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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

In-situ synthesis of 3D ultra-small gold augmented graphene hybrid for highly sensitive electrochemical binding capability

The fascinating properties of graphene can be augmented with other nanomaterials to generate hybrids to design innovative applications. Contrary to the conventional methodologies, we showed a novel yet simple, in-situ, biological approach which allowed for the effective growth of gold nanostructures on graphene surfaces (3D Au NS@GO). The morphology of the obtained hybrid consisted of sheets of graphene, anchoring uniform dispersion of ultra-small gold nanostructures of about 2-8 nm diameter. Surface plasmon resonance at 380 nm confirmed the nano-regimen of the hybrid. Fourier transform infrared spectroscopy indicated the utilization of amine spacers to host gold ions leading to nucleation and growth. The exceptional positive surface potential of 55 mV suggest that the hybrid as an ideal support for electrocatalysis. Ultimately, the hybrid was found to be an efficient receptor material for electrochemical performance towards the binding of uric acid which is an important biomolecule of human metabolism. The designed material enabled the detection of uric acid concentrations as low as 30 nM. This synthesis strategy is highly suitable to design new hybrid materials with interesting morphology and outstanding properties for the identification of clinically relevant biomolecules

Facile in situ generation of bismuth tungstate nanosheet-multiwalled carbon nanotube composite as unconventional affinity material for quartz crystal microbalance detection of antibiotics

Overuse and thus a constant presence of antibiotics leads to various environmental hazards and health risks. Thus, accurate sensors are required to determine their presence. In this work, we present a mass-sensitive sensor for the detection of rifampicin. We chose this molecule as it is an important antibiotic for tuberculosis, one of the leading causes of deaths worldwide. Herein, we have prepared a carbon nanotube reinforced with bismuth tungstate nanocomposite material in a well-defined nanosheet morphology using a facile in situ synthesis mechanism. Morphological characterization revealed the presence of bismuth tungstate in the form of square nanosheets embedded in the intricate network of carbon nanotubes, resulting in higher surface roughness of the nanocomposite. The synergy of the composite, so formed, manifested a high affinity for rifampicin as compared to the individual components of the composite. The developed sensor possessed a high sensitivity toward rifampicin with a detection limit of 0.16 mu M and excellent specificity, as compared to rifabutin and rifapentine. Furthermore, the sensor yielded statistically good recoveries for the monitoring of rifampicin in human urine samples. This work opens up a new horizon for the exploration of unconventional nanomaterials bearing different morphologies for the detection of pharmaceuticals

Synthesis of SPIONs-CNT Based Novel Nanocomposite for Effective Amperometric Sensing of First-Line Antituberculosis Drug Rifampicin

Synthesis of SPIONs-CNT Based Novel Nanocomposite for Effective Amperometric Sensing of First-Line Antituberculosis Drug Rifampici

Solution growth of 1D zinc tungstate (ZnWO4) nanowires; design, morphology, and electrochemical sensor fabrication for selective detection of chloramphenicol

Solution growth of 1D zinc tungstate (ZnWO4) nanowires; design, morphology, and electrochemical sensor fabrication for selective detection of chloramphenico