Serum Creatine Phosphokinase Levels Research Articles

Assessment of cardiac adverse events following COVID-19 vaccination by speckle tracking echocardiography

Cardiac discomfort has been reported periodically in COVID-19-vaccinated individuals. Thus, this study aimed to evaluate the role of myocardial strains in the early assessment of the clinical presentations after COVID-19 vaccination. Totally, 121 subjects who received at least one dose of vaccine within 6 weeks underwent laboratory tests, electrocardiogram (ECG), and echocardiogram. Two-dimensional speckle tracking echocardiography (2D-STE) was implemented to analyze changes in the left ventricular myocardium. After vaccination, 66 individuals (55.4 ± 17.4 years) developed cardiac discomforts, such as chest tightness, palpitations, dyspnea, and chest pain. The ECG readings exhibited both premature ventricular contractions and premature atrial contractions (n = 24, 36.4%), while none of the individuals in the control group manifested signs of cardiac arrhythmia. All had normal serum levels of creatine phosphokinase, creatine kinase myocardial band, troponin, N-terminal pro b-type natriuretic peptide, platelets, and D-dimer. Left ventricular ejection fraction in the symptomatic group (71.41% ± 7.12%) and the control group (72.18% ± 5.11%) (p = 0.492) were normal. Use of 2D-STE presented global longitudinal strain (GLS) and global circumferential strain (GCS) was reduced in the symptomatic group (17.86% ± 3.22% and 18.37% ± 5.22%) compared to the control group (19.54% ± 2.18% and 20.73% ± 4.09%) (p = 0.001 and p = 0.028). COVID-19 vaccine-related cardiac adverse effects can be assessed early by 2D-STE. The prognostic implications of GLS and GCS enable the evaluation of subtle changes in myocardial function after vaccination.

Cardioprotective role of royal jelly in the prevention of celecoxib-mediated cardiotoxicity in adult male albino rats

BackgroundCelecoxib, a cyclooxygenase-2 selective inhibitor non-steroidal anti-inflammatory drugs, is used for the management of short- and long-term pain as well as in other inflammatory conditions. Unfortunately, its chronic use is highly associated with serious abnormal cardiovascular events. The current study was designed to explore the effect of long-term administration of celecoxib on the cardiac tissues of male albino rats. The study also examined the alleged cardioprotective effect of royal jelly.MethodsThirty, male albino rats were randomly divided into 3 equal groups; 10 each: (1) rats served as the control group and received no drug; (2) rats received celecoxib (50 mg/kg/day, orally), for 30 consecutive days; (3) rats received celecoxib (50 mg/kg/day, orally) plus royal jelly (300 mg/kg/day, orally) for 30 consecutive days. Sera were collected to assay cardiac enzymes and oxidant/antioxidant status. Rats were euthanatized and cardiac tissues were dissected for quantitative estimation of apoptotic genes (Bax) and anti-apoptotic gene (Bcl-2).ResultsLong-term celecoxib administration caused cardiotoxicity in male albino rats as manifested by significant elevation of serum levels of creatine phosphokinase (CPK), creatine kinase-MB (CK-MB), and lactate dehydrogenase (LDH), with ameliorative effects of royal jelly against celecoxib-induced cardiotoxicity as manifested by significantly decrease in serum CPK, CK-MB, and LDH levels. It also showed a significant decrease in the oxidative stress indicator malondialdehyde (MDA) levels and the bax gene. Additionally, it demonstrated significant increases in the bcl-2 gene and superoxide dismutase (SOD) levels, which contribute to its therapeutic effects against celecoxib-induced cardiotoxicity.ConclusionLong-term celecoxib administration caused cardiotoxicity in male albino rats with protective effect of royal jelly being given together. It could be concluded that royal jelly may prove a useful adjunct in patients being prescribed celecoxib.Trial registrationNot applicable.

