Cost variation analysis of antipsychotic drugs available in Indian market: an economic perspective

Background: Pricing of drugs plays a very important role in a developing country like India especially in the management of chronic conditions. There exists a huge price variation among the different brands of the same drug. Hence this study was planned to find out variation in prices of antipsychotic drugs marketed in India. The objective was to compare the percentage price variation and cost ratio of various formulations of oral and parenteral antipsychotic drugs available in the Indian market.Methods: Cost of oral and parenteral antipsychotic drugs available in the Indian market manufactured by different companies, in the same strength, number and dosage form was obtained from http://www.medguideindia.com. The percentage price variation and cost ratio of each formulation was calculated.Results: Among the typical group of antipsychotic drugs, Tab Haloperidol 0.25mg shows maximum price variation of 650% and a cost ratio of 7.5 followed by Tab Trifluoperazine 1mg having a price variation of 555.5% and a cost ratio of 6.55. Among the atypical group of drugs, tab Risperidone 3mg shows a price variation of 2282.35% with a cost ratio of 23.82 followed by Tab Risperidone 4mg with a price variation of 1976.92 % and a cost ratio of 20.76.Conclusions: There is a wide variation between the minimum and maximum cost among the different brands of the same drug in the same formulations. Combined efforts are needed from the regulatory authorities, pharmaceutical companies, physicians and pharmacist towards controlling the prices and attaining maximum economic benefits for the patient

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Water and ionic liquid synergy: A novel approach for the synthesis of benzothiazole-2(3H)-one

Synergy between water, a green reaction medium and ionic liquid, a green catalyst has opened new vistas in the field of organic transformation. The developed methodology has emerged as an interesting combination for an environmentally benign, facile and efficient synthesis of benzothiazole-2(3H)-one. Product was achieved in excellent yield by the reaction of structurally diverse 2-iodoanilines with potassium thiocyanate. The strategy involves nucleophilic substitution forming NC and SC bonds resulting in the desired heterocyclic scaffold. This novel approach is also helpful for the synthesis of other related heterocycles for the development of an important drug like library. The reaction proceeded smoothly at an ambient temperature

Water and ionic liquid synergy: A novel approach for the synthesis of benzothiazole-2(3H)-one

Synergy between water, a green reaction medium and ionic liquid, a green catalyst has opened new vistas in the field of organic transformation. The developed methodology has emerged as an interesting combination for an environmentally benign, facile and efficient synthesis of benzothiazole-2(3H)-one. Product was achieved in excellent yield by the reaction of structurally diverse 2-iodoanilines with potassium thiocyanate. The strategy involves nucleophilic substitution forming NC and SC bonds resulting in the desired heterocyclic scaffold. This novel approach is also helpful for the synthesis of other related heterocycles for the development of an important drug like library. The reaction proceeded smoothly at an ambient temperature

The potential of esculin as a therapeutic modality in diabetes mellitus and its complications

The available medications for diabetes mellitus (DM) are not sufficient to reverse the pathophysiological abnormalities and complications associated with the disease. Considering the undesirable side-effects linked to existing anti-diabetic drugs, there is a paradigm shift towards natural substances for the management and treatment of DM. Plant products such as secondary metabolites or bioactive phytoconstituents are a remarkable source of natural medicines used in ameliorating various diseases, including diabetes. This review article focuses on a natural compound esculin, a coumarin derivative, which possesses multiple biological properties such as anti-inflammatory, anti-oxidative, analgesic, diuretic, anti-coagulative, anti-apoptotic and anti-depressive. It could be a possible candidate as a therapeutic agent in ameliorating diabetes and its complications. Although studies related to the pharmacodynamics of esculin are limited and not fully understood, the anti-diabetic properties of esculin could be exploited as an alternative treatment for type-2 diabetes mellitus (T2DM) either in combination therapy in integrative medicine or as a natural anti-diabetic medicine. However, comprehensive chemical and pharmacological studies are required to validate the available data on esculin from both in vivo and in vitro studies before it can be considered as a potential therapeutic agent in DM