Efficacy and safety of quercetin and polyvinylpyrrolidone in treatment of patients with newly diagnosed destructive pulmonary tuberculosis in comparison with standard antimycobacterial therapy

Objective/background: The objective/background of this work was to study the efficacy and safety of quercetin and polyvinylpyrrolidone (QP) in the treatment of patients with newly diagnosed destructive pulmonary tuberculosis in comparison with standard antimycobacterial therapy. Materials and methods: The study involved 124 patients aged between 20 years and 70 years with newly diagnosed destructive pulmonary tuberculosis. Patients were allocated to two groups. The first (control) group of patients received standard antimycobacterial and pathogenetic therapy and included 31 (25.00 ± 3.89%) patients. The second (main) group of patients received QP therapy in addition to chemotherapy and included 93 (75.00 ± 3.89%) patients. Results: Intoxication symptoms in the second group were reduced following 1.33 ± 0.15 months, whereas in the first group intoxication symptoms were reduced following 2.64 ± 0.20 months, p < .001. Conclusion: Administration of QP combined with chemotherapy in patients with newly diagnosed destructive pulmonary tuberculosis resulted in a comparatively quick reduction of disease manifestation

Neurocysticercosis with symptomatic epilepsy manifestation

Aim To present a unique case of a 22-year-old male patient with symptomatic epilepsy manifestation on a background of neurocysticercosis (NCC). Methods An Indian student in Kharkiv, who lived in rural parts in India, presented with sudden episodes of seizure followed by severe headaches. Laboratory analyses and neurological status (MRI) were performed. Results Neurological status of the patient revealed nystagmus and difficulty in performing co-ordination tests. General analysis of blood showed raised eosinophil count to 8%. The MRI showed a few small conglomerating peripherally enhancing thick-walled infective granulomas in left frontal lobe with extensive surrounding oedema in the left fronto-parietal lobe. The patient was treated with albendazol, levipil, methylprednisolone and pantoprazole. Clinical symptoms and subsequent MRI showed improvement. Conclusion Neurocysticercosis is often misdiagnosed in the early stages, which leads to adverse outcomes. Although seizures are the most common clinical manifestation, it is a symptom that is not found in majority of the patients. The NCC of adult onset accompanying epileptic seizures is not well studied and a link between the helminthic invasion, epilepsy and psychiatric conditions needs to be established. This disease is potentially eradicable with wellplanned eradication programs targeting all stages of Taenia solium life cycle

Association between effectiveness of tuberculosis treatment and cytochrome P-4502E1 polymorphism of the patients

Context: The risk of antituberculosis (TB) drug‑induced liver injury could be determined by patients’ genotype polymorphism of the xenobiotic‑metabolizing enzymes. To find the meaning of cytochrome P‑4502E1 (CYP2E1) polymorphism in TB patients. Corresponding of CYP2E1 polymorphism in TB patients with the level of isoniazid and rifampicin as well as for the outcome and toxicity development during inpatient TB treatment. Methods: CYP2E1 genotype was detected with the help of polymerase chain reaction and endonuclease analysis. The level of rifampicin, isoniazid, diene conjugates (DC), and catalase activity in the blood was determined spectrophotometrically. We have considered medical records at the beginning and at the end of inpatient treatment. Statistical Analysis Used: Kruskal–Wallis, ANOVA, and Chi‑square tests were used in this study. Results: The concentration of rifampicin 6 h after its intake was 17.6% higher in carriers of slow metabolizer (SM) CYP2E1 genotype than in patients with rapid metabolizer (RM) genotype that proved a participation of hepatic enzyme CYP2E1 in metabolism of rifampicin. According to obtained results in TB patients with RM genotype, the indexes of cytolysis (alanine aminotransferase, aspartate aminotransferase) and bile stasis (gamma‑glutathione transferase) were higher comparatively to SM genotype both before and after inpatient treatment. This correlated with a higher concentration of DC in the blood (+8.6%) and lower plasma catalase activity (−50.0%) in the patients with RM genotype comparatively with the patients with SM genotypes. Conclusion: Polymorphism of CYP2E1 genotype is an important criterion for the development of hepatotoxicity before and during TB treatment while increased rifampicin level has no influence on it

