Creatinine Phosphokinase Levels Research Articles

Severe Rhabdomyolysis without Systemic Involvement: A Rare Case of Idiopathic Eosinophilic Polymyositis.

Introduction. Eosinophilic polymyositis (EPM) is a rare cause of rhabdomyolysis characterized by eosinophilic infiltrates in the muscle. We describe the case of a young patient with eosinophilic polymyositis causing isolated severe rhabdomyolysis without systemic involvement. Case Presentation. A 22-year-old Haitian female with no past medical history presented with progressive generalized muscle aches without precipitating factors. Examination of the extremities revealed diffuse muscle tenderness. Laboratory findings demonstrated peripheral eosinophilia and high creatinine phosphokinase (CPK) and transaminase levels. Workup for the common causes of rhabdomyolysis were negative. Her CPK continued to rise to greater than 100,000 units/L so a muscle biopsy was performed which showed widespread eosinophilic infiltrate consistent with eosinophilic polymyositis. She was started on high dose systemic corticosteroids with improvement of her symptoms, eosinophilia, and CPK level. Discussion. This case illustrates a systematic workup of rhabdomyolysis in the presence of peripheral eosinophilia. Many differential diagnoses must be considered before establishing a diagnosis of idiopathic eosinophilic polymyositis. To our knowledge, our case of eosinophilic polymyositis is unique as it presented with severe rhabdomyolysis without another organ involvement. Clinicians should maintain a high index of suspicion for this physically debilitating disease to aid in prompt diagnosis.

Aquapuncture Using Stem Cell Therapy to Treat Mdx Mice

Duchenne muscular dystrophy (DMD) occurs due to genetic mutations that lead to absence or decrease of dystrophin protein generating progressive muscle degeneration. Cell therapy using mesenchymal stem cell (MSC) has been described as a treatment to DMD. In this work, MSC derived from deciduous teeth, called stem cells from human exfoliated deciduous teeth (SHED), were injected in acupoint as an alternative therapy to minimize muscle degeneration in twenty-two mdx mice. The treatment occurred three times with intervals of 21 days, and animals were analyzed four times: seven days prior treatment (T-7); 10 days after first treatment (T10); 10 days after second treatment (T31); and 10 days after third treatment (T52). Animals were evaluated by wire test for estimate strength and blood was collected to perform a creatinine phosphokinase analysis. After euthanasia, cranial tibial muscles were collected and submitted to histological and immunohistochemistry analyses. Treated groups presented improvement of strength and reduced creatinine phosphokinase levels. Also, a slight dystrophin increase was observed in tibial cranial muscle when aquapuncture was associated SHED. All therapies have minimized muscle degeneration, but the association of aquapuncture with SHED appears to have better effect, reducing muscle damage, suggesting a therapeutic value.

Primary percutaneous coronary intervention ameliorates complete atrioventricular block complicating acute inferior myocardial infarction.

ObjectiveComplete atrioventricular block (CAVB) in acute inferior ST-segment elevation myocardial infarction (STEMI) is associated with poor clinical outcomes after noninvasive treatment. This study was designed to determine the effect of primary percutaneous coronary intervention (PCI) in patients with CAVB complicating acute inferior STEMI, at a single center.MethodsWe enrolled 138 consecutive patients diagnosed with STEMI involving the inferior wall; of these, 27 patients had CAVB. All patients received primary PCI. The clinical characteristics, procedural data, and clinical outcomes were compared in patients with versus without CAVB.ResultsBaseline clinical characteristics were similar between patients with and without CAVB. Patients with CAVB were more likely to present with cardiogenic shock, and CAVB was caused primarily by right coronary artery occlusion. Door-to-balloon time was similar between those two groups. After primary PCI, CAVB was reversed in all patients. The peak creatinine phosphokinase level, left ventricular ejection fraction and in-hospital mortality rate were similar between the two groups. After a median follow up of 318 days, major adverse cardiac events did not differ between the groups (8.1% in patients without CAVB; 11.1% in patients with CAVB) (P=0.702).ConclusionWe conclude that primary PCI can ameliorate CAVB-complicated acute inferior STEMI, with an acceptable rate of major adverse cardiac events, and suggest that primary PCI should be the preferred reperfusion therapy in patients with CAVB complicating acute inferior myocardial infarction.

