Efficacy of selenium supplementation on autoantibody titers in Graves' Ophthalmopathy

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Selenium (Se) shows potential benefit in Graves' disease (GD) especially those with active Graves' ophthalmopathy(GO).   <br /><strong>OBJECTIVES:</strong> To evaluate the efficacy of Se supplementation among patients with GD and GO. <br /><strong>METHODOLOGY:</strong> We performed a meta-analysis of trials evaluating the efficacy of Se supplementation among adult patients with GD and active GO, versus either placebo or an alternative drug, and on top of standard therapy. Results were presented as mean differences, standard errors, and 95% confidence intervals,and graphically presented as forest plots.Estimates were calculated using the inverse variance method for continuous variables and pooled using the fixed effects model. I2 and Chi2 tests were used to assess heterogeneity.<br /><strong>RESULTS:</strong> Only  two  trials  were  ultimately  included  in  the  analysis. Both studies totaled 197 participants with GD and non-severe  GO  on  standard  therapy,  and  compared  Se  supplementation to placebo. The only common outcomes of  interest  were  changes  in  TSH  receptor  antibody  (TRAB)  and thyroid peroxidase antibody (TPOAB) titers. We found no statistically significant difference in either TRAB (95% CI,-1.38  [-3.19,  0.44],  p=0.14)  or  TPOAB  (95%  CI,  36.66  [-32.56, 105.88], p=0.30) titers between Se and placebo groups on follow  up.However,our analysis was limited by the small number of included studies, a small sample size, and lack of other synthesizable outcomes.<br /><strong>CONCLUSION:</strong> This is the  first  meta-analysis  summarizing  the available data on Se supplementation in patients with GD and  non-severe  GO.We found no statistically significant differences in both TRAB and TPOAB titers between Se and placebo groups. We recommend larger studies to validate these findings. </p>

Kikuchi Fujimoto disease: A series of three cases

@#<p style="text-align: justify;"><strong>INTRODUCTION:</strong> Kikuchi-Fujimoto disease (KFD) is a  rare self-limited disorder manifested by painful cervical lymphadenopathies commonly associated with fever and night sweats.This is a series of three female patients presenting with fever and lymphadenopathies diagnosed with KFD.<br /><strong>CASE:</strong> The first case is a 34-year-old female admitted due to fever of 10 days associated with lymphadenopathies and joint pains.Excision biopsy done showed necrotizing histiocytic lymphadenitis consistent with KFD.Other laboratories showed hypocomplementemia, positive ANA and anti-dsDNA.Patient was discharged improved with low dose oral corticosteroid and hydroxychloroquine.The second case is a 53-year-old female with fever,lymphadenopathies,polyarthritis and morning stiffness.Biopsy of the cervical lymph node was done showing KFD and lupus serologies (ANA 1:640 speckled, anti-dsDNA and anti-Smith) revealed positive results as well.Patient was then diagnosed with SLE and was started on low dose oral corticosteroid and hydroxychloroquine which resulted to resolution of fever and gradual resolution of lymph nodes on out-patient follow up.The last case is a 45-year-old female admitted due to persistent fever, painful lymphadenopathies and headache. Serological work-up including autoantibody tests for SLE were all unremarkable but showed associated iron deficiency anemia. Biopsy of the cervical lymph node showed Kikuchi's disease. Patient was discharged with oral methylprednisolone.<br /><strong>CONCLUSION:</strong> The rarity of KFD makes defining an autoimmune etiology a challenge to clinicians.Careful disease course follow up is then recommended for patients who initially lack parameters for SLE diagnosis.</p>