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Although prophylactic tranexamic acid administration after cesarean delivery resulted in a lower incidence of calculated estimated blood loss of1000 mL or red cell transfusion by day 2, its failure to reduce the incidence of hemorrhage-related secondary clinical outcomes (TRAnexamic Acid for Preventing Postpartum Hemorrhage Following a Cesarean Delivery trial) makes its use questionable. The magnitude of its effect may differ in women at higher risk of blood loss, including those with multiple pregnancies.This study aimed to compare the effect of tranexamic acid vs placebo to prevent blood loss after cesarean delivery among women with multiple pregnancies.This was a secondary analysis of the TRAnexamic Acid for Preventing Postpartum Hemorrhage Following a Cesarean Delivery trial data, a double-blind, randomized controlled trial from March 2018 to January 2020 in 27 French maternity hospitals, that included 319 women with multiple pregnancies. Women with a cesarean delivery before or during labor at ≥34 weeks of gestation were randomized to receive intravenously 1 g of tranexamic acid (n=160) or placebo (n=159), both with prophylactic uterotonics. The primary outcome was a calculated estimated blood loss of1000 mL or a red blood cell transfusion by 2 days after delivery. The secondary outcomes included clinical and laboratory blood loss measurements.Of the 4551 women randomized in this trial, 319 had a multiple pregnancy and cesarean delivery, and 298 (93.4%) had primary outcome data available. This outcome occurred in 62 of 147 women (42.2%) in the tranexamic acid group and 67 of 152 (44.1%) receiving placebo (adjusted risk ratio, 0.97; 95% confidence interval, 0.68-1.38; P=.86). No significant between-group differences occurred for any hemorrhage-related clinical outcomes: gravimetrically estimated blood loss, provider-assessed clinically significant hemorrhage, additional uterotonics, postpartum blood transfusion, arterial embolization, and emergency surgery (P.05 for all comparisons).Among women with a multiple pregnancy and cesarean delivery, prophylactic tranexamic acid did not reduce the incidence of any blood loss-related outcomes.

Summary Background Cataract surgery is one of the most common operations in health care. Femtosecond laser-assisted cataract surgery (FLACS) enables more precise ocular incisions and lens fragmentation than does phacoemulsification cataract surgery (PCS). We hypothesised that FLACS might improve outcomes in cataract surgery compared with PCS despite having higher costs. Methods We did a participant-masked randomised superiority clinical trial comparing FLACS and PCS in two parallel groups (permuted block randomisation stratified on centres via a centralised web-based application, allocation ratio 1:1, block size of 2 or 4 for unilateral cases and 2 or 6 for bilateral cases). Five French University Hospitals enrolled consecutive patients aged 22 years or older who were eligible for unilateral or bilateral cataract surgery. Participants, outcome assessors, and technicians carrying out examinations were masked to the surgical treatment allocation until the last follow-up visit and a sham laser procedure was set up for participants randomly assigned to the PCS arm. The primary clinical endpoint was the success rate of surgery, defined as a composite of four outcomes at a 3-month postoperative visit: absence of severe perioperative complication, a best-corrected visual acuity (BCVA) of 0·0 LogMAR (logarithm of the minimum angle of resolution) or better, an absolute refractive error of 0·75 dioptres or less, and unchanged postoperative corneal astigmatism power (≤0·5 dioptres) and axis (≤20°). The primary economic endpoint was the incremental cost per additional patient who had treatment success at 3 months. Primary outcomes were assessed in all randomly assigned patients who met all eligibility criteria (missing data considered as failure). We used mixed logistic regression models or mixed linear regression models for statistical comparisons, adjusted on centres and whether cataract surgery was bilateral or unilateral. The study is registered with ClinicalTrials.gov , NCT01982006 . Findings Of the 907 patients (1476 eyes) randomly assigned between Oct 9, 2013, and Oct 30, 2015, 870 (704 eyes in FLACS group and 685 eyes in the PCS group) were analysed. We identified no significant difference in the success rate of surgery between the FLACS and PCS groups (FLACS: 41·1% [289 eyes]; PCS: 43·6% [299 eyes]); adjusted odds ratio 0·85, 95% CI 0·64–1·12, p=0·250). The incremental cost-effectiveness ratio was €10 703 saved per additional patient who had treatment success with PCS compared with FLACS. We observed no severe adverse events during the femtosecond laser procedure, and most of the complications in the FLACS group related to the primary outcome measures occurred during the phacoemulsification phase or postoperatively. Interpretation Despite its advanced technology, femtosecond laser was not superior to phacoemulsification in cataract surgery and, with higher costs, did not provide an additional benefit over phacoemulsification for patients or health-care systems. Funding French Ministry of Social Affairs and Health.

