Kikuchi-Fujimoto disease, simultaneously diagnosed with systemic lupus erythematosus in an Arabic female: an agonizing combination.

Kikuchi-Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is a rare, benign condition affecting young Oriental-Asian females. It is characterized by fever and tender cervical lymphadenopathy with an unclear aetiology, and in most longitudinal reviews, KFD occurs before systemic lupus erythematosus (SLE). Herein, the case of a 28-year-old Kuwaiti female without any relevant past medical history, who was simultaneously diagnosed with KFD and SLE following an Ebstein-Barr virus infection, is reported. The patient was treated with oral prednisolone, hydroxychloroquine, cyclosporin, and belimumab and her response was clinically and biochemically favourable. Although KFD is prevalent in Asian populations, it may affect all races. Early diagnosis of KFD is difficult, particularly when simultaneously diagnosed with SLE, but crucial to preventing inappropriate therapy. Clinicians need to know about this rare disease, especially when patients present with fever and swollen lymph nodes, due to a risk of misdiagnosis with tuberculosis or lymphoma, as these are more often thought to be the cause of such symptoms.

Perceptions of undergraduate medical students on artificial intelligence in medicine: mixed-methods survey study from Palestine.

BACKGROUND: The current applications of artificial intelligence (AI) in medicine continue to attract the attention of medical students. This study aimed to identify undergraduate medical students' attitudes toward AI in medicine, explore present AI-related training opportunities, investigate the need for AI inclusion in medical curricula, and determine preferred methods for teaching AI curricula. METHODS: This study uses a mixed-method cross-sectional design, including a quantitative study and a qualitative study, targeting Palestinian undergraduate medical students in the academic year 2022-2023. In the quantitative part, we recruited a convenience sample of undergraduate medical students from universities in Palestine from June 15, 2022, to May 30, 2023. We collected data by using an online, well-structured, and self-administered questionnaire with 49 items. In the qualitative part, 15 undergraduate medical students were interviewed by trained researchers. Descriptive statistics and an inductive content analysis approach were used to analyze quantitative and qualitative data, respectively. RESULTS: From a total of 371 invitations sent, 362 responses were received (response rate = 97.5%), and 349 were included in the analysis. The mean age of participants was 20.38 ± 1.97, with 40.11% (140) in their second year of medical school. Most participants (268, 76.79%) did not receive formal education on AI before or during medical study. About two-thirds of students strongly agreed or agreed that AI would become common in the future (67.9%, 237) and would revolutionize medical fields (68.7%, 240). Participants stated that they had not previously acquired training in the use of AI in medicine during formal medical education (260, 74.5%), confirming a dire need to include AI training in medical curricula (247, 70.8%). Most participants (264, 75.7%) think that learning opportunities for AI in medicine have not been adequate; therefore, it is very important to study more about employing AI in medicine (228, 65.3%). Male students (3.15 ± 0.87) had higher perception scores than female students (2.81 ± 0.86) (p < 0.001). The main themes that resulted from the qualitative analysis of the interview questions were an absence of AI learning opportunities, the necessity of including AI in medical curricula, optimism towards the future of AI in medicine, and expected challenges related to AI in medical fields. CONCLUSION: Medical students lack access to educational opportunities for AI in medicine; therefore, AI should be included in formal medical curricula in Palestine.

E-cigarette use among university students in Palestine: Prevalence, knowledge, and determinant factors.

