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Sharksrx Newsletter Fall 2026, Nova Southeastern University

NSU Sharks Rx

No abstract provided.

From Advisory To Action: The Case For Preserving Paccarb In The Fight Against Antimicrobial Resistance, Leila S. Hojat, Muhammad Dhanani, Amy Y. Kang, Salome O. Chitavi, Robert A. Weinstein, Edward Stenehjem

Pharmacy Faculty Articles and Research

The Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria (PACCARB) was established to advise the government on strategies to mitigate antimicrobial resistance (AMR) and its increasing threat to public health and national security. Its members included experts from diverse disciplines such as healthcare, veterinary medicine, industry, public health, and agriculture who were positioned to interface with key stakeholders and the public in an aspirational multidisciplinary approach to combating AMR. The council was successful in elevating AMR as a national priority and played a crucial role in watershed events for antimicrobial stewardship (AS) such as the development of the second National Action …

Comparative Potency Testing Of Diphtheria Toxoid In Guinea Pigs And Mice For In-House Diphtheria-Tetanus-Pertussis And Diphtheria-Tetanus Vaccines, Wanlop Leeden, Supanee Ummalukacholk, Orawin Mangkhaladul, Eakachai Prompetchara

The Thai Journal of Pharmaceutical Sciences

Background: Diphtheria remains endemic in parts of Thailand and continues to threaten unvaccinated populations. To strengthen vaccine self-sufficiency, the Government Pharmaceutical Organization has developed in-house diphtheria–tetanus–pertussis (DTP) and diphtheria– tetanus (dT) vaccines. Potency testing of diphtheria toxoid is traditionally performed in guinea pigs; however, limitations in animal availability, cost, and logistics have prompted evaluation of alternative models.
Objectives: To compare diphtheria toxoid potency estimates of in-houseproduced DTP and dT vaccines using guinea pigs and mice, followed by a Vero cell-based toxin neutralization assay, and to assess the suitability of mice as an alternative model for potency testing.
Materials and Methods: …

Current Advances In Cancer Immunotherapy: Mechanisms, Therapeutic Strategies, Challenges, And Future Perspectives, Mohamed E. Abd El-Hack, Mahmoud Moustafa, Mahmoud Kamal, Vincenzo Tufarelli, Muhammad Arif, Laith Aldabbagh

Al-Mustaqbal Journal of Pharmaceutical and Medical Sciences

Cancer immunotherapy has emerged as a transformative therapeutic strategy that harnesses the host immune system to recognize and eliminate malignant cells. This review provides a comprehensive overview of current immunotherapeutic approaches, including immune checkpoint inhibitors (ICIs), monoclonal antibodies (mAbs), cancer vaccines, dendritic cell (DC)-based vaccines, chimeric antigen receptor (CAR)-T cell therapy, and oncolytic virus therapy. The mechanisms of action, therapeutic applications, and clinical benefits of each modality are discussed. Monoclonal antibodies selectively target tumor-associated antigens, whereas ICIs restore antitumor immunity by blocking inhibitory immune checkpoints. Cancer vaccines and DC-based vaccines enhance antigen-specific immune responses, while CAR-T cell therapy employs genetically …

Pacific Rxtracts - September 2026, Pacific Rxtracts

Pacific RxTracts

Articles

• Efficacy of Daraxonrasib Versus Chemotherapy in Previously Treated Metastatic Pancreatic Cancer (Breaking News)
• A Multi-Drug, All-Age Unified PopPK Model for Aminoglycoside Dosing (General News)
• Digital Outreach to Improve Statin Refills in Patients With Low Statin Adherence (Cardiology)
• Low-Dose Hydrocortisone and Cognition in Women With HIV (Endocrine)
• Rethinking Pediatric Propofol Limits in the Absence of PRIS (Pediatrics)
• Eptinezumab in Chronic Migraine and Medication Overuse Headache: The RESOLUTION Trial (Neuropsychology)
• Ropeginterferon alfa-2b-njft Treatment in Essential Thrombocythemia: Mutation-Stratified Outcomes from EXCEED-ET (Oncology)
• Respiratory Syncytial Virus Vaccine Effectiveness in Medicare Beneficiaries Residing in Nursing Homes (Infectious Disease)
• Conclusive Evidence in Support of Amoxicillin …

