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Estudio de un caso clínico de sarcoma de partes blandas que resulta ser un Dermatofibrosarcoma Protuberans. La paciente es una mujer de 44 años que presentaba el tumor cutáneo en el hueco poplíteo del miembro inferior izquierdo por lo que es sometida a cirugía oncológica de exéresis más injerto. El tratamiento posquirúrgico consistió en curas seriadas desde atención primaria siguiendo pautas estrictas desde la unidad de cirugía plástica. Como efecto iatrogénico de la cirugía resultante la paciente padece de linfedema de grado II, que afecta imagen corporal de la paciente y limita su movilidad y calidad de vida. El plan de cuidados integral llevado acabo logro paliar en cierta medida los patrones funcionales alterados. ABSTRACT: [Holistic nursing care in a clinical case of soft tissue sarcoma with lymphedema outcome] Study of a clinical case of soft tissue sarcoma that turns out to be a Dermatofibrosarcoma Protuberans. The patient is a 44-year-old woman who presented the cutaneous tumor in the popliteal hollow of the left lower limb and underwent oncologic surgery of excision plus grafting. Post-surgical treatment consisted of serial cures from primary care following strict guidelines from the plastic surgery unit. As an iatrogenic effect of the resulting surgery, the patient suffers from grade II lymphedema, which affects the patient's body image and lim-its her mobility and quality of life. The integral care plan carried out was able to alleviate to a certain extent the altered functional patterns.

Prevenir y/o tratar el deterioro de la integridad cutánea y tisular en pacientes afectados o en riesgo de padecerlo, suele ser una las acciones o actividades de cuidados más frecuentes del ámbito clínico sanitario y sociosanitario de las/os enfermeras/os, en su quehacer diario. Desde nuestra perspectiva enfermera, debemos prestar atención a cómo se desarrolla la formación en heridas desde la base, es decir desde el pregrado de enfermería, ya que condicionará cómo será el futuro de los profesionales en esta área de cuidados, que habilidades atesoran los recién egresados y que planificación formativa será la más adecuada adquirir u ofertar los sistemas de salud. En esta editorial se opina sobre el estado del arte en esta materia y que propuestas hay en la actualidad para evolucionar hacia un programa estandarizado de competencias en el grado de enfermería. [NURSING DEGREE AND CORE COMPETENCIES IN CHRONIC WOUNDS] Preventing and/or treating the deterioration of skin and tissue integrity in patients affected or at risk of suffering it, is usually one of the most frequent actions or care activities of nurses in their daily work. From our nursing perspective, we must pay attention to how wound training is developed from the base, that is, from undergraduate nursing, as it will determine how the future of professionals in this area of care will be, what skills recent graduates have and what training planning will be the most appropriate to acquire or offer health systems. This editorial gives an opinion on the state of the art in this area and what proposals there are at present to evolve towards a standardized program of competencies in the nursing degree.

Durante la época veraniega “tomar el sol” es una de las costumbres humanas más placenteras. Como cada año, la mayoría poblacional realiza el ritual estival de alcanzar el tono de piel “moreno” o bronceado, considerado socialmente un claro signo de “buena salud” y de imagen estética “ideal”. La excepción está en aquellos que padecen enfermedades dérmicas en las que el Sol es remedio terapéutico (psoriasis, vitíligo, acné…) y, en contraposición los que exponen de manera indiscriminada y abusiva su piel a los rayos ultravioleta, siendo esta una forma patológica llamada tanorexia. [Tanorexia, when tanning turns into an addiction] During the summer season, "sunbathing" is one of the most pleasurable human habits. As every year, the majority of the population performs the summer ritual of achieving a "brown" or tanned skin tone, socially considered a clear sign of "good health" and an "ideal" aesthetic image. The exception is in those who suffer from skin diseases for which the sun is a therapeutic remedy (psoriasis, vitiligo, acne...) and, in contrast, those who indiscriminately and abusively expose their skin to ultraviolet rays, this being a pathological form called tanorexia.

