Post operative sore throat: Comparison between Macintosh versus video laryngoscope in patients intubated by trainee anaesthetists - A randomised control trial

Objectives: Postoperative sore throat (POST) is a common complication related to endotracheal intubation. The aim of this study was to compare the incidence of POST in patients intubated by trainee anaesthetist using Video Laryngoscope™ (VDL) or Conventional Macintosh Laryngoscope (CL).Methods: Total 110 patient scheduled for elective laparoscopic cholecystectomy were included from main operating room of Aga Khan University Hospital between June 2017-2018. The standardized perioperative protocol was used for general anaesthesia. Selected patients were randomly allocated into conventional laryngoscopy (CL) group or video laryngoscopy (VDL) group. The evaluation of sore throat was done at 1st, 12th and 24th hour postoperatively using a ten-point visual analogue scale.Results: The demographic characteristics, including intubation time, related complications or any other maneuver required were similar between the groups. The incidence of POST at 1st hour was 47% patients in CL group and 38% in VDL group (p=0.335). At 12th hour, 34.5% patients in CL and 38% in VDL reported POST (p=0.692). Similarly at 24th hour, 25% patients in CL and 16% in VDL group reported POST (p=0.669).Conclusions: There was no significant difference in incidence of POST for patients intubated by trainee anaesthetists using either CL or VDL. Objective evidence of training and laryngoscope technique can impact of POST

Expectations in a Marriage Proposal: A Gender-Based Comparison in Pakistan

To determine the differences in expectations of males and females regarding marriage proposals. It was a cross-sectional study conducted in Karachi. Young people aged between 18 and 45 years were enrolled in the study. An online questionnaire was circulated through a convenience sampling technique. Our sample had 456 participants with n=294 64.5% females. N=387 84.9% were between 18-25 years of age. N=292 64% did not have a preference regarding spouse’s skin tone but n=269 59.0% preferred a taller spouse. Body type was a considerable factor for n=227 49.8%. N=309 67.8% preferred their partner to have a job, own a business and have a career. Love marriage was preferred by n=194 42.5%. Majority of the sample (58.1%) did not have a preference in terms of ethnicity but n=193 42.2% wanted a spouse from the same sect, denomination or caste. N=357 78.3% were against dowry. 52% of the participants said their choices were influenced by societal norms and culture to some extent. Four most important personality traits in a potential spouse were loyalty (75.7%), respect (62.7%), maturity (49.3%) and honesty (46.5%). The findings of this study are reflective of our community and culture as the majority of individuals are under societal influence. Moreover, their preference in traits emphasizes mutual understanding as opposed to physical characteristics. An adequate understanding of an individual's expectations from a marriage proposal decreases the risk of psychological distress associated with the relationship

Postoperative Wound Pain and Hospital Stay in Patients of Open Lumbar Discectomy (OLD) Versus Endoscopic Lumbar Discectomy (ELD) in Lumbar Disc Herniation (LDH)

Background: Endoscopic lumbar discectomy is also beneficial regarding relieving wound pain, less hospital stay and smaller incisions. We compared visual analog scores (VAS) and hospital stay in patients treated with either endoscopic lumbar discectomy or open lumbar discectomy postoperatively.Material and Methods: Half patients underwent open lumbar discectomy – OLD (group A) and half operated with endoscopic lumbar discectomy – ELD (group B). The pain was quantified through visual analog score (VAS) observation in all patients. A preoperative medical management included prescribing a combination of an analgesic and a muscle relaxant along with physiotherapy with an avoidance of lifting heavy loads. Mann- Whitney (U) tests were applied for the comparison of postoperative VAS and hospital stay between groups.Results: 85% patients were having left sided prolapsed paracentral disc, and 15% were having right sided prolapsed paracentral disc. The mean postoperative VAS was 4 in patients treated with ELD and it was 1.32 in patients treated with OLD. The mean hospital stay was 1.5 days in ELD treatment, whereas, it was 2.5 days in OLD treatment. A significant difference (p=0.037) was found in the comparison of mean post-operative VAS between two vertebral levels (i.e., L4-L5 & L5-S1). The post-operative VAS and hospital stay (days) in ELD group were statistically significantly higher than the OLD group (p values 0.000).Conclusion: ELD procedure was effective as compared to open lumbar discectomy in terms of postoperative wound site pain and hospital stay. Endoscopic Lumbar discectomy is a minimally invasive procedure for discectomy

Consumer acceptance toward takaful in Pakistan An application of diffusion of innovation theory

