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BACKGROUND: Situs inversus totalis is a very rare congenital anatomical variation, in which all thoracic and abdominal organs are right-left inverted. This condition is associated with an increased risk of organ malformations including ectopic kidney, which is a very rare combination. CASE PRESENTATION: A 56-year-old male presented with colicky left iliac pain associated with nausea, vomiting, and irritative lower urinary symptoms. The patient has a medical history of recurrent lower urinary infections and a family history of situs inversus totalis. Radiological images demonstrated dextrocardia, situs inversus totalis of all the abdominal organs, and an ectopic pelvic kidney on the left side, with 4 stones inside it. Left nephrectomy was performed due to extensive renal damage. At discharge and during follow-up, the patient's condition was satisfactory and stable. CONCLUSIONS: The ectopic kidney may present diagnostic and therapeutic challenges when associated with situs inversus.
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Dextrocardia , Cálculos Renais , Situs Inversus , Masculino , Humanos , Pessoa de Meia-Idade , Dextrocardia/complicações , Dextrocardia/diagnóstico por imagem , Situs Inversus/complicações , Situs Inversus/diagnóstico por imagem , Cálculos Renais/complicações , Cálculos Renais/diagnóstico por imagem , Cálculos Renais/cirurgiaRESUMO
BACKGROUND: Ductus deferens may manifest in a variety of anomalies such as its absence, duplication, ectopy, or diverticulum. Ectopic seminal tract opening has two main types, ectopic ejaculatory duct opening, and ectopic vas deferens opening. Generally, ductus deferens anomalies affect approximately 0.05% of the population. Patients may be asymptomatic or complaining of urinary tract infections and/or epididymitis. Most of these cases are associated with renal dysplasia. To confirm the diagnosis Cystourethroscopy catheterization and retrograde urethrogram should be performed, but the definitive diagnosis is done by vasography. The definitive treatment is complete surgical resection of the pathological urogenital connection. This case is commonly discovered while exploring other findings such as testicular torsion and inguinal hernia. CASE PRESENTATION: We report a rare case of an 11-year-old male who presented with gross hematuria and numerous congenital malformations including a left polydactyly clubfoot, polyorchidism, with several surgical procedures, and left kidney dysgenesis. Surgery was performed for a left inguinal hernia, during which a third undescended testicle was discovered incidentally and was eradicated. A retrograde urethrogram was performed to establish the diagnosis. A fistula- that is connected with the left ureter- was resected. The histopathologic findings confirmed the diagnosis of true duplication of the Vas deferens, with communication between the ureter and the vas deferens. By follow-up, the kidney function tests were within normal limits. CONCLUSIONS: This case report aims to highlight the early diagnosis and management of the duplicated vas deferens and the associated congenital malformations to improve the prognosis and kidney function and to avoid long-term complications.
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Anormalidades Múltiplas , Testículo/anormalidades , Fístula Urinária/diagnóstico por imagem , Ducto Deferente/anormalidades , Anormalidades Múltiplas/diagnóstico por imagem , Anormalidades Múltiplas/cirurgia , Criança , Pé Torto Equinovaro , Cistoscopia , Ductos Ejaculatórios/anormalidades , Fístula/complicações , Hematúria/etiologia , Hérnia Inguinal/complicações , Hérnia Inguinal/cirurgia , Humanos , Rim/anormalidades , Rim/diagnóstico por imagem , Masculino , Ureter/diagnóstico por imagem , Ureteroscopia , Fístula Urinária/cirurgia , Ducto Deferente/diagnóstico por imagemRESUMO
BACKGROUND: Small intestine diverticula are rare findings that were mostly reported in the elderly population as asymptomatic findings. However, they can also present with a wide range of symptoms (bloating, early satiety, chronic abdominal discomfort, and diarrhea/steatorrhea) or complications (gastrointestinal bleeding, small bowel obstruction, acute diverticulitis, or perforation) which in turn warrant medical treatment or urgent surgical intervention. CASE PRESENTATION: This is a case report of an 84-year-old female who presented with an acute surgical abdomen. An exploratory laparotomy revealed complicated small bowel diverticula with a jejunal diverticulum perforation, for which a diverticulectomy was performed. CONCLUSIONS: Throughout this paper, we are aiming to outweigh the consideration of the possibility of complicated small bowel diverticula as a differential in the evaluation of any acute abdomen, especially in the elderly, which warrants emergency surgical management.
