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Ognean ML, Mutică IB, Vișa GA, Șofariu CR, Matei C, Neamțu B, Cucerea M, Galiș R, Cocișiu GA, Mătăcuță-Bogdan IO. D-Bifunctional Protein Deficiency Diagnosis-A Challenge in Low Resource Settings: Case Report and Review of the Literature. Int J Mol Sci 2024; 25:4924. [PMID: 38732138 PMCID: PMC11084724 DOI: 10.3390/ijms25094924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/28/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
D-bifunctional protein deficiency (D-BPD) is a rare, autosomal recessive peroxisomal disorder that affects the breakdown of long-chain fatty acids. Patients with D-BPD typically present during the neonatal period with hypotonia, seizures, and facial dysmorphism, followed by severe developmental delay and early mortality. While some patients have survived past two years of age, the detectable enzyme activity in these rare cases was likely a contributing factor. We report a D-BPD case and comment on challenges faced in diagnosis based on a narrative literature review. An overview of Romania's first patient diagnosed with D-BPD is provided, including clinical presentation, imaging, biochemical, molecular data, and clinical course. Establishing a diagnosis can be challenging, as the clinical picture is often incomplete or similar to many other conditions. Our patient was diagnosed with type I D-BPD based on whole-exome sequencing (WES) results revealing a pathogenic frameshift variant of the HSD17B4 gene, c788del, p(Pro263GInfs*2), previously identified in another D-BPD patient. WES also identified a variant of the SUOX gene with unclear significance. We advocate for using molecular diagnosis in critically ill newborns and infants to improve care, reduce healthcare costs, and allow for familial counseling.
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Affiliation(s)
- Maria Livia Ognean
- Faculty of Medicine, Lucian Blaga University, 550025 Sibiu, Romania; (M.L.O.); (C.M.); (B.N.); (I.O.M.-B.)
- Neonatology Department, Clinical County Emergency Hospital, 550245 Sibiu, Romania
| | - Ioana Bianca Mutică
- Neonatology Department, Clinical County Emergency Hospital, 550245 Sibiu, Romania
| | - Gabriela Adriana Vișa
- Research and Telemedicine Center in Pediatric Neurology, Pediatric Clinical Hospital Sibiu, 550169 Sibiu, Romania; (G.A.V.); (C.R.Ș.)
| | - Ciprian Radu Șofariu
- Research and Telemedicine Center in Pediatric Neurology, Pediatric Clinical Hospital Sibiu, 550169 Sibiu, Romania; (G.A.V.); (C.R.Ș.)
- Pediatric Clinical Hospital Sibiu, 550169 Sibiu, Romania
| | - Claudiu Matei
- Faculty of Medicine, Lucian Blaga University, 550025 Sibiu, Romania; (M.L.O.); (C.M.); (B.N.); (I.O.M.-B.)
| | - Bogdan Neamțu
- Faculty of Medicine, Lucian Blaga University, 550025 Sibiu, Romania; (M.L.O.); (C.M.); (B.N.); (I.O.M.-B.)
- Research and Telemedicine Center in Pediatric Neurology, Pediatric Clinical Hospital Sibiu, 550169 Sibiu, Romania; (G.A.V.); (C.R.Ș.)
- Department of Computer Science and Electrical Engineering, Faculty of Engineering, Lucian Blaga University Sibiu, 550025 Sibiu, Romania
| | - Manuela Cucerea
- Department of Neonatology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, 540142 Targu Mures, Romania;
| | - Radu Galiș
- Department of Neonatology, Clinical County Emergency Hospital Bihor, 410167 Oradea, Romania;
- Department of Neonatology, Poznan University Medical Sciences, 60-512 Poznan, Poland
| | | | - Ioana Octavia Mătăcuță-Bogdan
- Faculty of Medicine, Lucian Blaga University, 550025 Sibiu, Romania; (M.L.O.); (C.M.); (B.N.); (I.O.M.-B.)
- Pediatric Clinical Hospital Sibiu, 550169 Sibiu, Romania
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Arillotta D, Totti A, Dimitrova A, Croce EB, Di Milia MG, Gambassi F, Gualco B, Pieraccini G, Mannaioni G, Vaiano F. Clinical manifestations and analytical reports for MDPHP acute intoxication cases. J Pharm Biomed Anal 2024; 241:115974. [PMID: 38277706 DOI: 10.1016/j.jpba.2024.115974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 01/28/2024]
Abstract
MDPHP is a synthetic cathinone (SC) belonging to α-pyrrolidinophenone derivatives. It is a central nervous system stimulant and may induce hallucinations, paranoia, tachycardia, hypertension, chest pain, and rhabdomyolysis. In literature, a few cases of intoxication have been reported. In the present study, 17 cases of MDPHP intake were described including the analytical findings and clinical manifestations. MDPHP was quantified by liquid chromatography-tandem mass spectrometry in blood (range 1.26-73.30 ng/mL) and urine (range 19.31-8769.64 ng/mL) samples. In three cases the presence of α-PHP was observed. In one case, MDPHP was the only detected substance. Concomitant use of MDPHP with other substances, particularly psychostimulants, was common and it was difficult to describe the peculiar clinical characteristics of this SC. Most of the symptoms overlapped those expected, some of them were unusual and all of them particularly severe thus inducing the research of NPS in laboratory tests. We demonstrated the presence of psychiatric, neurological, and respiratory symptoms, as well as the possible presence of rhabdomyolysis and cardiotoxicity associated with the use of MDPHP. ED admissions were also more frequent in patients with addiction problems. In some cases, MDPHP intake required intensive supportive care. A multidisciplinary approach, including specialist consultation, is recommended for patients showing challenging features. Moreover, we demonstrated that the adoption of advanced analytical techniques, i.e., liquid chromatography-tandem mass spectrometry, is necessary to detect these molecules. Further studies are needed to understand MDPHP intake patterns and associated symptoms. It is essential to raise awareness in addiction treatment centers and among potential users, especially young people, and chemsex addicted.
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Affiliation(s)
- Davide Arillotta
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy
| | - Arianna Totti
- Toxicology Unit, Poison Control Center, Careggi University Hospital, Florence, Italy
| | - Alexandra Dimitrova
- FT-LAB Forensic Toxicology Laboratory, Department of Health Science, University of Florence, Florence, Italy
| | - Emma B Croce
- FT-LAB Forensic Toxicology Laboratory, Department of Health Science, University of Florence, Florence, Italy
| | - Maria Grazia Di Milia
- FT-LAB Forensic Toxicology Laboratory, Department of Health Science, University of Florence, Florence, Italy
| | - Francesco Gambassi
- Toxicology Unit, Poison Control Center, Careggi University Hospital, Florence, Italy
| | - Barbara Gualco
- Department of Health Science, University of Florence, Florence, Italy
| | | | - Guido Mannaioni
- Toxicology Unit, Poison Control Center, Careggi University Hospital, Florence, Italy
| | - Fabio Vaiano
- FT-LAB Forensic Toxicology Laboratory, Department of Health Science, University of Florence, Florence, Italy.
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Mütze U, Ottenberger A, Gleich F, Maier EM, Lindner M, Husain RA, Palm K, Beblo S, Freisinger P, Santer R, Thimm E, vom Dahl S, Weinhold N, Grohmann‐Held K, Haase C, Hennermann JB, Hörbe‐Blindt A, Kamrath C, Marquardt I, Marquardt T, Behne R, Haas D, Spiekerkoetter U, Hoffmann GF, Garbade SF, Grünert SC, Kölker S. Neurological outcome in long-chain hydroxy fatty acid oxidation disorders. Ann Clin Transl Neurol 2024; 11:883-898. [PMID: 38263760 PMCID: PMC11021608 DOI: 10.1002/acn3.52002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/04/2024] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE This study aims to elucidate the long-term benefit of newborn screening (NBS) for individuals with long-chain 3-hydroxy-acyl-CoA dehydrogenase (LCHAD) and mitochondrial trifunctional protein (MTP) deficiency, inherited metabolic diseases included in NBS programs worldwide. METHODS German national multicenter study of individuals with confirmed LCHAD/MTP deficiency identified by NBS between 1999 and 2020 or selective metabolic screening. Analyses focused on NBS results, confirmatory diagnostics, and long-term clinical outcomes. RESULTS Sixty-seven individuals with LCHAD/MTP deficiency were included in the study, thereof 54 identified by NBS. All screened individuals with LCHAD deficiency survived, but four with MTP deficiency (14.8%) died during the study period. Despite NBS and early treatment neonatal decompensations (28%), symptomatic disease course (94%), later metabolic decompensations (80%), cardiomyopathy (28%), myopathy (82%), hepatopathy (32%), retinopathy (17%), and/or neuropathy (22%) occurred. Hospitalization rates were high (up to a mean of 2.4 times/year). Disease courses in screened individuals with LCHAD and MTP deficiency were similar except for neuropathy, occurring earlier in individuals with MTP deficiency (median 3.9 vs. 11.4 years; p = 0.0447). Achievement of dietary goals decreased with age, from 75% in the first year of life to 12% at age 10, and consensus group recommendations on dietary management were often not achieved. INTERPRETATION While NBS and early treatment result in improved (neonatal) survival, they cannot reliably prevent long-term morbidity in screened individuals with LCHAD/MTP deficiency, highlighting the urgent need of better therapeutic strategies and the development of disease course-altering treatment.
