Effects of metformin on autoimmune immunoglobins and interferon-γ in patients with early diagnosed pemphigus vulgaris: a prospective clinical trial.

The management of pemphigus vulgaris (PV) is challenging. This study aimed to evaluate the immunomodulating effects of metformin on PV. The study was conducted in two phases: in the first phase, patients received routine first-line treatment (prednisolone plus azathioprine) for 2 months, then in the second phase, metformin was added to this regimen for another 2 months. After addition of metformin to the first-line medications, significant reductions were seen in serum IgG1 (reduced from 534.92 ± 134.83 mg/dL to 481.58 ± 130.46 mg/dL, P < 0.001), IgG4 (51.83 ± 27.26 mg/dL to 44.50 ± 26.05 mg/dL, P < 0.001) and interferon-γ (277.99 ± 108.71 pg/mL to 45.05 ± 17.080 pg/mL, P = 0.03) concentrations. The suppressant effect of metformin was greatest on IgG4 (coefficient of variation 1.28), the dominant subclass of IgG involved in PV. Metformin could have immunomodulating effects on PV with controlling effects on steroid complications.

Endomyocardial Biopsy via the Femoral Vein Using a Long, Curved Sheath.

BACKGROUND: Endomyocardial biopsy (EMB) has been defined as the gold standard method for surveillance of rejection after heart transplantation, and it has also been used in the diagnosis of myocarditis and the unknown causes of cardiomyopathies. The procedure, however, is not free from complications. Access through the jugular vein or the femoral vein is the standard approach. In this study, we performed biopsies by using a long, curved sheath and evaluated the rate of complications with this technique. METHODS: In this descriptive case series study, 97 EMBs were performed in 72 patients who were referred to a cardiovascular and medical research center in Tehran, Iran, between October 2011 and May 2013. The procedures were performed via the femoral approach by using a long bioptome with a long, curved sheath. RESULTS: Adequate specimens were obtained in 97.9% of the total EMBs, with an average of 5 fragments per procedure. No deaths occurred, and there were no cases of pericardial effusion, myocardial rupture, papillary muscle rupture, increase in the severity of tricuspid regurgitation, atrioventricular block, sustained and nonsustained ventricular tachycardia, or atrial fibrillation. There was one case of persistent right bundle branch block. CONCLUSIONS: Using a long, curved sheath can facilitate access to the interventricular septum compared with common sheaths and can be used safely in EMB via the femoral approach.