Objective: To evaluate the effectiveness and safety of ivermectin in patients with mild and moderate COVID-19. Methods: This study was a single-center, randomized, open-label, controlled trial with a 2-arm parallel-group design on 68 patients with COVID-19. According to the 1:1 ratio between the study groups (ivermectin group and standard treatment group), patients were randomly admitted to each intervention arm. Results: The mean age of the participants in the ivermectin group was (48.37±13.32) years. Eighteen of them were males (54.5%) and the participants in the control group had a mean age of (46.28±14.47) years, with nineteen of them being males (59.4%). As a primary outcome, after 5 days of randomization, there was no significant difference between the ivermectin group and the control group in the length of stay in the hospital (P=0.168). ICU admission (P=0.764), length of stay in ICU (P=0.622), in-hospital mortality (P=0.427), adverse drug reactions, and changes in the mean difference of laboratory data had not any significant difference between the two groups (except for urea change). In addition, the radiologic findings of the two groups of patients were not significantly different. Linear regression analysis showed that for every 10 years increase of age, 0.6 day of hospitalization duration was increased. There was no statistically significant association between other variables and clinical outcomes. Conclusions: Among adult hospitalized patients with moderate to severe COVID-19, there was no significant relationship between the administration of ivermectin single dose in a five-day course and clinical improvement, and mortality of the participants.

Objective: To determine the prevalence and risk factors associated with tuberculosis mortality in Brunei Darussalam and to explore its underlying causes. Methods: A retrospective cohort study was conducted where data on socio-demographics, clinical characteristics and treatment outcomes of all tuberculosis patients registered at the National tuberculosis Coordinating Centre between 2013 and 2017 were collected. Overall tuberculosis mortality and the proportion of tuberculosis-related deaths were calculated. Logistic regression analysis was used to determine the risk factors of tuberculosis mortality when compared to those who are cured and/or completed tuberculosis treatment. Results: Of 1 107 tuberculosis cases, 99 died, giving an overall tuberculosis mortality rate of 8.9% (95% CI 7.4%-10.8%). Significant risk factors associated with tuberculosis mortality were age ⩾40 years (adjusted OR for 40-59 years was 3.89; 95% CI 1.13-1.69; adjusted OR for ⩾60 years was 22.3; 95% CI 7.27-91.9, using 20-39 years as reference), female sex (adjusted OR 1.74; 95% CI 1.09-2.79), having renal disease (adjusted OR 25.7; 95% CI 2.82-191.50) and having any cancers (adjusted OR 3.61; 95% CI 1.26-10.00). The majority (75.8%) of the recorded deaths were not related to tuberculosis. Conclusions: Tuberculosis patients who were older than 40 years, female, and having renal disease and any cancer will need close monitoring in their management program to prevent tuberculosis mortality. Clinicians should also focus on other non-tuberculosis aspects of the patient’s medical history.

Objective: To determine the suitable ecological habitats of Aedes (Ae.) aegypti and Ae. albopictus in Iran due to climate change by the 2070s. Methods: All data relating to the spatial distribution of Ae. aegypti and Ae. albopictus worldwide, which indicated the geographical coordinates of the collection sites of these mosquitoes, were extracted from online scientific websites and entered into an Excel file. The effect of climatic and environmental variables on these mosquitoes was evaluated using the MaxEnt model in the current and future climatic conditions in the 2030s, 2050s, and 2070s. Results: The most suitable areas for the establishment of Ae. aegypti are located in the southern and northern coastal areas of Iran, based on the model outputs. The modelling result for suitable ecological niches of Ae. albopictus shows that in the current climatic conditions, the southern half of Iran from east to west, and parts of the northern coasts are prone to the presence of this species. In the future, some regions, such as Gilan and Golestan provinces, will have more potential to exist/establish Ae. albopictus. Also, according to the different climate change scenarios, suitable habitats for this species will gradually change to the northwest and west of the country. The temperature of the wettest season of the year (Bio8) and average annual temperature (Bio1) were the most effective factors in predicting the model for Ae. aegypti and Ae. albopictus, respectively. Conclusions: It is required to focus on entomological studies using different collection methods in the vulnerable areas of Iran. The future modelling results can also be used for long-term planning to prevent the entry and establishment of these invasive Aedes vectors in the country.

