Background and Objectives: Thyroid dysfunction is common among patients with mood disorders. The main purpose of this study is to estimate the prevalence of thyroid dysfunction among patients with various types of mood disorders. Materials and Methods: The study compromised of 50 patients meeting the inclusion and exclusion criteria selected by simple random sampling technique who attended the psychiatry OPD at B P Koirala Institute Of Health Sciences Dharan, Nepal. These patients were classified into different types of mood disorders according to ICD-10 DCR Criteria. Nineteen patients (38%) were diagnosed BPAD, fourteen patients ( 28%) as Depressive Disorder and the rest as single episode mania , Recurrent depressive disorder and dysthymia. Results: Out Of a total 50 cases, Fifteen Patients(30%) were found to have some form of thyroid dysfunction , the most common being subclinical hypothyroidism seen in 22% and the rest 8% with overt hypo/hyperthyroidism cases. This data is clearly /significant higher than the general population. However, there was no significant association found between socio-demographic variables and mood disorders with thyroid dysfunction. Conclusions: This study shows that thyroid dysfunction is common among patients with mood disorders though larger studies in the community setting are required for further evaluation. DOI: http://dx.doi.org/10.3126/jpan.v3i1.11348 J Psychiatrists’ Association of Nepal Vol .3, No.1, 2014: 23-28

Presence of single umbilical persistent vitelline artery distinguishes sirenomelia from caudal regression syndrome. We report a case of a12-year-old boy who had bilateral umbilical arteries presented with fusion of both legs in the lower one third of leg. Both feet were rudimentary. The right foot had a valgus rocker-bottom deformity. All toes were present but rudimentary. The left foot showed absence of all toes. Physical examination showed left tibia vara. The chest evaluation in sitting revealed pigeon chest and elevated right shoulder. Posterior examination of the trunk showed thoracic scoliosis with convexity to right. The patient was operated and at 1 year followup the boy had two separate legs with a good aesthetic and functional results.

Neurotoxicity is a rare side effect of Cefepime use. Cefepime can cross the blood-brain barrier and can be neurotoxic by competitive albeit weak antagonism of the gamma-aminobutyric acid complex. It is cleared by the kidneys which puts individuals with renal impairment at risk of side effects. We describe a case of Cefepime neurotoxicity in the context of nephrotoxicity secondary to the use of other drugs.

Patients hospitalized for acute myocardial infarction (AMI) may have concomitant positive coronavirus disease 2019 (COVID-19). We aimed to compare the risk of in-hospital mortality in patients primarily hospitalized for AMI with or without concomitant COVID-19 positive status. Using the random-effects model, we conducted a systematic review and meta-analysis of published articles from December 1, 2019, to April 1, 2022. There were eight studies with 10,128 patients, including 612 patients with COVID and 9516 patients without COVID. A total of 261 patients (42.64%) with COVID-19 positive and 612 patients (6.43%) with negative COVID-19 status died in the hospital. Pooled data showed that patients with a primary diagnosis of AMI with COVID-19 infection had more than five times increased risk of in-hospital mortality compared to patients without COVID-19 (OR: 5.06, 95% CI: 3.61, 7.09; I 2 = 35%, P < 0.001). However, pooled data from five studies with adjustment of baseline differences in patient demographics and characteristics, comorbidities, and in-hospital pharmacology revealed more than three times increased risk of in-hospital mortality compared to patients who had primary AMI without COVID-19 infection (aOR: 3.47, 95% CI: 2.21, 5.45; I 2 = 0%, P < 0.001). In subgroup analysis, ST-elevation myocardial infarction (STEMI) had lower in-hospital mortality (OR 4.23, 95% CI: 3.31, 5.40; I 2 = 0%, P < 0.001) compared to non-ST-segment elevation myocardial infarction (NSTEMI) (OR 9.97, 95% CI: 5.71, 17.41; I 2 = 0%, P < 0.001) (p-value = 0.006). Our study shows that COVID-19 infection is associated with increased in-hospital mortality in patients with index hospitalization for AMI.

