Risk Factors of Suicidal Ideation in Iraqi Crystal Methamphetamine Users

Crystal methamphetamine, a potent psychostimulant, presents a complex clinical landscape. However, insights into the predisposing factors for suicidal tendencies among Iraqi users remain limited. Our study delves into these risks among 165 patients. Rigorous multivariable analysis was conducted, employing binary logistic regression, drawing from patients from Baghdad Medical City and Ibn-Rushd Teaching Hospital. Most participants were in their third decade (26.62 ± 0.53 years). Regarding suicidal ideation, our model demonstrated robust accuracy, supported by the Hosmer-Lemeshow goodness-of-fit test (NagelKerke's R2 = 0.49, accuracy = 79.4%, p = 0.885). Notably, chronic methamphetamine use exceeding a year (OR = 6.15, p = 0.001), absence of psychological trauma (OR = 4.58, p = 0.006), and incidence of visual hallucinations (OR = 4.52, p = 0.001) rendered users more susceptible to suicidal ideation. Furthermore, our investigation unveiled risk factors tied to psychotic features and withdrawal manifestations. The study underscores pivotal predictors of suicidal ideation, warranting interdisciplinary vigilance from psychiatrists, clinical psychologists, and social workers. By monitoring at-risk individuals, progression toward the intricate spectrum of suicide can be potentially averted. These findings illuminate the urgency of tailored interventions for crystal methamphetamine users, contributing to enhanced holistic care.

Infoveillance and Critical Analysis of the Systematically Reviewed Literature on Dimethyltryptamine and the "God Molecule"

Aboriginals of Latin America have used DMT (N,N-dimethyltryptamine) in ritualistic ceremonies for centuries. Nevertheless, there are limited data on web users' interest concerning DMT. We aim to review the literature and explore the spatial-temporal mapping of online search behavior concerning DMT, 5-MeO-DMT, and the Colorado River toad via Google Trends over the past 10 years (2012-2022) while using 5 search terms: "N,N-dimethyltryptamine", "5-methoxy-N,N-dimethyltryptamine", "5-MeO-DMT", "Colorado River toad", and "Sonoran Desert toad". Literature analysis conveyed novel information concerning DMT's past shamanic and present-day illicit uses, showcased experimental trials on DMT uses for neurotic disorders, and highlighted potential uses in modern medicine. DMT's geographic mapping signals originated mainly from Eastern Europe, the Middle East, and Far East Asia. In contrast, 5-MeO-DMT signals prevailed in Western Europe, Indo-China, and Australasia. Signals concerning the toad originated from the Americas, Australia, India, the Philippines, and Europe. Web users searched the most for "N,N-dimethyltryptamine" and "5-MeO-DMT". Three terms exhibited significant upgoing linear temporal trends: "5-MeO-DMT" (β = 0.37, p < 0.001), "Sonoran Desert toad" (β = 0.23, p < 0.001), and "Colorado River toad" (β = 0.17, p < 0.001). The literature and Infoedemiology data provided crucial information concerning DMT's legal status, risks and benefits, and potential for abuse. Nonetheless, we opine that in the upcoming decades, physicians might use DMT to manage neurotic disorders pending a change in its legal status.

Past Myocardial Infarctions and Gender Predict the LVEF Regardless of the Status of Coronary Collaterals: An AI-Informed Research

BACKGROUND: The degree of the development of coronary collaterals is long considered an alternate – that is, a collateral – source of blood supply to an area of the myocardium threatened with vascular ischemia or insufficiency. Hence, the coronary collaterals are beneficial but can also promote harmful (adverse) effects. For instance, the coronary steal effect during the myocardial hyperemia phase and that of restenosis following coronary angioplasty. OBJECTIVES: Our study explores the contribution of coronary collaterals – if any exist – while considering other potential predictors, including demographics and medical history, toward the left ventricular (LV) dysfunction measured through the LV ejection fraction (LVEF). METHODS: Our cross-sectional design study used convenience sampling of 100 patients (n = 100; a male-to-female ratio of 4:1). We conducted frequentist inference statistics using IBM-SPSS version 24 and Microsoft Office Excel 2016 with the analysis ToolPak plugin; we ran parallel neural networks (supervised machine learning (ML)) and a two-step clustering (non-supervised ML) for robust conjoint inference with frequentist statistics. RESULTS: The past incidents of myocardial infarction (p = 0.036) and gender (p = 0.072) influenced the LVEF; both are significant predictors at a 90% confidence interval. We found that gender and past incidents of MI influenced the LVEF regardless of the status of coronary collaterals. Our study did not yield any positive or significant findings concerning the status of coronary collaterals or the coronary circulation dominance patterns. CONCLUSION: Regardless of the status of coronary collaterals, we verified that the female gender is protective of the LV function, contrary to the past infarction incidents that predispose to a deteriorated LV function. Our study’s innovation relates to its status as the first study from India to explore the coronary collaterals and the ejection fraction while incorporating frequentist statistics and narrow artificial intelligence to infer reliable results.

Suicidal Ideation in Iraqi Medical Students Based on Research Using PHQ-9 and SSI-C

Suicidal ideation is a spectrum of contemplations, wishes, and preoccupations with suicide. Its prevalence is ambiguous in Iraq, especially among the youth. We aim to survey the prevalence of suicidal ideation among Iraqi students and explore its risk factors. We surveyed Iraqi undergraduate medical students (n = 496) using two psychometric tools, the PHQ-9 and Beck's SSI-C. We also explored potential risk factors, including the students' attributes, socio-demographics, and history of mental illnesses. The current study included males (23.8%) and females (76.2%) in their early twenties (21.73 ± 0.11). Concerning PHQ-9 and SSI-C, most students had either moderate (28%) or mild depression (27.8%), while those with suicidal ideation accounted for an alarming 64.9%. The strongest association existed between the SSI-C and PHQ-9 scores (p = 0.001, OR = 4.70). Other associations existed with the personal history of mental illness (p < 0.001, OR = 2.87) and the family history of suicidality (p = 0.006, OR = 2.28). Path analysis highlighted four suicidal ideation predictors, including the PHQ-9 score (standardized estimate = 0.41, p < 0.001), personal history of mental illness (0.16, p < 0.001), previous psychiatric consultation (0.12, p = 0.002), and family history of suicidality (0.11, p = 0.005). Suicidal ideation is highly prevalent among Iraqi students. Univariable testing, multivariable analyses, and structural modeling yielded congruent results. The students' inherent rather than inherited attributes influenced the phenomenon the most, which is in harmony with Durkheim's theory on the social roots of suicide. We encourage psychiatrists and psychology counselors to be vigilant concerning these risk factors among potential suicidal ideation victims.

Pre-operative systemic inflammatory response index influences long-term survival rate in off-pump surgical revascularization

Coronary artery bypass revascularization is still the optimal treatment for complex coronary artery disease with good long-term results. The relation between inflammatory activation in the post-operative period and the long-term prognosis was already postulated. The possible predictive role of preoperative inflammatory indexes after the off-pump coronary artery bypass grafting technique on long term survival was the aim of the study. Study population included 171 patients with a median age of 64 years (59-64) operated on using off-pump technique between January and December 2014. Patients enrolled in the current study were followed-up for 8 years. We conducted a multivariable analysis of pre-operative and post-operative inflammatory markers based on analysis of the whole blood count. The overall survival rate was 80% for the total follow-up period, while 34 deaths were reported (30-days mortality rate of 1%). In the multivariable analysis, a pre-operative value of systemic inflammatory response index (SIRI) >1.27 (HR = 6.16, 95% CI 2.17-17.48, p = 0.012) revealed a prognostic value for long-term mortality assessment after off-pump surgery. Preoperative inflammatory activation evaluated by systemic inflammatory reaction index (SIRI) possess a prognostic value for patients with complex coronary artery disease. The SIRI value above 1.27 indicates a worse late prognosis after off-pump coronary artery bypass (AUC = 0.682, p<0.001).

A concept for causality assessment and causal inference of adverse events cases

Dear Editor,   Causality assessment of adverse drug events is essential in pharmacovigilance to assess the relationship between the medicine and the event.1,2 Regulatory authorities recommend using standardized methods for causality assessment.3,4 The World Health Organization-Uppsala Monitoring Center (WHO-UMC) system offers generalized criteria for establishing causal relationships.3 In contrast, the Roussel Uclaf Causality Assessment Method (RUCAM) provides a specialized system to assess Drug-Induced Liver Injury (DILI) cases. We systematically reviewed the literature and verified that these systems are among the best tools currently available for signal detection and causality assessment. [...]

