Ensayo controlado y aleatorizado del uso de Heberkinasa® en el derrame pleural paraneumónico en niños / Randomized Controlled Trial of the Use of Heberkinase® in Parapneumonic Pleural Effusion in Children

Introducción: El derrame pleural paraneumónico resulta la complicación más frecuente de la neumonía bacteriana, de manejo complejo y muchas veces quirúrgico. No existen publicaciones en Cuba provenientes de ensayos clínicos controlados y aleatorizados ni del uso de la estreptoquinasa recombinante (Heberkinasa®) en el derrame pleural. Objetivo: Evaluar la eficacia y la seguridad de la Heberkinasa® en el tratamiento del derrame pleural paraneumónico complicado complejo y el empiema en niños. Métodos: Ensayo clínico fase III, abierto, aleatorizado (2:1), en grupos paralelos y controlado. Se concluyó la inclusión prevista de 48 niños (1-18 años de edad), que cumplieron los criterios de selección. Los progenitores otorgaron el consentimiento informado. Los pacientes se distribuyeron en dos grupos: I- experimental: terapia estándar y administración intrapleural diaria de 200 000 UI de Heberkinasa® durante 3-5 días y II-control: tratamiento estándar. Las variables principales: necesidad de cirugía y la estadía hospitalaria. Se evaluaron los eventos adversos. Resultados: Ningún paciente del grupo I-experimental requirió cirugía, a diferencia del grupo II-control en el que 37,5 por ciento necesitó cirugía video-toracoscópica, con diferencia altamente significativa. Se redujo la estadía hospitalaria (en cuatro días), las complicaciones intratorácicas y las infecciones asociadas a la asistencia sanitaria en el grupo que recibió Heberkinasa®. No se presentaron eventos adversos graves atribuibles al producto. Conclusiones: La Heberkinasa® en el derrame pleural paraneumónico complicado complejo y empiema resultó eficaz y segura para la evacuación del foco séptico, con reducción de la necesidad de tratamiento quirúrgico, de la estadía hospitalaria y de las complicaciones, sin eventos adversos relacionados con su administración(AU)

Introduction: Paraneumonic pleural effusion is the most frequent complication of bacterial pneumonia, with complex and often surgical management. There are no publications in Cuba from randomized controlled clinical trials or the use of recombinant streptokinase (Heberkinase®) in pleural effusion. Objective: To evaluate the efficacy and safety of Heberkinase® in the treatment of complex complicated parapneumonic pleural effusion and empyema in children. Methods: Phase III, open-label, randomized (2:1), parallel-group, controlled clinical trial. The planned inclusion of 48 children (1-18 years of age), who met the selection criteria, was completed. Parents gave informed consent. The patients were divided into two groups: I-experimental: standard therapy and daily intrapleural administration of 200,000 IU of Heberkinase® for 3-5 days; and II-control: standard treatment. The main variables: need for surgery and hospital stay. Adverse events were evaluated. Results: No patient in group I-experimental required surgery, unlike group II-control in which 37.5 percent required video-assisted thoracoscopic surgery, with a highly significant difference. Hospital stay (to 4 days), intrathoracic complications and infections associated to healthcare in the group that received Heberkinase® was reduced. No serious adverse events attributable to the product occurred. Conclusions: Heberkinase® in complex complicated parapneumonic pleural effusion and empyema was effective and safe for the draining of the septic focus, with reduction of the need for surgical treatment, hospital stay and complications, with no adverse events related to its administration(AU)

Administración intrapleural de estreptoquinasa recombinante en tres niños graves con derrame pleural paraneumónico complicado / Intrapleural administration of recombinant streptokinase in three seriously ill children with complicated parapneumonic pleural effusion

