Manejo farmacoterapéutico del paciente hospitalizado con enfermedad de Parkinson

236 p.Los pacientes con enfermedad de Parkinson (EP) ingresan en el hospital más frecuentemente y durante más tiempo que otros pacientes del mismo grupo etario. El motivo de ingreso es a menudo diferente de su enfermedad de base, y en muchas ocasiones son atendidos en servicios en los que el personal posee conocimientos más limitados de la enfermedad. Tanto los errores en la administración del tratamiento antiparkinsoniano como el uso inapropiado de fármacos con acción antidopaminérgica central conllevan un riesgo de deterioro motor y complicaciones de diversa gravedad. Además, la información sobre reacciones adversas en pacientes con EP no está suficientemente estudiada y existen dudas sobre si el perfil de seguridad de fármacos con actividad antidopaminérgica es extrapolable a los pacientes con EP. Por otra parte, es conocido el potencial efecto nocivo del uso de fármacos con actividad anticolinérgica en pacientes con EP debido, entre otros, al hecho de que pueden producir un efecto deletéreo en el sistema nervioso central especialmente en las personas de edad avanzada, al riesgo de interacciones farmacodinámicas en pacientes en tratamiento con inhibidores de la colinesterasa, o a sus efectos anticolinérgicos periféricos. Teniendo en cuenta la situación descrita, los objetivos de esta tesis son: Evaluar el uso de antidopaminérgicos con acción central (antipsicóticos y antieméticos) y el cumplimiento de las pautas de dosificación con levodopa en pacientes ingresados con EP en los hospitales de agudos de Osakidetza-Servicio Vasco de Salud en el periodo 2011-2012, analizando su influencia sobre la mortalidad y el tiempo de estancia hospitalaria; Analizar de las reacciones adversas (RAM) a antidopaminérgicos de acción central en pacientes con EP notificadas al sistema español de farmacovigilancia (FEDRA), y compararlas con las descritas en la literatura y; Determinar la carga anticolinérgica total en los pacientes con EP ingresados en los hospitales de agudos de Osakidetza-Servicio Vasco de Salud en el periodo 2011-2012. Los resultados demuestran que los errores en la farmacoterapia detectados afectaron a aproximadamente la mitad de los 1623 pacientes y a un tercio de los 2546 ingresos hospitalarios. Tanto la administración inapropiada de antidopaminérgicos de acción central como la omisión de tomas en el tratamiento con levodopa contribuyeron al incremento de la mortalidad intrahospitalaria y prolongan en tiempo de estancia. Por otro lado, el análisis de los datos contenidos en FEDRA ha permitido detectar algunas RAM a antipsicóticos en la EP no publicadas previamente. Cabe destacar, los primeros casos de síndrome neuroléptico maligno (SNM) asociados a quetiapina y risperidona, además del segundo caso de este síndrome asociado a haloperidol en pacientes con EP. Tras evaluar las RAM a antidopaminérgicos de acción central en pacientes con EP publicadas en la literatura, se concluye que tanto clozapina como quetiapina son los que presentan un perfil de seguridad más favorable.La carga anticolinérgica en pacientes ingresados con EP fue relativamente elevada, utilizándose fármacos con actividad anticolinérgica en aproximadamente la mitad de los ingresos. El número total de medicamentos y el uso de inhibidores de la colinesterasa se asociaron de forma independiente con el uso de medicamentos anticolinérgico

Pharmacotherapeutic Challenges in Parkinson’s Disease Inpatients

During the natural history of Parkinson’s disease (PD), many patients require hospital admission for medical or surgical problems other than the motor features of PD. Therefore, they are often admitted to non-neurological wards where the staff is unfamiliar with PD management. Among the issues related to hospitalization in patients with PD, drug-related problems such as inappropriate levodopa timing of administration, the use of contraindicated, centrally acting antidopaminergic drugs and anticholinergic burden remain among the most troublesome

Farmakokutsadura eta Garapen Iraunkorrerako 6. Helburua: ur garbia eta saneamendua

