Objective: Coronavirus disease (COVID-19) vaccinations have been shown to prevent infection with efficacies ranging from 50% to 95%. This study assesses the impact of vaccination on the clinical severity of COVID-19 during the second wave in Brunei Darussalam in 2021, which was due to the Delta variant. Methods: Patients included in this study were randomly selected from those who were admitted with COVID-19 to the National Isolation Centre between 7 August and 6 October 2021. Cases were categorized as asymptomatic, mild (symptomatic without pneumonia), moderate (pneumonia), severe (needing supplemental oxygen therapy) or critical (needing mechanical ventilation) but for statistical analysis purposes were dichotomized into asymptomatic/mild or moderate/severe/critical cases. Univariate and multivariable analyses were conducted to identify risk factors associated with moderate/severe/critical disease. Propensity score-matched analysis was also performed to evaluate the impact of vaccination on disease severity. Results: The study cohort of 788 cases (mean age: 42.1 + 14.6 years; 400 males) comprised 471 (59.8%) asymptomatic/mild and 317 (40.2%) moderate/severe/critical cases. Multivariable logistic regression analysis showed older age group (>45 years), diabetes mellitus, overweight/obesity and vaccination status to be associated with increased severity of disease. In propensity score-matched analysis, the relative risk of developing moderate/severe/critical COVID-19 for fully vaccinated (two doses) and partially vaccinated (one dose) cases was 0.33 (95% confidence interval [CI]: 0.16–0.69) and 0.62 (95% CI: 0.46–0.82), respectively, compared with a control group of non-vaccinated cases. The corresponding relative risk reduction (RRR) values were 66.5% and 38.4%, respectively. Vaccination was also protective against moderate/severe/critical disease in a subgroup of overweight/obese patients (RRR: 37.2%, P = 0.007). Discussion: Among those who contracted COVID-19, older age, having diabetes, being overweight/obese and being unvaccinated were significant risk factors for moderate/severe/critical disease. Vaccination, even partial, was protective against moderate/severe/critical disease.

A pyogenic liver abscess (PLA) is uncommon and a potentially life-threatening condition. Clinical manifestations and laboratory investigations can be non-specific and the detection of PLAs requires imaging, which can often be delayed. Point-of-care ultrasound (POCUS) is now becoming more widely adopted and plays an important role in clinical practice. We report two cases of PLA, one of which was a gas-forming PLA that we encountered in a district general hospital where POCUS played an important role in the diagnosis and management. The diagnoses of PLAs were initially unsuspected due to a combination of non-specific symptom manifestations, initial negative imaging, and a subtle radiological clue that was missed due to a lack of awareness. Bedside POCUS examinations were done due to clinical deterioration in one patient and lack of inflammatory marker improvement in both patients. These cases highlight the important role of POCUS in the management of patients with liver abscesses.

We read with interest the article by Kim et al.1 on the long-term control of diabetes mellitus (DM) after visiting a tertiary university hospital. In this study, patients were categorized into 4 groups based on HbA1c changes at three months; Best (≥ 1.6% decrease), Better (0.5-1.5% reduction), Neutral (≤ 0.4% decrease or ≤ 0.4% increase), and Worst (≥ 0.5% increase). The Best group had the best control up to 7 years, regardless of the baseline Hba1c. The groups with improvement (Best and Better) had lower risk for complications (cardiac and cerebrovascular), albeit not significant. This study provided important guides for target HbA1c reductions within 3, if not 12 months (no data on 3-month HbA1c reported). The accompanying editorial stressed on this and highlighted the benefits of the ‘legacy effects’, and alluded to factors that contribute to poor control that included beta cell dysfunctions, inconsistencies with guidelines and practices, and clinical inertia especially in the primary care settings.2 Treatment at primary and even secondary care levels are usually a bottom-up approach (stepwise increase in medications) and there also may be clinical inertia on part of doctors to introduce or escalate, including use of insulin, mainly for fear of inducing hypoglycemia and patient’s reluctance to accept treatment modifications.

