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Aim: To compare the mean time for first rescue analgesia after preemptive gabapentin versus paracetamol for pain control after tonsillectomy in children. Method: This random controlled trial was conducted by Anesthesia team in ENT OT in Jinnah Hospital, Lahore from January 1, 2018 to June 30, 2018. After taking informed consent, 60 patients fulfilling the selection criteria were recruited and after obtaining demographic information, two groups were formed using lottery method Group G and Group P each having 30 patients. Patients were given oral Paracetamol 20 mg/kg and oral Gabapentin 10 mg/kg 120 minutes before induction of anesthesia in Group P and Group G respectively. Post-operatively, patients’ pain was monitored with VAS after every 30 minutes. When VAS exceeded 3, it marked the demand of first post-operative rescue analgesia was given and time was noted. Injection Ketorolac 0.5mg/kg was given as rescue analgesia. Mean time of first rescue analgesia was compared in between 2 groups via SPSS 19 Results: There were no significant differences for variables such as age and BMI in between two groups. The main result of study is that mean time for first rescue analgesia in group G and group P found to be 468.00± 57.14 & 377.00±51.47 minutes respectively. The calculated p-value was P < 0.0001 proving significant difference in duration for first analgesia in between two groups. Conclusion: There is significant difference in mean time for first rescue analgesia after preemptive gabapentin versus paracetamol for pain control after tonsillectomy in children. Keywords: Preemptive Analgesia, Gabapentine, Paracetamol, Post-operative pain control

Background: Post-operative pain is one of the common concerns in all the surgical interventions including gynecological surgeries. There is always a need for the agent with better efficacy and minimal side effect profiles. Aim: To compare the mean postoperative pain score between intravenous Paracetamol vs intravenous ketorolac among patients undergoing gynecological abdominal surgery Study design: Randomized Controlled Trial Setting & duration: Department of Anesthesia, Hameed Latif Hospital, Lahore from 12-06-2018 to 12-12-2018 Methodology: In this study, females with age 20 - 50 years with ASA I and II undergoing gynecological abdominal surgery were included. Group A was administered with intravenous paracetamol and group B with ketorolac. Pain was measured in terms of mean of numerical rating scale recorded at 12 hours postoperatively. Results: In the present study there were total 80 cases included, 40 in each group. The mean age in group B was 37.66±12.67 years and in group A was 41.29±11.36 years Mean post operative pain score was 3.05±0.61vs 3.56±0.89 in group B and A with p= 0.04 Mean post operative pain was 3.04±0.61 vs 3.51±0.77 with p= 0.03 in cases with BMI > 25. There was no significant difference in terms of type of procedure and mean pain score in both groups. Conclusion: Ketorolac is significantly better than Paracetamol in gynecological abdominal surgeries and this difference is also significantly better in cases with BMI > 25. Keywords: Pain, ketorolac, paracetamol, BMI

Aim: To evaluate the rationality of pharmacotherapy of UTI and to identify drug related problems (DRPs) in the treatment of UTI. Methodology:, a prospective study was perfomed in Ayub Teaching Hospital Abbottabad Pakistan for a period of three months (December 2019 to March 2020) on 62 patients suffering from UTI. Data of patient disease and treatment was collected from patient medical chart record file and then pharmacotherapy was evaluated for accessing rationality and identification of DRP using standard book like British national formulary and standard treatment guidelines. Statistical analysis of the data was performed by using SPSS. Results: Result of this study showed that prevalence of UTI was more in female (67.74%) than males (32.25%). Patients belonging to the age group of 20-40 years were more prone to UTI. The most frequent problems were presence of drug interactions, dosage problems cases, overprescribing cases, therapeutic duplication cases and lack of cost effectiveness cases. After analyzing the use of antibiotics it was found that most widely used antibiotics in the treatment of UTI was ceftriaxone, followed by levofloxacin and ciprofloxacin. Culture Sensitivity test for appropriate selection of antibiotics was not perfomed in 80% of cases. Wrong dose of antibiotics was prescribed in 27.4% cases; therapeutic duplication of antibiotics was found in 6% of patient prescription and over usage of antibiotics was observed in 18% of cases. Conclusion: Irrational use of drugs especially antibiotics in the treatment of UTI can adversely affect desired therapeutic outcome, lead to therapy failure and emergence of resistance of antibiotics which is a major concern. Drugs for the treatment of UTI should be used rationally according to the need and standard prescribing protocol to improve patient therapeutic outcome and to decrease the adverse consequences of drug therapy. . Keywords: Urinary tract infection, drug related problems and antibiotic use

