High HIV prevalence in an early cohort of hospital admissions with COVID-19 in Cape Town, South Africa

Background. South Africa (SA) has a high prevalence of HIV and tuberculosis. Cape Town was the SA metropole most affected in the early stages of the COVID-19 pandemic. Early observational data from Africa may provide valuable insight into what can be expected as the pandemic expands across the continent.Objectives. To describe the prevalence, clinical features, comorbidities and outcome of an early cohort of HIV-positive and HIV-negative patients admitted with COVID-19.Methods. This was a descriptive observational study of an early cohort of adults with COVID-19 pneumonia admitted from 25 March to 11 May 2020.Results. Of 116 patients (mean age 48 years, 61% female) admitted, 24 were HIV-positive (21%). The most common symptoms reported were cough (n=88; 73%), shortness of breath (n=78; 69%), fever (n=67; 59%), myalgia (n=29; 25%) and chest pain (n=22; 20%). The most common comorbidities were hypertension (n=46; 41%), diabetes mellitus (n=43; 38%), obesity (n=32; 28%) and HIV (n=24; 21%). Mortality was associated with older age (mean (standard deviation) 55 (12) years v. 46 (14) years; p<0.01); the presence of hypertension or hypertension along with diabetes and/or obesity; lower partial pressure of arterial oxygen to fraction of inspired oxygen ratio; and higher urea level, white cell count, neutrophil count, and C-reactive protein, lactate dehydrogenase and ferritin levels, and high neutrophil to lymphocyte ratio. The overall survival rate for all hospital admissions was 86/116 (73%). In this early cohort, survival was similar in patients with HIV (n=18; 75%) compared with those without HIV (n=67; 75%) (p=1). Of the 74 patients admitted to the wards, 63 (85%) survived, whereas 22 of 42 (52%) admitted to the intensive care unit survived.Conclusions. Patients with HIV infection represented a large proportion of all COVID-19 admissions. The presentation and outcome of patients with HIV did not differ significantly from those of patients without HIV

Morbidity and mortality profile of patients seen in medical emergency unit of a teaching hospital in Nigeria: A 4-year audit

Background: Ahmadu Bello University Teaching Hospital (ABUTH) Zaria is strategically located to serve as referral center for most stable and emergency cases in the northwestern part of Nigeria. Patients also come on self­referral. Objective: This study aimed to describe the pattern of medical presentation and outcomes at the emergency unit of ABUTH over a 4­year period. Materials and Methods: A review of medical admissions into the Emergency unit of ABUTH, Zaria, between January 2013 and December 2016 was carried out using the case records of patients as well as register of admissions and discharges, information obtained were entered into a predetermined questionnaire. Results: The patients admitted during the period numbered 5193, with age rangeof 15­92 years. There were 2895 (56.0%) males and 2298 (44.0%), with a male­to­female ratio of 1.3:1. Emergencies attributable to infectious diseases occurred with the highest frequency (20.6%), followed by gastrointestinal (20.5%), renal (14.5%), endocrine (13.8%),respiratory (12.4%),cardiac (9%), neurological (2.8%), and hematological (1.1%). There was a significantly (P < 0.001) higher occurrence of noncommunicable diseases (71.5%) than communicable diseases (28.5%), as well as higher male cases in renal, respiratory,hematological emergencies (P < 0.05). There were more admissions in the wet season, (April to September) while the October to January period consistently recorded the low admission rates. An increasing trend in emergency medical admissions was observed, being highest in the year 2016. The median duration of stay was 4.5 days (range of 0­12 days). The outcomes of admission revealed 470 (9%) deaths, 2012 (37%) direct discharges, and 2801 (54%) transfers to male or female medical wards. Cases of tetanus had the highest case fatality rate (45%) while hypertensive emergencies had the lowest (4%). Conclusion: There is a rising trend ofcommunicable as opposed to non-communicable diseases' emergencies in Zaria. Of the non-communicable diseases, incidence of gastro-intestinal emergencies was the highest while that of haematology was the least. The intra-hospital mortality rate attributable to medical emergencies is relatively lower in Zaria

The Experience and Psychosocial Needs of Patients with Traumatic Fractures Treated for More than Six Months at Doctors on Call for Service Hospital; Goma; Democratic Republic of Congo

