Cutaneous sporotrichosis is a fungal infection caused by traumatic inoculation of Sporothrix. We aimed to study the clinical characteristics of human sporotrichosis, risk factors for infection, the yield of diagnostic methods and therapeutic response to standard clinical therapy. A cohort study of was performed. A total of 29 patients with clinical features suggestive of sporotrichosis were recruited within a one-year period from all public hospitals in Kedah, Malaysia. Majority were females (86%) who were housewives (69%). The most common comorbidities were diabetes mellitus (38%), hypertension (31%) and dyslipidaemia (21%), none was a significant risk factor for severity of infection. Mean duration of disease was 2±2 months. More than 2/3 of the patients (79%) had pet cats, 14(48%) recalled minor cat-inflicted trauma. Lymphocutaneous sporotrichosis (62%) was more common than fixed cutaneous type, affecting the upper limbs in 94%. Ulcerations and nodules were the main lesion morphology. Histopathology showed granulomatous inflammation in 72%, culture grew Sprorothrix in 55% and polymerase chain reaction (PCR) detected Sporothrix schenkii sensu stricto in 65%. Itraconazole was effective with 93% of patients achieving complete resolution with 4 months of therapy. Sporotrichosis in Malaysia remains endemic. Feline contact is the most important risk factor for infection. Diagnosis is best confirmed with tissue PCR while culture and histopathology are also useful. Sporothrix schenkii sensu stricto was the only species identified and itraconazole is an effective first line therapeutic agent.

Purpose: This study aimed to report a series of cases of cytomegalovirus retinitis reactivation in immunocompromised patients, focusing on the characteristic clinical and laboratory findings associated with reactivation.Case summary: We retrospectively reviewed the medical records of patients diagnosed with cytomegalovirus retinitis at our clinic between January 2012 and November 2023. We analyzed ophthalmologic clinical findings and diagnostic test results, including quantitative cytomegalovirus polymerase chain reaction (CMV PCR). Reactivation was defined as the resolution or stabilization of the overall lesions on fundus examination, followed by the identification of new retinitis or vitreitis findings. The analysis excluded patients with cytomegalovirus retinitis resistant to ganciclovir or foscarnet. Among 24 patients (34 eyes) treated for cytomegalovirus retinitis, four showed reactivation, and the remaining 20 patients showed improvement with initial treatment. Recurrence occurred at an average of 24.8 days (18–35) after discontinuation of ganciclovir maintenance treatment, and in all cases, new lesions were discovered at the border of existing lesions. The CMV PCR test value tended to increase an average of 8 days (4–14) before recurrence was observed on fundus examination, and declined absolute neutrophil count preceded the increase in CMV PCR by an average of 12.8 days (6–26). Conclusions Monitoring quantitative CMV PCR tests in immunocompromised patients with cytomegalovirus retinitis could be helpful in predicting reactivation.

Purpose: The aim of this study was to summarize the clinical characteristics and outcomes of patients with ocular chemical injury by analyzing their medical records from January 2018 to December 2023. Methods: This study involved a retrospective review of patient data, including age, sex, season, location of ocular chemical injury, causative agents (properties, pH values), initial and final ocular findings including visual acuity and intraocular pressure, distribution and severity of chemical injury, management methods, and complications. Results: A total of 218 patients were included in this study. Most patients were aged between 27 and 56 years. The most common ocular injury setting, season, severity classifications, causative chemical agent, management method, and complications were domestic households, summer and winter, grade I, acidic substance, medical treatment, and no complications, respectively. Conclusions We evaluated the clinical characteristics and outcomes of patients with ocular chemical injuries in Incheon, South Korea. Despite societal changes and widespread safety education, ocular chemical injuries still occur owing to various substances and situations. Therefore, self-protection and comprehensive educational programs should be encouraged to prevent ocular chemical damage.

