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Coronavirus disease 2019 (COVID-19) caused a pandemic with high morbidity & mortality worldwide. COVID19 is a highly infectious disease caused by severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) which started from China in 2019. It affected human with all ages but especially elderly and immune-compromised patients with co-morbidities may end up with high morbidity & mortality. In our study we analyzed the outcomes of post renal transplant patients with COVID-19 at our center.

The use of intracardiac echocardiography (ICE) is beneficial during the ablation of atrial fibrillation (AF). Evidence is conflicting regarding the clinical impact of using ICE on arrhythmia recurrence and mortality.Patients undergoing catheter ablation of AF during 2010-2017 were identified using the International Classification of Diseases-9th and 10th Revision-Clinical Modification (ICD-9-CM and ICD-10-CM) from the Nationwide Readmissions Database. Propensity matching was used to generate a control group. Patient demographics, Charlson comorbidity indexes, time from discharge to readmission, and the reason of readmission were extracted.From 2010 to 2017, 51 129 patients were included in the analysis out of which ICE was used in 8005 (15.7%) patients. The in-hospital mortality at readmission was significantly higher in the patients without ICE use (2.9% vs. 1.7%, p = .02). The length of stay (LOS) at readmission was significantly higher in non-ICE arm (median [interquartile range, IQR]: 3 [2-6] vs. 2 [3-5] days, p .0001) with similar healthcare-associated cost (HAC) in both the groups (median [IQR]: US$7507.3 [4057.8-15 474.2] vs. 7339.4 [4024.8-15 191.6], p = .43). Freedom from readmission was 12% higher (hazard ratio [HR] [95% confidence interval, CI]: 0.88 [0.83-0.94], p .0001) with the use of ICE at 90-day follow-up, which was driven by 24% reduction in heart failure (HF) at follow-up (HR [95% CI]: 0.76 [0.60-0.96], p = .02).ICE use during AF ablation procedure reduces readmissions at 90 days by 12%, driven by a 24% decrease in HF-related admissions. The non-ICE arm showed a significantly higher LOS which offsets marginally higher HAC in the ICE arm.

The kidney is the most vulnerable organ in coronavirus disease-2019 (COVID-19) patients besides the lungs, with evidence of acute kidney injury (AKI). We aimed to find the prevalence of AKI among COVID-19 patients and further evaluate the association of between COVID-19 and AKI along with an understanding of mortality. A prospective observational study was conducted among COVID-19 patients admitted to a tertiary care hospital, Hayatabad Medical Complex, between March 2020 and June 2020. Chi-square test was applied for comparative analysis, whereas for predictors of mortality, odds ratios (OR) were calculated using logistic regression. A total of 606 patients with COVID-19 were admitted to the dedicated ward, of which 250 (41.3%) had AKI and 190 (31.4%) died, whereas, patients having AKI presented 62.1% of mortality. Our study revealed a statistically significant association between AKI and mortality (OR = 3.5; P0.0001). Moreover, we observed a greater risk of deaths among patients with AKI stage I-III i.e., AKI stage I (OR = 2.4; P0.0001), stage II (OR = 5.5; P = 0.0001), and stage III (OR = 6.6; P0.0001). Our study reported AKI and associated mortality in a considerable number of patients with COVID-19. AKI patients have significantly higher chances of death versus non-AKI patients. Further, the risk of mortality increases with further deterioration in kidney function, i.e., patients with AKI stage III showed a higher mortality rate compared with stage II and stage I.

Emerging literature has highlighted the relationship between inflammatory and neuroinflammatory biomarkers and tinnitus. Neuroinflammation may help to explain the mechanisms underpinning hyperactivity in the cochlea, cochlear nucleus, inferior colliculus, medial geniculate body, and the auditory cortex in those with tinnitus. Glial activation and pro-inflammatory cytokines may cause excitatory-inhibitory synaptic imbalance. Advancing our understanding of these mechanisms may help elucidate the pathogenesis of tinnitus and lead to improvement in subtyping subjective tinnitus. The chapter explores our current understanding of the neuroinflammatory model within the context of the classical auditory pathway and what we can infer about the underlying mechanisms based on these studies.

