[Superficial peroneal nerve entrapment: ultrasound-guided hydrodissection. A case report]. / Atrapamiento de nervio peroneo superficial: hidrodisección ecoguiada. A propósito de un caso.

Peripheral nerve entrapment is an underdiagnosed pathology when it is not the most common syndromes such as carpal tunnel syndrome or cubital tunnel syndrome. The symptomatic lesion of the superficial peroneal nerve (SPN) has a low incidence, being its diagnosis sometimes complex. It is based on a exhaustive physical examination and imaging tests such as ultrasound (US) or magnetic resonance imaging (RMI). Conservative treatment may sometimes not be sufficient, requiring surgical techniques in refractory cases. We present a patient diagnosed with superficial peroneal nerve entrapment by ultrasound and diagnostic nerve block that was subsequently resolved by hydrodissection technique at the level of the deep crural fascia tunnel. The results were satisfactory with a complete resolution of the clinical process since the application of this technique.

Las manifestaciones primordiales de la fibromialgia, dolor generalizado e insomnio, en la pintura de Remedios Varo / Fibromyalgia's main features, widespread pain, and insomnia in the paintings of Remedios Varo

La sensibilidad de las artistas plásticas ante el sufrimiento humano ha quedado plasmada de diversas maneras. Este artículo relata las circunstancias que llevaron a la pintora surrealista hispano-mexicana, Remedios Varo, a representar en forma original las 2 manifestaciones cardinales de la fibromialgia: dolor generalizado e insomnio. (AU)

The sensitivity of plastic artists to human suffering has been expressed in different ways. This article recounts the circumstances that led the Spanish-Mexican surrealist painter, Remedios Varo, to depict in an original way the 2 cardinal manifestations of fibromyalgia; widespread pain and insomnia. (AU)

Fibromyalgia's main features, widespread pain, and insomnia in the paintings of Remedios Varo.

The sensitivity of plastic artists to human suffering has been expressed in different ways. This article recounts the circumstances that led the Spanish-Mexican surrealist painter, Remedios Varo, to depict in an original way the two cardinal manifestations of fibromyalgia; widespread pain and insomnia.

Mild sensory symptoms during SARS-CoV-2 infection among healthcare professionals.

INTRODUCTION: It is not yet possible to estimate the proportion of patients with COVID-19 who present distinguishable classical neurological symptoms and syndromes. The objective of this study is to estimate the incidence of sensory symptoms (hypoaesthesia, paraesthesia, and hyperalgesia) in physicians who have presented the disease at Hospital Universitario Fundación Alcorcón (HUFA) in Madrid; to establish the relationship between sensory symptoms and the presence of other signs of infection; and to study their association with the severity of COVID-19. METHODS: We conducted a descriptive, cross-sectional, retrospective, observational study. HUFA physicians who presented SARS-CoV-2 infection between 1 March and 25 July 2020 were included in the study. A voluntary, anonymous survey was distributed via corporate email. Sociodemographic and clinical characteristics were collected from professionals with PCR- or serology-confirmed COVID-19. RESULTS: The survey was sent to 801 physicians and we received 89 responses. The mean age of respondents was 38.28 years. A total of 17.98% presented sensory symptoms. A significant relationship was found between the presence of paraesthesia and cough, fever, myalgia, asthaenia, and dyspnoea. A significant relationship was also found between paraesthesia and the need for treatment and admission due to COVID-19. Sensory symptoms were present from the fifth day of illness in 87.4% of cases. CONCLUSIONS: SARS-CoV-2 infection can be associated with sensory symptoms, mostly in severe cases. Sensory symptoms often appear after a time interval, and may be caused by a parainfectious syndrome with an autoimmunity background.

La frambuesa insular del cerebro / The insular raspberry of the brain

La patogenia de las mal formaciones vasculares cerebrales aun no está totalmente definida. La mayoría son congénitas y esporádicas. Su tamaño varía ampliamente y algunas experimentan crecimiento, remodelación o regresión con el tiempo. La cirugía de cavernomas solo está indicada cuando existen síntomas y signos de sangrado. La escisión radical tiene como objetivo eliminar el riesgo de sangrado adicional y, finalmente, eliminar el efecto de masa. En cuanto al pronóstico, depende principalmente de la ubicación de la lesión. (AU)

