Asymptomatic paroxysmal ventricular standstill in an elderly male following revascularization of multivessel coronary disease: A case report and literature review.

Ventricular standstill is a dangerous arrhythmia that requires prompt diagnosis and intervention, especially in patients with structural heart disease. Clinicians should recognize ventricular standstill as a complication of cardiac revascularization and be cognizant of asymptomatic cases necessitating intervention. Early evaluation to facilitate pacemaker implantation portends good outcomes in this patient subgroup.

Erenumab for episodic migraine.

In this review, the authors provide an overview of erenumab, a monoclonal antibody used for the preventative treatment of episodic migraine by targeting the CGRP pathway. Randomized controlled trials have shown that erenumab is associated with a statistically significant decrease in monthly migraine days in patients with episodic migraine at monthly doses of 70 or 140 mg when given for a period of 9-12 weeks. Post hoc analyses have also shown long-term maintenance of efficacy. Clinical trials have found erenumab at doses of both 70 and 140 mg to have a favorable safety profile. Erenumab faces significant limitations because of its high financial cost. Additional long-term real-world data are needed to understand the role of erenumab in the treatment of migraine.

In this review, the authors give an overview of erenumab, an injectable medication used to prevent migraine headaches. Erenumab has been proven to be significantly effective in patients with episodic migraines when used at doses of 70 or 140 mg. Furthermore, studies have shown sustained benefit starting as early as the first week of treatment as well as improvement in patients' quality of life. Erenumab has been found to be as safe as placebo in some studies, but there have been some reports of a link to high blood pressure and constipation. However, because of its high cost, patients still face significant barriers to access to erenumab. Additional long-term real-world data are needed to understand the current role of erenumab in the treatment of migraine.

Reactive Thrombocytosis Related Cerebral Venous Thrombosis: A Rare Complication of Untreated Iron Deficiency Anemia.

Thrombocytosis can be either primary or secondary, and it can cause venous pro-thrombotic states like cerebral venous thrombosis. Untreated iron deficiency anemia is postulated to cause reactive (secondary) thrombocytosis due to the proliferation of common progenitor cells. Here we present a case of a middle-aged woman with polycystic ovary syndrome and episodes of menorrhagia. She presented with headache and focal sensory deficits, and her neuroimaging showed evidence of cerebral venous sinus thrombosis (CVST). Laboratory tests showed microcytic hypochromic anemia, low ferritin, high total iron-binding capacity (TIBC), and thrombocytosis with a platelet count of 1,523,000/mm³. A comprehensive workup for hypercoagulable states and primary causes of thrombocytosis was negative. It was concluded that the etiology of her CVST was a reactive thrombocytosis from chronic untreated iron deficiency anemia. Anticoagulation with apixaban and corrective treatment for iron deficiency anemia was initiated. A repeated neuroimaging after four months showed significantly less clot burden in the cerebral venous sinuses, and then apixaban was stopped after six months. Laboratory tests after one year of iron replacement therapy showed improvement in the hemoglobin and hematocrit as well as normalization of platelet count. This case highlights a rare yet potentially dangerous complication of a common untreated condition, i.e., iron deficiency anemia.

Retraction: Idiopathic CD4+ Lymphocytopenia Due to Homozygous Loss of the CD4 Start Codon.

[This retracts the article DOI: 10.7759/cureus.15251.].

A Review of Eptinezumab Use in Migraine.

We present a review of the efficacy and safety profile of eptinezumab (also known by the brand name Vyepti), a calcitonin gene-related peptide (CGRP) monoclonal antibody (mAb) developed by Lundbeck Seattle BioPharmaceuticals, Inc., that received its first approval in the USA on 21 February 2020 for the preventive treatment of migraine in adults. It is administered by an intravenous infusion at a 100 mg dose every 3 months and shows no drug interactions. Studies have shown that eptinezumab is an effective preventative medication in migraine which starts showing its effect from day 1 of its administration, which maintains a consistent level of efficacy through a year of its treatment at doses 100 mg and 300 mg. It was found to be effective at reducing time to headache pain freedom during acute migraine attacks as well. Eptinezumab is a relatively safe drug for the prevention of migraines with treatment-related adverse events occurring at a low frequency. They bear a safe profile in patients with comorbidities like obesity and type 1 diabetes. The most frequent adverse events observed were nasopharyngitis, upper respiratory tract infections (URTIs), and sinusitis and were usually mild. The development of anti-drug antibodies was common, but they declined to undetectable levels with continued dosing and did not appear to impact the overall safety profile of the drug. Further studies are needed to assess long-term safety, use in different patient populations, and to compare its efficacy to other drugs of its class.

Idiopathic CD4+ Lymphocytopenia Due to Homozygous Loss of the CD4 Start Codon.

Idiopathic CD4+ lymphocytopenia (ICL) is an extremely rare condition characterized by low numbers of CD4+ cells (<0.3 K/µL) without human immunodeficiency virus (HIV) infection or any other cause of immunodeficiency. In this case report, we report a case of idiopathic CD4+ lymphocytopenia in a 22-year-old woman initially presenting with insomnia, fatigue, and a sore throat. However, this rapidly progressed to shortness of breath and chest pain, ultimately leading to acute respiratory distress syndrome (ARDS) over the span of a few days. Broad-spectrum antimicrobials were administered, resulting in prompt recovery. Serological studies were negative for malignancy and severe infections, including HIV1 and HIV2. Flow cytometry revealed an absence of CD4+ cells and an increase in double-negative T-cells. Further genetic workup revealed that in the second exon of the CD4 gene, the patient had a homozygous c.1ATG>GTG (p.Met1Val; p.M1V) mutation. Family screening showed that the patient's mother, father, and brother all had a single p.M1V mutation, allowing for deleterious effects to be partially offset by the normal copy of the gene. We have provided an organized analysis of the existing literature in addition to a concise overview of this case, with the intention of identifying patterns in presentation, clinical course, and outcomes. This case discusses the effects of the loss of the CD4+ start codon in the patient. Although this specific form of lymphocytopenia is very uncommon, it illustrates the importance of genetic testing and the integral nature of laboratory testing in therapy charting.