Loading…

Hyponatremia Prevalence in Decompensated Chronic Liver Disease: Insights from a Tertiary Care Hospital

Liver cirrhosis is a prominent global contributor to mortality, and hyponatremia is a common complication in patients with decompensated chronic liver disease (DCLD). Hyponatremia is characterized by kidney impairment when eliminating solute-free water. The presence of contradictory findings in exis...

Full description

Saved in:
Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2024-09, Vol.16 (9), p.e68907
Main Authors: Azam, Muhammad Usman, Saeed, Najam-Us-Sehar, Javed, Salman, Memon, Muuhammad Yousuf Y, Aftab, Muhammad Asad, Shafqat, Muhammad Nabeel, Sadiq, Hafiz Zeeshan, Maqbool, Arman, Mand Khan, Fasih, Zahoor, Faizan
Format: Article
Language:English
Subjects:
Citations: Items that this one cites
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
cited_by
cites cdi_FETCH-LOGICAL-c262t-6f3a5f789a2b67a4c17a9737325a76d84120efd9e941d2a5f453787b134370bd3
container_end_page
container_issue 9
container_start_page e68907
container_title Curēus (Palo Alto, CA)
container_volume 16
creator Azam, Muhammad Usman
Saeed, Najam-Us-Sehar
Javed, Salman
Memon, Muuhammad Yousuf Y
Aftab, Muhammad Asad
Shafqat, Muhammad Nabeel
Sadiq, Hafiz Zeeshan
Maqbool, Arman
Mand Khan, Fasih
Zahoor, Faizan
description Liver cirrhosis is a prominent global contributor to mortality, and hyponatremia is a common complication in patients with decompensated chronic liver disease (DCLD). Hyponatremia is characterized by kidney impairment when eliminating solute-free water. The presence of contradictory findings in existing literature prompted this study. The objective of this study was to determine the prevalence of hyponatremia in patients with DCLDs presenting at a tertiary care hospital.  This six-month cross-sectional study was performed at the Allied Institute of Medical Sciences Teaching Hospital in Gujranwala, Pakistan, from January 2022 to June 2022. A total of 133 patients were selected as subjects. Researchers took blood samples from these patients and sent the samples to the hospital pathology lab for evaluation of serum sodium levels. If sodium levels were ≤130 mmol/L, the patient was considered to have hyponatremia. All information was recorded on proforma.  The mean age of patients was 47.68 ± 12.89 years. Overall, 80 (60.15%) were male, and 53 (39.85%) female. The mean BMI of patients was 23.20 ± 3.11 kg/m and the average duration of DCLD was 7.24 ± 4.12 years. Among participants, 48 (36.09%) patients had hyponatremia, whereas 85 (63.91%) did not have hyponatremia. The mean sodium level was 132.39 ± 11.37 mEq/L. Stratified analysis based on patient age revealed that among patients aged 21-45 years, 27 (45.8%) had hyponatremia, whereas, in the group aged 46-70 years, 21 (28.4%) had hyponatremia with a p-value < 0.05. Stratification of the basis of BMI, among underweight patients, all eight (100%) had hyponatremia, whereas of overweight patients, 14 (31.1%) had hyponatremia. This difference was statistically significant (p < 0.05). The prevalence of hyponatremia was notably elevated among individuals suffering from DCLD. Age and BMI were the most common risk factors for hyponatremia among subjects with DCLD. This study recommends that patients with DCLD should have their serum sodium levels screened at regular intervals to prevent complications, including encephalopathy, which occurs particularly in younger and underweight DCLD patients.
