Vol 60, No 4 (2022): October 2022 Issue

Background: There are varying and contradicting reports and in the face of lack of evidence generated on the effect of ACE2 (Angiotensin-converting enzyme inhibitors) expression inhibiting drugs on COVID-19 Disease. The aim of this study was to assess the effect of acute or chronic ACEIs, ARBs (Angiotensin receptor blockers) and/or NSAIDs (Nonsteroidal anti-inflammatory drugs) use on COVID-19 disease severity, outcome and length of admission among patients with COVID-19 admitted to the Millennium COVID-19 Care Center in Ethiopia.

Methods: A retrospective cohort study was conducted among 945 patients with COVID-19 who were on follow up from July 2^nd to December 25^th, 2020. Data was described using frequency tables and cross tabulations. To identify the effect of ACEIs, ARBs and/or NSAIDs use on COVID-19 disease severity, disease outcome and length of admission, Marginal Structural Model (MSM) with inverse probability weighting (IPW) approach was used.

Results: Among the 945 patients studied, 115 (12.2%) had a history of ACEIs, ARBs and/or NSAIDs use. At admission, the majority (39.6%) had mild disease and 272 (28.8%) had severe disease. Among the study participants, 900 (95.2%) were discharged improved and the rest 45 (4.8%) died. The median length of admission was 14.0 days (IQR, 13-16). Multinomial Logistic Regression, Log Binomial Regression and Negative Binomial Regression models were fitted to assess the effect of ACEIs, ARBs and/or NSAIDs use on disease severity, outcome and length of admission respectively. In all the three outcome models, ACEIs, ARBs and/or NSAIDs use didn’t show a statistically significant association with the outcomes.

Conclusion: Acute or chronic use of ACEIs, ARBs and/or NSAIDs showed no effect on COVID-19 disease severity, outcome and length of admission and therefore should not be withdrawn from patients who need these therapies unless new evidences proving clear contraindications emerge.

Background: Antiretroviral therapy (ART) coverage in many Sub-Saharan African countries remains low (48%) for children <15 years living with HIV. One possible reason for this low performance is low pediatric HIV case finding. In this study we describe the coverage of HIV testing for children of infected parent(s) (also called index case testing or ICT) and factors affecting it.

Methods: Secondary analysis of the Zambia, Malawi, Eswatini, and Tanzania Population HIV Impact Assessment (PHIA) household surveys which were conducted between 2015-2016 were used for this study. Couples where there is at least one HIV infected person were identified and matched to their children <15 years. HIV testing status of children was measured and factors associated with testing of children studied using logistic regression. Sampling weights were applied during analysis taking into account complex sampling design of these surveys.

Results: 3,435 children <15 years had at least one infected parent. Of those children, 38.9% (32.9%-44.8%) were tested for HIV. Rural areas had more undiagnosed children in all study countries. Maternal HIV testing was associated with the highest odds of testing for children (adjusted Odds ratio: 84.51 (10.72-666)) as was maternal HIV infection (Odds ratio: 5.9 (95% confidence interval (CI): 3.9-8.9)).

Conclusion: Pediatric HIV testing for children of HIV infected parent(s) was found to be low. Maternal HIV testing was found to be the single most important factor associated with testing of children of HIV infected parent(s). Rural settings need to be prioritized for ICT in order to address testing gap.

Background: Antiretroviral therapy (ART) coverage in many Sub-Saharan African countries remains low (48%) for children <15 years living with HIV. One possible reason for this low performance is low pediatric HIV case finding. In this study we describe the coverage of HIV testing for children of infected parent(s) (also called index case testing or ICT) and factors affecting it.

Methods: Secondary analysis of the Zambia, Malawi, Eswatini, and Tanzania Population HIV Impact Assessment (PHIA) household surveys which were conducted between 2015-2016 were used for this study. Couples , where there is at least one HIV-infected person, were identified and matched to their children <15 years. HIV testing status of children was measured and factors associated with the testing of children were studied using logistic regression. Sampling weights were applied during analysis taking into account the complex sampling design of
these surveys.

Results: 3,435 children <15 years had at least one infected parent. Of those children, 38.9% (32.9%-44.8%) were tested for HIV. Rural areas had more undiagnosed children in all study countries. Maternal HIV testing was associated with the highest odds of testing for children (adjusted Odds ratio: 84.51 (10.72-666)) as was maternal HIV infection (Odds ratio: 5.9 (95% confidence interval (CI): 3.9-8.9)).

