In spite of there being several case reports, coronary stent fracture is not a well-recognized entity and incidence rates are likely to be underestimated. In this article, we review different aspects of stent fracture, including incidence, classification, predictors, outcome, diagnosis, and management.

Background: Awareness of risks associated with radiation exposure to patients and medical

Background: Combined oral contraceptive pills are associated with an established risk for venous thrombosis; however, their risk for arterial thrombosis remains uncertain, especially with the development of low dose new generations of combined oral contraceptive. Arterial thrombosis is less likely to occur with the use of oral contraceptive pills in the absence of cardiovascular risk factors. Case presentation: We report a 35-year old female with no cardiovascular risk factors who presented with thrombotic anterior wall myocardial infarction 6 months after using a third generation low dose combined oral contraceptive pills (Marvelon; ethinylestradiol 30 mcg and desogestrel 150 mcg). Conclusion: Third generation low dose combined oral contraceptives may lead to myocardial infarction in young women, even in the absence of other cardiovascular risk factors.

In 1992, the Brugada brothers published a patient series of aborted sudden death, who were successfully resuscitated from ventricular fibrillation (VF). These patients had a characteristic coved ST-segment elevation in the right precordial leads on their 12-lead electrocardiogram with no apparent structural heart abnormality. This disease was referred to as “right bundle branch block, persistent ST-segment elevation, and sudden death syndrome.” The term Brugada syndrome (BrS) was first coined for this new arrhythmogenic entity in 1996. BrS is more prevalent in Southeast Asian ethnic groups and was considered a familial disease due to the presence of syncope and/or sudden deaths in several members of the same family, however, the genetic alteration was only noted in 1998. The genetic characterization of BrS has proven to be challenging. The most common and well-established BrS genotype involves loss-of-function mutations in the SCN5A gene, but only represents between 15% and 30% of the diagnosed patients. Patients with BrS can present with a range of symptoms which can include syncope, seizures, and nocturnal agonal breathing due to polymorphic ventricular tachycardia or VF. If these arrhythmias are sustained, sudden cardiac death may result. Despite the significant progress on the understanding of BrS over the last two decades, there remain a number of uncertainties and challenges; we present an update review on the subject.

Colorectal cancer (CRC) is a global burden, with an expected 2.2 million annual cases and 1.1 million deaths by 2030. Nearly 90% of CRC cases occur in people over the age of 50. However, early onset (<50 years) of CRC is increasing in Egypt. Prior studies suggest that alteration in microbiome composition (dysbiosis) disturbs the symbiotic relationship between the colorectum and resident micro-organisms and promotes CRC. We hypothesize that, for Egyptians, microbiome dysbiosis is responsible for early-onset of CRC. We further hypothesize that there is cross-talk between the microbiome, tumor molecular features, and the immune microenvironment. Thus, we investigated the molecular profiling of these patients via integrated transcriptional-microbiome analysis. We assessed the colonic microbiota and the expression of specific host response genes in normal colonic mucosal samples from 8 healthy individuals and samples from 20 Egyptian CRC patients. A retrospective convenience sample design was employed. Colonoscopy was performed on these patients at Alexandria University Hospital, Alexandria, Egypt. Microbiota composition was determined by 16S rRNA amplicon sequencing. A panel of 784 genes involved in tumor, microenvironment, and immune response were used to characterize differential expression across patient groups by the Nanostring method. This panel facilitates the estimation of immune cell abundance for 15 tumor-infiltrating immune cell types. Differential abundance and cross-talk between the relative abundance of microbiota and tumor RNA expression were evaluated using negative binomial model fitting and Wald statistics. One third of our CRC patient population was under 50 years old at the time of diagnosis with CRC, and most were female. Healthy controls were even younger than CRC cases, and most were females. There were differences in relative abundances of bacteria between healthy controls and those with CRCs. Analysis showed a low abundance of Mitsuokella multacida, a short-chain fatty acid (SCFA)-producing bacterium, in CRC patients when compared to healthy individuals. In particular, this trend was evident for older CRC patients (≥ 50 years); of note, this bacterium was absent in younger patients (<50 years) (adj. p-value = 0.01). Further, there was a high abundance of Fusobacterium nucleatum in all CRC patients compared to healthy individuals (adj. p-value = 0.04). In cross-talk analysis for healthy controls, elevated abundance of M. multacida was inversely associated with macrophage abundance (global p-value =0.055).For Egyptian patients, the absence of SCFA-producing multacida in younger patients may be a reason for early onset of CRC. These findings suggest that the oncoprotective effect of Mitsuokella multacida should be further investigated. These studies are supported by the US-Egypt STDF grants (NAS 2000007148 and 144/17) and the Impact funds of University of Alabama at Birmingham. Citation Format: Amr Elkholy, Michael Behring, Mohammed Mohsen, Prachi Bajpai, Amira Embaby, Doaa Header, Reham Abo Elwafa, Hesham Saeed, Mona Fouad, Waleed Arafat, Upender Manne. Absence of Mitsuokella multacida is associated with early onset of colorectal cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 6103.

A 46-year-old female presented with a 20-day history of right pleuritic chest pain and progressive shortness of breath. She was found to have a right pleural based malignancy initially thought to be a malignant mesothelioma but staining with the mesothelioma tumor markers calretinin, HBME-1 and CK5/6, was negative. Some epithelial markers were positive and microscopically it was consistent with a poorly differentiated large-cell carcinoma. The case was diagnosed as a pseudomesotheliomatous lung carcinoma of poorly differentiated large-cell type.

A 39-year-old woman was admitted with right leg deep venous thrombosis (DVT). She was started on apixaban tablets but developed pulmonary embolism. The medical history showed sleeve gastrectomy. The failure of the antithrombotic drug shed light on the efficacy and pharmacodynamic changes of DOACs after bariatric surgery Old is gold, sometimes! Apixaban after Bariatric Surgery

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