Post-traumatic stress disorder in adult victims of cluster munitions in Lebanon: a 10-year longitudinal study

Magnitude and factors associated with post-traumatic stress disorder among war-affected internally displaced people in northwest Ethiopia, 2022

Background

A large number of people are often directly involved in armed conflict and, therefore, are at greater risk of developing a wide range of mental disorders, including post-traumatic stress disorder. Despite this, few have been reported about it in low- and middle-income countries, including Ethiopia.

Objective

This study was carried out to assess the magnitude and factors associated with post-traumatic stress disorder among war-affected internally displaced people in northwest Ethiopia, 2022.

Methods

Cross-sectional study design was conducted from May 23 to June 22, 2022, and simple random sampling was used to select a sample of 412 participants. Data were collected by structured interviewer-administered questionnaires. The post-traumatic stress disorder checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition with extended criteria-A was used to assess post-traumatic stress disorder. Multivariable logistic regression analysis was done to identify factors associated with post-traumatic stress disorder.

Results

A total of 412 participants were interviewed with the response rate of 100%. The mean age of the respondents was 34.7 (±10.9) years. The prevalence of post-traumatic stress disorder was found to be 60.98% (95% CI: 56.1%, 65.5%) with an estimated prevalence of 23.5% and 76.5% among males and females, respectively. In multivariable analysis, female sex (AOR = 2.39; 95% CI: 1.48, 3.86), having depression (AOR = 2.86; 95% CI: 1.78, 4.60), family history of mental illness (AOR = 3.67; 95% CI: 1.43, 9.42), and poor social support (AOR = 3.61; 95% CI: 1.74, 7.47) were factors significantly associated with post-traumatic stress disorder at p-value < 0.05.

Conclusion and recommendation

Based on this study, at least 6 out of 10 war-affected populations have experienced post-traumatic stress disorder. Especially females, those who had depression, family history of mental illness, and poor social support, were more vulnerable to post-traumatic stress disorder. Therefore, it is recommended to do on-site screening and provide treatment for all displaced populations suffering from post-traumatic stress disorder by giving special concern for females, individuals having depression, poor social support, and family history of mental illness.

Long-term burden of war injuries among civilians in LMICs: case of the July 2006 war in Lebanon

Introduction

Lebanon, a country located on the eastern shore of the Mediterranean Sea, is one of the world's smaller sovereign states. In the past few decades, Lebanon endured a perpetual political turmoil and several armed conflicts. July 12, 2006, marked the start of a one-month war in Lebanon, which resulted in thousands of casualties. Little is known about the long-term consequences of war injuries inflicted on civilians during the July 2006 war.

Methods

The objectives of this paper were to identify and evaluate: 1- civilians' access to healthcare and medicine under conditions of war; 2- the long-term socioeconomic burden on injured civilians; and 3- their quality of life more than a decade post-war. We adopted a mixed-method research design with an emphasis on the qualitative component. We conducted interviews with patients, collected clinical and financial data from hospital medical records, and administered a self-rated health questionnaire, the EQ-5D-5L. Simple descriptive statistics were calculated using Excel. NVivo 12® was used for data management and thematic analysis.

Results

We conducted 25 interviews. Injured civilians were mostly males, average age of 27. The most common mechanism of injury was blast injury. Most patients underwent multiple surgeries as well as revision surgeries. The thematic analysis revealed three themes: 1- recall of the time of the incident, the thousand miles journey, and patients' access to services; 2- post-trauma sequelae and services; and 3- long-term impact. Patients described the long-term burden including chronic pain, poor mobility, anxiety or depression, and limited activities of daily living.

Discussion

Civilians injured during the July 2006 war described the traumatising events they endured during the war and the limited access to medical care during and post-war. Up until this study was conducted, affected civilians were still experiencing physical, psychological, and financial sequelae. Acknowledging the limitations of this study, which include a small sample size and recall bias, the findings underscore the necessity for the expansion of services catering to civilians injured during wartime.

The risk of eating disorders following the August 4th, 2020 explosion in Beirut and its relationship with trauma exposure and PTSD symptoms

INTRODUCTION

To date, no study has demonstrated the link between the diagnosis of provisional PTSD and ED in people exposed to the explosion of August 4th, 2020.

