Assessment of knowledge and awareness of stroke among the Syrian population: unveiling the current landscape in Syria through the first nationally representative study.

Stroke is a global public health concern, contributing to high rates of morbidity and mortality. In Syria, the current conflict and associated challenges have had a profound impact on healthcare infrastructure, including education and awareness programs related to stroke. An essential aspect of preventing stroke is the awareness of individuals. The study aimed to investigate factors associated with knowledge and awareness of stroke among Syrian people. A cross-sectional national representative study was conducted in Syria. The questionnaire was created on Google form and disseminated as a link through online platform social media like Facebook, WhatsApp, and Twitter. The population of the study was divided using proportionate random sampling into the 14 governorates. A random sample was selected from each area. The STROBE reporting guideline for cross-sectional studies was followed. Logistic regression analysis was performed to identify the factors associated with poor knowledge of stroke. A total of 1013 Syrian adults participated in the study. With more than half of them were females (53.5%) and employed (55.6%). Significant associations were found between ability to identify at least one correct risk factor and employability status (p = 0.029), single group (p = 0.036) and smokers (p < 0.001). In addition, significant associations were found between identifying at least one correct stroke symptom and smokers (p < 0.001) and no-obese people (p = 0.048). Furthermore, younger age group (below 30 years) were significantly able to list at least one correct stroke consequence compared to the older age groups (p = 0.025). Moreover, a significantly higher number of smokers compared to non-smokers correctly identified at least one stroke consequence (p = 0.019). The study revealed that there is a relatively weak understanding of the preventable nature of stroke among Syrian population. The overall awareness is still inadequate and varies depending on lifestyle factors and employment status.

Diabetes care and outcomes of pediatric refugees and migrants from Ukraine and Syria/Afghanistan with type 1 diabetes in German-speaking countries.

Introduction: Currently, over two million war refugees live in Germany. Exposure to war and flight is associated with a high burden of diseases, not limited to mental disorders and infections. We aimed to analyze diabetes treatment and outcomes of pediatric refugees and migrants from Ukraine and Syria/Afghanistan with type 1 diabetes (T1D) in German-speaking countries. Materials and methods: We included patients with T1D documented between January 2013 and June 2023 in the German/Austrian/Luxembourgian/Swiss DPV registry, aged < 20 years, born in Ukraine [U], in Syria or Afghanistan [S/A], or without migration background [C]. Using logistic, linear, and negative binomial regression models, we compared diabetes technology use, BMI-SDS, HbA1c values, as well as severe hypoglycemia and DKA rates between groups in the first year of treatment in the host country. Results were adjusted for sex, age, diabetes duration, and time spent in the host country. Results: Among all patients with T1D aged < 20 years, 615 were born in Ukraine [U], 624 in Syria or Afghanistan [S/A], and 28,106 had no migration background [C]. Compared to the two other groups, patients from Syria or Afghanistan had a higher adjusted BMI-SDS (0.34 [95%-CI: 0.21-0.48] [S/A] vs. 0.13 [- 0.02-0.27] [U] and 0.20 [0.19-0.21] [C]; all p<0.001), a lower use of CGM or AID system (57.6% and 4.6%, respectively [S/A] vs. 83.7% and 7.8% [U], and 87.7% and 21.8% [C], all p<0.05) and a higher rate of severe hypoglycemia (15.3/100 PY [S/A] vs. 7.6/100 PY [C], and vs. 4.8/100 PY [U], all p<0.05). Compared to the two other groups, patients from Ukraine had a lower adjusted HbA1c (6.96% [95%-CI: 6.77-7.14] [U] vs. 7.49% [7.32-7.66] [S/A] and 7.37% [7.36-7.39] [C], all p<0.001). Discussion: In their first treatment year in the host country, young Syrian or Afghan refugees had higher BMI-SDS, lower use of diabetes technology, higher HbA1c, and a higher rate of severe hypoglycemia compared to young Ukrainian refugees. Diabetologists should be aware of the different cultural and socioeconomic backgrounds of refugees to adapt diabetes treatment and education to specific needs.

