Effect of Vitamin D Analogue on Rosuvastatin-Induced Myopathy in Wistar Rats.

OBJECTIVES: Statin-induced myopathy is one of the major causes of poor adherence and discontinuation of this medication. There are contrary results regarding association of vitamin D insufficiency with statin-induced myopathy. This study was done to determine the effect of the vitamin D3 analogue alfacalcidol on Rosuvastatin-induced myopathy in rats. Methodology. Animals were divided into six groups with 6 rats in each group. Groups I and II acted as controls, Group III and Group IV were administered Rosuvastatin 120 mg/kg/day and 160 mg/kg/day, Groups V and VI were administered alfacalcidol 0.1 µg/kg/day in addition to Rosuvastatin 120 mg/kg/day and 160 mg/kg/day, respectively. All drugs were administered orally for 15 days. Plasma creatine kinase (CK) levels were estimated on day 10 and day 15. Animals were sacrificed and muscles were sent for histopathological examination. RESULTS: On day 10, Groups V and VI showed a statistically significant increase in plasma CK levels as compared to the control (p < 0.001) and were significantly lower (p < 0.001) as compared to Groups III and IV, respectively. However, on day 15, plasma CK levels in Groups V and VI were comparable to those of control groups with a nonsignificant difference (p > 0.05). On comparing the histology, Groups V and VI showed a significant difference as compared to statin-only groups (Groups III and IV) as there were signs of regeneration, less splitting, and fragmentation of muscle fibres. CONCLUSION: The present study shows that the vitamin D analogue alfacalcidol prevents statin-induced myopathy. The serum CK levels are comparable to the control group on day 15 of vitamin D administration.

A Case of Hyper Sexuality Probably Associated with Clozapine.

Introduction: Schizophrenia treatment needs to cover several psychological interventions and pharmacological treatment for stabilizing the disease course and decreasing relapses. Sexual side effects are a major hindrance to patients and lead to decreased adherence to therapy and reduced quality of life. Recently, several studies outlined that sexual dysfunction is one of the most distressing side effects of antipsychotics and a major cause of a poor quality of life. We hereby report a case of hypersexuality probably associated with clozapine in a middle-aged woman with schizoaffective disorder. Case Report: 45-year-old female diagnosed as a case of schizoaffective disorder, was initiated on quetiapine 150 mg, risperidone 4 mg, lithium 900 mg for her psychotic and maniac symptoms, and lorazepam 2 mg for insomnia. Due to non-compliance and relapse of symptoms, she was started on clozapine 450 mg which was further increased to 650 mg along with an injectable antipsychotic zuclopenthixol 400 mg. After 3 months of treatment with an increased dose of clozapine, patient exhibited unprovoked and increased sexual urges towards male relatives, exhibitionism and an increased libido compared to normal days. A complete physical examination ruled out any extrapyramidal signs. Clozapine was tapered to 400 mg and stopped. Upon cessation of clozapine, her symptoms of hypersexuality gradually reduced. Conclusions: Clozapine's dopaminergic agonistic effects at the mesolimbic circuit may be responsible for this hypersexuality phenomenon. Poor understanding of the condition by the patient could lead to marital discord and suffering. WHO scale indicates clozapine as the probable cause of sexual dysfunction in our patient.

Addison's Disease Mimicking as Acute Pancreatitis: A Case Report.

Over past two decades there has been significant improvement in medical field in elucidating the underlying pathophysiology and genetics of Addison's disease. Adrenal insufficiency (Addison's disease) is a rare disease with an incidence of 0.8/100,000 cases. The diagnosis may be delayed if the clinical presentation mimics a gastrointestinal disorder or psychiatric illness. We report a case of Addison's disease presenting as acute pain in abdomen mimicking clinical presentation of acute pancreatitis.

Risperidone Induced Granulomatous Mastitis Secondary to Hyperprolactinemia in a Non-Pregnant Woman-A Rare Case Report in a Bipolar Disorder.

Idiopathic granulomatous lesion is a rare entity of the breast seen in young-middle aged women. Diagnosis and management of granulomatous lesions with known aetiology does not impose major clinical problems. However, most often these lesions are undetected or unnoticed due to lack of timely diagnosis and inappropriate management, as primarily it is idiopathic. Hyperprolactinemia have been proposed as one of the mechanisms underlying the development of granulomatous lesions of the breast. We report a case of hyperprolactinemia due to risperidone therapy for bipolar mood disorder in a woman who eventually developed granulomatous mastitis. Histologically, the diagnosis was confirmed by the presence of granulomatous lesion and by ruling out other potential causes. In this case, raised prolactin was possibly an important factor which was secondary to risperidone therapy. However, idiopathic granulomatous mastitis could not be completely ruled out.