Tishreen University Journal -Medical Sciences Series

Assessment of factors predicting difficult laparoscopic cholecystectomy preoperatively

2024-03-04T08:03:56+00:00

Background: Laparoscopic cholecystectomy is considered the most commonly performed operation and as the standard treatment for cholelithiasis. Difficult cholecystectomy is associated with serious complications and high rate of surgical conversion.

Aim: The purpose of this study was to investigate the predictive factors for difficult laparoscopic cholecystectomy.

Materials and Methods: This was an analytical study (cross sectional) involving 156 patients who underwent laparoscopic cholecystectomy. They were selected from Department of General surgery, Tishreen University Hospital, Lattakia, during the period 2022-2023.

Results: Out of 156 patients, 46 were male and 110 were female. Mean age of the patients was 62.13±7.4 years with presence of diabetes mellitus(DM) in 14 cases(9%). According to Randhawa score, cholecystectomy was easy in 138 cases(88.5%) and difficult in 18 cases(11.5%) with detecting operative difficulty in laparoscopic cholecystectomy in 111 cases(71.2%). Cholecystectomy was more difficult in patients older than 50 years(p:0.04) and with increasing body mass index(BMI)(p:0.03). There were no significant differences regarding of difficult cholecystectomy according to gender(p:0.9), precence of DM(p:0.2), previous history of ERCP(p:0.3), hospitalization for cholecystitis (p:0.07), prior abdominal surgery(p:0.2), levels of CRP(p:0.8), echographic findings including thickening of the gallbladder wall(p:0.08), pericholecystic fluid(p:0.1), impacted stone in gallbladder neck(p:0.1), and Randhawa score(p:0.07). Accuracy, sensitivity, specificity, and positive predictive value of Randhawa score were37.82%, 14.41%,95.55%, and 88.88% respectively. In addition to, cholecystectomy was easy in 61 cases(39.1%) and difficult in 95 cases(60.9%) according to modified Randhawa score depending on the most statistically significant factors with accuracy, sensitivity, specificity, and positive predictive value: 69.23%,71.17%, 64.44%, and 83.15% respectively.

Conclusion: The current study demonstrated the importance of use preoperative scale to predict the difficulty of surgery in patients who are planning laparoscopic cholecystectomy , inform patient with adequate preoperative planning and request support if necessary.

Early Oral Refeeding In Patients With Mild Acute Pancreatitis

2024-03-06T06:25:28+00:00

Background: Acute pancreatitis is the most common inpatient gastrointestinal diagnosis in the United States. 80% of acute pancreatitis cases were classified as mild in severity and resolved within 5-7 days. the optimal timing for recommencing oral feeding is still controversial.

Aim: To evaluate the safety and efficacy of early oral refeeding (EOR) in patients with mild acute pancreatitis (AP).

Materials and Methods: This was a prospective, randomized, comparative study conducted in the department of gastroenterology in Tishreen University Hospital in 2022-2023 years. A total of (96) patients who suffer from mild acute pancreatitis. They were splited randomly into two groups, 48 patients in early oral refeeding group (EOR) (started oral feeding once they subjectively felt hungry) and 48 patients in Late (regular) oral refeeding group (LOR). Patients of the two groups were compared for abdominal pain relapse, serum amylase elevation after oral refeeding and total length of hospitalization (LOH).

Results: There were 48 patients in each group, There was no significant statistical differences when comparing abdominal pain relapse and serum amylase elevation after oral refeeding between the two groups which shows good tolerance for early oral refeeding. patients in the EOR group had significantly shorter total length of hospitalization (LOH) (3.61 ± 0.57 vs 5.81 ± 0.77 days; P˂ 0.05) than LOR group.

Conclusion: In patients with mild acute pancreatitis, early oral refeeding (EOR), with the subjective feeling of hunger, is safe, efficient, and reduces LOH.

Keywords: refeeding in acute pancreatitis, early oral refeeding.

Investigation of Thyroid Disorders in Recently Diagnosed Patients with Breast Cancer in Tishreen University Hospital

2024-02-26T08:41:18+00:00

Introduction: Breast cancer (BC) is one of the most prevalent malignancies worldwide and also Syria. The relationship between thyroid disorders and breast cancer (BC) is debated. Many reports show interesting findings about the nature and the incidence of thyroid disorders in relation to breast cancer.

Objective: The aim of this study was to analyze the prevalence of thyroid disorders in recently diagnosed patients with a positive biopsy for breast cancer prior to specific antitumor treatment, in Tishreen University Hospital.

Materials and Methods: To clarify this controversial issue, a cross-sectional study on thyroid function in recently diagnosed BC patients was performed. Serum thyroid hormones (TSH, FT3, FT4) and thyroperoxidase antibodies (Anti-TPO Abs) levels were evaluated in 50 BC patients before or after surgery, and 30 healthy control women.

Results: Invasive ductal carcinoma is the common histologic subtype of BC 86%. The incidences of thyroid diseases were higher in BC patients than in control individuals, especially subclinical and overt hypothyroidism (64% versus 20%, P=0.002). The mean values for TSH and Anti-TPO abs were significantly higher in BC (P=0.0001) and increasing positively with tumor Grade.

Conclusion: Our results indicate an increased prevalence of subclinical and overt hypothyroidism, higher TSH and A-TPO levels in BC. Our study suggests the existence of an association between hypothyroidism, high TSH and A-TPO levels and BC. However, further studies are required to confirm this association.

Diagnostic significance of total PSA in differential diagnosis between prostate cancer and benign prostate diseaseswith PSA (4-10) ng/ml and age below 75 year

2024-03-02T06:30:15+00:00

Objective: The aim of the research is Revealing the diagnostic importance of prostate-specific antigen (PSA) analysis at values between (4-10) ng/ml in the differential diagnosis between prostate cancer and benign prostatic diseases at the age of less than 75 years in patients visiting Tishreen University Hospital between the years 2021-2022.

