Cambios enzimáticos durante el entrenamiento anaeróbico láctico y su influencia en la capacidad aeróbica / Enzymatic changes during lactic anaerobic training and their influence on aerobic capacity

Introducción: El entrenamiento deportivo es un proceso que requiere una planificación orientada a la adaptación del cuerpo a las cargas internas versus cargas externas; de allí, surge la necesidad de conocer el comportamiento de algunas enzimas musculoesqueléticas a través del control bioquímico y fisiológico del entrenamiento en el atletismo de medio fondo. Objetivo: Analizar los cambios enzimáticos de la creatinfosfoquinasa y la lactodeshidrogenasa durante el entrenamiento anaeróbico láctico y su influencia en la capacidad aeróbica en atletas de medio fondo. Método: Se utilizó el método descriptivo comparativo con una muestra de 20 sujetos aleatorizados en dos grupos: experimental y control; el análisis se realizó bajo el modelo estadístico Anova descriptiva, pruebas T y diseño de medidas repetidas con un intervalo del 95 por ciento de confianza (p<0,05). Resultados: En las variables creatinfosfoquinasa y lactodeshidrogenasa inicial y final no hubo variaciones significativas intergrupos; se observaron diferencias en la creatinfosfoquinasa en varianza (p=0,022) del orden del 97,8 por ciento; que en promedio (p=0,088) representó los niveles alcanzados del 91,2 por ciento. En las medidas repetidas no se presentaron cambios estadísticamente significativos intergrupos. Para la variable del VO2máx se aplicó la prueba T para comparar los estados inicial y final en cada grupo y hubo diferencias en ambos grupos (control p=0,002; experimental p=0,000). Conclusiones: No hubo cambios enzimáticos importantes durante los entrenamientos anaeróbico láctico y aeróbico, a su vez, el entrenamiento anaeróbico láctico si tuvo influencia en la capacidad aeróbica(AU)

Introduction: Sports training is a process that requires a planning oriented to the adaptation of the body to internal loads versus external loads; from there, arises the need to know the behavior of some musculoskeletal enzymes through the biochemical and physiological control of training in middle-distance athletics. Objective: To analyze the enzymatic changes of creatine phosphokinase and lactodehydrogenase during lactic anaerobic training and their influence on aerobic capacity in middle-distance athletes. Methods: The descriptive comparative method was used with a sample of 20 subjects randomized in two groups: experimental and control; the analysis was performed under the descriptive Anova statistical model, T-tests and repeated measures design with a 95 percent confidence interval (p<0.05). Results: In the initial and final creatine phosphokinase and lactodehydrogenase variables, there were no significant intergroup variations; differences were observed in creatine phosphokinase regarding variance or standard deviation (p=0.022) in the order of 97.8 percent; which in average (p=0.088) represented the levels reached of 91.2 percent. In the repeated measures, there were no statistically significant intergroup changes. For the VO2max variable, the T-test was applied to compare the initial and final states in each group and there were differences in both groups (control p=0.002; experimental p=0.000). Conclusions: There were no important enzymatic changes during lactic anaerobic and aerobic training, and lactic anaerobic training had an influence on aerobic capacity(AU)

Rapidly progressing treatment resistant anti-TIF1 gamma antibody positive dermatomyositis

Dermatomyositis is an idiopathic inflammatory myositis involving progressive muscle weakness with skin manifestations. Incidence of dermatomyositis is 1 per 100,000 in general population. Diagnosis is based on characteristic skin rashes, progressive muscleweakness and elevated muscle enzymes levels (creatine phosphokinase). The diagnosis is confirmed by clinical examination, abnormal electromyogram and autoimmune workup. In this case report, we report a case of difficult to treat dermatomyositis with proximal muscle weakness in an elderly male patient with classical skin lesions. The patient was resistant to steroid and immunoglobulin therapy.

