Primary Iris Stromal Cyst in a Female Patient Aged 26 Years.

This case report describes a diagnosis of primary iris stromal cyst in female patient aged 26 years during a routine ophthalmologic examination.

Suprachoroidal triamcinolone acetonide for the treatment of macular edema associated with retinal vein occlusion: a pilot study.

BACKGROUND: Suprachoroidal Drug Delivery has emerged in recent years as a novel promising approach, which may help address the clinical unmet needs in the management of Retinal Vein Occlusion (RVO) associated Macular Edema (ME). In this study, we aim to evaluate the feasibility in regard of the potential efficacy and safety of suprachoroidal injection of Triamcinolone Acetonide (TA) using a microinjector as a mono-treatment of ME due to RVO. METHODS: This trial included 16 eyes of 16 patients with RVO associated ME presenting to the department of ophthalmology, Al Mouwasat university hospital, Syria. 4 mg of preserved TA was injected suprachoroidally 4 mm away from the inferotemporal limbus using a patient-customized microinjector. After injection, patients were followed after 1 week then monthly for 3 months. Primary outcome measures included the percentage of participants with best-corrected visual acuity (BCVA) gain≥15 letters and increased intraocular pressure (IOP) ≥ 20 mmHg in months 1,2, and 3, secondary measures included mean change from baseline BCVA, central subfield thickness (CST), and IOP through each of the follow-up points in addition to other measures. RESULTS: After injection, BCVA gain≥15 letters occurred in 68.7, 62.5, 50, 50% of patients at week 1 and through months 1,2 and 3 respectively, the mean BCVA improved significantly by 16.4, 16, 14.4, and 11.9 letters (p-value< 0.0005) at week 1 and months 1,2 and 3 respectively. This visual gain was associated with a significant reduction of CST by 290.94 ± 181.76 (week-1) (p-value< 0.0005), 274.31 ± 184.60 (month-1) (p-value< 0.0005), 183.50 ± 165.61 (month-2) (p-value = 0.006) and 137,75 ± 156.25 µm (month-3) (p-value = 0.038). We reported one case of increased IOP ≥ 20 mmHg in the first month that decreased in the second month. The mean change of IOP readings was not statistically significant, with an increase ranging from 0.75 mmHg after the first week (p-value = 0.09) and 0.5 mmHg after 3 months (p-value = 0.72). CONCLUSION: This study suggests that suprachoroidal TA could be well tolerated and efficacious as a mono-treatment of RVO associated ME. Future clinical trials are required to confirm its longer-term safety and efficacy and to compare this efficacy with the other therapeutic options. TRIAL REGISTRATION: This study was retrospectively registered at clinicaltrials.gov (ID: NCT05038072) on 08/09/2021. This article was published as a preprint on 22/06/2022. https://doi.org/10.21203/rs.3.rs-1701105/v1 .

The optimal period for oocyte retrieval after the administration of recombinant human chorionic gonadotropin in in vitro fertilization.

BACKGROUND: Our objective was to investigate the existence of an optimal period for oocyte retrieval in regards to the clinical pregnancy occurrence after the administration of recombinant human chorionic gonadotropin (rhCG) (Ovitrelle®). METHODS: We studied the digital records of 3362 middle eastern couples who underwent in vitro fertilization (IVF) treatment between 2019 and 2021. RESULTS: Through statistical testing, we found that there is a significant positive correlation between the oocyte retrieval period and the clinical pregnancy occurrence up to the 37th hour, where retrieval at the 37th hour was found to provide the most optimal outcome, especially in the case of gonadotropin-releasing hormone agonist (GnRHa) long protocol. CONCLUSIONS: This cohort study recommends retrieval at hour 37 after ovulation triggering under the described conditions.

Ovulation stigma and rupture of ovarian tunica albuginea in a patient with polycystic ovary syndrome (video).

A 25-year-old patient was referred to the fertility clinic in our hospital, complaining of primary infertility for 3 years. The patient reported having irregular menses, and physical examination showed clinical hirsutism, while transvaginal ultrasound revealed polycystic ovarian morphology. Hormonal workup showed elevated Anti-Müllerian Hormone (7 ng/ml), and normal levels of prolactin and thyroid stimulating hormone. Hysterosalpingogram revealed bilateral obstruction of fallopian tubes. Semen analysis of the husband was within normal limits.

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.

A 13 cm asymptomatic abdominal aortic aneurysm complicated with arterial obstruction in the left lower limb: A Case report.

