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.

Background: Central venous catheters (CVC’s) are useful tools for the treatment of critically ill patients, especially in the emergency room, and are recognized for decreasing rates of failure and mechanical complications. Certain parameters can act as predictors to determine the likelihood of this type of complication. The aim of this study is to determine the incidence and predictors of mechanical complications using internal jugular venous (IJV) cannulation, especially when considering planned versus emergency cannulation. Methods: A prospective, observational study was performed at Hospital de los Valles, Quito, Ecuador, during a three-year period. All patients who presented to the emergency room with an indication for IJV cannulation and with no potential contraindications were included. Demographic, safety and procedure related data were collected. Variables were analyzed using STATA, and p-values <0.05 were considered significant. Results: A total of 142 patients were included. The majority of procedures (64%) were planned. The main indication for CVC placement via IJV cannulation was chronic renal failure (54%), all of which were planned procedures, followed by sepsis (15%), where most procedures (91%) were emergencies. The IJV was anatomically located lateral to the carotid artery in 38.73% of cases. Mechanical/technical complications were reported in 13 patients. Cannulation time greater than two minutes was found to be the only factor independently associated with a higher probability (12.4 times) of developing mechanical/technical complications. The vessel location did not affect the incidence of complications either in emergency or planned procedures when using ultrasound. Conclusions: Ultrasound-guided IJV cannulation is a safe technique that can be performed as an emergency or planned procedure without increased complication rates in the emergency room. Additionally, a puncture time of less than two minutes is associated with the safest profile in this patient population.

Background: Acne is a common disease that causes a large global disease burden. The Global Burden of Skin Disease reported that in 188 countries the burden from acne as measured by disability-adjusted life years (DALYs), years lived with disability and years of life lost is greatest in Western Europe, high-income North America and Southern Latin America. This paper aims 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 male sex (OR=2.76 95%CI [1.72; 4.43]), 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 population. Further research should be performed to reassess potential risk factors and complete the adaptation of the tool for the Ecuadorian population, with a larger and more representative study population.

In December 2019, an outbreak of a new coronavirus disease (formally known as COVID-19) was first reported in Wuhan, China, and soon spread around the world. On March 11, 2020, COVID-19 was declared as a pandemic by the World Health Organization (WHO). So far, COVID-19 has proven to be a disease with multiorgan involvement, affecting the hematological system as well. Patients with COVID-19, especially those with moderate to severe disease, frequently experience a coagulopathy associated with a high incidence of thrombotic events, which leads to poor outcomes. The pathogenesis of COVID-associated coagulopathy (CAC), is not fully understood yet, although the host inflammatory response to the infection appears to be a crucial element in the development of CAC. IL2, IL-6, IL7, G-CSF, PI10, MIP1, and TNF alpha, among other molecules, act as proinflammatory cytokines that stimulate endothelium damage and alter the coagulation homeostasis. CAC usually manifests as venous thromboembolisms (VTE). While bleeding can also occur, it is a rare form of presentation. Inpatients with COVID-19 must receive thromboprophylaxis, mainly with low-molecular-weight heparin (LMWH); unfractioned heparin can be accepted under certain circumstances. Patients with a diagnosis or high suspicion of VTE should receive the complete doses of anticoagulation treatment and must continue on it for at least three months. Recommendations regarding prophylaxis and treatment may vary among institutions and countries. There is not clear evidence for the regular use of antiplatelet therapy in patients with COVID-19. This review will provide key insights regarding the pathophysiology, clinical manifestations, diagnosis and treatment of COVID-19 and its associated coagulopathy.