Mohammed Merzah

The association between alcohol consumption and Parkinson's disease (PD) risk remains unclear, whereas smoking has an inverse relationship with the disease. This study systematically reviewed and meta‐analyzed 16 studies (2014–2024) from PubMed, Scopus, Web of Science, MEDLINE, and the Cochrane Library to assess the relationship between alcohol intake and PD risk, examining sex differences, dose–response patterns, smoking interactions, and genetic factors. Alcohol consumption was classified as low, moderate, or heavy, considering beverage type, sex, smoking status, and gene–environment interactions. Random‐effects meta‐analyses were used to evaluate sex‐stratified and subtype‐specific associations. PD progression, Mendelian randomization (MR), and gene–environment results were narratively synthesized. Sex‐stratified analyses showed inverse associations between alcohol consumption and PD risk versus non‐drinkers (lifetime relative risk [LRR] = −0.35 to −0.62), with significant effects in women and no association in low‐level drinkers. Subtype analyses indicated protective effects for liquor (RR = −0.12) and wine (RR = −0.16), but not for low‐level drinkers. Combined alcohol and smoking exposure produced the greatest PD risk reduction (LRR = −0.37), with pooled estimates confirming an inverse association (LRR = −0.20, I ² = 90.1%). However, MR and gene–environment studies showed inconsistent evidence. Light‐to‐moderate alcohol consumption, particularly wine and liquor, may reduce PD risk, with the strongest effects when combined with smoking. These findings highlight the combined effects of sex, genetic susceptibility, and lifestyle factors. Further longitudinal and MR studies stratified by sex and genotype are needed to elucidate the mechanisms; however, smoking cannot be recommended due to its detrimental effects. © 2026 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Cancer is one of the biggest health burdens for women in the Middle East and North Africa (MENA), with the incidence of breast, cervical and colorectal cancer on the rise. Although preventive measures such as the HPV vaccination and population-based screening are available, access to them remains very unequal. Women in rural, low-income and refugee communities face additional barriers, cultural stigmatisation, low health literacy, gender norms and fragile health systems, leading to delayed diagnoses and poorer outcomes. This review summarises the results of 724 peer-reviewed publications to assess the current situation of cancer screening in MENA and Mediterranean countries. The studies were classified into four dimensions: cancer type (breast, cervical, colorectal), behavioural constructs (awareness, uptake, education), vulnerability factors (e.g., migrants, refugees, low-literacy groups), and geography (indigenous MENA populations versus diaspora and Mediterranean immigrant communities). The results show large inequalities in access and participation due to fragmented policies, socio-cultural resistance and infrastructure gaps. Nevertheless, promising approaches are emerging: community-led outreach, mobile screening programmes, AI-assisted triage and culturally appropriate digital health interventions. Comparisons between the local and diaspora populations make it clear that systemic and cultural barriers persist even in well-equipped facilities. Closing the screening gap requires a culturally sensitive, digitally enabled and policy aligned approach. Key priorities include engaging religious and community leaders, promoting men’s engagement in women’s health and securing sustainable funding. With coordinated action across all sectors, MENA countries can build inclusive screening programmes that reach vulnerable women and reduce preventable cancer mortality.

Background/Objectives: Despite the availability of highly effective medications, hypertension is among the most important risk factors for mortality. Because medication adherence is challenging worldwide, enhancing it to improve the prognosis of hypertension is useful. The aim of this study was to describe the prevalence of antihypertensive medication nonadherence among individuals aged 18–64 years in a deprived Hungarian population and its determinant factors, and to quantify the impact of antihypertensive medication nonadherence on premature mortality. Methods: We used data from a cohort of hypertensive individuals aged 18–64 years linked to the Health Insurance Fund’s medication purchasing data. The antihypertensive treatment adherence appropriateness (ATAP) was computed as the ratio of the observed time when a patient was properly treated to their observed survival time. ATAP was dichotomized by an observed mean of 0.872. Using adjusted odds ratios (AORs) from multivariate logistic regression models with 95% confidence intervals (CIs), we analyzed the factors influencing the mortality risk in 4962 participants over seven years of follow-up. Results: A total of 493 deaths occurred. An extremely high mortality risk was observed among patients with inappropriate adherence (AOR = 56.2, 95%CI: 41.9–75.4), which could be attributed partly to residual confounding. Significant protective factors were female sex and high education attainment. However, older age and all investigated comorbidities (diabetes mellitus, ischemic heart disease, chronic obstructive pulmonary disease, and cancer) were significantly associated with an increased risk of a lethal outcome. Similarly, smoking was also a risk factor. Conclusions: Our investigation revealed the following: (1) in the studied group of patients aged 18–64 years from an extremely disadvantaged Hungarian population, 87.2% of the person-time was covered by the appropriate redemption of medications; (2) nonadherence to medication was more common among younger adults, men, Roma people, current smokers, and COPD patients, whereas the likelihood of appropriate adherence was higher among patients with diabetes mellitus; (3) medication nonadherence was an extremely strong risk factor for a lethal outcome of HTN during the 7-year follow-up period; and (4) methods by which nonadherent patient behavior can be detected should be applied rigorously, and the detected nonadherence should be considered a signal for intervention to improve the prognosis of HTN.

