Pharmacy Ethics and the Spirit of Capitalism: A Review of the Literature

This chapter explores the issue of the conflict (real or potential) between the ethical imperatives that should guide the pharmacist in the typical practicing of the profession (i.e. within a pharmacy) and the economic constraints derived from the business dimension of the pharmacy. Marrying service and business in a single profession, pharmacy is supposed to balance harmoniously its two sides, if not to subject business demands to the higher societal, ethical requirements. However, such a balancing exercise is rather like dancing on a rope, and ethics may be trumped by economics, a phenomenon deplored sometimes by pharmacy academics or hospital pharmacists, and by a part of community pharmacists as well. Economics may prevail over ethics in rough forms such as selling health risk products (as it was in the past for tobacco or alcohol) or in more elusive ones, such as longer work hours and shorter counselling times, promoting or dispensing needless or ineffective products (food supplements, cosmetics, etc.), silently refusing to provide or recommend lower cost generics, etc. Ethical research in the field of pharmacy has generally been scarce, and numerous knowledge gaps remain to be filled by future investigations

EDUCATION FOR WORK RELATED TO LIFESTYLE HEALTH

Studies performed in various countries, including Romania, have shown that a number of factors are negatively impacting the health of the population at the workplace and in the household. The connection between health and work has been researched for a number of years as an important driver towards wellbeing. Several studies have been conducted in order to identify problems and to find solutions to harmonize the balance between wealth and health. Increased globalization, the chase for competitive advantage and the reduction of costs (especially labor costs) moved employee attention of from the wellbeing of employees to higher profits. We discuss about such situations mainly in the East European Countries since the labor force is cheaper than in Western Europe. We should not forget that this current trend started in the US and was adopted also by European companies in order to increase profits. In West Europe there are quite a number of studies regarding relation between work and health, while in East Europe the number of such studies is quite small. The present paper proposes as an objective the study of several working factors and the relationship to health in Romania. Some of the results in our study reveal the concordance between the propensity of individuals to sacrifice from their one time and time for work without significant discrepancies between genders. Also the more people invest in their time to rest, the more they are able to work hard without injuries. When it comes to gender characteristics we determined slight changes in behavior with almost the same labor pattern for both participants.Another interesting finding was that rural and urban areas are clearly determining the type of stress exposure for participants with a higher impact for workers coming from the urban area. Physical exercise and labor can be channeled in good order according to the gender capabilities

Separation and assay of ascorbic acid by HPLC: a review of the scientific literature

Disciplina Botanică farmaceutică şi Biologie celulară, Facultatea de Farmacie, UMF “Carol Davila” Bucureşti, Romania, Disciplina Chimie Analitică, Facultatea de Farmacie, UMF “Carol Davila” Bucureşti, RomaniaObiectivul studiului: Analiza publicaţiilor relevante în privinţa metodelor de separare şi dozare a acidului ascorbic prin HPLC (excluzând metodele LC/MS), pentru stabilirea principalelor caracteristici ale acestora, care să ghideze selecţia unei metode în funcţie de obiectivele urmărite şi resursele disponibile. Materiale şi metode: S-a realizat o interogare computerizată Medline utilizând cuvinte-cheie adecvate (“HPLC AND ascorbic”), iar rezultatele returnate au fost revizuite pentru selectarea celor relevante. S-au analizat în special date referitoare la tipul de coloană, fază mobilă, debit şi tipul de eluţie (izocratică sau în gradient); metoda de detecţie; limita de detecţie; timpul de rulare a analizei; prepararea probelor (în funcţie de matricea analitică); datele referitoare la validitatea metodei şi stabilitatea acidului ascorbic în cursul analizei. Rezultate şi discuţii: Interogarea Medline a returnat 1881 de articole, publicate între anii 1975 şi 2014, dintre care 122 au fost selectate ca relevante pentru analiză. Au fost dezvoltate metode pentru o largă varietate de probe biologice. S-au utilizat mai multe coloane cromatografice (faze staţionare), dar majoritatea metodelor publicate au aplicat coloane cu fază inversă. În principal se utilizează detecţia electrochimică (peste 40% din publicatiile analizate) sau UV (de cele mai multe ori în jurul valorii de 254 nm; peste 40% din articole), mai puţin cea fluorimetrică în urma derivatizării pre- sau postcoloană (sub 10% din articole). S-a propus o varietate considerabilă de faze mobile, de cele mai multe ori cu un pH acid (3-4) şi o componentă majoritară apoasă (≥ 70%). Limitele de detecţie publicate au fost de ordinul microgramelor şi picogramelor, iar durata separărilor a variat între 3-5 şi 60 minute. Acurateţea diverselor metode publicate a fost în toate cazurile de peste 90%. Numeroase publicaţii evidenţiază problemele de stabilitate a acidului ascorbic şi propun diverse soluţii pentru protecţia acestuia în cursul analizelor. Concluzii: Marea varietate de metode permite dozarea adecvată a acidului ascorbic dintr-o varietate de matrice, dar există încă limitări în comparabilitatea inter-laboratoare

