Prophylactic Administration of Tranexamic Acid Reduces Blood Products' Transfusion and Intensive Care Admission in Women Undergoing High-Risk Cesarean Sections.

Postpartum hemorrhage (PPH) remains a major cause of maternal mortality. Tranexamic acid (TxA) has shown effectiveness in reducing PPH-related maternal bleeding events and deaths. We conducted a cohort study including parturient women at high risk of bleeding after undergoing a cesarean section (CS). Participants were divided into two groups: the treatment group received prophylactic 1-g TxA before surgery (n = 500), while the comparison group underwent CS without TxA treatment (n = 500). The primary outcome measured increased maternal blood loss following CS, defined as more than a 10% drop in hemoglobin concentration within 24 h post-CS and/or a drop of ≥2 g/dL in maternal hemoglobin concentration. Secondary outcomes included PPH indicators, ICU admission, hospital stay, TxA complications, and neonatal data. TxA administration significantly reduced hemoglobin decrease by more than 10%: there was a 35.4% decrease in the TxA group vs. a 59.4% decrease in the non-TxA group, p < 0.0001 and hemoglobin decreased by ≥2 g/dL (11.4% in the TxA group vs. 25.2% in non-TxA group, p < 0.0001), reduced packed red blood cell transfusion (p = 0.0174), and resulted in lower ICU admission rates (p = 0.034) and shorter hospitalization (p < 0.0001). Complication rates and neonatal outcomes did not differ significantly. In conclusion, prophylactic TxA administration during high-risk CS may effectively reduce blood loss, providing a potential intervention to improve maternal outcomes.

The effect of timing of intravenous paracetamol on perioperative pain and cytokine levels following laparoscopic bariatric surgery, a randomized controlled trial.

OBJECTIVE: Bariatric surgeries involve manipulation of the viscera and are associated with significant postoperative pain. Paracetamol is a nonopioid analgesic with a rapid onset, and it is effective and safe. The study compared the effects of pre- and postincisional intravenous paracetamol administration for optimal postoperative pain management in patients undergoing bariatric surgeries. METHODS: This is a prospective, double-blinded, placebo-controlled randomized clinical trial of adult patients, admitted electively for laparoscopic bariatric surgery. The patients were randomly divided into two groups. One group of patients was given paracetamol at the beginning of the operation, prior to the surgical incision, the other group of patients received the same treatment at the end of the operation. RESULTS: Patients who were given preincisional intravenous paracetamol presented significantly lower visual analog scale (VAS) scores following the surgery compared with patients who were given intravenous paracetamol in the last 30 minutes of the operation (VAS, median [IQR] = 2 [2-3] vs. 5 [3-6]; p < 0.001). They also required fewer postoperative opioids and tramadol (in milligrams, respectively, 1 [0-5] vs. 7.5 [5-10] and 300 [100-400] vs. 400 [200-500]) compared with later analgesia administration (p < 0.001 and p = 0.03). The levels of inflammatory markers measured at fixed intervals from paracetamol administration were not statistically different between the study groups. CONCLUSION: Early analgesia with intravenous paracetamol, given before the surgical incision, may result in lower VAS scores postoperatively compared with the same treatment administered toward the end of the operation.

The effect of prophylactic use of tranexamic acid for cesarean section.

AIM: Treatment with tranexamic acid (TxA) significantly reduces maternal death due to postpartum hemorrhage. There is increasing interest in whether it can also be used as prophylaxis for postpartum hemorrhage, especially during cesarean sections (CS). This impact study is aimed to determine the effect of routine prophylactic tranexamic acid during CS on maternal hemorrhage and the rate of the associated side effects. METHODS: This retrospective population-based cohort single-center impact study include 2000 women who delivered by CS divided into two groups with (n = 1000) and without (n = 1000) prophylactic administration of 1gram TxA prior to surgery. Primary outcomes were to determine the: (1) rate of women experiencing >10% or ≥2 g/dL hemoglobin drop from the preoperative concentration within 24 h after CS. (2) incidence of women having a hemoglobin drop of ≥2 g/dL. RESULTS: Women who did not receive TxA prophylactic had a higher rate of >10% hemoglobin decrease and a higher rate of ≥2 g/dL hemoglobin decrease Than those who received TxA prophylaxis (p < .0001, for both). Mean hospital stay (p = .002) and umbilical cord pH (p < .05) were higher among those who received TxA prophylaxis than in those who were not treated. CONCLUSIONS: The finding of our study suggest that prophylactic administration of TxA prior to CS improves maternal and neonatal outcomes.