Efficacy and safety of quercetin and polyvinylpyrrolidone in treatment of patients with newly diagnosed destructive pulmonary tuberculosis in comparison with standard antimycobacterial therapy

Objective/Background: The aim of this work was to study the efficacy and safety of quercetin and polyvinylpyrrolidone (QP) in the treatment of patients with newly diagnosed destructive pulmonary tuberculosis (TB) in comparison with standard antimycobacterial therapy. Materials and methods: The study involved 124 patients aged between 20 years and 70 years with newly diagnosed destructive pulmonary TB. Patients were allocated to two groups. The first (control) group received standard antimycobacterial and pathogenetic therapy and included 31 (25.0 ± 3.89%) patients. The second (main) group of patients received QP therapy in addition to chemotherapy and included 93 (75.0 ± 3.89%) patients. All patients received standard chemotherapy, consisting of oral isoniazid (0.3g), rifampicin (0.6g), pyrazinamide (2g), ethambutol (1.2g), and/or an intramuscular injection of streptomycin (1g) with a dose reduction after the intensive phase of therapy. The anti-TB drugs were procured through the centralized national supply system in Ukraine. QP was used at a dose of 0.5g in 100 mL 0.9% sodium chloride solution intravenously once per day for 10 days, starting on admission to hospital. Results: Intoxication symptoms in the second group were reduced after 1.33 ± 0.15 months, whereas in the first group, intoxication symptoms were reduced following 2.64 ± 0.20 months (p <0.001). Moreover, respiratory symptom regression in the second group was observed after 1.43 ± 0.30 months, whereas in the first group, it was after 2.33 ± 0.30 months (p <0.05). Bacillary excretion period evaluated within 3 months was reduced, as it was shown by 97.67 ± 1.63% in the main group compared to 72.41 ± 8.45% (p <0.05) in the control group. In addition, the period of cavity healing was reduced to 2.86 ± 0.15 months in the main group compared to 3.43 ± 0.20 months (p <0.05) in the control group. Residual radiological lung damage findings (mild or slight or even no signs) were observed in 84 (90.32 ± 3.07%) patients in the main group versus 22 (70.97 ± 8.15%) patients in the control group. Significant residual radiological lung damage findings were observed in nine (9.68 ± 3.07%) patients in the main group and in nine (29.03 ± 8.15%) patients in the control group (p <0.05). In addition, QP increased anti-TB drug tolerance by 20.42% and had an immunomodulatory effect. Conclusion: Administration of QP combined with chemotherapy in patients with newly diagnosed destructive pulmonary TB resulted in a rapid reduction in disease manifestation

Interleukin-10 gene polymorphism is associated with multi-drug resistant tuberculosis during the intensive phase of standard chemotherapy

