Hurdles in Mandatory Generic Medicine Prescription

Coronavirus pandemic has brought forth the urgency of providing affordable health care to everyone. Generic medicines are often one-fourth to one-tenth of the cost of the branded drugs, and so offer a remarkable opportunity to significantly lower the health-care expenditure. However, the argument for promoting generic medicines is indisputable, we have to think about the other enabling conditions which are necessary for a successful health policy on encouraging generics without causing unintended adverse repercussions. This paper attempts to answer such questions by considering the motivations of the various stakeholders of the broader health services ecosystem in India and undertaking a systematic analysis of the winners and losers from such a policy. We argue that generic prescription will not be successful without prior improvement in the state capacity for quality control of drug manufacturing; rise in awareness among the doctors, patients, and pharmacists; improved trust in the medical systems; and innovative demand-side interventions.

Post Operative Evaluation of Patients of Laparoscopy Cholecystectomy with and without Drain with the Help of Ultrasonography

Introduction: Most common complaints after laparoscopiccholecystectomy are abdominal pain, shoulder tip pain, andnausea, vomiting in the post-operative period. These havebeen attributed to high pressure pneumoperitoneum usingcarbon dioxide gas causing irritation of the diaphragm andother abdominal viscera. Thus, a drainage tube is insertedto decrease the intra-abdominal pressure to mitigate thesesymptoms. However, the role of routine drainage afterlaparoscopic cholecystectomy is still controversial. Severalstudies including some meta-analysis performed to assessthe role of drains in reducing complications in laparoscopiccholecystectomy could not definitively establish the same.The surgical community is divided on this issue due to thelack of evidence on usefulness of drain. Therefore, we planneda controlled randomized comparative study to assess the valueof drain in uncomplicated laparoscopic cholecystectomy.Material and methods: The study was conducted indepartment of General surgery Maharishi MarkendeshwarMedical college and Hospital, Kumarhatti, Solan, HimachalPradesh, India from July 2018 to June 2019. During a periodof one year, 50 patients (group A) were randomized to havea drain placed, with No. 14 Ryles tube, kept in sub hepaticspace after laproscopic surgery, whereas the other 50 patients(group B) did not have any drain in the subhepatic space.These patients were evaluated regarding any differences inmorbidity, postoperative pain, wound infection and hospitalstay between the two groups.Result and Conclusions: The present study was unableto substantiate the utility of subhepatic drain following theelective laproscopic cholecystectomy procedure.

To Evaluate the Efficacy of Bi Pedicled Strip of External Oblique Aponeurosis for Augmentation of Posterior Wall of Inguinal Canal in Inguinal Hernia Repair

Introduction: In Homo sapiens and other mammalianquadrupeds, there is an absence of posterior rectus sheathbelow the arcuate line and insubstantial transversalis fasciain groin. This anatomical arrangement presents no particularfunctional, anatomic difficulty for quadrupeds as their inguinalcanal is directed uphill during ambulation and therefore isnot subjected to significant gravitational stress. Aims andobjectives: To evaluate the efficacy of bipedicled strip ofexternal oblique aponeurosis for augmentation of posteriorwall of inguinal canal in inguinal hernia repair.Material and methods: This study was carried out onfifty consecutive patients of inguinal hernia admitted in theSurgery Department of Guru Nanak Dev Hospital attached toGovernment Medical College, Amritsar.Conclusion: The present study was an attempt to evaluatethe role of bipedicled strip of external oblique aponeurosis inaugmentation of posterior wall of inguinal canal in inguinalhernia repair. Our findings suggest that the bipedicledundetached strip of external oblique aponeurosis is as efficientas a synthetic mesh in inguinal hernia repair. This repair isalso economically more beneficial for poor patients whocannot afford to have mesh repair. Although the present studyis small and follow up period is short but we still recommendthis procedure as a good alternative to Modified Bassini’s,Shouldice repair and mesh based repairs

Efficacy of Levosulpride in minimizing Post-operative Nausea and Vomiting after Laparoscopic Cholecystectomy

Introduction: Gallstone disease is a common problemin our country. Approximately, 80% of the gallstones areasymptomatic. The risk factors predisposing to gallstoneformation has been female sex, obesity, pregnancy, rapidweight loss, gallbladder stasis, and increasing age. Currentstudy aimed to evaluate the efficacy of levosulpiride inminimizing PONV in our patients.Material and Methods: The present study was conducted overa period of one year in the Department of Surgery from January2018 to December2018. One hundred patients fulfilling theeligibility criteria for elective laparoscopic cholecystectomywere enrolled in the study and were randomly placed into 2groups of fifty each.Result: Injection of 25 mg levosulpiride in the preoperative phase in patients undergoing elective laparoscopiccholecystectomy surgeries under general anesthesiasignificantly (P<0.001) reduces the incidence of nausea &vomiting in post-operative phase.Conclusion: levosulpride improved the quality of patient carein immediate post-operative phase and decreased the durationof hospital stay.

To Evaluate The Efficacy Of Bipedicled Strip Of External Oblique Aponeurosis For Augmentation Of Posterior Wall Of Inguinal Canal In Inguinal Hernia Repair.

In Homo sapiens and other mammalian quadrupeds, there is an absence of posterior rectus sheath below the arcuate line and insubstantial transversalis fascia in groin. This anatomical arrangement presents no particular functional, anatomic difficulty for quadrupeds as their inguinal canal is directed uphill during ambulation and therefore is not subjected to significant gravitational stress. Aims and objectives: To evaluate the efficacy of bipedicled strip of external oblique aponeurosis for augmentation of posterior wall of inguinal canal in inguinal hernia repair. Material and methods: This study was carried out on fifty consecutive patients of inguinal hernia admitted in the Surgery Department of Guru Nanak Dev Hospital attached to Government Medical College, Amritsar. Conclusion :The present study was an attempt to evaluate the role of bipedicled strip of external oblique aponeurosis in augmentation of posterior wall of inguinal canal in inguinal hernia repair. Our findings suggest that the bipedicled undetached strip of external oblique aponeurosis is as efficient as a synthetic mesh in inguinal hernia repair. This repair is also economically more beneficial for poor patients who cannot afford to have mesh repair. Although the present study is small and follow up period is short but we still recommend this procedure as a good alternative to Modified Bassini's, Shouldice repair and mesh based repairs.

A Study To Evaluate The Efficacy Of Alfuzosin In Acute Urinary Retention.

There has been an increasing trend towards the use of drugs in both the progression and treatment of AUR due to prostatic obstruction. The immediate management of AUR requires bladder decompression by catheterisation. Until recently, secondary management consisted exclusively of BPH surgery performed either within a few days after AUR (emergency surgery) or within 1 to 3 months after the event, with the patient returning home with a catheter in situ during the interval. AIMS AND OBJECTIVE: 1. To study the efficacy of alfuzosin in acute urinary retention. 2. To observe its side effects. MATERIAL AMD METHODS: Group I (Control): 50 patients were taken under consideration and advised analgesics/antibiotics as and when required during trial period. Group II (Study): 50 patients were given Tab. Alfuzosin 10mg in morning and analgesic/antibiotics as and when required during trial period. These patients were catheterized and catheter was removed after 3 days.