Renal function impairment might be worsened by SARS-CoV-2 virus: a triple critical care disease causing hypoxemia.

People who have underlying chronic renal disease may be more susceptible to the catastrophic disease caused by coronavirus disease 2019 (COVID-19), which is characterized by multisystem organ failure, thrombosis, and an aggravated inflammatory response. Case presentation: On 11 July 2022, a middle-aged black African male merchant, 57 was taken to the emergency room. The patient arrived at the emergency room with grade II pitting edema, weight loss, a cold intolerance, stress, a fever, a headache, dehydration, and shortness of breath that had persisted for 2 days. After 28 h, the results of the polymerase chain reaction test on a throat swab confirmed the presence of the severe acute respiratory syndrome coronavirus-2 virus. An auscultation of the chest revealed bilateral wheezing, crepitations in the right infrascapular region, and bilateral airspace consolidations, which were more pronounced on the left side and included practically all zones. He received 1000 ml of fluid resuscitation (0.9% normal saline) and insulin therapy through a drip as soon as he was admitted to an ICU. He received subcutaneous enoxaparin 80 mg once every 12 h as treatment for his confirmed COVID-19 and thromboprophylaxis. Clinical discussion: The COVID-19 infection can cause difficulties in infected individuals that can result in pneumonia, intubation, admission to an ICU, and even death. Common diseases, including diabetes mellitus and chronic renal disease, have a synergistic relationship with early death. Conclusion: The existence of prior chronic renal impairment may possibly be a factor in the increased prevalence of kidney involvement seen in hospitalized COVID-19 patients.

How is ischemic stroke linked to a COVID-19-infected patient different from other cardiovascular risk factors? a case report.

Ischemic stroke is a recognized neurological consequence of an acute coronavirus disease 2019 (COVID-19) infection. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) directly infects endothelial cells, generating widespread endothelial inflammation. This may be the mechanism leading to an ischemic stroke. Infection with SARS-CoV-2 and inflammatory responses cause vascular damage, hypercoagulability, thrombin activation, platelet aggregation, and plaque shedding as a result of hemodynamic alterations, which increase the risk of ischemic stroke. Case presentation: On 19 September 2022, 3 h after the commencement of the right-sided weakness, a 61-year-old black African male farmer was sent to transported to the emergency room. When an radiography of the chest was performed, it showed diffuse bilateral infiltrates, coarse, slightly bilateral crepitation, and scattered reticulations. Cardiovascular testing of the patient turned up nothing unexpected. The eye-opening reaction was 1/4 (no eye opening) on the Glasgow Coma Scale, the motor response was 3/6 (abnormal flexion), and the verbal response was 3/5 (inappropriate words). When his breathing became difficult, he needed five intranasal doses of oxygen every minute to maintain saturation. He started taking low-dose aspirin daily for a month at 81 mg. He took consumed 75 mg of clopidogrel once a day for a month. Clinical discussion: Stroke was associated with in-hospital death among hospitalized patients with the COVID-19 infection. In patients who have risk factors for stroke, such as high blood pressure, obesity, and diabetes, COVID-19 increases the risk of stroke. The risk of stroke was highest in older people within the first few days after receiving a COVID-19 diagnosis. Conclusion: Patients with COVID-19 are more likely to get an ischemic stroke from large infarctions, mostly as a result of major artery thrombosis. From the start of COVID-19 signs, neurological problems can appear anywhere between 3 and 14 days later. Due to severe inflammation, immobility, hypoxia, and diffuse intravascular coagulation, SARS-CoV-2 also possesses neurological invasive capabilities and may migrate from the respiratory system to the central nervous system.

Explore the reasons for SARS-CoV-2 vaccine hesitancy among healthcare workers: a cross-sectional study.

