Serum Creatine Phosphokinase Levels Research Articles

Posterior versus lateral surgical approach: functionality and quality of life after total hip arthroplasty in a matched cohort study

BackgroundOne of the most controversial aspects for maximizing outcomes after total hip arthroplasty (THA) remains the surgical approach to the hip joint. The posterior (PA) and lateral approaches (LA) are the two most commonly performed approaches used worldwide, but sparse data are available for their comparison in terms of health-related quality-of-life (HRQoL). The aim of this study was to assess the role of the PA and LA in the HRQoL and hip functionality of patients who underwent primary and elective THA for osteoarthritis, after a minimum 2-year follow-up.MethodsOne hundred twenty-eight patients (140 THAs: 68 with PA and 72 with LA) were evaluated in a matched cohort study. Data gathered included the body mass index, the American Society of Anesthesiologists score, surgery time, serum creatine phosphokinase (CpK) levels, estimated intraoperative blood loss and intra- or postoperative complications. Preoperatively and at the last follow-up, the activities of daily living, and the instrumental activities of daily living (IADL) scales, the Western Ontario and Mac Master University (WOMAC) Questionnaire, the Harris Hip Score (HHS) and the Visual Analogue Scale (VAS) were used to assess HRQoL and functionality. The Short Form-36 Health Survey (SF-36) Questionnaire was administered at the last follow-up.ResultsPostoperatively, CpK was higher in the LA group compared to the PA (695 ± 648 vs. 447 ± 326 UI/L, p < 0.001). At a mean follow-up of 47 ± 22 months for the LA group and 42 ± 29 months for the PA group, IADL, VAS, HHS and WOMAC scores significantly improved for both groups (all p < 0.001), but PA reported better VAS, residual pain and WOMAC scores (p = 0.002, p = 0.004 and p = 0.018, respectively). The PA group demonstrated a significant higher mental SF-36 subscale values than the LA group (49 ± 13 vs. 42 ± 19, p = 0.001). The LA group showed a higher number of Trendelenburg signs (p = 0.029). On the contrary, the PA group showed a higher number of leg lengthening (p = 0.020); however, most of these cases was less than the clinically significant value of 10 mm (p = 0.738).ConclusionsPatients who underwent THA performed with the PA reported greater improvement in HRQoL with lower residual pain, postoperative muscle damage and Trendelenburg signs than those who underwent the LA.

Estimation of Serum Creatine Phosphokinase and Serum Lactate Dehydrogenase Levels in Oral Leukoplakia and Oral Cancers – A Clinicopathological Study

Aims: Evaluation of total serum creatine phosphokinase and serum lactate dehydrogenase levels as a biochemical parameter in the diagnosis of oral cancer, oral leukoplakia by the case-control method. Settings and Design: A hospital-based, case-control study was conducted at the Department of Oral Medicine, Diagnosis, and Radiology. Materials and Methods: The study included clinically and histopathologically diagnosed oral leukoplakia and oral cancers with 20 patients in each group. The control group consisted of 20 healthy patients without lesions or tobacco-related habits or any systemic diseases. The blood samples were collected from the study and control groups, centrifuged, and serum was analyzed for serum creatine phosphokinase and serum lactate dehydrogenase (CK and LDH) levels using an autoanalyzer. Statistical Analysis: Comparison of three groups with respect to each biochemical parameter was done by one-way ANOVA. Comparison between the groups was done by Tukey's multiple post hoc test. Results: It was found that total serum CK levels were statistically significantly decreased in both oral leukoplakia and oral cancer when compared with that of the control group. Total serum LDH levels were statistically significantly increased in both oral leukoplakia and oral cancer when compared with that of the control group. Conclusion: Although the results of the present study showed increased levels of LDH in both oral leukoplakia and oral cancer, and CK levels statistically decreased but they were within normal limits. Further. studies with a greater number of samples, different grades of epithelial dysplasias, and assessment of individual isoenzymes has to be carried out to evaluate the exact role of CK and LDH in the etiopathogenesis of oral cancer.

