Prevention and treatment of cerebral vasospasm after aneurysmalsubarachnoid hemorrhage

Background. Cerebral vasospasm is the most serious complication of subarachnoid hemorrhage. It can be defined as deferred and self-limited condition whose severity is linked to the volume, solidity, prolonged presence and location of subarachnoid blood. Almost 70% of these patients have angiographic manifestation of vasospasm, and circa 50% of these patients experience neurological deficits. The purpose of this article is to concentrate on the current progress and prospective approaches in the prevention and treatment of cerebral vasospasm after aneurismal subarachnoid hemorrhage. Materials and methods. A thorough literature search through the Medline and Ebscodatabases was performed. Original investigations, meta-analyses and reviews from the past 10 years, with accessible full-texts, in the English language, were selected. Prevention and treatment. The main medical approach for prevention of vasospasm includes upkeep of normal blood circulation level and oral Nimodipine. The only type of treatment for cerebral vasospasm, which is recognized at present, is induced hypertension with the maintenance of euvolemia. Percutaneous transluminal angioplasty and/or selective intra-arterial vasodilator therapy are recommended in patients with symptomatic cerebral vasospasm, especially in those without quick response to hypertensive therapy. Conclusion. Novel approaches with immunomodulators, anesthetics, hypothermia, acupuncture, neuroprotective agents and multimodal treatment regimens are under active development and hold promise in the treatment of vasospasm in the coming years

Reslizumab versus placebo for poorly controlled, severe eosinophilic asthma: Meta-analysis

Background/Aim. Reslizumab is humanized monoclonal antibody produced by recombinant DNA technology which binds to circulating interleukin-5 (IL-5) and down-regulates the IL-5 signaling pathway. Reslizumab is indicated for the add-on maintenance treatment of patients 18 years and older with severe eosinophilic asthma phenotype whose symptoms were inadequately controlled with inhaled corticosteroids. The aim of this meta-analysis was to assess the efficacy and safety of reslizumab compared to placebo in patients suffering from inadequately controlled, moderateto- severe asthma with elevated blood eosinophil counts. Methods. Our meta-analysis was based on systematic search of literature and selection of high-quality evidence according to pre-set inclusion and exclusion criteria. The effects of reslizumab and placebo were summarized using Review Manager (RevMan) 5.3.5 and heterogeneity was assessed by the Cochrane Q test and I² values. Several types of bias were assessed and publication bias shown by Funnel plot and Egger’s regression. Results. The meta-analysis included 5 randomized, placebo-controlled clinical trials. Reslizumab 3.0 mg/kg produced substantial improvements in forced expiratory volume in 1. second (FEV 1) (mean difference 0.15 [0.10, 0.21]) and in forced vital capacity (FVC) (mean difference 0.21 [0.09, 0.32]) over the 15 or 16-week treatment period, substantial decrease versus placebo in Asthma Control Questionnaire (ACQ) score (mean difference -0.28 [-0.41, -0.16]), and substantial increase vs. placebo from baseline in Asthma Quality of Life Questionnaire (AQLQ) total score (mean difference 0.24 [0.06, 0.43]). Also, reslizumab 3.0 mg/kg caused less adverse events versus placebo (OR 0.67 [0.51, 0.88]), especially asthma worsening (OR 0.53 [0.36, 0.77]) or bronchitis (OR 0.42 [0.24, 0.74]). Conclusion. On the basis of published clinical trials reslizumab could be considered as an effective and safe therapeutic option for severe, poorly controlled eosinophilic asthma for the time being. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. 175007