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When we talk about venous thromboembolic disease, we refer to a process characterized by the formation of a thrombus (blood clot) within the deep venous system, which can grow or break apart, disrupting normal blood flow and causing various complications.
The main manifestations of venous thromboembolic disease are deep vein thrombosis (DVT) and pulmonary embolism, among others. DVT occurs when a thrombus or clot forms inside a deep vein, usually in the legs (although it can also occur in the arms, portal vein, iliac veins, or even the vena cava), obstructing normal blood circulation in the affected veins.
A thrombus that forms in a deep vein can fragment or break off and become detached. The resulting embolus then travels through the veins toward the heart and reaches the lungs via the pulmonary arteries. In the lungs, the embolus lodges and obstructs one or more pulmonary arteries, preventing normal blood flow. This process is called a pulmonary embolism or thromboembolism (PE).
Deep vein thrombosis (DVT):
- Swelling or inflammation of the affected leg
- Pain or tenderness in the leg, often starting in the calf
- Increased warmth in the leg
- Changes in skin color (redness or bluish and shiny appearance)
Pulmonary embolism (PE):
- Sudden shortness of breath or difficulty breathing (dyspnea)
- Increased respiratory rate
- Increased heart rate
- Sharp chest pain
- Dry cough, sometimes with blood
- Fainting (syncope)
The incidence of venous thromboembolic disease in the general population, including any of its manifestations, is estimated at 1–2 cases per 1,000 inhabitants per year. In Spain, this translates to more than 80,000 cases annually. About 70 % of cases are deep vein thromboses, with the remainder being pulmonary embolisms.
DVT:Diagnosis involves assessing patient symptoms, blood tests, and imaging. The preferred imaging method is Doppler ultrasound (eco-Doppler), which allows visualization of the deep veins and confirms or rules out the diagnosis.
PE:If a pulmonary embolism is suspected, diagnosis is confirmed using tests such as a chest CT scan or a lung scan (ventilation-perfusion scintigraphy).
The main goal in any type of thrombosis is to dissolve the thrombus and restore blood flow to prevent further complications.
Anticoagulation is the treatment of choice for venous thromboembolic disease. Anticoagulants are medications that alter blood clotting to prevent new thrombi from forming and help dissolve existing clots.
Laboratory tests, such as D-dimer Imaging tests, including Doppler ultrasound, CT scans, and lung scintigraphy.
THROMBOPHILIA STUDY: In some cases, a blood test is performed to determine if the patient has abnormalities in clotting proteins that predispose them to thrombosis.
Knowing the risk factors for venous thromboembolic disease is key to managing and reducing risk. One of the simplest and most effective preventive measures is walking, as movement helps prevent thrombus formation.
Fibromyalgia is a chronic condition related to an altered pain perception in the central nervous system. It is mainly characterized by widespread pain, often accompanied by fatigue and sleep disturbances. It can affect people of all ages, especially women. Treatment combines patient education, physical exercise, psychological support, and sometimes medication.
Fibromyalgia is a common condition, affecting 2.4 % of the general population, and is part of the so-called central sensitization syndromes. It is mainly characterized by widespread pain. There is hyperexcitation of the central nervous system with a lowered pain threshold, causing pain to appear earlier and be more intense, longer-lasting, and more diffuse. There is an exaggerated response to painful stimuli (hyperalgesia) and pain in response to normally non-painful stimuli (allodynia). Its cause is unknown, but sometimes there are clear triggers such as physical or emotional trauma or infections.
It is a chronic condition with a fluctuating course, with periods of improvement and others of clinical worsening.
The main symptom is widespread pain, but it is often accompanied by other symptoms such as fatigue, insomnia, tingling in the limbs, headache, dizziness, memory and concentration problems, anxiety, or depression.
It usually affects middle-aged women, with a peak between 40 and 49 years, but it can affect people of all sexes and ages.
Diagnosis is based on criteria that rely on the patient’s clinical presentation, according to the presence of characteristic symptoms and signs.
There is no specific medical test.
Laboratory tests and sometimes imaging studies help rule out other conditions that are often concomitant (present at the same time).
Treatment of fibromyalgia should be based on four pillars: patient education (general information about the disease and attitude toward it), physical exercise according to tolerance, cognitive-behavioral therapy if appropriate, and pharmacological treatment.
1. Patient education and attitude toward the disease
The disease should be explained, providing general advice to improve well-being.
2. Physical exercise according to tolerance
There is evidence of its effectiveness on pain, well-being, and physical function.
It is recommended to start with low-impact aerobic exercise: walking, swimming, stationary cycling, aquagym, tai chi, or pilates.
