Search

Heart failure poses a global health challenge affecting millions of individuals, and access to guideline-directed medical therapy is often limited. This limitation is frequently attributed to factors such as drug availability, slow adoption, clinical inertia, and delayed diagnosis. Despite international recommendations promoting the use of guideline-directed medical therapy for heart failure management, personalized approaches are essential in settings with resource constraints. In India, crucial treatments like angiotensin II receptor blocker neprilysin inhibitors and sodium-glucose co-transporter 2 inhibitors are not fully utilized despite their established safety and efficacy. To address this issue, an expert consensus involving 150 specialists, including cardiologists, nephrologists, and endocrinologists, was convened. They deliberated on patient profiles, monitoring, and adverse side effects and provided tailored recommendations for guideline-directed medical therapy in heart failure management. Stressing the significance of early initiation of guideline-directed medical therapy in patients with heart failure, especially with sodium-glucose co-transporter 2 inhibitors, the consensus also explored innovative therapies like vericiguat. To improve heart failure outcomes in resource-limited settings, the experts proposed several measures, including enhanced patient education, cardiac rehabilitation, improved drug access, and reforms in healthcare policies. [ABSTRACT FROM AUTHOR]

Essential medicines or drugs are recognized as highly cost-effective components within contemporary healthcare, demonstrating significant potential for improving health outcomes. The provision of essential medicines directly impacts the functioning of healthcare facilities, resulting in financial hardship. This review aims to fill knowledge gaps by examining obstacles hindering access and utilization of essential medicines in India. This study conducted a comprehensive evidence synthesis, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, to analyse articles on the availability and utilization of essential medicines in India. The search strategy included various databases and keywords. Published, peer-reviewed articles focusing on the National/State List of Essential Medicines and meeting specific criteria were considered. Data items included essential medicines, drug availability, utilization, and challenges. Data was extracted, synthesized, and analysed using thematic framework analysis. Out of 1,129 articles, 11 were selected for review. Studies consistently highlighted the inadequate availability of essential medicines in different Indian states. Availability of essential medicines varies in the range of 17-51 percent across major states of India. Stock-outs of medicines vary from 4 to 14 weeks. Governance issues including differential procurement mechanisms across states of India, hinder seamless availability of essential medicines. Other challenges included distribution and purchasing system inefficiencies, governance-related issues, and facility/user-level challenges impacting drug utilization. Disruptions in utilization were observed due to improper prescription practices and non-availability of affordable options. Accessibility and affordability also affected drug utilization. Issues with supply chain management and conflicting guidelines further contributed to the obstacles faced in ensuring availability and utilization of essential medicines in India. Ensuring the availability, accessibility, and affordability of essential medicines is of utmost importance. The public health system needs to strengthen its procurement and distribution management. Strengthening the logistics support for an efficient supply of essential medicines will reduce the time lag in receipt of drugs. Guidelines on essential drugs prepared by the National Health System Resource Centre need to be strictly adhered to and monitored in inventory management system. There is an urgent need to develop a sustainable model for achieving uniformity in the availability and utilization of essential medicines in India. [ABSTRACT FROM AUTHOR]

Background: Antihypertensive drug supply is sometimes inadequate in public sector health facilities in India. One of the core strategies of the India Hypertension Control Initiative (IHCI) is to improve the availability of antihypertensive drugs in primary and secondary care facilities. We quantified the availability of antihypertensive drugs in 2019–20 and described the practices in supply chain management in 22 districts across four states of India. Methods: Twenty-two districts from 4 states (Punjab, Madhya Pradesh, Telangana, and Maharashtra) were studied. We described the practices and challenges in supply chain management. We collected data on drug procurement from 2018 to 2020 and drug availability from April 2019 to March 2020. Quantity procured, the proportion of facilities with stockout at the end of each quarter, and availability of drugs in patient days were tabulated. Results: All states selected drug- and dose-specific protocols with Amlodipine as the initial drug and shifted to morbidity-based forecasting. The total number of antihypertensive tablets procured for the 22 districts increased from 16 million in 2017–2018 to 160 million in 2019–2020. The proportion of facilities with Amlodipine stock-out was below 5% during the study period. Amlodipine stock was available for at least 60 patient days from the third quarter of 2019 onward in all districts. Conclusions: This study demonstrates that including best practices can gradually strengthen the procurement and supply chain for antihypertensives in a low-resource setting. As the program was rapidly growing, there were still gaps in the procurement and distribution system which needed to be addressed to ensure the adequacy of drugs. We recommend that best practices, including choosing a single protocol, basing supply on projected patient load rather than an increment from historical levels, and using simple stock management tools, be replicated in other districts in India to increase and sustain coverage of hypertension treatment. [ABSTRACT FROM AUTHOR]

