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In recent years, rapidly changing disease profile patterns, shortage & uneven utilization of healthcare professionals contributed massive burden on the Indian healthcare system, which resulted in varying, fragmented, inconsistent healthcare delivery to the patients and poor patient management. Patients often face and experience many challenges like lack of accessibility, poor patient-healthcare provider relationships, and inadequate quality of care, resulting in unnecessary economic burden in managing their health conditions. Thus Indian healthcare reform is essential in enhancing its capacity to fulfill patients' health needs that can be addressed by focusing on key sustainable strategies and initiatives meant for enhancing coordination of care, expanding services accessibility, redeveloping healthcare infrastructure, implementing workforce innovation and strong governance with the incorporation of core principles such as patient-centeredness, integrated care and collaborative care approaches. The clinical and ambulatory pharmacy practice are fragment of the healthcare delivery which delivers pharmaceutical care and fulfils the needs of patients across healthcare settings. This paper focuses on the present & future perspectives of ambulatory pharmacy practice in India and the factors to be considered for implementing it in patient care. [ABSTRACT FROM AUTHOR]

This paper demonstrates the synthesis and storage of molecular-imprinted polymers (MIP) at room temperature using bulk polymerization of atenolol (Ate), which is characterized by high sensitivity, low costs, and high stability. The research used 0.99:6:20 mmol ratios of template, monomer, and cross-linking agents for the polymerization in order to ensure an appropriate adsorption capacity. By making MIP for atenolol as Ate-MIP, which could be looked at with a UV-VIS spectrophotometer at 276 nm, Fourier- transform infrared spectroscopy (FT-IR), and scanning electron microscopy (SEM), a functional monomer of allyl chloride with cross-linking ethylene glycol dimethyl acrylate was made. Mass spectrometric (MS) detection may use allyl chloride to determine atenolol levels in pharmaceutical preparations. The GC/MS methods developed in this study are accurate, sensitive, and precise and can be easily applied to (NOVATEN/India and ATENOIOI/U.K.) tablets in pharmaceutical preparation. The elution process was applied to the template (Ate) from the Ate-MIP, which developed cavities, caused by using porogenic solutions of methanol, chloroform, and acetic acid (70:20:10, respectively). The maximum adsorption capacity of Ate-MIP was 2.9957 µmol/g, and the ratio of template to monomer was 1:1 in adherence to the Langmuir isotherm model. A solid-phase extraction (SPE) syringe packed with molecular imprinted polymers (MIPs) was used to selectively separate and pre-concentrate Ate from aqueous solutions and estimations of atenolol. [ABSTRACT FROM AUTHOR]

This paper summarizes the current approaches in method of extraction of okra mucilage and application in pharmaceutical drug delivery system. Okra is a species of Abelmoschus esculentus L. belongs to the family of malvacae. In India, medicinal activity of okra is reported in traditional system like Unani, siddha and Ayurveda. Pharmacological uses of okra are anti-cancer, anti-diabetic, anti-oxidant, anti-microbial and anti-ulcer activity. Easily available in tropical and sub-tropical countries, non-toxic, biodegradable and cost effective used as excipient. Okra mucilage's were extracted in different method using acetone, ethanol etc. It is a property of highly viscous the may retard the drug in sustained release. This article mainly scrutinized that okra mucilage approaches in pharmaceutical drug delivery system. [ABSTRACT FROM AUTHOR]

The study analyzes the Marine drugs research output from the year 1989-2017. The data was downloaded from the Web of Science maintained by Thomson Reuters. The findings of the study revealed that the highest number of TLCS and TGCS witnessed in the year 2010 i.e. 1131 (9.63%) and 10381 (7.29%). The study shows that a major source of publication in Marine Drugs research comes in the form of articles and India with 416 records ranked the third position among the country-wise distribution of records. [ABSTRACT FROM AUTHOR]

Traditional folk medicine has a long history and is very deep rooted in India. It was practiced since the pre-vedic periods. The vedic and post-vedic periods has celebrated noted physicians and herbalists like Charaka, Shrushut, Nagarjuna, and Vaghbhata. Indeed, the knowledge of ancient Indian medicine has survived among the primitive societies of India, the aboriginal tribal folk healers. They mostly inhabited in deep forests and remote villages. The tribals and rural people have obtained this knowledge from their fore fathers, which were in closed relation with these peoples. In the present paper some herbal drugs used in the treatment of digestive disorders were mentioned. [ABSTRACT FROM AUTHOR]

Pharmacies have hit the internet and received a warm response. Against the traditional way of buying medicines from pharmacy stores after seeking a medical advice, people are getting adapted to buying medicines online. A common practice among the druggists is to provide a substitute medicine. Customers are highly concerned and sensitive about their health. People are well aware of the fact that medicines though cure, are accompanied with major or minor side effects. Online availability of medicines has brought revolution in the health sector. Online pharmacies in India are in a nascent stage right now but have immense potential for growth. Online medicine market is growing at an exponential rate. Indian consumers are welcoming the trend of online buying of medicines. Online pharmacies provide facilities like home delivery, easy access and reminders to customers along with pocket-friendly offers. For marketers, it becomes all the more important to cater to the mindset of customers. Existing literature in the Indian context is limited to online buying of drugs by consumers without being specific to generic or non-generic. This brings forward a research gap to explore the online buying behaviour of consumers with respect to generic as well as nongeneric medicines. [ABSTRACT FROM AUTHOR]

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This paper attempts to explain a solution to tackle the problem of counterfeit medicines in India by proposing a resilient electronic health networks using blockchain. The distribution and consumption of fake medicines take thousands of lives every year. There are no effective measures to combat the network of the fake medicine syndicate in the country, and the stakeholders in the healthcare ecosystem have to work under trust-deficit relationships amongst them. Blockchain is a decentralized system of computer nodes, where each node stores the same data, and coexist with other nodes without having to trust them. The proposed solution is based on recording the medicine logistics requirements from medicine manufacturing to the patient on the blockchain network. If, at any stage, counterfeit medicine is introduced into the system, it will be detected immediately, and its further penetration will be stopped. The system is simulated using a hyper ledger fabric platform, and its performance is also compared with other existing methods. Results show that the system thus formed is computationally intensive but offers a reliable solution to the menace of fake medicines. [ABSTRACT FROM AUTHOR]

Purpose While interpretative phenomenological analysis (IPA) has been used in health psychology research, it has so far not been applied to seek deeper insights into the patients' experiences about treatment. The purpose of this paper is to address this gap by using IPA to understand patient non-adherence. Design/methodology/approach In total, 18 patients with chronic conditions seeking healthcare services in Goa and Karnataka, India, were selected by using the snowball sampling method. In-depth interviews were conducted face to face. A semi-structured questionnaire developed by the researchers was used to collect the data. IPA was used to explore the themes to predict patient non-adherence. Findings The study results indicate that economic factors, health system related factors, social factors and psychological factors impact patient non-adherence. Patient non-adherence includes medication non-adherence and lifestyle modification non-adherence. Research limitations/implications Being cross sectional in design, the results may not be as appropriate as the results derived from a longitudinal study given that non-adherence occurs over time. Practical implications Patient non-adherence is a global health issue. Multidisciplinary approach to enhance patient adherence to treatment should form part of public healthcare policy. Social implications Exploring the factors influencing patient non-adherence will help the health-care industry stakeholders to reduce healthcare cost and improve patient's quality of life. Originality/value Although there is extensive quantitative research on the prevalence of non-adherence, qualitative research is limited. This paper addresses this gap by using IPA to understand patient non-adherence and its factors and dimensions. [ABSTRACT FROM AUTHOR]