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Aim: To compare the frequency of better glottic visualization and ease of tracheal intubation in Macintosh versus McCoy blades. Study design: An observational analytical study. Settings: Department of Anesthesia, Lahore Medical and Dental College/Ghurki trust teaching hospital, Lahore. Study duration: Six months (2nd September 2017 to 1st March 2018) Methods: After approval from research, education and clinical audit department, we selected 60 patients for elective procedures under general anesthesia of age ranges from 20-40 years including both males and females. Patients were randomized by lottery method into two groups I & II. Laryngoscopy was performed with McCoy in group I and with Macintosh in group II and the best possible view of the glottis was obtained. After achieving best possible glottis view of each patient, vocal cord visualization was determined according to Grade-I to IV. Ease of tracheal intubation was also noted. Results: The demographic data was comparable in both groups. In this study, we have found better glottic visualization in 60.0% of patients with Macintosh blade (group II) and with McCoy blade (group I), it was 83.33% (p-value = 0.045). Ease of intubation was 73.33% with Macintosh blade (group II) and with McCoy blade (group I), it was 93.33% (p-value = 0.038). Conclusion: We concluded that frequency of better glottic visualization and ease of tracheal intubation with McCoy blade is higher as compared to Macintosh blade. Keywords: Endotracheal intubation, Glottic visualization, McCoy blades, Macintosh blades.

Objective: To compare intravenous paracetamol vs Voltral (Diclofenac) suppositories for post operative pain in gynaecological procedures. Methods: This was a non randomized controlled trial that was carried out at Department of Anaesthesiology, Sheikh Zayed Hospital, Rahim Yar Khan during 01-07-2019 to 31-12-2019 in which all female cases with age range of 20 to 60 year undergoing any gynaecological surgery requiring general anaesthesia were included. The cases were divided into two equal groups and anesthesia was offered in standard doses. Just before reversal the cases in group Awere given intravenous paracetamol in a dose of 1 gm stat and then at 8-hour interval and those in group B were offered diclofenac suppositories in a dose of 50 mg twice a day, 12 hours apart. The pain was assessed at 4,8,12 and 24 hours and was labelled on visual analogue scale (VAS). Results: In this study there were 62 cases (31 in each group). The mean age in group A and B was 45.41±10.21 vs 48.12±11.13 years with p= 0.47. Mean duration of surgery in both groups was 57.51±15.23 vs53.11±14.79 minutes with p= 0.81. There was no significant difference in mean pain score at 4 and 8 hours with p= 0.91 and 0.81 respectively in group A and B. Mean pain score was 4.43±1.67 vs 3.21±1.09 with p= 0.01 at 12 and 4.57±1.71 vs 3.34±1.27 at 24 hours in group A and B with p values of 0.01 each. Mean time taken for rescue analgesia was 9.13±2.11 in group Aand 13.11±1.23 hours in group B with p= 0.001. Conclusion: Voltral (Diclofenac sodium) suppositories are better than paracetamol infusion in controlling pain after gynecological surgeries and this difference is significantly better at 12 and 24 hours. Key words: Gynaecological surgery, Pain, Paracetamol, Voltral suppository How to cite: Khan Z., Khaleeq S., Rehman Ur A., Maan A., Farooq U. Nadeem A. Comparison Between Paracetamol Vs Voltral Suppositories for Post-Operative Pain in Gynaecological Procedures. Esculapio 2021;17(02):191-194.

A topological index (TI) is an important tool in forecast properties of a chemical compound (CC). With the help of TIs, we can attach a special number to a chemical structure. Drugs and other chemi...

With the help of topological index (TI) we can guess different properties of molecular structures. TI enables us to associate a number with a molecular structure. Numerous compounds can be transfor...

Arteriovenous (AV) fistula and AV graft are considered superior to venous catheter access, remarkable success has been achieved in increasing prevalence of AV fistula. However, vascular access complications are common and result in increased hospitalization, mortality and expense. Guidelines suggest various methods to maintain patency of vascular access. Amongst these various methods used for vascular access monitoring and surveillance, intra-access pressure (PIA) is a simple tool which can be helpful in early detection and management of stenosis in vascular access. Intra-access pressure, although a very simple and quick method of vascular access evaluation, has a low diagnostic accuracy in prediction of vascular access stenosis as compared to other methods of access surveillance. We discuss here the physiology, methodology and the utility of intra-access pressure.

