Changes in Surgical Volume and Outcomes During the Coronavirus Disease 2019 Pandemic at Two Tertiary Hospitals in Ethiopia: A Retrospective Cohort Study.

BACKGROUND: Limited data exist concerning how the coronavirus disease 2019 (COVID-19) pandemic has affected surgical care in low-resource settings. We sought to describe associations between the COVID-19 pandemic and surgical care and outcomes at 2 tertiary hospitals in Ethiopia. METHODS: We conducted a retrospective observational cohort study analyzing perioperative data collected electronically from Ayder Comprehensive Specialized Hospital (ACSH) in Mekelle, Ethiopia, and Tibebe Ghion Specialized Hospital (TGSH) in Bahir Dar, Ethiopia. We categorized COVID-19 exposure as time periods: "phase 0" before the pandemic (November 1-December 31, 2019, at ACSH and August 1-September 30, 2019, at TGSH), "phase 1" starting when elective surgeries were canceled (April 1-August 3, 2020, at ACSH and March 28-April 12, 2020, at TGSH), and "phase 2" starting when elective surgeries resumed (August 4-August 31, 2020, at ACSH and April 13-August 31, 2020, at TGSH). Outcomes included 28-day perioperative mortality, case volume, and patient district of origin. Incidence rates of case volume and patient district of origin (outside district yes or no) were modeled with segmented Poisson regression and logistic regression, respectively. Association of the exposure with 28-day mortality was assessed using logistic regression models, adjusting for confounders. RESULTS: Data from 3231 surgeries were captured. There was a decrease in case volume compared to phase 0, with adjusted incidence rate ratio (IRR) of 0.73 (95% confidence interval [CI], 0.66-0.81) in phase 1 and 0.90 (95% CI, 0.83-0.97) in phase 2. Compared to phase 0, there were more patients from an outside district during phase 1 lockdown at ACSH (adjusted odds ratio [aOR], 1.63 [95% CI, 1.24-2.15]) and fewer patients from outside districts at TGSH (aOR, 0.44 [95% CI, 0.21-0.87]). The observed 28-day mortality rates for phases 0, 1, and 2 were 1.8% (95% CI, 1.1-2.8), 3.7% (95% CI, 2.3-5.8), and 2.9% (95% CI, 2.1-3.9), respectively. A confounder-adjusted logistic regression model did not show a significant increase in 28-day perioperative mortality during phases 1 and 2 compared to phase 0, with aOR 1.36 (95% CI, 0.62-2.98) and 1.54 (95% CI, 0.80-2.95), respectively. CONCLUSIONS: Analysis at 2 low-resource referral hospitals in Ethiopia during the COVID-19 pandemic showed a reduction in surgical case volume during and after lockdown. At ACSH, more patients were from outside districts during lockdown where the opposite was true at TGSH. These findings suggest that during the pandemic patients may experience delays in seeking or obtaining surgical care. However, for patients who underwent surgery, prepandemic and postpandemic perioperative mortalities did not show significant difference. These results may inform surgical plans during future public health crises.

Lipid Droplets Form from Distinct Regions of the Cell in the Fission Yeast Schizosaccharomyces pombe.

Eukaryotic cells store cholesterol/sterol esters (SEs) and triacylglycerols (TAGs) in lipid droplets, which form from the contiguous endoplasmic reticulum (ER) network. However, it is not known if droplets preferentially form from certain regions of the ER over others. Here, we used fission yeast Schizosaccharomyces pombe cells where the nuclear and cortical/peripheral ER domains are distinguishable by light microscopy to show that SE-enriched lipid droplets form away from the nucleus at the cell tips, whereas TAG-enriched lipid droplets form around the nucleus. Sterols localize to the regions of the cells where droplets enriched in SEs are observed. TAG droplet formation around the nucleus appears to be a strong function of diacylglycerol (DAG) homeostasis with Cpt1p, which coverts DAG into phosphatidylcholine and phosphatidylethanolamine localized exclusively to the nuclear ER. Also, Dgk1p, which converts DAG into phosphatidic acid localized strongly to the nuclear ER over the cortical/peripheral ER. We also show that TAG more readily translocates from the ER to lipid droplets than do SEs. The results augment the standard lipid droplet formation model, which has SEs and TAGs flowing into the same nascent lipid droplet regardless of its biogenesis point in the cell.