Effectiveness and Safety of Teriflunomide in Relapsing-Remitting Multiple Sclerosis and Improvements in Quality of Life: Results from the Real-World TERICARE Study.

INTRODUCTION: Teriflunomide is a once-daily oral immunomodulator approved for relapsing forms of multiple sclerosis (MS) or relapsing-remitting multiple sclerosis (RRMS; depending on the local label), based on extensive evidence from clinical trials and a real-world setting on efficacy, tolerability and patient-reported benefits. The TERICARE study assessed the impact of teriflunomide treatment over 2 years on health-related quality of life (HRQoL) and some of the most common and disabling symptoms of MS, such as fatigue and depression. METHODS: This prospective observational study in Spain included RRMS patients treated with teriflunomide for ≤ 4 weeks. The following patient-reported outcomes (PROs) were collected at baseline and every 6 months for 2 years: the 29-item Multiple Sclerosis Impact Scale version 2 (MSIS-29), the 21-item Modified Fatigue Impact Scale (MFIS-21), the Beck Depression Inventory (BDI-II), the Short Form (SF)-Qualiveen and the Treatment Satisfaction Questionnaire for Medication v1.4 (TSQM). Annualised relapse rate (ARR), disability progression according to the Expanded Disability Status Scale (EDSS), and no evidence of disease activity (NEDA-3) were also assessed. RESULTS: A total of 325 patients were analysed. Patients had a mean (SD) age of 43.2 years (10.4), a mean baseline EDSS score of 1.75 (1.5), a mean number of relapses in the past 2 years of 1.5 (0.7), and 64% had received prior disease-modifying therapy (DMT). Patients showed significant improvements in the psychological domain of MSIS-29 from 35.9 (26.6) at baseline to 29.4 (25.5) at 18 months (p = 0.004) and 29.0 (24.6) at 24 months (p = 0.002). Levels of fatigue and depression were also reduced. After 2 years of treatment with teriflunomide, ARR was reduced to 0.17 (95% CI 0.14-0.21) from the baseline of 0.42 (95% CI 0.38-0.48), representing a 60.1% reduction. Mean EDSS scores remained stable during the study, and 79.9% of patients showed no disability progression. 54.7% of patients achieved NEDA-3 in the first 12 months, which increased to 61.4% during months 12-24. Patients reported increased satisfaction with treatment over the course of the study, regardless of whether they were DMT naive or not. CONCLUSION: Teriflunomide improves psychological aspects of HRQoL and maintains low levels of fatigue and depression. Treatment with teriflunomide over 2 years is effective in reducing ARR and disability progression.

Miastenia gravis. Actualización diagnóstica y terapéutica / Myasthenia gravis. Update on diagnosis and therapy

La miastenia gravis es una enfermedad autoinmune causada por la presencia de anticuerpos específicos dirigidos a diferentes componentes postsinápticos de la unión neuromuscular, y clínicamente se caracteriza por la presencia de debilidad muscular fatigable. En la etiopatogenia juega un papel central el timo, y los autoanticuerpos patogénicos más frecuentemente detectados están dirigidos al receptor de la acetilcolina. El incremento en el conocimiento de los componentes inmunológicos de la unión neuromuscular en las últimas dos décadas ha sido fundamental para identificar nuevos anticuerpos patogénicos, reducir el porcentaje de pacientes con miastenia seronegativa y proponer una clasificación de los pacientes en subgrupos con interés clínico-terapéutico. Además, en los últimos años hemos asistido al desarrollo de nuevos fármacos destinados al tratamiento de los pacientes con miastenia que muestran refractariedad al tratamiento inmunosupresor convencional (AU)

Myasthenia gravis is an autoimmune disease caused by the presence of specific antibodies targeting different postsynaptic components of the neuromuscular junction, and is clinically characterized by the presence of fatigueable muscle weakness. In the etiopathogenesis plays a central role the thymus and the most frequently detected pathogenic autoantibodies are targeted to the acetylcholine receptor. The increase in the knowledge of the immunological components of the neuromuscular junction in the last two decades has been fundamental to identify new pathogenic antibodies, reduce the percentage of patients with seronegative myasthenia, and propose a classification of patients into subgroups with clinical-therapeutic interest. In addition, in recent years, new drugs have been developed for the treatment of patients with myasthenia gravis that are refractory to conventional immunosuppressive treatment (AU)

[Myasthenia gravis. Update on diagnosis and therapy]. / Miastenia gravis. Actualización diagnóstica y terapéutica.

