The effects of short-term omission of daily medication on the pathophysiology of heart failure

Aims Pharmacological therapies for heart failure (HF) aim to improve congestion, symptoms, and prognosis. Failing to take medication is a potential cause of worsening HF. Characterizing the effects of short-term medication omission could inform the development of better technologies and strategies to detect and interpret the reasons for worsening HF. We examined the effect of planned HF medication omission for 48 h on weight, echocardiograms, transthoracic bio-impedance, and plasma concentrations of NT-proBNP. Methods and results Outpatients with stable HF and an LVEF <45% were assigned to take or omit their HF medication for 48 h in a randomized, crossover trial. Twenty patients (16 men, LVEF 32 ± 9%, median NT-proBNP 962 ng/L) were included. Compared with regular medication, omission led to an increase in NT-proBNP by 99% (from 962 to 1883 ng/L, P < 0.001), systolic blood pressure by 16% (from 131 to 152 mmHg, P < 0.001), and left atrial volume by 21% (from 69 to 80 mL, P = 0.001), and reductions in transthoracic bio-impedance by 10% (from 33 to 30 Σ, P = 0.001) and serum creatinine by 8% (from 135 to 118 µmol/L, P = 0.012). No significant changes in body weight, heart rate, or LVEF were observed. Conclusions The characteristic pattern of response to short-term medication omission is of increasing congestion but, in contrast to the pattern reported for disease progression, with a rise in blood pressure and improved renal function. In stable HF, weight is not a sensitive marker of short-term diuretic omission

Recordar lo que no pasó: memoria y usos del olvido en torno a la recepción de los refugiados judíos del nazismo en México

Although the Mexican authorities closed the doors to Jewish immigration during the Nazi period, the memory of this episode has been reconfigured over time and transformed into the opposite view. This article analyzes the process of how the collective memory was reinterpreted – in the governmental sector as much as within the Jewish community itself – and why the image of the country’s welcoming of Jewish refugees is the one that prevailed.Si bien las autoridades mexicanas cerraron las puertas del país al exilio judío durante el nazismo, el recuerdo de este episodio ha sido reconfigurado en el tiempo para convertirse en su imagen opuesta. Este artículo analiza cómo ha sido el proceso de reelaboración de la memoria colectiva —tanto en el sector gubernamental como en el de la comunidad judía— y por qué ha terminado prevaleciendo la imagen de la apertura del país hacia los refugiados judíos

Acquiring control in emerging markets: Foreign acquisitions in Eastern Europe and the effect on shareholder wealth

YesThis paper examines stock market reaction to cross-border acquisition announcements that involve Eastern European emerging-market targets. Using a unique and a manually collected dataset, we identify 125 cross-border acquisitions in which developed-market firms from France, Germany, Netherlands, and the United Kingdom acquire ownership stakes in emerging as well as developed-markets in Europe during the period January 2000 through December 2011. In line with previous findings on foreign cross-border merger and acquisitions (M&As) in emerging- markets, evidence suggests that when the target firm is located in either the Czech- Republic, Hungary, Poland, or Russia, cumulative abnormal return (CAR) to the acquiring developed-market firm shows a statistically significant increase of 1.26% over a three day event window, following the announcement. Thereby, the relative size of the acquirer to the target appears to be the only significant factor that contributes to positive acquirer returns. The result is robust to the inclusion of controls for country, industry, as well as acquirer, target, and firm specific characteristics. Moreover, cross-border M&As involving an emerging-market target result in higher value creation for the acquiring shareholders than cross-border transactions into developed-markets

Abundance ratios and IMF slopes in the dwarf elliptical galaxy NGC 1396 with MUSE

Deep observations of the dwarf elliptical (dE) galaxy NGC 1396 (MV = −16.60, Mass ~4 × 10^8 M�), located in the Fornax cluster, have been performed with the VLT/ MUSE spectrograph in the wavelength region from 4750 − 9350 Å. In this paper we present a stellar population analysis studying chemical abundances, the star formation history (SFH) and the stellar initial mass function (IMF) as a function of galacto-centric distance. Different, independent ways to analyse the stellar populations result in a luminosity-weighted age of ∼ 6 Gyr and a metallicity [Fe/H]∼ −0.4, similar to other dEs of similar mass. We find unusually overabundant values of [Ca/Fe] ∼ +0.1, and under-abundant Sodium, with [Na/Fe] values around −0.1, while [Mg/Fe] is overabundant at all radii, increasing from ∼ +0.1 in the centre to ∼ +0.2 dex. We notice a significant metallicity and age gradient within this dwarf galaxy. To constrain the stellar IMF of NGC 1396, we find that the IMF of NGC 1396 is consistent with either a Kroupa-like or a top-heavy distribution, while a bottom-heavy IMF is firmly ruled out. An analysis of the abundance ratios, and a comparison with galaxies in the Local Group, shows that the chemical enrichment history of NGC 1396 is similar to the Galactic disc, with an extended star formation history. This would be the case if the galaxy originated from a LMC-sized dwarf galaxy progenitor, which would lose its gas while falling into the Fornax cluster

Comprehensive in-hospital monitoring in acute heart failure : applications for clinical practice and future directions for research. A statement from the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

This paper provides a practical clinical application of guideline recommendations relating to the inpatient monitoring of patients with acute heart failure, through the evaluation of various clinical, biomarker, imaging, invasive and non-invasive approaches. Comprehensive inpatient monitoring is crucial to the optimal management of acute heart failure patients. The European Society of Cardiology heart failure guidelines provide recommendations for the inpatient monitoring of acute heart failure, but the level of evidence underpinning most recommendations is limited. Many tools are available for the in-hospital monitoring of patients with acute heart failure, and each plays a role at various points throughout the patient's treatment course, including the emergency department, intensive care or coronary care unit, and the general ward. Clinical judgment is the preeminent factor guiding application of inpatient monitoring tools, as the various techniques have different patient population targets. When applied appropriately, these techniques enable decision making. However, there is limited evidence demonstrating that implementation of these tools improves patient outcome. Research priorities are identified to address these gaps in evidence. Future research initiatives should aim to identify the optimal in-hospital monitoring strategies that decrease morbidity and prolong survival in patients with acute heart failure.Peer reviewe

Human ocular sparganosis in southern Brazil

We report the first case of human ocular sparganosis in the state of Santa Catarina, southern Brazil. A young female patient presented with three periocular moveable inflammatory masses in her right eye, during two years. By surgical excisional biopsy, a helminth larval stage was removed and identified as sparganum. Clinical, laboratory and epidemiological data on this parasite are presented