Syrian national growth references for children and adolescents aged 2-20 years.

BACKGROUND: During the past three decades, growth charts have become one of the principal tools for monitoring anthropometric development in individuals and populations as well. Growth references by the CDC and other countries have been widely used in our hospitals and healthcare units for clinical assessment of children's development. The apparent overestimation and underestimation of many children's anthropometrics indicated the need to construct our own references. The objective of this study is to establish the national growth references for the Syrian population 2-20-year-old. METHODS: A multicenter cross-sectional sample of 13,548 subjects, aged 2-20 years, were recruited from various kindergartens, schools, and universities across the Syrian Arab Republic between February and May-2019. Response variables (stature, weight, and BMI) were fitted against age using P-splines and three empirical distributions: Box-Cox T, Box-Cox Power Exponential, and Box-Cox Cole and Green. Residuals diagnostic Q-tests and worm plots were used to check the validity of fitted models. RESULTS: Box-Cox T provided the best fit for stature-for-age, whereas Box-Cox Power Exponential provided the best fit for weight-for-age and BMI-for-age. Residuals diagnostics revealed adequate models fitting. BMI cutoffs revealed an increased prevalence of obesity (4.5% and 3.66%) and overweight (20.1% and 19.54%), for boys and girls respectively, in our population. CONCLUSIONS: Growth charts are available for use now in our hospitals and healthcare units. For 0-2-year-old children, we recommend using the World Health Organization's standards.

Association of KCNJ11 rs5219 gene polymorphism with type 2 diabetes mellitus in a population of Syria: a case-control study.

BACKGROUND: Type 2 diabetes mellitus is believed to be a polygenic disorder that develops as a result of a complex interaction between multiple genes and environmental factors. KCNJ11 gene encodes a Kir6.2 protein which forms the inner section of the potassium channels in pancreatic beta cells. Several studies found that KCNJ11 polymorphism increases T2DM risk. Our study aimed to investigate the association between rs5219 polymorphism of the KCNJ11 gene and T2DM in Syrian patients. METHODS: This case-control study involved 75 T2DM patients and 63 healthy controls. The KCNJ11 rs5219 polymorphism was genotyped by Restriction Fragment Length Polymorphism (RFLP). RESULTS: The frequency of the risk allele K was similar between the two groups (38.7% vs. 38.1%, P = 0.132). The frequency of the KK genotype was higher among the patients' group (16% vs. 4.8%), and the frequency of the EK genotype was higher among the control group (45.3% vs. 66.6%); however, the differences were statistically insignificant. The KK genotype was significantly associated with T2DM in the recessive model with an OR of 3.81 (95% CI 1.024-14.17, P = 0.035). CONCLUSIONS: This study showed that rs5219 polymorphism of the KCNJ11 gene is an important risk factor for type 2 diabetes mellitus in a sample of the Syrian population.

Compliance with Deferoxamine Therapy and Thyroid Dysfunction of Patients with ß-Thalassemia Major in Syria.

Hypothyroidism is one of the common endocrine complications described in patients with ß-thalassemia major (ß-TM). Studies have reported its incidence and severity depending on the region, quality of management and treatment protocols. The reported thyroid dysfunction includes overt hypothyroidism, subclinical hypothyroidism and rarely, central hypothyroidism. The main aims of this study were to identify the incidence of hypothyroidism in 82 patients with ß-TM in Syria, and also to evaluate the effect of compliance with deferoxamine (DFO) therapy on the patients' thyroid function. Out of the 82 patients included in this study, 24 had subclinical hypothyroidism (29.27%) and one patient had overt hypothyroidism (1.22%). It was demonstrated by this study that noncompliance with DFO therapy increases the risk of thyroid dysfunction 6.38-times compared to compliance with DFO [risk ratio (RR) = 6.385; 95% confidence interval (95% CI) 2.40-16.95)]. These results emphasize the importance of compliance with chelation therapy to minimize the burden of thyropathy on patients' quality of life, and also augment the rationale for a routine follow-up and endocrine evaluation for early detection and management of these complications.