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Diverticulite , Divertículo , Perfuração Intestinal , Doenças do Jejuno , Idoso , Idoso de 80 Anos ou mais , Diverticulite/complicações , Diverticulite/diagnóstico , Diverticulite/cirurgia , Divertículo/complicações , Divertículo/diagnóstico , Divertículo/cirurgia , Feminino , Humanos , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Intestino Delgado/cirurgia , Doenças do Jejuno/complicações , Doenças do Jejuno/diagnósticoRESUMO
Chondral delamination is the separation or debonding of the articular cartilage from the underlying subchondral bone. The hyaline cartilage has a limited capacity for healing, meaning it does not possess the innate ability to restore its normal structure or to heal the subchondral bone once detached from it. The purpose of this article is to report the outcomes of a microfracture technique used to manage chondral delamination in a 59-year-old male; we also reviewed the treatment options mentioned in the literature. The patient was admitted to the Department of Orthopedic Surgery complaining of recurrent severe right knee pain with multiple episodes of knee locking, denying any direct or twisting trauma to the knee. The plain X-ray showed mild degenerative changes with articular surface irregularity. On Magnetic resonance imaging, wide chondral delamination was noted in the medial femoral condyle. After 12 months' post-op, his condition improved. No locking was observed. Pain improved in comparison to the pre-operative levels. The international knee documentation committee improved from 26.4% to 52.9%. In a follow-up magnetic resonance imaging, the adhesion of most parts of the delaminated cartilage.
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Cartilagem Articular , Traumatismos do Joelho , Artroscopia/métodos , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/lesões , Cartilagem Articular/cirurgia , Humanos , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/cirurgia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Dor/patologiaRESUMO
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.
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COVID-19 , Estudantes de Medicina , COVID-19/epidemiologia , Atenção à Saúde , Humanos , Pandemias , SARS-CoV-2RESUMO
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.
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Vacinas contra COVID-19 , COVID-19 , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , SARS-CoV-2 , Síria , Vacinação , Adulto JovemRESUMO
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.
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Infecções por Coronavirus/prevenção & controle , Países em Desenvolvimento/estatística & dados numéricos , Surtos de Doenças/prevenção & controle , Disseminação de Informação/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Mídias Sociais , Betacoronavirus , COVID-19 , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/epidemiologia , SARS-CoV-2 , Síria/epidemiologiaRESUMO
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.
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Educação Médica , Multilinguismo , Materiais de Ensino , Árabes/educação , Educação Médica/métodos , Feminino , Humanos , Masculino , Estudantes de Medicina , Inquéritos e Questionários , Síria , Tradução , Adulto JovemRESUMO
Social media has become a source of disseminating information to the public during the COVID-19 outbreak which has been a great advantage for healthcare centers. However, foreign anti-vaccination campaigns on social media increased the disbelief in vaccine safety. To our knowledge, the effects of social media on COVID-19 vaccine acceptance are not well-studied in low-income countries. The primary objective of this survey is to investigate Syrians' dependence on social media platforms to get information about vaccines, and to what extent it affects their vaccination decision. A web-based cross-sectional study was conducted in Syria from May 26th to July 26th, 2022 using an online questionnaire as Google Form posted on various social media platforms. The questionnaire consisted of 53 questions related to each of the socio-demographic characteristics, beliefs, and knowledge about COVID-19 vaccination, willingness to get vaccinated, and social media frequency use and its effects. Univariate and multivariate logistic regression was performed to identify factors associated with vaccination behavior. A total of 780 questionnaires were completed; around 42.2% of study participants did not get the vaccine, and 24% would take it only under compulsory rules. Also, only 3.08% of the participants answered correctly on the knowledge-evaluation questions. Results of the univariate analysis showed that being female, living in an urban residential area, and having good vaccine knowledge were positive predictors of vaccine receiving. The unvaccinated group had a higher likelihood of being college students, not trusting in the vaccine, knowing relatively less about the vaccine, and not having previously been exposed to the virus. No significant correlation between vaccination status and using social media was shown in our investigation. However, our results show the importance of social media information in health-related decisions in war-torn countries and emphasize further investigations to confirm causality and determine the best health policy choice.
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Vacinas contra COVID-19 , COVID-19 , Mídias Sociais , Humanos , Mídias Sociais/estatística & dados numéricos , Síria , Estudos Transversais , Masculino , Vacinas contra COVID-19/administração & dosagem , Feminino , Adulto , COVID-19/prevenção & controle , COVID-19/epidemiologia , Inquéritos e Questionários , Pessoa de Meia-Idade , Conhecimentos, Atitudes e Prática em Saúde , Hesitação Vacinal/psicologia , Hesitação Vacinal/estatística & dados numéricos , Adulto Jovem , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , SARS-CoV-2 , Vacinação/psicologia , Vacinação/estatística & dados numéricos , AdolescenteRESUMO
The Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) held the 13th edition of the Clinical Practices Harmonization Workshops. Our workgroup reviewed the current data on the incidence, screening methods and international guidelines for the prevention of secondary solid cancers following allogeneic hematopoietic stem cell transplantation. The purpose of this workshop was to provide recommendations for the screening and prevention of secondary malignancies to Francophone transplantation centers.
