Randomised trial to assess the efficacy of pelvic drainage in preventing pelvic collection after elective rectal resection for cancer

INTRODUCTION: Rectal cancer is the third most commonly diagnosed cancer occurring in both males and females globally. In India, the incidence of rectal cancer among males is higher than females, which is different from the rest of the world. Increasing incidence among younger males in India has been seen as a trend. Low socioeconomic status has been seen to be associated with the incidence of rectal cancer both globally and in India. Though the management of rectal cancer is multimodal, adequate surgical resection is the mainstay of treatment and is considered the primary treatment modality. Rectal resection remains a morbid operation, one of the most troublesome complications being pelvic collection. Pelvic drainage by means of closed tubular drainage has been practised routinely with the objective of reducing the post operative morbidity. This study aims to observe the role of closed tube pelvic drainage in the post operative outcome following rectal resection. Although the ineffectiveness of such an intervention in reducing postoperative morbidity has been established in patients undergoing small intestinal and colonic resections, there is no conclusive data in patients undergoing rectal resection. In fact the effectiveness of such an intervention for rectal resection has been questioned. OBJECTIVES: 1. To detect the presence of pelvic collection by ultrasonographic imaging of the pelvis on the 5th post operative day and measure its volume if present. 2. To assess the morbidity in terms of deviation in the normal post operative course 3. To record the number of days of hospital stay according to ‘fit for discharge’ criteria. 4. To document the occurrence of urinary tract infection (UTI) during the post operative period (30 days following surgery). METHODS: The study was a randomized controlled trial which included all patients undergoing elective rectal resection under General Surgery Unit 2. The intervention was absence of pelvic drainage and this was compared against the comparator which was closed pelvic drainage. The exclusion criteria were: 1. Patients operated on an emergency basis. 2. Patients with disseminated disease where surgery is a palliative procedure. 3. Patients with compromised immunity (on steroids, immunosupression, post transplant patients). 4. Patients with intraoperative complications for which drainage is inevitable (spillage). The method used for randomisation was a block randomisation with concealment in sealed envolopes. The sample size was calculated by a two proportion methos with a power of 80% and an alpha error of 5%. Statistical analysis was performed by means of chi square test and independent sample T test. RESULTS: Although the study was not carried on till the complete sample size was reached, the results were all consistent and showed trends in the same direction. However, statistically significant conclusions cannot be drawn from the analysis of the results. The duration of the study and the time constraint is one of the major limitation of this study. Apart from this, sensitivity of a pelvic ultrasonogram, observer bias and the inability to perform blinding are the other limitations. The increased incidence of rectal cancer among younger males has stood out in this study which is in contrast with studies from the western population. The use of pelvic drainage has not shown to drastically contribute towards reducing post operative morbidity in terms of decreased pelvic collections or reduced hospital stays. Infact, the absence of a pelvic drain has shown a trend towards reduced incidence of pelvic collection and reduced hospital stay. However, these results are not statistically significant. CONCLUSIONS: The aim of conducting this study was to establish a definitive association between the routine use of closed tube drainage of the pelvis in patients undergoing resection for rectal cancer. The paucity of data in this area and the equivocal results of existing studies further warranted the need for this study. Although the study was not carried on till the complete sample size was reached, the results were all consistent and showed trends in the same direction. However, statistically significant conclusions cannot be drawn from the analysis of the results. The duration of the study and the time constraint is one of the major limitation of this study. Apart from this, sensitivity of a pelvic ultrasonogram, observer bias and the inability to perform blinding are the other limitations. The increased incidence of rectal cancer among younger males has stood out in this study which is in contrast with studies from the western population. The use of pelvic drainage has not shown to drastically contribute towards reducing post operative morbidity in terms of decreased pelvic collections or reduced hospital stays. Infact, the absence of a pelvic drain has shown a trend towards reduced incidence of pelvic collection and reduced hospital stay. However, these results are not statistically significant. The other factor that contributed to the outcome of these patients was neoadjuvant therapy in the form of long course chemoradiation. The lack of unequivocal evidence in the benefit of routine pelvic drainage has shown that it is a questionable intervention

Resource Sharing among Medical Teaching Libraries: A Developing Country Perspective

