4-[(2-Hy­droxy-5-nitro­benzyl­idene)amino]­benzene­sulfonamide

The title Schiff base compound, C13H11N3O5S, exists in an E configuration with respect to the C=N double bond. The benzene rings are almost coplanar, making a dihedral angle of 2.82 (6). The sulfonamide group is twisted away from the attached phenyl ring with an N—S—C—C torsion angle of 64.84 (11)°. An intra­molecular O—H⋯N hydrogen bond stabilizes the mol­ecule, generating an S(6) ring motif. In the crystal, inter­molecular N—H⋯O and C—H⋯O hydrogen bonds link the mol­ecules into a three-dimensional network

Aqua­(1,10-phenanthroline-κ2 N,N′)(dl-threoninato-κ2 N,O 1)copper(II) chloride dihydrate

The asymmetric unit of the title compound, [Cu(C4H8NO3)(C12H8N2)(H2O)]Cl·2H2O, contains a complex cation, a chloride anion and two water mol­ecules. The CuII ion has a distorted square-pyramidal coordination geometry formed by one bidentate phenanthroline ligand, one O,N-bidentate dl-threoninate ligand and one apical water mol­ecule. In the crystal structure, inter­molecular O—H⋯O, N—H⋯O, N—H⋯Cl and O—H⋯Cl hydrogen bonds link the components into layers. A single weak inter­molecular C—H⋯O inter­action connects these layers into a three-dimensional network

Prophylactic Topical Tranexamic Acid versus Placebo in Surgical Patients: A Systematic Review and Meta-Analysis

Introduction: Tranexamic acid (TxA) is used in surgery to reduce blood loss. However, its safety profile is unclear. This review examined the efficacy and safety profile of topical TxA. Method: Electronic databases including Medline and EMBASE were searched from inception to May 2019. Randomised controlled trials (RCTs) published in English comparing topical TxA with placebo were included. Primary outcomes were mortality and blood transfusion incidence. Secondary outcomes included venous thromboembolism. Result: 7,539 patients from 71 RCTs were analysed. Compared to placebo, topical TxA reduced blood transfusion incidence (OR 0.30, 95%CI [0.26 - 0.34], p<0.001). Topical TxA use had no impact on mortality (OR 0.78, 95%CI [0.45 - 1.36], p = 0.39). Pulmonary embolism (OR 0.73, 95%CI 0.27 to 1.93, p = 0.52) and deep vein thrombosis (OR 0.79, 95%CI [0.65 to 1.77], p = 0.79) were not associated with topical TxA use. Conclusion: Topical TxA is effective in reducing transfusion need in surgery without association to major adverse events. However, its optimal dosing regime remain to be determined

Prophylactic Topical Tranexamic Acid Versus Placebo in Surgical Patients: A Systematic Review and Meta-Analysis

Objectives: Perioperative bleeding remains a major concern to all clinicians caring for perioperative patients. Due to the theoretical risk of thromboembolic events associated with tranexamic acid (TXA) when administered intravenously, topical route of TXA has been extensively studied, but its safety and efficacy profile remain unclear in the literature. The primary aim of this review was to assess the effect of topical TXA on incidence of blood transfusion and mortality in adults undergoing surgery. Data sources: EMBASE, MEDLINE, CENTRAL, and ISI Web of Science were systematically searched from their inception until May 31, 2019. Review methods: Parallel-arm randomized controlled trials were included. Results: Seventy-one trials (7539 participants: orthopedics 5450 vs nonorthopedics 1909) were included for quantitative meta-analysis. In comparison to placebo, topical TXA significantly reduced intraoperative blood loss [mean difference (MD) -36.83 mL, 95% confidence interval (CI) -54.77 to -18.88, P < 0.001], total blood loss (MD -319.55 mL, 95% CI -387.42 to -251.69, P < 0.001), and incidence of blood transfusion [odds ratio (OR) 0.30, 95% CI 0.26-0.34, P < 0.001]. Patients who received topical TXA were associated with a shorter length of hospital stay (MD -0.28 days, 95% CI -0.47 to -0.08, P = 0.006). No adverse events associated with the use of topical TXA were observed, namely mortality (OR 0.78, 95% CI 0.45-1.36, P = 0.39), pulmonary embolism (OR 0.73, 95% CI 0.27-1.93, P = 0.52), deep vein thrombosis (OR 1.07, 95% CI 0.65-1.77, P = 0.79), myocardial infarction (OR 0.79, 95% CI 0.21-2.99, P = 0.73), and stroke (OR 0.85, 95% CI 0.28-2.57, P = 0.77). Of all included studies, the risk of bias assessment was "low" for 20 studies, "unclear" for 26 studies and "high" for 25 studies. Conclusions: In the meta-analysis of 71 trials (7539 patients), topical TXA reduced the incidence of blood transfusion without any notable adverse events associated with TXA in adults undergoing surgery

Efficacy and Safety of Elective Switching from Intravenous to Subcutaneous Infliximab [CT-P13]: A Multicentre Cohort Study