Frequency of SARS-COV-2 infection and COVID-19 vaccine uptake and protection among Syrian refugees : COVID-19 Vaccine among Syrian Refugees.

It is aimed to examine the frequency of COVID-19 disease, the rates of COVID-19 vaccination and the vaccine effectiveness (VE) among Syrian refugees. It is a retrospective cohort study. Syrian refugees aged 18 years and above registered to a family health center in Sultanbeyli district in Istanbul were included. Vaccine effectiveness were calculated for both Pfizer BioN-Tech and CoronaVac (Sinovac) vaccines. The data of 2586 Syrian people was evaluated in the study. The median age of the participants was 34.0 years (min:18.0; max: 90.0). Of the participants 58.4% (n = 1510) were female, 41.6% (n = 1076) were male. In our study of the refugees 15.7% had history of COVID-19 infection. Refugees having full vaccination with Biontech and Sinovac have a significantly lower COVID-19 infection rate than those without vaccination (HR = 8.687; p < 0.001). Adjusted VE for Biontech, Sinovac, and both were 89.2% (95.0% CI:83.3-93.1), 81.2% (95.0% CI:48.72-93.1) and 88.5% (95.0% CI:82.7-92.3), respectively. The results of the study highlight the importance of vaccinations against COVID-19 pandemic, since both vaccines were highly protective in refugees.

Acute watery diarrhoea cases during cholera outbreak in Syria: a cohort study.

OBJECTIVES: The aim of this study is a descriptive presentation of cases of acute watery diarrhoea (AWD) that were presented to Aleppo University Hospital (AUH) during the recent cholera outbreak in Syria. DESIGN: Prospective, observational, cohort study. SETTING AND PARTICIPANTS: A total of 1061 patients with AWD were admitted to AUH during the timeframe of 20 September 2022 to 20 October 2022. The data collection was done through a structured questionnaire. This includes comprehensive clinical observation, laboratory analyses, therapeutic interventions and holistic case evaluations. RESULTS: The analysis has revealed notable insights: a predominant proportion of patients (58.6%) were residents from urban areas and 40.3% were residents from rural areas. Intriguingly, a diverse range of potential infection sources emerged from patient data within our hospital, including uncontrolled well water, vegetables and faecal-oral transmission through contaminated street/fast food. At discharge, most patients were in good health (79.7%), followed by moderate health (17.6%) and poor health (2.3%), with a minimal percentage dying before discharge (0.4%). The most common complications reported at admission and during hospitalisation included electrolyte imbalance (28.2%), followed by severe dehydration (16.3%). In the follow-up period, the majority of patients exhibited good health (81.0%). Older patients (>60 years) had poorer outcomes, with 8.4% having poor health and 4.2% death rate. CONCLUSIONS: The study found results consistent with previous AWD outbreaks in developing countries like Yemen, Nigeria and Lebanon. Preventative measures like improving water sanitation and hygiene practices are essential to prevent future outbreaks and ease the strain on healthcare systems. Therefore, future studies must investigate the risk factors that increase the spread and the severity of the disease and investigate the best management method.

A qualitative survey on factors affecting depression and anxiety in patients with rheumatoid arthritis: a cross-sectional study in Syria.

