ABSTRACT
Background@#With the emergence of the coronavirus disease 2019 (COVID-19) and inability of healthcare systems to control the disease, various therapeutic theories with controversial responses have been proposed. Plasmapheresis was administered as a medication.However, the knowledge of its efficacy and indications is inadequate. This study evaluated the use of plasmapheresis in critically ill patients with cancer. @*Methods@#This randomized clinical trial was conducted on 86 patients with malignancies, including a control group (N=41) and an intervention group (N=45) with severe COVID-19 during 2020-21. Both groups were treated with routine medications for COVID-19 management according to national guidelines, and plasmapheresis was applied to the intervention group. C-reactive protein (CRP), D-dimer, ferritin, lactate dehydrogenase, hemoglobin, and white blood cell, polymorphonuclear, lymphocyte, and platelet levels were measured at admission and at the end of plasmapheresis. Other variables included neutrophil recovery, intensive care unit admission, intubation requirements, length of hospital stay, and hospitalization outcomes. @*Results@#CRP (P ＜0.001), D-dimer (P ＜0.001), ferritin (P =0.039), and hemoglobin (P =0.006) levels were significantly different between the groups after the intervention. Neutrophil recovery was remarkably higher in the case than in the control group (P ＜0.001). However, plasmapheresis did not affect the length of hospital stay (P =0.076), which could have significantly increased survival rates (P ＜0.001). @*Conclusion@#Based on the study findings, plasmapheresis led to a significant improvement in laboratory markers and survival rate in patients with severe COVID-19. These findings reinforce the value of plasmapheresis in cancer patients as a critical population suffering from neutropenia and insufficient immune responses.
ABSTRACT
Brucellosis is a zoonotic disease that is common in developing countries such as Iran which is a serious medical impact. Vascular complications, including arterial and venous associated with Brucella infection, have rarely been reported. In a review of articles, it is clear that, only five cases of deep venous thrombosis [DVT] of the lower extremities and just one case of cerebral venous thrombosis, associated with brucellosis have been reported so far. In this article a case of DVT of the left leg in association with acute Brucella infection was reported. Apparently, this case report is the first case of DVT due to brucellosis in Iran. Patient is a 28-year-old male who presented with clinical manifestations of fever, unilateral calf pain and swelling. Peripheral venous doppler ultrasound showed DVT and patient was treated with anti coagulants. Through controlling the fever and decreasing the lower extremity. The patient discharged with warfarin therapy. During follow up, the patient came back with repeated fever, sweating, myalgia and bilateral knee swelling. Because of patient clinical manifestation and epidemiologic status, brucellosis serology test was recommended, which was positive in high titer. He was discharged with a prescription of anti-brucellosis treatment. In the course of treatment, the patient referred to hospital due to sudden dyspnea, cough, hemoptysis, pleuretic chest pain. In spiral CT with protocol PTE, pulmonary thrombo emboli was detected and standard therapy for PTE was administered. In the course of his hospitalization other etiologies of thrombo phelebitis were excluded. Finally, the patient's clinical presentation subsided with warfarin therapy and anti brucellosis multi drug regimen. Early detection and appropriate treatment of Brucellosis are crucial measures to prevent problematic complications of the disease. The authors' case and those previously reported, suggest that brucellosis should be included among the etiologies and the infections which are taken into account in patients suffering from DVT, particularly in those coming from Brucella-endemic areas.