Obesity and its related factors among university medical students in Syria: A cross-sectional study.

Introduction: Obesity is a worldwide pandemic that has many contributing factors. There is very scarce data available on this issue for the population in Syria. We aim to evaluate the body mass index and related obesity rates of medical students as they are the role model for the general population. We aim to explore the breadth of potential associated factors including psychological, physical activity, dietary, and a broad array of lifestyle and socio-demographic factors. Methods: This is a cross-sectional study that was conducted at a major university in Damascus. Paper-based questionnaires were distributed that included the International Physical Activity Questionnaire short version and the Depression, Anxiety and Stress Scale. Results: The mean body mass index was 23.5 (±4.2) kg/m2 with 540 participants enrolled in this study. Males had significantly higher body mass index than females by 2.5 kg/m2 (p < 0.001, χ2 = 47.9, V = 0.3). In our sample, 304 (60.68%) had normal body mass index (18.5-24.99), 40 (7.98%) were considered underweight (body mass index ⩽ 18.5), 120 (23.95%) were considered overweight (body mass index = 25-29.99) and 37 (7.39%) were considered obese. While many factors were found to be significantly associated with body mass index and obesity, only physical activity, depression, having a first-degree family history with obesity and poor dietary habits were associated in regression analyses evaluating all predictors concurrently. Conclusion: The findings reflect an ongoing epidemic of obesity. Our findings can guide targeted intervention for this young population who will become doctors and health role models in the future. More studies should be conducted to find the best possible ways to tackle this issue in the future.

Exploring Women's Religious Coping Strategies and Psychological Impact After the 2023 Earthquake in Syria.

This paper examined gender (N = 1406;77.7% women) patterns of religious coping and psychological impact following the devastating 2023 Syrian earthquakes. Measures in this nation-wide convenience sample study included positive religious coping (PRC) and negative religious coping (NRC) using the Brief Religious Coping Scale (RCOPE), and probable PTSD, depression, and anxiety, using the PCL-5, PHQ-9, and GAD-7, respectively. Women reported higher endorsement of PRC items while men higher endorsement of NRC items. Within the women only sample, lower education and lower income, education and younger age predicted PRC and NRC, respectively. NRC was strongly positively associated with PTSD, depression and anxiety; while, PRC was positively associated only with PTSD. These vulnerable women require targeted support to adopt more adaptive religious coping strategies.

The mental health impact of the 2023 earthquakes on the Syrian population: cross-sectional study.

BACKGROUND: Natural disasters have a significant impact on the mental health of affected populations. The February 2023 earthquakes in Syria and Turkey caused widespread devastation. AIMS: To explore the mental health impact of the earthquakes in Syria on the population across areas differentially damaged by the disaster. METHOD: This cross-sectional study conducted in Syria included 1406 adults recruited via social media platforms 1 month after the February 2023 earthquakes. Demographic information, earthquake exposure questions, the PTSD Checklist for DSM-5 (PCL-5: for probable post-traumatic stress disorder, PTSD), the Patient Health Questionnaire-9 (PHQ-9: for probable depression) and the seven-item Generalized Anxiety Disorder scale (GAD-7: for probable anxiety) were included to compare outcomes across areas severely, moderately and slightly damaged by the earthquakes. RESULTS: Probable PTSD and GAD rates were higher in the severely (57.9 and 57.3% respectively) and moderately damaged regions (55.4 and 56.3% respectively) than in the slightly damaged regions (44.6 and 48.3% respectively) (PTSD: P < 0.001, GAD: P = 0.005). More participants in severely damaged regions (60.6%) reported symptoms of depression compared with moderately (53.1%) and slightly damaged (50.8%) regions (P = 0.003). Poorer mental health outcomes were associated with being female, single, younger, having a damaged or destroyed house, seeing something tragic in person and hearing tragic stories. Seeing something tragic on social media was not statistically significant. CONCLUSIONS: This study highlights the higher prevalence of probable mental disorders in areas with more severe earthquake damage, with over 50% of the population reporting probable PTSD, depression or anxiety. The study also suggests a significant cumulative effect of these earthquakes on an already trauma- and disaster-affected population.

Effective surgical management of glomus tympanicum tumor using diode laser: A case report study.

