Background: The current classification of acute myocardial infarction (AMI) into ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) has limitations in identifying patients with acute coronary occlusion (ACO) who do not exhibit classic ST-elevation. Emerging evidence suggests that a reclassification to "Occlusive Myocardial Infarction" (OMI) may enhance diagnostic accuracy and therapeutic interventions. Methods: A comprehensive review of the literature was conducted, focusing on the pathophysiology, electrocardiographic (EKG) patterns, and management of ACO. The utility of the OMI paradigm was evaluated against the traditional STEMI/NSTEMI framework, with a particular emphasis on atypical EKG findings and their role in guiding early intervention. Results: Traditional STEMI criteria fail to identify ACO in approximately 30% of NSTEMI patients, leading to delayed reperfusion and increased mortality. The OMI framework demonstrates improved sensitivity (78.1% vs. 43.6% for STEMI criteria) for detecting ACO by incorporating subtle EKG changes, including hyperacute T-waves, de Winter T-waves, and posterior infarction patterns. OMI-guided management facilitates timely diagnosis and intervention, potentially reducing adverse outcomes. Emerging artificial intelligence (AI) tools further enhance EKG interpretation and clinical decision-making. Conclusions: Transitioning to the OMI paradigm addresses critical gaps in the STEMI/NSTEMI framework by emphasizing the identification of ACO irrespective of ST-segment elevation. This approach could significantly improve patient outcomes by reducing delays in reperfusion therapy. Future randomized trials are needed to validate the OMI paradigm and optimize its implementation in clinical practice.

Background & Aims: Probe-based confocal laser endomicroscopy (pCLE) provides real-time, cellular-level “optical biopsy” during endoscopy. This review synthesizes the technology, diagnostic performance, clinical use, safety, costs, and future directions of pCLE across gastrointestinal indications. Methods: Targeted narrative review of randomized trials, meta-analyses, and observational studies on pCLE in Barrett’s esophagus, gastric intestinal metaplasia (GIM), colorectal neoplasia, inflammatory bowel disease (IBD), and indeterminate biliary strictures. Outcomes included sensitivity/specificity, impact on biopsy yield and management, adverse events, and cost effectiveness. Results: pCLE combines a fiber-optic probe and IV fluorescein with 488-nm excitation to generate optical sections (~ 1 µm lateral resolution; depth ~ 55–70 µm). In Barrett’s esophagus, adding pCLE to high-definition endoscopy nearly doubled neoplasia detection sensitivity versus standard protocols. For GIM, pooled sensitivity and specificity reached 97% and 94%. For colorectal lesions, sensitivity 81–91% and specificity 75–91% allowed in vivo characterization and fewer unnecessary resections. In IBD surveillance, pCLE identified more neoplasia with fewer biopsies (up to ~ 4.7-fold increase) and pooled sensitivity/specificity of 87–100%/90–94%. In indeterminate biliary strictures, pCLE integrated with ERCP/EUS improved accuracy and achieved negative predictive values up to 100%. Safety is favorable; risks relate mainly to fluorescein. Limitations include superficial penetration, narrow field of view, operator dependence, image-interpretation variability, procedure time, and high capital and per-case costs. Current guidelines view pCLE as an adjunct rather than routine standard. Emerging AI-assisted interpretation and molecular/ multispectral probes may standardize reads, expand indications, and improve yield. Conclusions: pCLE strengthens endoscopic decision-making by enabling immediate, near-histologic assessment, targeted sampling, and earlier therapy. Broader adoption hinges on standardized training, validated image criteria, multicenter randomized trials with health-economic endpoints, and integration of AI and molecular imaging to reduce variability and cost.

Objectives: Post-COVID-19 vaccine-associated vasculitis stands as one of the most serious side effects attributed to COVID-19 vaccines. This complication encompasses diverse manifestations which vary in presentation and severity. Moreover, it can impact patients across all age groups, with a notably elevated incidence in the elderly. This systematic review seeks to review and evaluate the spectrum of vasculitis manifestations linked to COVID-19 vaccination. Methods: A systematic review of the literature was done by searching through PubMed, Google Scholar, and Scopus up to October 2022. Articles including data about sex, age at diagnosis, vasculitis clinical manifestations, type of vaccination, most commonly used investigations, comorbid medical conditions, treatments, and clinical outcomes were included in the final analysis. Furthermore, vasculitis flare-ups post-vaccination were considered part of this review. Results: A total number of 117 studies describing 158 patients developing vasculitis following COVID-19 vaccination were included in the final analysis. Among the patients who developed vasculitis, the most administered type of vaccination was the mRNA vaccine subtype ( n = 103), followed by the viral vector vaccines ( n = 42) and inactivated viral vaccines ( n = 10). On the other hand, about 38% of vasculitis-related symptoms occurred after the administration of the first dose of the vaccine and 37% occurred after taking the second dose. The skin (60.7%) and the kidneys (27.8%) were the most affected organs and complete remission was achieved in 111 patients (70%), while partial remission occurred in 11% of the patient population. Conclusion: COVID-19 vaccine-induced vasculitis is a rare occurrence associated with COVID-19 vaccines. It generally presents a favorable prognosis and outcomes for the vast majority of patients, ultimately leading to full remission within days. This review emphasizes the notion that the advantages of COVID-19 vaccines outweigh the potential risks, particularly for individuals with compromised immune systems.

COVID-19 has been linked to autoimmune hemolytic anemia (AIHA), a rare but serious condition causing red blood cell destruction. This systematic review examines the clinical characteristics, management, and outcomes of AIHA in COVID-19 patients. A systematic search of PubMed, CINAHL, and Scopus identified 85 studies encompassing 105 patients. Data on demographics, clinical features, and treatment outcomes were extracted. Of 1402 articles, 85 met inclusion criteria. Most patients were male (54.3 %) with a mean age of 50.6 years, predominantly from Asia (83.5 %). Cold agglutinin AIHA was most common (48.2 %). Presenting symptoms included fatigue, dyspnea, and fever. Steroids were the most effective treatment, used in 95 % of recovered cases. Mortality was 14.3 %, with 26.7 % of deaths directly related to AIHA. COVID-19 is associated with AIHA, often presenting with non-specific symptoms. Early recognition and prompt steroid therapy are critical for improving outcomes. Further research is needed to guide management.

Parkinsonism-hyperpyrexia syndrome (PHS) is a rare, potentially fatal neurological emergency, that is seen in Parkinson’s Disease (PD) patients and mimics neuroleptic malignant syndrome. The most common trigger for PHS is sudden withdrawal of anti-parkinsonian medications, specifically levodopa. However, it can also be due to Deep Brain Stimulation (DBS) device malfunction. In this work, we describe three cases of PHS; the first of which is related to DBS battery depletion, and the remaining two to dopaminergic withdrawal. Additionally, we will include the results of a literature review on PHS, its etiologies, presentation, and management.

We present a case of rituximab-induced organizing pneumonia (OP) along with bronchiectasis and pulmonary fibrosis, in a patient with a history of granulomatosis with polyangiitis (GPA), on long-term maintenance therapy with rituximab. T-cell dysregulation and B-cell depletion associated with the chronic use of rituximab often lead to a profound immunosuppressed state with hypogammaglobulinemia and unbalanced T-cell response. This acquired immunodeficient state with severe immune dysregulation predisposed this patient to recurrent pulmonary infection and ultimately led to bronchiectasis and pulmonary fibrosis.