Severe COVID-19 Patients Show an Increase in Soluble TNFR1 and ADAM17, with a Relationship to Mortality.

Overproduction of inflammatory cytokines is a keystone event in COVID-19 pathogenesis; TNF and its receptors (TNFR1 and TNFR2) are critical pro-inflammatory molecules. ADAM17 releases the soluble (sol) forms of TNF, TNFR1, and TNFR2. This study evaluated TNF, TNFRs, and ADAM17 at the protein, transcriptional, and gene levels in COVID-19 patients with different levels of disease severity. In total, 102 patients were divided into mild, moderate, and severe condition groups. A group of healthy donors (HD; n = 25) was included. Our data showed that solTNFR1 and solTNFR2 were elevated among the COVID-19 patients (p < 0.0001), without increasing the transcriptional level. Only solTNFR1 was higher in the severe group as compared to the mildly ill (p < 0.01), and the level was higher in COVID-19 patients who died than those that survived (p < 0.0001). The solTNFR1 level had a discrete negative correlation with C-reactive protein (p = 0.006, Rho = -0.33). The solADAM17 level was higher in severe as compared to mild disease conditions (p < 0.01), as well as in COVID-19 patients who died as compared to those that survived (p < 0.001). Additionally, a potential association between polymorphism TNFRSF1A:rs767455 and a severe degree of disease was suggested. These data suggest that solTNFR1 and solADAM17 are increased in severe conditions. solTNFR1 should be considered a potential target in the development of new therapeutic options.

Películas infantiles como alternativa a la sedación en el estudio ecocardiográfico de pacientes pediátricos

Introducción. La realización del ecocardiograma se dificulta si el niño no coopera, por lo que es necesario sedarlo. Para evitar los posibles efectos adversos de la sedación se ha propuesto utilizar la proyección de películas infantiles durante el estudio. Material y métodos. Se formaron 2 grupos de pacientes no cooperadores entre 1 y 3 años de edad de manera aleatoria: uno sometido a sedación (13 niños) y otro al que se proyectó una película infantil (15 niños). En ambos grupos se evaluaron escalas semicuantitativas de cooperación, calidad de imagen y el tiempo de realización del estudio. Resultados. No se encontró diferencia estadísticamente significativa entre ambos grupos en cuanto a las escalas de cooperación y calidad de imagen, así como en el tiempo de realización del estudio. Conclusiones. Este método evita la exposición a los riesgos de la sedación, obteniendo cooperación e información similares, y pudiera disminuir los recursos necesarios para la realización del estudio.

Introduction. It is often difficult to perform echocardiograms in small children because of lack of cooperation, hence the need for sedation. In order to avoid the possible adverse effects of sedation, the projection of age-appropriate films during the study has been proposed as an alternative. Material and methods. Pediatric non-cooperative patients, ages between 1 and 3 years old with an indication for elective echocardiography were randomly assigned to either 1 of 2 groups: the first one (13 patients) with intranasal midazolam sedation (300 mg/kg), and the other group (15 patients) with video-projection of movies. Cooperation and image quality scores differences were evaluated (Mann-Whitney), as well as the mean study performance time between the 2 groups. Results. Cooperation and image quality scores were similar between the 2 groups. There was a trend toward a shorter mean study performance time in the video group, not reaching statistical significance. Conclusions. Projection of age-appropriate movies during echocardiographic studies in pediatric non-cooperative patients is a good alternative to sedation, avoiding related risks and resource expenditure with similar cooperation and echocardiographic information.