BACKGROUND: Recent reports indicated accelerated rates of e-cigarette use, especially among youth in various Middle Eastern countries, including Palestine. Nevertheless, little is known about knowledge, attitudes, and perceptions regarding this topic in Palestine. This study aimed to assess the prevalence of e-cigarette use among Palestinian university students, along with their knowledge, attitudes, and perceptions about e-cigarette use. METHODS: An observational cross-sectional study, utilizing an online self-administered questionnaire, was conducted on Palestinian students from five universities between 17/04/2023 and 04/11/2023. RESULTS: A total of 1002 Palestinian university students completed the questionnaire. The prevalence of e-cigarette use among students was 18.1%. The mean knowledge score about e-cigarettes was significantly lower among the users of e-cigarettes compared to non-users. E-cigarette use was significantly associated with the participants' smoking status. Among e-cigarette users, 43.6% were also current traditional cigarette users, and 66.9% were current waterpipe users. E-cigarette use was significantly associated with having a friend who is a smoker and/ or a smoking mother. Binary logistic regression revealed a significant positive effect between the participant's smoking status, the mother's smoking status, knowledge about e-cigarettes, and the use of e-cigarettes (p-value < 0.05). Among e-cigarette users, 18.8% used them in indoor places at the university, and 25% reported using them daily in the past month. Affordability of e-cigarettes was the most reported reason for their use (47.5%). CONCLUSION: This study concluded that e-cigarette use is prevalent and rapidly rising among university students in Palestine. This is worrisome as it is significantly associated with insufficient knowledge about the adverse health effects of E-cigarette use, and its addictive nature. These findings focus on the importance of improving the students' knowledge about e-cigarette use by implementing educational campaigns and considering age regulations on e-cigarette availability and use.

Psychological effects of anti-Arab politics on American and Arab peoples' views of each other.

Disparaging rhetoric about Arab people was prevalent during Donald Trump's political rise in the United States. Although this rhetoric was intended to energize conservative Americans, it also echoed throughout many liberal parts of the United States and around the world. In this research, we experimentally examined the effects of such rhetoric on American and Arab people's attitudes and visual representations of each other before and after Trump was elected. Although people overwhelmingly reported not liking the negative rhetoric, the rhetoric alone did not influence explicit and implicit intergroup biases in either location, as measured by feeling thermometers and Implicit Association Tests. However, the election outcome moderated the way rhetoric influenced how American and Arab people visually represented each other. Our research sheds light on nuanced effects of global politics on various information processing stages within intergroup perception.

[JEWISH MEDICAL STUDENTS FROM THE BRITISH MANDATE OF PALESTINE/ERETZ ISRAEL - THEIR FINAL MD EXAMINATION IN BERLIN DURING THE THIRD REICH].

INTRODUCTION: Two Jewish medical students who were forced to discontinue their study upon the raise of the Nazi regime, returned/ immigrated to Palestine and did their internship in Palestine. A third student, although faced with many procedural limitations, was able to continue most of his studies in Berlin including passing the MD examination. The first two students returned, after some years, to Berlin to sit for the Doctor examination which enabled them to gain a permanent medical license in Palestine. We describe the different backgrounds of the 3 students which enabled them to do the examination at Berlin's medical faculty during the Nazi regime. The follow up of the three, revealed glorious medical career during the British mandate and during the first years of the new state of Israel. The Dissertations were signed and supported by three leading Professors of the Berlin's Faculty. Two of them were found to have a National-Socialistic background.

A Comparison of Hidradenitis Suppurativa Characteristics Among Israeli Arabs and Jews: Analysis of Two Cohorts.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease involving apocrine gland-bearing regions. There is an under-representation of non-Caucasians in epidemiologic studies of HS. The characteristics of HS in Israeli Arabs have not yet been studied. OBJECTIVES: To investigate the demographic and clinical profile of HS in the Israeli Arab population. METHODS: A retrospective analysis was conducted in two cohorts of patients with HS in Israel. The patients were derived from the database of a large health management organization (n=4191, 639 Arabs; population-based) and a major tertiary medical center (n=372, 49 Arabs). Demographic and clinical data were compared between ethnic groups. RESULTS: The prevalence of HS in Israeli Arabs was found to be 0.5%, fivefold higher than in Jews. Arab patients were younger (35.3 vs. 40.5 years, P < 0.001) and mostly male (52% vs. 35.7%, P < 0.001), with lower rates of co-morbidities, including smoking (40.8% vs. 55.7%, P < 0.001), hyperlipidemia, and depression as well as a higher rate of dissecting cellulitis (10.2% vs. 1.9%, P = 0.008). HS was more severe in Arabs, but of shorter duration, with mainly axillary involvement (79.6% vs. 57.9%, P = 0.004). Treatment with hormones was more common in Jews, and with biologic agents in Arabs. CONCLUSIONS: The findings suggest a different phenotype of HS in Arabs, warranting further study.

Arab mothers' viewpoints: Why their children are removed from home.

