Characteristics and outcome of crescentic glomerulonephritis in patients with both antineutrophil cytoplasmic antibody and anti-glomerular basement membrane antibody.

A subset of patients with crescentic glomerulonephritis (CGN) is characterized serologically by the presence of antineutrophil cytoplasmic antibody (ANCA) and anti-glomerular basement membrane antibody (anti-GBM) called "double positive" disease. The clinical significance of the occurrence of both antibodies is not clear. This study aims to describe the clinical and histologic characteristics and outcomes of CGN in a US cohort of double positive (DP) patients and compare them to patients with anti-GBM disease only or ANCA only (ANCA-associated vasculitis (AAV)). Renal biopsies with a diagnosis of CGN with either pauci-immune or linear immunofluorescence were selected and classified as AAV, anti-GBM disease, or DP based on serologic testing at the time of biopsy. Data on demographics, clinical presentation, treatment, and outcome were obtained by chart review. Six patients with anti-GBM disease, 9 with DP disease, and 18 AAV patients matched for year of diagnosis with DP were identified. Extrarenal disease manifestations were more prominent in the DP patients. The DP patients had severe renal dysfunction at presentation with eight of nine patients requiring dialysis at presentation. Renal biopsy findings of DP patients were similar to anti-GBM disease with majority of glomeruli showing cellular crescents. Eighty-nine percent of patients were treated with immunosuppressive therapy and 78 % with plasmapheresis. At 1 year, all nine DP patients reached end-stage renal disease. We conclude that the DP patients share extrarenal manifestations similar to AAV patients while the renal manifestations resemble anti-GBM patients clinically and histologically. The renal prognosis of DP patients remains poor despite treatment.

Residual solvent analysis in hydrochloride salts of active pharmaceutical ingredients.

GMP conditions commands to control adequately the quality of APIs by checking the levels of residual solvents. Organic solvents such as acetone, ethyl acetate, isopropyl alcohol, methanol, tetrahydrofuran and toluene frequently used in pharmaceutical industry for the manufacturing of Active Pharmaceutical ingredients (APIs). A selective Gas Chromatographic (GC) method has been developed and validated as per ICH guidelines for residual solvent analysis in 10 different hydro chloride salts of APIs. Residual solvents in APIs were monitored using gas chromatography (GC) with Flame Ionisation detector (FID). The separation was carried out on BP 624 column (30 mx0.53 mm i.d.x0.25 m coating thickness), using GC 17 A shimadzu, with nitrogen as carrier gas in the split mode by direct injection method. The method described is simple, sensitive, rugged, reliable and reproducible for the quantitation of acetone, ethyl acetate, isopropyl alcohol, methanol, tetrahydrofuran and toluene at residual level from hydrochloride chloride salts of APIs.

Simultaneous determination of salbutamol sulphate and bromhexine hydrochloride in tablets by reverse phase liquid chromatography.

A simple reverse phase liquid chromatographic method has been developed and subsequently validated for simultaneous determination of salbutamol sulphate and bromhexine hydrochloride. The separation was carried out using a mobile phase consisting of acetonitrile, methanol and phosphate buffer, pH 4 in the ratio 60:20:20 v/v. The column used was SS Wakosil-II C-18 with a flow rate of 1 ml/min and UV detection at 224 nm. The described method was linear over a concentration range of 10-110 mug/ml and 20-140 mug/ml for the assay of salbutamol sulphate and bromhexine hydrochloride, respectively. The mean recovery was found to be 95-105% for salbutamol sulphate and 96.2-102.1% for bromhexine hydrochloride when determined at five different levels.

Pericardial effusion in patients with schizophrenia: are they on clozapine?

Clozapine is used in the treatment of resistant schizophrenia. It is used as a reserve drug mainly because of its adverse effect profile affecting gastrointestinal, haematological and cardiorespiratory systems. Cardiac side effects are uncommon but could be potentially life threatening, hence early recognition and active monitoring are essential to prevent serious cardiac side effects. A case of pericarditis with pericardial effusion is described in a patient who was recently started on clozapine which disappeared within 1 week after discontinuation of clozapine.

RPLC Determination of Tinidazole and Diloxanide Furoate in Tablets.

A simple reverse phase liquid chromatographic method has been developed and subsequently validated for simultaneous determination of tinidazole and diloxanide furoate. The separation was carried out using a mobile phase consisting of acetonitrile, methanol and 0.2 M potassium dihydrogen phosphate (pH 5) in the ratio 2:3:2.The column used was SS Wakosil-II C-18 with a flow rate of 1 ml/min and UV detection at 282 nm. The described method was linear over a concentration range of 10-70 µg/ml and 10-90 µg/ml for the assay of diloxanide furoate and tinidazole, respectively. The mean recovery was found to be 100-101% for tinidazole and 97-103% for diloxanide furoate when determined at three different levels.

Persistent left-sided superior vena cava--a pacing challenge.

A left sided superior vena cava (LSVC) occurs in 0.3% of the population. LSVC normally drains into the right atrium through a dilated coronary sinus. We illustrate two cases of dual chamber permanent pacemaker implantation by using (1) left subclavian vein in a 35-year-old woman with symptomatic Mobitz type II atrioventricular block; and (2) right subclavian vein in a 64-year-old man who was hospitalized with bradycardia, complete heart block, and alternating bundle branch block. After accessing the subclavian vein, the pacing leads were advanced into the LSVC, which was situated to the left of the vertebral column in the mediastinum. The leads followed the course of the LSVC medially before entering into the right atrium. Once inside the right atrium, the ventricular lead made a U-turn towards the tricuspid valve and into the right ventricle by shaping the stylet, and it was helped by right atrial contraction. An active fixation atrial lead was used in both cases to secure a satisfactory location within the right atrium. A small volume of contrast can be injected into the pacing sheath to visualize the coronary sinus opening into the right atrium, and the right ventricle. Fluoroscopy in oblique views can be helpful in guiding the atrial lead into the anteriorly positioned atrial appendage. In emergency transvenous ventricular temporary pacing where the subclavian or internal jugular vein is used, it is important to recognize the presence of a LSVC. The lead should first be directed into the right atrium and then looped back into the right ventricle. Excessive force must be avoided to prevent cardiac perforation and tamponade. If this is not successful, access through a femoral vein should be attempted.

Relationship of intestinal parasitism, malaria and under-nutrition to prevalence of anaemia in an urban community.

The presence of intestinal parasitic infection, malaria and under-nutrition in relation to prevalence of anaemia was evaluated in a cluster of urban population in Hyderabad. Prevalence of anaemia was 25.7 per cent by clinical assessment from pallor as against 80.5 per cent by estimation of haemoglobin concentration. Presence of intestinal parasitic infection (48.4 per cent) and malaria infection (18.3 per cent) had no statistical significant association with anaemic state. Under-nutrition (31.9 per cent of anaemic individuals) and low per capita monthly income of Rs. 100 and below (60.9 per cent of enaemic individuals) had a statistically significant relationship to anaemia. Clinical assessment of anaemia from pallor had a low sensitivity (31.9 per cent) and a high false negative rate (54.9 per cent), though clinical pallor had a strong statistical association to the presence of anaemia. (p less than 10.01), (Q = 1.0).