Insects and food security in South Africa in the light of climate change

The Covid-19 pandemic has had a devastating socio-economic effect on the country, including the death of more than 102 000 people, many of whom were the breadwinners of their families. This could not have happened at a worse time, since the economy of the country was in a recession even before the pandemic. The situation is exacerbated by the highest level of unemployment in the world, widespread nepotism and corruption, the plundering of state coffers and the favouring of the business interests of BRICS partners by government officials over those of South Africans. The government's commitment to prioritising their BRICS partners' business interests over those of the South African people contributes to food insecurity in South Africa. This includes the export of coal from mines in Mpumalanga to China and India, while nothing is done to rehabilitate the region, which was once known for its agriculture. The government handed over to the Chinese company SAEMB the Musina-Makhado Special Economic Zone, where four opencast mines, a 3 300 MW power station and an iron smelting plant will be developed. This development, however, requires the government to build a dam that will harvest 60% of the annual runoff of the Limpopo River, which in turn will have a devastating effect on farmers and communities downriver in South Africa, Zimbabwe and Mozambique who irrigate their crops with water from the Limpopo River. The same kowtowing of the South African government to its BRICS partners can be seen in the reluctance with which the government responds to the plundering of our marine resources by Chinese fishing boats and abalone smugglers. The unfair competition imposed on local chicken farmers by distributers of dumped chicken, mainly from Brazil, with the approval of government, caused the closure of several South African chicken farms and the resulting loss of tens of thousands of jobs along the supply chain. The reluctance of the government to take sides in the Russia-Ukraine war is partly linked to the fact that South Africa imports fertilizer and wheat from Russia. South Africa, a water-scarce country, is more vulnerable than many other countries to the effects of global climate change. The abnormal rain pattern, that is characterised by severe droughts in certain regions and heavy rainstorms and floods in others, has a devastating impact on the already economically struggling South African community. Abroad, attempts are made to ensure that mean temperatures do not exceed the pre-industrial level mark by more than 1,5 degrees C. South Africa, however, heats up twice as fast as many other countries, and has already exceeded the pre-industrial era level by more than 2 degrees C;it will continue to get warmer and drier, causing most of the country to become desertified by 2050. A third of South African rivers do not reach the sea anymore because of over ion of water from rivers;similarly, there is extensive ion of groundwater. Together farming and forestry account for 70% of water use in South Africa. This over ion of water, worsened by the heat and aridification resulting from climate change, led to the degradation of most wetland and estuarine ecosystems and the drying and burning of irreplaceable peatlands. These political, socioeconomic and environmental calamities create the worst possible scenario for food security in South Africa. Already one in four people in Africa suffers from food insecurity and this number will rapidly rise in the wake of global climate change, which will result in the loss of two thirds of arable land by 2025. South Africa is nearing socioeconomic collapse. This, in conjunction with continuing droughts, storms and rising temperatures associated with global climate change, will lead to food insecurity, starvation and anarchy. The effect of global climate change will make it progressively more difficult to produce enough food for the South African population. It is imperative that South Africans consider alternative methods of food production, including water use. Entomophagy is widely practiced throughout the world, but is especially prevalent in South America, the Far East and Africa, where approximately 2 billion people use 1 900 species of insects as food. The nutritional value of insects is unsurpassed and, in some respects, even more nutritious than meat. The larvae of the black soldier fly (BSF) Hermetia illucens are a source of high-quality proteins and unsaturated fats that are used worldwide as animal feed. Insects are a source of minerals such as iron, calcium, copper, zinc and magnesium and high levels of vitamin A, B 2 and C. The ecological and socioeconomic benefits of using BSF larvae instead of grain as feed for fish, chickens and pigs are enormous. BSF larvae can be bred almost for free by feeding it a wide variety of organic waste, including rotten vegetables and fruit, manure and even carcases that would have ended up in rubbish dumps and would have contributed to the methane and carbon dioxide pollution emanating from such dumps. The water use of BSF is negligible, because the water in the organic waste that would have been discarded in waste dumps is sufficient to sustain them. BSF affords the subsistence and small-scale farmer the opportunity to raise chickens at a lower input cost than ever before. The conversion of feed to food in insects is far greater than that of chickens, pigs or cattle. In the case of the house cricket (Acheta domestica) the conversion rate of feed to food is twice as effective as that of chickens, four times as effective as pigs and twelve times greater than that of cattle. Compared to conventional farming, this implies that with insects far more exceptionally nutritious food can be produced in a smaller area, with little water and no poison or fertilizer whatsoever, while waste and the associated methane gas are removed from the environment at the same time. A few South African companies have already seen the potential of insects as food and feed. Even though insect farming is still in its infancy, it is already generating jobs and new socioeconomic opportunities in South Africa. Insect farming, especially BSF farming, will in the near future probably grow in popularity all over the world as an affordable, healthy, ecologically sustainable alternative food source that will, directly or indirectly, be consumed by humans. BSF afford the environmentally conscious homesteader who wants to produce livestock such as chickens, fish, or pigs in a sustainable manner an unsurpassed environmentally friendly alternative. BSF will also give the desperate, impoverished and starving population of the future an alternative free source of feed that will offer them economic prospects and food security.

