Presence Of Myalgia Research Articles

Determination of Liver Function Tests and Liver Ultrasonographic Findings in Patients with Leptospirosis in a Tertiary Hospital.

Leptospirosis is an important zoonotic disease commonly found in tropical or sub-tropical countries. The most severe form is Weil's syndrome which presents with jaundice, renal failure, and bleeding diatheses. Although jaundice occurs in 38% of patients with leptospirosis, no studies in Asia have focused on the liver biochemical profile of these patients. Characterization of liver biochemical profile and ultrasonographic findings may shed more light on the disease process. Identification of liver biochemical parameters that portend a poor prognosis may also allow for early aggressive intervention. To describe the liver biochemical profile and liver ultrasonographic findings in adult patients with laboratory-confirmed leptospirosis, admitted at a tertiary hospital in Manila, Philippines. The association of clinical and laboratory features with clinical outcomes (i.e., severe liver injury, Weil's syndrome, and mortality) was also investigated. This retrospective cross-sectional study reviewed all available cases of adult patients with laboratory-confirmed leptospirosis admitted in the Philippine General Hospital from January 2009 to August 2018. The clinical features, liver biochemical profiles, and ultrasound findings were recorded and analyzed. Comparison between the means of each group based on clinical outcome (i.e., mortality, Weil's syndrome) was done via Students' t-test for continuous variables, and calculation of the Odds Ratio for categorical variables. Total and direct bilirubin levels were elevated in patients with leptospirosis compared to serum amino-transferases and alkaline phosphatase levels which were only mildly elevated. Abdominal ultrasound showed typically un-enlarged livers with normal parenchymal echogenicity, normal spleens, and non-dilated biliary trees. Dyspnea was associated with an increased odds for mortality. Although jaundice was present in 39.5% of patients and significantly associated with severe liver injury, this was not associated with mortality. Liver biochemical test values did not differ among patients who expired and those who survived to discharge. The presence of myalgia and abdominal pain increased the odds for Weil's syndrome. To date, no local studies have fully described the liver biochemical profile of patients with leptospirosis. Our findings are compatible with previous studies showing that leptospirosis typically presents with predominantly elevated direct bilirubin from cholestasis and systemic infection. Contrary to previous literature, however, our study found no association between jaundice and mortality.

Serological response to COVID-19 pneumonia and increasing severity over 18months in a prospective cohort of hospitalized patients.

In this study, we present an 18-month serological follow-up of 294 patients with COVID-19 pneumonia. The aim was to assess the dynamics of serological response and its correlation with clinical worsening, as well as to describe clinical worsening determinants. Results of the study showed an early immunoglobulin M response, which clearly diminished starting at 4months, but nonetheless, a small group of patients remained positive. As for immunoglobulin G, levels were higher up to 6months in patients who presented clinical worsening during hospitalization. High titers of the immunoglobulin were maintained in all patients during follow-up, which would indicate that humoral immunity due to infection is long-lasting. Male sex, presence of myalgias and extensive radiological affectation were significantly correlated with clinical worsening.

Exploring the trajectory curve of long-term musculoskeletal post-COVID pain symptoms in hospitalized COVID-19 survivors: a multicenter study.

