Search Results (485)

Greece and the eastern Mediterranean are among the regions that are most exposed to climate-driven natural hazards, with wildfires, floods, and extreme rainfall events consistently producing significant socioeconomic and environmental impacts. Although previous literature has addressed each hazard type individually, a systematic, comparative analysis of the atmospheric circulation regimes associated with all three hazard categories within a unified Lagrangian framework has not yet been conducted for Greece. In this study, a 96 h HYSPLIT back-trajectory analysis driven by ERA5 reanalysis data, combined with k-means clustering, is employed to characterise the air mass origins associated with extreme events in Greece from 2000 to 2020 at two atmospheric levels: 750 m and 3000 m above sea level. Wildfire events are predominantly linked to short-distance northeast airflow at 750 m, and are directly associated with the Etesian wind system and to a coherent northwest-west Mediterranean signal at 3000 m, reflecting the influence of the summer blocking anticyclone over Europe. Conversely, flood events are dominated by northerly flow at 750 m, driven by the eastern flank of Mediterranean depressions. These results indicate that flooding in Greece is primarily conditioned by surface cyclogenesis, regardless of the upper-level flow geometry. Extreme rainfall events exhibit the most complex structure, with a dominant upper-level cluster that describes a recurving trajectory consistent with cut-off low dynamics. Cross-hazard comparisons demonstrate that similar near-surface trajectory patterns may arise from different atmospheric drivers, underscoring the necessity of integrating Lagrangian trajectory classification with additional context, such as thermodynamic and seasonal, to enable robust multi-hazard attribution and enhance early warning capabilities in the eastern Mediterranean. Full article

Cardiac rehabilitation (CR) is underused globally, and evidence on its availability and delivery in the World Health Organization Eastern Mediterranean Region (WHO EMR) remains fragmented. This scoping review mapped evidence on cardiac rehabilitation (CR) across countries of the World Health Organization Eastern Mediterranean Region (WHO EMR), including service availability, delivery models, participation pathways, and barriers and enablers, with focused consideration of Saudi Arabia. Studies published from 1 January 2000 to 14 January 2026 were searched in MEDLINE, Scopus, Web of Science Core Collection, CINAHL, Embase, and the WHO Index Medicus for the Eastern Mediterranean Region. Data were synthesised descriptively and narratively in accordance with scoping review methodology. Twenty-five studies met the inclusion criteria, covering eight WHO EMR countries and one regional audit. Evidence was unevenly distributed, centre-based outpatient CR predominated, and losses were most evident at referral and enrolment stages. CR evidence across the WHO EMR remains fragmented and uneven. Stronger referral pathways, greater service capacity, and flexible delivery models are needed, including in Saudi Arabia. Full article

This study assesses the effects of upper-level configuration on heavy rain episodes over the Levant. The dynamic upper-level forcings are attributed to ageostrophic effects. One is related to meandering jet ahead of troughs and the second to acceleration near both ends of straight jets. We collected 23 rainy episodes contained in four rainy months. The rain analysis was done on the eastern coast of the Mediterranean, and the synoptic analysis covers the domain 15–45° N, 12–45° E. The data were retrieved from ERA5 reanalysis, with 0.25° × 0.25° resolution. A subjective analysis revealed that the rain episodes are associated with three configurations, the two aforementioned and an additional, under upper trough, without upper-level divergence. In fourteen cases, the region was found ahead of trough and in only one at the end of a straight jet. In the remaining eight cases, upper trough was located over the region, implying an absence of upper-level support for rain formation. These configurations are exemplified by case studies and by composite maps. Most rain events occurred when an upper trough dominated the Levant, situated upstream (west) of a surface Cyprus Low (CL), with both contributing to rain formation. The CL persisted in the cases of the third type, in spite of an absence of upper-level support, due to surface-induced cyclogenesis. The two most frequent configurations are apparently similar but differ in the rain-producing factors. The one for the “ahead of” is upper-level dynamic, and for the “under trough”—lower level dynamic and enhanced static instability. Full article

