A randomized double blinded clinical trial to explore the clinical outcomes of vaginal isonicotinic acid hydrazide (INH) administration six hours prior to T380A intrauterine device insertion in persons delivered only by cesarean delivery

OBJECTIVE

To compare insertion pain and ease of insertion in participants with a prior caesarean delivery having copper intrauterine device (IUD) after pretreatment with isonicotinic acid hydrazide (INH) 900 mg vaginally or placebo.

STUDY DESIGN

From September 2020 to September 2021, we conducted a randomized, double-blind, placebo-controlled experiment at Aswan University Hospital in Egypt with participants who were delivered solely by caesarean delivery and desired copper T380A IUD insertion. The participants were randomly assigned to either vaginal INH or placebo six hours before IUD insertion in a 1:1 ratio. The primary objective of the research was the individuals' self-reported pain during cervical tenaculum placement, sound insertion, IUD insertion, and 5 minutes after the placement, as measured by a 10-cm visual analogue scale (VAS). Our secondary outcomes were ease of insertion, satisfaction, the need for analgesics, and adverse effects. IUD insertion ease was graded from 0 to 10 on a 10-cm VAS scale, with 0 suggesting very easy insertion and 10 denoting extremely difficult insertion.

RESULTS

When compared to the placebo group, the INH group experienced considerably less pain during IUD insertion (2.9±0.85vs.5.11±0.82;p<0.01), lower median ease of insertion score (3(1-4)vs.5(3-6);p<0.01), and better satisfaction (8.17±0.69vs.5.57±0.75). The two groups had comparable side effects.

CONCLUSIONS

Vaginal INH administered before IUD insertion reduce the amount of discomfort participants feel throughout the process in individuals who had previously only been delivered via CD. It also has the potential to make insertion easier.

IMPLICATIONS

In participants who were delivered solely by CD before, vaginal INH given prior to IUD placement reduces the amount of discomfort participants experience throughout the procedure. Furthermore, it could increase the ease of insertion.

Andrographis paniculata mitigates first-line anti-tubercular drugs-induced nephrotoxicity in Wistar rats

CONTEXT

Anti-tubercular drugs (ATDs) mediated adverse drug reactions are major concerns for clinicians to treat tuberculosis infection. This study aimed to investigate Andrographis paniculata extract-based phytotherapy to combat the nephrotoxic effects caused by ATDs therapy.

METHODS

Reno-protective effect of A. paniculata extract in ATDs-induced rats was evaluated through LPO, GSH, CAT, SOD, GST, urea, creatinine, uric acid, and histopathological studies. Standardization of the extract was performed RP-HPLC and FTIR analysis. Whereas, the effect of A. paniculata extract on ATDs induced genetic perturbation was analyzed using micronucleus assay. Moreover, the expression level of the xenometabolic gene was investigated using RT-PCR to explore the therapeutic mechanism.

RESULTS

The nephrotoxic effect of ATDs was indicated by elevated levels of LPO and renal function markers along with the reduced activity of renal antioxidants. An up-regulated expression profile of NAT gene and histological alterations were observed in renal tissue however, micronucleated PCEs were observed in bone marrow cells. Concomitant treatment with A. paniculata extract revealed a noticeable amelioration of elevated oxidative stress markers, gene expression levels, genotoxic perturbation, and histological alterations in a dose-dependent manner.

CONCLUSION

Hence, the present study using A. paniculata leaf extract confirmed to play effective phytotherapy against ATDs induced renal toxicity.