doi_str_mv 10.7759/cureus.68907
format article
fullrecord <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11458934</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3114500534</sourcerecordid><originalsourceid>FETCH-LOGICAL-c262t-6f3a5f789a2b67a4c17a9737325a76d84120efd9e941d2a5f453787b134370bd3</originalsourceid><addsrcrecordid>eNpd0c9LHDEUB_BQlCpbbz2XgBcPrs2PmSTjRWRtu8KCHvQc3mbeuJGZZExmFvzvHV0rtqc8yIcv7_El5DtnZ1qX1U83JhzzmTIV01_IoeDKzA03xd6n-YAc5fzIGONMC6bZV3IgK2l4ofQhaZbPfQwwJOw80NuEW2gxOKQ-0Ct0sesxZBiwpotNisE7uvJbTPTKZ4SM5_Q6ZP-wGTJtUuwo0DtMg4f0TBeQkC5j7v0A7Tey30Cb8ej9nZH737_uFsv56ubP9eJyNXdCiWGuGgllo00FYq00FI5rqLTUUpSgVW0KLhg2dYVVwWsx0aKU2ug1l4XUbF3LGbnY5fbjusPaYRgStLZPvpt2shG8_fcn-I19iFvLeVGaaoqZkZP3hBSfRsyD7Xx22LYQMI7ZylfJWPlGj_-jj3FMYbpvUkKYUinJJ3W6Uy7FnBM2H9twZl9LtLsS7VuJE__x-YIP_Lcy-QIXpZlV</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3122856631</pqid></control><display><type>article</type><title>Hyponatremia Prevalence in Decompensated Chronic Liver Disease: Insights from a Tertiary Care Hospital</title><source>PubMed Central Free</source><source>ProQuest - Publicly Available Content Database</source><creator>Azam, Muhammad Usman ; Saeed, Najam-Us-Sehar ; Javed, Salman ; Memon, Muuhammad Yousuf Y ; Aftab, Muhammad Asad ; Shafqat, Muhammad Nabeel ; Sadiq, Hafiz Zeeshan ; Maqbool, Arman ; Mand Khan, Fasih ; Zahoor, Faizan</creator><creatorcontrib>Azam, Muhammad Usman ; Saeed, Najam-Us-Sehar ; Javed, Salman ; Memon, Muuhammad Yousuf Y ; Aftab, Muhammad Asad ; Shafqat, Muhammad Nabeel ; Sadiq, Hafiz Zeeshan ; Maqbool, Arman ; Mand Khan, Fasih ; Zahoor, Faizan</creatorcontrib><description>Liver cirrhosis is a prominent global contributor to mortality, and hyponatremia is a common complication in patients with decompensated chronic liver disease (DCLD). Hyponatremia is characterized by kidney impairment when eliminating solute-free water. The presence of contradictory findings in existing literature prompted this study. The objective of this study was to determine the prevalence of hyponatremia in patients with DCLDs presenting at a tertiary care hospital.  This six-month cross-sectional study was performed at the Allied Institute of Medical Sciences Teaching Hospital in Gujranwala, Pakistan, from January 2022 to June 2022. A total of 133 patients were selected as subjects. Researchers took blood samples from these patients and sent the samples to the hospital pathology lab for evaluation of serum sodium levels. If sodium levels were ≤130 mmol/L, the patient was considered to have hyponatremia. All information was recorded on proforma.  The mean age of patients was 47.68 ± 12.89 years. Overall, 80 (60.15%) were male, and 53 (39.85%) female. The mean BMI of patients was 23.20 ± 3.11 kg/m and the average duration of DCLD was 7.24 ± 4.12 years. Among participants, 48 (36.09%) patients had hyponatremia, whereas 85 (63.91%) did not have hyponatremia. The mean sodium level was 132.39 ± 11.37 mEq/L. Stratified analysis based on patient age revealed that among patients aged 21-45 years, 27 (45.8%) had hyponatremia, whereas, in the group aged 46-70 years, 21 (28.4%) had hyponatremia with a p-value &lt; 0.05. Stratification of the basis of BMI, among underweight patients, all eight (100%) had hyponatremia, whereas of overweight patients, 14 (31.1%) had hyponatremia. This difference was statistically significant (p &lt; 0.05). The prevalence of hyponatremia was notably elevated among individuals suffering from DCLD. Age and BMI were the most common risk factors for hyponatremia among subjects with DCLD. This study recommends that patients with DCLD should have their serum sodium levels screened at regular intervals to prevent complications, including encephalopathy, which occurs particularly in younger and underweight DCLD patients.