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SDLG getting the job done for 50 years

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Represented by Babcock in southern Africa since 2012, Shandong Lingong Construction Machinery Company Limited (SDLG) celebrates its 50th anniversary of operating in the construction machinery industry this year. SDLG is listed in the Top 100 of China’s Mechanical Industry Enterprises, and has a 70% shareholding by Volvo Construction Equipment.

Jay Moodley, regional manager of Babcock’s equipment division, says that Babcock has gained considerable market ground with SDLG since introducing the machines to the southern African infrastructure sector 10 years ago.

“SDLG is a quality value brand that complements and supports the premium Volvo range of construction equipment. SDLG machines are developed around the concept of ‘reliability in action’, and are designed to be reliable, hardworking, cost-effective and easy to operate,” says Moodley.

“When we introduced SDLG to the market, Babcock went to great effort in building customer confidence and trust in the brand. Over the last decade, our customers have seen that SDLG machines are competitively priced, fuel efficient and easy to service and maintain. With strong aftersales support from Babcock, the machines have proven their reliability to get the job done, and we have made solid in-roads in the infrastructure sector with the SDLG portfolio.

“Our customers were already familiar with the high standards of Volvo construction equipment, and were reassured that SDLG products are also manufactured to similar standards at the state-of-the-art factory in China. SDLG is very responsive to customer feedback and places ongoing emphasis on innovation in all phases of its design and production to deliver ever more dependable products and services to its global customer base,” says Moodley.

He adds that lead times on SDLG machines are good as the company is flexible with ordering products, rather than working on a build-slot basis like many other OEMs.

As part of its aftersales support, Babcock has streamlined SDLG part availability and holds a constant inventory of spares to provide fast assistance. “We are committed to keeping our customers going and preventing units from standing. We pride ourselves in our aftersales service, and have branches across the country, including the major port hubs,” affirms Moodley.

“Of note is that the SDLG machines are serviced by our Volvo-qualified mechanics, so our customers know their machines are getting top-class servicing.”

Babcock currently offers three SDLG products in southern Africa: the 9220F grader, and the 938L and 958F wheeled or front-end loaders.

Moodley says that the grader is used predominantly in the public sector for road maintenance, and that the pricing and availability of these machines, combined with the aftermarket service from Babcock have positioned the SDLG grader as a front-runner in this sector.

The majority of the wheeled loaders are used in southern Africa’s coastal belt at ports for material handling, moving of mineral resources, commodities and fertiliser, stock piling, and loading and offloading of vessels. Some wheeled loaders are also used in quarry applications, and clean-up operations in the public sector.

Demand for South Africa’s mineral resources on the back of the electric revolution, and the war in Ukraine has seen an increase in port activities, which in turn is driving the demand for material handling machinery, says Moodley. “There is huge potential for growth in this market, and Babcock is continuously seeking opportunities to supply products required by the industry.”

The SDLG product range currently available in South Africa includes:

  • SDLG grader G9220F
  • The G9220F is a well, balanced, versatile machine for all grading applications, with good traction and excellent blade down force. The 164 kW Dalian Deutz engine has three power curve settings for the smoothest grade on any surface while reducing fuel consumption. The Machine Blade Control System (MBCS) is controlled by hydraulic mechanical levers in the cab, allowing the operator to swing the blade himself if required. No manual handling is required for improved safety.
  • The G9220F is a well, balanced, versatile machine for all grading applications, with good traction and excellent blade down force. The 164 kW Dalian Deutz engine has three power curve settings for the smoothest grade on any surface while reducing fuel consumption. The Machine Blade Control System (MBCS) is controlled by hydraulic mechanical levers in the cab, allowing the operator to swing the blade himself if required. No manual handling is required for improved safety.

Winter storm challenges U.S. East Coast energy complex

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The U.S. energy industry is facing a massive test of its infrastructure as an intense winter storm roars up the Atlantic Coast, threatening power outages, refinery shutdowns and spikes in heating prices, reports Reuters.

The storm swept up the U.S. Southeast toward New England on Wednesday, bringing snow, freezing rain and strong winds to a record-shattering cold already affecting much of the eastern United States. Temperatures are expected to keep dropping throughout the weekend, according to AccuWeather forecasts.