Evaluation Of Antibiotic Use Using The Gyssens Method On Clinical Outcomes In Ischemic Stroke Patients, Juniarto Mende, Graciano A. Maturbongs, Yohana K. A. Mbulang

Pharmacology and Clinical Pharmacy Research

Ischemic stroke is a health problem that causes death and neurovascular disability worldwide. The inflammatory response due to infection can increase ischemic stroke and increase brain damage through changes in blood pressure, coagulation, immune response, and endothelial function. This study aims to evaluate the rationality of antibiotic use on clinical outcomes in ischemic stroke patients. This study used a cross-sectional design. Retrospective data were taken from the medical records of Jayapura Regional Hospital for the period January 1, 2023, to May 31, 2025. The study subjects were all patients who suffered ischemic stroke and received antibiotics. Evaluation of the rationality …

Pacific Rxtracts - August 2026, Pacific Rxtracts

Pacific RxTracts

• Articles:
• FDA Approves First Oral Carbapenem Antibiotic for Complicated UTIs
• Bemotrizinol: First FDA-Approved Sunscreen Ingredient in 20 Years
• Effects of Mavacamten in Hypertrophic Cardiomyopathy
• Small Increase in Bleeding Risk With Immediate Intensive Statin Therapy and Dual Antiplatelet Therapy in Mild Ischemic Stroke
• Retatrutide for Type 2 Diabetes: The TRANSCEND-T2D-1 Phase 3 Trial
• Reimagining Insulin Therapy: Clinical Impact of CagriSema in REIMAGINE-3
• FDA Approval of Veligrotug-vvze Establishes a New IV Biologic Option for TED
• Novel Oral GLP-1 Receptor Agonist HRS-7535 Shows Promising Results in Type 2 Diabetes
• FDA Approves First Gene Therapy for Young Children with Sickle Cell Disease
• Pockets of …

Promoting Scientific Impact At The Nih, Fred D. Ledley M.D.

CISI Publication

We are honored to offer our comments on Promoting Scientific Impact at the NIH in response to NOT-OD-26-087: Request for Information on Measuring and Rewarding Scientific Impact.

These comments are informed by my professional experience as the founding director of the Center for Integration of Science and Industry at Bentley University, which has a mission to “advance the translation of scientific discoveries for public value by engaging science, business, and policy in transdisciplinary dialogue, scholarship, and education.” Our approach is to bring together the perspectives of natural science, business, analytics, economics, law, and policy to better understand, and advance, the …

Pacific Rxtracts - July 2026, Pacific Rxtracts

Pacific RxTracts

Articles:

• Tribute: In Memory of Evan Le
• Redefining Influenza Prevention: Phase 3 Trial of an mRNA Influenza Vaccine
• Risk of Non-Vitamin K Anticoagulants in Atrial Fibrillation
• Oral Semaglutide and Cardiovascular Risk: Expanding Its Role in High-Risk Patients
• Baxdrostat for Resistant Hypertension: The Bax24 Phase 3 Trial
• SGLT2 Inhibitors Shown to Normalize Blood Pressure in Patients with Type 2 Diabetes
• Brolucizumab: A New Vision for Treating Proliferative Diabetic Retinopathy
• Mavacamten Comes of Age: FDA Expands Treatment Options for Adolescent Hypertrophic Cardiomyopathy
• Children and Adolescent CKD Management: New Evidence Supports RAAS Inhibitors as First-Line Therapy
• Comparing Survival Outcomes of CDK4/6 Inhibitors plus …

Identification Of Active Compounds And Antidiabetic Activity Of Red Shoot (Syzygium Myrtifolium) Leaves Extract With In Vitro And In Silico Methods, Muhamad Iqbal Prakoso, Siti Warnasih

Pharmaceutical Sciences and Research

Diabetes mellitus (DM) is a chronic metabolic disease that affects approximately 537 million people worldwide (1 in 10 individuals), and its prevalence is projected to reach 783 million by 2045. One of the plants that has the potential to be an antidiabetic is red shoots (Syzygium myrtifolium) since it contains various secondary metabolite compounds such as flavonoids, triterpenoids, steroids, saponins, phenolics, and anthocyanins. This study aimed to evaluate the antidiabetic properties of red shoot leaves extract and to identify and predict interactions between its active compounds and the α-glucosidase receptor. Ethanol, ethyl acetate, and n-hexane extracts of red …

