Damascus Hospital

Fibroepithelial polyps of the ureter are rare benign lesions that can produce long-standing obstruction and hematuria and may be misinterpreted as calculi or malignancy, risking delayed diagnosis and renal injury. We report the case of a 17-year-old male with a 10-year history of intermittent left flank pain and recurrent macroscopic hematuria, whose recent symptom progression prompted imaging that revealed grade-3 left hydronephrosis and a focal intraluminal soft-tissue density at the ureteral transition zone. Diagnostic ureteroscopy demonstrated a fungating polypoid mass in the upper third of the left ureter; endoscopic biopsy and subsequent histopathology confirmed a fibroepithelial ureteral polyp. The lesion was managed by segmental ureteral excision with primary end-to-end anastomosis; postoperative recovery was uneventful and follow-up intravenous pyelography showed normal renal drainage. This case highlights the diagnostic challenge posed by ureteral fibroepithelial polyps and reinforces the role of ureteroscopic assessment with targeted biopsy to enable kidney-sparing treatment and prevent unnecessary radical surgery.

Placental lakes are smooth and blood-filled cavities of varying sizes observed during routine ultrasound examination of pregnant women. This report describes a case of a 35-year-old Syrian woman who complained of vaginal bleeding at 39 weeks of gestation. The patient had a history of seven cesarean sections. Echography revealed anterior accreta placenta previa and 4 large placental lakes measuring 10, 8, 4, and 4 cm. Complete hysterectomy was performed, and the patient was discharged without complications. The importance of this case lies in the presence of four placental lakes, with the largest reaching a size of 10 cm, accompanied by an accreta placenta previa, which is rare. Maternal and fetal complications remain controversial, as some studies have suggested direct effects on the health of the mother and fetus, whereas others have refuted any correlation.

BackgroundKaposi sarcoma is a vascular neoplasm linked to human herpes virus 8 and presents in four main variants. The development of Kaposi sarcoma, particularly the iatrogenic form, in younger women with autoimmune conditions such as multiple sclerosis is exceedingly rare and presents unique diagnostic and therapeutic challenges.Case presentationWe report the case of a 48-year-old Arab woman with an 18-year history of multiple sclerosis managed with corticosteroids, who developed cutaneous iatrogenic Kaposi sarcoma on her lower extremities. The diagnosis was delayed for 2 years as the lesions were initially misattributed to her underlying multiple sclerosis. A skin biopsy eventually confirmed Kaposi sarcoma, and staging revealed localized cutaneous disease with no visceral involvement. The patient was treated with weekly paclitaxel, showing a favorable response. Due to conflict-related logistical issues, treatment was temporarily switched to vincristine and vinorelbine, which resulted in disease progression and adverse effects. Paclitaxel was successfully reintroduced, leading to sustained clinical improvement, and 2 years after completing therapy, the patient remains in good health with no evidence of Kaposi sarcoma recurrence or multiple sclerosis exacerbation.ConclusionThis case expands the known clinical and demographic spectrum of Kaposi sarcoma, underscoring the importance of maintaining a high index of suspicion in atypical patient populations to prevent diagnostic delays. The co-occurrence of multiple sclerosis and Kaposi sarcoma underscores the importance of recognizing iatrogenic Kaposi sarcoma in patients receiving immunosuppressive therapy and calls for further research into the complex intersection of autoimmune disorders and iatrogenic treatment-related immune dysregulation in oncogenesis. This report underscores the importance of individualized, persistent therapeutic strategies in managing Kaposi sarcoma.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13256-025-05683-4.

IntroductionThe widespread application of interleukin (IL) inhibitors for various conditions, including gastrointestinal, rheumatologic, dermatologic and pulmonary diseases, has raised concerns regarding the potential for hepatitis B virus reactivation (HBVr). However, the precise risk of HBVr remains unclear due to inconsistencies in existing research. This systematic review aims to quantify the risk of HBVr in patients receiving IL inhibitor therapies.Methods and analysisThis systematic review will follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search will be conducted in MEDLINE, PubMed, Google Scholar, CENTRAL, Scopus, Embase, Web of Science and ClinicalTrials.gov up to October 2025. Two reviewers will independently screen studies and extract data, resolving discrepancies by consensus. Eligible studies will include HBV-infected patients receiving IL inhibitors. HBVr rates will be estimated using a generalised linear mixed model with a binomial distribution, applying random-effects models to account for interstudy variability. Heterogeneity will be assessed using I², Cochran’s Q and τ². Leave-one-out sensitivity analyses will evaluate robustness. Subgroup analyses will consider HBV serostatus, IL inhibitor type and study characteristics. Studies including patients on antiviral prophylaxis will be excluded from the primary analysis. A secondary analysis will assess prophylaxis efficacy in preventing HBVr according to hepatitis B surface antigen status. Publication bias will be evaluated using Doi plots and the Luis Furuya-Kanamori index.Ethics and disseminationThis study does not require ethics approval as it involves no patient-specific data. Findings will be disseminated at gastroenterology conferences and through peer-reviewed publications.PROSPERO registration numberThe protocol is registered in PROSPERO (CRD42024614179).

