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 ...

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The role of women in economic development and the global environment is vital for progressing them towards the United Nations sustainable development goal (SDG-5) that emphasized the need to empower women in every walk of life. The study examines women’s autonomy in the sustainable development agenda under China’s open innovation system from 1975 to 2019. The study employed an autoregressive distributed lag (ARDL) model, vector autoregressive (VAR) Granger causality, and innovation accounting matrix to estimate parameters. The existing data are summarized and collated in the context of China to explain as a correlational study. The results show that women’s autonomy moderated with technology spills over to decrease greenhouse gas (GHG) emissions and substantiate the hump-shaped relationship between them. The increased spending on research and development (R&D) activities, patent publications, and renewable energy consumption empowers women to be equipped with the latest sustainable technologies to improve environmental quality. The pollution haven hypothesis verifies a given country, where trade liberalization policies tend to increase polluting industries to set up their plants that engaged in dirty production that exacerbate GHG emissions. The causality estimates confirmed that technological innovations and renewable energy consumption leads to women’s autonomy. In contrast, females’ share in the labor force participation rate leads to an increase in renewable energy consumption. Thus, it is evident that there is a positive role of women in the country’s sustainable development.

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Regions of Iran, Afghanistan, Pakistan and northwestern India have been proposed as the place of origin of Mus musculus castaneus. But despite the fact that Pakistan encompasses an important part of its range, M. m. castaneus populations in Pakistan have not been the subject of intensive genetic and biogeographic studies, except for a very small number of samples included in past studies. We studied genetic variation in M. m. castaneus (CAS) from northern Punjab Province, Pakistan, by using cytochrome b (Cytb) analysis in a sample of 98 individuals. Median-joining network revealed four well differentiated CAS sub-lineages coexisting within a small geographical region; these had previously been thought to have largely non-overlapping geographic distributions. Moreover, haplotypes from Pakistan occupied a central position in the network and all identified global haplotypes were also present in Pakistan. All identified CAS sub-lineages proved to be highly diverse on the basis of haplotype and nucleotide diversity indices. Tajima's D test and Fu's Fs tests of neutrality suggest recent population expansions in all sub-lineages. Expansion times were estimated as 21,760-134,930, 10,800-64,400 and 4950-30,665 ybp using substitution rates of 2.5%, 5% and 11%, respectively. Our results support the hypothesis that northern Punjab Province in Pakistan is the most likely source area for M. m. castaneus, and that the CAS sub-lineages in this region have undergone rapid population expansion events at different time periods, which appear to have benefitted from human-mediated transport, although one of them clearly predates the establishment of human settlements in this region.

OBJECTIVE:To determine the frequency, causes and outcome of postpartum haemorrhage (PPH) at METHODS: This descriptive study was conducted on diagnosed patients of PPH admitted in labour room of LMH, KIMS, Kohat, Pakistan. Data regarding mode of delivery, management and outcome of PPH was collected from January 2011 to December 2015. The blood loss measurement was subjective. The standard criterion for PPH definition and classification was used. The data was analysed via SPSS-21. RESULTS: Out of 46266 deliveries during the study period, documented PPH cases were 1453 (3.14%). The most common cause of PPH was atonic uterus (n=566; 38.95%), followed by genital tract trauma (n=489; 33.7%). Primary PPH was seen in 1408 (96.9%) cases. Out of 1453 cases of PPH, 993 (68.34%) had caesarean section, 330 (22.71 %) were delivered vaginally and 130 (8.95%) had abdominal delivery for ruptured uterus. Conservative medical management was done in 535 (36.82%) patients; repair of various kinds of tears was done in 489 (33.65%) patients and subtotal abdominal hysterectomy in 198 (13.63%) cases. Nine (0.62%) patients had disseminated intravascular coagulation (DIC), 7 (0.48%) patients had ruptured bladder along with ruptured uterus, 5 (0.34%) patients had renal failure and 3 (0.21%) patients developed pulmonary edema. Thirty five (2.41 %) patients died due to PPH. CONCLUSION:In all the observed patients of PPH, atonic uterus and genital tract trauma were the main causes while DIC and ruptured uterus were main complications of PPH.

Background: Dystrophic Epidermolysis bullosa (DEB) is a rare, severe subtype of epidermolysis bullosa (EB), characterized by blisters and miliary rashes of the skin. Dystrophic EB (DEB) includes variants inherited both in an autosomal-dominant or autosomal-recessive manner. Recessive dystrophic EB (RDEB) is divided into many subtypes and prevails as a result of biallelic genetic mutations in COL7A1 gene encoding type VII collagen, a major stabilizing molecule of the dermo-epidermal junction. The blister formation is mainly due to the variable structural and functional impairment of anchoring fibrils in VII collagen (COLVII), responsible for the adhesion of the epidermis to the dermis. Method: Three Pakistani families (A, B and C) affected with congenital dystrophic epidermolysis bullosa were recruited in the present study. The whole-exome sequencing (WES) approach was utilized for the detection of the pathogenic sequence variants in probands. The segregation of these variants in other participants was confirmed by Sanger sequencing. Results: This study identified a novel missense variant c.7034G>A, p. Gly2345Asp in exon 91, a novel Frameshift mutation c.385del (p. His129MetfsTer18) in a homozygous form in exon no 3, and a previously known nonsense variation (c.1573 C>T; p. Arg525Ter) in exon 12 of COL7A1 gene in families A, B, and C, respectively, as causative mutations responsible for dystrophic epidermolysis bullosa in these families. Conclusion: Our study validates the involvement of the COL7A1 gene in the etiology of dystrophic epidermolysis bullosa. It further expands the COL7A1 gene mutation database and provides an additional scientific basis for diagnosis, genetic counseling, and prognosis purposes for EB patients.

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