Tranexamic acid in patients with traumatic brain injury: a meta-analysis.

BACKGROUND: We performed a meta-analysis to assess the effectiveness and safety of tranexamic acid in patients with traumatic brain injury (TBI). METHODS: We searched the literature for articles evaluating the effectiveness and safety of tranexamic acid (TXA) in TBI published between January 2012 and January 2021, and identified 8 studies with a total of 10860 patients: 5660 received TXA and 5200 served as controls. We used a dichotomous or continuous approach with a random or fixed-effect model to assess the efficacy and safety of TXA in TBI, and calculated the mean difference (MD) and odds ratio (OR) with the corresponding 95% confidence interval. RESULTS: In patients with TBI, early administration of TXA was associated with a greater relative benefit (MD -2.45; 95% CI = -4.78 to -0.12; p=0.04) and less total haematoma expansion (MD - 2.52; 95% CI = -4.85 to -0.19; p=0.03) compared to controls. There were no statistically significant differences in mortality (OR 0.94; 95% CI=0.85-1.03; p=0.18), presence of progressive haemorrhage (OR 0.75; 95% CI=0.56-1.01; p=0.06), need for neurosurgery (OR 1.15; 95% CI=0.66-1.98; p=0.63), high Disability Rating Scale score (OR 0.90; 95% CI=0.56-1.45; p=0.68), and incidence of ischaemic or thromboembolic complications (OR 1.34; 95% CI=0.33-5.46; p=0.68) between TBI patients treated with TXA and controls. CONCLUSIONS: Early administration of TXA in TBI patients may have a greater relative benefit and may inhibit haematoma expansion. There were no significant differences in mortality, presence of progressive haemorrhage, need for neurosurgery, high Disability Rating Scale score, and incidence of ischaemic or thromboembolic complications between TBI patients treated with TXA and controls. Further studies are needed to validate these results.

Oral sildenafil citrate: a potential approach for improvement of endometrial thickness and treatment of unexplained infertility in women.

OBJECTIVE: The study aimed to determine the impact of using sildenafil citrate as an adjuvant with clomiphene citrate (CC) in the treatment of women with unexplained infertility. PATIENTS AND METHODS: 130 women with unexplained infertility were enrolled in a prospective randomized study. After dividing into two groups, all patients received CC 50 mg-BD from the 2nd to the 7th day of the cycle. Oral sildenafil citrate 20 mg was given BD to the study group from the end of menstruation till ovulation. A transvaginal ultrasound was carried out for all patients to assess ovulation, number of follicles, and endometrial thickness (ET). The beta-hCG blood test was used to determine pregnancy two weeks after ovulation followed by an ultrasound to confirm viability. Adverse effects were recorded and miscarriage, ectopic, and multi-fetal pregnancy were followed up for twelve weeks. RESULTS: Median ET in the study group was 8 mm compared to 7 mm in the control group (p<0.01). The number of pregnancies increased in the study group but with no significant difference. The median ET was greater in the study group with an infertility duration of less than 2 years. Headache was the most significant adverse effect in the study group (9.2% vs. 1.5%, p=0.052). CONCLUSIONS: Adding sildenafil citrate to CC is a good choice for overcoming the antiestrogenic action of CC and improving ET in women with unexplained infertility, especially in those with less than 2 years of infertility.

The impact of cinnarizine and griseofulvin on juvenile and adult stages of Schistosoma mansoni.

Schistosomiasis affects millions globally. There is no vaccine, and treatment depends entirely on praziquantel (PZQ). Field isolates exhibit reduced susceptibility to PZQ, and resistance has been experimentally induced, suggesting that reliance on a single treatment is particularly dangerous. The present study investigated the value of cinnarizine and griseofulvin against Schistosoma mansoni through their in vitro effects on adult worms and oviposition as well as in vivo evaluation in early and late infection, compared to PZQ, in a preliminary experimental model. In vitro, both cinnarizine and griseofulvin showed uncoupling, sluggish worm movement and complete absence of ova at 100 µg/ml. In early infection, cinnarizine showed a significant reduction in the number of porto-mesenteric couples compared to the griseofulvin and control groups, a finding similar to PZQ. Remarkably, cinnarizine significantly exceeded PZQ and griseofulvin in reducing the total worm burden. In late infection, cinnarizine and griseofulvin showed results similar to PZQ by significantly reducing the numbers of hepatic and porto-mesenteric couples and total worm burden compared to controls. Cinnarizine performed better than griseofulvin by reducing hepatic and intestinal ovum counts, and it led to complete disappearance of the first two immature stages. The current work suggests the possibility of using cinnarizine and griseofulvin, mainly in late S. mansoni infection, especially cinnarizine, which showed similar results to PZQ and surpassed it in early infection. Further studies are required to elucidate their exact mechanisms of action and particularly their synergistic effect with PZQ.

The potential effects of silver and gold nanoparticles as molluscicides and cercaricides on Schistosoma mansoni.

Schistosomiasis seriously affects human health in tropical regions. Its prevention is more important than treatment, raising the need for effective control methods. Recently, the role of nanomaterials in medical science has been growing. The present study aimed to evaluate the potential effects of silver (Ag) and gold (Au) nanoparticles (NPs) on Biomphalaria alexandrina snails and Schistosoma mansoni cercariae in vitro and to assess their effects on the infectivity of cercariae in vivo. The in vitro study proved that Ag and Au NPs were effective in killing B. alexandrina snails, with 30 µg/ml Ag and 160 µg/ml Au causing 100% mortality. The LC50 of 9.68 µg/ml for Ag NPs and 133.7 µg/ml for Au NPs prevented snail infection with S. mansoni miracidia. Furthermore, Ag NPs at 50 µg/ml and Au NPs at 100 µg/ml increased the mortality of S. mansoni cercariae in a dose- and time-dependent manner, reaching 100% mortality after 1 h. The in vivo study found that Ag NPs prevented the occurrence of infection when cercariae were treated before the infection by either the tail immersion (TI) or subcutaneous (SC) route, as proven by parasitological parameters and by the absence of granuloma formation in hepatic tissue. Meanwhile, infection of mice by untreated cercariae followed by treatment with NPs 1 h post-infection (PI) caused a decrease in egg count/g intestine and egg count/g liver in the TI-infected group only. The oogram patterns and granuloma formation results were similar between infection control and the SC-infected group. On the other hand, Au NPs led to a decrease in total worm burden (TWB) in all tested groups, with a decrease in egg count/g intestine and egg count/g liver in TI-infected groups with either pre-treated or post-treated cercariae, in contrast to SC-infected groups. However, the oogram patterns and granuloma formation showed similar results to infection control. Ag and Au NPs have potential as molluscicides and cercaricides in vitro and can prevent or modulate the infectivity of cercariae in vivo.