G.P.225: Concomitant alpha and gamma sarcoglycan deficiencies in a Turkish boy with a novel deletion in the alpha sarcoglycan gene

Limb-girdle muscular dystrophy type 2D (LGMD-2D) is caused by autosomal recessive defects in the alpha-sarcoglycan gene located on chromosome 17q21. In this study, we present a child with alpha-sarcoglycanopathy and describe a novel deletion in the alpha-sarcoglycan gene. A 5-year-old boy had a very high serum creatinine phosphokinase level, which was determined incidentally, and a negative molecular test for the dystrophin gene. Muscle biopsy showed dystrophic features. Immunohistochemistry showed that, there was diminished expression of alpha and gamma sarcoglycans. DNA analysis revealed a novel 7bp homozygous deletion in exon 3 of the alpha-sarcoglycan gene. His parents were consanguineous heterozygous carriers of the same deletion. We believe this is the first confirmed case of primary alpha-sarcoglycanopathy with a novel deletion in Turkey. In addition, this study demonstrated that, both muscle biopsy and DNA analysis remain important methods for the differential diagnosis of muscular dystrophies because dystrophinopathies and sarcoglycanopathies are so similar.

G.P.226: Sarcolemmal deficiency of sarcoglycan complex in an eighteen months old Turkish boy with a huge deletion in the beta sarcoglycan gene

Limb-girdle muscular dystrophy type 2E (LGMD-2E) is caused by autosomal recessive defects in the beta-sarcoglycan gene located on chromosome 4q12. In this study, the clinical findings, histopathological features and molecular genetic data in a boy with beta-sarcoglycanopathy are presented. An eighteen-month-old boy had a very high serum creatinine phosphokinase level, which was determined incidentally. He had consanguineous parents. The result of molecular analyses for dystrophin gene was found normal. He underwent a muscle biopsy which showed dystrophic features. Immunohistochemistry showed that, there was a total loss of sarcolemmal sarcoglycan complex (alpha, beta, delta and gamma sarcoglycans) while sarcolemmal dystrophin expression was normal. DNA analysis revealed a huge deletion in the beta-sarcoglycan gene. The deletion was homozygous and occurred from exon 1 to 6. This study demonstrated that the total absence or abnormal expressions of all 4 sarcoglycans are more likely to indicate a primary defect in the beta sarcoglycan gene.

443O - Pimasertib (Pim) and Sar245409 (Sar) - a Mek and Pi3K/Mtor Inhibitor Combination: a Phase Ib Trial with Expansions in Selected Genotype-Defined Solid Tumors