METHODS

Online participants were classified into 4 categories according to the degree of exposure to the explosion (unexposed, slightly exposed, moderately exposed, and severely exposed). The screening for ED was done using the standardized SCOFF questionnaire and the screening for provisional PTSD using the standardized IES-R questionnaire.

RESULTS

Our sample included 703 participants. In the bivariate analysis, there was a trend for an association between degree of exposure to the explosion and the risk of development of an ED (p = 0.055). The independent variables included in the multivariate analysis that were statistically associated with a risk of developing eating disorders are secondary school as the highest level of education (p = 0.029; OR = 2.15) and the risk of PTSD (p = 0.041; OR = 2.05) according to IES-R, specifically hyperarousal (p = 0.028; OR = 1.07) as a symptom cluster. Provisional PTSD played a mediating role, creating a partial and indirect relationship between the degree of exposure to the explosion and the risk of developing ED with a β coefficient of 0.075 (p < 0.001) CONCLUSION: The risk of PTSD according to IES-R was found to be a determinant of a higher risk of developing ED among participants exposed to the explosion in addition to mediating between the effect of exposure severity and the risk of ED. It is essential to fully assess and manage PTSD symptoms and ED patients exposed to such a psychological trauma.

University students' experience of the Beirut port explosion: associations with subjective well-being and subjective symptoms of mental strain

BACKGROUND

On 4 August 2020, an explosion shook Beirut, killing more than 200 people and leaving thousands injured or homeless.

AIMS

This study examined mental health of university students through a cross-sectional online survey between December 2020 and January 2021.

METHODS

The questionnaire consisted of the WHO-5, sense of coherence (SoC), future anxiety, self-developed subjective symptoms of mental strain (SSMS), and items assessing proximity to explosion, extent of injury and house damage. Gender, study level and social status were used as sociodemographic characteristics.

RESULTS

Of 1042 participants, 30.8% were at 0-7 km from explosion; 38.1% reported physical injuries; and 12.4% saw their home damaged. Two third (60.3%) reported ≥3 SSMS, and 73.4% reported low well-being. Students with low well-being were more often female and master students (p < 0.001). Females were more often affected by ≥3 SSMS (p < 0.001). Regression analysis with low well-being as dependent variable revealed significant associations with study level (OR: 2.30-2.94), future anxiety (OR: 2.72-4.34) and SoC (OR: 1.81-5.61). For ≥3 SSMS, females (OR: 3.09), moderate/very close distance (OR: 2.13-4.98), injury/death of family member or friend (OR: 2.07-2.06), house damage (OR: 1.72) future anxiety (OR: 1.97-3.11) and SoC (1.79-2.88) were significant predictors.

DISCUSSION

Preventive mental health strategies that strengthen SoC and outlook on future could protect against SSMS and low well-being following major trauma.

Findings From the World Mental Health Surveys of Civil Violence Exposure and Its Association With Subsequent Onset and Persistence of Mental Disorders

Importance

Understanding the association of civil violence with mental disorders is important for developing effective postconflict recovery policies.

Objective

To estimate the association between exposure to civil violence and the subsequent onset and persistence of common mental disorders (in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV]) in representative surveys of civilians from countries that have experienced civil violence since World War II.

Design, Setting, and Participants

This study used data from cross-sectional World Health Organization World Mental Health (WMH) surveys administered to households between February 5, 2001, and January 5, 2022, in 7 countries that experienced periods of civil violence after World War II (Argentina, Colombia, Lebanon, Nigeria, Northern Ireland, Peru, and South Africa). Data from respondents in other WMH surveys who immigrated from countries with civil violence in Africa and Latin America were also included. Representative samples comprised adults (aged ≥18 years) from eligible countries. Data analysis was performed from February 10 to 13, 2023.

Exposures

Exposure was defined as a self-report of having been a civilian in a war zone or region of terror. Related stressors (being displaced, witnessing atrocities, or being a combatant) were also assessed. Exposures occurred a median of 21 (IQR, 12-30) years before the interview.

Main Outcomes and Measures

The main outcome was the retrospectively reported lifetime prevalence and 12-month persistence (estimated by calculating 12-month prevalence among lifetime cases) of DSM-IV anxiety, mood, and externalizing (alcohol use, illicit drug use, or intermittent explosive) disorders.

