A case of sub-acute compartment syndrome of bilateral pectoralis major, deltoid and triceps muscles

A 19-year-old healthy bodybuilder presented to the emergency department with gradually worsening pain in both his upper arms and shoulders and inability to fully flex his elbows. The haematological investigations revealed a markedly raised Creatinine Kinase (74,400 U/L) and myoglobinuria. The patient required an emergency surgical decompression of the pectoral and the anterior and posterior compartments of arms of both upper limbs with secondary closure after 48 h. The patient had an uneventful post-op and recovery of his functions with some initial restriction of full flexion of his left elbow and some weakness in his triceps, all of which gradually improved.

Acute Kidney Injury Following Rhabdomyolysis in Critically Ill Patients

Introduction Rhabdomyolysis, which resulted from the rapid breakdown of damaged skeletal muscle, potentially leads to acute kidney injury. Aim To determine the incidence and associated risk of kidney injury following rhabdomyolysis in critically ill patients. Methods All critically ill patients admitted from January 2016 to December 2017 were screened. A creatinine kinase level of > 5 times the upper limit of normal (> 1000 U/L) was defined as rhabdomyolysis, and kidney injury was determined based on the Kidney Disease Improving Global Outcome (KDIGO) score. In addition, trauma, prolonged surgery, sepsis, antipsychotic drugs, hyperthermia were included as risk factors for kidney injury. Results Out of 1620 admissions, 149 (9.2%) were identified as having rhabdomyolysis and 54 (36.2%) developed kidney injury. Acute kidney injury, by and large, was related to rhabdomyolysis followed a prolonged surgery (18.7%), sepsis (50.0%) or trauma (31.5%). The reduction in the creatinine kinase levels following hydration treatment was statistically significant in the non- kidney injury group (Z= -3.948, p<0.05) compared to the kidney injury group (Z= -0.623, p=0.534). Significantly, odds of developing acute kidney injury were 1.040 (p<0.001) for mean BW >50kg, 1.372(p<0.001) for SOFA Score >2, 5.333 (p<0.001) for sepsis and the multivariate regression analysis showed that SOFA scores >2 (p<0.001), BW >50kg (p=0.016) and sepsis (p<0.05) were independent risk factors. The overall mortality due to rhabdomyolysis was 15.4% (23/149), with significantly higher incidences of mortality in the kidney injury group (35.2%) vs the non- kidney injury (3.5%) [ p<0.001]. Conclusions One-third of rhabdomyolysis patients developed acute kidney injury with a significantly high mortality rate. Sepsis was a prominent cause of acute kidney injury. Both sepsis and a SOFA score >2 were significant independent risk factors.

Case Report: Refractory Immune-Mediated Necrotizing Myositis and Limited English Proficiency

Statement of Significance: We report the case of a 76-year-old Spanish-speaking patient with a three-year history of statin induced immune-mediated necrotizing myositis (IMNM) who presented with worsening symptoms and increasing creatinine kinase levels despite escalating treatment strategies. IMNM is a rare and challenging diagnosis. This case report details a myositis flare refractory to first and second-line therapies. Our report also examines limited English proficiency as a structural barrier to care in the United States, particularly in the setting of visits conducted via telehealth modalities. Purpose: To report a rare presentation of statin-induced IMNM and the clinical impacts of language barriers and telehealth. Methods: Case report. Results: A 76-year-old male with a three-year history of statin-induced IMNM presented for follow-up to the rheumatology clinic. He reported worsening weakness after beginning leucovorin to mitigate side effects ascribed to methotrexate therapy. He had previously achieved baseline strength and normal creatinine kinase (CK) levels with a regimen of weekly methotrexate and monthly infusion of intravenous immunoglobulin (IVIG). His decline in condition appeared to result from inappropriate medication scheduling due to a language barrier. The patient was taking weekly leucovorin on the day before his weekly dose of methotrexate, thus mitigating the efficacy of methotrexate. However, his condition continued to decline with three months of the recommended treatment schedule. The patient was then switched to mycophenolate mofetil as an alternative immunosuppressant. This therapy has demonstrated benefit thus far and provided the patient with symptomatic relief.

