[XVI Post-ECTRIMS Meeting: review of the new developments presented at the 2023 ECTRIMS Congress (II)]. / XVI Reunión Post-ECTRIMS: revisión de las novedades presentadas en el Congreso ECTRIMS 2023 (II).

The XVI Post-ECTRIMS meeting was held in Seville on 20 and 21 October 2023, where expert neurologists in multiple sclerosis (MS) summarised the main new developments presented at the ECTRIMS 2023 congress, which took place in Milan from 11 to 13 October. The aim of this article is to summarise the content presented at the Post-ECTRIMS Meeting, in an article in two parts. This second part covers the health of women and elderly MS patients, new trends in the treatment of cognitive impairment, focusing particularly on meditation, neuroeducation and cognitive rehabilitation, and introduces the concept of fatigability, which has been used to a limited extent in MS. The key role of digitalization and artificial intelligence in the theoretically near future is subject to debate, along with the potential these technologies can offer. The most recent research on the various treatment algorithms and their efficacy and safety in the management of the disease is reviewed. Finally, the most relevant data for cladribine and evobrutinib are presented, as well as future therapeutic strategies currently being investigated.

TITLE: XVI Reunión Post-ECTRIMS: revisión de las novedades presentadas en el Congreso ECTRIMS 2023 (II).Los días 20 y 21 de octubre se celebró en Sevilla la XVI edición de la reunión Post-ECTRIMS, en la que neurólogos expertos en esclerosis múltiple (EM) resumieron las principales novedades presentadas en el congreso del ECTRIMS 2023, celebrado en Milán del 11 al 13 de octubre. El objetivo de este artículo es sintetizar las ponencias que tuvieron lugar en la reunión Post-ECTRIMS en un artículo desglosado en dos partes. En esta segunda parte se abordan la salud de la mujer y del paciente mayor con EM, las nuevas tendencias en el tratamiento del deterioro cognitivo, con especial mención a la meditación, la neuroeducación y la rehabilitación cognitiva, y se introduce el concepto de fatigabilidad, poco utilizado en la EM. El papel clave de la digitalización y la inteligencia artificial en un futuro teóricamente cercano es objeto de debate, junto con las expectativas que pueden ofrecer. Se repasa la investigación más reciente sobre los distintos algoritmos de tratamiento, y su eficacia y seguridad en el manejo de la enfermedad. Por último, se exponen los datos más relevantes sobre la cladribina y el evobrutinib, y se presentan las futuras estrategias terapéuticas actualmente en investigación.

[XVI Post-ECTRIMS Meeting: review of the new developments presented at the 2023 ECTRIMS Congress (I)]. / XVI Reunión Post-ECTRIMS: revisión de las novedades presentadas en el Congreso ECTRIMS 2023 (I).

The XVI Post-ECTRIMS meeting took place in Seville on 20 and 21 October 2023. This meeting was attended by neurologists specialising in multiple sclerosis (MS) from Spain, who shared a summary of the most interesting innovations at the ECTRIMS congress, which had taken place in Milan the previous week. The aim of this article is to summarise new developments related to the pathogenesis, diagnosis and prognosis of MS. The contributions of innate immunity and central nervous system resident cells, including macrophages and microglia in MS pathophysiology and as therapeutic targets were discussed. Compartmentalised intrathecal inflammation was recognised as central to understanding the progression of MS, and the relationship between inflammatory infiltrates and disease progression was highlighted. Perspectives in demyelinating pathologies were reviewed, focusing on neuromyelitis optica and myelin oligodendrocyte glycoprotein antibody-associated disease, highlighting their pathophysiological and diagnostic differences compared to MS. Advances in neuroimaging were also discussed, and especially the analysis of active chronic lesions, such as paramagnetic rim lesions. In the absence of clinical improvements in trials of remyelinating treatments, methodological strategies to optimise the design of future studies were proposed. Breakthroughs in detecting the prodromal phase of MS, the use of biomarkers in body fluids to assess activity, progression and treatment response, and research on progression independent of flares were addressed. The need to define criteria for radiologically isolated syndrome and to clarify the concept was also discussed.

TITLE: XVI Reunión Post-ECTRIMS: revisión de las novedades presentadas en el Congreso ECTRIMS 2023 (I).La XVI edición de la reunión Post-ECTRIMS se celebró los días 20 y 21 de octubre de 2023 en Sevilla. Este encuentro reunió a neurólogos especialistas en esclerosis múltiple (EM) de España, quienes compartieron un resumen de las innovaciones más destacables del congreso ECTRIMS, acontecido en Milán la semana anterior. El objetivo de este artículo es sintetizar las novedades relativas a la patogenia, el diagnóstico y el pronóstico de la EM. Se destacaron las contribuciones de la inmunidad innata y las células residentes del sistema nervioso central, incluyendo macrófagos y microglía, en la patofisiología de la EM y como objetivos terapéuticos. La inflamación intratecal compartimentada se reconoció como fundamental para entender la progresión de la EM, y destaca la relación entre infiltrados inflamatorios y la evolución de la enfermedad. Se revisaron perspectivas en patologías desmielinizantes, enfocadas en la neuromielitis óptica y la enfermedad asociada a anticuerpos contra la glucoproteína de mielina de oligodendrocitos, subrayando sus distinciones patofisiológicas y diagnósticas con la EM. También se abordaron los avances en neuroimagen, especialmente en el análisis de las lesiones crónicas activas, como las lesiones con borde paramagnético. Ante la ausencia de mejoras clínicas en ensayos de tratamientos remielinizantes, se propusieron estrategias metodológicas para optimizar el diseño de futuros estudios. Se abordaron los avances en la detección de la fase prodrómica de la EM, el uso de biomarcadores en fluidos corporales para evaluar la actividad, la progresión y la respuesta al tratamiento, y la investigación sobre la progresión independiente de la actividad de brote. Además, se debatió sobre la necesidad de definir criterios para el síndrome radiológico aislado o precisar su concepto.

