Comparison of Bupivacaine and Dexmedetomidine versus Bupivacaine Alone in Transversus Abdominis Plane Block for Post-Operative Analgesia

Objective: To study the effects of adding dexmedetomidine to bupivacaine in transverses abdominis plane block in comparison with using bupivacaine alone. Materials and Methods: This was a prospective comparative study that was conducted in the Anaesthesia Department, CMH, Lahore over a period of six months from 1st June 2020 to 30th November 2020. Fifty patients of the American Society of Anesthesiologist Class I and II with an age range between 40 to 60 years were divided into two groups. Group B received 20ml of 0.25% bupivacaine with 2ml of normal saline on each side in the transversus abdominis plane block while group BD was given 20ml of 0.25% bupivacaine with dexmedetomidine 0.5mcg/kg on each side (in a volume of 2ml). Post-operative pain was assessed with a visual analogue scale. Rescue analgesia was given when a score of greater than 3 was observed using this scale. Time to first rescue analgesia was noted. Total opioid consumption in the first 24 hours was also recorded. Patients were observed for postoperative hypotension and bradycardia.Results: The mean-time for the first dose of analgesia for group B and BD was 302.92 ± 24.01 and 419.28 ± 31.97 minutes respectively with a p-value of 0.001. The mean of the total consumption of opioids in 24 hours post-operatively for group B and BD was 14.20±2.36 and 10.40±1.38 mg respectively with a p-value of 0.001. Hypotension was not seen in any patient in either group. Only one patient developed bradycardia and he belonged to group BD. P-value was 0.327.Conclusion: The addition of dexmedetomidine to bupivacaine for transversus abdominis plane block for postoperative analgesia significantly prolongs the duration of analgesia and reduces the postoperative opioid requirements

How Promotional Advertisements Can Change the Buying Behavior of Children

This study aims to highlight the impact of promotional advertising on children's buying behavior.Promotions are tools that maximize the sales of any organization. Retailers or manufacturers apply this toolto invite consumers to buy more products. The proposed study aims to focus the advertising impact on childpurchases in the Pakistani capital. It is convenient to sample 500 respondents and collect data with the helpof the questionnaire. The results show that there is a negligible correlation between the purchase behaviorand coupons. On the contrary, buying one-to-one free, the physical environment impacts significantly on thepurchase behavior. The proposed research helps marketers recognize most effective promotional ads thatcan significantly affect a child's buying behavio

Non-Volumetric Pricing is a Threat to Water Reserves

Pakistan is a country having the world largest irrigation system but despite that, it is facing several droughts and floods. The storage capacity of the country is only 30 days whereas the required standard capacity is 120 days. The major source of water for the country is surface water and in many areas, groundwater is also used in a large quantity for domestic as well as agricultural use. Pakistan has large water reservoirs but still, it is facing serious challenges in providing safe drinking water due to the mismanagement of natural water resources. The major cause behind the depletion of water resources of the country is over-use of water. The main objective of this study is to find the behavior of people by comparing volumetric and nonvolumetric water use and the price they pay for both. There is a need to compare volumetric and nonvolumetric water pricing scenarios and its impact on water conservation for the district of Hyderabad. The study was conducted through questionnaire surveys, from three administrative units of the Hyderabad namely Qasimabad, Latifabad, and City. Three types of water utilities, namely Tapped water (water supplied by WASA), groundwater and tankered water were found as major sources for domestic use. The domestic use of groundwater is found to be mostly unpaid, while people having lined water services pay an average of Rs 300 (USD 2.2) but the percentage of these people is only 60%. On the other hand, people who consume tankered water (volumetric based charging) are paying on average Rs 5000 (USD 35.7) per month. The main finding of this study is that the households which were using tanker water were more careful in optimizing the use of water as compared to those who were using tapped water. Therefore, considering the economic worth of water, if it is charged on a volumetric basis then the misuse of water can be reduced noticeably

Pre-operative Anxiety Compounding Intra-operative Hypotension in Parturient women undergoing Cesarean Deliveries under Spinal Anesthesia

OBJECTIVE: To assess the relation of intra-operative hypotension with severity of pre-operative anxiety in patients undergoing caesarean section under spinal anesthesia. STUDY DESIGN: Prospective observational study. PLACE AND DURATION OF STUDY:  This study was carried out from June 2017 to May 2018 at anesthesia department of Combined Military Hospital Lahore. METHODOLOGY: One hundred and twenty patients belonging to America Society of Anesthesiology class I and II, undergoing caesarean section under spinal anesthesia were selected.  Verbal Analogue Scale for anxiety (VASA) and Straight Trait Anxiety Inventory (STAIs) questionnaire were used to measure pre-operative anxiety. Patients were divided into three groups as mild (VASA<3or STAIs<44), moderate (VASA 4-7 or STAIs 44-55) and severe (VASA 7-10 or STAIs>55) anxiety. Baseline mean arterial pressure was measured. Patients were placed in supine position immediately after induction of spinal anesthesia at L3-L4 or L4-L5 level with 12mg bupivacaine. Blood pressure was measured every two minutes until the delivery of baby. Hypotension was labeled when mean arterial pressure dropped by 20% below the baseline. The effect of level of anxiety on drop in MAP was assessed. RESULTS: Seventeen (14.17%) patients had mild pre-operative anxiety; out of which four (23.53%) developed hypotension. Seventy three (60.83%) patients had moderate anxiety; out of which twenty seven (36.99%) developed hypotension. Thirty (25%) patients had severe anxiety; out of which twenty two (73.33 %) developed hypotension. P-value (0.001) was quite significant. CONCLUSION:  It was concluded in our study that severity of pre-operative anxiety has significant effect on intra-operative spinal hypotension

