There is a need for effective therapy for COVID-19 pneumonia. Convalescent plasma has antiviral activity and early observational studies suggested benefit in reducing COVID-19 severity. We investigated the safety and efficacy of convalescent plasma in hospitalized patients with COVID-19 in a population with a high HIV prevalence and where few therapeutic options were available. We performed a double-blinded, multicenter, randomized controlled trial in one private and three public sector hospitals in South Africa. Adult participants with COVID-19 pneumonia requiring non-invasive oxygen were randomized 1:1 to receive a single transfusion of 200 mL of either convalescent plasma or 0.9% saline solution. The primary outcome measure was hospital discharge and/or improvement of ≥ 2 points on the World Health Organisation Blueprint Ordinal Scale for Clinical Improvement by day 28 of enrolment. The trial was stopped early for futility by the Data and Safety Monitoring Board. 103 participants, including 21 HIV positive individuals, were randomized at the time of premature trial termination: 52 in the convalescent plasma and 51 in the placebo group. The primary outcome occurred in 31 participants in the convalescent plasma group and and 32 participants in the placebo group (relative risk 1.03 (95% CI 0.77 to 1.38). Two grade 1 transfusion-related adverse events occurred. Participants who improved clinically received convalescent plasma with a higher median anti-SARS-CoV-2 neutralizing antibody titre compared with those who did not (298 versus 205 AU/mL). Our study contributes additional evidence for recommendations against the use of convalescent plasma for COVID-19 pneumonia. Safety and feasibility in this population supports future investigation for other indications.

Lung cancer remains the leading cause of cancer-related deaths in southern Africa. Early trials of chest radiograph-based screening in males at high risk for lung cancer found no mortality benefit of a radiograph alone, or a radiograph plus sputum cytology screening strategy. Large prospective studies, including the National Lung Screening Trial, have shown an all-cause mortality benefit when lowdose computed tomography (LDCT) was used as a screening modality in patients that are at high risk of developing lung cancer. The South African Thoracic Society, based on these findings, and those from several international guidelines, recommend that annual LDCT should be offered to patients between 55-74 years of age who are current or former smokers (having quit within the preceding 15 years), with at least a 30-pack year smoking history and with no history of lung cancer. Patients should be in general good health, fit for surgery, and willing to undergo further investigations if deemed necessary. Given the high local prevalence of tuberculosis (TB) infection and post-TB lung disease, which can radiographically mimic lung cancer, a conservative threshold (nodule size ≥6 mm) should be used to determine whether the baseline LDCT screen is positive (thus nodules <6 mm require no action until the next annual screen). If a non-calcified, solid or partly solid nodule is ≥6 mm, but <10 mm with no malignant features (e.g., distinct spiculated margins), the LDCT should be repeated in 6 months. If a solid nodule or the largest component of a non-solid nodule is ≥10 or ≥6 mm and enlarging or with additional malignant features present, definitive action to exclude lung cancer is warranted. Patients should be screened annually until 15 years have elapsed from date of smoking cessation, they turn 80, become unfit for a curative operation or significant changes are observed.

Traumatic brain injury (TBI) can be defined as 'an alteration in brain function manifest with confusion, altered level of consciousness, seizure, coma, or focal sensory or motor neurologic deficit resulting from blunt or penetrating force to the head. ' [1] It poses a major public health problem, with an estimated annual hospitalisation rate of 90.5 per 100 000 population in the USA, [2] and more than 200 per 100 000 in Europe. [3] Although there is a paucity of epidemiological studies regarding the incidence of TBI in South Africa (SA), an incidence of 316 per 100 000 per year has been reported. [4] TBI is generally graded as mild if the Glasgow Coma Scale (GCS) score is 13 -15, moderate if 9 -12 and severe if 3 -8 after resuscitation. [5] Since the brain is enclosed in a non-deformable skull, any increase in intracerebral volume as a result of haemorrhage or oedema can cause a significant increase in intracranial pressure. Raised intracranial pressure can potentially lead to reduced cerebral perfusion pressure (CPP) associated with cerebral hypoxia and ischaemia, ultimately resulting in permanent neurological impairment. The management of patients with severe TBI therefore mainly entails reducing intracranial pressure by draining any haematomas that exert a pressure effect on the underlying brain parenchyma, but it also aims to prevent secondary brain injury by means of optimising CPP and via oxygenation of brain tissue. [6] This can be achieved by intubating and ventilating the patient, providing isotonic fluid and vasopressor therapy to ensure normotension, maintaining normothermia and preventing either hypo-or hyperglycaemia.In SA, most people suffering TBIs are young and otherwise healthy adults who may survive the initial injury, but are often left with severe cognitive or functional impairment. [7] Furthermore, the reality in resource-constrained countries such as SA is that post-hospital discharge rehabilitation or long-term care facilities for patients with severe neurological disabilities are not readily available in the public healthcare sector. [8] Andrew et al. [9] report alarming information on the admission of patients with TBI to a public rehabilitation centre in the Western Cape Province. According to previously unpublished statistics, only 2.4% (n=16) of 654 patients with TBI treated at Groote Schuur Hospital in 2009 were admitted to a rehabilitation facility. In 2013, a total of 2 851 patients with TBI were treated at Groote Schuur and Tygerberg Hospitals, of whom 2.9% (n=82) were discharged from hospital to a rehabilitation centre. [9] Webster et al. [8] reported that <9% of all patients with TBI were admitted to the Western Cape Rehabilitation Centre for the 5-year period 2008 -2012. No similar information is currently available for the Free State Province.It has been argued that SA patients are not hospitalised for a sufficient period of time after sustaining a TBI. Because of the shortage of specialised rehabilitation facilities, which negatively influences Background. Despite the conditi...

Diffuse pulmonary meningotheliomatosis is a rare condition of the lung that presents with nonspecific respiratory symptoms, and usually follows a benign course. It should, however, be considered in the differential diagnosis of a miliary pattern on chest-imaging studies, as illustrated in the case reported

Background. Mortality rates in patients with haematological malignancies who required intensive care unit (ICU) admission have in the past been high. More recently, however, improved outcomes for critically ill haematological patients have been reported. Objective. To determine outcomes, average length of ICU stay, and factors associated with mortality in patients with haematological malignancies and neutropenic fever in the multidisciplinary ICU (MICU) at Universitas Academic Hospital (UAH), Bloemfontein, Free State Province, South Africa. Methods. We conducted a retrospective review of medical and laboratory records of all patients admitted to the UAH MICU with haematological malignancies and febrile neutropenia between 2010 and 2019. Results. A total of 182 patients with haematological malignancies were admitted to the MICU between 1 January 2010 and 31 December 2019, of whom 51 (28.0%) fulfilled the inclusion criteria for the study. The median age was 33 years, and 29 patients (56.9%) were female. Most patients had either acute myeloid leukaemia (n=22; 43.1%) or acute lymphocytic leukaemia (n=16; 31.4%), while B-cell lymphoma (n=12; 23.5%) and multiple myeloma (n=1; 2%) were less frequent. The median length of stay in the ICU was 3 days. ICU mortality was 76.5% and hospital mortality 82.4%. Factors associated with mortality included septic shock, vasoactive agent use and mechanical ventilation. Conclusion. Patients with haematological malignancies and febrile neutropenia in the UAH MICU have high ICU and hospital mortality rates. More needs to be done with regard to timeous management of patients with haematological malignancies and septic shock in our setting to improve survival.