Exploring prenatal depression and postpartum depression: Findings from a prospective cohort study at University Hospital Obstetrics in Damascus.

The perinatal period is crucial for both mother and newborn, and mental health, including prenatal and postpartum depression (PPD), is a significant aspect. Screening for these disorders allows for early treatment and helps prevent risks to both mother and child. This prospective cohort study was carried out at University Hospital Obstetrics in Damascus City. The first phase was during the third trimester of pregnancy and the second phase involved a follow-up assessment after 6 weeks of delivery. The Arabic-validated version of the Edinburgh Postnatal Depression Scale questionnaire (EPDS) was used. A cutoff of 13 or higher was used to determine the presence of probable depression in both assessments. Of 347 pregnant women, 38.6% had prenatal depression (PND). 295 patients have achieved the second assessment, of which 30.2% had PPD. Furthermore, 42.6% who had PND developed PPD on follow-up. Binary logistic regression indicated that PND was predicted by non-Syrian nationality, paternal absence, poor financial status, number of previous pregnancies, and a history of depression independent of pregnancy. PPD was predicted by a history of PPD, and work status. Findings underscore potential value of early screening for depressive symptoms as a predictive measure. It is recommended that women with a history of depression receive heightened attention and care, irrespective of the timing of their depressive episodes.

Evaluation of Patient-Reported Outcome Measures (PROMs) Associated With the Acceleration of Canine Retraction by Piezosurgery in Comparison With Low-Level Laser Therapy: A Three-Arm Randomized Controlled Clinical Trial.

Background and objectives Recently, both surgical and non-surgical interventions have gained popularity in accelerating orthodontic tooth movement, but there is no randomized controlled trial (RCT) comparing both modalities in terms of patient-reported outcome measures (PROMs) during maxillary canine retraction. Therefore, this trial aimed to assess the PROMs associated with either low-level laser therapy (LLLT) or piezocision-assisted acceleration in the context of maxillary canine retraction. Materials and methods This was a single-blinded, single-center, three-arm RCT. A total of 54 patients (12 males, 42 females, mean age 20.65 ± 2.85) whose treatment needed upper-first-premolar extraction to facilitate canine retraction were enrolled and randomly divided into three groups: piezocision group (PG), LLLT group (LLLTG), and the control group (CG). Standardized questionnaires using a visual analog scale were distributed to patients at five assessment times: 1 (T1), 3 (T2), 7 (T3), 14 (T4), and 28 days following the canine retraction initiation (T5). The patients' pain, discomfort, swelling, chewing difficulty, satisfaction, and acceptance were recorded. Results Regarding pain and discomfort, the levels were significantly lower in the LLLTG during the first two weeks of canine retraction compared to the other two groups (p<0.017). At the same time, these levels were significantly greater in the PG than the CG in the first week of canine retraction (p<0.017). Patients in the PG had a "mild to moderate" perception of swelling at T1 and T2, which was significantly different than that of the other two groups (p<0.001). Regarding chewing difficulty, the levels in the LLLTG were significantly lower than those in PG at the first three assessment times (p<0.017). Patients' satisfaction with canine speed was significantly greater in the intervention groups compared to the CG (p<0.001). In contrast, no statistically significant differences were found between the three groups regarding satisfaction with gum appearance surrounding the canine (p=0.061) and acceptance (p=0.125). Conclusion The LLLT-assisted canine retraction was associated with significantly lower negative patient-reported outcomes during the first two weeks of retraction than piezocision-assisted retraction. However, the levels of pain and discomfort were significantly greater in the piezocision-assisted retraction group than those in the conventional canine retraction group, which in turn were greater than those with the LLLT-assisted canine retraction group during the first week of retraction. Patient satisfaction and acceptance were high with both piezocision and LLLT interventions.

Evaluation of the Impact of Orthodontic Treatment on Patients' Self-Esteem: A Systematic Review.

