Background Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0•9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0•9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124.

The Vietnam Maritime Administration has established and dominated the seaborne cargo transportation market in Vietnam in order to prevent pollution of the marine environment from ship-source pollution as well as other sources from ships. The issue of marine pollution caused by trash, sewage, and air pollution from ships is then present, parallel to that development. One of these sources that has a negative effect on the quality of seawater in Vietnam is ship waste, which is regarded as one of the primary sources of pollutants. Additionally, the existence of plastics and microplastics, which have a diameter of less than 5 mm, has a detrimental impact on both the marine environment and human health. Therefore, Vietnam's crucial task going forward is to swiftly add laws to prevent and regulate marine environmental pollution brought on by ship waste. The method proposed is to study the participation, implementation of International Conventions, and improvement of laws of other countries. The author offers valuable experiences for Vietnam to quickly improve laws in this field.

Because of the clinical implications of Human Immunodeficiency Virus (HIV) status on treatment of tuberculosis (TB) and in view of the low percentage of patients in whom HIV testing is performed, we evaluated immunological features of 54 patients with newly diagnosed TB and its ability to predict HIV co-infection. All 54 patients had initially unknown HIV status and had no other Acquired Immunodeficiency Syndrome (AIDS) defining illnesses. Twenty-two patients were found to be HIV seropositive and 32 were seronegative. The median CD4 and CD8 counts were statistically different between the HIV seropositive and seronegative patients, however, there was overlap between the two groups. The median CD4:CD8 ratio was 0.17 in HIV seropositive patients and 1.95 in the seronegative patients and had minimal overlap (p < 0.0001). A CD4:CD8 ratio < or = 0.7 gave a sensitivity of 100%, specificity of 94%, positive-predictive value of 92% and a negative-predictive value of 100% in predicting HIV co-infection. In conclusion, HIV-co-infection in patients with newly diagnosed TB could be predicted on the basis of the CD4:CD8 ratio.

The extent and nature of sexual violence throughout the war vary. Sexual violence is pervasive in some conflicts, such as ethnic conflicts, but it is relatively rare in other conflicts. Sexual slavery is one form of sexual violence in inevitable conflicts, while detention torture is another. The ICTY has carried out in-depth prosecutions and investigations of cases of sexual violence committed during times of war, leading to the filing of several indictments for crimes perpetrated in Bosnia - Herzegovina as early as 1995. By enabling the litigation of sexual violence as a war crime, crime against humanity, and genocide, the ICTY has advanced international criminal equity in sex crimes. This article attempts to provide readers with a clear understanding of two types of obligations: personal criminal culpability and state responsibility. The responsible for sexual violence presents a significant challenge to international law and misinterprets other laws, according to the conclusion. People are struggling with responsibility because, as the article pointed out, there are two different kinds of accountability in contemporary society: individual accountability and state accountability. The article's conclusions indicate that sexual violence is a personal responsibility.

Background Tuberculosis (TB), a preventable airborne infectious disease, early detection is essential to improve health outcomes. Extent of childhood tuberculosis is unknown and is estimated to be around 6% of all incidences. Diagnosis of pediatric tuberculosis is always difficult and no age is spared, however, children <5 years are more at risk. Children frequently admitted through emergencies of hospitals with different working diagnoses and later diagnosed as tuberculous. Despite multiple studies from Pakistan; the complex and multifaceted ED presentation of childhood tuberculosis was not looked in. Primary objective was to assess the clinical profile of tuberculosis patients presenting to ED, the secondary objective was to evaluate the relation of BCG vaccination, history of contact, and measles. Methods This was a retrospective chart review of children admitted to the study center with the discharge diagnosis of Childhood Tuberculosis from June 2010 to June 2015 as per WHO criteria. Patient demographic characters, medical history, and physical examination findings in ED along with vital signs and laboratory variables will be recorded from the charts. CXR, CBC, ESR, sputum analysis, and lab other parameters were recorded from an electronic database. Results We enrolled 264 children, majority, 139 (53%) were below 5 years of age, 152 (58%) males, 112 (42%) females. BCG vaccination was given to 81 (30%) male and, 60 (23%) female children. 183 (69%) children had pulmonary symptoms, 81 (31%) had extra extrapulmonary tuberculosis. The commonest extrapulmonary manifestation was GIT 34 (13%), followed by CNS 27 (10%) cases. Cough was found in 54 (31%) followed by respiratory distress 49 (27%), almost all of them were below 5 years of age. CXR was performed in all cases, 85 (32%) didn’t have radiological findings. The frequency of BCG vaccination status, history of contact, measles about age gender, and systemic involvement was also analyzed and found significant results. 23 children, had a history of contact and measles both. Miliary was found in 6 (26%) cases, however, 22 (99%) of 23 didn’t have BCG vaccination. History of weight loss was found in 46 (33%) who either didn’t get BCG vaccination or didn’t remember (no BCG scar, 123), out of 92 children with weight loss 31 (34%) have contact history. Conclusion Diagnosing childhood tuberculosis in emergency with vague/overlapping clinical presentations is a dilemma. Clinical scoring system may not identify most cases, hence suspicion must be high in all suspected cases with prolonged history, contact tracing methods, weight loss or failure to gain weight, etc.