The Effect of Clinical, Laboratory Findings and Parenchymal Infiltration Features on the Diameter of the Main Pulmonary Artery in COVID-19 Pneumonia

Amaç: Şizofreni tanılı hastalarda klozapin ile eşzamanlı olarak uygulanan elektrokonvulziv tedavinin daha iyi tedavi yanıtı ve hastanede yatış süresinde kısalmaya neden olma olasılığını incelemek amaçlanmıştır. Yöntemler: Kadın psikiyatri servisimizde 5 yıl boyunca (01.02.2014 ve 01.02.2019 arasında) yatarak tedavi gören şizofreni tanılı hastaların tıbbi kayıtları retrospektif olarak incelendi. Tedavi yanıtını değerlendirmede Klinik Global İzlem – İyileşme (KGİ-İ) ölçeği kullanılmıştı. Bulgular: EKT ile tedavi edilmiş olan 191 olgu içinde; 8 şizofreni olgusu (K-EKT) EKT ve eşzamanlı klozapin ile tedavi edilmiş ve 14 olguya ise (EKT-Ö) önce EKT uygulanmış, sonrasında klozapin tedavisine başlanmıştı. İki grup arasında EKT seans sayıları ve nöbet süreleri açısından anlamlı fark yoktu (p > 0,05). EKT’ ye yanıt oranının (KGİ-İ: 2 ya da 3), K-EKT grubunda %75 (n=6); EKT-Ö grubunda ise %85,7 (n=12) olduğu görüldü. Ortalama KGİ-İ skorları arasında gruplar arasında anlamlı fark yoktu (p > 0,05). K-EKT grubunun hastanede yatış süresi (37,7  14,44 gün), EKT-Ö grubundan (56,0  19,2 gün) daha kısaydı (p = 0,04). EKT seansları sırasında ya da yatışlar süresince ciddi yan etki görülmedi. Sonuç: Her iki uygulamada da tedaviye iyi yanıt yüksek orandaydı ve anlamlı fark yoktu. EKT ile eşzamanlı klozapin uygulamasının hastanede yatış süresini anlamlı oranda kısaltırken ciddi bir komplikasyona ve yan etki artışına neden olmadığı görüldü.

Anahtar Kelimeler:

EKT, Şizofreni, Klozapin

The Effect of Clinical, Laboratory Findings and Parenchymal Infiltration Features on the Diameter of the Main Pulmonary Artery in COVID-19 Pneumonia

Purpose: Determining whether adjunctive electroconvulsive therapy (ECT) with clozapine leads to better treatment response and fewer days in hospital for patients with schizophrenia. Methods: Medical records of patients with schizophrenia who were treated with ECT-clozapine combination in our women’s mental health clinic in a period of 5 years (between 01.02.2014 and 01.02.2019) were investigated retrospectively. Clinical Global Impression of Improvement (CGI-I) scale was used for assessing treatment response. Results: Of the 191 cases treated with ECT, there were 8 cases of schizophrenia who were treated with ECT and concomitant clozapine (C-ECT) and 14 cases who were treated with ECT before the initiation of clozapine (ECT-B). Number of ECT sessions and duration of seizures were not significantly different for both groups (p > 0.05). There was good and mild response (CGI-I score of 2 and 3) in 75% of the patients (n=6) for C-ECT and 85.7% of the patients (n=12) for ECT-B. Mean CGI-I scores between the two groups were not significantly different (p > 0.05). Duration of hospitalization for the C-ECT group (37.7  14.44 days) was shorter than the duration of hospitalization for the ECT-B group (56.0  19.2 days) (p = 0.04). No serious adverse events were observed during the ECT sessions or during the index hospitalizations Conclusion: Response rate was high and similar with both of the procedures and the duration of hospitalization was shorter for C-ECT group with no major complication and no significant increase in adverse effects.