Objective: Patients who recover from coronavirus disease (COVID-19) infection are at risk of long-term health disorders and may require prolonged health care. This retrospective observational study assesses the number of health-care visits before and after COVID-19 infection in Brunei Darussalam. Methods: COVID-19 cases from the first wave with 12 months of follow-up were included. Health-care utilization was defined as health-care visits for consultations or investigations. Post-COVID condition was defined using the World Health Organization definition. Results: There were 132 cases; 59.1% were male and the mean age was 37.1 years. The mean number of health-care visits 12 months after recovery from COVID-19 (123 cases, 93.2%; mean 5.0 ± 5.2) was significantly higher than the prior 12 months (87 cases, 65.9%, P<0.001; mean 3.2 ± 5.7, P<0.001). There was no significant difference when scheduled COVID-19 visits were excluded (3.6 ± 4.9, P = 0.149). All 22 cases with moderate to critical disease recovered without additional health-care visits apart from planned post-COVID-19 visits. Six patients had symptoms of post-COVID condition, but none met the criteria for diagnosis or had alternative diagnoses. Discussion: There were significantly more health-care visits following recovery from COVID-19. However, this was due to scheduled post-COVID-19 visits as per the national management protocol. This protocol was amended prior to the second wave to omit post-COVID-19 follow-up, except for complicated cases or cases with no documented radiological resolution of COVID-19 pneumonia. This will reduce unnecessary health-care visits and conserve precious resources that were stretched to the limit during the pandemic.

Coronavirus disease (COVID-19) and tuberculosis (TB) coinfection is expected to become more common in countries where TB is endemic, and coinfection has been reported to be associated with less favourable outcomes. Knowing about the manifestations and outcomes of coinfection is important as COVID-19 becomes endemic. During the second wave of the COVID-19 pandemic in Brunei Darussalam, we encountered seven patients with COVID-19 and Mycobacterium coinfection. Cases of coinfection included three patients with newly diagnosed pulmonary Mycobacterium infection (two cases of pulmonary TB [PTB] and one case of Mycobacterium fortuitum infection) and four patients who were already being treated for TB (three cases of PTB and one case of TB lymphadenitis). Among the new cases, one had previously tested negative for PTB during a pre-employment medical fitness evaluation and had defaulted from follow up and evaluation. One case died: a 42-year-old man with diabetes mellitus, chronic kidney disease and hypertension who had severe COVID-19 and needed urgent dialysis and supplemental oxygen. All other patients recovered from COVID-19 and completed their TB treatment.

Objective: Differences in clinical manifestations between strains of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported. This retrospective descriptive study compares the clinical and demographic characteristics of all confirmed coronavirus disease (COVID-19) cases admitted to the National Isolation Centre (NIC) in the first wave and at the beginning of the second wave of the pandemic in Brunei Darussalam. Methods: All COVID-19 cases admitted to the NIC between 9 March and 6 May 2020 (first wave) and 7–17 August 2021 (second wave) were included. Data were obtained from NIC databases and case characteristics compared using Student’s t-tests and chi-squared tests, as appropriate. Results: Cases from the first wave were significantly older than those from the second wave (mean 37.2 vs 29.7 years, P<0.001), and a higher proportion reported comorbidities (30.5% vs 20.3%, P=0.019). Cases from the second wave were more likely to be symptomatic at admission (77.7% vs 63.1%, P<0.001), with a higher proportion reporting cough, anosmia, sore throat and ageusia/dysgeusia; however, myalgia and nausea/vomiting were more common among symptomatic first wave cases (all P<0.05). There was no difference in the mean number of reported symptoms (2.6 vs 2.4, P=0.890). Discussion: Our study showed clear differences in the profile of COVID-19 cases in Brunei Darussalam between the first and second waves, reflecting a shift in the predominating SARS-CoV-2 strain. Awareness of changes in COVID-19 disease manifestation can help guide adjustments to management policies such as duration of isolation, testing strategies, and criteria for admission and treatment.

In any infectious disease outbreak, early diagnosis, isolation of cases and quarantine of contacts are central to disease containment. In Brunei Darussalam, suspected cases of coronavirus disease 2019 (COVID-19) were quarantined either at home or at designated centres and were tested immediately for severe acute respiratory syndrome coronavirus 2. We report on 10 cases of COVID-19 that initially tested negative for COVID-19 and were positive on re-testing after becoming symptomatic. These cases comprised 3.8% of the 266 total confirmed COVID-19 cases in Brunei Darussalam as of 9 July 2021, when this study was conducted. All the cases were in quarantine at home and were tested early during their quarantine period. Since then, home quarantine has been replaced by quarantine at designated centres only, with testing on the 12th day of quarantine.

