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Background: Diabetes affects multiple organs of the body mainly cardiovascular system. We decided to find out effects of HbA1C levels on the perioperative outcome in patients undergoing CABG off pump. Role of HbA1C levels in predicting the probability of perioperative hyperglycaemia, regional hypoperfusion, increased inotropic requirement, post-operative renal dysfunction, increased incidence of infections and arrhythmias in the postoperative period, duration of stay in the ICU & hospital in patients undergoing Off Pump CABG. Materials and Methods: A study was conducted on 200 patients, divided into two groups: Group A: HbA1C>7%, Group B: HbA1C< 7%. During the perioperative period, all demographic data, hemodynamic parameters, ionotropic requirements and total insulin requirements during surgery and all laboratory measurements-renal function, total leucocyte counts & HbA1C levels & Random Blood Sugars, lactates & pH were performed. Any infections, arrthymia duration of ICU & hospital stay. Results: In our study we found a correlelation between patients with HbA1C levels >7% and increased risk of intraoperative tachycardia, acidosis and high lactates, perioperative and postoperative hyperglycemia and increased insulin requirements, higher inotropic support requirements in both intra-operative and postoperative periods, raised creatinine levels postoperatively predisposing to renal dysfunction, infections and arrhythmias postoperatively and a longer ICU, hospital and ventilation period. Conclusion: HbA1C levels >7% have increased risk of tachycardia, acidosis and high lactates, increased insulin requirements, higher inotropic requirements, infections and arrhythmias & having a longer ICU stay, hospital stay and ventilation period. Thus in patients with higher HbA1C levels preoperatively, the risk benefit ratio to be considered before taking for surgery and in these patients surgery may be delayed until the blood sugars are controlled with a HbA1c level<7% for a better outcome. [ABSTRACT FROM AUTHOR]

Objective: Role of serum procalcitonin (PCT) in critically ill patients is well defined for identification of bacterial infection but it’s role in prediction of survival is not well established. We studied plasma kinetics of PCT, over the first three critical care days to validate its role in prediction of survival of patients with sepsis according to plasma level. Methods: A prospective observational study was conducted in CCU (KGMU). Total 53 consecutive patients either sex were recruited. Patients with systemic inflammatory response syndrome (SIRS) were recruited. PCT was measured on 1st and 3rd days. We studied 50 days survival using Kaplan-Meier analysis and diagnostic accuracy of PCT using ROC analysis. Results: In our study, PCT was statistically significantly higher in non-survivor patients compared to survivor patients (p<0.05). ROC curve was made with PCT based on culture at both time intervals. On the basis of ROC curve, we determined a cut-off value as 12.21 ng/ml of PCT on day 3 to predict sepsis with high sensitivity (93.7%) and specificity (71.4%). Area under curve (AUC) was also higher observed at day 3 (AUC=0.864, p<0.001) compared to day 1 (AUC=0.658, p<0.05). According to Kaplan-Meier curve, risk of mortality was by 83% (HR 0.17(95% 0.07-0.44)) lower in low sepsis category group (≤12.21 ng/ml) compared to high sepsis category group (>12.21 ng/ml). Conclusion: According to our study results, we conclude that serum PCT has good clinical diagnostic and prognostic values in prediction of survival in patients with sepsis. Kinetic studies of PCT can improve sensitivity and accuracy when evaluating the prognosis of patients with sepsis as well as survival rate. [ABSTRACT FROM AUTHOR]

Cardiovascular diseases (CVDs) remain major causes of global mortality in the world. Genetic approaches have succeeded in the discovery of the molecular basis of an increasing number of cardiac diseases. Genome-editing strategies are one of the most effective methods for assisting therapeutic approaches. Potential therapeutic methods of correcting disease-causing mutations or of knocking out specific genes as approaches for the prevention of CVDs have gained substantial attention using genome-editing techniques. Recently, the clustered regularly interspaced short palindromic repeats/CRISPR-associated protein 9 (CRISPR/Cas9) system has become the most widely used genome-editing technology in molecular biology due to its benefits such as simple design, high efficiency, good repeatability, short cycle, and cost-effectiveness. In the present review, we discuss the possibilities of applying the CRISPR/Cas9 genome-editing tool in the CVDs. [ABSTRACT FROM AUTHOR]

Background: Cardiac surgery is frequently associated with macro and microcirculatory hypoperfusion. Patients with normal central venous oxygen saturation (Scvo2) also suffer from hypoperfusion. We hypothesized that monitoring central venous-arterial pco2 difference (dCO2) could also serve as additional marker in detecting hypoperfusion in cardiac surgery patient.Methods: This is a prospective observational study. Patients undergoing off-pump coronary artery bypass grafting included in this study. The dCO2 was measured postoperatively. The patients with a ScvO2 ≥70% were divided in to 2 groups, the high-dCO2 group (≥8 mmHg) and the low-dCO2 group (<8 mmHg).Results: The 65 patient had scvO2 ≥70%. Out of these, 20 patients were assigned to the high dCO2 group and 45 patients to the low dCO2 group. Patients with high dco2 had higher lactate levels after ICU admission. They also had significantly prolonged need for mechanical ventilation (14.90 ± 10.33 vs 10 ± 9.65, P = 0.0402), ICU stay (5.05 ± 2.52 d vs 3.75 ± 2.36 d, P = 0.049) and hospital stay (12.25 ± 5.90 d vs 8.57 ± 5.55 d P = 0.018). The overall rate of post-operative complications was similar in both the group.Conclusion: The present study demonstrates dCO2 as an easy to assess and routinely available tool to detect global and microcirculatory hypoperfusion in off-pump CABG patients, with assumed adequate fluid status and ScvO2 as a hemodynamic goal. We observed that high dCO2 (>8 mmHg) was associated with decreased DO2I, increased oxygen extraction ratio, the longer need for mechanical ventilation and longer ICU stay. [ABSTRACT FROM AUTHOR]