Earthquakes are among the most impressive natural phenomena with very high potential to set off a chain of effects that significantly affects public health through casualties and injuries. Related disasters are attributed not only to the strong ground motion and coseismic phenomena but also to secondary effects, comprising mainly landslides and tsunamis, among others. All these can create harsh conditions favorable for the emergence of infectious diseases that are capable of causing additional human and economic losses and disruption of the emergency and recovery process. The present study comprises an extensive narrative review of the existing literature on the earthquake-triggered infectious diseases recorded worldwide, along with their symptoms, causative pathogens, associated risk factors, most vulnerable population groups, and prevention strategies. Respiratory, gastrointestinal, and vector-borne diseases, as well as wound and skin infections, are mainly recorded among the earthquake-affected population. Measures for effectively preventing earthquake-triggered infectious diseases are also proposed. One of the widely proposed measures is the establishment of a proper disease surveillance system in order to immediately and effectively identify the pre- and post-disaster occurrence of infectious diseases. This approach significantly contributes to disease trends monitoring, validation of early warning, and support of the emergency response and recovery actions. Earthquakes are among the most impressive geological processes and remain one of the most unpredictable natural disasters, with the potential to cause destructive effects on humans and structures. Based on an overview of the last 20 years disasters, 552 earthquakes occurred, accounting for 8% of all disasters worldwide and ranking third after floods  and storms  .Despite the low percentage of earthquakes in the total number of disasters worldwide from 2000 to 2019, and despite the quantitative predominance of mainly hydro-meteorological phenomena, earthquakes are among the deadliest events that can also cause mega-disasters with tens to thousands of human casualties, injured, and homeless people in earthquake-affected areas. In terms of the economic impact, earthquakes have caused economic losses of 636 million over the above period , an amount that assigns earthquakes third place on the list after storms  and floods  [Several factors are responsible for the high mortality and morbidity of earthquakes. They can be classified into factors related to the seismotectonic setting and the geotechnical regime of the affected area, the time of earthquake occurrence, the weather conditions during the post-disaster period, the demographic characteristics of the affected area, the social, cultural, and community characteristics, and the structural characteristics of the built environment ,10,11,12Earthquakes cause a multitude of accompanying and subsequent phenomena ,14 with Earthquake casualties can be classified as instantaneous, rapid, or delayed ,16,17,18Τhe main causes of earthquake casualties worldwide comprise (i) the collapse of buildings due to ground shaking ,39,40,41Major injuries are mainly attributed to the partial or total collapse of buildings, movement of landslide material, generation of post-earthquake fires, physical impact with debris in fast-flowing tsunami water, and spill of hazardous chemicals ,53,54,55As regards the earthquake effects on survivors’ mental health, the most common psychiatric conditions seen among earthquake survivors are post-traumatic stress disorder (PTSD) and major depression (MD) . The preFrom the abovementioned, it is clear that earthquakes have the potential to set off a chain of events that significantly affect public health and can also create adverse conditions in the affected communities, favorable for the occurrence of sporadic cases, outbreaks, and epidemics of infectious diseases.Although it is impossible to accurately predict which diseases would be transmitted after a certain type of natural hazard, infectious diseases can be categorized as either water-borne, air-borne, or vector-borne diseases, or contamination from wounded injuries . InfectiThe aim of this study is to conduct an extensive narrative review of the existing scientific literature to present the infectious diseases associated with earthquakes and their accompanying effects that occurred worldwide. Furthermore, their symptoms and their causative pathogens are also reviewed, along with the risk factors associated with the occurrence of infectious diseases. This review also highlights the magnitude of earthquakes followed by infectious diseases, as well as their distribution in active and seismic fault systems worldwide.Based on the data of this review, as well as lessons learned and good practices from emergency responses to parallel occurrence and evolution of geophysical and biological hazards in recent years, the most effective prevention strategies to mitigate the adverse effects of earthquakes on public health will be highlighted and presented in a multi-hazard frame. The proposed measures aim at protecting all involved in an emergency situation, starting from the affected local population and the most vulnerable population groups up to the first responders, including Civil Protection staff, health workers, members of voluntary groups, and staff of emergency shelters.For this narrative review, all major medical, scientific, and technical research databases and resources contained in the National Center for Biotechnology Information (NCBI), part of the National Library of Medicine (NLM), were thoroughly investigated to identify documented sporadic cases, outbreaks, and epidemics of infectious diseases in humans around the world, which were considered to be associated with earthquakes and earthquake-triggered phenomena, including landslides and tsunami. More specifically, keyword searches were conducted on PubMed, Scopus and ScienceDirect.The search terms were based on the World Health Organization (WHO) document “Communicable diseases following natural disasters: risk assessment and priority interventions” . A list No standard definition of what constitutes an infectious disease outbreak was used to avoid omitting potentially relevant studies of public health significance. Additionally, no filters were used to identify specific study designs.Sporadic cases, outbreaks, and epidemics of infectious diseases in humans induced by earthquakes and their accompanying phenomena, including landslides and tsunamis, were documented worldwide at various points in time, since the review was not focused on a specific time period. Based on the available related information, it was found that the earthquakes associated with the occurrence of infectious diseases fell within a time period from 1980 to 2016.The main parameters of the studied earthquakes such as the moment magnitude, the intensity and the number of human losses, injured people, and total affected people are summarized in As shown in In terms of their distribution, the earthquakes that have the potential to induce infectious diseases in the post-disaster period occur within major active fault systems worldwide, such as the Tethyan Alpine system , the Circum Pacific Belt, better known as the Ring of Fire , and the Caribbean-Central America fault system (an earthquake in Haiti).Reporting of the infectious disease occurrence after destructive earthquakes generated around the world between 1980 and 2016 showed that the incidence of infectious diseases increased after each of these earthquake events. Respiratory, gastrointestinal, and skin infections are the most common infections detected in the post-earthquake period. The presence and recording of wound infections is also pronounced. The timing and magnitude of an earthquake, its area of occurrence , the earthquake-triggered environmental effects, including landslides, hydrological anomalies, and tsunamis, and the synergy with different types of natural hazards can play an essential role in the increased incidence of infectious diseases.n = 13), the 2015 Gorkha  Mw = 7.8 earthquake (n = 11), the 1999 Izmit (Turkey) Mw = 7.6 earthquake (n = 9), the 1999 Chi-Chi (Taiwan) Mw = 7.7 earthquake (n = 9), the 2003 Bam (Iran) earthquake Mw = 6.6 (n = 8), the 2010 Haiti (n = 8) Mw = 7.0 earthquake, and the 2004 Indonesia Mw = 9.2 earthquake (n = 7) (Taking into account the information presented in  (n = 7) .Upper respiratory tract infections were observed quite frequently in the short-term period after disasters induced by earthquakes generated in several continents, including North America  earthquake was higher than that of neighboring unaffected counties ,82. MostSurveillance of infections in the rural town of San Sebastian after the 2001 El Salvador earthquake showed that upper respiratory infections (30%) were the second most prevalent after skin infections .Survivors of the 2003 Bam earthquake in Iran were temporarily housed in tents and received daily visits as part of an infectious disease surveillance system. Upper respiratory tract infections were recognized as the most common problem. Overall, 792 cases occurred 3 weeks after the earthquake due to the low temperatures, especially at night . The stuA search of the medical records of all outpatients examined between August 2006 and December 2008, following the 2005 Kashmir earthquake in Pakistan, showed that the most common condition was viral upper respiratory tract infection (23%) .After the 2009 Sumatra earthquake, 1015 patients were examined at two primary health care clinics. Respiratory diseases accounted for the most frequent diagnoses .After the 2010 Haiti earthquake, approximately 42,361 cases were recorded during the period from 25 January to 24 April 2010. Nationally, the most commonly reported cases were acute respiratory infections (16.3%) .Ten days after the 2013 Lushan earthquake in Sichuan Province (China), common infectious diseases recorded in children included respiratory infections, among others .In the Philippines in 2013, disasters were attributed to different types of natural hazards: a flood, an earthquake, and a typhoon. Communicable infectious diseases were the predominant group of diseases recorded in all three types of disasters and included acute respiratory infections .Cephalonia Island (Ionian Sea) is located in one of the most seismic active areas of Europe. It was affected by the early 2014 earthquakes, on January 26 and February 3 with Mw = 6.1 and Mw = 5.9, respectively. The earthquakes were generated during the winter period characterized by low temperatures and rainfall for several days between the two events, leading to an increase of respiratory infection cases .Contagious airborne diseases were among the most common findings observed after the 2015 Gorkha earthquake . Among tThe two earthquakes that struck Kumamoto (Japan) in April 2016 caused evacuation in the earthquake-affected area. Evacuees were forced to spend an extended period of time in temporary camps and experienced upper respiratory tract infections, among other gastrointestinal and skin infections .As regards the impact of earthquake-induced tsunami on public health, it is demonstrated that the harsh conditions following the Indian Ocean tsunami caused by the Mw = 9.2, Sumatra–Andaman earthquake on 26 December 2004, the Samoa tsunami caused by the Mw = 8.1, Samoa earthquake on September 29, 2009, and the Great East Japan tsunami caused by the Mw = 9.0, Tohoku (Japan) earthquake on 11 March 2011, have favored the emergence and incidence increase of respiratory infectious diseases . Among tCoccidiodes immitis, which grows in the upper layers of soil in limited semi-arid areas of the western hemisphere . Approximately 60% of infected individuals are asymptomatic. The disease most commonly presents as an influenza-like respiratory illness, although a wide range of clinical symptoms may occur. Overall, only 1 in 200 people infected with C. immitis develop diffuse diseases [After the Northridge earthquake, between 24 January and 15 March 1994, Ventura County  experienced a major epidemic of coccidioidomycosis, a respiratory disease caused by inhalation of airborne spores of the dimorphic fungus diseases .Landslides that occurred after the earthquake and its strong