Prices for heating oil and natural gas in the U.S. Northeast are at their highest levels in several years on the back of near-record heating demand.

MSHS Group

The extreme cold has stoked fears that a significant disruption could lead to a heating oil shortage, as inventories of distillate products, including heating oil, in the New England and Mid-Atlantic regions are at their lowest levels for this time of year since 2015. A number of tankers carrying diesel and heating oil from Europe are bound for the United States to address supply worries.

The U.S. Coast Guard in the key ports of Boston, the New York Harbor and Philadelphia have deployed ice-breaking ships to help keep trade traffic moving, but delays are expected.

Gasoline and diesel futures have climbed above five-year highs for this time of year, boosting key refining margins CL321-1=R to a five-year high for this time of year.

“I think we’ll see a big bang and price response but I don’t expect the impact and price response to be as long lasting as what you saw during Hurricane Harvey. Markets tend to over react,” said John Auers, executive vice president at consultancy Turner, Mason & Co. in Dallas.

Refiners along the U.S. East Coast were bracing for difficulties in the next few days. So far, the five refineries along the East Coast are dealing with frozen pipes and other challenges, but have not experienced any significant outages, according to sources at the plants.

“We’ve had a lot of freeze up but haven’t lost any units. This weekend will be bad,” said a source at Monroe Energy’s 185,000 barrel-per-day refinery outside Philadelphia.

Monroe Energy did not immediately respond to a request for comment.

Although most refineries, particularly those in northern climates, are designed to operate throughout the winter, increasingly extreme weather conditions in recent years have tested their capabilities. In 2015, more than a third of the U.S. East Coast’s capacity was abruptly shut down due to glitches.

Philadelphia Energy Solutions delayed a planned shutdown of 50,000 bpd hydrotreater and a benzene unit at the Girard Point section of the Philadelphia refinery complex due to severe weather conditions, a source told Reuters Wednesday.

U.S. natural gas demand was expected to remain near record highs this week due to the frigid weather. Natural gas is the major fuel for residential and commercial heating in the U.S. Northeast and is also widely used by power plants.

Total gas consumption in the lower 48 U.S. states peaked at 141.9 billion cubic feet per day on Monday, New Year’s Day, and was expected to remain near that level all week, according to Thomson Reuters analysts.

One bcfd of gas is enough to fuel about five million U.S. homes.

Natural gas prices in New England NG-CG-BS-SNL last week jumped to $53.50 per million British thermal units, highest since January 2014. The average price for gas in New England in 2017 was $3.80/mmBtu.

Oil trades near strongest levels since mid-2015 on Iranian unrest

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Oil prices posted their strongest start to a year since 2014 on Tuesday, with crude rising to mid-2015 highs amid large anti-government rallies in Iran and ongoing supply cuts led by OPEC and Russia, reports Reuters.

U.S. West Texas Intermediate (WTI) crude futures CLc1 traded broadly flat at around $60.40 a barrel by 1425 GMT after hitting $60.74 earlier in the day, their highest since June 2015.

Brent crude futures LCOc1, the international benchmark, were also flat at around $66.80 a barrel after hitting a May 2015 high of $67.29 earlier in the day.

It was the first time since January 2014 that the two crude oil benchmarks opened the year above $60 per barrel.

MSHS Group

“Growing unrest in Iran set the table for a bullish start to 2018,” the U.S.-based Schork Report said in a note to clients on Tuesday.

Iran’s Supreme Leader on Tuesday accused the country’s enemies of stirring unrest as the death toll from anti-government demonstrations that began last week rose to 21.

Iran is OPEC’s third largest crude producer. Iranian oil industry and shipping sources said protests have had no impact on oil production or exports so far.

“Geopolitical risks are clearly back on the crude oil agenda after having been absent almost entirely since the oil market ran into a surplus in the second half of 2014,” Bjarne Schieldrop, chief commodities analyst at SEB, said, also citing Kurdistan and Libya.

Even without the unrest in Iran, which is a major oil exporter, market sentiment was bullish.

“Falling inventories globally and strong economic growth offset the restart of the Forties pipeline and the resumption of production following a pipeline outage in Libya,” said Jeffrey Halley, senior market analyst at futures brokerage Oanda in Singapore.