Methods: Study type: A Retrospective Observational Study
The research sample consisted of 53 patients attending the Urology Clinic and Department at Tishreen University Hospital with lower urinary tract symptoms in the period extending between 2021 and 2021 AD. Each patient was studied by taking a clinical history, clinical, radiological and laboratory examination, recording findings such as prostate size, DRE , PSA value, and performing a prostate biopsy for patients who met the inclusion and exclusion criteria. A special form was organized that included the clinical history, clinical examination, laboratory results, and pathological autopsy report. Taking into consideration the following: Pay attention while taking the clinical history to the presence of a history of acute urinary continence, urethral catheterization, use of transurethral endoscopic instruments, or any acute lesion of the prostate before drawing a blood sample , as this may lead to a false increase in the PSA value.Draw blood samples before performing a DRE

Results: The most frequent age group was 60-69 years, with a rate of 50.9%. This can be explained by the hormonal changes observed with age and accompanying diseases, which play a role in the pathogenic mechanism of prostate diseases.Prostate cancer was diagnosed in (17%) of the research sample according to the histopathological findings, compared to (83%) benign cases, the largest percentage of which was (BPH) with 33 patients, constituting (62.3%) of the studied sample.The DRE was positive in the majority of cases of prostate cancer (88.9%) compared to 34.1% in benign cases. The negative test in some cases is due to DRE identifying disorders in the posterior and lateral aspect of the prostate only.The size of the prostate in cases of prostate cancer was statistically significantly lower compared to benign lesions of the prostate (P: 0.03), where it was 53±18.4 g) in malignant cases compared to 77.52±32.7 g) in benign ones.It was observed that there was a statistically significant increase in PSA values with increasing age (P: 0.02), as it reached (4.81±0.7 ng/ml) in the age group (40-49 years) compared to 6.59±2.1 ng/ml (in ages older than 70 years). This is due to the accompanying increase in the size of the prostate gland with age, in addition to the fact that the natural barriers of the prostate that retain PSA within the prostate ducts become more permeable with age, allowing PSA to enter the circulation.No statistically significant differences were observed in PSA values according to the presence of prostate cancer (P: 0.7), as it reached (6.39±1.7 ng/ml) in prostate cancer versus (6.18±1.9 ng/ml) in its absence, or in relation to the result of anal probing (P: 0.2). The slight increase in PSA values in cancer cases can be explained by the fact that cancer cells allow PSA to easily pass through the cell wall into the peripheral extracellular fluid and reach the blood, as cancer cells lack the basal layer that limits the passage outside the cells. The cut-off point for PSA (cut-off value: 5.38) gave a sensitivity of (55.6%) and specificity (59.8%) in diagnosing prostate cancer. The accuracy of prostate size was higher in diagnosing prostate cancer (AUC: 0.73) compared to PSA (AUC: 0.42) in patients with PSA within range (4-10ng/ml).

Conclusions: 1- Emphasizing the importance of conducting a biopsy and histological study in patients with a PSA within the range of 4-10 ng/ml, while linking it to the clinical findings directed at verifying prostate cancer (age - DRE- prostate size).

2- Emphasizing the importance of routinely titrating the prostate-specific antigen in all men over fifty, and then periodically titrating it according to the risk factors and family history of each patient.

3- Increasing public awareness about prostate cancer and the importance of early detection.

4- The importance of conducting new studies on the incidence of prostate cancer in patients whose antigen value is within the normal range, below 4 ng/ml.

Study of influence of blood pressure variabilities in outcome of spontaneous acute intracerebral hemorrhage in Tishreen University Hospital

2024-02-26T03:58:36+00:00

Background: Spontaneous intracerebral hemorrhage SICH is considered a serious disease despite progressing medical development, in which is associated with significant morbidity and mortality. Arterial hypertension is the most important risk factor for SICH and alterations in blood pressure is related to poor outcome.

Aim: The purpose of this study was to investigate the effects of blood pressure variability on the clinical course of SICH.

Materials and Methods: This was an analytical cohort prognostic study involving 107 patients with proven diagnosis of SICH at Neurology unit, Internal Medicine Department, Tishreen University Hospital, Lattakia, during the period 2022-2023.

Results: Out of 107 patients,70 were male and 37 were female. Mean age of the patients was 60.33±9.7 years and hypertension represented the most frequent comorbidities(85.1%). Outcome was good in 21.5% and poor in 78.5% without presence of any significant differences between two groups regarding of age and gender(p>0.05). The following factors were detected in high frequency in patients with poor outcome: hypertension(p:0.02), diabetes mellitus(p:0.001), coronary disease(p:0.004) and smoking(p:0.0001). Means of systolic blood pressure values were significantly higher in poor outcome group on admission, during 6 hours, and 24 hours(203.1±25.4 versus 182.3±23.4,p:0.0001),( 190.5±13.4 versus171.1±15.3,p:0.0001 ), and(162.3±18.3 versus140.8±16.4,p:0.0001 ) respectively with presence of systolic pressure variability in 59 cases(55.1%). blood pressure variability was associated with the risk for hospital mortality OR: 4.8[2.1-9.8],p:0.0001and poor outcome OR:2.9[1.1-7.7],p:0.0001.

Conclusion: The current study demonstrated that presence of hypertension and the associated variability are considered modifiable warning flags that might improve final outcome of the patients with SICH

Prevalence of Anemia in Patients with Type 2 Diabetes Mellitus

2024-03-06T06:35:48+00:00

Background: Anemia is one of the common complications of diabetes mellitus, and their risk in diabetic patients is estimated to be 2 – 3 times higher than that of patients without diabetes. Presence of anemia in diabetes leads to progression the vascular complications.

Objectives: Evaluating the prevalence of anemia in patients with type 2 diabetes mellitus, studying the relationship of anemia with demographic characteristics, lifestyle, and laboratory variables, and evaluating the severity of anemia and determining its type.

Methods and patients: 300 adult patients with type 2 diabetes mellitus (185 females, 115 males) attending the Endocrinology and Metabolic Diseases Clinic and Department at Tishreen University Hospital in Lattakia during the period 2022-2023 participated in the study.

