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Aims Musculoskeletal toxicity is a typical side effect of daptomycin (DAP). However, the risk factors have not been well established. Here, we aimed to identify independent factors affecting DAP-induced musculoskeletal toxicity using a combination of machine learning and conventional statistical methods. Methods A population-based, retrospective, observational cohort study was conducted using the Japanese electronic medical record database. Patients who received DAP between October 2011 and December 2020 were enrolled. Two definitions of musculoskeletal toxicity were employed: (1) elevation of creatine phosphokinase (CPK) value more than twice from baseline and >200 IU/L, and (2) >1000 IU/L. First, multiple logistic regression analyses (a conventional statistical method) were performed to identify independent factors affecting CPK elevation. Then, decision tree analyses, a machine learning method, were performed to detect combinations of factors that change CPK elevation risk. Results Of the 2970 patients who received DAP, 706 were included. Elevation of CPK values >200 IU/L and >1000 IU/L occurred in 83 (11.8%) and 17 (2.41%) patients, respectively. In multiple logistic regression analysis, baseline CPK value and concomitant use of hydrophobic statins were commonly extracted as independent factors affecting each CPK elevation, but concomitant use of hydrophilic statins was not. In decision tree analysis, patients who received hydrophobic statins and had high baseline CPK values were classified into the high-risk group. Conclusion Our novel approach revealed new risk factors for CPK elevation. Our findings suggest that high-risk patients require frequent CPK monitoring.

Background. The secondary traumatic brain injury (TBI) consequences are associated with multiple cascades of biochemical reactions caused by initial neurotrauma. We assessed changes in radical oxidation and marker membrane-associated enzymes involved into various redox reactions reflecting basic metabolic processes by measuring creatine phosphokinase (CPK), CPK-BB, adenosine triphosphate (ATP), adenosine diphosphate (ADP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase, lactate dehydrogenase (LDH) in the patients with long-term consequences after TBI. Materials and methods. Eighty-two patients (mean age (±SD) 39.04 ± 14.62 years), thirty controls (29.60 ± 4.73 years) were tested for serum CPK, CPK-BB, ATP, ADP measured using spectrophotometry methods according to standard manufacturer’s protocols. Serum AST, ALT, alkaline phosphatase, LDH levels were detected on gas-liquid chromatograph, by calorimetric methods. Results. We found elevated serum CPK level in patients with long-term consequences after TBI compared to controls (P < 0.001, t = 5.073, 95% CI –188.6 to –92.16) with the medians of total CPK of 163.5 ± 14.1 versus 92.6 ± 11.4 pg/ml in the basic and control groups, respectively. We found abnormal high serum CPK-BB level in the basic group with medians of total CPK-BB level of 24.7 ± 2.7 versus 16.14 ± 1.83 IU/L in controls (p < 0.05; t = 4.9). Metabolic changes in our patients were associated with higher LDH content being in direct proportion with disease duration (p < 0.05; r = +0.42); the median of total LDH level was 694.1 ± 16.3 and 381.9 IU/l in basic and control groups (p < 0.05), respectively. The patients investigated were detected with deficiency of macroergic compounds: ATP and ADP being in direct proportion with disease duration over 15 years (p < 0.05; r = +0.67); the medians of total ATP level were 627.60 ± 12.38 and 735.48 ± 14.57 μmol/l (p < 0.05) in the basic and control groups; for ADP: 256.20 ± ± 14.21 versus 273.88 ± 11.42 (p < 0.05), respectively. Conclusions. Patients with long-term consequences after TBI showed higher serum CPK level associated with increased LDH level reflecting bioenergy dyshomeostasis and severity of secondary brain injuries., Актуальность. Формирование отдаленных последствий закрытой черепно-мозговой травмы (ЗЧМТ) сопровождается каскадом биохимических реакций, которые инициируются первичной нейротравмой. Цель работы. Мы оценивали состояние и изменения радикального окисления и маркерных мембранасоциированных ферментов, которые участвуют в различных окислительно-восстановительных реакциях и отражают основные метаболические процессы организма, путем измерения уровней креатинфосфокиназы (КФК), КФК-ВВ, аденозинтрифосфата (АТФ), аденозиндифосфата (АДФ), аспартатаминотрансферазы (АСТ), аланинаминотрансферазы (АЛТ), щелочной фосфатазы, лактатдегидрогеназы (ЛДГ) у пациентов с отдаленными последствиями ЗЧМТ. Материалы и методы. Восемьдесят два больных (средний возраст (±SD) 39,04 ± 14,62 года), тридцать здоровых пациентов (29,60 ± 4,73 года) были протестированы на уровень КФК, КФК-BB, АТФ, АДФ, которые были определены в сыворотке крови спектрофотометрическим методом в соответствии с прилагаемыми стандартными инструкциями. АЛТ, АСТ, щелочная фосфатаза, ЛДГ были измерены хроматографическим и калориметрическим методами. Результаты. Был выявлен повышенный уровень КФК в сыворотке крови больных с отдаленными последствиями ЗЧМТ по сравнению с контролем (р < 0,001; t = 5,07), средний уровень КФК составлял 163,5 ± ± 14,1 против 92,6 ± 11,4 пг/мл у здоровых людей. Нами был выявлен очень высокий уровень КФК-BB в сыворотке крови в общей группе пациентов, у которых средний уровень КФК-BB составлял 24,7 ± 2,7 против 16,14 ± 1,83 МЕ/л в контрольной группе (р < 0,05; t = 4,9). Метаболические изменения у пациентов заключались в более высоких показателях ЛДГ, которые были прямо пропорциональны увеличению продолжительности посттравматического периода (p < 0,05; r = +0,42); в общей и контрольной группах средний уровень ЛДГ составлял 694,1 ± 16,3 и 381,9 МЕ/л соответственно (р, Актуальність. Формування віддалених наслідків закритої черепно-мозкової травми (ЗЧМТ) супроводжується каскадом біохімічних реакцій, які ініціюються первинною ней-ротравмою. Мета роботи. Ми оцінювали стан і зміни радикального окислення та маркерних мембранасоційованих ферментів, що беруть участь у різних окислювально-відновних реакціях та відображають основні метаболічні процеси організму, шляхом вимірювання рівнів креатинфосфокінази (КФК), КФК-ВВ, аденозинтрифосфату (АТФ), аденозиндифосфату (АДФ), аспартатамінотрансферази (AСT), аланінамінотрансферази (AЛT), лужної фосфатази, лактатдегідрогенази (ЛДГ) у пацієнтів із віддаленими наслідками після ЗЧМТ. Матеріали та методи. Вісімдесят два хворі (середній вік (±SD) 39,04 ± 14,62 року), тридцять здорових осіб (29,60 ± 4,73 року) були протестовані на рівень КФК, KФК-BB, ATФ, AДФ, що були вимірювані у сироватці крові спектрофотометричним методом згідно з доданими стандартними інструкціями. AЛT, AСT, лужна фосфатаза, ЛДГ були вимірювані хроматографічним та калориметричним методами. Результати. Було виявлено підвищений рівень КФК у сироватці крові хворих із віддаленими наслідками після ЗЧМТ порівняно з контролем (р < 0,001; t = 5,07), середній рівень КФК становив 163,5 ± 14,1 проти 92,6 ± 11,4 пг/мл у здорових осiб. Ми виявили дуже високий рівень KФК-BB у сироватці крові у загальній групі пацієнтів, де середній рівень KФК-BB становив 24,7 ± 2,7 проти 16,14 ± 1,83 МО/л у контрольній групі (р < 0,05; t = 4,9). Метаболічні зміни в пацієнтів полягали в більш високих показниках ЛДГ, які були прямо пропорційні збільшенню тривалості посттравматичного періоду (p < 0,05; r = +0,42); у загальній та контрольній групах середній рівень ЛДГ становив 694,1 ± 16,3 та 381,9 МО/л відповідно (р < 0,05). В обстежених хворих було виявлено дефіцит макроергічних сполук, а саме АТФ та АДФ, які знаходились у прямій залежності від тривалості захворювання, особливо понад 15 років (р < 0,05; r = +0,67); у загальній групі пацієнтів середній рівень АТФ становив 627,60 ± 12,38 мкмоль/л порівняно з 735,48 ± 14,57 мкмоль/л у групі контролю(р < 0,05); для AДФ: 256,20 ± 14,21 і 273,88 ± 11,42 (p < 0,05) відповідно. Висновки. У пацієнтів із віддаленими наслідками після ЗЧМТ були виявлені високий рівень загальної активності KФК у сироватці крові та підвищення рівня ЛДГ, що відображає біоенергетичний дисгомеостаз та тяжкість перебігу віддалених наслідків травми мозку.