Nailfold Capillaroscopy Abnormalities Correlate With Disease Activity in Adult Dermatomyositis

Objectives: The aim of this study was to determine the relationship between disease activity in adult patients with dermatomyositis (DM) and other biomarkers of disease activity such as C-reactive protein creatinine kinase and nailfold video capillaroscopy (NVC).Methods: We performed a prospective single center study of 15 adult patients with DM. Study participants underwent two assessments at least 9 months apart including clinical, laboratory and NVC evaluations. Patients received immunosuppressive medications for their dermatomyositis, and ongoing disease activity was measured by the Myositis Intention to Treat Index (MITAX). NVC evaluation included assessment of capillary density, capillary apical diameter (mm), and the number of microhemorrhages per digit.Results: Microvascular abnormalities were present in most DM patients. Of these, capillary density (4.71 vs. 6.84, p = 0.006) and mean apical diameter (56.09 vs. 27.79 μm, p = 0.003) significantly improved over the study period in concordance with improving disease control (MITAX 8.53 vs. 2.64, p = 0.002). Longitudinal analysis demonstrated that capillary density was independently associated with MITAX (β = −1.49 [CI −2.49, −0.33], p = 0.013), but not other parameters such as C-reactive protein and creatinine kinase.Conclusions: Nailfold capillary density is a dynamic marker of global disease activity in adult DM. NVC may be utilized as a non-invasive point-of-care tool to monitor disease activity and inform treatment decisions in patients with DM.

N-TERMINAL PRO-B-TYPE NATRIURETIC PEPTIDES IN INFANTS AND CHILDREN WITH NON-CARDIAC DISEASES

Objective: To evaluate the levels of N-terminal pro-B-type Natriuretic Peptide in infants and children with non-cardiac diseases especially respiratory diseases. Study Design: Cross-sectional study. Place and Duration of Study: Department of Chemical Pathology/Biochemistry Laboratory Services of Liaquat National Hospital Karachi Pakistan, from Dec 2018 to Nov 2019. Methodology: Infants and children admitted to the Pediatric department with non-cardiac diseases were included in the study. Non-probability consecutive sampling was done. Blood was taken and analyzed for N- terminal pro-B-type Natriuretic Peptide, Troponin I, urea, creatinine, Lactate dehydrogenase, Creatinine Kinase, lactate and sodium analysis. Results: Out of the 93 patients, 74 (80%) were diagnosed with respiratory disorders, with bronchopneumonia making up 54 (59%) Bronchiolitis 15 (17%) and 4% had miscellaneous respiratory diseases. Out of the remaining 20%, 8 (9%) patients were diagnosed with sepsis, and the remaining 11% were diagnosed with miscellaneous diseases. There was a positive correlation of N- terminal pro-B-type Natriuretic Peptide with Troponin I, urea, creatinine, Creatinine Kinase and Lactate dehydrogenase levels (p<0.05). Conclusion: N- terminal pro-B-type Natriuretic Peptide levels were found to be raised in pediatric patients with non-cardiac diseases especially broncho-pneumonia and in future it may be used as a marker of bronchopneumonia in children.

