Creatine Phosphokinase Values Research Articles

P409 MYOCARDITIS OR RHABDOMYOLYSIS WITH MYOCYTE NECROSIS?

Abstract Rhabdomyolysis is a clinical syndrome involving skeletal muscle tissue characterized by muscle weakness, myalgias and increased creatine phosphokinase (CPK) levels, usually 5 times up the normal limit. During rhabdomyolysis troponin (TNI) may be released due to mismatch between oxygen supply and demand, cytokine and endotoxin toxicity, presence of heterophile antibodies that cause false positive results and cross–reactivity between TNI isoforms produced by skeletal muscle and TNI isoforms produced by cardiac muscle. The triggering causes are multiple and include viral infections and genetic pathologies involving skeletal muscles. Genetic mutations of filamin C can cause myofibrillar myopathies, a heterogeneous group of neuromuscular disorders characterized by myopathy involving proximal and distal muscles that often occur in adulthood and may be associated with cardiomyopathies. Genetic mutations of filamin C can also be found in healthy adults because some variants have a subclinical expression. Case Report A 34 years old man came to the Emergency Department (ED) with fever, diarrhoea, asthenia and anuria. His past medical history was characterized by 4 episodes of myocarditis (TNI value increased up to 21 ng/dl, reduced left ventricular ejection fraction to 40%) all occurring in conjunction with acute gastroenteritis. The genetic analysis, performed six months before, showed a heterozygous mutation of the gene coding for filamin C. Blood tests performed in ED showed an increase in CRP values (4.8mg/dl), in transaminases values and a modest increase in troponin values (0.96ng/dl) without electrocardiographic and echocardiographic abnormalities (ejection fraction was preserved). He was admitted to Emergency Cardiology Department with a diagnosis of myocarditis. The CPK value resulted to be 22.503 U/l (n.v. 60 –190 U/l). Cardiac MRI underlined no signs of acute myocarditis. The patient, treated with intravenous fluid therapy, after one week showed clinical improvement and normalization of CPK and TNI values. Conclusions in the present case the acute gastrointestinal event was the trigger of rhabdomyolysis and not of an acute myocarditis as initially erroneously interpreted, in a patient carrying a genetic mutation predisposing to myopathies. Follow–up will evaluate whether and to what extent the genetic abnormality will lead to the development of myopathy and/or cardiomyopathy.

A STUDY ON PROGNOSTIC VALUE OF SERUM LACTATE DEHYDROGENASE AND CREATINE PHOSPHOKINASE LEVELS IN DENGUE FEVER

Worldwide about 100 million people are affected with dengue fever every year. Dengue is the most widely distributed mosquito-borne viral infection of humans1. In categorization of South East Asian countries for dengue fever, India is considered under Category-A where it is a major public health problem with hyperendemicity of all 4 serotypes in urban areas and spreading to rural areas2. India being a developing country there is a need for better utilization of resources to predict the severity of disease. Assessment of severity is essential for further management of the disease.In this study, we looked at the prognostic value of lactate dehydrogenase(LDH) and creatine phosphokinase(CPK). To study the predictive value of LDH and CPK in dengue feve AIM: Methods and r according to severity. materials: 85 patients of different severities of Dengue fever admitted to NRIGH are taken into a cross sectional prospective study and assessed. Dengue fever (DF), dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) are the different stages of severity taken into account. Statistical analysis: Statistical data analysis included mean, standard deviation, median, percentage and its level of signicance. Results of laboratory parameters (continuous measurements) are displayed as mean ± standard deviation, median and range. Frequency (Categorical) measurements are presented as numbers and percentage. Paired t-test, Mann Whitney U test and Fischer's Exact Test are applied as necessary. Results: Among 85 patients with dengue fever, 78 were having DF, 6 had DHF and 1 had DSS. The mean age of the patients included in the study was 38.7 years with standard deviation of 15.6. Maximum number of individuals was within the age group of 20 – 39 years. The eldest in the study was 73 years. This study showed no statistically signicant correlation between CPK levels and severity of dengue fever. Conclusion: Studies done at different parts of the world showed signicant correlation between serum LDH and CPK levels. This study didn't nd signicant correlation between serum LDH levels, serum CPK levels with severity of dengue fever but signicant variation was noted in CPK and LDH levels among dengue subtypes. Probably lack of equal proportional cases from different subtypes we couldn't nd correlation. Study with larger sample size and proportional cases in different subtypes might be required to test the correlation.

