Polygeline 17.5g/500ml solution for injection bottles

The authors reported no conflicts of interest.The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest. The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest. We thank the author for his interest in our article titled “Conventional Versus Miniaturized Cardiopulmonary Bypass: A Systematic Review and Meta-Analysis.”1Cheng T. Barve R. Cheng Y.W. Ravendren A. Ahmed A. Toh S. et al.Conventional versus miniaturized cardiopulmonary bypass: a systematic review and meta-analysis.JTCVS Open. 2021; 8: 418-441Abstract Full Text Full Text PDF Scopus (6) Google Scholar It is well known that cardiopulmonary bypass induces a systemic inflammatory response due to the contact of the patient's blood with nonendothelial surfaces and air, which is accompanied by an increase in cytokine levels. The attenuation of this inflammatory response is associated with a reduction of morbidity and mortality after cardiac surgery. We note that the author reported the formation of a colloid film as an incidental finding during the administration of polygeline (Emagel) for volume integration in the establishment of cardiopulmonary bypass. The use of a colloid film as a solution to temporarily reduce air–blood contact in optimized open circuits has both potential benefits and risks. The elimination of the air–blood interface reduces contact activation of blood components when exposed to air, especially with longer perfusion times (Figure 1). However, the clinical benefits of this are controversial and not well proven.2Kiessling A.-H. Khalil M. Assaf O. Isgro F. Kretz K.-U. Saggau W. Blood-air interface during cardiopulmonary bypass.Asian Cardiovasc Thorac Ann. 2004; 12: 198-201Crossref PubMed Scopus (13) Google Scholar,3Schönberger J.P.A.M. Everts P.A.M. Hoffmann J.J. Systemic blood activation with open and closed venous reservoirs.Ann Thorac Surg. 1995; 59: 1549-1555Abstract Full Text PDF PubMed Scopus (78) Google Scholar Colloid solutions are effective in increasing circulatory blood volume and maintaining colloid osmotic pressure in cardiopulmonary bypass. However, the use of such solutions increases the cost of cardiac surgery and may cause adverse reactions such as histamine release, resulting in hypotension, bronchospasm, and skin rash.4Davies M.J. Polygeline.Dev Biol Stand. 1987; 67: 129-131PubMed Google Scholar,5Themes U.F.O. Extracorporeal circulation [Internet]. Thoracic key. 2018.https://thoracickey.com/extracorporeal-circulation/Date accessed: February 19, 2023Google Scholar The hemodilution effect caused by large amounts of colloids could result in an increased risk of stroke or other neurological events through cerebral hypoperfusion.6Habib R.H. Zacharias A. Schwann T.A. Riordan C.J. Durham S.J. Shah A. Adverse effects of low hematocrit during cardiopulmonary bypass in the adult: Should current practice be changed?.J Thorac Cardiovasc Surg. 2003; 125: 1438-1450Abstract Full Text Full Text PDF PubMed Scopus (342) Google Scholar, 7Karkouti K. Djaiani G. Borger M.A. Beattie W.S. Fedorko L. Wijeysundera D. et al.Low hematocrit during cardiopulmonary bypass is associated with increased risk of perioperative stroke in cardiac surgery.Ann Thorac Surg. 2005; 80: 1381-1387Abstract Full Text Full Text PDF PubMed Scopus (206) Google Scholar A stagnant colloid film also may be a point of stasis that increases the risk of clinical coagulopathy. Although the formation of a colloid film reduces air–blood contact for a short period of time, the clinical benefits of this are not well investigated. The use of solutions to limit air–blood contact in optimized open circuits is thought provoking, and more research is needed to fully evaluate its effectiveness and safety.

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Cerebral collaterals are dynamically recruited after arterial occlusion and highly affect tissue outcome in acute ischemic stroke. We investigated the efficacy and safety of four pathophysiologically distinct strategies for acute modulation of collateral flow (collateral therapeutics) in the rat stroke model of transient middle cerebral artery (MCA) occlusion. A composed randomization design was used to assign rats (n = 118) to receive phenylephrine (induced hypertension), polygeline (intravascular volume load), acetazolamide (cerebral arteriolar vasodilation), head down tilt (HDT) 15° (cerebral blood flow diversion), or no treatment, starting 30 min after MCA occlusion. Compared to untreated animals, treatment with collateral therapeutics was associated with lower infarct volumes (62% relative mean difference; 51.57 mm 3 absolute mean difference; p < 0.001) and higher chance of good functional outcome (OR 4.58, p < 0.001). Collateral therapeutics acutely increased cerebral perfusion in the medial (+40.8%; p < 0.001) and lateral (+19.2%; p = 0.016) MCA territory compared to pretreatment during MCA occlusion. Safety indicators were treatment-related mortality and cardiorespiratory effects. The highest efficacy and safety profile was observed for HDT. Our findings suggest that acute modulation of cerebral collaterals is feasible and provides a tissue-saving effect in the hyperacute phase of ischemic stroke prior to recanalization therapy.