Background: The value of creatine phosphokinase (CPK) monitoring during isotretinoin therapy is still a matter of debate because of the rarity of muscular and kidney damage in this setting. The aim of the study was to investigate the incidence of CPK elevation during a low starting dose isotretinoin regimen and to discuss the clinical approach to patients with increased CPK. Methods: We reviewed the records of the acne patients from 2015 to 2018 at the University of Ferrara and at the University of Modena and Reggio Emilia. Routine clinical and laboratory follow-up was analyzed. Results: The records of 328 patients were included in the study. Abnormal CPK levels were observed in 5.5% of cases. Revised Leeds acne scores and visual assessment scale (VAS) measurements decreased significantly after isotretinoin therapy. Discussion: The adoption of the low starting dose isotretinoin regimen is associated with low incidence of CPK elevation. The finding of CPK over the conventional value of 5 times above the limit was rarely observed and was never associated with kidney damage. Therefore, it should be interpreted as a relatively benign phenomenon that does not require the interruption of isotretinoin therapy and that should be managed mainly through the reassurance of the patient.

Background In this study, we investigated the risk factors for daptomycin-associated creatine phosphokinase (CPK) elevation and established a risk score for CPK elevation. Methods Patients who received daptomycin at our hospital were classified into the non-elevated or elevated CPK group based on their peak CPK levels during daptomycin therapy. Univariable and multivariable analyses were performed, and a risk score and prediction model for the incidence probability of CPK elevation were calculated based on logistic regression analysis. Results The non-elevated and elevated CPK groups included 181 and 17 patients, respectively. Logistic regression analysis revealed that concomitant statin use (odds ratio [OR], 4.45 [95% confidence interval {CI}, 1.40–14.47]; risk score 4), concomitant antihistamine use (OR, 5.66 [95% CI, 1.58–20.75]; risk score 4), and trough concentration (Cmin) between 20 and Conclusions These results suggested that concomitant use of statins with antihistamines and Cmin ≥20 µg/mL were risk factors for daptomycin-associated CPK elevation. Our prediction model might aid in reducing the incidence of daptomycin-associated CPK elevation.

Dengue fever is an arbovirus (dengue virus DEN) disease caused by bite of mosquitoes, affecting people worldwide but is frequently seen as pandemic in Latin America and Asian countries. Among children it has been the most frequent reason for hospitalization and mortality. Symptoms range from subclinical disease to severe flu-like illness including myalgias. Dengue commonly presents as myalgia but myositis and/or elevated serum creatine phosphokinase (CPK) is rarely witnessed in dengue fever. Therefore, we present a case of dengue fever presenting as myositis: muscle weakness with raised creatine phosphokinase (CPK).

Background The adverse drug reactions (ADRs) related to clonazepam are mild, and only two cases of myotoxicity induced by clonazepam have been reported, with both patients recovering well. We present a unique case of a serious ADR outcome after taking clonazepam. Case presentation A 24-year-old woman with a long-standing history of polio and a 2-year history of epilepsy developed a serious ADR after repeated exposure to oral clonazepam combined with sodium valproate that manifested as myotoxicity and elevated levels of creatine phosphokinase. The patient is currently bedridden and unable to take care of herself. Conclusion Clinicians should be vigilant of the possibility of myotoxicity induced by clonazepam, especially in specific populations such as polio patients or when clonazepam is used in combination therapies.

Background Paravertebral compartment syndrome occurring without trauma is quite rare. We report a case of compartment syndrome that occurred after spinal exercises. Case presentation A 23-year-old Japanese rower developed severe back pain and was unable to move 1 day after performing exercises for the spinal muscles. Initial evaluation at a nearby hospital revealed hematuria and elevated creatine phosphokinase levels. He was transferred to our hospital, where magnetic resonance imaging revealed no hematoma but confirmed edema in the paravertebral muscles. The compartment pressure measurements were elevated bilaterally. Despite his pain being severe, his creatine phosphokinase levels were expected to peak and decline; his urine output was normal; and surgery was undesirable. Therefore, we opted for conservative management. The next day, the patient’s compartment pressure diminished, and his pain levels decreased to 2/10. After 5 days, he was able to walk without medication. Conclusions We present a rare case of compartment syndrome of the paravertebral muscles with good resolution following conservative management. We hope our case findings will help avoid unnecessary surgery in cases of paravertebral compartment syndrome.