Rhabdomyolysis with acute kidney injury after single episode of generalized seizure in a known case of epilepsy: a case report

Rhabdomyolysis is defined as breakdown of skeletal muscle fibers with subsequent release of its cellular components into the circulation. It is associated with variety of causes and status epilepticus is one of it. The excessive muscular activity associated with seizure is possible explanation for it. It is clinically evident by the new onset severe generalized bodyache, weakness and myalgia associated with dark coloured urine. Acute kidney injury is one of the most serious complications associted with rhabdomyolysis. Single episode of generalized seizure is not a frequent cause for rhabdomyolysis. Acute kidney injury due to rhabdomyolysis, following a single episode of seizure is a rare entity. Here we report a case of rhabdomyolysis with acute kidney injury following a single episode of generalized seizure. High index of suspicion is required to timely diagnose and treat such patients. Timely intervention with hemodialysis along with other supportive care can completely revert this potentially serious complication to normal.

Role of Inflammation and Serum Creatine Phospho Kinase in Seizures

Background and Objectives: Epilepsy which is a disorder with an extensive variability of symptomatology and multifactorial origins is categorized by emergent and recurrent seizures. Numerous studies showed that seizures are triggered by hyperactivity of the neurons of the brain which may be atypical and synchronous. Our study was aimed to find out the association of inflammation in terms of total leukocyte count (TLC) and serum creatine phosphokinase (CPK) concentration in epilepsy and their comparison with pseudo-seizures and healthy controls. Methodology: We conducted this study in Mayo Hospital, Lahore with the collaboration of the Physiology Department of King Edward Medical University, Lahore after approval from Advanced Studies and Research Board of KEMU, Lahore. The sample size was ninety and they were divided equally into three groups, 30 patients of GTCS, 30 patients with a history of pseudoseizures and 30 healthy subjects of comparable age. p< 0.001 was taken as significant. Statistical analyses were done using SPSS 21. Results: Mean total leukocyte count (TLC) in Pseudo-seizures groups was 8216.3 ± 2195.8 cu.mm, in the epileptic group was 13219.9 ± 2686.8 cu.mm and in the control group, the mean TLC was 6832.1 ± 1154.9 cu.mm. Mean serum CPK in pseudo-seizure groups was 130.1 ± 74.3 IU/100 ml, in the epileptic group was 257.7 ± 24.6 IU/100 ml and in the control group, the mean CPK was 79.9 ± 27.7 IU/100 ml. Conclusion: Total leukocyte count (TLC) and CPK were higher in the epileptic group as compare to the pseudo-seizure groups as well as the control group. Elevated WBC levels may be a result of continuing inflammatory progressions in the pathogenesis of epilepsy. Therefore it was concluded that serum CPK and TLC may serve as a differentiating marker between epileptic generalized tonic-clonic seizures (GTCS) and pseudo seizers.

Correlation of serum creatine phosphokinase and serum cholinesterase in organophosphate poisoning in children

Background: Organophosphate (OP) poisoning is one of the most common pesticide poisoning in India in adolescents because of its easy availability. Serum pseudocholinesterase levels are commonly used to assess the severity and to know the prognosis in OP compound poisoning. Serum creatine phosphokinase (CPK) levels is another lab parameter which gets deranged in OP poisoning and has been tried in adults to assess the severity and to know the prognosis.'Authors objective was to study the correlation of serum pseudocholinesterase and serum CPK in organophosphate poisoning at admission and to compare outcome with serum CPK levels.Methods: All the children in the age group of 1 month to 18 yrs, who were admitted with the history of suspected OP compound poisoning were enrolled for the study. Estimation of cholinesterase and CPK levels were done at admission and after 1 week. Patients were categorised in to latent, mild, moderate and severe cases based on the S. Cholinesterase levels. These values were analysed to see the correlation.Results: Among 34 OP poisoning cases,13(38%) were males and 21(62%) were females. Mean age of study population was12.6+4.25 yrs. The median CPK values in latent, mild, moderate and severe cases were 121.5 IU/L,276.5 IU/L, 308IU/L and 467IU/L respectively (p=0.015). Spearman's rho Correlation coefficient was -0.522 between S. Cholinesterase and S CPK at admission which was significant. The median serum CPK level after 1week in non survivors was 2498.0IU/L and in survivors was 201.0IU/L (p0.014).Conclusions: There was a strong negative relationship between serum cholinesterase and serum CPK at admission in OP poisoning. Follow up values at 1 week showed that significantly high serum CPK and low cholinesterase, which was also significant and was associated with mortality.

