Damascus University

Introduction Tracheomalacia (TM) is characterized by a high degree of compliance. Our case is unique since it is thought to be the most common congenital tracheal defect, which is uncommon in adults, with the long-lasting symptoms and the absence of classic risk factors. A wide range of symptoms, such as stridor, wheezing, barking cough, and cyanotic episodes, are indicative of TM. Case presentation A 29-year-old male with a history of shortness of breath, hoarseness of voice, and difficulty swallowing for 8 years presented with symptoms. Upon physical examination, the patient appeared unwell but not dyspneic. A bronchoscopy showed obstruction of the tracheal lumen during expiration, narrowing of both main bronchus, and reduced peak expiratory flow, and the CT scan confirmed the diagnosis. Clinical discussion TM was diagnosed in our 29-year-old patient despite his medical history which was free of risk factors. His clinical manifestations, alongside Bronchoscopy and CT findings, prompted doctors to consider TM, although it is extremely rare in such ages. TM can be treated with Y-shaped stents but there are currently no conclusive signs that demonstrate the necessity of surgery in management Conclusion This unique case highlights the need for increased awareness and early detection of such uncommon presentations in adult patients. Undoubtedly, additional case reports and research on these patients will improve our knowledge and ability to treat adult TM.

Background White spot lesion formation around orthodontic brackets is a major complication associated with fixed orthodontic treatment. Objective This review aimed to evaluate the current evidence regarding the differences in white spot lesion formation between self-ligating and conventional ligating brackets. Methods Eleven bibliographic databases were searched until January 2025. This review covered parallel-group and split-mouth randomized controlled trials, controlled clinical trials, and cross-sectional studies that investigated the differences in white spot lesion formation between self-ligating and conventional ligating brackets. Results Three randomized controlled trials, one controlled clinical trial, and one cross-sectional study were included in this systematic review. Among these, three studies were classified as having a low risk of bias. Four of the five included studies showed no statistically significant difference in white spot lesion formation between the two types of bracket systems (p < 0.05). Conclusion There are no potential differences in white spot lesion formation between self-ligating and conventional ligating bracket systems. However, orthodontists must be aware of the other factors affecting white spot lesion formation, with oral hygiene being the most critical factor. Registration: The protocol was registered in the PROSPERO database (CRD42022353478) on 25 August 2022.

Dimensionality reduction is one basic and critical technology for data mining, especially in the current “big data” era. It is the process of reducing the number of features (or dimensions) in a dataset while retaining as much information as possible. This can be done for a variety of reasons, such as reducing the complexity of a model, improving the performance of a learning algorithm, or making it easier to visualize the data. Motivated from aforementioned reasons, this paper proposed a new feature reduction approach, which reduce and weight the most important features from of universal features set to fit the big data analytics on IoT based cybersecurity systems. The minimal number of features are chosen by using feature selection methods (ANOVA, Variance Threshold, Information Gain, Chi Square) which performed on the IoT-23 dataset. According to the approach, we divided the universal features into several subgroups, and evaluated the performance of ML Algorithms (NB, KNN, RF, LR). Extensive experiments are performed on the CICIDS2017 dataset to validate the effectiveness of the proposed approach. As a result, the Random Forest algorithm was the best in terms of performance, as the lowest value of all metrics (Accuracy, Precision, Recall, F1-Score) we obtained was 93%, except for the case in which we used features that we assumed were the least important feature subset. The proposed approach reduced the number of features to only two features and achieved high results.

Introduction benign cystic growths called epidermoid cysts (ECs) are derived from the germ-native epithelium. They are typically asymptomatic. It is challenging to diagnose these cystic lesions in this region. In one instance, recurrence occurred even following total surgical excision. A precise diagnosis and separation from dermoid are crucial for the best outcome. Case presentation A six-month-old boy complained of swelling that was getting bigger and was entrenched in his tongue’s anterior region. An intraoral examination found a smooth-surfaced, painful cyst that was well-circumscribed. A benign epithelial squamous cyst was discovered following the aspirated fluid’s referral to the pathological anatomy division. It was decided to perform surgery. The recommended treatment plan was successful. Discussion While ECs are commonly located on the face, head, neck, chest, and upper back, instances involving the head and neck region are only 7%, with even fewer affecting the oral cavity, particularly the floor of the mouth Conclusion With minimal risk of malignancy and recurrence, successful treatment involves complete surgical excision. Accurate diagnosis and differentiation from dermoid cysts are essential for optimal treatment outcomes

