Drawing Parallels between SARS, MERS, and COVID-19: A Comparative Overview of Epidemiology, Pathogenesis, and Pathological Features.

Background: Since November 2019, when the novel coronavirus arose in Wuhan City, over 188 million people worldwide have been infected with COVID-19. It is the third coronavirus outbreak in the twenty-first century. Until now, practically all coronavirus epidemics have occurred due to zoonotic spread from an animal or transitional host or through the consumption of their products. Coronaviruses can infect humans and cause severe illness and even death. Material and Methods: This review was designed to help us recognize and harmonize the similarities and differences between these three coronaviridae family members. Result: Measures aimed at containing the epidemic should be emphasized in this circumstance. Prioritizing and planning these activities require an understanding of the particulars of these three viruses. Given the pandemic's enormous death toll and rapid spread, we should be cognizant of the parallels and differences between these three viruses. Additionally, this pandemic warns us to be cautious against the possibility of a future pandemic. Conclusion: We highlight the fundamental characteristics of coronaviruses that are critical for recognizing coronavirus epidemiology, pathogenesis, and pathological features that reveal numerous significant pathological attributes and evolutionary patterns in the viral genome that aid in better understanding and anticipating future epidemics.

Ocular Toxicity of Ethambutol During Both Intensive and Continuation Phases of Anti-Tubercular Therapy in Children.

OBJECTIVE: The study was conducted to evaluate the ocular toxicity of ethambutol given in both intensive and continuation phases of treatment in children with drug-sensitive tuberculosis. METHODS: A prospective study of 94 eyes from 47 patients receiving an ethambutol-containing regimen was conducted between 1 December, 2018 and 31 August, 2020. Visual acuity, visual field, visual evoked response (VER), contrast sensitivity, colour perception, and retinal nerve fiber layer (RNFL) thickness [using optical coherence tomography (OCT)] were tested for each patient before, during, and after the treatment. RESULTS: On follow-up, visual acuity, color vision, contrast sensitivity, fundus, and visual fields were not affected in any of the patients. There was no statistically significant increase in the mean latency of the P(100) wave at any point in time. On OCT, no significant loss of mean RNFL thickness was detected. CONCLUSIONS: Ethambutol is safe to use up to a dose of 20 mg/kg/day throughout the entire course of anti-tubercular therapy in children with drug-sensitive tuberculosis.

Post Chikungunya Fever and Post COVID-19 Bilateral Pedal Edema: A Case Report.

An 86-year-old male presented with fever and joint pain for seven days. Clinical features were suggestive of chikungunya fever, but reverse transcription-polymerase chain reaction (RT-PCR) was negative. After ruling out the differentials, the patient was clinically diagnosed with chikungunya fever. Chikungunya IgG antibody was positive two months after the onset of symptoms. He had a history of asymptomatic coronavirus disease (COVID-19) infection two months ago. About 20 days after his first symptom, he developed bipedal edema, refractory to diuretics. All other causes of pedal edema, including heart failure, renal failure, and liver failure, were ruled out. The bipedal edema was managed conservatively with compression bandages. Only a few case reports and studies on limb edema as a symptom post chikungunya fever have been published up to this point. Furthermore, it is difficult to say whether his COVID-19 infection is linked to the edema.

Outcome of COVID-19 in Children With Tuberculosis: Single-Center Experience.

OBJECTIVE: To evaluate the outcome of Coronavirus disease 2019 (COVID-19) infection in children and adolescents with tuberculosis. METHODS: We analyzed hospital records for the period May, 2020 to September, 2021 for children who were severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcriptase-polymerase chain reaction (RT-PCR) positive or SARS-CoV-2 antibody positive. They were divided into two groups viz., those with tuberculosis (tuberculosis group) and those without tuberculosis (non-TB group). Demographic information, symptoms, and outcomes of COVID-19 were compared between the two groups. RESULTS: Median (IQR) age of participants was 11 (8,14) and 4.5 (2,9) year for the tuberculosis and non-TB groups, respectively. 93.5% and 36.1% of children were asymptomatic in the tuberculosis and non-TB group, respectively. No variable in the study was significantly associated with COVID-19 positivity in children with tuberculosis. No difference was found in the outcomes of COVID-19 infection in children having tuberculosis. CONCLUSIONS: No differences were noted in the outcomes of COVID-19 infection in children having tuberculosis.

Targeting Oxidative Stress Mechanisms to Treat Alzheimer's and Parkinson's Disease: A Critical Review.

