16 research outputs found
Erratum to Tranexamic acid for the prevention of blood loss after cesarean section: an updated systematic review and meta-analysis of randomized controlled trials. American Journal of Obstetrics & Gynecology MFM. Volume 5, Issue 8, August 2023, 101049
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Tranexamic acid for the prevention of blood loss after cesarean section: an updated systematic review and meta-analysis of randomized controlled trials
No full textObjective: Tranexamic acid (TXA) is a cost-effective intervention for the prevention of postpartum hemorrhage (PPH) in women undergoing cesarean section but the evidence to support its use is conflicting. We conducted this meta-analysis to evaluate the efficacy and safety of TXA in low- and high-risk cesarean deliveries. Data sources: We searched MEDLINE (via PubMed), Embase, the Cochrane Library, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform (ICTRP) portal from inception to April 2022 (updated October 2022 and February 2023) with no language restrictions. Additionally, grey literature sources were also explored. Study eligibility criteria: All randomized controlled trials (RCTs) investigating the prophylactic use of intravenous TXA in addition to standard uterotonic agents in women undergoing cesarean deliveries as compared to placebo, standard treatment, or prostaglandins were included in this meta-analysis. Methods: We used the revised Cochrane "Risk of Bias" tool (RoB 2.0) to assess the quality of included RCTs. RevMan 5.4 was used to conduct all statistical analyses under a random-effects model. Results: We included 50 RCTs (6 in only high-risk patients and 2 with prostaglandins as the comparator) evaluating TXA in our meta-analysis. TXA reduced the risk of blood loss >1000 mL, mean total blood loss, and the need for blood transfusion in both low- and high-risk patients. TXA was associated with a beneficial effect in our secondary outcomes including decline in hemoglobin levels and the need for additional uterotonic agents. TXA increased the risk of non-thromboembolic adverse events but, based on limited data, did not increase the incidence of thromboembolic events. The administration of TXA before skin incision, but not after cord clamping, was associated with a large benefit. The quality of evidence was rated as low to very low for outcomes in the low-risk population and moderate for most outcomes in the high-risk subgroup. Conclusions: TXA may reduce the risk of blood loss in cesarean deliveries with a higher benefit observed in high-risk patients but the lack of high-quality evidence precludes any strong conclusions. Additional studies, especially in the high-risk population and evaluating the timing of TXA administration, are needed to confirm or refute these findings
Evolutionary Algorithms for Strength Prediction of Geopolymer Concrete
No full textGeopolymer concrete (GPC) serves as a sustainable substitute for conventional concrete by employing alternative cementitious materials such as fly ash (FA) instead of ordinary Portland cement (OPC), contributing to environmental and durability benefits. To increase the rate of utilization of FA in the construction industry, distinctive characteristics of two machine learning (ML) methods, namely, gene expression programming (GEP) and multi-expression programming (MEP), were utilized in this study to propose precise prediction models for the compressive strength and split tensile strength of GPC comprising FA as a binder. A comprehensive database was collated, which comprised 301 compressive strength and 96 split tensile strength results. Seven distinct input variables were employed for the modeling purpose, i.e., FA, sodium hydroxide, sodium silicate, water, superplasticizer, and fine and coarse aggregates contents. The performance of the developed models was assessed via numerous statistical metrics and absolute error plots. In addition, a parametric analysis of the finalized models was performed to validate the prediction ability and accuracy of the finalized models. The GEP-based prediction models exhibited better performance, accuracy, and generalization capability compared with the MEP-based models in this study. The GEP-based models demonstrated higher correlation coefficients (R) for predicting the compressive and split tensile strengths, with the values of 0.89 and 0.87, respectively, compared with the MEP-based models, which yielded the R values of 0.76 and 0.73, respectively. The mean absolute errors for the GEP- and MEP-based models for predicting the compressive strength were 5.09 MPa and 6.78 MPa, respectively, while those for the split tensile strengths were 0.42 MPa and 0.51 MPa, respectively. The finalized models offered simple mathematical formulations using the GEP and Python code-based formulations from MEP for predicting the compressive and tensile strengths of GPC. The developed models indicated practical application potential in optimizing geopolymer mix designs. This research work contributes to the ongoing efforts in advancing ML applications in the construction industry, highlighting the importance of sustainable materials for the future
Development of Sugarcane Bagasse Ash Blended Cementitious Composites Reinforced with Carbon Nanotubes and Polypropylene Fibers
