Type 3 of progressive familial intrahepatic cholestasis (PFIC-3): Case report

Genetic testing should always be advised in both parents and children of families with progressive familial intrahepatic cholestasis as early detection will provide more options to a better qualitative life.

The epidemiology of in-hospital burn patients in a tertiary hospital in Damascus, Syria. A retrospective cohort study

BACKGROUND

Syria has been facing a dreadful crisis for the past 11 years, which has had a significant toll on the healthcare system of the country, and its ability to adequately manage acute injuries. In this research, we study the epidemiology and outcomes of burn patients admitted to the burn center of Al-Mouwasat Hospital in Damascus, Syria.

METHODS

A retrospective cohort research was conducted from January 2017 to December 2021. All accessible paper-based medical records of burn injury patients admitted to the hospital were evaluated. ABSI score was used to classify injury degrees. Chi-square test and logistic regression model were used to study the association between demographic variables and outcomes.

RESULTS

Of the 641 patients, 367 (57.3%) were males and 274 (42.7%) were females. Children represented more than half of our sample 377 (58.8%). The most common cause of burns was flame 393 (61.3%), followed by scalding 199 (31.0%). Most of the patients had a more than 10% TBSA of burns 511 (79.7%). 209 (32.6%) patients had a moderate ABSI score, followed by moderately severe in 149 (23.2%) patients. Children, patients who had high ABSI scores, and those who needed respiratory support were more likely to die than others 2.545 (1.079-6.004), 9.208 (4.061-20.879), respectively.

CONCLUSION

Death was the outcome of third of the hospitalized patients. Furthermore, Children made up more than half of the sample, and had the highest rates of leaving the hospital against medical advice. These results underline the importance of an updated nationally uniformed protocol for the management of burn patients.

An asymptomatic giant extra-renal retroperitoneal angiomyolipoma: Case report

RATIONALE

Angiomyolipoma is a benign mesenchymal tumor that consists of adipose tissue, muscle cells and blood vessel. Renal angiomyolipomas represent almost one percent of all renal tumors.

PATIENT CONCERNS

We reported a case of a 42-year-old woman complaining of mild abdominal pain with no other symptoms and no remarkable medical history.

DIAGNOSIS

Clinical examination was inconclusive and revealed a large, smooth, non-tender, and immovable mass in the right abdomen. Ultrasound examination confirmed the existence of a large, homogeneous, hyperechoic tissue mass. Abdominal multi-slice computed tomography (CT) scans also confirmed the presence of a well-rounded mass in the right abdomen. The histopathology tests confirmed the diagnosis of a large retroperitoneal mass.

INTERVENTIONS

The patient underwent a traditional laparotomy without complications to remove the tumor.

OUTCOMES

The open surgery was the best option, and the patient's condition improved due to the following-up.

LESSONS

Retroperitoneal extra-renal angiomyolipomas are extremely rare, and in this case, we document a case of retroperitoneal angiomyolipoma manifested with only mild abdominal pain in Syrian women.

Fibromyalgia: epidemiology and risk factors, a population-based case-control study in Damascus, Syria

Background

Fibromyalgia is a chronic disease with a high burden. We aim to be the first to investigate the prevalence of fibromyalgia (FM) in Syria and assess its risk factors.

Methods

A self-reported questionnaire was distributed to the public to identify fibromyalgia patients using the American College of Rheumatology (ACR) 2010 modified criteria. Identified cases were matched using age with controls free from rheumatic disorders that were randomly sampled from the same population.

Results

Out of 2966 participants, 350 (11.8%) satisfied the diagnostic criteria. Of these, only 29 (8.2%) were previously diagnosed by a physician, 239 (68.3%) were females, and 69 (19.71%) were diagnosed with depression. Female sex (OR = 1.31), diagnosis of major depressive disorder (OR = 2.62), irritable bowel syndrome (OR = 1.8), and Restless legs syndrome (OR = 1.72) were associated with a higher likelihood of fibromyalgia.

Conclusion

Our study revealed one of the highest prevalence rates of fibromyalgia ever reported in the general population. Efforts must be intensified to increase awareness about this disease in Syrian society as well as among healthcare providers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41927-022-00294-8.

Knowledge and attitudes about influenza and the common cold in Syria post COVID-19: A qualitative study

Background

The common cold and the influenza are common infections that are frequent in the community. In this study, we estimate the level of knowledge regarding those diseases among the Syrian population in the COVID era as it is important to have this knowledge for future health planning and policies.

Methods

A qualitative study was conducted from November to December in 2021. A structured self-administered questionnaire was distributed as Google Forms on social media platforms and hard copies of the questionnaire to patients, their companions, or workers in public hospitals. Chi-square test and Mann Whitney test were used to study the associations between categorical groups.

