The relevance of the subject matter is conditioned by the constantly growing need to meet human needs in the field of medicine, in particular, the search, study, and further introduction of new types of medicines into practical use. The purpose of this study is to investigate the synthesis of modified quinine alkaloid derivatives, and their structure, to identify the properties and biological activity of antimalarial drugs based on quinine molecules, and to structure the general data of these substances. The leading approach is the analysis of the synthesis of quinine derivatives, their chemical and physical properties, and their ability to exert a medicinal effect. The abstracting method allows structuring alkaloid derivatives and establishing a general relationship between the structural configuration of molecules and their impact on human health in a number of related derivatives. The study identifies the main antimalarial drugs based on quinine molecules, including a comparative analysis of their effectiveness and overall biological activity.
Chloroquine is a prototype antimalarial drug, widely used in several branches of medicine. Antimalarial drugs are used in the treatment of various dermatological, immunological, rheumatological and infectious diseases. Examples of off-labelled indications for chloroquine analogues use include dermatomyositis, sarcoidosis, polymorphous light eruption, disseminated granuloma annulare and porfiria cutanea tarda. There is a relatively small number of adverse effects related to chloroquine analogues used in standard doses, such as gastrointestinal disturbances, headaches, skin reactions, hypotension, convulsions, extrapyramidal symptoms and visual disturbances. Psychiatric side effects of chloroquine seem to be rare, but may manifest in a wide range of symptoms, such as confusion, disorientation, ideas of persecution, agitation, outbursts of violence, loss of interest, feeling sad, suicidal ideas and impaired insight. There is also a report of a manic episode with psychotic features in the course of bipolar disorder, and another case report of persecutory delusions, anxiety, derealisation and visual illusions triggered by chloroquine. The duration of psychiatric symptoms usually ranges from one to two weeks, and symptoms usually disappear within several days following cessation of chloroquine usage and starting psychiatric treatment where indicated. This article reviews the case studies of patients diagnosed with mental disorders resulting from the use of chloroquine, and discusses the management in such cases.
PL
Chlorochina jest prototypowym lekiem przeciwmalarycznym, szeroko stosowanym w kilku gałęziach medycyny. Leki przeciwmalaryczne wykorzystuje się w leczeniu różnych chorób dermatologicznych, immunologicznych, reumatologicznych i chorób zakaźnych. Przykłady pozarejestracyjnych wskazań użycia analogów chlorochiny obejmują zapalenie skórno- -mięśniowe, sarkoidozę, wielopostaciowe osutki świetlne, rozsiany ziarniniak obrączkowaty i porfirię skórną późną. W standardowych dawkach chlorochina powoduje stosunkowo niewielką liczbę działań niepożądanych, takich jak zaburzenia żołądkowo-jelitowe, bóle głowy, reakcje skórne, obniżone ciśnienie, drgawki, objawy pozapiramidowe i zaburzenia widzenia. Wydaje się, iż psychiatryczne objawy niepożądane chlorochiny występują rzadko, ale w szerokim zakresie możliwości – od splątania, dezorientacji, urojeń prześladowczych, pobudzenia i zachowań agresywnych po utratę zainteresowań, uczucie smutku, myśli samobójcze oraz zaburzenie wglądu. Istnieje również doniesienie, w którym opisuje się epizod manii z cechami psychotycznymi w przebiegu choroby afektywnej dwubiegunowej, a także opis przypadku z urojeniami prześladowczymi, niepokojem, derealizacją i iluzjami wzrokowymi wywołanymi zastosowaniem chlorochiny. Czas trwania objawów psychiatrycznych zazwyczaj zawiera się w przedziale od jednego do dwóch tygodni, a objawy zazwyczaj ustępują w ciągu kilku dni po zaprzestaniu przyjmowania chlorochiny oraz po włączeniu leczenia psychiatrycznego, jeżeli istnieją do tego wskazania. W artykule przedstawiono opisy przypadków pacjentów z rozpoznaniem zaburzeń psychicznych wynikających z zastosowania chlorochiny, a także przedstawiono zastosowane postępowanie w takich przypadkach.
Plasmodium chabaudi, a rodent malaria parasite with a synchronous asexual cycle in the blood, depending on the host’s circadian rhythm, was desynchronized by modifying its normal timing: blood taken from a donor mouse in the morning was kept 8 h at +4°C and inoculated in the evening into naive mice. When the infection had become asynchronous (from day 4 to day 7) mice were treated with a single dose of chloroquine. The efficacy of chloroquine was lower in mice with an asynchronous infection than in the control mice with a normally synchronous infection.
The identified mutations in the pfcrt, dhfr and dhps genes of Plasmodium falciparum show a very high correlation with resistance to chloroquine, pyrimethamine and sulfadoxine, the drugs that are still used as malaria chemoprophylaxis or treatment. We undertook a molecular screening of 82 Polish P. falciparum isolates, mainly imported from different countries of sub-Saharan Africa to assess their molecular drug-resistance profiles. Only 4 isolates showed no mutations in the three analyzed gene fragments. In the remaining isolates from one to six mutations in one or more examined genes were found. Different mutations in the pfcrt, dhfr and dhps genes were found in ca. 76%, 80% and 70% of P. falciparum isolates, respectively. About forty our patients used chloroquine or pyrimethamine + sulfadoxine as malaria chemoprophylaxis and/or antimalarial treatment, but without success. In all but 5 of the P. falciparum isolates obtained from these persons, mutations associated to resistance of the parasite to chloroquine and the antifolate drugs were found.