Anemia was defined by hemoglobin values of ˂ 13 g/dl in males and ˂ 12 g/dl in females, based on the criteria of the World Health Organization (WHO).

Results: The prevalence of anemia in our study was 39.7% (119 patients), and inflammatory anemia was the most common at 74% (88 patients) followed by iron deficiency anemia at 26% (31 patients). We found that 27% of males (31 males) and 47.6% of females (88 females) were anemic, and inflammatory anemia was the most common in both sexes. The severity of anemia was divided into mild anemia at a rate of 59.66%, anemia of moderate severity at a rate of 38.66%, and severe anemia at a rate of 1.68%.

There are statistically significant differences with regard to sex, age, physical activity, abdominal obesity, duration of diabetes, treatment of diabetes, hypertension, metabolic syndrome.

There is also a statistically significant difference regarding the distribution of anemia severity according to gender, age groups, and duration of type 2 diabetes mellitus.

Conclusion: There is a high prevalence of anemia of chronic diseases in patients with type 2 diabetes mellitus. This affects the disease progression, enhances the cardiovascular risk, and increases the risk of co morbid conditions.

Sensitivity and specificity of ocular movements test (HINTS) in detection of central acute vestibular syndrome

2024-03-17T04:05:16+00:00

Background : Acute vestibular syndrome may seem intimidating due to the large overlap of symptoms with vestibular and non-vestibular causes, including serious and benign causes. In addition to the lack of a diagnostic method to differentiate between central and peripheral causes early.
Objective : This study aimed to evaluate the sensitivity and specificity of ocular movements test (HINTS) in detection of central acute vestibular syndrome.
Materials and Methods : A prospective cross-sectional study was designed which included (n=58) patients admitted with a complaint of acute vestibular syndrome to Tishreen University Hospital in Lattakia during the years 2021-2022. Patients with acute vestibular syndrome (according to the definition of the International Classification of Vestibular Disorders) who were admitted to the hospital and who had at least one risk factor for stroke, were included. Patients with a history of recurrent vertigo, those with diseases that would preclude HINTS testing such as cervical or ocular diseases, and those for whom MRI was contraindicated were excluded. HINTS testing and brain CT were performed on admission. Brain MRI was performed 48 hours after the onset of symptoms. The central lesion was diagnosed with a positive CT scan or MRI.
Results : Among the 58 patients 23 patients were diagnosed with a central lesion and 35 patients with a peripheral lesion. We found that in patients with a central lesion, ischemic stroke was the most common cause at all, and cerebellar infarction was the most common with a rate of 34.78%. We found bulbar infarction in 5 patients with a rate of 21.74%, pontine infarction in 4 with a rate of 17.39%, cerebellar metastasis in 3 with a rate of 13.04%, cerebellar peduncle infarction in 2 with a rate of 8.70%, and cerebellar hemorrhage in 1 with a rate of 4.35%. The HINTS test was positive (i.e. indicate a central lesion), in 22 patients with a central lesion, and negative (i.e. indicate a peripheral lesion), in 33 patients with a peripheral lesion. Thus, the sensitivity of the HINTS test in detecting central acute vestibular syndrome reached 95.65% and its specificity reached 94.29%.
Conclusion : The HINTS test is of particular importance because it is a simple clinical test that can be performed within minutes and without cost. The HINTS test has high sensitivity and specificity in diagnosing central acute vestibular syndrome.

Analytical Study of Portal Vein Thrombosis: Risk Factors and Clinical Characteristics

2024-03-17T03:40:12+00:00

Background: Portal vein thrombosis (PVT) is an important and poorly studied condition with a poorly defined natural history.

The diagnosis of portal vein thrombosis has increased in recent years due to the availability of modern imaging techniques.

The main aim of this study was to determine the risk factors, symptoms, and clinical signs of PVT.

Methods: The study included 30 patients diagnosed with portal vein thrombosis by Doppler ultrasound or CT scan from patients attending Tishreen University Hospital from January 2023 to January 2024.

Results: A single risk factor for portal vein thrombosis was found in 70% of patients, two factors were present in 10%, and PVT was idiopathic in 20%.

Abdominal malignancies were the most common risk factor (36.6%) and abdominal pain was the most common manifestation (53.3%).

The percentage of acute thrombosis was 63.3% and chronic thrombosis was 36.7%.

Splenomegaly, gastrointestinal haemorrhage, and oesophageal and gastric varices were more common by a statistically significant difference in patients with chronic thrombosis.

Ascites was more common in patients with cirrhosis or cancer compared to patients without cirrhosis and cancer.

Death occurred in 9 patients, 7 of whom were cancer patients.

Conclusion: Portal vein thrombosis is an important condition that has become considered an separate clinical entity, the possible causes and risk factors must be investigated and treated if possible because the prognosis is primarily depended on the underlying cause rather than on the thrombosis and its complications.

In- house preparation of modified Kleihauer-Betke test reagents for estimation of fetomaternal hemorrhage

2024-03-11T10:30:51+00:00

Fetomaternal hemorrhage (FMH) refers to the entry of fetal blood into maternal circulation before or during delivery. In addition to its role in diagnosing idiopathic neonatal anemia, estimation of FMH is essential in the passive prophylaxis programs of hemolytic disease of the fetus and newborn (HDFN) by the appropriate administration of RhDIg to RhD negative women following delivery of D positive babies, or after exposure to a sensitizing event during pregnancy. The Kleihauer-Betke test (KBT) is still considered one of the most important tests in the detection of fetal red blood cells within the maternal circulation. KBT principle is based on the the characteristic resistance of fetal hemoglobin (HbF) to acid elution, in contrast to adult hemoglobin (HbA). In this study, we aimed to prepare in –house reagents needed in the KBT to use them in the detection of fetal hemoglobin and the estimation of FMH ,thus alleviating the need to import the highly expensive kits .

