[Sleep-related movement and behavioural disorders in adults]. / Trastornos del movimiento y de la conducta durante el sueño en el adulto.

Sleep-related movement and behaviour disorders may have an impact on sleep quality and lead to daytime symptoms. These groups of conditions include diseases such as restless legs syndrome, periodic leg movements, and REM and NREM parasomnias. The knowledge of their clinical features and management is of utmost importance for the neurologist and sleep specialist. Frequently, these patients are referred to such specialists and it is relevant to know that certain sleep disorders may be associated with other neurological conditions.

TITLE: Trastornos del movimiento y de la conducta durante el sueño en el adulto.Los trastornos del movimiento y de la conducta durante el sueño pueden tener un impacto en la calidad del sueño del paciente y dar lugar a síntomas diurnos. En estos grupos de enfermedades se incluyen entidades como el síndrome de piernas inquietas, los movimientos periódicos de las piernas y las parasomnias del sueño de movimientos oculares rápidos (REM) y no REM. El conocimiento de sus características clínicas y nociones sobre su manejo es de gran importancia para el neurólogo y especialista en sueño por su frecuencia e impacto en la calidad del sujeto. Con frecuencia, estos pacientes son referidos a dichos especialistas, y es relevante conocer que ciertos trastornos del sueño pueden asociarse a otras enfermedades neurológicas.

[Recommendations on neurophysiological studies during the COVID-19 pandemic]. / Recomendaciones sobre estudios neurofisiológicos en tiempos de pandemia de COVID-19.

At the end of January, the current outbreak of COVID-19 coronavirus disease was declared an important international public health emergency. In Spain, since the government declared the state of alarm on 14 March 2020, doctors responsible for carrying out neurophysiological tests have been performing them without any consensus criterion or clear safety guidelines for doctors, technicians or patients. The following recommendations, based on current knowledge of the disease and therefore liable to change in the future, are proposed when the pandemic appears to have entered a process of decreasing virulence and, with it, the strict containment measures established to date. However, in view of the possibility of a second wave of the pandemic, it seems necessary to establish basic and minimum recommendations to respect the patient's right to appropriate care, similar to that provided prior to the pandemic, and to maintain minimum safety standards for the patients themselves and for the doctors, technicians and health personnel carrying out these tests. These recommendations concern the constitution of a priority based on the reason for consultation, the establishment of calls to check the patient's clinical situation before going to the outpatient department and the rules for carrying out neurophysiological tests, which are generally based on the preservation of hospital circuits, respect for and observation of the known barriers to contagion of this disease, and the use of disposable material. These recommendations are of particular interest, especially given the uncertainty of not knowing the evolution of the SARS-CoV-2 infection in the coming weeks or months.

TITLE: Recomendaciones sobre estudios neurofisiológicos en tiempos de pandemia de COVID-19.A finales de enero, la Organización Mundial de la Salud declaró el brote actual de la enfermedad por coronavirus COVID-19 como emergencia de salud pública de importancia internacional. En España, desde que el 14 de marzo de 2020 el Gobierno decretase el estado de alarma, los médicos encargados de las pruebas neurofisiológicas las hemos estado realizando sin tener un criterio consensuado ni unas pautas adecuadas de seguridad claras para los facultativos, los técnicos ni los pacientes. Las siguientes recomendaciones, basadas en el actual conocimiento de la enfermedad y, por tanto, susceptibles de variaciones en el futuro, se proponen cuando la pandemia parece que ha entrado en un proceso de disminución de la virulencia y, con ello, las medidas estrictas de confinamiento hasta ahora mantenidas; sin embargo, ante la posibilidad de una segunda oleada de rebrotes de la pandemia, parece necesario establecer unas recomendaciones básicas y de mínimos para respetar el derecho del paciente a una atención adecuada, similar a la previa a la pandemia, y mantener unos mínimos de seguridad para los propios pacientes y los médicos, técnicos y personal sanitario que realizan estas pruebas. Se trata de recomendaciones sobre el establecimiento de una prioridad basándose en el motivo de consulta, el establecimiento de llamadas de comprobación de la situación clínica del paciente antes de acudir a la consulta externa y las normas de ejecución de las pruebas neurofisiológicas, que se basan, en general, en la preservación de circuitos hospitalarios, el respeto y el cuidado de las barreras de contagio conocidas de esta enfermedad, y la utilización de material desechable. Estas recomendaciones son de especial interés, sobre todo por la incertidumbre de no saber la evolución de la infección por el SARS-CoV-2 en las próximas semanas o meses.

