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Dystrophinopathies are a spectrum of X-linked muscular disorders associated with pathogenic/likely pathogenic variants in the dystrophin gene (DMD). Typically, the condition develops in males, but cases of symptom manifestation have also been described in females. The review presents contemporary data on the manifestations of dystrophinopathies in women with pathogenic variants in the DMD gene, discussing the reasons for the varying degrees of symptom expression in carrier women with pathogenic/ likely pathogenic variants. It discusses the importance of mutation screening in the DMD gene for women presenting with muscular dystrophy symptoms and investigating carrier status in relatives of patients with Duchenne/Becker muscular dystrophy.

Type 1 diabetes mellitus (T1DM) is an autoimmune illness that targets specific organs and associated with other autoimmune conditions. Dermatomyositis is an idiopathic systemic autoimmune condition involving skeletal muscles and skin. Co-occurrence of both disorders is quite rare. We diagnosed dermatomyositis in a young male with T1DM who presented with muscle weakness and cutaneous manifestations. There is an additional metabolic hurdle in T1DM, as high doses of glucocorticoids used in dermatomyositis management are related to glycemic instability which requires regular blood sugar monitoring and insulin dose titration accordingly. Considering the prognostic consequences, early diagnosis and management of dermatomyositis is essential.

Precision daptomycin dosing faces clinical implementation barriers despite known exposure-safety concerns with the use of twice the regulatory-approved doses. We propose achieving a single 7–11-hour post-dose plasma target concentration of 30 mg/L to 43 mg/L to be a practical starting point to facilitate precision daptomycin dosing. [ABSTRACT FROM AUTHOR]

This study sought to assess how post-game creatine kinase (CK) levels correlate with the number of sprints and the impact of the ACTN3 polymorphism on this response. This research constituted a descriptive/observational, retrospective cross-sectional study. DNA was extracted from blood samples for ACTN3 polymorphism genotyping. CK was measured 48 h after official matches, and the number of sprints (>19 km/h) was tracked using Global Positioning System (GPS) technology. The main cohort included 23 professional soccer players from the top tier of the Brazilian Championship. We analyzed 115 GPS + CK data sets. The replication cohort comprised 18 professional soccer players from the First Division of the Championship, had the same methodology applied, and featured a total of 90 GPS (sprints > 25.2 km/h) + CK data sets. For the main cohort, a significant positive correlation was seen between the number of sprints and the CK levels (p = 0.009). Athletes with the ACTN3 RR genotype had higher CK levels as more sprints were performed during the match (p = 0.017). However, the relationship was not found for X allele carriers (p > 0.05). For the replication cohort, there was a near-significant correlation between CK levels and the number of sprints (p = 0.05), and RR individuals showed a significant association (p = 0.01), whereas X allele carriers did not (p = 0.06). A greater number of sprints during matches is linked to higher CK levels, primarily among players with the ACTN3 RR genotype, which is potentially due to an increased presence of type II muscle fibers. These findings were replicated for both cohorts of elite Brazilian soccer players, emphasizing the importance of genetic factors in injury prevention. [ABSTRACT FROM AUTHOR]

Type 1 diabetes mellitus (T1DM) is an autoimmune illness that targets specific organs and associated with other autoimmune conditions. Dermatomyositis is an idiopathic systemic autoimmune condition involving skeletal muscles and skin. Co-occurrence of both disorders is quite rare. We diagnosed dermatomyositis in a young male with T1DM who presented with muscle weakness and cutaneous manifestations. There is an additional metabolic hurdle in T1DM, as high doses of glucocorticoids used in dermatomyositis management are related to glycemic instability which requires regular blood sugar monitoring and insulin dose titration accordingly. Considering the prognostic consequences, early diagnosis and management of dermatomyositis is essential. [ABSTRACT FROM AUTHOR]

Rhabdomyolysis is a rare condition characterised by muscle oedema and inflammation. Radiological imaging, particularly Magnetic Resonance Imaging (MRI), plays a crucial role in the diagnosis and management of patients with muscle injuries. Hereby, the authors present a case report of a 21-year-old male who recently joined a gym a month ago. After a recent upper body workout, he began experiencing vague pain around the posterior aspect of the entire right arm, radiating towards the shoulder and elbow. An MRI was performed to evaluate the musculature of the right arm and forearm. T2-weighted axial images revealed hyperintense signals within the long head of the triceps muscle. Short Tau Inversion Recovery (STIR) coronal and STIR axial sequences showed increased signal intensity in the short field of view sequences, consistent with the presence of subcutaneous inflammation. The patient was managed conservatively with anti-inflammatory medications. A follow-up scan after one month showed complete resolution of muscle oedema. The ability of MRI to accurately assess the degree and severity of muscle injury allows for appropriate treatment planning and monitoring of disease progression. In cases of suspected muscle injury, prompt radiological evaluation can facilitate early diagnosis and intervention, ultimately improving patient outcomes.

Key Clinical Message: We present a case of parenchymatous glossitis with unilateral severe inflammation of the hyoglossus muscle, resulting in laryngeal edema. The route of inflammation was unique. Contrast‐enhanced CT was useful for diagnosis. Administration of sensitive antibiotics led to improvement. Creatine phosphokinase may be an indicator of diagnosis and treatment response. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the clinical and laboratory features, complications, and outcomes of patients with rhabdomyolysis in the Saudi population. Methods: Retrospectives descriptive study of adult patients who presented to King Abdulaziz Medical City (KAMC) withrhabdomyolysis between January 2016 and December 2022. Results: Most of the participants (84.5%) were male, with a median age of 41 years and a body mass index of 26.5 kg/m2. Medications, mainly statins (22.4%) and illicit drugs (15.5%), constituted the root causes of rhabdomyolysis in the cohort (44.8%). The most common presenting complaints were myalgia (63.8%) and fatigue (37.9%). More than one-third of the participants (32.8%) developed AKI, with 3 patients requiring temporary hemodialysis, and only 8.6% developed acute liver failure (ALF). Intensive care unit (ICU) admission was required for 10 patients (17.2%), and the overall mortality rate was 8.6%. Patients who developed complications (composite outcomes of AKI, ALF, multiorgan failure, or death) had significantly reduced kidney function and higher levels of blood urea nitrogen, anion gap, and uric acid upon admission than those who did not. Conclusion: This study offers a thorough understanding of clinical and laboratory features, causes, complications, and outcomes of rhabdomyolysis among Saudi patients. The insights gained enhance our understanding of rhabdomyolysis within this population, providing a foundation for future research and improvements in clinical management. [ABSTRACT FROM AUTHOR]