A novel mutation in ACADVL causing very long-chain acyl-coenzyme-A dehydrogenase deficiency in a South Asian pediatric patient: a case report and review of the literature

BackgroundVery long-chain acyl-coenzyme-A dehydrogenase deficiency is a rare, severe life-threatening metabolic disorder of mitochondrial fatty acid oxidation, caused by mutations in ACADVL gene. Here we present a genetically confirmed case of a South Asian baby girl with severe, early-onset form of very long-chain acyl-coenzyme-A dehydrogenase deficiency due to a novel mutation in ACADVL gene.Case presentationIndex case was the second baby girl of second-degree consanguineous South Asian parents. She had an uncomplicated antenatal period and was born by spontaneous vaginal delivery at term with a birth weight of 2910 g. She had been noted to have fair skin complexion, hypotonia, and 3 cm firm hepatomegaly. Since birth, the baby developed grunting, poor feeding, and recurrent episodes of symptomatic hypoglycemia and convulsions with multiple semiology. Her septic screening and urine ketone bodies were negative. The baby had high anion gap metabolic acidosis and elevated transaminases and serum creatine phosphokinase levels. Echocardiogram at 4 months revealed bilateral ventricular hypertrophy. Acylcarnitine profile revealed elevated concentrations of tetradecanoylcarnitine (C14), tetradecanoylcarnitine C14:1, and C14:1/C16. Unfortunately, the baby died due to intercurrent respiratory illness at 4 months of age. Sequence analysis of ACADVL gene in perimortem blood sample revealed homozygous frame shift novel variant NM_001270447.1, c.711_712del p.(Phe237Leufs*38), which confirmed the diagnosis of very long-chain acyl-coenzyme-A dehydrogenase deficiency.ConclusionsThis case demonstrates the importance of early diagnosis and management of very long-chain acyl-coenzyme-A dehydrogenase deficiency in improving the outcome of the patients. Implementation of newborn screening using tandem mass spectrometry in Sri Lanka will be beneficial to reduce the morbidity and mortality of treatable disorders of inborn errors.

Endogenous dipeptide-carnosine supplementation ameliorates hypobaric hypoxia-induced skeletal muscle loss via attenuating endoplasmic reticulum stress response and maintaining proteostasis.

High altitude is an environmental stress that is accompanied with numerous adverse biological responses, including skeletal muscle weakness and muscle protein loss. Skeletal muscle wasting is an important clinical problem, progressing to critical illness, associated with increased morbidity and mortality. The present study explores the protective efficacy of endogenous dipeptide, carnosine (CAR), supplementation in ameliorating skeletal muscle protein loss under hypobaric hypoxia (HH). Male Sprague-Dawley rats (n=5) were randomly divided into control group, HH-exposed group (3 days HH exposure equivalent to 7,620 m), and HH-exposed rats supplemented with carnosine (3 days; 150 mg/kg b.w, orally) (HH + CAR). HH-exposed rats supplemented with CAR ameliorated HH-induced oxidative protein damage, lipid peroxidation, and maintained pro-inflammatory cytokines levels. HH-associated muscle protein degradative pathways, including calpain, ubiquitination, endoplasmic reticulum stress, autophagy, and apoptosis were also regulated in carnosine-supplemented rats. Further, the muscle damage marker, the levels of serum creatine phosphokinase were also reduced in HH + CAR co-supplemented rats which proved the protective efficacy of CAR against hypobaric hypoxia-induced muscle protein loss. Altogether, CAR supplementation ameliorated HH-induced skeletal muscle protein loss via performing multifaceted ways, mainly by maintaining redox homeostasis and proteostasis in skeletal muscle.

Characterization of Patients With Dermatomyositis According to Anti-Melanoma Differentiation-Associated Gene-5 Autoantibodies in Centers from 3 Latin American Countries: A Cohort Study.

