Covid-19 vaccination reported side effects and hesitancy among the Syrian population: a cross-sectional study.

INTRODUCTION: Studying post-vaccination side effects and identifying the reasons behind low vaccine uptake are pivotal for overcoming the pandemic. METHODS: This cross-sectional study was distributed through social media platforms and face-to-face interviews. Data from vaccinated and unvaccinated participants were collected and analyzed using the chi-square test, multivariable logistic regression to detect factors associated with side effects and severe side effects. RESULTS: Of the 3509 participants included, 1672(47.6%) were vaccinated. The most common reason for not taking the vaccine was concerns about the vaccine's side effects 815(44.4). The majority of symptoms were mild 788(47.1%), followed by moderate 374(22.3%), and severe 144(8.6%). The most common symptoms were tiredness 1028(61.5%), pain at the injection site 933(55.8%), and low-grade fever 684(40.9%). Multivariable logistic regression analysis revealed that <40 years (vs. ≥40; OR: 2.113, p-value = 0.008), females (vs. males; OR: 2.245, p-value< .001), did not receive influenza shot last year (vs. did receive Influenza shot last year OR: 1.697, p-value = 0.041), AstraZeneca (vs. other vaccine brands; OR: 2.799, p-value< .001), co-morbidities (vs. no co-morbidities; OR: 1.993, p-value = 0.008), and diabetes mellitus (vs. no diabetes mellitus; OR: 2.788, p-value = 0.007) were associated with severe post-vaccine side effects. Serious side effects reported were blood clots 5(0.3%), thrombocytopenia 2(0.1%), anaphylaxis 1(0.1%), seizures 1(0.1%), and cardiac infarction 1(0.1%). CONCLUSION: Our study revealed that most side effects reported were mild in severity and self-limiting. Increasing the public's awareness of the nature of the vaccine's side effects would reduce the misinformation and improve the public's trust in vaccines. Larger studies to evaluate rare and serious adverse events and long-term side effects are needed, so people can have sufficient information and understanding before making an informed consent which is essential for vaccination.

Age < 40 years, females, not receiving influenza shot, AstraZeneca vaccine, co-morbidities, and diabetes mellitus were factors significantly associated with severe post-vaccination side effects.Although most of the reported vaccine side effects were mild in severity and well-tolerated, larger prospective studies to understand the causes of rare serious adverse events and long-term side effects are needed to overcome vaccine hesitancy among people and enable them to have sufficient information and understanding before making an informed consent which is essential for vaccination.

Prevalence of childhood obstructive sleep apnoea syndrome and its role in daytime sleepiness in Syria: a large-scale school-based cross-sectional study.

Obstructive sleep apnoea syndrome (OSAS) has become vastly conceded in the last decade as a possible reason for significant morbidity in childhood. This study aims to evaluate the prevalence of OSAS among school children and to assess the interrelationship between OSAS and daytime sleepiness. Methods and materials: This cross-sectional study was conducted with 1029 children and adolescents aged 6-15 years attending elementary and secondary schools in Damascus, Syria. The questions involved 19 sleep problems items using the children sleep habits questionnaire, and 4 sleep disorder items (loud snoring, having snorts or gasps, breathing pauses, daytime sleepiness). Total sleep time (TST) was determined by sleep habits. Severe possible OSAS (p-OSAS) was addressed as having all OSA symptoms "frequently", and mild p-OSAS was defined as having any of the symptoms "sometimes". Severe and mild daytime sleepiness were rated as being very sleepy during the day "frequently", and "sometimes", respectively. Logistic regression was applied to predict risk factors of severe and mild daytime sleepiness. Results: The prevalence of p-OSAS was 22.2%, of them 15.8% were mild, and 6.3% were severe. p-OSAS was more recognized in males 15.2% children (P<0.05). Most p-OSAS children sleep less than 6 h of TST; however; the mean TST was significantly lower at the secondary school level (P≤0.001). Predicted risk factors for severe and mild daytime sleepiness were students' grade level (P<0.05), severe and mild p-OSAS (P≤0.001), and TST less than 6 h (P≤0.001). Conclusions: A significant number of children have p-OSAS, affecting daytime sleepiness in school age. Physicians should consider loud snoring, and breathing pauses as marked symptoms of severe daytime sleepiness. Moreover, raising parents awareness about OSAS and daytime sleepiness is essential to ensure early access to primary care.