Helping Women Suffering from Drug Addiction: Needs, Barriers, and Challenges

Statistical data on the use of various psychoactive substances indicate a narrowing of previous differences in substance use between men and women. Data from studies conducted among women suffering from drug addiction are increasingly published, with the authors highlighting the specific needs of this group and the difficulties that women with addiction problems encounter. The current study aimed to identify the barriers and needs of this audience, both when seeking help and during treatment. The method used in the study was secondary content analysis. To identify publications describing the barriers and needs of women suffering from drug addiction, we searched the PubMed database to find publications that met the adopted research objective. We set the data search period to the last ten years to examine the timeliness of the issue under study. The search yielded 199 research reports. Twenty-three articles describing 21 studies were included in the final analysis. The selected publications dealt with the difficulties and challenges faced by women with addiction problems. Barriers to accessing treatment for this group, the needs, and the challenges of helping women suffering from addiction were identified. Results showed that the barriers are mainly stigma but also deficits in the therapeutic offerings for this group. The primary need was identified as the introduction of appropriate drug policies, and the challenges, unfortunately, are the still-reported gender inequalities. To improve the situation of women, regular attention to these issues and the need to include them in national health strategies is essential.

A Thousand Words About Modern Medical Education: A Mini-Review Concerning the Theory of Education

The present article represents a mini-review and a reflective essay concerning modern medical education methods, as well as ways to adapt them to medical education's local conditions (disciplines), including basic medical sciences. We introduced Gagné's theory of learning and other theories – Constructivist, Experiential, and Humanistic – followed by Dennik's "twelve tips" for effective learning and Harden's ten questions for curriculum development. Outcome-based education (OBE) was discussed and related to relevant concepts within Miller's pyramid and Bloom's taxonomy. Harden's SPICES model was emphasized concerning education strategies while discussing the assessment of learning (AoL), assessment as learning (AaL), and assessment for learning (AfL). Finally, the authors advise exploring the adaptation of modern education methods for a specific discipline of basic medical sciences – Human Anatomy – by incorporating the abovementioned concepts and integrating different AfL and AaL assessment tools while conveying a graphical concept map for this scenario.

Comparison of Hand Eczema in Iraq Before and During SARS-CoV-2 Pandemic Using Frequentist Statistics and Polynomial Models

Introduction. SARS-CoV-2 pandemic spread around the world exponentially. People use disinfectants excessively to protect themselves from the novel coronavirus, which may cause contact eczema; local health authorities can monitor these. Our study explores the internet to detect significant changes in online information search (seeking) behaviors connected with eczema in Iraq during the pandemic. Material and Methods. We searched the internet, via Google Trends, using five search terms; "اكزيما", "الاكزيما", "اكزيما اليد", "كحول", and "مطهر"; these are the Arabic translation for "eczema", "the eczema", "hand eczema", "alcohol", and "disinfectant". We explored the internet covering two years, one before and one during the pandemic. Results. Spatial mapping conveyed data from six governorates in Iraq, including Ninawa, Babil, Al-Najaf, Baghdad, Basrah, and Erbil. Basrah governorate had the highest score (interest) for the search term "the eczema" (الاكزيما), while Al-Najaf had the highest score for the search term "disinfectant" (مطهر). Temporal mapping exhibited high variability, the highest of which was for the search terms "the eczema" (الاكزيما) and "alcohol" (كحول). Exploring the temporal variabilities, using polynomial models showed weak predictive power over the two years. However, during the pandemic year, the predictive models for each search term possessed a moderate power. Conclusions. Changes in human behavior during pandemic events are of prime importance for pharmacovigilance experts. Pandemics can influence medical conditions, including hand eczema, as a manifestation of disinfectants' overuse. Combining data analytics and artificial intelligence facilitates screening, detecting, and collecting pharmacovigilance and safety data.

The Significance of Systemic Immune-Inflammatory Index for Mortality Prediction in Diabetic Patients Treated with Off-Pump Coronary Artery Bypass Surgery

Diabetes mellitus (DM) represents a complex carbohydrate metabolism disorder characterized by inflammatory over-reactivity. The study aimed to investigate the potential influence of postoperative inflammatory activation on mortality risk after off-pump coronary artery bypass grafting in diabetic patients. There were 510 patients treated with off-pump coronary artery bypass grafting due to stable complex coronary artery disease, including 175 patients with type-2 DM (T2DM.) The mean follow-up time was 3.7 +/− 1.5 years with a 9% all-cause mortality rate in the diabetic group. In multivariable analysis, preoperative comorbidities (stroke, peripheral artery disease, postoperative systemic inflammatory index >952, and postoperative left ventricle ejection fraction (LVEF) < 45%) were revealed as prognostic factors. The receiver operator characteristics curve analysis for postoperative calculations of systemic immune-inflammatory index (SII) appeared significant (AUC = 0.698, p = 0.008), yielding sensitivity of 68.75% and specificity of 71.07%. Systemic immune-inflammatory index (SII) can be regarded as a predictive marker for long-term prognosis in diabetic patients after off-pump coronary artery bypass grafting. The role of perioperative inflammatory activation may play a crucial role in mortality prediction.

Predictors of New-onset Diabetes After Kidney Transplantation During 2019-nCoV Pandemic: A Unison of Frequentist Inference and Narrow AI

BACKGROUND: New-onset diabetes after kidney transplant (NODAT) is a severe metabolic complication that frequently occurs in recipients following transplantation. AIM: The study aims to verify NODAT, compare cases and non-cases of this entity, and explore potential predictors in recipients within 1 year following kidney transplantation. METHODS: The research is a retrospective study of 90 renal transplant recipients (n = 90). Demographic factors and clinical aspects were analyzed using non-Bayesian statistics and machine learning (ML). The clinical aspects included the glycated hemoglobin (HbA1c) level, associated viral infections (hepatitis B virus [HBV], hepatitis C virus [HCV], and cytomegalovirus [CMV]), prior kidney transplant, hemodialysis status, body mass index (BMI) at transplant time, and 3 months later, primary causes of renal failure, and post-transplant therapeutics. All individuals were on cyclosporine and prednisolone treatment. RESULTS: The mean age was 39 (±1.5) years; recipients included 27 females (30%) and 63 males (70%). Donor type was live related (16, 17.8%) or live unrelated (74, 82.2%); 27 recipients (30%) had O+ blood group, while 70% belonged to other groups. Thirteen recipients (14.4%) were not on dialysis. Only 32 individuals (35.6%) developed NODAT. Concerning virology, confirmed by real-time polymerase chain reaction before transplantation, 19 recipients (21.1%) were CMV positive, 9 (10%) were HCV positive, and 2 (2.2%) had HBV. CONCLUSIONS: In reconciliation with frequentist statistics, the dual ML model validated several predictors that either negatively (protective) or positively (harmful) influenced HbA1c level, the majority of which were significant at 95% confidence interval. Individuals who are HCV and CMV positive are predicted to develop NODAT. Further, older individuals, with blood group O+ve, prior history of hemodialysis, a relatively high BMI before the transplant, and receiving higher doses of prednisolone following the transplant are more likely to develop NODAT. The current study represents the first research from Iraq to explore NODAT predictors among kidney transplant recipients using frequentist statistics and artificial intelligence models.

SARS-CoV-2 and pediatric encephalopathy: Google analytics and predictive modeling

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is rare in children and possesses distinctive clinical features. Aims and Objectives: The primary objective is to bring clinicians,’ researchers,’ and epidemiologists’ attention to pediatric encephalopathy as part of the clinical manifestations of SARS-CoV-2 in children. Materials and Methods: Google analytics aimed to explore the spatial-temporal (geographic-chronological) mapping of SARS-CoV-2 in conjunction with pediatric encephalopathy and encephalitis. We retrieved longitudinal data from Google Trends, for one year starting from December 2019, by deploying five search topics; “SARS-CoV-2,” “Coronavirus disease 2019, COVID-19” “Pediatric Encephalopathy,” “Pediatric Encephalitis,” and “Encephalitis in Children.” Results: Spatio-temporal mapping was most conclusive for “COVID-19” and “Severe acute respiratory syndrome coronavirus 2.” Internet users were least interested in topics related to pediatric encephalopathy and encephalitis in children; potentially, reflecting the rarity of these entities in SARS-CoV-2 infections in children. We are also reporting a case of atypical SARS-CoV-2 in an 8-year-old child, in which pediatric encephalopathy occurred in a PCR-confirmed COVID-19 case. Conclusion: Google analytics reconciled with the case report. SARS-CoV-2 in children may present with neurological rather than respiratory manifestations, which is atypical and rare. We are conveying two key messages; (1) pediatricians can collaborate with data scientists to realize evidence-based pediatric medicine and (2) digital data are worthy of exploration to guide subsequent rigor research, including randomized controlled trials and meta-analytics.

