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MYASTHENIA GRAVIS

Myasthenia gravis is an autoimmune neurological disorder caused by autoantibodies against the acetylcholine receptor or against a receptor-associated protein, muscle-specific tyrosine kinase (MuSK-Ab).
The autoimmune attack at the muscle endplate leads to failure of neuromuscular transmission and eventually muscle weakness.
In the active phase of the disease, symptoms typically fluctuates and then become severe; myasthenic crisis occur in this phase.
In the stable/inactive phase, symptoms are stable but still persist; it usually worsen attributable to infection, fatigue, tapering of medications or other identifiable factors.
In the burnt-out phase, remission may occur wherein patients are on immunotherapy and symptom-free, or may even be off medications.
In 15-20 years, if the symptoms left untreated, patient's weakness becomes fixed wherein the most severely affected muscles become atrophic.

Myasthenia%20gravis Treatment

Treatment

Surgical Intervention

Thymectomy

No consensus is in place on which surgical method is first line
Based on a study, more severe cases of myasthenia gravis may benefit from thymectomy compared to patients with mild myasthenia gravis
It is advisable that the patient be stabilized with immunotherapy before undergoing thymectomy to reduce perioperative morbidity and mortality
Patients with acetylcholine receptor antibody-positive early-onset generalized myasthenia gravis with insufficient response to pyridostigmine therapy are candidates for thymectomy
Video-assisted thoracoscopic surgery (VATS) may be considered in preference to the transsternal approach
Many papers demonstrate superior results of VATS in terms of hospital stay, operative blood loss, and patient satisfaction compared to the transsternal approach

Presence of Thymoma

If patient has a thymoma it is highly recommended that the patient undergo early total thymectomy to prevent local tumor spread (although most tumors are benign)
- Tumor and adherent structures should be completely removed
- Chest cavity should be inspected for tumor implants

66% of patients with myasthenia gravis and nonmalignant thymoma were found to be symptom-free at 6 months-7 years after thymectomy and treatment with Prednisolone and/or Azathioprine therapy

Non-Thymomatous Autoimmune Myasthenia Gravis

Thymectomy in the absence of tumor offers possibility of long-term benefit for those with generalized myasthenia gravis and anti-acetylcholine receptor antibodies
- It may increase the probability of improvement or drug-free remission

Studies showing improvement have conflicting differences in baseline characteristics of prognostic factors and confounding variables (eg age, severity of myasthenia gravis)
- Regardless, most studies have found improvement or myasthenia gravis remission in patients undergoing thymectomy
- Improvement is slow and may take months-years

Ophthalmic Surgery

For correction of ptosis and/or diplopia

Long COVID: What we have learned so far

Prof. Ghassan Dbaibo, 27 Apr 2023

The WHO defines long COVID as a condition that occurs 3 months from COVID-19 onset, whose symptoms last ≥2 months and cannot be attributed to an alternative diagnosis. In an interview with MIMS Doctor, Professor Ghassan Dbaibo of the Center for Infectious Diseases, American University of Beirut, Beirut, Lebanon, describes the evolving attitudes towards long COVID among healthcare professionals (HCPs), some unexpected predisposing factors, potential biological mechanisms behind prolonged symptom duration and shares data on vaccination’s protective effects against long COVID.

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