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BackgroundThe objective of this study was to assess the accessibility and content of the Accreditation Council for Graduate Medical Education (ACGME)-accredited general cardiology fellowship websites.MethodsUsing the online information provided by the Electronic Residency Application Services (ERAS), we compiled a list of ACGME-accredited cardiac fellowship programs. The program links on ERAS were evaluated followed by a standard Google search of the program name + “cardiology fellowship”. Each program website was evaluated on the basis of program content, applying/recruiting and education.ResultsAt the time of this study, we reviewed 231 general cardiology fellowship programs provided through ERAS. Of the 231 programs, 12 were excluded due to broken links, repeated links on ERAS, and websites with a general lack of content. We analyzed the data collected from the remaining 219 programs to assess the availability and general content of those websites. Data collected revealed a general lack of information regarding application processing and educational services but were sufficient in providing program descriptions and contact information.ConclusionsERAS can be used to locate general cardiology fellowships participating in the current match; however, the links provided by the program websites on ERAS are lacking in general content and accessibility. Although most websites did contain enough information about their program, there was a distinct lack of key information provided typically in the education services and application process.

Diabetic ketoacidosis (DKA) is a life-threatening metabolic emergency traditionally associated with Type 1 diabetes but is increasingly recognized in Type 2 diabetes, particularly with the use of sodium-glucose cotransporter-2 (SGLT-2) inhibitors. Euglycemic DKA, characterized by near-normal blood glucose levels, is a distinct variant that has gained attention. This case report highlights a unique presentation of euglycemic DKA in a 56-year-old female with a past medical history of Type 2 Diabetes Mellitus who presented to the emergency department with a one-week history of chest pain.

Lipid metabolism is critical to coordinate organ development and physiology in response to tissue-autonomous signals and environmental cues. Changes to the availability and signaling of lipid mediators can limit competitiveness, adaptation to environmental stressors, and augment pathological processes. Two classes of lipids, the N-acyl amides and the 2-acyl glycerols, have emerged as important signaling molecules in a wide range of species with important signaling properties, though most of what is known about their cellular functions is from mammalian models. Therefore, expanding available knowledge on the repertoire of these lipids in invertebrates will provide additional avenues of research aimed at elucidating biosynthetic, metabolic, and signaling properties of these molecules. Drosophila melanogaster is a commonly used organism to study intercellular communication, including the functions of bioactive lipids. However, limited information is available on the molecular identity of lipids with putative biological activities in Drosophila. Here, we used a targeted lipidomics approach to identify putative signaling lipids in third instar Drosophila larvae, possessing particularly large lipid mass in their fat body. We identified 2-linoleoyl glycerol, 2-oleoyl glycerol, and 45 N-acyl amides in larval tissues, and validated our findings by the comparative analysis of Oregon-RS, Canton-S and w1118 strains. Data here suggest that Drosophila represent another model system to use for the study of 2-acyl glycerol and N-acyl amide signaling.

Infective endocarditis (IE) is a rare but serious infection of the cardiac endothelium. This case report presents a rare instance of left-sided endocarditis in an immunocompetent patient without traditional risk factors for IE. endocarditis is uncommon and usually associated with specific factors. The patient in this case was a 30-year-old male with end-stage renal disease, receiving hemodialysis through a tunneled dialysis catheter, who developed a fever. Blood cultures confirmed as the causative agent, which prompted the administration of appropriate antibiotics and the removal of the catheter. However, subsequent imaging revealed significant damage to the mitral valve. Despite timely mitral valve replacement and aggressive medical treatment, the patient's condition worsened, and he ultimately succumbed to the infection. This case also emphasizes the necessity of timely diagnosis and intervention. In this patient, by the time it was diagnosed and managed, significant mitral valve damage had already occurred. Therefore, it should be considered a differential diagnosis even in patients with no risk factors and should be managed vigorously. endocarditis is associated with high mortality, and successful treatment often requires a combination of antipseudomonal antibiotics due to the organism's ability to develop resistance. Surgical intervention, such as valve replacement, is frequently necessary. This case underscores the importance of considering infection, even in patients without traditional risk factors for IE. Early diagnosis, appropriate antibiotic therapy, and timely surgical intervention are critical for improving outcomes in endocarditis cases.