Introduction: Rhabdomyolysis and hemolysis cause pigment nephropathy that progresses to chronic kidney disease (CKD) requiring hemodialysis in some patients. As this is a significant financial burden, understanding the etiologies and renal biopsy findings aids in timely diagnosis and optimizing outcomes. Objectives: We analyzed the etiology, clinicopathological features, and renal outcome of seventeen patients with pigment nephropathy. Patients and Methods: This retrospective study was conducted from 2018 to 2021. Data on detailed clinical history, laboratory parameters, renal biopsy records and the renal outcome was collected. Results: Among seventeen patients with pigment nephropathy, the etiology was rhabdomyolysis in 15 patients and hemolysis in two patients. Oliguria was the most common clinical presentation, and all patients presented with acute kidney injury (AKI). Renal biopsy revealed reddish beaded granule and vermiform-like casts in 10, brownish casts with intra-tubular hemosiderin in three, and granular and calcific casts in two patients each. While fourteen patients recovered to normal renal function within three months, one progressed to stage 5 CKD, one had stage 2 CKD, and one died. Conclusion: In most patients, clinical history did not reveal a direct diagnosis of rhabdomyolysis, and hence one must remain vigilant even in the absence of the classical triad of symptoms. [ABSTRACT FROM AUTHOR]

Defined as the destruction of the skeletal muscle wall and the release of cellular contents into the bloodstream, rhabdomyolysis has been reported as a complication for some forms of vaccines. On the other hand, the COVID-19 pandemic has led to the extensive production and use of several vaccines against SARS-CoV-2, meanwhile, the side effects of these vaccines are gradually being reported. Up to now, few cases of rhabdomyolysis due to COVID-19 vaccination have been reported in the studies. The present study intended to report two cases of rhabdomyolysis due to vaccination with Oxford/AstraZeneca COVID-19 vaccines. The patients were two men aged 70 and 75 years old who presented to a healthcare facility with weakness, myalgia, nausea, and vomiting for about ten days after receiving their first dose of the Oxford/AstraZeneca COVID-19 vaccine. Patients had elevated levels of creatine phosphokinase (CPK), which were 5540 IU/L and 18760 IU/L in patients, respectively [ABSTRACT FROM AUTHOR]

Key Clinical Message We present a case of parenchymatous glossitis with unilateral severe inflammation of the hyoglossus muscle, resulting in laryngeal edema. The route of inflammation was unique. Contrast‐enhanced CT was useful for diagnosis. Administration of sensitive antibiotics led to improvement. Creatine phosphokinase may be an indicator of diagnosis and treatment response.

Background. Duchenne muscular dystrophy (DMD) is a severe genetic disease that usually affects boys and it is characterized by a gradual loss of muscle strength up to respiratory arrest from the childhood. Currently, there are several types of successful pathogenic therapies for the disease, but it is most effective before the age of 5 years. Thereby, the problem of verifying the diagnosis before the treatment fails to work (when treatment can still make the patient’s life easier) becomes urgent. In the Russian Federation only about 1,500 boys are diagnosed with DMD, when the calculated value is 3,500.Aim. To identify all cases of DMD among patients in the neurological departments of hospitals in the Krasnoyarsk region by measuring the level of creatine phosphokinase.Materials and methods. This study was estimated by neurologists in the Krasnoyarsk Interdistrict Children’s Clinical Hospital No. 1 and the Krasnoyarsk Regional Clinical Center for Maternal and Child Health. When elevated levels of creatine phosphokinase were detected in children, genetic analysis was performed to verify DMD.Results and conclusion. Innovate experience of Krasnoyarsk region made it possible to identify all patients with DMD in the neurological departments of the Krasnoyarsk Interdistrict Children’s Clinical Hospital No. 1 and the Krasnoyarsk Regional Clinical Center for Maternal and Child Health using cheap creatine phosphokinase level analysis. The number of patients diagnosed with DMD is now ~4 cases per year. As a result, there is a correspondence between the number of real patients and the epidemiological estimate quantity for the Krasnoyarsk region.

Muscle involvement is common in hypothyroidism and is seen in nearly 80% of the cases. However, rhabdomyolysis is a rare manifestation and is usually triggered by precipitating factors such as exercise, statins, and toxins. We describe the case of a 58-year-old woman with de novo hypothyroidism presenting with severe rhabdomyolysis requiring hemodialysis. A 58-year-old diabetic and hypertensive female was presented at our tertiary care center with symptoms of generalized weakness, difficulty in walking, and decreased urine output. Her blood investigations showed elevated creatine phosphokinase (CPK), renal parameters, and thyroid-stimulating hormone (TSH) levels suggestive of autoimmune thyroiditis with rhabdomyolysis. She was treated with thyroid hormone supplementation and hemodialysis. The patient recovered gradually with normalization of renal parameters. Although muscle involvement is common in hypothyroidism, rhabdomyolysis is a rare manifestation. Diagnosis is established by demonstrating elevated CPK and TSH levels. Management consists of hydration and thyroid hormone supplementation. Hemodialysis is required in severe cases with established acute kidney injury.