This review summarizes the intricate relationship between the microbiome and cancer initiation and development. Microbiome alterations impact metabolic pathways, immune responses, and gene expression, which can accelerate or mitigate cancer progression. We examine how dysbiosis affects tumor growth, metastasis, and treatment resistance. Additionally, we discuss the potential of microbiome-targeted therapies, such as probiotics and fecal microbiota transplants, to modulate cancer metabolism. These interventions offer the possibility of reversing or controlling cancer progression, enhancing the efficacy of traditional treatments like chemotherapy and immunotherapy. Despite promising developments, challenges remain in identifying key microbial species and pathways and validating microbiome-targeted therapies through large-scale clinical trials. Nonetheless, the intersection of microbiome research and cancer initiation and development presents an exciting frontier for innovative therapies. This review offers a fresh perspective on cancer initiation and development by integrating microbiome insights, highlighting the potential for interdisciplinary research to enhance our understanding of cancer progression and treatment strategies.

Introduction and importance Multiple primary malignancies (MPMs) are separate malignant tumors in the same patient that are not caused by metastasis or recurrence; they represent between 1.84% and 3.9% of all malignancies . Synchronous MPMs, where the tumors are detected at the same time, are even rarer, with a rate of about 0.7%. Moreover, synchronous primary neoplasms involving both the kidneys and ovaries are extremely rare and have been reported in only a few cases in medical literature. Presentation We present the first case to be reported in Syria as multiple primary tumors of a 62-year-old woman who presented with heaviness in her lower abdomen and right hypochondrium and was found to have synchronous primary tumors, left renal clear cell carcinoma and right ovarian papillary serous cystadenocarcinoma based on CT-scan and histopathology . The patient underwent left radical nephrectomy and resection of the right ovary and will receive adjuvant chemotherapy, with regular follow-up recommended to monitor for any signs of recurrence or metastasis. Discussion Based on our literature review, the co-occurrence of ovarian tumor with renal cell carcinoma (RCC) is uncommon. Distinguishing between metastatic tumors and simultaneous primary tumors presents a significant diagnostic challenge. Achieving a precise diagnosis requires the observation of markedly different histologies to confirm the presence of concurrent primary tumors. Conclusion This case serves as a reminder that when a patient presents with multiple masses, it is important to consider the possibility that they could be separate primary tumors despite its rarity.

Drought stress poses a significant threat to potato production in Syria, necessitating the development of resilient cultivars. This study, conducted at the Plant Biotechnology Laboratory of the National Commission for Biotechnology in Damascus, investigated the impact of drought stress on key growth parameters of regenerated somaclones derived from selected callus of three potato cultivars (Solanum tuberosum L.): Salvador, Yalas, and Arizona. The research revealed striking differences in regeneration efficiency among cultivars. Yalas exhibited the highest somaclone regeneration rate at 32.1% when cultured on medium supplemented with 25 mg·L⁻¹ adenine sulfate and 1.5 mg·L⁻¹ BAP. Salvador and Arizona followed with regeneration rates of 21.4% and 14.5%, respectively, using 15 mg·L⁻¹ adenine sulfate plus 1.5 mg·L⁻¹ BAP. Comprehensive analysis of growth indicators (including plant height, leaf number and area, and root number and length) under drought stress conditions identified superior drought-tolerant somaclones. Notably, Y3 and Y2 (Yalas), S3 and S6 (Salvador), and A1 (Arizona) demonstrated exceptional drought resilience across multiple growth parameters. These findings provide valuable insights for potato breeding programs aimed at enhancing drought tolerance, potentially mitigating the impact of water scarcity on potato production in Syria and similar arid regions.

