Effectiveness of Plasmapheresis Treatment in the Treatment of Patients with COVID-19 Disease.

Background: According to the World Health Organization, COVID-19 management focuses primarily on infection prevention, case management, case monitoring, and supportive care. However, due to the lack of evidence, no specific anti-SARS-CoV-2 treatment is recommended. This study aimed to evaluate the effectiveness of plasmapheresis treatment in COVID-19 patients with symptoms of pulmonary involvement on the computed tomography (CT) of the lung. Methods: In 2021, an experimental study in critically ill patients admitted to the COVID-19 ward in the Hazrat-e Rasool hospital diagnosed with COVID-19 was conducted in the second phase (pilot study). The diagnosis was confirmed according to clinical signs, CT scan of the lung, and the Polymerase chain reaction (PCR) test. All patients received the usual treatments for COVID-19 disease and underwent plasmapheresis at a dose of 40 cc/kg daily up to 4 doses. All patients were observed for 24 hours for complications of plasmapheresis treatment and simultaneously for symptoms of COVID-19, after which only routine care measures were performed. The next day and 2 weeks after resumption of the treatment, patients experienced COVID-19 symptoms, including shortness of breath, cough, and fever. Blood oxygen saturation, and treatment results were evaluated. Qualitative and rank variables were described using absolute and relative frequencies and quantitative parametric variables were used using mean and confidence interval. Frequencies were compared in groups using the chi-square test. All tests were performed in 2 directions and P > 0.05 was considered statistically significant. Results: Of the 120 patients studied, 79 (65.8%) were men and 41 (34.2%) were women. The mean age was 60.30 ± 15.61 years (22-95 years). The mean hospital stay was 12.89 days ± 7.25 days (2-38 days). Increased blood oxygen saturation levels in patients had an increasing trend. Inflammatory indices had a downward trend in patients. The frequency of plasmapheresis had no significant effect on reducing the downward trend of inflammatory markers. The greatest reduction occurred in the first plasmapheresis. Conclusion: Finally, according to the findings, plasmapheresis is one of the appropriate treatments to improve patients' symptoms and reduce cytokine storm. Recovered patients had lower levels of inflammatory markers than those who died.

Spontaneous pneumothorax and pneumomediastinum in patients with COVID‐19: A case series from Iran

Here, we report six cases of spontaneous pneumothorax and pneumomediastinitis in patients with COVID‐19 in Iran, which were treated with different drugs such as hydroxychloroquine, sofosbuvir, atazanavir, and remdesivir as antiviral agents. Despite the differences in the type of drugs, pneumothorax occurred in all patients. Chest CT can provide useful information in patients with COVID‐19‐associated pneumonia. Pneumothorax and pneumomediastinum may develop in COVID‐19‐associated pneumonia due to alveolar damage. Pneumothorax and pneumomediastinum may be the first symptom of COVID‐19 or a late complication. Pneumothorax and pneumomediastinum may appear in the patients with different antiviral therapy.

Spontaneous pneumothorax and pneumomediastinum in patients with COVID-19: A case series from Iran.

Here, we report six cases of spontaneous pneumothorax and pneumomediastinitis in patients with COVID-19 in Iran, which were treated with different drugs such as hydroxychloroquine, sofosbuvir, atazanavir, and remdesivir as antiviral agents. Despite the differences in the type of drugs, pneumothorax occurred in all patients.

Renal failure and lung hemorrhage as a presentation of COVID-19 infection, a case report.

The concurrent involvement of the lung and kidneys happens in COVID-19 infection. The patient's respiratory symptoms resolved after hemodialysis. This finding raises the question that if hemodialysis can have a role in the treatment of COVID-19.

Lung abscess as a complication of COVID-19 infection, a case report.

To our knowledge, no previous studies have reported lung abscess as a complication of COVID-19 infection. It is essential to follow-up with the patients after discharge for such complications, especially if they are symptomatic.

Neuropsychiatric manifestations of COVID-19 can be clustered in three distinct symptom categories.

Several studies have reported clinical manifestations of the new coronavirus disease. However, few studies have systematically evaluated the neuropsychiatric complications of COVID-19. We reviewed the medical records of 201 patients with confirmed COVID-19 (52 outpatients and 149 inpatients) that were treated in a large referral center in Tehran, Iran from March 2019 to May 2020. We used clustering approach to categorize clinical symptoms. One hundred and fifty-one patients showed at least one neuropsychiatric symptom. Limb force reductions, headache followed by anosmia, hypogeusia were among the most common neuropsychiatric symptoms in COVID-19 patients. Hierarchical clustering analysis showed that neuropsychiatric symptoms group together in three distinct groups: anosmia and hypogeusia; dizziness, headache, and limb force reduction; photophobia, mental state change, hallucination, vision and speech problem, seizure, stroke, and balance disturbance. Three non-neuropsychiatric cluster of symptoms included diarrhea and nausea; cough and dyspnea; and fever and weakness. Neuropsychiatric presentations are very prevalent and heterogeneous in patients with coronavirus 2 infection and these heterogeneous presentations may be originating from different underlying mechanisms. Anosmia and hypogeusia seem to be distinct from more general constitutional-like and more specific neuropsychiatric symptoms. Skeletal muscular manifestations might be a constitutional or a neuropsychiatric symptom.

Evolution and resolution of brain involvement associated with SARS- CoV2 infection: A close Clinical - Paraclinical follow up study of a case.

The new severe acute respiratory syndrome- coronavirus 2 is reported to affect the nervous system. Among the reports of the various neurological manifestations, there are a few documented specific processes to explain the neurological signs. We report a para-infectious encephalitis patient with clinical, laboratory, and imaging findings during evolution and convalescence phase of coronavirus infection. This comprehensive overview can illuminate the natural history of similar cases. As the two previously reported cases of encephalitis associated with this virus were not widely discussed regarding the treatment, we share our successful approach and add some recommendations about this new and scarce entity.