Purpose – The purpose of this paper is to determine the factors influencing customer adoption toward takaful products in Pakistan. Design/methodology/approach – The study used five attributes of diffusion innovation theory (DOI), namely, relative advantage, compatibility, trialability, observability and complexity. Furthermore, the authors introduced two additional constructs, namely, consumer awareness and religiosity to analyze the adoption behavior of customers. A total of 365 questionnaires were distributed among the participants of the study. The survey was conducted in the Karachi city where the respondents were the existing and potential users of takaful products. The theoretical model of DOI theory was tested using structural equation modeling. Findings – The findings report that complexity has a negative impact on the adoption of takaful, whereas relative advantage, compatibility, trialability, observability, religiosity and consumer awareness shows a positive and significant influence. Originality/value – It is a noteworthy point that past literature is quite limited to investigate the determinants of consumer intentions to adopt takaful products. Based on this argument, the authors build the study to provide a scope and coverage in the field of Islamic insurance. The authors also expect that the research will encourage and provide a venue for forthcoming studies to help policy makers and academicians in this emerging business

Leading cause of addiction among teenagers of Pakistan and the role of security forces regarding their rehabilitation

Initially cocaine, opium, cannabis and alcohol were used for the purpose of relieving the physical and mental capabilities, and for medicinal and surgical purpose. But the human spirit of innovation must have led to the use of these substances for mood-altering effects and offer an escape from the real and difficult world of existence to a more agreeable world of fantasy. The major purpose of the study is to highlight the origin and development of the drug addiction in the Pakistani Youth and role of security forces in their rehabilitation. The security forces play a major role in the controlling and smuggling of these drugs. These forces also proving helpful in the rehabilitation of addicts and in the awareness program. But due to the presence of some black sheep the number of young addicts is increasing day by day

Influence of different formulation variables on the performance of transdermal drug delivery system containing tizanidine hydrochloride: in vitro and ex vivo evaluations

The present study was aimed at preparation of transdermal patches of tizanidine HCl, evaluation of the effect of polymers on in vitro release pattern of the drug, and the effect of permeation enhancers on the penetration of the drug through the rabbit skin. Various proportions of hydrophilic (HPMC) and hydrophobic (Eudragit L-100) polymers were used with PEG 400 as film-forming agent, and Span 20 or DMSO as permeation enhancer. The formulations were assessed for physicochemical characteristics and in vitro drug release studies using USP paddle over disc method in phosphate buffered saline (pH 7.4) at 32.0±1°C. On the basis of in vitro studies and physicochemical evaluations, S03-A and S04-A were selected at Eudragit : HPMC ratios of 8 : 2 and 7 : 3, respectively, for further ex vivo analysis. The effects of different concentrations of Span 20 and DMSO were evaluated on excised rabbit skin using Franz diffusion cell. Cumulative drug permeation, flux, permeability coefficient, target flux, and enhancement ratio were calculated and compared with the control formulations. Kinetic models and Tukey’s multiple comparison test were applied to evaluate the drug release patterns. Formulation SB03- PE containing Eudragit L-100:HPMC (7:3) with Span 20 (15% w/w) produced the highest enhancement in drug permeation, and followed zero order kinetic model with super case-II drug release mechanism

How perceived risk, benefit and trust determine user Fintech adoption: a new dimension for Islamic finance

Purpose – This study’s objectives are twofold; first, this paper aims to explore the determinants of perceived benefit and perceived risk of Islamic Fintech. Second, this study examines the influence of perceived benefit, perceived risk and user trust on the intention to adopt Islamic Fintech. Design/methodology/approach – The sample of 350 was distributed among the respondents, while a usable sample of 321 was retained for the analysis. The study performed a self-administration survey to collect the sample data while the hypothesized model was tested using SmartPLS. Findings – The results revealed that perceived benefit and perceived risk were significant and positively influenced by their factors. Moreover, perceived benefits showed a positive and significant impact on trust. However, perceived risk had a negative and significant impact on trust. The results also found a strong positive and significant relationship between trust and intention to adopt Islamic Fintech. Originality/value – The outcome of this research may be used to develop strategies for Fintech and enables the financial sector to attain economies of scale in the world

Use of Dark Chocolate for Diabetic Patients: A Review of the Literature and Current Evidence

Dietary changes are a major lifestyle factor that can influence the progression of chronic diseases such as diabetes. Recently, flavanols, a subgroup of plant-derived phytochemicals called flavonoids, have gained increasing attention, due to studies showing an inverse correlation between dietary intake of flavanols and incidence of diabetes. Flavanoids in the cocoa plant may ameliorate insulin resistance by improving endothelial function, altering glucose metabolism, and reducing oxidative stress. Oxidative stress has been proposed as the main culprit for insulin resistance. The well-established effects of cocoa on endothelial function also points to a possible effect on insulin sensitivity. The relationship between insulin resistance and endothelial function is a reciprocal one. Overall, the evidence from these studies suggests that cocoa may be useful in slowing the progression to type 2 diabetes and ameliorating insulin resistance in metabolic syndrome. Additionally, results from several small studies indicate that cocoa may also have therapeutic potential in preventing cardiovascular complications in diabetic patients. Studies highlighting the potential of cocoa-containing diets, in large-randomized controlled trials should be performed which might give us a better opportunity to analyze the potential health-care benefit for reducing the risk of complications in diabetic patients at molecular level