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

Study of urinary interferon gamma-induced protein 10 (IP-10) and urinary soluble CD 25 (sCD25) as markers of lupus nephritis and their relation to histological class

Objective: To study the role of urinary interferon gamma-induced protein 10 (IP-10) and urinary soluble CD 25 (sCD 25) as diagnostic and prognostic markers of lupus nephritis (LN) and their relation to the LN class in renal biopsy.Subjects and methods: This study included 45 lupus patients fulfilling the Systemic Lupus International Collaborating Clinics (SLICC) classification criteria: 25 patients with active LN during activity and during follow up (3 months later) as [group A] and 20 patients without any signs of activity [group B]. (20) age and sex matched healthy subjects were enrolled as control group [group C]. Urine samples were collected at baseline and at follow up. Urinary IP-10 and sCD25 were measured by ELISA.Results: Urinary IP-10 and sCD25 levels were higher in group A compared to groups B and C (P < 0.001 for both). In patients with active nephritis, urinary IP-10 and sCD25 correlated positively with serum creatinine (P < 0.001 for both), proteinuria (p = 0.010; p = 0.007), anti ds-DNA (p = 0.002; p < 0.001), SLEDAIscore (global) (P < 0.001 for both), and renal SLEDAI score (p = 0.002; p < 0.001) respectively. The urinary IP-10 and sCD25 levels were highest in patients with class (IV) LN and lowest in class (II) patients with a statistically significant difference. In patients achieving remission with treatment, both markers decreased significantly.Conclusion: Urinary IP-10 and sCD25 are potential biomarkers for early recognition and follow up of LN.Keywords: Lupus nephritis, Urinary, IP-10, CD2

Relation of testosterone level and other factors with bone mineral density in male kidney transplant recipients: a cross-sectional study

Abstract Background Although testosterone has a pivotal role in bone health, its correlation with bone mineral density (BMD) is understudied in kidney transplant recipients who are at high risk of osteoporosis. This study aimed to elucidate if there is any correlation between serum free testosterone and BMD in this population. Patients and methods Sixty male kidney transplant recipients were enrolled in this cross-sectional study, and they were subjected to history taking, clinical examination, and laboratory investigations (including total and free testosterone). BMD was assessed in three regions (forearm, hip, and lumbar spine) using DEXA scan. Results The mean age of the included patients was 45.55 ± 13.58 years. Serum total and free testosterone had mean values of 5.17 ± 1.4 ng/ml and 95.46 ± 28.24 pg/ml, respectively, with all levels within the normal range. DEXA scan detected osteoporosis and osteopenia in 9 (15%) and 30 (50%) patients in the lumbar region, 3 (5%) and 36 (60%) in the hip region, as well as 21 (35%) and 33 (55%) in the forearm region, respectively. BMD of the lumbar region had a significant positive correlation with free testosterone, phosphorus, and eGFR, while it had a significant negative correlation with platelets and patient age. BMD of the hip region was positively correlated with serum phosphorus, parathyroid hormone, and duration since the transplant, whereas it was negatively correlated with platelets and total testosterone level. BMD of the forearm had a significant positive correlation with eGFR, whereas it had a significant negative correlation with age and duration since transplantation. In addition, forearm BMD was significantly lower in patients with a radiocephalic AVF. Conclusion Even within the normal range, free testosterone has a significant positive correlation with lumbar spine BMD with no significant association with the forearm or hip BMD