Jagirdhar, Gowthami Sai Kogilathota

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.

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: 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.

Abstract Background Although visceral leishmaniasis is endemic in various parts of India, management is still a challenge due to multiple drug resistance. Here we describe a case of a 50 years old female who was diagnosed with visceral leishmaniasis at a tertiary care hospital in northern parts of India and was managed with a repeated trial of liposomal Amphotericin B. Methods Case Discussion: The patient presented in the outpatient department with recurrent fever, mild intermittent abdominal discomfort associated with generalized weakness for the past one month. On per abdomen examination the patient had splenomegaly with spleen palpable 8 cm below the left costal margin. Blood investigations were suggestive of pancytopenia (leukocyte of 1800/cumm, Hemoglobin 7 g/dl, Platelet count: 80,000/cumm) along with severe neutropenia (Absolute neutrophil count: 400/cumm) . The CT abdomen showed massive splenomegaly (23 cm) with mild hepatomegaly . Leishmania Immunoglobulin G was positive. Bone marrow biopsy revealed hyperproliferative marrow with plasmacytosis (12-15%). Bone marrow Leishman-Donovan bodies were negative. Serum immunofixation was negative for M spike and serum light chain assay was also negative. She was managed with liposomal Amphotericin B (3mg/kg) for 7 days and was subsequently discharged. After 3 months, the patient again presented with continuous fever, lethargy, running nose, palpitations. Her blood work-up revealed severe pancytopenia again. She was tested for Leishmania anti- rk39 antibody, which was positive. She was given a repeat trial of Liposomal Amphotericin B with a different regimen-3 mg/kg dose on Day 1 to 5, followed by 6th dose on Day 14, followed by 7th dose on Day 21, as per the FDA approved regimen. Patient recovered well. The most recent total leukocyte counts eventually improved to 4800 with normal differential count. Platelets increased to 180,000, Hemoglobin was around 10.8g/dl and spleen was non palpable on physical examination. Results Treatment of leishmania can become complicated due to resistance to various drugs especially when a single agent is being given. Conclusion But in resource limited countries different regimens of liposomal amphotericin B can be tried which might be helpful due to speedy clinical recovery and cost effectiveness. Disclosures All Authors: No reported disclosures.