Not only COVID-19. Not only Ukraine. Under-reported hunger crises in the Horn of Africa and the politics around them.

Funding requirements for humanitarian needs have reached a record high, driven by Ukraine's war, other conflicts worldwide, the COVID-19 pandemic, climate change-related disasters, economic slowdown, and their combined global consequences. More people are in need of humanitarian assistance, and more are forcibly displaced than ever before, the majority of them from countries facing acute food insecurity. The largest global food crisis in modern history is unfolding. Particularly, in the Horn of Africa, levels of hunger are alarmingly high, with countries edging close to famine. This article discusses why and how famine, which had declined in frequency and lethality, is resurging, using Somalia and Ethiopia as 'mini case studies', emblematic as they are of a broader trend. Technical and political aspects of food crises and their consequences on health are analysed. The article examines some of the most contentious issues around famine: the data challenges for declaring it and the use of starvation as a weapon of war. The article concludes with the claim that the elimination of famine is possible, but only through political action. Humanitarians can warn of an impending crisis and mitigate some of its consequences, but they are powerless in the face of an ongoing famine, like those described in Somalia and Ethiopia.

Somatic and mental aspects of anorexia nervosa: Basic knowledge of the diagnostics and treatment for pediatricians

Anorexia nervosa is the mental disorder with the highest mortality and is often associated with a chronic course. During the corona pandemic the number of patients in need of treatment significantly increased, especially for affected patients in childhood. In addition, there is an increasing prevalence of atypical anorexia nervosa characterized by normal or overweight but with similar somatic or psychiatric symptoms. The prevalence of anorexia nervosa in males is probably underestimated because clinicians are not well informed about its characteristics in the male sex. Somatic consequences of anorexia nervosa are mostly starvation-induced and can affect many organs. Depressive symptoms, anxiety and obsessive-compulsive disorders are the most frequent psychiatric comorbid disorders or sequelae. Besides an important genetic disposition, further biological risk factors are discussed for the etiology of anorexia nervosa. Treatment consists of somatic stabilization, achievement of a healthy body weight and psychotherapy. The parents should always be integrated into the treatment of children and adolescents with anorexia nervosa. Weight stabilization and its adjustment to growth are essential for a positive long-term outcome. The new concept of anorexia nervosa as a metabo-psychiatric disorder is associated with the hope of new research and treatment strategies.