Patients with end-stage renal disease (ESRD) on maintenance dialysis have an increased risk of ischaemic events, such as recurrent myocardial infarction (MI) and stroke. Potent antiplatelet therapy may help mitigate this risk. Nonetheless, ERSD patients are also at increased risk of bleeding due to their complex vascular milieu, which limits the routine use of potent P2Y

Epileptogenic zone (EZ) localization is a crucial step during diagnostic work up and therapeutic planning in medication refractory epilepsy. In this paper, we present the first deep learning approach to localize the EZ based on resting-state fMRI (rs-fMRI) data.Our network, called DeepEZ, uses a cascade of graph convolutions that emphasize signal propagation along expected anatomical pathways. We also integrate domain-specific information, such as an asymmetry term on the predicted EZ and a learned subject-specific bias to mitigate environmental confounds.We validate DeepEZ on rs-fMRI collected from 14 patients with focal epilepsy at the University of Wisconsin Madison. Using cross validation, we demonstrate that DeepEZ achieves consistently high EZ localization performance (Accuracy: 0.88 ± 0.03; AUC: 0.73 ± 0.03) that far outstripped any of the baseline methods. This performance is notable given the variability in EZ locations and scanner type across the cohort.Our results highlight the promise of using DeepEZ as an accurate and noninvasive therapeutic planning tool for medication refractory epilepsy.While prior work in EZ localization focused on identifying localized aberrant signatures, there is growing evidence that epileptic seizures affect inter-regional connectivity in the brain. DeepEZ allows clinicians to harness this information from noninvasive imaging that can easily be integrated into the existing clinical workflow.

Objective: To find out the frequency of benign and malignant skin adnexal neoplasms. Study design: Descriptive study. Materials and methods: It is a descriptive study in which we studied all cases of skin adnexal tumors that are registered in Mayo hospital over the period of six months. Tumors were evaluated according to the type and site , age and gender of the patient. The tumors are classified by WHO classification. Data collected was analyzed using SPSS Version 21 for statistical analysis. Results: 45 skin adnexal tumors were studied in which, 40 (88.9%) were benign and 5 (11.1%) were malignant. Conclusion: Skin adnexal tumors are comparatively uncommon lesions. Benign neoplasms are more frequent than malignant.

A comprehensive strategy has been developed to construct nano-sized homogeneous and heterogeneous core/shell structures of NaYF4 host. Synthesis conditions of cubic phase/α-NaYF4 and hexagonal phase/β-NaYF4 are discussed. Pure cubic NaYF4:Yb,Er nanocrystals were synthesized with different average sizes extending from 7 nm to 15 nm by varying the reaction time. Temperature and time thresholds of hexagonal nucleation were determined and utilized for controlled core/shell structures of different phases. α-NaYF4:Yb,Er@α-NaYF4, α-NaYF4:Yb,Er@β-NaYF4, β-NaYF4:Yb,Er@α-NaYF4, and β-NaYF4:Yb,Er@β-NaYF4 core/shell structures were prepared by adopting the required conditions to achieve the desired phase. Excess sodium was used to grow hexagonal shell over metastable cubic core under controlled conditions of reaction time and temperature to prevent the structural transition of the core. Upconversion emission spectra have also been obtained. UCL integrated intensities demonstrated about 5-fold enhancement for α-shell over α-core as compared to the core alone and 22-fold enhancement with β-shell. On the other hand, α-shell over β-core exhibited 5-fold enhancement and β-shell over β-core exhibited 6-fold enhancement.