Impact of comorbidities on hospitalised Syrian patients with COVID-19: a retrospective study.

OBJECTIVES: This study aims to compare the clinical manifestations, laboratory findings, outcomes and overall survival time of patients with COVID-19 with and without comorbidities. DESIGN: Retrospective design. SETTING: This study was undertaken at two hospitals in Damascus. PARTICIPANTS: A total of 515 Syrian patients met the inclusion criterion, laboratory-confirmed COVID-19 infection following the Centers for Disease Control and Prevention. Exclusion criteria were suspected and probable cases that were not confirmed with a positive reverse transcription-PCR assay, and patients who self-discharged from the hospital against medical advice. PRIMARY AND SECONDARY OUTCOME MEASURES: First, assess the impacts of comorbidities on COVID-19 infection in four areas (clinical manifestations, laboratory findings, severity and outcomes). Second, calculate the overall survival time for patients with COVID-19 with comorbidities. RESULTS: Of 515 patients included, 316 (61.4%) were male and 347 (67.4%) had at least one coexisting chronic disease. Patients with comorbidities compared with no comorbidities were more vulnerable to poor outcomes such as severe infection (32.0% vs 9.5%, p<0.001), severe complications (34.6% vs 9.5%, p<0.001), the need for mechanical ventilation (28.8% vs 7.7%, p<0.001) and death (32.0% vs 8.3%, p<0.001). Multiple logistic regression showed that age ≥65 years old, positive smoking history, having ≥2 comorbidities and chronic obstructive pulmonary disease were risk factors linked to severe COVID-19 infection in patients with comorbidities. Overall survival time was lower among patients with comorbidities (vs no comorbidities), patients with ≥2 comorbidities (vs one comorbidity), and patients with hypertension, chronic obstructive pulmonary disease, malignancy or obesity (vs other comorbidities) (p<0.05). CONCLUSION: This study revealed that COVID-19 infection had poor outcomes among those with comorbidities. Severe complications, mechanical ventilation usage and death were more prevalent among patients with comorbidities compared with those with no comorbidities.

Antimicrobial resistance patterns in paediatric infections at Damascus Hospital, Syria: a retrospective cohort study.

Antimicrobial resistance is the third top-ranking global causative of death. Ninety per cent of babies with sepsis who were admitted to the ICU in the Middle East had antibiotic-resistant bacteria. We aim to describe the epidemiology, culture findings, bacterial antibiotic resistance, as well as the outcomes of children who present with nosocomial or community-acquired infections. Methods: A retrospective observational cohort study was conducted to analyze children with positive culture results presenting with nosocomial or community-acquired infections in Damascus Hospital, Damascus, Syria, which is considered one of the biggest hospitals in Syria. Results: In all, 116 patients with 177 positive culture results were included in the study. However, 54 (47%) were males, and 62 (53%) were females. Ages ranged between 3 h and 13 years. Cases of positive culture results peaked at the age or period of 0-11 months, that is 59(50%). The most prevalent bacteria were Staphylococcus aureus (33%), Enterobacter (21%), Pseudomonas aeruginosa (15%) and Escherichia coli (12%). The most used antibiotics were ceftriaxone (70%), vancomycin (60%) and amikacin (25%). The highest bacterial antibiotic resistance occurred with third-generation cephalosporins, and the most antibiotic-resistant bacterium was P. aeruginosa. Nosocomial infections occurred in 51% of the patients. Death was the outcome of 16% of the patients. Conclusion: The situation regarding bacterial resistance to antibiotics is critical, with the most notable examples of these resisted antibiotics being ceftriaxone, cefepime, cefotaxime, trimethoprim, gentamycin, levofloxacin and piperacillin with tazobactam, and there is no doubt that this is a major contributing factor to the high prevalence of nosocomial infections and death rates found in this study.

