Effect of the injectable contraceptive depot-medroxyprogesterone acetate on coagulation parameters in new users.

AIM: The aim of this study was to assess the effects of the injectable depot-medroxyprogesterone acetate (DMPA) contraceptive on selected blood coagulation parameters in young, healthy new users. METHODS: The prospective study included 39 healthy women aged 20-39 years, with a body mass index (BMI; kg/m2 ) < 30, who were never users of DMPA, and who opted to use DMPA (21 women) or a copper intrauterine device (IUD; 18 women). The women in the two groups were matched for age (±1 year) and BMI (±1). Blood samples were obtained from all participants at baseline and at 6 and 12 months. Activated partial thromboplastin time, D-dimer, protein C, antithrombin, protein S, and thrombin generation test (lag time, endogenous thrombin potential, time to peak, and velocity index of thrombin generation) were analyzed. Repeated-measures analysis of variance was used to compare the groups. RESULTS: There were no significant differences between the groups at baseline with respect to any of the parameters evaluated; however, in the DMPA group, D-dimer levels were lower and the time to peak thrombin generation was longer than in the IUD group at 12 months of evaluation. CONCLUSION: Lower D-dimer and longer time to peak thrombin generation in new users of DMPA suggest a positive profile against hypercoagulability.

Increased intraoperative bleeding in patients undergoing abdominoplasty after gastroplasty is not due to coagulopathy.

BACKGROUND: Abdominoplasties carried out in patients previously underwent gastroplasty present high rates of complications, including increased bleeding in the intra- and postoperative periods. METHODS: This study evaluated bleeding, coagulation parameters (coagulogram, dosage of fibrinogen, FII, FV, FVII, FVIII, FIX, FX, and FXII), and thromboelastography in two groups of women who underwent abdominoplasties: a group with a history of gastroplasty by the Fobi-Capella technique (group I) and the other group without a history of obesity (group II). Analyses were performed before, during, and after each surgical procedure. Vitamins K and C were also dosed. Bleeding was measured by counting and weighing compresses at the end of each surgery, and the withdrawn surgical specimens were weighed. RESULTS: Statistically, group I patients had more bleeding than group II in all evaluated operative periods (p = 0.007). There was no significant change in the coagulogram or decrease in coagulation factors that could be associated with increased bleeding in any of the analyzed groups. Thromboelastography, which provides a comprehensive analysis of thrombin generation and of hemostasis in real time, did not differ between groups. Vitamin K was significantly increased in group I patients (p = 0.019). The weight of the surgical specimens removed was significantly higher in group I (p = 0.007) and there was correlation of the weight with the degree of bleeding. CONCLUSIONS: The results of this study demonstrate an increase of bleeding during the intraoperative period of abdominoplasty in patients with a history of gastroplasty that it is not due to changes in hemostasis. LEVEL OF EVIDENCE IV: 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 .

SARS-CoV-2 infects adipose tissue in a fat depot- and viral lineage-dependent manner.

Visceral adiposity is a risk factor for severe COVID-19, and a link between adipose tissue infection and disease progression has been proposed. Here we demonstrate that SARS-CoV-2 infects human adipose tissue and undergoes productive infection in fat cells. However, susceptibility to infection and the cellular response depends on the anatomical origin of the cells and the viral lineage. Visceral fat cells express more ACE2 and are more susceptible to SARS-CoV-2 infection than their subcutaneous counterparts. SARS-CoV-2 infection leads to inhibition of lipolysis in subcutaneous fat cells, while in visceral fat cells, it results in higher expression of pro-inflammatory cytokines. Viral load and cellular response are attenuated when visceral fat cells are infected with the SARS-CoV-2 gamma variant. A similar degree of cell death occurs 4-days after SARS-CoV-2 infection, regardless of the cell origin or viral lineage. Hence, SARS-CoV-2 infects human fat cells, replicating and altering cell function and viability in a depot- and viral lineage-dependent fashion.

The importance of objectively measuring functional tests in complement to self-report assessments in patients with knee osteoarthritis.

BACKGROUND: Osteoarthritis (OA) is a chronic degenerative disease which can result in chronic pain, loss of joint function and consequently decline in quality of life. RESEARCH QUESTION: A variety of instruments that measure the different dimensions of health status in patients with OA are available. However, despite the fact that WOMAC and other questionnaires and scales may provide additional understanding regarding the patient's condition, some studies have reported discrepancies between patients' perceptions and their actual ability to perform the task. The aim of the present study was investigate the physical capabilities with the function domain of WOMAC. METHODS: This study has a cross-sectional design including patients diagnosed with moderate to severe knee OA (i.e., grades II, III and IV) according to the Kellgren-Lawrence. These patients were submitted to the battery of functional tests recommended by the OARSI group (30-second chair stand test, 40 m fast paced walking test, Stair climb test, timed "Up and Go", and Six-minute walking test) and filled the WOMAC. Pearson's correlation and multiple linear regression was applied. RESULTS: A total of 153 patients were included. A significant and weak correlation was observed between WOMAC and the 40-meter walking test, TUG, stair-climbing test, and the 6MWT. In addition, 30-second chair stand test demonstrated a significant and moderate correlation (r=-0.503). The multiple regression analysis results indicated that only 30-second chair stand test was a significant (p = 0.001) predictor of WOMAC. This result remains significant even after adjusting for age, BMI, total muscle mass, and number of knees affected SIGNIFICANCE: The 30-second chair stand test is associated with the WOMAC function domain. There is no correlation of this domain with any other functional tests, emphasizing the importance of including other tests for a global evaluation.