aftershocks in the Santa Susana Mountains located north of Simi Valley resulted in dust clouds that were dispersed into nearby valleys by northeasterly winds . FollowiIndividuals who reported physical presence in dust clouds were 3 times more likely to be diagnosed with acute coccidioidomycosis than those who did not. The risk of being diagnosed with acute coccidioidomycosis increased with increasing duration of exposure and staying in dust clouds .C. immitis spread with dust clouds due to landslides caused by the 1994 Northridge earthquake [Both the location and timing of the outbreaks strongly suggest that the outbreak of coccidioidomycosis in Ventura County was caused when arthrospores of rthquake .Mycobacterium tuberculosis infection in children from earthquake-affected areas showed that of the 5476 children tested, 355 were positive for the tuberculin skin test, used to diagnose latent tuberculosis, and 16 had active tuberculosis. Although the prevalence of tuberculosis did not differ significantly between areas that were severely or less severely affected by the earthquake, living in a shelter with >25 people was found to have a significant effect on the tuberculosis incidence. Tuberculin skin test positivity appeared to be associated with older age, previous tuberculosis treatment, known contact with a person with tuberculosis, and living on a geographically isolated island. These data should be taken seriously in the design of national tuberculosis control programs, particularly with regard to the role that children’s vulnerability and geographically isolated communities play in the transmission and maintenance of tuberculosis [Following the 2013 Bohol (Philippines) earthquake, an assessment of the risk of rculosis .In 2010, Haiti suffered a devastating earthquake that destroyed the healthcare infrastructure in the capital Port-au-Prince and left 1.5 million people homeless. Subsequently, there was an increase in reported tuberculosis in the affected population . Even beCompared to previous national estimates , undiagnosed tuberculosis was three times higher in a shelter with internal displaced people  and five times higher in an urban slum  . Early dSix months after the 2008 Sichuan earthquake, tuberculosis cases recorded in hospitals in the affected Wenchuan region have increased compared to the same period of the previous year. Overall, 88.27% of patients lived in simply constructed temporary shelters in the affected area, among which only 58.06% met adequate sanitary conditions. Poor living conditions, overcrowding, excessive fatigue and stress, treatment interruption, and temporary inability to manage patients resulting from the disaster likely contributed to the worsening of tuberculosis epidemiology .A 14-year-old girl, who was living with her family in a temporary emergency shelter, presented with fever, abdominal pain, and vomiting at a temporary health center in the earthquake-affected city of Bhakatpur in Gorkha . Clinical abdominal examination indicated acute peritonitis. On laparotomy, three ileal perforations were identified, and histopathological examination showed cystic granulomas. Combined with the fact that her father had pulmonary tuberculosis with positive sputum, the child was diagnosed with tuberculous peritonitis and responded well to the administered anti-tuberculosis chemotherapy .Waterborne and foodborne diseases are mainly caused by the ingestion of water or food contaminated with pathogenic microorganisms  derived from human or animal feces. Gastrointestinal infections associated with earthquakes have been reported following the 1980 Irpinia  , 1999 IzOver a period of seven weeks after the 1980 Irpinia earthquake  32 suspected outbreaks were reported, of which only two were confirmed: (a) an outbreak of gastroenteritis in a group of firefighters (39 cases) and (b) an outbreak of viral hepatitis (Hb negative) (6 cases) in a community in the province of Potenza adjacent to the earthquake zone .After the 1999 Izmit earthquake, several factors, such as very hot weather conditions, close contact with the local population left homeless after the event, and the absence of proper water and sanitation systems in the area, could have increased the risk of infectious diseases among members of the Israeli Defense Force (IDF) search and rescue (SAR) team. A mild gastroenteritis outbreak was recorded among SAR personnel at the secondary rescue site in Chinargik town, where 30 out of 62 IDF soldiers complained of two to three loose or watery stools accompanied by abdominal pain. The incident was attributed to poor food handling practices because the cooked meats had been stored without refrigeration for several hours . The lowExcept from the respiratory infections, the 2014 Cephalonia Island (Greece) earthquakes also resulted in a gastrointestinal outbreak comprising 22 gastroenteritis cases among soldiers that developed diarrhea and abdominal pain 6–7 h after consuming a meal prepared by the same catering company. However, no clinical sample was collected for laboratory testing .Members of search and rescue (SAR) teams and first responders visiting and operating in affected areas are characterized as vulnerable groups of travelers. Following the earthquakes in Nepal in April and May 2015, there was an influx of such teams in the affected areas. Common problems recorded among volunteers included traveler’s diarrhea and skin problems. It was found that the volunteers were not adequately prepared for the situations they were likely to face, suggesting that proper information and advice on health issues before acting to the affected area can help reduce the incidence of health problems among this particular group . An asseThe distribution of shigellosis is worldwide and is estimated to cause around 600,000 deaths per year. Two thirds of cases and the majority of deaths are in children under 10 years of age. Outbreaks are observed in overcrowding conditions and where personal hygiene rules are not followed such as in prisons , day carShigella species, Salmonella species, and Giardia intestinalis, could be the possible causes of diarrheal disease outbreaks due to the hot summer, damaged infrastructure, and difficulties in obtaining safe drinking water [Shigella species were the most common isolates [Immediately after the devastating 1999 Izmit (Turkey) earthquake, an infectious disease surveillance system was set up in Kocaeli province, which was the most affected by the earthquake. Waterborne microorganisms that were observed before the earthquake, such as ng water . Diarrheisolates .Following the 1999 Chi-Chi (Taiwan) earthquake, 15 cases of shigellosis were recorded in Nantou County from 21 September to 31 October 1999. Four and eleven cases were reported in Nantou County during the corresponding periods in 1997 and 1998, respectively . The incSalmonella enterica infection occurred in children in the town of L’Aquila  between June 2013 and October 2014, four years after the 6 April 2009 devastating earthquake [S. enterica strain probably following contamination of natural springs’ water due to geological processes that occurred during the devastating earthquake [An epidemic of rthquake . Salmonerthquake .Francisella tularensis transmission [Wild and domestic animals, such as rabbits or rodents, as well as ticks, can transmit tularemia to humans. There are four modes of transmission, including ingestion of contaminated food or water, handling infected animals, insect bites, and inhalation of contaminated dust . In Eurosmission .The first case of tularemia in the town of Golcuk, Kocaeli province was recorded after 5 patients were admitted to a central hospital in the province in January 2005 . They alVibrio cholerae. Transmission of the disease occurs through the consumption of contaminated food or water [Cholera is an acute diarrheal disease caused by the intestine being attacked by the enterotoxin produced by the bacterium or water . Water iV. cholerae, Ogawa biotype, serogroup O1, as the causative pathogenic agent. Several of the patients reported drinking untreated water from the Artibonite River and not using toilets [After the 2010 Haiti earthquake, cholera was thought to have been reintroduced to Haiti after the country had been cholera-free for almost a century . On 19 O toilets . Therefo toilets .V. cholerae serogroup O1 serotype Ogawa due to drinking contaminated water in densely populated areas of Kuleshwor and Kalimati districts in Kathmandu [V. cholerae were reported in 2015, of which 150 were identified in Kathmandu Valley.In addition to Haiti, cholera outbreaks occurred after the 2015 Gorkha earthquake in Kathmandu, the capital and largest city of Nepal. Twenty-nine people developed cholera from athmandu . Accordiathmandu , 169 casH. pylori infection [H. pylori was found in disaster survivors compared to patients screened during the same period before the earthquake. These results suggest that a seismic event could contribute to the development of H. pylori infection in individuals living in the disaster-affected areas [One month after the 2011 Van earthquake in Turkey, 209 dyspeptic patients undergoing gastroscopy were screened for the presence of nfection . A signied areas .Giardia lamblia that colonizes the small intestine of mammals. Humans become infected accidentally by ingesting protozoan cysts either through ingestion of feces-contaminated food and water or through direct contact with infected individuals [Giardiasis is an infection of the digestive tract by the protozoan ividuals .Giardia infection included the use of communal toilets  and water supply from municipal sewers  [Giardia lamblia was found in children living in camps after the Armenian earthquake. Giardiasis is an emerging disease after destructive events and appropriate prevention measures should be implemented during these conditions [On 25 January 1999, a strong earthquake destroyed 70% of the houses in the city of Armenia (Colombia). Emergency shelters were organized and operated for up to 2 years after the disaster. Parasitological studies carried out on the affected population showed that giardiasis was the most common parasitic infection . Factorsl tanks) . A high nditions .Giardia cysts from drinking water at a rate of about 99%, but the use of more than one disinfectant is required [The application of hygiene measures and adequate washing of fruits and vegetables before consumption help to avoid ingestion of contaminated cysts. Protozoan cysts are known to survive in chlorinated water but can be destroyed by boiling, drying, and freeze/thaw cycles. Filtration processes have been shown to be effective in removing required .p < 0.05) [Two earthquakes in the north-western region of Turkey destroyed 80% of the houses and schools in the city of Düzce in 1999. Oztürk et al.  compared < 0.05) .The 2005 Kashmir earthquake caused widespread contamination of drinking water sources and contributed to a rotavirus outbreak between October and December 2005. Rotavirus is the leading cause of severe diarrhea worldwide among children younger than 5 years and is responsible for around 40% of related deaths, estimated at over 500,000 per year . In KashHepatitis A and E infections remain an important public health concern in many developing countries, where poor socioeconomic conditions and high population density contribute to the transmission of these viral infections . HoweverSencan et al.  investigKaya et al.  assessedVector-borne diseases are infections transmitted by the bite of infected arthropod species, such as mosquitoes, midges, ticks, and mites. They were detected in areas affected by the 1991 Costa Rica , 2003 BaOrientia tsutsugamushi and is transmitted to humans through bites of infected mites found in forests, bushland, gardens, and beaches. Most cases are recorded in rural areas of Southeast Asia, Indonesia, Japan, China, India, and northern Australia [Scrub typhus is caused by ustralia .O. tsutsugamushi and consequently increased the likelihood of human exposure to these infected vectors. The detection of O. tsutsugamushi in humans, rodents, and mites in the affected areas, as well as the widespread reports of scrub typhus cases across the country for 3 consecutive years, confirms the ongoing transmission of O. tsutsugamushi with a firmly established ecology in