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Displaying 131 - 140 of 1949 in Annals of Internal Medicine
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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
In type 1 diabetes, weekly basal insulin Fc was noninferior to daily insulin degludec for HbA1c at 26 wk
Source Citation Kazda CM, Bue-Valleskey JM, Chien J, et al. Novel once-weekly basal insulin Fc achieved similar glycemic control with a safety profile comparable to insulin degludec in patients with type 1 diabetes. Diabetes Care. 2023;46:1052-1059. 36920867
In prediabetes, oral vitamin D reduces progression to new-onset diabetes
Source Citation Pittas AG, Kawahara T, Jorde R, et al. Vitamin D and risk for type 2 diabetes in people with prediabetes: a systematic review and meta-analysis of individual participant data from 3 randomized clinical trials. Ann Intern Med. 2023;176:355-363. 36745886
KDIGO provided recommendations on SGLT2 inhibitors and nonsteroidal MRAs in patients with diabetes and CKD
Source Citation Navaneethan SD, Zoungas S, Caramori ML, et al. Diabetes management in chronic kidney disease: synopsis of the KDIGO 2022 clinical practice guideline update. Ann Intern Med. 2023;176:381-387. 36623286
SGLT2 inhibitors reduce adverse renal and CV outcomes in patients with or without diabetes
Source Citation Nuffield Department of Population Health Renal Studies Group; SGLT2 inhibitor Meta-Analysis Cardio-Renal Trialists' Consortium. Impact of diabetes on the effects of sodium glucose co-transporter-2 inhibitors on kidney outcomes: collaborative meta-analysis of large placebo-controlled trials. Lancet. 2022;400:1788-801. 36351458
In type 2 diabetes, the BT-001 smartphone app reduced HbA1c more than a control app at 90 d
Source Citation Hsia J, Guthrie NL, Lupinacci P, et al. Randomized, controlled trial of a digital behavioral therapeutic application to improve glycemic control in adults with type 2 diabetes. Diabetes Care. 2022;45:2976-81. 36181554
In type 2 diabetes, liraglutide reduced CV events at 5 y vs. glargine, glimepiride, or sitagliptin
Source Citation GRADE Study Research Group; Nathan DM, Lachin JM, Buse JB, et al. Glycemia reduction in type 2 diabetes—microvascular and cardiovascular outcomes. N Engl J Med. 2022;387:1075-88. 36129997
In type 2 diabetes, glargine and liraglutide each improved glycemic outcomes at 5 y vs. glimepiride or sitagliptin
Source Citation GRADE Study Research Group; Nathan DM, Lachin JM, Balasubramanyam A, et al. Glycemia reduction in type 2 diabetes—glycemic outcomes. N Engl J Med. 2022;387:1063-74. 36129996
Displaying 131 - 140 of 142 in Annals of Internal Medicine: Clinical Cases
Multiple Hepatosplenic Abscesses From an Uncommon Pathogen in a Patient With Acute Promyelocytic Leukemia | Annals of Internal Medicine: Clinical Cases
We report a patient case of Magnusiomyces capitatus fungemia with multiple hepatosplenic abscesses. Magnusiomyces spp. are rare but emerging, opportunistic fungal pathogens causing potentially lethal invasive disease, especially in patients with neutropenia secondary to chemotherapy for a hematologic malignancy. Given the frequent use of echinocandins as empirical therapy for febrile neutropenia, extra caution should be exercised if culture results indicate the presence of a yeast other than Candida species.
Physical Examination Manifestations of Aortic Insufficiency | Annals of Internal Medicine: Clinical Cases
The eponyms of aortic regurgitation are well recognized, yet their diagnostic accuracy remains poor. Nevertheless, they remain part of the medical nomenclature, highlight the importance of the physical examination, and provide a historical lens to a disease in the age before more modern technology.
A Case of Spontaneous Isolated Superior Mesenteric Artery Dissection in a Patient With Celiacomesenteric Trunk Anomaly | Annals of Internal Medicine: Clinical Cases
Celiacomesentric trunk (CMT) is a rare vascular anomaly with a common origin for the celiac artery and superior mesenteric artery. To our knowledge, this is the first case of superior mesenteric artery (SMA) dissection in patients with CMT. Here, we discuss a case of a 65-year-old male with acute-onset epigastric pain who was found to have SMA dissection with CMT. He was treated conservatively with symptomatic improvement. Diagnostic imaging studies include computed tomography (CT) scanning of the abdomen with or without contrast and CT angiography. Management options include a conservative approach, endovascular repair, and surgical management based on the classification/location of the dissection.