FREQUENCY AND CORRELATES OF MYOPATHY IN PATIENTS WITH DIABETES TAKING ATORVASTATIN

Objective: To determine the myopathy in patients with diabetes taking atorvastatin and look for the factors correlated with the presence of myopathy among these patients. Study Design: Cross sectional analytical study. Place and Duration of Study: Department of Medicine, Pak Emirates Military Hospital Rawalpindi from, Jul to Dec 2018. Methodology: A total of 166 patients of both genders with type 2 diabetes mellitus taking atorvastatin for at least three to twelve months were included. Blood samples were drawn and Creatinine kinase (CK) levels were determined by automated analysis by colorimetry. Myopathy was taken as muscle symptoms associated with elevations in Creatinine Kinase at least 10 times the upper limit of normal. Results: Mean age of patients was 51.530 ± 5.70 years with age range from 40-70 years with. Mean duration of diabetes was 6.174 ± 2.27 years, mean duration of taking atorvastatin 7.186 ± 2.17 months and mean creatinine kinase levels were 1760.325 ± 5111.71 IU/L. Males were 68.7% as compare to females 31.3%. Myopathy was seen in 8.4% patients. Long duration of Diabetes Mellitus and atorvastatin use was statistically significantly related with the presence of myopathy. Conclusion: Myopathy was found in a significant number of patients taking atorvastatin. High risk population in our study emerged out to be patients with long duration of Diabetes Mellitus and long use of atorvastatin.

Effect of Dyslipidemia Therapy on Creatinine Kinase Activity Level in Patients with Heart Disease

Cardiovascular disease remains a significant health problem in the Asia Pacific region. Several studies have found that dyslipidemia is a cause of morbidity and mortality and requires high medical costs. Dyslipidemia is a risk factor for atherosclerosis. The most widely used therapy for dyslipidemia is statins. Statins often cause muscle disorders such as myalgia, myopathy, and rhabdomyolysis, which can cause death. A prospective cohort study design was carried out at Airlangga University Hospital, Surabaya, from April to November 2019. A total of 26 sample pairs containing 13 samples were treated with Atorvastatin, and 13 samples were treated with Simvastatin. The subjects were examined for the creatinine kinase activity level using enzymatic methods. The mean creatinine kinase levels in the atorvastatin group before and after treatment was 105.71 IU/L and 100.03 IU/L, respectively, because the subjects were diagnosed with acute coronary syndromes and blood was collected during acute conditions. Median creatinine kinase levels in the Simvastatin group were 85.5 IU/L before therapy and 118.1 IU/L after therapy, indicating significant differences in creatinine kinase levels before and after treatment. Simvastatin is very susceptible to certain drug interactions that can increase the concentration of statins in the serum. There were differences in levels of creatinine kinase activity before and after Simvastatin therapy but not Atorvastatin.

Impact of Diamond Nanoparticles on the Efficiency of Vinblastine against Ehrlich Solid Carcinoma in Mice

Aim: This investigation pointed to estimate skeletal muscle efficiency of diamond nanoparticles in enhancing Vinblastine (VBL) effects. Methodology: One hundred Albino mice, weighing (23- 28 grams) were utilized in this research, after a week of habituation, the mice were divided into five groups at random (20 mice each). Group 1 (control) obtained distilled water infusions, Group 2 (ESC group) injected Ehrlich cells via intramuscular infusion (IM), and Group 3 (ESC+VBL group) gained Vinblastine only, Group 4 (ESC+VBL+ND) received an IM injection of Vinblastine loaded on diamond nanoparticles and Group 5 (ESC+VBL+CS+ND) received IM administration of Vinblastine stacked on Chitosan with nanodiamond. Finally, blood specimens were taken. Serum was obtained to measure Asparaginase aminotransferase, Alanine aminotransferase, and Creatinine kinase. The muscle was removed and observed under a light microscope. Results: Aspartate aminotransferase (AST), alanine aminotransferase (ALT) and Creatinine kinase levels in the blood were elevated in ESC than in normal and treated groups. Levels of these enzymes were enhanced after treatment of VBL, diamond nanoparticles and chitosan. Conclusion: Nanodiamond are influenced in the VBL delivery system for the therapy of Ehrlich Solid carcinoma in mice models. The embattled VBL liberates tumor cells and reduced the side effect of VBL on skeletal muscle.

