Wits Journal of Clinical Medicine
Wits Journal of Clinical Medicine is a peer-reviewed open-access scientific journal (ISSN 2618-0189; eISSN 2618-0197), created to share the scientific research from the School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, and from the Clinical Medicine Departments in other institutions in South Africa and internationally. Our objective is to be the primary diffusion portal for Clinical Medical scientists from Southern Africa, using standards that accredit the process of scientific publication.
| Publisher | Wits University Press |
|---|---|
| Frequency | Tri-annually |
| Coverage | Volume 1 Issue 1 2019 - current |
| Language | English |
| Journal Status | Active |
| Collection(s) |
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More LessBackground: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the disease it causes, coronavirus disease 2019 (COVID-19), has spread rapidly across the globe resulting in more than 7,000,000 cases and 400,000 deaths worldwide, of which 52,991 cases and 1162 deaths have occurred in South Africa.
Objective: To describe the clinical characteristics of the first 100 patients with COVID-19 admitted to a tertiary hospital in Johannesburg, South Africa.
Methods: We conducted a single-centre retrospective review of the first 100 patients with reverse transcriptase polymerase chain reaction-confirmed COVID-19 infection admitted to a tertiary academic hospital in Johannesburg, South Africa.
Results: The 100 patients were predominantly male (53%), of black ethnicity (79%) and had a median age of 42 years. The most common comorbidities were hypertension (31%), diabetes mellitus (18%) and 47% of the patients had an endomorphic phenotype. Eleven per cent (11%) of our patients were HIV positive. During hospitalisation, 14 patients (14%) required admission to the intensive care unit (ICU). For those patients with an outcome available, the overall mortality rate was 10% (n = 6), and 57% (n = 4/7) for those admitted to the ICU. Mean length of stay for those who had died or had been discharged was 6.8 days.
Conclusion: This case series describes clinical characteristics in the first 100 patients with confirmed COVID-19 admitted to a large centre in Johannesburg, South Africa. Our findings are concordant with universally reported data; however, more data is needed on COVID-19 in the South African setting, specifically related to tuberculosis and HIV.
Background: The 2019 coronavirus (COVID-19) pandemic has brought unprecedented challenges to the health sector nationwide and internationally. Across all disciplines, unique and novel modes of presentation with substantial morbidity and mortality are being encountered, and growing evidence suggests that psychiatric comorbidity is likely among COVID-19 patients.
Objective: This article aims to broaden the current discussion on the psychiatric sequalae of COVID-19, which has largely focused on anxiety, and examine the recently documented psychiatric sequelae of COVID-19 infection, the secondary effects of the pandemic on public mental health, and future psychiatric conditions that may arise due to COVID-19.
Methods: We conducted an in-depth review of the current global psychiatric literature and describe the wide range of psychopathological presentations reported among past COVID-19 patients worldwide and those that are expected to emerge.
Results: Current discussions in the psychiatric literature on COVID-19 report anxiety and anxiety disorders as a predominant set of clinical presentations during the pandemic. The impacts of direct COVID-19 infection, associated psychopathological sequelae, and drastic lifestyle changes due to the COVID-19 pandemic in South Africa, are associated with a broad range of psychopathologies and other neuropsychiatric presentations. Pre-existing societal conditions and burdens on the health system in South Africa prompt healthcare providers and public health planners to accordingly prepare for the expected rise in new psychiatric presentations.
Conclusion: Greater awareness of the various psychiatric conditions attributed to COVID-19 infection may allow for earlier screening, more effective treatment, and greater positive health outcomes and better prepare health systems to address the growing pandemic in South Africa.
Objective: This article aims to broaden the current discussion on the psychiatric sequalae of COVID-19, which has largely focused on anxiety, and examine the recently documented psychiatric sequelae of COVID-19 infection, the secondary effects of the pandemic on public mental health, and future psychiatric conditions that may arise due to COVID-19.
Methods: We conducted an in-depth review of the current global psychiatric literature and describe the wide range of psychopathological presentations reported among past COVID-19 patients worldwide and those that are expected to emerge.
