No abstract

Statins were prescribed to children younger than suggested by current Australian guidelines, with atorvastatin being the preferred statin of choice. Long-term safety studies on the use of statins in children have only included FH patients so far, who are generally healthy besides their raised lipid levels. Further long-term safety studies are needed to include the more vulnerable transplant and renal patients, identified in this audit as being prescribed statins. This can help formulate guidelines for the safest possible use of this class of drugs in the pediatric setting, including the possibility of weight-based recommendations for younger children.

Linear scleroderma "en coups de sabre" (LScs) is a variant of localized scleroderma, which is confined to the hemiface but may occasionally be bilateral. 1 First described by Addison in 1854, disease incidence peaks during the fifth decade of life. However, in children, it is often diagnosed between the ages of 2-14 years, and it affects females more than males (3:1). Clinical manifestations include scar-like lesions in the forehead and the scalp, and atrophy of the underlying skin and subcutaneous tissues including muscle, tendon, and bone. 1-5 In the craniofacial region, intracranial neural structures may be involved, with some patients exhibiting seizures. 5 The soft-tissue changes often progress slowly over a period of 2-5 years, after which the disease stabilizes. 6-8 The result is an acute facial asymmetry that can be distressing to the affected young adults. 9,10 Medical treatments in terms of immunosuppressants and anti-inflammatory drugs do not adequately address the soft-tissue atrophy. Thus, surgical correction has continued to be a mainstay of treatment. 2,9,11 It is important to distinguish LScs from Parry-Romberg syndrome, where the latter often initiates in the cheek and nose, is unilateral, and does not exhibit skin changes. 5 In this report, we present a rare case of LScs that was successfully managed by single-stage autologous fat grafting.

Background Fibromyalgia is a chronic disease with a high burden. We aim to be the first to investigate the prevalence of fibromyalgia (FM) in Syria and assess its risk factors. Methods A self-reported questionnaire was distributed to the public to identify fibromyalgia patients using the American College of Rheumatology (ACR) 2010 modified criteria. Identified cases were matched using age with controls free from rheumatic disorders that were randomly sampled from the same population. Results Out of 2966 participants, 350 (11.8%) satisfied the diagnostic criteria. Of these, only 29 (8.2%) were previously diagnosed by a physician, 239 (68.3%) were females, and 69 (19.71%) were diagnosed with depression. Female sex (OR = 1.31), diagnosis of major depressive disorder (OR = 2.62), irritable bowel syndrome (OR = 1.8), and Restless legs syndrome (OR = 1.72) were associated with a higher likelihood of fibromyalgia. Conclusion Our study revealed one of the highest prevalence rates of fibromyalgia ever reported in the general population. Efforts must be intensified to increase awareness about this disease in Syrian society as well as among healthcare providers.

Background Liposuction and autologous fat transplantation represent widely used techniques in plastic surgery to correct or enhance contour irregularities in the face and body. While these techniques are assumed to be safe, liposuction and fat grafting impose a hidden risk for serious preventable surgical complications and adverse patient outcomes. We hereby report two cases of iatrogenic sciatic nerve injury and provide recommendations on how to prevent this serious surgical complication. Case presentation We present two cases of sciatic nerve injury - one related to liposuction and the other related to gluteal lipo-augmentation. The first case is a 20-year-old female who presented to our institution with right leg weakness one week after undergoing scar revision and fat grafting in the left peri-oral region to correct peri-oral cicatricial banding and tissue atrophy. Fat was harvested from the medial thigh using a 3-mm cannula with low-pressure manual suction, utilizing minimal tumescent solution. Nerve conduction velocity and electromyography testing suggested a right-sided sciatic nerve lesion as a result of direct trauma. The patient was observed for a period of 4 months during which time she underwent physical therapy. At four months post-operatively, she had recovered completely. The second case is that of a 39-year-old female who presented to our institution with left-sided weakness of foot eversion and dorsiflexion five days after she had undergone liposuction of the thighs, flanks, and abdomen in addition to gluteal lipo-augmentation at an outside facility. The patient had undergone super wet liposuction in the areas of the abdomen, flanks and thighs. 200 mL of collected fat was then transplanted into each buttock at multiple levels. Post-operative computed tomography and electroneurography revealed acute left sided sciatic injury consistent with direct trauma to or compression of the sciatic nerve. The patient underwent an extensive regimen of physical therapy. Three months post-operatively, the patient had regained some motor function, but was lost to follow-up thereafter. Conclusion The sciatic nerve is relatively superficial and vulnerable to injury in the upper thigh and lower buttock regions. Therefore, extreme care should be taken when working in these areas to avoid direct or indirect injury to the sciatic nerve by compression or traction.