A review of peri-operative diabetes care at Watford General Hospital

Diabetes affects around 15% of surgical patients and is associated with significant morbidity [1]. Poor peri-operative glycaemic control can result in longer hospital stays, up to 50% increased mortality and adverse postoperative outcomes including wound infection [1, 2]. Therefore, it is important to ensure diabetic peri-operative care is optimal, and as noted, in recent years, there is room for improvement. Methods A retrospective re-audit of electronic patient records was conducted to determine if peri-operative diabetic management was in line with local and national guidelines. We included all diabetic adults undergoing emergency or elective surgery, excluding obstetrics, in January 2022 at Watford General Hospital. Results Forty-seven of 618 (7.6%) patients who underwent surgery in January 2022 were diabetic adults meeting inclusion criteria. Of these 87% had type 2 diabetes, 51% were male and 55% were elective cases. Median age was 67 years (interquartile range 58-78.5 years). The majority (49%) were designated ASA status 2. Five of 21 elective cases had a glycated haemoglobin (HbA1c) result of > 69 mmol.l-1. Median surgical start time for elective diabetic patients was midday with 38% of cases occurring after midday. Starvation time was more than one missed meal or 12 h in 49% of patients. Variable rate intravenous insulin infusions (VRIIIs) were indicated in 43% of patients but only 10% received VRIIIs. Peri-operative blood glucose was maintained between 6-10 mmol.l-1 in 34% patients, 70% had intra-operative glucose monitoring but none hourly. Ketone testing occurred in one of two patients where indicated. Dexamethasone was given to 51% of patients (five of those were diet-controlled). Discussion A larger sample size was obtained on re-audit with 47 patients vs. 10 patients in January 2021, likely due to effects of the COVID-19 pandemic on elective surgery. Blood glucose monitoring pre- and postoperatively in diabetic patients has remained at least 70% in both audit cycles, but use of VRIIIs fell from 60% to 20%. We presented the findings at a clinical governance meeting and discussion of the guidelines identified that multiple documents and significant text acted as barriers to implementation. Therefore, we designed a flowchart to improve compliance and placed this in theatres and pre-operative areas. We hope this initiative, in addition to local teaching, will improve peri-operative diabetic care. We plan to re-audit and consider implementing further changes if care remains suboptimal. (Figure Presented).

The unhappy ending of the «India story»

According to a Lancet report (2020), life expectancy has increased to 70.8 years, but Indians are living more years with illness and disability. The authors move from the assumption that «hunger is democracy's opposite» and cannot be tolerated in a democratic country (p. 62). Since independence, India has registered several episodes of extreme hunger and famines: in Bihar (1966–67) 13.4 million people were trapped in destitution and thousands of citizens starved to death;in Maharashtra (1973) 130,000 deaths were reported;in the 1990s serious starvation was denounced in Orissa. [...]recently, the country has been facing a form of hunger that kills in silence getting less media attention than famines. According to the 2020 Global Hunger Index, India is 94th (out of 107 nations).

