Ghina Haidar’s research while affiliated with Damascus University and other places

Background Few studies are available in the medical literature on the expected benefit of platelet-rich plasma (PRP) injections for osteoarthritis knee, and most of the studies reported improvements in pain, stiffness, and function in mild and moderate degrees of osteoarthritis. There is no study in Syria concerning any data about knee osteoarthritis (KOA). In our study, we aimed to determine the extent of the benefit within 6 weeks of PRP injections in Syrian patients with osteoarthritis of the knee. Methods 310 Syrian patients suffering from osteoarthritis of the knee were injected with PRP at 2-week intervals for 6 weeks. Pain, function, and stiffness were calculated at baseline and after 6 weeks as well as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) tool before the start of treatment, after PRP injections, and after 6 weeks. All patients who were diagnosed with KOA, according to the classification criteria of the American College of Rheumatology, and grade 2 or 3 of Kellgren-Lawrence classification, and who were older than 18 years were included in our study, and exclusion criteria included patients with other rheumatic conditions, chronic liver or kidney disease, and malignancies. Results The age was 55.96 ± 11.29 years, with 58.70% of the sample being female. The majority of patients had OA grades 2 and 3 and were overweight. The PRP injected into each patient differed slightly in the range of 5 ml. There was a reduction in WOMAC scores from the baseline between each category. This is followed by a rise at the 6-week follow-up post the third injection. None of these changes from baseline until 6 weeks post-treatment was statistically significant. The reduction in all scores up until before the third injection was given, but none of these changes from baseline until the follow-up 6 weeks after treatment were statistically significant ( P < 0.001) upon Kruskal–Wallis tests. The greatest improvements were seen in patients with mild OA. A limitation of this study is that the one-center study, the limited follow-up to 12 weeks, lack of a control group. It was important for us to show its importance in the advanced stages of KOA. Further studies with a larger sample size across multiple centers, and the presence of a control group, with multivariate analysis may provide higher-level evidence for the practice. Conclusions There has been no statistically significant decrease in total WOMAC, pain, stiffness, and physical function scores from baseline up until follow-up 6 weeks after treatment. The injections did not completely provide relief for any patient in this study. It must be questioned whether PRP injections are beneficial for patients with grade 3 OA and whether they only be carried out in patients with grade 2 OA. Further larger multicenter studies are needed to determine the efficacy of these injections and which grade of OA patients shall receive the greatest benefit. Conclusion Despite other RCTs showing an improvement, in their setting with their treatment protocol, the results showed a trend of reduction in the WOMAC score. PRP is a safe and promising management option for symptom modification in the setting of knee OA, so it can be recommended in specific cases.

Introduction Aphthae are common lesions that occur inside the mouth on the mucous membrane, often associated with various diseases. The causal pathogenesis generally depends on the accompanying condition, but there is usually no serious underlying cause. Case presentation This case report describes a 33-year-old male patient with a 10-year history of recurrent oral ulcers and impaired glucose tolerance. The patient had previously been treated with glucocorticoids, which provided temporary relief. Laboratory tests and immune profiles were normal. After 1 week of treatment with metformin at a dose of 500 mg twice daily, the lesions were relieved, and the patient required further metformin treatment for three years without any recurrence. Discussion Metformin has been shown to have anti-inflammatory effects in preclinical studies, making it a potential treatment option for mucocutaneous manifestations. This case report highlights the clinical effectiveness of metformin in treating oral ulcers and suggests its potential as an alternative treatment option for this condition. Conclusion Further studies are needed to confirm the efficacy and safety of metformin in treating mucocutaneous manifestations.

Background Temporal arteritis is a large-vessel vasculitis mostly seen in the elderly. Amyloidosis may be secondary to a chronic inflammation of body organs. Here, we present the second case report of temporal arteritis complicated by amyloidosis that was successfully treated by tocilizumab. Case presentation A 64-year-old female presented complaining of fatigue, fever, and diarrhea accompanied by abdominal pain. One year before presentation, she was diagnosed with temporal arteritis. She was treated with 15 mg/day oral prednisone for the last 6 months, with partial remission, but persistence of the fatigue and an elevated erythrocyte sedimentation rate (ESR, 56 mm/h). Physical examination showed tenderness of both temporal arteries and a soft abdomen. Colon tissue biopsy showed amyloid depositions in the vessels and stroma that were positive for Congo red staining. Tocilizumab was started with 8 mg/kg intravenous, the diarrhea resolved, and the arthralgia improved within 1 month, with a decrease in the ESR to 8 mm/h, and a C-reactive protein (CRP) level of 0.98 mg/dl. Monthly tocilizumab therapy remains efficacious 12 months later and was stopped due to lack of tocilizumab from the hospital. No side effects of tocilizumab were registered. Conclusion Chronic inflammation may be complicated by amyloidosis in patients with rheumatic diseases and genetic predisposition. Therefore, it is important to screen for intestinal Amyloid A (AA) amyloidosis in individuals with gastrointestinal disorders complicated by rheumatic disorders. AA amyloidosis may be complicated by temporal arteritis and presented with gastrointestinal symptoms such as diarrhea. LEARNING POINTS Amyloidosis is manifested by the deposition of insoluble protein aggregates in organs. Amyloid A (AA) amyloidosis occurs as a complication of chronic inflammation in patients with a genetic predisposition to rheumatic diseases. Temporal arteritis complicated with AA amyloidosis is extremely rare.