The anti-melanoma differentiation-associated protein 5 (MDA5) autoantibodies have been associated with a high frequency of interstitial lung disease (ILD) and rapidly progressive ILD (RP-ILD) in dermatomyositis (DM) patients, mainly in Asian subjects. However, there is scarce information about these parameters in Latin American patients. This was a medical records review cohort study that included classic DM (CDM) and clinically amyopathic DM (CADM) patients from 3 Latin American countries (Argentina, Brazil, and Mexico). A total of 270 DM patients were evaluated: 25.9% with CADM and 74.1% with CDM. The overall prevalence of ILD and RP-ILD, respectively, was 70 (25.9%) and 4 (1.5%) of the 270 patients, and the distributions were comparable between patients with CDM and CADM. The anti-MDA5 was present in 31 (25.4%) of 122 CDM patients and in 17 (48.6%) of 35 CADM patients; it was not associated with presence of ILD and RP-ILD. However, anti-MDA5-positive CDM patients had significantly high frequency of "mechanic's hands," arthralgia, arthritis, and lower serum levels of creatine phosphokinase, whereas anti-MDA5-positive CADM patients had significantly high frequency of arthritis. Pulmonary infection and ILD are main causes of death in DM patients. In the present study, the prevalence of ILD in DM patients is comparable to that described in the literature, in contrast to the very low frequency of RP-ILD. In addition, the anti-MDA5 is not associated with ILD and RP-ILD, but anti-MDA5-positive DM patients present conditions that mimic antisynthetase syndrome. Pulmonary infection and ILD were the main causes of death in our sample.

Effect of tourniquet on skeletal muscle ischaemia and return of function: A prospective randomized clinical study

Objectives: The purpose of this prospective randomized trial was to examine the effect of tourniquet use on skeletal muscle damage and return of function after closed tibial interlocking nail. Methodology: 74 patients who underwent closed tibial nailing were randomly allocated to the use of an inflated pneumatic tourniquet (group 1, n =37) or no tourniquet (group 2, n =37). Patients with Compound tibia fractures; Compartment syndrome; Multiple fractures; Polytrauma and infection were excluded. The primary outcome measures were pain, measured with a visual analog scale (VAS), return of activity measured by ability to do SLR(Straight Leg Raising) postoperatively and serum creatine phosphokinase (CPK) levels monitored preoperatively and 24 hours postoperatively. Results: The 2 groups did not differ in baseline demographics. Mean duration of surgery was similar in both groups. There was threefold increase in mean CPK in group1when the duration of surgery is < 90 minutes and fivefold increase when duration exceeded 90 minutes, but only 2 times increase of CPK in group2 which was not affected by the duration of surgery. The difference in the mean scores between the two groups was statistically significant from 2nd to 4th postoperative day (P-value < 0.05). The mean days to regain SLR in patients with duration of surgery more than 90 minutes were significantly higher than that of mean scores in patients with duration of surgery less than 90 min in group1 only. Conclusions: It is much safer not to use tourniquet where surgery is going to be prolonged than 90 minutes. Early postoperative pain is lesser and return of function is faster in patients who were operated without a tourniquet as compared to patients with prolonged surgery with tourniquet.

A Rare Complication of Rhabdomyolysis: Peripheral Neuropathy

Rhabdomyolysis is a complex medical condition characterized by muscle necrosis and the release of intracellular components into the circulation. Although its most common cause is a direct traumatic injury, it can result from non-traumatic factors as well, including infection, toxins, and drugs. Serum creatine phosphokinase (CPK) levels are usually elevated in this condition and they correlate with the severity of the muscle damage (the higher the CPK peak, the greater the magnitude of muscle damage), although lower levels of CPK do not necessarily rule it out. The common complications associated with rhabdomyolysis include acute kidney injury, compartment syndrome, and, in rare cases, peripheral neuropathy. In this report, we present a case of a young patient, with a history of alcohol abuse, who presented with bilateral numbness of the feet post-immobilization and was subsequently found to have severe rhabdomyolysis.

