Management of Hypnotics in Patients with Insomnia and Heart Failure during Hospitalization: A Systematic Review

Background: Heart failure is a chronic, progressive syndrome of signs and symptoms, which has been associated to a range of comorbidities including insomnia. Acute decompensation of heart failure frequently leads to hospital admission. During hospital admission, long-term pharmacological treatments such as hypnotics can be modified or stopped. Aim: To synthesize the scientific evidence available about the effect of withdrawing hypnotic drugs during hospital admission in patients with decompensated heart failure and insomnia. Method: A systematic review of the literature following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines was carried out in the following scientific databases: PubMed, Scopus, Dialnet and Cochrane. Inclusion criteria: studies including a population of adults with heart failure and sleep disorders in treatment with hypnotics and admitted to hospital, studies written in English or Spanish and published until June 2020. Exclusion criteria: studies involving children, patients admitted to intensive care and patients diagnosed with sleep apnea. Results: We identified a total of 265 documents; only nine papers met the selection criteria. The most frequently used drugs for the treatment of insomnia in patients with heart failure were benzodiazepines and benzodiazepine agonists; their secondary effects can alter perceived quality of life and increase the risk of adverse effects. Withdrawal of these drugs during hospital admission could increase the risk of delirium. Future research in this area should evaluate the management of hypnotics during hospital admission in patients with decompensated heart failure. In addition, safe and efficient non-pharmacological alternatives for the treatment of insomnia in this population should be tested and implemented

The Pit-1/Pou1f1 transcription factor regulates and correlates with prolactin expression in human breast cell lines and tumors

The transcription factor Pit-1/Pou1f1 regulates GH and prolactin (PRL) secretion in the pituitary gland. Pit-1 expression and GH regulation by Pit-1 have also been demonstrated in mammary gland. However, no data are available on the role of Pit-1 on breast PRL. To evaluate this role, several human breast cancer cell lines were transfected with either the Pit-1 expression vector or a Pit-1 small interference RNA construct, followed by PRL mRNA and protein evaluation. In addition, transient transfection of MCF-7 cells by a reporter construct containing the proximal PRL promoter, and ChIP assays were performed. Our data indicate that Pit-1 regulates mammary PRL at transcriptional level by binding to the proximal PRL promoter. We also found that Pit-1 raises cyclin D1 expression before increasing PRL levels, suggesting a PRL-independent effect of Pit-1 on cell proliferation. By using immunohistochemistry, we found a significant correlation between Pit-1 and PRL expression in 94 human breast invasive ductal carcinomas. Considering the possible role of PRL in breast cancer disorders, the function of Pit-1 in breast should be the focus of further research

Measurement of top-pair cross section and top-quark mass in the di-lepton and full-hadronic channels with CMS

This note describes the selection and reconstruction of top-pair events with the CMS detector at the LHC, and the determination of the top-quark mass. Two of the three main channels, classified by the decay of the W boson arising in top decay, are considered here: di-lepton and fully hadronic \ttbar events. The performance of the selections, the resulting cross section measurements, and the mass reconstruction accuracy are evaluated based on a detailed simulation of the CMS detector

Removing exogenous information using pedigree data

Management of certain populations requires the preservation of its pure genetic background. When, for different reasons, undesired alleles are introduced, the original genetic conformation must be recovered. The present study tested, through computer simulations, the power of recovery (the ability for removing the foreign information) from genealogical data. Simulated scenarios comprised different numbers of exogenous individuals taking partofthe founder population anddifferent numbers of unmanaged generations before the removal program started. Strategies were based on variables arising from classical pedigree analyses such as founders? contribution and partial coancestry. The ef?ciency of the different strategies was measured as the proportion of native genetic information remaining in the population. Consequences on the inbreeding and coancestry levels of the population were also evaluated. Minimisation of the exogenous founders? contributions was the most powerful method, removing the largest amount of genetic information in just one generation.However, as a side effect, it led to the highest values of inbreeding. Scenarios with a large amount of initial exogenous alleles (i.e. high percentage of non native founders), or many generations of mixing became very dif?cult to recover, pointing out the importance of being careful about introgression events in populatio

