A case report on methotrexate induced pancytopenia

Systemic lupus erythematosus (SLE) is a non-specific systemic inflammatory disease that affects various organ systems in the body leading to a wide spectrum of clinical presentations. The management of SLE includes therapy with immunosuppressant agents who have a narrow safety range and a wide adverse effect profile. Methotrexate discussed in this case report is one of such drugs whose short term and long term usage has been associated with various adverse events that affect the individuals quality of life. So, it is always advisable to take prophylactic measures and to provide patient education to detect and prevent adverse events at the earliest.

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Anti-MDA5 Antibody Dermatomyositis Overlap with Systemic Lupus Erythematosus: A Case Report and Review of the Literature

The Open Rheumatology Journal ◽

10.2174/1874312901610010122 ◽

2016 ◽

Vol 10 (1) ◽

pp. 122-128 ◽

Cited By ~ 2

Author(s):

Emily C. Milam ◽

Jacobo Futran ◽

Andrew G. Franks Jr.

Keyword(s):

Systemic Lupus Erythematosus ◽

Case Report ◽

Interstitial Lung Disease ◽

Connective Tissue ◽

Lupus Erythematosus ◽

Clinical Phenotype ◽

Review Of The Literature ◽

Systemic Lupus ◽

American College Of Rheumatology ◽

Clinical Presentations

Background: Dermatomyositis (DM) is an autoimmune connective tissue disease that primarily targets the muscle, skin, and lungs. Many patients have autoantibodies that correspond to distinct clinical phenotypes. Melanoma differentiation-associated gene 5 (anti-MDA5) antibody, a specific antibody that targets the melanoma differentiation-associated gene 5 (MDA5), has been reported in DM cases and is significant for a distinct cutaneous presentation and rapidly progressive interstitial lung disease. Objective: Herein, we describe a patient with DM with a positive anti-MDA5 antibody and characteristic clinical phenotype, who subsequently developed coexisting systemic lupus erythematosus (SLE). A diagnosis of SLE was supported by his clinical phenotype, positive serologies, hypocomplementemia, and progression to glomerulonephritis and lupus cerebritis, features of which fulfilled the American College of Rheumatology criteria for SLE. Conclusion: DM is known to overlap with other autoimmune diseases, including SLE, and coexistence can lead to a wide variety of clinical presentations. SLE overlapping with anti-MDA5 positive DM may present with distinct clinical features.

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Systemic Lupus Erythematosus Disease: An Overview of the Clinical Approach to Pathogenesis, Diagnosis, and Treatment

Borneo Journal of Pharmacy ◽

10.33084/bjop.v4i2.1950 ◽

2021 ◽

Vol 4 (2) ◽

pp. 91-98

Author(s):

Saurabh Nimesh ◽

Md. Iftekhar Ahmad ◽

Shikhka Dhama ◽

Pradeep Kumar ◽

Muhammad Akram ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Immune System ◽

Chronic Disease ◽

Lupus Erythematosus ◽

The Body ◽

Clinical Approach ◽

Systemic Lupus Erythematosus Disease ◽

Systemic Lupus ◽

Organ Systems ◽

Novel Approaches

The systemic lupus erythematosus (SLE), commonly known as Lupus, is a rare and complex multisystem autoimmune disease where one’s immune system is overactive, and the body attacks its organ systems. SLE is a historically old disease described already in antiquity; it is an example of a chronic disease with physical, psychological, financial, and social implications for individuals diagnosed. It has inspired medical and basic biological scientists that focus on molecular biology, basic immunology, immunopathology, clinical science, genetics, and epidemiology. The syndrome is real in its existence-although hidden behind obstacles, cumbersome for patients and clinicians, and rebellious for scientists. There is currently no cure for SLE. The goal of treatment is to ease symptoms. This article will review information on the general approach to SLE therapy, focusing on currently approved therapies and novel approaches that might be used in the future.

