Leadership and early strategic response to the SARS-CoV-2 pandemic at a COVID-19 designated hospital in South Africa.

While many countries are preparing to face the COVID-19 pandemic, the reported cases in Africa remain low. With a high burden of both communicable and non-communicable disease and a resource-constrained public healthcare system, sub-Saharan Africa is preparing for the coming crisis as best it can. We describe our early response as a designated COVID-19 provincial hospital in Cape Town, South Africa (SA).While the first cases reported were related to international travel, at the time of writing there was evidence of early community spread. The SAgovernment announced a countrywide lockdown from midnight 26 March 2020 to midnight 30 April 2020 to stem the pandemic and save lives. However, many questions remain on how the COVID-19 threat will unfold in SA, given the significant informal sector overcrowding and poverty in our communities. There is no doubt that leadership and teamwork at all levels is critical in influencing outcomes.

Leadership and early strategic response to the SARS-CoV-2 pandemic at a COVID-19 designated hospital in South Africa

While many countries are preparing to face the COVID-19 pandemic, the reported cases in Africa remain low. With a high burden of both communicable and non-communicable disease and a resource-constrained public healthcare system, sub-Saharan Africa is preparing for the coming crisis as best it can. We describe our early response as a designated COVID-19 provincial hospital in Cape Town, South Africa (SA).While the first cases reported were related to international travel, at the time of writing there was evidence of early community spread. The SA government announced a countrywide lockdown from midnight 26 March 2020 to midnight 30 April 2020 to stem the pandemic and save lives. However, many questions remain on how the COVID-19 threat will unfold in SA, given the significant informal sector overcrowding and poverty in our communities. There is no doubt that leadership and teamwork at all levels is critical in influencing outcomes

Pilot trial to determine the efficacy of a low dose of fish oil in the treatment of angina pectoris in the geriatric patient.

23 geriatric patients completed a single-blind placebo controlled, crossover trial using fish oil as adjunctive therapy for stable angina pectoris. The results indicated a significant reduction in the number of anginal attacks, as well as a significant reduction in the consumption of sublingual isosorbide dinitrate tablets. A possible prolonged carry over effect of fish oil was noted after crossover from the active substance to placebo.

Increased frequency of the transferrin C2 subtype in Alzheimer's disease.

Several genetic variants of transferrin can be separated by polyacrylamide gel isoelectric focusing. Studies by other workers have revealed that the genetic type Tf C2 has an increased frequency in certain malfunctions which are associated with the formation of free radicals, suggesting that the iron binding of Tf C2 promotes the formation of hydroxyl radicals. In our study population of 20 patients with Alzheimer's disease, 13 had the C2 genetic subtype. Since the frequency of C2 in the South African population is 0.136 (14%), this represents a significant increase (p < 0.005) in the appearance of this genetic subtype.

Membrane fluidity of platelets and erythrocytes in patients with Alzheimer's disease and the effect of small amounts of aluminium on platelet and erythrocyte membranes.

The membrane fluidity of platelet and erythrocyte membranes in 10 Alzheimer's disease patients and 9 age-matched controls was studied. The platelet membranes of patients with Alzheimer's disease were found to be significantly more fluid than those of controls (p less than 0.02). However, erythrocyte membranes of Alzheimer patients were less fluid (more viscous) than those of controls (p less than 0.05). On further investigation of platelet and erythrocyte membranes obtained from healthy volunteers, the fluidity was found to change with increasing aluminium concentrations. When aluminium ammonium sulphate (0.01-10 microM) was added to membrane suspensions, the fluidity of platelet membranes was increased, whereas the fluidity of erythrocyte membranes was decreased (i.e. the microviscosity was increased).

Oxprenolol plus ethanol causes no central nervous system depression--a comparison with lorazepam plus ethanol.

Oxprenolol, a fat-soluble beta-adrenergic blocker, promoted as an anxiolytic agent to alleviate peripheral symptoms associated with anxiety, and lorazepam, a 1,4-benzodiazepine anxiolytic drug, may both depress central nervous system (CNS) function. It is generally accepted that ethanol, when concurrently ingested, potentiates the CNS-depressant effects of drugs. The effects on CNS function of oxprenolol, lorazepam and placebo alone and in combination with ethanol were determined by a Leeds Psychomotor Tester and we concluded that oxprenolol in combination with ethanol is less hazardous to people operating power tools/machines or driving motor vehicles than the combination of lorazepam with ethanol.

