Acute watery diarrhoea cases during cholera outbreak in Syria: a cohort study.

OBJECTIVES: The aim of this study is a descriptive presentation of cases of acute watery diarrhoea (AWD) that were presented to Aleppo University Hospital (AUH) during the recent cholera outbreak in Syria. DESIGN: Prospective, observational, cohort study. SETTING AND PARTICIPANTS: A total of 1061 patients with AWD were admitted to AUH during the timeframe of 20 September 2022 to 20 October 2022. The data collection was done through a structured questionnaire. This includes comprehensive clinical observation, laboratory analyses, therapeutic interventions and holistic case evaluations. RESULTS: The analysis has revealed notable insights: a predominant proportion of patients (58.6%) were residents from urban areas and 40.3% were residents from rural areas. Intriguingly, a diverse range of potential infection sources emerged from patient data within our hospital, including uncontrolled well water, vegetables and faecal-oral transmission through contaminated street/fast food. At discharge, most patients were in good health (79.7%), followed by moderate health (17.6%) and poor health (2.3%), with a minimal percentage dying before discharge (0.4%). The most common complications reported at admission and during hospitalisation included electrolyte imbalance (28.2%), followed by severe dehydration (16.3%). In the follow-up period, the majority of patients exhibited good health (81.0%). Older patients (>60 years) had poorer outcomes, with 8.4% having poor health and 4.2% death rate. CONCLUSIONS: The study found results consistent with previous AWD outbreaks in developing countries like Yemen, Nigeria and Lebanon. Preventative measures like improving water sanitation and hygiene practices are essential to prevent future outbreaks and ease the strain on healthcare systems. Therefore, future studies must investigate the risk factors that increase the spread and the severity of the disease and investigate the best management method.

Bridging the first-aid knowledge gap: a cross-sectional study of medical scope students in Syria.

INTRODUCTION AND OBJECTIVE: Sufficient knowledge required to deal with emergencies at the accident site may not be found in most medical students due to the lack of effective first-aid training in most medical education curricula. This study aims to assess and evaluate medical students' knowledge level in providing first-aid care, especially first-year students. METHODS: An electronic questionnaire was distributed via social media to 1,855 medical students in October 2020. The knowledge level was assessed based on scores obtained for each clinical scenario requiring first aid and classified as good, intermediate, or weak. Statistical analysis was performed using SPSS software. RESULTS: The study found that academic year and specialization significantly influence medical students' first-aid knowledge level. However, demographic factors such as gender, university, marital status, housing status, work status, financial condition, and previous first-aid training did not show any significant effect. CONCLUSION: The level of knowledge among Syrian medical students in providing first-aid care is somewhat limited. Therefore, first-aid courses should be made more accessible to these students, and their effectiveness should be ensured and maintained through frequent updates. Moreover, more attention should be placed on publicizing first-aid knowledge to make life-saving procedures attainable to anyone, anytime and anywhere.

The prevalence and risk factors of irritable bowel syndrome (PRIBS study) among adults in low- and middle-income countries: A multicenter cross-sectional study.

Background and Aims: Because of the plenty and abundance of risk factors and the expected increase in the prevalence of irritable bowel syndrome (IBS) in the world in general and in low- and middle-income countries in particular, this international cross-sectional study was conducted in 15 low- and middle-income countries according to our previous protocol, NCT05340400. Methods: Participants were recruited in the period from April 22, 2022 to June 14, 2022. The diagnosis of IBS was according to ROME IV. We determined the physical activity, daily stress, and fatigue of the participants. A large number of collaborators were chosen from different regions and institutions within each country to achieve diversity within the sample and reduce the probability of bias. Results: The prevalence of IBS appears to be higher in low- and middle-income countries (mean = 25.2%, range [6.2%-44.2%]) than in high-income countries, with a higher prevalence among Africans than Caucasians and Asians. The prevalence of IBS increased in the fourth decade by 32.1% and in the fifth decade by 31.1% (p-value < 0.001). In addition to the previously known risk factors for IBS such as female sex, smoking, psychological stress, and chronic fatigue, other risk factors were discovered such as chronic diseases, including high blood pressure and diabetes, allergies to some substances, previous infection with COVID-19, and the participant having a first-degree relative with a patient. There are also some other modifiable risk factors, such as an abnormal body mass index (whether high or low), smoking, a protein- or fat-rich diet, drinking caffeine-containing beverages, and poor physical activity. Conclusions: Highlighting the prevalence and increasing risk factors of IBS in developing countries should draw the attention of those responsible for health care in these countries and reduce the risk factors.