Background and Aim: Ectopic pregnancy (EP) is still one of the leading preventable causes of maternal morbidity and mortality in the first trimester. Amidst the use of sensitive assays for β-HCG and high-definition ultrasonography for the identification of EP, the search for a more reliable and sensitive marker remains a challenge till date. Our aim was to determine the validity of creatine phosphokinase (CPK) and its isoenzyme (CPK-MB) in the prediction of tubal EP. Materials and Methods: A prospective and comparative diagnostic accuracy study was conducted among 105 pregnant women in the first trimester who met the eligibility criteria in the Department of Obstetrics and Gynecology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS). The study included 35 patients each with tubal EP (EP), abortive intrauterine pregnancy (AP), and normal intrauterine pregnancy (NP). CPK, CPK-MB, and β-HCG were measured among all the participants, and the participants were followed up longitudinally. Results: A total of 105 pregnant women were included. The mean CPK and CPK-MB levels were significantly higher among the women with EP when compared to NP (P < 0.05) and AP (P < 0.05) women; however, there was no significant difference between the NP and AP groups (P > 0.05). Moreover, the receiver operating characteristic (ROC) curve showed that both CPK and CPK-MB were good predictors of EP, with CPK (area under the curve [AUC] = 0.764) being a better predictor than CPK-MB (AUC: 0.650) in the diagnosis of EP. Conclusion: Early diagnosis of EP allows appropriate and timely management, which would not only reduce mortality and morbidity associated with the condition but also enable preservation of fertility and improve future pregnancy outcome. Hence, the need of the hour is a reliable biochemical diagnostic marker for EP, such as CPK.

This study presents a detailed account of an exceptional case of severe myositis, characterized by an initial creatine phosphokinase (CPK) level of 13,575 U/L, in a 66-year-old female patient with a sevenyear history of granulomatosis with polyangiitis (GPA). The patient's condition was marked by significant deterioration in overall health, characterized by muscle weakness in the upper and lower extremities that resulted in her becoming bedridden. Treatment with methylprednisolone was initiated, leading to a significant decrease in CPK levels, yet the patient's health saw only minor improvement. The patient did not have autoantibodies usually associated with idiopathic inflammatory myositis. The patient ultimately succumbed to complications arising from pneumonia and sepsis a month after admission. This case provides valuable insights into the diagnostic challenges and treatment complexities of severe myositis in patients with GPA. [ABSTRACT FROM AUTHOR]

Introduction: Rhabdomyolysis and hemolysis cause pigment nephropathy that progresses to chronic kidney disease (CKD) requiring hemodialysis in some patients. As this is a significant financial burden, understanding the etiologies and renal biopsy findings aids in timely diagnosis and optimizing outcomes. Objectives: We analyzed the etiology, clinicopathological features, and renal outcome of seventeen patients with pigment nephropathy. Patients and Methods: This retrospective study was conducted from 2018 to 2021. Data on detailed clinical history, laboratory parameters, renal biopsy records and the renal outcome was collected. Results: Among seventeen patients with pigment nephropathy, the etiology was rhabdomyolysis in 15 patients and hemolysis in two patients. Oliguria was the most common clinical presentation, and all patients presented with acute kidney injury (AKI). Renal biopsy revealed reddish beaded granule and vermiform-like casts in 10, brownish casts with intra-tubular hemosiderin in three, and granular and calcific casts in two patients each. While fourteen patients recovered to normal renal function within three months, one progressed to stage 5 CKD, one had stage 2 CKD, and one died. Conclusion: In most patients, clinical history did not reveal a direct diagnosis of rhabdomyolysis, and hence one must remain vigilant even in the absence of the classical triad of symptoms.

Defined as the destruction of the skeletal muscle wall and the release of cellular contents into the bloodstream, rhabdomyolysis has been reported as a complication for some forms of vaccines. On the other hand, the COVID-19 pandemic has led to the extensive production and use of several vaccines against SARS-CoV-2, meanwhile, the side effects of these vaccines are gradually being reported. Up to now, few cases of rhabdomyolysis due to COVID-19 vaccination have been reported in the studies. The present study intended to report two cases of rhabdomyolysis due to vaccination with Oxford/AstraZeneca COVID-19 vaccines. The patients were two men aged 70 and 75 years old who presented to a healthcare facility with weakness, myalgia, nausea, and vomiting for about ten days after receiving their first dose of the Oxford/AstraZeneca COVID-19 vaccine. Patients had elevated levels of creatine phosphokinase (CPK), which were 5540 IU/L and 18760 IU/L in patients, respectively.

Background and Aim: Ectopic pregnancy (EP) is still one of the leading preventable causes of maternal morbidity and mortality in the first trimester. Amidst the use of sensitive assays for β-HCG and high-definition ultrasonography for the identification of EP, the search for a more reliable and sensitive marker remains a challenge till date. Our aim was to determine the validity of creatine phosphokinase (CPK) and its isoenzyme (CPK-MB) in the prediction of tubal EP. Materials and Methods: A prospective and comparative diagnostic accuracy study was conducted among 105 pregnant women in the first trimester who met the eligibility criteria in the Department of Obstetrics and Gynecology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS). The study included 35 patients each with tubal EP (EP), abortive intrauterine pregnancy (AP), and normal intrauterine pregnancy (NP). CPK, CPK-MB, and β-HCG were measured among all the participants, and the participants were followed up longitudinally. Results: A total of 105 pregnant women were included. The mean CPK and CPK-MB levels were significantly higher among the women with EP when compared to NP (P < 0.05) and AP (P < 0.05) women; however, there was no significant difference between the NP and AP groups (P > 0.05). Moreover, the receiver operating characteristic (ROC) curve showed that both CPK and CPK-MB were good predictors of EP, with CPK (area under the curve [AUC] = 0.764) being a better predictor than CPK-MB (AUC: 0.650) in the diagnosis of EP. Conclusion: Early diagnosis of EP allows appropriate and timely management, which would not only reduce mortality and morbidity associated with the condition but also enable preservation of fertility and improve future pregnancy outcome. Hence, the need of the hour is a reliable biochemical diagnostic marker for EP, such as CPK. [ABSTRACT FROM AUTHOR]

