Net worth of adults approaching retirement age: Personal health, presence of a chronically ill or disabled household member, and out of home caregiving

The US population is aging. As a result, an increasing number of workers, many in their prime earning years, will be called upon to provide care for older relatives and friends who live either within or outside of the worker's household (Caputo et al., 2016). Caregiving for others may occur over a number of years, as when parents are caring for a child with disabilities into their adult years, or for a shorter period of time, as when caring for a spouse or an older parent. As the COVID-19 pandemic has made clear, caregiving expectations may arise unexpectedly. Unpaid caregiving and paid employment both compete for a working adult's time. Over the life course, moving in and out of the labor market to meet caregiving needs of relatives or friends with chronic illness or disabilities may create economic turmoil in households that also may face increased need for costly health care-related goods and services (Parish et al., 2009;N.N.;Seltzer et al., 2001). A report from the National Alliance for Caregiving indicates that even before the pandemic, 70% of workers who provided care to elderly or disabled family members made adjustments to their work in order to handle caregiving activities, with impacts on take home pay and net worth for some individuals (NAC & AARP, 2015). The COVID-19 pandemic has further highlighted the need for structural changes to preserve the financial well-being of caregivers (van Dalen & Henkens, 2020). © 2022,Social Work and Society. All Rights Reserved.

Addressing Inequalities in the Music Industry before, during, and after COVID-19: The Campaigning Work of the UK's Independent Society of Musicians

This chapter explores the work of the UK's Independent Society of Musicians (ISM) in tackling inequalities within the classical music industry and the wider music sector. It offers a brief outline of research into existing inequalities, before focusing on the ISM's work to address equality and diversity through the Dignity at Work campaign. The campaign was launched in 2017 and has produced three reports that explore the prevalence of discrimination within the music sector: Dignity at Work, Dignity in Study (produced jointly with the Musicians' Union and Equity), and Dignity at Work 2: Discrimination in the music sector. The chapter then examines the effect of the pandemic upon musicians, many of whom were self-employed and whose livelihoods were negatively affected by the measures introduced by the government to curb the spread of COVID-19;and how the ISM's campaigning work evolved through the pandemic to include calls for improved support for musicians financially and to help them return to performing. © Oxford University Press 2023. All rights reserved.

A study of burnout and associated factors in Irish GPs and GP trainees during the COVID-19 pandemic

Background: Prior to the COVID-19 pandemic, burnout among Irish GPs was estimated at 6.6% using the Maslach Burnout Inventory. Associated factors were male gender, younger age and early career status. During the COVID-19 pandemic burnout frequency was reported as high as 76% in medical residents in Romania and doctors in Northern Italy. In the US burnout was seen in 46.3% of physician trainees exposed to the virus at work while in China, burnout was noted in 13% of frontline healthcare staff. Research question: This study aims to measure burnout and associated factors in Irish GPs and GP Registrars during the COVID-19 pandemic. Method(s): A cross-sectional study using an online questionnaire, comprising of the 16-item Oldenburg Burnout Inventory (OLBI) and a 24-item novel demographic and wellbeing questionnaire that was designed to assess demographic, personal, practice and health system related factors that may be associated with burnout. Data collection was conducted from January to April 2021. Data was analysed using SPSS v27. Result(s): A total of 153 of the 172 responses received were suitable for calculating burnout inventories. OLBI subtotal scores for disengagement and exhaustion were high in 9.8% and 12.7%, respectively. The total OLBI score was elevated in 12.1% respondents. High OLBI scores were most strongly associated (p<0.01) with less downtime, less sleep, less family time and a fear of colleagues being off work with COVID-19. Female gender was associated with higher total OLBI scores. Conclusion(s): High OLBI total scores were associated with several factors. Most notable were the effects of the pandemic on practitioner well-being outside of work. Fear of the effects of colleagues being off work with COVID-19 was also associated with higher burnout scores. Further evaluation is required to investigate the nature of the relationship between these factors and burnout.

