Journals
2025 EN
Loureiro Diaz Javier · Surendran Praveen Jayaprabha · Jacob Prasobh
+4 more
ABSTRACT Heart failure with reduced ejection fraction leads to exercise intolerance due to central and peripheral dysfunction. Improvements in exercise performance are not fully captured by traditional measures like peak oxygen consumption alone. A 57‐year‐old male with a complex cardiac medical history of hypertrophic cardiomyopathy with left ventricle non‐compaction, Wolff‐Parkinson‐White syndrome, transient ischemic stroke, and heart failure with reduced ejection fraction with an implanted cardiac resynchronization therapy defibrillator underwent cardiac rehabilitation. Cardiopulmonary exercise testing revealed a non‐proportional improvement in peak oxygen consumption (0.3 METs, 9%) versus peak workload (48 W, 61%). Gross mechanical economy and efficiency improved at all physiological thresholds: at ventilatory threshold by 11%, at respiratory compensation point by 60% and 41%, and at peak oxygen consumption by 47% and 33%, respectively. Mechanical economy and mechanical efficiency should be measured and reported for assessing rehabilitation outcomes in heart failure with reduced ejection fraction.
Journals
2025 EN
Antoun Ibrahim · Helal Ayman · Ali Momen
+2 more
ABSTRACT Takotsubo cardiomyopathy (TTC), also known as stress cardiomyopathy, is characterized by transient regional wall motion abnormalities that mimic acute coronary syndrome (ACS) but without obstructive coronary artery disease. Among its various forms, the mid‐ventricular variant is uncommon and diagnostically challenging. We present a case of a 77‐year‐old female patient with chest discomfort, elevated troponin, and ECG changes mimicking ACS. Coronary angiography revealed unobstructed coronary arteries. Multimodal imaging, particularly cardiac magnetic resonance (CMR), demonstrated circumferential mid‐ventricular hypokinesis, sparing the apical and basal segments, which confirmed mid‐ventricular transmural thickening (TTC). The patient experienced full clinical recovery with normalization of cardiac function on follow‐up imaging. This case underscores the diagnostic value of echocardiography and CMR in distinguishing atypical TTC from other myocardial pathologies.
Journals
2025 EN
Abrar Sakib · Khalil Ibrahim · Ahmed Shah Tanvir
+3 more
ABSTRACT Takayasu arteritis, a rare chronic large‐vessel vasculitis primarily affecting the aorta and its major branches, poses significant diagnostic and therapeutic challenges due to its heterogeneous manifestations and potential for severe vascular complications. This case report details a 40‐year‐old female presenting with a 12‐month history of right arm pain and restricted movement, ultimately diagnosed with Takayasu arteritis. The patient exhibited hallmark features, including a diminished right radial pulse, blood pressure asymmetry (150/92 mmHg left, 125/80 mmHg right), and mild right arm weakness (4/5 strength). Physical examination of the shoulders revealed limited active range of motion in the right shoulder, with abduction restricted to 90° and external rotation to 30°, likely due to ischemic changes, while the left shoulder showed full range of motion. Laboratory findings confirmed active inflammation, with C‐reactive protein ( CRP ) at 18.4 mg/L and erythrocyte sedimentation rate ( ESR ) at 45 mm/h, alongside mild anemia (11.5 g/ dL ) and reactive thrombocytosis (360–410 × 10 3 / μL ). CT angiography revealed thrombotic occlusion of the left vertebral artery (60%–70%), significant narrowing with thin flow in the left common carotid and subclavian arteries, moderate occlusion with reconstituted flow in the left mid and distal brachial and radial arteries, and narrowing in the right ulnar and interosseous arteries. Additionally, a 4.0 cm infrarenal aortic aneurysm was identified, a potentially life‐threatening complication. Treatment was initiated with intravenous methylprednisolone (1 g daily for 3 days), transitioning to oral prednisone (50 mg/day), combined with ibuprofen for pain (400 mg as needed, up to 1200 mg daily), amlodipine and nifedipine for hypertension, and esomeprazole for gastric protection. A multidisciplinary approach was emphasized, integrating rheumatology and vascular surgery, with plans for steroid‐sparing agents (methotrexate or azathioprine) and serial aneurysm surveillance. This case underscores the complexity of Takayasu arteritis, highlighting the need for comprehensive vascular assessments, tailored immunosuppression, and vigilant monitoring to prevent complications and optimize outcomes.