BackgroundIntravenous [IV] infliximab is a well-established therapy for inflammatory bowel diseases [IBD] patients. A subcutaneous [SC] formulation of infliximab [CT-P13] has recently been shown to be as effective as IV infliximab after two doses of IV induction in a randomised trial, but there are no data to support elective switching of patients on maintenance IV infliximab therapy. We aimed to assess the effectiveness of an elective switching programme to SC CT-P13 in patients treated with IV infliximab.MethodsPatients on established maintenance IV infliximab, who switched to SC CT-P13, were included in this retrospective multicentre cohort study. Disease activity was monitored serially with the Harvey-Bradshaw Index [HBI] for Crohn's disease [CD] and the Simple Clinical Colitis Activity Index [SCCAI] for ulcerative colitis (UC) for up to 12 months at months 3, 6, and 12. Faecal calprotectin [FC] and C-reactive protein [CRP] were recorded at baseline and follow-up, if available. Infliximab trough levels were measured prior to switch and at months 3, 6, and 12 following switch. The primary outcome measure was treatment persistence at latest follow-up. Secondary outcome measures included infliximab pharmacokinetics [PK], safety, need for corticosteroid rescue therapy, and need for surgery.ResultsWe included 181 patients, of whom 115 [63.5%] had CD. The majority [72.4%] were on 8-weekly dosing of intravenous infliximab prior to switching, and more than half [59.1%] were on concomitant immunomodulatory therapy. The majority of patients (CD: 106, 92.2%; UC: 46, 76.7%; and IBD unclassified [IBD-U]: 5, 83.3%) were in clinical remission. Treatment persistence rate was high [n = 167, 92.3%] and only 14 patients [7.7%] stopped treatment during the follow-up period. There was no significant difference between baseline and repeat measurements at 3, 6, or 12 months for HBI, SCCAI, CRP, or FC. Of the total cohort, 25 patients (13.8%) had perianal CD. Of these, only two patients [8%] had worsening of perianal CD and required antibiotic therapy and further examination under anaesthesia [EUA]. Both these patients also switched back to intravenous infliximab. Median infliximab level increased from a baseline of 8.9 µg/dl [range 0.4-16] to 16.0 µg/dl [range 2.3-16, p ConclusionsAmong patients on IV infliximab maintenance therapy switched to SC CT-P13, we observed high treatment persistence rates and low rates of immunogenicity, with no change in clinical disease activity indices or biomarkers. Infliximab levels increased after switch to SC CT-P13, and only ATI was associated with serum infliximab levels. Patient acceptance and satisfaction rates were high with SC CT-P13

The effect of melatonin on delirium in hospitalised patients: A systematic review and meta-analyses with trial sequential analysis

Objectives: Melatonin is an endogenous hormone, which regulates circadian rhythms and promotes sleep. In recent years, several randomised controlled trials examining the prophylactic use of melatonin to prevent delirium were published with conflicting findings. The primary aim of this review was to determine the effect of melatonin on the incidence of delirium in hospitalised patients. Data sources: MEDLINE, EMBASE and CENTRAL were systematically searched from their inception until December 2018. Review methods: All randomised clinical trials were included. Results: Sixteen trials (1634 patients) were included in this meta-analysis. Incidence of delirium was not significantly lower in patients who received melatonin, with an odd ratio, OR (95%Cl) of 0.55 (0.24–1.26); ρ = 0.16, certainty of evidence = low, trial sequential analysis = inconclusive. However, patients who randomised to melatonin had a significantly shorter length of stay in intensive care units, with a mean difference, MD (95%CI) of −1.84 days (−2.46, −1.21); ρ < 0.001. No differences were demonstrated in the need for physical restraints (OR 95%Cl 0.65; 0.31–1.37; ρ = 0.26) and the requirement of sedative agents (OR 95%Cl 0.86; 0.48–1.55; ρ = 0.62). Conclusions: In summary, the results of this meta-analysis of sixteen trials neither support nor oppose the use of melatonin in the prevention of delirium of hospitalised patients. We identified high heterogeneity across all the included trials and low certainty of evidence with potential type II error. Future multi-centre, adequately powered randomised controlled trials are warranted to provide more certainty on the use of melatonin for the prevention of delirium. PROSPERO: CRD42019123546. © 2019 Elsevier Inc

The effect of ketamine on emergence agitation in children: A systematic review and meta‐analysis

Background: Ketamine is believed to reduce the incidence of emergence agitation in children undergoing surgery or procedure. However, recent randomized controlled trials reported conflicting findings. Aims: To investigate the effect of ketamine on emergence agitation in children. Methods: Databases of MEDLINE, EMBASE, and CENTRAL were systematically searched from their start date until February 2019. Randomized controlled trials comparing intravenous ketamine and placebo in children were sought. The primary outcome was the incidence of emergence agitation. Secondary outcomes included postoperative pain score, duration of discharge time, and the adverse effects associated with the use of ketamine, namely postoperative nausea and vomiting, desaturation, and laryngospasm. Results: Thirteen studies (1125 patients) were included in the quantitative meta-analysis. The incidence of emergence agitation was 14.7% in the ketamine group and 33.3% in the placebo group. Children receiving ketamine had a lower incidence of emergence agitation, with an odds ratio being 0.23 (95% confidence interval: 0.11 to 0.46), certainty of evidence: low. In comparison with the placebo, ketamine group achieved a lower postoperative pain score (odds ratio: −2.42, 95% confidence interval: −4.23 to −0.62, certainty of evidence: very low) and lower pediatric anesthesia emergence delirium scale at 5 minutes after operation (odds ratio: −3.99, 95% confidence interval: −5.03 to −2.95; certainty of evidence: moderate). However, no evidence was observed in terms of incidence of postoperative nausea and vomiting, desaturation, and laryngospasm. Conclusion: In this meta-analysis of 13 randomized controlled trials, high degree of heterogeneity and low certainty of evidence limit the recommendations of ketamine for the prevention of emergence agitation in children undergoing surgery or imaging procedures. However, the use of ketamine is well-tolerated without any notable adverse effects across all the included trials. PROSPERO registration: CRD42019131865. © 2019 John Wiley & Sons Lt