Nepal [A few months after the 2015 Gorkha earthquake in Nepal and the subsequent strong aftershocks, scrub typhus outbreaks were reported in different parts of the country, particularly in earthquake-affected areas ,141. Ovein Nepal . The 201In 1991, a huge increase in malaria cases was recorded following the earthquake and floods in Costa Rica because of an increase in the mosquito population caused by deforestation and changes in river flow patterns . Sáenz ePlasmodium falciparum is endemic in Haiti and the main mosquito vector is Anopheles albimanus, which is mainly active at dawn and dusk and prefers to live and feed outdoors. Consequently, populations living outdoors or in temporary shelters, as well as thousands of first responders in Haiti, are at significant risk of developing malaria from P. falciparum. During the period 12 January to 25 February 2020, CDC received reports of 11 laboratory-confirmed cases of P. falciparum malaria occurring in Haiti  [Malaria caused by raveler) .Leishmania tropica and L. major, respectively [Cutaneous leishmaniasis is a disease with a wide range of clinical manifestations and occurs mainly in seven countries: Afghanistan, Algeria, Algeria, Brazil, Iran, Iran, Peru, Saudi Arabia, and Syria . Two forectively .Detecting and reporting of cutaneous leishmaniasis cases in the rural town of Zarindasht in the southern Iranian province of Fars from April 2002 to April 2004 showed that 2003 earthquakes may have led to an outbreak of the disease as the annual incidence increased from 58.6 confirmed cases/100,000 in the 12 months before the earthquakes to 864 confirmed cases/100,000 (at the peak of the outbreak) in the following 12 months . Most ofLeishmania species. Since 2004, the epidemiology of cutaneous leishmaniasis has changed with the emergence of new outbreaks and non-healing clinical forms that persist for a long time [Construction of new settlements, expansion of villages, development of previously uninhabited areas, and poor management of waste and debris piles are risk factors that have contributed to the increase of the disease incidence . The 200ong time ,148.All age groups were affected, especially children aged 10 years, which probably suggests the existence of (a) acquired immunity in older city dwellers and (b) behavioral patterns of children, such as outdoor play, that increase their exposure to sandflies .It is noteworthy that although both earthquakes accounted for only one human loss, they caused huge ecological changes, disrupted the normal activities of residents, and forced many of them to sleep outdoors until the threat of aftershocks and further damage to buildings was reduced. The ecological changes that created an ideal environment for the development of the sandflies population and the aftershock behavior of the city residents  contributed to the increased exposure of the affected population to the sandflies bites .Despite considerable efforts and implementation of various approaches to reduce transmission of the disease, cases of cutaneous leishmaniasis increased to epidemic proportions after the earthquake, particularly during 2006–2008 in Bam city ,136. DurIt is worth noting that, although the prevalence of cutaneous leishmaniasis cases has increased after the earthquake , the sevMost cases of cutaneous leishmaniasis occurred in unimmunized men. In the post-earthquake period, the Bam population increased significantly, mainly due to the massive movement of workers and contractors undertaking large-scale construction projects. After the earthquake, men aged >20 years were mainly infected, the majority of them with skin lesions located on the extremities (hands or feet) ,138. JobThe Sichuan earthquake in China occurred in May 2008, when the hot and humid weather was beneficial for insect breeding and multiplication. Zhang et al.  examinedAedes aegypti and Aedes albopictus, as well as by other routes of transmission, including sexual transmission [Zika virus (ZIKV) is an arbovirus transmitted to humans by the mosquitoes smission . Despitesmission .The 2016 Ecuador earthquake contributed to the increase of reported Zika virus infection cases . BuildinAs of 16 April 2016, a total of 92 cases of ZIKV had been recorded across the country. In the aftermath of the earthquake, this number rose rapidly to 1106 total cases in just 3 months. In total, 80% of these cases were reported in Manabi province, the area most affected by the earthquake . Reina OThe ZIKV outbreak in the city of Manabi, Ecuador, after the 2016 earthquake, demonstrates the negative impact of natural hazards in socially vulnerable areas where climatic conditions are not considered normal for the region. An extremely strong El Niño event created environmental conditions that favored the proliferation of mosquito vectors just as ZIKV first appeared in Ecuador .The increase in ZIKV incidence may be associated with the movement of population groups and overcrowding that may increase exposure to virus vectors. Destruction of property and sewage and water management systems may increase the number of Aedes aegypti breeding sites. Stressful conditions alter the immune status and increase the susceptibility of the population to developing symptomatic disease .Wound and skin infection refers to the infection of tissues by one or more types of microorganisms. The type of wound infection depends mainly on the environment in which the injury took place, the extent of the injury, the microorganisms present on the skin of the injured person, the microorganisms to which the person has been exposed during wound healing, and the general health and immune status of individuals.Traumatic injuries that occur after an earthquake disrupt the balance of the immune system and increase the predisposition to infectious complications. Being trapped under rubble for a long period of time can cause severe crush injuries, leading to an increased risk of exposure to pathogens.Wound and skin infections were reported after the 1999 Izmit (Turkey) ,152,153,Staphylococcus aureus, but only 24.4% of all isolated microorganisms were Gram-positive bacteria and 73.2% were Gram-negative, such as Escherichia coli, Acinetobacter baumannii, Enterobacter cloacae, and Pseudomonas aeruginosa [Most patients in the 2008 Sichuan earthquake were buried under rubble with soil, bricks, or stone. Time under debris and time from injury to treatment was associated with the wound infection occurrence. Victims who survived the earthquake were often severely injured. The incidence of wound infections was high due to inadequate provision of medical personnel, surgical equipment and antibiotics, subsequent rainfall, and high temperature in earthquake-affected areas . The mosruginosa ,168,169.A. baumannii (27%), E. cloacae (18%), and P. aeruginosa (13%). However, this distribution of pathogens differed from that in hospitalized cases in the year before the earthquake. The pathogens most frequently isolated in the pre-earthquake period were E. coli (27%), S. aureus (23%), and coagulase-negative staphylococci (9%) [A similar picture was seen in the studies by Kang et al.  and Zhancci (9%) . Meanwhicci (9%) .After the 2010 Haiti earthquake, the majority of earthquake victims were admitted to hospitals for limb injuries requiring orthopedic surgery and treatment of infected wounds. Overall, 77% of the wound infections were polymicrobial and involved predominantly Gram-negative bacteria, which were resistant to the antimicrobials recommended in current CDC and WHO guidelines .P. aeruginosa, Enterobacter spp., and Acinetobacter spp.) were the most common microorganisms isolated from polymicrobial wound infections [After the 2005 Kashmir earthquake in Pakistan, Gram-negative bacteria (fections . The prefections .Recording these changes in the spectrum and resistance of pathogens isolated after earthquakes can contribute to the timely administration of effective treatment after similar seismic events like the 2008 Sichuan (China) earthquake . EarthquAcinetobacter was the main bacterial isolate identified from patients with wound infections attributed to the 1999 Izmit earthquake compared to the almost non-existent prevalence of Acinetobacter infections in the ICU of the same hospital. S. aureus and E. coli were the most common pathogens at the initial stage of hospitalization. With a prolonged ICU stay, A. baumannii and Klebsiella pneumoniae gradually became the dominant pathogens [Crush syndrome can lead to prolonged hospitalization and is associated with an increased risk of subsequent infection . A high athogens .Aeromonas spp., E. coli, K. pneumoniae, P. aeruginosa, and Proteus spp. [It is noteworthy that the aforementioned isolated bacteria differed significantly from the isolation pattern recorded in the 2004 Indian Ocean earthquake and tsunami, where the most commonly reported infectious agents were eus spp. ,158,159.The high frequency of Gram-negative bacilli isolation from wound cultures is probably explained by the mode of wounding. Gram-negative bacilli are naturally present in soil and water and people are probably exposed to these bacteria at the time of injury. It is also likely that these infections are hospital-acquired because most patients come from front-line hospitals, where drug resistance rates can be high ,173.Laboratory microbiological analysis is essential for the optimal selection of antibiotics to treat infection, as well as for preventing and possibly reducing the risk of hospital-acquired infection. In addition, effective management of infection contributes to better wound care and therefore leads to lower mortality and disability rates .S. aureus and S. epidermidis. Gram-negative bacteria (35.6%), including E. cloacae, K. pneumoniae, and Serratia rubidaea, were detected in a smaller number of samples in contrast to the pattern seen in wound infections in other body areas [Craniocerebral injuries are rarely vulnerable to infection due to the abundant blood supply. However, among individuals injured in the Sichuan earthquake, scalp wound infections were recorded quite frequently . Gram-pody areas .Certain measures can improve the prognosis of patients with severe infection, including early recognition of infection, early identification of microorganisms, rational use of antimicrobial agents with the guidance of infectious disease experts, targeted therapy to boost the immune system, necessary surgical removal of infected foci, early debridement, and strict surveillance for hospital-acquired infections .Clostridium tetani. The bacterial spores are mainly found in soil, human feces, and on the surface of rusty objects [Tetanus is an acute infectious disease caused by the exotoxin of  objects .Despite being easily preventable with a highly effective vaccine, tetanus remains a major source of morbidity and mortality worldwide. The death rate from tetanus remains high in developing countries affected by natural hazards, where tetanus vaccination coverage is often low or non-existent. Successful treatment of tetanus depends on prompt diagnosis, timely administration of treatment, administration of sedative and muscle relaxant drugs, maintaining an open airway, and mechanical respiratory support in the management of respiratory failure . TetanusIn January 2005, an epidemic of tetanus was detected among the tsunami survivors in Indonesia. Of the 106 cases, 79% were over 25 years old (the median age was 40 years) and 62% were male . The casThe tetanus cases detected following the 2004 Indian Ocean earthquake and tsunami was the largest cluster reported after a natural disaster or an event with huge number of casualties, surpassed only by the 2005 Kashmir earthquake after which 139 cases were recorded . The enoFollowing the 2006 Yogyakarta earthquake, 26 tetanus cases were recorded, including 8 fatalities. Significant predictors of death included the distance from the patient’s residence to the hospital and the type of hospital .Clostridium perfringens. A prerequisite for the occurrence of gas gangrene is wound contamination in such a way that anaerobic conditions are created, i.e., either the wound is deep or the tissues from the injury have been necrosed. Gas gangrene cases were detected in victims of the Sichuan earthquake and several of these were confirmed after culture to have resulted from