Biomedical and health research geography in the Eastern Mediterranean Region.

BACKGROUND: Measuring scientific outputs allows for objective evaluation of established health research systems and ranking countries according to scientific achievements. To our knowledge, attempts for systematic mapping health research output in the Eastern Mediterranean Region (EMR) are limited. AIMS: We aimed to conduct a detailed bibliometric analysis of EMR biomedical and health research productivity during the period 2004-2013, considering country of first author. METHODS: We applied an improved PubMed search strategy to obtain precise data on EMR research productivity, limiting articles to reviews, original research and case reports. Data were normalized to global research output, represented by total articles indexed in PubMed per year from 2004-2013, according to population size of each country. Second order polynomial trend lines were calculated and comparing 5-year periods: 2004-2008 with 2009-2013. RESULTS: Inspecting overall raw data, a clear increasing trend is observed. Regional share of global health related research ranged from 0.85-2.36% of total PubMed indexed publications during the study period. Five countries contributed to 80% of all published articles during study period; i.e., Islamic Republic of Iran (39%), Egypt (14%), Saudi Arabia (11%), Tunisia, and Pakistan (8% each). Overall, 2.35 articles are published per 100 000 population per year. While Kuwait maintained the highest per capita publication (followed by Tunisia, Lebanon, Qatar and Islamic Republic of Iran), Qatar, Islamic Republic of Iran and Saudi Arabia demonstrated the highest "per capita" population growth in publications. Three academic institutions accounted for over 10% of all publications that were led by an investigator from the Region. Collectively, most prolific 25 EMR institutions published 44% of all published biomedical and health research in the EMR. CONCLUSIONS: The overall global share of EMR health research publication is smaller than its global share of population or wealth. Biomedical and health research needs greater encouragement and supporting many EMR countries and/or institutions, especially those found to be least prolific in our analysis. The increase in academic publication on health has been more prominent in a few countries only. It is anticipated that the concentration of biomedical and health research in EMR academic institutions would help in translating knowledge into public health outcomes, if more suitable conditions are provided.

Development of an Eastern Mediterranean Region search strategy for biomedical citations indexed in PubMed.

PubMed, a 'barrier-free' bibliographic database covering biomedical and health disciplines, has been successfully used to identify a multitude of indicators that assist in analyzing global trends for biomedical research productivity. The current study represents an original attempt to develop and optimize an Eastern Mediterranean Region (EMR) search strategy in PubMed to pave the way for subsequent descriptive analyses. The refined EMR search strategy contains elaborate syntaxes which facilitate controlling the search process and maintaining a proper balance between sensitivity and precision of the obtained results. Country-specific citation data were manually scanned for false positive publications. Our results indicate that publication productivity increased nearly five-fold in the EMR from 2004 to 2013. Five countries (Islamic Republic of Iran, Egypt, Saudi Arabia, Tunisia and Pakistan; in order of total publications) contributed to 80% of all EMR publications during this period. Each of the remaining 17 EMR countries contributed less than 4%. We believe that the methodology presented in this study can be used in conjunction with other metrics to extract invaluable indicators to describe EMR health research systems.

Arab gene geography: From population diversities to personalized medical genomics.

Genetic disorders are not equally distributed over the geography of the Arab region. While a number of disorders have a wide geographical presence encompassing 10 or more Arab countries, almost half of these disorders occur in a single Arab country or population. Nearly, one-third of the genetic disorders in Arabs result from congenital malformations and chromosomal abnormalities, which are also responsible for a significant proportion of neonatal and perinatal deaths in Arab populations. Strikingly, about two-thirds of these diseases in Arab patients follow an autosomal recessive mode of inheritance. High fertility rates together with increased consanguineous marriages, generally noticed in Arab populations, tend to increase the rates of genetic and congenital abnormalities. Many of the nearly 500 genes studied in Arab people revealed striking spectra of heterogeneity with many novel and rare mutations causing large arrays of clinical outcomes. In this review we provided an overview of Arab gene geography, and various genetic abnormalities in Arab populations, including disorders of blood, metabolic, circulatory and neoplasm, and also discussed their associated molecules or genes responsible for the cause of these disorders. Although studying Arab-specific genetic disorders resulted in a high value knowledge base, approximately 35% of genetic diseases in Arabs do not have a defined molecular etiology. This is a clear indication that comprehensive research is required in this area to understand the molecular pathologies causing diseases in Arab populations.

