In vitro studies have shown the efficacy of Ivermectin (IV) to inhibit the SARS—CoV-2 viral replication, but questions remained as to in-vivo applications. We set out to explore the efficacy and safety of Ivermectin in persons infected with COVID19. We conducted a translational proof of concept randomized, double blind placebo controlled, dose response and parallel group study of IV efficacy in RT—polymerase chain reaction proven COVID 19 positive patients. Sixty-two patients were randomized to three treatment groups. (A) IV 6 mg regime, (B) IV 12 mg regime (given Q84 h for 2 weeks) (C, control) Lopinavir/Ritonavir. All groups plus standard of Care. The Days to COVID negativity (DTN) was significantly and dose dependently reduced by IV (P = 0.0066). The DTN for Control were, = 9.1+/–5.2, for A 6.0 +/– 2.9 and for B 4.6 +/–3.2. Two way repeated measures ANOVA of ranked COVID 19 +/– scores at 0, 84, 168 and252h showed a significant IV treatment effect (P = 0.035) and time effect (P < 0.0001). IV also tended to increase SPO2% compared to controls, P = 0.073, 95% CI—0.39 to 2.59 and increased platelet count compared to C (P = 0.037) 95%CI 5.55—162.55 × 10³/ml. The platelet count increase was inversely correlated to DTN (r = –0.52, P = 0.005). No SAE was reported. 12mg IV regime given twice a week may have superior efficacy over 6mg IV given twice a week, and certainly over the non IV arm of the study. IV should be considered for use in clinical management of SARS-COV2, and may find applications in prophylaxis in high risk areas.

Introduction: The term micropulse laser trabeculoplasty suggests that only a fraction of the laser power is applied to the trabeculum to effect pressure lowering. It has not yet been exclusively used in Negroes, and we wish to report on our experience in Nigerian patients. Methods: The study design is a retrospective chart review of our patients at the Rachel Eye Center in Abuja. The 810 diode Optos FastPulse laser was used to apply 34 cycles of treatment to 30 eyes of 16 individuals. Patients were selected based on the failure of maximal medical therapy. One patient had two extra rounds of treatment, while two patients were treated in only one eye. The pressure change at 1 hour after the treatment was analyzed. Patients were followed up for a mean period of 160 days with continuous monitoring of pressure changes. Patients’ original therapy was not disturbed. Results: Postlaser immediate drop in intraocular pressure (IOP) averaged 3.2 mmHg (CI 1.6–4.7, P<0.0001) representing 17.2% drop from baseline prelaser IOP. The drop in IOP was sustained over varying periods, from a few weeks to several months. There was a temporary spike in three instances. No serious side effects were noted. Conclusion: Micropulse diode laser trabeculoplasty is a useful adjunct in the management of open-angle glaucoma in Nigerians. This corroborates the findings of other researchers in western populations.

Linezolid is a synthetic antibiotic, the first of the oxazolidinone class, used for the treatment of infections caused by multi-resistant bacteria including Streptococcus, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). We report on a case of endophthalmitis caused by vancomycin-resistant Enterococcus feacium treated with intravitreal linezolid. It has proved efficacious in animal models but its safety in humans is not fully known. An 84-year-old man who had phacoemulsification surgery and anterior chamber intraocular lens due to posterior capsule rent. Visual acuity (VA) following surgery was 6/24 uncorrected. The following week he developed signs of endophthalmitis, characterized by corneal infiltration and keratic precipitates, with anterior chamber and vitreous haze. Cultures yielded no growth, while repeated treatments with intravitreal vancomycin, ceftazidime, and amphotericin B did not control the infection. Vitrectomy was performed twice during the patient's course, with intravitreal amikacin injection after the second vitrectomy, but poor control of the endophthalmitis persisted. After several weeks of limited response to treatments, the diagnosis was finally made using Giemsa stain of direct smear which showed characteristic morphology of Enterococcus faecium. Linezolid, one of the oxazo-lidinones, was initially given in oral form 600 mg BID for three weeks, but did not prove efficacious. Subsequently, intravitreal linezolid 200 mcg in 0.1ml was injected, which cleared the vitreous and cornea infection within a week. However, there was a residual exudative detachment of the retina in the posterior pole, leaving the patient with a final vision of hand movement. Vancomycin-resistant enterococcus is a rare cause of endophthalmitis. Intravitreal linezolid is an effective treatment, but the subsequent exudative retinal detachment may have been related to this novel therapy.

Peer reviewed article authored by (Babalola OE, Adu A, Akano AO). Read article or submit your manuscript for publishing.

Direct non-medical costs are health expenditures which are not part of the cost of medical services such as cost of transportation, feeding and accommodati