Prevention of heart failure events with sodium-glucose co-transporter 2 inhibitors across a spectrum of cardio-renal-metabolic risk

Aims Trials have tested the safety and efficacy of sodium-glucose co-transporter 2 inhibitors (SGLT2i) across various disease states. We performed a meta-analysis of randomized controlled trials (RCTs) to estimate the relative and absolute effects of SGLT2i in the prevention of heart failure (HF) events across different risk groups. Methods and results We conducted a systematic review and meta-analysis of large, placebo-controlled RCTs with >1000 participants evaluating HF hospitalization and the composite of cardiovascular (CV) death or HF hospitalization. Due to varying durations of therapeutic exposure and follow-up, absolute risk reductions and number needed to treat were calculated based on incidence rates (per 100 patient-years). Across 71 553 patients enrolled in 10 late-phase RCTs, SGLT2i reduced the risk of HF hospitalization by 31% [hazard ratio (HR) 0.69, 95% confidence interval (CI) 0.64-0.74; I-2 = 0%] and the composite outcome of CV death or HF hospitalization by 24% (HR 0.76, 95% CI 0.72-0.80; I-2 = 1.4%) compared with placebo. The number of patient-years of treatment exposure needed to prevent one CV death or HF hospitalization ranged from 19-26 (established HF) to 72-125 (chronic kidney disease) to 96-400 (high-risk type 2 diabetes). In mixed-effects meta-regression analyses, the benefits of SGLT2i on HF hospitalizations or the composite outcome (CV death or HF hospitalization) were not influenced by age, sex, or change in intermediate markers (glycated haemoglobin, systolic blood pressure, and body weight) (all P >= 0.10). Conclusion Despite wide variation in baseline risks and disease states evaluated, SGLT2i demonstrated comparable relative risk reductions in preventing HF events. Patients at highest baseline risk derived the greatest absolute benefits in preventing HF events. These composite estimates may help guide targeted implementation of SGLT2i for the prevention of HF events in type 2 diabetes and chronic kidney disease and in the treatment of HF

Crowned dens syndrome presenting as pyrexia of unknown origin (PUO)

Background. Deposition of calcium pyrophosphate crystals in the cervical spine around the odontoid process may lead to neck pain and fever. This condition is called crowned dens syndrome (CDS)

Role of herpesviruses in coronary artery disease

Coronary artery disease (CAD) is a huge global burden and is a leading cause of morbidity and mortality across the world. We have done this review to elucidate the pathogenesis of herpesviruses in causing CAD and to study an association between herpesviruses (cytomegalovirus [CMV] and herpes simplex virus [HSV-1 and -2]) and CAD. CMV can cause atherosclerosis directly through the activity of its gene products on endothelial cells, monocytes/macrophages, and smooth muscle cells and indirectly through production of pro-inflammatory cytokines at far off place. HSV infection causes atherosclerosis mainly by causing increased prothrombotic activity on endothelial cells, accumulation of cholesterol esters and triacylglycerols in vascular smooth muscle cells, and upregulating expression of Lectin like oxidized Low density lipoprotein receptor-1 (LOX-1) receptor on macrophages. The association between CMV and CAD is related to its seroprevalence with a positive association in developing countries (higher seroprevalence) and no significant association in developed countries (lower seroprevalence). However, the association between HSV infection and atherosclerosis is not related to its seroprevalence

A rare case of takotsubo cardiomyopathy: The masquerader

Takotsubo cardiomyopathy (TCM) is a form of transient systolic dysfunction that masquerades myocardial infarction clinically. We report a case of a 57-year-old female with a normal cardiac profile who underwent an abdominal surgery. However, immediately after the operation, she developed chest pain and dyspnea, ST-segment elevation and QRS complex widening on electrocardiography, and increased left ventricle diastolic diameter, apical ballooning, and decreased ejection fraction on two-dimensional echocardiography. However, coronary angiography was normal. Based on these findings, she was diagnosed with TCM. She was started on diuretics and beta-blocker, and her heart function returned to normal within 2 weeks. Possibility of TCM should be kept in mind when acute coronary syndrome like manifestation is immediately preceded by a stress episode, like in this case

Acute right bundle branch block due to pneumothorax

Changes in electrocardiogram (ECG) due to pneumothorax have been studied and are well described mainly in case of left-sided pneumothorax. Classic ECG finding in left-sided pneumothorax includes right-axis deviation, diminution of QRS complex, T-wave inversion, phasic R wave variation, and reduced R wave in precordial leads. There has been reported case of incomplete right bundle branch block (RBBB) in left-sided pneumothorax. We hereby report the first case of acute-onset complete RBBB due to left-sided pneumothorax in a young patient after blunt chest trauma from a motor vehicle accident. ECG findings revert back to normal after 1.5 h of decompression of pneumothorax. We summarize the possible mechanisms that could lead to this unusual finding on ECG. Pneumothorax can cause unusual ECG changes like in our case and should be kept in the list of differential diagnosis in appropriate clinical conditions

Selfies: A boon or bane?

Background: Selfie deaths have become an emerging problem and we performed this study to assess the epidemiology of selfie-related deaths across the globe. Subject and Methods: We performed a comprehensive search for keywords such as “selfie deaths; selfie accidents; selfie mortality; self photography deaths; koolfie deaths; mobile death/accidents” from news reports to gather information regarding selfie deaths. Results: From October 2011 to November 2017, there have been 259 deaths while clicking selfies in 137 incidents. The mean age was 22.94 years. About 72.5% of the total deaths occurred in males and 27.5% in females. The highest number of incidents and selfie-deaths has been reported in India followed by Russia, United States, and Pakistan. Drowning, transport, and fall form the topmost reasons for deaths caused by selfies. We also classified reasons for deaths due to selfie as risky behavior or non-risky behavior. Risky behavior caused more deaths and incidents due to selfies than non-risky behavior. The number of deaths in females is less due to risky behavior than non-risky behavior while it is approximately three times in males. Conclusion: “No selfie zones” areas should be declared across tourist areas especially places such as water bodies, mountain peaks, and over tall buildings to decrease the incidence of selfie-related deaths

Falciparum malaria mimicking acute myocardial infarction

Severe malaria is a concerning problem in developing country and is mostly due to Plasmodium Falciparum. Common organs involved are liver, central nervous system, lungs, kidneys, and vasculature. Cardiac involvement is very rare and is mostly underestimated. Cardiac involvement occurs in the form of myocardial dysfunction, arrhythmia, and ventricular systolic dysfunction. This is the rare case of acute pericarditis due to plasmodium falciparum mimicking as inferolateral ST elevation myocardial infarction (STEMI) due to suggestive electrocardiography (ECG) findings