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1.
Investigating raised creatine kinase.
Kim, EJ, Wierzbicki, AS
BMJ (Clinical research ed.). 2021;:n1486
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2.
Dietary Supplementation for Attenuating Exercise-Induced Muscle Damage and Delayed-Onset Muscle Soreness in Humans.
Tanabe, Y, Fujii, N, Suzuki, K
Nutrients. 2021;(1)
Abstract
Dietary supplements are widely used as a nutritional strategy to improve and maintain performance and achieve faster recovery in sports and exercise. Exercise-induced muscle damage (EIMD) is caused by mechanical stress and subsequent inflammatory responses including reactive oxygen species and cytokine production. Therefore, dietary supplements with anti-inflammatory and antioxidant properties have the potential to prevent and reduce muscle damage and symptoms characterized by loss of muscle strength and delayed-onset muscle soreness (DOMS). However, only a few supplements are considered to be effective at present. This review focuses on the effects of dietary supplements derived from phytochemicals and listed in the International Olympic Committee consensus statement on muscle damage evaluated by blood myofiber damage markers, muscle soreness, performance, and inflammatory and oxidative stress markers. In this review, the effects of dietary supplements are also discussed in terms of study design (i.e., parallel and crossover studies), exercise model, and such subject characteristics as physical fitness level. Future perspectives and considerations for the use of dietary supplements to alleviate EIMD and DOMS are also discussed.
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3.
Polyarteritis nodosa isolated to muscles-A case series with a review of the literature.
Ganeshanandan, LR, Brusch, AM, Dyke, JM, McLean-Tooke, APC
Seminars in arthritis and rheumatism. 2020;(3):503-508
Abstract
Muscular polyarteritis nodosa where disease is isolated to skeletal muscle is a rare and often poorly recognised clinical entity. Patients typically present with fever and severe muscle pain limiting ability to ambulate without rise in creatine kinase. Often there is a significant delay between presentation and diagnosis, which requires histological confirmation. Musculoskeletal MRI is a sensitive investigation that can lead to timely biopsy and improve diagnostic yield. Early diagnosis of this condition is essential as patients typically respond favourably to corticosteroid treatment. Here we report 4 cases of muscular polyarteritis nodosa and review the reported literature.
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4.
Myopathy after rapid correction of hyperthyroidism: A case report and review of literature.
Lu, R, Wang, H, Hong, T, Gao, H
Medicine. 2020;(3):e18878
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Abstract
RATIONALE Myalgia and elevated creatine kinase (CK) have been reported during the treatment of hyperthyroid patients. The causes of these symptoms are usually considered to be treatments of antithyroid drugs (ATDs), thyroidectomy or radio-iodine (131-I). However, the underlying cause may be the rapid correction of thyrotoxicosis (or relative hypothyroidism), which was usually neglected in clinical practice. PATIENT CONCERNS This report describes a case of a 25-year-old female with typical symptoms and laboratory test results of Grave hyperthyroidism. The patient complained about fatigue and myalgia 7 weeks after receiving methimazole (MMI) treatment. Blood tests showed dramatically elevated serum CK level, although free triiodothyronine (FT3) and free thyroxine (FT4) level had returned to the normal reference range. MMI was; therefore, discontinued and the patient's muscular symptoms disappeared quickly with the normalization of CK level and the relapse of hyperthyroidism. Later she received 131-I treatment and suffered similar muscular symptoms when FT3 and FT4 decreased to the normal range. This time, her symptoms were quickly relieved by levothyroxine (L-T4) replacement treatment. DIAGNOSES Myopathy induced by rapid correction of hyperthyroidism (or relative hypothyroidism). INTERVENTIONS MMI was discontinued after the patient's first episode of muscular symptoms. And for her second episode of muscular injury after 131-I treatment, we initiated L-T4 supplementation. OUTCOMES For the 2 episodes of muscular injury after ATDs or 131-I treatment, both of the interventions mentioned above brought a rapid relief of symptoms accompanied with normalization of CK level and restoration of thyroid hormone level. LESSONS Myopathy can be caused by a rapid reduction of thyroid hormone during the treatment of hyperthyroidism. This relative hypothyroidism syndrome should be considered if patients make complaints about fatigue and myalgia, even when thyroid hormone level is within the normal range during the antithyroid treatments. Serum CK level and thyroid function should be closely monitored post antithyroid treatments. Reduction of ATD dosage or replacement of thyroid hormone is suggested to relieve muscular symptoms.
