Background: Despite the growing concern worldwide regarding the quality of life (QoL) and mental well-being among chronic kidney disease (CKD), a few research has been done to address this issue. The study aims to measure depression, anxiety, and QoL prevalence among Jordanian patients with End Stage Renal Disease (ESRD) on hemodialysis and how all of these variables are correlated. Methods: This is a cross-sectional, interview-based study on patients at the Jordan University Hospital (JUH) dialysis unit. Sociodemographic factors were collected, and the prevalence of depression, anxiety disorder, and QOL was assessed using the Patient Health Questionnaire 9 (PHQ9), the Generalized Anxiety Disorder 7-item (GAD7), and the WHOQOL-BREF, respectively. Results: In a study of 66 patients, 92.4% had depression, and 83.3% had generalised anxiety disorder. Females had significantly higher depression scores than males (mean = 6.2 ± 3.77 vs 2.9 ± 2.8, p < 0.001), and single patients had significantly higher anxiety scores than married patients (mean = 6.1 ± 6 vs 2.9 ± 3.5, p = 0.03). Age was positively correlated with depression scores (rs= 0.269, p = 0.03), and QOL domains showed an indirect correlation with GAD7 and PHQ9 scores. Males had higher physical functioning scores than females (mean = 64.82 vs 58.87, p = 0.016), and patients who studied in universities had higher physical functioning scores than those with only school education (mean of College/University = 78.81 vs mean of School Education = 66.46, p = 0.046). Patients taking < 5 medications had higher scores in the environmental domain (p = 0.025). Conclusion: The high prevalence of depression, GAD, and low QOL in ESRD patients on dialysis highlights the need for caregivers to provide psychological support and counselling for these patients and their families. This can promote psychological health and prevent the onset of psychological disorders.

Background: The coronavirus disease 2019 (COVID-19) pandemic has negatively impacted public health systems worldwide and created anxiety and stress among communities, resulting in the stigmatization of patients infected with the virus. Stigmatization of individuals who are sick or thought to be infected has a long history and can lead to discrimination and prejudice. This study aims to evaluate the prevalence of COVID-19-related stigma in Jordan, assess the relationship between stigma and the quality of life (QoL) in healthcare workers, and identify possible measures to decrease stressful events. Understanding the psychological effects of healthcare workers' jobs and reducing their burden is essential to improving medical outcomes and the QoL of patients. Methodology: This cross-sectional study was conducted in three primary hospitals in Amman, Jordan, from July to December 2021. Healthcare workers were recruited through convenience sampling and completed a self-administered questionnaire, which included demographic information, a validated COVID-19 stigma questionnaire, work conditions during the pandemic, the Depression, Anxiety and Stress Scale - 21 Items (DASS-21) questionnaire to measure depression, anxiety, and stress, and the EUROHIS-QOL questionnaire to assess the QoL. Data were analyzed using descriptive and inferential statistics, including chi-square tests and post hoc analysis. The study was approved by the institutional review board, and participation was voluntary and confidential. Results: The study was conducted among 683 healthcare workers in Jordan, with 77.7% based in the capital city, Amman. Most of the participants were between 18 and 30 years of age, and slightly more than half were female. The study found that 38.1% of healthcare workers would not take the COVID-19 vaccine once it became available. More than half (56%) reported experiencing stress, 61% reported anxiety, and 65% reported depression during the pandemic. Internal medicine specialties and frontline nurses reported the highest levels of stress, and healthcare workers with greater exposure to COVID-19 patients reported higher levels of anxiety and stress. Only 3% of participants reported experiencing stigmatization (p=0.043), with low-income participants reporting it more frequently. Stigmatization was significantly correlated with feelings of depression, anxiety, and stress (p<0.001). Conclusion: Healthcare workers’ mental well-being has been affected negatively by the COVID-19 pandemic, resulting in depression, anxiety, and stress. Widespread mental surveillance for healthcare workers is crucial to protect healthcare workers from psychological issues and to improve the healthcare service provided to patients. Stigma among healthcare workers can be a major factor that may increase depression, anxiety, and stress.