Journals
2025 EN
Mifty Sumaya Khan · Chowdhury Saiful Islam · Rahman Tahmidur
+5 more
ABSTRACT We report a diagnostically complex case of visceral leishmaniasis (Kala‐azar) in a 73‐year‐old male from a country where the disease was eliminated in 2023. The patient presented with a 2‐month history of low‐grade fever, fatigue, progressive skin hyperpigmentation over 2 years, and hepatosplenomegaly. Initial investigations revealed pancytopenia (hemoglobin 10.4 g/dL, white blood cells 3500/mm 3 , platelets 60,000/mm 3 ), prompting a differential diagnosis of Kala‐azar versus myelodysplastic syndrome (MDS). The rapid diagnostic test (rK39) for Kala‐azar was positive, but bone marrow examination showed dysplastic changes, hypercellularity, decreased myeloid‐erythroid ratio, binucleate erythrocytes, and maturation arrest at the myelocyte stage without Leishmania donovani (LD) bodies, complicating the diagnosis. Financial constraints precluded fluorescence in situ hybridization (FISH) testing for MDS confirmation. Repeated peripheral blood film (PBF) and rK39 testing (qDetect Kala‐azar) on February 6, 2025, confirmed Kala‐azar, ruling out MDS as the primary pathology. The patient responded well to liposomal amphotericin B treatment (3 mg/kg/day according to WHO regimen). This case underscores the challenge of diagnosing Kala‐azar in post‐elimination settings, particularly when clinical and laboratory features overlap with hematological disorders like MDS. It highlights the critical need for persistent diagnostic evaluation, including repeated serological and hematological testing, to differentiate infectious causes from malignancies in patients with unexplained pancytopenia. Clinicians must remain vigilant for re‐emerging infectious diseases, even in regions where they are deemed eliminated, to ensure accurate diagnosis and prompt treatment, ultimately improving patient outcomes in resource‐limited settings.
Journals
2025 EN
Khalil Ibrahim · Faiyaz Ahmed Fahim · Promi Sunjida Amin
+1 more
ABSTRACT Idiopathic inflammatory myopathy (IIM) encompasses rare autoimmune disorders causing muscle inflammation and weakness, with subtypes including dermatomyositis, necrotizing myopathy, antisynthetase syndrome, and inclusion body myositis. This case report details a 25‐year‐old South Asian male presenting with a 60‐day history of progressive proximal muscle weakness, dysphagia, and dysphonia, alongside coexisting vitamin D deficiency (serum 25‐hydroxyvitamin D: 19.3 ng/mL). Initial vitamin D supplementation (50,000 IU weekly) failed to halt symptom progression. Diagnostic workup revealed markedly elevated creatine kinase (4569 U/L), electromyography findings of myogenic motor unit potentials with abnormal spontaneous activity, and a biceps muscle biopsy showing inflammation, necrosis, and fibrosis, confirming IIM, most suggestive of likely necrotizing myopathy. Myositis‐specific autoantibodies (MSAs) were not tested, limiting definitive subtype classification. Comprehensive immunological tests were negative, ruling out other autoimmune conditions. No paraneoplastic workup was performed. Treatment with oral prednisolone (1 mg/kg/day) and azathioprine (50 mg twice daily) led to significant improvement in muscle strength, resolution of dysphagia, and normalized CPK levels within weeks, supported by physical therapy and ongoing vitamin D supplementation. This case highlights the diagnostic complexity of IIM in the presence of vitamin D deficiency, which was coincidental in this instance and may potentially exacerbate disease severity by amplifying inflammation and muscle damage, though it is not causative. However, no temporal relationship between vitamin D supplementation and symptom improvement was observed, and follow‐up vitamin D levels were not reassessed. Routine vitamin D screening in IIM patients may be considered recommended to identify and address deficiency as an adjunctive measure, potentially mitigating severity and corticosteroid‐related complications like osteoporosis. We recommend complete autoimmune myositis panels, including MSAs, and malignancy screening in similar cases. Further research is needed to define vitamin D's therapeutic role in IIM management, particularly through longitudinal studies and randomized trials.
