THE USE OF CREATINE PHOSPHOKINASE LEVEL IN ASSESSMENT OF ATHLETES’ URGENT AND LONG-TERM ADAPTATION TO TRAINING LOADS

2015 ◽  
2020 ◽  
pp. 089719002095823 ◽  
Author(s):  
Leroy Koh ◽  
Punit J. Shah ◽  
Sarfraz Aly

Daptomycin possesses excellent activity against many multidrug-resistant gram positive organisms. However, a side effect of concern with daptomycin is skeletal muscle injury, which is manifested in the form of elevated creatine phosphokinase (CPK). Management of such CPK elevations has traditionally been discontinuation of the offending agent, with many studies showing a resolution of a normal CPK level within 1 week of discontinuation and no long term adverse effects. Nevertheless, the question remains if daptomycin can be successfully restarted in such patients. Here, we present a case of a “daptomycin holiday” in which daptomycin was withheld upon CPK elevation and successfully reintroduced to the patient’s regimen again after several days without further elevation of the CPK. The patient had a peak CPK of 2,557 U/L, and had no associated symptoms. A hypothesis for this holiday could be the adaptability of the skeletal muscle myocytes, in which the extra period between doses may allow for additional recovery of the membrane structure to further daptomycin exposure. Giving an asymptomatic patient with elevated CPK level, a short daptomycin holiday to allow for the CPK level to trend downward before resuming daptomycin therapy could be a potential strategy in patients for whom continuing daptomycin is still preferred.


Author(s):  
Robertus M. A. de Bie

Neuroleptic malignant syndrome is an iatrogenic movement disorders emergency characterized by rigidity, altered consciousness, and autonomic instability of varying degrees of severity. In severe cases this can be a fatal syndrome, so recognition and withdrawal of potentially causative medications is the priority. Management is otherwise supportive, and some patients will require admission to an intensive care unit. Creatine phosphokinase can be used to monitor the disease course; a decreasing creatine phosphokinase level with an increasing temperature may indicate an infection. The incidence of neuroleptic malignant syndrome has declined considerably with the increased use of atypical neuroleptics with greater D2 receptor blockade compared to older agents.


2021 ◽  
Vol 9 (1) ◽  
pp. 44-54
Author(s):  
V.I. Trykhlib ◽  
T.I. Lysenko ◽  
A.O. Yeroshenko ◽  
О.S. Martynchuk ◽  
K.P. Bieliaieva ◽  
...  

The article provides a review of the literature on the effectiveness of glucocorticoids in viral infections, including the new coronavirus infection COVID-19. The results of our research of the dynamics of laboratory parameters in patients who recovered and those who died are presented. The average age of patients who received 8 mg of dexamethasone and recovered was less than that of the deceased. The average day on which the patients were hospitalized in the ICU and who received 8 mg of dexamethasone in both groups was the same (on average on day 7). It is noteworthy that in patients who recovered, the febrile temperature was more often recorded before hospitalization, while in those who died it was more often subfebrile. The temperature during hospitalization in all categories of patients was on average at subfebrile numbers. The respiratory rate on admission in all categories of patients did not differ significantly and on average was about 19/min (up to 20/min was in 50 % of patients who recovered and 58.3 % of those who died). Those who recovered were more likely to have a normal heart rate on admission, but tachycardia was less common than within those who died. In patients who subsequently died, lower saturation levels were more often recorded upon admission. In the first 3 days after hospitalization, in patients who recovered and received 8 mg of dexamethasone, leukocytosis and granulocytosis were recorded more often; there was an increased number of stab neutrophils and the number of patients with it. The patients who subsequently died more often developed leukopenia, more pronounced lymphopenia with an increased quantity of patients with it; they presented more pronounced thrombocytopenia (the number of patients with it did not differ from those who recovered), higher erythrocyte sedation rate. In patients who subsequently died, during the observation period, there was a gradual increase in the number of leukocytes, but a gradual decrease in the number of lymphocytes, the creatine phosphokinase level increased from the 7th–9th days of hospitalization; on days 4–6 of hospitalization, the lactate dehydrogenase level significantly increased with its subsequent decline to a level that was greater than this in patients who recovered. Initially. The patients who recovered had an increase in leukocytes with their subsequent gradual decrease, a gradual increase in the level of lymphocytes, a decrease in the level of creatine phosphokinase, lactate dehydrogenase. In all categories of patients, a gradual decrease in the number of stab neutrophils was observed over time, a gradual increase in the number of platelets was also observed over time, but in those who recovered their level was slightly higher; in both groups, an increase in the urea level was observed over time, but in those who died its level from day 7 and later was significantly higher than in those who recovered; in patients in both groups, an increase in the level of creatinine was observed over time, but in those who died, its level from day 7 and later was significantly higher than in those who recovered; both groups showed a decrease in C-reactive protein over time, but those who died from the very beginning of their hospital stay and during all follow-up periods had higher levels than those who recovered.


2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Gurveen Malhotra ◽  
Nitya Ramreddy ◽  
Serafin Chua ◽  
Mira Iliescu ◽  
Tanjeev Kaur

Antisynthetase (AS) syndrome is a major subgroup of inflammatory myopathies seen in a minority of patients with dermatomyositis and polymyositis. Although it is usually associated with elevated creatine phosphokinase level, some patients may have amyopathic dermatomyositis (ADM) like presentation with predominant skin involvement. Interstitial lung disease (ILD) is the main pulmonary manifestation and may be severe thereby determining the prognosis. It may rarely present with a very aggressive course resulting in acute respiratory distress syndrome (ARDS). We report a case of a 43-year-old male who presented with nonresolving pneumonia who was eventually diagnosed to have ADM through a skin biopsy without any muscle weakness. ADM may be associated with rapidly progressive course of interstitial lung disease (ADM-ILD) which is associated with high mortality. Differentiation between ADM-ILD and AS syndrome may be difficult in the absence of positive serology and clinical presentation may help in clinching the diagnosis.


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