En este artículo informamos de la posibilidad de realizar algunos cursos en formato MOOC relacionados con el cuidado de la piel y la dermo-cosmética. Son cursos online disponibles para todos los interesados en el tema (sean profesionales de la salud o no), ofrecidos por prestigiosas universidades y/o instituciones académicas pero que, generalmente no emiten un certificado oficial o de verificación al final de su realización, con la excepción del pago de una tasa establecida para acreditarse posteriormente una vez obtenido el nivel de superación del curso. [LEARNING ABOUT SKIN CARE THROUGH MASSIVE OPEN ONLINE COURSES (MOOC)] ABSTRACT In this article we report on the possibility of taking some courses in MOOC format related to skin care and dermo-cosmetics. These are online courses available to all those interested in the subject (whether they are health professionals or not), offered by prestigious universities and/or academic institutions but which generally do not issue an official certificate or verification at the end of their completion, with the exception of the payment of a fee established for subsequent accreditation once the level of completion of the course has been obtained.

Desde hace unos meses, en la isla de La Palma(España),hemos presenciado la erupción explosiva de tipo estromboliana del volcán de Cumbre Vieja; un fenómeno excepcional en nuestro país, que nos ha permitido investigar y estudiar los peligros medioambientales (emisión de cenizas y gases tóxicos al aire, contaminación atmosférica y terrestre…); y tener presente qué lesiones dermatológicas son más frecuentes (pero poco comunes), como consecuencia de los efectos adversos por exposición a gases tóxicos y cenizas volcánicas sobre la piel humana.Por ello, en este artículo editorial trataremos de hacer un breve recordatorio de cuáles son los principales riesgos para la piel relacionados con dicha exposición y que medidas de protección debemos instaurar para protegernos. [SKIN HAZARDS FROM EXPOSURE TO VOLCANIC GASES AND ASHES] ABSTRACT A few months ago, on the island of La Palma (Spain), we have witnessed the explosive Strombolian eruption of the Cumbre Vieja volcano; an exceptional phenomenon in our country, which has allowed us to investigate and study the environmental hazards (emission of ash and toxic gases into the air, atmospheric and terrestrial pollution...); and to keep in mind which dermatological lesions are more frequent (but uncommon), as a consequence of the adverse effects of exposure to toxic gases and volcanic ash on human skin.Therefore, in this editorial article we will try to make a brief reminder of what are the main risks to the skin related to such exposure and what protective measures we must put in place to protect ourselves.

RESUMEN: La vacunación (inmunización activa) es una de las medidas de prevención de salud pública, junto con la higiene de manos, consideradas de las más importantes para combatir y/o mitigar eficazmente los efectos devastadores de la pandemia por Covid-19. Aun así, la vacunaciónno está exenta deriesgos, y ya se han puesto en marcha trabajos deinvestigación en Europa y EE.UU que tienen como objetivo analizar las reacciones dermatológicas asociadas con cada tipo de vacuna Covid. A la espera de los resultados concluyentes de esos estudios, con esta editorial queremos adelantar cuál es el panorama de conocimiento actual sobre dichas reacciones dermatológicas derivadas de estudiados realizados previamente en las fases de ensayo de dichas vacunas y los eventos adversos cutáneos que se van notificando a medida que avanza la vacunación en nuestro país y el resto del mundo. [SKIN REACTIONS ASSOCIATED WITH THE COVID VACCINE, WHAT DO WE KNOW?] ABSTRACT: Vaccination (active immunization) is one of the public health prevention measures, along with hand hygiene, considered among the most important to effectively combat and/or mitigate the devastating effects of the Covid-19 pandemic. Even so, vaccination is not without risk, and research work is already underway in Europe and the USA to analyze the dermatological reactions associated with each type of Covid vaccine. While awaiting the conclusive results of these studies, with this editorial we would like to present the current state of knowledge on these dermatologic reactions derived from previous studies carried out in the trial phases of these vaccines and the cutaneous adverse events that are being reported as vaccination progresses in our country and the rest of the world.&nbsp