Approved and Commercialized Antidiabetic Medicines (Excluding Insulin) in Seven European Countries—A Cross-Sectional Comparison

Diabetes mellitus is a complex, multifactorial, progressive condition with a variety of approved therapeutic options. The purpose of this study was to offer an overview of the authorized antidiabetic medicines (excluding insulin) compared with marketed products in seven European countries. Data were obtained from primary sources, including the websites of national authorities and directly from specialists in the countries of interest. The range of marketed medicines compared with the authorized group was assessed in terms of active pharmaceutical ingredients (>60% in Bulgaria, France, Serbia), brand names (>70% in Bulgaria, the Czech Republic, Romania, Serbia, Spain), pharmaceutical forms (>60% in all countries), strengths (>60% in Bulgaria, the Czech Republic, Romania, Serbia, Spain), marketing authorization holder (≥50% in all countries) and the status of medicine. Spain was found to have the highest number of products based on most of these attributes. Over 90% of authorized medicines had a pharmacy price in Serbia. Regarding the newer class of GLP-1 receptor agonists, a retail price for all approved substances was available in Bulgaria, Romania, Serbia, and Spain. Only one brand name with one concentration was found available for some agents, being susceptible to drug shortages: glibenclamide (Romania, Serbia, Spain), glipizide (the Czech Republic, Poland, Romania, Spain), glisentide (Spain), acarbose (the Czech Republic), sitagliptin (Bulgaria, Poland), vildagliptin (the Czech Republic, Poland) and saxagliptin (the Czech Republic, France, Romania, Serbia). An overview of the national and international therapeutic options may allow competent authorities and health professionals to take rapid measures in case of supply problems or health crises

