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Background Dry Eye Disease (DED) is a multifactorial ocular condition characterized by the disturbance of the tear film and interpalpebral ocular surface. It is characterized by ocular itchiness, grittiness, burning, and visual disturbances. Many risk factors were linked to DED, including occupational-related risk factors. This study aimed to investigate the prevalence and impact of DED on work productivity among outdoor and indoor workers in the West Bank of Palestine and the impact of DED on daily activities performance. Methods A population-based descriptive cross-sectional study was conducted on male and female Palestinian workers aged 18 years or older, carried out between July to October 2024. Structured interview questionnaires using the Arabic version of the Ocular Surface Disease Index questionnaire (Arab-OSDI) and the Work Productivity and Activity Impairment questionnaire (WPAI) for participants who scored 13 or higher on OSDI. Results A total of 464 participants were included, ages 18 or older. Males were 81.3% of the study population. 50% of the sample were indoor workers and 50% were outdoor workers. The prevalence of DED in Palestinian workers was 61.4%, which was higher among outdoor workers (64.7%) than indoor workers (58.2%), but this difference was not statistically significant ( p  = 0.15). The impact of DED on work productivity was reported in all severity levels ( p  < 0.001); participants with severe DED had a mean of 5.93 h, which is higher than the mean for moderate and mild DED patients (4.71 and 3.42 h), respectively. Similarly, the impact on the ability to perform daily activities was significant ( p  < 0.001), greatest among respondents with severe disease (5.86 h). Conclusions Outdoor workers have been associated with DED more than in-office workers in the West Bank. Meanwhile, workers with DED report lower productivity and struggle with everyday tasks regardless of the severity level. This underlines the detrimental effects of the workplace on the ocular surface, which present a significant risk for the onset and exacerbation of dry eye symptoms.

COVID-19 complications still present a huge burden on healthcare systems and warrant predictive risk models to triage patients and inform early intervention. Here, we profile 893 plasma proteins from 50 severe and 50 mild-moderate COVID-19 patients, and 50 healthy controls, and show that 375 proteins are differentially expressed in the plasma of severe COVID-19 patients. These differentially expressed plasma proteins are implicated in the pathogenesis of COVID-19 and present targets for candidate drugs to prevent or treat severe complications. Based on the plasma proteomics and clinical lab tests, we also report a 12-plasma protein signature and a model of seven routine clinical tests that validate in an independent cohort as early risk predictors of COVID-19 severity and patient survival. The risk predictors and candidate drugs described in our study can be used and developed for personalized management of SARS-CoV-2 infected patients. Prognostic markers for patients with COVID-19 are of critical importance in determining the course of SARS-CoV-2 infection and patient handling. Here the authors determine and apply a prognostic proteomic panel for risk and drug prediction in the management of SARS-CoV-2 infected patients.

A 62-year-old Sudanese female was diagnosed with a nonfunctioning pituitary adenoma in 2006. Despite undergoing 3 transsphenoidal surgeries and radiotherapy, her tumor persisted, causing debilitating symptoms, including headaches and visual defects. As a last resort, she was treated with pasireotide, a second-generation somatostatin analog with a broader receptor affinity than first-generation drugs. Over 6 months, the tumor mass was stabilized, and her symptoms, including headaches, disappeared. This case demonstrates a potential new therapeutic possibility for treating resistant pituitary adenoma with pasireotide, offering hope for patients when traditional treatments fail.

Normal pregnancy causes marked increases in lipids, but in women with underlying dyslipidaemia, this can lead to severe hypertriglyceridemia (triglyceride >1000 mg/dL) and acute pancreatitis. Coexisting conditions like diabetes and hypothyroidism further exacerbate this risk. We report a 34-year-old G2P1 woman at 32 weeks of gestation with type 2 diabetes and treated hypothyroidism who presented with acute pancreatitis and a serum triglyceride level of 33.8 mmol/L. Her management included therapeutic plasmapheresis, insulin infusion, and fenofibrate, followed by a planned elective caesarean section at 35 weeks, which resulted in the delivery of a healthy infant. This case highlights the critical need for vigilant lipid monitoring and a coordinated, multidisciplinary approach in high-risk pregnancies to prevent life-threatening complications and improve maternal and fetal outcomes.

