Fever, Fasting, and Rhabdomyolysis in an Adult Male

Mitochondrial diseases in South Asia - A systematic review

BACKGROUND

Mitochondrial diseases are largely underdiagnosed due to their heterogeneity in clinical presentation and genotype. This is especially true for resource-constrained settings in South Asian countries such as Afghanistan, Bangladesh, Bhutan, India, Maldives, Pakistan, Nepal, Sri Lanka and Myanmar. This study aims to evaluate the current status of clinical presentations, diagnosis and treatment of Mitochondrial diseases in the South Asian region.

METHODS

We undertook a systematic review of the literature on mitochondrial diseases in the South Asian region. We searched Medline, Pubmed, Cochrane library, and Google scholar using the search terms, "Mitochondrial diseases" AND "Metabolic diseases" (Mesh terms) in the title or the abstract field for each South Asian Country (Afghanistan, Bangladesh, Bhutan, India, Maldives, Pakistan, Nepal, Sri Lanka and Myanmar).

RESULTS

We found 89 citations in Pubmed, 22 citations in Cochrane library and 68 in Google scholar respectively. A total of 25 non-duplicated studies met the inclusion and exclusion criteria. After assessing the quality of the published studies 18 were included. Which comprised of 17 case reports and one case-control study.

CONCLUSION

Studies that were published were case reports from India, Pakistan, and Sri Lanka. Due to the paucity of published data on mitochondrial diseases in the South Asian region, it is difficult to estimate its true burden.

Exercise-Induced Rhabdomyolysis: A Case Report and Literature Review

A 19-year-old man presented to the ED with bilateral leg pain and dark discoloration of the urine after he started an intense aerobic exercise. Blood workup showed significantly elevated creatine kinase (CK), acute kidney injury (AKI), and disseminated intravascular coagulation (DIC). The patient had a double-incision, bilateral fasciotomy with debridement to relieve the bilateral, lower-limb, compartment syndrome following admission. Also, his kidney function deteriorated, requiring several sessions of hemodialysis. His hospital stay was complicated by multidrug-resistant (MDR) Acinetobacter baumannii bacteremia. After three weeks of hospital admission, the patient was discharged home with a follow-up outpatient physiotherapy for bilateral foot drop, which showed a remarkable recovery eventually. This case highlights the potentially life-threatening risks associated with unaccustomed physical exercise and emphasizing the essential preventive measures to reduce the risk of developing exercise-induced rhabdomyolysis. We present the pathophysiology of exercise-induced rhabdomyolysis, clinical presentation, diagnosis, treatment, and prognosis.