Knowledge, Attitude, and Practice Regarding HIV, HBV, and HCV Among Medical Students of Syrian Private University, Damascus, Syria.

BACKGROUND: Hepatitis B, Hepatitis C, and HIV/AIDS are infections that constitute major health concerns impacting national health systems worldwide. This is the first study to determine Syrian medical students' attitudes, awareness and knowledge of HIV/HBV/HCV, regarding general knowledge about, clinical features, transmission, and prevention. METHODS: This cross-sectional study was conducted at Syrian Private University on World AIDs Day (1/12/2019), Damascus, during the Syrian war crisis. Data were collected through self-administered surveys which targeted social demographic information, general knowledge, attitude, towards HBV, HCV, HIV. Data were divided and analysed according to the source of information, study year, marital status, and GPA using one-way analysis of variance to assess the level of knowledge. RESULTS: Of 317 respondents, the majority (59.8%) were males with age ranging from 18 to 30 years of age. . The majority of students 188(59.3%) showed an average level of knowledge, 73(23%) showed a good level of knowledge. This study revealed adequate knowledge. However there were misconceptions regarding transmission pathways. The majority 173(54.6%) had a positive attitude, and 144(45.4%) had a neutral attitude, while none had a negative attitude towards HIV/HBV/HCV infected individuals. Clinical year students (mean 73.0%, SD ± 10.0%) demonstrated higher levels of awareness compared to pre-clinical students (mean 39.7%, SD ± 13.0%). CONCLUSIONS: This study revealed that medical students have adequate knowledge regarding HIV/HBV/HCV. Medical students play a pivotal role in raising awareness and disseminating knowledge among the community, thus more effort should be concentrated on developing educational programs to limit the risks of such infections.

Prevalence of Ménière's Disease in Syrian Patients with hypothyroidism: Cross-sectional study.

Background: Ménière's Disease, a long-term debilitating disorder has been increasingly found among patients with hypothyroidism. Our study aims to evaluate the prevalence of ménière's disease among hypothyroid patients and assess the interrelationship between patients' symptomology and ménière's disease. Materials and methods: A cross-sectional study was performed at the endocrinology clinics at Damascus Hospital and Syrian Red Crescent Hospital, Damascus, Syria between September 2021 and January 2022. Patients with hypothyroidism were interviewed using a questionnaire. The questionnaire contained questions about socio-demographic information, hypothyroid history, diagnostic criteria of ménière's disease, chief complaint, medical history, and lab test results. Patients, who reported ménière's disease symptoms, were referred to the otorhinolaryngology clinic for confirmation or exclusion of ménière's disease. At the clinic, patients underwent an otoscopy and a pure tone audiometry, probable and definite ménière's disease was diagnosed accordingly. Results: Of 217 hypothyroid patients included in the sample, 17 (7.8%) were diagnosed with definite ménière's disease and 31 (14.3%) were diagnosed with probable ménière's disease. Hypothyroid symptoms reported among patients diagnosed with definite ménière's disease compared to no diagnosis differed by feeling low (χ2 (1, 217) = 4.014, p = 0.045), and depressive appearance (χ2 (1, 217) = 8.887, p = 0.003). Patients diagnosed with definite ménière's disease, probable ménière's disease, and both definite and probable ménière's disease were more likely to report that their symptoms affected their lifestyle compared to those that reported no effect (χ2 (3, 217) = 62.565, p < 0.001), (χ2 (3, 217) = 31.380, p < 0.001), and (χ2 (3, 217) = 35.542, p < 0.001), respectively. Conclusion: A high number of hypothyroid patients were diagnosed with MD. Clinicians should consider clinically screening for MD among hypothyroid patients presenting to clinics.