Neurodegenerative disorders such as Alzheimer's disease (AD) and Parkinson's disease (PD) are becoming more frequent as the age increases. Contemporary therapies provide symptom resolution instead of targeting underlying pathological pathways. Consequently, there is considerable heterogeneity in response to treatment. Research has elucidated multiple potential of pathophysiological mechanisms contributing to neurodegenerative conditions, among which oxidative stress pathways appear to be suitable drug targets. The oxidative stress pathway has given rise to numerous novel pharmacological therapies that may provide a new avenue for neurodegenerative diseases. For example, SKQ (plastoquinone), MitoVitE, vitamin E, SOD mimic, MitoTEMPO (SOD mimetic), and bioactive molecules like curcumin and vitamin C have indeed been examined. To better understand how oxidative stress contributes to neurodegenerative diseases (such as Alzheimer's and Parkinson's), we analyzed the medicinal qualities of medicines that target markers in the cellular oxidative pathways. The specific pathway by which mitochondrial dysfunction causes neurodegeneration will require more investigation. An animal study should be carried out on medications that tackle cellular redox mechanisms but are not currently licensed for use in the management of neurodegenerative conditions.

Comparison of public health measures taken during Spanish flu and COVID-19 pandemics: A Narrative Review.

The similarity of the consequences of COVID-19 reminded us of the destruction caused by the Spanish flu over a century ago and led us to find similarities in the way the two pandemics were handled. PRISMA Guideline was followed for a systematic search to identify eligible published articles. Information about the public health measures adopted during both the pandemics was taken from literature. It was found that there are parallels between the two pandemics in terms of general unpreparedness, attitudes of the community and government, and various policy issues. All the measures implemented in 2020 were the same as those implemented in 1918-1919, with the same trend, uncertainty, early relaxing, and rapid reversals. Even from a scientific standpoint, all the elements were already known. All the issues such as social isolation, intra-family spread, personal protective equipment, medicine types (quinine, aspirin, anti-inflammatories, etc.), immunization requirements, and so on had already been addressed. No doubt, we do have technology today at our disposal for managing the spread of the disease and even spread awareness among people much easily. We also have taken many steps forward in the world of globalization, which make the progression and spread of the pandemic very fast as well. Both factors tend to counter each other and hence make timely public health intervention as important (if not more) today as it was yesterday. When possible, approaches and goals should be found on scientific facts and include ethical input. Finally, we must take careful notice of past local and national lessons to avoid repeating the mistakes done in the past. The development of a strategy ahead of time that includes all levels of government health infrastructure and outlines clear lines of duties and functions is critical. The main objective of this article was to compare the public health measures undertaken during the pandemic of Spanish Flu and the pandemic of COVID-19, and assess the similarities and differences in the public health measures taken during these pandemics. The correlation of the public health measures and the outcomes was assessed and the implication of this article was to be pandemic-ready in the future.

Have the COVID-19 pandemic and lockdown affected children's mental health in the long term? A repeated cross-sectional study.

OBJECTIVE: The study aimed to evaluate the impact of the COVID-19 pandemic on levels of anxiety and depressive symptoms in children and adolescents. DESIGN: Cross-sectional surveys were carried out on the mental health of children; one survey was conducted before the COVID-19 pandemic and one into the pandemic, 15 months after the school closures and implementation of lockdown and social distancing. Demographic data and COVID-19 pandemic-related data were collected from specific parent-report and self-report questionnaires. PARTICIPANTS: Participants included children and adolescents between ages 6 and 16 years, attending a tertiary care hospital without any diagnosed major psychiatric or chronic disorder. ANALYSIS: Data were collected at two points (before the COVID-19 pandemic and during it) and compared. Levels of anxiety and depressive symptoms were compared and tested for statistically significant differences between these two points using appropriate statistical tests. Regression models were constructed to predict the factors affecting increased anxiety levels and depressive symptoms in the COVID-19 period. RESULTS: 832 and 1255 children/adolescents were included in the study during the pre-COVID-19 and COVID-19 times, respectively. The median age of the participants was 10 years (IQR=4 years). The median (IQR) Spence Children's Anxiety Scale score was 24 (12) at the pre-COVID-19 point and 31 (13) during the COVID-19 pandemic (p<0.001, r=-0.27). 11% and 16% of children reported being depressed at these two-time points, respectively (p=0.004, φc=-0.063). Regression analysis showed that many factors, including the duration of smartphone use, female gender and only child status, were associated with increased anxiety or depression levels. CONCLUSION: A large proportion of children had elevated anxiety and depressive symptoms during the pandemic relative to before the pandemic, suggesting a need for measures to engage children in healthy habits to protect children's mental health and continuous monitoring of children during such scenarios.

OMICs Technologies for Natural Compounds-based Drug Development.