Real-world effectiveness and safety of baricitinib including its effect on biomarkers and laboratory data in Japanese adult patients with atopic dermatitis: a single-center retrospective study

Baricitinib demonstrated efficacy and tolerable safety in clinical trials for atopic dermatitis (AD); however, real-world data are limited. We examined effectiveness and safety of baricitinib, and laboratory data in AD patients treated with baricitinib in our department. We also evaluated baseline clinical severity in responders and non-responders. All adult AD patients treated with baricitinib in our department between January 2021 and February 2023 were included. Data on 30 Japanese AD patients were analyzed. Objective severity scores and patient-reported outcomes improved at one and 3 months, except for the affected body surface area at 1 month. The proportions of patients who achieved eczema area and severity index-50% improvement were 30.0% (9/30) at 1 month and 53.3% (16/30) at 3 months. There were no significant changes in AD biomarkers. No significant difference was observed in baseline clinical severity between responders and non-responders. No significant changes were observed in laboratory results except for increased serum creatine phosphokinase levels at 3 months. One case of herpes zoster and one case of ocular herpes were observed. Baricitinib showed mild effectiveness and favorable safety including laboratory findings. Biomarkers did not reflect clinical improvement. Further study is needed to identify characteristics of responders.

Pediatric kidney care experience after the 2023 Turkey/Syria earthquake.

Two earthquakes on February 6th, 2023 destroyed ten cities in Türkiye. We report our experience with pediatric victims during these catastrophes, with a focus on crush syndrome related-acute kidney injury (Crush-AKI) and death. A web-based software was prepared. Patient demographics, time under rubble (TUR), admission laboratory data, dialysis, and kidney and overall outcomes were asked. 903 injured children (median age: 11.62 years) were evaluated. Mean TUR was 13h (Interquartile range-IQR: 32.5), max 240h). 31 of 32 patients with a TUR of >120h survived. The patient who rescued after ten days survived.Two-thirds of the patients were given 50mEq/L sodium-bicarbonate in 0.45% sodium-chloride solution on admission day. 58% of patients were given intravenous fluid (IVF) at a volume of 2000-3000mL/m2 body surface area (BSA), 40% of 3000-4000mL/m2 BSA, and only 2% of >4000mL/m2 BSA. 425 patients had surgeries, 48 suffered from major bleeding. Amputations were recorded in 96 patients. Eighty-two and 66 patients required ventilator and inotropic support, respectively.Crush-AKI developed in 314 patients (36% of all patients). 189 patients were dialyzed. Age>15 years, creatine phosphokinase (CK)≥20950U/L, TUR≥10h, and the first-day IVF volume<3000-4000mL/m2 BSA were associated with Crush-AKI development. 22 deaths were recorded, 20 of 22 occurred in patients with Crush-AKI and within the first 4 days of admission. All patients admitted after 7 days survived. This is the most extensive pediatric kidney disaster data after an earthquake. Serum CK level was significantly associated with Crush-AKI at the levels of >20950U/L, but not with death. Adolescent age and initial IVF of less than 3000-4000mL/m2 BSA were also asscoiated with Crush-AKI. Given that mildly injured victims can survive longer periods in the disaster field, we suggest uninterrupted rescue activity for at least 10 days.

Factors Associated with Acute Kidney Injury Occurrence and Prognosis in Rhabdomyolysis at the Emergency Department.

