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La presente investigación tuvo como objetivo conocer el índice verde y la disponibilidad de parques en las alcaldías de mayor densidad poblacional en la Ciudad de México. Fue realizado mediante un análisis cuantitativo sobre bases de datos poblacionales proporcionados por el Instituto Nacional de Estadística y Geografía (INEGI) y Consejo Nacional de Población (CONAPO) para 2017 y 2020. El índice verde y la disponibilidad se calcularon mediante el geoprocesamiento de las áreas verdes correspondientes a parques de acuerdo con el Levantamiento de Áreas Verdes del 2017, considerando el portal de datos abiertos del gobierno de la Ciudad de México. Los datos geoestadísticos, fueron ajustados mediante la agrupación de polígonos y recálculo de áreas, no modificando la vectorización original. Los resultados indican que la alcaldía de Iztapalapa es la que mayor disponibilidad de parques tiene (259) y el mayor índice verde de áreas verdes en parques con un valor de 1.64 m2hab-1. Iztacalco, que es la alcaldía con mayor densidad de población registra un índice de 0.2 m2hab-1. Lo anterior refleja la enorme necesidad que existe de abrir espacios verdes recreativos a efecto de equilibrar la densidad de población con su índice verde en parques.

Introduction Cognitive impairment (CI) has a prevalence of 45–70% in people with multiple sclerosis (MS), producing a negative impact on their quality of life, personal life, and work. Early detection of CI has become an important aspect to be considered for an adequate follow-up, to optimize social adaptation and to implement specific cognitive rehabilitation strategies. The aim of this work is to propose a suitable cognitive evaluation of patients with MS based on available and efficient tools for diagnosis and monitoring purposes well supported by literature review and clinical experience. Methods A multidisciplinary panel of professionals from the field of neurology, neuropsychology, and neuroimaging performed a literature review of the topic of cognitive impairment assessment. This was combined and completed with their clinical experience to produce a set of recommendations. Results Some limitations to cognitive evaluation are described: shortage of time and resources during the neurology consultation, scarceness or absence of specialized professionals’ availability, importance of tests adaptation, and doubts about its use to define therapeutic efficiency. We recommend a baseline and annual screening evaluation, and we suggest a baseline and periodic neuropsychological assessment. The latter ought to change to a recommendation with the presence of either positive screening test, or subjective to cognitive complaints, screening-test results and patient or family report mismatch, or in specific social/work situations. Conclusions Cognitive evaluation should be performed on all patients diagnosed with MS and throughout follow-up. It is necessary to support the creation of multidisciplinary MS teams to optimize the evaluation and follow-up of MS patients.

Esclerosi múltiple; Neurodegeneració Esclerosis múltiple; Neurodegeneración Multiple sclerosis; Nneurodegeneration Multiple sclerosis (MS) is primarily an inflammatory and degenerative disease of the central nervous system, triggered by unknown environmental factors in patients with predisposing genetic risk profiles. The prevention of neurological disability is one of the essential goals to be achieved in a patient with MS. However, the pathogenic mechanisms driving the progressive phase of the disease remain unknown. It was described that the pathophysiological mechanisms associated with disease progression are present from disease onset. In daily practice, there is a lack of clinical, radiological, or biological markers that favor an early detection of the disease's progression. Different definitions of disability progression were used in clinical trials. According to the most descriptive, progression was defined as a minimum increase in the Expanded Disability Status Scale (EDSS) of 1.5, 1.0, or 0.5 from a baseline level of 0, 1.0–5.0, and 5.5, respectively. Nevertheless, the EDSS is not the most sensitive scale to assess progression, and there is no consensus regarding any specific diagnostic criteria for disability progression. This review document discusses the current pathophysiological concepts associated with MS progression, the different measurement strategies, the biomarkers associated with disability progression, and the available pharmacologic therapeutic approaches.

