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Hypercalcemia is a common metabolic complication associated with malignancies, particularly in solid tumors, such as lung and breast cancers. However, its occurrence in hematologic malignancies, including diffuse large B-cell lymphoma (DLBCL), is rare. The pathophysiology of hypercalcemia in lymphomas is often related to the secretion of parathyroid hormone (PTH)-related peptide (PTHrP). However, an alternative and less common mechanism involves the ectopic overproduction of 1,25-dihydroxyvitamin D (1,25(OH)2D), which has been reported in some cases of lymphoma-associated hypercalcemia. In this case report, we present a 60-year-old female who was incidentally found to have hypercalcemia during the evaluation of nonspecific symptoms, ultimately leading to the diagnosis of DLBCL with liver and splenic involvement. The patient presented to the emergency department with symptoms of shortness of breath, palpitations, insomnia, polydipsia, and polyuria. Laboratory evaluation revealed a critical calcium level of 12.5 mg/dL, along with suppressed PTH levels and elevated 1,25(OH)2D levels, suggesting an ectopic source of 1-alpha-hydroxylase activity. Imaging revealed hepatic and splenic masses, and a liver biopsy confirmed the diagnosis of DLBCL. Further evaluation ruled out more common causes of hypercalcemia, such as osteolytic metastases and PTHrP-related mechanisms, reinforcing the likelihood that the patient's hypercalcemia was due to ectopic 1,25(OH)2D production. This case underscores the complexity of hypercalcemia in patients with DLBCL, particularly when uncommon mechanisms such as ectopic 1,25(OH)2D synthesis are involved. While the exact etiology of hypercalcemia in DLBCL remains incompletely understood, it is emerging as a potential biomarker for poor prognosis. Studies suggest that hypercalcemia in DLBCL may correlate with aggressive disease features, shorter diagnosis-to-treatment intervals, and worse overall outcomes. In this case, the patient's hypercalcemia may reflect the biological aggressiveness of her disease, with a relatively short interval to treatment after diagnosis. Further research is necessary to better understand the prognostic significance of hypercalcemia in DLBCL and its underlying mechanisms., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Hegazy et al.)

Pneumocephalus is a rare but potentially serious complication of spinal procedures, characterized by the presence of intracranial air. This report presents the case of a 40-year-old female who developed pneumocephalus following a lumbar epidural steroid injection. She presented to the emergency department with a persistent headache, blurred vision, and eye pain, which began shortly after the procedure. Computed tomography (CT) scans of the head and lumbar spine revealed several air pockets in the cerebellar cisterns and the left frontal horn, as well as in the epidural and paraspinal regions. Despite the presence of intracranial air, the patient's symptoms gradually improved with conservative management, including bed rest, caffeinated drinks, intravenous fluids, and symptomatic relief with butalbital-acetaminophen-caffeine. A repeat CT scan on day four showed a reduction in air pockets, and by day 10, all air pockets had resolved without the need for neurosurgical intervention. The patient's headaches subsided, though she experienced mild residual vision changes. This case emphasizes the importance of recognizing pneumocephalus as a potential complication of epidural steroid injections and highlights the efficacy of conservative treatment. While most cases of simple pneumocephalus resolve spontaneously, careful monitoring is essential to prevent progression to tension pneumocephalus, a life-threatening condition that requires urgent surgical intervention. Further studies are needed to evaluate the risks and outcomes of different techniques used during epidural procedures., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Hegazy et al.)

This case report highlights the atypical presentation of coronary artery vasospasm in a 59-year-old patient presenting with syncope due to ventricular arrhythmia. Despite initially elevated troponin levels and non-significant lesions observed during left heart catheterization, the patient experienced recurrent chest pain and dizziness, prompting further evaluation. Ultimately, coronary vasospasm was identified as the likely differential diagnosis, supported by various diagnostic modalities including electrocardiogram, Zio patch monitoring, transthoracic echocardiogram, cardiac MRI, and CT angiography. Management involved the initiation of calcium channel blocker therapy, leading to a non-eventful follow-up in the cardiology clinic., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Baig et al.)

Point-of-care ultrasound (POCUS) has emerged as a powerful diagnostic tool in healthcare, offering rapid and cost-effective evaluation of cardiovascular and respiratory conditions. This case series highlights the vital role of POCUS in diagnosing life-threatening conditions and emphasizes the need for adequate training in its use. The first case describes a patient with chest pain, where POCUS revealed findings suggestive of thoracic aortic dissection, leading to timely transfer and surgical repair. The second case involves a patient with altered mental status and hypoxia, where POCUS identified a right atrial thrombus leading to thrombectomy. The discussion explores the expanding applications of POCUS in various medical specialties, including critical care and trauma, and its potential to improve patient outcomes. While POCUS has shown great promise, it remains a user-dependent technology, necessitating comprehensive training and collaboration among healthcare professionals to ensure its effective and safe use., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Ghallab et al.)