Cancer is one of the biggest health burdens for women in the Middle East and North Africa (MENA), with the incidence of breast, cervical and colorectal cancer on the rise. Although preventive measures such as the HPV vaccination and population-based screening are available, access to them remains very unequal. Women in rural, low-income and refugee communities face additional barriers, cultural stigmatisation, low health literacy, gender norms and fragile health systems, leading to delayed diagnoses and poorer outcomes. This review summarises the results of 724 peer-reviewed publications to assess the current situation of cancer screening in MENA and Mediterranean countries. The studies were categorised along four dimensions: Cancer type (breast, cervical, colorectal), behavioural constructs (awareness, uptake, education), population vulnerability (e.g. migrants, refugees, low literacy groups) and geographical context (indigenous MENA population vs. diaspora communities). The results show large inequalities in access and participation due to fragmented policies, socio-cultural resistance and infrastructure gaps. Nevertheless, promising approaches are emerging: community-led outreach, mobile screening programmes, AI-assisted triage and culturally appropriate digital health interventions. Comparisons between the local and diaspora populations make it clear that systemic and cultural barriers persist even in well-equipped facilities. Closing the screening gap requires a culturally sensitive, digitally enabled and policy aligned approach. Key priorities include engaging religious and community leaders, promoting men's engagement in women’s health and securing sustainable funding. With coordinated action across all sectors, MENA countries can build inclusive screening programmes that reach vulnerable women and reduce preventable cancer mortality.

Background: Numerous healthcare services have been affected by the COVID-19 pandemic worldwide. Specialized healthcare services were postponed or canceled, potentially compromising regular services for hemato-oncology patients. The current study aimed to analyze the impact of the COVID-19 pandemic on access to hemato-oncology services in Almaty, the largest city in Kazakhstan. Methods: We retrospectively analyzed the socio-demographic characteristics of patients admitted to two large tertiary centers rendering hemato-oncology services, the City Clinical Hospital 7 (H7) and the Kazakh Institute of Oncology and Radiology (KazIOR). All data were retrieved for the period spanning from 1 March 2019 to 28 February 2022. The retrieved variables included age, gender, type of residence, hospitalization rate, treatment outcomes (discharged/deceased), bed days, diagnoses according to International Classification of Diseases (ICD-10) (acute leukemia and hematopoietic depression, lymphoproliferative diseases, and myeloproliferative diseases), and referral sources (ambulance, another hospital, consultative and diagnostic assistance, primary healthcare, self-referral, and referrals from hematologists’ offices). Results: In the 2019–2022 period, 6763 hemato-oncology hospitalizations were registered: 3583 in H7 and 3180 in KazIOR. The mean age at hospitalization was 55.04 (SD = 16.07) for females and 51.2 (SD = 16.7) for males. The proportion of hospitalized urban and rural patients differed significantly: 6191 (92%) and 571 (8,4%), respectively (χ² = 13.8, p = 0.001). In the 2020–2021 period, fewer patients were discharged (n = 2047) compared to 2019–2020 (n = 2387) and 2021–2022 (n = 2081) (χ² = 20.09, p = 0.003). However, the proportion of deaths in the 2020–2021 period (3.5%) was higher than in the 2019–2020 (3.2%) and 2021–2022 periods (2.6%) (χ² = 20.09, p = 0.003). A total of 403 (19%) hospital admissions were carried out by ambulance (emergency cases) in the 2020–2021 period, 368 (14.8%) in 2019–2020, and 394 (18.3%) in 2021–2022 (χ² = 2231, p < 0.001). The number of patients transferred from other hospitals to H7 and KazIOR increased by 12.4% in the 2020–2021 period. Conclusions: Our findings indicate a negative impact of the COVID-19 pandemic on access to hemato-oncology services, leading to increased mortality. Further studies are warranted to explore factors underlying the trends in hospitalizations and mortality of hemato-oncology patients during healthcare crises.

