151
|
Kok SXS, Tan TJ. Clinics in diagnostic imaging (179). Severe rhabdomyolysis complicated by myonecrosis. Singapore Med J 2018; 58:467-472. [PMID: 28848989 DOI: 10.11622/smedj.2017081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A 32-year-old man presented to the emergency department with severe right lower limb pain and swelling of three days' duration. He had multiple prior admissions for recurrent seizures and suicide attempts. Markedly elevated serum creatine kinase levels and urine myoglobinuria were consistent with a diagnosis of rhabdomyolysis. Initial magnetic resonance imaging of the right lower limb revealed diffuse muscle oedema and features of myositis in the gluteal muscles and the adductor, anterior and posterior compartments of the thigh. Follow-up magnetic resonance imaging performed 11 days later showed interval development of areas of myonecrosis and haemorrhage. The causes, clinical presentation and imaging features of rhabdomyolysis are discussed.
Collapse
Affiliation(s)
| | - Tien Jin Tan
- Department of Diagnostic Radiology, Changi General Hospital, Singapore
| |
Collapse
|
152
|
Manspeaker S, Henderson K, Riddle D. Treatment of exertional rhabdomyolysis in athletes: a systematic review. ACTA ACUST UNITED AC 2018; 14:117-47. [PMID: 27532656 DOI: 10.11124/jbisrir-2016-001879] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Exertional rhabdomyolysis (ER) is the breakdown of skeletal muscle tissue following intense physical activity that results in impairment of the cell membrane, which allows intracellular contents to be released into the bloodstream. Signs and symptoms include myalgia, myoglobinuria and increased creatine kinase (CK) levels. Athletes are vulnerable to this condition due to their increased level of physical activity. The severity and effects of this condition vary between individuals; however, all athletes are at risk of significant muscle damage, renal failure and perhaps death if not recognized and treated quickly. Effective methods for treatment and return to activity following this condition should be established. OBJECTIVES The objective of this review was to identify effective treatment methods associated with ER in athletes. INCLUSION CRITERIA TYPES OF PARTICIPANTS Adult and adolescent patients (15 years of age and older) in the athletic population who have been diagnosed with ER. TYPES OF INTERVENTIONS Fluid resuscitation/replacement or other treatment methods that aim to improve CK levels and decrease myoglobinuria and treat ER. TYPES OF STUDIES Due to the absence of randomized control trials, the quantitative component of the review considered descriptive studies, case series and individual case reports for inclusion. OUTCOMES PRIMARY OUTCOMES CK and myoglobinuria levels. SECONDARY OUTCOMES length of hospital stay; length of time from diagnosis to premorbid levels of physical activity. SEARCH STRATEGY A comprehensive search of the following databases with no date limitation was conducted: CINAHL, PubMed, ProQuest, Embase, SPORTDiscus and Physical Education Index. Results were limited to those available in English. METHODOLOGICAL QUALITY Two independent reviewers evaluated the retrieved articles for methodological quality using the standardized critical appraisal instrument from the Joanna Briggs Institute Meta-Analysis of Statistics and Review Instruments. DATA EXTRACTION Data were extracted from the articles by two independent reviewers using the standardized Joanna Briggs Institute extraction tool. DATA SYNTHESIS Narrative and tabular synthesis. RESULTS Fourteen studies with a combined total of 53 participants were included. Aggressive intravenous (IV) fluid resuscitation was found to be the most commonly utilized treatment method for decreasing CK levels and resolving myoglobinuria. The addition of compounds within the IV fluid varied between studies. CONCLUSION Due to the types of included studies and variation in reported treatment methods and outcomes for ER among athletes, effectiveness of treatment could not be determined. The limited evidence available indicates that IV fluid replacement, specifically normal saline, is the most commonly reported treatment for decreasing CK levels and myoglobinuria following ER. It appears that normal saline may be combined with other compounds including sodium bicarbonate, sodium chloride or potassium chloride to achieve reduction of CK levels and myoglobinuria. Clinically, early IV fluid replacement appears to be delivered at a rate of approximately 400 ml/hour, with adjustments ranging between 200 and 1000 ml/hour, depending on severity and volume states. Hospitalization time varies, depending on severity of condition, and return to activity is widely inconsistent among the athletic population.
Collapse
Affiliation(s)
- Sarah Manspeaker
- 1Athletic Training, Duquesne University, Pittsburgh, Pennsylvania, USA 2Texas Christian University Center for Evidence-based Practice and Research: a Collaborating Center of the Joanna Briggs Institute, Fort Worth, Texas, USA 3Rehabilitation Sciences, Florida Gulf Coast University, Fort Myers, Florida, USA 4Nursing, Texas Christian University: a Collaborating Center of the Joanna Briggs Institute, Fort Worth, Texas, USA
| | | | | |
Collapse
|
153
|
Saguin E, Keou S, Ratnam C, Mennessier C, Delacour H, Lahutte B. Severe rhabdomyolysis induced by quetiapine and mirtazapine in a French military soldier. J ROY ARMY MED CORPS 2018; 164:127-129. [PMID: 29632134 DOI: 10.1136/jramc-2018-000939] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 03/21/2018] [Accepted: 03/26/2018] [Indexed: 11/04/2022]
Abstract
Rhabdomyolysis is a potential complication of psychotropic drugs use and may potentially lead to life-threatening complications, such as an acute renal failure. We describe the case of a 40-year-old military soldier suffering from post-traumatic stress disorder was admitted for an adaptation of his treatment. Mirtazapine was introduced and quetiapine increased. Two days later, the patient presented with severe rhabdomyolysis syndrome. Mirtazapine administration was paused and intravenous hydration commenced. Shortly after the creatine kinase levels decreased enabling mirtazapine to be reintroduced without complication. It is our opinion that 5-hydroxytryptamine 2a serotonergic receptors inhibition (related to mirtazapine and quetiapine) associated with muscle training was responsible for inducing rhabdomyolysis. This must be kept in mind when psychotropic medications are adjusted, especially in an athletic population such as military.
Collapse
Affiliation(s)
- Emeric Saguin
- Department of Psychiatry, Hopital d'Instruction des Armees Begin, Saint Mande, France
| | - S Keou
- Department of Medicine, Hopital d'Instruction des Armees Begin, Saint Mande, Île-de-France, France
| | - C Ratnam
- Department of Biology, Hopital d'Instruction des Armees Begin, Saint Mande, Île-de-France, France
| | - C Mennessier
- Department of Psychiatry, Hopital d'Instruction des Armees Begin, Saint Mande, France
| | - H Delacour
- Department of Biology, Hopital d'Instruction des Armees Begin, Saint Mande, Île-de-France, France
| | - B Lahutte
- Department of Psychiatry, Hopital d'Instruction des Armees Begin, Saint Mande, France
| |
Collapse
|
154
|
Combined Therapy with Extracorporeal Shock Wave and Adipose-Derived Mesenchymal Stem Cells Remarkably Improved Acute Ischemia-Reperfusion Injury of Quadriceps Muscle. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2018; 2018:6012636. [PMID: 29805730 PMCID: PMC5901825 DOI: 10.1155/2018/6012636] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/20/2018] [Accepted: 02/01/2018] [Indexed: 12/18/2022]
Abstract
Extracorporeal shock wave (ECSW) and adipose-derived mesenchymal stem cells (ADMSCs) have been recognized to have capacities of anti-inflammation and angiogenesis. We tested the hypothesis that ECSW and ADMSC therapy could attenuate ischemia-reperfusion- (IR-) induced thigh injury (femoral artery tightened for 6 h then the tightness was relieved) in rats. Adult male SD rats (n = 30) were divided into group 1 (sham-control), group 2 (IR), group 3 (IR + ECSW/120 impulses at 0.12 mJ/mm2 given at 3 h/24 h/72 h after IR), group 4 (allogenic ADMSC/1.2 × 106 cell intramuscular and 1.2 × 106 cell intravenous injections 3 h after IR procedure), and group 5 (ECSW + ADMSC). At day 7 after the IR procedure, the left quadriceps muscle was harvested for studies. At 18 h after the IR procedure, serum myoglobin/creatine phosphokinase (CPK) levels were highest in group 2, lowest in group 1, and with intermediate values significantly progressively reduced in groups 3 to 5 (all p < 0.0001). By day 5 after IR, the mechanical paw-withdrawal threshold displayed an opposite pattern of CPK (all p < 0.0001). The protein expressions of inflammatory, oxidative-stress, apoptotic, fibrotic, DNA-damaged, and mitochondrial-damaged biomarkers and cellular expressions of inflammatory and DNA-damaged biomarkers exhibited an identical pattern of CPK among the five groups (all p < 0.0001). The microscopic findings of endothelial-cell biomarkers and number of arterioles expressed an opposite pattern of CPK, and the angiogenesis marker was significantly progressively increased from groups 1 to 5, whereas the histopathology showed that muscle-damaged/fibrosis/collagen-deposition areas exhibited an identical pattern of CPK among the five groups (all p < 0.0001). In conclusion, ECSW-ADMSC therapy is superior to either one applied individually for protecting against IR-induced thigh injury.