The prevalence and risk factors of functional dyspepsia among adults in low- and middle-income countries: An international cross-sectional study.

Dyspepsia is one of the most common chronic digestive diseases, which is due to underlying organic causes that can be detected, or causes that cannot be detected called functional dyspepsia (FD). There is no epidemiological study to date that measures the prevalence and risk factors of the FD in low- and middle-income countries, so this international cross-sectional study was conducted in 15 low- and middle-income countries from data previously published its protocol NCT05340400. Participants were recruited in the period from 22/April/2022 to 14/June/2022. The diagnosis of the FD was according to clinical manifestations. We determined the physical activity, daily stress, and fatigue of the participants. A large number of collaborators were chosen from different regions and institutions within each country to achieve diversity within the sample and reduce the probability of bias. Our study concluded that the prevalence of FD is much higher in low- and middle-income countries 37.9% [6.2%-44.2%], compared to high-income countries 10% [8%-12%], with a higher rate among the Afro-Caribbean race 47.9%. Sudan obtained the highest prevalence 44.3%, then Egypt 41.4%, while the lowest prevalence was in Algeria 25.7%. Moreover, there are many risk factors, including modifiable ones, such as severe stress, chronic fatigue, smoking, abnormal BMI, insufficient or too many hours of sleep, and previous infection with Covid-19, and non-modifiable ones such as advanced age, chronic diseases, and female sex. Highlighting the prevalence and increasing risk factors of FD in low- and middle-income countries should draw the attention of those responsible for health care in these countries and reduce the risk factors.

A primary gastric Adenosquamous carcinoma: Case report.

INTRODUCTION: Adenosquamous carcinoma (ASC) is too rare accounting for <0.5 % of all gastric cancers and has a worse prognosis than adenocarcinoma. CASE PRESENTATION: We report a case of a man with digestive symptoms and epigastric discomfort came to a Gastrointestinal clinic. CT scan of the abdomen and pelvis showed a large mass localized in the gastric fundus and cardia. A PET-CT scan showed a localized lesion in the stomach. Gastroscopy revealed a mass in the gastric fundus. Biopsy from the gastric fundus reported a poorly-differentiated squamous cell carcinoma. A laparoscopic abdominal exploration found a mass and Infected Lymphatic Nodes on the abdomen wall. a second biopsy reported an Adenosquamous cell carcinoma grade II. The therapeutic was open surgery and then chemotherapy. CLINICAL DISCUSSION: Adenosquamous carcinoma usually presents at an advanced stage with metastasis (Chen et al., 2015). In our case, the patient presented with a stage IV tumor; including two lymph nodes metastasis (pN1, N = 2/15) and abdominal wall involvement (pM1). CONCLUSION: Clinicians should be aware of this potential site of adenosquamous carcinoma (ASC) because this carcinoma has a poor prognosis even if diagnosed at an early stage.

Misdiagnosis of sphincter of Oddi disorder treated as familial Mediterranean fever for ten years: A case report.

INTRODUCTION: Sphincter of Oddi dysfunction is a rare disease caused by sphincter of Oddi functional or mechanical abnormality. Misdiagnosis of familial Mediterranean fever is very high due to overlapping symptoms with many diseases. Our case is the first case report in the medical literature which describes the misdiagnosis of Sphincter of Oddi dysfunction as familial Mediterranean fever. CASE PRESENTATION: A 46-year-old woman presented with recurrent episodes of abdominal pain and arthralgia. The patient had familial Mediterranean fever for ten years which was diagnosed clinically without performing genetic tests. Analysis of the mutation in the MEFV gene was performed and was negative. Thereby, the diagnosis of familial Mediterranean fever was eliminated and colchisine was discontinued. Afterward, laboratory and radiological tests were performed, and the diagnosis of sphincter of Oddi disfunction was confirmed. The patient underwent biliary sphincterotomy and take sulpiride daily. DISCUSSION: The most common diseases were misdiagnosed with familial Mediterranean fever are appendicitis, acute rheumatic fever, gastrointestinal diseases and inflammatory arthritis. Endoscopic retrograde cholangiopancreatography with Manometry of the Sphincter of Oddi is the gold-standard test. CONCLUSION: Sphincter of Oddi dysfunction may interfere with many other disorders and should be considered as a differential diagnosis for any recurrent abdominal pain. Misdiagnosis of familial Mediterranean fever is common in endemic countries due to the reliance on clinical symptoms without analysis of the mutations in the MEFV genes particularly, before 1997.

