writing skills to establish a better healthcare system.

Microbiome-metabolome reveals that the Suxiao Jiuxin pill attenuates acute myocardial infarction associated with fatty acid metabolism

Ethnopharmacological relevanceThe Suxiao Jiuxin pill (SJP) is a Chinese medical patent drug on the national essential drug list of China, with well-established cardiovascular protective effects in the clinic. However, the mechanisms underlying the protective effects of SJP on cardiovascular disease have not yet been elucidated clearly, especially its relationship with the gut microbiota. Aim of the studyThis study aimed to investigate the cardioprotective effect of SJP against isoproterenol-induced acute myocardial infarction (AMI) by integrating the gut microbiome and metabolome. MethodsA rat model of AMI was generated using isoproterenol. Firstly, the effect of antibiotic (ABX) treatment on the blood absorption and excretion of the main components of SJP were studied. Secondly, 16S rRNA sequencing and untargeted metabolomics were used to discover the improvement of SJP treatment on gut microbiota and host metabolism in AMI rats. Finally, targeted metabolomics was used to verify the effects of SJP treatment on host metabolism in AMI rats. ResultThe results showed that ABX treatment could affect the blood absorption and fecal excretion of the main active components of SJP. At the same time, SJP can restore the richness and diversity of gut microbiota, and multiple gut microbiota (including Jeotgalicoccus, Lachnospiraceae, and Blautia) are significantly associated with fatty acids. Untargeted metabolomics also found that SJP could restore the levels of various fatty acid metabolites in serum and cecal contents (p < 0.01, FC > 1.5 and VIP >1). Targeted metabolomics further confirmed that 41, 21, and 39 fatty acids were significantly altered in serum, cecal contents, and heart samples, respectively. Interestingly, these fatty acids belong to the class of eicosanoids, and SJP can significantly downregulate these eicosanoids in AMI rats. ConclusionThe results of this study suggest that SJP may exert its cardioprotective effects by remodeling the gut microbiota and host fatty acid metabolism.

A drug utilisation pattern in non-dialysis patients of diabetic nephropathy in a government-run tertiary care hospital in South-Asia.

The objective of the present study was to evaluate the Drug utilisation pattern in patients of diabetic nephropathy (stage 1-4) in a tertiary care hospital in South-Asia. A cross-sectional observational study was conducted in the nephrology out-patient-department of a tertiary care hospital in South-Asia. WHO core prescribing, dispensing, and patient care indicators were evaluated, and adverse drug reactions (ADRs) encountered by the patients were analysed for causality, severity, preventability, and outcome. The most commonly prescribed antidiabetics indiabetic nephropathy patients were insulin (17.42%), followed by metformin (4.66%). Current drugs of choice SGLT-2 inhibitors were prescribed in a lesser frequency than expected. Loop diuretics and calcium channel blockers (CCBs) were the preferred antihypertensives. The use of ACE inhibitors (1.26%) and ARBs (3.45%) for hypertension was restricted to Stage 1 and 2 nephropathy. The patients were on 6.47 drugs on average. 30.70% of drugs were prescribed by generic names, 59.07% of the drugs were prescribed from the national essential drugs list and34.03% of the prescribed drugs were supplied by the hospital. CTCAE grade 1 (68.60%) and grade 2 (22.09%) ADR severity was the highest. Prescribing patterns in patients of diabetic nephropathy were adapted from relevant medical evidence, affordability and availability of the drugs. Generic prescribing, availability of drugs and ADR preventability in the hospital have a broad scope for improvement.

Inclusion of nicotine replacement therapy in the national essential drug list in India: Benediction for tobacco quitters?

1. Ministry of Health & Family Welfare, Government of India. National List of Essential Medicines (NLEM) of India (2022). September 13, 2022. Accessed September 15, 2022. https://main.mohfw.gov.in/news... Google Scholar

