Normal values of antistreptolysin O for adults ages 30 to 70 in Syria: A cross sectional study.

BACKGROUND: Group A Streptococcus is a very common pathogen which infects a large scale of people around the world causing many symptoms such as scarlet fever, sinusitis, and pneumonia. Most strains of group A and many other strains of group C and G Streptococcus bacteria secreted antigen called Streptolysin O. Anti-streptolysin O (ASO) is an antibody produced against streptolysin O that rises after 1 week of infection by streptococcus bacteria, which helps in diagnosing this type of infectious diseases. We conducted a Cross-Sectional study to determine the Upper Limit of Normal (ULN) for healthy adult in Aleppo, Syria. MATERIALS AND METHODS: A sero-epidemiological cross-sectional study was conducted from September to October in 2019. ASO titers were determined on 267 healthy patients' companions who visited Aleppo University Hospital. Geometric mean titer and Upper Limit of Normal of ASO were calculated according to sex, age and residency. Upper Limit of Normal were defined as the 80th percentile. RESULTS: Out of 267 participants; 126 (45.7%) were males and 150 (54.3) were females. The Upper Limit of Normal for total participants was 210.8 IU/ml. There was no significant difference (P-value > 0.05) among males (204.6 IU/ml) and females (225.8 IU/ml). In contrast to sex, there was a significant difference (P-value < 0.05) according to age groups, where the highest Upper Limit of Normal was in the 30-39 age group (256.0 IU/ml). CONCLUSION: ASO test is a common, easy, cheap method, so getting enough data about it is very important in the developing countries (such as Syria). In Aleppo, Syria we found that the ULN was higher than ULN from other studies. There was no significant difference according to sex and residency. On the other hand, there was significant difference according to age groups.

Peak Systolic Blood Pressure During the Exercise Test: Reference Values by Sex and Age and Association With Mortality.

[Figure: see text].

Attitudes towards organ donation in Syria: a cross-sectional study.

BACKGROUND: The perception of organ donation and brain death among Syrian population has not been previously explored. The goal of this study is to evaluate the attitude and knowledge of organ donation among Syrians and the willingness of this population to donate their organs. METHODS: We conducted a survey-based cross-sectional study in four hospitals in Aleppo, Syria in November 2019. Patient demographic, awareness of brain death; and attitude toward organ donation were collected and analyzed. RESULTS: A total of 350 individuals were invited to participate in the survey among whom 303 (197 females, 106 males) agreed to participate in the study (87% response rate). The majority of our participants (n = 249, 82%) heard about organ donation with television (n = 166, 55%), social media (n = 77, 25%), and the internet (n = 77, 25%) being the most common sources of information. When assessing knowledge about brain death, only 40% (n = 116) answered 3 or more questions (out of 5) correctly. Fifty-eight percent (n = 176) of respondents agreed with the idea of organ donation and 183 (62%) would like to donate their organs one day. The leading motivation to organ donation was the desire to help (n = 234, 77%), while the most common reason to refuse donation was the refusal to disfigure a dead body by removing an organ (n = 125, 41%). Religious reasons were cited as motivation for organ donation by 43% of participants (n = 130), and a reason for refusing to donate organs by 24% (n = 71). Most respondents (n = 261, 88%) were unaware of the laws and legislations related to organ donation in Syria. When asked if religion and law were encouraging organ donation, 76% of respondents (n = 226) would donate their organs. Although more positive attitude was found in those with better brain death knowledge (score ≥ 3), this did not translate into more willingness to donate organs in this group of participants. CONCLUSIONS: The promotion of organ donations from deceased donors is a necessity given the rising shortage of organs. The information provided by this study could help policy makers build future strategies to promote deceased organ donation programs and overcome current obstacles preventing such initiatives from achieving their goals.

Gender differences in specialty preference among medical Students at Aleppo University: a cross-sectional study.

BACKGROUND: This study aims to identify gender differences in specialty preference and career choice among Syrian medical students. METHOD: A cross-sectional study comprising currently enrolled second, fourth and sixth year medical students at Aleppo University was conducted. Demographics, specialty preferences and factors influencing this decision were collected and analyzed. RESULTS: A total of 561 students (44% males, 56% females) responded to our survey (87% response rate). Surgical specialties (40%) and internal medicine (16%) comprised the two most common specialties chosen by males. In contrast, the majority of females preferred other specialties (17%), internal medicine (16%) and surgical specialties (15%). The most common factor affecting the choice of a specialty by both genders (74% females and 71% males) was 'A specialty that I like and find interesting'. Work/life balance and anticipated income were the second most common influencing factors by females (62%), males (67%), respectively. The majority of both genders supported the idea that medical students should be able to pursue any medical specialty they want, regardless of their gender. However, females more often believed that they had decreased opportunities for professional advancement based on their gender compared to males (33% vs. 4% respectively, p < 0.001). CONCLUSIONS: We illustrated significant gender differences in specialty preferences and factors influencing this decision. While the majority of participants agreed that medical students should be able to pursue any medical specialty they desire regardless of gender, more women believed they had decreased opportunities for professional advancement based on gender. Policy makers should advocate for a culture of gender equity and develop educational programs to insure gender balance of physicians into different specialties.

Primary Tuberculous Mastitis: The first report from Syria.

