Clinical management of COVID-19: Experiences of the COVID-19 epidemic from Groote Schuur Hospital, Cape Town, South Africa.

The SARS-CoV-2 pandemic has presented clinicians with an enormous challenge in managing a respiratory virus that is not only capable of causing severe pneumonia and acute respiratory distress syndrome, but also multisystem disease. The extraordinary pace of clinical research, and particularly the surge in adaptive trials of new and repurposed treatments, have provided rapid answers to questions of whether such treatments work, and has resulted in corticosteroids taking centre stage in the management of hospitalised patients requiring oxygen support. Some treatment modalities, such as the role of anticoagulation to prevent and treat potential thromboembolic complications, remain controversial, as does the use of high-level oxygen support, outside of an intensive care unit setting. In this paper, we describe the clinical management of COVID-19 patients admitted to Groote Schuur Hospital, a major tertiary level hospital at the epicentre of South Africa's SARS-CoV-2 epidemic during its first 4 months.

Giant hepatic hemangiomas: diagnostic and therapeutic dilemmas.

This report describes four cases of surgically treated giant hepatic hemangiomas which illustrate some diagnostic and therapeutic difficulties encountered in the management of this condition. An important diagnostic triad has emerged, which should alert the physician to the possibility of a complicated hepatic hemangioma: the clinical signs of an acute inflammatory liver process contrasted with a normal white blood cell count and liver function tests. Hemangiomas of the left lobe were either missed or poorly demonstrated on selective hepatic angiographic examination, and in two patients the diagnosis was made only at the time of laparotomy. Hepatic resection was successfully performed in all patients; there was minimal morbidity and none of the patients died. In two patients with multiple hemangiomas, only symptomatic or easily resectable lesions were removed. All patients are alive and well; three have been followed up for more than 5 years. We conclude that resection in asymptomatic cases should be carried out only in those cases that require a diagnostic laparotomy and in those where the lesion is easily resectable. The majority of patients with symptomatic and complicated tumors should undergo resection, but even in these patients continued conservative treatment is appropriate when the risk of major resection outweighs the small risk of live-threatening bleeding.

Finite element stress analysis of the crowns of normal and restored teeth.

Stress distributions are presented for a normal and a restored mandibular second premolar under masticatory-type forces. These were obtained using the finite element method of stress analysis applied to two-dimensional models. The effect of the relative stiffness of the materials is examined in each instance.

A common diagnostic problem and a commonly misused drug.

Two common clinical problems are discussed, one diagnostic and one therapeutic. Chest pain, because of the possibility of cardiac origin, makes it an urgent diagnostic problem. Ischemic chest pain is considered from a diagnostic standpoint. Common causes of chest pain other than those of cardiac origin are considered. The objectives and basis of therapy for angina are briefly reviewed. Digitalis is discussed from the standpoint of its use and abuse. Digitalis intoxication is frequently overlooked, and it may be the cause of deterioration of the patient's cardiac status, rather than progression of the basic cardiac problem.