Case Report: Triple M (myocarditis-myositis-myasthenia gravis) Syndrome: A Severe Immune-Mediated Toxicity in Cancer Immunotherapy, a diagnostic challenge   by Vishal Varghese, Shobana Anpalakhan, Chinar Osman

“…Immunotherapies have revolutionized cancer care, however there are increasing cases of complications including overlapping syndromes which are difficult to manage. Triple M (myocarditis-myositis-myasthenia gravis) syndrome is a rare and severe complication of immune checkpoint inhibitor (ICI) therapy with no clear consensus of management. …”
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THE LGORITHMIC BASICS OF MEASUREMENTS by A. A. Moskvitin, A. B. Cheboksary, A. V. Duplishchev

“…For this purpose, the following definition of the empirical structure is introduced. The triple (M,N,p) - empirical structure, if appropriate (giv-en by (n + m)-local relation Rm,n,p satisfies the condition (Vii... in gM) (Vai... am g N) Rm,n,p (ii, in; ai, am); in this case, the pair of numbers r = (n, m) is called the rank of this structure, and if М п N= 0, then the number k = n + m is called its complexity. …”
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Prediction of Optimum Operating Parameters to Enhance the Performance of PEMFC Using Machine Learning Algorithms by Arunadevi M, Karthikeyan B, Anirudh Shrihari, Saravanan S, Sundararaju K, R Palanisamy, Mohamed Awad, Mohamed Metwally Mahmoud, Daniel Eutyche Mbadjoun Wapet, Abdulrahman Al Ayidh, Hany S. Hussein, Mahmoud M. Hussein, Ahmed I. Omar

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VF arrest secondary to immune checkpoint inhibitor (ICI)-associated myocarditis; improving patient outcomes by maintaining a high clinical suspicion for ICI toxicity by Victoria Floyd-Ellis

“…Discussion: Of all ICI toxicities, myocarditis is a rare complication, but carries a mortality rate as high as 50%.4 Its presentation varies widely, with only two other cases presenting with cardiac arrest being described in the literature.5,6 A systematic review reported presenting cardiac symptoms in only 47.1% of 238 ICI myocarditis cases. 12.6% reported non-specific symptoms, while 10.1% were asymptomatic. 30.3% presented with neuromuscular symptoms, a reminder that ICI myocarditis often develops as ‘triple-M syndrome’, concurrent with myositis and/or myasthenia gravis.7The systematic review echoes the importance of maintaining a low threshold for suspecting and investigating ICI myocarditis despite ambiguous symptoms.ESCO recognises that cancer therapy-related cardiovascular toxicity (CTR-CVT) risk is varied and provides suggestions for the level of attention such patients require depending upon the combination of likelihood (based on reported incidence) and degree (severity or grade) of adverse events. …”
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