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Affiliation(s)
- Ulrike Mütze
- Medical Faculty of Heidelberg, Center for Child and Adolescent Medicine, Division of Child Neurology and Metabolic MedicineHeidelberg UniversityHeidelbergGermany
| | - Alina Ottenberger
- Medical Faculty of Heidelberg, Center for Child and Adolescent Medicine, Division of Child Neurology and Metabolic MedicineHeidelberg UniversityHeidelbergGermany
| | - Florian Gleich
- Medical Faculty of Heidelberg, Center for Child and Adolescent Medicine, Division of Child Neurology and Metabolic MedicineHeidelberg UniversityHeidelbergGermany
| | - Esther M. Maier
- Dr. von Hauner Children's Hospital, Ludwig‐Maximilians‐UniversityMunichGermany
| | - Martin Lindner
- Division of Pediatric NeurologyUniversity Children's Hospital FrankfurtFrankfurtGermany
| | - Ralf A. Husain
- Center for Inborn Metabolic Disorders, Department of NeuropediatricsJena University HospitalJenaGermany
| | - Katja Palm
- Division of Endocrinology, Diabetology and Metabolic MedicineUniversity Children's HospitalMagdeburgGermany
| | - Skadi Beblo
- Department of Women and Child Health, Hospital for Children and Adolescents, Center for Pediatric Research Leipzig (CPL)University Hospitals, University of LeipzigLeipzigGermany
| | - Peter Freisinger
- Children's Hospital Reutlingen, Klinikum am SteinenbergReutlingenGermany
| | - René Santer
- University Medical Center Hamburg‐Eppendorf, University Children's HospitalHamburgGermany
| | - Eva Thimm
- Department of General Pediatrics, Neonatology, and Pediatric CardiologyUniversity Children's Hospital, Heinrich Heine University DüsseldorfDüsseldorfGermany
| | - Stephan vom Dahl
- Department of Gastroenterology, Hepatology and Infectious DiseasesUniversity Hospital, Heinrich Heine University DüsseldorfDüsseldorfGermany
| | - Natalie Weinhold
- Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Center of Chronically Sick ChildrenCharité ‐ Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - Karina Grohmann‐Held
- Department of Pediatrics and Adolescent MedicineUniversity Medicine GreifswaldGreifswaldGermany
| | - Claudia Haase
- Department of Pediatrics and Adolescent MedicineHelios Hospital ErfurtErfurtGermany
| | - Julia B. Hennermann
- Villa Metabolica, Center for Pediatric and Adolescent MedicineMainz University Medical CenterMainzGermany
| | | | - Clemens Kamrath
- Department of General Pediatrics and NeonatologyUniversity Hospital of Gießen and MarburgGießenGermany
| | - Iris Marquardt
- Department of Child NeurologyChildren's Hospital OldenburgOldenburgGermany
| | - Thorsten Marquardt
- Department of General Pediatrics, Metabolic DiseasesUniversity Children's Hospital MuensterMuensterGermany
| | - Robert Behne
- Medical Faculty of Heidelberg, Center for Child and Adolescent Medicine, Division of Child Neurology and Metabolic MedicineHeidelberg UniversityHeidelbergGermany
| | - Dorothea Haas
- Medical Faculty of Heidelberg, Center for Child and Adolescent Medicine, Division of Child Neurology and Metabolic MedicineHeidelberg UniversityHeidelbergGermany
| | - Ute Spiekerkoetter
- Department of General Pediatrics, Adolescent Medicine and NeonatologyMedical Center ‐ University of Freiburg, Faculty of MedicineFreiburgGermany
| | - Georg F. Hoffmann
- Medical Faculty of Heidelberg, Center for Child and Adolescent Medicine, Division of Child Neurology and Metabolic MedicineHeidelberg UniversityHeidelbergGermany
| | - Sven F. Garbade
- Medical Faculty of Heidelberg, Center for Child and Adolescent Medicine, Division of Child Neurology and Metabolic MedicineHeidelberg UniversityHeidelbergGermany
| | - Sarah C. Grünert
- Department of General Pediatrics, Adolescent Medicine and NeonatologyMedical Center ‐ University of Freiburg, Faculty of MedicineFreiburgGermany
| | - Stefan Kölker
- Medical Faculty of Heidelberg, Center for Child and Adolescent Medicine, Division of Child Neurology and Metabolic MedicineHeidelberg UniversityHeidelbergGermany
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Wongchaisuwat N, Gillingham MB, Yang P, Everett L, Gregor A, Harding CO, Sahel JA, Nischal KK, Scanga HL, Black D, Vockley J, Arnold G, Pennesi ME. A proposal for an updated staging system for LCHADD retinopathy. Ophthalmic Genet 2024; 45:140-146. [PMID: 38288966 PMCID: PMC11010772 DOI: 10.1080/13816810.2024.2303682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/05/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To develop an updated staging system for long-chain 3-hydroxyacyl coenzyme A dehydrogenase deficiency (LCHADD) chorioretinopathy based on contemporary multimodal imaging and electrophysiology. METHODS We evaluated forty cases of patients with genetically confirmed LCHADD or trifunctional protein deficiency (TFPD) enrolled in a prospective natural history study. Wide-field fundus photographs, fundus autofluorescence (FAF), optical coherence tomography (OCT), and full-field electroretinogram (ffERG) were reviewed and graded for severity. RESULTS Two independent experts first graded fundus photos and electrophysiology to classify the stage of chorioretinopathy based upon an existing published system. With newer imaging modalities and improved electrophysiology, many patients did not fit cleanly into a single traditional staging group. Therefore, we developed a novel staging system that better delineated the progression of LCHADD retinopathy. We maintained the four previous delineated stages but created substages A and B in stages 2 to 3 to achieve better differentiation. DISCUSSION Previous staging systems of LCHADD chorioretinopathy relied on only on the assessment of standard 30 to 45-degree fundus photographs, visual acuity, fluorescein angiography (FA), and ffERG. Advances in recordings of ffERG and multimodal imaging with wider fields of view, allow better assessment of retinal changes. Following these advanced assessments, seven patients did not fit neatly into the original classification system and were therefore recategorized under the new proposed system. CONCLUSION The new proposed staging system improves the classification of LCHADD chorioretinopathy, with the potential to lead to a deeper understanding of the disease's progression and serve as a more reliable reference point for future therapeutic research.
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Affiliation(s)
- Nida Wongchaisuwat
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA
- Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Melanie B. Gillingham
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, Oregon, USA
| | - Paul Yang
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA
| | - Lesley Everett
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, Oregon, USA
| | - Ashley Gregor
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, Oregon, USA
| | - Cary O. Harding
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, Oregon, USA
| | - Jose Alain Sahel
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ken K. Nischal
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Hannah L. Scanga
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Danielle Black
- Division of Genetic and Genomic Medicine, University of Pittsburgh Medical Center Children’s Hospital, Pittsburgh, Pennsylvania, USA
| | - Jerry Vockley
- Division of Genetic and Genomic Medicine, University of Pittsburgh Medical Center Children’s Hospital, Pittsburgh, Pennsylvania, USA
| | - Georgianne Arnold
- Division of Genetic and Genomic Medicine, University of Pittsburgh Medical Center Children’s Hospital, Pittsburgh, Pennsylvania, USA
| | - Mark E. Pennesi
- Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, Oregon, USA
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Everard E, Laeremans H, Boemer F, Marie S, Vincent MF, Dewulf JP, Debray FG, De Laet C, Nassogne MC. Impact of newborn screening for fatty acid oxidation disorders on neurological outcome: A Belgian retrospective and multicentric study. Eur J Paediatr Neurol 2024; 49:60-65. [PMID: 38377647 DOI: 10.1016/j.ejpn.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/20/2024] [Accepted: 02/06/2024] [Indexed: 02/22/2024]
Abstract
Fatty acid oxidation (FAO) disorders are autosomal recessive genetic disorders affecting either the transport or the oxidation of fatty acids. Acute symptoms arise during prolonged fasting, intercurrent infections, or intense physical activity. Metabolic crises are characterized by alteration of consciousness, hypoglycemic coma, hepatomegaly, cardiomegaly, arrhythmias, rhabdomyolysis, and can lead to death. In this retrospective and multicentric study, the data of 54 patients with FAO disorders were collected. Overall, 35 patients (64.8%) were diagnosed after newborn screening (NBS), 17 patients on clinical presentation (31.5%), and two patients after family screening (3.7%). Deficiencies identified included medium-chain acyl-CoA dehydrogenase (MCAD) deficiency (75.9%), very long-chain acyl-CoA dehydrogenase (VLCAD) deficiency (11.1%), long-chain hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency (3.7%), mitochondrial trifunctional protein (MTP) deficiency (1.8%), and carnitine palmitoyltransferase 2 (CPT 2) deficiency (7.4%). The NBS results of 25 patients were reviewed and the neurological outcome of this population was compared with that of the patients who were diagnosed on clinical presentation. This article sought to provide a comprehensive overview of how NBS implementation in Southern Belgium has dramatically improved the neurological outcome of patients with FAO disorders by preventing metabolic crises and death. Further investigations are needed to better understand the physiopathology of long-term complications in order to improve the quality of life of patients and to ensure optimal management.
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Affiliation(s)
- Emilie Everard
- Pediatric Neurology Unit, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium.
| | | | - François Boemer
- Biochemical Genetics Lab, Department of Human Genetics, CHU Sart-Tilman, University of Liège, Liège, Belgium.
| | - Sandrine Marie
- Laboratoire des Maladies Métaboliques Héréditaires/Biochimie Génétique et Centre de Dépistage Néonatal, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium.
| | - Marie-Françoise Vincent
- Laboratoire des Maladies Métaboliques Héréditaires/Biochimie Génétique et Centre de Dépistage Néonatal, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium.
| | - Joseph P Dewulf
- Laboratoire des Maladies Métaboliques Héréditaires/Biochimie Génétique et Centre de Dépistage Néonatal, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium.
| | | | - Corinne De Laet
- Nutrition and Metabolism Unit, Department of Pediatrics, University Children's Hospital Queen Fabiola, Brussels, Belgium.
| | - Marie-Cécile Nassogne
- Pediatric Neurology Unit, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
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Schwantje M, Mosegaard S, Knottnerus SJG, van Klinken JB, Wanders RJ, van Lenthe H, Hermans J, IJlst L, Denis SW, Jaspers YRJ, Fuchs SA, Houtkooper RH, Ferdinandusse S, Vaz FM. Tracer-based lipidomics enables the discovery of disease-specific candidate biomarkers in mitochondrial β-oxidation disorders. FASEB J 2024; 38:e23478. [PMID: 38372965 DOI: 10.1096/fj.202302163r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/05/2024] [Accepted: 01/26/2024] [Indexed: 02/20/2024]
Abstract
Carnitine derivatives of disease-specific acyl-CoAs are the diagnostic hallmark for long-chain fatty acid β-oxidation disorders (lcFAOD), including carnitine shuttle deficiencies, very-long-chain acyl-CoA dehydrogenase deficiency (VLCADD), long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHADD) and mitochondrial trifunctional protein deficiency (MPTD). The exact consequence of accumulating lcFAO-intermediates and their influence on cellular lipid homeostasis is, however, still unknown. To investigate the fate and cellular effects of the accumulating lcFAO-intermediates and to explore the presence of disease-specific markers, we used tracer-based lipidomics with deuterium-labeled oleic acid (D9-C18:1) in lcFAOD patient-derived fibroblasts. In line with previous studies, we observed a trend towards neutral lipid accumulation in lcFAOD. In addition, we detected a direct connection between the chain length and patterns of (un)saturation of accumulating acylcarnitines and the various enzyme deficiencies. Our results also identified two disease-specific candidate biomarkers. Lysophosphatidylcholine(14:1) (LPC(14:1)) was specifically increased in severe VLCADD compared to mild VLCADD and control samples. This was confirmed in plasma samples showing an inverse correlation with enzyme activity, which was better than the classic diagnostic marker C14:1-carnitine. The second candidate biomarker was an unknown lipid class, which we identified as S-(3-hydroxyacyl)cysteamines. We hypothesized that these were degradation products of the CoA moiety of accumulating 3-hydroxyacyl-CoAs. S-(3-hydroxyacyl)cysteamines were significantly increased in LCHADD compared to controls and other lcFAOD, including MTPD. Our findings suggest extensive alternative lipid metabolism in lcFAOD and confirm that lcFAOD accumulate neutral lipid species. In addition, we present two disease-specific candidate biomarkers for VLCADD and LCHADD, that may have significant relevance for disease diagnosis, prognosis, and monitoring.
