Financial Impact of Complex Cancer Surgery in India: A Study of Pancreatic Cancer.

PURPOSE: The rapidly increasing burden of cancer in India has profound impacts on health care costs for patients and their families. High out-of-pocket (OOP) expenditure, lack of insurance, and low government expenditure create a vicious cycle, leading to household impoverishment. Complex cancer surgery is now increasingly important for emerging countries; however, little is understood about the macro- and microeconomics of these procedures. After the Lancet Oncology Commission on Global Cancer Surgery, we evaluated the OOP expenditure for patients undergoing pancreatico-duodenectomy (PD) at a government tertiary cancer center in India. METHODS: Prospective data from 98 patients who underwent PD between January 2014 and June 2015 were collected and analyzed. The time frame for consideration of expenses, including all preoperative investigations, was from the first hospital visit to the day of discharge. Catastrophic expenditure was calculated by assessing the percentage of households in which OOP health payments exceeded 10% of the total household income. RESULTS: The mean expenditure for PD by patients was Rs.295,679.57 (US$74,420, purchasing power parity corrected). This amount was significantly higher among those admitted to a private ward and those with complications. Only 29.6% of the patients had insurance coverage. A total of 76.5% of the sample incurred catastrophic expenditure, and 38% of those with insurance underwent financial catastrophe compared with 93% of those without insurance. The percentage of patients facing catastrophic impact was highest among those in semiprivate wards, at 86.7%, followed by those in public and private wards. CONCLUSION: The cost of PD is high and is often unaffordable for a majority of India's population. A review of insurance coverage policies for better coverage must be considered

Antimikrobno djelovanje derivata 3-hidroksi-2-metilen-3-fenilpropionske kiseline

Twenty Baylis-Hillman adducts were synthesized from different aromatic aldehydes and activated vinyl derivatives. The adducts, which are differently substituted 3-hydroxy-2-methylene-3-phenylpropionic acid derivatives, were screened for their antimicrobial activity in vitro by the serial dilution method. Many of these molecules displayed potent antibacterial and antifungal activities. The ease of synthesis from low-cost starting materials along with potent antimicrobial activity of these molecules provide the lead for further improvement of activity and reflect the possibility of therapeutic use.Iz različitih aromatskih aldehida i aktiviranih vinil derivata sintetizirano je dvadeset Baylis-Hillmanovih adukata, različito supstituiranih derivata 3-hidroksi-2-metilen-3-fenilpropionske kiseline. Ispitano je njihovo antimikrobno djelovanje in vitro metodom serijskih razrjeđenja. Većina ispitivanih spojeva pokazala je snažno antibakterijsko i antifungalno djelovanje. Jednostavni sintetski postupak iz jeftinih sirovina i snažno antimikrobno djelovanje pružaju vodeće spojeve za daljnju modifikaciju, koji mogu dovesti do ljekovitih tvari pogodnih za terapijsku primjenu

Gradijentna HPLC analiza raloksifen hidroklorida i primjena u kontroli kvalitete

A rapid, sensitive and selective method for the determination of raloxifene hydrochloride (RLX) in pure drug and in tablets was developed using gradient high performance liquid chromatography (HPLC). The devised method involved separation of RLX on a reversed phase Hypersil ODS column and determination with UV detection at 284 nm. The standard curve was linear (R = 0.999) over the concentration range of 50-600 μg mL1 with a detection limit of 0.04 μg mL1 and a quantification limit of 0.16 μg mL1. Intra-day and inter-day precision and accuracy of the method were established according to the current ICH guidelines. Intra-day RSD values at three QC levels (250, 450 and 550 μg mL1) were 0.20.5% based on the peak area. The intra-day relative error (er) was between 0.2 and 0.5%. The developed method was successfully applied to the determination of RLX in tablets and the results were statistically compared with those obtained by a literature method. Accuracy, evaluated by means of the spike recovery method, was excellent with percent recovery in the range 97.7103.2 with precision in the range 1.62.2%. No interference was observed from the conformulated substances. The method was economical in terms of the time taken and the amount of solvent used.Koristeći gradijentnu tekućinsku kromatografiju visoke učinkovitosti razvijena je brza, osjetljiva i selektivna metoda za određivanje raloksifen hidroklorida (RLX), čiste supstancije i u tabletama. U radu je primijenjena reverzno-fazna kolona Hypersil ODS te UV detekcija pri 284 nm. Standardna krivulja bila je linearna (R = 0,999) u koncentracijskom području 50600 μg mL1. Granica detekcije bila je 0,04 μg mL1 a granica određivanja 0,16 μg mL1. Repetabilnost, intermedijalna preciznost i ispravnost ispitivane su prema važećim ICH uputama. Mjerenjem površine ispod pika na tri koncentracijske razine (250, 450 i 550 μg mL1) procijenjena je repetabilnost na 0,20,5%. Relativna pogreška procijenjena unutar jednog dana (er) bila je između 0,2 i 0,5%. Razvijena metoda uspješno je primijenjena za određivanje RLX u tabletama. Rezultati su statistički uspoređeni s rezultatima dobivenim prema ranije objavljenoj metodi. Analitički povrat bio je u rasponu 97,7103,2 uz preciznost od 1,6 do 2,2%. Nije primijećena interferencija pomoćnih tvari. Metoda je ekonomična s obzirom na utrošeno vrijeme i količine upotrebljenog otapala

Development of dissolution test method for a telmisartan/amlodipine besylate combination using synchronous derivative spectrofluorimetry

The dissolution process is considered an important in vitro tool to evaluate product quality and drug release behavior. Single dissolution methods for the analysis of combined dosage forms are preferred to simplify quality control testing. The objective of the present work was to develop and validate a single dissolution test for a telmisartan (TEL) and amlodipine besylate (AML) combined tablet dosage form. The sink conditions, stability and specificity of both drugs in different dissolution media were tested to choose a discriminatory dissolution method, which uses an USP type-II apparatus with a paddle rotating at 75 rpm, with 900 mL of simulated gastric fluid (SGF without enzymes) as the dissolution medium. This dissolution methodology provided good dissolution profiles for both TEL and AML and was able to discriminate changes in the composition and manufacturing process. To quantify both drugs simultaneously, a synchronous first derivative spectrofluorimetric method was developed and validated. Drug release was analyzed by a fluorimetric method at 458 nm and 675 nm for AML and TEL, respectively. The dissolution method was validated as per ICH guidance

Nonhalogenated organic molecules from Laurencia algae

The marine red algae of the genus Laurencia have produced more 700 secondary metabolites and exhibited high molecular diversity and intriguing bioactivity. Since the halogenated structures have been comprehensively reviewed previously, this review, covering up to the end of 2012, mainly focuses on the source, structure elucidation, and bioactivity of nonhalogenated organic molecules from Laurencia spp. as well as the relationship between nonhalogenated and halogenated products. Overall, 173 new or new naturally occurring compounds with 58 skeletons, mainly including sesquiterpenes, diterpenes, triterpenes, and C15-acetogenins, are described.The marine red algae of the genus Laurencia have produced more 700 secondary metabolites and exhibited high molecular diversity and intriguing bioactivity. Since the halogenated structures have been comprehensively reviewed previously, this review, covering up to the end of 2012, mainly focuses on the source, structure elucidation, and bioactivity of nonhalogenated organic molecules from Laurencia spp. as well as the relationship between nonhalogenated and halogenated products. Overall, 173 new or new naturally occurring compounds with 58 skeletons, mainly including sesquiterpenes, diterpenes, triterpenes, and C-15-acetogenins, are described