ABSTRACT Aim: To investigate safety and efficacy in four expansion cohorts treated with the combination of PIM and SAR. Methods: The recommended phase 2 dose (RP2D) for the combination of PIM and SAR has previously been defined in a dose escalation part of the same trial as 60 mg and 70 mg QD, respectively. Inclusion criteria included ECOG PS 0-1, and in the expansion cohorts prior MEK and/or PI3K inhibitor therapy was not allowed (NCT01390818). With an extract date of 25 March 2014, we carried out preliminary analyses for safety and efficacy using standard criteria (NCI CTCAE v4.0 and RECIST v1.1). Results: At the RP2D, 4 disease- and genotype-specific cohorts were recruited: RAS mutated non-small cell lung cancer (NSCLC, n = 24), triple-negative breast cancer (TNBC, n = 26), BRAF inhibitor resistant malignant melanoma (MEL, n = 15) and dual KRAS and PIK3CA mutated colorectal cancer (CRC, n = 18). The most frequent (≥20%) all grade treatment-emergent adverse events were: diarrhea (77.1%), fatigue (54.2%), nausea (50.6%), vomiting (47.0%), dermatitis acneiform (37.3%), maculo-papular rash (30.1%), decreased appetite (30.1%), peripheral edema (25.3%), pyrexia (25.3%), stomatitis (24.1%), dizziness (24.1%), dyspnea (21.7%), skin rash (21.7%), increased creatinine phosphokinase levels (21.7%), abdominal pain (20.5%) and pruritus (20.5%). Serous retinal detachment, which is a class effect of MEK inhibitors, was reported in 34.9% of pts and all cases were resolved without serious damage to the eyesight. Confirmed responses were observed in 2 of 18 evaluable NSCLC patients and in 1 of 13 evaluable MEL pts. Conclusions: Toxicities were manageable and improved or resolved with drug interruptions and/or dose reductions. Clinical activity was observed and an updated response evaluation will be presented at the meeting. We plan to evaluate whether there is a specific subset of pts who are more likely to benefit from the combination treatment with PIM and SAR. Disclosure: R.S. Heist: Research funding (for clinical trials) going to the institution at which I work (MGH), from the following companies: Genentech, GSK, Pfizer, Debiopharm, Infinity, Exelixis, EMD Serono, Sanofi F. Campana: Frank Campana is a Sanofi employee; C. Egile: Coumaran EGILE is a Sanofi employee; V. Jego: I am currently working for Cytel Inc, a CRO contracted by Merck KGaA. I do not have any stock ownership or advisory board or board of director membership or other substantial relationship beyond employment; L. Damstrup: I am an employer of Merck Serono, no other conflict of interest. All other authors have declared no conflicts of interest.

Acute muscular sarcocystosis: an international investigation among ill travelers returning from Tioman Island, Malaysia, 2011-2012.

Through 2 international traveler-focused surveillance networks (GeoSentinel and TropNet), we identified and investigated a large outbreak of acute muscular sarcocystosis (AMS), a rarely reported zoonosis caused by a protozoan parasite of the genus Sarcocystis, associated with travel to Tioman Island, Malaysia, during 2011-2012. Clinicians reporting patients with suspected AMS to GeoSentinel submitted demographic, clinical, itinerary, and exposure data. We defined a probable case as travel to Tioman Island after 1 March 2011, eosinophilia (>5%), clinical or laboratory-supported myositis, and negative trichinellosis serology. Case confirmation required histologic observation of sarcocysts or isolation of Sarcocystis species DNA from muscle biopsy. Sixty-eight patients met the case definition (62 probable and 6 confirmed). All but 2 resided in Europe; all were tourists and traveled mostly during the summer months. The most frequent symptoms reported were myalgia (100%), fatigue (91%), fever (82%), headache (59%), and arthralgia (29%); onset clustered during 2 distinct periods: "early" during the second and "late" during the sixth week after departure from the island. Blood eosinophilia and elevated serum creatinine phosphokinase (CPK) levels were observed beginning during the fifth week after departure. Sarcocystis nesbitti DNA was recovered from 1 muscle biopsy. Clinicians evaluating travelers returning ill from Malaysia with myalgia, with or without fever, should consider AMS, noting the apparent biphasic aspect of the disease, the later onset of elevated CPK and eosinophilia, and the possibility for relapses. The exact source of infection among travelers to Tioman Island remains unclear but needs to be determined to prevent future illnesses.

Concomitant alpha- and gamma-sarcoglycan deficiencies in a Turkish boy with a novel deletion in the alpha-sarcoglycan gene.

Limb-girdle muscular dystrophy type 2D (LGMD-2D) is caused by autosomal recessive defects in the alpha-sarcoglycan gene located on chromosome 17q21. In this study, we present a child with alpha-sarcoglycanopathy and describe a novel deletion in the alpha-sarcoglycan gene. A 5-year-old boy had a very high serum creatinine phosphokinase level, which was determined incidentally, and a negative molecular test for the dystrophin gene. Muscle biopsy showed dystrophic features. Immunohistochemistry showed that there was diminished expression of alpha- and gamma-sarcoglycans. DNA analysis revealed a novel 7 bp homozygous deletion in exon 3 of the alpha-sarcoglycan gene. His parents were consanguineous heterozygous carriers of the same deletion. We believe this is the first confirmed case of primary alpha-sarcoglycanopathy with a novel deletion in Turkey. In addition, this study demonstrated that both muscle biopsy and DNA analysis remain important methods for the differential diagnosis of muscular dystrophies because dystrophinopathies and sarcoglycanopathies are so similar.

