The widespread outbreak of SARS-CoV-2 was declared a public health emergency by the World Health Organization and various governments worldwide. This prompted the implementation of stringent infection control measures to curb the spread of the virus. Amidst this, the medical community faced the challenge of treating the virus without specific therapies or a vaccine, leading to reliance on empirical treatment approaches. In this context, hydroxychloroquine, an antimalarial and antirheumatic drug, gained attention as a potential treatment option. Despite its theoretical benefits, such as inhibiting viral entry, reducing inflammation, and modulating immune responses, empirical studies yielded inconsistent results. Some indicated a potential for symptom relief, while others showed no significant improvement in patient outcomes. The initial enthusiasm waned as the lack of substantial evidence led to revoking its Emergency Use Authorization, and several clinical trials were prematurely halted. The review in question critically examines the factors contributing to the ineffectiveness of hydroxychloroquine in treating SARS-CoV-2 infection, highlighting the complexities of drug repurposing during a rapidly evolving pandemic.

Sepsis and septic shock are life-threatening conditions that are globally responsible for almost 20% of mortality, especially in low and middle-income countries. This review was conducted on PubMed and Google Scholar databases with keywords sepsis, septic shock, sepsis management, and sepsis complications. Articles published up to July 2023 in English were included. Diagnosis and management should be carried out without unnecessary delay. Cooperation between various medical specialties including intensive care doctors, neurologists, hepatologists, cardiologists, and pediatric doctors is needed if a child is affected. New strategies have to be implemented in low and middle-income countries to decrease the sepsis incidence and reduce mortality in the population.

Objective: To evaluate the risk factors of death caused by COVID-19 in Iran. Methods: This study was a retrospective cohort study from February 20, 2020, to August 22, 2022, in the hospitals in Isfahan, Iran. The data were collected through a researcher-made checklist. To determine the risk factors of the death, logistic regression and Cox regression models were used. For each variable, the odds ratio and 95% confidence interval were also reported. Results: 1 885 Patients were included. The age of deceased persons was significantly higher than that of the surviving persons. The risk of death for the age group above 60 years was about 14 times higher than that of people aged 19-35 years [95%CI: 14.41 (2.02-102.99), P<0.01]. Hypertension [95%CI: 1.92 (1.47-2.5), P<0.01], diabetes [95%CI: 1.62 (1.23-2.13), P<0.001], and chronic obstructive pulmonary disease [95%CI: 1.92 (1.47-2.50), P<0.01] were also risk factors of mortality. Conclusions: This study reveals that the mortality rate due to COVID-19 is associated with old age, longer hospitalization in the ICU, increased length of stay, and comorbidities of high blood pressure, diabetes, and chronic pulmonary disease.

Objective: To investigate the distribution pattern of animal bites in Mirjaveh, Iran from 2015 to 2020. Methods: The data on animal bites were collected from the Department of Infectious Diseases, the provincial health center. Monthly climatic data on precipitation and temperature during the study period were also collected. The correlation between incidence and temperature, precipitation rate, land type, and altitude was also analyzed. Results: The results showed that men were more affected by animal bites than women (76.4%, P<0.001), and the highest incidence rate occurred in the age group of 5-19 years. The incidence rate of animal bites was found to be correlated with temperature and altitude. An increase in temperature was associated with a rise in the incidence rate of animal bites. The number of animal bites increased until 2019, possibly due to an increase in the number of dogs in the area. Conclusions: Targeted interventions should be implemented to reduce the incidence of animal bites, particularly among children, housewives, and students. Improving access to appropriate treatments, increasing public awareness of the hazards of animal bites, and increasing the number of vaccinated dogs in the area are essential strategies to be considered.

