Psoriasis is a chronic inflammatory disease that is debilitating, particularly in its more severe forms. Multiple systemic therapies are used in moderate-to-severe psoriasis, but the development of biological interventions has revolutionized its management and improved its outcomes. To compare the effectiveness and safety of the different biological interventions approved for use in moderate-to-severe plaque psoriasis. Multiple databases were searched for relevant articles and a prospectively planned network meta-analysis was conducted on randomized controlled trials that assessed biological treatments in moderate-to-severe psoriasis. The search yielded 84 trials that encompassed 39,798 patients. Infliximab 5 mg/kg had the highest probability of achieving 75

Objective: The objective of this study was to investigate the effect of age, gender, body mass index (BMI), food intake, and smoking on serum prolactin (PRL) levels among healthy adults. Methods: In total, 100 healthy adults (46 males and 54 females) aged ≥18 years were recruited. Serum PRL levels were measured after a 9 h overnight fast, 1 h postprandially (early), and 3 h postprandially (late). Results: Mean PRL levels were significantly higher in females than males in the fasting, early, and late postprandial states. PRL levels were suppressed significantly after food intake in both genders. Mean PRL levels were significantly higher in younger individuals (<30 years) in the fasting and the early postprandial states compared to older individuals (≥30 years) and suppressed significantly after food intake in younger individuals only. Mean PRL levels were not significantly different between individuals with a normal BMI (<25 kg/m2) compared to those overweight and with obesity (BMI ≥ 25 kg/m2); however, PRL levels were significantly suppressed after food intake only in subjects with a normal BMI. Mean PRL levels did not differ significantly according to smoking status. PRL levels were suppressed significantly after food intake in nonsmokers only. Conclusion: Our data suggest that age, gender, and food intake should be considered when the serum PRL level is measured in clinical practice.

Introduction Ebstein anomaly (EA) is a rare congenital malformation characterized by abnormalities of the tricuspid valve and right ventricle. Despite being uncommon, the diagnosis, management, and prognosis remain understudied in older populations, where survival beyond 50 is rare. Currently, no reported cases discuss the discrepancy between different echocardiographic modalities for proper evaluation and management of tricuspid regurgitation (TR) severity in patients with EA. We present a case that highlights such a discrepancy. Case A 49-year-old gentleman presented to the cardiology clinic for a regular check-up. He had a history of varicose veins, varicocele, and splenomegaly but had no active complaints. Routine echocardiography revealed findings meeting the criteria for EA, including a basal displacement of the tricuspid septal leaflet by 1 mm/m2. Upon examination with spectral Doppler (SD), a triangular tricuspid regurgitant waveform suggestive of severe TR was observed. However, Color Doppler (CD) was suggestive of a milder disease. The patient had no other echocardiographic findings of right ventricular dysfunction. Eventually, he underwent right heart catheterization to evaluate the degree of TR and rule out pulmonary hypertension. Hemodynamic measurements showed normal right-sided and pulmonary pressures and normal waveforms, ruling out significant regurgitation indicated by the spectral Doppler. Accordingly, the decision was made to follow up with the patient conservatively without further medical interventions. Discussion In asymptomatic tricuspid regurgitation in Ebstein anomaly, surgery is unnecessary. However, early intervention and careful monitoring may delay the progression of regurgitation or development of complications, but with no clear cut-off points. Our case highlights an exceptional patient with EA who has been tolerating the condition for over 50 years without requiring any intervention. Moreover, the discrepancies observed between the color and spectral Doppler results in this patient with EA shed light on the potential variation that may be seen in TR of different etiologies and warrants further investigation. As differentiation between different stages is critical, it is vital to investigate these discrepancies to determine whether they are exclusive to those with TR caused by EA. This report underscores the significance of careful evaluation and monitoring in patients with EA to delay the progression of TR and the onset of symptoms.