Effect of oral isotretinoin on muscle strength in patients with acne vulgaris: a prospective controlled study

BackgroundMusculoskeletal side effects related to isotretinoin are frequently reported. This study aimed to investigate the effect of oral isotretinoin treatment on muscle strength. Our second aim was to evaluate whether there was a correlation between the serum creatine phosphokinase (CPK) level, a specific marker of muscle breakdown, and muscle strength.MethodsThis study included 30 patients who presented to our hospital and were started on oral isotretinoin treatment for acne vulgaris and 30 patients in the control group who were given local treatment. Age, sex, height and weight of the patients were recorded, and the body mass index (BMI) was calculated. The hamstring and quadriceps muscle strengths of the non-dominant side were evaluated in all patients using an isokinetic dynamometer, and the peak torque (PT) values ​​were recorded. In the isotretinoin group, isokinetic measurements were performed again in those that completed six-month drug treatment and compared with the initial PT values.ResultsThe two groups were similar in terms of age, sex, and BMI (p > 0.05). There was no significant difference between the isotretinoin and control groups in terms of muscle strength at the beginning of the treatment (p > 0.05). No significant change was observed in hamstring and quadriceps PT values in the isotretinoin group after 6 months of treatment compared to baseline (p > 0.05). No statistically significant correlation was found between the serum CPK level and hamstring and quadriceps muscle strength (p > 0.05).ConclusionOral isotretinoin doesn’t alter muscle strength. There is no relationship between the serum CPK levels and muscle strength.

Reappraisal of the incidence, various types and risk factors of malignancies in patients with dermatomyositis and polymyositis in Taiwan

Our study aimed to investigate the incidence, risk factors and time to occurrence of malignancy in patients with dermatomyositis (DM) and polymyositis (PM). The electronic medical records of 1100 patients with DM and 1164 patients with PM were studied between January 2001 and May 2019. Malignancies after myositis were diagnosed in 61 (5.55%) patients with DM and 38 (3.26%) patients with PM. The cumulative incidence of malignancies in patients with DM were significantly higher than patients with PM (hazard ratio = 1.78, log-rank p = 0.004). Patients with DM had a greater risk of developing malignancy than those with PM at 40–59 years old (p = 0.01). Most malignancies occurred within 1 year after the initial diagnosis of DM (n = 35; 57.38%). Nasopharyngeal cancer (NPC) was the most common type of malignancy in patients with DM (22.95%), followed by lung, and breast cancers. In patients with PM, colorectal, lung and hepatic malignancies were the top three types of malignancy. The risk factors for malignancy included old age (≥ 45 years old) and low serum levels of creatine phosphokinase (CPK) for patients with DM and male sex and low serum levels of CPK for patients with PM. Low serum levels of CPK in patients with myositis with malignancy represented a low degree of muscle destruction/inflammation, which might be attributed to activation of the PD-L1 pathway by tumor cells, thus inducing T-cell dysfunction mediating immune responses in myofibers. A treatment and follow-up algorithm should explore the occurrence of malignancy in different tissues and organs and suggested annual follow-ups for at least 5.5 years to cover the 80% cumulative incidence of malignancy in patients with DM and PM.

