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BACKGROUND: Loculated pleural effusions present as a challenging clinical scenario due to the formation of loculations, often leading to increased morbidity and prolonged hospital stays. Intrapleural Streptokinase(STK) has been proposed as a potential therapeutic option to facilitate pleural adhesiolysis and improve pleural fluid drainage in these cases. METHODOLOGY: Designed as an analytical study in a prospective manner. Conducted from July 2022 to June 2024 at Government Chest Diseases and TB Hospital, Hanamkonda, Warangal. 30 patients having loculated pleural effusions were included in the study. All the cases were evaluated with detailed history, examination, blood workup, pleural fluid analysis and after informed written consent, all the cases were given Intrapleural streptokinase at a dose of 2,50,000 IU per day for 2 - 7 days. Patients were assessed based on amount of pleural fluid drained before and after instillation of streptokinase, improvement of chest x ray and ultrasound clearance of loculations. All the patients were carefully monitored for the possible complications. RESULTS: In 73.3% of the patients there is complete lysis of adhesions and drainage of pleural fluid with the use of intrapleural streptokinase. [ABSTRACT FROM AUTHOR]

Background: Streptococcus dysgalactiae subspecies equisimilis (SDSE) is increasingly recognized as an emerging cause of invasive diseases including necrotizing soft tissue infections (NSTIs). In contrast to the closely related Streptococcus pyogenes, SDSE infections mainly affect older and comorbid patients. Biofilm formation has been demonstrated in soft tissue biopsies of S. pyogenes NSTI cases. Results: Here, we show that bacterial aggregations indicative of biofilms are also present in SDSE NSTI. Although streptokinase (Ska) activity and biofilm formation did not correlate in a diverse set of clinical SDSE isolates, addition of exogenous Ska at an early time point prevented biofilm formation for selected strains. Deletion of ska in SDSE S118 strain resulted in increased biofilm forming capacity. Ska-deficient mutant strain was characterized by a higher metabolic activity and consequent metabolome profiling of biofilms identified higher deposition of a wide range of metabolites as compared to the wild-type. Conclusions: Our results argue that Ska suppresses biofilm formation in SDSE independent of its original plasminogen converting activity. However, the impact of biofilms and its consequences for patient outcomes in streptococcal NSTIs remain to be elucidated. [ABSTRACT FROM AUTHOR]

Introduction: Endotoxin or lipopolysaccharide (LPS) is one of the components of the wall of gram-negative bacteria, which, when in contact with blood, stimulates the immune system and causes fever and even serious adverse effects or death. Removing endotoxin is one of the most daunting challenges presented to the purification process in the production of recombinant biological drugs. Bacterial endotoxin (LPS) is resistant to heat and passes through sterilizing filters, and due to its dangerous side effects in living organisms, part of the target protein purification process is always related to removing this disturbing factor from the product. Materials & Methods: The affinity matrix S3E3-S-Sepharose, which was produced by immobilizing the improved variant of antimicrobial peptide S3 called S3E3 peptide on Sepharose chromatography resin, was used to remove endotoxin from active pharmaceutical ingredient (API) of streptokinase, and the performance of this matrix was compared with the performance of a disposable commercial matrix (containing S3 peptide as its ligand) and with ion exchange chromatography resin. Results: The statistical analysis of the results revealed that compared to commercial S3 matrices and ion exchange chromatography, the S3E3-S-Sepharose matrix had higher protein recovery (84.07% compared to 81.50 and 75.31%, respectively) and higher streptokinase biological activity recovery (81.95% vs. 27 76.76 and 61.54%, respectively). Conclusion: As evidenced by the obtained results, the S3E3-S-Sepharose matrix seems to be a suitable candidate for use in the purification processes of Streptokinase API and other recombinant biopharmaceuticals. [ABSTRACT FROM AUTHOR]

Abstract Background Streptococcus dysgalactiae subspecies equisimilis (SDSE) is increasingly recognized as an emerging cause of invasive diseases including necrotizing soft tissue infections (NSTIs). In contrast to the closely related Streptococcus pyogenes, SDSE infections mainly affect older and comorbid patients. Biofilm formation has been demonstrated in soft tissue biopsies of S. pyogenes NSTI cases. Results Here, we show that bacterial aggregations indicative of biofilms are also present in SDSE NSTI. Although streptokinase (Ska) activity and biofilm formation did not correlate in a diverse set of clinical SDSE isolates, addition of exogenous Ska at an early time point prevented biofilm formation for selected strains. Deletion of ska in SDSE S118 strain resulted in increased biofilm forming capacity. Ska-deficient mutant strain was characterized by a higher metabolic activity and consequent metabolome profiling of biofilms identified higher deposition of a wide range of metabolites as compared to the wild-type. Conclusions Our results argue that Ska suppresses biofilm formation in SDSE independent of its original plasminogen converting activity. However, the impact of biofilms and its consequences for patient outcomes in streptococcal NSTIs remain to be elucidated.

This study aimed to investigate the effects of platelet rich plasma (PRP) and streptokinase (SK) on postoperative intra-abdominal adhesion formation in rats. The 4-month-old, healthy, non-pregnant female Wistar-Albino rats were used as animal material. The remaining 24 animals were divided into three groups with 8 rats in each group (PRP, SK and Control). The fibroblast proliferation, mononuclear cell infiltration and giant cells were clearly prominent in control group. A decrease was observed in the ratio of these cells in the PRP and SK groups. The comparison of the expression levels of vWF, CASP3 and IL-6 genes showed that the vWF gene was downregulated in the SK group and the IL-6 gene was downregulated in the PRP and SK groups. They were statistically significantly compared to the control group. It was concluded that the expression level of CASP3 gene decreased in the PRP and SK groups compared to the control group, but this decrease was not statistically significant. The PRP and SK could be applied intraperitoneal to prevent the adhesions after intra-abdominal surgery. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to evaluate the knowledge and proficiency of nurses in managing thrombolytic therapy for myocardial infarction. Methodology: A cross-sectional research design was adopted and conducted in a public teaching hospital from May 2020 to September 2020. Registered professional nurses (n=52) working in the emergency department (ED) and cardiac care unit (CCU) were invited to participate. A structured, pre-validated questionnaire was used for data collection. The study received approval from the institutional review board and ethics committee. Data were analyzed using SPSS version 25.0. Results: Fifty ED nurses participated in the study, predominantly male, aged = 34 years, with = 3 years of experience. The overall knowledge score of nurses regarding thrombolytic therapy was 71%, while the practice score was 79%. The lowest level of knowledge was related to contraindications (65%) and treatment protocols (66%), while the highest was for therapy considerations (85.2%). The lowest task performance (47.8%) was observed in the pre - administration phase. There was a negative correlation (r = -0.226) between knowledge and practice. Knowledge levels were higher among male nurses, while task performance was better among those with cardiac certification. Conclusion: The study revealed that while nurses had a favorable level of knowledge about thrombolytic therapy, their practical implementation was poor. This gap highlights the need for targeted educational programs and the establishment of efficient documentation systems to enhance clinical practice. [ABSTRACT FROM AUTHOR]