BACKGROUND: Many studies have explored the impact of child removal on both children and professionals, but there is limited research on the experiences of mothers whose children social services had removed from their homes, particularly within Arab society. OBJECTIVE: This study focused on Arab mothers from East Jerusalem-an ethnic minority in Israel's society, that faces unique challenges-whose children removed from home. The study examines, from the mothers' perspectives (1) reasons for the removal, and (2) relationships with welfare services. METHODS: 15 Arab mothers from East Jerusalem, aged 25 to 49 who had at least one child removed through a court order participated in the study. Nine of the mothers were divorced, separated, or widowed. RESULTS: The mothers described several reasons for their children's removal, including domestic violence and lack of support from their own families after leaving abusive husbands, poverty leading to what social services interpreted as neglect, the child's challenging behavior, and false accusations. The second theme reveals a lack of cooperation between social workers and the mothers, and social workers' negative perceptions of the mothers hindering reunification. CONCLUSIONS: The study sheds light, for the first time as far as we know, on the perspectives of Arab mothers concerning their children's removal. Early support could avert removal, and social workers should make greater efforts to promote child reunification. It is paramount that professionals build trust with these mothers, through culturally sensitive and empowering engagement.

The role of social support among caregivers of people with cancer from Chinese and Arabic communities: a qualitative study.

PURPOSE: Cancer caregivers from culturally and linguistically diverse (CALD) communities have reported significant unmet emotional support needs. This study aimed explore the role of social support to manage emotional wellbeing among cancer caregivers from Arabic and Chinese communities in Australia. METHODS: Semi-structured interviews were conducted with Chinese (n = 12) and Arabic (n = 12) speaking cancer caregivers. Participants' mean age was 40.6 years; majority were female (83%) and providing care to a parent (41.67%). RESULTS: Using thematic analysis to analyse interview data, five overarching themes emerged describing caregivers' perspectives on social support. Themes were related to the following: (1) receiving emotional support from social networks, (2) barriers to accessing emotional support from social networks, (3) isolation and loss of connection following the cancer diagnosis, (4) faith as a source of support, and (5) utility of support groups and caregiver advocates. Several caregivers relied on social networks for emotional support; however, caregivers identified key cultural and generational barriers to seeking support from their social networks which prevented caregivers from disclosing their emotions and caregiving situation. Caregivers also reported being isolated from their support system. CONCLUSION: Empirical testing of culturally appropriate strategies that improve social support seeking among caregivers from CALD communities is recommended.

Common misconceptions and myths about ovarian cancer causation: a national cross-sectional study from palestine.

BACKGROUND: Women's inability to recognize ovarian cancer (OC) causation myths to be incorrect may lead to behavioral changes that could distract them from actual risk factors and impact their treatment decision making. This study examined Palestinian women's recognition of OC mythical causes, and explored factors associated with good recognition. METHODS: A national cross-sectional study was conducted. Adult Palestinian women were recruited from hospitals, primary healthcare facilities, and public areas in 11 governorates. The Cancer Awareness Measure-Mythical Causes Scale was modified and utilized for data collection. Awareness level was determined based on the number of myths around OC causation recognized to be incorrect: poor (0-4), fair (5-9), and good (10-13). RESULTS: A total of 5618 participants agreed and completed the questionnaire out of 6095 approached (response rate = 92.1%), and 5411 questionnaires were included in the final analysis. The most recognized food-related myth was 'drinking from plastic bottles' (n = 1370, 25.3%) followed by 'eating burnt food' (n = 1298, 24.0%). The least recognized food-related myth was 'eating food containing additives' (n = 611, 11.3%). The most recognized food-unrelated myth was 'having a physical trauma' (n = 2899, 53.6%), whereas the least recognized was 'using mobile phones' (n = 1347, 24.9%). Only 273 participants (5.1%) had good awareness of OC causation myths as incorrect. Earning higher monthly incomes as well as visiting governmental healthcare facilities were associated with a decrease in the likelihood of exhibiting good awareness. CONCLUSION: The overall recognition of OC causation myths was low. Addressing mythical beliefs should be included in OC prevention strategies and public health interventions to improve women's understanding of OC risk factors versus mythical causes.

Severe Transfusion-Dependent Thalassemia in Compound Heterozygote Palestinian Siblings with Two α-Globin Gene Defects, Hb Taybe D HBA1: C.119_121delCCA Mutation and HBA2: C.*94A > G Mutation.