Serum creatine phosphokinase as a predictor of upper limb amputation in electrical trauma

To study the relationship between serum creatine phosphokinase and outcomes of injury in victims with electrical burns. Among 40 patients with electrical injury, 7 (18%) ones underwent upper limb amputation. There were 37 (92.5%) men and 3 (7.5%) women aged 37 (28; 47) years. We analyzed total serum creatine phosphokinase and MB fraction on the first day in patients with and without amputations. Total serum creatine phosphokinase exceeded the upper reference value in 11 out of 33 patients without amputation and in all 7 patients with limb amputation (p=0.001). Patients with limb amputation had significantly higher total serum creatine phosphokinase and MB fraction (p<0.001 and p=0.030, respectively). Logistic regression equation showed that high total serum creatine phosphokinase significantly influenced amputation rate (p<0.001), as evidenced by odds ratio (42.7, 95% CI 3.5-514.8). ROC analysis revealed the cut-off value of total serum creatine phosphokinase (950 IU/L). Sensitivity was 100% (63; 100), specificity - 94% (86; 94), positive predictive value - 78% (49; 78), negative predictive value - 100% (92; 100). Total serum creatine phosphokinase depends only on severity of electrical and flame burns. Serum creatine phosphokinase is a predictor of upper limb amputation in patients with electrical injury. Total serum creatine phosphokinase ≥ 950 IU/L is significant for upper limb amputation (in CK-MB fraction within the reference values).

Estimation of Blood Biochemical Constituents and Cortisol as Stress Predictors and Prognostic Biomarkers in Buffaloes Affected With Uterine Torsion

Full term pregnant buffaloes (n=24) affected with uterine torsion were equally divided into four experimental groups based on duration of uterine duration viz 6-12 hours (Group I); 12-24 hours (Group II); 24-48 hours (Group III) and more than 48 hours (Group IV). The control (Group V) consisted of six normal full term pregnant buffaloes. The experimental buffaloes were treated by modified Schaffer’s method. Those buffaloes, in which detorsion failed following modified Schaffer’s method, were treated by caesarean section. As the duration of uterine torsion increased, there was a corresponding increase in blood glucose levels from Group I to Group IV. There was a definite reduction in serum total protein and albumin concentrations in buffaloes affected with uterine torsion. As the duration of uterine torsion increased, a concomitant increase in blood urea nitrogen (BUN) and greater increase in serum creatinine levels were noticed. The mean creatine phosphokinase (CPK) and aspartate aminotransferase (AST) levels ranged from 152.71±39.09 to 445.30±44.57 and from 80.84±2.19 to 110.83±2.67 U/L, respectively. The successful detorsion in treatment groups caused drastic reduction in serum CPK and AST values at 24 hours after detorsion and 30 days after fetal delivery. The mean serum cortisol level ranged from 44.02±3.30 to 79.39±1.78 ng/ml in buffaloes affected with uterine torsion and it was 12.17±0.54 ng/ml at 24 hours before calving in normally calved buffaloes. Prior to detorsion in all the treatment groups, tremendous increase in mean serum cortisol levels was observed. It can be concluded that serum biochemical parameters and cortisol concentration may help to predict the prognosis of uterine torsion in buffaloes.

Rhabdomyolysis-associated Acute Kidney Injury.