Introduction. For more than a decade, following the ECTRIMS Congress, the Post-ECTRIMS Meeting has been held in Spain, where neurologists with expertise in multiple sclerosis (MS) from all over the country meet to review the most relevant latest developments presented at the ECTRIMS congress (on this occasion held together with ACTRIMS). Aim. This article, published in two parts, summarises the presentations that took place at the Post-ECTRIMS Meeting, held online on 16 and 17 October 2020. Development. This first part includes the latest results regarding the impact of the environment and lifestyle on risk of MS and its clinical course, and the role of epigenetics and genetic factors on these processes. Findings from preclinical and clinical research on the lymphocyte subtypes identified and the involvement of lymphoid follicles and meningeal involvement in the disease are discussed. Changes in brain structure are addressed at the microscopic and macroscopic levels, including results from high-resolution imaging techniques. The latest advances on biomarkers for the diagnosis and prognosis of MS, and on the involvement of the microbiome in these patients are also reported. Finally, results from patient registries on the impact of COVID-19 in MS patients are outlined. Conclusions. There have been new data on MS risk factors, the impact of MS at the cellular and structural level, the role of the microbiome in the disease, biomarkers, and the relationship between COVID-19 and MS.

Editorial: Dar un mayor nivel de información sanitaria a las personas garantizará que la sociedad, y nuestra población de referencia, adquiera una percepción de riesgo adecuada sobre el problema del cambio climático, lo que llevaría a que cada individuo adopte conductas saludables como sería el seguir hábitos correctos de fotoprotección e hidratación cutánea, adquisición de una actitud responsable hacia la prevención de la contaminación ambiental de su entorno local (laboral y doméstico); todo ello, con la finalidad de evitar riesgos dermatológicos innecesarios (infecciones cutáneas, alergias…). También, precisamos una mayor concienciación de los ciudadanos, las autoridades, los políticos y los profesionales de la salud para desarrollar medidas de adaptación y mitigación del cambio climático, hecho que pasa necesariamente por promover la investigación en este campo e implementar las buenas prácticas que vayan surgiendo. [Climate change and dermatological diseases: what can we do?] Editorial: Giving a higher level of health information to people will ensure that society, and our reference population, acquires an adequate perception of risk on the problem of climate change,which would lead to each individual adopting healthy behaviors such as following correct habits of skin protection and hydration, acquiring a responsible attitude towards the prevention of environmental contamination of their local environment (work and home); all of itin order to avoid unnecessary dermatological risks (skin infections, allergies ...). Also, we need greater awareness of citizens, authorities, politicians and health professionals to develop climate change adaptation and mitigation measures,This fact necessarily involves promoting research in this field and implementing the good practices that arise.

RESUMEN:Objetivo: Evaluar el nivel de calidad global de la colección de guías prácticas de heridas del Servicio Gallego de Salud (Sergas) para la toma de decisiones clínicas.Método: Evaluación de guías basadas en la evidencia (GBP). Selección de todas las GBP que componen la colección sobre heridas publicadas por el Sergas. Valoración a través del instrumento AGREE II-GRS (Global Rating Scale). Revisión por tres experto/as.Resultados: Fueron evaluadas siete GBP: úlceras por presión, úlceras de la extremidad inferior, pie diabético, lesiones cutáneas neoplásicas, lesiones por quemadura, herida quirúrgica aguda y lesiones cutáneasasociadas a la humedad. Se evaluaron cuatro apartados: el proceso de desarrollo, el estilo de presentación, la integridad de la información y la validez clínica. Todas las GBP obtuvieron una puntuación entre 5 y 7. A nivel global se obtuvo una nota media de 6 (“calidad alta”).Conclusiones: Las GBP publicadas por el Sergas son guías de muy buena calidad, recomendables para el uso clínico y aconsejable su implementación en los procesos de toma de decisiones en el área de las úlceras y heridas. Appraisal of the overall quality of the collection of practical guides for wounds of the galician health service ABSTRACT:Objective: To appraise the quality global level of the collection of practical guides for wounds of the Galician Health Service (Sergas) for professional decision-making.Method: Evaluation of Best Practice Guidelines (BPG). Selection of all BPG of the collection on injuries/wounds published by Sergas. Valuation through the AGREE II-GRS instrument (Global Rating Scale). Review by three experts.Results: Seven BPG were evaluated: pressure ulcers, ulcers of the lower limb, diabetic foot, skin tumor lesions, burn injuries, acute surgical wound and skin lesions associated with humidity. Four sections were evaluated: the development process, the presentation style, the integrity of the information and the clinical validity. All the GBP obtained a score between 5 and 7. On a global level, an average score of 6 was obtained (High quality).Conclusions: The BPG published by Sergas are guides of very good quality, recommended for clinical use and advisable to implement them in decision-making processes in the area of ulcers and wounds.&nbsp

