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

Estimation of D-Dimer Level among Sudanese Patients with COVID-19 Infection-Khartoum State 2022

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirusdisease 2019 (COVID-19) has rapidly evolved from an epidemic outbreak in Wuhan, China  into a pandemic infecting more than one million individuals all over the world, where as billions of citizens are affected by measures of social distancing and the socioeconomic impact of the pandemic Material and methods: This was case control study, conduct at COVID-19 quarantine hospitals in Khartoum state during the period from May to July 2022, for the measurement of D-dimer level among Sudanese covid 19 patients. One hundred participants were selected as cases and apparently fifty participants were selected as control group. 2.8 ml of venous blood samples were collected in Tri Sodium Citrate anticoagulant The D-dimer was performed using B50protein analyzer . Results: When compared the D-dimer results between case and control there was highly significant difference with p.value 0.000. In addition the D-dimer in cases compared with the other study variables which revealed; significant differences with the chronic disease and the severity of the disease, in significant differences with the age, gender and smoking status. Conclusion: This study concluded that D-dimer was significantly increase in COVID-19 patients, and it had significant differences with the chronic disease and the severity of the disease, insignificant differences with the age, gender and smoking status. Keywords: COVID-19, SARS-CoV-2, D-dimer, chronic disease and B50protein analyze

Sudanese live sheep and mutton exports competitiveness

The livestock sector of Sudan provides livelihood for about 17% of the population. Sudanese livestock products meet the domestic demand for meat in addition to a substantial excess for export amounting to about 22% of total country exports. It contributes about 19% of GDP. Sheep marketing in Sudan is characterised by traditional operations and is informally organised, although, recently there are great efforts by the formal livestock authorities to organise some secondary and terminal livestock markets. These markets are deficient in basic infrastructures and systematic marketing research. The system as a whole is faced by various complex obstacles and constraints, which decrease the contribution of livestock in general, and sheep in particular, to the national economy, and suppress the optimum exploitation of this resource. These obstacles are represented in the lack of transportation networks that connect the production and consumption centres to break the seasonality of supply that creates shortages and high prices at the consumption centres. This paper employs the policy analysis matrix (PAM) technique to examine the Sudanese live sheep and mutton competitiveness in the international market. The results indicated that the market price was greater than the border price implying a positive incentive as an implicit subsidy to the live sheep exporter. The mutton exporters were found subsidised as well. The international value added (IVA) indicted a positive foreign exchange earnings or savings. Exported live sheep and mutton coefficient of competitiveness (CIC) implied that sheep and mutton exports are profitable and internationally competitive

Molecular Phylogenetic Analysis of 16S rRNA Sequences Identified Two Lineages of Helicobacter pylori Strains Detected from Different Regions in Sudan Suggestive of Differential Evolution

Background. Helicobacter pylori (H. pylori) is ubiquitous among humans and one of the best-studied examples of an intimate association between bacteria and humans. Phylogeny and Phylogeography of H. pylori strains are known to mirror human migration patterns and reflect significant demographic events in human prehistory. In this study, we analyzed the molecular evolution of H. pylori strains detected from different tribes and regions of Sudan using 16S rRNA gene and the phylogenetic approach. Materials and methods. A total of 75 gastric biopsies were taken from patients who had been referred for endoscopy from different regions of Sudan. The DNA extraction was performed by using the guanidine chloride method. Two sets of primers (universal and specific for H. pylori) were used to amplify the 16S ribosomal gene. Sanger sequencing was applied, and the resulted sequences were matched with the sequences of the National Center for Biotechnology Information (NCBI) nucleotide database. The evolutionary aspects were analyzed using MEGA7 software. Results. Molecular detection of H. pylori has shown that 28 (37.33%) of the patients were positive for H. pylori and no significant differences were found in sociodemographic characteristics, endoscopy series, and H. pylori infection. Nucleotide variations were observed at five nucleotide positions (positions 219, 305, 578, 741, and 763–764), and one insertion mutation (750_InsC_751) was present in sixty-seven percent (7/12) of our strains. These six mutations were detected in regions of the 16S rRNA not closely associated with either tetracycline or tRNA binding sites; 66.67% of them were located in the central domain of 16S rRNA. The phylogenetic analysis of 16S rRNA sequences identified two lineages of H. pylori strains detected from different regions in Sudan. The presence of Sudanese H. pylori strains resembling Hungarian H. pylori strains could reflect the migration of Hungarian people to Sudan or vice versa. Conclusion. This finding emphasizes the significance of studying the phylogeny of H. pylori strains as a discriminatory tool to mirror human migration patterns. In addition, the 16S rRNA gene amplification method was found useful for bacterial identification and phylogeny

Intellectual Profiles of Children with Autism Spectrum Disorder: Identification of verbal and nonverbal subscales predicting intellectual quotient

Objectives: This study aimed to explore the intelligence quotient (IQ) profile among children with autism spectrum disorder (ASD) and identify the most important subscales that predict the IQ. The analysis of an intellectual profile with age and gender differentials and the identification of a battery of subscales of intelligence are important for clinical management of ASD among children and for facilitating placement for remedial and educational services. Methods: Data were collected through an exploratory study of 100 children aged between three and 13 years, who were referred to the department of child health and development in Sultan Qaboos University Hospital, a tertiary hospital, in Oman between June 2016 and June 2019. Results: Among the 100 participants of this study, 79% were male, resulting in a male–female ratio of 4:1. The mean of full-scale IQ was found to be 68.6 } 18.1. Furthermore, the mean of nonverbal IQ (73.5 } 17.5) was significantly higher than that of verbal IQ (65.5 } 17.6). Finally, more than half (61%) of the children were observed to have had mild to moderate impairment in their IQ levels. Conclusions: Age and gender showed no significant association with IQ level. The regression analysis identified nonverbal fluid reasoning, nonverbal visual-spatial processing, nonverbal working memory and verbal knowledge as the significant predictors of total IQ. The crucial dimensions of verbal and nonverbal IQ identified in this study can be used to evaluate complicated cases. Keywords: Autism; Intelligence; Oman

Les crises soudanaises des années 80

Ce dossier est constitué, dans sa quasi-totalité, de contributions de chercheurs et universitaires soudanais proposant une analyse de certains des problèmes cruciaux que leur pays a connus depuis le début des années 80. Les articles qui le composent correspondent aux communications qui devaient initialement être présentées lors d’un colloque portant sur le même thème, prévu à Paris pour décembre 1991 et qui n'a pu avoir lieu du fait de l’impossibilité où se trouvaient certains de ses participants soudanais de quitter leur pays. […