Objectives: Vaccine hesitancy remains a global issue, especially within poverty-stricken countries where there's an interplay of financial and non-financial barriers. This narrative review aims to understand attitudes and behaviors toward COVID-19 vaccination in four South Asian countries and make context-specific recommendations to vaccine program drivers and decision-makers.Methods: A search was conducted using PubMed and Science Direct, and CINHAL from January 2020 up to May 2022 restricted to the English language for terms: “Afghanistan” OR “Pakistan” OR “India” OR “Bangladesh” in combination with “COVID-19 vaccine” and other related terms. All articles were initially included, and those with relevance were included in the synthesis of this paper.Results: A narrative review was performed for this study. Our narrative review included a total of eighteen studies with a sample size (n = 223–5,237) averaging about 1,325 participants per study conducted. The studies included revealed public hesitancy to receive the COVID-19 vaccine ranging from 6.3 to 56.2% with an average of 31.63% across all eighteen studies. Several reasons were linked to this observation in these four South Asian countries, and the predominant ones included: Insufficient information provided to the general public about the side effects of the vaccines, concerns regarding vaccine safety, and skepticism of vaccine efficacy.Conclusion: Vaccine hesitancy is a global problem within the context of COVID-19, and issues regarding equity, misinformation, and poverty in South Asian countries makes it difficult to meet goals for herd immunity. Policymakers and governments should aim toward financial and non-financial incentives to drive the public toward vaccination.

Background and Objectives: Bartter syndrome (BS) is a rare group of autosomal-recessive disorders that usually presents with hypokalemic metabolic alkalosis, occasionally with hyponatremia and hypochloremia. The clinical presentation of BS is heterogeneous, with a wide variety of genetic variants. The aim of this systematic review was to examine the available literature and provide an overview of the case reports and case series on BS. Materials and Methods: Case reports/series published from April 2012 to April 2022 were searched through Pubmed, JSTOR, Cochrane, ScienceDirect, and DOAJ. Subsequently, the information was extracted in order to characterize the clinical presentation, laboratory results, treatment options, and follow-up of the patients with BS. Results: Overall, 118 patients, 48 case reports, and 9 case series (n = 70) were identified. Out of these, the majority of patients were male (n = 68). A total of 21 patients were born from consanguineous marriages. Most cases were reported from Asia (73.72%) and Europe (15.25%). In total, 100 BS patients displayed the genetic variants, with most of these being reported as Type III (n = 59), followed by Type II (n = 19), Type I (n = 14), Type IV (n = 7), and only 1 as Type V. The most common symptoms included polyuria, polydipsia, vomiting, and dehydration. Some of the commonly used treatments were indomethacin, potassium chloride supplements, and spironolactone. The length of the follow-up time varied from 1 month to 14 years. Conclusions: Our systematic review was able to summarize the clinical characteristics, presentation, and treatment plans of BS patients. The findings from this review can be effectively applied in the diagnosis and patient management of individuals with BS, rendering it a valuable resource for nephrologists in their routine clinical practice.

Introduction: Acinetobacter baumannii (AB) is a multidrug-resistant pathogen commonly associated with nosocomial infections. The resistance profile and ability to produce biofilm make it a complicated organism to treat effectively. Cefoperazone sulbactam (CS) is commonly used to treat AB, but the associated data are scarce. Methods: We conducted a systematic review of articles downloaded from Cochrane, Embase, PubMed, Scopus, and Web of Science (through June 2022) to study the efficacy of CS in treating AB infections. Our review evaluated patients treated with CS alone and CS in combination with other antibiotics separately. The following outcomes were studied: clinical cure, microbiological cure, and mortality from any cause. Results: We included 16 studies where CS was used for the treatment of AB infections. This included 11 studies where CS was used alone and 10 studies where CS was used in combination. The outcomes were similar in both groups. We found that the pooled clinical cure, microbiological cure, and mortality with CS alone for AB were 70%, 44%, and 20%, respectively. The pooled clinical cure, microbiological cure, and mortality when CS was used in combination with other antibiotics were 72%, 43%, and 21%, respectively. Conclusions: CS alone or in combination needs to be further explored for the treatment of AB infections. There is a need for randomized controlled trials with comparator drugs to evaluate the drug’s effectiveness.