Myasthenia gravis is an autoimmune disease caused by the presence of specific antibodies targeting different postsynaptic components of the neuromuscular junction, and is clinically characterized by the presence of fatigueable muscle weakness. In the etiopathogenesis plays a central role the thymus and the most frequently detected pathogenic autoantibodies are targeted to the acetylcholine receptor. The increase in the knowledge of the immunological components of the neuromuscular junction in the last two decades has been fundamental to identify new pathogenic antibodies, reduce the percentage of patients with seronegative myasthenia, and propose a classification of patients into subgroups with clinical-therapeutic interest. In addition, in recent years, new drugs have been developed for the treatment of patients with myasthenia gravis that are refractory to conventional immunosuppressive treatment.

Mental Health, Burnout, and Resilience in Healthcare Professionals After the First Wave of COVID-19 Pandemic in Spain: A Longitudinal Study.

OBJECTIVE: This study aims to examine whether there are differences in symptoms of posttraumatic stress, depression, anxiety, levels of burnout and resilience in Spanish healthcare staff between the first wave of the COVID-19 pandemic and after it, depending on several demographic and work-related variables. METHODS: A longitudinal study was conducted in April 2020 (T0), and July 2020 (T1). Symptoms of posttraumatic stress, depression, anxiety, burnout, levels of resilience, along with demographic and work-related variables in 443 workers were assessed. RESULTS: Symptoms and burnout were more pronounced at T0, whereas the levels of resilience were higher at T1. Being women, being young, holding a lower-level job, less years of experience, lower educational level, and/or working rotating shifts are associated with having more posttraumatic stress symptoms and burnout. CONCLUSION: These variables would be considered in similar situations.

Diagnóstico inicial de salud desde la farmacia comunitaria en el barrio de San Isidro de Granadilla de Abona (Tenerife) / Initial health diagnosis from the community pharmacy in the neighbourhood of San Isidro de Granadilla de Abona (Tenerife)

Introducción: Este diagnóstico comunitario de salud surge de la necesidad de un conocimiento compartido del territorio, sus recursos, sus retos, con el objetivo de desarrollar una acción comunitaria para la salud desde una farmacia.Métodos. Se ha realizado un inventario de recursos comunitarios categorizados en: territoriales, sanitarios, sociales, económicos, educativos, culturales y de ocio y asociativos; y 31 entrevistas semiestructuradas a 68 personas que integran instituciones, ONG o asociaciones vecinales.Resultados. Se presenta resumen de la guía de recursos, que tienden a concentrarse en torno a la avenida Santa Cruz. Los resultados iniciales del diagnóstico comunitario presentados muestran un barrio donde las desigualdades en salud tienen un peso importante, con problemas estructurales en relación con distintos determinantes de la salud.Discusión. El proceso ha generado relaciones de colaboración en materia de promoción de la salud en el territorio. El Ayuntamiento de Granadilla de Abona ha mostrado su voluntad de extender la iniciativa al resto del municipio. Es necesario mejorar la participación en salud de los y las pacientes en espacios de construcción compartida e incluir técnicas como el análisis del discurso y análisis de contenido. (AU)

Diagnóstico inicial de salud desde la farmacia comunitaria en el barrio de San Isidro de Granadilla de Abona (Tenerife) / Health mapping and diagnosis from the community pharmacy. Initial results of an experiment in San Isidro

