25-(OH)D、糖化血红蛋白检测对2型糖尿病合并高血压患者的临床价值

目的 分析2型糖尿病(T2DM)合并高血压患者血清25-羟基维生素D[25-(OH)D]、糖化血红蛋白(HbA1c)表达及其与T2DM合并高血压的关系。方法 回顾性选取2022年1月—2023年1月河南省第二人民医院接收的107例T2DM患者,分为两组A组(T2DM合并高血压患者)59例、B组(单纯T2DM)48例,同时选取同时期健康志愿者62例(计为C组)作为对照。结果 A组血清25-(OH)D水平低于B组、C组(P<0.05),B组25-(OH)D浓度低于C组(P<0.05),而A、B、C组的血清HbA1c水平依次降低(P<0.05);25-(OH)D、HbA1c血清浓度与T2DM患者是否合并高血压相关(P<0.05)。ROC分析显示,当25-(OH)D<26.12μg/L、HbA1c>8.74%时,T2DM患者易合并高血压,两者联合预测(串联模型)的AUC最大(为0.801)(P<0.05)。结论 合并高血压的T2DM患者血清25-(OH)D会呈现一定程度的降低、HbA1c水平升高,对于25-(OH)D、HbA1c出现异常变化的T2DM患...     

不同糖耐量状态人群血清25-羟维生素D的变化及相关性研究

目的 探讨不同糖耐量状态人群25(OH)D与早相胰岛素分泌及胰高血糖素分泌的关系.方法 按75g口服葡萄糖耐量试验(OGTT)结果分为3组:用电化学发光法测定血25(OH)D,并测定空腹和负荷后30、120min的血糖、胰岛素(INS)和胰高血糖素(GLC)水平,计算早相胰岛素分泌指数(△I30/△G30)、稳态模型胰岛素分泌指数(HOMA-β)、稳态模型胰岛素抵抗指数(HOMA-IR)及胰高血糖素浓度上升率,分析25(OH)D与△130/△G30、HOMA-β、HOMA-IR及胰高血糖素浓度上升率的关系.结果 (1)各组25(OH)D均低,IGR组、初诊T2DM组25(OH)D水平明显低于NGT组(P均＜0.00).(2)各组间△130/△G30、HOMA-β、HOMA-IR及胰高血糖素浓度上升率水平差异均有统计学意义(P＜0.05),IGR组、初诊T2DM组△130/△G30、HOMA-β明显低于NGT组(P均＜0.05),初诊T2DM组△130/△G30、HOMA-β明显低于IGR组(P＜0.05);IGR组、初诊T2DM组HOMA-IR、胰高血糖素浓度上升率明显高于NGT组(P均＜0.05),初诊T2DM组HOMA-IR、胰高血糖素浓度上升率明显高于IGR组(P＜0.05).(3)秩相关分析显示:25(OH)D水平与空腹血糖和负荷后2h血糖水平负相关(r分别为-0.199,-0.162,P均＜0.05),与HOMA-β水平正相关(r为0.261,P＜0.00).结论 不同糖耐量状态人群均存在血清维生素D(VD)不足或缺乏,VD水平与胰岛素分泌有关,与胰岛素抵抗、胰高血糖素分泌无关.     

