ABSTRACT
Aim: COVID-19 is mostly well known because of its respiratory pathology, nevertheless several ischemic complications have been reported during the pandemia. The aim of this report is to present 9 cases of acute intestinal ischemia in patients with concomitant SARS-COV- 2 bilateral pneumonia. Method(s): We present a case series collected from a retrospective database, that includes 9 patients with intestinal ischemia and bilateral COVID 19 pneumonia diagnosed during the years 2020 and 2022 at the "Hospital Universitario Nuestra Senora de Candelaria." Results: Of the 9 patients, 6 were men with a mean age of 63 years, 5 of them unvaccinated and 2 with partial dose. All presented with bilateral covid pneumonia requiring admission and intubation at the intensive care unit. During admission, after a hemodynamic worsening with increasing lactate, acute intestinal ischemia was diagnosed on a CT scan (7 non occlusive and 2 occlusive ischemia of the SMA). 7 of them underwent damage control surgery of whom only 2 survived. The remaining 3, died hours after diagnosis, not undergoing surgical treatment due to poor short-term prognosis. Conclusion(s): The severe inflammatory response along with a hypercoagulable state secondary to COVID 19 is responsible for many severe ischemic diseases such as intestinal ischemia. These can go unnoticed in intubated critically ill patients, or with concomitant respiratory disease due to the absence of obvious clinical manifestations. Given its high mortality, it is essential to take this differential diagnosis into account, to obtain an early diagnosis and treatment.
ABSTRACT
IntroductionClozapine is the most effective antipsychotic for treatment resistant schizophrenia. In patients treated with clozapine, COVID-19 infection may result in complications including an increased risk of pneumonia, clozapine toxicity, and disruption to clozapine treatment by COVID-19 induced lymphopenia.ObjectivesWe report 5 cases of elevated clozapine levels occurring in patients with COVID-19 infection who had been previously managed for several years on stable doses.MethodsSubjects: 48 admitted patients to a long-stay psychiatric unit. COVID-19 infection confirmed by positive nasopharyngeal swab for viral ribonucleic acid of SARS-CoV-2. Hematological controls between March and April 2020.Results16 patients (33%) treated with clozapine.18 patients (37’5%) had COVID-19 infection, of which 5 (10’4%) were treated with clozapine. Results are presented in table 1. Increases in plasma clozapine levels were observed in all cases (49’38 to 307.5%). We don’t have the clozapine levels of a patient who presented a pneumonia requiring admission and treatment in the general hospital. Two cases of neutropenia were observed, of which one had to discontinue treatment with clozapine. In the other three patients the dose of clozapine was reduced and they did not present haematological or intoxication complications that required further adjustments.ConclusionsCovid-19 infection is associated with increased serum clozapine levels by probably multifactorial mechanisms (systemic infection, reduced smoking). Importance of full clinical assessment of suspected COVID-19 infection in clozapine treated patients, including assessment clozapine level, and full blood count. The general recommendation is to reduce the dose of clozapine in this patients.