Impact of Topical Phytotherapeutic Effects on Elevated Level of Serum Creatine Kinase- Muscle as Risk Factor of muscular degeneration in Knee-Osteoarthritis: Part III. A Systematic Meta-Analysis

Background: The knee-osteoarthritis (KOA) is a risk for muscular degeneration by the elevation of creatine kinase-muscle (CK-MM). The present study was aiming to normalize the elevated level of CK-MM by topical phytotherapeutic protocol correlated with anatomical measurements, the Kellgren- Lawrence (KL) grading systems of radiographic KOA, body mass index (BMI), overall improvement of pain under visual analogue scale (VAS) and pain, stiffness and physical function under WOMAC index. Methods: Baseline data from 108 patients (66.67 % females) with KOA aged 40-75 years old were recruited in this cross-sectional study. Bilateral anatomical measurements included the gap at the knee between the short head of the biceps femoris and the surface of the bed, diameter of muscles of thighs and calves, angles of straight leg raising, flexion and extension in different positions and BMI were measured using appropriate instruments. The elevated level of CK-MM, scored KL grading system and pain under VAS and WOMAC index were also evaluated at the baseline and after 42 days of treatment. Results: All the bilateral leg anatomical measurements were symmetry at the end of the 42nd session (P<0.0001). The significant changes were observed in VAS (P<0.00001), WOMAC index (P<0.0001), CK-MM level (P<0.0001), BMI (P<0.0001) and improvement of KL grading scores. Conclusions: The improvements of damaged leg muscles due to muscular dystrophy, connective tissue damage etc. confirmed with normalization of elevated serum CK-MM level, above mentioned anatomical measurements, BMI, VAS, WOMAC index and KL grading systems may be synergistic effect of phytochemicals during specific phytotherapeutic treatment protocol.

Myocardial preservation of stellate ganglion block in the off-pump coronary artery bypass grafting / 临床麻醉学杂志

Objective To explore the application values and the effect of myocardial preservation of right stellate ganglion block in off-pump coronary artery bypass grafting (OPCABG). Methods Sixty-two patients with ASA Ⅱ or Ⅲ,aged 50-75 years,scheduled for OPCABG were randomly divided into stellate ganglion block group (group SGB)and control group (group C)with 31 cases each.The patients in group SGB received right-lateral SGB before anesthesia induction.The medications and methods of anesthesia induction in the two groups were identical.Hemodynamics be-fore start of anethesia (T0 ),after induction (T1 ),after intubation tube (T2 ),after sternotomy (T3 ),at the beginning of bypass surgery for interrupted coronary artery (T4 ),at the end of coronary bypass grafting (T5 )were observed.Meanwhile,changes of serum cardiac troponin I (cTnI)and cre-atine phosphokinase MB (CK-MB)at T0 ,6 h (T6 ),12 h (T7 ),24 h (T8 )after operation were also observed.The operative time,the amount of drugs used and postoperative recovery were recored. Results MAP,HR of group SGB increased at T2-T5 compared with T0 ,and MAP,HR of group C significantly increased at T2-T5 comparing with T0 (P <0.05).Compared with those in group SGB, MAP,HR significantly increased at T2-T5 in group C (P <0.05 ).The Concentrations of cTnI and CK-MB of group C increased more obviously than those in group SGB at T6-T8 (P <0.05).Compared with group C,patients in group SGB needed less medication,less hospitalization time in ICU and had faster postoperative recovery.Conclusion SGB for patients during OPCABG stabilizes hemodynamy stability,further reduces myocardial injury,thus protecting myocardium.