Objetivo: Conocer cómo era la cura del Dr. Elik, utilizada para curar heridas traumáticas durante la guerra civil española Método: Estudio descriptivo de revisión bibliográfica. Selección y lectura de documentos históricos de 1936-1939. Exposición narrativa de textos y casos referentes a la época. Resultados: El Dr. Elik fue un médico militar de origen checoslovaco que participó en la guerra civil española. En el año 1938 publicó un artículo en la “Revista de Sanidad de Guerra” donde describe cómo aplicar su dispositivo para curar heridas traumáticas y evitar utilizar apósitos o vendajes Conclusiones: La cura de Elik fue el resultado de la innovación médica ante la escasez de vendas y gasas durante la guerra española. Su técnica resultó económica, pero no se conocen evidencias clínicas.

Diphyllin and its derivatives are well known cytotoxic natural products structurally related to the anti-cancer drug podophyllotoxin. We here study their structure-activity relationship upon human melanoma cells for first time. To this end, human melanoma A375 cells were incubated with Justicidin B and its 4-methoxylated or 4-glycosylated derivatives to evaluate their selective cytotoxicity and study their effects on cell cycle distribution, caspase activation, apoptosis induction using Annexin V-FITC/PI staining, cell morphology and western blot analysis. Diphyllin methyl ether (GI50 = 3.66 μM) and Justicidin B (GI50 = 1.70 μM) caused an elevation of both early and late apoptosis populations whereas Diphyllin apioside (GI50 = 0.84 μM) and its acetate (GI50= 0.39 μM) enhanced late apoptosis population only (Annexin V-positive/PI-positive). All induced cell cycle arrest at S phase and classic morphological indicators of apoptosis (blebbing, apoptotic bodies, and nuclear fragmentation) accompanied with an elevation of cells with low DNA content (sub-G1). All compounds increased the Bax/Bcl-2 ratio by enhancing Bax expression which evidences the involvement of the mitochondria (intrinsic pathway) in the apoptotic process. These caspase-3/7 results evidence that 4-methoxylation or 4-O-glycosylation of Justicidin B -a caspase independent mitochondrial apoptosis-inducer- triggers caspase-3/7 activation at different times (24h vs. 48h, respectively). Interestingly, the methoxylation causes attenuation of Bcl-2 protein expression contrarily to Diphyllin methyl ether or the O-glycosylated derivatives. Finally, the compounds exhibited significantly less toxicity when tested in adult human dermal fibroblasts and their GI50 in melanoma Sk-Mel-5 cells was not influenced by MDR1/Pgp inhibitors. This study may inform the synthesis of future Diphyllin derivatives with different apoptosis mechanism of action towards human melanoma cells.

En este artículo (carta al director), se pone en valor el hecho de que, de forma pionera, un apósito de nombre comercial Urgostart® (Urgo Medical), ha sido reconocido a principios de 2019 por la NICE, atribuyéndole evidencia concluyente para tratar úlceras venosas de las piernas y úlceras de pie diabético. No es la primera vez que la NICE hace evaluación de apósitos para determinar la evidencia en la prevención o tratamiento de diferentes úlceras o heridas crónicas; pero hasta la fecha, todas ellas habían concluido sin poder determinar dicha evidencia de forma definitiva. Las conclusiones de la NICE sobre UrgoStart se resumen en las siguientes recomendaciones: a) Hay evidencia para usar los apósitos UrgoStart como primera opción para tratar las úlceras del pie diabético y úlceras venosas de la pierna (cuando no hay infección) y b) Existe evidencia del uso de UrgoStart para tratar las úlceras del pie diabético, con un ahorro de costes de £ 342 (401,40€) por paciente/año y evidencia no concluyente en el caso de úlceras venosas en la pierna. [New evidence for the treatment of venous leg ulcers and diabetic foot] Abstract: In this article (letter to the director), the fact that, in a pioneering way, a dressing of commercial name Urgostart® (Urgo Medical), has been recognized at the beginning of 2019 by the NICE, attributing conclusive evidence to treat venous leg ulcers and diabetic foot ulcers.It is not the first time that NICE has evaluated dressings to determine the evidence in the prevention or treatment of different ulcers or chronic wounds; but to date, all of them had concluded without being able to determine that evidence definitively. The NICE conclusions on UrgoStart are summarized in the following recommendations: (a) There is evidence to use UrgoStart dressings as the first option to treat diabetic foot ulcers and venous leg ulcers (when there is no infection) and (b) There is evidence of use of UrgoStart to treat diabetic foot ulcers, with a cost savings of £ 342 (€ 401,40) per patient / year and inconclusive evidence in the case of venous leg ulcers.