The 450,000 barrel per day (bpd) capacity Forties pipeline system in the North Sea returned to full operations on Dec. 30 after an unplanned shutdown.

Oil markets have been supported by a year of production cuts led by the Middle East-dominated Organization of the Petroleum Exporting Countries and Russia. The cuts started in January 2017 and are scheduled to cover all of 2018.

U.S. commercial crude oil inventories have fallen by almost 20 percent from their historic highs last March, to 431.9 million barrels.

Strong demand growth, especially from China, has also been supporting crude.

However, rising U.S. production, which is on the verge of breaking through 10 million bpd, is somewhat hampering the outlook into 2018.

“We think U.S. tight oil production growth warrants close monitoring as it could spoil OPEC’s market-balancing efforts, pushing the market into surplus in 2018,” Barclays bank said.

U.S. oil production C-OUT-T-EIA, driven largely by onshore tight shale oil fields, has risen by almost 16 percent since mid-2016, to 9.75 million bpd at the end of last year.

Integrated Pump Technology plans expanding southern Africa footprint

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Participation at Electra Mining Africa 2022 will serve to underpin Integrated Pump Technology’s drive to increase its footprint in Africa. According to general manager, Jordan Marsh in the less than 10 years since the company secured the Grindex pump distributorship for southern Africa it has already significantly increased the product’s installed footprint in South Africa and made good inroads in southern Africa.

Marsh says this can be attributed to a number of reasons, chief among which is the strategically situated distributor network which Integrated Pump Technology maintains in South Africa, and it is this successful operating model that will be further extended beyond its existing African distributor base in the coming months.

“Distributors are a critical link for us, more often than not forming a solid relationship and logistical chain between ourselves and the end-user. These partners are carefully selected, and we maintain extremely strong relationships with them to ensure customers are assured of technical competence from before the purchasing decision is made, with quality after-market support provided for the full lifecycle of a product,” Marsh continues.

Distributor footprint

Strengthening its distributor footprint in Africa will give ready access to both product and support to existing and potentially new customers in the regions served by Integrated Pump Technology which include all countries bordered by South Africa as well as Zambia and the DRC.

“There is a large installed base of Grindex pumps in Africa with the brand well-recognised and we have been looking at individual regions and country demands as well as available partners to ensure that we have a distributor in place with the requisite depth of knowledge of that particular country’s market requirements, can speak the local language and also has the necessary technical background.”

Integrated Pump Technology recently appointed new distributors in Zambia and in the DRC, which the company considers to be vital markets for the dewatering solutions that Grindex pumps offer. With the high rainfall season due to begin in September, the company anticipates continued growth in this region.

“When extending our distributor footprint, it is essential that end-users be able to access the level of technical support that our customer in South Africa can,” he says. Unpacking what Integrated Pump Technology means by technical support, Marsh explains that competent product engineers and service personnel from the company are assigned to support individual distributors. These individuals, who are a dedicated resource to a distributor, have the ability to assess any given dewatering application and propose the best fit solution for the end-user. In addition, we bolster the technical competence of distributor personnel by proving ongoing upskilling and product training.

“This is important as we do not see ourselves as order takers; our focus is on maintaining existing relationships with end-users in these regions as well as establishing new ones, and this is achieved effectively through the appointment of credible reputable distributors who have networks in each country,” he says.

“Our ability to rapidly service the market with from our stockholding of Grindex products received a significant boost recently with access to additional capital, and this has allowed us to increase the Grindex pump stockholding at our head office in Boksburg. This also gives assurance to the market that there is ready access off-the-shelf of popular models, and we have also streamlined our logistics allowing for rapid deployment of pumps both to distributors and end-users,” Marsh says. “Many of our distributors also carry stock commensurate with the product footprint in their areas of operation.”

Commenting on the rational behind the injection of capital, Marsh says that in recent months there has been a demand for certain Grindex pumps which impacted on lead times and the company made the decision to invest in more stock to meet the growing demand. It goes without saying that the parts stockholding has also been increased to ensure the same level of access for distributors and customers.

Integrated Pump Technology also recently expanded its workshop facility to fabricate engineered solutions for pump installations including protective cages, control panels, base plates and the like.

