Serum Creatine Phosphokinase Levels Research Articles

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.

Prevalence of peripheral neuropathy and myopathy in patients post-COVID-19 infection.

BackgroundSevere acute respiratory syndrome (SARS‐CoV‐2), caused by the Coronavirus 2019 (COVID‐19), has become a life‐threatening epidemic, affecting multiple organs, including the nervous system. Recent studies have documented that COVID‐19‐associated peripheral neuropathy is a common and frequent problem, with central and peripheral nervous system complications.ObjectiveThis work aims to evaluate the peripheral nerves and muscle involvement after COVID‐19 infection, in addition to studying the prevalence rate and risk factors of their affection.MethodsThe study involved 400 patients, divided into 2 groups, with a history of COVID‐19 infection with or without symptoms of neuromuscular affection, and 30 gender‐ and age‐matched healthy volunteers were involved as controls. They were referred to the Department of Rheumatology and Rehabilitation for electro‐diagnosis. All participants performed complete clinical examination and laboratory measures with an electrophysiological study.ResultsThe prevalence of peripheral neuropathy and myopathy in post‐COVID‐19 patients was 56.3% among all patients. A significant difference was detected among patients of both groups regarding serum creatine phosphokinase level, clinical signs, and electrophysiologic findings of neuropathy and myopathy compared to the control group, with more prominent features among the symptomatic group. Histories of hospitalization, severe and long‐lasting respiratory symptoms were risk factors for developing neuromuscular complications.ConclusionsThe present study could indicate that muscle involvement and peripheral nerve affection are common problems even among asymptomatic patients after COVID‐19 infection, especially in the presence of any risk factors.

The Association of Serum Creatine Phosphokinase Levels with Severity of Lung Involvement and Hypoxia in Patients with COVID-19

Background: An increase in the serum levels of creatine phosphokinase (CPK) could be associated with an unfavorable clinical outcome in coronavirus disease (COVID-19) patients; however, detailed information on this association is scarce. The aim of this study was to investigate upon admission CPK serum level and its relationship with the degree of involvement in chest computed tomography (CT) scans and hypoxia in patients with COVID-19. Methods: This cross-sectional survey was conducted on 191 COVID-19 patients who were referred to a major respiratory referral center in Tehran, Iran, in 2019. CPK serum level, oxygen saturation, blood pressure, temperature, and severity of lung involvement (based on lung CT scan) were measured. The severity of lung involvement in cuts of CT imaging was reported with a score between 1 and 4. The descriptive and relational statistics were conducted using Pearson's correlation coefficient and one-way analysis of variance. Results: The average age of the patients was 55.22 ± 15.39 years, and the male was predominant in gender (65.4%). There was a statistically significant relationship between CPK serum level and the severity of lung involvement in patients with COVID-19 (P = 0.04). Furthermore, a significant and reverse correlation was observed between CPK serum level and oxygen saturation in the patients (r = –0.160, P = 0.04). Conclusion: The results of this study showed that COVID-19 patients with elevated CPK levels upon admission are prone to more severe lung involvement, worsening oxygenation, and respiratory failure. Hence, considering the initial critical care strategies for such patients could be of the essence.

A study to correlate serum pseudocholinesterase and serum creatine phosphokinase levels in acute organophosphorus poisoning with respect to Peradeniya organophosphorus poisoning scale

Background: Organophosphorus insecticides are one of the most common causes of poisoning in India. It has a high mortality rate and accounts for a third of suicidal deaths in south-east Asia.Methods: The objectives were to estimate serum pseudocholinesterase and creatine phosphokinase (CPK) levels in organophosphorus poisoning and correlate them with the severity and prognosis described by the Peradeniya organophosphorus poisoning (POP) scale at initial presentation. This was a cross-sectional study conducted over 18 months. A total of 180 organophosphorus-poisoning subjects were divided into mild, moderate and severe grades based on POP scale at admission. Serum pseudocholinesterase and CPK levels were estimated at admission. The outcome was noted, and the results were statistically analysed.Results: It was found that 112 (62.2%), 51 (28.3%) and 17 (9.4%) patients had mild, moderate and severe poisoning, respectively, according to POP scale. Mean pseudocholinesterase level (units/litre) was 2393.29, 1104.37 and 638.18 and mean serum CPK level (units/ litre) was 153.41, 344.94 and 280.53 in mild, moderate and severe poisoning, respectively. ICU and ventilator were required for 84 (46.75%) and 72 (40%) patients, respectively. Mortality was 17.8%. Negative, weak and significant correlation was seen between POP score and pseudocholinesterase (r=-0.265, p=0.00). Positive, moderate and significant correlation was seen between POP score and CPK levels (r=0.449, p=0.00).Conclusions: POP scale applied at admission along with serum pseudocholinesterase and CPK levels serve as a simple and effective system to determine early need for ventilation and mortality in rural, peripheral centres in developing nations.