Background Bladder Cancer (BC) is an environmental cancer caused by exposure to a globally widespread carcinogen, which is smoking, and it is characterized by high rates of recurrence and mortality. High Mobility Group A2 (HMGA2) protein is an oncofetal protein that belongs to the HMG family proteins. It is involved in various stages of carcinogenesis and cancer progression. This study investigated the presence and levels of the HMGA2 protein in bladder urothelial carcinoma patients’ plasma and in healthy individuals and their association with the clinicopathological features of bladder urothelial carcinoma. Methods This case–control study included 80 individuals divided into two groups: a healthy group (n = 22) and a patient group with bladder urothelial carcinoma (n = 58). There were 16 patients with Muscle-Invasive Bladder Cancer (MIBC) and 42 patients with Non-Invasive Bladder Cancer (NMIBC) in the patients’ cohort according to the European Association of Urology (EAU) classification. HMGA2 plasma levels were measured by Sandwich Enzyme-Linked ImmunoSorbent Assay (ELISA). The statistical analysis was performed using IBM SPSS statistics (version 25) software. The t-test and the Mann–Whitney test were used. Results Plasma HMGA2 protein levels were higher in the BC group than in the healthy group (P < 0.001), they also were higher in MIBC (pT2-pT3) than in NMIBC (pTa-pT1) (P < 0.001). HMGA2 plasma levels were higher in high grade BC patients than in low grade BC patients (P = 0.049). Conclusions This study confirmed that the plasma HMGA2 protein level was higher in bladder cancer patients than in healthy individuals and that its elevated plasma levels were correlated with advanced stage and grade of BC; thus, the plasma HMGA2 protein level represents a potential non-invasive marker that could be included in bladder cancer diagnosis approach.

Mutations in the NDUFV1 gene are associated with mitochondrial complex I deficiency and have been linked to various clinical conditions such as Leigh syndrome, severe infantile lactic acidosis, newborn cardiomyopathy, progressive leukoencephalopathy, and other encephalomyopathies. Genetic alterations revealed mitochondrial complex 1 deficiency, nuclear type 4 |AR: two compound heterozygous missense mutations in the NDUFV1 gene, c.640G < A (p.E214K) chr11:67377981 (Exon 1) and c.248C < T (p.S83L) chr11:67376115 (Exon 3) gene. Our case identifies a previously unknown pathogenic effect of the variant ‘c.248C > T’ in the NDUFV1 gene, observed in a 4-year-old boy with left-sided facial paralysis and balance impairment. While this discovery is significant, further exploration of NDUFV1 gene variants is essential for a comprehensive understanding and effective treatment strategies.

Background Rhabdomyosarcoma is classified into histologic subtypes: embryonal, alveolar, pleomorphic, spindle, and mixed-type. Embryonal rhabdomyosarcoma is mainly a disease of children. It occurs rarely in adults. When rhabdomyosarcoma is found in adults, it usually exhibits worse outcomes than in pediatric patients. Case presentation We present a case report of a 20-year-old Arab woman who presented with generalized musculoskeletal pain, unintended weight loss, and excessive night sweats. There was no remarkable history of medications, diseases, or surgeries. A positron emission tomography scan showed multiple osteolytic lesions with metabolic activity, as well as pleural effusion and soft tissue mass around the thoracic area. Following this, a bone marrow biopsy was performed and showed metastatic embryonal rhabdomyosarcoma according to immunochemistry stainings. Chemotherapy was started with 3 doses of vincristine, actinomycin D, and cyclophosphamide regimen for 3 months, after which a positron emission tomography scan showed a total disappearance of the soft tissue mass, but revealed metabolic activity of new foci. Therefore, the patient took another 3 doses of the vincristine, actinomycin D, and cyclophosphamide regimen, and received a total of 30 Gy of radiotherapy on the new foci. Conclusion This paper describes a case of a patient diagnosed with adult rhabdosmyosarcoma at an uncommon age and in an uncommon site; therefore, it is important to consider rhabdomyosarcoma in the differential diagnosis of patients given an abnormal presentation and unexplained findings. Early detection of the disease, which is difficult with nonspecific symptoms, is crucial for improving outcomes.