International audience; Among women with vaginal delivery who received prophylactic oxytocin, the use of tranexamic acid did not result in a rate of postpartum hemorrhage of at least 500 ml that was significantly lower than the rate with placebo. (Funded by the French Ministry of Health; TRAAP ClinicalTrials.gov number, NCT02302456 .).

Objectif Les intoxications par les substances psychoactives (SPA) sont nombreuses en Europe, notamment dans les festivals de musique, et peuvent-etre responsables de deces pour lesquels les centres antipoison et d’addictovigilance sont regulierement sollicites. Les objectifs de cette etude sont de determiner les molecules circulant dans ces evenements festifs avec identification analytique a l’appui, et de decrire les tableaux cliniques les plus graves pour ameliorer la prise en charge ulterieure. Methode Apres avis favorable du CPP IDF1 (ClinicalTrials.gov ID : NCT03203213 ), etait inclu tout patient majeur admis au poste medical avance (PMA) du festival Garorock de Marmande (30 juin–2 juillet 2017) avec des troubles neurologiques et/ou du comportement (i) presentant une agitation a l’admission ou pendant la surveillance au PMA et qui dira (ou son entourage) avoir consomme des SPA ou qui sera dans l’incapacite de dire qu’il a pris une SPA et pour lequel aucune autre etiologie n’est evidente, et/ou (ii) pour lequel la gravite du cas necessite une admission aux urgences ou en reanimation, que le medecin ait connaissance ou non d’une prise de SPA (et en l’absence d’une autre etiologie evidente) et/ou (iii) si le medecin du PMA considere qu’une analyse toxicologique est necessaire pour la suite de la prise en charge. Chaque patient beneficiait d’un examen clinique, d’un prelevement sanguin sur buvard Dried Blood Spot ou DBS) et capillaire, ainsi que des soins adaptes. Resultats Vingt cinq patients (13 femmes, 12 hommes) de 18 a 30 ans ont ete inclus, 25 DBS analyses, et 24 prelevements de cheveux analyses. Quatorze (93 %) indiquaient qu’ils avaient pris des SPA. Les signes observes etaient neurologiques [mydriase (71 % – 17), troubles de la conscience (88 % – 22), hyper ou hypotonie (respectivement 40 % – 6 et 47 % – 7), agitation (44 % – 11), mouvements anormaux (36 % – 9)], cardiovasculaires [tachycardie 46 % (11)], respiratoires [polypnee 55 % (6)], ou autres [hypoglycemie 4 % (1), fievre 7 % (1)] et 16 % (4) ont ete hospitalises. L’evolution a ete favorable pour tous. Les substances avouees consommees (23 patients) etaient : « cristal », ecstasy, « MD », MDMA, champignons et cannabis, parfois associes. Dans les DBS etaient retrouves de l’ecstasy (surtout MDMA), du THC, de la cocaine et leurs metabolites, du paracetamol, de l’hydroxyzine, de la chloroquine, du levamisole, de la quinine, de la quinidine, et de la cetirizine. Les memes substances ont ete decelees dans les cheveux mais egalement de la MDEA, du MDMB-CHMICA, de la doxylamine, de l’oxomemazine et de la codeine. Conclusion L’etude a permis de decrire precisement les tableaux cliniques. Aucun nouveau produit de synthese n’a ete retrouve dans le sang, mais certains d’entre eux ont des concentrations sanguines circulantes tellement faibles qu’elles ont pu echapper a la detection dans les DBS.