DelNido cardioplegia versus St Thomas cardioplegia solution in double valve replacement: a single centre experience.

INTRODUCTION: The role of cardioplegia cannot be underrated in cardiac surgery. St Thomas solution is the most widely used cardioplegic, but needs repeated dosing. Del Nido solution provides long duration of asystole with adequate protection; but has been used mainly in paediatric patients. This study was aimed to compare Del Nido cardioplegia with St Thomas cardioplegia in adult cardiac surgeries, requiring double valve replacement and compare the outcomes. METHODOLOGY: This retrospective, observational, descriptive study was conducted over a time period spanning from January 2016 to December 2019. A total of 209 patients were included and were separated in two groups DC group (n = 114) and BC group (n = 95) on the basis of cardioplegic solution used. Del Nido solution was administered as single dose. Parameters noted were CPB time, cross clamp time, wean off bypass time, DC shocks given, inotropic support required, ventilation duration, duration of ICU and hospital stay. RESULTS: There was significantly shorter aortic cross clamp time (72.6 ± 10.2 vs. 98.2 ± 9.2), CPB time (92.1 ± 12.3 vs.129.5 ± 11) and wean off bypass time (19.4 ± 5.9 vs. 31.3 ± 7.6) and less requirement of DC shocks (21.2% vs. 65.9%) in DC group. Inotropic requirement in immediate post-operative period was significantly less in DC group both on day of surgery (5.35 ± 1.44 vs. 7.52 ± 3.8) and 24 hours later (3.4 ± 2.12 vs. 2.18 ± 0.72). There was no significant difference in duration of ventilation, ICU and hospital stay. CONCLUSION: Del Nido can be used safely in long duration adult cardiac surgeries and in a single dose with better intra operative and immediate post-operative outcomes as compared to St Thomas solution.

Evolutionary dynamics of the delayed replicator-mutator equation: Limit cycle and cooperation.

Game theory deals with strategic interactions among players and evolutionary game dynamics tracks the fate of the players' populations under selection. In this paper, we consider the replicator equation for two-player-two-strategy games involving cooperators and defectors. We modify the equation to include the effect of mutation and also delay that corresponds either to the delayed information about the population state or in realizing the effect of interaction among players. By focusing on the four exhaustive classes of symmetrical games-the Stag Hunt game, the Snowdrift game, the Prisoners' Dilemma game, and the Harmony game-we analytically and numerically analyze the delayed replicator-mutator equation to find the explicit condition for the Hopf bifurcation bringing forth stable limit cycle. The existence of the asymptotically stable limit cycle imply the coexistence of the cooperators and the defectors; and in the games, where defection is a stable Nash strategy, a stable limit cycle does provide a mechanism for evolution of cooperation. We find that while mutation alone can never lead to oscillatory cooperation state in two-player-two-strategy games, the delay can change the scenario. On the other hand, there are situations when delay alone cannot lead to the Hopf bifurcation in the absence of mutation in the selection dynamics.

Safety considerations for Health care Workers involved in Cytoreductive Surgery and Perioperative chemotherapy.

The combined modality treatment of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has gained worldwide acceptance for management of selected patients with peritoneal metastases from various cancers. Cytoreductive surgery is performed with the goal of removing all macroscopic disease and is coupled with perioperative chemotherapy (POC) in the form of HIPEC with or without EPIC (early postoperative intraperitoneal chemotherapy) to deal with the microscopic residual disease. These treatments entail the use of cytotoxic drugs in the operation theatre or in the intensive care unit where they are not commonly used and put the healthcare workers participating in the treatment at risk of exposure. CRS is performed with high voltage electrocautery generating a large amount of surgical smoke which is inhaled by the involved personnel and has potential health hazards. This article outlines the safety measures to be taken while performing CRS and POC.