Efficacy of different doses of ketamine as a bolus in major depressive disorder

Background: Major depressive disorder is a severe, heterogeneous, common medical illness and a leading cause of disability throughout the world that poses a significant public health issue. Previous studies have shown rapid antidepressant effects following a single administration of ketamine. This study aimed to assess the impact of route of administration and dose of ketamine for the reduction of depressive symptoms and compare the effects of different doses and methods. Methods: A double-blind clinical controlled trial was done on 100 patients with a primary diagnosis of major depressive disorder who were assigned into two groups of 50 subjects at a dose of 0.5 mg/kg and 0.75 mg/kg ketamine and each group was divided into two groups of 25 subjects following a single dose of intravenous bolus and infusion of ketamine. The patient’s severity of depression was evaluated with Hamillton Depression Rating Scale and Beck Depression Inventory scores after 2 days, 7 days, 30 days and 60 days of ketamine administration, then the results were compared between groups. Results: According to Hamilton and Beck score, the treatment response in investigated patients was 64% and 60%, respectively. Conclusions: These data suggest that ketamine effect is related to drug dose and type of administration. The dose of 0.75 mg/kg of ketamine is more effective than 0.5 mg/kg and a bolus injection of low-dose ketamine (0.5 mg/kg) is more effective than infusion and in high-dose ketamine (0.75 mg/kg), there was no difference between the methods of drug administration

Extensive Acute Lower Extremity Arterial Thrombosis: A Major Thrombus Formation Caused by COVID-19

Acute thromboembolic events have been frequently reported in patients with coronavirus disease 2019 (COVID-19) due to an increase in the coagulation system activity and endothelial dysfunction. This report describes a patient with COVID-19 who initially reported respiratory symptoms and developed acute lower limb ischemia secondary to extensive macrovascular arterial thrombosis, which was treated with thrombectomy. The development of such extensive arterial thrombosis with anticoagulants at therapeutic doses is a new sign of increased viral pathogenicity, and it is necessary to develop and apply updated prophylaxis protocols for thrombosis in these patients