Melatonin in the Prophylaxis of SARS-CoV-2 Infection in Healthcare Workers (MeCOVID): A Randomised Clinical Trial.

We evaluated in this randomised, double-blind clinical trial the efficacy of melatonin as a prophylactic treatment for prevention of SARS-CoV-2 infection among healthcare workers at high risk of SARS-CoV-2 exposure. Healthcare workers fulfilling inclusion criteria were recruited in five hospitals in Spain and were randomised 1:1 to receive melatonin 2 mg administered orally for 12 weeks or placebo. The main outcome was the number of SARS-CoV-2 infections. A total of 344 volunteers were screened, and 314 were randomised: 151 to placebo and 163 to melatonin; 308 received the study treatment (148 placebo; 160 melatonin). We detected 13 SARS-CoV-2 infections, 2.6% in the placebo arm and 5.5% in the melatonin arm (p = 0.200). A total of 294 adverse events were detected in 127 participants (139 in placebo; 155 in melatonin). We found a statistically significant difference in the incidence of adverse events related to treatment: 43 in the placebo arm and 67 in the melatonin arm (p = 0.040), and in the number of participants suffering from somnolence related to treatment: 8.8% (n = 14) in the melatonin versus 1.4% (n = 2) in the placebo arm (p = 0.008). No severe adverse events related to treatment were reported. We cannot confirm our hypothesis that administration of melatonin prevents the development of SARS-CoV-2 infection in healthcare workers.

Cefalea y sueño / No disponible

Introducción: la relación entre cefalea y sueño es conocida desde hace muchos años. El sueño y la cefalea tienen una fuerte interacción bidireccional, y comparten elementos anatómicos y fisiológicos. La intención de la presente revisión es presentar los distintos tipos de cefaleas relacionadas con el sueño y su aproximación fisiopatológica. Desarrollo: exponemos los distintos tipos de cefaleas relacionadas con el sueño, es decir aquellas que ocurren durante la noche o en las primeras horas de la mañana, la migraña, la cefalea en racimo, la hemicránea crónica paroxística y la cefalea hípnica. También, desarrollamos el síndrome de la cabeza que explota o síndrome del estallido cefálico, puesto que en la práctica clínica debe ser valorado en el diagnóstico diferencial de las cefaleas relacionadas con el sueño. Conclusión: se necesita una mayor investigación en el tema para establecer conclusiones, esclarecer los mecanismos fisiopatológicos entre cefalea y sueño, así como entender cómo los cambios en la biología del sueño provocan dolor de cabeza y por qué los distintos tipos de cefaleas afectan a la biología del sueño (AU)

Introduction: the link between cephalalgia and sleep has been known for many years. Sleep and cephalalgia have a strong bidirectional interaction and share anatomical and physiological aspects. The intention of this paper is to present the different types of cephalalgias related with sleep and their physiopathological closeness. Discussion: different types of cephalalgia related with sleep will be exposed. That is, cephalalgia that occurs at night time or first time in the morning: migraine, cluster headache, chronic hemicrania continua and hypnic headaches. We also review the exploding head syndrome since it should be assessed in differential diagnosis when looking at sleep-related cephalalgias. Conclusions: further research is needed on this subject in order to establish conclusions, to clarify physiopathological mechanisms between cephalalgia and sleep and to understand how changes in sleep biology cause headaches and why different types of cephalalgias affect sleep biology (AU)

¿Es el síndrome de apnea-hipoanea durante el sueño (SAHS) un factor de riesgo de enfermedad neurodegenerativa en el trastorno de conducta en sueño REM (RBD)? / No disponible