Introducción: Este diagnóstico comunitario de salud surge de la necesidad de un conocimiento compartido del territorio, sus recursos, sus retos, con el objetivo de desarrollar una acción comunitaria para la salud desde una farmacia. Métodos: Se ha realizado un inventario de recursos comunitarios categorizados en: territoriales, sanitarios, sociales, económicos, educativos, culturales y de ocio y asociativos; y 31 entrevistas semiestructuradas a 68 personas que integran instituciones, ONG o asociaciones vecinales. Resultados: Se presenta resumen de la guía de recursos, que tienden a concentrarse en torno a la avenida Santa Cruz. Los resultados iniciales del diagnóstico comunitario presentados muestran un barrio donde las desigualdades en salud tienen un peso importante, con problemas estructurales en relación con distintos determinantes de la salud. Discusión: El proceso ha generado relaciones de colaboración en materia de promoción de la salud en el territorio. El Ayuntamiento de Granadilla de Abona ha mostrado su voluntad de extender la iniciativa al resto del municipio. Es necesario mejorar la participación en salud de los y las pacientes en espacios de construcción compartida e incluir técnicas como el análisis del discurso y análisis de contenido. (AU)

Introduction: This community health diagnosis arises from the need for a shared knowledge of the region, its resources and challenges. The aim is to develop community health action from a Pharmacy. Methods. An inventory of community resources has been made, categorized as: territorial, health, social, economic, educational, cultural and leisure and associative; and 31 semi-structured interviews with 68 people comprising institutions, NGOs or community associations. Results. A summary of the community resources, which tend to be concentrated around Avenida Santa Cruz, is presented. The initial results of the community diagnosis presented reveals a neighbourhood where health inequalities play an important role with structural problems in relation to different health determinants. Discussion. The process has generated collaborative relationships in the area of health promotion in the territory. The City Council of Granadilla de Abona has shown its willingness to extend the initiative to the rest of the municipality. It is necessary to improve the participation of patients in health within spaces of shared construction and to include techniques such as discourse analysis and content analysis. (AU)

Negative frequency-dependent selection maintains shell banding polymorphisms in two marine snails (Littorina fabalis and Littorina saxatilis).

The presence of shell bands is common in gastropods. Both the marine snails Littorina fabalis and Lttorina saxatilis are polymorphic for this trait. Such polymorphism would be expected to be lost by the action of genetic drift or directional selection, but it appears to be widespread at relatively constant frequencies. This suggests it is maintained by balancing selection on the trait or on a genetically linked trait. Using long time series of empirical data, we compared potential effects of genetic drift and negative frequency-dependent selection (NFDS) in the two species. The contribution of genetic drift to changes in the frequency of bands in L. fabalis was estimated using the effective population size estimated from microsatellite data, while the effect of genetic drift in L. saxatilis was derived from previously published study. Frequency-dependent selection was assessed by comparing the cross-product estimator of fitness with the frequency of the polymorphism across years using a regression analysis. Both studied species showed patterns of NFDS. In addition, in L. fabalis, contributions from genetic drift could explain some of the changes in banding frequency. Overdominance and heterogeneous selection did not fit well to our data. The possible biological explanations resulting in the maintenance of the banding polymorphism are discussed.

Design and flight results of the VHF/UHF communication system of Longjiang lunar microsatellites.

As a part of China's Chang'e-4 lunar far side mission, two lunar microsatellites for low frequency radio astronomy, amateur radio and education, Longjiang-1 and Longjiang-2, were launched as secondary payloads on 20 May 2018 together with the Queqiao L2 relay satellite. On 25 May 2018, Longjiang-2 successfully inserted itself into a lunar elliptical orbit of 357 km × 13,704 km, and became the smallest spacecraft which entered lunar orbit with its own propulsion system. The satellite carried the first amateur radio communication system operating in lunar orbit, which is a VHF/UHF software defined radio (SDR) designed for operation with small ground stations. This article describes and evaluates the design of the VHF/UHF radio and the waveforms used. Flight results of the VHF/UHF radio are also presented, including operation of the radio, performance analysis of downlink signals and the first lunar orbit UHF very-long-baseline interferometry (VLBI) experiment.