Collapse
|
155
|
Lim YS, Cho H, Lee ST, Lee Y. Acute kidney injury in pediatric patients with rhabdomyolysis. KOREAN JOURNAL OF PEDIATRICS 2018; 61:95-100. [PMID: 29628970 PMCID: PMC5876511 DOI: 10.3345/kjp.2018.61.3.95] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 10/13/2017] [Accepted: 10/17/2017] [Indexed: 12/18/2022]
Abstract
Purpose This study aimed to evaluate the clinical findings in pediatric rhabdomyolysis and the predictive factors for acute kidney injury (AKI) in Korean children. Methods Medical records of 39 Korean children, who were newly diagnosed with rhabdomyolysis from January 2008 to December 2015, were retrospectively analyzed. The diagnosis was made from the medical history, elevated serum creatinine kinase level >1,000 IU/L, and plasma myoglobin level >150 ng/mL. Patients with muscular dystrophy and myocardial infarction were excluded. Results The median patient age at diagnosis was 14.0 years (range, 3–18 years), and the male to female ratio was 2.5. The most common presenting symptom was myalgia (n=25, 64.1%), and 14 patients (35.9%) had rhabdomyolysis-induced AKI. Eighteen patients (46.2%) had underlying diseases, such as epilepsy and psychotic disorders. Ten of these patients showed rhabdomyolysis-induced AKI. The common causes of rhabdomyolysis were infection (n=12, 30.7%), exercise (n=9, 23.1%), and trauma (n=8, 20.5%). There was no difference in the distribution of etiology between AKI and non-AKI groups. Five patients in the AKI group showed complete recovery of renal function after stopping renal replacement therapy. The median length of hospitalization was 7.0 days, and no mortality was reported. Compared with the non-AKI group, the AKI group showed higher levels of peak creatinine kinase and myoglobin, without statistical significance. Conclusion The clinical characteristics of pediatric rhabdomyolysis differ from those observed in adult patients. Children with underlying diseases are more vulnerable to rhabdomyolysis-induced AKI. AKI more likely develops in the presence of a high degree of albuminuria.
Collapse
Affiliation(s)
- Young Shin Lim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Heeyeon Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Taek Lee
- Department of Pediatrics, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Yeonhee Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
156
|
Jeong JY, Kim KT, Kim MJ, Kim YJ. Rhabdomyolysis Following Colonoscopy: A Case Report. Ann Coloproctol 2018. [PMID: 29535989 PMCID: PMC5847405 DOI: 10.3393/ac.2018.34.1.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We experienced a case of 1 patient who died from rhabdomyolysis-related complications after colonoscopy. A 60-year-old man had undergone an ‘uncomplicated’ colonoscopic polypectomy. Approximately 10 hours following this procedure, the patient complained of increasing left abdominal pain. His computed tomography image showed free gas, but his operative findings revealed no macroscopic perforation or abscess formation. Eight hours after the operation, the patient presented with myoglobulinuria, and we diagnosed the condition to be rhabdomyolysis. Based on this case, we recommend that rhabdomyolysis be added to the list of complications following a colonoscopic procedure. Moreover, for prevention and early treatment, endoscopists should be attentive to the risk factors and signs/symptoms of rhabdomyolysis.
Collapse
Affiliation(s)
- Jin Yong Jeong
- Department of Surgery, Presbyterian Medical Center, Jeonju, Korea
| | - Kap Tae Kim
- Department of Surgery, Presbyterian Medical Center, Jeonju, Korea
| | - Mi Jin Kim
- Department of Surgery, Presbyterian Medical Center, Jeonju, Korea
| | - Yea Jeong Kim
- Department of Surgery, Presbyterian Medical Center, Jeonju, Korea
| |
Collapse
|
157
|
Wongrakpanich S, Kallis C, Prasad P, Rangaswami J, Rosenzweig A. The Study of Rhabdomyolysis in the Elderly: An Epidemiological Study and Single Center Experience. Aging Dis 2018; 9:1-7. [PMID: 29392076 PMCID: PMC5772847 DOI: 10.14336/ad.2017.0304] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/04/2017] [Indexed: 01/04/2023] Open
Abstract
Rhabdomyolysis is a syndrome caused by injury to skeletal muscle. There is limited data of rhabdomyolysis in the elderly. The objective of this study is to investigate demographic data, etiologies, laboratory values, prognostic factors, and mortality of rhabdomyolysis in the geriatric population. A 4-years retrospective chart review study was conducted. Our inclusion criteria were age above 65 years and creatinine kinase level excess five times of normal upper limit. Among 167 patients, 47.3% were male. The median age at diagnosis was 80.11 (66-101) years. The duration of follow up in the study ranged from 0 to 48 months. Fall (with or without immobilization) was the most frequent cause of rhabdomyolysis in 56.9%. The mean baseline glomerular filtration rate (GFR), GFR at diagnosis, and peak decline in GFR was 76.94, 48.96, and 54.41 cc/min respectively. The mean CK at diagnosis and peak CK was 5097.22 and 6320.07. There were 45 deaths (21%) over the span of 4 years. Multivariate analysis demonstrated that number of medications pre-admission (Meds No.), peak decline in GFR, and acute kidney injury (AKI) are independent predictors for overall survival for rhabdomyolysis in the elderly. To our knowledge, this is the first epidemiological study of rhabdomyolysis in the elderly. Falls (with and without immobilization) were the most common etiology. Meds No. (>8), peak decline in GFR (<30 cc/min), and evidence of AKI are associated with shorter overall survival and can serve as potential independent prognostic markers for rhabdomyolysis in elderly patients.
Collapse
Affiliation(s)
| | - Christos Kallis
- Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA
| | - Prithiv Prasad
- Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA
| | - Janani Rangaswami
- Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA
| | - Andrew Rosenzweig
- Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA
| |
Collapse
|
158
|
Navarrete N. Hyperkalemia in electrical burns: A retrospective study in Colombia. Burns 2018; 44:941-946. [PMID: 29395406 DOI: 10.1016/j.burns.2017.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 11/30/2017] [Accepted: 12/11/2017] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Classically, hyperkalemia has been regarded as a complication in patients with electrical burns. The etiology of hyperkalemia includes metabolic acidosis, destruction of red blood cells, rhabdomyolysis and the development of renal failure. The purpose of this study was to determine the prevalence of hyperkalemia within the first 24h after electrical burn injury and to evaluate the possible association of serum potassium concentration with cutaneous burn size (%TBSA) and serum creatine phosphokinase (CPK) concentration. METHODS A retrospective, cross-sectional study was conducted, based on review of medical records of adult patients hospitalized in the first 24h post electrical injury. Serum potassium (K+) levels were divided into low, normal, and high groups, with breakpoints at 3.5mmol/L and 5.0mmol/L and normal 3.6-4.9mmol/L. To assess potential differences according to the time elapsed between the time of the injury and the sampling time, data were grouped as follows: t1: samples obtained in the first 6h post-injury; t2: samples taken at 6-12h; t3: samples taken at 12-24h. RESULTS 336 patients were studied. The median age was 32 years old (IQR: 25-43). 95.2% of patients were men. Low and normal values of K+ were observed in 13.7% and 85.1%, respectively. The prevalence of hyperkalemia was only 1.2%, and was not related to previously-administered medications or to simple blood gas pH value during admission. CPK>10,000IU/L was observed in 22.6%. No association was found between the serum potassium concentration and either %TBSA burned or the highest CPK value. CONCLUSIONS First, patients admitted to our burn unit with electrical injury accompanied by significant skin and muscle injury rarely exhibit hyperkalemia. Secondly, the presence of hyperkalemia is independent of the severity of rhabdomyolysis or the extent of the burn.
Collapse
Affiliation(s)
- Norberto Navarrete
- Emergency Physician, Clinical Epidemiology, Burn Intensive Care Unit, U.S.S. Simón Bolívar Hospital, Bogotá, Colombia.
| |
Collapse
|
159
|
Al Manasra ARA, Shattarah OK. Massive Rhabdomyolysis; A Rare Cause of Hepatocellular Dysfunction. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:105-108. [PMID: 29375119 PMCID: PMC5800360 DOI: 10.12659/ajcr.906452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Rhabdomyolysis syndrome is a rare surgical complication. It is infrequently reported in prolonged operations under lateral decubitus position. This syndrome mainly impacts kidney function and electrolytes levels; liver is another organ that is uncommonly affected. CASE REPORT A 54-year-old male underwent a partial hepatectomy in the supine position, the procedure lasted three hours. After five days of uneventful recovery from surgery, he was readmitted to the hospital with rhabdomyolysis syndrome involving his lower limbs. No predisposing factors other than surgery could be identified. Based on blood tests, the only affected organ was the liver. Upon aggressive hydration, the creatinine kinase, hepatic enzymes, bilirubin levels, and prothrombin time were normalized. The patient regained normal physical strength over the next few weeks. CONCLUSIONS Liver dysfunction secondary to rhabdomyolysis is rare but should be considered when other causes are excluded. Prothrombin time, bilirubin levels and albumin levels may help to identify concomitant liver damage. Rhabdomyolysis is rarely reported in liver resection surgeries.
Collapse
Affiliation(s)
- Abdel Rahman A Al Manasra
- Department of General Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Osama K Shattarah
- Department of General Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| |
Collapse
|
160
|
Rhabdomyolysis and acute kidney injury: creatine kinase as a prognostic marker and validation of the McMahon Score in a 10-year cohort: A retrospective observational evaluation. Eur J Anaesthesiol 2018; 33:906-912. [PMID: 27259093 DOI: 10.1097/eja.0000000000000490] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND High-volume fluid resuscitation and the administration of sodium bicarbonate and diuretics have a theoretical renoprotective role in patients at high risk of acute kidney injury (AKI) following rhabdomyolysis. Abnormally elevated creatine kinase has previously been used as a biological marker for the identification of patients at high risk of AKI following rhabdomyolysis. OBJECTIVE To assess the sensitivity and specificity of plasma creatine kinase (admission and peak values) for the prediction of AKI requiring renal replacement therapy (RRT) or of death in patients with confirmed rhabdomyolysis. To compare the diagnostic performance of creatine kinase with the McMahon score. DESIGN Retrospective observational study. Data collection included McMahon and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores; daily creatine kinase; daily creatinine and electrolytes; ICU length of stay and mortality. SETTING Neurosciences and Trauma Critical Care Unit (Cambridge, UK). PATIENTS In total, 232 adults with confirmed rhabdomyolysis (creatine kinase > 1000 Ul) admitted to Neurosciences and Trauma Critical Care Unit between 2002 and 2012. MAIN OUTCOME MEASURES AKI, RRT and mortality. RESULTS Forty-five (19%) patients developed AKI and 29 (12.5%) patients required RRT. Mortality was significantly higher in patients who developed AKI (62 vs. 18%, P < 0.001). Average creatine kinase on admission was 5009 (range 69-157 860) Ul. Creatine kinase peaked between the day of admission and day 3 in 91% of cases. PEAK creatine kinase of at least 5000 Ul is 55% specific and 83% sensitive for the prediction of AKI requiring RRT. A McMahon Score of at least 6 calculated on admission is 68% specific and 86% sensitive for RRT. CONCLUSIONS Creatine kinase is not a specific or early predictor of AKI in patients with rhabdomyolysis. Although a PEAK creatine kinase of at least 5000 Ul has sensitivity acceptable for screening purposes, this is often a delayed finding. A McMahon score of at least 6 calculated on admission allows for a more sensitive, specific and timely identification of patients who may benefit from high-volume fluid resuscitation.
