Infliximab biosimilar for treating neurosarcoidosis: tolerance and efficacy in a retrospective study including switch from the originator and initiation of treatment

Journal of Neurology - Infliximab is increasingly used to treat neurosarcoidosis. We aimed to determine the efficacy and tolerance of an infliximab biosimilar for treating neurosarcoidosis. We...     

Revisiting Grade 3 Diffuse Axonal Injury: Not All Brainstem Microbleeds are Prognostically Equal

Background

Recovery of functional independence is possible in patients with brainstem traumatic axonal injury (TAI), also referred to as “grade 3 diffuse axonal injury,” but acute prognostic biomarkers are lacking. We hypothesized that the extent of dorsal brainstem TAI measured by burden of traumatic microbleeds (TMBs) correlates with 1-year functional outcome more strongly than does ventral brainstem, corpus callosal, or global brain TMB burden. Further, we hypothesized that TMBs within brainstem nuclei of the ascending arousal network (AAN) correlate with 1-year outcome.

Methods

Using a prospective outcome database of patients treated for moderate-to-severe traumatic brain injury at an inpatient rehabilitation hospital, we retrospectively identified 39 patients who underwent acute gradient-recalled echo (GRE) magnetic resonance imaging (MRI). TMBs were counted on the acute GRE scans globally and in the dorsal brainstem, ventral brainstem, and corpus callosum. TMBs were also mapped onto an atlas of AAN nuclei. The primary outcome was the disability rating scale (DRS) score at 1 year post-injury. Associations between regional TMBs, AAN TMB volume, and 1-year DRS score were assessed by calculating Spearman rank correlation coefficients.

Results

Mean ± SD number of TMBs was: dorsal brainstem = 0.7 ± 1.4, ventral brainstem = 0.2 ± 0.6, corpus callosum = 1.8 ± 2.8, and global = 14.4 ± 12.5. The mean ± SD TMB volume within AAN nuclei was 6.1 ± 18.7 mm³. Increased dorsal brainstem TMBs and larger AAN TMB volume correlated with worse 1-year outcomes (R = 0.37, p = 0.02, and R = 0.36, p = 0.02, respectively). Global, callosal, and ventral brainstem TMBs did not correlate with outcomes.

Conclusions

These findings suggest that dorsal brainstem TAI, especially involving AAN nuclei, may have greater prognostic utility than the total number of lesions in the brain or brainstem.

     

Dermatology in Botswana: The American Academy of Dermatology's Resident International Grant

In 2008, the American Academy of Dermatology began sponsoring North American dermatology residents to travel to Botswana in sub-Saharan Africa and spend 4 to 6 weeks working with the Botswana-UPenn Partnership, the Baylor International Pediatrics AIDS Initiative, Princess Marina Hospital, and surrounding smaller district hospitals. During their time in Botswana, the residents staff the busy outpatient dermatology clinic and see adult and pediatric inpatients at Princess Marina Hospital in Gaborone, the capital city. The residents also travel to 4 rural hospitals to provide clinical services to patient and education to local health care providers. The program goals include providing direct care to the people of Botswana, capacity-building through dermatologic education for local clinicians, and educating the residents about delivering dermatologic care in resource-limited and culturally diverse settings and using teledermatology consulting services. Since the start of the program, more than 1500 patients have been seen, and 35 residents would have completed the program by the end of 2010.     

Residential mobility in a cohort of primiparous women during pregnancy and post-partum

OBJECTIVE: To quantify the residential mobility rate in a population of pregnant women expecting their first baby. METHOD: We verified residential mobility in a cohort of 585 primiparous Australian women who were enrolled in late pregnancy and had participated in a randomised controlled trial and followed-up to at least 16 weeks post-partum. RESULTS: We found a residential mobility rate of 19%. Movers and non-movers differed by socio-demographic factors, with movers more likely be younger, relative risk (RR)=2.14 (95% confidence interval (CI) 1.41-3.13), and not living with a partner RR=2.46 (95% CI 1.60-3.77). CONCLUSION: Most prospective epidemiological studies can expect some attrition in the study population. The family formation period is acknowledged as a highly mobile time and this mobility may contribute to loss to follow-up. Implications: Researchers planning prospective studies in pregnant populations should consider the impact of residential mobility, especially differential mobility, and implement strategies to reduce attrition and optimise response rates.     

Stem cell transplantation in advanced cutaneous T-cell lymphoma

Cutaneous T-cell lymphomas are a type of indolent non-Hodgkin's lymphoma where patients with limited skin disease can be successfully treated with a variety of skin-directed, systemic, and immunomodulating therapies, whereas durable remissions are difficult to achieve in patients with tumor, erythrodermic, or systemic disease. We describe a patient with cutaneous T-cell lymphoma and malignant cells constituting 99% of her peripheral blood lymphocytes who had a sustained complete response after an HLA-matched sibling allogeneic stem cell transplantation. We also review the current literature regarding both autologous and allogeneic stem cell transplantations for advanced stages of cutaneous T-cell lymphoma, discuss the importance of the graft-versus-tumor immunomodulatory effect in successful transplantations, and suggest that allogeneic stem cell transplantation deserves further consideration and study as a potential treatment for selected patients who are younger and at high risk.