The prevalence of work-related musculoskeletal disorder among health care workers in Damascus, Syria. A cross-sectional study.

Background and Aims: Healthcare workers in particular frequently report Work-related musculoskeletal diseases (WRMSDs). The purpose of this study is to evaluate the prevalence and features of WRMSDs in residents from different specialties and trainee nurses from educational hospitals in Damascus, Syria. Methods: A cross-sectional survey was undertaken aiming at the medical residents and the trainee nurses working in the public health sector in 11 hospitals. The sample size was found to be 2016. In this study, a modified version of the Standardized Nordic Questionnaire was employed. Results: After the inclusion and exclusion criteria was the number of the participants 1855. In general, musculoskeletal pain was in the past week (69%) and the past 12 months (85%). Musculoskeletal pain in medical care practitioners was found to be linked to higher mean age (p = 0.0053) and body mass index (BMI) (p = 0.0437) in the last year. Females had a higher prevalence of WRMSDs than males (p = 0.0036), and those who were married also had a higher prevalence (p = 0.0218). Working longer hours per week and per month were associated with musculoskeletal pain in the previous 7 days (p = 0.0043 and p = 0.0003, respectively). Conclusion: WRMSD prevalence was 85% among our study participants in the previous year. The most common complaint was lower back pain. Aging, female gender, and increasing BMI have been associated with higher reporting of WRMSDs. Our results suggested that doctors were twice as susceptible to developing WRMSDs as nurses. These results highlight the increasing urgency for ergonomics training programs and effective interventions to reduce WRMSDs and enhance working conditions for healthcare professionals in Syria.

Stress, depression, anxiety, and quality of life among the healthcare workers during COVID-19 pandemic in Syria: a multi-center study.

BACKGROUND: The COVID-19 pandemic emerged as an expected source of stress and anxiety as the healthcare workers had to work for long hours in close contact with infected patients, thus increasing the probability of medical errors and threatening the patients' safety. This study aims to measure the levels of depressive symptoms, anxiety symptoms, and stress among Syrian healthcare workers and their quality of life during the COVID-19 pandemic. METHODS: A cross-sectional study was conducted in six central hospitals in Damascus, Syria. Data were collected from 1 to 30 June-2021. The Depression Anxiety Stress Scale-21 (DASS-21) was used to evaluate depression, anxiety, and stress among healthcare workers. Quality of life was assessed using the EUROHIS-QOL 8-item index. RESULTS: A total of 700 participants were included in this study. 61.6% (n = 431) were males and 38.4% (n = 269) were females. Younger ages (18-29 years old) were significantly associated with higher levels of depression and stress (p < 0.0083). Female healthcare workers had higher significant levels of anxiety (p < 0.05). Significant anxiety and stress levels were reported when healthcare workers had contact with COVID-19 patients, even if they had protective equipment (p < 0.05). Half of the participants (50%; n = 349) reported a good quality of life. CONCLUSION: Stress levels and depressive symptoms were remarkably higher in healthcare workers of ages 18 and 29 years old, whereas anxiety levels were significantly higher and more severe in female healthcare workers. Moreover, direct interaction with COVID-19 patients was associated with higher levels of stress and anxiety symptoms.

The prevalence of stress among medical students in Syria and its association with social support: a cross-sectional study.

INTRODUCTION: Chronic stress can interrupt personal life and cause fatigue, inability to concentrate, and irritability. This study aims to determine the prevalence of stress and its associated factors among medical students in Syria and whether social support could be a protective factor against stress. METHODS: A cross-sectional study was conducted in the faculty of medicine of five Syrian universities. The Medical Student Stressor Questionnaire (MSSQ) was used to evaluate the stress caused by the possible sources of stress. And Social Support Questionnaire - short version (SSQ - short version) was used to assess the social support that medical students received from family, friends, and their fellow medical students using six questions. RESULTS: A total of 1472 medical students participated in the study. Among the total participants, 671 (45.6%) were males, and 801 (54.4%) were females. The majority of the participators had mild (50.6%; n = 745) and moderate (37.0%; n = 545) stress levels. Academic-related stressors were the most important cause of stress among undergraduate medical students. Social support was provided equally to both genders, and genders reported the same degree of satisfaction. CONCLUSION: Our results emphasize the importance of improving the curricula, providing mental health consultants for students, and paying more attention to the mental health of female students. Finally, students in their clinical years should also receive mental health care, decreasing their duties and providing more self-free time.

