Poliomyelitis: historical facts, epidemiology, and current challenges in eradication

Survivorship of total knee arthroplasty in poliomyelitis patients: long-term results from the R.I.P.O. registry and single-institution retrospective study

INTRODUCTION

The survival of total knee arthroplasty (TKA) in patients with poliomyelitis remains a debated topic due to the high recurrence of postoperative genu recurvatum. This study aims to report the long-term survival of TKA in patients with poliomyelitis, using data from the Italian Register of Prosthetic Implantology.

MATERIALS AND METHODS

A registry-based population study was conducted, utilizing data from the Emilia Romagna orthopedic arthroplasty implants registry (RIPO - Registro Implantologia Protesica Ortopedica). The cohort consisted of 71 patients with poliomyelitis-related arthritis who underwent TKA. The study assessed and analyzed demographic data, implant type, fixation method, insert type, and level of constraint. Additionally, variations in preoperative and postoperative both clinical and functional Knee Society Scores (KSS) were collected.

RESULTS

Eight implants required revision surgery (16%), and three patients died (6.1%), resulting in a 10-year survival rate of 86.6% and a 15-year survival rate of 53.9%. Aseptic loosening was the primary cause of revision, accounting for 37.5% of failures, followed by insert wear (25%). No statistically significant correlation was found between the level of constraint and implant survival (p=0.0887, log-rank). Both the clinical and functional KSS improved postoperatively.

CONCLUSION

TKA is a viable alternative to knee arthrodesis and, in properly selected patients, might represent the first-choice treatment for articular degeneration due to its high survivorship. Despite the complexity of these cases, TKA can effectively alleviate articular pain, instability, and angular deviation, thereby preserving knee functionality.

Ageing with (and into) assistive technology: an exploration of the narratives of amputees and polio survivors

PURPOSE

Assistive technologies (AT) perform an important social role, interacting with cultural systems to produce or hinder accessibility to biosocial environments. This interaction profoundly shapes not only how an individual body can be experienced by users but also produce and hinder accessibility to biosocial environments. AT users have historically been viewed through a medical model, which deems them disabled by their impairments and by dominant ableist narratives. Therefore, this paper serves to provide an insight into the importance of ageing with and into AT. This paper aims to investigate polio survivors' and diabetic amputees' experiences of assistive technologies in order to better understand impacts upon narrative and identity. By applying an anthropological and sociological lens, a holistic view of the experiences of polio survivor and amputee AT users is developed.

METHOD

This paper draws on 16 in-depth interviews with polio survivors and diabetic amputees in the United States (US) and Australia, which were analysed using an experience-centered narrative approach. Both projects were approved by ethics boards. All participants provided written consent.

RESULTS

Five themes were identified: a) disruption to biographies, which reflected AT impact on how narratives become altered; b) impacts to autonomy, which reflected the importance of regaining previous daily activities; c) re-engaging with community life, which highlighted how AT supported participation in valued activities; d) self-perceptions of assistive technologies, which act in opposition to external perspectives and challenge ableist narratives; and e) an intergenerational comparison of new and older AT users highlights the importance of temporalities.

CONCLUSION

This paper offers new perspectives on ageing with assistive technologies, with a focus on identity and narrative. The importance of this paper is to contribute to the existing literature that demonstrates the cultural implications that arise through embodiment and assistive technologies.IMPLICATIONS FOR REHABILITATIONThe use of assistive technology can help individuals regain function, but the individual circumstances require considerationThe use of assistive technology is a complex entanglement of bodies, environments, biographies, and imagined futures.The use of assistive technology can provide participants autonomy over their narratives and assist with maintaining their identities.

Peripheral nervous system and neuromuscular disorders in the emergency department: A review

INTRODUCTION

Acute presentations and emergencies in neuromuscular disorders (NMDs) often challenge clinical acumen. The objective of this review is to refine the reader's approach to history taking, clinical localization and early diagnosis, as well as emergency management of neuromuscular emergencies.

METHODS

An extensive literature search was performed to identify relevant studies. We prioritized meta-analysis, systematic reviews, and position statements where possible to inform any recommendations.

SUMMARY

The spectrum of clinical presentations and etiologies ranges from neurotoxic envenomation or infection to autoimmune disease such as Guillain-Barré Syndrome (GBS) and myasthenia gravis (MG). Delayed diagnosis is not uncommon when presentations occur "de novo," respiratory failure is dominant or isolated, or in the case of atypical scenarios such as GBS variants, severe autonomic dysfunction, or rhabdomyolysis. Diseases of the central nervous system, systemic and musculoskeletal disorders can mimic presentations in neuromuscular disorders.

CONCLUSIONS

Fortunately, early diagnosis and management can improve prognosis. This article provides a comprehensive review of acute presentations in neuromuscular disorders relevant for the emergency physician.

Stem Cell Transplant in Immune-deficiency-associated Vaccine-derived Poliovirus

Patients with severe primary immunodeficiency are at risk for complications from live-attenuated vaccines. Here, we report a case of a vaccine-associated paralytic polio and Bacille Calmette-Guérin disease in a 6-month-old girl with severe combined immunodeficiency resulting from homozygous recombinant activating gene 1 deficiency. The patient was successfully treated with intravenous immunoglobulins and oral pocapavir for poliovirus, and antimycobacterial therapy for regional Bacille Calmette-Guérin disease, allowing stem cell transplant. Following transplantation, poliovirus type 3 with 13 mutations was detected from cerebrospinal fluid but not from stool, indicating ongoing viral evolution in the central nervous system despite pocapavir treatment. Clinical improvement and immune reconstitution allowed the patient to be successfully discharged with no further detection of poliovirus.

Temporal and spatial distribution trends of polio vaccine coverage in less than one-year old children in Brazil, 2011-2021

BACKGROUND

Low polio vaccine coverage can result in the spread of Poliovirus to areas free from viral circulation. This study analyzed the temporal trends and spatial distribution of polio vaccine coverage in one year-old children in Brazil, between 2011 and 2021.

METHODS

This was an ecological, time-series study (2011 to 2021) with annual vaccine coverages against poliomyelitis, extracted from the Information System of the National Immunization Program from the 26 States and the Distrito Federal (DF). The percentage reductions in vaccination coverage in Brazil and in the Regions were calculated. Prais-Winsten regression models were used to analyze time series for the Regions and States, and spatial analysis identified the distribution of clusters (high-high; low-low; high-low and low-high) of vaccination coverages across Brazilian municipalities, using a 5% significance level.

RESULTS

From 2011 to 2021, the coverage of polio vaccines decreased by 29,9%. There was a progressive increase observed in clusters resulting in low vaccination coverages (140 low-low Brazilian municipalities in 2011 vs. 403 in 2021), mostly reported in the North and Northeast regions of the country. There was a downward trend in vaccination coverages in 24 of the 26 States and DF (p ≤ 0.05).

CONCLUSIONS

The reduction in polio vaccine coverage, as observed in the North and Northeast regions of Brazil, may favor the spread of Poliovirus. Therefore, vaccination strategies should be prioritized for children residing in areas with sharp and recurrent declines in vaccination coverages, including travelers, migrants, and refugees.

Oncolytic virotherapies for pediatric tumors

INTRODUCTION

Many pediatric patients with malignant tumors continue to suffer poor outcomes. The current standard of care includes maximum safe surgical resection followed by chemotherapy and radiation which may be associated with considerable long-term morbidity. The emergence of oncolytic virotherapy (OVT) may provide an alternative or adjuvant treatment for pediatric oncology patients.