Magnolol reduces myocardial injury induced by renal ischemia and reperfusion.

Magnolol is a component of the bark of Magnolia officinalis, which is a traditional herbal remedy used in China. In this study, we investigated whether magnolol can reduce myocardial injury induced by renal ischemia and reperfusion (I/R). Renal I/R was elicited by a 60-minute occlusion of the bilateral renal arteries and a 24-hour reperfusion in Sprague-Dawley rats. Magnolol was administered intravenously 10 minutes before renal I/R to evaluate its effects on myocardial injury induced by renal I/R. Renal I/R significantly increased the serum levels of creatine phosphokinase (CPK), lactate dehydrogenase (LDH), and cardiac troponin I and caused myocardial damage. The terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling-positive nuclei and caspase-3 activation was significantly increased in the myocardium, indicating increase of apoptosis. Echocardiography revealed left ventricular dysfunction, as evidenced by reduction of left ventricular ejection fraction and left ventricular fractional shortening. Furthermore, serum levels of tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, and IL-6 were significantly elevated, while the IL-10 level was suppressed. However, intravenously, pretreatment with magnolol at doses of 0.003 and 0.006 mg/kg 10 minutes before renal I/R significantly prevented the increases of CPK, LDH, and cardiac troponin I levels, as well as the histological damage and the apoptosis in the myocardium. Echocardiography showed significant improvement of left ventricular function. Furthermore, the increases in TNF-α, IL-1β, and IL-6 and the decrease in IL-10 were significantly limited, while Bcl-2 was increased and Bax was decreased in the myocardium. Phosphorylation of Akt and extracellular signal-regulated kinases 1 and 2 was increased, while phosphorylation of p38 and c-Jun N-terminal kinase was reduced. Magnolol reduces myocardial injury induced by renal I/R. The underlying mechanisms for this effect might be related to modulation of the production of pro- and anti-inflammatory cytokines and the limiting of apoptosis.

Are Chronic Pain Syndromes the Reason for Statin-Associated Muscle Symptoms?

Background: Statin induced myalgia is defined as muscle pain without elevation of serum creatine phosphokinase levels, and is a well-known complaint among statin users. Chronic pain syndromes affect a high percentage of the population; and it may be possible that these pain syndromes confound the reports of statin induced myalgia. We sought to compare the occurrence of chronic pain among patients on statin therapy who developed myalgia with those who did not. Methods: This study included 112 statin-treated patients, followed up at the clinic of the Lipid Center in Sheba Medical Center. Fifty-six of the subjects had a diagnosis of statin associated muscle symptoms (SAMS) and 56 did not. Verified questionnaires were used to assess the diagnoses of fibromyalgia, pain intensity, functional impairment, anxiety and depression in the study population. Results: Patients with statin myalgia were more likely to fulfil the diagnostic criteria for fibromyalgia than patients without statin myalgia (11 (19.6%) vs. zero, respectively). Patients in the SAMS group also exhibited higher levels of anxiety and depression in comparison with the control group. Female sex, higher scores on the Brief Pain Inventory pain intensity scale, and a Hamilton rating scale level indicative of an anxiety disorder were found to be significant predictors for fibromyalgia in patients suffering from statin myalgia. Conclusion: A significant percentage of patients, diagnosed with statin myalgia actually fulfilled the diagnostic criteria for fibromyalgia, depression or anxiety disorder. Detection of these patients and treatment of their primary pain disorder or psychiatric illness has the potential to prevent unnecessary cessation of effective statin therapy.

