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Aortic stenosis (AS) is a prevalent condition among the elderly, characterized by the narrowing of the aortic valve, which, if untreated, can lead to heart failure and decreased quality of life in terms of reduced activity and high mortality in one to two years. Surgical aortic valve replacement (SAVR) has long been the standard treatment for AS. However, it poses significant risks, particularly in older patients with comorbidities. In recent years, transcatheter aortic valve replacement (TAVR) has emerged as a less invasive alternative and is increasingly used in low- and moderate-risk patients. This review seeks to assess the comparative outcomes of TAVR and SAVR in patients with moderate-risk AS. A systematic review was conducted in accordance with PRISMA guidelines, focusing on randomized controlled trials (RCTs) that compared TAVR and SAVR in this patient population. Also, the review included three major RCTs: PARTNER 2, UK TAVI, and DEDICATE. We analyzed the key outcomes of TAVR and SAVR, such as mortality, reintervention rates, complications (such as myocardial infarction, prosthetic valve endocarditis, and pacemaker implantation), and reintervention rates, to evaluate the relative efficacy and safety of TAVR and SAVR. The analysis included data from 4,359 patients across the three trials. TAVR demonstrated a lower all-cause mortality in two of the three trials, with an overall trend favoring TAVR in terms of survival. However, TAVR was associated with a higher incidence of prosthetic valve endocarditis, a greater need for pacemaker implantation, and more frequent reinterventions compared to SAVR. In conclusion, the findings suggest that TAVR may be a better option for moderate-risk AS patients, offering higher survival rates and a less invasive recovery process. While TAVR carries increased risks of endocarditis and pacemaker dependency, its overall benefits, particularly in terms of lower mortality and improved patient outcomes, make it a preferable option over SAVR for many patients. However, acknowledging potential limitations such as variations in trial design and differences in patient populations would indeed provide a more comprehensive perspective. Further research and long-term follow-up are essential to confirm these findings and refine patient selection criteria., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ajmal et al.)

Background Stroke  is a debilitating condition that adds morbidity to the patient and is an economic burden to society. Several modifiable risk factors can be identified and controlled, and dyslipidemia is one such under-diagnosed and least reported risk factor in Pakistan. We aimed to conduct this study to determine the frequency of dyslipidemia in ischemic stroke patients. Methodology We conducted a prospective cross-sectional study for seven months at Shalamar Hospital, Lahore, from November 2020 to May 2021. One hundred four patients were enrolled as per inclusion and exclusion criteria. After informed consent, a blood sample was taken from the patients and sent to a laboratory to determine dyslipidemia. Demographic details, history, and co-morbidities were also noted on a performa. All the collected data were analyzed in SPSS 20.0. Results The mean age was 53.09 ± 12.51 years. Of 104 patients, 60 (57.69%) were male, and 44 (42.31%) were females, with a male-to-female ratio of 1.4:1. The mean duration of disease in our study was 5.77 ± 3.33 hours. The mean BMI was 27.54 ± 3.03 kg/m2. In our study, the frequency of dyslipidemia in ischemic stroke patients was 39.42% (41 patients).  Conclusion This study concluded that dyslipidemia in ischemic stroke patients is very high in the Pakistani population. This highlighted the need to control this modifiable risk factor in the population. Strategic measures, including pharmacological therapy and diet modification, should be adopted, and awareness about the disease burden, control, and importance should be spread., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Khan et al.)

