Influence of Counter Movement Jump Session with Different Rest Intervals on Muscle Damage and Soreness

Objectives: Plyometrics has been used in sports training and many aspects of this modality are poorly understood. This study measures the magnitude of variations of serum creatine kinase (CK) activity and perceived muscle soreness after one session of Countermovement Jump (CMJ) session and compares 1 and 3 minutes rest intervals between each sets.Methods: A group of 30 young male was dividing in two groups and performed ten sets of ten CMJ with 1 or 3 minutes rest interval between sets. Before and after session (24, 48, and 72-h) they informed the muscle soreness perception and blood samples were collected for dosage of serum CK activity. Two (time) x Two (treatment) ANOVA was used to test differences in serum CK activity and muscle soreness. The alpha level was set at 0.05.Results: Serum CK activity measured 48 h after session augments ~2 and ~1.5 times in 1 min and 3 min rest interval respectively. No significant difference between groups that rests 1 or 3 minutes between sets was found. Muscle soreness rises 24 h after session without significant differences between groups.Conclusions: The findings show that the CMJ increases perceived muscle soreness and increases the serum CK activity, and the intervals of rest do not modulate these variables.

Serum Creatine Kinase Levels are not Associated with an Increased Need for Continuous Renal Replacement Therapy in Patients with Acute Kidney Injury Following Rhabdomyolysis

BackgroudRhabdomyolysis is a syndrome caused by the breakdown and necrosis of skeletal muscle tissues. As a result, there is leakage of various intercellular myocyte contents into the circulating blood stream. Severe rhabdomyolysis can lead to acute kidney injury (AKI) and cause potentially permanent kidney damage. Previous studies have reported benefit from continuous renal replacement therapy (CRRT) for rhabdomyolysis-associated AKI. For patients with AKI, the termination of CRRT often depends on the patient’s renal functions. Here, we asked whether serum creatine kinase (CK) levels should be considered for CRRT termination in patients with AKI following rhabdomyolysis.MethodsWe compared different CK levels in patients after CRRT termination and we observed the correlation between CK levels and clinical outcomes. For a retrospective study, we collected 86 cases with confirmed rhabdomyolysis-associated AKI, who had received CRRT from January 1st of 2012 to December 31th of 2020 in Tongji Hospital. Patients’ renal functions were assessed within 24 hours of intermission, and patients with urine output ≥ 1,000 mL and serum creatinine ≤ 265 umol/L were considered for CRRT termination. Following CRRT termination, patients were divided into a CK > 5,000 U/L group (experimental group) and a CK < 5,000 U/L group (control group). The outcomes, such as in-hospital mortality and in-hospital length of stay, were compared between two groups.ResultsThirty-three (38.37%) patients were classified as having CK > 5,000 U/L, while 53 (61.63%) were categorized as having CK < 5,000 U/L. The majority of laboratory examinations were comparable between the two groups on admission. The higher CK levels, as well as worse renal functions, predicted the necessity of CRRT continuation for patients. After CRRT termination, the in-hospital mortality (27.27% vs 22.64, p = 0.389) and Multiple Organ Dysfunction Syndrome (MODS) incidence (51.52% vs 49.06%, p = 0.064) were similar between two groups, while the experimental group showed a significantly shorter in-hospital length of stay (11.88 ± 1.469 vs 16.42 ± 1.290, p = 0.026) and Intensive Care Unit (ICU) length of stay (7.545 ± 0.866 vs 10.11 ± 0.793, p = 0.038).ConclusionCRRT termination may be independent of s the CK levels for patients with rhabdomyolysis-associated acute kidney injure, providing their renal functions have recovered to an appropriate level. Prospective clinical trials would be needed to more thoroughly investigate the optimal CK range that could be used as a gauge to prevent recurrence of renal impairments after treatments.

Elevated serum creatine kinase levels due to osimertinib: A case report and review of the literature

Introduction Osimertinib is a tyrosine kinase inhibitor that targets the epidermal growth factor receptor. Elevated serum creatine kinase level is an uncommon adverse event associated with osimertinib treatment for lung cancer. Case Report We report a previously healthy 56-year-old woman who developed elevated serum creatine kinase levels during osimertinib monotherapy for epidermal growth factor receptor mutation-positive lung adenocarcinoma. Management & Outcome During treatment, she experienced leg cramps and her serum creatine kinase levels increased, peaking at 989 U/l. Further investigation revealed no evidence of cardiotoxicity or myositis; thus, osimertinib-induced myopathy was assumed to be the cause of her elevated serum creatine kinase levels. We successfully managed both lung cancer and osimertinib-induced myopathy using 1-week pauses of osimertinib therapy without dose reduction. Discussion Short-term suspension of osimertinib without dose reduction may be a reasonable option for osimertinib-induced myopathy.