This multicenter cohort study investigated the prevalence of musculoskeletal post-COVID pain during the first year after the infection with mosaic plots and an exponential bar plot model and its associated risk factors. Patients hospitalized because of COVID-19 in 5 hospitals of Madrid (Spain) were scheduled for a telephone interview at 2 follow-up periods after hospitalization for collecting data about musculoskeletal post-COVID pain. Hospitalization and clinical data were collected from hospital medical records. From 2000 patients initially recruited, 1593 (44.6% women, age: 61 ± 15 years) were assessed at T0 (hospital admission), T1 (mean: 8.0 ± 1.5 months after discharge), and T2 (mean: 13.2 ± 1.5 months after discharge). The prevalence of musculoskeletal pain (myalgia) was 30.3% (n = 483) at T0, increased to 43.4% (n = 692) at T1, and decreased to 37.8% (n = 603) at T2. The trajectory curve revealed a decreasing prevalence trend of musculoskeletal post-COVID pain the following years after hospitalization. According to the presence of pre-existing pain symptoms, the prevalence of new-onset post-COVID pain was 75.9%. Female sex (odds ratio [OR] 1.593, 95% confidence interval [CI] 1.148-2.211), history of musculoskeletal pain (OR 1.591, 95% CI 1.211-2.07), the presence of myalgia (OR 1.371, 95% CI 1.032-1.821) or headache (OR 2.278, 95% CI 1.622-3.199) at hospitalization, the days of hospitalization (OR 1.013, 95% CI 1.000-1.025), and the presence of post-COVID pain at T1 (OR 11.02, 95% CI 8.493-14.305) were factors associated with musculoskeletal post-COVID pain 1 year after hospitalization. In conclusion, musculoskeletal post-COVID pain remains highly prevalent 1 year after hospitalization. Female sex, previous history of pain symptoms, pain symptoms at onset, and days at hospital were factors associated with musculoskeletal post-COVID pain 1 year after hospitalization.

The confocal microscopy of the cornea in post-COVID syndrome; the clinical observation

One of the most important complications of the post-COVID-19 syndrome may be a small fiber neuropathy, which cannot be evaluated by a routine electroneuromyography. Confocal microscopy of the cornea (CCM) may be a promising method for early neuropathy verification. To study the possibility of the small fiber neuropathy evaluation using the CCM in a patient with the post-COVID-19 condition. The patient is a female of 61 years old, which suffered from a COVID-19 infection in October 2020. After a month, she noted the presence of myalgia and polyneuropathy. A year after the onset of the disease, in addition to myalgia, headaches, neuropathy pain, the patient also experienced bowel disorders and stomach aches, which cannot be explained with an alternative diagnosis. The patient underwent CCM to assess the structure of nerve fibers to prove the presence of the small fiber neuropathy as a complication of the COVID-19 infection. The presence of the small fiber neuropathy was evaluated in the patient as well as enlarged Langerhans cells in the cornea. Considering the pivotal role of these cells in the immunological processes, the "activated" dendritic cells in post-COVID-19 patients may serve as another evidence of the autoimmune nature of this complication and possibly, a method for the monitoring treatment effectiveness of this disease. In this clinical case of a 61-year-old patient with the post-COVID-19 syndrome, the possibility of application of the confocal microscopy of the cornea for the diagnosis of neuropathy of small fibers and monitoring of the patient›s condition is shown.

Association Between Suggestive Symptom of Restless Legs Syndrome and COVID-19 Vaccination: A Pilot Study

Objectives: Various sensory symptoms have been recognized after COVID-19 vaccination. Here, we aimed to explore the association between the suggestive symptom of restless legs syndrome (RLSss) and COVID-19 vaccination using an online survey.Methods: We prospectively studied participants who were working in our hospital after at least the first dose of the ChAdOx1 or BNT162b2 mRNA vaccine. The participants were invited via smartphone messages and voluntarily filled out an online questionnaire that included adverse events after vaccination. We considered the participants as having RLSss if they reported that they had three or more symptoms in the restless legs syndrome (RLS) diagnostic criteria.Results: A total of 628 participants (506 female; mean age, 37.7±12.4 years) responded fully to our online survey. 588 participants (93.6%) received the first dose of the ChAdOx1 vaccine (BNT162b2 mRNA vaccine for 40 participants). A total of 44 out of the 628 participants (7.0%) reported that they had RLSss. Myalgia was more common in participants with RLSss than in those without RLSss (97.7% vs. 67.3%, <i>p</i><0.001). Multivariate testing showed that age (odds ratio, 1.037 per 1 year increase; 95% CI, 1.004–1.071) and the presence of myalgia (odds ratio, 20.479; 95% CI, 4.266–368.206) were associated with the presence of RLSss.Conclusions: This pilot study explored RLSss after COVID-19 vaccination and the results suggested that RLS might be one of the causes of adverse symptoms after COVID-19 vaccination. Further studies are required to confirm the relationship between RLS and COVID-19 vaccination.

