Primary psoas tuberculosis abscess with an iliac bone lytic lesion: a case report.

BACKGROUND: Primary psoas tuberculosis is the presence of "Koch's bacillus'' within the iliopsoas muscle caused by hematogenous or lymphatic seeding from a distant site. Muscular tuberculosis has relatively low prevalence in comparison with other cases of extrapulmonary tuberculosis, which explains the difficulties in establishing the diagnosis. CASE PRESENTATION: In this report, we present a challenging diagnostic case of primary psoas tuberculosis in a 38-year-old middle eastern female from southern Syria. The diagnosis was based on the clinical orientation, the observation of pulmonary lesions on the computed tomography scan, and the necrotic signs in the vicinity of the infected area. Despite the misleading primary false-negative results, the final diagnosis was reached after sufficient repetition of tuberculosis-specific testing. The patient was treated with isoniazid-rifampin-pyrazinamide-ethambutol for 2 months, then isoniazid and rifampin for 7 months, with full recovery in follow-up. CONCLUSIONS: This case highlights the importance of a clinical-based approach in the treatment of patients with psoas abscesses, especially in areas with high tuberculosis prevalence.

Protective Measures Practices Among Hospitals' Professionals Working in a Fragile Health System.

OBJECTIVE: This study aimed to assess the protective measures among health-care workers (HCWs) in a war-torn area during coronavirus disease 2019 (COVID-19) pandemic. METHODS: An online cross-sectional questionnaire was administrated to HCWs in Syria between April 1 and May 21, 2020. The questions aimed to assess the HCWs' application of safety, hygiene, and necessary protection considerations while attending to suspected or proven COVID-19 cases. Unpaired t-test and 1-way analysis of variance (ANOVA) were used for statistical analysis. RESULTS: Of the 290 participants included in the statistical analysis, 250 were medical doctors. Low scores of protective practices were noticed among the participants, as only 12% of doctors had a score above 6/15 points, and only 37.5% of nurses had a score of more than 4/12 points. Medical doctors who were not on the frontlines scored significantly higher than those who were on the frontlines (4.69 vs 3.80 points, respectively; P < 0.001). CONCLUSIONS: More courses and training sessions should be implemented to improve the practice of protective measures among HCWs (frontliners in particular) in areas with fragile health systems, such as Syria, during the COVID-19 pandemic, especially those on the frontlines. Moreover, specific COVID-19 protection measures guidelines to low-income countries are needed.

Assessment of medical students' preparedness and willingness for integration into a war-torn healthcare system: the example of COVID-19 pandemic scenario.

In Syria, medical students were placed on call to provide sufficient human resources during COVID-19 pandemic. This research aimed to explore the ability and willingness of the final-year medical students to assist during COVID-19 in the Syrian war-torn and fragile health-system. Final-year Syrian medical students were approached between 9th-17th April 2020 through an online questionnaire. Students' COVID-19-related medical knowledge (5-point score), clinical judgement (5-point score), and preparedness and willingness to integrate in healthcare facilities were assessed. A 10-point score was created, and linear regression and Tukey's HSD test were conducted. 1673 valid responses were received, of which 1199 (71.66%) responses were from the final-year students. Of the latter, 728 (60.71%) scored 4 points or higher in the medical knowledge score (mean 3.69 points), while 298 (24.85%) scored 4 or higher in the clinical judgement score. Final-year students scored significantly higher than the fourth-year students in the clinical judgement score. Finally, 682 (56.88%) of the final-year students expressed willingness to volunteer with healthcare teams. Final-year medical students may provide medical aid, on voluntary basis, by working in fragile health systems during pandemics. However, this should be undertaken in cases of extreme need. Sufficient personal protective measures, intensive training, and adequate supervision should be guaranteed.

Endocarditis-induced thrombotic thrombocytopenic purpura mimicking preeclampsia: A case report.

TTP, Preeclampsia have similar manifestations in pregnancy. Establishing the right diagnosis is essential as the treatment is different. Endocarditis-induced TTP should be suspected when neurological symptoms, thrombocytopenia are present.

The substantial awareness role of web-based and social media platforms in developing countries during a pandemic scenario: the example of COVID-19.

