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The aim of this research is to examine the effect of GHRM practices on hotel environmental performance in Pakistan. The study further analyze the effects of green POS, pro-environmental behavior, or green innovative work behavior (GIWB). The target area was belong of five-star hotel workers in Pakistan. PLS-SEM was used to analyse data gathered by a survey questionnaire from 225 workers. According to the findings green POS, which leads to pro-environmental behavior and GIWB, was establish to be a powerful predictor of GHRM practices (green recruitment or hiring, green training, green rewarding, or green performance assessment). The results also revealed that pro-environmental behavior or GIWB had a momentous effect on hotel environmental performance. Moreover, Green HRM practices are considered to indirectly contribute to environmental performance via green POS, pro-environmental behavior, and GIWB. This research is one of the unique efforts in the area of environmental management to incorporate GHRM practices with green POS, pro-environmental behaviors, and GIWB. It makes a clear contribution towards a new streamline of research to realize the critical function of GHRM exercise to modify the environmental performance in hotels. The research aggregation have suggested GHRM is an important indication for supporting green POS and encouraging pro-environmental behaviors, as well as GIWB. It can support hotel managers to promote the green POS among the employees by practicing the GHRM practices that enables pro-environmental behavior and GIWB to solve the hotel industry's increasing environmental problems. Recent research suggests that managers should maintain and follow GHRM efforts and policies to improve environmental performance.

Introduction: A large number of patients with coronary artery disease (CAD) encounter surgical cardiopulmonary bypass [on-pump coronary artery bypass (ONCAB) or off-pump coronary artery bypass (OPCAB)]. Since two techniques have been commenced, the doubt of which one is more convincing and efficacious has always been discussed and is still controversial. Objective: The purpose of this study was to determine the early patency and survival rate of coronary grafts after CABG in On-Pump vs Off-pump groups. Material and methods: This retrospective cross sectional study was conducted in the Cardiac surgery department of Punjab Institute of Cardiology, Lahore in year 2020 using the data of previous surgeries done from 01-01-2009 to 01-03-2010 (14 months). Total 792 patients fulfilling inclusion criteria were included. The data consisted of two groups Group-A ONCAB (341) and Group B OPCAB (451), with total number of grafts (2333). Out of 792 patients only 315 were followed up the same year and in 2020, 135 were followed up for survival rate. The sampling technique used in this study was non probability sampling. Results: The mean age of the patients in Group A was 56.13 ±9.305 years and in Group B was 53.9 ± 9.382 years. In 315 followed up patients the number of grafts applied were 949. The mean number of grafts applied in Group A was 3.11±0.949 and in Group B was 2.95±0.959. There was no statistically significant difference seen between these groups. Out of 949 grafts 795 were patent from which 410 were applied in group A and 385 were applied in group B. 154 were blocked out of which 67 were applied in group A and 87 were applied in group B. After 10 years, only 135 were followed for survival rate, out of which 22.22% had angioplasty done, 51.85% reported events of shortness of breath, 13.33% had another attack of myocardial infarction, 30.37% had angiography done and mortality rate was 14.07%. There were 85.4% patients still alive in Group A and 86.8% in Group B. The overall survival rate is 85.9%. Conclusion: In overall comparison there is no significant difference in patency and occlusion rate. However, the survival rate is 85.9%. So we can say both groups are equally safe and no procedure is preferred over another, entailing an identical caliber of anastomosis.

Introduction: Myocardial protection is the major component in cardiac surgery affecting the patient’s outcome (morbidity and mortality). The key components are cardiopulmonary bypass (CPB), hypothermia and the cardioplegia solution. Objective: To compare conventional vs Del Nido cardioplegias using Cardiac Troponin-I (CTnI) and CK MB release as the primary outcome variable in patients with preserved left ventricular ejection fraction undergoing coronary artery bypass surgery. Material and Methods: Retrospective comparative study conducted at Punjab Institute of Cardiology, cardiac surgery department. After informed consent, patients undergoing coronary artery bypass surgery were included in the study. Data was analyzed by comparing Del-Nido with Conventional Cardioplegia using CTnI and CKMB release as the primary outcome variable. Results: A total of 140 patients were divided in two groups 70 (50%) in Del-Nido group and 70 (50%) in conventional group. In Del Nido group the mean Cardioplegia volume given was 1271.43 ± 447.91 ml and in Conventional Cardioplegia mean volume given was 2142.86 ± 584.48 ml with p-value