Viral hepatitis in children: state and prospects for solving the problem

The problem of viral hepatitis (VH) today is an acute problem for the world healthcare system. Along with the COVID-19 pandemic, the VH pandemic claims up to 1.5 million lives annually. Since 2016, the Russian Federation has launched a WHO program aimed at combating VH. One of the first steps on the path of global elimination is getting rid of the virus in the small groups, among which micro-elimination in the child population is one of the promising areas.This review is devoted to the current state of the problem of VH in children in the Russian Federation today. The success of vaccine prevention (against viral hepatitis A and B) made it possible to achieve results in the form of a significant decrease in the incidence of children, minimizing the risk of perinatal infection. However, in recent years, there has been a progressive decline in vaccination coverage. This is mainly due to the growing popularity of anti-vaccination lobbies, a decrease in the awareness of patients and health workers about the need for timely vaccination, as well as the introduction of restrictive measures to prevent a new coronavirus infection. The emergence of mutant, "vaccine-eluting" strains, which are also resistant to available antiviral drugs, is another serious problem on the way to eliminating viral HBV. In the field of treating children with HBV, the possibilities are extremely limited, only 2 drugs are available, one of which (tenofovir alafenamide) is available only from the age of 12. Registration of direct antiviral drugs for the treatment of adolescents with chronic hepatitis C has made it possible to bring closer the goal of microelimination of the virus in children. However, the high cost of drugs poses a challenge for the state to introduce long-term benefit programs to ensure the availability of treatment. In addition, at the moment, the treatment of young children in our country remains a prospect for the future.Thus, despite significant advances in the strategy for the elimination of viral hepatitis, a number of problems remain relevant and present significant difficulties in achieving the global goal.

Evaluation of adherence of patients with atrial fibrillation to anticoagulant therapy at the outpatient stage of treatment

Despite clinical guidelines for the treatment of atrial fibrillation (AF) patient adherence to oral anticoagulants (OACs) in routine clinical practice remains low. Assessing the factors affecting adherence to the OACs regimen and developing strategies for its improvement is important. Aim. To assess the adherence of patients with AF to the prescribed anticoagulant therapy at the outpatient stage of treatment. Methodology. The object of the study was 165 patients with nonvalvular AF undergoing treatment in a specialized cardiology department or receiving outpatient treatment in a specialized cardiological dispensary in Saratov from February 2018 to December 2019. After 3, 6, 12 months, a telephone contact with the patients was carried out, a specially designed questionnaire was filled out, in which the anticoagulant therapy received by AF patients was reflected, the Morisky-Green questionnaire was filled out, the answers of patients about the reasons for skipping or stopping the administration of the OACs were recorded. Results. After 3 months. 16.6 % of AF patients replaced the OACs intake with antiplatelet agents, 16 % refused antithrombotic therapy; 43.1 % of AF patients were adherent to OACs. After 6 months. antiplatelet agents were taken by 24.5 % patients (p<0.05), 11.9 % completely stopped taking antithrombotic drugs; 30.8 % of patients were adherent to OACs (p<0.05). After 12 29,5 % patients replaced OACs treatment with antiplatelet agents, 7.6 % patients did not take any antithrombotic drugs; 31.8 % of AF patients were adherent to OACs. The most common reasons for a decrease in the adherence to OACs therapy were the cost of drugs, lack of understanding of the value of OACs administration in AF, and the lack of appreciable effect of OACs administration. Conclusion. At the outpatient stage of treatment, there was an insufficient level of adherence of AFpatients to OACs treatment.

Baseline Assessment of Poultry Production, Pharmaceutical Product Use, and Related Challenges on Commercial Poultry Flocks in Kano and Oyo States of Nigeria

Poultry production is a major component of the livestock sector in Nigeria and continues to expand rapidly; however, it is still constrained by low productivity. A farm survey was conducted to provide a baseline assessment of poultry production (products generated, farm costs, and revenue), pharmaceutical use, and related challenges faced by farmers on 44 commercial poultry farms in Oyo and Kano states of Nigeria. Live spent layers, eggs, and used beddings were the most frequently sold products for revenue. Antibiotic products were widely used, the most reported were Doxygen, Tylosin, and Conflox. Overall, 40% of farms used feed additives (including toxin binders, minerals, and vitamins) and 12% used coccidiostats. Access to pharmaceutical products was a key challenge and appeared to disproportionally affect farmers in the northern part (Kano) of Nigeria. Other challenges included perceived antibiotic ineffectiveness, high cost of drugs, and long distances to pharmaceutical suppliers. Challenges related to vaccine use were unavailability, distance to the supplier, and health issues interfering with the vaccination schedule. Study findings highlight the need for improved access to veterinary pharmaceuticals, particularly in the northern states. Further investigations into the causes of antibiotic ineffectiveness and strategies for distribution of high-quality, effective pharmaceuticals are also necessary.