BACKGROUND: Occipital-cervical fusion (OCF) and ventral decompression (VD) may be used in the treatment of pediatric Chiari-1 malformation (CM-1) with syringomyelia (SM) as adjuncts to posterior fossa decompression (PFD) for complex craniovertebral junction pathology. OBJECTIVE: To examine factors influencing the use of OCF and OCF/VD in a multicenter cohort of pediatric CM-1 and SM subjects treated with PFD. METHODS: The Park-Reeves Syringomyelia Research Consortium registry was used to examine 637 subjects with cerebellar tonsillar ectopia ≥ 5 mm, syrinx diameter ≥ 3 mm, and at least 1 yr of follow-up after their index PFD. Comparisons were made between subjects who received PFD alone and those with PFD + OCF or PFD + OCF/VD. RESULTS: All 637 patients underwent PFD, 505 (79.2%) with and 132 (20.8%) without duraplasty. A total of 12 subjects went on to have OCF at some point in their management (PFD + OCF), whereas 4 had OCF and VD (PFD + OCF/VD). Of those with complete data, a history of platybasia (3/10, P = .011), Klippel-Feil (2/10, P = .015), and basilar invagination (3/12, P

Objective: To evaluate stent patency with and without endoscopic sphincterotomy in malignant biliary obstruction. Methods: This prospective study was conducted in Endoscopy Suite, Surgical Unit IV, Civil Hospital Karachi from April, 2021 to January, 2022 for a period of 10 months. Patients undergoing ERCP for inoperable malignant biliary obstruction were randomized into EST group and non EST group. Stent patency was the primary end point. Patients were evaluated for resolution of jaundice, bleeding, perforation, pancreatitis and cholangitis. Statistical analysis was performed using the SPSS version 22. Results: Total number of patients was 83. Out of which 48 patients were in EST group and 35 in non EST group. 55 pts were male and 28 were female with a mean age of 64.2 ± 7.2 yrs. Stent patency was higher in non EST group (74.28% vs 68% P < 0.05). There was no significant difference in other complications between the two groups. Conclusion: In our study stent patency was significantly higher in non EST group.

Background: The patients' physiological state, morbidity rates following emergency laparotomies can be misleading. There are a number of surgical risk assessments that are widely used, including the Portsmouth-POSSUM (P-POSSUM), a version of the physiologic and operational severity score that is used to count the number of deaths during surgery. These facts are frequently acquired from the operation room itself. Objective: The purpose of this study is to investigate the predictive efficacy of the P-POSSUM scores in patients receiving emergency laparotomy. Methodology: Civil Hospital Karachi's emergency department patients were the subjects of a cross-sectional, qualitative, prospective study. Our target enrollment is 90 patients during the course of the research. People who come from the hospital's emergency room will be included in the study. A Google form will be filled out for each patient with their demographics and the type of admission, ASA grade, urgency of surgery, P-POSSUM score, indication of surgery, length of stay and outcome cardiac signs (GCS, GCS, Cardiac Status Hb, WBC, operative parameters), operative blood loss, peritoneal examination, malignancy status, physiology score, operative severity and morbidity calculator and mortality measures. Results: The average age of the study's 100 participants was 44.37 years with 16.541 Std. P-POSSUM projected a morbidity mean of 43.82 with 31.8 Std, but P-POSSUM predicted a mortality mean of 10.37 with 16.89 Std. Chi-square tests revealed considerable link between observed and anticipated mortality, with P values of 0.003 for P- POSSUM indicating meaningful association. Whereas, anticipated morbidity value which significantly overestimates actual morbidity. There is no correlation between P-POSSUM's overestimation of morbidity and a P value of 0.521 in a correlation test. Conclusion: P-POSSUM appear to be good and valid markers for use in the risk prediction of morbidity and mortality in the Pakistani population

