Mononeuritis Multiplex Due to Hansen's Disease: A Look Through Ultrasound and Electrodiagnosis.

Hansen's disease is caused by Mycobacterium leprae. This bacillus can invade the peripheral nerves asymmetrically, including the ulnar, median, and radial nerves, causing mononeuritis multiplex. We present the case of a 41-year-old man with a history of Hansen's disease with sensory and motor symptoms. Electrodiagnostic studies and ultrasound showed asymmetric lesions of the median, ulnar, and radial nerves. Because this is the main complication of this pathology, electrodiagnosis is clearly valuable for its diagnosis, demonstrating axonal and myelin involvement, as well as signs of denervation and reinnervation. Ultrasound is valuable in the detection, diagnosis, and assessment of the extent of mononeuritis multiplex due to Hansen's disease. It aids in identifying significant inflammatory deterioration, as indicated by increased blood flow in the nerves and enlargement of the nerves. This technique allows for the exploration of nerves such as the ulnar nerve and branches of the brachial plexus. In a complementary way, ultrasound provides information on the severity of the disease. Early diagnosis of this entity is essential because it can generate aesthetic and functional permanent affectation.

Could We Consider Ultrasound-Guided Minimally Invasive Autopsy as a Part of POCUS?

We present a 3-patient case series that support the use of ultrasound guided minimally invasive autopsy (MIA). This technique has a high diagnostic accuracy in specific clinical settings. It makes easier to diagnose pathologies once the patient has died, avoiding body deformation, with a notable reduction in sample processing time compared to the open autopsy study and, therefore, a shorter overall diagnostic response time. MIA shows some similarities with point of care ultrasound (POCUS), like examination protocols or that they can be performed at the bedside.

More difficult still: Treating severe rapidly progressive glomerulonephritis in the context of COVID-19 pneumonia.

We present the case of a male patient with severe SARS-CoV-2 pneumonia, with simultaneous onset of p-ANCA positive rapidly progressive glomerulonephritis. We discuss the different therapeutic possibilities, emphasising the appropriateness of their administration according to the time in the course of the infection.

Normas Internacionales para la Clasificación Neurológica de las Lesiones de la Médula Espinal: la clasificación ASIA 2019 / International Standards for the Neurological Classification of Spinal CordInjuries the 2019 ASIA classification

Las normas internacionales para la clasificación neurológica de las lesiones de la médula espinal (ISNCSCI, por sus siglas en inglés), surgen de la necesidad de establecer un lenguaje común en la evaluación inicial y el seguimiento del paciente con lesión medular espinal (LME). La versión 2019 incorpora nuevos conceptos acerca de las deficiencias no relacionadas con la lesión de la médula espinal y de las zonas de preservación parcial en lesiones medulares incompletas. Esta clasificación permite estandarizar el examen físico, lo cual aumenta la reproducibilidad entre diferentes examinadores y el seguimiento a largo plazo. Además, facilita establecer el tratamiento y el pronóstico

The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) arose from the need to establish a common language in the initial evaluation and follow-up of the patient with spinal cord injury (SCI). The 2019 version incorporates new concepts about non-spinal cord injury-related impairments and areas of partial preservation in incomplete SCI. This classification allows standardization of the physical examination, which increases reproducibility between different examiners and long-term follow-up. It also facilitates the establishment of treatment and prognosis.

More difficult still: Treating severe rapidly progressive glomerulonephritis in the context of COVID-19 pneumonia. / Más difícil todavía: tratar una glomerulonefritis rápidamente progresiva grave en el seno de una neumonía por COVID-19.

We present the case of a male patient with severe SARS-CoV-2 pneumonia, with simultaneous onset of p-ANCA positive rapidly progressive glomerulonephritis. We discuss the different therapeutic possibilities, emphasising the appropriateness of their administration according to the time in the course of the infection.

Rehabilitación intrahospitalaria en el paciente con Covid-19 / In-hospital rehabilitation in patients with Covid-19

La enfermedad Covid-19 se declaró pandemia en el mes de marzo de 2020. Sus manifestaciones clínicas son variadas: desde pacientes asintomáticos hasta enfermedad respiratoria severa y falla multiorgánica, lo cual puede conducir a la muerte. Los pacientes con enfermedad severa o crítica que requieren hospitalización en la unidad de cuidados intensivos (UCI), pueden presentar complicaciones directas o indirectas a las lesiones causadas por la infección, como el síndrome de des acondicionamiento físico, el síndrome post-UCI, entre otros. Se describe el abordaje de la evaluación y la rehabilitación en el paciente adulto hospitalizado con infección por Covid-19, con énfasis en la rehabilitación respiratoria. El presente documento se fundamenta en la literatura disponible actualmente y presenta recomendaciones dirigidas al escenario nacional.

Covid-19 disease was declared a pandemic in March 2020. Its clinical manifestations are varied: from asymptomatic patients to severe respiratory disease and multi-organ failure, which can lead to death. Patients with severe or critical illness who require hospitalization in the intensive care unit (ICU) may present direct or indirect complications to the lesions caused by the infection, such as the physical conditioning syndrome, post-ICU syndrome, among others. The approach to evaluation and rehabilitation in the hospitalized adult patient with Covid-19 infection is described, with emphasis on respiratory rehabilitation. This document is based on currently available literature and presents recommendations for the national setting.