Insekte en voedselsekerheid in Suid-Afrika in die lig van klimaatsverandering

The Covid-19 pandemic has had a devastating socio-economic effect on the country, including the death of more than 102 000 people, many of whom were the breadwinners of their families. This could not have happened at a worse time, since the economy of the country was in a recession even before the pandemic. The situation is exacerbated by the highest level of unemployment in the world, widespread nepotism and corruption, the plundering of state coffers and the favouring of the business interests of BRICS partners by government officials over those of South Africans. The government's commitment to prioritising their BRICS partners' business interests over those of the South African people contributes to food insecurity in South Africa. This includes the export of coal from mines in Mpumalanga to China and India, while nothing is done to rehabilitate the region, which was once known for its agriculture. The government handed over to the Chinese company SAEMB the Musina-Makhado Special Economic Zone, where four opencast mines, a 3 300 MW power station and an iron smelting plant will be developed. This development, however, requires the government to build a dam that will harvest 60% of the annual runoff of the Limpopo River, which in turn will have a devastating effect on farmers and communities downriver in South Africa, Zimbabwe and Mozambique who irrigate their crops with water from the Limpopo River. The same kowtowing of the South African government to its BRICS partners can be seen in the reluctance with which the government responds to the plundering of our marine resources by Chinese fishing boats and abalone smugglers. The unfair competition imposed on local chicken farmers by distributers of dumped chicken, mainly from Brazil, with the approval of government, caused the closure of several South African chicken farms and the resulting loss of tens of thousands of jobs along the supply chain. The reluctance of the government to take sides in the Russia-Ukraine war is partly linked to the fact that South Africa imports fertilizer and wheat from Russia. South Africa, a water-scarce country, is more vulnerable than many other countries to the effects of global climate change. The abnormal rain pattern, that is characterised by severe droughts in certain regions and heavy rainstorms and floods in others, has a devastating impact on the already economically struggling South African community. Abroad, attempts are made to ensure that mean temperatures do not exceed the pre-industrial level mark by more than 1,5 °C. South Africa, however, heats up twice as fast as many other countries, and has already exceeded the pre-industrial era level by more than 2 °C;it will continue to get warmer and drier, causing most of the country to become desertified by 2050. A third of South African rivers do not reach the sea anymore because of over ion of water from rivers;similarly, there is extensive ion of groundwater. Together farming and forestry account for 70% of water use in South Africa. This over ion of water, worsened by the heat and aridification resulting from climate change, led to the degradation of most wetland and estuarine ecosystems and the drying and burning of irreplaceable peatlands. These political, socioeconomic and environmental calamities create the worst possible scenario for food security in South Africa. Already one in four people in Africa suffers from food insecurity and this number will rapidly rise in the wake of global climate change, which will result in the loss of two thirds of arable land by 2025. South Africa is nearing socioeconomic collapse. This, in conjunction with continuing droughts, storms and rising temperatures associated with global climate change, will lead to food insecurity, starvation and anarchy. The effect of global climate change will make it progressively more difficult to produce enough food for the South African population. It is imperative that South Africans consider alternative methods of food production, including water use. Entomophagy is widel practiced throughout the world, but is especially prevalent in South America, the Far East and Africa, where approximately 2 billion people use 1 900 species of insects as food. The nutritional value of insects is unsurpassed and, in some respects, even more nutritious than meat. The larvae of the black soldier fly (BSF) Hermetia illucens are a source of high-quality proteins and unsaturated fats that are used worldwide as animal feed. Insects are a source of minerals such as iron, calcium, copper, zinc and magnesium and high levels of vitamin A, B2 and C. The ecological and socioeconomic benefits of using BSF larvae instead of grain as feed for fish, chickens and pigs are enormous. BSF larvae can be bred almost for free by feeding it a wide variety of organic waste, including rotten vegetables and fruit, manure and even carcases that would have ended up in rubbish dumps and would have contributed to the methane and carbon dioxide pollution emanating from such dumps. The water use of BSF is negligible, because the water in the organic waste that would have been discarded in waste dumps is sufficient to sustain them. BSF affords the subsistence and small-scale farmer the opportunity to raise chickens at a lower input cost than ever before. The conversion of feed to food in insects is far greater than that of chickens, pigs or cattle. In the case of the house cricket (Acheta domestica) the conversion rate of feed to food is twice as effective as that of chickens, four times as effective as pigs and twelve times greater than that of cattle. Compared to conventional farming, this implies that with insects far more exceptionally nutritious food can be produced in a smaller area, with little water and no poison or fertilizer whatsoever, while waste and the associated methane gas are removed from the environment at the same time. A few South African companies have already seen the potential of insects as food and feed. Even though insect farming is still in its infancy, it is already generating jobs and new socioeconomic opportunities in South Africa. Insect farming, especially BSF farming, will in the near future probably grow in popularity all over the world as an affordable, healthy, ecologically sustainable alternative food source that will, directly or indirectly, be consumed by humans. BSF afford the environmentally conscious homesteader who wants to produce livestock such as chickens, fish, or pigs in a sustainable manner an unsurpassed environmentally friendly alternative. BSF will also give the desperate, impoverished and starving population of the future an alternative free source of feed that will offer them economic prospects and food security. [ FROM AUTHOR]