AREAS COVERED

We reviewed seven virus types that have been investigated in past or ongoing pediatric tumor clinical trials: adenovirus (AdV-tk, Celyvir, DNX-2401, VCN-01, Ad-TD-nsIL-12), herpes simplex virus (G207, HSV-1716), vaccinia (JX-594), reovirus (pelareorep), poliovirus (PVSRIPO), measles virus (MV-NIS), and Senecavirus A (SVV-001). For each virus, we discuss the mechanism of tumor-specific replication and cytotoxicity as well as key findings of preclinical and clinical studies.

EXPERT OPINION

Substantial progress has been made in the past 10 years regarding the clinical use of OVT. From our review, OVT has favorable safety profiles compared to chemotherapy and radiation treatment. However, the antitumor effects of OVT remain variable depending on tumor type and viral agent used. Although the widespread adoption of OVT faces many challenges, we are optimistic that OVT will play an important role alongside standard chemotherapy and radiotherapy for the treatment of malignant pediatric solid tumors in the future.

The Fight against Poliovirus Is Not Over

Poliovirus (PV), the virus that causes both acute poliomyelitis and post-polio syndrome, is classified within the Enterovirus C species, and there are three wild PV serotypes: WPV1, WPV2 and WPV3. The launch of the Global Polio Eradication Initiative (GPEI) in 1988 eradicated two of the three serotypes of WPV (WPV2 and WPV3). However, the endemic transmission of WPV1 persists in Afghanistan and Pakistan in 2022. There are cases of paralytic polio due to the loss of viral attenuation in the oral poliovirus vaccine (OPV), known as vaccine-derived poliovirus (VDPV). Between January 2021 and May 2023, a total of 2141 circulating VDPV (cVDPV) cases were reported in 36 countries worldwide. Because of this risk, inactivated poliovirus (IPV) is being used more widely, and attenuated PV2 has been removed from OPV formulations to obtain bivalent OPV (containing only types 1 and 3). In order to avoid the reversion of attenuated OPV strains, the new OPV, which is more stable due to genome-wide modifications, as well as sabin IPV and virus-like particle (VLP) vaccines, is being developed and offers promising solutions for eradicating WP1 and VDPV.

Public opinion changing patterns under the double-hazard scenario of natural disaster and public health event

In the context of the COVID-19 epidemic, a "double-hazard scenario" consisting of a natural disaster and a public health event occurring simultaneously is likely to arise. Focusing on this double-hazard scenario, this study developed a new opinion dynamics model that verifies the effect of opinion dynamic in practical applications and extends the realistic meaning of the logic matrix. The new model can be used to quickly identify changing trends in public opinion about two co-occurring public safety events in China, helping the government to better anticipate and respond to these real double-hazard scenarios. The new model was tested with three real double-hazard scenarios involving natural disasters and public health events in China and the simulation results were analyzed. Using visualization and Pearson correlation coefficients to analyze more than a million items of network-wide public opinion data, the new model was found to show a good fit with reality. The study finally found that in China, public attention to both natural hazards and public health events was greater when these public safety events co-occurred (double-hazard scenario) than when they occurred separately (single-hazard scenarios). These results verify the coupling phenomenon of different disasters in a multi-hazard scenario at the information level for the first time, which is greatly meaningful for multi-hazard research.

Public health concerns surrounding the cVDPV2 outbreak in Africa: Strategies for prevention and control with a special focus on Nigeria

Background and Aim

Poliovirus is a global health issue that affects children in different parts of the world. Despite the efforts of national, international, and nongovernmental organizations to eradicate the disease, it is re-emerging in Africa due to poor sanitation, vaccine hesitancy, new ways of transmission, and poor surveillance among others. Circulating vaccine-derived poliovirus type 2 (cVDPV2) is a major step in eradicating poliovirus and preventing outbreaks in developing countries. Strengthening African healthcare systems, increasing surveillance, hygiene and sanitation, and proper mass vaccination to achieve herd immunity are required in the fight against polio disease. This paper discusses the outbreak of cVDPV2, public health challenges, and recommendations in Africa with a special emphasis on Nigeria.

Methods

We searched for articles documenting the incidence of cVDPV2 in Nigeria and other African countries on Pubmed, Google Scholar, and Scopus.

Results

A total of 68 distinct cVDPV2 genetic emergences were found across 34 nations between April 2016 to December 2020, and in Nigeria, three cVDPV2 emergences were found. Also, 1596 instances of acute flaccid paralysis linked to cVDPV2 outbreaks were reported in four areas of the World Health Organization where Africa contributed 962 cases out of 1596 cases. Available data indicate that Africa has the most cVDPV2 cases and is associated with various challenges like the unidentified virus source, poor sanitation system, and inability to achieve herd immunity of the cVDPV2 vaccine.

Conclusion

Collaborative efforts of stakeholders are crucial in combating infectious diseases, especially those transmitted via environments such as water and air, like poliovirus. Therefore, a collaboration between environmental health workers, veterinarians, community health workers, laboratory scientists, policymakers, and other professionals is required.

Response to back-to-back outbreaks of circulating vaccine-derived poliovirus type 2 in two nomadic pastoralist settlements in Oti Region, Ghana-2019

BACKGROUND

The global switch from trivalent oral poliovirus vaccine (OPV) to bivalent OPV in April 2016 without corresponding co-administration of inactivated poliovirus vaccine (IPV) until June 2018, created a cohort of poliovirus type 2 naïve children with risk of developing vaccine-derived poliovirus type 2 (VDPV2). In November and December 2019, two cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) were confirmed in quick succession through Acute Flaccid Paralysis (AFP) surveillance in two nomadic pastoralist settlements in Oti Region. We investigated to determine the outbreak extent, identify risk factors and implement control and preventive measures.

METHODS

We interviewed case-patients' families, abstracted immunization records, assessed AFP surveillance and conducted rapid OPV and IPV vaccination coverage surveys. Using AFP case definition of any child less than 15 years in the community with sudden onset of paralysis from July to November 2019 (in case-patient 1's district) and August to December 2019 (in case-patient 2's district), we conducted active case search. Stool samples from apparently healthy children and close contacts of the case-patients were collected and tested for poliovirus. We conducted environmental assessment of the community to identify potential risk factors.

RESULTS

Case-patient 1 was an eight-year-old female who had taken two doses of OPV while case-patient 2 was an eight-month-old male who had taken three out of required four OPV doses in addition to IPV at seven months. Families of both case-patients had either travelled to or received visitors from areas with confirmed cVDPV2. Of all children surveyed, eight (29.6%) of 27 and three (18.8%) of 16 eligible children in communities of case-patient 1 and 2 respectively had received required four doses of OPV. No AFP case was found in both communities and surrounding settlements. Both communities had no source of potable water and toilet facilities. A stool sample from a contact of case-patient 1 tested positive for cVDPV2.

CONCLUSION

Outbreaks of cVDPV2 occurred in insanitary, under-vaccinated nomadic pastoralist settlements in Oti Region. Three rounds of monovalent OPV vaccination campaigns for children under 5 years of age in the districts and region as well as countrywide IPV vaccination campaign for poliovirus type 2 naïve cohort were conducted.

Emerging Recombinant Oncolytic Poliovirus Therapies Against Malignant Glioma: A Review

Glioblastoma multiforme (GBM) is a fourth-grade malignant glioma that continues to be the main contributor to primary malignant brain tumour-related death in humans. The most prevalent primary brain tumours are gliomas. The most dangerous of these neoplasms, GBM, has been shown to be one of the most lethal and refractory tumours. For those who have been diagnosed with GBM, the median time to progression, as determined by magnetic resonance imaging, is roughly six months, and the median survival is approximately one year. GBM is challenging to manage with old treatments like chemotherapy, tumour debulking, and radiation therapy. Treatment outcomes are poor, and due to this effect, the treatment is not up to the mark. GBM also shows diagnostic complexity due to limitations in the use of specific targeted therapies. The treatment protocol followed currently has an entire focus on safe resection and radiotherapy. Protein synthesis is not tightly regulated physiologically in malignant cells, which promotes unchecked growth and proliferation. An innovative, experimental technique for treating cancer uses polioviruses that have been genetically altered to target a fascinating aberration of translation regulation in cancer. This approach enables precise and effective cancer cell targeting based on the convergence of numerous variables. Oncolytic viruses have revolutionised cancer treatment. However, their effectiveness in glioblastoma remains restricted, necessitating more improvement. Oncolytic poliovirus has shown great potential in the treatment of GBM. Factors like the blood-brain barrier, immunosuppressive tumour microenvironment (TME), and tumour heterogeneity make treatment for malignant gliomas ineffective. In this review, we have focused on oncolytic viruses, specifically oncolytic poliovirus, and we explore malignant glioma treatments. We have also discussed currently available conventional treatment options for malignant glioma and other brain tumours.