Clostridium perfringens infection [Gas gangrene or myonecrosis is a highly fatal deep soft tissue infection caused by nfection ,171.In the first three months after the 1999 Izmit earthquake, registrations to the outpatient clinic of a dermatology department included infections/infestations and dermatoses mainly due to damaged infrastructures and unhygienic life conditions. In the following 3 months, erythematous squamous, pruritus, neurocutaneous dermatoses, and eczemas predominated and were due to psychoemotional factors related to the earthquake .The evaluation of skin problems recorded at a general hospital in Banda Aceh after the 2004 Indian Ocean earthquake showed that the most common skin problems were infections/infestations, followed by eczemas and traumatic skin disorders, which were more common in men . The preEarthquakes alter existing environmental conditions, resulting in direct public health impacts, including occurrence of sporadic cases, outbreaks, and epidemics of infectious diseases in the affected population and those involved in emergency response and recovery actions.Coccidioides immitis were transferred to Ventura County with dust clouds generated during the 1994 Northridge, California earthquake [Strong ground motion alters the stability conditions on slopes, resulting in slides and rockfalls on natural and artificial slopes. The resulting dust clouds have a high potential to adversely affect public health, especially when carried by prevailing winds to residential rural and urban areas. A typical example of such an effect is the outbreak of coccidioidomycosis that occurred when airborne spores of rthquake ,69.The vertical displacement of the seabed and offshore earthquake-triggered landslides can generate large tsunamis with significant impacts on infrastructure and the population of coastal areas. Typical examples are tsunamis generated in individual parts of the Ring of Fire, including the Indian Ocean tsunami on 26 December 2004, the Samoa Islands (South Pacific Ocean) tsunami on 29 September 2009, and the Japan tsunami on 11 March 2011, which have flattened extensive coastal areas with thousands of human casualties and widespread post-event public health impacts .Apart from the above direct effects of secondary seismic phenomena on public health, there are also indirect effects, mainly resulting from damage and malfunction of the main elements of the built environment. The strong ground shaking and the resulting severe structural damage to residential buildings create an emergency need for immediate sheltering of thousands of people in places, whether organized or not, where overcrowding prevails and sanitary conditions deteriorate.Damage to health care facilities causes problems and delays in providing first aid and immediate medical care to the affected people. The destruction of parts of the road network causes temporary disruption to transport services and difficulties in accessing essential supplies and emergency services immediately. These effects on lifelines are characterized by high potential to induce the occurrence of infectious diseases and even result in human casualties among earthquake survivors.Heavy structural damage to critical healthcare infrastructure, including facilities and buildings, remained unfixed during the emergency response and the subsequent recovery, causing delayed management and treatment of severe infectious diseases cases.Lack of awareness and provision of early or real-time warning for the upcoming and the ongoing events, resulting in little time for preparedness or evacuation.Severely injured earthquake and tsunami survivors highly exposed to high pathogen densities in soil and water.Immense changes in climate and aggravating weather conditions in the emergency response phase including dramatic temperature changes.○airborne particulate matter due to large dust clouds formed by earthquake-triggered landslides.○airborne particulate matter due to contaminated ejecta dust formed by earthquake-triggered liquefaction phenomena with a destructive impact on water and sewage systems.Prolonged physical exposure to and inhalation of:Prolonged physical exposure to and aspiration of contaminated water due to tsunami generation and impact on the coastal residential zones.○High population density and overcrowding.○Poor living conditions comprising small places for individuals and families and insufficient equipment for the homeless and evacuees .○Lack of clean running water due to damage and contamination of the water supply systems and water sources, respectively.○Unsanitary conditions (poor hand hygiene) due to a shortage of personal hygiene items.○Malnutrition due to insufficient food provision and shortage of long-lasting food supplies.○Insufficient equipment comprising essentials and poor heating, ventilation and air conditioning systems among others.○Rodent/vector infestation.Emergency shelters and evacuation camps with:Increased exposure to vectors and rodents due to earthquake-triggered ecological changes, leading to extensive formation of potential breeding and feeding sites of vectors and rodents.The weak immune system of vulnerable groups of the affected population comprising the elderly, the chronically ill individuals, and young children.The dependency of young children, people with disabilities, and elders of the affected communities seeking assistance with daily activities.Poor socio-economic conditions, including large percentage of low education level, a large part of the population living below the national poverty line leading to insufficient personal hygiene and denial of risk, disinterest, and ignorance of risk, as well as poorly constructed buildings and infrastructures.Poor health education and training on infectious disease prevention and control.Lack of emergency preparedness and training of residents and medical staff for infectious disease prevention.Insufficient or low vaccination coverage due to limited vaccination campaigns and short supplies.Close contact with cases and activities and interaction in areas where clusters of infectious disease cases have been observed.As concluded from the above literature review on earthquake-triggered infectious diseases, the risk factors that can lead to the occurrence of sporadic cases, outbreaks, and epidemics of infectious diseases in an earthquake-affected area are summarized as follows ,183,184:The knowledge of factors underlying earthquake-triggered infectious diseases can contribute to the adoption and application of effective prevention strategies. These measures should be taken in the light of a more multihazard approach to environmental, disaster, and crisis management, related to different types of hazards. This need has begun to emerge in recent decades as the interactions between mainly natural hazards became increasingly evident ,186. It One of the widely proposed measures for the prevention of infectious diseases after an earthquake and its effects is the establishment of a proper disease surveillance system. The main purpose of the surveillance system is initially to immediately and effectively identify the pre- and post-disaster infectious disease cases and trends through the collection, compilation, and analysis of information related to the number of cases of various diseases.Through this rapid identification of infectious disease cases, it is possible to contribute effectively to improvement of disease trends monitoring, validity of early warnings, support for vaccine development, the development of more effective prevention strategies and thus to a more complete assessment of the public health burden of infectious diseases. Among the key structural elements of this surveillance system are the alert and response components.One of the most important prerequisites for strengthening the early warning component of a surveillance system is the regular exchange of information between the competent authorities. Proper disease surveillance after a disaster is further enhanced by prompt diagnosis and subsequent treatment, which should be expanded to all high-risk parts of the earthquake-affected areas in order to prevent the acquisition of infectious diseases and the subsequent emergence of outbreaks and epidemics.The significance of the infectious disease surveillance systems should be emphasized in emergency shelters for the implementation of infection prevention and control measures. The emergency shelters are critical post-disaster infrastructures, providing immediate temporary shelter to those who leave their homes due to severe structural damage or evacuation of an area affected by both the earthquake and its accompanying phenomena. However, in the first days or hours after the earthquake occurrence that has led to a surge of evacuees and internal displaced people and heavy structural damage of the healthcare facilities and life lines in affected areas, emergency shelters are the places where the first cases of infectious diseases may occur, leading to related outbreaks or even epidemics.Typical examples of sporadic cases, outbreaks, and epidemics of infectious diseases come from Japan and the emergency shelters that were set up to accommodate those in need of immediate shelter and food after the 2011 earthquake and the subsequent tsunami that hit much of the coastal zone in the eastern part of the country ,184. EmeIn order to prevent such adverse effects during staying in emergency shelters, it is necessary to conduct actions to mainly cover the gaps in the organization and operation of these places. Thus, ample amounts of bottled water and canned and dry food should be available, adequate ventilation (heating and air-conditioning) should be provided, personal protective equipment  should be distributed to prevent the spread of respiratory tract infections, mosquito nets and insect repellents should be distributed and spraying should be carried out to prevent vector-borne diseases, and appropriate pharmaceutical material and effective vaccines should be available in sufficient quantities. As regards the awareness-raising and information of evacuees and staff, material comprising posters and leaflets should be posted in several sites of the shelters for enhanced prevention of infectious diseases not only in the emergency shelters but also in the affected community.In order to avoid overcrowding in emergency shelters, more shelters of the same or different type should be constructed. This approach was successfully used in the case of devastating earthquakes that hit Greece during the COVID-19 pandemic, where maintaining physical distance between evacuees was a measure to limit the spread of SARS-CoV-2 in the earthquake-affected communities ,188,189.Infectious disease mitigation measures in emergency shelters can be divided into (i) measures for first responders and personnel involved in the emergency response, (ii) mitigation measures for accommodated staff and visitors in emergency shelters, (iii) administrative and engineering controls in emergency shelters, including changes in the layout of facilities and distribution practices of supplies, and (iv) designation of isolation facilities to separate suspected cases of infectious diseases .When an earthquake causes extensive structural damage to the built environment and a major impact on the population of the affected area, search and rescue teams are mobilized not only from the services of the affected country and neighboring countries but also from other countries on other continents with different epidemiological characteristics. In order to avoid sporadic cases, outbreaks, or even epidemics of infectious diseases in non-endemic countries or the addition of epidemic risk factors to existing ones, all people involved and responding to disaster management comprising rescuers, volunteer teams, and aid organizations should respect the fundamental principle of all assistance, which is initially not to harm. With this in mind, measures should be taken to protect the health of both first responders and the affected population. With regard to the first aspect of protecting those involved in the immediate response, strict adherence to personal hygiene and safety and environmental sanitation protocols should be applied in areas where SAR operations are conducted and in emergency shelters. Furthermore, adherence