Impact of the COVID-19 pandemic on malaria in pregnancy indicators in Northern Uganda: a joinpoint regression analysis

BACKGROUND

Pregnancy is both a risk factor for P. falciparum infection and development of severe malaria. In low- and middle-income countries, the COVID-19 pandemic severely impacted health systems, including utilization of maternal services. This study aimed to assess trends in delivering malaria in pregnancy-related health-care services before and during COVID-19 in Northern Uganda.

METHODS

An interrupted time-series study comparing pre-COVID-19 (January 2018 to April 2020) and COVID-19 (May to December 2021) periods, based on the date the first COVID case was detected. The study involved 30 health facilities in Northern Uganda with 22,650 estimated pregnancies per year, 14% of which took place in hospital. Monthly data were sourced from District routinely collected indicators. Trends were analyzed by joinpoint regression models.

RESULTS

From the onset of the COVID pandemic in Uganda (May 2020), we found a significant reduction in the number of women accessing a fourth antenatal care visit (from APC + 183.5 to + 4.98; p < 0.001) and taking at least three doses of intermittent preventive treatment in pregnancy (IPTp, from APC + 84.28 to -63.12; p < 0.001). However, we found no significant change in the trend of the total number of pregnant women managed as outpatients or hospitalized for malaria, as well as in the number of women attending their first antenatal visit and in the number of institutional deliveries.

CONCLUSIONS

In our study, the COVID-19 pandemic significantly reduced access to ANC visits and IPTp uptake. However, the healthcare system maintained its capacity for managing malaria cases, first antenatal visits, and institutional deliveries.Trial registration: This study has been registered on the ClinicalTrials.gov public website on 26 April 2022. ClinicalTrials.gov Identifier: NCT05348746.

Self-reported olfactory and gustatory dysfunctions in COVID-19 patients: a 1-year follow-up study in Foggia district, Italy

BACKGROUND

From the initial stages of the pandemic in early 2020, COVID-19-related olfactory and gustatory dysfunctions have been widely reported and are emerging as one of the most frequent long-term sequelae of SARS-CoV-2 infection. However, data regarding the long-term recovery of the sense of smell and taste are lacking. This study aimed to characterize the evolution up to one year after the diagnosis of self-reported olfactory and gustatory dysfunctions in COVID-19 cases.

METHODS

Based on the data of the active surveillance platform of the Apulia region, Italy, we selected the residents of Foggia district who were confirmed positive for SARS-CoV-2 from March 1st to June 16th, 2020, and home-quarantined with paucisymptomatic-to-mild clinical presentation. Self-reported olfactory and gustatory dysfunctions were recorded at baseline through a survey of dichotomous questions. The evolution of these symptoms at approximately one year was prospectively assessed via telephone by the validated sino-nasal outcome test 22 (SNOT-22, Italian version).

RESULTS

Among the 1,175 COVID-19 cases notified in the Foggia district during the first epidemic wave, 488 had paucisymptomatic-to-mild clinical presentation. Of these, 41.2% (n = 201, 95% confidence interval [CI] 36.8-45.7%) reported at least one sensory dysfunction. A total of 178 to 201 (88.5%) patients agreed to participate in the follow-up survey. According to the SNOT-22 results, the persistence of a sensory dysfunction was observed in the 29.8% (n = 53, 95% CI 23.2-37.1%) of them. Particularly, loss of smell persisted in 25.8% (n = 46, 95% CI 19.6-32.9%), loss of taste in 21.3% (n = 38, 95% CI 15.6-28.1%), loss of both in 17.4% (n = 31, 95% CI 12.2-23.8%) of participants in the follow-up. The rates of full recovery increased over time: from 59% at 30 days to 71.9% at 90 days for the sense of smell; from 61.3% at 30 days to 74.7% at 90 days for the sense of taste.

CONCLUSIONS

The persistence of COVID-19-related olfactory and gustatory dysfunctions up to 12 months after the disease onset in a noteworthy proportion (approximately 3 out of 10) of patients with paucisymptomatic-to-mild clinical presentation deserves further investigations due to its possible pathophysiological implications and impact on the quality of life.

Infected congenital urethral diverticulum manifested as a scrotal mass in an adult male: case report and review of the literature

Congenital anterior urethral diverticula in adult males are infrequent urological diseases. Clinical manifestation is frequently described with irritative and/or obstructive voiding symptoms or ventral bulging, but manifestation as a scrotal mass is extremely rare. Diagnostic imaging is useful to correctly diagnose the above in the majority of cases. We report the first case of a urethral diverticulum in which neither clinical nor instrumental evaluations were performed to confirm the diagnosis of urethral diverticulum. We stress the importance of a surgical approach in evaluating scrotal mass if diagnostic imaging cannot confirm an exact diagnosis. A complete review of the literature was also carried out.