Familial Mediterranean Fever (FMF) is among the most frequent autoinflammatory diseases in populations originating from the area of Middle Eastern and Mediterranean countries. It is caused by mutations in the MEFV gene, which causes dysregulated pyrin expression and thus an immunologic anomaly. FMF is diagnosed by recurrent episodes of fever and serosal inflammation, predominantly peritonitis and pleuritis, as well as other systemic symptoms. Recent research is dedicated to searching for factors beyond genetic code contributing to how FMF evolves, the severity of its symptoms and response to conventional therapy—colchicine. These factors include epigenetic modifications of the MEFV gene and other environmental factors, such as cold exposure, stress, composition of gut flora and diet. Among these factors, vitamin D, best known for its classical role in musculoskeletal health, has emerged as a powerful immune modulator. It has been documented that vitamin D has been implicated in the regulation of pro-inflammatory cytokines and may modulate immune responses. Notably, in regions with some of the highest reported prevalences of MEFV mutations—likely reflecting Mediterranean populations more broadly—vitamin D concentrations are frequently low. This overlap raises the hypothesis that vitamin D deficiency may be associated with FMF pathogenesis, although current data are largely correlational and do not establish causality. In this review, we summarize current evidence on FMF pathogenesis, potential triggers, and vitamin D metabolism, and explore how vitamin D may modulate immune responses and intersect with key autoinflammatory pathways, considering whether adequate vitamin D supplementation could help reduce disease burden in some patients with FMF. Full article

Understanding the extent to which anthropogenic activity shapes vegetation dynamics is a central challenge in palaeoecology. In the Eastern Mediterranean, pollen-based studies have traditionally identified human impact through qualitative interpretations of anthropogenic indicators, particularly within the framework of the Beyşehir Occupation Phase (BOP). However, proxy-based quantitative comparison of anthropogenic signals across multiple sites remains limited. This study compiles pollen datasets from multiple lacustrine records across Anatolia (Türkiye) to construct a regional multi-site dataset and evaluates anthropogenic influence using a quantitative BOP period anthropogenic taxa integrated with Principal Component Analysis (PCA). The relative representation of pollen indicators enabling the determination of anthropogenic effect was evaluated using a composite pollen index based on Olea, Juglans, Plantago lanceolata-type, Cerealia and Rumex acetosa-type taxa. The results reveal substantial spatial variability in anthropogenic signals, with combined pollen percentages ranging from less than 1% to 16% among lakes. PCA results show clear inter-site differentiation, with the first two components explaining 42.94% and 21.95% of the total variance, respectively. In particular, Olea emerges as the most influential indicator, strongly contributing to the primary ecological gradient. These findings provide a proxy-based quantitative extension of the traditionally qualitative BOP concept and show that selected anthropogenic pollen indicators are spatially heterogeneous across Anatolian lake records. By integrating a composite anthropogenic index with multivariate analysis, this study offers a robust and transferable framework for comparing human–environment interactions across different regions and ecological settings. Full article

Hepatitis E is a liver inflammation caused by the hepatitis E virus (HEV). In pregnant women, the infection significantly increases the risk of acute liver failure, fetal loss, and maternal death. According to the World Health Organization, infection by HEV during the third trimester of pregnancy may increase the risk of maternal mortality in 20–25% of cases. In Tunisia, little is known about HEV infection and its outcome, especially in pregnant women. This study aims to evaluate the prevalence of HEV infection in a large cohort of pregnant women in Tunisia. A total of 891 women who attended the Centre of Maternity and Neonatology of Tunis during 2021–2023 were included. Serum samples were screened to detect HEV-antibodies and RNA using commercial ELISA tests and molecular assays, respectively. Statistical analyses were conducted using SPSS 21.0 software and the EPISTAT package version 7.2.6. Seroprevalence of HEV infection was 3.82%, based on the detection of anti-HEV IgG. The distribution of the seroprevalence according to age was statistically significant (p < 0.05), showing a higher seroprevalence among women over 30 years. Among the 51 women with composite outcomes, viral RNA was detected in one case by real-time RT-PCR. Our findings indicate a low HEV prevalence among pregnant women in Tunisia. Expanding the study to other cohorts and to environmental surveillance would improve understanding of HEV burden in Tunisia and support hepatitis elimination efforts. Full article

