Promotion of access to essential medicines for Non-Communicable Diseases: Practical implications of the UN Political Declaration

Access to medicines and vaccines to prevent and treat non-communicable diseases (NCDs) is unacceptably low worldwide. In the 2011 UN political declaration on the prevention and control of NCDs, heads of government made several commitments related to access to essential medicines, technologies, and vaccines for such diseases. 30 years of experience with policies for essential medicines and 10 years of scaling up of HIV treatment have provided the knowledge needed to address barriers to long-term effective treatment and prevention of NCDs. More medicines can be acquired within existing budgets with efficient selection, procurement, and use of generic medicines. Furthermore, low-income and middle-income countries need to increase mobilisation of domestic resources to cater for the many patients with NCDs who do not have access to treatment. Existing initiatives for HIV treatment offer useful lessons that can enhance access to pharmaceutical management of NCDs and improve adherence to long-term treatment of chronic illness; policy makers should also address unacceptable inequities in access to controlled opioid analgesics. In addition to off-patent medicines, governments can promote access to new and future on-patent medicinal products through coherent and equitable health and trade policies, particularly those for intellectual property. Frequent conflicts of interest need to be identified and managed, and indicators and targets for access to NCD medicines should be used to monitor progress. Only with these approaches can a difference be made to the lives of hundreds of millions of current and future patients with NCDs

Whole-Genome Sequencing to Identify Missed Rifampicin and Isoniazid Resistance Among Tuberculosis Isolates—Chennai, India, 2013–2016

India has a high burden of drug-resistant tuberculosis (DR TB) and many cases go undetected by current drug susceptibility tests (DSTs). This study was conducted to identify rifampicin (RIF) and isoniazid (INH) resistance associated genetic mutations undetected by current clinical diagnostics amongst persons with DR TB in Chennai, India. Retrospectively stored 166 DR TB isolates during 2013–2016 were retrieved and cultured in Löwenstein-Jensen medium. Whole genome sequencing (WGS) and MGIT DST for RIF and INH were performed. Discordant genotypic and phenotypic sensitivity results were repeated for confirmation and the discrepant results considered final. Further, drug resistance-conferring mutations identified through WGS were analyzed for their presence as targets in current WHO-recommended molecular diagnostics. WGS detected additional mutations for rifampicin and isoniazid resistance than WHO-endorsed line probe assays. For RIF, WGS was able to identify an additional 10% (15/146) of rpoB mutant isolates associated with borderline rifampicin resistance compared to MGIT DST. WGS could detect additional DR TB cases than commercially available and WHO-endorsed molecular DST tests. WGS results reiterate the importance of the recent WHO revised critical concentrations of current MGIT DST to detect low-level resistance to rifampicin. WGS may help inform effective treatment selection for persons at risk of, or diagnosed with, DR TB

Phenotypic and genotypic characterization of Mycobacterium tuberculosis pyrazinamide resistance—India, 2018–2020

Pyrazinamide (PZA) is a key first-line antituberculosis drug that plays an important role in eradicating persister Mycobacterium tuberculosis (TB) bacilli and shortening the duration of tuberculosis treatment. However, PZA-resistance is on the rise, particularly among persons with multidrug-resistant (MDR) tuberculosis. This nationwide study was conducted to explore the prevalence of mutations conferring PZA resistance, catalogue mutation diversity, investigate the associations of PZA resistance with specific lineages, examine co-resistance to 13 first- and second-line drugs, and evaluate the diagnostic accuracy of sequencing pncA and panD genes for predicting PZA resistance. Whole genome sequencing was performed on 2,207 M. tuberculosis isolates from 25 States and 4 Union Territories of India. The majority of phenotypically PZA-resistant isolates (77%) harbored 171 distinct mutations in pncA; however, a small number of mutations in panD, rpsA and clpC1 were also observed. A set of novel mutations associated PZA resistance was uncovered, along with an additional 143 PZA resistance-conferring mutations in pncA based on application of WHO-endorsed grading rules. PZA resistance was predominately observed in Lineage 2 and eight lineage-specific resistance markers were identified. Mutations distributed across pncA correlate to 94% of PZA resistance and were the predominant drivers of phenotypic resistance; evidence generated herein substantiates sequencing the entire gene and promoter for comprehensive genotypic-based prediction of PZA resistance. This work provides key insights into the scope of PZA-resistance in India, a high drug-resistant TB burden country, and can support the effectiveness of TB prevention and control efforts

Promoting hemiplegic gait

Introduction and Aim: Balance synergy includes a number of postural response that enable an individual to arise and remain erect during standing and locomotion. Balance deficits causes an insufficient coordination, postural instability and impaired gait. Maintaining the independence in activities of activities of daily living is an important factor for the quality of life. Hence this study is done to promote Hemiplegic Gait in stroke patients.&#x0D; Materials and Methods: 150 community dwelling hemiparetic subjects from Chennai aged &lt;65 both male and female subjects were allocated in three groups (n=50) using convenient sampling method and were followed up for a period of 12 weeks with intervention duration of 45 mins daily and were assessed with POMA, FALL RISK , TUG and 6 minute walk test. Paired‘t’ test was used for assessing pre and post-test values.&#x0D; Results: There was significant difference with p &lt; 0.001 at both Tinetti Performance oriented mobility assessment, Time up and Go Test, Fall Risk and 6 minute walk test minimal significant difference in  chair stand test in both the groups.&#x0D; Conclusion: There was significant difference in POMA, FALL RISK , TUG and 6 minute walk test p&lt;.005 in Group C &amp; Group B.&#x0D;  </jats:p

Towards a Novel Privacy-Preserving Distributed Multiparty Data Outsourcing Scheme for Cloud Computing with Quantum Key Distribution

The intersection of cloud computing, blockchain technology, and the impending era of quantum computing presents a critical juncture for data security. This research addresses the escalating vulnerabilities by proposing a comprehensive framework that integrates Quantum Key Distribution (QKD), CRYSTALS Kyber, and Zero-Knowledge Proofs (ZKPs) for securing data in cloud-based blockchain systems. The primary objective is to fortify data against quantum threats through the implementation of QKD, a quantum-safe cryptographic protocol. We leverage the lattice-based cryptographic mechanism, CRYSTALS Kyber, known for its resilience against quantum attacks. Additionally, ZKPs are introduced to enhance data privacy and verification processes within the cloud and blockchain environment. A significant focus of this research is the performance evaluation of the proposed framework. Rigorous analyses encompass encryption and decryption processes, quantum key generation rates, and overall system efficiency. Practical implications are scrutinized, considering factors such as file size, response time, and computational overhead. The evaluation sheds light on the framework's viability in real-world cloud environments, emphasizing its efficiency in mitigating quantum threats. The findings contribute a robust quantum-safe and ZKP-integrated security framework tailored for cloud-based blockchain storage. By addressing critical gaps in theoretical advancements, this research offers practical insights for organizations seeking to secure their data against quantum threats. The framework's efficiency and scalability underscore its practical feasibility, serving as a guide for implementing enhanced data security in the evolving landscape of quantum computing and blockchain integration within cloud environments.Comment: 15 pages, 5 figure