A review of the DTaP-IPV-HB-PRP-T Hexavalent vaccine in pediatric patients

INTRODUCTION

Hexaxim is a hexavalent vaccine approved as primary and booster vaccination in infants 6 weeks and older, protecting against diphtheria, tetanus, pertussis, poliomyelitis, hepatitis B and Haemophilus influenzae type b.

AREAS COVERED

To evaluate the immunogenicity and reactogenicity (safety) of Hexaxim (Hexyon, Hexacima) in primary and booster vaccine schedules; long-term antibody persistence; concomitant use with other childhood vaccines and use in immunocompromised infants. Hexaxim was found to be noninferior to other licensed hexavalent vaccines, being highly immunogenic for all toxoids/antigens and with an acceptable safety profile. It can be administered concomitantly with other childhood vaccines. Hexaxim can be given as a booster for infants primed with Infanrix Hexa and given in a pentavalent-hexavalent-pentavalent series. Hexaxim elicits a similar immune response and safety profile in human immunodeficiency virus (HIV) positive infants. It has the benefit of being a ready-to-use liquid formulation, minimizing dosage errors and preparation time.

EXPERT OPINION

Hexaxim has an acceptable safety profile and provides immunity against all six targeted diseases. It is an acceptable alternative to other hexavalent vaccines on the market. Further studies are required on the use of immunocompromised patients as well as the antibody persistence of each of the vaccine components.

Global polio eradication; can we replicate the smallpox success story?

Although the Global Polio Eradication Initiative has been largely successful in elimination of polio from various parts of the world, sporadic local outbreaks in non-endemic areas continue to pose a threat to global polio eradication efforts. In the two endemic countries, Pakistan and Afghanistan, a staggering 176 cases of wild poliovirus 1 (WPV1) were reported in 2019. In 2020 alone, 959 cases of Circulating Vaccine Derived Poliovirus 2 were reported globally from 27 countries. After staying polio-free for years, cases of WPV were detected in Malawi and Mozambique in 2022. The roots of the reported strains matched with the WPV strain from Pakistan. The emergence of WPV cases in Malawi and Mozambique underscores the fact that WPV still has the chance to spread beyond the Afghanistan-Pakistan region and sustained efforts are required for its complete eradication. In the case of smallpox, surveillance-containment was the key to eradication as many countries had already eradicated smallpox and the bigger concern was to track and contain any new cases emerging. Smallpox eradication followed a comprehensive plan which included elements like quality control and standardisation of vaccination protocols. Governments all over the world should prioritise immunisation drives, surveillance, and awareness campaigns to achieve the dream of a polio-free world.

Poliovirus returns to the UK after nearly 40 years: current efforts and future recommendations

On 22 June 2022, the UK Health Security Agency declared a 'rare national incidence' after finding poliovirus in sewage in London for the first time in nearly 40 years. Although no cases of the disease or accompanying paralysis have been documented, the general public's risk is considered minimal. However, public health experts recommend that families are up to date on their polio vaccines to decrease the chance of harm. This article discusses the epidemiology of poliovirus by examining the aetiology of the disease and current mitigation policies implemented to prevent the spread of type 2 vaccine-deceived poliovirus in the UK. Finally, by examining the clinical features of polio, which range from mild gastroenteritis episodes, respiratory sickness, malaise and severe paralysis type, this article offers an advice on particular therapies and tactics to avoid poliovirus outbreaks and other future outbreaks.

Tonsillectomy and poliomyelitis: Development of causality

OBJECTIVE

This paper serves to review the historical progression of clinical, epidemiological and immunological evidence on the relationship between tonsillectomy and poliomyelitis and its influence on clinical medicine.

METHODS

A literature review was conducted using terms relating to poliomyelitis, tonsillectomy, and immunology. Primary sources published between 1900 and 2000 were reviewed, analyzed and evaluated based on their historical, clinical, epidemiological, scientific and immunological pertinence towards the relationship between tonsillectomy, and poliomyelitis during epidemics.

RESULTS

The first study proposing a relationship between poliomyelitis and tonsillectomy was a case report published in 1910 by Phillip Sheppard. In response, other physicians began conducting clinical and epidemiological studies investigating the relationship between recent tonsillectomy and poliomyelitis in children. While the results of many of these studies demonstrated an increased morbidity and mortality rate associated with poliomyelitis in children who underwent recent tonsillectomy, other studies claimed there was no connection. Opposing study results and diverging physician views on this relationship left the medical community divided on whether to recommend against elective tonsillectomies during poliomyelitis outbreaks. The relationship between tonsillectomy and poliomyelitis was established after many years of clinical and epidemiological studies. Further scientific and immunological investigations revealed the causal nature of this relationship.

Importance of Population Education in Implementation of Compulsory Immunization Against Polyomyelitis in Children

Poliomyelitis is a contagious disease characterized by the appearance of fever, malaise, scratching in the throat, gastrointestinal signs, and after a few days the appearance of muscle paralysis, as well as respiratory and vasomotor disorders. Today, this disease is very rare, due to systemic active immunization. The aim of this study was to assess the level of knowledge and attitudes toward poliomyelitis and importance of immunization against it.

A specially designed survey questionnaire was used for interviewing purposes. Data analysis and processing were performed using a statistical data processing package (SPSS for Windows, version 20). A chi-square test was used from the statistical tests.

The educated profile of the respondents was as follows: medical sciences - 37 (50%), natural sciences and mathematics - 6 (8,1%), social sciences - 5 (6,8%), technical sciences - 19 (25,7%) and arts - 7 (9,5%). The study findings indicate a high level of awareness and knowledge of the population regarding polio, as well as good health awareness of the population about immunization i.e. polio vaccination. 34 respondents from the field of medical education answered the question exactly how the vaccine protects against the disease. In the field of natural mathematical sciences, a total of 3 gave the correct answer, which makes 50% of the total number of persons (6) in the mentioned field. In addition, majority of the study sample (70,3%) is aware that child should be vaccinated. Furthermore, 91,9% of respondents agree that education of parents regarding children vaccination is of great importance for whole community.

Based on findings of present study it can be concluded that efforts still need to be made in education of the wider population toward polio and the importance of vaccination. In addition to healthcare professionals, the entire community should participate in this strategic task.

