Health Science Reports

The COVID-19 pandemic has disrupted health care delivery globally. Patients on in-centre haemodialysis(HD) are particularly affected due to their multiple hospital visits and the need for uninterrupted care for their well-being and survival. We studied the impact of the pandemic and the national policy for pandemic control on the HD care delivery in Karnataka state in India in April 2020, when the first and second national lockdown were in place. An online, questionnaire based survey of dialysis facilities was conducted and the responses analysed. The questions were pertaining to the key areas such as changes in number of dialysis treatments, frequency, duration, expenses, transportation to and from dialysis units, impact on availability of consumables, effect on dialysis personnel and on machine maintenance. 62 centres participated. Median of dialysis treatments for the months of March and April 2020 were 695.5 and 650 respectively. Reduction in dialysis treatments was noted in 29(46.8%) facilities, decreased frequency reported by 60 centres. In at least 35(56.5%) centres, dialysis patients had to bear increased expenses. Cost and availability of dialysis consumables were affected in 40(64.5%) and 55(88.7%) centres respectively. Problems with transportation and movement restriction were the two key factors affecting both patients and dialysis facilities.This survey documents the collateral impact of COVID-19 on the vulnerable group of patients on HD, even when not affected by COVID. It identifies the key areas of challenges faced by the patients and the facilities and implores the care-providers for finding newer avenues for mitigation of the problems.

Chronic Kidney Disease (CKD) is a major complication of diabetes with a high burden in low-resource settings including Ethiopia due to lack of dialysis, early screening and failure to identify the risk factors for the disease. In Ethiopia, there is a shortage of comprehensive evidence on CKD among diabetic patients. Therefore, this study focused on the gap to addresses CKD in diabetic patients and associated factors in Harari region, eastern Ethiopia. Hospital-based cross-sectional retrospective study was conducted among 315 diabetic patients. Five years data (from January 1, 2019, to December 31, 2024) was collected. Data was collected using Kobo software through chart reviews and checklists in February, 2025, and analyze by SPSS version 25. Descriptive statistics were used to describe frequency, percentage, and tabulation. Bivariable and multivariable logistic regression analyses were conducted to identify associated factors with the outcome variable. Adjusted odds ratio (AOR) with 95% confidence intervals were reported to quantify the strength of associations, and statistical significance was declared at a p-value < 0.05.The study revealed that the prevalence of CKD was (33.2%, 95% CI: 28.5-38.3) among diabetic patients. Alcohol consumption (AOR, 3.89; 95% CI: 1.88-8.03), duration of diabetic (AOR, 3.13; 95% CI: 1.62, 3.77), LDL (AOR, 2.13; 95% CI: 1.21-2.32), prior renal disease (AOR, 4.51; 95% CI: 4.36-5.45), and history of cardiovascular disease (AOR, 2.28; 95% CI: 1.17-4.43) were significantly associated with CKD. However, oral antidiabetic medications has protective effect of CKD (AOR, 0.025; 95% CI: 0.007-0.094). In the study, more than one-third of diabetic patients has developed CKD. Alcohol consumption, LDL, duration of diabetic, prior renal disease, history of cardiovascular disease, and oral therapy were found significantly associated with CKD. A tailored interventions like screening, and awareness creation should be given to diabetic patients to reduce the burden of CKD among diabetic patients.

The COVID-19 pandemic has caused an evolving public health crisis and challenged the medical system globally, especially in the rural-stricken regions. There is concern about the spread of coronavirus in regions with lower education level, weaker health systems and underdeveloped economy. The risk of viral transmission in HD center is elevated because of the densely-populated and high mobility in an enclosed environment.This paper demonstrated the main experiences and strategies of preventing secondary COVID-19 transmission in a HD center from a poverty-stricken rural region in China. Data of subjects including 17 medical workers and 249 patients were collected from the HD center in Huangchuan County Peoples Hospital from February to April 2020. It is the first paper to provide the experiences and strategies about preventing COVID-19 secondary transmission in HD center for poverty-stricken rural region.

