Mohammad Firoz Anjum,1 Suraj Sah,2Inesh Khanal,2 Sharmila Gainju,3Sriram KC41Pediatric Nephrologist, Patan Academy of Health Sciences, Lagankhel, Lalitpur, Nepal, 2Intern Doctor, Patan Academy of Health Sciences, Lagankhel, Lalitpur, Nepal,3Resident, Department of Pediatrics, Patan Academy of Health Sciences, Lagankhel, Lalitpur, Nepal,4Pediatrician, Armed Police Force Hospital, Balambu, Chandragiri, Kathmandu, NepalCorrespondence: Dr Inesh Khanal, Intern Doctor, Patan Academy of Health Sciences, Lagankhel, Lalitpur, Nepal, Email: std.ineshkhanal@pahs.edu.np , Phone: +977-9813865449.Author contribution:Dr. Firoz Anjum: Conceptualization; Investigation; Methodology; Project administration; Software; Supervision; Validation; Writing - original draft; Writing - review & editing.Dr. Suraj Sah: Conceptualization; Methodology; Writing - original draft; Writing - review & editingDr. Inesh Khanal: Conceptualization; Formal analysis; Software; Supervision; Writing - original draft; Writing - review & editingDr. Sharmila Gainju: Conceptualization; Methodology; Project administration Supervision; Writing - review & editingDr. Sri Ram KC: Conceptualization; Investigation; Supervision; Writing - original draft; Writing - review & editingAbstractLupus nephritis is a severe manifestation of systemic lupus erythematosus (SLE) typically characterized by glomerular “full-house” immunofluorescence. However, non-lupus nephropathies may occasionally exhibit similar patterns, creating diagnostic uncertainty. Non-lupus full-house nephropathy (FHN) is a recently recognized entity in which a full-house immunofluorescence pattern occurs in the absence of serological or clinical evidence of SLE. We report a 4-year-old girl who presented with generalized edema, hematuria, hypertension, and nephrotic-range proteinuria. Laboratory evaluation revealed anemia, elevated serum creatinine, and low complement C3 levels but negative antinuclear antibody (ANA) and anti-double-stranded DNA (anti-dsDNA) tests. Renal biopsy demonstrated diffuse proliferative glomerulonephritis consistent with lupus nephritis Class IV, with full-house immunofluorescence positivity for IgG, IgA, IgM, C3, and C1q. In the absence of systemic or serologic lupus features, a diagnosis of non-lupus full-house nephropathy was made. The patient was treated with pulse methylprednisolone followed by oral prednisolone, monthly cyclophosphamide for six months, and maintenance therapy with azathioprine and low-dose steroids. Hydroxychloroquine and antihypertensive agents were added. She achieved clinical and biochemical remission on follow-up.Keywords: Non-lupus full-house nephropathy, Lupus nephritis, Seronegative lupus, Pediatric nephrology, Diagnostic dilemma

Paclitaxel-coated balloons have demonstrated improved efficacy compared with uncoated percutaneous transluminal angioplasty for femoropopliteal artery disease. While applying a long balloon, twisting of the balloon can be occurred. We reported two cases with twisting of the Ranger drug-coated balloon for treating superficial femoral artery.

INTESTINAL PERFORATION SECONDARY TO BORTEZOMIB INDUCED AUTONOMIC NEUROPATHY

Type of manuscript: Case reportTitle: Cogan Syndrome presenting with giant pseudoaneurysm of ascending aorta for surgery facilitated by deep hypothermic circulatory arrest.

A document by Joydip Chowdhury. Click on the document to view its contents.