Coronavirus disease 2019 has rapidly enveloped the world in a pandemic after emerging in Wuhan, China, in December 2019. We describe a 49-year-old man presenting with fever, cough, dyspnea, and myalgia diagnosed with coronavirus disease 2019 along with rhabdomyolysis and acute kidney injury. The creatine phosphokinase was elevated to 23,800 U/L before trending down to normal levels. Rapid identification and treatment with aggressive intravenous hydration and correction of electrolyte abnormalities remain key to successful management. In a pandemic, often atypical presentations of this new disease have to be considered as differentials for early diagnosis and treatment of life-threatening conditions.

Background Lung cancer is the second most common cancer in both men and women and the leading cause of cancer death worldwide. The development of novel tyrosine kinase inhibitors (TKIs) represented a paradigm shift in the management of lung cancer and has resulted in markedly prolonged survival. Osimertinib is a TKI that was fast-tracked by the United States Food and Drug Administration in 2015 and subsequently approved for the treatment of metastatic epidermal growth factor receptor T790M mutation-positive non-small cell lung cancer. However, despite the generally favorable outcomes associated with osimertinib, rapid development and deployment of any new drug increases the risk of unforeseen adverse effects. Post-marketing surveillance studies therefore play an important role in further elucidating the risks and benefits of novel anti-neoplastic agents. Material and Methods We describe four patients with non-small cell lung cancer who developed myositis after beginning treatment with osimertinib. In addition, we review the literature on osimertinib-associated myositis. Using PubMed, the following terms were searched and relevant citations assessed: creatine phosphokinase, myositis, osimertinib, rhabdomyolysis, osimertinib, and Tagrisso. Case Presentation Thirty-eight patients were treated with osimertinib in our community clinic. Four with non-small cell lung cancer developed myositis after beginning treatment. The onset of symptoms and/or elevation of creatine phosphokinase occurred between two weeks and eleven months after osimertinib was initiated. Alternative causes for myositis were not identified. In two patients, myositis resolved within one month of withdrawing treatment. Two other patients continued osimertinib treatment with close monitoring. Conclusion Myositis is a serious and potentially underreported adverse effect of osimertinib. Previous studies suggest that osimertinib-associated myositis is rare, occurring in less than 1% of patients. However, myositis occurred in over 10% of patients treated with osimertinib in our clinic population. We suggest regular monitoring for myositis among patients being treated with osimertinib and dose-reduction or cessation of treatment if clinically indicated.

Context: Proximal lower limb weakness presenting acutely with or without preceding fever is a strong mimic of Guillain–Barre syndrome (GBS). Benign acute childhood myositis (BACM) forms an important differential diagnosis in such cases. Aim: To characterize the clinical and laboratory findings of patients with BACM for better understanding of the disease. Settings and Design: This prospective longitudinal study was conducted in a tertiary care hospital of northern India. Materials and Methods: Thirty-two patients presenting in the outpatient or emergency clinic of the hospital with severe myalgia that exacerbated with straight leg raising test and fever from July 2016 to July 2017 were included in the study. Statistical Analysis: All the continuous data were expressed as number and percentage or mean ± standard deviation/median. Non-parametric continuous data between groups were analyzed by Friedman’s test. Results: The mean age of the patients was 14.3 (±8.7) years and they presented after a nonspecific febrile illness in most of the cases (53.1%). The symptoms resolved after a mean of 5.7 (±1.6) days. Myalgia was present in 21 (65%) cases, whereas proximal weakness was the prominent finding in 14 (43%) cases. Electrolyte abnormality (hypokalemia) was present in four (12.5%) cases. In all patients, the muscle enzymes (creatine phosphokinase, serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase, and lactate dehydrogenase) were elevated at presentation, and electromyography showed myopathic pattern. A significant recovery took place in the next 5–7 days. Conclusion: BACM should be actively looked for in cases of painful acute proximal limb weakness in the adolescents.

Limb Girdle Muscular Dystrophy-Type 2A (LGMD-2A) is an autosomal recessive disease caused due to mutation in the Calpain-3 (CAPN3) gene, leading to partial or total loss of protein. In India, LGMD-2A is the most prevalence form of the disease accounting for 47% of cases amongst the heterogeneous group. Here, we report a case of 26-year-old female, having difficulty in walking due to proximal muscle weakness since the age of 13 years and had elevated Creatine Phosphokinase (CPK) with abnormal muscle biopsy findings. She was considered for the targeted gene panel based diagnosis with the query of muscular dystrophy. A homozygous exon 17 to 24 deletion was detected in the CAPN3 gene located in the long arm of chromosome 15, which was consistent with the patient’s clinical reports of calpinopathy.

BACKGROUND: The intense ischemic pain of acute compartment syndrome can be difficult to discriminate from the pain related to an associated fracture. Lacking objective measures, the decision to perform fasciotomy is often only based on clinical findings and performed at a low threshold. Biomarkers of muscle cell damage might help to identify and monitor patients at risk. In patients with fractures, however, markers of muscle cell damage could be elevated because of other reasons associated with the trauma, which would make interpretation difficult. In a review of all patients who underwent emergency fasciotomy in our health care district we aimed to investigate the decision-making process and specifically the use of biomarkers in patients with and without fractures. METHODS: In the southeast health care region of Sweden 79 patients (60 men) with fractures (median age 26 years) and 42 patients (34 men) without associated fractures (median age 44 years) were treated with emergency fasciotomy of the lower leg between 2007 and 2016. Differences in clinical findings, p-myoglobin and p-creatine phosphokinase as well as pressure measurements were investigated. RESULTS: P-myoglobin was analyzed preoperatively in 20% of all cases and p-creatine phosphokinase in 8%. Preoperative levels of p-myoglobin were lower in patients with fractures (median 1065 μg/L, range 200-3700 μg/L) compared with those without fractures (median 7450 μg/L, range 29-31,000 μg/L), p Funding agencies: Linkoping University; Region Ostergotland; Medical Research Council of Southeast Sweden

In order to reduce the time of feeding, increase the intensity of weight gain without hormones, antibiotics, anabolic drugs, as well as to obtain high-quality meat with marble structure, the authors studied the influence of ovarioectomy on the intensification of the metabolic processes in gilts. The experiments were carried out in the FGUP “Mummovskoe” – the educational experimental enterprise of the Russian State Agrarian University - Moscow Timiryazev Agricultural Academy (RSAU – MAA named after K.A. Timiryazev), in the Atkarsky district of the Saratov region. Two groups of Duroc gilts (10 animals each) raised under the same conditions were studied. As a result of the experiment, the influence of ovariectomy on the level of insulinlike growth factor-1 (IGF-1) and indicators of metabolic processes in gilts were established. It is confirmed that stimulation of the the somatotropin/insulin-like growth factor (ST-IGF) system along with hereditary factors and the characteristics of feeding contributes to the development of muscle tissue. Stimulation of ST secretion with insulin-like growth factor facilitates the development of muscle tissue. An increase in IGF-1 level leads to the development of new muscle fibers and muscle hyperplasia. After surgery, the major factors of changes in meat and feeding indicators in gilts were the rise in the metabolic activity of muscle tissue and fat metabolism, enhancement of production of IGF-1, which has insulin-like action and ensures activation of the processes of cell proliferation and differentiation. Increase in IGF-1 level had a positive impact on meat productivity, chemical and biochemical composition of pork. Simultaneous triggering of the systemic catabolic and local anabolic reactions in gilts after ovariectomy contributed to obtaining higher nutritional value of meat.

