Abstract Objective: To evaluate the efficacy and safety of a treatment for multiple sclerosis (MS) flares alternative to the conventional method, the intravenous route. Method: Observational and retrospective, during the months of July-Novembre 2020, coinciding with the period of mobility limitation in Spain due to SARSCoV-2. The sample included 7 patients. The variables were: sex, age, type of MS, result on the expanded disability scale (EDSS), treatment, symptoms and evolution. The programs used were: patient history, outpatient dispensing and magnetic resonance imaging (MRI). Results: The results of 7 patients with a mean age of 44.85±13 years were measured. All with a diagnosis of relapsing remitting MS. The mean EDSS score was 3. The main symptoms referred to were: paresthesia, muscle weakness and urinary incontinence. 85% ofthe patients evolved favorably. Anotheraspect that stands out is the comfort ofthe patient from home instead of goingto the hospital. Discussion and conclusion: Oral administration of 1,400 mg prednisone for 5 days is a safe, effective and comfortable alternative as a treatment for acute outbreaks in multiple sclerosis. The objective was to evaluate the efficacy and safety of an alternative treatment for MS flares to the conventional method, the intravenous route.

Resumen Objetivo: Evaluar la eficacia y seguridad de un tratamiento para los brotes por esclerosis múltiple (EM) alternativo al método convencional, la vía intravenosa. Método: Estudio retrospectivo y observacional durante los meses julio-noviembre 2020, coincidiendo con el período de limitación de movilidad en España por SARS-CoV-2. La muestra incluyó a 7 pacientes. Las variables fueron: sexo, edad, tipo de EM, resultado en escala expandida de discapacidad (EDSS), tratamiento, sintomatología y evolución. Los programas utilizados fueron: historia clínica del paciente, dispensación de pacientes externos y visualización resonancias magnéticas (RNM). Resultados: Se midieron los resultados de 7 pacientes con una edad media 44,85±13 años. Todos con diagnóstico EM remitente recurrente. La puntuación media de la EDSS fue 3. Los principales síntomas referidos fueron: parestesias, debilidad muscular e incontinencia urinaria. El 85% de los pacientes evolucionaron de forma favorable. Otro aspecto, es la comodidad del paciente desde su domicilio en lugar de acudir al centro hospitalario. Discusión y conclusión: La administración de 1.400 mg de prednisona oral durante 5 días, es una alternativa segura, eficaz y cómoda como tratamiento de los brotes agudos en la esclerosis múltiple. El abordaje multidisciplinar mejora la sobrecarga asistencial que sufre el sistema sanitario durante la pandemia evitando desplazamientos a urgencias hospitalarias.

Abstract Background. A brain-machine interface (BMI) is a device or experimental setup that receives a brain signal, classifies it and then uses it as a computer command. There is not a consensus on which kind of learning methodology (deep learning, convolutional networks, AI, etc.) and/or type of algorithms in each methodology, are best to run BMI’s. Objective. The aim of this work was to build a low-cost, portable, easy-to-use and a reliable Motor Imagery Electro-encephalography (EEG-MI) based BMI; comparing different algorithms to find the one that best satisfies such conditions. Methods. In this study, motor imagery (MI) EEG signals, from both PhysioNet public data and our own laboratory data obtained using an Emotiv headset, were classified with four machine learning algorithms. These algorithms were: Common spatial patterns (CSP) combined with linear discriminant analysis (LDA), Deep neural network (DNN), convolutional neural network (CNN) and finally Riemannian minimum distance to mean (RMDM). Results. The mean accuracy for each method was 78%, 66%, 60% and 80% respectively. The best results were obtained for the baseline vs Motor Imagery (MI) comparison. With global-training public data, an accuracy between 86.4% and 99.9% was achieved. With global-training lab data, the accuracy was above 99% for the CSP and RMDM cases. For lab data, the classification/prediction computing time per event were 8.3 ms, 18.1 ms, 62 ms and 9.9 ms, respectively. In the discussion a comparison between the results presented here and state-of-the-art of methodologies and algorithms for BMI’s can be found. Conclusions. The CSP and RMDM algorithms resulted in fast (computing time) and effective (success rate) tools for their implementation as deep learning algorithms in BMIs.

