Monkeypox: A comprehensive review of a multifaceted virus.

In May 2022, the world witnessed the re-emergence of the zoonotic disease monkeypox. While this was not the first epidemic of this disease, what differentiated the outbreak was the rapid global spread and increase of cases, which led the WHO to declare monkeypox a global health emergency. Although the disease spreads mainly through inadequately cooked meat of various rodent species, this virus also shows droplet, respiratory, sexual, and even vertical transmission. Monkeypox further multiplies in lymphoproliferative organs and presents with a classical smallpox-like rash, fever, headache, and muscle aches. Diagnosis is confirmed with a polymerase-chain-reaction test and is managed largely supportively with possible usage of some antivirals and immunoglobulins. Moreover, some pre-exposure and postexposure prophylactic vaccines have been developed. This paper aims to conduct an in-depth review of the historical epidemics, transmission, pathophysiology, clinical presentation, and management of the monkeypox disease.

Retraction: Predictors of Quality of Life in Patients With Rheumatoid Arthritis in Pakistan: A Cross-Sectional Study.

[This retracts the article DOI: 10.7759/cureus.17381.].

Retraction: The Impact of Charlson Comorbidity Index on Mortality From SARS-CoV-2 Virus Infection.

[This retracts the article DOI: 10.7759/cureus.19937.].

Retraction: Agreement and Correlation Between Arterial and Venous Blood pH, PO2, PCO2, Lactate, and HCO3.

[This retracts the article DOI: 10.7759/cureus.18401.].

Retraction: Comparison of Challenges and Problems Encountered in the Practice of Exclusive Breast Feeding by Primiparous and Multiparous Women in Rural Areas of Sindh, Pakistan: A Cross-Sectional Study.

[This retracts the article DOI: 10.7759/cureus.14976.].

Retraction: Comparison of Outcomes of Percutaneous Nephrolithotomy (PCNL) Between Adults and Pediatrics Population: A Single-Center Retrospective Study.

[This retracts the article DOI: 10.7759/cureus.22690.].

Comparison of Outcomes of Percutaneous Nephrolithotomy (PCNL) Between Adults and Pediatrics Population: A Single-Center Retrospective Study.

INTRODUCTION: Percutaneous nephrolithotomy (PCNL) has almost completely replaced open surgery for kidney stones because of continuous advancements in the method since the first PCNL was performed in 1976. The aim of this study is to compare the characteristics and outcomes of adult patients and pediatric patients who had undergone PCNL. METHODOLOGY: A retrospective study was conducted at the Sindh Institute of Urology and Transplantation (SIUT) Hospital in Karachi, Pakistan. It included the data of patients who underwent PCNL from January 2015 to January 2022 at the SIUT hospital. The primary outcome variable was the stone-free rate (SFR). Secondary outcomes included length of hospital stay, and complications were assessed using modified Clavien classification system Results: There is no significant difference in the SFR at discharge between pediatric and adult patients (86.67% vs 88.69%, p=0.634). There is no significant difference between the two groups in relation to the total length of hospital stay (p=0.446). Moreover, 12.50% and 11.11% of adults and children developed complications, respectively, after the procedure. The percentages are not significantly different between the two groups (p=0.266). CONCLUSION: The current study using standardized and consistent PCNL techniques shows that SFR is similar in both adults and children, and there is no difference in complications between adults and children.

Association of Atrial Fibrillation With Patient Characteristics in Postoperative Coronary Artery Bypass Grafting Surgery.

Introduction Atrial fibrillation (AF) after coronary artery bypass grafting (CABG) is correlated with poor patient outcomes. The study evaluated the association of patients' clinical and sociodemographic characteristics with the incidence of atrial fibrillation, postoperatively.  Methodology A longitudinal study was performed in the cardiology department of a tertiary care unit, Sindh, Pakistan between October 2019 and November 2020. All patients who underwent CABG surgery irrespective of gender aged 30 to 75 years were included in the study. Patients with a history of atrial fibrillation or severe left ventricular dysfunction were excluded from the study. The incidence of atrial fibrillation was determined by observing an irregular pattern on electrocardiography (ECG) with no definite P-wave and irregular R-R interval. The patients were monitored for seven postoperative days. The final outcome was measured on the seventh postoperative day.  Results A total of 247 patients with a mean age of 63.43 ± 9.72 were enrolled in the study. Out of the 247 patients, 9.7% developed new-onset atrial fibrillation, postoperatively. Age above 65 years was associated with the occurrence of AF but it was not statistically significant (p>0.05). Similarly, patients who developed AF were more likely to have a left ventricle ejection fraction (LVEF) of less than 35% than those without AF (66.67% vs 43.95%; p=0.033).  Conclusion A high rate of AF was observed in the study. Older age and impaired ventricular function were significantly associated with atrial fibrillation. It is recommended that hospitals should devise guidelines and protocols for the prevention and management of atrial fibrillation in patients undergoing cardiothoracic surgeries in order to minimize patient mortality and improve patient outcomes.