Vaccine hesitancy is described by the WHO as "a delay in acceptance or refusal of safe immunizations notwithstanding the availability of vaccine services." In Ethiopia, the cumulative acceptance rate of the COVID-19 vaccination was 57.8%. Ethiopia had a lower rate of COVID-19 vaccination acceptance than was required to create herd immunity. This study was carried out to determine the prevalence of COVID-19 vaccine reluctance and its contributing factors. Based on the findings of the study, recommendations were made to the relevant bodies in order to reduce vaccine hesitancy and increase vaccination acceptability. Objectives: A cross-sectional online-based study was conducted to better understand the reasons for SARS-CoV-2 vaccine hesitancy among healthcare workers (HCWs) in Oromia regional state, Ethiopia. Materials and methods: A cross-sectional survey using an internet platform was conducted from 18 June 2021, to 29 June 2022. A multistage cluster sampling strategy was used to find participants, with each cluster representing a sampling unit made up of a set of population elements. Participants are then randomly chosen from those clusters. The data were entered in Epi Info 7.2.0.1, then exported to Microsoft Excel and imported into statistical programs for social sciences (26.0 version) for statistical analysis. Statistical significance was considered to be a P value of less than 0.05. Results: Four hundred twenty-two HCWs completed the online survey. The majority of the HCWs were male (n=234, 55.5%), urban residents (n=396, 93.8%), protestants (n=168, 39.8%), and married people (n=232, 55.0%). The prevalence of HCWs reluctant to receive the SARS-CoV-2 vaccination was 69.7% (n=294). Age from 19 to 34 [adjusted odds ratio (AOR) =1.48, 95% CI: 1.69-7.42, P=<0.001], female sex (AOR =3.68, 95% CI =1.370-6.413, P=0.002), income between 3501 and 8500 ETB (AOR =1.67, 95% CI =1.380-5.697, P=0.048), information from websites (AOR =1.79, 95% CI =1.720-31.179, P=0.013), vaccine skepticism (AOR =4.75, 95% CI =3.210-8.152, P=0.009), and potential adverse effects of a SARS-CoV-2 vaccine (AOR =2.18, 95% CI =1.732-5.248, P=0.043) were independent predictors of SARS-CoV-2 vaccine hesitancy among HCWs. Conclusion and recommendations: HCWs were reluctant to get the SARS-CoV-2 immunization at a high percentage overall. To reduce hesitancy to receive the SARS-CoV-2 vaccination among HCWs, the Oromia regional state health bureau should be required to increase HCWs' knowledge of the COVID-19 vaccine by providing proper training for all HCWs.

How is Guillain-Barre syndrome associated with COVID-19 infection differentiated from hypokalemic periodic paralysis? a case report.

Patients with coronavirus disease 2019 (COVID-19)-associated Guillain-Barre syndrome (GBS) exhibit a range of clinical symptoms, such as cranial nerve paralysis and axonal or motor-sensory electrophysiological signals. Case presentation: A 61-year-old retired black African female was brought into the emergency room on 13 May 2022, with a 4-day history of shortness of breath and high-grade fever and a 1-day history of global body weakness (bilateral paralysis of the upper and lower extremities). Motor examination indicated reduced muscular strength in all limbs, with a Medical Research Council score of 2/5 in the right arm of the upper extremities, 1/5 in the right leg of the lower extremities, 1/5 in the left leg of the lower extremities, and 2/5 in the left arm of the upper extremities. Her electrocardiogram revealed ST depression in the anterior-lateral leads and sinus tachycardia. For the COVID-related infection, azithromycin 500 mg per day for 5 days was begun. After cerebrospinal fluid findings supported the diagnosis of GBS, she underwent intravenous immunoglobulin 400 mg/kg every day for 5 days. Clinical discussion: In the majority of COVID-19-related GBS cases, areflexic quadriparesis developed suddenly. A COVID-19 infection related to a GBS case was the only one that had preceding signs, including ageusia and hyposmia. By testing serum potassium levels, this study determined that there is no connection between GBS and hypokalemia, which can lead to diagnostic and therapeutic conundrums by evaluating serum potassium levels, which showed a normal value. Conclusion: One of the neurological symptoms of the COVID-19 infection is GBS. Several weeks after a COVID-19 acute infection, GBS is frequently observed.