A large quantity of India's population is reduced to destitution because of high coverage health-care expenses and also suffering from antagonistic consequences of poor health care services. India has accomplished several gains in the field of Health since the new millennium, such as, life expectancy at birth has increased, the infant mortality and maternal mortality ratio has fell down and the spread of contagious diseases such as HIV/AIDS has been controlled etc. Again WHO, recently officially declared India free from maternal and neonatal tetanus and also polio free. But at the same time, among the five BRICS Nations, namely (Russia, Brazil, South Africa, China and India), India is considered as the poorest performer on the health indicators. India has failed to sufficiently protect its citizens against poor quality of health care as well as financial risks associated with health expenditure. Health Care Industries of a Country can play crucial roles not only in providing quality care and improving access to medicines for the citizens, but also in developing economic growth of the Country. Again, as it is universally accepted that Health is magnificent and efficacious investment for the economic growth of a Nation, this paper will analyze several major challenges that India need to be addressed, most notably the poor and ineffective regulation of the country, the rapid growth of commercialization of health care services, inadequate public expenditure along with very low level of public expenditure. Here the approach of Judiciary towards the various challenges surrounding the health care services in India will also be discussed. [ABSTRACT FROM AUTHOR]

Globally Cancer is the second leading cause of death and approximately 9.6 million deaths due to cancer in 2018. Approximately about 1 in 6 deaths is due to cancer globally. In low and middle-income countries approximately 70% of deaths are due to cancer. Some common cancers in Indian women are Breast, Cervix, Ovary, Mouth & Esophagus, Colorectal and other cancers. Breast cancer is the commonest cancer among women across the World as well as in India. Although rapid advancement, mammography & screening has increased rate of survival but women who survive continue to face medical, physical, social and psychosocial challenges. Evaluation of quality of life is also important for understanding the effect of treatment and how much different factors affect quality of life of the breast cancer patients. This paper aims to predict Quality of Life (QoL) in breast cancer patients using various physical, psychological, social and spiritual domains. This descriptive and cross sectional study was undertaken to determine the factors affecting quality of life (QOL) in breast cancer patients. Patient's response and hospital records analyses the dimensions which affects quality of life among breast cancer patients in the state of Uttar Pradesh. Findings suggest strong relationship between clinical and socio-demographical factors and breast cancer patients' QoL. This study demonstrates the strength of the relationship between education and physical well-being, education with social well-being and education with spiritual well-being. A strong relationship was found between marital status and spiritual well being. A strong relationship was found between clinical stage and spiritual well being. A good relationship was found between tumor stage and social and spiritual well being. A strong relationship was also found between type of treatment and physical, psychological and social well being. This study fills a gap in the literature related to QoL in Indian women suffering from carcinoma breast. [ABSTRACT FROM AUTHOR]

In 2020 editor-in-chief (Andrew Malekoff) issued a special call for papers for group work stories on pandemic 2020. Among the 28 stories accepted for the series there were 16 from India, 9 from the United States, 2 from Canada and 1 from Israel. General submissions from the U.S., Canada and Israel were typical for the journal. Atypical are submissions from India. Rather than publish the stories in one special issue of the Journal, he decided to spread them out over several issues through 2022. In the course of organizing the special series (with a December 2021 deadline) he continued communication with a few of the authors from India, with particular interest and concern in the deteriorating situation as 2021 unfolded. Although the present commentary is not about group work per se, it is an update by Ajay Saini, Nancy and Andrew Malekoff on the current state of affairs in India, with some contrast to the situation in the U.S., that offers continuing context for the stories in the series. [ABSTRACT FROM AUTHOR]

Unani System of Medicine is also known as Greco-Arabic medicine, and developed into an elaborate scientific medical system by Arab and Persian physicians, such as Rhazes (850-925AD), Avicenna (980-1037AD), Al-Zahrawi and Ibn Nafis. It is practiced in India since eighth century AD and is a recognized Indian traditional system of medicine with good infrastructure for education; research and manufacturing unitswhich are well regulated by the Government. In Unani medicine there are well developed pharmacopeia and pharmaceutical processings for single & compound formulations for the treatment of several local and systemic ailments. The most important formulation among various Unani formulations is Sharbat-e-Unnab, a Unani pharmaceutical preparation acting as Dafa-e-Sual (antitussive), Khashunat-e-Halaq (sore throat), Musaffi-e-Khoon (blood purifier), Musakkine-Hiddat-e-Khoon (suppressive blood heat) etc. Unnab (Ziziphus jujuba Mill. / Jujube) fruit is the main ingredient of the formulation. Unnab is also an ingredient of Unani Joshanda which has been recommended for relief in upper respiratory tract symptoms in mild cases of COVID-19. Few scientific studies related to Sharbat Unnab have been conducted in problems like Acne vulgaris and Primary Hypertension. Apart from this Unnab, the main ingredient has also been studied for its antioxidant and anti-cancerous activities. This formulation is being used by Unani physicians since time immemorial. Therefore, this paper will describe the brief review of the formulation along with its ingredient. [ABSTRACT FROM AUTHOR]

Ayurveda is the ancient medical system in India that uses nasal therapy. During COVID -19 pandemic, the ministry of AYUSH provided guidelines to boost immunity. The Nasya (nasal delivery) was one of the recommendations by the AYUSH ministry to boost immunity. Nasya has been still in practice for various ailments like chronic rhinitis, headache, cervical spondylosis, Dyspnea, etc., but the knowledge about how Nasya works is still unclear. This review article discusses the practice and current advances in nasal delivery in modern science. It also discusses the possible mechanism of how Nasya can act and boost immunity and what research can be done in the form of clinical and experimental studies to increase the knowledge and understanding of Nasya. [ABSTRACT FROM AUTHOR]

Background: A new contraceptive microarray patch (MAP) for women is in development. Input on this method from potential end-users early in the product development process is important to guide design decisions. This paper presents the qualitative component of a broader study exploring initial acceptability of the MAP and selected product features. The qualitative research was intended to identify product features that are most salient to end-users and to contextualize preferences around them with subsequent research planned to assess quantitatively the relative importance of those features. Methods: We conducted 16 focus group discussions and 20 in-depth interviews with women and 20 IDIs with family planning providers in New Delhi, India, and Ibadan, Nigeria. Input from the MAP developer served to identify plausible features of the MAP to include in the focus group discussions and in-depth interviews. Interviews were audio-recorded, transcribed into English, coded, and analyzed to examine key dimensions of MAP features. Results: Many participants viewed the MAP as potentially easy to use. Interest in self-application after learning correct use was high, especially in India. Participants favored formulations affording protection from pregnancy for three or six months, if not longer. Interest in a shorter-acting MAP was particularly low in Nigeria. Non-desirable MAP features included a potential localized skin rash and pain at application. Views on patch size and location of application were related to the potential for rash and pain, with a desire to permit discreet use and minimize pain. Results indicate that the side effect profile, effectiveness, and pricing are also important factors for acceptability and uptake of a future product. Conclusion: Study findings indicate that a contraceptive MAP is of potential interest to women and that specific MAP attributes will be important to acceptability. [ABSTRACT FROM AUTHOR]