This article presents a study comparing the effectiveness of two different agents, streptokinase and reteplase, in resolving catheter occlusion in patients undergoing hemodialysis. The study involved 100 patients divided into two groups, with one group receiving streptokinase and the other reteplase. Both agents had similar success rates in resolving catheter occlusion, but reteplase required more time for treatment. No major adverse effects were reported for either agent. The study suggests that streptokinase may be preferred due to the lower frequency of re-injections required. However, further research is recommended to increase understanding of streptokinase. The study adhered to ethical guidelines and was approved by the Isfahan University of Medical Sciences Ethics Committee. [Extracted from the article]

Background This study was conducted to ascertain whether the modified Selvester QRS scoring system would be able to predict the clearance of ST segment elevation in patients undergoing streptokinase-based thrombolytic treatment for acute myocardial infarction. Methods This study was conducted in a hospital setting and involved 61 patients aged between 30 and 80 years who were diagnosed with a new onset acute ST elevation myocardial infarction receiving thrombolytic therapy with streptokinase. Based on 37 criteria and a modified Selvester scoring method, the QRS score was determined, yielding a total of 29 points. A QRS score greater than four was regarded as non-resolution. Additionally, patients were divided into non-resolution groups (STR < 50% of STE1) and resolution groups (STR = 50% of STE1). The SPSS 24 program was used to carry out the statistical analysis. Results Patients with diabetes exhibited high QRS scores, but there was no relationship between them and the ST resolution. There was a substantial association between the QRS score, ST resolution and cardiac failure. The QRS score was higher and the incidence of ST nonresolution was higher in patients with heart failure. In this investigation, there was no significance for patients with dyslipidemia or MI. The resolution group's QRS score was lower than that of the non-resolution group. A noteworthy inverse relationship was observed between the STR and QRS scores. Additionally, there was a negative connection between QRS score and ejection percentage. Conclusion When patients with STEMI are receiving thrombolytic therapy, the QRS score accurately predicts the resolution of the ST segment. Patients are more likely to experience nonresolution of the ST segment if their QRS score is greater than 4. [ABSTRACT FROM AUTHOR]

Bleeding complications following thrombolytic treatment for acute myocardial infarction (AMI) are not infrequent, among which intracranial hemorrhage is commonly reported. In contrast, retroperitoneal hematoma following the administration of thrombolytics is rarely reported in the literature. We are reporting a case of a middle‐aged man, who presented with left‐sided chest pain and was diagnosed with acute coronary syndrome with anterior wall ST elevation AMI. The patient was administered with thrombolytic drugs, including streptokinase and heparin. Percutaneous coronary intervention in the form of Coronary angioplasty with stent insertion was done to the left anterior descending artery, given coronary artery disease. The blood investigations showed elevated activated partial thromboplastin time and prothrombin time. The patient developed vomiting, altered sensorium, and left‐sided weakness, and a non‐contrast computerized tomography brain was done, which showed acute hemorrhage involving the right frontal lobe with intraventricular extension, so the ventricular drain was placed. The patient developed cardiac arrest and died on the third day. On autopsy examination, the brain showed subarachnoid hemorrhage, intraparenchymal hemorrhage over the right frontal lobe, and clotted blood in all the ventricles. A retroperitoneal hematoma of around 1500 cc was seen over the left side of the peritoneal cavity. This case highlights that although intracranial hemorrhage is a known complication after administrating thrombolytic therapy, clinicians should also be aware of the possibility of retroperitoneal hemorrhage. This case emphasizes the value of an autopsy in determining the cause of death in such situations. [ABSTRACT FROM AUTHOR]

Streptokinase is being successfully used as a thrombolytic agent for restoring the blood flow following thromboembolism and myocardial infarction. However, high immunogenicity of the drug has limited its use in clinics. To overcome this limitation, several approaches including PEGylation, use of polymeric particles and liposomes have been suggested. Here, an overview of options for encapsulating the streptokinase has been provided. The suggested options in the literature include PEGylation, polymeric nano/micro-capsules and liposomes. In each approach, efficacy, side effect(s) and pharmacokinetic profile of streptokinase has been evaluated. The data show that while efficacy of streptokinase does not appear to change importantly, side effects and pharmacokinetics have been improved. [ABSTRACT FROM AUTHOR]

Introduction: A myocardial infarction (MI), commonly known as a heart attack, is the result of a sudden interruption in the blood flow to the heart muscle. This is frequently caused by a blood clot forming within the coronary arteries. Acute myocardial infarction (AMI) is a major health hazard that causes over a million deaths annually in the US and affects up to 3 million people globally. Thrombolytic therapy, such streptokinase, is used to break up blood clots and improve blood flow, which stops ischemia injury. Injectable streptokinase is used to activate plasminogen in a nonenzymatic manner. Material And Method: This study examined thrombolytic outcomes in 120 patients with ST elevation myocardial infarction (STEMI) using a prospective interventional trial design. Patients were grouped according to gender and diabetes status. A thorough statistical analysis was carried out, looking at the relationship between gender and diabetes status and thrombolytic outcomes. Measurements such as glucose levels, ECG results, and random blood sugar were examined. Result: There were notable differences in ST segment resolution between MI patients with diabetes and those without. Of the 70 diabetic MI patients, 61.42% had failed thrombolysis (less than 30% ST resolution), whereas 21.42% had successfully completed thrombolysis (more than 70% resolution) (p=0.003). Compared to diabetics, non-diabetic MI patients (n=50) had a greater success rate (44%) and a higher percentage of failed thrombolysis (24%; p=0.049). Anterior wall MI was more common in both groups, followed by inferior wall MI, while anteroseptal MI was less common. Men with diabetes (n = 45) demonstrated 23 failed, 10 partial, and 12 effective resolutions; women with diabetes (n = 25) demonstrated 11 failed, 9 partial, and 5 successful resolutions. Non-diabetic females (n=25) had only two instances of unsuccessful resolution, compared to three among non-diabetic males (n=25). Conclusion: When comparing the thrombolytic effects of streptokinase, patients with diabetes had a higher incidence of unsuccessful thrombolysis (less than 30% ST resolution) than their non-diabetic counterparts. On the other hand, non-diabetic STEMI patients are more likely to have effective thrombolysis (>70% ST resolution). This highlights the effect of type 2 diabetes on the results of thrombolysis. Given the documented difficulties in establishing successful thrombolysis in this subgroup, percutaneous coronary intervention may therefore be preferred to thrombolysis in diabetic STEMI cases. [ABSTRACT FROM AUTHOR]