Background Pleural effusions can occur due to acute pericarditis and can necessitate intervention. We sought to add to the evidence base by performing a retrospective review of patients presenting to the advanced cardiac imaging unit with pericarditis and pleural effusion to determine laterality, trends in pleural fluid analyses, and the need for pleural intervention. Local ethical (Caldicott) approval was obtained for this study. Methodology Descriptive statistical methodology was applied with continuous data presented as mean (standard deviation, SD; range) and categorical variables as frequencies or percentages. Results In 60 patients with pericarditis, 24 (39%) had pleural effusions on contemporaneous imaging. The mean age of the study population was 63.3 years (range: 20-83), and 17 patients were males. Diagnoses were viral (five), rheumatological (one), amyloidosis (one), listeria (one), and the rest idiopathic (17). Four effusions were only left-sided, one right-sided, and 20 bilateral. Ten pleural taps were performed, one for a unilateral effusion and nine for one side being bigger than the other. The mean pH was 7.46 (7.33-7.6), mean lactate dehydrogenase was 210 (74-393 U/L), mean fluid protein was 36.1 (19-56 g/L) (four effusions exudative/three transudative), mean glucose was 5.8 (4.8-6.8 mmol/L), and all cytologies were negative. Five patients underwent large volume aspirations for symptom control. Three indwelling pleural catheters (IPC) were placed for treatment refractory effusions. There was one pleural space infection in six months related to an IPC. There were three deaths at 12 months, with none related to pericarditis. Conclusions Pleural effusions associated with pericarditis are usually small, bilateral, and exudative. Treatment refractory cases require pleural intervention, with aspirations, drains, and IPCs being viable options. Further prospective studies are warranted.

This review describes the clinical presentations and treatment options for commonly recognized epilepsy syndromes in the pediatric age group, based on the 2017 International League Against Epilepsy classification. Structural epilepsies that are amenable to surgical intervention are discussed. Lastly, emerging technologies are reviewed that are expanding our knowledge of underlying epilepsy pathologies and will guide future syndromic classification systems including genetic testing and tissue repositories.

Linear regression can be applied to time series data to extract model parameters such as the effective force and friction constant matrices of the system. Even highly nonlinear systems can be analyzed by linear regression, if the total amount of data is broken up into shorter “time windows”, so that the dynamics is considered to be piece-wise linear. Traditionally, linear regression has been performed on the equation of motion itself (which approach we refer to as LRX). There has been surprisingly little published on the accuracy and reliability of LRX as applied to time series data. Here we show that linear regression can also be applied to the time correlation function of the dynamical observables (which approach we refer to as LRC), and that this approach is better justified within the context of statistical physics, namely, Zwanzig-Mori theory. We test LRC against LRX on a simple system of two damped harmonic oscillators driven by Gaussian random noise. We find that LRC allows one to improve the signal to noise ratio in a way that is not possible within LRX. Linear regression using time correlation functions (LRC) thus appears to be not only better justified theoretically, but it is more accurate and more versatile than LRX.

Aim Total thyroidectomy, being a common surgical option, for multinodular goitre and selective cases of Graves’ disease, is associated with risks related to temporary hypocalcaemia and vocal quality dysfunction. Dexamethasone, as a steroid, has well-established anti-inflammatory and immune-modulating effects. As researchers continue to understand its pathophysiology on hypocalcaemia and voice quality, we aim to assess the effect of preoperative dexamethasone used to improve hypocalcaemia and vocal cord function/post-thyroidectomy voice disorder. Methods We conducted a single-centre, non-randomised, double-blinded placebo-controlled, parallel-group study with short follow-up in a public sector hospital from January 2014 to December 2019. Patients were equally distributed in two groups to compare the effect of dexamethasone with placebo on hypocalcaemia and vocal cord function/post-thyroidectomy voice disorder Results Out of 192 patients, 36 (18.75) male patients while 156 (81.25) were female. Age range was 18 to 60. Eighteen patients had both low calcium level at 24 hours after the operation and hypocalcemic symptoms, of which 4 remain to have hypocalcaemia on third postoperative day. Forty patients defined as having voice dysfunction at 24 hours after being scored using Voice scale. Of these 40 patients with voice dysfunction, 8 had low calcium level in blood at 24 hours while only 2 of these remained with low calcium level on third postoperative day. 6/8 patients had symptomatic hypocalcaemia on first postoperative day. Conclusions Single-dose dexamethasone, during the preoperative period, is as safe and as effective in improving transient postoperative hypocalcaemia and Temporary vocal quality dysfunction/post-thyroidectomy voice disorder.