[Healthy sleep: evidence and guidelines for action. Official document of the Spanish Sleep Society]. / Sueño saludable: evidencias y guias de actuacion. Documento oficial de la Sociedad Española de Sueño.

One of the main objectives of the Spanish Sleep Society is to promote healthy sleep in both the general population and in health professionals. This document aims to conduct a review of the current scientific literature on sleep habits that can serve as the basis on which to establish a set of general recommendations, regarding healthy sleep, for use by the general population in Spain as well as to identify the main challenges faced by research into sleep habits. The document has been developed by a multidisciplinary team made up of members of the Spanish Sleep Society who are experts in paediatric sleep medicine, clinical neurophysiology, pulmonology, neurology, chronobiology, physiology and psychology. The existing scientific literature dealing with sleep habits in the general population was reviewed, and the following aspects were addressed: the current state of sleep habits in the Spanish population; a generic review of the optimum number of hours of sleep; the impact of the environmental setting (noise, temperature, illumination, etc.), hours of sleep, diet and sport, together with several specific sections for children and teenagers, shift-workers and drivers of different vehicles. The conclusions from all the aspects addressed in this document have resulted in a set of final general recommendations that will serve as a guide for the general population and health professionals. Likewise, the principal environmental challenges and future lines of research are also discussed.

Phenotyping the central nervous system of the embryonic mouse by magnetic resonance microscopy.

Genetic mouse models of neurodevelopmental disorders are being massively generated, but technologies for their high-throughput phenotyping are missing. The potential of high-resolution magnetic resonance imaging (MRI) for structural phenotyping has been demonstrated before. However, application to the embryonic mouse central nervous system has been limited by the insufficient anatomical detail. Here we present a method that combines staining of live embryos with a contrast agent together with MR microscopy after fixation, to provide unprecedented anatomical detail at relevant embryonic stages. By using this method we have phenotyped the embryonic forebrain of Robo1/2(-/-) double mutant mice enabling us to identify most of the well-known anatomical defects in these mutants, as well as novel more subtle alterations. We thus demonstrate the potential of this methodology for a fast and reliable screening of subtle structural abnormalities in the developing mouse brain, as those associated to defects in disease-susceptibility genes of neurologic and psychiatric relevance.

Situación de la atención farmacéutica en los centros sociosanitarios públicos de la Comunidad Valenciana / No disponible