Background and Objectives: This study aimed to analyze patients with rhabdomyolysis who presented to emergency departments and identify their distribution of related disease and prognostic factors. Materials and Methods: A retrospective cohort study was conducted on patients with rhabdomyolysis who presented to emergency departments over a 10-year period. Patient data, including patients' demographic variables (sex and age), mode of arrival, final diagnosis, statin use, rhabdomyolysis trigger factors, and levels of serum creatine phosphokinase (CPK), myoglobin, creatinine, sodium, potassium, phosphate, calcium, and lactate, were analyzed. Univariate and multivariate logistic regression analyses were conducted to identify the predictive factors of acute kidney injury (AKI). Results: Among the patients, 268 (65.6%) were found to have trigger factors without underlying diseases. Furthermore, 115 (28.2%) patients developed AKI. This comprehensive study sheds light on the diverse factors influencing the occurrence of AKI in rhabdomyolysis and provides insights into AKI predictive markers. Furthermore, we analyzed the cases by dividing them into six groups: occurrence of AKI, occurrence of infection, and simple or complex rhabdomyolysis. CPK time course was found to be important in clinical prognosis, such as AKI occurrence, dialysis or not, and mortality. Conclusions: Age, statin use, elevated creatinine and lactate levels, and initial serum CPK level emerged as significant predictors of AKI. CPK time course was also found to be an important factor in predicting the clinical outcomes of patients with rhabdomyolysis.

Efficacy of Levothyroxine Sodium Soft Gelatin Capsules in Thyroidectomized Patients Taking Proton Pump Inhibitors: An Open-Label Study.

Background: Treatment with proton pump inhibitors (PPIs) and antacids affects the gastrointestinal absorption of levothyroxine sodium (LT4) tablets. Patients with hypothyroidism taking LT4 and PPIs or antacids, thus, require appropriate monitoring. The objective of this study was to determine whether a soft gelatin capsule of LT4 (Tirosint®) would obviate the effect of PPIs on LT4 absorption. The objective was achieved by assessing the effects of a switch from a conventional LT4 tablet form to the same dose as soft capsules in thyroidectomized patients on treatment with LT4 and PPIs. Methods: Patients with history of hypothyroidism due to total thyroidectomy on stable treatment with LT4 tablets, and with gastrointestinal disease treated with PPIs, were switched to a 12-week treatment with Tirosint at the same dose of the LT4 tablets, while maintaining treatment with PPIs. Serum thyrotropin (TSH) levels were the primary endpoint of the study. Secondary efficacy endpoints were: serum levels of free thyroxine (fT4), total thyroxine (TT4), free triiodothyronine (fT3), total triiodothyronine (TT3), creatine-phosphokinase (CPK), sex-hormone binding globulin, ferritin, angiotensin converting enzyme, and a lipid panel. Results: Forty-seven patients (36 females and 11 males, mean age 55.4 years) were enrolled and 45 of them completed the study (2 patients withdrew consent). During treatment with Tirosint, mean TSH levels demonstrated a statistically significant decrease (mean changes from baseline: -0.32 mIU/L at week 6 and -0.68 mIU/L at week 12) and concomitant increases in thyroid hormone (TH) levels from baseline to week 12, which were statistically significant for fT3 and TT3 (mean changes from baseline: 0.26 pmol/L and 0.10 nmol/L, respectively). Significant decreases of serum low-density lipoprotein, total cholesterol, and CPK levels were observed at week 12. No signs/symptoms arose during the study that could be specifically correlated to either hypo- or hyperthyroidism. Conclusions: In thyroidectomized patients taking PPIs and replacement LT4, a switch from conventional LT4 tablets to LT4 soft capsules at the same dose was associated with a significant decrease in TSH and increase in TH, indicating that LT4 absorption may be less affected by PPIs when given in the form of soft capsules. Clinical Trial Registration: NCT03094416.

Biomarker array for prediction of acute kidney injury after percutaneous coronary intervention for patients who had acute ST segment elevation myocardial infarction