Prevalence and risk factors of musculoskeletal pain symptoms as long-term post-COVID sequelae in hospitalized COVID-19 survivors: a multicenter study.

This study investigated the prevalence of long-term musculoskeletal post-COVID pain and their risk factors in a large cohort of COVID-19 survivors. A multicenter cohort study including patients hospitalised because of COVID-19 in 5 hospitals of Madrid (Spain) during the first wave of the pandemic was conducted. Hospitalisation and clinical data were collected from medical records. Patients were scheduled for a telephone interview after hospital discharge for collecting data about the musculoskeletal post-COVID pain. Anxiety/depressive levels and sleep quality were likewise assessed. From 2000 patients recruited, a total of 1969 individuals (46.4% women, age: 61 years, SD: 16 years) were assessed on average at 8.4 (SD: 1.5) months after discharge. At the time of the study, 887 (45% women) reported musculoskeletal post-COVID pain. According to the presence of previous pain symptoms, the prevalence of "de novo" (new-onset) musculoskeletal post-COVID pain was 74.9%, whereas 25.1% experienced an increase in previous symptoms (exacerbated COVID-related pain). Female sex (odds ratio [OR]: 1.349, 95% confidence interval [CI]: 1.059-1.720), history of musculoskeletal pain (OR 1.553, 95% CI 1.271-1.898), presence of myalgia (OR 1.546, 95% CI 1.155-2.070) and headache (1.866, 95% CI 1.349-2.580) as COVID-19-associated onset symptoms, and days at hospital (OR 1.013, 95% CI 1.004-1.022) were risk factors associated with musculoskeletal post-COVID pain. In conclusion, musculoskeletal post-COVID pain is present in 45.1% of COVID-19 survivors at 8 months after hospital discharge with most patients developing de novo post-COVID pain. Female sex, history of musculoskeletal pain, presence of myalgia and headache as COVID-19 symptoms at the acute phase, and days at hospital were risk factors associated with musculoskeletal post-COVID pain.

Myalgia as a symptom at hospital admission by severe acute respiratory syndrome coronavirus 2 infection is associated with persistent musculoskeletal pain as long-term post-COVID sequelae: a case-control study.

This study investigated the association between COVID-related myalgia experienced by patients at hospital admission and the presence of post-COVID symptoms. A case-control study including patients hospitalised due to COVID-19 between February 20 and May 31, 2020, was conducted. Patients reporting myalgia and patients without myalgia at hospital admission were scheduled for a telephone interview 7 months after hospital discharge. Hospitalisation and clinical data were collected from medical records. A list of post-COVID symptoms with attention to musculoskeletal pain was evaluated. Anxiety and depressive symptoms, and sleep quality were likewise assessed. From a total of 1200 hospitalised patients with COVID-19, 369 with and 369 without myalgia at hospital admission were assessed 7.2 months (SD 0.6) after hospital discharge. A greater proportion (P = 0.03) of patients with myalgia at hospital admission (20%) showed ≥3 post-COVID symptoms when compared with individuals without myalgia (13%). A higher proportion of patients presenting myalgia (odds Rratio 1.41, 95% confidence interval 1.04-1.90) exhibited musculoskeletal post-COVID pain when compared to those without myalgia. The prevalence of musculoskeletal post-COVID pain in the total sample was 38%. Fifty percent of individuals with preexisting musculoskeletal pain experienced a worsening of their symptoms after COVID-19. No differences in fatigue, dyspnoea, anxiety/depressive levels, or sleep quality were observed between myalgia and nonmyalgia groups. The presence of myalgia at hospital admission was associated with preexisting history of musculoskeletal pain (OR 1.62, 95% confidence interval 1.10-2.40). In conclusion, myalgia at the acute phase was associated with musculoskeletal pain as long-term post-COVID sequelae. In addition, half of the patients with preexisting pain conditions experienced a persistent exacerbation of their previous syndromes.

