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OBJECTIVE Since thyroid dysfunction is a common disorder and affecting all populations regardless of iodine status, a comprehensive evaluation of thyroid dysfunction in Bahrain is essential to draw a national strategy, increase public awareness, and recognize the role of ethnicity. METHODS Following the approval of the Research Ethics Committee, the study was initiated by collecting laboratory and patient's data that have performed thyroid function tests (TFTs) during January 2018 till January 2019 at the Royal Services of Bahrain Defense Force (BDF) Military Hospital. TFTs data for 19,736 subjects were collected and analyzed using SPSS. Deoxycytidine RESULTS Based on the TFTs measurements and including treated euthyroid, 44.9% of subjects had thyroid dysfunction categorized as treated euthyroid (15.1%), hypothyroid (20%), hyperthyroid (3.3%), and subclinical hypothyroid (6.5%). Females having thyroid dysfunction were 2.9 times more than males, and the most female age group affected was 20-10 µIU/l and the counterpart groups of TSH between 4-10 µIU/l (p less then 0.001). CONCLUSION This study showed that hypothyroidism predominates in the Bahraini population, and most of the patients were females with an age group of 20- less then 40 years old. In addition, the thyroid dysfunctions were correlated with the high percentages of positive frequencies with TPOAb and TGAb, indicating the predomination of autoimmune thyroid diseases. Besides, the determination of risk factors in relation to hypothyroidism occurrence such as genetic predisposition and loci genetic variants is highly essential. Also, more national studies and public awareness are needed to reduce the potential illnesses of thyroid dysfunction.Case 1 was a 51-year-old man diagnosed with thyrotropin (TSH)-secreting pituitary tumor. The octreotide loading test showed suppression of TSH secretion. Treatment with lanreotide preoperatively at 90 mg/month resulted in normalization of thyroid function. Three months after treatment initiation, tumor shrinkage was observed, and pituitary tumor resection was performed through transsphenoidal surgery. Case 2 was a 47-year-old woman in whom the octreotide loading test showed suppressed TSH secretion. link2 Treatment with lanreotide preoperatively at 90 mg/month resulted in normalization of thyroid function. After six months of treatment, tumor reduction was observed, and transsphenoidal surgery was performed. In both cases, lanreotide administration before TSH-secreting pituitary tumor resection achieved normalization of thyroid function and tumor shrinkage. Treatment with lanreotide seems effective in patients who show TSH secretion suppression in the octreotide loading test.BACKGROUND Neurofilament light chain (NfL) is considered a major marker of neurodegeneration and disease activity. Higher levels of NfL are associated with worse clinical outcomes and increased brain atrophy. In treated patients with Relapsing-Remitting Multiple Sclerosis (RRMS), we aimed to determine the level of NfL, an association between NfL and demographic, clinical and magnetic resonance imaging (MRI) characteristics as well as brain volume parameters. We wanted to confirm that level of NfL is clinically useful as biomarker of neurodegeneration and disease activity. METHODS 56 treated RRMS patients were enrolled. Plasmatic levels of NfL (pNfL) were measured by SIMOA® technique. Clinical severity of MS was expressed by Expanded Disability Status Scale (EDSS), and volumetric analysis of MRI data was performed using Icobrain software. RESULTS The mean pNfL level was significantly higher in MS patients than in healthy controls (14.73 ± 6.38 versus 6.67 ± 3.9, p less then 0.001). In patients, we did not find association between pNfL and MRI activity, number of new T2 lesions, and number of enhancing lesions. Levels of pNfL correlated significantly with atrophy of whole brain volume (Wbv), atrophy of grey matter volume (Gmv), and negatively with Wbv. We found significantly positive correlation between pNfL levels and EDSS. CONCLUSION Study shows association of pNfL with Wbv, presence of brain atrophy and EDSS, and strong correlation of EDSS with multiple MRI volume parameters. link3 We did not confirm association pNfL with disease activity. Our data suggest that pNfL and MRI volume parameters could be considered as biomarkers of neurodegeneration in MS.BACKGROUND Insulinoma as a cause of epileptic seizure has been thoroughly described but often not considered in differentials for previously established diagnoses of seizure disorder. Hypoglycemic symptoms can mimic neurological disorders such as epilepsy. CASE PRESENTATION A 52-year-old woman presented with a history of epilepsy on anti-epileptic drugs (AEDs) developed repeated episodes consisting of seizures and neuropsychiatric symptoms with no predisposing factors for epilepsy at age 52. She had received full AED treatment before the possibility of hypoglycemia was considered. Following a clinical diagnosis of insulinoma, distal pancreatectomy was performed, and her seizures did not occur again. CONCLUSION The early diagnosis of insulinoma requires vigilance, not only for hypoglycemia in patients with neuropsychiatric symptoms, but also for the possible masking effects of a history of epilepsy and preceding AED usage.OBJECTIVE This article describes the role of imagery in supervision which is a part of the work of both the supervisee and the supervisor. Imagination bears outstanding importance in psychotherapy and supervision. METHOD The relevant texts for this narrative review were identified through the Web of Science and PubMed databases, within the period 1990-2019. The search terms included Supervision, Cognitive behavioural therapy, Imagination, Imagery, Imagery rescripting, Therapeutic relationship, Supervisory relationship. The