COVID-19 increases a person's risk of cardiovascular problems: how common is chronic heart failure in SARS-CoV-2 patients? a case report.

The coronavirus disease of 2019 (COVID-19) infection typically affects the lungs but can also cause life-threatening heart issues. Heart failure is a common condition that can occur either with an existing heart condition or de novo as part of the clinical course of COVID-19. Case presentation: On 11 October 2022, a 60-year-old middle-aged black African woman widow was admitted with a history of muscular weakness for 2 days, a lack of appetite, and occasional vomiting for 1 day. She arrived at the emergency room after complaining for 2 days of peeing less than usual, a fast heartbeat, swelling in the feet, pink blood-tinged mucus, fever, headache, dehydration, a nonproductive cough, and shortness of breath. The left ventricular ejection fraction was 43% on the echocardiogram. Routine reverse transcription polymerase chain reaction testing was performed in the emergency room; she tested COVID-19 positive. To treat her proven COVID-19 infection, she received subcutaneous enoxaparin 80 mg every 12 h as prophylaxis for deep venous thromboembolism. Clinical discussion: A COVID-19 infection can induce cardiac failure and arrhythmias, as well as cause direct harm to the heart. This study explains how enoxaparin has dual benefits in this case report: it reduces the risk of venous thromboembolism in the COVID-19 hospitalized case and prevents death and cardiac ischemia in myocardial infarction. Conclusion: Higher mortality and more frequent acute decompensation may be caused by the capacity of severe acute respiratory syndrome associated coronavirus 2 to cause myocardial injury, as well as by patients with chronic heart failure's lower baseline features, decreased cardiopulmonary reserve, and susceptibility for myocardial injury.

Hypertensive emergency occurred due to forgetting to take antihypertensive medication: A case study.

A life-threatening condition known as a "hypertensive emergency" is marked by a severe increase in blood pressure together with acute or significant target-organ damage. On 1 June 2022, a 67-year-old black male farmer was admitted to the emergency department with a major chief complaint of breathing difficulty. The patient was traveling to the village for work and forgetting his medication at home, and he was losing consciousness and motor activity at his workplace. He presented with symptoms of shortness of breath, confusion, dizziness, nausea, vomiting, blurred vision, and faintness. An abnormal cardiac region was visible on chest X-rays, and there were no changes to the pulmonary parenchyma or fluid overload. Upon admission, hydralazine (5 mg) intravenously was administered immediately, and he was reassessed after 20 min and kept at the emergency department. The next day, sustained-release nifedipine (20 mg) was initiated orally twice a day for the patient, and he was transferred to the medical ward. In the medical ward, the patient was assessed for 4 days, and in those 4 days, he showed marked improvement. Hypertensive emergency treatment intends to reverse target-organ damage, readily lowering blood pressure, decreasing adverse clinical complications, and enhancing the quality of life.

Acute pancreatitis in pregnancy: how was it determined whether it was caused by pregnancy or by COVID-19? A case report.

Acute pancreatitis is a pancreatic inflammatory condition that has the potential to cause serious morbidity. Acute pancreatitis is a relatively uncommon and potentially fatal pregnancy condition. Abdominal pain, pancreatic damage, or acute pancreatitis may all be related to the coronavirus disease 2019 (COVID-19) infection. Case presentation: On 12 August 2022, a 33-year-old black woman, gravida three, para two, a housewife, was taken to the obstetric care unit at 24 weeks of pregnancy with a 1-week history of lethargy, fever, and a dry cough. Reverse transcriptase-PCR testing on a sample of her nasopharyngeal swab revealed the presence of the severe acute respiratory syndrome coronavirus 2 virus. An abdominal computed tomography scan indicated an atrophic pancreas with broad fatty infiltration, little fluid and fat stranding around the pancreas, and reactive lymph nodes. She received 24-h-long insulin infusion therapy in addition to potassium chloride administered intravenously. She received crystalloid isotonic intravenous fluid to treat her severe pancreatitis and stop the progression of acute respiratory distress syndrome. Clinical discussion: Severe consequences of the severe acute respiratory syndrome coronavirus 2 infection are more likely to affect pregnant women who already have diabetes as concomitant conditions. Acute pancreatitis caused by COVID-19 is uncommon and can occur after a mild infection or even after the viral infection has cleared up. Lipasemia typically manifests following the peak of systemic inflammatory activity that triggers the release of pancreatic enzymes like lipase. Conclusion: Symptoms of the digestive system, including anorexia, nausea, vomiting, stomach pain, and diarrhea, can be brought on by the COVID-19 infection. She had diarrhea as a clinical symptom, showing that the COVID-19 infection was the root cause of her acute pancreatitis. She had also refrained from vomiting, demonstrating that her acute pancreatitis was not related to pregnancy.

