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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.
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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.
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[This retracts the article DOI: 10.7759/cureus.17381.].
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[This retracts the article DOI: 10.7759/cureus.19937.].
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[This retracts the article DOI: 10.7759/cureus.18401.].
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[This retracts the article DOI: 10.7759/cureus.14976.].
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[This retracts the article DOI: 10.7759/cureus.22690.].
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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.
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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.
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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).