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Home > A Randomised Controlled Trial Comparing Haemodynamic Stability in Elderly Patients Undergoing Spinal Anaesthesia at L5, S1 Versus Spinal Anaesthesia at L3, 4 at the Aga Khan University Hospital, Nairobi

A Randomised Controlled Trial Comparing Haemodynamic Stability in Elderly Patients Undergoing Spinal Anaesthesia at L5, S1 Versus Spinal Anaesthesia at L3, 4 at the Aga Khan University Hospital, Nairobi

Thesis Info

Author

Mbaya, Karen N.

Department

Anaesthesia (East Africa)

Program

MMed

Institute

Aga Khan University

Institute Type

Private

City

Karachi

Province

Sindh

Country

Pakistan

Thesis Completing Year

2012

Thesis Completion Status

Completed

Subject

Medicine

Language

English

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676728033110

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Background: Spinal anaesthesia is a routinely used anaesthetic technique for elderly patients undergoing operations involving the lower limbs, lower abdomen, pelvis and the perineum. Spinal anaesthesia has several advantages over general anaesthesia and these include stable haemodynamic variables, less blood loss, less post operative pain, faster recovery time and less post operative confusion. However, despite these advantages, the sympathetic blockade induced by spinal anaesthesia can result in hypotension, bradycardia, dysrhythmias and cardiac arrests. Conventionally, spinal anaesthesia is performed at the level of L3,4 interspace; with a reported incidence of hypotension in the elderly ranging between 65% and 69%. A possible strategy for reducing spinal induced hypotension would be to minimize the peak block height to as low as possible for the planned procedure. The purpose of this study was to investigate the decrease in mean arterial pressures and change heart rates from baseline values (haemodynamic stability) of elderly patients undergoing spinal anaesthesia performed at the level of L5, S1 compared to the conventional level at the L3, 4 interspace. Objective: To determine the difference in haemodynamic stability between elderly patients undergoing spinal anaesthesia at L5, S1 interspace compared to elderly patients undergoing spinal anaesthesia at L3, 4. Study design: A randomized single blinded controlled trial Methods: Thirty two elderly patients scheduled for lower limb or pelvic surgery under spinal anaesthesia were randomized into 2 groups (control group and intervention group) using a computer generated table of numbers. Control group; received 2.5 mls 0.5% hyperbaric bupivacaine injected intrathecally at the L3, 4 interspace Intervention group; 2.5mls 0.5% hyperbaric bupivacaine injected intrathecally at the L5, S1 interspace Results: The two groups had similar baseline characteristics in age, sex, body mass index and use of anti-hypertensive medications. There was 68.75% proportion of hypotension in the control group and 75% in the intervention group. The difference was not found to be statistically significant (p= 0.694). During the study period, there were 106 episodes of hypotension, out of which, 65 were in the control group and 41 in the intervention group (p=0.004). This difference was statistically significant.Linear regression analysis of the decrease in mean arterial pressures (MAP) showed a higher decrease in MAP in the control group (p 0.018). There were more crystalloids used in the control group (1006mls ± 374) than in the intervention group (606mls ±211) with a p< 0.0001. There was no difference in the amounts of vasopressors used between the two
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غزل

اگرچہ ہے جہان- فن، ستم خانہ سا لگتا ہے
مجھے کوئی بتائے یہ، محبت ہے کہاں ملتی
یہ دل جس کو خدا نے آپ اپنا گھر بنایا ہے
نہ آنے کی خوشی اس میں  نہ جانے کی خوشی اس سے
بھلے آباد ہو دنیا بھلے میلے ہوں ہر جانب
نہ ہی رسم و رہ- الفت نہ رشتوں میں ہی طاقت ہے
بڑی ویرانیاں ہر سو ،فریحہ ہو کا عالم ہے

 

یہاں جو دیکھتا ہے خواب دیوانہ سا لگتا ہے
کوئی جو ڈھونڈنے نکلے تو افسانہ سا لگتا ہے
مگر جو جھانک کر دیکھوں تو بت خانہ سا لگتا ہے
یہ عالم سچ میں ایسا ہے کہ میخانہ سا لگتا ہے
کسی کا دل جو ٹوٹا ہو تو ویرانہ سا لگتا ہے
جسے بھی غور سے دیکھو وہ بیگانہ سا لگتا ہے
خوشی کا ایک لمحہ بھی تو نذرانہ سا لگتا ہے

عائلی مسائل میں اقوال تابعین سے استشہادکے نظائر

There is major influence of quotes of Sahabaa’h and taa’baeen on Islamic Jurisprudence. A plain study of Fiqh presents the role of tab’aeen and their quotes in method of extraction. There quotes not mere only help us in various matters of virtues, but also in family issues and others. As a matter of fact, a major number of fatawas are based on their quotes or practice as well. Moreover, every school of thought in fiqh narrates their sayings in favour of their vision, I.e. Hanfiya, Shafiya and Malkiya used to narrates their quotes and sayings. Family life is base of any nation or civilization. Books of fiqh also discussed numerous issues of family life and their solutions in the light of Shariaah. In this article a view of tab’aeen’s quotes related to family issues will be discussed. It will support in understanding the importance of their quotes in Islamic Jurisprudence and its compilation. Relevant examples of different school of thought will be discussed from their own books respectively

Social Media Effect on English Language Learning Proficiency at University Level in Khyber Pakhtunkhwa Pakistan

Social media has become pervasive, impacting the social and cultural fabric of our society. It has revolutionized the way we communicate, interact and socialize. Therefore, the present study was conducted to find out the effect of social media sources on enhancement of English language learning proficiency at university level. Major objectives of the study were: to find out access of learners regarding use of social media sources for English language learning at university level across gender groups and discipline groups. To compare the views of learners regarding ranking of social media sources for English language skills and competency development at university level across gender groups and discipline groups. To determine the utilization of time regarding the use of social media sources for English language learning proficiency development across gender and discipline groups. To find out the importance regarding different social media sources on EFL learners’ language proficiency at university level across gender groups and discipline groups. To find out the effect of social media sources on enhancement of EFL learning proficiency between gender groups and discipline groups. The study was guided by null hypothesis in order to make appropriate recommendations based on findings of the study. The study was descriptive in nature that is why self-structured questionnaire was used for collection of data from the given sample of population. Population of the study was all the master level students enrolled in session 2015-16 of social sciences and pure sciences in public sector universities of Khyber Pakhtunkhwa, and sample size of the present study was eight hundred students of four public sector universities of southern districts in Khyber Pakhtunkhwa. Data was collected from the given sample of population and then arranged, coded, analyzed, and tabulated through SPSS version 24. Statistical tools which were used for analysis of collected data were percentage, mean, standard deviation, independent sample t-test, and one way ANOVA post hoc. After the successful completion of analysis findings of the present study clearly revealed that majority of university level mature learners have access to the use various social media sources for English language learning. Similarly, so for as the raking of various social media sources are concerned the findings of the study showed that Facebook is most commonly used social media source among the university level learners of Khyber Pakhtunkhwa. The findings of the present study also clearly revealed that university level learners utilize most of their leisure time in use of various social media sources and it has positive effect in English language learning proficiency development at university level. Therefore, in light of the findings of this study it is recommended that this research study may be beneficial to English teachers, curriculum developers/reviewers, textbook writers/reviewers, working and perspective teachers to promote standard based education.