Client Satisfaction Towards Quality of Health Services: an Assessment at Primary Healthcare of District Gujranwala

This survey designed to evaluate the satisfaction level and the factors that affect the patient satisfaction regarding health care delivery services with the aim to improve the services in the primary health care settings of Gujranwala. A Cross Sectional Study done on randomly selected patients attending the basic health units of Gujranwala, with more than18 years of age. Pretested structured "Liker scale questionnaire" was used for data collection. Out of total respondents, 62 (41.3%) clients were satisfied with the services provided by the basic health units of Gujranwala. The factors identified to determine patient satisfaction were accessibility of services, behavior of staff, health education, level of cleanliness, drug availability and miscellaneous services. Not a single ranked area of satisfaction noticed. Client\u27s occupation and income had significant relationship with the patient satisfaction level. Gender, age, and education of clients were not contributing factors; they not affect the client satisfaction level.Less than half clients were satisfied with the services provided by the basic health units. Management of health facilities needs to improve the services

A comparison of morphine and nalbuphine for intraoperative and postoperative analgesia

Introduction: Short acting narcotics are not available in Pakistan and the supply of drugs like morphine and pethidine is short and erratic; therefore there is a need for investigating acceptable alternatives for analgesia, to be used for balanced anaesthesia.Objective: We studied the agonist-antagonist narcotic nalbuphine compared to morphine, for intra and postoperative pain relief in total abdominal hysterectomies.Methods: In a randomised double blind trial, fifty ASA I and II patients in two groups of twenty five each were given equianalgesic doses of morphine and nalbuphine. Hemodynamic stability, intraoperative analgesia, recovery profiles, incidence of side effects and need for postoperative supplements were compared using standard anaesthesia technique for induction, maintenance and reversal. Postoperative analgesia profile was studied by the need for supplements in twenty four hours using the unidimensional verbal category scale.Results: We found that patients in the morphine group showed a rise of mean blood pressure and heart rate to 20% above the baseline in response to intubation whereas in the nalbuphine group it remained within 20% of baseline. Twelve out of twenty five patients in the morphine group and four out of twenty five patients in the nalbuphine group needed intraoperative supplements. Recovery profiles were similar in the two groups; postoperative nausea and vomiting and need for postoperative supplements was significantly less in the nalbuphine group.CONCLUSION: We conclude that nalbuphine provides better haemodynamic stability and better analgesia, recovery profile and postoperative pain relief compared to morphine in patients undergoing total abdominal hysterectomy

Evaluation of oral midazolam as pre-medication in day care surgery in adult Pakistani patients

A placebo controlled randomized double blind study was designed to assess the suitability of oral Midazolam as a premedication in day care surgery in adult Pakistani patients. Fifty ASA I and II patients aged between 20-60 years received either Midazolam 7.5 mg or a placebo approximately one hour prior to surgery. Midazolam 7.5 mg produced significant anxiolysis and sedation (p \u3c 0.001) in comparison to placebo after one hour of premedication. There was a significant difference (p \u3c 0.001) in the mean heart rate and blood pressure in both groups after 1 hour of premedication with a lesser rise in blood pressure and heart rate in the Midazolam group. Psychomotor performance assessed by \u27n\u27 deletion test was impaired by Midazolam (p \u3c 0.001) and recall of pictures revealed differences (p \u3c 0.05) in the groups at one hour after premedication. However, at four hours after surgery there were no differences in both groups. These findings indicate that rapidly acting oral Midazolam in doses of 7.5 mg provided safe and effective premedication in terms of anxiolysis, sedation, amnesia and psychomotor performance and is suitable for day surgery

A Short Review on the Development of Salt Tolerant Cultivars in Rice

Rice is staple food for half of the world. With a population of almost 9.6 billion by the year 2050, there is a dire need of developing techniques to improve the crop plants, not only in terms of better yield but also to withstand harsh environmental conditions and stresses like drought, temperature, flood and salinity. Salinity is second to drought stress and hence it is very important to develop crops tolerant to salinity stress. This review discusses the mechanisms of salt tolerance and the recent developments in understanding the complex tolerance phenomena. One way to address the salinity issue is to develop tolerant rice varieties using conventional and modern breeding techniques for which screening the rice germplasm for the varieties with desired traits is critical. Conventional methods to develop tolerant rice varieties are discussed along with modern biotechnology techniques are also discussed. Quantitative Trait Loci (QTL) and Marker Assisted Selection (MAS) are promising techniques. In addition to these modern techniques, some recent developments in the fields of transgenic plants, haploid breeding and Somaclonal variations have also been discussed. The limited knowledge about molecular and genetic mechanisms to tolerate abiotic stresses, however is a barrier to efficiently develop tolerant cultivars. A combination of conventional and modern biotechnology techniques could possibly open up the new ways

Regular ag-groupoids characterized by (∈, ∈ ∨ q k)-fuzzy ideals

In this paper, we introduce a considerable machinery which permits us to characterize a number of special (fuzzy) subsets in AG -groupoids. Generalizing the concepts of (∈, ∈ ∨q) -fuzzy bi-ideals (interior ideal), we define (∈, ∈ ∨ q k) -fuzzy bi-ideals, (∈, ∈ ∨ q k )-fuzzy left (right)-ideals and ( , ) k ? ? ?q -fuzzy interior ideals in AG -groupoids and discuss some fundamental aspects of these ideals in AG -groupoids. We further define ( ∈, ∈ ∨ q k) -fuzzy bi-ideals and (∈, ∈ ∨ q k)-fuzzy interior ideals and give some of their basic properties in AG -groupoids. In the last section, we define lower/upper parts of (∈, ∈ ∨ q k ) -fuzzy left (resp. right) ideals and investigate some characterizations of regular and intera-regular AG -groupoids in terms of the lower parts of ( ∈, ∈ ∨ q k ) -fuzzy left (resp. right) ideals and ( ∈, ∈ ∨ q k )-fuzzy bi-ideal of AG -groupoids