COVID-19 Hastalarında Myalji Sıklığı ve Kreatin Kinaz Düzeyleri ile İlişkisi

Aim: Many studies have showed that myalgia is a common onset symptom in coronavirus disease 2019 (COVID-19). This study aimed to determine the frequency of muscle pain in patients followed with COVID-19 diagnosis, and to investigate the relationship between muscle pain and creatine kinase (CK), pH, lactate and lactate dehydrogenase (LDH) levels.
 Material and Methods: One hundred ten patients diagnosed with COVID-19 in our hospital were included retrospectively in this study. Presence of myalgia at the time of admission and on the 14th day of control were investigated. The first admission laboratory findings, 3rd day CK values and 14th day control CK values of all patients were recorded retrospectively from their files.
 Results: The study included 110 patients diagnosed with COVID-19. Fifty patients (45.5%) had muscle pain at the time of admission, and it was one of the most common musculoskeletal complaints. High CK results were obtained in 48 (43.6%) of the 110 patients at the time of admission. Thirty-two (66.7%) of 48 patients with high CK had muscle pain (p

COMPLAINTS OF THE PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS AND ACTIVE CYTOMEGALOVIRUS AND EPSTEIN-BARR VIRUS INFECTION; THEIR DIAGNOSTIC VALUE

COMPLAINTS OF THE PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS AND ACTIVE CYTOMEGALOVIRUS AND EPSTEIN-BARR VIRUS INFECTION; THEIR DIAGNOSTIC VALUE

Leukocytosis and alteration of hemoglobin level in patients with severe COVID-19: Association of leukocytosis with mortality.

Leukocytosis and alteration of hemoglobin level in patients with severe COVID-19: Association of leukocytosis with mortality.

Acute myopathic quadriplegia in patients with COVID-19 in the intensive care unit.

It is well known that the spectrum of SARS-CoV-2 infection ranges from asymptomatic or mildly symptomatic patients to rapidly progressive, acute respiratory distress syndrome (ARDS) and death. Although various reports indicated the presence of myalgia in 44%–70% and increased creatine kinase (CK) in about 33% of hospitalized patients,1 or <skeletal muscle injury> (increased CK and myalgia) in 23%,2 the characterization of neuromuscular involvement is still unsatisfactory, and no electrophysiologic studies have been performed. Very recently, patients who developed the Guillain-Barré syndrome (GBS) in the course of coronavirus disease 2019 (COVID-19) have been described.3 In the past literature, there were a few reports of neuromuscular involvement in association with other beta-coronavirus, including critical illness myopathy (CIM) or polyneuropathy.1,4 Moreover, myopathic changes, as fiber atrophy or necrosis, have been reported in postmortem muscle samples of 8 patients who died of SARS (severe acute respiratory syndrome) due to SARS-CoV infection.4

Anosmia and dysgeusia associated with SARS-CoV-2 infection: an age-matched case-control study.

Anosmia and dysgeusia have been reported as potential symptoms of coronavirus disease 2019. This study aimed to confirm whether anosmia and dysgeusia are specific symptoms among those who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We conducted an age-matched case-control study in the Eastern Townships region of Quebec between Mar. 10 and Mar. 23, 2020. We included adults (age ≥ 18 yr) who tested positive for SARS-CoV-2 by reverse transcription polymerase chain reaction. Cases were matched (1:1) according to 5-year age groups with control patents selected randomly from among all patients who tested negative for SARS-CoV-2 during the same period. Demographic and laboratory information was collected from medical records. Clinical symptoms and comorbidities associated with anosmia and dysgeusia were obtained by telephone interview with a standardized questionnaire. Among 2883 people tested for SARS-CoV-2, we identified 134 positive cases (70 women [52.2%] and 64 men [47.8%]; median age 57.1 [interquartile range 41.2-64.5] yr). The symptoms independently associated with SARS-CoV-2 positivity in conditional logistic regression were anosmia or dysgeusia or both (adjusted odds ratio [OR] 62.9, 95% confidence interval [CI] 11.0-359.7), presence of myalgia (adjusted OR 7.6, 95% CI 1.9-29.9), blurred vision (adjusted OR 0.1, 95% CI 0.0-0.8) and chest pain (adjusted OR 0.1, 95% CI 0.0-0.6). We found a strong association between olfactory and gustatory symptoms and SARS-CoV-2 positivity. These symptoms should be considered as common and distinctive features of SARS-CoV-2 infection and should serve as an indication for testing and possible retesting of people whose first test result is negative.