Abdominal aortic aneurysm is often asymptomatic when it is small to medium in size, up to a maximum of 8 cm, in this case, a patient presented to the vascular surgery department with a complaint of acute pain in the left lower extremity with pallor due to the presence of arterial obstruction. On physical examination, we found a large pulsating mass in the abdomen. After performing a multislice computed tomography, we confirmed the presence of aneurysm with diameters of 13 × 8 cm below the level of the renal arteries. The rarity of this case in the medical literature come from that the aneurysm has reached this size and did not even rupture and did not cause any digestive discomfort or abdominal pain only complicated with an arterial obstruction in the lower left extremity as a result of the dissection that occurred. An emergency surgical operation was performed to remove the aneurysm and install the Dacron joint, and the patient was placed for 24 hours under intensive care and discharged after 5 days to have excellent results with the patient's condition improving without any complications after the operation. In conclusion, aneurysms constitute a serious condition facing vascular surgeons, especially if they are large in size without any symptoms.

Pelvic chodroma in the left obturator foramen: The first case report.

INTRODUCTION AND IMPORTANCE: Chondroma is a benign and slow-growing tumour usually located in the hand and foot. Although many cases reported pelvic chondroma, to the best of our knowledge, this case is number one in the world because of the location of the sensitive tumour within the obturator foramen, and we did not review any case mentioned in the medical literature corresponding to our case. CASE PRESENTATION: A 9-years-old male presented to our hospital, complaining of an inguinal mass, the patient had no history of pelvic discomfort. Computed tomography showed a hard mass in the left inguinal region. By open surgery, we extracted the mass. The patient was discharged after 4 days with no complaints. CLINICAL DISCUSSION: Pelvic chondroma is one of the challenging cases that orthopedist's face. We presented a patient with a very hard, painless, not rubefacient and fixed on palpation mass. Computed tomography is considered an imaging study to evaluate such patients. Most cases of chondroma are treated by performing open surgery to extract the mass. CONCLUSION: Pelvic chondroma should be extracted by open surgery in order not to extend to nearby tissue and hurt urinary and reproductive organs. The follow-up of these patients is essential, by imaging and pathological studies. Checking family history up is necessary, but in our case, there is no.

Messaging apps use in undergraduate medical education: The case of National Medical Unified Examination.

The Internet and social media became an integral aspect of our life. WhatsApp has the potential to increase collaboration, problem-solving, networking, easily sharing ideas, and study material among medical students. In order to achieve a more student-centered learning environment. Three months before the National Unified Medical Examination (NUME), the Faculty of Medicine of Syrian Private University deanship created a special WhatsApp group included students preparing for October 2018. NUME and university academic staff and professors from different specialties. We assessed the effect of the WhatsApp group on the academic performance measured by NUME grades. We conclude that WhatsApp Messenger groups have a positive effect on the NUME score. More participation in the group correlated with more NUME scores. It may be an important measure especially in the era of Social Distancing during COVID-19 pandemic as frequent and large classes are avoided as much as possible.

Impact of Thyroid Autoimmunity in euthyroid women on the outcomes of In Vitro Fertilization.

OBJECTIVE: Infertility is inadequately acknowledged as a problem in developing countries. Thyroid Autoimmunity (TAI) has been neatly investigated for its association with unfavorable pregnancy and reproductive consequences. We aim to evaluate Clinical Pregnancy Rate (CPR) as a primary outcome following In Vitro Fertilization/Intra Cytoplasmic Sperm Injection (IVF/ICSI) in women with Thyroid Autoimmunity (TAI). METHODS: A Retrospective cohort study included 584 women who underwent IVF/ICSI treatment between November 2012 and April 2017 in Orient Hospital, Damascus, Syria. Patients were tested for TAI before IVF/ICSI procedure. RESULTS: CPR did not significantly differ between TAI positive and TAI negative groups (p > 0.05). Subgroup analysis for only primary infertility patients showed a statistically significant difference in CPR between TAI positive and TAI negative groups. CONCLUSION: Although several arguments were in favor of the relation between IVF/ICSI outcomes and Thyroid autoimmune disease, the presence of TAI positivity did not adversely affect the clinical pregnancy rate.

Antiphospholipid antibodies levels and potential effects on in-vitro fertilization in a large cohort of infertile Syrian women.

BACKGROUND: Obstetric morbidities represent a common hallmark manifestation of antiphospholipid syndrome (APS), with the recurrent loss of pregnancy as the main complication. The presence of antiphospholipid antibodies (APA) and its potential impact have not been established yet in infertile women seeking assisted reproduction technologies in Syria.This study aims to determine the prevalence of anticardiolipin antibodies (aCL) and lupus anticoagulation (LAC) and their association with age and the In vitro fertilization (IVF) outcomes in a large sample of Syrian women. MATERIALS AND METHODS: The electronic patients' records were screened and relevant data extraction was performed retrospectively. The study included 876 women who had IVF between January 2012 and January 2020 in a tertiary care hospital. RESULTS: The prevalence of APA among the included women was less than 1%. Only 5 patients had positive APA. No correlation was found between the APA levels and age. Additionally, the APA did not have an impact on neither the IVF outcomes nor the number of IVF cycles. CONCLUSION: the added value of APS antibodies' screening could be considered very modest when compared to its financial burden on patients since it has a very low prevalence in women having IVF.