Benefits and challenges of using virtual primary care during the COVID-19 pandemic: From key lessons to a framework for implementation

Background: With the onset of COVID-19, general practitioners (GPs) and patients worldwide swiftly transitioned from face-to-face to digital remote consultations. There is a need to evaluate how this global shift has impacted patient care, healthcare providers, patient and carer experience, and health systems. Research question: We explored GPs' perspectives on digital remote care's main benefits and challenges. Method(s): GPs across 20 countries completed an online questionnaire between June and September 2020. GPs' perceptions of main barriers and challenges were explored using free-text questions. Thematic analysis was used to analyse the data. Result(s): In our survey 1605 respondents participated. The benefits identified included reducing COVID-19 transmission risks, guaranteeing access and continuity of care, improved efficiency, faster access to care, improved convenience and communication with patients, greater work flexibility for providers, and hastening the digital transformation of primary care and the accompanying legal frameworks. Main challenges included patient's preference for face-to-face consultations, digital exclusion, lack of physical examinations, clinical uncertainty, delays in diagnosis and treatment, overuse and misuse of digital remote care, and unsuitability for certain types of consultations. Other challenges include the lack of formal guidance, higher workloads, remuneration issues, organisational culture, technical difficulties, implementation and financial issues and regulatory weaknesses. Conclusion(s): At the frontline of care delivery, GPs can provide important insights on what worked well, why, and how. Lessons learned during the emergency phase can inform the stable adoption of virtual care solutions and co-design processes and platforms that are technologically robust, secure, and supported by a long-term strategic plan.

Sepsis presentation and pathophysiology

As a disease process sepsis represents an interplay between pathogen and host immune response. This interaction results in characteristic physical exam findings that can differ based on pathology. Early recognition and proper understanding of the underlying disease pathology is imperative to effective treatment and prevention of long-term complications. This chapter reviews disease presentation, pathophysiology, and current standard of care treatment for patients with sepsis, including those with COVID-19 pneumonia. Utilizing the most up-to-date guideline recommendations, this overview covers both medical and surgical causes of sepsis along with their treatments, while providing a molecular and cellular understanding for the disease process. © 2023 Elsevier Inc. All rights reserved.

Rare Case of Homozygous Ifnar1 Deficiency in a Samoan Child with Disseminated Varicella after Vaccination

Introduction: Autosomal recessive interferon alpha/beta receptor 1 (IFNAR1) deficiency increases susceptibility to live-attenuated vaccines and wild-type viruses. Currently 16 cases, half with Polynesian ancestry have been reported since the discovery in 2019. Most cases present with severe MMR or yellow fever vaccine-related disease. Some cases report severe SARS-CoV-2, herpes simplex, and enterovirus. Varicella vaccine-related disease has been hypothesized but not previously reported. Case Description: A pediatric Samoan girl with congenital cardiac anomaly, otherwise healthy until receiving Varicella and MMR vaccines at 12 months. Two weeks later with presumed incomplete Kawasaki Disease with 10-day fever, red lips, and maculopapular rash, given IVIG and infliximab;also, positive SARS-CoV-2 PCR and IgG that admission. Developed diffuse vesicular rash 3 weeks after vaccination requiring re-admission for disseminated varicella. At 14 months, admitted again for acute respiratory failure with viral pericarditis, positive for rhinovirus/enterovirus on respiratory viral panel and varicella serum PCR. Samoan parents are first-degree cousins and her stillborn sister had significant homozygosity on genetic evaluation. Normal lymphocyte subsets, normal mitogen proliferation, absent antigen proliferation in vitro, and normal NK function. Intact humoral immunity. Primary immunodeficiency disease panel identified homozygous pathogenic variant in IFNAR1. Future live viral vaccines contraindicated. Managed with acyclovir with return to baseline. Discussion(s): This case demonstrates a novel finding of homozygous IFNAR1 deficiency predisposing to disseminated varicella after vaccination. TNF inhibition may have also contributed. IFNAR1 deficiency should be considered in patients with severe varicella or other severe viral illnesses, especially after live-attenuated viral vaccines in those of Polynesian ancestry. Copyright © 2022

Prevalence of Depression in an Urban, Predominantly Black ESKD Population During the COVID-19 Pandemic