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Guidelines on clinical presentation and management of nondystrophic myotonias.
Stunnenberg, BC, LoRusso, S, Arnold, WD, Barohn, RJ, Cannon, SC, Fontaine, B, Griggs, RC, Hanna, MG, Matthews, E, Meola, G, et al
Muscle & nerve. 2020;(4):430-444
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Abstract
The nondystrophic myotonias are rare muscle hyperexcitability disorders caused by gain-of-function mutations in the SCN4A gene or loss-of-function mutations in the CLCN1 gene. Clinically, they are characterized by myotonia, defined as delayed muscle relaxation after voluntary contraction, which leads to symptoms of muscle stiffness, pain, fatigue, and weakness. Diagnosis is based on history and examination findings, the presence of electrical myotonia on electromyography, and genetic confirmation. In the absence of genetic confirmation, the diagnosis is supported by detailed electrophysiological testing, exclusion of other related disorders, and analysis of a variant of uncertain significance if present. Symptomatic treatment with a sodium channel blocker, such as mexiletine, is usually the first step in management, as well as educating patients about potential anesthetic complications.
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Does Low-Level Laser Therapy Decrease Muscle-Damaging Mediators After Performance in Soccer Athletes Versus Sham Laser Treatment? A Critically Appraised Topic.
Bettleyon, J, Kaminski, TW
Journal of sport rehabilitation. 2020;(8):1210-1213
Abstract
Clinical Scenario: Low-level laser therapy (LLLT) is a controversial topic for its use in athletic recovery, mainly due to inconsistency in research regarding the application of LLLT. Articles on LLLT have assessed its effectiveness in untrained humans through pain scales, functional scales, and blood draws, and it has been found capable in nonathletic rehabilitative use. The controversy lies with LLLT in the recovering athlete. Not only do athletes need to perform at high levels, but each sport is unique in the metabolic demands placed on the athletes' bodies. This modality can alter chemical mediators of the inflammatory process, specifically blood lactate (BL) and creatine kinase (CK). During soccer contests, it is a common problem for athletes to have an average CK level of 800 U/L and BL of 8 mmol·L, increasing delayed-onset muscle soreness and fatigue. Micro-CK level elevation is associated with cellular membrane damage, localized hypoxia, and electrolyte imbalances, hindering the recovery process. Clinical Question: Does LLLT decrease muscle-damaging mediators effecting player fatigue and delayed-onset muscle soreness after performance in soccer athletes versus sham treatment? Summary of Key Findings: In 3 studies, preperformance, postperformance, or preperformance and postperformance LLLT was performed and evaluated BL (2 of 3) and CK (2 of 3). In each article, BL and CK showed a significant decrease (P < .05) when performed either preperformance or postperformance versus the control group. The greatest decrease in these mediators was noticed when postperformance laser therapy was performed. Clinical Bottom Line: LLLT at 10, 30, or 50 J performed at a minimum of 2 locations on the rectus femoris, vastus lateralis, and vastus medialis bilaterally for 10 seconds each is significant in decreasing blood serum levels of BL and CK when performed postexercise. Strength of Recommendations: All 3 articles obtained a Physiotherapy Evidence Database score of ≥8/10.
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[Myalgia and statins: Separating the true from the false].