Combination Therapy in Diabetes Mellitus Patients Attending Outpatient Department in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Assessing anti-diabetic drug use patterns in hospitals is an important activity which helps to promote the rational use of drugs and may suggest measures to change prescribing habits for the better. This study aimed to find the use of combination therapy in diabetes mellitus patients attending the outpatient department of a tertiary care centre. A descriptive cross-sectional study was conducted among 201 diabetes mellitus patients in the internal medicine department from 2 March 2022 to 30 June 2022 for a duration of four months after approval from the Institutional Review Committee (Protocol No: IRC-LMC-01/R-022). Diabetic patients prescribed at least one anti-diabetic drug in prescription forms were included. Socio-demographic profiles, clinical characteristics and anti-diabetic drug use pattern-related data were collected. Convenience sampling was used. Point estimate and 95% Confidence Interval were calculated. Among 201 patients, 134 (66.66%) (60.14-73.18, 95% Confidence Interval) patients were given combination therapy. The most common combination therapy was metformin 500 mg and sitagliptin 50 mg. A total of 324 anti-diabetic drugs were used. The average number of drugs prescribed per patient was 1.6±0.7. The number of anti-diabetic drugs prescribed by generic name and from the national essential drugs list was 74 (22.83%) and 188 (58.02%) respectively. Biguanides were used in 176 (87.56%) patients. These findings were similar to some other studies conducted in similar settings. In most patients, combination drug therapy was more prevalent. Among combination therapy, two drug combinations were more prevalent. diabetes mellitus; drug combinations; outpatients; teaching hospital.

Development strategy and current situation of Chinese patent medicine for children in China

This study took the 2020 edition of Chinese Pharmacopoeia(ChP) and the 2018 edition of National Essential Drug List(NEDL) for children as research carriers to systematically analyze the current situation of and problems in the use of Chinese patent medicine for children(CPMC) in China. In view of the problems of imprecise dosage, incomplete safety information, and lack of sui-table varieties, dosage form and specification of CPMC in China, development strategy of CPMC in the future was proposed. It is reco-mmended to carry out systematic post-marketing revaluation studies of CPMC, encourage the development of new varieties or new dosa-ge forms suitable for children, advocate the continuous promotion of real-world studies on children, and expand the information on the use of CPMC with real-world data, so as to lay the foundation for post-marketing revaluation of CPMC and guide the rational use of clini-cal medicines. This study was expected to build a positive policy ecosystem to ensure the supply of CPMC, and promote the high-quality development of CPMC.

Barriers for using amoxycillin dispersible tablet in pediatric pneumonia treatment in Bangladesh

Abstract World Health Organization recommends guideline for integrated management of childhood illnesses (IMCI) where Amoxicillin Dispersible Tablet (DT) appears as the first drug of choice for treating childhood pneumonia. The Government of Bangladesh adopted the IMCI strategy in 1998, and scaled it up nationwide by 2014. But, even today, the use of Amoxicillin DT, either in public or private sector, for managing childhood pneumonia is a rare event in Bangladesh. We conducted this exploratory study to understand the existing barriers, both in public and private sector, those have influences on reduced availability of Amoxicillin DT and non-compliance of health service providers to follow IMCI guideline by using Amoxicillin DT for treating a child with pneumonia, in Bangladesh. We conducted desk review of relevant strategy and policy documents, key informant interviews with 19 key individuals from Ministry of Health and national / international NGOs. Collected information were analyzed and interpreted using thematic analysis method. Identified barriers through this study pointed to inadequate policy level focus on IMCI implementation, non-inclusion of Amoxicillin DT in the national essential drug list, single source of Amoxicillin DT producing pharmaceutical in the country coupled with bureaucracy and procurement procedural complexity, lack of training of health service providers and abundant availability of antibiotic over the counter. Study respondents recommended for policy level strengthening of IMCI program, increasing coverage of training for health care provider, including practicing pediatricians both at public and private sectors, facilitating production and procurement procedures and prohibiting antibiotic sell over the counter. Key messages • Facilitation of production and procurement procedure coupled with enforcement of law prohibiting antibiotics availability over the counter are urgent needs. • Policy level support emphasizing full compliance of service providers for quality of implementation of IMCI program in Bangladesh (and similar other settings) is also important.

Application of network composite module analysis and verification to explore the bidirectional immunomodulatory effect of Zukamu granules on Th1 / Th2 cytokines in lung injury