Abstract Introduction: Subglottic stenosis (SGS) is a pathological narrowing of the airway within the subglottic region, situated just below the vocal cords. This condition can cause significant respiratory compromise, ranging from dyspnea to life-threatening hypoxemia. While SGS may be congenital or acquired, the acquired form is more prevalent and is most frequently iatrogenic. Prolonged endotracheal intubation or tracheostomy are common causes, with post-intubation SGS accounting for approximately 90% of acquired cases in the pediatric population. Case Presentation: A 45-day-old male infant presented with a history of biphasic stridor and recurrent acute respiratory infections. Diagnostic bronchoscopy identified a Myer-Cotton grade III subglottic stenosis. The lesion was successfully managed in a single procedure using a Holmium laser via a rigid bronchoscope. At the seven-month follow-up, the infant remained in good health with no respiratory complications. Discussion The Holmium laser has been established as a viable pediatric tool, with applications in excising tracheal granulomas, webs, and stenoses, as well as in managing other pathologies such as hemangiomas and bronchogenic cysts. Its technical profile is particularly advantageous for the delicate pediatric airway. The laser is hydrophilic, touch-triggered, and characterized by a minimal thermal injury zone of 0.5–1.0 mm, which helps to minimize collateral damage. While many authors recommend adjunctive cryotherapy post-ablation to reduce the risk of restenosis, this was not employed in the present case. Conclusion Management of pediatric SGS typically requires a multi-modality approach. However, this case demonstrates that the Holmium laser can serve as a definitive single-modality treatment, even in very young infants with severe (Myer-Cotton grade III) stenosis. The patient showed no evidence of restenosis and maintained excellent respiratory function at the seven-month follow-up.

ABSTRACTRenal lymphangiectasia is a rare condition resulting from miscommunication between renal and retroperitoneal lymphatic ducts, causing ductal dilatation and lymphatic fluid collection. In this report, we present this condition and highlight an uncommon management approach involving cyst marsupialization. A 24‐year‐old female presented with flank pain and lumbar tenderness. Ultrasonography revealed a fluid collection, further evaluated by contrast‐enhanced CT, which provided additional details and ruled out urine as the source. Fluid analysis confirmed its lymphatic origin, leading to a diagnosis of renal lymphangiectasia. The condition was managed with marsupialization into the peritoneal cavity. At a one‐year follow‐up, the patient's symptoms had resolved, and ultrasonography showed that the kidney was decompressed with no fluid collection. This case of renal lymphangiectasia underscores its diagnostic challenges and sheds light on the rarely reported marsupialization technique, demonstrating its potential effectiveness and contributing to the growing literature on this rare condition.

The Syrian crisis, severe economic conditions, and the COVID-19 pandemic have significantly impacted the mental health of Syrians, including mothers who have given birth during these difficult times. These conditions have led to an increased prevalence of postpartum depression (PPD), exacerbated by inadequate responses to these crises. The study aims to assess the prevalence of PPD among Syrian mothers during the Syrian crisis, economic crisis, and the COVID-19 pandemic. It also seeks to identify the influence of these factors on the occurrence of PPD. A prospective longitudinal study was conducted between November 13, 2020 and April 27, 2021, in Damascus, Syria. PPD was evaluated among women who visited the Obstetrics and Gynecology University Hospital in Damascus, using the Arabic version of the Edinburgh Postnatal Depression Scale after birth and again 6 weeks later. Pearson's chi-square test and logistic regression were used to investigate the correlation between the variables. A total of 402 women participated in the study, with only 378 remaining for follow-up at 6 weeks postpartum. The prevalence of PPD was found to be 46% immediately after birth and 25.3% 6 weeks later. Women's house devastation (Sig. 0.033, 95% confidence interval (CI): 1.043-2.801), loss or injury of family members (Sig. 0.018, 95% CI: 1.110-3.008), and a preference for a female child (Sig. 0.034, 95% CI: 0.162-0.931) were significantly associated with PPD. We did not find an impact of COVID-19 pandemic on the prevalence of depression. Detecting and addressing PPD is crucial, especially during the Syrian crisis, the COVID-19 pandemic, and ongoing economic difficulties, as these factors heighten stress during the postpartum period. Particular attention should be given to displaced mothers and those who have lost family members due to the conflict.