Collapse
|
161
|
Girard-Martel C, Gagnon M. Acute Bilateral Compartment Syndrome Secondary to Polydipsia-Induced Severe Hyponatremia. CLINICAL SCHIZOPHRENIA & RELATED PSYCHOSES 2018; 11:197-200. [PMID: 25711505 DOI: 10.3371/csrp.maga.022015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
|
162
|
Guerrero-Hue M, Rubio-Navarro A, Sevillano Á, Yuste C, Gutiérrez E, Palomino-Antolín A, Román E, Praga M, Egido J, Moreno JA. Efectos adversos de la acumulación renal de hemoproteínas. Nuevas herramientas terapéuticas. Nefrologia 2018; 38:13-26. [DOI: 10.1016/j.nefro.2017.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 04/21/2017] [Accepted: 05/16/2017] [Indexed: 12/18/2022] Open
|
163
|
Kamal F, Snook L, Saikumar JH. Rhabdomyolysis-Associated Acute Kidney Injury With Normal Creatine Phosphokinase. Am J Med Sci 2018; 355:84-87. [DOI: 10.1016/j.amjms.2017.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 04/14/2017] [Accepted: 04/18/2017] [Indexed: 10/19/2022]
|
164
|
Klainbart S, Agi L, Bdolah-Abram T, Kelmer E, Aroch I. Clinical, laboratory, and hemostatic findings in cats with naturally occurring sepsis. J Am Vet Med Assoc 2017; 251:1025-1034. [PMID: 29035656 DOI: 10.2460/javma.251.9.1025] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To characterize clinical and laboratory findings in cats with naturally occurring sepsis, emphasizing hemostasis-related findings, and evaluate these variables for associations with patient outcomes. DESIGN Prospective, observational, clinical study. ANIMALS 31 cats with sepsis and 33 healthy control cats. PROCEDURES Data collected included history; clinical signs; results of hematologic, serum biochemical, and hemostatic tests; diagnosis; and outcome (survival vs death during hospitalization or ≤ 30 days after hospital discharge). Differences between cats with and without sepsis and associations between variables of interest and death were analyzed statistically. RESULTS The sepsis group included cats with pyothorax (n = 10), septic peritonitis (7), panleukopenia virus infection (5), bite wounds (5), abscesses and diffuse cellulitis (3), and pyometra (1). Common clinical abnormalities included dehydration (21 cats), lethargy (21), anorexia (18), pale mucous membranes (15), and dullness (15). Numerous clinicopathologic abnormalities were identified in cats with sepsis; novel findings included metarubricytosis, hypertriglyceridemia, and high circulating muscle enzyme activities. Median activated partial thromboplastin time and plasma D-dimer concentrations were significantly higher, and total protein C and antithrombin activities were significantly lower, in the sepsis group than in healthy control cats. Disseminated intravascular coagulopathy was uncommon (4/22 [18%] cats with sepsis). None of the clinicopathologic abnormalities were significantly associated with death on multivariate analysis. CONCLUSIONS AND CLINICAL RELEVANCE Cats with sepsis had multiple hematologic, biochemical, and hemostatic abnormalities on hospital admission, including several findings suggestive of hemostatic derangement. Additional research including larger numbers of cats is needed to further investigate these findings and explore associations with outcome.
Collapse
|
165
|
Alaygut D, Torun Bayram M, Kasap B, Soylu A, Türkmen M, Kavukcu S. Rhabdomyolysis with different etiologies in childhood. World J Clin Pediatr 2017; 6:161-168. [PMID: 29184760 PMCID: PMC5691034 DOI: 10.5409/wjcp.v6.i4.161] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 03/21/2017] [Accepted: 07/24/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate different etiologies and management of the rhabdomyolysis in children.
METHODS Eight pediatric rhabdomyolysis cases who applied to the Dokuz Eylul University Faculty of Medicine Department of Pediatric Nephrology with different etiologies between January 2004 and January 2012 were evaluated in terms of age, gender, admission symptoms, physical examination findings, factors provoking rhabdomyolysis, number of rhabdomyolysis attacks, laboratory results, family history and the final diagnosis received after the treatment.
RESULTS Average diagnosis ages of eight cases were 129 (24-192) ± 75.5 mo and five of them were girls. All of them had applied with the complaint of muscle pain, calf pain, and dark color urination. Infection (pneumonia) and excessive physical activity were the most important provocative factors and excessive licorice consumption was observed in one case. In 5 cases, acute kidney injury was determined and two cases needed hemodialysis. As a result of the further examinations; the cases had received diagnoses of rhabdomyolysis associated with mycoplasma pneumoniae, sepsis associated rhabdomyolysis, licorice-induced hypokalemic rhabdomyolysis, carnitine palmitoyltransferase II deficiency, very long-chain acyl-CoA dehydrogenase deficiency, congenital muscular dystrophy and idiopathic paroxysmal rhabdomyolysis (Meyer-Betz syndrome).
CONCLUSION It is important to distinguish the sporadic and recurrent rhabdomyolysis cases from each other. Recurrent rhabdomyolysis cases should follow up more regardful and attentive.
Collapse
Affiliation(s)
- Demet Alaygut
- Department of Pediatric Nephrology, Dokuz Eylul University Faculty of Medicine, 35340 İnciralti İzmir, Turkey
| | - Meral Torun Bayram
- Department of Pediatric Nephrology, Dokuz Eylul University Faculty of Medicine, 35340 İnciralti İzmir, Turkey
| | - Belde Kasap
- Department of Pediatric Nephrology, Dokuz Eylul University Faculty of Medicine, 35340 İnciralti İzmir, Turkey
| | - Alper Soylu
- Department of Pediatric Nephrology, Dokuz Eylul University Faculty of Medicine, 35340 İnciralti İzmir, Turkey
| | - Mehmet Türkmen
- Department of Pediatric Nephrology, Dokuz Eylul University Faculty of Medicine, 35340 İnciralti İzmir, Turkey
| | - Salih Kavukcu
- Department of Pediatric Nephrology, Dokuz Eylul University Faculty of Medicine, 35340 İnciralti İzmir, Turkey
| |
Collapse
|
166
|
Babak K, Mohammad A, Mazaher G, Samaneh A, Fatemeh T. Clinical and laboratory findings of rhabdomyolysis in opioid overdose patients in the intensive care unit of a poisoning center in 2014 in Iran. Epidemiol Health 2017; 39:e2017050. [PMID: 29121712 PMCID: PMC5790980 DOI: 10.4178/epih.e2017050] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/08/2017] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the clinical and demographic characteristics and some laboratory findings of hospitalized patients with acute opioid toxicity and rhabdomyolysis. METHODS This cross-sectional study investigated 354 patients hospitalized at Baharloo Hospital in Tehran in 2014 with acute illicit drug toxicity. Data were collected using an investigator-made checklist. The collected data (such as mortality rate, demographic data, and renal function tests, as well as serum biochemical findings) were analyzed by descriptive statistics and the chi-square test. RESULTS A total of 354 patients were admitted to the hospital in 2014 with acute illicit drug toxicity, including 291 males and 63 females. The total number of patients with rhabdomyolysis was 76 (21.5% of the total), of whom 69 (90.8%) were male and 7 (9.2%) were female. Most cases of rhabdomyolysis were associated with methadone abuse, followed by opium abuse. Rhabdomyolysis was most common in those 20-29 and 30-39 years old, with methadone and opium the most commonly abused illicit drugs. The mean blood urea level was 3.8±1.0 mg/dL, and the mean serum potassium and sodium levels were 3.8±0.3 mg/dL and 140.4±4.0 mg/dL, respectively. Five patients, all of whom were male, passed away due to severe renal failure (6.5%). CONCLUSIONS Toxicity caused by opioids is associated with clinical complications and laboratory disorders, such as electrolyte disorders, which can lead to lethal or life-threatening results in some cases. Abnormal laboratory test findings should be identified in patients with opioid toxicity in order to initiate efficient treatment.
Collapse
Affiliation(s)
- Khoshideh Babak
- Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Arefi Mohammad
- Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghorbani Mazaher
- Department of Forensic Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Akbarpour Samaneh
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | |
Collapse
|
167
|
oğuz S, Tuygun N, Karacan CD. Enalapril ve essitalopram ile özkıyım girişimi sonrası gelişen rabdomiyoliz. EGE TIP DERGISI 2017. [DOI: 10.19161/etd.393483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
168
|
Huynh A, Leong K, Jones N, Crump N, Russell D, Anderson M, Steinfort D, Johnson DF. Outcomes of exertional rhabdomyolysis following high-intensity resistance training. Intern Med J 2017; 46:602-8. [PMID: 26949203 DOI: 10.1111/imj.13055] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 02/17/2016] [Accepted: 02/26/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND High-intensity resistance training (HIRT) programmes are increasingly popular amongst personal trainers and those attending gymnasiums. We report the experience of exertional rhabdomyolysis (ER) at two tertiary hospitals in Melbourne, Australia. AIMS To compare the clinical outcomes of ER with other causes of rhabdomyolysis. METHODS Retrospective cross-sectional study of patients presenting with a serum creatine kinase (CK) of greater than 25 000 units/L from 1 September 2013 to 31 August 2014 at two tertiary referral hospitals in Melbourne, Australia. Records were examined to identify care measures implemented during hospital stay, clinical outcomes during admission and on subsequent follow up. RESULTS Thirty four cases of rhabdomyolysis with a CK of greater than 25 000 units/L (normal range: 20-180 units/L) were identified during the 12-month study period. Twelve of the 34 cases (35%) had ER with 10 of 12 related to HIRT. No acute kidney injury, intensive care admission or death were seen among those with ER. All cases were managed conservatively, with 11 admitted and 9 receiving intravenous fluids only. In contrast, patients with rhabdomyolysis from other causes experienced significantly higher rates of intensive care admission (64%, P = 0.0002), acute kidney injury (82%, P = 0.0001) and death (27%, P = 0.069). CONCLUSION ER resulting from HIRT appears to have a benign course compared with rhabdomyolysis of other aetiologies in patients with a serum CK greater than 25 000 units/L. Conservative management of ER appears to be adequate, although this requires confirmation in future prospective studies.
