Duration of Supplemental Oxygen Requirement and Predictors in Severe COVID-19 Patients in Ethiopia: A Survival Analysis

BackgroundWith the rising number of new cases of COVID-19, understanding the oxygen requirement of severe patients assists in identifying at risk groups and in making an informed decision on building hospitals capacity in terms of oxygen facility arrangement. Therefore, the study aimed to estimate time to getting off supplemental oxygen therapy and identify predictors among COVID-19 patients admitted to Millennium COVID-19 Care Center in Ethiopia.MethodsA prospective observational study was conducted among 244 consecutively admitted COVID-19 patients from July to September, 2020. Kaplan Meier plots, median survival times and Log-rank test were used to describe the data and compare survival distribution between groups. Cox proportional hazard survival model was used to identify determinants of time to getting off supplemental oxygen therapy, where hazard ratio (HR), P-value and 95%CI for HR were used for testing significance and interpretation of results.ResultsMedian time to getting off supplemental oxygen therapy among the studied population was 6 days (IQR,4.3–20.0). Factors that affect time to getting off supplemental oxygen therapy were age group (AHR=0.52,95%CI=0.32,0.84, p-value=0.008 for ≥70 years) and shortness of breath (AHR=0.71,95%CI=0.52,0.96, p-value=0.026).ConclusionAverage duration of supplemental oxygen therapy requirement among COVID-19 patients was 6 days and being 70 years and older and having shortness of breath were found to be associated with prolonged duration of supplemental oxygen therapy requirement. This result can be used as a guide in planning institutional resource allocation and patient management to provide a well-equipped care to prevent complications and death from the disease.     

Enhanced contractile responses of arteries from streptozotocin diabetic rats to sodium fluoride.

1. Previous studies from this laboratory have demonstrated that alpha 1-adrenoceptor-mediated increases in tension and phosphoinositide metabolism are enhanced in the aorta and mesenteric arteries from diabetic rats. The purpose of the present investigation was to determine whether contractile responses to sodium fluoride (NaF), which directly stimulates GTP-binding proteins (G-proteins), are also enhanced in diabetic arteries. 2. NaF (1-20 mM) in the presence of 10 microM aluminium chloride produced slowly developing, concentration-dependent contractions in mesenteric arteries from three month streptozotocin-diabetic (60 mg kg-1, i.v.) male Wistar rats and age-matched control rats. The maximum contractile response but not the sensitivity to NaF was significantly greater in mesenteric arteries from diabetic than from control rats, as was the response to noradrenaline (NA). Maximum contractile responses of aorta and caudal artery from diabetic rats to NaF were also significantly enhanced. 3. Removal of the endothelium and denervation with 6-hydroxydopamine did not significantly alter the maximum contractile response of mesenteric arteries from either control or diabetic rats to NaF. Similarly, NaF had no effect on cyclic AMP levels in aorta, and no difference in cyclic AMP levels, either basally or in the presence of NaF, was detected between control and diabetic rat aorta. 4. Contractile responses of mesenteric arteries from both control and diabetic rats to NaF were diminished in calcium-free Krebs solution, but the NaF response remained significantly elevated in mesenteric arteries from diabetic rats compared to control. 5. Ryanodine (30 microM) which depletes intracellular calcium stores, nifedipine (3 microM) which blocks dihydropyridine-sensitive calcium channels and calphostin C (0.5 microM) which selectively inhibits protein kinase C, all significantly inhibited maximum contractile responses of mesenteric arteries from control and diabetic rats to NaF. There were no significant differences between control and diabetic arteries in the relative magnitude of the inhibition produce by the three antagonist. 6. These data suggest that there may be increased activation of the same signalling processes that mediate NA-stimulated vasoconstriction, perhaps contraction-associated G-proteins or the effectors coupled to these G-proteins, in response to NaF in mesenteric arteries from diabetic rats. This may also be responsible for the enhanced contractile responses of these arteries to alpha 1-adrenoceptor stimulation.     

