Presence of procoagulant peripheral blood mononuclear cells in severe COVID-19 patients relate to ventilation perfusion mismatch and precede pulmonary embolism.

PURPOSE: Pulmonary emboli (PE) contribute substantially to coronavirus disease 2019 (COVID-19) related mortality and morbidity. Immune cell-mediated hyperinflammation drives the procoagulant state in COVID-19 patients, resulting in immunothrombosis. To study the role of peripheral blood mononuclear cells (PBMC) in the procoagulant state of COVID-19 patients, we performed a functional bioassay and related outcomes to the occurrence of PE. Secondary aims were to relate this functional assay to plasma D-dimer levels, ventilation perfusion mismatch and TF expression on monocyte subsets. METHODS: PBMC from an ICU biobank were obtained from 20 patients with a computed tomography angiograph (CTA) proven PE and compared to 15 COVID-19 controls without a proven PE. Functional procoagulant properties of PBMC were measured using a modified fibrin generation time (MC-FGT) assay. Tissue factor (TF) expression on monocyte subsets were measured by flow cytometry. Additional clinical data were obtained from patient records including end-tidal to arterial carbon dioxide gradient. RESULTS: MC-FGT levels were highest in the samples taken closest to the PE detection, similar to the end-tidal to arterial carbon dioxide gradient (ETCO2 - PaCO2), a measurement to quantify ventilation-perfusion mismatch. In patients without proven PE, peak MC-FGT relates to an increase in end-tidal to arterial carbon dioxide gradient. We identified non-classical, CD16 positive monocytes as the subset with increased TF expression. CONCLUSION: We show that the procoagulant state of PBMC could aid in early detection of PE in COVID-19 ICU patients. Combined with end-tidal to ETCO2 - PaCO2 gradient, these tests could improve early detection of PE on the ICU.

Abdominal tuberculosis in a children's hospital in Addis Ababa.

A review of the clinical records of all patients with the diagnosis of abdominal tuberculosis, admitted to the Ethio-Swedish Children's Hospital (ESCH), Addis Ababa, Ethiopia, over a ten year period was made. There were 57 patients that fulfilled the inclusion criteria, accounting for 0.22% of all admissions. Both sexes were nearly equally affected. In more than a quarter of the patients (30%), the diagnosis of tuberculosis was not considered at admission. Fever, weight loss, night sweating and abdominal pain were common presenting symptoms. The role of positive Mantoux and elevated erythrocyte sedimentation rate (ESR) as an aid to diagnosis were limited. The number of admitted patients with abdominal tuberculosis at ESCH is much lower than what has been reported from other African countries. The findings of the present study clearly indicate the need for a high index of clinical suspicion. Laparoscopic and peritoneal biopsy should be included in the diagnostic work up of patients suspected of having abdominal tuberculosis.

Frequency of isolation of Cryptosporidium oocysts in Ethiopian children with acute diarrhoeal disease.

Stool specimens from one hundred children with acute diarrhoeal disease seen at the Gondar College of Medical Sciences Hospital, north-western Ethiopia were prospectively screened for the presence of oocysts of Cryptosporidium species. The study was conducted between June 1989 and January 1990. Nine out of one hundred specimens were positive for oocysts of Cryptosporidium. This study has demonstrated the presence of this parasite in the study region. A well desgned case control study is recommended to elucidate its clinical manifestations and association with malnutrition.

PIP: Between June 1989 and January 1990 in Ethiopia, health workers collected 2 gm diarrhea samples from 100 patients, 2-48 months old, at the oral rehydration unit of the Gondar College Medical Sciences Hospital to test for the presence of Cryptosporidium species' oocysts. Laboratory personnel used Loeffler's alkaline methylene-blue solution to isolate oocysts in 9 children. 6 of these children were 12 months old. None of the children with Cryptosporidium oocysts exhibited signs of severe protein energy malnutrition, but 31 other children did exhibit these signs. The presence of oocysts in the 9 children did not necessarily indicate that Cryptosporidium species were the only causes of their acute diarrhea. The 9% isolation rate may be an underestimate, because Baxby and Blonde have demonstrated that safranin-methylene blue yields a better Cryptosporidium oocyst isolation rate than does Loeffler's alkaline methylene-blue. A well-designed study is needed to determine the true prevalence of cryptosporidiosis, to describe its clinical profile, and to define its association with other diarrhea-causing enteropathogens and its association with malnutrition.

Childhood appendicitis: factors associated with its incidence and perforation in Ethiopian children.

Acute appendicitis is a common paediatric emergency necessitating surgical intervention. Factors contributing to the incidence of the disease and appendiceal perforation in all children with acute appendicitis admitted to the Ethio-Swedish Children's Hospital in Addis Abeba, Ethiopia from Jan 1983 to December 1987 were studied. There were a total of 278 cases of appendicitis, with matched controls, seen. The incidence of perforation was 67%. Statistically significant differences between cases and controls were seen for the educational status of the parents (p less than .001), the parental income (p less than .001) and the nutritional status of the patient (p less than .001). The risk of perforation increased with increased duration of the illness. Perforation was common in children with normal height and better parental education. The incidence of appendicitis appears to be related to improved socioeconomic status. Prospective studies to examine this and other associations are warranted.