Malocclusion may affect interpersonal relationships, self-esteem (SE), and psychological well-being, weakening patients' psychological and social activities. Several studies investigated the effect of orthodontic treatment on these social and psychological aspects, such as SE. However, the direct relationship between SE and orthodontic treatment has not yet been confirmed. This systematic review aimed to evaluate the existing evidence in the literature concerning the influences of orthodontic treatment on patients' SE systematically and critically. An electronic search in the following databases was done in September 2022: PubMed®, Web of Science™, Scopus®, Embase®, GoogleTM Scholar, Cochrane Library databases, Trip, and OpenGrey. Then, the reference list of each candidate study was checked for any potentially linked papers that the electronic search might not have turned up. Inclusion criteria were set according to the population/intervention/comparison/outcome/study design (PICOS) framework. For the data collection and analysis, two reviewers extracted data separately. The risk of bias 2 (RoB-2) and the risk of bias in non-randomized studies (ROBINS-I) tools were used to assess the risk of bias for randomized controlled trials (RCTs) and non-RCTs, respectively. The grading of recommendations assessment, development and evaluation (GRADE) approach was employed to evaluate the quality of the evidence for each finding. Sixteen studies (five RCTs, seven cohorts, and four cross-sectional) were included in this review. Unfortunately, the results could not be pooled into a meta-analysis. Only six studies have reported an increase in SE after orthodontic treatment (P<0.05 in these studies). No agreement between the included studies was observed regarding the influence of fixed orthodontic treatment, gender, or age on SE. The quality of evidence supporting these findings ranged from very low to low. There is low evidence indicating that fixed orthodontic treatment can improve patients' SE. In addition, unclear data are available about the influence of patients' gender and age on SE after orthodontic treatment. Therefore, high-quality RCTs are required to develop stronger evidence about this issue.

Stress, depression, anxiety, and quality of life among the healthcare workers during COVID-19 pandemic in Syria: a multi-center study.

BACKGROUND: The COVID-19 pandemic emerged as an expected source of stress and anxiety as the healthcare workers had to work for long hours in close contact with infected patients, thus increasing the probability of medical errors and threatening the patients' safety. This study aims to measure the levels of depressive symptoms, anxiety symptoms, and stress among Syrian healthcare workers and their quality of life during the COVID-19 pandemic. METHODS: A cross-sectional study was conducted in six central hospitals in Damascus, Syria. Data were collected from 1 to 30 June-2021. The Depression Anxiety Stress Scale-21 (DASS-21) was used to evaluate depression, anxiety, and stress among healthcare workers. Quality of life was assessed using the EUROHIS-QOL 8-item index. RESULTS: A total of 700 participants were included in this study. 61.6% (n = 431) were males and 38.4% (n = 269) were females. Younger ages (18-29 years old) were significantly associated with higher levels of depression and stress (p < 0.0083). Female healthcare workers had higher significant levels of anxiety (p < 0.05). Significant anxiety and stress levels were reported when healthcare workers had contact with COVID-19 patients, even if they had protective equipment (p < 0.05). Half of the participants (50%; n = 349) reported a good quality of life. CONCLUSION: Stress levels and depressive symptoms were remarkably higher in healthcare workers of ages 18 and 29 years old, whereas anxiety levels were significantly higher and more severe in female healthcare workers. Moreover, direct interaction with COVID-19 patients was associated with higher levels of stress and anxiety symptoms.

Global Asthma Network Phase I Syria asthma surveillance and the impact of the war.

Background: Asthma is the most prevalent chronic respiratory disease (CRD) in children. It causes extensive morbidity and mortality worldwide. Since the International Study of Asthma and Allergies in Childhood (ISAAC Phase III 2001-3), there have been no worldwide standardised surveys of prevalence and severity of asthma in school children. The Global Asthma Network (GAN) Phase I aims to provide this information. We participated in GAN with the aim of tracking changes in Syria and comparing the results to those of ISAAC Phase III. We also aimed to track the impact of war pollutants and stress. Methods: GAN Phase I, following the same methodology of ISAAC in a cross-sectional study. The same ISAAC questionnaire translated into Arabic was repeated. We added questions about displacement from home, and the impact of war pollutants. We also added the Depression, Anxiety and Stress Scale (DASS Score). In this article, we focused on the prevalence of 5 core asthma indicators (wheezing in the past 12 months, wheezing ever, severe wheeze, exercise wheeze and night cough) in adolescents from two centres in Syria: Damascus and Latakia. Additionally, we investigated the impact of the war on our two centres, while the DASS score was investigated only in Damascus. We surveyed 1,100 adolescents from 11 schools in Damascus and 1,215 adolescents from 10 schools in Latakia. Results: In Syria, which is a low-income country, wheeze prevalence before the war in ISAAC III was 5.2% for 13-14-year-old, whilst it was 19.28% in GAN during the war. Prevalence of severe asthma symptoms was 2.5% in ISAAC III and 12.8% in GAN. Wheezing appearing after the war or becoming more severe was statistically significant p=0.0001. War is associated with higher exposure to new environmental chemicals and pollutants and higher anxiety and depression scores. Conclusions: It is paradoxical to note that in Syria, current wheeze and severity are much higher in GAN (19.8%) than in ISAAC III (5.2%), which seems positively associated with war pollution and stress.