La actual ralentización del crecimiento demográfico junto con el envejecimiento progresivo de la poblaciónimplican la acumulación de problemas de salud a lo largo de la vida, tanto en la incidencia como en la prevalenciade muchas enfermedades, así como en las limitaciones del bienestar psíquico, físico y de la autonomía. Todo esto se traduce en una importante demanda de bienes y servicios que comienza a requerir la población y que se agudizará en los próximos años tanto en atención social como en atención sanitaria. La mejor expectativa es la adaptación para la mejora de la calidad de vida en este sector de la población, en la cual el farmacéutico tiene una participación activa muy importante, ofreciendo soluciones para garantizar el uso racional de los medicamentos e integrándose en un equipo multidisci-plinar en la atención farmacéutica en los centros sociosanitarios o de atención sociosanitaria.La Comunidad Valenciana ha sido la pionera en llevar a cabo un modelo eficaz en este tipo de prestación especiali-zada de atención farmacéutica en centros sociosani-tarios, ya que se han evidenciado numerosas mejoras, entre las que destacan los balances económicos positivos en cuanto a la adquisición de medicamentos y material sanitario, la disminución de errores en la dispensación, la implantación de un sistema de control de calidad, la atención farmacéutica especializada e individualizada que reciben los pacientes y la incorporación de la figura del farmacéutico en un nuevo ámbito de trabajo.La experiencia se inició en la provincia de Valencia, en el año 1990, con un botiquín farmacéutico en la Residencia Mixta de la Tercera Edad de Carlet, desde donde se llevó a cabo un modelo de asistencia farmacéutica que ha conseguido instaurarse en toda la Comunidad Valenciana y actualmente están funcionando cinco servicios de farmacia en los que se encuentra integrada la figura del farmacéutico especialista en farmacia hospitalaria. Debido a la distancia entre los servicios de farmacia y los centros sociosantiarios suministrados por éstos, se establece un depósito de medicamentos en cada centro sociosanitario en función de las necesidades del mismo, en los que se garantiza la disponibilidad de los medicamentos a través del sistema de dosis unitarias, así como la adaptación de los tratamientos a una guía pautada farmacoterapéutica sociosanitaria. Tanto los servicios de farmacia como los depósitos de medicamentos cuentan con los medios personales y materiales necesarios para el adecuado cumplimiento de sus funciones, así como la garantía dedisponibilidad de los medicamentos necesarios para la población asistida en los centros.Durante los últimos años se ha producido un notable incremento en la autorización por parte de la Conselleriade Sanidad de estos depósitos de medicamentos en los centros sociosanitarios y se prevé que vaya en aumento, ya que son la mejor herramienta para el crecimiento y desarrollo de una buena labor asistencialen el ámbito farmacéutico

The present slow growth of the population in addition with the aging of the population implies an accumulationof health problems during life. This is reflected not only on the incidence and prevalence of many illnesses,but also in the limitations of the autonomy and physical and psychological welfare of the people.All this is translated into an important demand of goods and services that the population requires and thatwill be intensified in the years to come as much as in social care as in health care.The best hope for this sector of the population is the adaptation to improve their quality of life, in which pharmacists play an important active role, offering solutions that guarantee the rational use of medicines and, in so doing, being integrated in a multidisciplinary team in the social health-care centres.The Valencian community has had a pioneering role in carrying out an efficient model of specialized pharmaceutical care in health-care centres, as numerous improvements have been shown. The most important ofthese are maintaining positive economic balances related to the acquisition of medicines and health material,the decrease of dispensing errors, the establishment of a quality control system, a specialized and individualized pharmaceutical care received by patients and the incorporation of the pharmacist in a new workingenvironment.The experience was initiated in 1990 in the province of Valencia with the provision of a first-aid kit at theCarlet’s Mixed Elderly Residence, where a model of pharmaceutical care was carried out. This model has beenestablished within the regions of the Valencian community and, nowadays, five pharmacy departments arefunctioning, in which the hospital pharmacy specialist is integrated.Due to the distance between the departments of pharmacy and the health-care centres that they supply, a medicinesstore is created in each health-care centre depending on their requirements. The availability of the medicines is guaranteed by a system of single doses as well as by adjusting the treatments according to a pharmaceuticalformulary. Both, the departments of pharmacy and the medicines stores, include enough staff and resources in order to carry out their functions appropriately and to guarantee the availability of the medicinesrequired by the patients assisted in the centres.During recent years there has been an important increase in the creation of these medicines stores in thehealth-care centres by the «Conselleria de Sanidad». It is thought this rate is going to increase, as these medicines stores are the best tool for the growth and development of a good welfare work in the pharmaceutical environment (AU)

[Therapeutic interchange between angiotensin II receptor blockers in institutionalized elderly patients. Implimenting a protocol]. / Intercambio terapéutico de antagonistas del receptor de la angiotensina-II en pacientes ancianos institucionalizados. Aplicación de un protocolo.