Antifungal Activity of the Phenolic Compounds Ellagic Acid (EA) and Caffeic Acid Phenethyl Ester (CAPE) against Drug-Resistant Candida auris

Candida auris is an emerging healthcare-associated fungal pathogen that has become a serious global health threat. Current treatment options are limited due to drug resistance. New therapeutic strategies are required to target this organism and its pathogenicity. Plant polyphenols are structurally diverse compounds that present a vast range of biological properties. In the present study, plant-derived molecules ellagic acid (EA) and caffeic acid phenethyl ester (CAPE) were investigated for their antifungal and antivirulence activities against Candida auris. We also tested against C. albicans. The minimum inhibitory concentration (MIC) for EA ranged from 0.125 to 0.25 µg/mL and for CAPE ranged from 1 to 64 µg/mL against drug-resistant C. auris strains. Killing kinetics determined that after 4 h treatment with CAPE, there was a complete reduction of viable C. auris cells compared to fluconazole. Both compounds might act by modifying the fungal cell wall. CAPE significantly reduced the biomass and the metabolic activity of C. auris biofilm and impaired C. auris adhesion to cultured human epithelial cells. Furthermore, both compounds prolonged the survival rate of Galleria mellonella infected by C. auris (p = 0.0088 for EA at 32 mg/kg and p = 0.0028 for CAPE at 4 mg/kg). In addition, EA at 4 μg/mL prolonged the survival of C. albicans-infected Caenorhabditis elegans (p < 0.0001). CAPE was not able to prolong the survival of C. albicans-infected C. elegans. These findings highlight the antifungal and antivirulence effects of EA and CAPE against C. auris, and warrant further investigation as novel antifungal agents against drug-resistant infections.

Intravaginal isonicotinic acid hydrazide (INH) versus misoprostol for cervical ripening prior to hysteroscopy

Objective

The aim of the present study was to compare the efficacy of vaginal isoniazid (isonicotinic acid hydrazide [INH]) and vaginal misoprostol in cervical ripening before hysteroscopic surgery.

Methods

This randomized controlled trial included patients scheduled for hysteroscopic surgery during April 2016 and June 2017. The inclusion criteria were as follows: postmenopausal women or those at premenopausal age who had not had a vaginal delivery and candidate for diagnostic or operative hysteroscopy with closed cervix before intervention. The INH group (intervention group) received 900 mg of vaginal isoniazid (three 300-mg pills) 6–8 hours before hysteroscopic surgery. The misoprostol group (control group) received 400 micrograms of vaginal misoprostol 6–8 hours before hysteroscopic surgery. Finally, the efficacy of the 2 agents was comparatively analyzed.

Results

Baseline characteristics were comparable between the groups. In 67 cases in the INH group (95%) and 45 in the misoprostol group (50%), hysteroscopic entry was successful without additional mechanical dilation, and this difference was statistically significant (P=0.001). The odds ratio (OR) obtained in this study was 0.57 for both INH and misoprostol groups (OR, 0.57; 95% confidence interval, 0.43–0.75). Further, 19 cases in the INH group vs. 45 cases in the misoprostol group did not respond to the intervention, indicating statistically significance (P=0.001).

Conclusion

Vaginal INH is more effective than misoprostol in cervical ripening before hysteroscopic surgery and can be a good alternative to misoprostol.

Trial Registration

Iranian Registry Clinical Trial (IRCT) Identifier: IRCT2015112821506N4

Methionine and vitamin B-complex ameliorate antitubercular drugs-induced toxicity in exposed patients