Agreement and Correlation Between Arterial and Venous Blood pH, PO2, PCO2, Lactate, and HCO3.

BACKGROUND:  The aim of this study is to assess the correlation and agreement between venous blood gas (VBG) values and arterial blood gas (ABG) values in patients presented in the emergency department of the Indus Hospital, Karachi. This study also included the evaluation of specificity and sensitivity of VBGs values for the identification of abnormal ABG values. METHOD: It was a retrospective, observational study conducted at the Indus Hospital and Health Network, Karachi, Pakistan. All VBG and ABG values in the same patient which were collected at the same time from April 2020 to May 2021 were included in the study.  Results: The study involved 377 patients; 52.8% of patients were female, while 47.2% were male. The mean age of patients was 53.4 years (±17.2). There is an acceptable agreement between the arterial and venous values of pH, bicarbonate (mEq/l), and lactate (mEq/l), respectively, and poor agreement in PCO2 (mmHg) and PO2. CONCLUSION: The study found that analysis of VBG has the potential to be used in the emergency setting in general. Blood gas values of Lactate, HCO3, and pH have shown acceptable association and significant correlation, and they can be considered clinically interchangeable with ABGs values. However, venous PCO2 and PO2 were found to be different between the two.

Right Unilateral Versus Bilateral Electroconvulsive Therapy in Patients With Clinical Depression.

Introduction Electroconvulsive therapy (ECT) is a functional treatment for a significant mental illness that involves a momentary application of electrical stimulation to induce generalized seizures. The use of right unilateral (RUL) and bilateral (BL) ECT has been controversial. Thus, the study aimed at comparing the effectiveness of RUL ECT and BL ECT in treating depression. Methodology A longitudinal study was conducted between September 2016 and January 2021 at a tertiary care hospital in Sindh, Pakistan. All patients over the age of 18 with clinically diagnosed depression in the last month were included in the study. Baseline depression scores and post-treatment scores were determined using Hamilton Depression Rating Scale (HDRS). All patients were assigned to each treatment group. Group A was administered right unilateral electroconvulsive therapy, while group B was administered bilateral electroconvulsive therapy. Adverse effects were documented right after treatment, at four hours, and then one day after therapy. Depression severity was determined after each ECT session using the HDRS scale. Electroconvulsive therapy was discontinued when an HDRS score of 10 was achieved.  Results  The mean HDRS score at baseline in the bilateral ECT group was 24.99 ± 3.938, which lowered to 17.56 ± 2.65 by the 3rd session, 12.45 ± 3.76 by the 6th session, and to 11.86 ± 2.3 by the end of treatment (p<0.0001). Similarly, the right unilateral ECT was equally effective in improving the depressive symptoms (p<0.0001). There was no significant difference between the efficacy of bilateral and unilateral placements of electrodes in electroconvulsive therapy (p=0.116).

Predictors of Quality of Life in Patients With Rheumatoid Arthritis in Pakistan: A Cross-Sectional Study.

Introduction Rheumatoid arthritis (RA) is a chronic, progressive inflammatory illness that primarily affects peripheral joints and belongs to systemic connective tissue diseases. Rheumatoid arthritis can cause varied and significant impacts on patients' health, including mental and physical wellbeing. The aim of this study is to analyze the factors affecting the quality of life of rheumatoid arthritis patients. Methodology A cross-sectional study was conducted in the outpatient orthopedics department of Indus Hospital and Health Network. The survey questionnaire was used to collect data from participants. The study's 36-item short-form survey (SF-36) questionnaire was used to assess the quality of life (QoL) among RA patients. Linear regression was used to assess the factors associated with the mental and physical components of QoL. Results A total of 154 patients were interviewed in this study. The mean age of participants was 48.96 (±51.35). Factors that contributed to the physical component of QoL included severity of disease, income, age, comorbidity, and anxiety while factors affecting the mental component of QoL included quality of sleep, anxiety, education, comorbidity, and disease severity. Conclusion Healthcare professionals need to work closely with patients to increase their capabilities of being more independent and controlling all the factors that can affect their QoL.

Comparison of Challenges and Problems Encountered in the Practice of Exclusive Breast Feeding by Primiparous and Multiparous Women in Rural Areas of Sindh, Pakistan: A Cross-Sectional Study.