Phytotoxicity assessment of some herbal extracts by Triticum bioassay

Disciplina Botanică farmaceutică şi Biologie celulară, Facultatea de Farmacie, UMF “Carol Davila”, Bucureşti, Romania, Catedra Farmacognozie și Botanică farmaceutică, IP USMF „Nicolae Testemiţanu”, Republica MoldovaObiectiv: Evaluarea fitotoxicităţii a trei extracte hidroalcoolice de origine vegetală, deoarece efectele asupra celulei vegetale, şi în special cele observate la nivelul nucleului, pot oferi indicii despre potenţiala toxicitate asupra celulei animale şi umane. Materiale şi metode: Efectele a două extracte hidroalcoolice obţinute cu etanol 70% din rădăcinile speciilor Glycyrrhiza glabra L., lemn dulce (fam. Fabaceae) şi Withania somnifera (L.) Dunal, ginseng indian (fam. Solanaceae) şi ale unui extract hidrosolubil de origine comercială obţinut din rădăcina speciei Panax notoginseng (Burkill) F. H. Chen ex C. Y. Wu& K. M. Feng, notoginseng (fam. Araliaceae) asupra rădăcinilor embrionare de Triticum aestivum au fost evaluate prin metoda Constantinescu. Din fiecare extract s-au preparat prin diluţii succesive, 6 soluţii de concentraţii diferite: 1%, 0,5%, 0,1%, 0,05%, 0,01% şi 0,001%. Efectele asupra alungirii radiculei principale ale cariopselor germinate de Triticum au fost evaluate cantitativ în comparaţie cu un martor negativ (apă distilată) la 72 de ore de la iniţierea tratamentului; comparaţiile statistice multiple s-au realizat la un nivel alfa=0,5 cu ajutorul testului Kruskal-Wallis, iar comparaţiile post-hoc prin aplicarea testului Wilcoxon cu ajustare pentru multiplicitate prin metoda Holm. Rezultate şi discuţii: Extractul de Liquiritiae radix a inhibat semnificativ (p< 0,01) dezvoltarea radiculelor embrionare de Triticum aestivum la primele 3 niveluri de concentraţie (1%-0,1%), extractul de Withania somnifera radix a inhibat semnificativ diviziunea celulară doar la primele 2 niveluri de concentraţie (1% şi 0,5%), iar cel de Panax notoginseng radix la primele 5 niveluri de concentraţie (1%-0,01%). În cazul Liquiritiae radix, inhibiţia a fost completă (indice de inhibiţie 100%) pentru primele 2 niveluri de concentraţie şi mult diminuată la cel deal 3-lea nivel (indice de inhibiţie, 41,03%). Extractul de Withania somnifera radix a determinat o inhibiţie completă (100%) la primul nivel de concentraţie şi de numai 62,4% la cel de-al doilea nivel, iar cel de Panax notoginseng radix a determinat o inhibiţie moderată, la toate cele 5 niveluri de concentraţie (indicele de inhibiţie variind nelinear între 53,8% şi 75,2%). Concluzii: Toate cele trei extracte vegetale hidroalcoolice (Withania somnifera radix, Liquiritiae radix, Panax notoginseng radix) au efecte mitoinhibitorii moderate la concentraţii ceva mai mari, în special extractul de Panax notoginseng radix. Mulţumiri Acest studiu a fost finanțat din Contractul nr. 8/23.12.2013 (Proiect bilateral Romania-Republica Moldova – Competiția N. Testemițanu)

Produse vegetale și fitopreparate cu acțiune hipoglicemiantă

Diabetul zaharat continuă să fie o problemă globală prin frecvența sa și este foarte costisitor pentru societate prin evoluția cronică pe tot parcursul vieții. Tratamentul diabetului este complex, include pe lângă tratamentul medicamentos cel fitoterapic și igieno-dietetic, iar identificarea de noi medicamente, cu un profil de siguranţă mai bun şi efcacitate comparabilă produselor actuale, rămâne o preocupare constantă a cercetărilor ştiinţifi ce, inclusiv prin evaluarea plantelor medicinale hipoglicemiante din flora României și a Republicii Moldova, cât și a principiilor active responsabile de acțiune. Importanţa actuală a fi toterapiei rezidă în ponderea tot mai mare a medicamentelor de origine vegetală, atunci când cota fitopreparatelor cu acțiune hipoglicemiantă în Republica Moldova constituie doar 1,25%, raportate la numărul total de produse înregistrate, cu o tendință de înregistrare a lor ca suplimente alimentare în România (peste 90 suplimente alimentare). Totodată, studiul pune în evidență necesitatea extinderii fitopreparatelor hipoglicemiante, prin testările plantelor medicinale mai puțin studiate până în prezent

The toxicological screening on a new anti-mycobacterial compound, derived of 5-aryl-2-thio-1,3,4-oxadiazole