CHALLENGES IN FLUID MANAGEMENT OF AN END-STAGE RENAL DISEASE PATIENT WITH COVID-19 PNEUMONIA AND STARVATION KETOACIDOSIS

INTRODUCTION Fluid management is a delicate process when it involves an anuric end-stage renal disease (ESRD) patient on regular hemodialysis, who has Coronavirus Disease-19 (COVID-19) pneumonia in acute respiratory distress syndrome (ARDS). The management is made even more challenging when the condition of the patient is complicated with starvation ketoacidosis. There is limited literature with regards to this issue. CASE We report the case of a 55-year-old male patient with ESRD, who is suffering from COVID-19 pneumonia in ARDS with concomitant starvation ketoacidosis. CONCLUSION Starvation ketoacidosis is an under-recognized cause of metabolic acidosis and may occur even in a diabetic patient who has been acutely unwell with poor oral intake. While the mainstay of therapy in a patient with starvation ketoacidosis is to provide an intravenous dextrosecontaining fluid replacement, this has to be judiciously given in an anuric ESRD patient on fluid restriction. A careful balance between low-dose insulin infusion to maintain euglycemia and strict fluid management is crucial to stop gluconeogenesis and ketogenesis. The ultimate goal is to bring the patient out of starvation ketoacidosis while avoiding the deleterious effect of fluid overload in a patient who is already in ARDS.

Starvation Ketoacidosis in the Third Trimester of Pregnancy

Introduction: Starvation ketoacidosis represents one of the three metabolic acidoses caused by the accumulation of ketone bodies within the bloodstream. Outside of late pregnancy, it is a relatively rare condition. In late pregnancy, the placental production of the hormones estrogen, cortisol, and human placental lactogen combined with increased lipolysis causes greater insulin resistance and an overall catabolic state which improves nutrient availability for vital fetal growth. However, this also allows for a magnified response to fasting that results in increased ketone production and in rare cases “accelerated starvation.” In this case, we present a 25-year-old pregnant patient who presented with nausea, vomiting, and poor oral intake, who was found to be in starvation ketoacidosis. Case Description: A 25-year-old G2P1001 cis female with a previous medical history of migraines presented at 33 weeks gestation with nausea, vomiting, and poor oral intake for four days prior to admission in the setting of COVID-19 infection. Patient presented hemodynamically stable and in no acute distress. Fetal non stress test on admission was reactive. Initial lab work revealed a glucose of 95, anion gap of 21, and a bicarbonate level of 7. A beta hydroxybutyrate (BHB) level was elevated at 5.26. Arterial blood gas showed a pH of 7.2 and a PCO2 of 23, consistent with an anion gap metabolic acidosis. Urinalysis revealed 3+ ketones. Overall labs were consistent with starvation ketoacidosis and the patient was immediately resuscitated with dextrose containing intravenous fluids and an insulin drip to help shunt away from ketoacidosis. Her BHB rapidly downtrended to 1.28 within 12 hours and within 24 hours it normalized. Her metabolic acidosis continued to improve throughout her hospitalization. She was able to tolerate a regular diet prior to being discharged home. A few weeks later, she had an uncomplicated full term delivery of a healthy baby. Discussion: Starvation ketoacidosis outside of pregnancy is rare and takes at least two weeks to manifest as a mild ketoacidosis. In pregnancy, patients are in an insulin resistant state which increases with gestational age, making them prone to ketoacidosis particularly in the second and third trimesters. Ketoacidosis in pregnancy is not only harmful for the pregnant individual, but for the developing fetus as well. Ketones can cross the placental barrier, leading to neurological impairment and even fetal demise if the acidosis is not addressed quickly. Prompt treatment with IV fluids, dextrose, and insulin is imperative to prevent neurodevelopmental compromise. Patients with appropriate and timely treatment can continue on to have uncomplicated pregnancies and deliveries.