Introduction and importance Elderly onset rheumatoid arthritis (EORA) is defined as the onset of rheumatoid arthritis (RA) in individuals over 60 years and presents unique clinical features. Nonsteroidal anti-inflammatory drugs and disease-modifying antirheumatic drugs are introduced immediately after the diagnosis is proven. In some cases, biological treatment may be used. We present a case report of EORA in an 89-year-old female. Case presentation An 89-year-old Syrian female presented with fatigue, fever, generalized arthralgia, and myalgia, with morning stiffness of more than 1 hour for 3 months. On physical examination, she had bilateral joint tenderness and swelling of more than 10 small joints. Laboratory tests revealed anemia and elevated inflammatory markers with a high titer of rheumatoid factor and anti-cytoplasmic citrullinated peptide (anti-CCP). Diagnosis of RA was confirmed, and she was put on prednisolone, methotrexate, and paracetamol. After 6 months, our patient’s clinical examination and laboratory tests had returned to normal. Clinical discussion About 70% of EORA cases have joint erosions, positive rheumatoid factor, and a worse prognosis, and 25% of EORA cases mimic polymyalgia rheumatic, with a favorable prognosis. EORA has a poor outcome, due to the risk of infection and comorbidities. Conclusion Our patient presented with symptoms mimicking polymyalgia rheumatica (PMR), so a definitive diagnosis is required between elderly RA and PMR due to their different treatment and complications. Medical professionals should consider a diagnosis of RA in elderly patients, regardless of their age.

Background Behçet’s disease is a chronic autoimmune disorder that affects various organs, including oral aphthae, genital ulceration, cutaneous manifestation, ocular involvement, and positive pathergy test according to the International Study Group for Behçet’s Disease criteria. This study aimed to investigate the oral health condition of patients with Behçet’s disease and to assess how it correlates with the patient’s gender, clinical symptoms, and severity of the disease. Methods A total of 92 participants, including 42 patients with Behçet’s disease and 50 healthy controls, were enrolled in this case-control study. The periodontal indices were measured and compared between the two groups. Logistic regression analysis was used to identify potential risk factors for disease severity. The P value must be ( P <0.05) to be considered as significant. Results This study assessed the periodontal health of patients with Behçet’s disease and found that they had significantly higher plaque, gingival, bleeding, and probing depth scores compared to healthy controls ( P <0.05). Logistic regression analysis revealed that plaque accumulation was a significant risk factor for higher severity scores in Behçet’s disease. Gender-specific approaches may be necessary in the management and treatment of periodontal disease in Behçet’s disease patients. Conclusions The findings of this study suggest that patients with Behçet’s disease are at increased risk for periodontal disease and its associated symptoms. Specifically, plaque accumulation is a significant risk factor for more severe periodontal health issues in these patients. Therefore, it is important for clinicians to be aware of this increased risk and to develop tailored treatment plans that address both the underlying Behçet’s disease and the associated periodontal disease.

Background Although humanity is important within the medical health field, the authors lack studies that address this topic. Objective The authors aimed to assess humanity among a sample of Syrian internal medicine interns. Methods The authors have used a validated scale based on the Medical Humanity Scale (MHS) categorized into seven human values included in 30 questions (patient-oriented care, respect, empathy, ethics, altruism, and compassion). The scale can test the differentiation between these interns with different levels of medical humanity. A 7-point Likert scale was adopted. Six hundred sixty-five participants from the Internal Medicine Department, Faculty of Medicine, Damascus University entered our study. Results The mean score of the MHS was 147.14 (13.1) Female residents humanity scores (mean 149.14, SD 15.1) was significantly higher than male students’ scores (mean 145.48, SD 13.35; P =.007), KMO=0.843>0.7, which is near 1, and the Bartlett test of sphericity =4187.043 (df=465; P =.01). The Cronbach α was >0.683, was indicating the validity and reliability of the scale. Conclusions The results of this study suggest that the humanity level is accepted by using a scale based on MHS among interns of the Internal Medicine Department, Damascus University.

