A primary pleural hydatid cyst was discovered months after an undiagnosed pneumothorax: A diagnostic and therapeutic dilemma in a rare case report from Syria.

INTRODUCTION: Primary pleural hydatid cysts (PPHCs) are a rare clinical condition caused by the larval stage of the parasite Echinococcus granulosus. They occur in <1 % of all hydatid cysts in the body and can cause serious complications such as pneumothorax, pleural effusion, and mediastinal shift. PRESENTATION OF CASE: We report a rare case of a 28-year-old female who was initially misdiagnosed and ignored her pneumothorax for several months, resulting in progressive dyspnea and chest pain. After performing radiological images, a primary pleural hydatid cyst was suspected. She was surgically treated and the cyst was removed by our doctors and the patient improved without any significant complications. DISCUSSION: PPHCs are a challenging diagnosis due to their nonspecific symptoms and low prevalence. They can mimic other pleural diseases such as tuberculosis, empyema, or malignancy. The diagnosis of PPHCs requires a high index of suspicion and a combination of imaging, serology, and histopathology. The treatment of choice is surgical removal of the cyst, along with perioperative anthelmintic therapy to prevent recurrence and anaphylaxis. CONCLUSION: PPHCs are a rare but potentially life-threatening condition that requires early diagnosis and management. Clinicians should be aware of this entity and include it in the differential diagnosis of pleural diseases, especially in developing countries. Surgical treatment is effective and safe, and can improve the quality of life of patients with PPHCs.

Medical education in Syria at a time of crisis: Analysis of the results of the knowledge-based National Medical Examination.

OBJECTIVE: This study explored how the Syrian crisis, training conditions, and relocation influenced the National Medical Examination (NME) scores of final-year medical students. METHODS: Results of the NME were used to denote the performance of final-year medical students between 2014 and 2021. The NME is a mandatory standardised test that measures the knowledge and competence of students in various clinical subjects. We categorised the data into two periods: period-I (2014-2018) and period-II (2019-2021). Period-I represents students who trained under hostile circumstances, which refer to the devastating effects of a decade-long Syrian crisis. Period-II represents post-hostilities phase, which is marked by a deepening economic crisis. RESULTS: Collected data included test scores for a total of 18 312 final-year medical students from nine medical schools (from six public and three private universities). NME scores improved significantly in period-II compared with period-I tests (p < 0.0001). Campus location or relocation during the crisis affected the results significantly, with higher scores from students of medical schools located in lower-risk regions compared with those from medical schools located in high-risk regions (p < 0.0001), both during and in the post-hostilities phases. Also, students of medical schools re-located to lesser-risk regions scored significantly less than those of medical schools located in high-risk regions (p < 0.0001), but their scores remained inferior to that of students of medical schools that were originally located in lower-risk regions (p < 0.0001). CONCLUSION: Academic performance of final year medical students can be adversely affected by crises and conflicts, with a clear tendency to recovery upon crises resolution. The study underscores the importance of maintaining and safeguarding the infrastructure of educational institutions, especially during times of crisis. Governments and educational authorities should prioritise resource allocation to ensure that medical schools have access to essential services, learning resources, and teaching personnel.

Vesicovaginal and vesicorectal fistula in a patient with systemic sclerosis: A case report.

Key Clinical Message: This case highlights the need for further research to explore a potential link between systemic sclerosis and fistula development, and the importance of raising awareness among clinicians about this possibility for timely appropriate management. Abstract: The primary diagnosis in this case is systemic sclerosis (scleroderma) in a 47-year-old female patient with various clinical manifestations, including vesicovaginal and vesicorectal fistulas. The medical interventions and diagnostic workup involved an electrocardiogram, cardiac echocardiogram, pulmonary function tests, beta blockers, aspirin, inhaled corticosteroids, albuterol, endoscopy, biopsy, treatment for Helicobacter pylori infection, fluconazole for candida esophagitis, endoscopic dilation for achalasia, anticholinergic therapy for mixed urinary incontinence, gabapentin for neuropathic symptoms, analgesia for knee pain, and psychiatric treatment with selective serotonin reuptake inhibitors. The outcomes described in the case report include the diagnosis of systemic sclerosis, the identification of vesicovaginal and vesicorectal fistulas, the patient's medical history and symptoms over the years, and various treatments and management strategies.