糖尿病肾病患者血清网膜素-1水平的变化

目的通过比较2型糖尿病肾病(DN)患者、新诊断的2型糖尿病(T2DM)患者、糖耐量正常者(NGT)血清网膜素-1的浓度,探讨网膜素-1与DN的关系,为糖尿病早期诊断、病情监测、DN的发病机制提供依据。方法纳入2013年6月至2014年10月山西医科大学第二医院内分泌科、肾内科住院的50例DN患者(Ⅲ期25例,Ⅳ期25例),内分泌科门诊新确诊的46例T2DM患者,以及年龄、性别等相匹配的44例NGT者。测定所有受试者的空腹血糖(FPG)、血脂、血肌酐(Scr)、尿素氮(BUN)、糖化血红蛋白(HbA1c)、尿微量白蛋白(MAU)、空腹血清胰岛素(FINs)、网膜素-1。结果 3组的性别、年龄、BMI值差异均无统计学意义。T2DM组、DN组的FBG、HbA1c、TG、HOMA-IR均显著高于NGT组(P<0.05),低密度脂蛋白(LDL)-C、网膜素-1水平均低于NGT组(P<0.05)。DN患者的Scr、BUN均显著高于新诊断的T2DM患者,而FBG、HbA1c、TG、FINs、网膜素-1水平则显著低于新诊断的T2DM患者(P<0.05)。结论血清网膜素-1水平随着糖尿病病程进展呈下降趋势。网膜素-1水平的下降使得其抑制炎症作用降低可能是DN的发病原因之一,网膜素-1是否能成为T2DM病情、DN肾功能监测指标之一,仍需进一步研究。     

2型糖尿病患者血清HIF-1α水平与胫前动脉粥样斑块的相关性

目的 观察2型糖尿病(T2DM)患者血清缺氧诱导因子-1α(HIF-1α)的变化,讨论胫前动脉粥样硬化性血管病变(FP)与HIF-1α水平升高的关系.方法 选取2014年1月至8月潍坊市人民医院住院2型糖尿病患者53例,其中27例T2DM合并胫前动脉斑块患者(T2DM+ FP组),26例单纯T2DM患者(T2DM组),随机选取25名健康体检者作为对照组(NC组).采用酶联免疫吸附法(ELISA法)检测HIF-1α浓度.结果 T2DM+ FP组和单纯T2DM组HIF-1α水平均显著高于对照组(均P＜0.01),T2DM+FP组HIF-1α水平明显高于T2DM组(P＜0.01).血清HIF-1α水平与空腹血糖(FPG)、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)呈正相关(均P＜0.05).多元线性逐步回归分析显示,HIF-1α水平的独立影响因素是糖化血红蛋白.结论 2型糖尿病伴有胫前动脉斑块患者体内高水平的HIF-1α可能与血糖和胰岛素抵抗有关,在糖尿病足的病变进展中发挥重要角色.     

2型糖尿病患者颈动脉粥样硬化与血清网膜素-1的相关研究

目的探讨血清网膜素-1与2型糖尿病(T2DM)患者颈动脉粥样硬化(CAS)的关系。方法选取30例新诊断T2DM不伴CAS患者及30例T2DM伴CAS患者作为研究组,30名正常糖耐量(NGT)者作为对照组。酶联免疫吸附试验(ELISA)法测定血清网膜素-1水平,并测定空腹血糖(FPG)、糖化血红蛋白(Hb A1c)、空腹胰岛素(FINS)、血脂等指标;CAS检测采用彩色多普勒超声仪。结果 1血清网膜素-1水平在T2DM伴CAS组、新诊断T2DM不伴CAS组均明显低于NGT组[(45±12)和(73±12)和(86±27)ng/L(P<0.05或P<0.01)];在CAS组较非CAS组显著降低(P<0.01)。2血清网膜素-1与体质量指数(BMI)、FPG、Hb A1c、FINS、胰岛素抵抗指数(HOMA-IR)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)呈负相关(P<0.05或P<0.01),与高密度脂蛋白胆固醇(HDL-C)呈正相关(P<0.01)。3网膜素-1是CAS的独立保护因素,HOMA-IR是CAS的独立危险因素。结论血清网膜素-1水平随着糖尿病病情发展逐渐降低,可能参与了T2DM患者CAS的发生。     

