Hydroxychloroquine in Treatment of Asymptomatic and Mildly Symptomatic COVID-19: A Multi-Centre Cohort Study

Background: Although hydroxychloroquine (HCQ) lacks benefit in patients with moderate-to-severe COVID-19, its role in asymptomatic and mildly symptomatic disease needs better elucidation. Methods: This multi-centre cohort study included asymptomatic and mildly symptomatic, RT-PCR confirmed COVID-19 cases between 30 March and 20 May, 2020. Patients were categorized into two groups (HCQ-treated and untreated) based on exposure to HCQ. Dose of HCQ used was 400 mg twice daily (day one) followed by once daily for seven days. HCQ-untreated patients were managed supportively without any active antiviral or immunomodulatory therapy.h Nasopharyngeal SARS-CoV-2 clearance by RT-PCR (primary outcome) was compared between HCQ-treated and untreated patients using Kaplan-Meier analysis and Cox proportional-hazards regression. Clinical efficacy and safety profile of HCQ were assessed (secondary outcomes). Results:162 patients [84 (51·9%) males; mean age 38·2 (15·2) years] were included. Forty-four (27·2%) patients had mild disease, rest 118 (72·8%) were asymptomatic. Seventy-five (46·3%) patients received HCQ. Median time to virological negativity was lesser in HCQ-treated (13 days) versus untreated patients (15 days) (log- rank<0·001) in both asymptomatic and mildly symptomatic patients. Treatment with HCQ was the only independent predictor of virological negativity (hazard- ratio=2·24; adjusted p-value<0·001). Two (5·4%) mildly symptomatic patients progressed to severe disease within 24 hours (two doses) of HCQ initiation, compared to none in the HCQ-untreated group. Five HCQ-treated patients developed minor gastrointestinal side effects, not requiring drug discontinuation. Conclusion: HCQ reduced the time to virologic negativity (by 2 days) in asymptomatic and mildly symptomatic COVID-19, without any serious adverse events. However, no obvious clinical benefit was noted.

Prevalence of primary drug resistance to rifampicin and isoniazid in newly diagnosed sputum smear positive pulmonary Tuberculosis

Background: To determine the prevalence of primary drug resistance to either rifampicin or isoniazid alone or both in newly diagnosed sputum smear positive pulmonary tuberculosis patients.Method: A prospective study 100 newly diagnosed sputum smear positive pulmonary TB patients was conducted. The patients with an age of ≥15 years and who had either not taken anti TB treatment or who had taken ATT for less than 1 month were enrolled in this study. Two sputum samples (5ml each), including one early morning sample as per the RNTCP guidelines were collected and subjected to line probe assay (LPA).Results: Out of 100 cases 6 were having resistance to both rifampicin and isoniazid, 9 has resistance to INH alone and 1 had resistance to rifampicin alone.Conclusion: The prevalence of primary drug resistance is high. For early and rapid detection of DR-TB newer modality should be used  for the detection of primary drug resistance in sputum smear positive TB patients.

Tubercular hepatic abscess--a rare presentation.

Hepatic tuberculosis is one of the rare forms of extra-pulmonary tuberculosis. The focal or nodular form presenting as tuberculoma or abscess is uncommon. Hepatic tuberculosis without involvement of lungs or other organs is even rarer. We report a rare case of primary tubercular liver abscess without involvement of any other organ of body.