Programa de atención a pacientes diabéticos y prediabéticos en farmacia comunitaria: 'DayBTS' / Treatment program for diabetic and prediabetic patients in community pharmacy: 'DayBTS'

JUSTIFICACIÓN: en España hay 6 millones de personas con diabetes. Canarias está 1,86 puntos porcentuales por encima de la media nacional. Aunque haya mejor conocimiento de la diabetes, el número de pacientes sigue aumentando. El farmacéutico comunitario puede jugar un papel importante a través de su formación académica como sanitario experto en el medicamento y por su cercanía al paciente. Por ello, son importantes proyectos de diseño y estandarización de servicios de seguimiento farmacoterapéutico en diabetes más un abordaje multidisciplinar. OBJETIVO: diseño de un servicio para atención a pacientes diabéticos y prediabéticos en farmacia comunitaria denominado DayBTS. Población diana: mayores de edad que acuden a la farmacia y cumplen al menos uno de estos requisitos: tratamiento con medicación antidiabética, presenten sobrepeso u obesidad, hipertensión arterial o hipercolesterolemia, presenten antecedentes familiares de diabetes o directamente soliciten el servicio. Estructura: serie de visitas divididas en dos fases. Fase inicio, comprende 5 visitas. Fase continuación, 2 visitas para seguimiento y nuevas dudas o problemas. Las actividades a realizar de forma general son: educación diabetológica, medición de variables clínicas (glucemia capilar, índice de masa corporal, hemoglobina glicosilada, patrones en glucemia), variables económicas (visitas a atención primaria, urgencias, número de medicamentos utilizados) y variables humanísticas (adherencia al tratamiento, calidad de vida, conocimientos sobre diabetes). Coste previsto: el coste por visita se estima en función de: tipo de visita, recursos materiales y tiempo del personal farmacéutico. Entre 5,95 € (paciente prediabético) a 20,90€ (paciente diabético) con precio propuesto de 7,44 € y 26,13 € para margen 20 %. El coste del servicio completo sería de 88,31-111 € (Prediabetes-Diabetes)

REASON: in Spain there are 6 million people with diabetes. The Canary Islands are 1.86 percentage points above the national average. Although information on diabetes has improved, the number of patients continues to increase. Community pharmacists can play a significant role thanks to their academic training as healthcare providers specialized in medications and their proximity to patients. For this reason, it is important to have projects for the design and standardization of pharmacotherapeutic monitoring services in diabetes, besides a multidisciplinary approach. OBJECTIVE: design of a treatment service for diabetic and prediabetic patients in community pharmacy called DayBTS. Target population: older people who visit the pharmacy and meet at least one of the following requirements: treatment with antidiabetic medication, are overweight or obese, arterial hypertension or hypercholesterolemia, with family history of diabetes or who ask for the service directly. Structure: series of visits in four phases. Initial phase, includes 5 visits. Continuation phase, 2 visits for monitoring and new doubts or issues. The activities to perform in general are as follows: diabetes education, measurement of clinical variables (blood glucose, body mass index, glycosylated hemoglobin, glycemic patterns), economic variables (visits at primary care, acute care, number of medications used) and human variables (treatment compliance, quality of life, knowledge of diabetes). Expected cost: the cost per visit is estimated according to: type of visit, material supplies and pharmaceutical staff time. Between 5.95 € (prediabetic patient) and 20.90 € (diabetic patient) with cost proposed 7.44 € and 26.13 € for a 20 % margin. The cost of the complete service would be 88.31-111 € (Prediabetes-Diabetes)

DECORE-21: Assessment of occupational stress in police. Confirmatory factor analysis of the original model.

There is scarce research on stress in Spanish police officers and on the use of instruments to assess this construct in this professional group. In Spain, the DECORE questionnaire has been one of the most used. Nevertheless, it had not been previously applied to police officers. The aim of this study was to analyze both the construct validity and the reliability of the original model of 44 items. A cross-sectional design and a non-probabilistic quota sampling were used. A total of 223 Spanish police officers participated. 202 police personnel were men (90.6%) and 21 were women (9.4%). The average age was 41 years old (SD = 7.52). These police officers answered the DECORE questionnaire. Confirmatory Factor Analysis was carried out. The results showed an unsatisfactory adjustment using the original model of 44 items. A final solution of 21 items and four factors was formulated with both suitable validity and reliability indexes. In this model, 23 items that did not weigh highly in any of the four factors were removed. The DECORE-21 questionnaire is recommended to assess work-related stress in police officers.