The study evaluated and compared the effect of adding streptokinase and amylase to antibiotics that are already used in clinical practice to treat Gram negative bacteria biofilm infection on indwelling devices on the antibiotics' minimum inhibitory concentration (MIC). 24 h-old biofilms were developed on 96-well plate with eight clinical isolates. MIC of amikacin, cefepime, ceftazidime, colistin, meropenem, and piperacillin–tazobactam, on biofilms were measured before and after the addition of 25 U/ml streptokinase and 25 μg/ml amylase with microplate reader. The addition of streptokinase reduces the MICs of cefepime, ceftazidime, colistin, meropenem from (16, 16, 8, 4 μg/ml) to (8, 1, 1, 0.5 μg/ml) in Escherichia coli (isolate 1). While the addition of amylase reduces the MICs of only cefepime, ceftazidime from (16, 16 μg/ml) to (2, 4 μg/ml) in E. coli (isolate 1). In Pseudomonas aeruginosa (isolate 4), the MICs of amikacin, cefepime, ceftazidime, colistin and meropenem (64, 16, 32, 4, 32 μg/ml) reduced to (2, 1, 0.5, 0.25, 0.5 μg/ml) with streptokinase and (4, 4, 4, 2, 0.5 μg/ml) with amylase respectively. Similar inhibitions were seen in Pseudomonas putida, Proteus mirabilis. We can conclude that the addition of streptokinase and amylase were effective in reducing the MICs of antibiotics that are commonly used to treat Gram negative bacteria biofilm infection on indwelling devices, thereby increasing susceptibility of bacteria to antibiotics. Streptokinase obviously had a greater effect than amylase, implying that it should be prioritized in future in vivo and clinical studies to obtain successful therapy with antibiotics on biofilm infections. [ABSTRACT FROM AUTHOR]

Fibrinolytic enzymes cleave fibrin which plays a crucial role in thrombus formation which otherwise leads to cardiovascular diseases. While different fibrinolytic enzymes have been purified, only a few have been utilized as clinical and therapeutic agents; hence, the search continues for a fibrinolytic enzyme with high specificity, fewer side effects, and one that can be mass-produced at a lower cost with a higher yield. In this context, this review discusses the physiological mechanism of thrombus formation and fibrinolysis, and current thrombolytic drugs in use. Additionally, an overview of the optimization, production, and purification of fibrinolytic enzymes and the role of Artificial Intelligence (AI) in optimization and the patents granted is provided. This review classifies microbial as well as non-microbial fibrinolytic enzymes isolated from food sources, including fermented foods and non-food sources, highlighting their advantages and disadvantages. Despite holding immense potential for the discovery of novel fibrinolytic enzymes, only a few fermented food sources limited to Asian countries have been studied, necessitating the research on fibrinolytic enzymes from fermented foods of other regions. This review will aid researchers in selecting optimal sources for screening fibrinolytic enzymes and is the first one to provide insights and draw a link between the implication of source selection and in vivo application.

INTRODUCTION: Valvular heart disease presents a significant and escalating global health challenge. Prosthetic valve thrombosis (PVT) following surgical valve replacement is a primary cause of valve failure. The aim of this study was to ascertain the outcomes and complications of fibrinolytic therapy in patients diagnosed with PVT.METHOD: This cross-sectional study enrolled 81 patients diagnosed with PVT who underwent fibrinolytic therapy between 2008 and 2018. Streptokinase was administered to 87.6% of patients, while 12.4% received reteplase. All demographic and clinical data were gathered from the patients’ medical records. The incidence of successful recovery and complications were assessed.RESULTS: The records of 81 patients (43.2% male, mean age: 51.6 ± 13.9 years) were examined. The findings revealed that 59% and 35% of the patients had mitral and aortic PVT, respectively. While 12% of the patients experienced drug complications, 90% achieved successful recovery. Stroke and severe hemorrhage were complications frequently reported by the patients treated with streptokinase (8% and 4% respectively). The patients treated with reteplase demonstrated a 100% recovery rate. Conversely, 89% of the patients treated with streptokinase achieved successful recovery, and 7% of the patients experienced a partial recovery.CONCLUSION: Fibrinolytic agents can serve as an effective treatment with an excellent success rate for managing PVT in patients post-surgical valve replacement.

Context Parapneumonic effusion and empyema are commonly encountered by the pulmonologist. The decision regarding management is still challenging. Aim To compare outcomes of intrapleural streptokinase with pigtail catheter drainage versus medical thoracoscopy in complicated parapneumonic effusion. Methods and material Forty patients with complicated parapneumonic effusion were randomly allocated to one of two groups. Twenty patients underwent streptokinase intrapleural instillation via pigtail catheter. The other twenty patients underwent medical thoracoscopy. Results Intrapleural streptokinase instillation procedure was significantly shorter duration (12.80 ± 3.05 min) than medical thoracoscopy procedure (25.26 ± 4.66 min). However medical thoracoscopy showed a significant less days required to remove the drainage system (5.80 ± 1.70 days) versus intrapleural streptokinase instillation procedure (9.40 ± 3.91 days). Both groups had no significant complications. Lung expansion was achieved in 90% of patients treated with intrapleural streptokinase instillation and in 95% of patients treated with a medical thoracoscopy technique, with no statistically significant difference between the two groups. Conclusions Treatment of complicated parapneumonic effusions is undeniably interdisciplinary. Both intrapleural streptokinase with pigtail catheter drainage and medical thoracoscopy are safe and improve outcomes in complicated parapneumonic effusion. Medical thoracoscopy has an advantage of fewer days required for tube withdrawal. Pigtail insertion has an advantage of shorter procedure time compared to medical thoracoscopy [ABSTRACT FROM AUTHOR]