The modified Kleihauer-Betke method according to Clayton 1963 was adopted in our study, and the required reagents were prepared according to the method depicted in the American Association of Blood Banks (AABB) Technical Manual. Negative controls and different dilutions of positive controls were prepared to test, i the efficinecy of our locally prepared reagents,. Our experiments were carried out at the Central Haematology Laboratory in Tishreen University Hospital. PH measurements of the regeants were performed at a regular intervals throughout a storage period of 60 days, along with their effieveincy in HbF detection and estimation), and the, and both were shown to be constant. KBT using local reagents showed good accuracy in detecting fetal cells with a little tendency to overestimate FMH. According to our results, we can consider this study as a starting point for the use of this reagent in the investigation of unexplained neonatal anemia, and in conducting larger studies of FMH determination in women, thus helping to improve and standardize RhDIg administration.

The effect of applying the PLISSIT model of sexual counseling on sexual problems among psychological women

2024-04-02T10:24:58+00:00

Introduction: Women's sexual health is an ongoing practical experience of physical, psychological and social well-being related to sex and an important component of emotional and physical happiness. It is an important aspect that must be taken into consideration in order to improve the well-being and health of women. Research objective : Evaluating the effect of applying the PLISSIT model of sexual counseling on sexual problems among psychological women. Research materials and methods: A quasi-experimental study was conducted on a random sample of 60 women one week after giving birth and up to 6 months after the last birth. They were selected by a simple random method in the women’s clinic at the Al-Assad Medical Complex in Hama, the women’s clinic at the Family Planning Center, and the women’s clinic in Comprehensive clinics in Hama. They were randomly divided into two groups: a control group of 30 women who were left to the care routine in the clinic, and an experimental group of 30 women (the PLISSIT model for sexual counseling was applied to them). Data were collected through two tools prepared for this purpose. Conclusions: The effectiveness of applying the PLISSIT model for sexual counseling in reducing the rate of sexual problems among women in the postpartum stage. There is no significant relationship between the two groups of the study in terms of the demographic characteristics of the women in the study sample, which indicates the homogeneity of the sample in the two groups.. Recommendations: The necessity of adopting the PLISSIT model for sexual counseling in the nursing care provided to women during the postpartum period and after it, educating and training midwives and nurses on how to apply the PLISSIT model for sexual counseling, conducting a similar study on a large sample and from several hospitals that allows generalizing the results that have been obtained.

The value of Mean Platelet Volume as a prognostic factor in Respiratory Distress Syndrome in premature neonates

2024-06-01T21:32:08+00:00

Background: Respiratory Distress Syndrome is a major cause of morbidity and mortality in premature neonates. MPV is an indicator of platelet function. It may be considered a risk factor for developing RDS.

Objective: to evaluate the role of Mean Platelet Volume as a prognostic indicator in the occurrence of respiratory distress syndrome in premature infants.

Materials and Methods: An analytical study)case-control) conducted on103 premature:49 males and 54 females, and who were admitted to the Neonatal Intensive Care Department at Tishreen University Hospital between July 2022 and July 2023 after applying exclusion criteria, study sample was divided into two groups: 56.3% of premature infants with RDS and 43.7% premature infants without RDS. Blood samples were taken on the first and third day of life to conduct complete blood count including (number of platelets and their average size).

Results: the mean of MPV on the first day of life was higher in the RDS group than in the other group with a statistically significant difference. MPV on the third day of life was higher in the RDS group±10.89)1.3(versus±9.21) 1.3) with P:0.0001. It was the best cut-off value for MPV on day1 that could be used for prediction RDS is9.9 fl with sensitivity 77.8% and specificity 62.1% respectively. elevation of the mean values of MPV on the first and third days of life increased with increasing severity of RDS. In addition, the mean values of MPV on the first day were higher in the group of premature infants who died(11.84±1.1 versus9.85±1.4, P:0.0001)

Conclusion: : MPV is a simple, readily available biomarker that can be used as an aid to predict RDS incidence.

comparative study between the outcomes and complications of abdominoplasty with / without tension sutures

2024-04-21T10:40:29+00:00

Background: Abdominoplasty or Abdominoplastie (in French), commonly referred to as "tummy Tuck," is a procedure for reducing excess skin and fat around the abdomen and strengthening the muscles of the abdominal wall.

Several studies have suggested that drainless abdominoplasty using PTS shows a high potential for reducing the risk of seroma formation.

Objective: The aim of this research is to assess the following consequences and complications of abdominoplasty using progressive tension suture and abdominoplasty without using PTS.

Materials and Methods: After taking informed consent from patients to take part in the study, surgical procedure was performed for patients under general anesthesia and with traditional abdominoplasty technique. Patients are randomly divided into two groups: group A: abdominoplasty with PTS, Group B: patients who had abdominoplasty without PTS.

The following variables examined the duration of surgery, the assessment of pain, daily and total drainage through the drain, drain removal timing hospitalization, local and systemic complications (delayed wound healing, infection, thrombotic accidents seroma occurrences (including frequency and drained volumes), readmissions, and emergency visits. The Numeric Rating Scale (NRS) was utilized to gauge pain intensity, with subsequent data entry and statistical analysis performed using SPSS Version 26.

Results: The study included 24 women, the age of patients in the sample ranged between 31-60 years with an average about 40.5 years. The average value of BMI was 29.4 kg/m². The surgery took 130.1 minutes on average (94-160 minutes). The average degree of pain was 5.04, the average daily drainage through study patients was 62.15 ml. Seroma formations were reported in one and three patients in Groups A and B, respectively, with varying drainage frequencies and volumes. Scar of surgical procedure were faster to heal in group "A" in which PTS were used compared to group "B" in which it didn’t.

Conclusions: Progressive Tension Sutures to reduce the risk of seroma, reduce daily and total drainage, periodic follow-up of patients in case of seroma formation, more studies involving larger numbers of patients and a longer period of study, are needed.