Problem: Soon after the start of the second wave of coronavirus disease 2019 (COVID-19) in Brunei Darussalam, which was confirmed to be due to the more infectious Delta strain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), it became apparent that the National Isolation Centre (NIC) was not coping. Context: The NIC was the only isolation and treatment centre for COVID-19 in Brunei Darussalam. During the first wave and the first 11 days of the second wave, all confirmed cases were admitted to the NIC for isolation and treatment in line with the management strategy to isolate all confirmed cases to control the outbreak. Action: The Ministry of Health opened five community isolation centres and two quarantine centres to divert asymptomatic and mild cases from the NIC. The community isolation centres also functioned as triage centres for the NIC, and the quarantine centres accommodated recovered patients who did not have their own quarantine facilities. Outcome: The community isolation and quarantine centres diverted cases from the NIC and enabled recovered cases to be transferred to these step-down facilities. This reduced the NIC's occupancy to a safe level and enabled the reorganization of the NIC to function as a treatment centre and a national COVID-19 hospital. Discussion: During any disease outbreak, health facilities must be prepared to adapt to changing situations. Strong leadership, stakeholder commitments, teamwork and constant communication are important in this process.

Both tuberculosis (TB) and melioidosis are endemic to certain parts of the world, including Brunei Darussalam, with TB being more widespread. Despite this, coinfection with TB and melioidosis is rarely encountered and reported. Although still uncommon, there has been an increase in the number of cases of this coinfection reported during the past 10 years, all of which have been in India and the World Health Organization's Western Pacific Region. We report a case of coinfection with pulmonary TB and melioidosis in a patient with poorly controlled diabetes mellitus. This 64-year-old man presented with symptoms and radiological features of pulmonary TB, confirmed by sputum smear, but sputum culture also yielded Burkholderia pseudomallei, the pathogen that causes melioidosis. Coinfection was detected due to our practice of routinely screening for other infections in patients suspected or confirmed to have pulmonary TB. This highlights the importance of awareness of melioidosis and the need to consider screening for infection, especially in endemic regions.

Objective: This retrospective, cross-sectional, observational study assessed the duration of coronavirus disease 2019 (COVID-19) symptoms during the second wave in Brunei Darussalam. Methods: Data from COVID-19 cases admitted to the National Isolation Centre during 7–30 August 2021 were included in the study. Symptom onset and daily symptom assessments were entered into a database during hospitalization and disease was categorized by severity. The time between symptom onset and hospital admission, the duration of symptoms and length of hospitalization were assessed separately by age group, disease severity and vaccination status using one-way analysis of variance with Bonferroni post hoc corrections. Results: Data from 548 cases were included in the study: 55.7% (305) of cases were male, and cases had a mean age of 33.7 years. Overall, 81.3% (446) reported symptoms at admission (mean number of symptoms and standard deviation: 2.8 ± 1.6), with cough (59.1%; 324), fever (38.9%; 213) and sore throat (18.4%; 101) being the most common. Being older, having more severe disease and being unvaccinated were significantly associated with the time between symptom onset and hospital admission, symptom duration and length of hospitalization. Discussion: Knowing which factors predict the duration of COVID-19 symptoms can help in planning management strategies, such as the duration of isolation, predict the length of hospitalization and treatment, and provide more accurate counselling to patients regarding their illness.

Approximately one-third of patients with COVID-19 develop thrombocytopenia, and it is more commonly seen in those with severe infection We present a 66-year-old gentleman with confirmed COVID-19 who developed severe thrombocytopenia during his admission He was asymptomatic at diagnosis He developed petechial rash over both arms, root of the mouth and under the tongue and was confirmed to have thrombocytopaenia This was managed by Platelet transfusion Thrombocytopenia is usually mild in patients with COVID-19 unlike our case Nonetheless, a comprehensive evaluation of thrombocytopenia remains important as treatment of the underlying cause may reduce the risk of potentially catastrophic consequences Clinicians should remain vigilant of the association between COVID-19 and thrombocytopenia, and instigate prompt supportive treatment accordingly © 2021