Itraconazole is now being used as the first line drug for dermatophytosis. Complete clinical and mycological cure are not achieved in some cases. The Super Bioavailable (SB) formulation is being marketed as a better formulation of drug in terms of bioavailability. To compare the efficacy and safety of SB and conventional Itraconazole in treatment of dermatophytosis. We compared the efficacy and safety of conventional itraconazole 100 mg twice daily with SB itraconazole 50 mg twice daily in dermatophytosis for two weeks. A convenient sample size of 30 was taken in each group. There was no significant difference in clinical parameters like erythema, scaling, number of papules between the two groups. Change in mean haemoglobin, total leucocyte count, platelet count, liver enzymes SGOT and SGPT and ALP did not differ significantly between the groups. There was no significant difference in the change in KOH status between the groups. There was no significant difference in clinical and mycological clearance between the conventional and the Super Bioavailable itraconazole at the end of two weeks in case of dermatophytosis of glabrous skin. [ABSTRACT FROM AUTHOR]

The bioavailability of a drug depends on the absorption of the drug, which is affected by its solubility in gastrointestinal fluid and permeability of the drug across gastrointestinal membrane. The rate of drug dissolution though, is greatly influenced by disintegration of the tablet. The need to enhance the dissolution rate of poorly-water soluble drugs led to the introduction of a group of disintegrants known as super-disintegrants. They achieve disintegration faster than the usual disintegrants. This study utilized scientometric analysis (study that can be applied to any discipline to find out its trends and growth of literature) to highlight the most impactful and influential publication sources, most active researchers and institutions as related to various researches into / using Superdisintegrants. 229 bibliographic documents were analyzed. These were obtained from the SCOPUS data base. Data obtained show that India has carried out the most impactful studies as it concerns superdisintegrants. The peak of such research was between the years 2011 - 2015. Scientometric analysis such as this, leads researchers to reliable sources of information. For this particular area of study, it can be noted that there is indeed a need for more collaboration within authors and various institutions involved in such researches. [ABSTRACT FROM AUTHOR]

Introduction: Scorpion envenomation is a life-threatening condition, particularly for children. Therefore, it is essential for primary care health providers to suspect, identify, and manage this condition early to prevent death and minimize morbidity. Objective: To identify the key epidemiological characteristics of scorpion envenomation and update the primary care health workers regarding the latest management practices of scorpion envenomation. Methodology: A non-systematic review was performed by searching the key terms on databases such as PubMed, Medline, Scopus, Google Scholar, and ResearchGate. Results: Worldwide, over 2.5 billion people are living at risk of scorpion stings. Every year, over 1.2 million are stung by scorpions leading to the death of at least 3,250 people globally. The most vulnerable group includes farmers, laborers, and those living in rural areas. Adults are most frequently stung but envenomation is more severe among children. Prazosin is a key drug to prevent death due to cardiovascular complications. Conclusion: Most of these stings and deaths could be preventable with proper awareness, safety precautions, and timely access to treatment. Government and local hospitals should ensure the availability of key drugs such as prazosin. [ABSTRACT FROM AUTHOR]

Spices are natural plant products enriched with the history of being used as herbal medicine for prevention of diseases. India is also known as the 'Land of Spices'. Out of 109 spices recognized by the International Organization for Standardization (ISO) more than 52–60 spice crops are grown in India. The major spices exported by India are turmeric, cumin, coriander, fenugreek, peppers, etc. The Indian spices are divided into three era viz. early period, middle age and early modern period. Spices are used in beverages, liquors, and pharmaceutical, cosmetic and perfumery products. The major issue with spices is their handling and storage. This review article mainly focuses on two aspects: at the outset the handling and storage of the spices is an essential factor as spices are available in different forms like raw, processed, fresh, whole dried, or pre‐ground dried. Therefore, the need of processing, packaging, storage and handling of the spices is important as the deterioration of spices can lead to the loss of therapeutic activity. Furthermore, many herbal constituents have the capability to enhance the bioavailability of drugs. Therefore, an attempt has been made to throw a light on the bioenhancer activity and therapeutic activity along with their mechanism of action of some Indian spices which are regularly used for cooking purpose on a daily basis to enhance the taste of food. The spices suggested by ministry of AYUSH which is relevant to its medicinal and biological property in treatment and prevention from COVID‐19 are discussed. © 2022 Society of Chemical Industry. [ABSTRACT FROM AUTHOR]

