Adherence to the evidence-based recommendations in managing bone health, pain, and mobility of patients with multiple myeloma: a mixed method in the Palestinian healthcare system.

BACKGROUND: Consensus/evidence-based recommendations for assessing, managing, and monitoring bone health, pain, and mobility in patients with multiple myeloma were developed. This study was conducted to assess the adherence of the hematologists-oncologists to the consensus/evidence-based recommendations for assessing, managing, and monitoring bone health, pain, and mobility in patients with multiple myeloma who received care in the Palestinian healthcare system. METHODS: A mixed method was used in this study. The consensus/evidence-based recommendations were identified through a systematic search in Scopus, PubMed, SpringerLink, ScienceDirect, and Google Scholar. A panel of 5 researchers (3 hematologists-oncologists, 3 medical students, and 1 pharmacologist) sorted the consensus/evidence-based recommendations and developed the survey tool during 3 iterative meetings. The extent to which the hematologists-oncologists in the 5 centers caring for patients with multiple myeloma adhered to the consensus/evidence-based recommendations was assessed using a questionnaire. RESULTS: Responses were collected from 10 hematologists-oncologists in all 5 healthcare centers where patients with multiple myeloma receive healthcare in the West Bank of Palestine. The median number of years in the practice of the hematologists-oncologists was 7.5 [2.75, 14.0] years and the median number of patients with multiple myeloma care per month was 12.5 [7.5, 21.25]. The vast majority (90%) of the hematologists-oncologists reported inadequate adherence to screening for medication problems related to bone health, pain, cardiopulmonary fitness, healthy behaviors, nutritional deficits, and mental health. Of the hematologists-oncologists, 70% reported inadequate adherence to ordering and evaluating calcium, vitamin D, alkaline phosphatase, electrolytes, and phosphorus levels to monitor bone health and 60% reported inadequate adherence to prescribing calcium and vitamin D supplements whenever there was a need. CONCLUSION: The findings of this study suggested inadequate adherence to the consensus/evidence-based recommendations and highlighted areas for improvement to ensure that patients receive optimal care. The findings suggested a need for further education and training on the latest guidelines and recommendations. Decision-makers and policymakers might need to design measures and implement policies to improve adherence to the consensus/evidence-based recommendations. Addressing these gaps in adherence to the consensus/evidence-based recommendations may improve the care and outcomes of patients with multiple myeloma.

Flash'O real-world evidence programme - Attitude and practices toward the use of omega-3 FA by physicians from Middle East Countries.

The Flash'O project was designed to provide insights into the current use of prescription omega-3 and their perceived benefits by physicians in real-world clinical practice, in Russia, Saudi Arabia, Thailand, and Gulf countries, and to determine the adherence of physicians to dyslipidemia management guidelines. The present study focuses on Flash'O's process and results in Middle East countries. A total of 338 physicians and specialists completed the online questionnaire. Most responding physicians were male (91.7%), general practitioners (42.6%) with more than 5 years of seniority (80.4%) and saw more than 50 patients a week (71.5%). Most surveyed physicians (64.2%) reported using guidelines in their daily practice for the management of their patients with dyslipidemia. They mostly followed national guidelines (68.6%). American or European ones were less commonly used. Responding physicians thought that omega-3 supplementation could be more beneficial in all types of dyslipidemia, except high non- hight density lipoproteins, and for patients suffering from obesity, type 2 diabetes mellitus, acute coronary syndrome with ST-segment elevation myocardial infarction and high cardiovascular diseases risk (score ≥ 5% and < 10%), but less beneficial in chronic kidney disease. Respondents recommended omega-3 to their patients mainly after statin treatment in patients with dyslipidemia and for the treatment of dyslipidemia. This survey confirmed that omega-3 fatty acids are at the heart of the cardiovascular medical strategy.

Student nurses' knowledge of and attitudes toward palliative care in the Middle East: an integrative review.