Background: The impact of climate change on birds’ migration and ticks’ reservoir habits is contributing to the spread of Crimean–Congo hemorrhagic fever (CCHF), caused by CCHF virus (CCHFV), to new continents and countries. CCHF is endemic to the Eastern Mediterranean Region, including Iraq, and is witnessing a substantial surge in confirmed cases with considerable disparity and gaps in managing CCHF cases. The increasing CCHF spread across Asia, Africa, and Europe, including Spain and Turkey, highlights the danger of its expansion. Developing high-confidence diagnostic criteria, identifying risk factors, and accurate predictors of CCHF outcomes are critical to managing suspected and confirmed cases of CCHF and to reducing the current case fatality rate of CCHF, which is the goal of this study. Methods: We completed a retrospective evaluation of 61 confirmed cases of CCHF in Basrah (Iraq). The cases were screened according to the clinical presentation, and CCHF cases were identified by ELISA and validated by PCR. Data was analyzed using SPSS version 22. T-tests, chi-square/Fisher exact tests, and Pearson’s correlation were used, with significance set at p < 0.05 and high significance at p < 0.01. Results: We found that repeated exposure to animals during animal slaughtering was a significant risk factor. In addition, 5% of the patients with confirmed CCHF, mainly from rural areas, reported exposure to rats. Clinical presentations included fever, headache, gastrointestinal problems, eye and orbital symptoms, and hemorrhagic complications. Predictors of death included advanced age, decreased platelet counts, and neuropsychiatric symptoms such as delusions and confusion. Conclusions: Our findings identify clinical and laboratory features of CCHF cases in Iraq, which will help to implement the most effective interventions to manage CCHF cases and protect the public in all Iraqi governorates. In summary, this study highlights a recent and significant rise in CCHF cases in Basrah Governorate, Iraq. Notably, 5% of confirmed cases reported contact with rats. The paper also proposes diagnostic criteria and identifies key predictors of mortality to support improved clinical management of CCHF. These findings underscore the urgent need for strengthened public health interventions, including enhanced infection prevention and control measures, increased awareness, and improved surveillance systems. The findings have important implications for improving control procedures, guiding therapeutic development, informing vaccine strategies, and supporting evidence-based policy alongside future research efforts. Full article

The forest dormouse (Dryomys nitedula) is a small, nocturnal, arboreal rodent widely distributed across Central and Eastern Europe. Yet, it remains one of the least studied European glirid species, with information on its ecology in southern populations being scarce. This study presents the first systematic investigation of the diel (24 h) activity patterns of D. nitedula in Greece. From March to December 2024, camera traps were deployed on trees facing branches or artificial nest boxes at 26 locations within a 30 ha forest–meadow mosaic in Northern Greece. Based on 958 independent detections at 22 sites, activity was highest at nest boxes and exhibited two nocturnal peaks that were consistent across seasons: a major one around midnight and a secondary one before sunrise. Temporal activity overlap between nest-box cameras and branch-facing cameras was high across all seasons. Activity, measured as the number of independent detections per night, was highest during short, humid nights with low levels of moonlight. Temperature and precipitation were not good predictors of activity levels. These findings confirm that the behavior of D. nitedula is predominantly nocturnal and reveal key environmental drivers shaping its activity in the Mediterranean region. Moreover, this study highlights the value of camera trapping as a non-invasive method for monitoring small arboreal mammals and provides essential baseline data for future ecological and conservation research on this understudied species. Full article

