Does therapeutic plasma exchange have a role in resistant cytokine storm state of COVID-19 infection?

Introduction: Among the main causes of mortality in COVID-19 patients is cytokine storm (CS) state. Few treatment options with variable efficacy results are available for its management. We aimed to illustrate the efficacy of Therapeutic Plasma Exchange (TPE) treatment in COVID-19 patients with resistant CS.Material and methods: This research is a prospective pilot study which included ten COVID-19 positive patients with CS state with no response after two doses of tocilizumab. Each patient received three to five TPE sessions according to his/her response. Respiratory status {oxygen (O2) requirements and data of mechanical ventilation} and laboratory markers (IL-6, CRP, ferritin, D dimer, LDH) were assessed before and after TPE. We reported mortality at 28 day of illness.Results: Six males and four females were enrolled in the study with a mean age of (52.9 years). Seven patients (70%) were on mechanical ventilation (MV). After TPE, oxygenation parameters and most laboratory markers improved significantly in all patients (p < 0.05). Four patients survived and were discharged (40%). One was on MV and three were not. The four patients had better hypoxic index (PaO2/FiO2 ratio) (˃100 vs <100), started TPE sooner after tocilizumab failure (2–3 vs 5–6 days), needed fewer TPE sessions (3 vs 4–5, p = 0.03), and less duration in ICU (6.5 vs 12.5 days) compared to those who did not benefit.Conclusions: In patients with CS state who did not respond well to tocilizumab and steroids, TPE could be a good option. Larger randomized clinical trials are needed to support its use.Clinical trials registration: ClinicalTrials.gov Identifier:NCT0445734

Role of aldose reductase C-106T polymorphism among diabetic Egyptian patients with different microvascular complications

The aldose reductase pathway proves that elevated blood glucose promotes cellular dysfunction. The polyol pathway converts excess intracellular glucose into alcohols via activity of the aldose reductase. This enzyme catalyzes the conversion of glucose to sorbitol which triggers variety of intracellular changes in the tissues. Among diabetes, activity is drastically increased in association with three main consequences inside the cells. The aim of this study was to detect the association of the C-106 T polymorphism of the aldose reductase gene and its frequency among a sample of 150 Egyptian adults with type 2 diabetic patients having diabetic microvascular. The detection of the aldose reductase C-106 T polymorphism gene was done by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The genotype distribution of the C-106 T polymorphism showed that CC genotype was statistically significantly higher among patients with retinopathy compared to nephropathy. Patients with nephropathy had significant association with the TT genotype when compared with diabetic retinopathy patients. Follow up study after the genotype detection among recently diagnosed diabetic patients in order to give a prophylactic aldose reductase inhibitors; studying the microvascular complications and its relation to the genotype polymorphisms. The study may include multiple gene polymorphisms to make the relation between the gene and the occurrence of these complications more evident.</p