Comparison of Dexamethasone Plus Metoclopramide, with Dexamethasone Alone in The Prevention of Postoperative Nausea and Vomiting in Patients Undergoing Elective Craniotomy

Objective:  To compare the efficacy of combination of dexamethasone plus metoclopramide with dexamethasone alone for control of postoperative nausea and vomiting in patients undergoing elective craniotomy. Study Design:  Double blinded randomized controlled clinical trial. Material and Methods:  One hundred ASA I – II patients listed for elective craniotomy were randomized to two groups of 50 patients each. Group A received dexamethasone 8 mg (2 ml) plus metoclopramide 10 mg (2 ml) pre-pared in two different syringes, and group B received dexamethasone 8 mg (2 ml) and normal saline (2 ml), pre-pared in two separate received syringes just before induction of anaesthesia. Anaesthesia was standardized. All episodes of Postoperative Nausea and Vomiting (PONV) during the first 24 hours postoperatively were evaluated at 3 time periods : 2, 4, and 24 hours. The presence or absence of nausea and vomiting (by simply yes or no) was assessed by research nurses aware of the study but blinded to the group to which the patient belonged.  Results:  The frequency of nausea and vomiting was clinically and statistically lower in dexamethasone plus metoclopramide group as compared to dexamethasone alone p-value 0.032 and 0.028 for nausea and vomiting respectively. Conclusion:  Combination of dexamethasone plus metoclopramide is more effective in preventing postoperative nausea and vomiting than dexamethasone alone when used for prophylaxis of Post-operative Nausea and Vomiting (PONV) before the induction of anaesthesia in patients undergoing elective craniotomy

Quantum Organizations with Islamic Way Forward

Firstly, this paper describes a phenomenon of transnational organization and general condition of world and ‘man in the world’. For developing a comprehensive framework, it presents authentic literature review beginning from modernity to post modernity using the hermeneutic-interpretivism research tradition to show the similarities between modernism and post modernism. By revealing the missing link in the quantum paradigm of ralph Kilmann (scholar of quantum organization) on one hand, it develops the possibility of reviving revealed knowledge back into the main frame knowledge of organization theory, on the other hand. By raising and addressing the question of how can the revealed knowledge addresses the current economic dilemma, the paper describes the three lenses available used to understand natural world, socio economic world and behavioral world in Newtonian verses quantum assumptions on organization theory   along with their implications. For cross fertilization of ideas and better understanding of God, cosmos and human it presents an alternative of Islamic way forward suggested by scholarly views from East and West. To further substantiate, it presents the stunning insights from the renowned wisdom traditions (pragmatic civilizations) to highlight why religions matter to show (the levels of reality and levels of selfhood as well as relationship between Necessity being and contingent being), responding the situation of power and domination prevalent in organizing world by suggesting historical/civilizational ethical mode and adopting psycho, spiritual-pragmatic approach with holistic world view (Big picture)

Effect of early release of tourniquet in total knee arthroplasty

Objective: To evaluate whether tourniquet release intraoperatively is better than postoperative release in reducing overall blood loss, duration of surgery, duration of tourniquet, length of hospital stay, wound related complications and transfusion requirement. Study Design: Comparative study. Place and Duration of Study: Department of Surgery, The Aga Khan University Hospital, Karachi, from January 2004 to June 2007. Methodology: One hundred and thirty patient files were reviewed retrospectively. Patients were divided into two groups. Group-A consisted of 65 patients with early deflation of tourniquet and group-B comprised of 65 patients with the release of tourniquet after applying compressive dressing. Total blood loss (determined by Gross method) and other study variables were noted as per objective and computed.Results: There were 22 males and 108 females with comparable BMI. All had undergone posterior stabilized cemented total knee replacement. Calculated blood loss was 1.208 L and 1.108 L in group-A and B respectively (p = 0.27). Significant increase in duration of surgery was noted in group-A patients. Four patients in group-B showed complication related to wound with 3 being minor and 1 requiring additional operation room visit. Mean length of hospital stay was 9 days. Transfusion frequency was higher in group-B despite comparable postoperative haemoglobin values. Conclusion: Intraoperative tourniquet release does not reduce overall blood loss with no effect in conserving blood after total knee replacement, however, this group had relatively shorter hospital stay

Minimally invasive plate osteosynthesis for tibial plateau fractures.