A rare case of lethal retroperitoneal abscess caused by Citrobacter koseri

Retroperitoneal abscesses are very uncommon clinical conditions. The characteristically vague symptomatology of retroperitoneal abscess and the inherent difficulty of identifying retroperitoneal disease by physical examination contributed to these dismal therapeutic outcomes. We present an unusual case of lethal retroperitoneal abscess, caused by Citrobacter diversus(koseri), treated with surgical drainage. Citrobacter species have rarely been involved in deep tissue infection and there is no reported case of lethal retroperitoneal abscess caused by C. koseri. This case is the only reported case of C. koseri as the sole pathogen associated with a lethal retroperitoneal abscess in immunocompetent patient. The case is also notable because it confirms the recent bacterial resistance to beta-lactam antibiotics and to other antimicrobial agents, like chloramphenicol or cotrimoxazol.

[Detection of the human papillomavirus in hyperplastic and cancerous prostatic tissue with PCR]

Human papillomavirus (HPV) infections are frequently associated with benign, pre-malignant and malignant lesions of the female genital region and male anogenital tract. Recently several studies have been performed to evaluate the presence of HPV in the adenomatous and carcinomatous prostatic tissue for the epidemiological implications due to the sexual transmission, and for the possible etiologic role in the development of prostatic carcinoma, first cause of death from neoplasia in men over 60 years in the developed countries. The role of HPV is still controversial since some authors evidenced the virus in prostatic tissue others did not detect its presence. We investigate the presence of HPV in 60 prostatic benign hyperplasias and in 5 prostatic carcinomas in surgically resected prostates by PCR technique using consensus and type specific primers. The analyzed specimens were negative for HPV DNA, although appropriate amplimers were present for beta-globin and positive controls. We therefore conclude that HPV infections are not commonly found in the human prostate.

Metastatic tumor of the spermatic cord from a primary silent colorectal adenocarcinoma

Tumors of the spermatic cord are indeed rare and 91% are of mesenchymal origin. Nearly all epithelial tumors are metastases with the primary tumor located in the gastrointestinal tract, prostate, kidney. In 9.5% of cases, initial symptoms are localized to the metastatic site prior to the discovery of the primary tumor. When a diagnosis of epithelial malignant tumor of the spermatic cord is made an investigation for the primary site must be performed. We report a case of metastatic tumor of the right spermatic cord occurring as first clinical manifestation of a silent adenocarcinoma of the sigmoid colon.

Paraffinoma of the penis: one-stage repair

OBJECTIVE

We report a rare case of paraffinoma of penis. A one-stage surgical treatment achieved optimal aesthetic and functional results.

METHODS

We evaluated a 32-year-old man who self injected paraffin into his penis to facilitate erection and increase potency. After two months of paraffin oil injection, sclerosis and retraction produced a deformity of the penis with erectile dysfunction. Complete removal of the compromised skin and subcutaneous tissue was performed and, simultaneously, a pedicled scrotal flap was accurately prepared, directly turned up and wrapped around the penile shaft with interrupted 3-0 silk sutures. The scrotal incision was then closed.

RESULTS AND CONCLUSION

Treatment by excision of granulomatous tissue and plastic reconstruction in a one-stage procedure, as also reported in the literature, is the only treatment that is able to achieve an effective result, both cosmetically and functionally. Excellent aesthetic and functional results were found at 34-months follow-up.

Myelolipoma of the adrenal gland presenting with dyspepsia and epigastric pain

Myelolipomas are rare benign neoplasms of the adrenal glands, characterized by the presence of adipose tissue and elements of bone marrow in various degrees of differentiation. Usually asymptomatic, they are discovered incidentally or at autopsy; sometimes larger masses may cause local symptoms. We report clinical, radiologic and therapeutic aspects of a large myelolipoma of the right adrenal gland, presenting with unusual epigastric symptoms.

[Simultaneous enucleo-resection of synchronous bilateral renal carcinoma, incidentally discovered during prostate disease screening]

Bilateral synchronous renal cell carcinoma is rare, incidental discovery is exceptional. We report a case of asymptomatic bilateral simultaneous renal tumor discovered during screening for prostatic disease. Two year previously the patient underwent sonography and IVP for right ureteral stone, spontaneously ejected, with no evidence of renal masses. Ultrasound, CT and selective digital angiography demonstrated two renal tumors < 3 cm in size. Bilateral simultaneous enucleoresection was the therapeutic choice, that we consider to be elective in such a case.

Artificial spermatocele inserted onto the vas deferens: a clinical report

This procedure was devised in an attempt to treat azoospermia caused by severe vas obstruction. An artificial spermatocele is prepared by resection of the vas slightly distal to the epididymal-deferential ansa and anastomosing onto its proximal stump a piece of Dardik's prosthesis sealed at the far end. During the partner's ovulatory period the spermatocele fluid is aspirated, mixed with fertile donor seminal plasma and used for artificial insemination. To date 8 subjects have had the operation: spermatocele fluids of 4 contained some highly motile spermatozoa with normal ability to penetrate cervical mucus for some months. Spermatocele implantation onto the vas apparently has the following advantages: the anatomic and functional integrity of the epididymis is maintained, the storage function of the epididymal-deferential ansa is preserved, and the risk of spermatocele collapse seems to be reduced by the high "vis a tergo" developed during ejaculation.