INTRODUCTION: Primary breast tuberculosis is a rare form of extrapulmonary tuberculosis even in endemic regions. To our knowledge, this is the first report of Primary breast tuberculosis from Syria. CASE PRESENTATION: We report a case of a 37-year-old female who admitted to the surgical clinic with a 4-month history of gradually growing mass in the breast. On physical examination there were a palpable mass, painful superficial abscess in her left lateral upper quarter of breast, redness and nipple retraction and ulceration. The patient history and physical examination were clear except for uncontrolled hypothyroidism. Radiological tests including mammography, echography and laboratory investigations were performed. The patient underwent lumpectomy. Histopathologic examination showed caseating Tuberculous Mastitis and a large tuberculous abscess, with no malignancy. Patient was put on anti-tubercular chemotherapy, but recurred after three months with three masses in the same area because she did not adhere to the treatment. Lumpectomy and Anti-tuberculous therapy were repeated again with close follow-up, and the patient recovered. DISCUSSION: Primary breast tuberculosis forms about 0.025-0.1 % of all surgically treated breast diseases. Diagnosis is based on bacteriological and histological examination. We can get higher accuracy in diagnosis by biopsy such as a core needle or surgical biopsy, surgical biopsy is necessary to confirm the diagnosis of tuberculous mastitis. CONCLUSION: Tuberculous mastitis is extremely rare variant of extrapulmonary tuberculosis. However, it should be kept in the mind of physicians and pathologists while approaching a breast mass, especially in endemic area.

Correction to: The impact of helicobacter pylori eradication on platelet counts of adult patients with idiopathic thrombocytopenic purpura.

[This corrects the article DOI: 10.1186/s12878-018-0119-y.].

Superior mesenteric artery syndrome caused by weight loss in a malnourished Syrian man.

Superior mesenteric artery syndrome is a rare cause of upper gastrointestinal obstruction in which the third part of the duodenum is compressed between the superior mesenteric artery and the abdominal aorta, and the compression of the duodenum is caused by a narrowed aortomesenteric angle. We report in this case a 35-year-old patient who came with features of small bowel obstruction, weight loss and had a history of malnutrition because of war. Multi-slice computerized tomography showed a narrowed aortomesenteric angle and distance. Conservative treatment was presented and, after 3 months of observation, the patient gained weight.

Bloom syndrome with myelodysplastic syndrome that was converted into acute myeloid leukaemia, with new ophthalmologic manifestations: the first report from Syria.

Bloom syndrome is a rare autosomal recessive disease, in which BLM gene is mutated, leading to genome instability and proneness to malignancy. It is characterized by short stature, sun-sensitive rash and immunodeficiency. We present a case of bloom syndrome with myelodysplasia complicated by acute myeloid leukaemia. This case has new ophthalmologic manifestations. We confirmed the diagnosis by detection of high rate of sister chromatid exchange. The patient received chemotherapy but did not tolerate it well and developed fungal pneumonia.

The impact of helicobacter pylori eradication on platelet counts of adult patients with idiopathic thrombocytopenic purpura.

Background: Idiopathic (immune) thrombocytopenic purpura (ITP) is an acquired disorder characterized by autoantibodies against platelet membrane antigens. Several studies found an association between Helicobacter Pylori infection and the incidence of ITP. So far, It is still unclear whether H. pylori eradication will increase platelet counts in adult ITP patients. We conduct this study to investigate platelet recovery in ITP patients after H. pylori eradication. Methods: This is a prospective study. The diagnostic criterion for Idiopathic thrombocytopenic purpura is: isolated thrombocytopenia, with no evidence of any underlying causes like drugs, TTP, SLE, hepatitis, HIV,CLL and… etc. We examined blood smears of all patients. We have diagnosed Helicobacter pylori infection by histological examination of several biopsies obtained from stomach and duodenum by esophagogastroduodenoscopy (EGD). If EGD was not applicable due to patient's poor situation or platelet count, H.pylori infection was diagnosed by the positivity of serum antibodies or respiratory urease test. We treated infected patients with triple therapy (omeprazole 40 mg once daily, amoxicillin 1000 mg twice daily and clarithromycin 500 mg twice daily) for 14 days. Uninfected patients did not receive any treatment. We did platelet quantification at the beginning of the study, at the end of the first month, at the end of the third month and at the end of the sixth month. Results: This study involved 50 patients with chronic ITP, 29 males (58%) and 21 females (42%). Participants ages range between18 and 51 years (mean age = 28.60 years). We diagnosed H. pylori in 36 patients (72%), who were treated with triple therapy. At the end of the sixth month, 10 of them (27.77%) showed complete response, and 18 of them (50%) showed partial response. The 14 uninfected patients, who did not receive any treatment, did not show neither complete nor partial response. Patient sex and age were not associated with achieving response, while baseline platelet count and H.pylori infection did. Conclusion: Helicobacter pylori eradication significantly increases platelet counts in adult ITP patients.

Successful Elimination of Gallbladder Ascariasis by Conservative Therapy, Followed by Cholecystectomy due to Developing Cholecystitis.

BACKGROUND: Ascaris lumbricoides is the most common parasitic infection in human. The worm is usually located in the small intestine, but may invade into the pancreatic or biliary tree, but rarely into gallbladder because of the anatomic features of the cystic duct. CASE PRESENTATION: We report a case of gallbladder ascariasis that was diagnosed incidentally in a 70-year-old man, with negative ova and parasite test and no eosinophilia. We also compared echography and computerizied tomograph as diagnostic tools for gallbladder ascariasis. The patient was managed conservatively, but he underwent cholecyctectomy later because of developing cholecystitis. CONCLUSION: Depending on this case, we suggest cholecyctectomy as an initial management of gallbladder ascariasis.