Pharmacokinetic aspects of carbamazepine and its two major metabolites in plasma during overdosage.

In 10 out of 25 patients admitted with carbamazepine overdosage to local teaching hospitals sufficient plasma level data of carbamazepine and two of its main metabolites (epoxide and dihydroxy) were obtained to characterize their terminal elimination kinetics. Some other pharmacokinetic aspects which could be useful in extrapolating to the amount and time of ingestion of the overdose are discussed.

Carbamazepine and its major metabolites in plasma: a summary of eight years of therapeutic drug monitoring.

For a period of 8 years, carbamazepine (CBZ) and its two major metabolites carbamazepine-10,11-epoxide (CBZE) and 10,11-dihydroxy-carbamazepine (CBZH) were monitored in plasma of black and white patients visiting outpatient epilepsy clinics. Mean CBZ, CBZE, and CBZH levels found in the black group (n = 451) were found to be significantly lower (p less than 0.0005) than in white patients (n = 2,225). The ratio of CBZE to CBZ levels was found to be significantly lower (p less than 0.0005) for blacks, with CBZ levels within the therapeutic range (5-10 micrograms/ml); the ratio of CBZH to CBZ levels was higher (p less than 0.0005), while there was no significant difference in the ratio of CBZH to CBZE between the two groups. This may indicate a difference in the monooxygenase enzyme activities, whereas the epoxide hydrase activity is probably the same for both groups. A poor linear correlation exists between CBZH and CBZ levels in both groups (for blacks, r = 0.614, n = 451; for whites, r = 0.338, n = 2,225); the correlation is better between CBZE and CBZ (for blacks, r = 0.745; for whites, r = 0.553) and good between CBZH and CBZE (for blacks, r = 0.752; for whites, r = 0.710). Abnormal ratios of CBZH to CBZE were found to be useful indicators of noncompliance in difficult cases presenting with therapeutic levels of CBZ.

[An epidemiological study of poisoning in the Bloemfontein area]. / Epidemiologiese studie van vergiftigings in Bloemfontein en omgewing.

an epidemiological study of human poisoning in the Bloemfontein area over a recent 3-year period was performed. Deliberate poisoning and accidental poisoning relative to age and sex were studied. Drugs were responsible for the majority of cases. Children seemed to have two peak periods of poisoning with regard to age, namely 1-4 years and 14-16 years. The incidences of some agents involved were compared with those in a study covering the preceding 7 years. Problem areas are identified and discussed with the aim of lowering the incidence of poisoning.

The pharmacological treatment of epilepsy.

A short classification and brief clinical description of epileptic seizures are presented. The pharmacokinetic principles underlying modern drug treatment of epileptic seizures are discussed and the drug(s) of choice for different seizure types are listed according to their clinical efficacy. The current view of using single-drug therapy rather than polypharmacy, whenever possible, is emphasized.

Epilepsy and IgA deficiency--the effect of sodium valproate.

IgA deficiency (less than 80 IU/ml serum) occurred in 29% of 41 epileptic patients on anticonvulsant therapy. Sodium valproate users had significantly lower mean IgA levels (102 IU/ml) than non-users (151 IU/ml) and had a significantly higher incidence of IgA deficiency (50%) than non-users (16%). The occurrence of IgA deficiency did not appear to be related to age, sex, number of drugs used or to serum anticonvulsant levels.

Evaluation of serum levels during prolonged combination therapy with phenytoin and phenobarbitone.

When phenobarbitone was added to the treatment regimen of epileptic patients who received phenytoin only, the serum levels of phenytoin increased significantly within 6 weeks. Eleven weeks after the introduction of phenobarbitone, phenytoin levels had returned to those existing before phenobarbitone therapy. In view of possible complex pharmacokinetic interactions which might occur when phenobarbitone is added to a regimen of phenytoin, or vice versa, frequent measurement of serum drug levels appears to be indicated for up to 10 weeks after effecting a change in treatment. During this period a constant change in serum levels could be expected, resulting either in toxicity or lack of efficacy.