Results: Current discussions in the psychiatric literature on COVID-19 report anxiety and anxiety disorders as a predominant set of clinical presentations during the pandemic. The impacts of direct COVID-19 infection, associated psychopathological sequelae, and drastic lifestyle changes due to the COVID-19 pandemic in South Africa, are associated with a broad range of psychopathologies and other neuropsychiatric presentations. Pre-existing societal conditions and burdens on the health system in South Africa prompt healthcare providers and public health planners to accordingly prepare for the expected rise in new psychiatric presentations.
Conclusion: Greater awareness of the various psychiatric conditions attributed to COVID-19 infection may allow for earlier screening, more effective treatment, and greater positive health outcomes and better prepare health systems to address the growing pandemic in South Africa.
COVID-19 is portrayed as presenting unique challenges to critical care specialists. Although the use of personal protective equipment and infection prevention may indeed present novel challenges, it is unlikely that there are novel pulmonary pathophysiological mechanisms at play. Key to debating the respiratory management of COVID-19 is an understanding of the pathophysiology of respiratory failure.
Two entities principally characterise respiratory failure – firstly an alteration in blood gases, particularly hypoxaemia and secondly a change in the work of breathing (WOB).(1) These will be reviewed before examining how each is altered in COVID-19 pneumonia.
Two entities principally characterise respiratory failure – firstly an alteration in blood gases, particularly hypoxaemia and secondly a change in the work of breathing (WOB).(1) These will be reviewed before examining how each is altered in COVID-19 pneumonia.
The coronavirus pandemic has had an immense impact on medical services worldwide, and significantly so in the nephrology community. This article briefly describes the occurrence of acute kidney injury in patients with COVID-19, its effect on patients with chronic kidney disease and on renal replacement therapy, and illness within transplant recipients, and offers early comment on local experiences within the nephrology community.
Background: The mortality rate from diabetes-related complications in Sub-Saharan Africa surpassed that of HIV/AIDS, tuberculosis and malaria combined. Point-of-care (POC) glycated haemoglobin (HbA1c) has been in routine use at a tertiary hospital’s diabetic clinic in Johannesburg, South Africa. This study set out to determine if having a readily available result on the day of consultation has led to improved glycaemic control.
Objective: The aim of this study was to determine if an immediately available POC HbA1c would result in more patients achieving target HbA1c compared to previously used laboratory HbA1c.
Methods: A retrospective audit of 195 attendees of the diabetic clinic at a public academic hospital who had been attending before the advent of the POC HbA1c test was recruited. The laboratory HbA1c taken on average 5 years before was compared to the current POC HbA1c to determine if there was any improvement in glycaemic control.
Results: The mean HbA1c before the POC test was 8.8% (SD 1.9) and the current POC HbA1c was 8.9% (SD 1.94). There was no statistically significant improvement in glycaemic control.
Conclusion: The POC test for HbA1c at a tertiary hospital’s diabetic clinic did not result in improved glycaemic control. This study has shown that the introduction of new technology alone may not result in better diabetic care. Comprehensive diabetic care is multifactorial and relies on the intensive efforts of a multidisciplinary team including physician and diabetic nurse educator with active patient participation to ensure optimal glycaemic control.
Objective: The aim of this study was to determine if an immediately available POC HbA1c would result in more patients achieving target HbA1c compared to previously used laboratory HbA1c.
Methods: A retrospective audit of 195 attendees of the diabetic clinic at a public academic hospital who had been attending before the advent of the POC HbA1c test was recruited. The laboratory HbA1c taken on average 5 years before was compared to the current POC HbA1c to determine if there was any improvement in glycaemic control.
Results: The mean HbA1c before the POC test was 8.8% (SD 1.9) and the current POC HbA1c was 8.9% (SD 1.94). There was no statistically significant improvement in glycaemic control.
Conclusion: The POC test for HbA1c at a tertiary hospital’s diabetic clinic did not result in improved glycaemic control. This study has shown that the introduction of new technology alone may not result in better diabetic care. Comprehensive diabetic care is multifactorial and relies on the intensive efforts of a multidisciplinary team including physician and diabetic nurse educator with active patient participation to ensure optimal glycaemic control.