</description><identifier>ISSN: 2168-8184</identifier><identifier>EISSN: 2168-8184</identifier><identifier>DOI: 10.7759/cureus.68907</identifier><identifier>PMID: 39381467</identifier><language>eng</language><publisher>United States: Cureus Inc</publisher><subject>Age ; Ascites ; Females ; Gastroenterology ; Gender ; Hyponatremia ; Internal Medicine ; Liver cirrhosis ; Liver diseases ; Mortality ; Overweight ; Patients ; Sample size ; Sodium ; Teaching hospitals ; Thyroid gland</subject><ispartof>Curēus (Palo Alto, CA), 2024-09, Vol.16 (9), p.e68907</ispartof><rights>Copyright © 2024, Azam et al.</rights><rights>Copyright © 2024, Azam et al. This work is published under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright © 2024, Azam et al. 2024 Azam et al.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c262t-6f3a5f789a2b67a4c17a9737325a76d84120efd9e941d2a5f453787b134370bd3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/3122856631/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/3122856631?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25753,27924,27925,37012,37013,44590,53791,53793,75126</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39381467$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Azam, Muhammad Usman</creatorcontrib><creatorcontrib>Saeed, Najam-Us-Sehar</creatorcontrib><creatorcontrib>Javed, Salman</creatorcontrib><creatorcontrib>Memon, Muuhammad Yousuf Y</creatorcontrib><creatorcontrib>Aftab, Muhammad Asad</creatorcontrib><creatorcontrib>Shafqat, Muhammad Nabeel</creatorcontrib><creatorcontrib>Sadiq, Hafiz Zeeshan</creatorcontrib><creatorcontrib>Maqbool, Arman</creatorcontrib><creatorcontrib>Mand Khan, Fasih</creatorcontrib><creatorcontrib>Zahoor, Faizan</creatorcontrib><title>Hyponatremia Prevalence in Decompensated Chronic Liver Disease: Insights from a Tertiary Care Hospital</title><title>Curēus (Palo Alto, CA)</title><addtitle>Cureus</addtitle><description>Liver cirrhosis is a prominent global contributor to mortality, and hyponatremia is a common complication in patients with decompensated chronic liver disease (DCLD). Hyponatremia is characterized by kidney impairment when eliminating solute-free water. The presence of contradictory findings in existing literature prompted this study. The objective of this study was to determine the prevalence of hyponatremia in patients with DCLDs presenting at a tertiary care hospital.  This six-month cross-sectional study was performed at the Allied Institute of Medical Sciences Teaching Hospital in Gujranwala, Pakistan, from January 2022 to June 2022. A total of 133 patients were selected as subjects. Researchers took blood samples from these patients and sent the samples to the hospital pathology lab for evaluation of serum sodium levels. If sodium levels were ≤130 mmol/L, the patient was considered to have hyponatremia. All information was recorded on proforma.  The mean age of patients was 47.68 ± 12.89 years. Overall, 80 (60.15%) were male, and 53 (39.85%) female. The mean BMI of patients was 23.20 ± 3.11 kg/m and the average duration of DCLD was 7.24 ± 4.12 years. Among participants, 48 (36.09%) patients had hyponatremia, whereas 85 (63.91%) did not have hyponatremia. The mean sodium level was 132.39 ± 11.37 mEq/L. Stratified analysis based on patient age revealed that among patients aged 21-45 years, 27 (45.8%) had hyponatremia, whereas, in the group aged 46-70 years, 21 (28.4%) had hyponatremia with a p-value &lt; 0.05. Stratification of the basis of BMI, among underweight patients, all eight (100%) had hyponatremia, whereas of overweight patients, 14 (31.1%) had hyponatremia. This difference was statistically significant (p &lt; 0.05). The prevalence of hyponatremia was notably elevated among individuals suffering from DCLD. Age and BMI were the most common risk factors for hyponatremia among subjects with DCLD. This study recommends that patients with DCLD should have their serum sodium levels screened at regular intervals to prevent complications, including encephalopathy, which occurs particularly in younger and underweight DCLD patients.