Comparison of Ephedrine Versus Lidocaine in Reducing the Frequency of Pain on Propofol Injection during Elective Surgeries

Background: To compare the ephedrine with lidocaine for reducing frequency of pain on propofol injection during elective surgeries.Methods: In this randomized controlled trial 80 patients were observed by taking 40 patients in each group, i.e. group A: ephedrine group and group B:lidocaine group. Patients with ASA–I (normal healthy patient), II (mild systemic disease with no functional limitation) aging between 20 and 40 years and opting for elective surgical procedures were included. The pain intensity was classified in four levels from no pain to severe pain. The frequencies of pain intensity were recorded during the injection period before the loss of consciousness according to the verbal rating scale (VRS) explained to patients at the preoperative visit. Chi square test was used to compare the frequency of pain in two groups, where p-value <0.05 was considered statistically significant. Effect modifiers i.e. the age, gender and ASA were controlled by stratification. The post stratification Chi-square test was applied keeping the p-value <0.05 as significant.Results: In Group A, 35% complained of severe pain, 42.5% had moderate pain, 22.5% had mild pain and no patients reported absence of pain as per our operational definition. In Group B 47.5% reported no pain during propofol injection, 40% complained of mild pain, 12.5% had moderate and no patients reported severe pain. The p-value is 0.00.Conclusion: Pretreatment with lidocaine resulted in significantly better pain control during propofol infusion than pretreatment with ephedrin

Suppressor of cytokine signaling-3 in pregnant females with or without hypertension

Suppression of Cytokine Signalling-3 (SOCS-3) modulates the inflammatory pathways responsible for vascular stability. Therefore, we aimed to estimate SOCS-3 levels in 2nd trimester pregnant females and correlate it with blood pressure. A case control study recruiting (n=111) females was conducted at the Aga Khan University. They were classified as pregnancy induced hypertensives ornormotensive as per American College of Obstetricians and Gynecologists Guidelines. Weight, Body mass index, lipid profile and blood glucose were recorded while SOCS-3 was measured by ELISA. Higher SOCS-3 levels were seen in hypertensive group (30 pg/ml) versus normotensive (16 pg/ml). Both Systolic & diastolic blood pressure (r=0.520; p \u3c0.001) (r=0.490; p \u3c0.001) showed an independent significant positive correlation with SOCS-3 level. It is safe to suggest that SOCS-3 has an association of causing high blood pressure. However, more research needs to be conducted to establish a mechanism and chronological order to these events in a pregnant female

A rare case of primary midgut volvulus necessitating extensive bowel resection in an adult

A cause of acute intestinal obstruction in adults, midgut volvulus can be categorized into two types: primary type with no identifiable underlying cause, and secondary type that occurs in the presence of a predisposing condition such as, postoperative adhesions. Primary midgut volvulus can lead to bowel ischemia and necrosis, making an extensive bowel resection imminent. A potential consequence of bowel resection is short-bowel syndrome - a failure of digestion and absorption by the intestines, leading to malnutrition and other complications. As such, we report the diagnosis and management of primary midgut volvulus - a rare entity in adults - occurring in an adult patient

Technical varieties of ross procedure: A case series.

Replacement of aortic valve with the pulmonary autograft is carried out through the Ross procedure due to its potential for growth, durability in pediatric population, and absence of anticoagulation. This case series reports the postoperative outcome of two technical variations of Ross procedure in eight patients who underwent surgery from January 2007 to December 2016. The dominant valvular hemodynamic indication was aortic regurgitation. The techniques employed for Ross procedure included free standing root replacement in six patients and modified root replacement with autograft stabilisation using Dacron interposition graft in two patients. Right ventricular outflow tract (RVOT) conduit reconstruction was achieved by utilisation of Contegra bio prosthesis in four patients; and use of manually constructed valved conduit comprising of PTFE (polytetrafluoroethelene) membrane and bovine pericardial tube in remaining four patients. There was no mortality and no re-intervention. The technical varieties of Ross procedure offer freedom from need of anti-coagulation, mortality, and RVOT conduit failure in younger adults

Validation of bioelectrical impedance analysis for assessing dry weight of dialysis patients in Pakistan

Accurate dry weight estimation (DW) to achieve euvolemia is one of the key objectives of hemodialysis (HD). While conventionally DW is estimated by clinical examination, bioelectrical impedance analysis (BIA) has been proposed as an objective method to determine DW and has been tested extensively in the Western population. We aim to validate BIA for determining DW in a Pakistani population against the conventional clinician\u27s method. This is a single-center validation study conducted at two outpatient HD units of Aga Khan Hospital, Karachi. One hundred and forty-eight DW readings of patients who were on maintenance HD were taken both by BIA technology and by clinical assessment. The clinician was blinded to readings obtained by BIA. Data analysis was carried out using the Statistical Package for Social Sciences (SPSS) version 19. Median age of patients was 63 years (range 12-89). Nearly 54.1% of the samples were female (n = 80). Spearman\u27s correlation between the clinician\u27s estimate and BIA-derived DW showed a correlation coefficient of 0.982, which was statistically significant (

Oral Health Status Among Pregnant Women Attending Gynae OPD of Tertiary Care Hospital in Rawalpindi

