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1.
Musculoskeletal toxicities in patients receiving concomitant statin and daptomycin therapy.
Kido, K, Oyen, AA, Beckmann, MA, Brouse, SD
American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists. 2019;(4):206-210
Abstract
PURPOSE This article evaluates the musculoskeletal safety of concomitant therapy with daptomycin and Hydroxymethylglutaryl-coenzyme A (HMG CoA) reductase inhibitors (statins). SUMMARY Often indicated for severe gram-positive infections, daptomycin is commonly administered with statins but there is limited guidance on the appropriate management of concomitant therapy with daptomycin and statins. A narrative review was conducted to review contemporary clinical evidence of the safety of concomitant therapy with daptomycin and statins. A total of 5 studies were identified comparing daptomycin monotherapy versus daptomycin and statin concomitant therapy for the primary outcome of creatine phosphokinase (CPK) elevations in a variety of patient populations with systemic, skin/soft tissue, and bone/joint infections. Of these studies, 4 also compared myalgia or myopathy as a secondary outcome. Case studies, the case-control study and 1 prospective registry comparing statin alone versus daptomycin and statin concomitant therapy were excluded. These studies showed that concomitant therapy with daptomycin and statin was not significantly associated with CPK elevation or higher event rate of myalgia or myopathy, compared to daptomycin monotherapy. CONCLUSION Published cohort studies do not demonstrate a statistically significant difference in the rate of CPK elevations or musculoskeletal toxicities between patients receiving daptomycin monotherapy and daptomycin plus a statin. Patients receiving statins who start daptomycin therapy should continue statin but with weekly monitoring of CPK levels. Continuation of statins is especially important in high-risk patients receiving statins for secondary prevention for atherosclerotic cardiovascular diseases. If myalgia develops, it is reasonable to evaluate the degree of CPK elevation and reassess the need for statin use during daptomycin treatment.
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2.
Side effects of whole-body electro-myo-stimulation.
Stöllberger, C, Finsterer, J
Wiener medizinische Wochenschrift (1946). 2019;(7-8):173-180
Abstract
Whole-body-electro-myo-stimulation (WB-EMS) has been introduced as an alternative to physical training. The aim of the review is to summarize the data about indications and side effects of WB-EMS.A literature search in PubMed disclosed 11 randomized trials, 3 cohort studies, and 7 case reports. From healthy volunteers, enormous creatine kinase (CK) elevations were reported. There is a lack of data about biological consequences of WB-EMS on other organs. In randomized trials, CK levels were not investigated, but several patients discontinued WB-EMS because of "muscular discomfort." Contraindications for WB-EMS are not clearly defined. Nine cases of rhabdomyolysis after WB-EMS were found, preferentially after the first application.Regulatory authorities should increase the safety of WB-EMS. Patients with a history of rhabdomyolysis should not undergo WB-EMS and those experiencing rhabdomyolysis should be neurologically investigated. Since the value of WB-EMS as an alternative to physical exercise is uncertain, we need to proof or disproof its benefit.
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3.
[Muscular polyarteritis nodosa-a case-based review].
Krusche, M, Ruffer, N, Kubacki, T, Matschke, J, Kötter, I
Zeitschrift fur Rheumatologie. 2019;(2):173-179
Abstract
BACKGROUND Myalgia is a common but unspecific set of symptoms that may be caused by orthopedic, neurological and internal medical conditions, often resulting in a diagnostic challenge. Muscular polyarteritis nodosa (PAN) is a rare differential diagnosis of myalgia with elevated serological inflammatory markers. OBJECTIVE Based on three clinical cases and the literature this review describes the essential clinical and diagnostic features of muscular PAN. RESULTS Muscular PAN typically presents with immobilizing myalgia confined to the lower limbs and elevated serological inflammatory markers but often normal creatine kinase (CK) levels. Contrast-enhanced magnetic resonance imaging of the affected muscles, which can often mimic myositis, and muscle biopsy provide the relevant histological findings that lead to the diagnosis of a vasculitis. CONCLUSION With respect to own experiences and the reviewed literature, muscular PAN should be considered as a possible diagnosis in cases of myalgia with elevated inflammatory markers but normal CK levels and a lack of further symptoms typical for vasculitis.
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4.
Creatine, Creatine Kinase, and Aging.