Evaluation of Anatomy Course Teaching and Learning Outcomes for Iraqi Pharmacy Students: Internet-based Learning versus Blended Learning During the Pandemic

BACKGROUND: Academic courses of human anatomy need to be reviewed periodically by students to ensure better learning outcomes, especially when the teaching process became internet-dependent during the pandemic. AIM: Our study aims to explore pharmacy students’ opinions concerning the theoretical and practical elements of the anatomy course taught in the College of Pharmacy at Al-Rafidain University. MATERIALS AND METHODS: The ethical committee of the College of Pharmacy at Al-Rafidain University approved the study. We prepared a questionnaire (Cronbach’s Alpha = 0.735) to evaluate the positive and negative aspects of the teaching process. The questionnaire was presented as an online survey to pharmacy students (n = 305) who finished their anatomy course in two learning modalities, Internet-based learning (n1 = 105, 34.43%) and blended learning (BL) (n2 = 200, 65.57%). RESULTS: Participants of both groups were satisfied with the syllabus, using internet-based materials, and problem-based learning concerning the theoretical aspect of the course. Concerning practical knowledge, both groups preferred using cadavers instead of dummies, and they verified the beneficial effect of online educational materials and computer-based applications. Pharmacy students demanded more than one anatomy course, while students from the BL group considered the anatomy course duration insufficient. Concerning the practical knowledge, students’ marks were superior for students using BL, and the opposite was the case with theoretical knowledge. CONCLUSIONS: BL is favored by Iraqi undergraduate pharmacy students; perhaps, it is attributed to the lively interaction between students and the teaching staff. We conclude that internet resources can be supportive of the classical teaching of anatomy.

Representations of Psychoactive Drugs' Use in Mass Culture and Their Impact on Audiences

Drug use has been increasing worldwide over recent decades. Apart from the determinants of drug initiation established in numerous studies, the authors wish to draw attention to other equally important factors, which may contribute to augmenting this phenomenon. The article aims to draw attention to the content of mass culture, especially representations of drug use in mass media, which may influence the liberalization of attitudes towards drugs and their use. The role of mass culture and its impact on the audience is discussed. It presents an overview of drug representations in the content of mass culture, e.g., in film, music, literature, and the occurrence of drug references in everyday products, e.g., food, clothes, and cosmetics. Attention was drawn to liberal attitudes of celebrities and their admissions to drug use, particularly to the impact of the presented positions on the attitudes of the audience, especially young people for whom musicians, actors, and celebrities are regarded as authorities. Indications for further preventive actions were also presented. Attention was drawn to the need to take appropriate action due to the time of the COVID-19 pandemic when many people staying at home (due to lockdown or quarantine) have the possibility of much more frequent contact with mass culture content, which may distort the image of drugs.

Dorsal expansion-related manual disability in verrucae vulgaris patients treated with cryotherapy: A longitudinal study via big data

Background: Common warts frequently occur over the hands and may overlie critical structures, including the extensor expansion of the digits, for which cryotherapy can lead to manual disability. Aims and Objectives: We aim to implement big data to infer knowledge on the interest of web users regarding the dorsal expansion-related manual disability in verrucae vulgaris patients managed with cryotherapy. Materials and Methods: We mapped the interest of users of the surface web in connection with five topics: cryosurgery, extensor digitorum muscle, human papillomavirus, manual disability, and verruca vulgaris. We retrieved longitudinal data [2004-2019] concerning the spatio-temporal variations of interest in these topics, using Google Trends. We are also reporting a case of interest while analyzing it using the Bradford Hill criteria. Results: Sixty-four nations contributed to the spatial (geographic) map, including ten countries from the Middle East and the north of Africa (15.63%). There was high temporal variability concerning cryosurgery 29.61 (+/- 0.94), extensor digitorum muscle 64.43 (+/- 0.86), human papillomavirus 0.01 (+/- 0.01), manual disability 2.89 (+/- 0.13), and verruca vulgaris 9.39 (+/- 0.20). Conjoint inference, via Post-Hoc testing and neural networks [machine learning], assigned the highest synaptic weight [effect size] to “cryosurgery” and “extensor digitorum muscle”, thus indicating that these topics are of prime interest for web users, including anatomists and dermatologists. Conclusions: We are conveying two messages: 1) Dermatologists are encouraged to collaborate with data scientists to realize the importance of big data for evidence-based dermatology. 2) Physicians should exercise extra caution in managing patients with verrucae vulgaris using cryotherapy. 

Predictive Epidemiology for SARS-CoV-2 Pandemic in Iraq

This is a Letter to Editor

Clustering analysis of coronavirus disease 2019 pandemic

This is Letter to the Editor

Reconciling artificial intelligence and non-Bayesian models for pterygomaxillary morphometrics

BACKGROUND

The base of the skull, particularly the pterygomaxillary region, has a sophisticated topography, the morphometry of which interests pathologists, maxillofacial and plastic surgeons. The aim of the study was to conduct pterygomaxillary morphometrics and test relevant hypotheses on sexual and laterality-based dimorphism, and causality relationships.

MATERIALS AND METHODS

We handled 60 dry skulls of adult Asian males (36.7%) and females (63.3%). We calculated the prime distance D [prime] for the imaginary line from the maxillary tuberosity to the midpoint of the pterygoid process between the upper and the lower part of the pterygomaxillary fissure, as well as the parasagittal D [x-y inclin.] and coronal inclination of D [x-z inclin.] of the same line. We also took other morphometrics concerning the reference point, the maxillary tuberosity.

RESULTS

Significant sexual as well as laterality-based dimorphism and bivariate correlations existed. The univariate models could not detect any significant effect of the predictors. On the contrary, summative multivariate tests in congruence with neural networks, detected a significant effect of laterality on D [x-y inclin.] (p-value = 0.066, partial eta squared = 0.030), and the interaction of laterality and sex on D [x-z inclin.] (p-value = 0.050, partial eta squared = 0.034). K-means clustering generated three clusters highlighting the significant classifier effect of D [prime] and its three-dimensional inclination.

CONCLUSIONS

Although the predictors in our analytics had weak-to-moderate effect size underlining the existence of unknown explanatory factors, it provided novel results on the spatial inclination of the pterygoid process, and reconciled machine learning with non-Bayesian models, the application of which belongs to the realm of oral-maxillofacial surgery.

The Prevalence of Self-Medication With Painkillers Among Iraqi Medical Students

BACKGROUND: The use of painkillers is widespread worldwide, some people experience unwanted side effects, and some may overuse them. Self-medication is the selection and use of medicines by individuals to treat self-recognized illnesses and collateral symptoms.&nbsp;&nbsp; OBJECTIVES: We aim to determine the prevalence and pattern of self-medication with painkillers among a population of undergraduate medical students in Baghdad. METHODS: We carried out a cross-sectional study, via convenient sampling, among 502 medical students (n=502) from the University of Baghdad, Al-Mustansirya University, Al-Kindy University, Al-Nahrain University, and Al-Iraqia University. We distributed an anonymous online questionnaire to the students. The survey included questions on demographic variables and information on self-medicating with painkillers during the academic year of 2018-2019. RESULTS: The prevalence of use of painkillers was 68.73%, 73% were females, and 27% were males. There was a statistically significant association between gender and the use of analgesics. Still, there was no statistically significant association between the academic level of students and analgesic use. The frequency of analgesic use per month was less than once (34.5%) of the participants, 1-3 times (37.1%), 4-6 times (14.2%), 7-9 times (7%), 10-12 times (3.1%), and more than 13 times (4%) of the participants. Most of the respondents (68%) reported that there was no difference in use between regular college days and exam days. The most common cause of use was headache (71%) for males and females, while dysmenorrhea was the second most common cause among female participants (36%). The most common source of information about analgesics relied on by the respondents was from friends (50.1%), family members, pharmacists, textbooks, the internet, and nurses. The most commonly used drug was Acetaminophen. CONCLUSION: Self-medication with analgesics is highly prevalent among undergraduate medical students in Baghdad, and we need to raise the awareness of the public on the potentials of addictive behavior.

Pragmatism of the Alcoholics Anonymous Fellowship

Alcoholics Anonymous is a fellowship of people addicted to alcohol, who share their experience from the period of drinking, but who primarily have ongoing personal struggles with unstable emotions, a disintegrated value system, broken social ties, and other consequences of their old lifestyle. Participants of AA meetings provide mutual support at every stage of recovery and gain hope for improvement in their situation. Acceptance and implementation of the principles of the AA Programme promote recovery and improvement in all areas of life. It helps achieve physical health, emotional stability and better social relations, and creates a stable normative system. Joining the AA Fellowship is very useful for almost every member. The principles and objectives of the AA Fellowship were inspired by American pragmatism. The article presents the constitutive features of this philosophical trend, the inspirations which the founders of the AA Fellowship followed, and data supporting the usefulness of the 12 Steps of AA in recovery from alcoholism.