Evaluation study of bond strength of two root canal posts

2024-03-06T06:43:05+00:00

Aim: The aim of this study was to compare the attachment of the modified diamond post and the Erlangen post within the root canal.

Materials and Methods: The research sample consisted of 30 healthy, single-canal human lower premolars extracted for orthodontic purposes, cleaned with periodontal curettes, and preserved in Timol solution during the research period. The dental crowns were cut, and the length of the canals was determined by inserting a #15 K file into the canal until it became visible, so the working length was equal to the length of the file minus 1 mm.

The teeth were then prepared in the traditional method, then filled using the lateral condensation technique using zinc oxide and eugenol with gutta percha. The teeth were then placed in the incubator for 7 days at a temperature of 27 degrees Celsius and 100% humidity.The teeth were then divided into two equal groups (each group had 15 teeth), so that the Erlangen wedge was applied in the first group, and the modified diamond post in the second group. The sample was then subjected to a tensile test, the data was recorded, and appropriate statistical tests were conducted.Results: The diamond post bond streangth were greater than the Erlangen post bond streangth within the root canal.Conclusion: Within the limits of this study, it can be concluded that diamond wedge bonding is better than Erlange post bonding.

Study of interaction between sugammadex as a modified gamma cyclodextrin and propranolol using different methods

2024-03-14T08:20:07+00:00

Sugammadex, a new modified gamma cyclodextrin, reverses the neuromuscular blockage induced by rocuronium by forming a strong complex with this muscle relaxant. In order to evaluate possible interactions with potentially co-administered drugs, the interaction between sugammadex and propranolol was investigated using three different methods; the affinity capillary electrophoresis (ACE) method coupled to an ultraviolet (UV) detector, the affinity capillary electrophoresis method coupled to fluorescence detector and Fluorimeter, for the first time. Using ACE, changes in the effective mobility of guest drug were correlated with the increasing concentration of the host molecules in background electrolyte (BGE). Using Fluorimeter, changes in the fluorescence intensity of guest drug were correlated with the increasing host concentration in sample solution. Detected changes were successfully fitted into a nonlinear curve equation; assuming 1:1 stoichiometric interaction. The calculated association constants (K_a) were: 4137 M^-1, 4215 M^-1and 4110 M^-1 using three methods as mentioned above; respectively. These values confirm the affinity strength of the predicted inclusion complex between sugammadex and propranolol.

Assessment the application of control infectious diseases procedures among preschool children by teachers' views in Kindergartens, Lattakia

2024-02-28T03:54:16+00:00

The current study aimed to assess the application of control infectious diseases procedures among preschool children by teachers' views in Kindergartens, Lattakia. It was conducted in six kindergartens between 04/02/3202 and 06/03/3202, on an available sample of 37 male and female teachers, and data was collected using a questionnaire. It consists of: The first part includes demographic information, and the second part includes infection control procedures in kindergartens.

The results showed that infection control procedures were being applied for: fever, diarrhea, chickenpox, and coronavirus, and that the procedures used to control infectious diseases among kindergarten children had a good level of application among teachers. Therefore, it is recommended to design educational programs that include teaching the procedures used to control infectious diseases among kindergarten children, and to enhance the role of the media and social media in publicize health awareness.

Antibiotic resistance of urinary tract pathogens among wide population of Syrian patients.

2024-03-30T07:46:35+00:00

The aim of this study was to evaluate the prevalence of antibiotic resistance among bacteria isolated from urine cultures of Syrian patients of different genders and age categories. The most frequently identified uropathogen in urine cultures was Escherichia coli (68%). Of the bacterial isolates, 2% were resistant to a single antibiotic, while 98% were resistant to at least two antibiotics. A significantly high in-vitro resistance rate (over 90%) was observed among bacterial isolates, particularly against Cefotaxime, Nalidixic acid, Cefexime, Cephalexin, and Cefpodoxime. Resistance rates for Cefetriaxone, Cefuroxime, and Trimethoprim-Sulfamethoxazole ranged from 70% to 80%. The resistance rates for Nitrofurantoin, Amoxicillin-Clavulanic acid, Ciprofloxacin, and Norfloxacin ranged from 37% to 60%. For some antibiotics, resistance rates remained consistently high across all age groups (Trimethoprim-Sulfamethoxazole, Cephalexin, and Cefexime), while for others, resistance rates increased with increasing patient age (Nitrofurantoin, Ciprofloxacin, and Norfloxacin). Finally, Amikacin, Gentamycin, and Imipenem demonstrated good sensitivity (over 90%) across all age groups.

The role of urodynamic study in setting the indication for surgical intervention in patients with benign prostatic hyperplasia

2024-03-30T08:01:18+00:00

Background: Benign prostatic hyperplasia (BPH) with LUTS represents the fourth most common disease in the male population over 50 years of age. When there is an obstruction at the level of the lower urinary tract accompanied by benign prostatic hyperplasia, surgical intervention is often the most applied option, despite the rate of accompanying complications that may occur. To ensure better results, appropriate indications for surgical intervention should be chosen, especially since BPH may not be the lesion causing the symptoms that the patient suffers from.

Objective: To determine the diagnostic value of urinary flow study in selecting BPH patients who will undergo prostatectomy.

Patients and methods: A randomized controlled clinical study, including all BPH patients attending the Department of Urology at Tishreen University Hospital in Lattakia and who will undergo surgery to remove enlarged prostate in the time period between 2022 - 2024. They were randomly divided into two groups: Group A (traditional investigations followed by surgical intervention to remove enlarged prostate), and group B (conventional investigations followed by urine flow studies).

Results: The research sample included 55 patients, distributed into two groups: Group A (27 patients) and Group B (28 patients). The average age was 67.78 years, the average value for IPSS was 21.74, the average value for prostate volume was 45.85 cc, and the average value for urinary residual was 157.09. As for the results of the urine flow study for group B patients, the average value of the Maximum flow rate was 11.50 ml/second, detrusor pressure was 12.17 cm H2O, and bladder compliance was 22.25 ml/cm H2O. Based on these results, 20 patients from group B were referred for surgery, and the remaining patients were referred for neurological treatment.