BACKGROUND: Palliative care is one of the most important areas of practice because it includes caring for vulnerable people who are mostly in their last stage of life. Palliative care is a relatively new specialty in the Middle East and little is known about student nurses' knowledge of and attitudes towards it. AIM: The aim of this study was to explore students' knowledge of and attitudes towards palliative care in the Middle East, and to use the findings to make recommendations to higher education institutions about its importance. DESIGN: An integrative review following an established framework was used. Hawker's Assessment Tool was employed to evaluate the quality of the research articles. RESULTS: The search found seven quantitative studies from four countries in the Middle East. Their focus was on students' knowledge (n=5) and attitudes (n=2). The number of participants ranged from 110 to 452, with knowledge scores ranging from 5.23 to 8.0 out of 20 on all or part of the Palliative Care Quiz for Nursing. Students' attitudes were marginally positive toward palliative care and dying patients. CONCLUSION: There are few studies in the Middle East investigating student nurses' knowledge of and attitude toward palliative care; consequently, more attention needs to be given to this area of practice.

Comparing and contrasting different herbal products intended for the management of obesity approved in the Palestinian markets.

BACKGROUND: The use of conventional medical therapies has proven to have many setbacks and safety concerns that need further improvement. However, herbal medicine has been used for over 2000 years, and many studies have proven the use of herbs to be effective and safe. This article discussed the efficacy of different herbal products used in the management of obesity. To evaluate the efficacy of seven herbal-based weight loss products currently available on the Palestinian market, using in vitro assays to screen for antioxidants, anti-amylase, and anti-lipase effects for each product. METHOD: Pancreatic lipase and salivary amylase inhibitory activities, as well as antioxidant analysis, were tested in vitro on a variety of herbal products. Then the IC50 was measured for each test. RESULTS: The anti-lipase assay results, IC50 values in (µg/mL) of each of the seven products (Product A, product B, product C, product D, product E, product F, and product G) were 114.78, 532.1, 60.18, 53.33, 244.9, 38.9, and 48.97, respectively. The IC50 value for orlistat (Reference) was 12.3 µg/ml. On the other hand, the IC50 value for alpha amylase inhibition of the seven products (Product A, product B, product C, product D, product E, product F, and product F) were 345.93, 13,803.84 (Inactive), 73.79, 130.91, 165.95, 28.18, and 33.11 µg/ml respectively, while acarbose (Reference) was 23.38 µg/ml. The antioxidant activity (IC50 values) for the seven products (Product A, product B, product C, product D, product E, product F, and product F) were 1258.92, 707.94, 79.43, 186.20, 164.81, 17.53, and 10.47 µg/ml respectively. While the IC50 value for Trolox was 2.70 µg/ml. CONCLUSION: It can be concluded that the seven products showed varied anti-lipase, anti-amylase, and antioxidant effects. However, products F and G showed superiority in all categories.

Quantification of the effect of host patch configuration on the abundance of Bemisia tabaci in central Argentina: a multimodel inference approach.

Bemisia tabaci is a complex of species, which is considered the most common and important pest of a wide range of crops belonging to many different botanical families. In Argentina, this species is recognized as a vector of geminiviruses, and Middle East-Asia Minor 1, Mediterranean, New World and New World 2 have been found to coexist in the same area. Landscape elements, like habitat patch area and isolation, define the habitat configuration and have a direct effect on insect populations between and within host patches. In this paper, we analyse the effect of potato patch configuration on the distribution and abundance of B. tabaci. Potato patches were identified using Landsat TM5 and TM7 images, and a supervised classification was performed to quantify the spatial distribution of the patches in the whole study area. Potato patch metrics were estimated using Fragstats 4.4. Generalized linear mixed models were employed to analyse the relationship between whiteflies and landscape configuration, through a multimodel inference approach, finding that B. tabaci abundance and landscape metrics were very variable. After a multimodel selection process, we found that perimeter-to-area ratio and Euclidean distance between patches were the variables that best explained whitefly abundance in potato patches. Implications of these findings are discussed.

Middle East consensus recommendations on the use of young child formula (YCF) in toddlers.

The transition of foods during toddlerhood and the suboptimal diets consumed in the Middle East make children susceptible to malnutrition and micronutrient deficiencies. Based on international recommendations, coupled with the merits of clinical studies on the application of young child formula (YCF), a group of fourteen experts from the Middle East reached a consensus on improving the nutritional status of toddlers. The recommendations put forth by the expert panel comprised twelve statements related to the relevance of YCF in young children; the impact of YCF on their nutritional parameters and functional outcomes; characteristics of the currently available YCF and its ideal composition; strategies to supply adequate nutrition in young children and educational needs of parents and healthcare professionals (HCPs). This consensus aims to serve as a guide to HCPs and parents, focusing on improving the nutritional balance in toddlers in the Middle Eastern region. The panellists considere YCF to be one of the potential solutions to improve the nutritional status of young children in the region. Other strategies to improve the nutritional status of young children include fortified cow's milk and cereals, vitamin and mineral supplements, early introduction of meat and fish, and the inclusion of diverse foods in children's diets.