Low voltage electric potential as a driving force to hinder biofouling in self-supporting carbon nanotube membranes.

This study aimed at evaluating the contribution of low voltage electric field, both alternating (AC) and direct (DC) currents, on the prevention of bacterial attachment and cell inactivation to highly electrically conductive self-supporting carbon nanotubes (CNT) membranes at conditions which encourage biofilm formation. A mutant strain of Pseudomonas putida S12 was used a model bacterium and either capacitive or resistive electrical circuits and two flow regimes, flow-through and cross-flow filtration, were studied. Major emphasis was placed on AC due to its ability of repulsing and inactivating bacteria. AC voltage at 1.5 V, 1 kHz frequency and wave pulse above offset (+0.45) with 100Ω external resistance on the ground side prevented almost completely attachment of bacteria (>98.5%) with concomitant high inactivation (95.3 ± 2.5%) in flow-through regime. AC resulted more effective than DC, both in terms of biofouling reduction compared to cathodic DC and in terms of cell inactivation compared to anodic DC. Although similar trends were observed, a net reduced extent of prevention of bacterial attachment and inactivation was observed in filtration as compared to flow-through regime, which is mainly attributed to the permeate drag force, also supported by theoretical calculations in DC in capacitive mode. Electrochemical impedance spectroscopy analysis suggests a pure resistor behavior in resistance mode compared to involvement of redox reactions in capacitance mode, as source for bacteria detachment and inactivation. Although further optimization is required, electrically polarized CNT membranes offer a viable antibiofouling strategy to hinder biofouling and simplify membrane care during filtration.

Paracetamol biodegradation by activated sludge and photocatalysis and its removal by a micelle-clay complex, activated charcoal, and reverse osmosis membranes.

Kinetic studies on the stability of the pain killer paracetamol in Al-Quds activated sludge demonstrated that paracetamol underwent biodegradation within less than one month to furnish p-aminophenol in high yields. Characterizations of bacteria contained in Al-Quds sludge were accomplished. It was found that Pseudomonas aeruginosa is the bacterium most responsible for the biodegradation of paracetamol to p-aminophenol and hydroquinone. Batch adsorptions of paracetamol and its biodegradation product (p-aminophenol) by activated charcoal and a composite micelle (octadecyltrimethylammonium)-clay (montmorillonite) were determined at 25°C. Adsorption was adequately described by a Langmuir isotherm, and indicated better efficiency of removal by the micelle-clay complex. The ability of bench top reverse osmosis (RO) plant as well as advanced membrane pilot plant to remove paracetamol was also studied at different water matrixes to test the effect of organic matter composition. The results showed that at least 90% rejection was obtained by both plants. In addition, removal of paracetamol from RO brine was investigated by using photocatalytic processes; optimal conditions were found to be acidic or basic pH, in which paracetamol degraded in less than 5 min. Toxicity studies indicated that the effluent and brine were not toxic except for using extra low energy membrane which displayed a half maximal inhibitory concentration (IC-50) value of 80%.

Co-metabolic oxidation of pharmaceutical compounds by a nitrifying bacterial enrichment.

The biotransformation of five selected pharmaceuticals ibuprofen (IBP), ketoprofen (KTP), carbamazepine (CBZ), dexamethasone (DXM) and iopromide (IOP) by a stable nitrifying enrichment culture was investigated at concentrations ranging between 25 µg/L and 2mg/L. Complete biotransformation was observed only for IBP and KTP, although, an inverse correlation between transformation rate and concentration was found. The transformation pattern observed is consistent with ammonia monooxygenase (AMO) activity. The metabolic succession of the compounds according to the biotransformation rates was: IBP>KTP>DXM>CBZ>IOP. A linear correlation between the calculated diffusive flux of the model compounds across a bilayer membrane and their biotransformation rates was found. Our results support the concept that augmentation with nitrifying activity can enhance the removal of trace organic pollutants during effluent treatment. Furthermore, ammonia-oxidizing activity appears as a good indicator for estimation of potential of biodegradability of pharmaceuticals, especially at low concentrations.