Epidemiology of poisoning in Syria (1999 through 2020).

INTRODUCTION: Acute poisoning is a significant international public health issue and one of the leading causes of death in the emergency department (ED). In the absence of any previous reports describing the poisoning profile in Syria, we present this study to assess the epidemiological and clinical characteristics of poisoning over 21 years. METHODS: We collected the data retrospectively from the Syrian Poisons Information Centre (SPIC) from January 1999 until December 2020. The data included patients who had accidental or non-accidental exposure to poisons, either by drugs, medicaments, and biological substances or substances chiefly nonmedicinal sources such as soaps and detergents, corrosive substances, pesticides, and other miscellaneous products. RESULTS: We collected the data of 120,972 poisoned patients, of whom 52.6% were females, and 47.4% were males. Aleppo governorate reported the highest number of poisoned cases (28.6%), followed by Damascus governorate (19.9%). The highest poisoning rates were recorded in 2020, 2014, and 2010. Pharmaceutical (37.0%) and animal (33.8%) sources were the most common causative agents. The oral route was the route of poisoning in 58.3% of patients, and 33.4% through the skin. The most common poison was scorpion stings 19.5% while the most common cause of death was organophosphates 15.7%. DISCUSSION: The differences in socioeconomic status, cultural habits, and agricultural and industrial activities between countries have led to a state of fluctuation regarding the most common poisoning agents. CONCLUSION: Damascus and Aleppo, the two major governorates in Syria, had the highest poisoning cases. Oral administration of pharmaceutical agents was responsible for most of the poisoning cases. The most common individual poison was the scorpion poison, while the top killer was organophosphates.

The development and validation of a novel COVID19 stigma scale among healthcare workers (COVISS-HCWs).

BACKGROUND AND AIM: Fear of coronavirus disease 2019 (COVID-19) and its complications may result in stigmatization of individuals who may carry the virus. This is of special concern to healthcare workers who tolerate additional physical and emotional stress at times of pandemic. The aims of this study are to (1) develop and validate the COVID-19 Stigma Scale (COVISS-HCWs) survey; and (2) investigate the experience of stigma among healthcare workers possibly dealing with COVID-19 patients in five major public hospitals in Damascus, Syria. METHODS: We divided the sample into two parts and then underwent EFA on the first 350 participants, dividing the 14 questions into two dimensions. Furthermore, CFA was conducted on the other 350 participants to confirm how correctly a hypothesized model matched the factor structure by EFA, as described above. Moreover, the coefficient of determination (R2) and item-scale correlations (standardized factor loading) were estimated to establish the acceptability of the final structure of the COVISS-HCWs. Through a cross-sectional study, a convenience sample of 700 healthcare workers participated in a self-administered questionnaire containing a section for demographic variables and another for newly designed COVISS-HCWs. The scale comprises 14 adapted and novel items that measure two subscales: feelings of perceived harm and inferiority, and avoidance. Descriptive statistics, reliability, and validity were evaluated. RESULTS: The 14 COVISS-HCWs items were reduced to 11 items with a high Cronbach's α of 0.909. A significant correlation was observed between the responses to each COVISS-HCWs item and the corresponding subscale, and between each subscale and the overall scale. Feeling stigmatized was reported by 9.86% of the participants. Younger age, low socioeconomic status, and higher intensity of contact with COVID-19 patients significantly correlated with higher stigmatization. CONCLUSIONS: The novel COVISS-HCWs is a reliable and valid tool to evaluate stigma among healthcare workers during the COVID-19 pandemic. The Stigma prevalence among healthcare workers was 9.86%. Therefore, this must be addressed to prevent possible psychosocial and public health repercussions.

