Combination Olanzapine and Samidorphan for the Management of Schizophrenia and Bipolar 1 Disorder in Adults: A Narrative Review

Schizophrenia is a debilitating psychotic disorder characterized by positive symptoms such as delusions, hallucinations, and disorganized thoughts, and negative symptoms like lack of effect or motivation. Bipolar 1 disorder (B1D) is a psychiatric illness characterized by recurrent manic episodes in alternation with depressive episodes and interspersed periods of euthymia, ultimately resulting in psychological distress and impairment of daily functioning. Effective treatments are needed for both schizophrenia and B1D to reach the treatment goals of reducing the debilitating symptomology, improving social functioning and quality of life, and increasing the chances of recovery and more favorable long-term outcomes. To date, olanzapine is one of the most efficacious atypical antipsychotics (AAPs) for the treatment of both schizophrenia and B1D and is associated with fewer extrapyramidal effects compared to other treatments. However, compared to other AAPs, olanzapine is associated with a greater chance of metabolic syndrome, limiting its clinical use and affecting treatment compliance. Samidorphan mitigates the weight gain side effects of olanzapine by antagonizing μ-, κ-, and δ-opioid receptors. The use of combination drugs to treat psychiatric conditions is an emerging field with the goal of increasing therapeutic efficacy and decreasing undesirable side effects. Clinical trials have demonstrated combination on olanzapine and samidorphan (OLZ/SAM) treatment resulted in significantly less weight gain than olanzapine monotherapy. Clinical trial patients reported improvements in symptoms of psychosis, reduced weight gain, and overall satisfaction with their treatment. OLZ/SAM has been as shown to be a safe and effective pharmaceutical option for the clinical management of schizophrenia and B1D

Síndrome de Takotsubo perioperatorio : a propósito de un caso.

Up to 10% of patients with ST-segment elevation myocardial infarction do not have obstructive coronary lesions, MINOCA, from the acronym in English. The diagnosis of MINOCA is functional and includes causes such as type II acute myocardial infarction, dissection, coronary spasm and embolism, myocarditis, and Takotsubo syndrome. Takotsubo syndrome is a pathology with its own entity, characterized by a transient and reversible dysfunction of the left ventricle without coronary obstructive lesions. It usually has triggers that cause an excess of plasma catecholamines. Its form of presentation during the intervention can be in the form of hypotension, shock or arrhythmias. In the acute phase it can be serious and present serious complications. The first-line imaging test is echocardiography. Management is symptomatic of the complications that may appear, avoiding catecholaminergic drugs.Hasta un 10%  de los pacientes con infarto agudo de miocardio con elevación del segmento ST no presentan lesiones coronarias obstructivas, MINOCA , del acrónimo en inglés. El diagnóstico de MINOCA es funcional e incluye  causas como el infarto agudo de miocardio  tipo II, la disección,  el espasmo y  embolismo coronario, la miocarditis y  el síndrome de  Takotsubo.    El síndrome  de Takotsubo  es una  patología con entidad propia, caracterizada por una disfunción transitoria y reversible del ventrículo izquierdo sin lesiones obstructivas coronarias. Suele tener unos desencadenantes que provocan un exceso de catecolaminas plasmáticas. Su forma de presentación durante la intervención puede ser en forma de hipotensión, shock o arritmias. En la fase aguda puede ser grave y presentar serias complicaciones. La prueba de imagen de primera línea es la ecocardiografía. El manejo es sintomático de las complicaciones  que puedan aparecer, evitando los fármacos catecolaminérgicos

Historical Pathways for Opioid Addiction, Withdrawal with Traditional and Alternative Treatment Options with Ketamine, Cannabinoids, and Noribogaine: A Narrative Review

Even as prescription opioid dispensing rates have begun to decrease, the use of illicit opioids such as heroin and fentanyl has increased. Thus, the end of the opioid epidemic is not in sight, and treating patients that are addicted to opioids remains of utmost importance. Currently, the primary pharmacotherapies used to treat opioid addiction over the long term are the opioid antagonist naltrexone, the partial-agonist buprenorphine, and the full agonist methadone. Naloxone is an antagonist used to rapidly reverse opioid overdose. While these treatments are well-established and used regularly, the gravity of the opioid epidemic necessitates that all possible avenues of treatment be explored. Therefore, in this narrative review, we analyze current literature regarding use of the alternative medications ketamine, noribogaine, and cannabinoids in treating patients suffering from opioid use disorder. Beyond its use as an anesthetic, ketamine has been shown to have many applications in several medical specialties. Of particular interest to the subject at hand, ketamine is promising in treating individuals addicted to opioids, alcohol, and cocaine. Therapeutically administered cannabinoids have been proposed for the treatment of multiple illnesses. These include, but are not limited to epilepsy, Parkinson\u27s disease, multiple sclerosis, chronic pain conditions, anxiety disorders, and addiction. The cannabinoid dronabinol has been seen to have varying effects. High doses appear to reduce withdrawal symptoms but this comes at the expense of increased adverse side effects such as sedation and tachycardia. Noribogaine is a weak MOR antagonist and relatively potent KOR agonist, which may explain the clinical anti-addictive effects. More research should be done to assess the viability of these medications for the treatment of OUD and withdrawal

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Natural Infections of Tetrathyridia of \u3ci\u3eMesocestoides\u3c/i\u3e Species in Deer Mice, \u3ci\u3ePeromyscus maniculatus\u3c/i\u3e, from New Mexico