Alpha and Beta Thalassemia are autosomal recessive anemias that cause significant morbidity and mortality worldwide, especially in the Middle East and North Africa (MENA) region where carrier rates reach up to 50%. We report the case of two siblings of Palestinian origin born who presented to our tertiary healthcare center for the management of severe transfusion dependent hemolytic anemia. Before presentation to our center, the siblings were screened for a-thalassemia using the Alpha-globin StripAssay. They were found to carry the α2 polyA-1 [AATAAA > AATAAG] mutation in the heterozygous form, which was insufficient to make a diagnosis. No pathogenic variants were detected on Sanger sequencing of the HBB gene. Full sequencing of the a-gene revealed compound heterozygous variants (HBA1:c.119_121delCCA and the previously detected HBA2:c.*+94A > G Poly A [A->G]) with trans inheritance. This report highlights the impact of non-deletional mutations on α-globin chain stability. The compound heterozygosity of a rare α-globin chain pathogenic variant with a polyadenylation mutation in the probands leads to clinically severe a-thalassemia. Due to the high carrier status, the identification of rare mutations through routine screening techniques in our populations may be insufficient. Ongoing collaboration among hematologists, medical geneticists, and counselors is crucial for phenotypic-genotypic correlation and assessment of adequate genetic testing schemes.

Characteristics, Risk Factors, and Outcomes in Acute Kidney Injury Patients: A Retrospective Cross-Sectional Study, Palestine.

Background: Acute kidney injury (AKI) is a major medical problem affecting patients' quality of life and healthcare costs. Objectives: This study evaluated the severity, risk factors, and outcomes of patients diagnosed with acute kidney injury (AKI), including community-acquired AKI (CA-AKI) and hospital-acquired AKI (HA-AKI), who were admitted to tertiary institutions in Palestine. Methods: This retrospective cross-sectional study was conducted at multiple tertiary care hospitals in Palestine by reviewing patient charts from January 2020 to March 2023. The study included all patients aged ≥18 years who were admitted to the hospital and diagnosed with AKI at admission (CA-AKI) or who developed AKI 48 hours after admission (HA-AKI). Patients with incomplete medical records and those with no reported creatinine levels during their stay, pregnant women, kidney transplant patients, and end-stage renal disease patients were excluded. Data were analyzed using SPSS v22.0. The incidence of AKI in each group was compared using the chi-squared test. Results: This study included 259 participants. HA-AKI was present in 27.3% of the patients, while CA-AKI was 72.7%. The most common stage among patients was stage 3 (55.7%, HA-AKI) (42.9%, CA-AKI), and the most common comorbidity contributing to AKI was CKD. NSAIDs, ACE-I/ARBs, and DIURETICs were the most nephrotoxic drugs contributing to AKI. Patients with hyperphosphatemia, hyperkalemia, severe metabolic acidosis, or stage 3 AKI require renal replacement therapy. In addition, our findings revealed a significant association among AKI mortality, age, and heart disease. Conclusion: CA-AKI was more prevalent than HA-AKI in Palestinian patients admitted for AKI. Risk factors for AKI included diabetes, CKD, and medications (antibiotics, NSAID, diuretics, and ACE-I/ARB). Preventive measures, medication management, and disease state management are necessary to minimize AKI during hospital admission or in the community.

Identity, culture, and feminism: Golda Meir - Israel's prime minister (1969-1974).

Like most historical leaders, Israel's fourth prime minister, Golda Meir, is a controversial figure. Some consider her the worst prime minister in Israel's history, who was responsible for Israel's lack of preparedness for the Yom Kippur War, and others perceive her to be the only 'man' who stood in the way of Arabs' countries victory over Israel. Some view her to be conservative, not brilliant, dogmatic, masculine, and racist, and some others, as a simple, modest, warm, and empathetic woman. The authors bridge between these two conflicting views by employing theories of identity, culture, and gender role bias to investigate how Golda Meir's early age trauma caused by pogroms against Jews, cultural transition between Russia, the USA, and Mandatory Palestine, and serving as a powerful woman leader in an all-men political system, influenced her personal and political behaviour and her public image.

Arab male physicians' perceptions about their own smoking behaviors: a qualitative study.