Results

This study included 18 212 respondents from 7 countries. Of these individuals, 2096 reported that they were exposed to civil violence (56.5% were men; median age, 40 [IQR, 30-52] years) and 16 116 were not exposed (45.2% were men; median age, 35 [IQR, 26-48] years). Respondents who reported being exposed to civil violence had a significantly elevated onset risk of anxiety (risk ratio [RR], 1.8 [95% CI, 1.5-2.1]), mood (RR, 1.5 [95% CI, 1.3-1.7]), and externalizing (RR, 1.6 [95% CI, 1.3-1.9]) disorders. Combatants additionally had a significantly elevated onset risk of anxiety disorders (RR, 2.0 [95% CI, 1.3-3.1]) and refugees had an increased onset risk of mood (RR, 1.5 [95% CI, 1.1-2.0]) and externalizing (RR, 1.6 [95% CI, 1.0-2.4]) disorders. Elevated disorder onset risks persisted for more than 2 decades if conflicts persisted but not after either termination of hostilities or emigration. Persistence (ie, 12-month prevalence among respondents with lifetime prevalence of the disorder), in comparison, was generally not associated with exposure.

Conclusions

In this survey study of exposure to civil violence, exposure was associated with an elevated risk of mental disorders among civilians for many years after initial exposure. These findings suggest that policy makers should recognize these associations when projecting future mental disorder treatment needs in countries experiencing civil violence and among affected migrants.

The Relationship Between Spirituality and Post-Traumatic Stress Symptoms in Syrian Adolescents in Jordan

The civil war in Syria began in 2011 and escalated over years resulting in one of the largest humanitarian crises since the Second World War. Injury, loss, poverty, and immigration trapped the Syrian population in a diversity of psychological disorders, including post-traumatic stress disorder (PTSD). Spirituality has, on the other hand, been consistently reported as a resilient factor against developing mental disorders. Hence, spirituality or religiosity have been incorporated in clinical and psychotherapeutic practice for several mental disorders. We explored the association between spirituality and the development of PTSD symptoms among Syrian refugee adolescents in Jordanian schools. A sample of 418 Syrian adolescent students (age range between 12-16 years) from Jordanian schools in the northern part of the country were enrolled in the study after informing on study context and objectives. The study questionnaire included sample demographics, smoking status, PTSD checklist - Civilian Version (PCL-C), two spirituality-targeting questions, and trauma and loss history. `Almost half of participants (N = 196) showed moderate PTSD symptoms while around 30% (N = 124) had a severe level of PTSD symptoms. On the other hand, 3 out of four students perceived themselves as highly spiritual. The study resulted in a positive correlation between belief in God and God's thankfulness. Furthermore, increased spirituality level did not appear to lower the risk of developing PTSD symptoms. Spiritual self-perception of Syrian refugee adolescents showed neither protective nor aggravating effect of on the occurrence of post-traumatic stress symptoms. Additional research and more accurate tools are needed to assess the potential impact of spiritual/religious values towards PTSD symptoms among adolescents.

Rate and correlates of post-traumatic stress disorder (PTSD) following the Beirut blast and the economic crisis among Lebanese University students: a cross-sectional study

BACKGROUND

Post-traumatic stress disorder (PTSD) is a mental illness that develops in some people after they have experienced a stunning, scary, or dangerous incident. Due to major disasters like as the Economic Crisis and the Beirut Blast, Lebanese people are struggling with a variety of mental health issues. The study objectives were to find the rate of PTSD and its association with stress, anxiety, depression, financial well-being and coping strategies among university students in Lebanon.

METHODS

This is a cross-sectional study, conducted between May and August 2021, which enrolled 419 university students from all districts of Lebanon. The PTSD Checklist-Specific Version (PCL-S) was used to evaluate manifestation of PSTD.

RESULTS

The results showed that 132 (31.5%), 109 (26.0%) and 169 (40.3%) had PTSD from COVID, Beirut blast and economic crisis respectively. More avoidant coping (Beta = 0.52) and more anxiety (Beta = 0.62) were significantly associated with more PTSD from the Beirut Blast. More avoidant coping (Beta = 0.56), depression (Beta = 0.40) and anxiety (Beta = 0.49) were significantly associated with more PTSD from the economic crisis, whereas more financial wellbeing (Beta = - 0.31) was significantly associated with less PTSD from the economic crisis.