Social and psychosocial factors affecting eating habits among students studying at the Syrian Private University: A questionnaire based cross-sectional study.

Syrian eating habits are trending towards westernized patterns that are high in carbohydrates, fats, and meat. This accompanied by an increasingly sedentary lifestyle has affected young adults' dietary habits. As a consequence, obesity and overweight young adults are significantly increasing in prevalence. This study aims to assess the pattern of eating habits and their relation with psychosocial factors among university students. A cross-sectional study was conducted among Syrian Private University students using a self-administrated questionnaire. The questionnaire consisted of 3 sections: socio-demographic characteristics, eating habits, and psychosocial factors. Each item from the eating habits questionnaire was scored "1" if the response was healthy or "0" if the response was unhealthy. All items were summed and the total score was obtained for each student. Students' scores were summed and divided by the total number of students to deduce the total mean of eating habits. Hierarchical multivariate linear regression was used to evaluate factors associated significantly with eating habit score and psychological factors. Of 728 students included in the study 398 (54.7%) were females. Overweight and obese participants represented 154 (21.4%) and 49 (6.8%) respectively. Around 316 (43.4%) were smokers and 135 (18.5%) drank alcohol. Only 259 (36.0%) students reported they adopted healthy eating habits. Of them, 233 (32%) and 306 (42%) ate meals and breakfast regularly respectively. Participants' had a moderate eating habits score; the mean total was 5.96 (SD ± 1.95). Multivariate analysis revealed that non-smokers (p < 0.001), exercising (p = 0.002), living with family (p < 0.001), and eating because of feeling happy (p = 0.014) were factors significantly associated with eating habits score and psychological factors. While R2 adjusted were 0.109 and 0.117 in the first and second model, the total model accounted for 13.2% of variance. Half of the students demonstrated unhealthy eating habits. The identified socio-demographic and psychological factors were significantly affecting students' eating habits. These findings can be used to provide targeted lifestyle modification advice via health promotion programs towards these specific groups.

Oral cancer knowledge and practice among medical students: A cross-sectional study during the Syrian crisis.

Background: lack of medical practitioners' knowledge about oral cancer has contributed to delays in referral and treatment. Oral cancer is amenable to treatment when detected early, which leads to better prognosis and survival rates. In this study, we aimed to assess the knowledge of the Syrian medical students about the risk factors of oral cancer, oral cavity changes associated with oral cancer, and the relation between the relation with Human Papilloma Virus (HPV) and oral cancer. Methods: This is a cross-sectional study conducted at the Syrian Private University. Data were collected through self-administered questionnaires, which targeted social demographic information, general knowledge, risk factors, oral changes and HPV knowledge associated with oral cancer. Data was categorized and analyzed to assess and compare the levels of knowledge between clinical and preclinical students. Results: 301 out of 401 medical students responded to the questionnaires bringing the response rate to 75.25%. The study revealed adequate knowledge about oral cancer, general information, clinical features, risk factors and relation to HPV. Clinical students showed higher levels of awareness compared to pre-clinical students. No significance in knowledge was found between the genders. Conclusion: The findings of the present study suggest that there is a need to reinforce the medical curriculum concerning oral cancer education, particularly in prevention and early detection to improve practices.

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.

COVID-19 Disease in Syrian Patients With Cancer: Clinical Manifestations, Laboratory Findings, Treatment, and Outcomes.

