Serum Creatine Phosphokinase Levels Research Articles

Comparative efficacy of unilateral biportal endoscopic and full-endoscopic posterior cervical foraminotomy in the treatment of cervical spondylotic radiculopathy: a retrospective analysis.

The aim of this study was to compare the clinical efficacy of the full-endoscopic posterior cervical foraminotomy (FE-PCF) and the unilateral biportal endoscopic posterior cervical foraminotomy (UBE-PCF) in the treatment of cervical spondylotic radiculopathy (CSR). Patients who underwent posterior cervical spine surgery in our hospital from January 2020 to December 2022 were retrospectively analyzed. According to the surgical method, the patients were divided into two groups: FE-PCF group and UBE-PCF group. Perioperative data included operation time, Intraoperative blood loss and postoperative hospital stay were collected. The Visual Analog Scale (VAS)-arm, VAS-neck, and Neck Diability Index (NDI) was used to evaluate the clinical outcomes at preoperative, postoperative 1 week and Last follow-up. Serum creatine phosphokinase (CPK) and C-reactive protein (CRP) levels were recorded to evaluate surgical invasiveness. A total of 160 patients were included, including 89 cases of FE-PCF and 71 cases of UBE-PCF. The demographic and preoperative data showed no significant differences between the two groups (P > 0.05). The mean operating time was significantly shorter in the UBE-PCF group compared to FE-PCF group (P < 0.05). Serum CRP and CPK levels of the two groups both exhibited a pattern of rising and then falling, peaking one day following surgery and decreasing to near normal values three days after the operation. Compared with preoperative, both groups showed significant improvement in postoperative VAS and NDI scores, with a statistically significant difference (P < 0.05). However, the differences in results between the groups were not significant. Both UBE-PCF and FE-PCF are secure and efficient methods for treating CSR by continuous visualization. UBE-PCF offers predictable and adequate decompression within a reduced surgical duration, facilitated by its separate observation and operation channels.

Application and clinical effects in lung bullae resection of CT 3-dimensional reconstruction.

To investigate the value and clinical effect of computed tomography (CT) 3-dimensional reconstruction technology in lung bullae resection. Ninety-eight patients who underwent thoracoscopic surgical resection of lung bullae in our hospital from February 2019 to February 2023 were selected and divided into 2 groups according to the principle of voluntary participation in the clinical trial, of which 43 cases underwent preoperative spiral CT for thin-layer enhancement or planar CT scanning of lung bullae (control group), and 43 cases were imaged with MimicsMedical 21 software for 3-dimensional reconstruction to develop a surgical plan (observation group). To compare the surgery-related indexes, postoperative complications, pain, and analgesic use between the 2 groups, we measured serum creatine phosphokinase and myoglobin levels. The amount of surgical bleeding, drainage volume, hospital stay, and postoperative visual analog scale score of the research group were lower than those of the control group (P < .05), and the duration of analgesic medication was shorter than that of the control group (P < .05), and the levels of serum creatine phosphokinase and myoglobin were lower than those of the control group at 1 and 3 days postoperatively, and the differences were statistically significant (P < .05). Preoperative CT 3-dimensional reconstruction technique can clearly show the anatomical structures around the lung bullae and has its application value for precise lung bullae.

Evaluation of the Clinical and Paraclinical Symptoms of Children Intoxicated With Amphetamines in Akbar Hospital of Mashhad, Iran 2021-2022.

Amphetamine poisoning in children is a significant public health concern due to its potential for severe adverse effects on physical and mental health. In this article, we describe a case series of 29 children under the age of 14 presenting with sympathomimetic toxidrome due to confirmed amphetamine poisoning. In this cross-sectional study, children (1 month to 14 years old) who were hospitalized in the emergency and pediatric departments of Imam Reza and Akbar Hospital in Mashhad from the beginning of April 2021 to September 2022 were identified with the diagnosis of amphetamine poisoning. Their demographic, clinical, and paraclinical (laboratory and electrocardiogram) information, which was included in the relevant checklists, were analyzed and reported. Out of 29 children included in the study, 18 (62%) were male and the rest were female. The average age of children was 44.75 ±43.9 months; most of them were less than 4 years old. In all patients, glasgow coma scale (GCS) was 15. In 25.92% of cases (8 patients) blood pressure was above the 90% percentile for age and sex, 82.60% (24 cases) were tachycardia, 72.41% crying (21 cases), 86.20% were restless (25 cases), 10.34% tremor (3 cases), 10.34% had body pain (3 cases), and 6.89% (2 cases) had delusions. None of the subjects had a seizure. The serum level of creatine phosphokinase was on average 771.99 ± 966 units/L. All children had an increase in creatine phosphokinase (CPK) and 25.9% of children had an increase in CPK to more than 1000 units/L. Based on the results, in children with symptoms such as restlessness, crying, and tachycardia, poisoning with amphetamine group substances should be included in the differential diagnosis list, and also measuring CPK and investigating the possible occurrence of rhabdomyolysis in cases of poisoning of children with amphetamine seems necessary.

