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Introducción La miastenia gravis (MG) y la enfermedad de Alzheimer (EA) son dos de las enfermedades neurológicas en cuya fisiopatología interviene la acetilcolina en distintos niveles. En la primera, la alteración de este neurotransmisor se produce en la unión neuromuscular, y en la segunda, en el sistema nervioso central. Objetivo Analizar la posible relación entre dichas patologías estudiando la prevalencia y la odds ratio de la EA dentro de los pacientes diagnosticados de MG con respecto a la prevalencia de EA en la población general. Pacientes y métodos Se han examinado datos de las historias clínicas electrónicas del sistema de salud de Castilla-La Mancha utilizando el procesamiento de lenguaje natural a través de la plataforma clínica de inteligencia artificial Savana Manager?. Resultados Se ha identificado a 970.503 pacientes mayores de 60 años, de los que 1.028 tenían diagnóstico de MG. La proporción de pacientes con diagnóstico de EA dentro de este grupo (4,28%) es mayor que en el resto de la población (2,82%; p = 0,0047), con una odds ratio de 1,54 (intervalo de confianza al 95%: 1,13-2,08; p = 0,0051), sin que se encuentren diferencias significativas en el análisis bivariante del resto de los factores de riesgo para EA más importantes conocidos hasta ahora. Conclusiones Nuestros resultados sugieren que podría existir un aumento de la prevalencia de EA en pacientes con MG. (AU)
INTRODUCTION Myasthenia gravis (MG) and Alzheimers disease (AD) are two of the most important diseases where the dysregulation of acetylcholine activity plays a crucial role. In the first, this dysregulation happens at the level of the neuromuscular junction and in the second, in the central nervous system (CNS). AIM To analyze the possible relationship between these two pathologies, analyzing the prevalence and the odds ratio of AD within patients previously diagnosed with MG. We will compare these data with respect to the prevalence of AD in the general population. PATIENTS AND METHODS We examined the data obtained by the electronic medical records of patients in the health care system of Castilla La Mancha using the Natural Language Process provided by a clinical platform of artificial intelligence known as the Savana Manager?. RESULTS We identified 970,503 patients over the age of 60 years, of which 1,028 were diagnosed with MG. The proportion of the patients diagnosed with AD within this group (4.28%) was greater than the rest of the population (2.82%) (p = 0,0047) with an odds ratio of 1.54 (confidence interval at 95% 1.13-2.08; p = 0.0051) without finding significant differences in the bivariate analysis for the rest of the most important actual known risk factors for AD. CONCLUSION. Our results suggest that there might be an increase in the prevalence of AD in patients previously diagnosed with MG. (AU)
Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Miastenia Gravis , Doença de Alzheimer , Acetilcolina , Memória , Disfunção Cognitiva , Registros Médicos , Inteligência Artificial , Estudos Retrospectivos , Estudos Multicêntricos como AssuntoRESUMO
Introducción. En los últimos años ha aumentado el número de exploraciones endovasculares en el estudio de la patología tanto cardiovascular como cerebrovascular. Una de las complicaciones poco frecuentes es la neurotoxicidad por contraste y su sospecha resulta imprescindible en el contexto de un déficit neurológico tras dichas exploraciones para llegar a su diagnóstico. Caso clínico. Varón de 61 años que tras una arteriografía diagnóstica en el estudio de una hemorragia subaracnoidea presentó una crisis epiléptica y posteriormente déficit hemisférico izquierdo. Tras descartar una patología vascular urgente, se realizó una resonancia magnética cerebral con sospecha de encefalopatía poscontraste. La clínica se limitó en 72 horas con corticoterapia. Conclusiones. La encefalopatía por contraste abarca un amplio espectro clínico, en la inmensa mayoría de los casos autolimitado en 24-72 horas, y en el contexto del daño neuronal tras la infusión de contraste. Su pronóstico es excelente y la sospecha diagnóstica es vital en el tratamiento (AU)
Introduction. In recent years there has been an increase in the number of endovascular examinations in the study of both cardiovascular and cerebrovascular diseases. One very infrequent complication is neurotoxicity due to contrast, and it must be suspected within the context of a neurological deficit following such examinations in order to be able to diagnose it. Case report. A 61-year-old male who presented an epileptic attack and later deficit in the left hemisphere following diagnostic arteriography. After ruling out the possibility of an urgent vascular pathology, he was submitted to a magnetic resonance brain scan with the suspicion of this condition. The clinical signs and symptoms were limited to 72 hours with cortisone therapy. Conclusions. Contrast-induced encephalopathy covers a wide range of clinical features which, in the vast majority of cases, are self-limiting to 24-72 hours, and within the context of neuronal damage following contrast infusion. Its prognosis is excellent, and diagnostic suspicion is crucial in its treatment (AU)
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Encefalopatias/induzido quimicamente , Extravasamento de Materiais Terapêuticos e Diagnósticos/complicações , Meios de Contraste/efeitos adversos , Angiografia , Síndromes Neurotóxicas/diagnóstico , Iodo/efeitos adversos , Diagnóstico Diferencial , Hemorragia Subaracnóidea/complicaçõesRESUMO
BACKGROUND: Migraine is a complex and disabilitating neurovascular disorder predominantly affecting women. There is strong evidence that nitric oxide is critically involved in migraine pathophysiology. The aim of the present study was to test the hypothesis that chronic migraine is associated with ultrasonographic endothelial dysfunction and increase in arterial stiffness. These parameters were assessed using a novel plethysmograph by peripheral arterial tonometry. METHODS: Twenty-one patients with chronic migraine and twenty-one healthy controls matched by sex and gender were recruited. Measurement of the ultrasonographic endothelial function and augmentation index were made according to manufacturer's protocol. RESULTS: The mean of patient's peripheral arterial tonometry ratios was 1.93 ± 0.39 and for healthy control 2.21 ± 0.44 (p=0.040). The median of patients' augmentation index was -6,0 (IQR: 6.5 to -15) in healthy controls and 9.0 (IQR: 4 to 12) in chronic migraine, (p=0.002). CONCLUSIONS: Patients with chronic migraine have ultrasonographic endothelial dysfunction and increase in the arterial stiffness. An improved understanding of the role in the endothelial system of migraine may provide a basis for preventive drugs in migraine and restore the endothelial function.
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Artérias/fisiopatologia , Endotélio Vascular/fisiopatologia , Transtornos de Enxaqueca/fisiopatologia , Rigidez Vascular/fisiologia , Adolescente , Adulto , Artérias/diagnóstico por imagem , Artérias/patologia , Estudos de Casos e Controles , Endotélio Vascular/diagnóstico por imagem , Endotélio Vascular/patologia , Feminino , Transtornos da Cefaleia/diagnóstico por imagem , Transtornos da Cefaleia/patologia , Transtornos da Cefaleia/fisiopatologia , Humanos , Hiperemia/fisiopatologia , Masculino , Manometria , Pessoa de Meia-Idade , Transtornos de Enxaqueca/diagnóstico por imagem , Transtornos de Enxaqueca/patologia , Pletismografia , Ultrassonografia , Adulto JovemRESUMO
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Humanos , Artrite Reumatoide/diagnóstico , Fator Reumatoide/isolamento & purificação , Nódulo Reumatoide/diagnósticoRESUMO
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Pessoa de Meia-Idade , Humanos , Doenças da Medula Espinal/etiologia , Artrite Reumatoide/diagnóstico , Doenças da Medula Espinal/diagnóstico , Doenças da Medula Espinal/cirurgiaRESUMO
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