Background Epilepsy is described as an enduring disposition toward recurrent unprovoked seizures and by the neurobiological, cognitive, psychological, and social consequences of this condition. This study aimed to find the clinical characteristics and etiology of epilepsy in children aged below two years. Methodology This cross-sectional study was conducted at the department of pediatric neurology, the Children's Hospital and Institute of Child Health, Multan, Pakistan, from February 2021 to July 2021. During the study period, a total of 226 children of both genders, aged below two years, presenting with epilepsy and who underwent electroencephalography (EEG) were included. Socio-demographic and clinical data along with clinical features and radiological/imaging findings were noted. Results In a total of 226 children, 121 (53.5%) were male and 105 (46.5%) female. Overall, the mean age was calculated to be 14.6±5.2 months while 107 (47.3%) children were aged between 13 to 24 months. Residential status was found to be rural in 142 (62.8%) children. Generalized seizures (both primary and secondary) were reported in 205 (90.7%) children while the remaining 21 (9.3%) children had focal seizures. The most common etiology of epilepsy was noted to be structural/metabolic in 122 (54.0%) children. Abnormal EEG findings were observed among 150 (66.4%) children. Developmental delay (p=0.0016), hypotonia (p<0.0001), microcephaly or macrocephaly (p<0.0001), abnormal brain CT or MRI (p<0.0001), and abnormal EEG findings (p=0.0161) were found to have a significant association with etiology of epilepsy. Conclusion Generalized seizures like tonic-clonic and clonic types were the most common findings among children below two years of age with epilepsy. Structural abnormalities were the most common etiology in children with epilepsy. Age between one to two years was the commonest age of onset of seizures among young children., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Rehman et al.)

Background The coronavirus disease 2019 (COVID-19) vaccinations have brought new hope to the world and have a significant psychosocial impact on communities as well as healthcare systems around the globe. This study aimed to assess the antibody titer level among healthcare workers after at least six weeks of the second dose of the COVID-19 vaccine. Methods Participants of the study were healthcare workers of a tertiary care cardiac center including doctors, nursing staff, paramedics, and office staff. All participants were fully vaccinated with recommended double dose of available vaccine at least six weeks before the study. A blood sample of five milliliters was collected from all the participants by a trained phlebotomist at a local laboratory, and COVID-19 antibodies titer level was assessed using Food and Drug Administration (FDA) approved kit with a standard range of 1.0. This qualitative assay detects IgG and IgM as total antibodies targeted against nucleocapsid antigen performed on a fully automated cobas® 6000 analyzer (F. Hoffmann-La Roche Ltd, Basel, Switzerland) using electrochemiluminescence technology. COVID-19 antibodies titer levels were categorized as ≤100, 101-250, and >250. Results A total of 151 healthcare workers were included, of which 70.2% (106) were male. The history of COVID-19 infection before vaccination was found in 41.1% (62). The mean duration since the last dose of the vaccine was 89.6±40.07 days. In total 71.5% (108) had antibodies titer level of >250, which were mostly found in participants of younger age and who had previous COVID-19 infection. However, antibodies titer level of >250 were observed in 84% (21/25) at 61 to 90 days of vaccination, which declined to 80% (20/25) after 91 to 120 days and to 57.1% (32/56) after >120 days of vaccination. Conclusions Good antibodies titer levels were observed in vaccinated healthcare workers, especially in those who were younger and had previous COVID-19 infection., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Ammar et al.)

Background Basilic transposition arteriovenous fistula (BT AVF) is a viable option for dialysis-dependent patients, which can be performed under either general or regional anesthesia. Regional anesthesia is reported to cause vascular dilatation during the perioperative period, leading to improved fistula success. Regional anesthesia is also considered safe as compared to general anesthesia in terms of hemodynamic stability. Limited and conflicting data are available comparing regional versus general anesthesia in terms of fistula maturation and patency. We aimed to compare the maturation, one-year patency rates, and complication rates in patients undergoing single-stage BT AVF in regional versus general anesthesia. Methods This retrospective observational study was conducted on patients undergoing single-stage BT AVF from January 2016 to December 2019. Patients were divided into regional (RA) vs. general anesthesia (GA) groups and compared in terms of maturation, one-year patency, and perioperative complication rates. Results Out of 152 patients, 110 (72.37%) were in GA while 42 (27.63%) were in the RA group. Elderly, female, diabetic, ischemic heart disease, and American Society of Anesthesiologists (ASA) class IV patients were more in the RA group. Other comorbid and vascular access-related factors were comparable between the groups. A trend toward higher maturation rates (97.6% vs. 92.1%) and one-year patency rates (62.5% vs. 56.6%) was observed in the RA vs. GA group, however, the difference did not attain statistical significance, p=0.359 and p=0.327, respectively. The rate of access abandonment was higher in the GA group (43.4% vs. 37.5%). The most prevalent cause of abandonment was death in the RA group while it was access failure in the GA group. Overall complication rates were comparable between both groups (20.2 % vs. 17.5%, p=0.816). Conclusion Regional anesthesia is a useful technique with potentially improved maturation and patency rates. Nevertheless, an assumed benefit of regional anesthesia in terms of anesthesia-related complications was not observed., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Muhammad Saleh et al.)