Thyroid nodules are commonly found in clinical practice, with a prevalence of 5%–7% on physical examination and up to 20%–67% when detected by high-resolution ultrasound in adults. The annual incidence of thyroid cancer varies significantly in different countries, ranging from 2.0 to 3.8/100,000 in women and from 1.2 to 2.6/100,000 individuals in men, with papillary thyroid cancer being the most frequently diagnosed type. While most of these nodules are nonfunctioning and benign, some may be hyperfunctioning (“hot” nodules), potentially causing thyrotoxicosis. Differentiated thyroid cancers, such as papillary and follicular thyroid carcinoma, are typically considered “cold” on scintigraphy, rarely presenting with hyperthyroidism. This case series describes a unique presentation of papillary and follicular thyroid carcinoma in two patients with thyrotoxicosis secondary to a hyperfunctioning nodule (“hot” nodule). Both patients presented with signs of hyperthyroidism. Diagnostic imaging revealed a hyperfunctioning thyroid nodule and subsequent histopathology confirmed the presence of both papillary and follicular carcinoma. This case series highlights the rare coexistence of differentiated thyroid cancer and thyrotoxicosis due to a hot nodule. It emphasizes the importance of thorough evaluation of hyperfunctioning nodules to rule out malignancy. Early recognition and appropriate management are crucial in optimizing patient outcomes.

Background Coexistence of TSH-secreting pituitary adenoma (TSHoma) and Graves’ disease (GD) is rare and complicates the management decision. Methods We present a case of the co-existence of TSHoma and GD. In addition, we systematically searched articles describing TSHoma and GD in the same patient published until 20th March 2023, using Pubmed, Scopus and Embase. Case presentation A 46-year-old man presented with symptoms of thyrotoxicosis. His thyroid function tests showed serum TSH 3.35 (reference range 0.3–4.2) mIU/L, FT3 19.7 (3.7–6.4) pmol/L, and FT4 68.9 (11-23.3) pmol/L. The serum TSH receptor antibody was 11.5 mIU/L (positive at ≥ 1.75 mIU/L). Pituitary magnetic resonance imaging showed macroadenoma compressing the optic chiasm. The patient underwent trans-sphenoidal resection of pituitary adenoma. Postoperatively, he remained on maintenance carbimazole and octreotide. Results Fourteen articles comprising 15 patients were identified from the systemic search. A total of 16 patients (including the current case) were included in the systematic review. The mean (± SD) age at diagnosis was 41 ± 13.6 years. The majority were females (75%). The median (IQR) TSH was 1.95 (0.12–5.5) mIU/L, the median (IQR) free T3 was 11.7 (7.6–19.7) pmol/L and the median (IQR) free T4 level was 47.6 (33.3–64.4) pmol/L. Ten (76.9%) patients had positive TSH receptor antibody levels. 84.6% had pituitary macroadenoma. Pituitary surgery was performed in 12 (75%) patients. At the last follow-up, 4 (25%) patients had complete resolution of symptoms after pituitary surgery, 3 (18.7%) were on maintenance treatment with thionamides for GD, 1 (6.25%) on beta-blockers and 1 (6.25%) on somatostatin analog. Conclusion TSHoma and GD can co-exist, and it is essential to identify this rare association as it can significantly impact treatment strategies.

Background: Recent studies revealed a high prevalence of venous thromboembolism (VTE) events in coronavirus disease 2019 (COVID-19) patients, especially in those who are critically ill. Available studies report varying prevalence rates. Hence, the exact prevalence remains uncertain. Moreover, there is an ongoing debate regarding the appropriate dosage of thromboprophylaxis. Methods: We performed a systematic review and proportion meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PubMed and EMBASE for studies exploring the prevalence of VTE in critically ill COVID-19 patients till 25/07/2020. We pooled the proportion of VTE. Additionally, in a subgroup analysis, we pooled VTE events detected by systematic screening. Finally, in an exploratory analysis, we compared the odds of VTE in patients on prophylactic compared with therapeutic anticoagulation. Results: The review comprised 24 studies and over 2,500 patients. The pooled proportion of VTE prevalence was 0.31 [95% confidence interval (CI) 0.24, 0.39; I 2 94%], of VTE utilizing systematic screening was 0.48 (95% CI 0.33, 0.63; I 2 91%), of deep venous thrombosis was 0.23 (95% CI 0.14, 0.32; I 2 96%), and of pulmonary embolism was 0.14 (95% CI 0.09, 0.20; I 2 90%). Exploratory analysis of few studies, utilizing systematic screening, VTE risk increased significantly with prophylactic, compared with therapeutic anticoagulation [odds ratio (OR) 5.45; 95% CI 1.90, 15.57; I 2 0%]. Discussion: Our review revealed a high prevalence of VTE in critically ill COVID-19 patients. Almost 50% of patients had VTE detected by systematic screening. Higher thromboprophylaxis dosages may reduce VTE burden in this patient's cohort compared with standard prophylactic anticoagulation; however, this is to be ascertained by ongoing randomized controlled trials.