Background: The COVID-19 pandemic has had far-reaching implications in terms of physical and mental health ramifications, and minority communities have been disproportionately impacted;particularly, prevalence of depression increased. Throughout the pandemic, ESKD patients have continued thrice-weekly in-center hemodialysis sessions or home therapies. We explored whether there was an increase in depression prevalence after the start of the pandemic in our urban predominantly Black ESKD population. Method(s): We used data from social worker-administered PHQ-2 questionnaire depression screenings (required by Centers for Medicare & Medicaid Services) in eligible patients treated at four Emory University affiliated in-center dialysis units and three home dialysis units from 2018-2019 (pre-pandemic) to 2020-2021 (pandemic). Excluded from this study were patients with no assessments or incomplete assessments. Data were analyzed using chi-square tests comparing the prevalence of depression in pre-pandemic versus pandemic period. Result(s): In 2021, 91.5% of our patients were Black. There were 2433 in-center patient depression scores and 586 home dialysis patient depression scores. Excluded from the study were 1045 patients in the in-center and 214 patients in the home population. Of the 2433 patient scores analyzed in the in-center group, 1289 were pre-pandemic and 1144 were in the pandemic period. 155 (12%) in-center patient scores in the prepandemic period were classified as depressed while 128 (11.2%) in-center patient scores during the pandemic were classified as depressed (two-sided p-value 0.5272). Of the 586 home dialysis patient scores, 325 were pre-pandemic and 261 in the pandemic period. 71 (21.8%) patient scores in the pre-pandemic period had a positive depression screening while 29 (11.1%) patient scores during the pandemic period had depression (two-sided p-value 0.0006). Conclusion(s): We did not observe an increase in depression prevalence during the COVID-19 pandemic in in-center dialysis patients, and surprisingly observed a statistically significant decrease in depression among our home dialysis patients. The decrease in depression in our home dialysis patients during the pandemic may reflect being at home is a protective mechanism, and this observation should be further investigated.

VOCLOSPORIN for LUPUS NEPHRITIS: RESULTS of the TWO-YEAR AURORA 2 CONTINUATION STUDY

Background: Voclosporin (VCS), a novel calcineurin inhibitor, was approved in the US in January 2021 for the treatment of adult patients with active lupus nephritis (LN) in combination with background immunosuppressive therapy. The Phase 3 AURORA 1 study showed that the addition of VCS to mycophenolate mofetil (MMF) and low-dose steroids in patients with LN signifcantly increased rates of complete renal response at 52 weeks. Objectives: Here we report the results of the completed continuation study, AURORA 2, which assessed the long-term safety and tolerability of VCS compared to placebo in patients with LN receiving treatment for an additional 24 months following completion of the AURORA 1 study Methods: Key inclusion criteria for the parent AURORA 1 study included a diagnosis of biopsy-proven active LN (Class III, I V, or V ± III/IV), proteinuria ≥1.5 mg/mg (≥2 mg/mg for Class V) and estimated glomerular fltration rate (eGFR) >45 mL/min/1.73 m2. Patients who completed AURORA 1 and who elected and were eligible to enter AURORA 2 continued on the same blinded therapy as at the end of AURORA 1 (either VCS or placebo twice daily in combination with MMF and low-dose steroids). Safety and tolerability were monitored, and eGFR, serum creatinine (SCr), and urine protein creatinine ratio (UPCR) were also assessed. Results: In total, 116 and 100 patients in the VCS and control arms enrolled in AURORA 2, with 92 (79.3%) and 73 (73.0%) patients in each respective arm receiving treatment to the end of AURORA 2. There were no unexpected safety signals in the VCS arm compared to control, with similar rates of serious adverse events reported in both arms (VCS [18.1%] vs. control [23.0%];Table 1). Eight patients in each arm experienced serious adverse events of infection;serious coronavirus infections were observed in 2 patients in the voclosporin arm and 5 patients in the control arm. There were 4 and 2 adverse events by preferred term of renal impairment reported in the VCS and control arms, respectively, none of which were considered serious, and no reports of acute kidney injury by preferred term in either arm. There were no deaths in the VCS arm during AURORA 2;four deaths were reported in the control arm (pulmonary embolism [n=1], coronavirus infection [n=3]). Mean eGFR and SCr levels remained stable through the end of AURORA 2. The difference between the VCS and control arms in LS mean change from baseline in eGFR was 2.7 mL/min/1.73 m2 at 4 weeks following study drug discontinuation (Figure 1). The mean reductions in UPCR observed in patients treated with VCS in AURORA 1 were maintained in AURORA 2 with no increase in UPCR noted at the follow-up visit 4 weeks after study drug discontinuation. Conclusion: Voclosporin was well-tolerated over 3 years of treatment with no unexpected safety signals detected. Further, eGFR remained stable throughout the study period, and the signifcant and meaningful reductions in proteinuria achieved in AURORA 1 were maintained. These data provide evidence of a longterm treatment beneft of VCS in patients with LN. Includes adverse events starting on or after the frst dose of study drug in AURORA 2 up to 30 days after the last dose and all events of death reported during study follow-up. Adverse events were aggregated by System Organ Class and Preferred Term and coded using Medical Dictionary for Regulatory Activities (MedDRA) Version 20.0. AE, adverse event.