Depression and anxiety often coexist with rheumatoid arthritis (RA) and affect the course of the disease. These mental health conditions can be overlooked or underdiagnosed in people with RA. There is conflicting evidence in previous studies regarding this topic, indicating that further research is necessary to provide a thorough understanding of the relationship between anxiety, depression, and RA. This study aims to determine the factors correlated with depression and anxiety symptoms in RA patients by evaluating disease activity at the same time. This cross-sectional study was conducted at four outpatient rehabilitation centers in four Syrian provinces: Damascus, Homs, Hama, and Latakia. The study included RA patients who attended the RA department of rehabilitation centers from January 1 to June 31, 2023. RA patients who presented at a rheumatology clinic were selected consecutively. RA patients were included in the study in accordance with the ACR/EULAR classification criteria, disease activity was assessed by disease activity score based on the 28-joint count (DAS28), and patients with DAS28 > 2.6 were considered to have active RA. The demographic data, as well as disease duration, educational status, Disease Activity Score with 28-joint counts (DAS28), health assessment questionnaire (HAQ) score, and the hospital anxiety and depression scale (HADS), were the parameters used in the analysis. Two hundred and twelve patients (female, 75%) with a mean age of 49.3 ± 13.1 years and a mean disease duration of 8.3 ± 6.9 years were studied. Depression was diagnosed in 79 (37.3%) patients and anxiety in 36 (16.9%) patients. Patients with depression and/or anxiety had higher HAQ and DAS28 scores compared to other RA patients. Blue-collar workers exhibited a higher prevalence of anxiety, whereas females, housewives, and individuals with lower educational attainment demonstrated a higher prevalence of depression. The current study found high rates of anxiety and depression in RA patients, highlighting the significant burden of these mental health conditions compared to the general population. It is essential for healthcare providers not to overlook the importance of psychiatric evaluations, mental health assessments, and physical examinations of RA patients.

Temporal pattern of dental caries at the western flank of the Central Plateau of Iran, c. 2700 BCE - 1600 CE.

OBJECTIVE: To analyze the overall frequency and inter-tooth patterns of caries in three populations from ancient cemeteries located along the western border of the Central Iranian Plateau as a means to explore whether the populations of Iran had greater access to fermentable sugars after the establishment of the great empires. MATERIALS: Dental collections from Kafarved-Varzaneh (Early Bronze Age, MNI=66), Estark-Joshaqan (Iron Age, MNI=57), Tappeh Poustchi (Timurid and Safavid Period, MNI=34), together with comparative data from NE Syria. METHODS: Frequencies of dental caries per tooth categories, location and size of carious lesions are analyzed using Smith's Mean Measure of Divergence, Correspondence Analysis, χ2 and Kruskal-Wallis tests. RESULTS: There are minimal differences in overall frequencies of carious lesions at Iranian sites, regardless of the chronology, but notable differences at Syrian sites. The inter-tooth pattern at the Iron Age cemetery in Estark appears distinctly different than the other Iranian sites and the comparative samples from Syria. CONCLUSIONS: Divergent subsistence strategies may be linked with different inter-tooth patterns since people buried at Estark were mobile herders, while the other cemeteries were used by settled farmers. SIGNIFICANCE: This comprehensive research on dental caries in three chronologically diverse populations in Iran sheds light on the association between dental caries and subsistence strategies, and introduces the Smith's Mean Measure of Divergence to explore inter-tooth carious patterns, which may prove useful to other researchers seeking to understand the relationships between subsistence, diet, and the presence of carious lesions. LIMITATIONS: The studied sample size is relatively small and therefore its temporal/regional distribution produces low-resolution results. SUGGESTIONS FOR FURTHER RESEARCH: More systematic research on the patterns of dental caries is necessary to produce more fine-grained reconstructions of diet and subsistence in Iran and around the globe.

Assessment the awareness of vitamin D deficiency among the general population in Syria: an online cross-sectional study.

