Comparison of hemodynamic changes in ketamine versus fentanyl as co-induction agent with propofol in elective surgical procedures

Objectives: To assess the hemodynamic changes caused by the co-induction of ketamine or fentanyl with propofol. Methodology: This prospective randomized trial included 220 patients that underwent elective surgical procedures under general anesthesia with endotracheal intubation. Random allocation of patients was done into two equal groups and drugs were administered using the double-blinded technique. Group A received propofol and fentanyl while group B received propofol and ketamine given as intravenous bolus doses. Measurement of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) was done before induction and 10 minutes after induction before the surgical stimulus. Independent samples t-test and paired t-test were employed for analysis of the collected data. Results: Both groups had normal hemodynamic parameters before induction; however, there was a significant difference in hemodynamic indices of both groups after 10 minutes of induction (p<0.001). Group A showed a significant decrease in SBP, DBP, and MAP after 10 minutes of induction (p<0.001). The patients in group B showed a significant increase in mean HR from baseline to 10 minutes (p<0.001). Group B demonstrated no change in the systolic, diastolic, and mean arterial pressures; however, group A elucidated a significant decrease in these hemodynamic parameters. Conclusion: The combination of ketamine and propofol provides better hemodynamic stability than fentanyl and propofol. More studies are required to evaluate these changes in patients with cardiovascular comorbidities

A STUDY OF THERAPEUTIC RESPONSE AND ADVERSE EFFECTS OF INTRAVENOUS ERYTHROPOIETIN VERSUS SUBCUTANEOUS ERYTHROPOIETIN ON HEMODIALYSIS PATIENTS IN THE DEPARTMENT OF NEPHROLOGY OF OHRC

Objective: To study the efficacy of intravenous erythropoietin and subcutaneous erythropoietin in hemodialysis patients who have persistent anemia despite correction of iron therapy and to measure the outcomes in terms of raise in haemoglobin concentration and adverse events in both the groups.Methods: After ethical committee approval the current study was conducted at the Department of Hemodialysis of Owasi Hospital and Research Centre, Hyderabad a period of 6 mo duration. 60 patients undergoing hemodialysis were recruited into out study who had haemoglobin less than 10.0 despite corrected iron levels. Patients were divided into two groups for intravenous administration and subcutaneous administration of alpha erythropoietin. Patients were stratified into three sub-groups of mild, moderate and severe anaemia. Therapeutic response was recorded in the form of monthly hemoglobin and hemoatocrit. Of the 30 patients in the subcutaneous group, erythropoietin was given to 19 males and 11 females, while intravenous erythropoietin was administered to 17 males and 13 females in the other 30 patients.Results: The mean hemoglobin level in the subcutaneous group was 5.16 at the commencement of the study and in the intravenous group the mean hemoglobin was 5.0. In the subcutaneous group, the mean rise in the hemoglobin was rapidly achieved in 3 mo duration when compared to the intravenous group. Mean Systolic Blood pressure was higher in the intravenous group when compared to the subcutaneous group. Spillage of the drug was minimal in subcutaneous group when compared to the intravenous group.Conclusion: After correction of the iron deficiency, low dose of erythropoietin subcutaneously promised to maintain expected hemoglobin level above 10 g/dL with no adverse events compared to intravenous erythropoietin. Erythropoitin alpha at a dose of 4000 IU was enough to achieve the therapeutic target of Hemoglobin>10.0 by administering subcutaneously accelerated hypertension was less when compared to Intravenous erythropieitn post dialysis. Hence we recommend to use erythropoietin subcutaneously rather than intravenously

A study of the neuroprotective role of Punica granatum and rosuvastatin in scopolamine induced cognitive deficit in rats

