AIM: To compare the efficacy and safety of recombinant streptokinase(rSK) vs hydrocortisone acetate-based suppositories in acute hemorrhoidal disease.METHODS: A multicenter(11 sites), randomized(1:1:1), open, controll...AIM: To compare the efficacy and safety of recombinant streptokinase(rSK) vs hydrocortisone acetate-based suppositories in acute hemorrhoidal disease.METHODS: A multicenter(11 sites), randomized(1:1:1), open, controlled trial with parallel groups was performed. All participating patients gave their written,informed consent. After inclusion, patients with acute symptoms of hemorrhoids were centrally randomized to receive, as outpatients, by the rectal route, suppositories of rSK 200000 IU of one unit every 8 h(first 3 units)and afterwards every 12 h until 8 administrations were completed(schedule A), one unit every 8 h until 6 units were completed(schedule B), or 25 mg hydrocortisone acetate once every 8 h up to a maximum of 24 administrations. Evaluations were performed at 3, 5,and 10 d post-inclusion. The main end-point was the 5thday response(disappearance of pain and bleeding, and≥ 70% reduction of the lesion size). Time to response and need for thrombectomy were secondary efficacy variables. Adverse events were also evaluated.RESULTS: Groups were homogeneous with regards to demographic and baseline characteristics. Fifth day complete response rates were 156/170(91.8%; 95%CI:87.3-96.2), 155/170(91.2%; 95%CI: 86.6%-95.7%),and 46/170(27.1%; 95%CI: 20.1%-34.0%) with rSK(schedule A and B) and hydrocortisone acetate suppositories, respectively. These 64.6% and 63.9%differences(95%CI: 56.7%-72.2% and 55.7%-72.0%)were highly significant(P < 0.001). This advantage was detected since the early 3rd day evaluation(68.8% and64.1% vs 7.1% for the rSK and active control groups,respectively; P < 0.001) and was maintained even at the late 10 th day assessment(97.1% and 93.5% vs67.1% for rSK and hydrocortisone acetate, respectively;P < 0.001). Time to response was 3 d(95%CI: 2.9-3.1)for both rSK groups and 10 d(95%CI: 9.3-10.7) in the hydrocortisone acetate group. This difference was highly significant(P < 0.001). All subgroup stratified analyses(with or without thrombosis and hemorrhoid classification) showed a statistically significant advantage for the rSK groups. Thrombectomy was necessary in4/251 and 14/133 patients with baseline thrombosis in the rSK and hydrocortisone acetate groups, respectively(P < 0.001). There were no adverse events attributable to the experimental treatment.CONCLUSION: rSK suppositories showed a significant advantage over a widely-used over-the-counter hydrocortisone acetate preparation for the treatment of acute hemorrhoidal illness, as well as having an adequate safety profile.展开更多
<strong><em>Background</em></strong><span style="font-family:Verdana;"><strong>:</strong></span><span style="font-family:;" "="">...<strong><em>Background</em></strong><span style="font-family:Verdana;"><strong>:</strong></span><span style="font-family:;" "=""><span style="font-family:Verdana;"> Despite of different adverse events, streptokinase (SK) is widely used to treat patients presented with acute ST segment elevation myocardial infarction. </span><b><i><span style="font-family:Verdana;">Objective</span></i><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"> The purpose of the present study was to observe different adverse events in patients of acute ST segment elevation myocardial infarction receiving SK infusion. </span><b><i><span style="font-family:Verdana;">Methodology</span></i><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"> This cross-sectional type of analytic observational study was carried out in the inpatient department of Cardiology at National Institute of Cardiovascular Diseases, Dhaka, Bangladesh from December 23</span><sup><span style="font-size:12px;font-family:Verdana;">rd</span></sup></span><span style="font-family:Verdana;"> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">2019 to February 22</span><sup><span style="font-size:12px;font-family:Verdana;">nd</span></sup><span style="font-family:Verdana;"> 2020 for a period of two (2) months. All patients diagnosed as acute ST segment elevation myocardial infarction receiving SK were included in the present study. Adverse events were documented through completing a questionnaire by reviewing the records in the medical file as well as interviewing with the patients. </span><b><i><span style="font-family:Verdana;">Result</span></i><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"> In this study, 43 (26.2%) patients developed different types of adverse events and 121 (73.8%) had no complications following SK infusion. The most common adverse event was hypotension </span><i><span style="font-family:Verdana;">i.e.