As the celiac disease (CD), the non-celiac gluten sensitivity (NCGS) has also been associated with several autoimmune manifestations. It is rarely associated with myasthenia gravis (MG). This paper shall introduce the case of a young female patient, initially presenting a peripheral neuropathy framework. During clinical and neurological follow-up, she began to present symptoms of various immune-mediated morbidities. Diseases related to gluten represent a clinical spectrum of manifestations with a trigger in common, the ingestion of gluten. CD is the most well-known and serious disease of the spectrum, also called gluten-sensitive enteropathy. The NCGS is diagnosed from clinical evidence of improvement in symptoms followed by a Gluten Free Diet (GFD) in patients without signs of enteropathy in duodenal biopsy. There are indications that, although rare, with a prevalence of 1 in 5000, myasthenia gravis (MG) may occur more often when CD is also present. Between 13 to 22% of the patients with MG have a second autoimmune disorder. However, it is often associated with dermatomyositis or polymyositis, lupus erythematosussystemic lupus erythematosus, Addison's disease, Guillain-Barré syndrome and juvenile rheumatoid arthritis. Thus, the symptoms of neuromuscular junction involvement may give a diagnostic evidence of this rare association.

Funding Acknowledgements Type of funding sources: Private hospital(s). Main funding source(s): Hospital Cardio Pulmonar INTRODUCTION Frailty has been considered an important predictor of morbidity and mortality in elderly patients with cardiovascular disease. Cardiovascular Rehabilitation (CVR) has a direct and unequivocal effect on improving functional capacity in patients with heart disease, however, the effect of CVR on frailty indicators has not yet been well established. PURPOSE: To evaluate the association of the CVR program with frailty indicators in elderly patients with heart disease referred to a cardiovascular rehabilitation program and to identify possible predictors of improvement in frailty in this population. METHODS: Retrospective cohort with patients over 65 years old referred to an CVR program in Salvador-BA, Brazil from August / 2017 to March / 2020. Frailty was assessed using the Edmonton Frail Scale (EFS) at baseline and at least 3 months after the start of the program. Student"s t and Chi-square tests were used to compare continuous and categorical variables, respectively, logistic regression to analyze independent predictors of improvement in frailty and p <0.05 adopted as statistically significant. RESULTS: 51 patients were included, with a mean age of 75 ± 6 years, 65% men, 39 (77%) with coronary artery disease, 23 (50%) with heart failure, 21 (41%) with diabetes, 34 (67%) with hypertension and 41 (80%) dyslipidemia. According to the American Heart Association (AHA) risk stratification for exercise, 21 (49%) were risk B and 22 (51%) risk C. Regarding functional capacity, 12 (31%) were class I, 21 (41%) class II, 5 (13%) class III and 1 (3%) class IV according to the New York Heart Association (NYHA). The average initial ejection fraction was 53 ± 16%. The mean time between the two assessments was 5 ± 2 months and the improvement observed in maximum oxygen consumption (VO2 max) was from 15 ± 4 to 16 ± 4 mL.Kg-1.min-1 (p = 0.001). Regarding frailty, there was an improvement from 5.4 ± 2.0 to 4.8 ± 1.9 in the average of the EFS score (p = 0.034), with 25 patients (49%) being considered responders. This group was predominantly formed by men, non-diabetics, using statins, at risk B (AHA) and with a higher score on the quality of life score and on the EFS. However, in the multivariate analysis, only the highest score on the EFS (OR 1.8 CI 95% 1.06-3.3; p <0.05) and the lowest risk on the AHA scale (OR 0.18 CI 95% 0.03-0.97; p <0.05) remained as independent predictors of response. CONCLUSIONS: There was a significant improvement in the frailty of elderly patients referred for CVR, the higher the baseline frailty score, the greater the chance of response.

A sleep medicine consultation was requested for an elderly male patient with nocturnal epilepsy, agitated sleep, and snoring. In-hospital polysomnography was performed.