Compounds isolated from natural sources have been used for medicinal purposes for many centuries. Some metabolites of plants and microorganisms possess properties that would make them effective treatments against bacterial infection, inflammation, cancer, and an array of other medical conditions. In addition, natural compounds offer therapeutic approaches with lower toxicity compared to most synthetic analogues. However, it is challenging to identify and isolate potential drug candidates without specific information about structural specificity and limited knowledge of any specific physiological pathways in which they are involved. To solve this problem and find a way to efficiently utilize natural sources for the screening of compounds candidates, technologies, such as next-generation sequencing, bioinformatics techniques, and molecular analysis systems, should be adapted for screening many chemical compounds. Molecular techniques capable of performing analysis of large datasets, such as whole-genome sequencing and cellular protein expression profile, have become essential tools in drug discovery. OMICs, as genomics, proteomics, and metabolomics, are often used in targeted drug discovery, isolation, and characterization. This review summarizes technologies that are effective in natural source drug discovery and aid in a more precisely targeted pharmaceutical approach, including RNA interference or CRISPR technology. We strongly suggest that a multidisciplinary effort utilizing novel molecular tools to identify and isolate active compounds applicable for future drug discovery and production must be enhanced with all the available computational tools.

Is it atopic asthma, chronic eosinophilic pneumonia, or eosinophilic granulomatosis with polyangiitis?

A 45-year-old man, used to work in a cement factory, presented to us with a history of adult-onset sub-optimally controlled asthma and was initially managed as a case of acute exacerbation of allergic asthma. However, his repeated evaluation revealed raised eosinophil count, raised serum total IgE and persistent chest infiltrates on imaging. He was provisionally managed empirically with a short course of oral steroids and advised follow-up on an out-patient basis to rule out the possibility of idiopathic eosinophilic pulmonary syndromes. The patient was then lost to follow-up, and after four years, he presented with a vasculitic presentation and was diagnosed with Eosinophilic Granulomatosis with Polyangiitis (EGPA). He improved with corticosteroids and cyclophosphamide pulse therapy. This case depicts the importance of evolving nature of EGPA wherein the eosinophilic phase of the disease can mimic other pulmonary eosinophilic diseases and vasculitic symptoms can be delayed as much as by four years.

Predictors of outcomes in children with Central Nervous System tuberculosis.

BACKGROUND: Central Nervous system tuberculosis (CNS-Tb) is the most lethal form of extra-pulmonary tuberculosis in children. The lack of markers of outcome provides little information on the efficacy of the current treatment protocols for CNS-Tb and thus results in a higher mortality rate than other extrapulmonary manifestations of tuberculosis. This study aims to identify significant factors that will reliably predict the outcomes at discharge in children admitted with CNS-Tb. METHODS AND MATERIAL: This is a prospective observational study in children with neurotuberculosis admitted at a tertiary care hospital. Clinical presentations at the time of admission were studied. Outcomes at the end of in-patient care (completely cured, survival with some/severe disability or death) were correlated with clinical, laboratory, microbiological, and radiological parameters. Univariate and multivariate analyses were applied to study the parameters and a p-value ≤ 0.05 with a confidence interval (CI) of 95% was considered as statistically significant. FINDINGS: The study included 100 children between 4 months and 12 years of age with a mean of 5.84 (±3.5) years. At discharge, 55% of children recovered completely, 20% had some or severe disability and 25% died. On multivariate analysis, high CSF protein (p = 0.050) and drug resistance (p = 0.034) were highly associated with fatality. Meningeal enhancements with basal exudates (p = 0.021) and CSF lymphocyte count >90% were highly associated with survival with disability. Stage I disease at presentation (p < 0.0001) was the only variable associated with complete recovery. INTERPRETATION: Reliable prognostic markers for CNS-Tb can aid in predicting the efficacy of the current treatment and the anticipated outcome in the children with this disease. FUNDING: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Measles elimination by 2020 - Current status and future challenges in India.

India, as a member of the World Health Organization South-East Asia Region, had committed to measles elimination by 2020. Efforts to increase immunization coverage, special immunization activities, and case-based surveillance have been implemented rigorously over the last 7 years, but India has not been able to eliminate measles. Multiple factors led to this namely inadequate vaccination coverage and COVID pandemic and others. The pandemic added its contribution in disruption of vaccine delivery services under Intensified Mission Indradhanush preventing the achievement of the elimination target, in stipulated time. India may need to think beyond strengthening the routine immunization activities and increasing the geographical coverage under Intensified Mission Indradhanush. Promising the future in the measles vaccine delivery system in the form of Measles-Micro-Array-Patches is seen on the horizon may prove to be a game-changer for targeting measles elimination, in the current decade.