The Prevalence and Risk Factors of COVID-Stress Syndrome.

Background COVID-19 is a serious disease causing negative psychological effects such as nervousness, isolation, depression, and suicide ideation. The COVID Stress Scale was developed to better understand and assess COVID-19-related distress. University students are predicted to be negatively impacted by the COVID-19 outbreak due to their lack of psychological skills and high levels of academic stress. This study compares the prevalence of COVID stress syndrome (CSS) among university students in Syria and Jordan during the outbreak. The questionnaire used in the study covers multiple aspects and can be applied to future pandemics or infectious diseases. Methodology This is a cross-sectional study conducted in Syria and Jordan between September 1 and December 1, 2021, to evaluate CSS among university students. Data were collected from a convenience sample of 2525 students using a structured, validated, and published questionnaire. Ethical considerations were taken, and informed consent was obtained from participants. The questionnaire had two parts: participant characteristics and CSS. The data were analyzed using the Statistical Package for the Social Sciences (SPSS, IBM Corp., Armonk, NY), and the chi-square test was used to compare the CSS scale between the two countries. Result The study involved 2525 university students, mostly Syrian (63.6%) and Jordanian (36.4%), aged 18-24 (89.5%), and mostly single (95.6%). Over 50% of students lived in homes with three or more people. More than half reported good to excellent economic status; non-smokers accounted for over 50%. Regarding CSS, 39.8% had a high score, 28% average, 20% severe, and 12.2% low to mild. Jordanian male students and single Syrian students showed a higher probability of experiencing CSS symptoms. The number of people in the household, financial status, and field of study also played a significant role. Conclusion The COVID-19 pandemic has negative impacts beyond physical health, including the economy, education, and mental health. A stress scale has been developed to measure COVID-19 stress syndrome, which includes Danger and Contamination Fears (DAN), Socioeconomic Consequences Fears (SEC), Xenophobic Fears (XEN), Traumatic Stress Symptoms (TSS), and Compulsive Checking and Reassurance Seeking (CHE). Non-medical faculty students are more likely to acquire CSS symptoms than medical faculty students.

The prevalence of stress among medical students in Syria and its association with social support: a cross-sectional study.

INTRODUCTION: Chronic stress can interrupt personal life and cause fatigue, inability to concentrate, and irritability. This study aims to determine the prevalence of stress and its associated factors among medical students in Syria and whether social support could be a protective factor against stress. METHODS: A cross-sectional study was conducted in the faculty of medicine of five Syrian universities. The Medical Student Stressor Questionnaire (MSSQ) was used to evaluate the stress caused by the possible sources of stress. And Social Support Questionnaire - short version (SSQ - short version) was used to assess the social support that medical students received from family, friends, and their fellow medical students using six questions. RESULTS: A total of 1472 medical students participated in the study. Among the total participants, 671 (45.6%) were males, and 801 (54.4%) were females. The majority of the participators had mild (50.6%; n = 745) and moderate (37.0%; n = 545) stress levels. Academic-related stressors were the most important cause of stress among undergraduate medical students. Social support was provided equally to both genders, and genders reported the same degree of satisfaction. CONCLUSION: Our results emphasize the importance of improving the curricula, providing mental health consultants for students, and paying more attention to the mental health of female students. Finally, students in their clinical years should also receive mental health care, decreasing their duties and providing more self-free time.

The development and validation of a novel COVID19 stigma scale among healthcare workers (COVISS-HCWs).