Disartria y disfagia aisladas como forma de presentación de un ictus isquémico agudo lacunar bilateral y simultáneo / Isolated dysarthria and dysphagia as the presenting symptoms of simultaneous bilateral acute lagunar ischaemic stroke

No disponible

MSP22.8 is a protease inhibitor-like protein involved in shell mineralization in the edible mussel Mytilus galloprovincialis.

The mussel shell protein 22.8 (MSP22.8) is recognized by a monoclonal antibody (M22.8) directed against larvae of the mussel Mytilus galloprovincialis. After being secreted by cells of the mantle-edge epithelium into the extrapallial (EP) space (the gap between the mantle and the shell), the protein is detected in the extrapallial fluid (EPF) and EP hemocytes and finally becomes part of the shell matrix framework in adult specimens of M. galloprovincialis. In the work described here, we show how MSP22.8 is detected in EPF samples from different species of mussels (M. galloprovincialis, Mytilus edulis, and Xenostrobus securis), and also as a shell matrix protein in M. galloprovincialis, Mytilus chilensis, and Perna canaliculus. A multistep purification strategy was employed to isolate the protein from the EPF, which was then analyzed by mass spectrometry in order to identify it. The results indicate that MSP22.8 is a serpin-like protein that has great similarity with the protease inhibitor-like protein-B1, reported previously for Mytilus coruscus. We suggest that MSP22.8 is part of a system offering protection from proteolysis during biomineralization and is also part of the innate immune system in mussels.

Cefalea trigeminoautonómica secundaria a un hematoma intraorbitario espontáneo / Trigeminal-autonomic cephalgia secondary to a spontaneous intra-orbital haematoma

No disponible

Migraña episódica frecuente y péptido relacionado con el gen de la calcitonina. Influencia del tratamiento con topiramato y zonisamida en los niveles del péptido / Frequent episodic migraine and calcitonin gene-related peptide. Influence of treatment with topiramate and zonisamide on levels of the peptide

Introducción. La fisiopatología del dolor en la migraña se relaciona con la activación del sistema trigeminovascular por medio de la liberación de neuropéptidos vasoactivos, y el más importante es el péptido relacionado con el gen de la calcitonina (CGRP), que causa una inflamación neurógena en los vasos leptomeníngeos. Objetivo. Investigar si el CGRP está incrementado en la migraña episódica frecuente y si el tratamiento preventivo con topiramato o zonisamida modifica sus niveles. Sujetos y métodos. Se estudiaron 28 pacientes con migraña episódica con o sin aura, cumpliendo los criterios de la Sociedad Internacional de Cefaleas, con una frecuencia de 4-14 días/mes. En todos los pacientes se determinaron los niveles plasmáticos del CGRP durante un período intercrítico (> 72 h sin dolor). Los pacientes se aleatorizaron en dos grupos de tratamiento, uno con 50 mg/día de topiramato y otro con 50 mg/día de zonisamida, durante tres meses. Al finalizar el período activo se analizó nuevamente el nivel del CGRP. El grupo control lo constituyeron nueve sujetos sanos. Resultados. El CGRP fue significativamente superior en el grupo de migraña episódica comparado con el grupo control (50,61 ± 22,5 pg/mL frente a 34,96 ± 17,03 pg/mL; p = 0,037). Después del tratamiento con neuromoduladores no se hallaron diferencias significativas en el nivel de CGRP (46,11 ± 24,2 pg/mL basal frente a 47,5 ± 24,88 pg/mL postratamiento). Tampoco se hallaron diferencias al analizar los grupos de topiramato y zonisamida de forma individualizada. Conclusiones. El nivel plasmático del CGRP está incrementado en la migraña episódica y sus niveles no son modificados por el tratamiento con dosis bajas de topiramato o zonisamida (AU)