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Overview of Biomedical Materials

MRS Bulletin ◽

10.1557/s0883769400056025 ◽

1991 ◽

Vol 16 (9) ◽

pp. 33-38 ◽

Cited By ~ 11

Author(s):

Michael N. Helmus

Keyword(s):

Medical Devices ◽

Synthetic Polymers ◽

The Body ◽

Soft Tissue Defects ◽

Intravenous Catheter ◽

Biomedical Materials ◽

Commercial Grade ◽

Organ Systems ◽

Tissue Defects

Biomedical materials are synthetic polymers, metals, ceramics, inorganics, and natural macromolecules (biopolymers), that are manufactured or processed to be suitable for use in or as medical devices or prostheses. These materials typically come in contact with cells, proteins, tissues, organs, and organ systems. They can be implanted for long-term use, e.g., an arrtificial hip, or for temporary use, e.g., an intravenous catheter. Except in isolated cases when a material is used by itself, such as collagen injections for filling soft tissue defects, biomedical materials are used as a component in a medical device. The form of the material (perhaps a textile) how it interfaces (blood contacting, for instance), and its time of use will determine its required properties. A material's use needs to be viewed in the context of the total device and its interface with the body. One material property alone is unlikely to lead to a successful and durable device, but the failure to address a key property can lead to device failure. Until recently, medical-grade polymers, ceramics, inorganics, and metals were purified versions of commercial-grade materials. A variety of polymers, biopolymers, and inorganics is now being specifically developed for medical applications. Table I summarizes the types of biomedical materials.

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Neurological Adverse Events Determine Morbidity and Mortality Post Allogeneic Hematopoietic Cell Transplantation

Blood ◽

10.1182/blood-2018-99-112032 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 5732-5732

Author(s):

Ioanna Sakellari ◽

Eleni Gavriilaki ◽

Sotirios Papagiannopoulos ◽

Maria Gavriilaki ◽

Ioannis Batsis ◽

...

Keyword(s):

Adverse Events ◽

Cell Transplantation ◽

Research Funding ◽

Hematopoietic Cell Transplantation ◽

Wide Spectrum ◽

Chronic Gvhd ◽

Human Herpesvirus ◽

Neurological Complications ◽

Hematopoietic Cell

Abstract Introduction: Despite advances in the field, diagnosis and management of the wide spectrum of neurological events as sequelae of allogeneic hematopoietic cell transplantation (alloHCT) remain challenging. Therefore, we investigated the incidence, diagnosis, management and long-term prognosis of neurological complications in alloHCT recipients. Methods: We enrolled consecutive allogeneic HCT recipients transplanted in our center (7/1990-9/2017). We performed a retrospective review of data in our prospectively acquired database. Results: Among 758 alloHCT recipients, 127 (16.8%) patients presented with neurological complications. Interestingly, neurological complications were more common in unrelated or alternative donors (p<0.001), ALL diagnosis (p<0.001) reduced intensity or toxicity regimens (p=0.037). In the multivariate model, these variables remained independent predictors of neurological complications. Neurological adverse events presented late post-transplant (median +140day, interquartile range/IR 232). Timing of neurological complications was associated only with acute and chronic graft-versus-host-disease/GVHD (p=0.001 and p<0.001, respectively). The majority of patients developed central nervous system/CNS complications (89.7%). 11 patients (8.7%) presented with >1 episodes (median 10.4 months, IR 25.1). Based on symptoms, timing and additional testing, neurological complications were classified into: CNS relapse (24), thrombotic microangiopathy (12), CNS hemorrhage (7), posterior reversible encephalopathy (6), drug-associated polyneuropathy (7) and seizure (6), other leukoencephalopathy (8), thromboembolic events (5), neuralgia (4), myopathy (3), sinusoidal obstruction syndrome (1), Guillain-Barre syndrome (1), Wernicke encephalopathy (1), myelitis (1) and multiple sclerosis (1). Opportunistic CNS infections were attributed to aspergillosis (12), mucormycosis (3), Cytomegalovirus (9), Epstein-Barr encephalitis (3) or lymphoproliferative disease (4), Human herpesvirus 6 (5), Human herpesvirus 7 (2), toxoplasmosis (3); while others could not be otherwise specified (10). Resolution of neurological complications was achieved in only 37 (29%) patients. With a median follow-up of 11.4 months (IR 30.3) in patients with neurological complications, incidence of chronic GVHD was 52.8%, relapse mortality 48.6%, treatment-related mortality 39.1% and 5-year overall survival (OS) 25.8% in patients with neurological complications. In the multivariate analysis, favorable OS was independently associated with resolution of neurological syndromes, absence of chronic GVHD and sibling transplantation. In the whole cohort, acute, chronic GVHD and relapse rates did not differ between patients with or without neurological complications. However, bacterial, viral and fungal infections were significantly increased in patients with neurological complications (p<0.001), possibly reflecting the immunosuppression status of these patients. Patients with neurological complications exhibited significantly decreased 10-year disease-free survival (21.7% versus 41.1%, p<0.001) in our cohort. 10-year OS was also significantly lower in patients with neurological complications (24.9% versus 46%, p<0.001), as shown in Figure. The same was true for 10-year OS when analysis was limited to non-relapsed patients with or without neurological complications (30.2% versus 57.9%, p<0.001). In the multivariate survival analysis of the whole cohort, unfavorable independent predictors of OS were: acute and chronic GVHD (beta=0.566, p<0.001 and beta=1.541, p<0.001, respectively), relapse (beta=0.566, p<0.001), fungal and bacterial infections (beta=0.705, p=0.013 and beta=0.784, p=0.039, respectively) and neurological complications (beta=0.685, p=0.008). Conclusions: Our large retrospective study highlights the wide spectrum of manifestations and etiologies of neurological complications in alloHCT recipients. Prompt diagnosis is required for adequate management, a major of determinant of survival. Thus, long-term increased awareness and collaboration between expert physicians is warranted to improve patient outcomes. Figure. Figure. Disclosures Gavriilaki: European Hematology Association: Research Funding. Vardi:Janssen: Honoraria; Gilead: Research Funding.

