Unraveling the Paradox: Can Anticoagulation Improve Outcomes in Patients With Heart Failure and Increased Bleeding Risk?

Heart failure (HF) patients frequently present with comorbidities such as atrial fibrillation (AF) or other cardiovascular conditions, elevating their risk of thromboembolic events. Consequently, anticoagulation therapy is often considered for thromboprophylaxis, although its initiation in HF patients is complicated by concomitant bleeding risk factors. This review explores the paradoxical relationship between HF, increased bleeding risk, and the potential benefits of anticoagulation. Through an examination of existing evidence from clinical trials, observational studies, and meta-analyses, we aim to elucidate the role of anticoagulation in HF patients with increased bleeding risk. Despite guidelines recommending anticoagulation for certain HF patients with AF or other thromboembolic risk factors, uncertainty persists regarding the optimal management strategy for those at heightened risk of bleeding. The review discusses the pathophysiological mechanisms linking HF and thrombosis, challenges in bleeding risk assessment, and strategies to minimize bleeding risk while optimizing thromboprophylaxis. Shared decision-making between clinicians and patients is emphasized as essential for individualized treatment plans that balance the potential benefits of anticoagulation against the risk of bleeding complications. Furthermore, it examines emerging anticoagulant agents and their potential role in HF management, highlighting the need for further research to delineate optimal management strategies and inform evidence-based practice. In conclusion, while anticoagulation holds promise for improving outcomes in HF patients, careful consideration of patient-specific factors and ongoing research efforts are essential to optimize therapeutic strategies in this population.

Risk factors for acne scarring in Ecuador.

BACKGROUND: Acne is a common disease that is associated with scarring and substantial psychosocial burden. The Global Burden of Skin Disease reported that the burden from acne as measured by disability-adjusted life years (DALYs) from 188 countries and specifically that it is greatest in Western Europe, high-income North America and Southern Latin America. This paper aimed to identify risk factors for acne scarring specific to the Ecuadorian population in order to adapt the 4-ASRAT tool accordingly. METHODS: This was an observational prospective study. Participants were recruited to complete a survey that was developed based on the potential risk factors for acne scarring and had facial photographs taken. To determine risk factors and their respective weighting, a logistic regression was performed. RESULTS: The study included 404 participants. Results from univariate analyses indicated that being male (OR = 2.76 95%CI [1.72; 4.43]), having severe or very severe acne scarring (OR = 4.28 95%CI [1.24; 14.79]), acne duration over 1 year (OR = 1.71 95%CI [1.12; 2.60]), oily skin (OR = 2.02 95%CI [1.27; 3.22]) and the presence of acne on the neck (OR = 2.26 95%CI [1.30; 3.92]), were all significantly associated with the presence of acne scarring. Male sex (2.56 95%CI [1.58;4.17]), oily skin (1.96 95%CI [1.20;3.20]) and severe or very severe acne (3.75 95%CI [1.05;13.37]) remained significant risk factors for acne scarring in the multivariate analysis. CONCLUSION: By identifying acne scarring risk factors and applying the tool in everyday dermatology visits, we can reduce the physical and psychological burden that acne scarring causes in the adolescent and adult populations. Further research should be conducted to reassess potential risk factors and complete the adaptation of the tool for the Ecuadorian population, with a larger and more representative study population.

The Searsville Lake Site (California, USA) as a candidate Global boundary Stratotype Section and Point for the Anthropocene series.