Introduction and importance: Truncus arteriosus type I is an uncommon congenital heart anomaly distinguished by the presence of a single arterial trunk emanating from the heart, resulting in the mixing of oxygenated and deoxygenated blood. Timely surgical intervention is crucial to segregate pulmonary and systemic circulations for improved prognoses. Case presentation: This report details a 19-year-old male presenting with chronic cyanosis, digital clubbing, and a diagnosis of Eisenmenger syndrome. Laboratory evaluations indicated elevated levels of hemoglobin, uric acid, urea, and C-reactive protein, while electrolyte levels remained within normal limits. Diagnostic imaging revealed significant pulmonary artery hypertension, a considerable perimembranous ventricular septal defect (VSD) with bidirectional shunting, alongside aortic arch anomalies. Clinical discussion: Owing to the irreversible pulmonary pressure and diminished cardiac output attributable to the VSD, surgical repair was deemed unfeasible. Hence, a conservative management approach was adopted, emphasizing pulse monitoring, iron supplementation, renal function assessment, infection prophylaxis, hemorrhage prevention, and appropriate vaccinations. Conclusion: This case report underscores the complexities in managing a 19-year-old male with Eisenmenger syndrome, emphasizing the need for a conservative approach and continual monitoring to enhance patient outcomes.

Objective: To evaluate the efficacy of 11% aqueous propolis extract in eliminating Enterococcus faecalis in necrotic pulp canals of primary anterior teeth compared to 2.5% sodium hypochlorite. Materials and Methods: E. faecalis were isolated from necrotic primary anterior teeth with periapical lesions, cultured, and incubated using paper points. The research sample comprised 30 extracted single-rooted necrotic primary anterior teeth, divided equally into two groups according to the irrigants used. Access cavities were prepared, and working lengths were determined. Afterward, canals were shaped using K-files, contaminated with E. faecalis, and placed in an incubator for a week. Initial microbial swabs were taken, and then each canal was irrigated with either 3 mL of a hand-made 11% aqueous propolis extract or 3 mL of 2.5% sodium hypochlorite for 5 min. Postirrigation microbial swabs were taken, cultured on blood agar plates, and incubated at 37°C for 48 h, followed by colony counts. Statistical tests included the paired sample T-test, Wilcoxon signed ranks, and Mann–Whitney U tests. The significance level was set at α = 0.05. Results: In total, 11% aqueous propolis extract contributed to a 61.8% reduction in E. faecalis (p<0.001), while 2.5% sodium hypochlorite contributed to an 84.1% reduction (p<0.001). The average change in logarithmic values in the sodium hypochlorite group was more significant than in the propolis group (p=0.002). Conclusion: In total, 11% aqueous propolis extract is antimicrobial against E. faecalis. However, its efficacy was less than 2.5% sodium hypochlorite.

Aflatoxin (AFB1) is a highly toxic mycotoxin that poses significant health risks through food contamination. Traditional detection methods, such as HPLC and ELISA, provide high sensitivity but are costly, time-consuming, and require complex sample preparation. In this study, this study investigated the capability of laser absorbance spectroscopy (at 858 nm) for AFB1 detection, offering a rapid, cost-effective, and reagent-free alternative. The system was optimized using the Taguchi method to determine the optimal laser wavelength, modulation type, and sample concentration. Calibration curves were constructed for each experimental condition by measuring absorbance as the response. Our results demonstrated high linearity (R² ≈ 0.99) and an improved detection limit (LOD) of 1.1 µg/L, comparable to conventional methods. This study highlights the potential of laser-based spectroscopy for mycotoxin detection, with future work focusing on validating the technique in real food matrices and integrating it into portable food safety monitoring devices. Graphical Abstract

Prompt identification of Hyperparathyroidism‐Jaw Tumor Syndrome (HPT‐JT) is vital, particularly for those with a family history or unusual symptoms like progressive facial changes. By employing a thorough diagnostic strategy that includes biochemical tests, imaging, and genetic analysis, we can achieve early diagnosis and effective intervention. In this case, the patient displayed maxillofacial tumors, hypercalcemia, and increased parathyroid hormone levels. Imaging confirmed a parathyroid adenoma, while histopathology showed characteristics of brown tumors. Subtotal parathyroidectomy is the recommended treatment. Additionally, regular follow‐ups every 6 months involving biochemical tests and imaging are crucial for ensuring the best patient outcomes.

