Correlations between the long noncoding RNA MEG3 and clinical characteristics for diabetic kidney disease in type 2 diabetes mellitus.

BACKGROUND AND AIMS: Diabetic kidney disease (DKD) is a common complication of type 2 diabetes mellitus (T2DM) that leads to systemic inflammation. Maternally expressed gene 3 (MEG3) is a tumor suppressor that is involved in inflammation regulation. The current study investigated the association between DKD and the prevalence of the single-nucleotide polymorphisms (SNPs) of MEG3. METHODS: A total of 706 and 735 patients were included in the DKD and non-DKD groups, respectively. The five SNPs of MEG3, namely rs4081134 (G/A), rs10144253 (T/C), rs7158663 (G/A), rs3087918 (T/G), and rs11160608 (A/C), were genotyped using TaqMan allelic discrimination. RESULTS: Our results revealed that, in the DKD group, the distribution of the GG genotype of the MEG3 SNP rs3087918 was significantly lower than that of the wild-type genotype (AOR: 0.703, 95% CI: 0.506-0.975, P = 0.035). In addition, in the pre-ESRD DKD subgroup, the distribution of the TG + GG genotype of the MEG3 SNP rs3087918 was significantly lower than that of the wild-type genotype (AOR: 0.637, 95% CI: 0.421-0.962, P = 0.032). In addition, among men in the DKD subgroup, the distribution of the GG genotype of the MEG3 SNP rs3087918 was significantly lower than that of the wild-type genotype (AOR: 0.630, 95% CI: 0.401-0.990, P = 0.045). Glycated hemoglobin (HbA1c) level was significantly higher in all T2DM patients with the wild-type genotype of the MEG3 SNP rs3087918 (P = 0.020). In addition, HbA1c levels were significantly higher in male patients and male DKD patients with the wild-type genotype of the MEG3 SNP rs3087918 (P = 0.032 and 0.031, respectively). CONCLUSION: MEG3 SNP rs3087918 is significantly less prevalent in patients with DKD, and the SNP rs3087918 of MEG3 is associated with lower HbA1c levels.

Laparoscopic Live Donor Nephrectomy: An Initial Moroccan Experience.

Introduction Laparoscopic nephrectomy is the gold standard for kidney removal in living donors, offering advantages such as reduced pain and quicker recovery. In Morocco, where end-stage renal disease (ESRD) is a growing concern, this approach could significantly impact the demand for kidney transplants. This study evaluates the safety and efficacy of laparoscopic live donor nephrectomy in the Moroccan healthcare system. Materials and methods Fifteen laparoscopic nephrectomies were analyzed, focusing on donor demographics, procedure details, and outcomes. Key parameters included donor age, BMI, operative time, warm ischemia time, and blood loss. Complications and graft outcomes were also assessed. Results The procedure was safe and effective, even in obese donors. Donors were predominantly female (80%), with an average age of 49.4 years. Obese donors had longer operative times (282 minutes vs. 220 minutes). Left kidney retrieval was preferred (95%). Warm ischemia averaged 6.27 minutes and blood loss was 207 mL. One donor had elevated creatinine postoperatively, while most maintained stable renal function. Eighteen complications, mostly minor, were reported. Conclusion Laparoscopic live donor nephrectomy is a safe and adaptable procedure in Morocco, offering low complication rates and favorable outcomes. It is effective for a diverse donor population, including older and obese individuals, and may help address the country's growing transplant needs.

A Case Report and Clinical Insights on Encapsulating Peritoneal Sclerosis: A Rare yet Critical Complication of Peritoneal Dialysis.

