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In this research, emphasis is placed on the information and diagnostic phase of the physical environment for land-use planning (LUP). Our work is mainly focused on a land-planning case study of a tectonic depression, the Tulum Valley, which extends into the Pampean flat-slab segment. We propose the use of tectonic structures to define Environment Units (EUs) as necessary boundaries for the LUP. For this purpose, we have studied tectonic structures using geophysical methods and, subsequently, subjected multiple dimensions of the physical environment in the territory to an exhaustive analysis. Moreover, we have examined the influence of structural geology on water, soils, processes, materials and forms in the landscape. The study revealed the close and significant relationship between the different elements of the physical environment observable on the surface (shape, distribution, appearance, degree of development) and the tectonic structures, which supported the use of this criterion to define EUs. In order to test it, we applied the same methodology in another area of South America, the city of Bucaramanga, where it was possible to define EUs based on tectonics and to also establish comparisons. The methodology proposed for the diagnostic phase based mainly on the tectonic factor represents a challenge as regards its application in other active tectonic zones. Some limitations could arise such as fragmented environmental information from different institutions or the small to non-existent number of tectonic studies available. As a strong point, we find that the method allows achieving a comprehensive study of the environmental setting and thus to propose activities and land uses in each EU according to the real reception capacity of the land. This exhaustive analysis of the physical environment will also help decision-makers to understand and manage the socio-natural risks of the territory where communities develop., Competing Interests: Declaration of competing interest None., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objectives: This observational, cross-sectional study based aimed to test whether heart failure (HF)-disease management program (DMP) components are influencing care and clinical decision-making in Brazil., Methods: The survey respondents were cardiologists recommended by experts in the field and invited to participate in the survey via printed form or email. The survey consisted of 29 questions addressing site demographics, public versus private infrastructure, HF baseline data of patients, clinical management of HF, performance indicators, and perceptions about HF treatment., Results: Data were obtained from 98 centers (58% public and 42% private practice) distributed across Brazil. Public HF-DMPs compared to private HF-DMP were associated with a higher percentage of HF-DMP-dedicated services (79% vs 24%; OR: 12, 95% CI: 94-34), multidisciplinary HF (MHF)-DMP [84% vs 65%; OR: 3; 95% CI: 1-8), HF educational programs (49% vs 18%; OR: 4; 95% CI: 1-2), written instructions before hospital discharge (83% vs 76%; OR: 1; 95% CI: 0-5), rehabilitation (69% vs 39%; OR: 3; 95% CI: 1-9), monitoring (44% vs 29%; OR: 2; 95% CI: 1-5), guideline-directed medical therapy-HF use (94% vs 85%; OR: 3; 95% CI: 0-15), and less B-type natriuretic peptide (BNP) dosage (73% vs 88%; OR: 3; 95% CI: 1-9), and key performance indicators (37% vs 60%; OR: 3; 95% CI: 1-7). In comparison to non- MHF-DMP, MHF-DMP was associated with more educational initiatives (42% vs 6%; OR: 12; 95% CI: 1-97), written instructions (83% vs 68%; OR: 2: 95% CI: 1-7), rehabilitation (69% vs 17%; OR: 11; 95% CI: 3-44), monitoring (47% vs 6%; OR: 14; 95% CI: 2-115), GDMT-HF (92% vs 83%; OR: 3; 95% CI: 0-15). In addition, there were less use of BNP as a biomarker (70% vs 84%; OR: 2; 95% CI: 1-8) and key performance indicators (35% vs 51%; OR: 2; 95% CI: 91,6) in the non-MHF group. Physicians considered changing or introducing new medications mostly when patients were hospitalized or when observing worsening disease and/or symptoms. Adherence to drug treatment and non-drug treatment factors were the greatest medical problems associated with HF treatment., Conclusion: HF-DMPs are highly heterogeneous. New strategies for HF care should consider the present study highlights and clinical decision-making processes to improve HF patient care.

Objective: This exploratory study assessed the safety of the combination of sulfamethoxazole, trimethoprim and guaifenesin (STG) in adult and pediatric patients with acute bronchitis according to local labelling in Peru., Results: We enrolled 51 pediatric and 52 adult participants diagnosed with acute bronchitis and indication of STG. The mean ages were 7.6 years (SD ± 3.2 years) and 42.8 years (SD ± 16.1) and the proportion of female patients were 51% and 65%, respectively. The duration of treatment in pediatric patients was < 5 days in 2% of patients, 5 days in 13.7%, 6-7 days, in 82.4% and > 7 days in 2% while in adults patients it was < 5 days in 17%, 5 days in 69.2%; 6-7 days in 28.8% of patients. Adverse events (AEs) were registered in 9.6% and 19.2% of pediatric and adult patients, respectively. These AEs had definite relation of causality with the study drugs in 2 adults (20% of AEs) and possible causality with the study drugs in 4 pediatric (80% of AEs) and 2 adult cases (20% of AEs). Our results provide valuable data to develop trials of pharmacovigilance where different statistical parameters should be considered to calculate an adequate sample size in studies evaluating STG in pediatric or adult patients. Trial registration NCT02879981 and NCT02902640.

Advances in high-throughput technologies and their involvement in the 'omics' of cancer have made possible the identification of hundreds of biomarkers and the development of predictive and prognostic platforms that model the management of cancer from evidence-based medicine to precision medicine. Latin America (LATAM) is a region characterised by fragmented healthcare, high rates of poverty and disparities to access to a basic standard of care not only for cancer but also for other complex diseases. Patients from the public setting cannot afford targeted therapy, the facilities offering genomic platforms are scarce and the use of high-precision radiotherapy is limited to few facilities. Despite the fact that LATAM oncologists are well-trained in the use of genomic platforms and constantly participate in genomic projects, a medical practice based in precision oncology is a great challenge and frequently limited to private practice. In breast cancer, we are waiting for the results of large basket trials to incorporate the detection of actionable mutations to select targeted treatments, in a similar way to the management of lung cancer. On the other hand and paradoxically, in the 'one fit is not for all' era, clinical and genomic studies continue grouping our patients under the single label 'Latin American' or 'Hispanic' despite the different ancestries and genomic backgrounds seen in the region. More regional cancer genomic initiatives and public availability of this data are needed in order to develop more precise oncology in locally advanced breast cancer.

Chagas disease leads to congestive heart failure, apical aneurysm, and may cause stroke or systemic embolism for intraventricular thrombus. We present a case of a 61-year-old man admitted for stroke 5 months after a renal embolism. An intraventricular thrombus was observed, probably the source of the cerebral and renal embolisms. The patient refused warfarin and rivaroxaban was used instead. After 40 days of treatment the thrombus had dissolved, after 20 months of regular use of rivaroxaban no more embolic events were observed. The use of rivaroxaban was effective in preventing embolic events in Chagas disease and intraventricular thrombus. < Learning objective: Warfarin is recommended for stroke prevention in patients with Chagas disease and left ventricular dysfunction or apical aneurysm, even in the absence of thrombus. None of the new oral anticoagulants is recommended in this context. Rivaroxaban was safe and effective in preventing embolic events in a patient with Chagas disease and a ventricular thrombus.>.