COVID­19 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 COVID­19, increasing the burden of NPRI in SA. In this study, we describe the prevalence, profile and clinical outcomes of pregnant women with COVID­19 admitted to a tertiary facility. OBJECTIVES: To describe the prevalence, profile and clinical outcomes of pregnant women with COVID­19 admitted to a tertiary facility in Gauteng, SA. METHODS: We performed a retrospective review of all pregnant women with COVID­19 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 COVID­19. 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 COVID­19. CONCLUSION: COVID­19-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.

Human pulmonary artery endothelial cells upregulate ACE2 expression in response to iron-regulatory elements: potential implications for SARS-CoV-2 infection

Background: The current Covid-19 pandemic has resulted in significant global impacts for healthcare systems and beyond. Age and or co-morbidities which are often chronic in nature are the main risk factors for severe Covid-19 infection with strong further associations with mortality. IL-6 is reported to be greatly elevated in patients with severe Covid-19 infection. As a key positive regulator for hepcidin biosynthesis this may suggest impacts for iron metabolism in these patients;elevated serum ferritin further reinforces this notion. Aim(s): To investigate the effects of IL-6 and hepcidin on ACE2 gene expression in pulmonary artery endothelial cells (PAECs). Method(s): PAECs were treated with IL-6 (1-10 ng/mL) and hepcidin (0.1-1 mug/mL). Gene expression was identified by RT-PCR and Western Blot (WB). Result(s): When challenged with either IL-6 or hepcidin, significant upregulation of ACE2 mRNA was observed in hPAECs (n= 3;*p<0.05). Significant elevated levels of ACE2 protein expression were also observed by western blot (n= 3;*p<0.05). In addition, knock-down of the ferroportin gene (SLC40A1) in these cells resulted in significant loss of ferroportin mRNA coupled with a strong significant up-regulation of ACE2 mRNA (n= 3;*p<0.05). Conclusion(s): Whilst our results demonstrate upregulation of ACE2 gene and protein in hPAECs in response to iron regulatory elements, such as hepcidin and IL-6, further studies need to be undertaken to establish if such effects result in enhanced SARS-CoV-2 infection and whether modulation of this axis may be protective.

LOSS OF EMPLOYMENT, LOCKDOWN MEASURES AND GOVERNMENT RESPONSES IN MALAYSIA DURING THE COVID-19 PANDEMIC: A NOTE

In this paper, we use daily administrative data from January 25, 2020 to December 31, 2020 to examine the relationship between job losses and the Malaysian lockdown measures. The Auto Regressive Distributed Lag (ARDL) approach is used to estimate both the long-run and short-run models. The results of the Bounds F-test for cointegration reveal that there is a long-run link between job losses and the Malaysian government lockdown measures (both linear and non-linear). The positive association between job loss and lockdown measures shows that as the lockdown gets tighter, more people will lose their jobs. However, as time passes, especially in conjunction with the government stimulus package programmes, job losses decrease.

Littoral cell angioma of the spleen in a child with Cornelia De Lange syndrome

Littoral Cell Angioma (LCA) is a benign and rare vascular tumor of the spleen. It is uncommon in children, and a comprehensive literature review has yielded only 12 published pediatric cases of LCA. Here we present a seven year old, female who was a known case of Cornelia De Lange syndrome who presented with splenic cysts and underwent splenectomy. Histopathological review revealed LCA. © 2021

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.