Journals
2025 EN
Chibwae Alfred · Jackson Andrew · Paul Christine
+5 more
ABSTRACT Acquired tracheoesophageal fistula (TEF) following delayed removal of an ingested button battery in children often presents with nonspecific symptoms and carries high morbidity. Early diagnosis using imaging and endoscopy is essential. Proximal TEF can be successfully managed through a lateral cervical approach with primary repair and interposition of an omohyoid muscle flap, which helps prevent recurrence and promotes favorable outcomes.
Journals
2025 EN
Alshami Yasmeen · Hroub Osama · Hroub Mohammad
+5 more
ABSTRACT Mitochondrial HMG‐CoA synthase deficiency should be suspected in infants with hypoketotic hypoglycemia, metabolic acidosis, and basal ganglia lesions. A 2‐year‐old boy with a novel HMGCS2 variant presented with refractory seizures and encephalopathy, highlighting the need for rapid metabolic and genetic evaluation for timely management.
Journals
2025 EN
Khalil Sondos K. · Yousif Zahra B. · Baraka Jawaher
+4 more
ABSTRACT Many dietary supplements commonly used by bodybuilders and athletes carry thrombogenic risks, potentially leading to life‐threatening conditions like arterial and venous thrombosis by either elevating testosterone levels or directly interfering with homeostasis. Increased awareness and further research are crucial for consumer safety and supplement regulation.
Journals
2025 EN
Elsherif Yasmine · Elsherif Omar · Karimi Mehran
+2 more
ABSTRACT This case of an 11‐month‐old female who developed severe neutropenia following COVID‐19 infection underscores the need for heightened vigilance and monitoring of hematological parameters in infants post‐COVID‐19. The exact mechanism of COVID‐19‐induced neutropenia is not fully understood, but it may involve cytokine‐induced suppression of hematopoiesis and bone marrow repression due to the inflammatory response. Given the potential for serious clinical implications, including increased susceptibility to infections, it is crucial to effectively identify and manage neutropenia in this vulnerable population. Further research is necessary to elucidate the underlying mechanisms and optimize treatment strategies for COVID‐19‐related hematological complications in infants.
Journals
2025 EN
De Vriendt Lisa · Khalil Ibrahim · Hickson Matthew Victor
+2 more
Abstract The hydrogenation of muconic acid (MA), a biobased platform molecule, offers a sustainable pathway to adipic acid (AA), a key industrial dicarboxylic acid. In this study, we explore the catalytic transfer hydrogenation (CTH) of muconic acid and muconates using ionic ruthenium complexes. Unlike previous approaches, our method aims to selectively hydrogenate MA toward the monounsaturated compound hexenedioic acid (HDA) or its ester. Alcohols (methanol and ethanol) are employed as a hydrogen donor, providing a safer and more moderate alternative to H 2 gas. Using hydrated RuCl 3 as the catalyst, the reaction successfully produces HDA, with no over‐hydrogenation toward AA observed. The resulting product mixture comprises up to four different HDA isomers, which were all identified and distinguished by GC, GC‐MS‐FID, and 1 H‐NMR methods. The trans ‐2 isomer was the most abundant, which was supported by mechanistic investigation using isotopically labeled experiments. A 2,5‐hydrogenation mechanism following a monohydride reaction cycle could be suggested. Furthermore, a kinetic model is presented to provide a deeper understanding of the various reaction pathways.