Introduction:Myocardial infarction with nonobstructive coronary artery disease (MINOCA) is a group of conditions that share common characteristics and is characterized by the absence of ≥50% stenosis of coronary arteries and without any evidence of atherosclerotic plaque rupture [1]. A study conducted by Waller et al. reported that 4% to 7% of all patients diagnosed with AMI, do not have underlying atherosclerotic coronary disease on autopsy or angiography [2].Coronary artery embolism is a rare and important non-atherosclerotic cause of acute myocardial infarction (AMI), and the first case of AMI secondary to coronary embolism was reported in 1856 by Rudolf Virchow and was classified initially as a precipitating factor for type-II MI, now recognized as one of the cause of MINOCA [3]. Coronary embolism (CE) is more frequently reported in infective endocarditis patients and it mainly involves the left main coronary artery system due to flow characteristics and aortic morphology [4, 5]. CE may also originate from mural thrombus within the left-sided cardiac chambers, but it has rarely been reported in the literature [6]. Most cases of coronary embolism in the literature have been reported secondary to infective endocarditis, valvular heart diseases, and atrial fibrillation [7-9]. Here, we are reporting a case of a 74-year-old female, who had a chronic history of atrial fibrillation on anticoagulation with questionable compliance and was admitted with sepsis and takotasubo cardiomyopathy and later developed AMI secondary to coronary embolism to the left anterior descending artery.

Introduction: Spontaneous coronary artery dissection (SCAD) is a tear or separation within the coronary artery wall forming an intraluminal hematoma reducing downstream blood flow leading to myocardial ischemia (MI)(Figure 1A-C)1 . Intraluminal hematomas may develop from ”inside-out” due to endothelial-intimal injury or ”outside-in” due to injury within the vasa vasorum leading to bleeding in the wall. The subsequent false lumen from either mechanism can extend and compress the true lumen to cause MI [2]. Unlike other luminal etiologies of MI, SCAD is not caused by atherosclerotic plaque rupture, coronary intervention, or trauma [3]. With significant MI from intraluminal hematoma, patients can present with signs and symptoms that mimic MI including chest pain with and without radiation, dyspnea, nausea and vomiting. It can also include elevated troponin with electrocardiogram (ECG) changes consistent with ST segment elevation or non-ST segment elevation MI. The diagnosis is made when other etiologies of acute coronary syndrome (ACS) are ruled out and there is an angiographic evidence of non-iatrogenic or non-atherosclerotic radiolucent intimal flap and contrast staining [1]. Left anterior descending (LAD) artery is the most commonly affected branch of the left main coronary [4]. Severe stenosis can lead to heart failure as well as cardiogenic shock amongst other post-MI complications including ventricular arrhythmias, ventricular free wall or septal wall rupture. If angiography is inconclusive, then intracoronary imaging with optical coherence tomography or intravascular ultrasound may be considered before repeat angiography [5].The etiology of SCAD is thought to be multifactorial without a clear underlying cause. Risk factors associated include fibromuscular dysplasia (FMD), peri and postpartum period, hormonal fluctuations, and arteriopathies. SCAD is a rare cause of ACS, although when present, there is a higher prevalence in young females without cardiac risk factors [6]. Stable patients are treated conservatively with medication while percutaneous coronary intervention (PCI) and coronary artery bypass graft are reserved for severe stenosis and acute change in hemodynamics. Use of antiplatelet therapy remains controversial as medications such as acetylsalicylic acid (i.e. aspirin) and P2Y12 receptor blockers can worsen intraluminal hematoma. Dual antiplatelet therapy is recommended for those who undergo stent placement [5]. Similarly, guideline directed medical therapy is initiated for new onset of heart failure. Review of literature reveals 90% recovery within one month with coronary computed tomography angiography [5]. Many cases of SCAD have been reported in young females with ischemic symptoms and angiographic findings in the distal LAD but only few cases highlight proximal coronary involvement. We present a case of a young woman with extensive left main and proximal LAD SCAD requiring intervention.

Studies have revealed an association of neural disfigurement with trisomy 18. Hereby, we report a rare coalition of Trisomy 18 and Arnold Chiari malformation along with myelomeningocele in a premature neonate. Despite managing hydrocephalus, the patient' condition deteriorated over time due to underlying cardiothoracic defects.

IntroductionIBD is a chronic systemic inflammatory disease that predominantly involves the gastrointestinal tract. At the same time, it exerts numerous cardiovascular manifestations, like atherosclerotic cardiovascular disease and thromboembolic events, due to a hypercoagulable state. Although the disease mechanism is unclear, factors responsible, like the disruption of the normal coagulation cascade, hyperhomocysteinemia, abnormalities in platelet-endothelial cell interactions, and increased fibrinolysis, are implicated.