</span></i><span style="font-family:Verdana;"> 26 (60.4%) and other adverse events were bleeding 8 (4.8%) and allergic reaction 7 (4.2%). Statistically significant higher rate of adverse events occurred in diabetic, hypertensive and dyslipidemia group which was 26 (56.5%) Vs. 17 (14.4%), </span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.000, 37 (36.6%) Vs. 06 (09.5%), </span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.000 and 18 (54.5%) Vs. 25 (19.1%), </span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.000 respectively. The independent factors for the development of adverse events were smoking {OR: 5.1</span></span><span style="font-family:Verdana;"> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">with 95% CI (1.7 to 15.1), </span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.003}, diabetes {OR: 14.9 with 95% CI (5.0 to 44.8), </span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.000}, hypertension {OR: 5.1with 95% CI (1.7 to 15.1), </span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.003} and dyslipidemia {OR: 4.6 with 95% CI (1.5 to 13.7), </span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.007}. </span><b><i><span style="font-family:Verdana;">Conclusion</span></i><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"> Streptokinase infusion was associated with different adverse events. Among them the commonest one was hypotension and other less common events were minor bleeding and minor allergic reaction. The adverse events were more frequently documented in patients who were smoker, diabetic, hypertensive and dyslipidemic.</span></span>展开更多
The aim of this study is to test the patency rate and safety of the accelerated streptokinase dose regimen for coronary thrombolysis compared with the conventional one. One hundred and four patients enterring three ho...The aim of this study is to test the patency rate and safety of the accelerated streptokinase dose regimen for coronary thrombolysis compared with the conventional one. One hundred and four patients enterring three hospitals up to 12 hours after the onset of definite acute myocardial infarction were randomizely treated with intravenous accelerated streptokinase dose regimen ( 1. 5 million units/30 min) (group A, 47 cases) and conventional dose regimen ( 1. 5 million units/60 min) (group B , 57 casese). The reperfusion rate of infarct-related arteries determined by clinical evidence of reperfusion was 76. 6% (36/47) in group A VS 61. 4% (35/57) in group B. There was significant difference in reperfusion rates among patients within 6 hours after the onset of chest pain : 87. 9% (29/33) in group A VS 67. 4 (29/43) in group B(P<0. 05 ). The incidence of mild bleeding , allergic reaction , hypotension was 12. 8 % ( 6/47 ) , 4. 3 % ( 2/47 ) , 12. 8 ( 6/47 ) respectively in group A vs 21. 1 ( 12/57 ) , 3. 5 (2/57) . 17. 5 % ( 10/57) respectively in group B. Compared to conventional dose regimen, intravenous accelerated streptokinase dose regimen for coronary thrombolysis seems to improve reperfusion rate markedly without increasing adverse events such as bleeding , allergic reaction and hypotension. It suggests that accelerated streptokinase therapy deserves more extensive investigation.展开更多
BACKGROUND： Screening of isolates for their potency to produce streptokinase was an important criterion of this research. The current study emphasizes the strain improvement, optimization and purification studies for...BACKGROUND： Screening of isolates for their potency to produce streptokinase was an important criterion of this research. The current study emphasizes the strain improvement, optimization and purification studies for enhanced production of streptokinase from Streptococcus uberis TNA-M1 isolated from bovine milk. METHODS： The study was carried out on samples collected from milk sample. Primary screening and characterization is used as an excellent source for the isolation of 13-hemolytic organisms. Strain improvement was done by both physical ＆ chemical mutagenesis. The enzyme activity was checked by clot lysis assay and confirmed by fibrin plate method. The partially purified and crude enzyme were analysed by high-performance liquid chromatography. Molecular weight ＆ enzyme purity was checked by SDS -PAGE, further confirmed by fibrin zymography. RESULTS： Out of the 3 isolated strains, only one isolate expressed 13-haemolysis with streptokinase （SK） activity. Based on the results of radial caseinolytic assay and blood clot dissolving assay, isolate TNA-M1 demonstrated the highest streptokinase activity. Based on morphological, biochemical and molecular characterization, it was identified as Streptococcus uberis and the strain was named as Streptococcus uberis TNA-M1. The results indicated that ultra-violet （UV） and ethyl methane sulfonate （EMS） were effective mutagenic agents for strain improvement of Streptococcus uberis TNA-M1 and enhanced SK productivity. HPLC analysis was performed in order to confirm the presence of streptokinase with the similar retention time （0.875 min） with its standard （0.854） min. SDS-PAGE of the enzyme showed protein band of approximately 47 kDa and confirmed by fibrin zymography. It exhibited fibrinolytic activity, which was more potent than other fibrinolytic enzymes. Glucose and peptone were recorded to be the optimum carbon and nitrogen sources respectively. CONCLUSION： Thus this study presents its novelty by highlighting the potential of Streptococcus uberis TNA-M1 as a significant source for the production of fibrinolytic enzymes.展开更多
