MEDICAL: DISEASES : PHYSICAL EXERCISE AND FITNESS : CHILDREN: A Teen’s Muscle Soreness Turned Out to Be This Life-Threatening Condition

 

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MEDICAL: DISEASES :

PHYSICAL EXERCISE AND FITNESS :

CHILDREN:

A Teen’s Muscle Soreness Turned Out to Be This Life-Threatening Condition

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A Teen’s Muscle Soreness Turned Out to Be This Life-Threatening Condition

By Rachael Rettner, Senior Writer

June 4, 2018 05:22pm ET

https://www.livescience.com/62738-teen-muscle-soreness-rhabdomyolysis.html

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A Texas teen who felt extremely sore after a hard gym workout turned out to have a rare and potentially life-threatening condition called rhabdomyolysis. But how do you tell the difference between run-of-the-mill soreness and rhabdomyolysis?

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The teen, Jared Shamburger, had recently signed up for a gym membership with his family, according to local news outlet KTRK. His older brother and dad had been weightlifting for years, and Shamburger wanted to “catch up” with them. “I have to go hard fast,” Shamburger, who is 17, told KTRK.

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But after a 90-minute weightlifting session, Shamburger said he felt particularly sore. “Everything hurt. It hurt to the touch. It was swollen,” he said.

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When the teen’s soreness and swelling didn’t go away, his mom, Judy Shamburger, looked up his symptoms online, and realized her son might have rhabdomyolysis. Her suspicion was right. The teen was diagnosed with the condition, sometimes referred to as “rhabdo,” and hospitalized for five days, KTRK reported.

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Shamburger is expected to make a full recovery, KTRK reported.

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Rhabdomyolysis – Wikipedia

https://en.wikipedia.org/wiki/Rhabdomyolysis

Rhabdomyolysis is a condition in which damaged skeletal muscle breaks down rapidly.[3] Symptoms may include muscle pains, weakness, vomiting, and confusion.[3][4] There may be tea-colored urine or an irregular heartbeat.[3] Some of the muscle breakdown products, such as the protein myoglobin, are harmful to the kidneys and may lead to kidney failure.[3]

The muscle damage is most often the result of a crush injury, strenuous exercise, medications, or drug abuse.[3] Other causes include infections, electrical injury, heat stroke, prolonged immobilization, lack of blood flow to a limb, or snake bites.[3] Some people have inherited muscle conditions that increase the risk of rhabdomyolysis.[3] The diagnosis is supported by a urine test strip which is positive for “blood” but the urine contains no red blood cells when examined with a microscope.[3] Blood tests show a creatine kinase greater than 1,000 U/L, with severe disease being above 5,000 U/L.[5]

The mainstay of treatment is large quantities of intravenous fluids.[3] Other treatments may include dialysis or hemofiltration in more severe cases.[4][6] Once urine output is established sodium bicarbonate and mannitol are commonly used but they are poorly supported by the evidence.[3][4] Outcomes are generally good if treated early.[3] Complications may include high blood potassium, low blood calcium, disseminated intravascular coagulation, and compartment syndrome.[3]

Rhabdomyolysis occurs in about 26,000 people a year in the United States.[3] While the condition has been commented on throughout history, the first modern description was following an earthquake in 1908.[7] Important discoveries as to its mechanism were made during the Blitz of London in 1941.[7] It is a significant problem for those injured in earthquakes and relief efforts for such disasters often include medical teams equipped to treat survivors with rhabdomyolysis.[7]

Contents

1 Signs and symptoms
2 Causes
2.1 Genetic predisposition
3 Mechanism
4 Diagnosis
4.1 General investigations
4.2 Complications
4.3 Underlying disorders
5 Treatment
5.1 Electrolytes
5.2 Acute kidney impairment
5.3 Other complications
6 Prognosis
7 Epidemiology
8 History
9 Etymology and pronunciation
10 Other animals
11 References
12 External links

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Rhabdomyolysis

Medline Plus

https://medlineplus.gov/ency/article/000473.htm

Rhabdomyolysis
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Rhabdomyolysis is the breakdown of muscle tissue that leads to the release of muscle fiber contents into the blood. These substances are harmful to the kidney and often cause kidney damage.
Causes

When muscle is damaged, a protein called myoglobin is released into the bloodstream. It is then filtered out of the body by the kidneys. Myoglobin breaks down into substances that can damage kidney cells.

