Damascus University

Future tools for supporting collaborations between technology and sustainable development include artificial intelligence (AI) applications in sustainable Urbanization roles. This article highlights the various applications of AI in advancing sustainable urbanization. From urban planning to disaster management, AI technology is revolutionizing the way cities are designed and managed. By leveraging data analytics, machine learning, and predictive modeling, AI is helping city officials make informed decisions, optimize resource usage, and improve quality of life for urban residents. Despite the immense potential of AI in sustainable urban development, there are still challenges and limitations to overcome. We show some of the most significant problems related to these issues. These include issues related to data privacy, algorithm bias, and ethical considerations. Continued research and innovation are needed to address these challenges and ensure that AI technology is used responsibly and effectively in shaping sustainable cities. As a result, AI has the power to transform urban environments and create more sustainable, resilient communities. By harnessing the capabilities of AI, cities can become more efficient, environmentally‐friendly, and prepared for the challenges of the future. It is essential for policymakers, urban planners, and technology developers to work together to harness the full potential of AI in sustainable urbanization and create a better future for all. Proactively addressing these challenges can unlock the full potential of AI in combating sustainable cities and building a sustainable future for all.

Promoting the education of talented and gifted students is a crucial aspect of establishing a strong society focused on scientific knowledge. This praxis article delves into the implementation of strategies in the Syrian Arab Republic to support and identify gifted students, focusing on initiatives such as the Syrian Scientific Olympiad, the National Centre for Distinguished Students, and Academic Programs for Distinguished Students. Data collection methods utilized in this study shed light on the outcomes of these initiatives and measures taken to promote gifted education in Syria. The analysis of this data provides insights into the impact of these programs on gifted students in crisis-stricken regions. The study emphasizes the significant role played by the Distinction and Creativity Agency in nurturing exceptional talents and fostering personal growth. Overall, the support provided to gifted students contributes to cognitive advancement, psychological well-being, and skill development, enhancing their overall well-being and paving the way for successful futures. The government's commitment to supporting gifted education in the Syrian Arab Republic reflects its dedication to promoting talent and creativity in the Arab region.

Paragangliomas are rare neuroendocrine tumors originating from the paraganglia. They are mostly benign, slow-growing, and non-secretory. This report describes a rare case of a catecholamine-secreting paraganglioma located in the pterygopalatine fossa. A 45-year-old man presented with severe hypertension, occipital headache, and facial pain. Imaging revealed a large pterygopalatine mass, initially misdiagnosed as chondrosarcoma. Gamma knife stereotactic radiosurgery was performed, followed by surgical resection via a maxillary swing approach. Histological examination confirmed the zellballen pattern typical of paraganglioma. Post-surgery, the patient’s blood pressure normalized immediately and subsequently. This case highlights the diagnostic challenges of head and neck paragangliomas in atypical locations and underscores the importance of surgical intervention for catecholamine-secreting tumors. Future studies should focus on refining diagnostic protocols and comparing the efficacy of radiosurgery versus surgical resection for these tumors.

Objective In this multicenter retrospective study, we evaluated the prognostic role of blood eosinophil count on clinical outcomes in hospitalized patients with exacerbations of chronic obstructive pulmonary disease (COPD). Methods We included patients aged 20 to 90 years with a COPD diagnosis. Patients were divided into groups with blood eosinophil count ≤300 or >300 cells/μL and then further classified into 1–99, 100–300, or >300 cells/μL. We compared sociodemographic features and clinical outcomes between groups and identified risk factors associated with mortality in hospitalized patients with COPD and blood eosinophil count ≤300 cells/μL. Results In total, 217 patients were included (82% men, average age 64.3±10.3 years). Patients with eosinophil counts ≤300 cells/μL had significantly longer hospital stays, more admissions to the intensive care unit (22.2% vs. 4.3%), and more frequent mechanical ventilation (21.6% vs. 4.3%) than those with eosinophil counts >300 cells/μL. Mortality only occurred in the group with ≤300 cells/μL; patients with COPD who had eosinophil counts >300 cells/μL had significantly better survival rates (17.0% vs. 0%). Conclusion High blood eosinophil counts at admission were associated with improved short-term outcomes. Our findings reveal the importance of considering eosinophil counts in clinical decision-making to manage hospitalized patients with COPD.