Background The ongoing conflict in Sudan leads to widespread displacement and increased mortality, significantly impacting the mental health of populations in conflict zones. This study aims to fill the gap and assess the level of stress, depression, and anxiety among Khartoum University undergraduate students in war-afflicted regions. Methods A cross-sectional study among 443 undergraduate students Was conducted using cluster and stratified sampling techniques. Data was collected using a valid questionnaire in a period of one month and analyzed using SPSS and a regression model to assess factors affecting distress. Results The study shows high levels of psychological distress, particularly among female students. Median anxiety and stress levels were 12.50 and 14.00, respectively, for women, significantly higher than those for men ( p  < 0.001). Faculty, physical health, time management, and support systems were also significantly correlated with distress levels. Students in the Faculty of Forests and Animal Breeding exhibited the highest levels of depression and anxiety. Poor physical health and seeking professional help were strongly associated with increased psychological distress. Regression analysis identified gender ( p  = 0.001) and time management ( p  = 0.022) as significant predictors of overall distress. Conclusion Undergraduate university students in war regions experience high levels of stress, anxiety, and depression due to conflict situations. These findings reflect the urgent need for interventions such as community-based programs and counselling. We recommended future studies to explore long-term impacts on students' mental health.

Approach to Hashimoto thyroiditis encephalopathy. Approach to Hashimoto thyroiditis encephalopathy

Calcium titanate nanoparticles (CaTiO 3 NPs) have garnered significant attention due to their unique properties and excellent biocompatibility, which have led to their increased use in various fields and consumer products. This rise in application necessitates a better understanding of their biological and toxicological effects. However, there is limited data on the cytotoxicity and genotoxicity of CaTiO 3 NPs in human normal skin fibroblasts (HSF) and non-small lung cancer (A-549) cells. Consequently, this study aimed to explore the effect of 48-hour exposure to CaTiO 3 NPs on cell viability, genomic DNA integrity, and oxidative stress induction in human cancer A-549 cells, compared to normal HSF cells. The cytotoxicity and genotoxicity of CaTiO 3 NPs were assessed using the Sulforhodamine B (SRB) cytotoxicity and Alkaline Comet assays, respectively. To estimate possible oxidative stress induction and variation in apoptotic gene expression, reactive oxygen species (ROS) analysis and quantitative real-time polymerase chain reaction (qRT-PCR) were also performed. Our findings demonstrated that exposure to CaTiO 3 NPs for 48 h resulted in low toxicity toward both normal HSF and cancer A-549 cells, with cell death observed only at high concentrations (100 and 1000 µg/ml). The IC50 value of CaTiO 3 NPs in both HSF and A-549 cells was greater than 1000 µg/ml; specifically, the IC50 value in A-549 cells at 48 h was 1670.65 µg /ml. However, treatment with CaTiO 3 NPs for 48 h at the IC50 concentration of 1670.65 µg /ml resulted in significant genomic DNA damage and excessive ROS generation, along with a notable disturbance in the expression level of apoptotic (p53 and Bax) and anti-apoptotic Bcl2 genes in A-549 cells. In contrast, no significant changes were observed in HSF cells treated for 48 h with the same concentration (1670.65 µg /ml) of CaTiO 3 NPs. Collectively, these findings indicated that despite short-term exposure to CaTiO 3 NPs causing low cytotoxicity in both normal HSF and A-549 cells. CaTiO 3 NPs were selectively genotoxic toward A-549 cells. This genotoxicity was mediated through excessive ROS generation, which disrupted genomic DNA integrity and altered the expression of apoptotic genes, triggering apoptosis in A-549 cells. Further in vitro and in vivo studies are needed to fully understand the toxicological and biological properties of CaTiO 3 NPs.