Performance of Thailand’s universal health coverage scheme: Evaluating the effectiveness of annual public hearings

BackgroundLegislative provisions in Thailand''s National Health Security Act 2002 mandate annual public hearings for providers, beneficiaries and other stakeholders in order to improve the performance of the Universal Health Coverage Scheme (UCS).ObjectiveThis study aims to explore the annual public hearing process, evaluate its effectiveness and propose recommendations for improvement.MethodIn‐depth interviews were conducted with 29 key informants from various stakeholder groups involved in annual public hearings.ResultsThe evaluation showed that the public hearings fully met the criteria of influence over policy decision and partially met the criteria of appropriate participation approach and social learning. However, there are rooms for improvement on public hearing''s inclusiveness and representativeness of participants, adequacy of information and transparency.ConclusionsThree recommendations were proposed a) informing stakeholders in advance of the agenda and hearing process to enable their active participation; b) identifying experienced facilitators to navigate the discussions across stakeholders with different or conflicting interests, in order to reach consensus and prioritize recommendations; and c) communicating policy and management responses as a result of public hearings to all stakeholders in a timely manner.     

Systemic Delivery of Nanoparticles Loaded with Pentagalloyl Glucose Protects Elastic Lamina and Prevents Abdominal Aortic Aneurysm in Rats

Degeneration of elastin plays a vital role in the pathology and progression of abdominal aortic aneurysm (AAA). Our previous study showed that pentagalloyl glucose (PGG), a core derivative of tannic acid, hinders the development of AAAs in a clinically relevant animal model when applied locally. In this study, we tested whether targeted nanoparticles (NPs) can deliver PGG to the site of an aneurysm and prevent aneurysmal growth by protecting elastin. PGG-loaded albumin NPs with a surface-conjugated elastin-specific antibody were prepared. Aneurysms were induced by calcium chloride-mediated injury to the abdominal aorta in rats. NPs were injected into the tail vein after 10 days of CaCl₂ injury. Rats were euthanized after 38 days. PGG delivery led to reduction in macrophage recruitment, matrix metalloproteinase (MMP) activity, elastin degradation, calcification, and development of aortic aneurysm. Such NP delivery offers the potential for the development of effective and safe therapies for AAA.     

Alleviating impact of hydroethanolic Murraya koenigii leaves extract on bisphenol A instigated testicular lethality and apoptosis in mice

Bisphenol A (BPA) is a well-known endocrine disruptor that imposees adverse effects on male fertility via interacting with germ cells of testis. Objectives of present study were to investigate the possible protective effects of hydroethanolic Murraya koenigii leaves extract (HEMKLE) against BPA-induced testicular damage and apoptosis in mice. Male Balb/c mice were divided into four different groups: Group I (control), Group II (HEMKLE), Group III (BPA) and Group IV (HEMKLE + BPA). Group III (BPA) showed significant decrease in sperm parameters, germ cell number along with increased lipid peroxidation (LPO) and reactive oxygen species (ROS). A significant decrease in antioxidant enzymes activity was also observed in Group III (BPA) animals. mRNA expression study revealed significant decrease in the expression of Bcl-2 and increase in expressions of caspase-9 and caspase-3, thus clearly demonstrate BPA-induced apoptosis. In addition, HEMKLE co-administration to BPA-treated mice showed a significant increase in sperm parameters, germ cell number, decreased levels of LPO and ROS, increased antioxidant enzymes activity in Group IV (HEMKLE + BPA). Also, mRNA expression study showed a significant increase in Bcl-2 and decrease in caspase-9 and caspase-3 gene expressions in Group IV (HEMKLE + BPA). Thus, the present study suggests that HEMKLE intervention provides protection against BPA-induced oxidative stress and apoptosis.     

Selenium attenuates venlafaxine hydrochloride-induced testicular damage in mice via modulating oxidative stress and apoptosis

The present study assessed the effect of selenium (Se) supplementation on Venlafaxine hydrochloride (VH)-induced testicular toxicity. Mice were segregated into Group I (C), Group II (0.5 ppm Se), Group III (VH at a dose 60 mg/kg b.w.) and Group IV (Se was given as per Group II, and VH was given as per Group III). After 10 weeks, sperm parameters, histology, sperm cell counts, antioxidants activities, apoptotic proteins and molecular analysis of testicular tissue were evaluated. Group III had significantly lower sperm concentration (from 2.17 ± 0.28 to 1.04 ± 0.22) and sperm motility (from 68.04 ± 5.5 to 21.47 ± 5.21), and showed an extensive vacuolisation in the germinal epithelium, abnormal basement membrane, and reduced germ cell number as compared to Group I. However, selenium supplementation in Group IV substantially increased sperm concentration (1.47 ± 0.48) and motility (33.27 ± 8.66), improved the histoarchitecture and repopulated the germ cells as observed by raised numbers of spermatogonia, spermatocytes, round spermatids and elongated spermatids contrasted to Group III. Group IV also showed a noteworthy decreased ROS, LPO levels, as well as expressions of Bax, caspase-9, and caspase-3 and increased the SOD, CAT, GPx, and GSH activities as well the expression of Bcl-2 as compared to Group III. This effect was further supported by FTIR analysis for nucleic acids. Thus, selenium supplementation showed significant protection against VH-induced testicular toxicity.     

Comparative analysis of quantity and quality of biomedical publications in Gulf Cooperation Council countries from 2011-2013

Objectives:

To compare the research productivity of different Gulf Cooperation Council (GCC) countries in the field of biomedical sciences from 2011-2013.

