Development of a Novel in-Vitro Hcov-Oc43 Screening Method

Aim: To develop a simple, inexpensive antiviral screening assay, applicable to SARS-CoV-2, using a plate-based bioassay approach to assess the in-vitro activity of compounds against HCoV-OC43. Background(s): Despite the successful deployment of vaccines against SARS-CoV-2 there remains a need for effective antivirals for acute infection treatment. A distinct problem facing the search for new anti-coronavirus compounds is the cost of antiviral screening, compounded by the biosecurity concerns of live SARSCoV- 2 culture. In concert with low pathogenic surrogate virus use, the resazurin reduction assay, which is often employed for compound cytotoxicity assessments can be employed for safe, rapid and inexpensive antiviral screening. Method(s): In-vitro cell based resazurin reduction assays were optimised using remdesivir as a control compound for the assessment of anti-HCoV-OC43 activity. Following optimisation, 246 purified natural compounds from the University of Western Australia's compound collection,were screened using the resazurin bioassay as a primary screen, under pre-treatment and cotreatment conditions. Five compounds, which demonstrated anti- HCoV-OC43 activity, were chosen for secondary screening with dose responses determined using qRT-PCR. Result(s): Primary screens of the 246 compounds using the resazurin bioassay identified five compounds with a relative viral inhibition >60% and a relative cell viability >70% (Table 1). The Z factor of the pre-treatment and co-treatment assays was >0.5 (average +/- SD;0.85 +/- 0.07, 0.91 +/- 0.03 respectively). Further dose response analysis of the top five compounds identified one compound with an IC50 value <10 muM. Conclusion(s): The method developed is an appropriate primary screening tool for the identification of novel compounds with anti-HCoV-OC43 activity.Copyright © 2023 Southern Society for Clinical Investigation.

The Role of Liquidity Creation in Managing the COVID-19 Banking Crisis in Selected Mena Countries

Banks are financial intermediaries who transform deposits into loans. Banks in the MENA (Middle East and North Africa) region use large deposits from oil companies and big businesses to finance trade, and fund government and private sector infrastructure projects. The role of banks in financing trade and development is significant as undeveloped capital markets are unable to perform this function. During the COVID-19 crisis, banks sustained liquidity shocks, as deposits were withdrawn to meet personal and business needs. Essentially, banks could not make loans, as the funds to make loans were depleted. The purpose of this study is to evaluate the effectiveness of liquidity creation as a main force, in conjunction with other performance predictors such as efficient asset management, asset quality, and bank size, on bank financial performance, either individually or in conjunction with liquidity creation during the COVID-19 financial crisis. We used bank financial data from a sample of 298 banks from 11 countries in the MENA region, including Egypt, Tunisia, Morocco, Qatar, Bahrain, Oman, Kuwait, Saudi Arabia, United Arab Emirates, Jordan, and Israel, from 2020 to2021. Liquidity creation, efficient asset management, asset quality, and bank size increased bank return on assets and return on equity. Bank size and asset quality acted jointly with liquidity creation to increase return on assets and increase return on equity. We conclude that as liquidity creation acts individually, and in conjunction with asset quality and bank size to increase bank profits, both its main effect and its moderated effect, can maintain bank profitability, during periods of extreme liquidity supply shocks, such as the COVID-19 crisis. © 2023 by the authors.

A comparative analysis of the impact of online, blended, and face-to-face learning on medical students' clinical competency in the affective, cognitive, and psychomotor domains.