A man with two pacemakers: the mystery of the electrocardiogramYingchun Hu1*, Xiaoyu Chen2*, Hui Huang1, Weiming Luo1,Yisheng Zhou1, Xingkao Chen1, Guoping Liu1, Hanping Zhang1#1Department of Cardiology, Guangzhou Development District Hospital, 196 Youyi Road, Huangpu District, Guangzhou 510730, Guangdong, China2Department of Nephrology, Rheumatism and Immunology, Chongqing Jiulongpo People’s Hospital, Chongqing, 400050, China* These authors have contributed equally to this work and were both the first authors.# The author is the corresponding author.# Correspondence to : Hanping ZhangE-mail: zhanghp0931@163.comMail to: Department of Cardiology, Guangzhou Development District Hospital, 196 Youyi Road, Huangpu District, Guangzhou 510730, Guangdong, ChinaKey words: electrocardiogram, pacemaker, battery depletion, pacing spikes, His bundle pacingKey Clinical MessageThe increasing growth in the elderly population and expanding indications for pacemaker use have led to a progressive rise in the number of pacemaker implants. As the number of pacemaker implants continues to grow, the demand for pacemaker replacements also increases. Therefore, regular follow-up and timely detection of pacemaker issues are particularly important. Our findings reported a confusing but interesting clinical practice. In our study, three spike signals are observed during stable pacing periods, with fixed spikes occurring during in AV delay at 180 ms intervals, excluding other operation types such as CRT and His bundle pacing.

A document by Mousa Ahmadpour-kacho. Click on the document to view its contents.

A case of tricuspid valve and papillary muscle rupture due to entrapment of the tendon of the tricuspid valve by the PENTARAYⓇ catheter.The patient was a 46-year-old male who had a premature ventricular contraction (PVC) with palpitation symptoms for the past 5 years. He was taking a beta blocker (carvedilol) for drug therapy and etizolam due to anxiety complications caused by palpitation symptoms. Electrocardiogram revealed PVC at the right ventricular (RV) outflow tract origin. The patient was referred to our hospital, and underwent percutaneous myocardial ablation.Mapping of the origin of the PVC with an irrigation catheter (THERMOCOOL SMARTTOUCHⓇ; Biosense Webster, California, USA) suggested an RV outflow tract septum origin. The PENTARAYⓇ catheter (Biosense Webster, California, USA) was used for more detailed mapping of multiple points. When the catheter was advanced into the RV outflow tract, there was resistance and passage was difficult.There was also resistance when pulling the catheter. When the catheter was rotated to remove the resistance, the resistance disappeared, and the catheter was removed. Tissue as shown in Figure 1a was wrapped around the leg of the PENTARAYⓇ and when removed and unfolded, it was a structure that appeared to be part of the papillary muscle and tendon cord/tricuspid valve (TV) (Figure 1b, c). Since the TV was considered injured and dissected, transthoracic echocardiography was performed to confirm the presence of tricuspid regurgitation (TR) and pericardial effusion, which revealed a new moderate degree of TR. Since there was no pericardial effusion and no decrease in blood pressure, catheter ablation was continued. After additional mapping with THERMOCOOL SMARTTOUCHⓇ again, the RV outflow tract septal wall was cauterized, and the PVC disappeared, completing the procedure. The tissue attached to the PENTARAYⓇ was submitted for histopathology and confirmed to be the TV, tendon cord and papillary muscle. The patient was discharged from the hospital without developing heart failure. He continues to have outpatient visits, however, he has no symptoms of right heart failure due to TR, and his TR remains mild on echocardiographic evaluation.Although pericardial effusion and cardiac tamponade are sometimes seen as complications of catheter ablation [1], there are no other case reports of TV rupture. When advancing the PENTARAYⓇ into the RV outflow tract, the leg of the PENTARAYⓇ caught on the tendon of the TV. Rotation of the catheter was applied to relieve the resistance of the catheter, which wrapped the tendon cords of the TV around the legs of the catheter and separated the papillary muscle and TV. Based on anatomical location, the ruptured papillary muscle was considered the septal papillary muscle. Rotation is sometimes used to relieve catheter resistance, however, catheters with multiple legs, such as PENTARAYⓇ, tend to wrap around the string-like structure when rotated. When passing a multipolar mapping catheter through the annulus, it is a preventive measure to reduce the risk of such complications by passing it through the center of the annulus without rotating it. If the multipolar mapping catheter becomes trapped in the chordal area, one direction rotation should be avoided because this may cause the surrounding chordae to become involved. During ablation, multipolar mapping catheters are often used due to their ease of mapping; however, caution is required when passing near the tendon chord.Author ContributionsDaisuke Yamazaki: conceptualization, data curation, methodology, supervision, writing – original draft, writing – review and editing.Ethics StatementThe authors have nothing to report.ConsentWritten informed consent was obtained from the patient to publish this report in accordance with the journal’s patient consent policy.Conflicts of InterestThe authors declare no conflicts of interest.References1. Latchamsetty R, Yokokawa M, Morady F, et al. Multicenter Outcomes for Catheter Ablation of Idiopathic Premature Ventricular Complexes .; 2015. doi:10.1016/j.jacep.2015.04.005Figure captionFigure 1. Tissue wrapped around PENTARAYⓇ catheter.Figure 1a. The catheter was retrieved. Tissue is wrapped around the leg of the PENTARAYⓇ catheter.Figure 1b. The scene of unwinding the tissue wrapped around the leg.Figure 1c. After unwinding the tissue wrapped around the leg, it was the part of the tricuspid valve.

