A Child with Benign Acute Childhood Myositis After Influenza

Background: Benign acute childhood myositis (BACM) is a rare transient muscle syndrome classically occurring in children after a viral upper respiratory infection (URI). BACM causes difficulty walking due to severe bilateral calf pain. The incidence of this well-described phenomenon is uncertain but infrequent, and it is typically appreciated during times of large influenza outbreaks and epidemics. The URI symptoms that precede BACM are consistent with an uncomplicated viral influenza infection and include fever, malaise, cough, sore throat, headache, and rhinitis. Objectives: Little is written in the Emergency Medicine literature regarding this clinical entity. In this report, a brief review of BACM from the current literature is provided, as well as tools to aid in differentiating it from more severe but similar disorders such as rhabdomyolysis and Guillain-Barré syndrome. Case Report: We present a case of BACM in a 7-year-old boy who presented to the emergency department after a resolving URI with the acute onset of calf pain causing alarming difficulty in his ability to walk. His presentation was typical for BACM and his condition improved with supportive treatment. Conclusions: Although quite alarming and potentially puzzling to the physician who is not familiar with BACM, this syndrome is self limited and spontaneously resolves with no specific intervention. Recognition of this rare but distinct clinical entity by the emergency physician can spare a patient from potentially unneeded invasive testing and hospital admission.     

Metabolic fate of fatty acids in type II cells isolated from adult rat lung

The present study is concerned with the metabolic fate of palmitate, oleate and linoleate in isolated rat lung type II cells. The cells readily oxidize the exogenously supplied fatty acids to CO₂ and incorporate them into lipids. The distribution between the pathways of oxidation and esterification is similar for saturated and unsaturated fatty acids. The majority of the fatty acids taken up by the cells is utilized for lipid synthesis. The fatty acids are incorporated preferentially into phospholipids, particularly into phosphatidylcholine. Addition of unsaturated fatty acids decreases the utilization of palmitate by type II cells. The distribution of palmitate between oxidation and esterification is not altered in the presence of unsaturated fatty acids. Addition of carnitine stimulates the fatty acid oxidation and decreases the esterification of fatty acids.     

Chronic hepatitis C infection in patients with end stage renal disease: characterization of liver histology and viral load in patients awaiting renal transplantation

OBJECTIVES: Hepatitis C virus (HCV) is common in patients with end stage renal disease (ESRD) awaiting renal transplantation (RT). However, few data are available on the liver histology and viral titer in these patients relative to patients with HCV and normal renal function. The aims of this study were to assess liver histology, quantitative HCV-RNA titer, and alanine aminotransferase (ALT) levels in patients with ESRD awaiting RT, and to identify clinical predictors of histological progression to advanced bridging fibrosis and/or cirrhosis. METHODS: A total of 50 consecutive patients (mean age 42 yr, 62% male) with ESRD and HCV, who were awaiting RT, underwent liver biopsy. Two HCV populations, one with persistently normal ALT and another with elevated ALT, both with normal renal function, served as controls. HCV-RNA titer was assessed by quantitative PCR. RESULTS: Of the patients with ESRD, 94% had normal ALT. Log HCV RNA titer was significantly higher in patients with ESRD (5.8+/-0.3) than in either normal ALT (5.4+/-0.1) or elevated ALT (5.3+/-0.1) controls (p < 0.05). Knodell Histological Activity Index (HAI) in patients with ESRD was similar to that observed in control patients with normal ALT (4.8+/-0.4 vs 4.9+/-0.4) but significantly less (p < 0.05) than that observed in control patients with elevated ALT (8.4+/-0.5). The percentage of patients with bridging fibrosis or cirrhosis was similar in patients with ESRD and controls with persistently normal ALT (22% vs 13%) but significantly less (p < 0.001) than that observed in control patients with elevated ALT (48%). No significant differences in ALT, HCV-RNA titer, duration on hemodialysis, or time from first possible exposure was observed between ESRD patients with advance fibrosis (n = 11) and those with mild disease (n = 39). CONCLUSIONS: Our data suggest that liver biopsy is necessary to exclude significant liver pathology in patients with HCV and ESRD, and to help define those patients in whom interferon treatment might be helpful.     

Adjunctive corticosteroids for <Emphasis Type="Italic">Pneumocystis jiroveci</Emphasis> pneumonia in patients with HIV infection: a meta-analysis of randomised controlled trials

Background  

The objective of this study was to review the effects of adjunctive corticosteroids on overall mortality and the need for mechanical ventilation in HIV-infected patients with Pneumocystis jiroveci pneumonia (PCP) and substantial hypoxemia (arterial oxygen partial pressure <70 mmHg or alveolar-arterial gradient >35 mmHg on room air).