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Abstract Background Patients on long-term dialysis for end-stage kidney disease have a high mortality rate, predominantly due to sudden cardiac death (SCD), which is associated with an increased risk of arrhythmias compared to the general population. Thus, the current systematic review and meta-analysis aimed to investigate the incidence of SCD among dialysis patients at risk of arrhythmia. Methods This systematic review and meta-analysis followed the PRISMA guidelines. PubMed, Cochrane Library, Google Scholar, Medline, and Europe PMC were searched for articles meeting our inclusion criteria. Studies with risk assessment of arrhythmias and the incidence of SCD in dialysis patients were considered for inclusion. Effect size from eligible studies was pooled using a random effects model and restricted maximum likelihood estimation. Heterogeneity was quantified using the I 2 statistic, and the risk of publication bias was evaluated by visually inspecting funnel plots. Results Our search strategy yielded 5861 studies, of which 1960 duplicate entries were removed in the prescreening stage, 3326 were excluded after title/abstract screening, and 519 after full-text screening for not meeting our inclusion criteria. Finally, 11 studies were included in the analysis, and two more were selected from the bibliography list of previous reviews. Eight included studies were randomized controlled trials, and five were cohort studies, which provided a pooled population size of 12,611 dialysis patients for the meta-analysis, which indicated a significantly larger effect size of arrhythmia [Cohen’s d = 110.38 (95%CI 42.72–178.05), p = 0.0]. Visual assessment of the funnel plot indicated no publication bias. Conclusion SCD remains a significant public health concern, particularly in patients undergoing dialysis. Meta-analysis results show that bradyarrhythmia is a common arrhythmic condition leading to SCD; however, other arrhythmias should also be considered.

Background and Aims: To investigate gender, racial, ethnic, and regional disparities in first and senior authorship positions in gastroenterology/hepatology-related randomised controlled trials (RCT). Method: Retrospective bibliometric analysis of PubMed-indexed RCTs published between January 2000 to December 2022 in leading journals with an impact factor of at least five. Results: 943 RCTs met our inclusion criteria, providing a participant pool of 301 female (15.96%) and 1,585 male (84.04%) authors from 37 countries (70% high-income countries). Despite a significant increase in the proportion of female authors in first and senior authorship positions between 2000 and 2022 (p<0.001), females were grossly underrepresented in both authorship positions, with a male-to-female ratio of 4.45 and 6.37, respectively. The male-to-female ratio was highest among Asian authors (7.79) than among White (4.22), Hispanic (1.44), and Black (1) authors in the first authorship position. In contrast, the male-to-female ratio was similar for Asian (6.2) and White (6.67) authors in the senior authorship position, with a low underlying frequency of Hispanic and Black female authors. Conclusion: Despite significant improvements in gender, racial and ethnic representation in first and senior authorship of gastroenterology/hepatology-related RCTs published in high-impact journals, progress toward parity remains slow. Targeted interventions to improve author diversity are warranted. [ABSTRACT FROM AUTHOR]

Background Sepsis is a challenging condition, especially in patients with malignancy, that is associated with worse mortality and increased complications. This study aimed to analyze the prevalence of sepsis, its complications, healthcare outcomes, and associated organism-specific mortality in patients with colorectal carcinoma using the National Inpatient Sample database. Methodology We included patients aged >18 years with a primary diagnosis of colon cancer. The patients were divided into two groups, those with sepsis and those without sepsis. Confounders were adjusted using multivariate regression analysis. We examined outcomes including mortality, hospital charges, length of stay, and other associated complications. Results Out of 876,769 patients diagnosed with colon cancer, 2,579 (0.2%) had methicillin-resistant Staphylococcus aureus (MRSA) sepsis, 1,004 (0.1%) had Staphylococcus aureus sepsis, and 6,439 (0.7%) had Escherichia coli sepsis. Patients with sepsis exhibited significantly longer hospital stays, the highest with Staphylococcus aureus and Enterococcus , as well as increased healthcare costs compared to those without sepsis. The highest mortality rates were associated with Staphylococcus aureus (n = 169/1,004, 17%), followed by Pseudomonas (n = 150/940, 16%) and MRSA (n = 374/2,579, 14%). Sepsis also led to higher rates of complications, including acute kidney injury and septic shock. Conclusions Through this study, we aim to highlight the need for early diagnosis and targeted management of colon cancer patients who develop sepsis during their hospital course. Future research should focus on the underlying pathophysiology and effective interventions to improve outcomes for patients with colorectal carcinoma and sepsis., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. 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, Iqbal et al.)

