Case Report: Neurological adverse events in subject with myasthenia gravis after PCSK9 inhibitor administration.

Background: Myasthenia gravis is a rare chronic autoimmune neuromuscular disorder mainly caused by autoantibodies to the nicotinic acetylcholine receptor. Cholesterol is an essential molecule that affects the distribution and proper functioning of this receptor. Several reports have described the potential worsening of myasthenia gravis in patients treated with statins. Case presentation: The patient was an obese 72 years old man, past smoker, diagnosed with ischaemic heart disease, type 2 diabetes mellitus and lipid metabolism disorder. Statin treatment was not implemented because of chronic myasthenia gravis and PCSK9i monotherapy [Repatha (evolucamab), 140 mg] was implemented to treat dyslipidaemia. Within 24 h after the first dose of PCSK9i the patient developed severe muscle weakness, joint pain, fever, and general discomfort, lasting for several days. Despite strong advice against the second dose administration, this was self-administered approximately 2 weeks later, leading to report significant worsening of the muscle problems, leading to the patient admittion to the neurology department where he was being treated for myasthenia gravis attack. Conclusion: Based on the neurologist's conclusion, it can be assumed that in this case, treatment with PCSK9i resulted in significant worsening of the patient's chronic disease.

Alcoholic chronic pancreatitis and liver cirrhosis: coincidence and differences in lifestyle.

BACKGROUND/OBJECTIVES: Alcoholic chronic pancreatitis (ACP) and liver cirrhosis (ALC) are sequels of excessive alcohol intake. They develop in a minority of long-term alcohol consumers. Their concomitant occurrence is rare and the organ selection remains unknown. The aim of study was to compare patients with ACP and ALC with respect to their lifestyle. METHODS: Sixty-six patients with ACP and 80 with ALC were personally interviewed about their lifestyle, drinking, and eating habits. RESULTS: The groups of ACP (60 males, 6 females) and ALC (64 males, 16 females) did not differ in the amount of alcohol intake (58 g/day vs. 64 g/day). Significantly more patients with ACP reported first alcohol contact before the age of 15 (28.5% vs. 88%; p=0.03). ACP patients had the highest alcohol intake between 20 and 30 years of age (43.6% vs. 20.3%; p<0.01), were more likely to smoke (92.4% vs. 78.7%; p=0.02) and more likely to start smoking before the age of 15 (16.7% vs. 3.7%; p=0.04). Patients with ACP had a lower level of education (p<0.01). We did not observe significant differences between the dietary habits of the groups. The incidence of cirrhosis in ACP patients was 16.7%. The incidence of pancreatitis in the ACL group was 2.5%. CONCLUSION: The socio-behavioral factors affecting development of either ACP or ALC differed. ACP was associated with an early onset of drinking and smoking, highest alcohol intake at a young age, and a lower level of education. Simultaneous occurrence was unusual. Supported by grant IGAMZ NS/10527-3.

A new model of corneal transplantation in the miniature pig: efficacy of immunosuppressive treatment.

Corneal allograft rejection is frequently studied in small rodent or rabbit models. To study mechanisms of rejection in a model that more closely mimics transplantation in humans, we performed orthotopic corneal transplantation in the miniature pig using a 7-mm diameter donor graft. Four groups of recipients were studied: 1) untreated naive, 2) untreated vascularized (high risk), 3) high-risk grafts treated by topical application of prednisolone, or 4) high-risk grafts treated with a combined systemic immunosuppression regime of oral prednisone, cyclosporine A, and mycophenolate mofetil. Both the clinical features and histological assessment of corneal graft rejection showed close similarities to graft rejection in humans. Interestingly, preliminary results indicated that topical steroid treatment was superior to systemic immunosuppression in significantly promoting graft survival. Thus, corneal transplantation in the pig represents an animal model most closely resembling corneal grafting in humans, and offers possibilities for testing various clinically applicable immunosuppressive treatments.