Objective: To investigate the frequency of exoU and exoY genes in patients with Pseudomonas aeruginosa infection. Methods: In this study, 100 clinical isolates of Pseudomonas aeruginosa were collected from patients hospitalized in educational-therapeutic hospitals and were identified using standard microbiological tests. Then, the antibiotic resistance pattern of the isolates was determined by the disk agar diffusion method. The bacterial DNAs were extracted by the alkaline lysis method. Finally, the presence of exoU and exoY genes was evaluated by the PCR test. Results: In this study, 47%, 72%, 29%, 39%, 40%, and 44% of the isolates were non-susceptible to piperacillin, aztreonam, ceftazidime, imipenem, tobramycin, and ciprofloxacin, respectively. In addition, 95% and 93% of the clinical isolates carried the exoU and exoY genes. Blood and fecal isolates had both virulence genes, while only one wound isolate had neither genes. Meanwhile, all urinary isolates contained the exoY gene and only one isolate lacked the exoU gene. Also, 88 isolates simultaneously had both exoU and exoY genes. Conclusions: High prevalence of exoU and exoY genes in this region indicates a significant role of type III secretion system in pathogenesis of Pseudomonas aeruginosa. The type III secretion system may be a suitable target to reduce the pathogenicity of this bacterium.

Rationale: Acute caustic ingestion from suicidal intent is not usual in emergency departments in developed countries. One of the substances commonly ingested by suicidal patients, phosphoric acid, tends to cause multi-system derangements. Patient’s Concern: A 41-year-old male patient presented with complaints of throat discomfort, severe generalized abdominal pain, and multiple episodes of hematemesis after ingesting a restroom cleaning solution. Diagnosis: Poisoning by acute caustic ingestion (containing <30% phosphoric acid and <4% ethylene glycol). Interventions: The patient was administered 50 mL of 8.4% sodium bicarbonate solution followed by an isotonic sodium bicarbonate solution running at 500 mL/h, a hyperkalemia kit, ceftriaxone, metronidazole, omeprazole, and atropine. The patient then underwent urgent hemodialysis. Outcomes: The patient suffered gastrointestinal bleeding as a result of local caustic injury. In addition, his course of illness was complicated by severe acidemia from high anion gap metabolic acidosis and deranged electrolytes (hyperphosphatemia, hyperkalemia, and hypocalcemia). He developed multi-organ failure and eventually demised. Lessons: The clinician needs to be mindful of the multi-system complications arising from such a caustic ingestion. These patients need to be monitored closely for deterioration, and have prompt management of the various arising complications, to reduce the high morbidity and mortality associated with this condition.

Acute infectious conjunctivitis (AIC) is one of the most common communicable diseases encountered in acute hospital settings. Transmission exists long before COVID-19. Research showed COVID-19 infections were associated with AIC, as the most common ocular manifestations[1]. Thus, an increase in AIC during COVID-19 is expected[2]. However, personal hygiene practices and public health measures throughout COVID-19 negatively impacted the incidence of influenza and other upper respiratory tract infections, as for AIC[3]. Our retrospective study extracted the data between July 2016 to June 2023, from the hospital communicable ocular diseases database. We aim to reveal the incidence of AIC across the pre- and post-COVID era in a local regional acute hospital. A total of 1 512 patients with AIC were identified in the last 7 years across the pre- and post-COVID era. Monthly incidences of AIC over the past 7 years were plotted as a line chart (Figure 1A). There was no obvious fluctuation throughout the years. February, when winter turns to spring in Hong Kong, got the lowest number of AIC throughout the year. In contrast, the middle of schools’ summer vacation in August, got the highest rate of AIC. September, when the school academic year started, was not associated with a surge of AIC. The annual incidence of AIC is plotted in Figure 1B. The mean number of AIC per year was 216±97. However, there was a significant (P<0.001) drop in AIC cases across 2020, when COVID-19 local outbreak happened in Hong Kong[4]. Social distancing and face masks wearing were lifted by the end of 2022, but there was no rebound of AIC cases observed after. Despite our study’s limitations lie on the decreased out-patient clinics’ attendance under COVID-19[5], and lack of microbiology diagnosis, we believe hand hygiene, alcohol hand rub, and avoidance of hand-to-eye contact practices inherited from COVID-19 pandemic have prevented many contagious AIC transmissions within our locality.