Syrian Patients Research Articles

Metabolic Syndrome in Overt and Subclinical Hypothyroidism Syrian Patients

Thyroid hormones have important functions in many metabolic pathways, including glucose and lipid metabolism, and may cause metabolic syndrome. Both hypothyroidism and metabolic syndrome are common in the Syrian population. This research was carried out to evaluate the incidence of the metabolic syndrome in two types of hypothyroidism and the effect of TSH levels on its occurrence. A retrospective cross-sectional study was performed of 91 overt hypothyroidism patients, 31 subclinical hypothyroidism patients without clinical symptoms, and 53 controls without thyroid disorders. We used the criteria for metabolic syndrome as per International Diabetes Federation (IDF) which are defined as central obesity depending on race- and gender-specific WC cutoffs(Waist circumference (WC)≥94 cm for male, WC≥80 cm for female) in addition to any two of the following four parameters: (Triglycerides level: ≥150 mg/dl (1.7 mmol/l) or history of treatment for TG abnormality, HDL cholesterol level: <40 mg/dl (1.03 mmol/l) in males and <50 mg/dl (1.29 mmol/l) in females or history of treatment for HDL cholesterol abnormality, high blood pressure: systolic BP ≥130 mm Hg or diastolic BP≥85mm Hg or on treatment for previously diagnosed hypertension and high FPG: ≥100 mg/dl or previously diagnosed type 2 Diabetes mellitus. In conclusion, our study showed a significant correlation between overt hypothyroidism and metabolic syndrome. It also revealed that a TSH level over 2.5 uIU‎/ml significantly increases the risk of metabolic syndrome.

Cancer among syrian refugees living in Konya Province, Turkey

BackgroundWith more than 3.6 million Syrian refugees Turkey hosts the world's largest number of Syrians. Considering the morbidity, mortality, and healthcare spending, cancer is one of the leading health and economic burden for patients and healthcare systems. However, very limited information available in the scientific literature to understand the burden and characteristics of cancer in countries hosting Syrian refugees. The aim of the present study is to evaluate the demographic and clinical characteristics, treatment outcome of Syrian cancer patients living in Konya, Turkey.MethodsWe retrospectively reviewed medical records of Syrian cancer patients at three major institutions from 2005 to 2020. The information regarding demographic and clinical characteristics of patients were identified. The number of days between the first symptom and diagnosis was considered as the “diagnostic interval”. Patients who failed to attend clinics within four weeks of appointment were assumed abandoned treatment. Survival curves were estimated using the Kaplan–Meier method.ResultsWe identified 230 adult and 38 children refugee diagnosed with cancer during the study period. With regards to adult patients, there were 114 (49.6%) male and 116 (50.4%) female. The median age at diagnosis was 52.4, 47.3 years for male, female respectively. The five most common cancer by site among all were; breast (24.8%), colorectal (10.9%), lung (7.4%), central nervous system (CNS) (7.0%), and stomach (5.2%). 93 (40.4%) had metastatic disease at diagnosis. The overall survival probability was 37.5% at five years for the adult population. Data were extracted for 20 boys and 18 girls with childhood cancer. Their median age at diagnosis was 5.8 and 6.0 years respectively. The three most common childhood cancer were; leukemias (21.1%), lymphomas (21.1%), and CNS (13.2%). Excluding leukemia, 13 (43.3%) of childhood cancer cases had the advanced disease at diagnosis. Three year survival probality was 69.5%. The median diagnostic interval for adult and childhood cancer was 96.5 (IQR = 53–165) and 23 (IQR = 13.5–59) days respectively. Twenty-one adults and four children had treatment abandonment.ConclusionThis study contributes to understanding the burden of cancer among Syrian refugees living in Konya, growing health issue for refugees. Larger and prospective studies will help to measure the real burden and compare the difference in cancer risk factors, care, and outcomes among the refugee and host populations.