A CASE REPORT ON THE MANAGEMENT OF DUCHENNE’S MUSCULAR DYSTROPHY (DMD) WITH MATRA BASTI

Duchenne’s Muscular Dystrophy (DMD) is the most common x-linked disorder in children presenting in early childhood due to recessive mutation of the dystrophin gene. It is characterized by progressive weak-ness in hip and shoulder girdle muscles beginning by age 5. Although there is no absolute cure for DMD, therapies can delay the onset or slow down the progression of disease. Survival beyond the age of 30 years is rare due to the severe chronic complication involving multiple systems. Serum Creatine Phosphokinase (CPK) level determination is the most specific objective parameter for the diagnosis and assessment of se-verity of Muscular Dystrophy (MD). Based on the presentation of DMD, it can be diagnosed as Mamsavru-ta Vatal leading to Mamsa Dhatu Upashoshana which is the consequence of Beejabhagavikruti. There will be continuous destruction of Dhatu leading to Vataprakopa again. Hence, the line of management is con-trolling the Vata and preventing the destruction. The best treatment for it which has this dual action is Mat-ra Basti. With this basic concept, a male child of 10 years diagnosed as Mamsavruta Vata was treated with Matra Basti using Dhanwantara Taila 10 ml/day for about 9 months. As there was associated Sama Do-shavastha, Agnichikitsa Lepa was advised for 7 days initially. The treatment showed significant reduction in the level of CPK tested before and after the treatment. Hence, the treatment protocol followed can be taken up for further research and can prove with evidence that, it can be effectively practiced in the man-agement of DMD. The long-term benefit, improvement in disease, quality of life can be accessed through the research with long term follow-ups.

An Analytical Study about Serum Creatine Phosphokinase as Predictor and Marker of Severity in Organophosphorus Poisoning

Introduction: Organophosphorus (OP) toxicity is an important global health problem, especially in many developing countries because of their widespread use and easy accessibility. The objectives of our study were to measure serial serum creatine phosphokinase (CPK) levels, to correlate CPK levels with severity of poisoning, and to record the total dose of atropine required. Methods: This was a retrospective and analytical study. One hundred patients of either sex, having age &gt;14 years, presented within 12 h of ingestion or inhalation of OP. It was observed that confirmation of OP poisoning was done by seeing the packet/container with clinical presentation. Clinical severity was categorized according to Peradeniya organophosphorus poisoning (POP) scale. Results: The severity of the poisoning increased in respect to POP score, the serum CPK levels, and total dose of atropine required for treatment also increased. The difference in serial CPK levels in patients without intermediate syndrome (IMS) and with IMS, it was observed that the difference in CPK between these patients was highly significant at baseline and 48 h. There was an increase in CPK levels at admission and 48 h, but reduced by 96 h. A weak positive correlation was observed between POP score and CPK levels, as well as CPK, and atropine dose. A negative correlation was observed between butyrylcholinesterase and CPK levels. Conclusion: In our opinion, these observations suggest that there is a direct relation between serum CPK levels and IMS. Hence, it is necessary for estimating CPK levels, especially after 48 h, in moderate-to-severe poisoning patients so that IMS can be recognized at the earliest and patients can be referred to higher centers for immediate management of respiratory failure, reducing morbidity and mortality.

Paracetamol use and lowered risk of acute kidney injury in patients with rhabdomyolysis.

Mortality with rhabdomyolysis-associated acute kidney injury can be as high as 80%. Experimental data from mouse models of rhabdomyolysis showed that paracetamol reduces the expected increase in serum creatinine level. We aimed to assess the association between paracetamol use and the need for starting renal replacement therapy (RRT). We conducted a propensity score-matched cohort study in Orléans Hospital, France (a 1136-bed, public, university-affiliated and teaching hospital). All patients with serum creatine phosphokinase (CK) level > 5000IU/L between January 1st, 2008 and December 31st, 2017 were included. A propensity score was calculated for each included patient by using multivariable logistic regression and all available baseline characteristics. The main outcome was the incidence of RRT initiation from day 1 to day 28 in the propensity score-matched cohort between patients exposed and unexposed to paracetamol. Over the study period, 1065 patients with at least one CK level measurement > 5000IU/L were included; 40 (3.8%) had at least one RRT session. Among the 343 matched pairs, 10 (2.9%) exposed and 24 (7.0%) unexposed patients underwent RRT before day 28 (P = 0.021). Primary time-to-event analysis showed that exposure to paracetamol was significantly associated with reduced absolute risk of RRT: absolute risk difference = - 3.18% (95% CI - 5.23 to - 1.20, P = 0.001). All secondary analyses showed a significantly reduced absolute risk of RRT in patients exposed to paracetamol. Our study showed a significant association between paracetamol exposure and reduced incidence of RRT among patients with rhabdomyolysis.