Dual insulin resistance causes: how frequently type 2 diabetes mellitus and COVID-19 infection caused diabetic ketoacidosis? a case report.

Infection with coronavirus disease 2019 (COVID-19) worsens insulin resistance and causes diabetic ketoacidosis (DKA). Patients with COVID-19 infection who develop DKA run the risk of worse outcomes. In both diabetic and nondiabetic patients, the COVID-19 infection may hasten the development of ketoacidosis, which could have negative effects on the fetus. Case presentation: A 61-year-old retired Black African female was taken into the emergency room on 22 April 2022, with significant complaints of frequent midnight urination, shortness of breath, blurry vision, and tingling in her hands and feet. On a chest radiography, bilateral diffuse, patchy airspace opacities that might be due to multifocal pneumonia or viral pneumonia were seen. The severe acute respiratory syndrome infection was confirmed by real-time reverse transcription-PCR testing from nasopharyngeal swabs. She received intravenous fluids and an intravenous insulin infusion and monitored her blood electrolyte levels as part of her treatment. She received subcutaneous enoxaparin 80 mg every 12 h a day for prophylaxis of deep venous thrombosis due to her confirmed COVID-19. Clinical discussion: In a large number of patients, COVID-19 has the ability to trigger DKA, and type 2 diabetes mellitus amplifies the underlying COVID-19 infection. Diabetes mellitus and COVID-19 are noted to have a reciprocal relationship in this regard. Conclusions: By making the body resistant to insulin and raising blood sugar levels, a COVID-19 infection can cause DKA. It is probable that her severe acute respiratory syndrome coronavirus 2 infection has a detrimental effect on the pancreatic beta cells, which are responsible for her body producing insufficient levels of insulin.

A confirmed COVID-19 in a patient with newly diagnosed hypertension and preexisting type 2 diabetes mellitus: a case report.

Coronavirus disease 2019 (COVID-19) aggravates preexisting diabetes mellitus and contributes to newly discovered hypertension by increasing blood pressure by inhibiting the activity of angiotensin-converting enzyme 2 in the rennin-angiotensin system. Diabetes patients may be more vulnerable to COVID-19 due to chronic comorbidities such as obesity and cardiovascular disease such as hypertension. Case presentation: On 23 March 2022, a retired black African woman in her 60s was taken into the emergency room with the chief complaints of frequent midnight urine, hazy vision, headache, fever, and tingling in her hands and feet. A throat swab PCR test that revealed positive results after 28 h was used to confirm COVID-19. Her electrocardiogram showed sinus tachycardia with a heart rate of 105 beats per minute. Fluid resuscitation (0.9% normal saline) of 1000 ml and drip insulin administration commenced as soon as she was brought to an ICU. Clinical discussion: In this case report, the patient had been previously diagnosed with type 2 diabetes mellitus. COVID-19 affects the beta cells, forcing them to release insulin and increasing insulin insufficiency, which leads to her blood glucose raising. Type 2 diabetes mellitus is therefore the most frequent comorbidity of COVID-19 in this case report. Conclusion: Poor blood glucose management in the case of COVID-19 may increase the pathogen's susceptibility, the likelihood that patients will be admitted to the hospital, and the likelihood that mortality will be enhanced.

Case report: a rare presentation of typhoid fever due to eating over-ripened pineapple.