Olanzapine is an atypical antipsychotic drug that is being increasingly used as an intentional overdose. It usually presents with reduced and fluctuating level of consciousness and coma. It may rarely present with muscle toxicity by binding to HT2A receptor in skeletal muscle and increasing its permeability. We report a case of such poisoning which had no obvious symptoms but was brought to emergency due to overdose and was found to have acute muscle toxicity as evidenced by raised creatine phosphokinase (CPK) levels. From this, we also want to emphasize that CPK levels should be checked in all the patient's prescribed olanzapine to look for muscle toxicity.

Non-traumatic exertional rhabdomyolysis (exRML) occurs in individuals with normal muscles when the energy supplied to the muscle is insufficient. Here, we report 11 cases of spinning-induced rhabdomyolysis and review related literature. Spinning is a kind of indoor bicycle sport. The 11 patients who were diagnosed with exRML and admitted to CHA Bundang Medical Center were female and their ages ranged from 15 to 46 years. Two to three days prior to the presentation, the patients had attended a spinning class for the first time. All the patients had been otherwise healthy without any known medical illnesses. They were successfully treated without any complications, except mild non-symptomatic hypocalcemia. However, in the literature, severe complications such as compartment syndrome or acute kidney injury had been reported in relation to exRML including spinning-induced rhabdomyolysis. This spinning exercise needs prior guidelines and specific warnings to prevent exertional rhabdomyolysis.

The relationships between pharmacokinetic (PK)/pharmacodynamic (PD) indices and outcomes were investigated in patients with skin and soft tissue infection (SSTI) who received daptomycin at 4mg/kg/day. Efficacy was evaluated in 55 patients from whom Staphylococcus aureus was isolated, with success rates of 94.5% and 69.1% for clinical and microbiological responses, respectively. The odds ratio for the relationship between the area under the day 1 concentration–time curve (AUC0–24h) to the MIC and the probability of clinical success was 1.03 (95% confidence interval [CI] 0.73–1.45), and that for the relationship for probability of microbiological success was 0.94 (95% CI 0.81–1.09). In 82 patients in the safety analysis, only 1 met the creatine phosphokinase (CPK) elevation criteria, and this patient's minimum concentration (Cmin) of plasma daptomycin was 5.37μg/mL. No significant relationship was found between peak CPK and Cmin (Pearson's correlation coefficient −0.0452). In conclusion, no clear correlation between PK/PD indices and the probability of efficacy or safety events was demonstrated when daptomycin was administered in SSTI patients using the clinically recommended dosage of 4mg/kg/day.

Sleep loss is among the most common yet frequently overlooked problems. This disruptive influence is associated with an adverse lipid profile (LP) and consequently results in an increased risk of cardiovascular disease. Furthermore, it has been well established that athletes are increasingly confronted with sleep problems. The aim of this study was to explore the effect of one night of partial sleep deprivation (PSD) on the cardiovascular profile and LP in young, trained athletes. Ten male Taekwondo athletes were randomized for three sleep conditions in a counterbalanced order: (i) following a baseline sleep night (BN), (ii) following PSD at the beginning of the night (PSDBN), and (iii) following PSD at the end of the night (PSDEN). Basal cardiovascular physiological measures were recorded, and blood samples were taken in the fasted state following each sleep session (i.e., in the morning at 07:00 h). The results showed that myoglobin and creatine phosphokinase increased significantly after PSDEN but not after PSDBN. By contrast, no alteration was observed in the LP and physiological parameters following the two types of PSD. In conclusion, these results show that PSDEN increases cardiac damage biomarkers significantly, even though they do not reach clinical significance. Thus, one night of PSD does not affect the physiological responses and biomarkers of LP in Taekwondo athletes.

Background: Organophosphorus (OP) compounds are commonly used pesticides. In OP poisoning, intermediate syndrome (IMS) manifests between the end of the acute cholinergic crisis and delayed neuropathy. Respiratory paralysis in IMS, if identified early can reduce the need for ventilator support, morbidity, and mortality. Serum creatine phosphokinase (CPK) is elevated in IMS. The objectives of our study were to measure serum CPK level, correlate CPK levels with severity of poisoning and estimate atropine dose used. Materials and Methods: A prospective, observational study was conducted for 1-year. Patients diagnosed with OP poisoning were included. Demographic characteristics, type of poison, time since poisoning, Peradeniya Organophosphorus Poisoning (POP) score, serum pseudocholinesterase, CPK levels, atropine dose, and outcome of treatment were documented. Results: Seventy-five patients were recruited of which 57% and 43% were males and females, respectively, with a mean age of 31.48 ± 11.76 years. The most common OP compound was chlorpyriphos followed by triazophos and methylparathion. The time required to reach hospital was 181.26 ± 89.53 min. About 73.3% and 26.7% of patients had mild and moderate poisoning, respectively, as per POP scale. Pseudocholinesterase level was 364 (205-2168) IU. The amount of atropine used was 190.66 ± 78.83 mg. Serial serum CPK values were 279.72 ± 350.21 IU, 389.78 ± 376.33 IU and 163.13 ± 155.15 IU at admission, 48 h, and 96 h after admission, respectively. A weak positive correlation between serum CPK levels and severity of poisoning ( r = 0.352) was observed. All patients recovered completely within 10.69 ± 5.57 days. Three patients developed IMS, and their serial CPK levels were 1837.33 ± 243.19 IU/L, 1935 ± 97.41 IU/L, and 714.66 ± 394.82 IU/L; and recovered in 17 ± 5.6 days. Conclusion: Increased serum CPK levels at 48 h after poisoning was observed in all the patients, but three patients had more than 1500 IU/L, who manifested with IMS. Early diagnosis of IMS by serial estimation of CPK may help in timely intervention and reduce further life-threatening complications.

