Toluidine blue as an adjunctive tool for early diagnosis of premalignant and malignant oral lesions

Objective: To determine the Toluidine blue as an adjunctive tool for diagnosis of premalignant and malignant oral lesions by taking histopathology as gold standard. Methodology: This cross-sectional study was held at the Outpatient Department of Isra Dental College Hospital, Isra University, Hyderabad, over six months from January 2017 to June 2017. All patients of oral premalignant lesions were selected. Toluidine blue staining was used at lesion’s area. The dye was applied directly with a cotton bud for 10-20 seconds and was decolorized and a photograph was taken. The dye retention pattern was evaluated by stain retention’s intensity on the lesion. Incisional biopsy was performed simultaneously from that site as gold standard. The data was filled in proforma and analysis was done via SPSS version 20. Results: Out of 60 cases, males were 49 (81.6%) and females were 11 (18.3%). The mean age of males and females was 41.9±10.7 years and 39.8±7.74 years respectively. 65.0% of patients had more than one addicting habit of mainpuri, gutka and supari. The commonest region of oral lesions was the buccal mucosa among 61.6% patients followed by alveolus in 16.6%, lips 8.3%, tongue 6.6%, retro molar area 3.33%, while palate and floor of mouth were involved in 1.66% patients. According to the diagnostic accuracy of methylene blue the sensitivity was 89.4% and specificity was 66.6%. Conclusion: Toluidine blue staining is the best, reliable and noninvasive screening tools to detect the early diagnosis of malignancy

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

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. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

JURISPRUDENTIAL STATUS OF RULES OF LAW IN MITIGATION OF SHARIAH ORDERS

   The welfare of human kind in individualand collective live is in believing and following Islamic way of life. Islamic code of life exalts the human kind to new dimentions. It has a code of life for all times and universal, not subservient to time and space. On the contemporary, Islamic code of life with all its manufestation is as much work-able and needed today as it was it was in the early glorious period of Islam. Allah, in all His mercy has made the "Islam" simple, workable with exceptions and relief where ever one feels difficulty, danger or deprivation. Based on the Quran, the Holy Prophet guided the followers on such matter where exceptions or relief was needed. After ther Holy Prophet, the reponsibility of guidance was taken out by his companions, after their period the Imams coded all the problems in "fiqah". Today the human kind, particulary Muslims face new chalangesregardingdifferent problems in the matter of practice. This study has established guidance and solutions in the form of exceptions and relief given in Sharia. The hall-mark of it is that Allah and his Prophet has provided relief where ever it is needed

Mucor pusillus immobilized Amberlite XAD-4 biocomposites for preconcentration of heavy metal ions by solid-phase extraction method

Abstract Background Solid phase extraction has been an effective tool for the determination of metal ions at trace or sub trace level from environmental aquatic streams. Sensitivity, accuracy, versatility and reusability of adsorbent entitle the solid phase as effective technique for the determination of metal ions. Methods A solid phase extraction procedure has been described for the determination of Cd, Cu, and Pb by High Resolution–Continuum Source Flame Atomic Absorption Spectrometry HR-CS FAAS using a mini-column of Mucor pusillus (Lindt., 1886) immobilized on Amberlite XAD-4. Method has been optimized by changing the pH of analyte solution, solid phase dosage, volume of eluents, flow rate of sample solution and volume of the sample solutions. Results The recoveries of Cd, Cu, and Pb under the optimum conditions were 99±3%, 97±2% and 96±2%, respectively. The resulting preconcentration procedure ensured a 50-fold improvement in the sensitivity of the elements. The detections limits were 62, 74 and 235 ng/mL for Cd, Cu, and Pb before enrichment, respectively. The method was validated by analysis of tomato leaves reference materials (SRM 1573a). Conclusions The proposed enrichment method has been successfully applied for the determination of Cd, Cu, and Pb in tomato leaves and water samples with a relative error ≤8%. This method is simple, sensitive, and accurate especially for water sample, only 200 mg of sorbent are required to capture the analytes. It can be concluded that the use of Mucor pusillus (Lindt., 1886) enhanced the sorption ability of Amberlite XAD-4 resin for the retention of Cd, Cu, and Pb

Toluidine blue as an adjunctive tool for early diagnosis of premalignant and malignant oral lesions

Objective: To determine the Toluidine blue as an adjunctive tool for diagnosis of premalignant and malignant oral lesions by taking histopathology as gold standard. Methodology: This cross-sectional study was held at the Outpatient Department of Isra Dental College Hospital, Isra University, Hyderabad, over six months from January 2017 to June 2017. All patients of oral premalignant lesions were selected. Toluidine blue staining was used at lesion’s area. The dye was applied directly with a cotton bud for 10-20 seconds and was decolorized and a photograph was taken. The dye retention pattern was evaluated by stain retention’s intensity on the lesion. Incisional biopsy was performed simultaneously from that site as gold standard. The data was filled in proforma and analysis was done via SPSS version 20. Results: Out of 60 cases, males were 49 (81.6%) and females were 11 (18.3%). The mean age of males and females was 41.9±10.7 years and 39.8±7.74 years respectively. 65.0% of patients had more than one addicting habit of mainpuri, gutka and supari. The commonest region of oral lesions was the buccal mucosa among 61.6% patients followed by alveolus in 16.6%, lips 8.3%, tongue 6.6%, retro molar area 3.33%, while palate and floor of mouth were involved in 1.66% patients. According to the diagnostic accuracy of methylene blue the sensitivity was 89.4% and specificity was 66.6%. Conclusion: Toluidine blue staining is the best, reliable and noninvasive screening tools to detect the early diagnosis of malignancy

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

BackgroundTranexamic 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.MethodsWe 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.FindingsBetween July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98).InterpretationWe found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial.</div