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Affiliation(s)
- Marit Schwantje
- Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Metabolic Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Signe Mosegaard
- Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology, and Metabolism, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
- Emma Center for Personalized Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Suzan J G Knottnerus
- Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology, and Metabolism, Amsterdam, the Netherlands
| | - Jan Bert van Klinken
- Core Facility Metabolomics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Ronald J Wanders
- Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology, and Metabolism, Amsterdam, the Netherlands
| | - Henk van Lenthe
- Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jill Hermans
- Core Facility Metabolomics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Lodewijk IJlst
- Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology, and Metabolism, Amsterdam, the Netherlands
| | - Simone W Denis
- Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Yorrick R J Jaspers
- Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Core Facility Metabolomics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Sabine A Fuchs
- Department of Metabolic Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Riekelt H Houtkooper
- Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology, and Metabolism, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
- Emma Center for Personalized Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Sacha Ferdinandusse
- Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology, and Metabolism, Amsterdam, the Netherlands
| | - Frédéric M Vaz
- Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology, and Metabolism, Amsterdam, the Netherlands
- Emma Center for Personalized Medicine, Amsterdam UMC, Amsterdam, the Netherlands
- Core Facility Metabolomics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Rouyer A, Tard C, Dessein AF, Spinazzi M, Bédat-Millet AL, Dimitri-Boulos D, Nadaj-Pakleza A, Chanson JB, Nicolas G, Douillard C, Laforêt P. Long-term prognosis of fatty-acid oxidation disorders in adults: Optimism despite the limited effective therapies available. Eur J Neurol 2024; 31:e16138. [PMID: 38015438 DOI: 10.1111/ene.16138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/25/2023] [Accepted: 10/21/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Fatty-acid oxidation disorders (FAODs) are recessive genetic diseases. MATERIALS AND METHODS We report here clinical and paraclinical data from a retrospective study of 44 adults with muscular FAODs from six French reference centers for neuromuscular or metabolic diseases. RESULTS The study cohort consisted of 44 adult patients: 14 with carnitine palmitoyl transferase 2 deficiency (32%), nine with multiple acyl-CoA deficiency (20%), 13 with very long-chain acyl-CoA dehydrogenase deficiency (30%), three with long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency (7%), and five with short-chain acyl-CoA dehydrogenase deficiency (11%). Disease onset occurred during childhood in the majority of patients (59%), with a mean age at onset of 15 years (range = 0.5-35) and a mean of 12.6 years (range = 0-58) from disease onset to diagnosis. The principal symptoms were acute muscle manifestations (rhabdomyolysis, exercise intolerance, myalgia), sometimes associated with permanent muscle weakness. Episodes of rhabdomyolysis were frequent (84%), with a mean creatinine kinase level of 68,958 U/L (range = 660-300,000). General metabolic complications were observed in 58% of patients, respiratory manifestations in 18% of cases, and cardiological manifestations in 9% of cases. Fasting acylcarnitine profile was used to orient genetic explorations in 65% of cases. After a mean follow-up of 10 years, 33% of patients were asymptomatic and 56% continued to display symptoms after exercise. The frequency of rhabdomyolysis decreased after diagnosis in 64% of cases. CONCLUSION A standardized register would complete this cohort description of muscular forms of FAODs with exhaustive data, making it possible to assess the efficacy of therapeutic protocols in real-life conditions and during the long-term follow-up of patients.
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Affiliation(s)
- Alice Rouyer
- Neurology Department, Raymond Poincaré University Hospital, Assitance Publique des Hopitaux de Paris, Garches, France
| | - Céline Tard
- Neurology Department, University of Lille, Inserm, Centre Hospialo-Niversitaire Lille, U1172-LilNCog (JPARC)-Lille Neuroscience and Cognition, Nord-Est-Ile-de-France Neuromuscular Reference Center, Cognitive-Motor Unit of Expertise, Centre Hospitalo-Régional Universitaire Lille, Lille, France
| | - Anne-Frédérique Dessein
- Institute of Biochemistry, Biology, and Pathology Center, Metabolism Department and Medical Reference Center for Inherited Metabolic Diseases, Lille University Hospital, Lille, France
| | - Marco Spinazzi
- Department of Neurology, Neuromuscular Reference Center Atlantique Occitanie Caraïbe, University Hospital, Angers, France
| | | | - Dalia Dimitri-Boulos
- Internal Medicine Department, Quinze-Vingts National Ophthalmology Hospital, Paris, France
| | - Aleksandra Nadaj-Pakleza
- Department of Neurology, Reference Center for Neuromuscular Disorders Nord-Est-Ile-de-France, European Reference Network for Rare Neuromuscular Diseases, University Hospital of Strasbourg, Strasbourg, France
| | - Jean-Baptiste Chanson
- Department of Neurology, Reference Center for Neuromuscular Disorders Nord-Est-Ile-de-France, European Reference Network for Rare Neuromuscular Diseases, University Hospital of Strasbourg, Strasbourg, France
| | - Guillaume Nicolas
- Neurology Department, Raymond Poincaré University Hospital, Assitance Publique des Hopitaux de Paris, Garches, France
- Nord-Est-Ile-de-France Neuromuscular Reference Center, Fédération Hospitalo-Universitaire PHENIX, Garches, France
- U 1179 INSERM, Paris-Saclay University, Montigny-le-Bretonneux, France
| | - Claire Douillard
- Endocrinology-Diabetology-Metabolism Department and Medical Reference Center for Inherited Metabolic Diseases Jeanne de Flandre Hospital, Centre Hospitalo-Régional Universitaire Lille, Lille, France
| | - Pascal Laforêt
- Neurology Department, Raymond Poincaré University Hospital, Assitance Publique des Hopitaux de Paris, Garches, France
- Nord-Est-Ile-de-France Neuromuscular Reference Center, Fédération Hospitalo-Universitaire PHENIX, Garches, France
- U 1179 INSERM, Paris-Saclay University, Montigny-le-Bretonneux, France
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8
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Bui PH, Handoko M, Diaz-Medina G, Ng AS, Katyayan A. Propofol for Anesthesia in Pediatric Patients With Epilepsy on the Ketogenic Diet: A Single-Center Experience. Pediatr Neurol 2023; 149:63-68. [PMID: 37806040 DOI: 10.1016/j.pediatrneurol.2023.08.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Propofol use is contraindicated in patients on ketogenic diet (KD) due to higher risk of propofol infusion syndrome (PIS). This study is intended to provide a descriptive analysis of our experience with propofol bolus and short infusions for anesthetic care in patients on the KD and to evaluate if any signs of PIS were observed. METHODS All patients on the KD who underwent anesthesia with propofol between 2012 and 2022 were reviewed. Anesthetic encounters and charts were studied for type of surgical procedure; signs of PIS, including new cardiac arrhythmias, acidosis, or rhabdomyolysis in the periprocedural period; hypoglycemia; unplanned admissions within 24 hours of the procedure; if procedure was unexpectedly aborted; and increased seizure frequency within one week. RESULTS We identified 65 patients, aged from one to 20 years who underwent 165 anesthetic encounters with propofol, of which 123 were boluses and 42 were infusions. In bolus dosing, the average dose was 2.8 mg/kg (0.7 to 12.8 ± 1.8 mg/kg). Of these, four encounters developed acidosis, one developed rhabdomyolysis, and one developed increased seizures. With infusions, the average infusion rate was 9 mg/kg/hour, with mean infusion duration of 83 minutes (10 to 352 ± 75 minutes). Of these, one developed acidosis and one increased seizures. No cases of PIS were identified. None of the adverse effects were attributed to propofol. CONCLUSIONS Boluses and brief infusions of propofol for anesthetic use in patients on the KD did not cause PIS in our cohort.
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Affiliation(s)
- Paul H Bui
- Department of Anesthesiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Maureen Handoko
- Department of Pediatric Neurology and Developmental Neuroscience, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Gloria Diaz-Medina
- Department of Pediatric Neurology and Developmental Neuroscience, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Ann S Ng
- Department of Anesthesiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Akshat Katyayan
- Department of Pediatric Neurology and Developmental Neuroscience, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
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9
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de Souza A, Liew BZ. Multifocal neuropathy and Horner's syndrome due to disseminated pyomyositis in an intravenous drug user. Neurol Sci 2023; 44:4519-4524. [PMID: 37651041 PMCID: PMC10641057 DOI: 10.1007/s10072-023-07024-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/15/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND The formation of abscesses with necrosis within large, striated muscles leads to pyomyositis, a condition relatively rarely encountered outside the tropics. Intravenous drug users and other immunocompromised individuals are predisposed toward this infection, which may occur due to local or haematogenous spread of infection to skeletal muscles previously damaged by trauma, exercise, or rhabdomyolysis. METHODS We report a young male intravenous drug user with rhabdomyolysis due to use of a synthetic opioid, in whom disseminated pyomyositis was detected following evaluation for sciatic and radial neuropathies and Horner's syndrome and review available reports of peripheral nerve dysfunction in the setting of this uncommon infection. We searched online databases to identify all published reports on adult patients with pyomyositis complicated by peripheral nerve dysfunction. CONCLUSIONS Peripheral nerve dysfunction may rarely occur via local spread of infection or compression from abscesses.
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Affiliation(s)
- Aaron de Souza
- Department of Medicine, Launceston General Hospital, 274-280 Charles Street, Launceston, TAS, 7250, Australia.
- Faculty of Medicine, Launceston Clinical School, University of Tasmania, Launceston, TAS, 7250, Australia.
| | - Brian Z Liew
- Department of Medicine, Launceston General Hospital, 274-280 Charles Street, Launceston, TAS, 7250, Australia
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10
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Ahmed A, Nadeem A, Chaudhry M. Letter to the Editor "Association between admission serum phosphate and risk of acute kidney injury in critically ill patients with rhabdomyolysis: A retrospective study based on MIMIC-Ⅲ". Injury 2023; 54:111090. [PMID: 37844442 DOI: 10.1016/j.injury.2023.111090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 10/02/2023] [Indexed: 10/18/2023]
Affiliation(s)
- Abdullah Ahmed
- Department of Medicine, Allama Iqbal Medical College, Allama Shabbir Ahmad Usmani Road, 54550 Lahore, Punjab, Pakistan.
| | - Arsalan Nadeem
- Department of Medicine, Allama Iqbal Medical College, Allama Shabbir Ahmad Usmani Road, 54550 Lahore, Punjab, Pakistan
| | - Mahrukh Chaudhry
- Department of Medicine, Allama Iqbal Medical College, Allama Shabbir Ahmad Usmani Road, 54550 Lahore, Punjab, Pakistan
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11
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Yılmaz-Gümüş E, Elcioglu NH, Genç E, Arıcı Ş, Öztürk G, Yapıcı Ö, Akalın F, Öztürk-Hişmi B. Management of acute metabolic crisis in TANGO2 deficiency: a case report. J Pediatr Endocrinol Metab 2023; 36:983-987. [PMID: 37381587 DOI: 10.1515/jpem-2023-0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVES TANGO2 deficiency is a rare inborn error of metabolism, with distinct clinical features. The clinical presentations of TANGO2 deficiency are developmental delay, speech difficulties, intellectual disability, non-life-threatening paroxysmal neurologic episodes (TANGO2 spells), acute metabolic crises, cardiac crises, seizures and hypothyroidism. Patients may die in acute metabolic crises. Here we report our experience in the management of an acute metabolic crisis in TANGO2 deficiency. CASE PRESENTATION A 9-year-old patient diagnosed with TANGO2 deficiency was admitted with fever, fatigue, unable to walk. In follow up, encephalopathy, rhabdomyolysis and arrhythmia were detected. Vitamin B-complex was started. Our patient's mental status and rhabdomyolysis improved dramatically, and cardiac crises ended without Torsades de pointes, ventricular tachycardia and/or fibrillation or myocardial dysfunction. CONCLUSIONS With this report, we aimed to show the effectiveness of vitamin B-complex in the management of acute metabolic crises.
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Affiliation(s)
- Emel Yılmaz-Gümüş
- Department of Pediatrics, Division of Pediatric Metabolic Diseases, Marmara University School of Medicine, Istanbul, Türkiye
| | - Nursel H Elcioglu
- Department of Pediatrics, Division of Pediatric Genetics, Marmara University School of Medicine, Istanbul, Türkiye
- Eastern Mediterranean University School of Medicine, Famagusta, Türkiye
| | - Emine Genç
- Department of Pediatrics, Division of Pediatric Metabolic Diseases, Marmara University School of Medicine, Istanbul, Türkiye
| | - Şule Arıcı
- Department of Pediatrics, Division of Pediatric Cardiology, Marmara University School of Medicine, Istanbul, Türkiye
| | - Gülten Öztürk
- Department of Pediatrics, Division of Pediatric Neurology, Marmara University School of Medicine, Istanbul, Türkiye
| | - Özge Yapıcı
- Department of Pediatric Radiology, Marmara University School of Medicine, Istanbul, Türkiye
| | - Figen Akalın
- Department of Pediatrics, Division of Pediatric Cardiology, Marmara University School of Medicine, Istanbul, Türkiye
| | - Burcu Öztürk-Hişmi
- Department of Pediatrics, Division of Pediatric Metabolic Diseases, Marmara University School of Medicine, Istanbul, Türkiye
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12
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Peng P, Men C, Yuan H. Rhabdomyolysis following prolonged urethral reconstruction in exaggerated lithotomy position. Asian J Surg 2023; 46:4031-4032. [PMID: 37105815 DOI: 10.1016/j.asjsur.2023.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Affiliation(s)
- Peng Peng
- Department of Pathology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong Province 264000, PR China
| | - Changping Men
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong Province 264000, PR China
| | - Hejia Yuan
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong Province 264000, PR China.
