Physicians' Understanding of Nutritional Factors Determining Brain Development and Cognition in the Middle East and Africa / 대한소아소화기영양학회지

PURPOSE: Proper nutrition is essential for brain development during infancy, contributing to the continued development of cognitive, motor, and socio-emotional skills throughout life. Considering the insufficient published data in the Middle East and North Africa, experts drafted a questionnaire to assess the opinions and knowledge of physicians on the impact of nutrition on brain development and cognition in early life. METHODS: The questionnaire consisted of two parts: The first focused on the responders' demographic and professional characteristics and the second questioned the role of nutrition in brain development and cognition. Descriptive statistics were used to summarize respondents' characteristics and their responses to questions. RESULTS: A total of 1,500 questionnaires were distributed; 994 physicians responded. The majority of the surveyed physicians (64.4%) felt that nutrition impacts brain development in early childhood (0–4 years), with almost 90% of physicians agreeing/strongly agreeing that preventing iron, zinc, and iodine deficiency would improve global intelligence quotient. The majority of physicians (83%) agreed that head circumference was the most important measure of brain development. The majority of physicians (68.9%) responded that the period from the last trimester until 18 months postdelivery was crucial for brain growth and neurodevelopment, with 76.8% believing that infants breast-fed by vegan mothers have an increased risk of impaired brain development. CONCLUSION: The results of this study show that practicing physicians significantly agree that nutrition plays an important role in brain and cognitive development and function in early childhood, particularly during the last trimester until 18 months postdelivery.

Knowledge, awareness and acceptability of anti-HPV vaccine in the Arab states of the Middle East and North Africa Region: a systematic review

Background: Rapid changes in lifestyle induced by globalization have brought about changes in sexual behaviour, especially among younger generations. These changes may lead to considerable consequences on the prevalence of sexually transmitted disease, including human papillomavirus [HPV] infection.

Aims: The objective of this study is to provide a systematic review of peer-reviewed literature on human papillomavirus [HPV] vaccine awareness and acceptability in the Arab states of the Middle East and North Africa region.

Methods: A systematic search was conducted across 2 electronic databases: PubMed and EMBASE, to identify studies related to HPV vaccination awareness and acceptability in the region between January 2010 and April 2017.

Results: Eighteen studies from 9 countries were identified. The analysis showed low to moderate HPV infection knowledge and anti-HPV vaccine awareness. Nevertheless, most studies reported moderate to high anti-HPV vaccine acceptability among subpopulations. Broad gaps in knowledge and willingness were highlighted regarding HPV vaccine acceptability.

Conclusions: An examination of the region collectively offers an insight into the willingness of the general population and healthcare providers to receive more information about the virus and prevention of infection through vaccination. This review suggests that the vaccine acceptability would be high once cost concerns are resolved

A review of methods to estimate the visibility factor for bias correction in network scale-up studies / 한국역학회지

Network scale-up is an indirect size estimation method, in which participants are questioned on sensitive behaviors of their social network members. Therefore, the visibility of the behavior affects the replies and estimates. Many attempts to estimate visibility have been made. The aims of this study were to review the main methods used to address visibility and to provide a summary of reported visibility factors (VFs) across populations. We systematically searched relevant databases and Google. In total, 15 studies and reports that calculated VFs were found. VF calculation studies have been applied in 9 countries, mostly in East Asia and Eastern Europe. The methods applied were expert opinion, comparison of NSU with another method, the game of contacts, social respect, and the coming-out rate. The VF has been calculated for heavy drug users, people who inject drugs (PWID), female sex workers (FSWs) and their clients, male who have sex with male (MSM), alcohol and methamphetamine users, and those who have experienced extra-/pre-marital sex and abortion. The VF varied from 1.4% in Japan to 52.0% in China for MSM; from 34.0% in Ukraine to 111.0% in China for FSWs; and from 12.0% among Iranian students to 57.0% in Ukraine for PWID. Our review revealed that VF estimates were heterogeneous, and were not available for most settings, in particular the Middle East and North Africa region, except Iran. More concrete methodologies to estimate the VF are required.