to good hygiene practice in the handling, preparation, and distribution of food should also be applied in the areas where these teams operate ,188,190.In the affected area where the SAR team was deployed, due to the absence of running water, abundant amounts of mineral water and baby wipes were used for washing. Food for the team was limited to prepackaged or canned field rations . The use of local products in meal preparation and their consumption was prohibited. Close medical guidance was given to all food handlers and environmental hygiene supervision was continuously carried out during the mission. These methods, combined with immunization, kept morbidity to a minimum. In another region, where all of the above was not strictly followed, there was a 48% gastroenteritis infection rate .Ensuring the safety of drinking water and sewerage systems not only in either temporary or permanent relief camps but also in areas characterized by high riskCompliance with the existing safety and hygiene measuresWhere existing measures are not sufficient, educational activities for hygiene and sanitation awareness raising should be conducted, aiming for the integration of safe water and hand hygiene best practices into households, communities, and countriesLarge-scale preventive vaccination and medicine programs for several infectious diseases should be implemented, along with the establishment of a proper disease surveillance program and a long–term empowering and strengthening of the public-sector health system.As far as the protection of the local population is concerned, the same strict adherence should be applied to personal and environmental hygiene rules. The example of the cholera epidemic following the 2010 Haitian earthquake, which caused human losses greater than those attributed to the earthquake’s impact on the country’s buildings and infrastructure, is typical. Many researchers have addressed this epidemic ,195,196.In order to provide relief efforts to a region systematically, data and information on the prevalent endemic and epidemic infectious diseases in the disaster-affected area should be collected shortly after the earthquake occurrence. A quick evaluation of the existing infectious disease patterns should be also assessed, along with the demographic conditions of the affected area, including the number, size, and location of residential areas and population density, the availability of safe clean running water and adequate personal and environmental sanitation facilities, as well as the nutrition status and the immunization coverage of the disaster-affected population .With regard to respiratory infections caused by secondary earthquake environmental effects, mainly including landslides and liquefaction, measures deal with limiting the exposure of affected people to dust clouds generated during landslides and the clearance of areas covered from extensive liquefied deposits ,197,198.2 per person. The UN Refugee Agency (UNHCR) [2 per person in cold climates and 3.5 m2 per person in tropical, warm climates. These recommendations could facilitate emergency evacuation planning and result in the reduction of ARI incidence at emergency shelters.Increased incidence of respiratory infections could be attributed to seasonal variations and overcrowding conditions in emergency shelters in the earthquake-affected areas. The correlation between shelter crowding and an increased ARI incidence rate was demonstrated by Kawano et al.  followin (UNHCR)  developeTo avoid the occurrence of waterborne diseases during the emergency in earthquake-affected areas, one of the most effective proposed measures is the examination of water and sewage systems for detecting non-structural and structural damage with potential to affect public health. It is a practice that has been applied in all developed countries for decades. If non-structural and structural damage is found in these systems, chlorination or even an initial supply from a different source is applied and then disinfection follows ,202. IndTo reduce the risk of vector- and rodent-borne diseases throughout the earthquake-affected areas, public health authorities should give priority to surveillance. The implementation of response activities and control measures, as well as the improvement of preparedness efforts aimed at emerging vector- and rodent-borne diseases, depends on the immediate recognition and identification of local vector and rodent species, environmental factors, and breeding habitats that influence local disease transmission.Information on how to avoid contact with water, especially if skin abrasion happens, avoid touching eyes, nose, or mouth, identify rodent- and vector-borne infection symptoms, and seek immediate medical help and advice if you become ill should be distributed to the general public and disaster management officials. Since misdiagnosis or delayed diagnosis has serious clinical implications, early detection of signs and symptoms, appropriate treatment, and application of disease-specific therapies are essential to reduce morbidity and mortality. The earthquake-affected population should also stay away from places like uncontrolled waste disposal sites, garbage dumps, and areas with stagnant water where they might come into contact with contaminated surface water or infected animal urine.A rapid risk assessment should be performed within the first week of the earthquake’s occurrence by gathering data on the earthquake-affected area and population, with a focus on internally displaced people, as well as the risk of infectious disease outbreaks and disruptions to the public health infrastructure. The establishment of adequate disease surveillance systems and the identification of suitable interventions for managing and mitigating the negative effects of infectious disease outbreaks that happen concurrently with or after an earthquake disaster are both made possible by recorded data.The improvement of health surveillance systems, the maintenance and provision of effective and efficient health care services, and the reduction of associated mortality and morbidity may all be aided by education, training, and awareness-raising initiatives for the identification and management of infectious diseases.It may be possible to prevent the onset of an infectious disease outbreak during the post-disaster phase or to mitigate and eliminate the negative effects on the public health after the onset of an infectious disease outbreak by taking awareness-raising and informational actions in areas with high seismic risk and susceptibility to seismic effects. In addition to making it simple to implement personal protective measures to prevent infection, these actions allow for effective management of an impending outbreak.Flexible preparedness planning and measures that can quickly and effectively incorporate unforeseen circumstances and associated negative effects are required in terms of long-term prevention. This strategy necessitates expanding our understanding of the connection between infectious diseases and disasters induced by natural hazards. Planning for emergency response to disasters by natural hazards should include measures for preventing infectious disease outbreaks and mitigating their effects on the affected population and the staff involved in emergency response and recovery.The public, in particular residents belonging to particular groups within communities who may be more susceptible than others to the negative effects of earthquakes and may therefore suffer the most from the generation of such events and subsequent infectious disease outbreaks, should also be informed of these measures in a timely and effective manner, in addition to the staff involved in the prevention and management of these emergencies. The elderly, people with disabilities, children, women, people with low incomes, the homeless, and migrants are some of these groups.Earthquakes occur in specific zones where active faults have been formed. A rupture along these active faults results in primary and secondary effects with considerable impact on the built environment and the local population of the affected areas.The synergy of pre-existing conditions and changes caused by the earthquake and its primary and secondary effects, combined with the physiographic characteristics of the affected area and the socio-economic characteristics of the affected communities, have high potential to cause public health impacts, including sporadic cases, outbreaks, and epidemics of infectious diseases, which may lead to human losses, resulting in a delay of the recovery process in the earthquake-affected area.This study shows that earthquake-triggered infectious diseases have occurred not only in areas devastated by destructive earthquakes with hundreds to thousands of human casualties, thousands to tens of thousands injured, and tens of thousands to millions internally displaced people, but also in areas affected by earthquakes with an extensive impact on elements of the built environment (buildings and lifelines) but with no direct impact on human life, including losses and injuries.The risk factors that favor the incidence of infectious diseases in earthquake-affected areas are related to the earthquake magnitude and intensity, the extent of its primary and secondary effects, the demographic and epidemiological characteristics of the affected area, and the level of education and living conditions of the affected communities, as well as the damage to public health structures and facilities.The infectious diseases that have been recorded to date following the occurrence of earthquakes around the world are classified into (a) respiratory infections, (b) gastrointestinal diseases (water- and food-borne diseases), (c) vector-borne diseases, and (d) wound and skin infections.Regarding measures for the prevention and management of earthquake-triggered infectious diseases, the most effective and widely recommended measure by almost all relevant published research is the establishment of an appropriate disease surveillance system. Such a system should be able to effectively identify infectious disease trends before and after the earthquake and contribute to a full assessment of the public health burden of the infectious diseases and their management. This system should be governed by a multiparametric, interdisciplinary, and multihazard approach. This approach is considered imperative, especially in recent years, where the parallel occurrence and evolution of geophysical and biological hazards and related disasters with public health implications is more frequent than ever before.


The mental health effects of Coronavirus2019(COVID-19) outbreak might be profound, including higher suicide rates.This phenomena is likely to become a more pressing concern as the pandemic spreads.While remarkable social distancing interventions have been implemented to reduce the rate of new infections,the potential for adverse outcomes on suicide risk is high, especially among vulnerable populations.The aim is to do a review of the literature of suicide prevention during the COVID-19 outbreak.Non-systematic review of the literature with selection of scientific articles published in the last 7 months; by searching the Pubmed databases, the following MeSH terms were used: Suicide prevention; COVID-19In order to prevent suicide, urgent consideration must be extend beyond general mental health approaches. A wide-ranging interdisciplinary response that recognises how the pandemic might heighten risk is needed. The application of knowledge about effective suicide prevention is the key. Mental health services should develop clear remote assessment and care pathways, and staff training to support new ways of dealing with. Publications on mental health and psychological effects of COVID-19 outbreak provide important information and recommendations for all three levels of suicide prevention: primary, secondary, and tertiary.The challenge of the COVID-19 outbreak might bring with it an opportunity to advance the field of suicide prevention and, thus, to save lives, which also represent a public health priority. The mental health community, backed by active vigilance and international collaboration, should be prepared and can use this challenging period to advance suicide prevention.


