Desvenlafaxine-Triggered Acneiform Eruptions on the Hand: A Compelling Case Report.

A 45-year-old male developed a skin eruption after starting Desvenlafaxine for depressive symptoms associated with schizophreniform disorder. The patient developed a rash on the hand, hyperpigmentation, and itching, which resolved after discontinuing the medication. The Naranjo score suggested a probable link between desvenlafaxine and the skin reaction. Stable vital signs and normal labs supported this conclusion. The case underscores the importance of recognizing and reporting adverse drug reactions, even with generally safe medications like desvenlafaxine. Further research with larger samples is needed to explore this relationship in more depth.

Exploring Esketamine's Therapeutic Outcomes as an FDA-Designated Breakthrough for Treatment-Resistant Depression and Major Depressive Disorder With Suicidal Intent: A Narrative Review.

The expansive spectrum of major depressive disorder (MDD) continues to pose challenges for psychiatrists to treat effectively. Oral antidepressant (OAD) medications that alter monoamine neurotransmitters, mainly selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs), have been the mainstay of therapy for decades. Although these drugs have been largely beneficial, a considerable subset of patients do not respond adequately to multiple conventional therapies administered for an appropriate length of time, leading to a diagnosis of treatment-resistant depression (TRD). Ketamine, a non-monoaminergic drug, has long been known for its beneficial effects on TRD when given intravenously (IV). Between 2019 and 2020, an intranasal formulation of the S (+) enantiomer of racemic ketamine, esketamine (ESK), was granted "breakthrough designation" by the FDA and approved for the indications of TRD and MDD patients exhibiting acute suicidal intent. The objective of this narrative review was to review the academic literature and collect clinical evidence that may corroborate intranasal ESK's effectiveness for its approved indications while addressing its safety and tolerability profile, adverse effects, and impact on cognition. An overview of the drug's origins, pharmacology, and standard treatment regimen are provided. The outcomes from double-blinded randomized control trials (DB-RCTs) of ESK are outlined to demonstrate the efficacy and safety data leading to its FDA approval, along with its long-term post-market safety outcomes. Comparative trials between ESK and ketamine are then evaluated to highlight ESK's consideration as a more practical alternative to ketamine in common clinical practice. The authors further discuss currently approved and developing therapies for TRD, propose future research directions, and identify the inherent limitations of the review and further research. To conduct the research required, three digital databases (PubMed, Medline, and ClinicalTrials.gov) were queried to search for key terms, including ketamine, esketamine, treatment-resistant depression, and biomarkers, using automation tools along with selective search engine results. After streamlining the results by title and abstract and removing duplicates, a total of 37 results were chosen, of which 18 are clinical trials. A reduction in the Montgomery-Asberg Depression Rating Scale (MADRS) score was the primary efficacy endpoint for most of these clinical trials. In conclusion, intranasal ESK, when used as an adjunct to market OADs, shows greater efficacy in treating TRD and MDD with suicidal intent compared to OADs and placebo alone and provides a more suitable alternative to IV ketamine. It is important to note that further research is required to fully understand the novel mechanism of action of ESK, as well as the establishment of a consensus definition of TRD, which may facilitate better detection and treatment protocols. More focused quantitative and qualitative ESK studies are needed, as well as those pertaining to its use in patients with co-existing mental illnesses.

Acute Psychosis and Mania: An Uncommon Complication of Dengue Fever.

Dengue fever is primarily known as a mosquito-borne viral infection that causes a range of physical symptoms, ranging from myalgia to bleeding tendencies. However, there is growing recognition of its potential to trigger psychiatric manifestations, although such cases remain relatively rare. We report a case of acute dengue fever in a 25-year-old male who developed mania and psychotic symptoms after one week of infection. A comprehensive diagnostic workup, including laboratory tests, including cerebrospinal fluid analysis, and neuroimaging, confirmed the absence of organic causes for his psychiatric symptoms, except for his prior exposure to the dengue virus. The patient was initiated on mood stabilizers and antipsychotic medications, leading to a gradual improvement in his mental health.

