The number of new and continuing drug shortages has continued to be on the rise for last ten years. Drug shortages not only reduces the quality of patient care but also contributes to the indirect costs on the healthcare systems by requiring additional time and money to be spent finding alternatives, rescheduling procedures, or modifying drug usage protocols. In order to better understand the dilemma of this crisis, this review article will focus on the specific causes, impact, and most importantly, management strategies of the drug shortage crisis.

Aim: To investigate the influence of genetic polymorphisms of Multidrug Resistant Gene (MDR1), Reduced Folate Carrier (RFC1), Folylpolyglutamyl Synthase (FPGS), Gamma Glutamyl Hydrolase (GGH), and Methylenetetrahydrofolate Reductase (MTHFR) on Methotrexate (MTX) efficacy and toxicity in Chinese patients with Rheumatoid Arthritis (RA).

Methods: One hundred and thirteen Rheumatoid Arthritis (RA) patients defined by the American College of Rheumatology (ACR) 1987 classification criteria were recruited in this study. All patients were treated with low-dose MTX (10-20 mg/week) without concomitant uses of other DMARDs for at least six months. RFC1 80G>A, MDR1 3435C>T, FPGS rs1544105 G>A, GGH - 401C>T, MTHFR 677C>T and MTHFR 1298A>C were genotyped by Polymerase Chain Reaction–Restriction Fragment Length Polymorphism (PCR–RFLP) methods. The MTX toxicity assessment was categorized according to the common toxicity criteria of the National Cancer Institute.

Result: The remission of RA symptoms was achieved in all the MDR1 3435TT genotype carriers (16/16), in 73.1% of subjects with 3435CT genotype (38/52), and in 75.6% of patients with 3435CC genotype (34/45) (P=0.046), respectively. Interaction between SNPs in RFC1 80 and MTHFR 1298 seemed to affect the efficacy of MTX with the best overall performances (accuracy of 0.67) and a CVC of 10/10 (P=0.002). MTHFR 677T allele carriers were more susceptible to MTX toxicity (P=0.007, OR:1.897, 95%CI: 1.725-2.087), compared to those with CC genotype. Of four diplotypes, patients with MTHFR CA-TA diplotype were more easy to experience toxicity (P=0.007, OR: 2.273, 95%CI: 1.303-3.964) when compared to patients without CA-TA diplotype.

Conclusion: MDR1 3435C>T might influence efficacy of RA therapy with MTX. Interaction between RFC1 80 and MTHFR 1298 seemed to impact MTX efficacy. Polymorphisms in the MTHFR gene were associated with toxicity of MTX. Further studies are warranted.

Objective: The main object of present study is to clinically evaluate the efficacy of an Ayurvedic compound formulation Phalatrikadi Kvatha (PTK) on Hepatitis B patients.

Method: Total 59 Hepatitis B positive patients were selected from OPD and IPD of S.S. Hospital, Institute of Medical Sciences, B.H.U. PKT was given in a dose of 80 ml/day in two divided doses for 6 months and follow up was done on every third month. In each follow up Routine Hematological examinations- Hb%, TLC, DLC and ESR; Biochemical investigations- LFT, Serological test- HBsAg (for HBV) and HBV DNA and Radiological tests- USG whole abdomen were done.

Result: Result showed significant effect of Phalatrikadi Kvatha (PTK) on sign and symptoms of Hepatitis which was evidenced by laboratory investigations i.e. LFT (p<0.05), negative HBsAg in 8 patients and HBV DNA (Chi-square =45.9 and P<0.01).Thus present results showed efficacy of PKT on Hepatitis.

Conclusion: Present findings suggest that Phalatrikadi Kvatha (PTK) is an effective and beneficial formulation for management of Hepatitis B patients.

Human sacrifice has been practiced on a number of occasions and in many cultures. The various rationales behind human sacrifice are the same that motivate religious sacrifice in general