Acute kidney injury (AKI) is a common complication after Percutaneous Coronary Intervention (PCI) for ST segment elevation myocardial infarction (STEMI) and is associated with poor outcomes. AKI is diagnosed by the dynamic change of serum Cr, but it could not predict AKI. This study aimed to evaluate a biomarker array that may fulfill this shortage. Setting: Cardiology Department, Tanta University Hospital. Design: Prospective interventional study included 280 acute STEMI patients who underwent emergency PCI. Serial samples of blood and urine were obtained at the time of admission to the hospital (T0) and PCI unit (T1) and at 12 h and 72 h (T12 and T72) after coronary revascularization to estimate levels of serum Cr, creatine phosphokinase, and heart-type fatty acid-binding protein (H-FABP) and calculation of neutrophil/lymphocyte ratio (NLR) and urinary liver-type FABP (L-FABP). AKI was diagnosed according to the recommendations of the European Renal Best Practice as the times of increased serum Cr concerning baseline level. 85 patients developed AKI. Regression analyses defined a high NLR ratio in the T0 sample as the most significant predictor for early AKI diagnosed at T1 time, while high NLR and serum H-FABP levels in T1 samples as the significant predictors for AKI defined at T12 time. However, high urinary L-FABP levels in T12 samples and high NLR are significant predictors for AKI at T72 time. Combined estimations of serum H-FABP and urinary L-FABP with the calculation of NLR could predict the oncoming AKI and discriminate its pathogenesis. The study protocol was approved by the Local Ethical Committee at Tanta Faculty of Medicine by approval number: 35327/3/22. For blindness purposes, the authors will be blinded about the laboratory results till the end of 72 h after revascularization and the clinical pathologist will be blinded about the indication for the requested investigations.

Serum creatinine phosphokinase: A potential prognostic marker in assessing clinical severity with organophosphorus poisoning.

Organophosphorus compound (OPC) poisoning undoubtedly being a major concern in cultivation sites of the developing world, including Bangladesh. Two potential biomarkers, for example, serum creatine phosphokinase (CPK) and lactate dehydrogenase (LDH), are widely used in OPC poisoning severity indicators in patients. In this study, we sought to correlate the severity score of acute OPC poisoning with CPK or LDH level and subsequently explore their prognostic value. This study was performed on a total of 70 patients with OPC poisoning admitted to the inpatient care unit at a territory-based hospital in Bangladesh. Sociodemographics and poison types were recorded, and severity was assessed according to Peradeniya Organophosphorus Poisoning (POP) scale. Serum CPK and LDH levels were measured and recorded. A total of seventy OPC patients were included with male to female ratio of 1.33:1, respectively, with a mean age of 28.7 ± 12.8 years. Chlorpyrifos and methylparathion were the most commonly utilized OP compounds, accounting for 42.9% and 28.6%, respectively. Among the OPC patients, the majority were married homemakers from rural areas. According to POP score, 55.7% and 37.1% of patients were categorized as mild and moderate, whereas very few were found to be severe. The mean serum CPK and LDH of OPC-patients at admission time were 235.6 ± 79.8 IU/L and 348.3 ± 154.1 IU/L, respectively. Serum CPK, atropine dose and hospital stay strongly correlated with clinical severity. We conclude that the serum CPK level strongly correlates with the degree of OPC poisoning and can be used as a predictor of the clinical intervention approaches.

Local-Anaesthetic-Induced Myotoxicity in Interfascial Plane Blocks: A Comparative Study between Bupivacaine and Ropivacaine

Objective: Local-anaesthetic (LA)-induced myotoxicity in the use of peripheral nerve blocks has emerged as a topic of interest recently. Very few studies on human subjects have been done in this field, though the technique of nerve blocks is being widely practiced both for anaesthesia and analgesia. Studies have shown that bupivacaine induces reproducible skeletal muscle degeneration. The present study is thus aimed at comparing the myotoxicity induced by bupivacaine and ropivacaine in interfascial plane blocks.Material and Methods: The study was a randomized comparative study done at a tertiary care hospital. The subjects were randomly assigned into 3 groups of 50 patients each:- Group B, with patients in whom bupivacaine was used; Group R, comprised of patients in which ropivacaine was used, Group N, who received no fascial plane block during their procedures. An erector spinae block (ESP block) was performed for patients undergoing unilateral lung decortication or lobectomy. Creatine phosphokinase (CPK) levels at 6 and 24 hours after completion of surgery were taken in all 3 groups and compared with baseline values using Repeated Measures Analysis of Variance.Results: Baseline serum CPK levels were similar in all 3 study groups. Significant increases in serum CPK levels were noticed in group B compared to group R at 6 hours and 24 hours, with no increase in group N.Conclusion: The study showed that serum CPK, a marker of skeletal muscle injury and local-anaesthetic-induced myotoxicity, significantly rose at 24 hours after an ESP block and this increase was considerably higher in group B (bupivacaine) compared to group R (ropivacaine), indicating significantly higher myotoxicity with bupivacaine.

