Administration of tranexamic acid for victims of severe trauma within pre-hospital care ambulance services (PHCAS) in Malaysia

@#Introduction: Trauma is a Global threat and the 5th highest cause of all-cause mortality in Malaysia caused predominantly due to road traffic accidents. Majority of trauma victims are young adults aged between 21-40 years old. In Malaysia, 24 out of 100,000 population die annually due to trauma, rating us amongst the highest in South East Asia. These alarming figures justify aggressive preventive and mitigation strategies. The aim of this paper is to promote the implementation of evidence-based interventions that will reduce the rate of preventable death because of trauma. Tranexamic acid is one of the few interventions in the early management of severe trauma with level-one evidence. Tranexamic acid has been proven to reduce all causes of mortality and mortality due to bleeding. Evidence proves that it is most effective when administered early, particularly within the 1st hour of trauma. This proposed guideline is formulated based upon quality evidence from multicentre studies, clinical practices in other countries and consideration of the local demographic factors with the intent of enabling an easy and simple pathway to administer tranexamic acid early in the care of the severely injured. Conclusion: The guideline highlights select pre-hospital criteria’s and the methods for drug administration. The authors recognise that some variants may be present amongst certain institutions necessitating minor adaptations, nevertheless the core principles of advocating tranexamic acid early in the course of pre-hospital trauma should be adhered to.

Effects of aluminum on rat cerebellar cortex and the possible protective role of Nigella sativa: a light and electron microscopic study

Aluminum [AL] is toxic to the central nervous system, and Nigella sativa [NS] reduces lipid peroxidation by its antioxidant activity. To investigate the effects of AL treatment on rat cerebellar cortex and the possible protective role of NS. Twenty-five adult male albino rats were divided into five groups: a control group, an NS-treated group, which received NS oil [1ml/kg] orally for 1.5 months, an AL-treated group, which received AL chloride daily [320mg/kg] for 1.5 months, an AL+NS group, which received NS with AL for 1.5 months at the same previous doses, and a withdrawal group, which received AL at the same previous dose for 1.5 months and was left for withdrawal for 1.5 months. Specimens of the cerebellar cortex were processed for light microscopic, electron microscopic, and immunohistochemical study. Morphometric and statistical analysis was carried out. The NS-treated group was very similar to the control group. After the administration of AL, the cerebellum showed a significant reduction in the number of Purkinje cells, which appeared irregular with a darkly stained cytoplasm. The ultrastructure showed Purkinje cells with cytoplasmic vacuolation, dilatation of Golgi cisternae, and mitochondria with dilated cristae. Granule cells showed mitochondria with destroyed cristae. The immune reaction for caspase-3 was intense compared with that of the control group. Administration of NS with AL showed an observable protection against these changes. The withdrawal group showed Purkinje cells that were irregular and darkly stained and their ultrastrucure showed mitochondria with destroyed cristae, but these changes were less marked than those in the AL-treated group. NS may play a protective role against AL-induced cerebellar toxicity in humans

Effects of green tea on azathioprine - induced liver injury in adult male albino rats: light and electron microscopic study

Azathioprine is an immunosuppressive drug that is used inhuman medicine and veterinary medicine to treat different diseases like inflammatory bowel diseases, acute lymphoblastic leukemia, rheumatoid arthritis and ulcerative colitis. There is evidence that it causes hepatotoxicity. These days, applying antioxidants in order to prevent diseases can play a protecting role in liver tissue. So, the present work aimed at a morphological and morphometric evaluation of the role of green tea to protect against azathioprine-induced liver injury in rats. 30 adult male albino rats were divided into 3 groups; each group consisted of 10 rats. Control group, treated group given azathioprine in a dose of 25mg/Kg body weight dissolved in 0.9% NaCl orally via intragastric route 6 days a week for 8 weeks. Protected group given green tea extract in a dose of 175mg/Kg body weight dissolved in water orally simultaneously with azathioprine in the same previous dose, 6 days a week for 8 weeks. The liver specimens were processed for both light and electron microscopic examinations. Morphometric analysis were also carried out. Aza induced degenerative changes manifested at LM; hislological changes in structure of the liver. At EM; manifestations of oxidative damage of hepatocytes. At morphometry; significant changes as regards size of hepatocytes and glycogen content. The protected group showed at LM; improvement of structure of liver. At EM; improved histological changes of hepatocytes. At morphometry; significant improvement of size and glycogen content of hepatocytes. The negative effects of azathioprine could be ameliorated by addition of green tea to the therapeutic regime of patients who may suffer liver injury due to azathioprine treatment

Effects of honey on carbon tetrachloride - induced kidney injury in adult male albino mice: light and electron microscopic study

In the recent years, extensive research work has been focused on the use of natural antioxidants against the toxic oxidative materials to ameliorate their toxic and cell damaging effects. In people who had died after exposure to CC14, kidney failure was frequently reported as the main cause of death. Honey is one of the natural antioxidants. So, the present work aimed at the morphological and morphometric evaluation of the efficacy of honey on the carbon tetrachloride-induced kidney injury.Thirty adult male albino Sprague-Dawley mice were divided into three groups, each group consisted of 10 mice. Control group [group I] received olive oil subcutaneously [S.C.]; CCL4 group [group II] were injected S.C. with 0.3% CCL4 dissolved in olive oil in a daily dose of 5ml/kg B. W. for 4 weeks. CCL4 + Honey group [group III] recieved both CCL4 and honey simultaneously daily for 4 weeks. The honey mixed with water and was given orally by gastric tube. The kidney specimens were processed for both light and electron microscopic examinations. Morphometric studies were also carried out. At L.M. level; carbon tetrachloride - induced degenerative changes in kidney cortex involved both corpuscles and tubules as well as inflammatory mononuclear cellular infiltration. By E.M.; thick interrupted glomerular basement membrane Morphometry showed significant changes of glomerulus, corpuscles and tubules. Honey effects were at L.M.; improvement of degenerative changes and inflammatory infiltration. At E.M; improvement of corpuscular and tubular changes. Morphometry showed better significant changes of glomerulus, corpuscles and tubules. Processed honey significantly reduced degenerative changes induced by CCL4 in the renal cortex on simultaneous administration

Study and evaluation of mole hydatidiform cases in pregnant women

The etymology is derived from hydatisia [Greek [a drop of water]], referring to the watery contents of the cysts, and mole [from Latin mola=millstone/false conception]. Molar pregnancy is an abnormal form of pregnancy, wherein a non-viable, fertilized egg implants in the uterus. study and evaluation of mole hydatidiform cases according to age and percentage of them. The material was received from Rabia Balkhi and Malalay hospital and many other private clinics, and after process of biopsy study has been done. the result shows that the received biopsy from hospitals which were studied in pathology department was 48 cases of Mole Hydatidiform. 32 of these cases were incomplete mole and remained 16 cases were complete mole. the result shows that the cases of incomplete Mole Hydatidiform was more than complete Mole. According to age the youngest onset is 19 years along with formation of fetus. And the oldest one is a woman of 47. Referring prior to doctors [Gynecologist] In case of vaginal bleeding without pain in pregnant young women - performing HCG test, clinical testing of thyroid gland and routine test of urine