COVID-19 induced impact on informal migrants in Bangladesh: a qualitative study

Purpose>This study intends to explore the impact of occupation and income on informal migrants in the face of COVID-19 induced lockdown in Bangladesh and their coping strategies to survive the pandemic situation.Design/methodology/approach>The study adopted a qualitative research design in which four urban areas were chosen purposively from various parts of Dhaka city. The authors conducted 21 semi-structured in-depth interviews, four FGDs and eight months over participant observation for achieving study objectives. The four stages of data analysis used a thematic approach in the interpretive phenomenological analysis.Findings>The results showed that respondents were massively affected due to loss of income and occupation in the period of induced lockdown. Besides, most people lost their earning sources entirely in this amid pandemic which bound them starvation in the mealtime along with several dynamic complications. The findings also revealed that they followed some surviving strategies such as taking loans, reducing expenses, consuming less food, selling land, jewelry, and goods, relatives and neighbor support, and government relief. Although these strategies somewhat supported them to struggle with the situation, their livelihood features became fragile immensely.Research limitations/implications>The findings will be an important guiding principle for the policymakers, aid organizations and development practitioners to prepare development policies for vulnerable informal migrants in developing countries like Bangladesh.Originality/value>This is the first study that explores the informal migrants’ occupation and income during COVID-19 induced lockdown in Bangladesh. This research also highlights coping strategies of the informal migrants to survive the pandemic situation.

Thymic Dysfunction and Atrophy in COVID-19 Disease Complicated by Inflammation, Malnutrition and Cachexia.

Background: The current COVID-19 pandemic has put millions of people, especially children at risk of protein-energy malnutrition (PEM) by pushing them into poverty and disrupting the global food supply chain. The thymus is severely affected by nutritional deficiencies and is known as a barometer of malnutrition. Aim: The present commentary provides a novel perspective on the role of malnutrition-induced thymic dysfunction, involution and atrophy on the risk and severity of disease in children during the COVID-19 pandemic. Methods: A review of pertinent indexed literature including studies examining the effects of malnutrition on the thymus and immune dysfunction in COVID-19. Results: Protein-energy malnutrition and micronutrient deficiencies of zinc, iron and vitamin A are known to promote thymic dysfunction and thymocyte loss in children. Malnutrition- and infection-induced thymic atrophy and immune dysfunction may increase the risk of first, progression of COVID-19 disease to more severe forms including development of multisystem inflammatory syndrome in children (MIS-C); second, slow the recovery from COVID-19 disease; and third, increase the risk of other infections. Furthermore, malnourished children may be at increased risk of contracting SARS-CoV-2 infection due to socioeconomic conditions that promote viral transmission amongst contacts and create barriers to vaccination. Conclusion: National governments and international organizations including WHO, World Food Program, and UNICEF should institute measures to ensure provision of food and micronutrients for children at risk in order to limit the health impact of the ongoing COVID-19 pandemic.

Effects of Knotweed-Enriched Feed on the Blood Characteristics and Fitness of Horses

The aboveground biomass of dry knotweed was administered daily to large groups of young (1- to 3-year-old) stallions of the Czech Warmblood, Czech-Moravian Coldblood and Silesian Norik breeds, fed individually for 4 and 6 months in two successive winter experiments. Their fitness was compared with control groups consisting of equally numerous subgroups comparable in age, breed, body mass and initial blood parameters. The effects of knotweed on the horses’ fitness were evaluated based on changes in blood characteristics. Even if administered in small amounts, 150 g per day, knotweed could (1) increase the thrombocyte numbers, (2) increase the globulin content (thus improving the horses’ immunity, which is desired in large groups of animals), (3) stimulate lipid metabolism in cold-blooded horses and (4) decrease the concentration of cholesterol. The long-lasting effect of knotweed on both the urea and triglyceride–cholesterol ratio presumably reflected, between the two experiments, the temporary protein starvation of horses on pastures with poor quality of grass in a dry summer.