Primary splenic T-cell/histiocyte-rich B-cell lymphoma in a patient with recurrent hairy cell leukemia: a case report.

T-cell/histiocyte-rich B-cell lymphoma is a high-grade, morphologic variant of diffuse large B-cell lymphoma. T-cell/histiocyte-rich B-cell lymphoma. It is rare as a primary splenic involvement and is usually reported as a second malignancy after hairy cell leukemia. Here, we report the first case that describes the occurrence of primary splenic T-cell/histiocyte-rich B-cell lymphoma in a patient with a previous diagnosis of recurrent hairy cell leukemia. A 53-year-old male patient was diagnosed with hairy cell leukemia in 1996 and achieved complete remission with Pentostatin. Then, recurrence of hairy cell leukemia was diagnosed in 2015 and treated with Cladribine. In 2016, he presented with B symptoms and hypersplenism. Therapeutic and diagnostic splenectomy was performed. Histopathological study with immunohistochemistry evaluation revealed the presence of T-cell/histiocyte-rich B-cell lymphoma. Therefore, second malignancies should be considered in patients with a previous neoplasm when symptoms recur or develop.

Assessing the Knowledge and Attitude towards Osteoporosis among Syrian Women: A Cross-Sectional Study.

Background: Osteoporosis is a progressive decline in the bone mass, which occurs with no alterations to the bone's composition. It is associated with increased bone fragility that may eventually lead to fractures. In this study, we aim to assess the level of awareness that Syrian women possess regarding osteoporosis and spread the knowledge about its prevention measures. Methods: This study was approved by the Institutional Review Board of the Syrian Private University. A validated questionnaire was asked to be filled in by women aged 18 and above, who were presented to clinics at Damascus, Al Helal, and Al Zahrawi hospitals between 28 November 2021 and 5 March 2022. Results: 6082 women were included, of which 63.9% (n = 3884) were under 30 years old and 89.3% (n = 5429) were in their reproductive age. The average knowledge score of osteoporosis was 69.2 ± 7.7 (28-100); 88.1% correctly defined osteoporosis while the majority (93.4%) has heard of it. The majority of our participants were living in rural areas (77.2%; n = 4698) while only 22.8% (n = 1384) were living in urban areas. The respondents from urban areas reported the highest knowledge scores (OR = 1.472; 95% CI: 1.258-1.723; P < 0.0001). 75.60% agreed that aging is a risk factor for osteoporosis. 64.6% were aware that osteoporosis is directly responsible for hip fractures. Smoking, family history, lack of exercise, and menopause were the main risk factors for osteoporosis, at 53.6%, 53.1%, 84.6%, and 60.7%, respectively. Social media represented the ultimate source of information on osteoporosis (64.70%). Conclusion: Our study is the largest in the region and the first of its kind in the country. Syrian women had an average knowledge score regarding osteoporosis; the vast majority has defined it correctly and has heard of it. We found no statistical significance between age or educational level and adequate knowledge about osteoporosis.

Pathophysiology of stress cardiomyopathy: A comprehensive literature review.

Introduction: Takotsubo cardiomyopathy is a transient type of acute heart failure with distinct wall motion abnormalities and unclear pathophysiology. This review focuses on the proposed pathophysiological mechanisms that could be involved in the occurrence takotsubo cardiomyopathy. Main body: Acute stress and subsequent excessive activation of the sympathetic nervous system are major factors in the pathophysiology of takotsubo cardiomyopathy. The high levels of catecholamine work in a triggering manner, generate reactive oxygen species, release inflammatory cytokines, and induce endothelial injury. The incidence of Takotsubo cardiomyopathy has increased following COVID-19 infection and vaccination, which suggests that neurohormonal and psychological factors (i.e., fear and anxiety of infection or vaccination) may have an additional role in the pathophysiology. In addition, inflammatory state, cytokine storm, augmented sympathetic activity, and endothelial dysfunction during the acute phase of COVID-19 infection may participate in Takotsubo cardiomyopathy. Chronic stress is also linked to this complex mechanism by accelerating cripple of endocrinal hypothalamic-pituitary-adrenal axis activity, which influences the cortisol effect on releasing catecholamine, which is directly related to the pathogenesis of takotsubo cardiomyopathy. Conclusion: The excessive activation of the sympathetic nervous system and subsequent high levels of catecholamines could initiate the process. The catecholamines, in turn, generate reactive oxygen species and release inflammatory cytokines (i.e., IL-1, IL-2, IL-6, IL-7, IL-8, CXCL1, TNF-α, and IFN-γ), which causes endothelial injury.

