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Infective endocarditis (IE) occurs more frequently in individuals living with congenital heart disease, often with high morbidity and mortality. Although gram-positive bacterial infections commonly cause IE, prosthetic valves are a known risk factor for fungal IE. We report a case of prosthetic pulmonary valve Candida parapsilosis IE in a 58-year-old male with repaired tetralogy of Fallot. He presented with fatigue, petechiae, and hematochezia. He had severe thrombocytopenia from idiopathic/immune thrombocytopenia purpura, which resolved with steroids and immunoglobulin. Treatment with antifungals as well as a surgical pulmonary valve replacement resulted in recovery without relapse at greater than a year.

Cytomegalovirus (CMV) is a DNA virus of the Herpesviridae family and is estimated to affect 15%-30% of high-risk solid organ transplant recipients. Typical manifestations of CMV end-organ disease in this population include colitis, esophagitis, and pneumonitis, and myocarditis is a rarely reported manifestation. We describe two cases of CMV myocarditis in solid organ transplant recipients and review the literature regarding previously published cases of CMV myocarditis.

Mental health conditions are common among persons with HIV (PWH). An understanding of factors associated with prescription medication use for these conditions and clinical impact of the prescription medications may improve care of mental health disorders in PWH.Psychotropic medication use was examined among PWH within the AIDS Clinical Trials Group A5322 (HAILO) study. Multivariable logistic models and Cox regression models estimated the association between psychotropic medications (any/none) with baseline and incident slow gait (1 s/m) and neurocognitive impairment (NCI) for more than 4 years.Of 1035 participants, the median age was 51 years.81% were men, 30% black, non-Hispanic, and 20% Hispanic. Psychotropic medication use was similar between men (34%) and women (38%; P = 0.19). PWH using psychotropic medications had greater odds of baseline slow gait {odds ratio 1.61, [95% confidence interval (CI): 1.23 to 2.10]; P0.001}. Men but not women using psychotropic medications had an increased risk of developing slow gait [hazard ratio 1.85; (1.29 to 2.65) vs 0.77; (CI: 0.35 to 1.68), P interaction = 0.045]. The sex-specific odds ratios for medication use and NCI were qualitatively but not statistically different [men: 1.79; (1.14-2.80); women: 1.27; (0.56-2.90); P interaction = 0.47]. Psychotropic medication use was associated with an increased risk of incident NCI [hazard ratio 2.18; (95% CI: 1.23 to 3.84), P = 0.007] in both men and women.Psychotropic medications are associated with impairment in functional outcomes of aging, with a greater risk of baseline NCI and incident slow gait among men. Further investigation is needed to optimize outcomes in PWH and prescription of psychotropic medications among both men and women.

The present study was carried with the objective to assess the relief in dysmenorrhoea attained by the consumption of two indigenous foods namely ginger aliquot and ajwain powder. The study was carried on a sample of 90 subjects who were divided into two groups namely test and control, with 45 subjects in each group. The Test group were administered ginger aliquot or ajwain powder according to the subject's willingness to consume, whereas the control did not receive any food item, and were only a platform for comparison. The intervention was for two cycles of menstruation and the subjects began consuming the relieving agents from the first day of menstruation. A questionnaire was the tool of study to collect information from the subjects. The information collected was both general and specific in nature. The general information included age, educational status, type of family of the subjects, while the specific information was in reference to the haemoglobin levels, clinical signs and symptoms, beliefs about food and their relation to menstrual cycle. The menstrual pattern which is specific for each female was also assessed. The last part of the questionnaire was the judgement of relief experienced by the subjects after the intervention trial. The analysis of the data obtained was done in the form of percentages. The results revealed that majority of the subjects in both the groups were anaemic when compared with the standards given by WHO. Some of the subjects reflected clinical signs and symptoms of anaemia. Pallor face was seen in 28.88 per cent and 22.22 per cent of subjects in control and test, respectively and pale conjunctiva in 35.55 per cent and 33.33 per cent of the subjects in control and test, respectively. Other signs like patches on cheeks, pale palms were also looked for in both control and test group. Signs of anaemia like headache, easy fatigue, and loss of appetite were also studied in the subjects, and some subjects in both control and test group were suffering from the above due to anaemia. Majority of the subjects in the control (66.66%) and more than half (55.55%) in the test group said that they avoided specific foods during menstruation. Sour and heat producing foods were such. The analysis of data obtained for the specific information reflected that majority in the control and the test group starting menstruating between the age of 12-16 years. The gap between two cycles was normal that is 28-30 days in 62.22 per cent of the subjects in the control and 66.66 per cent of the test group, respectively. The duration of pain that is dysmenorrhoea was 48 hours in 88.88 per cent and 80.00 per cent of the subjects in the control and test group, respectively and majority that is 62.22 per cent and 77.77 per cent of the subjects in control and test groups had a regular cycle. The last part of the study was the assessment of ginger aliquot and ajwain powder on relief in dysmenorrhoea. The results revealed that out of 15 samples consuming ginger aliquot nine (9) felt moderate relief from cramping abdominal pain and from amongst the 30 sample units consuming ajwain 24 experienced a moderate relief in pain. The two values made the percentage of subjects experiencing relief equal to 60 per cent and 80 per cent after receiving ginger aliquot and ajwain powder, respectively. In conclusion it can be said that both ginger and ajwain can be used as home remedies for dysmenorrhoea in young adult women. They are both safe, non toxic and have great medicinal and therapeutic properties.

Background Mental health (MH) conditions and pain are common among people living with HIV (PLWH). An understanding of factors associated with prescriptions for these conditions and clinical impact of the prescriptions may improve care of MH disorders in PLWH. Methods The use of mental health/pain-related medications was examined among PLWH within the AIDS Clinical Trials Group A5322 (HAILO) study. Use of medications (any use and class) was compared by sex. Multivariable logistic models estimated the association between MH medications (any/none) with (i) insurance status and race/ethnicity and (ii) baseline and incident slow gait (>1 second/m) and neurocognitive impairment (NCI) over 4 years. Results Of 1035 participants, the median age was 51. 81% were men, 30% black, and 20% Hispanic. Similar numbers of men (34%) and women (38%) were on MH medications (P = 0.19).Women were more likely to be prescribed opioids (12% vs. 5%; P < 0.001); other classes were similar. In multivariable models, MH-medicated PLWH were more likely to have Medicare (odds ratio [OR] 2.50, 95% CI 1.50–4.16, P < 0.001) or public insurance (1.85; 1.23–2.78, P = 0.003) vs. no/unknown insurance; and less likely to be Hispanic vs. white (0.48; 0.33–0.69; P < 0.001). MH-medicated PLWH had greater odds of baseline slow gait (1.80; 1.34–2.40; P < 0.001). The sex-specific ORs for NCI were qualitatively different (men: 1.70; 1.09–2.66; women: 0.96; 0.43–2.18); but this difference was not significant in the multivariable model (P interaction = 0.227). There was an increased risk of incident slow gait among MH-medicated men but not women (hazard ratio 1.74; 1.22–2.48 vs. 0.76; 0.38–1.52, P interaction = 0.038), and a trend toward increased risk of incident NCI (1.76; 0.91, 3.39, P = 0.09) for both sexes. Conclusion Our results highlight socioeconomic and ethnic differences in prescription of MH medications. The higher proportion of opiate prescriptions among women needs confirmation and should be a priority for intervention. The greater risk of baseline NCI and incident slow gait among men may be the result of differences in toxicity, drug interactions, or persistent mental health symptoms; further investigation is needed to optimize outcomes in PLWH and prescription of mental health medications. Disclosures All authors: No reported disclosures.