Production of recombinant streptokinase from Streptococcus pyogenes isolate and its potential for thrombolytic therapy

To produce an effective recombinant streptokinase [rSK] from pathogenic Streptococcus pyogenes isolate in yeast, and evaluate its potential for thrombolytic therapy. This study was conducted from November 2012 to December 2013 at King Khalid University, Abha, Kingdom of Saudi Arabia [KSA]. Throat swabs collected from 45 pharyngitis patients in Asser Central Hospital, Abha, KSA were used to isolate Streptococcus pyogenes. The bacterial DNA was used for amplification of the streptokinase gene [1200 bp]. The gene was cloned and in vitro transcribed in an eukaryotic expression vector that was transformed into yeast Pichia pastoris SMD1168, and the rSK protein was purified and tested for its thrombolytic activity. The Streptococcus pyogenes strain was isolated and its DNA nucleotide sequence revealed similarity to other Streptococcus pyogenes in the Gene bank. Sequencing of the amplified gene based on DNA nucleotide sequence revealed a SK gene closely related to other SK genes in the Gene bank. However, based on deduced amino acids sequence, the gene formed a separate cluster different from clusters formed by other examined genes, suggesting a new bacterial isolate and accordingly a new gene. The purified protein showed 82% clot lysis compared to a commercial SK [81%] at an enzyme concentration of 2000 U/ml. The present yeast rSK showed similar thrombolytic activity in vitro as that of a commercial SK, suggesting its potential for thrombolytic therapy and large scale production.

Increased systemic low-grade inflammation in high altitude native rats mediated by adrenergic receptors

To compare the serum levels of inflammatory mediators in high altitude [HA] native rats, and to search for the possible underlying mechanism[s]. The study was carried out between January and April 2013. Fifty male rats from the same genetic pool were bred at either a HA or low altitude [LA] area. The study was carried out in 2 stages. In the first stage, serum levels of inflammatory markers, adhesive molecules, lipid profiles, catecholamines, magnesium [Mg[+2]], and lipid peroxidation were compared between theses 2 groups. In the second stages, inflammatory response and lipid peroxidation were analyzed in HA native rats after treatment with either alpha [Prazosin] or beta [propranolol] adrenergic blockage. The HA native rats showed significant increases in the serum levels of inflammatory cytokines, lipid profiles, as well as a significant increase in the urinary norepinephrine with a concomitant decrease in the serum levels of Mg[+2] and increased lipid peroxidation. Blockage of the beta and alpha adrenergic receptors of the HA rats caused partial or complete decreases in both inflammatory and oxidative stress mediators. Living under HA conditions results in an increased systemic inflammatory reaction; an effect that is mediated through the sympathetic nervous system mainly via alpha-adrenergic receptors and could be attributed to low Mg[+2] levels

Ricin poisoning causing death after ingestion of herbal medicine

Ricin intoxication is a fatal and an uncommon medical condition. We report a case of ricin poisoning in a 42-year-old Saudi male patient who ingested a herbal medicine mixture containing ricin bean powder, after which he presented with gastrointestinal symptoms followed by gastrointestinal bleeding and hypotension. The patient then passed into a state of shock with respiratory failure followed by cardiac arrest and death. Public health awareness of self-prescribed herbal medications is necessary

Clinical and therapeutic profiles of heart failure patients admitted to a tertiary hospital, Aseer region, Saudi Arabia

This study aimed to investigate the clinical and therapeutic profiles of heart failure [HF] cases admitted to Aseer Central Hospital [ACH], Saudi Arabia. A retrospective cohort of 300 consecutive patients admitted with the diagnosis of HF to ACH from 1 June 2007 to 31 May 2009 were included in the study. Data on demographic variables, aetiologic factors, risk factors, and therapeutic profiles of patients with HF were collected and analysed. The patients' mean age was 67.4 +/- 13.7 years and 68.7% of them were male. The commonest aetiologies for HF were ischaemic heart disease [IHD] and hypertension in 38.3% and 33.3% of patients, respectively. A total of 61.3% of patients were diabetics. Other risk factors for HF included renal failure in 9.7%, atrial ejection fraction [EF] was 33% +/- 17. Angiotensin converting enzyme inhibitors [ACEI] or angiotensin 2 receptor blockers were used in 68.3% of cases, beta-blockers in 51.6% of cases of digoxin in 28.3% of cases. The major causes of HF in our study were IHD and hypertension. Diabetes and anaemia were common risk factors. The cohort constituted an intermediate HF risk group [ejection fraction [EF] 33%]. Important therapeutic agents like angiotensin converting enzyme inhibitor I, beta-blockers and digoxin were underutilised. Fostering such therapy in practice will lead to a better outcome in the management of HF patients. Anaemia was a significant risk factor in our HF patients and should be managed properly

