Primary breast angiosarcoma resembling a common benign tumor: A case report.

INTRODUCTION AND IMPORTANCE: The breast angiosarcoma is a rare malignant vascular neoplasm; it represents nearly 0.05% of all breast cancers. Clinically, it could look like a haemangioma or pseudoangiomatous hyperplasia. Here, we report a case of a primary angiosarcoma of the breast (PAB) that mimics a giant fibroadenoma in physical examination and ultrasound features. CASE PRESENTATION: A 22 year-old woman came to our hospital complaining of a mobile non-tender mass in her right breast. It was monitored for a while until it became an 8 × 7 cm2. Past medical and family histories were unremarkable. Ultrasonography showed a well circumscribed hypoechoic lobular mass. The wide excision was performed and the pathological study showed angiosarcoma. The patient was re-operated for total mastectomy, screened for distant Metastases and followed-up closely for one year. CLINICAL DISCUSSION: Fibroadenoma-like lesions are not uncommon and physicians should pay an attention for any breast mass even in the patient who is young and has no risk factors of the traditional breast cancer. PAB is used to be missed in the clinical practice over the world; it is extremely rare and is proved by Immunohistochemistry. The full management could be totally completed by a mastectomy with/out axillary node dissection. CONCLUSION: The primary angisarcoma of the breast (PAB) could resemble a fibroadenoma in pre-operative investigations. In many reviews, PAB mimicked many diseases. Thus, the medical literature needs more case reports and series to identify an ideal protocol of diagnosis and management.

Smoking behaviour and patterns among university students during the Syrian crisis.

BACKGROUND: The ongoing Syrian war has resulted in many changes in the social and economic life of Syrians. To date, no study has documented the relationship between smoking behaviour and the war. AIM: To determine the prevalence of cigarette smoking among university students during the crisis in Damascus, Syrian Arab Republic, and the impact of the war on smoking behaviour. METHODS: We conducted an anonymous online cross-sectional survey of 1027 undergraduate students from all years and colleges at Damascus University. RESULTS: The overall prevalence of tobacco smoking was 24.73% for cigarettes and 30.4% for waterpipe. Prevalence of cigarette smoking was significantly higher in men, non-health profession students, and in students living away from their families. There was no significant difference in prevalence of smoking cigarettes when comparing students according to their origin (urban vs rural), year of study, and change of residence due to war. War was associated with a significant increase in mean number of cigarettes smoked daily, and 53.1% of smokers reported that the number of cigarettes consumed per day had increased since the beginning of the war. CONCLUSIONS: Increased smoking is an additional health concern in areas of conflict and may require special consideration and efforts by public health authorities.

Video-assisted Thoracoscopic Surgery (VATS) with mini-thoracotomy for the management of pulmonary hydatid cysts.

BACKGROUND: Hydatid cyst is an endemic infectious disease. Various modalities have been provided to approach hydatosis. This article reports a 20-years-experience of a new minimally invasive technique for the management of solitary pulmonary hydatid cysts using video-assisted thoracoscopic surgery (VATS) with mini-thoracotomy. METHODS: We reviewed the medical records of patients who underwent unilateral or bilateral single pulmonary hydatid cyst excision using VATS with mini-thoracotomy. All patients were managed by the same surgeon over the period from January 1996 till January 2015. RESULTS: The study involved 120 patients aged between 11 and 74 years (median age = 30 years). The overall number of conducted surgeries was 130 (10 patients needed two surgeries). No deaths were reported during or after surgery. No recurrences were seen in the follow-up period that ranged between 10 and 30 months. Three patients (2.3% out of the 130 surgeries) developed post-operative complications: one patient had prolonged air leak and two patients developed empyema. CONCLUSION: VATS with mini-thoracotomy is an effective and safe option for managing intact or ruptured solitary pulmonary hydatid cysts. Further studies in controlled prospective design are needed to compare this approach to other modalities of management.

Attitudes, barriers, and practices toward research and publication among medical students at the University of Damascus, Syria.

