Quantitative [1]H NMR spectroscopy for analysis of topiramate in presence of its degradation products

High-resolution NMR Spectroscopy is a powerful tool in the elucidation of a structure with respect to constitution, configuration and conformation. In recent years, NMR has increasingly used in quantitative analysis. In the present study, we describe the degradation of topiramate under different ICH stress conditions [acid, base, oxidation, neutral], and show the ability of [1]H NMR for selective determination of drug substance and drug product. The NMR method described here is able to determine the content of topiramate in presence of less than 1.0% of its degradation products. The limit of detection and quantification were found to be 0.04 mM/0.5 ml and 0.13 mM/0.5 ml DMSO-d[6] respectively. The described method has advantages over the reported methods as the assay was completed in less than 3 min with high accuracy and selectivity. It is concluded that [1]H NMR is a versatile concept for routine analysis with respect to time and cost. The method was validated according to ICH guidelines with satisfied results and can be successfully applied for quality evaluation and stability testing

Anti-cyclic citrullinated peptide antibodies in juvenile rheumatoid arthritis: prevalence and association with clinical, laboratory and radiographic findings

Objective: To study the prevalence of anti-cyclic citrullinated peptide [anti-CCP] antibodies in patients with juvenile rheumatoid arthritis [JRA] and to evaluate the association of these antibodies with clinical manifestations, laboratory investigations and radiographic outcomes

Patients and Methods: The study comprised 65 JRA patients [26 with polyarticular onset, 28 with pauciarticular onset and 11 with systemic onset]. All patients were subjected to complete history taking, thorough clinical examination, and laboratory investigations including determination of anti-CCP antibodies, rheumatoid factor [RF] and antinuclear antibodies [ANA]. Radio graphs of hands and feet of all patients were also evaluated

Results: Anti-CCP antibodies were found in 11/65 [16.9 %] of the patients. The prevalence rates of these antibodies were 34.6 %, 7.1 % and 0.0 % in JRA patients with polyarticular onset, pauciarticular onset, and systemic onset respectively. In JRA patients with polyarticular onset and RF-positive, the prevalence of anti-CCP antibodies was 70%. Presence of anti-CCP antibodies was found to be significantly associated with late disease onset, polyarticular onset, polyarticular course, RF positivity and radiographic joint damage

Conclusion: The overall prevalence of anti-CCP antibodies in JRA is not high; however, these antibodies can be detected in a substantial proportion of JRA patients with polyarticular onset and RF-positive. Anti-CCP antibodies in JRA are associated with late disease onset, polyarticular onset, polyarticular course and RF positivity. In addition, presence of these antibodies in JRA patients is indicative for poorer radiological outcome, so cautious radiographic follow up is recommended for JRA patients having anti-CCP antibodies

Comparative study of cognitive behavior versus relaxation therapies in rehabilitation of chronic fatigue syndrome patients

Objective: To evaluate the efficacy of cognitive behavior therapy [CBT] versus relaxation therapy [RT] in rehabilitation of patients suffering from chronic fatigue syndrome [CFS]

Methodology: Forty patients with CFS were randomly divided into 2 groups, each including 20 patients. Group I was treated by 12 sessions of CBT; while group II was managed by 12 sessions of RT. Patients were evaluated at study entry [baseline], at end of treatment and 6 months after treatment [Follow up]. Parameters of evaluation were fatigue severity, physical functioning, work status [hours worked per week] and subjective assessment

Results: The study was completed by 35 patients [18 in group 1 and 17 in group II]. At end of treatment and 6 months after treatment, patients undergoing CBT showed significantly higher improvements than patients receiving RT on measures of fatigue severity, physical functioning and work status [p>0. 05 ]. On comparing with basal values, group I patients scored highly significant improvements [p>0.001] in fatigue severity, physical functioning and work status at end of treatment and these improvements were sustained over 6 months after treatment, while group II patients had significant improvements [p>0.05] in these outcome measures at end of treatment, however these improvements were not maintained up to 6 months. Regarding subjective evaluation, CBT patients had better results with significant difference compared with RT patients at end of treatment and 6 months after treatment. In group I, percentages of patients who were satisfied or improved were 72.2% and 61.1% at end of treatment and at 6 months after treatment respectively. In group II, these percentages were 47.0% and 17.7% respectively

Conclusion: Cognitive behavior therapy is more effective than relaxation therapy in rehabilitation of patients with chronic fatigue syndrome. Improvements are sustained up to 6 months in patients undergoing cognitive behavior therapy