PURPOSE: This study aims to describe the clinical manifestations, laboratory findings, treatment, and outcomes of patients with cancer with COVID-19 infection in Syria. The primary objective was to identify the overall survival (OS) time, and the secondary objectives were to identify factors associated with severe COVID-19 infection. METHODS: This multicenter retrospective study was undertaken at four hospitals in Damascus, Syria, between March 28, 2020, and March 29, 2021. Data extracted from medical records included clinical manifestations, radiologic findings, laboratory results, treatment, and outcomes. Survival analysis was done by using the Kaplan-Meier method and Cox regression model for follow-up and anticancer treatment patients to study the effect on OS time. The effects of potential risk factors of developing severe COVID-19 were studied by multivariable logistic regression. RESULTS: Of 114 patients included, 61 (53.51%) were male. Smokers represented 29 (25.44%), and 63 (55.26%) patients had a history of coexisting chronic diseases. The most common cancer type was breast cancer 17 (14.91%). Sixty-eight (59.65%) patients were receiving anticancer treatment within 1 month of being diagnosed with COVID-19 infection and 46 (40.35%) were outpatient follow-ups. Multiple logistic regression analysis showed that comorbidities (odds ratio: 2.814, P = .044) and anticancer treatment (odds ratio: 8.790, P < .05) were risk factors linked to severe to critical COVID-19 infection. OS time was 245 (95% CI, 217.96 to 272.47) days, lower among patients with cancer with COVID-19 infection receiving anticancer treatment compared with follow-up patients (P value < .05). CONCLUSION: Patients with cancer with COVID-19 infection receiving anticancer treatment had a lower OS time. It may be worth considering stopping anticancer treatment in patients with cancer with COVID-19 when possible in search of better outcomes.

A cross-sectional survey of COVID-19: attitude and prevention practice among Syrians.

Introduction: Coronavirus disease of 2019 has overwhelmed public health systems worldwide and forced governments to impose draconian lockdowns on entire populations. With no vaccine or treatment during the early days of the pandemic, it is of paramount importance to assess the public's awareness about COVID-19 so that prevention-focused educational campaigns can be sufficiently deployed. This study aimed to gauge the Syrian public's adherence to infection control measures by assessing attitudes and practices during the pandemic which ravaged an already war-torn Syria. Methods: The web-based cross-sectional study was conducted in March 2020, nearly 11 years into the Syrian crisis. The survey contained 3 sections: socio-demographic characteristics, attitudes, and practice. Multivariable logistic regression analysis was performed to identify factors associated with good practices and negative attitudes. Data were analyzed using the Statistical Package for Social Sciences version 25.0. Results: Of the 3586 participants, 68.2% were females, 50.8% were unemployed, and 79.2% were college-educated. Only 1402 (39.1%) participants wore face masks when leaving their homes. Multiple logistic regression analysis revealed that female, age, and residence were factors associated with good practices such as avoiding mass gatherings, wearing face masks, and maintaining a 1-meter interpersonal distance. However, age and occupation were factors associated with negative attitudes towards the closure of universities and schools, travel bans, and quarantines for travellers. Conclusion: This survey highlights the need to address specific populations using various measures; there should be a specialized method of prevention for each occupation, age group, and place of residence to contain further outbreaks of COVID-19. This can be achieved through targeted awareness campaigns.

Assessing diabetes mellitus knowledge among Syrian medical students: A cross-sectional study.

BACKGROUND: Diabetes mellitus is the fastest growing global health emergency of the 21st century. The Middle East and North Africa region have the highest prevalence of diabetes in the world. Since medical students are the pillars of future healthcare systems, their knowledge of the disease must be evaluated, updated, and enhanced appropriately. METHODS: A cross-sectional study was conducted at the Syrian Private University (SPU) in November 2019 on World Diabetes Day in Damascus, during the Syrian war crisis. Data were collected through self-administered questionnaires and analyzed using the Statistical Package for Social Sciences version 25.0 (SPSS Inc., United States). RESULTS: Of the 275 students, 74 (26.9%) were preclinical students and 201 (73%) were clinical students with a mean age of 21.9 (±3.70) years. 67 (25.0%) are overweight, and 26 (9.7%) are obese. Students revealed a good level of knowledge regarding clinical features, risk factors, and complications; however, a lack of knowledge was noticed in the general information and the diagnostic criteria section. Clinical year students (4th, 5th, 6th) demonstrated higher levels of awareness compared to students in pre-clinical years (1st, 2nd, 3rd). CONCLUSIONS: Knowledge and awareness of medical students about diabetes mellitus were found to have some gaps. Health education efforts are required to reinforce its identification and management at all levels, while also encouraging lifestyle modifications among our students.