BACKGROUND:Bleeding outcomes are crucial primary safety endpoints in studies involving thrombolytic agents.This study aimed to determine the incidence,characteristics and mortality outcomes of bleeding following ST-el...BACKGROUND:Bleeding outcomes are crucial primary safety endpoints in studies involving thrombolytic agents.This study aimed to determine the incidence,characteristics and mortality outcomes of bleeding following ST-elevation myocardial infarction(STEMI)thrombolysis in an Asian population.METHODS:This single-centre retrospective study included all STEMI patients who received thrombolytic therapy from 2016 to 2020 in a Malaysian tertiary hospital.Total population sampling was used in this study.The primary outcome was bleeding events post-thrombolysis,categorised using the Thrombolysis in Myocardial Infarction(TIMI)bleeding criteria.Inferential statistics were used to determine the associations between relevant variables.RESULTS:Data from 941 patients were analysed.A total of 156(16.6%)STEMI patients bled post-thrombolysis.Major,minor,and minimal TIMI occurred in 7(0.7%),17(1.8%),and 132(14.0%)patients,respectively.Age 65 years(P=0.031)and Malaysian Chinese(P=0.008)were associated with a higher incidence of bleeding post-thrombolysis.Conversely,foreigners(P=0.032)and current smoker(P=0.007)were associated with a lower incidence of bleeding.Both TIMI major(P<0.001)and TIMI minor(P<0.001)were associated with a higher incidence of all-cause in-hospital mortality among STEMI patients.TIMI minor bleeding was significantly higher in the streptokinase recipients.The bleeding sites were comparable between streptokinase and tenecteplase recipients,except for a significantly higher incidence of gastrointestinal bleeding in the streptokinase recipients(P=0.027).CONCLUSION:In our Asian population,the incidence of total bleeding events following STEMI thrombolysis is comparable to that previously reported.The development of TIMI major and minor bleeding complications is associated with higher mortality.展开更多
Objective:To study the phytochemical and biological properties(antioxidant,anthelmintic and thrombolytic)of methanolic extracts of Enhydra fluctuant Lour.,a plant belonging to the Asteraceae family.Methods:The phytoch...Objective:To study the phytochemical and biological properties(antioxidant,anthelmintic and thrombolytic)of methanolic extracts of Enhydra fluctuant Lour.,a plant belonging to the Asteraceae family.Methods:The phytochemical evaluation was carried out by qualitative analysis.In vitro antioxidant activity of extract was studied using free radical scavenging assay,ability of reduction,total phenol and total flavonoid contents determination assays.The anthelmintic activity was determined using paralysis and death time of Pheretima posthuma(earthworm)and thrombolytic activity by clot disruption assay.Results:The phytochemical evaluation showed significant presence of flavonoids,triterpenes,carbohydrate,reducing sugars,saponins,phenols,diterpenes,protein and tannin.The antioxidant activity was found significant[IC_(50)(135.20±036)μg/mL]as compared to ascorbic acid[(130.00±0.76)μg/mL].The reducing power was increased with concentration.Total phenol and total flavonoid contents were(153.08±0.38)mg/mL and(172.04±0.56)mg/mL respectively.The paralysis and death time of earthworms for different concentrations of extract were determined and compared with albendazole.The results showed that 10 mg/mL of the crude extract had similar effect with albendazole.Additionally,the crude extract showed a concentration depended relationship with its anthelmintic property.The clot lysis activity of crude extract was compared to the standard streptokinase's clot lysis(40.13%)activity and found significant(31%).Conclusions:The study proves that the crude methanolic extract of Enhydra fluctuant Lour,has significant antioxidant,anthelmintic and thrombolytic activity containing wide range of phytochemicals.展开更多
The treatment of gastric carcinoma consists of neoadjuvant chemoradiation,partial gastrectomy,subtotal gastrectomy,total gastrectomy,extended resection,and postoperative chemotherapy.Currently,gastrectomy and extended...The treatment of gastric carcinoma consists of neoadjuvant chemoradiation,partial gastrectomy,subtotal gastrectomy,total gastrectomy,extended resection,and postoperative chemotherapy.Currently,gastrectomy and extended lymphadenectomy is the optimal choice for late gastric carcinoma.Postoperative complications are common after total gastrectomy including hemorrhage,anastomotic leakage,f istula,and obstruction.However,deep venous thrombosis(DVT) is an uncommon complication after gastrectomy for gastric carcinoma.We describe a case of a 68-year-old female patient with DVT after gastrectomy for gastric carcinoma.The patient was treated with anticoagulants and thrombolytics and subjected to necessary laboratory monitoring.The patient recovered well after treatment and was symptom-free during a 3-mo follow-up.We conclude that correct diagnosis and treatment of DVT are crucial.展开更多
