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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.
Significance of Asymptomatic Hyper Creatine-Kinase Emia.
Finsterer, J, Scorza, FA, Scorza, CA
Journal of clinical neuromuscular disease. 2019;(2):90-102
Abstract
OBJECTIVES Whether asymptomatic hyper-CKemia (AHCE) should prompt a thorough work-up for muscle disease or not is controversially discussed. This review aims at summarizing and discussing recent findings concerning the cause, frequency, evolution, and work-up of conditions manifesting as AHCE and normal or abnormal electromyography (EMG) respectively muscle biopsy. METHODS Systematic PubMed search. RESULTS There are numerous primary (hereditary) and acquired myopathies that manifest with permanent, recurrent, or temporary AHCE with/without myopathic EMG or muscle biopsy. AHCE particularly occurs at onset of these conditions, which include dystrophinopathies, myotilinopathies, calpainopathy, caveolinopathy, dysferlinopathy, central core disease, multicore disease, desminopathy, MD1, MD2, hypoPP, malignant hyperthermia susceptibility, Pompe disease, McArdle disease, myoadenylate deaminase-deficiency, CPT2-deficiency, mitochondrial disorders, or myopathy with tubular aggregates. Most likely, other primary myopathies manifest with AHCE as well, without having been reported. Patients with AHCE should be taken seriously and repeated CK determination must be conducted. If hyper-CKemia is persisting or recurrent, these patients should undergo an EMG and eventually muscle biopsy. If noninformative, genetic work-up by a panel or whole exome sequencing should be initiated, irrespective of the family history. Patients with AHCE should avoid excessive exercise, require sufficient hydration, require counseling with regard to the risk of malignant hyperthermia, and should inform anesthesiologists and surgeons about their condition before elective surgery. CONCLUSIONS Recurrent AHCE should be taken seriously and managed with conventional work-up. If noninformative, genetic work-up should follow irrespective of the family history.
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5.
Cabozantinib-induced serum creatine kinase elevation and musculoskeletal complaints.
Stump, SE, Whang, YE, Crona, DJ
Investigational new drugs. 2018;(6):1143-1146
Abstract
Cabozantinib is a multikinase inhibitor approved for the treatment of metastatic medullary thyroid cancer and advanced renal cell carcinoma (RCC) in patients who have received prior anti-angiogenic therapy. While associations between serum creatine kinase (CK) elevations and other tyrosine kinase inhibitors used for the treatment of solid malignancies have been previously reported, we report a case of cabozantinib-associated CK elevation that was associated with musculoskeletal complaints by an RCC patient. Nine days following initiation of cabozantinib, the patient reported muscle cramps and serum CK had increased from levels 12 months earlier that were within normal limits to a grade 1 elevation of 244 units/L. Despite a dose reduction, her CK continued to rise over the next 2 months, leading to a peak CK of 914 units/L. Due to this grade 3 elevation, cabozantinib was permanently discontinued, and her CK subsequently returned to a grade 1 elevation within one week and then to baseline within 3 weeks. The temporal relationship between drug exposure and CK increase strongly suggests causality. To the authors' knowledge, this is the first reported case of CK elevation attributed to cabozantinib, but cabozantinib-induced CK elevations could be under-reported, and providers should monitor for musculoskeletal complaints during cabozantinib therapy.
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6.
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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7.
Cardiotoxicity of anthracycline (ANT) treatment in children with malignant tumors.
Hu, H, Zhang, W, Huang, D, Yang, Q, Li, J, Gao, Y
Pediatric hematology and oncology. 2018;(2):111-120
Abstract
OBJECTIVE To investigate the cardiotoxicity indexes in children with malignant tumors after the administration of anthracycline (ANT) chemotherapy. MATERIALS AND METHODS Data from 131 children with malignant tumors who were treated using ANT chemotherapy at our hospital from January 2011 to December 2015 were collected to analyze the serologic indexes (such as N-terminal pro-brain natriuretic peptide [NT-proBNP] and isoenzyme of creatine kinase [CK-MB]) and changes in corrected QT interval(QT-c) and left ventricular ejection fraction (LVEF) before and after treatment with different ANT cumulative doses. RESULTS General clinical data revealed that 2 of the 131 children developed clinical cardiotoxicity. The ANT cumulative dose range was 12-697 mg/m2. All patients were divided into three groups according to the ANT cumulative dose: group 1 (<100 mg/m2), 2 (≥100 and <200 mg/m2), and 3 (≥200 mg/m2). Although NT-proBNP and LVEF among the three groups differed significantly after chemotherapy (p = 0.022 and 0.035, respectively), no significance was noted for CK-MB and QT-c among the three groups after chemotherapy (p = 0.190 and p = 0.084, respectively). Multiple linear regression analysis revealed that the ANT cumulative dose had the most significant impact on NT-proBNP (standardized coefficient 0.423, p = 0). Pearson correlation analysis revealed that ANT cumulative dose was positively correlated with NT-proBNP post-treatment (correlation coefficient 0.423), but LVEF was negatively correlated with NT-proBNP after chemotherapy (correlation coefficient -0.542). CONCLUSIONS NT-proBNP showed significant changes when the ANT dose was >200 mg/m2. Post-treatment serum NT-proBNP was linearly correlated with ANT cumulative dose, hence strictly controlling the ANT cumulative dose and monitoring serum NT-proBNP may have certain clinical significance in predicting cardiotoxicity.
