The multisystem effects of SARS-CoV-2 encompass the thyroid gland as well. Emerging evidence suggests that SARS-CoV-2 can act as a trigger for subacute thyroiditis (SAT). We conducted a systematic literature search using PubMed/Medline and Google Scholar to identify cases of subacute thyroiditis associated with COVID-19 and evaluated patient-level demographics, major clinical features, laboratory findings and outcomes. In the 21 cases that we reviewed, the mean age of patients was 40.0 ± 11.3 years with a greater female preponderance (71.4%). Mean number days between the start of COVID-19 illness and the appearance of SAT symptoms were 25.2 ± 10.1. Five patients were confirmed to have ongoing COVID-19, whereas the infection had resolved in 16 patients before onset of SAT symptoms. Fever and neck pain were the most common presenting complaints (81%). Ninety-four percent of patients reported some type of hyperthyroid symptoms, while the labs in all 21 patients (100%) confirmed this with low TSH and high T3 or T4. Inflammatory markers were elevated in all cases that reported ESR and CRP. All 21 cases (100%) had ultrasound findings suggestive of SAT. Steroids and anti-inflammatory drugs were the mainstay of treatment, and all patients reported resolution of symptoms; however, 5 patients (23.8%) were reported to have a hypothyroid illness on follow-up. Large-scale studies are needed for a better understanding of the underlying pathogenic mechanisms, but current evidence suggests that clinicians need to recognize the possibility of SAT both in ongoing and resolved COVID-19 infection to optimize patient care.

Alzheimer’s disease (AD) is the most common cause of dementia in elderly patients, affecting individuals older than 60 years. It is a complex degenerative brain disease characterized by progressive cognitive impairment. AD constitutes a major global health concern. A central role for inflammation has been implicated in the pathogenesis of AD. Despite the understanding of multiple molecular pathways in the pathophysiology of AD, novel treatment agents with a possible role in modifying the disease activity are still lacking. Our article provides a comprehensive review of various observational studies and randomized trials encompassing the use of anti-inflammatory agents in the management of AD patients and utilizes the conclusions derived therefrom to give recommendations in this regard.

BackgroundPunjab is the most populous province of Pakistan, with only 12 countries in the world succeeding it in terms of population.AimsThis review article has the objective of providing novel statistics regarding available cancer therapeutics in Punjab across four different sectors—including government, semi‐private, trust and private sectors.Methods and ResultsKeywords such as “cancer treatment,” “facilities,” “Pakistan,” were used to search Pubmed Database. 36 results were generated: after sifting based on a personal reference list as well as for relevance, 16 articles were finally reviewed. Novel statistics regarding current state of access to cancer facilities were drawn from personal references as well as from studies conducted in other LMICs. There is a gross deficit of oncological services in Punjab, with the ratio of medical oncologists to population being 0.027 per 100, 000, and every oncologist checking 1300‐1500 patients annually. Only 21.4% of the population has access to radiotherapy facilities. Major problems include lack of healthcare professional awareness; poor infrastructure including drug access, radiotherapy, and cancer pain management facilities; lack of planning; and lack of educational and research programs.ConclusionsImproving education & training, developing infrastructure based on public‐private‐partnership models, building cancer registries and organizing national cancer screening programs, as well as encouraging basic health education and research in oncology, are measures that can ensure Punjab's healthcare delivery system becomes capable of handling increasing incident burden of cancer.

This is a brief review covering the currently available literature on ocular manifestations of COVID-19, andprevention strategies for ophthalmologists. A literature search was carried out of Pubmed, Google Scholar andWHO database of publications on COVID. Keywords used in the search were eye, ocular manifestations,ophthalmology, COVID-19, nCoV-2019, and coronavirus disease. All available articles were reviewed and thosepertinent to the study topic were included. Considering the dearth of information available, ophthalmology journals were also searched separately for relevant articles. Major ocular manifestation of COVID reported in literature is red eye, which usually presents before the onset of respiratory symptoms. Since the eye can be a possible transmission route for SARS-CoV-2, infection control measures should be undertaken by ophthalmologists, including use of personal protection equipment and eye/face covering. A framework for structuring ophthalmological services during the COVID pandemic is also presented in this review.

Objectives: To determine frequency and impact of burnout among surgeons and residents of different specialties at a tertiary care hospital in Punjab, Pakistan, over a period of 6 months. Study Design: Observational Cross-sectional study. Setting: Departments of General Surgery and Ophthalmology, Mayo Hospital Lahore and the Department of Gynecology, Lady Willingdon Hospital Lahore. Period: September to November 2019. Material & Methods: Out of 150 invited participants, 124 responded to the questionnaire. Grades of burnout were determined according to the American Public Welfare Association (APWA) inventory. Data analysis was performed using SPSS 26.0, with qualitative statistics determined as frequency and percentages, and quantitative correlations among variables determined by application of chi-square test with p-value ≤ 0.05 as significant. Results: Out of 124 participants, 48.3% were female while the rest were male, mostly in the age group of 26-30 years (75%). Majority (50.8%) belonging to General Surgery; 32.3% were from Gynecology and Obstetrics and 16.9% were from Ophthalmology. Most of the participants (81.4%) were residents, with majority (51.6%) working 60-80 hours per week. There was high rate of burnout, with 46.3% of females and 32.8% of males reporting early burnout, and 36.6% of females along with 25% of males reporting advanced burnout. General surgeons and gynecologists were more prone to advanced burnout, while eye surgeons and residents had an increased propensity towards developing burnout. Conclusion: There is a high rate of burnout among surgical residents and consultants, attributable to increased working hours, less pay, and decreased job satisfaction. Measures should be taken to curb this trend, both for patient safety as well as for personal and mental health improvement of surgeons.