Proliferative Glomerulonephritis With Monoclonal IgG Deposits: Another Unusual Presentation.

Proliferative glomerulonephritis with monoclonal immunoglobulin G (IgG) deposits (PGNMID) is a relatively rare diagnosis with variable presentation. When detectable, the disease is typically indolent rather than malignant and recurs in transplant cases. Here, we report a case of PGNMID, which presented clinically as rapidly progressive glomerulonephritis (RPGN). The patient presented to his primary care physician's office with diarrhea for one day and was admitted for acute kidney injury. Urine sediment was active, and the patient had nephrotic range proteinuria. Serologic workup was negative for any monoclonality: ANA, c-ANCA, and p-ANCA. Kidney biopsy showed diffuse proliferative and crescentic glomerulonephritis with IgG3-kappa restricted deposits, consistent with PGNMID. The patient required dialysis initiation, and corticosteroids were administered. The patient declined further immunomodulatory treatment and remains hemodialysis-dependent. This case highlights the potential for severe renal damage from monoclonal proteins despite an indolent or even undetectable hematologic clone. This entity needs further studies to better understand its immuno-physiological background and develop a standard treatment regimen.

Dialyzing a Brain-Dead Individual for Organ Procurement.

Many patients are unable to receive organ transplantation as there is an expanding gap between the number of patients waiting for an organ and the number who receive it. Organ procurement from the brain-dead can address this expanding gap, especially because one brain-dead patient can potentially donate multiple organs to several recipients. Here, we describe a rare case of a previously healthy 26-year-old male who was declared brain dead after a motor vehicle accident but underwent hemodialysis to treat his acute kidney injury and hyperkalemia before successfully donating his heart and left kidney.

Beyond Immunosuppression: The Intricate Relationship Between Tacrolimus and Microangiopathy.

Tacrolimus, widely known as Prograf, has become the preferred immunosuppressant for preventing graft rejection in solid organ transplant recipients, particularly in steroid-sparing regimens. Its efficacy and reduced risk of acute and chronic rejection compared to cyclosporine have made it the preferred treatment option for transplant patients. However, tacrolimus has drawbacks as it is associated with adverse effects, such as renal tubular necrosis, kidney failure, hypertension, metabolic acidosis, and new-onset diabetes mellitus. Among the less common but potentially severe complications is thrombotic microangiopathy linked to tacrolimus usage. Identifying and addressing this condition early on is crucial given its severity and potential complications. Manifestations of this microangiopathy can vary, encompassing renal, neurological, cardiac, and respiratory symptoms, and, in some cases, presenting as pancreatitis, intestinal ischemia, or skin abnormalities. Although conventional management often involves plasma exchange as the primary therapeutic option, recent insights into the pathophysiology have led to newer drugs, such as eculizumab and belatacept, offering promising outcomes. In this narrative review, we delve deeper into the underlying pathophysiological mechanisms of tacrolimus-induced thrombotic microangiopathy and aim to provide clinicians with valuable recommendations for efficient and timely treatment strategies. By understanding the complexities of this condition and staying abreast of the latest advancements in therapeutic options, healthcare providers can optimize patient outcomes and ensure safer tacrolimus administration in solid organ transplant recipients.

Covid- 19 Vaccine-induced Myocarditis.

Myocarditis and pericarditis are rare adverse reactions, more commonly seen in young males after receiving the second dose of an mRNA vaccine. However, the benefits of vaccination heavily outweigh the risk of these side effects. In addition, vaccination boosters are effective against the newest, more infective variants. Therefore we expect more vaccines to be administered in the following years. The objective of this study is to review the current understanding of the mechanism, diagnosis, and treatment of myocarditis and pericarditis. Proposed mechanisms include molecular mimicry against the S protein and hypersensitivity reactions with mRNA vaccines and platelet aggregation and thrombus formation in cardiac blood vessels with adenoviral vaccines. Diagnosis of myocarditis is based on clinical findings, cardiac enzymes, ECG, MRI, and echocardiographic findings. Management includes NSAIDs and cardiovascular support in selected cases with ventricular dysfunction. Most patients have a mild presentation with preservation of cardiac function and recover entirely within seven days; the average hospital stay is three days. Long-term complications are infrequent.

Universal Health Care System in India: An In-Depth Examination of the Ayushman Bharat Initiative.

This editorial provides an in-depth review of the Ayushman Bharat initiative, India's universal healthcare scheme, designed to address significant disparities in healthcare access and quality across the country. Following the structure of the healthcare system and socioeconomic trends, the manuscript assesses the reasons for the initiative's creation, its coverage, implementation strategies, role during the COVID-19 pandemic, auxiliary pilot programs, and challenges for future progress. It focuses on how the initiative has increased healthcare accessibility, financial protection, transformed the healthcare infrastructure, and provided relief during the COVID-19 crisis. Critical issues such as gaps between supply and demand, the need for increased government spending, and the challenges of access and quality in rural health centers are also discussed. We aim to raise awareness about the program's benefits among potential beneficiaries, which is a key to the initiative's success and a potential role model for equitable global healthcare.

