A combination of suprachoroidal injection of triamcinolone using a custom-made needle and intravitreal Ziv-aflibercept every eight weeks to manage naïve/denovo central DME: a single-center retrospective case series.

BACKGROUND: Previous studies have shown promising effects of combining intravitreal bevacizumab and suprachoroidal injection of triamcinolone acetonide in treating DME. However, further research is needed. OBJECTIVE: To assess the efficacy and safety of combining both intravitreal Ziv-aflibercept and suprachoroidal injection of triamcinolone acetonide using a custom-made needle in naïve and de novo central diabetic macular edema (DME) patients every eight weeks for 24 weeks. METHODS: Central macular thickness was measured via spectral domain-optical coherence tomography, and best-corrected visual acuity was measured via a Snellen chart at baseline and at 4, 8, 12, 16, and 24 weeks postinjection. Additionally, cataract progression, intraocular pressure (IOP), and ocular safety were analyzed. RESULTS: A total of 10 eyes of 6 patients were treated with suprachoroidal injections of triamcinolone acteonid combined with an intravitreal injection of Ziv-aflibercept. Vision improved from 0.69 log minimum angle of resolution (MAR) at baseline to 0.39 log MAR after treatment. Central macular thickness significantly decreased from 462.3 ± 166 µm at baseline to 362.7 ± 77.6 µm at 24 weeks postinjection. CONCLUSION: Suprachoroidal injection of triamcinolone using a custom-made needle with the intravitreal agent Ziv-aflibercept to treat de novo/naïve central DME has favorable outcomes and adequate safety results. Moreover, this study demonstrated the benefit of adapting the previous treatment combination for extending the interval between anti-VEGF treatments from 4 to 8 weeks, which could prevent further expenses, especially in low-income countries.However, large multicenter randomized clinical trials with longer follow-up periods are needed to assess this treatment route, especially in low-income and resourced countries.

Basic life support awareness among medical undergraduate students in Syria, Iraq, and Jordan: a multicenter cross-sectional study.

BACKGROUND AND AIMS: Basic life support (BLS) training rates vary widely worldwide, and there is a general scarcity of surveys that assess students' knowledge and awareness of BLS in middle eastern nations. This study aims to evaluate medical students' knowledge and awareness towards basic life support. METHODS: A cross-sectional study, using an online web-based questionnaire, assessing BLS awareness and knowledge, was conducted from 3 to 30 November 2021. The study included 2114 medical students from Syria, Iraq, and Jordan. The questionnaire consisted of three sections: demographic baseline characteristics, knowledge about BLS, and ability to apply basic life support. A binominal logistic regression was done between the total score and other demographic characteristics to determine if we could predict the research sample's appropriate knowledge of BLS level. RESULTS: There was a moderate knowledge of BLS and cardiopulmonary resuscitation (CPR) skills among participating students with an average score of 19.67 (0-34). Seventy-eight of the participants (1656) stated that they have not attended a basic life support course. There was a significant difference between the participants from different countries, where the mean score in Syria, Jordan, and Iraq was 18.3, 24.3, and 18.8, respectively (p < 0.05). Considering the level of knowledge, 18.3%, 72.8%, and 8.9% of the participants had a high, intermediate, and low level, respectively. Furthermore, students who took a BLS course had a higher level of knowledge than those who did not, with an odds ratio of 5.168 (p value < 0.0001). CONCLUSION: The overall knowledge of medical students' basic life support knowledge is insufficient and need to be greatly improved. According to this study, previous participation in basic life support training had a positive effect on knowledge level. As a result, universities must establish basic life support programs as quickly as possible.

Renal primitive neuroectodermal tumor. The first case series from Syria.

Primitive neuroectodermal tumor (PNET) mainly arises from soft tissues of the extremities such as humerus, femur, C tibia. It rarely arises from kidney; less than 200 cases have been reported in the literature. The clinical presentation and radiography findings are not specific. Here we first report two cases of renal primitive neuroectodermal tumor in Syria. the first patient was 26-year-old- female that presented to urology clinic complaining of right flank pain. Ultrasonography of the abdomen showed a large mixed heterogeneous mass in the right kidney with no hemorrhage or calcification and MSCT of abdomen and pelvis demonstrate a mixed well-demarcated heterogeneous mass measuring (74*117) mm in the right kidney right radical nephrectomy was performed. The second patient 19-year-old-male presented with left flank pain. Ultrasonography of the abdomen showed mixed large mass involving the left kidney, with unmarked border. The CT of the abdomen and pelvis demonstrating a (30*110*90) mm left renal mass and periaortic lymphadenopathy measuring (45*28) mm. The patient underwent Left radical nephrectomy with periaortic lymphadenectomy dissection. The final diagnosis for both cases was Renal PNET based on microscopic and immunohistochemistry examination. In patient with suspected renal mass in the radiographic images, the diagnosis of renal primitive neuroectodermal tumor should be kept in the mind despite its rarity. The final diagnosis is done by histopathological study in association with immunohistochemical examination.