Fungal sinusitis of the paranasal sinuses is a rare infection in healthy individuals but is relatively common in immunocompromised patients. It is often misdiagnosed and frequently a severe disease, as a few forms of it are linked with a higher mortality rate. Effective handling necessitates a speedy analysis and often counts on radiological findings. On cone-beam computed tomography (CBCT) analysis, a bulky polypoid-shaped lesion with a density close to that of soft tissue in CBCT was visualized in the right ethmoid and sphenoid sinuses. There was a significant expansion of the borders of the right ethmoid sinus, and discontinuity or perforation of the sphenoid sinus floor was suspected from CBCT images. Non-contrasted multi-detector computed tomography (MDCT) exhibited opacification and extension of the lesion into the majority of sinuses with dense inspissated materials in the center, which resembled radiographic features of invasive fungal sinusitis. Computed tomography (CT) scan of the maxillofacial region, specifically paranasal sinuses, plays a considerable role in diagnosing fungal sinusitis. In a majority of cases, fungal sinusitis is noticed and diagnosed in immunocompromised patients. However, it is also seen in healthy patients in very rare circumstances, similar to the patient in this report. If the patient is treated rapidly, the prognosis is fair. We present a case of fungal sinusitis in an otherwise healthy young male patient to increase awareness among dental professionals. Fungal sinusitis or pansinusitis is considered an uncommon inflammatory process of the paranasal sinuses, and it primarily affects immunocompromised patients and occasionally immunocompetent individuals. The recent increase in the reporting of this condition is attributed to advanced diagnostic techniques, immunodeficiency caused by cancer treatment, diabetes, overuse of antibiotics, and post-transplant therapy .Rhizopus arrhizus remained the primary causative agent of acute invasive sinusitis, whereas Aspergillus fumigates was the primary contributing factor for allergic fungal sinusitis [Fungal infection of the paranasal sinuses is broadly classified as noninvasive or invasive based on the non-appearance or appearance of the fungal hyphae in tissue, submucosa, mucosa, blood, or bone of the paranasal sinus. Noninvasive infection is further sub-categorized as allergic fungal sinusitis and fungal mycetoma . Invasive type is further sub-divided into acute, chronic, and granulomatous invasive fungal sinusitis . A retroinusitis .The acute invasive form is an aggressive infection observed mainly in poor diabetic control and immunocompromised patients. It reports a mortality rate of 50–80%, making it the most lethal variant . To diffWe report an incidental finding of fungal sinusitis in a healthy 21-year Caucasian male, contrary to the usual findings. We aim to highlight the role played by radiologists in the early detection of this case and emphasize the importance of interpreting each CBCT image by a trained radiologist. It also alerts the dental community to be observant about the disease to undertake the right diagnosis and precise treatment planning, and avoidance of unexpected complications.A 21-year-old male reported to the radiology department for evaluation of the potential site for implant placement . The patOn examination, missing right maxillary lateral incisor and third molars were noted . A full Contrary to the clinical finding that the patient was asymptomatic, radiographic features were aggressive, which may downgrade the inflammatory course in the differential diagnosis. The patient was directed to an otolaryngologist for further assessment. Further, a non-contrasted multi-detector computed tomography (MDCT) was performed, and the images in all three planes showed inclusive soft tissue opacification in the affected sinuses . ExpansiThis case report presents an incidental finding of fungal sinusitis in a patient who was supposed to undergo a routine dental procedure. Timely radiological diagnosis and appropriate intervention saved the patient from subsequent complications. This case has two significant points of reasoning. First, it stresses the importance of radiological screening before surgical procedures and the application of appropriate imaging for a judicious diagnosis. Second, this study emphasizes the awareness of different life-threatening fungal diseases among dental professionals.The presentation of fungal colonies in a sinonasal tract is not uncommon and necessarily does not mean an infection. Humans are exposed to a variety of omnipresent fungi and usually do not cause any disease. The immunity of a person plays a significant role in determining the individual's susceptibility to the disease , 7. DepeRadiographic evaluations are an invaluable tool for early diagnosis and effective management of the disease. CBCT is one of the methods used to assess bony erosion and other osseous changes. Erosion of bone, sinus, and nasal cavity involvement, and mucosal thickening can be found in other diseases, too; however, when found in the immunocompromised patient, one of the differential diagnoses must be invasive fungal sinusitis . InfiltrThe hyperattenuating soft-tissue collection could be seen in a non-contrast CT within one or more of the paranasal sinuses. Due to the destructive nature of lesions towards borders of sinuses and expansion beyond the sinus boundaries may resemble malignancy. On contrasted CT, periantral soft tissue and adjacent musculature may enhance depending on the duration of fungal invasion.Surgical–medical therapy is of paramount importance since it rapidly spreads invasive disease; otherwise, the condition can be fatal. If only the sinus is involved, the prognosis is fair, while it is poor with intracranial involvement. The treatment of choice is radical debridement, anti-fungal therapy, and the treatment of any underlying condition.With the growing popularity of CBCT and its diagnostic worth, the numbers of dental health professionals utilizing this advanced imaging technology in their practice are sure to increase. Presurgical implant planning and orthodontic and prosthodontic evaluations often include paranasal sinuses; however, the majority of these scans are not evaluated entirely. It is desirable that all the CBCT images are read by a trained oral and maxillofacial radiologist. According to the American Academy of Oral and Maxillofacial Radiology (AAOMR) executive opinion statement, “It is the practitioners' responsibility to examine the entire image dataset” . Eluding


With this review, we summarize the state-of-the-art of scientific studies in the field of motor imagery (MI) and motor execution (ME). We composed the brain map and description that correlate different brain areas with the type of movements it is responsible for. That gives a more complete and systematic picture of human brain functionality in the case of ME and MI. We systematized the most popular methods for assessing the quality of MI performance and discussed their advantages and disadvantages. We also reviewed the main directions for the use of transcranial magnetic stimulation (TMS) in MI research and considered the principal effects of TMS on MI performance. In addition, we discuss the main applications of MI, emphasizing its use in the diagnostics of various neurodegenerative disorders and psychoses. Finally, we discuss the research gap and possible improvements for further research in the field. The ability to create and simulate new objects, sensations, and concepts in mind without directly affecting the senses is known as imagination. It is a complex phenomenon that is challenging to study, understand and explain. Publications in scientific journals dedicated to the experimental study of the essence of imagination appeared at the beginning of the 20th century . Since tScholars have recently used “motor imagery” (MI) to refer to the imagination of moving particular body parts. Among the frameworks trying to explain the essence of motor imagery, there are two primary ones—motor simulation and motor emulation theory . The MotTo summarize, MST supposes a rehearsal of the motor system influenced solely by internal motor representations, while emulation theory makes claims about the emulation of both the motor and sensory systems simultaneously. Numerous studies have been carried out to investigate which theory provides a more plausible explanation for the phenomenon of imaginary movement or provides a novel cause of imagery inner mechanisms ,7,8,9. TIn this review, we provide a comprehensive observation of the recent results in the field of imagery movements by grouping all the empirical results achieved by different tools and approaches together, providing an inner-comparison  and an outer-comparison (comparing results from various sources) and critically assessing them to gain a more complete and systematic picture of human brain functionality in cases of MI. Recent relevant papers were aggregated and formed brain region maps for MI and ME and a comparison table of grouped studies dedicated to neuroimaging during MI and ME. Recent studies that use single-pulse or repetitive transcranial magnetic stimulation (spTMS/rTMS) were analyzed to expand the results of the neuroimaging section. These methods are active and more dynamic in terms of neurofeedback than those presented in the first stage of the search . Considered studies with TMS added complementary details to the difference between ME and MI obtained with TMS motor-evoked potential (MEP) analysis and revealed the neuroplastic potential of the MI + TMS protocol.Since MI has great applications  is widely accepted as a powerful noninvasive tool for analyzing the central and peripheral nervous systems of people. Magnetic stimulation has a similar activation mechanism to electrical stimulation for activating peripheral nerves. TMS excites the pyramidal neurons transsynaptically resulting in the rise of I (indirect) waves. In contrast, transcranial electrical stimulation excites the pyramidal tract axons directly, either at the beginning segment of the neuron or at proximal internodes in the subcortical white matter, resulting in D (direct) waves .The significant and well-studied feature of TMS is its application in motor and motor imagery studies. While the studies revealed in Single-pulse transcranial magnetic stimulation (spTMS) is non-invasive technique for examining and modulating the excitability and plasticity of the human brain. Single-pulse TMS (spTMS) elicits the complex activation of various types of cortical neurons in the motor cortex, resulting in a stereotyped instantaneous response in muscle termed excitatory muscular motor evoked potential (MEP) . Most stRepetitive TMS (rTMS) is a non-invasive brain stimulation technique whose effect on the subject varies by stimulation settings. High-frequency (>1 Hz) stimulation is thought to cause a local increase in cortical excitability, whereas low-frequency (≤1 Hz) stimulation causes the opposite effect ,82. A siFirst of all, we clustered all the selected papers by the brain areas activated during the different types of movements to find the most plausible and frequently observed results on this matter. As a result, we have obtained three characteristic brain maps—for MI, ME, and common for MI and ME. These results could help us to better understand the nature of imagery movements that is useful for future elaborations of motor imagery theories and provide proven descriptions of physiological processes underlying motor imagination as a reference model for future assessment of imagination in the new research. In turn, it could profit from a broad field of research, including sports, music, disease prevention, and rehabilitation ,92,93,94Next, we systematized the known MI assessment methods and discussed their limitations. Therefore, one can consider the results of this analysis to find the recently used imagery assessment methods appropriate for the planned experiment. Consistent use of the same assessment methods reduces research variability and improves reproducibility, so it is important to