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 Syria has experienced war since 2011, leaving over 80% under the poverty line and millions displaced. War and its retaliations have significantly impacted the mental health of Syrians. This study evaluates the post-traumatic stress disorder (PTSD), and the severity of the mental distress caused by war and other factors such as low social support. This study also evaluates other variables and compares the findings with those of multiple studies on Syria and refugees. Methods This is a cross-sectional study that included people who lived in Syria in different governorates. Online surveys were distributed into multiple online groups and included the Kessler 10 (K10) scale which screens for anxiety and depression, the Screen for Posttraumatic Stress Symptoms (SPTSS) tool, the Multidimensional Scale of Perceived Social Support, and questionnaires on demographic and war-related factors. Results Our study included 1951 participants, of which, 527 (27.0%) were males and 1538 (78.8%) between the age of 19 and 25. Among participants, 44% had likely severe mental disorder, 27% had both likely severe mental disorder and full PTSD symptoms, 36.9% had full PTSD symptoms, and only 10.8% had neither positive PTSD symptoms nor mental disorder on the K10 scale. Around 23% had low overall support. Half of the responders were internally displaced, and 27.6% were forced to change places of living three times or more due to war. Around 86.6% of the responders believed that the war was the main reason for their mental distress. Those with high SPTSS and K10 scores were found to take more days off from work or school due to negative feelings and having somatic symptoms. Moreover, the number of times changing places of living due to war, educational level, and being distressed by war noise were the most prominent factors for more severe PTSD and mental distress. No differences in PTSD and mental disorder prevalence were noted in participants living in different governorates or among different types of jobs. A strong significant correlation (r = 0.623) was found between SPTSS and K10 scores. Conclusion The conflict in Syria has left the population at great risk for mental distress which was higher compared to Syrian refugees elsewhere. Many measures with an emphasis on mental health are needed to help the people against a long-term avoidable suffering.

Background. Allergic rhinitis (AR) is a global disease that affects a huge proportion of people around the world especially in the Middle East, where multiple allergy-promoting factors can be found. Although AR is not fatal, it severely affects the quality of life. However, it is usually overlooked in developing countries due to resource scarcity. Methods. An online questionnaire on social media was used which included demographics, smoking, socioeconomic-status (SES), war-related questions, and the score for allergic rhinitis (SFAR), a simple self-reporting tool with the cut-off point at 7. Findings. This study included 968 subjects with 721 (74.5%) females. The mean age was 24.69 years with AR prevalence at 47.9%. AR was associated with male gender [P=0.001 (OR, 1.677; 95% CI 1.249-2.253)], having a job [P=0.049 (OR, 1.309; 95% CI 1.001-1.713)], the having a chronic medical condition (P<0.0001) mainly other allergies [P<0.0001 (OR, 9.199; 95% CI 3.836-22.063)] and asthma [P=0.006 (OR, 5.060; 95% CI 1.396-18.342)], using medications (P<0.0001) and living in particular provinces (P=0.010). However, no significant correlation was found with type of work and war factors except being distressed by war sounds [P=0.027 (OR, 1.348; 95% CI 1.034-1.757)]. Finally, no associations were found with age, consanguinity, SES, educational level, and cigarette or/and shisha smoking (P>0.05). Interpretation. Approximately half of the sample displayed AR symptoms, indicating a potentially high burden of AR in the community. A correlation to being distressed from war noises was found with AR which could reflect a psychological aspect. In addition, in war harmful allergens are released which can be an additional AR risk factor which adds to the environment in the Middle East that is associated with AR. However, we need further studies to discover and minimize this huge prevalence of AR.