A rare combination of acute myeloid leukemia with Vit B12 deficiency: Case report.

Introduction and importance: Acute myeloid leukemia (AML) is a malignant disease with several risk factors from hematologic disorders, which almost presents as anemia. AML is characterized by the presence of myeloblast in the blood picture. On the other hand, macrocytic anemia characterized by the presence of megaloblastic marrow morphology. We are presenting a rare case of combined Acute myeloid leukemia with macrocytic anemia. Case presentation: A 45 years old married woman was admitted for hyperthermia, dysuria, and chills. She had suffered from general malaise, weakness, and myalgia for two months. In her laboratories, the peripheral blood sample showed: HGB 26.1% (5.6 g/dL), RBCs 1.4 M/µL, WBC 13.3 K/µL. The blood smear showed megaloblastic features, so she was diagnosed with macrocytic anemia, and the treatment was blood transfusion, antibiotics, and muscular Vit B12. After one month, the peripheral blood sample showed an elevation of WBC, the bone marrow aspiration showed myeloblast infiltration represents 60% of the total events, and the flow cytometry for the bone marrow aspiration agrees with Acute Myeloblastic leukemia with Maturation M2 (AML-M2). Clinical discussion: The incidence of macrocytic anemia and leukemia in one patient is infrequent, case reports give scarce information concerning a potential increased occurrence of leukemia in patients putting up with macrocytic anemia. Several theories discussed the reasons for the association of the two conditions. Conclusion: we need more research on similar cases to identify the pathological mechanism.

Ewing's sarcoma in scapula, epidemiology, clinical manifestation, diagnosis and treatment: A literature review.

Background: Ewing's sarcoma (ES) can affect any bone, but its occurrence in the scapula is extremely rare. Only 15 studies investigating this condition exist in the medical literature. Materials and methods: A literature search was conducted in PubMed and Scopus, and studies on ES of scapula published in the English medical literature were retrieved. A total of 15 studies were found and were included in our study. Results: ES prevalence was highest in Asia. Moreover, ES was predominant in males (60%), with a male-to-female ratio of 3:2. ES in 53.3% and 46.6% of the cases were found in the right and left scapula, respectively. The main presentation of patients with ES of scapula was swelling, which was observed in 73.33% of the cases. Of the included studies, 46.6% used plain radiography as the primary investigation method, and 60% used computed tomography for staging and metastasis detection. For definitive diagnosis, 86.6% of the studies used immunohistochemistry markers. Adjuvant chemotherapy was considered in most studies (80%). Neoadjuvant chemotherapy was given in 6 out of 10 cases who underwent surgical treatment. Complications included malignant pleural effusion, respiratory failure, and movement restriction. Conclusion: The scapula is an extremely rare site for ES. Local invasion was found in 63.64% of the cases, whereas pre-metastases were found in 35.71% of the cases. Magnetic resonance imaging was considered to be the best radiological method used to diagnose ES of scapula. Adjuvant chemotherapy, neoadjuvant chemotherapy, and surgery were the main treatments for ES.

Normal values of antistreptolysin O for adults ages 30 to 70 in Syria: A cross sectional study.

BACKGROUND: Group A Streptococcus is a very common pathogen which infects a large scale of people around the world causing many symptoms such as scarlet fever, sinusitis, and pneumonia. Most strains of group A and many other strains of group C and G Streptococcus bacteria secreted antigen called Streptolysin O. Anti-streptolysin O (ASO) is an antibody produced against streptolysin O that rises after 1 week of infection by streptococcus bacteria, which helps in diagnosing this type of infectious diseases. We conducted a Cross-Sectional study to determine the Upper Limit of Normal (ULN) for healthy adult in Aleppo, Syria. MATERIALS AND METHODS: A sero-epidemiological cross-sectional study was conducted from September to October in 2019. ASO titers were determined on 267 healthy patients' companions who visited Aleppo University Hospital. Geometric mean titer and Upper Limit of Normal of ASO were calculated according to sex, age and residency. Upper Limit of Normal were defined as the 80th percentile. RESULTS: Out of 267 participants; 126 (45.7%) were males and 150 (54.3) were females. The Upper Limit of Normal for total participants was 210.8 IU/ml. There was no significant difference (P-value > 0.05) among males (204.6 IU/ml) and females (225.8 IU/ml). In contrast to sex, there was a significant difference (P-value < 0.05) according to age groups, where the highest Upper Limit of Normal was in the 30-39 age group (256.0 IU/ml). CONCLUSION: ASO test is a common, easy, cheap method, so getting enough data about it is very important in the developing countries (such as Syria). In Aleppo, Syria we found that the ULN was higher than ULN from other studies. There was no significant difference according to sex and residency. On the other hand, there was significant difference according to age groups.

