We report a case of risperidone induced pedal oedema in a 16-year-old boy with severe learning disability, autism, epilepsy and challenging behaviour. When he was referred to our clinic for the management of his challenging behaviour he was on a daily dose of sodium valproate 1600 mg and carbamazepine 400 mg for his epilepsy and on melatonin 5 mg for his sleep disturbance.As his challenging behaviour was related to his autism, we started him on a low dose of risperidone and titrated the dose to 2 mg daily. His behaviour improved significantly and after 4 months of stable behaviour we gradually withdrew the risperidone. However, soon after its withdrawal, his behaviour and sleep worsened again, following which risperidone was reinstated to 2 mg per day. But within a few weeks he seemed to have developed bilateral ankle oedema. The oedema was minimal in the morning but became significant by the end of the day.On examination, there was mild non-pitting oedema in the right ankle but no oedema in the left ankle. He did not have associated medical conditions like cardiac failure, renal disease, hepatic dysfunction or thyroid disorder. Physical examination and blood investigations (urea and electrolytes, liver function tests, thyroid function tests, FBC) were normal. The oedema fully resolved 2 weeks after the risperidone was reduced to 1 mg per day. Fortunately his behaviour did not deteriorate.Oedema was recently included as a side-effect of risperidone in the British National Formulary (2002). There have been a number of case autism
BACKGROUND Psychiatric disorders in pemphigus vulgaris may occur due to long term course, impact of body image, unlikelihood of complete recovery and frequent recurrences. These are the major predisposing factors towards depression and anxiety. Although, investigators have evaluated psychiatric aspects of the patients suffering from skin diseases, there are rare studies in India concerning mental health in pemphigus patients. Aim-The aim and objectives of the study is to estimate the prevalence of depression and anxiety in patients with pemphigus vulgaris, to assess the socio demographic profile and quality of life. MATERIALS AND METHODS Between august 2017 and September 2017, a cross sectional study of 105 patients diagnosed as pemphigus vulgaris attending pemphigus clinic of dermatology department, Rajiv Gandhi Government General Hospital, Chennai were assessed using semi structured proforma and following questionnaires GHQ-12, HAMA, HAMD, DLQI. RESULTS 105 patients were evaluated; 55% presented depression (58/120; 46 women and 12 men); 45 patients (43%) with mild depression, 13 patients (12%) with moderate depression. Duration of illness and social support presented statistical significance (P = 0.039) and (P <0.001) respectively. 32% presented anxiety (34/105; 25 women and 9 men); 32 patients (30%) with mild anxiety, 2 patients (2%) with moderate anxiety. Social support showed statistical significance (P<0.001). In DLQI, 32 patients had no effect, 24 patients (23%) had small effect, 33 patients (31%) had moderate effect, 16 patients (15%) had very large effect. QOL was significantly impaired, particularly with poor social support (P<0.001), low education (P=0.010), duration of illness (P = 0.003) and number of episodes (P = 0.017). CONCLUSIONS Prevalence of depression and anxiety were higher in patients with pemphigus vulgaris and depression was found to be higher among females and anxiety was higher among male patients. Also increased duration of illness, increased number of episodes, site of lesion especially at genitals and whole body showed increased prevalence of depression and anxiety and affected their quality of life. They are at need of mental health professionals help and should be screened for depression and anxiety.
Primary nocturnal enuresis is a rare condition. Literature review revealed that 1% of boys still bed wet at 17 years of age. There is a paucity of literature on the incidence and prevalence of bed wetting in patients above 17 years of age. We therefore present a case of 18-year-old boy having bed wetting since childhood.
Dilated cardiomyopathy (DCM) is one of the commonly acquired myocardial disease of dogs which most often is accompanied by electrocardiographic abnormalities. The present study was aimed to identify the electrocardiographic (ECG) abnormalities that were present in DCM affected dogs as well as their management. A total of 52 dogs with DCM were evaluated electrocardiographically using RMS Vesta 301i as per standard procedure. Pre-therapeutic electrocardiographic evaluation revealed normal sinus rhythm in 15 cases (28.84%), sinus tachycardia in 18 cases (34.61%), atrial fibrillation in 8 cases (15.38%), ST coving in 6 cases (11.53%), reduced ‘R’ amplitude in 5 cases (9.6%), junctional premature complexes in 2 cases (3.84%), ventricular premature complex in 2 (3.84%), atrial flutter in 1 case (1.92%) and isorhythmic atrioventricular disassociation in 1 case (1.92%). All the cases were treated for DCM using standard protocol. Atrial fibrillation and flutter were treated with Diltiazem @ 1-1.5 mg/kg three times a day and Digoxin @ 0.003 mg/kg twice a day orally and ventricular premature complex was treated with Sotalol @ 1-2 mg/kg two times a day orally. Six cases of atrial fibrillation was presented for follow-up and all achieved effective control of heart rate i.e., rate control and two of them reverted to normal sinus rhythm i.e., rhythm control, one to atrial flutter and three persisted with atrial fibrillation. VPC’s in both the dogs were successfully controlled by 15th day of therapy.
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