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

An ethnopharmacological evaluation of Navapind and Shahpur Virkanin district Sheikupura, Pakistan for their herbal medicines

Abstract Background The chief aim of this study was to enlist the ethnobotanical uses of wild plants in district Sheikhupura, province Punjab, Pakistan. Due to extreme geographical and climatic conditions, Pakistan has a great floral diversity. Plants have been used by the indigenous people for treatment of different ailments since long. They are still dependent on the plants for their domestic purposes. Moreover, plants are used as first aid to treat diverse ailments such as cold, cough, influenza, asthma, cancer, antidote, gastric and hepatic disorders. The traditional uses of medicinal plants lead to the discovery of natural drugs. This is first quantitative ethnobotanical documentation of medicinal plants in NavaPind and ShahpurVirkan district Sheikhupura, province Punjab, Pakistan. Methods This ethnobotanical information was collected from about 400 informants including male and female. Sample size was determined by statistical formula. The informative data was based on semi-structured interviews, group discussions, Questionnaire and field visits. Then the data was analyzed by applying different quantitative indices such as Informant Consent Factor (ICF), Use value (UV), Relative Frequency of Citation (RFC), the Fidelity level (FL) and Jaccard Index (JI). Results Almost 96 plants belonging to 34 families were reported. Most-frequently cited families were Poaceae (16 species) and Fabaceae (15 species). The most dominant life form was herbs (30.20%). The most-used plant parts were leaves (31.14%), followed by whole plant (24.59%), Most common mode of administration is extraction (81.25%). Generally herbal medicines were acquired from fresh plant material. Among all 54.16% plants were toxic, 31.25% were nontoxic, whereas the remaining 14.58% may be toxic or nontoxic because of their dual attitude. Almost 34 species were reported with their different medicinal uses as has been reported in literature. Conclusions This ethnobotanical documentation revealed that the plants are still used by natives of rural areas in their day-to-day lives. This study provides basis for the conservation of local flora. Plants with high ICF, UV and FL can be further used for phytochemical and pharmacological studies. This documentation could provide baseline information which can be used to develop new plant-based commercial drugs

Occurrence of Massively Enlarged Multiple Hydatid Cysts in the Lung and Liver of a Pediatric Patient in Pakistan

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A survey on postanesthetic patient satisfaction in a university hospital

Background and Objectives: Patient satisfaction after anesthesia is an important outcome of hospital care. The aim is to evaluate the postoperative patient satisfaction during the patient stay at King Khalid University Hospital in Riyadh, Saudi Arabia. Patients and Methods: Three hundred and fifty-three patients who underwent surgery under general/regional anesthesia were surveyed. They were interviewed face to face on the first postoperative day. We recorded pain and pain controls in addition to some common complication of anesthesia like nausea and vomiting (postoperative nausea and vomiting) as a parameter to assess the rate of patient′s satisfaction. Results: The overall level of satisfaction was high (95.2%); 17 (4.8%) patients were dissatisfied with their anesthetic care. There was a strong relation between patient dissatisfaction and: (i) Patients with poor postoperative pain control 13 (12.4%), (ii) patients with moderate nausea 8 (11.1%) and (iii) patients with static and dynamic severe pain 6 (21.4). Several factors were associated with dissatisfaction can be prevented, or better treated. Conclusion: We concluded that the patient satisfaction was high. Postoperative visit should be routinely performed in order to assess the quality and severity of postoperative pain, nausea and vomiting and the other side-effects postoperatively

Polymer blend: a new approach for eliminating curing effect of aqueous dispersion coatings

The aim of present work was to investigate blends of Eudragit® NE 30D with Aquacoat® ECD using different ratios to eliminate curing effect associated with individual polymers. Propranolol HCl 10% w/w was layered onto sugar cores using 5% w/w HPMC as a binder. Drug-layered-cores were coated either with pure or blends of Aquacoat® ECD: Eudragit® NE 30D in a fluidized bed coater to obtain 20% w/w coating level. Talc 35% w/w was used as anti-tacking agent. The pellets were characterized for in vitro dissolution studies, morphology, water uptake-weight loss, osmolality and adhesion of coating after curing at 60 °C or 60 °C/75% RH for 24 h. The findings revealed that Aquacoat® ECD coated pellets showed curing effect due to further gradual coalescence of polymeric particles which resulted into better film formation upon curing. In contrast, the curing effect of Eudragit® NE 30D coated pellets was caused by decrease in adhesion of coatings after curing which provided entirely different swelling behavior of uncured (localized swelling) and cured (uniform swelling) pellets. The undesired curing effect of individual polymers was eliminated by using their blends in appropriate ratio

Synthesis, characterization, in silico and in vitro studies of novel glycoconjugates as potential antibacterial, antifungal, and antileishmanial agents

In the present work, several new glycoconjugates (8a–e) were generated from glycopyranosyl-α-trichloroacetimidates (sugar-OTCA) as glycosyl donors and dimethyl-l-tartrate as an aglycone acceptor in good to excellent yields. In the synthetic protocol, various monosaccharides were transformed into pentaacetylated derivatives and then into glycopyranosyl-α-trichloroacetimidates. Afterward, the sugar-OTCA was reacted with dimethyl-l-tartrate using Schmidt’s trichloroacetimidate protocol to give the desired products. The newly synthesized glycoconjugates were characterized by FT-IR, 1H, and 13C-NMR spectroscopic analytical methods. All the target compounds (8a–e) were tested in vitro against various strains of bacteria and fungi at different concentrations. The results revealed that the target compounds had encouraging antibacterial and antifungal potential. The antileishmanial activity of the target compounds against Leishmania tropica promastigotes was also investigated. The in vitro results were further supported by the in silico docking study that indicated minimum values of the docking scores and binding energies for the resulting complexes obtained by the favorable interactions between the target compounds (8a–e) and the selected strains of bacteria and fungi. The docking results proposed promising antibacterial and antifungal activities of the target compounds (8a–e) against the selected bacterial and fungal species