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OBJECT The objective of this study was to investigate epidemiology and outcome after surgical treatment for spinal injuries in Ethiopia. METHODS Medical records of patients who underwent surgery for spine injuries at Myungsung Christian Medical Center in Addis Ababa, Ethiopia, between January 2008 and September 2012 were reviewed retrospectively. Assessment of outcome and complications was determined from patient consultations and phone interviews. RESULTS A total of 146 patients were included (129 males, 17 females). Their mean age was 31.7 years (range 15–81 years). The leading cause of injury was motor vehicle accidents (54.1%), and this was followed by falls (26.7%). The most common injury sites were lumbar (41.1%) and cervical (34.2%) regions of the spine. In 21.2% of patients, no neurological deficit was present before surgery, 46.6% had incomplete spinal cord injury (American Spinal Injury Association [ASIA] Impairment Scale [AIS] Grade B-D), and 32.2% had complete spinal cord injury (AIS Grade A). Follow-up was hampered by suboptimal infrastructure, but information regarding outcome was successfully obtained for 110 patients (75.3%). At follow-up (mean 22.9 months; range 2–57 months), 25 patients (17.1%) were confirmed dead and 85 patients (58.2%) were alive; 49 patients (33.6%) underwent physical examination. At least 8 of the 47 patients (17.0%) with a complete injury and 29 of the 68 patients (42.6%) with an incomplete injury showed neurological improvement. The reported incidences of pressure wounds, recurrent urinary tract infections, pneumonia, and thromboembolic events were 22.5%, 13.5%, 5.6%, and 1.1%, respectively. CONCLUSIONS Patients showed surprisingly good recovery considering the limited resources. Surgical treatment for spine injuries in Ethiopia is considered beneficial.

BacgroundSuper-infections in COVID-19 patients with acute respiratory distress syndrome (ARDS) on mechanical ventilation were initially reported to be rare. Little is known of their incidence after dexamethasone was introduced as standard care. We aimed to determine the incidence and characteristics of superinfections in mechanically ventilated COVID-19 patients during the course of the COVID-19 pandemic, and explore the possible impact of the introduction of dexamethasone as standard therapy. MethodsIn this national, multi-center, observational, retrospective study we included patients ≥ 18 years admitted from March 1 st 2020 to January 31 st 2021 with polymerase chain reaction (PCR)-confirmed SARSCoV-2 infection treated with invasive mechanical ventilation. Data was collected from electronic health records. Patient characteristics, clinical findings, microbiology, length of stay and 90-day survival were examined with backwards stepwise multiple regression. Results155 patients (115 men, mean age 62 years, range 26-84 years) were included. 73 patients (47%) had a total of 101 superinfections where pneumonia dominated (70%). Superinfections were more commonly observed in patients receiving dexamethasone (67% vs 30%, p<0.0001), and in patients with pre-existing autoimmune disease (18% vs 5%, p<0.01). Invasive fungal infections were reported exclusively in dexamethasone-treated patients [9/72 (13%) vs 0/83 (0%), p<0.0001]. There was no difference in 90-day survival between patients with and patients without superinfections (64% versus 73%, p=0.238). In multiple regression analysis, superinfection was associated with dexamethasone use [OR 5.35 (2.62–11.35), p<0.001], pre-existing autoimmune disease [OR 4.90 (1.50–19.4), p=0.008] and higher lymphocyte count at the time of admission [OR 2.31 (1.23–4.86), p=0.009]. ConclusionIn critically ill COVID-19 patients receiving invasive ventilation, introduction of dexamethasone as standard of care was strongly and independently associated with superinfections. A focus on this complication is warranted when studying alternative anti-inflammatory therapy.

IntroductionCerebral autoregulation (CA) maintains cerebral blood flow (CBF) despite changes in arterial blood pressure (ABP). However, CA has been shown to be frequency‐dependent: Slow‐frequency ABP oscillations are buffered, while rapid changes in ABP may be transmitted to the cerebral circulation. This may be clinically relevant, as mechanical ventilation during hypovolemia can induce oscillations in ABP. Our objective was to investigate whether CBF is maintained when ABP oscillates at respiratory frequency.MethodsIn eight healthy subjects (3 males), median age 21 yrs (range 19–29), rapid cyclical variations in ABP were generated by oscillatory lower body negative pressure (LBNPosc). The LBNP was changed from 0 to −30 mmHg within 0.5 s, oscillating at the individual subject's respiratory frequency, which was maintained by metronome breathing. Start of inspiration coincided with onset of LBNP, while chamber pressure was normalized during expiration. Beat‐by‐beat blood velocity in the right internal carotid artery (ICA) was measured by Doppler ultrasound (5 MHz, Vingmed SD‐100, GE). ICA beat volume (ICA BV) was calculated using right internal carotid artery diameter measured at normovolemia by B‐mode ultrasound. Non‐invasive finger ABP was recorded continuously from the right middle finger (Finometer), providing beat‐to‐beat mean arterial pressure (MAP) and estimated beat‐to‐beat cardiac stroke volume (SV). Heart rate (HR, ECG), respiratory frequency (respiration belt), and end□tidal CO2 (ETCO2, capnography) were also recorded. The study was approved by the regional ethics committee and conformed to the Declaration of Helsinki. MAP variability (MAPV) and ICA beat volume variability (ICA BVV) were calculated by spectral analysis. Results are medians and 95% confidence intervals calculated by Hodges‐Lehmann's estimates. Wilcoxon signed rank sum test for paired samples was used to test differences between conditions. P<0.05 was considered significant.Preliminary resultsMAPV increased significantly from 1.18 mmHg2 (0.55; 1.59) at baseline to 4.81 mmHg2 (2.8; 7.4) during LBNPosc (p=0.01). Median MAP barely decreased [baseline: 70 mmHg (62; 83), LBNPosc: 68 mmHg (58; 82), p=0.02], while SV, HR, and ETCO2 remained unchanged. Median ICA BV decreased by 10% (−19.7; −2.1) from baseline [6.7 ml (5.3; 8.2)] to LBNPosc [6 ml (4.8; 6.9), p=0.04]. ICA BVV was not significantly changed [from 0.07 ml2 (0.04; 0.18) to 0.14 ml2 (0.05; 0.29)], however coherence between MAPV and ICA BVV was high [0.6 (0.43; 0.76)] at LBNPosc, and significantly increased from baseline [0.32 (0.2; 0.56), p=0.01].ConclusionsOscillatory LBNP at respiratory frequency increased MAPV markedly, while the change in MAP was very small. ICA BV decreased by 10% during oscillations in MAP. Coherence between MAPV and ICA BVV was high during LBNPosc. Thus, the buffering capacity of the CA may be outpaced during rapid variations in ABP, resulting in CBF not being maintained. This might have clinical implications for cerebral perfusion in hypovolemic patients undergoing mechanical ventilation.Support or Funding InformationRCN and UiOThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.