Lactation and Progression to Type 2 Diabetes Mellitus After Gestational Diabetes Mellitus

Screening for Abnormal Blood Glucose and Type 2 Diabetes Mellitus

Screening for Abnormal Blood Glucose and Type 2 Diabetes Mellitus

Diet and Physical Activity Promotion Programs to Prevent Type 2 Diabetes

Diet and Physical Activity Promotion Programs to Prevent Type 2 Diabetes

In adults with overweight or obesity and CVD, but without diabetes, semaglutide reduced MACE at a mean 40 mo

Source Citation Lincoff AM, Brown-Frandsen K, Colhoun HM, et al; SELECT Trial Investigators. Semaglutide and cardiovascular outcomes in obesity without diabetes. N Engl J Med. 2023;389:2221-2232. 37952131

In adults with BMI ≥27 kg/m2 and type 2 diabetes, adding tirzepatide to a lifestyle intervention increased weight loss at 72 wk

Source Citation Garvey WT, Frias JP, Jastreboff AM, et al; SURMOUNT-2 investigators. Tirzepatide once weekly for the treatment of obesity in people with type 2 diabetes (SURMOUNT-2): a double-blind, randomised, multicentre, placebo-controlled, phase 3 trial. Lancet. 2023;402:613-626. 37385275

In patients with type 2 diabetes or HF, SGLT2 inhibitors reduce gout-related outcomes

Source Citation Banerjee M, Pal R, Maisnam I, et al. Serum uric acid lowering and effects of sodium–glucose cotransporter-2 inhibitors on gout: a meta-analysis and meta-regression of randomized controlled trials. Diabetes Obes Metab. 2023;25:2697-2703. 37334516

In obesity or overweight without diabetes, orforglipron increased weight loss at 26 wk

Source Citation Wharton S, Blevins T, Connery L, et al; GZGI investigators. Daily oral GLP-1 receptor agonist orforglipron for adults with obesity. N Engl J Med. 2023;389:877-880. 37351564

In type 2 diabetes, weekly basal insulin Fc was noninferior to daily insulin degludec for HbA1c at 26 wk

Source Citation Bue-Valleskey JM, Kazda CM, Ma C, et al. Once-weekly basal insulin Fc demonstrated similar glycemic control to once-daily insulin degludec in insulin-naive patients with type 2 diabetes: a phase 2 randomized control trial. Diabetes Care. 2023;46:1060-1067. 36944059

Targetable Immune Dysregulation in a Patient With Heart Failure: Cardiovascular Manifestations of CTLA-4 Deficiency Improve With Evolocumab | Annals of Internal Medicine: Clinical Cases

We report the case of a 76-year-old man with germline CTLA-4 deficiency manifesting as multivessel coronary artery disease, heart failure with mid-range ejection fraction, and an aortic root aneurysm. New York Heart Association (NYHA) class 3 functional limitation was disproportionate to ischemic burden despite guideline-directed medical therapy. Statin intolerance prompted initiation of evolocumab, a PCSK9 inhibitor. Within 3 weeks, the patient's symptoms improved to NYHA class 1, suggesting a rapid immunomodulatory effect. This case illustrates targetable cardiomyopathy mediated by CTLA-4 deficiency, supports exploring PCSK9 inhibition for the management of immune-driven heart failure, and emphasizes genetic evaluation in unexplained cardiomyopathy.

Mad Honey Mimicking Acute Coronary Syndrome | Annals of Internal Medicine: Clinical Cases

A 56-year-old Nepalese man presented to the hospital with syncope, bradycardia, and hypotension. Throughout his admission, he was hemodynamically unstable, with associated electrocardiographic changes and fluctuations in consciousness. This followed the unintentional overdose of the traditional medicine “mad honey” containing grayanotoxins with hallucinogenic properties. Following treatment with an anticholinergic infusion, he made a full recovery within 48 hours. This case underlines the importance of considering atypical causes for presentations such as bradycardia and hypotension, especially in patients from cultures where mad honey usage is common, and highlights the potential adverse events of this traditional medicine to be life-threatening.

The Mystery of Dropped Gallstones: A Case Series and Review of the Literature | Annals of Internal Medicine: Clinical Cases

Laparoscopic cholecystectomy (LC) is the gold standard general surgical procedure for symptomatic gallbladder (GB) disease. The 2 most common complications of LC are GB perforation and dropped gallstones (DGs). Dropped gallstones mostly stay asymptomatic but can rarely serve as a nidus for infection with delayed formation of abscesses, granulomas, and fistulas after many years. We describe a case series of 2 patients with abdominal abscesses and fistula formation from symptomatic retained DGs presenting many years later as a delayed complication of LC.