Sumien, N, Shetty, RA, Gonzales, EB
Sub-cellular biochemistry. 2018;:145-168
Abstract
With an ever aging population, identifying interventions that can alleviate age-related functional declines has become increasingly important. Dietary supplements have taken center stage based on various health claims and have become a multi-million dollar business. One such supplement is creatine, a major contributor to normal cellular physiology. Creatine, an energy source that can be endogenously synthesized or obtained through diet and supplement, is involved primarily in cellular metabolism via ATP replenishment. The goal of this chapter is to summarize how creatine and its associated enzyme, creatine kinase, act under normal physiological conditions, and how altered levels of either may lead to detrimental functional outcomes. Furthermore, we will focus on the effect of aging on the creatine system and how supplementation may affect the aging process and perhaps reverse it.
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5.
Creatine kinase, neuromuscular fatigue, and the contact codes of football: A systematic review and meta-analysis of pre- and post-match differences.
Hagstrom, AD, Shorter, KA
European journal of sport science. 2018;(9):1234-1244
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Abstract
Physiological or performance tests are routinely utilised to assess athletes' recovery. At present, the ideal tool to assess recovery remains unknown. Therefore, the aim of this systematic review was to examine the change in creatine kinase (CK) and neuromuscular function as measured via a countermovement jump (CMJ) following a match in the contact codes of football. A comprehensive search of databases was undertaken with RevMan (V 5.3) used for statistical analysis. Our results demonstrated that CK pre- versus post-match (standardised mean difference (SMD) = 0.90, 95% CI = 0.50 to 1.31, p < .0001), CK pre- versus 24 h post-match (SMD = 1.50, 95% CI = 1.12 to 1.88, p < .00001), and CK pre- versus 48 h post-match all increased significantly (SMD = 0.90, 95% CI = 0.50 to 1.31, p < .0001), while CMJ peak power (PP) pre- versus post-match (SMD = -0.59, 95% CI = -1.12 to -0.06, p = .03), and pre- versus 24 h post-match (SMD = -0.80, 95% CI = -1.31 to -0.28, p = .002) decreased significantly. There was a significant relationship between the change in CK and the change in CMJ PP from immediately pre to immediately post (r = -0.924, p = .025), and between CMJ immediately following a match and 24 h CK change (r = -0.983, p = .017). In conclusion, CK levels increase and performance in the CMJ decreases following a match of a contact code of football. The identification of this relationship may allow coaching staff to implement a standalone measure of recovery.
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Myasthenia triggered by immune checkpoint inhibitors: New case and literature review.
Gonzalez, NL, Puwanant, A, Lu, A, Marks, SM, Živković, SA
Neuromuscular disorders : NMD. 2017;(3):266-268
Abstract
Immune checkpoint molecules are potent regulators of immunologic homeostasis that prevent the development of autoimmunity while maintaining self-tolerance. Inhibitors of immune checkpoint molecules are used as immunotherapy in the treatment of melanoma and different types of refractory cancer, and can trigger various autoimmune complications including myositis and myasthenia gravis. We describe a case of generalized myasthenia gravis induced by pembrolizumab and review 11 other cases. Five patients also had elevated serum CK levels ranging from 1200 to 8729 IU/L, and biopsy showed myositis in one. Severity was highly variable as symptoms normalized spontaneously in one patient, but three others developed myasthenic crisis (including two with fatal outcomes). Steroids have been recommended as a preferred treatment of autoimmune complications of immune-checkpoint inhibitors. Myasthenia gravis should be considered when weakness, diplopia or bulbar symptoms are seen after treatment with immune checkpoint inhibitors, and additional studies are needed to characterize association with hyperCKemia.
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Compartment syndrome after gynecologic laparoscopy: systematic review of the literature and establishment of normal values for postoperative serum creatine kinase and myoglobin levels.
Hefler-Frischmuth, K, Lafleur, J, Brunnmayr-Petkin, G, Roithmeier, F, Unterrichter, V, Hefler, L, Tempfer, C
Archives of gynecology and obstetrics. 2017;(2):285-293
Abstract
PURPOSE To evaluate published evidence in the literature on compartment syndrome (CS) in association with gynecologic surgery and to establish postoperative normal values for serum creatine kinase (CK) and myoglobin. METHODS The present study consists of a case report of a patient with CS, a systematic review including 37 studies and 86 patients with CS, and a retrospective cohort study of 300 patients undergoing various types of laparoscopy for benign or malignant diseases in order to establish postoperative normal values. RESULTS We report on a patient with early-stage ovarian cancer, who developed CS after laparoscopic surgery with massively elevated serum CK and myoglobin levels, i.e., 1109 U/L and 18151 µg/L, respectively. In our systematic review, median serum CK and myoglobin levels among women with CS were 19,223 (177-27,412) U/L and 1248 (285-1360) µg/L, respectively. In our cohort study, the median postoperative serum CK and myoglobin levels were 68 (14-1576) U/L and 45 (14-1040) µg/L, respectively. The 95th and 99th percentile of serum CK and myoglobin levels were 158 and 391.5 U/L, and 152.3 and 298.9 µg/L, respectively. CONCLUSION Markedly elevated postoperative serum levels of CK and myoglobin levels might raise the suspicion for CS and could therefore aid in the rapid diagnosis of CS.