The first line drugs in the management of thromboernbolic diseases in Nigeria include Urokinase and Streptokinase. These drugs come with their attendant shortcomings. The need to source for cheap and accessible altern...The first line drugs in the management of thromboernbolic diseases in Nigeria include Urokinase and Streptokinase. These drugs come with their attendant shortcomings. The need to source for cheap and accessible alternative therapy forms the basis of this study. The fibrinolytic potentials of 10 Nigerian medicinal plants： Anona senegalensis, Buchholzia coriaceae, Citrullus colocynthis, Cnidoscolus aconitifolius, Curculigo pilosa, Nicotiana tabaccum, Parinari curatellifolia, Pepperomia pellucida, Sida acuta and Xylopia aethiopica extracts were evaluated using water and streptokinase as negative and positive controls respectively. Trace metal （Cu, Fe, Ca and Zn） analysis of the plant extracts was carried out using atomic absorption spectrophotometer. Methodology involved in vitro clot lysis method, the crude methanolic extract ofParinari curatellifolia （56.122%）, Cnidoscolus aconitifolius （48.385%）, Anona senegalensis （46.360%）, Xylopia aethiopica （43.205%） and Buchholzia coriaceae （27.062%） were found to have significant （P 〉 0.001） fibrinolytic activity. Maximum effect was exhibited by the positive standard： Streptokinase （60.20 ± 4.30%）, followed by Parinari curatellifolia （56.122 ± 3.86%）, our findings reveal that fibrinolytic activity is independent of elemental Copper or Iron content of the extracts. This study indicated that methanolic extracts of Parinari curatellifolia, Cnidoscolus aconitifolius, Anona senegalensis, Xylopia aethiopica and Buchholzia coriaceae could serve as cheap and accessible alternative.展开更多
Fibrinolytic therapy for arterial or venous thrombotic disorders involves the systemic administration of thrombolytics such as streptokinase, which is associated with serious bleeding complications. With this study, w...Fibrinolytic therapy for arterial or venous thrombotic disorders involves the systemic administration of thrombolytics such as streptokinase, which is associated with serious bleeding complications. With this study, we provide a proof-of-concept of photothermal thrombus ablation with gold nanorods exposed to near-infrared irradiation, both in vitro using materials generated from purified fibrinogen or plasma and in vivo in murine blood vessels. This is the first report of the application of photothermal therapy as an anti-thrombotic measure. Remarkably, the addition of streptokinase had a multimodal additive effect with regard to acceleration of photothermal lysis of thrombi even at a dose significantly below the therapeutic concentration, thus minimizing the life- threatening side effects and adverse complications. This combinatorial approach exhibits great promise for lysing pathological clots while effectively overcoming the drawbacks of existing therapies.展开更多
Objective:To compare cytotoxic and thrombolytic activity of crude methanolic extract of Cissus pentagona(C.pentagona)and Thunbergia grandiflora Roxb.(T.grandiflora)leaves.Methods:The screening of cytotoxic activity wa...Objective:To compare cytotoxic and thrombolytic activity of crude methanolic extract of Cissus pentagona(C.pentagona)and Thunbergia grandiflora Roxb.(T.grandiflora)leaves.Methods:The screening of cytotoxic activity was done by using brine shrimp lethality bioassay while the thrombolytic activity was evaluated by using the in vitro clot lysis model.In brief,venous blood from five healthy volunteers was allowed to form clots which were weighed and treated with the tested plant materials to disrupt the clots.Weight of clot before and after treatment provided a percentage of clot lysis and the results with streptokinase as positive control and water as negative control were compared.Results:Moderate cytotoxicity was found for both methanol extracts,and it was compared with the standard drug vincristine sulfate in the brine shrimp bioassay.In the present study,the LC50 values of the methanol crude extract of C.pentagona as well as T.grandiflora and vincristine sulfate were 291.33,243.37 and 12.59μg/mL,respectively.In thrombolytic study,it was found that C.pentagona and T.grandiflora showed(24.27±2.61)%and(19.56±2.98)%of clot lysis,respectively.Among the herbs studied,C.pentagona showed very significant(P<0.001)percentage of clot lysis than T.grandiflora,compared with reference drug streptokinase[(63.54±2.61)%].Conclusions:The results of the study demonstrated that the leaf of the plants contains preliminary cytotoxic effect on brine shrimp and promising thrombolytic activity in vitro when it is tested on human blood.However,further study is needed to evaluate its potential as a thrombolytic agent.展开更多
基金Supported by Heber Biotec,Havana(products,reagents) and the Ministry of Public Health of Cuba(hospital facilities and general medical care of the patients)
文摘AIM: To compare the efficacy and safety of recombinant streptokinase (rSK) and phenylephrine-based suppositories in acute hemorrhoidal disease.