Evaluation of the Acute Flaccid Paralysis Virological Surveillance System in Polio-Free Morocco, 2010–2018

Background. The goal of Acute flaccid paralysis (AFP) surveillance is to comprehensively investigate and report any case of a child below 15 years with a floppy weakness. This is essential for the poliovirus eradication initiative. Objective. In this study, we analyzed the results of nine-year surveillance (2010–2018) of AFP in Morocco. Method. This was a descriptive, retrospective study of cases with AFP routinely documented at the National Referral Laboratory of Polio (NRLP) from 2010 to 2018. Results. Among the 884 AFP cases identified and analyzed, we identified 11 polioviruses as Sabin-like vaccine strains (PSL). PSL were isolated in 11 samples of AFP cases received at the laboratory, including one PSL1, three PSL2 + PSL3, one PSL1 + PSL2, and one PSL1 + 2 + 3. The annualized nonpolio AFP rate per 100,000 children under 15 years ranged from 0.84 during 2011–2015 to 2.29 in 2018. The stool adequacy indicator was poor and may be improved with better delivery times and maintaining the cold chain. The incidence of isolated nonpolio enteroviruses (NPEV) varied between 2.27% and 12.6%, with the average not exceeding 6.35%; the incidence remained low compared to the indicator set by the World Health Organization (WHO). Conclusion. Morocco was certified polio-free by WHO in 2015, and since then no cases of wild poliovirus have been reported. Overall, although the nonpolio AFP rate has risen to the WHO standard, stool adequacy and the proportion of nonpolio enteroviruses need to be improved. The laboratory can adopt alternative techniques, independent of cell culture, to ensure that imported cases of poliovirus are not missed, especially in this era of eradication.

Ganoderma lucidum: Unutilized natural medicine and promising future solution to emerging diseases in Africa

Ganoderma lucidum is a well-known medicinal mushroom that has been used for the prevention and treatment of different ailments to enhance longevity and health specifically in China, Japan, and Korea. It was known as "God's herb" in ancient China as it was believed to prolong life, enhance the youthful spirit and sustain/preserve vitality. G. lucidum is seldom collected from nature and is substantially cultivated on wood logs and sawdust in plastic bags or bottles to meet the international market demand. Both in vitro and in vivo studies on the copious metabolic activities of G. lucidum have been carried out. Varied groups of chemical compounds including triterpenoids, polysaccharides, proteins, amino acids, nucleosides, alkaloids, steroids, lactones, lectins, fatty acids, and enzymes with potent pharmacological activities have been isolated from the mycelia and fruiting bodies of G. lucidum. Several researchers have reported the abundance and diversification of its biological actions triggered by these chemical compounds. Triterpenoids and polysaccharides of G. lucidum have been reported to possess cytotoxic, hepatoprotective, antihypertensive, hypocholesterolemic, antihistaminic effects, antioxidant, antimicrobial, anti-inflammatory, hypoglycemic antiallergic, neuroprotective, antitumor, immunomodulatory and antiangiogenic activities. Various formulations have been developed, patented, and utilized as nutraceuticals, cosmeceuticals, and pharmaceuticals from G. lucidum extracts and active compounds. Thus, this review presents current updates on emerging infectious diseases and highlights the scope, dynamics, and advances in infectious disease management with a particular focus on Ganoderma lucidum, an unutilized natural medicine as a promising future solution to emerging diseases in Africa. However, details such as the chemical compound and mode of action of each bioactive against different emerging diseases were not discussed in this study.

Total knee replacements using rotating hinge implants in polio patients: clinical and functional outcomes

Little evidences are available in the literature concerning the outcomes of total knee replacement (TKR) in poliomyelitis patients with severe knee deformities or degeneration. Encouraging results have been reported concerning the use of constrained implants, i.e., rotating hinge knee prosthesis (RHK), compared to less constrained ones. The purpose of this paper is to report our experience with rotating hinge total knee replacement, using only RHK prosthesis, to determine functional results, complications, and survival of TKR in poliomyelitis patients. We performed a retrospective chart review of 14 patients with a history of knee osteoarthritis following poliomyelitis that underwent primary TKR, for a total of 15 surgical procedure (one bilateral case). Preoperative and postoperative clinical measurements have been conducted for all patients using the Knee Society Score (KSS). Hip-knee angle, recurvatum knee angle, and Insall-Salvati index were evaluated with full weight-bearing panoramic view X-ray preoperatively and postoperatively. The 2-year postoperative clinical KSS significantly improved from the preoperative scores. The average clinical KSS improved from 32,9 (range 3-48) preoperatively to 77,4 (range 60-88) postoperatively (P value < 0.005). The average functional KSS improved from 32,5 (range 10-60) preoperatively to 59,4 (range 30-95) postoperatively (P value < 0.005). TKR is a successful treatment in improving knee function and patient's quality of life. Using constrained implants, especially rotating hinge implants in polio patients with a quadriceps muscle weakness, could be a good alternative to maintain a physiological kinematics and reducing the revision rate due to knee instability.

Immunology Meets Bioengineering: Improving the Effectiveness of Glioblastoma Immunotherapy

Glioblastoma (GBM) therapy has seen little change over the past two decades. Surgical excision followed by radiation and chemotherapy is the current gold standard treatment. Immunotherapy techniques have recently transformed many cancer treatments, and GBM is now at the forefront of immunotherapy research. GBM immunotherapy prospects are reviewed here, with an emphasis on immune checkpoint inhibitors and oncolytic viruses. Various forms of nanomaterials to enhance immunotherapy effectiveness are also discussed. For GBM treatment and immunotherapy, we outline the specific properties of nanomaterials. In addition, we provide a short overview of several 3D (bio)printing techniques and their applications in stimulating the GBM microenvironment. Lastly, the susceptibility of GBM cancer cells to the various immunotherapy methods will be addressed.

Household access to basic drinking water, sanitation and hygiene facilities: secondary analysis of data from the demographic and health survey V, 2017-2018

BACKGROUND

In Benin, access to water, sanitation and hygiene (WASH) remains an issue. This study aims to provide an overview of household access to basic WASH services based on nationally representative data.

METHOD

Secondary analyses were run using the 'HOUSEHOLD' dataset of the fifth Demographic and Health Survey 2017-2018. The dependent variables were household access to individual and combined basic WASH services. The characteristics of the household head and those related to the composition, wealth and environment of the household were independent variables. After a descriptive analysis of all study variables, multivariate logistic regression was performed to identify predictors of outcome variables.

RESULTS

The study included 14,156 households. Of these, 63.98% (95% CI = 61.63-66.26), 13.28% (95% CI = 12.10-14.57) and 10.11% (95% CI = 9.19-11.11) had access to individual basic water, sanitation and hygiene facilities, respectively. Also, 3% (95% CI = 2.53-3.56) of households had access to combined basic WASH services. Overall, the richest households and few, and those headed by people aged 30 and over, female and with higher levels of education, were the most likely to have access to individual and combined basic WASH services. In addition, disparities based on the department of residence were observed.

CONCLUSION

The authors suggest a multifactorial approach that addresses the identified determinants.

An alternative to airborne droplet transmission route of SARS-CoV-2, the feco-oral route, as a factor shaping COVID-19 pandemic

The Chinese scenario, a rapid increase in the frequency of SARS-CoV-2 infections and sudden decline, is uncommon worldwide. Enormous differences in COVID-19 severity among individual countries are the striking findings of the pandemics. It has been demonstrated that a mild course of COVID-19 is associated with gastrointestinal symptoms, less inflammatory response, and better prognosis. The presence of SARS-CoV-2 was observed longer in the gastrointestinal tract than in respiratory swabs, promoting feco-oral transmissions and mild virus attenuation. The spread of the pandemic and its severity might, consequently, depends on the dominant environmental route of infection and emerging immunity. We hypothesize that the feco-oral SARS-CoV-2 transmission may help to achieve the long-term immunity against COVID-19, since it enables the continuous contact with viral antigens in the gastrointestinal tract, resulting in lower mortality rate. To conclude, countries producing rice through traditional methods developed rapidly emerging long-lasting population immunity, possibly through increased SARS-CoV-2 antigen exposure in the gastrointestinal tract. Our hypothesis brings attention to this potential route of herd immunity against SARS-CoV-2 which warrants further investigation in the future.

