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

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

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

Objective of the study: to evaluate the clinical efficacy and safety of suppositories based on distrept enzymes H46A (streptokinase and streptodornase) in reducing the size of postoperative hematomas (POH), alleviating symptoms, and preventing chronicity in patients after hysterectomy.Materials and methods. This prospective study included 69 women with POH following either transabdominal or transvaginal hysterectomy. Patients were randomized into two groups. The treatment group (group 1, n = 35) received a combined distrept enzymes H46A (streptokinase/streptodornase) preparation in the form of suppositories alongside standard antibacterial therapy for 12 days. The control group (group 2, n = 34) received only standard treatment. Clinical symptoms (pain intensity, hyperthermia), inflammation activity (C-reactive protein), and POH size based on ultrasound findings were evaluated at baseline (day 0), at the end of treatment (day 12), and after two weeks of follow-up (day 26).Results. The treatment group demonstrated faster achievement of target body temperature levels, reduced inflammatory activity (as indicated by C-reactive protein levels of 8.9 ± 0.31 mg/L vs. 13.4 ± 0.41 mg/L in the control group, p < 0.001), and positive dynamics in pain syndrome across all POH localizations (p < 0.05). Ultrasound findings confirmed a more pronounced regression in POH size in the enzyme therapy group during the treatment and follow-up periods. Complete resorption of POH was observed in 46% of patients in group 1 immediately after the treatment course (day 12) and in 100% of cases at the end of the follow-up period. In group 2, target body temperature levels were achieved more slowly, and pain was more intense and prolonged. On days 12 and 26 of the study, POH persisted in 82% and 6% of patients in the control group, respectively (p < 0.05).Conclusions. The use of local enzyme therapy with suppositories containing distrept enzymes H46A (streptokinase/streptodornase) in combination with standard antibacterial therapy demonstrated several advantages: reduced inflammatory activity, more pronounced regression of pain syndrome, increased rate of complete hematoma resorption, and a prolonged effect even after the treatment course was completed.</jats:p

Abstract licence: CC BY

BackgroundIntra-abdominal adhesions after surgery are usually in the form of bands and can annoy the patient throughout life causing repeated surgical procedures. Therefore, any action to prevent adhesions after surgery can increase longevity and quality of life. For this aim, this study investigates the effect of streptokinase and normal saline on the 7th day and 1 month after laparotomy.Materials and methodsExperimental study was conducted on thirty healthy male Wistar rats weighing 200-250 g with age of 3 months divided into three groups of 10. Group I: No treatment, Group II: Received normal saline, and Group III: Received normal saline and streptokinase at the same time. One week and 1 month after laparotomy, the frequency of the presence or absence of adhesion bands was performed by a person who was unaware of the sample grouping. The collected information was analyzed with the SPSS software (version 16; SPSS Inc., Chicago, IL, USA).ResultsAdhesion frequency was found to be 20% on the 7th day (early) and 1 month after laparotomy (late) for Group 1, and it was 40% on early and late for Group II, while 0% on the early and late for Group III. Hence, in the group receiving streptokinase, no early or late adhesion was observed; therefore, it had a significant role in the prevention of intra-abdominal adhesions (P P > 0.05).ConclusionAccording to the results of our study, we believe that streptokinase could be a good antiadhesive agent considering its effectiveness.

Abstract licence: CC BY-NC-SA