Pancytopenia as a first presentation of late-onset systemic lupus erythematosus: a case report.

Introduction: Systemic lupus erythematosus (SLE) is a systemic immune disease that classically occurs in young to middle-aged women and may present with cutaneous, renal, haematologic, neurological, and/or other symptoms at the time of diagnosis. Late-onset SLE or SLE in the elderly is a subtype that differs from classic SLE in terms of age group, clinical symptoms, organ involvement and severity. Case presentation: A 63-year-old female noted to have pancytopenia. The patient was diagnosed with lupus upon obtaining clinical presentations and serological marker, along with high titres of the antinuclear antibody and/or anti-double-stranded DNA antibody. The patient was managed with glucocorticoids and mycophenolate mofetil therapy, which led to a rapid response. Discussion: Late-onset SLE accounts for 2-12% of SLE patients with a minimum age of onset of 50 years and older, leading to significant delays in diagnosis. Late-onset SLE differs from early-onset SLE in terms of sex and ethnicity prevalence, clinical symptoms and signs, development of organ damage, disease activity and severity, and prognosis. Some studies have also shown that late-stage SLE patients have higher rates of RF and anti-Ro/anti-La antibody positivity, lower complement titre, and higher incidence of elevated creatinine and decreased creatinine clearance. First-line treatment of pancytopenia is glucocorticoid. In refractory cases, rituximab and immunosuppressants can be used. Conclusion: It is important to assess any unusual presentation of SLEs when clinical suspicion remains high and conducting further laboratory and imaging investigation.

Exploring prenatal depression and postpartum depression: Findings from a prospective cohort study at University Hospital Obstetrics in Damascus.

The perinatal period is crucial for both mother and newborn, and mental health, including prenatal and postpartum depression (PPD), is a significant aspect. Screening for these disorders allows for early treatment and helps prevent risks to both mother and child. This prospective cohort study was carried out at University Hospital Obstetrics in Damascus City. The first phase was during the third trimester of pregnancy and the second phase involved a follow-up assessment after 6 weeks of delivery. The Arabic-validated version of the Edinburgh Postnatal Depression Scale questionnaire (EPDS) was used. A cutoff of 13 or higher was used to determine the presence of probable depression in both assessments. Of 347 pregnant women, 38.6% had prenatal depression (PND). 295 patients have achieved the second assessment, of which 30.2% had PPD. Furthermore, 42.6% who had PND developed PPD on follow-up. Binary logistic regression indicated that PND was predicted by non-Syrian nationality, paternal absence, poor financial status, number of previous pregnancies, and a history of depression independent of pregnancy. PPD was predicted by a history of PPD, and work status. Findings underscore potential value of early screening for depressive symptoms as a predictive measure. It is recommended that women with a history of depression receive heightened attention and care, irrespective of the timing of their depressive episodes.

Exploring associations with depressive and anxiety symptoms among Syrian patients with ankylosing spondylitis undergoing biological treatment: A cross-sectional study.

People with ankylosing spondylitis (AS) are vulnerable group to experience mood disorders. It is crucial to identify factors that contribute to depression and anxiety in order to improve outcomes. This study seeks to determine the rates of depression and anxiety in Syrian AS patients, as well as identify potential predictors for these conditions. This cross-sectional study was conducted using convenience sampling at the Biological Treatment Unit of the Rheumatology Department of the Damascus Hospital. Data were collected from face-to-face interviews with patients using validated structural questionnaire. A multivariate linear regression model was used to investigate potential predictive factors of depressive and anxiety symptoms. Of the 103 patients, 49.5% showed clinically significant depressive symptoms, and 36.9 % showed clinically significant anxiety symptoms. Multivariate linear regression indicated that depressive and anxiety symptoms were predicted by job layoff, hip pain, positive history of mental distress, poor quality of life, severe fatigue, and high frequency of sleep disturbance with relatively high explanatory powers. depressive and anxiety symptoms were predicted by disease activity scores but with low explanatory power. This study demonstrated high levels of that depressive and anxiety symptoms among Syrian patients with AS undergoing biological treatment. Poor quality of life, severe fatigue, and high-frequency sleep disturbances are major predictive factors for depressive and anxiety symptoms. Screening for depression and anxiety holds significant importance in the comprehensive management of ankylosing spondylitis even in the context of concurrent biological treatment administration.

Prevalence of childhood obstructive sleep apnoea syndrome and its role in daytime sleepiness in Syria: a large-scale school-based cross-sectional study.