Tuberculosis therapy utilizes drugs that while effective cause treatment‐related toxicity. Modulation of antitubercular drugs‐induced toxicity by methionine and vitamin B‐complex in patients was evaluated. 285 treatment‐naïve tuberculosis patients at the Chest Clinics of Infectious Diseases Hospital, Yaba and General Hospital, Lagos in Lagos, Nigeria was prospectively recruited and allotted into test (antitubercular medicines, methionine and vitamin B‐complex) and control groups (antitubercular medicines). Data on adverse drug reactions and blood samples were collected at initiation, 2 months and 6 months, and then analyzed. Red blood cells and packed cell volume were significantly higher (P < 0.05) in the test group compared to control at 6 months of therapy. At the end of 2 months, results showed a significant decrease (P < 0.001) in aspartate aminotransferase, alkaline phosphatase, alanine aminotransferase, urea, creatinine and total bilirubin in the test group compared to control. Reduced glutathione and superoxide dismutase were significantly increased (P < 0.001) and malondialdehyde significantly decreased (P < 0.001) in the test versus control groups at the end of 2 and 6 months. Adverse drug reactions were significantly lower (P < 0.001) in the test group (32.4%) compared to control group (56.2%), with 1 death. Hepatotoxicity was significantly higher (P = 0.026) in control (6.9%), compared to test group (0%). Alcohol and cigarette smoking were significantly (P = 0.019 and P = 0.027) associated with the occurrence of adverse drug reactions. Methionine and vitamin B‐complex modulated hepatic, renal, hematological, antioxidant indices and adverse effects in patients administered antitubercular medicines. Such interventions can enhance compliance and better treatment outcomes in tuberculosis patients.

The ameliorating effect of Centella asiatica ethanolic extract on albino rats treated with isoniazid

BACKGROUND

Isoniazid, also called isonicotinyl hydrazine (INH), is a commonly used drug for treating tuberculosis. The main drawback is its toxic side effects. Centella asiatica has long been used in the Ayurvedic system of medicine owing to its wide medicinal properties. This study was designed to examine the effectiveness of C. asiatica ethanolic leaf extract (CA) on INH-treated albino rats.

METHODS

The adverse effects induced by INH (50 mg/kg bw) administration on haematological parameters, oxidative status (thiobarbituric acid-reactive substances, superoxide dismutase, catalase, and reduced glutathione), liver and kidney function markers, and their amelioration by various concentrations of CA (20, 40, 60, and 100 mg/kg bw) or silymarin (SIL) (50 mg/kg bw, administered before 1 h of INH treatment for 30 days to rats) were studied. Moreover, histological studies were carried out in liver and kidney tissues of rats treated with the most effective concentration to further support the possible effectiveness of CA on INH-intoxicated rats.

RESULTS

All the affected parameters returned to near-normal levels, and the effective concentration of extract was found to be 100 mg/kg bw. The histology of both the liver and the kidneys subsequently supported the effectiveness of CA (100 mg/kg bw).

CONCLUSIONS

Altogether, the results suggest that CA at 100 mg/kg bw can substantially reduce the toxic effects of INH.

Isonicotinic acid hydrazide (INH): A new agent for cervical ripening at term

The aim of this study was to assess the efficacy and safety of intravaginal isonicotinic acid hydrazide (INH) compared with misoprostol for cervical ripening at term. In this randomised controlled trial, 150 pregnant women, scheduled for labour induction, with Bishop's score (BS) ˂5, were recruited. They were assigned randomly to vaginal administration of isonicotinic acid hydrazide (INH) (900 mg) or misoprostol (25 μg), which were repeated every 4 h up to 3 times as needed. The efficacy of medications were evaluated by predetermined primary and secondary outcome variables for cervical ripening and induction of labour and delivery. Within the first 12 h of study, there was a significant increase in BS in each group. However, in the INH group changes in of BS were greater 12 h after starting the medication (p = 0.04). In the INH group, labour induction was needed more frequently, and the time from start of medication to the beginning of the active phase of labour and to the time of delivery were significantly longer (p˂0.001). Vaginal INH is an effective agent for cervical ripening at term.

The protective role of caffeic acid phenethyl ester against streptomycin ototoxicity

OBJECTIVE

The aim of this experimental study was to investigate the efficacy of caffeic acid phenethyl ester (CAPE) in the prevention of streptomycin-induced ototoxicity.

MATERIALS AND METHODS

Thirty-two adult Wistar albino rats were divided into 4 groups: control (n = 8), streptomycin (n = 8), CAPE (n = 8), and streptomycin + CAPE (n = 8). Rats were tested with distortion product otoacoustic emissions (DPOAEs) before drug administration. The animals in all groups were killed under general anesthesia on the 45th day following last DPOAE measurements. Hearing results were analyzed statistically to determine differences in amplitudes of DPOAE. Also, the cochleas of each rat were evaluated by histopathological and immunohistochemical examination.

