Improving Academic Writing in a Low-Resource Country: A Systematic Examination of Online Peer-Run Training.

Problem: Syrian medical research synthesis lags behind that of neighboring countries. The Syrian war has exacerbated the situation, creating obstacles such as destroyed infrastructure, inflated clinical workload, and deteriorated medical training. Poor scientific writing skills have ranked first among perceived obstacles that could be modified to improve Syrian research conduct at every academic level. However, limited access to personal and physical resources in conflict areas consistently hampers the implementation of standard professional-led interventions. Intervention: We designed a peer-run online academic writing and publishing workshop as a feasible, affordable, and sustainable training method to use in low-resource settings. This workshop covered the structure of scientific articles, academic writing basics, plagiarism, and the publication process. It was also supplemented by six practical assignments to exercise the learned skills. Context: The workshop targeted healthcare professionals and medicine, dentistry, and pharmacy trainees (undergraduate and postgraduate) at all Syrian universities. We employed a systematic design to evaluate the workshop's short- and long-term impact when using different instructional delivery methods and assignment formats. Participants were assigned in a stratified manner to four groups; two groups attended the workshop synchronously, and the other two groups attended asynchronously. One arm in each group underwent a supervised peer-review evaluation for the practical writing exercises (active), while the other arm in each group self-reviewed their work on the same exercises using exemplary solutions (passive). We assessed knowledge (30 questions), confidence in the learned skills (11 questions), and the need for further guidance in academic writing (1 question) before the workshop and one month and one year after it. Impact: One-hundred-twenty-one participants completed the workshop, showing improved knowledge, confidence, and need for guidance. At one-year follow-up, participants showed stability in these gains. Outcomes for the synchronous and asynchronous groups were similar. Completing practical assignments was associated with greater knowledge and confidence only in the active arms. Participants in the active arms engaging in the peer-review process showed greater knowledge increase and reported less need for guidance compared to those who did not engage in the peer-review. Lessons learned: Peer-run interventions can provide an effective, affordable alternative to improving scientific writing skills in settings with limited resources and expertise. Online academic writing training can show improvements regardless of method of attendance (i.e., synchronous versus asynchronous). Participation in supplementary practical exercises, especially when associated with peer-review, may improve knowledge and confidence.

Factors influencing research productivity among Syrian medical professionals amidst conflict: a case-control study.

BACKGROUND: Medical research productivity is globally increasing, with a lagging progress in third-world countries due to significant challenges, including inadequate training and brain drain. Syria had been showing a slow upward trend until the war broke out and severely hindered academic growth and productivity. A deeper understanding of the factors influencing research productivity in this context are fundamental to guide educational policies and resource allocation. Previous cross-sectional studies that evaluated the perspectives of Syrian academics on the issue were limited by the small sample size of published healthcare workers, making it difficult to identify the factors that enabled them to pursue research. METHODS: To address this challenge, we employed a case-control design. We isolated published early-career Syrian healthcare workers and compared their characteristics and perceptions to unpublished matched controls. Authors in the fields of medicine, dentistry, and pharmacy affiliated with any Syrian University were identified through an extensive search of PubMed and Google Scholar.These authors were invited to complete a questionnaire that covered participants' research contributions, alongside their self-assessed knowledge, attitudes, and barriers towards research. The questionnaire was publicly published to recruit an equal sample of matching controls, with half consisting of unpublished researchers and the other half of participants without prior research contributions. RESULTS: Six-hundred-sixteen participants were recruited. Their knowledge, attitudes, and perceived barriers explained 46% and 34% of the variability in research involvement and publication, respectively (P < 0.001). Getting involved in and publishing research studies associated with higher research-related knowledge and attitudes (P < 0.001). Respondents' assessment of research-related barriers and their academic scores did not differ between cases and controls. Superior research-related knowledge and attitudes were associated with male gender, higher English competency, and better internet connectivity. Meanwhile, extracurricular training and mentors' support were associated with more positive research-related attitudes and less perceived barriers. CONCLUSIONS: Research productivity of medical professionals in Syria exhibits a positive correlation with their knowledge and favorable attitudes towards medical research. Noteworthy, the demographic variations are linked to disparities in research-related knowledge and motivation. In conclusion, these results suggest a potential avenue for enhancement through concentrated efforts on improving extracurricular training interventions and mentors' support.

Activated protein C resistance impact on Syrian candidates for in vitro fertilisation and the benefit of anticoagulation therapy: a retrospective cohort study.