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Approach to asymptomatic creatine kinase elevation.
Moghadam-Kia, S, Oddis, CV, Aggarwal, R
Cleveland Clinic journal of medicine. 2016;(1):37-42
Abstract
How to manage a patient who has an elevated serum creatine kinase (CK) level but no or insignificant muscle-related signs and symptoms is a clinical conundrum. The authors provide a systematic approach, including repeat testing after a period of rest, defining higher thresholds over which pursuing a diagnosis is worthwhile, and evaluating for a variety of nonneuromuscular causes. They also outline a workup for neuromuscular causes.
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Approach to the Patient With HyperCKemia.
Venance, SL
Continuum (Minneapolis, Minn.). 2016;(6, Muscle and Neuromuscular Junction Disorders):1803-1814
Abstract
PURPOSE OF REVIEW Neurologists commonly receive consultation requests regarding the evaluation of patients with an elevated serum creatine kinase (CK), a condition known as hyperCKemia. This article outlines an approach to the history and examination of patients with hyperCKemia in order to narrow the localization and differential of an elevated CK and guide possible next steps. This article aims to help clinicians identify treatable or reversible etiologies as well as those that will change management. RECENT FINDINGS An unrevealing patient history (assessing for acquired and hereditary etiologies) in an otherwise neurologically intact individual who has a normal nerve conduction study and EMG predicts that the likelihood of diagnosing the patient after further investigations will be quite low. After a comprehensive workup, a positive diagnosis is made in approximately 25% of cases of hyperCKemia. SUMMARY The best predictors for added diagnostic yield with further testing in hyperCKemia are a higher level of CK and a younger age; the presence of weakness increases the likelihood of a specific cause other than idiopathic or familial hyperCKemia. Many etiologies do not yet have treatments that alter clinical outcomes, and, even in the absence of a specific diagnosis, good communication with patients and primary care providers remains essential to ensure longitudinal surveillance with expectant management for potential consequences. Many patients with hyperCKemia of uncertain etiology, however, will not develop significant muscle disease on longitudinal follow-up.
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The value of serum creatine kinase in predicting the risk of rhabdomyolysis-induced acute kidney injury: a systematic review and meta-analysis.
Safari, S, Yousefifard, M, Hashemi, B, Baratloo, A, Forouzanfar, MM, Rahmati, F, Motamedi, M, Najafi, I
Clinical and experimental nephrology. 2016;(2):153-61
Abstract
INTRODUCTION Identifying the potential effective factors of rhabdomyolysis-induced acute kidney injury (AKI) is of major importance for both treatment and logistic concerns. The present study aimed to evaluate the value of creatine kinase (CK) in predicting the risk of rhabdomyolysis-induced AKI through meta-analysis. METHODS Two reviewers searched the electronic databases of Medline, EMBASE, Cochrane library, Scopus, and Google Scholar. Data regarding study design, patient characteristics, number of cases, mean and screening characteristics of CK, and final patient outcome were extracted from relevant studies. Pooled measures of standardized mean difference, OR, and diagnostic accuracy were calculated using STATA version 11.0. RESULT 5997 non-redundant studies were found (143 potentially relevant). 27 articles met the inclusion criteria but 9 were excluded due to lack of data. The correlation between serum CK and AKI occurrence was stronger in traumatic cases (SMD = 1.34, 95 % CI = 1.25-1.42, I(2) = 94 %; p < 0.001). This correlation was more prominent in crush-induced AKI (adjusted OR = 14.7, 95 % CI = 7.63-28.52, I(2) = 0.0 %; p = 0.001). Area under the ROC curve of CK in predicting AKI occurrence was 0.75 (95 % CI = 0.71-0.79). CONCLUSION The results of this meta-analysis declared the significant role of rhabdomyolysis etiology (traumatic/non-traumatic) in predictive performance of CK. There was a significant correlation between mean CK level and risk of crush-induced AKI. The pooled OR of CK was considerable, but its screening performance characteristics were not desirable.