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

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

Dengue Fever Presenting with Severe Myositis-A Case Report

Dengue fever is one of the most common vector-borne diseases, which is a viral infection transmitted by female Aedes aegypti mosquitoes. It is most common in tropical countries like India. Dengue fever symptoms can range from a mild infection to severe flu-like sickness. Myalgia is a symptom of dengue infection. Dengue fever with myositis and/or high serum creatine phosphokinase (CPK) levels, on the other hand, is extremely uncommon. Dengue virus can cause myositis in many mechanisms. One of the most common mechanisms is by direct invasion of the myocytes by the dengue viruses. Myotoxins, Inflammatory cytokines have also been a part of the development of myositis. The clinical spectrum is broad, from the mild asymmetrical weakness of lower extremities to sudden progressive severe limb and trunk weakness, and even lung failure. This case study aims to show the rare neuromuscular complications of dengue fever, which can be managed well with a high index of suspicion. Our patient presented with fever and severe myalgia and was diagnosed with dengue. We started treating the patient with a provisional diagnosis of dengue-associated myositis. Significantly elevated CPK levels confirmed the myositis. Hereby, we are presenting a case of dengue fever with myositis with muscle weakness &amp; elevated creatine phosphokinase (CPK) levels who recovered completely with early suspicion of dengue-associated myositis and early management. Hence, Physicians should have a high index of suspicion and early management of dengue-associated neuromuscular complications.

Initial perioperative outcomes of robot-assisted thoracoscopic lobectomy using a confronting setting.

Most robot-assisted thoracoscopic surgery (RATS) is performed from the vertical view. This study evaluates the initial outcomes of our novel confronting RATS technique, in which the patient was viewed horizontally, as in open thoracotomy. We reviewed data on patients who underwent thoracoscopic lobectomy between January, 2019 and April, 2022. Perioperative outcomes were compared between RATS and video-assisted thoracoscopic surgery (VATS), using propensity-score matching. RATS and VATS were performed for 83 and 571 patients, respectively. After propensity-score matching, data on 81 patients from each of the two groups were retrieved. The operative time was significantly longer for RATS than for VATS (199 ± 44min vs. 173 ± 37min, p < 0.001). There was no mortality or conversion to thoracotomy in either of the groups. The rates of overall complications and prolonged air leak did not differ significantly between the groups. The serum creatine phosphokinase level on postoperative day 4 was higher after RATS than after VATS. The number of resected lymph nodes and the rates of nodal upstaging did not differ significantly between the groups. The initial perioperative outcomes of RATS using the confronting settings were comparable to those of VATS.

A study of serum creatine phosphokinase and severity of organophosphorus poisoning

Organophosphorus (OP) poisoning is an important global health problem especially in developing countries. Estimation of erythrocyte cholinesterase (EChE) and plasma cholinesterase (BChE) as an evidence of OP poisoning is costly, not regularly performed and shows wide inter-individual variability. To study the feasibility of using serum creatine phosphokinase (CPK) as a predictor for severity of OP poisoning. Thirty four patients were included in this study who were admitted to tertiary care centre with history of OP poisoning less than 24hrs. The clinical severity of patients categorized according to Peradeniya organophosphorus poisoning (POP) scale. In our study 53.0% were male, 47.0% were female. Incidence of OP poisoning was more common among age group 21-30 years. Farmers (38.2%) were more common among occupation. Monocrotophos (46.0%) was commonly used compound for poisoning. 38.2% patients were severe. There was significant reduction in plasma cholinesterase and significant increase in CPK levels. There was a highly significant correlation between initial serum CPK levels and severity of acute OP poisoning. This study recommends CPK as an alternative biomarker for acute OP poisoning.