Collaborative genomics for human health and cooperation in the Mediterranean region.

The US government has proposed the development of scientific centers of excellence to solve global challenges. We propose such a center of excellence devoted to the genomic analysis of Mediterranean populations of all creeds. This genomic focus is rooted in the region's demographic history, builds on the area's rapidly developing expertise in human genetics, and will yield scientific discoveries of both local and global significance. The genome sequence data of Mediterranean populations will offer unique insights into human evolution and early human migration. The potent combination of highly consanguineous populations in the Mediterranean's southern and eastern rims and regional medical and scientific expertise could lead to the identification and characterization of many genes responsible for human disease. Such discoveries will enable genetic knowledge to be translated into medical knowledge that will benefit local populations and contribute substantially to the understanding of the genetic bases of human diseases worldwide.

Consanguinity and reproductive health among Arabs.

Consanguineous marriages have been practiced since the early existence of modern humans. Until now consanguinity is widely practiced in several global communities with variable rates depending on religion, culture, and geography. Arab populations have a long tradition of consanguinity due to socio-cultural factors. Many Arab countries display some of the highest rates of consanguineous marriages in the world, and specifically first cousin marriages which may reach 25-30% of all marriages. In some countries like Qatar, Yemen, and UAE, consanguinity rates are increasing in the current generation. Research among Arabs and worldwide has indicated that consanguinity could have an effect on some reproductive health parameters such as postnatal mortality and rates of congenital malformations. The association of consanguinity with other reproductive health parameters, such as fertility and fetal wastage, is controversial. The main impact of consanguinity, however, is an increase in the rate of homozygotes for autosomal recessive genetic disorders. Worldwide, known dominant disorders are more numerous than known recessive disorders. However, data on genetic disorders in Arab populations as extracted from the Catalogue of Transmission Genetics in Arabs (CTGA) database indicate a relative abundance of recessive disorders in the region that is clearly associated with the practice of consanguinity.

Bibliometric analyses of biomedical research outputs in Lebanon and the United Arab Emirates (1988-2007).

OBJECTIVE: We assessed the role of bibliometric methods in representing quantitative and qualitative differences in biomedical research outputs in Lebanon and the United Arab Emirates (UAE). METHODS: Data on biomedical research productivity for years 1988-2007 were obtained from PubMed then imported into a specifically designed local database system and normalized to the population size for each country. RESULTS: Data reveal a continuous increase in research production in Lebanon, whereas a plateau phase is observed in the UAE between 1998 and 2007. In Lebanon, most of the citations originated from the capital city of Beirut, mainly the American University of Beirut. Detailed analysis of biomedical research objectives in Lebanon indicate a focus on internal medicine, anesthesiology, surgery, transplantation, medical genetics, pediatrics, obstetrics, neoplasms, and pain management. In the UAE, most of the biomedical publications originate from Al-Ain University. Detailed analysis of biomedical research objectives in the UAE indicate developed interest in pediatrics, obstetrics, clinical dysmorphologies, transplantation, dermatology, diabetes, and consanguinity. CONCLUSION: Biomedical research outputs quickly recovered in Lebanon following a long war (1974-1992) mainly supported by uninterrupted activities in private higher education institutes. In the UAE, the plateau phase for biomedical research output size could be due to the limitation of most of the research in the country to Al-Ain University. This situation may only improve when other institutes offering biomedical programs engage also in research activities.

CTGA: the database for genetic disorders in Arab populations.

The Arabs comprise a genetically heterogeneous group that resulted from the admixture of different populations throughout history. They share many common characteristics responsible for a considerable proportion of perinatal and neonatal mortalities. To this end, the Centre for Arab Genomic Studies (CAGS) launched a pilot project to construct the 'Catalogue of Transmission Genetics in Arabs' (CTGA) database for genetic disorders in Arabs. Information in CTGA is drawn from published research and mined hospital records. The database offers web-based basic and advanced search approaches. In either case, the final search result is a detailed HTML record that includes text-, URL- and graphic-based fields. At present, CTGA hosts entries for 692 phenotypes and 235 related genes described in Arab individuals. Of these, 213 phenotypic descriptions and 22 related genes were observed in the Arab population of the United Arab Emirates (UAE). These results emphasize the role of CTGA as an essential tool to promote scientific research on genetic disorders in the region. The priority of CTGA is to provide timely information on the occurrence of genetic disorders in Arab individuals. It is anticipated that data from Arab countries other than the UAE will be exhaustively searched and incorporated in CTGA (http://www.cags.org.ae).