El objetivo de este estudio fue determinar los efectos de la recuperación activa post esfuerzo realizada en 3 momentos diferentes:: inmediatamente, 12 y 24 horas sobre los marcadores bioquímicos como la Creatin Kinasa en jugadores juveniles de futbol. Un Ensayo Controlado Aleatorizado con asignación a 3 grupos fue realizado: A. recuperación activa inmediata post esfuerzo, B. recuperación activa realizada a las 12 horas post esfuerzo. C. recuperación activa realizada 24 horas después del esfuerzo. Este estudio incluyo 27 sujetos pertenecientes a un equipo de futbol Colombiano de la segunda división. La velocidad, fuerza explosiva y Creatin Kinasa (CK) en sangre fueron evaluados antes y después de las intervenciones. El protocolo SAFT fue aplicado a los participantes para generar fatiga. La muestre de CK fue tomada una hora antes y una hora después de la aplicación del test de fatiga, y también a las 48 horas después de la toma inicial. Mejorías en el salto y la velocidad fueron observadas en los 3 grupos (P0.05) pero no se encontraron diferencias estadísticamente significativas entre los grupos. En todos los participantes hubo un incremento significativo en la CK después de la aplicación del SAFT 90 (mediana 103.1-111.1). La CK medida después de 48 horas refleja una recuperación en todos los grupos, sin embargo el grupo C muestra un decline en los niveles de CK en comparación con la línea de base (-55.5 (-96.3 / -20.4)) lo cual es un hallazgo significativo. Otras investigaciones han mostrado que la CK no retorna rápidamente a la línea de base, pero nuestro estudio mostró que la recuperación activa favorece al aclaramiento de este biomarcador. Abstract: The aim of this study was determine the effects of active recovery post effort made at three different times: immediately, at 12 and 24 hours on biochemical markers creatine kinase in youth soccer player’s categories. A randomized controlled trial with allocation to three groups was performed: A. active recovery immediately after the effort; B. active recovery performed at 12 hours after the effort; C. active recovery made at 24 hours after the effort. This study included 27 subjects belonging to a Colombian soccer team of second division. The velocity, explosive force and Creatin Kinase (CK) in blood was tested before and after interventions. SAFT 90 protocol was applied to participants for generate fatigue. CK samples were taken one hour before the application of the fatigue test, one hour after the fatigue protocol and 48 of the initial CK sample. Improvements in jumping and speed recovery the 3 groups (p 0.05), but no statistically significant differences between groups was observed after recuperation. In all participants there was a significant increment of CK when applied SAFT 90 in all the groups (median 103.1-111.1). The CK measurement after 48 hours reflects a recovery in all groups, however the group C, a decline below baseline levels of -55.5 (-96.3 / -20.4) which is a significant find. Other research has shown that CK does not return quickly to their baseline, but our study shows that active recovery favors the clearance of CK. Maestría

Summary Background Necrotizing fasciitis (NF) is a life-threatening soft tissue infection. It is usually caused by Streptococcus pyogenes and other Gram-positive bacteria. Several reports, however, emphasize the importance of Gram-negative rods in this infection. Methods We retrospectively studied all cases of monomicrobial necrotizing fasciitis hospitalized in our center during the years 2002–2012. We compared clinical characteristics and outcomes of patients with Gram-negative versus Gram-positive infection. Results Forty-five cases were reviewed, 19 caused by Gram-negative organisms, 10 of them Escherichia coli , and 26 caused by Gram-positive organisms, 10 of them S. pyogenes . Compared to Gram-positive infections, patients with Gram-negative infections were more likely to have a baseline malignancy (9/19, 47.4%) or to have undergone recent surgery (4/19, 42.3%). The 30-day mortality was higher among Gram-negative infected patients (8/19, 42.1% vs. 8/26, 30.8%). Creatine phosphokinase (CPK) was elevated in a minority of patients with Gram-negative necrotizing fasciitis, and its absolute value was lower than in Gram-positive necrotizing fasciitis. Conclusions In our center, 42% of monomicrobial necrotizing fasciitis cases were found to be caused by Gram-negative organisms, mostly E. coli . These infections usually appeared in immunocompromised or postoperative patients, often presented with normal CPK levels, and were associated with high mortality rates.

Renal histology results are very scarce in dengue-associated rhabdomyolysis patients developing acute kidney injury (AKI). We report a case of dengue fever-induced AKI associated to rhabdomyolysis with a renal biopsy showing acute tubular necrosis (ATN) and renal deposition of myoglobin. A 28-year-old patient who presented dengue fever (DF) complicated by severe AKI and rhabdomyolysis is described. The patient required hemodialysis for three weeks. A renal biopsy revealed ATN with positive staining for myoglobin in the renal tubuli. The patient was discharged with recovered renal function. In conclusion, this case report described a biopsy proven ATN associated to DF-induced rhabdomyolysis, in which renal deposition of myoglobin was demonstrated. We suggest that serum creatine phosphokinase should be monitored in DF patients to allow for an early diagnosis of rhabdomyolysis and the institution of renal protective measures.

Background: Food and Drug Administration–approved daptomycin dosing uses actual body weight, despite limited dosing information for obese patients. Studies report alterations in daptomycin pharmacokinetics and creatine phosphokinase elevations associated with higher weight-based doses required for obese patients. Limited information regarding clinical outcomes with alternative daptomycin dosing strategies in obesity exists. Objective: This study evaluates equivalency of clinical and safety outcomes in obese patients with daptomycin dosed on adjusted body weight versus a historical cohort using actual body weight. Methods: This retrospective, single center study compared equivalency of outcomes with two one-sided tests in patients with body mass index ⩾30 kg/m2 who received daptomycin dosed on actual body weight versus adjusted body weight. The primary outcome was clinical failure. Secondary outcomes included 90-day readmission and 90-day mortality. A combined safety endpoint included creatine phosphokinase elevation, patient-reported myopathy, and rhabdomyolysis. Results: A total of 667 patients were screened for inclusion; 101 patients were analyzed with 50 in the actual body weight cohort and 51 in the adjusted body weight cohort. The two regimens were statistically equivalent for clinical failure (2% actual body weight versus 4% adjusted body weight; p < 0.001 for equivalency). The two regimens were also statistically equivalent for 90-day mortality (6% actual body weight versus 4% adjusted body weight; p = 0.0014 for equivalency). Limitations include single center, retrospective design, and sample size. Daptomycin dosing intensified throughout the study period. Conclusion: The two daptomycin dosing cohorts were statistically equivalent for both clinical failure and 90-day mortality. More data are needed to assess outcomes with higher (⩾8 mg/kg/day) daptomycin doses in this patient population.

