Diabetes mellitus (DM) predicts ominous outcomes in acute pulmonary embolism (PE). The influence of gender on the prognostic impact of DM in PE is unknown. We did a retrospective analysis of a cohort of patients hospitalized with PE between 2006 and 2013. The exclusion criteria were age <18, non-pulmonary veins thromboembolism, recurrent PE, chronic thromboembolic pulmonary hypertension, no radiologic confirmation of PE, and active neoplasia. The primary endpoint was all-cause mortality. The follow-up was from diagnosis until October 2017. We assessed the prognostic impact of DM using a multivariate Cox regression analysis. The analysis was stratified according to gender. The interaction between gender and DM in the outcome of patients with PE was tested. We studied 577 PE patients (median age 65 years, 36.9% men, 19.8% diabetic). The genders were similar regarding the prevalence of DM, the extension and location of PE, and the thrombolytic therapy or brain natriuretic peptide (BNP) value. Diabetics presented higher all-cause mortality (Hazard ratio (HR) = 2.33 (95% confidence Interval (CI) 1.513.61)) when compared with non-diabetics. However, when analysis was stratified according to gender, DM was independently associated with a worse prognosis only in women (HR = 2.31 (95% CI 1.453.65)), while in men the HR was 1.10 (95% CI 0.592.04). The interaction between gender and DM was significant (p = 0.04). Gender influences the prognostic impact of DM in acute PE. Diabetic women with PE have twice the long-term mortality risk, while DM is not mortality-associated in men.

Cushing’s syndrome (CS) is a rare condition associated with increased morbidity and mortality. Complications derive from hypercortisolism and are mainly cardiovascular, infectious and thrombotic. Most manifestations are unspecific, and the diagnosis is frequently delayed and made only in the setting of complications. We present a woman in whom CS was investigated because of refractory hypokalemia, hypernatremia and metabolic alkalosis. The patient had many cardiovascular risk factors and was admitted to the hospital due to a serious bacterial infection - muscle abscesses evolving into osteomyelitis. The final etiological diagnosis was not possible because the acute event had a fatal outcome. Immunosuppression associated with hypercortisolism makes these patients predisposed to severe infection. Indeed, infectious complications are a relevant cause of death in CS. Diagnosing and treating CS early is paramount in preventing its dismal complications.

Eosinophilic colitis and hypereosinophilic syndrome with colic involvement are rare diagnosis that are characterized by wide-ranging gastrointestinal symptoms and idiopathic infiltration of eosinophils in the colon. The diagnostic workup is challenging since there are no standardized criteria. We report a case of a man admitted to the hospital with a history of nonbloody chronic diarrhea. The detailed workup demonstrated blood eosinophilia, and the colonic biopsies revealed extensive eosinophilic infiltration. He was treated with steroids with clinical and analytical improvement. Due to relapsing colitis after therapy withdrawal, he was chronically medicated with 10 mg of prednisolone with ultimate symptom control. This case report describes the diagnostic workup and highlights the most important features of this often underdiagnosed entity.

Background: Patients with heart failure often have multiple cardiovascular risk factors (CVRFs) and comorbidities (CMBs). We evaluated the impact of additive CMB and CVRF on heart failure prognosis. Methods: We retrospectively analyzed ambulatory patients with systolic dysfunction between January 2012 and May 2018. Follow-up was until January 2021. The endpoint was all-cause death. CVRF analyzed arterial hypertension, diabetes mellitus, and smoking. CMB evaluated coronary artery disease, noncoronary atherosclerotic disease, respiratory disease, dementia, anemia, chronic kidney disease, inflammatory/autoimmune disease, active cancer, and atrial fibrillation. Classification according to the number of CVRFs and/or CMBs is <2 and ≥2. The independent prognostic impact of CVRF/CMB burden was assessed with multivariate Cox regression. Results: Most patients had ≥2 CMBs (67.9%). Regarding CVRF, 14.9% presented none, 40.2% had 1, and 32.1% had 2. During a median 49-month follow-up, 419 (49.1%) patients died. Mortality was higher among patients with ≥2 CVRFs (56.1 versus 43.4% in those with <2) and in those with ≥2 CMBs (57.7 versus 31.0%). While patients with 1 CMB had similar mortality than those with none. Patients with ≥2 CMBs had higher long-term mortality risk: hazard ratio (HR), 2.47 (95% CI, 1.95–3.14). In patients with ≥2CVRFs, the HR of dying is 1.39 (95% CI, 1.14–1.70). When taken together, there was a clear survival disadvantage for patients with ≥2 CVRFs/CMBs—adjusted HR, 2.20 (95% CI, 1.45–3.34). Conclusions: The presence of only 2 CVRFs/CMBs more than doubles the patients´ risk of dying. CVRF and CMB should be assessed as part of routine patient management.

Background: The impact of systolic blood pressure (SBP) variation on chronic heart failure (HF) is largely unknown. We assessed the impact of SBP variation in patients with chronic HF. Methods: This is a retrospective analysis of adult ambulatory patients with HF with left ventricular systolic dysfunction (LVSD). SBP variation = SBP at the index visit – SBP at the 1-year visit. Patients dying in the first year or with missing data concerning SBP were excluded. Patients with SBP increase ≥10 mmHg during the first year were compared with the remaining. Determinants of SBP increase were assessed by binary logistic regression analysis. The patients were followed up from the 1-year visit up to 5 years. The primary end point was all-cause mortality. A Cox regression analysis was used to determine the association of SBP variation with mortality. Results: We studied 787 patients (68% male), with a mean age of 70 years. SBP increased by ≥10 mmHg in 277 patients (35.2%) and remained stable or decreased in 510. Patients in whom SBP increased more often presented severe LVSD and nonischemic HF; they had lower baseline SBP and were more medicated with loop diuretics. Independent predictors of SBP increase were lower basal SBP and loop diuretic use. Patients with a SBP increase ≥10 mmHg had a crude hazard ratio (HR) of all-cause mortality of 0.74 (0.59–0.94), and the multivariate-adjusted HR was 0.61 (0.46–0.79). Conclusions: Patients with chronic HF with SBP increase ≥10 mmHg over the first year have a 39% reduction in the all-cause mortality risk irrespective of basal SBP, severity of ventricular dysfunction, and evidence-based drug use. Patients with SBP stability or decrease have a similarly poor prognosis.