Objective/background: To study whether interleukin (IL)-10 gene polymorphism is associated with multi-drug resistant tuberculosis (MDR TB) during the intensive phase of standard chemotherapy. Methods: The study comprised 170 individuals in Kharkiv region of Ukraine including 74 patients with pulmonary MDR TB (Group 1), 66 patients without MDR TB (Group 2), and 30 healthy donors (Group 3). Serum level of IL-10 was evaluated by enzyme-linked immunosorbent assay (pg/L). Measurements of serum samples were conducted before or during the initial days after hospital admission and after 2 months on antituberculous therapy. Investigations of IL-10 gene polymorphism were performed using restriction analysis of the amplification products of specific regions of the genome. The method of investigation (for the sets real-time) — an allele-specific PCR using intercalating coloring Sybr Green. Polymorphism G1082A of gene IL-10 rs1800896 were genotyped with amplification-refractory mutation system-polymerase chain reaction. Results: In Group 1, the level of IL-10 was (38.01 ± 0.78) pg/L, compared with 43.88 ± 0.70 in Group 2, and 50.25 ± 1.26 in Group 3 (p <0.05 among the groups). In Group 1, 56 (75.68 ± 4.99%) patients had heterozygote GA genotype, 11 (14.86 ± 4.14%) patients had homozygote AA genotype, and seven (9.46 ± 3.40%) patients had homozygote GG genotype. In Group 2, 41 (62.12 ± 5.97%) patients had homozygote AA genotype, 17 (25.76 ± 5.38%) patients had heterozygote GA genotype, and eight (12.12 ± 4.02%) patients had homozygote GG genotype. In Group 3, 17 (56.67 ± 9.05%) healthy donors had homozygote GG genotype, seven (23.33 ± 7.72%) healthy donors had heterozygote GA genotype, and six (20.0 ± 7.30%) healthy donors had homozygote AA genotype (p <0.05 among the groups). Following 2 months antituberculous therapy treatment, there was a significant increase in IL-10 levels in Group 1 (44.58 ± 0.78) and Group 2 (50.59 ± 0.99; p <0.05 between the groups), when compared to the beginning of therapy and after 2 months (p <0.001). Conclusion: Compared to the healthy control group, patients with TB had significantly lower levels of IL-10. This coincided with a greater frequency of heterozygote GA genotype in Group 1 and homozygote AA genotype in Group 2. Further studies are warranted to determine whether a higher number of patients without MDR TB have a causal immunogenetic relationship with IL-10 gene polymorphisms than patients with MDR TB. Standard 2-month TB therapy results in reversal of inflammation characterized by increased IL-10 to a level comparable to that in healthy donors. IL-10 is an immune correlate of treatment outcome and can help to identify a better strategy for TB management. TB chemotherapy may have an immunomodulatory effect of an anti-inflammatory nature

Morphological changes in experimental tuberculosis resulting from treatment with quercetin and polyvinylpyrrolidone

AbstractObjective/BackgroundMorphological study of a mice of tissue necrosis stages in experimental organ-preserving tuberculosis (TB) pharmacotherapy using quercetin and polyvinylpyrrolidone (QP).MethodsA total of 32 laboratory mice of C57BL/6JLacSto strain were used in the experiment. The animals were divided into five groups (Group 1–5), with six to seven mice in each group: Group 1, Mycobacterium tuberculosis (MBT)-uninfected mice; Group 2, MBT-infected mice; Group 3, MBT infected and treated with anti-TB preparation (ATP); Group 4, MBT infected and QP treated; and Group 5, MBT infected and treated with ATP and QP. The mice were infected through caudal vein injection with the MTB H37Rv strain. The QP preparation, which belongs to the capillary-stabilizing-remedy group, was used for the research. The ATP included isoniazid and streptomycin. Thus, the drug doses for the mice contained the following drugs: isoniazid (10%, 5mL), 45mg/kg; streptomycin (1g), 90mg/kg; and QP (0.5g), 45mg/kg of the body weight of a mouse. The medicines used in the experimental studies on the mice were applied as follows: isoniazid and streptomycin, administered intramuscularly once a day; and QP, administered intraperitoneally according to a schedule (on the 5th day after the introduction of the infection every 2h, and then every 12h; on the 6th day and 7th day two times a day every 12h).ResultsQP produced a strict delineation of caseous necrosis from the unaffected parts of the connective tissue with fibrosis in the center and a large number of Langerhans cells, which was not observed in the control groups without QP. The combination of QP and ATP had more pronounced effects. In MBT-infected mice, where QP was not used, unlike the group where QP was used, adipose dystrophy of hepatocytes was observed. Thus, the hepatoprotective effect of QP against TB can be suggested.ConclusionUnder the influence of QP, the separation of caseous necrosis of granulomas from unaffected areas begins through connective tissue with fibrotization in the central part and a large number of Langerhans cells and lymphocytes that are not observed in the control groups. The interaction of QP with anti-TB drugs shows more obvious effects: fast tendency of epithelioid cellular tubercles to fibrotization and separation of TB granulomas through connective tissue. In addition, in the control groups of animals infected with TB, in contrast to the experimental groups, fatty degeneration of hepatocytes is observed. Thus, we have shown the hepatoprotective function of QP against TB