Objective The aim of this study was to determine common microorganisms causing septicemia and their antimicrobial sensitivities in patients admitted to a tertiary care hospital. Methods A cross-sectional study was conducted using clinical criteria to diagnose patients as having septicemia where blood for culture and sensitivity (CS) was sent to the laboratory of a tertiary care hospital, Rehman Medical Institute, (Peshawar), Pakistan, during 2019. All patients diagnosed with septicemia regardless of age and gender were included in the study. The blood CS report was collected after 7-14 days of inoculation. Data were recorded on structured performa and analyzed using SPSS Version 20 (IBM Corp.). Results A total of 176 patients, with a mean age of 2.92±1.32 years, fulfilled the criteria for sepsis with a mean age of 2.92±1.32 years. Among them, 61.9% were male and 38.1% were female. Among common bacterial isolates, Staphylococcus aureus was found in 37.5% of samples followed by skin contaminants (18.2%), methicillin-resistant Staphylococcus aureus (MRSA) (14.8%), and Escherichia coli in (11.4% cases). None of the antibiotics had susceptibility of more than 60%. Susceptibility to piperacillin/tazobactam and ampicillin/sulbactam was found in 21.5% and 14.6% of the samples, respectively, while in cephalosporins, cefoxitin's susceptibility was 28.5%, whereas both ceftriaxone and cephazolin were equally effective in 19.4% cases. Furthermore, 38.9% of the samples were susceptible to ciprofloxacin and 24.3% to levofloxacin. The susceptibilities of amikacin and gentamicin in aminoglycosides were 56.3% and 47.2%, respectively, while that of imipenem and meropenem were 59.7% and 22.9%, respectively. Lastly, clindamycin had an efficacy in 42.4% of samples. Conclusion The susceptibility of bacterial isolates in septicemia to common antibiotics was low, thus risking therapeutic failure in septic patients. Widespread resistance may be due to the excessive use along with over-the-counter availability of antibiotics, which therefore requires regulation as it is an alarming situation., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Rehman et al.)

[This retracts the article DOI: 10.7759/cureus.5346.]., Competing Interests: No competing interests declared., (Copyright © 2019, Rehman et al.)

Introduction Poor adherence or non-adherence to the prescribed medications among heart failure (HF) patients is a common problem. This leads to hospital admission due to increased HF exacerbations, reduced physical function, and even death. The study was conducted to assess the heart failure medication adherence level, using Morisky Medication Adherence Scale (MMAS-8), among heart failure patients visiting the adult cardiology department of a tertiary care cardiac center in Karachi. Methods This cross-sectional study included patients diagnosed with heart failure visiting for the follow-up to both inpatient and outpatient departments of a tertiary care cardiac center of Karachi, Pakistan. Medication adherence level was assessed using a validated Morisky Medication Adherence Scale (MMAS-8). The total MMAS-8 score was calculated by adding all of the 8 individual question scores and patients with a score of eight were classified as adherent, otherwise non-adherent. Results A total of 200 patients were included in this study, out of which 61.5% (123) were male and 38.5% (77) were female. More than half, 54% (108), of the patients were rural residents and majority were Urdu (39.5%) speaking followed by Sindhi (19.5%) and Pashto (19.0%) speaking. Almost all, 99.5% (199) were married and 52% (104) patients were uneducated. Overall 76.5% (153) were adherent to the prescribed medication. And reaming 23.5% (47) were moderately adherent with MMAS-8 score of seven and six. Non-adherence to the prescribed medication is more common among rural residents and uneducated patients. Conclusion Non-adherence to the prescribed medication was observed in a significant number of heart failure patients (23.5%) in our population, and it was more common observation for the patients with rural residence and uneducated. It is important to counsel the patients about the importance of medication adherence to marginalize the re-hospitalization and complications these patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2019, Rehman et al.)