Sunday, November 22, 2020

Luna G, Alping P, Burman J et al.  Infection risks among patients with multiple sclerosis  treated with fingolimod, natalizumab, rituximabm  and injectable therapies.  JAMA Neurology2020; 77:184-91.

Swedish study examines risk of infections severe enough to cause hospitalization in 6421 MS patients and controls.  The rate of infections among patients taking injectibles was higher than the population 8.9 v 5.2 per 1000 person years. It was higher still in patients taking fingoli,od (14.3), and natalizumab (11.4) and highest among patients taking rituximab (19.7).
MG after dabrafenib and trametinib in metastatic melanoma.  Case report.  Neurology 2020; 94: 322-3/

In this patient, challenge , withdraw and rechallenge brought out MG symptoms and resolved when withdrawn within 24 hours.  {atient was ab positive. These drugs, BRAF and MEK inhibitors  now are standard of care for melanoma.  This is a separate phenomenon from checkpoint inhibitors causing mg 
A Columbian woman in a kindred of patients who developed Alzheimer's disease was homozygote for the Christchurch mutation, which is rare, and maintained cognition into her seventies. She was apo E3 double positive. She had high amyloid but limited tau. This provides a potential target for studies.
Atrial fibrillation and falls: a mechanistic or age confounded relationship?   (editorial) Mayo Clinic Proceedings 95; 2020, pp632-4  AuthorsHu T et al.  

Meta-analysis shows falls and AF are related,  independently of  age.  Odds ratio is about 1.8.  The relationship exists even after pacemaker placement.  Authors cite an AF complex of symptoms that include cognitive dysfunction, endothelial dysfunction and dysautonomia.