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13
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Bhai SF, Vissing J. Diagnosis and management of metabolic myopathies. Muscle Nerve 2023; 68:250-256. [PMID: 37226557 DOI: 10.1002/mus.27840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/13/2023] [Accepted: 04/16/2023] [Indexed: 05/26/2023]
Abstract
Metabolic myopathies are a set of rare inborn errors of metabolism leading to disruption in energy production. Relevant to skeletal muscle, glycogen storage disease and fatty acid oxidation defects can lead to exercise intolerance, rhabdomyolysis, and weakness in children and adults, distinct from the severe forms that involve multiple-organ systems. These nonspecific, dynamic symptoms along with conditions that mimic metabolic myopathies can make diagnosis challenging. Clinicians can shorten the time to diagnosis by recognizing the typical clinical phenotypes and performing next generation sequencing. With improved access and affordability of molecular testing, clinicians need to be well-versed in resolving variants of uncertain significance relevant to metabolic myopathies. Once identified, patients can improve quality of life, safely engage in exercise, and reduce episodes of rhabdomyolysis by modifying diet and lifestyle habits.
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Affiliation(s)
- Salman F Bhai
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Neuromuscular Center, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian, Dallas, Texas, USA
| | - John Vissing
- Department of Neurology, Rigshospitalet, Copenhagen Neuromuscular Center, University of Copenhagen, Copenhagen, Denmark
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14
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Finsterer J. Does SARS-Cov-2 Trigger Rhabdomyolysis in Carnitine-Palmitoyltransferase-II Deficiency? Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2023; 44:5-6. [PMID: 37453115 DOI: 10.2478/prilozi-2023-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
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15
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Bidar F, Abrard S, Lamblin A, Rimmelé T. Hemoperfusion: Indications, Dose, Prescription. Contrib Nephrol 2023; 200:88-97. [PMID: 37263188 DOI: 10.1159/000529294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/23/2023] [Indexed: 06/03/2023]
Abstract
Recent advances in the development of sorbent materials have enabled the development of hemoperfusion (HP). However, HP dose and prescription are not standardized and there is no consensus in clinical practice guidelines. Adequate prescription and modality are of utmost importance to ensure HP effectiveness. Although the main indication of CytoSorb®, HA330/380, polymyxin B, and Seraph® is sepsis, these devices may be beneficial in many other situations such as liver failure, rhabdomyolysis, pancreatitis, cardiopulmonary bypass, extensive burns, and trauma or to ensure antiplatelet therapy drug removal. They can be applied as stand-alone therapies or combined with renal replacement therapy. The usual prescribed blood flow varies between 100 and 700 mL/min. CytoSorb® sessions usually last 24 h and may be repeated up to 7 days, whereas HA330/380, polymyxin B, and Seraph® sessions usually last between 2 and 4 h and are repeated up to 3 days. Current clinical data are lacking to establish the optimal operating conditions of HP and studies focusing on defining the optimal timing, dose, and duration of these therapies could help define future clinical applications.
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Affiliation(s)
- Frank Bidar
- Department of Anesthesiology and Critical Care Medicine, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
- EA 7426, Pathophysiology of Injury-Induced Immunosuppression, Hospices Civils de Lyon-Biomérieux-University Claude Bernard Lyon 1, Lyon, France
| | - Stanislas Abrard
- Department of Anesthesiology and Critical Care Medicine, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
- MitoVasc Institut, INSERM 1083 - CNRS 6015, University of Angers, Angers, France
| | - Antoine Lamblin
- Department of Anesthesiology and Critical Care Medicine, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | - Thomas Rimmelé
- Department of Anesthesiology and Critical Care Medicine, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
- EA 7426, Pathophysiology of Injury-Induced Immunosuppression, Hospices Civils de Lyon-Biomérieux-University Claude Bernard Lyon 1, Lyon, France
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16
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Erfanifar A, Mahjani M, Gohari S, Hassanian-Moghaddam H. Fatal overdose from injection of human growth hormone; a case report and review of the literature. BMC Endocr Disord 2022; 22:271. [PMID: 36348360 PMCID: PMC9644502 DOI: 10.1186/s12902-022-01193-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 10/29/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Human growth hormone (HGH) is a categorized as a performance-enhancing substance. HGH has been abused by athletes for doping purposes. CASE PRESENTATION We present a first lethal case of HGH acute toxicity. A young-agitated-athlete with a history of somatropin for the past 2-year, who had hallucinations referred to the emergency department reporting to have abused of 300 mg subcutaneous injections of HGH. He was tachycardic with mild hypertension. Lab data revealed hypernatremia (157 mEq/L), hyperkalemia (5.3 mEq/L), high LDH (1448 U/L), and CPK (2620 U/L), in favor of rhabdomyolysis. Routine drug screening tests were negative for all substances. He was intubated due to low O2 saturation and progressive loss of consciousness. After several episodes of hyperthermia, hypertension, and possibly pulmonary embolism, he died subsequent to somatropin overdose. CONCLUSIONS Complications of HGH misuse can be life-threatening and athletes should be warned of its deleterious effects.
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Affiliation(s)
- Azam Erfanifar
- Department of Internal Medicine, School of Medicine, Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahsa Mahjani
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Family Medicine, Alborz University of Medical Science, Alborz, Iran
| | - Sepehr Gohari
- Department of Family Medicine, Alborz University of Medical Science, Alborz, Iran
- Student Research Center, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Hossein Hassanian-Moghaddam
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Department of Clinical Toxicology, Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, South Karegar Street, Kamali St, Tehran, Iran.
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17
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Zhang Y, Huang X, Qi B, Sun C, Sun K, Liu N, Zhu L, Wei X. Ferroptosis and musculoskeletal diseases: “Iron Maiden” cell death may be a promising therapeutic target. Front Immunol 2022; 13:972753. [PMID: 36304454 PMCID: PMC9595130 DOI: 10.3389/fimmu.2022.972753] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022] Open
Abstract
Ferroptosis is a novel form of cell death precisely regulated by iron metabolism, antioxidant processes, and lipid metabolism that plays an irreplaceable role in the development of many diseases. Musculoskeletal disorders (MSKs), including osteoporosis, osteoarthritis, rheumatoid arthritis, intervertebral disc degeneration, sarcopenia, and rhabdomyolysis, have become one of the most common causes of disability and a major burden on public health and social care systems. The mechanism of ferroptosis in MSKs has recently been elucidated. In this review, we briefly introduce the ferroptosis mechanism and illustrate the pathological roles of ferroptosis in MSKs with a focus on how ferroptosis can be exploited as a promising treatment strategy. Notably, because the toxicity of compounds that inhibit or induce ferroptosis in other organs is largely unknown, ferroptosis appears to be a double-edged sword. We point out that more research is needed in the future to verify the therapeutic effects based on ferroptosis in MSKs.
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Affiliation(s)
- Yili Zhang
- School of Traditional Chinese Medicine and School of Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xinyi Huang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Baoyu Qi
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Chuanrui Sun
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Kai Sun
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ning Liu
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Liguo Zhu
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Liguo Zhu, ; Xu Wei,
| | - Xu Wei
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Liguo Zhu, ; Xu Wei,
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18
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Zhao P, Li Q, Wang S, Wang Y, Zhu J, Zhu L, Tang J, Luo Y. Quantitative Analysis of Renal Perfusion in Rhabdomyolysis-Induced Acute Kidney Injury Using Contrast-Enhanced Ultrasound: An Experimental Study. Ultrasound Med Biol 2022; 48:2110-2118. [PMID: 35914992 DOI: 10.1016/j.ultrasmedbio.2022.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 05/25/2022] [Accepted: 05/29/2022] [Indexed: 06/15/2023]
Abstract
The aim of this study was to evaluate renal perfusion changes in rats with acute kidney injury induced by rhabdomyolysis, using quantitative parameters obtained with contrast-enhanced ultrasound (CEUS). Sprague-Dawley (SD) rats were randomly divided into an experimental group (n = 40) and a control group (n = 20). Each group was further divided into four subgroups (0.5-, 6-, 24- and 72-h groups). Time-intensity curves and related quantitative parameters of the renal cortex and medulla were obtained by CEUS, and the contrast characteristics analyzed for different time points. In the experimental group, the CEUS quantitative parameters for the renal medulla of time to peak (TTP), descending time/2 (DT/2) and area under the curve (AUC) increased, whereas ascending slope (AS) and descending slope (DS) decreased. Similarly, renal cortical AS, DS and AUC in the experimental group differed significantly from those in the control group. With respect to the CEUS quantitative parameters for the renal cortex, AUC increased, and AS and DS decreased. These parameters differed significantly between the experimental and control groups. CEUS is sensitive to change in renal perfusion in rhabdomyolysis-induced acute kidney injury and, thus, has diagnostic value.
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Affiliation(s)
- Ping Zhao
- Chinese PLA Medical School, Beijing, China; Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Qiuyang Li
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Shuo Wang
- Chinese PLA Medical School, Beijing, China; Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yiru Wang
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jianing Zhu
- Chinese PLA Medical School, Beijing, China; Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Lianhua Zhu
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jie Tang
- Chinese PLA Medical School, Beijing, China; Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yukun Luo
- Chinese PLA Medical School, Beijing, China; Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China.
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19
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Schwantje M, Ebberink MS, Doolaard M, Ruiter JPN, Fuchs SA, Darin N, Hedberg‐Oldfors C, Régal L, Donker Kaat L, Huidekoper HH, Olpin S, Cole D, Moat SJ, Visser G, Ferdinandusse S. Thermo-sensitive mitochondrial trifunctional protein deficiency presenting with episodic myopathy. J Inherit Metab Dis 2022; 45:819-831. [PMID: 35403730 PMCID: PMC9542805 DOI: 10.1002/jimd.12503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/24/2022] [Accepted: 04/07/2022] [Indexed: 11/29/2022]
Abstract
Mitochondrial trifunctional protein (MTP) is involved in long-chain fatty acid β-oxidation (lcFAO). Deficiency of one or more of the enzyme activities as catalyzed by MTP causes generalized MTP deficiency (MTPD), long-chain hydroxyacyl-CoA dehydrogenase deficiency (LCHADD), or long-chain ketoacyl-CoA thiolase deficiency (LCKATD). When genetic variants result in thermo-sensitive enzymes, increased body temperature (e.g. fever) can reduce enzyme activity and be a risk factor for clinical decompensation. This is the first description of five patients with a thermo-sensitive MTP deficiency. Clinical and genetic information was obtained from clinical files. Measurement of LCHAD and LCKAT activities, lcFAO-flux studies and palmitate loading tests were performed in skin fibroblasts cultured at 37°C and 40°C. In all patients (four MTPD, one LCKATD), disease manifested during childhood (manifestation age: 2-10 years) with myopathic symptoms triggered by fever or exercise. In four patients, signs of retinopathy or neuropathy were present. Plasma long-chain acylcarnitines were normal or slightly increased. HADHB variants were identified (at age: 6-18 years) by whole exome sequencing or gene panel analyses. At 37°C, LCHAD and LCKAT activities were mildly impaired and lcFAO-fluxes were normal. Remarkably, enzyme activities and lcFAO-fluxes were markedly diminished at 40°C. Preventive (dietary) measures improved symptoms for most. In conclusion, all patients with thermo-sensitive MTP deficiency had a long diagnostic trajectory and both genetic and enzymatic testing were required for diagnosis. The frequent absence of characteristic acylcarnitine abnormalities poses a risk for a diagnostic delay. Given the positive treatment effects, upfront genetic screening may be beneficial to enhance early recognition.
