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Home > A Randomised Controlled Trial Investigating the Effect of Adding Fentanyl to Low Dose Bupivacaine in Combined Spinal-Epidural Anaesthesia, Using Epidural Volume Extension Technique in Caesarean Section

A Randomised Controlled Trial Investigating the Effect of Adding Fentanyl to Low Dose Bupivacaine in Combined Spinal-Epidural Anaesthesia, Using Epidural Volume Extension Technique in Caesarean Section

Thesis Info

Author

Manyano, Mudola V.

Department

Anaesthesia (East Africa)

Program

MMed

Institute

Aga Khan University

Institute Type

Private

City

Karachi

Province

Sindh

Country

Pakistan

Thesis Completing Year

2011

Thesis Completion Status

Completed

Subject

Medicine

Language

English

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676728033498

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Background: Epidural volume extension (EVE), is a technique whereby a small-dose intrathecal block is enhanced by an epidural injection of physiological saline. This epidural injection exerts a compression effect on the dura, which then leads to a cranial increase in sensory spread of the intrathecal local anaesthetic. The lower dose of local anaesthetic required in the EVE technique has made it possible to avoid the side effects of the conventional dose of local anaesthetic while still having the benefit of adequate anaesthesia. Several studies have been conducted in this area; these studies have either used or omitted fentanyl. The successful results demonstrated in these trials have been solely attributed to the EVE effect without taking into consideration the pharmacological effect of fentanyl on the total outcome. No study has been done to demonstrate the effect of fentanyl on the epidural volume extension block and whether adding or omitting it would make a difference on spinal block level and other characteristics. Objective: The study aims at determining the effect of fentanyl plus low dose bupivacaine on the spinal block level of combined spinal epidural (CSE) anaesthesia utilizing the Epidural Volume Extension technique. Study design: A randomised controlled trial Methods - Intervention: Forty four women scheduled for elective caesarean section were randomized to 2 groups. One group got intrathecal bupivacaine with fentanyl followed by Epidural Volume Extension with physiological saline (Fentanyl group). The second group got intrathecal bupivacaine without fentanyl followed by epidural volume extension with physiological saline (No-fentanyl group). - Outcome measures: The outcome measures for this study were, the maximum sensory level which was measured by loss of sensation to temperature using a cold spirit swab, the motor block which was assessed using the Bromage score and the time to first request to analgesia taken as the time the patient first needed to use their PCA device or epidural supplementation intraoperatively. Results: The sensory block level after epidural volume extension increased in both arms. The increase was more in the intervention arm (Fentanyl group) than in the control arm (Nofentanyl group). This increase was however not statistically significant P=0.19. The sensory block level after epidural volume extension in the fentanyl group was 4 levels higher than the initial intrathecal block, while in the control arm the change was 3 levels higher than the than the initial intrathecal block. The time to first request of analgesia was shorter in the no-fentanyl
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پروفیسر نثار احمد فاروقی

پروفیسر نثار احمد فاروقی
دارالمصنفین، شبلی اکیڈمی میں ۲۹؍ نومبر ۲۰۰۴؁ء کو علامہ شبلیؒ سمینار کا چوتھا اجلاس ہورہا تھا کہ یہ افسوس ناک خبر ملی کہ جید عالم اور اردو کے محقق، نقاد اور ادیب جناب نثار احمد فاروقی ۲۷ و ۲۸ نومبر کی درمیانی شب میں انتقال کرگئے، اناﷲ وانا الیہ راجعون، ان کی لاش دہلی سے امروہہ لائی گئی اور ۲۸؍ نومبر کو اپنے آبائی قبرستان میں سپرد خاک کردیے گئے۔
وہ بڑے صحت مند تھے مگر پچھلے کئی برس سے طبیعت خراب رہنے لگی تھی، گزشتہ سال جنوری کے آخر میں ان کے گھر ملاقات کے لیے گیا تو مجھے بہت مضمحل معلوم ہوئے، دریافت کرنے پر بتایا کہ رات ہی بمبئی سے آیا ہوں، وسط مارچ میں رام پور رضا لائبریری کے سمینار میں ملے تب بھی کچھ سست اور بجھے بجھے دکھائی دیے تاہم ان کی تقریر اب بھی کانوں میں گونج رہی ہے، دلی سے ان کا جاننے والا کوئی آتا تو وہ بھی ان کی علالت کا ذکر کرتا، دارالمصنفین کے سمینار میں اسی لئے شروع میں ان کو زحمت دینے میں تامل ہورہا تھا مگر ان کو مجھ سے اور دارالمصنفین سے جو لگاؤ تھا، اس کی وجہ سے طبیعت نہ مانی اور دعوت نامہ بھیج دیا، اسی دوران اخباروں میں پڑھا کہ وہ پروفیسر گوپی چند نارنگ کے ہم راہ دوحہ (قطر) ایوارڈ لینے گئے ہیں، اس لیے ایک عزیز کو دستی خط دے کر اصرار کیا کہ آپ تشریف لاکر مفتخر فرمائیں، خطوط کا جواب وہ فوراً دیتے تھے مگر اس دفعہ کسی خط کا جواب نہیں آیا، جب سمینار میں دہلی اور دوسری جگہوں سے لوگ آنے لگے تو جناب شعیب اعظمی نے جو بٹلہ ہاؤس میں ان کے قریب ہی میں رہتے ہیں بتایا کہ وہ سخت بیمار ہیں، آنے کے لائق نہیں...