The environmental impact of drugs or pharmaceuticals is a topic of growing concern. Drugs have been found in all environmental compartments, especially in water. Although the main route of access to the environment for drugs is related to consumption and resulting excretion, emissions can occur in any of the complex life cycle of pharmaceuticals. Apart from their ecotoxicological effects, pharmaceuticals in the environment can also affect human health (e.g: antibiotic resistance). In this article, we will focus on the potential influence of drug pollution on the 6th Sustainable Development Goal (SDG), describing possible solutions. SDGs have a special relevance in developing countries, where water is more polluted with drugs. The “One-Health” approach, which considers the relationship between humans, animals, and the shared environment, is needed to understand drug pollution. Collaboration of all the stakeholders involved in the life cycle of drugs is mandatory. Considering the cost-effectiveness and sustainability of the measures will be necessary to prevent drug pollution from becoming an obstacle to obtaining the 6th SDG.; Medikamentuek naturan duten inpaktua geroz eta interes handiagoa pizten duen gaia da. Ezaguna da medikamentuak eta haien hondakinak ingurumen-konpartimentu guztietan aurkitu direla, batez ere uretan. Medikamentuak ingurumenera iristeko bide nagusia kontsumoarekin eta haren ondoriozko iraizpenarekin dago erlazionatuta. Nolanahi ere, medikamentuen bizi-zikloaren beste faseetan ere gerta daitezke ingurumenerako igorpenak. Farmako-kutsadurak eragina du ingurumenean dauden izaki bizidunetan, eta baita giza osasunean ere. Antibiotikoekiko erresistentzien gorakada da horren adibideetako bat. Bestalde, uraren erabilgarritasuna, saneamendua eta higienea giza eskubideak badira ere, mundu osoko biztanle guztiek ez dauzkate bermatuta. Artikulu honetan, Garapen Iraunkorrerako 6. Helburua (GIH) -hots, ur garbia eta saneamendua- eta haren erronkak aztertuko ditugu, farmakokutsaduraren ikuspuntutik, konponbideak aztertuz. GIHek garrantzi berezia dute garapen-bidean dauden herrialdeetan; hain zuzen ere, uretako farmakokutsadura gehien dutenetan. Farmakokutsadura ulertu eta aztertzeko, "One-Health" ikuspuntua bultzatu beharra dago, hau da, osasun bakarrean bateratzea gizakion osasuna, animaliena eta partekatzen dugun ingurumenarena, eta, arazoari aurre egiteko, nahitaezkoa da medikamentuen bizi-zikloan parte hartzen duten eragile guztien elkarlana. Farmakokutsadura 6. GIHa lortzeko oztopo bihur ez dadin, beharrezkoa da lekuan lekuko osasun publikoaren beharrez gain neurrien kostu-eraginkortasuna ere kontuan hartzea, neurrien eraginkortasuna ziurtatzeko

Occurrence and ecological risk assessment of organic UV filters in coastal waters of the Iberian Peninsula

This study aimed to assess the presence of 21 UVFs and metabolites in coastal regions of the Iberian Peninsula, to evaluate their environmental risk, and identify possible influential factors affecting their measured concentrations. Sampling was carried out in spring and summer to assess possible seasonal variations. UVFs were detected in 43 of the 46 sampling sites. Only 5 were found above LOD: BP4, OC, BP3 and metabolites BP1 and BP8. Samples collected in Mar Menor had the greatest variety of compounds per sample and the highest cumulative concentrations. The risk was characterized using Risk Quotients (RQ). BP1 showed a Low environmental Risk in 2 sites while for OC the RQ indicated a Moderate Risk in 22 points. The variables that contribute most to the variation are population density, sampling season, whether it was an open bay or not, and level of urbanization. The presence of WWTPs had a lower influence.We thank the Rey Juan Carlos University Internal Program for the Promotion and Development of Research and Innovation – Bridge Grants 2020; the Spanish Ministry of Education and Professional Development, and the “Salvador Madariaga” Program in Support of Research Stays for Professor and Senior Researchers in Foreign Research Centres. A. Rico acknowledges the funding provided by the Talented Researcher Support Programme – PlanGenT(CIDEGENT/2020/043) of the Generalitat Valenciana. G. Quintana acknowledges the Spanish Ministry of Science and Innovation (Project CEX2018-000794-S) for his fellowship.Peer reviewe