Peritoneal dialysis (PD) offers a valuable alternative to hemodialysis in the management of end-stage renal disease. While PD offers several advantages, such as improved patient autonomy and preservation of residual kidney functions. It has a wide spectrum of complications, which include mechanical ones such as catheter malfunction or migration, hernias and dialysate leak, or infectious complications, which can be limited to exit site and tunnel infections or extend interiorly to cause peritonitis. One detrimental long-term complication of PD is encapsulating peritoneal sclerosis (EPS), a rare condition characterized by formation of a fibrous cocoon around the bowel loops often initiated by chronic exposure to PD solutions. Other implicated factors include peritonitis, medications and systemic inflammatory conditions. Risk of EPS increases with the duration of PD, particularly after five years. Diagnosis of EPS is challenging and often delayed, given non-specific and wide spectrum of symptoms that may range from loss of appetite to frank signs of abdominal obstruction, which result in significant consequences that can lead to treatment failure and high mortality rate. Imaging in the form of a CT abdomen is the cornerstone in diagnosis, although many patients are diagnosed intraoperatively during exploratory laparotomy. Treatment is usually directed at eliminating provoking factors and directed therapy based on the disease phase.  In this case, we are discussing a 69-year-old patient presenting with signs of abdominal obstruction and found to have a large cystic lesion compressing small bowels. Eventually, patient obstruction was relieved with draining though interventional radiology after a trial of conservative management failed. Our goal is to notify our colleagues that we have a high index of suspicion coupled with prompt imaging evaluation that can facilitate early diagnosis, offering hope for improved patient outcomes through timely management strategies.

Does the hemodialysis program affect the testosterone serum level in patients with end-stage renal disease?

PURPOSE: This study aimed to evaluate the effect of high flux membrane hemodialysis on total serum testosterone (TST) levels in male patients with end-stage renal disease (ESRD). METHODS: The study included 60 male ESRD patients with a mean age of 54.02 ± 13.40 years, undergoing a standard hemodialysis program et al. Najah National University Hospital. All patients underwent three weekly sessions of four hours each using high flux membrane hemodialysis. TST and hematocrit (Hct) levels were measured before and after hemodialysis. Patients with prostate cancer, liver insufficiency, prior prostate surgery, or those on androgen therapy were excluded. The study assessed changes in TST and Hct levels and their correlation. RESULTS: Post-dialysis, there was a significant increase in serum testosterone levels from 3.13 ± 1.44 ng/ml to 4.17 ± 2.04 ng/ml (r = 0.78, p = 0.001). Hematocrit levels also rose significantly from 32.31% ± 3.90% to 35.27% ± 4.89% (r = 0.754, p = 0.001). The percentage change in TST and Hct levels was 35 ± 0.33% and 9 ± 0.1%, respectively, with a correlation between these changes (r = 0.277, p = 0.032). CONCLUSION: High flux membrane dialysis did not filter testosterone molecules, and the significant increase in TST levels post-dialysis is likely due to hemoconcentration. Since many patients had low or borderline TST levels before dialysis, androgen supplementation may offer clinical benefits.

Rapid onset severe hyperkalemia during robotic radical cystectomy: a case report.

Radical cystectomy is a preferred treatment for muscle-invasive bladder cancer.  Despite known complications, rapid onset, severe hyperkalemia necessitating abortion of surgery has not been reported.  In this case report, a patient with end stage renal disease (ESRD) undergoing attempted cystectomy developed severe intraoperative hyperkalemia and acidosis that led to abortion of surgery and transfer to the medical intensive care unit for emergent hemodialysis.  The multifactorial etiology was related to respiratory acidosis, ESRD, patient positioning, clipping of ureters, and body habitus, as well as an idiopathic element.  Knowledge of hyperkalemia etiologies can assist in diagnosis and treatment of this serious condition.

Cardiovascular and fracture events analysis and intervention strategies in patients undergoing parathyroidectomy with secondary hyperparathyroidism.

Background: Chronic kidney disease (CKD), especially end-stage renal disease (ESRD), is the most common cause of secondary hyperparathyroidism (SHPT), and SHPT is the most severe complication of ESRD. This study aimed to analyze the influencing factors of cardiovascular and fracture events in patients with SHPT which are the leading causes of death in patients with CKD, and provide a reference for selecting patients for whom surgery is more suitable. Methods: Patients who underwent parathyroidectomy (PTX) for SHPT at The First Affiliated Hospital, Zhejiang University School of Medicine from September 2021 to April 2024 were selected as the study object, with the inclusion and exclusion criteria as followed. They were divided into rural and urban residents for comparison as a cross-sectional study. The study evaluated the comorbidities, socioeconomic status, and postoperative complications diagnosed by radiography of patients undergoing surgery for SHPT. Results: A total of 119 patients were included, among whom, 71 were from rural areas and 48 were from urban areas. Compared with urban residents, rural residents had poorer economic conditions, a longer interval from disease onset to PTX, and a higher incidence of cardiovascular and fracture events and concurrent nephrolithiasis, all of which were statistically significant. Multivariate analysis indicated that place of residence, age, and duration of uremia were independent risk factors of cardiovascular/fracture events. Conclusions: Medical staff in ESRD outpatient clinics should pay attention to patients with SHPT. ESRD patients should have better surveillance especially for rural, elder and poor phosphorus control patients, and promptly assess surgical intervention measures.