Several studies have reported on the shortage of drugs with the changing demographic and disease profile, especially triggered by the growing burden of lifestyle diseases. However, very few have evaluated the demand-side challenges from the objective of universalisation of healthcare. Therefore, this study was designed to evaluate the factors that have impeded access to affordable generic and essential drugs in non-metropolitan urban and rural India. The study was conducted in six states and responses were elicited from a sample of doctors, pharmacists, nurses, accredited social health activist (ASHA) workers, state officials, warehouse managers and patients across the study states. The study reveals that while the acceptance of prescribing generic drugs has improved over the last decade, the use of branded drugs has been restricted only to complex cases or where generic drug efficacy has not been established. The centralised procurement efficiencies seem to have hit a plateau in terms of assuring drug availability to the last mile, thereby impacting local purchase, especially pandemic procurement. Most states have also established dedicated corporations for drug procurement, albeit at different levels of organisational maturity as far as adherence to the processes and systems are concerned. However, supply chain phenomena like the bullwhip effect gets accentuated given the levels of our public health system. Learnings from other consumer-facing sectors with similar challenges of increased variability and uncertainty are yet to be explored for the health sector to leapfrog towards achieving improved 'drug availability' or 'zero stock-out'. Standardising drug categories, regular updating of the essential drug list (EDL) reflecting the demographic and disease profile, various practices like complete digitisation, rolling forecasts, stock-keeping unit rationalisation, flexible public procurement contracts, etc., have been explored as potential solutions in this paper. Creating a dedicated team of forecasters within the procurement organisations, well adept at using analytics, could be key to real-time demand estimation, paving the way for a quarterly rolling forecast to facilitate procurement using well-designed rate contracts with suppliers that captures variability in such rolling forecasts. [ABSTRACT FROM AUTHOR]

Background: Medical 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. Methods: We 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. Results: Medicines 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. Conclusion: Opportunities 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. Plain language summary: Medical abortion is popular in India and benefits from a liberal legal context. It is important to understand the availability of quality abortion medicines in the country. Using the World Health Organization country assessment protocol and availability framework for medical abortion medicines we examined the availability of these medicines from supply to demand. We used this information to identify opportunities for increasing availability of quality-assured medical abortion medicines. We found that the context for medical abortion varies across states. Strengthening procurement and supply chain management, with a greater emphasis on quality-assurance and regulation of manufacturing should be instituted at the state-level. Training is also needed to increase provider knowledge of the latest national guidelines and laws to ensure respectful and person-centered services. Finally, the public should be informed about medical abortion as a safe and effective choice, especially for early abortions. [ABSTRACT FROM AUTHOR]

Background: India has very rich diversity of medicinal plants. Medicinal plants are thought to be a rich source of ingredients that can be used in the development of pharmaceutical or synthetic drugs. Aside from that, these plants play an important role in the development of human drug all over the world. Whether in modern or traditional medicine, medicinal plants are used to maintain health, to treat a specific condition, or both. Nardostachys is one of the most important medicinal plant having several therapeutic properties. It is threatened in its natural habitat due to over exploitation for therapeutic purposes and high demand in the traditional medicine system. Keeping these points in mind, we attempted to investigate alternative uses of in vitro grown plants in place of wild plants without disrupting plant-based therapeutics and market demand. And then compare the root extract of the Nardostachys jatamansi plant's antioxidant and flavonoid levels under in vitro and natural growth conditions. Methods: Nardostachys jatamansi is a plant that is widely used in traditional medicine systems. Because of its wide spread use in traditional medicine, this plant is considered endemic. In our study, we compare of antioxidant quality and Flavonoid amount of Natural and in vitro propagated Nardostachys jatamansi. Firstly we cultivated in vitro plants from Nardostachys jatamansi nodal explants for comparative analysis. The methanol extract of in vitro grown and wild-type plant root extract was then prepared using the maceration method. The extract was subjected to a comparative DPPH method to determine the presence of antioxidant potential in natural and in vitro grown plants. Furthermore, the HPLC analysis was used to detect and quantify the amount of Quercetin in both natural and in vitro propagated plants. Result: When grown in vitro at a higher concentration, the roots of Nardostachys jatamansi have greater antioxidant potential than when they are grown naturally. They demonstrated antioxidant DPPH radical scavenging activity, with an IC50 value of 29.55 µg/ml for in vitro generated plants and 24.18 µg/ml for naturally grown plants. The concentration of Quercetin (mg/ml) for natural plant species is 1.95 and for in vitro propagate plant is 1.83. The HPLC analysis presents distinct peaks, with the main peaks having retention time for standard Quercetin (10.38) in the natural plant (10.34) and in vitro grown plants (10.32). In the end, natural-type species that had been produced in vitro were used to obtain the potential of micro propagated plants. The DPPH test and flavonoid were tested on the root extract of natural and in vitro plants. Both plants displayed promising antioxidant activity and an HPLC study identified the Quercetin component. [ABSTRACT FROM AUTHOR]

Background: Active Pharmaceutical Ingredient (API) manufacturing is an important segment of the Indian pharma industry. India ranks third in terms of volume of medicines produced, and is a major global supplier of generic medicines. However, India depends heavily on the import of several raw materials used to produce some of these medicines. Main Body: This paper highlights how the situation emerged, as well as the various steps taken by the government to reduce import dependency and promote domestic manufacturing of APIs. Through various consultations with government officials, policy analysts and academicians, and interactions with key industry experts, the paper also highlights the public health perspectives of such dependence, especially regarding the secure access to essential medicines. India needs a conducive ecosystem to capitalize on the full potential of its API manufacturing capabilities, which may require some short-term and some mid/long-term interventions. Conclusions: It concludes by providing certain short-, medium- and long-term recommendations in the policy, fiscal and technology domains, to promote API independence. It also summarizes the various steps taken by the government in moving towards domestic manufacturing of APIs. [ABSTRACT FROM AUTHOR]

Introduction: Training young doctors is essential for carrying out need-based research. The field of Traditional Medicine (TM) has made significant contributions to modern medicine, and there is unlimited scope for exploring it further in search of improved treatment options. However, there is a lack of systematic research studies on traditional medicines. It was, therefore, considered necessary to assess the interest and awareness among modern medicine practitioners regarding Traditional Medicine Research (TMR). Aim: To assess the need for training in TMR among modern medicine practitioners. Materials and Methods: A cross-sectional questionnaire-based study was conducted in the Department of Pharmacology and Therapeutics at Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India, from March 2020 to September 2020 among modern medicine practitioners from the Western region of India. A validated questionnaire was used to collect data regarding the level of training in research methodology, research experience including TMR, areas for training, attitude towards training in TMR, challenges in TMR, and therapeutic areas to focus TMR efforts. The data were analysed using descriptive statistics. Results: Out of 109 participants, 96 (88.1%) were trained in research methodology. At least one research project was undertaken by 91 (83.5%) participants. Ninety-seven percent of participants felt that TMR was necessary. TMR was conducted by 19 (17.4%) participants. Approximately 65 (59.6%) participants felt that conducting TMR poses challenges such as lack of funds, infrastructure, lack of belief in TM, unavailability of literature pertaining to TM, lack of expertise, and lack of corporate attention and marketing. Therapeutic areas identified to focus research efforts included lifestyle-related disorders, diabetes mellitus, cancer, ageing, allergic disorders, osteoarthritis, and obesity. Conclusion: All the participants expressed the need to undergo training in TMR. However, the experience of conducting TMR was limited. Lack of funds, infrastructure, and expertise were mentioned as the main hurdles in undertaking TMR. It is essential to conduct systematic and need-based training programs for modern medicine practitioners in basic research methodology and TMR. [ABSTRACT FROM AUTHOR]