Exercise should be performed regularly and progressively.
It is recommended to do 20–50 minutes per session, at least three days per week.
In cases of lower tolerance, start with ten minutes per session, four to six days per week, and gradually increase duration, frequency, and intensity, if possible, each month.
3. Cognitive-behavioral therapy
Provided by clinical psychologists in cases of accompanying anxiety or depression.
Although fibromyalgia is not a psychological condition, anxiety and depression can trigger and perpetuate symptoms.
4. Pharmacological treatment
Can help manage some symptoms such as pain, fatigue, or sleep disturbances, although its effectiveness is limited in a large percentage of patients.
Currently, analgesics, muscle relaxants, anticonvulsants, and some groups of antidepressants are used.
The risk/benefit and potential side effects of any medications should be carefully evaluated.
A healthy lifestyle is recommended, maintaining weight with aerobic exercise according to tolerance and a balanced diet, organizing and prioritizing daily tasks with short breaks, and avoiding physically and emotionally stressful activities.
Health advice for people with fibromyalgia is provided.
Myasthenia Gravis (MG) is a neuromuscular disease characterized by fatigue and weakness that worsens with exercise and improves with rest. Etymologically, the word myasthenia comes from the Greek “mys” (muscle) and “astheneia” (weakness), while “gravis” (severe) derives from Latin.
MG is classified as a rare disease, meaning it is uncommon. Its estimated prevalence is 50 to 200 cases per million people. It has a bimodal presentation: in women, it typically begins before the age of 40, while in men it usually appears around 50 years of age. It is rare in children. Recent epidemiological studies have described an increase in the incidence of late-onset cases (after age 60) without a clear sex predominance.
The main initial symptom of myasthenia gravis (MG) is muscle weakness and fatigue, which vary throughout the day. Muscle weakness worsens progressively during periods of physical activity and improves after rest. Many patients also report fluctuations related to seasons, work or psychological stress, menstruation, or intercurrent infections. In general, weakness and fatigue worsen toward the end of the day. These fluctuations and the worsening with physical activity are key signs to differentiate MG from other conditions, such as mental fatigue or chronic fatigue syndrome, where tiredness appears in the morning or at rest.
MG usually begins with ocular symptoms, such as double vision (diplopia) and/or drooping eyelids (ptosis), which can be unilateral or bilateral. Ocular symptoms often worsen when watching TV, reading, driving, or in bright light. Symptoms from bulbar muscle involvement are also common, including difficulty swallowing, chewing, or speaking. Approximately 16% of patients present initially with one of these bulbar symptoms. Other possible manifestations include difficulty holding the head upright, inability to keep the mouth closed, shortness of breath, early fatigue when walking, turning in bed, raising arms, or opening bottles or jars.
Approximately 20% of patients may experience a myasthenic crisis during their lifetime, causing serious respiratory or swallowing problems that may require hospitalization. Crises can be triggered by stress, infections, medications, surgery, or even emotional stress.
Diagnosis of MG is based on symptoms, physical examination, and paraclinical tests. The most important tests include electromyography (EMG and SF-EMG) and the edrophonium test (Tensilon®). In most patients, antibodies (AChR and MuSK) can be detected in serum. A small percentage of patients are seronegative. A CT scan is recommended to rule out the presence of a thymoma.
Treatment usually involves acetylcholinesterase inhibitors combined with immunosuppressive medications. Most of these drugs have dose-dependent side effects that must be considered. Treatment decisions should be made jointly with the patient, taking into account disease guidelines, physician experience, and the clinical form of MG. Care of an MG patient typically involves lifelong follow-up with a neurologist.
Thymectomy (surgical removal of the thymus) can improve symptoms, prevent certain complications, and reduce the dose of immunosuppressive drugs. It is recommended for generalized MG in patients under 55 years of age and in all patients with thymoma, regardless of age.
Plasmapheresis and intravenous immunoglobulins (IVIG) can be used during exacerbations. In myasthenic crises, mechanical ventilation may be required.
With proper treatment, most patients lead relatively normal lives and have a normal life expectancy.
Pregnancy: Physiological changes during pregnancy (nausea, vomiting, weight gain, increased blood volume, changes in kidney function, and altered gastrointestinal absorption) can affect MG and may require medication dose adjustments. Pregnant women with MG are at higher risk of complications and adverse effects. About one-third of pregnancies experience clinical worsening of MG, mainly in the first and third trimesters and postpartum. Some medications used in MG can cause fetal malformations or increase the risk of miscarriage or low birth weight.