Introduction. The pathophysiology of pain in migraine is related to the activation of the trigeminovascular system by releasing vasoactive neuropeptides, the most important of which is calcitonin gene-related peptide (CGRP), which causes a neurogenic inflammation in the leptomeningeal vessels. Aim. To study whether CGRP is increased in frequent episodic migraine and whether preventive treatment with topiramate or zonisamide modifies its levels. Subjects and methods. We studied 28 patients with episodic migraine with or without aura, in accordance with the International Headache Society criteria, with a frequency of 4-14 days/month. Plasma levels of CGRP were determined in all the patients during an interictal period (> 72 hours without pain). Patients were divided at random into two treatment groups, one with 50 mg/day of topiramate and the other with 50 mg/day of zonisamide, for three months. At the end of the active period the CGRP level was analysed again. The control group consisted of nine healthy subjects. Results. CGRP was significantly higher in the episodic migraine group than in the control group (50.61 ± 22.5 pg/mL versus 34.96 ± 17.03 pg/mL; p = 0.037). After treatment with neuromodulators no significant differences were found in the level of CGRP (46.11 ± 24.2 pg/mL basal versus 47.5 ± 24.88 pg/mL post-treatment). Neither were any differences found on analysing the topiramate and zonisamide groups individually. Conclusions. The plasma level of CGRP is increased in episodic migraine, and its levels are not modified by treatment with low doses of topiramate or zonisamide (AU)

A novel method for estimating the strength of positive mating preference by similarity in the wild.

Mating preference can be a driver of sexual selection and assortative mating and is, therefore, a key element in evolutionary dynamics. Positive mating preference by similarity is the tendency for the choosy individual to select a mate which possesses a similar variant of a trait. Such preference can be modelled using Gaussian-like mathematical functions that describe the strength of preference, but such functions cannot be applied to empirical data collected from the field. As a result, traditionally, mating preference is indirectly estimated by the degree of assortative mating (using Pearson's correlation coefficient, r) in wild captured mating pairs. Unfortunately, r and similar coefficients are often biased due to the fact that different variants of a given trait are nonrandomly distributed in the wild, and pooling of mating pairs from such heterogeneous samples may lead to "false-positive" results, termed "the scale-of-choice effect" (SCE). Here we provide two new estimators of mating preference (Crough and Cscaled) derived from Gaussian-like functions which can be applied to empirical data. Computer simulations demonstrated that r coefficient showed robust estimations properties of mating preference but it was severely affected by SCE, Crough showed reasonable estimation properties and it was little affected by SCE, while Cscaled showed the best properties at infinite sample sizes and it was not affected by SCE but failed at biological sample sizes. We recommend using Crough combined with the r coefficient to infer mating preference in future empirical studies.

Characterization of a Monoclonal Antibody Directed against Mytilus spp Larvae Reveals an Antigen Involved in Shell Biomineralization.

The M22.8 monoclonal antibody (mAb) developed against an antigen expressed at the mussel larval and postlarval stages of Mytilus galloprovincialis was studied on adult samples. Antigenic characterization by Western blot showed that the antigen MSP22.8 has a restricted distribution that includes mantle edge tissue, extrapallial fluid, extrapallial fluid hemocytes, and the shell organic matrix of adult samples. Other tissues such as central mantle, gonadal tissue, digestive gland, labial palps, foot, and byssal retractor muscle did not express the antigen. Immunohistochemistry assays identified MSP22.8 in cells located in the outer fold epithelium of the mantle edge up to the pallial line. Flow cytometry analysis showed that hemocytes from the extrapallial fluid also contain the antigen intracellularly. Furthermore, hemocytes from hemolymph have the ability to internalize the antigen when exposed to a cell-free extrapallial fluid solution. Our findings indicate that hemocytes could play an important role in the biomineralization process and, as a consequence, they have been included in a model of shell formation. This is the first report concerning a protein secreted by the mantle edge into the extrapallial space and how it becomes part of the shell matrix framework in M. galloprovincialis mussels.

[Delirium Prevention]. / Prevención del delirium.