Marsh says that visitors to the company’s Electra Mining Africa stand will be able to see the Grindex Mega 90 dewatering pump, commonly referred to as the workhorse of the industry, as well as the Grindex Bravo 900 slurry pump which comes standard with a cooling jacket and agitator. Technical personnel will also be available on the stand to provide more information about the company’s engineered solutions capability. The Integrated Pump Technology stand is on the outside island.

ExxonMobil and ITQ discover material that could reduce the amount of energy and emissions associated with ethylene production

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  • Collaboration leads to discovery of a new material able to separate ethylene from ethane
  • Targeting up to a 25 percent reduction in both process energy needs and carbon dioxide emissions
  • Research published in nation’s leading peer-reviewed journal Science

Scientists from ExxonMobil and the Instituto de Tecnologia Quimica in Valencia, Spain have discovered a potentially revolutionary new material that could significantly reduce the amount of energy and emissions associated with the production of ethylene. Depending on the application, use of the new material, in conjunction with other novel separation processes, could result in up to a 25 percent reduction in both the energy needed for ethylene separation, as well as the associated carbon dioxide emissions. Results of the research have been published in the peer-reviewed journal Science .

Tyndale-Carhartt

ExxonMobil and ITQ researchers found that the new material, composed of a uniquely structured silica zeolite, can be used in gas separation processes, such as the recovery of ethylene from ethane, with an unprecedented degree of selectivity at ambient temperature. The new material could provide insights into the design of additional materials to be used as adsorbents or membranes in a variety of different gas separation applications associated with chemical manufacturing. Zeolites are porous materials frequently used as adsorbents and catalysts in chemical processes.

“Cryogenic distillation, the current commercial-scale process used for ethylene separation, is an energy-intensive process,” said Vijay Swarup, vice president of research and development at ExxonMobil Research and Engineering Company. “If advanced to commercial scale, use of this new material could significantly reduce the amount of energy and emissions associated with ethylene production. This is another great example of collaboration between industry and a university that is focused on driving solutions for improving energy efficiency and reducing carbon emissions from industrial processes.”

Ethylene is a critical component in producing chemicals and plastics. Finding alternative, low-energy technologies to separate ethylene from ethane has been a longstanding challenge due to their similar properties. While chemical manufacturers have evaluated a number of alternatives to cryogenic distillation, including new adsorbents and separation processes, many of these technologies are hindered by low selectivity and an inability to regenerate when exposed to contaminants.

The patented new material, ITQ-55, is able to selectively adsorb ethylene over ethane as a result of its unique flexible pore structure. Built from heart-shaped cages interconnected by flexible elongated pore openings, the material allows the diffusion of the flatter ethylene molecules as opposed to the more cylindrical-shaped ethane molecules. The new material acts as a flexible molecular sieve.

“ITQ-55 is a very interesting material whose unique combination of pore dimension, topology, flexibility and chemical composition results in a highly stable and inert material that is able to adsorb ethylene and filter out ethane,” said Professor Avelino Corma of the Instituto de Tecnologia Quimica and co-author of the research. “We are excited about this discovery and look forward to continuing our fruitful collaboration with ExxonMobil.”

Additional research must be conducted before the material can be considered for larger-scale demonstration and commercialization. Fundamental research will continue focusing on incorporating the material into a membrane and developing additional novel materials for gas separation.

“Our ultimate goal of actually replacing cryogenic distillation is a long-term challenge that will require many more years of research and testing, in and out of the lab,” said Gary Casty, section head for catalysis at ExxonMobil Research and Engineering Company. “Our next steps will focus on better understanding the full potential of this new zeolite material.”

Chemical plants account for about eight percent of global energy demand and about 15 percent of the projected growth in demand to 2040. As global populations and living standards continue to rise, demand for auto parts, housing materials, electronics and other products made from plastics and other petrochemicals will continue to grow. Improving industrial efficiency is part of ExxonMobil’s mission to meet the world’s growing need for energy while minimizing environmental impacts.

ExxonMobil works with about 80 universities around the world to explore next-generation energy technologies. In 2016, ExxonMobil and the Georgia Institute of Technology announced the development of a potential new material focusing on liquids separation that could also reduce the amount of energy and emissions associated with manufacturing plastics. The results of this joint research were published by Science, as well.

