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. 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.

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:Breastfeeding (BF) in infancy is associated with a decreased risk of acute lymphoblastic leukaemia (ALL). However, most of the studies were conducted in developed countries, neglecting developing countries where mothers might be exposed to different carcinogenic substances which could be transferred through breastmilk.Methods: This is a case-control study which was conducted in the major paediatric cancer centre in Syria. Data of case and control groups were obtained from the hospital’s records. Only patients with no hereditary or chromosomal syndrome and aged 4 years and younger were included. The case group included ALL patients and control group contained hospital patients who visited its various clinics. The patients were categorised into 3 groups depending on their feeding habits before the age of 6 months. Results:Our sample contained 70 patients in the case group with 42 (60%) being males and 82 patients in the control group with 52 (55.3%) being males. Sixty (85.7%) cases and 59 (72%) controls were exclusively breastfed. We found a statistically significant difference when comparing cases and controls in BF patterns (P<0.05) as cases were exclusively breastfed more frequently. Exclusive breastfeeding was found more frequently in the case group compared to other patterns of infancy feeding P=0.04 (OR, 2.339; CI, 1.025 -5.336). In case group, parents of a low educational level breastfed their children more frequently (P<0.05). Number of siblings was not associated with ALL or any of its variables. Furthermore, infancy feeding pattern correlation with gender, being born with no complications, consanguinity, CD10, FAB classification, ALL-subtype, risk, and family history were insignificant. Conclusion:There are certain practices among the Syrian people, especially among parents of a low educational level that has possibly exposed their children to carcinogenic substances which were possibly transferred through BF, causing this association between ALL and BF. We speculate certain substances and behaviours being responsible. However, BF had minor effects on the prognosis and subtype of ALL, and number of siblings had no effect on ALL.

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.

Backgrounds: Syria has entered its ninth year of conflict and as its medical sector facing major hurdles, laryngopharyngeal reflux (LPR) is often overlooked although it has an association with worsening quality of life and affecting many aspects as it is chronic and left untreated although it can lead to many complications such as dysphonia. This study is to evaluate LPR prevalence and its association with different aspects such as cigarette, and shisha smoking, and the effect of war on LPR.Methods: Cross-sectional study by using online questionnaires that included demographics, smoking, war related questions and reflux symptom index (RSI) were used online in many cities around Syria.Findings: This research included 734 responders with 75.5% being female and the mean age being 23.97 years. 31.9% of subjects had symptoms suggestive of LPR. Participants were Syrians and we included every responder who agreed and did not neglect any question. We only found that being distressed from war noises was associated with positive LPR symptoms [P=0.009 (OR, 1.562; 95% CI 1.117-2.183)], but losing someone or changing place of living due to war were not associated with LPR. LPR was associated with cigarette smoking (P<0.05). Finally, having asthma, and male gender in the younger population were associated with LPR (P<0.05). No clear association with age, or shisha and no significant associations were found with consanguinity, marital status, educational level and SES.Interpretations: About one third had LPR symptoms. War distress from war noise, cigarette smoking, asthma, and allergic were significantly correlated with LPR.

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.