Use of gonadotropin-releasing hormone agonists for ovarian preservation in patients receiving cyclophosphamide for systemic lupus erythematosus: A meta-analysis.

BACKGROUND: Cyclophosphamide (CYC) has known cytotoxic effects on ovarian reserve and has been linked to premature ovarian failure (POF) in systemic lupus erythematosus (SLE). The concurrent use of gonadotropin-releasing hormone agonists (GnRHas) is postulated to preserve ovarian function by reducing the number of follicles exposed to CYC, but there is paucity of data to establish its efficacy. We conducted a meta-analysis to summarize the effect of concurrent GnRHa use in persevering ovarian function and pregnancy. METHODS: English language databases of PubMed, Embase, and Cochrane were searched to include studies published between 2000 and 2021. Studies in females with rheumatic diseases receiving concurrent GnRHa and CYC therapy to evaluate ovarian preservation as defined by amenorrhea, follicle stimulating hormone (FSH), anti-mullerian hormone (AMH), or estradiol levels or successful pregnancy were included. We used a fixed effect, exact, Mantel-Haenszel approach to estimate the overall odds ratio (OR) and associated 95% confidence intervals (95% CIs). RESULTS: Seven studies with 218 female patients were included. The ovarian function was preserved in 125/132 (94.6%) of women who received GnRHa concurrently with CYC compared to 50/86 (58%) of women who did not receive GnRHa (OR = 10.3, CI = 4.83-36.29). The OR for pregnancy with GnRHa use = 2.94 (CI = 1.04-9.89). CONCLUSION: Our results based on limited published studies suggest that concurrent GnRHa use preserves ovarian function and increase odds of pregnancy. It can be considered for premenopausal SLE females receiving CYC. Long-term follow-up studies are needed to establish the efficacy and safety of GnRHa use for ovarian preservation.

A nationwide cohort analysis to determine the prevalence of sinus node dysfunction and rates of pacemaker implantation in systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) has been known to have various degrees of cardiac involvement. However, limited evidence exists on prevalence of heart rhythm disorders in patients with SLE who have subsequent pacemaker (PM) implantation. The purpose of this study was to examine the prevalence of sinus node dysfunction (SND) in patients with SLE. The data was retrospectively analysed from the National Inpatient Sample database for the years 2010 to 2014 using the International Classification of Disease-9 diagnosis codes for SLE and SND in patients 18 years or older. We analysed data of 158,368 patients with SLE that were admitted from 2010 to 2014. The sample of patients ranged between 18 and 101 years of age (M = 52.13 ± 17.61), were primarily female (88.2%), and were Caucasian (50.6%). The prevalence of SND was 4.3%. In patients with both SLE and SND, the prevalence of PM implantation over the five-year period of analysis was 3.6% and the majority of these patients had a dual-chamber PM (85.6%). Prevalence rates of SND in patients with SLE increased for females over this five-year period (p = 0.023). Prevalence estimates of complications associated with PM in patients with SLE and SND were venous thromboembolism (2.1%), cardiac tamponade (0.4%), sepsis and severe sepsis (0.4%), septic shock (0%), pneumothorax (0%) and PM site hematoma (1.7%). The findings of this study revealed that the prevalence of SND and the prevalence of PM in patients with both SLE and SND have remained relatively consistent over the five years that our study analysed.

Brucella Endocarditis of the Native Mitral Valve Treated With Antibiotics.

Brucellosis is a rare zoonotic infection with a low annual incidence in the United States. Infective endocarditis secondary to brucellosis involving native or prosthetic valves is contemplated to be an extremely rare entity. As Brucella can present with non-specific sign and symptoms, clinicians need to have a higher degree of suspicion of Brucella endocarditis in culture-negative endocarditis patients, particularly those who have a history of exposure to farm animals. Timely diagnosis with appropriate management using antibiotics can prevent valvular damage and restore the valve's structural integrity. In this case report, we present a case of culture-negative, serology-proven Brucella endocarditis of native mitral valve, with an initial presentation of stroke that was successfully treated with combination antibiotic therapy.

A Case of Dengue Fever With Hemorrhagic Manifestations.

Dengue fever is an arboviral infection spread by the Aedes mosquito with a wide spectrum of presentations encompassing simple flu-like illness to hemorrhagic manifestations. Hemorrhagic complications range from simple petechiae and purpura to gastrointestinal bleeding, hematuria, and severe central nervous system (CNS) bleeds. Herein we present a case of a 38-year-old male with dengue fever along with its hemorrhagic manifestations. Additionally, we conducted an extensive review of the literature to elucidate pathophysiology, diagnosis, and management of hemorrhagic manifestations in dengue fever.

Cyclophosphamide-induced Atrial Fibrillation With Rapid Ventricular Rate.

Cyclophosphamide (CYA), also known as cytophosphane, is a medication used as a chemotherapeutic agent and immune suppressor.Its common adverse effects include nausea, vomiting, diarrhea, bone marrow suppression, hemorrhagic cystitis, alopecia, lethargy, and cardiotoxicity. Cyclophosphamide-related cardiac toxicity is not uncommon and causes potentially serious complications in patients. In this review, we present a case of a 65-years-old patient who developed atrial fibrillation with rapid ventricular rate (RVR) after receiving a single dose of CYA. In this case, the advanced age of the patient, pre-treatment with prednisone, and renal insufficiency most likely predisposed the patient to CYA-induced cardiac toxicity. A relevant literature review was also conducted to determine the pathogenesis, risk factors, and spectrum of CYA-induced cardiac toxicity.

Glomangiosarcoma Involving the Heart with an Unknown Primary Lesion.

Glomus tumors are usually benign tumors of the glomus cells with the immunocytochemical and structural features of smooth muscle cells. The majority of the cases of glomus tumors are benign but, rarely, they demonstrate malignant features both clinically and histologically (also known as glomangiosarcomas). Although glomangiosarcoma involving extracutaneous sites is uncommon, a few cases have been reported. A glomangiosarcoma of the heart is extremely rare due to the rarity of glomus bodies in the myocardium. In this case report, we present the case of a 31-year-old female with glomangiosarcoma involving the heart with an unknown primary lesion.

High-grade Burkitt Lymphoma Presenting as a Buttock Mass and Foot Drop.

Burkitt lymphoma (BL), a highly aggressive B-cell non-Hodgkin lymphoma (NHL), usually presents in children and young adults with large extranodal masses involving jaw bones, gastrointestinal tract, and central nervous system. The three main subtypes of BL are endemic, sporadic, and immunodeficiency variant. Extranodal involvement is common in each variant of BL, although muscle tissue involvement is distinctly rare. Mode of spread may be hematogenous or via direct extension of the primary tumor. In this report, we present a case of a 41-year-old male who presented with a palpable mass in the buttock leading to foot drop as the initial manifestation of BL. An exhaustive review of the literature failed to discover any previous reports of BL occurring in this location.