Introducción: Estudios epidemiológicos han observado una elevada prevalencia del RBD y SAHS en el anciano. El RBD se clasifica como idiopático y asociado a enfermedades neurodegenerativas. La presencia de SAHS en el RBD es frecuente (34-61 %), aunque parece que su gravedad es menor. Iranzo y Santamaría identificaron un subgrupo de pacientes con “pseudo-RBD”, que eran pacientes con SAHS severo exclusivamente. Objetivo: Determinar la prevalencia de SAHS en una muestra de pacientes que cumplen criterios clínicos y vídeo-PSG de RBD y cuantificar el riesgo de desarrollar una enfermedad neurodegenerativa. Material y métodos: 38 pacientes con diagnóstico de RBD y seguimiento durante varios años. Se observó que un 41,2% desarrollaron procesos neurodegenerativos. El diagnóstico de RBD y SAHS se realizó mediante vídeo-PSG. La cobertura estadística: 89,5% (34/38). El 68,4% hombres con edad media de 62,9 años. La prevalencia de SAHS fue del 64,7 %, del 55% en el grupo RBD idiopático frente al 78,5% en el grupo que desarrolló una enfermedad neurodegenerativa. Para llevar a cabo el análisis de los paciente se realizó un estudio observacional, cohorte. La implicación del SAHS se estudió mediante el Riesgo Relativo (RR). Definición de caso: persona con diagnóstico de RBD y SAHS que desarrolla una enfermedad neurodegenerativa. Resultados: Se obtuvo un RR del 2, con un IC del 95% (0,69-5,75), estadísticamente no significativo. Discusión y Conclusiones: En nuestra muestra se demostró una prevalencia y características del RBD congruentes con la literatura. La investigación no permitió demostrar una asociación estadísticamente significativa (AU)

Introduction: Epidemiological studies have observed a high prevalence of RBD and SAHS among the elderly. RBD qualifies as idiophatic and is associated with neurodegenerative diseases. Presence of SAHS in RBD is frequent (34-61 %), though it seems that its seriousness is minor. Iranzo and Santamaría identified a patient’s subgroup with "pseudo-RBD", who exclusively had severe SAHS. Our goal is to determine SAHS prevalence in a patients sample that meet the clinical criteria and RBD video-PSG, and on the other hand to quantify the risk of developing a neurodegenerative disease. Material and methods: 38 patients with RBD diagnosis and follow-up during a few years.We observed that 41.2% developed neurodegenerative diseases. Diagnosis of RBD and SAHS was performed by video-PSG. Statistical coverage: 89.5% (34/38). 68.4% men with mean age of 62.9 years. SAHS prevalence was 64.7 %, 55% for RBD idiophatic group, against 78.5% for the group that developed a neurodegenerative disease. To carry out the analysis, an observational cohort study was performed. Implication of SAHS was analyzed by means of Relative Risk (RR). Definition of case: it presents with diagnosis of RBD and SAHS that develops a neurodegenerative disease. Results: RR of 2 was obtained, with an IC of 95% (0.69-5.75), statistically not significant. Discussion and Conclusions:In our sample, RBD prevalence and characteristics were consistent with literature. Research did not allow proving a statistically significant association (AU)

La encefalopatía con estatus epiléptico eléctrico durante el sueño / No disponible

Introducción: La encefalopatía con estatus eléctrico durante el sueño es una encefalopatía epiléptica relacionada con la edad, que se caracteriza por un patrón electroencefalográfico durante el sueño, y se presenta con crisis epilépticas y regresión neurocognitiva. Desarrollo: revisamos las características clínicas, los hallazgos en las exploraciones complementarias, y el tratamiento en pacientes con esta patología. Conclusión: consideramos de gran importancia la detección temprana del patrón de estatus eléctrico durante el sueño, para realizar un abordaje terapéutico precoz, antes de que la actividad epiléptica deteriore el normal proceso madurativo cerebral (AU)

No disponible

Bronchial involvement in the cramp-fasciculation syndrome.

BACKGROUND/AIMS: Cramp-fasciculation syndrome (CFS) is an acquired, chronic, usually benign and rather heterogeneous condition with isolated fasciculations and muscle cramps generally induced by physical exercise. They commonly involve calf and quadriceps muscles. The pathophysiology of CFS is related to peripheral nerve hyperexcitability, most often located at the motor nerve terminal or intramuscular arborization. METHODS: A 21-year-old man presented with a progressive syndrome of bronchospasm, cramps and muscle twitches related to physical exercise. Spirography showed bronchial hyperresponsiveness, so he received inhaled corticosteroids and beta2-agonists that improved respiratory symptoms. Electrodiagnostic studies were consistent with CFS. Gabapentin was then introduced. RESULTS: Both respiratory and muscle symptoms improved. A new spirogram after all inhaled medication had been discontinued was normal. CONCLUSION: This picture suggests a concomitant involvement of the peripheral motor nerves of both skeletal and airway autonomic smooth muscle, a presentation not previously reported in CFS.