Streptokinase 100,000unit / Streptodornase 25,000unit topical powder vials and diluent

BackgroundSurgical wounds that become infected are often debrided because clinicians believe that removal of this necrotic or infected tissue may expedite wound healing. There are numerous methods of debridement available, but no consensus on which one is most effective for surgical wounds.ObjectivesTo assess the effects of different methods of debridement on the rate of debridement and healing of surgical wounds.Search methodsIn October 2021, we searched the Cochrane Wounds Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL. To identify additional studies, we searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies, reviews, meta-analyses, and health technology reports. There were no restrictions on language, date of publication, or study setting.Selection criteriaWe included randomised controlled trials (RCTs) that enrolled people with a surgical wound that required debridement, and reported time to complete wound debridement or time to wound healing, or both.Data collection and analysisTwo review authors independently performed study selection, risk of bias assessment using the RoB 1 tool, data extraction, and GRADE assessment of the certainty of evidence.Main resultsIn this fourth update, we identified one additional study for inclusion. The review now includes six studies, with 265 participants, aged three to 91 years. Five studies were published between 1979 and 1990 and one published in 2014. The studies were carried out in hospital settings in China, Denmark, Belgium, and the UK. Six studies provided six comparisons. Due to the heterogeneity of studies, it was not appropriate to conduct meta-analyses. Four studies evaluated the effectiveness of dextranomer beads/paste; however, each study used a different comparator (Eusol-soaked dressings, 10% aqueous polyvinylpyrrolidone, 0.1% chloramine-soaked packs, and silicone foam elastomer dressing). One study compared streptokinase/streptodornase with saline-soaked dressings, and one compared endoscopic surgical debridement with conventional 'open' surgical debridement. Five studies reported time to complete debridement (reported as time to a clean wound bed) and three reported time to complete healing. One study reported effect estimates (surgical debridement via endoscopy versus surgical debridement) for time to a clean wound bed and time to complete wound healing, and it was possible to calculate effect estimates for one other study (dextranomer paste versus silicone foam elastomer) for time to complete wound healing. For the other four studies that did not report effect estimates, it was not possible to calculate time to a clean wound bed or time to complete wound healing due to missing variance and participant exclusions. None of the included studies reported outcomes pertaining to proportion of wounds completely healed, rate of reduction in wound size, rate of infection, or quality of life. All studies had unclear or high risk of bias for at least one key domain. Dextranomer paste/beads (autolytic debridement) compared with four different comparators Four studies compared dextranomer paste or beads with Eusol-soaked gauze (20 participants), 10% aqueous polyvinylpyrrolidone (40 participants), 0.1% chloramine-soaked dressings (28 participants), or silicone foam elastomer (50 participants). There is very low-certainty evidence that there may be no clear difference in time to a clean wound bed between dextranomer beads and Eusol gauze. The study did not report adverse events. There is very low-certainty evidence that there may be no difference in time to a clean wound bed between dextranomer paste and 10% aqueous polyvinylpyrrolidone gauze. There was low-certainty evidence that there may be no difference in deaths and serious adverse events. There may be a difference in time until the wounds were clinically clean and time to complete wound healing between dextranomer paste and 0.1% chloramine favouring 0.1% chloramine, but we are very uncertain. There is low-certainty evidence that there may be no difference in deaths and serious adverse events. There is very low-certainty evidence that there may be no difference in time to complete healing between dextranomer beads and silicone foam elastomer. The study did not report adverse events. Streptokinase/streptodornase solution (enzymatic) compared with saline-soaked dressings One study (21 participants) compared enzymatic debridement with saline-soaked dressings. There is low-certainty evidence that there may be no difference in time to a clean wound bed or secondary suture between streptokinase/streptodornase and saline-soaked dressings. There is very low-certainty evidence that there may be no difference in deaths and serious adverse events. Surgical debridement via endoscopic ('keyhole') surgery compared with surgical debridement by 'open' surgery (the wound is opened using a scalpel) One study (106 participants) reported time to complete wound healing and time to a clean wound bed. There is low-certainty evidence that there may be a reduction in time to complete wound healing and very low-certainty evidence that there may be no difference in time to a clean wound bed with surgical debridement via endoscopy compared to 'open' surgical debridement. The study did not report adverse events. Overall, the evidence was low to very low-certainty for all outcomes. Five included studies were published before 1991 and investigated treatments that are no longer available. Worldwide production of dextranomer products has been discontinued, except for dextranomer paste, which is currently only available in South Africa. Furthermore, Eusol, used in one study as the comparator to dextranomer, is rarely used due to risk of harmful effects on healthy tissue and the enzymatic agent streptokinase/streptodornase is no longer available worldwide.Authors' conclusionsEvidence for the effects of different methods of debridement on complete wound debridement and healing of surgical wounds remains unclear. Adequately powered, methodologically robust RCTs evaluating contemporary debridement interventions for surgical wounds are needed to guide clinical decision-making.

