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.

IntroductionHealth care workers are exposed to the risk of blood-borne diseases such as HIV, Hepatitis B and C in their daily encounter with infected patients and materials through unsafe injections. This study determined the baseline and post-intervention knowledge and practice of modern injection safety standards among health care workers.MethodsThe study population was the healthcare workers in a teaching hospital in southeastern Nigeria. Data was collected using a self-administered 37-item structured questionnaire assessing their knowledge and practice on injection safety. Collected data was analyzed using SPSS.ResultsNurses comprised 62.8% (98/156) of the population. While most had heard of injection safety only 67.2% (84/125) had previously had any form of training on it. Only 54% (81/150) had heard or seen color coded bins. The standard needle and syringe is still widely used and 45% (65/145) still recap needles on syringes after use irrespective of type of personnel. Half (50.6% =78/154) of our respondents had had a previous needle prick injury. Only 25.6% (20/78) with previous needle prick injury had post-exposure prophylaxis. All doctors and laboratory scientists always use gloves compared to 94.8% (91/96) nurses while handling patients or materials. Following the intervention, a significantly high number became aware of post-exposure prophylaxis and color coded bins and liners.ConclusionThere is a need for healthcare workers to be regularly updated on changing safety standards in their practice. Also hospitals must be encouraged to acquire and use internationally accepted standard materials in collection and disposal patient's samples.

IntroductionHighly active antiretroviral therapy (HAART) has improved survival of human immunodeficiency virus (HIV) patients. Concurrent morbidities from liver diseases among these patients have also been observed due to co-infection with hepatitis B and C viruses (HBV and HCV). HAART reduces liver-associated morbidities and mortalities in such patients. Unfortunately free testing of HBV and HCV are not provided alongside free HIV testing and treatment in Nigeria. We assessed the seroprevalence of HBV and HCV among HIV patients presenting for treatment in our center.MethodsThis prospective study of adult patients with HIV/AIDS assessed the seroprevalence of HBV and HCV co-infection using a 19-item questionnaire and collection of 2ml venous blood for hepatitis B surface antigens (HBsAg) and anti-HCV antibodies. All previously diagnosed HIV patients of the unit were excluded from the study.ResultsOf the 404 patients, 69.2% were females while 30.8% were males. Married participants were 59.6%, 25.3% were single and 15% were previously married. A large proportion (69%) of patients were farmers, artisans and traders. Most had some formal education; secondary (55.3%), primary 27.3%, tertiary 13.8%. HBsAg positive participants were 9 (2.2%) while 3 (0.7%) were positive for HCV. No participant had triple infection of HIV/HBV/HCV.ConclusionSeroprevalence of HBV and HCV is low among HIV patients in Orlu. However there is a need for HBV and HCV testing of all HIV positive patients to reduce morbidities and mortalities from liver diseases.

Commonly available analgesics, such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs), are used widely with few or no adverse events by most individuals. However, some adverse events have been observed following the use of these drugs. This paper reports a case of paracetamol and NSAID-induced seizures in a patient with the human immunodeficiency virus infection/acquired immune deficiency syndrome (HIV/AIDS). These seizures occurred at different times, first with paracetamol and then diclofenac (a NSAID). She was concurrently on anti-retroviral drugs and