Mycophenolate mofetil (CellCept): an alternative therapy for autoimmune inflammatory myopathy

OBJECTIVES: Mycophenolate mofetil (MMF) is a new immunosuppressive agent currently being used for the prevention of renal allograft rejection. MMF is a specific inhibitor of lymphocytes and is well tolerated leading to its use in other autoimmune diseases. We have used MMF for the treatment of seven patients with inflammatory myopathy and are hereby reporting our results. CASE SERIES: All of our patients were females (age 17-65 yr). They were symptomatic upon presentation and met classification criteria for idiopathic inflammatory myopathy. Inflammatory markers such as erythrocyte sedimentation rate and C-reactive protein as well as creatine kinase were significantly elevated in all the patients, indicating active disease. Corticosteroids were concomitantly being administered (20-60 mg/day of prednisone). Initial therapy with conventional immunosuppressives was either ineffective or had significant adverse effects leading to their discontinuation. MMF was started in doses of 500 mg twice a day and titrated up to 1 g twice a day. RESULTS: Our patients have exhibited an impressive serological response to therapy with MMF and six patients had a marked improvement in their weakness. One patient had incomplete improvement in her weakness and has required additional therapies. MMF has been well tolerated during the treatment period (12-36 months). CONCLUSION: A striking clinical and laboratory response of active myositis in six out of seven patients in this series illustrates that MMF can be effectively used in management of autoimmune inflammatory myopathy and may be a suitable alternative to the conventional immunosuppressive agents.     

Advances in Sudden Death Prevention: The Emerging Role of a Fully Subcutaneous Defibrillator

Randomized clinical trials support the use of implantable defibrillators for mortality reduction in specific populations at high risk for sudden cardiac death. Conventional transvenous defibrillator systems are limited by implantation-associated complications, infection, and lead failure, which may lead to delivery of inappropriate shocks and diminish survival. The development of a fully subcutaneous defibrillator may represent a valuable addition to therapies targeted at sudden death prevention. The PubMed database was searched to identify all clinical reports of the subcutaneous defibrillator from 2000 to the present. We reviewed all case series, cohort analyses, and randomized trials evaluating the safety and efficacy of subcutaneous defibrillators. The subcutaneous defibrillator is a feasible development in sudden cardiac death therapy and may be useful particularly to extend defibrillator therapy to patients with complicated anatomy, limited vascular access, and congenital disease. The subcutaneous defibrillator should not be considered in patients with an indication for cardiac pacing or who have ventricular tachycardia responsive to antitachycardia pacing. Further investigation is needed to compare long-term, head-to-head performance of subcutaneous defibrillators and conventional transvenous defibrillator systems.     

Haemangioma or vascular malformation of the tympanic membrane? a case report and review of literature

Benign vascular lesions are rarely found on the tympanic membrane. We report a case of such a lesion in a novel location, with review of the relevant literature. We also highlight the significance of accurate classification of such lesions, proposing adoption of more pathophysiologically-correct nomenclature of “haemangioma” and “vascular malformation”.     

Haemangioma or vascular malformation of the tympanic membrane? a case report and review of literature

Benign vascular lesions are rarely found on the tympanic membrane. We report a case of such a lesion in a novel location, with review of the relevant literature. We also highlight the significance of accurate classification of such lesions, proposing adoption of more pathophysiologically-correct nomenclature of “haemangioma” and “vascular malformation”.     

Rheumatoid arthritis: diagnosis and management

Accurate diagnosis of rheumatoid arthritis may be difficult early in its course and demands high clinical suspicion, astute examination, and appropriate investigations. Early use of disease-modifying antirheumatic drugs and biologics has improved outcomes but requires close monitoring of disease course and adverse events.     

Multiplex detection of four pathogenic retroviruses using molecular beacons

We describe a multiplex nucleic acid assay that identifies and determines the abundance of four different pathogenic retroviruses (HIV-1, HIV-2, and human T-lymphotrophic virus types I and II). Retroviral DNA sequences are amplified in a single, sealed tube by simultaneous PCR assays, and the resulting amplicons are detected in real time by the hybridization of four differently colored, amplicon-specific molecular beacons. The color of the fluorescence generated in the course of amplification identifies which retroviruses are present, and the number of thermal cycles required for the intensity of each color to rise significantly above background provides an accurate measure of the number of copies of each retroviral sequence that were present originally in the sample. Fewer than 10 retroviral genomes can be detected. Moreover, 10 copies of a rare retrovirus can be detected in the presence of 100, 000 copies of an abundant retrovirus. Ninety-six samples can be analyzed in 3 hr on a single plate, and the use of a closed-tube format eliminates crossover contamination. Utilizing previously well characterized clinical samples, we demonstrate that each of the pathogenic retroviruses can be identified correctly and no false positives occur. This assay enables the rapid and reliable screening of donated blood and transplantable tissues.