Novel corona virus disease (COVID-19) pandemic, which started in China's Hubei province in 2019, has caused a significant loss of human lives globally. This study describes the epidemiologic and clinical profiles of COVID-19 related deaths among patients admitted to treatment centers in Sidama region, Ethiopia. A cross-sectional study of 186 in hospital COVID-19 related deaths that occurred from July 2020 to December 2021 in Sidama region were analyzed. Data was extracted from regional emergency operation center death report. Data was entered using Epidata v3.1 and analysis was done using SPSS v.20. Categorical data was summarized using frequency and percentage while continuous data was summarized using median and interquartile range. Association between variables was assessed using chi-square test. More than two-third of the deceased patients were male (135; 72.6%) and median age at death was 60. The majority of deaths (151; 81.1%) occurred in 2021, while April 2021 had the highest death records. Cough and shortness of breath were the main presenting symptoms occurring in 89.2% and 85.5% of deceased patients respectively. Most of the COVID-19 related deaths (64.5%) had associated comorbidities. Diabetes (50%) and Hypertension (39.2%) were the most prevalent comorbidities. Significant proportion of patients (74.73%) presented on severe end of disease spectrum (critical/ severe). Of the deceased patients, around two-third required Intensive care unit (ICU) admission and 111 of them were put on mechanical ventilator. Moreover, the median ICU stay was 4 days. Around half of the death (48.4%) occurred in the first 5 days. The median survival time from symptom onset was 11.5 days with most (43.5%) of the deaths occurring within the first 14 days of symptom onset. Age category was significantly associated with the number of days from onset to death (p=0.006). The case fatality rate was 1.87% which is lower than national and global reports. Unlike previous studies, the prevalence of asthma among deceased patients was low and there were no patients with documented COPD.

Objective: To evaluate maternal and neonatal outcomes of women with placenta accreta spectrum (PAS) disorders managed by a dedicated multidisciplinary team at a tertiary referral centre in Riyadh, Saudi Arabia. Methods: We conducted a prospective case series of all women with antenatally suspected and intraoperatively or histopathologically confirmed PAS managed at King Fahad Medical City between April 2018 and December 2024. Women with high suspicion of PAS were electively admitted at 31+6 weeks’ gestation for optimisation when feasible and delivered by midline laparotomy and fundal or classical caesarean incision with the placenta left in situ. Definitive management consisted of hand-assisted retrograde caesarean hysterectomy or segmental uterine resection with reconstruction. Outcomes included operative time, quantified blood loss, transfusion requirements, intra- and postoperative complications, intensive care unit (ICU) admission, hospital stay, and neonatal morbidity. Results: A total of 236 women with confirmed PAS were managed. Median maternal age was 36 years and placenta previa coexisted in 86.9%. Elective caesarean delivery at 34+0–35+6 weeks occurred in 72.0%, whereas 28.0% required emergency delivery for haemorrhage or labour. Caesarean hysterectomy was performed in 85.2% and conservative segmental uterine resection in 14.8%. Median operative time was 135 minutes and median blood loss 4.3 L; the median transfusion requirement was six units of packed red blood cells. Intraoperative complications occurred in 27.1%, most commonly bladder injury (14.8%). One woman (0.4%) died intraoperatively from disseminated intravascular coagulation with intracardiac thrombosis. ICU admission was required in 66.0%. Neonatal intensive care unit admission occurred in 53.0%, mainly because of prematurity; there were no neonatal deaths. Conclusion: Centralised multidisciplinary management of PAS with planned delivery at 34–35 weeks, avoidance of placental removal, and use of retrograde hysterectomy or segmental resection can minimise haemorrhage and maternal mortality while maintaining acceptable neonatal outcomes in a high-volume referral centre.

VAP, or Ventilator Associated Pneumonia, is a type of pneumonia that arises in patients receiving mechanical ventilation. This condition is a serious complication and can lead to the patient's decline while on a mechanical ventilator, posing a significant risk for secondary complications if not addressed promptly. In particular, VAP is a prevalent issue in intensive care units, where the healthcare team works to prevent further deterioration of the patient. VAP is associated with a notably high mortality rate, particularly in individuals with weakened immune systems, as well as in younger and older populations. Extended intubation and prolonged sedation can contribute to the onset of VAP. The previous study had found that incidence of VAP accounts for 9 % to 27 % endotracheal intubated patients, whereas VAP has a mortality rate ranging from 25 % to 50 % [1-3]. VAP increased ICU and hospital length of stay, antibiotic consumption, and healthcare cost (Zhi Mao et al, 2016) [4]. While using the subglottic suctioning could prevent and help the intubated patient to decreased the development of VAP. The study shown by Smith et al (2021) [5] SSD is a technique employed to reduce micro aspiration of oropharyngeal secretions in patients with cuffed endotracheal airways. Aspiration of oropharyngeal secretions is the accepted cause of the majority of ventilator-associated pneumonia (VAP), a complication of invasive ventilation with high associated mortality. Another study by Rahul Gujadhur et al (2005) [6], subglottic suction has also been shown to delay the onset of VAP but no benefits in terms of ventilation time, hospital stay or mortality benefit have ever been shown. This investigation into subglottic suctioning may assist the healthcare team, particularly in the intensive care unit, in preventing the development of VAP and shortening the duration of ventilation for patients. The advantages of subglottic suctioning are often debated, particularly regarding its impact on the duration of intubation. However, recent research indicates that implementing subglottic suctioning within a time frame of fewer than three days could help reduce intubation duration and lead to improved patient recovery.

