Browsing by Author "Parker, Arifa"
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- ItemBenefit v. risk when using chloroquine in patients with severe COVID-19 disease(Health & Medical Publishing Group, 2020-04-02) Decloedt, Eric H.; Allwood, Brian W.; Parker, Arifa; Koegelenberg, Coenraad F. N.; Blockman, Marc; Taljaard, Jantjie; Reuter, HelmuthENGLISH ABSTRACT: Chloroquine (CQ) is widely advocated as treatment for coronavirus disease 2019 (COVID-19), including the president of the USA publicly supporting the use of hydroxychloroquine (HCQ) as a ‘game-changer’ on the social media platform Twitter. CQ and HCQ are structurally similar, with HCQ having an N-hydroxyl-ethyl side-chain in place of the N-diethyl group.[1] Currently only CQ is being marketed in South Africa. We encourage the development of curative directed therapy against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using appropriate designed trials and regulatory oversight, and caution against the indiscriminate use of CQ or HCQ. Careful patient selection is essential, including assessing prognosis, anticipated benefit and potential harms prior to initiating CQ/HCQ therapy.
- ItemClinical evolution, management and outcomes of patients with COVID-19 admitted at Tygerberg Hospital, Cape Town, South Africa : a research protocol(BMJ Publishing Group, 2020-08-06) Allwood, Brian W.; Koegelenberg, Coenraad F. N.; Irusen, Elvis; Lalla, Usha; Davids, Razeen; Chothia, Yazied; Davids, Ryan; Prozesky, Hans; Taljaard, Jantjie; Parker, Arifa; Decloedt, Eric; Jordan, Portia; Lahri, Sa'ad; Moosa, Rafique; Schrueder, Neshaad; Du Toit, Riette; Viljoen, Abraham; English, Rene; Ayele, Birhanu; Nyasulu, Peter; COVID-19 Research Response TeamIntroduction The outbreak of the SARS-CoV-2 virus causing COVID-19, declared a global pandemic by the WHO, is a novel infection with a high rate of morbidity and mortality. In South Africa, 55 421 cases have been confirmed as of 10 June 2020, with most cases in the Western Cape Province. Coronavirus leaves us in a position of uncertainty regarding the best clinical approach to successfully manage the expected high number of severely ill patients with COVID-19. This presents a unique opportunity to gather data to inform best practices in clinical approach and public health interventions to control COVID-19 locally. Furthermore, this pandemic challenges our resolve due to the high burden of HIV and tuberculosis (TB) in our country as data are scarce. This study endeavours to determine the clinical presentation, severity and prognosis of patients with COVID-19 admitted to our hospital. Methods and analysis The study will use multiple approaches taking into account the evolving nature of the COVID-19 pandemic. Prospective observational design to describe specific patterns of risk predictors of poor outcomes among patients with severe COVID-19 admitted to Tygerberg Hospital. Data will be collected from medical records of patients with severe COVID-19 admitted at Tygerberg Hospital. Using the Cox proportional hazards model, we will investigate the association between the survival time of patients with COVID-19 in relation to one or more of the predictor variables including HIV and TB. Ethics and dissemination The research team obtained ethical approval from the Health Research Ethics Committee of the Faculty of Medicine and Health Sciences, Stellenbosch University and Research Committee of the Tygerberg Hospital. All procedures for the ethical conduct of scientific investigation will be adhered to by the research team. The findings will be disseminated in clinical seminars, scientific forums and conferences targeting clinical care providers and policy-makers.
- ItemThe impact of comorbidities on coronavirus disease 2019 in a population with high human immunodeficiency virus, tuberculosis and obesity prevalence.(Stellenbosch : Stellenbosch University, 2023-12) Parker, Arifa; Koegelenberg, Coenraad FN; Meintjes, Graeme; Taljaard, Jantjie J; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Medicine: Internal Medicine.ENGLISH ABSTRACT: Introduction The emergence of a novel coronavirus in Wuhan, China in December 2019 launched a devastating global pandemic, with over 6.9 million reported deaths. This virus, subsequently named severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) resulted in coronavirus disease 2019 (COVID-19), a clinical spectrum of respiratory illness ranging from mild upper respiratory infections to severe pneumonia with hyperinflammation. Prior to any cases in South Africa, early reports suggested a link between comorbidities such as hypertension and COVID-19 severity. The impact of the pandemic on the overburdened public healthcare system South Africa with a high prevalence of Human Immunodeficiency Virus (HIV), non-communicable diseases, and high incidence of Tuberculosis was not known. The aim of this PhD study was to describe the local epidemiology, including clinical features, the prevalence and role of comorbidities (specifically HIV, Tuberculosis, and obesity) and outcome in patients hospitalised with COVID-19. The secondary aim was to explore pathophysiology by investigating the role of adipose tissue in the pathogenesis of COVID-19 severity and outcome. Methods A single-centre descriptive study was done to describe the clinical features, comorbidities, and outcome of an early cohort of patients admitted to hospital with COVID-19. Then a robust multicentre cohort study using a COX proportional model was conducted to identify independent risk factors of mortality. To identify the true prevalence of obesity, including in people with HIV (PWH) we conducted a point prevalence study of measured body mass indices (BMI’s) in all COVID-19 admissions over a 14-day period. Lastly, an exploratory cross-sectional cohort study investigating adipose tissue (AT) for presence of SARS-CoV-2 RNA and associations between adipokine concentrations with COVID-19 severity and outcome in persons with HIV/and or obesity was performed. Results In persons hospitalised with COVID-19, one in five (20%) were PWH. By measuring heights and weights the prevalence of obesity (BMI ≥ 30) was higher than previously reported (69%), including in PWH (75%). A BMI ≥ 25 was prevalent in 85% of all admissions, and in 83% of PWH. Prevalence of active tuberculosis was low (3-4%). With active tuberculosis, PWH had higher mortality (n=11, 38%) than persons without HIV (n=3, 20%, p=0.001). On survival regression analysis, higher risk of mortality was only associated with older age, male sex and being “overweight or obese” (Adjusted Hazard Ratio 1,3 (95%confidence interval 1.03-1.61) p=0.02). HIV and active TB were not associated with increased risk of COVID-19 mortality. We detected SARS-CoV-2 RNA in adipose tissue of 3 of 8 patients who died, and one of 30 who survived (38% vs 3%, p=0.02). There was no cytokine or adipokine differences in PWH. Obesity was associated with significantly higher leptin concentrations, lower adiponectin/leptin ratios, and higher leptin/resistin ratios. Only higher leptin/resistin and lower adiponectin resistin in adipose tissue, but not serum, was associated with mortality. Conclusion The findings of this PhD study highlight the need for urgent measures to address obesity, including in PWH. Eliminating obesity may improve resilience against future pandemics, where obesity may contribute to clinical severity and mortality.