A review of methods to estimate the visibility factor for bias correction in network scale-up studies / 한국역학회지

Network scale-up is an indirect size estimation method, in which participants are questioned on sensitive behaviors of their social network members. Therefore, the visibility of the behavior affects the replies and estimates. Many attempts to estimate visibility have been made. The aims of this study were to review the main methods used to address visibility and to provide a summary of reported visibility factors (VFs) across populations. We systematically searched relevant databases and Google. In total, 15 studies and reports that calculated VFs were found. VF calculation studies have been applied in 9 countries, mostly in East Asia and Eastern Europe. The methods applied were expert opinion, comparison of NSU with another method, the game of contacts, social respect, and the coming-out rate. The VF has been calculated for heavy drug users, people who inject drugs (PWID), female sex workers (FSWs) and their clients, male who have sex with male (MSM), alcohol and methamphetamine users, and those who have experienced extra-/pre-marital sex and abortion. The VF varied from 1.4% in Japan to 52.0% in China for MSM; from 34.0% in Ukraine to 111.0% in China for FSWs; and from 12.0% among Iranian students to 57.0% in Ukraine for PWID. Our review revealed that VF estimates were heterogeneous, and were not available for most settings, in particular the Middle East and North Africa region, except Iran. More concrete methodologies to estimate the VF are required.

Overview on main nutrition-related diseases in three countries from North Africa

The aim of this review article is to give a holistic overview on the magnitude of nutrition-related diseases in the North African region and to outline major factors associated with the prevalence of these complications. A literature analysis was performed on PubMed and Google Scholar for data relating to nutrition-related diseases published between January 2007 and March 2017. The employed keywords were; "Algeria AND Morocco AND Tunisia AND Nutrition-Related diseases". We focused firstly on the nutrition-related diseases associated to inadequate intake of nutrients and unhealthy dietary habits such as low birth weight, anaemia and micronutrient deficiencies, thereafter, diseases associated with changes in lifestyle such as obesity, diabetes and cardiovascular disease are highlighted. Factors contributing to nutritional problems vary from country to another. Low socioeconomic status, low educational levels, unhealthy eating habits, poverty and ignorance are mainly responsible for both under and over nutrition problems. Despite their alarming rates, national strategies to combat these nutritional diseases do not exist or are ineffective in North African countries. Efforts are focused on therapeutic actions, however, the scarcity or the complete lack of preventive health care services, epidemiological surveys, nutritional surveillance and lack of nutritional assessment need to be considered. Continuous and accurate analyses of the evolving situation will allow setting up a good tools, strategies and health intervention programs in North African countries. ​

Plague in Iran: its history and current status / 한국역학회지

OBJECTIVES: Plague remains a public health concern worldwide, particularly in old foci. Multiple epidemics of this disease have been recorded throughout the history of Iran. Despite the long-standing history of human plague in Iran, it remains difficult to obtain an accurate overview of the history and current status of plague in Iran. METHODS: In this review, available data and reports on cases and outbreaks of human plague in the past and present in Iran and in neighboring countries were collected, and information was compiled regarding when, where, and how many cases occurred. RESULTS: This paper considers the history of plague in Persia (the predecessor of today’s Iran) and has a brief review of plague in countries in the World Health Organization Eastern Mediterranean Region, including a range of countries in the Middle East and North Africa. CONCLUSIONS: Since Iran has experienced outbreaks of plague for several centuries, neighboring countries have reported the disease in recent years, the disease can be silent for decades, and the circulation of Yersinia pestis has been reported among rodents and dogs in western Iran, more attention should be paid to disease monitoring in areas with previously reported human cases and in high-risk regions with previous epizootic and enzootic activity.

