Thyroid storm is a rare, life-threatening condition characterized by severe or exaggerated clinical manifestations of thyrotoxicosis, commonly occurring in patients with longstanding, untreated hyperthyroidism such as Graves' disease and toxic nodular goiter. Subacute painful thyroiditis, also known as de Quervain thyroiditis, is a self-limited inflammatory disease of the thyroid gland that is characterized by neck pain, a tender diffuse thyroid goiter, elevated inflammatory markers, and a predictable course of thyroid function evolution. Rarely, it can cause thyroid storm. Herein, we report a rare case of a 25-year-old woman who was admitted for sepsis and acute painful thyroiditis who then developed thyroid storm. The patient was treated in the intensive care unit (ICU) and responded very well to steroids, propranolol, a seven-day trial of propylthiouracil, and ultimately achieved a euthyroid state on discharge.

Background Coronavirus disease 2019 (COVID-19) pandemic has had a great impact on every aspect of society. All countries launched preventive measures such as quarantine, lockdown, and physical distancing to control the disease spread. These restrictions might effect on daily life and mental health. This study aimed to assess the prevalence and associated factors of depressive symptoms in patients with COVID-19 at the Treatment Center. Methods A cross-sectional telephone survey was carried out at Hmawbi COVID-19 Treatment Center, Myanmar from December 2020 to January 2021. A total of 142 patients with COVID-19 who met the criteria were invited to participate in the study. A pre-tested Center for Epidemiologic Studies Depression Scale (CES-D) was used as a tool for depressive symptoms assessment. Data were analyzed by using binary logistic regression to identify associated factors of depressive symptoms. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) was computed to determine the level of significance with a p < 0.05. Results The prevalence of depressive symptoms in patients with COVID-19 was 38.7%, with the means (± standard deviation, SD) subscale of somatic symptom, negative effect, and anhedonia were 4.64 (±2.53), 2.51 (± 2.12), and 5.01 (± 3.26), respectively. The patients with 40 years and older (AOR: 2.99, 95% CI: 1.36–6.59), < 4 of household size (AOR: 3.45, 95% CI: 1.46–8.15), ≤ 400,000 kyats of monthly family income (AOR: 2.38, 95% CI: 1.02–5.54) and infection to family members (AOR: 4.18, 95% CI: 1.74–10.07) were significant associated factors of depressive symptoms. Conclusion The high prevalence of depressive symptoms, approximately 40%, was found in patients with COVID-19 in the Treatment Center. Establishments of psychosocial supports, providing psychoeducation, enhancing the social contact with family and friends, and using credible source of information related COVID-19 would be integral parts of mental health services in COVID-19 pandemic situation.

Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, there has been a growing and justifiable fear of catching the virus from the emergency rooms, thus decreasing the hospital visits. With Virginia State slowly reopening and HCA local hospitals resuming elective procedures, the number of emergency room visits, are recovering and increasing. We report a sad and unfortunate case of an 87-year-old female who was experiencing pressure-like chest pain but presented to the emergency room five days later out of fear of catching COVID-19 from the hospital. On presentation to the ED, she was found to have an non-ST-elevation myocardial infarction, which required urgent stenting of the left anterior descending artery. Unfortunately, several hours later, she developed fatal cardiogenic shock due to ventricular septal rupture. We are reporting this case to highlight one of the many potential bad outcomes as a result of a delay in seeking necessary medical attention due to the fear of contracting the virus.

Immunotherapy with checkpoint inhibitors such as ipilimumab, a cytotoxic T-lymphocyte antigen-4 (CTLA-4) inhibitor, and nivolumab, a programmed death-1 (PD-1) inhibitor, has significantly improved the survival of patients with metastatic melanoma. The immune-related endocrinopathies of these treatments have been well documented, such as hypothyroidism, hyperthyroidism, primary adrenal insufficiency (PAI), insulin-dependent diabetes, and hypophysitis. We report the onset of PAI in a patient with metastatic melanoma to the lung and neck of unknown primary origin who was treated with ipilimumab. The patient's symptoms resolved with steroid replacement. After the completion of 16 cycles of another checkpoint inhibitor, nivolumab, full remission was achieved.

The COVID-19 pandemic caused >6 million deaths worldwide, often from respiratory failure. Complications frequently occurred in hospitalized patients, particularly in the intensive care unit. Among these, fungal infections were a cause of high morbidity and mortality. Invasive aspergillosis, candidiasis and mucormycosis were the most serious of these infections. Risk factors included alterations in immune defense mechanisms by COVID-19 itself, as well as immunosuppression due to various therapies utilized in severely ill patients. Diagnosis was often challenging due to lack of sensitivity of current testing. Outcomes were generally poor, due to significant co-morbidities and delayed diagnosis, with mortality rates >50% in some studies. High index of clinical suspicion is needed to facilitate early diagnosis and initiation of appropriate antifungal therapy.