This study determined if 6-weeks vitamin D2 supplementation (vitD2, 3800 IU/day) had an influence on muscle function, eccentric exercise-induced muscle damage (EIMD), and delayed onset of muscle soreness (DOMS) in National Association for Stock Car Auto Racing (NASCAR) NASCAR pit crew athletes. Subjects were randomized to vitD2 (n = 13) and placebo (n = 15), and ingested supplements (double-blind) for six weeks. Blood samples were collected and muscle function tests conducted pre- and post-study (leg-back and hand grip dynamometer strength tests, body weight bench press to exhaustion, vertical jump, 30-s Wingate test). Post-study, subjects engaged in 90 min eccentric-based exercise, with blood samples and DOMS ratings obtained immediately after and 1- and 2-days post-exercise. Six weeks vitD2 increased serum 25(OH)D2 456% and decreased 25(OH)D3 21% versus placebo (p < 0.001, p = 0.036, respectively), with no influence on muscle function test scores. The post-study eccentric exercise bout induced EIMD and DOMS, with higher muscle damage biomarkers measured in vitD2 compared to placebo (myoglobin 252%, 122% increase, respectively, p = 0.001; creatine phosphokinase 24 h post-exercise, 169%, 32%, p < 0.001), with no differences for DOMS. In summary, 6-weeks vitD2 (3800 IU/day) significantly increased 25(OH)D2 and decreased 25(OH)D3, had no effect on muscle function tests, and amplified muscle damage markers in NASCAR pit crew athletes following eccentric exercise.

Objective: To evaluate the cardioprotective potential of 70% ethanolic extract of bark of Spathodea campanulata P. Beauv (EEBSC). Methods: Wister strain rats were pretreated with EEBSC in two different doses (250 and 500mg/kg) orally for 14 d and then intoxicated with isoproterenol (200 mg/ kg, s.c. for 2 consecutive days at an interval of 24 h on 14th and 15th day of treatment protocol) to induce myocardial injury. Results: Cardioprotection was assessed by estimating serum aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, creatine phosphokinase, triglycerides, total cholesterol, low density lipoproteins and high density lipoproteins. The levels of thiobarbituric acid reactive substances and reduced glutathione were analyzed in heart homogenate. In isoproterenol-treated group, shrinkage of cardiac markers in serum and elevated lipid peroxidation accompanied by decreased content of reduced glutathione in heart. The prior administration of EEBSC significantly (P

Amiodarone (Amio), a potent anti-arrhythmic drug, is associated with life-threatening pulmonary toxicity involving fibroses and inflammation. A unique nutrient mixture (NM) consisting of lysine, proline, ascorbic acid, N-acetyl cysteine and green tea extract has previously been shown to exhibit a broad spectrum of pharmacological, therapeutic, cardiovas- cular and chemopreventive properties. The present study was undertaken to determine whether the NM exhibits preventive effects on Amio‑induced cardiac toxicity. Six‑week‑old male BALB/c mice were divided into four groups (A-D) of six animals per group. Mice in groups A and C were fed a regular diet for three weeks, while the diets of the mice in groups B and D were supplemented with 1% NM during that period. After three weeks, the mice in groups C and D received daily Amio injections of 50 mg/kg body weight intraperitoneally for 4 days, whilst those in groups A and B received saline alone. At 24 h after the final dose , mice were sacrificed, blood was withdrawn and serum was collected for clinical chemistry of the heart enzymes creatine phosphokinase (CPK) and aspartate aminotransferase (AST). In addition, livers, kidneys, hearts and lungs were excised and weighed. No significant differences in weight gain were identified among the groups and liver, kidney, heart and lung weights were comparable in all four groups. Administration of Amio to group C resulted in a significant increase in serum CPK levels , whereas in NM-fed group D, the CPK levels were comparable to those in the saline injection groups, A and B. Amio administration also resulted in a significant increase in serum AST levels in group C, but not in the group D animals which exhibited similar levels to those of groups A and B. Therefore, the results indicate that NM has the potential to protect against Amio-induced cardiac toxicity.

The intent of this study was to determine whether nutritional supplements [protein (0.4 g·kg −1 ) vs. carbohydrate (0.4 g·kg −1 ) vs. placebo] would affect muscle recovery differently after eccentric exercise-induced muscle soreness in untrained healthy young men (n = 21) aged 20-28 years. During this double-blind randomized block study design, each subject completed three, 3-day trials (separated by = 2 weeks), identical except for treatment, with each subject serving as his own control. Trials began with a bout of right-leg eccentric exercise (Biodex), followed directly by treatment. At 0 (baseline), 24 and 48 hours, data were collected: creatine phosphokinase from pre-exercise blood samples, subjective muscle soreness questions, and strength tests (power, torque, work). ANOVA indicated that exercise caused mild muscle damage, as evidenced by an overall day effect ( p = 0.0001) for muscle soreness, with the lowest median values (0-10 scale) on day 1 (0.7), increasing ( p = 0.0001) on day 2 (3.2), and remaining elevated on day 3 (3.4). We also noted an overall day effect ( p = 0.0001) for creatine phosphokinase, with the lowest median values on day 1 (136 U·L-1), increasing ( p = 0.0001) on day 2 (235 U·L-1), and remaining elevated on day 3 (189 U·L-1). ANOVA revealed no significant treatment effect on indicators of soreness or damage during recovery. Our results indicated that protein or carbohydrate supplement after exercise that caused mild muscle damage did not facilitate muscle recovery in adequately nourished, healthy young men.