Activated protein C resistance (APCR) is a common thrombophilia, caused mainly by a mutation. The impact of APCR on the efficacy of In Vitro Fertilization (IVF) are still unclear, and no solid recommendations for its management were published. To investigate the effect of APCR on IVF outcomes and assess the efficacy of our management protocol, we retrospectively scanned the medical records of women who were tested with APCR assay in 2019 at our fertility centre. The 66 women (12%) positive for APCR had lower odds of reaching clinical pregnancies after IVF 0.18 [95% CI: 0.07-0.47] and fewer live births. The administration of low-molecular-weight heparin and aspirin associated with more implantation in treated compared to untreated APCR-positive women with an odds ratio of 43.2 [7.51-248.6]. In conclusion, APCR negatively affects the number of clinical pregnancies after IVF, but anticoagulation therapy can mitigate this effect and significantly increase clinical pregnancies.Impact StatementWhat is already known on this subject? The evidence about the impact of APCR on IVF outcomes is still inconclusive. According to the Canadian guideline, routine screening for thrombophilia in patients with recurrent pregnancy loss is not recommended. No clear recommendations regarding the management of APCR in the planning for IVF are yet available.What do the results of this study add? APCR significantly increases implantation failure among infertile women who conduct IVF. Management of APCR using LMWH and aspirin was effective in mitigating this effect and increasing successful implantation.What are the implications of these findings for clinical practice and/or further research? Our findings can support the recommendation to include APCR assay in the routine tests for infertile women conducting IVF, and suggest the combination between LMWH and aspirin as an effective therapy to increase successful implantation in APCR positive candidates. However, more controlled clinical trials are still needed to confirm our results.

Overlapping between squamous cell carcinoma and mucocutaneous leishmaniasis in a diabetic patient.

Mucocutaneous leishmaniasis (MCL) is a leishmania infection; that usually affects the oral and nasal mucosa. The coexistence of leishmania and malignancy is rarely reported and mainly in immunocompromised patients. We report a case of an overlapping between leishmania and squamous cell carcinoma (SCC) in a 60-year-old immunocompetent Syrian female. The patient presented with a one-year crusty nodule on the lower lip. Since she lives in an endemic region, leishmaniasis was suggested, and confirmed with a Giemsa-stained smear. After 20 days of meglumine antimoniate treatment, the patient revealed no signs of recovery, thus, the treatment was prolonged with the addition of sodium stibogluconate injections. Later, she presented with increased symptoms. A biopsy was performed due to SCC suspicion, and it was verified. The patient underwent complete surgical removal of the lesion. After a one-year follow-up, no recurrence was observed. We illustrated the importance of considering SCC in cases of refractory leishmaniasis.

Heterotopic pregnancy with superfetation following ovarian stimulation: A case report.

Heterotopic pregnancy (HP) is a rare phenomenon. Despite its rarity, there has been a notable increase in its incidence in recent decades due to the greater use of in vitro fertilization (IVF). However, information about the relation between ovarian stimulation and HP is scarce. We report a case of HP after ovarian stimulation using clomiphene citrate. A 26-year-old pregnant woman presented to the emergency department with mild vaginal bleeding, and abdominal pain. She had a history of pelvic inflammatory disease (PID) and left salpingectomy due to a previous ectopic pregnancy. She had undergone ovarian stimulation with clomiphene citrate three months earlier. Transvaginal ultrasound revealed an eight-week-old ruptured tubal pregnancy with an intrauterine ten-week-old gestational sac confirming superfetation HP. An urgent laparoscopic right salpingectomy was performed and the extrauterine pregnancy was successfully removed with the preservation of the intrauterine embryo. The course of the intrauterine pregnancy was uneventful and the patient gave birth to a healthy boy via cesarean section. Women receiving ovarian stimulation are at an increased risk of developing HP especially when they also have other predisposing factors for HP. Thus, close monitoring using transvaginal ultrasound with extra attention to the adnexa is required for a timely diagnosis and management of HP.

A retroperitoneal cystic lymphangioma involving the spleen and pancreas: a case report.