Bouveret Syndrome: Rare but Quite Impactful | Annals of Internal Medicine: Clinical Cases
Bouveret syndrome is a rare cause of gastric outlet obstruction that arises from a gallstone passing through a choledochoduodenal fistula. It remains poorly understood and is frequently misdiagnosed. We describe a case in which a patient was successfully treated for Bouveret syndrome. The patient presented with recurrent abdominal pain, anorexia, and intractable nausea and vomiting. Esophagogastroduodenoscopy revealed a large, affected stone in the proximal duodenum. The stone was removed via exploratory laparotomy, and the patient was discharged with a prescription for ursodiol. This case aims to serve as a guide to physicians in the early identification of Bouveret syndrome.
Laryngeal Histoplasmosis in an Immunocompromised Host | Annals of Internal Medicine: Clinical Cases
Laryngeal histoplasmosis is a rare manifestation of histoplasmosis infection and presents as a diagnostic challenge. It has been documented to occur in immunocompromised and immunocompetent hosts. This is a case of laryngeal histoplasmosis in a patient with idiopathic CD4 lymphocytopenia, an immunocompromising condition that presents similarly to HIV. There is no known cause or standardized treatment of idiopathic CD4 lymphocytopenia, which leaves patients at risk for opportunistic infections and malignancy.
Giant Coronary Artery Aneurysm After Breast Radiation in a Patient With Congenital Coronary Arteriovenous Fistula | Annals of Internal Medicine: Clinical Cases
An 84-year-old Hispanic woman with medical history of coronary artery disease, hypertension, breast cancer, and left circumflex coronary artery ectasia with arteriovenous fistula to the coronary sinus was found with a new giant obtuse marginal 1 (OM1) saccular aneurysm measuring 8.4 × 6.5 cm on gated computed tomography angiogram 15 years after the first coronary angiogram. Coronary artery aneurysms are unusual anomalies that are encountered in 0.3% to 4.9% of patients who undergo coronary angiography. The incidence of giant coronary artery aneurysm is reported at 0.02% and we are not aware of any reports of OM1. Here, we report an extremely rare case of a OM1 giant coronary artery aneurysm.
Eosinophilic Fasciitis: Clinical Signs Leading to Diagnosis | Annals of Internal Medicine: Clinical Cases
Eosinophilic fasciitis is a rare disease characterized by peripheral eosinophilia and inflammatory infiltrate on muscular fascia and subcutaneous tissue. Patients present with edema and stiffening of limbs, progressing rapidly to fibrosis. The Groove sign is a classical physical examination finding. A skin–fascia–muscle biopsy is the gold standard for diagnosis, but nuclear magnetic resonance imaging is also useful. Glucocorticoids in high doses are the initial treatment of choice. We report the patient case of a 22-year-old man with expressive eosinophilia and whose clinical findings (Groove sign and others) led to the diagnosis.
Acute Localized Abdominal Pain From Primary Epiploic Appendagitis | Annals of Internal Medicine: Clinical Cases
This report describes primary epiploic appendagitis in a 40-year-old man. He had the classic physical finding of highly localized abdominal pain and the classic computed tomography findings of a hyperattenuating ring sign and a central dot sign.
Antibiotic and Surgical Treatment of a Ventriculoperitoneal Shunt-Related Soft Tissue Abscess Caused by Brucella melitensis | Annals of Internal Medicine: Clinical Cases
We report on the antibiotic and surgical treatment of a woman who presented with an abscess caused by Brucella melitensis related to a ventriculoperitoneal shunt, which is an atypical presentation of brucellosis. There were no signs of neurologic, osteoarticular, or peritoneal infection. The abscess initially healed after ultrasound-guided drainage and antibiotic treatment with gentamycin/doxycycline for 5 days, followed by doxycycline/ciprofloxacin for 8 weeks, allowing shunt preservation. Three months after treatment ended, however, a relapse occurred that required partial surgical shunt revision and readministration of antibiotics. Seven months after surgery and 12 months after the initial diagnosis, the patient's remission status has been maintained.
An Unusual Case of an Incidentally Detected Angioplasty Wire in the Aorta | Annals of Internal Medicine: Clinical Cases
A retained angioplasty wire is rarely described, and there are no guidelines as to how it should be managed. Thus the management of this complication remains highly individualized. In the present instance, a 74-year-old woman was found on routine transthoracic echocardiography to have a linear echogenic structure that was initially concerning for a dissection flap. A computed tomography angiogram of the aorta revealed a linear density that followed the curvature of the aortic arch, which was concerning for a retained angioplasty wire from a percutaneous coronary intervention done 11 years earlier. Because the patient had not reported any symptoms, a multidisciplinary decision was made to defer any surgical intervention.