First report on simplified diagnostic criteria for pre-hypertension and hypertension in a national sample of adolescents from the Middle East and North Africa: the CASPIAN-III study / Primeiro relatório sobre critérios de diagnóstico simplificado para pré-hipertensão e hipertensão em uma amostra nacional de adolescentes do Oriente Médio e da África do Norte: o estudo CASPIAN-III

OBJECTIVE: This study aimed to simplify the diagnostic criteria of pre-hypertension (pre-HTN) and hypertension (HTN) in the pediatric age group, and to determine the accuracy of these simple indexes in a nationally-representative sample of Iranian children and adolescents. METHOD: The diagnostic accuracy of the indexes of systolic blood pressure-to-height ratio (SBPHR) and diastolic BPHR (DBPHR) to define pre-HTN and HTN was determined by the area under the curve of the receiver operator characteristic curves. RESULTS: The study population consisted of 5,738 Iranian students (2,875 females) with mean (SD) age of 14.7 (2.4) years. The prevalences of pre-HTN and HTN were 6.9% and 5.6%. The optimal thresholds for defining pre-HTN were 0.73 in males and 0.71 in females for SBPHR, and 0.47 in males and 0.45 in females for DBPHR, respectively. The corresponding figures for HTNwere 0.73, 0.71, 0.48, and 0.46, respectively. In both genders, the accuracies of SBPHR and DBPHR in diagnosing pre-HTN and HTN were approximately 80%. CONCLUSIONS: BPHR is a valid, simple, inexpensive, and accurate tool to diagnose pre-HTN and HTN in adolescents. The optimal thresholds of SBPHR and DBPHR were consistent with the corresponding figures in other populations of children and adolescents with different racial and ethnic backgrounds. Thus, it is suggested that the use of these indexes can be generalized in programs aiming to screen elevated blood pressure in the pediatric age group. .

OBJETIVO: Este estudo visa simplificar os critérios de diagnóstico da pré-hipertensão (pré-HTA) e hipertensão (HTA) na faixa etária pediátrica e determinar a precisão desses índices simple sem uma amostra nacionalmente representativa de crianças e adolescentes iranianos. MÉTODO: A precisão diagnóstica dos índices de relação pressão arterial sistólica/altura (RPASA) e RPAA diastólica (RPADA) para definir a pré-HTA e HTA foi determinada pela área sob as curvas de características de operação do receptor. RESULTADOS: A população estudada contou com 5738 alunos iranianos (2875 meninas) com idade média (DP) de 14,7 (2,4) anos. A prevalência de pré-HTA e HTA foi 6,9% e 5,6%. Os limites ideais para a definição de pré-HTA foram 0,73 em meninos e 0,71 em meninas com relação à RPASA e 0,47 em meninos e 0,45 em meninas com relação à RPADA, respectivamente. Os valores correspondentes com relação à HTA foram 0,73, 0,71, 0,48 e 0,46, respectivamente. Em ambos os gêneros, a precisão de RPASA e RPADA no diagnóstico de pré-HTA e HTA foi de aproximadamente 80%. CONCLUSÕES: A RPAA é uma ferramenta válida, simples, barata e precisa no diagnóstico da pré-HTA e HTA em adolescentes. Os limites ideais de RPASA e RPADA foram compatíveis comos números correspondentes em outra população de crianças e adolescentes com diferentes históricos raciais e étnicos, assim, sugerimos que a utilização desses índices possa ser generalizada em programas de triagem com relação à PA elevada na faixa etária pediátrica. .

[Study of the diet of a pest rodent [Meriones shawii Duvernoy, 1842 Mammalia, Rodentia] in Algeria]

In order to better understand and control Meriones shawii population outbreaks in Algeria, a study of its diet was undertaken both in field and in laboratory experiment. The annual survey of faeces composition displays diet differences according to season with a preference for leaves and seeds of Graminea in spring [53,12%] and summer [92%]. This could be related to cereals cycle. In autumn and winter, these are replaced by Leguminose, Composacea, Malvacea. In captivity, M. shawii prefers barley [Hordeum vulgare] grains to Triticum durum and Triticum aestivum. This work allows one to make some recommendations to improve rodent control of this agronomic pest.