基金Supported by Heber Biotec,Havana(for providing products and reagents)and the Ministry of Public Health of Cuba(for hospital facilities and general medical care of patients)
文摘AIM: To compare the efficacy and safety of recombinant streptokinase(rSK) vs hydrocortisone acetate-based suppositories in acute hemorrhoidal disease.METHODS: A multicenter(11 sites), randomized(1:1:1), open, controlled trial with parallel groups was performed. All participating patients gave their written,informed consent. After inclusion, patients with acute symptoms of hemorrhoids were centrally randomized to receive, as outpatients, by the rectal route, suppositories of rSK 200000 IU of one unit every 8 h(first 3 units)and afterwards every 12 h until 8 administrations were completed(schedule A), one unit every 8 h until 6 units were completed(schedule B), or 25 mg hydrocortisone acetate once every 8 h up to a maximum of 24 administrations. Evaluations were performed at 3, 5,and 10 d post-inclusion. The main end-point was the 5thday response(disappearance of pain and bleeding, and≥ 70% reduction of the lesion size). Time to response and need for thrombectomy were secondary efficacy variables. Adverse events were also evaluated.RESULTS: Groups were homogeneous with regards to demographic and baseline characteristics. Fifth day complete response rates were 156/170(91.8%; 95%CI:87.3-96.2), 155/170(91.2%; 95%CI: 86.6%-95.7%),and 46/170(27.1%; 95%CI: 20.1%-34.0%) with rSK(schedule A and B) and hydrocortisone acetate suppositories, respectively. These 64.6% and 63.9%differences(95%CI: 56.7%-72.2% and 55.7%-72.0%)were highly significant(P < 0.001). This advantage was detected since the early 3rd day evaluation(68.8% and64.1% vs 7.1% for the rSK and active control groups,respectively; P < 0.001) and was maintained even at the late 10 th day assessment(97.1% and 93.5% vs67.1% for rSK and hydrocortisone acetate, respectively;P < 0.001). Time to response was 3 d(95%CI: 2.9-3.1)for both rSK groups and 10 d(95%CI: 9.3-10.7) in the hydrocortisone acetate group. This difference was highly significant(P < 0.001). All subgroup stratified analyses(with or without thrombosis and hemorrhoid classification) showed a statistically significant advantage for the rSK groups. Thrombectomy was necessary in4/251 and 14/133 patients with baseline thrombosis in the rSK and hydrocortisone acetate groups, respectively(P < 0.001). There were no adverse events attributable to the experimental treatment.CONCLUSION: rSK suppositories showed a significant advantage over a widely-used over-the-counter hydrocortisone acetate preparation for the treatment of acute hemorrhoidal illness, as well as having an adequate safety profile.
