SummaryBackgroundPost-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.MethodsIn 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.FindingsBetween 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 ...
Aims: This study was done to observe the rate of vaginal cuff dehiscence of one minute technique of laparoscopic vault closure in laparoscopic hysterectomy.Methods: It was a descriptive study performed in Birat Hospital among 1012 patients undergoing total laparoscopic hysterectomy for both benign and malignant gynaecological conditions between 2012 to 2013. Monopolar cautery was used for laparoscopic colpotomy and vault was closed by laparoscopic single running suture, that is, one-minute laparoscopic vault closure technique. Patients were followed up for vaginal cuff dehiscence and the dehiscence rate was compared with other techniques of laparoscopic vault closure in laparoscopic hysterectomy.Results: This study showed that the rate of vaginal cuff dehiscence after one minute technique of laparoscopic vault closure in laparoscopic hysterectomy was 1/1012 patients (0.09%) which was significantly less as compared to other techniques of laparoscopic vault closure in laparoscopic hysterectomy quoted in the literature.Conclusions: One minute technique of laparoscopic vault closure after colpotomy with monopolar cautery using single running suture has encouraging results. It is a noble technique of laparoscopic vault closure with excellent support. It can be practiced in low resource setting also.
We reviewed 76 climate change adaptation projects that were operational between 2010 and 2020. The review was followed by office and field visits for verification. The office visit helped crosscheck the findings, and the field observations carried out between December 2020 and April 2021 asked 24 key informants and collected supplementary information appraisal and indicator development. Of the CCA projects studied, the most (n = 48, 32%) were community-based initiatives, while the least (n = 12, 8%) were ecosystem-based interventions. The main environment-centered projects were Ecosystem-based Adaptations and Ecosystems Protecting Infrastructure and Communities (EPIC) while Enhanced Action of Inclusive CSOs for Participation in Climate Resilient Economic Growth (UTHAN), Initiative for CCA (ICCA), Support to Rural Livelihoods and Climate Change Adaptation in the Himalayas (HIMALICA), etc., adaptation projects were community-based. Capacity building and awareness-raising were the major thrust of the CbA projects, while the abatement of climate vulnerabilities and risks through nature-based solutions were priorities of EbA. Payment for Ecosystem services is a nature-based solution that can play a role in enhancing adaptation to climate change at a local scale by adopting community-based and culturally appropriate methods and enhancing and incentivizing adaptation measures and capacities. A set of 11 criteria and 40 indicators comprised the institutional and behavioral responses and the use of technologies, and the design of climate-resilient plans and climate-smart practices were proposed as appraisal measures to evaluate the success of CCA interventions. The importance of criteria and indicators lies in the fact that such a comprehensive assessment would lead to effective and efficient adaptation projects, which could help benefit beyond the borders. It also furthers ongoing adaptation interventions and is set to be an integral part of associated studies and monitoring and review of new adaptation interventions.
Climate change has become one of the most compelling fields of empirical research over the last couple of decades, partly due to its socio-economic impacts. Using a meta-analysis of 235 peer-reviewed articles published between January 2010 and July 2020, this paper appraises climate change adaptation (CCA) research in Nepal and draws lessons for future adaptation planning. The number of research is observed to have increased significantly in recent years (2015-2020) although there is no consistent pattern over the review period and at the thematic level. Findings submit that the agriculture and food security has the highest number of publications (37%) followed by gender equality and social inclusion (18%) and forest, biodiversity and watershed management (16%). There are no studies found in rural and urban settlement theme. Geographic distribution of CCA studies revealed that over 40% studies were carried out from central Nepal, while no study was conducted in ten districts of eastern and western Nepal. The study focus was also discrete, and the perception and attitude and impact assessment of climate change were common agendas; however, the drivers of change and options for adaptation were understudied. CCA with multipronged initiatives provide a broader understanding of dynamics and governance of climate change that not only affects rural livelihoods, but also influences regional and global environments and biodiversity.
Climate change brings lasting changes in forests and biodiversity together with the ecosystem services altering its ability to support present and future economic activities. Current forest utilization and preservation is based on how forests developed under past climatic conditions. Policy-makers and forest managers must accept that climate change is inevitable and from which forests and forest communities are significantly impacted globally and in Nepal also, sustainable forest management (SFM) is already based on many measures to adapt to climate change as planned adaptation will reduce vulnerability at intervened sites and will have long term impacts. However, many forest species will be adapting autonomously and society will have to adjust to the result. Adaptation requires planning for change so that a suite of options for the future but based on the present practice and knowledge is to be available whenever needed. On the foundation of concurrent learning, knowledge and experiences of National Adaption Program of Action (NAPA) process, the National Adaptation Plan (NAP) process for forests and biodiversity will build medium and long-term adaptation strategies and plans with widely accepted objectives of future forests and biodiversity management. Banko JanakariA Journal of Forestry Information for NepalVol. 27, No. 2, 2017, page: 21-31
Anaemia is the commonest problem in pregnancy throughout the world and vast majority of this burden occurs in developing countries especially in Nepal. The study was aimed for determining the various risk factors of anaemia in group of pregnant women of eastern region located in Nepal. To assess prevalence of anaemia and to identify the association between the demographic variables of pregnant women of eastern region. Thus there is necessity for investigate the prevalence of anaemia for pregnant women. This was a follow-up study design was for the study in Obstetrics and Gynaecology department, Birat Medical College & Teaching Hospital, Biratnagar conducted from Oct. 2014 to Jan. 2016.A total of 545 pregnant women were enrolled in this study. Venous blood was obtained for determination of haemoglobin and questionnaire was designed to collect age of marriage, age of first child birth and socioeconomic status. Women were followed up at delivery. Haemoglobin levels of 10-10.9 g/dl, 7.0-9.9 g/dl and <7 g/dl were considered as mild, moderate severe anaemia respectively. The collected data were analysed using SPSS 2, programme. Chi-square test and p-value was used. A total of 545 pregnant women were included in this study. Their mean age was 25.93±4.60. The overall prevalence of anaemia was 40.7% (N=222). The mild, moderate and severe anaemia were at rates of 55.0% (N=122),39.2% (N=87) and 5.9% (N=13) respectively. Women aged 20-24 years were found more anemic with prevalence by severity of 42.8% (N=95). The mean age of marriage and first child birth were 21.92±3.02 and 23.47±2.96 respectively. Majority of pregnant women were at high school level with nuclear family and monthly income NRs<5000 were 35.0% (N=191). Anaemia is significant risk factor for maternal mortality in Nepal. Prevalence of anaemia during pregnancy was 40.7% and this rate is higher to those indicated in others developing countries. In our study population Women with pregnancy had a higher risk of anaemia at the age group 20-24 years by severity of 42.8%. The study revealed that anaemia present at considerable levels in eastern Nepal.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.