Introduction and importance The COVID-19 pandemic has led to a post-acute syndrome that can persist for an extended period. The correlation between anorexia nervosa (AN) and some autoimmune diseases has been reported. Systemic lupus erythematosus (SLE) is a systemic autoimmune disease, presented with different clinical ions and periods, affecting all ages, especially females. The coexistence of SLE and AN has been reported in rare cases. The authors present the case of a 22-year-old male with severe AN coexisting with SLE. Case presentation We present a case of a 22-year-old male diagnosed with SLE. He also completely refused to eat and drink and presented with behavioral disorders and suicidal thoughts. He was on 200 mg/day of oral hydroxychloroquine, 400 units/day of vitamin D, and 1000 mg/day of oral calcium. There was no positive other history, trauma, drug addiction, or family history. AN was diagnosed according to ICD-10 and DSM-V. Physical examination revealed decreased subcutaneous tissue and muscle atrophy. The weight of the patient was 35.3 kg. Verbal contact was maintained, and psychotic symptoms were not observed. Tenderness in all joints was noticed, while swelling in both knees and right ankle joints was found. Laboratory tests revealed elevated inflammatory markers. Treatment includes a high-calorie diet administered by a feeding tube. The patient began to gain weight after 3 months. He is on 200 mg/day hydroxychloroquine, with remission till now January 2024. Clinical discussion The novelty of our case is that it is a case of a young adult man presented with AN during mild lupus, who responded well to treatment with steroids and a high-calorie diet. Conclusions Previous research has suggested the existence of a close link between food and eating disturbance and autoimmunity, and herein we provide further evidence to support this relationship by presenting a case report of an adult male with SLE and AN.

Background Rheumatoid arthritis (RA) is a systemic immune disease. The authors aimed to report the characteristics of ocular manifestations in patients with RA. Methods Demographic and clinical characteristics were collected including: age, sex, and BMI. Disease data included the duration, the present main complaint, including the number of painful and swollen joints, duration of morning stiffness, and the patient’s self-evaluation form had also been applied and registered. Eye symptom including pain, dryness, redness, photophobia, discharge, and blurred vision was asked and registered, in addition to full medical history, treatment, and evaluation of clinical disease activity index. Rheumatologic examination included: the number of tender and swollen joints in patients was done. All study subjects underwent complete ophthalmological examination in the following manner: visual acuity assessment by Snellen’s chart, evaluation of pupil diameter and reflexes as well as eyeball movements, tear film evaluation by using Schirmer’s test, intraocular pressure measurement, slit-lamp evaluation of the anterior segment with concentration on ocular surface assessment, followed by installation of topical mydriatic/cycloplegic eyedrops for posterior eye segment exam and fundoscopy. Laboratory tests included rheumatic factor, anti cytoplasmic citrulinted peptide, C-reactive protein, and erythrocyte sedimentation rate were performed and analyzed. Results Mean age of study group was 41.5±10 years,78.59% of which were females. Ocular manifestations were present in 31.14%. Dry eye was diagnosed in (36.71%), among which burning sensation was found in (35.15%), and photophopia in (27.34%). The most frequent ocular manifestation was episcleritis (66.40%), while scleritis was diagnosed in (22.65%), and keratoconjuctivitis was present in (7.04%). Discussion The most common manifestations of ocular involvement in our RA patients was episcleritis, dry eye, and scleritis. Positive serum rheumatoid factor and anticitrulinated peptide antibody significantly increased the risk of having ocular manifestations, especially dry eyes, and the ocular manifestations prevalence was higher among male patients, long disease duration and treatment with biologics and disease-modifying antirheumatic drugs. Conclusion Ocular symptoms are relatively frequent manifestation of RA. Regular ophthalmological examinations are essential among patients with RA.

Introduction Multiple myeloma (MM) is a malignant plasma cell proliferation producing large numbers of monoclonal immunoglobulins. Typical MM symptoms include anemia, bone pain, hypercalcemia, and renal failure. Atypical presentations like joint involvement were rarely reported in the literature and may cause significant delays in treatment and adverse outcomes. Case presentation The authors report a case of a 54-year-old female who presented with symmetrical polyarthritis and was misdiagnosed with rheumatoid arthritis. The diagnosis of MM was made after failing many treatments of rheumatoid arthritis and with further laboratory tests and procedures. Conclusion This rare manifestation of MM carries a diagnostic challenge and causes a significant delay in treating such patients. Here, the authors report this unusual initial presentation with a review of several cases in the literature describing similar presentations.

Introduction Systemic Lupus Erythematosus is a systemic immune disease that classically occurs in young to middle-aged women and may present with cutaneous, renal, hematologic, neurological, and/or other symptoms at the time of diagnosis. Late-onset Systemic Lupus Erythematosus or Systemic Lupus Erythematosus in the elderly is a subtype that differs from classic Systemic Lupus Erythematosus in terms of age group, clinical symptoms, organ involvement and severity. Case presentation A 63 years old female noted to have pancytopenia. The patient was diagnosed with lupus upon obtaining clinical presentations and serological marker, along with high titers 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 gender 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 titer, 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 Systemic Lupus Erythematosus when clinical suspicion remains high and conducting further laboratory and imaging investigation.