Cold Medications Aggravated Rhabdomyolysis Symptoms Induced by Building Construction Work and Strenuous Exercise: a Case Report

SUMMARY: A 21-year-old healthy Korean man worked on a building construction site every day for almost 2 months and exercised every day for 1 or 2 hours after working hard. He felt dizziness, nausea, and experienced vomiting and body aches immediately after exercise and immediately took cold medicines including acetaminophen, cimetidine, bepotastine, and Codenal? complex for the common cold symptoms for 2 days because he was scheduled to participate in navy training at that time. He complained of severe trapezius pain and aches in his left calf 3 days after joining the Navy training. Testing revealed creatine phosphokinase (CPK) 6260 U/L, myogloblin 176 mcg/L in the urine, liver enzymes increased, and oliguria, suggesting rhabdomyolysis. He recovered with intravenous fluids without any complications.

Clinical and laboratory description of a series of cases of acute viral myositis / Descrição clínico-laboratorial de uma série de casos de Miosite Aguda Viral

ABSTRACT 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, o acompanhamento e o 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 no 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 de sete 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 média de 4,3 dias. Os sintomas músculo-esqueléticos foram: dor localizada nas panturrilhas (80%), deambulação limitada (57%), marcha anormal (40%) e fraqueza muscular nos membros inferiores (71%), com duração média de 3,6 dias. Observou-se elevação importante das enzimas CPK (5.507 ± 9.180) U/l, DHL (827 ± 598) U/l e AST (199 ± 245) U/l e tendência a leucopenia (4.590 ± 1.420) leucócitos/mm3. A recuperação completa 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 autolimitado foram os indícios para o diagnóstico. A elevação de enzimas musculares indica a atividade miotrópica transitória relacionada à influenza sazonal que deve ser considerada, a despeito da identificação viral, possivelmente associada com o vírus influenza ou outros vírus respiratórios.

Sindrome de hipertermia maligna: a propósito de un caso clínico / Malignant hyperthermia syndrome: case report

El síndrome de hipertermia maligna es una miopatía familiar de naturaleza farmacogenética, que se presenta como un síndrome hipercatabólico del músculo esquelético ligado a la anestesia. La incidencia en pediatría es de 1 cada 10 000 cirugías. Puede ser de instalación rápida, asociado a succinilcolina, o tardía, relacionado con agentes inhalatorios. El cuadro ocurre con taquicardia, hipertermia, hipercapnia, acidosis, rigidez muscular, hiperpotasemia, falla renal y arritmia. La mortalidad sin tratamiento específico es del 80% y desciende al 7% con el uso de dantroleno sódico. Reportamos el caso de un paciente de 8 años que se internó para cirugía de fimosis. Por presentar taquicardia, hipercapnia y rigidez muscular, se inició tratamiento con dantroleno sódico en quirófano, el cual se mantuvo durante 72 h. Evolucionó las primeras 12 h con bajo gasto cardíaco, con máximo valor de creatina fosfoquinasa de 155 147 U/L. Permaneció con asistencia mecánica respiratoria por 48 h. Se otorgó alta al sexto día, sin secuelas.

Malignant hyperthermia syndrome is a family myopathy of pharmacogenetic nature, which appears as a skeletal muscle hypercatabolic syndrome linked to anesthesia. The incidence in pediatrics is 1 event per 10 000 surgeries. The clinical picture may have a rapid onset associated with succinylcholine, or a late onset related to inhalation agents. The clinical picture includes tachycardia, hyperthermia, hypercapnia, acidosis, muscle rigidity, hyperkalemia, renal failure and arrhythmia. Mortality without specific treatment is of 80% and drops to 7% with the use of dantrolene sodium. We report an 8-year-old patient admitted for phimosis surgery; having tachycardia, hypercapnia and muscle rigidity, he started treatment with dantrolene sodium in the operating room, which was maintained for 72 hours. He evolved the first 12 hours with low cardiac output and creatine phosphokinase maximum of 155 147 U/L. He remained with mechanical ventilation for 48 hours. Discharge was given on the sixth day without sequelae.