Low-Cost Drugs Still Relevant in the Present-Day Era

Escalating medical costs contribute to poverty in countries with low resources. The drug costs account for 17 percent of medical expenses. Revisiting time-tested, cost-effective drugs can reduce these costs. Some of them find a place in the WHO Model List of Essential Medicines for Children. The list consists of medicines for a basic healthcare system. They are safe and cost-effective. The present paper identifies co-trimoxazole and chloramphenicol as antimicrobials, chloroquine for malaria, adrenaline, theophylline for asthma, and phenobarbital as an anti-epileptic drug that merits consideration for reviving interest in them and reduce drug treatment costs. What is already known about this subject? • The cost of drugs contributes to rising medical costs. • Medical expenses push a large population below the poverty line. What does this study add? • Rediscovering the relevance of old low-cost drugs is essential. • Revisiting the WHO Model List of Essential Medicines for Children may be useful. • Drugs such as chloramphenicol and theophylline are such examples.

Application of interdisciplinary collaborative hospice care for terminal geriatric cancer patients: A prospective randomised controlled study

Background Hospice care (HC) is specialized medical care for terminal patients who are nearing the end of life. Interdisciplinary collaborative hospice care (ICHC) is where experts from different disciplines and patients/caregivers form a treatment team to establish shared patient care goals. However, the ICHC efficacy has not been frequently studied in the terminal geriatric cancer patients (TGCPs) population. This study aimed to gain insight into ICHC provided to TGCPs by an ICHC team and identify factors to ameliorate multidimensional HC. Methods 166 TGCPs were equally divided into ICHC group and life-sustaining treatments (LSTs) group as control. The scores of these questionnaires [such as EORTC QLQ-C30, Hamilton Anxiety Scale], the median survival time (MST), symptoms improvement, the median average daily cost of drugs (MADDC), the median total cost of drugs (MTDC) in the last 2 days, and medical care satisfaction were observed in both groups. Results After treatment, the emotional function and symptoms in the ICHC group were statistically higher improvement than those in the LSTs group (P < 0.05). The MADDC and the MTDC in the last 2 days were statistically lower in the ICHC group than those in the LSTs group (P < 0.01). In addition, the overall satisfaction situation and the cooperation ability in the ICHC group were statistically higher than those in the LSTs group (P < 0.01). Conclusion The ICHC could provide TGCPs with coordinated, comfortable, high-quality, and humanistic care.

Analysis of Types And Costs of Drugs Used For 7 Days Before Death of Terminal Cancer Patients Hospitalized In Hospice And General Wards.

1) PurposeThe need for hospice palliative care continues to grow as the number of deaths from cancer increases with increasing interest in and need for the management of end stage cancer patients. We conducted this study to determine differences in quantity and cost of drugs used by end-stage cancer patients who were hospitalized in general wards or hospice wards for 7 days before death.2) MethodsAmong patients who died in the hospice ward or the general ward of a university hospital in a metropolitan city (Seoul) from January 2016 to September 2019, patients aged over 18 years with a hospital stay of 8 days or more were selected. A total of 526 patients were selected, including 290 from hospice wards and 236 from general wards.3) ResultsNumbers of PO, injections, and fluid, but not opioids, used in the hospice ward were significantly lower than those in the general ward. Cost of PO, injections, fluid, and total costs were significantly lower in the hospice ward than in the general ward. In the case of opioids, the cost was higher for the hospice ward. Total costs including all drug costs in the hospice ward were significantly lower than those in the general ward. 4) ConclusionCaring for people with terminal cancer in a hospice can lower costs and increase satisfaction for dying patients. Reducing the proportion of patients caring for terminal cancer in general wards and increasing access to hospice services can address health insurance deficits and exhaustion.

The Ghanaian Flora as a Potential Source of Anthelmintic and Anti-Schistosomal Agents

Parasitic infections including schistosomiasis and soil transmitted helminthiasis are the most commonly encountered Neglected Tropical Diseases (NTDs) in the world. These diseases remain a major public health concern affecting millions of people especially those living in poor regions where access to effective conventional health care is a challenge. Interventions to control these infections in endemic areas have not been successful due to the high cost of drugs, limited availability as well as inequity of access to preventive chemotherapies. Another problem is the development resistance to the limited number of recommended medications due to their intensive use in both human and live-stock. There is an increasing awareness of the potential of natural products as chemotherapeutic agents to combat parasitic infections. Natural products may offer an unlimited source of chemically diverse drug molecules which may be safe, efficient, less toxic, less expensive and readily available for use especially in low-income countries. The Ghanaian flora provides such a ready source for new therapeutic interventions for the local population. Several researches have provided evidence of the anti-parasitic activity of Ghanaian medicinal plants. This chapter provides a review with special focus on medicinal plants collected from Ghana with anthelmintic and anti-schistosomal activity. Evidence of pharmacological activities of crude extracts, fractions and bioactive phytoconstituents as well as possible mechanisms of action where investigated are discussed.

