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

A. millefolium L. in pharmacy. What should a pharmacist know?

A complex aggregate of about 24 species, A. millefolium L. agg. (Asteraceae) is one of the medicinal plants with a long tradition of use, dating back from ancient times. This paper attempts to answer to three main questions: What are the A. millefolium products available in pharmacy (on the Romanian market) that a patient might be interested in? What are their potential uses (based on clinical evidence and officially recognized traditional use in the European Union) and the relevant posology? What knowledge do we have about the safety of those products

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

The state of health in the European Union (EU-27) in 2019: a systematic analysis for the Global Burden of Disease study 2019

BackgroundThe European Union (EU) faces many health-related challenges. Burden of diseases information and the resulting trends over time are essential for health planning. This paper reports estimates of disease burden in the EU and individual 27 EU countries in 2019, and compares them with those in 2010.MethodsWe used the Global Burden of Disease 2019 study estimates and 95% uncertainty intervals for the whole EU and each country to evaluate age-standardised death, years of life lost (YLLs), years lived with disability (YLDs) and disability-adjusted life years (DALYs) rates for Level 2 causes, as well as life expectancy and healthy life expectancy (HALE).ResultsIn 2019, the age-standardised death and DALY rates in the EU were 465.8 deaths and 20,251.0 DALYs per 100,000 inhabitants, respectively. Between 2010 and 2019, there were significant decreases in age-standardised death and YLL rates across EU countries. However, YLD rates remained mainly unchanged. The largest decreases in age-standardised DALY rates were observed for “HIV/AIDS and sexually transmitted diseases” and “transport injuries” (each -19%). “Diabetes and kidney diseases” showed a significant increase for age-standardised DALY rates across the EU (3.5%). In addition, “mental disorders” showed an increasing age-standardised YLL rate (14.5%).ConclusionsThere was a clear trend towards improvement in the overall health status of the EU but with differences between countries. EU health policymakers need to address the burden of diseases, paying specific attention to causes such as mental disorders. There are many opportunities for mutual learning among otherwise similar countries with different patterns of disease