CONCLUSION

Significant rates of PTSD were found in our sample of Lebanese university students, whether from the Beirut blast, or from the current economic crisis. Significant correlations of these PTSD rates were found with factors such as avoidant coping, depression, anxiety and financial wellbeing. Such findings must raise the attention to serious mental and psychosocial alteration endured by Lebanese youth that are still under fatal cumulative traumatic events, that were and even may be, intergenerationally and unintentionally transmissible, therefore, affecting not only the present, but also the future of a whole nation.

About Six in Ten Survivors of the November 2020 Maikadra Massacre Suffer from Posttraumatic Stress Disorder, Northwest Ethiopia

BACKGROUND

Post-traumatic stress disorder (PTSD) is characterized by recurrent, involuntary, and intrusive distressing memories of a traumatic event and dissociative reactions. Little is known about post-traumatic stress disorder in low and middle income countries such as Ethiopia where armed conflict, human rights violations, and ethnic-based violence are becoming everyday occurrences.

OBJECTIVE

This study aimed to assess the prevalence of post-traumatic stress disorder and associated factors among residents of Maikadra, North West Ethiopia.

METHODS

A community-based cross-sectional study was employed in April 2021. A multi-stage cluster sampling technique was employed to select the study participants. A post-traumatic stress disorder checklist (PCL-5) was used to assess post-traumatic stress disorder through a face-to-face interview. Bivariate and multi-variable binary logistic regression analyses were carried out to examine the association between posttraumatic stress disorder and several demographic and psychosocial variables. Statistical significance was declared at a P-value <0.05.

RESULTS

A total of 610 participants were interviewed with a response rate of 98.8%. The prevalence of PTSD in this study was 59.8% with a 95% CI of 55.7-63.9. Female sex (AOR=1.93, 95% CI=1.64-3.24), having a close family member killed or seriously injured (AOR=1.96, 95% CI=1.1-3.48), having moderate (AOR=3.35, 95% CI=1.98-5.68) and high perceived threat to life (AOR=3.66, 95% CI=1.85-6.95), having depression (AOR=1.67, 95% CI=1.13-2.47) and anxiety disorder (AOR=1.85, 95% CI=1.21-2.83), and being directly exposed to the event (AOR=3.27, 95% CI=1.09-9.83) were significantly associated with post-traumatic stress disorder.

CONCLUSION

The majority of the residents of Maikadra town where the November 2020 massacre took place experienced posttraumatic stress disorder. Female sex, having a family member or a friend murdered or seriously injured, having depression and anxiety disorders and being directly exposed to the trauma were found to be significant predictors of post-traumatic stress disorder. People who have been exposed to such an intense traumatic event need psychosocial support to help them recover from the horrible experiences.

A Generation at Risk: The Impacts of Lebanon's Escalating Humanitarian Crisis on Children

Lebanon is in the midst of a rapidly escalating, unprecedented humanitarian crisis that is plunging the country deep into poverty and threatens population well-being, economic development, social welfare and national and regional stability. The dire situation is due to the compounding effects of the August 2020 Beirut blast, massive economic collapse and the COVID-19 pandemic, in a setting of longstanding entrenched political corruption and a dysfunctional, mismanaged crisis response by the state. This current emergency occurs on the background of a turbulent history and complex regional geopolitical context – including the Syrian refugee crisis, the ongoing influence of foreign actors and their local proxies, the United-States-imposed sanctions, endemic corruption, a culture of nepotism and entitlement among the political dynasties, dysfunctional power-sharing and deep-seated sectarian divides. With over half the population now living in poverty, a generation of children are among those at risk. This Perspective provides a brief overview of Lebanon's current complex humanitarian crisis, discusses the impacts of the evolving situation on youth and proposes a suite of recommendations to mitigate the effects.

