Unlike other adverse drug reactions, visceral organ involvement is a prominent feature of drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome and correlates with mortality. The aim of this study was to systematically review cases published in PubMed-indexed, peer-reviewed journals in which patients had renal injury during the episode of DRESS syndrome (DS). We found 71 cases, of which 67 were adults and 56% were males. Female sex was associated with higher mortality. Chronic kidney disease (CKD) was present in 14% of patients who developed acute kidney injury (AKI) during DS. In 21% of cases, the kidneys were the only visceral organ involved, while 54% of patients had both liver and kidney involvement. Eosinophilia was absent in 24% of patients. The most common classes of medication associated with renal injury in DS were antibiotics in 34%, xanthine oxidase inhibitors in 15%, and anticonvulsants in 11%. Among antibiotics, vancomycin was the most common culprit in 68% of patients. AKI was the most common renal manifestation reported in 96% of cases, while isolated proteinuria or hematuria was present in only 4% of cases. In cases with AKI, 88% had isolated increase in creatinine and decrease in glomerular filtration (GFR), 27% had AKI concomitantly with proteinuria, 18% had oliguria, and 13% had concomitant AKI with hematuria. Anuria was the rarest manifestation, occurring in only 4% of patients with DS. Temporary renal replacement therapy was needed in 30% of cases, and all but one patient fully recovered renal function. Mortality of DS in this cohort was 13%, which is higher than previously reported. Medication class, latency period, or pre-existing CKD were not found to be associated with higher mortality. More research, particularly prospective studies, is needed to better recognize the risks associated with renal injury in patients with DS. The development of disease-specific biomarkers would also be useful so DS with renal involvement can be easier distinguished from other eosinophilic diseases that might affect the kidney.

Extraintestinal manifestations of celiac disease (CD) should be considered, even in patients without typical intestinal symptoms. The aim of our study is to examine the literature regarding the occurrence of thrombotic events in CD, and to synthesize the data from case reports and case series. A systematic review of the literature was conducted by searching the Pub-Med/MEDLINE database, from the date of database inception to January 2022, to identify published cases and case series on this topic, in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 55 cases were included in the study. The majority of patients were previously healthy individuals, with no comorbidities. In less than one-third of the cases (30.91%), the diagnosis of CD was established before the onset of thrombosis, while in the remaining cases (34.54%), thrombosis preceded the diagnosis or was diagnosed concomitantly with CD. The most common sites for thrombosis occurrence were hepatic veins (30.91%), while thrombosis of cerebral blood vessels, deep venous thrombosis of lower extremities, and pulmonary thromboembolism were less frequent. Thrombosis was most commonly isolated to one site only (78.18%). In 69.09% of cases (n = 38), some form of anticoagulation, along with a gluten-free diet, was initiated.

Hemophagocytic lymphohistiocytosis (HLH) secondary to tick-borne infections is a rare but potentially life-threatening syndrome. We performed a scoping review according to PRISMA guidelines to systematically analyze the existing literature on the topic. A total of 98 patients were included, with a mean age of 43.7 years, of which 64% were men. Most cases, 31%, were reported from the USA. Immunosuppression was present in 21.4%, with the most common cause being previous solid organ transplantation. Constitutional symptoms were the most common, observed in 83.7% of the patients, while fever was reported in 70.4% of cases. Sepsis was present in 27.6%. The most common laboratory abnormalities in this cohort were thrombocytopenia in 81.6% of patients, while anemia, leukopenia, and leukocytosis were observed in 75.5%, 55.1%, and 10.2%, respectively. Liver enzyme elevation was noted in 63.3% of cases. The H-score was analyzed in 64 patients, with the mean value being 209, and bone marrow analysis was performed in 61.2% of patients. Ehrlichia spp. was the main isolated agent associated with HLH in 45.9%, followed by Rickettsia spp. in 14.3% and Anaplasma phagocytophilum in 12.2%. Notably, no patient with Powassan virus infection or Lyme borreliosis developed HLH. The most common complications were acute kidney injury (AKI) in 35.7% of patients, shock with multiple organ dysfunction in 22.5%, encephalopathy/seizure in 20.4%, respiratory failure in 16.3%, and cardiac complications in 7.1% of patients. Treatment included antibiotic therapy alone in 43.9%, while 5.1% of patients were treated with immunosuppressants alone. Treatment with both antibiotics and immunosuppressants was used in 51% of patients. Appropriate empiric antibiotics were used in 62.2%. In 43.9% of cases of HLH due to tick-borne disease, patients received only antimicrobial therapy, and 88.4% of those recovered completely without the need for immunosuppressive therapy. The mortality rate in our review was 16.3%, and patients who received inappropriate or delayed empiric therapy had a worse outcome. Hence, we suggest empiric antibiotic treatment in patients who are suspected of having HLH due to tick-borne disease or in whom diagnostic uncertainty persists due to diagnostic delay in order to minimize mortality.

