Background Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0•9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0•9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124.

The COVID-19 pandemic continues to be a global health crisis. The gut microbiome critically affects the immune system and some respiratory infections are associated with changes in the gut microbiome, here we evaluated the role of nutritional and lifestyle habits that modulate gut microbiota on COVID-19 outcomes in a longitudinal cohort study that included 200 consecutive patients infected with COVID-19. Of these, 122 cases were mild and 78 were moderate, according to WHO classification. After detailed explanation by a consultant in clinical nutrition, participants responded to a written questionnaire on daily sugar, probiotic and prebiotic intake in food, sleeping hours, exercise duration, and antibiotic prescription, during the past one year before infection. daily consumption of prebiotic-containing foods, less sugar, regular exercise, adequate sleep, and fewer antibiotic prescriptions, led to a milder disease and rapid virus clearance. Additionally, data on these factors were compiled into a single score, the ESSAP score (Exercise, Sugar consumption, Sleeping hours, Antibiotics taken, and Probiotics and Prebiotics administration; 0–11 points), median ESSAP score was 5 for both mild and moderate cases; however, the range was 4–8 in mild cases but 1–6 in moderate (p = 0.001, OR:4.2, 95%CI:1.9-9.1), our results showed a negative correlation between regular consumption of yogurt containing probiotics and disease severity (p = 0.007, OR:1.6, 95%CI:1.1-2.1). Mild COVID-19 disease was associated with 10-20 minutes of daily exercise (p = 0.016), sleeping at least 8 hours daily prescribed antibiotics less than 5 times per year (p = 0.077), ate plenty of prebiotic-containing food.

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Background:The novel coronavirus disease 2019 presents an urgent threat to global health. As the epidemic grows, prognosis prediction is essential for monitoring risky patient. It is thus important to consider gastrointestinal manifestations and the duration of symptoms as predictors of prognosis. Our aim was to determine the correlation of gastrointestinal symptoms and laboratory markers with disease outcomes and whether symptom duration varies substantially between patients. We also undertook this study to determine the optimal time to predict COVID-19 outcome. Patients and Methods: A total of 190 patients with polymerase chain reaction-confirmed COVID-19 were followed up until recovery. We proposed a correlation between gastrointestinal symptoms and disease severity (based on clinical data, and diagnostic investigations) to estimate the duration of symptoms as a predictor of COVID-19 prognosis. Results: The prevalence of gastrointestinal symptoms was 49.5%, consisting mainly of diarrhea in 27.9% of patients. In addition, a longer disease duration and higher temperature were observed in patients with diarrhea. Symptom duration was variable, with a median of 12 days and a range of 1-55 days. Statistical analysis indicated that patients with a duration of symptoms ≥12 day had more severe symptoms and a worse prognosis. Patients who complained of diarrhea had 2.7 times the odds of a longer duration of symptoms, and those with a history of chronic lung disease have 7.2 times the odds of a longer duration of symptoms. Conclusion: GIT manifestations (mainly diarrhea) and the duration of symptoms of COVID-19 provide prognostic evidence of COVID-19 outcomes, irrespective of earlier categorization by the World Health Organization. Thus, patients with mild symptoms who present with diarrhea and a duration of symptoms longer than 12 days are expected to have a worse prognosis.

Only few studies reported the impact of Child A cirrhosis on pregnancy outcomes. Therefore, we aimed to assess the outcomes of pregnancy in Child A cirrhotic patients compared to noncirrhotic pregnant females in terms of maternal and neonatal outcomes. The present retrospective study was conducted from January 2013 till January 2018. Pregnant females with Child A cirrhosis and age and gestational age-matched, noncirrhotic pregnant women were included. The main aim of this work was the differences in the pregnancyrelated outcomes between both studied groups. The present study included 100 pregnant cirrhotic women and 100 pregnant noncirrhotic women as a control group. In terms of the association between the presence of cirrhosis and maternal outcomes. The incidence of preeclampsia in the cirrhotic group was 6% in comparison to 2% in the noncirrhotic group (P = .27). On the other hand, 35% of women in the cirrhosis group underwent cesarean section (CS) delivery compared to 20% only in the noncirrhotic group (P = .018). Regarding neonatal outcomes, the incidence of preterm delivery and low birth weight were notably higher in the cirrhotic group than the noncirrhotic group (25% vs 7%, 15% vs 6% and P = .001, and 0.038). In contrary, there were no statistically significant variations between both groups in terms of stillbirth (P = .72), small for gestational age (P = .33), malformation (P = .99), and neonatal death (P = .99). Child A cirrhosis appears to increase the risks of prematurity, low birth weight and CS delivery; while it has no impact on maternal or neonatal mortality.