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Untreated rabies is fatal, globally killing 60,000 persons/years. Rabies vaccine (RV) is life-saving, of various types and used in high-risk rabies exposure (HRRE) as a post-exposure prophylaxis (PEP) series of initial (RV-i) and completion (RV-c) doses. Polygeline has been implicated in immediate allergic reactions to tick-borne encephalitis vaccine and is an excipient in Rabipur, a purified chick embryo vaccine (PCECV) as part of Thai Red Cross (TRC) RV protocol. In United States, RVs are Rabavert (PCECV), containing polygeline, and Imovax Rabies, a human diploid cell vaccine (HDCV) that does not. RV-associated adverse reactions occur up to 6% as mostly non-IgE/skin-limited or immune complex and rarely nonfatal anaphylaxis. We describe TRC-RV-immediate allergic reaction in a male child traveling in Thailand and how after his return to United States , we were able to overcome RV-PEP delays and demonstrate safe treatment tolerance with a different RV. Review of literature, Thai/US RV and Allergy Protocols, Pink Book/RV Inserts A healthy 4-years old US boy had HRRE from feral cat bite in Thailand with immediate disseminated hives at 1 hour post-TRC-RVi (Day 0), resolved with oral antihistamine. Upon US return (Days 3-8), clinicians stopped RV-PEP due to RV allergy fears; Day 6 rabies-immunoglobulin given. On Day 9, US academic Allergist/Infectious Disease referral done: no other medical problems found; HDCV skin prick test (negative); TRC-RV (not available); two-step HDCV-RV challenge performed (10%, then full); Days 13 and 20, HDCV-RV-c full tolerated; Days 30+, asymptomatic; serum tryptase 3.2 ng/ml; Rapid Fluorescent Foci Inhibition Test (RFFIT) RV type I hypersensitivity reactions are uncommon, components to RVs vary worldwide and such adverse RV reactions should not stop RV-PEP. Analysis of vaccine content, exposures, and relevant testing is critical to deducing likely reaction type and candidate antigens as excipients in non-RVs and across RV types. IgE-vaccine tests may not be reliable/possible and mid-series RV change to non-polygeline type may be a viable option when RV-c must be done to reach timely RV-c-PEP treatment tolerance and avoid hypersensitivity reactions. All authors: No reported disclosures.

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BACKGROUND: Genuine sensitization to beef and pork is rare, with the best-characterized allergens being beef and pork (Bos d 6 and Sus s1). There are different presentations of mammalian meat allergy: cat-pork syndrome, alpha-gal syndrome, milk-related allergy, and primary sensitization. CASE REPORT: A 49-year-old man presented with urticaria after ingesting beef and pork and mild intermittent nasal symptoms. The initial approach was aeroallergen testing: positive for cat. Cat-pork syndrome was suspected. A prick-to-prick test was performed on raw and cooked pork: positive; raw beef: positive; cooked beef: indeterminate; oral examination was performed: positive; 40 minutes later, wheal-like lesions were present on the neck, anterior thorax, and face. Fel d 1 (0.92 kcal/L) and Fel d 2 (0.05 kcal/L) were ordered, confirming genuine cat sensitization and ruling out cat-pig syndrome. Specific IgE to pork (0.18 kcal/L), confirming sensitization to pork. Given the presence of symptoms associated with beef and the likelihood of α-Gal syndrome, skin and intradermal polygeline testing was performed: negative. Bos d4 (0.02 kcal/L) and Bos d5 (0.01 kcal/L) were negative, confirming primary sensitization to beef. CONCLUSION: After ruling out other mechanisms, primary sensitization to mammalian meat is presumed. A molecular approach can improve diagnostic accuracy and guide therapeutic decision-making in this case: Total avoidance.

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