Resource sharing is a functional as well as financial need of any library. In this modern era of information technology while information explosion is at extreme, it is impossible for a library to cover the entire surface of available knowledge. Developed countries are actual beneficiaries of this practice where idea of resource sharing has been transformed into a formal practice. Developing South Asian countries are also working on this concept in order to adopt it as a practice. This study identified the resource sharing opportunities for medical teaching libraries in Lahore with reference to perception and willingness. The sample of this study encompassed 26 leading medical libraries of all public and private degree awarding institutions in Lahore, Pakistan. The survey research method was adopted for this study. Findings showed that resource sharing is a valuable practice. It enhances the level of user satisfaction. It adds value to library collections which is not limited to library books only. Libraries are willing to initiate resource sharing through creating union catalogues. This study could be applied to all medical libraries in Pakistan to develop a real time formal resource sharing network which would accelerate performance reaming in limited financial resources

Purposes to Seek Information Resources by Academicians of the Oldest & Leading University of the Sub-Continent: An Explanatory Study

Major goal of this research was to know the purposes of seeking information resources by the academicians at GC University Lahore. As an allied goal, effort was made to know the role of the university library in meeting information and research needs of the academic faculty. Mixed methods research design was adopted for meeting goals of the research. Explanatory Sequential Design (QUAN + qual) was utilized. Firstly, quantitative data was collected through the instrument of questionnaire and analyzed by SPSS Software. Qualitative data was collected from 30 seasoned academicians working in different departments of the university. Thematic approach was followed to make analysis of the qualitatively driven data. Results of the study show that academicians search information resources for the purposes of preparing lectures, for guiding research scholars and students, for presenting research papers, to keep up with current developments, for writing research articles and enhancing their general knowledge. Findings of the study show that respondents are satisfied with the resources and services of university library. Participants recommend the need of formal training for developing skills to search specific information resources through online sources. Findings of this study are limited to the teaching faculty at GC University Lahore Pakistan, a leading institute of the sub-continent. The study has practical implication for the authorities of the universities and policy-makers of Higher Education Commission, Islamabad to design services in accordance with the needs of faculty members of the university. The study has revealed purposes of seeking information resources by academic faculty of the university, role of the library and practical solutions to meet information and research needs of the teaching faculty members

THE EFFECTS OF SEED SOAKING WITH PLANT GROWTH REGULATORS ON SEEDLING VIGOR OF WHEAT UNDER SALINITY STRESS

Effects of seed soaking with plant growth regulators (IAA, GA3, kinetin or prostart) on wheat (Triticum aestivum cv. Auqab-2000) emergence and seedling growth under normal (4 dS/cm) and saline (15 dS/cm) conditions were studied to determine their usefulness in increasing relative salt-tolerance. During emergence test, emergence percentage and mean emergence time (MET) were significantly affected by most of priming treatments, however, root and shoot length, fresh and dry weight of seedlings were significantly increased by 25 ppm kinetin followed by 1% prostart for 2 h treatments under both normal and saline conditions. All pre-sowing seed treatments decreased the electrolyte leakage of steep water as compared to that of non-primed seeds even after 12 h of soaking. Seed soaking with 25 ppm kinetin induced maximum decrease in electrolyte leakage while an increase in electrolyte leakage was observed by 25, 50 or 100 ppm IAA treatments. It is concluded that priming has reduced the severity of the effect of salinity but the amelioration was better due to 25 ppm kinetin and 1% prostart (2 h) treatments as these showed best results on seedling growth, fresh and dry weights under non-saline and saline conditions whereas seed soaking with IAA and GA3 were not effective in inducing salt tolerance under present experimental material and conditions

A robust variable-structure LQI controller for under-Actuated systems via flexible online adaptation of performance-index weights

This article presents flexible online adaptation strategies for the performance-index weights to constitute a variable structure Linear-Quadratic-Integral (LQI) controller for an underactuated rotary pendulum system. The proposed control procedure undertakes to improve the controller s adaptability, allowing it to flexibly manipulate the control stiffness which aids in efficiently rejecting the bounded exogenous disturbances while preserving the system s closed-loop stability and economizing the overall control energy expenditure. The proposed scheme is realized by augmenting the ubiquitous LQI controller with an innovative online weight adaptation law that adaptively modulates the state-weighting factors of the internal performance index. The weight adaptation law is formulated as a pre-calibrated function of dissipative terms, anti-dissipative terms, and model-reference tracking terms to achieve the desired flexibility in the controller design. The adjusted state weighting factors are used by the Riccati equation to yield the time-varying state-compensator gains

