Integrating health planning and primary care infrastructure for COVID-19 and tuberculosis care in India: Challenges and opportunities.

Tuberculosis (TB) is the leading cause of death from a single infectious agent worldwide. The COVID-19 pandemic has overburdened healthcare services around the world especially in resource constrained settings. It has shaken already unstable foundation of TB control programs in India and other high burden states. A 25% decline is expected in TB detection while estimates suggest 13% increase in TB deaths due to the impact of the pandemic. However, the significant intersections between the two diseases perhaps offer potential opportunities for consolidating the efforts to tackle both. The widespread implementation and acceptance of universal masking and social distancing in India has helped limit transmission of both diseases. Integrating the capacity building strategies for the two diseases, optimizing the existing the surveillance and monitoring systems which have been achieved over the years will result in a single vertically integrated national program addressing both, rather than multiple parallel program which utilize the already sparse primary care manpower and infrastructure. In this article, we explore the impact of the COVID-19 pandemic on tuberculosis in India and offer suggestions on how effective health planning can efficiently integrate infrastructure and manpower at primary level to provide care for both COVID-19 and tuberculosis.

Post-Discharge Prophylactic Anticoagulation in COVID-19 Patients: A Clinical Dilemma.

BACKGROUND: COVID-19 pandemic has taken a great toll on the health care system worldwide. Along with the pandemic, there is also a concern regarding post COVID-19 complications in recovered patients. Thromboembolism (TE) has been reported as a fatal complication in recovered patients with COVID-19. There is still a great dilemma in post-discharge TE prophylaxis and its long-term benefits. CASE DESCRIPTION: We reported three cases of post COVID-19 with complications related to both diseases as well as post discharge anticoagulant therapy. The first case is about a 60-yr-old male who developed Covid-19 pneumonia (moderate disease) and was discharged on rivaroxaban after initial improvement. 3 weeks later, the patient was readmitted with lower gastro-intestinal bleeding. The other two cases developed pulmonary thromboembolism within a span of 2-3 months (after recovered from COVID-19 pneumonia). Both these patients were not prescribed anticoagulants for TE prophylaxis. CONCLUSION: There is an imperative need for effective guidelines for post discharge TE prophylaxis in COVID-19.

COVID-19 and Neurology: An Emerging Association.

BACKGROUND: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus, which is a cause of the ongoing pandemic, has the potential to infect the nervous system and cause neurological manifestations. However, patients with primarily neurological symptoms are often overlooked, therefore, they are being tested later. OBJECTIVE: We aim to summarize all the neurological manifestations that have been reported so far, to aid in early diagnosis and prevent further complications of the disease. METHODS: We did a literature search on the topic through Google Scholar, PubMed, and WHO resources by keywords, including coronavirus, SARS-CoV-2, COVID-19, clinical features, stroke, transverse myelitis, encephalitis, encephalopathy, Guillain-Barre syndrome, hypogeusia, hyposmia, anosmia, and neurological manifestations. DISCUSSION: SARS-CoV-2 can affect the neuronal cells by both direct and indirect mechanisms. This can lead to various neurological manifestations ranging from subtle symptoms of myalgia, headache, dizziness, hypogeusia, hyposmia to dreaded complications like stroke, encephalitis, demyelinating disease like Guillain-Barre syndrome. CONCLUSION: Presentation of COVID-19 with neurological features is not uncommon, and these patients should be tested earlier to help in the prevention of transmission, early diagnosis, and management.

Endocrine Involvement in COVID-19: Mechanisms, Clinical Features, and Implications for Care.

Coronavirus 2019 (COVID -19) has rapidly emerged as a global pandemic with multi-system involvement. Involvement of the endocrine system is expected in COVID-19 as the interplay between severe acute respiratory syndrome corona virus-2 (SARS CoV-2) and the endocrine system occurs at multiple levels. The widespread presence of ACE-2 receptors on various tissues suggests scope for direct viral infection. The interactions via the activation of inflammatory mediators and indirect immune-mediated damage are also postulated. Evidence so far suggests that COVID-19 can cause functional hypopituitarism by direct and indirect effects on the hypothalamo-pituitary axis resulting in inappropriate adrenal response to stress. Several reports highlight possible immune-mediated damage to thyroid glands resulting in subacute thyroiditis. COVID-19 is implicated in precipitating hyperglycemia in known diabetics and uncovering insulin resistance in those previously undiagnosed. COVID-19 has also been shown to trigger Type 1 Diabetes with ketosis. Various mechanisms including direct virus-induced beta cell apoptosis and immune-mediated beta-cell damage have been demonstrated. The presence of virus in semen has unclear clinical significance at present. In this mini-review summarize the endocrine manifestations reported so far in COVID-19 disease and explore mechanisms to decipher how SARS CoV-2 may affect various endocrine organs.