Collapse
Affiliation(s)
- A Huynh
- Department of General Medicine, Austin Health, Melbourne, Victoria, Australia
| | - K Leong
- Department of General Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - N Jones
- Department of General Medicine, Austin Health, Melbourne, Victoria, Australia
| | - N Crump
- Department of Neurology, Austin Health, Melbourne, Victoria, Australia
| | - D Russell
- Department of General Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - M Anderson
- Shinbone Medical Centre, Melbourne, Victoria, Australia
| | - D Steinfort
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - D F Johnson
- Department of General Medicine, Austin Health, Melbourne, Victoria, Australia
| |
Collapse
|
169
|
Kim YS, Cha YS, Kim MS, Kim HJ, Lee YS, Youk H, Kim HI, Kim OH, Cha KC, Kim H, Lee KH, Hwang SO. The usefulness of diffusion-weighted magnetic resonance imaging performed in the acute phase as an early predictor of delayed neuropsychiatric sequelae in acute carbon monoxide poisoning. Hum Exp Toxicol 2017; 37:587-595. [PMID: 28812367 DOI: 10.1177/0960327117722821] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Delayed onset of neuropsychiatric symptoms after apparent recovery from acute carbon monoxide (CO) poisoning has been described as delayed neuropsychiatric sequelae (DNS). No previous study has determined whether early use of diffusion-weighted magnetic resonance imaging (DWI) can predict which patients will develop DNS in the acute CO poisoning. This retrospective observational study was performed on adult patients with acute CO poisoning consecutively treated over a 17-month period. All included patients with acute CO poisoning underwent DWI to evaluate brain injury within 72 h after CO exposure. DWI was evaluated as follows: (1) presence of pathology, (2) number of pathologies, (3) asymmetry, and (4) location of pathology. Patients were divided into two groups. The DNS group was composed of patients with delayed sequelae, while the non-DNS group included patients with no sequelae. A total of 102 patients with acute CO poisoning were finally enrolled in this study. DNS developed in 10 patients (9.8%). Between the DNS group and the non-DNS group, presence of pathology on DWI and initial Glasgow Coma Scale (GCS) showed significant difference. There was also a statistical difference between the non-DNS group and DNS group in terms of CO exposure time, troponin I, rhabdomyolysis, acute kidney injury, and pneumonia. The presence of pathology in DWI and initial GCS (cutoff: <12) at the emergency department served as an early predictors of DNS.
Collapse
Affiliation(s)
- Y S Kim
- 1 Department of Emergency Medicine, Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea
| | - Y S Cha
- 1 Department of Emergency Medicine, Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea
| | - M S Kim
- 2 Department of Radiology, Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea
| | - H J Kim
- 2 Department of Radiology, Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea
| | - Y S Lee
- 1 Department of Emergency Medicine, Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea
| | - H Youk
- 1 Department of Emergency Medicine, Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea
| | - H I Kim
- 1 Department of Emergency Medicine, Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea
| | - O H Kim
- 1 Department of Emergency Medicine, Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea
| | - K-C Cha
- 1 Department of Emergency Medicine, Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea
| | - H Kim
- 1 Department of Emergency Medicine, Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea
| | - K H Lee
- 1 Department of Emergency Medicine, Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea
| | - S O Hwang
- 1 Department of Emergency Medicine, Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea
| |
Collapse
|
170
|
Mehta P, Morrow M, Russell J, Madhuripan N, Habeeb M. Magnetic Resonance Imaging of Musculoskeletal Emergencies. Semin Ultrasound CT MR 2017; 38:439-452. [DOI: 10.1053/j.sult.2017.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
171
|
Odolini S, Gobbi F, Zammarchi L, Migliore S, Mencarini P, Vecchia M, di Lauria N, Schivazappa S, Sabatini T, Chianura L, Vanino E, Piacentini D, Zanotti P, Bussi A, Bartoloni A, Bisoffi Z, Castelli F. Febrile rhabdomyolysis of unknown origin in refugees coming from West Africa through the Mediterranean. Int J Infect Dis 2017; 62:77-80. [PMID: 28756023 DOI: 10.1016/j.ijid.2017.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/17/2017] [Accepted: 07/19/2017] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Cases of undiagnosed severe febrile rhabdomyolysis in refugees coming from West Africa, mainly from Nigeria, has been observed since May 2014. The aim of this study was to describe this phenomenon. METHODS This was a multicentre retrospective observational study of cases of febrile rhabdomyolysis reported from May 2014 to December 2016 in 12 Italian centres. RESULTS A total of 48 cases were observed, mainly in young males. The mean time interval between the day of departure from Libya and symptom onset was 26.2 days. An average 8.3 further days elapsed before medical care was sought. All patients were hospitalized with fever and very intense muscle aches. Creatine phosphokinase, aspartate aminotransferase, and lactate dehydrogenase values were abnormal in all cases. The rhabdomyolysis was ascribed to an infective agent in 16 (33.3%) cases. In the remaining cases, the aetiology was undefined. Four out of seven patients tested had sickle cell trait. No alcohol abuse or drug intake was reported, apart from a single reported case of khat ingestion. CONCLUSIONS The long incubation period does not support a mechanical cause of rhabdomyolysis. Furthermore, viral infections such as those caused by coxsackievirus are rarely associated with such a severe clinical presentation. It is hypothesized that other predisposing conditions like genetic factors, unknown infections, or unreported non-conventional remedies may be involved. Targeted surveillance of rhabdomyolysis cases is warranted.
Collapse
Affiliation(s)
- Silvia Odolini
- University Department of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy.
| | - Federico Gobbi
- Centre for Tropical Diseases, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy
| | - Lorenzo Zammarchi
- Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze, Florence, Italy; SOD Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | | | - Paola Mencarini
- Istituto Nazionale per le Malattie Infettive "Lazzaro Spallanzani", IRCCS, Rome, Italy
| | - Marco Vecchia
- Clinica di Malattie Infettive, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Nicoletta di Lauria
- Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze, Florence, Italy; SOD Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Simona Schivazappa
- Infectious Diseases-IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Tony Sabatini
- Department of Internal Medicine, Gastroenterology and Digestive Endoscopy, Poliambulanza Hospital Clinical Institute, Brescia, Italy
| | - Leonardo Chianura
- Division of Infectious Diseases, AO Niguarda Ca' Granda Hospital, Milan, Italy
| | - Elisa Vanino
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | - Paola Zanotti
- University Department of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy
| | - Anna Bussi
- Clinica di Medicina Interna, Azienda Socio Sanitaria Territoriale del Garda, Manerbio (BS), Italy
| | - Alessandro Bartoloni
- Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze, Florence, Italy; SOD Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Zeno Bisoffi
- Centre for Tropical Diseases, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy
| | - Francesco Castelli
- University Department of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy
| |
Collapse
|
172
|
Gosselt A, Olijhoek J, Wierema T. Severe asymptomatic rhabdomyolysis complicating a mycoplasma pneumonia. BMJ Case Rep 2017; 2017:bcr-2016-217752. [PMID: 28747412 DOI: 10.1136/bcr-2016-217752] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Rhabdomyolysis is a very rare and serious extrapulmonary manifestation of a Mycoplasma pneumoniae infection. We describe a case of a 47-year-old male patient who presented with progressive dyspnoea, hypoxaemia and cough during the last 3 days. He had no relevant muscular complaints but was diagnosed with severe rhabdomyolysis for which he was treated with hyperhydration. Molecular diagnostics confirmed M. pneumoniae as the causative agent and our patient was successfully treated with doxycycline.Only a few cases of rhabdomyolysis complicating a M. pneumoniae infection have been described, mostly in infants. In this case, typical suggestive complaints of rhabdomyolysis were absent suggesting that the complication might be underdiagnosed.
Collapse
Affiliation(s)
- Alex Gosselt
- Department of Internal Medicine, Tweesteden Ziekenhuis, Tilburg, The Netherlands
| | - Jobien Olijhoek
- Department of Internal Medicine, Tweesteden Ziekenhuis, Tilburg, The Netherlands
| | - Thomas Wierema
- Department of Internal Medicine, Tweesteden Ziekenhuis, Tilburg, The Netherlands
| |
Collapse
|
173
|
Koubar SH, Estrella MM, Warrier R, Moore RD, Lucas GM, Atta MG, Fine DM. Rhabdomyolysis in an HIV cohort: epidemiology, causes and outcomes. BMC Nephrol 2017; 18:242. [PMID: 28716131 PMCID: PMC5512985 DOI: 10.1186/s12882-017-0656-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/05/2017] [Indexed: 11/23/2022] Open
Abstract
Background The Literature on rhabdomyolysis in the HIV-positive population is sparse and limited. We aimed to explore the incidence, patient characteristics, etiologies and outcomes of rhabdomyolysis in a cohort of HIV-positive patients identified through the Johns Hopkins HIV clinical registry between June 1992 and April 2014. Methods A retrospective analysis of 362 HIV-positive patients with non-cardiac CK elevation ≥1000 IU/L was performed. Both inpatients and outpatients were included. Incidence rate and potential etiologies for rhabdomyolysis were ascertained. The development of acute kidney injury (AKI, defined as doubling of serum creatinine), need for dialysis, and death in the setting of rhabdomyolysis were determined. Logistic regression was used to evaluate the association of peak CK level with the development of AKI. Results Three hundred sixty two cases of rhabdomyolysis were identified in a cohort of 7079 patients with a 38,382 person years follow-up time. The incidence rate was nine cases per 1000 person-years (95% CI: 8.5–10.5). Infection was the most common etiology followed by compression injury and drug/alcohol use. One-third of cases had multiple potential etiologies. AKI developed in 46% of cases; 20% of which required dialysis. Thirteen percent died during follow-up. After adjustment, AKI was associated with higher CK (OR 2.05 for each 1-log increase in CK [95% CI: 1.40–2.99]), infection (OR 5.48 [95% CI 2.65–11.31]) and higher HIV viral load (OR 1.22 per 1-log increase [95% CI: 1.03–1.45]). Conclusion Rhabdomyolysis in the HIV-positive population has many possible causes and is frequently multifactorial. HIV-positive individuals with rhabdomyolysis have a high risk of AKI and mortality.