Blacher, J, Bruckert, E, Farnier, M, Ferrières, J, Henry, P, Krempf, M, Mourad, JJ
Presse medicale (Paris, France : 1983). 2019;(10):1059-1064
Abstract
In therapeutic trials, the incidence of adverse muscle effects under statin is low, exceptional for some authors,<5% for others. In observational studies, however, this incidence is much higher, up to 20% of patients. These adverse effects are drug-dependent and dose-dependent. It is often complex to distinguish between a real adverse effect and a nocebo effect. Causality is more likely if the symptoms are symmetrical and affect the large muscle masses dependent on the large joints, occur within one month of the introduction of the statin and disappear quickly, within a few weeks after discontinuation of treatment. It seems important not to waste time trying to convince the patient that the alleged muscle symptoms are unrelated to statin therapy. In these patients with suspected statin intolerance, therapeutic impasse is rare and there is a need to attempt dosage reductions, experiment different statins or even prescribe other cholesterol-lowering agents.
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Protein-Based Supplementation to Enhance Recovery in Team Sports: What is the Evidence?
Poulios, A, Georgakouli, K, Draganidis, D, Deli, CK, Tsimeas, PD, Chatzinikolaou, A, Papanikolaou, K, Batrakoulis, A, Mohr, M, Jamurtas, AZ, et al
Journal of sports science & medicine. 2019;(3):523-536
Abstract
Protein supplementation is a major nutritional practice among professional and amateur team-sport athletes representing a market of $5 billion in the USA alone. This practice, however, may not be supported by evidence-based science. Our objective as to present a thorough review of literature investigating the effects of protein supplementation on performance recovery and exercise-induced muscle damage following team-sport activity. PubMed-derived, full English language articles investigating the effects of protein-based supplementation/feeding on skeletal muscle performance, muscle damage and inflammatory status during recovery following team-sport activity were included. Studies investigated professional or amateur team-sport athletes participating in regular training and competition as well as examining the impact of protein supplementation on performance, muscle damage/soreness and inflammatory markers after team-sport activity. Finally, ten articles (150 participants) met the inclusion criteria. Experimental designs were evaluated for confounders. All protocols employing team-sport activity increased systemic muscle damage indicators and inflammatory markers and deteriorated performance during recovery. Protein-based supplementation attenuated the rise in muscle damage markers and enhanced performance recovery in six (60% of the studies included) and three (30% of the studies included) out of 10 studies, respectively. In contrast, immunity and muscle soreness remained unaffected by protein ingestion, independent of dosage and distribution pattern. In conclusion, there are limited and inconsistent data showing that protein supplementation may enhance performance recovery following team-sport activity despite an attenuation of indirect markers of muscle damage. Interpretation of results is limited by small sample sizes, high variability in tested supplements, participants' training level, length of recovery periods, absence of direct measurement of myofibrillar disruption, protein turnover and protein metabolism, and lack of dietary monitoring during experimentation.
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Exercise-induced muscle damage: What is it, what causes it and what are the nutritional solutions?
Owens, DJ, Twist, C, Cobley, JN, Howatson, G, Close, GL
European journal of sport science. 2019;(1):71-85
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Abstract
Exercise-induced muscle damage (EIMD) is characterized by symptoms that present both immediately and for up to 14 days after the initial exercise bout. The main consequence of EIMD for the athlete is the loss of skeletal muscle function and soreness. As such, numerous nutrients and functional foods have been examined for their potential to ameliorate the effects of EIMD and accelerate recovery, which is the purpose of many nutritional strategies for the athlete. However, the trade-off between recovery and adaptation is rarely considered. For example, many nutritional interventions described in this review target oxidative stress and inflammation, both thought to contribute to EIMD but are also crucial for the recovery and adaptation process. This calls into question whether long term administration of supplements and functional foods used to target EIMD is indeed best practice. This rapidly growing area of sports nutrition will benefit from careful consideration of the potential hormetic effect of long term use of nutritional aids that ameliorate muscle damage. This review provides a concise overview of what EIMD is, its causes and consequences and critically evaluates potential nutritional strategies to ameliorate EIMD. We present a pragmatic practical summary that can be adopted by practitioners and direct future research, with the purpose of pushing the field to better consider the fine balance between recovery and adaptation and the potential that nutritional interventions have in modulating this balance.
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Rheumatologic manifestations in celiac disease: what should we remember?
Dima, A, Jurcut, C, Jinga, M
Romanian journal of internal medicine = Revue roumaine de medecine interne. 2019;(1):3-5