Background Sleep quality significantly impacts cognitive function and mental health, yet medical students globally report high rates of sleep disturbances. This cross-sectional study investigates the prevalence of poor sleep quality and its associations with mental health and academic performance among medical students in three Syrian universities. Methods An online survey was administered to 722 medical students from Kalamoon University, Al Sham Private University, and Syrian Private University. Validated tools, including `assessed sleep quality and psychological distress. Academic performance was measured via self-reported GPA. After exclusions, 682 participants were analyzed using SPSS v27, with chi-square tests and regression models (α = 0.05). Results Poor sleep quality (PSQI ≥ 5) was prevalent in 83.3% of participants, with significant variations across universities (p = 0.011). Sleep quality correlated with academic year (p = 0.037), physical inactivity (p = 0.001), unhealthy diet (p = 0.001), smoking (p = 0.001), and low academic attendance (p = 0.001). Poor sleepers exhibited higher depression (p = 0.001), anxiety (p = 0.001), and stress (p = 0.001) scores. No direct association emerged between sleep quality and GPA (p = 0.8). Preparatory-year students (OR = 0.355, p = 0.009), those with severe depression (OR = 0.537, p = 0.023), and severe stress (OR = 0.493, p = 0.034) were likelier to be low academic achievers. Conclusion Poor sleep quality is alarmingly high among Syrian medical students and strongly linked to mental health challenges and modifiable lifestyle factors. Academic performance (GPA) showed no direct relationship with sleep quality, stress and depression .Targeted interventions promoting sleep hygiene, physical activity, and mental health support are urgently needed. Further longitudinal studies should explore causal pathways and cultural influences on sleep behaviors.

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.

Introduction: Allergic bronchopulmonary mycoses, primarily from Aspergillus fumigatus, complicate asthma and cystic fibrosis, presenting diagnostic challenges due to overlapping respiratory symptoms. Case presentation: A 48-year-old male with asthma and a history of Guillain-Barré syndrome presented with cough, chest pain, dyspnea, and weight loss. He was diagnosed with allergic bronchopulmonary aspergillosis after a series of investigations, including CT scans and bronchoscopy. Clinical discussion: Allergic bronchopulmonary aspergillosis (ABPA) is a rare lung disease caused by an immune reaction to Aspergillus fungi in individuals with pre-existing respiratory conditions like asthma or cystic fibrosis. The primary treatment for ABPA involves systemic corticosteroids, often combined with antifungal agents, to reduce the need for long-term high-dose steroid therapy. Conclusion: This case highlights the need for accurate and early diagnosis of ABPA, especially in patients with asthma or other respiratory diseases, which helps prevent potential complications. Additionally, the case provides valuable insights into how to manage patients with ABPA, contributing to the improvement of protocols and medical care in the future.

Introduction and importance: Multiple endocrine neoplasia type 2A (MEN2A) is a rare condition that combines three different tumors: pheochromocytoma, medullary thyroid cancer and hyperparathyroidism. Genetic testing is usually the standard method of diagnosis; however, financial limitations in this case led us to forego the genetic test and rely on clinical findings. Presentation of case: A 28-year-old female presented to the surgery department with episodes of hypertension, blurred vision, redness of hands, and excessive sweating. Computed tomography confirmed multiple adrenal tumors. Combined with medullary thyroid cancer that was demonstrated in a fine needle aspiration from thyroid nodule and elevated parathyroid hormone in laboratory investigation, the diagnosis of MEN2A was made. Then the patient underwent an adrenal gland excision. This case is an interim report, but we did have a follow-up plan. Clinical discussion: A rare autosomal mutation causes MEN2A. Our patient exhibited numerous clinical manifestations of this rare condition, which led us to forego the genetic testing and make the diagnosis in order to decide the proper procedures to treat the patient’s symptoms. This maneuver was necessary because of limitations due to resource constraints in diagnosis and treatment. Following that, a noticeable change in quality of life was what we aimed for, such as the absence of headaches and episodes of hypertension, sweating, and palpitations. Conclusion: This case demonstrates the need for confirming clinical criteria that consider the financial difficulties of low-income countries in order to diagnose MEN2A, which, therefore, will result in effective treatment of this case.

Introduction: Bietti crystalline dystrophy (BCD) is a rare, inherited eye disease that causes progressive damage to the back of the eye (chorioretinal atrophy), characterized by sparkling crystals in the cornea and retina. Case presention: A 30-year-old man presented with gradual vision loss in both eyes. Fundus photography revealed retinal crystals and retinal pigment epithelium atrophy, consistent with BCD. Enhanced depth imaging optical coherence tomography confirmed retinal and choroidal abnormalities, supporting the diagnosis. Genetic testing was not performed due to financial constraints. Clinical discussion: Subretinal rAAV2/8-hCYP4V2 gene therapy for BCD is safe and effective, but COVID-19 or AAV8 antibodies may hinder its efficacy. VFQ-25 correlates with visual acuity improvement. Hypertriglyceridemia and hypercholesterolemia were observed as potential side effects. Conclusion: Health care professionals should be vigilant in recognizing rare eye diseases like BCD, even in uncommon regions. Further research is crucial to understand BCD, develop treatments, and improve the quality of life for affected individuals.

Introduction: A paraganglioma is a rare neuroendocrine neoplasm that may develop at various body sites (including the head, neck, thorax, and abdomen). It is a benign tumor, but in rare cases, it can metastasize to other parts of the body. In less than 30%, this tumor secretes catecholamines. Norepinephrine is dominant in extra-adrenal asymptomatic cases, or its symptoms include headaches, hypertension, or sympathetic paraganglia. The tumor may cause palpitations, excessive sweating, and anxiety. Usually, laboratory tests such as catecholamine tests and imaging tests are used to diagnose it .Surgery is the most common treatment, but there are other treatment options, including radiation therapy, chemotherapy, or targeted therapy. Case presentation: We present a 37-year-old female with parietal chest pain, exertional dyspnea, palpitations, and left neck swelling, found to have metastatic paraganglioma diagnosed via biopsy. The patient underwent surgery to remove the tumor, resulting in significant symptom improvement without complications. Clinical discussion: Paragangliomas (PGLs) are neuroendocrine tumors found in ganglia, with head and neck PGL (HNPGL) making up 65–70% of PGL cases. Most HNPGLs are benign, but 6–19% can metastasize, complicating diagnosis and surgical removal due to vascular challenges and potential complications like Horner syndrome and CN damage. Conclusion: Paragangliomas can cause varied symptoms, sometimes mimicking other conditions. Rarely, carotid body tumors may metastasize, potentially explaining atypical symptoms alongside classic ones.