</description><subject>Age</subject><subject>Ascites</subject><subject>Females</subject><subject>Gastroenterology</subject><subject>Gender</subject><subject>Hyponatremia</subject><subject>Internal Medicine</subject><subject>Liver cirrhosis</subject><subject>Liver diseases</subject><subject>Mortality</subject><subject>Overweight</subject><subject>Patients</subject><subject>Sample size</subject><subject>Sodium</subject><subject>Teaching hospitals</subject><subject>Thyroid gland</subject><issn>2168-8184</issn><issn>2168-8184</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><recordid>eNpd0c9LHDEUB_BQlCpbbz2XgBcPrs2PmSTjRWRtu8KCHvQc3mbeuJGZZExmFvzvHV0rtqc8yIcv7_El5DtnZ1qX1U83JhzzmTIV01_IoeDKzA03xd6n-YAc5fzIGONMC6bZV3IgK2l4ofQhaZbPfQwwJOw80NuEW2gxOKQ-0Ct0sesxZBiwpotNisE7uvJbTPTKZ4SM5_Q6ZP-wGTJtUuwo0DtMg4f0TBeQkC5j7v0A7Tey30Cb8ej9nZH737_uFsv56ubP9eJyNXdCiWGuGgllo00FYq00FI5rqLTUUpSgVW0KLhg2dYVVwWsx0aKU2ug1l4XUbF3LGbnY5fbjusPaYRgStLZPvpt2shG8_fcn-I19iFvLeVGaaoqZkZP3hBSfRsyD7Xx22LYQMI7ZylfJWPlGj_-jj3FMYbpvUkKYUinJJ3W6Uy7FnBM2H9twZl9LtLsS7VuJE__x-YIP_Lcy-QIXpZlV</recordid><startdate>20240907</startdate><enddate>20240907</enddate><creator>Azam, Muhammad Usman</creator><creator>Saeed, Najam-Us-Sehar</creator><creator>Javed, Salman</creator><creator>Memon, Muuhammad Yousuf Y</creator><creator>Aftab, Muhammad Asad</creator><creator>Shafqat, Muhammad Nabeel</creator><creator>Sadiq, Hafiz Zeeshan</creator><creator>Maqbool, Arman</creator><creator>Mand Khan, Fasih</creator><creator>Zahoor, Faizan</creator><general>Cureus Inc</general><general>Cureus</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20240907</creationdate><title>Hyponatremia Prevalence in Decompensated Chronic Liver Disease: Insights from a Tertiary Care Hospital</title><author>Azam, Muhammad Usman ; Saeed, Najam-Us-Sehar ; Javed, Salman ; Memon, Muuhammad Yousuf Y ; Aftab, Muhammad Asad ; Shafqat, Muhammad Nabeel ; Sadiq, Hafiz Zeeshan ; Maqbool, Arman ; Mand Khan, Fasih ; Zahoor, Faizan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c262t-6f3a5f789a2b67a4c17a9737325a76d84120efd9e941d2a5f453787b134370bd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Age</topic><topic>Ascites</topic><topic>Females</topic><topic>Gastroenterology</topic><topic>Gender</topic><topic>Hyponatremia</topic><topic>Internal Medicine</topic><topic>Liver cirrhosis</topic><topic>Liver diseases</topic><topic>Mortality</topic><topic>Overweight</topic><topic>Patients</topic><topic>Sample size</topic><topic>Sodium</topic><topic>Teaching hospitals</topic><topic>Thyroid gland</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Azam, Muhammad Usman</creatorcontrib><creatorcontrib>Saeed, Najam-Us-Sehar</creatorcontrib><creatorcontrib>Javed, Salman</creatorcontrib><creatorcontrib>Memon, Muuhammad Yousuf Y</creatorcontrib><creatorcontrib>Aftab, Muhammad Asad</creatorcontrib><creatorcontrib>Shafqat, Muhammad Nabeel</creatorcontrib><creatorcontrib>Sadiq, Hafiz Zeeshan</creatorcontrib><creatorcontrib>Maqbool, Arman</creatorcontrib><creatorcontrib>Mand Khan, Fasih</creatorcontrib><creatorcontrib>Zahoor, Faizan</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>ProQuest - Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Curēus (Palo Alto, CA)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Azam, Muhammad Usman</au><au>Saeed, Najam-Us-Sehar</au><au>Javed, Salman</au><au>Memon, Muuhammad Yousuf Y</au><au>Aftab, Muhammad Asad</au><au>Shafqat, Muhammad Nabeel</au><au>Sadiq, Hafiz Zeeshan</au><au>Maqbool, Arman</au><au>Mand Khan, Fasih</au><au>Zahoor, Faizan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hyponatremia Prevalence in Decompensated Chronic Liver Disease: Insights from a Tertiary Care Hospital</atitle><jtitle>Curēus (Palo