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Development of Diabetes Type 3 After SARS-COV-2 Pancreatic B Cell Injury

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.760 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A373-A373

Author(s):

Francisco Jose Zayas ◽

Marianne Hernandez-Negron ◽

Michelle Marie Mangual Garcia

Keyword(s):

Blood Glucose ◽

Previous History ◽

Endocrine System ◽

Diabetes Type ◽

The Body ◽

C Peptide ◽

Organ Systems ◽

History Of ◽

Type 3

Abstract SARS-COV-2 has caused millions of deaths in less than one year, yet little is known about the long-term consequences survivors may suffer. The novel coronavirus uses the ACE2 receptor to infect human cells, allowing it to target organ systems with such receptors including the respiratory, cardiovascular, gastrointestinal and endocrine system. The purpose of this case report is to describe the long-term implications COVID-19 may cause in the endocrine system. A 46-year-old woman was referred to our clinic due to abrupt uncontrolled blood glucose levels ranging from 200-550mg/dL after being infected with COVID-19 for approximately 10 weeks. She has a past medical history of Diabetes Mellitus Type 2 which was diagnosed 3 years ago and was well controlled with diet. Present history reveals polyuria, polydipsia, tiredness and a decreased appetite. Laboratory values show HbA1C 12, negative islet cell antibodies/GAD antibodies, low C-peptide, high TSH, normal FT4 and positive anti-TPO antibodies/thyroglobulin antibodies. The sudden loss of blood glucose control along with low c peptide levels without evidence of autoimmunity support the diagnosis of Pancreatic Diabetes. SARS-COV-2 infection may cause Diabetes Type 3, rendering a patient dependent on insulin use for life. Covid-19 survivors, with or without a previous history of endocrinopathy, should be evaluated for possible long-term sequels of infection as the virus targets tissues throughout the body.

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MDMA-Associated Liver Toxicity: Pathophysiology, Management, and Current State of Knowledge

AACN Advanced Critical Care ◽

10.4037/aacnacc2019852 ◽

2019 ◽

Vol 30 (3) ◽

pp. 232-248

Author(s):

Ruff Joseph Macale Cajanding

Keyword(s):

Young Adults ◽

Liver Toxicity ◽

Wide Spectrum ◽

The Body ◽

Current Evidence ◽

Recreational Drug ◽

Nursing Management ◽

Related Factors ◽

Current State ◽

Organ Systems

3,4-Methylenedioxymethamphetamine (MDMA, ecstasy) has become a popular recreational drug of abuse among young adults, partly because of the belief that it is relatively safe compared with other drugs with the same stimulant and hallucinogenic effects. However, MDMA use has been associated with a wide spectrum of organ toxicities, with the liver being severely affected by its deleterious effects. This article discusses the essential pharmacology of MDMA and describes the effects MDMA has on various organ systems of the body, with particular focus on the liver. The putative mechanisms by which MDMA can cause liver damage are explored, with emphasis on patient-related factors that explain why some individuals are more susceptible than others to damage from MDMA. The incidence of hepatotoxicity related to MDMA use is presented, and the nursing management of patients who develop acute liver failure due to MDMA overuse is explored in light of current evidence.

