Predictors and outcomes of COVID-19 patients with hypoxemia in Lagos, Nigeria

Objectives: The coronavirus disease 2019 (COVID-19) pandemic is the current public health concern. Hypoxemia has been identified as an independent risk factor for mortality in COVID-19 patients regardless of age or sex. This study therefore aimed to assess the profile of COVID-19 patients with hypoxemia in Lagos, Nigeria and identify their associated socio-demographic and clinical risk factors, predictors, and outcomes.Materials and Methods: This was a retrospective cohort study in which data were extracted from medical records of real-time polymerase chain reaction confirmed COVID-19 positive patients admitted between April and October 2020. Data extracted included age, sex, comorbidities, disease category/classification, symptoms, lowest oxygen saturation (SPO2), and outcomes. Bivariate analysis was done to test associations between hypoxemia and other variables. Multivariate analysis was done to determine significant predictors of hypoxemia.Results: A total of 266 patients were included in the study; mean (SD) 49.80 (± 16.68) years. Hypoxemia (lowest SPO2 ≤ 90 in adults and < 92% in children) was found in 102 (38.3 %) of the cases. SPO2 of hypoxemic patients ranged from 33% to 90%, Mean ±SD of 77±13%. About half of the hypoxemic cases, 53 (52%) were ≥ 60 years and mostly male 70 (68.6%). Difficulty breathing was present in 56 (55%), while the common comorbidities were hypertension 86 (32.3%) and diabetes mellitus 47 (17.7%). Age ≥ 60, difficulty breathing, and fever were independent predictors of hypoxemia. Hypoxemia was significantly associated with death (X2-42.13; P < 0.001); odds ratio 14.5 (95% CI: 5.4–38.8).Conclusion: Hypoxemia occurred in 1 out of every 3 COVID-19 patients with poor prognosis. SPO2 monitoring and early presentation in hospital for those 60 years and above or with dyspnea may be essential for early identification and treatment of hypoxemia to reduce mortality

Immune Dysfunction in HIV: A Possible Role for Pro- and Anti-Inflammatory Cytokines in HIV Staging

HIV infection is a chronic infection that almost inevitably progresses to AIDS. The infection is characterized by the deterioration in the immune function leading to opportunistic infections and malignancies. Additionally, there is an associated immune dysfunction characterized by a persistent inflammatory state and unhealthy elaboration of both pro- and anti-inflammatory cytokines. The CD4+ T cell count has been used as a surrogate for the level of immune dysfunction that exists in patients with HIV infection. Eighty-eight (88) patients with HIV infection, forty-four (44) of whom were treatment naïve patients and forty-four (44) who were treatment-experienced patients, were recruited. The serum concentrations of cytokines IL-6 and IL-10 were carried out using R&D human Quantikine ELISA kits, while patients’ CD4+ T cell counts were evaluated using the Partec easy count kit. The serum IL-6 and IL-10 concentrations were significantly higher among the AR-naïve participants compared to the ART-experienced group. Additionally, the IL-6 and IL-10 concentrations were higher in patients with lower CD4+ T cell count compared to those with higher cell counts though this was not statistically significant. Also, both IL-6 and IL-10 concentrations were higher in patients with higher WHO clinical staging of disease, significantly so for IL-6

Use of exchange blood transfusion in the management of severe COVID-19 infection in pregnancy: experience from Lagos, Nigeria

Coronavirus disease 2019 (COVID-19) presents with symptoms that may be mild or severe. The individual with the severe form of the disease usually presents with a constellation of respiratory symptoms typical of acute respiratory distress syndrome. In this report, we present our experience of the successful management of an oxygen-dependent pregnant woman with severe COVID-19 infection who had 2 sessions of partial exchange blood transfusion. We discussed the principles that informed this intervention and the need to adopt this novel approach in the care of severe COVID-19 infection

Saliva all positive figures.

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Age and sex distribution of study participants (n = 299).

Age and sex distribution of study participants (n = 299).</p

SARS-CoV-2 positivity by gender and sample type.

SARS-CoV-2 positivity by gender and sample type.</p

Relationship of SARS-CoV-2 positivity with gender and age groups.

Relationship of SARS-CoV-2 positivity with gender and age groups.</p

Raw data and analysis.

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S2 File -

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Fig 1 -

Cycle Threshold (Ct) values for SARS-CoV-2 positivity to (A) E-gene, (B) N-gene, and (C) Orf1ab gene respectively, show good comparison on both the Saliva and the Nasopharyngeal swab: The median Cycle Threshold (Ct) values for the three SARS-CoV-2 genes (E, N, and Orf1ab) of the positive samples (Ct 40) from both the nasopharyngeal swab and saliva samples were compared using the Wilcon signed rank exact test. The p values of 0.07715, 0.8438, and 0.2293 were determined for the E, N, and Orf1 ab genes respectively. There were no statistically significant differences between the median SARS-CoV-2 E-gene, N-gene, and Orf1ab gene Ct values detected for the Nasopharyngeal swab and Saliva samples.</p