BACKGROUND: The Coronavirus Disease-2019 (COVID-19) pandemic in South Africa compelled medical schools to switch to a purely online curriculum. The innovative changes transformed the standard clinical skills curriculum to increase learning transfer to bridge the theory-practice gap. The efficacy of this intervention remains unknown. This study aims to measure medical students' clinical competency in the affective, cognitive, and psychomotor domains by assessing clinical skills knowledge retention and transfer from the online platform compared to face-to-face and blended learning. METHODS: A non-random cross-sectional quasi-experimental study assessed third-year medical students' knowledge retention and learning transfer in three domains of clinical skills competence. Data were obtained using a score sheet during a directly observed formative and a trial online summative assessment. One hundred and one third-year medical students volunteered for the formative onsite assessment that tested the psychomotor domain. Two hundred and thirty-nine students were evaluated on the affective and cognitive domains in the summative online trial mini-objective structured clinical examination (tm-OSCE). The OSCE scores were analysed using descriptive statistics. The significance of the findings was evaluated by comparing OSCE scores with the pre-pandemic 2019 third-year medical students. RESULTS: Statistically significant differences were found between the two cohorts of medical students from both years (p < 0.05). The 2021 blended group's (n = 101) medians were 90%, 95%CI [86, 92], 82%, 95%CI [80, 85], and 87%, 95% CI [84, 90] for the psychomotor, affective, and cognitive skills, respectively. The e-learning group's affective and cognitive skills medians were 78%, 95%CI [73, 79] and 76%, 95%CI [71, 78], respectively. The 2019 face-to-face cohort (n = 249) achieved medians of 70%, 95% CI [69, 72] and 84%, 95%CI [82, 86] for the affective and psychomotor skills, respectively. CONCLUSION: Medical students demonstrated near and far transfer bridging the theory-practice gap in three clinical skills domains. The blended group performed significantly better than the e-learning and face-to-face groups. Medical schools and educators play a vital role in overcoming learning challenges and achieving higher transfer levels by adopting multiple student-centered teaching delivery approaches and arranging immediate application opportunities. This study offers medical educators suggestions that encourage the transfer of online learning to face-to-face practice, decentralising medical education with a revised blended learning strategy.

Risk communication in an informal settlement during COVID-19: case of Dinaweng, Bloemfontein South Africa

This article interrogates the nuances of risk communication in a poor neighbourhood of South Africa during the COVID-19 pandemic. We argue that risk communication had multifaceted implications for managing and governing the COVID-19 pandemic. This pandemic has coincided with the information age, where multiple communication channels affect the success of risk communication through miscommunication, false news, or distortion. Using a qualitative study premised on a phenomenological research design, data were collected from 60 purposively sampled residents in Bloemfontein to capture their perspectives regarding risk communication on COVID-19. This data was triangulated with secondary sources to enhance the validity of the findings. Among the secondary data sources are reviews of news media outlets reporting on the COVID-19 pandemic at the international and the local level. The study's findings reveal that the poor residing in informal settlements are marginalised in risk communication. This is mainly a result of the digital divide that has resulted in challenges for the poor communities in accessing specific news channels, while also making it difficult for them to validate some information.

Broken bridges over troubled waters: COVID-19 and the urban poor residing in Dinaweng informal settlement, Bloemfontein, South Africa

The increasing informal urbanism in Africa exposes its residents to multiple shocks, including urban public health pandemics. South Africa is not an exception due to the squalid living conditions, lack of essential services and amenities, and overcrowding characterizing informal settlements. We argue that such conditions compromise the liveability of the informal settlements and the wellbeing of the communities. The urban health inequality concept is used to analyse the risks and vulnerability of informal settlements to public health problems. This study uses the impact of the novel coronavirus (COVID-19) to investigate the exposure of the urban poor in South Africa’s informal settlements to public health crises. This study is ethnographic and uses the case of Dinaweng informal settlement, Bloemfontein. Data was collected from secondary data sources triangulated with 60 in-depth interviews with household heads to enhance the validity of the findings. The study found that the poor in Dinaweng are disproportionately affected by disease pandemics that are exacerbated by the challenges in their daily lives characterized by their informal livelihoods. We conclude that informal settlements are complex spaces that require carefully considered strategies and responses for addressing pandemics such as COVID-19;otherwise, the residents in these settlements remain marginalized. [ FROM AUTHOR] Copyright of South African Geographical Journal is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

TURNING CONSTRAINTS into OPPORTUNITIES: ONLINE DELIVERY of COMMUNICATION SKILLS SIMULATION SESSIONS to UNDERGRADUATE MEDICAL STUDENTS during the COVID-19 PANDEMIC