Background Fibromyalgia is a chronic disease with a high burden. We aim to be the first to investigate the prevalence of fibromyalgia (FM) in Syria and assess its risk factors. Methods a self-reported questionnaire was distributed to the public to identify fibromyalgia patients using the American College of Rheumatology (ACR) 2010 modified criteria. Identified cases were matched using age with controls free from rheumatic disorders that were randomly sampled from the same population. Results out of 2966 participants, 350 (11.8%) satisfied the diagnostic criteria. Of these, only 29 (8.2%) were previously diagnosed by a physician, 239 (68.3%) were females, and 69 (19.71%) were diagnosed with depression. Female sex (OR=1.7, CI: 1.3-2.1), unemployment (OR=1.4, CI:1.1 – 1.79), diagnosis of major depressive disorder (OR=3.8, CI: 2.7 – 5.35), generalized anxiety disorder (OR=2.7, CI: 1.95 – 3.72), and irritable bowel syndrome (OR=2.4, CI: 1.78 – 3.17) were significant risk factors for FM. Conclusion our study revealed one of the highest prevalence rates of fibromyalgia ever reported in the general population. Efforts must be intensified to increase the awareness about this disease in the Syrian society as well as among healthcare providers.

Introduction Inflammation of the gut lining constitute the basis for IBD pathogenesis, a disease with multifactorial etiology. In addition, there is suggestive evidence that the interaction of CD147, β1 integrin and Syndecan‐1 (Sdc‐1) could control the inflammation process and impact healing. Aim The aim of this work is to look at the pathogenesis of IBD in Sdc‐1 null mice as compared to control (BALB/C). Our hypothesis is that in the absence of Sdc‐1 a more severe inflammation will be observed. Method In this study, 32 male (16 BALB/c and 16 Sdc‐1 null) mice, 8‐10 weeks old were used after the Institutional Animal Care and Use Committee approval. They were divided equally into 4 groups. Half of the mice (8 BALB/C and 8 Sdc‐1 null were given 1 cycle of 2.5 % DSS in drinking water for 1 week while the rest were given the 1st cycle of DSS then 2 weeks normal drinking water followed by a second cycle of 7 days of 2.5% DSS in drinking water. The animals were monitored and weighed daily/ observed clinically for body weight, stool consistency, gross bleeding scores as well as fecal occult blood. The animals were sacrificed at 1 week, 3 weeks and 4 weeks post DSS and 8 animals (4 BALB/C and 4 Sdc‐1 null) were supposed to be sacrificed 6 weeks post DSS yet at week 5 all the Sdc‐1null mice died while the BALB/C mice are still alive. The lengths of the colons were measured and the sigmoid part was used for histological comparison, at this stage, between the two strains. Results Preliminary data showed that in Sdc‐1 null mice there was more weight loss, earlier rectal bleeding and death of animals compared to BALB/C. Moreover, the histological alterations in Sdc‐1 null were more sever with more dissemination of the inflammation and cryptitis as well erosion of the intestinal lining epithelium compared to BALB/C mice. Conclusion Sdc‐1null mice are more sensitive to IBD induction compared to the control BALB/C. The loss of Sdc‐1 makes the inflammation more acute and lethal. More dose effect studies and characterizations are ongoing, hoping it will lead to a novel therapeutic approach for IBD treatment.