The simultaneous occurrence of acute myeloid leukemia (AML) and autoimmune hemolytic anemia (AIHA) is exceedingly rare, with an incidence of less than 1%. We report the case of a 50–year–old patient newly diagnosed with this uncommon combination. This case underscores the complexity and infrequency of this dual diagnosis, highlighting the diagnostic and therapeutic challenges it presents.

Hyperlipidaemia is considered one of the most common risk factors for ischemic heart disease. Severely elevated triglyceride levels may lead to hyperviscosity which may contribute to endothelial dysfunction, tissue ischemia and chylomicronaemia. This case report features a 39-year-old, non-smoker male with a past medical history of hypertension and no family history of coronary artery disease, who presented to the clinic with angina. The electrocardiogram and echocardiogram were normal. Laboratory tests were normal except for severely elevated triglyceride levels. A dobutamine stress echocardiogram was positive, so the patient underwent coronary angiography which revealed normal coronary arteries with slow flow in all of the coronary arteries (TIMI 2 flow grade). The patient was then discharged on high-intensity statin, fenofibrate, isosorbide mononitrate, nebivolol, and was given lifestyle modification instructions. After 3 months the patient came back to the clinic for follow-up. He was in good general condition and symptom free. Laboratory tests (including lipid profile) were within normal limits.

Objectives Endotracheal tube intubation by laryngoscope during general anesthesia is a safe procedure with a few complications. However, it may cause some damage to the oral cavity structures, which leads to postoperative pain and discomfort. Traumatic dental injuries associated with endotracheal tube intubation are one of the most common complications. The study aimed to determine the incidence of traumatic dental injuries during oral-endotracheal tube intubation in general anesthesia among children receiving surgery at the Children’s Hospital in Damascus City during 2022–2023. Methods It was a prospective longitudinal study which investigated the incidence of traumatic dental injuries during oral-endotracheal tube intubation under general anesthesia in 110 children aged 6–12 years old at the University Children’s Hospital in Damascus City in 2022. After ensuring that the child met inclusion criteria and obtained written consent. Each child was examined before, during, and after 12–24 h of entering the operation room. Personal information (gender – age), information related to anesthesia procedures, and some oral cavity characters were collected. Results The incidence of traumatic dental injuries during general anesthesia was 9.1%. Most of them intra-oral soft tissue injuries. The concussion is the most common injury related to teeth damage. In addition, the tongue was the most common-place. There is a correlation between the incidence of traumatic dental injuries and the difficulty of intubation, the number of intubation attempts, Mallampati score ( p < 0.05). Conclusion The anesthesiologist should evaluate the condition of each patient carefully. Document every detail in their record and inform the patient of the possibility of dental damage during the procedures especially in the case that has difficulty intubation.