Study of serum creatine phosphokinase (CPK) as a prognostic indicator in patients with organophosphorus compound poisoning

Organophosphorus (OP) is an easily accessible pesticide which has a high morbidity and mortality on human exposure. Serum cholinesterase (SChE) is usually used for assessing the severity of poisoning, in this study we assess the role of serum creatine phosphokinase (CPK) as an alternative prognostic marker. This was a single centred, hospital-based, prospective and observational study, conducted on 88 patients with a history of OP compound consumption who were admitted to the ICU of tertiary care hospital, from the time period October 2019 to March 2021. The patients were clinically categorized into mild, moderate and severe categories according to Peradeniya Organophosphorus Poisoning (POP) scale and before initiation of treatment, the samples were sent for estimation of SChE and serum CPK. Out of the 88 patients, OP poisoning was more common in the age group of 21-30 years and males had a higher incidence. Chlorpyriphos (62.5%) was the most common compound. A higher POP score, marked reduction in SChE levels, and increased serum CPK levels were observed to have increased the duration of hospital stay, increased the severity of poisoning, increased the need for ventilator support and also increased the mortality.

Relation between Serum Creatine Phosphokinase Levels and Acute Kidney Injury among ST-Segment Elevation Myocardial Infarction Patients.

Background: Among patients with rhabdomyolysis, the leakage of intracellular skeletal muscle content such as creatine phosphokinase (CPK) into the bloodstream has been associated with an increased risk of acute kidney injury (AKI). We evaluated the possible relationship between serum CPK levels and AKI occurrence among patients with myocyte injury secondary to ST-elevation myocardial infarction (STEMI). Methods: We retrospectively included 2794 patients with STEMI. Patients were stratified according to peak serum CPK levels into mild (<1000 U/L, n = 1603), moderate (1000–5000 U/L, n = 1111), and severe (>5000 U/L, n = 80) categories. The occurrence of AKI was defined by the KDIGO criteria as an increase in serum creatinine (sCR) ≥0.3 mg/dL within 48 h following PCI. The predictive value of CPK for the risk of AKI occurrence was assessed using multivariate logistic regression models. Results: The overall occurrence of AKI was 10.4%. Incidence of AKI showed a gradual increase between patients with mild, moderate, and severe serum CPK level elevations (7.8% vs. 11% vs. 26% respectively; p < 0.001). In multivariate logistic regression models, both moderate or higher (OR 1.6, 95% CI 1.1–2.2; p = 0.01) and severe (OR 2.8 95% CI 1.4–5.6; p = 0.004) serum CPK level elevations were independently associated with AKI. Conclusions: Among STEMI patients, elevated CPK levels were associated with AKI. This association is presumably independent; however, it remains unclear whether it is due to direct toxic (myoglobin-related) or hemodynamic effects (poor left ventricular function). Further studies are required to reveal the underlying mechanism.

Comparison of Primary Versus Revision Lumbar Discectomy Using a Biportal Endoscopic Technique.

Retrospective study. To compare the clinical outcomes of the biportal endoscopic technique for primary lumbar discectomy (BE-LD) and revision lumbar discectomy (BE-RLD). Eighty-one consecutive patients who underwent BE-LD or BE-RLD, and could be followed up for at least 12months were divided into two groups: Group A (BE-LD; n = 59) and Group B (BE-RLD; n = 22). Clinical outcomes included the visual analog scale (VAS), Oswestry Disability Index (ODI), and modified MacNab's criteria. Perioperative results included operation time (OT), length of hospital stay (LOS), amount of surgical drain, and kinetics of serum creatine phosphokinase (CPK) and C-reactive protein (CRP). Clinical and perioperative outcomes were assessed preoperatively and postoperatively at 2days and at 3, 6, and 12months. Postoperative complications were noted. Both groups showed significant improvement in pain (VAS) and disability (ODI) compared to baseline values at postoperative day 2, which lasted until the final follow-up. There were no significant differences in the improvement of the VAS and ODI scores between the groups. According to the modified MacNab's criteria, 88.1 and 90.9% of the patients were excellent or good in groups A and B, respectively. OT, LOS, amount of surgical drain, and kinetics in serum CRP and CPK levels were comparable. Complications in Group A included incidental durotomy (n = 2), epidural hematoma (n = 1), and local recurrence (n = 1) and in Group B incidental durotomy (n = 1) and epidural hematoma (n = 1). BE-RLD showed favorable clinical outcomes, less postoperative pain, and early laboratory recovery equivalent to BE-LD.

Effects of swimming training on myocardial protection in rats.