Conclusion: Urodynamic study contributes to determining the indication for surgical intervention in patients with BPH by accurately determining the cause of the urinary symptoms that the patient suffers from.

Tumor necrosis factor TNF-a alpha

2024-03-11T10:26:57+00:00

Tumor necrosis factor alpha and nesting failure with its effects on gestational development, based on the fact that the ideal pregnancy in its various stages requires the development of an ideal utero-placental unit, and based on the fact that the placental unit needs the formation of the coronary villi responsible for maternal embryo transfer, which are formed from the villous gasoblasts and also need to form In the spiral arteries, which originate in extravillous invaginations, the effect of tumor necrosis factor, depending on the stage at which it affects what was previously mentioned, can lead to failure of nesting if it inhibits the transformation of invadoblasts into villous invaginations, or lead to chemical nesting if it inhibits the transformation of invaginations into Extravillous gasoblast However, if its effect is in the later stages, it may lead to miscarriage or continuation of the pregnancy with high arterial pressure or decreased fetal growth inside the uterus. The main mechanism of action of TNF alpha is to stabilize the expression of aquaporins 3 and 9, which are water channels responsible for the process of maternal-fetal blood exchange or the process of Inflammation mediated by cytokines and interleukins leads to the same result, and therefore it is accused of different roles, as for the mechanism of blood ischemia through inhibiting the migration of blood cells. Extravillous invasion and its penetration into the uterine myometrium, and this is consistent with the vascular role or an immune role mediated by cytokines and interleukins, resulting from the imbalance between immune rejection and immune tolerance, or the loss of the process of balance and coordinated action between fetal and maternal tissues by breaking the balance between the inflammatory state and immune-releasing factors.

Dissection Technique for Abdominoplasty: A Prospective Study on Scalpel versus handheld electrocautery.

2024-04-16T07:59:00+00:00

Background: Abdominoplasty, colloquially known as "tummy tuck," is a surgical procedure aimed at removing excess skin and fat around the abdomen while strengthening the muscles of the abdominal wall. Numerous recent studies have delved into the comparison between employing a surgical scalpel and handheld electrocautery for dissecting a skin-lipofacial flap, highlighting the variations in complications and the duration of the surgical procedure, given the distinct advantages and drawbacks of each technique.

Aim: The primary goal of this research is to assess outcomes and complications post-complete surgical abdominoplasty by comparing the dissection methods employing a surgical scalpel versus an electrical clipping technique utilizing a unipolar handheld electrocautery device.

Materials and Methods: Informed consent was obtained from participating patients who underwent surgery under general anesthesia using the conventional tummy tuck approach. Subjects were randomly grouped into Group A, where skin adipose flap dissection was performed using a surgical scalpel, and Group B, where dissection was executed using electrocautery.

Key variables scrutinized encompassed surgical duration, pain intensity evaluations, daily and overall drainage through the drain, drain removal timing, hospitalization, local and systemic complications (e.g., delayed wound healing, infection, thrombotic incidents), seroma occurrences (including frequency and drained volumes), readmissions, and emergency visits. The Numeric Rating Scale (NRS) was utilized to gauge pain intensity, with subsequent data entry and statistical analysis performed using SPSS Version 26.

Results: Patient ages in the study ranged from 31 to 60 years, with an average BMI of 29.4 among participants. The mean surgical duration was 146.2 minutes in Group A and 117.3 minutes in Group B. Postoperative pain scores averaged 5.5 in Group A and 5.1 in Group B. Daily drainage through the drain measured an average of 57.4 ml in Group A and 75.5 ml in Group B. Seroma formations were reported in one and three patients in Groups A and B, respectively, with varying drainage frequencies and volumes. The main volume of seroma aspiration in group A was 20.6 ml, and 45 ml in group B.

Conclusion: Employing a surgical scalpel for dissection mitigates seroma occurrence, reduces drainage rates, and alleviates postoperative pain severity. Meanwhile, handheld electrocautery dissection aids in minimizing surgical duration, cost reduction, procedural complexities, and intervention rates, albeit with potential complications like bleeding.

Study of diagnostic accuracy of bone marrow aspiration and bone marrow biopsy in pancytopenia patients

2024-03-17T03:42:22+00:00

Background:Pancytopenia is defined by reduction of all three formed elements of blood below the normal reference. It can be a manifestation of a wide variety of disorders, yet there is a few reported studies of the frequencies of various etiologies, and these frequencies exhibit substantial geographic variation. Bone marrow aspiration and biopsy evaluation along with good clinical correlation is of utmost importance to evaluate the causes of pancytopenia.Aim of study: The present study was a prospective clinicohaematological study undertaken to analyze the various causes of pancytopenia by evaluating bone marrow aspiration and biopsy and correlating with clinical findings, complete blood counts and peripheral blood picture. The present study was under taken to evaluate the accuracy of the bone marrow aspiration and biopsy in the diagnosis of hematological disorders presenting with pancytopenia. Methods: This was prospective study Conducted in Tishreen academic hospitals in Lattakia city, Syria, over a period of one year (May 2016-May 2017).A total of 70 patients (32 female, 38 male) with the diagnosis of pancytopenia were enrolled in the study, written consent was obtained for the patients to participate in the study. A detailed medical history, full physical examination, complete blood count with peripheral film, erythrocyte sedimentation rate , liver function tests and serology for viral hepatitis, ultrasonography of abdomen. Bone marrow aspiration and bone marrow biopsy have been done for all patients. Perl’s stain, immune-histochemistry and reticulin were done wherever necessary. Results:The majority of cases were encountered in the age group of more than sixty years old .Infiltration disorders were the commonest cause ( 35.71%) followed by viral infections (25.71%) , megaloblastic anemia (10%) , aplastic anemia (10%) , myelodysplasia (7,14%), myelofibrosis( 7,14%) and leshmaniosis ( 4,28%) . bone marrow biopsy was superior in the diagnosis of infiltrative lesions (100% versus 33-50%), in aplastic anemia (100% versus 0%) myelofibrosis (100% versus 0%) and myelodysplasia (100% versus 20%), while bone marrow aspiration was superior in the diagnosis of infectious lesions such as leishmaniasis (66.66% versus 33.33%). Bone marrow aspiration was diagnostic of in 100% of cases in megaloblastic anemia the bone marrow aspiration alone was conclusive in only 20 patients( 25.71%), while the bone marrow biopsy procedure alone was conclusive in 50 patients ( 71.42%), and when the aspiration and biopsy were performed together, the diagnostic rate increased to 84.2% (59/70) patients. Conclusion: This study concluded that most common cause of pancytopenia is infiltration disorders followed by infections. The advantages of bone marrow aspiration and biopsy differ; both are complimentary to each other and should be performed simultaneously for a complete bone marrow work up and evaluation. Elaborate hematological investigations and bone marrow examination, both, in correlation with clinical findings are vital for the diagnosis of pancytopenia.