BRASH syndrome, characterized by bradycardia, renal failure, atrioventricular (AV) blockage, shock, and hyperkalemia, is an emerging clinical entity that challenges healthcare practitioners. This case report presents a unique instance of BRASH syndrome with an atypical presentation in a 56-year-old woman with a past medical history of hypertension, diabetes, and chronic kidney disease. Initial laboratory results revealed severe normocytic anemia, thrombocytopenia, renal dysfunction, acidosis, and hyponatremia, alongside hyperkalemia and hypothyroidism. An electrocardiogram depicted sinus arrest with atrial escape rhythms, indicative of severe bradycardia. Imaging studies revealed pleural effusion and ground glass opacities. Management involved anti-hyperkalemic measures, discontinuation of AV nodal-blocking agents, thyroid hormone replacement, and vasopressor support. The patient eventually improved following continuous renal replacement therapy (CRRT) and hemodialysis. The diagnosis of BRASH syndrome emerged as the most likely due to recurrent admissions with similar clinical features. BRASH syndrome represents a complex interplay between AV nodal block and hyperkalemia, leading to severe bradycardia and shock, often affecting older patients with limited renal reserve. While the current literature primarily consists of case reports, raising awareness of BRASH syndrome is crucial for timely intervention and improved patient outcomes. Further research is needed to better understand the mechanisms underlying this syndrome., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Ghallab et al.)

Pulmonary nodules are commonly encountered in medical practice, necessitating thorough evaluation due to their diverse etiologies. Identifying the underlying cause is of utmost importance, particularly in patients with a history of extrapulmonary cancer, to differentiate between metastasis and other etiologies. We present a rare case of a 24-year-old male with supraglottic squamous cancer who developed multiple pulmonary nodules, which surprisingly were caused by a rare infectious agent. The patient presented with bilateral infiltrates on imaging, raising strong suspicion of metastatic disease from primary cancer. However, bronchoscopy and biopsy revealed no malignancy but confirmed the presence of Corynebacterium amycolatum , leading to a change in the treatment approach from palliative to curative. This case highlights the importance of considering other etiologies, especially infections, in patients with cancer and pulmonary nodules. Accurate diagnosis is crucial to guide appropriate management decisions and optimize patient outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Alagha et al.)

This case report describes a patient with systemic sclerosis (SSc) who presented with a large pericardial effusion and a scleroderma renal crisis (SRC). The patient's clinical presentation, diagnostic workup, and treatment plans are reviewed. The coexistence of these complications presents a challenging clinical scenario requiring an interdisciplinary approach. The management of pericardial effusion in SSc and SRC is discussed, emphasizing the need for early detection and prompt treatment. Further research is needed to better understand and manage these complex complications in SSc patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Ghallab et al.)

This case report presents the clinical course of a 70-year-old female with a history of hypertension who developed sinus pauses following abdominal surgery, ultimately requiring the placement of a pacemaker. The patient initially presented with altered mental status preceded by abdominal pain, which progressed to confusion and obtundation. Examination revealed signs of toxicity, tachycardia, tachypnea, and a distended abdomen with absent bowel sounds. A computed tomography (CT) scan of the abdomen indicated closed-loop small bowel obstruction with free air and ascites. The patient underwent exploratory laparotomy, revealing purulent fluid and a necrotic, perforated appendix, leading to appendectomy and peritoneal irrigation. Subsequent surgeries addressed the coagulative necrosis of the omentum and wound closure. During the recovery period, the patient exhibited bradycardia with sinus pauses, including episodes of complete heart block. Cardiology consultation attributed this to increased parasympathetic tone following surgery and recommended the placement of a temporary transvenous pacemaker. As the patient's condition improved, the sinus pacing function progressively returned, leading to the removal of the pacemaker. This case underscores the potential development of sinus pauses after abdominal surgery and highlights the importance of prompt recognition, appropriate management, and collaboration between surgical and cardiology teams to ensure patient recovery., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Ghallab et al.)