U.S. crude stockpiles fall as gasoline inventories build

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U.S. crude oil stockpiles fell more than expected last week as refineries hiked output, but gasoline and distillate inventories posted surprisingly large builds, reports Reuters.

Crude inventories fell 5.6 million barrels in the week to Dec. 1, compared with analysts’ expectations for an decrease of 3.4 million barrels. At 448.1 million barrels, crude stocks, not including the strategic petroleum reserve, were at their lowest since October 2015.

Oil prices initially rose on the data before pulling back, as traders also reacted to rising U.S. crude production and strong builds in gasoline and distillate stocks.

“Demand for gasoline is curiously weak. And these weeks towards the end of the shopping period normally rival the summertime. So the report overall was bearish,” said John Kilduff, partner at Again Capital in New York.

Tyndale-Carhartt

Gasoline stocks rose 6.8 million barrels, much more than with analysts’ expectations in a Reuters poll for a 1.7 million-barrel gain.

Crude production continued to inch up to hit another weekly record, rising 25,000 barrels per day (bpd) to 9.71 million bpd, though that figure is still shy of monthly figures that show the United States produced more than 10 million bpd in the early 1970s.

U.S. crude futures were down 1.5 percent, or 88 cents, at $56.74 a barrel as of 10:46 a.m. EST (1546 GMT), while Brent dropped 80 cents, or 1.3 percent, to $62.06 a barrel.

Crude stocks at the Cushing, Oklahoma, delivery hub for U.S. crude futures fell 2.8 million barrels, the EIA said. Those figures have been affected by the shutdown of the Keystone pipeline after a 5,000-barrel leak in South Dakota in mid-November. That line reopened on Nov. 28, so this report captures a period where the line was still largely closed.

Distillate stockpiles, which include diesel and heating oil, rose 1.7 million barrels, versus expectations for a 1 million-barrel increase, the EIA data showed.

Refinery crude runs rose 192,000 bpd, EIA data showed. Refinery utilization rates rose by 1.2 percentage points to 93.8 of total capacity.

U.S. crude imports fell last week by 73,000 bpd.

EQT announces 2018 operational forecast: $2.2b in well development

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EQT Corporation announced the Company’s 2018 capital expenditure (CAPEX) forecast of $2.4 billion, which includes $2.2 billion for well development and $150 million for acreage fill-ins and bolt-on leasing. Based on current pricing and synergy capture, the 2018 drilling program is expected to be fully funded through adjusted operating cash flow attributable to EQT.

“We have already begun to realize synergies associated with completion of the Rice Energy acquisition, which include an estimated $100 million reduction in our projected corporate G&A expenses,” stated Steve Schlotterbeck, EQT’s president and chief executive officer. “Initial development plans for our consolidated acreage target a 50% increase in average lateral lengths, which is exceeded with 12,600 foot laterals projected in Pennsylvania, resulting in a 40% reduction in per unit LOE and production SG&A expenses. These cost structure and capital efficiency improvements support a more compelling investment proposition, as we shift from maximizing volume growth to focusing on capital returns and returning cash to shareholders.”

Tyndale-Carhartt

EQT forecasts 2018 production sales volume of 1,520 – 1,560 Bcfe. The 2018 drilling program anticipates a 15% increase in production sales volume in 2019. It is anticipated that the 2019 development plan will be funded entirely by the cash flow provided by EQT Production.

EQT’s 2018 CAPEX forecast excludes CAPEX for its retained midstream assets, as well as for EQT Midstream Partners, LP and Rice Midstream Partners LP, master limited partnerships controlled by EQT Corporation and consolidated in EQT’s financial statements. EQM and RMP announced their 2018 CAPEX forecasts today in a separate news release, which can be found at www.eqtmidstreampartners.com and www.ricemidstream.com, respectively.

MARCELLUS DEVELOPMENT

In 2018, the Company plans to drill 139 Marcellus wells with an average lateral length of 11,800 feet – all of which will be on multi-well pads to maximize operational efficiency and well economics. The program will focus on the Company’s core Marcellus acreage, which is targeting 111 wells in Pennsylvania and 28 wells in West Virginia. During the year, the Company plans to turn-in-line (TIL) 160 –170 Marcellus wells.