Rhabdomyolysis may be caused by injury or any other condition that damages skeletal muscle.

Problems that may lead to this disease include:

Trauma or crush injuries
Use of drugs such as cocaine, amphetamines, statins, heroin, or PCP
Genetic muscle diseases
Extremes of body temperature
Ischemia or death of muscle tissue
Low phosphate levels
Seizures or muscle tremors
Severe exertion, such as marathon running or calisthenics
Lengthy surgical procedures
Severe dehydration

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Symptoms

Symptoms may include:

Dark, red, or cola-colored urine
Decreased urine output
General weakness
Muscle stiffness or aching (myalgia)
Muscle tenderness
Weakness of the affected muscles

Other symptoms that may occur with this disease:

Fatigue
Joint pain
Seizures
Weight gain (unintentional)

Exams and Tests

A physical exam will show tender or damaged skeletal muscles.

The following tests may be done:

Creatine kinase (CK) level
Serum calcium
Serum myoglobin
Serum potassium
Urinalysis
Urine myoglobin test

This disease may also affect the results of the following tests:

CK isoenzymes
Serum creatinine
Urine creatinine

Treatment

You will need to get fluids containing bicarbonate to help prevent kidney damage. You may need to get fluids through a vein (IV). Some people may need kidney dialysis.

Your health care provider may prescribe medicines including diuretics and bicarbonate (if there is enough urine output).

Hyperkalemia and low blood calcium levels (hypocalcemia) should be treated right away. Kidney failure should also be treated.
Outlook (Prognosis)

The outcome depends on the amount of kidney damage. Acute kidney failure occurs in many people. Getting treated soon after rhabdomyolysis will reduce the risk of permanent kidney damage.

People with milder cases may return to their normal activities within a few weeks to a month. However, some people continue to have problems with fatigue and muscle pain.
Possible Complications

Complications may include:

Acute tubular necrosis
Acute renal failure
Harmful chemical imbalances in the blood
Shock (low blood pressure)

When to Contact a Medical Professional

Call your provider if you have symptoms of rhabdomyolysis.
Prevention

Rhabdomyolysis can be avoided by:

Drinking plenty of fluids after strenuous exercise.
Removing extra clothes and immersing the body in cold water in case of heat stroke.

Images

Male urinary systemMale urinary system

References

O’Connor FG, Deuster PA. Rhabdomyolysis. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 113.

Parekh R. Rhabdomyolysis. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 119.

Uduman J, Singasani R. Rhabdomyolysis. In: Ferri FF, ed. Ferri’s Clinical Advisor 2018. Philadelphia, PA: Elsevier; 2018:1122-1124.
Review Date 8/1/2017

Updated by: Walead Latif, MD, nephrologist and Clinical Associate Professor, Rutgers Medical School, Newark, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC’s accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.’s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsements of those other sites. Copyright 1997-2018, A.D.A.M., Inc. Duplication for commercial use must be authorized in writing by ADAM Health Solutions.

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Rhabdomyolysis

PUBMED Health

https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024696/

Rhabdomyolysis

Rhabdomyolysis is a condition in which damaged skeletal muscle tissue breaks down rapidly. Breakdown products of damaged muscle cells are released into the bloodstream. Some of these, such as the protein myoglobin, are harmful to the kidneys and may lead to kidney failure.