THE CHANGE IN RUBELLA AND CYTOMEGALOVIRUS SEROPOSITIVITY RATES IN PREGNANT SYRIAN REFUGEES ACCORDING TO YEARS AND COMPARED TO THE LOCAL POPULATION IN KAHRAMANMARAS

We aimed to evaluate the rates of Rubella and Cytomegalovirus congenital infection agents in pregnant Syrian refugees and to compare these with the local population infection rates over time to determine whether or there was compatibility with the region of settlement. A retrospective examination was made of the Rubella and Cytomegalovirus seroprevalence in all pregnant patients who presented at our hospital for normal prenatal follow-up between January 2012 and July 2021. The pregnant women were grouped as local population and Syrian refugees, and in year groups of 2012-2016, and 2017-2021. The results were compared proportionally according to the time periods. In the 2012-2016 time period, the rubella IgM and IgG seropositivity of the Syrian patients was determined to be statistically significantly higher than that of the local population (p=0.013, p=0.003, respectively). When evaluated in the first and second time periods, there was seen to be a statistically significant proportional decrease in the rubella IgM and IgG seropositivity of the Syrian patients (p=0.006, p=0.005, respectively). When the groups were compared in respect of CMV IgM seropositivity, there was seen to be a significant difference between the groups in the first period (p=0.011). The change over time in the Syrian refugees was statistically significant (p=0.026). In the second time period, the difference between the Syrian refugees and the local population was not statistically significant (p=0.793). In the period of 2012 to 2016, when there was a great increase in the wave of Syrian refugees into Turkey, the seropositivity rates were seen to be significantly high in comparison with the local population. In the second time period examined in this study, there was determined to have been a significant decrease in the rates, most likely in parallel with the access to better living conditions in that time.

Etiologic-sociodemographic assessment and comparison of dialysis modalities in pediatric Syrian migrants with chronic kidney disease.

Background:Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are among the important causes of mortality and morbidity in childhood. Early diagnosis and treatment of the underlying primary disease may prevent most of CKD patients from progressing to ESRD. There is no study examining chronic kidney diseases and dialysis modalities in Syrian immigrant children. We aimed to retrospectively research the etiologic, sociodemographic, and clinical factors in CKD among Syrian refugee children, and at the same time, to compare the clinical characteristics of patients with ESRD on peritoneal dialysis and hemodialysis.Methods:Our study included a total of 79 pediatric Syrian patients aged from 2-16 years monitored at Hatay State Hospital pediatric nephrology clinic with diagnosis of various stages of CKD and with ESRD. Physical-demographic features and clinical-laboratory information were retrospectively screened.Results:The most common cause of CKD was congenital anomalies of the kidneys and urinary tracts (CAKUT) (37.9%). Other causes were urolitiasis (15.1%), nephrotic syndrome (10.1%), spina bifida (8.8%), hemolytic uremic syndrome (7.5%), and glomerulonephritis (7.5%). Twenty-five patients used hemodialysis due to bad living conditions. Only 2 of the patients with peritoneal dialysis were using automatic peritoneal dialysis (APD), with 5 using continuous ambulatory peritoneal dialysis (CAPD). Long-term complications like left ventricle hypertrophy and retinopathy were significantly higher among hemodialysis patients. There was no difference identified between the groups in terms of hypertension and sex.Conclusion:Progression to ESRD due to preventable reasons is very frequent among CKD patients. For more effective use of peritoneal dialysis in pediatric patients, the responsibility of states must be improved.

Determination of rational drug use knowledge levels of adult Syrians under temporary protection applying to immigrant health centers in Malatya province and related factors

In this study, it was aimed to determine the rational drug use knowledge level of Syrians under temporary protection who applied to migrant health centers in Malatya province and related factors. A total of 983 Syrian patients under temporary protection in four Migrant Health Centers in Malatya were included in the study. Socio-demographic characteristics form and Rational Drug Use Scale were used as data collection tools. The mean duration of stay of the population included in the study in Turkey was 5.8±2 (1-12, median 6) years, and the mean duration of stay in Malatya was 5.2±2.1(1-10, median 6) years. According to the questionnaire on the Rational Drug Use Scale, the average score of the participants was approximately 6 points behind the cut-off value of 34 points. Only 23.1% of them were able to score 35 and above. While the scores of the patients did not differ according to gender, a weak correlation was found with age. In addition, it was determined that education level, year lived in Turkey, marital status and regular working life in Syria and living in a village or town were effective factors on rational drug use scores. According to the findings of this study, it was determined that the rational drug use knowledge level of the participants was low.