Objective: Bacterial co-infections in cases of coronavirus disease 2019 (COVID-19) can lead to less favourable outcomes. The aim of this study was to determine the prevalence of primary bacterial co-infections among patients with COVID-19 in Brunei Darussalam. Methods: Seventy-one of 180 patients admitted to the National Isolation Centre between 9 March 2020 and 4 February 2021 were screened for primary bacterial co-infection (infection occurring <= 48 h from admission). We compared patients with a primary bacterial co-infection to those without. Results: Of the 71 screened patients, 8 (11.2%) had a primary bacterial co-infection (sputum 37.5% [6/16], blood 2.8% [1/36], urine 1.7% [1/60]), for a period prevalence rate of 4.4% (respiratory tract infection 3.3% [6/180], bloodstream 0.6% [1/180], urine 0.6% [1/180]) among all COVID-19 patients. Older age, presence of comorbidity, symptoms at admission (fever, dyspnoea, nausea/vomiting), abnormal chest X-ray (CXR) and more severe COVID-19 (P < 0.05) were associated with primary bacterial co-infection. Primary bacterial co-infection was also associated with development of secondary infection and death (all P < 0.05). Only one patient with primary bacterial co-infection died (methicillin-sensitive Staphylococcus aureus septicaemia and multiorgan failure). Conclusions: Our study showed that primary bacterial co-infection affected 4.4% of patients with COVID-19 in Brunei Darussalam. Older age, presence of comorbidity, symptoms and abnormal CXR at admission and more severe disease were associated with a primary bacterial co-infection. Lower respiratory tract infection was the most common co-infection.

