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١۔اجازت

اجازت

شاہد اشرف

"یہ راستہ آگے چل کر چشمے کی طرف نکلتا ہے " راہگیر یہ کہ کر آگے بڑھ گیا. میں شش و پنج میں مبتلا اسے جاتے ہوئے دیکھتا رہا پھر آہستہ آہستہ رستے پر گامزن ہو گیا. اس نے کہا تھا کہ. تھوڑے فاصلے پر چشمہ ہے اور چشمے کا نام و نشان دکھائی نہیں دیتا تھا. میں تھکن, پژ مردگی اور مایوسی سے پہلے ہر حال میں چشمے تک پہنچنا چاہتا تھا. پختہ سڑک کے بعد یہ راستہ زائرین کو پیدل طے کرنا پڑتا تھا. آخر کار چشمہ آ گیا . میں نے پانی پیا اور وہیں زمین پر بیٹھ گیا. اُس نے مجھے یہاں تک آنے کے لیے کہا تھا, اس کے بعد مزار تک پہنچنے کا فاصلہ مجھے اس کے ساتھ طے کرنا تھا. وہ میرے بعد چشمے پر پہنچا اور آتے ہی بولا " آؤ چلیں " ہم چل پڑے اور راستے میں باتیں کرتے رہے. ایک طویل فاصلہ طے کرنے کے بعد اس نے دور سے مزار کی طرف اشارہ کیا اور پھر نا معلوم منزل کی جانب گامزن ہو گیا۔ میں مزار کی طرف بڑھنے لگا ۔ جلد ہی مجھے احساس ہو گیا۔ میں جتنا مزار کے قریب جاتا ہوں ۔ مزار اتنا ہی مجھ سے دور ہو جاتا ہے ۔ میں نے تیز بھاگنے کی کوشش کی اور میرا سانس پھول گیا. میرے پاؤں بوجھل ہونے لگے اور میں حسرت و یاس کے عالم میں مزار کی طرف دیکھتا رہا. مجھے معلوم ہو گیا کہ مجھے باریابی کی اجازت نہیں ہے. میں اپنے بعد آنے والوں کو مزار کی سمت جاتے دیکھتا ہوں۔ سب مجھے حیرت سے دیکھ کر گزر جاتے ہیں۔ میں خستہ حال اور تہی دست ایک عمر سے وہاں پر رکا ہوا ہوں.

Shibli, English, and the Step-Mother

The relationship between English (in what this term comes to mean as a language, as a discipline of studies, and as a synecdoche of Western culture) and our culture as Muslim Pakistanis has developed over a period of time since the British colonization. The history of this cultural interaction may be divided into three broad phases: the initial, the middle, and the present. The strategy adopted in this paper is based upon the argument that this relationship may be traced through some of the most representative figures of our culture, such as, Shibli, Iqbal, Faiz etc. In each phase of this interaction. The present essay on Shibli deals with the first phase of our cultural interaction with English. It adopts what may be termed as an analogical approach to the issue as it intends to engage with what I think to be rather unwarranted psychoanalytic forays of some of our critics into the psycho-dynamics of such culturally representative figures like Shibli in their relationship with English. The paper exploits the analogy first used by Sheikh Muhammad Ikram, and later employed by Nasir Abbas Nayyar that Shibli’s attitude towards English was the same as his attitude towards his step-mother at home. English, in other words, was a step-mother for Shibli, and for the generations represented through his figure in this early phase of our cultural interaction with the language. Shibli’s terms of engagement with his step-mother, and analogically with English, is the subject of this essay.

A Randomized Control Trial Comparing Train of Four Ratio ≥0. 9 to Clinical Assessment of Return of Neuromuscular Function Before Endotracheal Extubation on Critical Respiratory Events in Adult Patients Undergoing Elective Surgery at the Aga Khan University Hospital, Nairobi

Background: There is increasing evidence that the incidence of postoperative residual paresis after using neuromuscular blockers ranges from 24 to 50% in post anaesthesia care unit and is associated with postoperative complications such as critical respiratory events as evidenced by hypoxia, hypoventilation and upper airway obstruction. Quantitative neuromuscular monitoring (such as the assessment of Train of four (TOF) ratio) and reversal of neuromuscular blockers has been shown to reduce postoperative residual paresis. There are very few outcome studies on effect of residual paresis in Post anaesthesia care unit (PACU). There are no published randomised control trials investigating whether using a TOF ratio ≥0.9 before endotracheal extubation compared to clinical assessment of return of neuromuscular function reduces the incidence of critical respiratory events in PACU. Primary Objective: To determine whether using TOF ratio ≥0.9 compared to clinical assessment of return of neuromuscular function before endotracheal extubation reduces the incidence of critical respiratory events in PACU Secondary objectives: To determine incidence and severity of hypoxia in PACU. To determine incidence of upper airway obstruction in PACU Study Design: Randomised, prospective, double blinded control trial Setting: Operating theatres of the Aga Khan University hospital Nairobi Population: Adults, aged 18-65 years ASA physical status I and II undergoing elective surgery under general anaesthesia. Sample size: 168 patients randomised to TOF ratio group and clinical assessment group, 84 per group. Methods: Patients requiring general anaesthesia for elective surgery with cisatracurium as the muscle relaxant were randomised into 2 groups using computer generated numbers. Group 1 were patients who required a TOF ratio of ≥0.9 before extubation. Group 2 patients were extubated based on clinical assessment of return of adequate neuromuscular function by the anaesthetist as is the standard of practice at the Aga Khan University hospital Nairobi. General anaesthesia was standardised in both groups. Both the investigators and patients were blinded during the study. Once the patient was transferred to PACU, oxygen saturation (SP02), respiratory rate and any signs of upper airway obstruction as demonstrated by stridor, laryngospasms or requirement of any airway manipulation was recorded for the first 30 minutes. Duration of anaesthesia and surgery was also recorded. Patient demographics were recorded and analysed. vii Results: There was no statistical difference between the 2 groups in terms of patient demographics, duration of surgery and anaesthesia and duration since last muscle relaxant was given. In terms of hypoxia on arrival in PACU, the incidence of
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