Newborns of MG mothers may present transient neonatal myasthenia due to maternal antibody transfer.
Because complications during pregnancy and delivery are unpredictable, specialized multidisciplinary care is recommended, involving at least a neurologist, obstetrician, anesthesiologist, and neonatologist.
Surgery, particularly thymectomy, can precipitate a myasthenic crisis. High disease functional scores, low spirometric values, and severe comorbidities are major risk factors. Risk assessment should involve pulmonologists, surgeons, and anesthesiologists.
Procedures under local, regional, or epidural anesthesia generally do not carry a risk of myasthenic crisis.
Some medications may worsen myasthenic symptoms, so it is important to inform healthcare providers about MG before prescribing new drugs. Certain vaccines, foods, and beverages may also be contraindicated. A list of safe medications is available at: https://www.neuromuscularbarcelona.org/miastenia/
Many MG patients also have other autoimmune disorders. The most common is hypothyroidism.
Daily gentle exercise with rest periods is recommended, considering the fluctuating nature of symptoms. Respiratory exercises at home can complement training. Maintaining a healthy weight is very important.
Treatment with the drug levodopa allows many of the functions deteriorated or lost due to the disease to be restored. It is the most effective treatment, but it also has limitations: as the disease progresses, its effect becomes transient and fluctuates. When the medication is working, the patient feels well, in the "On" state. When the effect wears off, the patient enters the "Off" state, and symptoms reappear.
To improve the effects of levodopa, different routes of administration have been investigated (inhaled, transdermal, intrajejunal) and various pharmaceutical formulations have been developed. Administration via gastrostomy with a levodopa gel infusion has been particularly successful.
There are also other pharmacological and neurosurgical treatments, such as electrical stimulation of specific brain areas, which provide good results. Research is ongoing to target the diseased brain using stereotactic ultrasound, avoiding trepanation and traditional surgery.
New avenues of research have opened in Parkinson’s disease to determine its causes, prevent its progression, and maximize symptom management.
Low-intensity physical exercise, practiced regularly and consistently—such as simply walking for half an hour to an hour each day—helps preserve automatic and semi-automatic motor functions.
Walking involves two aspects of movement: voluntary and automatic. The voluntary movement would be the act of taking steps, while others—such as arm swinging, foot placement when stepping, head and neck position, etc.—have an important involuntary component.
All body movements benefit from exercise. The motor abilities we all have, which seem easy and permanent, are not necessarily so. Certain movements—like touching the floor with your fingers while keeping your legs straight—can be lost over time if not practiced.
We need constant maintenance, perhaps of low intensity, but sustained over time, to enjoy the full potential of our bodies throughout life.
Multiple myeloma is a type of blood cancer that originates from the abnormal proliferation of plasma cells (a type of white blood cell or immune cell). These plasma cells can damage the bones if they grow excessively and cause anemia. At the same time, they are capable of producing immunoglobulins, proteins that in excess can harm the kidneys and increase the risk of infections.
Its annual incidence in adults is 4–6 new cases per 100,000 inhabitants per year, representing 1% of all cancers and 10% of blood cancers, figures that place it among rare diseases. It usually affects predominantly older adults, with an average age of 70 years.
Excess immunoglobulins (Ig) interfere with the properties of the blood, the normal function of the kidneys, and promote the development of infections (since the production of other normal Igs is reduced). If there is also an excess of plasma cells, the bones containing the bone marrow can be damaged, leading to fractures and pain. Normal production of red blood cells, white blood cells, and platelets may also be impaired, increasing the risk of anemia, infection, and bleeding.
The classic symptoms of multiple myeloma are summarized by the English acronym for the affected organs: “CRAB” (Calcium, Renal, Anemia, Bone). However, other symptoms may also occur:
Often, monoclonal gammopathy is found incidentally in a routine blood test, or anemia is detected, or a fracture is diagnosed after persistent bone pain that does not improve with conventional painkillers.
To confirm the diagnosis and determine the extent of the disease or the need for treatment, the following are required:
The treatment of multiple myeloma has changed significantly over the past decade, especially in recent years, with the emergence of new drugs and mechanisms of action.
The goal of treatment is to control the disease for as long as possible with minimal side effects and to achieve a good quality of life.
Treatment of multiple myeloma includes drugs that can be classified according to their mechanism of action:
In addition to these drugs, which can be combined, the treatment plan may also consider the possibility of one or two bone marrow transplants.
In multiple myeloma, the development of new treatments is growing exponentially. New drugs with different mechanisms of action or potentially beneficial combinations are being developed, which in selected cases may be offered within clinical trials.
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