INTRODUCTION: Delirium is the most prevalent neuropsychiatric syndrome in the general hospital. Its presence is a marker of poor prognosis for patients. Its prevention could be the most effective strategy for reducing its frequency and its complications. OBJECTIVE: To review recent findings and strategies for the prevention of delirium. METHODOLOGY: A non-systematic review of scientific articles published in the last ten years in Spanish and English. A search was made in databases such as MEDLINE, Cochrane, EMBASE, Ovid, and ScienceDirect, for articles that included the terms, delirium and prevention. RESULTS: Identification of predisposing and precipitating factors for delirium and a better understanding of the pathophysiological mechanisms underlying the onset of delirium have enabled the implementation of various pharmacological and non-pharmacological strategies in patients at high risk to develop hospital delirium. The studies to prevent delirium have focused on surgical patients. The current evidence supports the daily implementation of non-pharmacological measures to prevent delirium, as they are easy and cost effective. The available evidence is still limited to recommend the daily use of pharmacological strategies in delirium prophylaxis, and there is a consensus against the modest use of antipsychotic drugs in surgical patients and dexmedetomidine in patients in intensive care. CONCLUSIONS: New high-quality clinical trials and studies involving non-surgical patients are needed to provide more evidence about this subject.

Prevención del delirium / Delirium Prevention

Introducción: El delirium es el síndrome neuropsiquiátrico más prevalente en el hospital general. Su presencia es un marcador de mal pronóstico para los pacientes. Prevenirlo puede ser la estrategia más efectiva para reducir su frecuencia y sus complicaciones. Objetivo: Identificar estrategias farmacológicas y no farmacológicas para la prevención del delirium. Metodología: Revisión no sistemática, en bases de datos como MEDLINE, Cochrane, EMBASE, Ovid y ScienceDirect, de artículos en español y en inglés publicados en los últimos diez arios, mediante una búsqueda que incluyó los términos delirium AND prevention. Resultados: La identificación de los factores predisponentes y precipitantes del delirium y una mayor comprensión de los mecanismos fisiopatológicos que subyacen a la aparición de este han permitido implementar diversas estrategias farmacológicas y no farmacológicas para pacientes con alto riesgo de contraer delirium hospitalario. Los estudios para prevenir el delirium se han concentrado en pacientes quirúrgicos. La evidencia actual apoya la implementación sistemática de medidas no farmacológicas para la prevención del delirium, por tratarse de estrategias fáciles de implementar y costo-efectivas. La evidencia disponible todavía es poca para recomendar el uso sistemático de medicamentos profilácticos para delirium, si bien existe consenso frente a la modesta utilidad de los antipsicóticos en pacientes quirúrgicos y de la dexmedetomidina en pacientes de cuidados intensivos. Conclusiones: Se necesitan nuevos ensayos clínicos de alta calidad que aporten mayor evidencia e incluyan a pacientes no quirúrgicos.

Introduction: Delirium is the most prevalent neuropsychiatric syndrome in the general hospital. Its presence is a marker of poor prognosis for patients. Its prevention could be the most effective strategy for reducing its frequency and its complications. Objective: To review recent findings and strategies for the prevention of delirium. Methodology: A non-systematic review of scientific articles published in the last ten years in Spanish and English. A search was made in databases such as MEDLINE, Cochrane, EMBASE, Ovid, and ScienceDirect, for articles that included the terms, delirium and prevention. Results: Identification of predisposing and precipitating factors for delirium and a better understanding of the pathophysiological mechanisms underlying the onset of delirium have enabled the implementation of various pharmacological and non-pharmacological strategies in patients at high risk to develop hospital delirium. The studies to prevent delirium have focused on surgical patients. The current evidence supports the daily implementation of non-pharmacological measures to prevent delirium, as they are easy and cost effective. The available evidence is still limited to recommend the daily use of pharmacological strategies in delirium prophylaxis, and there is a consensus against the modest use of antipsychotic drugs in surgical patients and dexmedetomidine in patients in intensive care. Conclusions: New high-quality clinical trials and studies involving non-surgical patients are needed to provide more evidence about this subject.