Collapse
Affiliation(s)
- Sahar H Koubar
- Department of Medicine/Division of Nephrology, American University of Beirut Medical Center and School of Medicine, Riad El Solh, PO Box 11-0236, Beirut, 1107 2020, Lebanon.
| | - Michelle M Estrella
- Kidney Health Research Collaborative, San Francisco VA Medical Center and University of California, 4150 Clement St., 111A1, San Francisco, California, CA, 94121, USA
| | - Rugmini Warrier
- Lincoln Nephrology & Hypertension, Lincoln, 7441 O St., Suite 304, Nebraska, 68510, USA
| | - Richard D Moore
- Department of Medicine/Division of Infectious Diseases, Johns Hopkins University Hospital and School of Medicine, 1830 E. Monument St., Room 435A, Baltimore, MD, 21287, USA
| | - Gregory M Lucas
- Department of Medicine/Division of Infectious Diseases, Johns Hopkins University Hospital and School of Medicine, 1830 E. Monument St., Room 435A, Baltimore, MD, 21287, USA
| | - Mohamed G Atta
- Department of Medicine/Division of Nephrology, Johns Hopkins University Hospital and School of Medicine, 1830 E. Monument Street - Suite 416, Baltimore, MD, 21205, USA
| | - Derek M Fine
- Department of Medicine/Division of Nephrology, Johns Hopkins University Hospital and School of Medicine, 1830 E. Monument Street - Suite 416, Baltimore, MD, 21205, USA
| |
Collapse
|
174
|
The clinical significance of technetium-99m methylene diphosphonate bone scintigraphy findings in patients with rhabdomyolysis. Nucl Med Commun 2017; 38:820-825. [PMID: 28692495 DOI: 10.1097/mnm.0000000000000709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE This study evaluated the relationship between bone scintigraphy finding and clinical factors and assessed the prognostic value of bone scintigraphy finding in patients with rhabdomyolysis. PATIENTS AND METHODS We retrospectively enrolled 143 patients with rhabdomyolysis who had undergone bone scintigraphy. Bone scintigraphy was classified into three groups: no or equivocal soft tissue uptake, a localized uptake, and a diffuse uptake. The relationship of bone scintigraphy findings with clinical factors was evaluated. Multiple logistic regression analysis was performed to identify the risk factors for acute renal failure (ARF) and renal replacement therapy (RRT). RESULTS Of 143 patients, 52 (36.4%) experienced ARF and 12 (8.4%) required RRT. Among cases caused by exercise, 83.7% showed localized soft tissue uptake. Diffuse soft tissue uptake was only shown among the patients with rhabdomyolysis caused by drug and toxin. Patients with localized or diffuse soft tissue uptake had higher levels of serum creatine kinase, myoglobin, aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase compared with patients with no or equivocal uptake (P<0.05). Multiple logistic regression analysis showed that age, female sex, and serum phosphate level were associated with a risk for ARF and only serum creatinine level was associated with a risk for RRT (P<0.05). Bone scintigraphy findings failed to show significance for predicting ARF and RRT (P>0.05). CONCLUSION Soft tissue uptake on bone scintigraphy in patients with rhabdomyolysis was related to etiologies and showed limited value for predicting ARF and RRT.
Collapse
|
175
|
Luckoor P, Salehi M, Kunadu A. Exceptionally High Creatine Kinase (CK) Levels in Multicausal and Complicated Rhabdomyolysis: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:746-749. [PMID: 28674380 PMCID: PMC5507674 DOI: 10.12659/ajcr.905089] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Male, 36 Final Diagnosis: Rhabdomyolysis induced acute renal failure Symptoms: Diarrhea • generalized weakness Medication: — Clinical Procedure: Hemodialysis • intubation Specialty: Critical Care Medicine
Collapse
Affiliation(s)
- Pavan Luckoor
- Department of Medicine, New York City Health + Hospital, Columbia University, Harlem, NY, USA
| | - Mashal Salehi
- Department of Medicine, New York City Health + Hospital, Columbia University, Harlem, NY, USA
| | - Afua Kunadu
- Department of Medicine, New York City Health + Hospital, Columbia University, Harlem, NY, USA
| |
Collapse
|
176
|
Floyd JS, Brody JA, Tiniakou E, Psaty BM, Mammen A. Absence of anti-HMG-CoA reductase autoantibodies in severe self-limited statin-related myopathy. Muscle Nerve 2017; 54:142-4. [PMID: 27038110 DOI: 10.1002/mus.25127] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2016] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Patients with self-limited statin-related myopathy improve spontaneously when statins are stopped. In contrast, patients with statin-associated autoimmune myopathy have autoantibodies recognizing 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase (HMGCR) and usually require immunosuppressive therapy to control their disease. On initial presentation, it can sometimes be difficult to distinguish between these 2 diseases, as both present with muscle pain, weakness, and elevated serum creatine kinase (CK) levels. The goal of this study was to determine whether patients with severe self-limited statin-related myopathy also make anti-HMGCR autoantibodies. METHODS We screened 101 subjects with severe self-limited cerivastatin-related myopathy for anti-HMGCR autoantibodies. RESULTS No patient with severe self-limited cerivastatin-related myopathy had anti-HMGCR autoantibodies. CONCLUSION Anti-HMGCR autoantibody testing can be used to help differentiate whether a patient has self-limited myopathy due to cerivastatin or autoimmune statin-associated myopathy; these findings may apply to other statins as well. Muscle Nerve 54: 142-144, 2016.
Collapse
Affiliation(s)
- James S Floyd
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Jennifer A Brody
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Eleni Tiniakou
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bruce M Psaty
- Department of Medicine, University of Washington, Seattle, Washington, USA.,Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Health Services, University of Washington, Seattle, Washington, USA
| | - Andrew Mammen
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,National Institutes of Health, Bethesda, Maryland, USA
| |
Collapse
|
177
|
Tung-Chen Y, González Alvárez G, Carballo-Cardona C. Edema de brazos tras rabdomiólisis aguda: un diagnóstico pasado por alto. Med Clin (Barc) 2017; 148:527-528. [DOI: 10.1016/j.medcli.2017.01.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 01/04/2017] [Accepted: 01/12/2017] [Indexed: 11/16/2022]
|
178
|
Assanangkornchai N, Akaraborworn O, Kongkamol C, Kaewsaengrueang K. Characteristics of Creatine Kinase Elevation in Trauma Patients and Predictors of Acute Kidney Injury. J Acute Med 2017; 7:54-60. [PMID: 32995172 PMCID: PMC7517910 DOI: 10.6705/j.jacme.2017.0702.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 10/14/2016] [Accepted: 12/02/2016] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Rhabdomyolysis in general trauma patients is a cause of acute kidney injury. However, there are limited data on prevalence, risk factors and the dynamics of creatine kinase (CK) as a surrogate marker for rhabdomyolysis. AIM This study aimed to examine the characteristics of CK elevation in general trauma patients and identify the risk factors of acute kidney injury (AKI). METHOD A retrospective study of trauma patients at Songklanagarind Hospital from January 2009 to August 2014 using CK, clinical characteristics and trauma severity as predictors and AKI as defined by the Acute Kidney Injury Network, 2005 criteria as the outcomes. RESULTS Of the 372 patients included in the study, the prevalence of rhabdomyolysis was 40.3%, the mean injury severity score (ISS) was 19.5 and 7% had AKI. The CK level peaked at 40 hours after admission with a rate change of 50.98 U/L/h. An initial mean arterial pressure < 65 mmHg, ISS ≥ 25 and CK elevation > 1,000 U/L/h were independently associated with AKI. CONCLUSION Traumatic rhabdomyolysis resulting in AKI occurs in patients with a high peak CK with an increasing rate of change and a high ISS. These parameters could identify patients who needed close monitoring of CK and renal function.
Collapse
Affiliation(s)
| | - Osaree Akaraborworn
- Prince of Songkla University Department of Surgery, Faculty of Medicine Songkhla Thailand
| | - Chanon Kongkamol
- Prince of Songkhla University Research Unit of Holistic Health and Safety Management in Community Songkhla Thailand
| | | |
Collapse
|
179
|
Chawla A, Dubey N, Chew KM, Singh D, Gaikwad V, Peh WC. Magnetic resonance imaging of painful swollen legs in the emergency department: a pictorial essay. Emerg Radiol 2017; 24:577-584. [PMID: 28523439 DOI: 10.1007/s10140-017-1514-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/05/2017] [Indexed: 11/29/2022]
Abstract
Patients presenting with a painful swollen leg are not infrequently encountered at the emergency department and can pose a diagnostic dilemma for attending physicians. The potential causes of leg pain and swelling include trauma, infection, inflammation, and neurogenic, vascular, and iatrogenic conditions; with magnetic resonance imaging (MRI) being an important tool in evaluation. We describe the MRI features of various conditions causing painful swollen legs. We also discuss the differential diagnosis and the useful clinical and laboratory findings that radiologists should be aware of, in order to arrive at an accurate diagnosis.
Collapse
Affiliation(s)
- Ashish Chawla
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore.
| | - Niraj Dubey
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore
| | - Kian Ming Chew
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore
| | - Dinesh Singh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore
| | - Vishal Gaikwad
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore
| | - Wilfred Cg Peh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore
| |
Collapse
|
180
|
Multimodality imaging findings in rhabdomyolysis and a brief review of differential diagnoses. Emerg Radiol 2017; 24:387-392. [PMID: 28497405 DOI: 10.1007/s10140-017-1512-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 04/28/2017] [Indexed: 01/06/2023]
Abstract
Rhabdomyolysis has traditionally been a clinical diagnosis with healthcare providers utilizing historical context, physical exam, and laboratory data to arrive at a diagnosis. However, there are myriad imaging findings that may be corroborative and support the presumptive diagnosis. This paper seeks to review imaging findings associated with rhabdomyolysis using different modalities including radiography, sonography, computed tomography (CT), magnetic resonance imaging (MRI), and bone scintigraphy.