Background The evaluation of neuromuscular diseases includes detailed clinical assessment, blood testing, electrodiagnostic studies (EDS), biopsy, and genetic tests. EDS alone cannot provide a specific diagnosis. Further testing in the form of genetic tests or muscle biopsy (MB) is required. Objective The objective of the study is to evaluate the yield of MB in patients with findings of myopathy on electrodiagnostic testing and assess the factors affecting an abnormal biopsy outcome. Methods Electromyography (EMG)/nerve conduction studies (NCS) performed for suspected myopathy over 5 years from 2011 to 2016, at the neurophysiology department of a tertiary care center in Pakistan, were reviewed. Based on inclusion criteria, records of 58 patients were retrospectively reviewed. Results After an EMG/NCS diagnosis of myopathy, the frequency of MB testing was only 10.1%. The median age of patients was 26.5 years. The clinically suspected diagnosis was categorized into hereditary myopathy (n = 15, 25.9%) and acquired myopathy (n = 18, 31%). The positive predictive value of EMG is 77.2%. Twenty-eight (48.2%) patients had abnormal MB whereas 20 (34.4%) revealed normal findings. Factors significantly influencing an abnormal outcome of biopsy included moderate-to-severe elevation of creatine kinase (>2,000 U/L),presence of denervation changes, and severe myopathy on EMG. Conclusion Even though the overall yield of MB testing may not be very high in our setting due to the unavailability of special techniques and expertise, certain factors can help to improve the diagnostic yield. Clinicians should encourage MB testing, especially in cases with strong clinical, laboratory and electrodiagnostic suspicion, and absence of genetic testing for suspected myopathy.

An extraosseous intradural presentation for a sacral chordoma in the pediatric age group has not been reported to date. This is a report on an 11-year-old boy who presented with an extraosseous, intradural sacral chordoma. He underwent gross-total resection and received adjuvant proton beam therapy. Neoplastic transformation of the notochord is reviewed to illustrate the developmental basis for the surgical anatomy and pathogenesis of the classic chordoma variant. Clinical and pathological features are reviewed to differentiate this chordoma presentation from classic osseous chordomas and ecchordosis physaliphora, a related benign developmental notochordal lesion. Finally, the role of developmental signaling in the pathogenesis of chordomas from postembryonic notochordal tissue is discussed.

An accurate enthalpy model for CO2-CH4-H2S-N2-brine fluid system is proposed in this work. For the gas system (CO2-CH4-H2S-N2), the model is based on Peng-Robinson EOS enthalpy deviation to calculate real gas system specific enthalpy. For the brine system, the model extends conventional saturation state enthalpy model considering pressure effect along with the temperature and salinity effects. For the dissolution heat, the model combines phase equilibrium parameters to describe the gas dissolved enthalpy. The model can predict CO2-CH4-H2S-N2-brine fluid system enthalpy well with temperature range from 0 to 300 ℃, pressure range from 0 to 1000 bar and salinity range from 0 to 6 mol/kg water. The model performs favorable with respect to existing experimental data and other models and reproduces reliable data for pure water, various salinity of brine and gas systems.

