Lečenje koronavirusne boLesti (CoviD-19)

Coronavirus disease (COVID-19) is caused by RNA virus of severe acute respiratory syndrome 2 (SARS-CoV-2) which is highly contagious to humans. The primary receptor for the virus is probably angiotensin-converting enzyme 2. COVID-19 is a respiratory infection, primarily transmitted by droplets and close contact with a diseased person. Estimated reproductive number (R0) is 2-2.5 and the mean incubation time is 5.2 days, ranging 1-14 days (95% confidence interval 4.1-7.0 days). The most common symptoms are: fever, dry cough, malaise, productive sputum and dyspnea, followed, sore throat, headache, myalgia, arthralgia, fever and dizziness and, occasionally, confusion, rhinorrhea, nasal congestion, gastrointestinal symptoms, hemoptysis and conjunctival injection. Initial atypical manifestations are also known. Real-time reverse transcriptase polymerase chain reaction (rRT-PCR) assay is the "gold" diagnostic standard, but its specificity and sensitivity have not been established. The most common complications are: acute respiratory distress syndrome, acute liver damage, acute heart damage and arrhythmia, followed by secondary infections, acute respiratory failure, acute renal impairment, sepsis and/or septic shock, pneumothorax, disseminated intravascular coagulation, acute heart failure and occasionally, rhabdomyolysis. Disease duration varies and in hospitalized patients it is estimated to be 16-26 days (interquartile range 12-29 days), while the global mortality rate is still unknown with certainty. Drugs against SARS-CoV-2 prescribed by empirical protocols (off-label use) are lopinavir/ritonavir, chloroquine and hydroxychloroquine, nitazoxanide, umifenovir, ribavirin, inhaled interferon Alpha while the new drugs of clinical trial stages are remdesivir, nafamostat i favipiravir. Proven drug prophylaxis of COVID-19 does not yet exist and vaccine against SARS-CoV-2 has not yet been developed.Publishe

Zuclopenthixol decanoate in pregnancy: Successful outcomes in two consecutive off springs of the same mother

Introduction. Almost all individual antipsychotics are classified into the intermediate pregnancy risk category as no or limited data exist about human pregnancy outcomes. We presented the case of zuclopenthixol decanoate using in two successive pregnancies of the same woman, which had not been published in the available peer-reviewed literature. Case report. A middle-age female subject who suffered from schizophrenia received zuclopenthixol decanoate injection during her two consecutive pregnancies. About four and a half months before diagnosis of the first pregnancy (~3.5 years after psychosis emergence), zuclopenthixol decanoate (400 mg every other week, im injection) was introduced to the treatment protocol (due to previous non-compliance with haloperidol and risperidone). A significant clinical improvement was achieved and the dose during pregnancy was reduced to 200 mg once monthly and maintained to date. In both pregnancies the women gave birth to healthy girls who have been developing normally until now, at their ages of 6 months and of 3.5 years. During pregnancy and after giving birth to children the mothers’ psychiatric status and her social functioning were significantly improved and are still stable. Close monitoring of the mother’s health, a multidisciplinary approach to both her treatment and the monitoring of pregnancies as well as the complete compliance with the prescribed drug protocol were likely to be crucial for the therapeutic success. Conclusion. A favorable outcome of the present case suggests that the zuclopenthixol decanoate is a rational therapeutic option for pregnant women suffering from psychosis when the expected benefit exceed the potential risk, but a definitive evidence for its safety requires large, controlled studies. [Projekat Ministarstva nauke Republike Srbije, br. 175014