Determination of crude fiber content in some commercial dietary fiber supplements available in Syria

2024-03-28T06:30:19+00:00

Due to numerous studies demonstrating the positive impact of dietary fiber intake on human health, many dietary supplements incorporating these fibers have recently been marketed as a reliable source to fulfill the recommended daily need for optimal benefit. However, high consumer demand, difference in composition, and the need to ensure safety, make regulation and quality control of such supplement mandatory, thus determining the amount of these fibers in their preparations is considered the first stage in this regulation process. Dietary fibers are defined as edible starchy polymers that can’t be digested in human intestine, and are classified into water soluble and insoluble fibers. Crude fiber determination is one of the routine analytical methods used to measure the amount of fiber in food samples. Crude fiber is defined as the organic matter that remains after digesting the plant sample in a diluted sulfuric acid solution (1.25%) and then in a diluted potassium aqueous solution (1.25%). This research aimed to determine the amount of crude fiber in five products available in the local market that were declared to contain granules, psyllium seeds powder, or wheat bran powder, depending on the acid and alkaline digestion method. The percentages of crude fiber in these preparations 0.046 ± 0.0276, 75.867 ± 21.4715, 25.4833 ± 14.8368, 4.167 ± 0.384 and 1.07 ± 0.2961. The difference in the crude fiber content in these preparations, when compared with each other or with their counterparts that have been studied before, may be due to the difference in the plant variety used as raw materials and to the difference in manufacturing to manufacturing procedures during the production of these pharmaceutical preparations.This study recommends the need to determine the type and quantity of dietary fiber in commercial preparations containing it and add this information to their label.

Studying the element of strength characterized by speed among football players during the stage of formation and preparation of Latakia clubs

2024-03-14T08:26:22+00:00

The training and development of the element of strength characterized of speed at the stage of formation and preparation of football players is one of the important factors in the success of the training program for coaches, which requires great attention to this physical element, which has a role and great importance in improving motor skills such as shooting and deception,it also contributes to improving special physical abilities and tactics such as starting, jumping and the power of high balls with the head.

The team that bounces individuals high is relatively superior,especially with vertical balls,more than the of strength characterized of speed among football players in Latakia before and after the completion of the training and preparation phase and to identify the level of change in it.

After conducting the test and completing it completely, the results were collected,statistically processed, presented and discussed in a scientific manner in order to achieve the research goal and at the end of the research we came to a clear difference in the two research sample

The Effect of Age on the Success of Intraovarian Platelet-Rich Plasma Injections to Improve Ovulation

2024-02-06T03:55:25+00:00

The research aimed to study the effect of age on the success of intraovarian injection of platelet-rich plasma to improve ovulation, whether related to cases of ovarian insufficiency (high FSH value), low ovarian reserve (low AMH value), or polycystic ovary PCO (high AMH value).

(40) female patients of reproductive age were admitted to the women's clinic at Tishreen University Hospital, who were suffering from infertility due to premature ovarian insufficiency, low ovarian reserve, or dysovulation due to polycystic ovary syndrome. The necessary general and hormonal tests were performed, as well as ultrasound imaging of the uterus and appendages to diagnose the condition, and a semen analysis of the husband was performed (provided that it was normal). The patient was prepared for laparoscopy in order to inject platelet-rich plasma after the end of the menstrual cycle in the first phase of the cycle. (10) ml of platelet-rich plasma was prepared from the blood of the concerned patient.

The research results showed that there is no effect of age on the success of intraovarian injection of platelet-rich plasma to improve ovulation, whether related to cases of ovarian insufficiency (high FSH value), low ovarian reserve (low AMH value), or polycystic ovary PCO (high AMH value).

Assessment of motor function for upper and lower extremities among patients with chronic stroke

2024-02-27T08:45:19+00:00

Assessment of motor function is essential for the effective management of chronic stroke patients, as it provides valuable information about the patient’s functional ability, diagnosis, and treatment effectiveness. Therefore, the current study aimed to assess motor function in 45 chronic stroke patients who were selected using a convenience sample method from the Department of Physical Therapy at Tishreen University Hospital in Lattakia. Data were collected using research tools. The results showed that the majority of patients had significant motor weakness with regard to the gross motor function of the upper and lower extremities. The study recommended finding a comprehensive protocol for evaluation, developing new techniques, conducting research on evaluation obstacles, and emphasizing the integration of regular evaluations of motor function into the practices of Health care professionals.

Comparison of Acute and Chronic Immunoglobulin (IgA, IgM, IgG) Concentrations in Relation to Middle ear Secretions in Adult Patients with Suppurative Otitis Media

2024-02-10T16:15:17+00:00

The research aimed to determine whether the concentrations of immunoglobulins IgA, IgG, and IgM in middle ear secretions are important in patients with suppurative otitis media by: studying the level of concentrations of immunoglobulins (IgA, IgM, IgG) in middle ear secretions in patients with otitis media. Acute and chronic suppurative disease in adults, and comparison between them.

