Conclusion:Consistent clinical features of iliac stress fractures appear to be pain over the iliac bone that may also be noted over the lateral hip or gluteal region, tenderness along the affected area, and elicitation of pain with flexion of the affected hip. MRI of the pelvis will demonstrate the stress fracture whereas plain radiography is typically negative. A period of relative rest for approximately one month followed by a gradual return to play management strategy has allowed previously affected patients to resume their activity successfully. A 61-year-old woman presented to the emergency room with first time onset of bilateral lower extremity weakness. Her only medical history was hypertension, asthma, and recently evaluated chronic back pain. Her medications were lisinopril and HCTZ, the latter of which she had not taken in two months. Physical examination was significant for proximal muscle strength of 2/5 in the shoulders and hip flexors, and 3/5 in all other distal muscle groups, with otherwise normal neurologic exam. Early labwork showed a potassium of 1.8, whereby she was given 50mEq of IV potassium, 320mEq of oral potassium, and lisinopril 40mg. Despite repeat potassium repletions, the patient continued to have K values of 1.8, 2.1, 2.2, and the patient further reported drinking and voiding frequently and severe pain in her legs, which was not responsive to gabapentin or opioids. She began to complain of pain in her legs, and was found to have a CK of 15,212, upon which a high rate of maintenance fluids was started. CK value climbed to 61,546, and urine was positive for myoglobin (332). CBC was unremarkable, CRP was not elevated at 0.5, and other routine tests for causes of muscle injury, ANA, SSA antibody, RF, TSH, Utox were all negative. Setting: Inpatient hospital. Results or Clinical Course: With appropriate fluid replacement and potassium repletion continued over a week, the patient's potassium and CK values normalized and weakness and pain improved. Discussion: The patient had no history of trauma, cocaine, burn, or prolonged immobility, which are typical risk factors for rhabdomyolysis. Furthermore, her case was associated with hypokalemia rather than hyperkalemia. An accepted, but unusual cause of rhabdomyolysis is severe hypokalemia.The mechanism of this disease occurs by the effect of extracellular potassium on blood vessels-which causes vasodilatation during muscle activity. This vasodilation normally increases the regional blood flow. Hypokalemia, however, causes relative ischemia in the active muscle leading to muscle cramps, and if severe, muscle necrosis and rhabdomyolysis. Conclusion: Severe hypokalemia is an important cause of muscle weakness and rhabdomyolysis that must be corrected aggressively.
Background<br />Exercise has been known to have beneficial effects on human health. The kidneys play an important role in regulating acid-base and water-electrolyte balance disturbances induced by exercise. The objective of this study was to investigate the effect of short term aerobic exercise (volleyball training) on the kidney function of apparently healthy individuals. <br /><br />Methods<br />An experimental study of pre-post test design was conducted involving 41 amateur volleyball players, comprising 22 males and 19 females. They were randomly divided into seven different teams. Each team trained for at least 45 minutes for four consecutive days for two weeks. Both pre-and post-exercise blood pressure (BP) was measured using an automatic blood pressure measuring device OMRON 907 (OMRON, Hoofddorp, Netherlands). Likewise, both pre- and post-exercise blood samples were collected into lithium heparin tubes and centrifuged at 3000 rpm for 10 minutes and the plasma separated into plain tubes. Electrolytes were analysed using ion selective electrode machine (SFRI 4000, Germany), urea using modified Berthelot method, creatinine using Jaffe-Slot method and uric acid using the uricase method and estimated glomerular filtration state (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) formula. <br /><br />Results<br />The mean levels of pre- and post-exercise systolic blood pressure, creatinine, urea, sodium, potassium, chloride, bicarbonate and eGFR did not differ significantly (p>0.05). However, serum uric acid was significantly increased (p<0.05), while diastolic BP significantly decreased after exercise (p<0.05).<br /><br />Conclusion<br />The study showed that short-term moderate intensity aerobic exercise does not have any significant effect on the renal functions.
Background: Lower extremity peripheral artery disease [LEAD] is common among patients with Diabetes mellitus (DM) and is under-diagnosed and under-treated. Early diagnosis and treatment will prevent associated cardiovascular events, minimize long term disability and improve quality of life. There is paucity of data on LEAD in Owerri and Southeastern Nigeria in general. Study Objectives: To determine the prevalence and predictors of LEAD among adults with type 2 diabetes mellitus (T2DM). Study Design: Cross-sectional analytical. Study Site: Endocrinology Clinic, Federal Medical Centre, Owerri, Nigeria. Methodology: Two hundred and seventy (270) T2DM patients and 135 non-diabetic controls were recruited consecutively between January and June, 2016. Questionnaires were used to collect relevant information, followed by focused physical examination and anthropometry. A portable Ankle Brachial Index (ABI) kit was used for measurement of ABI and participants with values < 0.9 were diagnosed as having LEAD. For participants with ABI ≥ 1.3, a toe pressure kit was used to measure their toe systolic pressure and those with toe brachial index (TBI) ≤ 0.7 were diagnosed as having LEAD. Fasting blood samples were also collected for assessment of glycated haemoglobin (HbA1c), fasting plasma glucose (FPG) and lipid profile. Data analysis was performed with SPSS version 22 and p-value < 0.05 was considered significant. Results: The mean ages of the T2DM and control participants were 59.8 ± 10.7 and 59.6 ± 12.3 years respectively (P = 0.89) while their mean ABIs were 0.97 ± 0.18 and 0.99 ± 0.16 respectively (P = 0.26). The prevalence of LEAD was 31.1% and 27.4% among T2DM and control participants respectively (P = 0.44) while among the T2DM participants that had LEAD, 57 (67.8%), 26 (31.0%) and 1 (1.2%) had mild, moderate and severe LEAD respectively. The only predictor of LEAD among T2DM participants was absent/reduced dorsalis pedis artery pulsation (AOR = 3.57, CI = 1.13 – 11.29, P = 0.03). Conclusions and Recommendations: There is a high prevalence of LEAD among adults with T2DM but this is not significantly higher than the prevalence among non-diabetic individuals. Regular screening of T2DM patients for LEAD should be encouraged. There is also need for regular palpation of dorsalis pedis artery among adults with T2DM to identify those with absent or reduced pulsation which may be an indication of the presence of LEAD.
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