Comparison between Tramadol and Pethidine in Patient Controlled Intravenous Analgesia

Objective: To compare the efficacy and side effects related to Tramadol with Pethidine in patient controlled intravenous analgesia (PCIA) after total abdominal hysterectomies. Methods: A total of 60 patients were randomized to receive either Tramadol or Pethidine by PCIA (30 in each group) after total abdominal hysterectomy. Pain assessments were recorded one hour after starting the PCIA and then at 6, 12, and 24 hours by using visual analogue scale (VAS). Nausea vomiting score and sedation score were also recorded. Good attempts, total attempts and total drug consumption was noted from PCIA pump at the end of the study period. Results: The analgesia achieved in Tramadol group was comparable to Pethidine. The incidence of nausea and vomiting was similar in both groups. Tramadol causes significantly less sedation than Pethidine (p \u3c 0.05). Mean drug consumption, total attempts and good attempts were also significantly less in Tramadol group than Pethidine group (p \u3c 0.05). Conclusion: Tramadol produces equivalent analgesia and less sedation and can be used as an alternative to Pethidine in Patient Controlled Intravenous Analgesia for postoperative pain relief after Total Abdominal Hysterectomy (TAH

Use of intravenous anti-D in patients with refractory and relapsed immune thrombocytopenic purpura

Objective: To determine the response to IV anti-D and its comparison with splenectomy as second line therapy in refractory and relapsed cases of ITP, in the Aga Khan University Hospital, Karachi. Methods: A total of 23 patients with chronic ITP were treated with either anti-D or splenectomy as second line treatment. The patients were assessed for time to achieve a response to second line treatment, duration ofresponse and adverse events. Results: There were 12 patients in the anti-D group and 11 in the splenectomy group. The mean platelet count at presentation was 9,000/cumm. The mean age was 8.9 years and 13.0 years and the male to female ratio was 1:1 and 1:1.2 in anti-D and splenectomy group respectively. 54.5% of the patient in the anti-D group responded compared to 81.8% in the splenectomy group. Median time to achieve a response was 7 days in the anti-D group and 1 day in the splenectomy group. Mean time to relapse was 87.8 days in the anti-D group and 55.4 days in the splenectomy group. No adverse events were recorded for any of the infusions of anti-D and none of the patients had more than 0.5 gm /dl fall in the hemoglobin level following anti-D infusion. Conclusion: It was thus concluded that Anti-D is a relatively safe, convenient and effective therapy for chronic ITP and can be used as a splenectomy sparing agent when treatment is clinically indicated

Future of Cooperative Farming in Pakistan

The main objective of this study was to work out production efficiency of some cooperative and non cooperative farmers in the central Punjab, Pakistan. For this purpose a survey of central Punjab was conducted in the year of 2008-09. Two type samples were taken for the study. First type sample was comprised of 15 respondents who had joined together in different ways to cultivate their available lands. Second type included 60 respondents, 20 from each district of Jhang, Faisalabad and TT Singh. The results obtained through t-statistics analysis revealed that the per acre use of Agri inputs and outputs obtained for all the cash crops was significantly different and  higher in case of cooperatives than non-cooperatives farmers. The benefit cost   (B-C) ratio indicated that it was 38% higher for cooperative than non-cooperatives as it was 1.98 and 1.43 for respective categories. But these cooperatives farming could not sustain for longer time due to the lake of education and conflicts between the members. Keywords: Cooperatives, Farming, Punjab, Pakista

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Haemodynamic effects of intrathecal bupivacaine for surgical repair of hip fracture

Objective: To determine the optimal dose of bupivacaine in providing adequate surgical anaesthesia with minimal haemodynamic disturbances.Methods: Three different doses of spinal bupivacaine in combination with or without fentanyl for surgical repair of hip fracture were used. Sixty patients were randomly divided into three groups (A, B and C) to receive a spinal anaesthetic of bupivacaine 10mg, 8mg and 6mg respectively. In addition to bupivacaine, group B and C also received fentanyl 20 microg in spinal mixture.Results: Intra operative heart rate was statistically insignificant in all three groups. Statistically significant drop in systolic blood pressure was found in group A & B at different study timings while statistically significant drop in diastolic blood pressure was only found in group A. Sensory block characteristics were similar among all three groups. Motor block pattern was found marginally significant in group C with highest time to achieve desired block. All patients had satisfactory level of surgical anaesthesia.CONCLUSION: This study concluded that low dose, 6 mg bupivacaine with 20 microg fentanyl provide adequate anaesthesia for surgical repair of hip fracture with stable haemodynamics

Problems and Prospects of Curbside Parking in Lahore: PolicyImplications for Effective Management