PubMed Health Glossary
(Source: Wikipedia)

About Rhabdomyolysis

Rhabdomyolysis is an extremely rare but serious side effect where muscle tissue gradually breaks down in certain muscles. This can lead to permanent paralysis, and the breakdown products can cause serious kidney damage.

In studies, rhabdomyolysis was found to occur in 1 out of 10,000 people who took statins for longer periods of time.

Signs of this side effect include muscle ache and dark-colored urine, so it is important to seek medical advice if you have these symptoms. Institute for Quality and Efficiency in Health Care (IQWiG)

ults: 1 to 20 of 60

Is continuous renal replacement therapy beneficial for people with rhabdomyolysis?

Rhabdomyolysis is a potentially life-threatening condition where damaged muscle tissue breaks down quickly, and products of damaged muscle cells are released into the bloodstream. Of these products, a protein called myoglobin is harmful to kidney health and can lead to acute kidney injury. There is some evidence to suggest that continuous renal replacement therapy (CRRT) may provide benefits for people with rhabdomyolysis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] – John Wiley & Sons, Ltd.
Version: June 15, 2014

Rhabdomyolysis in bariatric surgery: a systematic review

BACKGROUND: Rhabdomyolysis (RML) is a rare complication of bariatric surgery. A systematic review was performed to identify risk factors and patient outcomes in morbidly obese patients undergoing bariatric surgery who develop RML.

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Prevention of kidney injury following rhabdomyolysis: a systematic review

OBJECTIVE: To conduct a systematic literature review to evaluate evidence-based recommendations for the prevention of rhabdomyolysis-associated acute renal failure (ARF).

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Utility of urine myoglobin for the prediction of acute renal failure in patients with suspected rhabdomyolysis: a systematic review

This review concluded that there was inadequate evidence to evaluate use of urine myoglobin as a predictor of acute renal failure in patients with suspected rhabdomyolysis. There were limitations in the review and included studies, but the overall conclusion reflected the evidence presented.

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McArdle disease is a rare disease of muscle metabolism. Affected people cannot use a starch-like substance called glycogen which is stored in muscle and used for energy at the beginning of activity and during strenuous exercise. The effects of the condition are fatigue and cramping within a few minutes of starting an activity, which can potentially lead to acute muscle damage. After about seven or eight minutes of exercise the muscle can start to use alternative sources of energy from fats and sugars supplied from the liver and so the symptoms ease. This phenomenon is called the ‘second wind’. In healthy people, aerobic training is known to improve the ability of muscle to burn fats for energy during exercise. In theory then, aerobic training could be beneficial to people with McArdle disease, as their muscles might be trained to use fats earlier and more efficiently during exercise. The purpose of this review was to identify any randomised controlled trials of aerobic training and assess its effects in people with McArdle disease. There were no randomised controlled trials of aerobic training in people with McArdle disease. There were, however, three small uncontrolled studies (the largest included nine participants). The studies showed that it is possible for people with McArdle disease to undergo exercise training and there were no harmful effects. Whether or not training is beneficial for people with McArdle disease needs further investigation, with randomised controlled trials including larger numbers of people with the condition.

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Stroke is a major public health problem than can cause death and severe disability. A limited number of drugs are available for treating patients with stroke. Statins, a group of drugs commonly used to reduce cholesterol levels, are known to be safe and effective when given to patients with an acute heart attack. Therefore, they may also be beneficial in patients with acute stroke. We identified eight relevant trials of statins in acute stroke involving 625 participants. Unfortunately, insufficient information was available to establish whether statins are safe and beneficial for patients with acute ischemic stroke

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In the United States, coronary heart disease and cardiovascular disease account for nearly 40% of all deaths each year. Coronary heart disease continues to be the leading cause of mortality and a significant cause of morbidity among North Americans. In 2006, coronary heart disease claimed 607 000 lives, translating into about 1 out of every 5 deaths in the United States. High levels of cholesterol, or hypercholesterolemia, are an important risk factor for coronary heart disease. The 3-hydroxy-3-methylglutaryl-coenzyme (HMG-CoA) reductase inhibitors, also known as statins, are the most effective class of drugs for lowering serum low-density lipoprotein cholesterol concentrations. They are first-line agents for patients who require drug therapy to reduce serum low-density lipoprotein cholesterol concentrations. The purpose of this review is to compare the benefits and harms of different statins in adults and children with hypercholesterolemia.