Femoral Shaft Fracture in Post-polio Syndrome Patients: Case Series from a Level-I Trauma Center and Review of Literature

BACKGROUND

Femoral shaft fracture in patients of post-polio syndrome (PPS) represents an uncommon yet complex injury pattern. Poorly developed soft-tissue envelope, decreased muscle bulk, reduced vascularity, regional osteopenia, joint contractures, and altered bony anatomy impose significant surgical challenges. Thorough pre-operative planning is imperative as each case requires individualized approach and method of fixation. The aim of the study was to analyze the clinical outcomes in such patients following fracture fixation and to assess the surgical challenges encountered and provide solutions.

MATERIALS AND METHODS

A retrospective case series of 33 patients with femoral shaft fracture in PPS limbs was undertaken. Mode of injury, method of fixation, surgical time, intra-operative blood loss, union time, and complications were recorded.

RESULTS

Low-energy fall was the most common mechanism of injury (73%). Thirty-three patients underwent fixation with intramedullary nailing being the most common mode (79%). Femoral canal diameter, femoral bow, fracture location and morphology and clinical deformities of the patients are key governing factors that determine the choice of implant. Locking plates, pre-contoured anatomical plates, and titanium elastic nailing system offer an alternative in patients unsuitable for nailing. With no difference between various implants, average time for bone healing was 13.8 ± 4.4 weeks. All patients resumed full weight-bearing mobilization and returned to pre-injury activity status at the end of 6 months post-surgery.

CONCLUSION

With detailed pre-operative work-up, contemplating intra-operative difficulties, individualized surgical plan, careful handling of soft tissues, and availability of back-up implants, good clinical outcomes can be achieved in femur fractures in PPS patients.

Amyotrophic lateral sclerosis mimics

Amyotrophic lateral sclerosis (ALS) is the most common adult-onset motor neuron disorder characterized by progressive degeneration of cortical, bulbar, and spinal motor neurons. When a patient presents with a progressive upper and/or lower motor syndrome, clinicians must pay particular attention to any atypical features in the history and/or clinical examination suggesting an alternate diagnosis, as up to 10% percent of patients initially diagnosed with ALS have a mimic of ALS. ALS is a clinical diagnosis and requires the exclusion of other disorders that may have similar presentations but a more favorable prognosis or an effective therapy. Because there is currently no specific diagnostic biomarker that is sensitive or specific for ALS, understanding the spectrum of clinical presentations of ALS and its mimics is paramount. While true mimics of ALS are rare, the clinician must correctly identify these disorders to avoid the misdiagnosis of ALS and to initiate effective treatment where available.

The Interplay Between Neuroinfections, the Immune System and Neurological Disorders: A Focus on Africa

Neurological disorders related to neuroinfections are highly prevalent in Sub-Saharan Africa (SSA), constituting a major cause of disability and economic burden for patients and society. These include epilepsy, dementia, motor neuron diseases, headache disorders, sleep disorders, and peripheral neuropathy. The highest prevalence of human immunodeficiency virus (HIV) is in SSA. Consequently, there is a high prevalence of neurological disorders associated with HIV infection such as HIV-associated neurocognitive disorders, motor disorders, chronic headaches, and peripheral neuropathy in the region. The pathogenesis of these neurological disorders involves the direct role of the virus, some antiretroviral treatments, and the dysregulated immune system. Furthermore, the high prevalence of epilepsy in SSA (mainly due to perinatal causes) is exacerbated by infections such as toxoplasmosis, neurocysticercosis, onchocerciasis, malaria, bacterial meningitis, tuberculosis, and the immune reactions they elicit. Sleep disorders are another common problem in the region and have been associated with infectious diseases such as human African trypanosomiasis and HIV and involve the activation of the immune system. While most headache disorders are due to benign primary headaches, some secondary headaches are caused by infections (meningitis, encephalitis, brain abscess). HIV and neurosyphilis, both common in SSA, can trigger long-standing immune activation in the central nervous system (CNS) potentially resulting in dementia. Despite the progress achieved in preventing diseases from the poliovirus and retroviruses, these microbes may cause motor neuron diseases in SSA. The immune mechanisms involved in these neurological disorders include increased cytokine levels, immune cells infiltration into the CNS, and autoantibodies. This review focuses on the major neurological disorders relevant to Africa and neuroinfections highly prevalent in SSA, describes the interplay between neuroinfections, immune system, neuroinflammation, and neurological disorders, and how understanding this can be exploited for the development of novel diagnostics and therapeutics for improved patient care.

Inborn errors of TLR3- or MDA5-dependent type I IFN immunity in children with enterovirus rhombencephalitis

Enterovirus (EV) infection rarely results in life-threatening infection of the central nervous system. We report two unrelated children with EV30 and EV71 rhombencephalitis. One patient carries compound heterozygous TLR3 variants (loss-of-function F322fs2* and hypomorphic D280N), and the other is homozygous for an IFIH1 variant (loss-of-function c.1641+1G>C). Their fibroblasts respond poorly to extracellular (TLR3) or intracellular (MDA5) poly(I:C) stimulation. The baseline (TLR3) and EV-responsive (MDA5) levels of IFN-β in the patients’ fibroblasts are low. EV growth is enhanced at early and late time points of infection in TLR3- and MDA5-deficient fibroblasts, respectively. Treatment with exogenous IFN-α2b before infection renders both cell lines resistant to EV30 and EV71, whereas post-infection treatment with IFN-α2b rescues viral susceptibility fully only in MDA5-deficient fibroblasts. Finally, the poly(I:C) and viral phenotypes of fibroblasts are rescued by the expression of WT TLR3 or MDA5. Human TLR3 and MDA5 are critical for cell-intrinsic immunity to EV, via the control of baseline and virus-induced type I IFN production, respectively.

Reviewing Antiviral Research Against Viruses Causing Human Diseases - A Structure Guided Approach

The littlest of all the pathogens, viruses have continuously been the foremost strange microorganisms to consider. Viral Infections can cause extreme sicknesses as archived by the HIV/AIDS widespread or the later Ebola or Zika episodes. Apprehensive framework distortions are too regularly watched results of numerous viral contaminations. Besides, numerous infections are oncoviruses, which can trigger different sorts of cancer. Nearly every year a modern infection species rises debilitating the world populace with an annihilating episode. Subsequently, the need of creating antivirals to combat such rising infections. In any case, from the innovation of to begin with antiviral medicate Idoxuridine in 1962 to the revelation of Baloxavir marboxil (Xofluza) that was FDA-approved in 2018, the hone of creating antivirals has changed significantly. In this article, different auxiliary science strategies have been described that can be referral for therapeutics innovation.

Ilizarov External Fixation for Correcting Complex Postpolio Foot and Ankle Deformity: A Case Study

Given their severity and resultant loss of function, postpoliomyelitic foot and ankle deformities require a unique correction method. Correction with dynamic Ilizarov external fixation is one such modality, although it is technically demanding and requires precise preoperative planning. In our case study, a 40-year-old male with a severe postpoliomyelitic equinocavovarus right foot and ankle deformity was treated with gradual correction using dynamic, hinged Ilizarov external fixation. The external fixation was in place for a total of 103 days, with gradual correction performed in 2 successive steps, achieving a functional, plantigrade foot. We maintained this position in a short leg cast for 30 days, followed by bracing and physiotherapy for 6 months. More than 2 years after the index surgery, the patient had achieved a painless and plantigrade foot, allowing for functional ambulation. This method does not require osteotomies, ankle arthrodesis, or tendon transfer.