Cores from Searsville Lake within Stanford University's Jasper Ridge Biological Preserve, California, USA, are examined to identify a potential GSSP for the Anthropocene: core JRBP2018-VC01B (944.5 cm-long) and tightly correlated JRBP2018-VC01A (852.5 cm-long). Spanning from 1900 CE ± 3 years to 2018 CE, a secure chronology resolved to the sub-annual level allows detailed exploration of the Holocene-Anthropocene transition. We identify the primary GSSP marker as first appearance of 239,240Pu (372-374 cm) in JRBP2018-VC01B and designate the GSSP depth as the distinct boundary between wet and dry season at 366 cm (6 cm above the first sample containing 239,240Pu) and corresponding to October-December 1948 CE. This is consistent with a lag of 1-2 years between ejection of 239,240Pu into the atmosphere and deposition. Auxiliary markers include: first appearance of 137Cs in 1958; late 20th-century decreases in δ15N; late 20th-century elevation in SCPs, Hg, Pb, and other heavy metals; and changes in abundance and presence of ostracod, algae, rotifer and protozoan microfossils. Fossil pollen document anthropogenic landscape changes related to logging and agriculture. As part of a major university, the Searsville site has long been used for research and education, serves users locally to internationally, and is protected yet accessible for future studies and communication about the Anthropocene. Plain Word Summary: The Global boundary Stratotype Section and Point (GSSP) for the proposed Anthropocene Series/Epoch is suggested to lie in sediments accumulated over the last ~120 years in Searsville Lake, Woodside, California, USA. The site fulfills all of the ideal criteria for defining and placing a GSSP. In addition, the Searsville site is particularly appropriate to mark the onset of the Anthropocene, because it was anthropogenic activities-the damming of a watershed-that created a geologic record that now preserves the very signals that can be used to recognize the Anthropocene worldwide.

Supervivencia de pacientes con cáncer de cérvix estadio clínico III y IV, sometidas a nefrostomía: Estudio descriptivo de centro único / Survival of patients with clinical stage III and IV cervical cancer undergoing nephrostomy: Descriptive study of a single center

Introducción: La cuarta parte de las mujeres con neoplasias ginecológicas cursa con obstrucción en la vía urinaria, secundaria a infiltración tumoral o compresión extrínseca de los uréteres. La nefrostomía es la alternativa clínica intervencionista para mejorar la nefropatía obstructiva y evitar el tratamiento de diálisis en un paciente oncológico con hidronefrosis. El presente estudio tiene el objetivo de determinar la supervivencia de pacientes con cáncer de cérvix portadoras de nefrostomía. Metodología: El presente estudio observacional se realizó en el Hospital Solón Espinosa Ayala "Solca-Núcleo de Quito" de enero-2014 a diciembre-2018. El cálculo muestral fue no probabilístico, se incluyeron casos de pacientes con cáncer de cérvix con nefrostomía. Las variables fueron: edad, su-pervivencia global, supervivencia con nefrostomía, tipo histológico de la neoplasia de cérvix, estadío, tratamiento oncológico luego de la nefrostomía, complicaciones y repuesta al tratamiento. Para el análisis se usó el método Kaplan Meier. Se analiza supervivencia según estadios funcionales ECOG . Resultados: Se incluyeron 96 casos en el estudio. La media de sobrevida luego de colocar la nefros-tomía fue de 277 días (9.2 meses), y la media de la sobrevida global fue de 462 días (15 meses). Las pacientes con ECOG-0 la supervivencia global fue de 625 días (20.8 meses), con ECOG 1, 2 y 3 fue de 437 días (14.5 meses) P= 0.013. Conclusión: Es este estudio las pacientes con cáncer de cérvix que tienen enfermedad localmente avanzada y metastásica con ECOG 0, son las más beneficiadas del procedimiento de nefrostomía con mejoría de la supervivencia. Las pacientes con enfermedad localmente avanzada y metastásica con ECOG 2 y 3, no mejoraron su sobrevida global con la colocación de nefrostomía, ya que a pesar de que recibieron tratamiento oncológico el 50% de ellas progresaron, pero evitaron el ingreso a programas de diálisis. La principal complicación luego de la colocación del catéter de nefrostomía fue la infección.