IntroductionChronic Kidney Disease (CKD) is being recognized as a global public health problem. CKD is a major non-communicable disease with the global prevalence varying between 10.5% and 13.1%. Diabetes and hypertension appear to be the leading causes of CKD and End Stage Renal Disease worldwide. The aim of this study is to determine the prevalence of CKD and its associated factors among patients admitted to medical ward in a tertiary hospital, Northern Ethiopia. MethodologyAn institution based cross-sectional study was undertaken using systematic random sampling technique to select study participants. Sample sizes of 450 patients were included in the study. Data was collected using a pre-tested semi-structured questionnaire designed to meet the study objective. The data collection period was from October 20, 2017 to March 20, 2018 G.C. Data was analyzed using SPSS version 21.The odds ratio with their 95% confidence interval and P value were calculated. Statistical significance was declared if P value < 0.05. ResultOf the 450 patients, 260(57.8%) were males. More than half (54.2%) were between ages of 25 to 40 years. The overall prevalence of CKD among patients admitted to medical ward was 17.3% (95% CI 13 - 29.9) and 14.4% (95 % CI 6.2 - 12.3) by Cockcroft Gault and MDRD equations respectively. Prevalence of stage 5 CKD was 61.5% by Cockcroft Gault equation. Hypertension AOR 3(95%CI 1.28, 4.1), history of recurrent urinary tract infection AOR 3.5 (95% CI 1.1, 7.3) and history of using nephrotoxic drugs AOR 3.4 (95% CI 2, 9.3) were significantly associated with CKD. ConclusionThe prevalence of CKD among adult patients admitted to medical ward in tertiary hospital, Northern Ethiopia was high and majority of patients with CKD were stage 5. Hypertension, use of nephrotoxic agents and recurrent urinary tract infections were significantly associated with CKD.

PurposeThis study, aimed at determining the epidemiology and antimicrobial susceptibility patterns of infectious diseases caused by ESKAPE and non-ESKAPE microorganisms in patients hospitalized at the Nigde Omer Halisdemir University Training and Research Hospital in Nigde, Turkey, is a crucial step in understanding and combating the global public health problem posed by the ESKAPE pathogens. Materials and methodsA retrospective analysis was conducted at a primary tertiary care teaching reference hospital in Nigde. The study included patients admitted to the hospital between June 2022 and June 2024. The hospital information system offered clinical and demographic data for the patients. Furthermore, the hospitals microbiology lab acquired information on bacterial isolates and antibiotic resistance. ResultsThis study included 13378 bacterial isolates, predominantly gram-negative bacteria, particularly those from the Enterobacterales group. Among these isolates, 9798 (73.2%) were identified as ESKAPE pathogens, and 3580 (26.8%) were identified as non-ESKAPE bacteria. The Intensive Care Unit (ICU) accounted for the highest proportion of infections (34.47%), followed by the pediatric unit (22.6%). The most common infections were caused by Escherichia coli (4747 isolates, 35.5%), K. pneumoniae (1921 isolates, 19.6 %), and Acinetobacter baumannii (1049 isolates, 10.7 %). Furthermore, the analysis revealed that approximately 50.86% of the ESKAPE isolates were classified as multidrug-resistant (MDR) or extensively drug-resistant (XDR). XDR was predominantly detected in Acinetobacter baumannii (72.4%), whereas MDR was predominantly detected in Enterococcus faecium (76.9%). In contrast, Non MDR was predominantly detected across non-ESKAPE pathogens in Staphylococcus hemolyticus (96.1%), Staphylococcus epidermidis (86.5%), and Staphylococcus hominis (84.5%). Demographic data from the study highlighted significant age group disparities in individuals infected by the ESKAPE and the non-ESKAPE bacteria, with a more substantial proportion of older and children individuals represented in the research sample. ConclusionsThis study underscores the significant threat posed by multidrug-resistant ESKAPE pathogens in reference hospital settings, emphasizing the urgent need for effective surveillance and control measures.