Tunisia is characterized by high precipitation variability, which results in frequent extreme floods and droughts. This study aims to develop long-term forecasting models for total and daily maximum annual precipitation by incorporating information related to climate variability. These models use low-frequency climate oscillation indices as predictors. A linear functional model for scalar response is developed for this purpose. The model based on functional data analysis is also compared to a linear regression model. The station under study is located in north-eastern Tunisia. The association between precipitation and four climate indices is evaluated: the North Atlantic Oscillation (NAO), the Pacific Decadal Oscillation (PDO), the Mediterranean Oscillation (MO) and the Western Mediterranean Oscillation (WeMO) climate indices. The results show that both linear and functional regression provide good and comparable results, likely due to the limited length of the data series. NAO, PDO and MO are the best indices to forecast total annual precipitation with an RMSE between 3.564% and 4.151% of the average precipitation, while MO seems to be the best index to forecast daily maximum annual precipitation achieving slightly higher RMSE between 11.174% and 11.916% of the average maximum precipitation. These results suggest that total precipitation at the study station is controlled by large-scale climatic processes operating over the Atlantic, Pacific, and Mediterranean regions, whereas the few most extreme precipitation events are primarily driven by regional climatic phenomena occurring at the Mediterranean scale. The results may have practical applications to improve disaster response preparedness and water resource management. Full article

Background/Objectives: The COVID-19 pandemic disrupted routine immunisation globally. Saudi Arabia presents a unique epidemiological context for measles, combining high vaccination coverage with mass pilgrimages and a large expatriate workforce. This study examined measles incidence trends, vaccination coverage, and demographic and geographic burden distribution in Saudi Arabia (2015–2024), with comparative analysis against GCC countries, the Eastern Mediterranean Region (EMR), and global data. Methods: Annual incidence and vaccination coverage data were obtained from the WHO Global Health Observatory and WHO/UNICEF WUENIC; monthly, regional, age- and nationality-stratified data from the Saudi Ministry of Health Annual Statistical Book (2015–2024). Incidence was expressed per 1,000,000 population across three epochs: pre-COVID-19 (2015–2019), pandemic disruption (2020–2021), and post-COVID-19 rebound (2022–2024). Descriptive analyses included period means, percentage changes, rate ratios, and rate differences. Results: Pre-COVID-19 incidence (mean 19.7/1,000,000) remained below EMR and global averages. The pandemic produced near-complete suppression (−96.6% to 1.1/1,000,000 in 2020), exceeding global (−82.2%) and EMR (−61.2%) declines. A marked rebound occurred in 2023 (67.8/1,000,000), surpassing the pre-pandemic peak despite MCV1/MCV2 coverage above 96%. Non-Saudi nationals bore disproportionate burden in 2021 (20.7 vs. 1.1/1,000,000) and 2023 (70.4 vs. 64.8/1,000,000). Children under 15 accounted for 71.6–90.6% of annual cases, with the 5–<15-year group’s contribution rising from 12.7% (pre-COVID mean) to 27.7% in 2024. Geographic burden shifted annually with no consistently dominant region. Conclusions: Saudi Arabia’s post-pandemic rebound despite high national coverage implicates sub-population susceptibility gaps among non-national residents and school-age children, alongside importation risks from mass pilgrimage. Targeted strategies addressing demographic and geographic heterogeneity are essential to meet WHO 2030 elimination targets. Full article