Background: Virtual reality (VR) has emerged as a promising treatment approach in rehabilitation for patients with multiple sclerosis (MS) due to its potential to increase patient motivation and rehabilitation adherence. One of the key features for rehabilitation adherence is patient satisfaction with the VR rehabilitation (VRR) program, and information on user satisfaction and not only effectiveness is required to systematically include VRR in routine clinical practice. Given that information on patient satisfaction with VRR is scarce, the primary objective of this study is to assess long-term patient satisfaction with a novel VRR program. This program has been specifically designed for MS patients by a multidisciplinary team of specialists, based on an effective conventional rehabilitation (CR) program. Secondarily, discomfort with VRR will be evaluated, and therapy adherence and changes in a variety of domains typically affected by MS will be compared between patients receiving VRR and patients receiving CR. Methods: In this prospective single-center 6-months follow-up study, 32 and 16 MS patients will receive VRR or CR, respectively. Patients will attend twice weekly rehabilitation sessions on site during 4 weeks, and they will continue with rehabilitation at home for five additional months. Satisfaction, assessed by the User Satisfaction Evaluation Questionnaire (USEQ), at 6 months of the VRR program initiation will be the primary outcome. Secondary outcomes include adherence, disability, spasms and spasticity, balance, fatigue, activities of daily living (ADLs), depression, anxiety, work status, cognition, demographic, and clinical characteristics (in the VRR and CR groups), and discomfort (in the VRR group). Outcome measures will be assessed at baseline, and at 1 and 6 months of rehabilitation initiation. Discussion: The study is intended to provide a better understanding of long-term patient satisfaction with a VRR program specifically designed for MS patients. Additionally, the study will provide information on long-term adherence, changes in motor symptoms, cognitive functions and patient-reported outcomes after the rehabilitation program. The results from this study will help to gather valuable knowledge on the use of rehabilitation with a new VR tool in MS patients.

INTRODUCTION: For more than a decade, after the ECTRIMS Congress, Spain has hosted the Post-ECTRIMS meeting, where neurologists with expertise in multiple sclerosis (MS) meet to review the new developments presented at the ECTRIMS. AIM: This article, published in two parts, summarises the presentations of the post-ECTRIMS meeting, held online on 16 and 17 October 2020. DEVELOPMENT: This second part highlights the importance of gender and age in understanding the pathology of the disease and optimising its management. The advances made in paediatric MS, from a neuropsychological and neuroimaging point of view, are presented. In turn, special attention is paid to the findings that contribute to a more personalised approach to therapy and to choosing the best treatment strategy (pharmacological and non-pharmacological) for each patient. Similarly, results related to possible strategies to promote remyelination are addressed. Although there are no major advances in the treatment of progressive forms, some quantitative methods for the classification of these patients are highlighted. In addition, the study also includes results on potential tools for assessment and treatment of cognitive deficits, and some relevant aspects observed in the spectrum of neuromyelitis optica disorders. Finally, the results of the papers considered as breaking news at the ECTRIMS-ACTRIMS are detailed. CONCLUSIONS: Most of the advances presented were related to the knowledge of paediatric MS, remyelination strategies and cognitive assessment in MS.

ObjectiveTo evaluate the accuracy of the recently proposed diagnostic criteria for chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS).MethodsWe enrolled 42 patients with hindbrain punctate and/or linear enhancements (ResultsAfter a median follow-up of 50 months (IQR 25–82), 13 out of 42 patients were CLIPPERS-mimics: systemic and central nervous system lymphomas (n=7), primary central nervous system angiitis (n=4) and autoimmune gliopathies (n=2). The sensitivity and specificity of the CLIPPERS criteria were 93% and 69%, respectively. Nodular enhancement ( ≥ 3 mm in diameter), considered as a red flag in CLIPPERS criteria, was present in 4 out of 13 CLIPPERS-mimics but also in 2 out of 29 patients with CLIPPERS, explaining the lack of sensitivity. Four out of 13 CLIPPERS-mimics who initially met the CLIPPERS criteria displayed red flags at the second attack with a median time of 5.5 months (min 3, max 18), explaining the lack of specificity. One of these four patients had antimyelin oligodendrocyte glycoprotein antibodies, and the three remaining patients relapsed despite a daily dose of prednisone/prednisolone ≥ 30 mg and a biopsy targeting atypical enhancing lesions revealed a lymphoma.ConclusionsOur study highlights that (1) nodular enhancement should be considered more as an unusual finding than a red flag excluding the diagnosis of CLIPPERS; (2) red flags may occur up to 18 months after disease onset; (3) as opposed to CLIPPERS-mimics, no relapse occurs when the daily dose of prednisone/prednisolone is ≥ 30 mg; and (4) brain biopsy should target an atypical enhancing lesion when non-invasive investigations remain inconclusive.