Grey wolf genomic history reveals a dual ancestry of dogs.

The grey wolf (Canis lupus) was the first species to give rise to a domestic population, and they remained widespread throughout the last Ice Age when many other large mammal species went extinct. Little is known, however, about the history and possible extinction of past wolf populations or when and where the wolf progenitors of the present-day dog lineage (Canis familiaris) lived1-8. Here we analysed 72 ancient wolf genomes spanning the last 100,000 years from Europe, Siberia and North America. We found that wolf populations were highly connected throughout the Late Pleistocene, with levels of differentiation an order of magnitude lower than they are today. This population connectivity allowed us to detect natural selection across the time series, including rapid fixation of mutations in the gene IFT88 40,000-30,000 years ago. We show that dogs are overall more closely related to ancient wolves from eastern Eurasia than to those from western Eurasia, suggesting a domestication process in the east. However, we also found that dogs in the Near East and Africa derive up to half of their ancestry from a distinct population related to modern southwest Eurasian wolves, reflecting either an independent domestication process or admixture from local wolves. None of the analysed ancient wolf genomes is a direct match for either of these dog ancestries, meaning that the exact progenitor populations remain to be located.

Adherence to UNRWA's anaemia treatment guidelines in the Jerash Camp Health Centre, Jordan: a retrospective observational study.

OBJECTIVE: The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) provides primary healthcare to 2.2 million Palestinian refugees in Jordan. This study aimed to measure patient and doctor adherence to the UNRWA guidelines for the prevention and treatment of iron deficiency anaemia in moderate to severe anaemia children, defined as haemoglobin (Hb) level <10.0 g/L. DESIGN, SETTING AND PARTICIPANTS: A retrospective observational study was conducted by analysing the electronic health records of 717 children (353 boys and 364 girls) children aged 12 months old in 2018 in the Jerash Camp Health Centre, Jordan. OUTCOME: Patient adherence to the UNRWA guidelines was calculated by the proportion of health centre visits and doctor adherence by the proportions of Hb tests and iron supplementation among moderate to severe anaemia children at screening, first, second and third follow-up visits, respectively using STATA. RESULTS: The prevalence of moderate to severe anaemia was 15.6% among 12-month-old children. After 1 month of iron supplementation, 83.7% of anaemic children improved their Hb status: mean±SD from 9.1±0.6 g/L to 10.1±1.0 g/L. Patient and doctor adherence to the UNRWA guidelines was above 80% at the screening visit but progressively decreased at follow-up visits, especially patient adherence at the third follow-up visit of 34.4%. The analysis revealed unnecessary health centre visits and iron supplementation being given to mildly anaemic children (Hb level=10.0 g/L-10.9 g/L). Additionally, children visited the health centre at an age significantly later compared with that recommended by the UNRWA guidelines for the screening, first and second follow-up visits (p-value<0.05). CONCLUSION: Adherence to the UNRWA guidelines was above 80% at screening but much lower at follow-up visits. Urgent action is needed to improve adherence at follow-up visits and to minimise any unnecessary health centre visits and iron supplementation to mildly anaemic children.

The perspective of antibiotic therapeutic challenges of brucellosis in the Middle East and North African countries: Current situation and therapeutic management.

Brucellosis is among the most prevalent zoonotic infections in Middle Eastern and North African (MENA) countries, critically impacting human and animal health. A comprehensive review of studies on antibiotic susceptibility and therapeutic regimes for brucellosis in ruminants and humans in the MENA region was conducted to evaluate the current therapeutic management in this region. Different scientific databases were searched for peer-reviewed original English articles published from January 1989 to February 2021. Reports from research organizations and health authorities have been taken into consideration. Brucella melitensis and Brucella abortus have been reported from the majority of MENA countries, suggesting a massive prevalence particularly of B. melitensis across these countries. Several sporadic cases of brucellosis relapse, therapeutic failure, and antibiotic resistance of animal and human isolates have been reported from the MENA region. However, several studies proved that brucellae are still in-vitro susceptible to the majority of antibiotic compounds and combinations in current recommended World Health Organization (WHO) treatment regimens, for example, levofloxacin, tetracyclines, doxycycline, streptomycin, ciprofloxacin, chloramphenicol, gentamicin, tigecycline, and trimethoprim/sulfamethoxazole. The current review presents an overview on resistance development of brucellae and highlights the current knowledge on effective antibiotics regimens for treating human brucellosis.