Serological study of louse borne and flea borne typhus in Addis Ababa

A total of 500 subjects (288 males and 212 females) were tested in Addis Ababa, Ethiopia, in Virology and Rickettsiology Division of the National Research Institute of Health, in 1987, for anti R. prowazekii using Complement Fixation Test (CFT). Out of these 58 subjects (41 males and 17 females) were also tested for anti R. typhi using the same test. The study population included three groups. Group I included 200 patients referred to the National Research Institute of Health (NRIH) for the Weil-Felix test for the diagnosis of typhus. Group II consisted of 200 patients with febrile illness visiting the Outpatient Department (OPD) of St. Paul's Hospital. Group III included 100 blood donors' serum samples included from previous collections. The blood donors had no sign of febrile illness during the collection of the blood samples. The results showed that anti R. prowazekii was detected in 38 subjects (7.6%). The sex ratio among the positive subjects indicated that there were 32 males (22%) and 6 females (2.8%). From the 58 subjects who were also tested for anti R-typhi only 7 (5 males and 2 females) (12%) were found to be positive. Only one person was found to be positive both for anti R. prowazekii and anti R-typhi. From 200 samples (Group-I) tested both by the Weil-Felix test and by Complement Fixation Test for anti R. prowazekii only 4 samples were positive by both test, thus showing very low percent agreement.(ABSTRACT TRUNCATED AT 250 WORDS)     

Cerebrovascular accidents in Ethiopia

The causes, risk factors and outcome of cerebrovascular accidents (CVA) in 150 patients admitted to Tikur Anbessa Hospital, Addis Ababa, Ethiopia, between 1983 and 1985 were studied. Cerebral thrombosis was the commonest cause of CVA (50.6%), followed by cerebral haemorrhage (24%) and cerebral embolism (15%). The single most important risk factor for CVA was hypertension. Mortality was highest with cerebral haemorrhage (89.4%) and lowest with cerebral embolism (13%). An important measure which could reduce the incidence of CVA is the vigorous and sustained control of hypertension.     

Treatment of human immunodeficiency virus (HIV) in children using antiretroviral drugs

Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) is having a devastating impact on African men, women and children. Antiretroviral treatment of children has lagged behind that of adults in Africa and globally. Fortunately, several national and international initiatives are helping to catalyze access of HIV-infected children to treatment. In general, the principles of antiretroviral treatment are the same for resource-rich and resource-poor settings. However, the more rapid progression of HIV disease often observed among children in Africa and some other resource-poor settings may argue for a more aggressive approach to initiation of treatment. In addition, numerous barriers to treatment of HIV-infected children in Africa and other resource-poor settings exist and must be overcome, including the expense of antiretroviral medications, lack of pediatric drug formulations, and poor human capacity and infrastructure for treatment administration. The 2.2 million African children currently living with HIV/AIDS, and many more living in poor countries on other continents, are dependent on all of us to work creatively to overcome barriers to the large-scale implementation of programs for health-restoring, life-prolonging antiretroviral treatment.     

Effects of adenosine analogs on inositol 1,4,5-trisphosphate production in porcine coronary artery

Using various pharmacological methods, we previously demonstrated that the smooth muscle and endothelium of porcine coronary artery contain vasorelaxant adenosine A2 receptors, which are predominantly the A2A subtype. The present study was intended to investigate the effect of adenosine receptor stimulation on agonist-induced inositol 1,4,5-trisphosphate (IP3) generation in porcine coronary artery using the nonselective adenosine analogs, 2-chloroadenosine (CAD) and 5'-(N-ethylcarboxamido)adenosine (NECA), and the A2A selective analog 2-p-(2-carboxyethyl)-phenethylamino-5'-N-ethylcarboxamidoadenosine (CGS). In both endothelium-intact and denuded coronary artery rings, CAD, NECA and CGS elicited a dose-dependent inhibition of prostaglandin F2 alpha (PG)-induced IP3 production. However, the inhibitory effect of NECA was relatively less in endothelium-denuded preparations. The nonselective xanthine adenosine receptor antagonist, 8-sulfophenyltheophylline (8-SPT), significantly attenuated the IP3-inhibitory effect of CAD and, to a lesser extent, that of NECA. Further, the A2A selective nonxanthine antagonist, 5-amino-7-(2-phenylethyl)-2-(furyl)-pyrazolo[4,3]-1,2,4-triazolo[1,5-c] pyrimidine (SCH), markedly decreased the effects of all CAD, NECA and CGS on PG-induced IP3 generation. These results provide evidence that activation of adenosine A2 receptors by CAD, NECA and CGS in porcine coronary artery causes inhibition of agonist-induced IP3 production, and these receptors involve at least the A2A subtype.