Background and Aims A cesarean section (CS) is a surgical procedure used during pregnancy and childbirth to ensure maternal and fetal well‐being. Global CS rates are increasing, with different studies demonstrating this trend. The purpose of this study, is to look into the prevalence of CS and its contributing factors in Syrian hospitals. Methods A retrospective cross‐sectional study was conducted at Aleppo University Hospital and Damascus University Hospital in Syria. The data were collected from patients' medical records during the period between January and December 2021. The study population included women who gave birth at these hospitals in 2021. The study used a questionnaire with four domains: sociodemographic features, mother's history, birth history, newborn information, and delivery type with indications and complications. CS indications were evaluated using protocols from the Association of Scientific Medical Societies in Germany (AWMF). Statistical analysis was conducted using SPSS Statistics 25.0. Results Among the deliveries, 47.4% were C‐sections, with slightly higher rate at Damascus. Population characteristics revealed differences in age, residency, smoking history, birth details, and associated medical conditions. The majority of participants were aged above 25 years old, rural residents, and nonsmokers. The primary CS cases were mainly medically indicated. Most C‐sections were repeat procedures (68%), with fetal distress being the most common indication. Aleppo had higher repeat C‐section rates (71.5% vs. 65.5% in Damascus). Most primary C‐sections were medically indicated (85.2%), while 14.8% were non‐indicated, often due to maternal requests or previous complicated births. Conclusion This study sheds light on CS prevalence, indications, and influencing factors in Syria, contributing to the broader discourse on optimizing CS rates and improving maternal and neonatal outcomes. Further research is necessary to explore additional factors and interventions to curb unnecessary CS procedures.

Background Evaluation tools for training programs vary, necessitating a standardized tool for assessing surgical clinical training quality to enhance program effectiveness, pinpoint improvement areas, and ensure resident readiness for independent practice. We present a new tool designed to provide a reliable and consistent framework for evaluating the effectiveness of surgical clinical training. Methods The Surgical Clinical Training Measurement (SCTM) was developed using the modified Delphi method to evaluate ten variables, including core competencies specific to surgical training. It employs a 5-point Likert scale, with scores ranging from 40 to 200. General surgery residents completed the SCTM twice to evaluate training levels. Results were categorized based on score ranges. Statistical analysis via SPSS included descriptive statistics, group comparisons, internal consistency assessments, correlations, and reliability tests to evaluate the SCTM scores, demographic characteristics, and language versions. ANOVA, Chi-Square, Cohen Kappa, and Spearman’s rho tests were employed for data analysis. Results 74 general surgery residents at Aleppo University Hospital have participated in this study. The SCTM scores indicated a mean total score of 131.42, with most residents falling into the good satisfactory category. Analysis showed no significant differences in total scores across specialty years, but post-hoc tests revealed differences between specific years. The SCTM demonstrated strong reliability, with a Kappa value of 0.884 indicating high agreement between English and Arabic versions (p < 0.05). Test-retest reliability was also high (r = 0.964, p < 0.01). Internal consistency was excellent across various domains, reinforcing its validity in surgical education. The analysis of variables showed different levels of reliability and mean scores among the various factors. The Pre-Operative Clinical variable had the highest performance, while the Evidence-Based Quality Clinical Training variable indicated the most potential for improvement. The strong positive correlations between various domains of SCTM emphasize the interconnected nature of skill development, with proficiency in patient care closely linked to competency in other areas such as Medical Knowledge, Practice-based Learning and Improvement, and Evidence-Based Quality Clinical Training. Conclusion SCTM offers a standardized and cohesive method for evaluating the quality of surgical clinical training. It’s a valuable resource for program directors, educators, and residents to assess and enhance training programs, and identify specific areas for improvement. Additional research is required to validate the SCTM in different settings and explore its applicability in other fields. Clinical trial number Not applicable.

Aase-Smith syndrome type 2 is a rare genetic disorder that affects erythropoiesis and bone development, causing hypoplastic anemia and abnormalities in the fingers and toes, specifically triphalangeal thumbs. While there is no cure, treatment involves managing symptoms through blood transfusions, surgical intervention, and genetic counselling. A 15-year-old student presented with an unmeasured fever for two months, recurrent lung infections, difficulty in speech, and impaired gait. The patient had multiple congenital malformations including triphalangeal thumbs and a history of mild anemia. Bone marrow biopsy revealed an isolated slowing of erythroid lineage maturation. Radiology studies showed scoliosis, hand deformities, and multiple calcified lesions in the brain. The patient's fever exacerbated, and oxygen saturation deteriorated, necessitating tracheal intubation. Several hours later, the patient passed away.