Introduction Glomerular filtration rate (GFR) is invasive to measure. Therefore, in clinical care, estimated GFR is derived from serum levels of endogenous filtration markers such as creatinine and cystatin C. Multiple studies from high income countries showed differences between estimated glomerular filtration rate based on cystatin C (eGFRcys) and creatinine (eGFRcr). This study aimed to assess the agreement between eGFRcys and eGFRcr in Ethiopian children and identify factors influencing higher eGFRcys and eGFRcr. Method We studied 350 Ethiopian children who were part of the iABC birth cohort study. At the recent follow-up (average age 10 years), serum cystatin C and creatinine were measured. Formulas by Berg (2015) and Hoste (2014) were used to estimate eGFRcys and eGFRcr, respectively, and Bland-Altman plots assessed their agreement. The difference in eGFR (eGFRdiff) was calculated and categorized as less than -15 mL/min/1.73 m2 (higher eGFRcr), between -15 and <15 mL/min/1.73 m2 (concordant), and greater than or equal to 15 mL/min/1.73 m2 (higher eGFRcys). Multinomial logistic regression was used to identify factors associated with higher eGFRcr and higher eGFRcys. Result Estimated glomerular filtration rate (eGFR) showed significant variation based on the estimation formula used. When using formulas by Berg (2015) and Hoste (2014), the median (IQR) eGFRcys and eGFRcr were 99.4 (90.0; 114.1), and 123.2 (110.3; 143.8) mL/min/1.73 m2, respectively. Overall, we observed a poor agreement between eGFRcys and eGFRcr, with only 94 (27.6%) children having concordant results compared to 220 (64.7%) with higher eGFRcr and 26 (7.6%) with higher eGFRcys. If the eGFRcys results are considered reliable, 27.5% of the children had eGFR below 90 mL/min/1.73 m2. Conclusion There was very marked variation in the distributions of estimated eGFRs depending on which formulas for children were used. Agreement between eGFR estimated using cystatin C and creatinine was poor among Ethiopian children. Relative to eGFRcys, kidney function may be overestimated by creatinine-based equation as up to 30ml/min in Ethiopia. Ideally, a validation study with GFR measured by gold standard methods (Inlulin clearance) among children is required. However, because of its invasive nature and financial concerns, Iohexol clearance studies are recommended.

IntroductionSerum neutrophil gelatinase-associated lipocalin (sNGAL), a renal tubular marker, and Neutrophil-to-Lymphocyte Ratio (NLR), a haematological inflammatory marker are two biomarkers that have recently received attention, because of their association with kidney disease. This study examined the diagnostic value sNGAL and NLR in type 2 diabetes mellitus (T2DM) patients with reduced eGFR. Materials and methodsIn this hospital-based case-control research, 97 T2DM participants and 70 healthy subjects were included. Participants information was documented using a structured questionnaire and patient case records. Venous blood was drawn from each participant to evaluate absolute neutrophil and lymphocyte count ratio, glycosylated haemoglobin (HBA1c), creatinine, sNGAL, and fasting blood glucose. ResultssNGAL and NLR were higher in diabetes patients with reduced eGFR than those with normal eGFR and control (p < 0.05). sNGAL level was negative correlated with eGFR among both good (r= -0.317, p= 0.036) and poor (r= -0.544, p< 0.001) glycaemic-controlled T2DM subjects with reduced eGFR. A negative correlation was observed between NLR and eGFR among poor glycaemic-controlled T2DM subjects with reduced eGFR (r= -0.329, p= 0.016). At a cut off of 8.87 {micro}g/L and 2.34 respectively, sNGAL and NLR were found to be good predictors of nephropathy among T2DM patients (AUC=100.0, p< 0.0001 and AUC=76.0, p< 0.0001 respectively) with sNGAL being the superior marker. ConclusionssNGAL and NLR have important diagnostic value for diabetic with reduced eGFR. Whiles sNGAL showed superiority and is recommended, NLR can serve as a less expensive and readily measurable alternative biomarker for diabetic patients with reduced eGFR, particularly in poorly controlled diabetes. These two markers can be added to the available array of tests used to indicate nephropathy in type 2 diabetics to help clinicians in better management of the disease.

BackgroundCatheter-related bloodstream infection (CRBSI) is a major cause of morbidity and mortality among patients undergoing hemodialysis (HD), particularly in low- and middle-income settings where non-tunneled hemodialysis catheters (NTHC) are widely used. Local epidemiological data are essential to guide preventive and therapeutic strategies. ObjectivesTo determine the prevalence, microbiological profile, antimicrobial resistance patterns, and clinical outcomes of CRBSI in patients undergoing HD via internal jugular NTHC at a tertiary care center in South India. MethodsThis retrospective observational study included adults initiated on HD using internal jugular NTHC between January 2017 and December 2023. Patients with pre-existing infections or catheters inserted elsewhere were excluded. CRBSI was defined using KDOQI criteria. Demographic, clinical, laboratory, microbiological, and outcome data were analyzed. Logistic regression identified risk factors, and receiver operating characteristic (ROC) analysis evaluated predictors of adverse outcomes. ResultsAmong 396 patients (mean age 56.3 {+/-} 14 years; 70.4% male), 65 (16.4%) developed CRBSI, with an incidence of 4.7 per 1000 catheter days. Emergency HD initiation (OR 14.86, p < 0.001) and access failure (OR 2.71, p = 0.004) significantly increased CRBSI risk, while planned initiation for uremic symptoms was protective. Patients with CRBSI had lower serum albumin and higher leukocyte counts. Gram-negative organisms predominated (53.8%), with Klebsiella pneumoniae being the most common isolate. High resistance was observed to {beta}-lactam/{beta}-lactamase inhibitor combinations and carbapenems. Gram-negative CRBSI was associated with significantly higher odds of hospitalization, ICU admission, inotropic support, and mortality. ROC analysis showed good predictive ability for adverse outcomes (AUC 0.73-0.77). ConclusionsCRBSI remains a significant complication of NTHC-based HD. Predominant Gram-negative infections with high antimicrobial resistance are associated with worse clinical outcomes, underscoring the need for early permanent access creation, strict catheter care, and robust antibiotic stewardship.