Treatment of Osteoporosis in Chronic Kidney Disease Population.

Osteoporosis is treated similarly in all patients with GFR greater than 30 mL/min. In patients with fragility fracture with a GFR less than 30 mL/min, correct diagnosis through biopsy and bone turnover markers of adynamic bone disease, hyperparathyroidism, osteomalacia, or osteoporosis is important because antiresorptive medications will not benefit a patient with adynamic bone disease.

The Importance of Multidisciplinary Teams in the Early Detection and Management of Disseminated Nannizziopsis Infections in Solid Organ Transplant Recipients: A Case-Based Review.

This case report presents the clinical course of a 58-year-old female renal transplant patient with a complex medical history, including type 2 diabetes mellitus, hypertension, and chronic immunosuppression, who developed a disseminated Nannizziopsis obscura infection. The patient presented with persistent left leg pain and rapidly progressed to multisystem involvement, including central nervous system abscesses. Despite aggressive antifungal therapy and multidisciplinary management, her condition deteriorated, leading to a transition to palliative care. This report highlights the challenges in diagnosing and managing rare fungal infections in immunocompromised patients, highlighting the importance of early detection, advanced imaging, and a coordinated approach to care. The case also emphasizes the ethical considerations in balancing aggressive treatment with quality of life in terminal conditions.

Delphi Panel Consensus Statement Generation: COVID-19 Vaccination Recommendations for Immunocompromised Populations in the European Union.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented pressure on healthcare systems globally. The lack of quality guidelines on the management of COVID-19 in rheumatologic disease, renal disease, hematological malignancy, and solid organ transplant recipients has resulted in a wide variation in clinical practice. METHODS: Using a Delphi process, a panel of 16 key opinion leaders developed clinical practice statements regarding vaccine recommendations in areas where standards are absent or limited. Agreement among practicing physicians with consensus statements was also assessed via an online physician survey. The strength of the consensus was determined by the following rating system: a strong rating was defined as all four key opinion leaders (KOLs) rating the statement ≥ 8, a moderate rating was defined as three out of four KOLs rating the statement ≥ 8, and no consensus was defined as less than three out of four KOLs provided a rating of ≤ 8. Specialists voted on agreement with each consensus statement for their disease area using the same ten-point scoring system. RESULTS: Key opinion leaders in rheumatology, nephrology, and hematology achieved consensuses for all nine statements pertaining to the primary and booster series with transplant physicians reaching consensus on eight of nine statements. Experts agreed that COVID-19 vaccines are safe, effective, and well tolerated by patients with rheumatological conditions, renal disease, hematologic malignancy, and recipients of solid organ transplants. The Delphi process yielded strong to moderate suggestions for the use of COVID-19 messenger ribonucleic acid (mRNA) vaccines and the necessity of the COVID-19 booster for the immunocompromised population. The expert panel had mixed feelings concerning the measurement of antibody titers, higher-dose mRNA vaccines, and the development of disease-specific COVID-19 guidance. CONCLUSIONS: These results confirmed the necessity of COVID-19 vaccines and boosters in immunocompromised patients with rheumatologic disease, renal disease, hematological malignancy, and solid organ transplant recipients. Statements where consensus was not achieved were due to absent or limited evidence.

COVID-19 Vaccination Recommendations for Immunocompromised Patient Populations: Delphi Panel and Consensus Statement Generation in the United States.