BACKGROUND: Smoking remains the leading preventable cause of disease, disability, and death worldwide. Although physicians have high levels of health literacy with awareness of the consequences of smoking and their essential role in smoking cessation of patients, some physicians continue to smoke. Rates of smoking among Arab male physicians are high. This study aimed to gain insights into Arab male physician's perceptions of their own smoking behaviors and their professional role in health promotion. METHODS: Using purposive sampling, we recruited 25 Arab male physicians working in hospital and community clinic settings who currently smoke. Semi-structured, hour-long, interviews were held during January-June 2022. We then performed a thematic analysis of the interview data. RESULTS: The analysis revealed three categories, two sub-categories, and 15 emerging themes. The category 'Antecedents: prior to becoming a physician' revealed the themes: smoking experience during adolescence; social and ethnic culture; stress during medical studies; and on & off periods of quitting smoking. The category 'Physicians' perception of smoking' was sorted into two sub-categories: (1) Personal aspects, including the themes 'relaxation from stress', 'self-compensation', 'addiction', and 'enjoyable experience', and (2) Professional aspects, including the themes 'lack of knowledge about cessation', 'inadequate workplace support', 'motivation to consult patients', and 'awareness of their role as primary care physicians'. The category'Impacts' revealed the themes 'personal health and well-being', 'professional competence', and 'professional image in public'. CONCLUSIONS: This study provides an in-depth understanding of the personal, socio-cultural, and professional aspects of the phenomenon of Arab male smoking physicians from their perspective. Based on this information, we recommend developing programs that support and empower all physicians to cope better with their personal and professional stress as well as instituting programs that will provide all physicians with specific knowledge and skills related to smoking cessation. These programs should improve the ability of physicians to serve as positive role models for their patients for preventing and ceasing smoking, thus enhancing the image of the medical profession and, most importantly, improving the health of the public.

The development and validation of the Palestinian children's traumatic events checklist in a war-torn environment.

Traumatic experiences in childhood can lead to trauma symptoms and impaired mental health, especially when children are exposed to war and political violence. Despite significant attention to child's exposure to traumas, few instruments to detect potentially traumatic events have been validated psychometrically. Our study aimed to develop, adapt and validate a user-friendly traumatic events checklist in Palestinian children living in three areas affected by low-intensity war and ongoing political and military violence. 965 Palestinian children (494 males and 471 females) living in the Gaza Strip, West Bank and East Jerusalem were administered with a tailor-made Traumatic Events checklist, Children Impact of Events scale, and Strengths and Difficulties Scale. Exploratory and Confirmatory factor analysis was run to detect the factorial structure of the checklist. Furthermore, ANOVA was performed to identify statistically significant demographic differences among participants. A three factors structure emerged with Political violence-related traumatic experiences (PVTE), military violence against individuals (MVI), and military violence against individuals and families (MVF). Gaza children and adolescents resulted in being the most exposed to potentially traumatic events. The instrument can clearly portray potentially traumatic experiences in children exposed to violent events and adverse childhood experiences.

Psychometric properties of an Arabic translation of the meaning in life scale in a sample of young adults.

BACKGROUND: Young adults are in a constant phase of realizing their meaning in life while being in a constant pursuit of meaning. Meaning in life is a subjective, personal construct related to the perception of one's own life. Considering that there are no measures that study this construct within the Arab context, this study aimed to examine the psychometric properties of an Arabic translation of the Meaning in Life Questionnaire (MLQ) in the Lebanese context with a sample of young adults. METHODS: A sample of 684 Lebanese young adults was recruited for this study, having a mean age of 21.74 years, 65.6% of which were females. Through an online questionnaire, participants were requested to complete the Meaning in Life Questionnaire (MLQ), Depression, Anxiety and Stress Scale (DASS-8) and the Oviedo Grit Scale (EGO). RESULTS: CFA indicated that fit of the original bi-dimensional model of MLQ scores was inadequate. Items 9 and 10 cross-loaded to both MLQ factors. After removal of those 2 items, the final model displayed good fit indices. Reliability was good for the Search (ω = 0.89 / α = 0.89) and Presence (ω = 0.88 / α = 0.87) subscales. Additionally, across three levels of gender invariance (Configural, Metric and Scalar), no significant gender-based distinctions were observed in the MLQ scores. The Search subscale was significantly and positively associated with higher GRIT but not psychological distress, whereas the Presence subscale was significantly associated with higher GRIT and lower psychological distress. CONCLUSION: The results of this study contribute to the psychometric reliability and validity of the Arabic version of the MLQ and makes it available for dissemination among young adults within the Arab context. This allows for the implementation of new research that target construct of meaning in life, allowing for the accessibility of interventions that aim to foster the presence of and search for meaning in the lives of young adults within the Arab nations.