BackgroundAntimicrobial drug resistance is of public health importance due to its potential to reduce treatment options and increase healthcare expenditure. There is, however, a paucity of studies that have examined antimicrobial resistance in countries with poor to moderate income. The present study examined the patterns and predictors of antimicrobial resistance in Staphylococcus isolates collected from humans at diagnostic laboratories in South Africa between 2012 and 2017. Method and materialsA cross-sectional study design using retrospective data of 404 217 diagnostic laboratory records of staphylococcal isolates collected between 2012 and 2017 was adopted in this study. Isolates were assessed for antimicrobial drug resistance against 24 antimicrobials. Descriptive statistics, and binary logistic regression models were used to analyse the data. Significance was assessed at < 0.05. ResultsThe highest resistance was observed against Cloxacillin (70.3%), while the lowest resistance was against Colistin (0.1%). A significant (p < 0.05) decreasing trend in AMR was observed over the study period, while a significant increasing temporal trend (p < 0.05) was observed for MDR over the same period. A Significant (p < 0.05) association was observed between specimen type, species of organism, and year of isolation with AMR outcome. Significant (p < 0.05) associations were observed between specimen type and season, with MDR. Discussion and recommendationsThe observed high levels of AMR and the increasing temporal trend in MDR is of public health concern. Clinicians should consider these findings when deciding on therapeutic options. Continued monitoring of AMR among Staphylococcus spp. and judicious use of antimicrobials in human medicine should be promoted.

BackgroundStaphylococcus aureus and Streptococcus pneumoniae are common inhabitants of the nasopharynx of children. HIV-infected children have higher risk of invasive diseases caused by these pathogens. With widespread use of pneumococcal conjugate vaccines and the emergence of methicillin-resistant S aureus, the interaction between S. aureus and S. pneumoniae is of a particular significance. We sought to determine the magnitude of colonization by methicillin-sensitive and -resistant S. aureus and colonization by S. pneumoniae; associated risk factors and antimicrobial susceptibility pattern among HIV-Infected children in Addis Ababa, Ethiopia. MethodA prospective observational study was conducted in 183 HIV-infected children at ALERT hospital Addis Ababa, Ethiopia from September 2016 to August 2018. S. aureus and S. pneumoniae were identified using standard bacteriological techniques, antimicrobial susceptibility testing was performed on S. aureus and screening for methicillin resistance was carried out by amplifying the mecA gene. Risk factors were analyzed by using binary logistic regression. ResultsThe prevalence of nasopharyngeal S. aureus, MRSA and S. pneumoniae colonization were 27.3%, 2.7% and 43.2% respectively. Multivariable analysis indicated an inverse association between S. aureus and S. pneumoniae nasopharyngeal colonization (aOR, 0.49; CI, (0.24, 0.99); p= 0.046). The highest level of resistance in both methicillin sensitive S. aureus (MSSA) and MRSA was observed against tetracycline. ConclusionsWe found an inverse association between S. aureus and S. pneumoniae colonization among HIV-infected children. Continued assessment of the impact of pneumococcal conjugate vaccines and anti-retroviral therapy on nasopharyngeal bacterial ecology is warranted.

