The Potential of Thyroid Hormone Therapy in Severe COVID-19: Rationale and Preliminary Evidence.

Tissue hypoxia is one of the main pathophysiologic mechanisms in sepsis and particularly in COVID-19. Microvascular dysfunction, endothelialitis and alterations in red blood cell hemorheology are all implicated in severe COVID-19 hypoxia and multiorgan dysfunction. Tissue hypoxia results in tissue injury and remodeling with re-emergence of fetal programming via hypoxia-inducible factor-1α (HIF-1a)-dependent and -independent pathways. In this context, thyroid hormone (TH), a critical regulator of organ maturation, may be of relevance in preventing fetal-like hypoxia-induced remodeling in COVID-19 sepsis. Acute triiodothyronine (T3) treatment can prevent cardiac remodeling and improve recovery of function in clinical settings of hypoxic injury as acute myocardial infarction and by-pass cardiac surgery. Furthermore, T3 administration prevents tissue hypoxia in experimental sepsis. On the basis of this evidence, the use of T3 treatment was proposed for ICU (Intensive Care Unit) COVID-19 patients (Thy-Support, NCT04348513). The rationale for T3 therapy in severe COVID-19 and preliminary experimental and clinical evidence are discussed in this review.

Measles pneumonitis.

Measles is an acute febrile illness, potentially fatal and highly contagious, which is transmitted through the respiratory mode. Fever combined with one of the following: cough, coryza, conjunctivitis are the first manifestations of the disease. Koplik's spots may also appear on the buccal mucosa providing an opportunity to set the diagnosis even before the emergence of rash. Rash typically appears 3-4 days after the onset of fever, initially on the face and behind the ears, and its appearance is associated with the peak of the symptoms. Measles affects multiple systems, including the respiratory system, with pneumonia being one of the most lethal complications. Management involves best supportive care, correction of dehydration and nutritional deficiencies, treatment of secondary bacterial infections and provision of vitamin A. Importantly, given that measles present with lifelong immunity following infection or vaccination, prevention through measles vaccination has a cardinal role for measles' elimination. Indeed, public education and vaccination led to an estimated 79% decrease in global measles deaths from 2000 to 2015. Nonetheless, the last two years have seen a measles outbreak in several countries, partially due to the anti-vaccination movement. This article aims to present two cases of measles in our hospital and highlight the pressing need for vaccination in order to eradicate a potentially fatal disease.

Prolonged Oxygen Kinetics During Constant Workload Submaximal Exercise Is Associated With Disease Severity in Adult Subjects With Cystic Fibrosis.

BACKGROUND: The goal of this study was to explore the relation between oxygen kinetics during constant work load submaximal cardiopulmonary exercise test (CPET) and disease severity in adult subjects with cystic fibrosis. METHODS: Fourteen adult subjects with cystic fibrosis (CF; 8 males, 22 ± 4 y old) and a mean Schwachman score of 73 ± 11 and 10 healthy individuals (5 males, 29 ± 4 y old) underwent pulmonary function tests at rest, maximal and constant work load submaximal CPET on a cycloergometer. Breath-by-breath analysis was used for measuring oxygen kinetic parameters and the time constant (tau), expressing phase 2 of submaximal CPET. RESULTS: Subjects with CF had a significantly prolonged tau compared with healthy subjects (42.3 ± 21.5 vs. 29.3 ± 6.4, s, P < .05). The tau during phase 2 was inversely correlated with FEV1(% pred) (r = -0.77, P = .001), breathing reserve (r = -0.74, P = .003), V̇O2peak (r = -0.53, P = .049), V̇O2/t slope (r = -0.58, P = .03), and Schwachman score (r = -0.80, P = .001). In a multivariate regression model including all the above variables, the Schwachman score (ß = -0.697, P = .002) emerged as independent predictor of tau (R2 = 0.719, P = .001). CONCLUSIONS: We conclude that adult subjects with CF present significant prolonged oxygen kinetics during constant work load submaximal exercise in relation to disease severity. Thus, submaximal exercise should be considered the preferable CPET choice in adult patients with severe CF.