Background and objectives: Various existing non-antiviral drugs are being used to treat severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection based mostly on existing data from previous coronavirus outbreaks. Ivermectin is one of such agents being widely used to treat early-stage of COVID-19. This study evaluated the outcome of ivermectin treated mild to moderate COVID-19 cases compared to usual care. Methods: This open-label randomised controlled study was conducted at a sub-district (Upazila) health complex from 1st May 2020 to the end of July 2020. Consecutive RT-PCR positive eligible COVID-19 patients were randomised into control and intervention arms. In the intervention arm, ivermectin 200 micrograms/kg single dose was administered orally in addition to usual care and was followed up till recovery. Repeat RT-PCR was done on day ten since the first positive result. The end point with regard to treatment outcome was time required for the resolution of symptoms from the onset of the symptoms and following enrollement in the study. Results: A total of 62 mild to moderate COVID-19 patients were enrolled in the study. There were 30 patients in the control arm and 32 patients in the intervention arm. Total recovery time from the onset of symptoms to complete resolution of symptoms of the patients in the intervention arm was 10.09 ± 3.236 days, compared to 11.50 ± 5.32 days in the control arm (95% CI -0.860,3.627, p>. 05) and was not significantly different. The mean recovery time after enrolment in the intervention arm was 5.31 ± 2.48 days, which also did not differ significantly from the control arm of 6.33 ± 4.23 days (95% CI – 0.766, 2.808, p> 0.05). Results of negative repeat RT- PCR were not significantly different between control and intervention arms (control 90% vs intervention 95%, p>.05). Conclusion: Ivermectin had no beneficial effect on the disease course over usual care in mild to moderate COVID-19 cases. Ibrahim Med. Coll. J. 2020; 14(2): 11-18

Ivermectin is an antiparasitic drug being investigated for repurposing to SARS-CoV-2. In-vitro, ivermectin showed limited antiviral activity and a COVID-19 animal model demonstrated pathological benefits but no effect on viral RNA. This meta-analysis investigated ivermectin in 18 randomized clinical trials (2282 patients) identified through systematic searches of PUBMED, EMBASE, MedRxiv and trial registries. Ivermectin was associated with reduced inflammatory markers (C-Reactive Protein, d-dimer and ferritin) and faster viral clearance by PCR. Viral clearance was treatment dose- and duration-dependent. In six randomized trials of moderate or severe infection, there was a 75% reduction in mortality (Relative Risk=0.25 [95%CI 0.12-0.52]; p=0.0002); 14/650 (2.1%) deaths on ivermectin; 57/597 (9.5%) deaths in controls) with favorable clinical recovery and reduced hospitalization. Many studies included were not peer reviewed and meta-analyses are prone to confounding issues. Ivermectin should be validated in larger, appropriately controlled randomized trials before the results are sufficient for review by regulatory authorities.

Coronavirus disease 2019 (COVID-19), the latest global pandemic is on the hunt and the incidence is sharply rising day by day. On the other hand, tuberculosis (TB) is the leading causes of death from infectious origin. Historically, coronaviral illness were reported with co-infection with TB; Severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) is not an exception. As both diseases have overlapping clinical features, sometimes it maybe very difficult to diagnose and long standing features of TB can easily be mistaken for post-acute COVID-19. This report emphasizes the importance of suspecting TB-COVID co-infection and its grave consequences. Birdem Med J 2020; 10, COVID Supplement: 111-114

Background and objectives: Various new manifestations and risk factors for COVID-19 have been unveiled in the course of the current pandemic. Understanding the clinical spectrums as well as the risk factors associated with the adverse outcome of the disease is critical to combat this pandemic. This study was conducted to identify the clinical features, overall outcome and the factors associated with adverse outcome of the hospitalised COVID-19 patients in a semi-urban healthcare setting. Methods: This study was conducted at Debidwar Upazila (sub-district) Health Complex under the Cumilla district from April 2020 to October 2020. Reverse transcriptase-polymerase chain reaction (RT-PCR) positive COVID-19 patients, aged 18 years and above, admitted at the Health Complex were enrolled in the study. All patients were followed till their recovery, referral or death. The data were collected in a pre-designed semi-structured questionnaire that included demographic, epidemiological, clinical and laboratory parameters. Result: Out of 50 RT-PCR positiveCOVID-19 adult participants, 30 (60%) were males and 20 (40%) were females. Twenty-four percent, 36%, and 40% of the patients had mild, moderate and severe disease respectively. The most common clinical symptom was fever (96%), followed by cough (86%) and shortness of breath (60%). Hypertension (54%), diabetes mellitus (40%), bronchial asthma (20%) and chronic obstructive pulmonary disease (COPD, 14%) were the major co-morbid conditions. Of the total cases, 2 (4%) died and 8 (16%) required referral to tertiary care hospital while 40 (80%) recovered. COPD was associated with poor outcome (OR 19; 95% CI: 2.88, 125.31; p < 0.05). Smokers were 7 times more likely to exhibit the negative outcome than non-smokers (95% CI: 1.52, 32.33; p < 0.05). Conclusion: In this study, COPD was associated with a negative outcome. Further study with larger sample should be carried out to determine the spectrum of risk factors. Ibrahim Med. Coll. J. 2020; 14(2): 42-54

Prolonged steroid use and the resultant adrenal insufficiency pose an increased risk of severe disease in patients with COVID-19. We describe here a case of Covid-19 with adrenal crisis in an elderly man at a semiurban primary healthcare center. He and his family were forced to leave their home because of being infected with SARS-CoV-2. He was managed for adrenal crisis at a limited resource setting with a good outcome. This case also highlights the importance of social stigma related to COVID-19 in Bangladesh. Birdem Med J 2020; 10, COVID Supplement: 122-126

Pulmonary aspergillosis is an uncommon condition and at the same time very much challenging to diagnose and difficult to treat. Here, we present two cases of chronic pulmonary aspergillosis, who presented with with chronic low-grade fever, refractory and distressing cough and haemoptysis. The first patient was diagnosed as having aspergilloma in a pre-existing healed tubercular cavity and the second one with subacute necrotizing pulmonary aspergillosis, which simulated as bronchial carcinoma. BIRDEM Med J 2021; 11(3): 227-230

Coronavirus disease 2019 , the latest global pandemic has already presented with a diverse range of complications. Hydropneumothorax has been a rarer one and has been observed without preexisting lung disease and mechanical ventilation. On the other hand, Pulmonary Tuberculosis is a well-established cause of hydropneumothorax. Historically, corona viral illness had been observed to be complicated with pneumothorax and coinfection with tuberculosis .This case report enumerates concurrent tuberculosis and COVID-19 and their common grave consequence hydropneumothorax.