Association between low-dose pulsed intravenous cyclophosphamide therapy and amenorrhea in patients with systemic lupus erythematosus: A case-control study

<p>Abstract</p> <p>Background</p> <p>The risk for amenorrhea following treatment of systemic lupus erythematosus (SLE) patients with low-dose intravenous cyclophosphamide (IVCY) has not been fully explored. Our objective was to ascertain the incidence of amenorrhea following treatment with low-dose IVCY and the association between amenorrhea and the clinical parameters of SLE.</p> <p>Methods</p> <p>A case-control retrospective study of premenopausal women ≤ 45 years old who had been treated for SLE with low-dose IVCY (500 mg/body/pulse) plus high-dose glucocorticoids (0.8-1.0 mg/kg/day of prednisolone; IVCY group) or glucocorticoids alone (0.8-1.0 mg/kg/day of prednisolone; steroid group) in our hospital from 2000 through 2009 was conducted using a questionnaire survey and medical record review.</p> <p>Results</p> <p>Twenty-nine subjects in the IVCY group and 33 subjects in the steroid group returned the questionnaire. A multivariate analysis revealed that age at initiation of treatment ≥ 40 years old was significantly associated with amenorrhea [<it>p </it>= 0.009; odds ratio (OR) 10.2; 95% confidence interval (CI) 1.8-58.7]. IVCY treatment may display a trend for association with amenorrhea (<it>p </it>= 0.07; OR 2.9; 95% CI 0.9-9.4). Sustained amenorrhea developed in 4 subjects in the IVCY group and 1 subject in the steroid group; all of these patients were ≥ 40 years old. Menses resumed in all subjects < 40 years old, irrespective of treatment.</p> <p>Conclusions</p> <p>Although low-dose IVCY may increase the risk for amenorrhea, our data suggest that patients < 40 years old have a minimum risk for sustained amenorrhea with low-dose IVCY treatment. A higher risk for sustained amenorrhea following treatment with IVCY is a consideration for patients ≥ 40 years old.</p

Winter Depression: Clinical, Psychosocial and Biochemical Characteristics

Seasonal Affective Disorder with depressive episodes during the autumn/winter seasons (winter depression) is common. Outpatients with winter depression were studied regarding temperament, psychopathology, social characteristics, psychosocial functioning and the neuropeptides corticotropin - releasing hormone (CRH) and neuropeptide Y (NPY), which are known to be involved in stress-regulation. The temperamental factors were measured by the Karolinska Scales of Personality and the Marke-Nyman Temperament questionnaire, the psychopathology was assessed by the Comprehensive Psychopathological Rating Scale, the social network by the Interview Schedule for Social interaction, the social adjustment by the Social Adjustment Scale, Self-Rating version and the psychosocial functioning by the Global Assessment of Function scale. The neuropeptides were analyzed by using immunoreactive ligands. Comparisons were made with patients with nonseasonal depression who were inpatients after attempting suicide, healthy controls, and data retrieved from the published literature. Patients with winter SAD displayed a specific, asthenic and hostile temperamental state compared to the healthy controls but less anxiety and hostility than the nonseasonal suicide attempters. SAD patients were found to have a severe, multisymptomatic psychopathology. They had higher ratings than the nonseasonal suicide attempters on the reported psychopathological items while the ratings on the observed items were similar. The social situation and the clinical background of SAD and suicide attempters were similar and both groups had equally weak social networks. SAD patients also displayed significantly lower concentrations of CRH and NPY than those of healthy controls. The CRH and NPY deviations in SAD were not significantly different from those of suicide attempters. It is concluded that patients with SAD have a specific temperamental constitution, a severe, multisymptomatic psychopathology, considerable social impairments and neuropeptide deviations which are similar to those of suicide attempters with non-seasonal major depression. Thus, the results of the studies included in this thesis reveal that SAD-patients are troubled by relatively serious symptoms. These findings oblige us to re-examine the common notion that SAD is a trivial disorder