The emperor's herbarium: The German physician Leonhard Rauwolf (1535?-96) and his botanical field studies in the Middle East.

This paper presents the results of the new interdisciplinary research done on Leonhard Rauwolf's herbarium with plants from the Middle East, which was later owned by Emperor Rudolf II. Using various sources, it examines how the herbarium came into the imperial collections, Early Modern methods of botanical research as described by Rauwolf in his printed travelogue, and how the illustrations for the printed book were produced from the specimens in the herbarium. The appendix (available in the online version) presents the new corrected botanical identification of the c. 200 plants in the fourth volume of Rauwolf's herbarium, and a correct transcription of the Early Modern Latin and vernacular names Rauwolf collected for these plants.

Phytochemical screening, antiobesity, antidiabetic and antimicrobial assessments of Orobanche aegyptiaca from Palestine.

BACKGROUND: Microbial resistance, diabetes mellitus, and obesity are global health care problems that have posed a serious threat to both human and environmental ecosystems. The goals of the present investigations are to investigate the phytoconstituents, antilipase, anti-α-amylase, and antimicrobial activity of Orobanche aegyptiaca Pers. (OA) from Palestine. METHODS: Identification of the phytoconstituents of OA plant petroleum ether, methylene chloride, chloroform, acetone, and methanol extracts were conducted using pharmacopeia's methods, while porcine pancreatic lipase and α-amylase inhibitory activities were examined using p-nitrophenyl butyrate and 3,5-dinitro salicylic acid methods, respectively. Moreover, the antimicrobial activity was evaluated utilizing broth microdilution assay against eight bacterial and fungal strains. RESULTS: The phytochemical screening results showed that the methanol extract of the OA plant is rich in phytochemical components, also this extract has powerful antilipase potential with an IC50 value of 19.49 ± 0.16 µg/ml comparing with the positive control (Orlistat) which has antilipase activity with IC50 value of 12.3 ± 0.35 µg/ml. Moreover, the methanol and chloroform extracts have powerful α-amylase inhibitory activity with IC50 values of 28.18 ± 0.22 and 28.18 ± 1.22 µg/ml, respectively comparing with Acarbose which has α-amylase inhibitory activity with IC50 dose of 26.3.18 ± 0.28 µg/ml. The antibacterial results showed that the methylene chloride extract exhibited the highest antibacterial activity among the other OA plant extracts with a MIC value of 0.78 mg/ml against S. aureus, while, the methylene chloride, petroleum ether, and chloroform extracts of the OA plant showed potential antifungal activity against C. albicans strains with MIC value of 0.78 mg/ml. CONCLUSION: The OA methanol and chloroform extracts could be excellent candidates as antilipase and anti-α-amylase bioactive materials. In addition, methylene chloride, petroleum ether, and chloroform extracts could be potential natural antimicrobial products.

Fatty Acids Quality in Middle Eastern Traditional Dishes, Arabic Sweets and Market Foods Frequently Consumed in Lebanon.

The prevalence of diet-related non-communicable diseases is on the rise in the countries of the Eastern Mediterranean, including Lebanon. This study aimed to provide data on fatty acid profiles and ratios of Lebanese composite dishes, Arabic sweets, and market foods. Methods: Thirty types of traditional dishes, collected from five different Lebanese governorates, thirty-seven types of Arabic sweets and forty-six market food products were considered for analysis. Food samples were chemically analyzed for total, unsaturated and saturated fatty acids. The range of total fatty acids in composite dishes, Arabic sweets, and market food products was between 1.2-11.7 g/100 g, 5.3-25.8 g/100 g, and 0.5-100 g/100 g, respectively. Additionally, the range of saturated fatty acids in composite dishes, Arabic sweets, and market food products was between 0.5-4.9 g/100 g, 2.5-23.6 g/100 g and 0.1-56.4 g/100 g, respectively. Furthermore, about 75% of these foods were poor in unsaturated fatty acids. Regarding saturated fatty acid, the polyunsaturated to monounsaturated (P.M.S) ratio was lower than the recommended ratio of 1:1:1 in 96% of samples. To conclude, there is a need to prioritize fat content in foods and consider processing modifications in the food production system with the aim of achieving a higher P:M:S ratio intake among the population.

