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Objective: To assess outcome of Left Atrial reduction plasty and sinus rhythm restoration in patients undergoing Mitral valve surgery with chronic Atrial Fibrillation. Study Design: Longitudinal study. Place and Duration of Study: Adult Cardiac Surgery Unit, Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi Pakistan, from Jan 2017-Jun 2022. Methodology: Thirty three (n=33) patients with mitral valve disease were recruited via convenience sampling, all of whom exhibited an enlarged left atrium and pre-operative Atrial Fibrillation (AF). Pre-operative cardiac evaluations were performed using Transthoracic Echocardiography (TTE). Pre-and post-surgery trans-esophageal echocardiography studies were conducted as a routine procedure. Follow-up echocardiographic assessments were carried out at intervals of 1 month, 3 months, and 6 months, alongside Electrocardiograms (ECGs). During surgery, median sternotomy was done. Cardiopulmonary Bypass (CPB) time was established followed by cardiac arrest. After Mitral valve Repair/Replacement (MVR), Left Atrial (LA) plication was done by a double needle. Results: Out of thirty three (n=33) patients, 25(75.7%) females and 8(24.2%) male patients, with mean age of 44.3±15.5 years, underwent mitral valve surgery(repair/replacement) followed by LA reduction and sinus rhythm restoration procedure. Complete restoration of sinus rhythm with re-appearance of "a" wave on echocardiography, signifying LA transport function through mitral valve was observed in 31(93.9%) patients on 3rd month and only 1(3.0%) individual continued to have persistent AF after 6 months. A significant reduction in LA size before and after procedure was noticed in all patients (83.70±2.50 mm vs. 47.50±1.08 mm) (p<0.001). Conclusion: Left atrial reduction by "Plication technique" followed by "Diathermy Fulguration" as a part of mitral valve surgery has yielded promising results in managing patients with mitral valve disease and enlarged left atrium. This approach can potentially lead to improved cardiac rhythm and better outcomes in selected cases. [ABSTRACT FROM AUTHOR]

Objective: To determine the efficacy of Ondansetron as a prophylctic agent in patients undergoing Coronary Artery Bypass Grafting. Study Design: Quasi-experimental study. Place and Duration of study: Adult Cardiac Surgery Department, AFIC/NIHD Rawalpindi Pakistan, from Nov 2022 to Feb 2023. Methodology: A total of 156 patients undergoing Coronary Artery Bypass Grafting Surgery irrespective of age and gender were included in the study via nonprobability consecutive sampling. Patients who had a previous history of psychiatric illness, and those in whom delirium could not be reliably tested were excluded from the study. The study population was divided into two groups (group A and group B). Those in the group A received 8mg Ondansetron intravenously on zero, first and second post-operative day. Group B did not receive any intervention. Descriptive statistics were used to measure percentages, frequencies and Mean±SD. Comparison between variables was made by Chi-square test for categorical variables and t-test for continuous variables. p<0.05 was considered statistically significant. Results: Total 156 patients were included in the study and mean age of the patients was 59.47±10.98 years. A total of 3(14.3%) patients who had been given Ondansetron compared to 18(85.7%) patients who were not given Ondansetron developed delirium (p<0.001). Other factors significantly associated with post cardiotomy delirium were age (p<0.001), hypertension (p<0.001), and diabetes (p=0.03). Conclusion: Our study revealed that Ondansetron can be used effectively to reduce the incidence of post cardiotomy delirium in patients of coronary artery bypass grafting. [ABSTRACT FROM AUTHOR]

Objective: To determine the impact of COVID-19 infection on outcome of cardiac surgery patients. Study Design: Comparative Cross-sectional study. Place and Duration of Study: Cardiac Surgery Department, Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi Pakistan, from Jul 2020 to Jun 2022. Methodology: All patients who underwent cardiac surgery were included. 1370 patients were recruited through non-probability consecutive sampling, which were further divided into three groups depending upon the COVID-19 infection as no COVID-19, post COVID-19 and active COVID-19 infection groups. The groups were compared for in-hospital mortality and morbidity of the cardiac surgery. Descriptive and inferential statistics were calculated by applying Chi-square test to compare the groups. Results: Out of 1370, Group-A (no COVID-19) had 1055(77.0%) patients, group-B (post COVID-19) had 296(21.6%) patients and group-C (active COVID-19) had 19(1.4%) patients. Male cases were 977(71.3%) and females were 393(28.7%). 759(55.4%) patients underwent conventional CABG, 327 (23.9%) had off-pump CABG and 284 (20.7%) had valve replacement surgery. On comparing these three groups for outcome, statistically significant findings were found. Morbidity in terms of renal derangement (p<0.001), respiratory illness (p<0.001), cardiac failure management (p<0.001), and mortality (p<0.001) was higher in patients of post COVID-19 and active COVID-19 group. Conclusion: Cardiac surgery with COVID-19 infection leads to high mortality and morbidity rate as compared to patients with no COVID-19 infection. Pulmonary complications in post-operative cardiac patients with COVID-19 were the major challenge to deal with. [ABSTRACT FROM AUTHOR]

Fraxinus xanthoxyloides is a perennial shrub belonging to family Oleaceae, traditionally used for malaria, jaundice, pneumonia, inflammation, and rheumatism. Our study is aimed to assess the total phenolics (TPC), flavonoids (TFC), terpenoids contents (TTC) and antioxidant profiling of F. xanthoxyloides methanol bark extract (FXBM) and its fractions, hexane, chloroform, ethyl acetate and aqueous, along with high-performance liquid chromatography with diode-array detection (HPLC-DAD). Further, the antioxidant and pulmonary protective potential was explored against carbon tetrachloride (CCl 4 )-induced CCl4-induced pulmonary tissue damage in rats. The highest TPC, TFC and TTC were found in FXBM (133.29±4.19 mg/g), ethyl acetate fraction (279.55±10.35 mg/g), and chloroform fraction (0.79±0.06 mg/g), respectively. The most potent antioxidant capacity was depicted by FXBM (29.21±2.40 μg/mg) and ethyl acetate fraction (91.16±5.51 μg/mg). The HPLC-DAD analysis revealed the predominance of gallic, chlorogenic, vanillic and ferulic acid in FXBM. The administration of CCl 4 induced oxidative stress, suppressed antioxidant enzymes' activities including catalase, peroxidase, superoxide dismutase, glutathione peroxidase, glutathione-S-transferase, and glutathione reductase. Further, it increased thiobarbituric acid reactive substances (TBARS) and H 2 O 2 levels, induced DNA injuries and reduced the total protein and glutathione content in lung tissues. The treatment of rats with FXBM restored these biochemical parameters to the normal level. Moreover, the histopathological studies of lung tissues demonstrated that FXBM protected rats' lung tissues from oxidative damage restoring normal lung functions. Thus, F. xanthoxyloides bark extract is recommended as adjuvant therapy as protective agent for patients with lung disorders., (© 2023 Wiley-VHCA AG, Zurich, Switzerland.)