Background: Childhood vaccination is crucial for preventing infectious diseases, yet parental concerns and hesitations persist. Understanding and assessing parental knowledge, attitudes, and practices (KAP) regarding vaccines is essential, as these factors influence confidence in vaccination and adherence to immunization schedules. Methods: This meta-analysis synthesized evidence on Arab parents' KAP toward childhood vaccination, based on a systematic review of eligible studies and pooled analysis using a random-effects model. Results: Fifteen studies were included: 14 reported knowledge scores (9,035 participants), 13 reported attitudes (8,523 participants), and 7 reported practices (5,106 participants). The pooled estimates were 0.73 for good knowledge (95% CI: 0.62–0.81), 0.83 for positive attitudes (95% CI: 0.74–0.89), and 0.77 for good practices (95% CI: 0.64–0.86), all with high heterogeneity (I² >97%). Meta-regression showed persistent variability (I² = 92.7%, 99.2%, 98.7%), with no significant link between KAP scores and the proportion of mothers. Conclusion: This meta-analysis highlights a strong association between good parental knowledge and positive attitudes, which translate into favorable vaccination practices. However, high heterogeneity across studies due to differences in design, populations, and cultural context limits the generalizability of findings. These findings underscore the need for targeted educational interventions to enhance parental vaccine awareness and uptake.

Non-communicable diseases (NCDs) have become a major public health concern in Iraq, playing a significant role in the country’s morbidity and mortality rates. To offer a thorough overview of the patterns and the overall impact of NCDs on public health, this study aims to map the trends in the incidence, prevalence, and mortality rates of NCDs in Iraq between 2003 and 2021. Data from the Global Burden of Disease (GBD) Study 2021 were utilized. The focus was on Iraq from 2003 to 2021, a period marked by significant social and political changes. Using the GBD results tool, age-standardized prevalence, incidence, and mortality rates (ASPR, ASIR, ASMR) for 12 major NCDs were extracted and expressed per 100,000 population. Descriptive statistics with 95% uncertainty intervals were calculated, and trends were analyzed. The analysis revealed a nuanced trajectory of NCDs in Iraq between 2003 and 2021. The ASPR of all NCDs increased slightly (change %: 0.1, 95% UI: -2.2 to 2.4), with a notable decline in chronic respiratory diseases (change %: −14.4, 95% UI: (-30.9 to 6.1) and a significant rise in neoplasms (change %: 32.7, 95% UI: -5.9 to 81.3). The ASIR of diabetes and kidney diseases showed the largest increase (change %: 42.9, 95% UI: 28.4 to 59.3), while chronic respiratory diseases had the greatest decline (change %: −12.1, 95% UI: -36.8 to 22.5). Cardiovascular diseases remained the leading cause of mortality in both sexes, with ASMRs increasing slightly for males and decreasing for females over the period. Skin and subcutaneous diseases showed the highest increase in ASMR (change %: 48.2), while digestive diseases experienced the largest decline (change %: −21.4). The GBD 2021 study highlights progress in reducing NCD mortality in Iraq, especially among younger people. However, older males still face high death rates from cardiovascular diseases. Rising cases of cancer, diabetes, and kidney diseases signal the need for targeted interventions. Continued focus on risk factors and healthcare access is essential.

Smoking is a well known risk factor for coronary artery disease (CAD). However, the effects of smoking on gene expression in the blood of CAD subjects in Hungary have not been extensively studied. This study aimed to identify differentially expressed genes (DEGs) associated with smoking in CAD subjects. Eleven matched samples based on age and gender were selected for analysis in this study. All subjects were non-obese, non-alcoholic, non-diabetic, and non-hypertensive and had moderate to severe stenosis of one or more coronary arteries, confirmed by coronary angiography. Whole blood samples were collected using PAXgene tubes. Next-generation sequencing was employed using the NextSeq 500 system to generate high-throughput sequencing data for transcriptome profiling. The differentially expressed genes were analyzed using the R programming language. Results: The study revealed that smokers exhibited non-significant higher levels of total cholesterol, low-density lipoprotein-cholesterol, and triglycerides compared to non-smokers (p > 0.05), although high-density lipoprotein-cholesterol was also elevated. Despite this, the overall lipid profile of smokers remained less favorable. Non-smokers had a higher BMI (p = 0.02). Differential gene expression analysis identified 58 DEGs, with 38 upregulated in smokers. The key upregulated genes included LILRB5 (log₂FC = 2.88, p = 1.05 × 10⁻⁵) and RELN (log₂FC = 3.31, p = 0.024), while RNF5_2 (log₂FC = −5.29, p = 0.028) and IGHV7-4-1_1 (log₂FC = −2.86, p = 0.020) were notably downregulated. Heatmap analysis showed a distinct clustering of gene expression profiles between smokers and non-smokers. However, GO analysis did not identify significant biological pathways associated with the DEGs. Conclusions: This research illuminates smoking’s biological effects, aiding personalized medicine for predicting and treating smoking-related diseases.