Factors in the Development of Somatoform Disorders Among Children: A Case-Control Study.

Introduction Somatoform disorders (SFDs) are a spectrum of diseases mainly manifesting with physical symptoms of no recognizable etiology. These disorders are believed to be primarily influenced and exacerbated by psychological factors. Given the connection between parental sociodemographics and psychological factors and SFDs, there is a pressing need to investigate this area further, particularly concerning parents and their children affected by somatoform disorders. Aims and objectives The aims and objectives of this study are as follows: i) study the determinants of SFDs, namely, parent handling of child, parent-child relationship, parenting with respect to attending to the needs of children, and intelligence quotient (IQ) of parents, and ii) compare host factors to the factors matched in control subjects. Materials and methods We adopted purposive sampling in our case-control study. The study sample was obtained from the psychiatry department of the Ganesh Shankar Vidyarthi Memorial (GSVM) Medical College, Kanpur, India, from September 2020 to December 2022, once a week, every Monday. Children manifesting SFD manifestations that are among the chief complaints were included in our study. Results A total of 115 cases were included in our study based on inclusion criteria. The study compared sociodemographic characteristics, intelligence quotient (IQ), parental characteristics, parental handling, parent-child relationships, and parenting practices between a patient group and a control group. The results showed no significant differences in sex, religion, occupation, domicile, and socioeconomic status in both control and patient groups. However, significant differences were found in parental characteristics, such as lower mean age, education, and IQ, in the patient group. This difference between the patient and control groups with respect to the parental handling questionnaire was statistically significant for the domain of "praise," "talk," "feel better," "comes to you," "unduly strict" items, "frequently reprimanded," "tried to control everything," creative activities, protectiveness, education, neglecting, objective punishment, housing, medical care, demanding, symbolic reward, loving, objective reward, food, parent-to-child communication, clothing, support, routine, recreation, social activities, rules, managing problem behavior, guidance for career, and security. Conclusion Parents were deficient in terms of years of education, occupational status, IQ, parental handling, parent-child relationship, and parenting with respect to the children's needs. These findings offer insights into the sociodemographic and psychological factors contributing to the patient group's condition.

Late-Onset Hypokalemic Periodic Paralysis in an Adult Female With Type 2 Renal Tubular Acidosis: A Case Report.

Proximal renal tubular acidosis (type 2 RTA) is a metabolic disorder characterized by an inability of the proximal renal tubules to reabsorb bicarbonate, resulting in excessive urinary loss of bicarbonate. In return, this causes a standard anion gap metabolic acidosis with aberrant renal acidification, culminating in excessive urinary potassium loss and hyperchloremic metabolic acidosis. Several sources can induce potassium deficiency, ranging from slight abnormalities in potassium homeostasis to catastrophic and occasionally lethal circumstances. Hypokalemic periodic paralysis (HPP) manifests with broad muscle weakness and the absence of deep tendon reflexes, with the facial, bulbar, and respiratory muscles spared, and it subsequently requires the administration of intravenous potassium chloride to address the potassium imbalance. Some patients suffering from chronic potassium shortage may have periods of weakness. The clinical symptoms of distal RTA are identical to those of attacks induced by familial hypokalemic periodic paralysis (FPP). Muscle weakness may begin slowly and worsen over 24-48 hours to flaccid quadriplegia. RTA and FPP typically spare speech, swallowing, and ocular and respiratory muscles. As a result, families with RTA children must be aware of this risk. We present a case of HPP in a female caused by type 2 RTA.

A Rare Presentation of Shared Phenomenon in Dissociative Disorders in Extreme of Ages: A Report of Two Cases.

