BackgroundCancer survivors suffer from many comorbid conditions even after the cure of their cancers beyond 5 years. We explored the differences in the association of comorbid conditions between the cancer survivors and patients without cancer.MethodsElectronic medical records of 280 adult cancer survivors and 280 age-matched patients without cancer in our suburban internal medicine office were reviewed.ResultsMean age of the cancer survivors was 72.5 ± 13.1 years, and the age of the patients without cancer was 72.5 ± 12.8 years. The number of male cancer survivors was significantly higher than the female cancer survivors (52.5% vs. 47.5%, P < 0.001). There were significantly more Caucasians and other races (majority Asians) in the cancer survivor group compared to the patients without cancer group (81.8% vs. 79.3% and 4.6% vs. 0.4%, respectively, P < 0.05); while there were significantly less African Americans and Hispanics in the cancer survivor group compared to the patients without cancer group (10.0% vs. 12.8% and 3.6% vs. 7.5%, respectively, P < 0.05). Hypertension (64.3%), hyperlipidemia (56.1%), osteoarthritis (34.3%), hypothyroidism (21.8%), diabetes mellitus (21.8%) and coronary artery disease (21.8%) were the most common comorbid conditions observed in the cancer survivors. Osteoarthritis was the only comorbid condition that was significantly less frequently associated with the cancer survivors compared to the patients without cancer (42.9%, P < 0.05). The frequencies of all other comorbid conditions were not significantly different between the two groups. The majority of our group of cancer survivors had one or more types of the top six cancers which include prostate cancer (30.7%), melanoma (13.9%), thyroid cancer (11.4%), colon cancer (11.1%), uterine cancer (11.1%) and urinary bladder cancer (11.1%); while only a few had cancer of the cervix (6.1%) or breast cancer (0.3%). Use of aspirin, statin, vitamin D, multivitamins, metformin and fish oil supplement in the cancer survivors was similar to the patients without cancer.ConclusionsHypertension, hyperlipidemia, osteoarthritis, hypothyroidism, diabetes mellitus and coronary artery disease are the most common associated comorbid conditions in the cancer survivors. Osteoarthritis is less frequently seen in the cancer survivors compared to the patients without cancer. The frequencies of other comorbid conditions are not significantly different between the two groups.

Although primarily a respiratory illness, coronavirus disease 2019 (COVID-19) has been associated with cardiac involvement with reported cases of myocardial ischemia, arrhythmia, myocarditis, pericarditis, and pericardial effusion leading to cardiac tamponade. Most cases of pericardial disease in this setting have been during the acute infection. Here, we present a patient who developed pericarditis leading to cardiac tamponade after the resolution of the acute COVID-19 infection. Her course of illness was further complicated by poor response to initial medical therapy with non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine which could possibly be related to early exposure to steroids. It is often difficult to establish an underlying etiology for acute pericarditis. Similarly, in our case, although there is no definitive test to prove the causal relationship, this effusion is highly suspicious of being secondary to post viral sequelae after COVID-19 infection when considering the clinical course. It is important to consider pericardial disease as a late complication of COVID-19 even after apparent resolution of the acute infection and be mindful of the therapeutic challenges that we might face while managing such patients.

Background We present a patient with central and peripheral hypogonadism, decreased libido, and erectile dysfunction, who was previously diagnosed with Kallmann syndrome confirmed by serum hormone panel and ultrasonography. Clinical Case A 27-year-old male with a past medical history of hypogonadotropic hypogonadism, Kallmann syndrome, obesity, and dyslipidemia presented to the clinic with concerns about his reproductive health. There was no family history of hypogonadism. He was diagnosed with Kallmann syndrome at the age of 14 due to short stature and had been treated using testosterone therapy. He had paused therapy for 6 months prior to the visit for the trial of a new medication, Menopur, to improve his fertility. However, the therapy had failed to improve his sperm count. Laboratory tests showed a subclinical total testosterone level of 7 ng/dL which was consistent with hypogonadism, so testosterone therapy was restarted with weekly 200 mg/mL testosterone cypionate intramuscular injections. Results were also significant for dyslipidemia with total cholesterol 299 mg/dL, triglycerides 240 mg/dL, HDL 38 mg/dL, LDL-c 217 mg/dL, and elevated BMI of 38.52 kg/m2, for which the patient was started on rosuvastatin 20 mg daily and counseled on lifestyle modification. HbA1c levels were in the pre-diabetic range of 5.8%, and he was started on metformin 500 mg BID. On a repeat visit, the patient complained of painless testicular swelling, for which ultrasonographic imaging was ordered. The results showed bilateral small testes for age measuring 1.9×1.4×1.2 cm on right and 2.5×1.4×1.4 cm on left with a 0.6×0.4 cm left epididymal cyst and evidence of mild right hydrocele and left varicocele. The patient was referred to a genitourinary specialist for further investigation. On follow-up visit, the patient presented with new labs showing improvement with total testosterone 943 ng/dL, free testosterone 255.6 pg/mL, FSH &lt;0.7 mIU/mL, and estradiol 64 pg/mL. The patient continued with testosterone therapy over the long term after failing the trial of Menopur for fertility improvement. Conclusion Failing of hormonal replacement in improving the fertility inpatient with central hypogonadism warranty the importance of gonadal examination. This is a patient with a past medical history of hypogonadotropic hypogonadism, who had been treated with testosterone since the time of diagnosis to improve his short stature and secondary sexual characteristics. Given the clinical picture of his testes and failed trial of a new drug regimen, there was a low chance of regaining fertility for this patient. Presentation: No date and time listed

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