Abernethy malformation (Type 1B) presenting in a 6-year-old boy with hematochezia and hematuria: A case report.

Abernethy malformation (Type 1B) presenting in a 6-year-old boy with hematochezia and hematuria: a case report Abernethy malformation is a rare congenital vascular abnormality defined by the diversion of portal blood flow to the inferior vena cava or its tributaries. Clinical presentations include neonatal cholestasis, liver tumors, and encephalopathy but variables in timing and symptomatology. Herein, we present a 6-year-old boy was referred to our hospital with complaints of hematochezia, hematuria, fecal, and urinary incontinence. A diagnosis of type 1b malformation was made depending on magnetic resonance angiography and cardiac catheterization findings, which demonstrated that the superior mesenteric vein and splenic vein joined to form a common trunk measuring 38 mm diameter and then drained into the dilated inferior vena cava with the absence of portal vein abnormalities in the liver. With further investigations, we indicated the presence of many arteriovenous malformations and urogenital abnormalities. The patient was managed conservatively.

A connective tissue pericardial hamartoma: A case report with literature review of cardiac hamartoma.

INTRODUCTION: Hamartoma is a tumor that can manifest anywhere in the body and results in the abnormal formation of tissue native to the anatomical location. It is usually a benign tumor that rarely arises from the heart or pericardium. Most of the cases are asymptomatic and discovered incidentally during the evaluation of other medical conditions. PRESENTATION OF CASE: We present a case of a 65-year-old female with dyspnea who was diagnosed with a mediastinal mass. After removing the mass surgically, the mass was found to be heart-like containing four chambers located in the pericardium, and a pathology report of a connective tissue hamartoma. CONCLUSION: Pericardial tumors including hamartoma should be considered in all patients with wide mediastinum and cardiopulmonary symptoms. We also present a review of the literature on the cardiac and pericardial hamartomas with a comparison of age, gender, location, symptoms, and management. Although cardiac hamartomas in general and epicardial hamartomas, in particular, are extremely rare, they should be considered in adults with cardiopulmonary symptoms and widened mediastinum.

Clinical Characteristics and Prognosis of COVID-19 patients in Syria: A cross-sectional multicenter study.

Background: COVID-19 ignited a global pandemic that, in Syria, further strained a nation and its healthcare system already ravaged by years of war and sanctions. The first case in Syria was reported on March 22, 2020, and this is the first study that aimed to describe the clinical characteristics, comorbidities, and prognosis of COVID-19 patients in Syria. Materials and methods: Demographic and clinical data for this cross-sectional prospective study were collected on COVID-19 patients with positive polymerase chain reaction tests who were admitted to Al Assad and Al Mouwasat university hospitals between April 1 and January 31 of 2021. Results: This study included 701 patients. The majority were over age 60 (59%) and male (67.9%). The commonest symptoms were fever (86.6%) and shortness of breath (75.6%). The commonest comorbidities were hypertension (53.9%) and diabetes mellitus (41.5%). On multivariable analysis, risk factors found to be significantly associated with poor outcomes were advanced age (≥60 years); male gender; high respiratory rate (>35); respiratory failure (PaO2/FiO2 ratio<100); heart failure; chronic lung disease; elevated white blood cell counts, lactate dehydrogenase, c-reactive protein; prolonged international normalized ratio; and low lymphocyte counts. The clinical outcomes of our patients were as follows: 59.2% improved and were discharged from the hospital, 3.5% were discharged with persistent symptoms and 37.2% died. Conclusion: Several biomarkers can serve as early warning and prognostic indicators of severe illness and mortality from COVID-19 in the highest risk patients, especially males with multiple comorbidities over 60 years of age. In the context of a national healthcare system stretched thin by years of civil war and sanctions, and high COVID-19 mortality rates as a consequence, extra care should be taken to use the predictive power of these biomarkers to stratify high-risk patients in the earliest possible stages of the disease to minimize severe illness and reduce fatalities.