Purpose: To provide a comprehensive review of daptomycin weight-based dosing methods for obese patients. Methods: PubMed, Embase, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched through December 31, 2022. Studies relevant to daptomycin weight-based dosing methods in obese adult patients were included. Results: Sixteen studies were included, of which five were case reports and 11 were cohort studies. Obese patients were included in all case reports, of which one was pregnant. The infections improved after receiving a daptomycin dose based on actual body weight (ABW) in all cases. Seven studies demonstrated that ABW, ideal body weight (IBW), and adjusted body weight (AjBW)-based daptomycin dosing differed in terms of treatment success, microbiological clearance, and creatinine phosphokinase (CPK) elevation. However, AjBW was not statistically equivalent to ABW in all evaluated outcomes, except for treatment success. Three studies showed a higher area under the concentration-time curve (AUC) by 60% in obese patients, whereas two studies indicated a higher maximum plasma concentration (Cmax) of ~2 folds. One study demonstrated that obese patients had higher levels of total clearance and volume of distribution, whereas other pharmacokinetic parameters were comparable between obese and non-obese patients. Conclusion: While most of the available evidence reported daptomycin dosing based on actual or total body weight, a few other studies have reported the use of ideal or adjusted body weight. A significant elevation in CPK was observed when daptomycin was administered based on AdjBW, but not with ABW and IBW. Further research is required to determine the optimal daptomycin weight-based dosing method in obese patients. [ABSTRACT FROM AUTHOR]

Necrotizing myopathies are a subtype of autoimmune myopathies characterized by muscle fiber necrosis with minimal infiltration by inflammatory cells on muscle biopsy. This group of myopathies is defined by flaccid palsies due to prima‑ ry skeletal muscle damage as well as extramuscular manifestations such as fever, rash, arthritis, Raynaud’s syndrome and interstitial lung disease. The presence of anti-SRP antibodies is associated with rapidly progressive refractory myositis predominantly affecting limb muscles and axial muscles.Objective of the work is to analyze the course of severe, refractory to several lines of immunosuppressive therapies anti-SRP associated necrotizing myopathy and to highlight an adequate treatment regime.Necrotizing myopathy was suspected in patients aged 39 and 56 years with rapidly progressive flaccid tetraparesis on the basis of clinical and anamnestic data, the results of needle electromyography and muscle magnetic resonance imaging, as well as the analysis of myositis-specific and myositis-associated autoantibodies. In both cases, a rapid development of atrophies, marked muscle weakness in the limbs, without involvement of the bulbar musculature, was observed. To achieve effective control of the disease progression, several lines of therapy were required: glucocorticosteroids, intravenous immunoglobulins, methotrexate and rituximab. Our observations are consistent with those in the literature.Our observations illustrate the clinical course of severe myopathy associated with anti-SRP antibodies. Early initiation of aggressive immunosuppression is crucial to control the disease progression. Treatment and rehabilitation allow achieving significant improvement of the patient’s condition.

Abstract Background The association between serum creatine phosphokinase (CPK), a standard biochemical measure of acute myocardial infarction, and serum uric acid (sUA) has not been studied. This study aimed to determine the association between sUA and CPK in the general population of the US. Methods Data from the National Health and Nutrition Examination Survey (NHANES) 2015–2018 were used, including a total of 8,431 subjects aged ≥ 30 years. Weighted multiple regression analysis was used to estimate the independent relationship between sUA and CPK. Fitted smoothing curves and weighted generalized additive models were also performed. Results We found a positive relationship between sUA and CPK after adjusting for potential confounders. In subgroup analyses stratified by sex and race/ethnicity, sUA was positively correlated with CPK in each subgroup. The association between sUA and CPK followed an inverted U-shaped curve in females (turning point: sUA = 428.3 μmol/L). Conclusions Our study suggested that sUA level was positively correlated with CPK in the general population of the US. However, CPK increased with sUA until the turning point (sUA = 428.3 μmol/L) in females. Fundamental research and large sample prospective studies are needed to determine the exact mechanism of the association between sUA and CPK.

Biochemical indices of blood and tissue of the gastrocnemius muscle chronically alcoholized (for 3, 6 and 9 months) rats were studied. С60 fullerene aqueous solution (C60FAS) was administered orally as a pharmacological agent at a dose of 1 mg/kg daily throughout the experiment in a three routes: 1 h before alcohol intake (preventive regimen), together with alcohol (therapeutic regimen I) and 1 h after alcohol intake (therapeutic regimen II). Creatine phosphokinase (CPK), lactate dehydrogenase (LDH), catalase, superoxide dismutase, glutathione peroxidase (GPx) activity and the level of creatinine, lactate, hydrogen peroxide, reduced glutathione were estimated with clinical diagnostic kits. A pronounced upward trend in creatinine and lactate content, CPK and LDH activity with increasing degree of alcoholic myopathy during experiment was detected. Administration of C60FAS was shown to reduce the biochemical indices of muscle injury and to reduce oxidative processes by maintaining the balance between pro-oxidant and antioxidant systems. The maximum positive effect was observed when C60FAS was administered together with alcohol (therapeutic regimen I). The results indicate on C60 fullerene ability to correct the pathological condition of the muscular system arising from alcohol intoxication.

Purpose: This study aims to identify serum biomarkers that contribute to vascular thrombosis and complete flap failure in delayed reconstruction with free flaps, as well as to develop a scoring system of risk assessment including these biomarkers. Methods: A retrospective review of the database was conducted for lower extremity open fractures reconstructed between 7 and 90 days from injury, from March 2014 to February 2022. We investigated changes in platelet count (PLT), D-dimer, creatine phosphokinase (CPK), and C-reactive protein (CRP) and then, developed a risk assessment system including these biomarkers as risk factors. Results: A total of 62 free flaps were enrolled, and vascular thrombosis occurred in 14 flaps (22.6%), 9 of which (14.5%) developed complete flap failure. The risk assessment score was set to a maximum of 6 points for 6 items: age ≤ 40 years, time from injury to coverage ≥ 14 days, zone of injury from middle to distal leg, D-dimer on the day of injury ≥ 60 µg/mL, maximum value of CPK ≥ 10,000 U/L, and maximum value of CRP ≥ 25 mg/dL. The best cutoff score was 3 in the vascular thrombosis model (sensitivity: 0.79, specificity: 0.77) and 4 in the complete flap failure model (sensitivity: 0.78, specificity: 0.92). Conclusions: Our risk assessment system showed that the risk of vascular thrombosis was high at ≥ 3 points and that of complete flap failure was high at ≥ 4 points. Significantly, elevated levels of D-dimer, CPK, and CRP require more caution during reconstruction using free flaps. [ABSTRACT FROM AUTHOR]