Obstructive sleep apnoea syndrome (OSAS) has become vastly conceded in the last decade as a possible reason for significant morbidity in childhood. This study aims to evaluate the prevalence of OSAS among school children and to assess the interrelationship between OSAS and daytime sleepiness. Methods and materials: This cross-sectional study was conducted with 1029 children and adolescents aged 6-15 years attending elementary and secondary schools in Damascus, Syria. The questions involved 19 sleep problems items using the children sleep habits questionnaire, and 4 sleep disorder items (loud snoring, having snorts or gasps, breathing pauses, daytime sleepiness). Total sleep time (TST) was determined by sleep habits. Severe possible OSAS (p-OSAS) was addressed as having all OSA symptoms "frequently", and mild p-OSAS was defined as having any of the symptoms "sometimes". Severe and mild daytime sleepiness were rated as being very sleepy during the day "frequently", and "sometimes", respectively. Logistic regression was applied to predict risk factors of severe and mild daytime sleepiness. Results: The prevalence of p-OSAS was 22.2%, of them 15.8% were mild, and 6.3% were severe. p-OSAS was more recognized in males 15.2% children (P<0.05). Most p-OSAS children sleep less than 6 h of TST; however; the mean TST was significantly lower at the secondary school level (P≤0.001). Predicted risk factors for severe and mild daytime sleepiness were students' grade level (P<0.05), severe and mild p-OSAS (P≤0.001), and TST less than 6 h (P≤0.001). Conclusions: A significant number of children have p-OSAS, affecting daytime sleepiness in school age. Physicians should consider loud snoring, and breathing pauses as marked symptoms of severe daytime sleepiness. Moreover, raising parents awareness about OSAS and daytime sleepiness is essential to ensure early access to primary care.

Golimumab therapy-induced isolated myelitis in a Behcet's disease patient: a case report.

Although central nervous system demyelinating lesions as a side effect of tumor necrosis factor (TNF)-alpha inhibitors have been reported, this treatment is still used in some autoimmune diseases. Case Presentation: A 34-year-old Syrian male presented with difficulty walking and tingling, and numbness on the left side of his body over the next 4 days, during golimumab treatment. Over the past 2 months, fatigue, recurrent calf spasms, and extremity numbness were found. Sense disturbance and hyper-reflexes of the lower extremities were found on neurological examination. MRI demonstrated variant demyelinating lesions. Steroid therapy was initiated, and golimumab was discontinued, with good outcomes as the symptoms have disappeared. Discussion: The incidence of demyelination following anti-TNF therapy is uncommon. Most studies have reported that the average time between the anti-TNFα inhibitor treatment and the demyelinating lesion presence is from 5 months to 4 years, and these lesions may appear even after the cessation of the anti-TNFα inhibitor; meanwhile, a total cure of the symptoms after treatment cessation happened in our case, which suggests a causal relation, although a temporal relationship, in this case, cannot be established. The authors believe that golimumab plays a role in the demyelinating lesions development, although it may be a clinical manifestation during the course of Behcet's disease. Conclusion: Caution should be taken for the side effects of Golimumab treatment, such as demyelinating lesions, and long-term monitoring of patients with Bechet disease is required.

Antibiotic prescription patterns for acute upper respiratory tract infections in an outpatient population with health insurance in Syria - a retrospective cross-sectional study.

Background: Antibacterial resistance is an ongoing global issue, threatening the lives of millions and affecting the quality of health systems, resulting in high costs to the worldwide economy. Syria is one of many countries with a high rate of antibiotic prescription or consumption, even before the war. Methods: A retrospective cross-sectional study was conducted to assess the pattern of antibiotic prescribing with regard to acute upper respiratory tract infection (AURTI) cases throughout the year 2019; data were collected from GlobeMed Syria (now Modern Healthcare Claims Management Company) following ethical approval. Results: The study comprised 14 913 cases, of which 13 382 (90%) had received an antibiotic prescription. All age groups showed high prescribing rates, with the 46-55 years age group having the highest (95.0%). Acute tonsillitis had the most significant percentage of antibiotics prescribed (98.7%). Cephalosporins were the most commonly prescribed antibiotic class. Family physicians were more inclined to prescribe antibiotics than those in other specialism groups. Conclusion: Syria has a high rate of prescribing antibiotics for AURTIs, which may contribute to the evolution of resistant bacteria. The rate is higher than those reported in other Arab countries. Physicians need to commit to following the official guidelines, taking the appropriate prescribing of antibiotics more seriously, and should take more care in distinguishing viral origins of AURTIs.