Mycoplasma pneumonia usually causes asymptomatic to mild respiratory tract infection. However, nonrespiratory manifestations are not rare with involvement of various organ including skin, cardiovascular, central nervous system. We are presenting a 43-year-old male who presented with diffuse rash, sever mucositis, confusion, and complicated by ischemic stroke; also, review of mycoplasma related stroke and Stevens-Johnson syndrome.

Background With the results of the largest randomized controlled trial (RECOVERY) and the most extensive retrospective cohort study on COVID-19 recently published, we performed a meta-analysis on the association of aspirin with mortality of COVID-19. We aimed to investigate the role of aspirin in COVID-19 hospitalizations. Materials and Methods We searched PubMed, EMBASE, and Cochrane databases for studies from January 1, 2020, until July 20, 2022, that compared aspirin versus non-aspirin use in hospitalized COVID-19 patients. We excluded case reports, review articles, and studies on non-hospitalized COVID-19 infections. We used the inverse variance method and random effects model to pool the individual studies. Results Ten observational studies and one randomized controlled trial met the criteria for inclusion. There were 136,695 total patients, of which 27,168 were in the aspirin group, and 109,527 were in the non-aspirin group. Aspirin use was associated with a 14% decrease in all-cause mortality compared to non-aspirin use in patients hospitalized with COVID-19 (RR 0.86, 95% CI: 0.76-0.97, P = 0.002, I2= 64%). Among subgroups of studies reporting in-hospital mortality in COVID-19 hospitalizations, aspirin use was associated with a 16% decrease in in-hospital mortality compared to non-aspirin use (RR 0.84, 95% CI: 0.71-0.99, P = 0.007, I2= 64%). Conclusion Our study shows that aspirin decreases in-hospital mortality in patients hospitalized with COVID-19. Further studies are needed to assess which COVID-19 patient populations benefit most, such as patients on aspirin for primary vs. secondary prevention of atherosclerotic disease. In addition, significant bleeding also needs to be considered when assessing the risk-benefit of aspirin use.

A 58-year-old male with severe psoriasis on Risankizumab presented with painful, left leg swelling with erythema and blisters concerning for necrotizing fasciitis. Intraoperative findings showed non-necrotizing bullous cellulitis. The blood and tissue cultures grew Shewanella algae. A handful case of non-necrotizing bullous cellulitis has been reported but this is the first documented case of non-necrotizing bullous cellulitis and bacteremia in PubMed.

Introduction: After FDA approval in 2017, chimeric antigen receptor (CAR) T-cell therapy gained high popularity in various hematological malignancies. Hypothesis: There are no sex-based differences in in-hospital mortality and length of stay after CAR T-cell therapy. Methods and Results: From 2018 to 2019, using national inpatient sample, among a total of 14,189,303 hospitalizations (unweighted sample) 704 (0.01%) CAR T-cell therapy were performed, 306 in 2018 and 408 in 2019. Among the CAR T-cell therapy performed, 58.4% (n = 417) were males, 2.9% (n=21) had pulmonary edema, 0.6% (n=6) had acute decompensated heart failure, 3.08% (n=22) had supraventricular tachycardia, 3.36% (n=24) had ventricular tachycardia, 1.94% (n=14) had pericardial effusion (including chronic pericarditis or tamponade), 0.14% (n=1) had acute pericarditis, 0.14% (n=1) had non ST-segment elevation myocardial infarction, 3.64% (n=26) required pressors, 8.68% (n=64) had atrial fibrillation, 3.64% (n=26) had disseminated intravascular coagulation, 4.76% (n=34) required mechanical ventilation. 3.92% (n=28) died in the hospital and mean length of stay (LOS) was 20.5 days. The mean age for CAR T-cell therapy was 54 ± 18 years. Among CAR T cell therapy population, compared to males, females were similar in age (mean age: 54.6 vs. 54 years; p=0.606), had lower incidence of atrial fibrillation (4.38% vs 11.75%, p<0.001) but similar in-hospital mortality (3% vs 4.6%, p=0.334) and similar LOS (21 days vs 20 days, p=0.740). Conclusions: CAR T cell therapy is associated with few cardiovascular conditions. We did not find sex-based differences in in-hospital mortality or LOS in CAR T cell therapy.