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 Türkiye earthquake.

Two earthquakes on 6 February 2023 destroyed 10 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. Web-based software was prepared. Patient demographics, time under rubble (TUR), admission laboratory data, dialysis, and kidney and overall outcomes were recorded. A total of 903 injured children (median age 11.62years) were evaluated. Mean TUR was 13h (interquartile range 32.5, max 240h). Thirty-one of 32 patients with a TUR of >120h survived. The patient who was rescued after 10days survived. Two-thirds of the patients were given 50mEq/L sodium bicarbonate in 0.45% sodium chloride solution on admission day. Fifty-eight percent of patients were given intravenous fluid (IVF) at a volume of 2000-3000mL/m2 body surface area (BSA), 40% at 3000-4000mL/m2 BSA and only 2% at >4000mL/m2 BSA. A total of 425 patients had surgeries, and 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). In all, 189 patients were dialyzed. Age >15years, creatine phosphokinase (CK) ≥20950U/L, TUR ≥10h and the first-day IVF volume <3000-4000mL/m2 BSA were associated with Crush-AKI development. Twenty-two deaths were recorded, 20 of 22 occurring in patients with Crush-AKI and within the first 4days of admission. All patients admitted after 7days survived. These are the most extensive pediatric kidney disaster data obtained 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 associated with Crush-AKI. Given that mildly injured victims can survive longer periods in the disaster field, we suggest uninterrupted rescue activity for at least 10days.

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.

Prevalence of COVID-19 neurological manifestations in patients referred to the Golestan Hospital in Ahvaz between March 2020 to the March 2023.

Due to the abundance of ACE2 receptors in nervous system cells, the SARS-CoV-2 virus can cause damage to this system. This study aims to examine the prevalence of neurological symptoms in COVID-19 patients. In this cross-sectional observational study, 75 COVID-19 positive patients admitted to Golestan Hospital's neurology department in Ahvaz, Iran, from March 2020 to March 2023, were investigated. Neurological clinical symptoms were categorized into three groups: central nervous system, peripheral, and muscular symptoms. The relevant information was collected from patient files, including medical history, imaging data, and laboratory test results. Statistical analysis was performed using SPSS software, employing the rank-biserial correlation coefficient (r), Mann-Whitney U tests, Phi correlation, Cramer's V, and Kendall's Tau to evaluate the prevalence and significance of neurological symptoms. The most common clinical symptoms observed were hemiparesis, dysarthria, Central Facial Palsy (CFP), ataxia, and nausea, respectively. Among these symptoms, headaches (p = 0.001), seizures (p = 0.024), and nausea (p = 0.046) were found to be more prevalent in younger patients. Additionally, a significant relationship was identified between the level of serum Creatine phosphokinase (CPK) and seizures (p = 0.024), with lower levels observed in individuals with vomiting (p = 0.024), and higher levels observed in individuals with CFP (p = 0.040). This study highlights that patients with COVID-19 may experience serious neurological symptoms. The clinical spectrum and range of neurological symptoms associated with COVID-19 were found to be diverse and extensive, emphasizing the importance of considering this infection as a potential cause of neurological disorders.

Acute kidney injury due to rhabdomyolysis in a patient with primary hypothyroidism

ABSTRACT Acute kidney injury (AKI), secondary to rhabdomyolysis (RM) following strenuous work with primary hypothyroidism, is rare. Here, is a case report of a 32-year-old female who developed AKI following strenuous work in a paddy field in the background of overt primary hypothyroidism. High serum creatine phosphokinase levels and high concentration of myoglobin in urine were noted, which was suggestive of myoglobinuria due to severe RM and elevated creatine level in serum, which indicated AKI. The patient’s condition improved significantly after initiation of levothyroxine replacement therapy and hemodialysis. AKI secondary to RM with primary hypothyroidism and strenuous work as a precipitating factor is quite rare. We expect this case report to add to the existing literature on this subject.

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).