The incidence of Clostridioides difficile infection (CDI) has been increasing compared to pre-COVID-19 pandemic levels. The COVID-19 infection and CDI relationship can be affected by gut dysbiosis and poor antibiotic stewardship. As the COVID-19 pandemic transitions into an endemic stage, it has become increasingly important to further characterize how concurrent infection with both conditions can impact patient outcomes. We performed a retrospective cohort study utilizing the 2020 NIS Healthcare Cost Utilization Project (HCUP) database with a total of 1,659,040 patients, with 10,710 (0.6%) of those patients with concurrent CDI. We found that patients with concurrent COVID-19 and CDI had worse outcomes compared to patients without CDI including higher in-hospital mortality (23% vs. 13.4%, aOR: 1.3, 95% CI: 1.12–1.5, p = 0.01), rates of in-hospital complications such as ileus (2.7% vs. 0.8%, p < 0.001), septic shock (21.0% vs. 7.2%, aOR: 2.3, 95% CI: 2.1–2.6, p < 0.001), length of stay (15.1 days vs. 8 days, p < 0.001) and overall cost of hospitalization (USD 196,012 vs. USD 91,162, p < 0.001). Patients with concurrent COVID-19 and CDI had increased morbidity and mortality, and added significant preventable burden on the healthcare system. Optimizing hand hygiene and antibiotic stewardship during in-hospital admissions can help to reduce worse outcomes in this population, and more efforts should be directly made to reduce CDI in hospitalized patients with COVID-19 infection.

Cisplatin is a first-line antitumor drug which is applied in the therapeutic field of numerous kinds of cancers. The main dose-dependent adverse effect of cisplatin is nephrotoxicity in approximately one-third of patients, who received this drug during their treatment. Oxidative stress is one of the most significant mechanisms in cisplatin nephrotoxicity. Cisplatin-induced oxidative stress stimulates apoptosis, inflammation, mitochondrial damage within cells, and endoplasmic reticulum (ER) stress. The administration of an antioxidant in this context could be a suitable approach for preventing of cisplatin nephrotoxicity. Antioxidants are categorized into four classes: dietary antioxidants, free radical scavengers, thiol-containing compounds, and iron chelators.

Background: Blinatumomab and inotuzumab ozogamicin (InO) are B-cell targeted agents used in the frontline and relapsed/refractory treatment of B-cell acute lymphoblastic leukaemia (B-ALL). Blinatumomab, a bispecific T-cell engager that targets CD19 and CD3, and InO, an antibody-drug conjugate targeting CD22, have both shown efficacy. However, recent reports have noted lineage conversion as a complication when these agents are used individually or sequentially. We present a rare case of this phenomenon in a 79-year-old male patient. Case description: A 79-year-old male with refractory B-ALL underwent a lineage switch to acute myeloid leukaemia following treatment with blinatumomab and InO. The patient initially achieved remission after initial therapy but relapsed and was subsequently treated with blinatumomab. Due to adverse effects, the treatment was discontinued. He was then treated with InO but again relapsed. A subsequent bone marrow biopsy revealed morphologic evidence of residual B-ALL, but with the presence of acute monocytic leukaemia. Fluorescence in situ hybridisation (FISH) analysis demonstrated an additional copy of KMT2A in a large percentage of cells which was a feature present since the initial diagnosis. Unfortunately, the patient’s condition deteriorated, and he died. Conclusion: This case underscores potential complication of lineage switch following treatment with B-cell directed therapies. Although such therapies have improved outcomes in B-cell malignancies, clinicians should remain aware of rare risks such as lineage transformation. Timely recognition is essential to guide appropriate clinical management.

Sickle cell disease (SCD) predominantly affects individuals of African descent and is characterized by frequent painful vaso-occlusive crises, often requiring opioid management. With the opioid epidemic raising concerns about opioid overdose, this study examines in-hospital outcomes among SCD and non-SCD patients hospitalized for opioid overdose. Using the National Inpatient Sample (NIS) from 2016 to 2021, we analyzed 479,175 opioid overdose hospitalizations, including 1,315 (0.3%) with a concomitant diagnosis of SCD. Propensity score matching was used to balance demographics, comorbidities, and hospital characteristics. SCD patients were younger (45.3% aged 30–49 vs. 33.1%, p < 0.001), predominantly of African descent (92.1% vs. 14.1%, p < 0.001), and more often from lower-income households (58.4% vs. 35.2%, p < 0.001). SCD patients had lower rates of mechanical ventilation (aOR: 0.7, 95% CI: 0.6–0.9) and anoxic brain injury (aOR: 0.5, 95% CI: 0.4–0.8) but experienced longer hospital stays and higher costs. No significant differences in in-hospital mortality were observed (aOR: 0.89, 95% CI: 0.7–1.1, p = 0.34). These findings emphasize the need for a nuanced approach to managing SCD patients during opioid overdose hospitalizations, focusing on mitigating complications, addressing prolonged hospital stays and higher costs, and reducing healthcare disparities through tailored strategies informed by the unique needs of this population.

Background: Warm autoimmune haemolytic anaemia (wAIHA) is an acquired haemolytic disorder most commonly treated with a combination of corticosteroids, rituximab and/or splenectomy. Third-line therapies for refractory cases include immunosuppressive agents. Mycophenolate mofetil is frequently used in these scenarios, although its use is supported by small studies and anecdotal evidence rather than large-scale data. Case description: We describe three cases of refractory warm autoimmune haemolytic anaemia successfully treated with mycophenolate mofetil. Case 1: A persistent case of autoimmune haemolytic anaemia in a 56-year-old was ultimately managed with mycophenolate mofetil, leading to successful steroid tapering and stable haemoglobin levels without relapse. Case 2: A woman with a complex oncological history, including lymphoma and breast cancer, achieved remission with mycophenolate therapy, maintaining stability post-steroid treatment. Case 3: Mycophenolate proved effective for a 63-year-old with cirrhosis after recurrent autoimmune anaemia and deep vein thrombosis, enabling cessation of steroids and maintaining remission. Conclusion: Management of this condition can be challenging and balancing the available treatments is crucial to reduce potential complications from long-term therapies that appear to be ineffective. Our case series demonstrates anecdotal experience on successful use of mycophenolate mofetil for complex refractory cases of wAIHA.