Tishreen University

This study was conducted in the Kassab area in Lattakia to examine the effect of spraying apple trees with marine algae extract, potassium, and boron. It dealt with eight factors: spraying with potassium (0.5%), boron (0.2%), marine algae extract, mixing potassium and boron, potassium and algae, algae, potassium, and boron, and with water only. The complete randomized design was used covering 24 trees with each transaction having 3 trees with one repeater tree. Averages were compared by the GenStat program and the lowest moral extent. The leaf content of nutrients and chlorophyll was significantly affected. The findings showed an increase in the ratios of nitrogen-phosphorus-potassium-calcium-magnesium-boron and total chlorophyll in the leaves. The nitrogen content of the leaves increased significantly by 2.447% when sprayed with marine algae extract for an average of two years compared to 1.63%. The marine algae extract treatment offered the highest phosphorous at 2.447%. The treatment with boron, potassium and marine algae outperformed the others for the two years at 1.203% and 1.293%, respectively. The boron treatment gave a significant effect over the others at 0.551%. The interaction between boron, potassium and marine algae showed remarkable improvement over the rest with the boron content in the leaves reaching 46.21 pm. For leaf chlorophyll content, the mixing treatment of potassium and boron outweighed the rest at 2.22 mg/g compared to the 1.29 mg/g for the control and exceeded that for marine algae extract of 2.30 mg/g while the control had 1.41 mg/kg. Total chlorophyll content for the boron and potassium was highest at 4.25 mg/g compared to the control (2.70 mg/g)

Prion diseases are rare, fatal neurodegenerative disorders caused by misfolded proteins. Sporadic Creutzfeldt–Jakob Disease (sCJD) is the most common form and develops without any identifiable triggers. This case report documents the first probable diagnosis of sCJD in Syria, involving a 72-year-old woman who presented with depressive symptoms for several months before rapidly deteriorating, and eventually succumbing to complications of the disease. Clinical examination findings, exclusion of CJD-mimicking conditions, and specific MRI findings, supported the diagnosis in the absence of biochemical tests or postmortem confirmation. This report emphasizes the challenges of diagnosing prion diseases in resource-limited settings and calls for the development of national surveillance systems in low- and middle-income countries to aid early detection, monitor the global disease burden, and reduce the risk of outbreaks. Raising awareness of prion diseases among physicians in such contexts is crucial for improving disease recognition.

Background Chronic kidney disease (CKD) poses a growing burden in Palestine’s West Bank; however, public awareness remains unassessed. This study evaluated the knowledge of kidney function, CKD risk factors, symptoms, prevention, and treatment among Palestinians and identified the predictors of awareness. Methods An online cross-sectional survey of 592 adults (≥18 years) was conducted in 11 West Bank cities (August–September 2024). A validated Arabic questionnaire was used to assess sociodemographic characteristics and CKD knowledge. Reliability was confirmed through pilot testing. Univariate and multivariate logistic regression analyses were used to identify predictors of high knowledge (≥70% score threshold). Results Only 35.135% of the respondents had attended CKD seminars. Attendees exhibited significantly higher overall knowledge than non-attendees (70.673% vs. 38.021%, p < 0.001). Key gaps included knowledge of kidney metabolic functions (31.250% vs. 17.708%), CKD stages (36.058% vs. 10.677%), and medication-based treatment (75.962% vs. 62.760%). Regression revealed higher odds of high knowledge among seminar attendees (aOR = 4.00, 95% CI: 2.82–5.67), adults >50 years (aOR = 5.56, 95% CI: 3.12–9.91), and females (aOR = 1.65, 95% CI: 1.05–2.59). Social media (25.636%) and academic materials (28.390%) were the primary information sources. Conclusion CKD knowledge gaps are prevalent in the West Bank, particularly regarding early symptoms and non-dialysis treatment. Educational seminars significantly improve awareness, but their reach remains limited. Future interventions should prioritize accessible community-based education, digital campaigns targeting youth, and screenings for high-risk groups. Further research should explore barriers among older populations and evaluate targeted awareness initiatives to address these issues.

Introduction and importance:Bilateral oophorectomy in females is rarely performed in the pediatric population due to its serious physical and mental long-term consequences on both the patients and their parents, which make it very complicated to manage.Case presentation:A 13-year-old female was referred to our pediatric clinic for evaluation of short stature and the absence of secondary sexual characteristics. As part of her past medical history, she underwent a bilateral oophorectomy that was performed along with a bilateral hernia repair at the age of 40 days due to misdiagnosis as complete androgen insensitivity syndrome (CAIS). The patient was initially started on transdermal hormonal replacement therapy and then replaced by oral treatment. A follow-up was planned every 6 months with a good response to the treatment regarding the development of secondary sexual characteristics and the satisfactory final height.Clinical discussion:The girl underwent bilateral oophorectomy after a misdiagnosis of CAIS without proper diagnostic procedures, leading to medicolegal and ethical issues. Karyotyping is necessary for the diagnosis of CAIS. The adolescent received hormonal replacement therapy and had a follow-up of her growth and sexual development. The concept of oocyte donation was also discussed with the family.Conclusion:Performing a karyotype and a complete hormonal workup is essential in any suspicion of CAIS in a phenotypically female infant to avoid making such an error. Performing the gonadectomy after sexual maturation is achieved in CAIS patients.