Keywords:

ECT, Schizophrenia, Clozapine,

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1. WHO Coronavirus (COVID-19) Dashboard https://covid19.who.int/ access date 09.10.2021
2. Batah SS and Fabro AT. Pulmonary pathology of ARDS in COVID-19: A pathological review for clinicians. Respir Med. 2021;176:106239. DOI: 10.1016/j.rmed.2020.106239.
3. van Eijk LE, Binkhorst M, Bourgonje AR, et al. COVID-19: immunopathology, pathophysiological mechanisms, and treatment options. J Pathol. 2021:10.1002/path.5642. DOI: 10.1002/ path.5642.
4. Chen X, Liu K, Wang Z, et al. Computed tomography measurement of pulmonary artery for diagnosis of COPD and its comorbidity pulmonary hypertension. Int J Chron Obstruct Pulmon Dis. 2015;10:2525-33. DOI: 10.2147/COPD.S94211.
5. Truong QA, Massaro JM, Rogers IS, et al. Reference values for normal pulmonary artery dimensions by noncontrast cardiac computed tomography: the Framingham Heart Study. Circ Cardiovasc Imaging. 2012;5:147-54. DOI:10.1161/CIRCIMAGING.111.968610
6. Bhalla V, Blish CA and South AM. A historical perspective on ACE2 in the COVID-19 era. J Hum Hypertens. 2020;1-5. DOI: 10.1038/ s41371-020-00459-3
7. Tekcan Sanli DE, Yildirim D, Sanli AN, et al. Predictive value of CT imaging findings in COVID-19 pneumonia at the time of firstscreen regarding the need for hospitalization or intensive care unit. Diagn Interv Radiol. 2020. DOI: 10.5152/dir.2020.20421.
8. Sanli DET, Yildirim D, Sanli AN, et al. A practical approach to imaging characteristics and standardized reporting of COVID-19: a radiologic review. Mil Med Res. 2021;8:7. DOI: 10.1186/s40779-021-00301-y.
9. Karmouty-Quintana H, Thandavarayan RA, Keller SP, et al. Emerging Mechanisms of Pulmonary Vasoconstriction in SARS-CoV-2- Induced Acute Respiratory Distress Syndrome (ARDS) and Potential Therapeutic Targets. Int J Mol Sci. 2020;21:8081. DOI: 10.3390/ ijms21218081.
10. Santamarina MG, Boisier D, Contreras R, et al. COVID-19: a hypothesis regarding the ventilation-perfusion mismatch. Crit Care. 2020;24:395. DOI: 10.1186/s13054-020-03125-9.
11. Peluso L, Abella BS, Ferrer R, et al. Fever management in COVID-19 patients. Minerva Anestesiol. 2021;87:1-3. DOI: 10.23736/ S0375-9393.20.15195-2.
12. Sanli DET, Altundag A, Kandemirli SG, et al. Relationship between disease severity and serum IL-6 levels in COVID-19 anosmia. Am J Otolaryngol. 2021;42:102796. DOI: 10.1016/j.amjoto.2020.102796.
13. Smilowitz NR, Kunichoff D, Garshick M, et al. C-reactive protein and clinical outcomes in patients with COVID-19. Eur Heart J. 2021:ehaa1103. DOI: 10.1093/eurheartj/ehaa1103.
14. Szarpak L, Ruetzler K, Safiejko K, et al. Lactate dehydrogenase level as a COVID-19 severity marker. Am J Emerg Med. 2020:S0735- 6757(20)31034-2. DOI: 10.1016/j.ajem.2020.11.025.
15. Zhou Y, Ding N, Yang G, et al. Serum lactate dehydrogenase level may predict acute respiratory distress syndrome of patients with fever infected by SARS-CoV-2. Ann Transl Med. 2020;8:1118. DOI: 10.21037/atm-20-2411.
16. Henry BM, Aggarwal G, Wong J, et al. Lactate dehydrogenase levels predict coronavirus disease 2019 (COVID-19) severity and mortality: A pooled analysis. Am J Emerg Med. 2020;38(9):1722-6. DOI: 10.1016/j.ajem.2020.05.073.
17. Sanli DET, Yildirim D, Sanli AN, Turkmen S, Erozan N, Husmen G, Altundag A, Tuzuner F. A practical approach to imaging characteristics and standardized reporting of COVID-19: a radiologic review. Mil Med Res. 2021;8(1):7. DOI: 10.1186/ s40779-021-00301-y.
18. Esposito A, Palmisano A, Toselli M, Vignale D, Cereda A, Rancoita PMV, et al. Chest CT-derived pulmonary artery enlargement at the admission predicts overall survival in COVID-19 patients: insight from 1461 consecutivepatients in Italy. Eur Radiol. 2021;31(6):4031- 41. DOI: 10.1007/s00330-020-07622-x
19. Yildiz M, Yadigar S, Yildiz BŞ, Aladag NB, Keskin O, Ozer RS, Topel C, Kahraman S. Evaluation of the relationship between COVID-19 pneumonia severity and pulmonary artery diameter measurement. Herz. 2021;46(1):56-62. DOI: 10.1007/s00059-020-05014-x.