sTIM-3及其配体Gal-9、HMGB1与2型糖尿病并发冠心病的相关性研究

目的 探讨血清中可溶性T细胞免疫球蛋白及黏蛋白分子-3(sTIM-3)、半乳糖凝集素-9(Gal-9)、高迁移率族蛋白B1(HMGB1)水平与2型糖尿病（T2DM）并发冠心病（CHD）的关系。方法 选取T2DM组患者50例、T2DM并发CHD组（T2DM+CHD组）患者52例,同期健康体检人员（Con组）48例。采用酶联免疫吸附试验（ELISA）检测3组血清中s TIM-3、Gal-9及HMGB1的水平。Spearman法分析血清sTIM-3、Gal-9、HMGB1、空腹血糖（FBG）、超敏C-反应蛋白（hs-CRP）间的相关性;使用受试者工作特征（ROC）曲线分析sTIM-3、Gal-9及两者联合检测对T2DM并发CHD的诊断能力;采用Logistic回归分析T2DM并发CHD的危险因素。结果 与Con组相比,T2DM组和T2DM+CHD组sTIM-3、Gal-9、HMGB1升高（P<0.05）;与T2DM组相比,T2DM+CHD组sTIM-3和Gal-9升高（P<0.05）,HMGB1差异无统计学意义。FBG、hs-CRP与sTIM-3、Gal-9、HMGB1呈正相关,...     

尿微量白蛋白 /肌酐比值、趋化因子样受体 1、血清 25-羟胆骨化醇与糖尿病视网膜病变的关系

目的探讨尿微量白蛋白 /肌酐比值( UACR)、趋化因子样受体 1(CMKLR1)、血清 25-羟胆骨化醇［ 25(OH)VD］与糖尿病视网膜病变( DR)发生及病变程度的关系。方法选择 2019年 5月至 2020年 1月邢台市第五医院 160例 2型糖尿病( T2DM)伴 DR病人、 80例无 DR的 T2DM病人及 50例健康体检人群作为研究对象，其中 DR病人根据病变程度分为非增生期 98例与增生期 62例。所有研究对象均采用 ELISA法(酶联免疫吸附法)检测 CMKLR1、25(OH)VD水平，采用免疫比浊法及肌酐酶法计算 UACR值，分析其与 DR发生及病变程度的相关性；并采用 ROC曲线分析其价值。结果三组 T2DM病人病程比较差异有统计学意义( P<0.05)Spearman相关系数为 3.97(P<0.001)。四组研究对象空腹血糖( FPG)、糖化血红蛋白( HbA1c)、三酰甘油(TG)、低密度脂蛋白(，LDL-C)、 UACR、CMKLR1及 25(OH)VD比较差异有统计学意义( P<0.05)。两两比较:增生期组 FPG(7.65±1.87)mmol/L、HbA1c(9.86±1.43)%、TG(2.41±0.32)mmol/L、LDL-C(3.42±0.51)mmol/L、UACR(345.55±40.65)mg/g及 CMKLR1(69.63±6.54)μg/L均高于对照组( 4.31±1.19)mmol/L、(4.53±0.95)%、(1.59±0.53)mmol/L、(1.73±0.61)mmol/L、(9.33± 3.38)mg/g、(69.63±6.54)μg/L及 T2DM非 DR组( 6.26±1.85)mmol/L、(6.47±1.66)%、(1.79±0.47)mmol/L、(2.44±0.66)mmol/L、(25.96±6.73)mg/g、(44.11±6.51)μg/L(P<0.05)， HbA1c、UACR及 CMKLR1均高于非增生期组( P<0.05)而 25(OH)VD低于对照组、 T2DM非 DR组及非增生期组( P<0.05)；非增生期组 FPG、HbA1c、TG、LDL-C、UACR及 CMKLR1均高，于对照组( P<0.05)FPG、HbA1c、TG、LDL-C、UACR高于 T2DM非 DR组( P<0.05)而 25(OH)VD低于对照组( P<0.05)； T2DM非 DR组 FPG、HbA1c、，LDL-C、UACR、CMKLR1均高于对照组( P<0.05)25(OH)VD低于，对照组( P<0.05)。logistic回归分析:病程长、 HbA1c高、 UACR高、 CMKLR1高及 25(OH)VD低是 DR发生的危险，因素( P<0.05)；病程长、 UACR高、 CMKLR1高及 25(OH)VD低是增生期 DR发生的危险因素( P<0.05)。 UACR、CMKLR1及 25(OH)VD预测 DR的 AUC面积分别为 0.77、0.70、0.76；病程、 UACR、CMKLR1及 25(OH)VD预测增生期 DR的 AUC面积分别为 0.77、0.72、0.73、0.74。结论糖尿病病程、 UACR、CMKLR1、25(OH)VD与 DR发生及病变程度密切相关，且对 DR发生及病变程度具有较好的预测价值。     

