Sharma, Arunima

Greater degrees of aerobic fitness are associated with greater insulin-mediated muscle glucose uptake. Insulin regulates adipose tissue lipolysis, whether aerobic fitness affects insulin’s ability to regulate lipolysis is unknown. We found that greater fitness is associated with improved adipose tissue insulin responsiveness independent of age, sex, BMI, visceral adipose tissue, body fat (kg), percent body fat, and adipocyte size. This suggests that exercise, if it improves fitness, may improve both adipose tissue and muscle function.

Introduction: Patients with sickle cell disease are at risk for many types of cardiac complications. We present a case of endocarditis of the superior vena cava (SVC) in a 22-year-old male with sickle cell disease. Case study: A 22 year old male with sickle cell disease presented to the hospital with 3 days of fever, night sweats, generalized body pains, vomiting and poor oral intake. 6 weeks ago, he had been admitted to an outside hospital for Methicillin related Staphylococcus aureus (MRSA) bacteremia. At that time an implanted venous access port in the patient’s chest was removed and 4 weeks of intravenous(iv) vancomycin were administered. He was admitted to the hospital for sepsis. Blood cultures were drawn which were positive for MRSA. A transesophageal echocardiogram revealed a large mobile vegetation in the SVC ( Fig. 1) The proximal end of the vegetation extended beyond the echocardiographic field of view, so a CT scan of the chest with contrast was performed (Fig. 2) This showed intraluminal filling defects in the distal SVC along with pulmonary emboli in the lower lobes of the lungs bilaterally. His antibiotics were changed to iv daptomycin and ceftaroline but he remained persistently bacteremic for 14 days. Therefore, removal of the SVC vegetation/thrombus was performed using AngioVac venous drainage cannula system. This was followed by resolution of bacteremia, and he was discharged from the hospital 9 days later. Conclusion: Echocardiographic evaluation of endocarditis should involve a comprehensive evaluation of all cardiac structures and not be limited to valves only. AngioVac venous drainage cannula system can be used to remove infected vegetations/thrombus.

Background Rotational and orbital coronary atherectomy (CA) are commonly utilized to treat complex calcified coronary lesions. We conducted a meta-analysis to evaluate sex differences in procedural complications and clinical outcomes after CA. Methods PubMed, Google Scholar, and Cochrane databases were searched for all studies comparing sex differences in procedural and clinical outcomes following CA. The outcomes of interest were procedural complications (coronary dissection, stroke, major bleeding, coronary perforation, cardiac tamponade, and slow or no flow in target vessel) and the clinical outcomes (including early mortality, mid-term all-cause mortality, stroke, myocardial infarction, and target vessel revascularization). Pooled risk ratios (RRs) with their corresponding 95% confidence intervals (CIs) were calculated using the Mantel–Haenszel random-effects model. Results Six observational studies with 3517 patients (2420 men and 1035 women) were included in this meta-analysis. While there was no significant difference in the early mortality (RR, 1.14; 95% CI, 0.37–3.53; P = 0.83) between men and women, at a mean follow-up of 2.9 years, all-cause mortality was significantly higher in women (RR, 1.29; 95% CI, 1.11–1.49; P = 0.0009). Women had an increased risk of procedure-related stroke (RR, 3.98; 95% CI, 1.06–14.90; P = 0.04), coronary dissection (RR, 2.10; 95% CI, 1.23–3.58; P = 0.006), and bleeding (RR, 2.26; 95% CI, 1.30–3.93; P = 0.004), whereas the rates of coronary perforation, cardiac tamponade, and the risk of slow or no flow in the revascularized artery were similar in both. Conclusion In our analysis, women undergoing CA are at increased risk of mid-term mortality and procedure-related complications including stroke, coronary dissection, and major bleeding.