Ecorxchoice.Com— An Sidp-Funded Calculator Integrating Environmental Metrics With Antimicrobial Stewardship, Pamela S. Lee, Hugh Gordon, Theresa Ferguson, Tien Dinh, Misty Vu, Marina Nguyen, Chaynor Hsiao, Gary Fong

Pharmacy Faculty Articles and Research

Healthcare sustainability is a multidisciplinary field that seeks to mitigate healthcare’s environmental consequences. Antimicrobial stewardship and healthcare sustainability both aim to reduce wasteful resource use while maximizing patient safety. However, a strong partnership between antimicrobial stewardship and healthcare sustainability has yet to develop. To facilitate environmentally sustainable decision-making in antimicrobial prescribing, we developed a web-based calculator (EcoRxChoice (www.ecorxchoice.com)) where users can enter different antimicrobial regimens and compare how much plastic waste each regimen creates. This work was supported in part by the Society of Infectious Diseases Pharmacists (SIDP), reflecting SIDP’s commitment to strengthening sustainability as a practical extension of antimicrobial …

Sharksrx Newsletter Summer 2026, Nova Southeastern University

NSU Sharks Rx

No abstract provided.

Detection And Evaluation Of Biofilm-Producing Clinical Bacterial Isolates By Tcp Method In Karbala-Iraq, Huda Ali Salman Almosawey

Al-Esraa University College Journal for Medical Sciences

Background: A biofilm is a complicated, three-dimensional microbial community that forms at an interface and interacts with its surroundings. To detect the ability of bacteria to form biofilms, the Tissue Culture Plate Method (TCP) is one of the most widely accurate methods and is frequently used with clinical isolates. Objective: This study aims to determine the ability of clinical bacterial isolates to form biofilms using the TCP method and to compare biofilm production between different types of bacteria; to study the relationship between biofilm formation and antibiotic resistance, which helps in understanding the reasons for the failure of some antibiotic …

Global Trends And Research Landscape Of Metformin And Artificial Intelligence: Bibliometric Analysis, Raya Doraid Mohammed, Alaa Qasim Hayder, Hamza A. Saadallah, Ali Q Saeed, Alice Louis Yousif, Safa M Salim, Noor Mahmood Sultan, Mohammed Ahb. Al-Krdoshi

Al-Esraa University College Journal for Medical Sciences

This bibliometric study examines global research trends and key thematic areas in Artificial Intelligence (AI) applications related to Metformin, especially in diabetes treatment. A total of 227 articles were retrieved from the Science Citation Index Expanded (Web of Science Core Collection) from 2020 to 2024. VOSviewer and CiteSpace were used to analyze publications by year, country, institution, journal, citation impact, and keyword co-occurrence. The United States, Canada, and South Korea contributed over 85% of the output, with leading institutions including the University of California, Los Angeles. Keyword mapping identified ``machine learning,'' ``Metformin,'' and ``Type 2 Diabetes'' as the most influential …

Clinical Interactions Of Celiac Disease And Relationship With Type 1 And Type 2 Diabetes Mellitus, Noor Thair Tahir, Raghda Shams Akram, Aseel Ibrahim Abbas, Sahar Abdul Wahab Alshaban, Fatma Abd Alhamza Obed

Al-Esraa University College Journal for Medical Sciences

Celiac disease is a typical autoimmune ailment that can be brought on by gluten, a protein present in wheat, barley, and rye. It is estimated that one person out of every 100 worldwide has celiac disease, with the majority going untreated. Although it can manifest asymptomatically, celiac disease is typified by a variety of gastrointestinal and extra-intestinal symptoms. The consistency of clinical, serological, and histopathological data is essential for the diagnosis of celiac disease. The diagnosis, nevertheless, is often missed and can be difficult. A higher risk of complications and a negative impact on quality of life are linked to …

Mpox Preparedness And Pandemic Memory: An Exploratory Study Among Young And Highly Educated Populations In Iraq, Israa M. Ali Alameen

Al-Esraa University College Journal for Medical Sciences

No abstract provided.