INTRODUCTION: Research is crucial for health-care delivery. However, medical students may not participate in research during their training, which might negatively affect their understanding of the importance of research and their future ability to conduct research projects. This is more prominent in developing countries. We aim to assess the attitudes of a sample of Syrian medical students toward research and suggest plausible solutions to reduce their self-reported barriers. METHODS: A cross-sectional study was conducted using a self-administered, pretested questionnaire. RESULTS: Three hundred and twenty-three responses were included. Most students demonstrated positive attitudes toward research. However, most of the responses indicated that they did not receive any training in academic writing or research and therefore did not have the opportunity to participate in formal research projects or scholarly writing. Students reported various types of barriers that challenged their progress in the field of research. Students who reported being encouraged by their professors to participate in research and writing/publishing scientific papers or reported receiving training about these activities were more likely to participate in research projects or writing scientific articles. CONCLUSION: Students have positive attitudes toward research and publication while they reported poor education, limited participation, and presence of many barriers that impede their participation in such activities.

Smoking behaviour and patterns among university students during the Syrian crisis

الخلفية: أسفرت الحرب الدائرة في سوريا عن كثير من التغييرات في الحياة الاجتماعية والاقتصادية للسوريين. ولم توثّق، حتى تاريخه، أي دراسةللعلاقة بين سلوك التدخين والحرب.الهدف: تحديد مدى انتشار تدخين السجائر بين الطلاب الجامعيين خلال الأزمة في دمشق، الجمهورية العربية السورية ، وأثر الحرب على سلوكالتدخين.طرق البحث: أجرينا مسحاً مقطعياً مغْفل الأسماء على الإنترنت لما مجموعه 1027 طالباً في المرحلة الجامعية من جميع السنوات الدراسية والكلياتفي جامعة دمشق.النتائج: بلغ المستوى العام لانتشار تدخين التبغ 24.73 % بالنسبة لتدخين السجائر، و 30.4 % بالنسبة لتدخين الشيشة )الأرجيلة(. وتبيّ أنمستوى انتشار تدخين السجائر أعلى بكثير بين الرجال وطلاب غير المهن الطبية والطلاب المغتربين عن أسرهم. ولم تظهر أي اختلافات كبيرة فيمستوى انتشار تدخين السجائر عند مقارنة الطلاب وفقاً لمكان نشأتهم )ريفيين مقابل حضريين(، وسنة الدراسة، وتغيير محل الإقامة بسبب الحرب.وتبيّ ارتباط الحرب بزيادة كبيرة في متوسط عدد السجائر المدخّنة يومياً، وأفاد 53.1 % من المدخنين بزيادة عدد السجائر التي يستهلكونها يومياً منذاندلاع الحرب. وتمثل زيادة التدخين شاغلاً صحياً إضافياً في مناطق النزاع وقد تتطلب اهتماماً وجهوداً خاصة من جانب السلطات المعنية بالصحةالعمومية.الاستنتاجات: تمثل زيادة معدلات التدخين شاغلاً صحياً إضافياً في مناطق النزاع وقد تتطلب اهتماماً وجهوداً خاصةً من جانب السلطات المعنيةبالصحة العامة

Background: The ongoing Syrian war has resulted in many changes in the social and economic life of Syrians. To date, no study has documented the relationship between smoking behaviour and the war. Aim: To determine the prevalence of cigarette smoking among university students during the crisis in Damascus, Syrian Arab Republic, and the impact of the war on smoking behaviour. Methods: We conducted an anonymous online cross-sectional survey of 1027 undergraduate students from all years and colleges at Damascus University. Results: The overall prevalence of tobacco smoking was 24.73% for cigarettes and 30.4% for waterpipe. Prevalence of cigarette smoking was significantly higher in men, non-health profession students, and in students living away from their families. There was no significant difference in prevalence of smoking cigarettes when comparing students according to their origin [urban vs rural], year of study, and change of residence due to war. War was associated with a significant increase in mean number of cigarettes smoked daily, and 53.1% of smokers reported that the number of cigarettes consumed per day had increased since the beginning of the war. Conclusions: Increased smoking is an additional health concern in areas of conflict and may require special consideration and efforts by public health authorities

