Ammad Javaid Chaudhary

Background: Clostridioides difficile infection (CDI) significantly contributes to healthcare‐associated morbidity and mortality. Vaccination against C. difficile toxins may provide an effective preventive strategy, yet current data remain inconclusive. This meta‐analysis evaluates the efficacy, immunogenicity, and safety of the C. difficile toxoid vaccine. Methods: We systematically searched PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials from inception through August 2024. Eligible studies were randomized controlled trials enrolling adults aged 50–85 years that compared genetically detoxified Clostridioides difficile toxoid vaccines (50–200 µg) with placebo and reported clinical efficacy, immunogenicity, or safety outcomes. Random‐effects meta‐analyses were performed, with risk of bias assessed using RoB 2.0 and certainty of evidence graded using GRADE. The study was prospectively registered in PROSPERO (CRD42024597465). No external funding was received for this study. Results: Eight trials (11,717 participants) showed no significant vaccine effect on overall CDI incidence (RR = 0.86; 95% CI 0.56–1.32; I ² = 0%) or severe CDI (RR = 0.25; 95% CI 0.02–3.75; I ² = 71%), though severe CDI risk trended lower in vaccinated groups. Immunogenicity analyses demonstrated significant seroconversion rates for toxin A (RR = 23.28; 95% CI 7.62–71.16; I ² = 0%) and toxin B (RR = 19.23; 95% CI 4.84–76.38; I ² = 0%). Vaccine recipients exhibited significantly elevated geometric mean concentrations (GMCs) for antitoxin A and B antibodies across various dosing regimens, particularly at higher doses (200 µg). Local adverse events, including pain (RR = 3.02; 95% CI 2.47–3.70), swelling (RR = 8.53; 95% CI 3.15–23.14), and erythema (RR = 6.78; 95% CI 2.35–19.61), were significantly increased postvaccination, but serious systemic reactions, infections, gastrointestinal disturbances, and mortality rates showed no significant differences compared to placebo. Interpretation of vaccine efficacy is limited by imprecision of effect estimates, heterogeneity in immunogenicity reporting, and the small number of trials evaluating severe CDI outcomes. Conclusion: Clostridioides difficile toxoid vaccines induce strong humoral immune responses and demonstrate an acceptable safety profile but do not significantly reduce the overall CDI incidence. Evidence suggests a potential role in mitigating severe disease; however, clinical benefit remains uncertain due to imprecision and heterogeneity.

Background: Dual liver–lung transplantation (DLLT) is an uncommon but definitive therapy for carefully selected patients with concurrent end‐stage hepatic and pulmonary disease. The combined operative complexity and dual‐organ immunosuppressive burden may predispose recipients to early morbidity and graft‐threatening complications [1–4]. Objective: To characterize early and late postoperative events (including acute cellular rejection (ACR), infectious complications, malignancy, and hospital readmissions) after DLLT and to describe associated clinical patterns. Methods: We performed a retrospective cohort study of adult DLLT recipients at a single tertiary center (2013–2024). Variables included demographics, transplant indications, ischemia times, readmissions (0–3 months; 3–12 months), infections (timing/etiology/site), biopsy‐proven rejection, malignancy, and survival. ACR was biopsy‐confirmed in cases of unexplained transaminitis beyond 30 days posttransplant. Analyses were descriptive, consistent with STROBE recommendations for small cohorts. Results: Ten patients (mean age 53.7 years; 50% female) underwent DLLT. Liver etiologies included alcohol‐related cirrhosis ( n = 2), HCV ( n = 1), cryptogenic ( n = 1), autoimmune ( n = 1), cystic fibrosis ( n = 1), and unspecified ( n = 4). Lung indications were IPF ( n = 5), pulmonary hypertension ( n = 2), ILD ( n = 2), and CF ( n = 1). All patients were readmitted within 90 days, most commonly for infection (40%), diarrhea (20%), critical illness myopathy (20%), rejection (10%), and biliary stricture (10%). Biopsy‐proven ACR occurred in 4/10 patients (40%) after the first month, uniformly presenting with hepatocellular transaminemia; 3/4 received pulse‐dose IV corticosteroids and 2/3 subsequently developed invasive fungal disease (Aspergillus and Candida ). Overall, 9/10 experienced infection within 6 months, predominantly pulmonary (fungal/bacterial pneumonias). Three patients developed malignancy (basal cell carcinoma, prostate carcinoma, and angiosarcoma [fatal]). Survival was 90% at 1 year, 70% at 3 years, and 60% at 5 years; no 10 year survivors were observed. Conclusions: DLLT is associated with early readmission and a high infectious burden, particularly invasive fungal disease after steroid‐treated ACR. Despite significant early morbidity, short‐term survival is favorable. Multicenter studies are needed to refine candidate selection, balance rejection prophylaxis with antifungal strategies, and standardize long‐term oncologic and dermatologic surveillance in DLLT.

