Severe neurologic syndrome associated with Middle East respiratory syndrome corona virus (MERS-CoV).

BACKGROUND: Since the identification of the first case of infection with the Middle East respiratory syndrome corona virus (MERS-CoV) in Saudi Arabia in June 2012, the number of laboratory-confirmed cases has exceeded 941 cases globally, of which 347 died. The disease presents as severe respiratory infection often with shock, acute kidney injury, and coagulopathy. Recently, we observed three cases who presented with neurologic symptoms. These are so far the first reported cases of neurologic injury associated with MERS-CoV infection. METHODS: Data was retrospectively collected from three patients admitted with MERS-CoV infection to Intensive Care unit (ICU) at King Abdulaziz Medical City, Riyadh. They were managed separately in three different wards prior to their admission to ICU. FINDING: The three patients presented with severe neurologic syndrome which included altered level of consciousness ranging from confusion to coma, ataxia, and focal motor deficit. Brain MRI revealed striking changes characterized by widespread, bilateral hyperintense lesions on T2-weighted imaging within the white matter and subcortical areas of the frontal, temporal, and parietal lobes, the basal ganglia, and corpus callosum. None of the lesions showed gadolinium enhancement. INTERPRETATION: CNS involvement should be considered in patients with MERS-CoV and progressive neurological disease, and further elucidation of the pathophysiology of this virus is needed.

Huge infra renal abdominal aortic aneurysm presented with concomitant divirticular abscess: A case report.

INTRODUCTION: It is a controversial and difficult problem for a surgeon to manage the simultaneously occurring diseases divirticular abscess and abdominal aortic aneurysm. Mostly surgeons are not willing to execute a non vascular procedures during the repair of an aneurysm because there can be a risk of graft infection. PRESENTATION OF CASE: In this case study, we have explained about the presentation of a huge infrarenal abdominal aortic aneurysm (AAA) that is found to be associated with a divirticular abscess and both needed an intervention. DISCUSSION: It has been suggested by various evidences that a one-stage elective surgical treatment is safer and cost effective for the treatment of patients with an abdominal aortic aneurysm associated with other problems like gastro-intestinal malignancies. However, the high risk of graft infection made the two staged procedure a popular option. CONCLUSION: The major dilemma is in the management of patients with large aneurysm which require an urgent repair and presented with concomitant pathologies that carry a high risk of sepsis. In this case report, we described an unusual presentation of a large aneurysm with a concomitant divirticular abscess where both needed an urgent intervention.

[Macrovesicular hepatic steatosis revealing pregnancy hemophagocytic lymphohistiocytosis]. / Stéatose hépatique macrovésiculaire majeure révélant un syndrome d'activation lymphohistiocytaire postgravidique.

INTRODUCTION: We report a case of post-partum hemophagocytic lymphohistiocytosis with marked macrovesicular hepatic steatosis. CASE REPORT: A 39-year-old woman was admitted for hemophagocytic lymphohistiocytosis with a serum ferritin level of 103,380 µg/L. Thoracic abdominal and pelvic CT-scan showed hepatomegaly with marked steatosis. Liver biopsy confirmed macrovesicular steatosis. The diagnosis was a primary hemophagocytic lymphohistiocytosis. After treatment failure including corticosteroids, intravenous immunoglobulin, tetracycline, acyclovir, antituberculosis drugs, and anti-IL1R therapy, clinical improvement was obtained with intravenous cyclosporine. At 4-year follow-up, the patient remained asymptomatic. CONCLUSION: Several aspects of this report of primary hemophagocytic lymphohistiocytosis are remarkable and include the association with post-partum, the severe radiologic and histologic macrovesicular steatosis, and the dramatic efficacy of cyclosporine.

Determination of mebendazole.

Direct and indirect non-aqueous titrimetric methods for the determination of mebendazole are presented. These methods are reproducible, with relative standard deviations of 0.3%. Mebendazole in tablets (100 mg per tablet) has also been determined spectrophotometrically with use of perchloric acid as solvent. The relative standard deviation was 1.4%. The methods are easy to automate for routine analysis.

Spectrophotometric determination of tranexamic acid with chloranil.

Tranexamic acid is reacted with aqueous alcoholic chloranil, buffered at pH 9, to give a complex with maximum absorption at 346 nm and with an apparent molar absorptivity of 15.7 x 10(3) l.mole(-1).cm(-1). A(max) is linearly related to concentration over the range 2-10 mug ml . When applied to tablets labelled as containing 500 mg each, the mean found was 496 +/- 4 mg. The results were comparable with those of the traditional formol titration method for amino-acids.

First-derivative spectrophotometric determination of salicylic acid in aspirin.

Salicyclic acid has been determined in aspirin powder and tablets by first-derivative spectrophotometry at 316 nm with base-line correction, with a coefficient of variation less than 1%.

Colorimetric determination of piperazine with p-benzoquinone.