International audienceLahore is a fast-growing metropolis experiencing rapid growth in people and vehicle population. This unprecedented growth has led to urban sprawl, dependency on motorized transport, and increased parking space demands throughout the city limits. Off-street parking supply is insufficient and the demand is met mainly by roadside parking with and without any authorization. Parking on the roads and sidewalks has resulted in reduction in traffic capacity, traffic speed variation, accidents and disruption in smooth flow of traffic. Though the government has adopted measures in the past to streamline roadside parking activities, these efforts have proved counter-productive. This paper provides a critical analysis of the existing parking situation in Lahore based on detailed surveys and interviews. It presents an assessment of the functional performance of selected parking sites located at various roads. The findings not only provide significant evidence of the problems caused by haphazard curbside parking but also highlight its prospects if managed properly. The paper argues that absence of by-laws governing curbside parking, weak institutions, and inadequate public transport are the main causes of prevailing parking crisis. It concludes that development of curbside parking regulations in line with urban transport policy is a first step towards managing existing and future curbside parking resources in Lahore

Informed Consent and Cultural Diversity

Introduction : Informed consent allows a mentally competent patient to make his/her decision of undergoinga medical procedure after adequate explanation. Individual practice of informed consent varies not onlyamong physicians but among different countries with different cultures, religious beliefs and practices. Methods : We conducted a study to determine the patient’s desire for information regarding anaesthesia andsurgery; to determine whether variables like age, sex, education, type of surgery and previous anaesthesiaexperiences have any association with the desire for information and to determine whether patients maketheir own decisions or want their family to be involved in the decision making process or give consent ontheir behalf. After written consent, patients visiting the preoperative clinic were asked to fill a questionnairesof 17 pieces of information regarding anaesthesia and surgery. Results : Majority of patients (91%) showed a desire for information. Among different variables only educationwas found to be significantly associated with the desire for information. Educated patients had a higherdesire. A large number of patients wanted to involve family in decision-making and give consent on theirbehalf. This trend was higher in females and less educated patients .Conclusions : We conclude from our study that educated people in society have more desire for informationand autonomy. Our study has also highlighted the influence of culture on the concept of patient autonomyand informed consent

Correlation of serum cortisol levels and stress among medical doctors working in emergency departments.

Abstract OBJECTIVE: To assess and correlate serum cortisol levels and self-perceived work-related stress among medical doctors working in emergency departments in different tertiary care hospitals of Karachi. DESIGN: Cohort study. PLACE AND DURATION OF STUDY: The study was conducted in Section of Chemical Pathology, Department of Pathology and Microbiology, AKUH, from December 2004 to August 2005. SUBJECTS AND METHODS: A total of 64 doctors participated from one private and two public tertiary care hospitals of Karachi. Thirty-four doctors were from emergency departments and 30 from non-emergency departments. Serum cortisol levels were measured in the morning (between 8.00-8.30 am) and in the evening (between 8.00-8.30 pm). Cortisol was measured by Florescence Polarization Immunoassay (FPIA) technique. Two questionnaires, modified mental Professional Stress Scale (PSS) and Aga Khan University Anxiety and Depression Scale (AKUADS) were used to assess stress levels. RESULTS: Emergency room physicians (ERP) were 1.2-year younger than non-emergency room physicians (NERP). Mean evening cortisol of emergency physicians was 60.72nmol/L higher than non-emergency physicians. The difference between morning and evening cortisol was marginally significant (p = 0.051). Morning diastolic blood pressure was 3mmHg higher in emergency physicians. Forty-one percent of emergency physicians and 20% of non-emergency physicians had AKUADS more than or equal to 20, the difference was borderline significant (p = 0.068). Mean value of professional stress scale for emergency physicians was significantly higher than non-emergency physicians. Evening serum cortisol concentration was significantly associated with PSS (p = 0.011). The sub-scales such as work-load (p = 0.007) and lack of resources were highly significant with evening cortisol (p = 0.005). CONCLUSION: In this study, evening serum cortisol levels significantly correlated with work overload and lack of resources, however, there was marginally significant correlation between morning and evening serum cortisol difference. Study suggests that emergency physicians perceive more stress than non-emergency physicians. Work overload and lack of resources are major contributing factors for stress in these doctors

Haemodynamic response of intravenous tramadol and intravenous morphine during laryngoscopy and endotracheal intubation

Objective: To compare the haemodynamic response of equipotent analgesic doses of morphine and tramadol to laryngoscopy and endotracheal intubation.Methods: A randomized double blind study of eighty ASA 1 and ASA II patients, age 18-50 years for elective surgery requiring endotracheal intubation was conducted. Forty patients were selected for each group, M (morphine) and T (tramadol). All patients received study drug three minutes prior to induction of anaesthesiaResults: Mean heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial blood pressure (MAP) between the groups and within the groups from base line and from preintubation period was significantly (p\u3c0.05)different at different time intervals.. When compared from base line maximum increase in heart rate in group M and T was 11.86% and 28.92% and maximum decrease was 12.08% and 1.43% respectively. Mean maximum increase in SBP was 8.06% in group T. Decrease was 18%and 10.48% in group M and T respectively. Maximum increase and decrease in DBP and MAP follow the same pattern and increase in blood pressures remained below 15% of the baseline value.CONCLUSION: Morphine is a better drug as compared to tramadol for attenuation of laryngoscopy and endotracheal intubation response