Studies on the components of the contact phase system in patients with acute nonlymphoblastic leukemia

The objective of the present study was to evaluate factors of the plasma kallikrein system in patients with acute nonlymphoblastic leukemia (ANLL), and compare the results to a normal control group. A prospective study was performed in the Tertiary Health Care Institution, Hemocentro, Campinas State University, Campinas, Sao Paulo, Brazil. Thirty-five patients, diagnosed as ANLL between 1988 and 1991, were considered for participation. Eleven patients were not elegible, according to the exclusion criteria: infection/septicemia, previous treatment of blood transfusion. The study was performed with 24 ANLL patients, average age 34 years (16-69 years), 14 men and 10 women. Nineteen healthy volunteers, workers from the Hematology Center, average age 32 years (21-59 years), 11 men and 8 women, were the control group. Plasmatic prekallikrein, C1-inhibitor, alpha 2-macroglobulin, activated partial thromboplastin time, prothrombin time, factor XII, factor XI, factor V and prealbumin were measured. Plasmatic prekallikrein (p=0.02) and prealbumin (p=0.03) were significantly decreased, and prothrombin time increased (p=0.003) in the patient group when compared to the control. Significant correlation (r=0.49, critical value=0.43, p<0.05) between prekallikrein and prealbumin, and between prothrombin time and factor V (r=0.54, critical value=0.44, p<0.05) was demonstrated in the patient group. No correlation was found between parameters analysed and circulant blast count or leukemia subgroups. Statistical analysis was performed by the Willcoxon test. Correlation between the parameters was also verified. These results suggest activation of the contact system or impaired liver synthesis in patients with ANLL, and could contribute to disease complications.

Uso de cola de fibrina na hemostasia dos tumores encefálicos / Use of fibrin glue to control tumor bed bleeding

Analisamos o uso de cola de fibrina na hemostasia do leito tumoral em nove pacientes submetidos à craniotomia para exérese do tumor. A cola de fibrina por nós utilizada é preparada com sangue do próprio doente, evitando-se, com isto, a contaminaçao por enfermidades transmitidas por transfusao. Utilizamos a cola de fibrina que é polimerizada no momento do seu uso, pela mistura de uma soluçao de fibrinogênio com outra soluçao, contendo trombina, na concentraçao de 300 U/ml e cloreto de cálcio. Estas soluçoes sao apresentadas em seringas separadas, em volumes iguais de 2 a 2,5 ml e injetadas no leito tumoral com a ponta das agulhas aproximadas para facilitar a mistura. O objetivo deste estudo foi o de padronizar o uso de um elemento autólogo como único coadjuvante da hemostasia do leito tumoral. A análise dos resultados demonstrou hemostasia adequada em todos os pacientes, dispensando-se o uso de elementos estranhos aplicados rotineiramente para controle da hemostasia, como "gelfoam" ou "surgicel".

Estudo da fibrinólise em meningeomas / Study of fibrinolysis in meningiomas

Neste trabalho apresentamos os parâmetros da hemostasia em 3 pacientes com diagnóstico de meningeomas intracranianos, submetidos a craniotomia e exérese completa do tumor. A análise foi feita antes da cirurgia, durante a exérese do tumor, no primeiro dia do pós-operatório e após o trigésimo dia da cirurgia. Foram dosados os seguintes parâmetros: Tempo de Protrombina (TP), Tempo de Tromboplastina Parcial Ativado (TTPA), Tempo de Trombina (TT), Plaquetas (PQ), Alfa-2-Macroglobulina (A2MC), C 1 inibidor (C1), Antitrombina III (AT III), Fator V (FV), Fibrinogênio (FIBR), Plasminogênio (PLASM), area de Lise em Placa de Fibrina (ALPF), Produto de Degradaçäo da Fibrina e Fibrinogênio (PDF), Procalicreina Plasmática (PK) e Pr'e-Albumina (PRE ALB). Este estudo demonstrou a ocorrência de fibrinólise no intraoperatório e primeiro dia do pós-operatório de intensidade variável para cada paciente. Sugerimos, com base neste trabalho e revisäo da literatura que, durante o manuseio dos meningeomas, ocorrendo grande sangramento que näo se justifique por lesöes de grandes vasos, se deva fazer uso de drogas inibidoras da plasmina (Acido tranexâmico, Gabaxate, Acido Epsilon Amino Caproico)