ABSTRACT
Liposuction remains one of the most frequently performed cosmetic surgical procedures and its popularity is increasing every year. However, since its inception, justified concerns regarding patient safety have placed limits on the volume of fat that can be aspirated, influenced by hemodynamic fluctuations and blood loss during liposuction. Tranexamic acid (TXA) is an antifibrinolytic agent that competitively inhibits the conversion of plasminogen to plasmin, thus preventing the binding and degradation of fibrin. Despite the existence of evidence of the effectiveness of TXA in orthopedic and cardiac surgeries, there is little evidence of its use in liposuction. The objective of this study was to evaluate the efficacy and safety of tranexamic acid in the control of surgical bleeding in patients undergoing liposuction, through a prospective, open, randomized and controlled clinical trial. Two groups of 25 participants each were formed to whom the application of TXA in a tumescent solution prior to liposuction or liposuction with the traditional technique was randomly assigned. The results showed a decrease in blood loss reflected by the differences in the final hematocrit values, as well as decrease in the same per aspirated volume (p = 0.003). No adverse events were found related with the TXA application and no blood transfusions were required in this group, in contrast to the control group where the need for blood transfusion was present in 20% of the intervened participants. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Subject(s)
Lipectomy , Tranexamic Acid , Blood Loss, Surgical/prevention & control , Humans , Lipectomy/methods , Prospective Studies , Tranexamic Acid/therapeutic use , Treatment OutcomeABSTRACT
BACKGROUND: Neural tube defects (NTDs) have been associated with biochemical factors involved in the conversion of homocysteine to methionine as folate deficiency and the mutation 677T in the N(5),N(10)-methylenetetrahydrofolate reductase gene (MTHFR). METHODS: A case-control study was performed to detect this mutation in 38 unrelated women with NTD deceased products and 31 mothers without antecedents of NTD offspring. All products were born in Nuevo León (northeastern Mexico) during 1997. Erythrocyte and plasmatic folate levels and the genotype of the 677 polymorphism at the MTHFR locus were analyzed in both groups. RESULTS: Although no significant differences were found in mean blood folate levels, the percentage of women in the case group with erythrocyte folate levels <160 ng/mL was significantly higher than in the control group (75 vs. 51.2%, p <0.05). The proportion of women with plasma folate levels <3.5 ng/mL was higher in the case group (16.2 vs. 0%, p <0.01). Genotype analysis demonstrated a significantly higher proportion of 677T homozygous mothers with NTD products (39.6 vs. 9.1%, p <0.05). Allele frequencies for the 677T mutation were 0.55 and 0.36 for cases and controls, respectively. The odds ratio (OR) for having a NTD product was 6.1 (95%, CI 1.56-23.6) for homozygous 677T mothers vs. homozygous 677C and heterozygous mothers. Significantly low levels of erythrocyte folate were found in the 677C homozygous case group and in plasma folate in the 677C/677T heterozygous case mothers. CONCLUSIONS: Our study suggests that folate deficiency and MTHFR unfavorable genotype in mothers are important risk factors for severe NTD phenotype in our population.
Subject(s)
Folic Acid Deficiency/genetics , Folic Acid/blood , Neural Tube Defects/etiology , Oxidoreductases Acting on CH-NH Group Donors/genetics , Pregnancy Complications/enzymology , Adult , Alleles , Amino Acid Substitution , Anencephaly/etiology , Anencephaly/mortality , Case-Control Studies , Codon/genetics , DNA Mutational Analysis , Erythrocytes/chemistry , Female , Folic Acid Deficiency/enzymology , Folic Acid Deficiency/epidemiology , Folic Acid Deficiency/metabolism , Gene Frequency , Genetic Predisposition to Disease , Genotype , Homocysteine/metabolism , Humans , Infant, Newborn , Male , Maternal-Fetal Exchange , Methylenetetrahydrofolate Reductase (NADPH2) , Mexico/epidemiology , Mutation, Missense , Neural Tube Defects/mortality , Pregnancy , Pregnancy Outcome , Risk Factors , Spinal Dysraphism/etiology , Spinal Dysraphism/mortalityABSTRACT
OBJECTIVE: To evaluate the effect of weekly administration of 5 mg. folic acid (FA) intake on folic acid blood levels. MATERIAL AND METHODS: This concurrent comparative study was conducted in 1998, in urban and rural areas of Nuevo Leon State, Mexico. The study population consisted of 74 women who delivered a child during 1997, 39 of whom had a child with a neural tube defect. Women were given 5 mg. of folic acid, weekly for 3 months. Blood levels of folic acid were determined by radioimmunoassay (RIA) at baseline, and a week after taking the last folic acid dose. Data are presented as means and standard deviations. RESULTS: Ninety per cent of the women had significantly increased folic acid intraerythrocytary blood levels. Red cell folate increased from 150.49 +/- 31.17 ng/ml to 184.21 +/- 35.53 ng/ml (p < 0.005). Plasma folate increased from 5.93 +/- 1.98 ng/ml a 7.03 +/- 2.5 ng/ml (p < 0.05). Eighty-two per cent of women reached intracellular levels above 160 ng/ml. CONCLUSIONS: The weekly administration of folic acid is a simple and efficient method that could be used to supplement this vitamin to low-income populations. The English version of this paper is available at: http://www.insp.mx/salud/index.html.