INTRODUCTION: The United States Advisory Committee on Immunization Practices (ACIP) and the Centers for Disease Control (CDC) recommend COVID-19 vaccines for all immunocompromised individuals. Certain disease groups are at increased risk of comorbidity and death for which disease-specific recommendations should be considered. The objective of the Delphi panel of experts was to summarize expert consensus on COVID-19 vaccinations for patients with rheumatologic disease, renal disease, hematologic malignancy and solid organ transplant (SOT) in the US. METHODS: A two-stage Delphi panel method was employed, starting with qualitative interviews with key opinion leaders (KOLs) in the four disease areas (n = 4 KOLs, n = 16 total) followed by three rounds of iterative revision of disease-specific COVID-19 vaccine recommendations. Final consensus was rated after the third round. Statements addressed primary and booster dosing (e.g., number and frequency) and other considerations such as vaccine type or heterologous messenger ribonucleic acid (mRNA) vaccination. Following the Delphi Panel, an online survey was conducted to assess physician agreement within the disease areas (n = 50 each, n = 200 total) with the consensus statements. RESULTS: Moderate to strong consensus was achieved for all primary series vaccination statements across disease groups, except one in hematology. Similarly, moderate to strong consensus was achieved for all booster series statements in all disease areas. However, statements on antibody titer measurements for re-vaccination considerations and higher dosages for immunocompromised patients did not reach agreement. Overall, approximately 62%-96% of physicians strongly agreed with the primary and booster vaccine recommendations. However, low agreement (29%-69%) was found among physicians for time interval between disease-specific treatment and vaccination, recommendations for mRNA vaccines, heterologous mRNA vaccination, antibody titer measurement and higher vaccine dosage for immunocompromised groups. CONCLUSION: Consensus was achieved for disease-specific COVID-19 vaccine recommendations concerning primary and booster series vaccines and was generally well accepted by practicing physicians.

Affinity peptide-based electrochemical biosensor with 2D-2D nanoarchitecture of nickel-chromium-layered double hydroxide and graphene oxide nanosheets for chirality detection of symmetric dimethylarginine.

The accurate assessment of kidney dysfunction is crucial in clinical practice, necessitating the exploration of reliable biomarkers. However, current methods for measuring SDMA often fall short in terms of sensitivity and specificity. In this study, we employed phage display technology to identify high affinity peptides that specifically bind to SDMA. The selected peptide was subsequently integrated into a novel Ni-Cr layered double hydroxide-graphene oxide (NCL-GO) nanoarchitecture. We characterized the electrochemical properties of the biosensor using cyclic voltammetry, electrochemical impedance spectroscopy and differential pulse voltammetry, systematically evaluating critical parameters such as limit of detection (LOD), reproducibility, and performance in complex biological matrices including urine. The NCL-GO architecture not only enhances the surface area available for electrochemical reactions but also facilitates rapid electron transfer kinetics which are essential for the accurate quantification of small molecule, SDMA. The electrochemical biosensor exhibited an outstanding limit of detection of 0.1 ng/mL in the 0-1 ng/mL range and 7.2 ng/mL in the 1-100 ng/mL range, demonstrating exceptional sensitivity and specificity for SDMA. Furthermore, the biosensor displayed excellent reproducibility with a relative standard deviation of 4.9%. Notably, it maintained robust chirality sensing capabilities, even in complex biological fluids. These findings suggest that this biosensor could play a pivotal role in early disease diagnosis and therapeutic monitoring, ultimately improving clinical outcomes and advancing biomedical research.

Anesthetic Challenges in a Pediatric Patient With Chronic Kidney Disease Complicated by Dilated Cardiomyopathy Undergoing Non-cardiac Surgery.

Dilated cardiomyopathy (DCM), a primary myocardial disorder, manifests through the dilation of one or both ventricles, coupled with systolic and valvular dysfunction. Renal agenesis is a congenital condition characterized by the absence of one or both kidneys at birth. Unilateral renal agenesis, wherein one kidney is absent, can subtly evade detection due to the impressive adaptability of the remaining kidney, often preserving typical functionality. Nevertheless, when compounded with chronic kidney disease (CKD), the repercussions of renal agenesis become notably more pronounced. CKD and DCM represent two significant and interrelated clinical challenges, particularly in pediatrics. This case report examines the anesthesia management of a 10-year-old female with CKD and right renal agenesis complicated by DCM undergoing bilateral hemi-epiphysiodesis for genu valgum correction. It emphasizes the crucial role of a multidisciplinary approach in achieving favorable outcomes in patients undergoing non-cardiac surgery.

Supporting Infants with Multicystic Dysplastic Kidney Disease: A Comprehensive Approach.

Multicystic dysplastic kidney (MCDK) is a congenital renal disease characterized by variable-sized noncommunicative cysts, impeding parenchymal development and functionality. Renal capabilities are relative to the functionality of the contralateral kidney and response to management. Unilateral and isolated cases are often asymptomatic with more positive outcomes, while severe bilateral derangements have a high mortality rate. We present a case of left-sided MCDK and right-sided renal dysplasia diagnosed at a nontertiary center. In addition, we offer a review of the epidemiology, epigenetics, and pathophysiology of MCDK. A concise discussion of prenatal, intrapartum, and postnatal renal function surveillance methods is presented to assist neonatal healthcare providers in collaborating with pediatric nephrology and urology specialists.