Effect of gender difference in management of heart failure patients in Aseer, Saudi Arabia

Heart failure [HF] is a common medical problem with a high impact on public health. Evidence of gender difference in management of HF is scarce. We conducted a retrospective study to evaluate the presence of gender difference in management of HF patients admitted to the tertiary care hospital in the Aseer region/ Saudi Arabia. A chart review was conducted at Aseer Central Hospital [ACH] on consecutive patients admitted with the primary diagnosis of HF between Jun 2007 and May 2009. Data were collected on clinical and management profiles and analyzed for the presence of gender difference in HF management. A total of 206 male patients and 94 female patients with HF were reviewed. Ischemic and dilated cardiomyopathy etiologies were significantly higher in male patients [42.7 vs. 28.7%, P< 0.021] and [13.1% vs. 3.2%, P< 0.008], respectively. Renal failure and atrial fibrillation were significantly higher in female patients with HF [20.2 vs., 5.3%, P< 0.001] and [20.2 vs. 10.2%, P <0.018], respectively. Smoking was significantly higher in male patients [11.7 vs. 0%, P <0.001]. Echocardiography was performed equally for both genders and ejection fraction was significantly higher in female patients [36.2 vs. 57.8%, P<0.001], while 30.4 +/- 16.6, P < 0.001]. Beta-blockers were prescribed significantly less to female patients [36.2 vs. 57.8%, P < 0.001], while ACE inhibitors and digoxin were prescribed significantly less to male patients [64.1 vs. 75.5%, P< 0.049] and [24.8 vs. 36.2%, P < 0.042, respectively]. Gender differences were detected in clinical presentation and management of HF. Female patients with HF had less ischemic etiology and smoking, but more atrial fibrillation and renal dysfunction. Female patients were under-treated by Beta-blockers while male patients were under-treated by ACE inhibitors and digoxin. Both genders were investigated equally, and female patients had a better ejection fraction

Gender differences in clinical presentation and management of patients with acute coronary syndrome in Southwest of Saudi Arabia

Gender differences in the clinical presentation and management of patients with acute coronary syndrome [ACS] have been reported in different parts of the world with contradicting results. We aimed at investigating the presence of gender bias in patients admitted with ACS to Aseer Central Hospital [ACH]. A retrospective cohort of all consecutive patients admitted to ACH with the diagnosis of ACS, during the period between the 1st of June 2007 and the 31st of May 2009 was studied. Data on demographic and clinical profiles, management and outcomes of ACS patients were collected and compared for both genders. The present study included 148 females and 397 males. Females were significantly older than males [62.9 +/- 14.2 vs. 60 +/- 13.4, respectively, P < 0.03], were less likely ever to have smoked [0.7% vs. 26.2%, respectively, P < 0.001], less likely to have had a history of hyperlipidemia [10.8% vs. 22.2%, respectively, P < 0.003] or family history of ischemic heart disease [10.1% vs. 18.9%, respectively, P < 0.014]. Female patients presented more with atypical presentation [42.6% vs. 28.9%, respectively, P < 0.003], more with unstable angina [72.3% vs. 50.4%, respectively, P < 0.001], and less with ST-elevation myocardial infarction [18.9% vs. 40.8%, respectively, P < 0.001]. Furthermore, they had significantly lower levels of hemoglobin compared to males [12.9 +/- 2.3 vs. 14.5 +/- 2.2 g/L, respectively, P < 0.001], and higher levels of high density lipoprotein [1.1 +/- 0.4 vs. 0.98 +/- 0.4 mmol/L, respectively, P < 0.008]. Left ventricular ejection fraction was significantly higher in female patients compared to males [50.9 +/- 14 vs. 45.8 +/- 14, respectively, P < 0.003]. Coronary angiography showed a higher rate of normal findings [29.3% vs. 8.9%, respectively, P < 0.001] and less severe disease [46.7% vs. 60.3%, respectively, P < 0.027] in women, however, they were less likely to undergo invasive revascularization procedures [31% vs. 42.8%, respectively, P < 0.013]. No significant differences were found between both sexes regarding in-hospital mortality or re-infarction rates. We documented gender differences in both clinical presentation as well as management of patients admitted with ACS to ACH. However, there were no significant differences between both genders regarding the clinical in-hospital outcomes. Emphasis should be made to avoid such bias in the future