Collapse
|
181
|
Gurrera RJ. A systematic review of sex and age factors in neuroleptic malignant syndrome diagnosis frequency. Acta Psychiatr Scand 2017; 135:398-408. [PMID: 28144982 DOI: 10.1111/acps.12694] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To examine sex and age distributions in neuroleptic malignant syndrome (NMS) patients based on a systematic literature review. METHOD EMBASE and PubMed databases were searched to identify any observation of NMS published from January 1, 1998 through November 1, 2014 that was accessible and interpretable (using language translation software). Redundant and equivocal reports were excluded. Sex ratio and age distributions were examined using standard graphical techniques and measures of association. RESULTS Twenty-eight independent sex ratio estimates were included. Males predominated in most (75%) estimates with an overall median sex ratio of 1.47 (95% CI, 1.20-1.80). NMS incidence peaked at age 20-25 years and declined steadily thereafter, with males consistently outnumbering females at all but the oldest age intervals. CONCLUSION NMS patients are 50% more likely to be males, and NMS is most likely to occur in young adulthood.
Collapse
Affiliation(s)
- Ronald J Gurrera
- Veteran Affairs Boston Healthcare System, Boston MA and Harvard Medical School Department of Psychiatry, Boston, MA, USA
| |
Collapse
|
182
|
Wang S, Zhang C, Li J, Niyazi S, Zheng L, Xu M, Rong R, Yang C, Zhu T. Erythropoietin protects against rhabdomyolysis-induced acute kidney injury by modulating macrophage polarization. Cell Death Dis 2017; 8:e2725. [PMID: 28383559 PMCID: PMC5477572 DOI: 10.1038/cddis.2017.104] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 02/02/2017] [Accepted: 02/15/2017] [Indexed: 12/15/2022]
Abstract
Erythropoietin (EPO) is a well-known hormone that is clinically used for the treatment of anemia. Very recently, an increasing body of evidence showed that EPO could still regulate bioactivities of macrophages. However, the details about the immunomodulatory effect of EPO on macrophages are not fully delineated, particularly in the setting of renal damages. Therefore, in the present study, we determined whether EPO could exert an impact on the dynamics of macrophages in a well-established model of rhabdomyolysis-induced acute kidney injury and explored the potential mechanisms. EPO was found to ameliorate kidney injuries by reducing macrophages recruitment and promoting phenotype switch toward M2 macrophages in vivo. It was also confirmed that EPO could directly suppress pro-inflammatory responses of M1 macrophages and promote M2 marker expression in vitro. Data indicated the possible involvement of Jak2/STAT3/STAT6 pathway in the augmentation of EPO on M2 polarization. These results improved the understanding of the immunoregulatory capacity of EPO on macrophages, which might optimize the therapeutic modalities of EPO.
Collapse
Affiliation(s)
- Shuo Wang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Chao Zhang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Jiawei Li
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Sidikejiang Niyazi
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Long Zheng
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Ming Xu
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Ruiming Rong
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Organ Transplantation, Shanghai, China.,Department of Transfusion, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Cheng Yang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Organ Transplantation, Shanghai, China
| | - Tongyu Zhu
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Organ Transplantation, Shanghai, China.,Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| |
Collapse
|
183
|
The role of postictal laboratory blood analyses in the diagnosis and prognosis of seizures. Seizure 2017; 47:51-65. [DOI: 10.1016/j.seizure.2017.02.013] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 02/23/2017] [Accepted: 02/24/2017] [Indexed: 12/18/2022] Open
|
184
|
Dineen M, Hansen E, Guancial E, Sievert L, Sahasrabudhe D. Abiraterone-induced rhabdomyolysis resulting in acute kidney injury: A case report and review of the literature. J Oncol Pharm Pract 2017; 24:314-318. [DOI: 10.1177/1078155217701294] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Abiraterone, a CYP17 inhibitor, blocks androgen biosynthesis in multiple tissue types. In combination with prednisone, it is approved as a first-line treatment for metastatic castration-resistant prostate cancer. We present a case of rhabdomyolysis associated with abiraterone therapy resulting in acute on chronic kidney injury in a patient with metastatic castration-resistant prostate cancer. Strict monitoring should be employed in patients started on abiraterone who have additional risk factors for developing rhabdomyolysis.
Collapse
Affiliation(s)
- Michael Dineen
- Wegmans School of Pharmacy, St. John Fisher College, Rochester, NY, USA
| | | | | | - Lynn Sievert
- University of Rochester Medical Center, Rochester, NY, USA
| | | |
Collapse
|
185
|
Cha YS, Kim H, Do HH, Kim HI, Kim OH, Cha KC, Lee KH, Hwang SO. Serum neuron-specific enolase as an early predictor of delayed neuropsychiatric sequelae in patients with acute carbon monoxide poisoning. Hum Exp Toxicol 2017; 37:240-246. [PMID: 28349731 DOI: 10.1177/0960327117698544] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Delayed onset of neuropsychiatric symptoms after apparent recovery from acute carbon monoxide (CO) poisoning has been described as delayed neuropsychiatric sequelae (DNS). To date, there have been no studies on the utility of serum neuron-specific enolase (NSE), a marker of neuronal cell damage, as a predictive marker of DNS in acute CO poisoning. This retrospective observational study was performed on adult patients with acute CO poisoning consecutively treated over a 9-month period. Serum NSE was measured after emergency department arrival, and patients were divided into two groups. The DNS group comprised patients with delayed sequelae, while the non-DNS group included patients with none of these sequelae. A total of 98 patients with acute CO poisoning were enrolled in this study. DNS developed in eight patients. The median NSE value was significantly higher in the DNS group than in the non-DNS group. There was a statistical difference between the non-DNS group and the DNS group in terms of CO exposure time, Glasgow Coma Scale (GCS), loss of consciousness, creatinine kinase, and troponin I. GCS and NSE were the early predictors of development of DNS. The area under the curve according to the receiver operating characteristic curves of GCS, serum NSE, and GCS combined with serum NSE were 0.922, 0.836, and 0.969, respectively. In conclusion, initial GCS and NSE served as early predictors of development of DNS. Also, NSE might be a useful additional parameter that could improve the prediction accuracy of initial GCS.
Collapse
Affiliation(s)
- Y S Cha
- 1 Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - H Kim
- 1 Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - H H Do
- 2 Department of Emergency Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - H I Kim
- 1 Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - O H Kim
- 1 Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - K-C Cha
- 1 Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - K H Lee
- 1 Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - S O Hwang
- 1 Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| |
Collapse
|
186
|
Marín de Mas I, Marín S, Pachón G, Rodríguez-Prados JC, Vizán P, Centelles JJ, Tauler R, Azqueta A, Selivanov V, López de Ceraín A, Cascante M. Unveiling the Metabolic Changes on Muscle Cell Metabolism Underlying p-Phenylenediamine Toxicity. Front Mol Biosci 2017; 4:8. [PMID: 28321398 PMCID: PMC5338303 DOI: 10.3389/fmolb.2017.00008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 02/09/2017] [Indexed: 12/15/2022] Open
Abstract
Rhabdomyolysis is a disorder characterized by acute damage of the sarcolemma of the skeletal muscle leading to release of potentially toxic muscle cell components into the circulation, most notably creatine phosphokinase (CK) and myoglobulin, and is frequently accompanied by myoglobinuria. In the present work, we evaluated the toxicity of p-phenylenediamine (PPD), a main component of hair dyes which is reported to induce rhabdomyolysis. We studied the metabolic effect of this compound in vivo with Wistar rats and in vitro with C2C12 muscle cells. To this aim we have combined multi-omic experimental measurements with computational approaches using model-driven methods. The integrative study presented here has unveiled the metabolic disorders associated to PPD exposure that may underlay the aberrant metabolism observed in rhabdomyolys disease. Animals treated with lower doses of PPD (10 and 20 mg/kg) showed depressed activity and myoglobinuria after 10 h of treatment. We measured the serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and creatine kinase (CK) in rats after 24, 48, and 72 h of PPD exposure. At all times, treatment with PPD at higher doses (40 and 60 mg/kg) showed an increase of AST and ALT, and also an increase of lactate dehydrogenase (LDH) and CK after 24 h. Blood packed cell volume and hemoglobin levels, as well as organs weight at 48 and 72 h, were also measured. No significant differences were observed in these parameters under any condition. PPD induce cell cycle arrest in S phase and apoptosis (40% or early apoptotic cells) on mus musculus mouse C2C12 cells after 24 h of treatment. Incubation of mus musculus mouse C2C12 cells with [1,2-13C2]-glucose during 24 h, subsequent quantification of 13C isotopologues distribution in key metabolites of glucose metabolic network and a computational fluxomic analysis using in-house developed software (Isodyn) showed that PPD is inhibiting glycolysis, non-oxidative pentose phosphate pathway, glycogen turnover, and ATPAse reaction leading to a reduction in ATP synthesis. These findings unveil the glucose metabolism collapse, which is consistent with a decrease in cell viability observed in PPD-treated C2C12 cells and with the myoglubinuria and other effects observed in Wistar Rats treated with PPD. These findings shed new light on muscle dysfunction associated to PPD exposure, opening new avenues for cost-effective therapies in Rhabdomyolysis disease.
