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The safety and efficacy of tafenoquine administered as a 200 mg dose once per day on days 1, 2, 3, and 10 was evaluated over a 28-day period in mild-moderate COVID-19 patients. The primary endpoint was Day 14 clinical recovery from COVID-19 symptoms, defined as cough mild or absent, respiratory rate < 24 bpm, and no shortness of breath or fever. Following a successful futility analysis after n = 86 patients out of a target n = 275 were randomized, the study was terminated and unblinded early to facilitate planning for confirmatory studies. The proportion of patients not recovered on Day 14 was numerically decreased by 27% in the ITT population [8/45 v 10/42 not recovered in the tafenoquine and placebo arms, P = 0.60] and 47% in the PP population [5/42 v 9/41, P = 0.25]. Amongst individuals who recorded responses in an electronic diary at Day 28, all tafenoquine patients were recovered, whereas up to 12% of placebo patients exhibited lingering dyspnea. Time to clinical recovery from COVID-19 symptoms was accelerated in the tafenoquine arm by about 2-2.5 days. There were two COVID-19 related hospitalizations in the placebo arm and one in the tafenoquine arm. Mild, drug related adverse events occurred in 8.4% of individuals in the tafenoquine arm [v 2.4% in the placebo]. Although this trial was underpowered for the primary endpoint due to its early termination, the data are suggestive of a therapeutic benefit associated with tafenoquine administration in outpatients with mild to moderate COVID-19 disease, and larger studies are planned.

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AIM: To examine stands of bracken fern (Pteridium esculentum) from throughout New Zealand for the presence and concentration of ptaquiloside (Pta), and to compare the presence and/or concentrations of Pta in areas where bovine enzootic haematuria (BEH) and/or acute haemorrhagic syndrome (AHS) has been known to occur with those where BEH/AHS has not been recorded. METHODS: Stands of bracken fern were sampled from 275 sites throughout New Zealand. Sixty-two stands were from a regional survey predominantly from the Waikato and Coromandel regions, 27 were from a farm in the King Country where BEH/AHS had been investigated previously, and 186 were from a national survey of the North and South Islands. Sampling sites were from a mixture of grazed paddocks, roadsides, and forest and bush areas. Samples comprised whole young fronds, the tops of unfurling young fronds, or, for the Regional Survey, mature green fronds from the previous season. Pta was extracted from the samples, and measured using high-performance liquid chromatography. Information on the occurrence of BEH/AHS at specific locations was obtained from published information and records from animal health laboratories in New Zealand. RESULTS: The 275 samples contained widely varying concentrations of Pta. In the Farm Survey, concentrations ranged from 280-13,300 (mean 3,800) microg/g (on a dry-weight basis) in the 63% of samples that contained Pta. A high proportion of samples from the Regional and National Surveys covering large areas of the country contained no detectable levels of Pta. The majority (61%) of samples from these two surveys which contained Pta were from areas where BEH/AHS was reported to occur. Combining data from all surveys, in areas with reported BEH/AHS, 42% of samples collected contained Pta, compared with 6% where BEH/AHS was not known to occur. CONCLUSIONS: Concentrations of Pta in bracken in New Zealand vary greatly, and in a high proportion of stands Pta is not found. A higher incidence of Pta, and some very high concentrations, are found in areas where BEH/AHS was known to occur.

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We have reviewed 33 patients undergoing primary reconstruction of the anterior cruciate ligament with a four-strand hamstring graft to assess the analgesic effect of a '3 in 1' lumbar plexus block. Patients were randomised into two groups to determine whether or not they received a catheter infusion of bupivacaine for 24 h after operation. Pain scores and additional analgesic requirements were assessed at 4, 8, 12, 16, 20 and 24 h after surgery. No difference was found between the two groups in terms of pain scores (P=0.884) and the numbers requiring morphine were similar (5/16 and 7/17). There was a trend (2.0 vs. 3.4 tablets) towards a greater coproxamol requirement for the non-block group, although not quite statistically significant (P=0.06). We conclude that the additional risk and cost of '3 in 1' lumbar plexus blockade is not justifiable after this procedure.

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