5جولائی 1977ء ضیاء الحق مارشل لاء
کامریڈ رئو ف لنڈ
پاکستان کی تاریخ کا وہ منحوس ترین دن جس کی طوالت اور تسلسل (بھلے شکلیں بدل کر ہی سہی مگر)آج تک جاری ہے ۔سیاسی تاریخ کی روشنی میں دیکھا جائے تو پتہ چلتا ہے کہ ملکوں میں محض ناپسندیدہ جمہوری حکومتوں کو بدلنے اور اگلی من پسند حکومتوں کے قیام کے لیے ہی مارشل لا ء لگائے جاتے ہیں ۔مگر پاکستان کی تاریخ کا یہ پہلا مارشل لاء ہے جو ذوالفقار علی بھٹو کی جمہوری حکومت ہٹانے کے ساتھ ساتھ پاکستان کے ان کروڑوں محنت کشوں کے خلاف لگا یا گیا کہ جنہوں نے 1967-68ء میں انقلابی سر کشی کر کے پاکستان کے سرمایہ داروں ،جاگیرداروں ،ملائوں ،ججوں اور جرنیلوں کے مسلط شدہ جبری اہتمام اور ان کی عائد کردہ رنگ و نسل ۔مسلک و مذہب ،ذات و برادری ،اور وطن و قومیت کی خبیث تقسیم کو مسترد کر دیا گیا تھا ۔عوام کے ذہن سے اس سرکشی کو کھرچنے اور محو کر نے کے لیے کھیلوں کے میدانوںمیں بے گناہ لوگوں کو ٹکٹکی پہ باندھ کے ان کے ننگے جسموں پہ کوڑے برسائے گئے ،پھانسیاں دی گئیں ،شاہی قلعوں کے عقوبت خانوں (جن کا نام سن کر آج بھی جسم پر لرزہ طاری ہو جاتا ہے )میں ڈال کر ان کو برفوں کی سلوں پر لٹایا گیا ۔بجلی کے جھٹکے دیے گئے ،پاخانہ پلا یا گیا ،سیاسی قیدیوں کے سامنے ان کی مائوں بہنوں کو ننگا لا یا گیا اور ان قیدیوں کے ہاتھوں اور پائوں کے ناخن نکالے گئے ۔پھر جب ان غیور محنت کشوں کو نہ جھکایا جا سکا تو پاکستان میں مذہبی بنیاد پرستی کے بیج بو کر ایک خدا اور ایک رسول کے ماننے والوں کو ایک دوسرے کے ہاتھوں ذبح کر ایا...
Human life is the subjective of change with the changing circumstances. If we look at the condition of our late grandfather or great – grandfather and look at the contemporary situation; it will not be difficult to understand this change. The rules about some important issues had been changed with the passage of time. In the initial descendants of Adam the marriage of brothers and sisters was allowed, after the flood of Noah, due to the scarcity of animals, the meat of all kinds of animals was allowed, two sisters were married to Hazrat Yaqub (A.S) at the same time, but the rules had been reversed afterwards. Even in the time of the Holy Prophet and the rightly guided caliphs, such changes took place and they were associated with the changing conditions. Initially it was banned to visit the graves and the sacrificial meet was not allowed to keep for more than three days and it was mandatory upon the women to attend the congregational prayer but afterwards the permissions were granted contrarily. Fortunately, we have a body of jurisprudence in the light of which not only contemporary issues can be solved but also guidance can be provided for the future. Our leading Jurists, who are followed, have done a remarkable job in this regard. The following article reviews the teachings of the three jurists, namely Imam Shafi’i, Imam Malik, and Imam Ahmad ibn Hanbal and teachings of their glean jurists. It will make clear that under changing circumstances these jurists seemed to agree on change. Therefore, by using the efforts of these jurists, we can try to resolve the problems of our contemporary changes and requirements throughout the Muslim World.
Background: Laryngeal mask airways (LMAs) are widely used in anaesthesia and are considered to be generally safe. Postoperative sore throat (POST) is a frequent complication following LMA use and can be very distressing to patients. The use of an LMA cuff pressure of between 30 and 32cm of H20 in alleviating postoperative sore throat has not been investigated.
Primary objective: To compare the occurrence of POST between the intervention group in which LMA cuff pressures will be adjusted to 30-32cm of H20 and the control group in which only monitoring of LMA cuff pressures will be done.
Secondary Objectives: To compare the severity of POST between the two study groups.
To compare the LMA cuff pressures between the two study groups.
Study Design: A single blind randomized control trial
Methods: Eighty consenting adult patients scheduled to receive general anaesthesia with use of an LMA were randomized into two groups of 40 patients each. In the intervention group LMA airway cuff pressures were adjusted by the principal investigator to a pressure of 30 to 32cm of H20.The control group only had LMA cuff pressures monitored throughout the surgery. All patients were interviewed postoperatively at two, six and twelve hours. Data of their baseline characteristics, occurrence and severity of POST was collected. If POST was present; a Numerical Rating Scale (NRS) was used to assess the severity. Cuff pressures between the two study groups were also determined.
Results: The baseline demographic characteristics of the participants were similar. The use of manometry to limit LMA AMBU® AuraOnce™ intracuff pressure to 30-32cm H2O reduced POST in surgical patient’s by 62% at 2 hours and 6 hours (Risk Ratio 0.38 95%CI 0.21-0.69)in the intervention group. The median POST pain score in the intervention group was significantly lower than the control group with scores of 0 at 2, 6 and 12 hours post operatively. Routine practice of LMA cuff inflation by anesthesiologists is variable, and the intracuff pressures in the control group were higher than in the intervention group. (P<0.001)
Conclusion: Among this population, reduction of LMA AMBU® AuraOnce™ intracuff pressure to 30-32cm H2O reduces the occurrence and severity of POST. The LMA cuff pressures should be measured routinely using manometry and reducing the intracuff pressures to 30-32 cm of H20 recommended as best practice.