Typhoid fever is an acute infection caused by Salmonella typhi, especially when it is waterborne or foodborne. Overripe pineapple causes typhoid fever because overripe pineapple is a desirable host for the survival of S. typhi. The importance of typhoid fever as a public health burden is reduced by early detection and appropriate antibiotic treatment. Case Presentation: A 26-year-old black African male health care worker was admitted to the clinic on 21 July 2022, with a significant chief complaint of headache, loss of appetite, and watery diarrhea. The admitted patient presented with a 2-day history of hyperthermia, headache, loss of appetite, and watery diarrhea, as well as back pain, joint weakness, and insomnia. The H antigen titer was positive, which was 1 : 189 greater than the normal range and showed the past history of S. typhi infection. The O antigen titer value detected was a false negative result because it was done before the 7-day onset of fever. On admission, ciprofloxacillin 500 mg was given orally twice a day for 7 days to treat typhoid by inhibiting the deoxyribonucleic acid replication of S. typhi by preventing S. typhi deoxyribonucleic acid topoisomerase and deoxyribonucleic acid gyrase. Clinical Discussion: Typhoid fever pathogenesis is based on pathogenic factors, infecting species, and host immunity. By using the agglutination biochemical test, the Widal test was able to identify the patient's bloodstream as carrying the S. typhi bacteria that causes typhoid fever. Conclusion: Due to contaminated food or unsafe drinking water sources, typhoid fever is associated with travel to developing nations.

Hypertensive Urgency and Anterior Epistaxis Caused by Antihypertensive Medication Noncompliance: A Case Report.

Background and Aims: A sudden increase in blood pressure without serious, life-threatening symptoms or indications of immediate target organ damage is referred to as "hypertensive urgency." This case study revealed the rare direct cause of epistaxis and the direct cause of hypertensive urgency in an elderly man due to antihypertensive medication noncompliance. Case Presentation: A black male farmer, age 63, was brought to the emergency room on June 1st, 2022, with chief complaints of breathing difficulties, epistaxis, and disorientation. The patient was hospitalized after exhibiting symptoms of breathlessness, malaise, nausea, and vomiting. Magnetic resonance imaging, an echocardiogram, and a computed tomography scan of the brain are all clear. For the treatment of epistaxis, he received 1g of tranexamic acid intravenously three times a day for two days. He received intravenous labetalol, which was effective in treating his hypertensive urgency and rebound hypertension, utilizing repeated dosages of 5-20 mg. The patient's intravenous labetalol and previous enalapril were switched to captopril 25 mg orally three times a day for one month after starting drugs per os. Discussion: The patient's hypertensive urgency is directly caused by forgetting to take his blood pressure medication and by not adhering to his previous antihypertensive drugs as prescribed. In this study, the patient's hypertension had been uncontrolled for the previous six months despite his treatment plan. Unaware that he had missed two doses of his antihypertensive medication, he was admitted to the emergency room with progressive anterior nose bleeding that persisted for four hours. The patient's elevated arterial blood pressure is what's causing the patient's nose to bleed.

Poisoning by Organophosphate Pesticides: A Case Report.

In many parts of the world, particularly in impoverished nations like Ethiopia, organophosphate compounds operate as suicide agents, are frequently employed as pesticides, and are strong inhibitors of the acetylcholinesterase enzyme. A 21-year-old Ethiopian female, a university student, was admitted to an emergency department on June 22, 2022, with a two-hour history of nausea and elevated secretions of salivation via the mouth. She had no previous history of psychiatric or neurological disorders, but three days before her admission, she quarreled with her boyfriend, became extremely depressed, and decided to commit suicide. She had a two-hour history of nausea and intermittent vomiting and a one-hour history of persistent vomiting, increased salivation secretions through the mouth, chills, progressive sweating, difficulty breathing, and dizziness. Upon admission, her neurological examination in the emergency department revealed a Glasgow Coma Scale score of 9/15. On admission, she was placed on two liters per minute of intranasal oxygen via the nasal cannula. On the same day, she was given atropine 0.15 mg intravenously, and the dose was doubled every 10 minutes until atropinization was achieved, and a bolus dose of 500ml of 0.9% of normal saline was initiated immediately.