Anticancer drug waste minimization and cost-saving study by using a closed-system transfer device for chemotherapy compounding

Introduction There is a need for an economic evaluation of the use of closed system (CSTD) in chemotherapy compounding, especially in resource-constrained settings. Objective The objective of this study was to assess the cost saving of the management of cancer drug leftovers before and after introduction of CSTD associated with an extension of the beyond-use date (BUD) of cancer vials. A secondary objective was to estimate the level of minimization of drug wastage. Materials and methods This was a prospective, single-center study with two periods of two months each. The cost of drugs saved by using conventional systems (syringe and needle) without a closed system in the first period was compared to the cost of drugs saved by using the CSTD Chemoclave® system in the second period. The drug waste minimization rate compared actual drug waste to potential waste in Period 2. Results In Period 1, the amount of drug saved accounted for an average of 10.3% of the amount used in milligrams and the amount of drug wasted accounted for an average of 18.7%. In period 2, these proportions were 15.2% and 6.4% respectively. The CSTD generated an extra cost of 11,962.5 USD compared to the conventional system. The drug saved cost related only to the CSTD and the acquisition cost of the CSTD was a deficit of -7,444.95 USD and the cost saved from the compounding (CSTD and syringes) was a gain of 1,722.01 USD. The waste minimization represented an average of 72.5% ± 24.4% of potential waste. Conclusion The use of CSTD to extend the BUD allowed to reduce waste due to microbiological instability without adding an economic profit.

Cost of therapy for cystic fibrosis in different age groups with consideration to the respiratory tract infection and complications

Despite the low prevalence of cystic fibrosis (CF), the costs of treating this disease are significant for the healthcare system. The aim of this economic study was to assess the total cost of drugs per year for children with CF, depending on age and course of the disease.Methods. For this pharmacoeconomic analysis, groups of “hypothetical” patients were formed according to the characteristics of the course of CF, taking into account the required volume of basic CF therapy, antibiotic therapy, and complications.Results. The cost of basic treatment for CF patients of different ages and disease progression in the hypothetical patient models can vary greatly. The cost of CF therapy increases significantly with age and Pseudomonas aeruginosa respiratory infection, especially in the patients with chronic infection, concomitant polyposis sinusitis, and low nutritional status.Conclusion. Patients with CF require regular follow-up with control of the microflora of the respiratory tract and effective eradication therapy for P. aeruginosa and other pathogenic microorganisms. Reducing infection rates and the severity of the disease can lead to significant cost savings.

Prise En Charge Sanitaire Des Malades Du Vih/Sida Au Centre Vivre Dans L’Esperance De Dapaong (Région Des Savanes Au Togo)

Résumé : L’apparition de la maladie du VIH/sida dans le monde a contraint les pays à prendre en charge les personnes infectées. C’est ainsi qu’au Togo, la prise en charge médicale de ces malades au « Centre vivre dans l’espérance MAGUY » de Dapaong a connu des fortunes diverses où l’engagement des Religieuses a permis aux malades du VIH/sida, d’avoir un niveau d’accès judicieux aux soins de santé. Cet article vise à analyser le mécanisme de prise en charge sanitaire des malades du VIH/sida dans ledit centre.Une méthodologie quantitative et qualitative a été utilisée. Au total, 260 personnes ont été enquêtées et les données collectées ont été traitées à partir des logiciels Cspro 7.4 et Nudist 1.71. Des cartes ont été réalisées grâce au logiciel Arc GIS 3.2.Il résulte de cette étude qu’il y a une bonne prise en charge de ces malades depuis 2000 avec 46% des enquêtés qui ont vu leur état de santé s’améliorer. Cela est dû essentiellement au coût moins élevé des médicaments, aux activités organisationnelles de prise en charge. Plus de 75% des personnes infectées interrogées ont déclaré que l’administration et la disponibilité des structures de prises en charge sont des facteurs non négligeables dans l’amélioration de leur état de santé.Mots clés : personnes infectées, prise en charge, santé, vivre dans l’espérance, VIH/sida, Dapaong. Abstract : The emergence of the disease of HIV / AIDS in the world has forced countries to take care of those infected. Thus in Togo, the medical care of these patients at the “Center to live in hope MAGUY” in Dapaong has experienced varying degrees of success where the commitment of the Religious has enabled HIV / AIDS patients to d '' have a judicious level of access to health care. This article aims to analyze the mechanism of health care for HIV / AIDS patients in the said center.A quantitative and qualitative methodology was used. A total of 260 people were surveyed and the data collected was processed using Cspro 7.4 and Nudist 1.71 software. Maps were produced using Arc GIS 3.2 software. The results of this study show that there has been good care for these patients since 2000, with 46% of respondents having seen their state of health improve. This is mainly due to the lower cost of drugs, to organizational support activities. More than 75% of the infected people questioned declared that the administration and availability of care structures are significant factors in improving their state of health.Keywords: infected people, care, health, living with hope, HIV / AIDS, Dapaong.