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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

Background: The goal of this study is to investigate the factors that influence the effectiveness of redo percutaneous Transvenous Mitral Commissurotomy (PTMC) and to See how it affects MVA and echocardiographic parameters. Methods: It was a single-center, retrospective research that took place at Cardiac Center QAMC Bahawalpur from 3rd January to 31st December 2020. All patients who had Redo PTMC had their medical records reviewed. The pre- and post-procedure values for mitral valve area (MVA), left atrial pressure (LA pressure), pulmonary artery systolic pressure (PASP), and mitral regurgitation (MR) were compared. Results:. Total 78 patients were enrolled , 28(36%) males and 50(64%) females with a mean age 37.15± 2.63 enrolled age range between 25-45 years. Patients were divided into two groups, the average age of in successful (Group I) patients was 31.08±5.83 years and in un-successful (Group II) patients was 30.73±4.21. In Group-I, 18(64.3%) males and 30(60.0%) females as compare with Group-2, 10(35.7%) males and 20(40%) female’s patients were enrolled. Both groups were well matched in other demographic and echocardiographic characteristics . Findings of echocardiographic parameter showed that there is difference in Mitral Valve Area in (successful vs unsuccessful group) 1.69±0.11 vs 0.67±0.23 with p-value 0. 024.. The mean PA pressure13.25±5.19 vs 23.25±6.55 and Mean LA Pressure 13.25±5.19 vs 23.25±6.55 with p-value 0.29 between pre and post-Redo PTMC was statistically significant as p-value = 0.001. Conclusion: In patients with mitral restenosis, PTMC is a viable, safe surgery with a high success rate and tolerable morbidity. Repeat PTMC should be the procedure of choice in individuals with poor echo scores and no concomitant illnesses. Redo PTMC can be utilized as a palliative approach in patients with more severe valvular and subvalvular deformity who are at high risk of morbidity and death with MVR due to the presence of substantial concomitant conditions. Keywords: PTMC Percutaneous transvenous mitral commissurotomy, MR Mitral Stenosis Rheumatic heart disease, Valve area, Mitral stenosis PASP pulmonary artery systolic pressure

Background: To bypass the obstruction in native coronary arteries both arterial and venous grafts are used. Inspite of having radial artery graft as a favored second conduit for bypass, venous grafts are more frequently used. Objective: To compare the CT angiography patency findings of radial artery graft vs. saphenous vein graft 3 months postoperatively. Study Design: Randomized controlled trial. Settings: The study was conductedat the Department of Cardiac Surgery, Mayo Hospital, Lahore. Data Collection: All patients fulfilling theinclusioncriteria were recruited. A written informed consentwastaken. The non-dominant arm was used almostexclusively forharvesting the radial artery in those patients who have positive modified Allen`s test as a pedicle by atraumatic "no-touch" technique. After heparanization, it was immersed in diluted solution (Inj. verapamil hydrochloride 5mg + Inj. nitroglycerin 2.5mg + Inj. heparin 500 IU + Inj. ringer lactate 300 ml with Inj. 8.4% NaHCO3 0.9 m1). All the patients in the study received LIMA to LAD and were done on pump. After that the patients were dividedinto2 groups namely Group I and Group II by computer generated method. In Group I, the patient received the radial artery as a second graft to a coronary having more than 90% stenosis. The third or fourth graft if required is saphenous vein graft. The group II had SVG as second, third or fourth grafts, one of the venous grafts were to a coronary having more than 90% stenosis. Results: Average age of all (n=62) patients was 38.82±9.93 years. Average age in Group-I & II patients was 39.09±9.49 & 38.54±10.50 years respectively. Among patients 47% were male and 53% were female patients. In Group-I, 12 (38.7%) of the patients were male, and 19 (67.3%) were female, whereas in Group-II, 17 (54.8%) of the patients were male, and 14 (45.8%) were female. In Group-I 1(3.2%) patient and in Group-II 3(9.7%) patients died (p=0.301). Insignificant difference was seen for cardiac arrhythmias i.e. Group-I:16.1% vs. Group-II: 19.4%, p=0.740. Myocardial infarction in Group-A 5(16.1%) patients and in Group-B 7(22.6%) (p=0.520). In Group-A, 30(96.8%) patients and in Group-B, 28(90.3%) patients showed patency of artery after coronary artery bypass grafting(P>0.05). Conclusion: We discovered no significant difference in the patency of both radial artery and saphenous vein grafts on 3 months postoperative CT angiography and clinical outcomes in terms of perioperative mortality, MI, and cardiac arrhythmias in patients who underwent CABG in this study. Keywords: radial artery graft, saphenous vein graft, coronary artery bypass grafting, Myocardial Infarction, Mortality, Cardiac arrhythmias

Objective: The aim of this study is to compare in hospital morbidity and mortality in on pump versus off pump CABG. Methodology: All the patients undergoing CABG surgery were enrolled after taking informed consent. Demographic and postoperative variables were entered in the predesigned questionnaire and patients were followed for early outcomes after surgical procedure. Results: A total of 470 patients wasdivided in two groups 235 (on pump and off pump).The mean age of patients was 54.85 ± 9.57 (23-85).There were 400(85.1%) males and 70(14.9%) females. The total data of 470 patients was divided in two groups 235 in on Pump and 235 in off pump CABG.The mean age of patients was 54.85 ± 9.57 (23-85). There were 400(85.1%) males and 70(14.9%) females. Different clinical outcomes were compared in both groups (On-Pump versus Off-Pump CABG) by using Euro Score, we found Peripheral Disease in On-Pump CABG group compared with Off-Pump CABG as 11(4.68% vs 12(5.11%) with p-value=0.831 which was statistically insignificant, current data assessed lung disease in both groups as 11(4.68%) vs 13(5.53%) with statistically insignificant p-value (0.675). and unstable angina were 12(5.11%, p-value 1.00) patients founded and Peri and post myocardial infarction also assessed in both groups with p-value (0.74 & 1.20). respectively.Data regarding in hospital mortality was analyzed and found that 7(2.98%) in on pump group compare with off pump group was According to our research mean number of grafts placed in On-Pump CABG were 9(3.83%) with statistically insignificant p-value (0.611). Conclusion:Proof is presented that surgery on beating heart (Off-Pump) is as safe and effective as Conventional CABG, and cheaper than conventional surgery. However, it is uncertain whether the cost savings are sustained over a longer period of time. Keywords: Coronary artery Bypass grafting surgery, On Pump Off Pump