O comportamento de constituintes bioquímicos sanguíneos (glicose, fibrinogênio, creatina fosfoquinase e gama-glutamiltransferase) foi monitorado, in vivo, em 12 equinos mestiços (seis machos e seis fêmeas), com idade entre 4 e 20 anos, submetidos à ozonioterapia. O tratamento foi realizado mediante administração de 500 ou 1000mL da mistura de oxigênio-ozônio (O2-O3) por via intravenosa, a cada três dias, durante 24 dias. Os equinos foram distribuídos em quatro grupos: MT500 constituído por três machos tratados com 500mL; MT1000 por três machos tratados com 1000mL; FT500, por três fêmeas tratadas com 500mL e FT1000, por três fêmeas tratadas com 1000mL. A ozonioterapia por via intravenosa não ocasionou alterações clínicas nos equinos. Os valores médios mínimos e máximos de glicose, fibrinogênio, creatina fosfoquinase e gama-glutamiltransferase mantiveram-se dentro dos limites de referência para a espécie equina. Houve diminuição nas concentrações da glicose e gama-glutamiltransferase ao longo dos períodos de aplicação e aumento nos valores do fibrinogênio. A creatina fosfoquinase não sofreu efeito do tratamento. The profile of blood biochemistry variables (glucose, fibrinogen, creatine phosphokinase, and gamma glutamyltransferase) was in vivo monitored in 12 crossbred horses (six males and six females), aging from four to 20-years-old treated with ozone therapy. Treatments were carried out by applying 500 or 1000mL of the mixture oxygen-ozone (O2-O3) via intravenous route, every three days, during 24 days. Horses were assigned to four groups: MT500 (three males given 500mL), MT1000 (three males given 1000mL), FT500 (three females given 500mL) and FT1000 (three females given 1000mL). Ozone therapy by intravenous route caused no clinical changes in the horses. Minimum and maximum mean values of glucose, fibrinogen, creatine phosphokinase, and gamma glutamyltransferase were within the range considered as normal reference for the equine species. There was decrease in glucose and gamma glutamyltransferase concentrations over the period of application, whereas fibrinogen increased and creatine phosphokinase was not affected by the treatment.

Background : Exercise can initiate a cascade of inflammatory and oxidative stress–related events leading to delayed onset muscle soreness. Polyphenols possess antioxidant and anti-inflammatory properties. Objective : The current study examined the effects of a proprietary polyphenolic blend (PB), containing catechins and theaflavins, on exercise performance and recovery following an eccentric exercise challenge. Design : Male participants (18–35 years of age) received placebo or PB at a low dose (PB-L, 1,000 mg/d) or high dose (PB-H, 2,000 mg/d) for 13 weeks. During the 13th week of supplementation, participants completed an eccentric exercise (40 min downhill treadmill run) followed by a strength assessment (peak torque on isokinetic leg extensions) pre-exercise, and 24, 48, and 96 h post-exercise. Muscle soreness (subjective questionnaire), markers of muscle stress (cortisol and creatine phosphokinase [CK]), and antioxidant capacity (ferric reducing ability of plasma [FRAP]) were also assessed. Results : PB-H attenuated the decrease in peak torque observed in the placebo group from pre-exercise to 48 h ( p= 0.012) and 96 h ( p= 0.003) post-exercise. At 48 h post-exercise, PB-H reduced whole body and hamstring soreness ( p =0.029) versus placebo. Chronic consumption of PB improved serum FRAP ( p =0.039). As expected, serum cortisol and CK increased from pre- to post-exercise in all groups; however, by 96 h, cortisol and CK levels returned to pre-exercise levels following PB supplementation. At 96 h, the change in cortisol from pre- to post-exercise was significantly greater in placebo versus PB-H ( p =0.039). Conclusion : These findings show that chronic consumption of PB improved antioxidant status, reduced markers of muscle stress, and promoted strength recovery post-exercise. Keywords: strength; catechins; theaflavins; cortisol; creatine phosphokinase; antioxidant; delayed onset muscle soreness (Published: 18 December 2015) Citation: Food & Nutrition Research 2015, 59: 30034 - http://dx.doi.org/10.3402/fnr.v59.30034

Background and Aims: Perioperative myocardial ischaemia (PMI) is one of the known complications during off pump coronary artery bypass (OPCAB) surgeries. The length of hospital stay is considerably prolonged in patients with PMI. Myocardial protection is an area which is being widely researched currently to prevent or reduce the incidence of PMI. Over the last decade it has become clear that volatile anaesthetic agents are protective in the setting of PMI and reperfusion. Hence, we planned to study the effect of two different volatile anaesthetics as myocardial protective agents in OPCAB surgery. Methods: A total of 40 patients were enrolled for the study; Group A (sevoflurane, n = 20) and Group B (desflurane, n = 20). All patients had a baseline measurement of Trop-T, creatine phosphokinase-MB (CPKMB) and myocardial performance index (MPI) pre-operatively, which was repeated 4 h after the surgery. Chi-square/Fisher test was used to find the significance of the differences between the two agents. Results: Patients were comparable in demographic, baseline, biochemical and echo criteria. Post-operative CPKMB levels (desflurane - 30.85 ± 2.69 u/L; sevoflurane - 29.05 ± 5.26 u/L, P = 0.7) and number of Trop-T positive patients (Sevoflurane - 9; desflurane - 6, P ≥ 0.05) were comparable. Post-operative MPI indicated decreased left ventricular function in sevoflurane group as compared to desflurane group (P ≤ 0.03). Conclusion: Desflurane exerts better cardioprotective effect than sevoflurane as indicated by better MPI in OPCAB surgeries.