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Affiliation(s)
- Marit Schwantje
- Department of Metabolic DiseasesWilhelmina Children's Hospital, University Medical Center UtrechtUtrechtThe Netherlands
- Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Merel S. Ebberink
- Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Mirjam Doolaard
- Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Jos P. N. Ruiter
- Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Sabine A. Fuchs
- Department of Metabolic DiseasesWilhelmina Children's Hospital, University Medical Center UtrechtUtrechtThe Netherlands
| | - Niklas Darin
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of Gothenburg, Sahlgrenska University HospitalGothenburgSweden
| | - Carola Hedberg‐Oldfors
- Department of Laboratory Medicine, Institute of BiomedicineUniversity of GothenburgGothenburgSweden
| | - Luc Régal
- Pediatric Neurology and Metabolism Department of PediatricsUZ BrusselJetteBelgium
| | - Laura Donker Kaat
- Department of Clinical Genetics, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Hidde H. Huidekoper
- Department of Pediatrics, Center for Lysosomal and Metabolic Diseases, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Simon Olpin
- Department of Clinical ChemistrySheffield Children's HospitalSheffieldUK
| | - Duncan Cole
- Wales Newborn Screening Laboratory, Department of Medical Biochemistry, Immunology and ToxicologyUniversity Hospital of WalesCardiffUK
- School of MedicineCardiff UniversityCardiffUK
| | - Stuart J. Moat
- Department of Clinical ChemistrySheffield Children's HospitalSheffieldUK
- Wales Newborn Screening Laboratory, Department of Medical Biochemistry, Immunology and ToxicologyUniversity Hospital of WalesCardiffUK
| | - Gepke Visser
- Department of Metabolic DiseasesWilhelmina Children's Hospital, University Medical Center UtrechtUtrechtThe Netherlands
- Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Sacha Ferdinandusse
- Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
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Lu Z, Liu G. The chronic muscle injury secondary to crayfish-related Haff disease. Acta Neurol Belg 2022; 122:785-787. [PMID: 33460004 DOI: 10.1007/s13760-021-01594-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 01/05/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Zhenchan Lu
- Department of Neurology of Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou Zhejiang, 313000, China.
| | - Gonglu Liu
- Department of Neurology and Research Center of Neurology in the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou Zhejiang, 310009, China
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Yano A, Sada KE, Sawada T, Ito H, Yano H, Ikeda T. Rhabdomyolysis with Multiple Electrolyte Imbalances under Proton Pump Inhibitor Treatment after Total Thyroidectomy. Acta Med Okayama 2022; 76:339-342. [PMID: 35790366 DOI: 10.18926/amo/63745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
A 90-year-old man presented with muscle weakness, difficulty concentrating, and dysphagia. About eighteen months prior to presentation, lansoprazole had been initiated to prevent stress ulcers; he also had a history of total thyroidectomy due to papillary thyroid cancer ten years prior. Laboratory findings were as follows: K 2.4 mEq/L, Ca 3.7 mg/dL, Mg 1.3 mg/dL, CK 5386 U/L, and intact PTH (iPTH) 14 pg/mL. Rhabdomyolysis with multiple electrolyte imbalances under proton pump inhibitor (PPI) treatment was diagnosed. We initiated intravenous hydration and electrolyte supplementation with discontinuation of PPI. After discontinuing PPI, the patient's serum magnesium, potassium, and calcium levels normalised with oral vitamin D and calcium supplementation. PPIs can cause hypocalcaemia and hypokalaemia via hypomagnesemia; hypocalcaemia is also a common postoperative complication of thyroidectomy. Careful monitoring of electrolyte levels is required in patients with long-term PPI treatment, especially in post-thyroidectomy cases.
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Affiliation(s)
- Akihiko Yano
- Department of General Medicine, Kochi Health Sciences Center
| | - Ken-Ei Sada
- Department of General Medicine, Kochi Health Sciences Center
- Department of Clinical Epidemiology, Kochi Medical School, Kochi University
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Tsutomu Sawada
- Department of General Medicine, Kochi Health Sciences Center
| | - Hideki Ito
- Department of General Medicine, Kochi Health Sciences Center
| | - Hiroko Yano
- Department of General Medicine, Kochi Health Sciences Center
| | - Tatsuya Ikeda
- Department of General Medicine, Kochi Health Sciences Center
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Liu Y, Yu M, Chen L, Liu J, Li X, Zhang C, Xiang X, Li X, Lv Q. Systemic Review of Animal Models Used in the Study of Crush Syndrome. Shock 2022; 57:469-478. [PMID: 35066515 DOI: 10.1097/shk.0000000000001911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Crush syndrome (CS), also known as traumatic rhabdomyolysis, is the leading cause of death following extrication from structural collapse due to earthquakes. Due to the unfeasibility of human studies, animal models are used to study crush syndrome pathophysiology, including biochemistry and treatment regimes. The aim of this systematic literature review was to identify the differences and benefits of various animal models used in the study of CS and provide valuable information for design of future research. A systematic search was conducted in two methods: with the filters "(crush syndrome) AND (crush muscle injury)" and with the keywords "(crush syndrome) AND (animal model)" covering all articles in the PubMed databases. The search generated 378 articles. After screening abstracts, 91 articles were retrieved and read, then 11 repeated articles were removed and 2 reference papers were included. We finally reviewed 82 original articles. There appear to be two primary methods employed for inducing crush syndrome in animal models, which are chemically induced injury and physically induced injury. Chemical method mainly includes intramuscular (IM) injection of tissue extract solution and IM injection of 50% glycerine. Physical method can be classified into invasive and non-invasive physical compression by elasticated material, inflatable band and heavy load. Various species of animals have been used to study CS, including mice (13.4%), rats (68.3%), rabbits (11.0%), canines (4.9%), goats (1.2%), and pigs (1.2%). Small animals are suitable for researches exploring the mechanism of disease or drug efficacy while large animals can work better with clinical application-related researches. In regard to the choice of modeling method, compressing the certain muscle of animals by heavy things is superior to others to cause systemic trauma-related rhabdomyolysis signs. In addition, due to the significant burden of crush injuries on animals, further attention shall be paid to the selection of the most suitable anesthetics and appropriate analgesics.
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Affiliation(s)
- Yahua Liu
- Emergency Department, Chinese PLA General Hospital (The Third Center), Beijing, China
- Beijing Key Laboratory of Disaster Rescue Medicine, Beijing, China
| | - Mengyang Yu
- General Medicine Department, Chinese PLA General Hospital (The Third Center), Beijing, China
| | - Li Chen
- General Medicine Department, Chinese PLA general Hospital (The First Center), Beijing, China
| | - Jing Liu
- Pathology Department, Chinese PLA General Hospital (The Third Center), Beijing, China
| | - Xin Li
- Emergency Department, Chinese PLA General Hospital (The Third Center), Beijing, China
| | - Chengying Zhang
- General Medicine Department, Chinese PLA General Hospital (The Third Center), Beijing, China
| | - Xueyuan Xiang
- Urology, Chinese PLA General Hospital (The Third Center), Beijing, China
| | - Xiaoxue Li
- Beijing Key Laboratory of Disaster Rescue Medicine, Beijing, China
- Chinese PLA General Hospital (Innovative Medicine Division), Beijing, China
| | - Qi Lv
- Institute of Disaster Medicine, Tianjin University, Tianjin, China
- Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin, China
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Uz I, Çetin M, Songur Kodik M, Guvenc E, Akarca FK, Ersel M. Emergency department management after the 2020 Aegean Sea - Izmir earthquake. ULUS TRAVMA ACIL CER 2022; 28:361-368. [PMID: 35485574 PMCID: PMC10493534 DOI: 10.14744/tjtes.2021.89679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/13/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND This article aims to provide an up-to-date resource on disaster management by reporting about the destructive fea-tures of the earthquake that occurred on October 30, 2020, and about the hospital and emergency service organization during a pandemic. METHODS This study was carried out with a multicentered, cross-sectional retrospective design on the victims of the 2020 Aegean Sea - Izmir earthquake. Local ethics committee approval was obtained. The data obtained by obtaining permission from two hospitals and ambulance services (transport data) located in the region where earthquake-related destruction was most prominent were evalu-ated. Patient data including demographic data, time of arrival to the emergency department, duration of stay under the debris, triage codes (green: not urgent, slightly injured; yellow: may be delayed, injured; red: critically injured; and black: dead), type of injuries, dura-tion of stay in the emergency department, crush syndrome, rhabdomyolysis, need for invasive procedures (e.g., surgery and dialysis), intensive care admission, hospital admission, and discharge were evaluated. RESULTS In total, 313 patients (60.4% females) were included in the study according to the inclusion criteria. The mean age of the participants was 38.0±21.0 years, with the youngest being a 6-month-old baby and the oldest a 91-year-old individual. Approximately 41.5% of the earthquake victims presented to the emergency department within the first 3 h of the earthquake, and patients with yellow triage code were the most common in the 1st h. Further, 35.2% of the patients who were rescued from under the debris were discharged alive. Four patients were discharged alive after being rescued from under the debris 24 h following the earthquake, of whom three were rescued after >48 h (longest duration, 91 h). Further, 32 (15.9%) patients who survived upon presentation to the emergency department had rhabdomyolysis, 4 (1.9%) underwent hemodialysis in the emergency department due to acute renal failure, and 8 (3.8%) underwent other emergency operations such as fasciotomy and amputation. In total, 122 patients died and 191 patients were discharged from the hospitals. Furthermore, 139 patients were discharged from the emergency department, 15 were admitted to the intensive care unit, 41 were hospitalized in the relevant clinics, and 112 were directly transferred to the morgue following preliminary evaluation. CONCLUSION Emergency services should be ready in terms of accurate registration, correct data entry, correct triage assignment, sufficient resources, adequate team, sufficient equipment, and adequate treatment areas for disasters such as earthquakes. Further, ade-quate disaster trainings should be provided, feasible disaster relief plans should be prepared, and regular exercises should be conducted.
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Affiliation(s)
- Ilhan Uz
- Department of Emergency Medicine, Ege University Faculty of Medicine, İzmir-Turkey
| | - Murat Çetin
- Emergency Medicine, Tınaztepe University Faculty of Medicine, İzmir-Turkey
| | - Meltem Songur Kodik
- Department of Emergency Medicine, Ege University Faculty of Medicine, İzmir-Turkey
| | | | - Funda Karbek Akarca
- Department of Emergency Medicine, Ege University Faculty of Medicine, İzmir-Turkey
| | - Murat Ersel
- Department of Emergency Medicine, Ege University Faculty of Medicine, İzmir-Turkey
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Köhler T, Schwier E, Praxenthaler J, Kirchner C, Henzler D, Eickmeyer C. Therapeutic Modulation of the Host Defense by Hemoadsorption with CytoSorb ®-Basics, Indications and Perspectives-A Scoping Review. Int J Mol Sci 2021; 22:12786. [PMID: 34884590 PMCID: PMC8657779 DOI: 10.3390/ijms222312786] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 01/08/2023] Open
Abstract
The "normal" immune response to an insult triggers a highly regulated response determined by the interaction of various immunocompetent cells with pro- and anti-inflammatory cytokines. Under pathologic conditions, the massive elevation of cytokine levels ("cytokine storm") could not be controlled until the recent development of hemoadsorption devices that are able to extract a variety of different DAMPs, PAMPs, and metabolic products from the blood. CytoSorb® has been approved for adjunctive sepsis therapy since 2011. This review aims to summarize theoretical knowledge, in vitro results, and clinical findings to provide the clinician with pragmatic guidance for daily practice. English-language and peer-reviewed literature identified by a selective literature search in PubMed and published between January 2016 and May 2021 was included. Hemoadsorption can be used successfully as adjunct to a complex therapeutic regimen for various conditions. To the contrary, this nonspecific intervention may potentially worsen patient outcomes in complex immunological processes. CytoSorb® therapy appears to be safe and useful in various diseases (e.g., rhabdomyolysis, liver failure, or intoxications) as well as in septic shock or cytokine release syndrome, although a conclusive assessment of treatment benefit is not possible and no survival benefit has yet been demonstrated in randomized controlled trials.
