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[This retracts the article DOI: 10.7759/cureus.19354.].
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[This retracts the article DOI: 10.7759/cureus.21311.].
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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.18803.].
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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.22114.].
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INTRODUCTION: Sepsis is a life-threatening illness caused by the body's response to uncontrolled infection. Different studies have been conducted to identify risk factors associated with the diagnosis of sepsis and mortality, but there has been considerably less focus on mortality due to sepsis-induced blood pressure. The current study was conducted to determine the incidence of mortality within 30 days among patients with sepsis-induced blood pressure drop and its risk factors. METHODOLOGY: It was a retrospective study conducted at the Pakistan Navy Station (PNS) Shifa Hospital, Karachi, Pakistan. Data of all patients aged 18 years or more who visited PNS Shifa Hospital and were diagnosed with sepsis and blood pressure reduction from November 2019 to October 2021 were extracted from Hospital Management Information System (HMIS) and retrospectively analyzed Results: All variables significantly associated with 30-days mortality in multivariable logistic regression analysis, including disturbance of consciousness, cardiac insufficiency, respiratory failure, diabetes mellitus, creatinine level, and aspartate aminotransferase (AST) level, were risk factors for mortality in patients with the sepsis-induced drop in blood pressure (p-value<0.05). CONCLUSION: Identifying these risk factors is important as it will help clinicians identify patients who are at high risk of mortality at an early stage. Through early identification, interventions can be done to reduce the incidence of in-hospital mortality among sepsis patients.
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Background and Objective: Total Knee Arthroplasty is a commonly performed procedure for arthritic knees. Preventing complications is of utmost importance for good functional outcomes and preventing morbidity. Wound closure after the procedure is as important as the replacement aspect of surgery.The objective of this study was to provide subjective and objective evidence of better closure technique and material; we conducted the study so that the outcome of TKA can be further improved. Methods: We conducted a randomized trial at The Indus Hospital, Karachi, from December 2018 to June 2020. All patients from age 40 to 70 years who underwent total knee arthroplasty were included in the study. The wound of one knee was closed with Polypropylene (Prolene) sutures, and the other with staples. The wound was assessed independently by two assessors using Hollander's score; lower score means a worse outcome. All data was entered and analyzed using STATA version 16. Results: Thirty patients who underwent bilateral total knee replacement were included in the analysis, among which 71.8% were female. The average age of participants was 57.3 (± 7.5) years. The mean incision length on the right knee was 17.6 ± 1.1 cm, while on the left the incision length was 18.3 ± 1.2 cm. Overall, the mean Hollander score was significantly different among participants in the sutures and staples group in both the right (p-value=0.001) and left knees (p-value=0.001). The score was significantly higher in knees closed with sutures as compared to staples. Also, the mean Hollander score is significantly higher in females than males in both the right knee (B=0.56, p-value=0.049) and the left knee (B=0.38, p-value=0.044). Conclusion: The study has shown that Hollander's score was significantly higher in knees closed with sutures as compared to the patients in whom staples were used for wound closure.
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INTRODUCTION: Various modalities are now being used to manage postoperative pain, such as regional nerve blocks techniques, continuous epidural analgesia, patient-controlled analgesia, opioids, and systemic non-steroidal anti-inflammatory drugs. This study compared the mean postoperative pain score between ultrasound-guided transversus abdominis plane (TAP) block and a local anesthetic wound infiltration at the surgical incision site. METHODOLOGY: A prospective, comparative, randomized controlled trial (RCT) was carried out from February 2021 to September 2021. The study was conducted in the anesthesia department of Dow University of Health Sciences, Karachi, Pakistan. Patients aged 18-80 years presenting with elective surgery of (both direct and indirect) inguinal hernia repair were enrolled in the study. Participants were randomly assigned into one of the two groups that are local anesthetic wound infiltration (Group A) and TAP block (Group B). The mean pain score was assessed using a visual analog scale and compared between the two groups. RESULTS: The study included 168 patients grouped in two different groups. The mean age in Group A was 43.87 (+17.21), and Group B was 47.01 (±15.37). Mean pain scores in groups A and B were 6.36±1.94 vs 4.51 ± 1.99 (p-value=0.001). The pain rescue medications were given to 57.14% of patients in Group A and 34.52% of patients in Group B, and it was significantly different in the two groups (p-value=0.003). It was found that patients in Group A reported more severe pain (41.67%) than patients in Group B (10.71%). CONCLUSION: When compared to local anesthetic wound infiltration, ultrasound-guided TAP block had better analgesic activity compared to local anesthetic wound infiltration.
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Introduction Double J stents (DJS) are commonly used in urological practice, but they do have a risk of complications, such as infection and hematuria. This study explored the association between ureteral double J stent colonization and lower urinary tract symptom (LUTS) severity. Methodology This cross-sectional study was conducted from January 2021 to June 2021 in patients admitted to a tertiary care hospital in Karachi, Pakistan, who required double J stent (DJS) insertion. Patients who came to the site for stent removal were invited to participate in the study and enrolled using a consecutive sampling technique between January 15, 2021, and March 15, 2021. Results The study enrolled 176 patients, of whom 73.33% had colonization and the remaining had no colonization. The factors significantly associated with symptom severity included colonization of the DJS (P-value = 0.001) and the patients' ages (P-value = 0.046). The two groups have significantly different symptoms, which included incontinence (P-value = 0.001), polyuria (P-value = 0.001), and nocturia (P-value = 0.001). Conclusion Our study found more severe symptoms in DJS patients with colonization than in those without colonization. Irritative voiding symptoms, including nocturia and dysuria, are more common in DJS patients with colonization.