In this work, Mn2+-doped ZnS nanorods were synthesized by a facile hydrothermal method. The morphology, structure, and composition of the as-prepared samples were investigated. The temperature-dependent photoluminescence of ZnS:Mn nanorods was analyzed, and the corresponding activation energies were calculated by using a simple two-step rate equation. Mn2+-related orange emission (4T1 → 6A1) demonstrates high stability and is comparatively less affected by the temperature variations than the defect-related emission. A metal–semiconductor–metal junction ultraviolet photodetector based on the nanorod networks has been fabricated by a cost-effective method. The device exhibits visible blindness, superior ultraviolet photodetection with a responsivity of 1.62 A/W, and significantly fast photodetection response with the rise and decay times of 12 and 25 ms, respectively.

In the case of sports injuries which occur in the ordinary course of the practice of sport, delictual liability may be excluded as a result of voluntary assumption of risk, also known as consent to the risk of injury (a ground of justification) which is embodied in the well-known maxim volenti non fit iniuria (Hattingh v Roux 2011 5 SA 135 (WCC) 141 hereinafter “Hattingh”; Prinsloo “Liability inSport and Recreation” 1991 TSAR 42–43; and Stoffberg v Elliott 1923 (CPD) 148–149). There is no doubt of the risk of injury inherent in sport, and all participants such as players, coaches, referees, supervisors, managers or spectators are at risk. In order to exclude delictual liability based on a successful reliance of voluntary assumption of risk as a ground of justification, all the requirements for consent must be present. In Hattingh, the court had to decide inter alia whether the plaintiff (R) voluntarily assumed the risk of injuryinherent in participating in a game of rugby. In this note, Hattingh is discussed with specific reference to the delictual elements of wrongfulness and fault, and the defence of voluntary assumption of risk. Reference is also made to other cases dealing with the defence.

We propose a novel neural network architecture, SZTrack, to detect and track the spatio-temporal propagation of seizure activity in multichannel EEG. SZTrack combines a convolutional neural network encoder operating on individual EEG channels with recurrent neural networks to capture the evolution of seizure activity. Our unique training strategy aggregates individual electrode level predictions for patient-level seizure detection and localization. We evaluate SZTrack on a clinical EEG dataset of 201 seizure recordings from 34 epilepsy patients acquired at the Johns Hopkins Hospital. Our network achieves similar seizure detection performance to state-of-the-art methods and provides valuable localization information that has not previously been demonstrated in the literature. We also show the cross-site generalization capabilities of SZTrack on a dataset of 53 seizure recordings from 14 epilepsy patients acquired at the University of Wisconsin Madison. SZTrack is able to determine the lobe and hemisphere of origin in nearly all of these new patientswithout retraining the network. To our knowledge, SZTrack is the first end-to-end seizure tracking network using scalp EEG.

Accurate and quantitative numerical modeling of phase behavior and speciation of gas-water-rock systems is crucial for fluid and rock evolution analysis, and important in scientific research and engineering applications. In our previous work, mutual solubility models of series gases and brine have been developed for wide temperature, pressure and composition ranges. The gas components included CO

OBJECTIVES (1) To evaluate adequacy and reproducibility of the gravity and manual stress imaging in the diagnosis of unstable ankle fractures and (2) to evaluate the diagnostic utility of lateral talar displacement ratio (LTDR) derived in relation to the talar body width on ankle stress imaging. DESIGN Retrospective cohort study. SETTING Level 1 Trauma Center. PATIENTS One hundred seventy consecutive patients who presented with supination-external rotation 2 ankle fractures (OTA/AO 44-B2.1) requiring dynamic stress testing. INTERVENTION Dynamic stress imaging to determine ankle stability. MAIN OUTCOME MEASURE Ankle instability and subsequent need for surgical fixation as determined by dynamic stress imaging. RESULTS No statistical significant difference was found between the adequacy of gravity stress radiographs and manual stress images in regards to surgical decision-making (P = 0.595). Using manual and gravity stress images, receiver operating characteristic curves were generated for medial clear space (MCS) (area under the curve = 0.793, 0.901) and LTDR (0.849, 0.850), corresponding to thresholds of 10.5% and 10.2% for manual and gravity, respectively. Seventy-three of 105 patients (69.5%) with MCS > 5 mm and 62 of 75 patients (82.7%) with LTDR > 10% were offered surgical intervention. Sixty-two of the 77 patients (80.5%) offered surgery had both MCS > 5 mm and LTDR > 10%. CONCLUSION This study shows that manual stress radiographs are just as effective as gravity stress radiographs in making an assessment of ankle fracture stability as there was no difference in diagnostic value between gravity and manual stress imaging in regards to surgical decision-making. Use of additional radiographic measurements such as the LTDR can provide additional information in determining stability when MCS is within a clinical gray area. LEVEL OF EVIDENCE Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