Consumo de estatinas y asociación con la elevación en los niveles de creatina fosfoquinasa / Statin use and association with elevated levels of creatine phosphokinase

Introducción: las estatinas son medicamentos hipolipemiantes asociados con miotoxicidad como efecto adverso. Objetivo: determinar la asociación entre el uso de estatinas y la elevación de la creatinafosfoquinasa. Materiales y métodos: se realizó un estudio transversal en pacientes consecutivos que asistieron al Laboratorio Clínico Hematológico (Medellín, Colombia) para la determinación del perfil lipídico. Se incluyeron 661 pacientes, 329 en el grupo de estatinas y 332 en el de no estatinas.A todos se les midieron los niveles séricos de creatina fosfoquinasa y se consideraron como elevados los niveles superiores a 170 mg/dL. Se estableció un nivel de significancia menor de 0,05. Resultados: se registró mayor proporción de pacientes con creatina fosfoquinasa elevada en el grupo con consumo de estatinas (64,9% frente a 47% en el grupo de no estatinas; razón de disparidad: 2,01; intervalo de confianza del 95%: 1,21-3,32; p= 0,0085). No se encontró asociación entre la elevación de la creatina fosfoquinasa y la presencia de dolor (razón de disparidad: 0,78; intervalo de confianza del 95%: 0,40-1,50; p= 0,5615), fatiga (razón de disparidad: 0,85; intervalo de confianza del 95%: 0,45-1,61; p= 0,7385) y debilidad muscular (razón de disparidad: 1,46; intervalo de confianzadel 95%: 0,68-3,12; p= 0,4333); aunque el grupo de estatinas presentó mayor frecuencia de dolor (razón de disparidad: 2,96), fatiga (razón de disparidad: 1,98) y debilidad muscular (razón de disparidad: 4,19). Conclusiones: el consumo de estatinas se relaciona con síntomas musculares y elevación de creatina fosfoquinasa, sin relación entre la elevación de creatina fosfoquinasa y la presencia de síntomas musculares.

Introduction: statins are a class of lipid-lowering medications associated with the adverse effect of myotoxicity. Objetive: To determine the association between statin use and creatine phosphokinase elevation. Materials and methods: A cross-sectional study, involving consecutive patients attending in the clinical laboratory Laboratorio Clinico Hematologico (Medellin, Colombia) for a serum lipid profile test was performance. A total of 661 patients were included, 329 belonged to the statin group and 332 to the non-statin group. All patients were tested for serum creatine phosphokinase and were considered elevated the serum levels higher than 170 mg/dL. The threshold for significance was set as p-value less than 0.05. Results: Creatine phosphokinase levels were more elevated in the statin group (64.9% versus 47% in non-statin group; odds ratio: 2.01; 95% confidence interval: 1.21-3.32, p= 0.0085). No association was found between the degree of creatine phosphokinase elevation and the presence of muscular pain (odds ratio: 0.78; 95% confidence interval: 95%, 0.40-1.50, p= 0.5615), fatigue (odds ratio: 0.85; 95% confidence interval: 0.45-1.61, p= 0.7385) or muscle weakness (odds ratio: 1.46; 95% confidence interval: 0.68-3.12, p= 0.4333). However, the statin group exhibited greater frequency of muscle pain (odds ratio: 2.96), fatigue (odds ratio: 1.98) and muscle weakness (odds ratio: 4.19). Conclusions: statin use is associated with a higher frequency of muscular symptoms and higher creatine phosphokinase levels, with no relationship between creatine phosphokinase elevation and the presence of muscle symptoms.