Thyroid disorders, despite their prevalence and possible significant complications, remain considerably underdiagnosed. Thus, awareness of thyroid disorders symptoms and risk factors is needed. This study gauged the knowledge, attitudes, and practices (KAP) of Jordanians towards thyroid disorders, using an online survey. The survey assessed knowledge of thyroid function; knowledge of risk factors, symptoms, and treatments of thyroid disorder; and finally, attitudes and practices toward thyroid disorders. The survey was completed by 579 participants, predominantly female (62.9%) and married (68.7%), with a mean age of 41.4. Participants had a mean knowledge score of 7.22 out of 14.00. Specific gaps in knowledge relevant to women’s health were recognized, where a minority recognized symptoms such as menstrual abnormalities (38.2%), and risk factors such as pregnancy (19.3%). Additionally, a minority believed that thyroid medications should not be stopped during pregnancy (31.8%). Better knowledge correlated with perceiving thyroid disorders as common, dangerous, and preventable. Factors predicting higher knowledge included being female, pursuing medical studies, and having a prior thyroid disorder diagnosis. Most participants preferred visiting an endocrinologist (75.6%) over primary care (19.3%) for thyroid-related symptoms. In conclusion, the study recommends targeted public health campaigns to enhance awareness, particularly among women and expectant mothers. Disseminating accurate information through various channels, including primary care centers, is crucial for creating an informed and proactive population regarding thyroid health.

Background: The most important anatomical variations of the posterolateral talar tubercle that can predispose patients to development of posterior ankle impingement syndrome (PAIS) are an os trigonum and Stieda process. The aim of this study was to elucidate the prevalence of different anatomical variants of posterolateral talar tubercle on CT imaging, their prevalence in patients with PAIS, and to evaluate the risk posed by these anatomical variants to PAIS. Methods: 1478 ankle CT scans were retrospectively reviewed for the different anatomical variants of the lateral talar tubercle, the type and size of os trigonum. In addition, these anatomical differences were assessed in a subgroup of patients with PAIS. Results: Normal sized lateral tubercle was found in 46.1%, Stieda’s process in 26.1%, os trigonum in 20.5% and almost absent tubercle in 7.3%. A statistically higher prevalence of Stieda’s process was found in males while os trigonum was higher in females (p<0.05). In patients with PAIS, the most common variant was os trigonum (48.8%), followed by Stieda process (34.1%). Patients with Stieda process were 1.5 times more likely to have PAIS, and patients with os trigonum were 4.4 times more likely to have PAIS. PAIS was observed in 20.8% of patients with os trigonum. Fused forms of os trigonum (by cartilage) and sizes larger than 1cm were associated with a higher risk of occurrence of PAIS (OR 2.10 and OR 1.96 respectively)(p<0.05). Conclusion: Patients with os trigonum, followed by Stieda process were more likely to have PAIS compared to other anatomical variants of lateral talar tubercle.

The aim of our study was to establish the prevalence of the different anatomical variants of the posterolateral tubercle of talus on CT imaging. 1478 ankle CT scans were retrospectively reviewed for the different anatomical variants of the posterolateral tubercle of talus, the type and size of os trigonum. Normal sized lateral tubercle was found in 46.1%, an enlarged posterolateral tubercle (Stieda’s process) in 26.1%, os trigonum in 20.5% and almost absent tubercle in 7.3%. A statistically higher prevalence of Stieda’s process was found in males while os trigonum was higher in females (p<0.05). Among feet with os trigonum, 25.7% were non-articulating and identified as a separate bone located posterior to the posterolateral tubercle of talus and 74.3% of os trigonum were identified as fused to the posterolateral tubercle by synchondrosis or syndesmosis. Additionally, 17.5% of os trigonum were associated with intact lateral tubercle, 53.5% were considered as part of the lateral tubercle and 29.0% were without a lateral tubercle. According to its size, 22.8 % of os trigonum were smaller than 0.5 cm, 55.4% were between 0.5 and 1cm, and 21.8% were larger than 1 cm. No significant differences were found between the different types/sizes of os trigonum according to gender (p>0.05). The posterolateral tubercle of talus and its accessory ossicle, the os trigonum, could vary morphologically. The data of this study could be helpful in understanding the clinical problems that could be associated with some of these variants.