Tracheal stenosis (TS) is an iatrogenic sequela after intubation or tracheostomy that is increasing despite technological improvement and skilled respiratory care in the ICU. According to the studies, the rate of TS varies from 10 to 22%, but only 1-2% of these stenoses are severe and present with inspiratory dyspnea that does not respond to medical management. Bronchoscopy is considered the most appropriate diagnostic test, and laser surgery and tracheobronchial stenting are the most commonly performed procedures for tracheal stenosis. However, alternative treatment options, including cryotherapy for inoperable patients, have yet to be studied widely. As the number of patients requiring ICU admission with mechanical intubation is increasing, it is crucial to acknowledge this complication and consider alternative management options. Here we present a review of the use of cryotherapy for post-intubation tracheal stenosis.  Pubmed, Cochrane, and EMBASE databases were inquired for studies performed using the keywords 'airway stricture' OR 'airway obstruction' AND 'post-intubation' OR 'post-extubation' OR 'tracheostomy' AND 'cryotherapy'. After the primary and secondary screening, five studies were included in the analysis.  We included 67 patients were included in the analysis, with a mean age of 50.2 (range: 42-55) years. Tracheal stenosis and subglottic stricture were the most common sites of stenosis. Twenty-nine patients were treated with cryotherapy only, while the rest 38 patients had cryotherapy followed by balloon dilation. After the intervention, 48 patients experienced improvement, five experienced no change in the symptoms, 13 patients were asymptomatic before the treatment, and one died. No complication was reported in 65 patients, with only minor complications reported in rest.  Although, there is no clear treatment protocol for patients with inoperable tracheal stenosis. Our review demonstrates that cryotherapy for inoperable tracheal stenosis can be an acceptable alternative treatment with significant clinical improvement. Additionally, cryotherapy has fewer adverse effects compared to other treatment options., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Hosna et al.)

Kawasaki Disease (KD) is a self-limited acute vasculitis that mainly affects medium-sized arteries in childhood, with the coronary arteries being one of the main targets. A well-known complication is a coronary aneurysm with myocardial ischemia. We report the case of a 29-year-old female with an insignificant past medical history who presented with sudden cardiac arrest. Labs were significant for elevated troponin, consistent with non-ST elevation myocardial infarction, given diffuse ST depression on the electrocardiogram. The patient underwent a coronary angiogram that revealed diffuse coronary artery disease with multiple ulcerations, aneurysms, and occlusions consistent with KD, despite denying prior history. Cardiac arrest may be the initial presentation of undiagnosed KD and should be considered as one of the differential diagnoses., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Sliem et al.)

Sarcoidosis is a multisystem disorder of unknown etiology commonly associated with hilar lymphadenopathy and granulomas. Cardiac involvement is less common; however, sarcoidosis is a known cause of restrictive cardiomyopathy. It typically presents as new-onset arrhythmias or heart failure, although cases of sudden cardiac death have been reported. We present a case of a 56-year-old male with a known history of pulmonary sarcoidosis, not on active treatment, who presented to the emergency department with a week of continuous hiccups every few seconds associated with non-exertional dyspnea. An initial computed tomography (CT) scan of the chest showed multiple stellate-like ground-glass opacities and the progression of bronchiectasis. Troponins were negative. On the initial electrocardiogram (EKG), he was found to be in atrial flutter and was admitted to the medical floor. Cardiology was consulted for suspected cardiac sarcoidosis, and they recommended transfer to the tertiary care center for further evaluation. Upon arrival, the patient underwent catheter ablation for atrial flutter and returned to sinus rhythm after the procedure. The initial nuclear scan with gallium was not suggestive of cardiac sarcoidosis. However, subsequent cardiac magnetic resonance imaging (MRI) showed cardiac involvement. Due to the high risk of arrhythmias, the patient was scheduled for implantable cardioverter defibrillator placement before discharge. The patient was given oral prednisone. The patient was discharged in stable condition, and interrogation of the device found it well functioning, and no significant arrhythmias were noted. Presentation of cardiac sarcoidosis can be variable, and any should be considered in any patient with a known history of sarcoidosis who presents with atypical symptoms above the diaphragm, such as hiccups or with new-onset arrhythmias., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Ghallab et al.)