ObjectiveThe aim of this study is to determine the prevalence of ESBL producing Klebsiella pneumoniae isolated from different clinical specimens gathered from different clinics in Khartoum State. Settings and DesignThis is a descriptive cross-sectional study conducted in Khartoum State during a period from February to May 2018. Methods and MaterialsKlebsiella pneumoniae isolated from patients attending to health-care settings with different infections, which was re-identiGied by conventional methods and screened for ESBL production by modiGied Kirby-Bauers method. The TEM and SHV genes were detected by PCR. ResultsOut of 100 K. pneumoniae isolates, 85% (85/100) were ESBL producing strains. The highest prevalence of ESBL production was in blood 100% (6/6) as well as stool 100% (4/4) followed by sputum 91% (21/23), wound 85% (12/14) and urine 82%(40\49) samples, while the lowest was noted in CSF 50% (2/4). The isolated K. pneumoniae showed high resistance to Ceftazidime 85% followed by Cefotaxime and Cefpodoxime 80% for each and 73% for Aztreonam. Furthermore, we found that 88% of isolates were resistant to Colistin and 33% were resistant to Meropenem. TEM and SHV genes were detected in 9.4% (8/85) and 1.2% (1/85) of ESBL producing strains, respectively. However, SHV was also detected in 6.7% (1/15) of non-ESBL-producing K. pneumoniae. ConclusionsA high prevalence of ESBL-producing K. pneumoniae was detected in this study Which is 85%. TEM and SHV genes were found in some strains of ESBL producing K. pneumoniae. The Gindings of this study alarm the physicians to take ESBL producing strains of K. pneumoniae under consideration before making treatment decisions.

Pseudomonas aeruginosa is an opportunistic pathogen with high clinical relevance in intensive care units (ICU) due to its elevated resistance to various antimicrobials, which lead to high morbidity and mortality in patients in critical situations. In this study, we aimed to detect variants of genes encoding {beta}-lactamases and efflux pumps in P. aeruginosa isolates resistant to {beta}-lactams, fluoroquinolones and aminoglycosides. All genes belonging to the subfamilies were included in this study: blaSHV, blaTEM, blaNDM, blaKPC, blaGES, blaCTX-M. In addition, we investigated the most relevant variants of the blaOXA subfamily and genes belonging to the efflux pumps of the Mex family. We tested 54 isolates of P. aeruginosa with a high prevalence of resistance to the antimicrobials piperacillin/tazobactam, ceftazidime, cefepime, imipenem and meropenem. Resistance genes related to carbapenems and spectrum {beta}-lactamases extended were found, which included blaKPC genes (81.49%), blaCTXM-2 (72.22%) and blaCTXM-1 (66.66%). In relation to the presence of Mex family efflux pumps genes, 100% of positivity were detected. These findings suggest that P. aeruginosa isolates exhibit an arsenal of genes encoding {beta}-lactamases able to induce phenotypic patterns of resistance to several antimicrobials commonly used as first-line treatment. Author SummarySince the introduction of the use of antimicrobials, resistance to antimicrobials has been growing and becoming a global public health problem, as it leads to ineffective treatment and an increased risk of mortality. P. aeruginosa is included in the World Health Organization (WHO) critical list of bacteria that have a higher rate of resistance to antimicrobials, requiring constant epidemiological investigation of the strains, especially in hospital environments, to correctly approach them. In this work, we used a methodology that detects 740 variants of different classes of {beta}-lactamases to evaluate the genotype of the study strains against the phenotype found. We evidenced a high prevalence of strains carrying genes related to carbapenems and extended-spectrum {beta}-lactamases, demonstrating a correlation with the phenotypes. Furthermore, we found a 100% positivity rate among the efflux pumps tested belonging to the MEX family.

IntroductionRotavirus is a common cause of infectious gastroenteritis in infants and children. The role of rotavirus infections in adults has potentially been underappreciated and there is a paucity of data on incidence and outcome of acute kidney injury in adult patients. MethodsWe conducted a retrospective cohort study of adult hospitalized patients with microbiologically confirmed rotavirus infection. The primary outcome was occurrence of acute kidney injury related to rotavirus infection. Secondary outcomes were in-hospital mortality, duration of hospitalization and occurrence of sodium disorders. Results314 hospitalized adult patients with rotavirus infection were evaluated. 200 patients, (63.7%) had community-acquired and 114 patients (36.3%) had nosocomial rotavirus infection. Acute kidney injury (AKI) occurred in 127 (40.4%) patients. AKI occurred more often in patients with community-acquired than nosocomial infection (110 (55.0%) vs 17 (14.9%), p<0.001). 26 (8.3%) patients died in hospital. Patients with AKI had worse survival (HR 2.63 (CI 1.20, 5.74) p=0.01). Hyponatremia was detected in 60 (30.6%) of 196 patients with community-acquired infection. Dehydration occurred in only 5 (2.6%) patients. ConclusionAdult outpatients with rotavirus infection and certain risk factors (age > 70 years and comorbidities, e.g. CKD) have a high risk of developing AKI. Patients should seek medical attention with a low threshold and, if necessary, undergo hospitalization to counteract volume depletion and the development of acute renal injury. Hyponatremia frequently occurs while dehydration is rare. Recommendations in outpatients at risk for AKI should focus on increasing salt intake rather than water intake.

