ABSTRACT
Background: The alpha wave of COVID-19 brought death and dismay to patients and to providers respectively. Remdesivir nor plasma was available. We studied this cohort to evaluate the need for mechanical ventilation (MV) and Renal replacement therapy and the outcome of hospital discharge. Is well known that the covid-19 causes Cytokine Release Syndrome (CRS), therefore, producing dysregulation and an increase in the immune response, interleukine 6, plays and central role in triggering the (CRS) and stimulating other inflammatory markers. Method(s): A retrospective-observational study. We reviewed the patients admitted to the intensive care unit of a metropolitan hospital in the Los Angeles area from February 17th, 2020, till March 14th, 2020. There was 24 patient who was in the ICU. At the time, Remdesivir was not available at the hospital Results: Eight of the 24 patients received Kevzara. Of the 8 patients, 2 required RRT while of the 16 patients who did not receive Kevzara, 6 required RRT. All 8 patients who received RRT also had MV for varying number of days and all were alive at 28 days. Among the 16 patients who did not receive Kevzara, 11 required mechanical ventilation, and 6 got RRT. 5 patients got both MV and RRT. The number of days of RRT was required was 12 in the Kevzara group and 4.25 in the none-Kevzara group. Chi Square value of 5.3706 p value = <0.5 Conclusion(s): Kevzara reduced 28-d mortality in the alpha wave of covid-19. There is incremental value in the use of Kevzara and Organ support technologies such as MV and RRT in the ICU. As the patient's life is prolonged in critical care units, there is increased demand for renal replacement therapy resources.
ABSTRACT
Introduction: Calcineurin inhibitor (CNI) neurotoxicity is common;has a wide array of presentation. Compromised blood brain barrier (BBB) is a risk factor. We studied a case of PCNSL in a kidney transplant recipient (KTR) with meningioma in order to bring to awareness of association between meningioma and PCNSL. Case Description: A 56-year-old female is a deceased donor KTR from 11-years ago by thymoglobulin induction. She develops new left hemiparesis and confusion. She was maintained on Tacrolimus (FK), Mycophenolate (MMF) and Prednisone. FK levels were therapeutic and and serum creatinine was 0.9 mg/dL. Epstein Barr Virus (EBV) and SARS-CoV-2 antigen tests were negative. Computed tomography (CT) of the brain showed a 4.2 x 4.5 x 3.9 cm mass centered in the left lentiform nucleus;midline shift of 1.1cm and a calcified meningioma. CT of the abdomen and pelvis was normal. Brain biopsy was consistent with PCNSL lymphoma. EBV encoded RNA staining was positive. Despite cytoreductive surgery and chemotherapy, PCNSL progressed. Her family elected hospice care. Discussion(s): Meningioma is common primary brain tumor with latency period of up to 30 years. A meningioma makes BBB permeable due to neo-angiogenesis at its margins. PCNSL constitute only 1% of Non-Hodgkin Lymphoma (NHL). Yet, PCNSL is 65 times more common in solid organ transplant recipients (SOTR) than in general population and six times more common than Non-Hodgkin's lymphoma (NHL). Therefore, we posit that PCNSL is a form of neurotoxicity due to persistently high concentration CNI via a permeable BBB. EBV is present in 90% of cases which makes host cell genome vulnerable to neurostructural changes. In our case PCNSL occurred despite therapeutic levels of CNI and despite absence of EBV in the serum. Conclusion(s): Meningioma related BBB permeability, increases severity of neurotoxicity and therefore, risk of PCNSL in a SOTR. Due to long latency of meningioma, risk of PCNSL can be and should be assessed prior to transplantation.