Key Home Message: Ectopic esophageal sebaceous glands are rare, benign lesions that may mimic more serious pathology. Recognition of this condition can prevent unnecessary interventions, guide management focused on symptom control, and provide reassurance to patients.Keywords: sebaceous, esophagus, ectopic, benign

Title PageTitle: Incidental Diagnosis of Fahr’s Disease Following Severe Traumatic Brain Injury: A Case ReportAuthors: Hadi Ebrahimi, Ali Holakoo*, Seyyed Ebrahim Hejazian, Hamed Ahmadian, Amir Hosein Zohrevand, Morteza SharifzadehAffiliation: Department of Neurosurgery, Babol University of Medical Sciences, Babol, Iran*Corresponding Author: Ali Holakoo, Email: draliholakoo@gmail.comKey Clinical MessageFahr’s disease can be incidentally detected during emergency imaging for unrelated conditions.Even in the context of life-threatening trauma, incidental findings of Fahr’s disease should not be overlooked.Recognizing its radiological features and excluding secondary causes are essential for accurate diagnosis and long-term management.

To Lyse or Not: The Role of Half-Dose Thrombolysis in Right Ventricular Clot Associated with Sub-Massive Pulmonary EmbolismNasreldin A. Hamza1, Wasfy J. Hamad1, Shamim K. Vakkulathil1, Vimalraj Sundaram1, Haidar M. Hadi2, Abdulqadir J. Nashwan3*1 Critical Care Department, Al-Khor General Hospital, Hamad Medical Corporation, Doha 3050, Qatar2 Cardiology Department, Al-Khor General Hospital, Hamad Medical Corporation, Doha 3050, Qatar3 Nursing Department, Hamad Medical Corporation, Doha 3050, Qatar*Corresponding author:Mr. Abdulqadir J. Nashwananashwan@hamad.qaMob: (+974) 66473549, P.O. Box 3050 Doha, QatarORCID: https://orcid.org/0000-0003-4845-4119E-mails: nhamza@hamad.qa; whamad1@hamad.qa; SVakkulathil@hamad.qa; VSundaram@hamad.qa; HHadi3@hamad.qa; Anashwan@hamad.qa

The patient was a 40-year-old man with penetrating chest trauma two days before being referred to our hospital.during first repair LAD artery was sutured.because of ongoing CP, he was candidate for bypass surgery and revascularization .The surgeon had reported ligation of LADA by some sutures during previous cardiac repair.

Under-expanded stents in calcific coronary stenoses are a common challenge for interventional cardiologists as we undertake more complex coronary interventions for older population cohorts. It results in short-term and long-term stent failure and adverse patient outcomes. These complex lesions can be treated after many years with intravascular lithotripsy (IVL-Shockwave).

