ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
Imatinib is used for patients with SR-cGVHD. However, in 50% of cases imatinib is discontinued due to intolerance or inefficacy. In order to investigate nilotinib's role as salvage therapy in those patients, we conducted a prospective, multicenter, phase II study. (NCT02891395). Patients with SR-cGVHD were included to receive imatinib. Patients who stopped imatinib due to intolerance or inefficacy switched to Nilotinib. The primary endpoint was defined as the week-12 response rate to Nilotinib. The response was considered successful if superior to the 30% endpoint. Sixty-two patients started the IM-phase. Fourteen patients (22%) discontinued imatinib before week 12 due to: cGVHD progression (10%) or TKI-class-specific intolerance (12%). At week 12, we observed complete remission in 13 patients (21%) and partial response in 8 patients (13%). Twenty-nine patients switched to Nilotinib. Nilotinib response at week-12 was observed in 6 patients (21%) while 23 patients (79%) discontinued Nilotinib due to intolerance/cGVHD progression. The primary endpoint was not reached. This prospective study confirmed the efficacy of imatinib in patients with steroid refractory cGVHD. It failed to demonstrate the efficacy of nilotinib as a salvage therapy in patients who were intolerant/unresponsive to imatinib.
Subject(s)
Graft vs Host Disease , Salvage Therapy , Humans , Imatinib Mesylate/adverse effects , Prospective Studies , Bone Marrow Transplantation , Pyrimidines/pharmacology , Pyrimidines/therapeutic use , Graft vs Host Disease/drug therapy , Graft vs Host Disease/chemically induced , Steroids , Treatment OutcomeABSTRACT
Patients with high-risk lymphoma have a poor prognosis when treated with standard chemoimmunotherapy. This retrospective study included 23 high-risk lymphoma patients with a median age at diagnosis of 59 (range, 35-68) years. They received 2 cycles of R-COPADM and 2 cycles of CYVE, completed by ASCT for fit patients. With a median follow-up of 46 (range, 3-78) months, three (13%) patients in the cohort died. Nearly half of the patients had an ECOG performance status of 2 or 3. Most patients in the cohort (91%, n = 21) had Ann Arbor stage III-IV disease, and 88% (n = 20) had an IPI of 3 to 5. LDH levels were elevated in 83% (n = 19) of patients. Overall, 30% of patients were identified as having double-expressor lymphoma and 22% as having DHL, while two patients (9%) had THL. The origin of the lymphoma was GC B-cell-like in 15 patients (65%) and ABC-like in 8 patients (35%). Cumulative incidence of relapse at 46 months was 14% (95% CI, 5-37), while overall survival was 87% (95% CI, 64-95) and progression-free survival was 83% (95% CI, 60-93). These results showed the efficacy and an acceptable safety profile of the R-COPADM/CYVE/ASCT regimen in high-risk lymphoma, including patients with DHL.
Subject(s)
Hematopoietic Stem Cell Transplantation , Lymphoma, B-Cell , Lymphoma , Humans , Adult , Middle Aged , Aged , Follow-Up Studies , Retrospective Studies , Disease-Free Survival , Neoplasm Recurrence, Local , Hematopoietic Stem Cell Transplantation/methods , Lymphoma, B-Cell/therapy , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Transplantation, AutologousABSTRACT
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.
Subject(s)
Dextrocardia , Kidney Calculi , Situs Inversus , Male , Humans , Middle Aged , Dextrocardia/complications , Dextrocardia/diagnostic imaging , Situs Inversus/complications , Situs Inversus/diagnostic imaging , Kidney Calculi/complications , Kidney Calculi/diagnostic imaging , Kidney Calculi/surgeryABSTRACT
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.
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In this article, we discuss again the definition, the risk factor and guideline to treat the graft failure, the poor graft function and erythrobalstopenia. Graft failure is a severe but rare complication after hematopoietic cell transplantation (HCT). Despite disparity in the literature, we defined this complication and discussed the factor risks and recommendation for treatment based on new studies. Poor graft function is also a more frequent complication after HCT. New studies will soon be available to prove or not the current recommendation suggested in this article based on therapeutics medicine or cellular therapy. Erythroblastopenia, is a rarer complication post HCT. Despite anticipation for a better choice of compatibility donor/recipient, some patients still suffer from this complication.
ABSTRACT
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.
Subject(s)
COVID-19 , COVID-19/epidemiology , COVID-19/prevention & control , Cross-Sectional Studies , Female , Humans , Male , Pandemics/prevention & control , SARS-CoV-2 , Syria/epidemiologyABSTRACT
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.
Subject(s)
Cartilage, Articular , Knee Injuries , Arthroscopy/methods , Cartilage, Articular/diagnostic imaging , Cartilage, Articular/injuries , Cartilage, Articular/surgery , Humans , Knee Injuries/diagnostic imaging , Knee Injuries/surgery , Knee Joint/diagnostic imaging , Knee Joint/surgery , Male , Middle Aged , Pain/pathologyABSTRACT
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.
Subject(s)
Psoas Abscess , Tuberculosis , Adult , Antitubercular Agents/therapeutic use , Female , Humans , Isoniazid/therapeutic use , Psoas Abscess/diagnostic imaging , Pyrazinamide/therapeutic use , Rifampin/therapeutic use , Tuberculosis/drug therapyABSTRACT
Morgagni's hernia is a congenital diaphragmatic hernia, which represents only 3% of all diaphragmatic hernias. Herein, we report a case of a 28-year-old symptomatic female patient with Morgagni's hernia who underwent a transabdominal surgery for hernia repair and mesh placement.
ABSTRACT
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.