single large dose of tranexamic acid before vaginal delivery: is it beneficial

Background: many factors are attributed in the management of postpartum hemorrhage after vaginal delivery

Objective: to assess the efficacy and safety of a single large dose of intravenous tranexamic acid in reducing postpartum blood loss after vaginal delivery

Subjects and Methods: this is a multicentric prospective randomized double blind placebo controlled trial. 240 pregnant women were randomized to receive either 60 mg/kg of TA [n=120] or placebo [n=120] intravenously in the second stage of labour. Postpartum blood loss was collected and measured accurately from placental delivery to 2 hours postpartum and adverse effects of were observed

Results: the mean estimated postpartum blood loss was significantly lower in women treated with tranexamic acid compared to women in the placebo group [241.5 +/- 82.7 versus 322.8 +/- 127.4, respectively; p < 0.001], and the proportion of women in the tranexamic acid group who had an estimated blood loss 500 mL was significantly lower than in the placebo group [ 5 [4.2%] versus 18 [15%], relative risk [RR]=0.30; 95% confidence interval [CI] 0.11 to 0.78; P<0.05]. Maternal and neonatal outcomes did not differ significantly between both groups

Conclusion: A single large dose of tranexamic acid administrated intravenously before vaginal delivery significantly reduces the amount of postpartum blood loss and contributes to prevention of PPH. Adverse effects were only mild and transient. Thus, tranexamic acid can be used safely and effectively to reduce bleeding after vaginal delivery

Detailed anatomical study of nerve supply of flexor digitorum superficialis muscle

The motor points of the skeletal muscles have recently attracted much attention from researchers in the field of functional electrical stimulation. Knowledge of the location of the nerve branches and the entry points facilitates the exact insertion and the suitable selection of the number of electrodes required for each muscle for functional electrical stimulation. To study the detailed nerve supply of the flexor digitorum superficialis muscle that may help the physiotherapists in the follow up and rehabilitation of the paralyzed patients. Twenty adult male human cadaveric forearms [13 right and 7 left] were dissected to study the branches of the nerves supplying the flexor digitorum superficialis muscle. The number of branches and their points of penetration on the muscle were detected, measured, tabulated and statistically analyzed. Dissection of the nerve supply of the flexor digitorum superficialis muscle revealed that the muscle received muscular branches from the median, anterior interosseus and ulnar nerves [triple nerve supply] in three [15%] specimens [2 left and one right]. In 15 [75%] specimens [10 right and 5 left], the flexor digitorum superficialis muscle received muscular branches from 2 different nerves, multiple branches from the median nerve in all 15 specimens and either a single branch from the anterior interosseus nerve in 13 specimens [8 right and 5 left] or a single branch from the ulnar nerve in 2 right specimens. In the remaining 2 [10%] right specimens our of 20, the muscle received muscular branches from the median nerve only. The number of the muscular branches of the median nerve to the muscle ranged from 2 to 7 on the right specimens, and from 2 to 6 in the left specimens, while the number of points of entry of these branches to the flexor digitorum superficialis ranged from 2 to 9 in the right specimens and from 2 to 8 in the left one. The distance between the origin of the proximal branch of the median nerve supplying the muscle and the articular line of the elbow varied from 0.5 to 8.3cm in the right specimens, in the left specimens it was 0.7 to 7.8cm, while the distance between the points of entry of this proximal branch to the muscle and the articular line of the elbow was 2.4 to II.2cm in the right specimens and 2.6 to 9.3cm in the left one. The distal branch arose from the median nerve to the muscle had a distance of 9.2 to 19.7cm from the articular line of the elbow in the right specimens, while it was 10.2 to 17.5cm in tile left specimens The distance between the points of entry of this branch to the muscle and the articular line of the elbow ranged between 12.8 to 19.6cm in the right specimens and 13.5 to 17.9cm in the left one. The median nerve supplied the flexor digitorum superficialis muscle along its whole length [proximal, middle and distal thirds]. The muscular branch arose from the anterior interosseus or the ulnar nerves entered the muscle at its proximal third only. It is necessary for the surgeons and physiotherapists dealing with this muscle to be aware about its nervous pattern and they should anticipate that the proximal third of this muscle is the most important part as it may have double or triple nerve supply