Manipulation of Host Cell Organelles by Intracellular Pathogens

Pathogenic intracellular bacteria, parasites and viruses have evolved sophisticated mechanisms to manipulate mammalian host cells to serve as niches for persistence and proliferation. The intracellular lifestyles of pathogens involve the manipulation of membrane-bound organellar compartments of host cells. In this review, we described how normal structural organization and cellular functions of endosomes, endoplasmic reticulum, Golgi apparatus, mitochondria, or lipid droplets are targeted by microbial virulence mechanisms. We focus on the specific interactions of Salmonella, Legionella pneumophila, Rickettsia rickettsii, Chlamydia spp. and Mycobacterium tuberculosis representing intracellular bacterial pathogens, and of Plasmodium spp. and Toxoplasma gondii representing intracellular parasites. The replication strategies of various viruses, i.e., Influenza A virus, Poliovirus, Brome mosaic virus, Epstein-Barr Virus, Hepatitis C virus, severe acute respiratory syndrome virus (SARS), Dengue virus, Zika virus, and others are presented with focus on the specific manipulation of the organelle compartments. We compare the specific features of intracellular lifestyle and replication cycles, and highlight the communalities in mechanisms of manipulation deployed.

Challenging definitions and diagnostic approaches for ancient rare diseases: The case of poliomyelitis

OBJECTIVE

This paper aims to contribute to the definition of ancient rare diseases in skeletons displaying pathologies associated with paralysis. It uses a new suite of methods, which can be applied to challenging cases of possible paralysis in archaeologically-derived human skeletal material, specifically applied to the identification of poliomyelitis.

MATERIALS

An adult male skeleton from Roman Halbturn, Austria.

METHODS

Morphological and entheseal change analyses, CT scans, X-rays, cross-section morphology, and histology, alongside modern clinical, as well as historic, literature were used to discuss paralyses.

RESULTS

The results suggest a diagnosis of poliomyelitis; now considered a rare disease, but perhaps ubiquitous in antiquity, thus complicating the definition of 'rare disease'.

CONCLUSIONS

The integrated methodological procedures employed for this case constitutes a replicable and thorough approach to diagnosis, and explores the nature of ancient rare diseases. Due to the socio-environmental aspects of poliomyelitis transmission, it is likely that polio was likely not rare in the past. Therefore, the definition of 'rare diseases in the past' must include rarely occurring rarely diagnosed diseases due to biases and challenges within the archaeological and environmental record.

SIGNIFICANCE

The developed suite of methods has not been applied to establish a diagnosis of polio in the past.

LIMITATIONS

The individual considered in this study is fairly well-preserved; thus, this set of analyses may not be applicable to all remains where preservation is poor or highly fragmentary, and the discussion of rare diseases requires relatively secure diagnoses and context.

SUGGESTIONS FOR FURTHER RESEARCH

Large collections and series of skeletal human remains are recommended to develop definitive conclusions.

The Current State: Epidemiology and Working Toward Eradication

Acute polio, once epidemic and a significant source of paralysis and disability, has been dramatically reduced through global vaccination programs. Although vaccination efforts have experienced a setback because of COVID-19, resulting in increased number of vaccine-associated and wild virus infections, polio eradication is still a realistic goal that will result in significant cost savings. The secondary health issues related to aging with the residual effects of polio, including postpolio syndrome, will persist for many years posteradication. Continued education of medical professionals is essential to ensure provision of the necessary care to this population.

Acute non-traumatic tetraparesis - Differential diagnosis

INTRODUCTION

Potentially life-threatening disorders may present in the emergency department with acute tetraparesis, and their recognition is crucial for an appropriate management and timely treatment. Our review aims to systematize the differential diagnosis of acute non-traumatic tetraparesis.

RESULTS

Causes of tetraparesis can be classified based on the site of defect: upper motor neuron (UMN), peripheral nerve, neuromuscular junction or muscle. History of present illness should include the distribution of weakness (symmetric/asymmetric or distal/proximal/diffuse) and associated clinical features (pain, sensory findings, dysautonomia, and cranial nerve abnormalities such as diplopia and dysphagia). Neurological examination, particularly tendon reflexes, helps further in the localization of nerve lesions and distinction between UMN and lower motor neuron. Ancillary studies include blood and cerebral spinal fluid analysis, neuroaxis imaging, electromyography, muscle magnetic resonance and muscle biopsy.

CONCLUSIONS

Acute tetraparesis is still a debilitating and potentially serious neurological condition. Despite all the supplementary ancillary tests, the neurological examination is the key to achieve a correct diagnosis. The identification of life-threatening neurologic disorders is pivotal, since failing to identify patients at risk of complications, such as acute respiratory failure, may have catastrophic results.

The lab-confirmed interval of COVID-19 clusters and its application in the strength evaluation of prevention and control measures

BACKGROUND

The lab-confirmed interval is the date from lab confirmation in a core case (infector) to lab confirmation in a second case (infectee); however, its distribution and application are seldom reported. This study aimed to investigate the lab-confirmed interval and its application in the preliminary evaluation of the strength of disease prevention and control measures.

METHODS

Taking European countries and Chinese provinces outside Hubei as examples, we identified 63 infector-infectee pairs from European countries from Wikipedia, and 103 infector-infectee pairs from official public sources in Chinese provinces outside Hubei. The lab-confirmed intervals were obtained through analysis of the collected data and adopting the bootstrap method.

RESULTS

The mean lab-confirmed interval was 2.6 (95% CI: 2.1-3.1) days for Europe and 2.6 (95% CI: 1.9-3.3) days for China outside Hubei, which were shorter than the reported serial intervals. For index patients aged ≥60 years old, the lab-confirmed interval in Europe was slightly longer (mean: 2.9; 95% CI: 2.0-3.6) and obviously longer in China outside Hubei (mean: 3.8; 95% CI: 1.9-5.5) than that for patients aged < 60 years.

CONCLUSION

Investigation of the lab-confirmed interval can provide additional information on the characteristics of emergent outbreaks and can be a feasible indication to evaluate the strength of prevention and control measures. When the lab-confirmed interval was shorter than the serial interval, it could objectively reflect improvements in laboratory capacity and the surveillance of close contacts.

Increased cerebral integrity metrics in poliomyelitis survivors: putative adaptation to longstanding lower motor neuron degeneration

BACKGROUND

Post-polio syndrome (PPS) has been traditionally considered a slowly progressive condition that affects poliomyelitis survivors decades after their initial infection. Cerebral changes in poliomyelitis survivors are poorly characterised and the few existing studies are strikingly conflicting.

OBJECTIVE

The overarching aim of this study is the comprehensive characterisation of cerebral grey and white matter alterations in poliomyelitis survivors with reference to healthy- and disease-controls using quantitative imaging metrics.

METHODS

Thirty-six poliomyelitis survivors, 88 patients with ALS and 117 healthy individuals were recruited in a prospective, single-centre neuroimaging study using uniform MRI acquisition parameters. All participants underwent standardised clinical assessments, T1-weighted structural and diffusion tensor imaging. Whole-brain and region-of-interest morphometric analyses were undertaken to evaluate patterns of grey matter changes. Tract-based spatial statistics were performed to evaluate diffusivity alterations in a study-specific whiter matter skeleton.

RESULTS

In contrast to healthy controls, poliomyelitis survivors exhibited increased grey matter partial volumes in the brainstem, cerebellum and occipital lobe, accompanied by increased FA in the corticospinal tracts, cerebellum, bilateral mesial temporal lobes and inferior frontal tracts. Polio survivors exhibited increased integrity metrics in the same anatomical regions where ALS patients showed degenerative changes.

CONCLUSIONS

Our findings indicate considerable cortical and white matter reorganisation in poliomyelitis survivors which may be interpreted as compensatory, adaptive change in response to severe lower motor neuron injury in infancy.

Immunovirotherapy for the Treatment of Glioblastoma and Other Malignant Gliomas

Glioblastoma multiforme (GBM) represents one of the most challenging malignancies due to many factors including invasiveness, heterogeneity, and an immunosuppressive microenvironment. Current treatment modalities have resulted in only modest effect on outcomes. The development of viral vectors for oncolytic immunovirotherapy and targeted drug delivery represents a promising therapeutic prospect for GBM and other brain tumors. A host of genetically engineered viruses, herpes simplex virus, poliovirus, measles, and others, have been described and are at various stages of clinical development. Herein we provide a review of the advances and current state of oncolytic virotherapy for the targeted treatment of GBM and malignant gliomas.

