Background: The pharmaceutical subsystem is a complex interrelationship among different stakeholders that ensure access to safe, effective, and quality pharmaceutical products in the market. Understanding the availability and affordability as key areas for access to medicines is essential to appreciate the strategies needed to strengthen the pharmaceutical subsystem. Objectives: This study aimed to determine the availability and affordability of essential antihypertensive medicines in public primary care facilities and private retail drugstores in a 4th class municipality. Further, the study determined the price comparisons of these essential antihypertensive medicines with international reference prices. Methods: This is a quantitative, cross-sectional study design which employed a modified WHO/HAI methodology to quantify antihypertensive medicines’ availability and affordability in public and private primary care drug facilities. Selection of medicines was based on a criteria applicable for the primary care setting. Availability was measured through visual inspection of the selected medicines in the facility, affordability was estimated through the selling price of medicines in the public and private facilities, respectively, and was divided by the local minimum wage of the municipality. Median price ratio was computed using the local median prices over the MSH 2015 international reference prices adjusted for inflation. Results: Availability of essential antihypertensive medicines was found to be 12.96% in public facilities and 60.32% in private facilities (p = 0.0002). Only amlodipine is observed to be available in both public (83.33%) and private (85.71%) facilities, while only metoprolol 50 mg tab (33.33%) and amlodipine 5 mg tab (83.33%) were available in public facilities. All medicines are below 1 MPR, but carvedilol 6.25 mg (1 tab BID: 1.32; 2 tabs BID: 2.65), 25 mg (BID: 2.65), and enalapril 5 mg (BID: 1.14; TID: 1.70) treatment regimens are unaffordable compared to a worker’s day wage. Conclusion Availability of essential antihypertensive medicines is diverse comparing public and private facilities. There is a need to increase the availability of antihypertensive medicines in public facilities as this is an important quality measure of primary care services. Public facilities can leverage on the availability of medicines in private pharmacies by forming Primary Care Provider Networks. While most medicines were deemed affordable in the private setting, there are still drugs such as carvedilol and enalapril, that need to be regulated. There is a need to strengthen the local pharmaceutical subsystem because it is essential to ensure safe, effective, and quality medicines in the local health system through adequate mobilization of resources.
Human ; access to medicines ; health services accessibility ; affordability ; costs and cost analysis

No abstract available.
Fires ; Open Access Publishing

Blood Pressure Monitoring, Ambulatory ; COVID-19/therapy* ; Cardiac Rehabilitation ; Cardiovascular Diseases/therapy* ; Communicable Disease Control ; Contact Tracing ; Health Literacy ; Health Services Accessibility ; Healthcare Disparities ; Humans ; Internet Access ; Poverty ; SARS-CoV-2 ; Singapore ; Social Class ; Social Conditions ; Socioeconomic Factors ; Telemedicine ; Telerehabilitation ; Transients and Migrants

Dorsalis pedis artery (DPA) aneurysms are very rare and fewer than 60 cases have been reported in the literature. Most affected patients present with false aneurysms after orthopedic surgery or trauma. Here we report an unusual case of a giant DPA pseudoaneurysm after cannulation for arterial line placement in a patient newly diagnosed with systemic lupus erythematosus (SLE). A diagnostic delay resulted in necrosis of the overlying skin. Excision of the pseudoaneurysm, ligation of the DPA, and debridement of the foot dorsum were performed, followed by a second flap coverage surgery. Although a DPA false aneurysm is rare after arterial line removal, it can cause the serious complications of skin necrosis, rupture and toe necrosis. Arterial puncture sites should be carefully monitored, especially in patients with SLE or other vasculitis.
Aneurysm ; Aneurysm, False ; Arteries ; Catheterization ; Debridement ; Delayed Diagnosis ; Foot ; Humans ; Ligation ; Lupus Erythematosus, Systemic ; Necrosis ; Orthopedics ; Punctures ; Rupture ; Skin ; Toes ; Vascular Access Devices ; Vasculitis

PURPOSE: Long-term venous access is cumbersome in children because of their thin caliber veins, less cooperative nature, and easy compromise of venous integrity. Hence, a study was conducted to evaluate the indication, efficacy, and safety of chemoport in children who require chronic venous access. MATERIALS AND METHODS: Children who underwent chemoport insertion between January 2008 and December 2017 were retrospectively evaluated. RESULTS: A total of 159 children (169 chemoports) were included in the study. The most common indication for chemoport insertion was acute lymphoblastic leukemia (51.5%). The mean chemoport days were 832±666 days. Among the 169 chemoports, 55.0% were removed after treatment completion. The chemoport was not removed in 35.5% of the patients, as 28.4% of the patients were still under treatment and 7.1% died during the treatment. Sixteen patients (0.1 per 1,000 chemoport days) had a premature chemoport removal. The indications were port-related bloodstream infection (12 patients), port pocket infection (1 patient), exposed chemoport (1 patient), and blocked chemoport catheter (2 patients). Twenty-two patients (0.15 per 1,000 chemoport days) had complications of port-related bloodstream infection (0.09 per 1,000 chemoport days), making it the most common. Other complications include block, fracture, arrhythmias, avulsion, bleeding, decubitus-over-port, and port pocket infection. CONCLUSION: Owing to the safe, reliable, and low complication rate of chemoports, more children can be saved from deadly illnesses. Chemoport is the best option for children who require chronic venous access.
Arrhythmias, Cardiac ; Catheters ; Child ; Hemorrhage ; Humans ; Leukemia ; Observational Study ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Retrospective Studies ; Vascular Access Devices ; Veins