INTRODUCTION: The UNICEF (United Nations International Children Education Fund) and WHO (World Health Organization) recommend exclusive breastfeeding (EBF) for the first six months of life. EBF is considered to be an important practice for enhancing infant health and wellbeing. Breastfeeding offers a wide range of psychological and physical health benefits in the long-term and short-term for young children, infants, and mothers. This study aims to compare exclusive breastfeeding practice among primiparous and multiparous mothers including reasons for discontinuing exclusive breastfeeding and problems faced during breastfeeding. METHODOLOGY: This cross-sectional study was conducted in rural areas of Sindh, registered with the Maternal Newborn Health Registry (MNHR). The study used a systematic sampling technique for the enrollment of study participants. A survey questionnaire was used to collect data from mothers about the practices of EBF. A total of 397 mothers were interviewed and analyzed. RESULTS: Among Primiparous mothers, 14.1% of mothers initiated breastfeeding within one hour of birth, while 22.4% of multiparous mothers, initiated breastfeeding within one hour of birth. The difference between the two is statistically insignificant (p-value=0.234). A high percentage of multiparous mothers exclusively breastfed their infants for six months (63.5%) as compared to primiparous mothers (51.5%). The most common reason for introducing pre-lacteal feed before six months among primiparous mothers is the lack of adequate milk production to fulfill baby needs; this was the case for 35.4% of mothers. On the other hand, the baby remaining hungry post breastfeeding was the major reason among multiparous mothers (44.0%) for introducing pre-lacteal feed before six months. CONCLUSION: This study helped in the identification of issues faced by primiparous and multiparous mothers during exclusive breastfeeding. Interventions for promoting EBF need to be tailored as per the need and challenges of the population.

The Correlation Between Blood Group Type and Diabetes Mellitus Type II: A Case-Control Observational Study From Pakistan.

Introduction Adult-onset type 2 diabetes mellitus (T2DM) is defined as a chronic hyperglycemic state, characterized by insulin resistance and declining islet B-cell function, eventually leading to islet B-cell function failure. The present study evaluated the association of T2DM with the type of blood group.  Methodology A case-control study was conducted from April 2020 to September 2021 in Karachi, Pakistan. An electronic questionnaire was used to determine if there is an association between ABO blood groups and type 2 diabetes mellitus. Our study involved two groups with an equal number of participants. The patient group contained participants who had been diagnosed with type 2 diabetes mellitus, whereas the control group contained participants who had never been diagnosed with type 2 diabetes mellitus. Information was collected through a self-administered electronic questionnaire which was circulated through social media. Results The mean ± SD age was reported to be 25.98 ± 12 years. The study found a significant association between blood group B and type 2 diabetes mellitus (p=0.006), whereas a negative association was seen between the blood group O and type 2 diabetes mellitus (p=0.001). It should be noted, however, no significant association was found between the blood groups A and AB and type 2 diabetes mellitus (p>0.05). Conclusion The results of this study indicate that there is an association between type 2 diabetes mellitus and the ABO blood group system; a significant association was found between blood group B and risk of type 2 diabetes mellitus (T2DM). Nevertheless, we recommend regular screening for T2DM in individuals with a high-risk profile. Those at risk can adopt measures that are beneficial for them in the long run such as dietary control and physical exercise. Further studies using explorative techniques with a diversified population are recommended.

The Impact of Charlson Comorbidity Index on Mortality From SARS-CoV-2 Virus Infection.

INTRODUCTION: Charlson Comorbidity Index (CCI) is a simple, validated, and readily acceptable method of determining the risk of mortality from comorbid disease. It has been used as a predictor of long-term survival and prognosis. The aim of this study is to determine the impact of CCI score on mortality in COVID-19 hospitalized patients and test the efficacy of the CoLACD score (COVID-19 lymphocyte ratio, age, CCI score, dyspnoea) in predicting mortality among hospitalized COVID-19 patients. METHODOLOGY: It was a retrospective cohort, and the data of this study were gathered from two tertiary hospitals of Karachi, including Liaquat National Hospital and Ziauddin Hospital. Data of patients hospitalized in any of these tertiary care hospitals and diagnosed with confirmed COVID-19 infection were used in the study from January 15, 2021, to April 30, 2021. RESULTS: The mean age of participants was 53.22 (±14.21) years. The majority of participants were males (74.91%). Predictors of mortality include CCI score, age of participants, D-dimer, smoking status, and shortness of breath. The sensitivity of this CoLACD score was 80.23%, and specificity was 50.23% (diagnostic accuracy is 60.45%). The negative predictive value (NPV) of this test was 39.44%, and the positive predictive value (PPV) was 83.01%. CONCLUSION: Our study showed that CCI can be used in a clinical setting to achieve a prediction of mortality in COVID-19 patients.