BACKGROUND: Vitamin D deficiency is an importance preventable problem in the global and associates with lack levels of awareness about vitamin D. According to prior studies, in the Arab world, there is low of knowledge and awareness toward vitamin D deficiency. The target of our study is evaluating the knowledge level about vitamin D deficiency and determining the associated factors with levels of awareness of its. METHOD: This online cross-sectional study was performed in Syria between 25 February to 29 March 2023 to assess the levels of knowledge about vitamin D deficiency among general Syrian population. The study's survey was obtained from previously published research and we conducted a pilot study to assure the validity and clarity questionnaire. All Syrian individuals aged 18 or older who were able to read and write and willing to participate were included, while, non-Syrian nationality individuals and all medical staff (doctors, nurses, and medical students…), as well, those under 18 age were excluded. The questionnaire consisted of 23 questions separated into four categories. The first section was sociodemographic information of the study population. The second section measured the level awareness of the study population regarding the benefits of vitamin D. In addition, the third and fourth part evaluated knowing of the respondents about sources of and toxicity consequences of vitamin D. The data were analyzed by utilizing multivariate logistic regression in IBM, SPSS V.28 version. RESULTS: Overall, 3172 of the study population accepted to participate in this research and 57.9% the majority of them were aged in the range among 18 and 28. While, the average age of the respondents were 30.80 ± 11.957. Regarding with the awareness toward knowledge of advantages and source of vitamin D and outcomes of vitamin D toxicity. Most of the participants mentioned that vitamin D is used to treat bone disease and rickets and contributes in maintaining calcium and phosphates (91.4% and 84.6%, respectively). Whereas, more than half of them reported that sun exposure does not cause vitamin D poisoning and that vegetarians are more likelihood to have vitamin D than non-vegetarians, (54.1% and 54.9%, respectively). Only, age and occupation out of nine predictors variables were significantly correlated with adequate knowledge of Vitamin D (p-value < 0.05). The respondents aged more than 60 years were high probability to have good recognition of Vitamin D than participants aged between 18 and 28 years. (OR = 7.95). Retired participants have shown lower aware of Vitamin D 0.38 times than students. CONCLUSION: Our research revealed that most of the participated individuals have sufficient comprehension about vitamin D, despite, there were significant gap. Health education via programs by government health-care agencies, NGOs and social workers is necessary to increase the awareness and knowledge toward benefits, source, deficiency and toxicity of vitamin D to avoid injury several diseases such as rickets.

Idiopathic nephrotic syndrome in Syrian children: clinicopathological spectrum, treatment, and outcomes.

BACKGROUND: Idiopathic nephrotic syndrome (INS) is the most common glomerular disease in children. We performed this study to report histopathological findings, the correlation between clinical and histopathological features, and the response to steroids and other immunosuppressive drugs and outcomes in Syrian children with INS. METHODS: A single-center retrospective observational cohort study was conducted at Children's University Hospital in Damascus, and included all patients aged 1-14 years, admitted from January 2013 to December 2022, with INS and who underwent kidney biopsy. RESULTS: The study included 109 patients, with a male/female ratio of 1.13:1, and a median age of 5 years with interquartile range (2.8-10). The main indication of kidney biopsy was steroid-resistant nephrotic syndrome (SRNS) (57.8%). The main histopathological patterns were minimal change disease (MCD) (45%) and focal segmental glomerulosclerosis (FSGS) (37.6%). FSGS was the most common histopathological pattern in SRNS (44.3%). In SRNS, we used calcineurin inhibitors to induce remission. Tacrolimus was used in 49 patients with response rate (complete remission of proteinuria) of 69.4% and cyclosporine in 20 patients with response rate of 50%. In steroid-dependent nephrotic syndrome (SDNS), we used mycophenolate mofetil (MMF) and cyclophosphamide to prevent relapses; MMF was used in 9 patients with response rate (maintaining sustained remission) of 89% and cyclophosphamide in 3 patients with response rate of 66.7%. Rituximab was used in four patients with FSGS, two SRNS patients and two SDNS patients, with sustained remission rate of 100%. Fifteen patients (13.7%) progressed to chronic kidney disease stage 5. Of them, 7 patients had FSGS and 8 patients had focal and global glomerulosclerosis;14 of them were steroid-resistant and one patient was steroid-dependent with persistent relapses. The most common outcome was sustained remission (47%) in MCD and frequent relapses (31.7%) in FSGS. CONCLUSIONS: FSGS was the most common histopathological pattern in idiopathic SRNS and had the worst prognosis. Calcineurin inhibitors could be an effective therapy to induce complete remission in SRNS. Rituximab may be an effective treatment to achieve sustained remission in SDNS and frequently relapsing NS and may have a potential role in SRNS with further studies required.

