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Objectives Low emotional intelligence (EI) may predispose individuals to applying maladaptive coping strategies. This may maintain anxious worrying, which is highly prevalent in patients with chronic heart failure (CHF) and may affect mental (MCS) and physical component summaries (PCS) of health-related quality of life (HRQoL). Design The current study is a cross-sectional and cross-cultural survey. Methods N = 200 outpatients with CHF were recruited at cardiology institutes in Germany and Pakistan and assessed with self-report questionnaires. Results Path analysis (χ2 (4) = 7.59, p = .11, GFI = .99) revealed that the expected associations between low EI and lower SF-36 MCS and PCS of HRQoL were fully mediated by negative metacognition and maladaptive coping in the Pakistani sample (p's ≤ .05). The German sample applied different maladaptive coping strategies, which also led to lower MCS and PCS scores, but did not mediate a direct positive effect of EI on HRQoL. Conclusion The current findings support culture-independent validity of the metacognitive model but also reveal major cultural differences regarding the application and effect of specific maladaptive coping strategies. This has important implications for caregivers in a cross-cultural context and highlights the need for culture-specific tailoring of psychosocial interventions. Statement of contribution What is already known on this subject? Worry, an integral component of generalized anxiety disorder (GAD) and highly comorbid in chronic heart failure (CHF) patients, contributes to anxiety and resulting stress as evident from metacognitive model of GAD. In addition, previous literature has also established the protective role of emotional intelligence (EI) against stress, thus maintaining quality of life. What does this study add? Cross-cultural (Pakistan vs. Germany) validation of the metacognitive model of GAD. Supportive evidence for the metacognitive model in patients with CHF. Mediation of maladaptive metacognitions and negative coping in the relationship of low trait EI and low health-related quality of life.

Ventilator associated pneumonia (VAP) is the most common nosocomial infection acquired by patients in an intensive care unit (ICU). However, there is scarce clinical data, particularly from Pakistani ICUs, regarding existing practices to prevent it.

Background & Objective: Recent meta-analysis reports have called for more randomized trials to evaluate the effectiveness of GIK solution in patients of cardiac surgery. So this study was conducted to evaluate the effectiveness of Glucose-insulin-potassium (GIK) solutions in non-diabetic patients undergoing coronary artery bypass grafting. Methods: A total number of one hundred and sixty (160) patients were randomized into two equal groups; GIK Group and non-GIK group. In GIK group, 5% dextrose containing 70 IU/L regular insulin and 70 meq/L of potassium was administered. The infusion was started at a rate of 30 ml/hour after induction of anesthesia and before the start of cardiopulmonary bypass. The infusion was started again after removal of aortic cross clamp and was continued for six hours after the operation. Results: In early post-operative period, peak CKMB levels were high in non-GIK group 48.50±19.79 IU/L versus 33.40±14.69 IU/L in GIK group (p-value

Introduction: Coronary artery bypass surgery is associated with post-operativecomplications like, atelactasis, pneumonia, plural effusion, pulmonary edema which effect onpost operative oxygenation of patient resulting in delayed recovery and prolong hospital stay.Materials and method: A total of 170 patients included in the study. Study Design: Randomizedcontrol trial. Setting: Department of Cardiac Surgery, Chaudary Pervaiz Elahi Institute ofCardiology Multan. Period: January 2016 to June 2016. Objective: To Compare postoperativeoxygenation outcomes in patients undergoing CABG with and without pre-operative spirometry.Results: Oxygenation variables pre-operative mean PO2 and SD in C group was 93.27 ± 5.04and in I group 97.29 ± 2.31. Similarly pre-operative PCO2 in C group was 41.73 ± 3.22 and in Igroup was 38.78 ± 2.99. Mean A-a gradient and SD in C group was 7.42 ± 1.70 and in I group4.56 ± 1.11. At the time of shifting from theater mean PO2 in C group was 91.22 ± 4.64 andin I group was 98.20 ± 2.00, similarly mean PCO2 and SD in C group was 43.18 ± 3.47 andin I group 39.65 ± 1.15. Mean A-a gradient and SD in C group was 8.02 ± 1.30 and in I group3.87 ± 0.88. After four hours mean PO2 and SD in C group was 92.00 ± 5.05 and in I group99.04 ± 1.15. Mean PCO2 after four hours in C group was 42.34 ± 4.08 and in I group 37.29 ±2.93. As concerned to A-a gradient mean and SD was 7.12 ± 1.70 and in I group 5.84 ± 1.92.Conclusion: Preoperative incentive spirometry have improved postoperative oxygenation andreduce the incidence of postoperative complications following CABG.

Objective: To compare the effectiveness of Morphine alone and Morphine with MgSo4 in pain management after CABG surgery. Methods: This randomized control trial was conducted in the department of anesthesia and critical care Choudhary Pervaiz Ellahi Institute of Cardiology, Multan from November 2016 to June 2017. All collected data was entered and analyzed by using computer software SPSS version 23.1. Quantitative data like age, VAS score was analyzed and presented as mean and standard deviation. Similarly qualitative data like gender and ASA status was calculated and presented as frequency and percentages. Independent sample T-test was applied for significance of VAS score. P value ≤0.05 was considered as significant. Results: A total number of 150 patients of both genders were included in this study. The main outcome variables of our study were VAS score. It was observed that, in group (M), the mean VAS score after 4, 12 and 24 hours of operation was 5.24±1.61, 5.8±2.27 and 5.44±2.27 respectively. And in group (MM), the mean VAS score after 4, 12 and 24 hours of operation was 4.36±2.58, 3.48±2.10 and 4.12±1.05 respectively. It was noted that both groups had statically significant difference of VAS score, as group (M) had higher VAS score than group (MM). Conclusion: Morphine with Mgso4 has better efficacy as compared to morphine alone when used as analgesic agent after CABG surgery.

Objective: To determine the frequency of post-operative pulmonary complications (PPCs) after cardio-pulmonary bypass and association of pre-operative and intraoperative risk factors with incidence of PPCs. Methods: This study was an observational analysis of five hundred and seventeen (517) patients who underwent cardiac surgery using cardiopulmonary bypass. Incidence of PPCs and risk factors of PPCs were noted. Logistic regression was applied to determine the association of pre-operative and intraoperative risk factors with incidence of PPCs. Results: Post-operative pulmonary complications occurred in 32 (6.2%) patients. Most common post-operative pulmonary complication was atelectasis that occurred in 20 (3.86%) patients, respiratory failure in 8 (1.54%) patients, pneumonia in 3 (0.58%) patients and acute respiratory distress syndrome in 1 (0.19%) patients. The main risk factor of PPCs were advance age ≥ 60 years [odds ratio 4.16 (1.99-8.67), p-value 120 minutes [odds ratio 3.62 (1.46-8.97) p-value 0.003], pre-op pulmonary hypertension [odds ratio 2.60 (1.18-5.73), p-value 0.016] and intraoperative phrenic nerve injury [odds ratio 7.06 (1.73-28.74), p-value 0.002]. Operative mortality was 9.4% in patients with PPCs and 1.0% in patients without PPCs (p-value 0.01). Conclusion: The incidence of post-operative pulmonary complications was 6.2% in this study. Advanced age (age ≥ 60 years), prolonged CPB time (CPB time > 120 minutes), pre-op pulmonary hypertension and intraoperative phrenic nerve injury are independent risk factors of PPCs after surgery.