Objective: To determine the effect of NAC in prevention of post-operative atrial fibrillation in patients undergoing CABG. Study Design: Quasi experimental study. Place and Duration of Study: Adult Cardiac Intensive Care Unit, Armed Forces Institute of Cardiology & National Institute of Heart Diseases (AFIC&NIHD) Rawalpindi during 6 months. Methodology: 146 patients of both gender undergoing elective CABG were included in the study, having age between 30-70 years. However, any patient with history of arrhythmia including AF, thyroid dysfunction, ejection fraction less than 25%, any valvular lesion, dilated left atrium, dilated left ventricle, dilated right atrium, dilated right ventricle or having right atrial tear during surgery were excluded from the study. By using non-probability consecutive sampling, patients were divided into two groups by using envelope method. One group was given standard treatment (control group) while other group was named as NAC group (experimental group). Data analysis was performed using SPSS version-23. Descriptive statistics were reported as Mean±SD. Categorical variables were reported as frequency and percentage. Chi square test and T-test was used to determine association between different variables. Results: A total of 146 patients with mean age 55.27±7.3 yrs. 127(87%) were male and 19(13%) were females. 28(19.2%) patients had atrial fibrillation while 11(7.5%) patients had ventricular premature contractions (VPC). There was no statistically significant difference between ages (p=0.784), gender (p=0.461), AF (p=0.207) and VPC (p=0.347). Out of 73 (50%) patients from each group; the mean age of NAC group was 55.41±7.3 yrs and of control group was 55.08±7.1 yrs (p=0.784). Gender wise distribution of NAC group had 8(11%) females and 65(89%) males while in control group 11(15%) females and 62(85%) were males. AF was found to be 11(15%) and 17(23.3%) in NAC and control group respectively. In NAC group, VPC was 4 (5.5%) and in control group it was 66 (90.4%). Conclusion: This study shows that NAC decreases the frequency of post-operative atrial fibrillation and ventricular premature contractions, but the decrease is statistically insignificant in Pakistani population. However, keeping in view other beneficial effects of NAC, we would recommend more studies on this subject in Pakistani population.

Objective: To determine the frequency of post-operative pulmonary complications after (coronary artery bypass grafting)CABG surgery and to compare the respiratory complications of post COVID and comparison group Study Design: Analytical Cross- sectional study Study Place and Duration: Study was conducted in Adult Intensive Care Unit, Armed Forces Institute of Cardiology,Rawalpindi Pakistan, from Sep 2021 to Mar 2022. Methodology: 40 patients were selected, and divided into two groups using Non-Probability consecutive sampling. Group-A had history of COVID-19 infection and Group-B was a comparison group and had no history of COVID-19 infection. Patients presenting for elective On-Pump (coronary artery bypass grafting) CABG surgery and known history of COVID-19 were included in our study. Patients of age ranging 30 to 70 years irrespective of gender were included in the study. Any patient who had cardiopulmonary bypass time of more than 120 min, respiratory illness like asthma or Chronic Obstructive Pulmonary Disease (COPD), history of smoking, or requiring post-operative re-ventilation due to cardiac or neurological complication, were excluded from the study. After patients were received from Operation theatre, they were monitored for the respiratory complications and both groups were compared. Results: A total of 40 patients were included in this study having mean age 57.9±7.62 years. Most of the patient population was male 31(77.5%) and only 09(22.5%) were female patients. Study population was equally divided into two groups i.e.20(50%) in comparison group and 20(50%) in post COVID-19 group. There was no significant difference in age (p=0.714), ventilation time (p=0.068), gender (p=1.000), and re-ventilation (p=0.451) of both groups. While Intensive Care Unit stay(p=<0.0001) and non-invasive ventilation (NIV) were found to be significant (p=0.007).

Objective: To identify frequency of nosocomial urinary tract infections along with their antibiotic susceptibility in spinal cord injury patients. Study Design: Cross-sectional study. Place and Duration of Study: Acute Spinal Ward, Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan, from Apr to Oct 2016. Methodology: Total 120 male and female patients of ages (18-70 years) with acute (>6 months) or chronic (>6 months) spinal cord injury admitted for rehabilitation and developing urinary tract infection 48 hours after admissionwere included. Patients whose culture results have polymicrobic bacteriuria samples, immune deficiency disorder and immunosuppressive therapy were excluded. Urine samples of all admitted patients suspected having urinary tract infections were collected and send to Armed Forces Institute of Pathology for culture sensitivity test showing isolated causative microorganisms and their antibiotics susceptibility. Results: About 34.58 ± 12.59 years was mean age, 120 patients were included. In these were 97 (80.80%) male and 23 (19.20%) females with male to female ratio of 4.2:1. Frequency of nosocomial urinary tract infections was found in 83 (69.17%) and no nosocomial urinary tract infections in 37 (30.83%) patients. This study shows the frequency of antibiotic susceptibility in spinal cord injury patients as follows; Amikacin in 111 (92.50%), Gentamicin in 108 (90%), Imipenemin 113 (94.17%), Tazocin in 115 (95.83%), Ceftriaxone in 105 (87.50%), Nitrofurantoin in 89 (74.17%) and Ciprofloxacin in 96 (80.0%) patients. Conclusion: This study shows that frequency of nosocomial urinary tract infections in spinal cord injury patients is high and tazocin and imipenem are the most sensitive antibiotics.