Se ha llegado al consenso de que existen al menos cuatro términos o constructos que definen las lesiones inevitables de la piel que se producen al final de la vida. Estas identidades se diferencian de las UPP y hacen referencia a: 1) Úlcera terminal de Kennedy (Kennedy Terminal Ulcer; KTU); 2) Lesión tisular terminal de Trombley-Brennan (Trombley-Brennan Terminal Tissue Injury;TB-TTI); 3) Cambios cutáneos al final de la vida (Skin Changes at Life’s End; SCALE.); 4) Fallo cutáneo o fracaso de la piel (Skin Failure; SKF). el gran reto es identificar las similitudes y diferencias de estos cuatro términos, así como, tratar de estandarizar un marco conceptual unificado. Por ello, divulgar este tipo de información entre los profesionales sanitarios facilitará la uniformización de la terminología de forma consistente y operativa para que la investigación asociada a este tema pueda generar las evidencias necesarias para la toma de decisiones clínicas, elaborar políticas y estrategias de salud que permitan concienciar a los profesionales sobre este problema y mejorar la comunicación interprofesional, ya sea, entre los profesionales dedicados al cuidado de heridas o con otras partes interesadas. Es prioritario aclarar los conceptos y establecer un sistema de clasificación que permita evaluar el riesgo y su adecuado abordaje.

Resumen (Editorial): A la vista de los resultado del 5º Estudio nacional de prevalencia de úlceras por presión, surge la necesidad de seguir reflexionando sobre el tema, de asumir autocrítica, e incluso de perfilar una línea de investigación que nos permita aclarar el "por qué la prevalencia de UPP no ha descendido a cotas más realistas según las evidencias actuales disponibles”. Evolution and developments in the prevalence of pressure ulcers and other dependence-related skin lesions Abstract: In view of the results of the 5th National Study of Pressure Ulcer Prevalence, there is a need to continue reflecting on the issue, to assume self-criticism, and even to outline a line of research that allows us to clarify the "why the prevalence of UPP has not dropped to more realistic levels based on current available evidence”.

Resumen: La relación entre plata liberada ytiempo se suele estudiar a través de distintos modelos “in vitro”, con diversas soluciones o medios de cultivo que se utilizan para saturar el apósito y cuantificar la plata liberada en diferentes intervalos de tiempo y con varias técnicas de medida. Todo ello, va determinar que dependiendo del tipo de ensayo realizado se puedan obtener unos valores u otros. Por ello, conviene que sepamos que existe un problema de estandarización entre los estudios clínicos “in vitro” y el resultado de tales apósitos en la práctica real. Finalmente, se ha demostrado “in vitro” la importancia de elegir bien el tipo de apósito de plata y conocer que patógeno hay que inhibir para que el tratamiento sea eficiente a las 24-72 horas. SPEAKING IN SILVER OF THE LIBERATING DRESSINGS THAT CONTAIN IT Abstract: The relationship between released silver and time is usually studied through different "in vitro" models, with different solutions or culture media that are used to saturate the dressing and quantify the released silver at different time intervals and with various measurement techniques. All this will determine that depending on the type of test carried out, one value or another can be obtained. Therefore, it is important to know that there is a problem of standardization between clinical studies "in vitro" and the result of such dressings in real practice. Finally, it has been demonstrated "in vitro" the importance of choosing the right type of silver dressing and knowing which pathogen must be inhibited for the treatment to be efficient after 24-72 hours.