War-related trauma and post-traumatic stress disorder prevalence among Syrian university students.

Background: Posttraumatic stress disorder (PTSD) is one of the most prevalent mental disorders in war-affected regions. Syria has endured 9 years of war and yet little is known about the impact of the conflict on the well-being of Syrians who remain. In this study, we investigated trauma and estimated PTSD prevalence among university students in Deir-ez-Zor, a Syrian governorate that was under the siege by ISIS for over 3 years. Methods: A descriptive cross-sectional study design was used on a sample of Al-Furat university students in Deir-ez-Zor. We collected data on socio-demographics, trauma exposure, and stress levels. PTSD Checklist for DSM-5 was used to provide prevalence rate estimates, and determine the symptom severity among Syrian university students. Binary logistic regression was used to identify factors associated with the development of PTSD symptoms. Results: A total of 833 students were recruited into the study, 86.4% of the participants were exposed to at least one traumatic event. The estimated PTSD prevalence was 28.2%, and the highest PTSD rates were found among students who were forced into sexual act (46.3%). A significant association was found between PTSD and internal displacement (p = .032), academic year (p = .002), and social economic status (p = .000). Binary logistic regression indicated that PTSD symptoms were predicted by smoking and third-year university students. Conclusions: The results presented in this research revealed a high prevalence of trauma exposure and PTSD symptoms among a sample of university students in Deir-ez-Zor. These findings call for immediate actions to help the affected population in restoring their mental health, so they can be prepared to face the challenges and demands of the post-conflict period.

Antecedentes: El trastorno de estrés postraumático es uno de los trastornos mentales más prevalentes en las regiones afectadas por la guerra. Siria ha soportado 9 años de guerra y, sin embargo, se sabe poco sobre el impacto del conflicto en el bienestar de los Sirios que quedan. En este estudio, investigamos el trauma y estimamos la prevalencia de TEPT entre estudiantes universitarios en Deir-ez-Zor, una gobernación Siria que estuvo bajo el asedio de ISIS durante más de 3 años.Métodos: Se utilizó un diseño de estudio descriptivo transversal en una muestra de estudiantes universitarios de Al-Furat en Deir-ez-Zor. Recopilamos datos sociodemográficos, sobre exposición al trauma y niveles de estrés. Se utilizó la lista de verificación de TEPT para el DSM-5 para proporcionar estimaciones de la tasa de prevalencia y determinar la gravedad de los síntomas entre los estudiantes universitarios sirios. Se utilizó regresión logística binaria para identificar factores asociados con el desarrollo de síntomas de TEPT.Resultados: Un total de 833 estudiantes fueron reclutados para el estudio, el 86,4% de los participantes estuvieron expuestos a al menos un evento traumático. La prevalencia estimada de TEPT fue del 28,2%, y las tasas más altas de TEPT se encontraron entre los estudiantes que fueron forzados a tener relaciones sexuales (46,3%). Se encontró una asociación significativa entre el TEPT y el desplazamiento interno (p = .032), el año académico (p = .002) y el estatus socioeconómico (p = .000). La regresión logística binaria indicó que los predictores de síntomas del TEPT fueron tabaquismo y cursar tercer año de Universidad.Conclusiones: Los resultados presentados en esta investigación revelaron una alta prevalencia de exposición al trauma y síntomas de TEPT entre una muestra de estudiantes universitarios en Deir-ez-Zor. Estos hallazgos exigen acciones inmediatas para ayudar a la población afectada a recuperar su salud mental, para que pueda estar preparada para enfrentar los desafíos y demandas del período posconflicto.

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.

Knowledge of breast cancer among medical students in Syrian Private University, Syria: a cross-sectional study.