Hemostatic system abnormalities have been previously associated with congestive heart failure (CHF). Here, we report a rare case of disseminated intravascular coagulopathy (DIC) in the setting of non-ischemic cardiomyopathy with right atrial and biventricular thrombus. We present a 55-year-old female with a past medical history of bronchial asthma who presented with a six-day history of bilateral leg swelling and dry cough. Her physical examination on admission was significant for signs of biventricular heart failure. Initial workup was significant for elevated pro-brain natriuretic peptide (ProBNP), elevated transaminases, marked thrombocytopenia (19,000/mcL), and coagulopathy with international normalized ratio (INR) of 2.5 and D-dimer of 15,585 ng/mL. Transthoracic echocardiogram (TTE) showed a large mobile right atrial thrombus protruding into the right ventricle and a more adherent left ventricular (LV) thrombus with severely reduced biventricular contractility. Pan CT was done and was significant for multifocal multilobar pulmonary emboli. A lower limb venous duplex was done and revealed extensive bilateral lower limb deep venous thrombosis (DVT). This rare case demonstrates an unusual association between DIC with non-ischemic cardiomyopathy, biventricular thrombus, extensive deep vein thrombosis, and pulmonary embolism (PE). In comparison, there are multiple prior reports for DIC with CHF and LV thrombus. However, our case differs from prior reports in terms of the presence of right atrial and biventricular thrombus. The patient received antibiotics, diuretics, and cryoprecipitate in the setting of persistent low fibrinogen levels. The patient underwent Interventional radiology-guided thrombectomy for extensive pulmonary emboli followed by inferior vena cava (IVC) filter insertion, resulting in the resolution of the right atrial thrombus and extensive decrease of the pulmonary emboli burden. The patient was then given apixaban after normalization of the platelet count and fibrinogen level. Hypercoagulability workup was inconclusive. The patient was then discharged after improvement of symptoms. Early recognition of DIC and cardiac thrombi in patients with new-onset heart failure is crucial for the implementation of the correct management by thrombectomy, optimizing heart failure medications, and anticoagulation to achieve better outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Ghallab et al.)

A 71-year-old female visiting from Colombia presented to the emergency room with a productive cough, subjective fever, and chills for the past three days. Baseline EKG demonstrated a QT interval of 385 milliseconds with left ventricular hypertrophy and T wave inversions in leads V4, V5, and V6. Azithromycin was administered, and she was subsequently found to have torsades de pointes (TdP) on telemetry. In high-risk individuals, medications with reduced effects on cardiac conduction should be considered to avoid potentially lethal reactions. This case highlights the importance of clinical history prior to the administration of medications that have a propensity to cause abnormalities in cardiac conduction. Our patient had a grossly normal QT interval prior to the administration of azithromycin; however, she subsequently developed torsades de pointes. The patient was on telemetry monitoring, and cardiopulmonary resuscitation was quickly initiated as she was in a hospitalized setting; however, in an outpatient community setting, she likely would not have survived. By examining all the elements which contribute to QT prolongation, clinicians can have a deeper understanding of the complexities, particularly in individuals with multiple co-morbid conditions prior to the administration of medications that have a propensity to affect the QT interval., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Foster et al.)

Takotsubo, or stress cardiomyopathy (SC), is described as a transient systolic dysfunction of the apical segments of the left ventricle mainly triggered by emotional or physical stress resembling the presentation of an acute coronary syndrome in the absence of obstructive coronary artery disease. Reverse Takotsubo SC is a rare variant of SC that presents with basal ballooning instead of apical ballooning seen in classic SC. We present a case of a 74-year-old male who was admitted to the ICU with septic shock. Laboratory test results showed elevated troponin. An echocardiogram showed reduced cardiac contractility and relative hypokinesis of the basal and mid segments compared to the apical segments, consistent with reverse Takotsubo SC, which recovered after 10 days. It can happen in critically ill patients in the ICU secondary to severe sepsis and could contribute to hemodynamic worsening, affecting the final clinical outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Ghallab et al.)

Endobronchial malignancies with significant airway obstruction can lead to multiple complications including pneumonia, and atelectasis over a period of time. Various intraluminal treatments have proven their value in palliative treatment for advanced malignancies. Nd:YAG (neodymium-doped yttrium aluminum garnet; Nd:Y3Al5O12) laser has established its role as a major palliative intervention due to its minimal side effects and improvement in quality of life by relieving local symptoms. The systematic review was conducted with the goal of elucidating the patient characteristics, pre-treatment parameters, clinical outcomes, and possible complications resulting from the use of the Nd:YAG laser. A thorough literature search for relevant studies was conducted on PubMed, Embase, and Cochrane Library from the inception of the idea to November 24, 2022. Our study included all original studies including retrospective studies and prospective trials, but excluded case reports, case series with less than 10 patients, and studies with incomplete or irrelevant data. A total of 11 studies were included in the analysis. The primary outcomes focused on the evaluation of pulmonary functional tests, postprocedural stenosis, blood gas parameters after the procedure, and survival outcomes. Improvement in clinical status, improvement in objective scale for dyspnea, and complications were the secondary outcomes. Our study shows that Nd:YAG laser treatment is an effective form of palliative treatment to provide subjective and objective improvement in patients with advanced and inoperable endobronchial malignancies. Due to the heterogeneous study populations in the studies reviewed and the presence of many limitations, more studies are still warranted to reach a definitive conclusion., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Umar et al.)