The Spectrum of Biopsy-Proved Kidney Disease: A Retrospective Single Center Study in Erbil-Iraq

BACKGROUND Renal biopsy is crucial to determine the pattern of the different types of renal diseases. It represents the gold standard of diagnostics for renal pathologies, including glomerular diseases, and it has an important value for the prognosis, monitoring disease progression, and planning the management protocol. AIMS AND OBJECTIVE To report the frequency of different pathological lesions affecting the kidney in patients who were admitted to our medical centre. MATERIALS AND METHODS This is a retrospective study of all patients with renal diseases who underwent percutaneous renal biopsy at the Erbil Kidney Centre for eight years  (1st of January 2010  to 31st of December 2017). A total of 893 cases were biopsied and subsequently studied via histopathological examination and immunofluorescence microscopy. The study is ethically permitted by the Kurdistan Board for Medical Specialization. RESULTS The average age of the patients was 30.9 years. The most common clinical indication for biopsy included nephrotic syndrome (46.47%), acute renal failure (19.04%), chronic renal failure (15.34%), nephritic syndrome (7.39%), proteinuria alone (7.28%), and hematuria alone (4.48%). In patients with a primary glomerular disease, focal segmental glomerulosclerosis and minimal change disease were the most frequent (27.44% and 16.01%) in the younger patients (18.61±13.47 years), while membranous glomerulonephritis was more common in older patients (38.94±13.69 years). Patients with a secondary glomerular disease were mainly diagnosed with lupus nephritis, amyloidosis, and diabetic nephropathy. CONCLUSION The epitome of our study signifies that the spectrum of glomerular diseases varies based on age, sex, ethnicity, and geographical distribution. The implementation of renal biopsy proved to be a cornerstone in reaching the correct diagnosis. Future studies should implement the use of electron microscopy in conjunction with classical techniques of histopathology and immunofluorescence microscopy to diagnose equivocal cases of interest.

The enzymopathy of G6PD deficiency in Jordan: a demographic and biochemical analysis

Background: G6PD deficiency is an inherited X-linked recessive condition leading to insufficient levels of glucose-6-phosphate dehydrogenase, thus causing hemolytic anaemia under certain circumstances. Materials and Methods: Our study is explorative for cases admitted to Jordan University Hospital. The studied parameters include demographics, clinical manifestations, biochemical markers including Hb level, WBC count, liver enzymes, and blood grouping. Results: Most of the patients were admitted to the emergency unit (53.13%). Individuals who were Rh-positive represented 57.81%, while patients of AB blood group accounted for 75%. The mean values were 4.81 years (age), 29.06 hours (time-to-hospital admission), 38.10 degree Celsius (temperature), 6.11 gm/dl (Hb), 13242.19 (WBC count), 343.20 U/L (S. ALP), and 50.98 IU/L (S. ALT). There was no significant difference between males and females or between favism-induced versus drug-induced hemolytic episodes. AB and Rh positive blood groups are of a protective effect in relation to liver enzymes. Patients who were admitted to the hospital within 24 hours from having clinical manifestations had a better prognosis. Conclusion: This study is the first inferential research on G6PD deficiency from the Middle East to explore cases from one of the largest healthcare centres in Jordan. The role of blood grouping should be investigated prospectively.

The digital epidemiology of phenylketonuria, aka folling’s disease: retrospective analysis and geographic mapping via google trends

Background: Phenylketonuria, commonly known as PKU, is an inherited disorder in which there is an abnormally elevated blood level of the amino acid phenylalanine leading to several pathologies affecting multiple organs including the central nervous system and resulting in debilitating intellectual disability and other neuropsychiatric disorders. Phenylalanine is a building block of several critical proteins within the biological systems.Aims and Objective: To assess the digital epidemiology and geographic mapping of Phenylketonuria.Materials and Methods: This study is a retrospective analytic (2013‑2017) of a very large database existing on the surface web known as Google Trends. it aims to extrapolate a statistical inference concerning the digital epidemiology and the geographic mapping of phenylketonuria. The trends database will be explored via thematic keywords specific to the condition of phenylketonuria including “Phenylketonuria [PKU]”, “Phenylalanine”, “Inborn errors of metabolism”, “Tetrahydrobiopterin”, and “Chromosome 12 (human)”.Results: The digital epidemiology is densely clustered in countries from the developed world, eastern Europe, and Latin America. Surface web users from China appears to possess the highest interest in phenylketonuria. The contribution of the Middle Eastern and Arabic countries to the geographic mapping did not exceed 10.51% at its best. Significant changes existed for year-to-year variations of trends. Statistical outliers were also found, the strongest of which was observed during April 2016 for which there’s no plausible explanation.Conclusion: Trends databases operating on the surface web represent potent tools of big data that can be exploited to assess the digital epidemiology and geographic mapping of countless phenomenon including rare genetic diseases and inborn errors of metabolism. There are also enormous potentials for real-time and predictive analytics of these databases when investing the application of automation in data collection and principles of machine learning.Asian Journal of Medical Sciences Vol.9(6) 2018 93-99

Digital epidemiology and geographic mapping of G6PD deficiency: retrospective analytic of trends database existing on the surface web

Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an inherited X-linked recessive condition in which the body does not synthesise a sufficient quantity of the G6PD enzyme. Hemolytic anaemic episodes occur following exposure to some medications, foods, or even infections in G6PD-deficient individuals.Aims and Objectives: To assess the digital epidemiology as well as the geographic mapping of G6PD deficiency in the world including countries of the Mediterranean basin.Materials and Methods: This study is primarily based on a digital epidemiological analysis and geographic mapping based on data retrieved from Google Trends database, a very large database, existing on the surface web. A retrospective analysis was carried out for the period from the 22nd of March 2015 to the 24th of January 2016. Trends data will also be contrasted with a collateral data set of a cross-sectional analytic for the same period which was conducted based on the exploration of cases of G6PD deficiency admitted to Jordan University Hospital.Results: Concerning geographic mapping, countries of the Basin of the Mediterranean Sea and the Arabian Gulf accounted for one-third of the entire geographic map at 15.66% and 18.18% respectively. Countries of the Mediterranean basin included Jordan, Italy, Lebanon, Israel, Egypt, Greece, Syria, Cyprus, Tunisia, Algeria, and Morocco. Contributing countries surrounding the Arabian Gulf included Kuwait, Kingdom of Saudi Arabia, Bahrain, Iran, United Arab Emirates, Qatar, and Iraq. The Hashemite Kingdom of Jordan contributed to 2.78% of the global map which accounted for 17.74% of the entire Mediterranean basin. Concerning digital epidemiology, the prevalence was recorded as highest during May 2015 (12.10%), August 2015 (11.17%), and November 2015 (11.28%). Concerning the percentile contribution of monthly records, data were in harmony for those cases admitted to hospital and signals recorded via Google Trends. Both datasets averaged a percentile contribution of approximately 9% per month.Conclusion: This study is the first inferential research on G6PD deficiency based on data from a trends database and parallel data from Jordan University Hospital. Ambitious future research should deploy the use of machine learning for real-time and predictive analytics which will provide an excellent value for public health services and epidemiological studies.Asian Journal of Medical Sciences Vol.9(5) 2018 57-61

The digital epidemiology of dysencephalia splanchnocystica, AKA meckel–gruber syndrome: Retrospective analysis and geographic mapping via google trends