Background: Syria has experienced war over the past seven years, leaving a high percentage of the population below the poverty line. This has significantly impacted Syrians which is reflected in the psychiatric aspect. This study evaluates the severity of the mental disorder caused by war and other factors, and evaluates the post-traumatic stress disorder (PTSD) in addition to support provided to Syrians. Methods: Online surveys including the Kessler 10 (K10) survey, the Screen for Posttraumatic Stress Symptoms (SPTSS) tool, the Multidimensional Scale of Perceived Social Support (MSPSS) and demographic and war-related questions were used for this study. Results: Our study included 1951 participants, comprising 527 (27.0%) males and 1538 (78.8%) aged (19-25) years. Of all the participants in the study, 44% had severe mental disorder, 27% had severe mental disorder with full PTSD symptoms, 36.9% had full PTSD symptoms, 79% had at least one PTSD symptom, and 10.8% had neither PTSD symptoms nor mental disorder. Only 23.2% had low overall support. Half of the responders were internally displaced and 27.6% of these participants were forced to move three times or more due to war. Only 13.4% of the responders did not believe that the crisis was the reason for their distress. Those with high SPTSS and K10 scores were found to take more days off of work or school due to negative feelings and have somatic symptoms. Moreover, low levels of education, low socioeconomic status, chronic medical conditions, war variables for example distress caused by war noises, changing place of living due to war were all associated with high distress and the presence of PTSD symptoms in this study. Strong significant correlation (r=0.623) was found between SPTSS and k10 score. Conclusion: The conflict in Syria has left the country’s population at great risk of psychological and mental distress. Drastic measures are required to save an entire population from permanent psychological suffering.

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 &lt; 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.

The Syrian crisis has entered its tenth year with incessant conflicts in many locations across Syria. Much of the population have been impacted including children who suffer the direct and indirect war effects of war. To date there has been no large scale study examining the mental health and academic impacts of the war of children in Syria. This large-scale cross-sectional study aims to evaluate the psychological profile of school students in Damascus Syria examining PTSD, anger and general mental health and examine their relationships with work, smoking and academic performance. The study included 1369 students from seven different schools. Surveys included assessment of mental and physical well-being using a measure of health related quality of life (SF8), Posttraumatic stress disorder (CRIES-13), problematic anger (DAR5) smoking, working habits, social support and academic grades. The study found that more than half of the children suffered from PTSD (53%), problematic anger (62%) with this being associated with poorer SF-8 (quality of life) scores in both mental and physical domains and more time watching TV and Internet. Around 46% declared fair or worse general health and 61% having moderate or severe mental health. War variables had an impact on PTSD, anger, and SF-8, but not an impact on grades. Worse HRQL was associated with war variables and smoking. Social support was negatively correlated with SF-8, PTSD, DAR-5 anger and declarations of close friends being the main source of support. This is the largest study of children is Syria to date that reports on the psychological ramification of war. The study demonstrates the severe impact on children across both mental health and physical health. Although direct war effect could not be observed, the high burden of PTSD and anger distress is a strong reflection of the chronic mental trauma. School students have had to work and face many hurdles in a young age which has left them severely impacted.

Background: Syria has experienced war since 2011, leaving over 80% under the poverty line and millions being displaced. War and its retaliations have significantly impacted the mental health of Syrians. This study evaluates the post-traumatic stress disorder (PTSD), and the severity of the mental distress caused by war and other factors such as low social support. This study also evaluates other variables and compares the findings with multiple studies of Syria and refugees.Methods: This is a cross-sectional study that included people who lived in Syria from different governorates. Online surveys were distributed into multiple online groups and included Kessler 10 (K10) questionnaire, the Screen for Posttraumatic Stress Symptoms (SPTSS) tool, the Multidimensional Scale of Perceived Social Support, and demographic and war-related questionnaires.Results: Our study included 1951 participants, of which, 527 (27.0%) were males and 1538 (78.8%) aged (19-25) years. Among participants, 44% had likely severe mental disorder, 27% had both likely severe mental disorder and full PTSD symptoms, 36.9% had full PTSD symptoms, and only 10.8% had neither positive PTSD symptoms nor mental disorder on the K10 scale. Around 23% had low overall support. Half of the responders were internally displaced, and 27.6% were forced to change places of living three times or more due to war. Around 86.6% of the responders believed that the crisis was the main reason for their mental distress. Those with high SPTSS and K10 scores were found to take more days off from work or school due to negative feelings and having somatic symptoms. Moreover, the number of times changing places of living due to war, educational level, and being distressed by war noise were the most important factors for more sever PTSD and mental distress. No differences in PTSD and mental disorder prevalence were noted in governorates and type of job. A strong correlation (r=0.623) was found between SPTSS and K10 scores. Conclusion: The conflict in Syria has left the population at a great risk for mental distress which was more severe compared to Syrian refugees elsewhere. Many measures with an emphasis on mental health are needed to aid the people against a long-term avoidable suffering.