Purpose:To evaluate radiological and clinical outcome of minimally invasive plate osteosynthesis (MIPO) for tibial plateau fractures. Methods: 35 men and 6 women aged 19 to 75 (mean, 40, standard deviation [SD], 14) years underwent MIPO for displaced tibial plateau fractures. According to the Schatzker system, the tibial plateau fractures were classified as types I (n=3), II (n=9), III (n=11), IV (n=6), V (n=7), and VI (n=5). Six Patients had open fractures, 2 of them underwent debridement before MIPO. 10 Patients needed additional bone grafting. Radiological (at immediate postoperation) and clinical (at the 12-month follow-up) assessments based on the Rasmussen anatomic and functional scoring system were recorded using a proforma. Patients with acceptable and unacceptable outcomes were compared in terms of age. Results: The mean Rasmussen anatomic score was 15.1 (SD, 2.2, range, 10-18), the mean Rasmussen functional score was 25.3 (SD, 3.2, range, 14-29), and the mean range of knee motion was 118 (SD, 10, range, 90-140) degrees. Anatomic outcome was excellent in 10, good in 28, and unacceptable in 3 Patients (one each had Schatzker type-I, -II, and -III fractures). 27 (71%) of the 38 Patients with acceptable anatomic outcome were aged 45 years or younger, whereas 2 (67%) of the 3 Patients with unacceptable anatomic outcome were aged 60 years or older (p=0.001). Functional outcome was excellent in 18, good in 19, and unacceptable in 4 Patients (2 had Schatzker type-III and another 2 had Schatzker type-I or -II fractures). 37 of the Patients had a range of knee motion of 120 degrees or more, 27 (73%) of them were aged 45 years or younger, whereas 3 (75%) of the 4 Patients with unacceptable functional outcome were aged 60 years or older (p=0.001). Conclusions: MIPO for tibial plateau fractures achieved good outcome with minimal soft-tissue complications. Older age was the predictor of unacceptable outcome

Genre Based Analysis of Acknowledgement Texts Written by Pakistani Writers

The aim of this study is to analyze and describe the structure of acknowledgement texts written by Pakistani authors in the light of two-tier genre model presented by Giannoni (2002). The corpus of this study, consisting of 3 samples, has been taken from the books written by Pakistani authors through convenient sampling technique. Analysis of the corpus shows that the acknowledgements written by Pakistani authors of books do not conform to the said model and vary in structure construction process and linguistic choices which are affected by cultural expectations, social norms and socio-cultural conventions. The analysis also shows that Pakistani acknowledgements are different from the acknowledgements from other cultures. Plus, Pakistani acknowledgements have been observed to be complex and dynamic in nature and characterized by hybridism. The study concludes that the acknowledgement writing is a matter of serious concern for Pakistani authors and shows intensified and strong sense of indebtedness and gratitude

Transfusion practice in orthopedic patients: do we really need it?

Abstract OBJECTIVE: To determine the proportion of inappropriate transfusions in patients undergoing orthopaedic surgery at a tertiary care university hospital, and factors associated with inappropriate transfusions. METHODS: The prospective study was conducted at Aga Khan University Hospital, Karachi, from December 2008 to September 2009, and comprised patients admitted to the Orthopaedic Department and received transfusion of at least one packed cell. Patients were divided into four groups: A, those with haemoglobin \u3c 7, B, haemoglobin 7.1-10 without ischemic heart disease, C, haemoglobin 7.1-10 with ischemic heart disease, and D, haemoglobin \u3e10. Variables recorded were, pre-transfusion haemoglobin level, co-morbids, symptoms of hypovolemia, pre-transfusion volume replacement with fluids, transfusion reactions, and haemoglobin after 48 hours. Indications of transfusion were assessed in accordance with available data. RESULTS: Of the 126 patients, 65(52%) were males and 61(48%) were females. There were 18(14%) patients in group A, 88(70%) in group B, 12(10%) in group C, and 8(6%) in group D. Overall, Overall, 44(35%) were transfused appropriately according to the criteria, and 82(65%) were inappropriate. CONCLUSIONS: The number of inappropriate transfusion was quiet high and demands revision of institutional policy of packed cell transfusion in accordance with available guidelines

Identifying the period of a step change in high-yield processes

Quality control charts have proven to be very effective in detecting out-of-control states. When a signal is detected a search begins to identify and eliminate the source(s) of the signal. A critical issue that keeps the mind of the process engineer busy at this point is determining the time when the process first changed. Knowing when the process first changed can assist process engineers to focus efforts effectively on eliminating the source(s) of the signal. The time when a change in the process takes place is referred to as the change point. This paper provides an estimator for a period of time in which a step change in the process non-conformity proportion in high-yield processes occurs. In such processes, the number of items until the occurrence of the first non-conforming item can be modeled by a geometric distribution. The performance of the proposed model is investigated through several numerical examples. The results indicate that the proposed estimator provides a reasonable estimate for the period when the step change occurred at the process non-conformity level. Copyright © 2009 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/64306/1/1007_ftp.pd

Site Selection for Hazardous Waste Using FuzzyLogic Combined With Analytic Hierarchy Process: ACase study in Nahavand, Iran

Hazardous wastes include various types of chemicals and other wastes generated from industrialand other sources. Because of the complexity of waste management systems, the selection of theappropriate solid waste landfill site requires consideration of multiple alternative solutions andevaluation criteria. This paper investigated the utilization of the fuzzy logic in combination withAnalytic Hierarchy Process (AHP) technique by applying GIS and IDRISI programming for choosinghazardous waste landfill site in Nahavand, Iran. Based on the real conditions of the study area, weconsidered economic, biological and topographical factors (12 criteria). The candidate sites weredetermined based on the criteria weights. The best location was determined via the fuzzy logic andthe AHP methods. This study found that the combination of fuzzy logic and the AHP method was thebest option for selecting a site for hazardous waste landfill. In the end, 6 suitable areas were selectedfor a hazardous waste landfill in the city. This study verified that the combination of the AHP methodwith fuzzy logic using GIS in our project is a powerful tool for solid waste landfill site selection