Background: The COVID-19 pandemic emerged as an expected source of stress and anxiety as the healthcare workers had to work for long hours in close contact with infected patients, thus increasing the probability of medical errors and threatening the patients’ safety. This study aims to measure the levels of depressive symptoms, anxiety symptoms, and stress among Syrian healthcare workers and their quality of life during the COVID-19 pandemic. Methods: A cross-sectional study was conducted in six central hospitals in Damascus, Syria. Data were collected from 1 to 30 June—2021. The Depression Anxiety Stress Scale—21 (DASS-21) was used to evaluate depression, anxiety, and stress among healthcare workers. Quality of life was assessed using the EUROHIS-QOL 8-item index. Results: A total of 700 participants were included in this study. 61.6% (n = 431) were males and 38.4% (n = 269) were females. Younger ages (18–29 years old) were significantly associated with higher levels of depression and stress (p < 0.0083). Female healthcare workers had higher significant levels of anxiety (p < 0.05). Significant anxiety and stress levels were reported when healthcare workers had contact with COVID-19 patients, even if they had protective equipment (p < 0.05). Half of the participants (50%; n = 349) reported a good quality of life. Conclusion: Stress levels and depressive symptoms were remarkably higher in healthcare workers of ages 18 and 29 years old, whereas anxiety levels were significantly higher and more severe in female healthcare workers. Moreover, direct interaction with COVID-19 patients was associated with higher levels of stress and anxiety symptoms.

Hemophagocytic lymphohistiocytosis (HLH) is a rare and potentially fatal hyperinflammatory syndrome marked by abnormal activation of the immune system, resulting in widespread tissue destruction and multi-organ failure. HLH can be classified as primary (genetic) or secondary, with triggers including infections, malignancies, autoimmune diseases, and increasingly, immunotherapy drugs. Early diagnosis is difficult because the clinical presentation is frequently nonspecific, including hepatosplenomegaly, cytopenias, persistent fever, and elevated inflammatory markers, and diagnosis is typically guided by established frameworks such as the Hemophagocytic Lymphohistiocytosis-2004 (HLH-2004) criteria or the H-score. We describe a case of HLH in a patient with breast cancer whose HLH developed after administration of pembrolizumab, a programmed cell death protein-1 (PD-1) inhibitor, used to treat her cancer. The patient developed multi-organ inflammation, cytopenias, and constitutional symptoms, initially confounded with other toxicities of antitumour therapy, which impeded prompt diagnosis. Laboratory and histopathological findings ultimately supported the diagnosis of HLH. This report emphasizes the need for clinician awareness of HLH as a rare but serious immune-related adverse event (irAE) in the context of cancer immunotherapy.

Watermelon duodenum, also known as duodenal bulb vascular ectasia (DBVE), is a rare and under-recognized cause of upper gastrointestinal bleeding. Unlike its more commonly reported gastric counterpart - gastric antral vascular ectasia (GAVE) - DBVE is seldom described in the literature, and its clinical presentation, risk factors, and optimal management remain poorly defined. We report the case of an elderly patient with multiple complex comorbidities, including hepatocellular carcinoma, atrial fibrillation on anticoagulation, and chronic immune thrombocytopenia, who presented with worsening confusion and lethargy consistent with hepatic encephalopathy. Laboratory studies revealed anemia and elevated ammonia levels, raising suspicion for an upper gastrointestinal source of bleeding as a precipitating factor. Urgent esophagogastroduodenoscopy demonstrated isolated, longitudinally arranged vascular ectatic lesions confined to the duodenal bulb, producing a characteristic “watermelon” appearance. No involvement of the gastric antrum was noted. The lesions were treated endoscopically with hemostatic therapy, argon plasma coagulation (APC), resulting in clinical stabilization and improvement of encephalopathy. This case emphasizes the need for heightened clinical awareness of DBVE as a potential source of upper gastrointestinal bleeding. Early identification and appropriate endoscopic management can significantly improve outcomes, particularly in patients with complex comorbid profiles.