UMF “Carol Davila” Bucureşti, Facultatea de Farmacie, Catedra Chimie farmaceutică și toxicologică, IP USMF “Nicolae Testemițanu”, Republica Moldova, Laboratorul de Sinteză organică, Institutul de Chimie a Academiei de Științe, Republica MoldovaObiectivul studiului: Tuberculoza reprezintă o problemă majoră de sănătate publică. Testarea unor substanţe active noi, cu potenţial antimicobacterian, constituie un obiectiv prioritar al cercetării ştiinţifice la nivel mondial. În acest studiu, ne-am propus ca obiectiv, investigarea profilului toxicologic al unui compus nou sintetizat: 2-(propiltio)-5H-[1,3,4]-tiadiazol[2,3-b] quinazolin- 5-ona, care a demonstrat o activitate antimicobacteriană remarcabilă in vitro. Material şi metode: Determinarea toxicităţii compusului de testat a fost realizată prin două metode: in vitro (inhibiţie pe celula vegetală) şi in vivo (şoareci albi, masculi, suşa NMRI). Testarea toxicităţii in vitro s-a realizat prin testul Triticum, care constă în determinarea diluţiei maxime active a substanţei studiate, care în funcţie de durata de acţiune influenţează alungirea radiculară şi filmul cariochinetic. S-au folosit cariopse de Triticum vulgare Mill, soiul Dropia, familia Poaceae. Pentru determinarea toxicităţii acute in vivo, s-au utilizat două metode care au vizat două aspecte: încadrarea substanţei de testat în clasele de toxicitate ale Sistemului Global Armonizat (GHS, Global Harmonized System – conform ghidului OECD 423) şi stabilirea DL50. La sfârşitul experimentului, animalele au fost sacrificate şi s-au recoltat probe de sânge pe care s-au efectuat examene hematologice şi biochimice. Pentru realizarea examenului histopatologic, au fost recoltate fragmente de organe fixate ulterior în soluţie 10% formaldehidă. Secţiunile histologice au fost colorate prin metoda hematoxilină- eozină. Rezultate: Rezultatele experimentale efectuate pe celula vegetală, au evidenţiat o relaţie liniară: concentraţie – efect inhibitor al alungirii radiculare. Determinarea toxicităţii in vivo, ne-a permis încadrarea substanţei de testat în clasele de toxicitate prevăzute de ghidul OECD 423, pentru determinarea toxicităţii acute. Concluzii: Cercetările privind toxicitatea compusului nou sintetizat: 2-(propiltio)-5H-[1,3,4]-tiadiazol[2,3-b] quinazolin- 5-ona, vor permite stabilirea dozelor eficace pentru investigarea profilului farmacologic la animale de laborator. Studiile au fost finanţate prin proiectul 14/ 23.12.2013 din competiţia „N. Testemiţanu”

Global, regional, and national burden of respiratory tract cancers and associated risk factors from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Prevention, control, and treatment of respiratory tract cancers are important steps towards achieving target 3.4 of the UN Sustainable Development Goals (SDGs)—a one-third reduction in premature mortality due to non-communicable diseases by 2030. We aimed to provide global, regional, and national estimates of the burden of tracheal, bronchus, and lung cancer and larynx cancer and their attributable risks from 1990 to 2019. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 methodology, we evaluated the incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs) of respiratory tract cancers (ie, tracheal, bronchus, and lung cancer and larynx cancer). Deaths from tracheal, bronchus, and lung cancer and larynx cancer attributable to each risk factor were estimated on the basis of risk exposure, relative risks, and the theoretical minimum risk exposure level input from 204 countries and territories, stratified by sex and Socio-demographic Index (SDI). Trends were estimated from 1990 to 2019, with an emphasis on the 2010–19 period. Findings Globally, there were 2·26 million (95% uncertainty interval 2·07 to 2·45) new cases of tracheal, bronchus, and lung cancer, and 2·04 million (1·88 to 2·19) deaths and 45·9 million (42·3 to 49·3) DALYs due to tracheal, bronchus, and lung cancer in 2019. There were 209 000 (194 000 to 225 000) new cases of larynx cancer, and 123 000 (115 000 to 133 000) deaths and 3·26 million (3·03 to 3·51) DALYs due to larynx cancer globally in 2019. From 2010 to 2019, the number of new tracheal, bronchus, and lung cancer cases increased by 23·3% (12·9 to 33·6) globally and the number of larynx cancer cases increased by 24·7% (16·0 to 34·1) globally. Global age-standardised incidence rates of tracheal, bronchus, and lung cancer decreased by 7·4% (−16·8 to 1·6) and age-standardised incidence rates of larynx cancer decreased by 3·0% (−10·5 to 5·0) in males over the past decade; however, during the same period, age-standardised incidence rates in females increased by 0·9% (−8·2 to 10·2) for tracheal, bronchus, and lung cancer and decreased by 0·5% (−8·4 to 8·1) for larynx cancer. Furthermore, although age-standardised incidence and death rates declined in both sexes combined from 2010 to 2019 at the global level for tracheal, bronchus, lung and larynx cancers, some locations had rising rates, particularly those on the lower end of the SDI range. Smoking contributed to an estimated 64·2% (61·9–66·4) of all deaths from tracheal, bronchus, and lung cancer and 63·4% (56·3–69·3) of all deaths from larynx cancer in 2019. For males and for both sexes combined, smoking was the leading specific risk factor for age-standardised deaths from tracheal, bronchus, and lung cancer per 100 000 in all SDI quintiles and GBD regions in 2019. However, among females, household air pollution from solid fuels was the leading specific risk factor in the low SDI quintile and in three GBD regions (central, eastern, and western sub-Saharan Africa) in 2019. Interpretation The numbers of incident cases and deaths from tracheal, bronchus, and lung cancer and larynx cancer increased globally during the past decade. Even more concerning, age-standardised incidence and death rates due to tracheal, bronchus, lung cancer and larynx cancer increased in some populations—namely, in the lower SDI quintiles and among females. Preventive measures such as smoking control interventions, air quality management programmes focused on major air pollution sources, and widespread access to clean energy should be prioritised in these settings.publishedVersio