Acute kidney injury represents one of the most severe complications of rhabdomyolysis. We performed a prospective observational study to analyze the etiology, clinical manifestations, laboratory profile, and outcome in patients with biopsy-proven pigment-induced nephropathy between January 2017 and September 2019. History, clinical examination findings, laboratory investigations, and outcomes were recorded. A total of 26 patients were included. Mean age was 34.81 ± 11.89 years. Mean peak serum creatinine was 6.79 ± 4.07 mg/dL. Median values of Creatine phosphokinase (CPK) and Lactate dehydrogenase (LDH) were 12500 U/L (3187, 17167.50) and 447 U/L (354.50, 908.75), respectively. Of the patients presenting with rhabdomyolysis, 12 patients (46%) had traumatic causes and 14 patients (54%) had nontraumatic causes. Nontraumatic etiology of rhabdomyolysis included seizures (1), wasp sting (1), paraphenylenediamine ingestion (2), rat killer ingestion (2), leptospirosis (2), dehydration (3), acute limb ischemia (1), Gloriosa superba ingestion (1), and prolonged immobilization (1). On renal biopsy, 16 patients had myoglobin cast nephropathy and one had immunoglobulin A deposits in addition to pigment nephropathy. Twenty (76.9%) were initiated on hemodialysis, and two patients (7.6%) were treated with peritoneal dialysis and four patients (15.5%) were treated with forced alkaline diuresis. A total of four patients died (15.4%) due to sepsis/disseminated intravascular coagulation and respiratory failure. At the mean follow-up of 6 months, two patients (7.7%) progressed to chronic kidney disease (CKD). Rhabdomyolysis-associated acute kidney injury is an important cause of renal failure requiring renal replacement therapy. In our study, it was more common in males. Traumatic and nontraumatic causes played an equal causative role. Most of the patients recovered from AKI. Forced alkaline diuresis was found useful in nontraumatic rhabdomyolysis AKI.

Risk assessment in delayed free flap reconstruction for severe lower extremity trauma.

This study aims to identify serum biomarkers that contribute to vascular thrombosis and complete flap failure in delayed reconstruction with free flaps, as well as to develop a scoring system of risk assessment including these biomarkers. A retrospective review of the database was conducted for lower extremity open fractures reconstructed between 7 and 90days from injury, from March 2014 to February 2022. We investigated changes in platelet count (PLT), D-dimer, creatine phosphokinase (CPK), and C-reactive protein (CRP) and then, developed a risk assessment system including these biomarkers as risk factors. A total of 62 free flaps were enrolled, and vascular thrombosis occurred in 14 flaps (22.6%), 9 of which (14.5%) developed complete flap failure. The risk assessment score was set to a maximum of 6 points for 6 items: age ≤ 40years, time from injury to coverage ≥ 14days, zone of injury from middle to distal leg, D-dimer on the day of injury ≥ 60µg/mL, maximum value of CPK ≥ 10,000 U/L, and maximum value of CRP ≥ 25mg/dL. The best cutoff score was 3 in the vascular thrombosis model (sensitivity: 0.79, specificity: 0.77) and 4 in the complete flap failure model (sensitivity: 0.78, specificity: 0.92). Our risk assessment system showed that the risk of vascular thrombosis was high at ≥ 3 points and that of complete flap failure was high at ≥ 4 points. Significantly, elevated levels of D-dimer, CPK, and CRP require more caution during reconstruction using free flaps.

The Association of Elevated Levels of LDH and CK-MB with Cardiac Injury and Mortality in COVID-19 Patients

Background: A new type of beta-coronavirus, named acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused coronavirus disease 2019 (COVID-19). Although COVID-19 is primarily associated with respiratory symptoms, cardiovascular complications can also occur. Herein, we aimed to evaluate whether the serum levels of enzymes related to cardiac injury, lactate dehydrogenase (LDH) and creatine kinase-MB (CK-MB), may associate with the mortality of COVID-19 patients to provide new insights to enhance clinical care. Methods: Based on hospital information systems (HIS) and patient records, we have retrospectively extracted laboratory findings of 159 patients with confirmed COVID-19 disease. The data of LDH and CK-MB of patients were defined as the day onset when the patients were admitted to the hospital. Results: The average age of all patients was almost 62 years old; the mean age in dead patients and recovered patients were 70 and 55 years old, respectively. The average aspartate aminotransferase (AST), alanine aminotransferase (ALT), and creatine phosphokinase (CPK) values were 91.74, 66.20 U/L, and 268.24 U/L, respectively in all patients. The average LDH was 758.69 U/L, and CK-MB was 39.87 U/L in all of the COVID-19 patients. Among all 140 patients, laboratory results revealed that 121 (86.4%) patients had an elevated LDH level. In total, for 159 patients, the results indicated that 114 (71.69%) patients had an elevated CK-MB value. The average LDH value in dead patients was 1012.22 U/L, while in recovered patients was 545.20 U/L (P&lt;0.0001). Also, the average CK-MB level in dead patients was 60.84 U/L, while in recovered patients was 35.17 U/L (P=00.0026). Conclusion: Elevated levels of LDH and CK-MB following COVID-19 disease increase the risk of death in these patients.

