Sex Differences in the Risk of Coronary Heart Disease Associated With Type 2 Diabetes: A Mendelian Randomization Analysis

OBJECTIVEObservational studies have demonstrated that type 2 diabetes is a stronger risk factor for coronary heart disease (CHD) in women compared with men. However, it is not clear whether this reflects a sex differential in the causal effect of diabetes on CHD risk or results from sex-specific residual confounding.RESEARCH DESIGN AND METHODSUsing 270 single nucleotide polymorphisms (SNPs) for type 2 diabetes identified in a type 2 diabetes genome-wide association study, we performed a sex-stratified Mendelian randomization (MR) study of type 2 diabetes and CHD using individual participant data in UK Biobank (251,420 women and 212,049 men). Weighted median, MR-Egger, MR-pleiotropy residual sum and outlier, and radial MR from summary-level analyses were used for pleiotropy assessment.RESULTSMR analyses showed that genetic risk of type 2 diabetes increased the odds of CHD for women (odds ratio 1.13 [95% CI 1.08–1.18] per 1-log unit increase in odds of type 2 diabetes) and men (1.21 [1.17–1.26] per 1-log unit increase in odds of type 2 diabetes). Sensitivity analyses showed some evidence of directional pleiotropy; however, results were similar after correction for outlier SNPs.CONCLUSIONSThis MR analysis supports a causal effect of genetic liability to type 2 diabetes on risk of CHD that is not stronger for women than men. Assuming a lack of bias, these findings suggest that the prevention and management of type 2 diabetes for CHD risk reduction is of equal priority in both sexes.     

Portal vein aneurysm: is it an incidental finding only?

Portal vein aneurysms are uncommon incidental imaging findings. They usually do not require any treatment unless symptomatic. Contrast enhanced CT is the imaging modality of choice for depicting its morphology and extension.     

MRI of fat necrosis of the breast: the "black hole" sign at short tau inversion recovery

Objective

To describe MRI features of fat necrosis of the breast.

Materials and methods

Twenty-five lesions in 16 patients were retrospectively analyzed. MRI was performed due to equivocal findings at conventional imaging after surgical treatment of cancer (n = 14) or during anticoagulant therapy (n = 1), after focal mastitis treated with ductal resection (n = 1). In the 15 patients with previous surgery MRI was performed after a median interval of 24 months, using short tau inversion recovery (STIR) and contrast-enhanced dynamic T1-weighted sequences. Signal-to-noise ratio (SNR) inside the lesion and surrounding healthy fat was calculated on both STIR and unenhanced T1-weighted images. Maximal lesion diameter was measured on STIR images. All lesions had final clinical and imaging assessment in favor of fat necrosis and negative clinical and imaging follow-up (21–40 months; median 24 months).

Results

At STIR sequence, fat necrosis appeared as a “black hole”, being markedly hypointense (median SNR = 29) compared with surrounding fat (median SNR = 95) (P < 0.001), while no significant difference was found at unenhanced T1-weighted sequence. No significant correlation with time from treatment was found. Of 25 lesions, 15 showed ring enhancement, with continuous increase (n = 10), plateau (n = 2), or wash-out curve (n = 3). The 11 enhancing lesions in the 8 patients with previous radiation therapy showed an initial enhancement higher than that of the 4 enhancing lesions in the 2 patients who did not, although the difference was not significant (P = 0.104).

Conclusion

Fat necrosis of the breast exhibits a “black hole” sign on STIR images, allowing for an easier diagnosis in clinical practice.     

Myopathy Associated With Statins and SGLT2 – A Review of Literature

Drug-induced myopathy is a well-described clinical entity characterized by muscle damage leading to symptoms ranging from myalgias to rhabdomyolysis and acute kidney injury. Many pharmacotherapies are known to precipitate myopathic symptoms. Recent case reports suggest a potential relationship between the use of sodium/glucose cotransport 2 (SGLT2) inhibitors and onset of myopathy. The pathogenesis of this has yet to be elucidated. The relevance of this association is augmented by the recent popularity of SGLT2 inhibitors as well as the tendency for them to be prescribed alongside statins. This study reviewed the literature on the incidence and mechanism of drug-induced myopathy in patients with type 2 diabetes mellitus who are taking SGLT2 inhibitors with and without the use of statins.     