This review aims to explore the use and educational impact of the Pecha Kucha presentation format in medical education, as well as its integration with active learning methodologies. A comprehensive literature search was conducted in Medline, Embase, ScienceDirect, and Scopus to identify studies that assessed Pecha Kucha in undergraduate, postgraduate, or patient education. Fourteen English-language studies published up to September 2024 were included. Studies were evaluated for design, participant population, learning outcomes, and pedagogical integration. The selected studies employed quantitative, qualitative, and mixed-method approaches. Most studies reported positive educational outcomes, including improved knowledge retention, clearer communication, and enhanced learner engagement. Pecha Kucha was particularly effective when integrated with self-directed, problem-based, case-based, or team-based learning strategies. Participants, including students, residents, and patients, highlighted the format’s value in promoting concise, visually engaging presentations, although some noted difficulties adapting to its strict timing constraints. Pecha Kucha is a promising educational tool that incites active learning, efficient communication, and engagement in medical education. When combined with other pedagogical strategies, it contributes to a more dynamic and student-centered learning environment.

Complete Percutaneous Coronary Revascularization: An Elegant Solution to Left Ventricular Dysfunction Caused by Severe Coronary Artery Disease Stefan Milutinovic1, Kamaldeep Singh2, Stevan Oluic3, Juan C. Lopez-Mattei2, Ricardo O. Escárcega1,2,4Florida State University College of Medicine Internal Medicine Residency Program at Lee Health, Cape Coral, FL, USALee Health Heart Institute, Fort Myers, FL, USADepartment of Internal Medicine, Mayo Clinic Health System, Mankato, MN, USAFlorida Heart Associates, Fort Myers, FL, USAEmail addresses: SM – smilutinovic@fsu.edu; KS – kamaldeep.singh@leehealth.org; SO – oluic.stevan@mayo.edu; JCLM – juan.lopezmattei@leehealth.org; ROE – orlando.escarcega@leehealth.orgCorrespondence:Stefan Milutinovic, MDFlorida State University College of Medicine Lee Health Heart Institute smilutinovic@fsu.edu+1 (239) 737-02372585 Liberty Park Dr, Apt 8209, Cape Coral, Fl 33909Disclosures: The authors report no relationships that could be construed as a conflict of interestFunding: None.Keywords : High-risk PCI, Chronic Total Occlusion, Mechanical Support , LV dysfunctionWritten informed consent was obtained from the patient to publish this report in accordance with the journal’s patient consent policy

We report a case of an 84 -year -old patient with Monoclonal Gammopathy of Undetermined Significance (MGUS) treated with multiple courses of antibiotics and steroids before being diagnosed with Mycobacterium chelonae infection. It is known that MGUS affects both humoral and cellular immunity with impairment of antibody production, function of T -cells, natural killer (NK) cells, and dendritic cells. This case report demonstrates the need to consider patients with MGUS as immunocompromised and draws attention to the correlation between MGUS and Mycobacterium infections. The delay in diagnosis exemplifies the importance of considering atypical pathogens and involving sub -specialists early in the treatment of infections in patients with a history of MGUS.