Objective: To study the value of some biochemical indicators and Peradeniya Organophosphate Poisoning scale in prediction and prognosis of organophosphorus poisoning. Methods: This was a hospital-based prospective, observational study. Various biochemical tests viz. complete blood count, random blood sugar, liver and renal function tests, creatine phosphokinase, and electrolytes were performed. Patients were assessed based on the Peradeniya Organophosphate Poisoning scale. All the patients were followed till the end point like recovery/death. Results: Out of the 100 patients, 72% were males and 28% were females. The majority of the patients were farmers and 21 to 30 years of age. Suicidal was the most common manner (92, 92%). Based on the Peradeniya Organophosphate Poisoning scale, 47% were mild, 34% moderate, and 19% severe. Serum creatinine, creatine phosphokinase, serum glutamic-oxaloacetic transaminase, serum glutamic pyruvic transaminase, and alkaline phosphatase levels showed a significant correlation with severity. Conclusions: Some biochemical indicators such as creatine phosphokinase, alkaline phosphatase can be used as prognostic markers of organophosphorus poisoning. The Peradeniya Organophosphate Poisoning scale can be used for assessing severity of the poisoning. [ABSTRACT FROM AUTHOR]

Creatine phosphokinase (CPK-MM), is an important constituent of active muscle, acts as a vital enzyme in intracellular energy transport and is a potential biomarker for diseases like muscular dystrophy (MD), acute renal failure, and muscle damage. Herein, we report a single-step solid-state synthesis of niobium iron oxide(FeNbO 4) modified nickel foam (FeNbO 4 /NF) for non-enzymatic detection of CPK-MM in simulated human blood serum. The X-ray diffraction (XRD) reveals an orthorhombic phase formation of FeNbO 4 with (111) family of planes. The FeNbO 4 /NF exhibits a low limit of detection (i.e., 0.75 μg/L) and high sensitivity of 1.9 mA/x. cm−2 (x = μg/L) with a wide linear range of detection ranging from 1 μg/L to 100 μg/mL. This performance of the sensor can be attributed to the excellent electrocatalytic activity of the FeNbO 4 nanomaterial facilitating the effective redox reaction of the CPK. In this mechanism, the presence of oxy functional groups on the surface of FeNbO 4 /NF facilitates the interaction between the electrocatalytic active sites of the electrode and the CPK-MM molecules. In addition, this sensor exhibits outstanding selectivity (in presence of different interfering species like ascorbic acid, bovine serum albumin, urea, and uric acid) with good stability as well as reproducibility. The sensor is found successful in the determination of CPK-MM concentration in simulated blood serum samples with good recovery percentages. This efficacy of the as-fabricated electrode demonstrates the FeNbO 4 as a potential platform for various electrochemical-based bioanalytical applications. [Display omitted] [ABSTRACT FROM AUTHOR]

For patients who qualify, statins are among the most frequently prescribed drugs for the primary and secondary prevention of cardiovascular disease. A wide range of clinical manifestations, from generalized muscle aches to severe necrotizing myositis, are present in statin-induced myopathy. Here, we present a case of a 49-year-old woman with Vitamin D deficiency who developed statin-induced myopathy 45 days after starting rosuvastatin. A 49-year-old female was admitted to the hospital with a history of lower back pain and bilateral lower limb pain for 7 days. Her ongoing medications include ticagrelor 90 mg BD, metoprolol 25 mg OD, nicorandil 5 mg BD, telmisartan 20 mg OD, dapagliflozin 10 mg OD, metformin 1000 mg OD, vildagliptin 100 mg OD, pantoprazole 40 mg OD, and rosuvastatin 40 mg OD, which were started 45 days back when she was diagnosed with ischemic heart disease. On neurological evaluation, muscle weakness was present in the lower extremities with proximal muscle involvement more than the distal muscle, power at the hip was 2/5, knee and ankle joint were 4/5, knee and ankle reflex were 2/5, and the plantar reflex was normal, with no upper limb involvement. Laboratory investigation on the day of admission revealed elevated creatine phosphokinase (9873.00 U/L) and serum creatinine (2.45 mg/dl). Arterial blood gas analysis revealed a high anion gap with increased lactate levels. Vitamin D levels were found to be insufficient, and serum calcium was in the low normal range. Magnetic resonance imaging of the bilateral lower limb revealed bilaterally symmetrical abnormal edematous signal in muscles of the gluteal region, extensor, adductor, and flexor compartment indicative of myopathy. Volitional testing revealed the presence of spontaneous activity, and an electromyography study revealed that the interference pattern was complete with early recruitment, similar to what is seen in inflammatory myopathy. The motor unit action potential was polyphasic with short duration and amplitude. She was diagnosed with statin-induced myopathy with acute kidney injury. In this case, initiation of rosuvastatin and Vitamin D deficiency were the only positive associated factors that were responsible for myopathy and acute kidney injury and liver injury. Despite the reported incidence of myopathy and renal toxicity by rosuvastatin in the present era, rosuvastatin holds a major market across the globe. Although the case was successfully treated by withholding rosuvastatin, it added to significant morbidity and health-care costs. Therefore, this case report not only calls for increased pharmacovigilance when prescribing rosuvastatin but also adds to the already existing safety controversies surrounding this drug.

Objective: To study the value of some biochemical indicators and Peradeniya Organophosphate Poisoning scale in prediction and prognosis of organophosphorus poisoning. Methods: This was a hospital-based prospective, observational study. Various biochemical tests viz. complete blood count, random blood sugar, liver and renal function tests, creatine phosphokinase, and electrolytes were performed. Patients were assessed based on the Peradeniya Organophosphate Poisoning scale. All the patients were followed till the end point like recovery/death. Results: Out of the 100 patients, 72% were males and 28% were females. The majority of the patients were farmers and 21 to 30 years of age. Suicidal was the most common manner (92, 92%). Based on the Peradeniya Organophosphate Poisoning scale, 47% were mild, 34% moderate, and 19% severe. Serum creatinine, creatine phosphokinase, serum glutamic-oxaloacetic transaminase, serum glutamic pyruvic transaminase, and alkaline phosphatase levels showed a significant correlation with severity. Conclusions: Some biochemical indicators such as creatine phosphokinase, alkaline phosphatase can be used as prognostic markers of organophosphorus poisoning. The Peradeniya Organophosphate Poisoning scale can be used for assessing severity of the poisoning.