Introduction: Pneumonia is the leading cause of death from infection in children worldwide. Despite global treatment recommendations that call for children with pneumonia to receive amoxicillin dispersible tablets, only one-third of children with pneumonia receive any antibiotics and many do not complete the full course of treatment. Poor adherence to antibiotics may be driven in part by a lack of user-friendly treatment instructions.Objective: In order to optimise childhood pneumonia treatment adherence at the community level, we developed a user-friendly product presentation for caregivers and a job aid for healthcare providers (HCPs). This paper aims to document the development process and offers a model for future health communication tools.Methods: We employed an iterative design process that included document review, key stakeholder interviews, engagement with a graphic designer and pre-testing design concepts among target users in India and Kenya. The consolidated criteria for reporting qualitative research were used in the description of results.Results: Though resources for pneumonia treatment are available in some countries, their content is incomplete and inconsistent with global recommendations. Document review and stakeholder interviews provided the information necessary to convey to caregivers and recommendations for how to present this information. Target users in India and Kenya confirmed the need to support better treatment adherence, recommended specific modifications to design concepts and suggested the development of a companion job aid. There was a consensus among caregivers and HCPs that these tools would be helpful and improve adherence behaviours.Conclusions: The development of user-friendly instructions for medications for use in low-resource settings is a critically important but time-intensive and resource-intensive process that should involve engagement with target audiences. [ABSTRACT FROM AUTHOR]

Objective: To test an infographic two-pager on medication abortions (MA) aimed to improve pharmacists counseling in India.Methods: A quantitative baseline survey was conducted among 283 pharmacists in three districts around Lucknow, Uttar Pradesh in January 2018. The intervention (infographic) was given to 117 of these pharmacists a few weeks later and a follow-up survey was conducted 3 months later with 281 pharmacists. In addition, mystery clients were sent to 115 of the pharmacists.Results: A statistically significant improvement in knowledge post-intervention was found, compared to pre-, for almost all quality items measured. Difference-in-difference estimators showed a difference in knowledge among indicators related to misoprostol in particular. However, mystery client reports showed few differences in pharmacist behaviors between intervention and control pharmacists.Conclusion: This simple, paper-based intervention, which required no training, showed a significant improvement in pharmacists' knowledge and was welcomed by the providers. Translating knowledge into behavior change, however, seems more difficult to impact. Adapting this simple intervention to motivate providers to change behaviors could improve the quality of care provided by pharmacists in India. [ABSTRACT FROM AUTHOR]

Background: Non-communicable diseases (NCDs) are a leading cause of death globally and disproportionately affect those in low- and middle-income countries lower-middle-income countries. Poor medication adherence among patients with NCDs is prevalent in India due to lack of initiation, missed dosing or cessation of treatment, and represents a growing healthcare and financial burden. Objective: This study aimed to identify factors influencing medication adherence in adults with NCDs in India. Methods: We performed a cross-sectional study, conducting secondary data analysis on the second wave of the World Health Organisation’s ‘Study on global AGEing and adult health (SAGE)’, a survey that collected data from predominantly older adults across India. Bivariate analysis and multivariate logistic regression modelling were conducted to specifically interrogate the reasons for lack of initiation and cessation of treatment. Reporting of this study was informed by the STROBE guidelines. Results: The average medication adherence rate was 51% across 2,840 patients with one or more NCDs, reflecting non-initiation and lack of persistence of treatment. The strongest factor significantly predicting non-adherence to medication across these components was multimorbidity (odds ratio 0.47, 95% CI 0.40–0.56). Tobacco use (OR = 0.76, CI 0.59–0.98) and never having attended school (OR = 0.75, CI 0.62–0.92) were significantly associated with poor medication adherence (p < 0.05) while rural living (OR = 0.70, CI 0.48–1.02), feelings of anxiety (OR = 0.84, CI 0.66–1.08) and feelings of depression (OR = 0.90, CI 0.70–1.16) were factors lacking statistically significant association with medication adherence on multivariate analysis. Older age (OR = 2.02, CI 1.51–2.71) was significantly associated with improved medication adherence whilst there was a weak association between increased wealth and improved medication use. Limitations: The SAGE2 survey did not capture whether patients were taking their medication doses according to prescribed instructions—as a result our findings may under-estimate the true prevalence of medication non-adherence. Conclusion: Our analysis provides evidence that poor medication adherence in India is multifactorial, with distinct socioeconomic and health-system factors interacting to influence patient decision making. Future large-scale surveys interrogating adherence should assess all components of adherence specifically, whilst public health interventions to improve medication adherence should focus on barriers that may exist due to multimorbidity, comorbid depression and anxiety, and low educational status. [ABSTRACT FROM AUTHOR]

Opioid dependence affects several neurocognitive domains, which can negatively affect the treatment outcome. Examining the relationship between neurocognitive functions and short-term treatment retention in subjects on buprenorphine-naloxone-based agonist treatment. We recruited 56 subjects (aged between 18 and 45 years) registered between March 2017 and December 2017. We excluded subjects dependent on other substances (except cannabis and tobacco), along with medical and other psychiatric comorbidities. During the first week of the agonist treatment, we assessed executive function, decision-making, attention, psychomotor speed, and working memory with the Wisconsin card sorting test (WCST), Iowa gambling test (IGT), and Trail making and verbal and visual N-back tests. Treatment retention was assessed after 12 weeks. The mean age of the subjects was 26 (±5.9) years. Twenty-eight (50%) subjects were retained in the treatment. Neurocognitive functions at the treatment entry did not differ between subjects retained in the treatment and those who dropped out. A higher severity and lower duration of dependence and use were associated with higher treatment discontinuation. The regression model, with the cognitive functions and significant clinical variables, could explain 38% variance for treatment retention. Neurocognitive functions at the treatment entry did not predict retention in opioid agonist treatment. There is some evidence of baseline cognitive functions predicting treatment retention in substance use disorders We wanted to test it in a group of patients on buprenorphine (naloxone)-based agonist management Relevant clinical and demographic variables were controlled for Executive functions, decision-making, attention, psychomotor speed, and working memory at the treatment entry did not predict retention at the end of three months Longer duration of opioid use (and dependence) was associated with better treatment retention [ABSTRACT FROM AUTHOR]

Objective: Neurological disorders are a major cause of morbidity, mortality and disability. These adversely affect the quality of life among all age group patients. Majority of neurological disorders include Epilepsy, Headache, Cerebrovascular disorders with hemiparesis, Neuropathic pain, Extrapyramidal syndrome, Cervical myelopathy and Parkinson's disease. This study was done with aim to evaluate the prescription pattern of various drugs in different types of neurological disorders and to use the WHO / INRUD prescribing indicators to assess the rational drug prescribing. Materials and Methods: A Prescription-based, Observational prospective study was carried out in a tertiary care hospital at South India. The prescription data of patients attending the neurology outpatient department was analysed over a period of 2 months. Rational use of drugs was analysed by the INRUD Scale. Results: Out of these, 166 patients were male, whereas 134 patients were female. Most prevalent neurological disorders were Trigeminal neuralgia (25.66%), 9.97% of the patient population received injections, with 4% receiving Inj. Dexamethasone 8mg. Overall drug prescribing performance scoring was 3.55. Conclusion: Our study revealed good Prescribing pattern as shown by WHO scale-IRUD/INRUD. Further such studies with large sample size are needed so as to guide clinicians toward rationale drug. [ABSTRACT FROM AUTHOR]