BackgroundChronic Kidney Disease (CKD) affects 10-15% of the population worldwide. The number of dialysis patients is steadily rising in Ethiopia. Chronic hemodialysis patients experience high rates of mortality; however, data is lacking in Ethiopia. We explored the mortality and its driving factors in selected dialysis center in Addis Ababa Methodwe retrospectively followed a group of End-Stage Renal Disease patients on hemodialysis from 2016 to2020 in St. Paul Millennium Medical College (SPMMC), Zewditu Memorial Hospital (ZMH), and Menellik II Hospital. We fitted Kaplan Meier analysis to estimate the one and five years survival probability of these patients and Cox Proportional regression analysis to model the predictors of mortality at p value [&le;]0.05. ResultWe analyzed a data of (139) patients under follow up. The mean age ({+/-} SD) of the patients was 36.8 ({+/-}11.95) years. Twenty-four (17%) of the patients died at the end of follow-up. The median survival time was 46.2 months (95% CI: 41.8, 50.5). The one and five-years survival probability of these patients was 64.8% and 18.7%, respectively. Our analysis showed that patients with hypertension (AHR = 4.33; 95% CI: 1.02, 34.56), cardiac complication (AHR = 4.69; 95% CI: 1.32, 16.8), and infection during dialysis (AHR = 3.89; 95% CI: 1.96, 13.8) were more likely to die. ConclusionThe survival status of hemodialysis patients in three was low. Preventing and treating comorbidities and complication during dialysis would reduce mortality of CKD patients.

BackgroundSince December 2019, Coronavirus Disease 2019(COVID-19) occurred in wuhan, China, and outbreaked rapidly into a global pandemic. This current poses great challenges to hemodialysis (HD) patients. ObjectiveTo make a comprehensive evaluation and comparison between HD patients confirmed with COVID-19 and the general HD patients. MethodsHD patients confirmed with COVID-19 in Wuhan No.5 Hospital were admitted as confirmed group from Jan 10 to Mar 15, 2020. And HD patients not infected in our dialysis center were chosen as control group. General characteristics, laboratory indicators were retrospectively collected, analyzed and compared. ResultsA total of 142 cases were admitted, including 43 cases in confirmed group and 99 in control group. Body mass index (BMI) was slightly lower in confirmed group than that in control group (P=0.011). The proportion of one or less underlying disease in confirmed group(51.16%) was higher than that in control group(14.14%)(P< 0.001), and the proportion of three or more underlying diseases in confirmed group(11.63%) was lower than that in control group(52.53%)(P< 0.001). Patients in confirmed group exhibited significantly lower hemoglobin, lymphocyte count, and lymphocyte percentage, but higher neutrophil percentage, neutrophil-to-lymphocyte ratio (NLR), C-reactive protein, aspartate transaminase, and alkaline phosphatase. There was no significant difference in age, gender, dialysis age, primary disease, the using of ACEI/ARB, platelet-to-lymphocyte ratio (PLR), and other indicators between the two groups. ConclusionsFaced with Severe Acute Respiratory Syndrome-CoV-2 (SARS-CoV-2), HD patients with lower BMI and hemoglobin were more susceptible to be infected, which might be related to malnutrition. Once confirmed with COVID-19, HD patients expressed obviously dis-regulated of inflammation and immune.

The novel coronavirus (COVID-19) is known to be the fifth pandemic causing massive deaths worldwide. This virus has not only been deeply associated with acute respiratory distress, but also acute kidney injury (AKI). This study describes the baseline characteristics and various outcomes of AKI based on the KDIGO 2012 Clinical Practice Guidelines in patients hospitalized with COVID-19 at a Philippine tertiary hospital. A total of 195 patient records were retrospectively reviewed for the study. Of the 195 patients, 81(42%) patients developed AKI. Significant baseline characteristics included older age (56.28 + 14.12), presence of hypertension (p=0.004), diabetes mellitus (p=0.002), and cardiovascular disease (p=0.003). Also, the use of diuretics, inotropes and antibiotics were more prevalent in patients who developed AKI. Most of the patients who had AKI were categorized as stage 1 (49.38%). Mechanical ventilation was significantly (p<0.001) more prevalent in patients with AKI (20.99%) compared to patients without AKI (5.26%). There was significantly higher rates (p<0.001) of renal replacement therapy in patients with AKI (30.86%). Lastly, higher mortality rates were observed in patients with AKI (50.62%) versus patients without AKI (12.28%). Our study demonstrated that patients with COVID-19 can develop AKI and tend to have a poorer prognosis.