Journal of Medical VirologyVolume 93, Issue 1 p. 199-201 LETTER TO THE EDITOR COVID-19 in children in Brunei Darussalam: Higher incidence but mild manifestations Shaji George, Corresponding Author Shaji George [email protected] Department of Pediatrics, PMMPMHAMB Hospital, Tutong, Brunei Correspondence Shaji George, Department of Pediatrics, PMMPMHAMB Hospital, Tutong TA1341, Brunei. Email: [email protected]Search for more papers by this authorMohammad Salahuddin Ansari, Mohammad Salahuddin Ansari Department of Pediatrics, PMMPMHAMB Hospital, Tutong, BruneiSearch for more papers by this authorAnto Kalliath, Anto Kalliath Department of Pediatrics, PMMPMHAMB Hospital, Tutong, BruneiSearch for more papers by this authorMohammad Jawaid Khan, Mohammad Jawaid Khan Department of Pediatrics, PMMPMHAMB Hospital, Tutong, BruneiSearch for more papers by this authorMuhammad Syafiq Abdullah, Muhammad Syafiq Abdullah Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei Institute of Health Science, PAPRSB, Unversiti Brunei Darussalam, Bandar Seri Begawan, BruneiSearch for more papers by this authorRosmonaliza Asli, Rosmonaliza Asli Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, BruneiSearch for more papers by this authorRiamiza Natalie Momin, Riamiza Natalie Momin Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, BruneiSearch for more papers by this authorBabu Ivan Mani, Babu Ivan Mani Institute of Health Science, PAPRSB, Unversiti Brunei Darussalam, Bandar Seri Begawan, BruneiSearch for more papers by this authorPui Lin Chong, Pui Lin Chong Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, BruneiSearch for more papers by this authorVui Heng Chong, Vui Heng Chong orcid.org/0000-0002-2844-4872 Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei Institute of Health Science, PAPRSB, Unversiti Brunei Darussalam, Bandar Seri Begawan, Brunei Department of Medicine, PMMPHAMB Hospital, Tutong, BruneiSearch for more papers by this author Shaji George, Corresponding Author Shaji George [email protected] Department of Pediatrics, PMMPMHAMB Hospital, Tutong, Brunei Correspondence Shaji George, Department of Pediatrics, PMMPMHAMB Hospital, Tutong TA1341, Brunei. Email: [email protected]Search for more papers by this authorMohammad Salahuddin Ansari, Mohammad Salahuddin Ansari Department of Pediatrics, PMMPMHAMB Hospital, Tutong, BruneiSearch for more papers by this authorAnto Kalliath, Anto Kalliath Department of Pediatrics, PMMPMHAMB Hospital, Tutong, BruneiSearch for more papers by this authorMohammad Jawaid Khan, Mohammad Jawaid Khan Department of Pediatrics, PMMPMHAMB Hospital, Tutong, BruneiSearch for more papers by this authorMuhammad Syafiq Abdullah, Muhammad Syafiq Abdullah Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei Institute of Health Science, PAPRSB, Unversiti Brunei Darussalam, Bandar Seri Begawan, BruneiSearch for more papers by this authorRosmonaliza Asli, Rosmonaliza Asli Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, BruneiSearch for more papers by this authorRiamiza Natalie Momin, Riamiza Natalie Momin Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, BruneiSearch for more papers by this authorBabu Ivan Mani, Babu Ivan Mani Institute of Health Science, PAPRSB, Unversiti Brunei Darussalam, Bandar Seri Begawan, BruneiSearch for more papers by this authorPui Lin Chong, Pui Lin Chong Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, BruneiSearch for more papers by this authorVui Heng Chong, Vui Heng Chong orcid.org/0000-0002-2844-4872 Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei Institute of Health Science, PAPRSB, Unversiti Brunei Darussalam, Bandar Seri Begawan, Brunei Department of Medicine, PMMPHAMB Hospital, Tutong, BruneiSearch for more papers by this author First published: 20 July 2020 https://doi.org/10.1002/jmv.26310Citations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. REFERENCES 1Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr. 2020; 109: 1088-1095. https://doi.org/10.1111/apa.15270 10.1111/apa.15270 CASPubMedWeb of Science®Google Scholar 2Peng H, Gao P, Xu Q, et al. Coronavirus disease 2019 in children: characteristics, antimicrobial treatment, and outcomes. J Clin Virol. 2020; 128:104425. https://doi.org/10.1016/j.jcv.2020.104425 10.1016/j.jcv.2020.104425 CASPubMedWeb of Science®Google Scholar 3Panahi L, Amiri M, Pouy S. Clinical characteristics of COVID-19 infection in newborns and pediatrics: a systematic review. Arch Acad Emerg Med. 2020; 8:e50. PubMedGoogle Scholar 4Chong VH, Chong PL, Metussin D, et al. Conduction abnormalities in hydroxychloroquine add on therapy to lopinavir/ritonavir in COVID-19 [published online ahead of print May 13, 2020]. J Med Virol. 2020. https://doi.org/10.1002/jmv.26004 10.1002/jmv.26004 Web of Science®Google Scholar 5Cui X, Zhang T, Zheng J, et al. Children with coronavirus disease 2019: a review of demographic, clinical, laboratory, and imaging features in pediatric patients [published online ahead of print May 17, 2020]. J Med Virol. 2020. https://doi.org/10.1002/jmv.26023 10.1002/jmv.26023 Web of Science®Google Scholar 6Miri SM, Noorbakhsh F, Mohebbi SR, Ghaemi A. Higher prevalence of asymptomatic or mild COVID-19 in children, claims and clues [published online ahead of print]. J Med Virol. 2020. https://doi.org/10.1002/jmv.26069 10.1002/jmv.26069 PubMedWeb of Science®Google Scholar 7Licciardi F, Pruccoli G, Denina M, et al. SARS-CoV-2-induced Kawasaki-like hyperinflammatory syndrome: a novel COVID phenotype in children [published online ahead of print]. Pediatrics. 2020:e20201711. https://doi.org/10.1542/peds.2020-1711 10.1542/peds.2020-1711 PubMedWeb of Science®Google Scholar 8Latimer G, Corriveau C, DeBiasi RL, et al. Cardiac dysfunction and thrombocytopenia-associated multiple organ failure inflammation phenotype in a severe paediatric case of COVID-19. Lancet Child Adolesc Health. 2020; 4: 552-554. https://doi.org/10.1016/S2352-4642(20)30163-2 10.1016/S2352-4642(20)30163-2 CASPubMedWeb of Science®Google Scholar Citing Literature Volume93, Issue1Special Issue on New coronavirus (2019‐nCoV or SARS‐CoV‐2) and the outbreak of the respiratory illness (COVID‐19): Part‐VIIIJanuary 2021Pages 199-201 ReferencesRelatedInformation