文摘<strong><em>Background</em></strong><span style="font-family:Verdana;"><strong>:</strong></span><span style="font-family:;" "=""><span style="font-family:Verdana;"> Despite of different adverse events, streptokinase (SK) is widely used to treat patients presented with acute ST segment elevation myocardial infarction. </span><b><i><span style="font-family:Verdana;">Objective</span></i><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"> The purpose of the present study was to observe different adverse events in patients of acute ST segment elevation myocardial infarction receiving SK infusion. </span><b><i><span style="font-family:Verdana;">Methodology</span></i><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"> This cross-sectional type of analytic observational study was carried out in the inpatient department of Cardiology at National Institute of Cardiovascular Diseases, Dhaka, Bangladesh from December 23</span><sup><span style="font-size:12px;font-family:Verdana;">rd</span></sup></span><span style="font-family:Verdana;"> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">2019 to February 22</span><sup><span style="font-size:12px;font-family:Verdana;">nd</span></sup><span style="font-family:Verdana;"> 2020 for a period of two (2) months. All patients diagnosed as acute ST segment elevation myocardial infarction receiving SK were included in the present study. Adverse events were documented through completing a questionnaire by reviewing the records in the medical file as well as interviewing with the patients. </span><b><i><span style="font-family:Verdana;">Result</span></i><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"> In this study, 43 (26.2%) patients developed different types of adverse events and 121 (73.8%) had no complications following SK infusion. The most common adverse event was hypotension </span><i><span style="font-family:Verdana;">i.e.</span></i><span style="font-family:Verdana;"> 26 (60.4%) and other adverse events were bleeding 8 (4.8%) and allergic reaction 7 (4.2%). Statistically significant higher rate of adverse events occurred in diabetic, hypertensive and dyslipidemia group which was 26 (56.5%) Vs. 17 (14.4%), </span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.000, 37 (36.6%) Vs. 06 (09.5%), </span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.000 and 18 (54.5%) Vs. 25 (19.1%), </span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.000 respectively. The independent factors for the development of adverse events were smoking {OR: 5.1</span></span><span style="font-family:Verdana;"> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">with 95% CI (1.7 to 15.1), </span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.003}, diabetes {OR: 14.9 with 95% CI (5.0 to 44.8), </span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.000}, hypertension {OR: 5.1with 95% CI (1.7 to 15.1), </span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.003} and dyslipidemia {OR: 4.6 with 95% CI (1.5 to 13.7), </span><i><span style="font-family:Verdana;">p</span></i><span style="font-family:Verdana;"> = 0.007}. </span><b><i><span style="font-family:Verdana;">Conclusion</span></i><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"> Streptokinase infusion was associated with different adverse events. Among them the commonest one was hypotension and other less common events were minor bleeding and minor allergic reaction. The adverse events were more frequently documented in patients who were smoker, diabetic, hypertensive and dyslipidemic.</span></span>
文摘The aim of this study is to test the patency rate and safety of the accelerated streptokinase dose regimen for coronary thrombolysis compared with the conventional one. One hundred and four patients enterring three hospitals up to 12 hours after the onset of definite acute myocardial infarction were randomizely treated with intravenous accelerated streptokinase dose regimen ( 1. 5 million units/30 min) (group A, 47 cases) and conventional dose regimen ( 1. 5 million units/60 min) (group B , 57 casese). The reperfusion rate of infarct-related arteries determined by clinical evidence of reperfusion was 76. 6% (36/47) in group A VS 61. 4% (35/57) in group B. There was significant difference in reperfusion rates among patients within 6 hours after the onset of chest pain : 87. 9% (29/33) in group A VS 67. 4 (29/43) in group B(P<0. 05 ). The incidence of mild bleeding , allergic reaction , hypotension was 12. 8 % ( 6/47 ) , 4. 3 % ( 2/47 ) , 12. 8 ( 6/47 ) respectively in group A vs 21. 1 ( 12/57 ) , 3. 5 (2/57) . 17. 5 % ( 10/57) respectively in group B. Compared to conventional dose regimen, intravenous accelerated streptokinase dose regimen for coronary thrombolysis seems to improve reperfusion rate markedly without increasing adverse events such as bleeding , allergic reaction and hypotension. It suggests that accelerated streptokinase therapy deserves more extensive investigation.
文摘BACKGROUND： Screening of isolates for their potency to produce streptokinase was an important criterion of this research. The current study emphasizes the strain improvement, optimization and purification studies for enhanced production of streptokinase from Streptococcus uberis TNA-M1 isolated from bovine milk. METHODS： The study was carried out on samples collected from milk sample. Primary screening and characterization is used as an excellent source for the isolation of 13-hemolytic organisms. Strain improvement was done by both physical ＆ chemical mutagenesis. The enzyme activity was checked by clot lysis assay and confirmed by fibrin plate method. The partially purified and crude enzyme were analysed by high-performance liquid chromatography. Molecular weight ＆ enzyme purity was checked by SDS -PAGE, further confirmed by fibrin zymography. RESULTS： Out of the 3 isolated strains, only one isolate expressed 13-haemolysis with streptokinase （SK） activity. Based on the results of radial caseinolytic assay and blood clot dissolving assay, isolate TNA-M1 demonstrated the highest streptokinase activity. Based on morphological, biochemical and molecular characterization, it was identified as Streptococcus uberis and the strain was named as Streptococcus uberis TNA-M1. The results indicated that ultra-violet （UV） and ethyl methane sulfonate （EMS） were effective mutagenic agents for strain improvement of Streptococcus uberis TNA-M1 and enhanced SK productivity. HPLC analysis was performed in order to confirm the presence of streptokinase with the similar retention time （0.875 min） with its standard （0.854） min. SDS-PAGE of the enzyme showed protein band of approximately 47 kDa and confirmed by fibrin zymography. It exhibited fibrinolytic activity, which was more potent than other fibrinolytic enzymes. Glucose and peptone were recorded to be the optimum carbon and nitrogen sources respectively. CONCLUSION： Thus this study presents its novelty by highlighting the potential of Streptococcus uberis TNA-M1 as a significant source for the production of fibrinolytic enzymes.