BACKGROUND AND AIM: Fear of coronavirus disease 2019 (COVID-19) and its complications may result in stigmatization of individuals who may carry the virus. This is of special concern to healthcare workers who tolerate additional physical and emotional stress at times of pandemic. The aims of this study are to (1) develop and validate the COVID-19 Stigma Scale (COVISS-HCWs) survey; and (2) investigate the experience of stigma among healthcare workers possibly dealing with COVID-19 patients in five major public hospitals in Damascus, Syria. METHODS: We divided the sample into two parts and then underwent EFA on the first 350 participants, dividing the 14 questions into two dimensions. Furthermore, CFA was conducted on the other 350 participants to confirm how correctly a hypothesized model matched the factor structure by EFA, as described above. Moreover, the coefficient of determination (R2) and item-scale correlations (standardized factor loading) were estimated to establish the acceptability of the final structure of the COVISS-HCWs. Through a cross-sectional study, a convenience sample of 700 healthcare workers participated in a self-administered questionnaire containing a section for demographic variables and another for newly designed COVISS-HCWs. The scale comprises 14 adapted and novel items that measure two subscales: feelings of perceived harm and inferiority, and avoidance. Descriptive statistics, reliability, and validity were evaluated. RESULTS: The 14 COVISS-HCWs items were reduced to 11 items with a high Cronbach's α of 0.909. A significant correlation was observed between the responses to each COVISS-HCWs item and the corresponding subscale, and between each subscale and the overall scale. Feeling stigmatized was reported by 9.86% of the participants. Younger age, low socioeconomic status, and higher intensity of contact with COVID-19 patients significantly correlated with higher stigmatization. CONCLUSIONS: The novel COVISS-HCWs is a reliable and valid tool to evaluate stigma among healthcare workers during the COVID-19 pandemic. The Stigma prevalence among healthcare workers was 9.86%. Therefore, this must be addressed to prevent possible psychosocial and public health repercussions.

Pathophysiology of stress cardiomyopathy: A comprehensive literature review.

Introduction: Takotsubo cardiomyopathy is a transient type of acute heart failure with distinct wall motion abnormalities and unclear pathophysiology. This review focuses on the proposed pathophysiological mechanisms that could be involved in the occurrence takotsubo cardiomyopathy. Main body: Acute stress and subsequent excessive activation of the sympathetic nervous system are major factors in the pathophysiology of takotsubo cardiomyopathy. The high levels of catecholamine work in a triggering manner, generate reactive oxygen species, release inflammatory cytokines, and induce endothelial injury. The incidence of Takotsubo cardiomyopathy has increased following COVID-19 infection and vaccination, which suggests that neurohormonal and psychological factors (i.e., fear and anxiety of infection or vaccination) may have an additional role in the pathophysiology. In addition, inflammatory state, cytokine storm, augmented sympathetic activity, and endothelial dysfunction during the acute phase of COVID-19 infection may participate in Takotsubo cardiomyopathy. Chronic stress is also linked to this complex mechanism by accelerating cripple of endocrinal hypothalamic-pituitary-adrenal axis activity, which influences the cortisol effect on releasing catecholamine, which is directly related to the pathogenesis of takotsubo cardiomyopathy. Conclusion: The excessive activation of the sympathetic nervous system and subsequent high levels of catecholamines could initiate the process. The catecholamines, in turn, generate reactive oxygen species and release inflammatory cytokines (i.e., IL-1, IL-2, IL-6, IL-7, IL-8, CXCL1, TNF-α, and IFN-γ), which causes endothelial injury.

Evaluation of Patient-Centered Outcomes Associated With the Acceleration of Upper Incisor Decrowding Using Self-Ligating Brackets With or Without Piezocision in Comparison With Traditional Brackets: A Three-Arm Randomized Controlled Trial.