Alto, CA)</jtitle><addtitle>Cureus</addtitle><date>2024-09-07</date><risdate>2024</risdate><volume>16</volume><issue>9</issue><spage>e68907</spage><pages>e68907-</pages><issn>2168-8184</issn><eissn>2168-8184</eissn><abstract>Liver cirrhosis is a prominent global contributor to mortality, and hyponatremia is a common complication in patients with decompensated chronic liver disease (DCLD). Hyponatremia is characterized by kidney impairment when eliminating solute-free water. The presence of contradictory findings in existing literature prompted this study. The objective of this study was to determine the prevalence of hyponatremia in patients with DCLDs presenting at a tertiary care hospital.  This six-month cross-sectional study was performed at the Allied Institute of Medical Sciences Teaching Hospital in Gujranwala, Pakistan, from January 2022 to June 2022. A total of 133 patients were selected as subjects. Researchers took blood samples from these patients and sent the samples to the hospital pathology lab for evaluation of serum sodium levels. If sodium levels were ≤130 mmol/L, the patient was considered to have hyponatremia. All information was recorded on proforma.  The mean age of patients was 47.68 ± 12.89 years. Overall, 80 (60.15%) were male, and 53 (39.85%) female. The mean BMI of patients was 23.20 ± 3.11 kg/m and the average duration of DCLD was 7.24 ± 4.12 years. Among participants, 48 (36.09%) patients had hyponatremia, whereas 85 (63.91%) did not have hyponatremia. The mean sodium level was 132.39 ± 11.37 mEq/L. Stratified analysis based on patient age revealed that among patients aged 21-45 years, 27 (45.8%) had hyponatremia, whereas, in the group aged 46-70 years, 21 (28.4%) had hyponatremia with a p-value &lt; 0.05. Stratification of the basis of BMI, among underweight patients, all eight (100%) had hyponatremia, whereas of overweight patients, 14 (31.1%) had hyponatremia. This difference was statistically significant (p &lt; 0.05). The prevalence of hyponatremia was notably elevated among individuals suffering from DCLD. Age and BMI were the most common risk factors for hyponatremia among subjects with DCLD. This study recommends that patients with DCLD should have their serum sodium levels screened at regular intervals to prevent complications, including encephalopathy, which occurs particularly in younger and underweight DCLD patients.</abstract><cop>United States</cop><pub>Cureus Inc</pub><pmid>39381467</pmid><doi>10.7759/cureus.68907</doi><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 2168-8184
ispartof Curēus (Palo Alto, CA), 2024-09, Vol.16 (9), p.e68907
issn 2168-8184
2168-8184
language eng
recordid cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11458934
source PubMed Central Free; ProQuest - Publicly Available Content Database
subjects Age
Ascites
Females
Gastroenterology
Gender
Hyponatremia
Internal Medicine
Liver cirrhosis
Liver diseases
Mortality
Overweight
Patients
Sample size
Sodium
Teaching hospitals
Thyroid gland
title Hyponatremia Prevalence in Decompensated Chronic Liver Disease: Insights from a Tertiary Care Hospital
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-04T14%3A20%3A49IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Hyponatremia%20Prevalence%20in%20Decompensated%20Chronic%20Liver%20Disease:%20Insights%20from%20a%20Tertiary%20Care%20Hospital&rft.jtitle=Cur%C4%93us%20(Palo%20Alto,%20CA)&rft.au=Azam,%20Muhammad%20Usman&rft.date=2024-09-07&rft.volume=16&rft.issue=9&rft.spage=e68907&rft.pages=e68907-&rft.issn=2168-8184&rft.eissn=2168-8184&rft_id=info:doi/10.7759/cureus.68907&rft_dat=%3Cproquest_pubme%3E3114500534%3C/proquest_pubme%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c262t-6f3a5f789a2b67a4c17a9737325a76d84120efd9e941d2a5f453787b134370bd3%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=3122856631&rft_id=info:pmid/39381467&rfr_iscdi=true