Background: Genetic diseases are diverse and many of which have debilitating consequences affecting the individual, the society, and the economy. Trends databases, including Google Trends database, can be used to estimate the digital epidemiology of these diseases. Digital Epidemiology is valuable when it comes to conditions of low prevalence as in the case of ciliopathies including that of Meckel–Gruber Syndrome.Aims and Objectives: To assess the digital epidemiology and the geographic mapping of Meckel- Gruber syndrome via a trends database of the surface web.Materials and Methods: Google Trends database will be usedfor geographic mapping and retrospective analysis of interest of users of the Surface Web. The aim is to infer and predict the digital epidemiology of Meckel–Gruber Syndrome. A retrospective analysis is conducted as far as the trends database permits (2004-2017). The trends database was explored using the thematic expression of keywords specific to Meckel–Gruber Syndrome including its synonyms. Subsequently, descriptive and inferential statistics were carried out to estimate the digital epidemiology as well as the geographic mapping. The aim was to conclude the existence of any significant change in web users’ interest and the variation of that interest versus geography (country) and chronology (time).Results: Concerning geographic mapping, signals of web users were found to be originating from the United States (68.49%) and Finland (31.51%). Globally, the average value of the relative interest of surface web users in Meckel–Gruber Syndrome was 34.10 (+/- 14.59). There was an overall decline in web users’ attention towards the condition for the period 2004−2010 versus 2011−2017 (20.06 vs 4.88, p-value<0.001) and for period 2004-2006 versus 2007-2009 (29.14 vs 14.19, p=0.001).Conclusion: Digital epidemiological analysis has been proven feasible with good accuracy via Googles Trends. In the case of Dysencephalia Splanchnocystica, the geographic mapping of the surface web has been limited to the developed world. Prospectively, Google Trends can be integrated into a predictive early warning system to anticipate any change in the interest of the users of the Indexed Web in a particular disease including genetic ones.Asian Journal of Medical Sciences Vol.9(5) 2018 81-86

The significance of hypoxia as a molecular and cellular event in patients with toxic and non-toxic goitre: A statistical inference based on cross-sectional analytic of Iraqi patients

Background: Disorders of the thyroid gland, including toxic and non-toxic goitre, are more common in adult female patients. Hypoxia-inducible factors, including HIF-1 and HIF-2, represent transcriptional activators that function as regulators of oxygen homeostasis. Rapid progress is being made in clarifying the homeostatic functions of HIFs in several physiological systems. However, there are much to be learned in connection with the thyroid gland and its pathologies.Aims and Objectives: To assess the biochemical and clinical significance of hypoxia-inducible factors in patients with multinodular goitre.Materials and Methods: The study is observational and cross-sectional analytic conducted among a population of individuals with diffuse and nodular thyroid goitre including clinically toxic and non-toxic patients. It will attempt to answer the research question concerning the significance of HIFs, via applying techniques of immunohistochemistry to histological samples of resected thyroid tissue, and in pertinence with the demographic and clinical parameters of patients.Results: The total number of patients was forty-three,and most was in their fifth decades of life. The percentile contribution of males and females was 11.63% and 88.37% respectively. Individuals with toxic goitres accounted for 13.95%, and those had significantly higher levels of both HIF-1 and HIF-2 than non-toxic patients (p=0.019, p=0.072). Clinically-toxic patients also had notably more elevated levels of HIF-1 as they grew older when compared to non-toxic patients.Conclusion: There is an evident inadequacy of published literature on hypoxia-inducible factors in patients with goitre. There are no studies whatsoever in correspondence to the research questions explored in this study. Future attempts should explore experimental designs while using human as well as animal models and from an interdisciplinary perspective.Asian Journal of Medical Sciences Vol.9(5) 2018 44-49

Novel Psychoactive Substances: Systematic Review and Evidence-Based Analysis of Literature

BACKGROUND: The research output within the discipline of novel psychoactive substances (NPS) has been evolving since the end of the last decade. The introduction of the concept of evidence-based Medicine led to a revolutionary growth of all fields of medical research. The enhancements of research quality were also paralleled by the development of tools for critical analysis of literature.MATERIALS & METHODS: The aim of the study is to assess the NPS research output, by means of evaluation of the level-of-evidence and the implemented statistical analyses. An extensive database of near 600 published manuscript was created; the papers were selected from the PubMed/Medline database by using pre-specified keywords. Each manuscript will be systematically scanned for; the first author, research institution, country, year of publication, type of study, statistical analysis, level-of-evidence, and journals of publication. Research efforts from the Middle East were also observed and quantified.RESULTS: Teams of NPS researchers included members in the range of one to twenty-nine, with and an average of 4.75 authors per publication. Research output was densely mapped in the developed countries including the UK (53%), US (19%), Italy (14%), Germany (14%), and Sweden (10%); the Middle East contribution was minimal (<1%). The top two research institutes were; King’s College London (UK) and Sapienza University of Rome (Italy). Studies included; Cross-sectional analyses (15%), Reviews (18%), and Analytic chemistry (36%). A considerable number of publications (34%) had no statistics at all, while only 14% had inferential statistics. Top journals of publication were; Journal of Psychopharmacology, Current Neuropharmacology, and Drug and Alcohol Dependence.CONCLUSION: Research output should always be assessed for quality control purposes. This study represents an innovative and systematic method of critical analysis of NPS literature. Future study efforts should be respondent to this study to achieve a better quality of research.

Adverse Effects of Amphetamines on the Cardiovascular System: Review and Retrospective Analyses of Trends

BACKGROUND: Amphetamine and amphetamine-type stimulants are powerful physical and psychostimulants; they are phenethylamine derivatives. The use of amphetamines can be either medicinal or illicit. Several amphetamines have been redesigned into illegal drugs of potent properties, also known as research chemicals and designer drugs. Hence, they are named novel (new) psychoactive substances (NPS).MATERIALS & METHODS: This study is a hybrid study of; data crunching and retrospective analysis of a trends database (1), and a systematic review of literature in relation to the amphetamines-induced adverse effects on the cardiovascular system (2). Google Trends database has been analysed in retrospect (2012-2017) to evaluate the attentiveness of surface web users towards amphetamine and a potent renowned amphetamine derivative known as captagon (fenethylline).RESULTS: Amphetamines appear to be highly popular worldwide, particularly in the developed world including North America and European countries, and to a less extent in the developing countries including the Middle East. However, the trends are oscillating with time with significant year-to-year changes although there was some steadiness in the temporal patterns (trends), for example in 2013-2014 (p-value=0.258). Variations in the trends were found to be correlated with global events including international terrorism. The adverse effects of amphetamines were found to be highly related to the cardiovascular system with a high incidence of intoxications and deaths among substance (ab)users.CONCLUSION: Several amphetamines are potent and used illicitly beyond their original therapeutic potential, as in the case of captagon, culminating in monumental public and economic threats. Legalising bodies should exercise tremendous and systematic efforts to counteract these threats. Database analyses can provide an accurate insight into this phenomenon that has been growing exponentially in the past decade.

Do (Ab)Users of Psychedelics Have Tendencies to Abuse High Authority? An Internet Snapshot Study

BACKGROUND: Hallucinogenic substances, also known as psychedelics and entheogens, represent a subset of novel psychoactive substances. The epidemiology of (ab)use and electronic commerce of Psychedelics has been well-mapped in the developed world. However, countries from the developing world are yet to be explored. Principles of psychology including thematic psychoanalysis were not implemented before in connection with psychedelics.MATERIALS & METHODS: This study is based on an internet snapshot technique; it will explore and analyse the comments of psychedelics’ (ab)users in relation to the possibility of abuse of some granted power (authority); several demographic parameters of (ab)users will be explored. The snapshot will implement thematic analysis and psychoanalysis of comments found on drug fora and social communication media.RESULTS: The highest contribution of psychedelic users existed in the developed world, while the developing countries including the Middle East contributed the least. More than half (57%) of Psychedelic (ab)users tend to misuse power, which may indicate an existing psychopathology.CONCLUSION: Psychedelic users tend to mishandle the use of authority. The prevalence of psychedelic (ab)users in the Middle East is considered to be minimal. Additional analyses are required and in different populations of students, academics, medical professionals, psychiatric patients, prisoners, terrorists, and military organisations.

Captagon, Octodrine, and NBOMe: An Integrative Analysis of Trends Databases, the Deep Web, and the Darknet

BACKGROUND: Captagon, Octodrine, and NBOMe are unique substances; each represents a chemical category of its own pharmacodynamic and pharmacokinetic properties. Captagon is an amphetamine-type stimulant, while octodrine is a sympathomimetic agent, on the other hand, NBOMe is a hallucinogen (psychedelic substance). However, the mechanism of action for each is exerted via monoamine transporters.MATERIALS & METHODS: This study will explore these substances using an integrative approach via the analysis of the surface and deep web, and a trends database. The aims are; to visualise the extent of diffusion of each substance on the internet, conclude the geo-mapping for the diffusion, to see if the patterns are compatible on both divisions of the web, and to infer data on the basis of the power (authority) for e-vendors on the darknet e-marketplace. This study is a hybrid of cross-sectional and retrospective analyses.RESULTS: Google Trends analyses confirmed that the popularity of captagon is ahead over both NBOMe and octodrine; captagon popularity was correlated with terror attacks in the developed world, particularly in western European countries. The contribution of the developing countries to the diffusion of these substances, including the Middle East, was minimal.CONCLUSION: This study proposes a novel method to analyse the e-markets on the darknet via the use of; analysis of the basis of power, inferential statistics, geo-mapping in parallel with data from Google Trends database. Data from Google Trends can serve as a foundation for data mining techniques for an efficient warning system against an anticipated swarm of intoxications or an attack of terror.