Contexte : La guerre qui sévit en République arabe syrienne a conduit à de nombreuses modifications dans la vie sociale et économique des Syriens. À ce jour, aucune étude ne documente la relation entre les comportements tabagiques et la guerre. Objectif : Déterminer la prévalence de la consommation de cigarettes parmi les étudiants à l'université pendant la crise à Damas, en République arabe syrienne, et l'impact de la guerre sur les comportements tabagiques. Méthodes : Nous avons organisé une enquête en ligne transversale et anonyme sur 1027 étudiants de premier cycle de toutes les années et dans toutes les facultés de l'Université de Damas. Résultats : La prévalence globale du tabagisme était de 24,73 % pour la cigarette, et de 30,4 % pour la pipe à eau. La prévalence de la consommation de cigarettes était significativement plus élevée chez les hommes, les étudiants d'autres filières que celle de la santé, et chez les étudiants ne vivant plus dans leurs familles. Aucune différence significative n'a été observée pour la prévalence de la consommation de cigarettes en fonction de l'origine des étudiants [urbaine ou rurale], de leur année d'étude, ou de leur changement de résidence du fait de la guerre. La guerre était associée à une augmentation significative du nombre moyen de cigarettes consommées quotidiennement, et 53,1 % des fumeurs rapportaient que le nombre de cigarettes qu'ils consommaient par jour avait augmenté depuis le début de la guerre. Conclusions : L'augmentation du tabagisme est une préoccupation sanitaire supplémentaire dans les zones de conflit, et requiert une attention spéciale ainsi que des actions de la part des autorités de santé publique

Psychological distress among medical students in conflicts: a cross-sectional study from Syria.

BACKGROUND: Medical education can be a time of great psychological distress for students. The ongoing Syrian conflict represents an additional factor potentially contributing to poor mental health among medical students. Studies revealed high levels of psychological distress among Syrians. We aimed to investigate the prevalence and risk factors of depression, anxiety and stress among medical students at Damascus University during this period of war. METHODS: A cross-sectional study was conducted using the Depression, Anxiety and Stress Scale (DASS-21) in addition to questions about demographic and financial characteristics, and questions about the effects of the ongoing war on the participants' lives. RESULTS: 350 students were included. Prevalence of depression, anxiety and stress was 60.6%, 35.1%, and 52.6%, respectively. Depression was more likely in females and those with "intermediate" or "insufficient" personal income. Anxiety was more likely in females and those with "insufficient" personal income while less likely in fifth- and sixth-year compared to second-year students. Stress was lower in fifth-year compared to second-year students and higher in "insufficient" personal income compared to "sufficient" personal income. CONCLUSIONS: We concluded that Syrian medical students suffer from high rates of psychological distress. Females, second-year students, and those with "insufficient" personal income were the most affected. Students' perception of their own financial status, rather than the financial status per se was related to psychological distress. There was no evidence of a direct relationship between the ongoing conflict and psychological distress. Further investigations of causes and consequences of poor mental health in Syrian medical students are essential.

Multiple strategy peer-taught evidence-based medicine course in a poor resource setting.

BACKGROUND: Teaching Evidence Based Medicine (EBM) is becoming a priority in the healthcare process. For undergraduates, it has been proved that integrating multiple strategies in teaching EBM yields better results than a single, short-duration strategy. However, there is a lack of evidence on applying EBM educational interventions in developing countries. In this study, we aim to evaluate the effectiveness of a multiple strategy peer-taught online course in improving EBM awareness and skills among medical students in two developing countries, Syria and Egypt. METHODS: We conducted a prospective study with pre- and post- course assessment of 84 medical students in three universities, using the Berlin questionnaire and a set of self-reported questions which studied the students' EBM knowledge, attitude and competencies. The educational intervention was a peer-taught online course consisting of six sessions (90 min each) presented over six weeks, and integrated with assignments, group discussions, and two workshops. RESULTS: The mean score of pre- and post-course Berlin tests was 3.5 (95% CI: 2.94-4.06) and 5.5 (95% CI: 4.74-6.26) respectively, increasing by 2 marks (95% CI: 1.112-2.888; p-value <0.001), which indicates a statistically significant increase in students' EBM knowledge and skill, similar to a previous expert-taught face to face contact course. Self-reported confidences also increased significantly. However, our course did not have a major effect on students' attitudes toward EBM (1.9-10.8%; p-value: 0.12-0.99). CONCLUSION: In developing countries, multiple strategy peer-taught online courses may be an effective alternative to face to face expert-taught courses, especially in the short term.

