Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Commercialisation of microfinance in Pakistan

This study investigates the growing commercial focus of microfinance institutions in Pakistan. Specifically, the aim of the study is to examine the impact of commercialisation on microfinance institutions and their users or clients – micro borrowers. A selective review of the multidisciplinary literature on microfinance, its commercialisation and its context specifically in Pakistan is used to develop a conceptual framework for the thesis. The study uses mixed methods, where analysis of a series of interviews and focus group meetings is combined with quantitative data analysis to give deeper and more nuanced understanding of the consequences of microfinance’s commercialisation. Moreover, particular attention is given to important themes, including: outreach, profitability, mission, and the prevailing practices of microfinance institutions. The principal findings of the study indicate, firstly, that with increased commercialisation, microfinance institutions in Pakistan tend to confined to a few parts of the country, mostly urban; in particular microfinance tends not to reach rural areas where poverty is more widespread. Secondly, it is found that microfinance institutions and some of the borrowers employ unsavoury practices that exploit cultural norms. Finally, this study argues that commercialisation of microfinance has resulted in a negative impact not only on micro borrowers but also on commercial microfinance institutions themselves, which largely fail to achieve their stated objective of profitability and ‘sustainability’

Outcome of Ultrasound Guided Trucut Biopsy of Adnexal Masses with Suspected Malignancy

Background: Ultrasound guided sampling techniques are frequently used in the tissue diagnosis of various tumours. Female patients commonly present with adnexal masses and require tissue diagnosis by trucut biopsy for initiation of the treatment. This study was done to determine the outcome of ultrasound guided trucut biopsy in patients presenting with suspected adnexal malignancy. Methodology: This cross sectional study was done at the Department of Radiology, MCH Centre, PIMS hospital, Islamabad from October 2018 to September 2020. In this study, all female patients aged 18 years and above with suspected adnexal malignancy were included. Trucut biopsy was performed under ultrasound guidance, sample sent for histopathology and various histopathological outcomes were assessed. Patients were kept under observation for 2 hours following biopsy. The data was entered and assessed by using SPSS version 24.0. Frequencies and percentages were calculated for nominal data and mean and standard deviation for numerical data. Results: Mean age of the subjects was 50.24±10.52 years and mean duration of symptoms was 2.97±1.23 months. Definitive diagnosis made in 59 (95.1%) out of 62 cases and only 3 (0.04%) cases were inconclusive; among which two showed inadequate sample and one showed normal tubo-ovarian tissue. 90% histopathological findings were conclusive and no complication was reported. Conclusion: Trucut biopsy has high diagnostic yield with no complications and most common malignancy detected was serous cystadenocarcinoma followed by mucinous carcinoma. Key words: Biopsy, Malignancy, Ultrasound &nbsp

Effect of storage at elevated temperature on the quality and stability of different almond oils: a comprehensive study

This study aimed to investigate the chemical changes and oxidative stability of almond oil varieties (Australian, American, and Iranian) during storage at 60 °C for 21 d. The physicochemical properties of oil were analyzed at various time intervals to determine its stability. The peroxide value, free fatty acid, p-anisidine, TOTOX, fatty acid composition, and effect on functional groups were evaluated to assess the quality of the almond oil during storage. The results showed a significant increase in PV and FFA, p-AV, totox of the almond oil during storage, indicating that oxidative degradation had occurred. During the oxidation process, some changes were observed in the following spectral regions: 3,700–3,150, 3,010–2,999, 1,800–1,600, and 1,200–900 cm−1. Whereas, the fatty acid composition of the almond oil remained relatively stable during storage, except for a small variation in oleic acid. Comparatively, American and Iranian almond oils showed better stability than the Australian almond variety. The findings of this study provide important insights into the oxidative stability of different almond varieties during storage and can aid in the development of strategies to prevent or mitigate oxidation in almond oil. The findings of this study could have significant implications for the food, cosmetics, and pharmaceutical industry, particularly in the formulation and production of products that use almond oil as an ingredient