Introduction The pain and discomfort associated with orthodontic treatment are considered undesirable complications which may negatively affect the patient's cooperation and reduce the efficiency of orthodontic treatment. This trial aimed to assess patient-centered outcomes in the treatment of class I malocclusion with severe crowding using self-ligating brackets (SLBs) with or without an acceleration procedure (piezocision) compared to the traditional brackets (TBs) in a three-arm trial. Materials and Methods Sixty-six patients (51 females, 15 males; mean age ± SD: 20.08 ± 2.61 years) attending the Department of Orthodontics, the University of Damascus, Damascus (Syria) from April 2019 to October 2020 participated in this study. The patients were randomly allocated to three groups: the TBs s group (n = 22; mean age ± SD: 18.72 ± 2.42), the SLBs group (n = 22; mean age ± SD: 20.48 ± 2.84), and the SLBs with the piezocision group (SLBs+P; n = 22; mean age ± SD: 19.17 ± 2.59). Patient-centered outcomes were assessed using two standardized questionnaires depending on visual analog scales (VAS) for the majority of the questions and a binary scale (Yes/No) for the last two questions in the second questionnaire. The levels of pain, discomfort, swelling, difficulties with mastication, swallowing, and jaw movement restriction were measured at five assessment times: one day (T1), 3 days (T2), 7 days (T3), 14 days (T4), and 28 days (T5) after the beginning of treatment. The satisfaction levels, acceptance to undergo the applied treatment again, and willingness to advise a friend to receive similar treatment were measured at the last assessment time (T5). One-way ANOVA test or its alternative nonparametric test (i.e., Kruskal-Wallis test) was utilized to compare the three groups. Results There were statistically significant differences between the three groups regarding pain, discomfort, swelling, difficulties with mastication, problems with swallowing, and jaw movement restriction during the first three assessment times only (T1, T2, and T3; P < 0.001). The differences were mainly between the SLBs+P group and the other two groups, where the mean values were greater in the SLBs+P group. Otherwise, there were no significant statistical differences between the SLBs and the TBs groups. Concerning patients' satisfaction with the provided treatment, a statistically significant difference between the three groups was detected after 28 days (T5; P < 0.001). The SLBs+P group showed the lowest mean values, whereas there were no significant differences between the two other groups. Conclusion The levels of pain and discomfort, swelling, difficulties in mastication and swallowing, and restriction of jaw movement were greater in SLBs with the piezocision group compared to the sole use of SLBs or TBs in the first week only. The patients showed a high level of satisfaction with the applied therapeutic procedures, which means that SLBs alone or in combination with piezocision can be an accepted treatment modality by patients in the acceleration of orthodontic tooth movement.

The Effect of Treatment With Clear Aligners Versus Fixed Appliances on Oral Health-Related Quality of Life in Patients With Severe Crowding: A One-Year Follow-Up Randomized Controlled Clinical Trial.

Objective To compare the level of oral health-related quality of life (OHRQoL) between patients receiving clear aligners or fixed appliances within one year of follow-up using Oral Health Impact Profile 14 (OHIP-14), a validated self-administered questionnaire. Materials and methods A single-centered, two-arm parallel-group randomized controlled clinical trial was conducted on 36 adult patients (19 females, 17 males; age range: 18 to 25 years) who had severe crowding and require orthodontic treatment with first premolars extraction. The patients were equally and randomly divided into two groups: The clear aligners (CA) group and the fixed appliances (FA) group. OHRQoL was assessed using the OHIP-14 tool at various times during comprehensive orthodontic therapy: baseline (T0), one week (T1), two weeks (T2), one month (T3), 6 months (T4), and 12 months (T5) after starting the active orthodontic treatment. Mann-Whitney U test or Friedman test were used to detect significant differences. The level of significance was set at 5%.  Results All of the selected patients entered the statistical analysis stage. There were no significant differences between the CA and FA groups for the psychological discomfort, psychological disability, social disability, and handicap (P˃0.05) at almost all assessment times. For the functional limitation, physical pain, physical disability, and the overall score, there were significant differences between the studied groups (P˂0.05), with the FA group having higher mean scores than the CA group in all of the assessment times. Conclusion Patients' treatment with clear aligners has less impact on OHRQoL than those treated using conventional fixed appliances during the first year of treatment.

Fear among Syrians: A Proposed Cutoff Score for the Arabic Fear of COVID-19 Scale.

COVID-19 pandemic has led to psychological health issues one of which is fear. This study validates the Arabic version of the fear of COVID-19 scale and suggests a new cutoff score to measure fear of COVID-19 among the Syrian Population. A total of 3989 participants filled an online survey consisting of socio-demographic information, the fear of COVID-19 scale, the patient health questionnaire 9-item, and the generalized anxiety disorder 7-item. Receiver operating characteristic analysis was used to define cutoff scores for the fear of COVID-19 scale in relation to generalized anxiety disorder 7-item and the patient health questionnaire 9-item. The Cronbach α value of the Arabic fear of COVID-19 scale was 0.896, revealing good stability and internal consistency. The inter-item correlations were between [0.420-0.868] and the corrected item-total correlations were between [0.614-0.768]. A cutoff point of 17.5 was deduced from the analysis. According to the deduced cutoff point, 2111(52.9%) were categorized as extreme fear cases. This cutoff score deduced from this study can be used for screening purposes to distinguish community members that may be prone to developing extreme fear of COVID-19. Therefore, early preventive and supportive measures can then be delivered.

