COVID-19 in pregnant women in South Africa: A retrospective review

Background. The majority of maternal deaths in South Africa (SA) occur as a result of non-pregnancy-related infections (NPRI). Pregnancy is a known risk factor in severe COVID-19, increasing the burden of NPRI in SA. In this study, we describe the prevalence, profile and clinical outcomes of pregnant women with COVID-19 admitted to a tertiary facility.Objectives. To describe the prevalence, profile and clinical outcomes of pregnant women with COVID-19 admitted to a tertiary facility in Gauteng, SA.Methods. We performed a retrospective review of all pregnant women with COVID-19 admitted to Charlotte Maxeke Johannesburg Academic Hospital between 6 March and 30 August 2020. Data collected included demographics, medical history, obstetric history, clinical findings and laboratory variables. Outcomes assessed were mortality, admission to intensive care unit (ICU), symptomatic v. asymptomatic disease, maternal and fetal outcome and mode of delivery.Results. A total of 204 pregnant women were included in the study. Of these, 33 (16.2%) women were critically ill, with 21 (10.3%) admitted to the ICU and 3 (1.5%) deaths related to COVID-19. The median gestational age was 37 weeks and median birthweight 2 940 g. Sixty-seven women (33%) were HIV-positive, in keeping with national statistics regarding HIV in pregnancy. Caesarean section was the most common mode of delivery (n=105, 60%). However, no women underwent caesarean section for indications related to COVID-19. Conclusion. COVID-19-related mortality in our cohort was higher than that seen internationally, likely due to differences in background maternal mortality rates and difficulty in accessing care.

Challenges around COVID-19 at a tertiary-level healthcare facility in South Africa and strategies implemented for improvement

SARS-CoV-2 has resulted in a global pandemic within months following its initial detection. South Africa (SA), like many other countries, was not prepared for the impact this novel infection would have on the healthcare system. In this paper, the authors discuss the challenges experienced while facing COVID-19 at a tertiary-level institution in Gauteng province, SA, and the dynamic strategies implemented to deal with the epidemic

Primary sclerosing cholangitis in a cohort of south african patients with inflammatory bowel disease at charlotte maxeke johannesburg academic hospital

Background: Primary Sclerosing Cholangitis (PSC) is a chronic, progressive cholestatic liver disease of unknown aetiology. Its incidence and prevalence vary considerably in Asian and Western studies.1 The differences in the recorded epidemiological data suggest that the presentation of PSC may vary in different populations. PSC has a strong association with Inflammatory Bowel Disease (IBD). The phenotype in patients with PSC alone can be different to that of patients with both PSC and IBD (PSC-IBD). There is a dearth of information on this topic from African countries in general and more specifically in the Black South African population

Cytomegalovirus (CMV)

Cytomegalovirus (CMV) is a member of the Herpes virus group. It is a double stranded DNA virus and is known as Human Herpes Virus 5 in human hosts. CMV seropositivity is frequent in Western populations with a seroprevalence of 58% being reported in the U.S.1 In Africa, pooled prevalence studies demonstrate rates as high as 81.8% amongst HIV uninfected adults. Amongst the HIV infected population prevalence rates of 81.9% and 94.8% were seen in AIDS and asymptomatic HIV positive patients respectively.2 This is likely a reflection of impaired humoral immunity amongst those with AIDS. In a rural South African cohort, a 100% seroprevalence was demonstrated amongst HIV positive treatment naïve patients with a negative association noted between CD4 counts and IgG titres.3

Massive recurrent hemorrhage due to duodenal diverticulum--role of tattooing and suture plication.

We report a 79-year-old lady with massive recurrent GI bleeding from a duodenal diverticulum arising at the mesenteric border. We used tattooing during endoscopy as a method for identifying the bleeding source at surgery. The diverticulum was treated with suture plication.