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.

Pemphigus vulgaris after the second dose of COVID-19 vaccination: a case report.

BACKGROUND: As many people worldwide have been vaccinated, more triggered autoimmune bullous diseases have been noticed. We reported a case of new-onset pemphigus Vulgaris after COVID-19 vaccinations. CASE PRESENTATION: A 50 years old Syrian female presented with multiple erosions on her extremities, in addition to oral erosions and genital ulcers, after the 2nd dose of the mRNA COVID-19 vaccine. The lesions were multiple tenders and well-defined, reddish erythematous oral ulcers. At the same time the Skin examination showed hyper-pigmented patches over the extremities, a sequel of ruptured bullae. Pemphigus Vulgaris was diagnosed by histology. She continued on 35 mg/day of prednisone for another 2 weeks. CONCLUSIONS: Pemphigus is not a contraindication to vaccination, although it may be worse or present as a first onset.

Studying the prevalence of musculoskeletal pain among a sample of medical students in Damascus, Syria. A cross-sectional study.

Background: A considerable number of medical students experience musculoskeletal pain (MSP) during their academic years. In this study, we seek to determine the prevalence of MSP, as well as its associated risk factors, among a sample of medical students at two major universities in Damascus, Syria. Methods: A cross-sectional study was conducted in two universities, with a total of 2009 medical students participating in filling-in the paper-based questionnaire. A modified version of the Standardized Nordic Questionnaire was utilized in this study. Results: The questionnaire was completed by 2009 medical students. The majority were between the ages of 21 and 25 years old, female (53%), and in their clinical years (55%). 1081 (54%) of all students had at least one MSP site in the previous week, while 1654 (82%) had at least one MSP site in the last year. MSP in the previous week was strongly linked with a history of trauma (odds ratio [OR] 2.26, 95% confidence interval [CI] 1.79-2.86, p = 0.001), as well as a family history of MSP (OR 1.40, 95% CI 1.12-1.76, p = 0.0029). MSP in the previous year was significantly associated with gender (OR 0.637, 95% CI 0.50-0.80, p = 0.0001), history of trauma (OR 4.59, 95% CI 2.93-7.17, p ≤ 0.001), and family history of MSP (OR 4.59, 95% CI 1.36-2.68, p = 0.0002). On multivariate analysis, factors associated with MSP in the previous week and last year were familial history of MSP (p = 0.0457) (p = 0.0024), respectively, and a history of trauma (p ≤ 0.001). Conclusion: MSP had a high prevalence among Syrian medical students, especially female students, those with history of trauma, and those with a family history of musculoskeletal disorders (MSD). This major health problem should be known to medical institutions, and awareness programs are required.

Commitment to protective measures during the COVID-19 pandemic in Syria: A nationwide cross-sectional study.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 continues to impose itself on all populations of the world. Given the slow pace of vaccination in the developing world and the absence of effective treatments, adherence to precautionary infection control measures remains the best way to prevent the COVID-19 pandemic from spiraling out of control. In this study, we aim to evaluate the extent to which the Syrian population adheres to these measures and analyze the relationship between demographic variables and adherence. METHODS: This cross-sectional study took place in Syria between January 17 and March 17, 2021. A structured self-administered questionnaire was used to collect the data. The questionnaire was distributed in both electronic and printed versions. Our sample consisted of 7531 individuals. Collected data were analyzed using SPSS v.25. The chi-square test was used to address the correlation between adherence and demographic variables. RESULTS: Of the 10083 reached out, only 8083 responded, and 7531 included in the final analysis with an effective response rate of 74.7%. Of them, 4026 (53.5%) were women, 3984 (52.9%) were single, and 1908 (25.3%) had earned university degrees. 5286 (70.25) were in the high level of adherence category to protective measures. Statistically significant differences were documented when investigating the correlation between commitment to preventive measures and age, sex, marital status, financial status, employment, and educational attainment. Furthermore, those who believed that COVID-19 poses a major risk to them, or society were more committed to preventive measures than those who did not. CONCLUSION: The participants in this study generally showed a high level of adherence to the preventive measures compared to participants in other studies from around the world, with some concerns regarding the sources of information they depend on. Nationwide awareness campaigns should be conducted and focus on maintaining, if not expanding, this level of commitment, which would mitigate the pandemic's impact on Syrian society.

Fibromyalgia: epidemiology and risk factors, a population-based case-control study in Damascus, Syria.