Consensus statement of the Spanish Society of Neurology on the treatment of multiple sclerosis and holistic patient management in 2023.

The last consensus statement of the Spanish Society of Neurology's Demyelinating Diseases Study Group on the treatment of multiple sclerosis (MS) was issued in 2016. Although many of the positions taken remain valid, there have been significant changes in the management and treatment of MS, both due to the approval of new drugs with different action mechanisms and due to the evolution of previously fixed concepts. This has enabled new approaches to specific situations such as pregnancy and vaccination, and the inclusion of new variables in clinical decision-making, such as the early use of high-efficacy disease-modifying therapies (DMT), consideration of the patient's perspective, and the use of such novel technologies as remote monitoring. In the light of these changes, this updated consensus statement, developed according to the Delphi method, seeks to reflect the new paradigm in the management of patients with MS, based on the available scientific evidence and the clinical expertise of the participants. The most significant recommendations are that immunomodulatory DMT be started in patients with radiologically isolated syndrome with persistent radiological activity, that patient perspectives be considered, and that the term "lines of therapy" no longer be used in the classification of DMTs (> 90% consensus). Following diagnosis of MS, the first DMT should be selected according to the presence/absence of factors of poor prognosis (whether epidemiological, clinical, radiological, or biomarkers) for the occurrence of new relapses or progression of disability; high-efficacy DMTs may be considered from disease onset.

Desenvolvimento de embriões de camundongas após manutenção em diferentes soluções de manipulação / Development of mice embryos after maintenance in different manipulation solutions

Avaliou-se a eficácia de duas soluções de manipulação (SM) de embriões de camundongas nos estádios de blastocisto inicial (Bin), mórula compacta grau I (McI) e II (McII), distribuídos aleatoriamente em três tratamentos (T), de acordo com a solução de manutenção. No T1 usou-se PBS modificado (controle); no T2, SME e no T3, SME enriquecida. Os embriões foram mantidos durante quatro horas na solução de manutenção e posteriormente classificados quanto ao estádio de desenvolvimento e à qualidade embrionária. Logo após, foram cultivados em meio TCM 199 e classificados novamente quanto ao estádio de desenvolvimento e à qualidade embrionária. A taxa de desenvolvimento dos embriões após manutenção por quatro horas em solução de manipulação foi menor (P<0,05) nos embriões do controle, comparada à de embriões do SME e SME enriquecida, diferença esta não observada (P>0,05) após o cultivo in vitro. Os embriões McII do T3 tiveram maior desenvolvimento (P<0,05) em relação aos embriões do T1 e T2, indicando o efeito benéfico do enriquecimento da solução SME. Conclui-se que as soluções de manipulação SME e SME enriquecida influenciaram beneficamente o desenvolvimento de embriões.

The effect of embryo manipulation solution followed by in vitro culture in mice embryos was studied. The embryos at early blastocyst (Bin), and compact morula grades I (McI) and II (McII) were randomly assigned into three treatments. T1 used modified PBS (control), T2 used EMS, and T3 used EMS supplemented. In each treatment, the embryos were kept in manipulation solution for four hours. Finishing the manipulation period, the embryos were classified according the development stage and quality. Following, the embryos were cultured in TCM 199. After the culture period, the embryos were evaluated according to quality and development stage. The development rate for Bin, McI, and McII after maintenance for four hours in manipulation solution was lower for control embryo (P>0.05) as compared to EMS and EMS supplemented embryos. After in vitro culture, no differences (P>0.05) on embryo development rate among control, EMS, and EMS supplemented were observed. Moreover, McII from EMS supplemented had a higher development (P<0.05) (93 percent) as compared to control (82.5 percent) and EMS (83.9 percent), suggesting a beneficial effect of EMS supplemented. EMS and EMS supplemented embryos had a positive effect on embryo development, showing higher embryo development than those in PBS solution.

Calidad de la dispensación en la oficina farmaceútica a demanda del paciente en farmacias de La Esperanza, Florencia de Mora y El Porvenir / Quality of prescription at pharmaceutical services demanded by patients at pharmacies of La Esperanza, Florencia de Mora and El Porvenir

Evaluación de la calidad de la dispensación en la Oficina Farmaceútica cuando el paciente demanda una consulta que se ofrece en casos de diarrea aguda (EDA), o infección respiratoria aguda (IRA), cuadros que no sólo son muy frecuentes sino fácilmente reductibles. Considerando tambien que un panorama signado por las acrencias alimenticias promueve el uso de medicamentos para lograr un aumento de peso, se observa la actitud del dispensador cuando se le presenta un cuadro de anorexia. Para fines de este estudio se escogieron los distritos de La Esperanza, El Porvenir y Florencia de Mora, en razón de que son zonas socio-económicas deprimidas, con los más altos índices de mortalidad infantil