Resumen. Selección de once aplicaciones móviles (apps) gratuitas sobre protección de radiación ultravioleta solar (UV) y cuidados de la piel en función del contenido que nos aportan y su utilidad. Dichas apps están concebidas para ayudarnos a protegernos de los rayos solares de forma adecuada y, a prevenir el envejecimiento prematuro de la piel a través de unos correctos cuidados. MOBILE APPLICATIONS THAT HELP US PROTECT AND CARE SKIN Abstract. Selection of eleven free mobile applications (apps) on protection from solar ultraviolet radiation (UV) and skin care based on the content they provide and their usefulness. These apps are designed to help us protect ourselves from the sun's rays properly and prevent premature aging of the skin through proper care.

Resumen: La piel es un ecosistema que alberga una gran variedad de comunidades microbianas que viven interaccionando entre sí a través de un complejo equilibrio de supervivencia, habitando diferentes nichos fisiológicos y topográficos a lo largo de la anatomía humana. El conocer qué comunidades microbianas residen y colonizan de forma natural nuestra piel, se considera una información útil y necesaria para evitar ciertas exposiciones de riesgo de nuestro mayor órgano de protección y conseguir mejorar su preservación, previniendo su alteración de forma prematura y su infección. THE MICROBIAL MAP OF HUMAN SKIN: GETTING TO KNOW OUR GUESTS Abstract: The skin is an ecosystem that hosts a great variety of microbial communities that live interacting with each other through a complex balance of survival, inhabiting different physiological and topographical niches along the human anatomy. Knowing which microbial communities reside and colonize our skin in a natural way is considered useful and necessary information to avoid certain risk exposures of our greatest protection organ and to improve its preservation, preventing its premature alteration and infection.

RESUMEN: Objetivo: Conocer cómo era la cura del Dr. Elik, utilizada para curar heridas traumáticas durante la guerra civil española Método: Estudio descriptivo de revisión bibliográfica. Selección y lectura de documentos históricos de 1936-1939. Exposición narrativa de textos y casos referentes a la época. Resultados: El Dr. Elik fue un médico militar de origen checoslovaco que participó en la guerra civil española. En el año 1938 publicó un artículo en la “Revista de Sanidad de Guerra” donde describe cómo aplicar su dispositivo para curar heridas traumáticas y evitar utilizar apósitos o vendajes Conclusiones: La cura de Elik fue el resultado de la innovación médica ante la escasez de vendas y gasas durante la guerra española. Su técnica resultó económica, pero no se conocen evidencias clínicas. ABSTRACT: Objective: To know what was the cure of Dr. Elik, used to treat traumatic injuries during the spanish civil war. Method: Descriptive study of bibliographic review. Selection and reading of historical documents from 1936-1939. Narrative exhibition of texts and cases referring to the era. Results: Dr. Elik was a military doctor of czechoslovak origin who participated in the spanish civil war. In 1938, he published a paper in the "Revista de Sanidad de Guerra" where he describes how to apply his device to treat traumatic wounds and avoid using dressings or bandages. Conclusions: Elik's cure was the result of medical innovation due to the scarcity of bandages and gauze during the spanish war. His technique was economical, but no clinical evidence is known.

Introduction: Gait impairment, a frequent sign in multiple sclerosis (MS), places a major burden on patients since it results in progressive loss of personal and social autonomy, along with work productivity. This guide aims to provide recommendations on how to evaluate gait impairment and use prolonged-release fampridine (PR-fampridine) as treatment for MS patients with gait impairment in Spain. Development: PR-fampridine dosed at 10 mg every 12 hours is currently the only drug approved to treat gait impairment in adults with MS. Additionally, PR-fampridine has been shown in clinical practice to significantly improve quality of life (QoL) in patients who respond to treatment. Treatment response can be assessed with the Timed 25-Foot Walk (T25FW) or the 12-item MS Walking Scale (MSWS-12); tests should be completed before and after starting treatment. The minimum time recommended for evaluating treatment response is 2 weeks after treatment onset. Patients are considered responders and permitted to continue the treatment when they demonstrate a decrease in their T25FW time or an increase in MSWS-12 scores. A re-evaluation is recommended at least every 6 months. The SF-36 (Short Form-36) and the MSIS-29 (MS Impact Scale-29) tests are recommended for clinicians interested in performing a detailed QoL assessment. This drug is generally well-tolerated and has a good safety profile. It should be taken on an empty stomach and renal function must be monitored regularly. Conclusions: These recommendations will help ensure safer and more efficient prescription practices and easier management of PR-fampridine as treatment for gait impairment in Spanish adults with MS. (C) 2015 Sociedad Espanola de Neurologia. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license.