Global burden of chronic respiratory diseases and risk factors, 1990–2019: an update from the Global Burden of Disease Study 2019

Background Updated data on chronic respiratory diseases (CRDs) are vital in their prevention, control, and treatment in the path to achieving the third UN Sustainable Development Goals (SDGs), a one-third reduction in premature mortality from non-communicable diseases by 2030. We provided global, regional, and national estimates of the burden of CRDs and their attributable risks from 1990 to 2019. Methods Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we estimated mortality, years lived with disability, years of life lost, disability-adjusted life years (DALYs), prevalence, and incidence of CRDs, i.e. chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease and pulmonary sarcoidosis, and other CRDs, from 1990 to 2019 by sex, age, region, and Socio-demographic Index (SDI) in 204 countries and territories. Deaths and DALYs from CRDs attributable to each risk factor were estimated according to relative risks, risk exposure, and the theoretical minimum risk exposure level input. Findings In 2019, CRDs were the third leading cause of death responsible for 4.0 million deaths (95% uncertainty interval 3.6–4.3) with a prevalence of 454.6 million cases (417.4–499.1) globally. While the total deaths and prevalence of CRDs have increased by 28.5% and 39.8%, the age-standardised rates have dropped by 41.7% and 16.9% from 1990 to 2019, respectively. COPD, with 212.3 million (200.4–225.1) prevalent cases, was the primary cause of deaths from CRDs, accounting for 3.3 million (2.9–3.6) deaths. With 262.4 million (224.1–309.5) prevalent cases, asthma had the highest prevalence among CRDs. The age-standardised rates of all burden measures of COPD, asthma, and pneumoconiosis have reduced globally from 1990 to 2019. Nevertheless, the age-standardised rates of incidence and prevalence of interstitial lung disease and pulmonary sarcoidosis have increased throughout this period. Low- and low-middle SDI countries had the highest age-standardised death and DALYs rates while the high SDI quintile had the highest prevalence rate of CRDs. The highest deaths and DALYs from CRDs were attributed to smoking globally, followed by air pollution and occupational risks. Non-optimal temperature and high body-mass index were additional risk factors for COPD and asthma, respectively. Interpretation Albeit the age-standardised prevalence, death, and DALYs rates of CRDs have decreased, they still cause a substantial burden and deaths worldwide. The high death and DALYs rates in low and low-middle SDI countries highlights the urgent need for improved preventive, diagnostic, and therapeutic measures. Global strategies for tobacco control, enhancing air quality, reducing occupational hazards, and fostering clean cooking fuels are crucial steps in reducing the burden of CRDs, especially in low- and lower-middle income countries. Funding Bill & Melinda Gates Foundation

Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

© 2020 Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Background: Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods: Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings: Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation: The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC. Funding: Bill & Melinda Gates Foundation