Post-traumatic stress disorder (PTSD), anger and mental health of school students in Syria after nine years of conflict: a large-scale school-based study.

BACKGROUND: The Syrian crisis has entered its ninth year with many being affected by the war. This is the largest-scale study that aims to evaluate the psychological profile of secondary school students in Syria. METHODS: This is a cross-sectional study in schools in Damascus, Syria. The surveys assessed working habits, smoking, war exposure, grades, socioeconomic status (SES), social support, health-related quality of life (HRQL), post-traumatic stress disorder (PTSD), problematic anger, and other parameters. RESULTS: This study included 1369 students of which 53% suffered from PTSD and 62% from problematic anger. Around 46% declared a fair or worse general health and 61% had moderate or severe mental health. Only 9.3% did not report exposure to any war-related variable. War exposure had an impact on PTSD, anger, and HRQL, but not on students' grades. Smoking, having consanguineous parents, and working did not have a clear association with grades or anger. Social support weakly reduced PTSD and anger scores. Interestingly, working was associatedwith lowerPTSD scores but was associated with a worse physical component of HRQL. CONCLUSION: This is the largest study on school students in Syria that reports the psychological ramifications of war. Although the direct effects of war could not be precisely described, the high burden of PTSD and anger distress was a strong reflection of the chronic mental distress.

Knowledge, stigma, and beliefs toward mental illnesses among schoolteachers in Damascus.

BACKGROUND: Teachers have an important role in promoting the mental wellbeing of their students, hence their knowledge and attitudes toward mental health disorders should be assessed. A very few studies regarding this topic were conducted in Syria, but due to the recent events which have had occurred the country, it is essential to deal with students who suffer from mental illnesses professionally especially that such disorders may be stigmatized by the society. AIMS: This paper aims to investigate knowledge, beliefs, and attitudes toward mental disorders in a sample of Syrian schoolteachers. METHOD: A cross-sectional study using self-administered questionnaire was conducted in Damascus and Refdimashq, involving 400 teachers from 16 schools. RESULTS: The results showed that the prevalence of stigmatizing positions toward psychiatric illnesses was low among teachers. The contributors did not state a correlation between spiritual beliefs and psychological disorders. It was also found that teachers were neutral in their knowledge about mental illnesses and psychiatric treatment or interventions along with their mental health resources. However, 42.5% of the participants use the internet for such purposes. CONCLUSION: In general, teachers of Damascus and its Refdimashq had a reasonable degree of awareness about mental disorders and treatments. Furthermore, neither stigma nor the relation between religious thoughts and mental disorders had been ascertained.

Prevalence of internet addiction among Syrian undergraduate medical students.

The purpose of this study is to determine the prevalence and risk factors for internet addiction disorder among Syrian medical students. Syrian medical students from 8 different universities participated in an online cross-sectional questionnaire study between May 13 and June 16, 2022. DASS-21 Depression, Anxiety, Stress Scale, and Internet Addiction Test were the 3 main determinants of the questionnaire. One thousand nine hundred fifty-three medical students from 8 different Syrian universities have participated in our cross-sectional. Half of the participants were from the Syrian private and Damascus universities. 62.1% were females, and most participants had good academic degrees (70-90/100). Sixty-nine percent of the study participants thought that COVID19 increased internet use rates. The Internet Addiction Scale's average score was 33.48 ±â€…16.29 (1-100). The total young internet addiction test score was high among medical students from the faculty of medicine university, students from Damascus University, males, smokers, and medical students with lower academic credentials than other subgroups. Both the relationship between internet addiction and DASS-21 subgroups and the correlation between DASS-21 subgroups were statistically significant. Our research showed that internet addiction was widespread among Syrian medical students, particularly when used more for entertainment than educational purposes. Additionally, it was linked to poor academic degrees in the exams at the university and mental health conditions, including depression, anxiety, and stress.

Psychological health problems among Syrians during war and the COVID-19 pandemic: national survey.