瑞格列奈联合α-葡萄糖苷酶抑制剂治疗社区老年T2DM患者的疗效分析

目的:探讨瑞格列奈联合α-葡萄糖苷酶抑制剂治疗社区老年2型糖尿病(T2DM)患者的疗效及对血糖水平影响.方法:选取我院2017年8月—2019年5月86例老年T2DM患者,按随机数字表法分联合组(n=43)、常规组(n=43).常规组予以瑞格列奈治疗,联合组予以瑞格列奈联合阿卡波糖治疗.比较两组疗效、不良反应、治疗前后...     

初诊2型糖尿病病人脂蛋白(a)与胰岛素抵抗的相关性分析

目的 探讨初诊2型糖尿病(T2DM)病人血清脂蛋白(a)[Lp(a)]与胰岛素抵抗的关系.方法 检测95例初诊T2DM病人(T2DM组)和40例健康体检者(NC组)血清生化指标,计算胰岛素抵抗指数(HOMA-IR).比较两组间各指标的差异.结果 T2DM组Lp(a)为(1.78±0.35)低于NC组的(1.85±0.57)(t=2.574,P=0.020).相关分析显示:Lp(a)与胰岛素、HOMA-IR、三酰甘油呈负相关(P<0.05)).线性回归分析显示:Lp(a)在NC组和T2DM组都与HOMA-IR相关(β=-0.003,P=0.001;β=-0.001,P=0.001).结论 Lp(a)在T2DM人群中水平低于正常人群,在两组中都与胰岛素抵抗呈独立的负相关性.     

老年2型糖尿病合并骨质疏松症患者血尿酸水平变化的临床分析

目的 探讨血尿酸(UA)在老年2型糖尿病(T2DM)合并骨质疏松症(OP)患者发生、发展中的变化情况。方法 选择确诊为T2DM的老年患者76例,进行骨密度(BMD)测定,依据T值水平将T2DM患者分为骨量正常组(T值≥-1.0, 26例)、骨量减少组(-2.50.05);四组年龄、病程、BMI、HbA1c、TG、Scr、25(OH)...     

Etomidate-anaesthesia, with and without fentanyl, compared with urethane-anaesthesia in the rat

In spontaneously breathing rats, continuous infusion of etomidate with and without fentanyl caused a slight decrease in blood pressure and heart rate. Coadministration of fentanyl and etomidate in order to obtain full anaesthesia and analgesia resulted in respiratory depression. In artificially ventilated rats both etomidate as well as the anaesthetic combination caused a strong reduction in aortic flow and an increase in total peripheral resistance. A single infusion of etomidate did not change blood pressure. Etomidate combined with fentanyl reduced blood pressure. Under adjusted ventilation blood pressure, aortic flow, max(dF/dt) and heart rate were progressively reduced during a 4 h period. In contrast, urethane anaesthesia reduced aortic flow to a minor extent. Total peripheral resistance and max(dF/dt) were hardly affected. The slightly reduced blood pressure and blood gas variables remained stable during the experiment. From pharmacokinetic studies it was established that effective etomidate plasma levels were maintained constant during the experimental period. Pharmacokinetic interaction between etomidate and fentanyl did not occur. It is concluded that for anaesthesia of longer duration during cardiovascular experiments in rats, urethane is preferable to etomidate/fentanyl because it does not cause serious changes in basal haemodynamic variables.     