Creatine phosphokinase enzyme elevation in two third-level hospitals of Córdoba

HyperCKemia is defined as the elevation of creatine phosphokinase (CK) levels greater than 1.5 times the upper limit (CK>285 U/L), being produced by multiple causes, which vary according different populations. The main objective of the study was to know the frequency of hyperCKemia in two hospitals in Córdoba and its main causes. Retrospective analytical study in two hospitals in Córdoba, Argentina, where all patients over 18 years of age who presented CK values ​​greater than 285 U/L on at least 2 occasions in a period between 1 and 4 weeks were identified, between the years 2015 and 2017. 254 patients with hyperCKemia were identified, the majority were male (n=181, 71.3%) and their median age was 65 years (interquartile range 25-75%=50-73 years). The main causes of hyperCKemia were ischemic myopathy in 99 (39%) patients and drug-induced myopathies in 45 (17.7%), with statins being the most frequently involved drugs in 31 cases. In only 3.1% of the cases the final diagnosis was not reached. Drug-induced hyperCKemias, when compared to other causes, occurred more frequently in patients with a history of chronic kidney disease (9/45 [20%] vs 18/209 [8.6%], p = 0.025) and in non-smokers (41/45 [91.1%] vs. 157/209 [75.1%], p=0.019). 254 cases of hyperCKemia were observed, the main causes being of ischemic origin and secondary to drug use, especially statins.

Elevated level of creatine phosphokinase in newborn: Clinical significance and association with congenital muscle diseases.

To establish the normal Creatine phosphokinase (CPK) range in newborns of all 3 modes of delivery and prove that high CPK level in neonates is not specific a indicator for muscular pathology. This is a prospective cohort study that is conducted in King Abdulaziz Medical City and King Abdullah Specialized Children Hospital in Riyadh and included 504 term neonates who were born between March 2021 and August 2021. Two hundred and fifty three were males and 251 were females. Data and consents were managed and collected using 2 coordinators. Duration of the second stage of labor, age on the first CPK test and fetal gestational age were significantly correlated with CPK values (r=0.197, r=-0.234, r=0.274, respectively). The normal ranges for each delivery type were 334 U/L-2667U/L in normal spontaneous vaginal delivery, 265U/L-1182U/L in elective cesarean section, and 223U/L-3082 U/L in emergency cesarean section. The CPK was elevated in all neonates in all 3 modes of deliveries. An elevated levels of CPK in neonates is not a specific indicator for any congenital muscular pathology.

Diagnostics of septic myocardial dysfunction in neonates

Neonatal sepsis (NS) continues to be the one of the major problems in neonatal practice. This is due to the variability of clinical manifestations and, in part, the lack of available diagnostic markers that are significantly associated with mortality as a result of neonatal sepsis. The purpose - to study the role of paraclinical markers of myocardial dysfunction in neonates with sepsis. Materials and methods. To achieve this goal, 87 newborns (the main group) with manifestations of a generalized infectious-inflammatory process were under our observation. The control group included 30 newborns, in which infectious and inflammatory diseases were refuted. Examination and treatment of patients with NS was carried out in accordance with modern international guidelines and recommendations. Results and discussion. Based on a comprehensive clinical and paraclinical examination of neonates of the main group, it was found that 25 (28.7%) newborns suffered from early sepsis, respectively, the remaining 62 (71.3%) patients had late NS. According to the severity of the condition, 76 (87.4%) children of the main group included in the study required intensive care, which was provided in the neonatal intensive care unit. The average value of procalcitonin in the main observation group was 2.53±0.33 ng/ml, respectively, in the control group - 0.24±0.04 ng/ml (p&lt;0.05). The mean values of creatine phosphokinase, MB fraction and troponin I in the main observation group were 58.44±2.39 U/l and 0.33±0.05 ng/ml, respectively, in the control group - 41.74±2.45 U/l and 0.04±0.01 ng/ml (p&lt;0.05). Conclusions. Generalized infectious-inflammatory process in neonates is accompanied by increased activity of cardiotropic biochemical markers. The study was conducted in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the children’s parents was obtained for the research. No conflict of interests was declared by the authors.

