World addiction medicine reports: formation of the International Society of Addiction Medicine Global Expert Network (ISAM-GEN) and its global surveys.

Addiction medicine is a dynamic field that encompasses clinical practice and research in the context of societal, economic, and cultural factors at the local, national, regional, and global levels. This field has evolved profoundly during the past decades in terms of scopes and activities with the contribution of addiction medicine scientists and professionals globally. The dynamic nature of drug addiction at the global level has resulted in a crucial need for developing an international collaborative network of addiction societies, treatment programs and experts to monitor emerging national, regional, and global concerns. This protocol paper presents methodological details of running longitudinal surveys at national, regional, and global levels through the Global Expert Network of the International Society of Addiction Medicine (ISAM-GEN). The initial formation of the network with a recruitment phase and a round of snowball sampling provided 354 experts from 78 countries across the globe. In addition, 43 national/regional addiction societies/associations are also included in the database. The surveys will be developed by global experts in addiction medicine on treatment services, service coverage, co-occurring disorders, treatment standards and barriers, emerging addictions and/or dynamic changes in treatment needs worldwide. Survey participants in categories of (1) addiction societies/associations, (2) addiction treatment programs, (3) addiction experts/clinicians and (4) related stakeholders will respond to these global longitudinal surveys. The results will be analyzed and cross-examined with available data and peer-reviewed for publication.

Tramadol, captagon and khat use in the Eastern Mediterranean Region: opening Pandora's box.

As defined by the World Health Organization, the Eastern Mediterranean Region (EMR), given its special geopolitical situation and internal/external conflicts, faces an increase in illegal activities such as drug production and trafficking, highlighting the need for a comprehensive understanding of the substance use situation. On the basis of a review of published papers between 2015 and 2021 we briefly review substance use in the EMR with special focus on the emerging drugs pertinent to this region, namely tramadol, captagon and khat.

Attitudes of medical students toward psychiatry in Eastern Mediterranean Region: A systematic review.

Background: Psychiatry is facing one of the highest levels of shortages among medical specialties. Stigma toward psychiatry plays an influential role in medical students' decision to choose psychiatry as a career and has been reported to be prevalent in different parts of the world, particularly in low/middle-income countries. Objective: To systematically review the Eastern Mediterranean Region (EMR) medical students' attitudes toward psychiatry, to assess whether their attitudes are stigmatized or not, and the factors affecting their attitudes. Method: PubMed, Scopus, Web of Science, and PsychInfo (PsycARTICLES) were searched using a combination of main terms "stigma," "psychiatry," "medical students," and the name of Eastern Mediterranean countries. Cross-sectional studies assessing the attitudes of EMR medical students toward psychiatry were included in this review. Results: Ten studies were eligible to be included in the result synthesis. These were from Pakistan (n = 3), Iran (n = 2), Saudi Arabia (n = 1), Lebanon (n = 1), Egypt (n = 1), Bahrain (n = 1), and Oman (n = 1). Most studies reported a combination of both positive and negative attitudes among medical students; however, the overall attitude was positive. Factors affecting medical students' attitude toward psychiatry included poor psychological well-being, having a friend with a psychiatric illness, involving in a romantic relationship with someone suffering from mental illness, young age, frequency of exposure to psychiatry clerkship/teaching, and quality of psychiatry clerkship. Nevertheless, the final positive or negative outcome of these factors on students' attitudes remained controversial. Conclusion: Considering the lack of sufficient data from most EMR countries, we need to exercise caution in interpreting the results of this review. Nevertheless, our review indicates that psychiatry is not stigmatized among EMR medical students, and they have generally positive attitudes toward it. The findings of studies evaluating influencing factors are contradictory and demand further exploration.

A Global Survey on Changes in the Supply, Price, and Use of Illicit Drugs and Alcohol, and Related Complications During the 2020 COVID-19 Pandemic.

Background and Aims: COVID-19 has infected more than 77 million people worldwide and impacted the lives of many more, with a particularly devastating impact on vulnerable populations, including people with substance use disorders (SUDs). Quarantines, travel bans, regulatory changes, social distancing, and "lockdown" measures have affected drug and alcohol supply chains and subsequently their availability, price, and use patterns, with possible downstream effects on presentations of SUDs and demand for treatment. Given the lack of multicentric epidemiologic studies, we conducted a rapid global survey within the International Society of Addiction Medicine (ISAM) network in order to understand the status of substance-use patterns during the current pandemic. Design: Cross-sectional survey. Setting: Worldwide. Participants: Starting on April 4, 2020 during a 5-week period, the survey received 185 responses from 77 countries. Measurements: To assess addiction medicine professionals' perceived changes in drug and alcohol supply, price, use pattern, and related complications during the COVID-19 pandemic. Findings: Participants reported (among who answered "decreased" or "increased") a decrease in drug supply (69.0%) and at the same time an increase in price (95.3%) globally. With respect to changes in use patterns, an increase in alcohol (71.7%), cannabis (63.0%), prescription opioids (70.9%), and sedative/hypnotics (84.6%) use was reported, while the use of amphetamines (59.7%), cocaine (67.5%), and opiates (58.2%) was reported to decrease overall. Conclusions: The global report on changes in the availability, use patterns, and complications of alcohol and drugs during the COVID-19 pandemic should be considered in making new policies and in developing mitigating measures and guidelines during the current pandemic (and probable future ones) in order to minimize risks to people with SUD.

Association between serum Vitamin E concentrations and the presence of Metabolic Syndrome: A population-based cohort study.