Objectives This study aimed to evaluate the efficacy of 5% EMLA cream and 8% lidocaine gel in reducing pain during inferior alveolar nerve block (IANB) compared with 20% Benzocaine in children aged 6–10 years. Materials and methods This was a triple‐blinded, randomized, parallel‐group, active-controlled trial with three arms. 45 children were randomly assigned into 3 groups. Group 1: control group, 20% benzocaine gel ( n = 15). Group 2: 8% lidocaine gel ( n = 15). Group 3: 5% EMLA cream ( n = 15). Each topical anesthetic was applied in an amount of 0.3 mL using a cotton swab for 2 min, followed by IANB administration. The following primary outcome measures were considered: pulse rate, the face, legs, activity, cry, consolability (FLACC) behavioral pain assessment scale, and the Wong-Baker FACES pain rating scale. Results The mean score of the FLACC behavioral pain assessment scale in group 2 (2.20 ± 1.86) was slightly higher, but this result was not statistically significant p = (0.806). Regarding the Wong-Baker FACES pain rating scale scores, no statistically significant difference was noted between the study groups p = (0.593). After IANB administration, the mean pulse rate was higher in group 3 (102.40 ± 14.28). However, this difference was not statistically significant p = (0.351). In addition, the mean change of the pulse rate from the baseline to this time point was not statistically significant p = (0.638), indicating a smaller physiologic response to the painful stimulus. Conclusion 8% lidocaine gel was not superior to 20% benzocaine nor 5% EMLA in reducing pain during IANB administration.

This study provides a comprehensive assessment of soil erosion dynamics in the El-Sarout River Watershed, encompassing 598.15 km² within the humid mountainous ecosystems of the eastern Mediterranean. Using the Coordination of Information on the Environment (CORINE) model, integrated with Geographic Information Systems and remote sensing, the research evaluates soil erosion susceptibility across varied landscapes. The CORINE model facilitates the creation of thematic maps essential for understanding soil erosion dynamics, including the Potential Soil Erosion Risk (PSER) and Actual Soil Erosion Risk (ASER) maps. PSER, derived from the Soil Erodibility Index, Erosivity Index, and Slope Index, identifies areas at risk under natural conditions. ASER refines this assessment by incorporating the Land Cover Index, which reflects current land use and management practices. Findings reveal that 18.56% (111.01 km²) of the watershed, particularly in the complex terrain of the southwest and north, faces high erosion risk. Another 11.7% (70.0 km²) exhibits moderate risk, while the majority, 69.74% (417.14 km²), experiences low risk. These results align with field observations of erosion features such as rills and gullies. The study emphasizes the complexity of soil erosion processes, highlighting the interaction between rainfall intensity, vegetation cover, and topography. Contrary to common assumptions, areas with dense vegetation may still be highly susceptible to erosion, particularly in steep regions subject to intense rainfall. The study calls the need for further research to establish negative thresholds for influencing factors and to incorporate rainfall intensity indicators into erosion models, aiming to enhance the precision and efficacy of soil conservation strategies.

Background Few studies are available in the medical literature on the expected benefit of platelet-rich plasma (PRP) injections for osteoarthritis knee, and most of the studies reported improvements in pain, stiffness, and function in mild and moderate degrees of osteoarthritis. There is no study in Syria concerning any data about knee osteoarthritis (KOA). In our study, we aimed to determine the extent of the benefit within 6 weeks of PRP injections in Syrian patients with osteoarthritis of the knee. Methods 310 Syrian patients suffering from osteoarthritis of the knee were injected with PRP at 2-week intervals for 6 weeks. Pain, function, and stiffness were calculated at baseline and after 6 weeks as well as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) tool before the start of treatment, after PRP injections, and after 6 weeks. All patients who were diagnosed with KOA, according to the classification criteria of the American College of Rheumatology, and grade 2 or 3 of Kellgren-Lawrence classification, and who were older than 18 years were included in our study, and exclusion criteria included patients with other rheumatic conditions, chronic liver or kidney disease, and malignancies. Results The age was 55.96 ± 11.29 years, with 58.70% of the sample being female. The majority of patients had OA grades 2 and 3 and were overweight. The PRP injected into each patient differed slightly in the range of 5 ml. There was a reduction in WOMAC scores from the baseline between each category. This is followed by a rise at the 6-week follow-up post the third injection. None of these changes from baseline until 6 weeks post-treatment was statistically significant. The reduction in all scores up until before the third injection was given, but none of these changes from baseline until the follow-up 6 weeks after treatment were statistically significant ( P < 0.001) upon Kruskal–Wallis tests. The greatest improvements were seen in patients with mild OA. A limitation of this study is that the one-center study, the limited follow-up to 12 weeks, lack of a control group. It was important for us to show its importance in the advanced stages of KOA. Further studies with a larger sample size across multiple centers, and the presence of a control group, with multivariate analysis may provide higher-level evidence for the practice. Conclusions There has been no statistically significant decrease in total WOMAC, pain, stiffness, and physical function scores from baseline up until follow-up 6 weeks after treatment. The injections did not completely provide relief for any patient in this study. It must be questioned whether PRP injections are beneficial for patients with grade 3 OA and whether they only be carried out in patients with grade 2 OA. Further larger multicenter studies are needed to determine the efficacy of these injections and which grade of OA patients shall receive the greatest benefit. Conclusion Despite other RCTs showing an improvement, in their setting with their treatment protocol, the results showed a trend of reduction in the WOMAC score. PRP is a safe and promising management option for symptom modification in the setting of knee OA, so it can be recommended in specific cases.