Towards an Artificial Intelligence Framework for Data-Driven Prediction of Coronavirus Clinical Severity

The virus SARS-CoV2, which causes coronavirus disease (COVID-19) has become a pandemic and has spread to every inhabited continent. Given the increasing caseload, there is an urgent need to augment clinical skills in order to identify from among the many mild cases the few that will progress to critical illness. We present a first step towards building an artificial intelligence (AI) framework, with predictive analytics (PA) capabilities applied to real patient data, to provide rapid clinical decision-making support. COVID-19 has presented a pressing need as a) clinicians are still developing clinical acumen to this novel disease and b) resource limitations in a surging pandemic require difficult resource allocation decisions. The objectives of this research are: (1) to algorithmically identify the combinations of clinical characteristics of COVID-19 that predict outcomes, and (2) to develop a tool with AI capabilities that will predict patients at risk for more severe illness on initial presentation. The predictive models learn from historical data to help predict who will develop acute respiratory distress syndrome (ARDS), a severe outcome in COVID-19. Our results, based on data from two hospitals in Wenzhou, Zhejiang, China, identified features on initial presentation with COVID-19 that were most predictive of later development of ARDS. A mildly elevated alanine aminotransferase (ALT) (a liver enzyme), the presence of myalgias (body aches), and an elevated hemoglobin (red blood cells), in this order, are the clinical features, on presentation, that are the most predictive. The predictive models that learned from historical data of patients from these two hospitals achieved 70% to 80% accuracy in predicting severe cases.

Secondary hyperaldosteronism and medullary nephrocalcinosis caused by self-administered and uncontrolled laxative use in an adolescent patient

Secondary hyperaldosteronism is respondent aldosterone secretion increase, occurring due to some diseases or drug use. It may be accompanied by normal arterial pressure with/without water retention or arterial hypertension without water retention. Secondary hyperaldosteronism without arterial hypertension and without water retention is usually caused by the use of laxative and diuretic drugs. This condition is characterized by the lack of salt wasting symptoms, presence of myalgia and muscle weakness resulting from hypokalemia, calcium oxalate crystalluria and sonographic signs of medullary nephrocalcinosis. Such characteristics of water-salt exchange and presence of nephrocalcinosis in combination with hypercalciuria are defined as Bartter-like syndrome. Peculiarity of the given clinical case is determined not by a diagnostic difficulty of secondary hyperaldosteronism but concealment of long term self-administered use of laxatives 2 years without medical indications in a female patient, resulting in medullary nephrocalcinosis. A well-informed patient may endanger medical practice, because it is impossible to foresee everything including the uncontrolled self-administered drug use leading to the undesirable consequences.

Prevalence of undifferentiated inflammatory arthropathy in patients with Hashimoto's thyroiditis in an endocrinology clinic.

Rheumatic manifestations are common in patients with Hashimoto's thyroiditis (HT). Since previous reports on the prevalence of arthritis in this disease may have a rheumatology referral bias, we sought to establish the prevalence of undifferentiated inflammatory arthropathy (UIA) in unselected HT patients as seen in an endocrinology clinic. Cross-sectional study of 92 consecutive HT patients and no definite rheumatic disease from the Endocrinology Division, Hospital Universitario de Caracas diagnosed by the presence of anti-thyroid peroxidase antibodies (n=68) or typical ultrasonographic findings (n=24). Undifferentiated inflammatory arthropathy was defined as combination of morning stiffness and joint pain with ≥2 characteristics of inflammatory joint pain. The study was revised and approved by the Ethics Committee of our hospital and all patients signed an informed consent form. Twenty-three patients (25%; 95% CI 16-34) met the criteria for UIA. Joints most commonly affected were the knees, hands and ankles and the most common pattern was oligoarticular (82.6%). In the multivariate analysis, variables associated to the presence of UIA were the presence of myalgia (odds ratio [OR]=19.41; 95% CI=2.38-158.38) and Raynaud's phenomenon (OR=4.32; 95% CI=1.01-18.60). No association was found with demographics, duration of disease, comorbidities or thyroid function status. Almost 1 in 4 patients with HT had no definite rheumatic disease present with UIA. An early identification of concurrent arthritis in HT patients is necessary for thorough differential diagnosis and prompt treatment initiation to halt potential joint damage and disability.