Prevalence and associated factors of post-traumatic stress disorder in Lebanon: A literature review

Lebanon has been under continuous conflict for more than four decades, putting millions of Lebanese at a high risk for post-traumatic stress disorder (PTSD) and creating a complex collective trauma. This paper aimed to review all studies from Lebanon reporting on PTSD in order to describe the prevalence of PTSD and its associated risk factors among Lebanese adults. A search of the MEDLINE/PubMed database was conducted in February/March 2021 to identify research articles on PTSD in Lebanese adults. A total of 1064 articles were identified, out of which 11 articles (5875 participants) published between 2003 and 2020 were included. PTSD prevalence estimates were highly variable across the individual studies, ranging from 2 % to 98 %. Female sex, economic hardship, lower educational level, being unemployed, number of witnessed/experienced traumatic events, and presence of comorbid psychological disorders were associated with higher PTSD rates. In light of the increasing PTSD risk in the Lebanese population as a result of the recent Beirut blast and ongoing social and economic crises, further culturally competent research is needed to provide rigorous evidence on the prevalence, course, and severity of PTSD in Lebanon.

Long-term impact of COVID-19 associated acute respiratory distress syndrome

Objectives

To determine the health status, exercise capacity, and health related quality of life (HRQoL) of COVID-19 associated acute respiratory distress syndrome (ARDS) survivors, 8 months after diagnosis.

Methods

All eligible patients were interviewed and underwent a physical examination, chest X-ray, and 6 min walk test (6MWT). Scales to evaluate post-traumatic stress disorder, depression, anxiety, and HRQoL were applied.

Results

Of 1295 patients, 365 suffered ARDS and 166 survived to hospital discharge. Five died after discharge and 48 were lost to follow-up. Of the 113 remaining patients, 81% had persistent symptoms. More than 50% of patients completed less than 80% of the theoretical distance on the 6MWT, 50% had an abnormal X-ray and 93% of patients developed psychiatric disorders. Mean SF-36 scores were worse than in the general population. After multivariate regression analysis, female sex, non-Caucasian race, and Charlson index>2 were independent risk factors for a worse mental health component summary score on the SF-36, and age was associated with a better prognosis. Female sex and chronic obstructive pulmonary disease were independently associated with a worse physical component summary score.

Conclusion

COVID-19 associated ARDS survivors have long-term consequences in health status, exercise capacity, and HRQoL. Strategies addressed to prevent these sequelae are needed.

Health worries, life satisfaction, and social well-being concerns during the COVID-19 pandemic: Insights from Lebanon

The COVID-19 outbreak has struck Lebanon in its worst period of instability, not only impacting physical health, but also increasing psychological distress. Using an online survey enhanced by response time measurement, this study describes the overall patterns in mental well-being outcomes and examines their association with sociodemographic characteristics during the COVID-19 pandemic. Furthermore, it identifies significant predictors for COVID-19 good practices. A total of 988 Lebanese were surveyed, with participants providing written online consent prior to filling the survey. Regression-based models were estimated. Findings show that individuals with higher education levels exhibit lower health concerns. People with children face higher health worries than those without. Men are more worried than women about their health and they are less satisfied with their lives during the pandemic. Descriptive statistics show that most Lebanese are very satisfied with their families (93.1%), but they are highly dissatisfied with their country (63%). Young adults and individuals who live alone exhibit significantly higher social well-being concerns. Age and having children were strong predictors for good COVID-19 practices. The odds of having good practices for older adults are 3.13 times higher than that of youth, while the odds for those with children are 3.18 times higher than those without. The findings of this study could pave the way for a well-coordinated national strategy and increased collaboration with public health professionals to mitigate the pandemic's adverse effects on mental health in the long-term.

Probing the Colorectal Cancer Incidence in Lebanon: an 11-Year Epidemiological Study

BACKGROUND AND OBJECTIVES

Lebanon has witnessed an increase in the rates of several cancer sub-types over the past couple of years. The aim of our study is to investigate the incidence rates of colorectal cancer over 11 years in Lebanon and compare them with other countries.

MATERIALS AND METHODS

Data was collected from the National Cancer Registry (NCR) of Lebanon from the years of 2005 till 2015 inclusive. Data of other countries was retrieved from the online database "Cancer Incidence in Five Continents". The age-specific and age-standardized incidence rates (ASR(w)) were calculated and analyzed using Joinpoint regression.