Anatomical study of the arterial supply of human extra ocular recti muscles

Extraocular muscles are highly specialized striated muscles exhibiting generous innervation and more variation in fiber size and type than other skeletal muscles. The arterial supply of the extraocular recti muscles [EORMs] is liable to be severely damaged during medial and lateral approaches to the orbit to treat various disorders. Was to study the arterial blood supply of the EORMs to help the surgeons to adopt procedures in which these arteries can be saved. Also to study the difference in the vascularity between the global and orbital layers of the muscles. Twenty human orbits were dissected after arterial injection of the internal carotid artery with red latex. The different arterial pedicles for each muscle were studied regarding their number, origin and points of entry. Morphometric study was done to count the number of the blood vessels in the orbital and global layers. The luminal cross sectional area of these blood vessels were studied, measured and statistically analyzed. The arterial supply to the extra ocular recti muscles came from the ophthalmic artery, the lacrimal artery and the inferior muscular artery. The superior rectus muscle was supplied by 1-2 arterial pedicles from the ophthalmic artery, while the medial rectus muscle was supplied by 2-6 pedicles from the ophthalmic and inferior muscular arteries. The inferior rectus muscle was principally supplied by 2-5 branches from the inferior muscular artery but the lateral rectus muscle was supplied by 2- 5 pedicles coming from the lacrimal artery and muscular branches from the ophthalmic artery. Through morphometric study, there were abundant blood vessels in the orbital layer and larger luminal cross sectional area of the blood vessels at midorbital portion in the global layer. The arterial blood supply to the EORMs was variable but always substantial and the pedicles were numerous, their number was 1-5 arterial pedicles for each muscle. Since 70-80% of the blood supply of the anterior segment of the eye ball arise from the forward extension of the muscular arteries[5]. So, in cases of transposition procedures during strabismus or retinal reattachment surgery, surgeons must take care of these muscular arteries in order to keep the blood flow within the corresponding anterior ciliary arteries.Also It could be concluded that the orbital layer of the EORMs has increased vascularity and increased content of mitochodria and oxidative enzymes than the global layer

Immediate implants in fresh extraction sockets

This clinical report summarized the procedure of immediate implants insertion into fresh extraction sockets. Hydroxylapatite and non- hydroxylapatite coated titanium implants were used in this study; however, it showed no difference in bone to implant contact. This procedure has proved to be successful in eliminating the conventional waiting period after the extraction and speeding the process of ailing teeth replacement. The surgical technique together with other recommendations were discussed in this report

Clinical evaluation of osseointegrated prosthesis attached to natural teeth using semiprecision attachment

A more complex biomechanical situation is created when a fixed prosthesis is supported by fixture and natural teeth. The natural teeth more but an implant is osseointegrated. When an implant is attached to natural teeth, the movement of the teeth is transmitted to the implant. The prosthesis should be designed to reduce tooth movement, which is harmful to an implant. The use of Minicon semiprecision attachment allows a tooth to move downward. It also gives lateral stability to an implant prosthesis. In this study, six partially edentulous individuals were selected and a total of 22 root from titanium core-vent implants were inserted. The fixed bridge prostheses with Minicon attachment were evaluated clinically [including plaque index, gingival index, probing depth], and radiographically for marginal bone loss

role of immunology in the pathogenesis of inflammatory papillary hyperplasia associated with denture wearers

1 - No significant difference of immunoglobulins level were found between denture and ono denture wearer.2 - Significant increase of immunoglobulins [G and E] level of palatal mucosa with papillary hyperplasia. 3 - In inflammatory papillary hyperplasia, synergistic activity may be present between inflammation and immunity where inflammation may enhance the immune response by maintaining a tissue environment of increased vascularity and permeability

Incidence of serum immunoglobulins in patients undergoing treatment for denture stomatitis

From this study the following may be concluded: 1 - Reduction of serum immunoglobulins level was observed in patients treated from denture stomatitis when using tissue conditioners with and without antibacterial additives for two weeks. 2 - From immunological point of view, it is preferable to use tissue conditioning lining material incorporating Nystatin powder as an-tifungal agent for treatment of denture stomatitis