Presentations of pulmonary embolism (PE) are often associated with various cardiac arrhythmias and conduction abnormalities detected on electrocardiograms (EKG). We describe a 65-year-old female with no known history of heart disease or arrhythmias who presented with an acute onset of shortness of breath. Initial EKG showed right bundle branch block (RBBB), and first-degree atrioventricular (AV) block with subsequent development of second-degree Mobitz type II AV block. The patient's clinical appearance was highly suggestive of a massive pulmonary embolism with hemodynamic instability, and treatment with alteplase (tPA) was given, followed by heparinization. A CT pulmonary angiography confirmed the provisional diagnosis and revealed a large saddle embolus within the right and left main pulmonary arteries. Subsequent EKG showed resolution of the RBBB, first-degree AV block, and second-degree AV block. The patient improved clinically and was discharged to a subacute rehab facility with follow-up appointments. This case highlights that pulmonary embolism may present with many EKG changes, including RBBB, first-degree, second-degree, or complete heart block. Early recognition of PE and thrombolytic treatment can improve cardiac function and restore heart rhythms. Further evaluation for underlying conduction abnormalities can later be performed., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Ghallab et al.)

Malaria is a life-threatening, parasitic disease that continues to infect millions of people, especially in endemic regions. Despite advancements in malaria treatment, treating the disease remains challenging. One major challenge is identifying the disease from its unconventional manifestations. Therefore, recognizing its unusual clinical presentations is imperative in early detection and management with a better prognosis. This case report highlights the unique finding of paralytic ileus from a patient with confirmed malaria. Further investigation on the concurrence between paralytic ileus and malaria may aid in identifying the disease and subsequent improvement in treatment., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Ghallab et al.)

Carbohydrate antigen 19-9 (CA 19-9) is a tumor marker used clinically to support the diagnosis and recurrence of pancreatic adenocarcinoma. CA 19-9 levels may be found to be elevated too in benign conditions, including hepatobiliary diseases such as choledocholithiasis, cholangitis, or cholestasis of any etiology. In this case, we are presenting a case of a 66-year-old man who has presented with diffuse abdominal pain and has been then found to have choledocholithiasis and obstructive jaundice treated with biliary sphincterotomy and balloon extraction. In the setting of extensive unclear gastroenterological surgeries, tumor markers were obtained, and the results revealed markedly elevated CA 19-9 with negative other tumor markers and a negative workup for malignancy. After reviewing the literature, we found that although CA 19-9 has been studied in diagnosing pancreatic and biliary malignancies, the serum level may also be elevated in many other benign conditions. As a result, the results must be individualized according to the clinical scenario of each patient., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Ghallab et al.)

Pernicious anemia (PA) is an autoimmune disease secondary to chronic atrophic gastritis leading to vitamin B12 deficiency. Rarely, some patients may develop advanced hematological complications that mimic those of thrombotic thrombocytopenic purpura (TTP). Differentiating these conditions is crucial because they require different management. We present a case of a 68-year-old male who presented with generalized weakness, fatigue, and shortness of breath. This patient had anemia, thrombocytopenia, and a markedly deficient serum level of vitamin B12. The symptoms initially mimicked those associated with TTP, but the activity of ADAMTS 13 was normal. A diagnosis of pseudo-TTP has been made due to vitamin B12 deficiency resulting from PA with reactive thrombocytosis. Ultimately, vitamin B12 deficiency pseudo-TTP should be considered a differential diagnosis for therapy refractory TTP because of its different management strategies ranging from parenteral Vitamin B12 in PA patients with highly favorable outcomes to more advanced treatment with less favorable outcomes in TTP patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Abosheaishaa et al.)