Piperazine and its salts are reacted with aqueous alcoholic p-benzoquinone, buffered at pH 5.4, to give a coloured product with maximum absorption at 516nm. The piperazine base has a molar absorptivity of 0.96 x 10(4)l.mole(-1).cm(-1) and Beer's law is obeyed over the range 2-10 mug ml . When applied to three commercial preparations, the proposed method gave mean recoveries within 1% of those obtained by the official gravimetric method. The relative standard deviation was less than 1%.

Spectrophotometric determination of methylphenobarbitone by use of orthogonal polynomials.

A direct spectrophotometric method for the determination of methylphenobarbitone in presence of degradation products is presented. The method is based on use of the combined polynomial method. The coefficient of the combined polynomial P(w), calculated over the wavelength range 228-272 nm at 4-nm intervals, is unaffected by the presence of any degradation products and is linearly related to the methylphenobarbitone concentration with a relative standard deviation of 0.4%. The mean recovery is 99.1 +/- 0.8%. The method can also be used for assessing the stability of methylphenobarbitone.

Colorimetric determination of some sulphonamides with phenothiazine.

Two simple and sensitive calorimetric procedures for determination of some sulphonamides with phenothiazine (thiodiphenylamine) are presented. One is based on reaction in aqueous alcohol solution in presence of hypochlorite, with direct measurement at 515 nm. The other is based on reaction in presence of copper(II) acetate at 70 degrees , extraction with chloroform and measurement at 515 nm. The method is applied to the determination of sulphonamides in pure and tablet form, with a coefficient of variation less than 2%.

Spectrofluorimetric determination of guanethidine sulphate, guanoxan sulphate and amiloride hydrochloride in tablets and in biological fluids using 9,10-phenanthraquinone.

A highly sensitive spectrofluorimetric method for the determination of some drugs of the monosubstituted guanidine derivatives in laboratory made tablets, in spiked human serum and in urine samples is presented. The method is based on the reaction of guanethidine sulphate (I), guanoxan sulphate (II) and amiloride hydrochloride (III) with 9,10-phenanthraquinone (IV) to give highly fluorescent derivatives. The linearity ranges were found to be 0.06-0.96 mug/ml for (I) and (II) and 0.04-0.28 mug/ml for (III), with relative standard deviation less than 2%. Mean percentage recoveries for tablets were found to be 99.9 +/- 1.3, 100.5 +/- 1.1 and 100.0 +/- 1.6 for I, II and III, respectively. For I and III the results are highly correlated with the B.P. methods. Using the synchronous fluorimetry, differentiation between I and II was possible. Chloroform, dichloromethane and ethyl acetate have been used to extract I, II and III, respectively from serum and urine at basic pH, followed by applying the proposed fluorimetric method. Percentage recoveries were found to be 95.7-102.2%. The limit of detection is 0.04 mug/ml for I and II and 0.02 mug/ml for III.

Spectrophotometric and fluorimetric determination of nomifensine maleate.

Three methods have been developed for the determination of nomifensine maleate alone and in capsules: a spectrophotometric, an iodine charge-transfer, and a spectrofluorimetric method. All three give linear calibration graphs, over the ranges 20-100, 1-5 and 0.1-0.5 microg/ml, respectively, with coefficients of variation of 0.8, 1.3 and 1.3%, respectively.

Spectrophotometric determination of vitamin A in oily capsules using first derivative curves.

The first derivative curve (D1) of the absorption spectrum of vitamin A acetate in cyclohexane possesses a trough (D11) at 348 nm and a maximum (D12) at 306 nm. D11, D12, and delta D1 (= D11 - D12) are linearly related to concentration over a range of 5-25 i.u. ml-1. When a tangent is drawn between D1 at 400 nm and D1, at 306 nm, the amplitude at 348 nm (D1 corr.) is linearly related to concentration. Ratios of magnitude of D11/magnitude of D12 and D1(corr.)/magnitude of D1 are independent of concentration, and have been used to reveal the presence of interferences in the D1 curves of vitamin A in oily capsules. Vitamin A in two oily preparations has been assayed using delta D1 and D1(corr.). The potency found was within +/- 2% from that obtained by using the B.P. method. The method is rapid, precise and accurate.

Spectrophotometric determination of flunarizine dihydrochloride through the formation of charge-transfer complex with iodine.

A spectrophotometric method is described for the assay of flunarizine dihydrochloride. The method is based on the molecular interaction between the drug and iodine, to form a charge-transfer complex in which the drug acts as n-donor and iodine as sigma-acceptor. The iodine was found to form charge-transfer complex in a 1:1 stoichiometry with absorption bands at 295 and 355 nm. The concentrations were linear over 8-13 micrograms ml-1 at both 295 and 355 nm, respectively. A complete, detailed investigation of the formed complex was made with respect to its composition, associated constant and free energy change. The method has been applied successfully to the analysis of commercially available flunarizine dihydrochloride capsules without interference from the capsules excipient. To validate the proposed method, its accuracy and precision, the results were statistically compared with a newly developed reversed-phase HPLC procedure using Student-t and F-ratio tests.