Physicians, pharmacists, and people with diabetes in India

Objective The present study was undertaken to elucidate the most frequently visited health care provider by the population attending a tertiary eye care hospital in South India. Methods A trained observer administered the questionnaire to 150 literate subjects aged above 30 years. Data collection included factors such as age, gender, single-index socioeconomic status (monthly income), presence of diabetes, and the name of the health care provider, including the number of times he or she was visited in the last 1 and 6 months. Results A total of 122 individuals (including persons with or without diabetes) responded to the questionnaire. Pharmacists were the most frequently visited health care providers; a pharmacist was visited nearly every month by a person with diabetes and about once in 2 months by a person without diabetes. Conclusion This study revealed that the most frequently visited health care providers by the population with diabetes were pharmacists.     

Response to cocaine, alone and in combination with methylphenidate, in cocaine abusers with ADHD

Attention deficit hyperactivity disorder (ADHD) is prevalent in adult cocaine abusers. Yet, it remains to be determined how the response to cocaine differs in cocaine abusers with ADHD compared to cocaine abusers without ADHD. Further, since ADHD is commonly treated with stimulants, such as methylphenidate (MPH), it is important to examine whether MPH maintenance alters the response to cocaine in cocaine abusers with ADHD. Thus, the first phase of this study compared the response to cocaine in adult cocaine abusers with ADHD to those without ADHD. The second phase assessed the effects of oral sustained-release methylphenidate (MPH-SR) maintenance (40 and 60 mg) on the response to cocaine only in those with ADHD. Cocaine abusers with ADHD (N=7) and without ADHD (N=7) who were not seeking treatment remained inpatient initially for 1 week, when the effects of cocaine alone were tested (Phase 1). Cocaine abusers with ADHD remained inpatient for an additional 3 weeks, during which the effects of cocaine during oral MPH-SR maintenance were tested (Phase 2). During cocaine fixed dosing sessions, participants received four injections of i.v. cocaine (0, 16 or 48 mg/70 kg), spaced 14 min apart. During cocaine choice sessions, participants had a choice between receiving i.v. cocaine (16 or 48 mg/70 kg) or two tokens, each exchangeable for 2 US dollars. Subjective effects related to ADHD symptoms (e.g. ratings of "Able to Concentrate") were significantly lower in cocaine abusers with ADHD compared to those without ADHD when placebo cocaine was administered. Active cocaine produced similar increases in cardiovascular and positive subjective effects in both groups and there was no difference in cocaine choice between the two groups. These data suggest that the response to cocaine is not different between cocaine abusers with ADHD compared to those without ADHD. When the cocaine abusers with ADHD were maintained on MPH-SR, cardiovascular effects were increased, however, this did not warrant termination of any test session. Maintenance on MPH-SR decreased some of the positive subjective effects of cocaine. Further, maintenance on a high dose of MPH-SR decreased cocaine choice. Thus, oral MPH-SR is safe in combination with repeated cocaine doses and decreases some of the positive and reinforcing effects of cocaine in cocaine abusers with ADHD.     

Triple-Combination Therapy with Olmesartan, Amlodipine, and Hydrochlorothiazide in Black and Non-Black Study Participants with Hypertension