RESULTS

Colorectal cancer ranked as the 5th most common cancer in Lebanon. The average ASR(w) was 12.6 per 100,00 for males and 10.7 per 100,00 for females. Colorectal cancer ASR (w) showed a significantly increasing trend in both males and females. Lebanon had the second highest incidence of colorectal cancer in the MENA region.

CONCLUSION

Incidence of colorectal cancer has been increasing significantly over the course of our study. It is important to study the risk factors associated with colorectal cancer and develop proper preventive and screening policies in order to decrease exposure and therefore decrease incidence rates in the future.

Evaluating the Effectiveness of an E-Mental Health Intervention for People Living in Lebanon: Protocol for Two Randomized Controlled Trials

Background

The lack of availability of evidence-based services for people exposed to adversity globally has led to the development of psychological interventions with features that will likely make them more scalable. The evidence for the efficacy of e-mental health from high-income countries is compelling, and the use of these interventions could be a way to increase the coverage of evidence-based psychological interventions in low- and middle-income countries. Step-by-Step is a brief (5-session) intervention proposed by the World Health Organization as an innovative approach to reducing the suffering and disability associated with depression.

Objective

This study aims to evaluate the effectiveness and cost-effectiveness of a locally adapted version of Step-by-Step with Syrian nationals (trial 1) and Lebanese nationals and other populations residing in Lebanon (trial 2).

Methods

This Step-by-Step trial involves 2 parallel, two-armed, randomized controlled trials comparing the e-intervention Step-by-Step to enhanced care as usual in participants with depressive symptoms and impaired functioning. The randomized controlled trials are designed and powered to detect effectiveness in 2 populations: Syrians in Lebanon (n=568) and other people residing in Lebanon (n=568; Lebanese nationals and other populations resident in Lebanon). The primary outcomes are depressive symptomatology (measured with the Patient Health Questionnaire-9) and functioning (measured with the World Health Organization Disability Assessment Scale 2.0). Secondary outcomes include anxiety symptoms, posttraumatic stress disorder symptoms, personalized measures of psychosocial problems, subjective well-being, and economic effectiveness. Participants are mainly recruited through online advertising. Additional outreach methods will be used if required, for example through dissemination of information through partner agencies and organizations. They can access the intervention on a computer, tablet, and mobile phone through a hybrid app. Step-by-Step has 5 sessions, and users are guided by trained nonspecialist “e-helpers” providing phone-based or message-based support for around 15 minutes a week.

Results

The trials were funded in 2018. The study protocol was last verified June 20, 2019 (WHO ERC.0002797) and registered with ClinicalTrials.gov (NCT03720769). The trials started recruitment as of December 9, 2019, and all data collection was completed in December 2020.

Conclusions

The Step-by-Step trials will provide evidence about the effectiveness of an e-mental health intervention in Lebanon. If the intervention proves to be effective, this will inform future scale-up of this and similar interventions in Lebanon and in other settings across the world.

Trial Registration

ClinicalTrials.gov NCT03720769; https://clinicaltrials.gov/ct2/show/NCT03720769

International Registered Report Identifier (IRRID)

DERR1-10.2196/21585

Trauma exposure, PTSD symptoms, and tobacco use: Does church attendance buffer negative effects?

Traumatic stress and posttraumatic stress disorder (PTSD) are overrepresented in urban African American communities, and associated with health risk behaviors such as tobacco use. Support and resources provided by churches may reduce trauma-related health risks. In the current study, we assessed weekly church attendance as a moderator of relations between (a) traumatic event exposure and probable PTSD, and (b) probable PTSD and tobacco use. Data were drawn from a health surveillance study conducted in seven churches located in Chicago's West Side. Participants (N = 1015) were adults from churches as well as the surrounding community. Trauma exposure was reported by 62% of participants, with 25% of those who experienced trauma reporting probable PTSD. Overall, more than one-third of participants (37.2%) reported current tobacco use. As compared with non-weekly church attendance, weekly church attendance was associated with a lower likelihood of PTSD (odds ratio [OR] = 0.41; 95% confidence interval [CI] = 0.26-0.62; p < .0001) and lower tobacco use overall (OR = 0.22; 95% CI = 0.16-0.30; p < .0001), but did not moderate the effect of trauma exposure on risk of PTSD, or the effect of PTSD on tobacco use. Findings support church attendance as a potential buffer of trauma-related stress.