Background: The present work has been planned to find out the effect of Punica granatum and Rosuvastatin on learning and memory in Scopolamine induced cognitive deficits in rats. Scopolamine being an anticholinergic agent is used fervently in experimental models for memory deficits and has been widely implicated for the screening of cognitive dysfunction. Punica granatum (Pomegranate) has shown to suppress tumor neuronal cells, hence it can be a potential agent in providing neuroprotection for preventing the development and progression of AD. There are conflicting reports indicating the role of statins as a neuroprotective agent. This contradiction led us to investigate the effect of the role of Rosuvastatin on memory. The test agents were further compared to the standard treatment group acetylcholinesterase inhibitor i.e. Donepezil.Methods: Male wistar rats 150-200gms were divided into 4 groups of 6 rats each. Amnesia was induced by scopolamine 3mg/kg ip at day 5 in all the groups. Group1 (amnesic control) given distilled water; group 2(standard treatment i.e. Donepezil 0.5mg/kg orally); group 3(Rosuvastatin group10mg/kg orally); group 4 (Punica granatum juice 500mg/kg orally) The methods for validating cognition deficits were behavioural tests like Cook’s pole response and Passive Avoidance response.Results: It was evident from our research that the Punica granatum juice and Rosuvastatin effectively antagonized the scopolamine induced cognitive impairment in the paradigms studied. The neuroprotective effect of Punica granatum juice was better as compared to the Rosuvastatin group and the effects of the former were comparable with the standard treatment i.e. Donepezil group.Conclusions: Punica granatum has a remarkable protective role in memory function, learning, cognition and behavior in Scopolamine induced amnesia model of Alzheimer’s disease which was better than Rosuvastatin treatment

Frequency of Different Types of Focal Hepatic Lesions on Triphasic Computed Tomography Scan in Adult Patients

Out of various pathologies that affect the liver, focal liver lesion form an important group. Triphasic computed tomography is the imaging modality most often used to evaluate focal liver lesions. The purpose of this study was to evaluate the role of computed tomography in the diagnosis of liver lesions and to determine frequency of these lesions.Keywords: Liver, focal lesion, liver parenchyma, enhancement, iso-dense, hypo-dense and hyper-denseDOI: 10.7176/JHMN/77-04Publication date:July 31st 202

Online Teaching and its challenges faced by Anatomists in Pakistan: A post-pandemic

BACKGROUND AND OBJECTIVE: Medical teachers in Pakistan lacked the concept of online teaching and had to adapt with limited resources and experience during the COVID-19 pandemic. They were also lacking the necessary IT skills and computer literacy. This study aims to access the different types of online teaching methods, explore computer literacy, and identify the challenges and opportunities faced by the teachers of anatomy to assess the success of online teaching. METHODOLOGY: An online survey gathered data from n=80, anatomy teachers on demographic factors, prior online teaching experience, teaching methods, IT skills, and perceptions of online teaching challenges and benefits. Responses were analyzed using frequencies and percentages. The Chi-square and Fisher's exact tests were employed to explore relationships between dependent and independent variables. RESULTS: The study found that 17.5% of anatomy teachers had prior online teaching experience, with Zoom being the preferred app for 54% of respondents. A mix of synchronous and asynchronous teaching was favored by 48.75%. Most teachers reported IT skills above 70-80%. Teaching gross anatomy was cited as the biggest challenge by 74% of participants. Statistical analysis revealed no significant difference in app preference between junior and senior faculty (p > 0.05). CONCLUSION: Teachers of anatomy in Pakistan faced many difficulties in online teaching during the pandemic which is evident by this study conducted in post-pandemic time but did their best to deliver lectures using the resources available and minimal training

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Ijtihad as a legislative function: Role of Ijtihad, Ifta and Taqleed in Legislative Process

In Islamic legislation Ijtihad plays an important role and has central position in the whole process. Demands of life change day by day thus it become necessary to take on the structural review of Islamic laws keeping in mind the spirit and discipline of Islamic. Ijtihad thus play as a perfect tool for legislation. Regarding fatawas the jurists followed the methodologies of companions, tabieen, and taba Tabaeen. In cases in which they did not find any legal opinion of their teachers related to a specific problem they themselves tried to find out the solution for that problem from the relevant Texts and formulate their own fatawa. In Pakistan the Judiciary that performs the task of interpretation for law-making, Majlis-e-Shura and various Ulama are exercising the job of Ifta. The Council of Islamic Ideology is the official legislative body of fatawa. Taqleed is also an acceptable mode of legislation whose proofs are evident from Quran and Sunnah. It has been used as a source of legislation in Pakistan as well. In constitution of Pakistan article 189 and 201 are related to Taqlid. Article 189 and 201 makes the decisions of Supreme Court binding on all courts and the High court judgments binding on all subordinate courts. Thus the legislative process in Islam employs the methods of Ijtihad, Ifta and Taqlid as a perfect tool of legislation