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Abstract Background Guillain–Barre syndrome after myocardial infarction occurs infrequently, and its occurrence following percutaneous coronary intervention is extremely rare. Due to the high mortality rate of myocardial infarction and the disability of Guillain–Barre syndrome, early identification of Guillain–Barre syndrome after myocardial infarction and early intervention can decrease the mortality rate, lead to early recovery, and provide a better outcome. Case presentation Herein, we reported a rare case of Guillain–Barre syndrome after myocardial infarction treated with percutaneous coronary intervention. The patient was a 75-year-old woman from China who was admitted to hospital due to sudden loss of consciousness. Electrocardiography showed acute myocardial infarction in the right ventricle and inferior and posterior walls. The patient underwent emergency percutaneous intervention of the posterior collateral artery of the right coronary artery. Soon after, her condition worsened resulting in limb weakness and numbness. Unfortunately, she continued to develop respiratory failure, and treated with intravenous immunoglobulin and ventilator-assisted breathing. A physical examination showed hypotonia of all four limbs, complete quadriplegia, bulbar palsy, dysarthria, and tendon areflexia. Serum immunoglobulin (Ig) G anti-ganglioside antibody analysis was positive with anti-GT1a antibodies (+ +), anti-GM1 antibodies ( +), anti-GM2 antibodies ( +), and anti-GM4 antibodies ( +), and he was diagnosed with Guillain–Barre syndrome after myocardial infarction. She was discharged due to poor response to treatment. The patient died two days after being discharged. Conclusions Myocardial infarction and/or percutaneous coronary intervention may activate immune-mediated response and cause severe complications. Clinician should be alert to Guillain–Barre syndrome after myocardial infarction and/or percutaneous coronary intervention.

From the restriction of access to primary percutaneous coronary intervention, about 46% of patients with ST-elevation acute coronary syndrome (STE-ACS) received fibrinolytic therapy as a reperfusion strategy; streptokinase is frequently used in Thailand. Despite the guidelines recommending potent P2Y12 inhibitors among these patients, the data are limited, especially among patients with STE-ACS post streptokinase therapy. The study was proposed to describe factors for P2Y12 inhibitors selection and evaluate outcomes of pharmacoinvasively treated STE-ACS receiving ticagrelor compared with clopidogrel in Thailand. We performed a retrospective observational study of patients with STE-ACS post streptokinase therapy followed by percutaneous coronary intervention (PCI) with coronary stent placement and receiving ticagrelor or clopidogrel as P2Y12 inhibitor treatment from January 2017 to June 2021. The primary outcomes described factors for P2Y12 inhibitor selection and evaluated safety outcomes with inverse probability weight (IPW) adjustment. The secondary outcome was a composite of all-cause death, myocardial infarction and stroke. The median time from streptokinase therapy to initiating ticagrelor in the switch group was 25.7 (IQR, 1.9–4.4) hours. The factors related to switching from clopidogrel to ticagrelor included young age, history of coronary artery disease (CAD), dose of streptokinase and use of intravascular imaging. Any bleeding events occurred among 83 patients (41.71%) in the switch group and 83 patients (41.09%) in the no switch group (adjusted HR 1.04, 95% CI 0.75–1.44; p = 0.826). The composite of efficacy outcomes occurred in 6 patients in the switch group (3.02%) and 12 patients (5.94%) in the no switch group (adjusted HR 0.57, 95% CI 0.21–1.57; p = 0.279). Conclusion: In real practice, ticagrelor switching among patients with STE-ACS post streptokinase therapy did not differ regarding safety outcomes and composite of efficacy outcomes compared with clopidogrel. [ABSTRACT FROM AUTHOR]

Background: Intrapleural instillation of fibrinolytic agents is novel in treating empyema. Although the efficacy of this method for treating empyema remains a topic of debate among experts, several studies have shown that the results of this technique are almost equivalent to surgical operations in the lower stages of the disease. However, in more advanced stages of empyema, surgery maybe required. Despite the worldwide use of fibrinolytic agents instead of surgical procedures, the benefits of using these agents postoperatively still need to be defined. Objectives: In this prospective study, we aimed to compare the effects of streptokinase and alteplase in managing empyema in patients who underwent any surgical operations. Methods: We prospectively compared the outcomes of using alteplase and streptokinase in children who underwent surgical operations for empyema between 2015 and 2022. Following the surgery, fibrinolytic agents were instilled through thoracostomy tubes according to a specific protocol. The length of stay, frequency of complications, need for another surgery, and mortality were measured in each group. Results: Among 53 patients who met the inclusion criteria, 31 (58.5%) patients received streptokinase postoperatively, while the others were treated using alteplase. The length of stay after the surgery, wound infection, and mortality rate did not differ significantly between the groups (P-value = 0.394, 0.080, 0.767, respectively). However, the need for another surgery due to unexpanded lungs was significantly lower in the alteplase group (0% vs. 19.4%, P = 0.028). Conclusions: Alteplase as an intrapleural fibrinolytic is more effective than streptokinase in patients who underwent surgical operations due to empyema. The need for another surgery following the instillation of alteplase through chest tubes postoperatively maybe decreased. [ABSTRACT FROM AUTHOR]