Abstract The concept of a Magnetic Resonance Imaging (MRI) device is based on the emission of radio waves produced by the protons of the hydrogen atoms in water molecules when placed in a constant magnetic field after they interact with a pulsed radio frequency (RF) current. When the RF field is turned on, the protons are brought to a spin excited state. When the RF field is turned off, the MRI sensors are able to detect the energy released as the protons realign their spins with the magnetic field. In this work we provide a simple model to describe the basic physical mechanism responsible for the operation of MRI devices. We model the water molecule in terms of a central force problem, where the protons move around the (unstructured) doubly negatively charged oxygen atom. First, we employ an analytical treatment to obtain the system’s wave function as well as its energy levels, which we show are degenerate. Next, the energy levels from the water molecule are studied in the presence of a uniform external magnetic field. As a result, they get shifted and the degeneration is lifted. We provide numerical results for a magnetic field strength commonly used in MRI devices.

Near-infrared spectroscopy (NIRS) could be a useful continuous, non-invasive technique for monitoring the effect of partial pressure of carbon dioxide (PaCO2) fluctuations in the cerebral circulation during ventilation. The aim of this study was to examine the efficacy of NIRS to detect acute changes in cerebral blood flow following PaCO2 fluctuations after confirming the autoregulation physiology in piglets. Fourteen piglets (<72 h of life) were studied. Mean arterial blood pressure, oxygen saturation, pH, glycemia, hemoglobin, electrolytes, and temperature were monitored. Eight animals were used to evaluate brain autoregulation, assessing superior cava vein Doppler as a proxy of cerebral blood flow changing mean arterial blood pressure. Another 6 animals were used to assess hypercapnia generated by decreasing ventilatory settings and complementary CO2 through the ventilator circuit and hypocapnia due to increasing ventilatory settings. Cerebral blood flow was determined by jugular vein blood flow by Doppler and continuously monitored with NIRS. A decrease in PaCO2 was observed after hyperventilation (47.6±2.4 to 29.0±4.9 mmHg). An increase in PaCO2 was observed after hypoventilation (48.5±5.5 to 90.4±25.1 mmHg). A decrease in cerebral blood flow after hyperventilation (21.8±10.4 to 15.1±11.0 mL/min) and an increase after hypoventilation (23.4±8.4 to 38.3±10.5 mL/min) were detected by Doppler ultrasound. A significant correlation was found between cerebral oxygenation and Doppler-derived parameters of blood flow and PaCO2. Although cerebral NIRS monitoring is mainly used to detect changes in regional brain oxygenation, modifications in cerebral blood flow following experimental PaCO2 changes were detected in newborn piglets when no other important variables were modified.

Abstract: Since the onset of the SARS-CoV-2 pandemic, the pediatric population has been less affected by the disease both in frequency and severity. However, since April cases of variable presentation and severity characterized by inflammatory phenomena that affect multiple organs have been reported, a condition called Multisystem Inflammatory Syndrome in Children (MIS-C). The literature has reported frequent cardiac involvement, up to 80%. This is characterized by myocardial injury with a significant increase of biomarkers such as serum troponins I and T, BNP, or NT-ProBNP coupled with varying degrees of ventricular dysfunction, pericarditis, valvulitis, and arrhythmias. Coronary compromise has also been described, which can occur in up to 23% of cases, and ranges from dila tations to aneurysms. Inpatient and outpatient cardiology follow-up has been systematized based on the clinical phenotypes such as myocardial injury (myocarditis, valvulitis, pericarditis), shock (usua lly vasoplegic), Kawasaki disease-type manifestations, and those MIS-C that do not comply with the clinic of the previous three. This last group represents the main challenge in the short-, medium- and long-term follow-up, therefore, it is necessary a multidisciplinary team for managing these patients. Considering the high frequency of cardiac compromise in MIS-C, and the importance of reaching a consensus regarding its management and follow-up, we present these recommendations according to the current state of knowledge regarding this recently described pathology.