[Evaluation of the nutritional value of some herbaceous plants grazed by Camel in the Sahara North-Western Algerian Sahara]

Understanding dromedary-desert rangelands relationships is a major element of eco-development and management of North Western Sahara areas which constitute the habitat of plants grazed by the dromedary. The latter remains the only breeding species capable of valorizing Saharian plants, thus providing meat and milk which constitute the main food source of indigenous population. In the current study, the nutritional value [energy and nitrogenous value] based on chemical composition of some annual plants [Anvillea radiata, Asteriscus graveolens, Cotula cinerea, Lifago dielsii, Moltkia ciliata, Helianthemum lippii, Salvia aegyptiaca, Stipagrostis plumosa, Neurada procumbens, Fagonia glutinosa] was investigated. The chemical composition analysis shows high contents of organic matter and low contents of total nitrogenous matter. The nutritional value assessment shows that the highest fodder unit milk [UFL] and fodder unit meat [UFV] values were recorded in Asteriscus graveolens [0.60 and 0.52] and Neurada procumbens [0.57 and 0.49]. However, the lowest values were obtained from Fagonia glutinosa [0.25 and 0.23] and Cotula cinerea [0.31 and 0.27]. Likewise, the nitrogenous value assessment shows that the highest values of digestible protein in the small intestine limited by nitrogen [PDIN] and digestible protein in the small intestine limited by energy [PDIE] were recorded in Stipagrostis plumosa [56.31g and 41.97g] and Neurada procumbens [54.46g and 31.71g].On the other hand, the lowest values correspond to Fagonia glutinosa [25.60g and 19.56g] and Lifago dielsii [39.48g and 17.36g]. This last plant is only consumed in the absence of other species. Indeed, these annual species that grow after rainfall constitute the most appreciated pastures for the dromedary.

Bone Mineral Density is an Independent Determinant of Left Ventricular Mass Index in the General Female Population

BACKGROUND AND OBJECTIVES: Left ventricular hypertrophy (LVH) is a well known cardiovascular prognostic predictor. Osteoporosis has been suggested to be associated with cardiovascular disease. According to studies of primary hyperparathyroidism, a pathophysiological association between calcium metabolism and LVH has been suggested but is not yet fully understood. This study was performed to investigate the association between bone mineral density (BMD) and left ventricular mass index (LVMI) in a general population. SUBJECTS AND METHODS: Data from 460 subjects among 543 subjects sampled from a general population in a rural area in Korea were analyzed. BMD, echocardiography, brachial-ankle pulse wave velocity (baPWV), carotid intima-media thickness (IMT) measurement as well as the measurements of blood pressure, blood chemistry and metabolic parameters were analyzed. BMD was measured using the Sahara Clinical Bone Sonometer (Hologic Inc., Mass., USA). RESULTS: Age of the subjects was 59.4+/-12.4 years. Males were 42.2% (n=194). In a simple correlation analysis on female subjects, age and waist circumference showed negative correlation, and body mass index (BMI) showed positive correlation with BMD. However, only age showed negative correlation with BMD in male subjects. After adjusting baPWV and carotid IMT, we found that BMD was an independent determinant of LVMI in female subjects (beta=-13.703, p=0.016), but not in male subjects (beta=-1.235, p=0.841). CONCLUSION: BMD is a consistent and independent determining factor of LVMI, BMI and carotid IMT in postmenopausal women.