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Transplante de Células-Tronco Hematopoéticas , Neoplasias , Humanos , Transplante de Medula Óssea , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Sociedades Médicas , FrançaRESUMO
Introduction: Univentricular heart disease is a relatively rare condition that affects infants, with a prevalence ranging from 0.05 to 0.1 per 1000 live births. It is characterized by an abnormality in the structure of the heart, specifically the presence of only one main pumping chamber (ventricle) instead of the usual two. Presentation of case: In this particular case, a newborn male was diagnosed with double-inlet left ventricle (DILV), a specific form of univentricular heart disease. Following his birth, he exhibited symptoms of central cyanosis (a bluish tint to the skin due to poor oxygenation) and difficulties with breastfeeding. Clinical evaluation, along with a heart ultrasound, confirmed the need for palliative surgery. At the age of 6 months, the patient is scheduled to undergo the Glenn procedure, a surgical intervention that aims to redirect blood flow to the lungs and improve oxygenation. Clinical discussion: Given the complexity of double-inlet single ventricle anomalies, there are multiple differential diagnoses that need to be considered for accurate diagnosis, including conditions such as tricuspid atresia, large ventricular septal defect and corrected transposition of the great arteries with ventricular septal defect. Conclusion: Early intervention in the immediate postnatal period plays a crucial role in improving survival rates and reducing long-term complications. It is, therefore, essential to continue researching and refining treatment approaches.
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Chimeric antigen receptor T cell (CAR-T cell) therapy has become a standard-of-care for several hematological and a promising treatment for solid malignancies or for selected non-malignant autoimmune disorders. Hematological complications following this treatment are very common with the majority of patients experiencing at least one cytopenia after CAR-T cell injections. The management of these adverse events is not standardized and represents an area of active research and unmet clinical needs. This harmonization workshop, gathering a group of experts who analyzed this topic, has been conceived for the optimization of the management of patients presenting with post-CAR-T cell hematological toxicities. Based on the data present in the literature, these practical recommendations were made to harmonize the practices of Francophone centers involved in the management of these patients.
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Timely transfusion of blood products is crucial, particularly in critical medical situations. Inadequate blood donation rates pose a significant threat to public health, potentially compromising patient care. This study aims to investigate the attitudes and willingness of Syrian college students to engage in blood donation, assess the prevalence of voluntary blood donation, evaluate their understanding of the determinants and procedures involved in the donation process, and identify the key factors influencing their behavior. A cross-sectional study was conducted employing a self-administered questionnaire, distributed in both electronic and hard copy formats among college students. Data analysis was performed using the R Statistical Software. Results were presented in terms of odds ratios (OR), with statistical significance defined at a P value of .05 and a 95% confidence interval. A total of 673 medical students participated in this study, with an average age of 21.6 years. The majority (59.2%) reported a good economic status, and a high level of knowledge (99.7%). A substantial proportion (40.4%) agreed with the notion that blood donation constitutes a personal duty for every eligible individual. Multiple comparison tests revealed a statistically significant P value of .0009716, specifically concerning individuals with low economic status. Our study demonstrates a positive attitude among college students towards voluntary blood product donation. However, the majority have not engaged in voluntary activities unless mandated for specific certification purposes. Donation rates were relatively higher than the reported rates in other similar studies conducted in Middle Eastern countries.
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Estudantes de Medicina , Humanos , Adulto Jovem , Adulto , Síria , Doação de Sangue , Estudos Transversais , Conhecimentos, Atitudes e Prática em Saúde , Doadores de Sangue , Inquéritos e Questionários , AtitudeRESUMO
The most common manifestation of skeletal tuberculosis is tuberculosis spondylitis. Symptoms may progress insidiously from back pain to cause many severe complications. Early diagnosis and management of spinal tuberculosis have special importance in prevention. We report a case of a 24-year-old female who was diagnosed with tuberculous spondylitis, complicated with psoas abscess and grade 1/5 of lower limb weakness. The patient was treated with anti-tuberculous drugs and underwent surgical debridement, interbody fusion and internal fixation accompanied by fibular autografting using a posterior-only approach and supplemental posterior spinal stabilisation on an infected background. Within 14 years of follow-up, full bone graft spinal fusion has been achieved with no major complications. According to its clinical efficacy and feasibility, this procedure is suggested to be an alternative treatment for Pott's disease.