Progressive liver failure post acute hepatitis A, over a three-month period, resulting in hepatorenal syndrome and death.

Hepatitis A is a common viral illness worldwide. It usually results in an acute, self-limiting disease and only rarely leads to fulminant hepatic failure or any other complications. During the period of conflict in Syria, and due to the damages to water infrastructure and poor sanitation, a dramatic increase in hepatitis A virus infection has been documented. Here we report a rare case of a 14-year-old male whose hepatitis A was complicated with hepatorenal syndrome and subacute liver failure. The war condition in Syria impeded transportation of the patient to a nearby country for liver transplantation, contributing to his unfortunate death.

Epidemiology and risk factors of uninvestigated dyspepsia, irritable bowel syndrome, and gastroesophageal reflux disease among students of Damascus University, Syria.

Uninvestigated dyspepsia (UD), irritable bowel syndrome (IBS), and gastroesophageal reflux disease (GERD) are common disorders universally. Many studies have assessed their epidemiological characteristics around the world. However, such information is not known for Syria. We aim to estimate the epidemiologic characteristics and possible risk factors for UD, IBS, and GERD among students at Damascus University, Damascus, Syria. A cross-sectional study was conducted in July-September 2015 at a campus of Damascus University. A total of 320 students were randomly asked to complete the survey. We used ROME III criteria to define UD and IBS, and Montreal definition for GERD. In total, 302 valid participants were included in the analysis. Prevalence for UD, IBS, and GERD was 25%, 17%, and 16%, respectively. Symptom overlap was present in 46 students (15%), with UD+IBS in 28 (9.3%), UD+GERD in 26 (8.6%), and IBS+GERD in 14 (4.6%) students. Eleven (3.6%) students had symptoms of UD+IBS+GERD. Each of these overlaps occurred more frequently than expected by chance. Significant risk factors included cigarettes smoking, waterpipe consumption, and body mass index <18.5kg/m2 for UD; female gender and three cups of coffee/d for IBS; and two cups of tea and one to five cigarettes/d for GERD. Risk factors for these disorders remain poorly characterized and need further investigations.

Self-reported study habits for enhancing medical students' performance in the National Medical Unified Examination.

BACKGROUND: The National Medical Unified Examination (NMUE) is currently required for graduation, joining postgraduate medical training, and practicing medicine in Syria. OBJECTIVE: To investigate self-reported study habits that correlate with high performance on the NMUE. METHODS: First through 3(rd) year residents at the three main hospitals in Damascus, Syria, were asked to complete a retrospective cross-sectional survey investigating their study habits and previous scores. RESULTS: Significantly higher score was associated with >15 study h/day and allocating 1-40% of study time for practicing questions. Mean NMUE score was not significantly different in relation to preparation months for examination or for those who reported spending all their time studying alone compared with spending any amount of time in a group setting. Scores of 231-240 on the Syrian scientific high school exam correlated with significantly higher NMUE performance compared with fewer scores, except scores of 221-230. For every 10 point increase in medical school cumulative grades, the NMUE score increased 3.6 (95% confidence interval 2.5-4.8). CONCLUSION: The NMUE score was significantly affected by hours spent studying per day, number of practice questions completed, percentage of study time allocated for doing questions, Syrian scientific high school exam scores, and the cumulative medical school class grades. It was not significantly affected by preparation months or studying in a group setting. More studies are needed to further describe and investigate the factors that might affect performance in the NMUE.

Report of two Syrian siblings with Mulibrey nanism.

Mulibrey (MUscle-LIver-BRain-EYe) nanism is a rare autosomal recessive disease characterized by growth failure, dysmorphic features and a wide range of abnormalities affecting multiple organ systems. This report is the first to present two cases of Mulibrey nanism affecting two siblings from Syria. Mulibrey nanism can be suspected clinically due to the distinctive features of the patients. The aim of this report is to document the presence of Mulibrey nanism in Syria and to familiarize physicians in and out of Syria with this rare disease and encourage them to develop high clinical suspicion if faced with patients with similar presentations.