211. Burkholderia Cenocepacia Infections at Sites Other Than the Respiratory Tract, a Large Case Series from a Tertiary Referral Hospital in Lebanon

Background Burkholderia cenocepacia has been described to cause mainly respiratory tract infections. We noticed an increased number of skin and soft tissue infections (SSTIs), bloodstream infections (BSIs) and osteomyelitis over the past years at our medical center.MethodsThis is a retrospective chart review of 44 patients with documented B. cenocepacia infection at sites other than the respiratory tract diagnosed between 2005 and 2020 at the American University of Beirut Medical Center, a tertiary referral hospital for the Middle East region. ResultsThe nationalities of our patients were Iraqi (40.9%), Lebanese (34.1%), and Syrian (20.5%). Twenty six of the infections (59.1%) were hospital-acquired infections (HAIs). The most common infections were BSIs (17/44, 38.6%), then SSTIs as well as deep seated cysts and abscesses (16/44, 36.4%) and vertebral osteomyelitis (8/44, 18.2%). Half of the vertebral osteomyelitis were located in the lumbar, and 3 in the cervical region; 5 of these cases were native osteomyelitis. Sixteen patients (36.4%) had prior antibiotic intake within 30 days with ceftazidime, carbapenems and quinolones being the most common. All the patients received directed therapy for an average duration of 23.48 (+/- 37.779) days, and for 60 days for those with osteomyelitis. Combination regimens of 2 antibiotics (ceftazidime, quinolones, carbapenems, trimethoprim-sulfamethoxazole (TMP-SMX)) were used in 10 patients, whereas 24 received a single antibiotic. Thirty three patients (75%) were admitted to the hospital, 20 (45.5%) of which had an indwelling catheter and 12 (27.3%) were in the intensive care unit. Thirty two patients (96.9%) were discharged home. Susceptibility testing revealed 84.1%, 54.5%, 63.2%, and 65.9% susceptibility to ceftazidime, tetracycline, TMP-SMX, and carbapenems respectively. Characteristics of patients Conclusion B. cenocepacia BSIs, SSTIs, abscesses, and osteomyelitis were noted to be more common at our medical center as HAIs particularly in Iraqi and Syrian patients, raising the concern that countries at war might be at increased risk for such infections. Our susceptibilities results were consistent with the literature. Although B. cenocepacia is a resistant bacteria, the majority of our patients were successfully treated. Disclosures All Authors: No reported disclosures

Novel MYO5B mutation in microvillous inclusion disease of Syrian ancestry.

Microvillus inclusion disease (MVID) is a rare autosomal recessive condition characterized by a lack of microvilli on the surface of enterocytes, resulting in severe, life-threatening diarrhea that could lead to mortality within the first year of life. We identify two unrelated families, each with one child presenting with severe MVID from birth. Using trio whole-exome sequencing, we observed that the two families share a novel nonsense variant (Glu1589*) in the MYO5B gene, a type Vb myosin motor protein in which rare damaging mutations were previously described to cause MVID. This founder mutation was very rare in public databases and is likely specific to patients of Syrian ancestry. We present a detailed account of both patients’ clinical histories to fully characterize the effect of this variant and expand the genotype–phenotype databases for MVID patients from the Middle East.

Frequency of FLT3 Internal Tandem Duplications in Adult Syrian Patients with Acute Myeloid Leukemia and Normal Karyotype.