Conclusion: Pediatric HIV testing for children of HIV infected parent(s) was found to be low. Maternal HIV
testing was found to be the single most important factor associated with testing of children of HIV infected parent
(s). Rural settings need to be prioritized for ICT in order to address testing gap

Background: Intensive care unit infections are health care problems affecting millions globally each year. Intensive care unit mortality of infectious patients is increasing and as high as 14.31% to 45.4%. This study aimed to determine the microbiological culture profile and antimicrobial susceptibility pattern of patients admitted to two intensive care units in Addis Ababa.

Methods and materials: An institutional-based retrospective observational study was carried out on all patients with microbiological culture and susceptibility results after admission to the adult intensive care unit at two Addis Ababa hospitals from January 2019 to December 2019. Data were collected by trained data collectors using a standard and pretested questionnaire. Collected data were coded, entered into Epi-Info, and analyzed using SPSS version 25. Correlation and regression analysis was used for assessing associations. A p-value of less than 0.05 was taken as significant.

Results:  A total of 106 patients with 173 culture results were analyzed. The majority, 68(64.2%), were males. The mean age of the patients was 35.08±1.6 years. The most common documented source of infection was the pulmonary system 84(54.5%), followed by urinary tract infection 26(16.9%). Forty-four (25.43%) of cultures had growth. Gram-negative was identified in 35(68.63%) isolates. Acinetobacter species account for 10(28.57%), followed by Klebsiella pneumoniae and E. coli 7(13.725%) respectively. Higher antimicrobial resistance was shown to cephalosporin and penicillin. The mortality rate among subjects was 32.1%.

Conclusion and Recommendations:  Pulmonary source being the common infection site, resistant gram negatives were the predominant microorganisms identified. Designs of future multicenter and prospectively designed studies are crucial to improve the outcome of critically ill patients

Background: Image-guided percutaneous aspiration and drainage (PAD) are a safe and cost-effective means of draining an abscess. PAD is noninvasive and has decreased procedure-associated morbidity and mortality, reduced cost of treatment, and reduced length of hospital stay as compared to open surgical drainage. The imaging modalities that can be used for drainage can either ultrasound (US) or Computerized Tomography (CT) or both of the modalities. This study aims to share our initial experiences in the successful introduction of percutaneous drainage of intra-abdominal collections in the tertiary center.

Method : An institution-based retrospective record review of patients with diagnosed to have intra-abdominal collections who were treated with PAD was done from 2020 back to 2013. Cases were collected from the accessible records of the department of radiology and patient charts were then retrieved. Data was collected using a structured questionnaire and a descriptive analysis of findings was done using SPSS version 25.

Results: A total of 53 patients were retrieved from the record. 35 (66%) were males and 18(34%) were females with patients’ age ranging from 10 years to 80years with a mean age of 43.1+15.8. 59 patients.  Most of the intra-abdominal collections were either idiopathic or surgical complications which accounted for 60.4% & 18.9% respectively and the success rate of PAD with a single attempt was 90.2% with success increased to 96.2% with a second attempt.

Conclusion: PAD can be used as an alternative way of managing patients with intra-abdominal collections not only in developed nations but also in developing countries like Ethiopia with a high rate of success.

Background: Placement of a chest tube drain is the commonest procedure performed, especially in an emergency setting to evacuate fluid, blood, and air from the pleural cavity. Even if it is a simple procedure, it is associated with tube malposition and related complications, which sometimes may lead to death. So,  This study analyses malpositioned chest tubes as seen on Computerized tomography (CT) scans.

Method : This is a retrospective record review of CT images of patients who have a diagnosis of malpositioned chest tubes.

Results: Most of the indications for chest tube placement were done for pleural fluid drain and pneumothorax. The retrospective CT analysis showed most of the chest tubes inserted were for the wrong diagnosis. Most malpositioned chest tubes were located in the normal or diseased lung. Intra-abdominal tube malpositions were seen in the spleen, liver, and retroperitoneum.

Conclusion: Chest tube insertion without proper indication may result in a malpositioned drainage tube  Abnormal tube positions may also cause injury to intrathoracic or intra-abdominal organs