Itraconazole, is the most commonly prescribed oral antifungal agent in India, and has a low minimum inhibitory concentration as compared to other oral antifungals, and in conjunction with the markedly high skin levels, the drug should have a predictably good clinical response which is not the consistent experience of clinicians. Probably the variation in pelletization parameters might affect the bioavailability of the drug and consequently affect the serum levels. The maximum bioavailability of conventional itraconazole is 55 percent, which is neither consistent nor predictable. However, the novel itraconazole (Super bioavailable Itraconazole) with targeted drug release in the small intestine has predictable serum levels with minimum interindividual variability, which could make it a potentially useful drug in recalcitrant dermatophytosis. [ABSTRACT FROM AUTHOR]

The estimated prevalence of hepatitis C virus (HCV) infection in India is between 0.5 and 1.5% with hotspots showing much higher prevalence in some areas of northeast India, in some tribal populations and in certain parts of Punjab. Genotype 3 is the most prevalent type of infection. Recent years have seen development of a large number of new molecules that are revolutionizing the treatment of hepatitis C. Some of the new directly acting agents (DAAs) like sofosbuvir have been called game-changers because they offer the prospect of interferon-free regimens for the treatment of HCV infection. These new drugs have not yet been approved in India and their cost and availability is uncertain at present. Till these drugs become available at an affordable cost, the treatment that was standard of care for the whole world before these newer drugs were approved should continue to be recommended. For India, cheaper options, which are as effective as the standard-of-care (SOC) in carefully selected patients, are also explored to bring treatment within reach of poorer patients. It may be prudent to withhold treatment at present for selected patients with genotype 1 or 4 infection and low levels of fibrosis (F1 or F2), and for patients who are non-responders to initial therapy, interferon intolerant, those with decompensated liver disease, and patients in special populations such as stable patients after liver and kidney transplantation, HIV co-infected patients and those with cirrhosis of liver. [ABSTRACT FROM AUTHOR]

The author reflects on the evolution of bio-banking as a concept and as an operationally special branch of science and its important role in biomedical research. Topics covered include the different aspects of bio-banking, the important functions of bio-banks and the factors that affect pharmacogenomics and bioavailability of medicines in India. He discusses the progress of bio-banking in neuroscience, the advantages of bio-banking and why bio-banking should be prioritized in India. [ABSTRACT FROM AUTHOR]

Bacillus licheniformis , a pathogenic new strain of bacteria is considered as the main cause of high mortalities and economic losses among the ornamental fish farms of India. The present study aimed to investigate the anti-bacterial and Immunostimulant activity of three selected Indian medicinal plants, Allium sativum, Adhatoda vasica and Centella asiatica for treating Bacillus licheniformis PKBMS 16 by subsequent experimental and clinical trials using different organic polar and non-polar solvents. The antimicrobial and Immunostimulant activity of methanolic crude extracts of Adhatoda vasica was fractions and active constituents was further characterized by chromatography and mass spectroscopy studies using FTIR, 1HNMR and 13c NMR to identify as well as to determine the nature of the pure compound which is phytol (C 20 H 40 O), a diterpene alcohol with a molecular weight of m / z 297. In order to study the in vivo anti-pathogenic influence of the biologically active compounds, phytol were incorporated to the artificial diets at the concentration of 2, 5 and 8 mg/kg and fed to the1.0 × 105 CFU/ml of Bacillus licheniformis PKBMS 16 injected experimentally challenged ornamental goldfish Carassius auratus for twenty days. Phytol treated group significantly (P < 0.01 and P < 0.05) reduced the rate of fish mortality. After the termination of survivability assay the estimation of hemato-biochemical parameters have been performed and revealed the significant recovery of health condition on 20th days post treatment. Therefore, the present study concluded that the low toxicity along with high bioactivity and tolerance by lower vertebrate supports the potential of phytol as a new compound for inducing fish immunity. Image 1 • Anti-bacterial and Immunostimulant activity of Adhatoda vasica , for treating Bacillus licheniformis PKBMS 16. • The active fraction of Adhatoda vasica was characterized by chromatography and mass spectroscopy studies using FTIR, 1HNMR and 13 CNMR to identify the pure compound. • This active biological molecule is phytol (C 20 H 40 O), a diterpene alcohol with a molecular wt. of m / z 297. • Phytol (2, 5 and 8 mg/kg doses) applied to experimentally challenged Carassius auratus infected by Bacillus licheniformis PKBMS 16 (1.0 × 105 CFU/ml). • Haemato-biochemical parameters revealed the significant recovery of health condition by 20th days. [ABSTRACT FROM AUTHOR]