MRI Changes Among Patients Of Eclampsia And Preeclampsia With Associated Neurological Symptom Analysis.

BACKGROUND: Pregnancy poses some stress on normal homeostasis of the human body and brings changes in the body which predisposes the individual towards various pathological conditions as well. Objective: Objective of the study was to determine the magnetic resonance imaging (MRI) changes and clinical symptoms associated with these changes among patients of eclampsia and preeclampsia managed at tertiary care unit. It was a cross-sectional study, conducted at Gynaecology and obstetrics department Pak Emirates Military Hospital (PEMH) Rawalpindi. January to June 2019. METHODS: A total of 80 pregnant women who were diagnosed by consultant obstetrician for eclampsia or pre-eclampsia were included in the study. All the patients underwent Plain MRI brain including TIWI, T2WI, FLAIR, DWI, ADC, GRE and SWI sequences at radiology department of PEMH RWP. Positive MRI findings were defined as presence of cerebral oedema, infarction, cerebral venous sinus thrombosis and cerebral haemorrhage. Headache, seizures, altered mental status and visual problems were correlated with MRI changes among the target population. RESULTS: Out of 80 pregnant women with eclampsia or preeclampsia, 49 (61.2%) had no changes on MRI while 31 (38.8%) had significant changes on MRI. Cerebral oedema 12 (15%) was the most common MRI finding followed by cerebral haemorrhage 8 (10%). Mean age of participants was 36.33±2.238 years. With Pearson chi-square analysis, it was found that presence of seizures and altered mental state had statistically significant relationship with presence of MRI findings among the target population. CONCLUSIONS: MRI changes were a common finding among the patients of eclampsia or pre-eclampsia. Cerebral oedema was the commonest finding in our study. Patients with serious clinical symptoms like seizures and altered mental state had more chances of having MRI changes as compared to patients without the serious clinical symptoms.

Therapeutic plasma exchange for coronavirus disease-2019 triggered cytokine release syndrome; a retrospective propensity matched control study.

BACKGROUND: Cytokine release syndrome (CRS) plays a pivotal role in the pathophysiology and progression of Coronavirus disease-2019 (COVID-19). Therapeutic plasma exchange (TPE) by removing the pathogenic cytokines is hypothesized to dampen CRS. OBJECTIVE: To evaluate the outcomes of the patients with COVID-19 having CRS being treated with TPE compared to controls on the standard of care. METHODOLOGY: Retrospective propensity score-matched analysis in a single centre from 1st April to 31st July 2020. We retrospectively analyzed data of 280 hospitalized patients developing CRS initially. PSM was used to minimize bias from non-randomized treatment assignment. Using PSM 1:1, 90 patients were selected and assigned to 2 equal groups. Forced matching was done for disease severity, routine standard care and advanced supportive care. Many other Co-variates were matched. Primary outcome was 28 days overall survival. Secondary outcomes were duration of hospitalization, CRS resolution time and timing of viral clearance on Polymerase chain reaction testing. RESULTS: After PS-matching, the selected cohort had a median age of 60 years (range 32-73 in TPE, 37-75 in controls), p = 0.325 and all were males. Median symptoms duration was 7 days (range 3-22 days' TPE and 3-20 days controls), p = 0.266. Disease severity in both groups was 6 (6.6%) moderate, 40 (44.4%) severe and 44 (49%) critical. Overall, 28-day survival was significantly superior in the TPE group (91.1%), 95% CI 78.33-97.76; as compared to PS-matched controls (61.5%), 95% CI 51.29-78.76 (log rank 0.002), p<0.001. Median duration of hospitalization was significantly reduced in the TPE treated group (10 days vs 15 days) (p< 0.01). CRS resolution time was also significantly reduced in the TPE group (6 days vs. 12 days) (p< 0.001). In 71 patients who underwent TPE, the mortality was 0 (n = 43) if TPE was done within the first 12 days of illness while it was 17.9% (deaths 5, n = 28 who received it after 12th day (p = 0.0045). CONCLUSION: An earlier use of TPE was associated with improved overall survival, early CRS resolution and time to discharge compared to SOC for COVID-19 triggered CRS in this selected cohort of PS-matched male patients from one major hospital in Pakistan.