Clinical characteristics of spinning-induced rhabdomyolysis and other causes of rhabdomyolysis: a comparative study

Introduction Spinning is an indoor stationary cycling programme that can cause severe rhabdomyolysis. We compared the clinical characteristics of spinning-induced exertional rhabdomyolysis (SER) with other exertional rhabdomyolysis (ER) and non-exertional rhabdomyolysis (NER). Methods This was a retrospective observational study of adult patients presenting with rhabdomyolysis to an emergency department from August 2018 to August 2019. Patients were classified as SER, ER or NER based on chart review. We compared patient demographics, serum creatine kinase (CK), transaminase and creatinine levels, admission rates, duration of hospitalisation and treatment prescribed. Results: 62 patients were analysed. SER patients were predominantly female (77% vs. 24% vs. 26%, p < 0.01), Chinese (100% vs. 47% vs. 79%, p < 0.01) and younger (mean age 27.7 vs. 34.6 vs. 59.4 years, p < 0.01) than those with ER and NER. The SER group had the highest CK level (20,000 vs. 10,465 vs. 6,007 U/L, p < 0.01) but the lowest mean serum creatinine level (53.5 vs. 80.9 vs. 143.5 μmol/L, p < 0.01) compared to the ER and NER groups. Admission rates were the highest in SER patients (100% vs. 57% vs. 90%, p < 0.01). SER mean inpatient length of stay was longer than ER but shorter than NER patients (4.3 vs. 1.9 vs. 6.0 days, p = 0.02). Conclusion: SER is a unique form of rhabdomyolysis. Predominantly seen in young, healthy women, it often presents with extremely high CK levels. However, the prognosis is good and the rate of complication is low with fluid treatment.

Myopathy Associated with Treatment of Graves’ Disease

Here, we report a case of an increase in serum creatine kinase (CK) concentration in an 11-year-old girl being treated for Graves’ disease with antithyroid drugs (ATDs). The patient complained of myalgia two weeks after methimazole treatment. Triiodothyronine (T3) and free thyroxine (FT4) levels were normal, but the serum CK level was significantly elevated. After switching to propylthiouracil, the serum CK level decreased to normal, and the myalgia was resolved. The development of myopathy during the treatment of hyperthyroidism may be considered as an adverse reaction of MMI. In this report, we present a rare pediatric case, along with a discussion on the possible causes of myopathy that occurred during the treatment of Graves’ disease. A careful follow-up (serum CK levels and thyroid function) and treatment reassessment should always be considered after antithyroid treatment.

ASSOCIATION OF SERUM LACTATE LEVELS WITH CREATINE KINASE – MB AND LACTATE DEHYDROGENASE IN PATIENTS WITH MYOCARDIAL INFARCTION

Objectives: Myocardial infarction is the most common form of coronary heart disease, the commonest cause of worldwide mortality. The present biochemical markers take atleast 6 hours for elevation following an episode of myocardial infarction. There is a need for sensitive marker for early diagnosis and prognosis. Lactate, the end product of anaerobic glycolysis is found to be elevated in many critical illnesses. Thus the study was undertaken to assess the levels of serum lactate in patients with myocardial infarction and to correlate it with the frequently used enzymatic markers for the diagnosis of myocardial infarction, i.e creatine kinase – MB and lactate dehydrogenase Methods: Fifty age and sex matched controls and fty cases of myocardial infarction were included in the study. Serum creatine kinase – MB, lactate dehydrogenase and lactate were estimated in these subjects. Results:The serum lactate levels were signicantly higher among cases when compared to controls. The serum lactate levels positively correlated with serum creatine kinase – MB among cases but not with lactate dehydrogenase. Conclusions: We conclude that serum lactate is altered in patients with myocardial infarction and may be considered as a prognostic risk factor in these patients. Further studies are needed to nd the cut-off value of serum lactate for assistance in the hemodynamic management of these patients.

Atypical presentation of anti-HMGCR myopathy

Immune-mediated necrotising myopathy is a subtype of idiopathic inflammatory myopathy characterised by muscle fibre necrosis without significant inflammatory infiltrate. Anti-3-hydroxy-3-methylglutaryl coenzyme A reductase (HMGCR) myopathy is seen in 6%–10% of idiopathic inflammatory myopathy and is diagnosed in the context of elevated serum creatine kinase levels, proximal muscle weakness and anti-HMGCR autoantibodies. We recently encountered a 61-year-old man with anti-HMGCR myopathy with an atypical skin manifestation, partially responsive to triple therapy with steroids, intravenous immunoglobulin (IVIG) and rituximab. To our knowledge, there have been only four reported cases of skin rash associated with anti-HMGCR myopathy. Our case demonstrates the importance of recognising atypical manifestations of anti-HMGCR myopathy. Early addition of IVIG and rituximab is also critical in patients not responding to steroid monotherapy. Delay in achieving remission leads to prolonged steroid use, lower likelihood of beginning physical therapy and overall worse clinical outcomes.