Monitorización del consumo de sustancias de abuso legales e ilegales en España a través de las aguas residuales en el marco de la red ESAR-Net

Trabajo presentado en el 4th Congreso Internacional y XLIX Jornadas Nacionales de Socidrogalcohol - VIII Congreso Nacional Patología Bio-Psicosocial, celebrado en Tenerife del 06 al 08 de octubre de 2022

Early SARS-CoV-2 outbreak detection by sewage-based epidemiology

Sewage can be used to determine the scale of COVID-19 outbreak. Sewage Epidemiology or Waste Based Epidemiology (WBE) approach has been successfully used to track and provide early warnings of outbreaks of pathogenic viruses such as Hepatitis A, Poliovirus and Norovirus. In untreated wastewater COVID-19 (excreted via faeces then introduced to wastewater) can survive from hours to days. Detection of COVID-19 can be carried out with nucleic acid−based polymerase chain reaction (PCR) assay, used for confirmation of COVID-19 patients around the globe. New cheaper and faster monitoring tools are being developed to detect Covid-19 in wastewater by biosensors, ELISA, or paper-based indicator methods. This will allow to reveal true scale of Covid-19 outbreak associated with population link to a specific wastewater treatment plant.Peer reviewe

Do we really need to invoke heroic measures for early SARS-CoV-2 outbreak detection?

Over half of the world’s population was locked down due to the SARS-CoV-2 pandemic [1]. Countries are gradually easing lock-down restrictions, allowing citizens to recover their new “normal life”, while authorities prepare for a possible second wave. In these times of uncertainty, government policies around the world are based on model assumptions rather on real-time evidence, as traditional epidemiological tools face important logistic and feasibility challenges. The importance of asymptomatic carriers in the epidemiology of COVID-19 is driving scientists to consider massive testing in order to promptly detect re-emergence of SARS-CoV-2 outbreaks in communities. For example, a “Dunkirk spirit” is called as the only way to perform 10 million PCR tests per day in the United Kingdom, so that every citizen is voluntarily weekly tested [2]. But if people who test positive know they will be put back into quarantine, the voluntariness may be a pitfall of this ambitious plan.Peer reviewe

Antipsychotics and seizures: Higher risk with atypicals?

AbstractPurposeAlmost all antipsychotics have been associated with a risk of epileptic seizure provocation. Among the first-generation antipsychotics (FGA) chlorpromazine appears to be associated with the greatest risk of seizures among the second-generation antipsychotics (SGA) clozapine is thought to be most likely to cause convulsions. This information is largely based on studies that are not sufficiently controlled. Besides, information about the seizure risk associated with newer antipsychotics is scarce.MethodThe Pharmacovigilance Unit of the Basque Country (network of centers of the Spanish Pharmacovigilance System, SEFV) provided reporting data for adverse reactions (AR) from the whole SEFV to estimate the reporting odds ratio (ROR) for antipsychotics and seizures (“convulsions” as Single MedDra Query). Data was obtained from SEFV database from 1984 to the June 2011.ResultsThe total number of convulsions reported for SGA was 169 (total reported AR 3.204). The number of convulsions reported for FGA was 35 (total reported AR 2.051). 94 convulsions were reported in association with clozapine (total AR 1.052). The ROR for SGA versus FGA was 3.2 (CI 95%: 2.21–4.63). The ROR for SGA excluding clozapine versus FGA was 2.08 (CI 95%: 1.39–3.12).ConclusionOur results show that SGA may pose a higher risk of seizures than FGA, mainly, but not only due to clozapine. This is line with recent studies suggesting that some SGA carried a higher average risk of electroencephalographic abnormalities than many FGA. Nonetheless, It is well known that spontaneous reports do not allow strong inferences about adverse drug effects, because differences in reporting fractions by time, drug or type of event are difficult or even impossible to distinguish from differences in the occurrence rates of adverse events. Still, we consider that the possibility of SGA carrying a higher risk of seizure induction than FGA warrants further research