Innate Immune Sensing of Viruses and Its Consequences for the Central Nervous System

Viral infections remain a global public health concern and cause a severe societal and economic burden. At the organismal level, the innate immune system is essential for the detection of viruses and constitutes the first line of defense. Viral components are sensed by host pattern recognition receptors (PRRs). PRRs can be further classified based on their localization into Toll-like receptors (TLRs), C-type lectin receptors (CLR), retinoic acid-inducible gene-I (RIG-I)-like receptors (RLRs), NOD-like receptors (NLRs) and cytosolic DNA sensors (CDS). TLR and RLR signaling results in production of type I interferons (IFNα and -β) and pro-inflammatory cytokines in a cell-specific manner, whereas NLR signaling leads to the production of interleukin-1 family proteins. On the other hand, CLRs are capable of sensing glycans present in viral pathogens, which can induce phagocytic, endocytic, antimicrobial, and pro- inflammatory responses. Peripheral immune sensing of viruses and the ensuing cytokine response can significantly affect the central nervous system (CNS). But viruses can also directly enter the CNS via a multitude of routes, such as the nasal epithelium, along nerve fibers connecting to the periphery and as cargo of infiltrating infected cells passing through the blood brain barrier, triggering innate immune sensing and cytokine responses directly in the CNS. Here, we review mechanisms of viral immune sensing and currently recognized consequences for the CNS of innate immune responses to viruses.

Molecular characterization, pathogen-host interaction pathway and in silico approaches for vaccine design against COVID-19

COVID-19 has forsaken the world because of extremely high infection rates and high mortality rates. At present we have neither medicine nor vaccine to prevent this pandemic. Lockdowns, curfews, isolations, quarantines, and social distancing are the only ways to mitigate their infection. This is badly affecting the mental health of people. Hence, there is an urgent need to address this issue. Coronavirus disease 2019 (COVID-19) is caused by a novel Betacorona virus named SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) which has emerged in the city of Wuhan in China and declared a pandemic by WHO since it affected almost all the countries the world, infected 24,182,030 people and caused 825,798 death as per data are compiled from John Hopkins University (JHU). The genome of SARS-CoV-2 has a single-stranded positive (+) sense RNA of ∼30 kb nucleotides. Phylogenetic analysis reveals that SARS-CoV-2 shares the highest nucleotide sequence similarity (∼79 %) with SARS-CoV. Envelope and nucleocapsids are two evolutionary conserved regions of SARS-CoV-2 having a sequence identity of about 96 % and 89.6 %, respectively as compared to SARS-CoV. The characterization of SARS-CoV-2 is based on polymerase chain reaction (PCR) and metagenomic next-generation sequencing. Transmission of this virus in the human occurs through the respiratory tract and decreases the respiration efficiency of lungs. Humans are generally susceptible to SARS-CoV-2 with an incubation period of 2-14 days. The virus first infects the lower airway and bind with angiotensin-converting enzyme 2 (ACE2) of alveolar epithelial cells. Due to the unavailability of drugs or vaccines, it is very urgent to design potential vaccines or drugs for COVID-19. Reverse vaccinology and immunoinformatic play an important role in designing potential vaccines against SARS-CoV-2. The suitable vaccine selects for SARS-CoV-2 based on binding energy between the target protein and the designed vaccine. The stability and activity of the designed vaccine can be estimated by using molecular docking and dynamic simulation approaches. This review mainly focused on the brief up to date information about COVID-19, molecular characterization, pathogen-host interaction pathways involved during COVID-19 infection. It also covers potential vaccine design against COVID-19 by using various computational approaches. SARS-CoV-2 enters brain tissue through the different pathway and harm human's brain and causes severe neurological disruption.

Antiviral Effects of Oleandrin

Over the past 15 years, investigators have reported on the utility and safety of cardiac glycosides for numerous health benefits including those as treatments for malignant disease, stroke-mediated ischemic injury and certain neurodegenerative diseases. In addition to those, there is a growing body of evidence for novel antiviral effects of selected cardiac glycoside molecules. One unique cardiac glycoside, oleandrin derived from Nerium oleander, has been reported to have antiviral activity specifically against 'enveloped' viruses including HIV and HTLV-1. Importantly, a recent publication has presented in vitro evidence for oleandrin's ability to inhibit production of infectious virus particles when used for treatment prior to, as well as after infection by SARS-CoV-2/COVID-19. This review will highlight the known in vitro antiviral effects of oleandrin as well as present previously unpublished effects of this novel cardiac glycoside against Ebola virus, Cytomegalovirus, and Herpes simplex viruses.

Altered supraspinal motor networks in survivors of poliomyelitis: A cortico-muscular coherence study

OBJECTIVE

Poliomyelitis results in changes to the anterior horn cell. The full extent of cortical network changes in the motor physiology of polio survivors has not been established. Our aim was to investigate how focal degeneration of the lower motor neurons (LMN) in infancy/childhood affects motor network connectivity in adult survivors of polio.

METHODS

Surface electroencephalography (EEG) and electromyography (EMG) were recorded during an isometric pincer grip task in 25 patients and 11 healthy controls. Spectral signal analysis of cortico-muscular (EEG-EMG) coherence (CMC) was used to identify the cortical regions that are functionally synchronous and connected to the periphery during the pincer grip task.

RESULTS

A pattern of CMC was noted in polio survivors that was not present in healthy individuals. Significant CMC in low gamma frequency bands (30-47 Hz) was observed in frontal and parietal regions.

CONCLUSION

These findings imply a differential engagement of cortical networks in polio survivors that extends beyond the motor cortex and suggest a disease-related functional reorganisation of the cortical motor network.

SIGNIFICANCE

This research has implications for other similar LMN conditions, including spinal muscular atrophy (SMA). CMC has potential in future clinical trials as a biomarker of altered function in motor networks in post-polio syndrome, SMA, and other related conditions.

History through the eyes of a pandemic

PURPOSE OF REVIEW

This review provides a historic perspective of the impact that major pandemics have had on human and their relationship with ophthalmology. The novel coronavirus epidemic is also analyzed, highlighting the relevance of the eye as a possible source of transmission, infection, and prognosis for the disease.

RESULTS

Smallpox is suspected to be present for more than 12 000 years. However, trachoma seems to be the first recorded ophthalmological infectious disease. The deadliest pandemics include the bubonic plague, smallpox, and Spanish flu. The CoVID-19 epidemic is still developing and measures need to be implemented to prevent further escalation of the crisis.

SUMMARY

Understanding the current facts in light of earlier historical evidence may help us prepare better to minimize the spread of infections in the future.

Oncolytic Virotherapy in Glioma Tumors

Glioma tumors are one of the most devastating cancer types. Glioblastoma is the most advanced stage with the worst prognosis. Current therapies are still unable to provide an effective cure. Recent advances in oncolytic immunotherapy have generated great expectations in the cancer therapy field. The use of oncolytic viruses (OVs) in cancer treatment is one such immune-related therapeutic alternative. OVs have a double oncolytic action by both directly destroying the cancer cells and stimulating a tumor specific immune response to return the ability of tumors to escape the control of the immune system. OVs are one promising alternative to conventional therapies in glioma tumor treatment. Several clinical trials have proven the feasibility of using some viruses to specifically infect tumors, eluding undesired toxic effects in the patient. Here, we revisited the literature to describe the main OVs proposed up to the present moment as therapeutic alternatives in order to destroy glioma cells in vitro and trigger tumor destruction in vivo. Oncolytic viruses were divided with respect to the genome in DNA and RNA viruses. Here, we highlight the results obtained in various clinical trials, which are exploring the use of these agents as an alternative where other approaches provide limited hope.