BACKGROUND: During the outbreak of coronavirus COVID-19, social media platforms have shown effectiveness in information dissemination. Delivering evidence-based medical knowledge and trustworthy recommendations is a difficult mission for classical entities, especially in a war-torn country with a fragile health system. In this context, the role of non-governmental scientific organizations was proven, filling the gap between original scientific sources and a non-English speaking population. METHODS: We reviewed an example of an organization named Syrian Researchers, which publishes based-on-reliable-sources of scientific content and has massive reachability across Middle East and beyond. RESULTS: We strongly believe that this model is a simple and suitable approach that may be helpful for other low-income or war-torn countries in the context of health-related disasters. CONCLUSIONS: This subject is of high importance and we believe that this approach may ameliorate public health knowledge, thus, participate in defying the COVID-19 consequences.

A review of potential treatments to date in COVID-19 patients according to the stage of the disease.

INTRODUCTION AND MOTIVATION: Since the end of 2019, the COVID-19 pandemic has affected millions of people worldwide. With the rapid spread of this virus, an immense burden has fallen upon both healthcare and economic systems. As a consequence, there is an unprecedented urgency for researchers and scientific committees from all over the world to find an effective treatment and vaccine. REVIEW STRUCTURE: Many potential therapies are currently under investigation, with some, like Hydroxychloroquine, being authorized for emergency use in some countries. The crucial issue is now clearly to find the suitable treatment strategy for patients given comorbidities and the timeline of the illness. Vaccines are also under development and phase 1 clinical trials are rolling. Despite all efforts, no single drug or vaccine has yet been approved. In this review, we aim at presenting the proposed pathophysiological mechanisms of SARS-CoV-2 and to provide clinicians with a brief and solid overview of the current potential treatments classified according to their use at the three different currently proposed disease stages. In light of pathogenesis and proposed clinical classification, this review's purpose is to summarize and simplify the most important updates on the management and the potential treatment of this emergent disease.

Language of written medical educational materials for non-English speaking populations: an evaluation of a simplified bi-lingual approach.

BACKGROUND: Debates have arisen in various non-English speaking countries over the chosen language of instruction in medical education, whether it has to be the English language or the mother tongue. English-based education supporters argue that English is the leading international language of medicine and research, and a crucial tool for Continuing Medical Education (CME), as well as for students who seek practice abroad. On the other hand, mother-tongue-based medical education supporters present it as a way to endorse communication and comprehension between medical practitioners and health care system users, to bridge the gap between practitioners and the paramedical staff, and to overcome linguistic dualism and the language thinking disparity while studying in another. This study aimed to evaluate one of the simplified bi-lingual approaches in terms of medical-educational-written texts for a non-English speaking population: Arabic speaking medical students in specific. METHODS: 1546 Arabic-speaking-medical students from different countries participated in a one-step-interactive-experimental-online test. The test assessed participants' scientific comprehension of three distinct written paragraphs: The first paragraph used conventional mother tongue (Arabic), the second combined English terminology and simplified mother tongue (hybrid), and the third used an English excerpt (English). Two multiple-choice questions (First question in Arabic, second in English) followed each paragraph. Response time was communicated for each paragraph. Participants were asked to select their favorable method. Repeated Measures ANOVA models and Paired Samples t-Test were used for statistical analysis. RESULTS: Participants scored a mean of [0.10] for the Arabic paragraph, [0.72] for the hybrid paragraph, and [0.24] for the English paragraph (P <  0.001). Results showed a significantly higher mean of points and correct answers within the fastest time for the hybrid paragraph [0.68] compared to the Arabic [0.08] and English [0.18] paragraphs (P <  0.001). Moreover, 50% of participants preferred the hybrid paragraph over the other two paragraphs. CONCLUSIONS: Taking into consideration the large number of participants and the statistically significant results, authors propose that simplified Arabic combined with English terminology may present a viable alternative method for medical-educational-written texts in Arabic-speaking population.

Concomitant fungal peritonitis and high ascitic amylase as a rare manifestation of gastric perforation.

High ascitic amylase concentration has been reported to be a characteristic of pancreatic ascites. However, values greater than 2000 U/l can also be seen in intestinal perforation. Fungal peritonitis is a serious entity that could also be caused by hollow viscous perforation. Herein we report a 22-year-old woman with epigastric pain, imitating an acute pancreatitis, and abdominal distention. Laboratory and radiological investigations revealed a high ascitic Amylase level with secondary fungal peritonitis due to gastric ulcer perforation. This case highlights the importance of careful clinical evaluation and a multi-disciplines approach in patients with high ascitic Amylase levels especially in limited-resources areas in order not to miss a diagnosis in which a surgical approach can be lifesaving. To the best of our knowledge, this is the first reported case of concomitant very high ascetic Amylase level and fungal peritonitis as a manifestation of gastric perforation.