Retroperitoneal cystic lymphangioma (CL) is a rare condition and accounts for 1% of all CL. It can be congenital in children associated with genetic disorders or acquired in adults with chronic diseases. Case presentation: In the present case, the girl complained of abdominal pain and dysuria. Clinical examinations showed a palpitated mass in her left pelvis; a radiology exam revealed a cystic mass infiltrating the spleen and pancreatic tail, reaching the pelvis. The mass, including the spleen and pancreatic tail, among the cystic compound was removed. The final diagnosis of benign CL was done based on a histopathology exam. A one-year follow-up showed no signs of recurrence. Clinical discussion: CL is usually asymptomatic. The retroperitoneal location of the mass delayed the diagnosis and allowed the mass to grow to a large size and compress nearby structures. The typical presentation of CL is usually a substantial, multichambers cystic mass. However, it could be easily misdiagnosed with other cystic tumors of the pancreas. Age-based differential diagnosis should be taken into consideration in children as abdominal mass can originate from gastrointestinal or genitourinary systems. Conclusion: The imaging features of CL are insufficient, and the final diagnosis depends on the histopathology exam. Furthermore, CL can mimic pancreatic cysts in its presentation and cite; therefore, it must be included in the diagnosing strategy whenever a retroperitoneal cyst is being investigated, as imaging features can be misleading. Surgical treatment of CL should be associated with long-term ultrasound follow-up to identify and manage recurrence early.

A new approach of using platelet-rich autologous plasma to increase the ovarian reservoir in a Syrian patient with ovarian insufficiency: A case report.

INTRODUCTION: The prevalence of Primary ovarian insufficiency (POI) is estimated to be 1-2%, resulting from many causes, including, iatrogenic causes which are becoming more common.There is no precise treatment to restore fertility in POI patients. However, new treatments -such as ovarian rejuvenation using platelet-rich autologous plasma (PRP)- are being tested and have shown promising results. We report using a new PRP injection protocol to manage a Syrian patient with ovarian insufficiency. CASE PRESENTATION: A 35-year-old woman with five years of primary infertility presented with decreased anti-mullerian hormone (AMH) after she underwent a laparoscopy one year ago. Where the AMH dropped from 1.07 to 0.39 ng/mL after it. She underwent an ovarian rejuvenation using PRP. Half mL of PRP was injected into every ovary, 2 mL were injected into the cervix, 7 mL intra-uterus, and 7 mL were injected intramuscularly to the patient's legs. Fifteen days following the operation, the patient's new AMH level was 0.94 ng/mL. The patient was placed on ovarian stimulation, and five days later the ultrasonography showed the development of six follicles in each ovary. DISCUSSION: Managing POI using ovarian rejuvenation is the best alternative treatment; When the donor eggs programs are not acceptable. The use of PRP in ovarian rejuvenation has been reported to be effective. CONCLUSION: The use of PRP was beneficial in restoring fertility in a Syrian patient with ovarian insufficiency. Furthermore, the new PRP injection protocol was successful. However, more studies are needed to confirm this result.

Metachronous breast cancer in a male with previous history of liposarcoma: A case report from Syria.

INTRODUCTION: Multiple primary cancers (MPC) are defined as the occurrence of two or more non-related cancers. The acquiring of male breast cancer (MBC) as secondary cancer in a sequence of MPC is extremely rare. Only one case of breast cancer following liposarcoma (LP) was previously reported in a female patient. We report the first case of MBC following LP. CASE PRESENTATION: A non-smoker male patient with a history of a well-differentiated liposarcoma was treated surgically and with radiotherapy 14 years ago with no signs of recurrence. The patient presented with a left breast mass; The excisional biopsy showed poorly differentiated grade III invasive ductal carcinoma. The patient underwent a mastectomy with axillary node resection and the final diagnosis was invasive ductal carcinoma stage IIA [T:2, N:0, M:0]. The tumor markers reported; Positive Estrogen Receptor (ER+), negative Progesterone Receptor (PR-), and negative Human Epidermal Receptor (HER-). He received eight sessions of chemotherapy with Docetaxel and 16 fractions of radiotherapy. The follow-up showed no signs of recurrence. DISCUSSION: Despite the rarity of diagnosis MBC as a second primary. Studies have found a relation between different types of breast cancer in male patients, and further, a relation was also found between MBC and lymphoma. While no studies that link MBC and LP were previously reported. CONCLUSION: We found that acquiring a treated LP would not affect the MBC prognosis or its response to treatment, yet further studies are needed to confirm this outcome.

A delayed post-operative diaphragmatic hernia with hemothorax due to a strangulated stomach.

Traumatic diaphragmatic hernias (TDHs) are uncommon, and they mostly occur following blunt or penetrating traumatic injury and rarely as a complication of Iatrogenic procedure. The management of TDHs is through surgical repair. In this article, we present the case of a diaphragmatic herniation presenting 1 year after thoracic surgery in a 16-year-old male. The patient presented with gastrointestinal obstruction symptoms and later developed a hypovolemic shock due to stomach bleeding. Immediate exploratory thoracotomy was performed, and the patient reached a full recovery afterward.