Placenta accreta spectrum (PAS) can cause complications like hysterectomy or death due to massive pelvic bleeding. We aim to evaluate the efficacy of two different arterial ligation techniques in controlling postpartum haemorrhage and minimizing bleeding complications. We searched six databases. 11 studies were finally included into our review and analysis. We graded their quality using the Cochrane tool for randomized trials and the NIH tool for retrospective studies. Our analysis showed that internal iliac artery ligation has no significant effect on bleeding control (MD = −248.60 [−1045.55, 548.35] P = 0.54), while uterine artery ligation significantly reduced the amount of blood loss and preserved the uterus (MD = −260.75, 95% CI [−333.64, −187.86], P < 0.00001). Uterine artery ligation also minimized the need for blood transfusion. Bleeding was best controlled by combining both uterine artery ligation with uterine tamponade (MD = 1694.06 [1675.34, 1712.78], P < 0.00001). This combination also showed a significant decrease in hysterectomy compared to the uterine artery ligation technique alone. Bilateral uterine artery ligation in women with placenta accreta spectrum can effectively reduce the amount of bleeding and the risk of complications. The best bleeding control tested is a combination of both, uterine artery ligation and cervical tamponade. These techniques may offer an easy and applicable way to preserve fertility in PAS patients. Larger randomized trials are needed to define the best technique.

Objective: Morphine is a potent analgesic used to manage the pain following total knee arthroplasty (TKA). We aim to assess the safety and efficacy of intrathecal morphine (ITM) compared with placebo following TKA.Methods: We systematically searched four databases for trials that study the safety and efficacy of ITM in TKA. From relevant studies, data were extracted and pooled as mean difference (MD) or standardized mean difference (SMD) with 95 percent confidence interval (CI) using Review Manager software (Version 5.3).Results: We included six randomized controlled trials in our study. ITM significantly reduced pain scores at 4 hours (SMD = –0.82, 95 percent CI [–1.52, –0.12], p = 0.02) and 24 hours (MD = –2.01, 95 percent CI [–2.93, –1.09], p = 0.0001) after surgery compared to placebo. No statistically significant difference in cumulative morphine use or nausea episodes was observed after 24 hours. ITM increased the risk of pruritus more than placebo (relative risk [RR] = 4.82, 95 percent CI [2.34, 9.93], p 0.0001).Conclusion: ITM reduces pain at 4 and 24 hours post-operatively with no effect on cumulative morphine consumption. The only feared side effect is pruritus.

Background Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) represent a range of both psychiatric and physical symptoms that impair quality of life and interfere with daily activities in females. Aims To assess the prevalence of PMS and PMDD in Egypt, Jordan and Syria, its demographic associations and the potential link to sexual harassment (SH). Methods We used an Arabic version of the premenstrual symptoms screening tool (PSST) to assess the prevalence of PMS and PMDD. Another two-part questionnaire was used to assess the harassment experience. Results 22,021 women agreed to fill the questionnaire; the majority (65%) aged 18–25 years old. PMS was more prevalent in Egyptian women 77.7% followed by women from Jordan 72.9% then Syria 66.3%. PMDD prevalence followed the same order (40%, 34.7% and 28.2%). Both conditions were significantly associated with obesity and working in medical careers (P = .001). 5733 women agreed to share their sexual harassment experience. Results showed a significant association between the diversity and frequency of sexual harassment and the frequency of the pre-menstrual conditions, PMS Frequency was 87.6%, 80.7% and 78% in participants who were harassed on daily basis Vs. once weekly or monthly vs. few times in their lifetime (p = .04). A similar statistically significant difference was noticed regarding having PMDD (66.4% vs. 47.6% vs. 42.5%). Conclusion The study showed high levels of both PMS and PMDD. The data provided by this study also sheds light on a potential link between SH and developing Pre-menstrual disorders.

Over six million individuals have died as a result of the infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) that causes Covid-19. The first COVID-19 vaccines were introduced to the public in 2020 through emergency authorizations. This study aims to uncover the fears and misconceptions behind the hesitation or refusal of taking the COVID-19 vaccine in Syria. Methods: Through a nationwide cross-sectional study, a convenience sample of 10006 participants who were at least 18 years old and living in Syria participated in a validated questionnaire during the period between January and May 2022 Results: The majority of recruited individuals were female (n= 6048; 60.4%) from the (18-24) age group (n= 5908; 59%). We recorded 5811 (58%) participants who still have fears and anxieties about the COVID-19 vaccine. The main concerns about vaccines were the rapid development of vaccines (41.4%), fears of blood clots (37.9%), the fears of common side effects (35.2%), and allergic reactions (26.5%). Conclusion: The COVID-19 vaccine is considered the most promising measure for controlling the spread of infection. The success of this policy will depend on the rate of global acceptance of the vaccine. High variability in vaccine acceptance and high vaccine hesitancy can affect the efforts to terminate the COVID-19 pandemic. Addressing the barriers associated with the acceptance of COVID-19 vaccination will be the cornerstone to achieving maximum vaccination coverage. The most common reasons behind refusing the vaccine in Syria were fear of side effects, followed by fears, general concerns, manufacturing-related reasons, and conspiracy belief

Background and Aims: Despite the significant milestone of vaccine discovery, the spread of misinformation and pseudoscientific claims has resulted in an increasing number of people refusing vaccination in Syria. In this study, we aimed to explore fears and misconceptions towards COVID-19 vaccines among the Syrian population.Methods: We conducted a nationwide cross-sectional study between January and May 2022, using a convenience sample of 10,006 participants aged at least 18 years and living in Syria. We administered a validated online/paper questionnaire and conducted face-to-face interviews. We used SPSS software (version 26) for statistical analysis, assessing our data using frequency and χ 2 tests, with p < 0.05 considered statistically significant.Results: The majority of the participants were female 6048 (60.4%), university degree holders 7304 (73%), and from urban areas 8015 (80.1%). Approximately half of the participants 5021 (50.2%) belonged to the medical sector (49% had concerns about the vaccine). Females, university degree holders, and participants with a history of symptomatic COVID-19 were more likely to have fears about the vaccines. The main concerns about the vaccines were the rapid development, fears of blood clots, and common side effects. The prevalence of some misconceptions was relatively high, such as the belief that the vaccine is an experiment or a secret plan to reduce the population. Reliable sources are crucial to fight misleading information on social media. Conclusion: COVID-19 vaccine is key to controlling the spread, but acceptance rate is critical. High variability in vaccine acceptance and high vaccine hesitancy can affect the efforts to terminate the COVID-19 pandemic. Addressing the barriers associated with the acceptance of COVID-19 vaccination will be the cornerstone to achieving maximum vaccination coverage. It is important to consider the reasons for Health Sci. Rep.