Diabetic complications and glycaemic control in remote North Africa

Background: Delivery of diabetes services in resource-poor areas of Africa is difficult. Control is often poor and complications are common. However, adequate robust surveys are uncommon, particularly in remote rural areas. This makes needs assessment difficult and health-care planning impossible. Aim: To accurately assess the glycaemic control and burden of complications in a group of diabetic patients from a remote area of a resource-limited north African country. Design: Prospective cohort study. Methods: Over a 6-week period, all patients attending the diabetic clinic at Mekelle Hospital in northern Ethiopia were intensively assessed, using imported western technology as necessary. Glycated haemoglobin (HbA1c), lipid profile, serum creatinine and urinary albumin­creatinine ratio were measured. Complications were assessed as accurately as possible, including examination of fundi by an ophthalmic specialist, and biosthesiometry for neuropathy. Results: There were 105 patients, mean (± SD) age 41 ± 16 years and diabetes duration 7 ± 6 years. There were 74 (70%) males, and 69 (66%) on insulin. Median body mass index was low at 20.6 kg/m2, but mean HbA1c high at 11.3 ± 2.8% (68% had an HbA1c over 10.0%). Cataract (12%), retinopathy (21%), neuropathy (41%) and microalbuminuria (51%) were common; but nephropathy (2%) was rare, as was large vessel disease (6% had peripheral vascular disease, and none had coronary artery disease or cerebrovascular disease). Risk factors such as hypertension (5%) and smoking (2%) were uncommon, and lipid profiles were generally good. Discussion: We conclude that in this severely resource-limited area of North Africa, glycaemic control amongst diabetic patients is very poor. Neuropathy, retinopathy and microalbuminuria are common; but large vessel disease risk factors are beneficial, and macroangiopathy prevalence is low. Scattered populations, shortage of drugs and insulin and lack of diabetes team care are major factors behind these serious issues of diabetic control and complications

Silent epidemic of depression in women in the Middle East and North Africa region: emerging tribulation or fallacy?

As the world is being gripped by economic depression, international psychological epidemiologists have amassed evidence to suggest that psychological depression and its variants are becoming leading contributors to the global burden of disease with the Middle East and North Africa [MENA] region being no exception. The main aim of the present discourse, based on a review of the available literature, is to discuss critically whether women in the MENA region have a higher rate of psychological depression than those in other parts of the globe. From the present synthesis, it emerges that the rate of depression may not be necessarily unique to the region. Although no society has totally overcome the marginalisation and lack of empowerment of women, in order to come to grips to this complex issue more vigorously designed epidemiological studies, using taxonomies that are standardised for cross-cultural populations, are needed to quantify the psychological functioning of women

Nutrition capacity development in the middle East and North Africa

The Middle East and North African Nutrition Capacity Development Initiative started in July 2004 as a component of a global initiative spearheaded by UNU and IUNS for development of human and institutional capacity in nutrition. The Middle East and North Africa Nutrition Association [MENANA] was established as an affiliated body to IUNS and took responsibility for identifying core areas for nutrition capacity building in the region. The members adopted a "new conceptual framework for planning nutrition capacity development activities within a comprehensive ten-year plan of action, using a new Conceptual Framework and Guideline for Nutrition Capacity Development Planning developed by Dr. Gohar for use by the MENANA members. A future vision for food security was agreed upon, supported by a prioritized plan of action. The member found that Regional research capacity needs strengthening to address the role of nutrition in prevention of diet related diseases and combating .malnutrition, including micronutrient deficiencies. Mapping research centers in the region was the first task decided to be undertaken by MENANA. Nutrition training to strengthen regional skills of nutritionists has been planned. Nutrition academic education and accreditation of dieticians was discussed, and a regional accreditation examination for dietitians established by MENANA. In the area of nutrition advocacy/education communication, a steering committee was established to organize workshops to enhance regional advocacy. Nutrition networking was planned to strengthen regional inter-country collaboration and cooperation for nutrition capacity building. The selected priorities were supported by the establishment of a regional Nutrition Capacity Building website to include a database of nutritionists in the region, their affiliations and field of interest. A matrix of selected, simple and sensitive nutrition status indicators was planned to be published in the website for the purpose of monitoring regional nutrition status. The website will also provide information services to nutrition professionals in the region and will be linked to important updated nutrition information

Saharan dust - a carrier of persistent organic pollutants, metals and microbes to the Caribbean? / Polvo sahariano: ¿portador de contaminantes orgánicos persistentes, metales y microbios al Caribe?

