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Nutrients Mar 2024Zinc, magnesium, and vitamin K are important nutrients for humans. There are various factors that contribute to the development of their deficiency, which might result... (Review)
Review
Zinc, magnesium, and vitamin K are important nutrients for humans. There are various factors that contribute to the development of their deficiency, which might result in or exacerbate various diseases. These nutrients can also interact with vitamin D metabolism and activity. This review discusses the main aspects of zinc, magnesium and vitamin K metabolism and action in the body, their clinical significance, and the "crosstalk" with vitamin D, as well as providing general suggestions for clinical practice when supplementation with these nutrients might be useful, in addition to vitamin D supplementation.
Topics: Humans; Magnesium; Zinc; Vitamin K; Dietary Supplements; Vitamin D; Vitamin D Deficiency
PubMed: 38542745
DOI: 10.3390/nu16060834 -
Journal of Shoulder and Elbow Surgery Feb 2024The effect of tranexamic acid (TXA) has been proven to be effective in reducing blood loss in lower limb arthroplasty. The aim of this study is to investigate the effect... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The effect of tranexamic acid (TXA) has been proven to be effective in reducing blood loss in lower limb arthroplasty. The aim of this study is to investigate the effect of TXA in shoulder surgery with the updated studies.
MATERIALS AND METHODS
A systematic review and meta-analysis of all the randomized controlled trials were conducted. We compared the outcomes of patients with and without TXA. The PubMed, MEDLINE, EMBASE, and CENTRAL databases were systematically searched for relevant studies.
RESULTS
A total of 14 studies, enrolling 1131 patients, were included for qualitative and quantitative analysis. Our results revealed that TXA was associated with a significant reduction in total volume blood loss (mean difference [MD]: -112.97, P = .0006), drain output (MD: -81.90, P < .00001), hemoglobin changes (MD: -0.55, P = .02), shorter operative time (MD: -6.19, P = .01), and lower risk of hematoma formation (odds ratio: -0.20, P = .01). The postoperative visual analog scale pain score was also significantly better in the TXA group (MD: -0.78, P < .00001). No significant difference was detected in length of hospital stay and incidence of thromboembolization.
CONCLUSION
The usage of TXA in shoulder surgery appeared to be safe and effective in reducing blood loss without any significant complication.
Topics: Humans; Antifibrinolytic Agents; Blood Loss, Surgical; Shoulder; Tranexamic Acid
PubMed: 37890768
DOI: 10.1016/j.jse.2023.09.024 -
Hamostaseologie Apr 2024Pulmonary embolism (PE) is the third most common acute cardiovascular disease. The risk of PE increases with age and mortality is high. Patients are stratified into... (Review)
Review
Pulmonary embolism (PE) is the third most common acute cardiovascular disease. The risk of PE increases with age and mortality is high. Patients are stratified into hemodynamically stable versus unstable patients, as this has important implications for diagnosis and therapy. Since clinical signs and symptoms of acute PE are nonspecific, the clinical likelihood of PE is estimated to guide diagnostic pathways. D-dimer testing is performed in hemodynamically stable patients with low or intermediate probability of PE and the visualization of thromboembolism and its sequelae is commonly achieved with computed tomography pulmonary angiography (CTPA), supplemented by ultrasound techniques. With confirmed PE, another risk stratification estimates disease severity and defines intensity and setting of the ensuing treatment. The therapeutic spectrum ranges from outpatient treatment with initial oral anticoagulation to thrombolytic or interventional treatment in the intensive care unit or catheterization laboratory. In single cases, even acute surgical thrombectomy is attempted.
Topics: Pulmonary Embolism; Humans; Practice Guidelines as Topic; Fibrin Fibrinogen Degradation Products; Anticoagulants; Computed Tomography Angiography; Thrombolytic Therapy
PubMed: 38688269
DOI: 10.1055/s-0044-1779011 -
Journal of Medical Toxicology :... Apr 2024
Topics: Humans; Tranexamic Acid; Drug Overdose; Blood Loss, Surgical
PubMed: 38334906
DOI: 10.1007/s13181-024-00989-z -
Arteriosclerosis, Thrombosis, and... Feb 2024Leaflet calcification contributes to the development and progression of aortic valve stenosis. Vitamin K activates inhibitors of vascular calcification and may modulate...
