Clinical evolution, management and outcomes of patients with COVID-19 admitted at Tygerberg Hospital, Cape Town, South Africa: a research protocol.

INTRODUCTION: 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.

Lessons learned from the world's first successful penis allotransplantation.

We performed a successful penis allotransplantation on 11 December 2014. Sharing the lessons learned might help more patients in need to be treated this way. We divided the project into manageable segments that was each overseen by an expert. The ethical review and conduct paved the way for a publically acceptable and successful project. Screening for a psychological stable recipient is important. The most difficult part of the project was finding a donor penis. This was successfully negotiated with the family of a brain dead donor by creating a neo-phallus for the donor, thereby maintaining the dignity of the donor. Working with transplant coordinators that are sympathetic to aphallic men is crucial. Surgeons versed in microvascular techniques is a critical part of the team. Transplant immunologists have to adapt to treat composite tissue transplantation patients.

Recent advances in the human microbiome - review

The human gut microbiome can be considered a 'new' internal organ, with a metabolic capacity exceeding that of the liver, or our primary connection to the environment, linking us to the world's ecology. The density of microbes within the colon is one of the highest in nature, and it is estimated that the number of microbes within our gut match or exceed that of our host human cell count, whilst their genetic machinery outnumbers our own by 100:1. This helps explain the remarkable new findings that show our microbiome not only affects the health and function of our intestines, but also has a strong influence on general body health through its close interaction with the gut immune system and through its production of bioactive metabolites that are absorbed and affect distant organ function. A state of dysbiosis can occur when its food source, fiberrich foods, becomes depleted and when oral antibiotics are used. Dysbiosis has been linked to an increasing list of human diseases, and in particular to 'westernized' diseases, such as colon cancer, allergy, diabetes, obesity, inflammatory bowel disease, and atherosclerosis, which pose the major threat to healthcare in the USA today