Cardiovascular adaptations and inflammation in marathon runners.

Long-distance running has become increasingly popular. Cardiovascular adaptations to exercise are relevant to the specific sports and this is also the case in long-distance running. Significant changes regarding inflammatory and endothelial markers along with indices of oxidative stress are observed in marathon and ultra-marathon runners. However, data linking inflammatory marker levels with cardiovascular adaptations to marathon running are limited. The aim of the present study was to describe the cardiovascular adaptations observed in a group of ultra-marathon runners and the association with a series of inflammatory and endothelial markers measured in their plasma. A total of 43 ultra-marathon runners were assessed by echocardiography and a treadmill exercise test. Blood samples were used for tumor necrosis factor-α (TNF-α), asymmetric dimethylarginine (ADMA), interleukin (IL)-6, IL-10, C-reactive protein, creatine phosphokinase (CPK) and oxidative stress indice measurements. Ultra-marathon runners who presented augmented left ventricular (LV) end diastolic diameters >55 mm had higher ADMA values (1.07±0.07 vs. 0.99±0.08 µmol/ml, P<0.01) and lower CPK values (192.5±21.3 vs. 219.1±37.3 mg/dl, P<0.05) compared with those with normal LV diameters. Runners with a moderate and severe abnormal indexed LV mass >131 g/m2 had statistically significant higher TNF-α values compared with runners, with mildly elevated and a normal LV mass indexed (16.2±1.42 vs. 14.0+1.16 pg/ml, P<0.05). Runners with an abnormal left atrial volume index (LAVI; >29 ml/m2) had higher IL-6 values compared with runners with a normal LAVI (1.09+0.19 vs. 0.99±0.08 pg/ml, P<0.05). ROC curves analysis revealed that ADMA values were able to predict an abnormal LV diameter detected by echocardiography [P<0.05; area under the curve (AUC), 0.763], while TNF-α values could predict an abnormal LV mass in marathon runners (P<0.05; AUC, 0.78). On the whole, the present study demonstrates that, in ultra-marathon runners, cardiovascular adaptations to running are characterized by a specific pattern of changes in inflammatory and endothelial markers, which in turn can be used to predict the occurrence of the observed adaptations.

Benign acute childhood myositis: A 5-year retrospective study

BackgroundBenign acute childhood myositis (BACM) is a rare, transient, and self-limited inflammatory condition of the skeletal muscle that usually occurs after a viral infection. It affects pre-school and school-aged children at a median age of 6–9 years, with a male predominance. Patients can be managed with analgesia, rest, and adequate hydration at home. MethodsA retrospective review was carried out of patients’ clinical records with an elevated level of creatine phosphokinase (CPK) who presented to the pediatric emergency department between January 1, 2015 and December 31, 2019. ResultsOut of 174 cases of elevated CPK values, 100 corresponded to BACM-compatible clinical presentations (n = 96). There was a male predominance (77%) with a median age of 6 years. There were more cases registered in 2019 compared with the previous years. The most frequently reported prodromal symptoms were fever, cough, and rhinorrhea. Bilateral calf pain was the most frequently reported BACM symptom, followed by gait complaints and refusal to walk. Hospitalization was an independent predictor of CPK levels. In two cases there was myoglobinuria. The most common hematological findings were leukopenia and thrombocytopenia. ConclusionOur results regarding male predominance, median age, and hematological findings are similar to the published reports. The outbreak during 2019 coincided with the 2019/2020 flu season. During this period, influenza B was the most prevalent virus and it is known to be the most myotrophic one. Physicians often take into consideration CPK levels during inpatient admission. All patients recovered fully, emphasizing the fact that BACM is benign, self-limited, and with an excellent prognosis.