Ethnopharmacological relevanceZukamu granules (ZKMG), as the preferred drug for the treatment of colds in Uygur medical theory, has been used for 1500 years. It is also widely used in China and included in the National Essential Drugs List (2018 edition). It has unique anti-inflammatory, antitussive and analgesic effects. Aim of the studyAiming at the research of traditional Chinese medicine (TCM) with the characteristics of overall regulation of body diseases and the immune regulation mechanism with the concept of integrity, this paper put forward the integrated application of network composite module analysis and animal experiment verification to study the immune regulation mechanism of TCM. Materials and methodsThe active components and targets of ZKMG were predicted, and network module analysis was performed to explore their potential immunomodulatory mechanisms. Then acute lung injury (ALI) mice and idiopathic pulmonary fibrosis (IPF) rats were used as pathological models to observe the effects of ZKMG on the pathological conditions of infected ALI and IPF rats, determine the contents of Th1, Th2 characteristic cytokines and immunoglobulins, and study the intervention of GATA3/STAT6 signal pathway. ResultsThe results of network composite module analysis showed that ZKMG contained 173 pharmacodynamic components and 249 potential targets, and four key modules were obtained. The immunomodulatory effects of ZKMG were related to T cell receptor signaling pathway. The validation results of bioeffects that ZKMG could carry out bidirectional immune regulation on Th1/Th2 cytokines in the stage of ALI and IPF, so as to play the role of regulating immune homeostasis and organ protection. ConclusionsThe network composite module analysis and verification method is an exploration to study the immune regulation mechanism of TCM by combining the network module prediction analysis with animal experiments, which provides a reference for subsequent research.

Evaluation of the state of pharmaceutical supply of patients with dementia with Alzheimer disease in Ukraine in accordance with international recommendations

The aim: to assess the state of pharmaceutical provision of patients with dementia in Alzheimer's disease in Ukraine in accordance with international recommendations.&#x0D; Materials and methods. In our studies, we used data from international guidelines, clinical protocols that regulate the organization of medical and pharmaceutical care for these patients in the USA, Australia, Japan, Germany, Great Britain, Finland, India, Kazakhstan, and Ukraine. The actual state of pharmaceutical provision of these patients in Ukraine was studied using a depersonalized database of medical prescriptions, which operates based on a number of specialized healthcare institutions. In addition, data from the Morion information search system were used. We used general theoretical (historical, formal, graphic, hypothetical-deductive, etc.) and applied (clinical-economic, organizational-economic, mathematical-statistical, etc.) research methods.&#x0D; Results. It has been established that a consolidated opinion has been formed in the world scientific community regarding the possibility of effective use in the pathogenetic treatment of patients with dementia in Alzheimer's disease of drugs from the groups N06DA Acetylcholinesterase inhibitors and N06DX-Other drugs for use in case of dementia. Thus, the pharmaceutical component of international recommendations, clinical protocols for the treatment of patients with dementia in Alzheimer's disease contains four drugs used in pathogenetic therapy. These are N06DA02 Donepezil, N06DA03 Rivastigmine, N06DA04 Galantamine and N06DX01 Memantine. It has been reported that all the above drugs are included in the domestic clinical protocol for the treatment of patients with dementia in Alzheimer's disease, the State Drug Formulary (with the exception of N06DA03 Rivastigmine), and the State Drug Registry. At the same time, all of them were absent from the National List of Essential Drugs, which has an important socio-economic and medical-pharmaceutical significance in the health care system. It was found that patients (200 people) received 2487 prescriptions (100.0 %), among which 9.41 % (234 prescriptions) were drugs used in pathogenetic treatment. There is a highly disproportionate nature of the distribution of prescriptions and consumption by international generic names of drugs. Thus, drugs N06DX01 Memantine accounted for 80.41 % (188 prescriptions) of all prescriptions in the group N06D Drugs for use in dementia, and the consumption rate was UAH 84420.20, which accounted for 91.48 % of the amount of expenses directed to patients with carrying out pathogenetic treatment. Significant dominance of drugs N06DX01 Memantine in the structure of prescriptions and consumption indicates the presence of severe, advanced forms of dementia in patients. This fact once again emphasizes the need for early detection and treatment of cognitive impairment, primarily for the rational use of limited health care resources. We have found that there are no prescriptions for N06D A04 Galantamine preparations, which are recommended by the relevant international recommendations in different countries of the world, as well as by the domestic clinical protocol for the pathogenetic treatment of mild and moderate forms of Alzheimer's disease. At the same time, N06DA05 Ipidacrine preparations were used in the treatment of domestic patients, which are not presented in the pharmaceutical component of international recommendations and protocols governing the pathogenetic treatment of the above-mentioned groups of neuropsychiatric patients.&#x0D; Conclusions. The peculiarities of the formation of the pharmaceutical component in the organization of the treatment process of patients with dementia in Alzheimer's disease in Ukraine, established by us, allow further research on the development of rational ways of resource provision of neuropsychiatric patients

A novel therapeutic approach for IPF: Based on the “Autophagy - Apoptosis” balance regulation of Zukamu Granules in alveolar macrophages

