Thyrotoxic hypokalemic periodic paralysis: A success story of a diagnostic challenge

Thyrotoxic hypokalemic periodic paralysis (THPP) is a rare but life-threatening complication of hyperthyroidism seen predominantly in males. It is generally characterized by hypokalemia and skeletal muscle paralysis requiring intensive care admission. Hypokalemia occurs due to the massive intracellular shift of potassium because of the hyperactivity of the sodium-potassium adenosine triphosphates pump (Na+ K+ ATPase). Its differential diagnosis from the other common causes of hypokalemic paralysis is essential to provide targeted therapy. We present a rare case of THPP in a female patient with no prior history of thyroid disease. THPP in this patient was precipitated by trauma and emotional stress, which served as a diagnostic challenge. Both hypokalemia and elevated levels of T3 and T4 are important diagnostic features during the acute episode. Treatment of THPP includes nonselective beta-blockade, which prevents the shift of intracellular potassium, and potassium replacement. THPP is curable once a euthyroid state is achieved

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

Effective utilization of time for non –operating room anaesthesia services at Aga Khan University Hospital Karachi: a prospective quality improvement audit

Objective: To identify service quality gaps by reviewing out-of-operating-room anaesthesia services in a tertiary care hospital. Method: This quality improvement audit was conducted at The Aga Khan University Hospital Karachi from July to September 2019, and comprised procedures conducted outside the operating room under anaesthesia and sedation from 8am to 5pm. A data collection form was designed to collect information related to the non-operating-room anaesthesia services. Data was analysed using SPSS Version 19. Results: A total of 123 radiological procedures were observed in 48 working days and endoscopic/radio-therapeutic procedures observed were 98 over 31 days. The mean anaesthesia coverage time was 2.96±1.71 hours per day for radiological procedures, and 2.59±1.07 hours for endoscopic/radio-therapeutic procedures, indicating underutlisation of resources both human and material . Conclusion:A multideciplinary team consisting of all stakeholders should be developed to facilitate the patients and enhance healthcare quality. Key Words: Non-operating-room anaesthesia, NORA, Radiological procedures, Monitored anaesthesia care,  Multideciplinary team

Microwave assisted extraction and dyeing of cotton fabric with mixed natural dye from pomegranate rind (Punica granatum L.) and turmeric rhizome (Curcuma longa L.)

Recently, natural dyes are used because these are environment-friendly, less lethal, and do not have any detrimental effect on health. For the present study, the cotton fabric and the mixed powder (pomegranate rind and turmeric rhizome) have been irradiated for (1–5) min. It has been found that 3 min is the effective exposure time for improvement in dyeing behavior of cellulosic fabric. Good color strength was observed by dyeing fabric irradiated at 65°C for 40 min in dyeing bath having pH 6. For improvements in color fastness, the optimum concentration of pre-mordant (4% copper) and post-mordant (8% chrome) was employed. It is observed that microwaves increased the color strength as well as color fastness properties of irradiated cotton using aqueous solubilized mixed extract of irradiated pomegranate rind and turmeric rhizome powder

Green Synthesis of Metal and Metal Oxide Nanoparticles Using Different Plants’ Parts for Antimicrobial Activity and Anticancer Activity: A Review Article

Nanotechnology emerged as a scientific innovation in the 21st century. Metallic nanoparticles (metal or metal oxide nanoparticles) have attained remarkable popularity due to their interesting biological, physical, chemical, magnetic, and optical properties. Metal-based nanoparticles can be prepared by utilizing different biological, physical, and chemical methods. The biological method is preferred as it provides a green, simple, facile, ecofriendly, rapid, and cost-effective route for the green synthesis of nanoparticles. Plants have complex phytochemical constituents such as carbohydrates, amino acids, phenolics, flavonoids, terpenoids, and proteins, which can behave as reducing and stabilizing agents. However, the mechanism of green synthesis by using plants is still highly debatable. In this report, we summarized basic principles or mechanisms of green synthesis especially for metal or metal oxide (i.e., ZnO, Au, Ag, and TiO2, Fe, Fe2O3, Cu, CuO, Co) nanoparticles. Finally, we explored the medical applications of plant-based nanoparticles in terms of antibacterial, antifungal, and anticancer activity