Background Although awareness of hypertension in Black patients has increased, blood pressure (BP) is frequently inadequately controlled. Objective This prespecified subgroup analysis of the TRINITY study evaluated the efficacy and safety of olmesartan medoxomil (OM) 40 mg, amlodipine besylate (AML) 10 mg, and hydrochlorothiazide (HCTZ) 25 mg triple-combination treatment compared with the component dual-combination treatments in Black and non-Black study participants. Study Design TRINITY was a 12-week, randomized, double-blind, parallel-group evaluation. The first patient was enrolled in May 2008 and the last patient completed the study in February 2009. The study consisted of a 3-week washout period for participants receiving antihypertensive therapy and a 12-week double-blind treatment period. For the treatment phase, all study participants were stratified by age, race, and diabetes mellitus status and randomized to a treatment sequence that led to their final treatment assignment, which they received from weeks 4 to 12 (OM 40 mg/AML 10 mg/HCTZ 25 mg, OM 40 mg/AML 10 mg, OM 40 mg/HCTZ 25 mg, or AML 10 mg/HCTZ 25 mg). In the first 2 weeks of the double-blind treatment period, all participants received either dual-combination treatment or placebo. Participants assigned to dual-combination treatment continued treatment until week 4, and participants receiving placebo were switched at week 2 to receive one of the dual-combination treatments until week 4. At week 4, participants either continued dual-combination treatment or randomly received triple-combination treatment until week 12. Setting 317 clinical sites in the USA and Puerto Rico were included in the study. Patients Study participants eligible for randomization (N = 2492) were ≥18 years of age with mean seated blood pressure (SeBP) ≥140/100 mmHg or ≥160/90 mmHg (off antihypertensive medication). Intervention The intervention was with dual- or triple-combination antihypertensive treatment: OM 40 mg/AML 10 mg/HCTZ 25 mg, OM 40 mg/AML 10 mg, OM 40 mg/HCTZ 25 mg, or AML 10 mg/HCTZ 25 mg. Main Outcome Measure The primary efficacy variable was the change in least squares (LS) mean seated diastolic BP (SeDBP) from baseline to week 12. Secondary efficacy variables included the LS mean change in seated systolic BP (SeSBP), percentage of study participants reaching BP goal, and safety parameters. >Results In both Black and non-Black participants, triple-combination treatment resulted in significant and similar mean reductions in SeDBP and SeSBP (p≤0.0001 vs each dual-combination treatment) with a greater proportion of participants reaching BP goal compared with dual-combination treatments, regardless of race. Most treatment-emergent adverse events were mild or moderate in severity and no new safety concerns were identified. Conclusion Triple-combination treatment provided greater BP reductions than dual-combination treatments regardless of race. Clinical Trial Registration Registered at ClinicalTrials.gov as NCT00649389.     

Effect of two weeks' treatment with thioridazine,chlorpromazine, sulpiride and bromazepam,alone or in combination with alcohol,on learning and memory in man

Forty paid healthy male students participated in two subacute experiments of 6 weeks each. In the first trial 20 of them received bromazepam, thioridazine, and placebo double blind cross over for 2 weeks each, and in the second trial the active agents administered to the other 20 participants were chlorpromazine and sulpiride. The tests used were paired associate learning with nonsense syllables and digit memory span. Before testing the subjects took either an alcoholic or a nonalcoholic bitter drink.As in the the previous study from this laboratory, alcohol was found to impair learning capacity. Of the drugs used only bromazepam impaired learning significantly, and the combined effect of alcohol and bromazepam on learning capacity was very deleterious. The adrenolytic effect of drugs did not correlate with their effect on learning. Caution is necessary when prescribing bromazepam for active outpatients at least in doses used in this study.     

Effects of metoprolol, alone and in combination with lidocaine, on ventricular fibrillation threshold: comparison with atenolol, propranolol, and pindolol