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Epithelial ingrowth following laser in situ keratomileusis (LASIK): prevalence, risk factors, management and visual outcomes

BMJ Open Ophthalmology ◽

10.1136/bmjophth-2017-000133 ◽

2018 ◽

Vol 3 (1) ◽

pp. e000133 ◽

Cited By ~ 12

Author(s):

Darren Shu Jeng Ting ◽

Sathish Srinivasan ◽

Jean-Pierre Danjoux

Keyword(s):

Risk Factors ◽

Wide Spectrum ◽

Visual Outcome ◽

Primary Treatment ◽

Early Postoperative Period ◽

Laser In Situ Keratomileusis ◽

Epithelial Ingrowth ◽

Clinical Presentations

The number of laser in situ keratomileusis (LASIK) procedures is continuing to rise. Since its first application for correcting simple refractive errors over 25 years ago, the role of LASIK has extended to treat other conditions, including postkeratoplasty astigmatism/ametropia, postcataract surgery refractive error and presbyopia, among others. The long-term effectiveness, predictability and safety have been well established by many large studies. However, due to the creation of a potential interface between the flap and the underlying stroma, interface complications such as infectious keratitis, diffuse lamellar keratitis and epithelial ingrowth may occur. Post-LASIK epithelial ingrowth (PLEI) is an uncommon complication that usually arises during the early postoperative period. The reported incidence of PLEI ranged from 0%–3.9% in primary treatment to 10%–20% in retreatment cases. It can cause a wide spectrum of clinical presentations, ranging from asymptomatic interface changes to severe visual impairment and flap melt requiring keratoplasty. PLEI can usually be treated with mechanical debridement of the affected interface; however, additional interventions, such as alcohol, mitomycin C, fibrin glue, ocular hydrogel sealant, neodymium:yttriumaluminum garnet laser and amniotic membrane graft, may be required for recurrent or refractory cases. The aims of this review are to determine the prevalence and risk factors of PLEI; to describe its pathogenesis and clinical features and to summarise the therapeutic armamentarium and the visual outcome of PLEI.

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Berotralstat (BCX7353) is a novel oral prophylactic treatment for hereditary angioedema: Review of phase II and III studies

Allergy and Asthma Proceedings ◽

10.2500/aap.2021.42.210034 ◽

2021 ◽

Author(s):

Michael E. Manning ◽

Jay M. Kashkin

Keyword(s):

Adverse Events ◽

Phase Ii ◽

Hereditary Angioedema ◽

Prophylactic Treatment ◽

Genetic Disorder ◽

The Body ◽

Treatment Burden ◽

On Demand ◽

Phase Ii And Iii

Background: Hereditary angioedema (HAE) is a rare genetic disorder characterized by unpredictable and potentially life-threatening episodes of swelling in various parts of the body. These attacks can be painful and debilitating, and affect apatient’s quality of life. Every patient who experiences an attack should be treated with on-demand medication to mitigateattack severity and duration. Many patients with HAE also receive long-term prophylaxis to reduce the frequency and severity of edema episodes. Although long-term prophylaxis reduces the disease burden for patients with HAE, available intravenous and subcutaneous treatments are accompanied by a significant treatment burden because of the logistical, emotional, and physical challenges posed by their long-term parenteral nature. Androgens are an effective oral prophylactic treatment; however, they are associated with significant adverse events and are not suitable for all patients. Thus, the HAE community has expressed interest in the development of alternative oral prophylactic therapies for preventing HAE attacks.Objective: Here, we review the phase II and III clinical data of berotralstat (BCX7353), which was approved by the U.S. Food and Drug Administration in December 2020.Results: Berotralstat is an oral, second-generation, synthetic, small-molecule plasma kallikrein inhibitor taken once dailyfor the prevention of HAE attacks in patients ages greater than or equal to 12 years. Results from the APeX studies (APeX-1 NCT02870972, APeX-2 NCT03485911, APeX-S NCT03472040, APex-J NCT03873116) demonstrated the efficacy of berotralstat as longterm prophylaxis for patients with HAE, which showed a reduction in the attack rate and on-demand medication usage.Berotralstat was well tolerated, and gastrointestinal treatment-emergent adverse events were generally mild and selflimited.Conclusion: Oral berotralstat is an effective and safe long-term prophylactic treatment for patients with HAE that will provide patients unable to tolerate parenteral therapies with the option of disease control. Berotralstat may be associated with reduced treatment burden compared with injectable therapies, highlighting the importance of patient preference with regard tothe administration route of their HAE prophylactic treatment.

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