Analysis of the Bases of Power of Key Players in the Industry of Novel Psychoactive Substances

BACKGROUND: The study of novel psychoactive substances (NPS) should be at the intersect of neuroscience, psychology, social science, data science, information and communication technology, policy-making, and legislation. The amalgamation of social science should be widely implemented; the concept of the individual basis of power (authority) has been applied in this study; the aim was to quantify the magnitude of authority for the major players in connection with the NPS industry.MATERIALS & METHODS: Data were collected for NPS researchers and e-vendors. Concerning the NPS scientists, fifty researchers were randomly picked using a random number generator. For each researcher; a power score was calculated; the power scoring is representative for the individual basis of power. There will be a kindred analysis for e-vendors on the darknet; the power scoring will rely on; e-vendor level, trust level, duration of membership in the e-market (vendor's antiquity), number of positive and negative feedbacks from e-customers, number of sold substances, number of subscribers, and e-vendor’s scoring on Grams search engine.RESULTS: Unfortunately, the summative power scores of NPS protagonists were higher than those who oppose and regulate the NPS phenomenon. Terrorist organisations were found to possess the highest power scores due to the additional use of illegal tactics. Power scoring for NPS researchers was highest in Europe, particularly the in the UK and Italy. On the other hand, e-vendors’ power scoring was highest for the AlphaBay e-market of the darknet.CONCLUSION: Principles of social science and psychology should be integrated into the collaborative efforts of NPS researchers. This study proposes a novel method to assess the authority of NPS-related personnel existing within the virtual space of the web; its applications are not limited to NPS researchers and e-vendors but can also be applicable for; e-markets, e-customers and (ab)users, and policy makers.

Let’s Go Out For A Day Trip? Perspectives of Psychedelics (Ab)Users on the Safety of Acid (LSD) Tripping in Public Places

BACKGROUND: Novel psychoactive substances (NPS) represent a unique phenomenon of the 21st century. These substances are of critical consequences on public health and national economies. Hallucinogens, also known as psychedelics and entheogens, represent one category of NPS. Numerous private groups do exist on the online drug fora and the online social platforms including Facebook. Psychedelic tripping or acid trip (using LSD) depicts one of the controversial life experiences; tripping can be indoor or in public.MATERIALS And METHODS: This study is observational and cross-sectional; it was based on an Internet Snapshot taken for a private group on Facebook; the group is dedicated for (ab)users of psychedelic substances. The snapshot was captured for a thread in relation to a critical question which was posted on the safety of day tripping using acid (LSD) in public places. Individual accounts of commenters (n=172) were analyzed in relation to demographics, length and themes of comments, and the attitude towards public tripping. This study is the first of its kind; it aims to conclude with an inference whether outdoor tripping is favourable by psychedelics users or not.RESULTS: A total of 137 psychedelic users’ comments were analyzed out of 172 (79.7%); males contributed more (n=111, 81%); the mean age was 32.14 years; most were Caucasian males from the US. (Ab)users were mainly geo-mapped into the US (85.4%), Canada (5.1%), and UK (3.7%). Those who had a positive attitude in relation to day tripping public places accounted for three-quarters (75.2%). Ethnicities and nationalities had no differential effect on a psychedelic user’s age nor his (her) enthusiasm for day tripping. However, (ab)users from the US were found to be more enthused. Further, there was a significant difference in relation to the attitude in between individuals with; positive attitude and negative attitude (p-value<0.001).CONCLUSION: Psychedelics (ab)users appeared to be in favour of having an acid trip in public; those were mainly geographically mapped into the developed countries, while the contribution of the developing countries was minimal. This study can be copied to populations of interest of different backgrounds, cultures, and ethnicities in an aim to infer changes in trends and preferences of individual users across time and place.

Commercial Acetic Acid: A Potential Regenerative Agent for Chronic Cutaneous Wounds? A Quasi-Experimental Study

BACKGROUND: The acetic acid in the form of vinegar has been used for medicinal purposes since ancient times. Acetic acid is reported to be used for medicinal uses at 1-5% concentration. The mechanism behind the regenerative potential of commercial acetic acid has not been fully explored.MATERIALS & METHODS: Twelve Iraqi patients with chronic skin ulceration were admitted and managed at a Dermatology clinic. Patients included men (7) and women (5) of diverse age groups (23-81 years). The aetiology behind the skin ulceration included; diabetic ulcer, decubitus ulcer, and others induced by trauma, bone fracture, insect bites and substance abuse. All patients were strictly treated with commercial acetic acid (at 4-6% concertation) and followed-up in time until the complete resolution of their cutaneous ulcerations.RESULTS & DISCUSSION: This study is quasi-experimental; two cases are discussed thoroughly; the first case belongs to a Caucasian male aged 26 years with schizophrenia and addiction towards psychoactive substances; he developed a refractory ulcer in left cubital fossa following an intravenous injection. The second case belongs to a middle age male patient, hypertensive otherwise healthy; he had a displaced intra-articular fracture affecting the distal end of the left radius; it was surgically treated with an internal fixation which was incriminated for the development of an ulcer over the volar aspect of left forearm overlying the internal fixation site. Local disinfection with commercial apple vinegar was very effective in restoring the skin integrity with minimal scarring.CONCLUSION: The regenerative potential of acetic acid has been marginally covered in the literature. The presented cases indicate a regenerative potential or at least an accelerant role in the process of cutaneous wound healing and repair.

Retrospective Analyses of High-risk NPS: Integrative Analyses of PubMed, Drug Fora, and the Surface Web

BACKGROUND: Novel psychoactive substances (NPS) can be classified based on their safety for use into low-risk and high-risk. High-risk NPS can be either lethal or poisonous. Fatalities can be either pharmacological or behavioural-induced, including suicide and homicide.MATERIALS & METHODS: Observational analysis, including retrospective, were implemented across; Google Trends, PubMed/MedLine database; Drug Fora, and the surface web. The aim was to collect data in relation to incidents of intoxication and fatalities caused by forty-seven (47) of the most popular NPS and to infer the high-risk (hazardous) substances. Geo-mapping was also applicable. Inferential analyses were also carried out to deduct data on the different age grouping of (ab)users.RESULTS: Among the most popular NPS substances, nearly half of them were labelled as high-risk due to their relatively high incidence of intoxications and deaths. The substances included; DMA/DOX, MXE, Mescaline, Methylone, Crack, GHB, Benzodiazepines, NBOMe, 2C-B, DMT, Stimulants RCs, Shrooms, Ketamine, Opioids, Heroin, Meth, Speed, LSD, MDMA, and Cocaine. Many of these substances were either psychedelic or dissociative substance. Geo-mapping of use indicated that the top ten contributing countries were; Australia, Canada, United States, United Kingdom, New Zealand, Ireland, Norway, Netherlands, Switzerland, and Estonia. The contribution of the Middle East was insignificant, although data have regularly been noticed originating from Israel, Iran, and Turkey.CONCLUSION: In this study, an unconventional inferential method is suggested for analysis of high-risk NPS; it is based on cross-sectional and longitudinal analysis of data. It relies primarily on data from; the surface web, Google Trends, PubMed/Medline database, and drug fora. This method is not only descriptive but also inferential for age and gender among (ab)users of a diverse array of high-risk NPS substances.

The Preferred Terminology Implemented by Psychedelic Users Existing on Online Platforms: A Cross-sectional Analysis

BACKGROUND: The epidemiologic magnitude of the NPS (ab)use has been thoroughly explored and geographically mapped in the developed world. However, there are still untapped geographic locations primarily in the developing countries including the Middle East. Historically, mapping has been done via observational analytics, cross-sectionally and longitudinally, in addition to few experimental studies.MATERIALS & METHODS: The study is cross-sectional; it will implement the internet snapshot technique, in addition to the application of thematic analysis and psychoanalysis of comments of NPS (ab)users on the online drug fora and social communication media. The data collected will be analysed for the purpose of concluding a statistical inference in relation to the terms most preferred by substance (ab)users towards hallucinogenic substances.RESULTS: The population was dominated by right-handed males; most of which were either heterosexual or bisexual. Psychedelics users have a preference for specific terms; psychedelic (73%), entheogen (12%), hallucinogen (11%), spiritual aids (3%), mysticomimetic (1%), psychotomimetic (<1%), medicines (<1%), and trip (<1%). Right-handed users who used the term psychedelic were a majority (53%), while right-handed individuals using the terms entheogen and hallucinogen contributed to 8% for each.CONCLUSION: This study is in line with other studies confirming the minute contribution of the Middle East to the global NPS phenomenon. Additional studies are mandatory for different populations including; students, academics and researchers, medical professionals, psychiatric patients, military and para-military organisations, delinquent and prisoners, and even terrorists.