BACKGROUND
Leaflet calcification contributes to the development and progression of aortic valve stenosis. Vitamin K activates inhibitors of vascular calcification and may modulate inflammation and skeletal bone loss. Therefore, we aimed to determine whether higher dietary intakes of vitamin K are associated with a lower incidence of aortic stenosis.
METHODS
In the Danish Diet, Cancer and Health study, participants aged 50 to 64 years completed a 192-item food frequency questionnaire at baseline, from which habitual intakes of vitamin K were estimated. Participants were prospectively followed using linkage to nationwide registers to determine incident aortic valve stenosis (primary outcome) and aortic stenosis with subsequent complications (aortic valve replacement, heart failure, or cardiovascular disease-related mortality; secondary outcome).
RESULTS
In 55 545 participants who were followed for a maximum of 21.5 years, 1085 were diagnosed with aortic stenosis and 615 were identified as having subsequent complications. Participants in the highest quintile of vitamin K intake had a 23% lower risk of aortic stenosis (hazard ratio, 0.77 [95% CI, 0.63-0.94]) and a 27% lower risk of aortic stenosis with subsequent complications (hazard ratio, 0.73 [95% CI, 0.56-0.95]), compared with participants in the lowest quintile after adjusting for demographics and cardiovascular risk factors.
CONCLUSIONS
In this study, a high intake of vitamin K-rich foods was associated with a lower incidence of aortic stenosis and a lower risk of aortic stenosis with subsequent complications.
Topics: Humans; Vitamin K 1; Aortic Valve Stenosis; Aortic Valve; Vitamin K; Eating; Risk Factors; Vitamin K 2
PubMed: 38152887
DOI: 10.1161/ATVBAHA.123.320271 -
Aesthetic Plastic Surgery Dec 2023Hematomas are common complications following plastic and esthetic surgeries. Large and complex hematomas might result in prolonged hospitalization, further... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Hematomas are common complications following plastic and esthetic surgeries. Large and complex hematomas might result in prolonged hospitalization, further interventions, additional expenses, and poor esthetic outcome. Tranexamic acid (TXA), an antifibrinolytic agent, has long been used to reduce blood loss. Its use in the field of plastic surgery has gained popularity recently. Several studies have presented the ability of TXA to reduce blood loss, hematomas, and ecchymoses after liposuctions. However, the proper dose and the route of administration remained controversial.
OBJECTIVE
The objective of the study was to quantify the effect of a low dose of TXA in an irrigation method in reducing hematomas and ecchymoses following liposuction.
METHODS
A prospective randomized controlled trial was conducted. Following liposuction, 400 mg of TXA were administered in an irrigation protocol to one side of the body in each patient, while the other side was administered with saline. The patients were photographed on 1, 2, 4, and 11 post-operative days. Ecchymosis and hematoma were measured and rated.
RESULTS
No statistical difference was observed between the intervention and control groups in terms of RBC in liposuction area (p = 0.11), RBC in lipoaspirate (p = 0.79), bruising size on days 1, 2, 4, and 11 (p = 0.68, 0.21, 0.42, and 0.75), and average ecchymosis score on the same days (p = 0.34, 0.72, 0.09, and 1) CONCLUSIONS: The use of a low-dose TXA irrigation solution did not demonstrate a statistically significant difference in post-operative hematoma formations rates and subsequent ecchymosis size and scale.
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 .
Topics: Humans; Tranexamic Acid; Lipectomy; Ecchymosis; Prospective Studies; Treatment Outcome; Hematoma; Double-Blind Method; Blood Loss, Surgical
PubMed: 37488309
DOI: 10.1007/s00266-023-03499-5 -
The Journal of Nutrition Mar 2024
Topics: Vitamin K; Risk Factors; Vitamin K 1
PubMed: 38246356
DOI: 10.1016/j.tjnut.2024.01.014 -
BJOG : An International Journal of... Sep 2023To examine the safety, efficacy and pharmacology of intravenous (IV), intramuscular (IM) and oral tranexamic acid (TXA) use in pregnant women. (Randomized Controlled Trial)
Randomized Controlled Trial
Alternative routes for tranexamic acid treatment in obstetric bleeding (WOMAN-PharmacoTXA trial): a randomised trial and pharmacological study in caesarean section births.
OBJECTIVE
To examine the safety, efficacy and pharmacology of intravenous (IV), intramuscular (IM) and oral tranexamic acid (TXA) use in pregnant women.
DESIGN
Randomised, open-label trial.