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Major Trauma: Service Delivery

A trauma service provides care for people who have sustained physical injuries. These injuries are often the result of an accident but can be sustained in other circumstances. Injuries range from minor to serious life-threatening trauma. The scope of this guidance is the delivery of services for people with major trauma in the initial phase of care, exploring areas of uncertainty and variation.

NICE Guideline – National Clinical Guideline Centre (UK).
Version: February 2016
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Fractures (Non-Complex): Assessment and Management

Two of the five guidelines in the NICE trauma suite relate to fractures. These are titled non-complex and complex fractures. In broad terms, non-complex fractures are those likely to be treated at the receiving hospital, whereas complex fractures require transfer or the consideration of transfer of the injured person to a specialist.

NICE Guideline – National Clinical Guideline Centre (UK).
Version: February 2016
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Antisocial Behaviour and Conduct Disorders in Children and Young People: Recognition, Intervention and Management

Antisocial behaviour and conduct disorders are the most common reason for referral to child and adolescent mental health services and have a significant impact on the quality of life of children and young people and their parents and carers. Rates of other mental health problems (including antisocial personality disorder) are considerably increased for adults who had a conduct disorder in childhood. This new NICE guideline seeks to address these problems by offering advice on prevention strategies, as well as a range of psychosocial interventions.

NICE Clinical Guidelines – National Collaborating Centre for Mental Health (UK).
Version: 2013
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Meta-analysis of safety of the coadministration of statin with fenofibrate in patients with combined hyperlipidemia

Addition of fenofibrate to statin therapy might represent a viable treatment option for patients whose high risk for coronary heart disease is not controlled by a statin alone. However, safety of coadministration of statin with fenofibrate has been a great concern. The present study tested the safety of coadministration of statin with fenofibrate. We systematically searched the literature to identify randomized controlled trials examining safety of coadministration of statin with fenofibrate. A meta-analysis was performed to estimate safety of coadministration of statin with fenofibrate using fixed-effects models. There were 1,628 subjects in the identified 6 studies. Discontinuation attributed to any adverse events (4.5% vs 3.1%, p = 0.20), any adverse events (42% vs 41%, p = 0.82), adverse events related to study drug (10.9% vs 11.0%, p = 0.95), and serious adverse events (2.0% vs 1.5%, p = 0.71) were not significantly different in the 2 arms. Incidence of alanine aminotransferase and/or aspartate aminotransferase =3 times upper limit of normal in the combination therapy arm was significantly higher than in the statin monotherapy arm (3.1% vs 0.2%, p = 0.0009). In the 6 trials with 1,628 subjects no case of myopathy or rhabdomyolysis was reported. In conclusion, statin-fenofibrate combination therapy was tolerated as well as statin monotherapy. Physicians should consider statin-fenofibrate combination therapy to treat patients with mixed dyslipidemia.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] – Centre for Reviews and Dissemination (UK).
Version: 2012

Efficacy and safety evaluation of intensive statin therapy in older patients with coronary heart disease: a systematic review and meta-analysis

PURPOSE: To reveal and evaluate the efficacy and safety of intensive statin therapy in older patients (age = 65 years) with coronary heart disease (CHD).

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] – Centre for Reviews and Dissemination (UK).
Version: 2013

A systematic review and economic evaluation of statins for the prevention of coronary events

OBJECTIVES: To evaluate the clinical effectiveness and cost-effectiveness of statins for the primary and secondary prevention of cardiovascular events in adults with, or at risk of, coronary heart disease (CHD).

