We read with great interest the letter by Ji et al. 1 Obesity is a wellrecognized risk factor for the development of non-alcoholic fatty liver disease (NAFLD) or metabolic dysfunction-associated liver disease (MAFLD) and is associated with adverse outcomes in COVID-19 patients. 2,3 Qatar's population has a high prevalence of obesity 4 and also has one of the highest rates of COVID-19 cases per million population, with one of the lowest mortality rates. 5 We hypothesized that NAFLD is an independent risk factor for worse outcomes in hospitalized COVID-19 patients in our population.

We read with great interest the recently published perspective "Erroneous Communication Messages on COVID-19 in Africa." In his perspective, Seytre 1 writes about the importance of miscommunication and how it affects society's attitudes. He goes on to discuss lingering mistrust generated by misinformation during the Ebola epidemic and its lasting impact on control of the COVID-19 pandemic. Social media has penetrated every sphere of our lives. Facebook, Twitter, Instagram, and blogs impact our thinking patterns, beliefs, and mental health. We concur with the author about the impact of miscommunication on society's mental, physical, and social fabric. In addition, we would like to highlight the personal toll it can take on individual members of any community. We are sharing two cases to highlight the real-world implications of social media misinformation during the current COVID-19 pandemic. Two middle-aged South Asian men of low socioeconomic status, living in separate shared housing, were exposed to COVID-19-positive contacts. Both patients presented to a designated COVID-19 treatment facility in Qatar after ingesting chemical substances. They had no past medical or psychiatric illnesses. The first man ingested about 15 mL of a surface disinfectant but did not report any symptoms. The second man experienced multiple episodes of non-bilious vomiting after ingesting approximately 100 mL of alcoholbased hand sanitizer. Apart from mild derangement in their transaminases, other laboratory tests were unremarkable. Both patients tested positive for COVID-19, and both, fortunately, had an unremarkable clinical course. These men ingested the disinfectant and sanitizer based on a firm belief that it would protect them from SARS-COV-2 infection, built on social media advice. Unvetted information is freely available on social media. Opinion pieces are perceived as facts. There has been a perpetual stream of news on the pandemic, creating a sense of urgency and anxiety. Repeated exposure to this stream of misinformation may affect the construct of external reality. This may lead to a delusion-like experience, which has been linked to anxiety and social media overuse. 2,3 Social isolation has tipped the balance of relationships and emotional connections from real to virtual for many. Indeed, we are in a virtual, long-term, emotionally charged relationship of sorts with social media. This relationship has led to a delusion-like experience, affecting multiple people separated by space and time, with social media as the common denominator. 4-6 The two described cases are just the tip of the iceberg of a "hidden epidemic" of nonevidence-based medical advice regarding COVID-19 that is rampant on social media, and not limited by geographic, religious, cultural, or socioeconomic boundaries. This "epidemic" adds to the strain of the pandemic on medical and psychological healthcare resources. It is incumbent on us to fight this social misinformation epidemic, before it turns into another pandemic.

Belantamab mafodotin (belamaf), an antibody-drug conjugate approved for the treatment of relapsed and refractory multiple myeloma (RRMM), is an anti B-cell maturation antigen (BCMA) agent. DREAMM-1, a first in-human trial of belamaf, reported several ocular toxicities requiring dose adjustments, dose delays and treatment discontinuations. In DREAMM-1, 53% of patients in part-1 and 63% of patients in part-2 had ocular toxicity. Similarly, 73% of patients in DREAMM-2 had keratopathy (71% in 2.5 mg/kg versus 75% in 3.4 mg/kg) with the most common symptoms being blurred vision and dry eyes. Ocular toxicity of belamaf is attributed to microtubule-disrupting monomethylauristatin-F (MMAF), a cytotoxic payload of the drug that causes an off-target damage to the corneal epithelial cells. Ocular adverse events (AEs) of belamaf are more frequent at higher doses compared with lower doses. Higher belamaf dose, history of dry eyes and soluble BCMA are associated with increased risk of corneal toxicity. Absence of ocular symptoms does not exclude the possibility of belamaf-induced ocular toxicity, so patients need slit lamp and Snellen visual acuity testing to detect microcytic-like epithelial changes and visual decline. Corticosteroid eyes drops for 4-7 days prior to belamaf dose do not prevent ocular AEs and may cause steroid-related AEs instead. Keratopathy and Visual Acuity scale (KVA) is recommended to document the severity of belamaf-induced ocular toxicity and make treatment adjustments. Management of toxicity includes dosage modifications, treatment interruption or discontinuations and preservative-free artificial tears along with close ophthalmology and hematology-oncology follow-ups.

Both DM and older age are independently associated with HE in patients with cirrhosis.

The COVID-19 pandemic has strained the healthcare system worldwide, leading to an approach favoring judicious resource allocation. A focus on resource preservation can result in anchoring bias and missed concurrent diagnosis. Coinfection of Mycobacterium tuberculosis (TB) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has implications beyond morbidity at the individual level and can lead to unintended TB exposure to others. We present six cases of COVID-19 with newly diagnosed cavitating pulmonary tuberculosis to highlight the significance of this phenomenon and favorable outcomes if recognized early.

BackgroundWith the exception of areas with high prevalence of tuberculosis, medical thoracoscopy is becoming the diagnostic modality of choice for exudative pleural effusions. The aims of this study were to determine the diagnostic yield and safety of medical thoracoscopy for exudative pleural effusions and ascertain the etiology of such effusions in Qatar.MethodsThis is a retrospective-descriptive study of 407 patients who underwent diagnostic medical thoracoscopy for exudative pleural effusions from January, 2008 till December, 2015 at the only tertiary referral center performing this procedure in Qatar.ResultsTuberculosis was the most common etiology of exudative pleural effusions in Qatar accounting for 84.5% of all causes. Around 85% of patients were young males (mean age of 33 ± 12.1 years). The diagnostic yield of medical thoracoscopy for tuberculous pleural effusion was 91.4%. Malignant pleural effusions accounted for 5.2% of cases. Minor bleeding occurred in 1.2% of cases with no procedure-related mortality observed.ConclusionMedical thoracoscopy is a very safe procedure. Tuberculous pleuritis is by far the most common etiology of exudative pleural effusions in Qatar. Closed needle biopsy is a worth consideration as an initial safe, easy and low-cost diagnostic modality for exudative pleural effusions in this country.

Hepatitis B reactivation (HBVr) in cancer patients is a well-established complication due to chemotherapy-induced immunosuppression. Studies have reported HBVr associated with immunosuppressive medications, such as rituximab, methotrexate, and high dose steroids. There are different risks for different types of chemotherapy with rituximab carrying one of the highest risks for hepatitis B reactivation. Tyrosine kinase inhibitors (TKIs) are the standard of care in patients with chronic myeloid leukemia (CML). The risk of HBVr in chronic myeloid leukemia has been reported in many studies, but to this date, there are no clear guidelines or recommendations regarding screening and monitoring of HBV in CML patients receiving TKIs. We conducted this review to identify the risk of HBVr in patients with CML who are treated with tyrosine kinase inhibitors. We recommend testing for HBV status in patients who are to be treated with TKIs and to consider giving prophylaxis in those who are positive for HBsAg at baseline. More studies are needed to assess the risk of reactivation in patients with Hepatitis B core antibody positive receiving TKIs. Currently, monitoring such patients for reactivation may be the best strategy.

Hypocupremia due to zinc products can cause sideroblastic anemia and neutropenia and mimics other serious hematological disorders. Early consideration of the copper deficiency and a thorough clinical history can prevent unnecessary interventions.