This study aims to assess the prevalence of depression and anxiety during the COVID-19 outbreak embedded within the war in Syria. A web-based cross-sectional survey design was employed. The 9-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder scale revealed a high prevalence of depressive (n = 3326; 83.4%) and anxiety symptoms (n = 2777; 69.6%) among the 3989 participants. Multivariable logistic regression analysis was performed to identify factors associated with depression and anxiety. There is an urgent need within the healthcare system in Syria to provide mental healthcare to alleviate acute mental health disturbances and associated physical health perceptions among Syrians.

Crisis-based psychiatry curriculum update: A cross-sectional study and an expert reflection from Syria.

Throughout human history, humanitarian catastrophes had a profound impact on the health and wellbeing of the local populations where they took place. The Syrian war was no different, rather it was the worst humanitarian crisis since World War II. Syrians' wellbeing was severely affected during this past decade, as had Syria's healthcare and mental health facilities. Syrian doctors have faced unprecedented difficulties and challenges across clinical disciplines and services, particularly in psychiatry. Medical students may play a central role in attenuating the burden of psychiatric diseases on their local community. However, a modification of the psychiatry curriculum to meet the current needs is an urgent necessity. Most of the published reports in psychiatry about Syrians were done on refugee populations in neighboring countries and worldwide. In contrast, this study captured the opinions of professors of psychiatry, specialists practicing psychiatrists, psychiatry residents, and a sample of senior medical students around Syria regarding the impact of war on different psychiatric diseases, and their suggestions to increase/reduce the teaching hours allocated to each of them. The votes were weighted then tested against crisis-related published psychiatry reports. The results suggested significant adjustments to the allocated training hours in the curriculum of psychiatry in Syrian medical schools. Increasing the focus of the curriculum of psychiatry on the prevalent disorders and conditions such as post-traumatic stress disorder, acute stress disorder, anxiety, and depression would empower fresh graduates to manage the basic cases of psychiatry, thus alleviating the consequences of the large shortage of psychiatrists inside Syria.

A short-term approach for promoting oral health of internally displaced children with PTSD: the key is improving mental health-results from a quasi-randomized trial.

BACKGROUND: Several studies have demonstrated that mental (MH) and oral health (OH) of displaced children are negatively affected during the wartime. This may be a result of general self-neglect and psychological suffering. Therefore, previous studies suggested that psychosocial support (PSS) is essential during and after humanitarian crises to prevent immediate and long-term MH and OH problems. This study was undertaken to evaluate the effectiveness of a short-term approach in improving (MH) and (OH) of displaced children suffering from posttraumatic stress disorder (PTSD). METHODS: A quasi-randomized clinical trial study was carried out including (118) displaced children suffering from PTSD. The Child Post-Traumatic Stress Reaction Index (CPTSD-RI) was utilized for the diagnosis of PTSD. Children were assigned into two groups (intervention and control group). Children in the intervention group were enrolled in a 6-week PSS program that contained oral health educational components designed especially for this study. Clinical evaluation included plaque index (PI) and gingival index (GI). Oral health related Quality of life (OHRQoL) was also evaluated using child perception questionnaire (CPQ11-14). Study variables were evaluated at baseline and at the end of the program for both groups. Wilcoxon rank test and t-test for independent samples were used for data analysis. RESULTS: A total of 118 children, aged between 9 and 14 years, participated in the recent study (mean age 11.0 ± 1.4). All participated children were previously diagnosed with PTSD. At baseline, there were no significant differences in the study variables between groups (P > 0.05). At the end of the program, children in the intervention group had significantly decreased PI, GI, CPQ11-14 and CPTSD-RI compared to their baseline scores (P = 0.000). In contrast, controls showed no differences at the end of the program (P > 0.05). Children in the intervention group had significantly (P = 0.000) lower PI (1.52 ± 0.55) and GI (1.48 ± 0.56) when compared to controls (PI = 1.89 ± 0.39, GI = 2.14 ± 0.32) post program. Moreover, the intervention group showed remarkable decline (P < 0.001) in their CPQ11-14 (47.16 ± 12.24) and CPTSD-RI (34.41 ± 12.23) scores compared to controls (CPQ11-14 = 72.65 ± 14.47, CPTSD-RI = 47.91 ± 14.24) post program. CONCLUSIONS: The designed approach could have positive improvements in PTSD symptoms, (OH) and (OHRQoL) of displaced children. Integration between (MH) and (OH) services should be considered during and after humanitarian crises to prevent immediate and long-term MH and OH problems. Trial registration Australian New Zealand Clinical Trials Registry (ACTRN12619000285156), Date registered: 25/02/2019, retrospectively registered. https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377001&isReview=true .