Objective: The objectives of this study were to determine the oral health status and treatment needs using DMFT & CPITN indices in pregnant women attending Gynae OPD of tertiary care Hospital in Rawalpindi, to Determine Association of Oral health status using DMFT and CPITN with socioeconomic status and to determine oral health status of various trimesters of pregnancy Materials and methods: An analytical cross-sectional study was carried out to assess the oral health status and treatment needs among pregnant women at Tertiary Care Hospital, Rawalpindi from April’ 2020 to September’ 2020. Consecutive sampling was used to select the study participants. An adaptive version of WHO questionnaire was used. Results were presented in the form of frequency tables. Chi square test of statistics was applied to assess the association between categorical DMFT and CPITN with the sociodemographic characteristics of the participating females. Results: The mean DMFT score pregnant females was 2.41 + 2.30 and were belonged to a middle socioeconomic status 43.8% (n=173). About 61.8% (n=244) of participants had DMFT total score 1-7. Whereas, majority of the participants were reported bleeding gums on probing 30.6% (n=121) on assessment by CPITN. The participating pregnant females also depicted the worsening of periodontal tissues (P=0.00) and dentition status (P=0.02). Socioeconomic status was not significantly associated with dentition (P=0.39) and periodontal status (P=0.69). Conclusion: The study revealed that oral health status was deteriorated during pregnancy. Education and gestational period were strong indicator for oral health status among pregnant women. Bleeding gums were reported in majority of participants during second trimester of pregnancy. Socioeconomic status was not significantly associated with oral health status by CPITN and DMFT score

Hepatitis C Virus Infection: Molecular Pathways to Insulin resistance

Chronic Hepatitis C virus has the potential of inducing insulin resistance and type 2 Diabetes Mellitus in vitro as well as in vivo . Structural and non-structural proteins of HCV modulate cellular gene expression in such a way that insulin signaling is hampered, concomitantly leads toward diabetes mellitus. A number of mechanisms have been proposed in regard to the HCV induced insulin resistance involving the upregulation of Inflammatory cytokine TNF-α, hypophosphorylation of IRS-1 and IRS-2, phosphorylation of Akt, up-regulation of gluconeogenic genes, accumulation of lipids and targeting lipid storage organelles. This review provides an insight of molecular mechanisms by which HCV structural and non-structural proteins can induce insulin resistance

Patients' perception and actual practice of informed consent, privacy and confidentiality in general medical outpatient departments of two tertiary care hospitals of Lahore

<p>Abstract</p> <p>Background</p> <p>The principles of informed consent, confidentiality and privacy are often neglected during patient care in developing countries. We assessed the degree to which doctors in Lahore adhere to these principles during outpatient consultations.</p> <p>Material & Method</p> <p>The study was conducted at medical out-patient departments (OPDs) of two tertiary care hospitals (one public and one private hospital) of Lahore, selected using multi-stage sampling. 93 patients were selected from each hospital. Doctors' adherence to the principles of informed consent, privacy and confidentiality was observed through client flow analysis performed by trained personnel. Overall patient perception was also assessed regarding these practices and was compared with the assessment made by our data collectors.</p> <p>Results</p> <p>Some degree of informed consent was obtained from only 9.7% patients in the public hospital and 47.8% in the private hospital. 81.4% of patients in the public hospital and 88.4% in the private hospital were accorded at least some degree of privacy. Complete informational confidentiality was maintained only in 10.8% and 35.5% of cases in public & private hospitals respectively. Informed consent and confidentiality were better practiced in the private compared to the public hospital (two-sample t-test > 2, p value < 0.05). There was marked disparity between the patients' perspective of these ethical practices and the assessment of our trained data collectors.</p> <p>Conclusion</p> <p>Observance of medical ethics is inadequate in hospitals of Lahore. Doctors should be imparted formal training in medical ethics and national legislation on medical ethics is needed. Patients should be made aware of their rights to medical ethics.</p

Surface and solution properties of single and mixed gemini/conventional micelles on solubilization of polycyclic aromatic hydrocarbons

194-200The surface properties and mixed micellization behaviour of single gemini bis(hexadecyldimethylammonium) pentane dibromide (G5) surfactant, three conventional surfactants (Cationic cetyltrimethylammonium bromide (CTAB), anionic sodium dodecyl sulfate (SDS) and nonioinic Polyethylene glycol dodecyl ether (Brij35)) and their equimolar binary mixtures have been investigated by surface tension and spectrophotometry methods at 300K. The critical micelle concentration (CMC), surface properties, max (maximum surface excess), Amin (minimum surface area per molecule) and πCMC (surface pressure at the CMC) have been determined. The deviation from the ideal of the mixed micelles has been discussed on the basis of Clint theory. For mixed systems, regular solution theory (Rubingh) and Rosen’s theories are used, which helps to evaluate the composition of the mixed micelle, the activity coefficient, and interaction parameters (β and β<span style="mso-char-type:symbol;mso-symbol-font-family:Symbol;mso-bidi-font-weight: bold">σ). Negativity of interaction parameters (β and βσ) for mixed micelle formation indicates attractive interaction for all the system. </span