SummaryThis retrospective analysis assessed the response, safety and duration of response to standard dose rituximab 375 mg/m 2 weekly for four weeks as therapy for patients with primary or secondary warm autoimmune haemolytic anaemia (WAIHA), who had failed initial treatment. Thirty-four patients received rituximab for WAIHA in seven centres in the Republic of Ireland. The overall response rate was 70Á6% (24/34) with 26Á5% (9/34) achieving a complete response (CR). The time to response was 1 month post-initiation of rituximab in 87Á5% (21/24) and 3 months in 12Á5% (3/24) of patients. The median duration of follow-up was 36 months (range 6-90 months). Of the patients who responded, 50% (12/24) relapsed during follow up with a median time to next treatment of 16Á5 months (range 6-60 months). Three patients were re-treated with rituximab 375 mg/m2 weekly for four weeks at relapse and responded.There was a single episode of neutropenic sepsis. Rituximab is an effective and safe treatment for WAIHA but a significant number of patients will relapse in the first two years post treatment. Re-treatment was effective in a small number of patients, suggesting that intermittent pulse treatment or maintenance treatment may improve long-term response.

To determine the efficacy and safety profile of rhubarb and α-keto analogs of essential amino acids supplementation in patients of diabetic nephropathy (DN), we studied 96 patients of DN attending a tertiary care center of the North India. The patients were randomly divided into three equal interventional groups. Group I (control) that received conservative management along with placebo, Group II (rhubarb) that received conservative management along with rhubarb capsule (350 mg, thrice daily), and Group III [keto amino acid (KAA)] that received conservative management along with α-keto analogs of essential amino acids (600 mg, thrice daily). The treatment was continued for 12 weeks. Clinical and biochemical parameters were assessed at 0, 4, 8, and 12 weeks of treatment. A progressive improvement in clinical features and biochemical parameters was seen in all three groups after 12 weeks of treatment. The KAA group showed more marked improvement in clinical features as well as biochemical parameters compared to the rhubarb group. There was a reduction in blood glucose, blood urea, serum creatinine, and 24 h total urine protein. There was an increase in hemoglobin, 24 h total urine volume, and glomerular filtration rate. There was no statistical difference between the rhubarb and KAA groups with respect to side effects (P > 0.05). Our study suggests that KAA is more effective than rhubarb as add-on therapy with conservative management in patients of DN.

Classification of the ANCA-associated vasculitides remains controversial. Existing systems, developed by the American College of Rheumatology (ACR) in 1990, the Chapel Hill Consensus Conference (CHCC) in 1994 and updated in 2012, and the European Medicines Agency algorithm, all have deficiencies, especially when applied to unselected patients. The ACR system did not include ANCA or microscopic polyangiitis, and the CHCC (1994) included MPA but not ANCA (this was rectified in the 2012 revision). These systems were developed as classification criteria and not as diagnostic criteria. There are currently no validated diagnostic criteria for AAV. The Diagnostic and Classification Criteria for Vasculitis (DCVAS) study is a global study with the objective of developing and validating diagnostic criteria.

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Our objective was to determine if highly active antiretroviral therapy (HAART), previously shown to ameliorate several pathological features of HIV encephalitis (HIVE) in a SCID mouse model, would also reduce additional established pathological features of HIV: cognitive dysfunction, TNF-alpha, production, and reduced MAP-2 expression. SCID mice with HIVE and control mice inoculated with uninfected monocytes were administered HAART or saline. The HIV pathological features evaluated included astrogliosis, viral load, neuronal apoptosis, MAP-2 expression, mouse TNF-alpha mRNA production and learning acquisition and retention. HAART reduced the HIV-induced viral load, and the astro- and microgliosis as previously observed; this effect was extended to HIV-induced increases in TNF-alpha mRNA production. In contrast, although HIV produced the cognitive deficits previously observed and also decreased MAP-2 expression in the area surrounding the injected HIV-infected human monocytes, HAART did not attenuate these effects. Interestingly, there was no neuronal apoptosis evident at the time point reflecting the above pathology. The results of this study combined with previous reports indicate that HAART reduces TNF-alpha mRNA, viral load and astrogliosis; however, HAART does not improve HIV-induced cognitive dysfunction or MAP-2 decreases. These results suggest that viral load, astrogliosis, TNF- alpha and apoptosis are not prominent in the pathogenesis of early functional deficits related to decreased MAP-2 expression or cognitive dysfunction in HIVE in SCID mice.

Objective. To evaluate the efficacy and safety of Rhubarb supplementation in patients of chronic kidney disease. Material and Methods. This study was a prospective comparative study conducted in patients of chronic kidney disease (stages 3 & 4) attending Renal Clinic of Department of Medicine, JN Medical College & Hospital, AMU, Aligarh. Patients were randomly divided into two interventional groups. Group I (Control) was given conservative management while Group II (Rhubarb) received conservative management along with Rhubarb capsule (350 mg, thrice daily) for 12 weeks. Haemogram and renal function tests were measured at 0, 4, 8, and 12 weeks of treatment. Results. There was progressive improvement in clinical features in both the groups after 12 weeks of treatment but Rhubarb group showed more marked improvement as compared to control group. Both groups showed gradual improvement in the biochemical parameters as compared to their pretreated values which was more marked in Rhubarb supplemented group. There was reduction in blood glucose, blood urea, serum creatinine, and 24 hour total urine protein (TUP). There was increase in haemoglobin, 24 hour total urine volume (TUV), and glomerular filtration rate (GFR). There was no statistical difference in two groups with respect to side effects (P > 0.05). Conclusion. Rhubarb supplementation improved the therapeutic effect of conservative management in stage 3 and stage 4 patients of chronic kidney disease.

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Objectives: Tuberculosis is one the most prevalent microbial diseases worldwide and hepatotoxicity is one of the major side effects of first line anti-tubercular drug, Isoniazid. The reported pharmacological activities of Nigella sativa oil include protection from liver damage caused by diseases, chemicals and chemotherapeutic agents. The aim of the present study was to evaluate therapeutic potential of Nigella sativa oil in hepatotoxicity induced by using Isoniazid. Methods: Isoniazid (50 mg/kg) was administered to all the animals for 28 days orally. Silymarin (50 mg/kg) was used as standard drug for this study. From 29 th day onwards isoniazid was stopped and therapeutic agents -normal saline, silymarin, Nigella sativa oil 0.5 ml /kg and 1ml/kg were given orally for the next 15 days in different animal groups respectively. On 44 th day rats were sacrificed, blood samples were collected for biochemical analysis and liver tissue was subjected to histopathological examination. Results: The rats treated with N. sativa oil showed significant reduction in the liver enzymes and total bilirubin levels when compared to negative control group. There was also significant improvement in the histopathological scores in N. sativa oil treated group when compared to the negative control group. Conclusion:This study demonstrates the effectiveness of Nigella sativa oil as a therapeutic agent in hepatotoxicity induced by isoniazid in a dose dependant manner.