Spinning-induced Rhabdomyolysis: Eleven Case Reports and Review of the Literature

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 effect of erythropoietin on creatine phosphokinase levels during ischemia reperfusion injury in rats / Efecto de la eritropoyetina en niveles de creatine fosfoquinasa durante daño por isquemia reperfusión en ratas

Objective: to examine the effect of erythropoietin testing on rat model and particularly the ischemia reperfusion protocol. Methods: experimental study of 40 rats weighing 247.7 g as average. The beneficial effect or non-effectiveness of the erythroproietin molecule on the blood creatine phosphokinase levels was biochemically studied. It was measured 60 min (groups A and C) and 120 min (groups B and D) after reperfusion with no administration of erythropoietin in groups C and D. Results: Erythropoietin administration significantly increased the creatine phosphokinase levels to 3586.05 IU/L (1873.115 IU/L-5298.985 IU/L;p= 0.0001). This finding was in accordance with the result of paired t-test (p= 0.0001). Reperfusion time significantly increased the CPK levels to 557.35 IU/L (-1513.284 IU/L-2627.984 IU/L; p= 0.5890), also in accordance with paired t-test (p= 0.4661). The interaction of erythropoietin administration and reperfusion time significantly increased the creatine phosphokinase levels to 1988.282 IU/L (918.2646 IU/L-3058.299 IU/L; p= 0.0006). Conclusions: Erythropoietin administration, reperfusion time and their interaction generally increase short-term effects on blood creatine phosphokinase after ischemia reperfusion injury.

Objetivo: examinar el efecto del test de eritropoyetina en un modelo de rata, particularmente el protocolo de isquemia reperfusión. Métodos: estudio experimental en el que se usaron 40 ratas con un peso medio de 247,7 g. Se estudió bioquímicamente el beneficio o el no efecto de la molécula de eritropoyetina en la creatín fosfokinasa sanguínea. Esta se midió en dos momentos: 60 min después de la reperfusión (grupos A y C) y 120 min después de esta (grupos B y D). No se administraron eritropoyetina en los grupos A y B, contrario a los grupos C y D. Resultados: la administración de eritropoyetina aumentó significativamente la creatín fosfokinasa sanguínea a 3586,05 UI/L (1873,115 IU/L-5298,985 UI/L; p= 0,0001), de acuerdo también con el test pareado t-test (p= 0,0001). El tiempo de reperfusión incrementó significativamente la creatín fosfokinasa sanguínea a 557,35 UI/L (-1513,284 UI/L-2627,984 UI/L; p= 0,5890), de acuerdo con el test aplicado t-test (p= 0,4661). La interacción de la administración de eritropoyetina y el tiempo de reperfusión elevó significativamente los niveles de creatín fosfokinasa sanguínea a 1988,282 UI/L (918,2646 IU/L-3058,299 IU/L; p= 0,0006). Conclusión: la administración de eritropoyetina, el tiempo de reperfusión y su interacción, generalmente incrementa los efectos a corto plazo en la creatín fosfokinase sanguínea después del daño por isquemia reperfusión.

Biopsy proven auute tubular necrosis due to rhadomyolysis in a dengue fever paatient: a case report and review of literature / Necrose tubular aguda comprovada por biopsia em paciente com dengue e rabdomiolise

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.

Resultados de histologia renal são muito escassos em pacientes com rabdomiólise e injúria renal aguda (IRA) associada a dengue. Descrevemos caso de dengue complicado por rabdomiólise e IRA no qual a biópsia renal mostrou necrose tubular aguda (NTA) e deposição renal de mioglobina. Paciente de 28 anos que apresentou dengue complicado por IRA grave e rabdomiólise é descrito. Ele necessitou de diálise por três semanas. A biópsia renal mostrou NTA, com imunohistoquímica fortemente positiva para mioglobina nos túbulos renais. O paciente recebeu alta com recuperação da função renal. Em conclusão, descrevemos caso de dengue complicado por IRA e rabdomiólise, em que a biópsia renal mostrou NTA e deposição de mioglobina. Sugerimos que creatinofosfoquinase deve ser monitorizada em pacientes com dengue para permitir o diagnóstico precoce de rabdomiólise e a instituição de medidas protetoras para o rim.

