Lung outcomes and related risk factors in patients after SARS-CoV-2 infection: a hospitalised single-centre cohort from Johannesburg, South Africa

Background

Sequelae post-SARS-CoV-2 infection, including lung and functional impairment, pose a significant challenge post-recovery. We explored the burden and risk factors for post-COVID-19 sequelae in an African population with prevalent comorbidities including tuberculosis (TB) and HIV.

Methods

We conducted an observational cohort study on hospitalised adults with confirmed SARS-CoV-2 infection from 20 March to 06 October 2021 at Chris Hani Baragwanath Academic Hospital, South Africa. We collected data on comorbidities, and COVID-19 severity using the World Health Organization (WHO) clinical progression scale. Prospectively, we followed up all participants within 40-days post-discharge to assess body mass index (BMI), COVID-19 symptoms and quality of life using St George's Respiratory Questionnaire (SGRQ), 6-min walking-test (6MWT), and spirometry. A subsequent in-depth visit assessed plethysmography, diffusing capacity for the lung for carbon monoxide (DLCO), and high-resolution chest-CT.

Findings

We followed up 111 participants, where 65.8% were female, median age 50.5 years, and predominantly black-African (92.8%). Relevant comorbidities included TB disease (18.9%) and HIV infection (36%). SGRQ total scores were elevated in 78.9%, median 6MWT distance was reduced at 300 m (IQR 210-400), and nearly half (49.5%) exhibited spirometry findings below the lower limit of normal (LLN). In-depth pulmonary assessment for 61 participants revealed abnormalities in total lung capacity (31.6% <80% predicted), DLCO (53.4% <80% predicted), and chest-CT (86.7% abnormal). Significant risk factors for individual abnormal outcomes, adjusted for age and sex, were TB disease, HIV with CD4 <200 cells/mm3, BMI <18.5 kg/m2 and >35 kg/m2, and initial COVID-19 severity.

Interpretation

This study demonstrates substantial lung and functional morbidity within the first weeks post-COVID-19, particularly in individuals with pre-existing comorbidities including TB, HIV, and low or high BMI. Chest-CT and DLCO show best early potential at reflecting COVID-19-related pathologies.

Funding

The Bavarian State Ministry of Science and Arts.

Oxygen efficient respiratory Aid (OxEraTM) device: A safety study

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Africa is a continent that has many developing countries that have constant strain on their healthcare systems.

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Now with the COVID pandemic, the use of oxygen and need for cost efficient and safe oxygen devices has increased.

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OxEra^TM is an oxygen delivery device that has been designed and developed by a consortium named Umoya for emergency use (approval from SAPHRA) in the COVID 19 pandemic.

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Given the potential for the widespread utilisation of this oxygen device in a resource-limited setting, we performed a clinical assessment safety study.

Background

Severe Coronavirus Disease 2019 (COVID-19) can develop pneumonia with severe complications. The Oxygen Efficient Respiratory Aid (OxEra^TM) device has been granted SAPHRA approval for emergency COVID-19 pandemic use. The device has the potential to be used widely in the healthcare sector due to its efficient oxygen supply and adjustable wall positive expiratory pressure (PEP).

Objectives

We assessed whether the OxEra^TM device was safe to use in a healthy adult volunteer population. Our primary objective was to ensure there was no asphyxiation, as assessed by changes observed from baseline End Tidal Carbon Dioxide (ETCO₂) exceeding 6.3 mmHg and above the 45 mmHg threshold. We also monitored changes in vital organ signs and assessed the pain and comfort of the participant at various intervals with changes in PEPs.

Methods

This was an experimental safety study of the OxEra^TM Device on 30 healthy participants at the ICU training centre of Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa. Each participant had basic vital-signs, ETCO₂, and Oxygen saturation percentages (SpO₂%) taken at baseline until the end of 2 h. In the first 20 min, the PEP was increased by 5 cmH₂0 until 20 min, then continued for the rest of the time on a PEP of 5 cmH₂0. At each interval, vital signs, subjective comfort, pain, and visual scores were measured.

Results

Thirty healthy participants were enrolled. There was no significant difference in ETCO₂ from baseline until 2 h. No participant experienced an increase in measured ETCO₂ greater than 45 mmHg and no increase in ETCO₂ from baseline was greater than 6.3 mmHg. The median increase in ETCO₂ over the study period was 2 mmHg. There were no significant changes in respiratory rate and blood pressure. The heart rate decreased significantly (73–68 bpm). The VAS and comfort score had a significant increase over the 2 h from baseline of 0–2 at maximum; however, the PAS scores showed no significant increase.

Conclusion

Overall the OxEra^TM device achieved the safety endpoints set out. There was no sign of asphyxiation and there were appropriate physiological responses to changes in PEP once applied. The comfort of the mask did worsen over the 2 h; however, the scores were minimally worse on PEP application but improved once-off PEP. No adverse event was recorded at all.

Classical Hodgkin Lymphoma involving the central nervous system (brain) - an unusual presentation

Key Clinical Message

Intracranial Hodgkin lymphoma (HL) is considered so atypical that an intracranial space-occupying lesion in a patient with known HL should be thoroughly investigated to rule out a second disease process.