Serum creatine phosphokinase as a marker of severity and prognosis in organophosphorus compound poisoning

Background: Various newer biomarkers for organophosphorus (OP) compound poisoning are being looked at from diagnostic and prognostic perspectives. The present study was conducted to observe if serum creatine phosphokinase (CPK) can be used as a marker to assess the severity and monitor prognosis in patients of OP compound poisoning. Methods: In this hospital based prospective, observational study, 100 duly screened patients presenting with OP compound were classified as per severity grade according to POP scale. Serum cholinesterase and serum CPK levels were assessed twice, on day 1 and on day 4; apart from requirements as per standard management protocol; and the levels were compared across severity grades of OP compound poisoning. Outcomes such as intermediate syndrome and need of intubation and chances of mortality were studied for correlation. Results: There was statistically significant positive correlation between serum CPK level on day 1 as well as on day 4 with the severity of poisoning. The day 1 mean serum cholinesterase level also increased with the increase in severity of poisoning, but not the day 4 level. Significantly positive correlation was observed between serum CPK levels and development of intermediate syndrome, need of intubation and chances of mortality amongst cases. Conclusions: Serum CPK can be used as an efficient marker of severity in the patients of OP compound poisoning and will be useful to predict prognosis and outcome.

Toxicological effect of exposure to different doses of zinc oxide nanoparticles on brain and heart structures of male Wistar rats.

Nanotechnology is rapidly developing in the fields of industry, medicine and nutrition. The aim of this study was to evaluate the effect of zinc oxide nanoparticles (ZnO Nps) toxicity on rats’ heart and brain. Eighty Wistar male rats were allotted into eight groups: control group, sham group receiving 0.9% normal saline and six treatment groups receiving ZnO Nps (4, 8, 25, 50, 100 and 200 mg/kg) intraperitoneally twice a week over 28 days. For behavioural evaluation, shuttle box and Y-maze tests were done. The heart and brain structures were obtained for bioaccumulation, histopathological exa­mination and biochemical analysis. Histopathologic lesions in the heart structures of 200 mg/kg ZnO Nps group included necrosis, hyperaemia, and vacuolar degeneration. In brain structures, changes included necrosis, gliosis and spongiform change. Serum levels of creatine phosphokinase (CPK) in the treated groups showed an increase compared to the control group. The accumulation of nanoparticles has also shown a dose-dependent increase in the heart and brain. Moreover, there was a significant difference between the control group and the 200 mg/kg group (P&lt;0.05). The mean acquisition of the passive avoidance test showed a significant decrease in the 200 mg/kg group compared to the control group (P&lt;0.05). The alternation behaviour test differed significantly between the 100 and 200 mg /kg groups with other groups (P&lt;0.05). The results indicated that zinc nanoparticles at doses more than 25 mg/kg were related to heart and brain toxicity in the form of increased bioaccumulation, malondialdehyde (MDA), histopathological lesions and CPK and decrease in behaviour index, glutathione peroxidase (GPx), superoxide dismutase (SOD) and ferric reducing antioxidant power (FRAP).