文摘BACKGROUND:Bleeding outcomes are crucial primary safety endpoints in studies involving thrombolytic agents.This study aimed to determine the incidence,characteristics and mortality outcomes of bleeding following ST-elevation myocardial infarction(STEMI)thrombolysis in an Asian population.METHODS:This single-centre retrospective study included all STEMI patients who received thrombolytic therapy from 2016 to 2020 in a Malaysian tertiary hospital.Total population sampling was used in this study.The primary outcome was bleeding events post-thrombolysis,categorised using the Thrombolysis in Myocardial Infarction(TIMI)bleeding criteria.Inferential statistics were used to determine the associations between relevant variables.RESULTS:Data from 941 patients were analysed.A total of 156(16.6%)STEMI patients bled post-thrombolysis.Major,minor,and minimal TIMI occurred in 7(0.7%),17(1.8%),and 132(14.0%)patients,respectively.Age 65 years(P=0.031)and Malaysian Chinese(P=0.008)were associated with a higher incidence of bleeding post-thrombolysis.Conversely,foreigners(P=0.032)and current smoker(P=0.007)were associated with a lower incidence of bleeding.Both TIMI major(P<0.001)and TIMI minor(P<0.001)were associated with a higher incidence of all-cause in-hospital mortality among STEMI patients.TIMI minor bleeding was significantly higher in the streptokinase recipients.The bleeding sites were comparable between streptokinase and tenecteplase recipients,except for a significantly higher incidence of gastrointestinal bleeding in the streptokinase recipients(P=0.027).CONCLUSION:In our Asian population,the incidence of total bleeding events following STEMI thrombolysis is comparable to that previously reported.The development of TIMI major and minor bleeding complications is associated with higher mortality.
基金Supported by the Department of Physiology,Biochemistry and Pharmacology,Faculty of Veterinary Medicine,Chittagong Veterinary and Animal Sciences University,Chittagong,Bangladesh(Grant No.RFLDC/MSC/res.sund/5004/3096)
文摘Objective:To study the phytochemical and biological properties(antioxidant,anthelmintic and thrombolytic)of methanolic extracts of Enhydra fluctuant Lour.,a plant belonging to the Asteraceae family.Methods:The phytochemical evaluation was carried out by qualitative analysis.In vitro antioxidant activity of extract was studied using free radical scavenging assay,ability of reduction,total phenol and total flavonoid contents determination assays.The anthelmintic activity was determined using paralysis and death time of Pheretima posthuma(earthworm)and thrombolytic activity by clot disruption assay.Results:The phytochemical evaluation showed significant presence of flavonoids,triterpenes,carbohydrate,reducing sugars,saponins,phenols,diterpenes,protein and tannin.The antioxidant activity was found significant[IC_(50)(135.20±036)μg/mL]as compared to ascorbic acid[(130.00±0.76)μg/mL].The reducing power was increased with concentration.Total phenol and total flavonoid contents were(153.08±0.38)mg/mL and(172.04±0.56)mg/mL respectively.The paralysis and death time of earthworms for different concentrations of extract were determined and compared with albendazole.The results showed that 10 mg/mL of the crude extract had similar effect with albendazole.Additionally,the crude extract showed a concentration depended relationship with its anthelmintic property.The clot lysis activity of crude extract was compared to the standard streptokinase's clot lysis(40.13%)activity and found significant(31%).Conclusions:The study proves that the crude methanolic extract of Enhydra fluctuant Lour,has significant antioxidant,anthelmintic and thrombolytic activity containing wide range of phytochemicals.