Introducción: El derrame pleural paraneumónico es la enfermedad pleural más frecuente de la infancia, el 40-60 por ciento de los casos se presenta como complicación de neumonía adquirida en la comunidad. Ante la aparición de líquido pleural viscoso, con fibrina o tabiques, la fibrinólisis intrapleural aporta beneficios en la resolución de esta grave afección. Objetivo: Describir la evolución clínica e imagenológica de tres niños graves con derrame pleural paraneumónico complicado complejo y empiema. Presentación de casos: Pacientes ingresados en la Unidad de Terapia Intensiva del Hospital Pediátrico Provincial "Dr. Eduardo Agramonte Piña" con el diagnóstico de neumonía adquirida en la comunidad complicada con derrame pleural paraneumónico complicado complejo, tratados con estreptoquinasa recombinante por vía intrapleural; la primera paciente presentó crecimiento de Pseudomona en el cultivo de líquido pleural, patógeno no habitual en las infecciones respiratorias agudas procedentes de la comunidad. El segundo caso, se recibió complicada con shock séptico y el tercer paciente con ecografía torácica que mostró derrame pleural multitabicado, con grandes bolsones y gruesos tabiques. Los tres casos evolucionaron satisfactoriamente, sin necesidad de tratamiento quirúrgico, ni aparición de reacciones adversas atribuibles al fibrinolítico. Conclusiones: La administración intrapleural de la estreptoquinasa recombinante en niños graves con derrame pleural paraneumónico complicado complejo y empiema, resulta un método eficaz y seguro en la evacuación del foco séptico pleural, lo que favorece el control de la infección, sin aparición de complicaciones. Los casos presentados tuvieron evolución satisfactoria y en ninguno se produjo evento adverso relacionado con la administración de la estreptoquinasa recombinante intrapleural(AU)

Introduction: Parapneumonic pleural effusion is the most common pleural disease in childhood; 40-60 percent of cases occur as a complication of community-acquired pneumonia. Given the onset of viscous pleural fluid, with fibrin or septums, intra-pleural fibrinolysis provides benefits to solve this serious condition. Objective: Describe the clinical and imaging evolution of three seriously ill children with complex complicated parapneumonic pleural effusion and empyema. Case presentation: Patients admitted to the Intensive Therapy Unit of "Dr. Eduardo Agramonte Piña" Provincial Pediatric Hospital with the diagnosis of pneumonia acquired in the community worsen with complex complicated parapneumonic pleural effusion, and treated in the intrapleural way with recombinant streptokinase. The first patient showed growth of Pseudomona in the culture of pleural fluid, a pathogen which is not common in acute respiratory infections from the community. The second case was complicated with septic shock; and the third patient had a chest ultrasound that showed multi-sited pleural effusion, with large bags and thick septums. All three cases evolved satisfactorily, without needing surgical treatment, or having adverse reactions attributable to fibrinolytic ones. Conclusions: Intrapleural administration of recombinant streptokinase in seriously ill children with complex complicated parapneumonic pleural effusion and empyema is an effective and safe method in the evacuation of pleural septic focus, which favors infection control, without complications. The cases presented had satisfactory evolution and none of them occurred adversely related to the administration of intrapleural recombinant streptokinase(AU)

Eficacia y seguridad de la estreptoquinasa recombinante en niños con derrame pleural paraneumónico / Effectiveness and security of recombinant streptokinase in children with parapneumonic pleural efussion

Introducción: El derrame pleural paraneumónico como complicación de neumonías adquiridas en la comunidad en la población pediátrica constituye un problema de salud mundial y en Cuba. El empleo de fibrinolíticos intrapleurales es una acertada opción terapéutica. Objetivo: Evaluar la eficacia y seguridad de la utilización de la estreptoquinasa recombinante en el tratamiento del derrame pleural paraneumónico complicado complejo en niños. Métodos: Ensayo clínico confirmatorio fase III, monocentro, abierto, aleatorizado y controlado (RPCEC00000292), realizado entre septiembre 2018 - octubre 2019. Se incluyeron niños (1 - 18 años de edad), que cumplieron los criterios de selección, incluida la voluntariedad. Todos recibieron el tratamiento convencional establecido y se distribuyeron en dos grupos: I-experimental (estreptoquinasa recombinante, dosis diaria intrapleural de 200 000 UI, 3-5 días); II-control (terapia convencional). Las variables principales fueron: necesidad de cirugía y la estadía hospitalaria. Se evaluaron también los eventos adversos. Resultados: Se evaluaron 55 niños con la enfermedad referida, de ellos, 34 (61,8 por ciento) se incluyeron en el estudio. Ningún paciente del grupo experimental requirió cirugía, a diferencia del grupo control que lo requirió en 25 por ciento. Se redujo significativamente la estadía hospitalaria en el grupo que recibió estreptoquinasa recombinante. No se presentaron eventos adversos graves atribuibles al tratamiento experimental. Conclusiones: La estreptoquinasa recombinante administrada en el derrame pleural paraneumónico complicado complejo resultó un método eficaz y seguro para la evacuación del foco séptico, con un impacto positivo expresado en la reducción de complicaciones, la necesidad de tratamiento quirúrgico y la estadía hospitalaria, sin la ocurrencia de eventos adversos relacionados con su uso(AU)