Efficacy and Safety of Intravenous Chemotherapy during Intensive Treatment Phase in Patients with Newly Diagnosed Pulmonary Tuberculosis

Introduction: The purpose of our study was to examine the efficacy and safety of intravenous chemotherapy during intensive treatment phase in patients with newly diagnosed pulmonary tuberculosis (pulmonary TB). Material and methods: The study involved 92 patients with newly diagnosed pulmonary TB aged between 20 and 68. All patients with newly diagnosed pulmonary TB and chemosensitive tuberculosis were enrolled in the study. The patients were allocated to two groups. The first (control) group of 46 patients received standard chemotherapy orally. The second (main) group consisted of 46 patients who were prescribed isoniazid, rifampin, ethambutol by i.v. transfusion, and pyrazinamide orally as a part of the standard treatment. Results: Symptoms of intoxication and chest manifestations in pulmonary TB patients from the second group were eliminated faster than the same symptoms in the group 1. In the group 2, the mycobacterial clearance in sputum smears was achieved more rapidly, and up to 2 months it was reached in 37 patients (80.43%), while in the control group in 25 patients (54.35%), p = 0.0066. Destruction healing and inflitrative change alleviation after 4 months was reached in 38 patients (82.61%) (in control group—28 (60.87%), (p = 0.0192). No additional negative effects were detected when compared with the control group at any time. Conclusions: Thanks to i.v. chemotherapy, clinical manifestations of the in-patients with pulmonary TB were eliminated faster, severe side effects of anti-TB drugs were not noticed, time of bacterial clearance and healing destruction was shorter, healing frequency of destructions increased and the of residual changes decreased

Interrelationship of endothelial function parameters in children with bronchial asthma in exacerbation and remission

Introduction: In children with asthma, endothelial dysfunction signs are observed, and their extent depends on the severity of the disease.These changes are also present in remission. High level of soluble Vascular Cell Adhesion Molecule-1 (sVCAM-1) expression causes activeadhesion of inflammatory cells and can indicate direct endothelium participation in development and supporting of chronic inflammation.Bronchial asthma (BA) is characterised by airways chronic inflammation. A special role in this inflammatory process formationis played by development of endothelial dysfunction.The aim of the study was to evaluate endothelial state in children with clinically stable and exacerbated asthma. Material and methods: 91 children with persistent asthma were examined. Among them there were 40 patients with mild persistent(group I), 34 subjects with moderate persistent (group II) and 17 individuals with severe persistent (group III) asthma. 20 healthy childrenwere selected as controls. The serum levels of sVCAM-1 were determined by enzyme-linked immunosorbent assay (ELISA). The ultrasoundassessment of endothelium-dependent flow-mediated dilation of the brachial artery (FMD%) has been made. Ultrasonography has been usedfor investigation of the intima-media thickness (I-M) complex. Data analysis was performed with the Statsoft Statistica Version 8 (Tulsa, OK). Results: The serum levels of sVCAM-1 were significantly increased in the patients with asthma exacerbation (p &lt; 0.001) andremission (p &lt; 0.001), compared with the controls. The index of FMD% was significantly diminished in the patients of I, II, IIIgroup with exacerbation (p &lt; 0.001) and stayed lower in the subjects with asthma in remission (p &lt; 0.001), compared with thecontrols. The thickness of I-M complex was significantly increased in the patients of I, II, III group, compared with the controls(p &lt; 0.001). The endothelium parameter levels: sVCAM-1 (H = 56.11, p = 0.0001), FMD% (H = 43.20, p = 0.0000), the thicknessof I-M complex (H = 49.37, p = 0.0000) depend on the severity of the disease. Correlations between the endothelium andpulmonary function parameters were proved (p &lt; 0.05). Conclusions: Endothelial dysfunction in children with asthma was determined. Dependence of severity of the disease on functionalstate of the vascular endothelium was proved