The most common hematological disorder associated with prostate cancer is disseminated intravascular coagulation (DIC). In most cases, cancer patients with DIC have compensated fibrinolysis with a low incidence of bleeding. However, DIC with excessive fibrinolysis is a rare albeit life-threatening variant that can present with massive bleeding and is thought to occur due to the unique properties of neoplastic cells of prostate cancer that activate both procoagulant and anticoagulant pathways simultaneously. Depending on the shift of the intricate balance between the two forces, the net result can be either systemic micro- (DIC) or macro-thrombi, deep venous thrombosis (DVT) or pulmonary embolism, or a bleeding syndrome from excessive vicious activation of fibrinolysis. Here, we present a unique case of suspected prostate cancer who underwent a diagnostic prostatic biopsy. Subsequently, he developed massive hematuria requiring intensive care unit admission with multiple supportive blood products. Additionally, he was administered epsilon-aminocaproic acid with a prophylactic dose of heparin, with prompt resolution of bleeding. After stabilization, he was discharged with planned outpatient chemotherapy. However, he subsequently presented with lower extremity DVT within a week, which led to a stroke in the setting of a patent foramen ovale. This unique case report highlights how a change in the intricate balance of the coagulation cascade causes a polar shift in clinical presentation and complications., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Ghallab et al.)

Nephrotic syndrome is a condition characterized by damage to podocytes that results in significant proteinuria, edema, hyperlipidemia, and hypercoagulability. Infections and malignancies are frequently associated with nephrotic syndrome. The COVID-19 virus has been associated with several atypical presentations of upper respiratory infections and acute kidney injury. Considering that COVID-19 causes systemic inflammatory changes, it seems plausible that it may also lead to nephrotic syndrome. This study aimed to investigate if an association between COVID-19 and the different types of nephrotic syndromes exists. Data were extracted into a spreadsheet. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS, IBM Corp., Armonk, NY, USA). We performed a systematic search of PubMed/Medline and Embase databases using both medical subject headings (MeSH) and regular keywords associated with COVID-19 and nephrotic syndrome, including different types of nephrotic syndromes. The search was performed on 17th December 2021. We included case reports and case series about adult patients who developed findings suggestive of nephrotic syndrome shortly after infection or vaccination. We excluded cases involving children, pregnant women, articles written in languages other than English, and those that were not retrievable. The relevance and quality of identified articles were assessed. We included 32 articles in the study, primarily case reports and case series. In our study, COVID-19 and the COVID-19 vaccine have been associated with the development of nephrotic syndrome, primarily a collapsing form of focal segmental glomerulosclerosis, although other forms have been observed as well. There was little consistency in patient histories, clinical presentations, clinical courses, or treatment regimens, although it appeared that most cases eventually resolved. More cases need to be reported and analyzed before more definitive conclusions can be reached. In conclusion, nephrotic syndrome is a possible complication of both COVID-19 infection and the COVD-19 vaccine and should be considered in patients exhibiting sudden onset edemas or deterioration in kidney function. While the majority of cases respond to standard treatment, clearer guidelines will need to be developed once more data is available., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Cancarevic et al.)

Vertebrobasilar angioplasty and stenting or mechanical thrombectomy (MT) using a stent retriever or suction thrombectomy are effective interventions in managing acute ischemic stroke caused by vertebrobasilar artery occlusion (VBAO). This study aims to investigate the safety and efficacy of self-expanding stents and balloon angioplasty in managing ischemic stroke. We reviewed the literature for relevant clinical trials and included those reporting the following primary outcomes: successful recanalization, favorable clinical outcome, and stenosis degree change. We included 24 studies (858 patients). In the subgroup analysis, participants were divided into three main subgroups based on the type of intervention: mechanical thrombectomy (MT), percutaneous transluminal angioplasty and stenting (PTAS), and MT+PTAS. Regarding overall mortality, the incidence was 34.5%, 9.9%, and 28.9% in the MT, PTAS, and MT+PTAS groups, respectively. The incidence of arterial dissection was 3.6% in the MT group, 3.1% in the PTAS group, and 16.7% in the MT+PTAS group. Incidence of distal embolization, MT, PTAS, and MT+PTAS groups had 3.4%, 5.8%, and 9.5% incidence rates, respectively. Favorable clinical outcomes were reported in 42.8% of subjects in the MT+PTAS group, 64.7% in the PTAS group, and 39.2% in the MT group. The incidence of intracranial hemorrhage was 5.2%, 4.5%, and 15.3% in the MT, PTAS, MT + PTAS groups, respectively. The incidence of successful recanalization was 85.3% in the MT group, 99.4% in the PTAS group, and 92.7% in the MT+PTAS group. Our analysis concludes that PTAS is the most effective intervention for VBAO and is associated with a lower rate of mortality compared to mechanical thrombectomy alone., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Nso et al.)