Culture and Psychiatric Evaluation: Operationalizing Cultural Formulation for DSM-5

The Outline for Cultural Formulation (OCF) introduced with DSM-IV provided a framework for clinicians to organize cultural information relevant to diagnostic assessment and treatment planning. However, use of the OCF has been inconsistent, raising questions about the need for guidance on implementation, training, and application in diverse settings. To address this need, DSM-5 introduced a cultural formulation interview (CFI) that operationalizes the process of data collection for the OCF. The CFI includes patient and informant versions and 12 supplementary modules addressing specific domains of the OCF. This article summarizes the literature reviews and analyses of experience with the OCF conducted by the DSM-5 Cross-Cultural Issues Subgroup (DCCIS) that informed the development of the CFI. We review the history and contents of the DSM-IV OCF, its use in training programs, and previous attempts to render it operational through questionnaires, protocols, and semi-structured interview formats. Results of research based on the OCF are discussed. For each domain of the OCF, we summarize findings from the DCCIS that led to content revision and operationalization in the CFI. The conclusion discusses training and implementation issues essential to service delivery

Optimal capital controls and real exchange rate policies: A pecuniary externality perspective

In response to the global Önancial crisis a new policy paradigm emerged in which capital controls and other quantitative restrictions on credit áows have become part of the standard crisis prevention policy toolkit. A new strand of theoretical literature studies the use of capital controls in a context in which pecuniary externality justiÖes policy interventions. Within the same theoretical framework adopted in this literature, we show that the optimal design of crisis prevention (ex-ante) policies depends on the e§ectiviness of crisis management (ex-post) policies. This interaction between ex-ante and ex-post policies gives rise to a new rationale for the use of capital controls. SpeciÖcally, we show that when ex-post policies are e§ective in containing crises, there is no need to intervene ex-ante with capital controls. On the other hand, if crises management policies entail e¢ ciency costs and hence lose e§ectiveness, then the optimal policy mix consists of both ex-ante and ex-post interventions so that crises prevention policies become desirable. In our model, the optimal policy mix combines capital controls in tranquil times with real exchange rate support to limit its depreciation during crises times and yields welfare gains of more than 1% in consumption equivalence terms

Efectos inmunológicos inducidos por los inhibidores de BCR. Experiencia en vida real en el hospital clínico Lozano Blesa. Zaragoza

PB-066 Introducción: Ibrutinib es un fármaco inhibidor de la TKB utilizado en Leucemia linfática crónica (LLC), linfoma del manto en recaída y Macroglobulinemia de Waldenström e Idelalisib es un inhibidor de PI3K? aprobado en LLC en recaída. Ambos disminuyen la proliferación de los linfocitos B inactivando el BCR, siendo altamente efectivos. No obstante, su interacción con el microambiente tumoral provoca reacciones inmunológicas como la neumonitis y colitis severa. Nuestro objetivo ha sido determinar la incidencia y el manejo terapéutico de dichas reacciones en nuestro centro. Metodología: Estudio observacional retrospectivo donde se incluyen todos los pacientes tratados con Ibrutinib o Idelalisib durante el período de tiempo : 01/2015- 05/2019. Criterios de inclusión: 1. Colitis: diarrea grado =3 con confirmación histopatológica ; 2. Neumonitis: TAC pulmonar compatible y lavado bronquioalveolar (BAL) excluyendo causas infecciosas. Figura 1. Sigmoiditis Figura 2. Neumonitis bibasal. Vidrio deslustrado Figura 3. Alveolitis en lóbulos superiores. Resultados: Se han incluido 27 pacientes, 10 (37%) mujeres y 17 (63%) hombres. La media de edad fue 73 años (53-84). Tratamiento con Idelalisib: 7 pacientes (25.9%); Ibrutinib: 20 pacientes (74.1 %). No patología pulmonar ni digestiva previa al inicio del tratamiento . De los pacientes tratados con Idelalisib, 1 presentó una sigmoiditis (14%)( caso1) y 1 presentó neumonitis intersticial (14%) (caso 2) . De los tratados con Ibrutinib 1 paciente presentó alveolitis (5%) (caso 3). Del total de pacientes estudiados el 11 % han presentado reacciones inmunológicas ..