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] – Centre for Reviews and Dissemination (UK).
Version: 2007

Risks associated with statin therapy: a systematic overview of randomized clinical trials

This review evaluated the risk of adverse events among patients taking statins. The authors concluded that statin therapy in carefully selected patients is associated with low adverse event rates in clinical trials. The reliability of the results is unclear given the lack of detail about the review process and potential for bias.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] – Centre for Reviews and Dissemination (UK).
Version: 2006

Primary prevention of cardiovascular mortality and events with statin treatments: a network meta-analysis involving more than 65,000 patients

This review concluded that statin treatment used for the primary prevention of cardiovascular disease was effective in reducing cardiovascular death and other major cardiovascular events. The conduct and reporting of the review were good and the conclusions are likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] – Centre for Reviews and Dissemination (UK).
Version: 2008

Intensive statin therapy compared with moderate dosing for prevention of cardiovascular events: a meta-analysis of >40,000 patients

This review found that intensive dosing with statins for prevention of cardiovascular events was associated with significant reductions in non-fatal events. The review was well conducted and the authors’ conclusions are likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] – Centre for Reviews and Dissemination (UK).
Version: 2011

Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90 056 participants in 14 randomised trials of statins

This prospective meta-analysis of individual patient data concluded that statin therapy can safely reduce the 5-year incidence of major coronary events, coronary revascularisation and stroke by about 20% per mmol/L reduction in cholesterol, largely irrespective of lipid profile or other characteristics. The authors’ conclusions reflect the evidence presented and are likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] – Centre for Reviews and Dissemination (UK).
Version: 2005

Meta-analysis of drug-induced adverse events associated with intensive-dose statin therapy

The authors concluded that intensive-dose statin therapy significantly reduced the risk of a serious cardiovascular event but increased the risk of a statin-induced adverse event, compared with moderate dose therapy. The reliability of these conclusions is uncertain due to methodological weaknesses in the review such as failure to assess study validity or check for heterogeneity between the studies.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] – Centre for Reviews and Dissemination (UK).
Version: 2007

Efficacy and safety of statin treatment for cardiovascular disease: a network meta-analysis of 170 255 patients from 76 randomized trials

This review concluded that statin therapies offered clear benefits in reducing cardiovascular outcomes across broad populations. The review appeared generally well conducted. The authors conclusions appear likely to be reliable, although it should be borne in mind that subgroup analysis by population type was conducted only for the primary outcome of cardiovascular disease mortality.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] – Centre for Reviews and Dissemination (UK).
Version: 2011

The effect of early, intensive statin therapy on acute coronary syndrome: a meta-analysis of randomized controlled trials

This review investigated the effects of early intensive statin therapy for acute coronary syndrome. It concluded that early treatment reduces cardiovascular events with benefits observed after 6 months, but an analysis of individual patient data is needed to confirm these findings. The pooled results should be regarded with some caution because of limitations such as the variation between study results.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] – Centre for Reviews and Dissemination (UK).
Version: 2006

Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170 000 participants in 26 randomised trials

This meta-analysis of individual patient data found that reducing low-density lipoprotein cholesterol with statins reduced the annual rate of heart attack, revascularisation and stroke by about 20% for each 1mmol/litre reduction achieved. These conclusions reflected the strong evidence presented and are likely to be reliable and applicable to a wide range of patients.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] – Centre for Reviews and Dissemination (UK).
Version: 2010

Meta-analysis of cardiovascular outcomes trials comparing intensive versus moderate statin therapy

The authors concluded that intensive statin treatment offers greater benefits than standard-dose treatment, mainly for nonfatal cardiovascular events. The review appears to support the authors’ conclusions, but the poor reporting of review methods and the lack of an assessment of study quality mean that the reliability of the conclusions is uncertain.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] – Centre for Reviews and Dissemination (UK).
Version: 2006

The clinical and cost-effectiveness of intensive versus standard lipid lowering with statins in the prevention of cardiovascular events amongst patients with acute coronary syndromes: a systematic review