Dolor neuropático, pensemos en Enfermedad de Fabry

RESUMEN El dolor es la razón más común de consulta y de búsqueda de atención médica, y el que presenta una mayor dificultad al recibir un paciente es el dolor neuropático. Una de las neuropatías de fibras finas por excelencia es la enfermedad de Fabry, un desorden poco conocido. El objetivo de esta revisión fue cotejar la bibliografía disponible para determinar los puntos clave en el manejo de esta enfermedad, usando herramientas de búsqueda como Up To Date, Pubmed y Google Scholar. Luego de la revisión de más de 30 artículos científicos se pudo concluir que el característico dolor y la hiposensibilidad térmica se deben al acúmulo de glicolípidos que producen una neuropatía de fibras finas. Esto se asocia a un cuadro de dolores quemantes en manos y pies que puede presentar gran dificultad al momento del diagnóstico y tratamiento. De este modo, sospechar el diagnóstico conlleva una serie de pasos desde la historia clínica y examen físico, que son de gran importancia, hasta la determinación bioquímica porcentual de la ausencia de actividad de la alfa-galactosidasa A hasta los exámenes neurológicos e histológicos. Se llegó a la conclusión de que las características clínicas de esta enfermedad pueden ser típicas en la mayoría de los pacientes, sin embargo se debería conocer la fisiopatología subyacente al problema y diferenciar el manejo de un dolor crónico con el de las crisis de dolor. Esto es imperioso debido a la importancia de instaurar la terapia especifica lo antes posible.

ABSTRACT Pain is the most common reason for consulting and seeking medical attention, and the one that presents the greatest difficulty in receiving a patient is neuropathic pain. One of the neuropathies of small fibers par excellence is Fabry Disease, a little known disorder. The objective of this review was to collate the available bibliography to determine the key points in the management of this disease, using search tools such as Up To Date, Pubmed and Google Scholar. After reviewing more than 30 scientific articles, it was concluded that the characteristic pain and thermal hyposensitivity are due to the accumulation of glycolipids that produce a neuropathy of small fibers. This is associated with a picture of burning pains in the hands and feet that can present great difficulty at the time of diagnosis and treatment. Thus, suspecting the diagnosis involves a series of steps from the clinical history and physical examination, which are of great importance, to the percentage biochemical determination of the absence of activity of alpha-galactosidase A until neurological and histological examinations. It was concluded that the clinical characteristics of this disease may be typical in most patients, however, the pathophysiology underlying the problem should be known and the management of chronic pain should be differentiated from that of pain crises. This is imperative because of the importance of establishing the specific therapy as soon as possible.

Qué pensar antes de decir que el paciente tiene un diagnóstico psiquiátrico. Parte I / What do you think before that you said: the patient has a psychiatric diagnosis. Part I

Resumen Los pacientes refieren sus síntomas en una gran variedad de términos como: "estoy cansado", "me duelen las articulaciones", "me pica todo el cuerpo", "tengo la boca seca", entre otros. Ante estos síntomas el médico piensa de manera automática en un número limitado de patologías que le son familiares, pero existen muchas otras causas a estos síntomas que no se tienen en cuenta. El desconocimiento del médico hace que en el paciente se genere inconformidad al no tenerse un diagnóstico correcto y un tratamiento adecuado, esto lleva a múltiples consultas y que el médico llegue a preguntarse a sí mismo "¿será que este paciente tiene un diagnóstico psiquiátrico?". En este artículo se enumeran las causas frecuentes de estos síntomas mencionados, se describen causas que son pocas veces sospechadas y las claves clínicas para que el médico pueda hacer el diagnóstico de éstas. La primera parte desarrollará los síntomas: fatiga, parestesias, prurito, artralgias, ansiedad y cambios en el comportamiento. La segunda parte desarrollará los síntomas: intolerancia a los alimentos, xerostomía, síncope, disfagia y manifestaciones en pacientes con cirugía bariátrica.

Abstract Patients refer their symptoms in a variety of terms such as: "I am tired", "my joints hurt", "my body itches", "my mouth is dry", among others. Given these symptoms, the doctor automatically thinks in a limited number of pathologies that are familiar to him, but there are many other causes to these symptoms that are not taken into account. The lack of knowledge of the doctor causes the patient to be dissatisfied by not having a correct diagnosis and adequate treatment, this leads to multiple visits and the doctor comes to ask himself "will this patient have a psychiatric diagnosis?". This article lists the frequent causes of these symptoms, describes causes that are rarely suspected and the clinical keys for the doctor to diagnose them. The first part will address the symptoms: fatigue, paresthesia, pruritus, arthralgia, anxiety and changes in behavior. The second part will develop the symptoms: intolerance to food, xerostomia, syncope, dysphagia and manifestations in patients with bariatric surgery.