Introduction: Renal transplantation provides the best result as a long-term renal replacement therapy. Lymphorrhea is considered a common surgical complication of renal transplantation. Although nonsurgical factors are also associated, it is primarily due to damage and improper ligation of lymphatic vessels draining donor kidney and perivascular lymphatics of iliac vessels. Lymphorrhea is associated with prolongation of hospital stay and increased chances of infection and it may lead to lymphocele formation. Hence, to localize the origin of postoperative lymphorrhea in transplant recipients in wake for its definitive management, the enzymatic activity of the two enzymes, namely, creatine phosphokinase (CPK) and Lactate dehydrogenase (LDH) in the drain fluid was evaluated. Materials and Methods: A total of 68 renal transplant recipients (including live and deceased-donor [DD] transplantation) were evaluated for2 years. The enzymatic value of CPK and LDH was calculated in perigraft drain fluid. It was compared with the values of CPK and LDH in postradical cystectomy pelvic drain fluid and simple renal cortical cyst fluid. The average value of CPK in pelvic drain fluid and LDH in renal cortical cyst fluid was considered as their baseline value in lymphatics draining lower limb and renal lymphatics, respectively. Results: The source for postoperative lymphorrhea in DD and live-related donor was iliac lymphatics, whereas in live unrelated donor, it was iliac and graft kidney lymphatics. Conclusion: Drain fluid assessment for CPK and LDH activity can localize the origin of lymphatic leak in renal transplant recipients.

Investigations into the causes of adverse outcomes of the novel coronavirus infection (COVID-19) have been ongoing since the beginning of the pandemic. There is evidence that coronavirus-induced cardiovascular injury is as important to a risk of adverse outcome as respiratory injury. Many studies have shown that concomitant cardiovascular disease aggravates the course of COVID-19. However, in some patients who did not have cardiovascular diseases before COVID-19, they are detected during hospitalization or after discharge from the hospital. The review examines data on the effect of serum biomarkers of cardiovascular disease determined during COVID-19 on the risk of adverse outcomes in the near and long-term follow-up periods. Among such biomarkers are considered: troponins, N-terminal pro B-type natriuretic peptide, creatine phosphokinase-MB, lactate dehydrogenase, myoglobin, growth stimulation expressed gene 2, pentraxin 3, angiotensin II, as well as D-dimer and homocysteine. Threshold values have been set for some of these biomarkers, which allow predicting the risk of an unfavorable outcome. At the same time, in most prognostic models, these markers are considered in association with cytokine storm indicators and other risk factors.

Background: The association between serum creatine phosphokinase (CPK), a standard biochemical measure of acute myocardial infarction, and serum uric acid (sUA) has not been studied. This study aimed to determine the association between sUA and CPK in the general population of the US. Methods: Data from the National Health and Nutrition Examination Survey (NHANES) 2015–2018 were used, including a total of 8,431 subjects aged ≥ 30 years. Weighted multiple regression analysis was used to estimate the independent relationship between sUA and CPK. Fitted smoothing curves and weighted generalized additive models were also performed. Results: We found a positive relationship between sUA and CPK after adjusting for potential confounders. In subgroup analyses stratified by sex and race/ethnicity, sUA was positively correlated with CPK in each subgroup. The association between sUA and CPK followed an inverted U-shaped curve in females (turning point: sUA = 428.3 μmol/L). Conclusions: Our study suggested that sUA level was positively correlated with CPK in the general population of the US. However, CPK increased with sUA until the turning point (sUA = 428.3 μmol/L) in females. Fundamental research and large sample prospective studies are needed to determine the exact mechanism of the association between sUA and CPK. [ABSTRACT FROM AUTHOR]

Introduction: Renal transplantation provides the best result as a long-term renal replacement therapy. Lymphorrhea is considered a common surgical complication of renal transplantation. Although nonsurgical factors are also associated, it is primarily due to damage and improper ligation of lymphatic vessels draining donor kidney and perivascular lymphatics of iliac vessels. Lymphorrhea is associated with prolongation of hospital stay and increased chances of infection and it may lead to lymphocele formation. Hence, to localize the origin of postoperative lymphorrhea in transplant recipients in wake for its definitive management, the enzymatic activity of the two enzymes, namely, creatine phosphokinase (CPK) and Lactate dehydrogenase (LDH) in the drain fluid was evaluated. Materials and Methods: A total of 68 renal transplant recipients (including live and deceased-donor [DD] transplantation) were evaluated for2 years. The enzymatic value of CPK and LDH was calculated in perigraft drain fluid. It was compared with the values of CPK and LDH in postradical cystectomy pelvic drain fluid and simple renal cortical cyst fluid. The average value of CPK in pelvic drain fluid and LDH in renal cortical cyst fluid was considered as their baseline value in lymphatics draining lower limb and renal lymphatics, respectively. Results: The source for postoperative lymphorrhea in DD and live-related donor was iliac lymphatics, whereas in live unrelated donor, it was iliac and graft kidney lymphatics. Conclusion: Drain fluid assessment for CPK and LDH activity can localize the origin of lymphatic leak in renal transplant recipients. [ABSTRACT FROM AUTHOR]