Medical schools in times of war: Integrating conflict medicine in medical education

Amid the rise in conflict and war and their ensuing repercussions, traumatic injuries, psychological distress, and communicable diseases spread widely. Today, health-care providers in the Middle East are faced with new and unfamiliar cases resulting from the use of new and advanced types of weapons. In addition, there has not been enough emphasis on hands-on experiences in medical school, which can be imperative in times of war. Lack of academia is another inadequacy that limits the transmission of knowledge onto the newer generations. Here, we will shed light on the inadequacies in medical curricula in the Middle East when it comes to addressing patients of war. We also call for action to advance medical education in war-ridden areas by incorporating "conflict medicine" as an integral module in medical curricula.

The serotonergic and alpha-1 adrenergic receptor modulator ACH-000029 ameliorates anxiety-like behavior in a post-traumatic stress disorder model

Post-traumatic stress disorder (PTSD) is a severe chronic mental illness that develops in individuals exposed to life-threatening trauma and is characterized by hyperarousal, flashbacks and nightmares. The serotonergic (5-HT) and noradrenergic (NE) systems are deeply involved in the pathogenesis of PTSD. We have previously reported a novel anxiolytic compound, ACH-000029, that modulates 5-HT and α1-adrenergic receptors and induces acute anxiolytic-like effects in rodents. Here, we investigated the potential of ACH-000029 to prevent anxiety-like behavior in the single prolonged stress (SPS) PTSD model. Mice were subjected to the SPS procedure, followed by a 7-day treatment with ACH-000029 and, for comparison, with the α1-adrenergic antagonist prazosin. Animals were behaviorally assessed using social interaction, elevated plus maze and open field tests. Interestingly, treatment with ACH-000029 but not with prazosin ameliorated the SPS-induced sociability impairment and anxiety-like behavior. The brain-wide c-fos mapping, used as a surrogate for brain activity, indicated the brain structures that were altered by SPS and putatively involved in the anxiolytic-like effect of ACH-000029. The SPS protocol produced long-lasting impairment of regions involved in stress-anxiety response, such as the amygdala, prefrontal cortex, globus pallidus and superior colliculus. ACH-000029 treatment reversed the SPS-induced c-fos changes in the globus pallidus, lateral septum and entorhinal cortex and exclusively modulated c-fos levels in subregions from the retrosplenial cortex, cerebellum, superior colliculus and ventromedial hypothalamus. These results support the hypothesis that the dual regulation of 5-HT and α1-adrenergic receptors is required to alleviate PTSD symptoms and suggest a possible role of ACH-000029 as a PTSD treatment.

Sport and exercise medicine research activity in the Arab world: a 15-year bibliometric analysis

Background

The role of sports in decreasing the prevalence of many diseases has led to a growing interest in the field of sport and exercise medicine. But sport and exercise medicine still remains new to the Arab world, waiting to be explored. The aim of this study is to describe and characterise sport and exercise medicine research activity in the Arab world between 2002 and 2016.

Methods

The PubMed database was used to search for publications related to sport and exercise medicine. Publications were classified according to the country of origin and filtered to include publications between 2002 and 2016. Research output was analysed with respect to gross domestic product (GDP) and population of each country.

Results

A total of 1148 papers related to sport and exercise medicine were found to be published in the Arab countries between 2002 and 2016. Sport-and-exercise-medicine-related publications constituted 0.86% of the total biomedical research papers published in the Arab world and 0.49% of the world’s sport and exercise medicine literature. The number of sport-and-exercise-medicine-related publications per country ranged from zero to 352, with Qatar occupying the top spot. Tunisia ranked first with respect to publications per average GDP, while Qatar ranked first with respect to publications per average population. Comoros, Mauritania, Somalia, Sudan and Yemen were found to have no publications related to sport and exercise medicine.

Conclusion

Sport and exercise medicine is a novel field in the Arab world. Recognising the barriers facing sport and exercise medicine research and exploring them meticulously remains an essential part of the plan to improve the Arab world’s output and contribution in this field.