Rhabdomyolysis in Community Acquired Bacterial Sepsis – A Retrospective Cohort Study

BACKGROUND AND OBJECTIVES:Rhabdomyolysis is often associated with sepsis and gram positive bacterial pathogens are reported to be the most frequent cause of sepsis induced rhabdomyolysis. We report the pattern of infecting bacterial pathogens and associated causal factors in a South-Indian cohort. DESIGN, SETTING, PARTICIPANTS #ENTITYSTARTX00026; MEASUREMENTS:Retrospective cohort study of adult patients with community acquired bacterial sepsis complicated by rhabdomyolysis from March 2003--August 2008. Rhabdomyolysis was defined as serum creatine kinase >2000 IU/L. The study population was divided into group-I (sepsis with gram positive pathogens), group-II (sepsis with gram negative pathogens) and group-III (culture negative sepsis). RESULTS:103 patients (group I -15, group II- 34 and group III- 54) formed the study cohort. Mean age was 55 years and two-third had diabetes. Mean creatine kinase was 7114 IU/L and mean serum creatinine on admission was 2.4 mg/dl. Causative pathogen of sepsis was identified in 47.5%. Gram negative pathogens were more frequently (33%) associated with rhabdomyolysis than gram positive pathogens (14.5%). Lung was the commonest foci of sepsis (38.8%). 78.6% of the study population had one or more additional causal factor for rhabdomyolysis like statin intake, chronic alcoholism, hypokalemia, hypernatremia and hypophosphatemia. Mortality was 59%. CONCLUSIONS:Gram negative bacterial pathogens were more frequently associated with rhabdomyolysis than gram positive pathogens. Rhabdomyolysis in patients with sepsis is multifactorial and is associated with high mortality

The clinical features of the piriformis syndrome: a systematic review

Piriformis syndrome, sciatica caused by compression of the sciatic nerve by the piriformis muscle, has been described for over 70 years; yet, it remains controversial. The literature consists mainly of case series and narrative reviews. The objectives of the study were: first, to make the best use of existing evidence to estimate the frequencies of clinical features in patients reported to have PS; second, to identify future research questions. A systematic review was conducted of any study type that reported extractable data relevant to diagnosis. The search included all studies up to 1 March 2008 in four databases: AMED, CINAHL, Embase and Medline. Screening, data extraction and analysis were all performed independently by two reviewers. A total of 55 studies were included: 51 individual and 3 aggregated data studies, and 1 combined study. The most common features found were: buttock pain, external tenderness over the greater sciatic notch, aggravation of the pain through sitting and augmentation of the pain with manoeuvres that increase piriformis muscle tension. Future research could start with comparing the frequencies of these features in sciatica patients with and without disc herniation or spinal stenosis

Description of Immature Stages and Development Time of Paralucilia paraensis (Mello) (Diptera: Calliphoridae) Associated with the Decomposition of a Partially Submerged Swine Carcass

We report on the bionomics and morphology of the immature stages of Paralucilia paraensis (Mello) (Diptera: Calliphoridae). Observations were made on a daily basis for 10 h (from 8 a.m. to 6 p.m.) on a 45-kg pig (Sus scrofa) whose carcass had been partially submerged in a stream of water on the 21st of November 2009, in a forested area of Manaus, Amazonas, Brazil. The collected specimens were placed in plastic vials and transferred to a growth chamber maintained at room temperature. Adults of P. paraensis were collected on the carcass between the 3rd and the 18th days. A total of 13 gravid females were captured; from these, 1,240 eggs were obtained and yielded 1,030 larvae that developed into 879 adults. The average time required for hatching was 13 h. On average, the larvae reached the second instar within 13 h, third instar within 18 h, and pupae within 46 h. The pupal stage lasted 96 h. The complete development time was 216 h. This is the first report on the development time and morphology of immature stages of P. paraensis in forested areas. Therefore, these results provided information for the implementation of future forensic studies in the state of Amazonas