Congenital hypothyroidism: a five-year retrospective study at Children's University Hospital, Damascus, Syria.

Background: Congenital hypothyroidism (CH) is a treatable thyroid hormone deficiency that causes severe mental retardation and growth deficiency if not detected and treated early. The treatment of CH is simple, inexpensive, and effective. With early detection and treatment, infants usually develop normally without mental retardation and become productive members of society. In Syria, a screening program is not available, and there is no published information about the actual incidence of CH. However, an unpublished pilot study supported by the International Atomic Energy Agency showed that the incidence of CH in Syria is more than the global incidence, indicating the importance of the application of a CH screening program in Syria. Objectives: The present study aimed to collect baseline information about CH in Syria to estimate the potential need of a screening program. Materials and methods: This retrospective study was performed at Children's University Hospital, Damascus. The study included the medical records of patients who had CH as the final diagnosis between 2008 and 2012. Some patients were diagnosed elsewhere and were then admitted to the hospital within the same period. Results: In this study, 70 cases registered as CH, 67 of them had confirmed, 40 (57.1 %) were male and 30 (42.9%) were female. Among the patients, (51.4%, n = 36) involved parental consanguinity and 6 had a family history of hypothyroidism. Additionally, 74.3% were not diagnosed during the first month of life. The signs and symptoms most commonly detected were cretinoid face (60%), pallor (44.3%), delayed neuropsychomotor development (37.1%), growth failure (36.7%), jaundice (35.7%), and hypotonia (35.7%). Conclusion: A CH screening program is necessary in Syria owing to the low specificity of the signs and symptoms of CH, which can lead to delayed diagnosis, and the presence of asymptomatic cases (subclinical hypothyroidism).

Autoimmune thyroid disease in patients with type 1 diabetes mellites: A cross-sectional study from Syria.

The present study aimed to investigate the occurrence of autoimmune thyroid disease (AITD) in patients with type 1 diabetes mellitus (T1DM) by the presence of antithyroid peroxidase (anti-TPO Ab). Furthermore, we studied the relationship of clinical and thyroid ultrasound (US) characteristics with anti-TPO Ab. This cross-sectional study was performed in Al- Mowasat and Al-Assad University Hospitals from 2021 to 2023. Clinical, laboratories, and US features were collected and analyzed between positive compared to negative anti-TPO Ab. Of 76 patients, anti-TPO Ab was positive in 12 patients (15.7%) with female predominance [n = 10 (83.3%)]. Gender showed a difference between anti-TPO Ab groups (P = .026). DM duration showed a difference (P = .034), which was dominant for a group of positive anti-TPO Ab (median = 9). The age at DM diagnosis also showed a difference (P = .048), where most patients were under 10- years old at diagnosis [n = 39 (51.3%)] and the highest number of anti-TPO Ab positive patients [n = 7 (58.3%)] were in this age category. US findings showed a significant difference (P = .001). Regarding positive anti-TPO Ab patients, the most frequent US finding was immune pattern [7 (58.3%)], which was more common than in the negative group (12.5%). Age, hemoglobin A1c (HBA1c), and body mass index (BMI) did not present differences (P = .391, 0.692, and 0.453, respectively), however, all anti-TPO Ab positive patients were older than ten years and had HBA1c more than 8. Thyroid-stimulating hormone (TSH) was abnormal in 2 patients (16.6%) and both in anti-TPO Ab positive group. This study suggests that anti-TPO Ab appears in older patients and with longer MD duration. Also, data support using US and anti-TPO Ab as earlier markers for AITDs, and further recommending regular annual monitoring by US and anti-TPO Ab in all patients with T1DM for AITDs diagnosis, especially in females.

The relationship between papillary thyroid carcinoma and preoperative TSH level: A cross-sectional study from Syria.

Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer, and thyroid stimulating hormone (TSH) is the major growth factor for thyroid cells. It is also an available, inexpensive test and performed routinely while evaluating thyroid nodules. Yet the relationship between TSH levels and PTC is still controversial. Understanding the relationship between preoperative TSH levels and thyroid cancer helps to break new ground of current prevention, diagnosis, and management approaches of thyroid cancer. A cross-sectional retrospective study of patients underwent total thyroidectomy during 2019 at Al-Assad University Hospital, which included 305 individuals. All patients underwent thyroid ultrasonography and laboratory assessment of serum TSH levels prior to surgery, in addition to recording histological features of resected thyroid samples. The malignancy rate was 21.3%, PTC patients had higher TSH values across the entire study even when gender, age and number of thyroid nodules differed. A statistically significant increase in TSH levels was noticed by moving from the benign thyroid nodular disease (BTND) group to papillary thyroid microcarcinoma (PTMC) group, then to thyroid cancer of larger size (TCLS) group (P = .001). A statistically significant relationship was also found between high TSH levels and lymph node metastases (LNM) (P = .008). TSH concentrations were significantly higher in patients with PTC, and higher TSH values were associated with TCLS and LNM.

Effect of laparoscopic mini-gastric bypass versus laparoscopic sleeve gastrectomy on hypertension and dyslipidemia in obese type 2 diabetes mellitus patients.

Objective: The aim of the research was to compare the effect of the laparoscopic mini-gastric bypass (LMGB) technique with the laparoscopic sleeve gastrectomy (LSG) technique in bariatric surgery on type 2 diabetes mellitus (T2DM), hypertension (HTN), and dyslipidemia in obese T2DM patients. Materials and methods: A prospective, cross-sectional study, conducted in Surgery Department at Al-Mouwasat and Al-Assad University Hospitals in Damascus, and included T2DM obese patients who would undergo bariatric surgery using the LMGB or LSG technique. Results: The research included two groups: the LSG group (92 patients, 60.9% female, age 44.6 year, BMI 41.85 kg/m2) and the LMGB group (137 patients, 59.1% female, age 47.1 year, BMI 43 kg/m2). Before surgery, the prevalence of HTN and dyslipidemia were similar in the two groups. After one year: T2DM improvement and remission rate in the LMGB group (13.9, 80.3%) were greater than in the LSG group (13, 62%), the difference was statistically significant. The HTN improvement and remission rate in the LMGB group (52.9, 41.4%) were greater than in the LSG group (47.5, 39%), the difference was not statistically significant. The dyslipidemia improvement rate was greater in LSG group (47.2 vs. 32.7%), while the dyslipidemia remission rate was greater in LMGB group (67.3 vs. 52.8%), the difference was statistically significant. Conclusions: The authors found that the LMGB technique was more effective than the LSG technique in controlling cardiovascular risk factors of obesity, T2DM, HTN, and dyslipidemia.

Diabetes Insipidus due to Metastases of Undiagnosed Lung Cancer: A Case Report from Syria.

Pituitary metastases (PM) are extremely uncommon, accounting for less than 1% of all intracranial metastases. PM of an undiagnosed malignancy can commonly present with symptoms of hormonal deficiencies, central diabetes insipidus, and/or visual symptoms. Lung and breast malignancies are the most common cancers associated with PM. Despite advances in diagnostic and therapeutic options, the prognosis remains poor and is influenced by primary malignancy and treatment methods. We report a case of a patient with PM from lung cancer who had polyuria, polydipsia, and nonspecific symptoms. A full evaluation confirmed central diabetes insipidus, hypogonadism, and metastatic lung cancer. We also discuss the current literature on PM diagnosis and management, emphasizing the need for a comprehensive evaluation of all available data. This is the first case of PM reported from Syria, to our knowledge.

Prolactinoma and hyperprolactinaemia: a transcultural comparative study between Germany as a western, liberal, industrialised country and Syria as an oriental society with a strong Islamic tradition.