OBJECTIVE: To assess the effectiveness of a therapeutic interchange protocol for angiotensin II receptor blockers (ARB's) in the maintenance of blood pressure levels for institutionalized elderly patients diagnosed with hypertension. METHODS: A new protocol was discussed by the Pharmacy and Therapeutics Committee, and its implementation by the Pharmacy Department was authorized. The protocol specifies equivalent doses between drugs and the patients' clinical follow-up. Criteria used in the assessment includes: need to change dosage for an ARB included in the Pharmacotherapeutic Guide, and blood pressure changes after drug interchange. RESULTS: In the absence of hepatic insufficiency, the protocol may replace the standard doses of any drugs within this group with losartan 50 mg daily. If needed, the dose of losartan may be increased to 100 mg daily divided into two doses. Eighteen patients, which represent 10% of all interchange operations carried out by the Pharmacy Department, were included in this study. Blood pressures both before and after the interchange process show no major differences between them. Only two patients required an increase in the dose of losartan. CONCLUSION: The implementation of a therapeutic interchange protocol as agreed upon by the Pharmacy and Therapeutics Committee allows the clinical follow-up of patients and therefore facilitates an evaluation of the process. This ARB interchange protocol, as suggested for the institutionalized elderly population setting, has proven effective in maintaining anti-hypertensive activity.

[Urinary tract infection in institutionalized elderly patients. Incidence of bacterial resistance and risk factors]. / Infecciones de tracto urinario en pacientes ancianos institucionalizados. Incidencia y factores de riesgo de resistencias bacterianas.

INTRODUCTION: The goal of the present work was to study urinary tract infections (UTI) in a sociosanitary center in order to characterize etiology, define sensitivity profiles, and study associations between these profiles and various clinical parameters. MATERIAL AND METHODS: A prospective study of all urinary tract infections at the caring unit of a geriatric sociosanitary center was carried out. Antibiograms were performed on all patients in which a UTI was suspected, and the association between the isolated organism or E. coli resistance with various clinical parameters (gender, bed confinement, recurrence, incontinence, neural impairment, basic daily life activities and drug use) was studied using a multivariate logistic regression analysis. RESULTS: Escherichia coli and Proteus mirabilis are the most commonly isolated organisms (51% and 15%, respectively). The former is associated with bed confinement and the female gender. The latter shows an inverse relation with recurrence in 90 days. Resistance to the antibiotics studied correlates with a number of clinical parameters, although associations vary for each antimicrobial agent. Previous use of antibiotics and recurrence of infection have no influence on resistance. DISCUSSION: Geriatric patients' characteristics may well account for some of the results encountered. However, the development of resistance in the center may be related to spreading from direct contact between patients. The relationship between resistance and drug use may be affected by the external administration, rather than in-center administration, of drugs.

[Simultaneous administration of drugs and artificial nutrition: practical aspects]. / Administración concomitante de medicamentos con nutrición artificial: aspectos prácticos.

Most patients on artificial nutrition, both parenteral or enteral, are also taking drugs. This means that factors covering pharmacokinetic, physico-chemical (stability) and mechanical (use of tubes) considerations have to be taken into account. Description of the pharmacokinetic processes of drugs and the influence of the nutritive state, nutrients and drugs on these processes. The simultaneous administration of drugs and Parenteral Nutrition may be done in two ways: by adding the drugs to the Parenteral Nutrient Units (PNU) and by administering the drugs using "Y equipment". The adding of drugs to PNU is mainly indicated in patients with restricted liquid intake, restricted venous access, patients subject to parenteral nutrition at home and the administering of drugs by continuous perfusion. With regard to enteral nutrition, factors such as the administration method, approach and galenic properties of the preparations should be taken into account.