Objectives: Coronary artery calcium measured by CT predicts future coronary events. Similarly, carotid artery calcium on dental panoramic radiographs has been associated with increased cardiovascular events. Pre-procedural assessment of candidates for valve replacement in our institution includes panoramic radiographs and chest tomography. We aimed to assess the association of carotid calcium on panoramic radiographs with coronary artery calcium on chest tomography. Methods: Paired pre-procedural panoramic radiographs and chest tomography scans were done in 177 consecutive patients between October 2016 and October 2017. Carotid calcium was quantified using NIH’s ImageJ. Coronary artery calcium was quantified by the Agatston score using Philips Intellispace portal, v. 8.0.1.20640. Results: Carotid calcium maximal intensity, area and perimeter were higher among patients with high coronary artery calcium. Non-zero carotid calcium was found in half of patients with high coronary artery calcium, doubling prevalence of low coronary artery calcium. Conclusion: Carotid calcium identified in panoramic radiographs was associated with high coronary artery calcium. Awareness of carotid calcium recognized by dental practitioners in low-cost, low radiation and commonly done panoramic radiographs may be useful to identify patients at risk of coronary disease with potential future cardiovascular events.

Sarcoidosis is a multisystemic disease characterized by the formation of noncaseating granulomas in various organs. Drug‐induced sarcoidosis‐like reactions (DISR) mimic sarcoidosis both clinically and histologically, with numerous drugs identified as potential triggers. This case report presents a 35‐year‐old female with atopic asthma who developed DISR following treatment with Dupilumab, a monoclonal antibody targeting interleukin‐4 and interleukin‐13. The patient experienced diffuse arthralgia, myalgia, erythema nodosum, and recurrent abscesses shortly after initiating Dupilumab. Diagnostic workup, including biopsy, revealed noncaseating granulomas, confirming the diagnosis of sarcoidosis. Symptoms improved after dupilumab discontinuation, highlighting the importance of recognizing DISR in patients undergoing immune‐modulating therapy. This case report underscores the need for awareness among clinicians of the potential for sarcoidosis‐like reactions in patients treated with newer biologic agents and calls for further studies to elucidate the underlying mechanisms and management strategies for such reactions.

Purpose Apixaban, a direct oral anticoagulant is administered for stroke prevention in atrial fibrillation patients. Dosing adjustment is guided by renal function, age, and body weight. However, no data exist on its pharmacokinetics in patients with a body mass index (BMI) ≥ 35 kg/m². The aim was to investigate the effects of BMI ≥ 35 kg/m² on trough plasma concentrations of apixaban in patients with atrial fibrillation. Methods This prospective study compared steady-state trough concentrations of apixaban in patients with a BMI ≥ 35 kg/m² and patients with a BMI < 35 kg/m². Results Sixty patients were included. In patients receiving 5 mg apixaban twice daily, the median trough plasma concentration was 29% lower in patients with a BMI ≥ 35 kg/m² than in those with a BMI < 35 kg/m² (148.9 ng/ml, interquartile range [IQR] 94.5–205.6, compared to 209.1 ng/ml, IQR 167–266.8 ng/ml, respectively; P = 0.044). However, median trough concentrations fell within the manufacturer’s predicted range for effective steady-state apixaban exposure. A similar trend was observed with 2.5 mg apixaban twice daily, although statistical significance was not reached. Multivariate analysis revealed no correlation between BMI values and trough concentrations. Conclusion BMI ≥ 35 kg/m² patients exhibited lower apixaban trough concentrations, while remaining within the manufacturer’s established range for effective steady-state apixaban, suggesting that dose adjustment is unnecessary for this specific patient group.