Purpose: To assess the effect of posterior strut removal during orbital decompression on exophthalmos reduction and strabismus outcomes in patients with Graves’ orbitopathy (GO). Methods: This retrospective analysis was conducted using the medical records of patients with GO who underwent balanced orbital decompression, balanced orbital decompression with posterior strut removal, or three-wall orbital decompression with strut removal. The preoperative and postoperative exophthalmos measurements were compared to evaluate the efficacy of strut removal in reducing exophthalmos. Patients were further divided into three groups based on the posterior strut removal status (none, unilateral, or bilateral) to evaluate changes in esotropia and vertical strabismus before and after surgery. Results: This study included 61 patients (101 eyes). Balanced orbital decompression was performed in 42 eyes, balanced orbital decompression with posterior strut removal was performed in 14, and three-wall orbital decompression was performed in 45 eyes. The average postoperative exophthalmos reduction was 4.20 ± 0.25 mm in the balanced orbital decompression group, 4.92 ± 0.29 mm in the balanced orbital decompression with posterior strut removal group, and 5.62 ± 0.58 mm in the three-wall orbital decompression group. The reductions in the balanced orbital decompression with posterior strut removal and three-wall orbital decompression groups were statistically significant compared to those in patients who only underwent balanced orbital decompression. The most notable increase in esotropia was observed in the unilateral strut removal group (2.00 ± 1.32 diopters), although this difference was not statistically significant compared to those in other groups. Furthermore, no significant differences in vertical strabismus were observed among the three groups, with a tendency towards reduced strabismus in the bilateral strut removal group. Conclusions Posterior strut removal during orbital decompression surgery resulted in a significant improvement in exophthalmos, with no significant effect on strabismus.

A 65-year-old male presented with chest pain that occurred after alcohol drinking at the early morning hours and relieved after taking sublingual nitroglycerin. Coronary angiography revealed a malformed left main coronary artery (LMCA) originating from the right sinus of Valsalva with 10%–20% stenosis and 80% vasospasm. Coronary artery spasm (CAS) in the LMCA is extremely rare but can present with catastrophic features. CAS is more frequently observed in atherosclerotic segments of coronary arteries, and multidetector computed tomography is preferred for assessing the degree of atherosclerosis in cases of LMCA spasm. Anomalous origin of coronary arteries (AOCA) is also rare but can lead to severe symptoms. Although surgical intervention is generally recommended for symptomatic patients, while management of asymptomatic cases remains a topic of ongoing research and debated. In this case, there was concern that the patient’s symptoms might be attributable to AOCA or CAS, medical management was selected over surgical intervention, given the presentation consistent with typical angina due to spasm.

Objective: Patients with severe symptomatic aortic stenosis are assessed for coronary artery disease (CAD) prior to transcatheter aortic valve implantation (TAVI) with treatment implications. Invasive coronary angiography (ICA) is the recommended modality but is associated with peri-procedural complications. Integrating machine learning (ML)-based computed tomography-derived fractional flow reserve (CT-FFR) into existing TAVI-planning CT protocol may aid exclusion of significant CAD and thus avoiding ICA in selected patients. Materials and Methods: A single-center, retrospective study was conducted, 41 TAVI candidates with both TAVI-planning CT and ICA performed were analyzed. CT datasets were evaluated by a ML-based CT-FFR software. Beta-blocker and nitroglycerin were not administered in these patients. The primary outcome was to identify significant CAD. The diagnostic performance of CT-FFR was compared against ICA. Results: On per-patient level, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were 89%, 94%, 80%, 97% and 93%, respectively. On per-vessel level, the sensitivity, specificity, PPV, NPV and diagnostic accuracy were 75%, 94%, 67%, 96% and 92%, respectively. The area under the receiver operative characteristics curve per individual coronary vessels yielded overall 0.90 (95% confidence interval 85%–95%). ICA may be avoided in up to 80% of patients if CT-FFR results were negative. Conclusion ML-based CT-FFR can provide accurate screening capabilities for significant CAD thus avoiding ICA. Its integration to existing TAVI-planning CT is feasible with the potential of improving the safety and efficiency of pre-TAVI CAD assessment.

