Middle East and North African Health Informatics Association (MENAHIA)

The region of the Middle East and North Africa (MENA) is diverse and retains a superior growth potential. It benefits from a privileged geographical location with big markets, a young and growing educated population, and competitive advantages in several industries. Regardless of their differences, countries face shared concerns, most notably in health. In response to the COVID-19 pandemic, MENA countries enact reforms to create a more robust and inclusive digital health systems to increase growth, development, and integrity. Throughout the coordinated containment and mitigation efforts, most of the countries have integrated digital technologies into the health systems. These procedures include digital government initiatives, the introduction of digital health training courses, live video surgeries and virtual patient monitoring, rural and remote telemedicine programs, and the development of a national electronic health records (EHR) system. Each country took necessary actions to address equity, literacy, and development of resilient health systems. The nine featured countries in this report illustrate the diversity among the MENA region and account for major opportunities and achievements as well as promises and challenges that digital health presents for its populations. © 2022 IMIA and Georg Thieme Verlag KG.

CHARACTERIZING MOVEMENT PATTERNS OF NOMADIC PASTORALISTS AND THEIR EXPOSURE TO RIFT VALLEY FEVER IN KENYA

The role of animal movement in spreading infectious diseases is highly recognized by various legislations and institutions such as the World Organisation for Animal Health and the International Animal Health Code. The increased interactions at the nexus of human-animal-ecosystem interface have seen an unprecedented introduction and reintroduction of new zoonotic diseases with high socio-economic impacts such as the COVID-19 pandemic. Rift Valley fever (RVF) is a zoonotic disease that affects both humans and animals and is transmitted by Aedes mosquitoes or through contact with the body fluids of infected animals. This study seeks to characterize movement patterns of pastoralist and how this movement behaviour increases their susceptibility to RVF virus exposure. We levarage on a rapidly growing field of movement ecology to monitor five herds collared from 2013 – 2015 in an RVF endemic semi-arid region in Kenya. The herds were also sampled for RVF antibodies to assess their exposure to RVF virus during the rainy seasons. adehabitatLT package in R was used to analyze the trajectory data whereas the first passage time (FPT) analysis was used to measure the area utilized in grazing. Sedentary herds grazed within 15km radius while migrating herds presented restricted space use patterns during the dry seasons and transient movement during the start and end of the rainy season. Furthermore, RVF virus antibodies were generally low for sedentary herds whereas the migrating herds recorded high levels during their transition periods. This study can be used to identify RVF risk zones for timely and targeted management strategies.

Stroke and COVID-19 Pandemic: The Dilemma

Background: While the COVID-19 pandemic affected more than thirty million people world-wide, still the true link between COVID-19 and the incidence of stroke remains to be eluci-dated. Method(s): Herein, we briefly discuss virology of COVID-19 and approaches for diagnosis and treatment of COVID-19 patients, as well as the mechanisms that link stroke and COVID-19. Result(s): Many pathophysiologic and immunologic mechanisms have been implicated in stroke occurring among patients with COVID-19. COVID-19 pandemic has, in different ways, negative im-pacts on the care of stroke patients world-wide, and still, neurologists have to face many challenges to improve the care of stroke patients during such crisis. Conclusion(s): Although the control of the COVID-19 is of crucial importance, at the same time, the management of stroke must not be neglected. Therefore, preserving care for critical conditions such as stroke, and providing strategies to ensure this continues, have a priority even during the cri-sis. Till vaccine is available for COVID-19, strategies for rapid diagnosis and those for treating patients with that disease are evolving. Further studies are warranted.Copyright © 2021 Bentham Science Publishers.

Artemisinin inhibits neutrophil and macrophage chemotaxis, cytokine production and NET release.

Immune cell chemotaxis to the sites of pathogen invasion is critical for fighting infection, but in life-threatening conditions such as sepsis and Covid-19, excess activation of the innate immune system is thought to cause a damaging invasion of immune cells into tissues and a consequent excessive release of cytokines, chemokines and neutrophil extracellular traps (NETs). In these circumstances, tempering excessive activation of the innate immune system may, paradoxically, promote recovery. Here we identify the antimalarial compound artemisinin as a potent and selective inhibitor of neutrophil and macrophage chemotaxis induced by a range of chemotactic agents. Artemisinin released calcium from intracellular stores in a similar way to thapsigargin, a known inhibitor of the Sarco/Endoplasmic Reticulum Calcium ATPase pump (SERCA), but unlike thapsigargin, artemisinin blocks only the SERCA3 isoform. Inhibition of SERCA3 by artemisinin was irreversible and was inhibited by iron chelation, suggesting iron-catalysed alkylation of a specific cysteine residue in SERCA3 as the mechanism by which artemisinin inhibits neutrophil motility. In murine infection models, artemisinin potently suppressed neutrophil invasion into both peritoneum and lung in vivo and inhibited the release of cytokines/chemokines and NETs. This work suggests that artemisinin may have value as a therapy in conditions such as sepsis and Covid-19 in which over-activation of the innate immune system causes tissue injury that can lead to death.

Determinants of weight, psychological status, food contemplation and lifestyle changes in patients with obesity during the COVID-19 lockdown: a nationwide survey using multiple correspondence analysis.