Thyrotoxic periodic paralysis (TPP) is a form of hypokalemic periodic paralysis associated with hyperthyroidism. It is characterized by hypokalemia associated with acute proximal symmetrical lower limb weakness and can progress to involve all four limbs and the respiratory musculature. We present a case of a 27-year-old Asian male with recurrent attacks of weakness in all four extremities. A subsequent diagnosis of thyrotoxic periodic paralysis was made, which was secondary to a previously undiagnosed Grave's disease. TPP should be a differential in a young male of Asian ethnicity who presents to the hospital with acute onset of paralysis.

Key Clinical Message Immune checkpoint inhibitors can rarely lead to occurrence of myositis, myocarditis, and myasthenia gravis (MG). Early recognition and multidisciplinary management are crucial for optimal outcomes. Vigilance for overlapping toxicities is essential in patients receiving combination immunotherapy. The use of immune checkpoint inhibitors (ICIs) has revolutionized cancer treatment, but it is associated with immune‐related adverse events (IRAEs) affecting various organ systems. The simultaneous occurrence of MG, myocarditis, and myositis highlights the complex nature of IRAEs. Early recognition and comprehensive multidisciplinary management are crucial for optimal patient outcomes. We present a unique case report of a 76‐year‐old male patient with advanced melanoma who developed concurrent myositis, myocarditis, and MG while receiving combination immunotherapy with Nivolumab and Ipilimumab. This case underscores the significance of recognizing and addressing the “Terrible Triad” of IRAEs in patients receiving ICIs. Healthcare providers should maintain a high index of suspicion for overlapping toxicities and promptly initiate appropriate interventions.

The right-to-left shunt (RTLS) through a latent patent foramen ovale (PFO) is a rare complication of right ventricle myocardial infarction (MI). Though a rare complication, the development of refractory hypoxemia after right ventricular MI should always alert clinicians to consider the possibility of shunting across PFO. Right-sided Impella (Impella RP) can be considered in such patients, which helps to decrease the elevated right heart pressure reducing the shunt, thereby providing a bridge to recovery.

Key Clinical Message Chronic ketamine use can lead to sphincter of oddi dysfunction (SOD), causing various hepatobiliary complications. Recognizing substance abuse history is vital for early detection. Timely intervention can prevent irreversible liver and pancreas damage. Ketamine is commonly abused as a recreational drug worldwide due to its ability to induce euphoria‐like effects. Ketamine abuse is associated with many hepatobiliary side effects ranging from cholestasis to biliary sepsis and death. Here we present a case of a young 29‐year female with upper abdominal pain due to SOD resulting from chronic use of ketamine. SOD can result in obstruction or dysfunction of the bile and pancreatic ducts. Ketamine induces SOD by activation of the muscarinic receptors in the sphincter of oddi. Detail history of substance abuse is crucial for early identification of ketamine‐induced SOD. Early identification and treatment of this rare condition can prevent permanent injury to the liver and pancreas. ERCP showing obstructive cholangiogram.

Brugada syndrome is an aberrant ST-segment elevation in the right precordial leads. It can progress into sudden cardiac death (SCD) among patients with structurally normal hearts. Most patients are asymptomatic at presentation, but those who develop symptoms can present with syncope due to other arrhythmias such as ventricular tachycardia or fibrillation. Early diagnosis and appropriate management can prevent future complications in patients with a significant family history.

Key Clinical Message Granulomatosis with polyangiitis (GPA), formerly known as Wegener's granulomatosis, is a necrotizing vasculitis characterized by small‐to‐medium‐sized vessel involvement and the presence of antineutrophil cytoplasmic antibodies (ANCA). We present a case of a 26‐year‐old Asian woman who was transferred to our center from a nearby hospital, where she presented with shortness of breath, tested positive for COVID‐19, and was being managed for COVID‐19 pneumonia. She also had hemoptysis, skin lesions, and left foot numbness. Serological markers and VATS‐guided lung biopsy confirmed the diagnosis. Treatment with methylprednisolone and rituximab led to stabilization, despite complications of subcutaneous emphysema and lower extremity neuropathic symptoms. Early recognition and appropriate management of GPA are crucial for optimal outcomes. In this unique case report, we present a 26‐year‐old Asian female initially diagnosed with COVID‐19 pneumonia who was ultimately found to have Granulomatosis with Polyangiitis (GPA). Despite her young age and COVID‐19‐like symptoms, further evaluation, including serological markers and VATS‐guided lung biopsy, confirmed the GPA diagnosis. Treatment with methylprednisolone and rituximab led to stabilization, emphasizing the importance of considering GPA in the differential diagnosis, even in younger individuals presenting with respiratory symptoms suggestive of COVID‐19. Early recognition and appropriate management of GPA are crucial for optimal outcomes.