Introduction: COVID 19 pneumonia can lead to an inappropriate inflammatory response, and can be complicated by acute respiratory distress syndrome, multivisceral failure with a high mortality rate. Objective: To observe the effect of therapeutic plasma exchange on the excessive inflammatory response. Materials and methods: In this study, we included 7 confirmed cases of COVID-19 in the intensive care unit (ICU) department of the university hospital of Oujda. COVID-19 cases were confirmed by RT PCR (reverse transcription-polymerase chain) and CT (computerized tomography) imaging according to WHO guidelines. Therapeutic plasma exchange was performed decrease cytokine storm-induced ARDS (Acute respiratory distress syndrome). Inflammation marker assays were performed before and after therapeutic plasma exchange to assess its efficacy. Results: Levels of inflammatory cytokines (IL-6) and acute phase response proteins, including ferritin and CRP, were elevated before therapeutic plasma exchange. After therapeutic plasma exchange, levels of acute phase reactants, inflammatory mediators, were significantly reduced (p < 0.05). Conclusion: Our data suggest that therapeutic plasma exchange reduces the inflammatory response in patients with severe COVID-19 not undergoing mechanical ventilation. Further studies are needed to explore the efficacy of therapeutic plasma exchange in patients with COVID-19.

Coronavirus disease 2019 (COVID-19) is the health crisis of our time and a great challenge we face, requiring the implementation of worldwide general containment. The symptoms and complications of COVID-19 are diverse, and rhabdomyolysis is an atypical manifestation. We report a case of a 63-year-old patient, admitted to the emergency room for myalgia and fever evolving over 5 days, in whom laboratory and other examinations indicated rhabdomyolysis complicated by renal insufficiency. During the diagnostic workup, the real-time polymerase chain reaction (RT-PCR) test result for COVID-19 was positive, revealing infection with sudden acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although the severity of COVID-19 infection relates mainly to acute respiratory syndrome, other complications can be prognostic, and these complications make the management of this disease difficult. Rhabdomyolysis is one of the fatal complications; first, because the pathophysiological mechanism is not yet understood, and second, because rhabdomyolysis, itself, is usually complicated by acute renal failure. This complication makes the disease management difficult, especially in patients with SARS. Rhabdomyolysis during COVID-19 infection represents a significant challenge, given the few reported cases, and further research is required to develop a therapeutic consensus.

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The medical care of patients with hematological malignancies who develop coronavirus disease 2019 (COVID-19) has been a major challenge during the current pandemic. We herein describe a patient in the blast phase of chronic myeloid leukemia who was hospitalized for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The patient was successfully treated with tocilizumab, and intubation was avoided. The severity of SARS-CoV-2 infection is mostly related to a severe acute respiratory distress syndrome that develops secondary to cytokine release syndrome, and interleukin 6 is the main cytokine involved in cytokine release syndrome. Very few reports have described the use of tocilizumab in patients with hematologic malignancies who develop SARS-CoV-2 infection, although a few cases of patients with multiple myeloma have been reported. To our knowledge, however, this is the first report of a SARS-CoV-2–infected patient in the blast phase of chronic myeloid leukemia who had a favorable response to treatment with tocilizumab. The management of patients with hematological malignancies who become infected with SARS-CoV-2 is a major challenge for practitioners, necessitating more specific research in this direction.