Early intensive lipid lowering with high-dose/potency statins for high risk acute coronary syndrome (ACS) patients significantly reduced the risk of death or major cardiovascular event in comparison with standard lipid lowering regimens. The authors’ conclusion is reasonable, but perhaps should be tempered as it was primarily based on one large trial and generalisability beyond that intervention might be premature.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] – Centre for Reviews and Dissemination (UK).
Version: 2007

Strength of evidence for perioperative use of statins to reduce cardiovascular risk: systematic review of controlled studies

This review determined the evidence on the use of statins during the peri-operative period to reduce the risk of cardiovascular events. The authors concluded that there was insufficient evidence for routine administration of statins to reduce peri-operative cardiovascular risk. Given the limitations of the evidence base, this conclusion seems reasonable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] – Centre for Reviews and Dissemination (UK).
Version: 2006

Effects of early treatment with statins on short-term clinical outcomes in acute coronary syndromes: a meta-analysis of randomized controlled trials

This review assessed the effects of starting statin therapy within 14 days of the onset of acute coronary syndrome. The authors concluded that early statin therapy does not reduce death, myocardial infarction or stroke up to 4 months, but may reduce unstable angina. This was a well-conducted and clearly reported review and the authors’ conclusions are likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] – Centre for Reviews and Dissemination (UK).
Version: 2006

Comparison of sequential rosuvastatin doses in hypercholesterolaemia: a meta-analysis of randomised controlled trials

This review provided evidence for improved efficacy, as assessed by surrogate markers, in treating patients with hypercholesterolaemia with each sequential titration of rosuvastatin and a generally consistent tolerability profile across the dose range. The authors’ conclusions reflect the evidence presented, but the lack of validity assessment and lack of reporting of some data made the reliability of the conclusions uncertain.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] – Centre for Reviews and Dissemination (UK).
Version: 2010

Systematic review: comparative effectiveness and harms of combinations of lipid-modifying agents and high-dose statin monotherapy

This review concluded that there was insufficient evidence to support the benefit for mortality, myocardial infarction, stroke, and revascularisation procedures of statin combination therapy over high-dose monotherapy in high-risk patients needing intensive lipid-lowering therapy. The authors’ conclusion reflected the evidence presented, but the reliability is potentially compromised by search restrictions and unclear quality of included studies.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] – Centre for Reviews and Dissemination (UK).
Version: 2009

Results: 10

Is continuous renal replacement therapy beneficial for people with rhabdomyolysis?

Rhabdomyolysis is a potentially life-threatening condition where damaged muscle tissue breaks down quickly, and products of damaged muscle cells are released into the bloodstream. Of these products, a protein called myoglobin is harmful to kidney health and can lead to acute kidney injury. There is some evidence to suggest that continuous renal replacement therapy (CRRT) may provide benefits for people with rhabdomyolysis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] – John Wiley & Sons, Ltd.
Version: June 15, 2014

When is it worth taking statins to lower high cholesterol?

High cholesterol levels could mean an increased risk of cardiovascular disease. Certain medications called statins lower the amount of cholesterol in the blood. They can prevent related medical conditions and increase life expectancy. Whether or not it’s worth taking them will depend on what other risk factors you have, though. If the risk of cardiovascular disease can’t be reduced enough through general measures, treatment with medication can be considered. Whether treatment with medication is a good idea will mostly depend on individual risk factors and how you yourself view the pros and cons of the treatment. The main factor is whether you have already had cardiovascular disease, such as coronary artery disease. That may greatly increase the risk of a heart attack or stroke. This risk can be reduced using medication. When deciding whether or not to have a certain treatment, it can help to find out about the advantages and disadvantages of the treatment. Various groups of drugs can be used for the treatment of high cholesterol. But only one group of drugs, known as statins, has been well studied in people who have never had a heart attack, stroke or other type of cardiovascular disease. Many different statins have been approved in Germany, including atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin and simvastatin.