Metoprolol and other beta-adrenergic blocking drugs are known to exert cardioprotective effects that include significant reduction in occurrence of ventricular fibrillation (VF) following myocardial ischemia and infarction. To help determine the mechanism of these cardioprotective effects, this study evaluated the effect of equipotent beta-blocking doses of metoprolol and three other beta-blockers with differing ancillary properties on ventricular fibrillation threshold (VFT) in the normal canine heart. Metoprolol tartrate (1.0 mg/kg i.v.), atenolol (0.3 mg/kg i.v.), propranolol hydrochloride (0.3 mg/kg i.v.), pindolol (0.03 mg/kg i.v.), or saline control (0.9% NaCl solution; vehicle) was given, alone and in combination with lidocaine (L), to groups of six pentobarbital (32.5 mg/kg i.v.) anesthetized mongrel dogs after control VFT and control isoproterenol-induced (ISO) positive chronotropic effects had been determined. The D- (membrane stabilizing, non-beta blocking) and L- (beta blocking) isomers of propranolol also were administered to separate groups of six anesthetized dogs in a dose of 0.3 mg/kg i.v. Blood samples (venous) were taken before drug or vehicle administration, 10 min after drug/vehicle administration and at half-hour intervals thereafter during experimentation. ISO responses and VFT were determined 5 and 15 min, respectively, after drug/vehicle administration and at half-hour intervals for a total experimental period of 165 min. VF was induced with a train of pulses (5 s, 100 Hz, 3-ms duration, 250-omega resistance) applied by bipolar platinum electrodes to a paced heart (200 beats/min). Voltage (V) was increased every 60 sec (0.25-V increments between 0-3.5 V and 0.5-V increments greater than 3.5 V) until VF occurred. Metoprolol increased VFT significantly (p less than 0.05) and maximally (max delta V = 2.3 +/- 0.7 V) at 135 min postdrug when the ISO-induced increase in heart rate was inhibited (%I ISO) by less than 53%. Max delta V was not significantly increased following i.v. administration of atenolol (0.8 +/- 0.6 V), pindolol (0.1 +/- 0.1 V), or saline (0.1 +/- 0.1 V). Max delta V was 0.5 +/- 0.2 in the D-propranolol-treated group and 0.5 +/- 0.3 in the L-propranolol-treated group. These values did not differ from max delta V obtained in the propranolol-treated group (0.6 +/- 0.4 V). Changes in VFT for all groups were, over time, negatively correlated with %I ISO and were not dependent on membrane stabilizing effect (metoprolol, propranolol (D,DL), pindolol), intrinsic sympathomimetic activity (pindolol), or cardioselectivity (metoprolol, atenolol).(ABSTRACT TRUNCATED AT 400 WORDS)     

Coagulopathy,Venous Thromboembolism,and Anticoagulation in Patients with COVID-19

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to a worldwide pandemic, and patients with the infection are referred to as having COVID-19. Although COVID-19 is commonly considered a respiratory disease, there is clearly a thrombotic potential that was not expected. The pathophysiology of the disease and subsequent coagulopathy produce an inflammatory, hypercoagulable, and hypofibrinolytic state. Several observational studies have demonstrated surprisingly high rates of venous thromboembolism (VTE) in both general ward and intensive care patients with COVID-19. Many of these observational studies demonstrate high rates of VTE despite patients being on standard, or even higher intensity, pharmacologic VTE prophylaxis. Fibrinolytic therapy has also been used in patients with acute respiratory distress syndrome. Unfortunately, high quality randomized controlled trials are lacking. A literature search was performed to provide the most up-to-date information on the pathophysiology, coagulopathy, risk of VTE, and prevention and treatment of VTE in patients with COVID-19. These topics are reviewed in detail, along with practical issues of anticoagulant selection and duration. Although many international organizations have produced guidelines or consensus statements, they do not all cover the same issues regarding anticoagulant therapy for patients with COVID-19, and they do not all agree. These statements and the most recent literature are combined into a list of clinical considerations that clinicians can use for the prevention and treatment of VTE in patients with COVID-19.     

Overt aggression and psychotic symptoms in patients with schizophrenia treated with clozapine, olanzapine, risperidone, or haloperidol

The subjects were 157 treatment-resistant inpatients diagnosed with chronic schizophrenia or schizoaffective disorder. They were randomly assigned to treatment with clozapine, olanzapine, risperidone, or haloperidol in a 14-week, double-blind trial. Incidents of overt aggression were recorded and their severity was scored. The Positive and Negative Syndrome Scale was administered. Atypical antipsychotics showed an overall superiority over haloperidol, particularly after the first 24 days of the study when the dose escalation of clozapine was completed. Once an adequate therapeutic dose of clozapine was reached, it was superior to haloperidol in reducing the number and severity of aggressive incidents. Patients exhibiting persistent aggressive behavior showed less improvement of psychotic symptoms than the other patients. There was an interaction between aggressiveness, medication type, and antipsychotic response: risperidone and olanzapine showed better antipsychotic efficacy in patients exhibiting less aggressive behavior; the opposite was true for clozapine. Clozapine appears to have superior antiaggresive effects in treatment-resistant patients; this superiority develops after the patient has been exposed to an adequate dose regimen.