OHIO UTICA DEVELOPMENT

The Company plans to drill 38 gross (25 net) Ohio Utica wells with an average lateral length of 11,300 feet. The Company plans to TIL 40 – 50 gross wells during the year.

UPPER DEVONIAN DEVELOPMENT

The Company plans to drill 19 Upper Devonian wells with an average lateral length of 15,600 feet. These wells will be limited to co-development on Marcellus pads in Pennsylvania. The Company plans to TIL 20 – 25 wells during the year.

RICE DEBT REPLACEMENT SAVINGS

As a result of the replacement of $1.3 billion of Rice senior notes with lower coupon investment grade debt, EQT expects to realize annual interest savings of approximately $45 million.

HAYWOOD H18 WELL

Earlier this week, the company turned in line the longest lateral completed to date by any operator in the Marcellus. The Haywood H18 well in Washington County, PA has a completed lateral length of 17,400 feet and will develop 42 Bcfe of reserves. Laterals of this length are projected to have development costs of $0.36 / Mcfe and will generate an IRR greater than 70% at $3.00 NYMEX. The company plans to drill 27 Marcellus wells at 17,000 feet or longer in 2018.

2018 GUIDANCE

Based on current NYMEX natural gas prices, adjusted operating cash flow attributable to EQT is projected to be $2,350 – $2,450 million for 2018, which includes $325 – $375 million from EQT’s interests in EQT GP Holdings, LP (NYSE:EQGP) and RMP. See the Non-GAAP Disclosures section for important information regarding the non-GAAP financial measures included in this news release, including reasons why EQT is unable to provide a projection of its 2018 net cash provided by operating activities, the most comparable financial measure to adjusted operating cash flow attributable to EQT and to EQT Production, calculated in accordance with GAAP.

All NNRTIs are not equal

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Nonnucleoside reverse transcriptase inhibitors (NNRTIs) are a class of antiretroviral compounds that bind in an allosteric binding pocket in HIV-1 RT. 

There are two primary factors that contribute to the emergence of resistance to NNRTIs

Rilpivirine (RPV) IS a human immunodeficiency virus type 1 (HIV-1)-specific nonnucleoside reverse transcriptase inhibitor (NNRTI) indicated for use in combination with other antiretroviral agents in adult patients not previously treated with antiretroviral therapy. RPV is primarily metabolised by the cytochrome P-450 (CYP)3A isoenzyme system. Therefore, providers should be cautious when administering drugs that are inhibitors or inducers of this pathway. Coadministration with CYP 3A inhibitors may lead to increased concentrations of RPV, thereby increasing the risk of adverse effects. Coadministration with inducers of CYP3A isoenzymes or drugs that increase gastric pH may lead to decreased concentrations of RPV, thus promoting virological failure or resistance to RPV. 

There are two primary factors that contribute to the emergence of resistance to NNRTIs: (1) HIV-1 RT can tolerate a wide range of sequences in and around the NNRTI binding pocket and (2) there is extensive HIV-1 genetic variation. Although most HIV-infected individuals are initially infected with a single virion, HIV-1 variants arise rapidly due to high viral loads in HIV-1 infected patients, which leads to the infection of large numbers of cells, the rapid turnover of these infected cells, and to errors made during HIV-1 replication. Ultimately, error-prone replication creates the mutations that enable HIV-1 to develop resistance against antiretroviral drugs. Several drug-resistant mutants were selected in HIV-infected individuals by the first generation NNRTIs (NVP, EFV, and DLV).  

The second-generation NNRTIs, ETR and RPV, were designed to be less bulky and more flexible, and are better able to adapt to the changes in the NNRTI binding pocket caused by resistance mutations. This allows these newer NNRTIs to effectively inhibit both WT HIV-1 and several drug resistant variants. Using a single-round infection assay, Smith et al (2016) identified several RPV analogues that potently inhibited a broad panel of NNRTI-resistant mutants. Additionally, they determined that several resistant mutants selected by either RPV or doravirine (DOR) caused only a small increase in susceptibility to the most promising RPV analogues. 