Resumen: Desde la aparición de la pandemia por SARS-CoV-2, la población pediátrica ha sido menos afectada por la enfermedad tanto en frecuencia como en severidad. Sin embargo, desde abril de este año se han reportado casos de presentación y gravedad variables, caracterizados por fenómenos inflamato rios que afectan múltiples órganos, condición denominada Síndrome Inflamatorio Multisistémico Pediátrico (PIMS). La literatura describe frecuente compromiso cardíaco, hasta en un 80%. Este se caracteriza por injuria miocárdica con significativa elevación de biomarcadores: Troponinas séricas I/T, BNP o NT-ProBNP, unido a diversos grados de disfunción ventricular, pericarditis, valvulitis y arritmias. Además, se ha evidenciado la presencia de compromiso coronario el cual puede ocurrir hasta en un 23% de los casos, en un rango que va desde dilataciones hasta aneurismas. El seguimien to cardiológico hospitalizado y ambulatorio se ha sistematizado en base a los fenotipos clínicos de presentación: injuria miocárdica (miocarditis, valvulitis, pericarditis), shock (habitualmente de tipo “vasopléjico”), manifestaciones tipo Enfermedad de Kawasaki y aquellos casos PIMS que no cumplen con la clínica de los tres precedentes. Este último grupo es el que representa el mayor desafío en el cor to, mediano y seguimiento a largo plazo. Por esta razón se requiere un equipo multidisciplinario para su manejo. Considerando la alta frecuencia del compromiso cardíaco en el PIMS y la importancia de lograr un consenso en su manejo y seguimiento, se presentan estas recomendaciones según el estado actual del conocimiento de esta patología recientemente descrita.

SUMMARY Objective: Describe and analyze the organizational changes for the setting-up of a new outpatient Pharmaceutical Care Unit (OPCU) of a “clean” SARS-COV-2 hospital during the pandemic and measure their impact. Methods: Study carried out in an 86-bed hospital (non-COVID-19 use) dependent on a 652-bed hospital (with care for COVID-19 patients), from March 11 to June 21. Activity was compared with the same period of the previous year and patients were surveyed. The staff was temporarily reinforced with a hospital pharmacist. Results: A total of 886 dispensations were made to 448 patients, compared to 34 dispensations to 9 patients the previous year. 60 patients were surveyed, where 60% expressed that if they had to go to the usual hospital they would not have collected the medication. 93% said they felt safe on their visit to the new OPCU. Satisfaction evaluation was excellent. The Kanban replenishment system reduced the request for medication to the main hospital. Conclusions: Setting-up of the OPCU allowed to continue with the non-COVID-19 activity, minimizing the risk of infection, thus improving adherence. The Kanban method was a good method of inventory control in quantity and time. Health crisis due to SARS-COV-2 has been a great challenge and the hospital pharmacy has demonstrated a high capacity for adaptation. The immediate future in the health field is uncertain, so it is essential to remain open to the incorporation of new strategies that strengthen health care.

RESUMEN Objetivos: Describir y analizar los cambios organizativos para la apertura de una nueva Unidad de Atención Farmacéutica a pacientes externos (UFPE) de un hospital “limpio” de SARS-COV-2 durante la pandemia y medir su impacto. Métodos: Estudio llevado a cabo en un hospital de 86 camas (uso no COVID-19) dependiente de un hospital de 652 camas (con atención a pacientes COVID-19), desde el 11 de marzo al 21 de junio. Se comparó la actividad con el mismo período del año anterior y se encuestó a los pacientes. La plantilla se reforzó temporalmente con un especialista en farmacia hospitalaria. Resultados: Se realizaron 886 dispensaciones a 448 pacientes, frente a 34 dispensaciones a 9 pacientes el año previo. Se encuestó a 60 pacientes, donde un 60% expresó que de haber tenido que desplazarse al hospital habitual no habrían recogido la medicación. Un 93% opinó sentirse seguro en su visita a la nueva UFPE. La evaluación de la satisfacción fue excelente. El sistema de reposición mediante método Kanban permitió reducir la solicitud de medicación al hospital principal. Conclusiones: La apertura de la UFPE permitió continuar con la actividad no-COVID-19 minimizando el riesgo de contagio, mejorando así la adherencia. El método Kanban supuso un buen método de control de existencias en cantidad y tiempo. La crisis sanitaria por SARS-COV-2 ha supuesto un gran desafío y la farmacia hospitalaria ha demostrado una elevada capacidad de adaptación. El futuro inmediato en el ámbito sanitario se muestra incierto por lo que es fundamental mantenerse abierto a la incorporación de nuevas estrategias que refuercen la asistencia sanitaria.

RESUMEN Objetivo. Se pretende determinar la prevalencia, la diversidad y la resistencia antimicrobiana de las cuatro especies zoonóticas de Arcobacter en cerdos sanos, a nivel de matadero. Materiales y métodos. Fueron recolectadas, mediante muestreo no probabilístico por conveniencia, 50 muestras fecales obtenidas por hisopado rectal de cerdos sanos a nivel de matadero, antes de su faenamiento. El aislamiento de las cepas de Arcobacter fue realizado por métodos microbiológicos, utilizando enriquecimiento selectivo en caldo y filtración pasiva, mientras que para la identificación de especie fueron utilizadas pruebas bioquímicas y moleculares (multiplex PCR). El comportamiento frente a los antimicrobianos fue determinado por el método de disco difusión. Resultados. Fueron aisladas las cuatro especies zoonóticas, las cuales presentaron las siguientes frecuencias de aislamiento: A. thereius (18.0%), A. skirrowii (18.0%), A. cryaerophilus (6.0%) y A. butzleri (2.0%). Se encontró alta frecuencia de resistencia a ciprofloxacina y en las cuatro especies fueron aisladas cepas multirresistentes (resistentes a más de tres antibióticos).