report also includes information from the books referred to by the articles. The supervisory experiences of the authors were also incorporated. The theoretical part is supplemented with case vignettes of strategies using imagination in CBT supervision. RESULTS Working with imagery can be used in transformative experiential learning. It can help to better map the situation with the patient, including its emotional components and basic psychological needs, to realise how the therapeutic relationship is set up, as well as to rework own therapist attitudes, schemas and emotional - behavioural responses, and plan future steps in the therapy. Many therapy steps could be learned during imagery exercises. Imagery also helps to understand and regulate the supervisory relationship. CONCLUSION It is useful to integrate imagery to the supervision. Using imagery can help to understand the patient, the therapeutic relationship better, and to plan optimal therapeutic strategies, as well as reflect/self-reflect and train difficult skills which promote professional and personal growth.BACKGROUND Aging is characterized by deep alterations of hormone secretion. In majority, hormone secretion, except gonadotropins, undergoes a pronounced decrease which is thought to contribute to the progression of aging. The recent data indicate that gonadotropin excess may also by itself influence the aging process. The aim of the present study was to investigate the relations between gonadotropins and steroid hormones with physical and mental abilities of older people. MATERIAL AND METHODS In a group of patients aged over 75 years, concentrations of FSH, LH, estradiol, testosterone, DHEAs and cortisol were measured. The mental ability was estimated by MMSE and CDT and the physical ability by TUG and SPPB tests. RESULTS AND CONCLUSIONS The positive correlation between SPPB scores and FSH and the negative correlations of SPPB with LH/FSH ratio were observed in men. The correlation of TUG scores and estradiol levels was also noted in men. The positive correlation between CDT scores and FSH in women and the negative correlation between CDT and LH/FSH ratio in men were found. The correlation between the results of CDT and cortisol levels in men was also observed. Thus, we did not confirm the simple deleterious effect of gonadotropins on cognitive abilities. FSH and LH seem exert different (antagonistic?) effects on cognitive functions, but this hypothesis needs further studies.Autoinflammatory diseases are characterized by recurrent fever attacks and clinical findings that arise from impaired natural immunity and spread to a wide variety of organ systems. The concept of autoinflammatory disease emerged after the definition of familial Mediterranean fever (FMF) and Tumor Necrosis Factor Receptor Associated Periodic Syndrome (TRAPS). Firstly, it is thought that this new group differs from the standard concept of autoimmune diseases, which is relatively better known in terms of basic features such as defects in innate immunity and the absence of antibodies. We have come a long way in understanding the genetic and pathogenetic mechanisms of this relatively new disease group in the past twenty years since they were first diagnosed. This growing understanding leads to some changes in the concept of autoinflammatory diseases. Recently, the definition of the autoinflammatory disease includes a wide range of diseases with different clinical features, mainly accompanied by changes in innate immune and rarely in humoral immunity. Owing to recent developments in molecular sciences and genetics, the spectrum of autoinflammatory diseases is rapidly expanding. In this review, clinical features, classification criteria, treatment options and long-term prognoses of Periodic Fever, Aphthous Stomatitis, Pharyngitis, Adenitis (PFAPA) syndrome, and other common autoinflammatory diseases are discussed in the light of current literature.INTRODUCTION Clinical data on short mandatory dual antiplatelet therapy (DAPT) followed by P2Y12 inhibitor monotherapy, compared with prolonged DAPT in patients undergoing percutaneous coronary intervention (PCI) are insufficient. We aim to evaluate the effectiveness and safety of P2Y12 inhibitor monotherapy and prolonged DAPT after short mandatory DAPT on cardiovascular events in patients undergoing PCI. EVIDENCE ACQUISITION A systematic literature search was performed in seven medical databases from building the database until July 2019. Three studies with randomized controlled trial (RCTs), totaling 21,970 patients, were included in this meta-analysis. The included studies were assessed by the Cochrane risk of bias and analyzed by Review Manager v. 5.3 software. EVIDENCE SYNTHESIS Our result of pooled analysis showed that there was noninferior rates of in major adverse cardiac and cerebrovascular events (MACCE), stroke, myocardial infarction and cardiac death between short mandatory DAPT followed by P2Y12 inhibitor monotherapy and prolonged DAPT in patients undergoing PCI. Pooled analysis showed that short mandatory DAPT followed by P2Y12 inhibitor monotherapy could significantly reduce the risk of bleeding BARC type 2-5 (OR=0.47, 95% CI 0.31-0.70, P=0.002), compared with prolonged DAPT in patients undergoing PCI. However, Pooled analysis showed that short mandatory DAPT followed by P2Y12 inhibitor monotherapy was not associated with BARC type 3-5, compared with prolonged DAPT. CONCLUSIONS This meta-analysis demonstrated that short mandatory DAPT followed by P2Y12 inhibitor monotherapy compared with prolonged DAPT resulted in noninferior rates of MACCE, all-cause mortality, cardiac death, stroke, myocardial infarction and stent thrombosis. Furthermore, short mandatory DAPT followed by P2Y12 inhibitor monotherapy could significantly reduce the risk of bleeding BARC type 2-5.
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