Inhibition of De Novo Pyrimidine Synthesis Depletes Acute Myleogenous Leukemia Stem Cells (LSCs) Burden and Triggers Apoptosis and Differentiation Associated with Oxidative Stress

Background: De novo nucleotide synthesis is necessary to meet the enormous demand for nucleotides, other macromolecules associated with acute myeloid leukemia (AML) progression 1, 2, 34. Hence, we hypothesized that targeting de novo nucleotide synthesis would lead to the depletion of the nucleotide pool, pyrimidine starvation and increase oxidative stress preferentially in leukemic cells compared to their non-malignant counterparts, impacting proliferative and differentiation pathways. Emvododstat (PTC299) is an inhibitor of dihydroorotate dehydrogenase (DHODH), a rate-limiting enzyme for de novo pyrimidine nucleotide synthesis that is currently in a clinical trial for the treatment of AML. Objectives: The goals of these studies were to understand the emvododstat-mediated effects on leukemia growth, differentiation and impact on Leukemia Stem Cells(LSCs). Comprehensive analyses of mitochondrial function, metabolic signaling in PI3K/AKT pathways, apoptotic signatures, and DNA damage responses were carried out. The rationale for clinical testing emvododstat was confirmed in an AML-PDX model. Results: Emvododstat treatment in cytarabine-resistant AML cells and primary AML blasts induced apoptosis, differentiation, and reduced proliferation, with corresponding decreased in cell number and increases in annexin V- and CD14-positive cells. Indeed, the inhibition of de novo nucleotide synthesis compromises the dynamic metabolic landscape and mitochondrial function, as indicated by alterations in the oxygen consumption rate (OCR) and mitochondrial ROS/membrane potential and corresponding differentiation, apoptosis, and/or inhibition of proliferation of LSCs. These effects can be reversed by the addition of exogenous uridine and orotate. Further immunoblotting and mass cytometry (CyTOF) analyses demonstrated changes in apoptotic and cell signaling proteins (cleaved PARP, cleaved caspase-3) and DNA damage responses (TP53, γH2AX) and PI3/AKT pathway downregulation in response to emvododstat. Importantly, emvododstat treatment reduced leukemic cell burden in a mouse model of AML PDX ( Complex karyotype, mutation in ASXL1, IDH2, NRAS), decreased levels of leukemia stem cells frequency (1 in 522,460 Vs 1 in 3,623,599 in vehicle vs emvododstat treated mice), and improved survival. The median survival 40 days vs. 30 days, P=0.0002 in primary transplantation and 36 days vs 53.5 days, P=0.005 in secondary transpantation in a PDX mouse model of human AML. This corresponded with a reduction in the bone marrow burden of leukemia and increased expression of differentiation markers in mice treated with emvododstat (Fig. 1). These data demonstrate effect of emvododstat on mitochondrial functions. Conclusion: Inhibition of de novo pyrimidine synthesis triggers differentiation, apoptosis, and depletes LSCs in AML models. Emvododstat is a novel dihydroorotate dehydrogenase inhibitor being tested in a clinical trial for the treatment of myeloid malignancies and COVID-19. Keywords: AML, emvododstat, DHODH, apoptosis, differentiation References: 1 Thomas, D. & Majeti, R. Biology and relevance of human acute myeloid leukemia stem cells. Blood 129, 1577-1585, doi:10.1182/blood-2016-10-696054 (2017). 2 Quek, L. et al. Genetically distinct leukemic stem cells in human CD34- acute myeloid leukemia are arrested at a hemopoietic precursor-like stage. The Journal of experimental medicine 213, 1513-1535, doi:10.1084/jem.20151775 (2016). 3 Villa, E., Ali, E. S., Sahu, U. & Ben-Sahra, I. Cancer Cells Tune the Signaling Pathways to Empower de Novo Synthesis of Nucleotides. Cancers (Basel) 11, doi:10.3390/cancers11050688 (2019). 4 DeBerardinis, R. J. & Chandel, N. S. Fundamentals of cancer metabolism. Sci Adv 2, e1600200, doi:10.1126/sciadv.1600200 (2016). [Formula presented] Disclosures: Weetall: PTC therapeutics: Current Employment. Sheedy: PTC therapeutics: Current Employment. Ray: PTC therapeutics: Current Employment. Andreeff: Karyopharm: Research Funding;AstraZeneca: Research Funding;Oxford Biomedica UK: Research Funding;Aptose: Consultancy;Daiich -Sankyo: Consultancy, Research Funding;Syndax: Consultancy;Breast Cancer Research Foundation: Research Funding;Reata, Aptose, Eutropics, SentiBio;Chimerix, Oncolyze: Current holder of individual stocks in a privately-held company;Novartis, Cancer UK;Leukemia & Lymphoma Society (LLS), German Research Council;NCI-RDCRN (Rare Disease Clin Network), CLL Foundation;Novartis: Membership on an entity's Board of Directors or advisory committees;Senti-Bio: Consultancy;Medicxi: Consultancy;ONO Pharmaceuticals: Research Funding;Amgen: Research Funding;Glycomimetics: Consultancy. Borthakur: ArgenX: Membership on an entity's Board of Directors or advisory committees;Protagonist: Consultancy;Astex: Research Funding;University of Texas MD Anderson Cancer Center: Current Employment;Ryvu: Research Funding;Takeda: Membership on an entity's Board of Directors or advisory committees;Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees;GSK: Consultancy.