Cultural Linkages Between the People of Sindh and Japan

Japan and the land of present Pakistan had cultural linkages since ages. Sindh has remained important part of this land. The Indus civilization had trade links with other countries including Sumerian and Babylonian civilizations. This trend continued afterwards, and trade relations were established between people of Sindh and Japan in the nineteenth century. This interaction led both the countries to have cultural linkages. Presently many Sindhis are residing in Japan who have adopted Japanese culture besides maintaining their own cultural traditions and customs. Sindhi poetry adopted Japanese Haiku and ‘Safarnamas’ were written in Sindhi language grasping the living and traditions, etc. Of Japan. This research paper also discusses that both countries’ people have similar style of sitting together and exchange of opinions and happenings of the day which is traditionally called ‘Katchehry’ in Sindh.

Genetic Diversity and Potential of Soybean Glycine Max. L. Brady Rhizobial Populations of Rawalakot Soils for Plant Growth Promotion

This study was conducted to examine the variability of soybean nodulation and growth in relation to elevation and soil properties across the slopping uplands of the Himalayan region of Rawalakot Azad Jammu and Kashmir (AJK), Pakistan in order to find efficient native N2 fixing bacteria adapted to local soil and climatic characteristics. Soils from twenty two different sites with variable altitude were collected and analyzed for different physico-chemical characteristics including the quantitative estimation of rhizobium population through spread plate method. Soybean cultivar William-82 was grown in these soils under greenhouse conditions for determining the nodulation potential (number and mass) and plant growth characteristics. Morphology of the nodules was observed through optical and transmission electron microscopy. Soil altitude ranged from 855 m to 3000 m while organic matter content varied between 0.8% to 3.5% and pH from 6.0 to 8.1. The number of nodules per plant varied from 7 to 40 (CV 38%) suggesting site/location as an important factor contributing towards rhizobia population and impacting root nodulation. Results showed a substantial variability between sites and this is likely to be due to inter/intra species diversity, as well as changes in microbial community composition/structure. Root nodules bacteria were isolated from soybean grown in soils of 22 different sites of subdivision Rawalakot. A total of 37 strains were isolated on YEMA medium and purified. All isolates were found Gram negative except NR15, NR30 and NR32. The isolates were further characterized for phosphate solubilization, indole acetic acid production and nitrogen fixation. Out of 37 strains, twenty eight were able to produce IAA while nine did not. The maximum IAA of 13.20 μg/mL was produced by the strain NR30 followed by 13.0 μg/mL by NR19, and 11.20 μg/mL by NR35 and NR4. Similarly, twenty nine strains solubilized P, while eight isolates were xxii not able to solubilize P in the culture medium. The maximum P solubilization of 15.56 μg/mL was recorded for strain NR15 followed by 12.52 μg/mL and 10.52 μg/mL for the strains NR35 and NR25, respectively. Five strains (NR15, NR19, NR29, NR30 and NR32) did not nodulate the host upon re-inoculation. Nitrogen fixing capacity of the strains was determined by acetylene reduction assay (ARA). A significant higher ARA (729 n moles/plant/hr) was recorded for NR20 followed by NR22 (697 n moles/plant/hr) and NR25 (680.7 n moles/plant/hr). Out of 37 bacterial strains isolated, 33 strains were sequenced and were submitted at Genbank data base and accession numbers were obtained. Out of 33 sequenced bacterial strains, 28 nodules forming rhizobial strains belong to Bradyrhizobium genera. Fourteen soybean root nodule forming strains were identified as Bradyrhizobium japonicum specie by showing the maximum similarity with Bradyrhizobium japonicum. Six nodules forming strains were identified as Bradyrhizobium elkanii specie. Three nodules forming strains belong to Bradyrhizobium yuamingense specie. Strains NR24 were identified as Bradyrhizobium liaoningense specie and four nodule forming strains were identified as Bradyrhizobium species on the basis of maximum sequence similarity. The five non-nodules forming strains were belong to five different genera. The bacterial strain NR15 was identified as Microbacterium specie, strain NR19 as Agrobacterium rhizogens, strain NR29 as Rhizobium specie, NR30 as Paenibacillus specie and NR32 as Bacillus specie on the basis of maximum sequence similarity. The