Search

Background: While the use of immunotherapy has revolutionised the treatment of various cancers, it is often associated with a myriad of immune-related adverse effects. Case Presentation: In this article, we report a rare case of durvalumab-induced triple-M syndrome in a 69-year-old woman with stage III lung adenocarcinoma. She was admitted with profound generalised muscle weakness, myalgia, and exertional breathlessness, about a week into her second cycle of durvalumab, an immune checkpoint inhibitor. She had clinicopathological features of myositis, myasthenia and myocarditis with acute onset symptomatic tri-fascicular block on electrocardiogram, requiring urgent cardiology intervention. Durvalumab was discontinued and she was treated with a combination of high-dose steroids and intravenous immunoglobulin after which she had clinical and biochemical improvement, albeit with residual muscle weakness. Conclusion: Myocarditis-myositis-myasthenia complex is a rare side effect of immunotherapy which has been reported in other immune checkpoint inhibitors, but less so with durvalumab. We report this clinical case to raise awareness of this rare and potentially life-threatening adverse effect of this agent.

This paper presents a new biased method for order reduction of linear continuous time interval systems. This method is based on the Stability equation method, Pade approximation and Kharitonov’s theorem. The higher order interval system is represented by four Kharitonov transfer functions using the Kharitonov’s theorem, and then reduced order models are obtained by the general form of the Stability equation method and Pade approximation. The Stability equation method is used to obtain a reduced order denominator polynomial while the Pade approximation is used for reduced order numerator coefficients. This method generates a stable reduced order model if the original higher order interval system is stable. The proposed method is illustrated with the help of typical numerical examples considered from the literature, and these are compared with well-known methods to show the efficacy of the proposed method.

This paper deals with a new method for model order reduction of linear continuous time interval system. This new method is based on the Kharitonov’s theorem, the Stability equation method and the error minimization by Differential Evolution. The reduced order interval model is determined by using Kharitonov’s polynomials, which make use of the Kharitonov’s theorem and general form of the stability equation method for denominator, while the numerator is obtained by minimizing the integral square error between the transient responses of original and reduced order models using Differential Evolution algorithm. This method generates stable reduced order interval system if the original higher order system is stable and retains the steady-state value. The proposed method is illustrated with the help of typical numerical example considered from the literature.