No full textCement-based composites, as primary construction materials, have undergone significant advancements over the years, yet researchers still face challenges in terms of their durability and impact on the environment. The goal of this research is to develop environmentally friendly cementitious composites blended with sugarcane bagasse ash (SCBA) and reinforce them with multi-walled carbon nanotubes and polypropylene (PP) fibers. Because of the high cost associated with carbon nanotubes (CNTs) and PP fibers, as well as CO2 emission, which affect the economic and environmental aspects of this field, an agricultural waste such as SCBA was introduced in the current study that is both economically and environmentally viable. For this purpose, five mixes were designed by varying the CNTs content whilst keeping the PP fibers and SCBA contents constant at 1.5% and 15% by weight of the binder (ordinary Portland cement + SCBA), respectively. The developed blends were tested for various mechanical and durability properties, i.e., compressive strength, flexural strength, impact strength, water absorption, and ultrasonic pulse velocity. Moreover, the microstructures of the newly developed low-carbon SCBA-based composites reinforced with PP fibers and CNTs were studied through scanning electron microscopy and energy dispersive spectroscopy. The results showed that the developed blends incorporating 15% SCBA, 1.5% PP fibers, and 0.08% CNTs, by weight of the binder, demonstrated the compressive, flexural, and impact strengths as 15.30 MPa, 0.98 MPa, and 0.11 MPa, respectively. The investigated blends proved to be cost-effective and environmentally beneficial, rendering them suitable for utilization in general construction and maintenance works
Synergistic impacts of high-volume fly ash and sugarcane bagasse ash on performance of cementitious composites reinforced with polyvinyl alcohol fibers
No full textDisposal of waste materials in fertile land is one of the pressing environmental issues, disrupting human, animal, and plant life. This has led the researchers to process and use such waste in ecofriendly construction products like mortar and concrete. Their usage as supplementary cementitious materials (SCMs) would reduce the quantity of cement used in the manufacturing of cement-based materials, lowering CO2 emissions related with cement production. In this regard, this study examines the feasibility of replacing high-volume of ordinary Portland cement (OPC) in engineered cementitious composites (ECC) with two widely used waste materials, sugarcane bagasse ash (SCBA) and fly ash (FA) as SCMs. Five different mixes were produced, each containing a fixed amount of polyvinyl alcohol (PVA) fibers at a dosage of 1.5 % by volume of the mix and a constant cement content of 50 % by weight of the binder (OPC + FA + SCBA). However, FA was replaced with SCBA in these mixes up to 100 % by the combined weight of the waste materials (FA + SCBA) in increments of 25 % (i.e., FA100-SCBA0, FA75-SCBA25, FA50-SCBA50, FA25-SCBA75, and FA0-SCBA100). The results showed that the compressive strength and flexural strength of the composites with the increasing levels of SCBA were reduced. Interestingly, the 28-day compressive strength of composite incorporating 50 % FA and 50 % SCBA was still as high as 25.58 MPa, which satisfied the minimum compressive strength requirement of ASTM C270, making the newly produced ECC suitable for use in normal construction works and repairs. The same optimum mix (FA50-SCBA50) produced an average density of 1867.96 kg/m3 as a result of substituting a significant amount of binder with SCBA, demonstrating that it has evolved into a lightweight engineered cementitious composite. Furthermore, the ultrasonic pulse velocity of the mixes decreased whereas water absorption increased as the proportion of SCBA to FA increased. According to microstructural analysis, unreacted SCBA particles were mostly responsible for the detrimental effects of rising SCBA levels on properties of ECC. Based on the aforementioned results, this research concludes that sugarcane bagasse ash, when combined with fly ash, could be a viable alternative for replacing regular cement up to 50 % by weight in the production of cost-effective and environmentally friendly cementitious composites
Blood flow restriction‐enhanced platelet‐rich plasma: A pilot randomised controlled trial protocol
No full textABSTRACT Purpose To assess platelet‐rich plasma (PRP) changes in platelet and leucocyte count, insulin‐like growth factor 1 (IGF‐1), and interleukin 6 (IL‐6) concentration after bilateral low‐load knee extensions under blood flow restriction (BFR). Methods The present randomised controlled trial protocol will include two groups: the intervention group, which will undergo bilateral knee extensions under BFR, and the control group, which will perform bilateral knee extensions without BFR. Participants will be randomly allocated in a 1:1 ratio. Twenty‐two healthy individuals will be enrolled if the predefined inclusion criteria are met: (1) males, (2) ages 18–40, (3) Tegner activity level ≥5 and (4) with no musculoskeletal conditions that would interfere with exercise. Exclusion criteria include (1) individuals with systemic inflammatory diseases, (2) cardiovascular risk factors, (3) any blood dyscrasia, (4) Tegner Activity scale scores <5, (5) under nonsteroidal anti‐inflammatory drugs and aspirin treatment within one week before testing or (6) that had previously performed exercises on the testing day. The participant will perform low‐load bilateral knee extensions under BFR following a standard protocol of 30‐15‐15‐15 repetitions of consecutive sets with 30‐s rest intervals at 80% of limb occlusive pressure and 30% of 1‐RM load. PRP platelet and leucocyte count, IGF‐1 and IL‐6 concentration measurements (via flow cytometry, chemiluminescence testing and immunochromatography, respectively) will be conducted before exercise and 10, 20 and 30 min after the intervention. Results The expected outcome is that the standard protocol of low‐load bilateral knee extensions under BFR will increase the platelet and leucocyte count, IGF‐1 and IL‐6 in the PRP preparation. Conclusion The current protocol allows the study of an enhanced PRP formulation for its potential implementation in multiple sports injuries
