An Insight about the Referral System in Health Care Network: Flaws with Recommendations for Improvement

Healthcare network is composed of primary, secondary and tertiary care centers. Purpose of each unit in this sophisticated zone is to allow steady and smooth delivery of healthcare to optimum level without wasting essential resources or time. If, primary care centers are not able to fulfill the needs of any health issues then, patients are referred to more advanced setup where their health issues can be timely addressed in a proficient way. Referral system forms an important component of healthcare network and it should be formulated in such a way that it can bring fruitful results with the proper use of time, energy, man force as well as technical resources without compromising patient’s health. In this paper, we discussed the core of healthcare network in the city, working with primary as well as referral health care centers, flaws affecting the referral system and recommendations to improve them.

effect of silybum marianum [L] Gaertn. seed extract [Silymarin] on galactose induced cataract formation in rats

Increased oxygen free radical and reduced glutathione level in the eye lens are important risk factor for cataract formation. The antioxidative property and increasing cellular and extra cellular glutathione level have been reported by several herbal medicines including silymarin. In present interventional study Silybum marianum L. seed extract [silymarin] was tested against galactose-induced cataract development in rats. Thirty male 45 days old wistar rats [150-200 g], were divided in three groups of 10 rats each. Cataract was induced in two groups of rats following feeding them with 30% galactose diet for 40 days. One group kept as control and silymarin in the dose of 200 mg/kg/d was administered orally [mixed with galactose diet] to other group for 40 days. Cataract development in the rats lens was observed daily by ophthalmoscope and naked eye during the study. The glutathione [GSH] and lipid peroxides [LPO] levels were determined after 20 days in all rats left eye lens. The results indicated that, in silymarin treated group all stage of cataract development were significantly delayed as compared to control group. In rats treated with silymarin the lens GSH level was increased significantly [P < 0.01] and LPO levels was decreased significantly as compared to control group [P < 0.05]. Administration of silymarin to galactose fed rats showed beneficial effect on prevention of cataract development as well as antioxidative defence system such as increase in lens GSH and decrease LPO levels

Clonidine reduces post operative nausea and vomiting in laparoscopic gynecological surgery

Post operative nausea and vomiting [PONV] is a distressing phenomenon after obstetrics laparoscopic surgery. In this study we assessed the efficacy of oral clonidine in controlling PONV in patients undergoing this type of surgery. In this prospective double blind study, 86 patients in ASA class one or two were selected. The study group [n=43] received clonidine 0.2mg tablet with 50ml water 60-90 minutes before surgery while control group [n=43] received placebo [the tablets were made at Ahwaz Pharmaceutics Department]. All patients were monitored for 24 hour post-operatively for presence of PONV. Hemodynamic changes after intubation between these groups were compared. Sedation and pain scores were also recorded during recovery using Ramsay score and by visual analogue scale respectively. Mean age in clonidine group was 28.5 years, and in control group was 30 years. Nine [21%] patients in study group and 19[44%] patients in control group nauseated. Seven [16.3%] patients in study group and 15 [34.9%] patients in control group vomited [P<0.05]. Moderate pain was reported in 18 [41.9%] patient in study group as compared to15 [34.9%] in control group. Severe pain was reported in seven [16.3%] patients in study group as compared to 21[48.8%] in control group [P<0.01]. Four [9.3%] patient in clonidine group and 12 [27.9%] in control group received rescue anti-emetics [P<0.05]. Mean blood pressure after intubation did not change in 35 [81.4%] of clonidine group compared to 26 [60.5%] in control group. Mean blood pressure on intubation decreased in five [11.5%] in clonidine group as compared to three [7%] in control group [p<0.02]. Heart rate was reduced in five [11.5%] study group, while only two [4.7%] in control group [p=0.001]. Ramsay sedation score was higher in most patients in clonidine group. Twelve [27.9%] patients in clonidine group had Ramsay score >3 compared to only 4 [9.3%] patients in control group [P<0.01]. Clonidine had statistically significant effect in reducing incidence of both nausea and vomiting. In addition it has favorable outcome on post operative pain score. Despite some limitations regarding higher sedation scores, no cases of significant hypoxemia or drop in blood pressure and heart rate was seen in both groups. It is an oral effective, inexpensive, readily available drug with low side effects and thus we suggest its routine use in laparoscopic surgery

Evaluation of epicoprostanol: a major sterol of ambergris for anti-inflammatory and antipyretic activities

The major sterol of epicoprostanol was isolated from ambergris by flash column chromatography. Its identity as epicoprostanol was confirmed by 1H - NMR and 13C - NMR spectroscopy. Epicoprostanol was studied for its anti - inflammatory and antipyretic activities. Epicoprostanol produced a significant inhibition of carrageenan induced paw oedema. The study on antipyretic activity showed, that epicoprostanol produced a significant reduction of yeast - induced hyperthermia in rat