Combined Mutations of DMD and CFTR Genes in an Azerbaijani Family

A 9 year old boy with the obvious traits of Duchene muscular dystrophy disease is a resident of Masalli region of Azerbaijan, located in the south-east foothill of Talysh Mountains. Family members such as mother, father and sister of this index patient were examined. To diagnose all members of the family, biochemical analysis was conducted for quantitative analysis of creatine phosphokinase in blood serum and genealogical survey identified inherited disease cystic fibrosis in first cousin of this index patient . Quantitative evaluation of creatine phosphokinase in blood serum was performed for all family members of the index patient ., and identified high values: in index patient (2298 U/L, norm - 38-137 U/L), in his mother (879 U/L, norm - 26-140 U/L) and his sister (852U/L, norm - 26-140 U/L), whereas his father had normal range values of creatine phosphokinase in blood (53,1 U/L, where norm - 38-137 U/L). Diagnosis of Duchenne muscular dystrophy disease was confirmed in index patient in hemizygous state. His mother and sister were found as heterozygous carriers of the (Duchenne muscular dystrophy) DMD gene. Molecular genetic analysis of the DMD gene (MLPA) identified mutation in the mother and sister of the index patient. Mutation type was nonsense, and classified as pathogenic class. Molecular genetic analysis of the DMD gene showed a gain of mutations, consisting of two copies encompassing exon 03 to 09 in the index patient, mother and his sister. The identified two different mutations of DMD gene in Azerbaijani family: fragment deletion of exon 45 in three sibs from Astara region of Azerbaijan, located in the south-east of the country, and deletion encompassing exons from 8 to 20 in 10-year-old boy in Balakan region, located in the north-west of the Republic Mutation type is a nonsense mutation and classified as pathogenic of class 1. Inherited cystic fibrosis in heterozygous state was additionally identified in the index patient, in father and sister. The screening of identified mutations may serve as a prenatal diagnostic tool to carefully plan the prophylaxis in patients with cystic fibrosis. Furthermore, our studies may serve as a basis for the future investigation of many aberrant molecular mechanisms and regulatory pathways. The study of Duchenne and Becker muscular dystrophy resulted in one of the first successful attempts at reverse genetics, better described as positional cloning, in humans. Discovery and subsequent analysis of the gene mutation that results in the clinical disorder led to the discovery of the encoded protein, dystrophin. This coinage set a precedent for the naming of proteins discovered by positional cloning of human disease genes: for example, huntingtin, emerin, and ataxin

Case Report: Severe Rhabdomyolysis and Multiorgan Failure After ChAdOx1 nCoV-19 Vaccination

BackgroundSevere skeletal muscle damage has been recently reported in patients with SARS-CoV-2 infection and as a rare vaccination complication.Case summaryOn Apr 28, 2021 a 68-year-old man who was previously healthy presented with an extremely severe rhabdomyolysis that occurred nine days following the first dose of SARS-CoV-2 ChAdOx1 nCov-19 vaccination. He had no risk factors, and denied any further assumption of drugs except for fermented red rice, and berberine supplement. The clinical scenario was complicated by a multi organ failure involving bone marrow, liver, lung, and kidney. For the rapid increase of the inflammatory markers, a cytokine storm was suspected and multi-target biologic immunosuppressive therapy was started, consisting of steroids, anakinra, and eculizumab, which was initially successful resulting in close to normal values of creatine phosphokinase after 17 days of treatment. Unfortunately, 48 days after the vaccination an accelerated phase of deterioration, characterized by severe multi-lineage cytopenia, untreatable hypotensive shock, hypoglycemia, and dramatic increase of procalcitonin (PCT), led to patient death.ConclusionPhysicians should be aware that severe and fatal rhabdomyolysis may occur after SARS-CoV2 vaccine administration.

Stress, Metabolic and Serum Muscle-Derived Enzymes Response of Horses Employed in Wooded Area and Field Trekking Courses