Background: There is underutilization of long-acting injectable (LAI) antipsychotics for first-episode schizophrenia (FES) despite having convenient dosing and treatment retention. LAIs are predominantly used for patients with poor compliance, chronic course, and multiple relapses. Materials and Methods: Seventy-two treatment naïve patients with the first episode of Schizophrenia (DSM-5) were assessed for baseline severity of psychopathology using the positive and negative syndrome scale (PANSS) and quality of life (QOL) using the WHOQOL-BREF scale. Patients were randomized to receive either oral haloperidol or LAI haloperidol for a period of 12 weeks. Results: Both the groups had a significant reduction in PANSS scores and improvement in QoL over 12 weeks period (P = 0.0001). The LAI group showed greater adherence and significantly better quality of life than the oral group (P = 0.023). The mean numbers of side effects were less in the LAI group at week 2 as compared to the oral group. Conclusion: LAI haloperidol is similar to oral haloperidol in patients with FES with respect to treatment response and offers benefits in form of a lesser number of side effects during early treatment, overall better adherence rates, and better QOL. [ABSTRACT FROM AUTHOR]

Introduction: Medication use during pregnancy is a major concern in India and poor awareness is driven by non scientific information sources. Primary care providers play a role in providing information on risk of teratogenic and folate deficiency birth defects. Aim: To assess Knowledge, Attitude and Practice (KAP) of pregnant women attending antenatal clinic regarding medication use and self-medication during pregnancy. Materials and Methods: This cross-sectional study was conducted on 100 pregnant women attending the antenatal clinic in a tertiary care teaching hospital of Eastern India from August to October 2021. The study looked at sources of drug information, attitudes regarding medication use and practice of medication use and self-medication among pregnant mothers attending antenatal clinic of the hospital. Consenting women were enrolled in the study and the qualitative data gathered from the women were analysed using tools of descriptive statistics. Results: This study included 100 pregnant women with mean age of 22±2.0 years of which 42% were primigravida. Of the participants 80% had atleast high school education. Two third of the mothers 66% cited their family members as source of their drug information and 76% were aware of the risks of self-medication during pregnancy. Self medication practice was seen in 25% pregnant women mainly with Paracetamol use for pain or over-the-counter drugs to control acid reflux and morning sickness symptoms. All the participants (100%) took their iron and folic acid supplements as advised. Conclusion: The pregnant women attending the hospital showed adequate knowledge and satisfactory practices regarding medication use. Counselling of the mothers attending the clinic regarding drug use and possible harms to the mother and baby can help reduce long-term risks. [ABSTRACT FROM AUTHOR]

Background: Anti-retroviral therapy (ART) for HIV has changed a highly fatal disease to a chronic manageable condition. National technical guidelines by NACO say that adherence of >95%(optimal) is required for optimal viral load suppression which is a challenge both for the patient and the health system. Objectives: This study was conducted to determine the reasons for missed and lost to follow-up (LFU) cases and to assess the impact of the COVID pandemic on ART adherence. Settings and Design: Cross-sectional study conducted at ART center, Jhansi. Methods and Material: 357 patients were administered a self-designed questionnaire after taking informed consent to enquire about the reasons for missing doses and LFU and whether they missed treatment during the lockdown. Statistical analysis used: The results were expressed in frequencies and percentages and appropriate statistical tests were applied. Results: 72% HIV patients had optimal adherence and 6.7% were on second-line treatment. Out of 357 patients, 56 had missed treatment and 10 were LFU. The main reasons for the missing were run out of pills, busy with other things and being away from home. The number of episodes of missed and LFU increased during the pandemic. The main problems faced were lack of transport (24), fear of catching the disease (7), no money to hire a vehicle (5). Conclusions: Constant monitoring and handholding of those with suboptimal adherence is required. Travel allowance to such patients and regular counseling will help to ensure adherence. Long-term solutions include vocational rehabilitation and awareness programs to reduce stigma and discrimination. [ABSTRACT FROM AUTHOR]

BACKGROUND: The concept of listing essential medicines can lead to improved supply and access, more rational prescribing, and lower costs of drugs. However, these benefits hinge on the prescription of drugs from an Essential Medicines List (EML). Several studies have highlighted the problem of underutilization of EMLs by prescribers. Therefore, as part of prescription research by the Indian Council of Medical Research-Rational Use of Medicines Centres Network, we evaluated the extent of prescription of drugs not listed in the National List of Essential Medicines (NLEM). MATERIALS AND METHODS: Prescriptions of outpatients from participating centers were included after obtaining verbal/written informed consent as approved by the Ethics Committee, and evaluated for prescription of drugs from the NLEM 2015. RESULTS: Analysis of 4838 prescriptions from 13 tertiary health-care institutes revealed that 2677 (55.33%) prescriptions had at least one non-NLEM drug prescribed. In all, 5215 (31.12%) of the total 16,758 drugs prescribed were not in NLEM. Of these, 2722 (16.24%) were single drugs and 2493 (14.88%) were fixed-dose combinations (FDCs). These comprised 700 different drug products – 346 single drugs and 354 FDCs. The average number of non-NLEM drugs prescribed per prescription was 1.08, while the average number of all drugs prescribed was 3.35 per prescription. It was also found that some of the non-NLEM drugs prescribed had the potential to result in increased cost (for example, levocetirizine), increased adverse effects (dextromethorphan), and less effectiveness (losartan) when compared to their NLEM counterparts. Nonavailability of an essential drug (oral hydroxocobalamin) was another important finding of our study. CONCLUSION: This study highlights the extent and pattern of drugs prescribed from outside the NLEM at the tertiary health-care level and the need for training and enhanced awareness among prescribers for greater utilization of the NLEM. [ABSTRACT FROM AUTHOR]

Dietary intake during pregnancy plays a vital role in determining the health of both mother and baby. Maternal undernutrition affects a large proportion of women in low and lower middle income countries (LLMIC) likely influencing high maternal, infant, and child mortality in these countries. Mobile health (mHealth) interventions have been proposed as effective solutions to improve maternal and neonatal health. This paper reviews the literature to evaluate the effectiveness of mHealth interventions on improving dietary/nutrients intake of pregnant women in LLMIC. Eight electronic databases were searched from inception up to April 2018, including the MEDLINE, EMBASE, CINAHL, Cochrane, Web of Science, Scopus, Global Index Medicus, and Maternity and Infant Care. Using Covidence, two reviewers assessed articles for inclusion, assessed study quality and extracted data. Only studies published in English language were included. Data were summarised narratively. In total, 6,778 were identified of which four were included, with three randomised controlled trials and one prepost experimental study. Studies were conducted in India (n = 2), Indonesia (n = 1), and Kenya (n = 1). All articles evaluated the use of nutrient supplements; iron supplements (n = 1), vitamin supplements (composition not mentioned; n = 1), or calcium supplements (n = 1). This review suggests that mHealth interventions can be used to improve intake of micronutrient supplementation and nutritional status of pregnant women in LLMIC. Further studies are needed to address the limited evidence base related to mHealth nutrition interventions targeting dietary intakes of pregnant women in LLMIC. [ABSTRACT FROM AUTHOR]

