Efficacy and Safety of Tranexamic Acid for the Control of Surgical Bleeding in Patients Under Liposuction.

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.

Molusco contagioso: actualización y casos clínicos / Molluscum contagiosum: an update and clinical cases

El molusco contagioso es una patología viral benigna muy frecuente, exclusiva del ser humano, y causada por un virus no clasificado del grupo de los Poxvirus. Las manifestaciones clínicas de la enfermedad inclu-yen lesiones en la piel, que pueden variar desde una pequeña pápula a un nódulo de mayor tamaño, pre-sentándose en forma solitaria o múltiple, dependien-do del estado inmunitario del paciente y del tiempo de evolución del proceso morboso. El estudio histo-patológico es importante para el diagnóstico, aunque en numerosas ocasiones éste se define clínicamen-te. Además del patrón histológico tradicional, y más frecuente, que exhibe hiperplasia e hipertrofia de la epidermis, se han descripto variantes poco usuales, cuyas características dependen, entre otros factores, de la sobreinfección y de la respuesta inmunitaria del paciente. En este trabajo se describen los rasgos ge-nerales del molusco contagioso y luego se presentan varios casos clínicos, uno de los cuales exhibe ma-nifestación inusual en la semimucosa del labio. Por último, se realizan comentarios referentes a la im-portancia que tiene para el odontólogo conocer esta patología y estar capacitado para detectarla, de modo de evitar sus complicaciones y su diseminación (AU)

Molluscum contagiosum is a very common benign viral pathologythat affects exclusively humans and is caused by an unclassified virus of the Poxvirus family. Clinical manifestations include skin lesions such as papule or nodule, which may range from a small papule to a larger nodule, presenting either solitary or multiple, depending on the immune status of the patient and the time of evolution of the morbid process. Histopathological study is important for the diagnosis, although in numerous occasions it is defined clinically. Classical and more frequent histology pattern exhibits hyperplasia and hypertrophy of the epidermis; however, distinct characteristics may occur depending on factors like superinfection and immune response of patients. This article describes general aspects of molluscum contagiosum and exposes several clinical cases, one of which exhibits an unusual manifestation in the semimucosa of the lip. Finally, comments are made regarding the importance for dentists to learn about the existence of this pathology and be able to recognize it in order to avoid its complications and spread (AU)

Tiroides Ectópica Lingual: caso Clínico / Lingual Ectopic Thyroid: a clinical case

La tiroides ectópica lingual es una patología muy poco frecuente, producida por la detención en el descenso normal de la glándula durante el desarrollo embrio-nario. La localización lingual de tejido tiroideo es la más común entre las tiroides ectópicas o aberrantes. Esta enfermedad puede ser asintomática pero, cuan-do los signos y síntomas están presentes, guardan estrecha correlación con la localización de la lesión y son proporcionales a su tamaño. El diagnóstico debe realizarse clínicamente y con el complemento de es-tudios por imágenes y endocrinológicos. En los aná-lisis de laboratorio se debe incluir dosaje de las hor-monas TSH, T4 libre y T3, vinculadas con la función tiroidea. Las biopsias deben evitarse ya que causan desequilibrio en la producción hormonal de la glándu-la y peligro de profusas hemorragias. En este artículo se desarrolla una descripción de las generalidades de la tiroides ectópica lingual, y se presenta un caso clínico de un niño con un tumor lingual, que fue deri-vado por su médica pediatra a cirugía para realizar una biopsia. Asimismo, se comenta la importancia que tiene para el odontólogo conocer esta patología a fin de poder evitar sus posibles complicaciones (AU)

Lingual thyroid is a rare disorder produced by a failure in the descent of thyroid gland to its normal position during embryological development. Lingual localization of thyroid tissue is the most common among the ectopic or aberrant thyroids. This condition can be asymptomatic, although when symptoms take place, they are connected to the lesion location and depend on its size. Diagnosis should be made clinically and complemented with imaging and endocrine studies. Laboratory analysis must include dosage of TSH, free T4 and T3, thyroid function-linked hormones. Due to the possible imbalance in the gland hormone production and the risk of massive bleeding, biopsy should be avoided. In this article, a brief description of lingual ectopic thyroid generalities is developed and a clinical case of a 7-years old child is provided. Additionally, dentistry importance of knowing this condition is commented, in order to prevent its possible complications (AU)

[Effects of high frequency chest wall oscillatory (HFCWO) therapy on gas exchange and ventilation in healthy participants]. / Efectos en población sana de la terapia con oscilación de alta frecuencia sobre la pared torácica (HFCWO) a nivel de la dinámica de gases pulmonares y de la mecánica respiratoria.