in the community by the pediatric population represents a health problem in the world and in Cuba. The use of intrapleural fibrinolytics is a good therapeutic option. Objective: To evaluate the effectiveness and security of the use of recombinant streptokinase in the treatment of complex parapneumonic pleural efussion in children. Methods: Phase III confirmatory clinical trial, monocentric, open, randomized and controlled (RPCEC00000292) - named as DENIS study- carried out from September 2018 to October, 2019. There were included children (from 1 to 18 years old) that met the selection criteria including voluntariness. All of them received the established conventional treatment and were distributed in two groups: I- experimental (recombinant streptokinase, intrapleural daily dose of 200 000 UI, 3 - 5 days); II- control (conventional therapy). The main variables were need of surgery and hospital stay. There were also assessed the adverse events. Results: 55 children with the above mentioned disease were assessed; 34 of them (61.8 percent) were included in the study. Any of the patients of the experimental group required surgery, opposite to the control group that required it in a 25 percent. The hospital stay was significantly reduced in the group that had treatment with recombinant streptokinase. There were not any severe adverse events related to the experimental treatment. Conclusions: When recombinant streptokinase was administered in the complex parapneumonic pleural efussion resulted in an efficient and safe method for the elimination of the septic focus, with a positive impact expressed in the reduction of complications, the need of surgical treatment and the hospital stay without presenting related adverse events while using it(AU)

Reteplase thrombolytic therapy on the lower extremity deep venous thrombosis / 重庆医学

Objective To investigate the treatment of the lower extremity deep venous thrombosis .Methods Sixty patients with lower extremity deep venous thrombosis were analyzed retrospectively .Thirty two patients underwent reteplase thrombosis ,and 28 patients underwent recombinant streptokinase thrombosis ;the effects of each group were compared;and the various complications and adverse events were observed .Results Patients in two groups were all effectively treated ,and the effective rate of reteplase group was higher than recombinant streptokinase group (P0 .05) .During the follow‐up ,there was no reoccurrence in all 60 patients .Conclusion Reteplase thrombolytic therapy for the lower extremity deep venous thrombosis is safe and effective .

Efectividad y eficacia terapéuticas de la trombolisis en pacientes venezolanos con infarto agudo del miocardio / Therapeutical effectiveness and efficacy of the thrombolysis in Venezuelan patients with acute myocardial infarction

Se realizó un estudio descriptivo y observacional de 24 pacientes con signos clínicos, electrocardiográficos y enzimáticos de infarto agudo del miocardio, a los cuales se les aplicó tratamiento trombolítico (estreptoquinasa recombinante), atendidos en la Unidad de Cuidados Intensivos del área de salud Socorro, perteneciente al municipio de Valencia en el estado de Carabobo (República Bolivariana de Venezuela), desde mayo de 2009 hasta igual mes de 2010, con vistas a evaluar el impacto de esta terapia. En la casuística predominaron el sexo masculino (58,3 %), el grupo etario de 50 a 59 años (45,8 %), los que recibieron tratamiento antes de las 3 horas (58,4 %), la hipotensión arterial como complicación más común (66,6 %), así como la topografía diafragmática (41,7 %). Se corroboró la efectividad y eficacia de la trombolisis, pues permite recuperar áreas isquémicas y elevar con ello la supervivencia de los afectados.