Introduction: Glucagon-like Peptide-1 (GLP-1) agonists cause delayed gastric emptying by acting on vagal afferent nerves. Retained Gastric Contents (RGC) increase the risk of pulmonary aspiration, particularly under anesthesia in endoscopic procedures. This systematic review and meta-analysis summarize the current evidence on pulmonary aspiration in patients receiving GLP-1 agonists who undergo endoscopy. Methods: A systematic review of the literature was conducted using Cochrane, Embase, and PubMed from inception to May 2024, including studies and case reports on GLP-1 agonists and pulmonary aspiration. Data on study characteristics, demographics, and GLP-1 agonist use were collected. A pooled analysis of retrospective studies was conducted using RevMan version 5.4.1. The study protocol was registered in the PROSPERO international database (ID CRD42024595241). Results: We identified five case reports involving six patients and twelve studies, including 210,216 patients. A total of 143/87691 (0.16%) in the GLP-1 agonist and 149/122525 (0.12%) in the placebo group had pulmonary aspiration. In the case reports, three patients had aspiration despite stopping medication >6 days prior to the procedure and fasting for >8 hours. Meta-analysis showed that GLP-1 agonists were associated with an odds ratio of 1.23 for pulmonary aspiration (P = 0.59; 95% CI, 0.58 to 2.60), which was not statistically significant. Conclusion: Our analysis found no statistically significant association between GLP-1 agonist use and the risk of pulmonary aspiration during endoscopic procedures. Further research is needed to determine optimal fasting protocols and peri-procedural management strategies.

Background and Objective: The association of non-alcoholic fatty liver disease (NAFLD) and metabolic-associated fatty liver disease (MAFLD) with intensive care unit (ICU) admissions and the need for mechanical ventilation and disease severity in COVID-19 patients. Material and Methods: A systematic literature review was conducted on the databases: Cochrane, Embase, PubMed, ScienceDirect, and the Web of Science from January 2019 to June 2022. Studies evaluating MAFLD using laboratory methods, non-invasive imaging, or liver biopsy were included. The study protocol was registered in PROSPERO (ID CRD42022313259), and PRISMA guidelines were followed. The NIH quality assessment tool was used for quality assessment. RevMan version 5.3 software was used for pooled analysis. A sensitivity analysis was performed to assess the result’s stability. Results: A total of 37,974 patients from 17 studies were assessed for the association between MAFLD and ICU admission. A total of 3396 COVID-19 patients required ICU admission: 1236 (20.41%) in the MAFLD group and 2160 (6.77%) in the non-MAFLD group. The odds ratio was 1.86 for ICU admission, p = 0.007, and a (95% CI) of [1.18–2.91]. A total of 37,166 patients from 13 studies were included in the need for invasive mechanical ventilation analysis. A total of 1676 patients required mechanical ventilation: 805 in the MAFLD group (14.20% of all MAFLD patients) and 871 patients in the non-MAFLD group (2.76% of all non-MAFLD patients). The odds ratio was 2.05, p = 0.02, and a (95% CI) of [1.12–3.74]. A total of 5286 patients from 14 studies were included in the COVID-19 disease severity analysis. Severe COVID-19 was seen in 1623 patients, with 33.17% (901/2716) of MAFLD patients and 28.09% (722/2570) of non-MAFLD patients having severe disease. The odds ratio was 1.59 for disease severity, p = 0.010, and a (95% CI) of [1.12–2.26]. Conclusions: Our meta-analysis suggests that there are significantly increased odds of ICU admissions, a need for invasive mechanical ventilation, and disease severity in MAFLD patients who acquire COVID-19.

Introduction: Violence against Healthcare Workers (HCWs) remains underreported globally, and calls for increased public awareness and education. We aim to report the nature of violence in the healthcare system, its risk factors, impact, and potential mitigation strategies. Methods: We conducted a global cross-sectional study called ViSHWaS - Violence Study of Healthcare Workers and Systems. The survey questionnaire was created using REDCap forms and distributed from June 5 to August 6, 2022. This study was exempted from Institutional Review Board. Findings: A total of 5,405 (79 countries) responses were analyzed, India, USA, and Venezuela were with the most responses. Of these, 53% were females, and the majority (45%) were within 26-35 years. The top four categories of respondents were medical students (21%), followed by consultants (20%), residents/fellows (15%), and nurses (10%). Fifty-five percent of HCWs reported experiencing violence first-hand, and 16% reported violence against their colleagues. Patients or their family members were described as the perpetrator in > 50% of cases, whereas 16% reported facing aggression from their supervisors. A majority (80%) reported that the incidence of violence has either stayed constant or increased during the COVID-19 pandemic. Fifty-five percent of HCWs who experienced violence felt less motivated or more dissatisfied with their job after the event, and an additional 25% were willing to quit. Interpretations: In a global cross-sectional study, violence against HCWs is reported by the majority of the HCWs. The incidence either increased or stayed the same during the COVID-19 pandemic. This has led to decreased job satisfaction. Funding: None Declaration of Interest: The authors of the survey-based study have no conflict of interest and have received no funding for the study. Ethical Approval: The Study received an exemption from the Mayo Clinic Institutional Review Board.