Using the Past to Maximize the Success Probability of Future Anti-Viral Vaccines

Rapid obtaining of safe, effective, anti-viral vaccines has recently risen to the top of the international agenda. To maximize the success probability of future anti-viral vaccines, the anti-viral vaccines successful in the past are summarized here by virus type and vaccine type. The primary focus is on viruses with both single-stranded RNA genomes and a membrane envelope, given the pandemic past of influenza viruses and coronaviruses. The following conclusion is reached, assuming that success of future strategies is positively correlated with strategies successful in the past. The primary strategy, especially for emerging pandemic viruses, should be development of vaccine antigens that are live-attenuated viruses; the secondary strategy should be development of vaccine antigens that are inactivated virus particles. Support for this conclusion comes from the complexity of immune systems. These conclusions imply the need for a revision in current strategic planning.

COVID-19 and possible links with Parkinson's disease and parkinsonism: from bench to bedside

This Viewpoint discusses insights from basic science and clinical perspectives on coronavirus disease 2019 (COVID-19)/severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection in the brain, with a particular focus on Parkinson's disease. Major points include that neuropathology studies have not answered the central issue of whether the virus enters central nervous system neurons, astrocytes or microglia, and the brain vascular cell types that express virus have not yet been identified. Currently, there is no clear evidence for human neuronal or astrocyte expression of angiotensin-converting enzyme 2 (ACE2), the major receptor for viral entry, but ACE2 expression may be activated by inflammation, and a comparison of healthy and infected brains is important. In contrast to the 1918 influenza pandemic and avian flu, reports of encephalopathy in COVID-19 have been slow to emerge, and there are so far no documented reports of parkinsonism apart from a single case report. We recommend consensus guidelines for the clinical treatment of Parkinson's patients with COVID-19. While a role for the virus in causing or exacerbating Parkinson's disease appears unlikely at this time, aggravation of specific motor and non-motor symptoms has been reported, and it will be important to monitor subjects after recovery, particularly for those with persisting hyposmia.

Enteric Viral Co-Infections: Pathogenesis and Perspective

Enteric viral co-infections, infections involving more than one virus, have been reported for a diverse group of etiological agents, including rotavirus, norovirus, astrovirus, adenovirus, and enteroviruses. These pathogens are causative agents for acute gastroenteritis and diarrheal disease in immunocompetent and immunocompromised individuals of all ages globally. Despite virus–virus co-infection events in the intestine being increasingly detected, little is known about their impact on disease outcomes or human health. Here, we review what is currently known about the clinical prevalence of virus–virus co-infections and how co-infections may influence vaccine responses. While experimental investigations into enteric virus co-infections have been limited, we highlight in vivo and in vitro models with exciting potential to investigate viral co-infections. Many features of virus–virus co-infection mechanisms in the intestine remain unclear, and further research will be critical.

Surveillance optimisation to detect poliovirus in the pre-eradication era: a modelling study of England and Wales

Surveillance for acute flaccid paralysis (AFP) cases are essential for polio eradication. However, as most poliovirus infections are asymptomatic and some regions of the world are inaccessible, additional surveillance tools require development. Within England and Wales, we demonstrate how inclusion of environmental sampling (ENV) improves the sensitivity of detecting both wild and vaccine-derived polioviruses (VDPVs) when compared to current surveillance. Statistical modelling was used to estimate the spatial risk of wild and VDPV importation and circulation in England and Wales. We estimate the sensitivity of each surveillance mode to detect poliovirus and the probability of being free from poliovirus, defined as being below a pre-specified prevalence of infection. Poliovirus risk was higher within local authorities in Manchester, Birmingham, Bradford and London. The sensitivity of detecting wild poliovirus within a given month using AFP and enterovirus surveillance was estimated to be 0.096 (95% CI 0.055–0.134). Inclusion of ENV in the three highest risk local authorities and a site in London increased surveillance sensitivity to 0.192 (95% CI 0.191–0.193). The sensitivity of ENV strategies can be compared using the framework by varying sites and the frequency of sampling. The probability of being free from poliovirus slowly increased from the date of the last case in 1993. ENV within areas thought to have the highest risk improves detection of poliovirus, and has the potential to improve confidence in the polio-free status of England and Wales and detect VDPVs.

Low Appendicular Lean Mass Index and Associations with Metabolic and Demographic Parameters in Wheelchair Athletes with Spinal Cord Injury

BACKGROUND

People suffering from spinal cord injury (SCI) undergo metabolic and physical disturbances that target the skeletal muscle, causing a progressive loss of muscle mass.

OBJECTIVE

To estimate the appendicular lean mass index (ALMI) in athletes with traumatic (T-group) and non-traumatic (NT-group) SCI, and its association with metabolic and demographic parameters.

METHODS

Wheelchair athletes with SCI aged 18 to 52 years old were included (n = 62). From DEXA assessment, we estimated the ALM index (ALMI = appendicular lean mass/height2) and classified participants according to the degree of muscle loss (ALMI < 2 SD from the reference populations). Fasting blood was assayed for glycaemia, insulin, cortisol, and IGF-1 serum levels. Data were compared by T-test and Fisher's Exact Test; predictors of ALMI were investigated by linear regression models.

RESULTS

The frequency of low ALMI was 63% in overall sample, 55% T-group and 71% NT-group. Low ALMI had no significant association with the origin of injury (X2 = 1.1, p = 0.29). Linear regression analyses showed significant association, in the whole sample, between ALMI and serum levels of IGF-1 (Beta = 0.69; p < 0.001), age (Beta=-5.8; p < 0.001), percentage fat mass (Beta=-0.26; p = 0.001), and energy intake (Beta = 0.32; p = 0.02). These significances were not maintained in the NT-group sub-analyses.

CONCLUSIONS

Low ALMI was very frequent in our SCI participants, despite exercising and independently of the type of injury. Metabolic and demographic variables associated with low ALMI were different according to the origin of injury, which possibly relies on physiopathology particularities. More studies are necessary to clarify our findings.

Non-polio enteroviruses among healthy children in the Philippines

BACKGROUND

Enteroviruses (EVs) are most commonly associated with either mild or asymptomatic infections, however, the presence of silent carriers in the community has been proven to play a crucial role in the spread of diseases such as hand, foot, and mouth disease (HFMD) that records high incidence in Asia Pacific region. In the Philippines, limited information is available on the etiology and prevalence of enterovirus outside the Acute Flaccid Paralysis (AFP) surveillance, thus, a study to determine the baseline prevalence of Non-Polio Enteroviruses (NPEVs) among healthy Filipino children was conducted.

METHODS

A descriptive, cross-sectional study was performed to determine the prevalence of NPEV among healthy children under 6 years old in the Philippines. Duplicate stool samples were collected from 360 healthy children residing in three major urban cities in the country. Virus isolation and polymerase chain reaction were performed to identify enteroviruses present in the samples. To determine if the results of the study are comparable to the AFP surveillance data, the results of the study were compared to the prevalence and isolation rate among AFP cases of the similar cases collected the same year.

RESULTS

Prevalence of enteroviruses among healthy children was found to be at 24.7%. Comparing the NPEV rates from the study and AFP surveillance of similar age and the same year of collection, there was no significant difference in NPEV case prevalence. The study identified a total of 19 different enterovirus serotypes with majority belonging to species Enterovirus B (EV-B).

CONCLUSION

The study was able to establish a baseline NPEV case prevalence of 24.7% among healthy children aged under 6 years old in three major urban sites in the Philippines. The high isolation of NPEV among healthy children signifies continuous fecal-oral transmission of enteroviruses in the community.