Spigelian hernia is a rare type of abdominal hernia; diagnosis is primarily through computed tomography, which is crucial for accurate diagnosis and planning early surgical intervention to preserve the herniated sac's contents.

Introduction Aphthae are common lesions that occur inside the mouth on the mucous membrane, often associated with various diseases. The causal pathogenesis generally depends on the accompanying condition, but there is usually no serious underlying cause. Case presentation This case report describes a 33-year-old male patient with a 10-year history of recurrent oral ulcers and impaired glucose tolerance. The patient had previously been treated with glucocorticoids, which provided temporary relief. Laboratory tests and immune profiles were normal. After 1 week of treatment with metformin at a dose of 500 mg twice daily, the lesions were relieved, and the patient required further metformin treatment for three years without any recurrence. Discussion Metformin has been shown to have anti-inflammatory effects in preclinical studies, making it a potential treatment option for mucocutaneous manifestations. This case report highlights the clinical effectiveness of metformin in treating oral ulcers and suggests its potential as an alternative treatment option for this condition. Conclusion Further studies are needed to confirm the efficacy and safety of metformin in treating mucocutaneous manifestations.

Introduction Inflammatory articular diseases are autoimmune diseases that affect mainly joints, muscles, and systemic organs, leading to a public health challenge for the world. Patient participation in health care is essential, especially regarding chronic or life-threatening diseases. In inflammatory articular diseases, educating patients contributes positively to their psychological well-being, adherence to therapy, global assessment, rate of depression, and functional disability. The overall level of information about these diseases is low among patients living as demonstrated by studies. We aim in our research to assess the knowledge and awareness of these diseases in a sample of the Syrian population. Methods The survey was conducted in Damascus, Syria, between 1 December 2021 and 1 December 2022 on participants. The validity and reliability of the survey were confirmed in a pilot test with 30 participants. After confirmation, participants were directed to the survey to complete questions around socio-demographic data, and knowledge and awareness questions about inflammatory articular diseases. We ranked our participants into five levels: excellent, good, average, bad, and very bad. Fisher’s exact test, and the Chi-squared test for comparison between the groups. Tests are considered statistically significant when P < 0.05. Results A total of 641 participants with a mean age of 28.5 were included. 54.45% of them were female. 50.39% of participants related to the medical field, 23.09% have a family history of inflammatory articular diseases, and 17.94% described themselves as having an inflammatory articular disease. Rheumatoid arthritis was the most frequently reported disease among our study sample participants. Finally, the respondents gave the right answer to a mean of 8.45 statements out of 20 statements. Conclusion More educational programs by healthcare professionals are needed to increase the knowledge and awareness about these diseases in Syria.

