Rituximab induced pulmonary fibrosis in a patient with lupus nephritis.

We describe a 26-year-old woman who was diagnosed eleven years ago with systemic lupus erythematosus and who had suffered multiple relapses. She presented with class IV lupus nephritis with thrombotic microangiopathy, for which she received three doses of rituximab along with plasmapheresis, with no response, and soon became dialysis dependent. One month after the last dose of rituximab, she presented with dyspnoea and hypoxia. A transbronchial lung biopsy revealed pulmonary fibrosis. A diagnosis of rituximab induced pulmonary fibrosis was made after excluding other causes and she was treated with intravenous methyl prednisolone with which there was marked improvement in symptoms and hypoxemia. This is the first report of rituximab induced pulmonary fibrosis in a patient with lupus nephritis.

Effect of dietary intake before F-18 FDG positron emission tomographic scanning on the evaluation of a solitary pulmonary nodule.

The uptake of fluorine-18 fluorodeoxyglucose (F-18 FDG) by a malignant tumor depends on the blood glucose level. The authors present a striking case that illustrates the importance of blood glucose measurement in F-18 FDG positron emission tomographic (PET) imaging in a patient with a solitary pulmonary nodule. With the emergence of freestanding imaging centers, this case emphasizes the importance of using an objective method, such as a glucometer, to measure blood glucose levels before F-18 FDG PET imaging. Results of the initial scan were equivocal (the patient had eaten before the scan), whereas a hypermetabolic focus was clearly identified on a second scan obtained 2 days later.

Efficacy of basiliximab induction in poorly matched living donor renal transplantation.

Non-depleting antibody induction has the best safety profile in transplant recipients without an increased risk of infection or malignancy. This observational study was performed in intermediate immunologic risk live donor renal transplants to assess basiliximab efficacy in patients on tacrolimus, mycophenolate, and prednisolone immunosuppression. A total of 46 patients on basiliximab induction were compared to risk matched 56 controls at the end of 6 and 12 months post-transplant. An additional cost of approximately Rs. 100,000/patient was incurred by the basiliximab group. The incidence of biopsy proven acute rejection in the control group (12.5%, 6 months and 20.5%, 1 year) and the basiliximab group (13%, 6 months and 18.9%, 1 year) was similar. At 6 months, there was a non-significant trend toward more steroid sensitive rejections and better glomerular filtration rate preservation in the basiliximab group (83.3%, 71.9 ml/min) versus the control group (28.6%, 62.2 ml/min). However, this difference was lost at 1 year (70.1 ml/min vs. 67.6 ml/min). The incidence of infections was similar and none of the patients had a malignancy. Death censored graft survival (94.6% basiliximab and 94.8% control) and the mean number of hospitalizations for all reasons at the end of 1 year were not different among the two groups. In our study, basiliximab induction did not confer an additional advantage in the intermediate risk live donor transplants in patients on tacrolimus and mycophenolate based triple drug immunosuppression.

Psychrobacter vallis sp. nov. and Psychrobacter aquaticus sp. nov., from Antarctica.

Twelve strains of psychrophilic bacteria were isolated from cyanobacterial mat samples collected from various water bodies in the McMurdo Dry Valley region of Antarctica. All the isolates were Gram-negative, non-motile, coccoid, psychrophilic, halotolerant bacteria and had C(16 : 1)omega7c, C(17 : 1)omega8c and C(18 : 1)omega9c as the major fatty acids, ubiquinone-8 as the respiratory quinone and DNA G+C content of 41-46 mol%. Based on these characteristics, the isolates were assigned to the genus Psychrobacter. Based on their SDS-PAGE profiles, the 12 isolates could be categorized into three groups. Six isolates of Group I were identified as representing strains of Psychrobacter okhotskensis. However, using detailed phenotypic and chemotaxonomic characteristics and phylogenetic analysis based on their 16S rRNA gene sequences, strain CMS 39(T), the only strain from Group II, and strain CMS 56(T), a representative strain of Group III, were different from each other and from all recognized species of Psychrobacter. Therefore, it is proposed to classify CMS 39(T) (=DSM 15337(T)=MTCC 4208(T)) and CMS 56(T) (=DSM 15339(T)=MTCC 4386(T)) as representing the type strains of novel species of Psychrobacter, for which the names Psychrobacter vallis sp. nov. and Psychrobacter aquaticus sp. nov., respectively, are proposed.

Effects of antimanic mood-stabilizing drugs on fetuses, neonates, and nursing infants.

Pregnancy presents a special problem to the clinician treating bipolar disorders in women. Since the first episode of mania typically occurs before the age of 30, many women in their prime childbearing years may be exposed to potentially teratogenic mood-stabilizing agents. This exposure may also continue for the nursing infant during lactation. Pregnancy itself can exacerbate bipolar symptoms and also alter the pharmacokinetics of mood-stabilizing drugs. Risks to mother and fetus can be reduced with a number of simple strategies, including monotherapy with the lowest effective dose of a drug for the shortest period necessary, periconceptional use of multivitamins with folate, prescription of drugs with established safety records, and avoidance of exposure to antimanic agents during the first trimester of pregnancy. In this article, we review existing evidence on the risks to fetuses and nursing infants of mothers taking specific mood-stabilizing agents, and we present appropriate management guidelines designed to minimize these risks.

Psychrophilic pseudomonads from Antarctica: Pseudomonas antarctica sp. nov., Pseudomonas meridiana sp. nov. and Pseudomonas proteolytica sp. nov.

Thirty-one bacteria that belonged to the genus Pseudomonas were isolated from cyanobacterial mat samples that were collected from various water bodies in Antarctica. All 31 isolates were psychrophilic; they could be divided into three groups, based on their protein profiles. Representative strains of each of the three groups, namely CMS 35(T), CMS 38(T) and CMS 64(T), were studied in detail. Based on 16S rRNA gene sequence analysis, it was established that the strains were related closely to the Pseudomonas fluorescens group. Phenotypic and chemotaxonomic characteristics further confirmed their affiliation to this group. The three strains could also be differentiated from each other and the closely related species Pseudomonas orientalis, Pseudomonas brenneri and Pseudomonas migulae, based on phenotypic and chemotaxonomic characteristics and the level of DNA-DNA hybridization. Therefore, it is proposed that strains CMS 35(T) (=MTCC 4992(T)=DSM 15318(T)), CMS 38(T) (=MTCC 4993(T)=DSM 15319(T)) and CMS 64(T) (=MTCC 4994(T)=DSM 15321(T)) should be assigned to novel species of the genus Pseudomonas as Pseudomonas antarctica sp. nov., Pseudomonas meridiana sp. nov. and Pseudomonas proteolytica sp. nov., respectively.