For the treatment of Covid-19 patients with remdesivir, poor renal- and liver function were both exclusion criteria in randomized clinical trials (RCTs) and contra-indication for treatment. Also, nephrotoxicity and hepatotoxicity are reported as adverse events. We retrospectively reviewed renal- and liver functions of covid-19 patients who received remdesivir in the 15 days after treatment initiation. Approximately 20% of the patient population met RCT exclusion criteria. In total, 11% of the patients had a decrease in estimated glomerular filtration rate larger than 10 ml/min/1.73m2. Also, 25% and 35% had increased alanine transaminase and aspartate transaminase levels, respectively. However, serious adverse events were limited. Therefore, contra-indications based on kidney- and liver function should not be absolute for remdesivir treatment in patients with Covid-19 if these functions are monitored regularly.

We report a case of P. yeei CAPD-peritonitis in a patient experiencing repeated episodes of peritonitis. P. yeei, an emerging opportunistic pathogen, takes advantage of specific virulence factors and peculiar circumstances. We discuss the exogenous or endogenous microbial source of the peritonitis and guidelines to decrease its occurrence.

Aerococcus urinae is rare in infective endocarditis. The best known risk factors are urogenital comorbidities. We report the case of a 46-year-old male with Down’s syndrom with infective endocarditis. The patient underwent successful treatment with amoxicillin and heart surgery with valve replacement.He had an unknown ventricular septal defect

As the clinical course of COVID-19 infection in SCD patients is not clear, close monitoring is essential. We emphasize that RBC exchange should be offered early to avoid possible deterioration. We present a case of COVID-19 infection in a SCD patient causing severe hemolysis, that improved after RBC exchange.

An Italian male with no link to China SARS-CoV-2 epidemic presented at Emergency Room with severe respiratory impairment. The RT-PCR on 20th February, 2020, nasopharyngeal swab revealed SARS-CoV-2 infection, confirmed with viral culture and sequencing. This was the first identified autochthonous SARS-CoV-2 transmission in Italy, that unveiled global pathogen diffusion.

Cryptococcosis is one of the common mycological conditions leading to morbidity and mortality in patients with AIDS. We are presenting a case of disseminated cryptococcosis in a patient infected with human immunodeficiency virus (HIV-1), which were both diagnosed postmortem using Minimally Invasive Tissue Sampling Method.

Aim Oral flucloxacillin may be co-administered with probenecid to increase flucloxacillin concentrations and increase attainment of pharmacokinetic-pharmacodynamic (PK-PD) targets. The aims of this study were to describe outcomes of patients treated with oral flucloxacillin plus probenecid as follow-on therapy from initial intravenous treatment, and to identify optimal dosing regimens when treating infections caused by susceptible Gram-positive organisms. Methods We performed a prospective observational study of adults treated with oral flucloxacillin 1000 mg and probenecid 500 mg 8-hourly (with food) for proven or probable staphylococcal infections. We developed a population pharmacokinetic model of free flucloxacillin concentrations within Monolix, in order to estimate probability of PK-PD target attainment (fT>MIC), and used Monte Carlo simulation to explore optimal dosing regimens. Results The 45 patients (73% male) had a median (range) age of 49 years (20 – 74), weight of 90 kg (59 – 167), fat free mass (Janmahasatian) of 65 kg (38 – 89) and eGFR (CKD-EPI) of 89 mL/min/1.73m2 (41 – 124). The most common infections were osteomyelitis (n=18, 40%) and septic arthritis (n=12, 27%). Forty patients (89%) were cured 30 days after completion of therapy. 10 (22%) experienced nausea which did not require treatment alternation. Free flucloxacillin clearance depended on allometrically-scaled fat free mass, and increased by 1% for each unit increase in eGFR. Conclusion Oral flucloxacillin and probenecid was well-tolerated and efficacious. Patients with higher fat free mass and eGFR may require four times daily dosing and/or therapeutic drug monitoring to ensure PK-PD target attainment.

A 55 years old woman with multiple myeloma was referred to us for autologous hematopoietic stem cell transplantation. The patient developed Legionella pneumonia while mobilization of hematopoietic stem cells.we report a case of successful treatment Legionella pneumonia in patient with multiple myeloma.

COVID-19 associated bronchiectasis is an atypical finding and it's not commonly described sequel of the disease. Here, we present a previously healthy middle-aged man who developed progressive bronchiectasis evident on serial chest CT scans with superimposed bacterial infection following COVID-19 pneumonia.

A 26-year-old patient was admitted with a 6-month history of fever,fatigue,and unintentional weight loss.Abdominal CT described an heterogeneous hepatosplenomegaly.Laboratory studies revealed leucopenia,anemia and elevated CRP.Bone marrow aspirate revealed amastigotes compatible with Leishmania spp.Was treated with liposomal amphotericin B with favourable outcome.Authors intend to raise awareness of VL in immunocompetentpatients.

This is a letter to the editor. Please see the manuscript.