Serevenia buxifolia is an evergreen citrus plant and has attracted considerable attention due to its bioactive components and biological activities. In the present study, the essential oil (EO) from S. buxifolia cultivated in Vietnam was demonstrated to exhibit the in vitro antioxidant, thrombolytic, anti‐hemolysis, anti‐inflammatory, and antidiabetic activities. Briefly, the gas chromatography coupled to mass spectrometry analysis revealed that the leaf EO of S. buxifolia was composed of 33 components, with the main constituents being β‐carypphyllene (32.5%), and elixene (9.8%). The extracted oil possessed a fairly high free radical scavenging activity against 2, 2‐diphenyl‐1‐picrylhydrazyl (DPPH), with an IC50 value of 190.7 μg/mL compared with positive control, α‐tocopherol, IC50 value of 42.6 μg/mL. The EO also exhibited thrombolytic activity: the percentage of inhibition was found to be 70.75% at 100 μL, in comparison with 87.2% for the positive control, streptokinase. For hemolytic activity, the percentage of inhibition of the EO was from 27.4% to 59.6% at concentrations from 10 to 100 μg/mL, respectively. The results of in vitro anti‐inflammatory activity indicated that the EO of S. buxifolia leaves effectively protects the heat‐induced denaturation, with an IC50 value of 40.25 μg/mL. The EO also exhibited antidiabetic potential, with IC50 values of 87.8 and 134.9 μg/mL against α‐amylase and α‐glucosidase, respectively. It is noteworthy that the potent biological activities of the obtained S. buxifolia oil increased in a dose‐dependent manner. The results achieved show that the EO of S. buxifolia leaves can be a potential source for oxidative stress, inflammatory, and diabetic management. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Intrapleural streptokinase can be an option for loculated hemorrhagic pleural effusion among patients receiving CAPD and under DAPT. Its use can be individualized based on risk benefit analysis by the treating clinician. Pleural effusion is seen in up to 10 percent of patients on peritoneal dialysis (PD). A hemorrhagic pleural effusion is a diagnostic dilemma and a therapeutic challenge. We report a complicated case of 67 years old man with end stage renal disease, with coronary artery disease and stent in situ under dual antiplatelet therapy and continuous ambulatory peritoneal dialysis. The patient presented with left‐sided loculated hemorrhagic pleural effusion. He was managed with intrapleural streptokinase therapy. His loculated effusion resolved without any local and systemic bleeding manifestations. Therefore, in poor resource settings, Intrapleural streptokinase can be an option for loculated hemorrhagic pleural effusion among patients receiving CAPD and under DAPT. Its use can be individualized based on risk benefit analysis by the treating clinician. [ABSTRACT FROM AUTHOR]

Pharmacological reperfusion remains the primary strategy for ST-elevation myocardial infarction (STEMI) in low- and medium-income countries. Literature has reported inconsistent incidences and outcomes of failed thrombolysis (FT). This study aimed to identify the incidence, mortality outcomes and predictors of FT in STEMI pharmacological reperfusion. This single-centre retrospective cohort study analyzed data on consecutive STEMI patients who received thrombolytic therapy from 2016 to 2020 in a public tertiary hospital. Total population sampling was used in this study. Logistic regression analyses were used to assess independent predictors of the mortality outcomes and FT. We analyzed 941 patients with a mean age of 53.0 ± 12.2 years who were predominantly male (n = 846, 89.9%). The in-hospital mortality was 10.3% (n = 97). FT occurred in 86 (9.1%) patients and was one of the predictors of mortality (aOR 3.847, p < 0.001). Overall, tenecteplase use (aOR 1.749, p = 0.021), pre-existing hypertension (aOR 1.730, p = 0.024), history of stroke (aOR 4.176, p = 0.004), and heart rate ≥ 100 bpm at presentation (aOR 2.333, p < 0.001) were the general predictors of FT. The predictors of FT with streptokinase were Killip class ≥ II (aOR 3.197, p = 0.004) and heart rate ≥ 100 bpm at presentation (aOR 3.536, p = 0.001). History of stroke (aOR 6.144, p = 0.004) and heart rate ≥ 100 bpm at presentation (aOR 2.216, p = 0.015) were the predictors of FT in STEMI patients who received tenecteplase. Mortality following STEMI thrombolysis remained high in our population and was attributed to FT. Identified predictors of FT enable early risk stratification to evaluate the patients' prognosis to manage them better. [ABSTRACT FROM AUTHOR]

Background: The appropriate use of intrapleural fibrinolytic agents in patients with complicated parapneumonic effusion and empyema remains unclear, especially regarding the choice of fibrinolytic agents. We conducted a network meta-analysis comparing outcomes of intrapleural fibrinolytic agents in patients with complicated parapneumonic effusion and empyema. Methods: MEDLINE and EMBASE were searched through April 2022 to identify randomized controlled trials (RCTs) that investigated outcomes in patients with complicated parapneumonic effusion or empyema who were treated with intrapleural fibrinolytic agents. The outcomes of interest were surgical requirements, bleeding, length of hospital stay, and all-cause mortality. Results: Our analysis included 10 RCTs that enrolled 1085 patients treated with intrapleural tissue plasminogen activator (TPA) (n = 138), TPA + deoxyribonuclease (DNase) (n = 52), streptokinase (n = 311), urokinase (n = 75), DNase (n = 51), or placebo (n = 458). The rates of surgical requirement were significantly lower with TPA and TPA + DNase than with placebo (risk ratio [RR]; 95% confidence interval [CI] = 0.36 [0.14–0.97], p = 0.038, RR [95% CI] = 0.25 [0.08–0.78], p = 0.017, respectively). The risk of bleeding was higher with TPA + DNase than with placebo (RR [95% CI] = 10.91 [1.53–77.99], p = 0.017), as well as TPA and TPA + DNase than with urokinase (RR [95% CI] = 17.90 [1.07–299.44], p = 0.044, RR [95% CI] = 89.3 [2.88–2772.49], p = 0.010, respectively). All-cause mortality was similar among the groups. Conclusion: TPA and TPA + DNase reduced the rates of surgical requirement compared with placebo. However, TPA + DNase increased the risk of bleeding compared with placebo. Intrapleural agents for complicated parapneumonic effusion and empyema should be selected with an individual risk assessment. [ABSTRACT FROM AUTHOR]

Context Parapneumonic effusion and empyema are commonly encountered by the pulmonologist. The decision regarding management is still challenging. Aim To compare outcomes of intrapleural streptokinase with pigtail catheter drainage versus medical thoracoscopy in complicated parapneumonic effusion. Methods and material Forty patients with complicated parapneumonic effusion were randomly allocated to one of two groups. Twenty patients underwent streptokinase intrapleural instillation via pigtail catheter. The other twenty patients underwent medical thoracoscopy. Results Intrapleural streptokinase instillation procedure was significantly shorter duration (12.80 ± 3.05 min) than medical thoracoscopy procedure (25.26 ± 4.66 min). However medical thoracoscopy showed a significant less days required to remove the drainage system (5.80 ± 1.70 days) versus intrapleural streptokinase instillation procedure (9.40 ± 3.91 days). Both groups had no significant complications. Lung expansion was achieved in 90% of patients treated with intrapleural streptokinase instillation and in 95% of patients treated with a medical thoracoscopy technique, with no statistically significant difference between the two groups. Conclusions Treatment of complicated parapneumonic effusions is undeniably interdisciplinary. Both intrapleural streptokinase with pigtail catheter drainage and medical thoracoscopy are safe and improve outcomes in complicated parapneumonic effusion. Medical thoracoscopy has an advantage of fewer days required for tube withdrawal. Pigtail insertion has an advantage of shorter procedure time compared to medical thoracoscopy