NBOMe Compounds: Systematic Review and Data Crunching of the Surface Web

BACKGROUND: NBOMe compounds, some of which commercially known as “N-Bomb” or “Smiles” signifying their potency, represent a uniquely potent group of phenethylamine derivatives. These have been recently used in the past decade for their powerful hallucinogenic properties to induce a “psychedelic trip”.METHODS: This study is an analytics of the surface web incorporating data from; the published literature, grey literature, drug fora, and trends’ databases. The study aims to review the pharmacodynamic effects of three most popular N-Bombs (25b, 25c, and 25i), analyse reported cases of intoxications and fatalities, and correlate these incidents with data retrieved from Google Trends.RESULTS: The potency and popularity of NBOMe compounds are tallied worldwide, 25b-NBOMe (least potent and least popular), 25i-NBOMe (most potent and most popular), while the 25c-NBOMe is in the middle. The popularity of each has been on the rise since 2011-2012, these compounds are most popular in the United States and the United Kingdom, while data from the developing world and the densely-populated India and China are either lacking or inadequate. The reported cases of intoxications and deaths were statistically proven to be correlated with the trends’ dataCONCLUSION: Inferential statistical information has associated cases of NBOMe(s)’ morbidities-mortalities with the public interest of surface web users in these hallucinogens. This study can serve a blueprint for an early warning system to be activated based on changes in trends’ data.

The Most Popular Chemical Categories of NPS in Four Leading Countries of the Developed World: An Integrative Analysis of Trends Databases, Surface Web, and the Deep Web

BACKGROUND: New psychoactive substances are very diverse; hundreds exist today. Several schemes exist to categorise them; NPS can be classified into Cannabinoids and Cannabimimetics (1), Phenethylamines (2), Cathinones (3), Tryptamines (4), Piperazines (5), Pipradrol derivatives (6), and miscellaneous substances (7)MATERIALS & METHODS: Observational analyses via multiple internet snapshots will be carried out on the surface web and the deep web. The analyses will be hierarchical and integrative to infer the most popular categories of NPS based on the attentiveness (interest) of web users.RESULTS: Analysis of Google Trends from 2012 to the end of 2016, shows that interest in cannabinoids was the highest (98%), while all other chemical categories of NPS summed up to a tiny fragment (2%). The trends were highly oscillating over the years and shooting up during holiday seasons. Geo-mapping and localisation of the Middle East were not possible (not allowed) via Google Trends, while trends were attributed to four major leading countries of the developed world; US (35%), UK (17%), Canada (26%), and Australia (22%). Cannabinoids and stimulants were also found to be the most popular on the darknet.CONCLUSION: A novel method is proposed in this study; it has been carried out to provide an updated extrapolation on the most favoured chemical categories of NPS. This method is based on a combinatory examination at multiple levels of the surface web and the deep web. Furthermore, this method when potentially combined with data mining tools should provide unprecedented real-time analyses of high quality.

The NPS Phenomenon and the Deep Web: Internet Snapshots of the Darknet and Potentials of Data Mining

BACKGROUND: The illegal electronic trade of NPS substances on the deep web and the darknet have never been thoroughly mapped. This study will propose and illustrate a blueprint for mapping of the darknet e-marketplace, including activities originating from the Middle East.MATERIALS & METHODS: Multiple Internet snapshots were taken for the darkest e-marketplace, e-markets, Grams search engine, and e-vendors. In relation to the most popular and high-risk NPS substances, the most dominant e-market will be identified. Special correlation will be carried out with the; population count of shipping countries of NPS, the incidence of rape and sexual assaults, and religious affiliation.RESULTS: The most popular high-risk NPS were identified; cannabis and cannabimimetic, MDMA, crack, Meth, and LSD. These were geo-mapped primarily into; Netherlands, US, UK, Germany, Australia, Canada, France, and Spain. AlphaBay e-market was found to be a proper representative for the darknet e-marketplace; the main advertised NPS were categorised into cannabis and cannabinoids (1), stimulants (2), empathogens (3), psychedelics (4), benzodiazepines (5), opioids (6), and prescription-related substances (7). The contributing Middle Eastern and Arabic countries included; UAE, Oman, Morocco, Egypt, and Cyprus.CONCLUSION: The e-commerce activities on the darknet have been ever evolving. Future attempts to study this e-marketplace should be innovative and rely on statistical inference. A blueprint is required for geo-mapping of the shipping countries, including those from the region of the Middle East. Principles of social sciences, including the analysis of the individual basis of power, should be considered.

(Dis)Inclination of Iraqi Medical Students Towards Creative Thinking: A Quasi-Experimental Study

BACKGROUND: There have been several attempts in the past centuries to quantify the human intelligence, many of these attempts were successful. On the other hand, there have been parallel trials to identify and quantify an individual’s creativity. To date, there is no universal definition of creativity nor a quantifying system to measure it with a reliable accuracy.MATERIALS & METHODS: This is a quasi-experimental study in an Iraqi population of undergraduate medical students aged 18-20 years; the male-to-female ratio is 3 to 10. The total number of participants was 195 (n=195) who were allocated into three groups; A, B, and C (nA=67, nB=61, nC=67). Each group was interviewed separately, and the participants were given a choice to either correspond to a quiz on an already taught medical subject or write down ideas (one or more) with creative-innovative potentials. There was no restriction on time, language, or the theme of the topics to be written.RESULTS: There was a significant difference in between the three groups’ tendency to take the quiz (p-value=0.040). However, inter-group and intra-group analyses failed to detect any significant difference in students’ tendencies towards either a creative or a classical form of thinking. Besides, gender was not found to be of a determinant effect on an individual’s tendency towards creativity (p=0.633) or traditional thinking based on an already taught medical knowledge (0.905).CONCLUSION: There were no statistically significant differences in the tendencies of students towards either an original (creative) or a standard pattern of thinking. However, inter-group analyses indicated some substantial differences in students’ affinity towards exploring an already taught medical knowledge.

The NPS Phenomenon and the Deep Web: Trends Analyses and Internet Snapshots

BACKGROUND: In relation to the phenomenon of novel psychoactive substances, activities on the surface web represent only the tip of the iceberg. The majority of the electronic commerce (e-commerce) activities exist on the deep web and the darknet. Observational analytic studies are failing to keep pace with these activities; these studies are either obsolete beyond the point in time of the taken internet snapshot or highly-consuming for resources including time, funding, and manpower.MATERIALS & METHODS: Cross-sectional and retrospective analyses via multiple Internet snapshots were carried out across Google Trends database and the e-markets on the darknet. Google Trends were scanned retrospectively (2012-2016) for keywords specific to the deep web in an aim to estimate and geo-map of the attentiveness (interest) of surface web users in the deep web and its illicit activities.RESULTS: The attentiveness of surface web users in the deep web was noticed to be incremented during 2013 and 2014; the top ten contributing countries were Norway, Germany, Denmark, Austria, Poland, Sweden, Slovenia, Switzerland, Finland, and Netherlands. Middle Eastern countries contributed minimally including; Syria, Iran, Israel, UAE, Morocco, Egypt, and Saudi Arabia. Power scoring of e-markets revealed that the top five markets were; AlphaBay, Agora, Nucleus, Abraxas, and Hansa. The most common categories of NPS on these markets were; cannabis and cannabimimetic (1st), stimulants (2nd), empathogens (3rd), and psychedelics (4th).CONCLUSION: The e-commerce activities on the deep web and the darknet e-marketplace represent an integral component of the NPS e-phenomenon. Unfortunately, recent attempts to examine and study those unlawful activities are outdated. Hence, to achieve real-time and reliable data, the inclusion of data mining tools and knowledge discovery in databases are critical to ensuring a future victory.

Google Trends Analyses and Case Report: A Persistently Dilated Pupil in Psychedelics’ User

An eighteen years old female patient of the Caucasian ethnicity from New Zealand, she presented with a persistently dilated pupil causing her discomfort and occasional burning sensation when outdoor due to an oversensitivity to sunlight. However, her pupillary reaction to light (pupillary light reflex) was intact. The patient is a known user of psychedelic substances (entheogens) including LSD, NBOMe, psilocybin, and DMT. The condition affects both eyes to the same extent. A thorough medical, neurological, and radiological examination, including an EEG and an MRI of the head and neck region, were completely normal. All these tests failed to detect any pathophysiological or anatomical abnormalities. The patient is a known case of chronic endogenous depression in association with attention deficit hyperactivity disorder, for which she is medicating with citalopram and Ritalin respectively. There was neither a family history nor a similar congenital condition in her family. Collateral inferential statistical analyses were implemented in relation to Google Trends database to seek out relevant data in relation to psychedelic substances and their corresponding geographic mapping.