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.

Bilateral hypotropic dissociated vertical deviation: a case report.

BACKGROUND: Hypotropic dissociated vertical deviation (DVD) is a special form of strabismus characterized by a slow drift of the non-fixating eye when the other eye is fixating on a target. In contrast to hypertropic DVD, which is common, hypotropic DVD is exceedingly rare and seldom reported in previous literature. In this case, we report the clinical features of a rare case of a Syrian child with bilateral hypotropic DVD accompanied by manifest latent nystagmus and intermittent exotropia. CASE PRESENTATION: A 4-year-old Syrian Arab girl presented with intermittent exotropia of both eyes since the age of 7 months, without any prior treatment. The fixation was alternating. She had manifest latent nystagmus in both eyes and anomalous head posture. She had bilateral hypotropic DVD in both eyes which only appeared when covering each eye. The patient underwent bilateral lateral rectus recession with posterior fixation and bilateral inferior oblique recession. Three months after surgery, she was orthophoric in the primary gaze position with a normal head posture. No alteration of the appearance of the hypotropic DVD was observed after the surgery. CONCLUSION: This is a rare case of hypotropic DVD showing bilateral hypotropic DVD with different characteristics from those previously reported cases (bilateral hypotropic DVD with intermittent exotropia, dissociated horizontal deviation, manifest latent nystagmus, and bilateral inferior oblique overaction). The hypotropic DVD only appeared when covering each eye, and thus there was no need for surgery. Moreover, the inferior oblique recession did not seem to negatively affect the appearance of the eyes.

Prevalence of Thyroid Autoimmune Antibodies in Women Seeking Fertility Care in Damascus, Syria.

Introduction Thyroid autoimmune (TAI) disease with a prevalence varying between 5 and 15%, represents the most common endocrine disorder in women with reproductive age. Not only is TAI disease five to 10 folds more common in women than men but also TAI diseases is often undiagnosed because it may be present without overt thyroid dysfunction for several years. Studies found an increased prevalence of TAI in women referred to fertility clinics compared with normal population. In this analysis we aimed to study the prevalence of TAI among women seeking fertility care in Damascus, Syria in order to understand its clinical and public health importance in population. Methods This study is a retrospective cross-sectional study on women patients seeking fertility care at Orient Hospital, Damascus city, Syria from April 2011 to March 2018. A total of 2526 women, with available biochemical data of anti-thyroid antibodies (anti-TPO) and anti-thyroglobulin antibodies (anti-TG) were included in our study. Thyroid stimulating hormone (TSH) titers data were also included in the statistical analysis. Results TAI was found positive in 559 patients (22.1%) of our studies population. TAI was more prevalent in patients with abnormal TSH levels. Conclusion Thyroid autoimmunity prevalence in women seeking fertility care in Damascus, Syria was 22.1% which is significantly higher than normal population. Further studies are needed to assess the relation of these antibodies in thyroid, gynecological and other factors for the Syrian population.

Awareness of diabetes and diabetic retinopathy among a group of diabetic patients in main public hospitals in Damascus, Syria during the Syrian crisis.

BACKGROUND: The awareness of diabetes mellitus (DM) and its complications, especially diabetic retinopathy (DR), is the key to reducing their burden. This study aimed to assess both the awareness of diabetic outpatients and their action towards periodic eye exam, and to determine the causes of non-compliance amongst patients who were aware. Because the Syrian Crisis affected all aspects of Syrians' life, the study aimed to determine the crisis' effects on patients' care-seeking behavior. Our study was the first step in paving the way of prevention strategies. METHODS: This observational cross-section study was conducted on 260 patients with DM who were visiting the four main hospitals in the Syrian capital, Damascus between August and November 2017. RESULTS: The mean (±SD) age of participants was 54.3(±12.8) years. Females were more than half (56.2%). The majority were from areas outside Damascus (72.3%). The mean (±SD) DM duration was 10.6 (±7.1) years. Almost all patients (93.8%) thought that DM could affect the eye. 67.3% believed that it could cause blindness. 86.9% of the patients conceived that DM patients should visit an ophthalmologist regularly. 37% did not visit any ophthalmologists at all, while 63% reported they had visited their ophthalmologists. Only 21.5% had a regular eye exam. Gender, educational level, economic status, province, and family history of DM had statistically an insignificant relation with an ophthalmologist visit. The preponderance of the patients who haven't visited regularly did not appreciate the necessity of regular eye exam. Diabetic neuropathy was the most common complication of DM that patients were aware of (92%) and suffered from (56.5%). Meanwhile, regarding the effects of the Syrian Crisis: 41.2% of diabetic patients had stopped their medications for at least one month, mainly because the drugs were unavailable (74.7% of them), as some drug companies had been destroyed. Half of the patients had struggled to reach a medical care center. Half of the patients had been displaced, two-third of them were from outside Damascus. CONCLUSION: A screening program for DR should be initiated. Also, awareness about DM and its complications, especially DR, should be raised through doctors and media.

