Use of rivaroxaban and acetylsalicylic acid as a combined treatment for peripheral arterial disease in Central Military Hospital

Background: The objective of this research was to evaluate the behavior of 3 risk indicators for peripheral arterial disease in patients under oral treatment with rivaroxaban 2.5 mg every 12 hours plus, acetylsalicylic acid 100 mg every 24 hours. It was hypothesized that the oral combination of rivaroxaban and acetylsalicylic acid presents a therapeutic advantage over other treatments.Methods: A prospective longitudinal and non-randomized study of a single center was performed. 59 patients with peripheral arterial disease were included and treated with acetylsalicylic acid + rivaroxaban. Peak systolic velocity, ankle-brachial index and C reactive protein index were evaluated.Results: Significant changes were found at month 1 and 3 of follow-up in maximum systolic velocity, ankle-arm index and C-reactive protein index. The baseline peak systolic velocity (PSV) in the anterior tibial artery had significant differences after one month of treatment (p=0.001) and after 3 months (p=0.001). The baseline PSV in the posterior tibial artery had significant differences compared to the values found at the month of treatment (p=0.001) and 3 months (p=0.001). In the ankle-brachial index a baseline median of 0.790 was found, one month after the treatment of 0.795 (p=0.147) and 3 months after 0.800 (p=0.019). The mean baseline C-reactive protein obtained was 73.142 mg/l, at one month 87.233 mg/l (p=0.001) and at 3 months at 79.009 mg/l (p=0.294) with a standard deviation of 67.18, 74.78 and 69.69 respectively.Conclusions: The combined use of acetylsalicylic acid and rivaroxaban allows a clinical improvement in patients with peripheral arterial disease

Breast reconstruction: a review

Surgeons in the late 19th - 20th century performed radical mastectomies as the only possible treatment for breast cancers. Since then, the medical-surgical/scientific community has been constantly encouraged to develop and study different less invasive alternatives in breast reconstruction. Over time, locoregional perforator flap options have served as practical alternatives to implant-based reconstruction and abdominal flaps, especially in the setting of patients who have received radiation therapy or have a history of failed reconstruction, as they effectively fill the missing volume and respect the musculature of the donor site. Breast reconstruction using strategies with one of the different locoregional flaps can preserve the musculature and innervation of the post-mastectomy site, which manages to reduce possible adverse events. In addition to evaluating the anatomical characteristics of the defect and affected quadrant, it is essential to assess the patient's body constitution and the skills of the surgical team as well as microsurgery training when designing a reconstructive plan. Different research protocols should be developed in the study and development of new medical-surgical therapeutic alternatives; we suggest joint development with tissue engineering

Intentional replantation: case report

Intentional reimplantation is a procedure in which an intentional tooth extraction is performed followed by reinsertion of the extracted tooth. We present the case of a 50-year-old male patient who came to the consultation due to incrustation detachment in tooth #37, when performing the radiographic study an extensive apical lesion was observed in tooth #36 with a sinuous path and the presence of purulent exudate. The tooth #36 was extracted, apicoectomy, retro preparation and retrograde filling were carried out for later reimplantation, showing bone regeneration after one year of evolution

Endodontic regenerative treatment for internal radicular resorption using bio-ceramic material, case report

The internal resorption of the internal radicular conduct is a process than can be both physiological or pathological, being the osteoclasts, odontoclasts and dentinoclast responsible for said process. 49-year-old female patient, refers orthodontic treatment at age 20, attends a dental check-up due to pain when chewing. Dental organ (DO) #11 was diagnosed with internal root resorption and symptomatic, suppurative apical periodontitis. Treatment started performing an endodontic access and taking a conductometry reading with an apical foramen locator, using a precision hybrid instrumentation technique and applying hypochlorite irrigation, the intra-canal was medicated with chemically pure calcium hydroxide for 7 days. The canal obturation was repaired infiltrating a bio-ceramic material (BIO-C Sealer) followed by the placement of the single cone using a vertical condensation technique

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Circadian locomotor activity rhythm in the freshwater crab Pseudothelphusa americana (De Saussure, 1857): Effect of eyestalk ablation

The circadian rhythm of locomotor activity in the freshwater crab, Pseudothelphusa americana, was studied in aquaria using infrared crossing sensors. Individuals with ablated eyestalks were compared with intact individuals in constant darkness (DD) and in light-dark cycles (LD). Our results showed that intact animals in DD displayed bimodal rhythms. In LD conditions the two peaks were associated with lights on and lights off, respectively. A significant difference in the free running periods before and after LD was observed in all intact animals. After eyestalk ablation (ES-X), the circadian rhythm of locomotor activity disappeared immediately, but reappeared several days later. Diurnal activity was seen in some ES-X animals when exposed to LD. Our results indicate that locomotor activity rhythm in P americana is driven primarily by oscillators located outside the eyestalks, and that extraretinal photoreceptors mediate either entrainment or masking effects

Circadian locomotor activity under artificial light in the freshwater crab Pseudothelphusa americana

Long-term recordings of locomotor activity were obtained from intact freshwater crabs, Pseudothelphusa americana in constant darkness (DD), constant light (LL) and different light-dark (LD) protocols. Bimodal rhythms were typically observed in this crab when subjected to DD or LD, with bouts of activity anticipating lights-on and lights-off, respectively. Freerunning circadian rhythms were expressed in both DD and LL for longer than 30 days. In DD, we observed that some animals presented different period lengths for each activity component. During LL, activity was primarily unimodal, however spontaneous splitting of the rhythms were observed in some animals. When activity was recorded under artificial long days, the morning bouts maintained their phase relationship but the evening bouts changed their phase relationship with the Zeitgeber. Our results indicate that, bimodal locomotor activity rhythm in the crab Pseudothelphusa americana is variable among organisms. The characteristics of phase relationship with LD and responses to LL for morning and evening bouts, suggest that, locomotor activity could be driven by multiple oscillators, and that coupling between these oscillators may be regulated by light

Circadian locomotor activity in the juvenile red eared turtle Trachemys scripta elegans: free running and entrainment

Long-term circadian locomotor activity under different light conditions and its corresponding free running periods were studied in the juvenile red-eared turtle Trachemys scripta elegans. Diurnal activity and a long free running period in darkness was observed in LD 12:12, skeleton photoperiod, and long and short days (LD 16:08, LD 08:16, respectively). Anticipation of activity to lights-on and length of activity phase depends on the photoperiod used. After-effects were observed in free running conditions after long day photoperiods. Constant light effect produces mainly the lack of circadian rhythm after a few days of period lengthening and the lack of rhythm may persist for a few days after re-entering constant darkness conditions. The results of the present report indicate that in T. scripta elegans, it is suitable to perform studies on circadian biology in juvenile turtles and its interaction with changes of photoperiod at constant temperature