This study aimed to estimate dental caries’ prevalence and potential risk factors among schoolchildren aged 8–12 in Damascus, Syria. The study was cross-sectional and conducted between February 2023 and April 2024, the target population was 1,052 children selected using multi-stage cluster sampling. Dental caries were determined using the DMFT/dmft index, while additional information on sociodemographic status, and attitude towards oral hygiene practices, were collected via a structured questionnaire. Data analyses were conducted using the Statistical Package for Social Sciences (SPSS). The overall prevalence of dental caries was 90.8%. Males had a slightly higher prevalence (91.9%) than girls (89.8%). Children aged [10–12] years showed the highest caries prevalence (91.7%). The mean DMFT/dmft score was 2.07 ± 1.91/3.74 ± 2.25, respectively. Caries prevalence was significantly associated with the type of school attended, family size, socioeconomic status, and parental education. Additionally, the frequency of tooth brushing, dental flossing, and irregular dental visits were significantly linked to higher caries incidence. It was found that caries experience remains high in the children in Damascus, with many associated factors including their sociodemographic factors and oral behaviors. We confirm that visiting the dentist regularly, using dental floss, and brushing regularly decreased the prevalence of dental caries among children.

This study aimed to ascertain whether the Merocel strips (MS) can achieve adequate hemostasis and effectively retract the gingiva compared to the aluminum chloride-impregnated knitted retraction cord (ACIKRC) utilizing a digital gypsum model. It was a randomized, double-blinded, split-mouth, active-controlled clinical trial. The sample consisted of 122 abutments that were randomly divided into two groups. Group A: Gingival retraction was evaluated in 44 abutments. A single gypsum model was created by matching models before (t0) and after (t1) gingival retraction utilizing exocad software to record gingival horizontal displacement angles. Group B: Hemostatic efficacy was assessed in 78 abutments at t0 and t1. Each group was further divided into two equal sub-groups. Sub-group I: ACIKRC Size 000. Sub-group II: MS. The mean value of gingival horizontal displacement angles in the MS (25.09 ± 15.53) group was higher than the ACIKRC (19.93 ± 10.95) group (p = 0.158). The mean value of gingival bleeding scores in the MS (0.02 ± 0.22) group was significantly lower than the ACIKRC (0.77 ± 0.71) group (p < 0.05) at t1. MS in 0.75 mm thickness without a temporary crown and ACIKC provided similar horizontal gingival retraction abilities. However, MS showed better bleeding control.

Background: Antimicrobial resistance has emerged as a truly serious issue. Motivating the scientific community to explore natural compounds as alternative treatments for infections, with a focus on plant-derived antimicrobials. Objective: The extract of following plants (Pelargonium graveolens, Centaurea hyalolepis, Rosa damascena, Portulaca olereaca) was tested for antibacterial activity. Methods: The bacterial specimens were collected from the Burns unit of Al-Mouwasat university hospital, and isolated by biochemical tests and morphological properties. The herbal ethanolic extracts were prepared by Soxhlet apparatus, and MICs were performed by macrodilution method. Results: we detected five main bacterial strains (Staphylococcus aureus, Staphylococcus epidermis, Klebsiella pneumonia, Pseudomonas aeruginosa, and Escherichia coli) from the collected specimens. The results were variable: P. graveolens showed lowest MIC for S. aureus (62.5µg/ml). P.graveolens and C.hyalolepis had lowest MIC for S. epidermis (31.25µg/ml). The previous extracts showed equal MIC against E. coli (62.5µg/ml), except P. olereaca had MIC 125µg/m, While C. hyalolepis, R. damascena had less MIC (62.5µg/ml) against P. aeruginosa. Finally, C. hyalolepis was most effective against K. pneumonia and the MIC was (62.5µg/ml). Conclusion: The results indicate moderate antibacterial activity against bacterial strains, suggesting that these plants could help us develop new medications for healing burns, in addition to their skin regenerative properties.