IntroductionSome patients with COVID-19 pneumonia present systemic disease involving multiple systems. There is limited information about the clinical characteristics and events leading to acute kidney injury (AKI). We described the factors associated with the development of AKI and explored the relation of AKI and mortality in Mexican population with severe COVID-19. MethodsWe retrospectively reviewed the medical records of individuals with severe pneumonia caused by SARS-CoV-2 hospitalized at the largest third-level reference institution for COVID-19 care in Mexico between March and April 2020. Demographic information, comorbidities, clinical and laboratory data, dates of mechanical ventilation and hospitalization, mechanical-ventilator settings and use of vasoactive drugs were recorded. ResultsOf 99 patients studied, 58 developed AKI (58.6%). The group with AKI had higher body mass index (p=0.0003) and frequency of obesity (p=0.001); a higher requirement of invasive mechanical ventilation (p=0.008) and vasoactive drugs (p=0.004); greater levels of serum creatinine (p<0.001) and D-dimer on admission (p<0.001); and lower lymphocyte counts (p=0.001) than the non-AKI group. The multivariate analysis indicated that risk factors for AKI were obesity (adjusted hazard ratio (HR)=2.71, 95% confidence interval (CI)=1.33-5.51, p=0.005); higher serum creatinine (HR=1.44, CI=1.02- 2.02, p=0.035) and D-dimer levels on admission (HR=1.14, CI=1.06-1.23, p<0.001). Inhospital mortality was higher in the AKI group than in the non-AKI group (65.5% vs. 14.6%; p=0.001). ConclusionsAKI was common in our cohort of patients with severe COVID-19 and it was associated with mortality. The risk factors for AKI were obesity, elevated creatinine levels and higher D-dimer levels on admission.

Backgroud and ObjectiveAcute kidney injury (AKI) is a significant complication of COVID-19 infection, with varied incidence rates globally. COVID-19 has exacerbated AKI cases, with a significant portion of patients experiencing kidney damage. This study investigates the prevalence and risk factors associated with AKI among COVID-19 patients in Semarang, Central Java, Indonesia. MethodsData from 364 hospitalized COVID-19 patients in a hospital in Semarang between March 2020 and September 2021 were analyzed. Statistical analysis using chi-square and logistic regression examined the relationship between AKI and its determinants, with p[&le;]0.05 considered significant. ResultsThe majority of patients were male, most had no prior medical conditions. Analysis indicated links between AKI and various factors like several physical and supportive examination results. Few comorbidities were found to increase the risk of AKI, followed also by abnormal vital signs except blood pressure, several elevated level of laboratory results, and radiologic pneumonia finding. ConclusionCOVID-19 may harm the kidneys causing AKI. This study highlights the importance of history taking, examination, and laboratory monitoring to detect AKI in COVID-19 patients.

