Background Middle East Respiratory Syndrome Coronavirus (MERS-CoV) emerged in the Middle East in 2012 and was associated with significant morbidity and mortality. Considering the role of cytokines in MERS-CoV infection and pathogenesis, this study was performed to assess the plasma levels of proinflammatory cytokines among MERS-CoV patients. Methods A total of 46 MERS-CoV infected patients (19 asymptomatic and 27 with symptoms) were compared to 52 normal healthy controls for the levels of proinflammatory cytokines (IL-1β, TNF-α, IL-17, IL-7, IL-6, IFN-α, IL-15) using a customized luminex kit. Results There was no difference observed between asymptomatic MERS-CoV patients and controls, however; the mean plasma levels among MERS-CoV symptomatic patients were significantly higher than asymptomatic MERS-CoV patients and normal controls: IL-1β (16.89 ± 1.23 pg/mL vs 12.80 ± 0.59 pg/mL; p<0.001), TNF-α (14.04 ± 0.93 pg/mL vs 10.35 ± 0.29 pg/mL; p<0.0001), IL-17 (14.33 ± 0.89 pg/mL vs 11.47 ± 0.61 pg/mL; p<0.001), IL-7 (21.56 ± 1.00 pg/mL vs 16.31 ± 0.30 pg/mL; p<0.0001), IL-6 (156.5 ± 37.90 pg/mL vs 18.60 ± 1.59 pg/mL; p<0.0001), and IFN-α (68.73 ± 13.06 pg/mL vs 23.57 ± 1.05 pg/mL; p<0.0001). The mean plasma levels of IL-15 were no different among the groups. Conclusion Significantly elevated proinflammatory cytokines (IL-1β, TNF-α, IL-17, IL-7, IL-6, IFN-α) among symptomatic MERS-CoV infected patients may contribute to manifestations of cytokine storm frequently observed among critically ill MERS-CoV patients.

Objectives: To assess a newly developed educational video about lumbar puncture (LP), in the parents’ native language, tailored to their social background, and whether it facilitates their consent for LP. Methods: The randomized, controlled trial was conducted at outpatient pediatric clinics at a teaching hospital, Riyadh, Saudi Arabia. The conventional arm used LP verbal explanation. The second group utilized a standardized video with similar information. Parents’ knowledge, perceived LP risks, and willingness to consent were measured, before and after the intervention. Results: We enrolled 201 parents, with similar baseline characteristics. Both groups had an increase in knowledge scores, with Wilcoxon signed-rank test showing significant knowledge gains (Verbal Explanation: W=2693, n=83, P<0.001, and Video: W=5538, n=117, P< 0.001). However, the conventional verbal counseling resulted in more consistent knowledge gain (SD=14.5) as compared to the video group (SD= 18.94). The video group reported higher perceived risk (Mean 8.2, SD 3.59) than the verbal group (mean 7.12, SD 2.51). The less-educated parents perceived higher LP risk after watching the video (P< 0.001). Conclusions: LP video education in parents’ native language is as effective as conventional verbal education for the informed consent, with the additional advantage of reproducibility and more illustrations. While videos could facillitate remote procedural consenting process during infectious disease outbreaks; however, this should be followed by direct verbal interaction with parents, to ensure their full understanding and address any further concerns.