Catecholamines (norepinephrine, epinephrine, dopamine) are stress hormones which actions are mediated through their adrenoceptors. The multisystem effect of excess secretion of these hormones in severe COVID-19 are manifested variedly as hypertension (cardiovascular and renin-angiotensin systems), marked inflammation and sometimes thrombosis (immune and hematologic systems), hypoxemia and ventilation problem (respiratory system), and hyperglycemia (metabolic and endocrine system). In severe COVID-19, there is systemic hyperinflammation induced by augmented production of proinflammatory cytokines. Such cytokine storm results into multi-organ dysfunction, cardiovascular collapse, and even death. Hypertension, diabetes, obesity, and old age have shown to be risk factors for the untoward events in severe COVID-19. Increased in catecholamine secretion is associated with increase in proinflammatory cytokines. And increased catecholamine levels can augment production of concentrations of proinflammatory cytokines. Takotsubo syndrome is a reversible cardiovascular condition in a setting of physical or emotional stress whereby the excess catecholamines leads to mild to severe myocardial edema. Chronic unabated elevation of these hormones, however, may lead to irreversible cardiomyopathy. Recent reports have shown that there is increased morbidity and mortality in patients with severe COVID-19 and Takotsubo syndrome. The interplay of acute elevation in circulating catecholamines in an already compromised CV function and cytokine storm could influence the clinical course of patients with severe COVID-19. Therefore, early recognition of acute hypercatecholaminergic surge and cytokine storm, so-called the deadly duo, is vital, and a timely and optimal management is critical for increased survival of patients with severe COVID-19.
BACKGROUND Relaxin (RLX), a hormone-like molecule with pleiotropic effects, has been found to reduce matrix deposition and mediate collagen degradation in animal models of chronic liver injuries and might be considered as an adjuvant therapeutic agent for progressive liver diseases. AIMS In the present study, we evaluated whether RLX affects the development of liver fibrosis in an experimental mouse model of NASH in C57BL6 male mice fed with a methionine-choline deficient diet (MCD). Methods Mice were treated per os as we intended to assess the enteric absorption and bioavailability of orally administered RLX (RLX purified from pig ovaries, IBSA SA, Lugano, Switzerland). Mice were fed the MCD diet for 6 weeks. After the initial 3 weeks, one group received drinking water supplemented with RLX (25 mcg/ml) whereas the other continued to receive regular water. A third group of mice fed a regular diet served as control. After 3 additional weeks mice were anesthetized and sacrificed. Results A significant, reduced expression of the pro-inflammatory cytokines TNF-α and of relevant markers of active fibrogenesis and extracellular matrix deposition, Col1A1 and α-SMA, was observed in mice treated with RLX vs controls. RLX also induced a significant decrease of TIMP1 and an increase of both MMP 2 and 9 when evaluated by zymographic analysis in liver extracts. Conclusions Although preliminary pharmacokinetics experiments showed barely detectable amounts of RLX in the blood of mice treated per os, these data support the absorption of orally administered RLX and confirm its potential therapeutic use in the management of liver fibrosis.
Gelatinous disease of the peritoneum or pseudo-peritoneal mixing is a very rare condition. Its origin is mainly appendicular (70 - 80%) and not only ovarian but other. Sporadic causes were described in the literature we add an observation of a patient who pres-ents a gelatinous ascites whose etiology found is an adenocarcinoma cardia which to our knowledge has not been reported. The anatomopathological results of the tumor blocks have a peritoneal tissue largely dissociated by pools of mucus comprising flaps of well differentiated glandular epithelium without mitosis. Cytoplasm are abundant with eosinophils and filled with mucus. We therefore concluded with a pseudo grade I peritoneal myxoma of the sugar baker classification.
