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Hospital Formulary by 
KPK Govt. for Public Hospitals

PESHAWAR: After the passage of the 18th amendment, health has become a provincial subject. Hence, the Government of Khyber PK has come up with a Hospital Formulary for government hospitals, something which needs to be commended and appreciated. The Government is also reported to have decided to remove some of the drugs from this formulary because of being overpriced.

According to reports a recent market survey carried out by the Medicine Coordination Cell showed that some pharmaceutical companies maneuvered to get their products included in the Formulary despite offering higher price. Three companies have been identified who indulged in this unethical practice as their drugs were found to be much cheaper in the market than quoted for the government. The Government had approved four hundred drugs and medicines prepared by national and multinational pharmaceutical companies for purchase by the provincial health department. The government will spend rupees three billion on purchase of drugs during 2016-2017. All DHQ Hospitals will purchase only those drugs which are included in this Hospital Formulary. They will also make payment direct to the pharmaceutical companies from whom the drugs are purchased. Earlier MCC team had identified fifty four pharmaceutical companies which follow current Good Manufacturing Practices who had participated in the bidding. The MCC found out that some of the companies pooled and gave inflated prices of some of the drugs before the clearance of those with lowest prices, as such some of these items are going to be deleted from the Formulary.

Preparing a Hospital Formulary is a step in the right direction and the Government of Khyber PK has now taken this initiative. One hopes it is implemented in letter and spirit because its success will depend on its efficient implementation. Let the other provincial Governments follow this example and come up with their own Hospital Formulary for the public hospitals which will ensure that cost effective drugs are available at all the public healthcare facilities.


Zika Virus update

Key points of the statement issued by the World Health Organization

  1. The most likely explanation of available evidence from outbreaks of Zika virus infection and clusters of microcephaly is that Zika virus infection during pregnancy is a cause of congenital brain abnormalities including microcephaly.
  2. The most likely explanation of available evidence from outbreaks of Zika virus infection and Guillain-Barré syndrome in whole populations is that Zika virus infection is a trigger of Guillain-Barré syndrome.

These findings are important because they provide evidence to refine the 31 March 2016 causality statement and underpin the public health and research measures WHO recommended following that statement which was based on a rapid assessment of evidence available at the time to combine rigour with timeliness for intervention research and policy. The March 2016 statement said “Based on observational, cohort and case-control studies there is strong scientific consensus that Zika virus is a cause of GBS, microcephaly and other neurological disorders.” For further details: http://www.who.int/emergencies/zika-virus/causality/en/


Model may help explain why
women experience orgasms

Why females have orgasm has puzzled biologists, anthropologists, and philosophers for over 2000 years. While male orgasm has a clear reproductive function, as it is coupled to sperm transfer, no such function has been identified for female orgasm.

In a recent article, evidence is presented that the human female orgasm is derived from a reflex that in many other mammals is necessary for ovulation. This model suggests that female orgasm originally had a reproductive function but lost it when spontaneous ovulation evolved, a situation found now in most primates including humans.

At the same time in evolutionary history, the anatomy of the female external genitalia changed so that the clitoris was removed from the copulatory canal. This may help explain why many women do not have orgasm during intercourse but are able to reach orgasm during masturbation or during clitoral stimulation during intercourse.

Homologous traits in different species are often difficult to identify, as they can change substantially in the course of evolution said lead Prof. Mihaela Pavlicev, whose model is published in the Journal of Experimental Zoology-B: Molecular and Developmental Evolution. We think the hormonal surge characterizes a trait that we know as female orgasm in humans. This insight enabled us to trace the evolution of the trait across species.


Brazil faces major challenges
in liver transplantation

A recent analysis indicates that more than 1700 liver transplantations are performed annually in Brazil. While Brazil performs more liver transplant surgeries than anywhere else in Latin America and is third worldwide in absolute terms, the country averages only 5 to 10 liver transplants per million population due to its increasing population and inadequate donor organ supply.

Investigators also found that access to liver transplantation in the underprivileged North, Midwest, and Northeast regions of Brazil is scarce. The results are published in Liver Transplantation.


New lipid-lowering drugs help
patients reduce LDL Cholesterol

A recent analysis indicates that adding new therapies called anti-PCSK9 antibodies to other lipid-lowering treatments can help patients lower their LDL cholesterol levels.

Mutations in the gene that encodes PCSK9 (proprotein convertase subtilisin/kexin type 9) have been linked to high cholesterol. PCSK9 causes elevated blood levels of LDL cholesterol because it binds to the LDL receptor. Two anti-PCSK9 antibodies have recently been approved by the US Food and Drug Administration and the European Medicines Agency: alirocumab and evolocumab.

Researchers identified 12 studies of alirocumab and nine of evolocumab, including more than 10,000 patients, most of whom were taking statins but still had elevated cholesterol. All studies demonstrated a reduction in LDL cholesterol with the anti-PCSK9 antibodies. Up to 87% of patients receiving alirocumab and up to 98% receiving evolocumab reached LDL cholesterol goals.

Both anti-PSCK9 antibodies have cardiovascular outcome studies ongoing with results expected in 2017. We are looking forward to them since it is rather unusual to have results of large outcome trials so soon after the launch of a drug in the market, said Prof. Ioanna Gouni-Berthold, lead author of the British Journal of Clinical Pharmacology study.


Study finds no link between
sleep apnea and joint pain

Consistent with previous reports, poor sleep quality was linked with joint pain in a recent Arthritis Care & Research study of the general population, but the study found no association between obstructive sleep apnea and pain or daytime sleepiness. This lack of association between pain and sleep apnea is surprising given the established link between pain and poor sleep quality.

Additional studies are needed to determine whether the relationship between pain and sleep apnea is different depending on the cause of sleep apnea. Furthermore, the mechanisms behind the different relationship between pain and sleep apnea compared with that of pain and sleep quality remain unclear and should be investigated.


Many physicians still prescribe
controversial drug combination

Safety concerns of the concomitant use of clopidogrel with the proton pump inhibitors (PPIs) omeprazole or esomeprazole were published in May 2009 and February 2010 by European regulatory agencies. After the last publication, there was an observed drop in dispensing these medicines in the Netherlands: 11.9 percent decreases for omeprazole and esomeprazole, versus an increase of 16.0 percent for other PPIs. Still 22.6 percent of patients started on omeprazole and esomeprazole in February 2010, placing them at risk for cardiovascular events.

Clopidogrel is an antiplatelet agent used to inhibit blood clots. Because of an increased risk of gastrointestinal bleeding with antiplatelet therapy, a PPI is often also prescribed, which reduces the secretion of stomach acid. Concomitant use of clopidogrel with esomeprazole/omeprazole may reduce the pharmacological activity of clopidogrel, however.The study’s findings indicate that advice from regulatory authorities were followed, but only reluctantly and not fully, probably partly because of scientific doubt about the interaction.

Regulatory agencies should base their advice on sound scientific data to convince prescribers, said Willemien J. Kruik-Kolloffel, MSc, PharmD, lead author of the Pharmacology Research & Perspectives analysis. We, the authors, doubt the interaction, as do a lot of professionals all around the world.

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