Determination The Prevalence Of Multidrug Antimicrobial Resistance Of Nosocomial Enterobacter Cloacae Isolates From Clinical Specimens In Baghdad Hospitals, Baidaa Mijbel Ali

Al-Esraa University College Journal for Medical Sciences

Background: Enterobacter cloacae have challenged global health through nosocomial infections, especially among immunocompromised patients. In the most overburdened healthcare systems, more study and strategy are anticipated. Aim of the study: To determine the prevalence of Enterobacter cloacae in hospital-acquired infections in Baghdad hospitals and to evaluate its antimicrobial resistance patterns across burn, wound, and urine samples, with a focus on multidrug resistance and antibiotic resistance trends. Methods: Three hundred and seventy-seven patient samples were collected and examined at a teaching laboratory in Baghdad between January 2024 and December 2024. These had 513 samples, 238 burn swabs, 139 wound swabs, and …

Epidemiology, Classification, Risk Factors, Pathophysiology And Management Of Diabetes Mellitus: A Review, Mohammed Raad Khalaf, Tariq Muhammed Ali, Entedhar K. Hussain, Alaa Al-Noori

Al-Esraa University College Journal for Medical Sciences

Diabetes mellitus is a common metabolic disorder, remains a global health challenge with escalating prevalence rates, necessitating a thorough understanding of its multifaceted aspects for effective management. This review synthesizes current knowledge on the epidemiology, classification, risk factors, pathophysiology, and management strategies of diabetes. The epidemiology highlights the rising global prevalence of DM and its regional variations, emphasizing the socio-economic and demographic factors contributing to this epidemic. The classification provides an in-depth analysis of the evolving classification systems, encompassing Type 1, Type 2, and gestational diabetes. Risk factors associated with the development of diabetes are explored, encompassing genetic predisposition, lifestyle …

Contribution Of Animals To Biomedical Advancements In The Current Era: A Narrative Review, Leena Rajathy Port Louis, Mani Rajarathinam, Prithiviraj Nagarajan, Divya Sekar, Nisha Perumal

The Thai Journal of Pharmaceutical Sciences

Animal research has played a major role in the development of vaccinations and therapies for illnesses such as tetanus, polio, meningitis, hepatitis, and Severe Acute Respiratory Syndrome Coronavirus 2. For every prescription drug available today, animal testing and research have contributed immensely. This narrative review aims to explore the contribution of animals to biomedical advancements in the current era, which involved a search of peer-reviewed literature using electronic databases such as Scopus, Web of Science, and PubMed. In current biomedical research, animals help develop new treatments for long-term illnesses such as cancer, HIV, and Alzheimer’s. Animals also aid in the …

Antimicrobial Resistance In Pediatric Infections: Current Status, Challenges, And Future Directions, Clare Dinh, Keykavous Parang

Pharmacy Faculty Articles and Research

Background/Objectives: Antimicrobial resistance in pediatric infections presents a worsening global public health challenge, with antimicrobial resistance (AMR) accounting for more than one million deaths annually and disproportionately affecting children younger than 5 years of age. Neonates and critically ill children face heightened risk owing to immature immunity, frequent healthcare exposures, and limited therapeutic options. This review synthesizes evidence on the epidemiology, mechanisms of resistance, clinical outcomes, and management of AMR across the full pediatric age range. Methods: PubMed/MEDLINE and Google Scholar were searched for literature from 2014 to 2026 using terms covering antibiotic resistance, pediatric populations, and key …

Impact Of Dolutegravir-Based Regimens On Patient Satisfaction And Quality Of Life Among People Living With Hiv: A Systematic Review And Meta-Analysis, Mustapha Muhammed Abubakar, Christabel Ogechukwu Okoye, Ruth Jeminiwa, Ifeanyi Kanayo Ifeorah, Lotanna Ezeja, Yusuf Dauran, Sahabi Musa, Silas Usen Joel, Abdurrahman Murtala Bello, Amauche Pearl Ngige, Gabriel Ezenri, Abdulmuminu Isah, Ifunanya Ikhile, Blessing Onyinye Ukoha-Kalu

College of Pharmacy Faculty Papers

Background: Despite the global scale up of dolutegravir (DTG)-based regimens as the preferred first-line therapy for persons living with HIV (PLHIV), no comprehensive evidence exists on its effect on patient-reported outcomes such as Quality of Life (QoL) and patient satisfaction (PS). We conducted a systematic review and meta-analysis to provide the first comprehensive quantitative synthesis of the effect of DTG-based regimens on QoL and PS among PLHIV.

