Faris Qaqish

Background/Objectives: Clostridioides difficile infection (CDI) is the leading cause of colitis and hospital-acquired diarrhea. Patients with Chronic Obstructive Pulmonary Disease (COPD) frequently have infectious exacerbations requiring treatment with antibiotics, which may be predisposing them to CDI. This study examines the prevalence and in-hospital outcomes of CDI in patients with COPD. Methods: Data for hospitalized patients with CDI was extracted from the National Inpatient Sample database for the years 2016 through 2020. Baseline risk factors were identified using the International Classification of Diseases codes. Patients were stratified into two groups: with COPD and without COPD. The primary outcome was in-hospital mortality. The secondary outcomes were septic shock, hypovolemic shock, AKI, cardiac arrest, need for intensive care unit (ICU) level of care and length of stay. Statistical analyses were conducted using SPSS. Results: 290,172 patients were included in this study. Patients with COPD had more comorbidities overall and higher in-hospital mortality rates compared to patients without COPD (7.7% vs. 5.9%, p < 0.001). On multivariate logistic regression analysis, patients with CDI and COPD had higher risk of in-hospital mortality (OR = 1.346, p < 0.001), septic shock (OR = 1.289, p < 0.001), hypovolemic shock (OR = 1.184, p < 0.001), cardiac arrest (OR = 1.362, p < 0.001) and required more ICU level of care. Conclusions: Patients with COPD experience frequent exacerbations, often requiring hospitalizations and broad-spectrum antibiotics, steroids, proton pump inhibitors and antacids. These factors contribute to the higher prevalence of CDI in this patient population. Patients with CDI and COPD are also more likely to require ICU level of care, shedding the light on the significant burden of CDI, long hospital stays and substantial hospital charges. Recognizing mortality outcomes is essential to guide patient-specific therapies and highlights the need for closer monitoring and targeted management of CDI in patients with COPD.

Background: Gastroesophageal reflux disease (GERD) is a highly prevalent gastrointestinal disorder worldwide. Management strategies include lifestyle modification, pharmacologic therapy, and surgical interventions. Diaphragmatic breathing exercises have been proposed as a non-pharmacological treatment aimed at improving lower esophageal sphincter function and reducing reflux episodes. Methods: A systematic search of PubMed/MEDLINE, Scopus, ScienceDirect, Google Scholar, and ClinicalTrials.gov was conducted from database inception to 10 March 2026 to identify randomized controlled trials evaluating diaphragmatic breathing in patients with GERD. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2.0 tool. Random-effects meta-analyses were performed to estimate pooled mean differences for symptom scores and quality-of-life outcomes. Results: Ten randomized controlled trials including 476 patients were analyzed (mean age: 39.9 ± 11.3 years). Diaphragmatic breathing interventions were performed in 229 participants, with an average duration of 20.36 min per session over approximately 5.1 weeks. Meta-analysis demonstrated a modest improvement in GERD symptom scores favoring diaphragmatic breathing (SMD −0.74; 95% CI −1.36 to −0.12; p = 0.019), with substantial heterogeneity (I² = 79.7%). Subgroup analyses comparing breathing with medication and sham breathing controls produced similar trends. Quality-of-life outcomes did not demonstrate statistically significant improvement (MD −2.35; 95% CI −6.35 to 1.65; p = 0.25) and showed considerable heterogeneity (I² = 85.3%). Risk-of-bias assessment revealed “some concerns” in several studies, primarily related to randomization procedures and outcome reporting. Conclusions: Although pooled results demonstrated a statistically significant reduction in GERD symptom scores favoring diaphragmatic breathing, this finding must be interpreted with considerable caution given the substantial heterogeneity observed. The current evidence remains limited by methodological heterogeneity, and inconsistent outcome assessment is insufficient to support definitive clinical recommendations, and the observed benefit may not be generalizable across patient populations or clinical settings. Larger standardized randomized trials are required to determine the clinical role of diaphragmatic breathing in GERD management.

Background Nonselective beta-blockers (NSBBs) have been used in the management of portal hypertension and the prevention of initial and recurrent variceal bleeding in patients with liver cirrhosis. However, there is controversy regarding the use of NSBBs in patients with decompensated cirrhosis (DC) due to concerns over potential adverse effects, such as worsening of hepatic function and risk of hepatorenal syndrome (HRS). HRS is a serious complication of DC characterized by acute kidney injury (AKI) and progressive renal failure, and its development can lead to significant morbidity and mortality in this setting. Therefore, using NSBBs in patients with DC remains an area of ongoing research and debate. Our study aims to investigate the potential effect of NSBBs on HRS development. Methodology A retrospective chart review of 404 patients with cirrhosis was performed across all Northwell Health institutions between January 01, 2019, and December 31, 2020. An analysis was done on 516 patient encounters. Inclusion criteria included patients with an established International Classification of Diseases 10th Revision code of cirrhosis and AKI. After adjusting for clinical predictors, the Student’s t-test or Mann-Whitney U-test was used to compare variables between the two outcome groups (HRS vs. no HRS) for the continuous variables. Pearson’s chi-square test or Fisher’s exact test was used for the categorical variables to test if an association existed between the use of NSBBs at home and HRS. A two-sided p-value <0.05 was considered statistically significant. SAS 9.4 (SAS Institute Inc., Cary, NC, USA) was used for statistical analysis. Results The primary outcome was the development of HRS during the hospital stay. With a total of 109 visits with HRS, we had 21 (23.60%) reported HRS in the 89 visits where NSBBs were used at home before the hospitalization, while 88 (20.61%) HRS were observed in the 427 visits with no NSBB use at home. The use of NSBBs at home was not significantly associated with the development of HRS (odds ratio = 1.1, 95% confidence interval = 0.6-1.9, p = 0.7321). We also found that higher serum albumin on admission is associated with lower odds of HRS. In contrast, increased serum creatinine, bilirubin, presence of ascites, and use of pressors were associated with a higher risk of HRS. Conclusions Our study highlights the relevant safety of NSBB use in end-stage liver disease. Their use did not appear to increase the risk of developing HRS during hospitalization with DC. Further randomized controlled trials are warranted to shed more light on the efficacy, dose tolerance limits, and safety of NSBBs in decompensated end-stage liver disease.

Acute pericarditis is an inflammatory condition involving the pericardium, the double-layered sac that surrounds the heart. It is characterized by chest pain, typically pleuritic and sharp, along with other clinical and laboratory findings indicative of pericardial inflammation. While acute pericarditis following influenza vaccination is rare, it has been reported in medical literature. The relationship between vaccinations, including the influenza vaccine, and pericarditis is particularly interesting, as it has implications for public health and vaccination programs. Understanding the pathophysiological mechanisms behind vaccine-induced pericarditis and recognizing the clinical presentation are essential for healthcare professionals to diagnose, manage, and educate patients appropriately.

Introduction: Inflammatory bowel disease is a chronic inflammatory disorder of the gastrointestinal tract. Biologic drugs target specific molecules in the body’s immune system to control inflammation. Recent studies have suggested a potential link between their use and an increased risk of nephrolithiasis. We conducted a study to further investigate this association. Methods: The study used multiple logistic regression analysis to assess the association between the use of biologic drugs and nephrolithiasis. A p-value of p = 0.0071) increased the odds of Nephrolithiasis by 31%. Conclusion: Vedolizumab use was associated with an increased risk of nephrolithiasis. The use of two or more biologic drugs also increased the risk compared to no biologic treatment.