INTRODUCTION: Chest physiotherapy is an essential part of the treatment of respiratory diseases with increased respiratory secretion and ineffective cough. To date, there have been no studies on the effect of high frequency chest wall oscillatory (HFCWO) therapy on respiratory muscle strength, ventilation and gas exchange. The aim of this study was therefore to assess these three factors in healthy participants. METHODS: Respiratory muscle strength was measured before and immediately after HFCWO therapy in 25 healthy participants. During the treatment, we continuously measured ventilation parameters, gas exchange, oxygen saturation and heart rate. All participants underwent HFCWO sessions twice (with 24hours difference) with the same procedure. Symptoms during the session and discomfort were measured with the visual analog scale (VAS). RESULTS: HFCWO therapy produced a change in breathing pattern with increased ventilation associated with altered gas exchange. Heart rate also increased, with no changes in oxygenation. There was no effect, either beneficial or deleterious, on the strength of respiratory muscles. Up to 20% of participants reported substantial discomfort (VAS≥5/10) during the session. CONCLUSIONS: This study shows that, during the application of HFCWO therapy in healthy participants, ventilation and heart rate increased. However, there were undesirable effects on gas exchange with a high degree of intolerance among volunteers, with no effects on respiratory muscle strength.

Analysis of association of FOXO3 gene with Trypanosoma cruzi infection and chronic Chagasic cardiomyopathy.

FOXO3, a member of the Forkhead family of proteins, plays a role in controlling immune response. FOXO3 gene variant rs12212067 has been associated to differential severity of infectious diseases like malaria. In this study, we assessed whether this FOXO3 gene polymorphism is related to susceptibility to infection by Trypanosoma cruzi and/or chronic Chagasic cardiomyopathy. A total of 1171 individuals from a Colombian region endemic for Chagas disease, classified as seronegative (n = 595), seropositive asymptomatic (n = 175) and chronic Chagasic cardiomyopathy (n = 401) were genotyped for the FOXO3 rs12212067 using TaqMan allelic discrimination. Our results showed no statistically significantly differences between allelic and genotypic frequencies of rs12212067 in seronegative individuals compared with seropositive individuals. Similarly, we observed no evidence of association when asymptomatic individuals were compared with chronic Chagasic cardiomyopathy patients. Our data suggest that the FOXO3 genetic variant rs12212067 do not play an important role in Chagas disease.

Casein kinase 2 (CK2) increases survivin expression via enhanced beta-catenin-T cell factor/lymphoid enhancer binding factor-dependent transcription.

Increased expression of casein kinase 2 (CK2) is associated with hyperproliferation and suppression of apoptosis in cancer. Mutations in the tumor suppressor APC (adenomatous polyposis coli) are frequent in colon cancer and often augment beta-catenin-T cell factor (Tcf)/lymphoid enhancer binding factor (Lef)-dependent transcription of genes such as c-myc and cyclin-D1. CK2 has also been implicated recently in the regulation of beta-catenin stability. To identify mechanisms by which CK2 promotes survival, effects of the specific CK2 inhibitors 4,5,6,7-tetrabromobenzotriazole (TBB) and 2-dimethylamino-4,5,6,7-tetrabromo-1H-benzimidazole were assessed. TBB and 2-dimethylamino-4,5,6,7-tetrabromo-1H-benzimidazole significantly decreased proliferation and increased apoptosis of HT29(US) colon cancer cells. RT-PCR and immunoblot analysis revealed that both inhibitors decreased survivin mRNA and protein levels in HT29(US) cells. Similar effects were observed with TBB in human DLD-1 and SW-480 colorectal cells as well as ZR-75 breast cancer cells and HEK-293T embryonic kidney cells. Expression of GFP-CK2alpha in HEK-293T cells resulted in beta-catenin-Tcf/Lef-dependent up-regulation of survivin and increased resistance to anticancer drugs. Augmented beta-catenin-Tcf/Lef-dependent transcription and resistance to apoptosis observed upon GFP-CK2alpha expression were abolished by TBB. Alternatively, HEK-293T cells expressing GFP-survivin were resistant to TBB-induced apoptosis. Finally, siRNA-mediated down-regulation of CK2alpha in HEK-293T cells coincided with reduced beta-catenin and survivin levels. Taken together, these results suggest that CK2 kinase activity promotes survival by increasing survivin expression via beta-catenin-Tcf/Lef-mediated transcription. Hence, selective CK2 inhibition or down-regulation in tumors may provide an attractive opportunity for the development of novel cancer therapies.