A rare case of spinomuscular atrophy masquerading neonatal encephalopathy in a newborn

Spinomuscular atrophy is a rare type of inherited neuromuscular disorder of degeneration of alfa cells of the anterior horn. The presentation and prognosis of disease vary depending upon the type, age of presentation and severity of the disease. Here we are presenting a case of a male baby who presented with lethargy, poor feeding, respiratory distress and seizures. On examination the child was sick looking, tachypnoeic, with Downe’s score of 7, with bilateral crypts with hypotonia and having seizures. The laboratory parameters showed thrombocytopenia, leucopenia, hypoglycaemia with normal serum levels of creatine phosphokinase. The septic screening was suggestive of sepsis. The amplitude integrated EEG showed abnormal pattern. The tandem mass spectroscopy for Inborn error of metabolism screening was normal. The neurosonography and MRI brain showed no abnormalities. The baby developed respiratory muscle weakness, hypotonia, bulbar palsy, areflexia and characteristic eyelid and tongue fasciculations subsequently as diseases progressed which required oxygen and respiratory support for prolonged duration. The gene study confirmed the deletion of exons 7 and 8. Sibling and parental screening were advised and the baby was managed with supportive care and referred to a higher centre for further advanced treatment. The knowledge and varying presentations of this illness are important for the treating doctors from the prognostic point of view

Cold-Water Immersion and Sports Massage Can Improve Pain Sensation but Not Functionality in Athletes with Delayed Onset Muscle Soreness.

This study aimed to investigate the effects of cold-water immersion (CWI) and sports massage on delayed-onset muscle soreness (DOMS) in amateur athletes. Sixty male amateur athletes were randomised into four equal groups (n = 15) receiving either CWI, sports massage, their combination, or served as controls after applying plyometric training to their lower extremities. The main outcomes measures were pain, exertion, rectus femoris perimeter, knee flexion range of motion, knee extensors isometric strength and serum creatine phosphokinase (CPK) levels examined before the plyometric training, immediately after the treatment, and 24, 48 and 72 h post exercise. We observed no significant differences between study groups in the most tested variables. CWI improved pain compared to the combined application of CWI and sports massage, and the control group both on the second and third day post exercise. Sports massage combined with CWI also led to a significant reduction in pain sensation compared to the control group. In conclusion the treatment interventions used were effective in reducing pain but were unable to affect other important adaptations of DOMS. Based on the above, sports scientists should reconsider the wide use of these interventions as a recovery strategy for athletes with DOMS.

Tourniquet Use Improves Intraoperative Parameters, Leading to Similar Postoperative Outcomes Compared With No Tourniquet Use in Anterior Cruciate Ligament Reconstruction: A Prospective, Double-Blind, Randomized Clinical Trial

To examine the effect of tourniquet use in arthroscopic anterior cruciate ligament reconstruction in terms of: (1) intraoperative visualization with operative time and consumption of sterile saline, and (2) intra- and postoperative blood loss, postoperative pain, opioid consumption, swelling, serum creatine phosphokinase (CPK) and hemoglobin (Hb) concentrations, clinical outcomes, and graft healing. In this prospective randomized clinical trial, patients were assigned to tourniquet inflation (tourniquet-up) or tourniquet deflation (tourniquet-down) groups. Primary outcomes were intraoperative visualization with operative time and sterile saline consumption. Secondary outcomes were intra- and postoperative blood loss, postoperative pain, opioid consumption, swelling, serum CPK, Hb concentration, subjective and objective functional scores, and graft healing. Intraoperative visualization was satisfactory in 100 of 100 cases in the tourniquet-up group and 64 of 100 cases in the tourniquet-down group (P < .05). The mean operative time was 58.4 ± 5.7 minutes in the tourniquet-up group and 72.5 ± 8.6 minutes in the tourniquet-down group (P < .05). The mean sterile saline consumption was 6.4 ± 2.5 L in the tourniquet-up group and 8.7 ± 4.6 L in the tourniquet-down group (P < .05). The respective amounts of estimated intraoperative and postoperative blood loss were 95.3 ± 25.1 mL and 240.3 ± 44.5 mL in the tourniquet-up group and 230.2 ± 22.3 mL and 75.6 ± 15.3 mL in the tourniquet-down group (P < .05). Our results showed no significant difference in postoperative pain, opioid consumption, percentage of patients using opioids, swelling, mean serum CPK and Hb levels, subjective and objective functional scores, or graft healing (P > .05) between the 2 groups. Tourniquet use during anterior cruciate ligament reconstruction significantly improves intraoperative visualization, shortens operative time, and decreases intraoperative sterile saline consumption and blood loss without serious adverse events or greater complication rates based on early postoperative outcomes. Level I, randomized controlled trial.