Background: Pain is a common complaint of patients after surgery. Different techniques or medications including local anesthetics infiltration, non-steroidal anti-inflammatory drugs or opioids have been used for postoperative analgesia. Lidocaine is an amide local anesthetic agent that works by influencing the complex phenomenon of pain. Aim: To compare the mean pain score with intraoperative lidocaine versus control in patients undergoing laparoscopic cholecystectomy under general anesthesia. Methods: 350 patients aged 20-60 years of either sex scheduled for laparoscopic cholecystectomy were included in the study. Patients with allergy to lidocaine; patients with neuromuscular disease, endocrine or metabolic disorder and pregnant patients were excluded from study. Patients were randomly divided in two groups by using lottery method after taking informed consent. On arrival to the operating room, monitor was attached to display continuous ECG, mean arterial blood pressure, and arterial oxygen saturation. Results: In lidocaine group, the mean age of patients was 39.93±11.56years. In control group, the mean age of patients was 37.93±11.83years. In lidocaine group, there were 91 (52%) males and 84 (48%) females. In control group, there were 77 (44%) males and 98 (56%) females. In lidocaine group, the mean BMI of patients was 26.66±4.81kg/m2. In control group, the mean BMI of patients was 26.77±4.76kg/m2. In lidocaine group, the mean pain score of patients was 1.00±0.84. In control group, the mean pain score of patients was 2.39±1.10. The difference was significant (p

A topological index (TI) is a number that is helpful in predicting the properties of chemical compounds. We can estimate the physical and chemical properties of several chemical compounds. In this study, we compute Zagreb polynomials and the redefined Zagreb indices for chemical compounds used in the treatment of COVID-19 namely remdesivir, chloroquine, hydroxychloroquine and theaflavin. Copyright(c) The Author

A topological index plays an important rule in predicting physicochemical properties of a molecular structure. There are more than 150 topological indices present in literature but not a single index predict perfect result. In this paper, we will introduce some new topological invariants namely Maxmin indices and Maxmin polynomials and calculate results for Chloroquine and Hydroxychloroquine. These structures are helpful in the treatment of COVID-19 patients.

A topological index is an important tool in predicting physicochemical properties of a chemical compound. Topological indices help us to assign a single number to a chemical compound. Drugs and other chemical compounds are frequently demonstrated as different polygonal shapes, trees, graphs, etc. In this paper, we will compute irregularity indices for the benzene ring embedded in a P-type surfaceBRpand the simple bounded dual of the benzene ring embedded in a P-type surfaceSBRp.

Background University academic setting consists of specific life stressors such as burnout that influence a student's psychological well-being. Previous literature has shown the role of social support and learning motivation, but little research is known about how these variables, of social support and learning motivation, can mediate the relationship. Methods We recruited 486 participants from three Chinese universities with an age range of 18-35 years. Measures in the study include Maslach Burnout inventory (MBI) for college students, Multidimensional Scale of Perceived Social Support (MSPSS), motivation strategy learning scale, and psychological well-being by Ryff. Ethical approval was gained from the respondents. Results Findings suggest that social support plays a significant role in the link between burnout and subjective well-being. Indeed, the chain mediation model of social support and learning motivation significantly indicated the link between burnout and psychological well-being. These findings show that an increase in social support at an educational institute reduces the effects of burnout and enhances psychological well-being. Conclusion The study indicates a sound interpretation of psychological well-being and reducing the level of burnout. Subsequent research has found that social support and learning motivation could be an essential variable in calculating the educational success and learning motivation of the students.

As a powerful displaying, investigation and computational device, graph theory is widely used in biological mathematics to deal with various biology problems. In the field of microbiology, graphs can communicate the sub-atomic structure. Where cell, quality or protein can be indicated as a vertex, and the associate component can be viewed as an edge. Thusly, the biological activity characteristic can be measured via topological index computing in the comparing graphs. In this article, we for the most part concentrate some topological lists for the Corona virus graph. At first,we give a general type of M-polynomial. From the M-polynomial, we recoup some well-known degree-based topological lists, for example, First and Second Zagreb Indices, Second Modified Zagreb Index, Randic´ Index, General Randic´ Index, Symmetric Division Index, Harmonic Index, Inverse Sum Index, Augmented Zagreb Index. Our results are extensions of many existing results.

A topological index is a quantity expressed as a number that help us to catch symmetry of chemical compounds. With the help of quantitative structure property relationship (QSPR), we can guess physical and chemical properties of several chemical compounds. Here, we will compute Shingali & Kanabour, Gourava and hype Gourava indices for the chemical compound Nicotine.