For the ninth year in a row the Post-ECTRIMS Meeting has been held in Madrid (Spain) with the aim of presenting and discussing the hottest issues debated at the ECTRIMS Congress by renowned specialists in multiple sclerosis in our country. One outcome of this scientific activity, endorsed by the Spanish Neurology Society, is this review article, which is published in two parts. This second part reflects the current controversy over the management of multiple sclerosis, especially as regards the progressive forms and their differential diagnosis. The work presents the latest advances in remyelination, where the use of the micropillar technique in laboratory stands out, and in neuroprotection, which is reviewed through a study of the optic nerve. Anti-CD20 antibodies are a very promising development and we find ourselves before a new mechanism of action and therapeutic target in cells to which little attention has been paid to date. Another notable fact is the high correlation between the levels of neurofilaments in cerebrospinal fluid and in serum, which could make it possible to avoid the use of cerebrospinal fluid as a biological sample in future studies of biomarkers. The review also provides a preview of the advances in clinical research, which will converge in clinical practice in the future, thereby conditioning the steps that should be taken in the therapeutic management of multiple sclerosis.

Jose M Prieto Department of Pharmaceutical and Biological Chemistry, UCL School of Pharmacy, London, UK Abstract: Migraine has a heavy socioeconomic impact in terms of lost productivity and burden on the health care system. The efficacy of current drug regimens in migraine prophylaxis is limited, and therapeutic alternatives are needed. These include a range of herbal medicines based on butterbur, feverfew, St John's wort, and Ginkgo. Of these, Petadolex®, an extract of the butterbur root, is the most promising. Petadolex® has been investigated in four studies, including one good quality clinical trial involving 202 patients, two randomized controlled trials with smaller cohorts including adults and children, and a large observational, open-label study. However, post-marketing surveillance only supports its safety at lower doses and over treatment durations shorter than those used in the clinical trials. Moreover, the long-term safety of the product has been called into question, leading to withdrawal in some European countries. This review draws an overall picture of this complex set of data. The safety and efficacy of Petadolex® remains a matter of debate by a number of clinical, regulatory, and professional bodies. Keywords: Petasites hybridus, migraine, herbal medicine, clinical evidence, safety

OBJECTIVE: The aim of this study was to test the safety of diazoxide and to search for signs of efficacy in patients with relapsing-remitting multiple sclerosis (RRMS). METHODS: In this multicenter, randomized, placebo-controlled, double-blind trial (treatment allocation was concealed), 102 patients with RRMS were randomized to receive a daily oral dose of diazoxide (0.3 and 4 mg/d) or placebo for 24 weeks (NCT01428726). The primary endpoint was the cumulative number of new T1 gadolinium-enhancing lesions per patient, recorded every 4 weeks from week 4 to week 24. Secondary endpoints included brain MRI variables such as the number of new/enlarging T2 lesions and the percentage brain volume change (PBVC); clinical variables such as the percentage of relapse-free patients, relapse rate, and change in the Expanded Disability Status Scale score; and safety and tolerability. RESULTS: Diazoxide was well-tolerated and it produced no serious adverse events other than 1 case of Hashimoto disease. At the 2 doses tested, diazoxide did not improve the primary endpoint or the MRI and clinical variables related to the presence of new lesions or relapses. Patients treated with diazoxide showed reduced PBVC compared with the placebo group, although such changes could be confounded by the higher disease activity of the treated group and the vascular effects of diazoxide. CONCLUSION: At the doses tested, oral diazoxide did not decrease the appearance of new lesions evident by MRI. The effects in slowing the progression of brain atrophy require further validation. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that for patients with RRMS, diazoxide (0.3 and 4 mg/d) does not significantly change the number of new MRI T1 gadolinium-enhancing lesions.