Racial/Ethnic Disparities in Post-acute Sequelae of SARS-CoV-2 Infection in New York: an EHR-Based Cohort Study from the RECOVER Program

BackgroundCompared to white individuals, Black and Hispanic individuals have higher rates of COVID-19 hospitalization and death. Less is known about racial/ethnic differences in post-acute sequelae of SARS-CoV-2 infection (PASC).ObjectiveExamine racial/ethnic differences in potential PASC symptoms and conditions among hospitalized and non-hospitalized COVID-19 patients.DesignRetrospective cohort study using data from electronic health records.Participants62,339 patients with COVID-19 and 247,881 patients without COVID-19 in New York City between March 2020 and October 2021.Main MeasuresNew symptoms and conditions 31–180 days after COVID-19 diagnosis.Key ResultsThe final study population included 29,331 white patients (47.1%), 12,638 Black patients (20.3%), and 20,370 Hispanic patients (32.7%) diagnosed with COVID-19. After adjusting for confounders, significant racial/ethnic differences in incident symptoms and conditions existed among both hospitalized and non-hospitalized patients. For example, 31–180 days after a positive SARS-CoV-2 test, hospitalized Black patients had higher odds of being diagnosed with diabetes (adjusted odds ratio [OR]: 1.96, 95% confidence interval [CI]: 1.50—2.56, q<0.001) and headaches (OR: 1.52, 95% CI: 1.11—2.08, q=0.02), compared to hospitalized white patients. Hospitalized Hispanic patients had higher odds of headaches (OR: 1.62, 95% CI: 1.21—2.17, q=0.003) and dyspnea (OR: 1.22, 95% CI: 1.05—1.42, q=0.02), compared to hospitalized white patients. Among non-hospitalized patients, Black patients had higher odds of being diagnosed with pulmonary embolism (OR: 1.68, 95% CI: 1.20—2.36, q=0.009) and diabetes (OR: 2.13, 95% CI: 1.75—2.58, q<0.001), but lower odds of encephalopathy (OR: 0.58, 95% CI: 0.45—0.75, q<0.001), compared to white patients. Hispanic patients had higher odds of being diagnosed with headaches (OR: 1.41, 95% CI: 1.24—1.60, q<0.001) and chest pain (OR: 1.50, 95% CI: 1.35—1.67, q < 0.001), but lower odds of encephalopathy (OR: 0.64, 95% CI: 0.51—0.80, q<0.001).ConclusionsCompared to white patients, patients from racial/ethnic minority groups had significantly different odds of developing potential PASC symptoms and conditions. Future research should examine the reasons for these differences.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-022-07997-1.     

Seroepidemiological study of malaria in a rural population of Chandigarh

A total of 1689 peripheral blood smears and serum samples were collected from healthy subjects from four villages of U.T. Chandigarh during the pre-monsoon season (February to May 1987) while 1809 such samples were collected during the post-monsoon season (October 1987-January 1988). None of the peripheral blood smears examined by Giemsa and acridine-orange stains showed malarial parasite. Out of 1689 serum samples tested by indirect haemagglutination (IHA) test during pre-monsoon season, 81 per cent showed malarial antibody titres of less than 1:8 and only 19 per cent showed titres of 1:8 or above. In contrast, out of 1809 serum samples tested during post-monsoon season, 58.3 per cent showed antibody titres of less than 1:8 while 41.6 per cent samples showed titres of 1:8 and above. Total number of malaria cases from these villages from June 1987 to January 1988 was also low (total 65 cases) as compared to corresponding period of previous year (total cases 191). Serological findings independent of positive cases of malaria suggest that though, no proved clinical cases of malaria were observed in the population surveyed, malaria transmission had certainly taken place as evidenced by higher antibody titres observed during the post-monsoon season compared to pre-monsoon season.     

Effect of growth on lung transfer factor and its components.

Measurement of lung transfer factor for CO (TLCO) and its constituent components, viz. diffusion capacity across alveolar capillary membrane (Dm) and instant pulmonary capillary blood volume (Vc) were undertaken in 120 healthy non-smoker males by single breath technique. All the three parameters (TLCO, Dm, Vc) showed direct negative correlation with age. While TLCO and Dm showed a significant direct positive correlation with height, there was no correlation between VC and height. The degree of correlation increased when both age and height were used together than either of them alone for prediction of TLCO120. The prediction formulae (TLCO120 = 3.8 + 21 H (m)-0.308 A) using both age and height has regression value (R) of 0.6479 (p < 0.001).