Unaccustomed exertion and opiate consumption leading to acute renal failure in a healthy male

A 38 year old male presented with stupor and acute renal failure (ARF) following opium consumption and a protracted excursion on foot to a holy shrine situated at altitude of 4329 m above sea level. The finding of dark colored urine, myoglobinuria and a markedly elevated serum creatinine phosphokinase level supported the diagnosis of rhabdomyolysis. The patient had a rapid and complete recovery following fluid resuscitation and haemodialysis.

Accuracy of ECG in assessment of postmyocardial infarction left ventricular function & its comparison with echocardiography

[4] However, its usage in measuring the size of the infarct and assessing left ventricular function is a relatively new concept. The two dimensional echocardiography made it possible to detect wall motion abnormalities which are used to differentiate reliably between patient with myocardial ischaemia or early infarction and patient with nonischaemic chest pain. [5] The major advantages of the two dimensional echocardiography is its non-invasive use and repeatability of the examination. [6] The wall motion abnormalities detected using the echocardiography can be used safely in the diagnosis of myocardial infarction in the appropriate setting when electrocardiogram is non diagnostic. This technique has shown good correlation with functional infarct size with studies using thallium ventriculography, coronary angiography, peak creatinine phosphokinase levels and nuclear ventriculography. [3] 2D-Echocardiography, because of its ability to determine global and regional ventricular function is suited ideally for determining early and late prognosis in patients with acute myocardial infarction. [5] When performed early in the course of myocardial infarction 2D-echocardiography can help stratify high and low risk groups. Now a days measurement of left ventricular function is made by means of „Ejection Fraction‟. Ejection fraction is global index of extent of ventricular fiber shortening and provides useful measure of overall left ventricular pump function. ECG and 2-D echocardiography both are feasible and acceptable investigation to diagnose LV dysfunction. The outcome may be improved when the results of the two are compared for final evaluation. II. Material And Methods The present study was carried out in fifty cases of acute myocardial infarction patients in the tertiary care Hospital . All the patients who were admitted in the Medical wards who had demonstrated Q waves in their electrocardiogram were included in this study and screened.This also included patients shifted from coronary care units convalescing from acute infarct. Patients who had a history of DIABETES MELLITUS HYPERTENSION, CHRONIC RENAL FAILURE and/or on treatment for the same were excluded from the study as these diseases may affect the myocardium directly. Patients with non- Q wave infarcts, [7] Patient with conduction blocks assessed by electrocardiogram and Patients who showed electrocardiography evidence of Right or Left Ventricular hypertrophy by ESTES criteria were excluded. [8] Also,patients who had echocardiography evidence of valvular heart diseases of any of the four valves were excluded.

Şiddetli solunum yetmezliğine neden olan polimiyozit ve hipotiroidi birlikteliği : Olgu sunumu

Polymyositis is a systemic, inflammatory muscle disease. Respiratory insufficiency as a result of respiratory muscle involvement could also be observed. Here we report a fortyone-year-old man who attended to the hospital with the complaints of shortness of breath and chest pain that have suddenly started. Physical examination has revealed proximal muscle weakness. Serum creatinine phosphokinase level has increased, ANA was positive and the electromyographic examination has revealed myopathic changes. Deltoid muscle biopsy was in accordance with polymyositis. Methyl-prednisolone 1 gram iv pulse therapy was given during the first 5 days. He was started with 25 mg/week parenteral methotrexate. Laboratory tests suggested hypothyroidism and levothyroxine replacement therapy was started. The clinical findings have improved concomitant with the reduction in the muscle enzymes and thyroid stimulant hormone levels into the normal ranges. He was discharged with the recommendation of the NIMV device application during night-time. The clinical symptoms are more severe in the presence of alveolar hypoventilation due to polymyositis and coincidantal hypothyroidism.

