Characteristics, treatment and prognosis of patients with chronic heart failure according to ejection fraction. Results of an Ecuadorian registry.

BACKGROUND: In Ecuador, there are few data about the clinical behaviour of heart failure (HF). This study aims to analyse the clinical characteristics, treatment and prognosis according to the current classification based on left ventricular ejection fraction (EF). METHODS: A retrospective observational study was carried out in patients with chronic HF from the 'Los Ceibos' registry during the period January 2017-December 2022. Patients were classified into HF with preserved EF (HFpEF) [EF ≥ 50%], HF with mildly reduced EF (HFmrEF) [EF:41-49%], and HF with reduced (HFrEF) [EF ≤ 40%]. The patients were followed up for a mean time of 2.28 (IQR 1.25-3.49) years. RESULTS: A total of 711 patients were included, 333 (46.8%) with HFrEF, 109 patients (15.3%) with HFmrEF and 269 patients (37.8%) with HFpEF. The average age was 69.8 ± 13.1 years, 31.4% were women. The main comorbidity was arterial hypertension (92.7%). Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers were used in 74.5%, beta-blockers in 82.3%, and mineralocorticoid receptor antagonists in 51.3%. 58.3% of patients with HFrEF received three drugs of the so-called foundational quadruple therapy. A lower all-cause (24.5%) and cardiovascular mortality rate (11,2%) was observed in the HFpEF group compared to HFmrEF (47.4% and 25,7%) and HFrEF (45.3% and 25,8%), p < 0.001. CONCLUSIONS: In the 'Los Ceibos' registry, a higher prevalence of HFrEF was observed. The main comorbidity was HTN. Half of the patients with HFrEF received three drugs of the foundational therapy. At four years of follow-up, lower all-cause and cardiovascular mortality rate was observed in the HFpEF group.

Exploring the Entropy Complex Networks with Latent Interaction.

In the present work, we study the introduction of a latent interaction index, examining its impact on the formation and development of complex networks. This index takes into account both observed and unobserved heterogeneity per node in order to overcome the limitations of traditional compositional similarity indices, particularly when dealing with large networks comprising numerous nodes. In this way, it effectively captures specific information about participating nodes while mitigating estimation problems based on network structures. Furthermore, we develop a Shannon-type entropy function to characterize the density of networks and establish optimal bounds for this estimation by leveraging the network topology. Additionally, we demonstrate some asymptotic properties of pointwise estimation using this function. Through this approach, we analyze the compositional structural dynamics, providing valuable insights into the complex interactions within the network. Our proposed method offers a promising tool for studying and understanding the intricate relationships within complex networks and their implications under parameter specification. We perform simulations and comparisons with the formation of Erdös-Rényi and Barabási-Alber-type networks and Erdös-Rényi and Shannon-type entropy. Finally, we apply our models to the detection of microbial communities.

Gastrointestinal Stromal Tumors: A Review.

The understanding of aberrant molecular pathways that result in gastrointestinal stromal tumors (GISTs) and the rapid development of molecular therapies that target these pathways represent one of the great milestones in translational oncology. The story of GIST is unique in that targeted molecular therapy was successfully applied in clinical therapeutics, with dramatic results redefining the management of these traditionally chemotherapy-resistant tumors. We briefly review the molecular biology and clinical presentation of GIST and then discuss the adjuvant and neoadjuvant use of tyrosine kinase inhibitors in early-stage GIST and their use in metastatic disease. Newer therapeutic advances in the rapidly changing field of GIST management are also discussed.

Relevancia de los factores de riesgo cardiovascular en pacientes con enfermedad renal crónica terminal / Relevance of cardiovascular risk factors in patients with terminal chronic kidney disease

Introducción: La enfermedad cardiovascular constituye una comorbilidad importante y a la vez, la primera causa de muerte en los pacientes con enfermedad renal crónica. Objetivo: Describir la asociación entre los factores de riesgo y la enfermedad cardiovascular en pacientes en plan continuo de hemodiálisis. Método: Estudio descriptivo, longitudinal y retrospectivo con 49 pacientes que participaron en el plan continuo de hemodiálisis del Hospital Calixto García en el 2012. Para la asociación de las variables se utilizó el índice de probabilidades (odds ratio), con su intervalo de confianza y la prueba exacta de Fisher. Resultados: El 83,7 por ciento de los pacientes fueron hipertensos y el 71,4 por ciento tuvo hipertrofia del ventrículo izquierdo. La edad avanzada fue el factor de riesgo que más se asoció con dicha hipertrofia [OR=4,35 (IC=1,03-18,37); p=0.036]. Los factores de riesgo que se asociaron con la disfunción diastólica, fueron la hipertensión arterial [OR=9,88 (IC=1,11-87,90); p=0.021], la diabetes mellitus [OR=12,94 (IC=1,49-112,44); p=0.006] y la hipoalbuminemia [OR=4,67 (IC=1,09-19,90); p=0.030]. Ningún factor de riesgo se asoció con la valvulopatía mitral. Conclusiones: El antecedente patológico más prevalente fue la hipertensión arterial y la mayor parte de la población tenía hipertrofia del ventrículo izquierdo, que se asoció con la edad avanzada; de la misma forma, la hipertensión arterial, la diabetes mellitus y la hipoalbuminemia se asociaron con la disfunción diastólica. No se encontró asociación estadística entre la valvulopatía mitral y ninguno de los factores de riesgo analizados(AU)