OBJECTIVE: Prolactinomas and hyperprolactinaemia cause hypogonadism and impairment of sexual and reproductive function. In this transcultural study, clinical characteristics of prolactinoma/hyperprolactinaemia were compared between a liberal, western, industrialised country and a more traditional, Islamic, oriental society. METHODS: Sixty-two Syrian patients with hyperprolactinaemia were compared to 62 German patients with hyperprolactinaemia. RESULTS: In Syria and Germany, prolactinoma and hyperprolactinaemia were more frequent in females than in males (Syria 87% females; Germany 63% females). Prolactinomas were larger in males, males were older at diagnosis in both countries. Recorded clinical symptoms were comparable, even if culturally determined differences in spontaneous reporting of and asking for symptoms might be considered. The average age of the Syrian patients at diagnosis of hyperprolactinaemia was more than 6 years lower than in the German cohort (33.4 ± 10.4 vs. 39.7 ± 17.6 years). In Germany, a variety of therapeutic regimens were applied. In Syria, bromocriptine was prescribed exclusively. DISCUSSION AND CONCLUSION: The differences may be attributed to culturally determined differences in sexual and reproductive behaviour, i.e. sexual intercourses of young, unmarried girls and women in association to the use of oral contraceptives regulating the menstrual cycle, maternal age at first delivery and birth frequency. Exclusive prescription of bromocriptine in Syria may be associated to limited resources and the safety of bromocriptine during pregnancy.

Two Cases of Pituitary Stalk Interruption Syndrome in Syrian Children.

Pituitary stalk interruption syndrome (PSIS) is an extremely rare cause of growth failure and delayed puberty. It can be diagnosed by magnetic resonance imaging (MRI) of the hypothalamus and pituitary gland, showing an ectopic or absent posterior pituitary, an absent or interrupted pituitary stalk, or small anterior pituitary, in combination with growth hormone or other pituitary hormone deficiencies. The exact etiology of PSIS is unknown. In this article, we describe two cases of PSIS in Syria which are, as far as we know, the first published cases.

Diagnostic Dilemma in Two Cases of Hyperandrogenism.

Hirsutism is a common endocrine complaint affecting about 10 percent of women. It may be caused by multiple etiologies including adrenal and ovarian disorders. Usually, it is a result of a benign entity such as PCOs and idiopathic hirsutism. However, sometimes especially when it is severe and rapid in progression an androgen-secreting tumor should be excluded. Sertoli-Leydig cell tumors constitute fewer than 0.5 percent of ovarian tumors and it may be benign or malignant. In this article, we present two cases of hyperandrogenism caused by occult ovarian Leydig cell tumors. one of them was confounded by the presence of coincidental bilateral adrenal nodules that complicated the diagnostic process. Tumor dissection was curative in both cases and the diagnosis was confirmed by pathological and hormonal testing after surgery.

Serum resistin levels in Syrian obese patients with diabetes mellitus type II.

OBJECTIVE: To determine serum resistin levels in obese patients with diabetes mellitus type II. METHODS: We studied 87 subjects in an sectional study, divided into 3 groups: obese, obese diabetic and normal subjects. Their age, gender and body mass index were recorded. Serum resistin, insulin, glucose, cholesterol, high-density lipoproteins, low-density lipoproteins, triglyceride, urea and creatinine were measured. RESULTS: The mean +/- SD plasma resistin for the obese diabetic group is 7.32 +/- 3.74 ug/ml versus 4.25 +/- 1.77 ug/ml in the control group (p=0.021). Intro-group comparison of obese subjects (diabetics versus non-diabetics) revealed higher levels of resistin, glucose, triglyceride, cholesterol and low density lipoproteins in diabetic subjects, but no statistically significant difference of high density lipoproteins. Furthermore, resistin correlated significantly and positively with body mass index (r = 0.375; p<0.05), resistin correlated significantly and negatively with high-density lipoproteins (r = -0. 363; p<0.05). CONCLUSION: Serum resistin levels are increased in obese patients with type 2 diabetes compared with controls. Resistin appears to be a possible link between obesity and type 2 diabetes in humans.