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Affiliation(s)
- Thomas Köhler
- Department of Anesthesiology, Surgical Intensive Care, Emergency and Pain Medicine, Ruhr University Bochum, Klinikum Herford, 32120 Herford, Germany; (E.S.); (J.P.); (D.H.); (C.E.)
| | - Elke Schwier
- Department of Anesthesiology, Surgical Intensive Care, Emergency and Pain Medicine, Ruhr University Bochum, Klinikum Herford, 32120 Herford, Germany; (E.S.); (J.P.); (D.H.); (C.E.)
| | - Janina Praxenthaler
- Department of Anesthesiology, Surgical Intensive Care, Emergency and Pain Medicine, Ruhr University Bochum, Klinikum Herford, 32120 Herford, Germany; (E.S.); (J.P.); (D.H.); (C.E.)
| | - Carmen Kirchner
- Department of General and Visceral Surgery, Thoracic Surgery and Proctology, Ruhr University Bochum, Klinikum Herford, 32120 Herford, Germany;
| | - Dietrich Henzler
- Department of Anesthesiology, Surgical Intensive Care, Emergency and Pain Medicine, Ruhr University Bochum, Klinikum Herford, 32120 Herford, Germany; (E.S.); (J.P.); (D.H.); (C.E.)
| | - Claas Eickmeyer
- Department of Anesthesiology, Surgical Intensive Care, Emergency and Pain Medicine, Ruhr University Bochum, Klinikum Herford, 32120 Herford, Germany; (E.S.); (J.P.); (D.H.); (C.E.)
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Affiliation(s)
- Marie Godet
- École régionale des infirmiers anesthésistes Poissy-Saint-Germain, UFR Simone-Veil-Santé, université de Versailles-Saint-Quentin-en-Yvelines, 2 avenue de la Source de la Bièvre , 78180 Montigny-le-Bretonneux, France.
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Maenhout TM, Vermassen T, Dalewyn L, Buyzere MLD, Delanghe JR. Exercise Induced Myoglobinuria is Determined by Haptoglobin Polymorphism. Clin Lab 2021; 67. [PMID: 33978364 DOI: 10.7754/clin.lab.2020.200855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND In professional soccer players (n = 27), confounders of quantitative myoglobinuria following physical training were assessed in order to improve interpretation of post-exercise myoglobinuria. METHODS Urine samples were collected in the morning before training sessions, 48 to 72 hours following a game. Urine myoglobin was assayed using immunoturbidimetry. Blood was drawn 48 hours following training session. Creatinine was assayed using a Jaffe method. Creatine kinase (CK) activity was assayed according to the IFCC reference method. Serum myoglobin was assayed using the same assay as the one used for urine. Hp polymorphism was assessed on hemoglobin supplemented serum. Serum Hp concentration was assayed nephelometrically. Training intensity was assessed using a wearable GPS tracking system. Physical load monitoring included the covered total distance, the distance at different speed zones, and the number of sprints/accelerations/decelerations/jumps. Multiple regression analysis was used to detect the determinants of post-exercise myoglobinuria. RESULTS Myoglobinuria negatively correlated with serum haptoglobin (Hp) concentration. Athletes presented with Hp values, which were lower than the Hp phenotype reference ranges, which can be explained by depletion of circulating Hp stores. Myoglobinuria was most pronounced in players carrying a Hp 2-2 phenotype, which is associated with the lowest Hp reference range. Myoglobin clearance was inversely correlated with Hp 2-2 concentration. Correlation between myoglobinuria and biomarkers of muscle damage was weak. Neither age nor glomerular filtration rate were found to be confounders of myoglobinuria. When comparing myoglobinuria with training intensity, the number of sprints, average acceleration speed, and maximal speed were determining factors for predicting exercise-induced myoglobinuria. CONCLUSIONS In athletes, plasma myoglobin binding capacity is depleted. Moderate myoglobinuria not only should be regarded as a muscle damage marker, but also should be interpreted as an indicator for Hp depletion. Apart from its significance as a biomarker for muscle damage and rhabdomyolysis, myoglobinuria in athletes should be a warning that the heme binding capacity of plasma Hp is depleted, indicating an exhausted defense against Fenton chemistry induced free radicals. Fenton chemistry is associated with free radical formation, which is to be avoided because of the causative relationship with inflammatory processes and tissue damage.
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Nemet D, Eliakim A. [MCARDLE'S DISEASE AND PHYSICAL ACTIVITY - A MIXED BLESSING]. Harefuah 2021; 160:377-381. [PMID: 34160155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
McArdle disease (Glycogen storage disease type V) is a myopathy caused by an inherited deficit of muscle glycogen phosphorylase (PYGM). Since glycogen is an important fuel for muscular activity, people with McArdle's disease experience exercise intolerance. Dynamic or static vigorous exercise may lead to rhabdomyolysis, myoglobinuria and renal failure. Although exercise intolerance appears early in childhood, most people with McArdle's disease are diagnosed in the second or third decade of life. People with McArdle's disease tend to avoid exercise, despite its clear beneficial effects on health. As with many chronic diseases, medically supervised exercise with proper nutrition is possible, important, and beneficial to people with McArdle's disease.
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Affiliation(s)
- Dan Nemet
- Child Health and Sports Center, Meir Medical Center
- Sackler Faculty of Medicine, Tel Aviv University
| | - Alon Eliakim
- Child Health and Sports Center, Meir Medical Center
- Sackler Faculty of Medicine, Tel Aviv University
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28
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Stokland AEM, Kloster I, Vikse BE, Skjold A, Vik R, Nedrebø BG. A woman in her fifties with abdominal pain and severe lactic acidosis. Tidsskr Nor Laegeforen 2021; 141:20-0669. [PMID: 33950649 DOI: 10.4045/tidsskr.20.0669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Pheochromocytoma is referred to as 'the great mimic' with a broad spectrum of presenting symptoms. In the following case, the diagnosis had an unusual presentation as a medical emergency - pheochromocytoma crisis. CASE PRESENTATION A previously healthy woman in her fifties was admitted due to abdominal pain and dyspnoea. At admission she was haemodynamically stable, with stable respiration, but arterial blood gas showed serious lactic acidosis with pH 6.8 (7.35-7.45), HCO3 3 mmol/l (22-26) and lactate 28 mmol/L (0.4-1.8). Her haemoglobin level was 12 g/dl (11,7-17,0). Further examination with CT and gastroscopy confirmed a duodenal bleeding. The lactic acidosis was corrected quickly, but the patient developed acute kidney injury, rhabdomyolysis and increased liver enzymes. The complex composition of organ manifestations could not be explained by the duodenal bleeding alone. An adrenal mass with high density was identified through re-evaluation of the CT scans. In the following case, a duodenal bleeding provoked catecholamine-induced haemodynamic instability and end-organ damage in a patient with an undiagnosed pheochromocytoma. INTERPRETATION Endocrine emergencies are important differential diagnoses in critically ill patients. Pheochromocytoma crisis most commonly presents as hypertensive crisis or catecholamine cardiomyopathy but can also lead to lactic acidosis and multi-organ failure.
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Shimizu M, Kaneda T, Sekino N, Nishizawa T. Kawasaki disease with acute myocarditis in an adolescent. BMJ Case Rep 2021; 14:e242283. [PMID: 33849884 PMCID: PMC8051407 DOI: 10.1136/bcr-2021-242283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2021] [Indexed: 11/04/2022] Open
Abstract
A previously healthy 16-year-old adolescent was admitted to our hospital with fever, sore throat, diarrhoea, strawberry tongue, rashes on lower extremities, and pain in the neck, abdomen and joints. He was initially diagnosed with IgA vasculitis triggered by acute pharyngitis. Despite antibiotic treatment, he gradually developed multiorgan failure and cardiac shock. Cardiac catheterisation did not show any signs of coronary artery disease. Subsequently, he developed serious rhabdomyolysis and peripheral extremity necrosis, suggesting peripheral arteritis. Although blood culture results were negative, he received endotoxin adsorption therapy, but it was ineffective. Hence, we suspected Kawasaki disease (KD). We administered high-dose intravenous immunoglobulin therapy (2 g/kg), which was effective. He gradually recovered without major complications and was given ambulatory discharge 43 days after admission. Early diagnosis and administration of intensive care in adolescents with KD with acute myocarditis are critical but challenging.
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Affiliation(s)
- Masato Shimizu
- Intensive Care Unit/Cardiology, Yokohama Minami Kyosai Hospital, Yokohama, Japan
| | - Toshio Kaneda
- Cardiology, Yokohama Minami Kyosai Hospital, Yokohama, Japan
| | - Nagaaki Sekino
- Intensive Care Unit, Yokohama Minami Kyosai Hospital, Yokohama, Japan
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30
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de Oliveira P, Cunha K, Neves P, Muniz M, Gatto G, Salgado Filho N, Guedes F, Silva G. Renal Morphology in Coronavirus Disease: A Literature Review. Medicina (Kaunas) 2021; 57:258. [PMID: 33799854 PMCID: PMC7998438 DOI: 10.3390/medicina57030258] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/05/2021] [Accepted: 03/07/2021] [Indexed: 12/28/2022]
Abstract
Renal biopsy is useful to better understand the histological pattern of a lesion (glomerular, tubulointerstitial, and vascular) and the pathogenesis that leads to kidney failure. The potential impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the kidneys is still undetermined, and a variety of lesions are seen in the kidney tissue of coronavirus disease patients. This review is based on the morphological findings of patients described in case reports and a series of published cases. A search was conducted on MEDLINE and PubMed of case reports and case series of lesions in the presence of non-critical infection by SARS-CoV-2 published until 15/09/2020. We highlight the potential of the virus directly influencing the damage or the innate and adaptive immune response activating cytokine and procoagulant cascades, in addition to the genetic component triggering glomerular diseases, mainly collapsing focal segmental glomerulosclerosis, tubulointerstitial, and even vascular diseases. Kidney lesions caused by SARS-CoV-2 are frequent and have an impact on morbidity and mortality; thus, studies are needed to assess the morphological kidney changes and their mechanisms and may help define their spectrum and immediate or long-term impact.