Results

This study included 13013 participants, 7856 (60.4%) were females, 78.4% were younger than 31 years old, only 3518 (27%) knew that the common cold and the influenza were caused by viruses, 6146 (47.2%) reported that runny nose was the most annoying symptom, 75.6% of the participants believed that antibiotics could kill viruses, and 7674 (58.9%) had fears from symptoms of common cold and influenza because of covid-19. Females were statistically significantly more knowledgeable and had more fears from the infection compared with males.

Conclusion

This study showed a low level of knowledge among the Syrian population. The view of influenza and common cold have changed after COVID as they are now taken more seriously. Many efforts should be made to spread awareness, effective management, and reducing antibiotic misinformation.

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The public in Syria mostly cannot distinguish between common cold and influenza.

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They still believe that antibiotics is the treatment of choice for them.

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COVID-19 has made people more aware and self-conscious of having flu-like symptoms as they can be from having COVID.

Two cases of Erythrodermic psoriasis treated with Golimumab

Introduction and importance

Erythrodermic psoriasis (EP) is a very severe subtype of psoriasis, with a challenge poses in its treatment, as currently available therapies often provide unsatisfactory results, for those many biologics have been used in the treatment of EP such as Golimumab which has been extensively studied for the treatment of psoriatic arthritis, and chronic plaque psoriasis. However, no clinical trials have been performed for EP.

Case presentation

We report two cases of a 23-year old female, and a 31-year male who presented with severe psoriasis that previously un respond to ultraviolet B phototherapy, methotrexate, cyclosporine, and topical agents. Skin lesions worsened progressively and developed into erythroderma. Therefore, we administered golimumab 50 mg, which lead to the improvement of the skin lesions according to the Psoriasis Area and Severity Index score after the first administration; lesions improved further throughout the treatment course.

Conclusion

Golimumab may be an alternative treatment for Erythrodermic psoriasis patients unrespond to other treatments even it did not have the FDA approval, so this is an off label indication and treatment.

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Erythrodermic psoriasis is a very severe subtype of psoriasis, with a challenge poses in its treatment.

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Golimumab is tumor necrosis factor inhibitors.

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Golimumab is FDA approved treatment for psoriatic arthritis, and chronic plaque psoriasis. However, no clinical trials have been performed for the treatment of erythrodermic psoriasis.

Oral cancer knowledge and practice among medical students: A cross-sectional study during the Syrian crisis

Background

lack of medical practitioners’ knowledge about oral cancer has contributed to delays in referral and treatment. Oral cancer is amenable to treatment when detected early, which leads to better prognosis and survival rates. In this study, we aimed to assess the knowledge of the Syrian medical students about the risk factors of oral cancer, oral cavity changes associated with oral cancer, and the relation between the relation with Human Papilloma Virus (HPV) and oral cancer.

Methods

This is a cross-sectional study conducted at the Syrian Private University. Data were collected through self-administered questionnaires, which targeted social demographic information, general knowledge, risk factors, oral changes and HPV knowledge associated with oral cancer. Data was categorized and analyzed to assess and compare the levels of knowledge between clinical and preclinical students.

Results

301 out of 401 medical students responded to the questionnaires bringing the response rate to 75.25%. The study revealed adequate knowledge about oral cancer, general information, clinical features, risk factors and relation to HPV. Clinical students showed higher levels of awareness compared to pre-clinical students. No significance in knowledge was found between the genders.

Conclusion

The findings of the present study suggest that there is a need to reinforce the medical curriculum concerning oral cancer education, particularly in prevention and early detection to improve practices.

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In Syria, the incidence and mortality rates of OC and OPC were 2 and 0.8 per 100,000 annum, respectively.

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Awareness about OC was positively correlated with the year of study

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Low level of awareness about OC was found among medical students.

COVID-19 vaccination acceptance among Syrian population: a nationwide cross-sectional study

Background

Severe Acute Respiratory Syndrome Coronavirus 2 continues to spread globally and in the absence of an effective treatment, the vaccine remains the best hope for controlling this disease. In this study, we seek to find out the extent to which people in Syria accept the Corona vaccine and what are the factors that affect their decision.

Methods

This cross-sectional study was conducted in Syria during the period from January 3 to March 17, 2021. A structured self-administered questionnaire was distributed in two phases: The first phase included distributing the questionnaire as a Google Form on social media platforms. In the second phase, a paper version of the questionnaire was handed to patients, their companions, and workers in public hospitals. SPSS v.25 and R v.4.1.1 were used to analyze the data. Pearson Chi-square test and Logistic Regression were used to study the associations between categorical groups.