Method: We conducted literature search on PubMed, Scopus, Embase and Cochrane Library databases for peer-reviewed, primary studies published from January 2015 to January 2025. Studies using validated tools to evaluate QoL and PS …

Pacific Rxtracts - June 2026, Pacific Rxtracts

Pacific RxTracts

Articles:

• FDA Approves First Non-Antipsychotic Drug for Patients with Alzheimer’s Disease Agitation
• FDA Approves Sparsentan for Focal Segmental Glomerulosclerosis
• Lunsotogene Rings in a New Era of Gene Therapy for Hearing Loss
• Sex Differences in Breakthrough Stroke Outcomes Despite Oral Anticoagulation for Atrial Fibrillation
• Asundexian for Secondary Prevention After Ischemic Stroke or TIA
• Marstacimab Prophylaxis in Hemophilia A/B with Inhibitors: A New Purpose
• FDA Approves First-in-Class Weekly Anifrolumab Autoinjector for Systemic Lupus Erythematosus 
• Cemdisiran in Generalized Myasthenia Gravis
• Medicare’s Impact on Early Sepsis Management and Discharge to Home
• Maralixibat Shows Broader Therapeutic Benefit for Children with Alagille Syndrome 
• Reaching the Littlest …

Expert Recommendations To Strengthen Chikungunya Outbreak Surveillance And Reporting For Traveler Health Protection, Daniel C. Payne, Karoun H. Bagamian, Jeffery Goad, Nathan D. Grubaugh, Michael A. Johansson, Moritz U. G. Kraemer, Eyal Leshem, Francesca F. Norman, Alfonso J. Rodríguez-Morales, Henrik Salje, Stephen Thomas, Scott C. Weaver, Lindsey A. Laytner, Rebecca Sturgis, Suzanne K. Scheele, Davidson H. Hamer

Pharmacy Faculty Articles and Research

Chikungunya, a debilitating mosquito-borne disease caused by chikungunya virus, has surged dramatically in the past two decades. Chikungunya outbreaks can intensify rapidly, with infections posing a significant endemic health burden in tropical/subtropical areas and for travelers. Health professionals require timely and accurate outbreak information to adequately protect travelers and assess chikungunya risk. However, detection is often insufficient in the areas most susceptible to outbreaks, leading to diagnostic and reporting delays. Consequently, travelers are often unaware of increased chikungunya infection risk at their destination. We assessed chikungunya surveillance and reporting resources, and we developed expert recommendations for traveler health protection. Because …

Environmental Mercury Alters Immune Pathways Linked To Autoimmune Risk In Mice Mirroring Humans, Maurgan Lee, Paul Stemmer, Randall Gill, Allen Rosenspire, Anil Aranha, Heather Gibson

Medical Student Research Symposium

Background and Purpose: Mercury is a pervasive environmental contaminant, and human epidemiologic studies have linked chronic low-level exposure to increased autoimmune disease-risk. Dysregulated lymphocyte activation and impaired signaling tolerance are central mechanisms in human autoimmunity. Protein phosphorylation governs lymphocyte differentiation and function, alterations in phosphoproteomic networks may represent a signature of immune disruption. This study evaluates how low dose mercury exposure modifies B and T cell abundance and intracellular signaling patterns in BALB/c and Diversity Outbred (DO) mice.

Methods: BALB/c and DO mice were exposed to low dose HgCl2 in their water for two weeks or provided standard water controls. …

In-Use Stability And Device Compatibility Define Clinically Actionable Handling Limits For A Gmp-Produced Attenuated Listeria Monocytogenes Vaccine Expressing Gucy2c, Jagmohan Singh, Taranjot Johar, Vannessa Scully, Scott A. Waldman, Babar Bashir, Adam E. Snook

Department of Pharmacology, Physiology, and Cancer Biology Faculty Papers

Background: Live-attenuated Listeria monocytogenes (Lm) vectors are a clinically validated cancer immunotherapy platform, but translation requires reproducible, clinically realistic workflows for dose preparation and infusion. For live bacterial products, in-use stability and device compatibility can drive dose variability through adsorption, settling, and device losses. Methods: We developed and GMP-manufactured an attenuated Lm vaccine expressing human GUCY2C (Lm-GUCY2C) and performed translational characterization, including construct verification and immunogenicity readouts, and defined the administration-focused in-use stability and device compatibility. Post-thaw stability was assessed in primary cryovials and during preparation and delivery from 250 mL saline infusion bags using standard clinical devices (syringes/needles, filter-free …