Objective: Describe the clinical and laboratory profile, follow-up, and outcome of a series of cases of acute viral myositis. Method: A retrospective analysis of suspected cases under observation in the emergency department was performed, including outpatient follow-up with the recording of respiratory infection and musculoskeletal symptoms, measurement of muscle enzymes, creatine phosphokinase (CPK), lactate dehydrogenase (LDH), transaminases (AST and ALT), blood count, C-reactive protein, and erythrocyte sedimentation rate in the acute phase and during follow-up until normalization. Results: Between 2000 and 2009, 42 suspected cases were identified and 35 (27 boys) were included. The median age was 7 years and the diagnosis was reported in 89% in the first emergency visit. The observed respiratory symptoms were cough (31%), rhinorrhea (23%), and fever (63%), with a mean duration of 4.3 days. Musculoskeletal symptoms were localized pain in the calves (80%), limited ambulation (57%), gait abnormality (40%), and muscle weakness in the lower limbs (71%), with a mean duration of 3.6 days. There was significant increase in CPK enzymes (5507 ± 9180 U/L), LDH (827 ± 598 U/L), and AST (199 ± 245 U/L), with a tendency to leukopenia (4590 ± 1420) leukocytes/mm3. The complete recovery of laboratory parameters was observed in 30 days (median), and laboratory and clinical recurrence was documented in one case after 10 months. Conclusion: Typical symptoms with increased muscle enzymes after diagnosis of influenza and self-limited course of the disease were the clues to the diagnosis. The increase in muscle enzymes indicate transient myotropic activity related to seasonal influenza, which should be considered, regardless of the viral identification, possibly associated with influenza virus or other respiratory viruses. Resumo: Objetivo: Descrever o perfil clínico-laboratorial, acompanhamento e desfecho de uma série de casos de Miosite Aguda Viral. Método: Foi conduzida uma análise retrospectiva de casos suspeitos, em observação em unidade de emergência, e seguimento ambulatorial com o registro de sintomas de infecção respiratória, sintomas músculo-esqueléticos, determinação de enzimas musculares, creatina-fosfoquinase (CPK), desidrogenase lática (DHL), transaminases (AST e ALT), hemograma, proteína C reativa e velocidade de hemossedimentação, na fase aguda e acompanhamento, até a normalização. Resultados: Entre 2000 e 2009, 42 casos suspeitos foram identificados e 35 (27 meninos) foram incluídos. A mediana de idade foi 7 anos e o diagnóstico relatado em 89%, na primeira visita de emergência. Os sintomas respiratórios observados foram: tosse (31%), coriza (23%), e febre (63%) com duração media de 4,3 dias. Os sintomas músculo-esqueléticos foram: dor localizada nas panturrilhas (80%), deambulação limitada (57%), marcha anormal (40%), fraqueza muscular nos membros inferiores (71%), com duração média de 3,6 dias. Observou-se elevação importante das enzimas CPK (5507 ± 9180) U/l, DHL (827 ± 598) U/l e AST (199 ± 245) U/l, e tendência a leucopenia (4590 ± 1420) leucócitos/mm3. A recuperação complete dos parâmetros laboratoriais foi observada em 30 dias (mediana) e a recaída clínica e laboratorial em um caso após 10 meses. Conclusão: Os sintomas típicos com enzimas musculares elevadas após diagnóstico de Influenza e o curso auto-limitado foram os indícios para o diagnóstico. A elevação de enzimas musculares indicam a atividade miotrópica transitória relacionada à influenza sazonal que deve ser considerada, à despeito da identificação viral, possivelmente associada com o vírus Influenza ou outros vírus respiratórios. Keywords: Influenza, Acute myositis, Creatine phosphokinase, Palavras-chave: Influenza, Miosite aguda, Creatina-fosfoquinase

The concept of minimally invasive lumbar disc surgery comprises reduced muscle injury. The aim of this study was to evaluate creatine phosphokinase (CPK) in serum and the cross-sectional area (CSA) of the multifidus muscle on magnetic resonance imaging as indicators of muscle injury. We present the results of a double-blind randomized trial on patients with lumbar disc herniation, in which tubular discectomy and conventional microdiscectomy were compared. In 216 patients, CPK was measured before surgery and at day 1 after surgery. In 140 patients, the CSA of the multifidus muscle was measured at the affected disc level before surgery and at 1 year after surgery. The ratios (i.e. post surgery/pre surgery) of CPK and CSA were used as outcome measures. The multifidus atrophy was classified into three grades ranging from 0 (normal) to 3 (severe atrophy), and the difference between post and pre surgery was used as an outcome. Patients' low-back pain scores on the visual analogue scale (VAS) were documented before surgery and at various moments during follow-up. Tubular discectomy compared with conventional microdiscectomy resulted in a nonsignificant difference in CPK ratio, although the CSA ratio was significantly lower in tubular discectomy. At 1 year, there was no difference in atrophy grade between both groups nor in the percentage of patients showing an increased atrophy grade (14% tubular vs. 18% conventional). The postoperative low-back pain scores on the VAS improved in both groups, although the 1-year between-group mean difference of improvement was 3.5 mm (95% CI; 1.4-5.7 mm) in favour of conventional microdiscectomy. In conclusion, tubular discectomy compared with conventional microdiscectomy did not result in reduced muscle injury. Postoperative evaluation of CPK and the multifidus muscle showed similar results in both groups, although patients who underwent tubular discectomy reported more low-back pain during the first year after surgery.

Rhabdomyolysis, a clinical syndrome in which skeletal muscle damage and necrosis, is precipitated by multi-therapy is most frequently described during statin treatment. Rhabdomyolysis is a rare, but serious side-effect that may lead to renal failure and dangerous electrolyte abnormalities in patients. We report a case of rhabdomyolysis after 5 years of atorvastatin therapy in an elderly patient, in multi-treatment for coronary artery disease.

Background Because neither the incidence and risk factors for rhabdomyolysis in the ICU nor the dynamics of its main complication, i.e., rhabdomyolysis-induced acute kidney injury (AKI) are well known, we retrospectively studied a large population of adult ICU patients (n = 1,769). Methods CK and sMb (serum myoglobin) and uMb (urinary myoglobin) were studied as markers of rhabdomyolysis and AKI (RIFLE criteria). Hemodialysis and mortality were used as outcome variables. Results Prolonged surgery, trauma, and vascular occlusions are associated with increasing CK values. CK correlates with sMb (p The logistic regression showed a positive correlation between CK and the development of AKI, with an OR of 2.21. Univariate logistic regression suggests that elevations of sMb and uMb are associated with the development of AKI, with odds ratios of 7.87 and 1.61 respectively. The ROC curve showed that for all three markers a significant correlation with AKI, for sMb with the greatest area under the curve. The best cutoff values for prediction of AKI were CK > 773 U/l; sMb > 368 μg/l and uMb > 38 μg/l respectively. Conclusions Because it also has extrarenal elimination kinetics, our data suggest that measuring myoglobin in patients at risk for rhabdomyolysis in the ICU may be useful.

Organophosphorus (OP), the commonest agent for poisoning in India due to its easy availability, acts by inhibiting acetylcholinesterase at muscarinic and nicotinic receptors. Erythrocyte cholinesterase (EchE) and plasma cholinesterase (PchE) are reduced in OP poisoning, but their estimation is costly and not regularly performed. There are emerging options for new cheaper biochemical markers in relation to OP poisoning. Serum level of creatine phosphokinase (CPK) is often found to be elevated in OP poisoning. This study was conducted to see if CPK may be used as an alternative of cholinesterase levels in blood to assess the severity of OP poisoning. This was a prospective and observational study. Sixty-three patients of OP poisoning without any prior treatment, presenting within 6 hours, were selected and their clinical severity was categorized according to Peradeniya organophosphorus poisoning (POP) scale. Level of serum CPK, blood EchE and pH were measured following admission, and total dose of atropine (mg) until the final clinical outcome (complete recovery or death) was calculated. Student's t-test and Pearson's correlation coefficient was used for the assessment of statistical significance. According to POP scale, clinical severity was mild (score 0-3) in 17 (27%), moderate (score 4-7) in 32 (50.8%) and severe (score 8-11) in 14 (22.2%) patients. Serum CPK, EchE level, blood pH and total atropine dose strongly correlated with clinical severity. Our study recommends serum CPK as an alternative marker.