Even more than two years, Coronavirus Disease 2019 (COVID-19) has been emerging as a harshening name which influence the health indicator of human being by life threatening illness in all over world. It had been revealed first time in Wuhan, China, in December 2019. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the etiological sources of COVID-19. There is currently no precise treatment or vaccine against COVID-19. India is second highly condensed country in the world, where is the limited sources of earning, education as well as technology. Therefore, in the shortcoming of pharmaceutical preparation, the advanced implementation of precautions and hygienic measures will be essential to control and to minimize human transmission of the virus. In response to the rapidly escalating number of publications on the emerging disease, this review attempts to provide a timely and comprehensive review of recent development and present situation of India in view of COVID-19. It has been more than two years of this havoc, still it is not eradicated completely. We will cover the preliminary knowledge towards the epidemiology, etiology, virology, diagnosis, treatment, prognosis, and prevention of the disease in the world as well as in India. Meanwhile many questions will be arising day by day; we are expecting that this review helps in the understanding and eradication of the threatening disease as a future outcome. [ABSTRACT FROM AUTHOR]

Background: Iron-folic acid deficiency is the most common complication during pregnancy. Iron deficiency is responsible for various health complications among pregnant women. Compliance with IFA supplementation is variable across India several factors are associated with compliance with IFA supplementation. Objective: The objective of this systematic review is to assess the factors affecting compliance toward oral iron-folic acid supplementation among pregnant women in India. Methods: The primary search was carried out using PubMed, Google scholar, the WHO website, and Research Gate which provide access to full-text research articles from January 2012 to 25th January 2022 published data were searched. Result: A total of 74 studies were identified, and 20 were included in this review. Out of the 20 studies, sixteen were cross-sectional, two mixed methods, and two randomized control trials. knowledge of IFA, education, socioeconomic status, the timing of registration and number of antenatal visits, type of family, and age of the pregnant women were the factors that affect the compliance of IFA supplementation. Conclusion: Knowledge of iron-folic acid supplementation, Timing of registration and number of Antenatal Care visits, educational level of the pregnant women, and age of the pregnant women were factors associated with the compliance of IFA supplementation among pregnant women in India. [ABSTRACT FROM AUTHOR]

Objectives: This study explored the subjective accounts of the main barriers to self-monitoring of blood-glucose (SMBG) and medication-management among Indian patients with type 2 diabetes (T2DM), their primary family-members (PFMs) and physicians. Methods: Using convenience sampling, patients with T2DM, their PFMs, and physicians, residing in a South Indian capital city, were recruited for semi-structured, audio-recorded interviews. Thematic analysis was used to analyze the data. Results: Fifty patients (female = 14; mean age = 42.5 years) and their PFMs (female = 38; mean age = 39 years), and 25 physicians (female = 4; mean age = 49.8 years) were recruited. Three superordinate themes were identified: (i) complex medication-regimen: confusion, forgetting and reduced motivation, (ii) family recommendations of alternative therapies due to the social pressures of avoiding stigma, intrusiveness and being misrepresented for injecting insulin, and (iii) an expensive illness: choosing to spend money on only medication. Discussion: Implications of the findings highlight the need to (i) train physicians in communication and empathy skills, (ii) empower patients to communicate their barriers to physicians through triadic communication models and question-prompt lists, (iii) educate communities on the benefits of insulin for managing T2DM to reduce stigma, and (iv) equip communities with information about health insurance to address the financial toll of T2DM management. [ABSTRACT FROM AUTHOR]

The article presents a research paper that aims to develop strategy to eliminate lymphatic filariasis (LA) in remote islands of the Bay of Bengal caused by Nicobarese. It informs that the National programme to eliminate lymphatic filariasis (PELF) was launched by the Directorate of Health Services in India in 2004 through mass drug administration (MDA) with albendazole.

Background: Disability certification is an essential requirement to avail of the various disability benefits including disability pension, family pension, insurance, income tax rebate, travel concession etc. The lack of awareness among persons with mental illness and their caregivers is a major barrier in availing such benefits. Aim of the study: To assess the socio-demographic and clinical variables along with the pattern of utilization of disability certificates for disability benefits by the persons with disability (PwD) having a mental illness. Materials and Methods: Consecutive patients who obtained disability certificates due to mental illness in the last 5.5 years were contacted and their responses were recorded on a semi-structured questionnaire telephonically. Result: Over a period of 5.5 years 123 certificates were issued to individuals of which 100 were contacted. Out of the 123 cases, 11 could not be contacted, one patient didn't collect the certificate to date, 6 patients expired after obtaining the certificate and 5 didn't come for reassessment. Out of the 100 cases who participated in the study, 91 persons (91%) mentioned that these certificates were useful for them. Regarding the disability-related benefits, 51% had received a disability pension, 43% used it for travel concession and the rest (1% to 9%) used it for getting income tax rebates, insurance and family pension. While exploring and interviewing for additional benefits other than those available currently by the Government of India, 13% wanted to get free medicines, 17% wanted increased job opportunities and 2% wanted to have a smooth procedure for availing benefits. Of those contacted, 19% also disseminated the information about the disability certification and the related benefits to other needy persons. Conclusion: The utilization of disability certificates by those with mental illness is largely limited mostly to availing pension or travel concession. [ABSTRACT FROM AUTHOR]

The present situation of sports led to a debate on the ways to improve the sports ecosystem in the country. It is against this backdrop, and it is pertinent to understand, analyze, and interpret the factors adversely affecting the sports in India and the steps taken by the government to rectify the situation. The purpose of the study is not only to assess the effectiveness of National Anti-Doping Agency (NADA) but also to reflect upon the critical challenges that the agency continues to face. So, the Author have elaborated the present challenges of Indian sports and where India lacks in achieving doping-free sports. The author has used doctrinal and analytical research methodology, including books, internet resources, case laws, journals, and articles. It is found that the main challenge in Indian sports regarding anti-doping program are Increase in drug use, Corruption, Lack of education and awareness and Inefficiency of NADA. From these challenges, it is clear and evident that the anti-doping program is not effectively working in India. The schemes, programs and efforts of the Government of India are necessary but not sufficient. [ABSTRACT FROM AUTHOR]

Pharmaceuticals and personal care products (PPCPs) are receiving global scientific attention due to their occurrence, persistence and risk to aquatic and terrestrial organisms. In this study, we investigated the occurrence of 19 PPCPs in 6 lakes and River Nag in the city of Nagpur, India. Grab samples were collected and screened by LC–MS/MS. A total of 13 compounds were detected. In the multiple‐site monitoring study, metformin (19–94 µg/L) and triclosan [upto 74.3 µg/L] were identified as the major PPCPs. In the single‐site study (performed for 2 days at 2‐hour interval), a spike was observed in the evening of Day 1, for example, atenolol (0.39–35.9 µg/L), metoprolol (ND‐26.4 µg/L), acetaminophen (1.64–14.2), naproxen (0.5–15.9 µg/L), etc. The maximum number of compounds were detected in Lake Futala (13), followed by Gandhisagar (7), Khindsi (6), Ambazari (4), Koradi (4) and Gorewada (1). Triclosan and methylparaben were the major compounds in lake samples. [ABSTRACT FROM AUTHOR]

