2.Pregnancy Outcomes in COVID-19: A Prospective Cohort Study in Singapore.
Citra Nz MATTAR ; Shirin KALIMUDDIN ; Sapna P SADARANGANI ; Shephali TAGORE ; Serene THAIN ; Koh Cheng THOON ; Eliane Y HONG ; Abhiram KANNEGANTI ; Chee Wai KU ; Grace Mf CHAN ; Kelvin Zx LEE ; Jeannie Jy YAP ; Shaun S TAN ; Benedict YAN ; Barnaby E YOUNG ; David C LYE ; Danielle E ANDERSON ; Liying YANG ; Lin Lin SU ; Jyoti SOMANI ; Lay Kok TAN ; Mahesh A CHOOLANI ; Jerry Ky CHAN
Annals of the Academy of Medicine, Singapore 2020;49(11):857-869
INTRODUCTION:
Pregnant women are reported to be at increased risk of severe coronavirus disease 2019 (COVID-19) due to underlying immunosuppression during pregnancy. However, the clinical course of COVID-19 in pregnancy and risk of vertical and horizontal transmission remain relatively unknown. We aim to describe and evaluate outcomes in pregnant women with COVID-19 in Singapore.
METHODS:
Prospective observational study of 16 pregnant patients admitted for COVID-19 to 4 tertiary hospitals in Singapore. Outcomes included severe disease, pregnancy loss, and vertical and horizontal transmission.
RESULTS:
Of the 16 patients, 37.5%, 43.8% and 18.7% were infected in the first, second and third trimesters, respectively. Two gravidas aged ≥35 years (12.5%) developed severe pneumonia; one patient (body mass index 32.9kg/m2) required transfer to intensive care. The median duration of acute infection was 19 days; one patient remained reverse transcription polymerase chain reaction (RT-PCR) positive >11 weeks from diagnosis. There were no maternal mortalities. Five pregnancies produced term live-births while 2 spontaneous miscarriages occurred at 11 and 23 weeks. RT-PCR of breast milk and maternal and neonatal samples taken at birth were negative; placenta and cord histology showed non-specific inflammation; and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific immunoglobulins were elevated in paired maternal and umbilical cord blood (n=5).
CONCLUSION
The majority of COVID-19 infected pregnant women had mild disease and only 2 women with risk factors (obesity, older age) had severe infection; this represents a slightly higher incidence than observed in age-matched non-pregnant women. Among the women who delivered, there was no definitive evidence of mother-to-child transmission via breast milk or placenta.
Abortion, Spontaneous/epidemiology*
;
Adult
;
COVID-19/transmission*
;
COVID-19 Nucleic Acid Testing
;
COVID-19 Serological Testing
;
Cohort Studies
;
Disease Transmission, Infectious/statistics & numerical data*
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Female
;
Fetal Blood/immunology*
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Humans
;
Infectious Disease Transmission, Vertical/statistics & numerical data*
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Live Birth/epidemiology*
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Maternal Age
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Milk, Human/virology*
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Obesity, Maternal/epidemiology*
;
Placenta/pathology*
;
Pregnancy
;
Pregnancy Complications, Infectious/physiopathology*
;
Pregnancy Outcome/epidemiology*
;
Pregnancy Trimester, First
;
Pregnancy Trimester, Second
;
Prospective Studies
;
RNA, Viral/analysis*
;
Risk Factors
;
SARS-CoV-2
;
Severity of Illness Index
;
Singapore/epidemiology*
;
Umbilical Cord/pathology*
;
Young Adult
3.Prescription Patterns for Bipolar Disorder in Asian Countries:Findings from Research on Asian Prescription Pattern-Bipolar Disorder
Shih-Ku LIN ; Shu-Yu YANG ; Seon-Cheol PARK ; Ok-Jin JANG ; Xiaomin ZHU ; Yu-Tao XIANG ; Wen-Chen OUYANG ; Afzal JAVED ; M. Nasar SAYEED KHAN ; Sandeep GROVER ; Ajit AVASTHI ; Roy Abraham KALLIVAYALIL ; Kok Yoon CHEE ; Norliza CHEMI ; Takahiro A. KATO ; Kohei HAYAKAWA ; Pornjira PARIWATCHARAKUL ; Margarita MARAMIS ; Lakmi SENEVIRATNE ; Sim KANG ; Wai Kwong TANG ; Tin OO ; Norman SARTORIUS ; Chay-Hoon TAN ; Mian-Yoon CHONG ; Yong Chon PARK ; Naotaka SHINFUKU
Clinical Psychopharmacology and Neuroscience 2022;20(1):61-69
Objective:
Pharmacotherapy including mood stabilizers and antipsychotics are frequently used in bipolar disorder (BD); however, the lack of consensus regarding the definition of polypharmacy hinders conducting comparative studies across different settings and countries. Research on Asian Prescription Pattern (REAP) is the largest and the longest lasting international collaborative research in psychiatry in Asia. The objective of REAP BD was to investigate the prescription patterns of psychotropic medications across Asian countries. The rates of polypharmacy and psychotropic drug load were also analyzed.
Methods:
The data collection was web-based. Prescription patterns were categorized as (1) mood stabilizer monotherapy: one mood stabilizer; (2) antipsychotic monotherapy: one antipsychotic; (3) simple polypharmacy: one mood stabilizer and one antipsychotic; and (4) complex polypharmacy: ≥ 2 mood stabilizers or/and antipsychotics. The psychotropic drug load in each patient was calculated using the defined daily dose method.
Results:
Among 2003 patients with BD (52.1% female, 42.4 years) from 12 countries, 1,619 (80.8%) patients received mood stabilizers, 1,644 (82.14%) received antipsychotics, and 424 (21.2%) received antidepressants, with 14.7% mood stabilizer monotherapy, 13.4% antipsychotic monotherapy, 48.9% simple polypharmacy, 20.3% complex polypharmacy, and 2.6% other therapy. The average psychotropic drug load was 2.05 ± 1.40. Results varied widely between countries.
Conclusion
Over 70% of psychotropic regimens involved polypharmacy, which accords with the high prevalence of polypharmacy in BD under a permissive criterion (2 or more core psychotropic drugs) worldwide. Notably, ≥ 80% of our sample received antipsychotics, which may indicate an increasing trend in antipsychotic use for BD treatment.