Phulwari

Researchers are evaluating the use of non-vitamin K oral anticoagulants (NOACs) compared to no anticoagulation in people who have experienced transient atrial fibrillation episodes triggered by stress and have additional risk factors for stroke. This multinational, investigator-initiated Phase 4 trial aims to prevent stroke and other serious cardiovascular events in this group by assessing the effects of NOACs on two main outcomes: the occurrence of non-hemorrhagic stroke or systemic embolism, and a combination of vascular death and other major cardiovascular problems, over a follow-up period lasting until the last participant reaches 24 months of observation. Participants in the study are randomly assigned to either receive one of several NOAC medications—edoxaban, apixaban, dabigatran, or rivaroxaban—with dosing adjusted as needed and chosen by their prescribing doctor, or to receive no oral anticoagulation. The treatment continues throughout the follow-up period. The trial is open-label, meaning both researchers and participants know which treatment is given. The study specifically focuses on patients who had transient atrial fibrillation related to stress, such as after certain surgeries or acute medical illness. During the study, participants undergo regular monitoring to track the incidence of stroke, embolism, vascular death, heart attacks, blood clots, and other cardiovascular events. Researchers collect information over up to two years to evaluate these outcomes. Safety and adherence to treatment are also monitored. This thorough follow-up helps determine the impact of NOAC treatment compared to no anticoagulation in this particular patient population.

Researchers are investigating the causes of fevers without a clear source in patients admitted to a hospital in Nepal. Many cases of fever in Nepal are currently diagnosed based on clinical signs alone, leading to treatment with multiple antibiotics without knowing the exact cause. This study aims to identify the specific infections causing fever lasting from 3 to 21 days using additional microbiological tests, helping to reduce unnecessary antibiotic use and improve patient care. The research focuses on infections that are common in Nepal, such as murine typhus, bartonellosis, Q fever, and several viral infections, many of which are not routinely tested currently. Participants will undergo standard care evaluations performed by their medical team, including clinical exams, basic lab tests, radiology, and microbiology. In addition, extra laboratory tests will be conducted to detect infections like murine typhus, bartonellosis, Q fever, chikungunya, Zika, Japanese B encephalitis, and West Nile virus. These additional tests aim to provide a clearer diagnosis during the hospital stay. The study does not involve specific treatments but focuses on improving diagnosis and guiding appropriate use of antimicrobials. During the study, participants will be monitored for up to 21 days to estimate the cause of their fever and evaluate how antimicrobials are used. Researchers will collect clinical information, laboratory results, and other relevant data to understand the infections better. The findings will help identify the burden of infectious diseases in Nepal, reduce unnecessary antibiotic use, and support public health measures for prevention and control. Patients must be admitted to the hospital and provide informed consent to participate.

The HIP ATTACK-2 trial is a multicentre, international, parallel group randomized controlled trial to determine whether accelerated surgery for hip fracture in patients with acute myocardial injury is superior to standard care in reducing death at 90 days after randomization. The trial will also assess secondary outcomes at 90 days after randomization: inability to independently walk 3 metres, time to first mobilization (first standing and first full weight bear), composite and individual assessment of major complications (e.g., mortality, non-fatal myocardial infarction, acute congestive heart failure, and stroke), delirium, length of stay, pain, and quality of life.