Priapism in a Child from Homocystinuria from Methylenetetrahydrofolate Reductase MTHFR (C677T) Mutation.

Priapism is a prolonged involuntary erection that can have severe complications if left untreated. Ischaemic priapism is very rare in children and requires urgent intervention to prevent permanent erectile dysfunction and penile shortening. It can be caused by ischaemia in sickle cell anaemia, leukaemia, trauma, drugs, or idiopathy. Homocystinuria is a rare autosomal recessive disorder that can cause hyperhomocysteinemia and hypercoagulability. Very few reports suggested that priapism can be caused by hyperhomocysteinemia, and they were in adults. However, we present the first of such a case to the best of our knowledge of a prepubescent child who only had the MTHFR (C677T) mutation that causes homocystinuria and had ischaemic priapism. A nine-year-old Syrian Arab boy was presented with priapism that lasted for a few hours. Blood tests show normal blood count, film, and haemoglobin electrophoresis. However, prothrombin time, partial thromboplastin time, homocysteine level, and C-reactive protein were elevated. Other coagulation tests were within the normal range. Doppler ultrasonography found decreased cavernous blood flow, and warm 0.9% saline lavage of the cavernosa was indicated and successfully treated the priapism. Genetic testing for the homozygous MTHFR (C677T) mutation was later confirmed, and warfarin was indicated. In conclusion, homocystinuria is very rare in priapism, and this is the first case to report this phenomenon in a child. Ultrasonography in low-income countries is an essential tool that helps identify a wide variety of medical conditions such as priapism and can be successfully managed by aspiration with warm saline.

Blood donation during COVID-19 lockdown and its association with anger and stress: A cross-sectional study from Syria.

Background: The demand for blood donations in Syria was high as the country has suffered for 9 years from war, and this demand has substantially increased during and after the lockdown from the COVID-19 pandemic. This study aims to assess blood donations in Syria and their association with multiple factors. Methods: Online questionnaires were distributed to social media groups, with questions related to stress, anger, and COVID-19 distress. Results: This study included 1,423 participants, of which 899 (63.2%) were women. Only 48.5% have ever donated blood, of which 33.3% donated only once in their lifetime. Not having a good reason to donate blood was the main reason for not donating. Obtaining documents was the main reason for blood donation among people who donated blood (64.8%). Stress, anger, and fear of infection were not associated with blood donation and its patterns. Losing someone close and being endangered by war were associated with more frequent blood donations in contrast to being distressed by war. Conclusion: COVID-19 distress, stress, and anger were not associated with the decrease in blood donation. Spreading awareness on volunteer blood donation is crucial to combat blood shortage during stressful times.

Post-traumatic stress disorder (PTSD), anger and mental health of school students in Syria after nine years of conflict: a large-scale school-based study.

BACKGROUND: The Syrian crisis has entered its ninth year with many being affected by the war. This is the largest-scale study that aims to evaluate the psychological profile of secondary school students in Syria. METHODS: This is a cross-sectional study in schools in Damascus, Syria. The surveys assessed working habits, smoking, war exposure, grades, socioeconomic status (SES), social support, health-related quality of life (HRQL), post-traumatic stress disorder (PTSD), problematic anger, and other parameters. RESULTS: This study included 1369 students of which 53% suffered from PTSD and 62% from problematic anger. Around 46% declared a fair or worse general health and 61% had moderate or severe mental health. Only 9.3% did not report exposure to any war-related variable. War exposure had an impact on PTSD, anger, and HRQL, but not on students' grades. Smoking, having consanguineous parents, and working did not have a clear association with grades or anger. Social support weakly reduced PTSD and anger scores. Interestingly, working was associatedwith lowerPTSD scores but was associated with a worse physical component of HRQL. CONCLUSION: This is the largest study on school students in Syria that reports the psychological ramifications of war. Although the direct effects of war could not be precisely described, the high burden of PTSD and anger distress was a strong reflection of the chronic mental distress.

Mental disorder and PTSD in Syria during wartime: a nationwide crisis.

