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Despite a mushrooming of a large number of universities in Pakistan during the past two decades, the country still stands at 45th position among the countries of the world regarding the meaningful research. In comparison, India stands on the comfortable 7th position. Over ninety medical journals are being published in Pakistan, but none of them has been able to attain ‘W’ category in the HJRS software being run by Higher Education Commission (HEC). It looks that millions of rupees spent in the name of research in the country are going down the drain. A large-scale effort is needed at the national level to start public-private partnership to promote meaningful and useful research, which helps the country to speed up its growth in every field and to shine at the international level. For its part, Anaesthesia, Pain & Intensive Care has been trying, since its inception, to promote genuine research in the country. A prominent research scholar, Logan Danielson published a series of five papers on research in the journal. We have been instrumental in publishing nice research papers from across the world, especially from the Far East and Central Asian countries. But the ratio of Pakistani papers remains few and far between. This invited editorial is another endeavor to draw the attention of our academic elite to focus on the promotion of the research culture in the country on the war footing. It sheds some light on the barriers as well as the possible remedial measures. Our graduate and postgraduate institutions, universities, and HEC need to pay attention towards this very important aspect. [ABSTRACT FROM AUTHOR]

Objective: To determine cephalometric factors influencing soft tissue profile beauty in Pakistanis and assess if the soft tissue values of Ricketts, Holdaway, and Merrifield analyses for Caucasians differ from those of attractive Pakistani profiles. Design: Cross-sectional study Materials and Methods: The study population included 45 subjects with normal occlusion and symmetric faces. Their lateral cephalograms were converted to black and white silhouettes, which were then ranked based on their attractiveness by a group of 30 laypeople. On the 12 profiles judged as aesthetically pleasing, Ricketts, Holdaway, and Merrifield analyses were performed. The Caucasian orthodontic norms were compared with the attractive group using a 1-sample t-test, taking a p-value of < 0.05 as significant. Results: The attractive group had significantly greater H angle (P = 0.001), skeletal profile convexity (P = 0.002), and superior sulcus depth (P = 0.041), while nose prominence (P = 0.000), Z angle (P = 0.000), and total chin thickness (P = 0.002) were less than the Caucasian norms. Conclusions: This study showed a preference for Ricketts' lip projection values in Pakistanis. Additionally, the study population showed significant differences from the orthodontic norms proposed in Holdaway's and Merrifield's analyses. [ABSTRACT FROM AUTHOR]

Objective The goals of this study were to evaluate the mean blood prolactin levels between healthy and psoriatic patients and to ascertain the prevalence of psoriasis in patients presenting to a teaching hospital in Punjab. Methods This study involved 153 patients of both genders aged between 18-70 years who presented at outpatient department of Dermatology, Mayo Hospital Lahore. 153 patients of both genders aged between 18-70 years were evaluated for psoriasis which was diagnosed clinically by the presence of red inflamed, sharply demarcated, indurated plaques, with silvery white scales over extensor surfaces and scalp for =6 months. 5ml of venous blood was sampled through venipuncture and was sent for serum prolactin level estimation. Mean serum prolactin level was compared between patients with and without psoriasis. A written informed consent was taken from each patient. Results The patients were 40.11±4.9 years old on average. The majority of the patients (n=103, 67.3%) were in the 18-44 age range. Male to female ratio was 2:1, with 102 (66.7%) men and 51 (33.3%) women among the patients. These individuals serum prolactin levels ranged from 5.6ng/ml to 15.9ng/ml, with an average of 8.9±2.3ng/ml. Six individuals (3.9%) had psoriasis, which was identified. The prevalence of psoriasis did not differ statistically significantly by gender (pvalue= 1.000) or by age (p-value=0.972). Patients with psoriasis had considerably higher mean serum prolactin levels than those without psoriasis (14.80±1.05 vs. 8.68±1.97 ng/ml; p-value 0.001). Patients with and without psoriasis were divided into several subgroups based on patient's age, with similar substantial differences in mean serum prolactin level being identified. Conclusion In the present study, 3.9% of patients presenting in dermatology outpatient department had psoriasis and these patients had significantly higher mean serum prolactin level compared to those without psoriasis which might be a potential therapeutic target and necessitates further studies in this regard to establish cause-effect relationship. [ABSTRACT FROM AUTHOR]

Pain has been associated with the mankind right from the very beginning, and the struggle to conquer pain is also as old as the human history. The pain, the human understanding of pain and the pain management, also have evolved in different phases with the passage of time. Perhaps, more awareness and perception of pain is one of the factors leading to an ever-increasing burden of pain patients on the healthcare perception. Pain medicine is now recognized as a sole specialty, with multiple sun-specializations. This editorial highlight different aspects of pain management and training in this rapidly evolving specialty. [ABSTRACT FROM AUTHOR]