Swimming is important for promoting and maintaining health, as it can increase the efficiency of the cardiovascular system and decrease the occurrence of cardiovascular diseases. The objective of the present study was to examine whether swimming training could decrease myocardial injury in rats caused by myocardial ischemia/reperfusion (I/R). Sprague-Dawley rats were randomized into four groups, namely the Sham, coronary artery occlusion, swimming training and ischemic preconditioning (IPC) groups. Myocardial I/R was induced in anesthetized male Sprague-Dawley rats by a 40-min occlusion followed by a 3-h reperfusion of the left anterior descending coronary artery. The rats were sacrificed after surgery and their hearts were examined. The results demonstrated that the number of TUNEL-positive nuclei and degree of caspase-3 activation were both significantly increased in the myocardium following myocardial I/R in rats, indicating increased cardiomyocyte apoptosis. On the other hand, swimming training decreased the serum levels of creatine phosphokinase, lactate dehydrogenase and cardiac troponin I, and was associated with reduced histological damage and myocardial infarct size. Furthermore, swimming training also reduced TNF-α levels, caspase-3 activation and enhanced Bcl-2 activation, which decreased the number of apoptotic cells in the myocardium. The findings of the present study showed that swimming training and IPC could similarly decrease myocardial injury following myocardial I/R, and may therefore be used as exercise training to effectively prevent myocardial injury.

English

BACKGROUND Organophosphorus poisoning is possibly the most common acute poisoning in the developing countries and is a global health problem.1,2 Between 750,000 and 3,000,000 of OP poisoning occur globally every year.3 OP insecticides bind and irreversibly inhibit butyrylcholinesterase. These compounds cause excessive stimulation of muscarinic and nicotinic cholinergic receptors in the central and autonomic nervous systems and at skeletal neuromuscular junctions.4 Butyrylcholinesterase (BChE) is also known as pseudocholinesterase.5 Due to the limitations in accuracy and cost of plasma pseudocholinesterase level estimation, alternate biochemical marker options for OP poisoning have been studied for evaluation of patients with OP poisoning. Increased creatine phosphokinase (CPK) levels are seen in OP poisoning in early phase.6,7 This study was conducted to correlate initial serum CPK levels with the clinical severity at presentation and the final clinical outcome. METHODS This descriptive study was carried out after reviewing case records of patients &gt;/= 18 years with acute organophosphorus (OP) poisoning who were admitted under the Internal medicine department of Government Medical College Thiruvananthapuram between January 2019 and December 2019. The severity of poisoning was categorized based on Peradeniya organophosphorus poisoning (POP) scale. Serum CPK level, serum pseudocholinesterase, and total dose of atropine in milligrams until the outcome in the hospital were recorded. The student's t-test and Pearson's correlation coefficient were used for the assessment of statistical significance. RESULTS Clinical severity as per POP SCALE was mild (score 0–3) in 24 (27 %), moderate (score 4–7) in 50 (55.81 %) and severe (score 8–11) in 16 (18 %) patients. Serum CPK, serum pseudocholinesterase level, and total atropine dose strongly correlated with clinical severity of OP poisoning. Our study strongly recommends serum CPK as an alternative marker. CONCLUSIONS Serum CPK level can be an effective biomarker in acute OP poisoning because its level can predict the prognosis of OP poisoning. KEY WORDS Creatine Phosphokinase, Organophosphorus Poisoning, Severity.

Percutaneous Full-Endoscopic versus Biportal Endoscopic Posterior Cervical Foraminotomy for Unilateral Cervical Foraminal Disc Disease.