The COVID-19 pandemic impacted higher-learning institutions. Communication skills training in medical education needed innovative solutions to adjust to the situation. In times of change, evaluation channels should be developed, and any problems raised by learners and educators should be responded to rapidly. A remotely facilitated communication skills simulation-based training programme was piloted by the clinical skills laboratory tutors using Zoom as the online platform. The goal of the pilot session was to establish a communication skills training strategy remotely, to test an online session using the defined online platform and to assess its effectiveness. Though locally facilitated face-to-face simulation-based training as the conventional format is easier to use and experience, training on virtual simulation-based communication skills enabled through the online portal has been described by participants as both feasible and effective. The results show that an efficient educational environment can be provided by remote simulation of communication skills. An important requirement for learner engagement with remotely facilitated simulation-based training is the development of contextual understanding, multiple exposures and a respectful learner-teacher relationship. Any negative impact of remotely facilitated simulation-based training may be concealed by an overarching high perceived value of simulation-based trainings in general. This pilot online simulation programme shows the value of using this modality and lays the foundation for communication skills teaching during future disasters. There is the need to consider how online simulation can be sustained after the pandemic and not just returning to the conventional face-to-face teaching and learning. © Creative Commons With Attribution (CC-BY)

AKI secondary to atypical hemolytic uremic syndrome caused by COVID-19

Introduction: Atypical Hemolytic Uremic Syndrome(aHUS) can be triggered by viral infections. So far there has been little data on COVID 19 infection-causing aHUS. We present one such case of acute kidney injury(AKI) secondary to aHUS with COVID-19 infection and its outcome. Case Description: A 55-year-old woman presented with altered mental status and shortness of breath from 2-3 days. The patient tested positive for the COVID-19 virus. Labs showed creatinine of 4.8g/dl from a baseline of 0.8g/dl, with a hemoglobin of 8.9g/dl and a platelet count of 20,000/uL. Peripheral smear showed evidence of a large number of schistocytes and thrombocytopenia. Haptoglobin and reticulocyte counts were 28mg/dl, reticulocyte count 3.8% respectively. In view of her symptoms and laboratory findings, there was high suspicion for Thrombotic thrombocytopenic purpura (TTP). Her PLASMIC score was 6. Treatment with plasma exchange therapy (PEX) and steroids was initiated but there was no significant clinical improvement. An ADAMSTS13 level was sent prior to the initiation of PEX and resulted at 65%, ruling out the diagnosis of TTP. Due to lack of evidence of TTP eculizumab was started for suspected aHUS. She responded remarkably well (within days) with mentation returning to baseline, hemoglobin stabilizing, platelet slowly trending towards normal and peripheral smear, labs showing no signs of hemolysis, and an improvement in her RFP. At 5 month followup, the patient eventually progressed to end-stage renal disease had to be placed on regular dialysis. Discussion: AHUS is a rare variety of thrombotic microangiopathy(TMA) which results in a classic triad of Coombs negative hemolytic anemia, renal injury, and thrombocytopenia. aHUS has a mortality rate of 25%. 50% of patients eventually progress to ESRD or have irreversible brain damage. Multiple triggers have been identified including various non-enteric infections, viruses, drugs, malignancies, transplantation, pregnancy, and other underlying medical conditions. At the time of writing this case report, there is only one other case report of COVID-19 virus-induced aHUS resulting in AKI. In aHUS renal damage is thought to be caused by microthrombi formation in the kidney vasculature. Endothelial damage is further escalated by anaphylatoxins produced by complement activation. aHUS induced AKI is an alternate mechanism for COVID -19 to cause AKI requiring eculizumab for optimal treatment.

Disaster Mitigation and Response in Cities: Drawing Lessons from COVID-19 Pandemic

This paper discusses disaster management and city resilience in the midst of the upsurge of case of COVID-19, a global biological disaster. The emerging pandemic of the Novel Coronavirus, which is one of the worst biological disasters in 75 years, has questioned various local and national governments on the relevance of their disaster management policies. Through documentary review, case study analysis and secondary data the research paper discusses the failures of technologically advanced countries such as Italy in responding to the COVID-19 pandemic. There is need for policymakers to fully equip themselves through the development and maintenance of disaster management sectors in the government as well as to maintain disaster management funds. This is vital as disasters make cities prone to economic regression thereby increasing the vulnerability of communities to a web of interlocking and continuous disruptions.