generalize assessment methods for more reliable results.Finally, we have analyzed the recent tendencies in MI studies with TMS. As a result, we grouped the studies by their goal, methodology, and results. Revealing such findings, we defined the research gap and summarized current findings and limitations in this field.Notably, there are overlapping activation sites associated with both motor imagery and physical execution in the premotor cortex (PMC), the primary motor cortex (M1), the primary (S1) and secondary (S2) somatosensory cortices, the supplementary motor region (SMA), striatum , cerebellar areas, the inferior, superior, and frontal-parietal lobes.Although previously described regions are common for both MI and ME, SMA , frontopNotably, only MI recruited the left dorsolateral prefrontal cortex (DLPFC) . The DLPCommon for motor imagery and execution, M1, S1, S2, and cerebellar areas exhibit stronger activation and a more prominent contralaterality for ME. Low activation for ME was observed in SMA, posterior, and inferior parietal lobes. The ME-specific area mentioned in the reviewed papers is precentral gyri.Methods for motor imagery assessment used in MI studies covered by the current review were grouped in Considering all the abovementioned criteria, the Questionnaire upon Mental Imagery (QMI) is not the option due to its general nature, assessing overall imagery ability rather than the motor one. On the contrary, the Florida Praxis Imagery Questionnaire (FPIQ), the Movement Imagery Questionnaire (MIQ), the Sport Imagery Questionnaire (SIQ) and the Exercise Imagery Questionnaire (EIQ) do not fit the criteria of a universal method because of the specificity of the task to be performed by subjects. The Vividness of Visual Imagery Questionnaire (VVIQ) and the Vividness of Movement Imagery Questionnaire (VMIQ) are not appropriate choices due to the lack of measurement of the kinesthetic aspect of MI. Remained MIQ-2 and the Kinesthetic and Visual Imagery Questionnaire (KVIQ) are the most appropriate options among questionnaire-based assessment methods for healthy subjects. MIQ-RS having a significant correlation with KVIQ  is a betThe scientific community is already taking steps toward more uniform and easy-to-use assessment methods. Thus, the software developed in  uses theThere are several tendencies regarding MI research with spTMS see . CorrelaHowever, this is not the only study among those selected that included the AOMI paradigm. A whole series of recent studies ,74,75 usAnother common MI aspect studied by recent studies using spTMS is neuroplasticity. References ,77 demonIt is worth mentioning another study concerning the application of spTMS determining the MI role in cortical processes. In experiment , two groThe emerging results see  demonstrThus, results in  allow anSpeaking of BCI in rTMS MI studies, it is noticeable that it is also one of the predominant areas among the included studies devoted to the analysis of post-stroke patients. Among BCI and rTMS-based studies, there are also protocols involving virtual reality (VR), where subjects need to perform the same MI activity but with feedback in the form of VR simulation. Studies ,101 explAs the TMS studies revealed ,78,79, MCoupled MI training and additional rTMS stimulation also demonstrated significant improvements in the classification metrics of BCI algorithms ,90, whicAnother direction of research on MI-based learning is using VR technologies in the experiment setup as was done in . It can The applications of MI for BCI operation, in rehabilitation systems in sports, have become conventional. There is a bulk of papers and reviews on these issues ,15,21,22The work  investigReference  addresseThus, motor imagery is a powerful and promising tool for research and diagnostics of various neurodegenerative disorders and psychoses, whose potential has not yet been fully realized.One of the identified gaps in the field of motor imagery is a lack of emphasis on the individual characteristics of the subjects and experiment conditions. Researchers tend to conduct studies in heterogeneous groups in which there is little or no regard for factors such as age, dominant hand, current health, mental conditions, and motivation. So that a unified or average view of the MI representation is created, which brings a little for the use of MI in practical applications. Recent studies demonstrated age-related changes in ME representations implying possible changes in MI due to the overlapping brain representations . Thus, mAnother essential aspect in the MI field that further research may need to study is an objective assessment of the imagery ability of subjects. Revealing more individualized biomarkers that indicate MI also implies gaining knowledge of features that characterize expertise in MI, which would result in a more objective assessment of the subject’s overall ability to imagine and the quality of the process of acquiring imagery skills. Finding this will make empirical research in MI more subjective, significantly advance our knowledge of the imagination and provide a basis for new research in MI. A potentially successful direction in addressing this issue could be the quantized measurement of MI capability, such as with spTMS pulses. As the studies have shown ,84, therFurther, one can utilize the knowledge of expertise-specific features to accelerate acquiring imagery ability. This could be done via rTMS stimulation applied to the specific brain sites that are responsible for expertise in MI, which would provide a chance for poor imagers, who are often not considered and are even weeded out in MI studies, to gain skills in MI and take full advantage of its recreational opportunities.Another important aspect that is often overlooked in MI research is the quality of MI performance without overt action by subjects. In the protocol of each MI study, it is crucial to introduce EMG control of unconscious movements or provide direct instructions to subjects to avoid overt movements. Differences in such details between study protocols create variability in results and lead to unintelligible findings ,74,80.This review aimed to generalize studies of different aspects of MI, including the influence of transcranial magnetic stimulation. The essential issue that still remains in this field is the absence of a universal criterion of imaginary movement, not averaged within the group but applicable to each object within it. We might accurately assess effects through heterogeneous areas of endeavor to advance the existing motor imagery practice, accelerate the development process of imagery skills and expand the audience to which the recreational opportunities of MI training will be applicable if we were able to define generalized biomarkers of motor-imagery based learning processes and MI expertise-specific features of brain activation.


The ABCDEF Bundle: Laying the Foundations for Long Term Wellness in ICU Survivors?” involved authors from different specializations and numerous countries, confirming the dissemination and implementation of the ABCDEF bundle is a very timely topic worldwide.This Research Topic entitled “Long-term morbidity, with cognitive, physical, and emotional symptoms, is common in critical illness survivors, with significant consequences for patients' and caregivers' quality of life. Consequently, health provider, families, and researchers have shifted their attention to methods to optimize recovery and outcomes of survivors of critical illnesses .Inadequately treated pain, deep sedation, delirium, and reduced mobilization have emerged as risk factors for acute muscle wasting and weakness and persisting physical and cognitive dysfunction. The ABCDEF bundle represents an evidence-based guide for clinicians to focus their attention on some fundamental elements that dramatically impact patient recovery and outcomes. The ABCDEF bundle aim to improve and optimize pain management and choice of sedation, reduce delirium, duration of mechanical ventilation, and ICU-acquired weakness and sleep disruption, and promote greater ICU patient and family involvement in the care process , 3. MultSeveral factors have been identified as barriers to ABCDEF bundle implementation and diffusion –7, incluThe COVID-19 pandemic has raised new challenges related to ethical, medical humanity, communication, psychological, patient safety, and clinical risk management issues –12.This article series has broadened our thinking and highlighted key concepts about the importance and feasibility of early mobility and light sedation also in very ill critical patients.Keng et al. conducted a retrospective study to investigate the association between post-rehabilitation functional status, weaning, and survival outcome in prolonged mechanical ventilation (PMV) patients. Functional status was measured by the de Morton Mobility Index (DEMMI). In patients with PMV, post-rehabilitation DEMMI was an important prognostic factor independently associated with weaning success, hospital survival, and 3-month survival after RCC discharge.Yuan et al. found that the change of position, evaluated through electrical impedance tomography (EIT), may improve the ventilation distribution in the study patients.Chen et al. investigated the frequency and characteristics of intensive care unit-acquired weakness (ICU-AW) in Extracorporeal membrane oxygenation (ECMO) patients. They found that the duration of mechanical ventilation, duration of deep sedation during ECMO operation, APACHE II, and lowest albumin level were independent predictors of ICU-AW in patients with ECMO support.Lippi et al. summarized the available evidence in literature on the efficacy of rehabilitative strategies to improve the weaning process and reduce mechanical ventilation (MV) duration. Shorter duration of MV is now recognized as a key moment to prevent the onset of severe complications and to ensure sustainability in terms of health care cost reduction.Gitti et al. highlighted the key concept of sedation in ICU patients. A “calm, comfortable, and collaborative” patient allows active cognitive stimulation, earlier liberation from the endotracheal tube, active mobilization, and improved interaction with the healthcare team and the family; all these topics are important patient-centered outcomes.These works highlighted the importance of factors so far overlooked and underestimated in the management of critically ill patients, but which are fundamental to ensure the optimal long-term quality of life. The aim of the ABCDEF bundle is to shift the attention beyond the walls of the ICU, laying the foundation for patient health after discharge from the unit.MV and AM compiled the manuscript. PB and KK undertook final amendments and approved the final version. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