Behavioral difficulties and associated factors among the 'lost generation' of Syrian children and adolescents.

Childhood and adolescence, vital in shaping adult life and society, are profoundly impacted during conflicts like Syria's devastating war. This study explores the prevalence of behavioral disorders in Syrian children and adolescents, examining the influence of war and family-related factors. This cross-sectional study was conducted on children aged 2-17 years at a children's outpatient clinic in Damascus, Syria. We assessed parents' quality of life, war and family-related factors, and behavioral difficulties through parental interviews using two questionnaires: the Arabic version of the Strengths & Difficulties Questionnaire (SDQ) and the brief Arabic version of the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF). 74.67% of children aged 2-4 years and 61.29% of children aged 5-17 years were experiencing behavioral difficulties, with emotional difficulties being the most prevalent ones. Children exposed to kidnapping, family losses, lack of school enrollment, and those with parents having lower education, lower socioeconomic status, and poorer quality of life exhibited higher Total SDQ scores. The high prevalence of behavioral difficulties among children and adolescents in Syria is a major concern, with both direct and indirect war-related factors contributing to this issue.

Exploring associations with depressive and anxiety symptoms among Syrian patients with ankylosing spondylitis undergoing biological treatment: A cross-sectional study.

People with ankylosing spondylitis (AS) are vulnerable group to experience mood disorders. It is crucial to identify factors that contribute to depression and anxiety in order to improve outcomes. This study seeks to determine the rates of depression and anxiety in Syrian AS patients, as well as identify potential predictors for these conditions. This cross-sectional study was conducted using convenience sampling at the Biological Treatment Unit of the Rheumatology Department of the Damascus Hospital. Data were collected from face-to-face interviews with patients using validated structural questionnaire. A multivariate linear regression model was used to investigate potential predictive factors of depressive and anxiety symptoms. Of the 103 patients, 49.5% showed clinically significant depressive symptoms, and 36.9 % showed clinically significant anxiety symptoms. Multivariate linear regression indicated that depressive and anxiety symptoms were predicted by job layoff, hip pain, positive history of mental distress, poor quality of life, severe fatigue, and high frequency of sleep disturbance with relatively high explanatory powers. depressive and anxiety symptoms were predicted by disease activity scores but with low explanatory power. This study demonstrated high levels of that depressive and anxiety symptoms among Syrian patients with AS undergoing biological treatment. Poor quality of life, severe fatigue, and high-frequency sleep disturbances are major predictive factors for depressive and anxiety symptoms. Screening for depression and anxiety holds significant importance in the comprehensive management of ankylosing spondylitis even in the context of concurrent biological treatment administration.

Prevalence and knowledge of polycystic ovary syndrome (PCOS) and health-related practices among women of Syria: a cross-sectional study.

Polycystic Ovarian Syndrome (PCOS) is a prevalent metabolic and hormonal disorder affecting women of reproductive age. Limited data exists on Syrian women's PCOS awareness and health behaviors. This study aimed to gauge PCOS prevalence, knowledge, awareness, and health-related practices among Syrian women. A cross-sectional online survey was conducted from 11 February to 27 October 2022, targeting Syrian women aged 18-45. Collaborators from specific medical universities distributed a questionnaire adapted from a Malaysian paper through social media platforms. Out of 1840 surveyed Syrian women, 64.2% were aged 21-29, and 69.6% held bachelor's degrees. Those with a bachelor's degree exhibited the highest mean knowledge score (12.86), and women previously diagnosed with PCOS had a higher mean knowledge score (13.74) than those without. Approximately 27.4% were confirmed PCOS cases, and 38.9% had possible cases. Women with PCOS were 3.41 times more likely to possess knowledge about the condition. The findings suggest a moderate level of PCOS knowledge and health-related practices among Syrian women, emphasizing the need for increased awareness. Consistent local PCOS screening programs, in collaboration with obstetrics and gynecology professionals, are crucial for improving understanding and clinical symptom recognition of this condition among Syrian women.