INTRODUCTION: Glomus tympanicum is an extremely rare benign paraganglioma of the middle ear. The distinctive features of these tumors include their propensity for recurrence following treatment and their remarkably vascular nature, posing significant challenges to surgeons and necessitating the development of effective surgical techniques. CASE PRESENTATION: A 56-year-old female presented with pulsatile tinnitus persisting for a year. Examination revealed a pulsating red mass in the lower section of the tympanic membrane. Computed tomography confirmed the presence of a mass occupying the middle ear, which was diagnosed as a glomus tympanicum tumor. The patient underwent surgical excision of the tumor, followed by diode laser application for coagulation at the site of the tumor. Histopathological examination confirmed the clinical diagnosis. DISCUSSION: Glomus tympanicum tumors are rare neoplasms that arise in the middle ear. The surgical management of these tumors varies depending on the size and extent of the lesion. Various techniques are available for excision, including bipolar cautery and laser. Laser has emerged as an effective method for reducing tumor mass and controlling intraoperative bleeding, with positive indications after surgery. CONCLUSION: Based on our case report, laser can be considered an effective and safe method for excision of glomus tympanicum, with positive indications for controlling intraoperative bleeding and reducing tumor mass.

Endovascular management of RCC in one-kidney patient: a case report study.

Renal cell carcinoma is considered one of the most common and deadly cancers, which remain asymptomatic until the late stage, needing total nephrectomy when it is detected. In mono-kidney patients this will lead to hemodialysis and later a kidney transplant. Case presentation: This case represents our center's experience and strategy in managing renal cell carcinoma in a one-kidney patient by endovascular management first followed by partial nephrectomy. Clinical discussion: The patient's postoperative follow-up has a good quality of life with no signs of tumor recurrence or metastasis in addition to normal kidney functions tests. Conclusion: Preoperative endovascular intervention can represent a good and accepted solution for a partial nephrectomy preserving not only a normal renal function, without the need for kidney transplantation, but also a good quality of life.

Mediastinal mature cystic teratoma in a child: A case report study.

INTRODUCTION: A mediastinal teratoma is a very rare disease, in which a relatively large mass grows in the space between the two lungs. Although it is a congenital abnormality, it is diagnosed late in the second or third decade. It could be benign or malignant, symptomatic or asymptomatic. PRESENTATION OF CASE: A five-year-old child presented with an acute respiratory distress episode due to an acute infection, unresponsive to first-line antibiotics and had a history of similar recurrent pulmonary infections. On imaging, the patient showed an abnormal mediastinal mass which was speculated to be a hydatid cyst or abscess; however, it was later diagnosed during surgery as a mature mediastinal cystic teratoma. DISCUSSION: Mediastinal tumors are slow-growing tumors that are mostly benign and asymptomatic, but sometimes they may grow, reaching a state where they can affect the neighboring anatomical structures, causing symptoms, which may lead to misdiagnosis. CONCLUSION: Teratomas, as a differential diagnosis, should be considered in children with recurrent pulmonary infection and radiological findings that resemble masses in the chest. This emphasizes on the importance of performing detailed radiological and lab investigations to set an appropriate diagnosis to ensure a better treatment and prognosis.

Rhabdomyoma in the base of the tongue : A case report.

INTRODUCTION: Rhabdomyomas are benign and rare mesenchymal tumors. They are classified into cardiac and extracardiac. However, the majority of adult subtype, which are extracardiac, tend to occur in the head and neck region. PRESENT OF CASE: A 57-year-old man with dysphagia, dysphonia and stertor one year ago. Head and neck endoscopy was the first step to detect a smooth mass at the base of the tongue, after that CT-scan showed great lobuled mass measured 7 × 5 × 6 cm. However, complete surgical excision was done and the histopathological examination play a central role to reveal an adult-type rhabdomyoma. DISCUSSION: the tongue base is absolutely one of the rarest sites of oral adult-type rhabdomyoma (ARM), because since 1948 to 2021 there were only four English-language articles which described ARM in the base of the tongue, anyway this type mimics malignant tumors on CT-scan because of its unclear borders and The golden diagnosis depends on histopathological examination and immunohistochemistry staining when the desmin markers are positive after that the tumor was completely excisioned as the best treatment. CONCLUSION: Base of the tongue is a very rare location for adult-rhabdomyoma which must be considered in the differential diagnosis of head and neck lesions.

Percutaneous transluminal interventions of transplant renal artery stenosis: A case series study.

Introduction: and importance: Transplant renal artery stenosis (TRAS) is a well-recognized vascular complication after kidney transplant that can lead to graft loss, when it is diagnosed early and treated appropriately it may prevent kidney damage and related systemic squeals. Case presentation: This case-series represents our center experience in managing TRAS using percutaneous transluminal angioplasty [either balloon angioplasty (PTA) or stent placement (PTAS)] in 11 patients. Clinical discussion: All treated patients experienced immediate total recovery of renal function and normalization of arterial blood pressure without any drug or reducing the number of drugs used; no complications related to the intervention were reported. Conclusion: PTA or PTAS of TRAS can be considered safe and effective when it diagnosed and treated early.