A Case of Syrian Child with Cerebral Infarction as an Extraintestinal Manifestation of Ulcerative Colitis.

Thromboembolic complications are rare but well-recognized manifestation of ulcerative colitis, especially because of their associated high mortality. We report a case of a Syrian child admitted to Damascus Hospital with a one-day complaint of sudden onset of numbness followed by weakness in the left lower and upper limbs, right mouth angle deviation, and loss of sphincters' control. Earlier, she was diagnosed with ulcerative colitis and treated with immunosuppressants. CT and MRI scans revealed focal infarction around the M2-M3 segments of the right middle cerebral artery; she was treated with Aspirin. On discharge, she had significant improved neurological examination and was able to walk. Subsequent proctocolectomy was performed. We highlight the importance of thromboembolism in ulcerative colitis as there is paucity in the literature regarding its management and its symptoms may be overlooked especially in high-load central hospitals. We conducted a brief literature search and summarized findings of similar reported cases.

Hepatitis C virus antibodies are absent among high risk group of health care workers in Damascus Hospital.

BACKGROUND AND STUDY AIMS: Liver disease caused by hepatitis C virus (HCV) is one of the most serious health issues worldwide. The prevalence of HCV among health care workers (HCWs) is higher than normal population. Our aim is to determine the seroprevalence of HCV among this high-risk group in Damascus Hospital, Syria in 2016. SUBJECTS AND METHODS: During March 2016, anonymous testing for HCV was offered to 150 residents and physicians from different departments (Surgery, otolaryngology, gastroenterology, anaesthesiology and laboratory) in Damascus Hospital using fourth-generation enzyme-linked immunosorbent assay (ELISA). In addition, each participant was interviewed and answered a comprehensive questionnaire which includes questions on potential hazards, risk factors and the level of awareness about the disease and its ways of transmission. RESULTS: Surprisingly, all samples tested negative for anti-HCV antibodies, though many participants were already exposed to many risk factors especially as HCWs. CONCLUSION: HCV is not a main issue regarding its prevalence among HCWs in Damascus Hospital. Nevertheless, it is still necessary to develop a mandatory well-organized program to increase the awareness among HCWs and develop stricter prevention policies especially about bloodborne diseases transmitted occupationally.

De novo Balanced Robertsonian Translocation rob(22;22)(q10;q10) in a Woman with Recurrent Pregnancy Loss: A Rare Case.

BACKGROUND: Recurrent pregnancy loss (RPL), one of the most common complications of pregnancy, is responsible for significant emotional distress to the couple desiring to conceive. In almost 50% of the cases, the etiology remains unknown. The frequency of chromosomal structural rearrangements associated with a history of RPL in couples varies between 2% to 8%. Robertsonian translocations (ROBs) have an estimated incidence rate of 1/1000 births, making this type of rearrangement the most common structural chromosomal abnormalities seen in the general population. According to the literature, there are few RPL cases with rob (22;22). CASE PRESENTATION: This case is a Syrian female offered to the Orient Hospital (Damascus, Syria), having RPL in the first trimester, no fetal malformations, and/or no neonatal death. She had a balanced chromosomal translocation involved the both short arms of chromosome 22. Banding cytogenetics, refined by array-proven multicolor banding (aMCB) revealed a rob (22; 22)(q10;q10). Her husband had a normal karyotype. Interestingly, chromosomal analysis was performed for her other family members and it revealed normal karyotype for all people, which indicates that translocation is of de novo origin. However, the couple did not have any living offspring after seven years of marriage. CONCLUSION: The present case was a case of RPL occurring due to rob (22;22). However, the rob(22;22)(q10;10) is the cause of recurrent abortions. Couples with the history of RPL should be suggested to do cytogenetic analysis in order to estimate whether they have chromosomal rearrangement. This diagnostic approach is of great significance to figure out what causes RPL.