The study was conducted on a sample of adults attending the ear department at Tishreen University Hospital in Lattakia with a history of purulent otitis media. The number of patients was (43) (7 acute otitis media - 36 chronic otitis media).

The results of the research showed that there is a statistically significant difference in the concentrations of immunoglobulin IgG (chronic inflammation is higher than acute inflammation), and there is a statistically significant difference in the concentrations of immunoglobulins IgM and IgA (acute inflammation is higher than chronic inflammation) in relation to middle ear secretions in adults.

The role of oral antidiabetic agents in improving insulin resistance and body mass index in overweight polycystic ovary patients: a randomized controlled RCT study.

2024-04-09T08:21:13+00:00

Background: Polycystic ovary syndrome is a common hormonal disorder that affects women of reproductive age. It is characterized by irregular menstruation, hyperandrogenism, insulin resistance, obesity, and subfertility, in addition to long-term consequences such as cardiovascular diseases such as atherosclerosis and hyperlipidemia, which justifies the importance of diagnosing and treating this syndrome to improve the quality of life and alleviate the symptoms of androgen excess.

Objective: This article is to determine the optimal treatment to improve insulin resistance and symptoms of androgen hyperactivity in female patients with polycystic ovary syndrome

Methods: The study included female patients with polycystic ovary syndrome in a randomized, unblinded RCT in the Department of Obstetrics and Gynecology at Tishreen University Hospital in Lattakia who met the inclusion criteria. The patients were divided into two groups, the first taking pioglitazone and the second taking metformin. A clinical, laboratory and abdominal ultrasound examination was performed for all participating women in the first visit and after 6 months as well.

Results: Weight and body mass index decreased in both groups. In group B, weight decreased by up to 10% compared to 5% for pioglitazone, with statistically significant differences P = 0.00, and body mass index in group B decreased by 8% compared to 6%, with statistically significant differences P = 0.00. 0.02

Fasting blood sugar concentration decreased in both groups without significant statistical differences

Fasting insulin concentration decreased in both groups, but with a clear advantage for group A, with a statistically significant difference, P = 0.00.

The concentration of insulin resistance decreased in both groups, with a preference for group A, with a statistically significant difference, P = 0.19

Conclusion: Pioglitazone treatment has an advantage over metformin in improving insulin resistance in patients with polycystic ovary syndrome, and in return, metformin is superior in reducing weight and BMl.

A comparative study of failure modes occurring in Empress 2 crowns made with two different manufacturing techniques (In Vitro Study)

2024-04-21T07:33:34+00:00

Aim : the aim of this study is to Compare the failure modes occurring in all-ceramic crowns made according to the IPS Empress2 system, with two different techniques (IPS Press, IPS CAD) after exposing them to different forces in order to determine the effect of the manufacturing technique used on the failure pattern occurring in The aforementioned crowns, in addition to study the effect of the type of force applied (vertical forces, inclined forces at an angle of 45 degrees) on the pattern of failure occurring.

Materials and Methods: The research sample consisted of 36 upper first premolars, free of cavities and cracks, and of similar sizes. The sample’s teeth were all prepared according to the academic protocol used to prepare for receiving full porcelain crowns in a completely symmetrical manner with the help of the silicone guide. The sample was then randomly divided into two main groups, each numbering 18 premolars. Then the sample items were numbered from 1 to 36, where the first main group (numbered from 1 to 18) received 18 porcelain crowns made according to the ips empress 2 system using the IPS Press technique , and the second main group (numbered from 19 to 36 ) 18 porcelain crowns made according to the ips empress 2 system using IPS CAD technology. All crowns were glued to their abutments using resin cement according to the approved protocol of bonding and based on the manufacturer’s instructions. Then we divided each main group into two sub-groups, each with a number of 9 crowns, in order to apply vertical forces (90 degrees) to the crowns of the first sub-group and inclined forces (45 degrees) to the crowns of the second sub-group, using a universal testing machine, and then the failure modes occurring in all crowns of the sample were measured according to the F.J.T BURKE index, which Failure is classified into 5 successive degrees according to the degree of damage occurring in each crown of the specimen

Results: there were statistically significant differences in the failure modes occurring at a confidence level of 95% between crowns manufactured using the IPS press technique and crowns manufactured using the IPS cad technique when applying both vertical and oblique forces at an angle of 45 degrees in favor of crowns manufactured using the Ips press technique

Conclusions: IPS CAD technique used in the manufacture of all-porcelain crowns according to the ips empress 2 system gave less bad failure modes than IPS Press technique , The failure modes were less bad when applying oblique forces (45 degrees) compared to vertical ones. (90 degrees)

Studying the relationship between the gene expression level of the HOTAIR molecule and HER2 receptor in breast cancer

2024-03-17T03:56:33+00:00

Objective: The molecular classification of breast cancer contributes to following targeted treatment lines, and HER2 receptors constitute one of the important characteristics in the therapeutic decision, and within the framework of the search for molecular markers that contribute to understanding the pathological mechanisms of breast cancer with the aim of developing accurate and specific treatment lines. A number of interventional experimental studies have clarified the role of Long non-coding RNA (LncRNA) molecules in the pathogenesis of breast cancer. The HOTAIR molecule was studied as a tumor-stimulating LncRNA molecule through its control of gene expression at several molecular levels. This molecule also had a role in the occurrence of therapeutic resistance in Breast cancer. Our study aims to measure the level of gene expression of the HOTAIR molecule in the serum of patients and study its relationship with HER2 receptors.materials and methods: An assay was conducted for the level of gene expression of the HOTAIR molecule in the plasma of 30 patients, by performing a reverse transcription reaction (qPCR). Gene expression was evaluated using the Levack equation, and HER2 receptors were identified on tissue biopsies in the pathology department. Then a statistical analysis of the results was performed.Results: The results of the study showed that there were significant differences (P<0.05) between the level of HOTAIR gene expression and HER2 receptor positivity.