Unusal Presentation of Dengue Fever as Pyomyositis

Dengue is the most common and widespread arthropod-borne arboviral infection. Symptoms include fever, headache, muscle, and joint pains, and a characteristic skin rash. Although viral myositis is common, myositis caused by the dengue virus is not commonly reported. The case of serologically confirmed dengue fever complicated by pyomyositis associated with a tenfold increase in serum creatine phosphokinase is presented.

SERUM CREATINE PHOSPHOKINASE ACTIVITY IN RABBIT DURING REGENERATION OF EXPERIMENTALLY DAMAGED MUSCLE TISSUE AND AFTER ITS STIMULATION BY TRANSPLANTED MSC

According to statistics, in modern veterinary practice, the percentage of muscle injuries among sport and working animals ranges from 40–70% of sports injuries. Quite often there are cases with muscle injuries of skeletal muscles, namely extremities. This scientific work describes the research methodology, stages of research step-by-step, and studies the relationship of dynamics of the activity of a single biochemical blood indicator. The essence of the method was to model the injury of muscle tissue performed by the skin and fascia dissection and cutting off in the area of midplane of the pelvic head of the biceps femoris muscle, measuring 1.5 x 1.5 cm to a depth of 1.5 cm of muscle tissue on 105 laboratory animals, divided into 4 groups with the use of various treatment methods. We analyze the results of one of the most effective biochemical methods for diagnosing muscle fiber of skeletal system damage and compare the activity of the enzyme creatine phosphokinase iso-enzyme depending on the stage of the study. Other research methods such as clinical, biochemical, ultrasonographic, histological research methods were recorded on 4, 7, 10, 14, 21, and 28 days. We analyzed the latest literature sources and concluded that on the 4th and 7th days, the level of creatine phosphokinase in the groups with intravenous administration, intramuscular administration of allogeneic mesenchymal stem cells is higher than the reference values but significantly lower compared to the control groups and the traditional method of treatment. But we observe a significant decrease in serum creatine phosphokinase levels in crawls on 10th day in the intravenous administration group compared to the control group of animals in 2 times, compared to traditional treatment in 1.6 times. The group of animals with intramuscular administration has reference values on the 14th day, compared with the control in 1.3 times lower, traditional treatment in 1.2 times. And on 21th day, we get reference values for a group of animals with traditional treatment. The level of creatine phosphokinase activity decreases in the control group of animals on 28th day of the research, which indicates a complete muscle rupture. The results of studies showed that the highest activity of the creatine phosphokinase enzyme during the study was shown by groups of animals with control and traditional treatment, which indicated significant structural, functional and destructive disorders of the muscle fibers of skeletal tissues with severe trauma. Thus, it is noted that the activity of the enzyme in conditions of damage of skeletal muscle tends to increase in accordance with the severity of the injury.

Colchicine for acute arthritis attacks prevention in patients with gout during urate-lowering therapy (results of a pilot study)

Objective: to investigate the efficacy and safety of low-dose colchicine in patients with gout receiving urate-lowering therapy (ULT).Patients and methods. A single-center prospective study included 113 patients with gout. The main group consisted of 92 patients who were prescribed colchicine 0.5 mg/day combined with ULT (allopurinol or febuxostat), control group – 21 patients with contraindications to colchicine therapy who received only ULT. Patient data were entered into individual registration cards at the first visit, as well as on the 90th and 180th day after the start of drug intake. The presence of arthritis attacks was recorded by doctor or patient using a validated questionnaire. We compared the mean frequency of arthritis attacks in the groups, their duration and maximum pain intensity according to the visual analogue scale (VAS). Laboratory tests included: complete blood count test, general urinary test, uric acid (UA), blood glucose, alanine aminotransferase, aspartate aminotransferase, creatinine, serum creatine phosphokinase.Results and discussion. Patients who did not receive prophylactic anti-inflammatory therapy had significantly longer duration of the disease and higher number of affected joints. For 6 months of follow-up, there were no arthritis attacks in 54% of patients who were prescribed colchicine, and only in 19% of patients who did not use prophylactic anti-inflammatory therapy (p=0.004). The duration of arthritis attacks and the intensity of pain according to the VAS were also statistically significantly lower in the colchicine group (p<0.031 and p<0.01, respectively). Due to the development of adverse events, related to colchicine therapy, only 3 were excluded from the study. The mean serum UA level by the end of the study in colchicine group did not differ from that in the control group.Conclusion. Administration of colchicine, 0.5 mg/dai for 6 months after initiation of ULT is safe and can reduce the frequency and severity of arthritis attacks.

Unusual case of recurrent hypoglycaemia in multiple bee sting envenomation

A bee sting can result in allergic and toxin-mediated local manifestations like pain, swelling, redness and itching to serious systemic effects like acute kidney injury (AKI), pancreatitis, Kounis syndrome and stroke. Melittin and phospholipase A2, which make up 62% of honeybee venom, have vasoactive, haemolytic properties causing severe AKI. Its role in lowering blood glucose in diabetics is an interesting research topic. We report an elderly herdsman, a known diabetic on irregular oral hypoglycaemic drugs, who presented with altered mental status due to hypoglycaemia. On further prodding, a recent multiple bee sting attack 5 days ago was found which was followed by altered coloured urine for 2 days for which no medical attention was sought. Additional analyses revealed reticulocytosis, azotemia and high serum creatine phosphokinase. The patient was treated with dextrose infusion, antihistamines, fluids and haemodialysis. Renal failure resolved completely and the patient was discharged in a stable condition.