Colorectal cancer (CRC) continues to be a significant global health issue contributing to a high mortality rate. Despite advancements in treatment, the risk of recurrence remains due to inherent mutations and the rapid turnover of intestinal mucosa. We present an exceptionally rare case of CRC metastasis to the duodenum in a 42‐year‐old female who has been compliant with postsurgical surveillance. Despite previous negative surveillance results, elevated CEA levels and a 3‐cm mesenteric mass were detected, raising concerns for carcinoma, which was later confirmed by biopsy. The tumor board deemed her ineligible for surgery due to vascular involvement, leading to palliative care and an attempt at neoadjuvant therapy. Vigilant monitoring is crucial for early detection and intervention.

Metastasis to the stomach is a rare occurrence, especially from renal cell carcinoma (RCC). We report a case of a 76-year-old man with a history of RCC, in remission for 11 years postnephrectomy, who presented with gastrointestinal symptoms, was found to have a 2 cm gastric mass confirmed as metastatic RCC. Endoscopic submucosal dissection was attempted, but due to the hypervascular nature of the mass, a hybrid endoscopic submucosal dissection was performed, achieving complete resection. Follow-up at 7 months showed no recurrence, highlighting the potential for endoscopic treatment options for isolated gastric metastasis, despite the lack of specific guidelines.

Our case highlights a rare instance of recurrent metastatic solid pseudopapillary epithelial neoplasms of the pancreas, emerging 8 years after radical pancreatic resection—an extended interval surpassing the reported average. Managing solid pseudopapillary epithelial neoplasm during pregnancy is uniquely challenging, given the increase in the expression of progesterone receptors during the intrapartum period, leading to tumor growth. Although surgical resection remains the primary approach, systemic chemotherapy, radiation therapy, and liver transplant are other considerations. The absence of consensus guidelines for recurrence monitoring emphasizes the need for vigilant, long-term surveillance extending beyond the conventional 5-year mark.

While Wernicke's encephalopathy (WE) is mostly caused by thiamine deficiency secondary to chronic alcohol use, other conditions that may affect one’s nutritional status, such as bariatric surgery, hyperemesis gravidarum, chronic gastrointestinal disease, HIV/AIDS, and certain malignancies, may also lead to this outcome. We are discussing one such case, WE, in a young man with acute myeloid leukemia (AML) who underwent chemotherapy. The patient presented with blurred vision, paresthesia, weakness, and vomiting. Although he denied alcohol abuse, his symptoms, physical exam findings, and MRI results were consistent with WE. Treatment with thiamine resulted in a significant improvement in his visual disturbances and mental status. The authors highlight the importance of recognizing WE in non-alcoholic patients, particularly those undergoing prolonged hospitalization and chemotherapy, as nutritional deficiencies can develop. They recommend thiamine supplementation for patients receiving chemotherapy and those with poor oral intake. The case underscores the need for high clinical suspicion and early intervention in atypical cases of WE.

Background Obesity is a complex and multifactorial medical condition that can have far reaching consequences on cancer patients, particularly those undergoing treatment such as chemotherapy. Our study focuses to comprehensively explore the various adverse outcomes in obese patients receiving chemotherapy during hospitalization. Methods The National Inpatient Sample 2020 was used using the ICD-10 codes to identify patients hospitalized with a primary discharge diagnosis of neoplastic chemotherapy with or without a secondary diagnosis of obesity. Statistical analysis using Stata software was done, and primary and secondary outcomes were obtained after adjusting for confounders using multivariate regression analysis. Results Mortality was similar in both obese and non-obese patients. Length of stay and total hospitalization charges were increased in obese patients. Obese patients had higher odds of developing acute respiratory failure and were more likely to require non-invasive and invasive mechanical ventilation. Conclusion Our study concluded that obesity could be considered an independent predictor of worse outcomes in patients admitted for neoplastic chemotherapy. Notably, addressing obesity could help to improve the efficacy of treatment for cancer patients while simultaneously reducing any negative consequences associated with being obese.