Inhaled nebulised unfractionated heparin (UFH) has a strong scientific and biological rationale that warrants urgent investigation of its therapeutic potential in patients with COVID-19. UFH has antiviral effects and prevents the SARS-CoV-2 virus’ entry into mammalian cells. In addition, UFH has significant anti-inflammatory and anti-coagulant properties, which limit progression of lung injury and vascular pulmonary thrombosis. Methods and intervention The INHALEd nebulised unfractionated HEParin for the treatment of hospitalised patients with COVID-19 (INHALE-HEP) meta-trial is a prospective individual patient data analysis of on-going randomised controlled trials and early phase studies. Individual studies are being conducted in multiple countries. Participating studies randomise adult patients admitted to the hospital with confirmed SARS-CoV-2 infection, who do not require immediate mechanical ventilation, to inhaled nebulised UFH or standard care. All studies collect a minimum core dataset. The primary outcome for the meta-trial is intubation (or death, for patients who died before intubation) at day 28. The secondary outcomes are oxygenation, clinical worsening and mortality, assessed in time-to-event analyses. Individual studies may have additional outcomes. Analysis We use a Bayesian approach to monitoring, followed by analysing individual patient data, outcomes and adverse events. All analyses will follow the intention-to-treat principle, considering all participants in the treatment group to which they were assigned, except for cases lost to follow-up or withdrawn. Trial registration, ethics and dissemination The meta-trial is registered at ClinicalTrials.gov ID NCT04635241. Each contributing study is individually registered and has received approval of the relevant ethics committee or institutional review board.

SARS-CoV-2 infection may present with numerous neurological manifestations. We report the case of a young obese lady, recently discharged after treatment for COVID-19 infection, who later presented with headache and blurred vision, diagnosed to have pseudotumor cerebri and concurrent bilateral optic neuritis.

This case report describes the clinical history of a COVID-19 patient with a non-immediate diagnosis of severe dysphagia that required a gastrostomy positioning. A vocal folds paresis was observed for the first time in the course of a Sars-CoV-2 infection. Thanks to intensive rehabilitation treatment, the outcome was favourable.

Introduction Inhaled nebulised unfractionated heparin (UFH) has a strong scientific and biological rationale and warrants urgent investigation of its therapeutic potential for COVID-19. UFH has antiviral effects and prevents the SARS-CoV-2 virus’ entry into mammalian cells. In addition, UFH has significant anti-inflammatory and anti-coagulant properties, which limit progression of lung injury and vascular pulmonary thrombosis. Methods and intervention This meta-trial is a prospective collaborative individual patient data meta-analysis of randomised controlled trials and early phase studies. Individual studies are conducted in multiple countries. Adult patients admitted to the hospital with confirmed SARS-CoV-2 infection, who do not require immediate mechanical ventilation, are randomised to inhaled nebulised UFH or standard care. All studies collect a minimum core dataset. The primary outcome is intubation (or death, for patients who died before intubation) at day 28, assessed in a time-to-event analysis. The secondary outcomes are oxygenation, clinical worsening and mortality, assessed in time-to-event analyses. Individual studies may have specific outcome measures in addition to the core set. Ethics and dissemination: The meta-trial is registered at ClinicalTrials.gov, ID NCT04635241. Results of this study will be shared with the WHO, published in scientific journals and presented at scientific meetings.

Cytomegalovirus (CMV) is an opportunistic organism. We report a young, healthy, immunocompetent female with no apparent cardiovascular risk factors presenting with acute myocardial infarction. She had CMV viremia and went on to develop CMV-colitis and hepatitis. This report highlights that CMV can cause clinically significant multi-organ disease in immunocompetent-patients

Background: Bedqauiline (BDQ) is a relatively new agent for multidrug (MDR) and extremely drug resistant (XDR) TB. It is important to look for cardiac safety and the bizarre adverse reactions after initiation of the drugs from the real world studies. Methods: An observational study was conducted on the institutionalized MDR and XDR patients under the conditional access program of BDQ in India. Daily ECG, adverse events and change in laboratory values for first two weeks were recorded with mortality and serious adverse events till first three months of initiation of BDQ containing regimen. Results: Among the total of 49 patients, nausea (n=33) was the most reported side effect. Though a mean rise of QTcF (12%) was noted after 14 days, individually, both prolongations (QTcF >440 ms) and shortening (from baseline values) of QTcF were noted in 95.92% (n=47) and 89.8% (n=44) patients. Three distinct QT patterns noted in ECG were, a) initial rise then fall (n=8), b) initial fall then rise (n=9) and c) rise followed by further rise (32). There was no serious adverse event leading to drug withdrawal or mortality in the first three months. Conclusions: Prolongation of QTcF occurs in alarming numbers during first two weeks of BDQ therapy as well as shortened QT. However, BDQ was otherwise tolerated well by the real world MDR & XDR-TB patients in short term. Intensive ECG and clinical monitoring is recommended to detect possible serious implications of such ECG changes in the long term.