BACKGROUND: Syria has experienced war since 2011, leaving over 80% under the poverty line and millions displaced. War and its retaliations have significantly impacted the mental health of Syrians. This study evaluates the post-traumatic stress disorder (PTSD), and the severity of the mental distress caused by war and other factors such as low social support. This study also evaluates other variables and compares the findings with those of multiple studies on Syria and refugees. METHODS: This is a cross-sectional study that included people who lived in Syria in different governorates. Online surveys were distributed into multiple online groups and included the Kessler 10 (K10) scale which screens for anxiety and depression, the Screen for Posttraumatic Stress Symptoms (SPTSS) tool, the Multidimensional Scale of Perceived Social Support, and questionnaires on demographic and war-related factors. RESULTS: Our study included 1951 participants, of which, 527 (27.0%) were males and 1538 (78.8%) between the age of 19 and 25. Among participants, 44% had likely severe mental disorder, 27% had both likely severe mental disorder and full PTSD symptoms, 36.9% had full PTSD symptoms, and only 10.8% had neither positive PTSD symptoms nor mental disorder on the K10 scale. Around 23% had low overall support. Half of the responders were internally displaced, and 27.6% were forced to change places of living three times or more due to war. Around 86.6% of the responders believed that the war was the main reason for their mental distress. Those with high SPTSS and K10 scores were found to take more days off from work or school due to negative feelings and having somatic symptoms. Moreover, the number of times changing places of living due to war, educational level, and being distressed by war noise were the most prominent factors for more severe PTSD and mental distress. No differences in PTSD and mental disorder prevalence were noted in participants living in different governorates or among different types of jobs. A strong significant correlation (r = 0.623) was found between SPTSS and K10 scores. CONCLUSION: The conflict in Syria has left the population at great risk for mental distress which was higher compared to Syrian refugees elsewhere. Many measures with an emphasis on mental health are needed to help the people against a long-term avoidable suffering.

Isolated tuberculosis of the spleen presenting with fever of unknown origin in a vaccinated child.

Tuberculosis (TB) is one of the top 10 causes of death worldwide and is more common in developing countries. Isolated splenic TB is typically found in trauma, miliary TB and immunocompromised status. We present a very rare case of an immunocompetent child with an isolated primary TB in the spleen. The child only had fever of unknown origin (FUO), and mild anaemia. The diagnosis was not made until splenectomy was performed. The patient took the quadruple therapy for TB, and follow-ups showed no recurrence. This case is unique because this child was immunocompetent with no history of trauma or active TB. TB diagnosis should never be ignored in FUO as this might prevent unnecessary procedures to the patient. Although the child was vaccinated with Bacillus Calmette-Guérin that usually protects against severe TB in first 5 years of life, it did not prevent from affecting the spleen.

Allergic Rhinitis and Its Epidemiological Distribution in Syria: A High Prevalence and Additional Risks in War Time.

BACKGROUND: Allergic rhinitis (AR) is a global disease that affects a huge proportion of people around the world especially in the Middle East, where multiple allergy-promoting factors can be found. Although AR is not fatal, it severely affects the quality of life. However, it is usually overlooked in developing countries due to resource scarcity. METHODS: An online questionnaire on social media was used which included demographics, smoking, socioeconomic-status (SES), war-related questions, and the score for allergic rhinitis (SFAR), a simple self-reporting tool with the cut-off point at 7. Findings. This study included 968 subjects with 721 (74.5%) females. The mean age was 24.69 years with AR prevalence at 47.9%. AR was associated with male gender [P = 0.001 (OR, 1.677; 95% CI 1.249-2.253)], having a job [P = 0.049 (OR, 1.309; 95% CI 1.001-1.713)], the having a chronic medical condition (P < 0.0001) mainly other allergies [P < 0.0001 (OR, 9.199; 95% CI 3.836-22.063)] and asthma [P = 0.006 (OR, 5.060; 95% CI 1.396-18.342)], using medications (P < 0.0001) and living in particular provinces (P = 0.010). However, no significant correlation was found with type of work and war factors except being distressed by war sounds [P = 0.027 (OR, 1.348; 95% CI 1.034-1.757)]. Finally, no associations were found with age, consanguinity, SES, educational level, and cigarette or/and shisha smoking (P > 0.05). Interpretation. Approximately half of the sample displayed AR symptoms, indicating a potentially high burden of AR in the community. A correlation to being distressed from war noises was found with AR which could reflect a psychological aspect. In addition, in war harmful allergens are released which can be an additional AR risk factor which adds to the environment in the Middle East that is associated with AR. However, we need further studies to discover and minimize this huge prevalence of AR.