SETTING
Hospitals in Pakistan and Zambia.
POPULATION
Women giving birth by caesarean section.
METHODS
Women were randomised to receive 1 g IV, 1 g IM, 4 g oral TXA or no TXA. Adverse events in women and neonates were recorded. TXA concentration in whole blood was measured and the concentrations over time were examined with population pharmacokinetics. The relationship between drug exposure and D-dimer was explored. The trial registration is NCT04274335.
MAIN OUTCOME MEASURES
Concentration of TXA in maternal blood.
RESULTS
Of the 120 women included in the randomised safety study, there were no serious maternal or neonatal adverse events. TXA concentrations in 755 maternal blood and 87 cord blood samples were described by a two-compartment model with one effect compartment linked by rate transfer constants. Maximum maternal concentrations were 46.9, 21.6 and 18.1 mg/L for IV, IM and oral administration, respectively, and 9.5, 7.9 and 9.1 mg/L in the neonates. The TXA response was modelled as an inhibitory effect on the D-dimer production rate. The half-maximal inhibitory concentration (IC ) was 7.5 mg/L and was achieved after 2.6, 6.4 and 47 minutes with IV, IM and oral administration of TXA, respectively.
CONCLUSIONS
Both IM and oral TXA are well tolerated. Oral TXA took about 1 hour to reach minimum therapeutic concentrations and would not be suitable for emergency treatment. Intramuscular TXA inhibits fibrinolysis within 10 minutes and may be a suitable alternative to IV.
Topics: Infant, Newborn; Humans; Female; Pregnancy; Tranexamic Acid; Cesarean Section; Antifibrinolytic Agents; Hemorrhage; Parturition; Administration, Intravenous
PubMed: 37019443
DOI: 10.1111/1471-0528.17455 -
JAMA Surgery Nov 2023
Topics: Humans; Tranexamic Acid; Brain Injuries, Traumatic; Intracranial Hemorrhages; Antifibrinolytic Agents
PubMed: 37755726
DOI: 10.1001/jamasurg.2023.3848 -
Handchirurgie, Mikrochirurgie,... Aug 2023Bleeding events in surgery are a problem and can lead to revision surgery and bleeding anaemia, which sometimes must be treated by blood transfusion. Tranexamic acid is...
BACKGROUND
Bleeding events in surgery are a problem and can lead to revision surgery and bleeding anaemia, which sometimes must be treated by blood transfusion. Tranexamic acid is an antifibrinolytic agent and is already known for its role in the prevention and treatment of perioperative bleeding in the fields of orthopaedics, cardiovascular surgery and gynaecology. In plastic surgery, the use of tranexamic acid is increasing in popularity and has already been described in individual studies.
METHODS
A literature search was performed using the database MEDLINE from the United States National Library of Medicine (NLM). The keywords "tranexamic acid in plastic surgery", "intravenous tranexamic acid in plastic surgery", "topical tranexamic acid in plastic surgery" and "subcutaneous tranexamic acid in plastic surgery" were used. The search was limited to the period from 2010 to 2023. The studies were analysed according to the level of evidence, validity and availability and divided into three groups for the topical, intravenous or subcutaneous application of tranexamic acid. Randomised controlled trials and non-randomised prospective and retrospective cohort studies were included in the systematic review. Studies from other disciplines, review articles, technical notes, experimental studies, letters to the editor, comments and case reports were excluded.
RESULTS
The literature search resulted in a total of 135 papers. Of these, 56 papers were assessed as relevant to plastic surgery. After further analysis, 41 papers were excluded using the exclusion criteria described above. Fifteen studies were finally included in the present work and recommendations for possible applications such as intravenous, topical and subcutaneous application of tranexamic acid, including the indications, contraindications and dosage formulas were developed.
DISCUSSION
Although the current study situation on the use of tranexamic acid is limited, the results show more advantages than disadvantages for perioperative use. Establishing the use of tranexamic acid in plastic surgery could facilitate the reduction of perioperative bleeding and lead to more precision in surgery, and it could enable a rapid removal of drains. However, following the analysis of benefit and risk factors, further randomised controlled trials are required for use in plastic surgery.
Topics: Humans; Tranexamic Acid; Surgery, Plastic; Prospective Studies; Retrospective Studies; Antifibrinolytic Agents; Hemorrhage
PubMed: 37473772
DOI: 10.1055/a-2082-1813