Introduction: A quarter of women with gynecological neoplasms present with obstruction in the urinary tract, secondary to tumor infiltration or extrinsic compression of the ureters. Nephrostomy is an interventional clinical alternative to improve obstructive nephropathy and avoid dialysis treatment in a cancer patient with hydronephrosis. The objective of this study was to determine the survival of patients with cervical cancer who underwent nephrostomy. Methodology: The present observational study was carried out at Solón Espinosa Ayala Hospital "Solca-Núcleo de Quito" from January 2014 to December 2018. The sample calculation was nonprobabilistic. Cases of patients with cervical cancer who underwent nephrostomy were included. The variables were age, overall survival, survival with nephrostomy, histological type of cervical neo-plasia, stage, oncological treatment after nephrostomy, complications, and response to treatment. For the analysis, the Kaplan­Meier method was used. Survival was analyzed according to ECOG func-tional stages. Results: Ninety-six cases were included in the study. The median survival after nephrostomy place-ment was 277 days (9.2 months), and the median overall survival was 462 days (15 months). Pa-tients with ECOG-0 had an overall survival of 625 days (20.8 months); those with ECOG 1, 2, and 3 had an overall survival of 437 days (14.5 months) (P= 0.013). Conclusion: In this study, patients with cervical cancer who had locally advanced and metastatic disease with ECOG 0 benefited the most from the nephrostomy procedure with improved survival. Patients with locally advanced and metastatic disease with ECOG scores of 2 and 3 did not improve their overall survival with nephrostomy placement. Fifty percent of them progressed despite receiving cancer treatment, but they avoided admission to dialysis programs. The main complication after placement of the nephrostomy catheter was an infection.

The impact of COVID-19 on alternative and local food systems and the potential for the sustainability transition: Insights from 13 countries.

The COVID-19 pandemic has been a major stress test for the agri-food system. While most research has analysed the impact of the pandemic on mainstream food systems, this article examines how alternative and local food systems (ALFS) in 13 countries responded in the first months of the crisis. Using primary and secondary data and combining the Multi-Level Perspective with social innovation approaches, we highlight the innovations and adaptations that emerged in ALFS, and how these changes have created or supported the sustainability transition in production and consumption systems. In particular, we show how the combination of social and technological innovation, greater citizen involvement, and the increased interest of policy-makers and retailers have enabled ALFS to extend their scope and engage new actors in more sustainable practices. Finally, we make recommendations concerning how to support ALFS' upscaling to embrace the opportunities arising from the crisis and strengthen the sustainability transition.

Pilot study for the evaluation and adaptation of a Four Item-Acne-Scar Risk Assessment Tool (4-ASRAT): a resource to estimate the risk of acne-induced scars.

Background: Acne-induced scarring is associated with a similar burden as acne, i.e. diminished quality of life, and may be avoided if patients receive appropriate and timely acne treatment. In 2017, a four item-Acne-Scar Risk Assessment Tool (4-ASRAT) was designed by Tan et al. to categorise patients with acne into lower-risk or higher-risk for acne scarring. Its applicability outside the initial study population (France, Brazil and United States) remains to be determined.  Methods: A study protocol was developed to create a systematic approach for validating and adapting 4-ASRAT to different populations, Ecuador in this case. The protocol was reviewed by 11 local and international dermatologists and pilot-tested in an Ecuadorian population using a sample of 10 participants who currently had or had had acne. Feedback from the pilot study was used to improve the study protocol. The results of the pilot study are included here, and the final study protocol is available as extended data.  Results: The protocol proved to be applicable. Images taken of participants were a valuable resource for dermatological evaluation about the presence or absence of acne scars. Tangential light is necessary for this evaluation. Although dermatological assessments varied, we concluded that assessment by three local dermatologists for each participant was adequate for reaching a consensus on the presence or absence of acne scars.   Conclusions: Considering the morbidity related to acne and acne scars, tools designed as prevention that alert patients about risk of developing scarring are necessary. The proposed protocol shows a feasible way of validating and adapting 4-ASRAT to different populations.