Evaluation of patient-centered outcomes associated with the acceleration of canine retraction by using minimally invasive surgical procedures: A randomized clinical controlled trial.

BACKGROUND: Only a few studies in the literature have reported patient-centered outcomes associated with minimally invasive corticotomy, and thus, related scientific evidence is limited. OBJECTIVES: The objective of this study was to evaluate patient-centered outcomes associated with upper canine retraction assisted with piezocision or laser-assisted flapless corticotomy (LAFC). MATERIAL AND METHODS: Thirty-two patients (19 females, 13 males) at a mean age of 18.25 ±3.05 years were randomly divided into 2 equal groups: the LAFC group (LG; n = 16) and the piezocision group (PG; n = 16). In each group, the surgical procedure was randomly assigned to one side of the maxillary arch, and the other side served as the control. Standardized questionnaires using the numerical rating scale (NRS) were distributed to all patients during the 1st month after the surgical procedure at 4 time points: 24 h (T1); 3 days (T2); 7 days (T3); and 14 days (T4). The patients' responses were obtained, regarding their feelings of pain, discomfort, swelling, eating difficulty, jaw movement restriction, analgesic consumption, and satisfaction. RESULTS: The levels of pain, discomfort, swelling, and difficulty in chewing were significantly greater at the experimental sides as compared to the control sides only at T1 in both groups (p < 0.05). The levels of pain and discomfort in LG were significantly lower than those in PG only at T1 (p = 0.013 and p = 0.009, respectively) whereas there were no significant differences between the groups regarding swelling, eating difficulty, jaw movement restriction, and analgesic consumption. The patients in both groups reported high levels of satisfaction, with no significant differences. The levels of pain, discomfort, swelling, eating difficulty, and jaw movement restriction were dramatically decreased 1 day after flapless corticotomy treatment in both groups (p < 0.05). CONCLUSIONS: Both LAFC and piezocision were associated with high levels of pain, discomfort, swelling, and difficulty in chewing at T1. Laser-assisted flapless corticotomy caused less pain and discomfort than piezocision.

Assessment of a single versus double application of low-level laser therapy in pain reduction following orthodontic elastomeric separation: A randomized controlled trial.

BACKGROUND: Periodontal ligament (PDL) pain, associated with the insertion of elastomeric separators, is one of the most annoying experiences at the beginning of orthodontic treatment. Low-level laser therapy (LLLT) has recently been suggested as a method of controlling this pain. OBJECTIVES: The aim of this study was to evaluate the effectiveness of LLLT on reducing the pain associated with elastomeric separation and to compare a single dose of LLLT (1 h before the insertion of elastomeric separators) vs 2 doses of LLLT (1 h before and immediately after the insertion). MATERIAL AND METHODS: This randomized controlled trial was conducted at the Department of Orthodontics, Faculty of Dentistry of University of Damascus and at the Department of Orthodontics of Adib-Allaham Center in Damascus, Syria. The sample population was comprised of 36 patients, aged between 12 and 25 years (mean age: 17 ±3.7 years), and the patients were randomly divided into 2 groups. A split-mouth design was employed. One group received 1 dose of laser therapy 1 h before the insertion of elastomeric separators, whereas the other one received 2 doses of laser therapy - 1 h before and immediately after the insertion of elastomeric separators. A GaAlAs laser with a wavelength of 830 nm and a power of 100 mW was used. The pain levels were recorded using the Visual Analog Scale (VAS) after 1, 6, 24, 48, and 96 h. Student's t-test and the repeated measures analysis of variance (ANOVA) were employed to detect significant differences. RESULTS: Low-level laser therapy significantly reduced post-separation pain when the experimental side was compared to the placebo side in the single-irradiation group (p < 0.05). Low-level laser therapy significantly reduced separation pain with no statistical difference between single and double irradiation protocols (p > 0.05). CONCLUSIONS: Low-level laser therapy had a positive effect on reducing the pain associated with elastomeric separation, whether it was applied as a single dose before elastomeric separation or as a double dose before and after this procedure.