Measles Outbreak in Lebanon: July 2023.

After the beginning of the Syrian crisis, increased rates of infectious diseases were reported. Lebanon, a neighboring country with a major socioeconomic crisis, witnessed a measles outbreak since July 2023, with 519 reported suspected cases. Half of the cases were under 5 y of age, most of them were unvaccinated. The mass displacement of refugees from conflict areas in Syria to Lebanon and the low vaccination coverage have made the situation more challenging. Further efforts are required in Lebanon to address identified gaps to prevent or at least better control future outbreaks.

Seroprevalence and risk factors of HBV, HCV and HIV among hemodialysis patients: a multicenter cross-sectional study from Damascus Syria.

OBJECTIVE: The aim of this study is to determine the prevalence rates of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infections among hemodialysis (HD) patients as well as to identify associated risk factors. METHODOLOGY: A multicenter cross-sectional study involved patients who had been on HD for at least three months. The study was conducted at five HD centers in Damascus, Syria from August 2019 to September 2021. HBsAg, HCV-Ab and HIV (antibody/antigen) seropositivity were identified using the third generation ELISA technique. Patients' information was extracted from their records and by face-to-face interview. Multiple logistic regression models were applied to identify risk factors associated with HBV or HCV seropositivity. The significance level was set at 5%. RESULTS: A total of 637 patients were included in the study with a mean age (SD) of 50.5 (15.6) years and 56.7% of them were men. The dialytic age ranged from one to thirty years with a mean (SD) of 6.10 (5.6) years. The prevalence of positive hepatitis B surface antigen, anti-HCV, co-infection of HBV and HCV, and anti-HIV (antibody/antigen) were 3.2%, 22.1%, 0.7%, and 0%, respectively. After controlling for co-variables, hepatitis B vaccine was the only predictor of seropositivity of HBV (OR: 0.15, 95% CI: 0.057-0.393, P < 0.001), as it significantly protected against contracting HBV. On the other hand, the dialytic age (OR: 1.42, 95% CI: 1.12-1.94, P = 0.032) and the dialysis center were significant factors affecting the prevalence of HCV. CONCLUSIONS: The prevalence of HCV and HBV infections among HD patients in Damascus, Syria has decreased remarkably compared with the results from 2001. Nevertheless, it is still considered relatively high. Thus, there is an urgent need to strengthen the prevention and control measures for viral infection transmission in HD centers in Damascus.

Prevalence of fibromyalgia and irritable bowel syndrome and its association with studying medicine, a cross-sectional study in Al-Baath University, Syria.

BACKGROUND: The aim of this study is to assess the prevalence rate of fibromyalgia (FM) and irritable bowel syndrome (IBS) among Al-Baath University students and find out whether studying medicine has an association with a higher prevalence rate. METHODS: The participants of this observational cross-sectional study were students aged 18-30 years from Al-Baath University. A structured self-estimated electronic questionnaire developed by Google Forms was distributed using social media platforms from 15 February to 15 March, 2023. We used The American College of Rheumatology (ACR) 2016 and Fibromyalgia Rapid Screening Tool criteria to assess the prevalence rate of FM. We used The ROME IV criteria to asses IBS prevalence rate. RESULTS: The final sample size was 800 individuals. The prevalence of IBS in the study population was 26.8%. Overall, IBS-Constipation was the most common subtype, and the prevalence rate was higher among medical students (14%) compared to other colleges (12.8%) (p = .002). The difference in IBS prevalence between males and females was (9.3% vs. 17.5%, p = .283), but this did not reach the statistical significance. The prevalence of FM according to The ACR in the study population was 3.6%. Females had higher prevalence rate than males (3.1% vs. 0.5%, p = .007). The prevalence of FM was also higher in other colleges compared to medicine (2.3% vs. 1.4%, p = .547), but this did not reach statistical significance. CONCLUSION: We found an increased prevalence of IBS among medical students. The prevalence of FM did not show any relation to studying medicine. We recommend additional prospective studies to assess whether studying medicine could be a risk factor for these disorders or not.