BackgroundSub-Saharan African (SSA) mens erotic desires for sexual prowess, stamina, and sturdy penile strength have created a multi-million-dollar industry for businesses retailing non-prescription plant-based aphrodisiacs (NPBAs). Globally, the registered and approved NPBA mass-producing sexual enhancement supplements (SESs) retailing industry, has reached almost $300 million in 2025, and is projected to increase by 6.9% yearly up until 2035. The gross increase will be approximately $600 million. Unlike the global market that heavily relies on manufactured SESs, a vast majority of male SSA citizens still prefer natural NPBAs. These NPBAs are natural plant species (herbs, flowering plants & roots) that are either consumed in their natural form or mixed with warm water to extract the plants or roots properties. Currently in SSA, almost 600 plant species have been discovered in less than 10 countries, and these plants are currently being used as NPBAs by men. However, due to the SSA region comprising of 49 countries and approximately 1.6 billion citizens, a large majority of untested, and unapproved plant species are currently being used as NPBAs. This is dangerous because the global, continental (Africa), and regional (SSA) health & medical science communities have not tested the toxicity levels of these NPBAs. This lack of knowledge has led to health risks such as nephritis (inflammation of the kidneys), and nephrosis (excessive protein loss due to damaged kidney filters) in SSA men. Moreover, the easy access in obtaining NPBAs in SSA and the excessive usage of them by men, has led to a spike in chronic kidney diseases (CKD) such as nephritis and nephrosis. CKD is currently a growing public health concern in SSA that has received minimal attention due to it being a non-communicable illness. Approximately 174 million SSA citizens are affected by CKD which has caused 77,000 deaths in the region, and the severity of this issue is proven by CKD increasing by 0,85% annually. Currently, the excessive use of unapproved NPBAs in SSA has been included as one of the leading causes of CKD in men. MethodsThe primary aim of this systematic review is to map out and synthesise evidence of, NPBAs inducing nephritis and nephrosis in SSA men from existing literature. The following databases will be utilized to search for studies: PubMed, PsycINFO, ProQuest, ERIC (Education Resources Information Center), Cochrane Reviews, WHO, and Scopus. The Preferred Reporting Items for Systematic and Meta Analyses (PRISMA) ScR flow chart/diagram presented in figure 1 will be utilized to summarize the study selection process. O_FIG O_LINKSMALLFIG WIDTH=148 HEIGHT=200 SRC="FIGDIR/small/25335902v2_fig1.gif" ALT="Figure 1"> View larger version (23K): org.highwire.dtl.DTLVardef@b742d3org.highwire.dtl.DTLVardef@184540borg.highwire.dtl.DTLVardef@a9b68corg.highwire.dtl.DTLVardef@fadfa_HPS_FORMAT_FIGEXP M_FIG O_FLOATNOFigure 1:C_FLOATNO The Preferred Reporting Items for Systematic and Meta Analyses (PRISMA) ScR flow chart/diagram C_FIG ConclusionDespite CKD/Kidney disease/nephritis & nephrosis not being included as: (i) a part of the NCDs that cause a large number of deaths globally, (ii) the 4 major NCDs, that are reported on within several global WHO NCD publications, within Africa and the SSA region this chronic disease is a serious public health crisis. Unfortunately, untested, unapproved, and unregulated NPBAs that currently exist in SSA, are also suspected of predominantly contributing to this crisis in men. Moreover, throughout the African continent and SSA region, only three countries (Ethiopia, South Africa & Zambia) offer both renal replacement by transplantation, and renal replacement therapy by dialysis. Hence, the escalating death rates caused by CKD/Kidney disease/nephritis & nephrosis. The proposed systematic review will generate findings pertaining to NPBAs inducing nephritis and nephrosis in SSA men. These findings will/can reveal the current existing literature gaps regarding NPBAs, CKD, nephritis and nephrosis. Systematic reviews registrationPROSPERO (CRD420251146160)

BACKGROUNDUrinary tract infections (UTIs) are among the most common infections in the community and hospital settings and Enterobacteriaceae, are responsible for most infections. This study determined the prevalence and resistance trends of E. coli and K. pneumoniae to fluroquinolones and cephalosporins among out-patients diagnosed with urinary infections at a Zonal tertiary hospital in Tanzania METHODSThis was a prospective cross sectional time series conducted in northern Tanzania and enrolled all out patients presenting with UTI symptoms. The study conducted for a period of six months between march 2021 to September 2021. RESULTSDuring the study period1582 patients were enrolled, the mean age was 20.2(SD 22.2) years and 883(55.8%) were female. The prevalence of E. coli was higher in female patients at 12.0% compared 6.7% in male. Both E. coli and K. pneumoniae were most prevalent in patients over >45 years at 13.3% and 3.2% respectively. E.coli resistance to Ceftriaxone, cefepime, and ciprofloxacin was 41.0%, 36.8% and 51.0% respectively. Resistance K. pneumoniae to ceftriaxone, cefepime, and ciprofloxacin was shown to be 52.8%, 47.4% and 28.2% respectively. Meanwhile, 76/192(39.6%) isolates were identified as ESBL. CONCLUSIONSIn this setting empirical treatment of urinary tract infections with ciprofloxacin a commonly prescribed antibiotics for this diagnosis may not work in over half of patients when E,coli is the causative pathogen. Moreover, E. coli, resistance of 43% to ceftriaxone implies that patients who do not respond to initial therapy with ciprofloxacin, are at a risk of not responding to subsequent therapy necessitating the use of reserve antibiotics.