Key Clinical MessageIntracranial 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.
Background: Age, body mass index (BMI) and pre-existing comorbidities are known risk factors of severe coronavirus disease 2019 (COVID-19). In this study we explore the relationship between vitamin D status and COVID-19 severity.Methods: We conducted a prospective, cross-sectional descriptive study. We enrolled 100 COVID-19 positive patients admitted to a tertiary level hospital in Johannesburg, South Africa. Fifty had symptomatic disease (COVID-19 pneumonia) and 50 who were asymptomatic (incidental diagnosis). Following written informed consent, patients were interviewed regarding age, gender and sunlight exposure during the past week, disease severity, BMI, calcium, albumin, magnesium and alkaline phosphatase levels. Finally, blood was collected for vitamin D measurement.Results: We found an 82% prevalence rate of vitamin D deficiency or insufficiency among COVID-19 patients. Vitamin D levels were lower in the symptomatic group (18.1 ng/mL ± 8.1 ng/mL) than the asymptomatic group (25.9 ng/mL ± 7.1 ng/mL) with a p-value of 0.000. The relative risk of symptomatic COVID-19 was 2.5-fold higher among vitamin D deficient patients than vitamin D non-deficient patients (confidence interval [CI]: 1.14–3.26). Additional predictors of symptomatic disease were older age, hypocalcaemia and hypoalbuminaemia. Using multiple regression, the only independent predictors of COVID-19 severity were age and vitamin D levels. The patients exposed to less sunlight had a 2.39-fold increased risk for symptomatic disease compared to those with more sunlight exposure (CI: 1.32–4.33).Conclusion: We found a high prevalence of vitamin D deficiency and insufficiency among patients admitted to hospital with COVID-19 and an increased risk for symptomatic disease in vitamin D deficient patients.
Asthma is a chronic, inflammatory airway disease involving airway hyper-responsiveness and intermittent airflow obstruction. Although potentially under-reported, asthma affects 20% of people in sub-Saharan Africa. [1] There is a wide range in prevalence among different geographic locations, owing in part to poverty, climate, and allergen exposure. [1] There appears to be a racial discrepancy in prevalence of asthma, with Asians being less affected than Native Americans, and a gender discrepancy, with a female preponderance among adult asthmatics. [2] Patients with asthma over the age of 65 years tend to fare worse than younger patients. [3] Identification of the level of severity of asthma and determination of the factors affecting asthma control are crucial to the design and implementation of strategies to reduce the number of exacerbations and hospital admissions, thus improving outcomes. Of vital importance is the documentation of important parameters in the management of asthma, particularly in a public hospital where patients often see different doctors at each visit. These include inhaler technique, frequency of exacerbations and number of admissions to hospital.Our impression is that the control of asthma in patients attending the Respiratory Outpatient Department (ROPD) at Chris Hani Baragwanath Academic Hospital (CHBAH), Johannesburg, is suboptimal. However, no study has been performed at our hospital to interrogate this hypothesis, or to quantify the proportion of our patients with severe disease and/or poor control. We are of the opinion that these data will provide important information on asthma management relevant to the South African (SA) healthcare system. MethodsWe undertook a retrospective analysis of scheduled visits by patients with asthma attending the ROPD at CHBAH. Data collected included demographics, symptoms, disease severity, medication prescription and usage, control of asthma, inhaler technique competency and spirometry. This information was captured by the investigator using a data collection sheet that is routinely completed as part of our patients' clinic records. The sources of information were the patients' files, held at ROPD.Definitions of asthma control and indicators of asthma severity were based on those advocated by local SA Thoracic Society guidelines. [4] Acute exacerbations and severity were determined by the need for oral steroid use, days off work, antibiotic use, number of Emergency Department visits (exacerbations), intensive care unit admissions and general ward ORIGINAL RESEARCHBackground. There is a sense among respiratory physicians that asthma is poorly controlled in public sector hospitals, possibly due to poor adherence and lack of knowledge regarding inhaler technique. Objective. To describe the status of asthma control in patients attending the Respiratory Outpatient Department at Chris Hani Baragwanath Academic Hospital. Methods. A retrospective record review was conducted on outpatient files of asthmatics known to the Respiratory Department. Data obtained...
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