Central line-associated bloodstream infections (CLABSIs) are important hospital-acquired infections that are related to increased mortality in cardiac intensive care units (CICUs). To determine the risk factors for CLABSIs, a case-control study was conducted in the CICU of our hospital. Emergency surgery (odds ratio: 9.6, 95% confidence interval: 1.633-56.926) was the strongest risk factor comparing the case group (n=11) to the control group (n=22). In addition, the indwelling period was significantly longer in the case group than in the control group (median 9 days versus 7 days, p=0.004). An intervention for the insertion of central lines was then started, with 1) thorough use of chlorhexidine-impregnated dressings (also known as chlorhexidine patches, CHG patches) in the insertion of central lines before emergency surgery, and 2) exchange of the central line 7 days after emergency surgery. After the intervention, the CLABSI incidence rate decreased from 6.8 to 0.8/1,000 device-days. These data suggest the usefulness of CHG patches and the importance of the early exchange of central lines in the CICU in patients following emergency surgery.

Authors describe autoptic findings of two cases whose COVID-19 diagnosis was supported by laboratory data. Both patients were Caucasian individuals of middle age (one male, 47 years old; the other a female aging 36 years) that were considered as previously healthy. Clinically they died from cardiorespiratory insufficiency while being treated in intensive care units. None of them was intubated and blood oxygen levels (SpO2) decreased below 90% only during the agonal phase. Myopericardial changes were visible from a macroscopic point of view, with hemorrhagic and necrotic areas involving pericardium. Fresh hemorrhage and severe hyperemia were both signs of vascular damage and extravasation leading to acute myocardial injuries. Lymphocytic presence was disparate and not constant.

Introduction: Concurrent infections or co-infections in patients diagnosed with Coronavirus Disease-19 (COVID-19) are not uncommon and predict a pejorative prognosis. A co-infection accounts for 1 out of every 5 cases of COVID-19 and increases the likelihood of adverse health outcomes such as mechanical ventilations, ICU admissions, and death. Specifically, Legionella spp. co-infection presents additional challenges in COVID-19 patients because of its rarity, similar clinical presentation to SARS-CoV-2, and poorer outcomes without prompt treatment. Cases Presentation: Case 1. A 62-year-old female presented with a 3-day history of subjective fever and worsening shortness of breath. Room air saturation (saO2) was 70% and improved to 100% on noninvasive positive- pressure ventilation (NIPPV). Lung auscultation revealed rales BL. Chest X –Ray (CXR) showed patchy airspace opacities bilaterally (BL), SARS-CoV-2 PCR and urine legionella antigen tests were positive. The diagnosis of hypoxic respiratory failure secondary to COVID-19 and Legionella pneumonia was made. Patient was admitted to intensive care unit (ICU) and managed with decadron, remdesivir, one unit of convalescent plasma for COVID-19 and Azithromycin for Legionella. Patient subsequently developed acute respiratory distress syndrome (ARDS). ARDS protocol was initiated. 13 days after, the patient was compassionately extubated. Case 2. A 41-year-old male presented with 5-day history of fever, worsening shortness of breath, cough and diarrhea. Patient admitted history of ethanol abuse. SaO2 was 88% and improved on oxygen canula. Lung auscultation revealed rhonchi BL. CXR showed extensive left lung consolidation. Urine test for legionella antigen was positive. COVID-19 PCR was negative, but SARS-CoV-2 IgG was reactive. The diagnosis of Legionnaire disease was made. Despite initial treatment with Azithromycin, patient's hypoxia continued to worsen requiring NIPPV, and subsequently mechanical ventilation in the ICU. The adjunction of empiric treatment for COVID-19 with convalescent plasma, remdesivir and steroids improved both clinicals and laboratory findings. Discussion: The cases illustrated the practical challenges of managing COVID-19 and legionella co- infection. Legionella spp and SARS-CoV-2 overlapping incubation periods and similar clinical presentations and complications. In the absence of diagnosis and treatment, legionella pneumonia has an intrinsic mortality rate of up to 80%. As some COVID-19 mitigation strategies, such as the closure of businesses, have enhanced the conditions for Legionella spp proliferation, the incidence of Co-infection with COVID-19 may increase. We recommend clinicians to have high-indexed suspicion of COVID-19 and Legionella co-infection in order to obtain complete work up at patient’s initial presentation.