Background COVID-19 is a new disease that appeared in December 2019. Millions of people have been infected and died from this infection. Until today, the pathophysiology and treatment of this infection remain unknown, but a lot of studies are trying to solve the mystery. The trail of inflammation remains the most convincing, especially the Interleukin 6 (IL-6) which could play an important role in a reaction cascade leading to a cytokine storm. According to studies, although few in number, the Tociluzimab (TCZ), which is an anti-IL6, could prevent or even suppress this storm, leading to a less severe clinical state of the disease and a faster recovery. This could decrease the use of oxygen, avoid the risk of intubation and mortality. Patients and methods This single-center retrospective observational case review brought together 557 COVID-19 seriously ill patients (pulmonary involvement> 25% + SatO 2 AA <90%) admitted to the intensive care unit of our university hospital from March 1 st , 2020 to February 28 th , 2021. They were divided into 2 groups a Tociluzimab group (TCZ group) and a Non Tociluzimab group (NON TCZ) to facilitate the comparison. The aim of the study was to compare the length of hospital stay, the use of mechanical ventilation and the mortality in the TCZ group versus the NON TCZ group. Results The average age of our patients was 62,05 years (±13.51) and 62.61 years (±16.33) respectively in the TCZ versus NON TCZ group. 76 (76%) were men while 24 were women (24%) in the TCZ group; and there was 313 (68.49%) men and 144 (31.51%) women in the NON TCZ group. Their average BMI was 28 kg/m2 (±4.52) in the TCZ group versus 27.89 kg/m2 (±4.73) in the NON TCZ group. Among them, the TCZ group included 38 (38%) diabetic patients, 38 hypertensive (38%), 12 heart disease (12%) and 2 chronic renal failure (2%), while the NON TCZ group regrouped 35 (7.65%) diabetics, 33 (7.22%) hypertensive, 12 heart disease (2.67%), and 5 chronic renal failure (1.09%) patients. The mean time to consultation of patients was almost similar in the two groups: 8.86 (±7,28) days for TCZ and 8.83 (±7,03) days for NON TCZ group. The mean length of ICU hospital stay was 9 days (4,94) for the TCZ group and 8,75 days (4,73) for the other one. The saturation at admission was at 74.92% (10.45) for the TCZ group ranging from 40% to 92%, and at 73,56% for the NON TCZ group. Lung damage from COVID-19 was extensive in 12%, severe in 32%, and critical in 56% of TCZ group enrolled cases. Meanwhile it was extensive in 23.63%, severe in 41,35%, and critical in 35,01% of the NON TCZ group. The biological findings found average of white blood cells at 12256/12082 e/mm 3 , lymphocytes at 761/842 e/mm 3 , CRP at 181/199 mg/L, ferritin at 1747/528 μg/L, and fibrinogen at 6.92/6.27 g/L for the TCZ group versus NON TCZ group. Medical care was...

Introduction Acute kidney injury (AKI) is commonly seen in critically ill hospitalized patients with COVID-19 and its incidence reaches 60% in this setting. The aim of this work was to determine the prevalence, characteristics, risk factors and mortality of AKI in patients admitted to the intensive care unit (ICU) for COVID-19. Patients and methods This observational retrospective case series was conducted between February 1, 2020 and December 31, 2020 at the ICU of the university hospital Mohammed VI of Oujda, Morocco. all COVID-19 patients hospitalized in the ICU with acute respiratory failure were included. AKI was defined and classified into three stages using the KDIGO criteria 2012. We excluded patients with end-stage kidney disease and those who were under 18 years old. Results Six hundred adult patients were included and 65.5% of them were men. Sixty patients had minimal lung damage (< 25%), 105 patients had mild lung damage (25-50%), 186 had severe lung damage (50-75%) and 193 patients had very severe lung damage (> 75%). A total of 210 patients (35%) developed AKI, of whom 78 (37.2%) had mild AKI (stage 1) and 132 (62.8%) severe AKI (stages 2 and 3). Patients in the severe and mild AKI groups had a higher rate of comorbidities, especially hypertension (mild AKI [46.2%] vs. severe AKI [36.4%] vs. no AKI [27.4%], p = 0.002) and diabetes (mild AKI [52.6%] vs. severe AKI [33.3%] vs. no AKI [26.4%], p < 0.001). During hospitalization, 23.3% of patients with AKI received kidney replacement therapy. In-hospital mortality was observed in 51.3% for mild AKI, 55.3% for severe AKI and 21% in patients who did not have AKI (p < 0.001). Conclusion Our findings revealed that not only severe AKI, but also mild AKI was correlated to in-hospital mortality. Whatever the severity of the kidney impairment, it remains a major prognostic element.

Introduction: Tuberculous Peritonitis (TP) in pregnancy is a rare condition, and the diagnosis can be deleyed because of the symptoms non specificity. Case report: 31-year-old parturient primigravidia at 34 weeks of amenorrhea presented diffuse and intense abdominal pain with vomiting. Examination found abdominal distention with ascites. Investigations did not lead to a precise diagnosis, therefore, an exploration by laporotomy with cesarean delivery were performed. The diagnosis of Tuberculous peritonitis on histopathologic examination was confirmed. Discussion: Tuberculous peritonitisis extremely rare in pregnancy, and the rate of TP among all forms of tuberculosis varies from 0.1% to 0.7% worldwide. Gold standards for the diagnosis of TP are the identification of M. tuberculosis in ascites and peritoneal biopsy findings compatible with tuberculosis. Bacteriologic examination of the biopsy specimen should be performed, because this could be positive for tuberculosis when histological examination is negative. Conclusion: The early diagnosis and treatment of TP in pregnancy are important to prevent obstetric and neonatal morbidities. Keywords: tuberculous peritinitis; pregnancy; rare; delayed diagnosis.

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