Publications

Takotsubo cardiomyopathy, or "broken heart syndrome," is a condition characterized by transient left ventricular dysfunction, typically triggered by intense emotional or physical stress. While initially thought to follow primarily negative life events, such as grief or fear, a subset of cases now recognized as "happy heart syndrome" occur instead after positive emotional triggers, such as celebrations, romantic moments, or good news. This review summarizes the current understanding of takotsubo syndrome (TTS) precipitated by joyful events, focusing on novel insights from the largest registry analysis to date of 37 "happy heart" cases from the international, multicenter GEIST registry. Compared with the more common negative emotional trigger group, these patients had a higher prevalence of men and atypical midventricular ballooning patterns. While event rates trended lower, likely due to the small sample size, acute complications, such as pulmonary edema, and long-term mortality did not definitively differ. The pathophysiology of "happy heart syndrome" remains unclear but implicates differences in central autonomic processing and peripheral catecholamine responses to positive vs negative emotional stimuli. Several key outstanding questions are highlighted, including understanding susceptibility factors, confirming prognostic differences, and leveraging insights into underlying brain-heart circuitry. Ultimately, dedicated research into this rare but fascinating condition could provide broader mechanistic insights and therapeutic opportunities for the prevention and management of all takotsubo phenotypes at the nexus of mind, brain, and heart.

This systematic review examined the role of bedside teaching (BST) in undergraduate medical education, focusing on its impact on clinical competence and professional growth. The review included 15 studies that investigated the effects of BST on physical examination skills, diagnostic abilities, communication skills, and confidence among medical students. The results showed that BST significantly improved physical examination skills, diagnostic abilities, and communication skills, and increased confidence among students. BST was also found to enhance empathy and professionalism among students. However, the review highlighted several challenges in implementing BST, including time constraints, lack of trained faculty, and declining opportunities for BST. To address these challenges, the review recommended integrating BST into the medical curriculum, providing faculty development programs, and utilizing technology-enhanced learning tools. The findings of this systematic review underscore the importance of BST in undergraduate medical education, emphasizing its potential to enhance clinical competence and professional growth among future healthcare professionals.

Multiple myeloma (MM) is a clonal plasma cell proliferative disorder that accounts for 1% of all cancers (Rajkumar). It is a disease of older adults, presenting with anemia, bone pain, and end-organ damage in the form of CRAB features. With increasing awareness regarding this entity and the availability of more-sensitive diagnostic modalities, involvement of younger age-groups with atypical presentations is becoming more common. Newer case series report that nearly 50% of MM cases present initially with renal failure of unknown etiology (Shankar et al.), highlighting the unique role of the nephrologist in the diagnosis of this condition. In these two case reports, we wish to highlight two cases presenting with acute renal failure of unknown etiology, who were subsequently diagnosed to have occult MM with light chain deposition disease (LCDD).

Takotsubo cardiomyopathy (TCM) is a type of disorder of cardiomyocytes in which there is apical akinesia and ballooning, whereas the base is hyperkinetic. Reverse Takotsubo cardiomyopathy (rTCM) is a rare variant of TCM in which the base of the heart is akinetic and ballooned out rather than the apex, which is hyperkinetic. Takotsubo cardiomyopathy is usually seen in postmenopausal women, but a rising number of cases of the reverse variant are being reported in peripartum women. We present a case of a 24-year-old primigravida at 37 weeks of gestation, who presented with an acute onset of breathlessness just after cesarean delivery. A 2D echocardiogram revealed changes of rTCM with an overall ejection fraction of 40%. She was treated for the same, and a 2D echocardiogram repeated after 1 week showed improvement in the ejection fraction to >60%, which supported our diagnosis of peripartum rTCM. Another important objective of this study is to differentiate TCM occurring in the peripartum period from peripartum cardiomyopathy (PPCM), both of which are clinically indistinguishable but have different etiopathogenesis, treatment, and prognosis. While rTCM treatment mostly includes the management of heart failure, such as oxygen supplementation, diuretics, and noninvasive mechanical ventilation, the management of PPCM also includes bromocriptine, along with treating heart failure. The outcome of rTCM is excellent, with recovery of left ventricle function in almost all cases, while a few patients of PPCM have irreversible heart failure, making it imperative to differentiate between the two clinical entities.