New insights in treatment of monosymptomatic enuresis.

OBJECTIVE: Nocturnal enuresis (NE) is defined as uncontrollable bed-wetting for at least three consecutive months in children over 5 years. Sleep could be dramatically altered in children with primary nocturnal enuresis (PNE); consequently, this helps to confirm the assumption that PNE appears to modify sleep structure, or it might be the result of an irregular sleep structure itself. METHOD: This study conducted on 180 patients with monosymptomatic nocturnal enuresis. Their age was ranged from 6 to 18 years, and they were still having nocturnal enuresis episodes. We record two main points: first, if the child is a regular sleeper or not. The second point if the child is a regular bed wetter or not. This work fully compliant with the STROCCS criteria (Agha et al., 2019). RESULT: A total of 180 children were included (Male 122, 67.8%, Female 58, 32.2%). The mean age was 8.9 (±2.4). This study showed that children aged 7-10 years are significantly more inclined to be reported as specific time bed-wetter's, whereas those aged between 11 and 13 are significantly less likely to wet their bed at a specific time (p = 0.001). Children who tend to sleep more often near a specific time each night are 6.74 times more prone to bed-wet around a particular time during their sleep (p < 0.001). CONCLUSION: This study can be considered as hypothesis-generating that shed light on the possible correlation between the adherence to sleep at a specific time and its effect on the time of enuresis and the number of bedwetting.

T-Cell B-Rich Lymphoma Presenting as Renal Colic with Positivity of CD3.

T-Cell Rich B-Cell Lymphoma (TCRBCL) is relatively a new entity, lately classified as a morphologic variant of Diffuse Large B-cell lymphomas (DLBCL). It consists (1-3) % of all B-cell lymphomas. The rate is far less when describing cases of primary splenic involvement with TCRBCL. Pathologically, TCRBCL is described as a limited number of scattered, large, atypical b-cells embedded in a background of abundant t-cells and frequently histiocytes. The similarity of this malignancy with other types makes it difficult to distinguish between them. Thus, it needs expertise in both clinical and pathological fields to make the right diagnosis.Here, we present a case of an adult male patient whose first presentation and previous medical history of renal colic misguided the initial diagnosis and suggested another colic episode as the underlying ailment. However, further physical, radiological and histopathological investigations uncovered the presence of primary TCRBCL within spleen with no involvement of other sites. Moreover, unusual pathologic finding of CD3 positivity was proved by immunohistochemistry.

Aggressive orbital rhabdomyosarcoma in adulthood: A case report in a public hospital in Damascus, Syria.

Orbital rhabdomyosarcoma (RMS) is a highly malignant tumor that originates mainly from mesenchymal tissue. It is considered a rare childhood malignancy; therefore, presentation in adulthood is scarce. In this case report, a 36-year-old male patient presented with a rapidly progressive RMS of the left orbit. The patient was treated in a different institution with radiochemotherapy with good response. However, relapse occurred after 2 months of completing the course, as rapid growing proptosis. Computed tomography scan revealed a lesion in the left orbit with invasion of the left ethmoid cells and the left maxillary sinus. Exenteration of the left orbit with the left partial maxillectomy and ethmoidectomy was performed. RMS is a highly aggressive malignancy that should be considered in any orbital mass that progresses rapidly. Surgery should be the first line in treatment. Delay in diagnosis and inappropriate treatment negatively affects the outcome.