Accurate field-scale wheat yield estimation is essential for precision agriculture, farm-level decision-making, and food security planning. However, operational studies conducted under real commercial farming conditions in the eastern Mediterranean remain limited. This study investigated whether multi-temporal Sentinel-2 imagery could support reliable wheat yield estimation across nine commercial wheat fields near Ptolemaida, Greece, during the 2023–2024 growing season. Both durum and common wheat fields were included, and combine-harvester yield maps were used as ground-truth observations. Six regression algorithms—the Random Forest (RF), Support Vector Regression (SVR), k-nearest neighbors (KNN), Decision Tree (DT), LASSO regression, and Gaussian Process Regression (GPR) algorithms—were evaluated using three feature configurations: raw Sentinel-2 spectral bands only (Sentinel-only (SO)), spectral bands combined with vegetation indices (Sentinel+Indices, SI), and vegetation indices only (Indices-only, IO). Model generalization was assessed through a strict Leave-One-Field-Out (LOFO) cross-validation protocol, and the method of SHapley Additive exPlanations (SHAP) was used to interpret model behavior and identify the most influential spectral regions and phenological stages. RF achieved the highest predictive accuracy, with a MAPE of 7.90% and an RMSE of 45.15 kg decare⁻¹ under the SO configuration, demonstrating a statistically significant improvement over DT and KNN models ($p<0.05$). SHAP analysis indicated that model predictions were mainly driven by SWIR-1, NIR-narrow, and red-edge bands acquired during late grain filling and maturity, while vegetation indices contributed limited additional information. These findings suggest that raw multi-temporal Sentinel-2 spectral bands are highly effective for field-scale wheat yield estimation within the scope of this study, although further validation across diverse growing seasons and geographic regions is required to confirm broad operational sufficiency. Full article

Understanding the climate-driven range dynamics of the oriental hornet (Vespa orientalis) is essential for ecological risk assessment and biodiversity management. This study utilized Maximum Entropy (MaxEnt) modeling to estimate current and future (2050) habitat suitability across the Western Palearctic. The model demonstrated strong predictive performance, yielding a mean cross-validation AUC of 0.95 ± 0.01 and a TSS of 0.78 ± 0.02, indicating high stability and discriminatory capacity. Jackknife analysis and response curves identified temperature annual range (bio7) and annual precipitation (bio12) as the primary environmental drivers. The species exhibits a distinct preference for moderate thermal variability and balanced moisture regimes, while extreme summer heat (bio5) and warm winter conditions (bio11) impose significant constraints. Current projections identify a high-suitability core concentrated within the Mediterranean basin. By mid-century, projections indicate a spatial reorganization marked by localized gains mainly in the eastern part of the study region alongside suitability losses across North Africa and parts of southern Europe. Multivariate Environmental Similarity Surface (MESS) analysis confirmed high model transferability across most expansion zones, despite increased uncertainty in hyper-arid and high-altitude regions. These findings underscore the dynamic nature of the V. orientalis climatic niche and provide a critical baseline for proactive biosecurity and monitoring in emerging high-risk regions. Given the global decline in Hymenoptera diversity, this study provides timely insights into species-specific responses to climate change, supporting broader efforts in biodiversity conservation and ecological risk assessment. Full article

Background: Congenital Adrenal Hyperplasia (CAH) is a group of autosomal recessive disorders caused by impaired adrenal steroidogenesis, most frequently due to pathogenic variants in the CYP21A2 gene leading to 21-hydroxylase deficiency (21-OHD). Epidemiology and management vary across the Mediterranean Basin as a result of genetic and healthcare differences. Objective: To provide an overview of the epidemiology, diagnostic approaches and treatment patterns of CAH in Mediterranean countries. Methods: A structured review of the literature was performed using PubMed, using combined disease-related, geographic and methodological terms. Eligible studies reporting on epidemiology, diagnosis, or management of CAH were included. Data on study design, population characteristics, incidence, diagnostics, genetics and treatment availability were extracted. Results: Data were collected from 23 Mediterranean and neighboring regions covering over 8.7 million screened newborns. In countries with established newborn screening (e.g., Spain, Italy, France, Greece), the incidence of classic CAH ranged from 1:10,000 to 1:25,000 live births. Higher rates were reported in parts of North Africa and the Eastern Mediterranean. Diagnostic set-up and access to biochemical and genetic confirmation varied widely. Hydrocortisone remains the primary therapy, while access to mineralocorticoids and modified-release glucocorticoids differed across settings. Conclusions: Overall, considerable heterogeneity in CAH epidemiology and care exists across the Mediterranean region. Genetic factors such as founder effects, consanguinity and healthcare organization contribute to these differences. Expanding newborn screening, improving diagnostics and availability to treatments are critical to reducing disparities in CAH care. Full article