Trauma-related consultations; admissions and complications are the leading problems at Doctors on Call for Service (DOCS) Hospital; Goma; Democratic Republic of Congo; and yet no studies have been carried out to document the experience of long-stay traumatic-fracture patients in this hospital. Aim: The aim of this study was to explore the experience and psychosocial needs of patients with traumatic fractures treated for more than six months at DOCS Hospital. Methods: Six free-attitude interviews were conducted with purposively selected patients. The interviews were recorded with a tape recorder and transcribed verbatim; and content analysis was used to identify themes from the interviews. Results: All patients could clearly connect the injury experience to severe pain that lingered on for weeks or months for some patients; accompanied by other symptoms such as insomnia; poor appetite and psychological symptoms. Most patients felt disabled; were abandoned by relatives or friends and experienced financial problems. Some benefited from the injury by way of strengthened marital links. Some patients complained of poor information about their illness and the management plan and did not appreciate the treatment from caregivers; while some disclosed their needs and expectations and appreciated the caregivers who showed interest in them. Conclusions: The experience of long-term trauma has negative effects on the whole person of the patient; including his or her work and family; and some patients continue to suffer from the effects of the traumatic event up to six months later. The needs of patients suffering from trauma include reassurance by physicians and nurses; more information and participation in the decision-making process; regular visits from friends and family; and better bedside manners from caregivers

A 6-Month Review of Medical Admissions in a Nigerian Teaching Hospital

Purpose: To provide an overview of morbidity and mortality in the medical wards of a teaching hospital and to generate discussions among staff members with a view to improving patient outcomes and data handling. Methods: A retrospective survey of admissions and mortalities in the medical wards of the University of Benin Teaching Hospital was undertaken from 1st January to 30th June 2006; using ward Record and Change books; and copies of death certificates. Morbidity data were assessed for two medical wards and mortalities for all medical admissions within the period under review were evaluated. Results: Health information was managed entirely manually. Data sources were quite often inaccessible or mutilated; and the utility of available data was limited by incomplete and incorrect documentation. No clinical coding of morbidities or mortalities was available. Human immunodeficiency virus (HIV) infection and its complications accounted for significantly more female than male admissions (26.1and 16.2respectively; p=0.005); and for more female than male deaths (34.6and 29.6respectively; p 0.0001). Most deaths occurred between midnight and the start of the working day; with a second peak during prime working hours. Conclusions: Less than optimal health information management was apparent in the health facility studied. Mortality among the patients was highest in HIV-infected patients than other diseases. Capacity building and appropriate infrastructural development is required to improve the management of vitally important health information

Seasonal variation in admission for heart failure, hypertension and stroke in Uyo, south-eastern Nigeria

Background:Seasonal variation in hospitalization for cardiovascular disease has been described in thetemperate regions of the world as well as in Northern Nigeria. Increase admission rates during the coldseasons have been reported in these areas. No studies have been done in Southern Nigeria. This studyis thus aimed at describing the seasonal variation in admissions for heart failure, uncontrolledhypertension and hypertension related-stroke in Southern Nigeria.Methods:Hospital records of patients admitted to the medical wards of the University of Uyo Hospital(UUTH) with heart failure of all causes, uncontrolled hypertension and hypertension­related stroke(Cerebrovascular accident) between January 1998 and December 2001 were used. Epi-Info 2002software was used to analyze data.Results:Of the 3500 patients admitted during the study period 542 (15.3%) were on account of heartfailure, uncontrolled hypertension and hypertension related cerebrovascular accident (CVA). The meanage of patients was 52±12.8 years. The average monthly admission was eleven (11). More admissionswere recorded in the rainy (cold) season than in the dry (hot) season. The observed difference washowever statistically significant only for heart failure and uncontrolled hypertension (P<.05).Conclusion:Admissions for heart failure and uncontrolled hypertension are therefore more during thewet (cold) season in southern Nigeria. This may be attributed to the high default rate to follow up visitin this season when agriculturalactivity is intense and less attention given to medical care. This leads topoor compliance to medications and clinical deterioration. The already bad road network both in ruraland urban centers also become worse at this time making access to medical care difficult. Facilities andmeasures should thus be put in place to provide adequate medical care for these patients during thatperiod of the yea