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Affiliation(s)
- Patrick de Oliveira
- Nephrology Service, Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, Natal 59066-230, RN, Brazil; (P.d.O.); (F.G.)
| | - Kaile Cunha
- University Hospital of Federal University of Maranhão, São Luis 65020-070, MA, Brazil; (K.C.); (M.M.); (N.S.F.)
| | - Precil Neves
- Nephrology Division, University of São Paulo Medical School, São Paulo 05403-000, SP, Brazil;
| | - Monique Muniz
- University Hospital of Federal University of Maranhão, São Luis 65020-070, MA, Brazil; (K.C.); (M.M.); (N.S.F.)
| | - Giuseppe Gatto
- Nephrology Service, University Hospital of Brasília, Brasília 70840-901, DF, Brazil;
| | - Natalino Salgado Filho
- University Hospital of Federal University of Maranhão, São Luis 65020-070, MA, Brazil; (K.C.); (M.M.); (N.S.F.)
| | - Felipe Guedes
- Nephrology Service, Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, Natal 59066-230, RN, Brazil; (P.d.O.); (F.G.)
| | - Gyl Silva
- Patology Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil
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Bindoff LA, Brown DA, Gorman GS, Karaa A, Keshavan N, Lamperti C, Mancuso M, McFarland R, Ng YS, O'Callaghan M, Pitceathly RDS, Rahman S, Russel FGM, Schirris TJJ, Varhaug KN, De Vries MC. Comment on "A severe linezolid-induced rhabdomyolysis and lactic acidosis in Leigh syndrome". J Inherit Metab Dis 2021; 44:6-7. [PMID: 33159463 DOI: 10.1002/jimd.12329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/02/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Laurence A Bindoff
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - David A Brown
- Department of Human Nutrition, Foods, and Exercise and the Virginia Tech Center for Drug Discovery, Virginia Tech, Blacksburg, Virginia, USA
| | - Gráinne S Gorman
- Wellcome Centre for Mitochondrial Research, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Amel Karaa
- Genetics Unit. Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nandaki Keshavan
- Mitochondrial Research Group, UCL Great Ormond Street Institute of Child Health, and Metabolic Unit, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Constanza Lamperti
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Michelangelo Mancuso
- Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Italy
| | - Robert McFarland
- Wellcome Centre for Mitochondrial Research, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Yi Shiau Ng
- Wellcome Centre for Mitochondrial Research, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mar O'Callaghan
- Department of Neurology, Metabolic Unit. Hospital Sant Joan de Déu, Barcelona, Spain. CIBERER, Instituto de Salud Carlos III, Barcelona, Spain
| | - Robert D S Pitceathly
- MRC Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Shamima Rahman
- Mitochondrial Research Group, UCL Great Ormond Street Institute of Child Health, and Metabolic Unit, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Frans G M Russel
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Radboud Center for Mitochondrial Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Tom J J Schirris
- Department of Pharmacology and Toxicology, Radboud Institute for Molecular Life Sciences, Radboud Center for Mitochondrial Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Kristin N Varhaug
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Maaike C De Vries
- Radboudumc Amalia Children's Hospital, Radboud Center for Mitochondrial Medicine, Radboudumc, Nijmegen, The Netherlands
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Primiano G, Servidei S. Author response: A severe linezolid-induced rhabdomyolysis and lactic acidosis in Leigh syndrome. J Inherit Metab Dis 2021; 44:8. [PMID: 33217034 DOI: 10.1002/jimd.12333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Guido Primiano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Serenella Servidei
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dipartimento Universitario di Neuroscienze, Università Cattolica del Sacro Cuore, Roma, Italia
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Ma H, Wu J, Qin W, Lin C, Li D, Zha B, Chen Q, Ma Y, Zhou T, Li S, Gong L, Ma W, Ge D, Cheng Z, Chen J, Li Q. Outbreak of Haff Disease along the Yangtze River, Anhui Province, China, 2016. Emerg Infect Dis 2020; 26:2916-2921. [PMID: 33219647 PMCID: PMC7706968 DOI: 10.3201/eid2612.191186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We investigated a large outbreak of Haff disease that occurred along the Yangtze River in Anhui Province, China, in 2016. Of the 672 cases identified during the outbreak, 83.3% (560/672) occurred in Wuhu and Ma’anshan. Patients experienced myalgia (100%) and muscle weakness (54.7%). The mean value of myoglobin was 330 + 121.2 ng/mL and of serum creatine kinase 5,439.2 + 4,765.1 U/L. Eating crayfish was the only common exposure among all cases; 96.8% (240/248) of implicated crayfish were caught on the shores of the Yangtze River or its connected ditches. Mean incubation period was 6.2 + 3.8 hours. This case–control study demonstrated that eating the liver of crayfish and eating a large quantity of crayfish were associated with an increased risk for Haff disease. The seasonal increases in crayfish population along the Yangtze River might explain the seasonal outbreaks of Haff disease.
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Sun X, Xu Q, He L, Huang T, Liu Y. [Children with parainfluenza pneumonia complicated with rhabdomyolysis syndrome and acute kidney injury: a case report and literature review]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2020; 32:861-863. [PMID: 32788024 DOI: 10.3760/cma.j.cn121430-20200324-00100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To investigate the diagnosis and treatment of children with parainfluenza pneumonia complicated with rhabdomyolysis syndrome and acute kidney injury (AKI). METHODS The clinical manifestations, laboratory and imaging examination results and diagnosis and treatment process of a child with parainfluenza pneumonia complicated with rhabdomyolysis syndrome and AKI admitted to the department of intensive medicine of the Second Affiliated Hospital of Fujian Medical University on July 14th, 2014 were retrospectively analyzed to provide experience and methods for the treatment of such patients. RESULTS The patient, a Chinese 11-year-old boy, admitted to hospital with "sore throat, fever, and double lower limb pain for 2 days". The clinical manifestations were sore throat, fever, pain in both lower extremities, fatigue, and soy sauce urine. Limb muscle tenderness, bilateral lower limb was obvious. Laboratory examination showed that blood creatine kinase (CK), MB isoenzyme of creatine kinase (CK-MB), aspartate transaminase (AST), lactate dehydrogenase (LDH), α-hydroxybutyrate dehydrogenase (HBDH) and hematuria myoglobin (Mb) were significantly elevated, and blood parainfluenza viruses (1, 2, 3 types) was positive for immunoglobulin M (IgM) antibodies. Chest X-ray shown bronchial pneumonia in the right lower lung. Pneumonia with rhabdomyolysis syndrome was considered. Anti-infection, fluid hydration, alkalized urine, diuresis and other treatment was initially prescribed. However, the condition became worse, combined with secondary epilepsy, AKI, acute heart failure, transferred to the intensive care unit (ICU). The child was put on mechanical ventilation through oral tracheal intubation, continuous hemofiltration, anti-infection and anti-virus treatment. The child's condition gradually recovered, symptoms and signs disappeared, and finally he was discharged with full recovery. CONCLUSIONS Children with parainfluenza pneumonia can induce rhabdomyolysis. If myalgia is progressively worsened and walking is difficult, we should be highly alert to the occurrence of rhabdomyolysis. And when soy sauce urine, hematuria were noticed, and blood CK, Mb increased significantly, rhabdomyolysis syndrome can be diagnosed. Once the diagnosis is established, rehydration, alkaline urine and diuresis should be carried out in a timely manner to increase myoglobin tubular excretion. Antiviral treatment can reduce the dissolution of striated muscles. If blood purification is needed, hemofiltration and/or plasma exchange can be selected.
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Affiliation(s)
- Xuri Sun
- Department of Intensive Medicine, the Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian, China. Corresponding author: Liu Yuqi,
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Babulovska A, Caparoska D, Velikj-Stefanovska V, Simonovska N, Pereska Z, Kostadinoski K, Naumoski K. CLINICAL AND BIOCHEMICAL FINDINGS OF RHABDOMYOLYSIS IN ACUTE INTOXICATIONS WITH PSYCHOACTIVE AND CHEMICAL SUBSTANCES. Georgian Med News 2020:90-96. [PMID: 32383709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The aim of the study is to identify possible differences in demographic, laboratory and clinical characteristics between patients with rhabdomyolysis due to intoxication with psychoactive and chemical substances. The study is a cross-sectional study conducted between 1 January and 30 June 2019. All the patients included during this period were treated due to intoxication (outpatient or hospitalized) at the University Clinic of Toxicology in Skopje. The patients with rhabdomyolysis were divided in two groups according to the nature of the substance used for intoxication: a) psychoactive substances and b) a chemical substance. Rhabdomyolysis was determined with a value of CPK (creatinine phosphate kinase) >250 U/L. Patients with rhabdomyolysis due to intoxication with chemical substances were significantly older than patients with rhabdomyolysis due to intoxication with psychoactive substances. There is a significant difference between the two groups of patients with rhabdomyolysis in terms of CPK, urea, hemoglobin values during the first day with regards to significantly higher values in the group where intoxication occurred with psychoactive substances. Five patients with rhabdomyolysis due to intoxication with psychoactive substances experienced muscle pain (10.9%), and one patient (3.8%) of those with rhabdomyolysis due to intoxication with chemicals, without any significant association between muscle pain and type of intoxication (Fisher exact test: p=0.3003). Muscle weakness and pigmented urine were identified consequently in six patients (13.0%) vs. five (10.9%) of patients with psychoactive intoxication and none with chemical. Rhabdomyolysis caused by psychoactive and chemical substances is associated with clinical manifestations and biochemical abnormalities. The values of CPK, myoglobin, AST, ALT, LDH, urea and creatinine were higher in favor of the group of intoxicated patients with rhabdomyolysis with psychoactive substances. The clinical symptoms of rhabdomyolysis are not present in all intoxicated patients, but are more present in the group intoxicated with psychoactive substances. Biochemical findings are crucial in establishing the diagnosis of rhabdomyolysis. Abnormalities of biochemical findings need to be identified in order to initiate appropriate treatment immediately to prevent mortality and morbidity.
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Affiliation(s)
- A Babulovska
- 1University Clinic of Toxicology, Medical Faculty, University "St. Cyril and Methodius", Republic of North Macedonia
| | - D Caparoska
- 1University Clinic of Toxicology, Medical Faculty, University "St. Cyril and Methodius", Republic of North Macedonia
| | - V Velikj-Stefanovska
- 2Institut of Epidemiology and Biostatistics, Medical Faculty, University "St. Cyril and Methodius", Republic of North Macedonia
| | - N Simonovska
- 1University Clinic of Toxicology, Medical Faculty, University "St. Cyril and Methodius", Republic of North Macedonia
| | - Z Pereska
- 1University Clinic of Toxicology, Medical Faculty, University "St. Cyril and Methodius", Republic of North Macedonia
| | - K Kostadinoski
- 1University Clinic of Toxicology, Medical Faculty, University "St. Cyril and Methodius", Republic of North Macedonia
| | - K Naumoski
- 1University Clinic of Toxicology, Medical Faculty, University "St. Cyril and Methodius", Republic of North Macedonia
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Duraisamy J, Ravichandran M. Statin Induced Rhabdomyolysis. J Assoc Physicians India 2020; 68:55. [PMID: 31979607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Abstract
Valproic acid (VPA) has been widely used more frequently as its approved indications have been expanded. More and more case reports on rare toxicities have been published in the literature (ie, hepatotoxicities, hyperammonemic encephalopathy, coagulation disorders, pancreatitis, thrombocytopenia). In spite of the long history of VPA, there is a lack of awareness of VPA toxicities among clinicians. We present two cases of a 44-year-old African American female and a 60-year-old Hispanic male taking chronic VPA therapy for psychiatric disorders admitted to the hospital with a combination of hepatotoxicities and acute kidney injury-associated rhabdomyolysis. In both cases, home VPA therapy was continued during hospitalization. Consequently, the female patient deceased and the male patient survived and discharged with continuation of his chronic VPA therapy. In cases of surviving patients, resumption of maintenance VPA upon discharge should be held and alternative therapy should be considered.