CONCLUSIONS 

The antiviral data suggested that there are RPV analogues that could be candidates for further development as NNRTIs, and one of the most promising compounds was modelled in the NNRTI binding pocket. This model can be used to explain why this compound is broadly effective against the panel of NNRTI resistance mutants. 

RPV’S PLACE IN THERAPY 

James et al (2012) reviewed the pharmacology, pharmacokinetics, drug interactions, clinical efficacy, adverse effects, dosage and administration, and place in therapy of RPV. 

Two phase III, randomised, double-blind, double-dummy, active-controlled trials compared RPV with EFV in HIV-infected adults not previously treated with an antiretroviral. The investigators concluded that RPV, when combined with two nucleoside or nucleotide reverse transcriptase inhibitors, was noninferior to EFV for reaching the endpoint of confirmed virological response (HIV-1 RNA level of <50 copies/mL) in adults with HIV infection not previously treated with antiretroviral therapy. The most commonly reported adverse effects included depression, insomnia, headache, and rash. RPV is administered as a single 25mg tablet given once daily in combination with other ARV drugs in order to optimise efficacy and reduce resistance. 

Conclusion: RPV is a viable NNRTI for HIV-infected patients who have not previously received antiretroviral therapy.  

The importance of heart health in cancer care

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The 2022 African Cardio Oncology Conference hosted by the Cardio Oncology Society of Southern Africa (COSOSA) recently emphasised early identification of cardiotoxicity risk and multidisciplinary collaboration at its recent meeting, attended by leading local and international experts.

International knowledge was shared at the COSOSA conference

“It is no use successfully treating cancer, only to allow the cancer patient to succumb to a cardiac event,” says convenor of the meeting, cardiologist and cardio-oncologist Dr YT (Trishun) Singh of the cardio oncology centre at Netcare uMhlanga Hospital, the first such unit to be established in Southern Africa. International attendees included the president of the British Cardio Oncology Society, Professor Alexander Lyon of the Royal Brompton Hospital in London, United Kingdom; Dr Susannah Stanway of the Royal Marsden Hospital in London; and Professor Sebastian Szmit, president of Cardio Oncology, Poland. 

“The inaugural COSOSA meeting was held just before South Africa entered the first Covid-19 hard lockdown on 7 March 2020. We are very pleased that this second meeting could be hosted in a hybrid format, allowing our colleagues from beyond our borders and around the world to participate through in-person or virtual attendance,” says Dr Singh. “Internationally, cardio oncology is well established as a field of medicine with specialised units in North America, Europe, Asia and Australia,” points out Dr Singh, who is the only International Cardio Oncology Society (ICOS) certified cardio oncologist in Southern Africa.   

“In Southern Africa we have a great need to develop more capacity by establishing more cardio oncology centres and developing local expertise. Oncologists, haematologists and cardiologists would benefit from skills that would enable them to implement cardio oncology principles in the daily practices of cancer care.” 

Topics covered during the 2022 conference, held at the Premier Hotel uMhlanga in Durban, included:  

  • Cardiotoxicity of cancer therapy and early recognition 
  • Baseline cardio oncology assessment of the patient before commencing chemotherapy or radiation
  • Thromboembolism and anticoagulation in cancer patients 
  • The need for a multidisciplinary approach in cancer treatment with particularly close cooperation between the cardio oncologist and oncologist
  • How to establish a cardio oncology centre in South Africa or elsewhere on the African continent 
  • Imaging tools in cardio oncology.

“With earlier detection and more advanced treatments, oncology medicine is increasingly successful in treating paediatric and adult cancer patients with modern chemotherapy, radiotherapy or in combination,” Dr Singh says. 

“Nearly all classes of chemotherapy and radiation to the chest may have side effects that put patients at greater risk of heart problems, known as cardiotoxicity. Cardiotoxicity does not just involve the heart muscle, but may also include heart rhythm disturbances, the vasculature (arteries and veins), heart valves, pericardium and conduction system. “Cardiotoxicity in people being treated for cancer is aggravated if underlying cardiac disease already exists, or if the patient has comorbidities such as diabetes, hypertension or dyslipidaemia,” he explains. The COSOSA meeting emphasised that all patients due to have potentially cardiotoxic cancer therapy must have a baseline cardio oncology assessment by an appropriately skilled cardiologist. “Following the guidelines and protocols by recognised cardio oncology societies such as ICOS, ongoing cardio oncology assessment during cancer therapy and post therapy surveillance is considered mandatory,” Dr Singh says. 