Ethnopharmacological relevanceZukamu Granules (ZKMG) is one of the representative Uygur patent drugs widely used in China, which is included in the National Essential Drugs List (2018 edition). As the first choice for common cold treatment in Uygur medicine theory, it has unique anti-inflammatory and antitussive efficacy. Aim of the studyAccording to the recent inflammatory hypothesis, the abnormal proliferation, autophagy and apoptosis process of lung cells especially alveolar macrophages (AMs) may play an important role in the progress of idiopathic pulmonary fibrosis (IPF). Therefore, we came up with a novel treatment approach for IPF by regulating the balance of AMs “autophagy - apoptosis”, and took ZKMG as the sample drug for our research. Materials and methodsNetwork pharmacology approach was conducted to predict the active components and intersected targets between ZKMG and inflammation. PPI network, GO and KEGG enrichment analysis were screened and analyzed to predict the anti-inflammatory mechanism of ZKMG. Biological experiment adopted from 128 rats, and hematoxylin-eosin staining, flow cytometry and RT-PCR were performed to examine the pathological morphology, HYP contents in lung tissue, AMs counting, AMs apoptosis, AMs phagocytosis rate, mRNA relative quantity determination of 3 key factors associated with AMs “autophagy - apoptosis” and mRNA relative quantity determination of AMs surface receptor signaling pathway. ResultsThe predicted results showed that the mechanism of ZKMG in anti-inflammatory was related to the response and elimination of inflammatory stimuli, the intervention of apoptosis and surface receptor signaling pathways of cells. The verification experiments showed that excessive apoptosis and insufficient autophagy of AMs always existed in the progression of IPF. ZKMG could inhibit AMs proliferation, significantly reduce AMs apoptosis rate, intervene the binding of the Bcl-2 to Beclin 1, inhibit the Caspase 3 activation, stimulate the enhancement of AMs phagocytosis, and inhibit the high expression of TLR4/MyD88/NF-κB surface receptor signaling pathway, which may partly retard the fibrosis process. ConclusionBy inhibiting proliferation, enhancing phagocytosis, inhibiting the formation of Bcl-2 complex, and inhibiting the high expression of MYD88-dependent TLR4 signaling pathway, ZKMG can regulate the balance of AMs “autophagy - apoptosis” in the alveolitis stage to retard the fibrosis process partly. With a comprehensive strategy of “target prediction - experimental verification”, we have demonstrated that inhibiting the apoptosis and promoting autophagy activity of AMs may suggest a new perspective for IPF treatment, which would provide reference for the subsequent development.

Nephroprotection of Garcinia mangostana Pericarp Extract and α-Mangostin Against Oxidative Stress in Renal Manifestation of Ulcerative Colitis in Mice

Garcinia mangostana (GM) pericarp is an herbal medicine in the Thailand National Essential&nbsp;Drug List. GM pericarp and its major active constituent α-mangostin (MGS) exhibit several pharmacological properties, including anti-oxidative activity. Ulcerative colitis (UC) is the consequence of prolonged oxidative stress and inflammation in the large intestine and can result&nbsp;in extraintestinal manifestations (EIM) in other organs. This study evaluated the impact of GM pericarp extract and MGS on oxidant-antioxidant status in the kidneys of UC-induced mice. Six-week-old ICR mice were administered orally GM pericarp extract (40, 200, and 1,000 mg kg-1 ),&nbsp;MGS (30 mg kg-1 ), or sulfasalazine (100 mg kg-1 ) for 7 consecutive days. UC was induced by&nbsp;administering dextran sulfate sodium (40 kDa; 6 g kg-1) on days 4-7. Kidneys were collected to&nbsp;determine the activity and expression of the catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GPx) antioxidant enzymes, lipid peroxidation levels, and glutathione&nbsp;stores. UC induction suppressed expression of Cat, CuZn-Sod, Mn-Sod, and Gpx mRNAs and&nbsp;reduced CAT, SOD, and GPx activities in the kidneys, which was followed by&nbsp; an increase in&nbsp;lipid peroxidation. Total GSH and reduced GSH contents decreased, while oxidized GSSG content increased, reducing the GSH/GSSG ratio in the kidneys. GM and MGS improved the oxidative status of the kidneys similar to sulfasalazine by restoring the expression and activity of&nbsp;the antioxidant enzymes and balancing the glutathione stores. GM and MGS are promising&nbsp;nephroprotective antioxidant treatments and are worthy of development as alternative medicines for renal EIMs of UC.