Access to Information ; Biomedical Research ; Editorial Policies ; Ethics, Research ; Humans ; Internet ; Journal Impact Factor ; Open Access Publishing ; Peer Review ; Periodicals as Topic ; Singapore

No abstract available.
Open Access Publishing

The Open Access Initiative is gaining momentum due to the worldwide availability of advanced digital tools, online publishing platforms, and systems for tracking academic contributions. Several declarations and initiatives, including Plan S, have already laid a foundation for moving away from subscription to full and immediate open-access publishing. The global initiatives imply targeting journals satisfying the upgraded quality and visibility criteria. To meet these criteria, a comprehensive approach to Open Access is recommended. This article overviews the essential components of the comprehensive approach, increasing transparency, adherence to ethical standards, and diversification of evaluation metrics. With the increasing volume of quality open-access journals, their indexing with free databases and search engines is becoming increasingly important. The Directory of Open Access Journals and PubMed Central currently free searches of open-access sources. These services, however, cannot fully satisfy the increasing demands of the users, and attempts are underway to upgrade the indexing and archiving of open-access sources in China, Japan, Korea, Russia, and elsewhere. The wide use of identifiers is essential for transparency of scholarly communications. Peer reviewers are now offered credits from Publons. These credits are transferrable to their Open Researcher and Contributor iDs. Various social media channels are increasingly used by scholars to comment on articles. All these comments are tracked by related metric systems, such as Altmetrics. Combined with traditional citation evaluations, the alternative metrics can help timely identify and promote publications influencing education, research, and practice.
Abstracting and Indexing as Topic ; Access to Information ; Bibliography as Topic ; China ; Education ; Japan ; Korea ; Metric System ; Open Access Publishing ; Peer Review ; Periodicals as Topic ; Russia ; Search Engine ; Social Media

Open access (OA) publishing is a recent phenomenon in scientific publishing, enabling free access to knowledge worldwide. In the Indian context, OA to science has been facilitated by government-funded repositories of student and doctoral theses, and many Indian society journals are published with platinum OA. The proportion of OA publications from India is significant in a global context, and Indian journals are increasingly available on OA repositories such as Pubmed Central, and Directory of Open Access Journals. However, OA in India faces numerous challenges, including low-quality or predatory OA journals, and the paucity of funds to afford gold OA publication charges. There is a need to increase awareness amongst Indian academics regarding publication practices, including OA, and its potential benefits, and utilize this modality of publication whenever feasible, as in publicly-funded research, or when platinum OA is available, while avoiding falling prey to poor quality OA journals.
Accidental Falls ; Bibliography as Topic ; Financial Management ; Humans ; India ; Open Access Publishing ; Platinum ; Publications

BACKGROUND: Controlled hypotension (CH) provides a better surgical environment and reduces operative time. However, there are some risks related to organ hypoperfusion. The EV1000/FloTrac system can provide continuous cardiac output monitoring without the insertion of pulmonary arterial catheter. The present study investigated the efficacy of this device in double jaw surgery under CH.METHODS: We retrospectively reviewed the medical records of patients who underwent double jaw surgery between 2010 and 2015. Patients were administered conventional general anesthesia with desflurane; CH was performed with remifentanil infusion and monitored with an invasive radial arterial pressure monitor or the EV1000/FloTrac system. We allocated the patients into two groups, namely an A-line group and an EV1000 group, according to the monitoring methods used, and the study variables were compared.RESULTS: Eighty-five patients were reviewed. The A-line group reported a higher number of failed CH (P = 0.005). A significant correlation was found between preoperative hemoglobin and intraoperative packed red blood cell transfusion (r = 0.525; P < 0.001). In the EV1000 group, the mean arterial pressure (MAP) was significantly lower 2 h after CH (P = 0.014), and the cardiac index significantly decreased 1 h after CH (P = 0.001) and 2 h after CH (P = 0.007). Moreover, venous oxygen saturation (ScVO2) decreased significantly at both 1 h (P = 0.002) and 2 h after CH (P = 0.029); however, these values were within normal limits.CONCLUSION: The EV1000 group reported a lower failure rate of CH than the A-line group. However, EV1000/FloTrac monitoring did not present with any specific advantage over the conventional arterial line monitoring when CH was performed with the same protocol and same mean blood pressure. Preoperative anemia treatment will be helpful to decrease intraoperative transfusion. Furthermore, ScVO2 monitoring did not present with sufficient benefits over the risk and cost.
Anemia ; Anesthesia, General ; Arterial Pressure ; Blood Pressure ; Cardiac Output ; Catheters ; Erythrocyte Transfusion ; Humans ; Hypotension, Controlled ; Medical Records ; Operative Time ; Orthognathic Surgery ; Osteotomy, Le Fort ; Oxygen ; Retrospective Studies ; Vascular Access Devices