Miastenia gravis asociada a la infección por SARS-CoV-2: una conjunción de factores / Myasthenia gravis associated with SARS-CoV-2 infection: a conjunction of several factors

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Assessing the strengths and weaknesses of the Clinical Frailty Scale through correlation with a frailty index.

BACKGROUND: Care for the elderly patient is a challenge that geriatricians now share with other medical specialties. Frailty has emerged as a key concept. Due to its simplicity and applicability, the Clinical Frailty Scale (CFS) is gaining increasing acceptance. AIM: Compare the CFS with the Frail-VIG index (IF-VIG), an index based on the accumulation of deficits and developed on the basis of comprehensive geriatric assessment. METHODS: Cross-sectional and single-center study carried out at the Acute Geriatric Unit of a University Hospital. Patients consecutively recruited on admission over a 6-month period (n = 184). The concurrent validity of the CFS was measured by assessing the concordance between the two measurement methods. The degree of association was determined by applying a linear regression model, calculating the Pearson correlation coefficient (r). RESULTS: The prevalence of frailty was 91.8%. A mean IF-VIG score of 0.41 (SD ± 0.14) was found. The two most frequently recorded CFS categories were 6 and 7. An effective correlation was established (r = 0.706, p < 0.001). In the cohort with severe dementia, the association fell (r = 0.442). In the whole population, it rose adding Charlson index score (r = 0.747). CONCLUSIONS: The strong correlation of the CFS with a frailty index supports its use. Incorporating comorbidity into the physical function domains of the CFS improved the correlation. However, the CFS was unsuitable in patients with dementia. To infer prognosis, in categories 6 and 7, the situational diagnosis should be extended with more discriminative tools.

Toma de decisiones compartida en la enfermedad renal crónica avanzada del anciano. Un ejemplo a seguir / Shared decision-making in advanced chronic kidney disease in the elderly. Follow the example

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Un simulador clásico de vasculitis sistémica / A classic mimicker of systemic vasculitis

Fundamento y objetivo. Las manifestaciones embolígenas y constitucionales de los tumores cardíacos intracavitarios se engloban dentro de los mimetizadores clásicos de las vasculitis sistémicas, sobre todo en aquellas ocasiones donde no se presentan manifestaciones cardiológicas. Se describe un caso de mixoma auricular con clínica exclusivamente sistémica, cuya orientación diagnóstica inicial fue de vasculitis. Se revisan los casos descritos en la literatura. Paciente y método. Se describe un caso de mixoma auricular con presentación en forma de manifestaciones sistémicas sin sintomatología cardiológica acompañante. Se expone el caso clínico y se compara con 11 casos de seudovasculitis por mixoma auricular descritos en la literatura, haciendo énfasis en las similitudes y divergencias. Discusión. Los síntomas constitucionales junto con las manifestaciones cutáneas fueron los más frecuentes. La mayoría de los casos presentaban respuesta parcial al tratamiento glucocorticoideo, reforzando la teoría del componente inflamatorio en su patogenia. La demora media en el diagnóstico fue de 12,27 meses. Conclusión. El mixoma auricular es un simulador de vasculitis sistémica y es de difícil diagnóstico cuando no presenta manifestaciones cardíacas. La demora diagnóstica puede conllevar complicaciones graves (AU)

Background and objective. Embolic and constitutional manifestations of intracavitary cardiac tumors are included within the classic mimickers of systemic vasculitis, especially in those in which there are no cardiac manifestations. We present a case report of atrial myxoma in which the patient only presented systemic symptoms and in whom an initial diagnostic approach of systemic vasculitis was made. We also performed a literature search of the cases described. Patient and method. A case report of atrial myxoma with atypical presentation manifested as a systemic disease with no concomitant cardiac symptoms is described. The case report is discussed and 11 cases of atrial myxoma pseudovasculitis described in the literature are reviewed, emphasizing their similarities and differences. Discussion. Constitutional symptoms and cutaneous manifestations were the most common. Most of the cases showed partial response to glucococorticosteroid treatment, reinforcing the theory of the inflammatory role in its pathogenesis. Mean delayed time to diagnosis was 12.27 months. Conclusion. Atrial myxoma is a systemic vasculitis mimicker, this being difficult to diagnose in the absence of cardiac manifestations. This delay in diagnosis entails serious complications (AU)

A classic mimicker of systemic vasculitis.

BACKGROUND AND OBJECTIVE: Embolic and constitutional manifestations of intracavitary cardiac tumors are included within the classic mimickers of systemic vasculitis, especially in those in which there are no cardiac manifestations. We present a case report of atrial myxoma in which the patient only presented systemic symptoms and in whom an initial diagnostic approach of systemic vasculitis was made. We also performed a literature search of the cases described. PATIENT AND METHOD: A case report of atrial myxoma with atypical presentation manifested as a systemic disease with no concomitant cardiac symptoms is described. The case report is discussed and 11 cases of atrial myxoma pseudovasculitis described in the literature are reviewed, emphasizing their similarities and differences. DISCUSSION: Constitutional symptoms and cutaneous manifestations were the most common. Most of the cases showed partial response to glucococorticosteroid treatment, reinforcing the theory of the inflammatory role in its pathogenesis. Mean delayed time to diagnosis was 12.27 months. CONCLUSION: Atrial myxoma is a systemic vasculitis mimicker, this being difficult to diagnose in the absence of cardiac manifestations. This delay in diagnosis entails serious complications.