Clinical spectrum of rhabdomyolysis presented to pediatric emergency department.

BackgroundRhabdomyolysis is a potentially life-threatening syndrome that can develop from a variety of causes. The aim of the work is to analyze the clinical spectrum and to evaluate the prevalence of various etiologies in children, who present to the emergency department (ED) with rhabdomyolysis.MethodsDuring a 6-year study period, we retrospectively analyzed the medical charts of patients, aged 18 years or younger, with a definite diagnosis of rhabdomyolysis and serum creatinine phosphokinase (CK) levels greater than 1000IU/L. We analyzed the clinical spectrum and evaluated the potential risk factors of acute renal failure (ARF).ResultsThirty-seven patients (mean age = 10.2 ± 5.5 years), including 26 males and 11 females, were enrolled in the study. Two of the most common presented symptoms in these 37 patients were muscle pain and muscle weakness (83.8% and 73%, respectively). Dark urine was reported in only 5.4% of the patients. The leading cause of rhabdomyolysis in the 0- to 9-year age group was presumed infection, and the leading cause in the 10- to 18-year age group was trauma and exercise. The incidence of ARF associated with rhabdomyolysis was 8.1 % and no child needed for renal replacement therapy (RRT). We did not identify any reliable predictors of ARF or need for RRT.ConclusionsThe classic triad of symptoms of rhabdomyolysis includes myalgia, weakness and dark urine are not always presented in children. The cause of rhabdomyolysis in younger age is different from that of teenager group. However, the prognosis of rhabdomyolysis was good with appropriate management.

Acute renal failure due to rhabdomyolysis following dengue viral infection: a case report

IntroductionWith more than one-third of the world’s population living in areas at risk for transmission, dengue fever is a leading cause of illness and death in the tropics and subtropics. Despite the high incidence of dengue fever, rhabdomyolysis leading to acute renal failure is an extremely rare complication of dengue fever. Only a few such cases have been reported in the literature.Case presentationWe describe the case of a 42-year-old, previously healthy Sri Lankan Sinhalese man who developed acute renal failure due to rhabdomyolysis following dengue virus infection. He was transferred to our institution with a five-day history of fever, headache, myalgia, impaired level of consciousness, and reduced urinary output. He was hemodynamically stable and did not have evidence of plasma leakage. His serology for dengue immunoglobulin M and immunoglobulin G was positive, and biochemical investigations disclosed evidence of rhabdomyolysis and acute renal failure. He was treated with induced alkaline diuresis and hemodialysis, and he experienced an uncomplicated recovery.ConclusionThe occurrence of acute renal failure significantly increases the mortality of patients with dengue fever. Therefore, early diagnosis and early management are crucial in rhabdomyolysis complicating dengue fever to prevent established acute renal failure. It should be kept in mind that the threshold for suspecting rhabdomyolysis is very low in dengue fever. Creatinine phosphokinase levels should routinely be measured in all patients with severe dengue fever for early detection of rhabdomyolysis to prevent acute renal failure.

Plasma mitochondrial DNA levels in patients with trauma and severe sepsis: Time course and the association with clinical status

PurposeThis study aimed to investigate the serial changes in plasma levels of mitochondrial DNA (mtDNA) in patients with trauma and severe sepsis and the mechanism of increase in mtDNA levels and the association between the levels and severity. Materials and MethodsWe conducted a prospective observational study of patients with trauma having injuries with an Abbreviated Injury Scale score of 3 or higher (n = 37) and patients with severe sepsis (n = 23). The mtDNA concentrations in clarified plasma were measured using real-time quantitative polymerase chain reaction. ResultsConcentrations of mtDNA peaked on the day of admission (day 1) in patients with trauma, whereas they increased on day 1 and remained constant until day 5 in patients with sepsis. The mtDNA levels on day 1 correlated with the maximal levels of creatinine phosphokinase in patients with trauma (R2 = 0.463, P < .05) but not in patients with sepsis (R2 = 0.028, P = .43). The mtDNA levels on day 1 were significantly higher in nonsurvivors compared with survivors of trauma (P < .05) but not sepsis. ConclusionsThe levels of mtDNA were elevated during traumatic injury and severe sepsis, although time course and prognostic significance differed between the groups, suggesting that the mechanisms of mtDNA release into plasma differ.