The mortality rate among patients with acute upper GI bleeding (with/without EGD) at Aleppo University Hospital: A retrospective study.

BACKGROUND: acute upper gastrointestinal bleeding (UGIB) is a common medical condition that results in substantial morbidity, mortality, and medical care cost. The mortality rate for patients with acute upper gastrointestinal (GI) bleeding is 5-10%, and it has not changed much since 1945, despite the development in medicines, endoscopy, intensive care units (ICU), and surgical management. We conduct this study to observe some of the factors that predict death in these patients. MATERIALS AND METHODS: The Study was conducted at the Internal Medicine Department, Digestive Division, Aleppo University Hospital, between July 2018 and June 2020. The study included all patients with acute upper GI bleeding who were admitted to the digestive division during the study period, or who were admitted by other departments requesting an upper GI endoscopy. RESULTS: This study involved 234 patients, 137 males (58.55%), 97 females (41.45%).The patients' ages ranged between 17 and 81 years old, and the mean age value ± standard deviation was 57.15 ± 22.89 years old.The number of deaths reached 22, at a rate of 9.40%, 14 male deaths (10.22%), 8 female deaths (8.25%). CONCLUSIONS: in this study we found a moderate inverse relationship between the hemoglobin value at admission and the incidence of death; the lower the hemoglobin value at admission, the higher the probability of patient's death. Also, there is a very significant direct relationship between the number of blood units transfused and the incidence of death, noting that all patients who died had received blood transfusions. Finally, we found a moderate inverse relationship between the arterial blood pressure value at admission and the incidence of death.

Epigastric pain associated with herpes esophagitis: case report.

BACKGROUND: Herpes esophagitis is uncommon disease caused by Herpes simplex virus (HSV). While the disease most often occurs in immunocompromised patients, including post-chemotherapy, immunosuppression with organ transplants, and in AIDS, Herpes esophagitis can also occur in immunocompetent individuals. CASE PRESENTATION: We report a case of herpes esophagitis in a 72 year- old woman who was presumed to be immunocompromised following prolonged radiotherapy and chemotherapy for lymphoma. Her main symptom was epigastric pain. Upper endoscopy showed multiple rounded ulcers in lower esophagus. The diagnosis was confirmed histologically by multiple biopsies. The patient received Valacyclovir for 2 weeks and started to get better within 3 days of treatment. CONCLUSION: Although there are few published cases of Herpes esophagitis disease in the medical literature, we recommend that this disease should be considered as one of the differential diagnoses when assessing immuno-compromised patients presenting with non-specific abdominal symptoms.

A rare case of bowel intussusception due to adenocarcinomatous polyp in a 14 year-old child: case report.

BACKGROUND: Intussusception is a form of intestinal obstruction in which a segment of the bowel prolapses into a more distal segment. It is an uncommon condition in children older than 2 years and causes intestinal obstruction. On the contrary of adult intussusception, childhood intussusception does not usually happen on a lead point of a malignant organic lesion. CASE PRESENTATION: A 14-year-old male presented with complaints of heavy, bilious emesis and periumbilical colicky pain. Ultrasonography showed a dilated intestinal loop with absent bowel movement. CT scan revealed two masses in the abdomen. We performed an exploratory laparotomy that revealed invaginated intestines and showed a polyp near the area of interest. Necrotic segments and the polyp were removed and examined pathologically. Pathology showed adenocarcinoma in the polyp. After surgery, the general condition of the patient was normal and no complications occurred. CONCLUSIONS: Intussusception mainly occurs during infancy and early childhood. Mostly it is an idiopathic ileo-colic invagination. In our case, the patient had a jejuno-jejunal intussusception in his late childhood, and the lead point was an adenocarcinomatous polyp, which is rare in children. Amongst the many types of treatment, we chose surgical resection because of patient's age.

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.

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.].

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.