Clinical and microbiological profiles of infective endocarditis in a tertiary hospital in Aseer region, Saudi Arabia

We aimed to evaluate demographic data, underlying cardiac abnormalities, clinical profile, microbiological features, treatments and complications of infective endocarditis [IE] in a tertiary hospital in Aseer region, Saudi Arabia. A retrospective study of all cases with the diagnosis of definite endocarditis according to modified Duke Criteria admitted to ACH between May 2002 and April 2007. Data were reviewed on demographic and clinical data, underlying cardiac disease, microbiological findings, treatments and complications of IE. The study included 44 patients [28 males and 16 females; mean age 31.1 +/- 16 years; range 13-65 years]. Infective endocarditis developed on a native valve in 31 [70.5%], a mechanical prosthetic valve in 10 [22.7%], mitral valve prolapse in 2 [4.5%] and ventricular septal defect in 1 [2.3%]. Rheumatic heart disease in 31 cases [70.5%] was the most common preexisting valvular abnormality in native valve endocarditis. The mitral valve was the most commonly affected valve 28 [63.6%]. Fever occurred in 40 [90.9%] of the cases. Electrocardiography was abnormal in 34 cases [77.3%]. Trans-thoracic and/or trans-esophageal echocardiography showed a vegetation in 22 [50%]. Staphylococci in 10 cases [22.7%] and Streptococci in 8 cases [18%] were the most common causative agents and cultures were negative in 20 cases [45.5%]. Twenty-two patients [50%] underwent surgical treatment. Congestive heart failure occurred in 16 [36.4%] cases, atrial fibrillation in 6 [13.6%] cases, and cerebrovascular accidents in 4 [9%] cases. Our data reflects the clinical and microbiological profiles of IE in a tertiary hospital in Aseer region, Saudi Arabia

underutilization of adjunctive pharmacotherapy in treating acute coronary syndrome patients admitted to a tertiary care hospital in Southwest Region, Saudi Arabia

Acute coronary syndrome [ACS] is the most prevalent cardiac disorder. Adjunctive pharmacotherapy has proved to be safe and effective in treating patients with this syndrome. Underutilization of such pharmacotherapy was reported in different studies. In this study, we evaluated the Underutilization of these pharmacotherapies on patients admitted to Aseer Central Hospital [ACH] with ACS, find out factors that may predict utilization of these therapies, and determine the effect of such pattern of drug utilization on survival at discharge. A retrospective cohort of 562 patients admitted with the diagnosis of ACS to ACH during the period from March 2007 to February 2009 was studied. beta-blockers [B-blocker] and angiotensin-converting enzyme inhibitors [ACEI] were used in only 69 and 59% of cases, respectively. Aspirin, clopidogrel, and statin were used in 98.4, 82.6, and 89.3% of cases, respectively. The presence of diabetes predicts the use of ACE inhibitors, whereas the diagnosis of unstable angina and ST-elevation myocardial infarction predict the use of statin. Survival rate at discharge was 95.6%. Use of statin and aspirin improved survival. Certain adjunctive pharmacotherapies were underutilized in ACS patients in Southwest region, Saudi Arabia, specifically beta-blockers and ACEI. Standard of care should be revised and updated, aiming to improve adherence to guidelines of management of patients with ACS

Angioedema of head and neck complicating the use of ACE inhibitors

To study the clinical manifistations and to assess our management of cases of angioedema of head and neck precipitated by the use of Angiotensin - Converting enzyme [ACE] inhibitors. Design and setting: This is a retrospective analysis of 42 consecutive cases with angioedema of head and neck seen and managed at the teaching hospitals of the University of Ottawa, between 1991 and 1995. Twnenty four cases were associated with the use of ACE inhibitors. Subjects:Female patients constituted 69% and males 31%. There was a male to female ratio of 1.0:2.2. The mean age of the patients was 64 years. More than two thirds of the patients [62%] presented as a first episode. The tongue was most commonly affected. Other affected areas included the lips,oro-pharynx, supraglottis and soft palate. ACE's were used in 24 [57%] cases. All cases treated medically responded to therapy which included the use of anti-histamine, steroids and sometimes subcutaneous epinephrine. Admission to intensive care unit [ICU] were required in 12 [28.6%] patients and endotracheal intubation was required in 3 [7%] cases. Fiberoptic Nasolaryngoscopy [FNLS] was utilized in the assessment of 21 patients [50%]. No mortality was recorded. Angiotensin - Converting Enzyme [ACE] inhibitors are relatively common cause of angioedema of head and neck. Treatment to keep the airway open during the acute phase is essential to prevent death