Objective: To assess the frequency of mental health problems among healthcare workers related to COVID-19 pandemic among health care workers in a tertiary cardiac care center.Study Design: Descriptive cross sectional study.Place and Duration of Study: This study was conducted at Armed Forces Institute of Cardiology/ National Institute of Heart Diseases (AFIC/NIHD) Rawalpindi (Pakistan) from Apr 2020 to Jun 2020. Methodology: This study was a hospital-based cross-sectional study consisted of 100 healthcare workers including 50 nurses and 50 doctors who volunteered to enroll in our study were included. Approval from the clinical research ethics committee of cardiac care hospital was received before the initiation of this study. Verbal informed consent was provided by all study participants prior to their enrollment. Exclusion criteria comprised of the healthcare workers who refused to participate in it. This study followed the COVID-19 Pandemic Mental Health Questionnaire (CoPaQ) 14. Descriptive statistics were used to describe the percentages and frequencies. Descriptive statistics were used to describe the percentages and frequencies were calculated and analyzed using the Statistical Package for the Social Sciences (SPSS), version 23.0. Results: A total of 100 healthcare workers completed the survey. Mean age of the healthcare workers was 36.5 ± 27.0 years (median=36.00), and 75 (75%) were women and men comprised 25 (25%). Of all participants, 50 (50.0%) were nurses, and 50 (50%) were doctors. A considerable proportion of participants reported symptoms of COVID19, 6 (6.0%), tested positive 14 (14%), currently quarantine 24 (24.0%). While 12 healthcare workers experienced 14 day quarantine time period. 16 healthcare workers reported COVID test positive of their closed one. The fear of infecting others with COVID-19 was found to be 30 (30%). The mental stress that that COVID-19 will personally affect us was found in 28 (28%) of healthcare workers. The fear that consequences of the COVID-19 will be severe health disasters was found in 40 (40%) of the individuals. Conclusion: In this study of physicians and nurses in hospitals with wards for patients with COVID-19, health care workers responding to the spread of COVID-19 reported high rates of symptoms of anxiety, fear, and distress.

Objective: To study the incidence of postoperative atrial fibrillation (POAF) and its predictors after coronary artery bypass grafting (CABG) in an Asian cohort. Study Design: Cross sectional study. Place and Duration of Study: The study was conducted at the department of Cardiothoracic Surgery, Almana Hospital, Al Khobar, Saudi Arabia, which is a tertiary care hospital. The study duration was form Oct 2019 to Dec 2021. Methodology: All the male and female consecutive patients with coronary artery disease undergoing coronary artery bypass grafting (CABG) were included in the study. All the surgeries were performed through median sternotomy using cardiopulmonary bypass. Patients with emergency CABG, off pump CABG and those undergoing multiple procedures were excluded from the study. A total of 220 consecutive patients were included in the study. Patients were followed in the perioperative period. Various variables were recorded on a preformed proforma. Patients were divided into two groups, those who had atrial fibrillation (AF) and those who did not have AF. Data was analyzed using SPPS version 23 (SPSS, Inc., Chicago,IL). Results: The mean age of the patients was 51.50±11 years in the AF group and 49.38±9 years in the no AF group. The incidence of atrial fibrillation postoperatively in our cohort was (n=52, 25%). There was no statistically significant difference between the groups with respect to hypertension and diabetes (p=0.408 and p=0.054) respectively). Conclusion: In spite of a younger population, the incidence of AF in our cohort undergoing CABG is comparable to the international literature. Lack of preoperative β-blockers, statins and low ejection fraction are predictors of new onset POAF.

Objective: To identify the incidence of cardiac surgery associated acute kidney injury and its association with different risk factors. Study Design: Descriptive cross sectional study. Place and Duration of Study: Adult cardiac surgery department, AFIC/NIHD, from Jan to Jun 2019. Methodology: Three hundred forty patients undergoing cardiac surgery were evaluated for Cardiac Surgery associated acute kidney injury according to acute kidney injury network criteria over a period of 6 months. The chi-square test was used find the relationship of different factor for cardiac surgery associated acute kidney injury. Results: Total of 430 patients were included. 345 (80.2%) were male and mean age of 55 ± 11.6 years and mean pre operative creatinine clearance was 80.7 ml/hr. Coronary artery bypass grafting was the most common procedure performed. Intra aortic balloon pump, Cardio-pulmonary bypass time, AXc time, ionotropes, transfusion of RCC and FFPs were found to be highly significant risk factors of acute kidney injury. Conclusion: Cardiac surgery associated acute kidney injury is very common complication; some of the modifiablefactors should be identified and controlled to reduce acute kidney injury.

Objective: To assess door to consultation time in cardiac OPD of a tertiary care hospital and to recommend strategies to reduce patients waiting time. Study Design: Cross sectional study Place and Duration of Study: Surgical Out-Patient Department, Armed Force Institute of Cardiology, National Institute AFIC/NIHD, Rawalpindi Pakistan, from Aug 2020 to Sep 2020. Methodology: This quality improvement project (QIP) was conducted for a period of 4 weeks from 15th, Aug-15th, Sep 2020 in the surgical out-patient department of Armed Force Institute of Cardiology, National Institute/National Institute of Heart Disease (AFIC/NIHD). Time for registration, waiting time pre-consultation and consultation times were recorded on a patient survey proforma. A non-probability consecutive sampling technique was used to recruit study participants. Results: Data was collected from a total of 278 respondents. The results showed that 142(51%) participants had the total door to consultation time of 30 minutes and 86(31%) participants had the door to consultation time of 30-60 minutes 86(31%), respondents reported the actual consultation time to be 11-20 minutes and an equal percentage of participants 86(31%) responded that it was 6-10 minutes. Sixty-six percent 183(66%) participants reported that the doctors were aware of theirmedical history which helped in shorter consultation time. Conclusion: In this QIP we concluded that patients who had shorter waiting time lead to a significantly shorter door to consultation time. A few areas of concern identified in the QIP of note were; less number of registration counters and patients presenting on same day without appointments. Recommendations were made to reduce waiting times in outpatient department (OPD) which would in turn increase patient satisfaction.

Objective: To find out the frequency of delirium associated with peri-operative use of dexmetedomidine and propofol in post CABG patients. Study Design: Comparative Cross-sectional study. Place and Duration of Study: Adult Intensive Care unit, Department of Cardiac Anesthesiology and Intensive Care, Armed Force Institute of Cardiology, Rawalpindi Pakistan from Feb to Jun 2022. Methodology: All post CABG patients who have undergone elective surgery were included through non-probability consecutive sampling technique. All the delirious patients amongst them were subjected to a modified version of ICU-CAM to establish post-operative delirium (POD) caused by either dexmedetomidine or propofol. POD in both the category of patients was compared. Results: A total of 179 CABG patients were included in our study. 140(78.2%) of the patients were subjected to the use of dexmedetomidine throughout their surgery while 39(21.8%) of the patients were given propofol. After subjecting the patients to our exclusion criteria which aimed to eliminate the confounding causes of POD in post-CABG patients, only 30(16.8%) had delirium while 149(83.2%) didn’t develop delirium (p-value=0.003). Majority of the delirious patients were given dexmedetomidine (n=29; 20.77%) in the operation theatre while only a fraction (n=1; 2.58%) were given propofol. Average duration of ICU stay in our study population was 5 days. 15(8.4%) cases out of our total study population underwent reintubation and re-ventilation because of low cardiac output or respiratory distress. Conclusion: Dexmedetomidine could possibly be associated with POD in patients undergoing cardiac surgery. Propofol on the other hand is considerably safe in this regard and doesn’t cause POD.