QUALITY IMPROVEMENT PROJECT FOR CROSS SITE HEPATOPANCREATICOBILIARY/INTERVENTIONAL REFERRALS

Introduction Chelsea and Westminster Hospital (C&W) Gastroenterology department currently provides interventional endoscopy/HPB services across West Middlesex, Royal Brompton, Royal Marsden and C&W Hospital sites. Historically referrals were made through multiple modes of communications e.g. Cerner, Gastro Spr bleep, phone, WhatsApp or email to individual NHS addresses. We had identified challenges in this practice in regards to vetting, planning and prioritizing the urgent cases. With the current practice there was no robust system in place to identify patients needing repeat procedure or follow up intervention. Methods We formulated a single platform to receive all intervention/HBP referrals from all sites to facilitate vetting, prioritising and organising pre-procedure investigations in a timely way, such a platform would help to utilize GA list slots to its maximum potential. We had identified referrals for patients who waited longer to get a slot as initial referrals had been sent to rotational doctors who were no longer working in Chelsea Hospital. After discussion with lead consultants we requested IT department set up a new generic email I.D which can be accessed by the appropriate staff members and developed a uniform referral system in our trust. chelwest.interventionalendoscopy@ nhs.net was introduced in October 2021 along with a new referral form which required the referring team to provide all the essential information deemed necessary for the preparation and procedure planning. This included not only current presentation and medical background, blood results and imaging but also COVID status, infection risk, anticoagulation and performance and consent status. Results We received excellent informal and then formal feedback from endoscopy staff, gastroenterology and anaesthetic colleagues for the changes we implemented for referrals which made our lists run smoothly and efficiently. The endoscopy team has been able to promptly book patients for any empty slots, organize their bloods, Covid swabs or other investigations required for procedures including admissions. Anaesthetic team has been able to identify high risk cases and ask for required pre-procedure investigations thereby improving patient safety and minimising last minute cancellations. We have performed 7 more interventional procedures in November 2021 as compare to November 2020 after implementation of our changes. Conclusion The above mention QIP has significantly improved in our HPB service making it more cost effective efficient to plan and run interventional list smoothly. To conclude we should use single platform for intervention/HPB referrals for HPB centres to improve endoscopy service.

Low Inflation Bends the Phillips Curve around the World

This paper finds strong support for a Phillips curve that becomes nonlinear when inflation is "low"-which our baseline model defines as less than 3 percent. The nonlinear curve is steep when output is above potential (slack is negative) but flat when output is below potential (slack is positive) so that further increases in economic slack have little effect on inflation. This finding is consistent with evidence of downward nominal wage and price rigidity. When inflation is high, the Phillips curve is linear and relatively steep. These results are robust to placing the threshold between the high and low inflation regimes at 2, 3, or 4 percent inflation or for a threshold based on country-specific medians of inflation. In this nonlinear model, international factors play a large role in explaining headline inflation (albeit less so for core inflation), a role that has been increasing since the global financial crisis. These results provide evidence of channels which could boost inflation in the future, even if they were dormant before the Covid pandemic.