ABSTRACT Objective. To establish the prevalence, diversity and antimicrobial resistance of the zoonotic species of Arcobacter in healthy pigs at slaughterhouse level. Material and methods. Fifty fecal samples were taken by rectal swabs from healthy pigs, before the beginning of the slaughter at the slaughterhouse of Loja city, Southern Ecuador. Sampling was done by means of a non-probabilistic method for convenience. Isolation of Arcobacter strains was done by microbiological methods and species identification using biochemical and molecular (multiplex PCR) tests. Antimicrobial behavior was performed using the disk diffusion method. Results. The four zoonotic species of Arcobacter were found. The isolation rates were A. thereius (18.0%), A. skirrowii (18.0%), A. cryaerophilus (6.0%) and A. butzleri (2.0%). High resistance to ciprofloxacin was found and multi-resistant strains were isolated from these four species. Conclusions. The fecal carriage of the zoonotic species of Arcobacter was demonstrated in pigs at slaughterhouse level. These species showed high resistance to ciprofloxacin being isolated muti-resistant strains among these four species.

ABSTRACT The researches related to the return period of extreme winds in Cuba contain a limited number of meteorological stations and consider the annual maximum gusts of wind. In this sense, evaluate the danger caused by maximum winds in Cuba is the goal of this article. For that, maximum daily wind values of the station records were use, which is quantified using the return period, using the technique of "Peaks on the Reference" to set the curve of extreme values through the Generalized Pareto Distribution. The article also presents an efficient computational technique for the separation of wind types and the corresponding calculation of the PR curve for the synoptics and storm with the Reliability Interval for a 95% probability. This is important for the authorities that must prepare risk management plans and the incorporation of the required measures, as well as aid for urban planning, trying to avoid the development of urban centers in high risk regions. In general, it was found that the danger caused by non-hurricane winds in Cuba is relatively low. It was also found that the station records are adequate to calculate the danger caused by wind, although in some station’s errors were found in the characterization of the present weather conditions, so as part of this work a simple technique was implemented to correct these errors.

RESUMEN Las investigaciones relacionadas con el período de retorno de vientos extremos en Cuba contienen un número limitado de estaciones meteorológicas y considera las rachas máximas anuales del viento. En tal sentido, el objetivo de este artículo es evaluar el peligro producido por vientos máximos en Cuba utilizando valores máximos del viento diarios de los registros de estaciones, el cual es cuantificado usando el periodo de retorno, empleando la técnica de “Picos sobre la referencia” para fijar la curva de valores extremos a través de la Distribución Generalizada de Pareto. En el artículo también se presenta una técnica computacional eficiente para la separación de los tipos de viento y el correspondiente cálculo de la curva de PR para los sinópticos y de tormenta con el Intervalo de Confiabilidad para una probabilidad del 95%. Esto es de suma importancia para las autoridades que deben elaborar planes de gestión de riesgos y la incorporación de las medidas requeridas, así como ayuda a la planeación urbana, tratando de evitar el desarrollo de centros urbanos en regiones de alto peligro. En general se encontró que el peligro producido por vientos no huracanados en Cuba es relativamente bajo. También se comprobó que los registros de las estaciones son adecuados para calcular el peligro producido por viento, aunque en algunas estaciones se encontraron errores en la caracterización de las condiciones de tiempo presente, por lo que como parte de este trabajo se implementó una técnica sencilla que permite corregir estos errores.

Abstract: The Preparticipation Physical Evaluation (PPE), defined as “the health supervision of individuals, prior to the practice of physical activity and/or sports, which seeks to optimize their safe participation in sports and provide an opportunity to identify current and future risks to their health and quality of life”, inclu des the Cardiovascular assessment, which aims to screen cardiovascular pathologies with the risk of worsening or sudden death during exercise. Although there is broad international consensus that the use of Pediatric Cardiovascular PPE in young athletes is useful, there is no consensus on whether this should be used in the entire pediatric population or on which is the best strategy to apply. This article presents the position of the scientific societies related to sport, physical activity and child health on the Pediatric Cardiovascular PPE.

