Abstract
Introduction: Myasthenia Gravis (MG) is an autoimmune and neuromuscular disease. The treatment of immunomodulation consists of intravenous immunoglobulin (IVIg), immunoadsorption (IA), plasmapheresis (PLEX) or double filtration plasmapheresis (DFPP). This systematic review aims to compare therapy modalities in MG crisis. Methods: The studies were identified through research in electronic databases and analyzed individually to clarify their methodological quality (through the Jadad and Newcastle Ottawa scale). Clinical trials randomized or not, and retrospective studies were included. The review included 1,983 patients in nine studies, the result analysis groups were divided into: IVIg x PLEX in the crises; IVIg x PLEX in the pre-thymectomy treatment phase and IVIg x DFPP in the myasthenic crisis. The evaluated outcomes were clinical improvement, adverse effects and length of hospital stay. Results: Immunomodulatory therapy when applied prior to thymectomy was shown to be effective in reducing symptoms and post-thymectomy hospitalization, with IVIg slightly higher, while PLEX showed more side effects. Therapy during crises in both interventions proved to be effective after the 14th start of treatment, in addition to IVIg being slightly superior. Treatment with IVIg was also economically favorable, due to the lower need for hospitalizations. IVIg proved to be inferior to therapy with DFPP and IA, mainly in reducing the need for hospitalization. Conclusion: It is concluded that IVIg therapy is a good therapeutic option in cases of crisis and when available, therapies with DFPP and IA should be the choices, aiming at less complications.
Highlights
Capsaicin is able to induce mast cell degranulation, an event probably related to the pathophysiology of a migraine attack
Objectives: The present review study aimed to address the mechanisms of action of capsaicin and other chemical inducers in mast cell degranulation and an interaction of nerves and events that happen in the dura mater with the activation of mast cells
The analyses showed significantly higher frequency of the genotype VV in those who had depression, compared with the allele A
Summary
Capsaicin is able to induce mast cell degranulation, an event probably related to the pathophysiology of a migraine attack. Neuroinfections are pathologies that affect the CNS, for example, we have Murcomycosis, a progressive infection caused by opportunistic fungi of the order Mucorales, with high frequency in Immunodepressed patients, Diabetes Mellitus (DM) is the main underlying pathology associated with the development of Rhinocerebral Murcomycosis, which represents 50% of the cases, with a mortality rate of 70% (Sidrim, 2012, p.168). The COVID-19 pandemic has been alarming the world since its first outbreak in December 2019 In this scenario, the presence of aggravating factors such as the elevation of the D-dimer and the reduction of the angiotensin-converting enzyme 2 (ACE2) during the clinical course of the disease, collaborated in the appearance of thromboembolic events derived from inflammatory processes and extensive intravascular coagulation, contributing to the emergence of diseases such as Hemorrhagic Stroke (ICH), leading the patient to have a worse clinical prognosis and a consecutive worsening of their health. Despite being classically associated with this etiology, the finding may be present in other diseases, especially infiltrative ones
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