文摘The treatment of gastric carcinoma consists of neoadjuvant chemoradiation,partial gastrectomy,subtotal gastrectomy,total gastrectomy,extended resection,and postoperative chemotherapy.Currently,gastrectomy and extended lymphadenectomy is the optimal choice for late gastric carcinoma.Postoperative complications are common after total gastrectomy including hemorrhage,anastomotic leakage,f istula,and obstruction.However,deep venous thrombosis(DVT) is an uncommon complication after gastrectomy for gastric carcinoma.We describe a case of a 68-year-old female patient with DVT after gastrectomy for gastric carcinoma.The patient was treated with anticoagulants and thrombolytics and subjected to necessary laboratory monitoring.The patient recovered well after treatment and was symptom-free during a 3-mo follow-up.We conclude that correct diagnosis and treatment of DVT are crucial.
文摘The first line drugs in the management of thromboernbolic diseases in Nigeria include Urokinase and Streptokinase. These drugs come with their attendant shortcomings. The need to source for cheap and accessible alternative therapy forms the basis of this study. The fibrinolytic potentials of 10 Nigerian medicinal plants： Anona senegalensis, Buchholzia coriaceae, Citrullus colocynthis, Cnidoscolus aconitifolius, Curculigo pilosa, Nicotiana tabaccum, Parinari curatellifolia, Pepperomia pellucida, Sida acuta and Xylopia aethiopica extracts were evaluated using water and streptokinase as negative and positive controls respectively. Trace metal （Cu, Fe, Ca and Zn） analysis of the plant extracts was carried out using atomic absorption spectrophotometer. Methodology involved in vitro clot lysis method, the crude methanolic extract ofParinari curatellifolia （56.122%）, Cnidoscolus aconitifolius （48.385%）, Anona senegalensis （46.360%）, Xylopia aethiopica （43.205%） and Buchholzia coriaceae （27.062%） were found to have significant （P 〉 0.001） fibrinolytic activity. Maximum effect was exhibited by the positive standard： Streptokinase （60.20 ± 4.30%）, followed by Parinari curatellifolia （56.122 ± 3.86%）, our findings reveal that fibrinolytic activity is independent of elemental Copper or Iron content of the extracts. This study indicated that methanolic extracts of Parinari curatellifolia, Cnidoscolus aconitifolius, Anona senegalensis, Xylopia aethiopica and Buchholzia coriaceae could serve as cheap and accessible alternative.
文摘Fibrinolytic therapy for arterial or venous thrombotic disorders involves the systemic administration of thrombolytics such as streptokinase, which is associated with serious bleeding complications. With this study, we provide a proof-of-concept of photothermal thrombus ablation with gold nanorods exposed to near-infrared irradiation, both in vitro using materials generated from purified fibrinogen or plasma and in vivo in murine blood vessels. This is the first report of the application of photothermal therapy as an anti-thrombotic measure. Remarkably, the addition of streptokinase had a multimodal additive effect with regard to acceleration of photothermal lysis of thrombi even at a dose significantly below the therapeutic concentration, thus minimizing the life- threatening side effects and adverse complications. This combinatorial approach exhibits great promise for lysing pathological clots while effectively overcoming the drawbacks of existing therapies.
基金Supported by Department of Pharmacy,International Islamic University Chittagong,Chittagong,Bangladesh(Grant No.Pharmacy P&D 59/04-10).
文摘Objective:To compare cytotoxic and thrombolytic activity of crude methanolic extract of Cissus pentagona(C.pentagona)and Thunbergia grandiflora Roxb.(T.grandiflora)leaves.Methods:The screening of cytotoxic activity was done by using brine shrimp lethality bioassay while the thrombolytic activity was evaluated by using the in vitro clot lysis model.In brief,venous blood from five healthy volunteers was allowed to form clots which were weighed and treated with the tested plant materials to disrupt the clots.Weight of clot before and after treatment provided a percentage of clot lysis and the results with streptokinase as positive control and water as negative control were compared.Results:Moderate cytotoxicity was found for both methanol extracts,and it was compared with the standard drug vincristine sulfate in the brine shrimp bioassay.In the present study,the LC50 values of the methanol crude extract of C.pentagona as well as T.grandiflora and vincristine sulfate were 291.33,243.37 and 12.59μg/mL,respectively.In thrombolytic study,it was found that C.pentagona and T.grandiflora showed(24.27±2.61)%and(19.56±2.98)%of clot lysis,respectively.Among the herbs studied,C.pentagona showed very significant(P<0.001)percentage of clot lysis than T.grandiflora,compared with reference drug streptokinase[(63.54±2.61)%].Conclusions:The results of the study demonstrated that the leaf of the plants contains preliminary cytotoxic effect on brine shrimp and promising thrombolytic activity in vitro when it is tested on human blood.However,further study is needed to evaluate its potential as a thrombolytic agent.