The biportal endoscopic technique (BE) is a fast-growing surgical modality that can be applied to posterior cervical foraminotomy (PCF), as well as lumbar discectomy and decompressive laminectomy. It has several technical differences from the percutaneous full-endoscopic technique (PE), which has been standardized as the representative endoscopic spinal surgery technique. The purpose of this study was to compare the short-term clinical outcomes between BE-PCF and PE-PCF. A retrospective review was conducted on 66 patients who had single-level unilateral cervical foraminal disc disease (UCFD). All patients underwent PE- or BE-PCF. Clinical outcomes including visual analog scale (VAS)-arm, VAS-neck, and Neck Disability Index (NDI) were evaluated. Perioperative data including operation time, length of hospital stay (LOS), amount of surgical drain, postoperative complications, and reoperation were collected. Serum creatine phosphokinase (CPK) and C-reactive protein (CRP) levels were recorded. A total of 65 patients were included in the final analysis: 32 with PE-PCF and 33 with BE-PCF. There was no statistically significant difference in demographic and preoperative data between the two groups. All patients had significant improvement in VAS-arm, VAS-neck, and NDI compared to the baseline value. The improvement of all parameters was comparable between the two groups at each point for 1 year after surgery (p > 0.05), except for the significantly lower VAS-neck at postoperative 2 days in PE-PCF (p = 0.005). The total operation time was significantly shorter in BE-PCF (p = 0.036). There were no statistically significant differences between the two groups in regard to LOS, amount of surgical drain, and serum CPK and CRP levels (p > 0.05). Reoperation and complications between the two groups were comparable (p > 0.05). The 1-year postoperative clinical outcomes of PE-PCF and BE-PCF for cervical pain and disability caused by UCFD were good and comparable. PE-PCF resulted in significantly less immediate postoperative neck pain, but BE-PCF required shorter total operation time.

Is Serum Creatine Phosphokinase Level Useful to Predict the Severity of Organophosphate Poisoning?

Organophosphate poisoning is a global health burden due to intentional and occupational exposure, particularly in Asian countries. Patients are usually monitored through serum acetylcholinesterase levels. Still, it is non-specific, does not correlate well with the severity of poisoning, and is not widely available in laboratory settings in developing countries. This study aims to assess serum baseline creatine phosphokinase (CPK) levels as a prognostic biomarker in acute organophosphate poisoning. We recruited all patients older than 12 years who were admitted to the wards of the Indoor Medicine Ward in Burdwan Medical College and Hospital in West Bengal (India) because of ingestion or inhalation of organophosphorus compounds within the previous 12 hours between May 1, 2019, and November 1, 2020. Clinical severity was categorized according to Peradeniya organophosphorus poisoning (POP) scale. Serum CPK, pseudocholinesterase levels, and pH were measured. Levels were reassessed on days three and seven, and patients were followed-up until death or discharge. 100 patients (68 men and 32 women) were included in the study. Most of them presented with miosis (98%), followed by abdominal pain (96%), diarrhea (78%), and vomiting (52%). In the multivariate analysis, the patients with a higher risk of being intubated were younger. Of the analytical levels, the one that showed a better relationship with the risk of intubation was the pseudocholinesterase level, although without statistical significance. Initial CPK levels, time of admission, or stratification on the POP severity scale, offered poor performance after adjustment. The analytical values of CPK or the POP severity scale at the time the patient presents in the emergency room have limited value to predict the final severity of the picture. The amount of the poison consumed should be collected for future studies to elucidate these differences.

Sodium dithionate (Na2S2O4) induces oxidative damage in mice mitochondria heart tissue

Sodium dithionite (Na2S2O4) is an inorganic sodium salt, a bleaching agent that has a reducing agent role and is generally used as food additive or preservative in the production of diverse foods and beverages. The aim of this study is to determine the effects of Na2S2O4 on cardiac mitochondria damage and biochemical parameters in male mice. Na2S2O4 were administered orally at doses of 10, 20, 50 and 100 mg/kg to male mice for 45 days. Heart mitochondria were isolated for the evaluation of oxidative stress biomarkers such as mitochondrial function, reactive oxygen species (ROS), lipid peroxidation (LPO), protein carbonyl (PC) content, catalase activity (CAT) and glutathione content (GSH). Blood samples were collected and Creatine phosphokinase (CPK), Creatine kinase-MB (CK-MB) and Troponin I were quantified in the serum. Mitochondrial function was significantly (P < 0.001) decreased and oxidative stress biomarkers including, ROS, LPO and PC were significantly enhanced. Also, CAT activity and GSH content were significantly decreased by Na2S2O4-treated groups in heart mitochondria when compared to the control group. Na2S2O4 administration elevated the serum levels of CPK, CK-MB, and troponin I (especially, at high doses) compared with the control group. These findings suggest that Na2S2O4 induces mitochondria toxicity and cardiac damage especially at high doses with a dose-dependent manner.

