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This case report delineates the complex management of a 65-year-old female with established diabetes, hypertension, and ischemic heart disease, who presented with refractory angina despite comprehensive medical management. Coronary angiography identified significant pathology in the right coronary artery alongside a previously placed, functioning stent in the left anterior descending artery. The intervention was complicated by the occurrence of a type B coronary artery dissection and a type III coronary perforation during an attempt to extract a stent. Immediate remedial measures, including balloon inflation and the placement of drug-eluting stents, were undertaken. The patient underwent a transient episode of collapse, from which she was successfully resuscitated. The concluding angiographic assessment confirmed the effective dilation of the lesion with no remaining dissection or perforation. This case accentuates the infrequent yet critical complications that can arise during percutaneous coronary intervention.
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Key Clinical Message: Tuberculous myocarditis is a rare presentation of tuberculosis, posing diagnostic challenges in endemic countries. Clinicians should consider this entity in patients with unexplained heart failure, conduction abnormalities, or sudden cardiac events in tuberculosis-endemic regions. Abstract: Tuberculous myocarditis is an uncommon manifestation of tuberculosis, often presenting as a diagnostic challenge, particularly in tuberculosis-endemic regions. We report a case of a 58-year-old male with a history of chronic cough and fever, who presented with progressive dyspnea, generalized body swelling, and New York Heart Association (NYHA) Class IV heart failure. Clinical examination revealed signs of cardiac decompensation and congestive heart failure. Emergency echocardiography demonstrated biventricular dysfunction, and imaging showed clots in both atria and the left ventricle. The patient responded well to initial treatment with anticoagulants, antibiotics, diuretics, and inotropic support. Subsequent investigations, including computed tomography pulmonary angiogram (CTPA) and high-resolution computed tomography (HRCT), confirmed active pulmonary tuberculosis. Anti-tuberculous treatment (ATT) was initiated, and the patient showed remarkable improvement. The diagnosis of tuberculous myocarditis was based on clinical, radiological, and laboratory evidence, as cardiac biopsy was not performed due to resource limitations. Tuberculous myocarditis is an underreported condition, and clinicians should be vigilant about its occurrence, especially in tuberculosis-endemic regions. Early recognition and prompt initiation of ATT can lead to favorable outcomes. This case highlights the importance of considering tuberculous myocarditis in patients with unexplained heart failure or cardiac abnormalities in areas with a high burden of tuberculosis.
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The motive of the current research is to determine the influence of family motivation on intent to leave and job performance using self-determination theory. Moreover, this study also explores the moderating role of collectivistic culture and the mediating role of psychological meaningfulness on the relationship between family motivation and work outcomes. The data (N = 175) were collected from paramedical staff working in Pakistani public hospitals, and data was analyzed using PROCESS method. The findings revealed that family motivation enhanced employee job performance and lessened employees' intent to leave. At the same time, family motivation and psychological meaningfulness are stronger in highly collectivistic cultures compared to less collectivist cultures. This study extends the investigation of the newly developed construct of family motivation by focusing on psychological meaningfulness and collectivistic culture. Moreover, this study is the first to introduce psychological meaningfulness as a mediator and collectivistic culture as a moderator for the relationship between family motivation and employee job outcomes. This study provides several critical insights for the hospitals by exploring the importance of family motivation as a potential motivational resource for maintaining high employee job-performance levels and lessening the intent of employees to leave.