Introduction and importance Leukopenia is a condition in which a person has few white blood cells. It should not be considered a disease in itself, but rather a sign of a disease that needs to be further investigated. Leukopenia is a rare complication and is not commonly seen in patients with COVID-19 disease. Here, we report a case of leukopenia in a previously immunocompetent female patient with SARS-CoV-2 infection. Case presentation A 31-year-old woman presented to the emergency department with complaints of fever, fatigue, and dyspnea with a dry cough of 10 days’ duration. Initial laboratory investigations revealed leukopenia. She was diagnosed with severe COVID-19 disease with leukopenia and admitted to intensive care. After 3 years of infection, she is doing well with persistent leukopenia. Clinical discussion Various hematological abnormalities have been reported in COVID-19 disease, including lymphopenia, thrombocytopenia, leukopenia, and hypercoagulability. Possible causes of leukopenia include nutritional deficiencies, megaloblastic anemia, hypersplenism, malignancies, radiotherapy, chemotherapy-induced bone marrow toxicity, connective tissue diseases, and immunosuppressive drugs. Conclusion Leukopenia is a rare complication of COVID-19 disease. We report a case of this manifestation associated with a disease likely caused by bone marrow suppression that persisted for 3 years.

Smith-Lemli-Opitz syndrome (SLOS) is a rare genetic disorder that affects cholesterol synthesis and causes various physical and mental abnormalities. The case is a 25-day-old male infant who presented with multiple congenital anomalies, such as microcephaly, facial dysmorphism, syndactyly, hypospadias, and other organ malformations. He also had severe vomiting, feeding difficulty, irritability, dehydration, and hyponatremia. Laboratory tests showed low serum cholesterol, in addition to genetic tests, confirming the diagnosis of SLOS. The infant was treated with simvastatin, which improved his irritability and was well tolerated. The paper discusses the clinical features, diagnosis, and management of SLOS, and highlights the importance of early recognition and intervention for this rare case. It is also considered the first documented case in Syria.

Background Traumatic dental injuries with tracheal intubation during general anesthesia are considered one of the most common complications. It is also the primary reason for malpractice legal claims against anesthesiologists according to insurance companies. There is much information regarding the incidence, consequences, and risk factors of traumatic dental injuries during general anesthesia. This study aimed to assess the awareness (knowledge, practice, and attitude) of anesthetists regarding peri‐anesthetic traumatic dental injuries and discuss measures to reduce the risk regarding peri‐anesthetic traumatic dental injuries. Materials and Methods Sixty seven anesthetists participated in this cross‐sectional survey between January 2023 and July 2023, which was carried out in the Syrian Arab Republic. The questionnaire was generated using Google Forms and sent individually, as the researcher (MNA) was accompanied by all included anesthesiologists while filling out all the questionnaire paragraphs to answer any questions. The Fisher exact test and Pearson's Chi‐squared test were used to analyze the results. Results The dental trauma caused by the anesthetists during their professional careers was 38.8%, and none of them were exposed to any legal claim. 77.6% of the anesthetists thought that avulsed permanent teeth could be replanted, 46.2% believed that the procedure must be done in < 30 min, and 84.6% thought they could not do it themselves and would send the patient to a dentist after the procedure. More than half of respondents (63.5%) indicated that the sterile saline solution was the best storage medium for avulsed teeth. Furthermore, 74.6% of anesthetists stated that emergency intubations are related to more traumatic dental injuries in comparison with elective intubation and about 62% were aware of the importance of mouthguard. However, nearly 57% complained about the shortage of knowledge related to the oral cavity and its special structure. Conclusions Syrian anesthetists have limited awareness (knowledge, practice, and attitude) of traumatic dental injury classification, prevention, and management. More information and training are still needed about factors used within clinical dentistry.

Introduction and importance Immunoglobulin G4 (IgG4)-related disease is an infrequent systemic condition that affects males more than females. Fatigue, arthralgia, salivary and lacrimal gland enlargement, symptoms of pancreatitis, tubulointerstitial nephritis, and retroperitoneal fibrosis are the frequent manifestations. The spectrum of IgG4-related thyroid disease includes Hashimoto thyroiditis, Graves’ disease, and Riedel thyroiditis. Case presentation We presented a 49‐year‐old male presented with progressive painless swallowing of the neck for a year without any accompanying symptoms. Conclusion Expanding goiter is common, but its severity leads to the rare diagnosis of IgG4-related thyroiditis.