A comprehensive strategy has been developed to construct nano-sized homogeneous and heterogeneous core/shell structures of NaYF

Highlights • Temporal encephalocele is a treatable cause of drug-resistant epilepsy. • Stereo-EEG can better localize seizure onset and identify potential post-op deficits. • We present a neurophysiologic illustration of an important anatomic relationship., Temporal lobe encephalocele has emerged as a potentially unrecognized cause of drug-resistant temporal lobe epilepsy (TLE) that can be effectively treated with epilepsy surgery. Here we present a case in which a 17-year-old male with drug-resistant epilepsy and left temporal encephalocele underwent workup for epilepsy surgery, and experienced unexpected pain with electrocortical stimulation. Stimulation of stereo-EEG electrodes in the left temporal pole resulted in severe, unilateral left-sided facial pain due to inadvertent stimulation of the trigeminal nerve. Stereo-EEG showed seizure onset adjacent to encephalocele with no involvement of mesial temporal structures. A temporal pole resection sparing the mesial temporal structures and repair of the sphenoid bone defect was performed. The patient experienced post-operative seizure freedom, with no loss of language function or sensory deficits in the distribution of the trigeminal nerve. This case highlights temporal encephalocele as a potentially overlooked cause of TLE and underscores the anatomical proximity of the trigeminal nerve to the temporal pole, an important consideration for surgical planning.

Background Inappropriate medication dosing can cause adverse drug reactions or ineffective therapy due to declined renal function in patients with renal insufficiency. This necessitates proper renal dose adjustment. This study was proposed to evaluate medication dosage adjustment in hospitalized chronic kidney disease (CKD) patients. Methods This study included all CKD patients hospitalized between May 1, 2019, and April 25, 2020, at the Institute of Kidney Disease, Peshawar, Pakistan. The estimated glomerular filtration rate was calculated using the Modification of Diet in Renal Disease formula, and dose appropriateness was established by evaluating practice with relevant reference books. Results Of the total 1,537 CKD patients, 231 (15.03%) had evidence of dosing error, which was considered for final analysis. Overall, 1,549 drugs were prescribed; 480 (30.99%) drugs required dose adjustment, of which 196 (40.42%) were adjusted properly and the remaining 286 (59.58%) were unadjusted. The most common unadjusted drugs were meropenem, cefepime, ciprofloxacin, and rosuvastatin, whereas captopril, aspirin, bisoprolol, pregabalin, and levofloxacin had the highest percentage of adjusted drugs. On multivariate logistic regression, the number of drugs requiring dosing adjustments and obstructive nephropathy were found to be statistically significant factors that increased the likelihood of the medication dosing errors: a unit increase in the number of drugs requiring dose adjustment increases 5.241 times the likelihood of dosing error. Similarly, the presence of obstructive nephropathy (OR: 0.383; 95% Cl: 0.153-0.960; p = 0.041) was found to be significantly associated with dosing error after adjustment for potential confounding factors. Conclusion The dosing of more than half of the prescribed drugs that required adjustment in CKD patients was not adjusted, which showed that medication dosing errors were high. This highlights the importance of medication prescription according to guidelines in these patients to improve the outcomes of pharmacotherapy.

The version of Fig. 5 in the initial online publication was incorrect. The original article has been corrected.