Objective:Activating mutations of the fms-like tyrosine kinase 3 gene (FLT3) by internal tandem duplications (ITDs) in the juxtamembrane domain (JMD) have been reported in ~30% of adult acute myeloid leukemia (AML) patients with cytogenetically normal karyotype (CN). However, FLT3/ITD mutations are frequently accompanied with leukocytosis, high percentage of blasts in bone marrow (BM), and increased the risk of treatment failure in AML patients. FLT3-ITD mutated AML patients mainly with normal karyotype have higher relapse probability and shorter duration of complete remission (CR) after chemotherapy, so FLT3-ITD mutation is considered as an independent poor prognostic factor in AML. Methods: FLT3-ITD and FLT3-KTD were studied by polymerase chain reaction (PCR) and restriction fragment length polymorphism- PCR (RFLP-PCR) in 44 adults AML patients with cytogenetically normal karyotype (AML-CN) at diagnosis to characterize FLT3 status. The results were correlated with the prognostic factors. Results:In this study, FLT3-ITD mutations were identified in 7 (15.9%) of the 44 AML-CN patients. Among the 7 patients with FLT3/ITD mutations, 6 patients revealed a typical ITDs mutation (fragment size was 329 bp) and one patient showed untypical ITD mutation (fragment size was ~400 bp). Whereas 37 patients (61.7%) were FLT3-ITD. None of all AML-CN patients examined showed FLT3-KTD mutations. Conclusions:Our results support that FLT3-ITD are independent adverse prognostic factors for elderly AML-CN patients and are associated with low overall survival (OS), low rate of CR, high relapse rate (RR), and high percentage of BM blast at diagnosis. We concluded, FLT3 mutation analysis should be performed as a routine test in AML-CN patients.

Evaluation of retinal nerve fiber layer thickness measured by (OCT) optical coherence tomography in patients with multiple sclerosis (MS)

Objective: The aim of this study is to evaluate the retinal nerve fiber layer (RNFL) thickness by optical coherence tomography (OCT) in Syrian patients with MS and diseases- free controls and to assess this thickness in MS-ON and MS-NON, and assess the relationship between RNFL thickness Expanded Disability Status Scale (EDSS) score. Although there are many similar studies to evaluate role of OCT at MS patients in different countries and many races,but this study is the first one of using OCT at MS patients in our country. Methods: This study (cross sectional ,case- control) was carried out at Tishreen University Hospital in Latakia. A total of 112 eyes from 56 individuals with an age range from 22 to 43 years were studied. twenty -six patients with definite MS, Diagnosis of MS was based on the MacDonald criteria.The disease-free controls were matched for age and gender (n=30; 60eyes). Retinal nerve fiber layer thickness was measured using optical coherence tomography (Spectralis OCT - Heidelberg Engineering), and gathering information about past ON history since more than 6 months and EDSS. Results: There were statistically Significant differences (p=0.0001) between both groups (case- control) were observed in OCT parameters (average, and all sectors especially temporal and superior sector) with lower RNFL thickness in the MS group (MS-ON,MS-NON).There were statistically significant differences (p=0.0001) between MS-ON (n = 20 eyes) and MS-NON (n = 32eyes) for all RNFL parameters measured by OCT, with lower RNFL thickness in (MS-ON).There were statistically significant inverse correlations was observed between average RNFL thickness and neurologic impairment (Expanded Disability Status Scale) (r=- 0.6، P=0.0001) and all sectors especially in temporal and superior quadrants (r=-7 , P=0.0001). Conclusions: OCT seems to be a reproducible test to detect axonal loss of ganglion cells in MS (RNFL). Further and larger longitudinal prospective studies would be valuable to assess the evolution over time of the RNFL measurements in Syrian MS patients.

