Cryptococcal meningitis is a fungal infection of the CNS, generally thought of as an opportunistic infection in those with T-cell immunodeficiencies including AIDS (usually with a CD4 count of less than 100), chronic steroid use, hematological malignancies, and transplant recipients.It can have irreversible CNS morbidity, including vision loss, intracranial hypertension, and cognitive decline. Diagnosis depends on cerebrospinal fluid (CSF) analysis, in which cultures and cryptococcal antigen are most sensitive. CSF PCR can also be done. Most patients have disseminated disease, and blood cultures are also positive. Outcomes remain guarded, with a poor prognosis (morbidity and high mortality) among survivors. This article presents a case of cryptococcal meningitis in an immunocompetent individual, where absolutely no identifiable risk factor was present.
While COVID-19 has gained popularity as a pandemic and as a cause of pulmonary-systemic disease, the condition continues to evolve our knowledge and understanding of immunology and medicine through its myriad clinical presentations. This article features a previously healthy 65-year-old female who presented with sudden features of cryptococcal meningitis, the progression of which raises questions as to what role the virus plays in the innate, adaptive, and overall host factors leading to immunosuppression.
Introduction: Less than 50% adherence is reported 1 year after initiating antihypertensives. We examined social disparities in cost-related medication non-adherence (CRN) by insurance and family income categories in adults with hypertension. Methods: We used National Health Interview Survey 2014-2017 data from adults who reported hypertension and were taking antihypertensive medications. Respondents reported their insurance plan and family income. A cumulative SDoH index was created by aggregating 45 determinants from 6 domains, and respondents were grouped by quartiles (SDoH-Q1 to Q4). Higher SDoH quartiles indicated greater disadvantage. CRN was present if an individual skipped medication to save money, took less medicine to save money, or delayed filling a prescription to save money in the last 12 months. Results: A total of 35,893 adults managed for hypertension were surveyed, with a mean age 62.48 [SD 14.24] years, female 51.3%). The prevalence of CRN was 9.5%. The uninsured (34.6%) and those with low income were most likely to report CRN. Regardless of insurance or income, higher SDoH quartile groups were more likely to report CRN. This trend was accentuated among the uninsured and the middle-income group. Adjusting for demographics and comorbidities, the least increment in the odds of CRN with SDoH quartiles was seen among Medicare beneficiaries and low-income: SDoH-Q4 was associated with OR = 8.47 (95%CI, 2.11, 33.93) for Medicare beneficiaries, and OR = 17.80 (95%CI, 7.91, 40.03) for low-income. The highest increment in the odds of CRN with SDoH quartiles were observed with the uninsured (OR = 22.89; 95%CI [4.91, 106.81]), and the middle-income group (OR = 21.57; 95%CI [13.78, 33.77]). Conclusion: While cumulative social disadvantage was associated with higher cost-related medication non-adherence among adults on medications for hypertension, this association was stronger in the uninsured, Medicaid beneficiaries, and the middle-income group.
Hyperthyroidism and thyrotoxicosis are common conditions in clinical practice. Untreated, they are associated with several co-morbidities. One of these conditions, and arguably the most lethal, is the thyroid storm. Our case presentation is one of a young female who had previously been diagnosed with thyroid illness but was lost to follow-up, subsequently given a clean bill of health, and emerged with what would eventually be diagnosed as a thyroid storm. While the thyroid storm may pose some diagnostic challenges, it has come a long way in securing diagnostic tools. What remains is a tool for physicians and patients to stratify patients by their risk of developing a storm in the outpatient setting.
This paper explores the neuropsychiatric consequences of SARS-CoV-2 (COVID-19) infection, specifically the use of intravenous immunoglobulin (IVIG) therapy in treating central nervous system (CNS) symptoms associated with COVID-19. The authors searched PubMed and Google Scholar using the keywords "IVIG" and "covid-19 neuropsychiatric symptoms" to find five articles, including three case reports, a retrospective study, and a prospective study, that detail the experiences of individuals with persistent neuropsychiatric symptoms after contracting COVID-19. The neuropsychiatric symptoms reported in the analyzed studies include sleep disturbance, exhaustion, cognitive decline, anxiety, and others. Common treatments for post-COVID neuropsychiatric symptoms include medications, cognitive behavioral therapy, and lifestyle modifications. IVIG therapy to manage CNS symptoms of COVID-19 has shown mixed results in studies, with some showing positive effects while others remain inconclusive. Further research is needed to understand this therapy's potential benefits and limitations fully.
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