Spider angioma at the injection site of the meningitis vaccine.

Spider angioma is a cutaneous nevus caused by a vascular abnormality, characterized by a central red area with radiating reddish, web-like extensions. It is typically associated with liver cirrhosis, hyperestrogenism, and alcohol consumption. In this case report, we present a unique instance of a patient who developed spider angioma at the injection site of the meningitis vaccine as a long-term adverse effect. The lesion was treated with electrocautery and diminished within one week of treatment. This case highlights the potential for spider angioma to develop as a long-term adverse effect of the meningitis vaccine, a possibility that has not been previously reported. Further research is required to understand the underlying mechanisms and identify potential risk factors for this rare adverse effect.

Lower urinary tract symptoms caused by scabies mites (sarcoptes scabiei): A case report.

Lower urinary tract symptoms (LUTS) are including an overactive bladder, voiding and storing urine. The causes of LUTS include infectious and inflammatory. In this paper we present a rare case of LUTS caused by scabies mites and could be the third case reported in the medical literature. A 12-year-old child came to hospital complaining of tenesmus, dysuria and hematuria several days ago. A diagnosis of LUTS was established and investigations showed the scabie mite is the possible cause for the disease. Scabies mites have the ability of entering into the urinary tract leading to LUTS in patients affected with scabies.

Is low dose of liposomal amphotericin B effective in management of acute invasive fungal rhinosinusitis? Our conclusions from Al-Mowassat University Hospital, Syria: a prospective observational study.

BACKGROUND: Acute invasive fungal rhinosinusitis (AIFRS) is a fatal infection associated with high morbidity and mortality. Although it is a rare disease, upsurge of AIFRS was noticed during the second wave of COVID-19 disease. Early diagnosis and management is the cornerstone for good outcomes. However, management of AIFRS is challengeable especially in developing countries due to limited resources and high prices of antifungal agents. No previous studies have been conducted to evaluate the outcomes of management of AIFRS in Syria. The purpose of this study is to report the results of management of AIFRS with low doses of liposomal amphotericin B in our tertiary hospital in Syria. METHODS: The outcomes of management of AIFRS cases were followed through a prospective observational study between January 2021 and July 2022. The required medical data were collected for each individual. Three-month mortality rate was studied. SPSS v.26 was used to perform the statistical analysis. Pearson Chi-square test was used to study the associations between different variables and mortality. Survival curves were plotted by the Kaplan-Meier to compare the survival probability. Log Rank (Mantel-Cox) test and Cox regression were conducted to evaluate the factors affecting survival within the follow up period. RESULTS: Of 70 cases, 36 (51.4%) were males and 34 (48.6%) were females. The mean age of patients was 52.5 years old. The most common underlying risk factor was diabetes mellitus (84.3%). The used dose of liposomal amphotericin B ranged between 2-3 mg/kg per day. The overall 3-month mortality rate was 35.7%. Significant association was found between survival and the following variables: Age, orbital involvement, stage, and comorbidity. CONCLUSION: The overall mortality rate was close to other studies. However, survival rate was worse than comparable studies in selected cases of AIFRS (older ages, involved orbits, advanced stages, and chronic immunodeficiency). Therefore, low doses of liposomal amphotericin B could be less effective in such cases and high doses are recommended.

Giant hypopharyngeal fibroepithelial polyp: A case report and literature review.

Hypopharyngeal fibroepithelial polyp is a rare entity. It could extend along the esophagus, leading to dysphagia. In rare cases, this polyp could present as airway compromise due to occlusion of the inlet of the larynx. The treatment of choice is surgical resection. Accurate defining of the origin of such polyp is mandatory in order to achieve complete resection and avoid recurrence. Although hypopharyngeal FEP is rare, physicians must keep this in mind when a patient presents dysphagia or airway compromise. In the current case, we present a rare case of giant hypopharyngeal FEP originating from the right pyriform sinus detected in a Caucasian female. The patient threw up the polyp after severe vomiting. This case should be the fourth and largest case of hypopharyngeal FEP reported in the literature.

Knowledge, attitude, and practice of evidence-based medicine among resident physicians in hospitals of Syria: a cross-sectional study.

BACKGROUND: Evidence-based medicine (EBM) is to integrate the best research evidence with our clinical expertise, circumstances, and unique values of our patient. However, there are no studies about using EBM in clinical practice among resident doctors in Syria. In this study, we aimed to evaluate the self-reported knowledge, attitude and practice (KAP) of EBM by resident doctors throughout different teaching hospitals in Syria. METHODS: The study is a cross-sectional. A self-reported online questionnaire was used to collect data about KAP of EBM from 214 resident physicians working in secondary and tertiary teaching hospitals. The study was conducted between September 2021 and February 2022. All data were analyzed using SPSS, and non-parametric statistical tests were used to identify the correlation between different variables and make the necessary comparisons. RESULTS: Two hundred and fourteen physicians responded to the questionnaire with a response rate of 85.6%. The overall mean scores of KAP of EBM were 59.2, 74.3 and 53.9%, respectively. The participants displayed a low level of awareness of resources and statistical terms used in EBM. The most well-known resources for residents were Up To Date and PubMed. Among the participants, pediatric residents achieved the highest score in practicing EBM, while family medicine residents scored the lowest score. CONCLUSION: The overall impression about the KAP of EBM among Syrian residents was as following: weak awareness, neutral attitude and poor practice of EBM. Training workshops should be set up to teach residents the skills needed to move from opinion-based practice to evidence-based practice.

Total Resection of Intraorbital Hydatid Cyst by Using Lynch Approach: A Case Report.

Hydatidosis is a chronic zoonotic infection of humans caused by the infestation of larvae of the tapeworm Echinococcus granulosus. All parts of the body can be infected, especially the liver and lungs. Intraorbital hydatid cyst (HC) is a rare entity and accounts for less than 1% of all hydatid cysts. Total resection of the cyst can be very challenging due to the limited area within the orbit and the severe adhesion to adjacent structures. Several surgical approaches have been described in the literature depending on the size and location of the cyst. We reported a case of retrobulbar HC in a 10-year-old boy which was completely resected using the Lynch approach. Our case should be the second reported case from Syria and the first case that used the Lynch approach in the literature.

Total resection of sellar and suprasellar epidermoid cyst by using endoscopic endonasal approach: a case report.

Epidermoid cysts (EC) are benign lesions resulting from incomplete separation of the neuroectoderm during embryonic development. The investigation of choice for EC is magnetic resonance imaging (MRI). Surgical resection is the treatment of choice. Full resection of EC including the cyst wall to prevent recurrence and malignant transformation should be considered when possible. Two main approaches were described in the literature and included craniotomy and endoscopic endonasal approach (EEA). Using of EEA to accomplish total resection could be challengeable. To best of our knowledge, only 6 manuscripts (with a total of eight patients) reported total resection of EC by using EEA. Our case should be the ninth such cases in the literature. In this paper, we reported a case of sellar and suprasellar epidermoid cyst which was resected completely by using EEA. We revealed the safety and efficacy of this approach in management of such cases.