Results

Of 7531 respondents, 3505 (46.5%) were males and 4026 (53.5%) were females. 3124 (41.5%) were 18–24 years old. Healthcare workers were participants’ main sources of information (50.9%), followed by Social Media users (46.3%). 2790 (37%) of the participant are willing to be vaccinated, and 2334 (31%) were uncertain about it. Fear of possible side effects was the main reason for the reluctance to take the vaccine 1615 (62.4%), followed by mistrust of the vaccine formula 1522 (58.8%). 2218 (29.5%) participants think COVID-19 poses a major risk to them personally. Vaccination intention was significantly associated with gender, residence, financial status, educational level, and geographic origin.

Conclusion

This study showed very negatively important results. The study participants Vaccination acceptance rate is almost the lowest when compared to its peers. A Lot of efforts should be made to correct misinformation about the vaccine and answer all questions about it, especially with a health system that has been ravaged by war for 10 years.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12186-6.

Assessing the Syrian Population's Knowledge, Attitudes, and Practices Regarding Antibiotic Usage

Background Antibiotic resistance is a serious public health threat that results mainly secondary to antibiotics misuse. The present study aimed to determine the knowledge, attitude, and practice toward antibiotic use among the Syrian population. Methods This cross-sectional study was conducted at the outpatient clinics of two major hospitals in Damascus, Syria. Applying a random convenience sampling, data were collected in a 1-week period by interviewing participants using a structured questionnaire, which targeted demographics, practice, knowledge, and attitude. Data were used to assess the relationship between the knowledge level and attitudes and demographics. Results Most respondents had a moderate level of knowledge (187, 74.8%) and a moderate attitude score (148, 59.2%). In addition, most respondents (149, 59.6%) stated that they take antibiotics based on pharmacist advice only and do not complete the full antibiotic course (200, 80%). A significant association was found between the knowledge level and financial status ( p -value = 0.003), education level ( p -value = 0.001), and having relatives working in the health care sector ( p -value = 0.021). In addition, a significant association was found between the attitude and having health insurance. Conclusion This study provides baseline evidence about the knowledge, attitudes, and practices regarding antibiotics among the Syrian population, that will help in designing targeted interventions to solve the inappropriate use of antibiotics.

Assessing diabetes mellitus knowledge among Syrian medical students: A cross-sectional study

Background

Diabetes mellitus is the fastest growing global health emergency of the 21st century. The Middle East and North Africa region have the highest prevalence of diabetes in the world. Since medical students are the pillars of future healthcare systems, their knowledge of the disease must be evaluated, updated, and enhanced appropriately.

Methods

A cross-sectional study was conducted at the Syrian Private University (SPU) in November 2019 on World Diabetes Day in Damascus, during the Syrian war crisis. Data were collected through self-administered questionnaires and analyzed using the Statistical Package for Social Sciences version 25.0 (SPSS Inc., United States).

Results

Of the 275 students, 74 (26.9%) were preclinical students and 201 (73%) were clinical students with a mean age of 21.9 (±3.70) years. 67 (25.0%) are overweight, and 26 (9.7%) are obese. Students revealed a good level of knowledge regarding clinical features, risk factors, and complications; however, a lack of knowledge was noticed in the general information and the diagnostic criteria section. Clinical year students (4th, 5th, 6th) demonstrated higher levels of awareness compared to students in pre-clinical years (1st, 2nd, 3rd).

Conclusions

Knowledge and awareness of medical students about diabetes mellitus were found to have some gaps. Health education efforts are required to reinforce its identification and management at all levels, while also encouraging lifestyle modifications among our students.

Knowledge of breast cancer among medical students in Syrian Private University, Syria: a cross-sectional study

BACKGROUND

Breast cancer is the most common cancer among women and the second leading cause of cancer death globally. Since early diagnosis is crucial to reducing mortality, high levels of knowledge regarding general information, risk factors, and symptoms are required among healthcare professionals to deliver breast cancer care. This study aimed to determine Syrian medical students' knowledge about breast cancer in the fields of general knowledge, common clinical features, and risk factors.

METHODS

This cross-sectional study was conducted at the Syrian Private University in October 2019 (Breast Cancer Awareness Month), Damascus, during the Syrian war crisis. Data were collected through self-administered surveys and analyzed using the Statistical Package for Social Sciences version 25.0 (SPSS Inc., United States). The chi-square test was applied to assess the relationship between the level of knowledge and gender. One way analysis of variance was performed to assess the overall differences in mean knowledge score by study year, GPA, mother's education, and source of information. Unpaired Student's T-test was used to analyze the differences in mean knowledge scores (continuous variable) based on smoking status and alcohol consumption.