Hepatitis C Virus Infection in Persons Who Inject Drugs in the Middle East and North Africa: Intervention Strategies.

There is a high incidence and prevalence of hepatitis C viral infection in persons with or without substance use disorders (SUDs) in the Middle East and North Africa (MENA) region, but only a small number receive comprehensive care. Highly effective direct-acting antiviral (DAA) medications are available at substantially lower costs; however, complete elimination of the hepatitis C virus (HCV) can only be achieved if integrated care strategies target those at highest risk for HCV infection and transmission and improve access to care. Due to the high prevalence of SUD in the MENA region, strategies to eliminate HCV must focus on integrated healthcare across multiple subspecialties, including addiction medicine, psychiatry, infectious diseases, hepatology, and social work. In this invited manuscript, we review the epidemiology of HCV in the MENA region and highlight intervention strategies to attain the WHO's goal of HCV eradication by 2030.

Effects of Anthocyanin Supplementation on Reduction of Obesity Criteria: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Anthocyanins, water-soluble flavonoids that produce red-to-blue pigment in plants, have antioxidant properties and have been developed as a functional food to fight obesity. In randomized controlled trials (RCTs), a systematic review with meta-analysis (SR-MA) was used to investigate these anti-obesity effects. Using search engines (PubMed, EMBASE, Cochrane-library, and CINAHL) and keywords (anthocyanins, BMI, WC, WHR, and inflammatory biomarkers), 11 out of 642 RCTs (28.3-500 mg/day of anthocyanins for 4 to 24 weeks) were included. The results showed a significant reduction in body mass index (BMI) (MD = -0.36, 95% CI = -0.58 to -0.13), but body weight (BW) and waist circumference (WC) did not change. Anthocyanins decreased BMI in the non-obese (non-OB) group in five RCTs (BMI ≤ 25; MD = -0.40 kg/m2; 95% CI = -0.64 to -0.16;) but did not affect BMI in the obese (OB) group. A subgroup analysis of six RCTs showed that fewer than 300 mg/day reduced BMI (MD = -0.37; 95% CI = -0.06 to -0.14), but ≥300 mg/day did not. A treatment duration of four weeks for four RCTs was sufficient to decrease the BMI (MD = -0.41; 95% CI = -0.66 to -0.16) as opposed to a longer treatment (6-8 or ≥12 weeks). An analysis of the effect of anthocyanins on the BMI showed a significant fall among those from the Middle East compared to those from Asia, Europe, South America, or Oceania. In conclusion, the anthocyanin supplementation of 300 mg/day or less for four weeks was sufficient to reduce the BMI and BW compared to the higher-dose and longer-treatment RCTs. However, further studies might be conducted regarding the dose- or period-dependent responses on various obese biomarkers.

Legacy of Syriac-Aramaic Scholars in Transmitting Neurosurgical Knowledge Between Antiquity and the Middle Ages.

The link between ancient Greek medicine and the Arabic translation period in the 9th century cannot be understood without studying the contributions of Syriac scholars. With their mastery of Greek and the related Semitic languages of Syriac and Arabic, they initiated a scientific translation process with methods that prevail to this day. In this paper, we reviewed Hunayn Ibn Isshaq's Ten Treatises on the Eye to elucidate the original contributions of the Syriac physicians to the field of neurologic surgery. We analyzed the oldest known diagram of orbital anatomy along with Hunayn's genuine ideas on the optic nerve anatomy and pathology, optic chiasm, afferent pupillary reflex, and papilledema and venous congestion. We also reviewed the neurosurgical elements found in the Syriac Book of Medicines including the thought process in localizing neurologic deficits based on clinical experience and anatomic dissections and the earliest recorded description of brachial plexus pathology.

Phytochemical Profile and In Vitro Antioxidant, Antimicrobial, Vital Physiological Enzymes Inhibitory and Cytotoxic Effects of Artemisia jordanica Leaves Essential Oil from Palestine.