Silicosis unveiled: Improving diagnostic accuracy and distinguishing it from tuberculosis: A case report from a low and middle-income countryChapagain, Sanskriti1 , Shrestha,Abhigan Babu2 ,Shrestha ,shumneva 3,Shrestha, sajina4,jaiswal ,vikash5,yadav,Hritik Raj 2, Shrestha ,Nilasma61. Devdaha Medical College and Research Institute, Bhaluhi, Rupandehi, Nepal2.M Abdur Rahim Medical Medical College Hospital, Department Of Internal MedicineDinajpur, Bangladesh3. Tribhuvan University Institute of Medicine Maharajgunj Medical Campus ,Nepal4. KIST Medical College, Department Of Internal Medicine, patan Imadol, Lalitpur,Nepal5. Medical AMA School of Medicine, Medicine Bangkal makati, Philippines Makati City, Luzon6.Kathmandu Medical College,Kathmandu,NepalCorresponding author :Chapagain,SanskritiDevdaha Medical College and Research Institute, Bhaluhi, Rupandehi, [email protected]

Japanese Encephalitis (JE) is a viral disease caused by the Japanese Encephalitis Virus (JEV) which is a mosquito-borne, single-stranded, RNA flavivirus belonging to the Flaviviridae family. It is imperative to note that JE can cause severe inflammation of the brain, leading to long-term neurological complications or even death in some cases. JE vaccine provides a crucial defense against this potentially fatal disease. Given the high prevalence of JE in Bangladesh, widespread vaccination campaigns and public health initiatives are necessary to promote awareness and ensure that individuals at risk receive the vaccine. The commentary emphasizes on how crucial it is that individuals who are at risk of JE infection receive the vaccine through nation wide immunization campaign in Bangladesh.

Heterotaxy pattern associated with Sinus Node Dysfunction in an adult: A case report.Authors : Naman Shah MBBS1, Sankalp Acharya2, Apoorva Tripathi MBBS2, Himanshi Bisht MBBS2,Maitri Shah MBBS1, Aayushi Pareek MBBS3, Asmit Gera MBBS4, Abhigan Babu Shrestha, MBBS5, Vikash Jaiswal MD61. GMERS Medical college Sola, Ahmedabad, India2. B. J. Medical College, Ahmedabad, India3. RHUS College of Medical Science, Jaipur, Rajasthan4. JCCR Cardiology Research, Varanasi, India5. M Abdur Rahim Medical College, Dinajpur, Bangladesh6. AMA School of Medicine, Makati, Philippines

INTRODUCTIONSchizencephaly is an uncommon anomaly of the brain characterized by abnormal gray matter lined clefts extending from the ependymal surface of the ventricle to the subarachnoid space. There are two distinct subtypes. Cleft with fused lips is a type 1 or closed type whereas unopposed lips allowing communication of the cleft to the ipsilateral ventricle is an open type.[1] Although the exact cause of this disorder is uncertain, diverse theories have been put forward to establish a definite underlying etiology. A defect in neuronal migration[2] or some form of molecular genetic abnormalities such as mutation in EMX2 [1], SHH and SIX 3 gene [3] , intrauterine infections[4] are few of the probable causes advocated in literature. MRI is the best suited imaging modality for diagnostic evaluations owing to its superiority in gray and white matter distinction, and hence distinguishing the entity from porencephaly or any other post infectious, postoperative or post necrotic lesions.[2][5]

We present a rare case of anagrelide-induced pericardial effusion that is presented with tamponade physiology in a patient with essential thrombocythemia. After cautiously weighing the risks and benefits of further invasive interventions following an unsuccessful pericardiocentesis, the decision was to stop anagrelide while managing the pericardial effusion medically.

In this case, we present a 47-year-old male who was found to have S. intermedius abscesses in his lungs, liver, and brain. The treatment of choice for these abscesses is a combination of drainage, surgery, and antibiotic therapy

Solitary fibrous tumours (SFT) are a rare group of spindle cell neoplasm of submesothelial origin with malignant potential. Here, we are presenting a case of a 45-years-old male patient, who presented with recurrent episodes of hypoglycemia spells and later on, it was diagnosed that hypoglycemic spells were secondary to fibroma.

We present a case of a 47-year-old female with a history of diagnosed KD and autoimmune hepatitis 13 years ago who presented with recurrent fevers and a desquamative rash on the lower extremities. Patient has elevated ASMA titer, and a subsequent liver biopsy confirmed the diagnosis of autoimmune hepatitis