Informed Health Online [Internet] – Institute for Quality and Efficiency in Health Care (IQWiG).
Version: September 7, 2017

Medication for the long-term treatment of coronary artery disease

The long-term treatment of coronary artery disease (CAD) mainly involves taking medication. Various medications can relieve the symptoms and lower the risk of complications. In order to prevent the development of related medical conditions, all people who have coronary artery disease (CAD) are advised to take two types of medication: Antiplatelets to prevent blood clots, and statins to protect the blood vessels. Beta blockers are sometimes taken too, to reduce the heart’s workload, particularly in people who have heart failure or high blood pressure. Good-quality studies have proven that these medications can lower the risk of complications such as heart attacks or strokes. People who have certain other medical conditions too may take other medications such as ACE inhibitors. But even the very best treatment with medications will offer only limited protection from heart disease. All medications can have side effects. Yet it is often possible to avoid them by adjusting the dose or by choosing a different medication in the same group of drugs. The side effects often go away after a while too, once the body has got used to the medication. The risk of side effects may increase when two or more medications are taken together, because they may interact. It is therefore important to tell your doctor what medication you are already taking. Generally speaking, the more risk factors someone has, the more likely it is that he or she will benefit from medication. The important thing is to continue to take your medication and to take it regularly its protective effect lasts only as long as it is taken.

Informed Health Online [Internet] – Institute for Quality and Efficiency in Health Care (IQWiG).
Version: July 27, 2017

Aerobic training for McArdle disease

McArdle disease is a rare disease of muscle metabolism. Affected people cannot use a starch-like substance called glycogen which is stored in muscle and used for energy at the beginning of activity and during strenuous exercise. The effects of the condition are fatigue and cramping within a few minutes of starting an activity, which can potentially lead to acute muscle damage. After about seven or eight minutes of exercise the muscle can start to use alternative sources of energy from fats and sugars supplied from the liver and so the symptoms ease. This phenomenon is called the ‘second wind’. In healthy people, aerobic training is known to improve the ability of muscle to burn fats for energy during exercise. In theory then, aerobic training could be beneficial to people with McArdle disease, as their muscles might be trained to use fats earlier and more efficiently during exercise. The purpose of this review was to identify any randomised controlled trials of aerobic training and assess its effects in people with McArdle disease. There were no randomised controlled trials of aerobic training in people with McArdle disease. There were, however, three small uncontrolled studies (the largest included nine participants). The studies showed that it is possible for people with McArdle disease to undergo exercise training and there were no harmful effects. Whether or not training is beneficial for people with McArdle disease needs further investigation, with randomised controlled trials including larger numbers of people with the condition.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] – John Wiley & Sons, Ltd.
Version: December 7, 2011

Statins for acute ischemic stroke

Stroke is a major public health problem than can cause death and severe disability. A limited number of drugs are available for treating patients with stroke. Statins, a group of drugs commonly used to reduce cholesterol levels, are known to be safe and effective when given to patients with an acute heart attack. Therefore, they may also be beneficial in patients with acute stroke. We identified eight relevant trials of statins in acute stroke involving 625 participants. Unfortunately, insufficient information was available to establish whether statins are safe and beneficial for patients with acute ischemic stroke

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] – John Wiley & Sons, Ltd.
Version: August 10, 2011

Single-dose oral celecoxib for postoperative pain

Acute pain is often felt soon after injury. Most people who have surgery have moderate or severe pain afterwards. People with pain are used to test pain killers. They have often had wisdom teeth removed. The pain is often treated with pain killers given by mouth. Results can then be applied to other forms of acute pain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] – John Wiley & Sons, Ltd.
Version: October 22, 2013