Hyperparathyroidism presented as multiple pulmonary nodules in hemodialysis patient status post parathyroidectomy: A case report.

BACKGROUND: Primary hyperparathyroidism is typically caused by a single parathyroid adenoma. Ectopic parathyroid adenomas occur as well, with cases involving various sites, including the mediastinum, presenting in varying frequencies. Secondary hyperparathyroidism develops in the context of chronic kidney disease, primarily due to vitamin D deficiency, hypocalcemia, and hyperphosphatemia. It is frequently diagnosed in patients undergoing dialysis. This article presents a rare case of hyperparathyroidism involving multiple hyperplastic parathyroid glands with pulmonary seeding in a 50-year-old female patient undergoing hemodialysis (HD). CASE SUMMARY: The patient had a history of parathyroidectomy 10 years prior but developed recurrent hyperparathyroidism with symptoms of pruritus and cough with sputum during a period of routine dialysis. Radiographic imaging revealed multiple nodules in both lungs, with the largest measuring approximately 1.35 cm. Surgical histopathology confirmed the presence of hyperplastic parathyroid glands within the pulmonary tissue. After tumor resection surgery via video-assisted thoracic surgery with wedge resection, the patient was discharged in stable condition and in follow-up her symptoms showed improvement. CONCLUSION: This article describes hyperparathyroidism presenting as pulmonary nodules in a patient undergoing post-parathyroidectomy HD, highlighting diagnostic challenges and a positive outcome from tumor resection surgery.

Incidental renal cell carcinoma post bilateral nephrectomy in autosomal dominant polycystic kidney disease.

BACKGROUND: Renal cell carcinoma (RCC) is more common in patients with autosomal dominant polycystic kidney disease (ADPKD) than in the general population. Diagnosing RCC in ADPKD is challenging due to the presence of multiple renal cysts, often leading to delays and difficulties in distinguishing RCC from cyst infection or hemorrhage. AIM: To analyze the prevalence and characterize the clinical features of RCC in patients with ADPKD undergoing simultaneous bilateral native nephrectomy. METHODS: Between May 2017 and April 2024, 19 ADPKD patients undergoing hemodialysis and awaiting kidney transplantation due to end-stage renal disease (ESRD) underwent bilateral nephrectomies in a single center. Parameters such as patient characteristics, intraoperative blood loss, blood transfusion volume, length of hospital stay, and postoperative complications were documented. Pathological findings for RCC were reviewed. RESULTS: A total of 38 kidneys were excised from 19 patients, with a mean age of 56.8 years and an average hemodialysis duration of 84.2 months. Eight patients underwent open nephrectomies, and 11 underwent hand-assisted laparoscopic nephrectomies. RCC was detected in 15.8% of kidneys, affecting 21.1% of patients. Two patients had multifocal RCC in both kidneys. All RCC cases were pT1 stage, with the largest lesion averaging 16.5 mm in diameter. The average operative duration was 120 minutes, with intraoperative blood loss averaging 184.2 mL. Five patients required blood transfusions. Postoperative complications occurred in five patients, with a mean hospital stay of 17.1 days. The mean follow-up period was 28.1 months. CONCLUSION: The prevalence of RCC is higher in patients with ADPKD with ESRD than in those with ESRD alone. Thus, clinicians should be cautious and implement surveillance programs to monitor the development of RCC in patients with ADPKD, particularly those on dialysis.

Relapsing Calciphylaxis of the Breast: Glucocorticoids - Friend or Foe?

Calciphylaxis is a rare life-threatening condition characterised by systemic medial calcification of arterioles causing tissue ischemia with subsequent necrosis. Calciphylaxis occur in areas of increased adiposity like abdomen, proximal extremities, buttocks and breast. We report an elderly lady with end-stage kidney disease who presented with severe mastalgia with breast nodules and overlying skin changes. Calciphylaxis was diagnosed based on clinical, mammography and histo-pathological findings. Poor response to standard conservative management prompted us to use glucocorticoids showing dramatic improvement. She had a relapse after 3 months necessitating glucocorticoids again. We report the use of glucocorticoids as an option in recalcitrant, recurrent breast calciphylaxis.