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8.
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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Decrements in Neuromuscular Performance and Increases in Creatine Kinase Impact Training Outputs in Elite Soccer Players.
Malone, S, Mendes, B, Hughes, B, Roe, M, Devenney, S, Collins, K, Owen, A
Journal of strength and conditioning research. 2018;(5):1342-1351
Abstract
Malone, S, Mendes, B, Hughes, B, Roe, M, Devenney, S, Collins, K, and Owen, A. Decrements in neuromuscular performance and increases in creatine kinase impact training outputs in elite soccer players. J Strength Cond Res 32(5): 1342-1351, 2018-The aim of the current investigation was to understand the impact of pretraining neuromuscular performance and creatine kinase (CK) status on subsequent training performance in elite soccer players. Thirty soccer players (age: 25.3 ± 3.1 years; height: 183 ± 7 cm; mass: 72 ± 7 kg) were involved in this observational study. Each morning before training, players completed assessments for neuromuscular performance (countermovement jump; CMJ) and CK levels. Global positioning technology provided external load: total distance, high-speed distance, sprint distance, accelerations, decelerations, average metabolic power, explosive distance, and high metabolic power distance (>25.5 W·kg). Mixed-effect linear models revealed significant effects for CK and CMJ Z-score on total high-speed distance, very high-speed distance, accelerations, decelerations, explosive distance, and maximal velocity. Effects are reported with 90% confidence limits. A CK Z-score of +1 corresponded to a -5.5 ± 1.1, -3.9 ± 0.5, -4.3 ± 2.9%, -4.1 ± 2.9%, -3.1 ± 2.9%, and -4.6 ± 1.9%, reduction in total high-speed distance, very high-speed distance, accelerations, decelerations, explosive distance, and maximal velocity, respectively. Countermovement jump Z-score of -1 corresponded to a -3.5 ± 1.1, -2.9 ± 0.5, -2.1 ± 1.4, -5.3 ± 2.9%, -3.8 ± 2.9%, -1.1 ± 2.9%, and -5.6 ± 1.2% reduction in these external load measures. Magnitude-based analysis revealed that the practical size of the effect of a pretraining CMJ Z-score of -1 and CK Z-score of +1 would have on total high-speed distance, very high-speed distance, high metabolic power distance (>25.5 W·kg), accelerations, decelerations, explosive distance, and maximal velocity was likely negative. The results of this study suggest that systematic pretraining monitoring of neuromuscular and muscle stress within soccer cohorts can provide coaches with information about the training output that can be expected from individual players during a training session.
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10.
Effects of lymphatic drainage and cryotherapy on indirect markers of muscle damage.
Behringer, M, Jedlicka, D, Mester, J
The Journal of sports medicine and physical fitness. 2018;(6):903-909
Abstract
BACKGROUND Muscle enzymes are cleared from the extracellular space by the lymphatic system, while smaller proteins enter the bloodstream directly. We investigated if manual lymphatic drainage (MLD), local cryotherapy (CRY), and rest (RST) differently affect the time course of creatine kinase (CK, 84 kDa) and heart-type fatty acid binding protein (h-FABP, 15 kDa) in the blood. METHODS Randomized controlled trial. After 4x20 unilateral, eccentric accentuated knee extensions (with one-third of the maximal isometric force) 30 sports students randomly received either a 30 min MLD, CRY or they rested (RST) for the same amount of time. CK, h-FABP, neutrophil granulocytes, and the perceived muscle soreness were assessed before, immediately after, and 1 hour, 4 hours, and 24 hours after the exercise. RESULTS All measures increased significantly (P<0.001) after the protocol indicating that muscle damage was induced. However, the responses did not differ between the treatments. CONCLUSIONS Large and small damage markers were not affected differently by MLD, CRY, or RST, when applied for 30 min and no beneficial effects on inflammation or muscle soreness could be found for MLD and CRY when compared to RST. This information is particularly important for those sports physicians and conditioning specialists who use biochemical muscle damage markers to adjust the training load and volume of athletes.