When Refugees Care for Refugees in Lebanon: Providing Contextually Appropriate Care from the Ground Up

Despite a surge in initiatives to integrate foreign-trained physicians into local health systems and a drive to learn from localised humanitarian initiatives under the COVID-19 pandemic, we still know little about the on-the-ground strategies developed by refugee doctors to meet the needs of refugee patients. In Lebanon, displaced Syrian health professionals have mounted informal, local responses to care for displaced Syrian patients. Drawing on ethnographic work shadowing these healthcare providers across their medical and non-medical activities, we explore how clinical encounters characterised by shared histories of displacement can inform humanitarian medicine. Our findings shed light on the creation of breathing spaces in crises. In particular, our study reveals how displaced healthcare workers cope with uncertainty, documents how displaced healthcare workers expand the category of ‘appropriate care’ to take into account the economic and safety challenges faced by patients, and locates the category of ‘informality’ within a complex landscape of myriad actors in Lebanon. This research article shows that refugee-to-refugee healthcare is not restricted to improvised clinical encounters between ‘frontliners’ and ‘victims of war’. Rather, it is proactively enacted from the ground up to foster appropriate care relationships in the midst of violent, repeated, and protracted disruptions to systems of care.

The impact of Syrian refugees on patient demographics and type 2 diabetes across five public health centers in Lebanon

Background The war in Syria triggered the influx of a large number of refugees into neighboring countries, particularly Lebanon. In 2019, the Syrian population made up 13.33% of the total population in Lebanon. This shift in demographics influenced many sectors in the country, including the healthcare system. The purpose of this study is to analyze the impact of Syrian refugees on the Lebanese healthcare system across five public health centers (PHCs) and the prevalence of type II diabetes (T2D) in these patients. Methods Patient data was collected across five PHCs from different regions in Lebanon. Comparisons between Lebanese and Syrian patients were analyzed for demographics, relative number of patients, and prevalence of T2D. Results We found that the number of patients admitted to PHCs has increased over the last few years, in both Syrian and Lebanese populations, putting more strains on an already threatened sector. In addition, the increase in Lebanese patients is significantly higher after 2015, and it parallels the surge in Syrian immigrants. The prevalence of T2D was found to be increasing over the years among the two populations, with a statistically significant increase in the Lebanese population after 2015. However, the prevalence of T2D was found to be statistically lower than the reported national prevalence in both groups, possibly due to inadequate rates of screening. Conclusions There has been an increase in admissions to PHCs as well as rates of T2D in Lebanon and in the Syrian population. Inadequate screening could be the reason behind the lower prevalence of T2D in our study compared to the reported national prevalence.

Comparison of Colonoscopy Results of Turkish and Syrian Patients, Frequency of Incomplete Colonoscopy and Causes of Incomplete Colonoscopy

Comparison of Colonoscopy Results of Turkish and Syrian Patients, Frequency of Incomplete Colonoscopy and Causes of Incomplete Colonoscopy

Investigation of Gonadal Function, Puberty, and their relationship to Serum Ferritin in Male patients with β-Thalassemia major in Syria

Objectives: Endocrine disorders continue to affect the health of thalassemia patients, foremost of which is hypogonadism being the most frequent endocrine complication that involves 70-80% of beta-thalassemia major (β-TM) patients. Actually, the role of iron overload in endocrine complications is well known. Our study goals were to investigate gonadal function, assess pubertal status among Syrian male patients with β-TM and correlate hormonal panel with serum ferritin as the marker of iron overload. Methods: 56 β-TM regularly transfused male patients were enrolled in this study, they were 21.91±5.01 years old. FSH, LH, Total Testosterone, and Serum Ferritin were measured for all patients, 52 of them undergone pubertal status evaluation. Results: Results showed that 60.7% of patients suffered from hypogonadism, which was hypogonadotropic hypogonadism in 97.06% of them. Delayed puberty was seen in 7.7% of the patients, while arrested puberty was found in 82.69% of them. All patients had iron overload and 92.86% of them suffered from severe iron elevation. Both gonadal and pubertal status were independent of the serum ferritin levels (P=0.73), (P=0.81) respectively. There was significant positive correlation between FSH: LH (r=0.584, P=0.0001), FSH: Testosterone (r=0.562, P=0.0001), LH: Testosterone (r=0.746, P=0.0001), MCHC: Testosterone (r=0.292, P=0.038), and BMI: Hb (r=0.351, P=0.009). Conclusions: Our findings indicated that hypogonadism, arrested puberty and severe iron overload were highly prevalent among male patients with β-TM. Patients with better gonadal reserve have higher BMI than those with gonadal dysfunction. We suggest that hypogonadism in β-TM patients is not directly related to serum ferritin levels; other potential factors (such as chronic anemia, hypoxia, and genetic predisposition) may contribute. Also we suggest that adequate blood transfusion and appropriate iron chelation, along with regular evaluation for gonadal status and timely intervention can improve the management of aforementioned complications, thus ameliorating patients’ quality of life.

Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as novel risk markers for diabetic nephropathy in patients with type 2 diabetes

IntroductionDiabetes mellitus causes serious complications such as diabetic nephropathy. Diabetic nephropathy is now the most common reason of chronic kidney disease. Inflammation plays a crucial role in development and progression of diabetic nephropathy. The aim of this study was to evaluate the relationship of Inflammatory markers (neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio) with diabetic nephropathy in Syrian patients. Materials and methodsA total of 158 patients with type 2 diabetes mellitus were distributed into three groups according to urinary albumin-to-creatinine ratio: Group A, type 2 diabetic patients with normoalbuminuria (urinary albumin-to-creatinine ratio <30 mg/g); Group B, type 2 diabetic patients with microalbuminuria (urinary albumin-to-creatinine ratio = 30–300 mg/g); Group C, type 2 diabetic patients with macroalbuminuria (urinary albumin-to-creatinine ratio ≥300 mg/g). Levels of inflammatory markers (neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio) were recorded and compared among the three groups. ResultsSignificant differences were detected between the groups in terms of neutrophil-to-lymphocyte ratio (p = 0.000) and platelet-to-lymphocyte ratio (p = 0.000). Receiver operating characteristic curve analysis of inflammatory markers and microalbuminuria prediction demonstrated an area under curve (AUC) of 0.869 for neutrophil-to-lymphocyte ratio (confidence interval: 0.813–0.926, p = 0.000) and 0.739 for platelet-to-lymphocyte ratio (confidence interval: 0.662–0.815, p = 0.000). ConclusionIncreased neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were significantly correlated with diabetic nephropathy, and high neutrophil-to-lymphocyte ratio & platelet-to-lymphocyte ratio may be served as a predictor and a prognostic risk marker of diabetic nephropathy.

A retrospective study of cases diagnosed with cystic fibrosis at a single care center in Syria

BackgroundAlthough there is relatively much information about the status of cystic fibrosis disease in different countries of the world, limited data are available on this disease among Syrian children. Therefore, we did a retrospective study that included 173 children diagnosed with cystic fibrosis according to the diagnostic criteria. This study was conducted to determine the diagnostic, clinical, and genetic characteristics of patients with cystic fibrosis in Syria and to assess the relationship between the genotype and the phenotype of disease in these patients.ResultsAs a result of the early classical manifestations, CF diagnosis was established in the present study by the age of 1 year in 78.6%; the mortality rate was 23.1% (82.5% of them were in the first year of life). The prevalence of respiratory and gastrointestinal symptoms was 81.5% and 78.6%, respectively with an average age of 7.8 and 3.4 months. Consanguinity was reported in 75.7% of the families. The most common pathogenic variant in the sample was F508del (36%) followed by W1282X (17%). There was a statistical correlation between incidence of steatorrhea and the presence of class I pathogenic variants. A relationship between the mortality rate and the presence of class II pathogenic variants (pathogenic deletion variants) was also observed. There was no statistical relationship between other clinical manifestation and pathogenic variant classes. However, the incidence of most CF-related conditions was a little higher in the presence of classes I, II, and III pathogenic variants compared to their incidence in the presence of classes IV and V pathogenic variants.ConclusionsThe number of cases diagnosed with cystic fibrosis in Syria is less than the number of real cases, and there is a need to perform CFTR gene sequencing on large sample sizes, to determine all CFTR pathogenic variants that could exist in Syrian patients and to make a better evaluation of the relationship between genotype and phenotype of the disease.