Mindfulness has been considered as a positive psychological trait that contributes to psychological well-being. This study investigated the mediating role of social connectedness and self-esteem in the link between mindfulness and psychological well-being. In this study, a sample of eight hundred and fifty-one students from three Chinese universities were selected to participate in the study. Participants filled in the questionnaires for mindfulness, social connectedness, self-esteem, and psychological well-being. Findings of the path analysis indicated social connectedness and self-esteem performed as a mediating role in the link between mindfulness and psychological well-being. In addition, the bootstrapping procedure demonstrated that the indirect effects of mindfulness on psychological well-being through social connectedness and self-esteem were significant. The study provides valuable implications to apply psychological interventions to improve students’ psychological well-being.

Background: Shivering is one of the very common side effects of spinal anesthesia. It can be extremely discomforting for parturient undergoing caesarean section. Aim: To compare intrathecal dexmedetomidine and bupivacaine with bupivacaine alone to see whether intrathecal dexmedetomidine can be helpful in preventing shivering in cases undergoing C-section Methodology: This was a prospective randomized controlled trial carried out at Department of Anaesthesiology, Sheikh Zayed Hospital, Rahim Yar Khan. In this study all pregnant females undergoing C section between the age of 18 to 40 years irrespective of their gravida and parity were included. The cases were divided into two equal groups B and D. Group B were offered injection Bupivacaine only and those in group D were offered Bupivacaine along with Dexmedetomidine. Final outcome was seen at 4 hours for shivering after giving spinal anesthesia. Results: In this study there were 120 cases, 60 in each group. The mean age in group B and D was 31.12±4.57 vs 30.67±5.03 years with p value 0.81 and mean BMI was23.19±4.11 vs 23.81±4.23 kg/m2 with P value 0.95 respectively. There were 80% cases in group B and 66.67% in group D belonging to rural population with p value 0.88. Shivering was observed in 24 (40%) cases in group B and 6(10%) in group D with p value 0.01. Conclusion: Combination of intrathecal Bupivacaine and Dexmedetomedine is significantly better than intra thecal Bupivacaine alone in prevention of shivering in patients undergoing C section. Keywords: Bupivacaine, Dexmedetomidine, Shivering, Intrathecal

Topological Index (TI) is a numerical value associated with the molecular graph of the compound. Smoothness property states that a TI is good if its Structure Sensitivity (SS) is as large as possible and its Abruptness (Abr) is small. In 2013, Gutman proved that Atomic Bond Connectivity (ABC) index has small SS and high Abr. In this paper, we defined reverse Atomic Bond Connectivity (ABC) index to overcome this problem. Moreover, we computed reverse ABC index for Silicon Carbides, Bismith Tri-Iodide and Dendrimers.

Topological indices are numerical values that correlate the chemical structures with physical properties. In this article, we will discuss some new reverse degree based topological indices ...

In the fields of chemical graph theory (CGT), mathematical chemistry and molecular topology, a~topological index (TI) also known as a connectivity~index~is a type of a molecular descriptor that is calculated based on the molecular graph of a chemical compound. \(BiI_3\) is an excellent inorganic compound and is very useful in qualitative inorganic analysis and topological indices of \(BiI_3\) help to predict many properties like boiling point, heat of formation, strain energy, rigidity and fracture toughness and correlate the structure with various physical properties, chemical reactivity and biological activities. This paper computes several degree-based topological indices like multiplicative first Zagreb index, multiplicative second Zagreb index, multiplicative atomic bond connectivity index, multiplicative first and second hyper Zagreb index and multiplicative geometric arithmetic index for Bismuth Tri-Iodide chains and sheets.

Based on research in the MSME sector in Indonesia experienced the impact of the COVID-19 Pandemic. The successive impacts are declining sales, capital difficulties, product distribution barriers, and raw material difficulties. The government has issued :p of social assistance to poor and vulnerable MSMEs, (b) tax incentives for MSMEs; relaxation and restructuring of credit for MSMEs; expansion of working capital financing of MSMEs; placing ministries, state-owned enterprises and local governments as buffers for MSME products; and e-learning Training. To support government policy, several short-term strategies and long-term strategies need to be considered by the government and encourage government collaboration with corporations in empowering MSMEs.