Background: The pharmacological efficiency of herbal drugs has shown to be effective as conventional pharmaceutical drugs. Preliminary screening of herbal extracts helps in analysing the bioactive compounds present. Ocimum sanctum, the queen of herbs keeps a spiritual importance in Indian culture and have important place in traditional medicinal system of India. Objectives: The present study was implement to investigate the preliminary phytochemical screening and GC-MS analysis of leaf extract of O. sanctum to determine the phytoconstituents. Materials and Methods: Leaves collected were dried, crushed and mixed with ethanol and water and further applied for extract preparation. The prepare extract was used for phytochemical and GC-MS analysis. Results: In qualitative phytochemical analysis tannins, carbohydrate, quinine, anthraquinones, coumarins, phlobatanins, alkaloids, flavonoids, glycosides, terpenoids, diterpenes, phenols were found present while GC-MS analysis showed Eugenol, Cyclohexane, bicyclo[7.2.0]undec-4-ene, 4,11,11-trimethyl-8-methylene, Oxatricyclo[ 8.2.0.0(4,6)]dodecane, 12-trimethyl-9-methylene, Tetracontane, Phytol were present in majority. Conclusion: The study concluded that O. sanctum leaf extracts contain many biological active compounds which could be exploited for a development of plant based drug. [ABSTRACT FROM AUTHOR]

Background: A large proportion of non-communicable diseases (NCDs) are treatable within primary health care (PHC) settings in a cost-effective manner. However, the utilization of PHCs for NCD care is comparatively low in India. The Access-to-Medicines (ATM) study examined whether (and how) interventions aimed at health service optimization alone or combined with community platform strengthening improve access to medicines at the primary health care level within the context of a local health system.Method: A quasi-randomized cluster trial was used to assess the effectiveness of the intervention (18 months) implemented across 39 rural PHCs (clusters) of three sub-districts of Tumkur in southern India. The intervention was allocated randomly in a 1:1:1 sequence across PHCs and consisted of three arms: Arm A with a package of interventions aimed at health service delivery optimization; B for strengthening community platforms in addition to A; and the control arm. Group allocation was not blinded to providers and those who assessed outcomes. A household survey was used to understand health-seeking behaviour, access and out-of-pocket expenditure (OOP) on key anti-diabetic and anti-hypertension medicines among patients; facility surveys were used to assess the availability of medicines at PHCs. Primary outcomes of the study are the mean number of days of availability of antidiabetic and antihypertensive medicines at PHCs, the mean number of patients obtaining medicines from PHC and OOP expenses.Result: The difference-in-difference estimate shows a statistically insignificant increase of 31.5 and 11.9 in mean days for diabetes and hypertension medicines availability respectively in the study arm A PHCs beyond the increase in the control arm. We further found that there was a statistically insignificant increase of 2.2 and 3.8 percentage points in the mean proportion of patients obtaining medicines from PHC in arm A and arm B respectively, beyond the increase in the control arm.Conclusion: There were improvements in NCD medicine availability across PHCs, the number of patients accessing PHCs and reduction in OOP expenditure among patients, across the study arms as compared to the control arm; however, these differences were not statistically significant.Trial Registration: Trial registration number CTRI/2015/03/005640 . This trial was registered on 17/03/2015 in the Clinical Trial Registry of India (CTRI) after PHCs were enrolled in the study (retrospectively registered). The CTRI is the nodal agency of the Indian Council of Medical Research for registration of all clinical, experimental, field intervention and observation studies. [ABSTRACT FROM AUTHOR]

Suboptimal adherence to Antiretroviral Therapy (ART) regimens can lead to the development of drug resistance, virologic and clinical failure, and, on the community level, the spread of drug-resistant HIV. To design effective interventions, it is crucial to understand locally specific barriers to optimal adherence. Self-report data from a cross-sectional sample of 527 adherence-challenged people living with HIV (PLWH) in the South-Indian state of Karnataka showed that they took on average 68% of prescribed doses in the past month. Large majorities of participants encountered individual (95%), social/structural (88%), and clinic/regimen (80%) adherence barriers. Multivariate linear regression analyses of past month adherence showed that disclosure to all adults in the household was positively related to adherence, as was employing a larger number of adherence strategies, perceiving more benefits of ART, and having been on ART for longer. Fears of stigmatization upon disclosure of HIV-status to friends and people at work were negatively related to adherence. These results suggest that some barriers, especially individual-level barriers like forgetfulness are very common and can be targeted with relatively simple individual-level strategies. Other barriers, related to fear of stigma and lack of disclosure may require family- or community-level interventions. [ABSTRACT FROM AUTHOR]

Background: Generic drugs are low-cost alternatives to branded drugs. The government of India is encouraging physicians to prescribe the generics to decrease out-of-pocket expenditure of health care. Looking at India's low-prescription on generic drugs, it is crucial to analyze the factors responsible for it. A patient's unawareness may be an important factor; hence, it should be evaluated systematically. Objectives: This study was designed with the aim of assessing knowledge and perception of generics among patients visiting the outpatient department of primary care physicians at the Patan city of Gujarat. Material and Methods: A trained research associate visited the OPDs of various general practitioners to collect the data. A prevalidated questionnaire was administered to these patients. The data was analyzed with the help of statistical software. Descriptive statistics were used to analyze the data. Results: Among 345 patients, only 33.6% reportedly heard about generics. Of these only a few patients (<13%) had used the generic drugs in past. The majority (>60%) believed that generics are safe. Those who were not willing to take generics reported efficacy as the major concern. Out of various factors that may affect knowledge of generic drugs, young age (OR = 5.3) and education (Primary (OR = 8.01), Secondary (OR = 6.19), and Higher secondary (OR = 3.07) were statistically significant. Conclusion: Awareness about the generic drugs was low among the patients visiting the primary care physician. The young age and primary and secondary education levels were significantly associated with the awareness regarding generics. [ABSTRACT FROM AUTHOR]

Summary: Background: Dermatophytic infections have undergone unprecedented changes in India in the recent past. Clinical trials to find out the effectiveness of the four main oral antifungal drugs are lacking. Objectives: We tested the effectiveness of oral fluconazole, griseofulvin, itraconazole and terbinafine in chronic and chronic relapsing tinea corporis, tinea cruris and tinea faciei in an investigator‐initiated, randomized, pragmatic trial. Methods: Two hundred patients with microscopy‐confirmed tinea were allocated to four groups (50 patients in each group): fluconazole 5 mg kg−1 per day, griseofulvin 10 mg kg−1 per day, itraconazole 5 mg kg−1 per day and terbinafine 7·5 mg kg−1 per day. Allocation was performed by concealed block randomization and the patients were treated for 8 weeks or until cure. Effectiveness was calculated based on intention‐to‐treat analysis. The trial was registered with the Clinical Trials Registry India (CTRI/2017/04/008281). Results: At 4 weeks, all drugs were similarly ineffective, with cure rates being 8% or less (P = 0·42). At 8 weeks, the numbers of patients cured were as follows: fluconazole 21 (42%), griseofulvin seven (14%), itraconazole 33 (66%) and terbinafine 14 (28%) (P < 0·001). Itraconazole was superior to fluconazole, griseofulvin and terbinafine (adjusted P ≤ 0·048). Relapse rates after 4 and 8 weeks of cure with the four treatments were not different (P ≥ 0·42). Numbers needed to treat (vs. griseofulvin), calculated on the basis of cure rates at 8 weeks, were as follows: fluconazole 4, itraconazole 2 and terbinafine 8. Conclusions: The results show limited effectiveness of all four antifungal drugs. In view of cure rates and the number needed to treat, itraconazole is the most effective drug, followed by fluconazole (daily), terbinafine and then griseofulvin, in chronic and chronic relapsing dermatophytosis in India. What is already known about this topic? Oral antifungal drugs are considered to have a high cure rate in tinea corporis, tinea cruris and tinea faciei.Unprecedented changes have been noticed in the last few years in India in the morphology, course and treatment responsiveness of tinea; however, data about the effectiveness of oral antifungals are lacking. What does this study add? Our results show limited effectiveness of four oral antifungal drugs (fluconazole, griseofulvin, itraconazole and terbinafine) in the current epidemic of altered dermatophytosis in India.Among the four drugs tested, oral itraconazole is the most effective. Linked Comment:Elewski. Br J Dermatol 2020; 183:798–799. What is already known about this topic? Oral antifungal drugs are considered to have a high cure rate in tinea corporis, tinea cruris and tinea faciei.Unprecedented changes have been noticed in the last few years in India in the morphology, course and treatment responsiveness of tinea; however, data about the effectiveness of oral antifungals are lacking. What does this study add? Our results show limited effectiveness of four oral antifungal drugs (fluconazole, griseofulvin, itraconazole and terbinafine) in the current epidemic of altered dermatophytosis in India.Among the four drugs tested, oral itraconazole is the most effective. Linked Comment:Elewski. Br J Dermatol 2020; 183:798–799. Plain language summary available online [ABSTRACT FROM AUTHOR]

