New-onset retroperitoneal fibrosis following COVID-19 mRNA vaccination: Coincidental or vaccine-induced phenomenon?

The Pfizer-BioNTech mRNA vaccine is a US Food and Drug Administration-approved coronavirus disease 2019 (COVID-19) vaccine. Although it is reported to be safe and effective, immune dysregulation leading to autoimmunity has become an area of concern. Retroperitoneal fibrosis (RPF) is an immune-mediated fibroinflammatory disease characterized by the deposition of fibrous tissues, primarily around the abdominal aorta and iliac arteries. Herein, we report a case of RPF following Pfizer BioNTech COVID-19 mRNA vaccination. To the best of our knowledge, there have been no published reports on RPF after COVID-19 mRNA vaccination. A 58-year-old woman with no history of autoimmune diseases presented with acute onset of epigastric pain 5 weeks after the second dose of the Pfizer-BioNTech vaccine. She had been diagnosed with stage I breast cancer 9 years ago and was in complete remission on admission. Abdominal computed tomography showed preaortic soft-tissue infiltration around the origin of the superior mesenteric artery but no evidence of breast cancer recurrence. Considering the temporal relationship between current symptoms and vaccination and the absence of other possible causes, she was diagnosed with RPF secondary to Pfizer-BioNTech vaccine-induced autoimmunity. This case may raise awareness of the possibility of RPF development following COVID-19 mRNA vaccination.     

Extensive chromosomal reshuffling drives evolution of virulence in an asexual pathogen

Sexual recombination drives genetic diversity in eukaryotic genomes and fosters adaptation to novel environmental challenges. Although strictly asexual microorganisms are often considered as evolutionary dead ends, they comprise many devastating plant pathogens. Presently, it remains unknown how such asexual pathogens generate the genetic variation that is required for quick adaptation and evolution in the arms race with their hosts. Here, we show that extensive chromosomal rearrangements in the strictly asexual plant pathogenic fungus Verticillium dahliae establish highly dynamic lineage-specific (LS) genomic regions that act as a source for genetic variation to mediate aggressiveness. We show that such LS regions are greatly enriched for in planta-expressed effector genes encoding secreted proteins that enable host colonization. The LS regions occur at the flanks of chromosomal breakpoints and are enriched for retrotransposons and other repetitive sequence elements. Our results suggest that asexual pathogens may evolve by prompting chromosomal rearrangements, enabling rapid development of novel effector genes. Likely, chromosomal reshuffling can act as a general mechanism for adaptation in asexually propagating organisms.Sexual reproduction is thought to enable responses to environmental challenges in nature and fosters evolution of pathogen genomes (Williams 1975; Maynard Smith 1978; Colegrave 2002; Goddard et al. 2005; Heitman 2006; de Visser and Elena 2007). Consequently, pathogen populations that undergo regular sexual reproduction are thought to pose a great risk to agriculture because they can recombine alleles that contribute to virulence in the face of dynamic environmental conditions (McDonald and Linde 2002). However, sexual reproduction comes at a cost because two compatible individuals need to locate each other to generate offspring, and fitness decreases due to break up of coadapted combinations of interacting alleles may occur (Agrawal 2006; Heitman 2006; Heitman et al. 2007; de Visser and Elena 2007). Sexual compatibility between individuals depends on so-called mating types in fungi. In heterothallic fungi, mating is restricted to genetically different individuals of opposite mating types, whereas in homothallic fungi, mating and sexual reproduction can occur between all individuals, including itself (Billiard et al. 2012). Although most fungi are able to undergo asexual and sexual reproduction, ∼20% of all fungal phyla reproduce strictly asexually (Heitman et al. 2007). Such strictly asexual organisms are thought to be less flexible than sexual ones, relying solely on random mutations to adapt to changing environments. Asexual organisms are often considered as evolutionary dead ends (Burt 2000; McDonald and Linde 2002). This is mainly due to the absence of meiotic recombination resulting in increased accumulation of deleterious mutations, an effect known as Muller''s ratchet (Felsenstein 1974), and a decreased ability to adapt to changing environmental conditions by generation of novel genetic combinations (Heitman 2006). Especially for pathogenic species that are continuously involved in an arms race with their hosts that try to ward off invading pathogens, quick adaptation in order to coevolve with the host immune system is essential for evolutionary success (Raffaele and Kamoun 2012). Nonetheless, many destructive plant pathogenic fungi are known as strictly asexually reproducing organisms, such as the vascular wilt fungus Verticillium dahliae (Fradin and Thomma 2006).V. dahliae is a soil-borne broad host-range plant pathogen that invades the water-conducting xylem vessels of susceptible plant species to cause vascular wilt disease (Fradin and Thomma 2006; Klosterman et al. 2009). Hundreds of dicotyledonous plant species can be infected by V. dahliae, including many economically important crops such as lettuce, cotton, and tomato (Bolek et al. 2005; Fradin and Thomma 2006; Klosterman et al. 2009; Atallah et al. 2010). Although two mating types have been found in V. dahliae, it is predicted that propagation is solely asexual (clonal) in most if not all populations, as a sexual cycle has never been observed and the ratio between both mating types is greatly skewed toward one of the two (Usami et al. 2008, 2009; Atallah et al. 2010; Inderbitzin et al. 2011). Only in a few plant species has monogenic resistance toward Verticillium wilt been described. These include tomato, for which a Verticillium resistance locus (named Ve) has been identified that mediates resistance against race 1 strains of V. dahliae and V. albo-atrum, and that thus become avirulent (unable to cause disease). Strains that are not contained by this Ve locus remain virulent (able to cause disease) and are assigned to race 2 (Schaible et al. 1951; Kawchuk et al. 2001; Fradin et al. 2009). The resistance that is established by the Ve locus is mediated by the Ve1 gene that encodes a receptor-like protein-type cell surface receptor (Fradin et al. 2009) that activates plant immunity upon perception of a corresponding pathogen-derived ligand. Recently, through comparative genomics the race 1-specific effector Ave1 (for Avirulence on Ve1 tomato) was identified that activates Ve1-mediated resistance in tomato (de Jonge et al. 2012). Remarkably, the Ave1 effector contributes to pathogen aggressiveness on tomato plants that lack Ve1, demonstrating that Ave1 acts as a virulence factor of V. dahliae (de Jonge et al. 2012). Race 2 strains lack the Ave1 gene, and are consequently less aggressive on tomato plants that lack Ve1 when compared with race 1 strains (Amen and Shoemaker 1985; Paternotte and van Kesteren 1993; de Jonge et al. 2012).In this study, we compared the genomes of 11 recently sequenced V. dahliae strains (Klosterman et al. 2011; de Jonge et al. 2012) that have been isolated from various geographical locations and hosts, and that are all, except for one, pathogenic on tomato. By assessing genetic diversity within this population we aimed to study the impact of asexual reproduction on the evolution of host adaptation and virulence in this plant pathogenic fungus.     