Migraine and tension-type headache among undergraduate medical, dental and pharmaceutical students of University of Aleppo: a cross-sectional study.

INTRODUCTION: Headache disorders are among the most common 10 causes of disability worldwide according to the global burden of disease survey 2010. Headache is also wildly common among universities students when compared with other populations. The purpose of this study is to assess headache prevalence among Aleppo University medical, dental and pharmaceutical undergraduate students. METHODS: A questionnaire-based cross-sectional study was conducted among medical, dental and pharmaceutical students at Aleppo University, Syria. We determined the type of headache according to the International Classification of Headache Disorder-III. The total number of participants was 2068. A χ2 test was used to evaluate the association between the categorical outcomes. P<0.05 was considered significant. RESULTS: Out of 2068 participants, 1604 (77.6%) were medical students, 205 (9.9%) were dental students and 259 (12.5%) were pharmaceutical students. The effect on daily activities was higher in chronic tension headache (96.7%) and migraine without aura (94.6%) than migraine with aura (91.3) and episodic tension headache (85.1%). Out of 1191 who had a headache, only 188 (15.9%) had a medical consultation. CONCLUSIONS: There was no a statistically significant difference in prevalence of tension headache and migraine according to faculties. There was a statistically significant difference in patients with migraine according to academic year, living with family and smoking. The effect on daily activities was higher in chronic tension-type headache and migraine without aura. There is a significant lack of medical consultation among students and most of them took over the counter analgesics depending on personal choice.

Bilateral anophthalmia and intrahepatic biliary atresia, two unusual components of Fraser syndrome: a case report.

BACKGROUND: Fraser syndrome or "cryptophthalmos syndrome" is a rare autosomal recessive disease. It is characterized by a group of congenital malformations such as: crytophthalmos, syndactyly, abnormal genitalia, and malformations of the nose, ears, and larynx. Although cryptophthalmos is considered as a main feature of Fraser syndrome, its absence does not exclude the diagnosis. Clinical diagnosis can be made by Thomas Criteria. Here we present the first documented case of Fraser Syndrome in Aleppo, Syria that is characterized by bilateral anophthalmia and intrahepatic biliary atresia. CASE PRESENTATION: During pregnancy, several ultrasound scans revealed hyperechoic lungs, ascites, and unremarkable right kidney at the 19th-week visit; bilateral syndactyly on both hands and feet at the 32nd-week visit. On the 39th week of gestation, the stillborn was delivered by cesarean section due to cephalopelvic disproportion. Gross examination showed bilateral anophthalmia, bilateral syndactyly on hands and feet, low set ears, and ambiguous genitalia. Microscopic examination of the lung, spleen, liver, ovary, and kidneys revealed abnormalities in these organs. CONCLUSION: The diagnosis of Fraser syndrome can be made prenatally and postnatally; prenatally by ultrasound at 18 weeks of gestation and postnatally by clinical examination using Thomas criteria. Moreover, intrahepatic biliary atresia was not described previously with Fraser syndrome; this recommends a more detailed pathologic study for Fraser syndrome cases.

A unique case of congenital transmesocolic hernia with malrotation in a 25-year-old female: a case report.

Congenital transmesocolic hernia of the transverse colon is a very rare type of internal hernia. In addition, intestinal malrotation is very rare in adults. Most of these patients do not have clear clinical manifestations. Incidence of congenital transmesocolic hernia of the transverse colon along with malrotation is an unusual phenomenon in medical literature and clinical practice. Here, we report a unique case of a 25-year-old woman diagnosed with transmesocolic hernia of the transverse colon and malrotation of the small intestine, without any history of trauma or previous surgery. The patient underwent surgery, where the hernia orifice was closed and Ladd's procedure was performed.