Cardiac Health Indicators in Critical COVID-19 Cases

Coronavirus disease-2019 (COVID-19) is an infectious disease that has spread worldwide and led to ongoing global concern. The pandemic prompted researchers to examine the impact of COVID-19 on human organs. The heart is one such organ. This study investigates the possible prediction of heart condition using some biochemical markers of particularly critically ill patients referred to an intensive care unit (ICU). Results of various serum biomarkers of patients infected with COVID-19 receiving treatment in the ICU, Asir Central Hospital, Asir Region, Saudi Arabia, were extracted and compared with healthy individuals using the Mann-Whitney U test. The study showed a distinguished increase in total Serum creatine phosphokinase-Total (CPK-Total), Serum creatine phosphokinase-MP (CPK-MP) levels among COVID-19/ICU patients. But, this increase was not statistically significant. Besides, aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase levels revealed a statistically significant increase in the infected group compared with controls. Examination of electrolytes showed a reduction in calcium median value in COVID-19/ICU patients. Data revealed a possible influence of COVID-19 on the heart. Herein, we observe significant parameters that may reflect cardiovascular injury elicited by the virus. These biomarkers possibly used to monitor the severity of disease on the cardiovascular system.

Identification of a Novel MICU1 Nonsense Variant Causes Myopathy with Extrapyramidal Signs in an Iranian Consanguineous Family

Background: Ca2+ as a universal second messenger regulates basic biological functions including cell cycle, cell proliferation, cell differentiation and cell death. Lack of the protein mitochondrial calcium uptake1 (MICU1) which has been regarded as a gatekeeper of Ca ions, leads to the abnormal mitochondrial Ca2+ handling, excessive production of reactive oxygen species (ROS), and increased cell death. Mutations in MICU1 gene (NM_006077.3) causes a very rare neuromuscular disease, Myopathy with extrapyramidal signs (MPXPS), due to primary alterations in mitochondrial calcium signaling which demonstrates the key role of mitochondrial Ca2+ uptake. To date 6 variants have been reported in MICU1 gene in approximately 21 pedigrees.Case presentation: here we report a 44-year-old Iranian patient presented with learning disability, muscle weakness, easy fatigability, reduced tendon reflexes, ataxia, elevated hepatic transaminase, elevated serum creatine phosphokinase and gait disturbance. We Identified a novel nonsense variant c.385C>T; p.(R129*) in MICU1 gene by whole exome sequencing and segregation analysis.Conclusions: Our finding along with previous studies provides more evidence on the clinical presentation of the disease caused by pathogenic mutations in MICU1. Finding more variants and expanding the spectrum of the disease increases the diagnostic rate of molecular testing in screening of this kind of diseases and in turn improves the quality of counseling for at risk couples and helps them to minimize the risks of having affected children.

Are we ignoring coexisting rhabdomyolysis as an important aggravating factor for acute kidney injury among childhood diabetic ketoacidosis?

ObjectivesAlthough Acute Kidney Injury (AKI) has been described among childhood diabetes ketocidosis (cDKA) there is scarcity of literature on the role of concomitant rhabdomyolysis.MethodA retrospective chart review was undertaken (2014–2018) to identify cDKA who developed AKI and had evidence of rhabdomyolysis defined by serum creatine phosphokinase (CPK) > 5 times upper limit of normal.Result46 cDKA were identified. Ten (22%) developed AKI with 6/10 reaching peak AKI Stage 3 and 8/10 had co-current rhabdomyolysis. In comparison to non rhabdomyolysis group, cDKA with rhabdomyolysis were at presentation significantly more likely to be hypotensive and have higher corrected sodium and calculated osmolality. Subsequently they were more likely to develop lower trough potassium levels during treatment. Five patients, all with rhabdomyolysis, needed dialysis: median duration 9 days (range 4–35). Three children in our cohort died, all from infection complications during treatment, one in AKI only group who did not receive dialysis and two in AKI with rhabdomyolysis on dialysis.ConclusionRhabdomyolysis was common among our cohort of cDKA with AKI and was associated with high morbidity and mortality. Rapid flux in electrolytes and osmolality may be important precipitating factors. We recommend larger prospective studies exploring the importance of rhabdomyolysis among cDKA with AKI.

Immune mediated necrotizing myopathy: A rare complication of statin therapy

Immune mediated necrotizing myopathy (IMNM) is part of the inflammatory myopathies group of diseases and presents with muscle weakness, myalgias and elevated serum creatine phosphokinase (CPK). Statin-induced IMNM is a rare complication. We present a patient with IMNM secondary to simvastatin use. The patient presented with proximal myopathy, dysphagia, and elevated creatinine kinase levels, and was subsequently found to have anti-3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR) autoantibodies with a necrotizing process on muscle biopsy. This patient’s case was further complicated by sequelae of multiple disease processes, ultimately leading to deterioration of his health.