A prospective randomized study to compare tramadol and morphine for postoperative analgesia in spine surgeries using intravenous patient controlled analgesia

Background: Spine surgeries particulary spine fusion surgeries provide a unique challenge with respect to postoperative analgesia as the choices to provide analgesia are limited. Uses of NSAIDS and neuroaxial anaesthesia for post-operative analgesia in spine surgeries have been controversial. Patient controlled analgesia with opioids is commonly used and morphine remains the gold standard. The aim of this study was to compare tramadol with morphine for postoperative analgesia in spine surgeries using iv patient controlled analgesia.Methods: A total of 80 adult patients of ASA grade I and 2 undergoing spine surgeries and divided into two groups i.e. morphine group M and tramadol group T with 40 patients in each group were included in the study. pain assessment was done by NRS (numeric rating scale) upto 48 hours postoperatively other parameters like nausea/vomiting and sedation were also noted. Both groups received boluses initially to control pain. Group M patients received 1mg i.v demand dose of morphine with lock out time of 10-15 minutes and in Group T patients PCA device was set to deliver 20mg i.v demand dose of tramadol with lock out time of 10-15 minutes. A bolus of 25mcg fentanyl was given as rescue analgesia in both groups by the nurse if required. No background infusion or four-hour maximal limit was set on PCA pumps.Results: Pain scores remained on lower side in both the groups, though slightly better with morphine and the difference was statistically significant at 4 hours, 12 hours and 24 hours. The total NRS mean value (0-48 hours) of morphine and tramadol is 3.270 and 3.629 with p value of 0.015 which is statistically significant. 7 patients in morphine group received rescue analgesia while it was received by 15 patients in tramadol group with p value of 0.78 which is statistically insignificant. Nausea and Vomiting was encountered more frequently in the tramadol group. Mean mobilization time in patients of tramadol group was 21.72 hours and that of morphine group was 17.10 hours with p value of 0.00 which is highly significant.Conclusions: Morphine and tramadol when used in PCA mode provide adequate pain relief post operatively after spine surgeries with morphine showing slightly better analgesia profile and significantly less nausea and vomiting than tramadol. 

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Super ( a , d ) - C 4 -antimagicness of book graphs

Let $G=(V,E)$ be a~finite simple graph with $|V(G)|$ vertices and $|E(G)|$ edges. An edge-covering of $G$ is a family of subgraphs $H_1, H_2, \dots, H_t$ such that each edge of $E(G)$ belongs to at least one of the subgraphs $H_i$, $i=1, 2, \dots, t$. If every subgraph $H_i$ is isomorphic to a given graph $H$, then the graph $G$ admits an $H$-covering. A graph $G$ admitting $H$ covering is called an $(a,d)$-$H$-antimagic if there is a bijection $f:V\cup E \to \{1,2,\dots, |V(G)|+|E(G)| \}$ such that for each subgraph $H'$ of $G$ isomorphic to $H$, the sum of labels of all the edges and vertices belonged to $H'$ constitutes an arithmetic progression with the initial term $a$ and the common difference $d$. For $f(V)= \{ 1,2,3,\dots,|V(G)|\}$, the graph $G$ is said to be super $(a,d)$-$H$-antimagic and for $d=0$ it is called $H$-supermagic. In this paper, we investigate the existence of super $(a,d)$-$C_4$-antimagic labeling of book graphs, for difference $d=0,1$ and $n\geq2$

Social networking security during COVID-19 : a systematic literature review

During the Covid-19 Pandemic, the usage of social media networks increased exponentially. People engage in education, business, shopping, and other social activities (i.e., Twitter, Facebook, WhatsApp, Instagram, YouTube). As social networking expands rapidly, its positive and negative impacts affect human health. All this leads to social crimes and illegal activities like phishing, hacking, ransomware, password attacks, spyware, blackmailing, Middle-man-attack. This research extensively discusses the social networking threats, challenges, online surveys, and future effects. We conduct an online survey using the google forms platform to collect the responses of social networking sites (SNS) users within Pakistan to show how SNS affects health positively and negatively. According to the collected response, we analyzed that 50% of the users use SNS for education purposes, 17.5% use it for shopping purposes, 58.2% use it for entertainment, 37.1% use it for communication, and 9.8% use it for other purposes. According to the response, the excessive use of SNS affects the health that 9.8% users face the physical threat, 42.8% user faces mental health issues due to excessive or inappropriate use of SN, and 50.5% users feel moral threat using Social sites. Finally, we conclude our paper by discussing the open challenges, conclusions, and future directions

Geographic accessibility to childhood tuberculosis care in Pakistan

Background Tuberculosis (TB) in children is difficult to detect and often needs specialists to diagnose; the health system is supposed to refer to higher level of health care when diagnosis is not settled in a sick child. In Pakistan, the primary health care level can usually not diagnose childhood TB and will refer to a paediatricians working at a secondary or tertiary care hospital. We aimed to determine the health services access to child TB services in Pakistan. Objective We aimed to determine the geographical access to child TB services in Pakistan. Method We used geospatial analysis to calculate the distance from the nearest public health facility to settlements, using qGIS, as well as population living within the World Health Organization’s (WHO) recommended 5-km distance. Result At primary health care level, 14.1% of facilities report child TB cases to national tuberculosis program and 74% of the population had geographical access to general primary health care within 5-km radius. To secondary- and tertiary-level health care, 33.5% of the population had geographical access within 5-km radius. The average distance from a facility for diagnosis of childhood TB was 26.3 km from all settlement to the nearest child TB sites. The population of one province (Balochistan) had longer distances to health care services. Conclusion With fairly good coverage of primary health care but lower coverage of specialist care for childhood TB, the health system depends heavily on a good referral system from the communities.publishedVersio

Psychrotolerant <i>Mesorhizobium</i> sp. Isolated from Temperate and Cold Desert Regions Solubilizes Potassium and Produces Multiple Plant Growth Promoting Metabolites

Soil potassium (K) supplement depends intensively on the application of chemical fertilizers, which have substantial harmful environmental effects. However, some bacteria can act as inoculants by converting unavailable and insoluble K forms into plant-accessible forms. Such bacteria are an eco-friendly approach for enhancing plant K absorption and consequently reducing utilization of chemical fertilization. Therefore, the present research was undertaken to isolate, screen, and characterize the K solubilizing bacteria (KSB) from the rhizosphere soils of northern India. Overall, 110 strains were isolated, but only 13 isolates showed significant K solubilizing ability by forming a halo zone on solid media. They were further screened for K solubilizing activity at 0 °C, 1 °C, 3 °C, 5 °C, 7 °C, 15 °C, and 20 °C for 5, 10, and 20 days. All the bacterial isolates showed mineral K solubilization activity at these different temperatures. However, the content of K solubilization increased with the upsurge in temperature and period of incubation. The isolate KSB (Grz) showed the highest K solubilization index of 462.28% after 48 h of incubation at 20 °C. The maximum of 23.38 µg K/mL broth was solubilized by the isolate KSB (Grz) at 20 °C after 20 days of incubation. Based on morphological, biochemical, and molecular characterization (through the 16S rDNA approach), the isolate KSB (Grz) was identified as Mesorhizobium sp. The majority of the strains produced HCN and ammonia. The maximum indole acetic acid (IAA) (31.54 µM/mL) and cellulase (390 µM/mL) were produced by the isolate KSB (Grz). In contrast, the highest protease (525.12 µM/mL) and chitinase (5.20 µM/mL) activities were shown by standard strain Bacillus mucilaginosus and KSB (Gmr) isolate, respectively