In this study, we implemented a remote sensing-based approach for monitoring abandoned agricultural land in the Yarmouk River Basin (YRB) in Southern Syria and Northern Jordan during the Syrian crisis. A time series analysis for the Normalized Difference Vegetation Index (NDVI) and Normalized Difference Moisture Index (NDMI) was conducted using 1650 multi-temporal images from Landsat-5 and Landsat-8 between 1986 and 2021. We analyzed the agricultural phenological profiles and investigated the impact of the Syrian crisis on agricultural activities in YRB. The analysis was performed using JavaScript commands in Google Earth Engine. The results confirmed the impact of the Syrian crisis on agricultural land use. The phenological characteristics of NDVI and NDMI during the crisis (2013–2021) were compared to the phenological profiles for the period before the crisis (1986–2010). The NDVI and NDMI profiles had smooth, bell-shaped, and single beak NDVI and NDMI values during the period of crisis in comparison to those irregular phenological profiles for the period before the crisis or during the de-escalation/reconciliation period in the study area. The maximum average NDVI and NDMI values was found in March during the crisis, indicating the progress of natural vegetation and fallow land, while they fluctuated between March and April before the crisis or during the de-escalation/reconciliation period, indicating regular agricultural and cultivation practices. Abandoned agricultural land is defined as lands without plantation practices or grazing management such as plowing, planting, and intensive grazing for specific growing seasons ,2,3. It Accurate identification and characterization of abandoned agricultural land starts by firstly defining the growing season phenological metrics such as the start of season (SOS), end of season (EOS), and length of season (LOS) in the study area. In this context, researchers have used various methods to define growing season metrics such as in situ observations, model simulations, and satellite-based vegetation indices (VIs) ,8,9. In The statistical approach relied on analyzing the measures of the maximum, minimum, and average values of the NDVI spectral index. This approach provides a better understanding of the data than using the individual values, particularly when dealing with a huge number of datasets. Here, abandoned agricultural lands could maintain higher NDVI values for a longer period during the growing season than active agricultural lands and managed grasslands .The phenological approach looks into the shapes and patterns of NDVI profiles in the growing seasons. This provides information about the agricultural activities within the area of interest. For instance, the phenological profiles of abandoned agricultural land would be characterized by regular, bell-shaped, and less temporal fluctuations during the growing season due to the succession of weeds, grasses, and eventually shrubs or trees ,13,14,15Mapping and monitoring of abandoned agricultural land have been conducted using various satellite systems including the Moderate Resolution Imaging Spectroradiometer (MODIS), Visible Infrared Imaging Radiometer Suite (VIIRS), Satellite Pour l’Observation de la Terre (SPOT), Sentinel-2, and Landsat ,17,18,19During the Syrian crisis, abandoned agricultural land has been documented in several parts of Syria with varying negative impacts . The mas2. The majority of the basin  is located in Syria [The Yarmouk River Basin (YRB) is a transboundary basin shared between Jordan and Syria . The totin Syria . The elein Syria .http://lpdaac.usgs.gov accessed on 15 November 2021) and processed using JavaScript commands in Google Earth Engine (GEE). As a matter of fact, GEE is indeed a web-based open-source processing platform that combines a multi-petabyte catalog of satellite imagery and geospatial datasets with planetary-scale analysis capabilities. It uses Java scripts for downloading satellite data, detecting landscape changes, classifying land cover types, mapping trends, and quantifying differences on the Earth’s surface, and has been recently used for various remote sensing applications [In this study, time-series surface reflectance images for 35 years  acquired by Landsat-5 and Landsat-8 satellites were used. The dataset was freely obtained from the United States Geological Survey  land cover map for the year 2019 as a background base-map to define the agricultural land within the study area. The CGLS is a global land cover map of 100 m spatial resolution provided for the period 2015–2019 over the entire globe; it is derived from the PROBA-V 100 m time-series with an accuracy of 80% at Level 1 for all years . In thisThe areas of YRB have witnessed armed activities starting from August 2011. Since then, the security situation in this part of Syria has been precarious. It has been the scene of intensive armed battles and interchangeable control authorities between the conflict parties, which were reflected in the forced movement of people. For instance, the governorates of Dara’a, Quneitra, As-Sweida, and Rural Damascus which consist the Syrian part of YRB witnessed massive internal movements of people within or between the other regions of Syria, and external movements to Jordan due to the armed conflict. By 2016, the total number of registered Syrian refugees in Jordan reached 953,289 persons residing either in refugee camps or in the cities, towns, and villages. Approximately 47.6% of them  reside in Irbid and Mafraq governorates which consist the Jordanian part of YRB . The IDPThe monthly average rainfall data  between NIR, Red, and SWIR are near infrared, red, and shortwave infrared spectral bands of Landsat 5 and Landsat 8. Here, we calculated the long-term monthly average NDVI and NDMI values for the whole study area from 1986 to 2021 by implementing Java scripts on GEE. We used the average monthly NDVI values to define the growing season metrics, the start of season (SOS), length of season (LOS), and end of season (EOS), taking into consideration that the NDVI values tend to increase starting from the SOS till they reach a peak value, then they start to decrease toward the end of the EOS [In this study, we used the normalized difference vegetation index ) and normalized difference moisture index ) to identify the growing season within the study area as they reflect the greenness and wetness conditions of vegetation and are frequently used in vegetation monitoring .(1)NDVI the EOS . We calcWe performed two approaches for identifying the abandoned agricultural lands in YRB: (i) an analysis of the variation in the maximum and average NDVI and NDMI values for the growing season  during the period of observation  bearing in mind that these NDVI and NDMI values would vary between abandoned and active agricultural lands; (ii) an analysis of the long-term phenological profiles of NDVI and NDMI values of the growing seasons between 1986–2020, taking in consideration that these NDVI and NDMI temporal profiles could provide information about the agricultural activities within YRB during the period of interest and especially during the conflict period in Syria.We also performed a country-specific analysis of YRB in Jordan and Syria. As such, we divided the basin into two parts  followinThe monthly average rainfall data, the data of internally displaced persons (IDPs) and spontaneous returnees, and the agricultural data were used to evaluate the remote-sensing-based results of mapping abandoned agricultural land in YRB. For instance, we examined whether the rainfall and/or the IDPs/returnees had influenced the agricultural activities, cultivation, yield, and crop production within the YRB, especially in its Syrian part, during the period of the crisis between 2011 and 2021 or not.The analysis of the long-term monthly average NDVI values for the agricultural land-use type during the period 1986–2021 shows that only one growing season exists in the study area . The pheThe spatiotemporal phenological profile of agricultural land-use type is shown in The analysis of NDVI and NDMI profiles at the country-specific parts of the YRB is shown in The analysis of rainfall data showed that the rainfall was within its normal annual range during the study period, including the active, abandoned, and recultivated periods. The long-term average rainfall amount during the period 1986–2021 was 304.7 mm in As-Sweida, 247.2 mm in Dara’a, and 612.5 mm in Quneitra. The monthly rainfall in these stations in the years of the crisis 2011–2021 was found within its normal levels where there were no extremely high or low rainfall records during the crisis’s calm years in 2019, 2020, and 2021, as shown in In this study, we provided the first consistent spatiotemporal analysis of abandoned agricultural land across the YRB in Syria and Jordan in relation to the Syrian crisis. The implementation of Landsat-based NDVI and NDMI data for identifying vegetation phenology successfully identified the phenological characteristics of the growing season in YRB. The statistics of NDVI and NDMI and their spatiotemporal profiles were generated using Landsat-5 TM and Landsat-8 OLI data for the study area. The NDVI and NDMI values were higher in the case of Landsat-8 data in all growing seasons. However, this might be related to the configuration variations between the two satellite sensors in terms of their spectral bandwidth and radiometric resolutions; similar findings were reported in previous work in different studies ,45. On tThe implemented method in this study provided the information about the timing of land abandonment/recultivation occurrences which would be an indicator of the status of agricultural land management practices in the study area during the years of crisis. For instance, the recultivation process would be identified by investigating that in comparison to the cultivated area, yield, and production values. Those results could be valuable for land cover mapping and for assessing the land cover trajectories and identifying the agricultural abandonment years, as well as the periods when lands were recultivated. In addition, our analysis was suitable for assessing land abandonment at the regional/watershed level in relation to human conflicts. The analysis of the rainfall data confirmed that the climate conditions did not trigger the agricultural or the abandonment/recultivation activities in the study area during 2019–2021 as the total rainfall was within its long-term normal average. Thus, the possible effect of rainfall conditions on increasing the agricultural activities and perhaps the NDVI values and its temporal profiles in those years might be negligible.The maps of IDP spontaneous returnees also supported the results of the remote-sensing-based NDVI and NDMI profiles. For instance, the study area contains major cities, towns, and villages where agriculture is the main economic activity for residents. These areas witnessed intensive airstrikes and ground armed battles between the conflict parties. Meanwhile, they witnessed different changeable control authorities between the government, the opposition, and other local armed groups during 2011–2021. UNOCH  reportedRemote sensing data and techniques provide key information needed to support agricultural land monitoring, including agricultural land abandonment. The analysis focused on agricultural land in the Yarmouk River Basin in northern Jordan and southern Syria during 1986–2021. The operative and efficient acquisition of information from remote sensing often helps in these studies as such data are acquired at regular time intervals and various geographic scales, which makes it possible to monitor the development of agricultural land in deferent land sizes. Here, we tested and proved that Landsat-5 and Landsat-8 time series data are well suited for monitoring abandoned agricultural land during the conflict period in Syria using NDVI- and NDMI-based phenological analysis. The analysis confirmed the common belief about agricultural land abandonment in areas under conflict. The results pointed to multiple trajectories regarding agricultural land cultivation in the study area: (i) active agricultural period between 1986 and 2010, (ii) agricultural land abandonment in the conflict period between 2011 and 2019; and (iii) recultivation and active agriculture in the period 2020–2021. Our study highlighted the need to understand the diverse conflict-related changes to agricultural land for the purpose of agricultural management and rehabilitation in YRB. The results were evaluated against information from the Syrian Ministry of Agriculture for Dara’a, Quneitra, As-Sweida, and Rural Damascus governorates which consist the Syrian part of YRB. These included (i) the monthly historical rainfall data between 1986 and 2021, (ii) the total cultivated area, yield, and production of field crops during 2011–2020, and (iii) the internally displaced person (IDP) spontaneous returnees from 2018 to 2021. This evaluation confirmed the remote-sensing-based results. However, it is worthwhile to consider the other factors that may affect the agricultural land abandonment when implementing the proposed method in other study areas and environments. Meanwhile, the implementation of the method would be valuable for monitoring and evaluating the changes in agricultural crop types and cultivation patterns in the study area, which would be considerable for further investigation in the near future.