The Ayounkon project: visual impairment, eye diseases and unmet eye care needs in the Syrian refugee population and the hosting community in Lebanon.

AIM: To report on the distribution of eye diseases, aetiologies of severe visual impairment/blindness (SVI/BL) and unmet eye care needs of the Syrian refugee population and the Lebanese host community. METHODS: This retrospective study analysed the data of patients that were examined during the Ayounkon project -an eye health care project offering medical and surgical treatment for Syrian refugees and Lebanese host community in the Bekaa Valley in Lebanon. The project took place in three different primary health care centres and involved cooperation between several NGOs and ophthalmologists working on a voluntary basis. Data was analysed for distribution of eye diseases and aetiologies responsible for monocular and binocular SVI/BL. RESULTS: A total of 2067 patients were included, 677 were children < 18 years. The most frequent pathologies were ocular allergy (10%), and cataract (7.4%). 158 patients (7.6%) were referred for surgery. Glasses were prescribed for 1103 patients (53.4%), of whom 242 (21.9%) were children of school age. SVI/BL was found in 276 patients (13%). The condition was bilateral in 116 patients (42%). SVI/BL was significantly more frequent in the Syrian population than in the Lebanese (186 patients, 14.8% versus 86 patients, 11.3%; p = 0.04). The main causes for SVI/BL were cataract, keratoconus/corneal decompensation and amblyopia. CONCLUSION: The Syrian refugee population and the Lebanese host community have a high prevalence of ophthalmic pathologies and SVI/BL. Visual impairment is more prevalent in the refugee population. Our findings underscore the importance of targeted interventions and access to eye care services for these populations.

Epidemiology of burns in a humanitarian setting: A national study among refugees in Lebanon.

INTRODUCTION: Burns represent one of the leading causes of morbidity worldwide and disproportionately impact women, children, and socioeconomically disadvantaged individuals. Syrian refugees who fled conflict to land in overcrowded informal settlements across Lebanon are a particularly vulnerable population. This study aims to assess the etiology and risk factors for burns in this population. METHODS: This cross-sectional, cluster-based population study adopted the Surgeons Overseas Assessment of Surgical Need (SOSAS) version 3.0 to capture data from refugees residing in informal settlements in multiple regions across Lebanon. The tool was contextualized and used to collect detailed information on burn cases sustained by refugees during the last 12 months prior to data collection. Univariate logistic regression models were performed to assess the relationship between burns and associated risk factors. RESULTS: From the 1468 households surveyed, a total of 223 households experienced a burn in the last 12 months. Over 63% of burns occurred in children under the age of ten years and almost 57% of burns occurred in females. More than 70% of burns resulted from hot liquid, while 17% were caused by direct heat contact. Over 3/4ths of burns occurred while preparing food (77.4%). Approximately 32% of those burned did not seek healthcare, of which almost 85% noted the cause was mainly due to financial limitations. CONCLUSION: Burns are a common injury in the Syrian refugee population living in Lebanon. Children and women are particularly impacted, often during cooking. Multi-level interventions are necessary to reduce burn injuries and improve care for those affected by burns. Community kitchens can be used to separate cooking and living environments and get stoves and hot liquids off the floor. Importantly, policies should allow for refugees to receive medical care when necessary without a major financial burden.

The prevalence of menstrual disorders and their association with psychological stress in Syrian students enrolled at health-related schools: A cross-sectional study.