Case Report: Diabetic Ketoacidosis During Pregnancy Due to Insulin Omission.

Diabetic ketoacidosis is an acute and severe complication commonly occurring in individuals with type-1 diabetes mellitus due to absolute insulin deficiency. A 28-year-old Black woman, gravida 2, para 2, secondary school teacher was admitted at 31 weeks of gestation to the obstetric ward on August 12/2022 with a two-day history of nausea and vomiting. She had a history of insulin-dependent diabetes mellitus four years earlier. She missed her insulin dose one day due to traveling to the village for greeting her family. She presented with a two-day history of nausea and vomiting, and a one-day history of shortness of breath, abdominal tenderness, hypotension, elevated heart rate, increased respiratory rate, frequent urination, and fatigue. Ketone testing done using her urine sample showed ketonuria of 3+. Her chest X-ray revealed coarse crackles on auscultation. Her breath odor revealed acetone-smelling breathing. Upon admission, she was treated with insulin infusion for 24 hours and 60 milliequivalents per liter of potassium chloride intravenously was also initiated. On the same day, 0.9% of normal saline 500 mL was initiated intravenously stat and repeats until systolic blood pressure was greater than 90 mmHg. The main objectives of diabetic ketoacidosis management are to restore volume status, normalize hyperglycemia, replace electrolytes lost, and lower ketoacidosis.

"Childrens are not just "little adults". The rate of medication related problems and its predictors among patients admitted to pediatric ward of southwestern Ethiopian hospital: A prospective observational study.

BACKGROUND: The rate of medication related problems is high in developing countries due to the complexity of pediatrics medication management. Pediatric population should have their own dosage regimens. The pediatric dosage regimens were derived from the adult dose that might lead to sudden reach of sub or supra-therapeutic doses. As the result, the medication therapy management is difficult in this populations. Despite this, a scanty of studies were conducted on medication related problems among pediatric populations. Therefore, this study examined the prevalence and risk factors for the occurrence of the medication related problems among patients admitted to pediatric ward of Mettu karl referral hospital. PATIENTS AND METHODS: The pediatric population who were received the pharmacotherapy for their disease was observed and followed for the occurrences of medication related problems at pediatric wards of Mettu karl referral hospital from February 12, 2020 to February 24, 2021. Patients whose age was less than or equal to 18 years and who were on drug therapy or who needs drug therapy during study period were included. The possibility of adverse drug reactions developed from the drug was assessed by using the Naranjo scale. Multivariable logistic regression analysis was used to determine the predictors of medication related problems. RESULT: Over the study period, a total of 189 pediatric populations were included. Among these, 115 (60.8%) were males, and the mean age of the patients was 1.4339 ± 0.864 years. The mediciation related problems was found among 121(64.01%) of pediatric patients. Among seven types of drug therapy problems unnecessary drug therapy, need additional drug therapy, ineffective drug therapy and dose too high were the most predominantly occured DRP that accounted 74 (27.72%), 67 (25.09%), 43 (16.10%), 36 (13.48%), respectively. The mean number of hospital stay was 4.29 days with minimum and maximum stay of 2 and 9 days and antibiotics 364(51.3%) were the most common class of drugs that was associated with drug related problems. Being a neonate (AOR = 1.48, 95CI%: 1.69-7.42, P = <0.001), hospital stay greater than or equal to seven days (AOR = 1.98, 95CI%: 2.471-12.644, P = 0.016), and the presence of co-morbidity(AOR = 2.507, 95CI%: 3.270-4.949, P = 0.080) were the predictors of the medication related problems. CONCLUSION: The prevalence of medication-related problems in pediatrics patient was found to be high. Being neonatal, prolonged hospital stay and the presence of a multiple disease were the predictors of medication-related problems in pediatric patients. Therefore special attention should be given for newborns, prolonged hospital stay and patients having co-morbidity. Besides this, the drug information service and the patients round activity should be started by clinical pharmacist to decrease the occurences of any preventable medication related problems.