INTRODUCTION: The corona virus disease 2019 (COVID-19) pandemic forced most of the Italian population into lockdown from 11 March to 18 May 2020. A nationwide survey of Italian Clinical Nutrition and Dietetic Services (Obesity Centers or OCs) was carried out to assess the impact of lockdown restrictions on the physical and mental wellbeing of patients with obesity (PWO) who had follow-up appointments postponed due to lockdown restrictions and to compare determinants of weight gain before and after the pandemic. METHODS: We designed a structured 77-item questionnaire covering employment status, diet, physical activity and psychological aspects, that was disseminated through follow-up calls and online between 2 May and 25 June 2020. Data were analyzed by multiple correspondence analysis (MCA) and multiple linear regression. RESULTS: A total of 1,232 PWO from 26 OCs completed the questionnaires (72% female, mean age 50.2 ± 14.2 years; mean BMI 34.7 ± 7.6 kg/m2; 41% obesity class II to III). During the lockdown, 48.8% gained, 27.1% lost, while the remainder (24.1%) maintained their weight. The mean weight change was +2.3 ± 4.8 kg (in weight gainers: +4.0 ± 2.4 kg; +4.2% ± 5.4%). Approximately 37% of participants experienced increased emotional difficulties, mostly fear and dissatisfaction. Sixty-one percent reduced their physical activity (PA) and 55% experienced a change in sleep quality/quantity. The lack of online contact (37.5%) with the OC during lockdown strongly correlated with weight gain (p < 0.001). Using MCA, two main clusters were identified: those with unchanged or even improved lifestyles during lockdown (Cluster 1) and those with worse lifestyles during the same time (Cluster 2). The latter includes unemployed people experiencing depression, boredom, dissatisfaction and increased food contemplation and weight gain. Within Cluster 2, homemakers reported gaining weight and experiencing anger due to home confinement. CONCLUSIONS: Among Italian PWO, work status, emotional dysregulation, and lack of online communication with OCs were determinants of weight gain during the lockdown period.

The prevalence of non-communicable diseases among Syrian refugees in Syria's neighbouring host countries: a systematic review and meta-analysis.

OBJECTIVES: Alarming rates of non-communicable diseases (NCDs) have been observed in low- and middle-income countries (LMICs) where most refugees reside. There is concern Syrian refugees may experience significant NCD-related health needs, which have significant health implications, including in the context of the COVID-19 pandemic, and which must be addressed by health systems in neighbouring host countries. Although primary studies on this topic exist, there has been no comprehensive synthesis of the existing evidence base. The aim of this systematic review and meta-analysis was to synthesise evidence on the prevalence of NCDs among Syrian refugees residing in neighbouring host countries. STUDY DESIGN: This was a systematic review and meta-analysis. METHODS: The review was carried out in line with PRISMA guidelines (PROSPERO CRD420201970430). MEDLINE, CINAHL, EMBASE and PubMed databases were searched from 1 January 2011 to 1 November 2021. Peer-reviewed studies reporting prevalence data on the five most common NCDs among adult Syrian refugees living in Turkey, Lebanon or Jordan were included. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal checklist for prevalence studies. Meta-analysis was carried out to estimate the pooled prevalence of these NCDs in community and primary care settings. RESULTS: A total of 466 citations were identified, 18 of which were included, representing 237,723 Syrian refugees. In community settings, the prevalence of hypertension, diabetes mellitus type II, cardiovascular diseases, chronic respiratory diseases and arthritis was 24% (95% confidence interval: 17-32), 12% (8-15), 5% (3-7), 4% (3-5) and 11% (7-14), respectively. The prevalence of hypertension 35% (33-36) and diabetes mellitus type II 48% (24-72) were significantly higher in primary care settings. CONCLUSION: The findings demonstrate a high prevalence of NCDs among Syrian refugees. Evidence-based preventive and management interventions for NCDs are needed in this context to address acute health needs during the COVID-19 pandemic and the longer-term health burden of NCDs.

Recurrent pericarditis associated with human coronavirus (HKU1) infection in a patient with systemic lupus erythematosus (SLE)

The presence of human coronavirus HKU1 infection associated with pericardial inflammation is not reported. We are reporting a young woman with systemic lupus erythematosus, who was positive for HKU1 during her pericarditis flare. Diagnostic imaging demonstrated pericardial effusion, edema, and late gadolinium enhancement on cardiac magnetic resonance imaging and echocardiography. She was on multiple anti-inflammatory medications and achieved remission with anakinra. Her management and a brief literature review is also presented.

COVID-19 Clinical Practice Guidelines Hadhramout Initiative Against Corona Group (HIAC Group) (preprint)

Hadhramout Initiative Against Corona (HIAC ) formed a working group of clinicians relevant to the management of COVID-19 to formulate clinical practice guidelines (CPG) for clinicians caring for the patients infected with COVID-19 in Yemen. The regional guidelines on the management of COVID-19 were thoroughly reviewed and its applicability was assessed for Yemen. HIAC’s recommendations covered (2) sections: the first one is the diagnosis, including case definition, risk stratification of the affected cases, investigations (prioritization of reverse transcription-polymerase chain reaction (RT-PCR) testing, D-dimer, chest x-ray, and chest computed tomography, while the second part covers the treatments (mainly Favipiravir, Remdesivir, Hydroxychloroquine, and Glucocorticoid, Anticoagulants, and Supportive measures). In conclusion, the adoption of cost-effective and evidence-based guidelines in Yemen will standardize the management of the patients infected with COVID-19 and protect both the patients and the health care workers from malpractice.