Objective: The aim of this study is to evaluate the clinical and safety profile of Pirfenidone treatment in IPF. Methodology: This is a retrospective analysis of prospectively collected data via electronic system called “Al Shifa”. Data of all patients, who received Pirfenidone at the Royal Hospital in the period between April 2012 to April 2017, were retrieved into an excel sheet. The data retrieved at two time points: before starting the drug and last readings at time of the study. Results: There were 90 patients with IPF that were treated with Pirfenidone, The age ranges between 35 to 91 years old. All patient assessed by Forced Vital Capacity (FVC) by spirometry, and 6-minutes’ walk test (6MWT). The mean percentage of pre- FVC (before starting the drug) was 59.3%, while follow-up FVC (the last reading at the time of entering the data) was 60.3%. The Pre-6MWT test; the mean of distance they manage to walk in 6 mints, was 339 meters, and follow-up-6MWT test was 320 meters, the difference between pre and post result in both tests are insignificant and hence these results indicated the stability of the disease. Also, only 16.6% experienced drug adverse effect; 10% due to gastro-intestinal symptoms, 2.2% weight loss and 4.4% due to Photo-sensitivity. Conclusion: Pirfenidone stabilized IPF patients, as there was no decline in lung functions test and exercise capacity was preserved as demonstrated by the 6MWT. Perifenidone was well tolerated with acceptable safety profile.

The amount of strain that cardiac surgery exerts on blood bank services is an example that emphasises the need for multimodel blood conservation stratergy. The most common factor which is being attibutable to increased bleeding after cardiac surgery is hyperfibrinolysis. Thererfore the use of antifibrinolytics during high risk cardiac surgery becomes inevitable. Commonly used antifibrinolytic include Tranexamic Acid(TA) and Epsilon-amino-caproic acid (EACA) .The aim of our study was to compare the effectiveness of both TA and EACA in reducing post surgical bleeding in on-pump CABG surgeries and to asses the post operative complications associated with its use.Material and Methods After obtaining informed written consent,approval of ethics and research commitee patients who were scheduled for on-pump CABG were included in the study.Patients were divided into two groups randomly by using a comupter generated randomized block design namely group TA(n=40) and group EACA (n=40). TA group received tranaxamic acid at a dose of 10mg/kg IV over 20 min at the time of induction then 1-2 mg/kg in CPB prime followed by 1 mg /kg/hr infusion during surgery. Group EACA received EACA in a dose of 100mg/kg/IV over 20 min at he time of induction then 5-10mg/kg in CPB prime followed by 10mg/kg/hr infusion during surgery . Pateints were assessed for blood loss and were monitored for fibrinogen level and D- dimer levels, Re-exploration and post operative complications. Result Primary outcomes like bleeding at 4hrs, there was no significant difference between the groups but when total bleeding at 24 hrs was compared there was a significantly lesser bleed in group TA group compared to group EACA (P=0.0022). The requirement of PRBC in group TA was for 3 patients,where as in EACA group 4 patients required PRBC (P>0.05).There was no significant difference in the rate of post operative complications between the groups. (P>0.05) .Conclusion from our study we concluded that both TA & EACA effectively inhibits fibrinolysis during on pump CABG surgery and thus results in decreased post operative bleeding.When compared between the two, TA was slightly better with respect to post operative bleeding at 24hrs.Our study also re emphesized the fact that neither of the drug led to any additional risk of post operative thrombotic complications.

Globally, as on March 17, 2020, 179 111 confirmed cases along with 7426 deaths have been reported. One of the World Health Organization’s (WHO) strategic objectives for this response is to communicate critical risk and event information to all and counter misinformation. We, therefore, aimed to highlight the key information issued by the WHO on preventive measures. Human-to-human transmissions have been described with incubation period between 2-10 days, facilitating its spread via droplets, contaminated hands or surfaces. In many instances, COVID-19 infection will cause mild respiratory illness including a runny nose, sore throat, fever, and cough, however, it can cause severe illness and, in some people, it can be fatal especially in elderly, and those with pre-existing medical conditions such as cardiovascular disease, chronic respiratory disease, hypertension or diabetes. The re-estimated mortality rate for China is 5.6 % and 15.2% elsewhere.

The Society of Thoracic Surgery Score and Euro II Score are tools for estimating major adverse cardiac events (MACE [death {or morbidity}, renal failure, stroke, prolonged ventilation, CSW infection, reoperation, prolonged admission]) after cardiac surgery.

This article is the second of the two-part series focusing on predicting and reducing perioperative major adverse cardiac events (MACE) resulting from the procedures cardiothoracic surgeons perform. The first addressed cardiac surgery. This article addresses non-cardiac procedural complications.