Conversion disorders (CD) are changes in sensorimotor activity experienced by an individual due to an external event. Patients may experience "pseudoseizures" accompanied by the presence or absence of loss of consciousness. Disorders of movement and sensation is the term used to classify the various kinds of CDs in the International Classification of Diseases, Tenth Revision (ICD-10) diagnostic manual, and they are the rarest among all dissociative disorders. We will discuss two instances that are particularly rare. The first includes an older couple, starting with the wife, who had nervousness, heightened worry, intrusive thoughts, heavy perspiration, palpitations, headaches, and problems sleeping. She was prescribed 10 mg once-daily escitalopram. She stopped taking her medication and had facial and hand problems. The patient's 65-year-old husband started having strange hand and face movements and lost consciousness. The pair was hospitalized willingly and had radiographic (MRI and non-contrast computerized tomography {NCCT} head), nerve conduction, and neurological tests to rule out a movement issue. No inquiry or inspections uncovered anything unusual. The second case involves a mother and her 13-year-old son, who was taken to a psychiatric unit after urinating on a religious shrine. His mother had the same issue and couldn't urinate for days. Both patients were given 25 mg of paroxetine and benzodiazepines for anxiety and sleeplessness. After a week of medicine and psychotherapy after identifying stressors, both cases improved.

A Rare Case of Extrahepatic Portal Venous Obstruction in a Nine-Year-Old Female and Its Management: A Case Report.

Extrahepatic portal vein obstruction (EHPVO) is a kind of liver vascular disease that causes structural abnormalities in the portal veins, including cavernomatous metamorphosis and obstruction. It is the most common cause of esophageal varices-related hematemesis in youngsters. Significant risk factors include congenital abnormalities, dehydration, sepsis, trauma, hypercoagulable conditions, and multiple transfusions. Acute extrahepatic portal vein blockage is often ignored because patients are usually asymptomatic. Subacute and chronic stages can cause symptoms including splenomegaly and hematemesis without hepatic decompensation. Imaging studies aid in the diagnosis; Doppler imaging is added to ultrasonography to visualize portal vein blood flow. MRI and CT scans are used to visualize portal vein blockage. Prevention of acute bleeding is the cornerstone in the management. Studies have shown that transhepatic thrombolysis is the preferred choice to avoid systemic side effects. Transjugular intrahepatic portosystemic shunt (TIPS) treats extrahepatic portal venous thrombosis and is typically followed by conservative variceal hemorrhage treatment. Liver transplantation is performed when other management measures fail. Here, we present a rare case of EHPVO in a nine-year-old female who was lost to follow-up for a long time and later showed signs of portal biliopathy and non-visualization of a surgically created splenorenal shunt. Re-shunting was performed after detailed conservative management, and the patient responded well to the treatment given.

A Comprehensive Review of the Management of Acute Respiratory Distress Syndrome.

Acute respiratory distress syndrome (ARDS) is an inflammatory process in the lungs that induces non-hydrostatic protein-rich pulmonary edema. ARDS occurs in roughly half of coronavirus disease 2019 (COVID-19) pneumonia patients, with most of them requiring intensive care. Oxygen saturation, partial pressure of the oxygen, and the fraction of the inspired oxygen are health indicators that may indicate a severe illness necessitating further investigation. As treatments have evolved, a typical pattern of ARDS has likewise evolved. In cases where mechanical ventilation is required, the use of low tidal volumes (<6 ml/kg ideal body weight) and airway pressures (plateau pressure <30 cmH2O) was recommended. For patients with moderate/severe ARDS (partial pressure to fractional inspired oxygen ratio <20), prone positioning was recommended for at least 16 hours per day. By contrast, high-frequency oscillation was not recommended. The use of inhaled vasodilators was recommended in patients with persistent hypoxemia despite invasive ventilation and prone position until extracorporeal membrane oxygenation (ECMO). The use of a conservative fluid management strategy was suggested for all patients. Mechanical ventilation with high positive end-expiratory pressure (PEEP) was suggested for patients with ARDS with a ratio of arterial oxygen partial pressure to fractional inspired oxygen (PF) ratios. ECMO was suggested as an adjunct to protective mechanical ventilation for patients with severe ARDS. In the absence of adequate evidence, research recommendations were made for corticosteroids and extracorporeal carbon dioxide removal. While decades of research have been conducted, treatment options for underlying pathologies remain limited, and mechanical ventilation, which removes carbon dioxide from the body, remains essential to achieving better clinical outcomes. This review aims to identify the best ARDS treatments that are currently available.