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Carcinoid heart disease is rare, and it is one of the primary pathologies of tricuspid and pulmonary valve. We present a 42-year-old woman who presented to our cardiology clinic with recent peripheral lower limb edema and dyspnea. Cardiac auscultation revealed a tricuspid regurgitation murmur the reason why we did the transthoracic echocardiography that demonstrated a unique right sided valvular heart disease with a morphological aspect of carcinoid heart disease. The patient has a right exophthalmos in the clinical examination that was highly suggestive of a brain tumor. So we decided to admit her in the hospital for further work up.

Endovascular treatment of femoralaretry occlusion is an increasingly common act, we have several mean sat our disposal to guide us during the treatment of occlusion of the femoral arteries, and with the advent of this new type of laser usedwithout a guidewire, the Dabra Laser represents an interesting alternative in our hands. Wedescribe the case of a 52-year-old man presented to ourclinicwithsevere intermittent claudication of the leftleg. A preoperative lower extremity arterial ultrasound indicated a long left superficial femoralartery (SFA) occlusion that was approximately 30 cm in length.We treated this patient with the new Laser technique DABRA retrogradely using the left anterior tibial artery with good final result.

Left Ventricular Free Wall Rupture (LVFWR) is the second most lethal complication of acute myocardial infarction, after cardiogenic shock. It occurswithin a few days of an extensive myocardial infarction. Two distinct patterns are described the first and most famous is the complete rupture leading to sudden death from cardiac tamponade. The second form, more rare, is rather less dangerous, appearing as an incomplete rupture or pseudo aneurysm formed by recurrent bleeding in the pericardium, which might also lead to fatal outcomes.Imaging tools especially echocardiography and cardiac magnetic resonance, which are performed depending on the clinical and hemodynamic conditions of the patient, confirm the diagnosis. Surgery is the first-line treatment of this condition. Herein we describe a case of a 53-year-old patient who presented to our department two weeks after myocardial infarction with an advanced right heart failure. However, his hemodynamic condition remained stable during hospitalization.Transthoracic echocardiogram showed pericardial effusion and signs of cardiac pre-tamponade. MRI showedthe rupture siteprotected by a thrombus inside an apical pseudo-aneurysm. The patient was immediately subjected to cardiac surgery with the diagnosis of cardiac rupture. Unexpectedly he refused surgery and asked for immediate discharge. Three month later, we noticed a good clinical and echocardiogram outcome. We reviewed the literature of this lethal complication of acute myocardial infarction.This case report highlights the fact that in a world full of invasive therapy, non-invasive management could sometimes matter.

Vitamin D (Vit D) deficiencymay be linked to the development of type 1 and type 2 diabetes mellitus (DM). Specific Vitamin D receptor (VDR) allelic variants have been linked totype-1 diabetes mellitus (T1DM) in many countries. However, in type 2 DM, Vitamin D deficiency leads to impaired insulin action and secretion in both animal models and humans. This study aims to determine the effect of low vitamin D on glycemic control in Egyptian patients with type 1and type 2 DM. Patients and Methods: This is a retrospective multi-centers study included280 diabetic patients (140 patients with type 1 DM, and 140 with type 2 DM). The patients\' data were collected from the patients\' medical files in the Diabetic Clinics and Internal Medicines Departments of 3 University hospitals (Benha, Helwan, and Assiut) in Egypt, including age, sex, BMI, onset and duration of DM, LDL-C, vitamin D, and HbA1c. Results: 50 (35.7%) type 1 diabetic patients had low vitamin D versus 110(78.6%) type 2 diabetic patients. The study revealed asignificant inverse correlation between the serum vitamin D level and HbA1c levelin patients with type 1 DM; but,in patients with type 2 DM,there was no significance correlation between serum vitamin D level and HbA1c level. Conclusion: low serum vitamin D level correlated inversely with the degree glycemic control in type 1 DM; but,such correlation had been failed to prove in patients with type 2 DM.Whether giving vitamin D supplementation to already vitamin D deficient diabetics will help to modulate the disease progression remains a debate.