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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 Multimorbidity is defined as the coexistence of more than one chronic condition in one individual. It is related to enhanced rates of disability and mortality, enhanced disease burden, decreased function levels, and it can affect the wellbeing and daily activities of people, including loss of autonomy and independence. The aim of the current study is to determine the predictors of quality of life among patients with multimorbidity in Karachi, Pakistan. Methodology It was a cross-sectional study conducted in 12 health care facilities of six districts in Karachi, Pakistan. Two health care facilities were selected from each district using a convenient sampling technique. The total sample size of this study was 690, equally distributed among 12 health care facilities. Results The majority of participants (33.47%) belonged to the age group of 40 to 49 years, while 29.85% of participants had an age between 30 to 39 years. More than half of the participants were females (50.87%). Overall, the multivariate analysis showed being male, married, younger, high educational status and employed were positively associated with quality of life. While having lower family income is negatively associated with quality of life. Conclusion The findings of this study had important implications for identifying distinct multimorbidity individuals who were at risk of a lower quality of life, and they emphasized the need for disease detection and treatment at an early stage. The study can also give important evidence for decision-makers when it comes to allocating health resources more efficiently, and health administrative departments can improve chronic disease management.
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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.
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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.
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Introduction The concept of illness severity scoring has been around for long and is currently being utilized in many neonatal intensive care unit (NICU). Scoring systems that help to quantify mortality risks on the basis of clinical conditions not only help in estimating prognosis, but also help clinicians in making decisions particularly in situations presenting with dilemmas. This study aims to determine SNAPPE-II (Score for Neonatal Acute Physiology-Perinatal Extension) score as a predictor of neonatal mortality in NICU at a tertiary care hospital in Pakistan. Methodology It was a longitudinal cohort study. The study was conducted at a neonatal intensive care unit (NICU) of Aga Khan University Hospital (AKUH) Karachi, Pakistan. All neonates were included who were born in AKUH and who needed respiratory support in NICU. Results A total of 333 newborns were enrolled for this study. Out of those 30 (9.1%) neonates expired while 298 (90.9%) survived. Area Under the Receiver operative curve was calculated to obtain the SNAPPE-II score's diagnostic discrimination ability. Area under the curve (AUC) was 80.2±4.6% which corresponds to a moderate diagnostic accuracy for the prediction of neonatal mortality. The 95% CI for this was between 71.1-89.2%. SNAPPE-II category III (>40) was found to be the strongest predictor of mortality, with a sensitivity of 40% and a specificity of 98.7%. Conclusion The SNAPPE-II scoring system, we conclude, might be a valuable technique for predicting newborn death in resource-constrained NICUs.
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OBJECTIVE: To determine the early breastfeeding initiation prevalence and factors associated with it in a rural seting. METHODS: The cross-sectional study was conducted at Eight areas of Thatta registed in MNHR from May 2019 to July 2019, and comprised data obtained from a larger survey related to exclusive breastfeeding among women in Thatta, Pakistan, in 2019. The survey had been conducted in areas registered with the Maternal and Neonatal Health Registry, which is a population-based study for developing countries to assess pregnancy-related outcomes. Data was analysed using Stata 16. RESULTS: There were 397 women with a mean age of 27.71±4.92 years. Of them, 305(76.8%) had not received any formal education, 45(11.3%) women had attended primary school, 278(70.1%) were unemployed, and 313(78.8%) had a monthly household income <7,500 rupees. Breastfeeding within the first hour of birth was initiated by 95(20.4%) mothers. Factors associated with early initiation were adequate knowledge, place of delivery, gestational age of the baby and the age of the mother (p<0.05). CONCLUSIONS: Providing counseling and health education to mothers before, during and after the pregnancy are important for motivating them to initiate breastfeeding early and continue exclusive breastfeeding for the recommended period of a minimum of 6 months.
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Breast Feeding , Data Analysis , Adult , Cross-Sectional Studies , Female , Humans , Infant , Infant, Newborn , Mothers , Parturition , Pregnancy , Young AdultABSTRACT
INTRODUCTION: Hip fractures are of major concern due to the aging population worldwide. Surgery on this vulnerable population carries high risk. Charlson comorbidity index (CCI), has been reported to predict the mortality in these patients. Investigators in this study aimed at studying the prediction effect of CCI on hip fracture surgery complications after controlling other patents' and procedures' related factors. METHODOLOGY: We conducted a retrospective cohort of 1045 patients with hip fractures who were treated surgically at our tertiary care and level 1 trauma Center between 2010 and 2018. Primary exposure was CCI and primary outcome was in-hospital and 30 days postoperative complications (major and minor). Cox proportional algorithm analysis was done at univariate and multivariable levels to report Crude Relative Risk (RR) and Adjusted Relative Risk (aRR), respectively. Results were reported in line with STROBE criteria. RESULTS: Exposed group included 867 (83%) of patients with 340 (39%) males. Postoperative complications occurred in 449 (43%) of the patients in exposed group with (62) 6% patients admitted in ICU postoperatively. At multivariable model, CCI was significantly associated with postoperative complications; patients with moderate-severe systemic diseases were 1.45 times (95% CI: 1.05-1.99) at risk of developing postoperative complications as compared to patients with low CCI scores after controlling for other variables in the model. Other significant factors included ASA status and postoperative ICU admission. CONCLUSION: CCI can be a good predictor independent variable of postoperative complications after hip fracture surgery. These patients need extra care and counseling to reach an informed decision keeping in mind the benefits versus risks of surgery. We recommend multi-center studies for corroboration.