Covid Connect: Chat-Driven Anonymous Story-Sharing for Peer Support

The mental-health impact of the Covid-19 pandemic and the related restrictions and isolation have been immense. In this paper, we present a system designed to break down loneliness and isolation, and to allow people to share their stories, complaints, emotions, and gratitude anonymously with one another. Using a chatbot interface to collect visitor stories, and a custom visualization to reveal related past comments from others, Covid Connect links people together through shared pandemic experiences. The collected data also serves to reflect the experiences of the community of participants during the third through fifth waves of the pandemic in the local region. We describe the Covid Connect system, and analyze the collected data for themes and patterns arising from stories shared with the chatbot. Finally, we reflect on the experience through an autobiographical lens, as users of our own system, and posit ideas for the application of similar approaches in other mental health domains. © 2022 ACM.

ENHANCING THE MANAGEMENT OF LONG COVID IN GENERAL PRACTICE: A SCOPING REVIEW

Persistent symptomatic COVID-19 is a multi-system condition that affects approximately 10% of those with acute COVID-19 infection. Affected patients often have complex care needs requiring holistic and multidisciplinary care approaches, the kind routinely provided in general practice. However, there is a lack of evidence of appropriate general practice interventions for the condition. A scoping review was conducted using Arksey and O'Malley's 2005 five-stage framework[1], with later recommendations by Levac et al.[2] to examine the literature and identify knowledge gaps in general practice management of persistent COVID-19. Nineteen papers were selected for review. The studies spanned numerous geographical locations, encompassing several study designs, and a range of populations and sample sizes. The included studies used various definitions for persistent symptomatic COVID-19. The literature was analysed qualitatively, and six major themes were identified. These themes were (i) GP uncertainty, (ii) Listening and empathy, (iii) Assessment and monitoring of symptoms, (iv) Coordinating access to appropriate services, (v) Facilitating provision of continual and integratedmulti-disciplinary care and (vi) Need to facilitate psychological support. Overall, the findings show that general practitioners play a key role in the management of persistent COVID-19, but that more clinical guidance on appropriate interventions is necessary to enhance care. There is a need for scientifically accepted definitions for persistent COVID-19 to ensure that patients can be recognized, assessed and managed appropriately. Patient and public involvement should guide policy makers when developing future care models. Meanwhile, future research should evaluate the implementation and effectiveness of proposed management strategies and interventions.

Effect of COVID-19 on agricultural production and food security: A scientometric analysis

Coronavirus disease has created an unexpected negative situation globally, impacting the agricultural sector, economy, human health, and food security. This study examined research on COVID-19 in relation to agricultural production and food security. Research articles published in Web of Science and Scopus were sourced, considering critical situations and circumstance posed by COVID-19 pandemic with regards to the shortage of agricultural production activities and threat to food security systems. In total, 174 published papers in BibTeX format were downloaded for further study. To assess the relevant documents, authors used “effects of COVID-19 on agricultural production and food security (ECAP-FS) as a search keyword for research published between 2016 and April 2021 utilising bibliometric innovative methods. The findings indicated an annual growth rate of about 56.64%, indicating that research on ECAP-FS increased over time within the study period. Nevertheless, the research output on ECAP-FS varied with 2020 accounting for 38.5%, followed by 2021 with 37.9% as at April 2021. The proposed four stage processes for merging two databases for bibliometric analyses clearly showed that one can run collaboration network analyses, authors coupling among other analyses by following our procedure and finally using net2VOSviewer, which is embedded in Rstudio software package. The study concluded that interruptions in agricultural food supply as a result of the pandemic impacted supply and demand shocks with negative impacts on all the four pillars of food security.