Artemisia jordanica (AJ) is one of the folkloric medicinal plants and grows in the arid condition used by Palestinian Bedouins in the Al-Naqab desert for the treatment of diabetes and gastrointestinal infections. The current investigation aimed, for the first time, to characterize the (AJ) essential oil (EO) components and evaluate EO's antioxidant, anti-obesity, antidiabetic, antimicrobial, anti-inflammatory, and cytotoxic activities. The gas chromatography-mass spectrometer (GC-MS) technique was utilized to characterize the chemical ingredients of (AJ) EO, while validated biochemical approaches were utilized to evaluate the antioxidant, anti-obesity and antidiabetic. The microbicidal efficacy of (AJ) EO was measured utilizing the broth microdilution assay. Besides, the cytotoxic activity was estimated utilizing the (MTS) procedure. Finally, the anti-inflammatory activity was measured utilizing a COX inhibitory screening test kit. The analytical investigation revealed the presence of 19 molecules in the (AJ) EO. Oxygenated terpenoids, including bornyl acetate (63.40%) and endo-borneol (17.75%) presented as major components of the (AJ) EO. The EO exhibited potent antioxidant activity compared with Trolox, while it showed a weak anti-lipase effect compared with orlistat. In addition, the tested EO displayed a potent α-amylase suppressing effect compared with the positive control acarbose. Notably, the (AJ) EO exhibited strong α-glucosidase inhibitory potential compared with the positive control acarbose. The EO had has a cytotoxic effect against all the screened tumor cells. In fact, (AJ) EO showed potent antimicrobial properties. Besides, the EO inhibited the enzymes COX-1 and COX-2, compared with the anti-inflammatory drug ketoprofen. The (AJ) EO has strong antioxidant, antibacterial, antifungal, anti-α-amylase, anti-α-glucosidase, and COX inhibitory effects which could be a favorite candidate for the treatment of various neurodegenerative diseases caused by harmful free radicals, microbial resistance, diabetes, and inflammations. Further in-depth investigations are urgently crucial to explore the importance of such medicinal plants in pharmaceutical production.

Cyclin-dependent kinase 9 (CDK9) predicts recurrence in Middle Eastern epithelial ovarian cancer.

BACKGROUND: Cyclin-dependent kinase 9 (CDK9) has been shown to play an important role in tumorigenesis of several malignancies. However, the expression of CDK9 in ovarian cancer from Middle Eastern ethnicity remains unknown. METHODS: A tissue microarray of 441 epithelial ovarian cancer (EOC) samples was used to study the expression of CDK9 immunohistochemically and their clinico-pathological associations were determined. Cox proportional hazards regression model was used for univariate and multivariate analysis of recurrence-free survival. RESULTS: CDK9 over-expression was noted in 56.2 % (248/441) of EOCs and was associated with adverse clinico-pathological parameters such as distant metastasis (p < 0.0001), stage IV tumors (p < 0.0001), tumor recurrence (p = 0.0105) and high Ki-67 index (p < 0.0001). Importantly, CDK9 over-expression was an independent predictor of poor recurrence-free survival (Hazard ratio = 1.51; 95 % confidence interval = 1.15-1.98; p = 0.0030). We also found that CDK9 outperforms Ki-67 as a predictor of tumor recurrence in EOC. CONCLUSIONS: Our results show that CDK9 expression correlates with markers of advanced disease in Middle Eastern EOC and is also a prognostic marker. CDK9 overexpression also identifies a subset of patients with highest likelihood of recurrence across the patient cohort. These patients may benefit from additional alternative therapies targeting CKD9.

The use of complementary and alternative medicine during pregnancy: a cross-sectional study from Palestine.