Is pull-through an acceptable replacement for low anterior resection for rectal cancers in low-income setting? A case-control study.

BACKGROUND: Colorectal cancers are the second most common cancers overall and are the third deadliest cancers. Complete resection is the treatment of choice for rectal cancers and chemoradiotherapy (CRT) is strongly recommended in stage 2 and 3. Low anterior resection (LAR) is the most common procedure used, but it requires the use of stapler which might be very expensive as one study estimated the median cost of LAR inpatients to be over 13.000 USD. However, coloanal pull-through (PT) used to be the common procedure before introducing staplers in the twentieth century and can be less expensive, but with higher complication rates. MATERIALS AND METHODS: This is a retrospective case-control study from patients' records who underwent either LAR or PT for their rectal cancer in Syria. All patients had either stage 2 or 3 cancer and were treated by the same group of surgeons and received the same adjuvant and neoadjuvant CRT protocol. Patients from both groups had the same prognosis and stages. RESULTS: This study included 60 participants, of which, 30 had LAR and 30 had PT. They all had successful removal of the cancer and follow-ups were for 1 year after the surgery. There were no significant differences between the two procedures in post-operative leak, urinary retention, stricture, sexual function and recurrence (p > 0.05). However, post-operative incontinence was more frequent with PT (p = 0.027). CONCLUSION: PT can be an acceptable substitute of LAR in low income settings despite having higher incidence of incontinence.

Was a forced lockdown adequate for a country in conflict? A psychological perspective from the Syrian population.

BACKGROUND: Syria has suffered for nine years from a conflict that left over 11.1 million inhabitants in need of humanitarian assistance and over 80% in poverty. A ten-week-long full lockdown was enforced in Syria and successfully minimized the spread of COVID-19. This study aims to estimate the occurrence of mental health disorders after lockdown termination among the citizens of war-torn Syria. METHODS: Online questionnaires, which included demographic and war-related questions, Dimensions of Anger Reactions 5 (DAR-5) and the Depression Anxiety Stress Scale-21 (DASS-21) were distributed to different social media groups. RESULTS: This study recruited 1445 participants, of which 515 (35.6%) were males, the mean age was 24.8 ± 6.3 years, 38% had problematic anger, 64% had moderate to very severe depression, 42.9% had moderate to severe anxiety and 39.7% had moderate to severe stress. Increased living expenses, not being able to go out and a reduced ability to earn income and provide food were significantly associated with the psychological burden after the lockdown (p < 0.05). The association of war variables with mental disorders was weaker than the effect of the deteriorating economy. Other healthcare workers had more severe distress than doctors, who themselves were found to have less distress than the general population (p < 0.05). Anger scores were approximately equal, regardless of the type of work. Finally, shisha smoking was associated with worse mental health (p < 0.05). CONCLUSION: The psychological burden of the damaged economy surpassed the direct damage due to COVID-19 and the effect of years of conflict. Urgent interventions are required, as this burden may continue for years, if not for decades. A full lockdown in countries with fragile economies may delay the spread of the virus, but it will severely damage the economy, which will lead to a deterioration of the mental health of their citizens.

An enormous arteriovenous malformation presenting in a child in sacro-gluteal region and managed successfully by recurrent embolisation and surgery.

BACKGROUND: Arteriovenous malformations (AVMs) are rare congenital lesions that affect multiple regions. AVMs often affect the brain and the buttock is the least common. They are usually congenital, but discovered later in life as they are asymptomatic, small and resemble a benign lesion. However, they can abruptly grow and become symptomatic and life-threatening as they can bleed and get infected. PRESENTATION OF CASE: An eight-year-old girl presented with ulcerated and bleeding AVM at the sacro gluteal region. However, due to financial difficulty, it grew to reach an enormous size of (15*15*2 cm) in the buttock. It was later managed by multiple embolisation followed by total surgical resection. DISCUSSION: This case reflects the first case of enormous AVM in the sacro-gluteal region in a child in the Middle East as they rarely reach such huge sizes. Total resection was possible by repeat embolisation and surgery. CONCLUSION: Embolisation can render even huge AVM operable. AVMs should be treated as early as possible as they continue to grow and drastically decrease the quality of life of the patient.