Effect of COVID-19 Pandemic on Global Stock Market Values: A Differential Analysis

This paper presents a current analysis of the effect of coronavirus pandemic on select global stock indexes (SSE Composite Index [China], Euronext 100 [Europe], Dow Jones Industrial Average [United States of America]. Objective: the objective of the paper is to evaluate the extent and direction of the differential effect of COVID-19 pandemic on select world stock index. Method: data on stock value performance were gathered for fifty days before and fifty days within the Coronavirus epidemic;data were analysed using the paired t-test of difference in mean stock values at an alpha level of 0.05(5%). Findings: Results reveal that the COVID-19 pandemic has different effects on the stock markets. Dow Jones Industrial Average showed a significant reduction in mean stock value during the coronavirus period, Chinese Stock Exchange Composite Index experienced a significant increase in mean stock values during epidemic higher than before the epidemic. On the contrary, the S&P 500 and the Euronext 100 indexes show a non-significant difference in mean stock price. Implications: The paper provides direction to stock market participants, investors and speculators regarding a safer investment destination during this time of COVID-19 pandemic;the paper serves a good case study for class room teaching and also provides direction for further research. Value: this paper provides the first empirical research on the early effect of COVID-19 pandemic on three global important regional stock indexes, which finds that some stock markets such as the Shanghai Composite Index is resilient to COVID-19 pandemic.

Ambroxol Hydrochloride Inhibits the Interaction between Severe Acute Respiratory Syndrome Coronavirus 2 Spike Protein's Receptor Binding Domain and Recombinant Human ACE2.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), enters the host cells through two main pathways, both involving key interactions between viral envelope-anchored spike glycoprotein of the novel coronavirus and the host receptor, angiotensin-converting enzyme 2 (ACE2). To date, SARS-CoV-2 has infected up to 26 million people worldwide; yet, there is no clinically approved drug or vaccine available. Therefore, a rapid and coordinated effort to re-purpose clinically approved drugs that prevent or disrupt these critical entry pathways of SARS-CoV-2 spike glycoprotein interaction with human ACE2, could potentially accelerate the identification and clinical advancement of prophylactic and/or treatment options against COVID-19, thus providing possible countermeasures against viral entry, pathogenesis and survival. Herein, we discovered that Ambroxol hydrochloride (AMB), and its progenitor, Bromhexine hydrochloride (BHH), both clinically approved drugs are potent effective modulators of the key interaction between the receptor binding domain (RBD) of SARS-CoV-2 spike protein and human ACE2. We also found that both compounds inhibited SARS-CoV-2 infection-induced cytopathic effect at micromolar concentrations. Therefore, in addition to the known TMPRSS2 activity of BHH; we report for the first time that the BHH and AMB pharmacophore has the capacity to target and modulate yet another key protein-protein interaction essential for the two known SARS-CoV-2 entry pathways into host cells. Altogether, the potent efficacy, excellent safety and pharmacologic profile of both drugs along with their affordability and availability, makes them promising candidates for drug repurposing as possible prophylactic and/or treatment options against SARS-CoV-2 infection.

Early impact of COVID-19 pandemic on paediatric surgical practice in Nigeria: a national survey of paediatric surgeons.

INTRODUCTION: The novel coronavirus disease has had significant impact on healthcare globally. Knowledge of this virus is evolving, definitive care is not yet known and mortality is increasing. We assessed its initial impact on paediatric surgical practice in Nigeria, creating a benchmark for recommendations and future reference. METHODS: Survey of 120 paediatric surgeons from 50 centres to assess sociodemographics and specific domains of impact of COVID-19 on their services and training in Nigeria. Valid responses were represented as categorical data and presented in percentages. Duplicate submissions for centres were excluded by combining and taking the mean of responses from centres with multiple respondents. RESULTS: Response rate was 74 (61%). Forty-six (92%) centres had suspended elective surgeries. All centres continued emergency surgeries but volume reduced in March by 31%. Eleven (22%) centres reported 13 suspended elective cases presenting as emergencies in March, accounting for 3% of total emergency surgeries. Twelve (24%) centres adopted new modalities for managing selected surgical conditions: non-operative reduction of intussusception in 1 (2%), antibiotic management of uncomplicated acute appendicitis in 5 (10%) and more conservative management of trauma and replacement of laparoscopic appendectomy with open surgery in 3 (6%), respectively. Low perception of adequacy of personal protective equipment (PPE) was reported in 35 (70%) centres. Forty (80%) centres did not offer telemedicine for patients' follow-up. Twenty-nine (58%) centres had suspended academic training. Perception of safety to operate was low in 37 (50%) respondents, indifferent in 24% and high in 26%. CONCLUSION: Majority of paediatric surgical centres reported cessation of elective surgeries while continuing emergencies. There was, however, an acute decline in the volume of emergency surgeries. Adequate PPE needs to be provided and preparations towards handling backlog of elective surgeries once the pandemic recedes. Further study is planned to more conclusively understand the full impact of this pandemic on children's surgery.

