Assessment of the hematological profile of children with chronic kidney disease on follow-up at St. Paul's Hospital Millennium Medical College and Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia.

BACKGROUND: Chronic kidney disease (CKD) is a major public health issue with an increasing incidence and prevalence worldwide. In CKD, hematological parameters are influenced, and the effect increases with CKD stage. Thus, the aim of this study was to assess hematological profile of children with CKD on follow up at Tikur Anbessa Specialized Hospital and St. Paul's Hospital Millennium Medical College in Addis Ababa, Ethiopia. METHODS: A cross-sectional study was carried out from March 1 to June 30, 2021 among 238 children with CKD. EDTA tubes were used to collect 4 ml blood samples, which were then examined by Beckman Coulter automated hematology analyzer. SPSS Version 20 was used for statistical analysis, and a bivariate and multivariate regression model were applied to assess correlations. Mean and standard deviation was used to determine hematological profiles. RESULTS: The total number of patients in the study were 238, with 42 (59.7%) of them being men. The majority of the patients (81%) had CKD stage 1. Mean ± standard deviation determined for white blood cell (WBC) parameters in (thousand/µL); WBC, Neutrophil, Lymphocytes, Eosinophil, Monocytes and Basophil were 8.93 ± 3.32, 4.6 ± 8.31, 2.79 ± 1.62, 0.31 ± 0.51, 0.50 ± 3.03 and 0.03 ± 0.24, respectively. For some of red blood cell (RBC) parameters; RBC (million/ µL), Hemoglobin (Hgb) (g/dL), Hematocrit (Hct) (%) and Mean cell volume (fl.) were 4.73 ± 0.87, 12.82 ± 2.76, 38.28 ± 7.53 and 80.32 ± 7.89, respectively. For the platelet count (PLT) (thousand/µL) and Mean Platelet volume (MPV) (fL) 349.34 ± 130.18 and 9.03 ± 4.31 were determined, respectively. This study also found hematologic parameters such as RBC, HGB, HCT and MPV were found to be positively correlated with eGFR with a P-value < 0.05 for all parameters. CONCLUSION: The study found that the majority of study participants were in stages 1 to 3 based on their estimated glomerular filtration rate (eGFR). Some of hematological parameters found to have positive correlation with eGFR. There is a need to improve multiple aspects of CKD management, including routine hematological tests for children with chronic kidney disease.

Unusual Fungal Endocarditis Causing Disseminated Infection After Renal Transplant.

Fungal endocarditis is a relatively uncommon disease; it mostly affects those with intracardiac devices and those with compromised immune systems. Scedosporium apiospermum (S. apiospermum), the asexual state of Pseudoallescheria boydii, has become increasingly reported as an opportunistic pathogen. These filamentous fungi present in soil, sewage, and polluted waters, and was previously recognized to cause human infection after their inhalation or traumatic subcutaneous implantation. In immunocompetent individuals, it usually causes localized diseases depending on the site of entry such as skin mycetoma. However, in immunocompromised hosts, the fungus species appear to disseminate and cause invasive infections, frequently reported to be life-threatening with poor response to antifungal medications. S. apiospermum invasive endocarditis remains a rare complication, mostly cited in immunocompetent hosts with prosthetic cardiac valves or other intracardiac devices and severely immunocompromised patients with hematologic neoplasia. Herein, we describe the case of a renal transplant patient on immunosuppressive medications who presented with S. apiospermum fungal septic infection that invaded the left ventricular outflow tract (LVOT) causing endocarditis with disseminated infection and resulted in poor clinical outcome.

Acute Pericarditis Secondary to COVID-19 Infection.

The Coronavirus disease 2019 (COVID-19) pandemic is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Cardiac injuries are among the complications caused by COVID-19. This report presents the case of a 25-year-old patient hospitalized due to Coronavirus infection with the complication of recurrent acute pericarditis. The patient was treated with colchicine and high-dose ibuprofen, and the patient was then discharged in stable condition. This report demonstrates an effective treatment plan for acute pericarditis secondary to COVID-19 infection.

Influence of smoking on the location of acute myocardial infarctions.

Objective. To determine whether there is an association between smoking and the location of acute myocardial infarctions. Methods. Using a cohort from our hospital and published cohorts from Ireland, Uruguay, and Israel, we calculated odds of having an inferior wall as opposed to an anterior wall acute myocardial infarction among smokers and nonsmokers. Results. In our cohort, there was a higher proportion of smokers than nonsmokers in patients with inferior acute myocardial infarctions than in patients with anterior infarctions. This difference was also present in each of the other cohorts. Odds ratios for an inferior versus an anterior acute myocardial infarction among smokers ranged from 1.15 to 2.00 (median odds ratio, 1.32). When the cohorts were combined (n = 3, 160), the pooled odds ratio for an inferior as opposed to an anterior acute myocardial infarction among smokers was 1.38 (95% confidence interval, 1.20 to 1.58) (P < .002). Conclusions. Cigarette smoking increases the risk of inferior wall acute myocardial infarction more than the risk of anterior wall infarction. Smoking thus appears to adversely affect the right coronary arterial circulation to a greater extent than the left coronary arterial circulation by a mechanism not yet understood.

Relation of nausea and vomiting in acute myocardial infarction to location of the infarct.

To determine whether the incidence of nausea and vomiting in patients with acute myocardial infarction (AMI) varies with infarct location, we studied 180 patients who had been admitted to our hospital for ST-segment elevation AMI or AMI associated with left bundle branch block. The presenting symptoms (chest pain, nausea, and vomiting), initial electrocardiographic findings, and additional demographic, clinical, laboratory, and outcome data were extracted from the medical records and correlated with the infarct location. Of the 180 patients with AMI, 108 (60%) had inferior and 72 (40%) had anterior infarcts. Nausea was reported in almost 2/3 of all patients, and vomiting in nearly 1/3. Both nausea and vomiting showed a trend toward a greater incidence in patients with inferior than with anterior infarcts (69% vs 56% and 33% vs 26%, respectively). However, the differences were not statistically significant. In conclusion, nausea and vomiting are common presenting symptoms in patients with either inferior or anterior wall AMI, but their frequency is unrelated to the infarct location.