Enoxaparin versus unfractionated heparin in acute ischemic stroke [in-evolution type] differential effects of enoxaparin on von Willebrand factor release and a possible relation to improved clinical outcomes

The significance of low-molecular-weight heparins [LMWHs] in the management of acute stroke remains controversial. One hundred patients with acute ischemic stroke in evolution were enrolled [with symptoms of stroke within eight hours of randomization]. Patients were randomized to receive Unfractionated Heparin [UFH] at a dose 5000 IU by IV bolus, followed by a continuous IV infusion; or to Enoxaparin [ENOX] at a dose of 0.5 mg per kilogram body weight. Therapy was continued for 10 days. National Institutes of Health Stroke Scale [NIHSS] and Computed Tomography [CT] scan were performed in all patients at the time of admission, and after 48 hours of randomization. It was found that, the mean baseline National Institutes of Health Stroke Score [NIHSS] was 9.14 +/- 0.62 among patients randomized to UFH, vs. 7.86 +/- 0.54 among patients randomized to ENOX [p = 0.2]. At discharge, the mean NIHSS showed a statistically significant difference in favor of the ENOX group [7.9 +/- 0.82 for the UFH arm versus 4.96 +/- 0.54 for the ENOX arm; p = 0.002]. The mean NIHSS after therapy in patients who demonstrated neurological improvement was 5.6 +/- 0.46 in the UFH arm, as opposed to 3.65 +/- 0.39 in the ENOX arm [p = 0.001]. A deterioration in the clinical neurological condition [progressive stroke symptoms] inspite of treatment with anticoagulant therapy was seen in 20% [n = 10] of the patients in the UFH treatment arm and no patients in the ENOX treatment arm showed this condition [p = 0.005]. No statistically significant differences were observed for pulmonary embolism, deep venous thrombosis, recurrent strokes, or death. It was concluded that, Enoxaparin [+ aspirin] was superior to UFH [+ aspirin] in reducing adverse neurological disability after acute ischemic stroke in evolution. This superiority was not associated with reductions in mortality, and could be explained by blunting of von Willebrand factor release by Enoxaparin

profile of fungi, mycoplasma and anaerobic bacteria in non tuberculous bronchopulmonary infections

Respiratory secretions were collected from 91 patients with non-tuberculous bronchopulmonary infections by sputum expectoration [38 cases], nebulization [40 cases] and invasive techniques [I.T.], [13 cases]. Before I.T. sputa were collected from patients of the invasive group and studied. So, for all [104] specimens, cultures were done to isolate aerobic, mycoplasma and fungal pathogens. Anaerobic cultures were done only to specimens collected by I.T. [13 specimens]. The most frequently isolated pathogens were Gram negative aerobic and facultatively anaerobic rods [28 cases], Strept pneumoniae [20 cases], Strept pyogenes [19 cases], Staph aureus [18 cases]. Fungi were isolated from 29 cases, mycoplasma pneumoniae were isolated from 7 cases and Branhamella cattarrhalis from 3 cases. Anaerobic bacterial pathogens were isolated from 4 cases out of the 13 cases studies by I.T. The study showed that anerobic bacteria, fungi and mycoplasma constitute a major share in bronchopulmonary pathogens. The study showed also the importance of I.T. in sampling the lower respiratory tract being the only method accepted for anaerobic cultures and giving a less fungal yield [15.4%] than that by expectoration [38.5%], before invasive techniques in the same 13 cases Also, the present series illustrated the clinicoradiological profile of the different pathogens which will help in suggesting the therapeutic strategies in the relevant clinical situations