Primary Sjogren's syndrome presenting as ptosis and eyelid swelling: A case report.

Key Clinical Message: This unique case report of primary Sjogren's syndrome (pSS) shows bilateral ptosis and significant periorbital edema, compromising vision. To avoid misleading diagnosis, antibody tests must be evaluated and interpreted in the context of clinical findings. Abstract: Primary Sjögren's syndrome is an idiopathic, autoimmune disorder involving the lacrimal and salivary glands characterized by both localized and systemic manifestations including xerostomia and keratoconjunctivitis sicca. Myasthenia Gravis (MG) is also an autoimmune disorder characterized by the development of auto-antibodies against nicotinic acetylcholine receptors that causes decreased muscle response to stimulation. It usually presents with ptosis and generalized body weakness. Ophthalmological involvement is common in both disorders but ptosis is very rarely seen in pSS. We report the case of a 27-year-old woman presenting to our clinic with the complaint of ptosis and eyelid swelling. She also had a positive anti-acetylcholine receptor antibody test and her initial presentation mimicked Myasthenia Gravis. Her autoimmune workup revealed a positive titer of Anti Ro SSA antibodies. Myasthenia Gravis was ruled out on electrodiagnostic studies which showed no decremental response, and pSS was confirmed on lip biopsy. Our case highlights that it is important to interpret the antibody test results in the context of clinical findings as we can have spurious results in autoimmune diseases. Autoimmune conditions can have varying presenting complaints hence, clinical judgment should always overrule diagnostic investigations and should thus guide patient management.

Corrigendum to "Prospective Analysis of Lipid Variations in Hyperthyroid Subjects from Lahore, Pakistan".

[This corrects the article DOI: 10.1155/2021/9936782.].

Prospective Analysis of Lipid Variations in Hyperthyroid Subjects from Lahore, Pakistan.

Perturbations in the actions of T3 and T4 influence the normal metabolic pathways. Responsiveness of lipid biomarkers like LDL-C, HDL-C, TC, TG, Apo-A, and Apo-B after rehabilitation of thyroid profile attaining euthyroid state was determined. A total of 179 age-matched subjects of both genders were recruited for this research. Sixty healthy controls, thirty-four subclinical, fifty overt hyperthyroid, and thirty-five follow-up subjects having 3 months of Carbimazole therapy were enrolled. Biochemical analysis was performed by chemistry analyzer, RIA, and ELISA. One-way ANOVA was applied for the statistical analysis, while significance (P < 0.05) of means was compared by the Student-Newman-Keuls (SNK) test. Pronounced reduction (P < 0.001) of cholesterol in overt as compared to control and subclinical was noticed, whereas marked improvement (P < 0.001) was evidenced in follow-up. Prominent elevation (P < 0.05) of TG in follow-up was evidenced as compared to control. Overt presented marked reduction of HDL-C as compared to subclinical and control (P < 0.01 and P < 0.001), respectively. Pronounced elevation (P < 0.001) of HDL-C was evidenced after treatment. Overt presented reduction of LDL-C as compared to subclinical and control (P < 0.01 and P < 0.05, respectively). The follow-up group demonstrated considerable (P < 0.001) improvement of LDL-C after treatment and elevation (P < 0.05) as compared to control. Overt presented reduction of Apo-B as compared to subclinical and control (P < 0.05 and P < 0.001, respectively). Improvement (P < 0.05) of Apo-B was evidenced in follow-up. Reduction (P < 0.05) of Apo-A in overt as compared to control and elevation (P < 0.05) in follow-up as compared to overt was evidenced. Conclusively, improvement after treatment was evidenced in lipid profile.

Occupational Factors Associated With Depression In Nurses Working In A Federal Government Tertiary Care Hospital In Islamabad.

BACKGROUND: Depression is more prevalent in women than in men. Among women's population sub-groups, there is paucity of research regarding occupational factors associated with depression in Pakistani nurses. METHODS: This cross-sectional study was conducted on 250 female nurses working in a Federal Government tertiary care hospital in Islamabad. Pretested modified form of Agha Khan University Anxiety and Depression Scale was used to collect primary data. The questionnaires collected data on depressive symptoms, work experience, working hours, working environment, harassment by patients or attendants, job satisfaction and job stress. SPSS version 20 was used for data analysis. Chi-square test was used to see the association between different variables and depression. RESULTS: This study indicated high level of depression in nurses who were having work experience of 5-7 years (p=0.000), who were working on rotating shifts (p=0.012), whose work hours were not flexible (p=0.032), who had experienced verbal abuse or harassment by patient or attendant (p=0.001), who thought that they had more responsibilities and less authorities at work (p=0.018), who suffered from injury at work (p=0.010), who thought that they had to work fast at job (p=0.004), who thought that they had to do extra physical work at job (p=0.003), who believed that they had insufficient time for patient care (p=0.006), who were not allowed to take decisions according to patient's requirements (p=0.005), who were neither appreciated nor received any feedback from their seniors (p=0.002), who did not enjoy their work (p=0.001), who did not enjoy relations with their colleagues (p=0.001), who were harassed by their administration (p=0.000), who were not satisfied from their job (p=0.012) and who believed that their job is stressful (p=0.000). CONCLUSIONS: This study concluded that occupational factors play a very important role in determining depression in Pakistani nurses.