Prevalence and Trajectory of COVID-19-Associated Hypercoagulability Using Serial Thromboelastography in a South African Population.

INTRODUCTION: The coagulation abnormalities resulting from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been attributed to inflammation and subsequent cytokine storm. Thromboelastography (TEG) is a point-of-care test used to assess clot formation and degradation in whole blood and is an indicator of the overall real-time coagulopathic state of the patient. METHODS: A single-centre, prospective, observational cohort study was conducted in South Africa, analysing the coagulation patterns of 41 patients with hypoxia related to SARS-CoV-2 using serial thromboelastography (TEG) on admission, after 48 hours, and at resolution of hypoxia/day 10. Results: Two-thirds (n = 26) were women. The median age was 61 (IQR 50-67), and the majority (88%) were Black patients. Almost half (22) of the patients were critically ill and ventilated, with median SOFA and SAPS2 scores of 3 and 22 (IQR2-4 and 18-30), respectively. The prevalence of hypercoagulability was 0.54 (95% CI 0.46-0.62), whilst 29/41 (0.71, CI 0.64-0.78)) met the definition of hypofibrinolysis. Differences between the hypercoagulable (HC) and non-hypercoagulable groups remained apparent at 48 hours after anticoagulation. At this time point, the K time was significantly lower (p ˂ 0,01), and the α-angle (p ˂ 0,01) and maximum amplitude (MA) (p ˂ 0,01) were significantly higher in the HC cohort. At resolution of hypoxia, or day 10, only MA was significantly higher in the hypercoagulable group compared to the non-hypercoagulable group (p = 0.01). The initial impairment in fibrinolysis (Ly30), α angle, and MA were significantly associated with mortality, with p values of 0.006, 0.031, and 0.04, respectively. CONCLUSIONS: In this South African population, hypercoagulability was a highly prevalent phenomenon in COVID-19 disease. It was typified by hypofibrinolysis and a persistently elevated MA, despite anticoagulation therapy.

Perceptions of patients and medical students towards each other in the setting of patient care-a South African perspective.

INTRODUCTION: South Africa urgently needs more doctors. We examined perceptions of patients and students to provide evidence for optimum student-patient ratios and substantiate solutions for this dilemma. METHODS: We interviewed 118 patients and invited 120 students to complete a self-administered questionnaire from four specialities in an academic hospital in Johannesburg. RESULTS: The total sample size was 238 participants. A total of 91/118 (77%) patients and 78/120 (65%) students were female. Almost all the patients had some level of education, with most patients having received at least a secondary education (71/120). More than half of the students (69/120) were final year students. A third (41/118) of the patients were unaware they were admitted to a teaching hospital. Half of the patients (60/118) thought they had the right to refuse interaction with students. Patients and students preferred smaller groups of between 1-3 and 4-8 students at a bedside tutorial (p < 0.001), although patients preferred smaller groups (1-3) compared with the students (4-8). Majority of patients said they never refused consent to students, while a third of students reported at least up to three patients refusing consent to be examined. The most frequent reason cited by students for refusal of consent by patients was the exposure to excessive numbers of students and healthcare professionals. CONCLUSION: Medical schools should consider patient safeguards while responding to the country's need for more doctors. The Medical Council and medical schools need to draw up professional guidelines on patient-student interactions, including the role of patients in this setting.

HIV-associated lipodystrophy in South Africa: the impact on the patient and the impact on the plastic surgeon.

BACKGROUND: With 67% of the world's human immunodeficiency virus (HIV)-infected population existing in sub-Saharan Africa and recent access to highly active antiretroviral therapy (HAART), the demand for plastic surgical intervention in addressing lipodystrophy has expanded dramatically. We assessed the rate of lipodystrophy in a random clinic cohort, the demand for surgical correction and risk of treatment non-compliance. METHOD: Questionnaire and database cross-sectional review of 554 patients over a 3-month period at the Themba Lethu Clinic, Johannesburg, South Africa. RESULTS: A total of 479 patients completed the questionnaire, 83% were female. Nearly 90% of patients were on, or had been on, stavudine (d4T). The prevalence of lipodystrophy was 11.7%. Nearly 5.9% of patients had considered stopping treatment due to the development of lipodystrophy; 47% would consider surgery to correct unwanted physical changes. Male patients were satisfied by the changes they noted in their physical features following treatment (pre-treatment satisfaction 38% vs. post-treatment satisfaction of 94%). Female patients had 6.5 times more breast hypertrophy-related symptoms than in their pre-treatment state. CONCLUSION: We identify a prevalence of 11.7% of patients with HIV-associated lipodystrophy, of whom 5.9% would consider non-compliance on the basis of this side effect alone. The demand for surgical correction is significant and needs to be addressed.