No abstract

Introduction: Severe acute respiratory syndrome-coronavirus 2 (SARSCoV2) pandemic has been an unceasing plight with a wide range of clinical presentations. The direct effects of the virus, increased use of medications, and lifestyle changes have contributed to the vulnerability to co-infections. Fungal and bacterial co-infections led to increased morbidity and mortality during the pandemic. Similarly, the surge of skin signs in conjunction with herpes zoster (HZ) manifestations has been reported. In this study, we pooled the data on the clinical characteristics of SARS-CoV-2 patients co-infected with HZ. Methodology: Electronic databases including PubMed, Scopus, and Google Scholar were extensively searched to identify the relevant studies on HZ infection among the SARS-CoV-2 patients. Results: A total of 79 patients (from case reports, series, and retrospective studies) were included in the analysis. Fever was the most common constitutional symptom recorded, followed by cough and dyspnea. A systemic rash was reported in 78.5% of cases with mild symptoms of HZ and SARS-CoV-2 in 87% and 76%, respectively. Only 19% of the cases presented during the prodrome period of SARS-CoV-2. HZV polymerase chain reaction (PCR) was positive in 8.9% of the cases, and the remaining were diagnosed clinically. SARS-CoV-2 PCR was reported positive in 65 cases (82.3%). Leukopenia was observed in 7 cases (8.9%) and lymphopenia in 25 (31.6%). All patients recovered through conservative treatment. Conclusion: SARS-CoV-2 escalated the incidence of HZ reactivation. Most of the patients were seen with older individuals either simultaneously or a few days after the SARS-CoV-2 infection, but a few cases were reported during the asymptomatic prodrome period of SARS-CoV-2

The use of Edaravone, given orally, for the treatment of amyotrophic lateral sclerosis (ALS) was officially approved by the Federal Drug Association (FDA) in 2017. ALS is a rare and progressive degenerative disease that worsens over time. It attacks and destroys the nerve cells that control voluntary muscles, thus leading to weakness, eventual paralysis, and, ultimately death. Edaravone was given initially intravenously, but recent evidence shows better results with oral suspension. This narrative review is aimed to investigate the benefit of Edaravone for the management of ALS, compare it to Riluzole, discuss its mechanism of action, route of use, and side effects, and ultimately discuss future implications of this pharmacotherapy.

To the Editor-Despite advances in recent years to end the tuberculosis (TB) epidemic and global efforts to reduce its prevalence, the disease remains a burden on public health in several countries. In Latin America and the Caribbean, the situation is no different. With incidence rates of 61.2 per 100,000 population in the Caribbean, 46.2 in South America, and 25.9 in Mexico and Central America, the region is at risk of falling short of the "End TB Strategy" goals. 1 TB transmission correlates with susceptible populations, which include the socioeconomically disadvantaged, migrants, ethnic minorities, individuals with comorbidities (eg, human immunodeficiency virus [HIV]), and persons deprived of their liberty (PDL). According to the World Health Organization (WHO), the incidence rate of TB is 100 times greater among inmates compared to the general population, and TB in PDL continues to increase because of gross neglect. 1 The disparity between prison and civilian TB control measures and the lack of policies to safeguard prison healthcare are the primary concerns. Overcrowding in prisons of Central and South America contributed to a 206% average increase in TB since 2000, higher than in any region. PDL TB in this region increased from 5% of the total reported cases in 2011 to 11.1% in 2017. 2 El Salvador, for example, had the greatest increase of 411% among TB PDL, with a corresponding increase in TB of 51.5%, in 2017. 3 In Brazil, the increase in the incarceration rate has led to more PDL than capacity in detention centers, with average occupancy at 161% of availability. A similar trend has been noted in other American countries. 4 Both the prison environment and host factors are responsible for TB surges. Globally, prisons have limited access to healthcare and medical facilities, lack of well-trained medical staff, an insufficient supply of newly updated quality medicine regimen, poor ventilation and sanitation, deficient new and upgraded diagnostic approach and laboratories, and malnutrition. These factors tend to be more conspicuous in Latin America. 5,6 Additionally, PDL are highly associated with low socioeconomic backgrounds, limited access to health care before incarceration, underprivileged ethnic groups, high tendency of substance misuse, smoking, and sexual

In the current literature, there is no consensus as to whether the medial pivot (MP) or posterior-stabilised (PS) knee provides the best result for the patient in the context of post-operative range of motion (ROM) and patient reported outcome measures (PROMs). The aim of this systematic review is to provide this equipoise with some clarity. We conducted this study following both the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement (PRISMA) and the Cochrane Handbook for systematic reviews and meta-analysis. Studies comparing the MP and PS knees from all regions and written in any language were included. Twenty- one studies were included in this meta-analysis. They were prepared and analysed using Review Manager V5.0 [Computer Program] (RevMan5). We calculated the risk ratio to measure the treatment effect, taking the heterogeneity of the studies into consideration. Random-effect models were also utilised. MP knees were found to have a significant advantage over PS knees in terms of WOMAC score at the midterm follow up, and insignificant advantages over PS knees in terms of ROM and FJS at one and two years follow- up. Additionally, the PS knees demonstrated an in significantly higher Knee Society Score (KSS) at short and midterm follow up. In terms of ROM, KSS, OKS and FJS this meta-analysis suggests a non-significant advantages for the MP knee compared with the PS prothesis in the short term. The MP implant also showed a significantly superior WOMAC score at short-term follow-up. An extended follow-up period is required to evaluate whether the MP knee is superior than the PS in the long-term.