Horse trekking is a non-competitive sport that, as other kinds of exercise, involves skeletal muscle effort and may implicate significant energy expenditure leading to stress. The aim of the current study was to assess the effect of trekking on metabolic and stress response as well as muscle damage markers in clinically healthy horses. Thirty horses were equally divided in 3 groups according to trekking course: Group A (trekking course 15 km long), Group B (trekking course 35 km long starting;), Group C (three trekking courses for three consecutive days; during the first day the trekking course was 25 km long, Group C1; during the second day the trekking course was 40 km long, Group C2; during the third day the trekking course was 25 km long, Group C3). Blood samples were collected from each horse before trekking (TPRE), after 5 min (TPOST) and 1 h from the trekking end to assess lactate, glucose, total proteins, non-esterified fatty acids (NEFAs), creatinine, aspartate aminotransferase (AST), creatine phosphokinase (CPK), lactate dehydrogenase (LDH) and cortisol concentration. Higher cortisol, lactate, glucose, NEFAs, creatinine, CPK, LDH and AST values were found after trekking than rest (P < .001). Horses of Groups C2 and C3 showed higher values of the investigated haematochemical parameters and muscle enzymes than Groups A and B. The findings suggest that trekking induces a metabolic reaction accompanied by an acute stress response in horses and underline that this recreational exercise, if not associated with the adequate recovery period, can increase the probability of muscle damage.

Relation between Serum Creatine Phosphokinase Levels and Acute Kidney Injury among ST-Segment Elevation Myocardial Infarction Patients.

Background: Among patients with rhabdomyolysis, the leakage of intracellular skeletal muscle content such as creatine phosphokinase (CPK) into the bloodstream has been associated with an increased risk of acute kidney injury (AKI). We evaluated the possible relationship between serum CPK levels and AKI occurrence among patients with myocyte injury secondary to ST-elevation myocardial infarction (STEMI). Methods: We retrospectively included 2794 patients with STEMI. Patients were stratified according to peak serum CPK levels into mild (<1000 U/L, n = 1603), moderate (1000–5000 U/L, n = 1111), and severe (>5000 U/L, n = 80) categories. The occurrence of AKI was defined by the KDIGO criteria as an increase in serum creatinine (sCR) ≥0.3 mg/dL within 48 h following PCI. The predictive value of CPK for the risk of AKI occurrence was assessed using multivariate logistic regression models. Results: The overall occurrence of AKI was 10.4%. Incidence of AKI showed a gradual increase between patients with mild, moderate, and severe serum CPK level elevations (7.8% vs. 11% vs. 26% respectively; p < 0.001). In multivariate logistic regression models, both moderate or higher (OR 1.6, 95% CI 1.1–2.2; p = 0.01) and severe (OR 2.8 95% CI 1.4–5.6; p = 0.004) serum CPK level elevations were independently associated with AKI. Conclusions: Among STEMI patients, elevated CPK levels were associated with AKI. This association is presumably independent; however, it remains unclear whether it is due to direct toxic (myoglobin-related) or hemodynamic effects (poor left ventricular function). Further studies are required to reveal the underlying mechanism.

Tropical spastic paraparesis-like illness in an HIV-Infected child

Human T-cell leukemia virus type 1(HTLV-1) is the etiological agent responsible for the clinical entity of tropical spastic paraparesis/HTLV-1-associated myelitis (TSP/HAM). HTLV-1 and HIV-1, being related retroviruses, coinfection with both is a well-recognized phenomenon but rarely reported in children. We describe a 5-year-old boy with no previously known comorbidity who presented with bilateral lower-limb weakness and calf pain along with urinary retention. Imaging confirmed the presence of myelitis. Investigations showed elevated creatine phosphokinase(CPK) values suggestive of myositis. It was later learned that the parents of the child were on treatment for HIV infection. Antibodies for HIV were positive by ELISA, and in view of the clinical picture, probability of a TSP-like illness as the initial presentation of a hitherto undiagnosed HIV infection was considered. TSP/HAM is an important yet underrecognized cause of spinal disease, especially in HIV-infected individuals. Certain features such as elevated to normal CD4 counts, absence of significant sensory symptoms, and associated myositis may serve as subtle clues to underlying HTLV-1 infection.

Is Serum Creatine Phosphokinase Level Useful to Predict the Severity of Organophosphate Poisoning?