RESULTS

Significant difference was not observed in cochlear hair cells in the control and CAPE groups. In the streptomycin group, severe degeneration of hair cells and increased apoptotic cells were observed. In the streptomycin + CAPE group, although some deteriorations were observed, hair cells were mostly preserved. The DPgram of the streptomycin and streptomycin + CAPE groups was significantly deteriorated (P < .05). The analysis of the DPgram results revealed statistically significant differences between the groups of streptomycin and streptomycin + CAPE (P < .05).

CONCLUSIONS

Caffeic acid phenethyl ester treatment attenuated hair cells injury in the inner ear, possibly via its antioxidant effect. Prophylactic administration of CAPE for streptomycin ototoxicity ameliorated hearing deterioration in rats.

Early treatment of radiation-induced heart damage in rats by caffeic acid phenethyl ester

The study is designed to determine the therapeutic effect of caffeic acid phenethyl ester (CAPE) in minimizing radiation-induced injuries in rats. Rats were exposed to 7Gy gamma radiation, 30min later rats were injected with CAPE (10μmol/kg body, i.p.) for 7 consecutive days. Rats were sacrificed at 8 and 15 days after starting the experiment. Gamma-irradiation induced significant increase in malondialdehyde (MDA) level and xanthine oxidase (XO) and adenosine deaminase (ADA) activities, and significant decrease in total nitrate/nitrite (NO(x)) level and glutathione peroxidise (GPx), superoxide dismutase (SOD) and catalase activities in heart tissue and augmented lipid fractions levels and activities of lactate dehydrogenase (LDH), creatine phosphokinase (CPK) and aspartate transaminase (AST) in serum. Irradiated rats early treated with CAPE showed significant decrease in MDA, XO and ADA and significant increase in NO(x) and SOD in heart tissue and in serum enzymes compared with irradiated group. Serum lipid profiles and cardiac enzymes were restored.

CONCLUSION

CAPE could exhibits curable effects on gamma irradiation-induced cardiac-oxidative impairment in rats.

Effect of caffeic acid and rofecoxib and their combination against intrastriatal quinolinic acid induced oxidative damage, mitochondrial and histological alterations in rats

Oxidative stress has long been implicated in the neurotoxic effects of glutamate acting through N-methyl-D-aspartate (NMDA) receptors. Therefore, present study has been designed to explore the effect of rofecoxib and caffeic acid on the involvement of oxidative stress, mitochondrial dysfunction and neuronal linked with NMDA receptor-mediated excitotoxicity. Caffeic acid, is a well-known antioxidant flavanoid, implicate anti-inflammatory and immunomodulatory like actions. The present study is an attempt to investigate the antioxidant-like effect of caffeic acid and rofecoxib and their combination against QA-induced oxidative damage, mitochondrial dysfunction and histological alterations. Intrastriatal injection of quinolinic acid (300 nmol) significantly increased oxidative stress (raised lipid peroxidation, nitrite concentration, depleted SOD and catalase), altered mitochondrial complex enzyme activities and histological alteration in the ex vivo striatum. Caffeic acid (5 and 10 mg/kg, p.o.) and rofecoxib (10 and 20 mg/kg, p.o.) treatment for 21 days significantly attenuated oxidative damage and impairment in mitochondrial activities of complex enzymes in the ex vivo striatum. Further, combination of sub effective doses of rofecoxib (10 mg/kg, p.o.) and caffeic acid (5 mg/kg, p.o.) potentiated their protective effect which was significant as compared to their effect per se. The present study suggests the therapeutic effect of caffeic acid and rofecoxib combination against QA-induced ex vivo oxidative damage, mitochondrial and histological alterations in rats.