Amyloidosis is an extremely rare condition with a variety of symptoms that, in extreme situations, can be fatal. Basically a protein misfolding disorder, it is characterized by deposition of insoluble polymeric protein fibrils in tissues and organs. There are different types of amyloidosis; here, we see a case of secondary amyloidosis, which is usually a consequence of a chronic disease. The case is unique, as there are many research projects showing the link of tuberculosis (TB) and secondary amyloidosis, but it is rarely documented because of extrapulmonary TB, which here is tuberculous lymphadenitis, and also here the patient is younger than the mean age. The clinical manifestations of this disease are seen mainly in the renal system, gastrointestinal system, and reticuloendothelial system. For which the management is mainly supportive, along with treatment of the underlying cause.

A high risk of thrombosis is linked to myeloproliferative neoplasm (MPN) and antiphospholipid syndrome (APS). The systemic autoimmune disorder known as APS is characterized by persistently positive antiphospholipid antibodies [anticardiolipin (aCL), lupus anticoagulant, and antibeta 2 glycoprotein 1 IgG and IgM antibodies] in conjunction with obstetrical complications or thrombosis (Chayoua et al.). Polycythemia vera (PV) is a MPN that causes too many red blood cells (RBCs) in the blood and proinflammatory cytokines. In this report, we present a case of a 25-year-old lady with a history of second-trimester abortion who presented with abdominal pain and hepatosplenomegaly. Owing to erythrocytosis, thrombocytosis, and moderate hepatosplenomegaly, workup for MPN was done along with prothrombotic workup including APS, and she turned out to be positive for both. Coexistence of MPN and APS is rare in the literature. The optimal management of patients with coexistent APS and MPN has not been defined so far. Immediate anticoagulation with specific treatment for MPN is essential to prevent further thromboembolic episodes and progression to catastrophic APS.

Woolly hair with palmoplantar keratoderma (WH-PPK) is a group of four autosomal recessive syndromes. Type 4 WH-PPK is usually associated with KANK2 mutation and does not have cardiac morbidity among its features. Here we report a 25-year-old woman with woolly hair, palmoplantar keratoderma without any cardiac morbidity. However, she had sensorineural hearing loss and maculopathy. Thus, we present a patient with type 4 WH-PPK with a novel phenotype to highlight the rare WH-PPK syndromes. The association of woolly hair and palmoplantar keratoderma without cardiomyopathy, and with macular deposits and sensorineural hearing loss, has not been reported before.

Internuclear ophthalmoplegia with ipsilateral horizontal gaze palsy is called one and a half syndrome. There are a number of numerical one and a half spectrum disorders. One such syndrome is nine syndrome, which is characterized by one and a half syndrome, ipsilateral lower motor neuron type facial palsy, and contralateral hemiparesis or hemihypesthesia or hemiataxia. Here we describe a case of nine syndrome with left one and a half syndrome, left lower motor neuron type facial palsy, and right hemiataxia.

Autoimmune hepatitis (AIH) is a long-lasting liver ailment. It causes hepatocellular necrosis and inflammation, leading to fibrosis. It can develop into cirrhosis and liver failure. The disease predominantly affects young to middle-aged women more than men. AIH flares up during gestation and is linked with a high rate of embryonic and maternal problems. With maternal and antenatal care becoming advanced, this disorder should be identified and managed for successful maternal and embryonic outcomes. We present a case report of a primigravida diagnosed with AIH at 14 weeks antenatally. Our main aim in reporting this case is to create general awareness for healthcare professionals and thereby for patients and caregivers about this condition in pregnancy.

We report a case of a 22-year-old male who was previously treated for asthma from childhood, and his repeated respiratory infections prompted the physician to start antitubercular therapy (ATT) thrice, suspecting pulmonary tuberculosis despite being sputum acid-fast bacillus (AFB) negative every time. Diagnosis of Kartagener syndrome (autosomal recessive inheritance having a triad of bronchiectasis, chronic sinusitis, situs inversus, and strongly associated with infertility) was made in this case at our tertiary care referral hospital, but it was already too late when he presented with life-threatening bilateral pneumonia, bilateral pleural effusion with type II respiratory failure, and associated cystitis warranting mechanical ventilation, and he succumbed because of extremely and irreversibly damaged lungs.