Factors Associated With Influenza in an Emergency Department Setting.

Emergency departments (EDs) become more overcrowded during peak respiratory virus season. Distinguishing influenza from other viruses is crucial to implement social distancing practices, early treatment, and prompt disposition. We sought to determine factors associated with influenza among a prospective cohort of consecutive ED patients with acute respiratory illness (ARI). Between December 2016 and March 2017, trained research assistants screened consecutive ED patients with ARI symptoms. ARI criteria included measured fever at home or in the ED >38°C and a cough, sore throat, or rhinorrhea with a duration of symptoms >12hours and <1week. After consent, research assistants collected demographics and clinical history using a standardized data form, and patients had a polymerase chain reaction-based assay that is nearly 100% sensitive for influenza. Univariate analysis was conducted on all predictor variables. Significant variables were entered into a multivariate logistic regression model to find factors that were independently associated with influenza. One hundred nineteen patients consented to enrollment and 31% were found to be positive for influenza. Myalgia, the absence of gastrointestinal symptoms (no diarrhea or vomiting), sore throat, chills, headache, and oxygen saturation ≥97% were significant on univariate analysis and were entered into the multivariate model. Myalgia (adjusted odds ratio [AOR] 3.9), the absence of gastrointestinal symptoms (AOR 4.7), and oxygen saturation ≥97% (AOR 2.8) were significant independent factors of influenza. The presence of myalgia, the absence of gastrointestinal symptoms, and oxygen saturation ≥97% are factors that can help distinguish influenza from other acute respiratory illnesses in the ambulatory ED population.

Measurement of Spee curve in individuals with temporomandibular disorders: a cross-sectional study

Several factors are cited as capable to influence the development of Temporomandibular Disorders (TMD), among them, the psychological, systemic, genetic, and occlusal factors. The curve of Spee is the factor directly related to the TMJ. However, the combination of variations in amplitude, and the presence of signs and symptoms of TMD have not been investigated. Objective: The aim of this study was to measure the curve of Spee in patients with TMD, through the use of study models, comparing these values with the different clinical and symptomatic presentations of such individuals. We evaluated 198 models of patients treated at the care service for patients with TMD at UFJF. The maximum depth of the curve was determined by the sum of the distances between the lowest part of the buccal cusp of the posterior teeth of each hemiarch to a reference plane, using a caliper to measure. The following factors were considered: gender, presence of myalgia (temporal, masseter, medial pterygoid, lateral and sternocleidomastoid muscles) and TMJ arthralgia, and the presence of occlusal interferences and parafunctional habit of bruxism. For statistical analysis, we used T-test and ANOVA test with a significance level of 5%. Conclusion: There was a statistically significant association between the presence of occlusal interferences and changes in the curve (p = 0.01). There was no association between the following factors: the presence of myalgia and/or arthralgia, gender, achievement of bruxism, and the type of TMD presented with changes in the Spee curve.