Objective: To assess the knowledge of healthcare workers on the measles vaccine and its cold chain management. Method: An institutional-based cross-sectional study was conducted from February 1 to March 30, 2022 in Gondar City Administration public health institutions among 165 healthcare workers. Data were collected using a structured questionnaire. In addition, an on-spot observation checklist was used to assess the availability, status and management of the cold chain. A logistic regression model was used to assess the relationship between the outcome and predictor variables. Crude and adjusted odds ratios were calculated with 95% confidence intervals. Results: Overall, 87 (52.7%; 95% Cl 44.8%-60.5%) of the healthcare workers had unsatisfactory knowledge regarding the measles vaccine and its cold chain management. One hundred thirty-six (82.4%) healthcare workers correctly mentioned the recommended range of temperature (2-8 °C) for measles vaccine storage. Healthcare workers aged 18-29 years (P=0.001) and 30-44 years (P=0.014) were observed as determinants of unsatisfactory knowledge on the measles vaccine and its cold chain management. One hundred and five (63.6%) of the healthcare workers did not correctly mention the type of measles vaccine used in routine immunization. More than one-third (36.4%) of the healthcare workers perceived that the measles vaccine is not safe and could cause measles. Conclusions: More than half of the healthcare workers in the study area had unsatisfactory knowledge on the measles vaccine and its cold chain management. It is necessary to provide technical support and in-service training for healthcare workers to ensure optimal immunization effectiveness.

Objective: To analyze data on socio-demographic and clinical characteristics of SARS-CoV-2 infected population whose samples were received from Medical Research Institute, Sri Lanka. Methods: Laboratory based retrospective study was done on patient samples which were tested positive for SARS-CoV-2 by National Reference Virology Laboratory at the Medical Research Institute, Sri Lanka, from November, 2020 to November, 2021. Data on socio-demographic characteristics and clinical presentation of 13 126 patients were examined. Results: The mean age of the study population was (36.0±7.2) years and the majority were men (64.0%). The highest number of positive cases were found in the 21-30 years-of-age group. Two distinct peaks were noted in the incidence of SARS-CoV-2 positive individuals. In addition, 42.5% of the positive samples tested positive (42.5%) were from Medical Officer of Health collection centres. Furthermore, 60.6% (7 951) of the infected subjects were asymptomatic whereas the remaining were symptomatic. The highest percentage of symptomatic patients were observed in the 91-100 years-of-age group while the highest asymptomatic subjects were found in the 31-40 years-of-age group. The percentage of asymptomatic children (65.3%) was significantly (P<0.05) higher than that of adults (43.4%). Conclusions: The findings of this study aid decision makers to focus on the vulnerable groups, and geographic and temporal distribution of patients in the public health strategies that aim at preventing the spread of the disease and reducinig its mortalities.

Objective: To present platelet large cell ratio (P-LCR), reticulocyte, and immature reticulocyte fraction (IRF) values as novel parameters in diagnosis and response to treatment in patients developing sacroiliitis. Methods: Sixty-eight patients with clinical symptoms and Brucella standard tube agglutination (Wright) or Brucella Coombs agglutination test titers ≥1:160 were included in the study. Two groups were established, one developing sacroiliitis and another with no sacroiliitis development. P-LCR, reticulocyte, and IRF levels were measured using a Sysmex XN-9000 device (Japan). These were then compared between the two groups. Results: Reticulocyte (P=0.037) and IRF (P=0.026) levels were significantly lower among the patients developing sacroiliitis compared to the non-sacroiliitis group, while P-LCR (P=0.003) levels were significantly higher. P-LCR had the most powerful correlation with sacroiliitis development. Significant negative correlation was observed between reticulocyte, IRF levels and sacroiliitis. Conclusions: Elevated P-LCR levels were observed as a marker of persisting inflammation in patients developing sacroiliitis, while low reticulocyte and IRF levels secondary to bone marrow involvement were detected. These three parameters emerged as highly significant markers in terms of diagnosis and reflecting responses to treatment in organ involvement such as sacroiliitis in brucellosis. These are presented as inexpensive, and easily accessible novel parameters.

Rationale: Pompholyx refers to pruritic vesicles or bullous rash that mainly distribute on the palms and lateral surfaces of the fingers. It is less common among Asians, and in a severe condition, secondary bacterial infection of pompholyx can happen and result in pain, swelling and pustules. Patient concerns: A 15-year-old girl complained of progressive wound and small bumps containing yellowish pus and crusts on her hands and feet for over 6 months and worsened in the last month before admission. She also had Ebstein anomaly. Diagnosis: Atypical pompholyx with secondary Staphylococcus and Klebsiella infections. Interventions: Wound care with wet dressing and applying moisturizer on crusts, application of antibiotics for Gram positive and negative bacteria and giving nutritional support with reckoning of proper calories. Outcomes: Skin lesions were completely healed and the patient was discharged after 10 days of hospitalization. Lessons: Atypical manifestation of pompholyx makes it hard to diagnose. The diagnosis can be confirmed with meticulous history-taking and physical examination. Wound caring and controlling of the infection should be done to earn an optimal outcome.