β-thalassemia minor, often referred to as the β-thalassemia trait, is among the most prevalent hemoglobinopathies globally, impacting around 80–90 million carriers, with a prevalence of up to 15% among Mediterranean, Middle Eastern, and Asian populations. Although traditionally regarded as clinically benign, pregnancy imposes hematologic and metabolic stressors that may unmask latent vulnerabilities. This review combines the latest data and findings about the pathophysiology of β-thalassemia minor during pregnancy, its short-term outcomes on the mother and fetus, and its long-term impact on the child, as well as management techniques. A narrative review of PubMed-indexed studies (2000–2025) was conducted, including cohort and case–control studies, systematic reviews, meta-analyses, and international guidelines. Outcomes were organized by theme, and quantitative findings (prevalence, relative risks, odds ratios) were combined when available. Anemia is a common health issue for mothers. Literature mentions that the pooled incidence is between 30% and 40% during the third trimester, with ~5%of carriers needing a blood transfusion (mainly in iron-deficient or baseline Hb 6–8 g/dL cases). Meta-analyses have shown elevated risks of pre-eclampsia (odds ratio (OR) ~ 1.4, 95% confidence interval (CI) 1.1–1.8) and postpartum hemorrhage (PPH); however, estimates differ by region. The odds of preterm delivery (OR ~ 1.4), small-for-gestational-age (SGA) (OR ~ 1.5), and low birth weight (LBW) are slightly increased for carriers, and neonatal intensive care unit (NICU) admission rates are also higher for carriers. However, the risk of stillbirth is not always increased. The usual approach is iron supplementation guided by ferritin levels to prevent overload, personalized transfusion thresholds, and regular folate support. There is not much evidence for long-term consequences for children of carrier mothers since no research has followed more than 200 children born to carrier mothers into adulthood. However, maternal anemia is linked to slower growth, neurodevelopmental issues, and a higher risk of cardiometabolic problems in larger groups of pregnant women. However, maternal anemia is associated with slower growth, neurodevelopment, and higher cardiometabolic risk in larger groups of pregnant women. β-thalassemia minor during pregnancy usually has a mild, though significant, impact. While most pregnancies proceed without complications, this condition is associated with a significantly higher prevalence of anemia and other adverse postnatal outcomes. Consequently, the implementation of risk-stratified monitoring, smart supplementation, and standardized management protocols is essential. Prospective registries, mechanistic placental research, and long-term offspring cohorts are necessary to better understand long-term trends. Full article

Mediterranean low-pressure systems or cyclones are responsible for many extreme events affecting the region. This study presents a comprehensive analysis of Mediterranean cyclones from 1940 to 2024 using high-resolution ERA5 reanalysis data. This study implements a detection algorithm based on geopotential height minima on three different pressure levels (1000 hPa, 850 hPa and 700 hPa). Cyclone tracks in this study are constructed by linking identified low-pressure centers at successive time steps using a nearest neighbor tracking algorithm. The number of cyclones at 1000 hPa is filtered by matching them with upper levels and restricting them within 150 km from the coast, covering the entire Mediterranean region, which we divided into three subregions: the western Mediterranean, the eastern Mediterranean, and the Black Sea. Seasonal analysis was performed for winter (December–February), spring (March–May), summer (June–August), and autumn (September–November). Our results have recorded 39,933 individual cyclone tracks, where the majority (25,265 cyclones; 63.3%) are short-lived (24–72 h). Regionally, the western Mediterranean has the highest cyclone density, followed by the Black Sea and the eastern Mediterranean. While there is only a small increase in total numbers, a notable increase in cyclone activity is observed during the summer months, particularly in August, with a statistically significant rise of 18.4% since 1980 across the whole Mediterranean region. In the western Mediterranean, this August intensification was even 23.8%. As a result of this, the annual peak of cyclone activity has shifted from May/June to August. Full article