BACKGROUND: Breast cancer is the most common cancer among women and the second leading cause of cancer death globally. Since early diagnosis is crucial to reducing mortality, high levels of knowledge regarding general information, risk factors, and symptoms are required among healthcare professionals to deliver breast cancer care. This study aimed to determine Syrian medical students' knowledge about breast cancer in the fields of general knowledge, common clinical features, and risk factors. METHODS: This cross-sectional study was conducted at the Syrian Private University in October 2019 (Breast Cancer Awareness Month), Damascus, during the Syrian war crisis. Data were collected through self-administered surveys and analyzed using the Statistical Package for Social Sciences version 25.0 (SPSS Inc., United States). The chi-square test was applied to assess the relationship between the level of knowledge and gender. One way analysis of variance was performed to assess the overall differences in mean knowledge score by study year, GPA, mother's education, and source of information. Unpaired Student's T-test was used to analyze the differences in mean knowledge scores (continuous variable) based on smoking status and alcohol consumption. RESULTS: Of 320 students, 301 completed the questionnaire (response rate = 94.0%), of which 179(59.5%) were males. The study revealed above-average knowledge scores (total mean = 68.4%) regarding breast cancer, general information (71.9%), common clinical features (71.6%), and risk factors (71.6%). Clinical students (4th, 5th, and 6th years) scored higher compared with pre-clinical students (1st, 2nd, and 3rd years). CONCLUSION: This study showed above-average knowledge scores regarding breast cancer. More efforts to correct misinformation, through reassessing the university curriculum and promoting awareness about breast cancer are required.

Foreign body aspiration in a tertiary Syrian centre: A 7-year retrospective study.

BACKGROUND: Paediatric foreign body aspiration constitutes significant lethal sequela worldwide. This is the first descriptive Syrian study that aims to describe the epidemiology of foreign body aspiration in a tertiary centre in Syria. METHODS: This is a retrospective cohort study conducted at the Children's University Hospital, Damascus, from 2011 to 2018 during the Syrian crisis. The children underwent rigid bronchoscopy at Al Mouwasat University hospital, the only properly equipped hospital to perform paediatric rigid bronchoscopy in Damascus. We included all cases with complete medical records of children under the age of 13 years with positive bronchoscopy findings of foreign body aspiration. The records of patients were examined, and data extracted included physical examination, CXR reports, bronchoscopy reports, and complications. Statistical package for social sciences 25.0 program for Windows was used to report frequencies, percentages, means, medians, and standard deviations. RESULTS: Of 560 children diagnosed with foreign body aspiration, the peak incidence was at the age of 1-3 years 376 (67.2%). Most patients presented with an explicit history of inhalation 453 (80.9%). The most frequent clinical findings were dyspnoea 320 (57.1%), wheezing 308 (55%), and chest retraction 209 (37.35%). Hyperinflation 260 (46.4%) followed by pulmonary infiltration 197 (35.2%) were the most common abnormal radiological findings. Seeds 273 (48.8%) were the most frequent foreign body extracted by rigid bronchoscopy. The right main bronchus 255 (40.2%) was the most frequent site of foreign body lodgement. Lobar pneumonia 16 (2.8%) was the commonest complication of foreign body aspiration. CONCLUSION: Foreign body aspiration is a major public health problem in Syria. The child's welfare must be our paramount concern. To prevent this accident, we should address a change in raising public health awareness with regards to appropriate food and eating habits. This would limit hazardous complications.

Crisis within a crisis, COVID-19 knowledge and awareness among the Syrian population: a cross-sectional study.