Background: The impact of weight or weight changes on kidney function remains a matter of debate. This study aimed to investigate the association between weight fluctuation and the incidence of end-stage renal disease (ESRD) using data from the Korean National Health Insurance Corporation health checkups (2009–2015). Methods: The study included 2,310,667 participants (1,546,749 men and 763,918 women), aged ≥40 years. Weight fluctuation was assessed using the average real variability (ARV) of weight and categorized into quartiles (Q1–Q4). Hazard ratios (HRs) and 95% confidence intervals for ESRD incidence were calculated using multivariable Cox proportional hazards models. Results: After adjustment for comorbidities, increased body mass index was associated with a decreased HR for ESRD. The highest quartile of weight variability (ARV Q4) demonstrated a higher probability and HR for ESRD compared to the lower variability quartiles (Q1–Q3). Among men, individuals with sustained weight, and those with weight gain, the ARV Q4 group showed significantly increased HRs for ESRD (HR of 1.372, 1.222, and 1.49, respectively). Furthermore, irrespective of changes in creatinine levels, all ARV Q4 groups exhibited increased HRs for ESRD (HR of 1.342, 1.472, and 1.299, respectively). Conclusions High weight fluctuation (ARV Q4) was associated with an increased incidence of ESRD in the general Korean population, with notable significance in men and in groups with sustained or increased weight. Clinically, individuals in the ARV Q4 category should be considered at risk for ESRD, and early interventions should be pursued for this population.

Nonalcoholic fatty liver disease (NAFLD) and heart failure with preserved ejection fraction (HFpEF) are two increasingly prevalent conditions that share common risk factors, including obesity, diabetes, and aging. NAFLD, marked by hepatic steatosis, is a leading cause of liver disease globally, with cardiovascular disease accounting for most deaths among those affected. HFpEF, characterized by diastolic dysfunction and systemic inflammation, accounts for a growing share of heart failure cases, especially among older adults. The bidirectional relationship between NAFLD and HFpEF involves shared mechanisms such as systemic inflammation, insulin resistance, and metabolic dysfunction. These overlapping processes create a vicious cycle that exacerbates each condition. This review emphasizes the shared pathophysiology, risk factors, and management strategies for these interconnected diseases. Promising interventions, including exercise, weight loss, and emerging pharmacological treatments like sodium-glucose cotransporter 2 inhibitors, are effective in addressing both NAFLD and HFpEF. By targeting these common pathways, there is a unique opportunity to develop integrated treatment approaches that could improve outcomes for affected patients.

Background and Objectives: Acute decompensated heart failure (ADHF) often necessitates invasive mechanical ventilation (MV) due to respiratory failure. Positive end-expiratory pressure (PEEP) is a critical component in MV management; however, the optimal PEEP level for patients with ADHF remains unclear. The High vErsus Low Positive end-expiratory pressure in mechanically ventilated patients with Acute Heart Failure (HELP-AHF) trial is a multicenter, open-label, randomized controlled study designed to compare the efficacy and safety of high versus low PEEP strategies in this population. Methods: A total of 120 patients with ADHF requiring MV within 24 hours of initiation will be randomized 1:1 to a high PEEP group (target: 10 cmH2 O) or a low PEEP group (target: 3 cmH2 O). Results: The primary outcome is ventilator-free days at day 28. Key secondary outcomes include in-hospital mortality, duration of intensive care unit and hospital stay, vasoactive-inotropic support, and rates of heart transplantation or left ventricular assist device implantation. Safety outcomes include hemodynamic instability requiring mechanical circulatory support, pulmonary complications, and weaning-related adverse events. Conclusions This HELP-AHF trial aims to provide valuable insights into optimal PEEP strategies in ADHF patients receiving invasive MV. Findings from this study have the potential to inform ventilatory management practices and improve outcomes in this high-risk population.