Tumor characteristics in immunosuppressed and renal dysfunction populations.

PURPOSE: Renal transplantation and end-stage renal disease are increasingly common. Renal dysfunction and immunosuppression are two risk factors in the development of renal cell carcinoma. Carcinomas in these patients are thought to be more indolent, however data are limited and mixed. Our objective was to describe the histology of resected tumors from the transplant and renal dysfunction population and compare them to a control population. MATERIALS AND METHODS: This was a single-center retrospective cohort study of all patients who had a nephrectomy for a renal mass from 2009 to 2019. All transplant status and end-stage renal disease diagnoses were identified by diagnostic or procedural coding and confirmed by chart review. Our primary endpoint was the pathology for each patient's tumor. Tumors were classified into aggressive or nonaggressive categories based on their histology and grade. RESULTS: We identified 1,150 radical and partial nephrectomies, of which 1,057 met inclusion criteria. Of these, 68 patients (6.4%) had renal dysfunction or a kidney transplant on immunosuppression at time of nephrectomy. After pathologic review, 270 (25%) tumors were classified as aggressive, and 673 (64%) tumors were pT1a or pT1b. On multivariable logistic regression controlling for age and gender, renal dysfunction was not associated with having an aggressive tumor (OR 1.24, 95%CI 0.72-2.15; P = 0.44). CONCLUSIONS: We did not observe a relationship between renal dysfunction status and aggressive pathology. These data suggest that renal dysfunction and transplant patients are at similar risk for aggressive pathology as the general population and should be managed according to the same clinical guidelines.

Tumoral calcinosis in chronic renal failure: A case report and literature review.

INTRODUCTION AND IMPORTANCE: Tumor calcinosis is a rare and benign disorder characterized by calcified periarticular soft tissue masses. It may be idiopathic or caused by a condition known as hyperphosphatemia. There is still no definitive guideline for treating this disease, with excision being one of the primary treatment modalities. CASE PRESENTATION: 2 patients with a history of longstanding diabetes and dialysis presented with a painless lump on their right buttock, measuring 18 × 30 cm in the right gluteal region. Laboratory examinations showed a high ureum, creatinine, and serum phosphate. A radiograph revealed opacity on the right hip joint, without involvement of the proximal femur bone. A biopsy confirmed the diagnosis of tumor calcinosis. Both patients were treated with calcium carbonate to control their high serum phosphate levels. Both patients showed excellent tumor control without progression. CLINICAL DISCUSSION: Tumoral calcinosis (TC) is an extra-articular benign but aggressive tumor. The precise mechanism of TC remains unknown, which partly explains the lack of established treatment modality. We treat our patients with calcium carbonate to reduce the serum phosphate and treat the tumor without surgery. The treatment yielded a satisfactory clinical result. CONCLUSION: This study showed that a secondary TC may be conservatively treated without any surgical excision if we address the underlying problem. But it may not result in a reduction of the tumor's size.

Apical Sparing in Routine Echocardiography: Occurrence and Clinical Significance.

Apical sparing is an echocardiographic pattern where myocardial strain is preserved at the apex compared to the basal segments. In a normal heart, longitudinal strain shows a gradient with lower values at the base and higher at the apex. This gradient becomes more pronounced in pathological states, such as cardiac amyloidosis, resulting in a relative apical sparing effect. This study explores cardiac conditions associated with apical sparing and the underlying mechanisms. We reviewed echocardiography examinations reporting apical sparing from 2021 to 2024 in our hospital database. Relevant echo exams and clinical data were retrieved and analyzed. Apical sparing was identified in 74 patients. Cardiac amyloidosis was diagnosed in 12 patients (16.2%). Other cardiac pathologies potentially contributing to apical sparing included hypertrophic cardiomyopathy, left ventricular hypertrophy due to hypertension, end-stage renal disease, coronary artery disease (involving the right coronary artery and left circumflex), reversed Takotsubo syndrome, and chemotherapy-induced cardiomyopathy. The clinical context of echocardiography was crucial in guiding the diagnostic work-up. Apical sparing is a nonspecific echocardiographic finding associated with various cardiac conditions. Its diagnostic value depends heavily on the clinical context. Understanding the broader clinical picture is essential for accurate interpretation and diagnosis.