Abstract licence: Public domain

BackgroundIntrapleural fibrinolytic therapy (IPFT) has been used as an effective agent since 1949 for managing complicated pleural effusion and empyema. Several agents, such as streptokinase, urokinase (UK), and recombinant tissue plasminogen activator (rt-PA), have been found to be effective with variable effectiveness. However, a head-tohead controlled trial comparing the efficacy of the most frequently used agents, i.e., UK and rt-PA (alteplase) for managing complicated pleural effusion has rarely been reported.MethodsA total of 50 patients were randomized in two intervention groups, i.e., UK and rt-PA. The dose of rt-PA was 10 mg, and that of UK was 1.0 lac units. UK was given thrice daily for 2 days, followed by clamping to allow the retainment of drugs in the pleural space for 2 hours. rt-PA was instilled into the pleural space twice daily for 2 days, and intercostal drainage was clamped for 1 hour.ResultsA total of 50 patients were enrolled into the study, of which 84% (n=42) were males and 16% (n=8) were females. Among them, 30 (60%) patients received UK, and 20 (40%) patients received alteplase as IPFT agents. The percentage of mean± standard deviation changes in pleural opacity was -33.0%±9.9% in the UK group and -41.0%±14.9% in the alteplase group, respectively (p=0.014). Pain was the most common adverse side effect, occurring in 60% (n=18) of the patients in the UK group and in 40% (n=8) of the patients in the alteplase group (p=0.24), while fever was the second most common side effect. Patients who reported early (within 6 weeks of onset of symptoms) showed a greater response than those who reported late for the intervention.ConclusionIPFT is a safe and effective option for managing complicated pleural effusion or empyema, and newer agents, such as alteplase, have greater efficacy and a similar adverse effect profile when compared with conventional agents, such as UK.

Abstract licence: CC BY-NC

В статье представлены результаты собственных исследований об эффективности и безопасности использования ферментного препарата, содержащего комбинацию стрептокиназы и стрептодорназы, у женщин после вагинальной пластики. Быстрое снижение боли, уменьшение инфильтрации и гематом, ускорение возврата лабораторных показателей к норме, а также более качественное формирование рубца – это ключевые индикаторы эффективности. В группе женщин, использовавших ферментный препарат, наблюдались более быстрое снижение боли (p<0,01), регресс отека и инфильтрации (p<0,05), уменьшение CRP и СОЭ, меньший инфильтрат по УЗИ, мягкий рубец (VSS 1,3±0,2 vs 2,7±0,4, p<0,01). Побочные эффекты редкие и легкие. Результаты убедительно демонстрируют, что процесс заживления более физиологичен: активная неоангиогенезия при минимальной фиброзной трансформации, мягкий, эластичный рубец при низкой выраженности сосудистой и коллагеновой гипертрофии. Применение ферментного препарата, содержащего комбинацию стрептокиназы и стрептодорназы, в послеоперационном периоде после вагинальной пластики является эффективным, безопасным и улучшает клинические и функциональные показатели заживления. Рекомендуется включать препарат в комплекс реабилитационной терапии, особенно у женщин с высоким риском образования грубых рубцов и спаек. The article presents the results of own studies on the effectiveness and safety of using an enzyme preparation containing a combination of streptokinase and streptodornase in women after vaginal plastic surgery. Rapid reduction of pain, decrease in infiltration and hematomas, acceleration of return of laboratory parameters to normal, as well as better scar formation are key indicators of effectiveness: in the group of women who used the enzyme preparation, there was a faster reduction of pain (p<0.01), regression of edema and infiltration (p<0.05), decrease in CRP and ESR, smaller infiltration on ultrasound, and a soft scar (VSS 1.3±0.2 vs 2.7±0.4, p<0.01). Side effects were rare and mild. The results convincingly demonstrate that the healing process was more physiological: active neoangiogenesis with minimal fibrous transformation, a soft, elastic scar with low vascular and collagen hypertrophy. The use of an enzyme preparation containing a combination of streptokinase and streptodornase are effective, safe, and improve clinical and functional healing outcomes in the postoperative period after vaginal plastic surgery. It is recommended to include the drug in the rehabilitation therapy, especially in women with a high risk of developing severe scars and adhesions.

Abstract licence: CC BY-NC-SA

Group A Streptococcus (GAS) is a major human pathogen that causes several invasive diseases including necrotizing fasciitis. The host coagulation cascade initiates fibrin clots to sequester bacteria to prevent dissemination into deeper tissues. GAS, especially skin-tropic bacterial strains, utilize specific virulence factors, plasminogen binding M-protein (PAM) and streptokinase (SK), to manipulate hemostasis and activate plasminogen to cause fibrinolysis and fibrin clot escape. A major unresolved question regards the temporal dynamics of how GAS enmeshed in a fibrin clot can access plasminogen for clot dissolution and eventual dissemination. Here, we reveal through live imaging studies that GAS trapped inside a fibrin clot can remain viable in a latent state, until access to plasminogen activates fibrinolysis and dissemination. RNA-sequencing (RNA-seq) analysis shows marked changes in the wild-type (WT)-GAS transcriptome from the time bacteria were enmeshed inside the clot (4 h) to when dissemination was initiated (8 h). To gain a more fully realized model of how GAS trapped in fibrin clots can disseminate in the blood system, we utilized a novel 3D endothelial microfluidic device to demonstrate that GAS is fully capable of fibrinolysis in an endothelial environment, revealing a major underappreciated route by which GAS may cause more invasive outcomes. Our findings reveal for the first time that GAS can engage a latent, growth-suspended phase whereby physical structures such as fibrin clots that immobilize an invading pathogen allow bacteria to remain viable until sufficient access to plasminogen allows it to initiate fibrinolysis and escape into surrounding blood system and tissues.ImportanceGroup A Streptococcus (GAS) is a human-specific bacterial pathogen that causes infections ranging in severity from mild to severe infections that can often be fatal. To protect the host, the innate immune system creates fibrin clots to trap bacteria and prevent deeper spread. GAS produces several factors that can initiate the dissolution of these fibrin clots to spread to deeper tissues, but we lack specific understanding of the timing of these events. Our studies demonstrate for the first time that GAS can delay their escape from fibrin clots to gain access to deeper tissues during infection, suggesting a key strategy that GAS utilize to cause more invasive disease.

Abstract licence: CC BY