OBJECTIVES: To gauge specific knowledge around clinical features, transmission pathways and prevention methods, and to identify factors associated with poor knowledge to help facilitate outbreak management in Syria during this rapid global rise of the COVID-19 pandemic. DESIGN: Web-based cross-sectional survey. SETTING: This study was conducted in March 2020, nearly 10 years into the Syrian war crisis. The Arabic-language survey was posted on various social media platforms including WhatsApp, Telegram, Instagram and Facebook targeting various social groups. PARTICIPANTS: A total of 4495 participants completed the survey. Participants with a history of COVID-19 infection, residing outside Syria or who did not fully complete the survey were excluded from the study. The final sample of 3586 participants (completion rate=79.8%) consisted of 2444 (68.2%) females and 1142 (31.8%) males. PRIMARY AND SECONDARY OUTCOME MEASURES: First, knowledge of COVID-19 in four areas (general knowledge; transmission pathways; signs and symptoms; prevention methods). Second, factors associated with poor knowledge. RESULTS: Of the 3586 participants, 2444 (68.2%) were female, 1822 (50.8%) were unemployed and 2839 (79.2%) were college educated. The study revealed good awareness regarding COVID-19 (mean 75.6%, SD ±9.4%). Multiple linear regression analysis correlated poor mean knowledge scores with male gender (ß=-0.933, p=0.005), secondary school or lower education level (ß=-3.782, p<0.001), non-healthcare occupation (ß=-3.592, p<0.001), low economic status (ß=-0.669, p<0.040) and >5 household members (ß=-1.737, p<0.001). CONCLUSION: This study revealed some potentially troubling knowledge gaps which underscore the need for a vigorous public education campaign in Syria. This campaign must reinforce the public's awareness, knowledge and vigilance towards precautionary measures against COVID-19, and most importantly aid in controlling the worldwide spread of the disease.

Assessing diagnostic radiology knowledge among Syrian medical undergraduates.

BACKGROUND: The role of radiology in medicine and healthcare is rapidly expanding worldwide, but awareness about this field among medical students is poor. This is the first study to assess Syrian medical students' knowledge and attitude regarding radiology. METHODS: This is a cross-sectional study conducted at the Syrian Private University, on November 8, 2019, on the International Day of Radiology during the war crisis. Data were collected through self-administered surveys and analyzed using the Statistical Package for Social Sciences version 25.0 (SPSS Inc., Chicago, IL, USA). RESULTS: The questionnaire was completed by 269 students whose ages ranged between 17 and 30 years old. Males constituted 63.6% of the respondents. The results revealed adequate knowledge about the basics of radiology. 73.6% of the students had previously heard about interventional radiology. There were slight misconceptions with certain points in each section, especially those pertaining to the radiation exposure of each imaging method. Finally, the students expressed low interest in radiology as a future career (24.5%). CONCLUSIONS: The level of awareness can affect a student's decision in considering radiology as a future career. Further evaluation of the methods of teaching, input from medical boards, curriculum advisors, and guidance from radiologists is required.

Prevalence and behavior regarding cigarette and water pipe smoking among Syrian undergraduates.

BACKGROUND: The devastating Syrian crisis has raised concern regarding the social acceptance of smoking especially with water pipe use becoming a growing epidemic. We aim to determine the prevalence of cigarette and water pipe smoking among university students, along with identifying the addictive behavior among university students. METHODS: A cross-sectional study was conducted at the Syrian Private University during World No-Tobacco Day, in Damascus, Syria during the war crisis. The survey consists of 4 sections: socio-demographic information, Fagerström Test of Nicotine Dependence, attitude towards water pipes, and perspective about smoking. Data were analyzed using the Statistical Package for Sciences version 25.0 (SPSS Inc., United States.). RESULTS: Of the 622 participants, 429 (69%) were males with a mean age of 21.3 ± 3.1 years. The prevalence of tobacco smoking was 320 (51.4%), 208 (23.8%) for cigarettes, and 112 (18.0%) for water pipe. Smoking was significantly higher among male non-medical university students. The majority were low to moderate dependent when assessed by the Fagerström Test of Nicotine Dependence. CONCLUSIONS: This study showed a very high prevalence of smoking indicating the need for smoking cessation programs, access to effective quitting treatments, and mass media campaigns to diminish smoking among the youth.