Revealing the significant shortcomings in the learning environment at the three largest medical schools in Syria: what's next?

BACKGROUND: Medical education in Syria still adopts a traditional, teacher-centered curriculum to this day. These elements imply the existence of issues in the learning environment (LE). This study aims to provide the first evaluation of the LE at the largest medical schools in Syria using the DREEM inventory. METHODS: The three largest medical schools in Syria are the ones at Damascus University (DU), University of Aleppo (AU), Tishreen University (TU). The Arabic version of the DREEM questionnaire was used. Students across all years of study except year 1 were approached. Both paper-based and electronic surveys were conducted. RESULTS: A total of 1774 questionnaire forms were completed (DU:941, AU:533, TU: 300). The overall DREEM score at DU, AU, and TU were 100.8 ± 28.7, 101.3 ± 31.7, and 97.8 ± 35.7 respectively with no significant difference (P = 0.254) between the three universities. DREEM subscales concerning Learning, Atmosphere, Academic Self-perception and Social Self-perception had a low score across all universities. Clinical-stage students reported significantly lower perception (P ≤ 0.001) of the LE in comparison to their pre-clinical counterparts across all subscales. CONCLUSIONS: The findings of this study highlight the significant shortcomings of the medical LE in Syria. If not addressed properly, the academic, clinical, and professional competence of the healthcare workforce will continue to deteriorate. Moreover, the negative LE might be a predisposing factor for medical students' exodus. The Syrian medical education system requires leaders who are willing to defy the status quo to achieve a true educational transformation.

An open reduction and internal fixation of a Pipkin type 1 fracture: A case report.

•A rare case of a Pipkin fracture type 1.•Emphasizing the importance of using clinical radiology precisely.•Using ORIF procedure urgently has significant better outcomes.•Protecting patients from femoral head necrosis and improving their mobility.

Rapid onset and unpredicted findings of a giant nodular melanoma arising on a congenital nevus: a case report.

Melanoma is a malignancy that develops from pigment-producing cells known as melanocytes. Although it is considered one of the most fatal tumors in the world, its early diagnosis is associated with a better prognosis and overall survival. A 49-year-old man was admitted to the dermatology department with a 15 cm lesion on the left arm. It was growing on a congenital nevus to reach an enormous size. Surgical excision was not possible and the treatment was controversial as the patient showed unpredicted resistance to immunotherapy. Further evaluations revealed false-negative BRAF mutation, which completely changed the course of treatment. Cutaneous melanoma is a rare malignancy, accounting only for 1% of skin cancer cases, and having it arising on a pre-existing congenital nevus is even much rarer. Although there is no decisive definition of giant melanoma, some authors define it as a lesion of more than 10 cm in diameter. Through the literature, only a few cases of giant melanoma on the arm have been reported. Through our paper, we are revealing the importance of early diagnosis and treatment of melanoma and confirming the significant role of regular follow-up for patients with a congenital melanocytic nevus. Moreover, we are showing the importance of having alternative methods for detecting BRAF mutations to avoid false-negative results and have better outcomes.

Recurrence of COVID-19 infection symptoms in short time; reinfection or reactivation? Three cases of three healthcare workers and a literature review.

Background: Since the beginning of the COVID-19 pandemic, many research papers have been published focusing on some recurrence cases of symptoms after a long period of free symptoms with a negative RT-PCR retest. There is no crucial evidence until now of the possibility of recurrence, immune system reactivation, or reinfection. Methods: Three cases of resident doctors who recovered from COVID-19 but represented symptoms with new positive RT-PCR were discussed. Clinical data, laboratory tests, RT-PCR results, and antibodies titers all were collected. Moreover, many cases from the literature have been reviewed and compared. Results: The long-term exposure has not succeeded in forming an effective immune response, especially, since they do not have any significant history of chronic illnesses or a diagnosed immune disorder. While the antibody response occurred only in the second patient, it did not prevent new infection, but did it control the severity of the infection or its complications? Conclusion: Our three patients are health workers and have been in direct contact with COVID-19 patients. The inflammatory response parameters may not be reliable in predicting the activation of the immune response and the formation of the antibodies. We still need to find answers for reactivation and reinfection issues.

Lymphoblastic lymphoma in two young siblings (coincidence or genetics?): two case reports.

BACKGROUND: Non-Hodgkin lymphoma is the fourth most common malignancy in children, and it is not considered to be a hereditary disorder. However, it could affect members from the same family. CASE PRESENTATION: We are presenting two cases of Caucasian female siblings who were diagnosed with mediastinal lymphoblastic lymphoma in the same year. The two young females were presented to the emergency department with respiratory symptoms. After doing radiological investigations and biopsies, they were diagnosed with lymphoblastic lymphoma. The elder sister died before confirming the diagnosis, and the other is on chemotherapy now, with good treatment outcomes. CONCLUSIONS: This case emphasizes the crucial role of precursor genetics in lymphoblastic lymphomas and suggests a strong relation between these genetics and age at symptom presentation. This is the first report of non-Hodgkin lymphoma in a pair of siblings in the pediatric population.

Diagnostic challenge of a cystic solid pseudopapillary tumor in pancreas: A case report.

A solid pseudopapillary tumor should be included in the differential diagnosis of every pancreatic cystic lesion. A constellation of microscopic morphology and immunohistochemistry, in addition to the clinical history, aids in reaching the correct diagnosis.