Resumen: La Evaluación Preparticipativa (EPP) definida como “la supervisión de salud de individuos, previo a la práctica de la actividad física y/o deporte, que busca optimizar su participación deportiva segura y brindar una oportunidad para identificar los riesgos actuales y futuros de su salud y su calidad de vida” contempla la EPP Cardiovascular (EPPC), que tiene por objetivo la pesquiza de patologías cardio vasculares con riesgo de agravarse o presentar muerte súbita durante la práctica de ejercicio. Si bien existe amplio consenso internacional respecto a que la realización de la EPPC en jovenes deportistas es de utilidad, no existe consenso respecto a si esta debe ser realizada a toda la población pediátrica ni tampoco sobre cuál es la mejor estrategia a aplicar. En el presente trabajo se presenta la posición de las sociedades cientificas relacionadas al deporte, actividad fisica y salud infantil sobre la Evaluación Preparticipativa Cardiovascular Pediátrica.

ABSTRACT Objective: Analyze the scientific production of the Journal of the Spanish Pain Society, in the period 2007-2016, through a bibliometric study. Material and methods: Descriptive-retrospective analysis of the journal's production during the period studied. Ten indicators were used, divided into four categories: productivity, citation, information consumption and content indicators. Results: A total of 597 documents were published, of which 292 were original, equivalent to 49 % of the total production. The journal received 546 citations between 2007 and 2016; 54.6 citations per year and 0.91 citations per document. 1,245 authors signed the documents; 1,108 of them published a single document in the period studied. The minimum number of authors signing for a document is 1 and the maximum 41. The cooperation rate is 2.08. The countries with the greatest contribution of documents are Spain (440), Mexico (39) and Chile (27). Hospital is the type of institution with the most published documents (73 %); the most productive hospital is Puerto del Mar University Hospital, also called Seguridad Social de Cádiz Hospital. The average number of references per article is 22. English is the predominant language in references (85 %). Conclusions: Article is the dominant document, being also the most cited. The journal is open access, which can positively influence the number of citations received. The indexing of the journal in well-known databases can also be a factor that influences the number of citations. Spain and the Latin American countries have a high contribution of documents. This may be related to the idiomatic factor (Spanish language). 75 % of the documents were written by two or more authors. Collaboration is generally between people from the same country. Collaborative work between authors from different countries is low. However it has shown an increase in recent years. The analysis can be useful to increase the visibility and impact of the journal.

RESUMEN Objetivo: Analizar la producción científica de la Revista de la Sociedad Española del Dolor en el periodo 2007 a 2016, a través de un estudio bibliométrico. Material y métodos: Análisis descriptivo-retrospectivo de la producción de la revista durante el periodo estudiado. Los indicadores utilizados fueron 10, divididos en cuatro categorías: indicadores de productividad, indicadores de citación, indicadores de consumo de información e indicadores de contenido. Resultados: Se publicó un total de 597 documentos, siendo originales 292 de ellos, lo que equivale al 49 del total de la producción. La revista recibió 546 citas entre 2007 y 2016; 54,6 citas por año y 0,91 citas por documento. Aparecen 1.245 autores firmantes de los documentos; de ellos, 1.108 publicaron un solo documento en el periodo estudiado. El mínimo de autores para un documento es 1 y el máximo 41. El índice de cooperación es 2,08. Los países con mayor contribución de documentos son España (440), México (39) y Chile (27). El tipo de institución con más documentos publicados son los hospitales (73 %), siendo el más productivo el Hospital Universitario Puerto del Mar, también denominado Hospital de la Seguridad Social de Cádiz. La media de referencias por artículo es de 22. El idioma predominante en las referencias es el inglés (85 %). Conclusiones: La tipología de documento preponderante es el artículo, siendo estos mismos mayoritariamente los más citados. La cantidad de citas recibidas puede verse afectada positivamente por ser la revista de acceso abierto y por su indización en diversas bases de datos. España y los países latinoamericanos tienen una alta contribución de documentos, lo que puede deberse a un factor idiomático. El 75 % de los documentos fue escrito por dos o más autores, pero la colaboración es generalmente entre personas del mismo país. El trabajo colaborativo entre autores de distintos países es bajo, sin embargo ha mostrado un aumento en los últimos años. El análisis puede ser de utilidad para aumentar la visibilidad e impacto de la revista.