Objective The objective of the study was to compare the frequency of outcome of fractional carbon dioxide (CO2) laser plus topical hyaluronic acid serum versus fractional CO2 laser alone in the treatment of post-acne scars. Methods 300 patients of both genders 18 to 40 years who presented with post-acne scars were enrolled. One side of patient's face was randomly allocated to treatment Group-A which received combination therapy of topical hyaluronic acid and fractional CO2 laser while the other side of face was allocated to treatment Group-B which was treated with fractional CO2 laser alone. Percent reduction in Goodman and Baron quantitative grading score from baseline was determined after 3 months of treatment and was graded as excellent, significant, moderate and slight improvement and was compared between the groups. Results In this study, the mean age of the patients was 23.2±4.7 years. There were 90 (30.0%) male and 210 (70.0%) female patients with a male to female ratio of 1:2.3. Both the groups were comparable in terms of mean Goodman and Baron quantitative grading score at baseline (54.68±14.30 vs. 53.66±14.83; p-value=0.391). The mean score at follow-up was significantly lower in patients receiving combination therapy as compared to fractional CO2 laser alone (22.66±12.46 vs. 24.85±13.85; p-value=0.042). The frequency of excellent (17.0% vs. 14.3%) and significant (53.3% vs. 44.0%) improvement was significant higher in patients receiving combination therapy consisting of fractional CO2 laser plus topical hyaluronic acid as compared to fractional CO2 laser alone. Conclusion Combining topical hyaluronic acid with fractional CO2 laser resulted in significantly better outcome as compared to conventional practice of fractional CO2 laser alone in patients with post-acne scars which advocates preferred use of this novel combination therapy in the management of such patients in future practice. [ABSTRACT FROM AUTHOR]

Lumbar spine surgery can be performed using different anaesthetic techniques such as general endotracheal anaesthesia (GA) or spinal-based regional anaesthesia (RA). Few of the studies have been done to compare the outcomes of spinal anaesthesia versus general anaesthesia for lumbar laminectomies as both having some advantages as well as disadvantages but still it is controversial. The objective of current study is to make a comprehensive review of literature for comparing the outcomes of lumbar laminectomy performed under general anaesthesia versus spinal anaesthesia. Method: Literature search was performed by using PubMed, Google scholar and bibliography of related articles. To compare groups of general anaesthesia versus spinal anaesthesia, the variables focused were mean heart rate (HR), mean arterial pressure (MAP), blood loss during surgery, duration of surgery, post-operative anaesthesia care unit (PACU) time, postoperative narcotic use/pain scale, post-operative urinary retention, and post-operative nausea/vomiting. Results: Data of eleven studies were presented in current article, of these five were randomized controlled trials, three case-controls and four were retrospective cohort studies. 5/8 studies reported that SA group having more hemodynamic stability with postoperative outcomes as compared to GA. Likewise, majority of reviewed studies (7/8) reported better pain control or decreased requirement of analgesics in SA group. Additionally, more than half of the reviewed studies (5/8) reported lower incidence of postoperative nausea and vomiting among patients of SA group. Conclusion: The current study concluded that SA has better outcomes than GA in terms of hemodynamic stability and decrease postoperative adverse effects. So special attention should be paid for SA as an alternative to GA for lumbar laminectomy. [ABSTRACT FROM AUTHOR]

Background: Regional anaesthesia is choice of anaesthesia for orthopaedic surgery due to lower side effects such as nausea, vomiting, postoperative pain and early mobilization. Despite of this, some orthopaedic patients refuse this modality. This study was conducted to interrogate the surgeons about their choice of anaesthesia in order to gain some insights into the concerns of surgeons and to change their minds and choose a safer mode of anaesthesia. The aim of the study was to assess the surgeons' fears and their perception about regional anaesthesia. Methods: After institutional approval, thirty surgeons from three different tertiary care hospitals were interviewed. They were asked questions as per the questionnaire to choose choice of anaesthesia for their patients. Results: After regional anaesthesia, 27.6% of respondents were concerned about paralysis and neurological disorders, 34.5% about seeing and hearing whatever is happening in theatre, 17.2% about perioperative pain, 24.1% about backache and 24.1% about delayed discharge. The most important reason to change their mind was the reassurance that the complications are not as frequently as they thought their patient would receive after a block. Conclusion: Due to the lack of information on regional anaesthesia and the risks of general anaesthesia, orthopaedic surgeons' fears and conceptions about regional anaesthesia are distorted. Anaesthesiologists should be aware of the concerns of the surgeons as well as the patients and should be willing to discuss the concerns with them and suggest the safest way to receive anaesthesia with evidence-based data. [ABSTRACT FROM AUTHOR]

Byline: Anne Beaudry, Kevin Laframboise, Huma Saleem This paper reports on a study that aimed at comparing the effectiveness of a web-based learning environment to the traditional classroom for introductory management information systems (MIS) class. Effectiveness here is defined as students' performance in examinations. More specifically, our study compared the performance of students enrolled in an introductory MIS course delivered either in traditional classrooms or through a web-based learning environment, while taking into consideration the students' learning style as measured by Kolb's (1984) instrument. Results suggest that the best and worst performers in both environments have very different learning preferences and styles. Implications for research and practice are discussed.