Clinical factors in predicting acute renal failure caused by rhabdomyolysis in the ED

PurposeThis study aimed to determine the clinical factors in predicting acute renal failure (ARF) in rhabdomyolysis and investigate the potential risk of renal replacement therapy (RRT). Basic ProceduresFrom 2006 to 2011, we retrospectively analyzed 202 patients 65 years or younger with a definite diagnosis of rhabdomyolysis and serum creatinine phosphokinase levels greater than 1000 IU/L. The related clinical factors were analyzed in the patients with ARF caused by rhabdomyolysis. In addition, receiver operating characteristic curves were used to establish the appropriate cutoff values of serum biomarkers in predicting ARF. Main FindingsThe most common causes of rhabdomyolysis were trauma (n = 54; 26.7%) and infections (n = 37; 18.3%). Of the 202 patients, 29 (14.4%) developed ARF, and RRT was indicated for 5 of these 29 patients. Predictive factors for ARF were dark urine, initial and peak serum myoglobin level, rhabdomyolysis caused by body temperature change, and an elevated serum potassium level. Receiver operating characteristic analysis showed that the best cutoff value of initial serum myoglobin level for predicting ARF was 597.5 ng/mL. Risk factors for RRT in patients with ARF were etiologies of rhabdomyolysis, peak blood urea nitrogen and creatinine levels, and the creatinine phosphokinase level on the third day as rhabdomyolysis developed. Principal ConclusionsAge, dark urine, etiologies, serum levels of blood urea nitrogen, creatinine and potassium, and initial and peak serum myoglobin levels may serve as important factors in predicting ARF in patients with rhabdomyolysis. We suggest that the appropriate cutoff value of initial serum myoglobin for predicting ARF is 600 ng/mL.

Mortality factors in idiopathic inflammatory myopathy: focusing on malignancy and interstitial lung disease

Objectives: The objective of this study was to assess the incidence and common types of concomitant malignancies and to define predictive factors of death in Korean patients with idiopathic inflammatory myopathy (IIM).Methods: From January 1989 to May 2011, 162 patients were diagnosed with IIM at a university hospital in Korea. The medical records were retrospectively reviewed. The clinical findings of the patients were compared for malignancy, and the prognostic factors predicting death were analyzed.Results: Malignancies were found in 17 patients (10.5 %), all of whom had a significantly lower frequency of interstitial lung disease (ILD) and an older age at onset. The main causes of death were ILD and malignancy. Older age at diagnosis, presence of malignancy, rapidly progressive ILD and minimal creatinine phosphokinase (CPK) elevation were independent risk factors for death.Conclusions: Malignancy was one of the most serious risk factor for death in our patients with IIM. Early discovery of malignancy is important, and an extensive investigation for common malignancies in each region should be done at diagnosis and for a minimum of 2 years thereafter. As minimally elevated CPK levels in ILD patients may be associated with fatal ILD, an early evaluation and a more aggressive treatment of ILD should be considered in these patients.

Combination of factor V Leiden and MTHFR mutations in myocardial infarction

Identifying patients who are at high risk of suffering myocardial infarction can be done by determining risk factors or by the adoption of molecular genetic testing for inherited thrombophilia. We report a case of myocardial infarction at a young age. The patient complained of dyspnea (stage III) and a burning pain of severe intensity that radiated to the left retrosternal side, but was not associated with palpitations or diaphoresis. A number of biochemical parameters were normal except for an elevated creatinine phosphokinase (CPK) level. Genetic testing revealed the subject to be heterozygous for both the factor V leiden and MTHFR C677T polymorphisms. The combination of these two mutations may be a high risk factor for myocardial infarction. Genetic screening for inherited thrombophilia in young patients, especially in the presence of a common risk factor, may be useful for primary thromboprophylaxis and in asymptomatic relatives of patients.