The stunting problem in South Sulawesi Province is very serious and needs more attention. On the other hand, this area has many moringa plants that have not been used optimally. The aims of this review to determine the effect of moringa leaf intervention on stunting factors in the 1000 HPK. The review was carried out from 17 result reviews of intervention research conducted in Indonesia and neighbourhood countries. The results of the research are searched online through Google Scholars, Scopus and the Open Knowledge Maps application (PubMed). The intervention of moringa leaf in the form of extract or flour can improve nutritional status, haemoglobin levels, prevent oxidation stress in pregnant women, prevent low birth weight, increase breastmilk (ASI) production and quality, and improve the nutritional status of children under five. Moringa leaf can be used to prevent stunting factors in the 1000 HPK. The effectiveness of moringa intervention will be maximized when added with honey or mixed in children's food.

Aim: To determine changes in intraocular pressures (IOP) associated with drugs used for general anesthesia (GA) induction in eye surgery. Study design: Observational prospective study Place and duration of study: Department of Ophthalmology, CMH Rawalpindi from 1st March 2015 to 31st May 2016. Methodology: Eighty subjects that were advised to undergone various ophthalmic surgical procedures under GA were included in the study. Visual acuity, intraocular pressure (IOP), extra ocular motility, anterior and dilated posterior segment examination were carried out to determine the ophthalmic status. Mixed anesthetics were used in all patients. IOP was recorded at T1 (10 min before induction of anesthesia), T2 (10 min after intubation), and T3 (at the conclusion of surgery before extudation) using Perkins tonometers. Changes in IOP before induction of GA, after intubation, and just before extubation were recorded. Results: Mean pre-anesthesia IOP for patients of age was 42.3 years with a range of 9-70 years and mean IOP was 16.4 with a range of 10-23 mmHg. There was a significant decrease in the mean IOP at T2 (Perkins: 4-6 mmHg) and T3 (Perkins: 5-8mmHg) as compared to the IOP at T1 (10-18mmHg. The decreases in IOPs at T2 and T3 were similar in both anesthetic groups (T2: P=4-6mmHg; T3: P = 5-8 mmHg). Conclusion: Significant decrease in IOP after GA was observed with mixed anesthetic agents. For management decisions this aspect of general anaesthesia drugs on IOP as noted with currently used anesthetic agents has to be accounted for and decisions are taken accordingly. Keywords: General anesthesia, inhalation anesthetics, intraocular pressure, Perkins tonometers

The initiation of hemodialysis in patients with chronic kidney disease (CKD) requires vascular access formation. The choice of vascular access for individual patient depends on various factors however arteriovenous fistula (AVF) is conventionally considered to be the vascular access of choice. Once hemodialysis is initiated through a mature AVF, there is an ongoing need for surveillance of the AVF to ensure adequate function and prevent vascular access issues among which flow obstruction (both inflow and outflow) remains the most important. AVF stenosis can potentially lead to inadequate dialysis delivery and thrombosis thus leading to access loss. Physical examination and AVF Doppler ultrasonography (DUS) are useful for evaluation of stenosis in the arteriovenous connection and the outflow tract. Periodic assessment of the AVF with Static Intra access Pressure (SIAPR) determination may be a reliable means of predicting vascular access stenosis. Material & Methods A cross sectional study carried out at Department of Nephrology, Fatima Memorial Hospital, Lahore from July 2018 to December 2018. In total 113 patients were included, and all patients underwent SIAPR assessment and Doppler Ultrasound of AVF. Results Mean age of the patients was 56.81±9.38 years, male to female ratio of the patients was 1.8:1. In this study the SIAPR was suggestive of stenosis in 87(76.99%) patients. The sensitivity, specificity and diagnostic accuracy of SIAPR against Doppler US of the AVF for detection of stenosis was 75.86%, 22.62% & 36.28% respectively Conclusion SIAPR has low specificity and diagnostic accuracy compared to Doppler US for detection of AVF stenosis.

Dendrimers are highly branched, star-shaped macromolecules with nanometer-scale dimensions. Dendrimers are defined by three components: a central core, an interior dendritic structure (the branches), and an exterior surface with functional surface groups. Topological indices are numerical numbers that help us to understand the topology of different dendrimers and can be used to predict the properties without performing experiments in the wet lab. In the present paper, we computed the Sombor index and the reduced version of the Sombor index for the molecular graphs of phosphorus-containing dendrimers, porphyrin-cored dendrimers, PDI-cored dendrimers, triazine-based dendrimers, and aliphatic polyamide dendrimers. We also plotted our results by using Maple 2015 which help us to see the dependence of the Sombor index and reduced Sombor index on the involved parameters. Our results may help to develop better understanding about phosphorus-containing dendrimers, porphyrin-cored dendrimers, PDI-cored dendrimers, triazine-based dendrimers, and aliphatic polyamide dendrimers. Our results are also useful in the pharmaceutical industry and drug delivery.