Can antidepressant use be associated with emotional blunting in a subset of patients with depression? A scoping review of available literature
No full textFrequency of migraine according to the ICHD-3 criteria and its association with sociodemographic and triggering factors in Pakistan: A cross-sectional study
No full textBACKGROUND: Migraine is a primary headache disorder marked by episodes of moderate to severe headache that is unilateral, throbbing in character, having a duration of 4 h to three days, and associated with nausea, vomiting, photophobia, and phonophobia. AIMS: Our study aims to determine the frequency of migraine in Pakistan, its association with sociodemographic variables and triggering factors, and the coping mechanisms used. METHODS: A cross-sectional study was conducted through an online survey from March 19, 2022, to June 15, 2022. The snowball sampling technique was used for data collection. The questions asked included those on sociodemographic information, screening questions, and questions on triggering factors and coping mechanisms. The screening was done using the ICHD-3 criteria and percentages were calculated using SPSS. RESULTS: Of the 986 respondents, 393 suffered from migraine. The majority of them were female (78.1%), belonged to the age group 20–29 years (69.2%), and were students (76.1%). 32.8% of the migraineurs had a family history of migraine. Most frequent triggers included sleep disturbance (70.5%), stress (66.7%) and fatigue (64.4%). Of the female migraineurs, 31.8% had menstruation as a trigger. The coping mechanisms used included taking rest, medication, staying in a quiet and dark place, and doing massage. CONCLUSION: The findings suggest that young adults, especially females, with a stressful and sleep-deprived lifestyle are more vulnerable to migraine. However, further studies must focus on trigger synergy and interrelation of triggers that precipitate migraine so a better understanding can be developed for the prevention, diagnosis, and treatment of migraine
Probiotics for the prevention of ventilator-associated pneumonia: an updated systematic review and meta-analysis of randomised controlled trials
No full textBackground: Presently, there is conflicting evidence regarding the efficacy of probiotics in the prevention of ventilator-associated pneumonia (VAP). This meta-analysis was conducted to update current clinical evidence and evaluate the efficacy and safety of probiotics for the prevention of VAP. Methods: We searched three databases and two trial registers to retrieve randomised controlled trials (RCTs) comparing probiotics or synbiotics with placebo or standard treatment for the prevention of VAP in adult patients receiving mechanical ventilation in the intensive care unit (ICU). Results: Our meta-analysis included 18 RCTs involving 4893 patients. Our results showed that probiotics may reduce the incidence of VAP (RR 0.68, 95% CI: 0.55–0.84; low certainty). However, in our subgroup and sensitivity analyses, the effect was not significant in double-blind studies, and in studies with a low risk of bias in the randomisation process. Probiotics reduced the length of ICU stay (MD −2.22 days, 95% CI: −4.17 to −0.28; moderate certainty) and the duration of antibiotic use (MD −1.25 days, 95% CI −1.86 to −0.64; moderate certainty). Conclusions: Probiotics may reduce the incidence of VAP but due to the low quality of pooled evidence, the use of probiotics warrants caution. Further, large-scale, high-quality RCTs need to be conducted to provide conclusive evidence
Efficacy and safety of microaxial flow pump in infarct-related cardiogenic shock: a meta-analysis
No full textIntroduction
Data regarding mechanical circulatory support with a microaxial flow pump (Impella) in patients with myocardial infarction complicated by cardiogenic shock are limited.
Material and methods
PubMed/Medline, Embase, and the Cochrane Library were used to search for randomized controlled trials (RCTs) from inception to 16 June 2024. Risk ratios (RRs) were pooled with corresponding 95% confidence intervals (CIs) using the random effects model.
Results
Four RCTs were included. The pooled analysis demonstrated a significantly reduced risk of all-cause death in patients with the use of a microaxial flow pump at 6-month follow-up (RR = 0.80; 95% CI: 0.67 to 0.97) and cardiac death (RR = 0.68; 95% CI: 0.49 to 0.94) as compared to the control group. However, the use of a microaxial flow pump was associated with a significantly increased risk of major bleeding (RR = 2.27; 95% CI: 1.21 to 4.24), limb ischemia (RR = 4.46; 95% CI: 1.31 to 15.16), and sepsis (RR = 2.01; 95% CI: 1.11 to 3.67). The risk of stroke and rehospitalizations remained comparable across the two groups.
Conclusions
The use of a microaxial flow pump in infarct-related cardiogenic shock can reduce mortality at the expense of increased risk of bleeding, limb ischemia, and sepsis. Further research is required to validate our findings