COMPARATIVE ANALYSIS OF BIOCHEMICAL PARAMETERS OF MUSCLE TISSUE ALTERATION DEPENDING ON APPROACHES FOR TOTAL HIP ARTHROPLASTY

The results of the comparative analysis of biochemical alterations of muscle tissue in the blood serum of patients who underwent primary total hip replacement. In this study, we consider the data of 75 patients who underwent total hip arthroplasty (75 operations) from November 2010 to April 2012 to analyze the data was divided into 3 groups of patients: the first - using a minimally invasive technique MIS AL (22 operations), the second - with the use of the modified approach Muller (pending on the invention) - (29 operations), and the third - with approach by Hardinge (26 operations). The levels of glutamic oxaloacetic transaminase, creatinine phosphokinase, lactate dehydrogenase, myoglobin, creatinine, and C-reactive proteine in serum were determined preoperatively and at 3, 5, 7, 9 days after surgery. CRP included in the study as an indicator of non-specific inflammation of the tissues. When comparing the biochemical indicators in three types of approaches to the hip joint, the highest increase in GOAT, LDH, CPK, CRP, and myoglobin was detected at surgery approach by Hardinge. The results of this study may indicate a decrease in the degree of tissue trauma during surgery using a minimally-invasive approaches, which is characterized by the retention of attachment to the middle gluteal muscle of the femur.

Administration of tomato juice ameliorates lactate dehydrogenase and creatinine kinase responses to anaerobic training

Creatinine phosphokinase (CPK) and lactate dehydrogenase (LDH) are important biological markers of various myocardial disorders and exercise-induced muscle damage. Lycopene, on the other side, is a natural anti-oxidant with protective action against cardiovascular risk. Fifteen anaerobically trained athletes with elevated LDH and CPK baseline levels were enrolled in this study after undergoing thorough biochemical and cardiovascular evaluation with echocardiocraphy. In nine athletes tomato juice, a lycopene plain juice, was administered during and after exercise, replacing the carbohydrate supplementation beverages commonly used during training for over a 2-month period. Tomato juice administration significantly reduced LDH and CPK levels, which returned back to almost normal levels. At the same time homocysteine and C-reactive protein were also attenuated. No changes were observed in the control group, where the usual carbohydrate supplementation had been followed.

Mediterranean Diet and Red Yeast Rice Supplementation for the Management of Hyperlipidemia in Statin-Intolerant Patients with or without Type 2 Diabetes

Lipid profile could be modified by Mediterranean diet (MD) and by red yeast rice (RYR). We assessed the lipid-lowering effects of MD alone or in combination with RYR on dyslipidemic statin-intolerant subjects, with or without type 2 diabetes, for 24 weeks. We evaluated the low-density lipoprotein (LDL) cholesterol level, total cholesterol (TC), high-density lipoprotein (HDL) cholesterol, triglyceride, liver enzyme, and creatinine phosphokinase (CPK) levels. We studied 171 patients: 46 type 2 diabetic patients treated with MD alone (Group 1), 44 type 2 diabetic patients treated with MD associated with RYR (Group 2), 38 dyslipidemic patients treated with MD alone (Group 3), and 43 dyslipidemic patients treated with MD plus RYR (Group 4). The mean percentage changes in LDL cholesterol from the baseline were −7.34 ± 3.14% (P < 0.05) for Group 1; −21.02 ± 1.63% (P < 0.001) for Group 2; −12.47 ± 1.75% (P < 0.001) for Group 3; and −22 ± 2.19% (P < 0.001) for Group 4 with significant intergroup difference (Group 1 versus Group 2, P < 0.001; Group 3 versus Group 4, P > 0.05). No significant increase in AST, ALT, and CPK levels was observed in all groups. Our results indicate that MD alone is effective in reducing LDL cholesterol levels in statin-intolerant patients with a presumably low cardiovascular risk, but associating MD with the administration of RYR improves patients' LDL cholesterol levels more, and in patients with type 2 diabetes.