RESUMO
INTRODUCTION: Cognitive impairment (CI) affects 40-65% of patients with multiple sclerosis (MS). Few studies address telematic cognitive stimulation (TCS) in MS. The objective of this study is to evaluate the efficacy and impact of telestimulation or distance cognitive stimulation (TCS), with and without the support of face-to-face cognitive stimulation (FCS) in cognitive impairment in MS. METHODS: Multicentre, prospective, randomised, controlled study. We will include 98 MS patients with EDSS ≤ 6, symbol digit modality test (SDMT) ≤ Pc 25, and Multiple Sclerosis Neuropsychological Screening Questionnaire (MSNQ) > 26 points. Patients will be randomised into 3 groups, a TCS group, a mixed TCS/FCS group, and a control group. CS is performed 3 days a week for 3 months. Processing speed, memory, attention, and executive functions will be rehabilitated. FCS will include ecological exercises and strategies. EDSS and a cognitive evaluation (SDMT, CTMT, PASAT, and TAVEC), MSNQ, psychological impact scales (MSIS), and depression (BDI) will be carried out, baseline, postrehabilitation, and also 6 and 12 months later, to evaluate the effect of CS in the longer term. CONCLUSION: This study could help to establish the usefulness of TCS or, in its absence, TCS with face-to-face help for CI in MS. The interest lies in the clear benefits of remote rehabilitation in the daily life of patients.
Assuntos
Disfunção Cognitiva/reabilitação , Remediação Cognitiva/métodos , Aplicativos Móveis , Esclerose Múltipla/reabilitação , Telemedicina/métodos , Adulto , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/complicações , Estudos ProspectivosRESUMO
Introducción. Se han descrito diferentes causas de patología inflamatoria mamaria. En ocasiones, existe la necesidad de plantear un diagnóstico diferencial y descartar un carcinoma mamario. Caso clínico. Mujer de 63 años con antecedentes de cirrosis. Presenta mama izquierda aumentada de tamaño, eritematosa y con edema con fóvea. Tras tratamiento antibiótico no existe mejoría. La ecografía, mamografía y biopsia resultan negativas. Finalmente, se plantea el proceso como una descompensación de la cirrosis, a pesar de su manifestación unilateral. Tras tratamiento con diuréticos, observamos una resolución del proceso. Conclusión. El diagnóstico diferencial en patología de la mama en ocasiones resulta muy dificultoso. Además, existen patologías que requieren un manejo rápido dado su mal pronóstico. El caso presentado muestra cómo en la búsqueda de un diagnóstico se deben considerar todas las causas posibles, pero además pensar en los antecedentes médicos del paciente ya que pueden influir o ser la causa del proceso (AU)
Introduction. Various causes of inflammatory breast disease have been described and sometimes a differential diagnosis is required to rule out breast carcinoma. Case report. A 63-year-old woman with a history of cirrhosis had an enlarged left breast, erythema, and edema. Antibiotic treatment produced no improvement. The results of ultrasound, mammography and biopsy were negative. Finally, the process was diagnosed as a decompensation of cirrhosis, despite its unilateral manifestation. The process resolved with diuretic therapy. Conclusion. The differential diagnosis of breast disease is sometimes extremely difficult. Some diseases require rapid treatment due to their poor prognosis. The case presented here illustrates how every possible cause of the entity and the patient's medical history should be considered because they could influence or even cause the process (AU)
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Doença da Mama Fibrocística/patologia , Doença da Mama Fibrocística/cirurgia , Doença da Mama Fibrocística , Diagnóstico Diferencial , Diuréticos/uso terapêutico , Cirrose Hepática/complicações , Cirrose Hepática/tratamento farmacológico , Mastite/complicações , Mastite/terapia , Mastite , Neoplasias da Mama/cirurgia , Neoplasias da Mama , Mamografia , Edema/patologia , EdemaRESUMO
La notalgia parestésica es una neuropatía sensitiva crónica caracterizada por cursar con intenso dolor y/o prurito en la zona superior o media de la espalda, típicamente debajo del hombro izquierdo. Suele asociar una zona de hiperpigmentación en el área afectada o cercana a ella. Aunque la etiología no se ha establecido con certeza, se ha intentado explicar por dos motivos, bien por un proceso degenerativo central, o bien por un cuadro de atrapamiento periférico de un nervio en ese ámbito. Aunque no se dispone de un tratamiento estandarizado, se suele tratar como cualquier otro tipo de proceso que curse con dolor o prurito neuropático. Se presenta una serie de seis casos de notalgia parestésica y se realiza una revisión de la literatura, haciendo especial hincapié en las diferentes teorías que intentan dilucidar la fisiopatología de esta entidad (AU)
The notalgia paresthetica is a chronic sensory neuropathy, characterized by intense pain and/or itching in the upper or middle back, typically below the left shoulder. Usually associated hyperpigmentation area in the affected area, or close to it. Although the aetiology has not been established with certainty, has been explained by two reasons: either by a central degenerative process, or by a process of peripheral nerve entrapment at that level. There is not standardized treatment available, but is usually treated as any other process with neuropathic pain or itching. We present six typical cases of notalgia paresthetica, together with a review of the literature, with special emphasis on the different theories that try to explain the pathophysiology of this entity (AU)