Measurement of Spee curve in individuals with temporomandibular disorders: a cross-sectional study

Several factors are cited as capable to influence the development of Temporomandibular Disorders (TMD), among them, the psychological, systemic, genetic, and occlusal factors. The curve of Spee is the factor directly related to the TMJ. However, the combination of variations in amplitude, and the presence of signs and symptoms of TMD have not been investigated. Objective: The aim of this study was to measure the curve of Spee in patients with TMD, through the use of study models, comparing these values with the different clinical and symptomatic presentations of such individuals. We evaluated 198 models of patients treated at the care service for patients with TMD at UFJF. The maximum depth of the curve was determined by the sum of the distances between the lowest part of the buccal cusp of the posterior teeth of each hemiarch to a reference plane, using a caliper to measure. The following factors were considered: gender, presence of myalgia (temporal, masseter, medial pterygoid, lateral and sternocleidomastoid muscles) and TMJ arthralgia, and the presence of occlusal interferences and parafunctional habit of bruxism. For statistical analysis, we used T-test and ANOVA test with a significance level of 5%. Conclusion: There was a statistically significant association between the presence of occlusal interferences and changes in the curve (p = 0.01). There was no association between the following factors: the presence of myalgia and/or arthralgia, gender, achievement of bruxism, and the type of TMD presented with changes in the Spee curve.

Risk factors for subclinical inflammation in children with Familial Mediterranean fever.

Familial Mediterranean fever (FMF) is the most common autosomal recessive inherited inflammatory disease characterized by attacks of painful inflammation. Some patients with FMF have subclinical inflammation persisting between the attacks. We aimed to identify the demographic, clinical and genetic risk factors for subclinical inflammation in children with FMF. The medical records of the children with FMF were evaluated retrospectively for acute-phase response along with gender, age at the onset of symptoms and at the time of diagnosis, clinical signs and symptoms, the presence of amyloidosis and MEFV genotype. Patients with persistently elevated acute-phase response between the attacks were considered to have subclinical inflammation. Patients with or without subclinical inflammation (Group 1 and Group 2, respectively) were compared for the parameters defined above. Independent risk factors for subclinical inflammation were identified by multivariate logistic regression analysis. There were 105 children (male/female: 52/53) who were compliant on colchicine treatment. Subclinical inflammation was detected in 22 (20%) patients. Group 1 had significantly higher rate of myalgia, arthritis/arthralgia, erysipelas like erythema, amyloidosis, protracted febrile myalgia and M694V mutation compared with Group 2. However, only the presence of myalgia and erysipelas like erythema were found to be independent risk factors for subclinical inflammation (OR 9.8 and 5.9, respectively). Children with FMF who have myalgia and erysipelas like erythema during the attacks are particularly at risk of ongoing inflammation and should be closely monitored for subclinical inflammation even during attack-free periods.

Musculoskeletal safety outcomes of patients receiving daptomycin with HMG-CoA reductase inhibitors.

Daptomycin, a cyclic lipopeptide antibiotic, and 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) are commonly administered in the inpatient setting and are associated with creatine phosphokinase (CPK) elevations, myalgias, and muscle weakness. Safety data for coadministration of daptomycin with statins are limited. To determine the safety of coadministration of daptomycin with statin therapy, a multicenter, retrospective, observational study was performed at 13 institutions in the Southeastern United States. Forty-nine adult patients receiving statins concurrently with daptomycin were compared with 171 patients receiving daptomycin without statin therapy. Detailed information, including treatment indication and duration, infecting pathogen, baseline and subsequent CPK levels, and presence of myalgias or muscle complaints, was collected. Myalgias were noted in 3/49 (6.1%) patients receiving combination therapy compared with 5/171 (2.9%) of patients receiving daptomycin alone (P = 0.38). CPK elevations of >1,000 U/liter occurred in 5/49 (10.2%) patients receiving combination therapy compared to 9/171 (5.3%) patients receiving daptomycin alone (P = 0.32). Two of five patients experiencing CPK elevations of >1,000 U/liter in the combination group had symptoms of myopathy. Three patients (6.1%) discontinued therapy due to CPK elevations with concurrent myalgias in the combination group versus 6 patients (3.5%) in the daptomycin-alone group (P = 0.42). CPK levels and myalgias reversed upon discontinuation of daptomycin therapy. Overall musculoskeletal toxicity was numerically higher in the combination group but this result was not statistically significant. Further prospective study is warranted in a larger population.