RESULTS

Of 320 students, 301 completed the questionnaire (response rate = 94.0%), of which 179(59.5%) were males. The study revealed above-average knowledge scores (total mean = 68.4%) regarding breast cancer, general information (71.9%), common clinical features (71.6%), and risk factors (71.6%). Clinical students (4th, 5th, and 6th years) scored higher compared with pre-clinical students (1st, 2nd, and 3rd years).

CONCLUSION

This study showed above-average knowledge scores regarding breast cancer. More efforts to correct misinformation, through reassessing the university curriculum and promoting awareness about breast cancer are required.

Knowledge, Attitude, and Practice Regarding HIV, HBV, and HCV Among Medical Students of Syrian Private University, Damascus, Syria

BACKGROUND

Hepatitis B, Hepatitis C, and HIV/AIDS are infections that constitute major health concerns impacting national health systems worldwide. This is the first study to determine Syrian medical students' attitudes, awareness and knowledge of HIV/HBV/HCV, regarding general knowledge about, clinical features, transmission, and prevention.

METHODS

This cross-sectional study was conducted at Syrian Private University on World AIDs Day (1/12/2019), Damascus, during the Syrian war crisis. Data were collected through self-administered surveys which targeted social demographic information, general knowledge, attitude, towards HBV, HCV, HIV. Data were divided and analysed according to the source of information, study year, marital status, and GPA using one-way analysis of variance to assess the level of knowledge.

RESULTS

Of 317 respondents, the majority (59.8%) were males with age ranging from 18 to 30 years of age. . The majority of students 188(59.3%) showed an average level of knowledge, 73(23%) showed a good level of knowledge. This study revealed adequate knowledge. However there were misconceptions regarding transmission pathways. The majority 173(54.6%) had a positive attitude, and 144(45.4%) had a neutral attitude, while none had a negative attitude towards HIV/HBV/HCV infected individuals. Clinical year students (mean 73.0%, SD ± 10.0%) demonstrated higher levels of awareness compared to pre-clinical students (mean 39.7%, SD ± 13.0%).

CONCLUSIONS

This study revealed that medical students have adequate knowledge regarding HIV/HBV/HCV. Medical students play a pivotal role in raising awareness and disseminating knowledge among the community, thus more effort should be concentrated on developing educational programs to limit the risks of such infections.

War-related ocular injuries in Damascus during the Syrian Crisis

BACKGROUND

. Ocular injuries constitute a major cause of visual morbidity, and they have a significant socioeconomic impact worldwide. We aimed to document the types and causes of Syrian War related ocular injuries in Damascus, Syria.

METHODS

. Medical records were retrospectively reviewed to evaluate all patients in Al-Mouwasat University Hospital and Damascus Hospital, whose ocular injuries were caused by war-related activities during the period extending between January of 2016 and December 2017.

RESULTS

. 150 eye injuries in 127 patients were reviewed, in which 46 (31%) were bilateral and 87 (58%) were open globe injuries. The leading cause of the observed ocular injuries was improvised explosive devices (IED) [37 eyes (41%)]. The majority of patients presented with an initial best corrected visual acuity (BCVA) of "light perception" (LP) to "hand movement" (HM) [51 eyes (34%)]. Information on the final BCVA was available for 69 injured eyes only, and it was "no light perception" (NLP) in 20 eyes (29%).

CONCLUSION

. Explosive weaponry is the main culprit in most war-related ocular injuries in Syria. The high incidence of open globe injuries caused many of the cases to be severe in nature. Education on the precautionary measures that protect the eyes such as the use of combat eye protection during wartimes ought to be enforced, so that future ocular injuries can be prevented.

Assessing diagnostic radiology knowledge among Syrian medical undergraduates

BACKGROUND

The role of radiology in medicine and healthcare is rapidly expanding worldwide, but awareness about this field among medical students is poor. This is the first study to assess Syrian medical students' knowledge and attitude regarding radiology.

METHODS

This is a cross-sectional study conducted at the Syrian Private University, on November 8, 2019, on the International Day of Radiology during the war crisis. Data were collected through self-administered surveys and analyzed using the Statistical Package for Social Sciences version 25.0 (SPSS Inc., Chicago, IL, USA).

RESULTS

The questionnaire was completed by 269 students whose ages ranged between 17 and 30 years old. Males constituted 63.6% of the respondents. The results revealed adequate knowledge about the basics of radiology. 73.6% of the students had previously heard about interventional radiology. There were slight misconceptions with certain points in each section, especially those pertaining to the radiation exposure of each imaging method. Finally, the students expressed low interest in radiology as a future career (24.5%).

