Research into TBI biomarkers has accelerated rapidly in the past decade owing to the heterogeneous nature of TBI pathologies and management, which pose challenges to TBI evaluation, management, and prognosis. TBI biomarker proteins resulting from axonal, neuronal, or glial cell injuries are widely used and have been extensively studied. However, they might not pass the blood-brain barrier with sufficient amounts to be detected in peripheral blood specimens, and further might not be detectable in the cerebrospinal fluid owing to flow limitations triggered by the injury itself. Despite the advances in TBI research, there is an unmet clinical need to develop and identify novel TBI biomarkers that entirely correlate with TBI pathologies on the molecular level, including mild TBI, and further enable physicians to predict patient outcomes and allow researchers to test neuroprotective agents to limit the extents of injury. Although the extracellular vesicles have been identified and studied long ago, they have recently been revisited and repurposed as potential TBI biomarkers that overcome the many limitations of the traditional blood and CSF assays. Animal and human experiments demonstrated the accuracy of several types of exosomes and miRNAs in detecting mild, moderate, and severe TBI. In this paper, we provide a comprehensive review of the traditional TBI biomarkers that are helpful in clinical practice. Also, we highlight the emerging roles of exosomes and miRNA being the promising candidates under investigation of current research.
Background:
The present meta-analysis aimed to synthesize evidence from all published studies with head-to-head data on the outcomes of a direct aspiration first pass technique (ADAPT) and the stent-retriever (SR) in acute ischemic stroke (AIS) patients.
Methods:
We searched PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials from inception to March 2021 for relevant clinical trials and observational studies. Eligible studies were identified, and all relevant outcomes were pooled in the meta-analysis random-effects model of DerSimonian-Laird.
Results:
Thirty studies were included in the meta-analysis with a total of 7868 patients. Compared with the SR, the ADAPT provides slightly higher rates of successful recanalization (RR 1.06, 95% CI [1.02 to 1.10]) and complete recanalization (RR 1.20, 95% CI [1.01 to 1.43]) but with more need for rescue therapy (RR 1.81, 95% CI [1.29 to 2.54]). There were no significant differences between the two techniques in terms of mortality at discharge, mortality at 90 days, change in the National Institutes of Health Stroke Scale score, the favorable outcome (modified Rankin scale (mRS) of 0-2), time to the groin puncture, or frequency of complications as intracerebral hemorrhage (ICH), symptomatic intracranial hemorrhage (sICH), embolus in a new territory (ENT), hemorrhagic infarction, parenchymal hematoma, subarachnoid hemorrhage, or procedural complications (all P > 0.05).
Conclusion:
Current evidence supports the use of the ADAPT technique to achieve successful and complete recanalization while considering the higher need for rescue therapy in some patients.
:
The current coronavirus disease (COVID-19) pandemic has affected about 247 million individuals around the world. Despite the extensive research efforts, there are currently few therapeutic options that offer direct clinical benefits for COVID-19 patients. Despite the advances in our understanding of COVID-19, the mortality rates remain significantly high owing to the high viral transmission in several countries and the rise of various mutations in the SARS-CoV-2. One of the currently available and widely used drugs that combine both anti-inflammatory and immunomodulatory actions is colchicine, which has been proposed as a possible treatment option for COVID-19. Colchicine still did not get much attention from the medical and scientific communities despite its anti-inflammatory and immunomodulatory mechanisms of action and its positive preliminary data from early trials. This literature review article provides the scientific rationale for repurposing colchicine as a potential therapeutic of COVID-19. Further, we summarize its mechanisms of action and possible roles in COVID-19 patients. Finally, we supplement this review with a summary of the doses, side effects, and the early efficacy data from clinical trials to date. Despite the early promising findings from multiple observational and clinical trials about the potential of Colchicine in COVID-19, data from the RECOVERY trial, the largest COVID-19 RCT in the world, showed no evidence of clinical benefits in mortality, hospital stays, or disease progression (n=11340 patients). However, multiple other smaller clinical trials showed significant clinical benefits. We conclude that while current evidence does not support the use of colchicine for treating COVID-19, the present body of evidence is heterogeneous and inconclusive. The drug cannot be used in clinical practice or abandoned from clinical research without additional large RCTs providing more robust evidence. At the present, the drug should not be used except for investigational purposes.
Many hospitals are teetering on the edge of being overwhelmed or already there because of the COVID-19 pandemic. A recent report has recently appeared warning of Nipah virus (NiV). NiV is a pleomorphic enveloped virus that belongs to the Paramyxoviridae family (genus Henipavirus); it affects both the respiratory and central nervous systems, with a fatality rate ranging from 40% to 75%, as documented by the World Health Organization. The first reported NiV outbreak was in early 1999 in Malaysia among people who had contact with infected pigs. NiV also affected Bangladesh and India, where the main infection route was the consumption of raw date palm sap contaminated by bats. The World Health Organization has listed NiV as one of the emerging pathogens that can lead to severe outbreaks at any moment in the future with limited existence of ready medical preparations for it and few projects in pharmaceutical firms’ pipelines. There is no licensed treatment for human use against NiV until now, and the management is limited to supportive care and symptomatic treatment. In severe cases with neurologic and respiratory complications, intensive care is needed. This article reviews the published literature and highlights the latest updates about this emerging pathogen and what we can do to avoid the spread of this disease during this critical period.
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