Collapse
Affiliation(s)
- Igor Marín de Mas
- Departament de Bioquímica i Biologia Molecular, Facultat de Biología, Universitat de BarcelonaBarcelona, Spain; Department of Environmental Chemistry, Institute of Environmental Assessment and Water Research, Consejo Superior de Investigaciones CientíficasBarcelona, Spain
| | - Silvia Marín
- Departament de Bioquímica i Biologia Molecular, Facultat de Biología, Universitat de Barcelona Barcelona, Spain
| | - Gisela Pachón
- Departament de Bioquímica i Biologia Molecular, Facultat de Biología, Universitat de Barcelona Barcelona, Spain
| | - Juan C Rodríguez-Prados
- Departament de Bioquímica i Biologia Molecular, Facultat de Biología, Universitat de Barcelona Barcelona, Spain
| | - Pedro Vizán
- Departament de Bioquímica i Biologia Molecular, Facultat de Biología, Universitat de Barcelona Barcelona, Spain
| | - Josep J Centelles
- Departament de Bioquímica i Biologia Molecular, Facultat de Biología, Universitat de Barcelona Barcelona, Spain
| | - Romà Tauler
- Department of Environmental Chemistry, Institute of Environmental Assessment and Water Research, Consejo Superior de Investigaciones Científicas Barcelona, Spain
| | - Amaya Azqueta
- Departamento de Farmacología y Toxicología, Facultad de Farmacia y Nutrición, Universidad de Navarra Pamplona, Spain
| | - Vitaly Selivanov
- Departament de Bioquímica i Biologia Molecular, Facultat de Biología, Universitat de Barcelona Barcelona, Spain
| | - Adela López de Ceraín
- Departamento de Farmacología y Toxicología, Facultad de Farmacia y Nutrición, Universidad de Navarra Pamplona, Spain
| | - Marta Cascante
- Departament de Bioquímica i Biologia Molecular, Facultat de Biología, Universitat de Barcelona Barcelona, Spain
| |
Collapse
|
187
|
Clarissa Samara V, Warner J. Rare case of severe serotonin syndrome leading to bilateral compartment syndrome. BMJ Case Rep 2017; 2017:bcr-2016-218842. [PMID: 28258180 DOI: 10.1136/bcr-2016-218842] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The term 'serotonin syndrome' describes a constellation of symptoms caused by serotonergic overstimulation. Its characteristic clinical presentation consists of encephalopathy, neuromuscular signs and autonomic hyperactivity. After removal of the offending agent, the clinical course is usually self-limited but can occasionally lead to severe symptoms. We report the case of a 68-year-old woman who presented emergently with encephalopathy. Home medications included paroxetine and dextroamphetamine/amphetamine. Physical examination revealed tachycardia, tachypnoea, diaphoresis, rigidity, hyperreflexia and clonus. Given the fast onset of symptoms, a diagnosis of serotonin syndrome was made. Laboratory studies showed acute-on-chronic kidney injury and elevated creatine kinase. The patient's mental status quickly returned to baseline with supportive care. Her rhabdomyolysis, however, persisted and led to acute compartment syndrome in her lower extremities. After bilateral leg fasciotomies and treatment of a severe wound infection with intravenous antibiotics, the patient has now recovered with complete resolution of her symptoms.
Collapse
Affiliation(s)
| | - Judith Warner
- University of Utah, Salt Lake City, Utah, USA.,Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
188
|
Cervellin G, Comelli I, Benatti M, Sanchis-Gomar F, Bassi A, Lippi G. Non-traumatic rhabdomyolysis: Background, laboratory features, and acute clinical management. Clin Biochem 2017; 50:656-662. [PMID: 28235546 DOI: 10.1016/j.clinbiochem.2017.02.016] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 02/20/2017] [Accepted: 02/20/2017] [Indexed: 12/11/2022]
Abstract
Rhabdomyolysis is a relatively rare condition, but its clinical consequences are frequently dramatic in terms of both morbidity and mortality. Although no consensus has been reached so far about the precise definition of this condition, the term rhabdomyolysis describes a rapid breakdown of striated, or skeletal, muscle. It is hence characterized by the rupture and necrosis of muscle fibers, resulting in release of cell degradation products and intracellular elements within the bloodstream and extracellular space. Notably, the percentage of patients with rhabdomyolysis who develop acute kidney injury, the most dramatic consequence, varies from 13% to over 50% according to both the cause and the clinical and organizational setting where they are diagnosed. Despite direct muscle injury (i.e., traumatic rhabdomyolysis) remains the most common cause, additional causes, frequently overlapping, include hypoxic, physical, chemical or biological factors. The conventional triad of symptoms includes muscle pain, weakness and dark urine. The laboratory diagnosis is essentially based on the measurement of biomarkers of muscle injury, being creatine kinase (CK) the biochemical "gold standard" for diagnosis, and myoglobin the "gold standard" for prognostication, especially in patients with non-traumatic rhabdomyolysis. The essential clinical management in the emergency department is based on a targeted intervention to manage the underlying cause, combined with infusion of fluids and eventually sodium bicarbonate. We will present and discuss in this article the pathophysiological and clinical features of non-traumatic rhabdomyolysis, focusing specifically on Emergency Department (ED) management.
Collapse
Affiliation(s)
| | - Ivan Comelli
- Emergency Department, Academic Hospital of Parma, Parma, Italy
| | - Mario Benatti
- Emergency Department, Academic Hospital of Parma, Parma, Italy
| | - Fabian Sanchis-Gomar
- NYU Langone Medical Center, Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, USA; Department of Physiology, Faculty of Medicine, University of Valencia and Fundación Investigación Hospital Clínico Universitario de Valencia, Instituto de Investigación INCLIVA, Valencia, Spain
| | - Antonella Bassi
- Laboratory of Clinical Chemistry and Hematology, University Hospital of Verona, Verona, Italy
| | - Giuseppe Lippi
- Section of Clinical Chemistry, University of Verona, Verona, Italy
| |
Collapse
|
189
|
Beavis EE, Bongetti EK, Martin WG, Darby J. An Australian perspective on the relationship between young women, spinning and rhabdomyolysis. Intern Med J 2017; 47:235-236. [DOI: 10.1111/imj.13352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 10/23/2016] [Accepted: 10/31/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Eleanor E. Beavis
- Department of Medicine; St Vincent's Hospital; Melbourne Victoria Australia
| | - Elisa K. Bongetti
- Department of Medicine; St Vincent's Hospital; Melbourne Victoria Australia
| | - William G. Martin
- Department of Medicine; St Vincent's Hospital; Melbourne Victoria Australia
| | - Jonathan Darby
- Department of Medicine; St Vincent's Hospital; Melbourne Victoria Australia
| |
Collapse
|
190
|
Poon SH, Stoddart L. Unexpected Cause of Rhabdomyolysis and Proximal Muscle Weakness. Arthritis Care Res (Hoboken) 2017; 69:1599-1605. [PMID: 28118531 DOI: 10.1002/acr.23200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 12/11/2016] [Accepted: 01/17/2017] [Indexed: 01/04/2023]
Affiliation(s)
- Samuel H Poon
- Manchester Veterans Administration Medical Center, Manchester, New Hampshire, and Harrington Memorial Hospital, Southbridge, Massachusetts
| | - Lanu Stoddart
- Harrington Memorial Hospital, Southbridge, Massachusetts
| |
Collapse
|
191
|
Mallappallil M, Sabu J, Friedman EA, Salifu M. What Do We Know about Opioids and the Kidney? Int J Mol Sci 2017; 18:E223. [PMID: 28117754 PMCID: PMC5297852 DOI: 10.3390/ijms18010223] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 12/30/2016] [Accepted: 01/17/2017] [Indexed: 12/12/2022] Open
Abstract
Evidence suggests a link between opioid use and kidney disease. This review summarizes the known renal manifestations of opioid use including its role in acute and chronic kidney injury. Both the direct and indirect effects of the drug, and the context which leads to the development of renal failure, are explored. While commonly used safely for pain control and anesthesia in those with kidney disease, the concerns with respect to side effects and toxicity of opioids are addressed. This is especially relevant with the worldwide increase in the use of opioids for medical and recreational use.
Collapse
Affiliation(s)
- Mary Mallappallil
- Department of Internal Medicine, State University of New York at Downstate, Brooklyn, New York, NY 11203, USA.
| | - Jacob Sabu
- Department of Internal Medicine, State University of New York at Downstate, Brooklyn, New York, NY 11203, USA.
| | - Eli A Friedman
- Department of Internal Medicine, State University of New York at Downstate, Brooklyn, New York, NY 11203, USA.
| | - Moro Salifu
- Department of Internal Medicine, State University of New York at Downstate, Brooklyn, New York, NY 11203, USA.
| |
Collapse
|
192
|
Abstract
Rhabdomyolysis, which is a characteristic occurrence in associated with muscle cell necrosis, develops due to various causes. We herein report a rare case of a patient with rhabdomyolysis after high intensity resistance training, in which markedly elevated levels of serum creatine kinase (CK) and urine myoglobin were observed. A previously healthy 37-year-old man presented with severe myalgia and dark urine after performing high-intensity exercise. The patient's serum CK level was 95,100 U/L and his urine myoglobin level was 160,000 ng/mL. His symptoms and laboratory findings gradually improved with the intravenous administration of saline and no complications (including electrolyte imbalance and acute renal failure) developed.