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The association between systemic sclerosis and other immune-mediated diseases such as primary sclerosing cholangitis and hyperthyroidism should be suspected in case the patient presents with similar symptoms. A 43-year-old woman presented to the hospital with progressive jaundice, dark urine, dyspnoea, fatigue, generalized arthralgia, weight loss, and amenorrhoea. In addition, she was diagnosed with systemic sclerosis seven years ago. The patient was diagnosed recently with primary sclerosing cholangitis and hyperthyroidism through laboratory tests and investigations such as magnetic resonance cholangiopancreatography, ultrasound, and computed tomography scan. After appropriate treatment and follow-up, the patient recovered well. Immune-mediated diseases can occur simultaneously or consequently due to the common immunological dysfunction that causes these conditions.
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Malaria is an infectious Anopheles mosquito-borne disease caused by five different eukaryotic protozoa parasites. Amoebiasis is a parasitic infection caused by Entamoeba histolytica. Both diseases are widespread in Liberia. A returning traveler was diagnosed and treated for malaria, and 20 days later, an amoebic liver abscess was discovered, meaning that the malaria infection masked the amoebic infection, which emphasizes the importance of a complete examination of returning travelers, especially for those returning from Sub-Saharan Africa, where coinfections are more common. Herein, we propose that the relationship between Malaria and amoebic liver abscesses should be explored by researching the effects of malaria on ferritin levels and the immune components in the liver and whether it helps the emergence of hepatic amoebic abscesses or not.
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Hemorrhagic cystitis (HC) is a common complication after allogeneic hematopoietic cell transplantation (allo-HCT). Its manifestations range from microscopic hematuria without urinary symptoms to extensive and prolonged macroscopic hemorrhage requiring invasive interventions that can often prolong the duration of hospitalization and result in significant morbidity. The early onset of HC is related to allo-HCT conditioning regimen, whereas the late onset form is secondary to viral infection, most commonly due to BK virus. In the framework of the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) practice harmonization workshops held in Lille in September 2021, the prophylaxis, the diagnostic approach and the treatments of HC following allografting were reviewed after analysis of published studies.
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Cistite , Transplante de Células-Tronco Hematopoéticas , Humanos , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante de Medula Óssea , Transplante Homólogo/efeitos adversos , Hemorragia/diagnóstico , Hemorragia/etiologia , Hemorragia/prevenção & controle , Cistite/diagnóstico , Cistite/etiologia , Cistite/prevenção & controleRESUMO
BACKGROUND: Septic pulmonary embolism (SPE), deep vein thrombophlebitis (DVT), and acute osteomyelitis (AOM) form a triad that is rarely seen in children and is usually associated with a history of trauma on long bones. Unfortunately, a delay in diagnosis is frequently observed in this syndrome, which places the patient at risk of life-threatening complications. This delay can largely be attributed to the failure to consider osteomyelitis as a potential underlying cause of DVT. CASE PRESENTATION: In this case report, we present the case of a 16-year-old Arabian male who presented with limb trauma and fever. The patient had a delayed diagnosis of osteomyelitis, which resulted in the formation of an abscess and subsequent joint destruction. Surgical drainage and joint replacement surgery were deemed necessary for treatment. CONCLUSIONS: persistent fever along with a history of trauma on a long bone with signs of DVT of the limb in a child should raise concern for osteomyelitis and an MRI evaluation of the limb should be obtained.
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Osteomielite , Embolia Pulmonar , Tromboflebite , Criança , Humanos , Masculino , Adolescente , Tromboflebite/complicações , Tromboflebite/diagnóstico , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/etiologia , Osteomielite/complicações , Osteomielite/diagnóstico , Osteomielite/terapia , Imageamento por Ressonância Magnética , Osso e Ossos , Doença AgudaRESUMO
Coexisting malignancies is not only an uncommon event but, it can also represent a medical challenge. Its complexity relies on the difficulty of management and the need for personalized and prioritized therapeutic approaches, on the one hand, and in the potential misdiagnosis of recurrence or even a de novo disease, on the other. Here, we present a case of a 69-year-old patient, who was initially diagnosed with a chronic myelomonocytic leukemia (CMML), followed by monoclonal gammopathy of uncertain significance (MGUS). Few years later, the patient developed Hodgkin's lymphoma (HL), and a new mutation, previously undocumented in the medical literature, was also detected. As a conclusion, we can say that the decision must be taken with caution and must be based on two major factors: 1- The rapid evolution of malignancies: give priority to treating the most rapid/life-threatening disease. 2- Prioritize the treatment of symptomatic disease and/or that which may most improve patients' quality of life.