Background: Endotracheal intubation is one of the basic prerequisites of general anaesthesia. Recovery of patients is delayed due to the development of post-operative nausea, vomiting, sore throat and shivering. This study was conducted to determine role of dexamethasone for improved recovery of patients. Methods: This randomized controlled trial was performed in the Department of Anaesthesia, Ayub Teaching Hospital, Abbottabad from June to November 2018. One hundred and twenty-two consenting patients of both genders, aged between 18–60 years, American Society of Anaesthesiologists (ASA) I and II, scheduled for general surgeries of 60–180 minutes duration under general anaesthesia were included. Patients with long duration surgeries, anticipated difficult airways, nasogastric tube in situ, upper respiratory tract infections, on steroid therapy and critically ill and emergency surgeries were excluded. They were randomly allocated into two groups by lottery method as dexamethasone (group A, n=61) or Placebo (group B, n=61). Postoperative nausea, vomiting, sore throat was observed at 2, 12 and 24 hours, shivering was observed at 2 hours only and patient satisfaction at 24 hours post-operatively. Results: Group A patients had statistically proven better outcomes at 2, 12 and 24 hours for post-operative sore throat, nausea and vomiting, shivering was controlled in 24.5% p-value (0.006). Patient satisfaction was found in 83.6% of group A patients. Conclusion: Thus, dexamethasone is effective drug for prevention of postoperative nausea, vomiting, sore throat and shivering in general surgical procedures thus improving patient satisfaction and their early discharge. [ABSTRACT FROM AUTHOR]

Background: Co-amoxiclav is used as a routine prophylactic antibiotic in surgical procedures. We present a case of 61 years old lady came to outpatient clinic with a diagnosis of right sided lower alveolar tumour. A plan was made to proceed with a Right Marginal Mandibulectomy. She received Co amoxiclav as prophylactic antibiotic and was clinically uneventful. On further questioning there were many different occasions on which the patient had oral co amoxiclav with no complications or side effects. No known drug allergies or otherwise were documented. As a part of surgical antibiotic prophylaxis, Co amoxiclav 1.2 gm was given to patient at the time of induction. After the antibiotic administration patient started having bronchospasm with increased airway pressures and severe hypotension indicating anaphylactic reaction. The patient was resuscitated, recovered from the anaphylactic shock successfully and provided extended recovery in post anaesthesia care unit followed by High Dependency Unit for overnight monitoring. Every centre or ward that administers injectable antibiotics have to have a standard protocol for the management of allergy reactions. A timely fashion is mandatory to make the best use of the drugs available and emergency gadget ought to be in vicinity in case this type of state of affairs rise up. [ABSTRACT FROM AUTHOR]

Background and Purpose Inositol 1,4,5-trisphosphate receptors ( IP3Rs) are intracellular Ca2+ channels. Interactions of the commonly used antagonists of IP3Rs with IP3R subtypes are poorly understood. Experimental Approach IP3-evoked Ca2+ release from permeabilized DT40 cells stably expressing single subtypes of mammalian I P3R was measured using a luminal Ca2+ indicator. The effects of commonly used antagonists on IP3-evoked Ca2+ release and 3 H-IP3 binding were characterized. Key Results Functional analyses showed that heparin was a competitive antagonist of all IP3R subtypes with different affinities for each ( IP3R3 > IP3R1 ≥ IP3R2). This sequence did not match the affinities for heparin binding to the isolated N-terminal from each IP3R subtype. 2-aminoethoxydiphenyl borate (2- APB) and high concentrations of caffeine selectively inhibited IP3R1 without affecting IP3 binding. Neither Xestospongin C nor Xestospongin D effectively inhibited IP3-evoked Ca2+ release via any IP3R subtype. Conclusions and Implications Heparin competes with IP3, but its access to the IP3-binding core is substantially hindered by additional IP3R residues. These interactions may contribute to its modest selectivity for IP3R3. Practicable concentrations of caffeine and 2- APB inhibit only IP3R1. Xestospongins do not appear to be effective antagonists of IP3Rs. [ABSTRACT FROM AUTHOR]