Organophosphate poisoning is a global health burden due to intentional and occupational exposure, particularly in Asian countries. Patients are usually monitored through serum acetylcholinesterase levels. Still, it is non-specific, does not correlate well with the severity of poisoning, and is not widely available in laboratory settings in developing countries. This study aims to assess serum baseline creatine phosphokinase (CPK) levels as a prognostic biomarker in acute organophosphate poisoning. We recruited all patients older than 12 years who were admitted to the wards of the Indoor Medicine Ward in Burdwan Medical College and Hospital in West Bengal (India) because of ingestion or inhalation of organophosphorus compounds within the previous 12 hours between May 1, 2019, and November 1, 2020. Clinical severity was categorized according to Peradeniya organophosphorus poisoning (POP) scale. Serum CPK, pseudocholinesterase levels, and pH were measured. Levels were reassessed on days three and seven, and patients were followed-up until death or discharge. 100 patients (68 men and 32 women) were included in the study. Most of them presented with miosis (98%), followed by abdominal pain (96%), diarrhea (78%), and vomiting (52%). In the multivariate analysis, the patients with a higher risk of being intubated were younger. Of the analytical levels, the one that showed a better relationship with the risk of intubation was the pseudocholinesterase level, although without statistical significance. Initial CPK levels, time of admission, or stratification on the POP severity scale, offered poor performance after adjustment. The analytical values of CPK or the POP severity scale at the time the patient presents in the emergency room have limited value to predict the final severity of the picture. The amount of the poison consumed should be collected for future studies to elucidate these differences.

Improvement in childhood limb-girdle muscular dystrophy with Ayurvedic management: A case report

The Limb-Girdle Muscular Dystrophies (LGMDs) include a heterogeneous group of disorders characterized by the progressive wasting and weakness of the proximal limb-girdle muscles. Sarcoglycanopathies are forms of LGMD that result from defect in the sarcoglycan complex. Ayurveda explains the condition in the line of Srotorodha (~obstructive pathology occurring in channels), especially at the Mamsa dhatu (~muscle tissue) level. This is the case report of an eight year old male child of autosomal recessive LGMD with no relevant family history. The patient was presented with gradual onset of proximal muscle weakness in all four limbs for two years along with pseudohypertrophy of bilateral calf muscles. He had elevated Creatine Phosphokinase (CPK) level and the genetic test findings revealed a homozygous missense variation in exon 2 of the SGCA gene. He visited the outpatient department of the tertiary Government Ayurveda Hospital and Ayurveda medications were administered along with dietary advices for two months followed by in-patient management for one month. There was a significant improvement in the clinical findings assessed by the Vignos scale of lower extremity and Barthel index along with reduction in the level of CPK value after three months of Ayurvedic management. Significant improvement in this short period of management substantiates the benefit of Ayurvedic medicines in the management of LGMD.

Новый способ прогнозирования характера изменений стенки желчного пузыря при остром холецистите

The aim of the research. To develop a method for predicting the degree of changes in the gallbladder wall in acute cholecystitis. Material and methods. A single-stage study was performed on 105 patients with an established diagnosis of acute cholecystitis who underwent laparoscopic cholecystectomy, comparable in age, gender and concomitant pathology. Upon admission to the hospital, the activity of creatine phosphokinase (CPK), lactate dehydrogenase (LDH), gamma-glutamiltranspeptidase (GGTP) and alkaline phosphatase was determined through the kinetic colorimetric method. Statistical processing of the obtained results was carried out using the SPSS Statistics 7.0 program in compliance with the principles of statistical analysis adopted for research in biology and medicine. Results. In patients with acute destructive cholecystitis, mean CPK values were 302.2±32.5 U/l (p &lt;0.05) and LDH - 318.3±29.4 U/l (p &lt;0.05), which is higher than the values obtained in the group with acute non-destructive cholecystitis: CPK – 168.7±18.3 U/l (p &lt;0.05) and LDH – 282.6±18.3 U/l (p &lt;0.05). Along with this, a direct correlation was revealed between an increase in the concentration of CPK, LDH and the degree of destructive process in the gallbladder wall. At the same time, in patients with non-destructive cholecystitis, mean values were 340±116.9 U/l (p &lt;0.05) for GGTP and 160.3±34.2 U/l (p &lt;0.05) for SCHF, which exceeds these values in the group of patients with acute destructive cholecystitis: GGTP was 70.5±18.5 U/l (p &lt;0.05), and SCHF was 93.5±16.5 U/l (p &lt;0.05). With progression of destructive processes in the gallbladder wall, the concentration of GGTP and alkaline phosphatase decreases.