BACKGROUND: The use of complementary and alternative medicine (CAM) is increasing worldwide. To the best of knowledge, there is a lack of studies that assess CAM use by Palestinian women during pregnancy. This research aims to determine the prevalence of Palestinian women's use of CAM during pregnancy, the most frequently used CAM products during the pregnancy period, the main sources that encourage the use of CAM among pregnant women, and the causes of CAM use. METHODS: A descriptive, cross-sectional study was conducted in Palestine using a questionnaire from April 2018 to March 2019. The samples were selected by convenience sampling, including currently pregnant or previously pregnant women in the Obstetrics and Gynecology (OBGYN) clinic at Rafedia Hospital and in primary health care clinics in Nablus city-Palestine. The questionnaire covered socio-demographic variables, health status, types and frequency of CAM used, patients' sources of information, causes of their usage, attitudes, and beliefs. RESULTS: Four hundred currently or previously pregnant women participated. Three hundred fifty-five (91.5%) used at least one method of CAM during pregnancy. Most women used at least one method of biologically-based therapies during pregnancy (87.7%). One hundred and one pregnant women (26.7%) utilised at least one type of herb during pregnancy. The most-reported herb used by 12.3% of participants was anise. Of the mind-body therapies, prayer was the most commonly used method during pregnancy (8.3%). Two hundred and sixty-one (65.3%) participants used CAM because they believed CAM was not harmful to them or their babies during pregnancy. Participants gained most of their information about CAM from their families (43.8%) and friends (24.3%). Approximately two-thirds of participants (64.0%) thought that obstetricians should be able to advise on commonly used CAM. CONCLUSIONS: During pregnancy, CAM products are commonly used, and it is important to determine what types are being used by women in Palestine. These findings supplement the body of knowledge on the use of CAM by pregnant women. Pregnancy care providers need to be aware to the familiar types of CAM that women use.

Delivering nutrition interventions to women and children in conflict settings: a systematic review.

BACKGROUND: Low/middle-income countries (LMICs) face triple burden of malnutrition associated with infectious diseases, and non-communicable diseases. This review aims to synthesise the available data on the delivery, coverage, and effectiveness of the nutrition programmes for conflict affected women and children living in LMICs. METHODS: We searched MEDLINE, Embase, CINAHL, and PsycINFO databases and grey literature using terms related to conflict, population, and nutrition. We searched studies on women and children receiving nutrition-specific interventions during or within five years of a conflict in LMICs. We extracted information on population, intervention, and delivery characteristics, as well as delivery barriers and facilitators. Data on intervention coverage and effectiveness were tabulated, but no meta-analysis was conducted. RESULTS: Ninety-one pubblications met our inclusion criteria. Nearly half of the publications (n=43) included population of sub-Saharan Africa (n=31) followed by Middle East and North African region. Most publications (n=58) reported on interventions targeting children under 5 years of age, and pregnant and lactating women (n=27). General food distribution (n=34), micronutrient supplementation (n=27) and nutrition assessment (n=26) were the most frequently reported interventions, with most reporting on intervention delivery to refugee populations in camp settings (n=63) and using community-based approaches. Only eight studies reported on coverage and effectiveness of intervention. Key delivery facilitators included community advocacy and social mobilisation, effective monitoring and the integration of nutrition, and other sectoral interventions and services, and barriers included insufficient resources, nutritional commodity shortages, security concerns, poor reporting, limited cooperation, and difficulty accessing and following-up of beneficiaries. DISCUSSION: Despite the focus on nutrition in conflict settings, our review highlights important information gaps. Moreover, there is very little information on coverage or effectiveness of nutrition interventions; more rigorous evaluation of effectiveness and delivery approaches is needed, including outside of camps and for preventive as well as curative nutrition interventions. PROSPERO REGISTRATION NUMBER: CRD42019125221.

Chemometrics-based aroma profiling for revealing origin, roasting indices, and brewing method in coffee seeds and its commercial blends in the Middle East.

Coffee is among the most consumed beverages worldwide. The present study reports on the aroma composition associated with coffee seeds brewing. Aroma of authentic coffee specimens of Coffea arabica and C. robusta alongside with typical products consumed in the Middle East were analyzed using HS-SPME coupled with GC-MS. In addition, multivariate data analysis (MVA) was employed. Results revealed for 102 volatiles with a distinct aroma profile between the different brewing methods. Infusion demonstrated higher esters level, while decoction and maceration were more abundant in sesquiterpenes and terpene alcohols, respectively. Besides, heat-induced products, i.e., 4-vinyl guaiacol was identified as potential roasting index in instant coffee and roasted C. robusta brews. Blending with cardamom further masked the smoky odor of such compounds by its fragrant terpinyl acetate. This study provides the first report on the chemical sensory attributes of Middle Eastern coffee blends and further reveal for the impact of brewing, roasting on its aroma composition.