Double Coronary–Cameral Fistula: Right Coronary Artery and Circumflex to Left Atrium | Annals of Internal Medicine: Clinical Cases

Coronary fistulas are an abnormal communication of the coronary arteries with the cardiac chambers or any vascular structure. Most are detected incidentally. Transthoracic echocardiogram is essential for evaluation, coronary computed tomography angiography can be useful in planning the procedure, allowing excellent anatomical delineation, and cardiac magnetic resonance imaging can help to outline the anatomy; however, the gold standard is coronary angiography. Treatment can be pharmacologic, surgical, or transcatheter. We present the case of a 71-year-old woman with angina and dyspnea in whom the diagnostic approach demonstrated the presence of coronary–cameral fistulas for which pharmacologic management was decided.

Pain as a Clinical Presentation of Osteopoikilosis | Annals of Internal Medicine: Clinical Cases

Osteopoikilosis, or disseminated condensing osteopathy, is an osteosclerosing dysplasia that is a rare genetic disorder of autosomal-dominant genetic transmission, and recent research suggests that the possible cause of osteopoikilosis might be the loss of function of the LEM domain-containing gene 3 (LEMD3). We describe the case of a young man with arm pain associated with increased volume, functional limitation, and fever who presented to the emergency department. Radiographic and magnetic resonance images are provided, which reveal bilateral periarticular osteosclerotic lesions in the pelvis, humeral head, and scapular region, showing no signs of malignancy.

Tacrolimus Toxicity in Two Renal Transplant Recipients Treated With Nirmatrelvir/Ritonavir: A Case Series | Annals of Internal Medicine: Clinical Cases

Since the onset of the SARS-CoV-2 (COVID-19) pandemic, significant effort has been devoted toward developing therapeutics that decrease the morbidity and mortality of COVID-19 infection. The antiviral nirmatrelvir/ritonavir (Paxlovid) has shown success in reducing hospitalization and death in patients with mild-to-moderate COVID-19 infection. However, enthusiasm over nirmatrelvir/ritonavir's ability has been met with caution as the result of potential drug–drug interactions. Here, we present 2 cases of tacrolimus toxicity, both in renal transplant recipients, following nirmatrelvir/ritonavir use. These cases are significant because, although the potential for pharmacologic interactions with nirmatrelvir/ritonavir is known, few cases of actual harm have been documented.

Left-Sided Acute Appendicitis With Situs Inversus Totalis | Annals of Internal Medicine: Clinical Cases

Left-sided appendicitis is difficult to diagnose, but a delayed diagnosis may have a fatal outcome. We describe a patient case of acute appendicitis with situs inversus totalis and left lower quadrant abdominal pain. Unexpected faint heart sounds in their typical location and chest radiograph demonstrating dextrocardia prompted the suspicion of situs inversus totalis and left-sided appendicitis.

Widespread Coronary Aneurysm Formation Due to Hypereosinophilic Vasculitis | Annals of Internal Medicine: Clinical Cases

Hypereosinophilic vasculitis, a variant of eosinophilic granulomatosis with polyangiitis, affects small- and medium-sized arteries. Cardiac involvement may manifest as heart failure, pericarditis, or valvular insufficiency (1, 2). Eosinophilia affects the endothelium and microvasculature, leading to thrombosis and fibrosis involving the endocardium and valves (3). Coronary artery aneurysms due to hypereosinophilia are extremely rare and have been reported sparsely in the literature (4, 5). Here, we describe a patient with hypereosinophilic vasculitis and widespread coronary artery aneurysms.

Incidentally Detected Chronic Left Ventricular Pseudoaneurysm After Subacute Inferior–Posterior Myocardial Infarction | Annals of Internal Medicine: Clinical Cases

We describe a 69-year-old man with subacute inferior myocardial infarction who had surgical repair for a left ventricular (LV) pseudoaneurysm incidentally detected by routine 6-month follow-up echocardiography. Although LV pseudoaneurysm is a rare complication after myocardial infarction, the delayed diagnosis and management can cause adverse patient outcomes. The present case suggests that patients with multiple risk factors for LV pseudoaneurysms, including advanced age, late presentation, and delayed revascularization, should receive intensive blood pressure control and closer examination using a multimodal imaging approach for early detection of aneurysmal formation and complications.

Vasculitis After a Vaccine: Rare Adverse Reaction Following a COVID-19 Vaccine | Annals of Internal Medicine: Clinical Cases

Fatigue, fever, localized soreness, urticaria, and rash are common adverse reactions of COVID-19 vaccines. However, the occurrence of serious autoimmune reactions is quite rare. Cutaneous small-vessel vasculitis is an autoimmune disorder that manifests with palpable purpura and petechiae involving extremities. It results from neutrophilic inflammation within and around dermal vessels and is usually self-limited. We report a 55-year-old woman presenting with a rash 48 hours after receiving the third (Moderna) COVID-19 vaccine dose. Blood investigations and a skin punch biopsy confirmed the diagnosis of COVID-19 vaccine–induced cutaneous small-vessel vasculitis. The patient ultimately improved after inpatient treatment with systemic steroids.