Mối tương quan giữa nồng độ đỉnh của men tim CK-MB huyết tương với sự xoay trục điện tim ở bệnh nhân nhồi máu cơ tim cấp được can thiệp thì đầu qua da

Mục tiêu: Đánh giá mối tương quan giữa nồng độ đỉnh men CK-MB huyết tương và sự thay đổi trục điện tim QRS ở bệnh nhân nhồi máu cơ tim cấp sau can thiệp động mạch vành thì đầu qua da. Đối tượng và phương pháp: Nghiên cứu hồi cứu trên 89 bệnh nhân nhồi máu cơ tim cấp được can thiệp động mạch vành qua da tại Bệnh viện Trung ương Quân đội 108 trong giai đoạn từ tháng 4/2018 đến tháng 4/2019. Trục của phức bộ QRS được tính theo công thức dựa trên chuyển đạo D1 và D3. Kích thước vùng nhồi máu cơ tim được xác định bằng nồng độ creatinine kinase (CK-MB). Kết quả: 89 bệnh nhân được đưa vào nghiên cứu có tuổi trung bình là 68,5 ± 9,1 năm, nam giới là chủ yếu (83,1%). 51,1% bệnh nhân nhập viện có nhồi máu cơ tim không ST chênh lên, 35,1% do nhồi máu cơ tim có ST chênh lên. Tổn thương vùng nhồi máu cơ tim khó xác định trên điện tim (49%) và tổn thương gặp nhiều nhất ở động mạch liên thất trước (51,7%). Mối tương quan giữa sự thay đổi trục điện tim và chỉ số CKMB yếu (r = 0,043), không có ý nghĩa thống kê (p>0,05). Phân tích dưới nhóm cho thấy có mối tương quan vừa giữa sư thay đổi góc alpha và men CKMB ở bệnh nhân tắc động mạch liên thất trước. Kết luận: Trục điện tim hay trục phức bộ QRS ít được chú ý trong lâm sàng. Tuy nhiên, trục QRS có thể được coi là một yếu tố tiên lượng kích thước nhồi máu cơ tim do tắc động mạch liên thất trước

Effects of Exercise Combined with Undenatured Type II Collagen on Endurance Capacity, Antioxidant Status, Muscle Lipogenic Genes and E3 Ubiquitin Ligases in Rats

The current study aimed to investigate the effect of exercise combined with undenatured type II collagen (UCII) administration on endurance capacity, lipid metabolism, inflammation, and antioxidant status in rats. Twenty-one male Wistar albino rats were divided into three groups as follows: (1) Sedentary control, (2) Exercise (E), (3) Exercise + UCII (4 mg/kg BW/day; E + UCII). The findings showed that the exhaustive running time in the UCII group was significantly prolonged compared to that of the non-supplemented group (p < 0.001). When compared to the control group, total serum cholesterol (TC, p < 0.05) and triglyceride (TG, p < 0.05) levels decreased, while creatinine kinase (CK) levels increased in the E group (p < 0.001). Serum creatinine kinase levels were reduced in the E + UCII group compared to the E group (p < 0.01). Serum lactate, myoglobin (p < 0.01), and osteocalcin levels (p < 0.01) increased significantly in exercised rats compared to sedentary control rats, while serum lactate (p < 0.01) and myoglobin (p < 0.0001) levels decreased in the E + UCII group compared to control. Additionally, UCII supplementation caused significant increases in antioxidant enzyme activities [SOD (p < 0.01) and GSH-Px (p < 0.05)] and decreases in malondialdehyde (MDA) and tumor necrosis factor (TNF-α) levels (p < 0.001). Muscle lipogenic protein (SREBP-1c, ACLY, LXR, and FAS) levels were lower in the E + UCII group than in other groups. In addition, UCII supplementation decreased muscle MAFbx, MuRF-1, myostatin and increased MyoD levels in exercised rats. Moreover, the E + UCII group had lower muscle inflammatory markers [TNF-α (p < 0.0001) and IL-1β (p < 0.01)] than the control group. These results suggest exercise combined with UCII (4 mg/kg BW/day) modulates lipid, muscle, and antioxidant status in rats.