Demographic, clinical, and laboratory findings of mushroom-poisoned patients in Kermanshah province, west of Iran.

BackgroundMushroom poisoning can cause gastrointestinal, renal, and hepatic symptoms and even death. This descriptive study examined the demographic, clinical, and laboratory findings of patients with fungal poisoning, a type of fungus causing the poisoning, and the incidence and mortality rates of fungal poisoning in Kermanshah province, western Iran, from 2014 to 2018.MethodsThe medical records of 193 patients with mushroom poisoning from 2014 to 2018 were evaluated. The liver and kidney function tests, electrolytes, abdominal and pelvic ultrasound, chest x-ray, coagulation tests, and coagulation factors (fibrinogen, prothrombin) were assessed. Data were collected from the medical records of patients admitted to the Poisoning Center of Imam Khomeini Hospital in Kermanshah, Iran using a researcher-made checklist. Data were analyzed by SPSS (version 16) using descriptive statistics, including mean, standard deviation, and frequency distribution tables. Trend analysis for proportion was done by chi-square statistics in STATA-14 software (ptrend command).ResultsOf cases, ‌51.3% were male, 92.6% were city dwellers, 38.3% were aged 21–40 years, and 92.5% were poisoned during the spring. The fungus that caused poisoning was Amanita virosa. The gastrointestinal, nervous, and visual systems were the most common systems involved. The most common gastrointestinal symptoms included nausea and vomiting (72.0%) and abdominal pain (71.0%). Vertigo (11.9%) and headache (9.3%) were the most common neurological symptoms. The most common visual manifestation was blurred vision (7.8%). Of cases, 23.7% had metabolic acidosis. The increased alkaline phosphatase level was the most common liver disorder in 98.7% of the cases. Increased blood urea nitrogen and creatinine levels were also reported in 21.0% and 17.7% of the cases, respectively. The serum lactic dehydrogenase and creatine phosphokinase levels also increased in 99.3% and 30.2% of the patients, respectively. The mortality rate was 1.6% (n = 3).ConclusionThe fungal poisoning diagnosis should always be considered in young patients referred to the emergency department with gastrointestinal complaints, a history of consuming wild self-picked mushrooms, and high liver and kidney test values. Since most fungal poisonings occur in the spring, it is necessary to inform the community of the dangers of consuming self-picked wild mushrooms, especially in this season.

Homoeopathic Management of Duchenne Muscular Dystrophy: A Case Report

Abstract Background Duchenne muscular dystrophy (DMD) is a hereditary disorder having a significant socioeconomic burden. Primary abnormality may be in muscle membrane, due to the alterations of dystrophin protein. The patient usually has trouble in muscular activities like running, climbing staircases, jumping, getting up from the ground, suffers from frequent falls and gait abnormality. Owing to the limited therapeutic modality for DMD in conventional medicine, an alternative approach is warranted. Case Report An 8-year-old male child presented with unsteady gait, frequent falls, polymyalgia and weakness of limbs. Based on the clinical presentation and laboratory investigations, we diagnosed the case as DMD. On laboratory investigation, the serum creatine phosphokinase (CPK) level was significantly raised. After a thorough clinical evaluation, he was treated with Radium bromide, Veratrum viride and Calcarea phosphorica at different time points. Clinically, the improvement was marked in regard to symptomatology and reduced serum CPK level. Conclusion This is the first case demonstrating a favourable therapeutic course of homoeopathic treatment in DMD. For any further conclusion regarding the causal attribution, an individualistic n-of-1 trial may be warranted.