High prevalence of cardiovascular disease and risk factors among type 2 diabetes patients followed in a hospital setting in Portugal: The PICT2RE observational study.

INTRODUCTION AND OBJECTIVES: Portugal is a country with a high prevalence of type 2 diabetes (T2D) and cardiovascular disease (CVD). The prevalence of CVD and cardiovascular (CV) risk factors among T2D patients followed in hospitals in Portugal is not known. The primary objective of this study was to assess the prevalence of CVD and CV risk factors among T2D patients in a hospital setting in Portugal. The clinical management of CVD in the hospital setting was also assessed. METHODS: We performed a non-interventional, multicenter, cross-sectional study with a retrospective phase. T2D patients were consecutively invited to participate. Data were collected retrospectively. RESULTS: A total of 715 patients were included in the study. Mean age and diabetes duration were 66.6 and 17.4 years, respectively. Of these, 286 patients (40.0%) had been diagnosed with CVD, mostly ischemic heart disease (50.4%). All patients had at least one CV risk factor. CVD was significantly associated with hypertension, hypercholesterolemia, low high-density lipoprotein cholesterol, hypertriglyceridemia and smoking. During the three years prior to study inclusion, the incidence of hyperglycemic episodes and T2D complications increased among patients with established CVD, but the numbers of hospitalization episodes and specialist appointments remained stable. An improvement was observed in key cardiometabolic risk factors. CONCLUSIONS: Our study revealed a high prevalence of CVD and CV risk factors among a sample of T2D patients in a hospital setting. Patients with established CVD seem to be adequately managed but further efforts are needed at the prevention stage for better control of risk factors and morbidity.

Aortitis Secondary to Cogan's Syndrome: A Rare Cause of Fever of Unknown Origin.

Fever of unknown origin remains a diagnostic challenge. Aortitis, defined as inflammation of the aorta, has multiple infectious and non-infectious causes. We report the case of an elderly woman with vertigo and bilateral hearing loss, presenting with fever of unknown origin. Blood tests were remarkable for leucocytosis with neutrophilia, elevation of C-reactive protein and the erythrocyte sedimentation rate, and positive antinuclear antibodies and rheumatoid factor, and an unremarkable search for multiple infectious causes of fever. During admission the patient developed a bilateral red eye. Abdominal and chest computed tomography was performed and demonstrated signs of aortitis. Due to the coexistence of aortitis, ocular inflammation, vertigo and bilateral hearing loss in a patient with persistent fever and elevation of inflammatory parameters, a presumptive diagnosis of Cogan's syndrome was made, with improvement after initiation of steroid therapy. LEARNING POINTS: Fever of unknown origin is a diagnostic challenge with an extensive list of possible causes.The coexistence of fever, aortitis, ocular and vestibulo-cochlear symptoms should raise the suspicion of Cogan's syndrome.Steroid therapy is the first-line treatment for Cogan's syndrome.

Traveler's myopericarditis.

Colitis caused by Shigella is an uncommon etiology of infectious diarrhea in developed countries, usually presenting as traveler's diarrhea. Aside from clinical intestinal manifestations, shigellosis can present with a wide variety of extra-intestinal symptoms. We present the case of a 38-year-old man with diarrhea, fever, and chest pain that started after a holiday in Cape Verde (Africa). Blood samples revealed an increase in cardiac enzymes. An electrocardiogram revealed a widespread elevation of the ST segment. Echocardiography showed a swift pericardial effusion, confirming the diagnosis of acute myopericarditis. Shigella boydii was identified in stool cultures. The patient was treated with ciprofloxacin and acetylsalicylic acid, resulting in improvement in clinical and laboratory findings.