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Affiliation(s)
- Cucnhat P Walker
- College of Pharmacy, 422238Larkin University, Miami, FL, USA
- Larkin Community Hospital, South Campus, Miami, FL, USA
| | - Subrata Deb
- College of Pharmacy, 422238Larkin University, Miami, FL, USA
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Izukura R, Kandabashi T, Wakata Y, Nojiri C, Nohara Y, Yamashita T, Takada A, Park J, Uyama Y, Nakashima N. The Development of an Electronic Phenotyping Algorithm for Identifying Rhabdomyolysis Patients in the MID-NET Database. Stud Health Technol Inform 2019; 264:1498-1499. [PMID: 31438200 DOI: 10.3233/shti190503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We aimed to develop rhabdomyolysis (RB) phenotyping algorithms using machine learning techniques and to create subphenotyping algorithms to identify RB patients who lack RB diagnosis. Two pattern algorithms, one with a focus on improving predictive value and one focused on improving sensitivity, were finally created and had a high area under the curve value of 0.846. Although we were unable to create subphenotyping algorithms, an attempt to detect unknown RB patients is important for epidemiological studies.
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Affiliation(s)
- Rieko Izukura
- Medical Information Center, Kyushu University Hospital, Fukuoka, Japan
| | | | - Yoshifumi Wakata
- Hospital Information Center, Tokushima University Hospital, Tokushima, Japan
| | - Chinatsu Nojiri
- Medical Information Center, Kyushu University Hospital, Fukuoka, Japan
| | - Yasunobu Nohara
- Medical Information Center, Kyushu University Hospital, Fukuoka, Japan
| | | | - Atsushi Takada
- Medical Information Center, Kyushu University Hospital, Fukuoka, Japan
- Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Jinsang Park
- Medical Information Center, Kyushu University Hospital, Fukuoka, Japan
| | - Yoshiaki Uyama
- Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Naoki Nakashima
- Medical Information Center, Kyushu University Hospital, Fukuoka, Japan
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Affiliation(s)
- Koyuru Kurane
- Department of Pediatrics, Jichi Medical University, Japan
| | - Masahide Goto
- Department of Pediatrics, Jichi Medical University, Japan
| | - Kazumi Sano
- Department of Pharmacometrics and Pharmacokinetics, Meiji Pharmaceutical University, Japan
| | - Kumiko Noguchi
- Department of Pediatrics, Jichi Medical University, Japan
| | - Daisuke Tamura
- Department of Pediatrics, Jichi Medical University, Japan
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Fernández Torres B, Peralta Espinosa E, Park RH, Prieto Gutiérrez JM. Considerations in Postoperative Rhabdomyolysis in Prolonged Maxillofacial Surgery. J Oral Maxillofac Surg 2018; 76:1384. [PMID: 29684309 DOI: 10.1016/j.joms.2018.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 03/09/2018] [Accepted: 03/09/2018] [Indexed: 11/18/2022]
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Abstract
CASE We present 2 unique cases of exertional supraspinatus syndrome related to overexertion in 2 young men. In both cases, the diagnosis was delayed because the symptom was nonspecific shoulder pain; however, progressive pain, an elevated creatine kinase (CK) level, and either increased compartmental pressures or findings on magnetic resonance imaging eventually led to the appropriate diagnosis. CONCLUSION The terms "supraspinatus compartment syndrome" and "supraspinatus rhabdomyolysis" are inappropriately used interchangeably. We believe that both conditions are part of a spectrum of pathology called exertional supraspinatus syndrome. It is important to differentiate between these conditions because a patient with supraspinatus compartment syndrome, which is distinguished by elevated compartment pressures, requires an immediate fasciotomy.
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Krieger J, Sims D, Wolterstorff C. A Case of Rhabdomyolysis Caused by Blood Flow-Restricted Resistance Training. J Spec Oper Med 2018; 18:16-17. [PMID: 29889951 DOI: 10.55460/1yxc-izh1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/01/2018] [Indexed: 06/08/2023]
Abstract
Blood flow-restricted resistance (BFRR) training is effective as a means to improve muscle strength and size while enduring less mechanical stress. It is generally safe but can have adverse effects. We present a case of an active duty Soldier who developed rhabdomyolysis as a result of a single course of BFRR training. He was presented to the emergency department with bilateral lower extremity pain, was admitted for electrolyte monitoring and rehydration, and had an uncomplicated hospital course and full recovery. This is an increasingly common mode of rehabilitation in the military, and practitioners and providers should be aware of it and its possible adverse effects.
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Finsterer J, Zarrouk-Mahjoub S. Trifunctional Protein Deficiency Due to HADHB Mutations Is a Multisystem, β-Oxidation Disorder. Arch Iran Med 2017; 20:767-769. [PMID: 29664318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 10/18/2017] [Indexed: 06/08/2023]
Affiliation(s)
| | - Sinda Zarrouk-Mahjoub
- University of Tunis El Manar and Genomics Platform, Pasteur Institute of Tunis, Tunisia
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Preisler N, Cohen J, Vissing CR, Madsen KL, Heinicke K, Sharp LJ, Phillips L, Romain N, Park SY, Newby M, Wyrick P, Mancias P, Galbo H, Vissing J, Haller RG. Impaired glycogen breakdown and synthesis in phosphoglucomutase 1 deficiency. Mol Genet Metab 2017; 122:117-121. [PMID: 28882528 DOI: 10.1016/j.ymgme.2017.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 08/15/2017] [Accepted: 08/20/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVE We investigated metabolism and physiological responses to exercise in an 18-year-old woman with multiple congenital abnormalities and exertional muscle fatigue, tightness, and rhabdomyolysis. METHODS We studied biochemistry in muscle and fibroblasts, performed mutation analysis, assessed physiological responses to forearm and cycle-ergometer exercise combined with stable-isotope techniques and indirect calorimetry, and evaluated the effect of IV glucose infusion and oral sucrose ingestion on the exercise response. RESULTS Phosphoglucomutase type 1 (PGM1) activity in muscle and fibroblasts was severely deficient and PGM1 in muscle was undetectable by Western blot. The patient was compound heterozygous for missense (R422W) and nonsense (Q530X) mutations in PGM1. Forearm exercise elicited no increase in lactate, but an exaggerated increase in ammonia, and provoked a forearm contracture. Comparable to patients with McArdle disease, the patient developed a 'second wind' with a spontaneous fall in exercise heart rate and perceived exertion. Like in McArdle disease, this was attributable to an increase in muscle oxidative capacity. Carbohydrate oxidation was blocked during exercise, and the patient had exaggerated oxidation of fat to fuel exercise. Exercise heart rate and perceived exertion were lower after IV glucose and oral sucrose. Muscle glycogen level was low normal. CONCLUSIONS The second wind phenomenon has been considered to be pathognomonic for McArdle disease, but we demonstrate that it can also be present in PGM1 deficiency. We show that severe loss of PGM1 activity causes blocked muscle glycogenolysis that mimics McArdle disease, but may also limit glycogen synthesis, which broadens the phenotypic spectrum of this disorder.
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Affiliation(s)
- Nicolai Preisler
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Jonathan Cohen
- Center for Human Nutrition, University of Texas Southwestern Medical Center, USA.
| | - Christoffer Rasmus Vissing
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Karen Lindhardt Madsen
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Katja Heinicke
- Department of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA; Neuromuscular Center, Institute for Exercise and Environmental Medicine of Texas Health Presbyterian Hospital, Dallas, USA
| | - Lydia Jane Sharp
- Department of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA; Neuromuscular Center, Institute for Exercise and Environmental Medicine of Texas Health Presbyterian Hospital, Dallas, USA.
| | - Lauren Phillips
- Department of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA; Neuromuscular Center, Institute for Exercise and Environmental Medicine of Texas Health Presbyterian Hospital, Dallas, USA.
| | - Nadine Romain
- Neuromuscular Center, Institute for Exercise and Environmental Medicine of Texas Health Presbyterian Hospital, Dallas, USA.
| | - Sun Young Park
- Department of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA; Neuromuscular Center, Institute for Exercise and Environmental Medicine of Texas Health Presbyterian Hospital, Dallas, USA.
| | - Marta Newby
- Neuromuscular Center, Institute for Exercise and Environmental Medicine of Texas Health Presbyterian Hospital, Dallas, USA.
| | - Phil Wyrick
- Neuromuscular Center, Institute for Exercise and Environmental Medicine of Texas Health Presbyterian Hospital, Dallas, USA.
| | - Pedro Mancias
- Department of Pediatrics, Division of Child and Adolescent Neurology, UTHealth at McGovern Medical School, Houston, TX, USA.
| | - Henrik Galbo
- Department of Inflammation Research, Rigshospitalet, Copenhagen, Denmark.
| | - John Vissing
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Ronald Gerald Haller
- Department of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA; Neuromuscular Center, Institute for Exercise and Environmental Medicine of Texas Health Presbyterian Hospital, Dallas, USA; North Texas VA Health Care System, Dallas, TX, USA.
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Kanaya H, Enokida M, Tanishima S, Hayashi I, Tanida A, Nagashima H. Conservative treatment for lumbar compartment syndrome shows efficacy over 2-year follow-up: a case report and literature review. Arch Orthop Trauma Surg 2017. [PMID: 28639076 DOI: 10.1007/s00402-017-2732-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Since in all studies of conservative treatment of lumbar compartment syndrome the follow-up duration was less than 6 months, it is difficult to draw firm conclusions. PURPOSE To report a patient with lumbar paraspinal compartment syndrome who was treated conservatively over a follow-up period of 2 years. STUDY DESIGN This is a case report of a 23-year-old male college student with lumbar paraspinal compartment syndrome who was treated conservatively. METHODS We report a case of a 23-year-old male college student with lumbar paraspinal compartment syndrome who was treated conservatively. We repeatedly checked his physical examination, laboratory tests, lumbar compartment pressures, and magnetic resonance imaging, and surgical teams were readily prepared to operate should the patient's condition worsen. To prevent complications of rhabdomyolysis, hydration and alkalization were performed. We followed him up to 2 years after discharge. RESULT Although the temporal changes on MRI up to the 1-year point, the patient continued to have no symptoms. CONCLUSIONS Conservative therapy can be recommended if rhabdomyolysis is under control.
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Affiliation(s)
- Haruhisa Kanaya
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan.
| | - Makoto Enokida
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Shinji Tanishima
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Ikuta Hayashi
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Atsushi Tanida
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Hideki Nagashima
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
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Affiliation(s)
- D Alan Nelson
- Stanford University School of Medicine, Stanford, CA
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Tseng MH, Hsia SH, Chi CS, Lin JL, Lin JJ, Lin SH. Exertional rhabdomyolysis, profound lactic acidosis, and acute kidney injury in a young boy: Answers. Pediatr Nephrol 2016; 31:1607-10. [PMID: 26156707 DOI: 10.1007/s00467-015-3150-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 06/10/2015] [Accepted: 06/12/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Min-Hua Tseng
- Division of Nephrology, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, Republic of China
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Shao-Hsuan Hsia
- Division of Pediatric Critical Care and Emergency Medicine, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Ching-Shiang Chi
- Department of Pediatrics, Tungs' Taichung Metroharbor Hospital, Taichung, Taiwan, Republic of China
| | - Ju-Li Lin
- Division of Medical Genetics, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University, Taichung, Taiwan, Republic of China
| | - Jainn-Jim Lin
- Division of Pediatric Critical Care and Emergency Medicine, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Shih-Hua Lin
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China.
- Division of Nephrology, Department of Medicine, Tri-service General Hospital, No. 325 Cheng-Kung Road, Section 2, Neihu 114, Taipei, Taiwan, Republic of China.
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Lim RB. Comment on: Rhabdomyolysis after bariatric surgery: a multicenter, prospective study on incidence, risk factors, and therapeutic strategy in a cohort from South-Italy. Surg Obes Relat Dis 2016; 12:390-1. [PMID: 26968502 DOI: 10.1016/j.soard.2015.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 11/18/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Robert B Lim
- Department of Surgery, Tripler Army Medical Center, Honolulu, Hawaii
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