Ocular adnexal lymphoma is considered an uncommon disease, but it is among the most common malignancies affecting the ocular adnexa. While diffuse large B-cell lymphoma constitutes 10% of ocular adnexal lymphomas, the initial presentation with bilateral eyelid swelling is quite rare and can be diagnostically challenging. Here, we report a case of a 64-year-old Middle Eastern male patient with no prior history of malignancy who presented with a 5-month history of bilateral upper eyelid swelling, mild enophthalmos, and ptosis. The patient had no systemic symptoms. The masses were surgically resected, and histopathological examination confirmed the diagnosis of diffuse large B-cell lymphoma. Following surgical resection, the patient developed submandibular and parotid gland enlargements. Subsequent contrast-enhanced computed tomography scan revealed an enhancing mass posterior to the descending aorta. The patient received six cycles of rituximab, cyclophosphamide, hydroxydaunorubicin, vincristine, prednisone regimen. Despite the aggressive nature of diffuse large B-cell lymphoma, clinical remission has been achieved. Follow-up positron emission tomography revealed no residual disease. Bilateral eyelid swelling is a rare initial sign of aggressive lymphoma, such as diffuse large B-cell lymphoma, even in the absence of systemic symptoms. Clinicians should consider malignancy in such atypical presentations to ensure early diagnosis and treatment.

<title>Abstract</title> Healthcare fraud and abuse remain a major global challenge, costing billions annually and threatening the sustainability of insurance systems. Traditional manual and rule- based approaches are increasingly ineffective given the scale, complexity, and adaptability of fraudulent schemes. This study develops and validates a data-driven framework leveraging ma- chine learning (ML) to detect fraudulent health insurance claims. Using a large, publicly available dataset, we applied rigorous preprocessing, including feature engineering to create domain- specific predictors and SMOTE resampling applied strictly to the training set to prevent data leakage. Five supervised al- gorithms—Logistic Regression, Decision Tree, SVM, Random Forest, and XGBoost—were compared against a stacking en- semble that combined Random Forest, XGBoost, and Logistic Regression. Performance was evaluated through stratified 10- fold cross-validation using Accuracy, F1-score, and AUC-ROC. Results show that the ensemble model achieved the best and most balanced performance (F1 = 0.81, AUC = 0.95), significantly outperforming individual classifiers. Feature importance analysis further revealed that the model identified clinically meaningful fraud indicators, such as diagnostic diversity and provider claim frequency. These findings highlight the potential of scalable, open- source ML frameworks to strengthen fraud detection, reduce financial risks, and complement commercial detection tools with cost-effective, interpretable solutions.

Hepatoid adenocarcinoma of the lung (HAL) is a rare and aggressive subtype of pulmonary adenocarcinoma, with cutaneous metastasis being an uncommon clinical manifestation. A 49-year-old male presented with a painful, nodular skin lesion on the upper back. Histopathological examination confirmed it as a cutaneous metastasis of HAL. Subsequent imaging revealed a large primary tumor in the left lung and widespread metastatic disease. Remarkably, the skin lesion was the initial and only presenting feature. This case illustrates the variable clinical presentation of HAL and underscores the need for thorough evaluation of atypical skin lesions.

Despite the high burden and regional variability of ovarian cancer (OC), data on its status in Syria, a country impacted by long-standing conflict, remain scarce. This study aimed to provide the first nationwide analysis of OC epidemiological and clinicopathological characteristics. In this national, multicenter, retrospective cross-sectional study, we collected data from three tertiary referral university hospitals in Syria: Tishreen University Hospital, Al-Bairouni University Hospital, and Ibn Rushd Hospital. The inclusion period spanned from 2017 to 2021. All included patients were 18 years or older and had a newly diagnosed, confirmed primary OC. Data collected included sociodemographic information, presenting symptoms, CA-125 levels, and treatment details. A total of 531 patients with OC with a mean age of 53.1 years (range: 18-91) were included in the study, representing 1.2% (95% confidence interval: 1.1%-1.3%) of the 44,248 patients diagnosed with all types of cancer. Serous carcinoma (55.4%) was the most common OC subtype, followed by mucinous (13.8%) and endometrioid carcinoma (9.7%). Among epithelial OCs, having high levels of CA-125 was associated with higher odds of serous carcinoma (adjusted OR: 2.30, 95% CI: 1.08-4.91) and lower odds of endometrioid cancer adjusted OR: 0.21, 95% CI: 0.08-0.54). Abdominal bloating was the most frequently reported symptom, affecting 194 patients (36.5%). Our study revealed a lower proportion of OCs diagnoses among all cancer cases compared to global and regional data which may be attributed to underreporting, influenced by the disease's specific characteristics and presence of more barriers for women to healthcare access in Syria's conflict-affected setting. Given the study's limitations, further research is essential to provide a more comprehensive assessment of the OC burden in Syria.