Background and objectives: Patients with ESRD have an increased incidence of coronary events with a relatively higher risk for mortality after acute myocardial infarction (AMI). We evaluated whether it is safer to delay dialysis in AMI or if delay poses separate risks.Design, setting, participants, & measurements: We conducted a retrospective review of 131 long-term hemodialysis patients who had AMI and were admitted between 1997 and 2005 at three New York City municipal hospitals. Patients were separated into three groups on the basis of time between cardiac symptoms and first dialysis (<24 h, 24 to 48 h, and >48 h).Results: A total of 17 (13%) patients died, 10 (59%) of whom had either hypotension or an arrhythmia during their first cardiac care unit dialysis. Although these groups were comparable in acuity and cardiac status, there were no findings of increased morbidity (26, 36, and 20%, respectively) or mortality (11, 18, and 13%, respectively), despite differences in the timing of each group's dialysis. We found that previous cardiac disease, predialysis K ؉ , ⌬K ؉ after dialysis, and APACHE scores were

Clozapine, an atypical antipsychotic has been associated with several side effects like sialorrhoea, sedation, tachycardia, agranulocytosis and seizure. Myotoxicity and neurotoxicity have also been reported with long-term use of clozapine. We report here a case of myotoxicity developing after acute overdose of clozapine. A 17-year-old daughter of a schizophrenic father consumed 3.9 g of clozapine in an attempted suicide. Clinical features of myotoxicity were detected on the third day, after the patient regained full consciousness. Elevated creatinine phosphokinase and muscle biopsy confirmed myositis. The patient also had tachycardia, which persisted for 10 days. This combination of myositis-induced muscle weakness and tachycardia is likely to be associated with poor outcome in clozapine overdose.

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A 24-year-old pregnant female patient presented with complains of bilateral lower limb swelling and fever for 1 month. On examination, blood pressure was 144/94 mmHg along with pitting pedal edema. She had bizarre skin lesions, aligned longitudinally and distributed over the approachable site of the body with tapering ends and in various stages of healing. Lower limbs examination also revealed similar lesions with signs of cellulitis. Her scalp had short and distorted hair suggesting pulling and plucking. These skin lesions and the denial of self-infliction by the patient made us reach the diagnosis of dermatitis artefacta with trichotillomania. Psychotherapy was advocated along with conservative management of skin lesions. The patient improved and is under our follow up.