McArdle disease with rhabdomyolysis induced by rosuvastatin: case report

The rosuvastatin inducing rhabdomyolysis in McArdle disease (MD) has not been reported to date. A 35-years-old man had exercise intolerance, muscular fatigue and cramps during physical activity since infancy. He presented severe rhabdomyolysis episode with seizure and coma after use of rosuvastatin. The investigation showed increased serum creatinekinase levels and the forearm ischemic exercise did not increased venous lactate. The muscle biopsy showed subsarcolemmal and central acummulation of glycogen and absence of the myophosphorylase enzyme. The statin induced myopathy is discussed and the danger of its use in MD is emphasized.

Rosuvastatina induzindo rabdomiólise na doença de McArdle (MD) não foi relatada até o momento. Descrevemos o caso de um homem de 35 anos que desde a infância apresentava sintomas de intolerância aos exercícios, fadiga muscular e cãibras durante o esforço físico, porém após o uso de rosuvastatina apresentou episódio de rabdomiólise com crises convulsivas e coma. A investigação mostrou creatinoquinase sérica elevada e teste do esforço isquêmico sem aumento no lactato venoso. A biópsia muscular revelou acúmulo central e subsarcolemal de glicogênio nas fibras e ausência da enzima miofosforilase. Discutimos as estatinas induzindo miopatia, enfatizando o risco do seu uso na MD.

High prevalence of hepatitis c virus infection in chronic hemodialysis patients

Hepatitis C virus (HCV) infection is very common among hemodialysis (HD) patients. Transmission of Infection in this setting has been related to the number of blood transfusions, the duration of hemodialysis and to nosocomial transmission of virus in the dialysis unit. We conducted a study of 74 HD patients to determine the frequency of HCV at a single point in time (cross-sectional analysis), and to evaluate the association between HCV infection and patients' demographic, clinical and biochemical features. Serum samples were tested for anti-HCV antibodies using a third-generation enzyme-linked immunosorbent assay (ELISA). In the case of a positive result, third-generation recombinant immunoblot and HCV RNA detection by polymerase chain reaction (PCR) tests were performed. Collected data included the patient's age, gender, time on HD, number of blood transfusions and serum alanine aminotransferase (ALT) activity. Twenty-nine patients (29/74.4 percent) were found to be HCV positive using a third generation ELISA assay. From these 29 patients, 27 were also positive by recombinant immunoblot assay and 2 patients had indederminate results. In the subgroup of anti-HCV ELISA positive, 20 (69 percent) of the 29 patients had detectable HCV RNA. The HCV RNA positive patients had received more blood transfusions (15ñ3 vs.5ñ1 units of packed red blood cells, p<0.0001) and had been on HD for a longer period of time than the HCV RNA negative patients (65ñ32 vs.32ñ29 months, p<0.0001). Mean serum ALT levels were significantly higher in the HCV RNA positive group (30ñ18 vs.15ñ9,p<0.0001). We were unable to determine the most likely mode of transmission in our unit, but these results emphasize the need for strict adherence to blood collecting and handing precautions, careful attention to hygiene in the dialysis units, and sterilization of dialysis machines in order to properly combat this frequent infection.

Eficácia da eritropoietina administrada por via intravenosa em doses baixas na anemia associada à insuficiencia renal crônica. Estudo de 20 pacientes em hemodiálise / Efficacy of the Erythropoietin maneged for saw intravenosa in loiw doses inthe associated anemia the chronical renal failure. Study pf 20 patients in hemodialysis

Foi estudado o efeito do tratamento com a eritropoietina (EPO) em 20 pacientes em hemodiálise. A EPO foi utilizada por via intravenosa, em dose inicial de 75 UI/Kg/semana, administrada após cada sessäo de hemodiálise e aumentada mensalmente em 25 UI/Kg/semana até se atingir hemotócrito de 30 porcento. Foi administrrado ferro intravenoso quando a saturaçäo de transferrina estava abaixo de 20 porcento. Houve um aumento de hematócrito de 22,8 porcento. A dose de EPO utilizada no último mês de estudo foi de 127,5 mais ou menos 4,3 UI/KG/semana. O potássio e a albumina aumentaram significativamente em relaçäo ao início do tratamento. A eritropoietina foi eficaz e segura, possibilitando o uso de baixas doses do hormônio, quando associado à administraçäo regular de ferro.(au)