FREQUENCY OF CAROTID ATHEROSCLEROSIS IN CEREBRAL INFARCTION

Objective: To know the frequency of carotid atherosclerosis in ischaemic stroke patients in our population using color Doppler ultrasound. Methodology: This is an observational study conducted in the department of Medicine Nishtar Hospital, Multan. All the patients admitted during this duration with CT scan proof of stroke were included in the study. Risk factors in all these patients were stratified. Doppler ultrasound was performed on all patients with ischaemic stroke according to the study protocol. Results: A total of 100 patients were included in this study over a period of five months. 66% of these were having cerebral infarction. Hypertension (72%), diabetes (35%), smoking (29%) and obesity (20%) were the common risk factors. The frequency of significant carotid atherosclerosis in acute ischaemic stroke patients was 21%. Conclusion: Carotid atherosclerosis is one of the most important indicators, predictors as well as an independent risk factor in the development of ischaemic stroke. KEY WORDS: Carotid, Atherosclerosis, Doppler ultrasound

EFFICACY OF INTRAVENOUS ACETAMINOPHEN VERSUS KETAMINE FOR POSTOPERATIVE PAIN AFTER ABDOMINAL HYSTERECTOMY

Objective; To determine the efficacy of intravenous acetaminophen versus ketamine for postoperative pain after abdominal hysterectomy. Material and Methods; A total of 114 women undergoing abdominal hysterectomy were taken in this study. The study was conducted from June 2017 to May 2018 at department of Anesthesiology, Nishtar Hospital, Multan. Results; Our study comprised of 114 ladies undergoing abdominal hysterectomy, mean age of the study cases was 54.13 ± 6.89 years (with minimum age of the patients was 39 years while maximum age was 68 years). Majority of our study cases i.e. 92 (80.7 %) had parity more than 3 and American Society of Anesthesiology (ASA) score level 1 in 93 (81.6%). Sixty one (53.1%) belonged to rural areas, while mean duration of surgery was 72.80 ± 11.32 minutes. Mean BMI level in our study cases was noted to be 23.98 ±4.17 Kg/m2 and obesity was present in 34 (29.8%) of our study cases. Efficacy was noted in 60 (52.6 %) of our study cases. Efficacy was 73.7% study cases in group A while 18 (31.6%) in group B (p=0.000). Conclusion; Our study results support the use of intravenous acetaminophen (IVA) for pain management in patients undergoing abdominal hysterectomy compared with ketamine. Intravenous acetaminophen is safe, reliable and effective for the pain management in postoperative abdominal hysterectomy patients which was associated with shorter hospital stay and cost effective for the suffering families. No adverse reactions were noted in this study with the use of intravenous acetaminophen. Keywords; Intravenous acetaminophen, Ketamine, Abdominal Hysterectomy.

Usage of Subscribed & Open Access Information Resources by LIS Research Scholars

Objectives of this study were to investigate the usage of subscribed and open access resources, preferences, level of awareness, reasons to utilize subscribed & open access information resources, and problems being faced while using the information resources by Library and Information Science (LIS) research scholars. Quantitative method followed by survey research design was used to conduct this study. Self-administered questionnaire validated by field experts was used to gather the data from the participants. The population of this study was postgraduate LIS research scholars from Punjab, who were enrolled in M. Phil. (2015-2017) and Ph. D. (2015-2018) programs. The survey was administrated personally. The data was gathered from 78 research scholars of Library and Information Science from the five LIS schools in Punjab. The data were analyzed through Statistical Package for Social Sciences (SPSS) Software. This study found that LIS participants preferred both resources like, subscribed and open access resources. The use of subscribed resources by Library and Information Science research scholars was preferred to open access resources for finding the articles and accessible anywhere of the world. There is a tendency among the researchers that due to lack of awareness, limited knowledge about existing research facilities, they do not fully utilize open access resources for their research and the database developed by the institution(s). A bunch of scholars does not aware of open access resources and due to this their utilization of this facility is quite low. Most of the libraries and the organization(s) do not have the facility and resources to have access to “subscribed electronic resources” due to heavy cost. Present study concludes that the LIS scholars prefer to use open access resources because of free availability on internet as compared to subscribed resources. Subscribed resources have a limited access only within the campus