An international team of scientists from government agencies and universities in the United States, U.S. Virgin Islands (USVI), Trinidad & Tobago, the Republic of Cape Verde, and the Republic of Mali (West Africa) is working together to elucidate the role Saharan dust may play in the degradation of Caribbean ecosystems. The first step has been to identify and quantify the persistent organic pollutants (POPs), trace metals, and viable microorganisms in the atmosphere in dust source areas of West Africa, and in dust episodes at downwind sites in the eastern Atlantic (Cape Verde) and the Caribbean (USVI and Trinidad & Tobago). Preliminary findings show that air samples from Mali contain a greater number of pesticides, polychlorinated biphenyls (PCBs) and polycyclic aromatic hydrocarbons (PAHs) and in higher concentrations than the Caribbean sites. Overall, POP concentrations were similar in USVI and Trinidad samples. Trace metal concentrations were found to be similar to crustal composition with slight enrichment of lead in Mali. To date, hundreds of cultureable micro-organisms have been identified from Mali, Cape Verde, USVI, and Trinidad air samples. The sea fan pathogen, Aspergillus sydowii, has been identified in soil from Mali and in air samples from dust events in the Caribbean. We have shown that air samples from a dust-source region contain orders of magnitude more cultureable micro-organisms per volume than air samples from dust events in the Caribbean, which in turn contain 3-to 4-fold more cultureable microbes than during non-dust conditions. Rev. Biol. Trop. 54 (Suppl. 3): 9-21. Epub 2007 Jan. 15.

Un grupo internacional de agencias gubernamentales y universidades de los Estados Unidos, las Islas Vírgenes (EUA), Trinidad y Tobago, la República de Cabo Verde y la República de Mali (África Oeste), está trabajando en conjunto para elucidar el papel que el polvo del Sahara puede estar jugando en el deterioro de los ecosistemas caribeños. El primer paso ha sido identificar y cuantificar los Contaminantes Orgánicos Persistentes (POPs, por sus siglas en inglés), los metales traza y los microorganismos viables presentes en la atmósfera de las áreas fuente de polvo de África occidental y en áreas ubicadas en la dirección del viento, como el Atlántico este (Cabo Verde) y el Caribe (IVEUA y Trinidad y Tobago), durante los episodios de transporte de polvo. Resultados preliminares indican que las muestras de aire de Mali contienen mayor número y mayores concentraciones de pesticidas, bifenilos policlorinados (PCBs) e hidrocarburos policíclicos aromáticos (PAHs) que las de los sitios del Caribe. Las concentraciones de POPs fueron similares en las muestras de USVI y de Trinidad. Se encontró que las concentraciones de metales traza fueron similares a las de la composición de la corteza, con un ligero enriquecimiento de plomo en Mali. Hasta la fecha, cientos de microorganismos cultivables han sido identificados en las muestras de Mali, Cabo Verde, IVEUA y Trinidad. Hallamos el patógeno de los abanicos de mar, Aspergillus sydowi, en las muestras de aire de Mali y en las muestras del Caribe durante polvaredas. Hemos demostrado que las muestras de aire provenientes de una región fuente de polvo, contienen más microorganismos cultivables por volumen -en órdenes de magnitud- que las muestras de aire tomadas en polvaredas en el Caribe, las cuales a su vez contienen tres a cuatro veces más microorganismos cultivables que aquellas tomadas cuando no hay polvaredas.

Fasciolasis hepatica: reporte de un caso y revisión de la literatura / Hepatic fasciolasis: report of a case and review of the literature

La fasciolasis humana es una zoonosis causada por la Fasciola hepática, trematodo que en su vida adulta afecta principalmente el ganado ovino y bovino, siendo el hombre huésped accidental. La dificultad en el diagnóstico clínico, dada su variada sintomatología, muchas veces requerirá del apoyo imagenológico, por lo que el radiólogo debe estar preparado y conocer la epidemiología de este patógeno, especialmente en aquellas zonas endémicas (Latinoamérica, zonas de Asia y el Norte de Africa). Es importante considerarla dentro del diagnóstico diferencial de lesiones focales hepáticas, especialmente en el contexto clínico de eosinofilia.