Background This study aimed to evaluate the efficacy and safety of using high-dose intravenous tranexamic acid (TXA) to reduce blood loss in idiopathic scoliosis surgery. Methods This study was a meta-analysis, which consisted of retrospective cohort studies (RCSs) and randomized control trials (RCTs) found by searching electronic databases, namely PubMed, Web of Science, The Cochrane Central Register of Controlled Trials (CENTRAL), and the Google Scholar Database, dating from 1960 to 2019. The points of interest included total blood loss, a need for transfusion and transfusion criteria, surgery time, and the evidence of intraoperative and postoperative complications, such as seizures or thromboembolic events. The weighted mean differences (WMD) and 95% confidence interval (CI) of blood loss in the TXA intervention group compared to the control or placebo group were extracted and combined using the random effects model. Results In this meta-analysis, there was a total of three RCSs and two RCTs, which involved 334 patients. The results showed that blood loss is significantly reduced, with a weighted mean difference in the TXA group (WMD = − 525.14, P = 0.0000, CI ranged from − 839.83, − 210.44, I2 = 82%). Heterogeneity was assessed using the random effects model. Conclusions A high dose of intravenous TXA reduced blood loss during adolescent idiopathic scoliosis surgery and did not lead to any significant thromboembolic event. Therefore, a high dose appears to be effective and safe for adolescent idiopathic scoliosis surgery. However, more high-quality research based on larger randomized controlled trials is still needed.

Rituximab is a chimeric monoclonal antibody directed against the CD20 expressed on B cells, originally used to treat lymphoma but is increasingly used for the treatment of autoimmune diseases. Membranous nephropathy is an autoimmune disease resulting from the deposition of IgG and complements components onto the subepithelial layer of the glomerular capillary wall and remains the leading cause of nephrotic syndrome in adults. Several prospective and retrospective studies showed rituximab induces remission and may decrease proteinuria in patients with membranous nephropathy. Considerable evidence supports the use of B-cell depletion as initial therapy in nephrotic patients with membranous nephropathy. This review focuses on the efficacy and safety of rituximab in the treatment of membranous nephropathy.Keywords: Membranous nephropathy; rituximab; treatment

Tranexamic acid is widely used as an antifibrinolytic drug to reduce blood loss intraoperative and postoperative time periods as well as to reduce transfusion of allogeneic blood. After releasing in the market, multidisciplinary surgeries have wide use of tranexamic acid due to its antifibrinolytic effect to reduce bleeding and transfusion of blood. In literature, there were mentioned a few adverse effects like thromboembolism, seizure, anaphylactic reaction, etc which are still unsolved questions to date. The aim of this review to minimize the blood loss from acute bleeding in different situations by updating the doses used in a different clinical scenario,since the release of tranexamic acid. It also gives an idea about appropriate doses to reduce blood loss, need for blood transfusion, minimize adverse effects and to understand the wide scope of application of TXA to date.

Introduction: Introduction: Spinal anesthesia has become the anesthesia of choice for most of the surgeries of the abdominal-pelvic region.  Cited with benefits such as lesser risks of apnea, minimal cardiopulmonary alteration, and abnormalities associated with neurocognitive development, it incorporates all components of balanced anesthesia, especially in pediatric surgeries. Encouraging results on the safety, efficacy, and feasibility of spinal anesthesia has increased its utility. The objective of our study was to assess the hemodynamic change occurring in children below four years undergoing lower abdominal and pelvic surgeries following spinal anesthesia. Method: This is a cross-sectional study conducted over 2 years and includes children undergoing surgery of the lower abdomen in Kathmandu Model Hospital. The information was data regarding patients' demography, hemodynamic status prior, during, and after the procedure of spinal anesthesia, measuring systolic blood pressure (SBP), diastolic blood pressure (SBP), mean arterial pressure (MAP), heart rate (HR), sensory and motor block characteristics (modified Bromage scale) and complications. Result: The intraoperative and postoperative hemodynamics did not show major differences. The mean peak sensory level was T4 (C7-T10) during the block. Recovery of sensory and motor blocks was complete in all patients. Modified Bromage scale was 1 in 57(98.27%), 2 h post-surgery.  The average duration of the block was 75 min (30-180). 1(1.72%) patient developed apnea during the surgery. Conclusion: Spinal anesthesia in small children showed minimal variation in intraoperative and postoperative hemodynamics and is a safer mode of anesthesia with sparing of respiratory alterations seen with general anesthesia.