Introduction: Most studies on opioid agonist treatment (OAT) from South Asia have assessed retention over short term. The aim of this study was to assess retention rates on buprenorphine-based OAT in a community clinic at 6 years, and to assess factors associated with long-term retention. Methods: Retrospective cohort study. Consecutive case records of patients with opioid dependence syndrome (as per International Classification of Diseases, Version 10) started on buprenorphine from 2005 to 2007 were reviewed for 6 years after an individual's initiation on buprenorphine. Multi-variate logistic regression and odd's ratio was used to assess variables that could predict retention to buprenorphine. Results: The OAT retention rate of 150 participants by the sixth year was 36%. Mean dose of buprenorphine was 6.4 milligram per day (SD: 2.3). Opioid withdrawals (OR: 0.05, 95% CI: 0.01–0.52), concomitant opioid use (OR: 0.02, 95% CI: 0–0.14), and visits to counselor (OR: 0.1, 95%CI: 0.01–0.87) predicted poor retention to buprenorphine maintenance. Improved occupational functioning (OR: 14.08, 95%CI: 4.62–42.93) significantly predicted OAT retention. Adjusting for other variables, illicit opioid use (OR: 0.04, 95%CI: 0–0.37) negatively predicted, while improved occupational functioning (OR: 12.96, 95%CI: 3.43–48.91) positively predicted retention. Conclusion: Patients have fairly good long-term retention rates on OAT with buprenorphine in community-based setting. Maintaining abstinence and improved occupational functioning improve buprenorphine retention. [ABSTRACT FROM AUTHOR]

We conducted a systematic review and meta-analysis to estimate the prevalence of adherence to antiretroviral therapy (ART) in India, the third largest HIV epidemic in the world. We identified peer reviewed literature published between 2007 and 2017 to extract data on ART adherence. We estimated pooled prevalence of adherence to ART using a random-effects model. Thirty-two eligible studies (n = 11,543) were included in the meta-analysis. Studies were mostly clustered in the southern and western Indian states. Overall, 77% (95% Confidence Interval 73–82; I2 = 96.80%) of patients had optimum adherence to ART. Women had higher prevalence of optimum adherence compared to men. Depression or anxiety were significant risk factors in seven of the fifteen studies reporting determinants of nonadherence. Studies should be performed to explore the reasons for gender gap in ART adherence and HIV program in India should prioritize mental health issues among HIV patients to improve ART adherence. [ABSTRACT FROM AUTHOR]

HIV seropositive adherence-challenged women, who reported being on ART for at least four months were interviewed. Data on healthcare history, anti-retroviral therapy, clinic visits, doctor communication, disclosure and fear of stigma were collected. Better engagement in care was significantly more likely among older women, ≥ 10 years of education, higher income, HIV status disclosure to family, with higher community stigma fears and fewer healthcare access barriers. To promote retention, women may be encouraged to consider disclosing their HIV serostatus to supportive household members. A variety of possible interventions to overcome the prevalent barriers to care are provided. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Cytochrome P450 2D6 (CYP2D6) enzyme metabolizes a quarter of prescription drugs. Polymorphisms of CYP2D6 gene and resultant phenotypic variations in metabolic activity have been described in various populations. We assessed the prevalence of CYP2D6 activity phenotypes, employing dextromethorphan (DXM) as probe drug in subjects with at least two parental generations residing in eastern India. MATERIALS AND METHODS: Unrelated healthy subjects took 60 mg DXM after fasting overnight. Blood samples were collected 3 h after dosing and plasma separated. DXM and its primary metabolite dextrorphan (DXT) were measured by liquid chromatography with tandem mass spectrometry. The DXM-to-DXT metabolic ratio (MR) was obtained for each subject. Histogram of MR values suggested bimodal distribution. A polynomial regression equation derived through probit analysis was solved to identify the antimode of the MR values. Subjects with log(MR) < antimode were extensive metabolizers (EMs). Log(MR) = antimode indicated poor metabolizers (PMs). RESULTS: We evaluated the results from 97 participants. The median MR was 0.209 (interquartile range: 0.090-0.609), while the antimode for MR was 3.055. From these, it was inferred that three subjects were PMs, while the rest were EMs. CYP2D6 polymorphism prevalence is low (3.09%; 95% confidence interval: 0.35%-6.54%) in the population of eastern India and matches the prevalence in other zones of the country. CONCLUSIONS: Differences in CYP2D6 activity has treatment implications and may lead to adverse events or therapeutic failure. Phenotyping of subjects receiving CYP2D6 metabolized drugs may help clinicians personalize treatment and avert adverse drug-drug interactions. However, the frequency of the PM phenotype is low in India, and routinely phenotyping for CYP2D6 activity will not be cost-effective. We cannot recommend it at this stage. [ABSTRACT FROM AUTHOR]

Background: Jan Aushadhi, a scheme to make affordable generic drugs available to large sections of population was launched by the Government of India across the country in the year 2008. This exploratory research was conducted to study the attitude of customers (Bengaluru, India) towards acceptance of Jan Aushadhi and an attempt was made to model buying behavior in order to suggest mechanisms to speed up the acceptance. Materials and Methods: Data was collected using structured questionnaire. Z-test and Exploratory factor analysis was conducted for hypothesis testing. Discriminant analysis was conducted to model consumption. Results and Conclusion: The variables that discriminated consumers from non-consumers were ‘effectiveness’, ‘doctor’s opinion’, ‘lower price’, ‘Quality’, ‘less expensive than other branded medicines’, ‘doctor’s prescription’, ‘convenience’, ‘doctor informs’, ‘home delivery’ and ‘brand reputation’. Results found that ‘doctor’s prescription’, ‘lower price’, ‘availability of Jan Aushadhi outlet’, ‘quality of generic medicine’ and ‘recommendation from others’ had a significant influence on acceptance of Jan Aushadhi. Therefore, the study recommends the doctors to prescribe generic medicine, increase the number of Jan Aushadhi outlets and provide awareness about the quality and efficacy of Jan Aushadhi. [ABSTRACT FROM AUTHOR]