Evaluation of Determine HIV-1/2 rapid diagnostic test by 4th generation ELISA using blood donors' serum at Felege Hiwot Referral Hospital, northwest Ethiopia

OBJECTIVE: The study aims to evaluate the HIV-1/2 rapid diagnostic test kit is routinely used to screen HIV infection for safe blood transfusion and VCT services in many parts of Ethiopia. METHODS: A total of 324 sera were collected from consecutive blood donors from February to May 2006. All samples were screened for HIV infection using Determine HIV-1/2 (Abbott Japan) at hospital blood bank laboratory. Blindly, all serums were retested at Regional Health Research Laboratory using 4th generation ELISA (Vironostika HIV Uni-Form II AG/Ab) and Determine HIV-1/2 (Abbott lab). Discordant samples were repeatedly retested using the same ELISA and Determine HIV-1/2 to avoid technical errors. Finally, discordant results were resolved using Western Blot at the National HIV/AIDS Laboratory. RESULTS: Determine HIV-1/2 and ELISA showed 94.4% concordance in HIV antibody testing with fair Cohen's Kappa statistic value (0.68) among blood donors. The sensitivity, specificity, positive and negative predictive values of Determine HIV-1/2 were 60.5%, 98.9%, 88.5% and 94.9% respectively. CONCLUSION: As a rapid HIV screening test for blood donors, Determine HIV-1/2 showed poor sensitivity. Further evaluation at multiple centres is recommended to test its validity as a routine HIV screening test in blood donors. Use of a combination of rapid assays is also recommended for screening of HIV infection among the donor population.     