Study of relationship between serum creatine phosphokinase levels with severity of alcohol withdrawal

Background: Alcohol withdrawal syndrome is a potentially life-threatening condition with severe complications such as withdrawal seizures and delirium tremens. A valid and reliable biomarker for predicting the severity of alcohol withdrawal can be instrumental in individualizing effective therapy at the earliest.Methodology: This was an observational study done on 120 patients to study the relationship between serum creatine phosphokinase (CPK) levels with severity of alcohol withdrawal. The assessment for the severity of alcohol withdrawal was done with Clinical Institute Withdrawal Assessment for Alcohol-revised (CIWA-Ar) scale and an association was studied between the serum CPK levels and the severity of alcohol withdrawal. The data was analyzed using Chi-square test and Kruskal–Wallis tests.Results: The severity of alcohol withdrawal as per the CIWA was 26.66% mild, 55% moderate, and 18.33% severe. The mean serum CPK level for mild withdrawal was 126.93 IU/L, moderate withdrawal was 303.66 IU/L, and for severe withdrawal was 780.81 IU/L. A statistically significant association was obtained indicating that patients with higher CIWA-Ar scores are likely to have a higher level of serum CPK levels.Conclusion: Serum CPK levels were significantly associated with severity of alcohol withdrawal and can possibly serve as a candidate biomarker.

Markers of muscle damage and strength performance in professional football (soccer) players during the competitive period.

BackgroundThe present study investigated the impact of competitive soccer on the short-term changes in isometric strength of the adductor muscle group during the competitive season.MethodsIn this cohort study we evaluated the association between a serum marker of muscle damage [creatine phosphokinase (CPK)] and isometric strength of the adductor muscles of the hip in 30 professional football players (age: 26.7±2.9 years) during two seasons of the national top-level championship. Serum CPK level was determined the day before the match, 12–20, 36–48, 60–72 h after the match. The maximum voluntary isometric contraction force of the adductor muscles complex was determined immediately after having taken blood samples.ResultsThere was evidence of a statistically significant positive association between age, body mass index (BMI), percentage of body fat, and muscle strength, and between weight and muscle strength. There was evidence of a statistically significant negative association between the level of CPK and the maximum isometric strength of the adductors of soccer players. Changes in CPK levels were associated with the muscle strength recovery trend (P<0.001). The strength/CPK ratio at different time points had a U-shaped curve.ConclusionsExercise induced muscle damage significantly affects the strength of the adductor muscle group of professional soccer players during the competitive period. The lower the CPK level, the greater the athletes' strength at a given time point. Also, the greater the decrease in CPK level, the greater the rate of strength restoration.

Subchronic safety evaluation of hot-water extract from thinned immature mangos (Mangifera indica 'Irwin'): 90-days oral toxicity study in rats.

Thinned immature fruit of the mango tree (Mangifera indica 'Irwin') are handled as waste. In this study, we conducted a 90-days toxicity study in male and female Sprague Dawley rats to evaluate the safety of a hot-water extract of thinned immature mango fruits (TIMEx) administered by oral gavage at doses of 500, 1000 and 2500 mg/kg body weight/day. Treatment did not result in death or changes in the behavior or external appearance of the animals. No alterations were observed in hematological or serum chemical parameters, urinalysis, food consumption, body weight gain or organ weights at the end of the treatment period, with the exception of higher mean corpuscular volume in male rats that received high doses and lower serum creatine phosphokinase levels in female rats that received medium doses. Under the conditions of this study and based on the toxicological endpoints evaluated, the no-observed-adverse-effect level (NOAEL) for TIMEx was 2500 mg/kg/day. The findings indicate that TIMEx is safe for consumption and should be investigated as a candidate food.

