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 new formulated aloe- and myrrh-based gels proved to be effective in topical management of MiRAS. Aloe was superior in decreasing ulcer size, erythema, and exudation; whereas myrrh resulted in more pain reduction.

Introduction: Uterine myomas are most prevalent benign tumors in reproductive-aged women. Myomectomy is a surgical treatment for symptomatic uterine myomas for women who want to preserve fertility. Uncontrolled intraoperative bleeding with others life-threatening complications make the surgery risky even more than the hysterectomy and require a skilled surgeon, several methods have been developed to reduce this complications. Misoprostol PE1 analogue, which is recently used as treatment and prophylaxis of postpartum hemorrhage, may reduce intra-operative blood loss during abdominal myomectomies when bleeding constitutes a major problem. Aim of the work: Was to assess the effect part of a single dose of Misoprostol (400 microgram) given rectally one hour preoperative on the amount of blood loss during open Myomectomy. Patients and Methods: In a prospective randomized double-blind placebo-controlled trial which was conducted at Ain shams maternity Hospital in Cairo from October 2017 to May 2018, 50 women undergoing abdominal myomectomy for symptomatic uterine myomas were randomly divided into 2 groups : Group I (control group) consisted of 25 patients, each patient was given 2 tablets of placebo trans-rectally one hour preoperatively and without any intervention to reduce blood loss and Group II (study group) consisted of 25 patients, each patient was given 400 micrograms of misoprostol transrectally one hour preoperatively. The primary outcome was intraoperative blood loss. This clinical trial was registered in clinicaltrial.gov registry with number: NCT03483142. Results: Intra-operative blood loss was significantly lower in those women randomized to receive rectal misoprostol versus the placebo group (460.8-155.2 mL vs. 815.4 -187.7 mL). Misoprostol group showed lower mean blood loss (P<0.01) ; additionally, there was a highly significant statistical difference between Misoprostol group and placebo group as regards the postoperative hemoglobin, hematocrit concentration, operative time and IV fluid infusion during surgery (P<0.01) as Misoprostol group showed a higher postoperative hemoglobin and hematocrit concentration, and less operative time and infused IV fluid. There was no statistical significant difference between both groups as regards the blood transfusion. Conclusion: Preoperative single dose of rectal misoprostol (400 micrograms) is an effective simple method for reducing intra-operative bleeding, operative time, mean post-operative HB and Hct drop.