Knowledge and (Ab)Use in Connection with Novel Psychoactive Substances: A Cross-Sectional Analysis of Psychedelic Users Existing on Online Platforms

BACKGROUND: The prevalence of use and misuse of novel psychoactive substances (NPS) has been escalating at an exponential rate in the past two decades. Studies on NPS are highly concentrated in relevance to the developed world, while few have been undertaken in the developing countries.MATERIALS & METHODS: This study is observational and cross-sectional in nature; it relies on a web-based survey distributed to a population of (ab)users of psychedelics and NPS; this community was accessible via dedicated online platforms psychedelics users located on the Facebook social communication medium. The aim of the study is to estimate the level of knowledge and the extent of (mis)use in connection with psychoactive substances, including the novel ones (NPS).RESULTS: The number of participants who responded to the survey reached 458 responders. The level of knowledge and (ab)use was relatively high. The majority of participating individuals were Caucasians males from the developed world including the US, the UK, India, and western European countries. The primary religious affiliation was either agnosticism or atheism. Approximately, 26% were diagnosed with the neuropsychiatric condition.CONCLUSION: The NPS phenomenon is still a major concern primarily in the developed world. Additional studies are required in virtual and non-virtual populations. The targeted populations should include; students, medical professionals, academics, patients with psychiatric and neurological abnormalities, convicts and criminals, and even terrorists.

Knowledge and (Ab)Use in Connection with Novel Psychoactive Substances: A Cross-Sectional Analysis of Iraqi Medical Students

BACKGROUND: The extent of (ab)use of the Novel Psychoactive substances has been thoroughly mapped in the developed world, particularly in the US, Canada, UK, Western Europe, Australia, and New Zealand. However, there are still untapped geographic locations particularly in the developing world including the Middle East.MATERIALS AND METHODS: This study is observational in nature and cross-sectional in design; it is based on a survey that will aim is to estimate the level of knowledge and the extent of (ab)use of psychoactive substances, traditional and novel, in a population of undergraduate medical students from Iraq. There will be an implementation of inferential statistical analyses for the purpose of hypothesis testing. Ethical approvals were granted from the College of Medicine at the University of Baghdad and the University of Hertfordshire.RESULTS: There was some degree of knowledge in connection with psychoactive substances among a population of medical students. However, the extent of (ab)use is still minimal when compared to that of the developed countries. In general, the knowledge and the extent of NPS (ab)use did not vary substantially as the students progressed through the medical college.CONCLUSION: The use of observational analytic tools for assessing the diffusion of the phenomenon of psychoactive and novel psychoactive substances is indispensable. The extent of knowledge and (ab)use of NPS in the Middle East may still be considered minute or insignificant. Further analyses are required in the Middle East; different populations are to be targeted including; students, academics, researchers, medical and paramedical staff, psychiatric patients, prisoners, military and para-military organisations, and even terrorists.

Captagon: use and trade in the Middle East

BACKGROUND

Fenetheylline, a psychostimulant drug, often branded as Captagon, is a combination of amphetamine and theophylline. Since the cessation of its legal production in 1986, counterfeited products have been produced illicitly in south-east Europe and far-east Asia. Its profitable trade has been linked to terrorist organizations, including Islamic State of Iraq and the Levant. This study aims to reach up-to-date data, concerning the Captagon e-commerce and use in the Middle East.

METHODS

A multi-staged and multi-lingual literature search was carried out. A list of prespecified keywords was applied across medical and paramedical databases, web and Dark web, search engines, social communication media, electronic commerce websites, media networks, and the Global Public Health Intelligence Network database.

RESULTS

The use of Captagon as a stimulant in terrorist settings has been marginally covered in the literature. Data can widely be retrieved from Google and AOL search engines, YouTube, and Amazon e-commerce websites, and to a lesser extent from Alibaba and eBay. On the contrary, Middle Eastern e-commerce websites yielded almost no results. Interestingly, the Dark web generated original data for Captagon e-commerce in the Middle East.

CONCLUSION

Further investigations are needed on the role that psychoactive drugs play in terrorist attacks and civil war zones. Unless a comprehensive methodological strategy, inclusive of unconventional methods of research, is implemented, it will not be feasible to face such a threat to humanity.

The relation between cerebral dominance and visual analytic skills in Iraqi medical students, a cross sectional analysis

Background: Cerebral dominance, also known as lateralization of brain functions, is the neurologic phenomenon in which one hemisphere is dominant over the other, and will thereby exercise greater influence over certain functions. The cerebral lateralization of many vertebrates, indicates an evolutionary advantage associated with the cerebral specialization. In humans, the majority of people are of left cerebral dominance. True bilateral cerebral dominance, manifested in ambidexterity, is exceedingly rare.Aims and Objective: To derive a statistical inference between determined parameters of cerebral dominance and the 3-dimensional visual analytic skills. The parameters are: handedness, , gender, and language skills.Materials and Methods: This survey targeted an audience of undergraduate medical students, 103 of them replied and fully completed an electronic-distributed survey. All participants were blinded to the outcome and aims of the study (single-blinded experimental design). The survey was created via Google Forms, and made available online for three days, on the University intranet system. Compiled data resulted in 523 pages. Statistical analyses were conducted using the Statistical Package for Social Sciences, Shodor-Interactivate software, and Microsoft Excel 2016. References of this paper, were retrieved via a detailed systematic review of literature databases, while carrying out critical evaluation of evidence. The databases included: PubMed, The Cochrane Library, Scopus, OpenGrey, and Google Scholar.Results: Males and females participated in the survey (34 and 69 participants respectively), 91 of participants (88.4%) were right-handed. Mapped participants’ demographics included: age, gender, handedness, siblings’ and parents’ handedness, number of siblings and birth order, and number of spoken languages. The 3D-visual analytic skills, were evaluated via a cross sectional survey and objectively-evaluated via a professional visual IQ testing. Statistics proven that there was no significant correlation between the 3D-visual skills and any of the tested parameters. Significance was considered at a p-value of 0.05 or less.Conclusion: In this sample of 103 tested subjects, all of which were not professional Anatomists. Our tested hypothesis of the presence of potential correlation between handedness (and other parameters of cerebral dominance) with the three-dimensional visual analytic skills, were proven statistically to be non-existent. Asian Journal of Medical Sciences Vol.7(5) 2016 47-52

Medio-lateral inclination of proximal and distal articular surface of the radius

Background: The radius, also known as the radial bone, is the shorter of the two bones of the forearm. It has proximal and distal articulations with the humerus, ulna, and carpal bones. It is almost universally present,as a skeletal blueprint, in eachtetrapod’s forelimb. The detailed morphometry of radius, has not been fully explored. Specifically, the inclination of its proximal and distal articular surfaces, which can be affected in many pathologies including: fractures-dislocations, joint’s degenerations, tumors, dystrophic calcifications, and pathologic deposits.Aims and Objectives: To derive a statistical inference concerning the inclination of the proximal and distal articular surface of radius.Materials and Methods: In a sample of 30 dry specimens of human radial bone (radius), measurements were done to derive statistical inference concerning: the inclination of proximal and distal articular surfaces (P and D), length of radius (L), mid-point thickness (T), length of head of radius (HL). Materials used for measurements included: electronic Vernier, digital inclinometer, and a tape measure. The most challenging parameter to be measured, was the inclination of articular surfaces, which required multiple reference points: at the interosseous border of radius, proximal and distal ends of radius.Results: The mean values (+/- standard deviation) were: 22.23 +/- 1.89 cm (L), 1.43 +/- 0.2 cm (T), 0.95 +/- 0.135 cm (HL), 6.283 +/- 3.253 (P), and 23.77 +/- 1.874 (D). The 95% Confidence Interval was: 0.90 to 1 (HL), 5.07 to 7.50 (P), and 23.07 to 24.47 (D). Linear regression was absent between most of the studied parameters, with exception for the correlation between the inclination of the proximal articular surface and the value of (P/HL), which revealed a Correlation coefficient (r): 0.958, and the relevant p-value is < 0.00001 (significant at p< 0.01).Conclusion: This study is in line with prior studies concerning the morphometry and inclination of radial articular surfaces. It has a tremendous value in biomedical science, biomechanical applications and prosthesis synthesis, corrective surgical and orthopedic procedures, anthropology, and forensic sciences.Asian Journal of Medical Sciences Vol.7(5) 2016 117-123