Azathioprine Hypersensitivity Syndrome in an Asian Woman

Azathioprine Hypersensitivity Syndrome in an Asian Woman

Clinical and epidemiological descriptions from trichinellosis outbreaks in Bulgaria

Bulgaria is one of European countries where trichinellosis continues to be regularly diagnosed and registered. The clinical and epidemiological features of 72 cases of trichinellosis associated with five outbreaks caused by Trichinella spiralis and Trichinella britovi between 2009 and 2011, are described. At hospital admission, patients were often initially treated with antibiotics, without any improvement. A range of signs and symptoms were recorded, including: myalgia, elevated temperature, arthralgia, difficulty with movement, facial oedema, conjunctival hyperaemia, ocular haemorrhages, diarrhoea, skin rash, headache, and fatigue. Due to the variable clinical course of the disease, the diagnostic process for trichinellosis is often complex and difficult. This means the diagnosis may be established late for an appropriate treatment, potentially leading to a severe course of the disease with complications. Laboratory abnormalities were expressed by marked eosinophilia (97.2%), leucocytosis (70.8%), elevated serum creatine phosphokinase levels (82%), and antibody-positive results by ELISA and indirect hemagglutination. Patients were treated with albendazole (Zentel) 10 mg/kg for 7–10 days.In two outbreaks, the aetiological agent was T. spiralis, in one outbreak T. britovi, and an unknown Trichinella species in the fourth outbreak. The sources of infection were domestic pigs, probably fed with scraps and offal of wild game. In one outbreak, T. spiralis was also detected in brown rats trapped close to where the pig had been raised in the backyard. These epidemiological factors are relevant in considering implementation of targeted control programmes.

Clinical significance of serum levels of anti-transcriptional intermediary factor 1-γ antibody in patients with dermatomyositis.

Dermatomyositis (DM) is an autoimmune inflammatory disease characterized by skin eruptions and myositis. Anti-transcriptional intermediary factor 1-γ antibody (anti-TIF1-γ Ab) is one of the most frequently detected myositis-specific autoantibodiesand adults positive for anti-TIF1-γ have markedly higher rates of malignancy. Our aim was to determine the clinical associations of anti-TIF1-γ levels in 31 Japanese adult DM patients positive for anti-TIF1-γ. We determined associations between the anti-TIF1-γ index and patient characteristics and disease severities. Sixteen patients with anti-TIF1-γ Ab had concomitant malignancies. A mild positive correlation was found between the levels of serum creatine phosphokinase at the first visit and anti-TIF1-γ levels. In contrast, there was no significant difference in the anti-TIF1-γ Ab index between patients with and without malignancy. Dysphagia tended to be observed in patients with malignancy. On sequential analysis, anti-TIF1-γ levels in patients without malignancy were lower or turned negative after treatment for DM. Ab titers tended to be sustained in patients with stage IV malignancies. Interestingly, a re-increase in the Ab titer was observed on recurrence of malignancy or increase in DM activity. Four patients were completely cured of their malignancies, and anti-TIF1-γ levels in three patients turned negative with the loss of DM activity. These data suggest that higher anti-TIF1-γ titers may not directly indicate the presence of malignancy. Nevertheless, longitudinal changes in the anti-TIF1-γ index in individual patients may partially reflect activities of both DM and malignancy.