Bartter syndrome in a female infant: A rare case report from Syria.

Antenatal Bartter syndrome is a rare condition that affects approximately 1.2 individuals per million. It is caused by renal tubular dysfunction that impairs the reabsorption of sodium and chloride. This results in various symptoms such as polyuria, vomiting, dehydration, and failure to thrive. Because of its low prevalence, diagnosing this disorder can be challenging for medical professionals. In this report, we describe a rare case of a 3-month-old female infant who had symptoms of Bartter syndrome, such as severe hypotension, facial flattening, cough, and seizures. She also had the typical features of the condition, except for prematurity and hypercalciuria, which were not present. In this case, we highlight the importance of regular follow-ups and monitoring of patients with dehydration and electrolyte imbalances, as these can lead to complications in Bartter syndrome. Early intervention and close monitoring can enhance patient outcomes and avoid complications.

Acute hemorrhagic edema of infancy: a rare case report from Syria.

Acute hemorrhagic edema of infancy (AHEI) is a rare leukocytoclastic vasculitis clinically characterized by the classic triad (palpable purpuric skin lesions, edema, and fever) and is commonly misdiagnosed as Henoch-Schönlein purpura. AHEI frequently occurs after infections, drug treatment, or vaccination, even though its etiology is undetermined. Besides having a sudden onset, AHEI is also characterized by a self-limiting course with complete and spontaneous recovery within 1-3 weeks. Case Presentation: We report a rare case of a 1-year-old Syrian infant who presented to the clinic with an abnormal rash covering his entire body following a viral respiratory infection. On physical examination, he had many purpuric lesions across his body, and laboratory tests revealed that they were within the normal range. AHEI was determined based on clinical evaluation and laboratory analysis. Discussion and Conclusion: The authors focus on this entity as a differential diagnosis of his Henoch-Schönlein purpura. To prevent potentially serious complications, doctors should recognize purpura lesions in children exposed to respiratory infections, which received particular drugs or were given vaccinations. Furthermore, there is no danger associated with this disease, and it is benign.

Ruptured hydatid cyst presenting with a hydropneumothorax in a 16-year-old boy: A case report from Syria.

INTRODUCTION AND IMPORTANCE: The rupture of the pulmonary hydatid cyst is a serious clinical problem because it causes significant local and systemic symptoms. Also, cyst rupture is not rare, but it is one of the most frightening and severe complications of hydatid cysts in the lung. CASE PRESENTATION: We report a 16-year-old male with a 15-x-15-cm cyst in the lower lobe of his left lung that had ruptured into the pleural space and bronchus, resulting in a fistula. The germinal layer was discovered within the fluid of the effusion inside the pleural cavity. The cyst was surgically excised and treated with albendazole. A three-month follow-up found the patient to be healthy and free of symptoms. CLINICAL DISCUSSION: The presented case highlights the importance of early detection and management of pulmonary hydatid cysts. The rupture of these cysts can lead to significant local and systemic symptoms, as well as the formation of fistulas. Echinococcus infection of the lung is relatively common, but hydatid cysts in general require special management due to their tendency to go undiagnosed until they are large and accompanied by cysts in other areas. The presented case highlights the importance of early detection and proper management of pulmonary hydatid cysts to prevent complications and ensure successful outcomes for patients. CONCLUSION: Infection of the left lung with Echinococcus is generally common, but hydatid cysts, in general, need special management because they usually are not detected early, are large, incidentally discovered, and are accompanied by cysts in other areas.