- ItemImplementing a video call visit system in a coronavirus disease 2019 unit(AOSIS, 2020-09-15) Moolla, Muhammad Saadiq; Broadhurst, Alistair; Parker, Mohammed A.; Parker, Arifa; Mowlana, AbdurasietENGLISH ABSTRACT: The lockdown and physical distancing strategies imposed to combat COVID-19 have caused seismic shifts at all levels of society. Hospitals have been particularly affected. Healthcare workers (HCW’s) wore PPE during all patient interactions and visitors were prohibited. Life for a patient became lonelier and for those with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) measures were even more severe. HCW’s must treat patients following a biopsychosocial approach and promote communication between patients and loved ones. We implemented a low cost Video Call Visit system at Tygerberg Hospital, Cape Town. In this article we discuss the elements of a successful implementation and potential pitfalls in the context of a pandemic, notably cross-infection and privacy. Rapid but responsible innovation using 21st century tools was required to address the many challenges of the pandemic, including improving the lived experience for patients and families. These should be intended to last after the pandemic has passed.
- ItemIvermectin for COVID-19 : promising but not yet conclusive(Health & Medical Publishing Group, 2021-03) Van Rensburg, Roland; Decloedt, Eric H.; Reuter, Helmuth; Parker, Arifa; Schrueder, Neshaad; Lahri, Sa'adIvermectin has been proposed as a potential definitive and prophylactic treatment for COVID-19.[1] Ivermectin is an anthelmintic drug that is usually indicated for filarial and resistant scabies infections, but has been shown to have antiviral activity and anti-inflammatory activity in vitro.[2,3] Ivermectin has the potential to be a promising directed therapy in the drug armamentarium against COVID-19, as it has been shown to have in vitro activity against SARS-CoV-2.[4] Several randomised controlled trials (RCTs) and observational studies have reported on the effectiveness and safety outcomes of ivermectin in COVID-19.[1,5] These data are very promising, showing large treatment effects and acceptable adverse effect profiles for ivermectin against COVID-19, especially when combined in metaanalyses.
- ItemStaff testing for COVID-19 via an online pre-registration form(medRxiv, 2020) Moolla, Muhammad Saadiq; Parker, Arifa; Parker, Mohammed Aslam; Sithole, Sthembiso; Amien, Leila; Chiecktey, Rubeena; Bawa, Tasneem; Mowlana, AbdurasietBackground: Healthcare workers are at increased risk of contracting SARS-CoV-2 and potentially causing institutional outbreaks. Staff testing is critical in identifying and isolating infected individuals while also reducing unnecessary workforce depletion. Tygerberg Hospital implemented an online pre-registration system to expedite staff and cluster testing. Objectives: We aimed to identify (1) specific presentations associated with a positive or negative result for SARS-CoV-2 and (2) staff sectors where enhanced strategies for testing might be required. Methods: Retrospective descriptive study involving all clients making use of the hospital's pre-registration system during May 2020. Results: Of 799 clients, most were young and female with few comorbidities. The most common occupation was nurses followed by administrative staff, doctors and general assistants. Doctors tested earlier compared to other staff (median: 1.5 vs 4 days). The most frequent presenting symptoms were headache, sore throat, cough and myalgia. Amongst those testing positive (n=105), fever, altered smell, altered taste sensation, chills and history of fever were the most common symptoms. Three or more symptoms was more predictive of a positive test, but 12/145 asymptomatic clients also tested positive. Conclusion: Staff coronavirus testing using an online pre-registration form is a viable and acceptable strategy. While some presentations are less likely to be associated with SARS-CoV-2 infection, no symptom can completely exclude it. Staff testing should form part of a bundle of strategies to protect staff including wearing masks, regular hand washing, buddy screening, physical distancing, availability of PPE and special dispensation for COVID-19-related leave.
- ItemThe utility of high-flow nasal cannula oxygen therapy in the management of respiratory failure secondary to COVID-19 pneumonia(Health & Medical Publishing Group, 2020-05-07) Lalla, Usha; Allwood, Brian W.; Louw, Elizabeth H.; Nortje, Andre; Parker, Arifa; Taljaard, Jantjie J.; Moodley, Desiree; Koegelenberg, Coenraad F. N.COVID-19 is a potentially fatal infection caused by SARS-CoV-2.[1] As of 4 May 2020, more than 6 000 cases had been confirmed in South Africa (SA) with numbers rising steadily, a situation that will place a major strain on the country’s health resources, including its ability to provide intensive care and ventilatory support to patients with severe disease.