Corpus overview


MeSH Disease

Human Phenotype


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    Clozapine. Pharmacodynamic Mechanisms, Potential Pharmacogenetic Biomarkers, and Risks in Schizophrenia HP Schizophrenia MESHD. Particularities in the Context of Covid-19. An Updated Overview

    Authors: Ana Miruna Dragoi; Ioana Radulescu; Anca Lucia Pop; Bogdana Adriana Năsui; Valentin Varlas; Simona Trifu

    id:202009.0724/v1 Date: 2020-09-30 Source:

    Background: Clozapine use is precarious due to its side effects - neurological, cardiovascular, and hematological; however, it is the gold standard in the therapy of resistant schizophrenia HP schizophrenia MESHD (TRS) in adults TRANS and harshly underused. Objective: Our purpose is to systematically examine the most recent data regarding clozapine in order to update the knowledge in pharmacological mechanisms, therapy benefits versus side effects to optimize its use in the context of a narrow and scarce of resources pathology, with particularities in the COVID-19 pandemic. (2) Data sources: We performed an accurate search in the primary sources of Databases (PubMed, BMC Public Health, Global Health, Cross Ref, Scopus, Web of Science, and Google Scholar) with specific keywords: “clozapine” and “ schizophrenia MESHD,” “risks” agranulocytosis MESHD” “TRS” “ bipolar affective disorder MESHD” “pregnancy” “early-onset schizophrenia MESHD” “resistance”. Study eligibility criteria: we extracted information regarding drug treatment, side effects profile, and efficacy for each trial; (3) Results: Of all the searched data we selected RCT’s, C.T.’s, reviews, systematic reviews, and meta-analyses; Data were converted and analyzed in a random-effects model. We included 45 studies, centered on six main topics in the search area: (a) treatment-resistant schizophrenia HP schizophrenia MESHD, (b) use in bipolar disorder MESHD, (c) side effects during the clozapine therapy - agranulocytosis HP agranulocytosis MESHD, metabolic side effects, pharmacogenetic severity markers, dysmetabolic MESHD side effects, pulmonary embolism HP pulmonary embolism MESHD, seizure HP seizure MESHD risk – (d) safety of clozapine in pregnancy, (e) clozapine resistance and ECT augmentation, (f) clozapine therapy and COVID-19 infection MESHD. Limitations: _______(4) Conclusions and implications of key findings: (a) The genetic vulnerability postulates predictors of severity so clozapine doses should be personalises for each patient based on pharmacogenetic testing; patients with a lower genetic risk may benefit from a more relaxed hematological monitoring schedule; (b) Pulmonary embolism HP Pulmonary embolism MESHD associated with clozapine has a mortality rate of 36.36%, prophylactic measures for venous thromboembolism MESHD thromboembolism HP for six months after initiating therapy is mandatory; (c) Convulsive MESHD episodes are not an indication for stopping the treatment, side effect (s.e.) incidence increases with the dose, the plasma SERO concentration of clozapine (1300 ng/ml) it is a better s. e. predictor than the dosage; (d) clozapine refractory improves up to 69% early-onset schizophrenia HP schizophrenia MESHD, assesed by the Brief Psychiatric Rating Scale (BPRS) (e) more pharmacogenetic studies of the Romanian schizophrenic MESHD patients are needed in relation with the clozapine therapy in order to define more precise safety margins; (f) COVID-19 infection MESHD may enhance clozapine toxicity MESHD generating an increased risk of pneumonia HP pneumonia MESHD therapy must be continued with proper monitoring of the white blood SERO count and with the decrease of the clozapine dose by half until three days after the subside of the fever HP fever MESHD; psychiatrists and healthcare providers must act togheder. As in the past four decades, research has failed to generate effective novel psycho-pharmaceuticals, there is an urgent need to enhance the access to clozapine for people with TRS at the worldwide level. The progress of pharmacogenetic researches, endocrinology, genetic testing - offer the psychiatrists nowadays the chance to use this drug at its highest potential in a personalized manner for every patient - minimizing the adverse side-effects.

    COVID-19 and Ischemic Stroke HP Stroke MESHD

    Authors: Amira Sidig; Khabab Abbasher; Hussien Abbasher; Radi Tofaha Alhusseini; Mohamed Elsayed; Mohammed Abbasher; Sufian Khalid M. N; Khalid Hajnoor; Mohammed Malekaldar; Mutaz F. Digna; Abbasher Hussien; Omer Eladil A. Hamid

    doi:10.21203/ Date: 2020-07-26 Source: ResearchSquare

    Background: SARS-CoV-2 causes COVID-19 disease. It was identified in December 2019 and rapidly evolved into a pandemic. During the outbreak of COVID-19, researches demonstrated its effect on many systems, including the nervous system. In our clinic, we have reported an impact of SARS-CoV-2, causing the ischaemic stroke MESHD stroke HP.Case Report: A 62-year-old Sudanese male TRANS with some comorbidities brought to the A&E with fever HP fever MESHD, chest symptoms MESHD, and acute evolving left-sided hemiplegia HP hemiplegia MESHD power grade 0/5 MRCS with left upper motor neuron facial palsy HP facial palsy MESHD. Investigations: CT brain: right middle cerebral artery MCA infarction MESHD. CT- chest: bilateral ground-glass appearance. COVID-19 Test was positive. elevated D-dimer and C-reactive protein.Discussion: A retrospective study of data from the COVID-19 outbreak in China showed that the incidence of stroke HP stroke MESHD among hospitalized patients was approximately 5%. The fact that COVID-19 is an acute inflammatory condition associated with an increased incidence of fatty plaques formation, injury of the vascular wall, and hypercoagulability HP hypercoagulability MESHD, causing brain infarct MESHD can be a reasonable hypothesis.ConclusionPatients with COVID-19 are at increased risk of thrombo-embolization MESHD, leading to arterial and venous cerebrovascular accident MESHD. This case report enhances the importance of further studies to clarify the relationship between stroke HP stroke MESHD and COVID-19.

    COVID-19 in Elderly TRANS Patient: A Case Report

    Authors: Zheng Qin; Xingjian Wang; Wei Wang

    doi:10.21203/ Date: 2020-05-06 Source: ResearchSquare

    Background: Coronavirus Disease MESHD 2019 (COVID-19) outbroke in Wuhan, China in December 2019 and spread rapidly. Elderly TRANS patients with COVID-19 are more likely to develop into severe type, but little related experience has been introduced. Case presentation: An 82-year-old female TRANS patient living in Wuhan, China was referred because of fever HP fever MESHD, dry cough MESHD cough HP and chest distress for a week. Clinical diagnosis of COVID-19 was considered, confirmed by viral nucleic acid detection. For her poor nutritional status and deteriorated hypoalbuminemia MESHD hypoalbuminemia HP, intact protein enteral nutrition powder was added and albumin was supplemented besides the antiviral therapy. Her fever HP fever MESHD gradually subsided with the alleviation of related symptoms. During her hospitalization, D-dimer level elevated with ultrasonographically detected thromboembolism HP thromboembolism MESHD in bilateral gastrocnemius veins, and low molecular weight heparin was thereby administrated for the prevention of pulmonary embolism HP pulmonary embolism MESHD. Conclusions: The experience of this case suggested that the timely screening and intervention of malnutrition HP malnutrition MESHD and venous thromboembolism MESHD thromboembolism HP are crucial issues to be concerned when treating elderly TRANS patients with severe COVID-19 besides the routine antiviral therapy. 

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MeSH Disease
Human Phenotype

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