Understanding of the importance of the normal intestinal microbial community in regulating microbial homeostasis, host metabolism, adaptive immune responses, and gut barrier functions has opened up the possibility of manipulating the microbial composition to modulate the activity of various intestinal and systemic diseases using fecal microbiota transplant (FMT). It is therefore not surprising that use of FMT, especially for treating relapsed/refractory Clostridioides difficile infections (CDI), has increased over the last decade. Due to the complexity associated with and treatment for these diseases, patients with hematologic and oncologic diseases are particularly susceptible to complications related to altered intestinal microbial composition. Therefore, they are an ideal population for exploring FMT as a therapeutic approach. However, there are inherent factors presenting as obstacles for the use of FMT in these patients. In this review paper, we discussed the principles and biologic effects of FMT, examined the factors rendering patients with hematologic and oncologic conditions to increased risks for relapsed/refractory CDI, explored ongoing FMT studies, and proposed novel uses for FMT in these groups of patients. Finally, we also addressed the challenges of applying FMT to these groups of patients and proposed ways to overcome these challenges.

Hypermucoviscous Klebsiella pneumoniae (HvKP) is a hypervirulent strain of Klebsiella that causes metastatic spread and life-threatening infection. While it is more common among people of Asian descent, it has been increasingly reported globally among people of other ethnicities as well. We report a case of pan-susceptible HvKP infection in a male patient of Asian descent who has been living in the US for 20 years. It caused a liver abscess, perigastric abscess, perisplenic abscess, multifocal pneumonia, septic emboli, and tricuspid valve infective endocarditis. He was treated with ceftriaxone, but his septic shock was refractory, ultimately leading to death. This case highlights the severity of infection caused by this strain, and its ability to present with radiographic signs suggestive of malignancy with metastasis. This case also suggests that this strain can become pathogenic after a very prolonged period of gastrointestinal colonization.

Hypertension is a great challenge for the public health professionals across the world, as it is a major risk factor leading to congestive heart failure, coronary heart disease, retinopathy, and renal disease. Therefore, the study aims to diagnose hypertension among the adults in Al-Riyadh district, Khartoum state of Sudan. The study investigated the prevention and management of primary and secondary hypertension. A cross sectional population-based study was conducted among 138 adult individuals aged between 16 and 75 years. The participants were selected using random sampling technique and each participant completed self-administered questionnaire to assess the prevention-management of primary and secondary hypertension. The mercury sphygmomanometer with standard cuff was used to take measurement of arterial blood pressure. The diagnosis of hypertension among the adults showed that its prevalence in the area of Riyadh was 28%. The highest proportion of hypertension (13.7%) was recorded among the patients aged from 45 and 60 years. There was significant association of age (p-value = 0.001), social status (p-value = 0.001), stress (p-value = 0.010), and diabetes (p-value = 0.050) with hypertension. The present study has highlighted the significant factors associated with hypertension that encourages the public health professionals to carry out awareness and prevention programs.A study conducted by Babiker et al. (2013) used structured questionnaires to investigate the awareness and factors linked with the uncontrolled hypertension among the Sudanese adults. The results showed that prevalence of

BackgroundMany co-existing medical conditions may affect the outcome in patients treated with immune checkpoint inhibitors for advanced cancer. There is currently not any information on whether metabolic syndrome (MetS) impacts the clinical outcome in patients treated with immune checkpoint inhibitors (ICIs) for advanced non-small cell line cancer (NSCLC).MethodsWe carried out a single-center retrospective cohort study to determine the effects of MetS on first-line ICI therapy in patients with NSCLC.ResultsOne hundred and eighteen consecutive adult patients who received first-line therapy with ICIs and had adequate medical record information for the determination of MetS status and clinical outcomes were included in the study. Twenty-one patients had MetS and 97 did not. There was no significant difference between the two groups in age, gender, smoking history, ECOG performance status, tumor histologic types, pre-therapy use of broad-spectrum antimicrobials, PD-L1 expression, pre-treatment neutrophil:lymphocyte ratio, or proportions of patients who received ICI monotherapy or chemoimmunotherapy. With a median follow-up of 9 months (range 0.5-67), MetS patients enjoyed significantly longer overall survival (HR 0.54, 95% CI: 0.31-0.92) (p = 0.02) but not progression-free survival. The improved outcome was only observed in patients who received ICI monotherapy and not chemoimmunotherapy. MetS predicted for higher probability of survival at 6 months (p = 0.043) and 12 months (p = 0.008). Multivariate analysis indicated that, in addition to the known adverse effects of use of broad-spectrum antimicrobials and the beneficial effects of PD-L1 (Programmed cell death-ligand 1) expression, MetS was independently associated with improved overall survival but not progression-free survival.ConclusionsOur results suggest that MetS is an independent predictor of treatment outcome in patients who received first-line ICI monotherapy for NSCLC.

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare aggressive malignancy with poor outcomes. Although novel options like tagraxofusp, a CD123-directed cytotoxin, has emerged and is promising, treatment options are very limited in the relapsed and recurrent setting. We present a case of refractory BPDCN in a 62-year-old man who showed a complete bone marrow response to liposomal daunorubicin and cytarabine (vyxeos).