Gynura procumbens (Lour.) Merr. (Family: Asteraceae) is a tropical Asian medicinal plant found in Thailand, China, Malaysia, Indonesia, and Vietnam. It has long been utilized to treat a variety of health concerns in numerous countries around the world, such as renal discomfort, constipation, diabetes mellitus, rheumatism, and hypertension. The chemical investigation resulted in the isolation and characterization of six compounds from the methanol (MeOH) extract of the leaves of Gynura procumbens, which were identified as phytol (1), lupeol (2), stigmasterol (3), friedelanol acetate (4), β-amyrin (5), and a mixture of stigmasterol and β-sitosterol (6). In-depth investigations of the high-resolution 1H NMR and 13C NMR spectroscopic data from the isolated compounds, along with comparisons to previously published data, were used to clarify their structures. Among these, the occurrence of Compounds 1 and 4 in this plant are reported for the first time. The crude methanolic extract (CME) and its different partitionates, i.e., petroleum ether (PESF), chloroform (CSF), ethyl acetate (EASF), and aqueous (AQSF) soluble fractions, were subjected to antioxidant, cytotoxic, thrombolytic, and anti-diabetic activities. In a DPPH free radical scavenging assay, EASF showed the maximum activity, with an IC50 value of 10.78 µg/mL. On the other hand, CSF displayed the highest cytotoxic effect with an LC50 value of 1.94 µg/mL compared to 0.464 µg/mL for vincristine sulphate. In a thrombolytic assay, the crude methanolic extract exhibited the highest activity (63.77%) compared to standard streptokinase (70.78%). During the assay for anti-diabetic activity, the PESF showed 70.37% of glucose-lowering activity, where standard glibenclamide showed 63.24% of glucose-reducing activity. [ABSTRACT FROM AUTHOR]

Failure of hemostasis and the formation of blood clots in the arteries are the main reasons that provoke the onset of cardiovascular diseases (CVDs) such as myocardial infarction and ischemic stroke. Cardiovascular diseases have become the primary cause of deaths and disabilities across the globe. Therefore, this problem needs to be addressed with urgency. The disintegration of blood clots requires fibrinolytic agents, which are involved in thrombolysis. Streptokinase and urokinase are fibrinolytic enzymes; the former is primarily produced from microbial sources and the latter is isolated from urine, respectively. Streptokinase and urokinase have been in use for a long time to treat cardiovascular diseases. This review explains in detail the comparison of employing streptokinase and urokinase for the said purpose in a cost-effective manner. The recombinant production of both the agents has been discussed in detail. Furthermore, the efficacy of both the agents has been compared based upon their side effects and retention time in the body. A thorough study has been made to compare the influence of using both the agents on the health of cardiovascular patients in the last decade. [ABSTRACT FROM AUTHOR]

Background: Guillain–Barre syndrome after myocardial infarction occurs infrequently, and its occurrence following percutaneous coronary intervention is extremely rare. Due to the high mortality rate of myocardial infarction and the disability of Guillain–Barre syndrome, early identification of Guillain–Barre syndrome after myocardial infarction and early intervention can decrease the mortality rate, lead to early recovery, and provide a better outcome. Case presentation: Herein, we reported a rare case of Guillain–Barre syndrome after myocardial infarction treated with percutaneous coronary intervention. The patient was a 75-year-old woman from China who was admitted to hospital due to sudden loss of consciousness. Electrocardiography showed acute myocardial infarction in the right ventricle and inferior and posterior walls. The patient underwent emergency percutaneous intervention of the posterior collateral artery of the right coronary artery. Soon after, her condition worsened resulting in limb weakness and numbness. Unfortunately, she continued to develop respiratory failure, and treated with intravenous immunoglobulin and ventilator-assisted breathing. A physical examination showed hypotonia of all four limbs, complete quadriplegia, bulbar palsy, dysarthria, and tendon areflexia. Serum immunoglobulin (Ig) G anti-ganglioside antibody analysis was positive with anti-GT1a antibodies (+ +), anti-GM1 antibodies (+), anti-GM2 antibodies (+), and anti-GM4 antibodies (+), and he was diagnosed with Guillain–Barre syndrome after myocardial infarction. She was discharged due to poor response to treatment. The patient died two days after being discharged. Conclusions: Myocardial infarction and/or percutaneous coronary intervention may activate immune-mediated response and cause severe complications. Clinician should be alert to Guillain–Barre syndrome after myocardial infarction and/or percutaneous coronary intervention. [ABSTRACT FROM AUTHOR]

Background: The QT interval dispersion (QTd) was first developed as a measure of the variability in ventricular repolarization times over space. This study aimed for comparing Streptokinase vs primary PCI for ST-elevation myocardial infarction: a comparison of QTD before and after therapy. Methods: Two hundred patients who had a STEMI and were treated with streptokinase or primary PCI were included in this prospective observational trial. Two groups of identical size were created, one for patients who received fibrinolytic therapy and the other for those who underwent primary PCI. Reperfusion therapy was administered to all patients via primary PCI or fibrinolyt ics after a thorough history and physical examination, including a 12-lead electrocardiogram. Quantifying the QT interval and its variability. Results: The PCI group demonstrated significantly higher percent change of max QTD (P=0.001) and QTcD (P < 0.001). In patients with anterior or inferior infarctions, the median percent change of QTD was significantly higher in those who underwent PCI (-33%) than in those who underwent SK (-21.43%). Additionally, in patients with lateral or posterior infarctions, the median percent change of QTD was significantly higher in those who underwent PCI (-37.05%) than in those who underwent SK (-16.67%). Conclusion: QTD values were shown to decrease more in the primary PCI technique. This study demonstrated a greater reduction in the incidence of harmful arrhythmia after primary PCI was used to treat the arrhythmia, and an elevated QT interval is a risk factor for the development of such an arrhythmia. [ABSTRACT FROM AUTHOR]