At Southern Methodist University campus about 6 miles south of Taos, New Mexico, we recovered tetrathyridia of Mesocestoides in five Peromyscus maniculatus in the summers of 2008 (3 of 129, 0.023%), 2009 (0 of 98, 0%), 2010 (1 of 112, 0.008%), 2011 (0 of 88, 0%), and 2012 (1 of 86, 0.011%). Tetrathyridia from the body cavity of one of the five infected mice were injected into the peritoneal cavity of laboratory white mice, Mus musculus. Our later examination of the laboratory mice revealed heavy infections of tetrathyridia continuing to reproduce asexually. Here we provide important new information on the prevalence of asexuality among tetrathyridia and underscore the need for further study of this variation among metacestodes of this cosmopolitan genus. Spanish abstract: En el campus de Southern Methodist University, aproximadamente seis millas al sur de Taos, Nuevo México, se colectaron tetrathyridia de Mesocestoides en cinco Peromyscus maniculatus durante los veranos de 2008 (3 de 129, 0.023%), 2009 (0 de 98, 0%), 2010 (1 de 112, 0.008%), 2011 (0 de 88, 0%) y 2012 (1 de 86, 0.011%). Tetrathyridia provenientes de la cavidad corporal de uno de los cinco P. maniculatus infectados fueron inyectadas dentro de la cavidad peritoneal de ratones Mus musculus del laboratorio. Posteriormente, nuestro estudio de los ratones del laboratorio reveló una fuerte infección de tetrathyridia, las cuales continuaban reproduciéndose asexualmente. Aquí contribuimos información nueva e importante sobre la prevalencia de la asexualidad entre tetrathyridia y senalamos la necesidad de más estudios de esta variación entre metacéstodos de este género cosmopolita

Metazoan Endoparasites of the Gray Fox, \u3ci\u3eUrocyon cinereoargenteus\u3c/i\u3e from New Mexico

Metazoan gastrointestinal endoparasites were recovered from 10 of 14 (71.4%) gray foxes [Urocyon cinereoargenteus (Schreber, 1775)] collected in New Mexico from 1996 -1998. They include a pentastome Porocephalus sp., (n=1, 7.1%), a trematode: Fasciola hepatica Linnaeus, 1758 (n=1, 7.1%), the nematodes: Physaloptera rara Hall and Wigdor, 1918 (n=3, 14.3%), Physaloptera praeputialis Linstow, 1899 (n=2, 14.3%), an unidentified female Physaloptera sp. (n=1, 7.1%), Toxocara mystax (Zeder, 1800) (n=2, 14.3%), Toxocara canis (Werner, 1782) (n=1, 7.1%), Spirocerca lupi (Rudolphi, 1809) (n=6, 42.9%), and cestodes: Taenia pisiformis (Bloch, 1780) n=3, n=3, (21.4%), Taenia serialis (Gervais, 1847) (n=3, 21.4%), and Mesocestoides kirbyi Chandler, 1944 (n=7, 50%). All parasites found are new records for the gray fox in New Mexico. The parasites, Porocephalus sp, Fasciola hepatica, Toxocara mystax and Mesocestoides kirbyi are new records for the gray fox for North America

Combination Olanzapine and Samidorphan for the Management of Schizophrenia and Bipolar 1 Disorder in Adults: A Narrative Review

Schizophrenia is a debilitating psychotic disorder characterized by positive symptoms such as delusions, hallucinations, and disorganized thoughts, and negative symptoms like lack of effect or motivation. Bipolar 1 disorder (B1D) is a psychiatric illness characterized by recurrent manic episodes in alternation with depressive episodes and interspersed periods of euthymia, ultimately resulting in psychological distress and impairment of daily functioning. Effective treatments are needed for both schizophrenia and B1D to reach the treatment goals of reducing the debilitating symptomology, improving social functioning and quality of life, and increasing the chances of recovery and more favorable long-term outcomes. To date, olanzapine is one of the most efficacious atypical antipsychotics (AAPs) for the treatment of both schizophrenia and B1D and is associated with fewer extrapyramidal effects compared to other treatments. However, compared to other AAPs, olanzapine is associated with a greater chance of metabolic syndrome, limiting its clinical use and affecting treatment compliance. Samidorphan mitigates the weight gain side effects of olanzapine by antagonizing μ-, κ-, and δ-opioid receptors. The use of combination drugs to treat psychiatric conditions is an emerging field with the goal of increasing therapeutic efficacy and decreasing undesirable side effects. Clinical trials have demonstrated combination on olanzapine and samidorphan (OLZ/SAM) treatment resulted in significantly less weight gain than olanzapine monotherapy. Clinical trial patients reported improvements in symptoms of psychosis, reduced weight gain, and overall satisfaction with their treatment. OLZ/SAM has been as shown to be a safe and effective pharmaceutical option for the clinical management of schizophrenia and B1D

Consumption and Emissions Analysis in Domestic Hot Water Hotels. Case Study: Canary Islands

We analyze the energy consumption of domestic hot water (DHW) in the hotels of the archipelago of the Canary Islands (Spain). Currently, systems use fossil fuels of propane and gas oil. However, this paper analyzes several alternative systems which focus on renewable and mixed energies, such as biomass, solar thermal and heat pumps systems associated with an electric generation with photovoltaic solar panels for self-consumption. The carbon footprint generated is calculated for each method of generation of DHW. In our analysis, we demonstrate that by using a high-temperature heat pump with an average coefficient of performance (COP) equal to or greater than 4.4 associated with photovoltaic solar panels, a zero-emission domestic hot water system can be achieved, when the installation area of the photovoltaic solar panels is equal to that of the solar thermal system. The importance of DHW’s carbon footprint is proven, as is the efficiency of using high-temperature heat pumps associated with photovoltaic solar panels. As such, such mixed system suggests that the generation of DHW would have zero emissions with maximum annual savings according to hotel occupancy, between 112,417 and 137,644 tons of carbon dioxide (CO2), compared to current boilers based on fossil fuels