A descriptive and observational study was carried out in 24 patients with clinical, electrocardiographic and enzymatic signs of acute myocardial infarction, in whom thrombolytic therapy was administered (recombinant streptokinase), attended in the Intensive Care Unit of Socorro health area, belonging to Valencia municipality in Carabobo state (Bolivarian Republic of Venezuela), from May 2009 to May 2010, with the purpose of evaluating the impact of this therapy. There was predominance of male sex (58.3 %), age group of 50 to 59 years (45.8 %), those that received treatment before 3 hours (58.4 %), hypotension as the most common complication (66.6 %), and diaphragmatic topography (41.7 %) in the case material. The effectiveness and efficacy of the thrombolysis was confirmed, because it allows to recover ischemic areas and thereby to increase the survival of those patients.

A pilot study on purification of human plasminogen from cord blood plasma and inducing posterior vitreous detachment / 中华实验眼科杂志

Background Many studies and clinical trials of pharmacologic vitreolysis are already under way to try to improve vitreo-retinal surgery and to liquefy and detach the vitreous from the retina ultimately, including chondroitinase,hyaluronidase,dispase and plasmin. However, there has not been any report on purification of human plasminogen from cord blood plasma and inducing posterior vitreous detachment of the animal eye at present.Objective This study was designed to isolate and purify the production of human plasminogen (Plg) from cord blood plasma with ethanol precipitation and evaluate the efficacy of Plg in inducing posterior vitreous detachment (PVD).Methods Human Plg was Separated and purified from cord blood plasma by ethanol precipitation method. The protein band corresponding to Plg with molecular mass of 92 000 was revealed in SDS-PAGE and confirmed by MALDI-TOF and Mascot database. Anion-exchange chromatography and plasminogen activity assay kit were used to obtain purified Plg with biological activity. Twenty-five fresh pig eyes were enucleated and assigned to 5 groups and 5 eyes for each group. The normal eyes were used as control group. Balanced salt solution(BSS)of 0.1 ml was intravitreally group and standard substance group. All of the eyes were then incubatedfor 60 minutes under the 37 ℃. Retinal histopathology and ultrastructure were examined under the light microscopy, scanning electron microscopy ( SEM ) and transmission electron microscopy (TEM). Results The Plg with potential fibrinolytic activity was successfully extracted and purified from cord blood plasma by ethanol precipitation method. No posterior vitreous detachment (PVD) was seen in normal control group, BSS group and r-SK group following the intravitreal injection under the sem. However,PVD was demonstrated in r-SK+ Plg group and standard substance group under the SEM. The inner limiting membrane ( ILM ) and the retina were well preserved in all of the experimental eyes. No retinal morphology and ultrastructural abnormality were found under the light and SEM and TEM. Conclusion Ethanol precipitation is a feasible way to isolate and purify Plg from human cord blood plasma. Extracted Plg shows potential fibrinolytic intravitreal injection of Plg.

Experimental study of preventive effect of recombinant streptokinase on cerebral vasospasm after subarachnoid hemorrhage / 临床神经病学杂志

Objective To study the preventive effect of recombinant streptokinase (r-SK) on cerebral vasospasm (CVS) after subarachnoid hemorrhage(SAH).Methods Rabbit models of SAH were made by double blood injection into cisterna magna. A tube was inserted into lateral ventricle after 24 h. In group treating one, 1.25 mg r-SK were injected into lateral ventricle, and the tube was opened for drainage after closed 6 h, and then 6 h later, injection, closed pipe and drainage were recycled for another 2 times. In the group SAH , 1 ml normal saline (NS) was injected into lateral ventricle, and then the way was the same as group treating one. In group treating two, 3.75 mg r-SK were injected for once. 6 h, 12 h ,1 d, 3 d, 5 d and 7 d later, 1 ml CSF was drained from the lateral ventricle in groups SAH , treating one and treating two ,respectively. The level of OxyHb in CSF was detected, angiograms of basilar artery(BA) were performed before and after 7 d of SAH,calculation the rate of calibre and histological examinations were also performed. Results (1)The level of OxyHb in CSF of group SAH was increased gradually while decreased in groups treating one and treating two. Compared with group SAH, the levels of OxyHb were significant lower in groups treating one and treating two at 1～7 d after administration(P