Streptokinase (SK) is one of the essential fibrinolytic agents and is commonly employed to treat myocardial infarction or heart attack. Despite its significance as an anti-clot agent, SK exhibits certain drawbacks, including limited half-life in the bloodstream, non-specific to fibrin, and may cause process workers to develop undesirable immune responses. Acknowledging the high specificity of staphylokinase (SAK) towards fibrin and the powerful recombinant DNA technology, this study was carried out to evaluate the fibrinolytic activity of a recombinant staphylokinase-streptokinase (SAK-SK) protein in Escherichia coli BL21(DE3). Briefly, the SAK gene isolated from Staphylococcus aureus was ligated at the 5'end of the SK gene using the pGEM®-3Zf (+) cloning vector and transformed into the expression host E. coliBL21(DE3) before being induced with isopropyl β-D-1-thiogalactopyranoside (IPTG).Subsequently, the produced recombinant SK protein was analyzed using 12% sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE).The biological performance of the recombinant SK protein was then examined via caseinolytic and fibrinolytic assays and compared to that of the native SK protein. Based on the results, the recombinant SK protein contained 563 amino acid residues with a molecular weight of approximately 63.1 kDa. The hybrid SK protein was more active in the casein lysis experiment compared to the native SK, with a more significant halo zone formation. Moreover, the hybrid SK protein demonstrated a complete clot lysis compared to the poor clot lysis of the native SK protein. In conclusion, this study successfully developed a recombinant hybrid SK protein with enhanced affinity to fibrin, making it a potential anti-clot agent. [ABSTRACT FROM AUTHOR]

Background: Management of traumatic hemothorax is an important problem in thoracic surgery. As an alternative to surgical treatment in patients who developed clotted hemothorax after trauma, intra-pleural fibrinolysis has been used with favorable results. This modality of treatment may reduce known morbidities secondary to surgical procedures and may result in significant medical cost savings. Aim of the study is to test the efficacy and safety of tissue plasminogen activator and Streptokinase for management of post traumatic clotted hemothorax. METHODS: our study included 40 patients presented with clotted hemothorax after chest trauma. Patients were divided into two groups each contains 20 patients. First group treated with intra-pleural Alteplase (tissue plasminogen activator) and the second group treated with streptokinase, both was instilled via an intercostal chest tube. Clinical and radiologic (chest radiographs (CXR) and chest computed tomography (CT) data used for evaluation of efficacy of both protocols. RESULTS: Alteplase give excellent results in clotted hemothorax, it showed dramatic improvement in both chest tube drain and pleural thickness without bleeding complications. Streptokinase protocol showed only improvement of chest tube drain. CONCLUSIONS: Intra pleural Alteplase is safe and more efficient than Streptokinase as a chemical modality in treating patients presented with post traumatic clotted hemothorax. [ABSTRACT FROM AUTHOR]

Acute thrombosis has a narrow therapeutic window and remains the leading cause of morbidity and mortality, while thrombolytic therapy has limited efficacy and risk of side effects. We have developed and investigated new fibrin-specific systems for local drug delivery to increase efficiency while minimizing the side effects of streptokinase. The experiment was carried out on dogs with 2-h thrombi in the femoral artery received intravenous injections of streptokinase, liposome-bound and free streptokinase at 40/60% ratio, and immunoliposomes. The completeness of the vessel lumen restoration affected by the thrombus, and the risks of side effects were assessed. Fibrinolytic parameters (plasminogen, fibrinogen, alpha2-antiplasmin, and D-dimers levels) were measured at several time points after thrombus induction and the administration of the drug. There was a strong activation of fibrinolysis and consumption of fibrinolysis inhibitors after therapy with all liposomal forms of streptokinase. According to the ultrasound data, immunoliposomal form of streptokinase significantly reduces the degree of residual stenosis to 32% [30.5; 33.7] in 180 min after injection. The high fibrinolytic effect of liposomal forms of streptokinase is not accompanied by a sharp drop in the fibrinogen concentration in the blood compared to the native streptokinase by 60 min. The morphometric evaluation of the artery samples showed that immunoliposomal form of streptokinase induces a significant increase in the degree of free vascular lumen compared to the native streptokinase (71.3% (62.7; 77.5) vs. 47.7% (39.6; 55.7), p < 0.001). Thus, the study shows the efficacy of streptokinase-induced thrombolysis using immunoliposomal form of drug delivery system. Mechanism of action of the immunoliposomal delivery system [ABSTRACT FROM AUTHOR]

Shock is a state of acute circulatory failure leading to decreased organ perfusion, inadequate delivery of oxygenated blood to tissues, and resultant end-organ dysfunction. A 45-year-old male patient a known case of Diabetes Mellitus (DM) presented to the Emergency Room (ER) with a complaint of fever for four days and shortness of breath for one day. The patient had a wound discharging pus over the dorsum of the right foot for two weeks following trauma. On examination, the patient’s vitals were: pulse rate-88 Beats Per Minute (bpm), respiratory rate-26 breaths per minute, SpO2-78% room air, Blood Pressure (BP)-82/40 mmHg mean arterial pressure- 54 mmHg. As a protocol of shock evaluation, Point Of Care Ultrasonography (POCUS) showed a distended Inferior Vena Cava (IVC), dilated right atrium and ventricle, and good left ventricular systolic function. Given the presence of right leg swelling, ultrasound was done, which showed a thrombus in the popliteal vein. Noradrenaline infusion was started to maintain a mean arterial blood pressure of 70 mmHg. A diagnosis of obstructive shock due to pulmonary embolism was strongly suspected, and thrombolysis with injection streptokinase was done. After two hours of thrombolysis, Two-Dimensional (2D) Echocardiography (ECHO) revealed normal right atrium and ventricle size and IVC collapsibility index of 70%, but the patient’s blood pressure didn’t improve significantly. So, adequate intravenous fluid was given as per the septic shock protocol. But, the noradrenalin requirement didn't improve. The patient was put on broad-spectrum antibiotics. Blood culture showed growth of Pseudomonas aeruginosa. So, a diagnosis of co-existing septic shock with obstructive shock was made. The patient improved and discharged in stable condition. The present case report highlights the co-existence of septic shock and obstructive shock and the usefulness of POCUS in differentiating and managing various shocks.

