Tehran University Medical Journal

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Background: Acne vulgaris is a common dermatologic disease. Isotretinoin is one of the medications prescribed in severe cases of acne. Despite its high efficacy, isotretinoin use for acne is associated with some side effects. This study was done to evaluate the effects of isotretinoin on serum levels of creatine phosphokinase (CPK) and musculoskeletal symptoms in patients with acne vulgaris.

Methods: This study was done on forty 15- to 30-year-old patients with moderate to severe acne vulgaris recruited from Semnan dermatology clinics in 2010. The participants were all candidates for isotretinoin therapy. Serum CPK levels and musculoskeletal physical exam were checked before the treatment and every 2 months for 6 months. Isotretinoin was prescribed 0.5-1 mg/kg/body weight and continued throughout the study period with the same dosage.

Results: Thirty-three (82.5%) patients were female. The mean (±Standard Deviation) age of the participants was 22.3±3.4 years. The mean serum CPK levels increased significantly, (P< 0.05), 2, 4 and 6 months after the treatment, but they remained below the upper limit of normal range (45-160 IU/L), except in an 18-year old patient, which it was 162 IU/L. Moreover, they did not exhibit noticeable musculoskeletal symptoms. Musculoskeletal symptoms, such as mild myalgia, were reported in 10% of the patients but they were relieved gradually.

Conclusion: It seems that the increase in serum levels of CPK, with or without musculoskeletal symptoms, in patients who are on isotretinoin, is a benign phenomenon. Therefore, we do not recommend measurement of CPK levels in patients with mild myalgia.

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Background: Acute compartment syndrome is considered a debilitating complication of limb trauma. Early detection of this compartment syndrome helps us in the early initiation of treatment which will result in preventing its subsequent complications reported in these cases.
Methods: This research was an analytical cross-sectional study. Patients with direct trauma to extremities, who were referred to the emergency department of Valiasr and Amir Al-Momenin hospitals were studied from October 2018 to April 2019 in Arak, Iran. Patients were selected if they met all of the inclusion criteria and none of the exclusion criteria. Vital signs were measured and recorded for each patient. Also, the results of physical examination, intra-compartmental pressure measurement by a wick catheter and the level of the creatine phosphokinase were recorded. All data analyses were performed with the use of SPSS v21 software.

Results: A total number of 70 subjects were included in this study, comprising 65 males (93.1%) and 5 females (6.9%). The results showed that there is a significant relationship between intra-compartment pressure and the level of creatine phosphokinase enzyme. The higher the intracompartmental pressure, the higher the creatine phosphokinase level. Statistically significant associations were observed between intracompartmental pressure and pallor, edema, lack of limb pulse, and diastolic blood pressure. No significant relationship was found between intracompartmental pressure and limb pain, numbness, inability to move the injured limbs, and systolic blood pressure. In addition, our findings indicated that creatine phosphokinase is significantly associated with edema and lack of limb pulse. No significant relationship was found between creatine phosphokinase with pain, pallor, numbness, inability to move limbs, and systolic and diastolic blood pressure. Conclusion: The study findings suggest that measurement of intracompartmental pressure could be considered as an effective alternative approach to creatine phosphokinase levels to diagnose compartment syndrome. So, this will prevent irreparable damage to the extremities and is of great importance.