Objectives: To compare the effectiveness of Del-Nido cardioplegia as myocardial protective agent with Saint Thomas cardioplegia in adult cardiac surgical patients. Methods: This prospective randomized study was conducted in cardiac surgery department of Bahawal Victoria hospital Bahawalpur, from October 2020 to March 2021. Eighty adult patients who underwent primary Isolated coronary artery bypass grafting (CABG) or isolated Valve surgery requiring cardiopulmonary bypass were randomly divided into Del Nido (DN, n=40) and Saint Thomas (ST, n=40) groups. Data regarding operative and post-operative variables such as cardiopulmonary bypass (CPB) and aortic cross clamp (AXC) times, inotropic requirements, resumption of sinus rhythm, need for electrical defibrillation, post-operative CKMB, blood requirement and ICU stay were noted. Results: CPB and AXC times were statistically insignificantly different. Resumption of Sinus rhythm was seen significantly in more patients of DN group (95%) than in ST group (72.5%) [p-value 0.05]. Less patients of DN group (5%) were candidates of electrical defibrillation than ST group (17.5%) [p-value <0.001). Post- operative CKMB values were significantly lower in DN group as compared to ST group (30.5±22.6 IU vs 50.5±50.28 IU, p value.008). Blood transfusion was significantly lower in DN group; 50% versus 80% in ST group (p-value 0.005). Ventilation time was significantly less in DN group than ST group (165.95±48.09 minutes versus 165.95±48.09 minutes respectively, p-value 0.03). While ICU stay was also less in DN group; 5.2±0.8 days versus 6.05±1.6 days in ST group (p-value 0.003). Conclusion: Del-Nido cardioplegia is a reliable and better myocardial protective agent than Saint Thomas cardioplegia in adult cardiac surgical procedures. doi: https://doi.org/10.12669/pjms.38.3.4730 How to cite this:Rizvi MFA, Yousuf SMA, Younas A, Baig MAR. Prospective randomized study comparing outcome of myocardial protection with Del-Nido Cardioplegia versus Saint Thomas Cardioplegia in adult cardiac surgical patients. Pak J Med Sci. 2022;38(3):---------.  doi: https://doi.org/10.12669/pjms.38.3.4730 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Despite advancing medical technology, Heart Failure (HF) is still a prevalent disease with high mortality and high health expenditure. To improve patient outcome and prognosis, it is important to identify the association of risk factors which leads to the co-morbid depression and anxiety in heart failure patients. Objectives: To determine the association of depression and/or anxiety with age, gender and ejection fraction in heart failure patients. Methods: It is an analytical cross sectional study including 323 CHF patients who visited the to the Faisalabad Institute of Cardiology hospital Out-Patient Department, 250 were males and 73 were females, mean age was 54.1 ± 9.2 years having 70 years as maximum and 25 years as minimum.  Data collection was done using Hospital Anxiety and Depression Scale (HADS) questionnaire to assess depression and anxiety. Data was analyzed using SPSS version 24. For quantitative data, mean and standard deviation was calculated and for qualitative data frequency and percentages was calculated. To measure the association of anxiety and depression with age categories, ejection fraction and gender, chi square test was used. P values less than and equal to 0.05 were taken as significant. Results: No association of depression and anxiety with gender and Left Ventricular Ejection Fraction (LVEF) was observed. However, depression and anxiety were found to be significantly associated with age Conclusions: The study concluded that age is a strong risk factor of depression and anxiety in congestive heart failure patients. Multidisciplinary health care team approach and interventions are required to cater chronic heart failure (CHF) patients to address the psychological burden.

Objective: The aim of current study was to find out the factors causing Acute Kidney Injury (AKI) in the postoperative period of cardiac surgery. This prospective study, Peri-operative Anemia, Urine Output, gender, need for Intra-operative blood transfusion were analyzed for association of AKI. Material and Method: The study was conducted at Cardiac Center, QAMC Bahawalpur from January, 2019 to June, 2021. A total of 180 patients who underwent cardiopulmonary bypass for IHD and Valve surgery were studied. CPB hemoglobin levels, Blood Transfusion in OR, Gender specificity, Peri-operative urine output (Group1 UO <4ml/kg/hr: Group 2 UO > 4ml/kg/hr) were correlated to establish their relationship in causing post-operative Acute Kidney Injury. The patients were divided into two groups one who had Acute Kidney Injury other who don’t. Results: Acute kidney injury developed in 20 out of 180 patients, current study showed insignificant relation between CPB time, X clamp time, Gender, Surgery type, MAP and Postoperative Acute Kidney Injury. Acute Kidney Injury was more associated with diabetes, need of blood transfusion, perioperative hemofiltration and reduced urine output. Conclusion: Current study showed that Acute Kidney injury is an avoidable complication if hemoglobin levels are kept above 8-9 gm/dl to ensure proper oxygen supply and need of Intraoperative hemofiltration and BT is reduced by reducing circuit length thus hemodilution and found a urine output less than 4 ml/kg/hr during cardiopulmonary bypass carries major risk for AKI. Keywords: AKI Acute Kidney injury CPB Cardiopulmonary bypass UO urine output MAP Mean Arterial Pressure

Objective: Cardiopulmonary bypass in cardiac surgery is often associated with metabolic changes. So, we conducted this study in order to find the supremacy between two risk factors base excess and hyperlactatemia in early prediction of morbidity and mortality in ICU after cardiac surgery. Material and Methods: Intraoperative data of total of 100 patients who had cardiac surgery was recorded. Intraoperative and postoperative data of base excess and lactate levels were recorded at 1st, 6th, 12th and 24th hour in ICU. Two perioperative groups for B.E(Group 1 B.E < +/-2.5 mmol: Group 2 B.E >+/- 2.5 mmol) and lactate (Group 1 Lactate < 3 mmol: Group 2 Lactate>mmol ) were created, Two post-operative groups for B.E(Group 1 B.E < +/-5.0 mmol: Group 2 B.E >+/- 5.0 mmol) and lactate( Group 1 Lactate <5mmol: Group 2 Lactate>5mmol )were created to find their correlation with early postoperative complications. Results: In our study ICU morbidity and mortality was more related to the lactate and base excess values in the early 24 hours. Progressive Hyperlactatemia and constant negative base excess values were both significantly associated with ICU complications. In the CPB period subgroup negative base excess was more superior in predicting ICU prognosis than Lactate. (P-value 0.001) similarly patients divided in subgroup BE >+/- 5mmol/l had demonstrated superiority in making such prediction. Both CPB (0.013) and X.C (0.036) time were associated independently with ICU prognosis. .Longer ventilation times were also associated with bad ICU prognosis. Conclusion: Our study found negative base excess values in the early postoperative period to be superior in predicting ICU morbidity and mortality when studied at subgroup level both peri-operatively and postoperatively.