IntroductionGranulomatosis with polyangiitis (GPA) is a chronic condition characterized by granulomatous inflammation of blood vessels, leading to damage in various organs, including the lungs, kidneys, and sinuses. This pattern of involvement can complicate the diagnosis of coexisting conditions, especially those involving granulomatous inflammation, like tuberculosis (TB). Its treatment typically involves the use of immunosuppressants, which can further complicate the diagnosis of infectious conditions. (1) Cardiac tuberculosis (TB) is a rare but clinically significant extrapulmonary manifestation of tuberculosis, often presenting substantial diagnostic challenges due to its nonspecific symptoms. Timely diagnosis and management are crucial as TB’s involvement in cardiac tissues can result in severe complications such as tuberculous pericarditis and cardiac tamponade. (2) Patients may exhibit symptoms like fatigue, weight loss, dyspnea, and chest pain, which can easily mimic other cardiac conditions, complicating both diagnosis and management. The prevalence of cardiac TB varies geographically, with notably higher rates observed in regions where TB is endemic. (2) In addition to cardiac TB, mitral-aortic intervalvular abscesses represent another rare yet critical complication associated with infective endocarditis, particularly in patients with pre-existing cardiovascular disease. This anatomical region, known as the mitral-aortic intervalvular fibrosa (MAIVF), consists of fibrous and avascular tissue that is particularly vulnerable to infections and trauma. These abscesses occur in less than 1% of endocarditis cases and can lead to severe sequelae, such as valvular dysfunction and heart failure, if not diagnosed and treated promptly. (3, 4)The primary causative agents are often bacterial infections, particularly from organisms like Staphylococcus aureus. These infections can invade the fibrous tissue following surgical interventions or arise in the context of chronic conditions that predispose patients to endocarditis.(5, 6) The co-occurrence of tuberculosis (TB) and granulomatosis with polyangiitis (GPA) presents a significant clinical challenge, especially among immunocompromised patients. This case report details a 45-year-old woman with end-stage renal disease secondary to GPA who developed an MAIVF abscess with necrotizing granulomatosis inflammation and a positive tissue PCR for TB. Understanding the interplay between these two conditions is critical for guiding distinct therapeutic approaches, given that both involve granulomatous inflammation.

Central hemangioma of mandible: Rare case

A document by Sakshi Prasad. Click on the document to view its contents.

Hypokalemic Periodic Paralysis in a Young Woman with Mast Cell Activation Syndrome: Atypical Presentation Associated with an Ultra-Rare CACNA1S VariantAli Moradi, Yasmin Aboutaleb, Saba Noreen, Abdullah Sahyouni, Hasin Sharma, Olugbenga Oyesanmi, Ian M. Kahane, Yizhi Lin, Hakan R. Toka1Ali Moradi M.D. Internal Medicine Resident, HCA Florida Blake Hospital, University of South Florida (USF), Morsani College of Medicine, Bradenton, USA. Email: Ali.moradi@hcahealthcare.com2Yasmin Aboutaleb M.D. Internal Medicine Resident, HCA Florida Blake Hospital, University of South Florida (USF), Morsani College of Medicine, Bradenton, USA. Email: Yasmin.aboutaleb@hcahealthcare.com3Saba Noreen, M.D. Internal Medicine Resident, HCA Florida Blake Hospital, University of South Florida (USF), Morsani College of Medicine, Bradenton, USA. Email: Saba.Noreen@hcahealthcare.com4Abdullah Sahyouni, M.D. Internal Medicine Resident, HCA Florida Blake Hospital, University of South Florida (USF), Morsani College of Medicine, Bradenton, USA. Email: Abdullah.Sahyouni@hcahealthcare.com5Hasin Sharma, Medical Student, Nova Southeastern University Kiran C. Patel College of Osteopathic Medicine, Florida, USA. Email: Hs987@mynsunova.edu6Olugbenga Oyesanmi, M.D. MPH, Division Research Director, HCA Florida Blake Hospital, University of South Florida (USF), Morsani College of Medicine, Bradenton, USA Email: Olugbenga.Oyesanmi@hcahealthcare.com7Ian M. Kahane M.D., Attending Physician, Internal Medicine, HCA Florida Blake Hospital, University of South Florida (USF), Morsani College of Medicine, Bradenton, USA. Email: Ian.Kahane@gmail.com8Yizhi Lin DO, Program Director, Internal Medicine, HCA Florida Blake Hospital, University of South Florida (USF), Morsani College of Medicine, Bradenton, USA. Email: Yizhi.Lin@hcahealthcare.com9Hakan R. Toka, M.D, PhD, Attending Physician, Nephrologist, Manatee Kidney Diseases Consultants, Bradenton, USA. Email: Hrtoka@gmail.com

A document by Dennis Machaku. Click on the document to view its contents.