To compare the performance of two predictive models for the survival of downer cows. The first model had been developed in 1987 using a dataset containing missing values, while the second, new model was developed on the same dataset but using modern data imputation and analytical methods. Missing data were imputed using multiple imputation by chained equations and a logistic regression model fitted to the imputed data, with survival or not as the outcome variable. The predictive ability of the model built on the imputed data was contrasted with the original prognostic model by testing them both on a second smaller but complete data set, collected contemporaneously with the development of the original model but from a different region of New Zealand. Sensitivity, specificity, accuracy, and cut point for the two models were calculated. The original 1987 model had a slightly higher accuracy than that of the new one with a sensitivity of 0.85 (95% CI = 0.72–0.94) and a specificity of 0.82 (95% CI = 0.7–0.91), using a cut point for the probability of survival = 0.313. The original prognostic formula published by Clark et al. in 1987 performed as well as a modern model built on an imputed data set. The use of a prognostic test based on the Clark model should remain an important part of the clinical examination of downer cows by New Zealand veterinarians. Abbreviations: AUC: Area under the curve; AST: Aspartate transaminase activity; CK: Creatine phosphokinase activity; GAM: Generalised additive model; NSAID: Non-steroidal-anti-inflammatory drugs; PCV: Packed cell volume [ABSTRACT FROM AUTHOR]

Background: In neonates, cerebral hypoxic-ischemia is the main cause of brain oedema which results in neurodevelopmental dysfunction. After cerebral injury, Aquaporin-4 (AQP4) is reported to be overexpressed in the astrocytes. This study was conducted to evaluate using of the blood level of aquaporin-4 in diagnosis of hypoxic ischemic encephalopathy in neonates. Methods: Blood samples were collected from 30 neonates with hypoxic ischemic encephalopathy (HIE), sample (1) at age of 2 days while sample (2) at age of 7 days, and from 30 neonates control groups. The collected blood samples were used to measure aquaporin-4 level and creatine phosphokinase (CPK). The study was conducted, during a period of 10 months, at Neonatal Intensive Care Unit, Pediatric Department, General Beni-Suef Hospital, and this study was case control study. Results: Aquaporin-4 at age of 2 days was found to be significantly higher in hypoxic patients than the control (220.83±98.85 vs. 135.51± 28.32 pg/ml). Moreover, the level of AQP4 at age of 7 day was 349.72±110.25 pg/ml. There was no significant difference in AQP4 level between preterm and full term hypoxic patients at age of 2 days, as the values were 275.33±69.72 pg/ml for preterm and 214.55±97.06 for full term. However, there was a significant difference in AQP4 level between preterm and full term hypoxic patients at age of 7 days, as the values were 453.93±66.19 pg/ml for preterm and 339.93± 108.22 pg/ml for full term. At age of 2 and 7 days, the severe hypoxic patients had significantly higher AQP4 levels than moderate or mild hypoxic patients. Conclusions: The obtained results indicate that serum Aquaporin-4 level and CPK enzyme activity could be used as early predictors in diagnosis of HIE. [ABSTRACT FROM AUTHOR]

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.

Benign acute myositis is a rare and transient condition that usually occurs after a viral upper respiratory infection. Several viruses have been associated with this process particularly influenza B. Viral myositis frequently occurs in school-age children with a male predominance. Patients complain about symmetrical calf muscle pain and uncoordinated gait and functional impairment. The presentation is associated with increased creatine phosphokinase. Benign acute myositis is a self-limiting condition with an excellent prognosis. Myoglobinuria is uncommon but severe. We report a case series of three patients presented with viral myositis. Pediatricians must be aware of this pathology to reach an early diagnosis and avoid unnecessary diagnosis investigations. It is also important to reach out to myoglobinuria, which can lead to renal impairment., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Arrab et al.)

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. [ABSTRACT FROM AUTHOR]

Background: Acute compartment syndrome is considered a debilitating complication of limb trauma. Early detection of this compartment syndrome helps us in the early initiation of treatment which will result in preventing its subsequent complications reported in these cases. Methods: This research was an analytical cross-sectional study. Patients with direct trauma to extremities, who were referred to the emergency department of Valiasr and Amir Al-Momenin hospitals were studied from October 2018 to April 2019 in Arak, Iran. Patients were selected if they met all of the inclusion criteria and none of the exclusion criteria. Vital signs were measured and recorded for each patient. Also, the results of physical examination, intra-compartmental pressure measurement by a wick catheter and the level of the creatine phosphokinase were recorded. All data analyses were performed with the use of SPSS v21 software. Results: A total number of 70 subjects were included in this study, comprising 65 males (93.1%) and 5 females (6.9%). The results showed that there is a significant relationship between intra-compartment pressure and the level of creatine phosphokinase enzyme. The higher the intracompartmental pressure, the higher the creatine phosphokinase level. Statistically significant associations were observed between intracompartmental pressure and pallor, edema, lack of limb pulse, and diastolic blood pressure. No significant relationship was found between intracompartmental pressure and limb pain, numbness, inability to move the injured limbs, and systolic blood pressure. In addition, our findings indicated that creatine phosphokinase is significantly associated with edema and lack of limb pulse. No significant relationship was found between creatine phosphokinase with pain, pallor, numbness, inability to move limbs, and systolic and diastolic blood pressure. Conclusion: The study findings suggest that measurement of intracompartmental pressure could be considered as an effective alternative approach to creatine phosphokinase levels to diagnose compartment syndrome. So, this will prevent irreparable damage to the extremities and is of great importance.

A 19-year-old male from a rural background with no prior co-morbidities came with chief complaints of fever for 4 days, associated with chills, rigors, myalgias and high coloured urine. On general examination, pallor was present. Vitals and systemic examination were normal. Routine blood investigations were sent, and two sets of blood cultures were sent. The patient was empirically started on ceftriaxone. Complete urine examination showed >20 red blood cells (RBCs)/high-power field (HPF) with four to five RBC casts/HPF. Initial creatine phosphokinase was 3216 U/L. The patient's fever spikes continued, and antibiotic was changed to piperacillin-tazobactam after 48 h and then to meropenem. Fever spikes continued. The patient developed pancytopenia and acute respiratory distress syndrome. Final blood culture report grew Brucella melitensis. The patient was started on streptomycin and doxycycline. The patient improved clinically and discharged in clinically stable condition.