BACKGROUND: Metabolic syndrome (MetS) is a cluster of clinical and metabolic features that include central obesity, dyslipidemia, hypertension and impaired glucose tolerance. These features are accompanied by increased oxidative stress and impaired antioxidant defenses. Vitamin E is a major factor in the non-enzymatic antioxidant defenses. The aim of present study was to investigate the association between serum levels of vitamin E and the presence of MetS and its components in a sample population of Mashhad stroke and heart atherosclerotic disorder (MASHAD) cohort study. METHODS: This cross-sectional study was carried out in 128 subjects with MetS and 235 subjects without MetS. MetS was defined according to the International-Diabetes-Federation criteria. Serum levels of vitamin E were measured using the HPLC method. Anthropometric and biochemical parameters were measured using standard protocols.  Results. MetS patients had significantly lower serum levels of vitamin E (Vit E), Vit E/Total cholesterol (TC), and Vit E/ (TC+triglyceride(TG)) compared to the control group (P < 0.05).  Vit E/ (TG+TC) was also significantly lower in diabetics or those with elevated levels of high sensitive C-reactive protein (hs-CRP). Additionally, there was a significant association between Vit E/ (TG + Total Cho) and the number of components of the metabolic syndrome (p= 0.02) Conclusions. There is a significant inverse association between indices of Vit E status and the presence of MetS. Moreover, a significantly lower Vit E/ (TC+TG) was observed along with individuals with increasing numbers of components of the MetS.

COVID-19 and Substance Use Disorder: Study Protocol for the International Society of Addiction Medicine Practice and Policy Interest Group Global Survey.

INTRODUCTION: As one of the major health problems in the present century, the COVID-19 pandemic affected all parts of the global communities and the health of substance users are potentially at a greater risk of harm. This global study has been designed and conducted by the International Society of Addiction Medicine Practice and Policy Interest Group (ISAM-PPIG) to understand better the health related issues of people with Substance Use Disorders (SUD) as well as responses of the relevant health care systems during the pandemic. METHODS: This is a cross-sectional study using convenient sampling. The data gathering was carried out with two follow-up stages each two months apart through an online conducted survey prepared using Google platform. The survey started by emergence of COVID-19 as a pandemic in March 2020 and respondents were followed till September 2020 when most of the initial lockdowns by most countries are supposed to be reopened. ETHICS AND DISSEMINATION: The study was approved by the ethics committee of University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. The results will be published in relevant peer reviewing journals and communicated with different international stakeholders.

Association of Serum hs-CRP Levels With the Presence of Obesity, Diabetes Mellitus, and Other Cardiovascular Risk Factors.

BACKGROUND: Diabetes mellitus remains one of the major health problems of the 21st century and is associated with comorbidities including obesity and metabolic abnormalities. The study was conducted to evaluate serum high-sensitivity C-reactive protein (hs-CRP) levels, as a marker of inflammation, in a large sample of Iranian population without a history of cardiovascular or inflammatory disease and cancer, and to relate this to fasting blood glucose (FBG) and the presence of diabetes mellitus. METHODS: The study consisted of 7,762 subjects divided into four groups-nonobese/nondiabetic, obese/nondiabetic, nonobese/diabetic and obese/diabetic-based on the BMI classification and their FBG. Anthropometric characteristics were measured and blood was collected for the evaluation of fasted lipid profile, FBG and serum hs-CRP levels. RESULTS: Several clinical and biochemical characteristics were significantly different among the four groups: FBG, P < 0.001; total cholesterol (TC), P < 0.001; and triglyceride (TG), P < 0.001. The subjects with a serum hs-CRP >3 mg/dl had higher TC (P < 0.001), low-density lipoprotein cholesterol (LDL-C, P < 0.001), TG (P < 0.001), fat percentage (P < 0.001), and systolic and diastolic blood pressure (P < 0.001) compared with subjects with a serum hs-CRP <3 mg/dl. Multivariate analysis showed FBG, LDL-C, and waist circumference (WC) associated with increased serum hs-CRP levels (P < 0.001). CONCLUSIONS: FBG, LDL-C, WC and gender are independently associated with serum hs-CRP concentrations.

Association between C-reactive protein, pro-oxidant-antioxidant balance and traditional cardiovascular risk factors in an Iranian population.

BACKGROUND: Inflammatory states are known to cause an imbalance in the redox status. We aimed to study the possible associations between pro-oxidant-antioxidant balance (PAB) and serum high-sensitive C-reactive protein (hs-CRP) concentrations and traditional cardiovascular disease (CVD) risk factors in an unselected Iranian population and in groups of individuals with specific disease. METHODS: The study was conducted among an unselected population of 758 male subjects. Biochemical markers, including hs-CRP and PAB values, were measured. RESULTS: Serum hs-CRP concentrations were positively associated with serum PAB values (r = 0.260, P ≤ 0.001). Univariate analysis showed that PAB values were statistically higher in individuals who were obese or smokers compared with non-obese and non-smokers individuals (P < 0.01). While serum hs-CRP concentrations were significantly higher in older subjects, subjects with obesity, diabetes mellitus, metabolic syndrome, central obesity, hypertriglyceridaemia, higher low-density lipoprotein cholesterol concentrations, positive history of CVD and lower physical activity than subjects without these risk factors (P < 0.05). Comparing hs-CRP and PAB values in different CVD risk score subgroups showed a significant incremental rise in both parameters as CVD risk score increased (P < 0.05). Using multiple linear regression analysis we found a strong association between PAB values and hs-CRP concentrations. CONCLUSIONS: This study showed that among Iranian subjects, the inflammatory marker, hs-CRP, was strongly and positively associated with a marker of oxidative stress and also with several traditional risk factors of CVD. Moreover, the impact of traditional cardiovascular risk factors on hs-CRP concentrations and PAB values differed.