\u201cI try the one that they say is good.\u201d - factors influencing choice of health care provider and pathways to diabetes care for Syrian refugees in Lebanon

BackgroundNavigating health systems in host countries can be a challenge for refugees, particularly in a multi-provider system such as Lebanon. Syrian refugees in Lebanon face a high burden of Non-Communicable Diseases (NCDs) including diabetes mellitus. Evidence on how refugees navigate the health system is essential to improve provision of NCD services. We conducted a qualitative study amongst Syrian diabetes patients visiting Médecins Sans Frontières (MSF) clinics in one urban and one rural setting in Lebanon to explore factors influencing choice of and pathways to diabetes care.MethodsIn-depth interviews were conducted with male and female adult participants with DM type 1 or type 2 who were receiving treatment at MSF clinics. Participants were recruited using convenience sampling. Interviews were conducted in Arabic and directly transcribed and translated into English. Data were coded in NVivo and analyzed using an inductive thematic approach.ResultsA total of 29 in-depth interviews were conducted with 13 men and 16 women. Knowledge and understanding of diabetes management differed among participants. Syrian refugees in Lebanon gathered information about health services for diabetes largely from social networks of family and peers rather than through formal means. Pathways to care included different combinations of providers such as clinics, pharmacists and informal providers.ConclusionsSyrian refugees with diabetes in Lebanon face considerable challenges in navigating the health care system due to their vulnerable status and limited knowledge of the host country systems. To ensure access to care for diabetes, efforts need to be made to support patients’ orientation in the Lebanese health system.

The Spectrum of Beta-Thalassemia Mutations in Syrian Refugees and Turkish Citizens.

Introduction and objectivesNeighboring the border between Turkey and Syria, Sanliurfa is one of the Turkish provinces with the highest number of Syrian refugees in our country. We aimed to find out the spectrum of beta-globin gene mutations in adult Turkish citizens and Syrian refugees with beta-thalassemia major.ResultsOf the participants, 35 patients (70%) were Turkish citizens and 15 patients (30%) were Syrian. The most common mutation in Turkish patients was found to be IVS-I-110 (G>A) with a frequency of 28.8%, followed by IVS-I-6 (T>C) with a frequency of 15.5%. Other common mutations were IVS-I-1 (G>A) and codon 39 (C>T) with frequencies of 11.1%. These four mutations accounted for 65.5% of all mutations in the Turkish cohort. The most common mutations in Syrian refugee patients were IVS-I-1 (G>A), IVS-II-1 (G>A), IVS-I-5 (G>C), and codon 5 (-CT), all with a frequency of 15.7%, accounting for 62.8% of all mutations in the Syrian patients. In the analysis, codon 5 (-CT) mutation (15.7% vs 0%, p=0.023) was found significantly higher in Syrian refugees compared to Turkish citizens.Discussion and conclusionsA wide spectrum of mutations was detected in beta-thalassemia major patients living in the Sanliurfa region. Mutational profiles in Turkish and Syrian patients were found to be significantly different from each other. Because marriages between Syrian refugees and Turkish citizens are increasing in our region, the genetic findings and the mutational profiles in Turkish and Syrian patients obtained in this study are thought to become useful for future prenatal molecular diagnostic tests.

Molecular analysis of the AGXT gene in Syrian patients suspected with primary hyperoxaluria type 1

BackgroundCharacterization of the molecular basis of primary hyperoxaluria type 1 (PH-1) in Syria has been accomplished through the analysis of 90 unrelated chromosomes from 45 Syrians patients with PH-1 from different regions.MethodsAlanine glyoxylate aminotransferase (AGXT) gene mutations have been analyzed by using molecular detection methods based on the direct DNA sequencing for all exons of the AGXT gene.ResultsSeventeen pathogenic mutations were detected in our patients. Six mutations were novels. The three most frequent mutations were c.33_34insC (p.Lys12fs) in Exon 1, c.584 T < G; p.Met195Arg in exon 5 and c.1007 T > A (p.Val336Asp) in exon 10, with a frequency of 33.3%, 12.2%, and 11.1%, respectively.ConclusionDNA sequencing used in this study can offer a useful method to investigate the mutations in Syrian PH-1 patients, and could offer an accurate tool for prenatal diagnosis and genetic counseling.