results of the study demonstrate the potential of indigenous Bradyrhizobium strains for P soluibilization, N2 fixation and phytohormone production those could be used in biofertilizers. Seven indigenous Bradyrhizobium strains, one exotic strain TAL-102, an un-inoculated control and three N fertilizer rates (urea) i.e. 25, 50 and 100 kg N ha-1 were tested on soybean variety William-82 in pots and under field conditions in the mountain region of Rawalakot Azad xxiii Jammu and Kashmir, Pakistan in 2009 and 2010. Results showed that Bradyrhizobium inoculation accelerated plant growth by increasing shoot length (26-47%), root length (45-73%) and shoot dry weight (58-104%). Seed yield in the control was 861 kg ha-1 that significantly increased to 1450–2072 kg ha-1 following inoculation with Bradyrhizobium strains. Seed yields obtained with the indigenous NR20 and NR22 strains was 24 and 28% higher than that obtained with the exotic strains TAL-102. Number of nodules, nodules dry weight (mass) and ARA (N2 fixation) under Bradyrhizobium strains were significantly higher i.e. 55–123%, 94–178%, and 38–103%, respectively than that recorded under the un-inoculated control. However, higher N fertilization rate (N100) depressed nodulation and N2 fixation. Both Bradyrhizobium inoculation and N fertilization significantly increased oil and protein content of seed compared to the uninoculated control. Similar results were obtained under pot experiments. Bradyrhizobium inoculation and N fertilization in general had no significant effect on the saturated fatty acids (palmitic and stearic) whereas unsaturated fatty acids (linoleic acid and oleic acid), significantly increased compared to un-inoculated control. The mineral nutrient content N, P, and K and their accumulation in seed showed a 2-3-fold increase in response to applied strains and N fertilizer. Results demonstrated a significant variation in the symbiotic effectiveness and yield potential characteristic of tested strains showing that inoculation response was site specific. Two indigenous strains NR20 and NR22 were found highly efficient and displayed superiority over the exotic strain TAL-102. Pot and field experiments were conducted to observe the residual effects of Bradyrhizobial inoculation of soybean for two consecutive years on succeeding wheat crop. Wheat was grown on the same pots and field in which soybean was grown for two consecutive years 2009 and 2010. The pots and seed beds used for growing soybean were not disturbed after xxiv harvesting soybean and were manually prepared by spade. The treatments comprised of a control, three N fertilization rates (i.e. 100 kg N ha-1, 50 kg N ha-1, 25 kg N ha-1) and eight Bradyrhizobial inoculation treatments of previous soybean crop. The inoculation strains were not applied to wheat crop. The treatments were assigned to respective pots and plots where soybean was sown accordingly. Wheat variety Shafaq-2006 was used as test crop. Results of the field study revealed that highest plant height, root length, leaf surface area and chlorophyll contents of wheat were recorded in N100 followed by N50. Similarly spike length, 1000 seed weight and biological yield of wheat significantly increased by the application of 100 kg N ha-1 followed by 50 kg N ha-1. Among the inoculation treatments of previous soybean crop, all treatments significantly increased the growth and yield parameters of wheat over control but statistically at par with that recorded in N25 (25 kg N ha-1). The maximum grain yield of 2365 kg ha-1 was recorded in N100 followed by yield of 2102 kg ha-1 under N50 and the difference between these two was also significant. Among different inoculation treatments, the highest yield of 1844 kg ha-1 was recorded in NR22 which was at par with NR20, NR18 and N25. Seed protein and NPK uptake was also significantly affected by N fertilization and inoculation treatments. Response of growth and yield attributes to different treatments in greenhouse experiment was same to that observed under field conditions. The results of the study clearly demonstrate that the residual effect of inoculation to soybean crop was almost equivalent to 25 kg N ha-1 and inclusion of soybean in rotation could save about 25 kg N ha-1 for succeeding wheat crop. Overall results of this study revealed a marked variation in soil properties and microbial indices among soils collected from different sites of Rawalakot. A diversity in soybean nodulating bradyrhizobia were recognized having varied potential in symbiotic effectiveness and PGP activities and these bradyrhizobia can be best utilized in biofertilizers in Pakistan." xml:lang="en_US