The availability of an effective vaccine does not equate to its use; its effectiveness primarily depends on vaccine acceptance by the targeted population. Despite the rapid development and widespread access to the COVID-19 vaccine, herd immunity is yet to be achieved, with vaccine hesitancy as a major barrier. This study sought to systematically assess the beliefs, attitudes, and acceptance towards COVID-19 vaccines, including factors contributing to vaccination hesitancy in the Eastern and Western Hemispheres. A comprehensive search of articles was conducted through Scopus, PubMed, Embase, CINAHL, Cochrane CENTRAL, and Web of Science databases for studies published from inception to May 2023 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our search yielded 1154, of which 21 were eligible for inclusion. The rate of willingness or intention to vaccinate varied with the geographic region, from 12% in the United States to 93.9% in China. Four studies from the Western region and two from the Eastern region reported a low acceptance rate (defined as <50%): United States (12%), Spain (48.3%), Switzerland (38.6%), Europe (multi-national, 31%), Nepal (38.3%), and Oman (43%). Overall, vaccine acceptance was low to moderate in the general population and healthcare workers (HCWs) in both Eastern and Western Hemispheres except for China which reported high acceptance (defined as >75%) among the general population and HCWs. Demographic characteristics (female, younger age, and higher education) and non-demographic factors (knowledge about the COVID-19 vaccine and its development, history of influenza vaccination, perceived susceptibility or severity of infection, and the belief that vaccines are effective in controlling the pandemic) were associated with high acceptance rates or intentions to take the COVID-19 vaccine. On the other hand, mistrust of the vaccine, its safety and effectiveness, disinformation or poor awareness of the vaccine, side effect concerns, belief in natural immunity, previous adverse experience with the vaccines, and distrust in the information sources about the COVID-19 pandemic were associated with vaccination hesitancy. For better acceptance, COVID-19 vaccination campaign strategies should be modeled based on regional political, economic, and social contexts., 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, Sorath et al.)

Aims Hepatocellular carcinoma (HCC) is one of the common liver malignancies that presents a challenge to global healthcare. The impact and outcomes of hypoglycemia in HCC have not been studied in detail before. This study aimed to investigate the outcomes and prognosis associated with hypoglycemia in patients diagnosed with HCC, utilizing a large-scale database approach. Methods Using the Nationwide Inpatient Sample (NIS) database from 2017 to 2020, we conducted a comprehensive retrospective analysis to examine the incidence, risk factors, and clinical implications of hypoglycemia on HCC patients. The patients were divided into two groups: those with hypoglycemia and those without hypoglycemia. Univariate and multivariate logistic regression were used to conduct the analysis. STATA® version 17.0 software (StataCorp LLC, College Station, TX) was used for this purpose. Results Out of a total of 343,895 patients with HCC, the prevalence of hypoglycemia was present in 1.5% of this patient population. We found that hypoglycemia was common in the male population (68%). Compared with patients without hypoglycemia, patients who had hypoglycemia with HCC had higher mortality (42%, p-value < 0.05) and higher risks of secondary outcomes such as hepatic failure, spontaneous bacterial peritonitis (SBP), ascites, and portal vein thrombosis compared to patients who did not have hypoglycemia. The multivariate-adjusted odds ratio for hepatic failure was 2.7 (2.3-3.1), for SBP was 2.9 (1.8-3.0), for ascites was 1.6 (1.4-1.9), and for portal vein thrombosis was 1.2 (0.9-1.4). Conclusion In conclusion, hypoglycemia in HCC is associated with increased mortality and worse outcomes., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. 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, Iqbal et al.)

Toxic shock syndrome is a rare and life-threatening condition that is typically caused by group A Streptococcus or Staphylococcus aureus. It classically presents with fever, hypotension, sunburn-like rash, and multi-organ system failure. We describe a case of a 70-year-old male with this condition who had an atypical presentation of left chest wall pain and left shoulder pain after two mechanical falls along with hemodynamic stability. The patient rapidly deteriorated on his second hospital floor day, resulting in a higher complexity of care and management in the intensive care unit (ICU). Despite a number of resuscitative measures, therapies, and multidisciplinary care, the patient unfortunately passed away within 24 hours of his ICU care., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Ishola et al.)