Evaluación de la actividad antimalárica de algunas plantas utilizadas en la medicina tradicional cubana / Evaluation of the antimalarial activity in some Cuban medicinal plants

The search for new treatments against malaria has a highpriority in the fight to bring this disease under control. The aim of this study was to assess the therapeutic potential of extracts of plants selected on the basis of ethnobotanical information collected from Cuban traditional medicine. Extracts from six plants (Bambusavulgaris, Parthenium hysterophorus, Melaleuca leucadendron, Indigofera suffruticosa, Artemisia absinthium, Simarouba glauca) were tested for their invitro effect against the F32/Tanzania strain ofPlasmodium falciparum. S. glauca, P. hysterophorus, M.leucadendron and A. absinthium exhibited minimum inhibitory concentrations (MIC) in the range from 3.1to 50 g/mL, while B. vulgaris and I. suffruticosa showed negative activity against this strain. The highest in vivo activities against Plasmodium berghei NK65 were shownby A. absinthium, with a 65.9% reduction in parasitemia at a dose of 500 mg/kg, M. leucadendron, with 50%reduction at 250 mg/kg, and S. glauca, with 43.2%reduction at 100 mg/kg. The less toxic extracts wereA. absinthium and M. leucadendron. These results demonstrate the antimalarial properties of some Cuban medicinal plants and pave the way to detailed researchon their active chemical constituents.

[Permanent AV junction (Coumel type) reciprocal tachycardia]. / Taquicardia reciprocante permanente de la unión AV (tipo Coumel).

UNLABELLED: Permanent auriculo-ventricular junctional reciprocating tachycardia is a special form of tachycardia usually incessant, secondary to an slow retrograde conduction pathway. OBJECTIVE: To establish the clinical, electrophysiological characteristics and therapy results in patients with this diagnosis. METHOD: Descriptive study. RESULTS: Nine patients with average age 28.1 +/- 19.2 years, six women. Seven patients presented with dyspnea or palpitations. The left ventricular ejection fraction before treatment was 43.3 +/- 19.5%. The electrocardiographic findings were: heart rate of 139.2 +/- 16.7 bpm, QRS 78.9 +/- 16.2 ms and RP'/P'R relation of 1.8 +/- 0.5. The location of the accessory pathways was: right postero-septal in seven (77.7%), left lateral in one (11.15%) and left postero-lateral in one (11.15%). Radiofrequency ablation was performed in eight patients with an 87.5% success rate, two cases were taken to surgery with successful treatment, one of them after percutaneous ablation failure. Those with systolic left ventricular dysfunction recover their function in the follow-up. Any case has recurred. CONCLUSIONS: In our center, permanent auriculo-ventricular junctional reciprocating tachycardia is an infrequent arrhythmia, predominantly in women and associated with reversible left ventricular dysfunction. Right postero-septal was the most frequent localization of the pathway. Radiofrequency ablation was performed successfully in 87.5% of cases.

Point mutations induced by 1,2-epoxy-3-butene N1 deoxyinosine adducts.

The National Toxicology Program has recently classified 1,3-butadiene (BD) as a human carcinogen. BD is metabolized to the intermediates 1,2-epoxy-3-butene (EB), 1,2:3,4-diepoxybutane (DEB), and 1,2-dihydroxy-3,4-epoxybutane. All three metabolites have been implicated in producing specific types of DNA damage and as genotoxic agents in mice, rat, and human cells. This study has focused on EB-induced N1 deoxyinosine lesions that are formed by deamination of deoxyadenosine following reaction of the epoxide at the N(1) position. The R and S stereoisomers of this lesion were incorporated site-specifically within the context of an 11-mer oligodeoxynucleotide, incorporated into M13mp7L2 single-stranded DNA, and transfected into E. coli. Both stereoisomers modestly reduced plaque-forming ability, indicating that neither lesion presents a base modification that cannot be bypassed. The resulting plaques were assessed for point mutations using differential hybridization and DNA sequence analyses. The overall mutagenic spectrum revealed that the N1 adducts were highly mutagenic (approximately 90% per replication cycle), causing a predominance of A --> G transitions.

Control of Trypanosoma cruzi infection in mice deprived of T-cell help.

The role of CD4+ T lymphocytes in the resistance of BALB/c mice to Trypanosoma cruzi was examined by in vivo depletion using monoclonal anti-CD4 antibodies (MoAbs). When the administration of MoAbs was initiated 2 days before, or 5 to 12 days after the infection (dpi) with 50 bloodstream-form trypomastigotes of the Tulahuén strain, mice showed an enhanced susceptibility to the parasite. Specific IgG, but not IgM responses, were inhibited in anti-CD4-treated and infected mice. However, when anti-CD4 treatment of mice was delayed until the 8th week of infection, neither a reactivation of the infection as determined by mortality or parasitaemia, nor a modulation of the titre of anti-T. cruzi IgG antibodies was detected. Furthermore, mice chronically infected with T. cruzi and deprived of CD4+ T cells resisted the challenge with 50,000 trypomastigotes (approximately 1000 LD50). Secondary antibody responses against parasite antigens were inhibited after in vitro depletion of CD4+ cells in chronically infected mice before boosting with T. cruzi antigens. However, recipients of CD4 or T-cell-depleted spleen cells from mice chronically infected with T. cruzi were protected when challenged with the parasite. The possibility that the parasite control is maintained by long-lived B cells capable of rapid differentiation into IgG-secreting plasma cells in the absence of T helper cells is discussed considering the present data.