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.

S ix approximately isoenergetic diets were formulated with protein levels from 20% to 45% in increments of 5%. The effects of varying dietary protein level on growth performance and economic efficiency were studied. The best growth rate was obtained with 30% dietary protein, followed by the diets containing 35,40, 45,25 and 20% protein, respectively. Feed conversion ratio was improved with increasing dietary protein levels up to 30%. Protein efficiency ratio was decreased with increasing dietary protein levels. Body protein was increased with increasing dietary protein levels up to 45%. There was an inverse relationship between the body moisture and lipid contents. Dietary protein levels did not affect the body ash content. From the economical point of view, the highest net return percentage of the total costs was 110.3% as recorded by the 3.0% Protein; followed by 102.4 % (25%. Protein) 99.4% (20%. Protein); 94.1 % (35%. Protein); 59.0 % (40%. Protein) and finally 48.6 % for (45%. Protein). The optimum dietary protein level for Nile tilapia (weighing 20g) was 30% and the feeding rate was 3% of body weight.

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