Prevalence and associated factors of TB/HIV co-infection among HIV Infected patients in Amhara region,Ethiopia

BackgroundTuberculosis is one of the world''s most common causes of death in the era of Human immunodeficiency virus. The purpose of this study was to determine the prevalence and associated factors of TB/HIV co-infection.MethodsHospital based retrospective studies were conducted among adult HIV-positive patients. Logistic regression method and Chi square test were applied.ResultsA total of 571 HIV positive study participants were enrolled. Of these, 158 (27.7%) were found to have pulmonary tuberculosis. Lower baseline CD4 count<200cell/µl, patients who drunk alcohol, patients who were ambulatory at the initiation of ART, patients whose marital status was single were significant predictors for increased risk of tuberculosis in PLWHIV (P <0.05). Non smoker patients, patients in WHO clinical stage I, patients in WHO clinical stage II and ownership of the house had significant protective benefit against risk of TB (P <0.05).ConclusionThe prevalence of TB/HIV co-infection in adults on ART in our study was moderately high. Having advanced clinical status and presence of risk factors were found to be the predicting factors for co-infection. The health office should open TB/HIV co-infection units in the hospitals and health workers should be cautious when a patient has an advanced disease.     

Prevalence and determinants of concurrent wasting and stunting and other indicators of malnutrition among children 6–59 months old in Kersa,Ethiopia

Malnutrition is the leading cause of poor child health in Ethiopia, and progress to avert it is unacceptably slow. In addition, little is known about the magnitude and factors associated with concurrent wasting and stunting (WaSt). Therefore, this study aimed to assess the prevalence and factors associated with WaSt, wasting, stunting and underweight among children 6–59 months in Kersa Health and Demographic Surveillance System, Ethiopia. Data from a total of 1091 children and their parents'' were analysed from a cross‐sectional study. Household questionnaires and anthropometric measurements were used for data collection. Height‐for‐age, weight‐for‐height and weight‐for‐age indices are expressed as standard deviation units from the mean for the reference group. Multivariate analyses were conducted to identify factors associated with WaSt, wasting, stunting and underweight. Statistical significance was declared at p < 0.05. The prevalence of indicators of malnutrition was WaSt (5.8%), wasting (16.8%), stunting (53.9%) and underweight (36.9%). Children aged 6–17 months had a higher odds of wasting (adjusted odds ratio [aOR] 1.8, 95% confidence interval [CI] 1.12–2.75) compared with those aged 36–59 months, whereas children aged 18–35 months (aOR 2.4, 95% CI 1.65–3.47) and 36–59 months (aOR 1.6, 95% CI 1.07–2.37) had higher odds of stunting compared with those aged 6–17 months. Similarly, children aged 18–35 months (aOR 1.6, 95% CI 1.07–2.37) and 36–59 months (aOR 2.2, 95% CI 1.52–3.10) had higher odds of underweight compared with children aged 6–17 months. Households that did not treat drinking water at point of use were at higher odds of WaSt (aOR 3.3, 95% CI 1.16–9.27) and stunting (aOR 1.9, 95% CI 1.31–2.85) compared with those who did treat drinking water. Boys were more likely to be WaSt, wasted, stunted and underweight. Cough was associated with WaSt, wasting and underweight. Furthermore, maternal education, maternal occupation and maternal age were significantly associated with wasting. Maternal body mass index (BMI) of less than 18.5 kg/m² and maternal BMI between 18.5 and 25 kg/m² were associated with child stunting. In Kersa, the prevalence of WaSt, wasting, stunting and underweight is very high and requires urgent public health intervention. This study highlights point‐of‐use water treatment, maternal education, hygiene and sanitation, child health service utilization and maternal BMI as important areas to improve to target child malnutrition. Furthermore, a community‐based programmatic and policy direction for early identification and management of WaSt in addition to other indicators of malnutrition is recommended.     

Involving religious leaders in HIV care and treatment at a university-affiliated hospital in Ethiopia: Application of formative inquiry

In sub-Saharan Africa, religious views strongly influence how people relate to illness, health, and healing. Belief in the curative power of religion, including for HIV, persists in many communities. As such, many funding agencies and organisations working in the field of HIV have incorporated religious institutions into their programmes in various capacities. Yet, debate continues regarding the benefits and drawbacks of including sectarian organisations in the fight against HIV. In the current study, we sought to explore whether patients with HIV would be amenable to receiving HIV-related psychosocial support from religious leaders. We interviewed 48 Ethiopian Orthodox Church followers who presented for routine HIV care at Gondar University Hospital ART (antiretroviral treatment) clinic. Although almost half (46%) of participants self-identified as ‘very religious’, the majority of them (73%) had not disclosed their HIV status to a religious leader. Study participants highlighted multiple factors that could potentially affect their willingness to involve religious leaders in their HIV care. We discuss these findings in relation to religion and HIV in the African context. Our findings support the use of formative qualitative work prior to developing and implementing programmes that integrate faith and medical communities.