The need of the hour: Adapting the delivery of clinical skills teaching remotely

As the World Health Organization (WHO) announced the prevailing COVID-19 pandemic, the South African government enforced a nationwide lockdown in March 2020. The resulting closure of medical schools necessitated the provision of clinical skills teaching on remote platforms. This presented numerous challenges especially for skills that require face-to-face interaction and hands-on instruction. The Nelson R Mandela School of Medicine, University of KwaZulu-Natal modified George's (2001) five stage process and devised a framework for online small group skills teaching with the help of videos. The adapted method retained as close as possible the significant concepts and frameworks of conventional face-to-face programmes allowing for continuation of teaching under the current constraints. © 2021 University of Pretoria. All rights reserved.

Intramuscular Hematomas and Compartment Syndrome - An Inevitable Consequence in the COVID-19 Saga

Introduction: Anticoagulation in COVID-19 induced hypercoagulable state remains to be balanced with bleeding complications. Spontaneous muscle hematomas (SMH) often occur in the rectus sheath or gluteal muscles. Risk factors include trauma, increased abdominal pressure, anticoagulation, and hypertension. We describe two cases of non-iatrogenic SMH in therapeutically anticoagulated COVID-19 patients. Case Report: 1. 64 year old Caucasian male with ARDS due to COVID-19 was treated with mechanical ventilation, proning, methylprednisolone, tocilizumab (TOZ), and azithromycin/hydroxychloroquine. Right popliteal-posterior tibial vein DVT led to full anticoagulation (FA) with enoxaparin. Later the hemoglobin dropped (12.2 to 6.1 g/dl). Imaging showed SMH in the left posterolateral chest wall and gluteus minimus requiring blood transfusions and cessation of FA. D-dimer was 1.2 μ g/ml. A week later, imaging showed increased hematoma size in the left chest wall and right gluteal area. After hemoglobin stabilized, he was started on DVT prophylaxis. He required tracheostomy/PEG tube and placement in a long term acute care (LTAC) facility where he had decannulation and PEG tube removal. Patient recovered fully and is home with normal function. 2. 27 year old Caucasian female with sepsis due to COVID-19 was treated with mechanical ventilation, dexamethasone, TOZ, convalescent plasma, colchicine, and remdesivir. D-dimer was 1.6 μ g/ml and FA was started with enoxaparin. After intubation, hemoglobin dropped (11-6.9 g/dl). Imaging showed SMH in left biceps and pectoralis. Decreased radial pulse and increased capillary refill time with enlarging forearm hematoma prompted arterial US and CT angiogram. No flow was seen in the distal left upper extremity. Fasciotomy of the left forearm and carpal tunnel was performed with adequate perfusion of radial and ulnar arteries. Debridement was required for the non-viable flexor carpi radialis, flexor digitorum superficialis and flexor digitorum profundus. Patient was extubated and did well thereafter. Discussion: Thrombosis contributes much to the morbidity and mortality in COVID-19 patients. In a recent Veterans Health Administration study, deep vein thrombosis, pulmonary embolism, and cerebral ischemia/infarction comprised 9.3% of these patients. Despite the study's limitations, HESACOVID has shown that therapeutic enoxaparin is associated with fewer days on the ventilator and large reductions in D-dimer levels. Monitoring for SMH should be routinely performed on these patients. Research on optimal anticoagulation is necessary to assess the risk/benefit in this population. The bleeding risks are however less likely to cause mortality or disability as compared to the coagulation problems.