CONCLUSIONS

The level of awareness can affect a student's decision in considering radiology as a future career. Further evaluation of the methods of teaching, input from medical boards, curriculum advisors, and guidance from radiologists is required.

Prevalence and behavior regarding cigarette and water pipe smoking among Syrian undergraduates

BACKGROUND

The devastating Syrian crisis has raised concern regarding the social acceptance of smoking especially with water pipe use becoming a growing epidemic. We aim to determine the prevalence of cigarette and water pipe smoking among university students, along with identifying the addictive behavior among university students.

METHODS

A cross-sectional study was conducted at the Syrian Private University during World No-Tobacco Day, in Damascus, Syria during the war crisis. The survey consists of 4 sections: socio-demographic information, Fagerström Test of Nicotine Dependence, attitude towards water pipes, and perspective about smoking. Data were analyzed using the Statistical Package for Sciences version 25.0 (SPSS Inc., United States.).

RESULTS

Of the 622 participants, 429 (69%) were males with a mean age of 21.3 ± 3.1 years. The prevalence of tobacco smoking was 320 (51.4%), 208 (23.8%) for cigarettes, and 112 (18.0%) for water pipe. Smoking was significantly higher among male non-medical university students. The majority were low to moderate dependent when assessed by the Fagerström Test of Nicotine Dependence.

CONCLUSIONS

This study showed a very high prevalence of smoking indicating the need for smoking cessation programs, access to effective quitting treatments, and mass media campaigns to diminish smoking among the youth.

Influence of a rumen-protected conjugated linoleic acid mixture on carcass traits and meat quality in young Simmental heifers

The aim of the present study was to investigate the influence of feeding rumen-protected CLA during the early growing period on physical and chemical beef properties in young Simmental heifers. A total of 36 heifers (5 mo old; initial BW 185 ± 21 kg) were fed 250 g of different rumen-protected fats daily for 16 wk in 1 of 3 treatment groups: 250 g of a CLA-free control fat; 100 g of a CLA fat containing 2.4% of cis-9,trans-11 CLA and 2.1% of trans-10,cis-12 CLA and 150 g control fat; or 250 g of the CLA fat. Heifer growth performance variables as well as carcass weight, classification (conformation and fatness), and weights of organs and fat depots were not affected (P > 0.05) by CLA supplementation. Concentration of trans-10,cis-12 CLA in tissues (LM and subcutaneous fat) was dose-dependently increased (P < 0.01) by CLA supplementation, whereas that of cis-9,trans-11 CLA in these tissues did not differ (P > 0.05) between groups. The ratio of SFA to MUFA was increased (P < 0.01) in tissues of CLA-fed heifers compared with control heifers. Concentration of α-tocopherol in LM was greater (P = 0.01) in heifers of the 2 CLA groups than in control heifers. Other quality characteristics such as drip loss during storage, cooking loss, intramuscular fat content, and color variables in LM did not differ (P > 0.05) between groups. In conclusion, the present study demonstrates that feeding rumen-protected CLA during the early growing period changes tissue fatty acid composition but does not influence beef quality variables. Performance variables and carcass traits in young heifers, unlike in pigs and laboratory animals, are not influenced by CLA feeding.

Effect of a rumen-protected conjugated linoleic acid mixture on hepatic lipid metabolism in heifers

This study was performed to assess the effects of rumen-protected conjugated linoleic acid (CLA) on hepatic lipid metabolism in heifers. In particular, it was of interest whether feeding CLA causes development of fatty liver as observed recently in mice. Thirty-six growing heifers with an initial body weight of 185 kg were allotted to three treatment groups and fed daily 250 g of different rumen-protected fats for 16 weeks: The control group received 250 g of a CLA-free control fat, the CLA100 group received 100 g of a CLA fat containing 2.4% of cis-9, trans-11 CLA and 2.1% of trans-10, cis-12 CLA and 150 g control fat and the CLA250 group received 250 g of the CLA fat. CLA supplementation had no effect on animal performance parameters, liver weight and hepatic triglyceride concentration. Moreover, mRNA expression of hepatic genes involved in lipogenesis, β-oxidation and fatty acid transport was not influenced by dietary CLA. The fatty acid composition of hepatic total lipids, with particular consideration of ratios of fatty acids indicative of Δ9-, Δ6- and Δ5-desaturation, was also less influenced by dietary CLA. In conclusion, the study shows that dietary rumen-protected CLA has less effect on hepatic lipid metabolism in young heifers and does not induce the development of a fatty liver such as in mice.