Myopathy in an alcoholic patient.

Aim :- To describe a patient with elevated creatine kinase , the cause of which is not encountered commonly. The CPK level of a blood sample obtained in the laboratory was found to be very high . When investigated it was found to be of a patient who presented to emergency after taking Alcohol for 5 days without food.The patient was being diagnosed with alcoholic myopathy.Alcoholic myopathy is not well recognized condition and should be considered in such patient presenting with muscle weakness.

Sustained increase of serum creatine phosphokinase levels and progressive muscle abnormalities associated with raltegravir use during a 32-week follow-up in an HIV-1 experienced patient on simplified HAART regimen, intolerant to protease inhibitors and abacavir: a case report / Aumento sostenido de los niveles de creatina fosfoquinasa sérica y las anormalidades musculares progresivas asociadas con el uso de raltegravir durante un seguimiento de 32 semanas en un paciente de VIH-1 experimentado en régimen de terapia TAAA simplificada, con intolerancia a los inhibidores de proteasa y abacavir: un reporte de caso

Sustained increase of serum creatine phosphokinase (CPK) concentrations and muscle abnormalities have been reported in patients taking raltegravir (RAL). In this report, we describe a case of sustained and asymptomatic increase of serum CPK concentrations associated with raltegravir, zidovudine, and lamivudine in an HIV-1 experienced patient with intolerance to protease inhibitor, abacavir and pencillin during 32 weeks of continuous drug monitoring.

Un aumento sostenido de las concentraciones de creatina fosfoquinasa sérica (CPK) y las anormalidades musculares ha sido reportado en relación con pacientes que toman raltegravir (RAL). En este reporte, describimos un caso de aumento sostenido y asintomático de concentraciones séricas de CPK asociadas con raltegravir, zidovudina y lamivudina en un paciente experimentado de VIH-1 con intolerancia al inhibidor de la proteasa, al abacavir y la penicilina durante 32 semanas de monitoreo farmacológico continuo.

Analysis of the Impact on Community Health after Accidental Leak of Hydrofluoric Acid

PURPOSE: The purpose of this study is to verify the influence of a massive hydrofluoric acid spill on community health through patients who claimed to have been exposed. METHODS: We analyzed 2459 patients who visited our emergency department with the claim of exposure to hydrofluoric acid, and retrospective analyses were performed. We analyzed changes in numbers of visitors per day from the day of the accidental hydrofluoric acid spill, symptoms presented by the 1924 patients, and general characteristics. Comparisons of symptoms and hematologic characteristics were made between the initially set evacuation zone(1.3 km radius parameters from the spill) and the outer zone. RESULTS: A total of 2,459 patients who claimed exposure visited our ED from 27 September 2012 to 23 October 2012, and there was a significant increase in the number of visiting patients from day 8 of the hydrofluoric acid spill. The most common complaints were a sore throat, 729(37.9%) and no specific symptom with health concern, 547(28.4%). Statistically significant findings were pulmonary symptoms (p=0.001), nasal symptoms (p=0.001), diarrhea (p=0.023), and skin symptoms (p=0.007). In hematologic study, a statistically significant difference was observed in white blood cell count (p=0.018), creatine phosphokinase (p<0.001), erythrocyte sediment rate (p=0.013), and phosphorus (p<0.001). CONCLUSION: A significant increase in the number of patients was observed one week after the accidental spill of hydrofluoric acid. The most frequent symptoms were sore throat, headache, cough, and sputum. Statistically significant increase in creatine phosphokinase level and decrease in phosphorus level were noted in patients within the evacuation zone.

