Background The awareness of diabetes mellitus (DM) and its complications, especially diabetic retinopathy (DR), is the key to reducing their burden. This study aimed to assess both the awareness of diabetic outpatients and their action towards periodic eye exam, and to determine the causes of non-compliance amongst patients who were aware. Because the Syrian Crisis affected all aspects of Syrians’ life, the study aimed to determine the crisis’ effects on patients’ care-seeking behavior. Our study was the first step in paving the way of prevention strategies. Methods This observational cross-section study was conducted on 260 patients with DM who were visiting the four main hospitals in the Syrian capital, Damascus between August and November 2017. Results The mean (±SD) age of participants was 54.3(±12.8) years. Females were more than half (56.2%). The majority were from areas outside Damascus (72.3%). The mean (±SD) DM duration was 10.6 (±7.1) years. Almost all patients (93.8%) thought that DM could affect the eye. 67.3% believed that it could cause blindness. 86.9% of the patients conceived that DM patients should visit an ophthalmologist regularly. 37% did not visit any ophthalmologists at all, while 63% reported they had visited their ophthalmologists. Only 21.5% had a regular eye exam. Gender, educational level, economic status, province, and family history of DM had statistically an insignificant relation with an ophthalmologist visit. The preponderance of the patients who haven’t visited regularly did not appreciate the necessity of regular eye exam. Diabetic neuropathy was the most common complication of DM that patients were aware of (92%) and suffered from (56.5%). Meanwhile, regarding the effects of the Syrian Crisis: 41.2% of diabetic patients had stopped their medications for at least one month, mainly because the drugs were unavailable (74.7% of them), as some drug companies had been destroyed. Half of the patients had struggled to reach a medical care center. Half of the patients had been displaced, two-third of them were from outside Damascus. Conclusion A screening program for DR should be initiated. Also, awareness about DM and its complications, especially DR, should be raised through doctors and media. Electronic supplementary material The online version of this article (10.1186/s12913-019-4375-8) contains supplementary material, which is available to authorized users.

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Introduction and importance Meckel's Diverticulum (MD) is the most occurring congenital anomaly of the gastrointestinal tract. It characterizes a patent remnant of the omphalomesenteric duct. Despite remaining asymptomatic most of the time, the rarity of its occurrence is reflected by the scarcity of data involving it in the literature. Gastrointestinal bleeding, bowel obstruction, and inflammation are the most prevalent complications of MD. Perforation of MD is very rare. Case presentation We present the case of a previously healthy 32-year-old female, who presented to the emergency department with a 2-day-history of generalized abdominal pain. Radiological analysis suggested a perforated viscus and an inflamed Appendix. Clinical discussion Our patient was diagnosed preoperatively with perforated hollow viscus and an exploratory laparotomy was indicated. Intraoperatively, a perforated MD was found and treated by surgical excision of the affected loop of bowel with end-to-end anastomosis and the specimens were sent for histopathological analysis. Histopathology revealed a perforated MD containing gastric mucosa. The patient had successful recovery. Conclusion Early recognition with swift surgical intervention must take place to provide therapeutic outcome for patients and to limit the resulting morbidity. This case highlights the necessity of considering MD as core differential diagnosis in patients with acute abdomen. Due to the scarcity of data on perforated MDs in adult females, it's worthy of studying to highlight its incidence. Due to the rarity of a perforated MD in an adult female, it's worthy to consider such cases to explore preoperative assessment techniques, surgical interventions options, and postoperative complications.

BackgroundMeckel’s Diverticulum is the most common congenital anomaly of the gastrointestinal tract. It characterizes a persistent remnant of the omphalomesenteric duct. Although it mostly remains asymptomatic, its infrequent incidence is reflected by the scarcity of data on it in the literature. Hemorrhage, intestinal obstruction, and inflammation are the most common complications of MD. Perforation of MD is highly rare. Case presentationWe present the case of a 32-year-old female, who presented to the emergency department with 2-day history of generalized abdominal pain. Radiology (X-Ray, Ultrasound) suggested perforated viscus and inflamed Appendix. ConclusionPerforation of MD is seldom diagnosed preoperatively. Complications of MD can be unpredictable, and early recognition with swift surgical management must take place to provide therapeutic outcome for patients. This is an unconventional case of a perforated MD that highlights the necessity of considering MD as core differential diagnosis in patients presenting with acute abdomen.