Risk Factors Associated with Multiple Sclerosis: A Case-Control Study in Damascus, Syria.

Objectives To assess the probable risk factors associated with Multiple sclerosis among Syrian patients in the city of Damascus. Method In a case-control study conducted from May to September 2020, 140 MS patients and 140 healthy controls were selected from two main hospitals in Damascus. Data regarding risk factors associated with MS was collected via a structured questionnaire and complementary laboratory tests. The statistical analysis was carried out by the SPSS Statistical Software Version 26. Results Factors such as smoking, family history of MS, migraine, and vitamin D deficiency were associated with a higher risk of developing MS: Smoking (OR = 2.275 95% CI (1.348-3.841) P = 0.002). Family history of MS (OR = 3.970 95% CI (1.807-8.719) P ≤ 0.001). Migraine (OR = 3.011 95% CI (1.345-6.741) P = 0.005). Vitamin D deficiency (OR = 4.778 95% CI (2.863-7.972) P ≤ 0.001). However, factors such as diabetes, hypertension, a surgical history of appendectomy, tonsillectomy, and being the first-born in a family were statistically irrelevant: Diabetes (OR = 0.652 95% CI (0.226-1.882) P = 0.426). Hypertension (OR = 1.445 95% CI (0.724-2.885) P = 0.295) Appendectomy (OR = 1.269 95% CI (0.486-3.317) P = 0.626) Tonsillectomy (OR = 1.280 95% CI (0.576-2.843) P = 0.544). First-born Child (OR = 0.933 95% CI (0.558-1.562) P = 0.793). Conclusion Our study suggests that smoking, vitamin D deficiency, family history of MS, and migraine are probable risk factors for multiple sclerosis. Therefore, engaging in outdoor activities and maintaining a healthy diet—for females in particular—is highly recommended.

Perinatal outcomes and survival predictors of severe red-cell alloimmunization treated by intrauterine transfusion.

To evaluate perinatal survival rates and predictors in severely anemic fetuses that underwent intrauterine transfusion (IUT). This was a retrospective study of both Turkish and Syrian patients who underwent IUT for fetal anemia due to Rh alloimmunization between 2015 and 2019. The association between pretransfusion factors and perinatal survival was evaluated by multivariate logistic regression. Receiver operating characteristics (ROC) curves were used to identify the level of fetal hemoglobin deficits that predict perinatal survival. Eighty-seven IUTs were performed in 42 pregnancies. Approximately 75% of fetuses were severely anemic and the overall perinatal survival rate was 50%. The survival rate was better in Syrian refugees compared to Turkish patients (71.4% vs. 39.3%, p < 0.05). In univariate analysis, hydrops presence (odds ratio [OR]=0.2; 95% confidence interval [CI]=0.05-0.7; p < 0.05), first IUT week (OR=1.4; 95% CI=1.1-1.8; p < 0.05), pretransfusion hemoglobin level (OR=1.99; 95% CI=1.22-3.27; p < 0.05), hemoglobin deficit (OR=0.5; 95% CI=0.3-0.8; p < 0.05), and birth week (OR=2.3; 95% CI=1.3-3.9; p < 0.05) were associated with survival. However in a multivariate analysis, only hemoglobin deficit (OR=0.47; 95% CI=0.22-0.99; p < 0.05) and birth week (OR=3.3; 95% CI=1.1-10.3; p < 0.05) were found to be associated with survival. On ROC analysis, a hemoglobin deficit of ≤6.25 g/dl showed a sensitivity of 0.95 and specificity of 0.62 for predicting perinatal survival. Despite the improvement in the treatment of fetal anemia, perinatal survival rate remains extremely low in severely anemic cases. Among pretransfusion factors, hemoglobin deficit seemed to be most important in predicting survival during fetal anemia.