Privacy Preserving Inference for Deep Neural Networks:Optimizing Homomorphic Encryption for Efficient and Secure Classification

The application of machine learning in healthcare, financial, social media, and other sensitive sectors not only involves high accuracy but privacy as well. Due to the emergence of the Cloud as a computation and one-to-many access paradigm; training and classification/inference tasks have been outsourced to Cloud. However, its usage is limited due to legal and ethical constraints regarding privacy. In this work, we propose a privacy-preserving neural networks-based classification model based on Homomorphic Encryption (HE) where the user can send an encrypted instance to the cloud and receive an encrypted inference from it to preserve the user’s query privacy. In contrast to existing works, we demonstrate the realistic limitations of HE for privacy-preserving machine learning by changing its parameters for enhanced security and accuracy. We showcase scenarios where the choice of HE parameters impedes accurate classification and present an optimized setting for achieving reliable classification. We present several results to demonstrate its effectiveness using MNIST dataset with highly improved inference time for a query as compared to the state of the art

Characterization of Hepatitis C Virus genotype 3a Hypervariable region 1 in patients achieved rapid virological response to alpha interferon and Ribavirin Combination therapy

<p>Abstract</p> <p>Background</p> <p>Hepatitis C virus roots a chronic liver disease. Currently approved treatment strategy includes administration of alpha interferon and ribavirin combined therapy for 24-48 weeks. One of the predictor of sustained virological response is an early virological response to treatment characterized as rapid response. Hyper variable region 1 (HVR1) of E2 protein is responsible for viral entry and acts as a target for neutralizing antibodies. Any mutation in this region would effect virus interaction with target cell and viral persistence.</p> <p>Methods</p> <p>Thirty one clones of six pre-treatment samples subjected to combination therapy were investigated. Three of the patients were rapid responders (R1, R2 and R3) and two were breakthrough responders (BT1 and BT2). Envelope 2 gene was amplified, cloned and sequenced. Amino acid substitution, frequency, composition and antigenic properties of HVR 1 of E2 protein were studied.</p> <p>Results</p> <p>In both rapid responders (R.R) (14 amino acid sites) and breakthrough responders (BT.R) (13 amino acid sites) half of the amino acid sites were either conserved or resistant to any physiochemical change due to amino acid substitution. It also indicated that average composition of hydrophilic and basic amino acids were comparatively lower in rapid responders than other samples affecting probable interaction of virus with target cells. A central non antigenic region was constant among the breakthrough responders but differed in length significantly among rapid responders reflecting the adaptive nature of HVR1 to the immune response.</p> <p>Conclusions</p> <p>We observed that although HVR1is quite variable region in HCV 3a patients responding differently to treatment it still maintains its physiochemical properties for its proper functioning and viability.</p

Motivational Factors for the Implementation of ISO-9001 in Construction Firms of Pakistan

Motivating public and private construction firms to implement various management systems in their firms is not a simple job. Especially in Pakistan, management system is a new practice, most of the construction firms are not aware about the benefits of management system and what will be achieved after the implementation of management system. The implementation of ISO 9001 Quality Management System (QMS) in the construction industry is a continuing development method, particularly in small construction firms. On the other hand, the awareness level and readiness level of construction industry firms in Pakistan is yet very low as associated to other countries of Asia and Europe where ISO 9001 initiated. The purpose current study is to determine most responsible factors which will motivate the public and private construction firms of Pakistan to adopt the QMS (ISO 9001). A questionnaire survey was conducted and a total of 337 out of 553 questionnaires were received from public and private construction firms of AZBAGIKHPUSI areas. The analysis results depict 3 significant factors, which will motivate construction firms of Pakistan to implement ISO 9001 are (1) to qualify for bidding (2) to improve quality management system of company (3) to reduce wastage. Hence, based on these results and findings, the construction companies require ISO 9001 certification system and registration with Pakistan Engineering Council (PEC) as a constitution passed for the construction firms then to qualify for the bidding

Adoptability of Lean Construction Techniques in Pakistan’s Construction Industry

There is a philosophy in the construction industry to reduce the cost of a project by reducing construction waste and improving productivity. With lower expenses, lean construction emphasizes the cost of the project at a minimum cost. Globally, the philosophy has gained a wide range of popularity in the construction sector. The Lean Construction has helped practitioners with several tools and techniques to implement at different stages of a construction project. Following global trends, this study has investigated lean practices in Pakistan. With the potential advantages experienced by its implementation in Pakistan's construction projects and the level of implementation of various types of tools and techniques has been analyzed. To achieve the goal, the study had tried to capture construction projects in which four shareholders are being represented, which are clients, consultants, contractors and material suppliers. Overall 34 completed questionnaires were collected and then analyzed. The results of the analysis have indicated that pull approach, standard of work, time consuming, visualization tools, the integrated project delivery methods and the quality failure in safe limits are common lean techniques which are being implemented to the local construction industry. While there are major benefits of waste reduction, client satisfaction, better communication, visual control and proper task management to build appropriate work are the key benefits of lean construction