Ijtihad as a legislative function: Role of Ijtihad, Ifta and Taqleed in Legislative Process

In Islamic legislation Ijtihad plays an important role and has central position in the whole process. Demands of life change day by day thus it become necessary to take on the structural review of Islamic laws keeping in mind the spirit and discipline of Islamic. Ijtihad thus play as a perfect tool for legislation. Regarding fatawas the jurists followed the methodologies of companions, tabieen, and taba Tabaeen. In cases in which they did not find any legal opinion of their teachers related to a specific problem they themselves tried to find out the solution for that problem from the relevant Texts and formulate their own fatawa. In Pakistan the Judiciary that performs the task of interpretation for law-making, Majlis-e-Shura and various Ulama are exercising the job of Ifta. The Council of Islamic Ideology is the official legislative body of fatawa. Taqleed is also an acceptable mode of legislation whose proofs are evident from Quran and Sunnah. It has been used as a source of legislation in Pakistan as well. In constitution of Pakistan article 189 and 201 are related to Taqlid. Article 189 and 201 makes the decisions of Supreme Court binding on all courts and the High court judgments binding on all subordinate courts. Thus the legislative process in Islam employs the methods of Ijtihad, Ifta and Taqlid as a perfect tool of legislation

Factors associated with non-adherence in chronic patients with multiple comorbid conditions

Background: To determine the association of non-adherence to the various age groups and related sociodemographic factors, this study was conducted. Materials and Methods: In different departments of Services Hospital Lahore, a cross-sectional survey was conducted. 370 patients voluntarily participated in the study. The data was collected using a questionnaire. The data was analyzed using chi-square. The level of significance was 0.05%. Results: In this study, 33.3% of patients were below the age of 40 years and 46.3% of patients were above the age of 40 years and were not adherents because of the experience that they did not get benefit from the treatment. Similarly, 21.5% of patients below age 40 and 22.3% of patients above age 40 think that they do not need medicine. 38.5% of patients below age 40 and 54.3% of patients aged above 40 stopped medicine after becoming better. Conclusion: None-adherence found more prevalent among elderly patients

A Spatio-Temporal Assessment Of Land use Land Cover Change on Agriculture Productivity in Punjab, Pakistan

Introduction/Importance of Study: The agricultural sector is crucial to the development of any nation, particularly where food security is a concern. In Punjab province, urban settlements are increasingly encroaching on established agricultural lands, posing a significant threat to agriculture in the region. This issue is compounded by the continuous urban expansion and encroachment on fertile lands. The primary aim of this study is to assess the impact of Land Use and Land Cover (LULC) changes on agricultural productivity in Punjab. Utilizing the Earth Engine, this research performs LULC classification and estimates wheat crop yields in the province. Novelty Statement: This study presents an innovative application of Earth Engine analytics to monitor and analyze the effects of LULC changes on agricultural productivity in Punjab province. Material and Method: The research employs 20 years of Land Use and Land Cover data from the MODIS dataset, accessed via Google Earth Engine (GEE). In addition, wheat crop production is estimated using the capabilities of GEE. Result and Discussion: The findings indicate a substantial shift in land cover in Punjab, which has significantly affected wheat crop production. The study emphasizes the importance of public awareness campaigns and the adoption of advanced agricultural technologies. Continuous monitoring of LULC changes using GEE can enable timely interventions to mitigate negative impacts. Concluding Remarks: By integrating urban growth management strategies with the preservation of agricultural lands, long-term agricultural sustainability and development can be achieved. This research highlights the urgent need for comprehensive policies and collaborative efforts to counteract the adverse effects of urban expansion on agricultural productivity