Biomedical science journals in the Arab world.

Medieval Arab scientists established the basis of medical practice and gave important attention to the publication of scientific results. At present, modern scientific publishing in the Arab world is in its developmental stage. Arab biomedical journals are less than 300, most of which are published in Egypt, Lebanon, and the Kingdom of Saudi Arabia. Yet, many of these journals do not have on-line access or are indexed in major bibliographic databases. The majority of indexed journals, however, do not have a stable presence in the popular PubMed database and their indexes are discontinued since 2001. The exposure of Arab biomedical journals in international indices undoubtedly plays an important role in improving the scientific quality of these journals. The successful examples discussed in this review encourage us to call for the formation of a consortium of Arab biomedical journal publishers to assist in redressing the balance of the region from biomedical data consumption to data production.

Deniz: the electronic database for beta-thalassemia mutations in the Arab world.

OBJECTIVE: Data on the distribution of beta-thalassemia mutations in Arab populations are usually destined to disparate locations and much of these become increasingly difficult for an average researcher to locate. That is why we aimed at establishing an electronic database network, called Deniz, for beta-thalassemia allele frequency distributions in the Arab world at http://biobase.fatih.edu.tr. METHODS: The scheme of the database combines the benefits of the relational and hierarchical systems. Detailed statistics of the frequencies of beta-thalassemia mutations are retrieved in tabular forms. Multiple permanent connections allow flexible movement within the database. Queries are processed by the systems language and sent to the user's browser as hypertext markup language documents. RESULTS: The database catalogues the frequencies of beta-thalassemia mutations in 14 Arab countries as pooled from the analysis of 3,138 chromosomes by 36 laboratories. Of the 57 B-globin gene mutations reported in Arabs, IVS-I-110 (G-A), IVS-I-5 (G-C), IVS-I-6 (T-C), IVS-II-1 (G-A), and IVS-I-1 (G-A) are the most encountered and they account for approximately two thirds of the Arab chromosomes registered in Deniz. CONCLUSION: In addition to its importance as a hub of updated information on the distribution of beta-thalassemia mutations in Arabs, information in Deniz may be used to predict diagnostic strategies that may be offered to natives of unstudied countries. Incidence data may also give important clues on the possible origins of beta-thalassemia in the Arab world. The integration of Deniz with other databases is currently in process and researchers are invited to contribute to the growth of the database.

Biomedical research in the Kingdom of Saudi Arabia (1982-2000).

OBJECTIVE: Because of the leading position of the Kingdom of Saudi Arabia in biomedical research among the Arab States, we aimed this study at providing a detailed analysis of the development of this domain in the Kingdom. METHODS: More than 1500 queries were mainly directed to the PubMed bibliographic database. Tags, boolean operators, and wild cards were utilized. RESULTS: Most of the Saudi biomedical citations originated from the capital city of Riyadh (70%), particularly from the King Saud University (29.5%) and King Faisal Specialist Hospital (21.5%). One of every 5 Saudi papers either describes a disease, a blood related analysis, or surgical observations. Only 0.5% of Saudi papers appear in the 200 highest impact-factor journals. CONCLUSION: A steady advancement in biomedical research is observed in the Kingdom mainly in years 1987-1996. The absence of uniformity in writing the addresses of authors in published articles from Saudi Arabia results in misleading data about the geographical distribution of biomedical research and sometimes improper rating of the scientific institutions in the Kingdom. The most dynamic biomedical fields in the Kingdom observed in the present analysis are Hematology, Surgery, Cancer, Pharmacology, and Microbiology. The main reasons behind the small number of Saudi papers appearing in high impact-factor journals are the bias and the economics of scientific publishing. We hope that the present study will lay the foundation for more detailed investigations on the directions of biomedical research in the Kingdom and will be of great importance to better found future strategies in this important realm.

Hereditary anemias in Lebanon.

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