Objective: Novel Coronavirus disease is a new infectious agent of the respiratory tract characterized by a severe acute respiratory syndrome. For this disease, there are limited data with regard to the clinical characteristics of the patients and prognostic factors. Study Design: Retrospective Cohort Setting: Secondary Referral Center Methods: We collected data from 213 patients who were hospitalized into COVID-19 isolation with positive PCR test results. We recorded various patient values, including blood test results. We also noted age, gender, additional diseases, duration of discharge, whether they live or die, whether they smoke, and their radiological staging. Results: In CT imaging with a staging of maximum 4 points and minimum 0 points, the mean value resulted in 1.95. The average radiological stage of the dead patients group was reported as 2.56. There was a correlation between the radiological predictor and the outcome status (p-value: 0.002). The number of smokers was 14 (6.5%). Of the 26 patients who died, 3 were smokers and 23 were non-smokers. Conclusion: 14 of the patients in the study were smokers (6.5%). One in four people in Turkey is a smoker, while in COVID-19 isolation service only a 6.5% rate of smoking was observed. That supports the theory that smoking hasn’t negative impact on COVID-19 development. The average radiological stage was reported as 2.56 in the dead patients’s group. There was a correlation between the radiological predictor and the outcome status (p-value: 0.002). It seems that an elevated radiological stage is a predictor of death. Keywords: Covid-19, SARS-CoV-2, smoking, computed tomography, predictor factors. Key points: to learn relations between smoking and covid-19, effect of Ct stages on the disease severity, effect of blood analysis on Covid-19, the parameters in deaths of Covid-19, ratio of smoking in Covid-19 inpatients

Pulmonary Tuberculosis (PTB) and Novel Coronavirus disease 2019 (COVID 19) primarily affect the lungs. Both diseases present with fever, cough, and shortness of breath and possess thrombotic potential as well. Therefore in COVID 19 pandemic, PTB must be taken into consideration for suspected cases in order to avoid fatal consequences.

Primary tuberculosis of the parotid gland is rare even in endemic countries. the clinical manifestations are polymorphic and non-specific. it is important for clinicians to be aware of this pathology.

Olfactory and gustatory dysfunctions were prescribed in COVID-19 infection. Monitoring and early detection for COVID-19 infection in pregnancy is essential. Keeping rare presentations and the impact they have on the pregnancy in mind is crucial.This is the first case of pregnant woman who had cacosmia as persistent symptoms after infection

Introduction: Referrals for OE have increased but the reasons for this remain unclear. We characterise referrals to inform primary secondary care interface improvements. Methods: Questionnaire study from dedicated consultant-led research clinic for OE referrals. Results: 62 patients responded; 63% female, mean age 54 years. One was excluded (not OE). Most had multiple primary care visits before referral (average 4 GP; 2 practice nurse). 60% had received oral antibiotics (16% multiple classes). 18% had never had ear drops. 39% were not advised to keep ears dry. 21% had dermatitis; 13% contact allergy, 30% systemic allergy, 5% diabetes. <10% had narrow canals. 36% had active discharge but <7% needed a wick. Conclusion: OE occurs most commonly in women - often with associated risk factors. Lifestyle advice and ototopical drops are frequently overlooked; instead often inappropriately treated with oral antibiotics. Most ear were anatomically normal and community aural care clinics may have a role in reducing referrals.

Aim: Efavirenz is still widely used as the preferred first-line antiretroviral agent in the middle- and low- income countries, including Malaysia. The efavirenz population pharmacokinetic profile among HIV-positive smokers is still unknown. We aimed to assess the association of smoking with efavirenz and the differences in HIV clinical outcomes. Methods: A total of 154 stable HIV-positive patients on efavirenz in northern Malaysia were recruited with a sparse sampling for this multicentre prospective cohort study. The association between smoking and efavirenz pharmacokinetic parameters was determined using the non-linear mixed-effect model (NONMEM). A mixture model of clearance was adopted to describe the metaboliser status because genetic data is unavailable. The effect of smoking on HIV clinical markers (CD4, CD4 / CD8 ratio and viral blips) for at least two years after the antiretroviral initiation was also investigated. Results: Our data were best fitted with a one-compartment mixture model with first-order absorption without lag time. Smoking significantly associated with higher clearance (CL/F) (β = 1.39; 95% confidence interval (CI): 1.07 to 1.91), while weight affected both CL/F and volume (V/F). From the mixture model, 20% of patients were in the slow clearance group, which mimic the genotype distribution of slow metaboliser. An efavirenz dose reduction is not recommended for smokers ≥60kg with normal metabolism rate. Smoking significantly associated with slower normalisation of CD4 and CD4 / CD8 ratio. Conclusion: HIV-positive smokers presented with significantly higher efavirenz clearance and unfavourable clinical outcomes. Close monitoring of adherence and clinical response among smokers is warranted.

Consumption of Japanese cuisine, such as sushi and sashimi, is accompanied by the risk of food poisoning through various pathogens. Kudoa hexapunctata, detected in both adult and juvenile Pacific bluefin tuna, causes foodborne diseases. Here, we report cases of food poisoning after Kudoa hexapunctata-infected PBT consumption.