Unique Presentation of Syphilis With Ocular Involvement: A Case Report.

Ocular syphilis could be the first sign of undiagnosed syphilis. In addition to otosyphilis, it can be observed in the primary, secondary, or tertiary stages of syphilis. Nonspecific clinical symptoms make diagnosis difficult. We report a patient who presented with generalized weakness and blurry vision for the past four to five days. In this case, we emphasize the importance of repeated cerebrospinal fluid (CSF) examinations as they led to the diagnosis of ocular syphilis and appropriate neurosyphilis treatment. It must be suspected in patients with primary or secondary neurological symptoms, such as blurred vision and weakness. Treponema, the causative organism, is invisible under light microscopy and is mostly identified by its distinct spiral movements under darkfield microscopy. Once the diagnosis was made, the patient was started on penicillin treatment to prevent spread to the brain and dorsal spinal cord. The patient responded well to antibiotic treatment, with improvement in visual acuity, and was discharged with close neurological and ophthalmological follow-up.

BK Polyomavirus-Induced Nephropathy in Native Kidney.

BK polyomavirus has been well-studied as an opportunistic infection in immunocompromised kidney transplant patients. In the majority of the population, BK polyomavirus establishes a lifelong infection in renal tubular and uroepithelial cells; however, in an immunocompromised state, the virus can reactivate and can lead to BK polyomavirus-associated nephropathy (BKN). In this case, the patient was a 46-year-old male with a past medical history of HIV, compliant with antiretroviral therapy (ART), and B-cell lymphoma treated with chemotherapy. The patient presented with worsening kidney function of unknown etiology. This prompted further assessment with a kidney biopsy. Kidney biopsy findings were consistent with BKN. In the literature, BKN has been studied in renal transplant patients; however, it rarely involves native kidneys.

Hydralazine-Induced Vasculitis.

Hydralazine is a commonly prescribed medication which is used in the treatment of hypertension. While it is generally considered to be a safe and effective treatment, in rare cases it can cause a serious side effect known as hydralazine-induced vasculitis. Here we discuss this rare presentation in the form of a case report in a 67-year-old female with a past medical history of chronic obstructive pulmonary disease (COPD), congestive heart failure, hypertension, hyperlipidemia, left renal artery stenosis status post stenting who presented in the nephrology office for evaluation of recent worsening kidney function, and on further evaluation was found to have hematuria and proteinuria in the urine analysis. On further workup, she was noted to have severely elevated myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) titers with renal biopsy revealed very focal crescentic glomerulonephritis, an increased number of occlusive red blood cell cast with acute tubular necrosis. Mild interstitial fibrosis of <20% was seen and a diagnosis of drug-induced vasculitis from hydralazine was made.

Is Coffee and Tea a Threat or Ally to Cardiovascular Health?

Tea and coffee have become ingrained in our daily lives and have become the most widely consumed drinks after water. Their effects vary on an individual basis depending upon the amount of daily consumption, genetic polymorphisms, and the presence of comorbidities. Non-habitual individuals experience an initial, brief increase in blood pressure due to caffeine's vasoactive effects. Caffeine also appears to be protective against arrhythmias and heart failure. Along with having a generally cardioprotective profile, they have also demonstrated to have a favorable impact on insulin resistance and reduced risk of diabetes mellitus. Physicians often practice caution and advise patients with known cardiovascular diseases to refrain from drinking caffeine; however, studies have shown that drinking two to three cups a day has either no or some beneficial effects on both patients with or without cardiac disorders like arrhythmias. This article focuses on the effects of tea and coffee on the cardiovascular system as well as the potential mechanisms involved.

Typing skills of physicians in training.

BACKGROUND: There is an increasing use of electronic health records in hospitals across the United States. The speed and accuracy of residents in documenting electronic health records has been insufficiently addressed. METHODS: We studied resident typing skills at New York Methodist Hospital. Participating residents typed a standard 100-word alphanumerical paragraph of a patient's medical history. Typing skills were assessed by calculating the net words per minute (WPM). Typing skills were categorized as follows: (1) fewer than 26 net WPM as very slow; (2) 26 to 35 net WPM as slow; (3) 35 to 45 net WPM as intermediate; and (4) greater than 45 net WPM as fast. Residents were further categorized into (1) American medical graduates; (2) American international medical graduates; and (3) non-American international medical graduates. RESULTS: A total of 104 of 280 residents (37%) participated in the study. There was equal representation from various specialties, backgrounds, and all postgraduate levels of training. The median typing speed was 30.4 net WPM. Typing skills were very slow (34 of 104, 33%), slow (28 of 104, 27%), intermediate (29 of 104, 28%), and fast (13 of 104, 12%) among the residents. Typing skills of non-American international medical graduates (mean net WPM of 25.9) were significantly slower than those of American medical graduates (mean net WPM of 35.9) and American international medical graduates (mean net WPM of 33.5). CONCLUSIONS: Most residents (60%, 62 of 104) who participated in the study at our institute lacked typing skills. As the use of electronic health records increases, a lack of typing skills may impact residents' time for learning and patient care.