OBJECTIVES: Menstrual disorders are among the most prevalent health issues among young female students studying in health science faculties. This study aimed to provide insights into the menstrual patterns among medical faculty students and determine whether stress can be a risk factor for its various disorders. METHODS: This cross-sectional study was conducted in the Faculties of Medicine, Dentistry, and Pharmacy at the Syrian Private University, Damascus, Syria, between October and November 2022. A total of 980 female students anonymously completed the identification of menstrual problems and the perceived stress scale (PSS) questionnaire. The data were analyzed using SPSS-25. RESULTS: The mean age of students was 21.52 ± 2.06 years. The most common menstrual disorders in this study were dysmenorrhea (88%), and premenstrual syndrome (87%). A total of 82% had mild to moderate stress, 10% had high stress, and 8% had low stress. Moderate to high perceived stress was associated with an increased risk of PMS (OR = 1.79, P = 0.0037). CONCLUSION: These findings stress the importance of universities, especially health science faculties, establishing protocols for early detection and intervention in students with stress and menstrual disorders. Implementing stress reduction education and timely counseling, along with preventive measures, is crucial for students' well-being. Further research is needed to refine interventions for this group.

The Spectrum of α-Thalassemia Mutations in Syrian Patients.

α-Thalassemia (α-thal) is a globally prevalent genetic disorder of hemoglobin (Hb) structure where the rate of α-globin chain synthesis is reduced or absent due to the presence of α-globin mutation(s). The aim of this study is to define the spectrum of α-globin gene mutations and evaluate their allele frequency in a group of α-thal carriers. A total of 55 individuals with possible α-thal patients were referred from the thalassemia centers in Syria. They have unexplained hypochromia and microcytosis. All patients were genetically tested for 21 common α-globin gene mutations using reverse hybridization kit. Seven different α-globin gene mutations and 13 different genotypes were detected in 55 patients. The two most frequently encountered mutations were -α3.7 deletion (47.1%) and --MED mutation (21.4%). The most commonly observed genotype was -α3.7/αα (40%), followed by --MED/αα genotype (21.8%). We determined the most common α thalassemia mutations in the Syrian patients. α-Thalassemia mutations with deletions were mostly observed in our study.

Breast cancer quality of care in Syria: screening, diagnosis, and staging.

BACKGROUND: The Syrian decade-long war has severely affected the healthcare system, including almost vanishing cancer screening practices, war-destroyed medical facilities, and lack of continuous medical education. This study aims to present data on the affected breast cancer screening practices, methods of diagnosis, and stages distribution in Syria. METHODS: Medical charts of breast cancer patients treated at Albairouni University Hospital between January 2019 and May 2022 were retrospectively reviewed. Eligible patients were women diagnosed with primary breast cancer. Exclusion criteria included females receiving neoadjuvant chemotherapy and incomplete charts. Data regarding the patient's age, city of residence, marital status, number of children, smoking habits, method of diagnosis, tumor size (T), lymph nodes (N), and distal metastasis (M) were collected. We used Microsoft Excel and Statistical Package for the Social Sciences (SPSS) to analyze data. Descriptive methodology (frequency [n], percentage) was used. RESULTS: The number of charts reviewed was 4,500. The number of remaining charts after applying the exclusion criteria was 2,367. The mean age was 51.8 (SD = 11.3). More than half of the patients (58.3%) came from outside Damascus -where the hospital is located- and its suburbs. Less than 5% of the population detected cancer by screening mammography. Only 32.4% of patients were diagnosed by a biopsy, while surgical procedures (lumpectomy and mastectomy) were used to diagnose 64.8% of the population. At the time of diagnosis, only 8% of patients presented with local-stage disease (stages 0 & I), 73% had a regional disease (stages II & III), and 19% had metastatic breast cancer (stage IV). CONCLUSION: Our retrospective chart review analysis is the first comprehensive review in Syria for female breast cancer patients. We found a significant low percentage of patients diagnosed based on a screening mammogram, much higher surgical biopsies rather than a simple imaging-guided biopsy, and much lower than the national average of early-stage disease. Our alarming findings can serve as the base for future strategies to raise the population's health awareness, create more serious national screening campaigns, and adopt a multidisciplinary approach to the disease in Syria.