Polarographic determination of phenytoin and benzophenone (as impurity) in pharmaceutical preparations.

A differential pulse polarographic method is described for detection and trace determination of benzophenone (the main impurity) in phenytoin powder. The method depends upon the polarographic activity of benzophenone in Britton-Robinson buffer pH 5.6. The limit of detection was found to be 2.5 x 10(-6) microg ml(-1). Phenytoin has been analysed polarographically after oxidation with alkaline permanganate to give benzophenone; the limit of detection was found to be 6 x 10(-6) microg ml(-1).

Liquid chromatographic determination of flunarizine dihydrochloride in the presence of its degradation product.

A simple, stability-indicating liquid chromatographic method has been developed for the assay of flunarizine dihydrochloride in the presence of its acid-induced degradation product. A Bondapak-C18 column was used with a mobile phase consisting of methanol-water (75:25, v/v) containing 0.5% w/v sodium chloride and 0.2% v/v triethanolamine adjusted to pH 6.6 with 30% hydrochloric acid at a flow rate 2 ml min-1. Quantitation was achieved with UV detection at 254 nm based on peak area or peak height ratios. The proposed method was successfully applied to the determination of the drug in laboratory-prepared mixtures in the presence of its degradation product and in capsules. Moreover, the method was utilized to investigate the kinetics of the degradation process at different temperatures and the apparent first-order rate constant, half-life and activation energy calculated.

Spectrophotometric analysis of some guanidino drugs by acid-dye and charge-transfer complexation methods.

Two spectrophotometric methods are described for the determination of guanethidine sulphate (I), guanfacine hydrochloride (II), guanoclor sulphate (III), guanoxan sulphate (IV) and debrisoquine sulphate (V). The first method involves ion-pair formation of the selected compounds (I-V) with bromocresol purple at pH 3.8. The yellow ion pair is extracted with chloroform and the absorbance is measured at about 415 nm. The second method is based on the reaction of the basic guanidino compounds (I, III-V) with iodine in chloroform to give molecular charge-transfer complexes with maximum absorbance at 292 and 345 nm. Beer's law was obeyed for both methods and the relative standard deviations were found to be less than 2%. The apparent molar absorptivities were found to be 2.1 x 10(4) to 6.9 x 10(4) l mol-1 cm-1 using bromocresol purple and 0.7 x 10(4) to 2.4 x 10(4) l mol-1 cm-1 using iodine. The investigated drugs were assayed in tablets. The mean percentage recoveries were found to be 99.8-100.8% by the acid-dye method and around 100.4% by the charge-transfer complexation method.

High performance liquid chromatographic determinations of khellin, phenobarbitone and dipyrone combination in tablets.

High performance liquid chromatographic methods for the individual determination of khellin, phenobarbitone and dipyrone in tablets are presented. The methods specify a reverse phase column: methanol + water (68 + 32) as mobile phase at a flow rate of 0.7 ml/min with detection at 254 nm for khellin, visgnagin and dipyrone; water + ammonia + methanol (94.5 + 0.5 + 5) as a mobile phase at a flow rate of 0.7 ml/min with detection at 240 nm for phenobarbitone. At sensitivity of 0.01 AUFS, linearity ranges were found to be 0.5-4 micrograms/ml for khellin, 2.5-12.5 micrograms/ml for dipyrone and 1-7 micrograms/ml for phenobarbitone and with relative standard deviations less than 2%. The mean percentage recoveries +/- SD of khellin, dipyrone and phenobarbitone added to tablets were found to be 101.0 +/- 0.65, 100.0 +/- 0.74 and 99.9 +/- 0.74, respectively. The system can detect 2% w/w visnagin in khellin.

The use of Fourier functions to eliminate interferences in spectrophotometric analysis (theory and application).

The basic principle for the use of Fourier functions in spectrophotometric analysis is discussed. Fourier function coefficients are linearly related to concentration and are associated with relative standard deviations of less than 1%. The proper choice of function and range, number of points and the transformation of an absorption curve are discussed. New trigonometric functions are derived to correct for linear irrelevant absorption. The method is illustrated by the determination of progesterone and testosterone propionate in oily solutions without prior chromatography. The results obtained are compared with those obtained using orthogonal polynomials.

Determination of mepyramine, aminophenazone, nialamide and chloroquine using the deltapj method.

Mepyramine maleate, aminophenazone, nialamide and chloroquine phosphate are examples of compounds which do not fulfil the requirements of the delta A method. By the proper choice of polynomial and wavelengths, the deltapj method has been successfully applied to their determination. The mean percentage recoveries were found to be 100.2 +/- 0.8, 99.6 +/- 0.6, 99.1 +/- 1.7 and 100.4 +/- 1.3, respectively.