Case series of COVID-19 infection in pregnancy complicated by ketoacidosis and symptomatic breathlessness.

Background: The differential diagnosis of acute shortness of breath in a pregnant woman with COVID-19 is broad. Pregnancy is a ketosis-prone state, which can result in metabolic acidosis and tachypnoea. Methods: We describe four pregnant women with COVID-19 and breathlessness where ketoacidosis was found to contribute to symptomatic tachypnoea. Results: One patient did not have associated COVID-19 pneumonitis, but presented with severe tachypnoea and metabolic acidosis; three women had pneumonitis and metabolic acidosis. Corrective treatment for the metabolic abnormalities resulted in resolution of the ketoacidosis in all cases. No women had coexistent diabetes. Conclusion: This is the first series of COVID-19 in pregnancy complicated by ketoacidosis and symptomatic tachypnoea. Ketoacidosis associated with COVID-19 is an important cause of tachypnoea requiring specific treatment, which should not be overlooked. Potential mechanisms for this are discussed with a framework for interpretation of blood gas results during pregnancy.

Worried of Not COVID-19 but Fear of Hunger and Starvation: Challenges of the Poor Nigerians.

Purpose: Lack of social welfare programs for vulnerable households during the coronavirus outbreak in Nigeria caused severe pain and economic hardship to households as millions suffered hunger in Nigeria and Africa at large.Method: To explore the socioeconomic impact of COVID-19 pandemic in Nigeria, a qualitative study was conducted with 70 participants from Lagos, Nigeria. We conducted 52 individual and 2 group interviews with 18 key stakeholders involved with enforcing lockdown orders. Responses were analyzed in themes using content and discourse analysis.Result: The participants stated that the greatest challenge faced by many amidst the pandemic is hunger and starvation and described government palliatives as grossly insufficient. This is linked to the high population of Nigerians living below poverty line, who depends on daily earning for survival.Discussion: Therefore, these viewpoints must be taken into account by the policymakers and social welfare providers when designing social welfare policies and interventions for poor/vulnerable Nigerians.

The impact of COVID-19 on Bangladeshi readymade garment (RMG) workers.

This paper describes the potential impact of the coronavirus disease 2019 (COVID-19) pandemic on the readymade garment (RMG) workers of Bangladesh. It articulates the RMG workers' existing vulnerability during the COVID-19 pandemic based on currently available evidence and personal conversations/communications with RMG workers. COVID-19 has already impacted RMG workers' health (both physical and mental health status) and wellbeing, and resulted in loss of employment. We argue that the COVID-19 pandemic will have long-lasting effects on the garment workers, especially related to their health issues, financial hardship and inability to pay for essentials such as food, and future employment opportunities. The stakeholders (such as the international retailers/brands, Bangladesh Garment Manufacturers and Exporters Association, Government of Bangladesh) responsible for the global supply chain RMG factories should reconsider the health and overall wellbeing needs of the RMG workers during the ongoing COVID-19 pandemic.