Background: Despite the large number of studies that have been done in this area, there is still a gap in the literature when it comes to comparing the orthodontic tooth movement (OTM) efficacy of Invisalign and fixed orthodontic appliances. The primary objectives of this study were to evaluate and compare the efficacy of Invisalign and fixed orthodontic appliances in terms of the amount and rate of OTM. Specifically, the study aimed to determine if there was a statistically significant difference between these two treatment modalities in achieving OTM and to assess whether treatment duration differs significantly between Invisalign and traditional fixed appliances. This investigation seeks to address the existing gaps in the literature by providing a clear comparison based on recent empirical evidence, thereby contributing to more informed treatment decisions in orthodontic practices. Methodology: Relevant MeSH keywords and Boolean operators were selected by a team of reviewers to search several online databases for papers that were in accordance with the objectives of our review. Results: At the end of the search protocol, 10 studies were deemed to be eligible for inclusion in the review. The pooled analysis revealed a statistically significant reduction in treatment time for patients using Invisalign compared to those with fixed appliances, with a total OR of 0.61 [95% CI 0.43, 0.85]. No significant heterogeneity was detected (I2 = 0%), and the test for overall effect was significant (Z = 2.86, p=0.004). Furthermore, a nonsignificant trend favoring Invisalign was shown, with an odds ratio of 1.43 and a confidence interval that included 1 (0.97, 2.10). The p value was 0.07, and there was negligible heterogeneity among studies, as indicated by an I2 of 0%. Conclusion: Based on the findings from the selected studies, it can be concluded that Invisalign and fixed orthodontic appliances have similar overall efficacy in eliciting OTM. However, Invisalign treatment requires significantly less time to complete than fixed orthodontic appliances. Despite these observations, further studies are required to explore the long-term stability of OTM achieved with Invisalign and fixed orthodontic appliances. Registration and Protocol: Registration was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards (CRD42023405593). The research protocol was created to meet the goals and was properly filed with PROSPERO; however, it has not been prospectively registered.

A BSTRACT Background In many cases, orthodontic treatment is necessary to improve the alignment and functionality of teeth. But there is still uncertainty about how orthodontic equipment may affect periodontal health, especially in individuals who already have periodontal disease. Materials and Methods For this investigation, a total of 50 patients with prior periodontal diseases were chosen. The participants were split into two groups: Group B ( n = 25) was the control group and did not get any orthodontic intervention, whereas Group A ( n = 25) had orthodontic therapy utilizing fixed appliances. At baseline, six months, and twelve months, periodontal health was evaluated using the Plaque Index (PI), Gingival Index (GI), and Clinical Attachment Level (CAL). Paired t-tests and ANOVA were used to assess the significance of time-series changes in the data. Results There was a statistically significant increase in plaque accumulation in Group A, as evidenced by the mean PI increasing from 1.2 ± 0.4 at baseline to 1.5 ± 0.5 at 12 months ( P < 0.05). Additionally, there was a noteworthy rise in the GI, from 1.1 ± 0.3 to 1.4 ± 0.4 ( P < 0.05). Though there was a modest drop in the CAL from 3.5 ± 0.8 mm to 3.4 ± 0.7 mm, it was not statistically significant ( P > 0.05) and remained very steady. Group B, on the other hand, showed no appreciable variations in PI, GI, or CAL during the course of the investigation. Conclusion Patients receiving orthodontic treatment who already have periodontal disease tend to be more prone to plaque buildup and gingival irritation. Nonetheless, the clinical attachment levels can be sustained for the duration of the treatment with proper periodontal maintenance.