Collapse
Affiliation(s)
- Sakiko Honda
- Department of Cardiology, Matsushita Memorial Hospital, Japan
| | | | | | | |
Collapse
|
193
|
Gurney M, Cotter TG, Wittich CM. 28-Year-Old Woman With Malaise, Cough, Myalgia, and Dark Urine. Mayo Clin Proc 2017; 92:e1-e5. [PMID: 28062066 DOI: 10.1016/j.mayocp.2016.03.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 03/22/2016] [Accepted: 03/25/2016] [Indexed: 01/04/2023]
Affiliation(s)
- Mark Gurney
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, MN
| | - Thomas G Cotter
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, MN
| | - Christopher M Wittich
- Advisor to residents and Consultant in General Internal Medicine, Mayo Clinic, Rochester, MN.
| |
Collapse
|
194
|
Raju NA, Rao SV, Joel JC, Jacob GG, Anil AK, Gowri SM, Kandasamy S. Predictive Value of Serum Myoglobin and Creatine Phosphokinase for Development of Acute Kidney Injury in Traumatic Rhabdomyolysis. Indian J Crit Care Med 2017; 21:852-856. [PMID: 29307967 PMCID: PMC5752795 DOI: 10.4103/ijccm.ijccm_186_17] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction: Rhabdomyolysis (RM) is a condition where there is injury to striated muscle fibers causing release of myoglobin, creatine phosphokinase (CPK), and other intracellular contents into the circulation. High myoglobin levels cause acute kidney injury (AKI). Trauma is the most common cause of RM and development of complications related to the degree of myoglobin released. Currently, the degree of RM is assessed and treatment is instituted based on serum CPK. As myoglobin is the direct cause of AKI, we set out to determine if serum myoglobin is a more reliable predictor than CPK for the development of AKI in traumatic RM. Methodology: A prospective observational study of 90 patients was admitted to the surgical Intensive Care Unit/high dependency unit of a tertiary hospital with traumatic RM whose serum CPK >5000 U/L. Along with standard treatment including intravascular volume optimization and hemodynamic stabilization, they were treated with “crush protocol.” Daily/twice a day, serum CPK and myoglobin were estimated. Categorical data are expressed as frequency and percentage, and the continuous variables are presented as mean (standard deviation) or median (interquartile range) based on normality. Other statistical analyses were done using the Chi-square test, independent t-test, and rank sum test based on normality. Results: Fourteen out of 90 patients developed AKI and one patient required renal replacement therapy. CPK value of >12,000 U/l was identified to have 64% sensitivity and 56% specificity for developing AKI whereas serum myoglobin value of >5000 ng/ml was identified to have 78% sensitivity and 77% specificity for developing AKI. Conclusion: Following traumatic RM, in patients on “crush protocol,” serum myoglobin is a more sensitive and specific test than serum CPK, for predicting AKI.
Collapse
Affiliation(s)
- Nithin Abraham Raju
- Division of Critical Care, Christian Medical College, Vellore, Tamil Nadu, India
| | - Shoma Vinay Rao
- Division of Critical Care, Christian Medical College, Vellore, Tamil Nadu, India
| | - J Chakravarthy Joel
- Department of Anaesthesia, Bangalore Baptist Hospital, Bengaluru, Karnataka, India
| | - Gijoe George Jacob
- Division of Critical Care, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - S Mahasampath Gowri
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Subramani Kandasamy
- Division of Critical Care, Christian Medical College, Vellore, Tamil Nadu, India
| |
Collapse
|
195
|
Alinejad S, Ghaemi K, Abdollahi M, Mehrpour O. Nephrotoxicity of methadone: a systematic review. SPRINGERPLUS 2016; 5:2087. [PMID: 28018795 PMCID: PMC5148752 DOI: 10.1186/s40064-016-3757-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 11/29/2016] [Indexed: 12/18/2022]
Abstract
Background Methadone is commonly administered for chronic pain relief and treatment of opioid dependence. Concurrent with its increased consumption, toxicities and fatalities have increased. One of the adverse effects of opioid analgesics, including methadone, is that of nephrotoxicity. Opioids can have an effect on renal function through several different mechanisms. Methods We searched common bibliographical databases for the terms methadone, toxicity, poisoning, kidney, renal, and nephrotoxicity and summarize our findings in this review. Results Methadone can have both direct and indirect effects on the kidney. These effects include rhabdomyolysis (leading to acute kidney injury), volumetric changes, renal lipidosis and amyloidosis, kidney growth during pregnancy, and kidney transplant rejection. Conclusion Improved understanding of the effects of methadone on kidney function can promote safer and more confident use of the drug.
Collapse
Affiliation(s)
- Samira Alinejad
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Moallem Avenue, Birjand, 9713643138 Iran
| | - Kazem Ghaemi
- Atherosclerosis and Coronary Artery Research Centre, Birjand University of Medical Sciences, Birjand, Iran ; Department of Neurosurgery, Birjand University of Medical Science, Birjand, Iran
| | - Mohammad Abdollahi
- Toxicology and Diseases Group, Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Omid Mehrpour
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Moallem Avenue, Birjand, 9713643138 Iran
| |
Collapse
|
196
|
Rhabdomyolysis in a Hospitalized 16-Year-Old Boy: A Rarely Reported Underlying Cause. Case Rep Pediatr 2016; 2016:7873813. [PMID: 27895953 PMCID: PMC5118508 DOI: 10.1155/2016/7873813] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/20/2016] [Indexed: 01/04/2023] Open
Abstract
Rhabdomyolysis can occur because of multiple causes and account for 7% of all cases of acute kidney injury annually in the United States. Identification of specific cause can be difficult in many cases where multiple factors could potentially cause rhabdomyolysis. We present a case of 16-year-old male who had seizures and was given levetiracetam that resulted in rhabdomyolysis. This side effect has been rarely reported previously and like in our case diagnosis may be delayed.
Collapse
|
197
|
Abstract
Rhabdomyolysis is a syndrome characterized by muscle pain, weakness and myoglobinuria and ranges in severity from asymptomatic to life threatening with acute kidney failure. While a common condition in adult populations, it is understudied in pediatrics and the majority of adolescent cases are likely exercise-induced, caused by strenuous exercise in athletes. Recently, in our pediatric sports medicine practice, we have seen numerous cases of late adolescent high school athletes who present with severe muscle pain and were found to have elevated creatine kinase levels. The cases review potential contributing factors including characteristics of the workout, use of supplements, caffeine, medication, and metabolic or genetic predisposition. Treatment for exercised-induced rhabdomyolysis rarely requires more than rehydration. Return to play should be progressive, individualized, and include acclimatization and monitoring of hydration status, though guidelines require further review.
Collapse
Affiliation(s)
- Kevin Hummel
- a Department of Pediatrics , Monroe Carell Jr Childrens Hospital at Vanderbilt , Nashville , TN , USA
| | - Andrew Gregory
- a Department of Pediatrics , Monroe Carell Jr Childrens Hospital at Vanderbilt , Nashville , TN , USA.,b Department of Pediatrics , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Neerav Desai
- a Department of Pediatrics , Monroe Carell Jr Childrens Hospital at Vanderbilt , Nashville , TN , USA.,b Department of Pediatrics , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Alex Diamond
- a Department of Pediatrics , Monroe Carell Jr Childrens Hospital at Vanderbilt , Nashville , TN , USA.,b Department of Pediatrics , Vanderbilt University Medical Center , Nashville , TN , USA
| |
Collapse
|
198
|
Faber ES, Gavini M, Ramirez R, Sadovsky R. Rhabdomyolysis After Coadministration of Atorvastatin and Sacubitril/Valsartan (Entresto™) in a 63-Year-Old Woman. DRUG SAFETY - CASE REPORTS 2016; 3:14. [PMID: 27804100 PMCID: PMC5089965 DOI: 10.1007/s40800-016-0036-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
A 63-year-old woman previously stable on a regimen of atorvastatin 40 mg daily, carvedilol 25 mg twice daily, digoxin 0.125 mg daily, furosemide 40 mg daily, spironolactone 25 mg daily, rivaroxaban 15 mg daily, and enalapril 20 mg twice daily for heart failure developed rhabdomyolysis 26 days after enalapril was stopped and sacubitril/valsartan (Entresto™) started. The patient received sacubitril/valsartan at 24/26 mg twice daily for heart failure; however, after 26 days she developed muscle and skin pain. Investigations revealed elevated creatine kinase and liver function tests, and rhabdomyolysis with raised transaminases was diagnosed. Sacubitril/valsartan and atorvastatin were discontinued and the patient was hydrated. She returned to baseline in 23 days and has not had any reoccurrence of rhabdomyolysis and elevated transaminases for 46 days. A Naranjo assessment score of 5 was obtained, indicating a probable relationship between the patient's rhabdomyolysis and her use of sacubitril/valsartan. The Drug Interaction Probability Scale score was 3, consistent with a possible interaction as a cause for the reaction, with sacubitril/valsartan as the precipitant drug and atorvastatin as the object drug.
Collapse
Affiliation(s)
- Eve S Faber
- Department of Family Medicine, SUNY-Downstate Medical Center, 450 Clarkson Avenue, Suite B, Brooklyn, NY, 11203, USA.
| | - Madhavi Gavini
- Department of Family Medicine, SUNY-Downstate Medical Center, 450 Clarkson Avenue, Suite B, Brooklyn, NY, 11203, USA
| | - Ronald Ramirez
- Department of Family Medicine, SUNY-Downstate Medical Center, 450 Clarkson Avenue, Suite B, Brooklyn, NY, 11203, USA
| | - Richard Sadovsky
- Department of Family Medicine, SUNY-Downstate Medical Center, 450 Clarkson Avenue, Suite B, Brooklyn, NY, 11203, USA
| |
Collapse
|
199
|
The myth of muscle uptake of Tc-99m bisphosphonate in bone scan because of rhabdomyolysis. Nucl Med Commun 2016; 37:1334-1336. [PMID: 27776041 DOI: 10.1097/mnm.0000000000000593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
200
|
Nara A, Yajima D, Nagasawa S, Abe H, Hoshioka Y, Iwase H. Evaluations of lipid peroxidation and inflammation in short-term glycerol-induced acute kidney injury in rats. Clin Exp Pharmacol Physiol 2016; 43:1080-1086. [DOI: 10.1111/1440-1681.12633] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 08/07/2016] [Accepted: 08/12/2016] [Indexed: 12/18/2022]
Affiliation(s)
- Akina Nara
- Department of Legal Medicine; Graduate School of Medicine; Chiba University; Chiba Japan
- Department of Forensic Medicine; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Daisuke Yajima
- Department of Legal Medicine; Graduate School of Medicine; Chiba University; Chiba Japan
| | - Sayaka Nagasawa
- Department of Legal Medicine; Graduate School of Medicine; Chiba University; Chiba Japan
| | - Hiroko Abe
- Department of Legal Medicine; Graduate School of Medicine; Chiba University; Chiba Japan
| | - Yumi Hoshioka
- Department of Legal Medicine; Graduate School of Medicine; Chiba University; Chiba Japan
| | - Hirotaro Iwase
- Department of Legal Medicine; Graduate School of Medicine; Chiba University; Chiba Japan
- Department of Forensic Medicine; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| |
Collapse
|