Accelerated activation of the human plasminogen zymogen (hPg) to two-chain active plasmin (hPm) is achieved following conformational changes induced by ligand-binding at the lysine-binding sites (LBSs) in four of the five hPg kringle domains. In this manner, pattern D skin-trophic strains of Group A streptococci (GAS), through the expression of surface plasminogen-binding M-protein (PAM), immobilize surface hPg, thereby enabling rapid hPg activation by GAS-secreted streptokinase (SK). Consequently, GAS enhances virulence by digesting extracellular and tight cellular junctional barriers using hPm activity. Many studies have demonstrated the singular importance of the kringle-2 domain of hPg (K2hPg) to PAM-binding using hPg fragments. Recently, we showed, using full-length hPg, that K2hPg is critical for PAM binding. However, these studies did not eliminate any modulatory effects of the non-K2hPg LBS on this interaction. Moreover, we sought to establish the significance of the intramolecular interaction between Asp219 of the LBS of K2hPg and its serine protease domain binding partner, Lys708, to conformational changes in hPg. In the current study, selective inactivation of the LBS of K1hPg, K4hPg, and K5hPg revealed that the LBS of these kringle domains are dispensable for hPg binding to PAM. However, the attendant conformational change upon inactivation of K4hPg LBS increased the affinity of hPg for PAM by an order of magnitude. This finding suggests that the native hPg conformation encloses PAM-binding exosites or sterically hinders access to K2hPg. While simultaneous inactivation of the LBS of K1hPg, K4hPg, and K5hPg inhibited hPg/SK association alongside hPg activation, the replacement of Lys708 generated a slight conformational change that optimally accelerated hPg activation. Thus, we accentuate disparate functions of hPg LBS and conclude, using intact proteins, that K2hPg plays a central role in regulating hPg activation.

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Background: Management of an early empyema is an important problem in thoracic surgery. As an alternative to surgical treatment empyema is in patients who developed early empyema, intra-pleural fibrinolysis has been used with favorable results. This modality of treatment may reduce known morbidities secondary to surgical procedures and may result in significant medical cost savings. Our study aim is to test the efficacy and safety of tissue plasminogen activator and Streptokinase for management of early empyema. Methods: Our study included 48 patients presented with complicated parapneumonic effusion and early empyema. Patients were divided into two groups each contains 24 patients. First group treated with intra-pleural Alteplase (tissue plasminogen activator) and the second group treated with streptokinase, both were instilled via an intercostal chest tube. Clinical and radiologic (chest radiographs (CXR) and chest computed tomography (CT) data used for evaluation of efficacy of both protocols. Results: Tissue plasminogen activator give excellent results in early empyema, it showed success rate 100%, dramatic improvement in both chest tube drain and pleural thickness with no need for further surgical intervention, Streptokinase showed success rate 83.4% in comparison to TPA. Conclusion: Intrapleural tissue plasminogen activator is safe and more efficient than Streptokinase as a chemical modality in treating patients presented with complicated pleural effusion and early empyema. [ABSTRACT FROM AUTHOR]

Background: Two-dimensional speckle-tracking echocardiography (2D STE) has been proven to be more accurate than prognostic metrics such as the left ventricular ejection fraction (LVEF) and wall motion score index (WMSI). Aim: To contrast the effectiveness of primary percutaneous coronary intervention (PCI) versus Streptokinase based pharmacoinvasive technique in ST elevation myocardial infarction (STEMI) patients. Patients and Methods: In this observational cross section research, 100 patients with acute STEMI were enrolled. They were then divided into two groups: Group A, which included 50 patients who underwent primary PCI as a reperfusion strategy, and Group B, which included 50 patients who underwent pharmacoinvasive technique, which involved streptokinase IV infusion, over the course of a year from November 2020 to November 2021. In order to evaluate the main outcome, which was LV systolic function, all patients had a thorough medical history review, physical examination, 12-lead surface ECG, and echocardiogram (2D global longitudinal strain [GLS] utilizing speckle tracking echocardiography [STE]. Results: Pre-intervention GLS showed no statistically substantial variation between the two groups (p=0.768), however post-treatment GLS showed statistically substantial variations between the two groups (p=0.004) and regarding change (%) GLS (p=0.001). Conclusion: Primary PCI remains the best option for resolving ischemia. When compared to IV streptokinase treatment, direct coronary angioplasty exhibited a substantial clinical advantage. To treat the myocardial infarction, it was superior to streptokinase based pharmacoinvasive therapy. [ABSTRACT FROM AUTHOR]

Aim:The aim of the present study to evaluate the efficacy of thrombolytic treatment with IV streptokinase in individuals with acute ST elevation myocardial infarction. Methods: A prospective observational study was conducted in the Department of Cardiology. In all, 105 patients with acute ST segment elevation were analysed both before and after Streptokinase thrombolysis. The study population was separated into three groups based on the values they had. CategoryA:<30% resolution of the sum of Stsegment elevation. CategoryB:30%-70% resolution of the sum of ST segment elevation. CategoryC:>70% resolution of the sum of STsegmentelevation. Results: Male patients were substantially more prevalent (76.19%) than female patients (23.81%). In this investigation, the most prevalent mode of presentation was chest discomfort, which was present in 96(91.43%) patients and was accompanied with sweating in 87(82.86%) patients and dyspnea in 26(24.76%) patients. Palpitation was seen in 7(6.67%) individuals and syncope in 12(11.43%). In this research, anterior wall myocardial infarction did not differ from inferior wall myocardial infarction. The ratio of anterior wall MI (57.14%) to inferior wall MI (42.86%) is quite high. Complete ST resolution was seen in 40 (38.09%) instances, partial resolution in 49 (46.67%) cases, and no resolution in 16 (15.24%) cases. Conclusions: Patients with no ST segment resolution at 90 minutes post-thrombolysis were associated with more frequent adverse events and increased mortality compared to the partial and complete resolution group, leading us to conclude that IV streptokinase for thrombolysis in acute STEMI has an efficacy of 42.86 percent. The percentage of ST segment improvement after 90 minutes of thrombolysis is a useful diagnostic tool for determining patient risk. [ABSTRACT FROM AUTHOR]