Human trichinosis in remotes of Uttarakhand, India.

Trichinosis is a parasitic zoonosis caused by ingestion of infected meat containing larvae of Trichinella, more prevalent in developing countries. Although infection with Trichinella is globally distributed, it has been documented only rarely in India. The reports are available where Trichinella larvae were found from animals in India but, to our knowledge, only one human case has been reported from India (Punjab), so far. This is the first report of small multiple outbreaks of human trichinosis in India (2009-2011). Epidemiological, clinical, and laboratory findings of trichinosis patients belonging to remote areas of Uttarakhand were analyzed retrospectively and prospectively. Patients belonged to remote areas of Garhwal, Uttarakhand, 77.78% were male, and 22.22% were female. The age of patients ranged from 9-55 yrs. History of eating meat of wild boar was given by all (100%). The signs and symptoms of the patients varied even after intake of same diet, and included generalized weakness/malaise, myalgia, fever, gastrointestinal symptoms, facial/periorbital edema, subconjunctival hemorrhages, retinal hemorrhages, muscle atrophy, and dyspnea. Laboratory investigations revealed eosinophilia, leukocytosis, creatine phosphokinase (CPK) and serum glutamic oxaloacetic transaminase (SGOT) elevation in 100%, 88.89%, 50% and 16.67%, respectively. Muscle biopsies revealed larvae in 27.78%. One patient expired while others improved. The prevalence of trichinosis is likely to be underestimated. The aim of this study is to emphasize on the magnitude of the problem, to educate people, especially in the affected areas about this health hazard and help implementation of epidemiological studies and preventive measures.

Efeito do manejo pré-abate sobre alguns parâmetros fisiológicos em fêmeas suínas pesadas / Effect of pre-slaughter management on physiological parameters of heavy-weight female pigs

O objetivo neste trabalho foi avaliar o efeito do período de descanso (3, 5, 7 e 9 horas) dos suínos no frigorífico (PDF) e da localização dos suínos na carroceria do caminhão (PBO), quando transportados, no inverno ou verão, sobre alguns parâmetros fisiológicos avaliados em 64 fêmeas, com peso médio de 130kg para abate, durante o manejo pré-abate. Para a análise estatística, foram considerados, no modelo de análise da variância, os efeitos de bloco, PDF, PBO e da interação (bloco x PDF), entre outros. O PDF influenciou, significativamente, as concentrações de lactato no sangue e cortisol na saliva. Suínos que descansaram 5 e 7 horas apresentaram maior concentração de lactato em relação aos animais que descansaram 3 e 9 horas. No transporte, a freqüência cardíaca foi muito maior em relação aos demais locais avaliados. Concluiu-se que o incremento do PDF não promove mudanças na freqüência cardíaca, nas concentrações de glicose e CPK no sangue e cortisol na saliva, mas interfere na concentração de lactato no sangue dos suínos.

The aim of the research was to evaluate the effect of pig lairage time (PDF=3, 5, 7 and 9 hours) and evaluate the effect of pig position into the truck (PBO) during transportation to slaughterhouse, in winter or summer conditions, on some physiologic parameters evaluated on 64 heavyweight females with mean liveweight of 130kg during pre-slaughter events. The following effects were considered in the statistical analysis of variance model: block (BL=summer farm or winter farm), PDF, PBO and interaction (Block x PDF), under other factors. The PDF influenced significativelly blood lactate and saliva cortisol levels. Pig submitted to 5 and 7 hours of lairage had higher levels of lactate when compared to pigs submitted to 3 and 9 hours of lairage. During transport the heart rate were higher than in other pre-slaughter events. It is concluded that increasing PDF above 3 hours had no effects on heart frequency, glucose and CPK levels and salivary cortisol levels but affects the blood lactate levels.