In this review, I aim to provide a complete overview of recent advances in knowledge regarding severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2)-induced thyroid dysfunction. I discuss the findings regarding the role of SARS-CoV-2 in the development of thyroid dysfunction, including subacute thyroiditis, Graves’ disease, non-thyroidal illness, thyrotoxicosis and Hashimoto’s thyroiditis during and subsequent to coronavirus disease 2019 (COVID-19). The thyroid gland and the entire hypothalamic–pituitary–thyroid (HPT) axis may represent key targets of SARS-CoV-2. Thyroid dysfunction during and subsequent to COVID-19 has been documented in clinical studies and is usually reversible. Most of the thyroid disorders, including Graves’ disease, euthyroid sick syndrome, Hashimoto’s thyroiditis and subacute thyroiditis, have been documented as sequelae to COVID-19, and the SARS-CoV-2 virus has been implicated in the aetiology of each. COVID-19 has been suggested to trigger the activation of pre-existing thyroid disease or autoimmunity. Furthermore, patients with uncontrolled thyrotoxicosis are at risk of SARS-CoV-2 infection-related consequences. Because of the neutropenia caused by antithyroid medications, which may obscure the signs of COVID-19, this group of patients should receive special attention. It is suggested that thyroid dysfunction during COVID-19 is caused by direct infection of the thyroid or “cytokine storm”-mediated autoimmune effects on the thyroid.

Background and Aims: Gastroesophageal reflux disease (GERD) was frequently managed by residents as they are the first physician who encounter the patient. This study was conducted to explore the knowledge and practice of physicians in the treatment of GERD and to compare between residents and consultants regarding their knowledge and practice. Methodology: A cross-sectional study, self-administered questionnaire. Results: Esophagogastroduodenoscopy (EGD) was the most commonly used method to screen for Barrett's esophagus for symptoms for 5 or more years. The most frequent guideline used was the American College of Gastroenterology (ACG) guideline. The most commonly used diagnostic tool for evaluating uncomplicated reflux disease was upper endoscopy with biopsy. Empiric trial with acid suppression was the most commonly used and proton pump inhibitors (PPIs) was the first-line treatment. The most common combination with PPI was prokinetic drugs, most often domperidone. The preferred maintenance strategy was the 'on demand' maintenance mode. Step-down strategy was commonly recommended. A total of 26% of residents and 37% of consultants could achieve a score of good knowledge. Overall patterns of knowledge and practice of GERD diagnosis and management were comparable between residents and consultants with only minor controversy in their knowledge and practice. Conclusion: The overall patterns of knowledge and practice of GERD diagnosis and management are comparable among residents and consultants but still there are areas of controversy and confusion. A good knowledge score was found among only a quarter of residents and 37% of consultants. Recommendations: The public health implications of deviations from evidence-based practice should be studied and implementing evidence-based practice should be emphasized.

Background The incidence of cognitive impairment (CI) is higher in patients with diabetes mellitus (DM). The association between DM and CI and the risk factors for CI need to be addressed to estimate the prevalence of cognitive impairment in patients with DM and to identify the potential risk factors. The study is a cross-sectional study using a convenient sample of 269 subjects. Sociodemographic diabetes-related variables including biochemical markers were collected. CI and diabetes-related distress (DRD) were assessed using the Arabic version of Montreal Cognitive Assessment scale (MoCA) and the Diabetes Distress Screening Scale respectively. Results Overall, 80.3% had cognitive impairment while 33.8% had severe impairment. Older age, female gender, low level of education, and low income were associated with CI; duration of diabetes and DRD were associated with CI while ophthalmic complications were associated with severe CI. Duration of diabetes was inversely associated with CI. Level of HbA1c was significantly higher in patients with severe CI, and the probability of CI increased as the level of HbA1c increased. Low level of education was associated with severe CI, and CI was two times more likely among patients with DRD. Conclusion CI was higher than worldwide figures. Elderly females with low educational level, long duration of DM, and low socioeconomic status are at more risk. The probability of severe CI increased with increased level of HbA1c. Screening for CI in patients with diabetes along with intervention programs while considering the DRD and the level of HbA1c is crucial.

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Objectives: To determine the prevalence of hypogonadism in male patients with Chronic obstructive pulmonary diseases (COPD), and to study its impact on skeletal muscle dysfunction and assess the effect of systemic markers of inflammation on testosterone level and muscle function. The study included 50 stable male COPD patients and 30 controls. Methods: Both groups were subjected to the following measurements; inflammatory markers levels (high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6)), sex hormones including; serum total (T) and free testosterone (FT), sex hormone binding globulins (SHBG), luteinizing hormone (LH), follicle-stimulating hormone (FSH) and 17b estradiol levels (E2), the exercise capacity (6-minute walk distance (6MWT)) and quadriceps muscle force (One repetition maximum (1RM) and EMG). COPD patients underwent spirometry. Results: There was a higher prevalence of hypogonadism in COPD patients than the controls (62% versus 17%). There was a significant negative correlation between serum testosterone levels (T and

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Background: This study aimed to estimate the prevalence of osteoporosis among patients with adrenal Cushing's syndrome (ACS) and Cushing's disease (CD), to investigate whether there is a difference in the degree of osteoporosis between both groups; and if so, what factors may be responsible for this variation.Methods: This is a cross-sectional study in which data from 19 patients with CD and eight patients with ACS were analyzed. Osteoporosis was assessed using the bone mineral density (BMD) of the lumbar spine using dual-energy X-ray absorptiometry (DEXA).Results: Bone loss was present in 81.5% of the patients with Cushing's syndrome. Osteoporosis is nearly three times more common in ACS (62.5%) than in CD (26.3%). BMD at the lumbar spine was lower in patients with ACS than in patients with CD. ACS had significantly lower levels of dehydroepiandrosterone sulfate (DHEA-S) than CD. In comparison to the CD group, the serum parathyroid hormone (PTH) concentration in the ACS group was significantly higher. In the entire patient population, there was a statistically significant correlation between the DHEA-S and the lumbar BMD values. Conclusions:Patients with ACS have more severe osteoporosis than patients with CD, and the difference in DHEA-S concentrations might be important in explaining this difference. BMD examinations should be prioritized to enable rapid recognition and intervention for osteoporosis. Measurement of bone turnover markers such as PTH may aid in the early diagnosis of the consequences of hypercortisolism on the bone.