As a result of widespread resistance to chloroquine (CQ) and sulphadoxine-pyrimethamine (SP), artemisinin-based combination therapy (ACT) has been recommended as a first-line anti-malarial regimen in Côte d’Ivoire since 2005. A thorough understanding of the molecular bases of P. falciparum resistance to existing drugs is therefore needed. The aims of this study were to analyze the in vitro sensitivity of P. falciparum field isolates from Abobo to CQ, pyronaridine (PYR) and dihydroartemisinine (DHA), and to investigate the polymorphisms associated with drug resistance. The standard in vitro drug sensitivity microtechnique recommended by the WHO was used to assess the sensitivity of Plasmodium falciparum isolates collected in December 2006. The Pfcrt haplotype 76 was analysed by PCR-RFLP while Pfatpase 6 amplification products were sequenced. Associations between drug sensitivity and parasite gene polymorphisms were evaluated with Cohen’s kappa test. The correlation between the IC50 values for different drugs was assessed by the coefficient of determination (r2). Significance was assumed at p<0.05. Of 128 in vitro tests performed, 112 (87.5%) were successful. Of the isolates, 56.2% were resistant for CQ and 48% for PYR. One isolate (3.6%) demonstrated reduced DHA sensitivity (IC50 higher than 10 nM). The mutant K76T pfcrt codon, present in 90% of DNA fragments analyzed, was associated with CQ-R (ĸ=0.76). The N669Y (16.1%), D734Y (28.6%) and D734H (1.8%) isolates were found to have mutant Pfatpase6, however, these mutations were not associated with diminished DHA sensitivity (k=0.01). These high levels of antimalarial drug resistance in Abobo (Côte d’Ivoire) demand further studies of drug efficacy across the whole country.
W opracowaniu zwrócono uwagę na dwa problemy kliniczne, mianowicie zjawiska immunologiczne nasilające efekt ucisku przepukliny w konfliktach krążkowo-korzeniowych oraz trudności związane z wiarygodnym, metrologicznym oszacowaniem zjawiska czucia bólu. Klinicznym celem pracy było zastosowanie w leczeniu bólu, oprócz typowego NLPZ, leku immunomodulacyjnego, podawanego przezskórnie do ogniska bólu oraz wykonanie testów klinicznych w grupach pacjentów posiadających odmienne lokalizacje ognisk, mianowicie w przestrzeni L4/L5, L5/S1 lub w stawie krzyżowo-biodrowym. Technicznym celem pracy było przedstawienie autorskiej koncepcji rejestracji elektrycznego równoważnika skórnych zjawisk czuciowych za pomocą komputerowego systemu PCP 3.0 generującego powtarzalnie potencjały diagnostyczne i rejestrującego reakcje czuciowe pacjenta. System daje możliwość różnicowania topografii choroby i monitorowania efektów leczenia. Po przeprowadzeniu badań stwierdzono: (1) swoistą zmienność wskaźników asymetrii W(1-3), uzależnioną od lokalizacji ogniska bólu; (2) wzrost wartości wskaźników W(1-3) w sposób zbieżny z centralizacją i spadkiem natężenia bólu; (3) większy i bardziej długotrwały efekt zmniejszenia bólu po przezskornym zastosowaniu chlorochiny w porównaniu z ketoprofenem, co przejawiało się dłuższym okresem utrzymywania się wyższych wartości symetrii zarówno dla testu Lasegue'a (WL), Yeomansa (WY), jak i parametrów elektrosensorycznych (W1-3). Wnioskując na podstawie przeprowadzonych testów, system PCP spełnia kryteria metody obiektywizującej określanie wymiaru i symetrii czucia skórnego.
EN
Two clinical issues have been presented in the study, i.e. immunological events intensifying the hernia pressure effect in disc-root conflicts and difficulties in providing a reliable, metrological evaluation of pain. The clinical objective of the study was treatment of pain using, apart from a conventional NSAID, an immunomodulatory drug administered percutaneously directly to the foci of pain and a clinical examination of patient groups with diverse pain foci locations, i.e. in areas of L4L5/L5S1 or in the sacroiliac joint. The technical aim of the study was presentation of the study author's own concept for the registration of an electrical equivalent of cutaneous sensory phe-nomena using the PCP 3.0 computer system, which generates repeating diagnostic potentials and registers a patient's sensory reactions. The system provides for diversification of an illness's topography and monitoring of treatment effects. The results of the study revealed: (1) a specific variability in the W(1-3) asymmetry coefficients, depending on the pain foci location; (2) increase of the (W1-3) indicators as the foci centralised and the pain decreased; (3) a more intense and longer-lasting pain relief effect after percutaneous administration of chloroquine, rather than ketoprofen, which manifested itself through longer-lasting high electrosensory parameters (W1-3) and symmetry values in Lasegue's test (WL) and Yeoman's test (WY). Based on the tests conducted it is concluded that the PCP system meets the criteria of a method for the objectification of the dimensions and symmetry of cutaneous sensations.
Bistramide D and K were extracted from a New Caledonian marine colonial ascidian Lissoclinum bistratum and tested against Plasmodium berghei and P. vinckei petteri in mice. Bistramide D was able to reduce parasitaemia by almost 50% in P. berghei infected mice, but the ID₅₀ (>5 mg/kg) was very close to the LD₅₀ (8 mg/kg). In the same assay, bistramide K was less active than bistramide D. The mid-term trophozoite and the old trophozoite were shown to be the stages most sensitive to bistramide D in P. vinckei petteri infected mice. Therefore, bistramides are interesting experimental tools but do not present a major interest as potential antimalarial drugs.
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