Eventual role of myocardial muscular in the pathogenesis of acute coronary syndrome

Aim of the study was to investigate the role of myocardial muscular «bridges» (MMB) in the pathogenesis of acute coronary syndrome (ACS). Material and methods. The study comprised of 27 patents with ACS: 21 (77,8 %) with diagnosed unstable angina pectoris (UA) and 6 (22,2 %) with acute anterior myocardial infarction with ST elevation (STEMI). Results. All patients with STEMI had positive qualitative troponin test. The serum level of creatine phosphokinase (CPK) was 857.7 ± 495.5 U/l, the CPK MB level was 46.5 ± 42.4 U/l. The patients’ age varied from 32 to 68 years (on average, 52.4 ± 4.6 years). Selective coronary angiography (CAG) revealed systolic functional obstruction of the LAD with vessel’s lumen recovery to the norm during diastole in all 27 patients, which is typical for MMB. In all cases with UA, the clinical aggravation was associated with ECG signs of transitory or permanent myocardial hypoxia in the territory supplied by the LAD, while the patients with STEMI had ECG, biochemical and EchoCG signs of myocardial damage and kinetics disturbances in the left ventricular areas supplied by the LAD. All patients underwent intravascular instrumental investigation. During in-hospital stage all patients received conservative therapy including β-adrenergic receptors or CA-channels blockers; ACE inhibitors; disaggregants. Upon 12 months all patients underwent repeated outpatient examination. In all cases, the conducted therapy resulted in the improvement of the patients’ condition. Conclusion. This study allows concluding that MMB play an essential role in the pathogenesis of ACS, including STEMI.

Study of the Clinical, Electrocardiographic and Biochemical Spectrum of Cardiovascular Complications in Patients With Aneurysmal Subarachnoid Hemorrhage − An Initial Experience at a Tertiary Centre in India

Objectives: Aneurysmal subarachnoid hemorrhage (SAH) is an extremely fatal condition with mortality as high as 45%. Apart from the intra-cranial causes, there are cardiovascular events, which add to the morbidity and mortality. These can manifest with deranged cardiac biomarkers. However, quantitative assessment of these biochemical markers and its correlation with prognosis has not been adequately studied. We tried to analyse the spectrum and outcome of cardiovascular complications in patients with aneurysmal SAH and whether elevated levels of serum biochemical markers have any association with the prognosis. Study Design: Prospective observational study. Materials and Method: We included patients of all grades of aneurysmal SAH with ictus less than 48 hours at the time of admission. The patient’s serum biochemical marker levels [troponin T (TnT), total creatine phosphokinase (CPK), cardiac-specific creatine phosphokinase (CPK − MB), brain natriuretic peptide (BNP) and C reactive protein (CRP)] were measured for 6 consecutive days from the day of admission (Day 0). Patient also underwent 12 lead Electrocardiography (ECG) and two dimensional echocardiography (2D Echo) on Day 0, Day 1 and Day 5. Statistical Analysis: Data analysis was performed by using Statistical Package for Social Sciences (SPSS) version 20:0. Chi-square test and Fisher’s exact test were used to find the association between diagnosis and various data variables associated with diagnosis. P value less than 0.05 was considered as significant. Data was graphically depicted with the help of box plots. Receiver Operating Characteristic (ROC) curves were plotted for TnT, CPK and BNP. Results: Twenty five patients were enrolled in the study. Out of the five serum biochemical markers studied, TnT, CPK and BNP were statistically associated with outcome. Serum TnT levels on day 4; serum CPK levels on day 3 and day 4; and serum BNP levels on day 3, day 4 and day 5 were statistically significant. BNP was the serum biochemical marker which had the strongest statistical association with outcome. ECG abnormalities were observed in 76% of the cases. Prolonged corrected QT (QTc) interval was the most common abnormal ECG finding among the patients who died. One patient developed 3rd degree heart block and another patient developed left ventricular dysfunction with an ejection fraction of 40% on 2D Echo following aneurysmal SAH. Conclusion: Cardiovascular complications are common in patients with aneurysmal SAH. Serum quantitative levels of TnT, CPK and BNP can be incorporated in the battery of routine blood tests in SAH patients for predicting outcome.