The moderating role of belongingness in the contribution of depression to suicide ideation following the October 7, 2023, terrorist attack in Israel: A nationwide prospective study.

INTRODUCTION: With >1300 civilians murdered, the terrorist attack of October 7 is one of the deadliest terrorist attacks in modern history. Previous research documented a sharp increase in depression in the aftermath of the attacks and the military conflict that followed. In this national prospective cohort study, we examined to what extent perceived belongingness (PB) moderates the association between depression and suicide ideation (SI) in the wake of the October 7th terrorist attack. METHODS: A representative sample of 710 Israeli adults (of them, 362 females, 51.1 %), Jews (557, 79.9 %), and Arabs (153, 20.1 %), aged 18-85 (M = 41.01, SD = 13.72) completed questionnaires assessing depression, current SI, and perceived belongingness at two timepoints: T1 (in August 2023) and T2 (in November 2023). RESULTS: Perceived belongingness at T1 predicted SI at T2 beyond demographic and trauma-related characteristics. Importantly, we found a significant interaction in which a PB at T1 moderated the link between depression and current SI at T2. Specifically, the level of depression at T2 contributed to current SI-T2 more strongly for individuals with low PB levels than for individuals with high PB levels. DISCUSSION: Our study highlights the impact of PB on SI following the October 7th terrorist attack. Clinicians treating individuals coping with depression should attend to their patients' sense of belongingness, as low PB comprises a significant risk factor for current SI. Moreover, community and national initiatives that could increase levels of PB among the citizens may help to diminish suicide risk in the aftermath of the attack.

Desalination and transboundary water governance in conflict settings.

Desalination can reduce both water scarcity and variability in supplies, two factors identified as drivers of transboundary water conflict. As such, some have predicted that increasing development of desalination capacity may reduce conflict over shared waters. Others have claimed that desalination may become a source of new conflicts. Additionally, desalination may open up new avenues for cooperation, but also may allow for unilateral action by parties, thereby decreasing cooperation. This study looks at the impact of the introduction of desalination on hydro-political relations in two protracted conflict settings: the island of Cyprus and the Arab-Israeli conflict. Using both quantitative and qualitative assessments, we find that desalination has fundamentally altered hydro-political relations, but find no consistent trends in terms of levels of conflict and cooperation. These findings suggest that the influence of desalination on hydro-political relations is likely to be a function of, rather than a transformer of, the larger geopolitical context.

It is Not Too Late for Reconciliation Between Israel and Palestine, Even in the Darkest Hour.

The conflict in Gaza and Israel that ignited on October 7, 2023 signals a catastrophic breakdown in the possibility of ethical dialogue in the region. The actions on both sides have revealed a dissolution of ethical restraints, with unimaginably cruel attacks on civilians, murder of children, destruction of health facilities, and denial of basic needs such as water, food, and shelter. There is a need both to understand the nature of the ethical singularity represented by this conflict and what, if any, options are available to allow the reconstruction of communication between the warring parties. This article seeks to address these tasks by analysing the conflict as inherently an ethical one, in the sense that it exposes a rupture in the fabric of communicative relationships that has evolved systematically out of the deep cultural structures from which all protagonists have emerged. Drawing on the work of Levinas, Habermas, Arendt, and others, and referring to the specific circumstances in the region, it examines the ethical sources of the crisis and tries to identify conditions for its resolution. The possibility of reconciliation-that is, of refiguring relationships to open up a space for dialogue to create pathways to heal the ruptures-is examined. The dark legacy of the Holocaust is identified as an abiding cultural vulnerability for both societies. It is concluded, however, that the rich history of partnerships and collaborations between Jews and Palestinians provides a robust infrastructure on the basis of which a sustainable peace might be built, providing a much-needed source of hope.