Background: Donor rhabdomyolysis may constrain kidney utilization due to anticipated unfavorable graft outcomes—especially in combination with acute kidney injury (AKI). There is a paucity of empiric data to inform organ acceptance decision‐making. Methods: A single‐center retrospective cohort study of adult transplant recipients of deceased‐donor kidneys with reported donor creatine phosphokinase (CPK) levels was conducted between 2014 and 2020. Recipients of CPK ≥ 1000 U/L kidneys were propensity matched to CPK < 1000 recipients according to outcome‐predictive baseline covariates, except AKI. Results: A total of 254 kidney transplants were propensity matched into CPK ≥ 1000 (n = 90) versus CPK < 1000 (n = 90) groups. Transplant outcomes with high versus low CPK kidneys were similar in terms of delayed graft function (P = 0.64), 1‐year estimated glomerular filtration rate < 25th percentile (P = 0.69) and mean (P = 0.58), and time to all‐cause graft failure (P = 0.58). There was no interaction between AKI and high CPK for these outcomes. Extreme CPK thresholds as high as > 8672 U/L were not associated with overall graft survival in the unmatched sample (P = 0.81). Conclusions: In a single center study, donor rhabdomyolysis was not associated with short‐term kidney transplant graft outcomes, nor was there an additive effect of AKI. However, studies with greater CPK and AKI severity and longer follow‐up are warranted. [ABSTRACT FROM AUTHOR]

Background: Alcohol withdrawal syndrome is a potentially life-threatening condition with severe complications such as withdrawal seizures and delirium tremens. A valid and reliable biomarker for predicting the severity of alcohol withdrawal can be instrumental in individualizing effective therapy at the earliest. Methodology: This was an observational study done on 120 patients to study the relationship between serum creatine phosphokinase (CPK) levels with severity of alcohol withdrawal. The assessment for the severity of alcohol withdrawal was done with Clinical Institute Withdrawal Assessment for Alcohol-revised (CIWA-Ar) scale and an association was studied between the serum CPK levels and the severity of alcohol withdrawal. The data was analyzed using Chi-square test and Kruskal–Wallis tests. Results: The severity of alcohol withdrawal as per the CIWA was 26.66% mild, 55% moderate, and 18.33% severe. The mean serum CPK level for mild withdrawal was 126.93 IU/L, moderate withdrawal was 303.66 IU/L, and for severe withdrawal was 780.81 IU/L. A statistically significant association was obtained indicating that patients with higher CIWA-Ar scores are likely to have a higher level of serum CPK levels. Conclusion: Serum CPK levels were significantly associated with severity of alcohol withdrawal and can possibly serve as a candidate biomarker.

Aims: Evaluation of total serum creatine phosphokinase and serum lactate dehydrogenase levels as a biochemical parameter in the diagnosis of oral cancer, oral leukoplakia by the case-control method. Settings and Design: A hospital-based, case-control study was conducted at the Department of Oral Medicine, Diagnosis, and Radiology. Materials and Methods: The study included clinically and histopathologically diagnosed oral leukoplakia and oral cancers with 20 patients in each group. The control group consisted of 20 healthy patients without lesions or tobacco-related habits or any systemic diseases. The blood samples were collected from the study and control groups, centrifuged, and serum was analyzed for serum creatine phosphokinase and serum lactate dehydrogenase (CK and LDH) levels using an autoanalyzer. Statistical Analysis: Comparison of three groups with respect to each biochemical parameter was done by one-way ANOVA. Comparison between the groups was done by Tukey's multiple post hoc test. Results: It was found that total serum CK levels were statistically significantly decreased in both oral leukoplakia and oral cancer when compared with that of the control group. Total serum LDH levels were statistically significantly increased in both oral leukoplakia and oral cancer when compared with that of the control group. Conclusion: Although the results of the present study showed increased levels of LDH in both oral leukoplakia and oral cancer, and CK levels statistically decreased but they were within normal limits. Further. studies with a greater number of samples, different grades of epithelial dysplasias, and assessment of individual isoenzymes has to be carried out to evaluate the exact role of CK and LDH in the etiopathogenesis of oral cancer.

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. [ABSTRACT FROM AUTHOR]

Background: Benign acute childhood myositis (BACM) is associated with several viral infections. The aim of this study was to evaluate the progression of myositis symptoms, laboratory findings and oseltamivir treatment in children with influenza- and non-influenza-associated BACM. Methods: Patients aged 0–18 years old, admitted to the pediatric emergency department in the seasonal influenza period between 2018 and 2020 were retrospectively analyzed. Patients with acute onset calf tenderness, pain, difficulty in walking and elevated serum creatine phosphokinase were included and were grouped according to influenza rapid test kit results as influenza (A and B) positive, and influenza negative. The time to symptom resolution, laboratory data and the oseltamivir treatment were compared between the groups. Results: There were 94 patients (67 male, 27 female) with a mean age of 77 ± 22 months. Influenza A was detected in 21, influenza B in 27, and neither were detected in 46 patients. Time to symptom resolution of BACM was shorter in the influenza-positive patients than in influenza-negative patients (2.9 ± 1.4 days and 3.5 ± 1.5 days, respectively, P = 0.027). Oseltamivir did not reduce the symptom resolution time in influenza patients. All children had normal hemoglobin and platelet counts, elevated creatine phosphokinase and 76% of them had leukopenia. Neither clinical recurrence nor metabolic disease were reported. Conclusion: Symptoms of BACM tended to resolve slightly earlier in influenza-positive patients and the duration of symptoms was not affected by oseltamivir treatment. [ABSTRACT FROM AUTHOR]

Abstract 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.

Objective: to investigate markers of anaerobic energy supply in overworked athletes after the combination rehabilitation. Materials and methods: all athletes were divided into two subgroups: 2nd A-subgroup (23 persons) - overworked athletes with combined rehabilitation and 2nd B-subgroup (24th) - athletes with traditional rehabilitation. Results: concentration of lactic acid in the blood of athletes of the 2nd A subgroup at rest is minimal in comparison with the 2nd B subgroup and 1-group athletes, P < 0,05-0,01. After the stress test there is an increase in the concentration of lactic acid in the 2nd A subgroup, P < 0.01. After the stress test athletes 2nd A subgroups, the level of lactate dehydrogenase is higher than that of athletes 2nd B subgroups. Conclusions: low concentration of lactic acid at rest in athletes of the 2nd A subgroup indicates the adaptation and energy saving of these young men, which is due to the prevalence of aerobic mechanisms in energy supply.