Use of the 1-minute sit to stand test in Patients presenting with suspected covid-19 to Assess need for hospital admission

Introduction The clinical presentation of Covid-19 varies widely with only a small proportion of those infected requiring hospitalisation. The ability to risk stratify patients upon presentation to the Emergency Department (ED) facilitates early safe discharge, with or without enhanced monitoring, which benefits hospital capacity management and infection control. In other lung parenchymal conditions oxygen desaturation during exercise has been used as an indicator of more severe disease. The exercise modality has typically been a field walking test or a bicycle or treadmill test which are impractical for delivery in ED. We investigated whether an alternative test, the 1-minute sit to stand test (1SST), was deliverable within an ED at the height of the COVID-19 pandemic. Methods During April to June 2020 at two large hospitals we performed 1SST in 201 people presenting with suspected Covid-19 and measured test performance (reps) plus change in pulse and oxygen saturations. Subsequently we identified clinical outcomes for all individuals diagnosed with Covid-19. A positive test was defined as 4% desaturation. Results The test was deliverable with 193/201 (96%) able to complete (2 were too unsteady, 6 failed to complete the minimum 5 reps). 111 (55%) were female, mean age of 49 (SD 16) years and an average of 17 (SD 7) reps completed. Mean fall in saturations was-1.6% and rise in pulse was 22. 34 people were diagnosed with Covid-19 based on a) positive swab or b) negative swab but diagnosed with 'clinical Covid-19' by a senior clinician based on clinical and radiological features. 1 person was unable to complete the 1SST test. The outcomes for people with a positive or negative test are shown in the table 1. In the early part of the study we were only able to swab people admitted to hospital so data from 109 further people is not included in the primary analysis. Conclusion The 1SST is feasible for people presenting acutely with Covid-19. It effectively identifies exercise induced oxygen desaturation and therefore augments the decision making relating to hospital admission.

P4 Use of the 1-minute sit to stand test in patients presenting with suspected Covid-19 to assess need for hospital admission

P4 Table 1 Positive 1SST Negative 1SST p value Number of subjects 9 24 Sex – M/F 3/6 13/11 0.26 Age (SD) 50.2 (±14.9) 47.6 (±16.2) 0.68 Reps (SD) 15.6 (±6.75) 18.9 (±7.1) 0.29 Change in oxygen saturations (SD) -7.22 (±3.23) 0.12 (±1.44) <0.01 Change in heart rate (SD) 22.43 (±12.93) 21.69 (±20.18) 0.96 Number admitted to hospital 8/9 (89%) 6/24 (25%) <0.01 Length of stay (days) 6.22 (±9.6) range 0–31 1 (±1.89) range 0–7 0.01 Required oxygen 5 (56%) 1 (4%) 0.01 Required ventilation 1 (11%) 0 (0%) 0.09 ConclusionThe 1SST is feasible for people presenting acutely with Covid-19. It effectively identifies exercise induced oxygen desaturation and therefore augments the decision making relating to hospital admission.

American Neurogastroenterology and Motility Society Task Force Recommendations for Resumption of Motility Laboratory Operations During the COVID-19 Pandemic.

The American Neurogastroenterology and Motility Society Task Force recommends that gastrointestinal motility procedures should be performed in motility laboratories adhering to the strict recommendations and personal protective equipment (PPE) measures to protect patients, ancillary staff, and motility allied health professionals. When available and within constraints of institutional guidelines, it is preferable for patients scheduled for motility procedures to complete a coronavirus disease 2019 (COVID-19) test within 48 hours before their procedure, similar to the recommendations before endoscopy made by gastroenterology societies. COVID-19 test results must be documented before performing procedures. If procedures are to be performed without a COVID-19 test, full PPE use is recommended, along with all social distancing and infection control measures. Because patients with suspected motility disorders may require multiple procedures, sequential scheduling of procedures should be considered to minimize need for repeat COVID-19 testing. The strategies for and timing of procedure(s) should be adapted, taking into consideration local institutional standards, with the provision for screening without testing in low prevalence areas. If tested positive for COVID-19, subsequent negative testing may be required before scheduling a motility procedure (timing is variable). Specific recommendations for each motility procedure including triaging, indications, PPE use, and alternatives to motility procedures are detailed in the document. These recommendations may evolve as understanding of virus transmission and prevalence of COVID-19 infection in the community changes over the upcoming months.