Parathyroid carcinoma is a rare cause of primary hyperparathyroidism. Compared to parathyroid adenoma, parathyroid cancer is more likely to be associated with marked levels of serum parathyroid hormone (PTH) and hypercalcemia with severe clinical manifestations. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is a rare variant of papillary thyroid cancer. Here, we report the case of a middle-aged woman who presented with multiple fractures and neck swelling. Neck ultrasound and fine-needle aspiration cytology revealed a provisional diagnosis of thyroid carcinoma. Parathyroid and bone scan were performed because of primary hyperparathyroidism and hypercalcemia and established the diagnosis of hyperfunctioning right-sided parathyroid tumor. Right parathyroidectomy and total thyroidectomy were performed, and the histopathological report confirmed the diagnosis of parathyroid carcinoma and NIFTP. The synchronic coexistence between parathyroid cancer and thyroid neoplasms is an extremely rare condition that prompted us to report this case.

Since COVID-19 was declared as a pandemic, a race between researchers has begun to deeply examine the mechanism of the virus and how to combat it. Few clinical investigations and studies have paid attention to the role of micronutrients in the disease's course and how it may affect the disease outcomes. Micronutrients have a noticeable effect on the host immune system regulation, as well as micronutrients insufficiencies where they can affect the host immune response against SARS-CoV-2 by, for example, altering the production and the function of the inflammatory cytokines such as IFN-γ, IFN-α, TNF and interleukins. Recent studies have shown that low levels of vitamin D, vitamin C, vitamin A, zinc, selenium, copper and magnesium have a great clinical impact on COVID-19 patients, where, they are linked to prolong hospital stay, increase the mortality rate and raise the complications rate related not only to the respiratory system but also to the other systems. Optimizing the need for these micronutrients will act as a productive factor by decreasing the incidence of COVID-19 infection, lowering the complication rate, and improving the disease prognosis and outcomes. Optimal micro-nutrition supports and contributes to the efficiency of COVID-19 vaccine. The aim of this review is to highlight the role of different micronutrients in the management of COVID-19 and optimizing vaccines, and to revile the clinical effects of micronutrients deficiencies on patients with COVID-19.

Background and Objective: Patients with schizophrenia are more prone to develop metabolic syndrome (MetS) with its related complications, including cardiovascular diseases and diabetes mellitus compared to the general population. In this study, we aim to evaluate the effect of low-carbohydrate diet on MetS Z score, weight status, and symptomatology of patients with schizophrenia in Bahrain. Materials and Methods: This single-group pretest–posttest study was executed while considering an ethical approach of volunteer participants, a sample size of 35 patients with schizophrenia. The participants were instructed to follow a low-carbohydrate moderate-fat diet for 8 weeks. Anthropometric measurements, mean arterial pressure, basal metabolic index, body fat percentage (BFP), body surface area (BSA), and MetS Z score and Clinical Global Impression (CGI) Scale were collected before and after the diet intervention. Descriptive statistics, including the mean and standard deviations, were used for continuous variables and percentages for the categorical variables. Paired t-tests and effect size were used to analyze the mean difference of the values before and after the diet intervention. Results: A statistical significance in the mean difference was observed among the following variables: MetS Z score, weight, body mass index (BMI), high-density lipoproteins (HDL), low-density lipoprotein (LDL), thrombin generation test, waist circumference (WC), BFP, BSA, and CGI-improvement (CGI-I). Weight, BMI, TG, BFP, BSA, and CGI-I had a large effect size of the mean difference, whereas LDL, HDL, and WC had a moderate effect size. There was no statistically significant difference in the MetS Z score between male and female after the diet intervention (P = 0.274). Conclusion: Dietary modification with low-carbohydrates restriction is a workable approach in the management of schizophrenia and its related metabolic complications. Clinical trials need to be conducted to corroborate the implementation of dietary intervention as a co-treatment of schizophrenia.

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