Background: Lutetium-177 PSMA radioligand therapy ([¹⁷⁷Lu]Lu-PSMA-RLT) is an effective treatment option for patients with metastatic castration-resistant prostate cancer (mCRPC). Prospective studies reported favourable efficacy and safety outcomes of up to 6 cycles of [¹⁷⁷Lu]Lu-PSMA. This study aimed to evaluate the efficacy and safety of [¹⁷⁷Lu]Lu-PSMA rechallenge therapy in patients with mCRPC who progressed after an initial course of [¹⁷⁷Lu]Lu-PSMA-RLT. Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A systematic search was performed using relevant keywords in PubMed, EMBASE, and Scopus from establishment to March 2025. Primary endpoints included biochemical responses with a decline in prostate-specific antigen (PSA) of more than 50% and any PSA decline. Secondary outcomes included survival outcomes and treatment-related toxicity following rechallenge therapy with [¹⁷⁷Lu]Lu-PSMA. A random-effects model was used to generate pooled proportions through meta-analysis. Results: Eleven studies with 307 patients were included in the final analysis. Of these, 196 received 177Lu-PSMA RLT alone, and 111 received tandem 177Lu/225Ac-PSMA RLT. The pooled proportions of patients with more than a 50% PSA decline and any PSA decline were 0.45 (95% CI: 0.36–0.54) and 0.71 (95% CI: 0.61–0.80), respectively. In a total of 102 patients, 44 (43%) showed low-grade 1–2 xerostomia; however, no cases of serious xerostomia (grade ≥ 3) were reported. Moreover, the pooled proportion of patients experiencing grade ≥ 3 toxicity was 0.14 (95% CI: 0.09–0.19). Conclusion: Rechallenge therapy with [¹⁷⁷Lu]Lu-PSMA is a feasible and safe treatment option for late/end mCRPC patients. Tandem approaches with [225Ac]Ac-PSMA may help expand understanding of how to optimize outcomes after [¹⁷⁷Lu]Lu-PSMA progression. However, these findings require confirmation in prospective, randomized studies comparing different rechallenge strategies to define optimal sequencing and patient selection criteria in advanced prostate cancer.

Background Sleep quality significantly impacts cognitive function and mental health, yet medical students globally report high rates of sleep disturbances. This cross-sectional study investigates the prevalence of poor sleep quality and its associations with mental health and academic performance among medical students in three Syrian universities. Methods An online survey was administered to 722 medical students from Kalamoon University, Al Sham Private University, and Syrian Private University. Validated tools, including `assessed sleep quality and psychological distress. Academic performance was measured via self-reported GPA. After exclusions, 682 participants were analyzed using SPSS v27, with chi-square tests and regression models (α = 0.05). Results Poor sleep quality (PSQI ≥ 5) was prevalent in 83.3% of participants, with significant variations across universities (p = 0.011). Sleep quality correlated with academic year (p = 0.037), physical inactivity (p = 0.001), unhealthy diet (p = 0.001), smoking (p = 0.001), and low academic attendance (p = 0.001). Poor sleepers exhibited higher depression (p = 0.001), anxiety (p = 0.001), and stress (p = 0.001) scores. No direct association emerged between sleep quality and GPA (p = 0.8). Preparatory-year students (OR = 0.355, p = 0.009), those with severe depression (OR = 0.537, p = 0.023), and severe stress (OR = 0.493, p = 0.034) were likelier to be low academic achievers. Conclusion Poor sleep quality is alarmingly high among Syrian medical students and strongly linked to mental health challenges and modifiable lifestyle factors. Academic performance (GPA) showed no direct relationship with sleep quality, stress and depression .Targeted interventions promoting sleep hygiene, physical activity, and mental health support are urgently needed. Further longitudinal studies should explore causal pathways and cultural influences on sleep behaviors.

Introduction and importance: Brucellosis, the most common microbial zoonotic disease in the world, is endemic in both industrialized and underdeveloped countries. Between 2 and 53% of patients with brucellosis, patients develop spondylitis, and people between the ages of 50 and 60 are the most commonly affected. It mostly affects the lumbar vertebrae (L4 and L5 in particular) and the thoracic vertebrae. Case presentation: A 52-year-old patient was brought to the neurological clinic after complaining of lower back discomfort, reduced mobility, and lower extremity weakness for 6 weeks. Both the cervical and lumbar columns were the sites of the specific discomfort. MRI showed cervical and lumbar discitis. Clinical discussion: A high titre of anti-brucella antibodies was found by serology testing. He was treated with oral doxycycline (100 mg, two times daily), rifampicin (900 mg) orally once daily, and gentamicin (400 mg) once daily. The patient had massive improvement after 3 months of treatment. Conclusions: This case should serve as a reminder to healthcare providers to keep a high index of suspicion for uncommon infections, including Brucella species, in patients exhibiting discitis symptoms, especially when traditional microbiological gram stain and culture are negative.

Key Clinical Message: A novel radiologic sign in patients with renal failure and uremic encephalopathy (UE) with metabolic acidosis has recently been identified as the lentiform fork sign. On magnetic resonance imaging (MRI), the “lentiform fork sign” has been described as bilateral symmetrical hyperintensities in the basal ganglia encircled by a hyperintese rim delineating the lentiform nucleus. Changes in uremic solute retention, aberrant blood–brain barrier transport, disordered vascular reactivity, altered electrolyte and acid–base balance, and altered hormone metabolism are the most likely causes of the condition. A 56‐year‐old male with end‐stage renal disease was brought to the emergency room for a progressive change in mental status and involuntary arm movements over the previous 5 days, which were accompanied by mild dyspnea. A brain MRI was performed, and it revealed hyperintensity on T2/FLAIR in the white matter surrounding the basal ganglia. the patient was treated with dialysis and improved greatly. Intensified hemodialysis and glycemic control are the cornerstones of treating diabetic uremic syndrome (DUS) with likely reversible clinical symptoms and remission of imaging abnormalities.

Introduction and importance: Mesenteric cysts are rare abdominal lesions that can present with varying clinical manifestations. Early diagnosis and management are crucial to prevent complications, especially in pediatric populations. Case presentation: A 10-year-old female patient presented to our facility with a palpable abdominal mass localized in the periumbilical region. Her medical history was unremarkable, with no previous illnesses or surgical interventions. Imaging studies, including abdominal ultrasound, revealed a complex cystic structure behind the umbilicus, interconnecting multiple compartments, and extending adjacent to the bladder and both renal poles. A computed tomography scan confirmed the presence of mesenteric cysts measuring up to 75 mm, devoid of malignant features. Clinical discussion: Exploratory laparotomy was performed, resulting in the complete resection of the mesenteric cysts. The pathological examination indicated a cystic configuration characterized by thick-walled vascular spaces lined by collagen fibers. This case underscores the importance of thorough evaluation and timely intervention when dealing with mesenteric cysts, particularly given the potential for complications such as infection or rupture. Conclusion: This case contributes to the existing literature on mesenteric cysts in children, emphasizing the need for meticulous imaging and appropriate surgical management. Continued research is warranted to establish standardized protocols for diagnosis and treatment. Highlights:

Key clinical Message: This case highlights the significance of maintaining clinical suspicion for CPBs in adults presenting with SBO. Early surgical intervention, offering both diagnosis and treatment, is essential for managing this rare cause of SBO. Increased clinical awareness of CPBs will help ensure they are considered in the differential diagnosis of adult patients with bowel obstruction.