“The damage to the heart muscle, heart valves, coronary arteries and pericardium due to radiation to the chest, can manifest a few years after completion of chest radiation and these patients need careful surveillance as guided by the protocols. 

“We also observed that childhood cancer survivors need very careful post therapy surveillance, as they may present many years later with premature heart failure and ischaemic heart disease,” Dr Singh says.  

COSOSA also resolved that a basic foundation in cardio oncology should be introduced in cardiology, oncology and haematology fellowship training programmes, and cardiologists must have at least a level two cardio oncology training and certification to provide cardio oncology opinions for cancer patients. 

“It is imperative that cardio oncologists, oncologists and haematologists work together for better outcomes for people being treated for cancer. The earlier high risk cancer patients are identified for cardiotoxicity, the sooner therapy to mitigate against cardiotoxicity can be started.  

“Now that Covid-19 is settling, COSOSA can pursue our teaching programme, sharing awareness and upskilling all those who are involved in cancer care about cardio oncology for better long-term outcomes for cancer patients,” Dr Singh concluded. 

Collaborating with the community to lower infant and maternal mortality rates in Chad

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Formal health facilities are often inaccessible. For some people, the closest health centre is 30 kilometres away and entirely unreachable in the rainy season. For others, the costs of healthcare are too high. For the women that do manage to get to a healthcare centre, they often find it to be dysfunctional, with some facilities having no skilled staff. In Chad, the odds are against you. Some pregnant women do not have access to a delivery kit they wash with after the birth.

According to Souat Ahmat Ramadan, a Chadian midwife: “A traditional birth attendant usually doesn’t have the training or the tools. She delivers the baby on the ground in the woman’s house. With a razor blade, she cuts the umbilical cord without disinfectant. She closes the cord with woollen strings or anything she can find.” [Image: Noor Cornelissen].

Introducing Traditional Birth Attendants

After listening to the struggles women in the communities of Sila face, our Doctors Without Borders (MSF) teams collaborated with them to pilot a traditional birth attendants (TBAs) project to try address some of the most urgent needs. TBAs are women, usually between the ages of 25 and 60, who provide help with childbirth, breastfeeding and other related matters.

The World Health Organization (WHO) estimates that community health workers in maternal health roles fulfil 17 trillion dollars’ worth of healthcare services a year. They are mostly women, almost always unpaid.

According to UNICEF, in Chad, only two out of five births take place in the presence of a skilled birth attendant such as a midwife or doctor. In the Koukou district in Sila province, only three out of 11 health centres have a skilled birth attendant. And as health centres are inaccessible to many, it is clear that TBAs have an invaluable role to play.

Each village elected a TBA to participate in our project. Most TBAs have had no formal education in midwifery; they are simply courageous women who have delivered children themselves after their mothers or grandmothers showed them how.

Souat Ahmat Ramadan, a Chadian midwife, explains, “A traditional birth attendant usually doesn’t have the training or the tools. She delivers the baby on the ground in the woman’s house. With a razor blade, she cuts the umbilical cord without disinfectant. She closes the cord with woollen strings or anything she can find.”

For the 31 elected TBAs, MSF designed a training programme to sharpen their skills in areas like recognising the signs of danger before, during and after a delivery.

Results from the project

After a few months, the first signs of impact are clear. Antenatal care consultations have increased substantially along with referrals to health centres for complicated deliveries. TBAs also report that their skills and confidence are growing.

This is a worthwhile project. After decades of working in this field, I have not yet worked with such an approach,” says Augustine Nsiloulou, an MSF midwife activity manager in Chad. “We face big challenges. None of the TBAs can read or write. We are limited in what they and we can do. But this approach is sustainable.”

We listened to the communities, and it led us to a new path,” says Noor Cornelissen, MSF project coordinator. “We are aware that our approach requires careful evaluation and needs to be accompanied by an advocacy strategy targeting structural public health deficits. In the future, MSF would like to train the TBAs on community pre-natal care, sexual violence, family planning and other topics.”