Discovery of Clioquinol and Analogues as Novel Inhibitors of Severe Acute Respiratory Syndrome Coronavirus 2 Infection, ACE2 and ACE2 - Spike Protein Interaction In Vitro (preprint)

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the etiological agent for coronavirus disease 2019 (COVID-19), has emerged as an ongoing global pandemic. Presently, there are no clinically approved vaccines nor drugs for COVID-19. Hence, there is an urgent need to accelerate the development of effective antivirals. Here in, we discovered Clioquinol (5-chloro-7-iodo-8-quinolinol (CLQ)), a FDA approved drug and two of its analogues (7-bromo-5-chloro-8-hydroxyquinoline (CLBQ14); and 5, 7-Dichloro-8-hydroxyquinoline (CLCQ)) as potent inhibitors of SARS-CoV-2 infection induced cytopathic effect in vitro. In addition, all three compounds showed potent anti-exopeptidase activity against recombinant human angiotensin converting enzyme 2 (rhACE2) and inhibited the binding of rhACE2 with SARS-CoV-2 Spike (RBD) protein. CLQ displayed the highest potency in the low micromolar range, with its antiviral activity showing strong correlation with inhibition of rhACE2 and rhACE2-RBD interaction. Altogether, our findings provide a new mode of action and molecular target for CLQ and validates this pharmacophore as a promising lead series for clinical development of potential therapeutics for COVID-19.

Early Impact of COVID-19 Pandemic on Paediatric Surgical Practice in Nigeria: a National Survey of Paediatric Surgeons. (preprint)

Introduction The novel Coronavirus disease has had significant impact on healthcare globally. Knowledge of this virus is evolving, definitive care is not yet known, and mortality is increasing. We assessed its initial impact on paediatric surgical practice in Nigeria, creating a benchmark for recommendations and future reference. Methods Survey of 120 paediatric surgeons from 50 centres to assess socio-demographics and specific domains of impact of COVID-19 on their services and training in Nigeria. Seventy four surgeons adequately responded. Responses have been analysed. Duplicate submissions for centres were excluded by combining and averaging the responses from centres with multiple respondents. Results Forty-six (92%) centres had suspended elective surgeries. All centres continued emergency surgeries but volume reduced in March by 31%. Eleven (22%) centres reported 13 suspended elective cases presenting as emergencies in March, accounting for 3% of total emergency surgeries. Nine (18%) centres adopted new modalities for managing selected surgical conditions: non-operative reduction of intussusception in 1(2%), antibiotic management of uncomplicated acute appendicitis in 5(10%), more conservative management of trauma and replacement of laparoscopic appendectomy with open surgery in 3(6%) respectively. Low perception of adequacy of Personal Protective Equipment (PPE) was reported in 35(70%) centres. Forty (80%) centres did not offer telemedicine for patients follow up. Twenty-nine (58%) centres had suspended academic training. Perception of safety to operate was low in 37(50%) respondents, indifferent in 24% and high in 26%. Conclusion Majority of paediatric surgical centres reported cessation of elective surgeries whilst continuing emergencies. There is however an acute decline in the volume of emergency surgeries. Adequate PPE need to be provided and preparations towards handling backlog of elective surgeries once the pandemic recedes. Further study is planned to more conclusively understand the full impact of this pandemic on children's surgery. Key words pandemic, COVID-19, children's surgery.