Journal of Medical VirologyVolume 92, Issue 10 p. 1810-1811 LETTER TO THE EDITOR Lipemic serum in patients with Coronavirus Disease 2019 (COVID-19) undergoing treatment Abdur Rahman Rubel, Abdur Rahman Rubel Department of Internal Medicine, PMMPMHAMB Hospital, Tutong, Brunei DarussalamSearch for more papers by this authorPui Lin Chong, Pui Lin Chong Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei DarussalamSearch for more papers by this authorMuhammad Syafiq Abdullah, Muhammad Syafiq Abdullah Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam Institute of Health Science, PAPRSB, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei DarussalamSearch for more papers by this authorRosmonaliza Asli, Rosmonaliza Asli Infectious Disease Unit, Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei DarussalamSearch for more papers by this authorRiamiza Natalie Momin, Riamiza Natalie Momin Infectious Disease Unit, Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei DarussalamSearch for more papers by this authorBabu Ivan Mani, Babu Ivan Mani Department of Internal Medicine, PMMPMHAMB Hospital, Tutong, Brunei DarussalamSearch for more papers by this authorVui Heng Chong, Corresponding Author Vui Heng Chong [email protected] orcid.org/0000-0002-2844-4872 Department of Internal Medicine, PMMPMHAMB Hospital, Tutong, Brunei Darussalam Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam Institute of Health Science, PAPRSB, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei Darussalam Correspondence Vui Heng Chong, Department of Internal Medicine, PMMPMHAMB Hospital, Jalan Sungai Basong, Tutong 1341, Brunei Darussalam. Email: [email protected]Search for more papers by this author Abdur Rahman Rubel, Abdur Rahman Rubel Department of Internal Medicine, PMMPMHAMB Hospital, Tutong, Brunei DarussalamSearch for more papers by this authorPui Lin Chong, Pui Lin Chong Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei DarussalamSearch for more papers by this authorMuhammad Syafiq Abdullah, Muhammad Syafiq Abdullah Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam Institute of Health Science, PAPRSB, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei DarussalamSearch for more papers by this authorRosmonaliza Asli, Rosmonaliza Asli Infectious Disease Unit, Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei DarussalamSearch for more papers by this authorRiamiza Natalie Momin, Riamiza Natalie Momin Infectious Disease Unit, Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei DarussalamSearch for more papers by this authorBabu Ivan Mani, Babu Ivan Mani Department of Internal Medicine, PMMPMHAMB Hospital, Tutong, Brunei DarussalamSearch for more papers by this authorVui Heng Chong, Corresponding Author Vui Heng Chong [email protected] orcid.org/0000-0002-2844-4872 Department of Internal Medicine, PMMPMHAMB Hospital, Tutong, Brunei Darussalam Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam Institute of Health Science, PAPRSB, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei Darussalam Correspondence Vui Heng Chong, Department of Internal Medicine, PMMPMHAMB Hospital, Jalan Sungai Basong, Tutong 1341, Brunei Darussalam. Email: [email protected]Search for more papers by this author First published: 28 April 2020 https://doi.org/10.1002/jmv.25942Citations: 12Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. REFERENCES 1Morrison AR, Johnson JM, Ramesh M, Bradley P, Jennings J, Smith ZR. Letter to the Editor: acute hypertriglyceridemia in patients with COVID-19 receiving tocilizumab. J Med Virol, 2020. https://doi.org/10.1002/jmv.25907 10.1002/jmv.25907 Google Scholar 2Matoga MM, Hosseinipour MC, Aga E, et al. Hyperlipidaemia in HIV-infected patients on lopinavir/ritonavir monotherapy in resource-limited settings. Antivir Ther. 2017; 22(3): 205-213. 10.3851/IMP3101 CASPubMedWeb of Science®Google Scholar 3Montes ML, Pulido F, Barros C, et al. Lipid disorders in antiretroviral-naive patients treated with lopinavir/ritonavir-based HAART: frequency, characterization, and risk factors. J Antimicrob Chemother. 2005; 55: 800-804. 10.1093/jac/dki063 CASPubMedWeb of Science®Google Scholar Citing Literature Volume92, Issue10Special Issue on New coronavirus (2019‐nCoV or SARS‐CoV‐2) and the outbreak of the respiratory illness (COVID‐19): Part‐VIOctober 2020Pages 1810-1811 ReferencesRelatedInformation

Novel coronavirus disease (COVID-19) is a highly contagious disease caused by severe acute respiratory distress syndrome coronavirus-2 that has resulted in the current global pandemic. Currently, there is no available treatment proven to be effective against COVID-19, but multiple medications, including hydroxychloroquine (HCQ), are used off label. We report the case of a 60-year-old woman without any cardiac history who developed right bundle brunch block and critically prolonged corrected electrocardiographic QT interval (QTc 631 ms) after treatment for 3 days with HCQ, which resolved on discontinuation of the medication. This case highlights a significant and potentially life-threatening complication of HCQ use.