Quality Improvement (Qi) Project Aimed At Reducing Unnecessary Antibiotic Usage Among Older Adult Patients By Addressing Inappropriate Antibiotic Prescribing In Primary And Long-Term Care Settings, Pamela M. Thomas

Seton Hall University Dissertations and Theses (ETDs)

Antibiotic overuse among older adults remains a significant patient safety and public health concern. Recent national data indicate that approximately 30%–50% of outpatient antibiotic prescriptions may be unnecessary, particularly for viral or self-limiting conditions (Chua et al., 2021). Antimicrobial resistance has been associated with more than 1.27 million deaths globally (Murray et al., 2022). This quality improvement project evaluated a multifaceted antimicrobial stewardship intervention in primary and long-term care settings. Baseline review of 167 antibiotic cases revealed 37.1% were inappropriate or questionable, and 28.7% lacked adequate diagnostic documentation. The intervention incorporated provider education, electronic health record decision-support tools, audit and …

Redefining Skincare For Sensitive Lives, Ashlyn G. Sierra Ms

Honors College Theses

This study outlines how a skincare company that is both ethically and effectively developed for people suffering from eczema could create accessible, affordable products as well as maintain its commitment to being inclusive. The study uses scientific data regarding eczema in order to examine why certain aspects of skin care are helpful or dangerous when it comes to individuals who suffer from eczema, in addition, it provides an assessment of current skin care product offerings that are designed for people with eczema. Using the Wise Leadership Framework, the study presents a hypothetical business plan for a new, eczema-based skin care …

The Influence Of Prosthetic Obturators On Quality Of Life In Individuals With Maxillectomy Defects, Minseok Kim

Oral Health

Abstract

Introduction: In recent years, there has been a growing focus on understanding the impact of oral cancer on patients' quality of life. Prosthetic rehabilitation techniques, such as maxillary obturators, often in conjunction with reconstructive surgery, have emerged as interventions to address the challenges posed by post-maxillectomy abnormalities.

Objective: This study aims to systematically review and evaluate the effectiveness of maxillofacial prosthetic rehabilitation using obturators in enhancing the quality of life of patients following maxillectomy.

Methodology: Systematic review of identified literature spanning the timeframe from 2000 to 2020 was used. The comprehensive search encompassed widely recognized databases including PubMed, …

The Impact Of Patient Navigation On The Hepatitis C Care Continuum In Underserved Populations: A Scoping Review, Deauntaye Jones

Honors Theses

Hepatitis C virus (HCV) remains a significant public health concern and is a leading cause of cirrhosis, hepatocellular carcinoma, and liver transplantation when left untreated. Although direct-acting antiviral therapies have made HCV curable for most patients, many underserved populations continue to experience barriers to diagnosis, linkage-to-care, treatment completion, and sustained virologic response (SVR). This study evaluated how patient navigation programs influence progression through the HCV care continuum among underserved populations. Relevant studies published between 2014 and 2025 were identified through searches of PubMed and Embase using terms related to HCV, patient navigation, linkage-to-care, underserved populations, and treatment outcomes. Following title, …

Evaluation Of Drug Use In Inpatient Care: A Retrospective Study At A Tertiary Hospital In Bandung, Indonesia (2024), Aliya Rosyidah Fitrianti, Athoya Delarosa, Husna Muharram Ahadi, Imam Adi Wicaksono, Falerina Puspita

Pharmacology and Clinical Pharmacy Research

Rational drug use is a critical component of improving healthcare quality. However, irrational prescribing remains a significant concern, particularly in developing countries like Indonesia. This study evaluates drug use patterns at a Type B hospital in Bandung using WHO standard: average number of drugs per prescription, percentage of generic drugs, antibiotics, injections, and adherence to the National Formulary. A retrospective, descriptive observational method was applied, using 2024 inpatient Drug Use Evaluation (DUE) data. Findings reveal an average of 3.4 drugs per prescription—slightly above the WHO standard (≤ 3.3); 68.4% of prescriptions used generic drugs (meeting the WHO standard ≥ 59%); …