La investigación busca comprender las experiencias de vida en el contexto fronterizo existente entre los países Colombia y Venezuela más específicamente en la zona de frontera ubicada en Norte de Santander, Cúcuta. El cual explora el análisis de las características migratorias y de retorno de las familias transfronterizas deportadas-repatriadas de Venezuela tras el cierre fronterizo que dio el 15 de Agosto del año 2015, clasificando los motivos migratorios de los actualmente deportados su contexto histórico y cronológico y de esta manera identificar elementos que contribuyan a mitigar la crisis humanitaria presente tras este hecho. Por ello, Se hace imprescindible abordar el contexto fronterizo de manera objetiva, teniendo como foco de estudio los antecedentes que marcaron la salida de su territorio natal, hacia otros territorios fronterizos y el estudio de la unidad familiar que se vio afectada por la decisión drástica unilateral por parte del Gobierno Venezolano al cerrar la frontera Colombo-Venezolana. El análisis histórico y cronológico de las familia deportadas repatriadas de Venezuela a Cúcuta según su contexto fronterizo, se analiza la información recolectada de acuerdo a las encuestas mixtas realizadas en el año 2016, generando así unos datos importantes y necesarios para el análisis de la información, determinado aspectos tanto para la disciplina como para el contexto en donde se encuentran estas familias, ya que para el trabajo social se evidenciaron nuevas tipologías familiares, como lo es la transfronteriza y la transnacional, aportando nuevos aspectos y elementos a la profesión. Por consiguiente, cada uno de los resultados obtenidos, son insumos indispensables para la realización de análisis descriptivos que muestran las necesidades, condiciones de vida y aspectos familiares que son indispensables, tanto para el análisis del contexto en el cual se encuentra la ciudad de Cúcuta, como también para la disciplina, teniendo en cuenta que la investigación debe proporcionar elementos teóricos que fundamenten la problemática, es decir, insumos científicos que puedan visibilizarse ante la sociedad

Introduccion. El ocrelizumab es un anticuerpo monoclonal humanizado contra el antigeno CD20 de las celulas B. Ha sido aprobado recientemente por las agencias sanitarias estadounidense (Food and Drug Administration) y europea (European Medicines Agency) para el tratamiento de la esclerosis multiple (EM), y supone el primer farmaco comercializado tanto para la EM remitente recurrente (EMRR) como para la EM primariamente progresiva (EMPP). Los ensayos clinicos, tanto para formas recurrentes (OPERA I/II) como para las formas progresivas de la enfermedad (ORATORIO), han demostrado su eficacia. El objetivo de esta revision es abordar los principales aspectos de eficacia y seguridad del ocrelizumab en la EM. Desarrollo. Se ha realizado una revision bibliografica a traves de PubMed de trabajos publicados en el congreso ECTRIMS 2017 y de estudios activos en ClinicalTrials. Con el fin de evaluar la eficacia y seguridad del ocrelizumab en la EM, se han revisado ensayos clinicos aleatorizados, asi como sus estudios de extension y de seguimiento, y se ha incluido informacion sobre seguridad de los programas de monitorizacion de la Food and Drug Administration y la European Medicines Agency. Conclusiones. El ocrelizumab es el primer farmaco que ha demostrado poder frenar de forma significativa la progresion de la discapacidad en 12 y 24 semanas en pacientes con EMPP. Es tambien eficaz en el control de la actividad clinica y radiologica en pacientes con formas de EMRR, y su aprobacion e indicacion engloban ambos fenotipos de la enfermedad. Hasta ahora, el perfil de seguridad del ocrelizumab se ajusta a lo observado en los ensayos clinicos, sin alertas inesperadas.

Our goal was to evaluate the relation between the presence of neutralizing antibodies (NABs) to interferon beta-1b in multiple sclerosis (MS) patients and the clinical evolution in the following years.As we previously reported, we tested NABs in 68 patients treated with interferon beta-1b after 2 years of treatment. We prospectively followed this cohort every three months for a minimum period of 6 years collecting data about relapses, disability, secondary effects and dropouts.During the 6 year follow-up period, the annualized relapse rate did not differ between patients with and patients without NABs. A sustained progression was observed in 33% of positive patients and in 38% of patients without NABs. No differences were found in the proportion of patients who reached an EDSS score of 6. Secondary effects were similar in both groups.Although our results do not vouch for a negative effect of the presence of NABs on the clinical evolution of MS patients treated with interferon beta, further longitudinal studies to clarify the real effect of the presence of NABs in these patients are still much needed.