Methods:

This is a retrospective study conducted in the College of Medicine, Alfaisal University, Riyadh, Saudi Arabia. Data on the biomedical publications originating from GCC countries published between January 2011 to December 2013 was searched via MEDLINE using PubMed. The total number of publications emanating from each country was normalized with the country’s population. The mean impact factor (IF) of all the publications in a year was calculated for comparative analysis.

Results:

A total of 11,000 publications were retrieved via MEDLINE using PubMed, out of which, 9222 were selected for analysis. A successive increase in the number of publications by every country was observed. The most striking increase in the number of publications was from Saudi Arabia. However, after normalization with population, the performance of Oman, Qatar, and Kuwait looks far better than Saudi Arabia in terms of research productivity. Data on mean IF showed that the overall mean IF of all GCC countries has remained largely unchanged except Oman. Although Oman had a comparatively low mean IF value in 2011, they recorded a tremendous improvement in successive years.

Conclusion:

All GCC countries underwent an increase in quantitative research productivity over the last 3 years. However, no increase in quality of research publications was noted based on the proxy reports of mean journal IF.The Gulf Cooperation Council (GCC) is a political and economic union of Arab states bordering the Persian Gulf. It includes Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates.1 The headquarter of the GCC is in Riyadh, the capital of Saudi Arabia. Although great cultural and linguistic similarity is found between the GCC countries, they are diverse at the education and research institution level. Much of this diversity arises due to the disparity in monetary resources, population, and country’s covered area. For instance, Saudi Arabia, the largest GCC country (spanning a total of 2,217,949 square kilometers) with a GDP of 748.4 billion US dollars,2 has vastly different resources compared to Bahrain, the smallest GCC country with a total covered area of 678 square kilometers and a GDP amounting to 32.8 billion US dollars.3 Similarly, there are huge differences in population among the member countries. These economic and demographic differences also extend to the number of educational and research-generating institutes within each country in the GCC. This in turn affects the productivity of research activity in each country. Research activities in a country have a direct impact on improving health care and policy.4 The history of education and research in GCC member countries is not very old although research activities are promoted at governmental and institutional levels. Even the guidelines for academic promotions of the faculty working in most of the institutes in GCC countries put a heavy weight age on the research productivity.5,6 Publication in journals is the eventual outcome of scientific research. Several previous studies have examined bibliometric trends in Iran,7 Oman,8 United Arab Emirates,9 and Saudi Arabia.10,11 Studies for the whole GCC countries have also been carried out.12-16 This study aims to extend this knowledge by comparing the research productivity of GCC countries in the field of biomedical sciences over the last 3 years. Research productivity was measured in 2 dimensions. Firstly, all countries were compared in terms of the number and types of publications in Pubmed-indexed journals and secondly, the quality of the publications was determined taking journal impact factor (IF) as a measure of quality.     

Targeting the PI3K and MAPK pathways to treat Kaposi's-sarcoma-associated herpes virus infection and pathogenesis

Cells require the ability to appropriately respond to signals in their extracellular environment. To initiate, inhibit and control these processes, the cell has developed a complex network of signaling cascades. The phosphatidylinositol 3-kinase (PI3K) and mitogen-activated protein kinase (MAPK) signaling pathways regulate several responses including mitosis, apoptosis, motility, proliferation, differentiation and many others. It is not surprising, therefore, that many viruses target the PI3K and MAPK pathways as a means to manipulate cellular function. Recently, Kaposi's sarcoma-associated herpes virus (KSHV) has been added to the list. KSHV manipulates the PI3K and MAPK pathways to control such divergent processes as cell survival, cellular migration, immune responses, and to control its own reactivation and lytic replication. Manipulation of the PI3K and MAPK pathways also plays a role in malignant transformation. Here, the authors review the potential to target the PI3K and MAPK signaling pathways to inhibit KSHV infection and pathogenesis.     

Patterns of HIV infection among native and refugee Afghans

The current study was conducted to explore the origins of the HIV epidemics among the Afghan refugees in Pakistan and the native Afghans in Afghanistan. Phylogenetic analysis of HIV gag gene from 40 samples showed diverse HIV variants, originating from a number of countries. Intermixing of diverse HIV variants among Afghans may give rise to seeding of infections with rare HIV strains which may pose serious challenges for the treatment and control of infection.     

Fabrication and characterisation of self-applicating heparin sodium microneedle patches

Abstract

The aim of this study was to develop heparin sodium loaded microneedle patches using different compositions of polyvinyl alcohol polymer and sorbitol. A vacuum micromolding technique was used to fabricate microneedle patches while heparin sodium was loaded into needle tips. Physical features of patches were evaluated by measuring thickness, width, folding endurance and swelling percentage. Patches were also characterised by optical microscopy and scanning electron microscopy to determine the microneedle length and surface morphologies. A preliminary assessment of the microneedle performance was studied by examining the in-vitro insertion to the parafilm and recording the in-vitro drug release profile. In-vivo activity of patches was confirmed by measuring activated partial thromboplastin time and histological examination of the micropierced skin tissues. Prepared patches were clear, smooth; uniform in appearance; with sharp pointed microprojections and remained intact after 1000 folding. The microneedles were stiffer in nature, as they reproduce microcavities in the parafilm membrane following hand pushing without any structural loss. Insertion study results showed successful insertion of microneedles into the parafilm. Disrupted stratum corneum evident from histological examination confirmed successful insertion of the microneedle without affecting the vasculature. In-vitro release study confirmed ～92% release of the loaded drug within 120?min. A significant prolongation of activated partial thromboplastin time (4 folds as compared to negative control) was recorded following the application of heparin sodium loaded microneedle patch onto rabbit skin. In conclusion microneedles are a valuable drug delivery system, benefiting the patients with minimal skin invasion and also allowing self-administration of heparin sodium in a sustained release manner for the management of chronic ailments.