Acute lymphoblastic leukaemia (ALL) is the most common childhood cancer and has a high survival rate when properly managed. prognosis is correlated with many factors such as age, gender, white blood cell (WBC) count, CD10, French-American-British (FAB) classification, and many others. Many of these factors are included in this study as they play a major role in establishing the best treatment protocol. this study aims to demonstrate clinical and laboratory features of childhood ALL in Syria. they were treated at children's University Hospital, the only working major cancer centre in Syria at the time of the study. Data of 203 patients who aged 0-14 years were obtained for this study. Most patients (48.8%) aged (5-9) years with a male predominance (60.9%). The major features for ALL included lymphadenopathy (82.9%), presenting with systemic symptoms (74.9%), TALL subclass (20.2%), L2 FAB classification (36.1%), low educational levels for fathers (53%) and mothers (56.2%), having a high risk (48.4%), and having a duration of symptoms before evaluation for more than 4 weeks (42.6%). Only three (1.5%) patients had normal full blood counts (FBC) and only one (0.5%) patient had an isolated high WBC count at time of presentation. Most patients had either abnormal platelet count (89.3%) or low haemoglobin level (88.8%) when presenting with only (2.0%) having normal levels for both. This suggests that having normal haemoglobin and platelet count can be used for quick screening in crisis time like in Syria for prioritising patients. Many prognostic factors were significantly different from medical literature which emphasises the importance of local studies in the developping countries. this study included a high prevalence of Tall , L2 FAB classification, high-risk and other variables which require further studies to evaluate the aetiology of these features, especially that treatment protocols may have a higher mortality in developing countries when not adjusted to local variables.

Background: Lockdown restrictions due to COVID-19 have affected many people's lifestyles and ability to earn a living. They add further distress to the lives of people in Syria, who have already endured 9 years of war. This study evaluates distress and the major causes of concerns related to COVID-19 during the full lockdown.Methods: Online questionnaires were distributed using SPTSS, K10, and MSPSS which were used with other demographic, war- and COVID-19-related questions that were taken from The (CRISIS) V0.1 Adult Self-Report Baseline Form.Results: Our sample included 5,588 with the mean age of 26.84 ± 7.815 years. Of those, only one case of COVID-19 was confirmed. Over 42.7% had two or more positive PTSD symptoms, 42.6% had moderate or severe mental disorder, but only 14.9% had low social support. Higher PTSD and K10 scores overall were seen in female participants and with most of war variables (P < 0.05). Relationships with the partner being negatively affected and distress from a decline in ability to work and provide food were the most prominent.Conclusions: The indirect effects of COVID-19 are far more than that of the pathogen itself. A reduced ability to earn and to provide food were the main concerns indicated in this study. Relationships deteriorated in participants with high K10 and PTSD scores who also had more symptoms and used more hypnotics in the last four weeks. Smoking patterns were not related to K10 and PTSD. Social support played a role in reducing stress, but when relationships were affected, lower support was observed.

Backgrounds: Shisha smoking has become an epidemic since the nineties and it adds an additional burden over cigarette smoking as it is more harmful, smoked socially and is widely accepted in many countries. We aim to discuss shisha and cigarette smoking prevalence in the Syrian community and university students with their associated risk factors and the relationship with many war factors.Methods: Online surveys were used that contained demographic and war-related questions along with cigarette and shisha smoking pattern questions.Results: The sample contained 987 responders with a mean age of 24.69, 25.7% being males, 16.4% smoking cigarettes, and 29.3% smoking shisha. Cigarette and shisha smoking was more common in males with P<0.0001 (OR, 4.762; 95% CI 3.333-6.757) and P=0.047 (OR, 1.364; 95% CI 1.003-1.855) for cigarettes and shisha respectively. Males also smoked daily, for longer years, more packs and more shisha every week than females P<0.05. However, females were more social smokers. While cigarette smoking was more prevalent in older ages, shisha was so in younger ages. Having a job, certain types of work and students at certain faculties were correlated with smoking more P<0.05. Losing someone due to the war and being distressed from war noises were also correlated with smoking. Field of education affected smoking patters as medical field students smoked fewer cigarettes and shisha while social studies students smoked more. Being a labourer, working as a clerk or in a restaurant, or as a technician was more frequently associated with smoking. However, no associations were found with SES, marital status and changing place of living due to war.Conclusions: Males tend to smoke more, heavier, more consistent, and for longer periods than females while women smoked shisha more socially. War increases smoking patterns while SES did not affect smoking in Syria. Shisha smoking increased and cigarette smoking decreased compared to previous studies and cigarette smoking remains lower than other regional countries, but shisha smoking is higher when compared to many other countries.

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.

Allergic rhinitis (AR) is a common medical condition worldwide. It is an inflammation in the nasal mucosa due to allergen exposure throughout the year. Laryngopharyngeal reflux (LPR) is another medical condition that can overlap with AR. LPR can be considered an extra oesophageal manifestation of gastro-oesophageal reflux disease (GORD) or a different entity. Its diagnosis imposes a real challenge as it has a wide range of unspecific symptoms. Although AR and LPR are not life-threatening, they can severely affect the quality of life for years and cause substantial distress. Moreover, having AR is associated with having asthma which is also in turn associated with GORD. This is a cross-sectional study which used surveys distributed online on Social Media and targeted people across Syria. All participants who responded to the key questions were included. Reflux symptom index (RSI) was used for LPR, and score for allergic rhinitis (SFAR) was used for AR. Demographic questions and whether the participant had asthma were also included in the survey. We found that there was an association between the symptoms of LPR and AR p < 0.0001 (OR, 2.592; 95% CI 1.846–3.639), and their scores were significantly correlated (r = 0.334). Having asthma was associated with LPR symptoms p = 0.0002 (OR 3.096; 95% CI 1.665–5.759) and AR p < 0.0001 (OR 6.772; 95% CI 2.823–16.248). We concluded that there was a significant association between having LPR, AR, and asthma. We need more studies to distinguish between their common symptoms and aetiologies.