Lipid-lowering agents for nephrotic syndrome

Nephrotic syndrome is a relatively rare disease in which the kidneys leak protein into the urine. A common early sign is swelling in the feet and face. Other signs and symptoms of nephrotic syndrome include low levels of protein in the blood, and high levels of fats in the blood, particularly cholesterol and triglycerides.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] – John Wiley & Sons, Ltd.
Version: December 10, 2013

Drug and nutritional treatment for McArdle disease

We reviewed the evidence about the effects of drug and nutritional treatment for McArdle disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] – John Wiley & Sons, Ltd.
Version: November 12, 2014

Statins can help reduce risk of death in people with chronic kidney disease who do not need dialysis

Adults with chronic kidney disease (CKD) have high risks of developing complications from heart disease. It is thought that statin treatment lowers cholesterol and reduces risk of death and complications from heart disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] – John Wiley & Sons, Ltd.
Version: May 31, 2014

Comparing Statins and Combination Drugs

How do statins and combination drugs compare in lowering “bad” cholesterol (LDL-c)?

PubMed Clinical Q&A [Internet] – National Center for Biotechnology Information (US).
Version: November 1, 2010

https://www.ncbi.nlm.nih.gov/pubmedhealth/c/pmh_cons/?term=rhabdomyolysis

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What’s to know about rhabdomyolysis?

Last reviewed Wed 5 July 2017

By Jennifer Huizen

Medical News Today

https://www.medicalnewstoday.com/articles/318224.php

Article Contents

What is rhabdomyolysis?

Causes

Symptoms

Diagnosis

Treatment

Preventing rhabdomyolysis

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Rhabdomyolysis

Updated: Nov 10, 2017

Author

Eyal Muscal, MD, MS Assistant Professor, Section of Pediatric Immunology, Allergy, and Rheumatology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital

Eyal Muscal, MD, MS is a member of the following medical societies: Alpha Omega Alpha, American College of Rheumatology

Disclosure: Nothing to disclose.
Coauthor(s)

Marietta Morales De Guzman, MD Associate Professor, Section of Immunology, Allergy and Rheumatology, Department of Pediatrics, Baylor College of Medicine; Clinic Chief, Pediatric Rheumatology Center, Texas Children’s Hospital

Marietta Morales De Guzman, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Rheumatology, Texas Pediatric Society

Disclosure: Nothing to disclose.
Chief Editor

Lawrence K Jung, MD Chief, Division of Pediatric Rheumatology, Children’s National Medical Center

Medscape

https://emedicine.medscape.com/article/1007814-overview

In most cases, the history reflects the inciting cause (though in some, it is nonspecific and thus diagnostically unreliable). Possible causes include the following:

Alcohol use and resultant unresponsiveness

Illicit drug use

Use of prescribed medications

Heatstroke

Infection

Trauma

Metabolic disorders

Inflammatory myopathies

Initial physical findings may be nonspecific. The following may be noted:

Muscular pain and tenderness

Decreased muscle strength

Soft tissue swelling

Skin changes consistent with pressure necrosis

Hyperthermia, hypothermia, and electrical injuries

Crush injuries or deformities in long bones

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Rhabdomyolysis and Acute Kidney Injury | NEJM

https://www.nejm.org/doi/full/10.1056/nejmra0801327

by X Bosch – ?2009 – ?Cited by 847 –
May 18, 2011 – Review Article from The New England Journal of Medicine Rhabdomyolysis and Acute Kidney Injury.

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Rhabdomyolysis – Mayo Clinic – YouTube
Video for rhabdomyolysis
? 2:25

https://www.youtube.com/watch?v=Hy0uEPo8-7w

Jun 22, 2011 – Uploaded by Mayo Clinic
Earlier this year, thirteen football players from the University of Iowa were hospitalized with Rhabdomyolysis …

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Sincerely,
David Dillard
Temple University
(215) 204 – 4584
jwne@…

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MEDICAL: DISEASES : PHYSICAL EXERCISE AND FITNESS : CHILDREN: A Teen’s Muscle Soreness Turned Out to Be This Life-Threatening Condition

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