The prevalence of pulmonary embolism in non-hospitalised de-isolated patients diagnosed with mild COVID-19 disease.

BACKGROUND: Pulmonary embolism (PE) is a known complication of COVID-19 disease. The mechanism of thromboembolic events appears to be stimulated by excessive thrombin production, inhibition of fibrinolysis and deposition of antiphospholipids and thrombi, as well as microvascular dysfunction in multiple vascular beds. The occurrence of PE has been well demonstrated in hospitalised patients with severe disease. Very few data are available on its incidence or prevalence in non-hospitalised patients diagnosed with a milder form of the disease. OBJECTIVES: To assess the prevalence of PE in non-hospitalised patients diagnosed with mild COVID-19 who presented with raised D-dimer levels and persistent or new-onset cardiopulmonary symptoms. METHODS: This was a retrospective study conducted in the Department of Nuclear Medicine at Universitas Academic Hospital, Bloemfontein, South Africa. We reviewed the studies of 65 non-hospitalised patients with COVID-19 referred to the department from July 2020 to January 2021 for a perfusion-only single-photon emission computed tomography/computed tomography (SPECT/CT) study or a ventilation/perfusion (VQ) SPECT/CT study. All 65 patients had raised D-dimer levels with persistent, worsening or new-onset cardiopulmonary symptoms after the diagnosis of COVID-19. RESULTS: Sixty-five patients were studied. The median (interquartile range) age was 46 (41 - 54) years and the majority (88.2%) were female. There were 22 patients (33.8%) with lung perfusion defects in keeping with PE. Two of these patients had a false-negative computed tomography pulmonary angiography (CTPA) study for PE performed the same day as their VQ SPECT/CT study. CONCLUSIONS: We confirm a high prevalence of PE in non-hospitalised patients diagnosed with mild COVID-19 who presented with raised D-dimer levels and persistent or new-onset cardiopulmonary symptoms. We recommend that irrespective of disease severity, hospitalised and non-hospitalised patients with COVID-19 presenting with persistent or new-onset cardiopulmonary symptoms and raised D-dimer levels should be investigated further for PE.

Assessment of effectiveness of traditional herbal medicine in managing HIV/AIDS patients in South Africa.

BACKGROUND: Very few clinical studies have been conducted in South Africa to assess the value and efficacy of traditional herbal medicines that are commonly used by traditional healers for the treatment of HIV-positive patients. OBJECTIVE: To assess efficacy of a South African traditional herbal medicine in reducing viral load and increasing CD4+T cell counts of HIV/AIDS patients. DESIGN: A descriptive, prospective, follow-up study of 33 HIV-positive volunteers over a one year period. Viral load and CD4 counts were taken three times from each participant. SETTING: From November 2001 to October 2002, patients were treated at the Rustenburg Community Based Centre for traditional therapy. Clinical and paraclinical treatments and screening of patients were done at Pretoria Gynaecological Hospital. PARTICIPANTS: Seven men and 26 women aged between 22 and 43 years took part in a 12-month long follow-up study. HIV monitoring was done at the beginning and after 4 and 8 months in symptomatic and asymptomatic patients with CD4 counts below 200 cells/mm3 or viral load counts above 10,000 copies. INTERVENTION AND ASSESSMENT: ab mitio and after 4-months, viral load, CD4+T cell count, FBC, LFT, glycaemia, U/E, cholesterol, pap smear, clinical and subjective assessment, modern drugs plus hospitalisation for opportunistic infections and resuscitation where needed, powder or suspension of herbal medicine followed by meals. MAIN OUTCOME MEASURES: Improvement in overall health condition and immune system, increase in CD4+T cell count and decrease in viral load count. The two sample paired t-test was used to compare initial and final counts at the 5% level of significance and power of 80%. Ninety five per cent confidence intervals were obtained for differences between mean values. RESULTS: After four and/or eight months of therapy, significant health improvement was achieved: better physical appearance (80% of patients), increased appetite (65%), feeling of well-being (60%), disappearance of skin marks (70%) and urogenital lesions (100%), resumption of workplace duties (60%), weight gain (80%), significant reduction in viral loads (85.4%, p = 0.0015) and significant increase in CD4+ T cell counts (226%, p = 0.0000). CONCLUSION: Achievement of health improvement within eight months indicates that herbal medicine can be used as supplementary or alternative treatment for HIV/AIDS patients, and that it is an obvious immune system booster and probable "virus-cidal" factor. The apparent safety and efficacy of herbal medication warrants further research with a larger sample size of study.