Objective We evaluated whether ivermectin combined with doxycycline reduced the clinical recovery time in adults with COVID-19 infection. Methods This was a randomized, blinded, placebo-controlled trial in patients with mild-to-moderate COVID-19 symptoms randomly assigned to treatment (n = 200) and placebo (n = 200) groups. The primary outcome was duration from treatment to clinical recovery. Secondary outcomes were disease progression and persistent COVID-19 positivity by RT-PCR. Results Among 556 screened patients, 400 were enrolled and 363 completed follow-up. The mean patient age was 40 years, and 59% were men. The median recovery time was 7 (4–10, treatment group) and 9 (5–12, placebo group) days (hazard ratio, 0.73; 95% confidence interval, 0.60–0.90). The number of patients with a ≤7-day recovery was 61% (treatment group) and 44% (placebo groups) (hazard ratio, 0.06; 95% confidence interval, 0.04–0.09). The proportion of patients who remained RT-PCR positive on day 14 and whose disease did not progress was significantly lower in the treatment group than in the placebo group. Conclusions Patients with mild-to-moderate COVID-19 infection treated with ivermectin plus doxycycline recovered earlier, were less likely to progress to more serious disease, and were more likely to be COVID-19 negative by RT-PCR on day 14. Trial Registration ClinicalTrials.gov Identifier: NCT04523831. Data Repository ID Dryad. doi:10.5061/dryad.qjq2bvqf6

Background Convalescent plasma has been widely used to treat COVID-19 and is under investigation in numerous randomized clinical trials, but results are publicly available only for a small number of trials. The objective of this study was to assess the benefits of convalescent plasma treatment compared to placebo or no treatment and all-cause mortality in patients with COVID-19, using data from all available randomized clinical trials, including unpublished and ongoing trials (Open Science Framework, https://doi.org/10.17605/OSF.IO/GEHFX). Methods In this collaborative systematic review and meta-analysis, clinical trial registries (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform), the Cochrane COVID-19 register, the LOVE database, and PubMed were searched until April 8, 2021. Investigators of trials registered by March 1, 2021, without published results were contacted via email. Eligible were ongoing, discontinued and completed randomized clinical trials that compared convalescent plasma with placebo or no treatment in COVID-19 patients, regardless of setting or treatment schedule. Aggregated mortality data were extracted from publications or provided by investigators of unpublished trials and combined using the Hartung–Knapp–Sidik–Jonkman random effects model. We investigated the contribution of unpublished trials to the overall evidence. Results A total of 16,477 patients were included in 33 trials (20 unpublished with 3190 patients, 13 published with 13,287 patients). 32 trials enrolled only hospitalized patients (including 3 with only intensive care unit patients). Risk of bias was low for 29/33 trials. Of 8495 patients who received convalescent plasma, 1997 died (23%), and of 7982 control patients, 1952 died (24%). The combined risk ratio for all-cause mortality was 0.97 (95% confidence interval: 0.92; 1.02) with between-study heterogeneity not beyond chance (I2 = 0%). The RECOVERY trial had 69.8% and the unpublished evidence 25.3% of the weight in the meta-analysis. Conclusions Convalescent plasma treatment of patients with COVID-19 did not reduce all-cause mortality. These results provide strong evidence that convalescent plasma treatment for patients with COVID-19 should not be used outside of randomized trials. Evidence synthesis from collaborations among trial investigators can inform both evidence generation and evidence application in patient care.

Background: Urinary tract infections (UTIs) remain the common infections in outpatients as well as hospitalized patients. Current knowledge on antimicrobial sensitivity pattern is essential for appropriate therapy. The aim of the study is to determine the changing pattern of antibiotic sensitivity among uropathogens causing UTI. Methods: Urinary isolates from symptomatic UTI cases attending in Square hospital were processed in the Microbiology lab. Antimicrobial susceptibility testing was performed by Kirby Bauer’s disc diffusion method. Extended spectrum beta lactamase (ESBL) production was determined by double disk synergy test method. Results: Of the 200 tested sample 110 samples showed growth of pathogens among which the most prevalent were E.coli (58.18%) followed by Enterococci (13.6%). The majority (68.18%) of the isolates were from female. ESBL production was observed in 46.87% o E.coli strains and 25% of Klebsiella strains. More than 98% of the isolates are sensitive to Imipenem, Meropenem , while 86.36% are sensitive to Amikacin, 73.63% to Nitrofurantoin and 74.54% to Gentamicin. Very high rate of resistance is seen against amoxicillin (88.19%), cefixime (65.46%), cotrimoxazole (68.19%) and ceftriaxone (63.63%). E. coli showed high sensitivity to meropenem, imipenem and amikacin (100%) followed by Gentamicin (94.1%). Conclusion: The study revealed that E.coli was the predominant bacterial pathogens of UTIs. An increasing trend in the production ESBLs among UTI pathogens in the community was noted. Nitrofurantoin should be used as empirical therapy for primary, uncomplicated UTIs. DOI: http://dx.doi.org/10.3329/bccj.v2i1.19952 Bangladesh Crit Care J March 2014; 2 (1): 21-24

Background: Glycopeptides such as vancomycin are frequently the choice of antibiotics for the treatment of infections caused by methicillin resistant Staphylococcus aureus (MRSA). For the last 7 years incidence of vancomycin intermediate S. aureus and vancomycin resistant S. aureus (VISA and VRSA respectively) has been increasing in various parts of the world. Objective: The present study was carried out to find out the presence of VISA and VRSA among isolated MRSA strains. Methodology: This cross sectional study was carried out in the Department of Microbiology in Dhaka medical college during period of January 2010 to December 2011. All S. aureus isolates were screened to detect methicillin resistance and then all MRSA isolates were subjected for MIC testing against vancomycin and oxacillin by agar dilution method, disc diffusion testing and PCR for mecA and pvl genes detection. Result: A total 112 S. aureus were isolated from 500 nasal swab sample collected from adult patients who were admitted in various departments and wards in Dhaka Medical College Hospital. Among 38 MRSA strains out of 112 Staph aureus isolates 3(7.89%) strains were resistance to vancomycin of which 2(5.26%) strains had MIC > 256 g/mL and one strain had MIC 256g/mL. All vancomycin resistance strains had MIC of oxacillin > 256 g/mL. All isolates possess mec-A gene. Conclusion: The present study reveals that emergence of VRSA upon admission at a tertiary care of hospital in Bangladesh. Continuous efforts should be made to prevent the spread and the emergence of VRSA by early detection of the resistant strains and using the proper infection control measures in the hospital setting.

During Ramadan, Muslims fast from dawn to dusk for one lunar month. Although a majority of Muslim patients with type 2 diabetes fast during the month of Ramadan, there are no accepted guidelines for its management during this period. The few studies on this subject suggest that there are important alterations in energy intake and physical activity, and that most patients change their pattern of drug intake. The objectives of this article is to assist in the task of advising diabetic patients who fast and provide them with guidelines regarding proper management of their diabetes during Ramadan.KYAMC Journal Vol. 6, No.-2, Jan 2016, Page 649-652