Journal of Medical VirologyVolume 92, Issue 11 p. 2322-2324 LETTER TO THE EDITOR Conduction abnormalities in hydroxychloroquine add on therapy to lopinavir/ritonavir in COVID-19 Vui Heng Chong, Corresponding Author Vui Heng Chong [email protected] [email protected] orcid.org/0000-0002-2844-4872 Department of Medicine, PMMPMHAMB Hospital, Tutong, Brunei Darussalam Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam Correspondence Vui Heng Chong, Department of Medicine, PMMPMHAMB Hospital, Tutong, Brunei Darussalam. Email: [email protected]; [email protected]Search for more papers by this authorPui Lin Chong, Pui Lin Chong Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei DarussalamSearch for more papers by this authorDhiya Metussin, Dhiya Metussin Department of Medicine, Infectious Disease Unit, RIPAS Hospital, Bandar Seri Begawan, Brunei DarussalamSearch for more papers by this authorRosmonaliza Asli, Rosmonaliza Asli Department of Medicine, Infectious Disease Unit, RIPAS Hospital, Bandar Seri Begawan, Brunei DarussalamSearch for more papers by this authorRiamiza Natalie Momin, Riamiza Natalie Momin Department of Medicine, Infectious Disease Unit, RIPAS Hospital, Bandar Seri Begawan, Brunei DarussalamSearch for more papers by this authorBabu Ivan Mani, Babu Ivan Mani Department of Medicine, PMMPMHAMB Hospital, Tutong, Brunei DarussalamSearch for more papers by this authorMuhammad Syafiq Abdullah, Muhammad Syafiq Abdullah Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei DarussalamSearch for more papers by this author Vui Heng Chong, Corresponding Author Vui Heng Chong [email protected] [email protected] orcid.org/0000-0002-2844-4872 Department of Medicine, PMMPMHAMB Hospital, Tutong, Brunei Darussalam Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam Correspondence Vui Heng Chong, Department of Medicine, PMMPMHAMB Hospital, Tutong, Brunei Darussalam. Email: [email protected]; [email protected]Search for more papers by this authorPui Lin Chong, Pui Lin Chong Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei DarussalamSearch for more papers by this authorDhiya Metussin, Dhiya Metussin Department of Medicine, Infectious Disease Unit, RIPAS Hospital, Bandar Seri Begawan, Brunei DarussalamSearch for more papers by this authorRosmonaliza Asli, Rosmonaliza Asli Department of Medicine, Infectious Disease Unit, RIPAS Hospital, Bandar Seri Begawan, Brunei DarussalamSearch for more papers by this authorRiamiza Natalie Momin, Riamiza Natalie Momin Department of Medicine, Infectious Disease Unit, RIPAS Hospital, Bandar Seri Begawan, Brunei DarussalamSearch for more papers by this authorBabu Ivan Mani, Babu Ivan Mani Department of Medicine, PMMPMHAMB Hospital, Tutong, Brunei DarussalamSearch for more papers by this authorMuhammad Syafiq Abdullah, Muhammad Syafiq Abdullah Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei DarussalamSearch for more papers by this author First published: 13 May 2020 https://doi.org/10.1002/jmv.26004Citations: 16Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. REFERENCES 1Sarma P, Kaur H, Kumar H, et al. Virological and clinical cure in COVID-19 patients treated with hydroxychloroquine: a systematic review and meta-analysis [published online ahead of print April 16, 2020]. J Med Virol. 2020. https://doi.org/10.1002/jmv.25898 10.1002/jmv.25898 PubMedWeb of Science®Google Scholar 2Jaffe S. Regulators split on antimalarials for COVID-19. Lancet. 2020; 395(10231): 1179. https://doi.org/10.1016/S0140-6736(20)30817-5 10.1016/S0140-6736(20)30817-5 CASPubMedWeb of Science®Google Scholar 3Taccone FS, Gorham J, Vincent JL. Hydroxychloroquine in the management of critically ill patients with COVID-19: the need for an evidence base [published online ahead of print April 15, 2020]. 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Click to increase image sizeClick to decrease image size Disclosure statementAll authors declare no conflict of interest and financial declaration.Additional informationFundingThe support of the Ministry of Health. No funding was required for the study.