SERUM CREATINE PHOSPHOKINASE ACTIVITY IN RABBIT DURING REGENERATION OF EXPERIMENTALLY DAMAGED MUSCLE TISSUE AND AFTER ITS STIMULATION BY TRANSPLANTED MSC

According to statistics, in modern veterinary practice, the percentage of muscle injuries among sport and working animals ranges from 40–70% of sports injuries. Quite often there are cases with muscle injuries of skeletal muscles, namely extremities. This scientific work describes the research methodology, stages of research step-by-step, and studies the relationship of dynamics of the activity of a single biochemical blood indicator. The essence of the method was to model the injury of muscle tissue performed by the skin and fascia dissection and cutting off in the area of midplane of the pelvic head of the biceps femoris muscle, measuring 1.5 x 1.5 cm to a depth of 1.5 cm of muscle tissue on 105 laboratory animals, divided into 4 groups with the use of various treatment methods. We analyze the results of one of the most effective biochemical methods for diagnosing muscle fiber of skeletal system damage and compare the activity of the enzyme creatine phosphokinase iso-enzyme depending on the stage of the study. Other research methods such as clinical, biochemical, ultrasonographic, histological research methods were recorded on 4, 7, 10, 14, 21, and 28 days. We analyzed the latest literature sources and concluded that on the 4th and 7th days, the level of creatine phosphokinase in the groups with intravenous administration, intramuscular administration of allogeneic mesenchymal stem cells is higher than the reference values but significantly lower compared to the control groups and the traditional method of treatment. But we observe a significant decrease in serum creatine phosphokinase levels in crawls on 10th day in the intravenous administration group compared to the control group of animals in 2 times, compared to traditional treatment in 1.6 times. The group of animals with intramuscular administration has reference values on the 14th day, compared with the control in 1.3 times lower, traditional treatment in 1.2 times. And on 21th day, we get reference values for a group of animals with traditional treatment. The level of creatine phosphokinase activity decreases in the control group of animals on 28th day of the research, which indicates a complete muscle rupture. The results of studies showed that the highest activity of the creatine phosphokinase enzyme during the study was shown by groups of animals with control and traditional treatment, which indicated significant structural, functional and destructive disorders of the muscle fibers of skeletal tissues with severe trauma. Thus, it is noted that the activity of the enzyme in conditions of damage of skeletal muscle tends to increase in accordance with the severity of the injury.

Uniportal Endoscopic Interlaminar Decompression in Lumbar Spinal Stenosis: A Comprehensive Review.

From the 1990s, there has been growth in the literature demonstrating the feasibility of minimally invasive approaches for treating variety lumbar spinal disorders. There is still much work to be done in overcoming the technical challenges and explicate relative advantages of endoscopic techniques in lumbar spine surgery. In this comprehensive literature review, we discuss the history, indications, contraindications, surgical techniques, learning curves, technical tips, adverse events, and examine peer-reviewed studies addressing uniportal endoscopic interlaminar decompression in lumbar spinal surgery. This literature review was conducted with keywords "endoscopic," "minimally invasive," "uniportal endoscopic decompression," "interlaminar decompression," and "lumbar spinal surgery" using PubMed, Embase, ClinicalKey, and Google Scholar. Review of 423 patients who underwent uniportal endoscopic interlaminar lumbar decompression showed satisfying results with 82% of patients no longer having leg pain, and 13% of patients having only occasional pain, with no significant operation-related deterioration in leg or back pain. To compare the outcomes between endoscopic and microscopic technique, a comparative review of 192 lumbar lateral recess stenosis patients demonstrated the uniportal endoscopic group had 29% shorter operation duration, 1.2% fewer perioperative complications, and significantly reduced postoperative pain (visual analog scale) over 5 days, and reduced use of pain medications. Multiple retrospective studies echoed the outcomes of endoscopic decompression surgery, showed shorter hospitalization time, lower mean dural expansion, lower increment of horizontal displacement measured, and less elevated levels of postoperative serum CPK (creatine phosphokinase) and CRP (c-reactive protein). Lastly, a systematic review and meta-analysis that enrolled 994 patients found that patients who received the full-endoscopic decompression technique showed statistically lower levels of back pain and leg pain and a 40% lower chance of having complications compared with those receiving microscopic decompression in lumbar stenosis. Based on our literature review, there are multiple positive outcomes with endoscopic interlaminar lumbar decompression, which reduces operation duration, perioperative complications, and better postoperative outcomes. However, the technical challenge highlights the importance of further training and innovation in this rapidly evolving field.