BACKGROUND: Fibromyalgia is a chronic disease with a high burden. We aim to be the first to investigate the prevalence of fibromyalgia (FM) in Syria and assess its risk factors. METHODS: A self-reported questionnaire was distributed to the public to identify fibromyalgia patients using the American College of Rheumatology (ACR) 2010 modified criteria. Identified cases were matched using age with controls free from rheumatic disorders that were randomly sampled from the same population. RESULTS: Out of 2966 participants, 350 (11.8%) satisfied the diagnostic criteria. Of these, only 29 (8.2%) were previously diagnosed by a physician, 239 (68.3%) were females, and 69 (19.71%) were diagnosed with depression. Female sex (OR = 1.31), diagnosis of major depressive disorder (OR = 2.62), irritable bowel syndrome (OR = 1.8), and Restless legs syndrome (OR = 1.72) were associated with a higher likelihood of fibromyalgia. CONCLUSION: Our study revealed one of the highest prevalence rates of fibromyalgia ever reported in the general population. Efforts must be intensified to increase awareness about this disease in Syrian society as well as among healthcare providers.

Two cases of Erythrodermic psoriasis treated with Golimumab.

Introduction and importance: Erythrodermic psoriasis (EP) is a very severe subtype of psoriasis, with a challenge poses in its treatment, as currently available therapies often provide unsatisfactory results, for those many biologics have been used in the treatment of EP such as Golimumab which has been extensively studied for the treatment of psoriatic arthritis, and chronic plaque psoriasis. However, no clinical trials have been performed for EP. Case presentation: We report two cases of a 23-year old female, and a 31-year male who presented with severe psoriasis that previously un respond to ultraviolet B phototherapy, methotrexate, cyclosporine, and topical agents. Skin lesions worsened progressively and developed into erythroderma. Therefore, we administered golimumab 50 mg, which lead to the improvement of the skin lesions according to the Psoriasis Area and Severity Index score after the first administration; lesions improved further throughout the treatment course. Conclusion: Golimumab may be an alternative treatment for Erythrodermic psoriasis patients unrespond to other treatments even it did not have the FDA approval, so this is an off label indication and treatment.

The prevalence of oral mucosal lesions and related factors in systemic lupus erythematosus patients.

BACKGROUND: Systemic lupus erythematosus (SLE) is a chronic inflammatory multi systematic disease of unknown aetiology. SLE has a wide range of symptoms. The most common symptoms are joint pain, skin rash and fever. Oral lesions in SLE manifest in a variety of forms, such as oral mucosal ulceration, mouth burns, xerostomia and salivary gland diseases, temporomandibular joint disease, periodontal disease, dysgeusia, white lesions, oedema, bleeding and petechiae. OBJECTIVE: This study was conducted to evaluate the prevalence of oral mucosal lesions and their related factors in patients with SLE, giving the lack of comprehensive statistical data in Syria and the differences between reported prevalence. PATIENTS AND METHODS: A cross-sectional study was performed in the Al-Mouassat University Hospital in Damascus. Patients were evaluated appropriating observation, clinical examination, completing questionnaires, studying patient's medical records and paraclinical laboratory tests if required. Four types of oral lesions were evaluated: ulcer, erythema, white plaque and spots. The diagnosis of these lesions was made according to observation and clinical examination, and the location of each lesion was also recorded. Data were analysed using SPSS version 16.0. RESULT: In this study, 42 (70% %) out of 60 patients (38 women and 4 men) had oral lesions, while 18 (30%) had none. The most common areas for the lesions were the buccal mucosa (26.1%) and the lips (14.2%). Of the 42 patients with oral lesions, 12 (27.6%) showed ulcers. There was a significant relationship between the following factors and oral lesions: oral hygiene status, the duration of the disease involvement, frequency of pregnancies, the amount of daily use of corticosteroids without significant difference between dosage groups, and medications used for SLE treatment other than corticosteroids (p < 0.008) without mentioned names or dosages. Conversely, age, sex, cigarette smoking and medications other than those used for SLE treatment were not significantly related to the presence of oral lesions (p value was greater than 0.05 in all subjects).

Castleman's disease with TAFRO syndrome: a case report from Syria.

Castleman's disease is a rare disorder, yet a rarer newly described syndrome called TAFRO syndrome was discovered to accompany it. TAFRO represents the constellation of symptoms (Thrombocytopenia, Anasarca, MyeloFibrosis, Renal failure, Organomegaly). Most cases were described in Japan. We present the first case of TAFRO syndrome in Syria. A 58-year-old Caucasian male with no relevant history presented with fatigue, oliguria, decreased platelets, increased creatinine level, hepatosplenomegaly, ascites, pitting edema and lymph node enlargement. Possible differential diagnoses were excluded by laboratory, radiologic and cytologic tests including TB, malignancy and autoimmune diseases. A biopsy of a supraclavicular lymph node confirmed Castleman disease. Our patient had Catleman's disease, and presented with only four diagnostic criteria for TAFRO syndrome (Myelofibrosis was absent) in addition to other minor characteristics (microcytic anemia, negative HIV and HHV-8 infections.) which make the presentation consistent with TAFRO syndrome described in the Japanese cases. The criteria for diagnosing TAFRO syndrome are still changing, and the pathophysiology behind it is unclear. We recommend further research to understand this syndrome taking into account that its prevalence might be worldwide.