No abstract

Novel coronavirus disease 2019 (COVID-19) was first identified in Wuhan, China, and declared by World Health Organization as a pandemic in March 2020. Since then, it has been well known for COVID-19 patients to present with clinical manifestations of severe acute respiratory syndrome (SARS-CoV-2) similar to the influenza. However, in the course of the disease, various pathological complications of high clinical significance have remained unknown. Impaired blood supply to the visceral vascular system can cause serious life-threatening acute damage. We report a case of a 60-year-old female with difficulty in breathing and extensive acute intestinal ischemia confirmed to be associated with SARS-CoV-2 infection. The patient developed a sudden abdominal pain and succumbed shortly after admission before imaging studies were performed. Autopsy revealed massive bowel ischemia. This case highlights the importance of paying attention to serious and less known clinical manifestations other than pulmonary symptoms and fever.

The current global pandemic caused by coronavirus has uncovered multiple symptoms, including sudden hearing loss in either one or both ears, with different outcomes. We present a 68-year-old female with sudden onset bilateral hearing loss, fever, generalized body weakness, and gastrointestinal disturbances. She tested positive for severe acute respiratory syndrome coronavirus 2, was isolated, and was treated with a variety of medications for 5 days before being discharged home to self-isolate. The audiological assessment revealed both sensorineural and conductive hearing loss with a progressive favorable outcome on follow-up visits, with resolution occurring approximately 2 months after the onset. The majority of cases have reported sensorineural hearing loss. However, this case is one of the few that has reported mixed hearing loss. This report highlights an alternate clinical feature of the coronavirus that requires a comprehensive audiological examination by clinicians to ensure proper identification and treatment.

Background: Acute kidney injury (AKI) is a recognized complication in critically ill patients. The epidemiology of AKI varies worldwide, depending on the diagnostic criteria used and the setting. The International Society of Nephrology has called for a reduction in preventable deaths from AKI to zero by the year 2025. It is suspected that the majority of AKI cases are in limited-resource countries, but the true burden of AKI in these settings remains unknown. Objective: We aimed to determine, using standardized KDIGO (Kidney Disease Improving Global Outcomes) criteria, the prevalence of AKI, associated factors, and clinical characteristics of adult (≥18 years) patients admitted to intensive care units (ICUs) at a tertiary hospital in Tanzania. Design: Prospective observational study from November 2017 to May 2018. Methods: In all, 320 patients admitted to medical and surgical ICUs were consecutively enrolled. Baseline, clinical, and laboratory data were collected on admission and during their ICU stay. Serum creatinine and urine output were measured, and KDIGO criteria were used to determine AKI status. Results: More than half (55.3%) of ICU patients were diagnosed with AKI. Of these, 80% were diagnosed within 24 hours of admission. Acute kidney injury stage 3 accounted for 35% of patients with AKI. Patients with AKI were older, more likely to have cardiovascular comorbidities, and with higher baseline serum levels of creatinine, potassium, universal vital assessment admission scores, and total white cell count ≥12. Sepsis (odds ratio [OR] = 3.81; confidence interval [CI] = 1.21-11.99), diabetes (OR = 2.54; CI = 1.24-5.17), and use of vasopressors (OR = 3.78; CI = 1.36-10.54) were independently associated with AKI in multivariable logistic regression. Less than one-third of those who needed dialysis received it. There was 100% mortality in those who needed dialysis but did not receive (n = 19). Limitations: Being based at a referral center, the findings do not represent the true burden of AKI in the community. Conclusion: The prevalence of AKI was very high in ICUs in Northern Tanzania. The majority of patients presented with AKI and were severely ill, suggesting late presentation, underscoring the importance of prioritizing prevention and early intervention. Further studies should explore locally suitable AKI risk scores that could be used to identify high-risk patients in the community health centers from where patients are referred.

deposition of immunoglobulins was detected with immunohistochemical staining on the renal tissue of mice. Immune cells were identified by flow cytometry. Results: We found a marked depletion of Lactobacillales in the gut microbiota in mice with HSPN. Faecal transplantation ameliorated proteinuria, improved renal lesion of these mice and prolonged their survival. Further studies revealed that faecal transplantation reduced migration of mucosal dendritic cells, which could capture antigen from intestinal commensal bacteria, to the intestinal epithelium. The decrease in DCs migration may decrease the antigen presentation and the activation of lymphoid cells. Consistent with this observation, the proliferation of ILC3 and ILC1 in the intestinal mucosal lamina propria and the migration of ILCs to the Peyer patch were significantly reduced after faecal transplantation. These results suggest that faecal transplantation can improve intestinal mucosal inflammation in HSPN mice. Inside the kidney, faecal transplantation reduced mesangial deposits of immunoglobulins along with decreased numbers of ILC3. In addition, the number of Breg cells significantly increased in the blood. Together, these results suggest that gut microbiota may attenuate mesangial proliferative glomerulonephritis by limiting renal deposition of immunoglobulins and skewing the Breg-effector B balance towards Breg. Conclusions: This work demonstrates essential mechanisms on how changes of the gut microbiota regulate mucosal immune responses and promote the development of HSPN in mice. Future studies are warranted to determine if these results can be replicated in human subjects.