Impact of atmospheric deposition on the dynamics of ultraphytoplanktonic populations in the Gulf of Gabès during an intense dust event (MERITE-HIPPOCAMPE campaign).

The ultraphytoplankton composition and dynamics were assessed during a Saharan dust event occurring off the southern Tunisian coasts during the MERITE-HIPPOCAMPE Trans-Mediterranean oceanographic cruise. The composition of atmospheric dust was characterized in terms of nutriments and trace metals. Data-assimilative hydrodynamic model revealed no differences in the hydrological features along the sampling track and almost no water transport occurred during the period of atmospheric deposition. Dust deposition increased the growth rates and the productivity of the major phytoplanktonic cytometric groups, resulting in the highest surface biomass along the Mediterranean transect. One group, distinguished by low fluorescence and nanoplanktonic size, reacted to dust deposition within hours, exhibiting the highest growth rate and net productivity. The dust composition showed a substantial enrichment with organic phosphorous representing (56 % of Total phosphorus) and trace metals mainly Fe, Mn and V.

Telecoupled urban demand from West African cities causes social-ecological land use transformation in Saharan oases.

Little is known about the long-distance telecoupling effects of urban food demands on land use changes (LUCs) in remote oases of the Southern Sahara. Using the example of two typical oasis settlements on Mont Bagzam in the southern Aϊr Mountains of Niger which are linked to regional and global markets by an unpaved road since 2015, this study aimed at analyzing time trajectories of LUCs and related changing agricultural production patterns. LUCs were quantified for 1955 to 2022 using GIS-based mapping of agriculture and natural vegetation based on historical aerial photographs, CORONA and multi-spectral satellite images, and high resolution drone-based surveys. The results show a major increment in actively used agricultural land in the 850 ha watershed of the two oases from 11 ha in 1955 to 13 ha in 2003 and 68 ha in 2022 as well as the addition of 92 irrigation wells to 16 existing ones between 2003 and 2022. LUCs and evapotranspiration calculated from climatic data of a local weather station allowed to estimate changes of irrigation water needs in the selected watershed. While annual precipitation averages only 214 mm, local reference evapotranspiration may reach 1,476 mm year-1. Therefore, the additional annual irrigation water needs for the newly established fields between 2003 and 2022 cultivated to cash crops rose by 696 million l. To detect LUC effects on soil quality, soil samples of onion and garlic fields of different ages were collected employing a false-time-series approach. Results reveal increasing soil pH and salt concentrations and falling ground water tables, which reflects a negative water balance and ground water extraction above recharge levels. Our study provides evidence that the newly established telecoupled production systems on Mont Bagzam threaten the sustainability of existing local agricultural production and related livelihoods of agro-pastoralists.

Rare Halophilic Nocardiopsis from Algerian Saharan Soils as Tools for Biotechnological Processes in Pharmaceutical Industry.

The Sahara Desert, one of the most extreme ecosystems in the planet, constitutes an unexplored source of microorganisms such as mycelial bacteria. In this study, we investigated the diversity of halophilic actinobacteria in soils collected from five regions of the Algerian Sahara. A total of 23 halophilic actinobacterial strains were isolated by using a humic-vitamin agar medium supplemented with 10% NaCl. The isolated halophilic strains were subjected to taxonomic analysis using a polyphasic approach, which included morphological, chemotaxonomic, physiological (numerical taxonomy), and phylogenetic analyses. The isolates showed abundant growth in CMA (complex medium agar) and TSA (tryptic soy agar) media containing 10% NaCl, and chemotaxonomic characteristics were consistent with their assignment to the genus Nocardiopsis. Analysis of the 16S rRNA sequence of 23 isolates showed five distinct clusters and a similarity level ranging between 98.4% and 99.8% within the Nocardiopsis species. Comparison of their physiological characteristics with the nearest species showed significant differences with the closely related species. Halophilic Nocardiopsis isolated from Algerian Sahara soil represents a distinct phyletic line suggesting a potential new species. Furthermore, the isolated strains of halophilic Nocardiopsis were screened for their antagonistic properties against a broad spectrum of microorganisms by the conventional agar method (agar cylinders method) and found to have the capacity to produce bioactive secondary metabolites. Except one isolate (AH37), all isolated Nocardiopsis showed moderate to high biological activities against Pseudomonas syringae and Salmonella enterica, and some isolates showed activities against Agrobacterium tumefaciens, Serratia marcescens, and Klebsiella pneumoniae. However, no isolates were active against Bacillus subtilis, Aspergillus flavus, or Aspergillus niger. The obtained finding implies that the unexplored extreme environments such as the Sahara contain many new bacterial species as a novel drug source for medical and industrial applications.

Northwest African Neolithic initiated by migrants from Iberia and Levant.

In northwestern Africa, lifestyle transitioned from foraging to food production around 7,400 years ago but what sparked that change remains unclear. Archaeological data support conflicting views: (1) that migrant European Neolithic farmers brought the new way of life to North Africa1-3 or (2) that local hunter-gatherers adopted technological innovations4,5. The latter view is also supported by archaeogenetic data6. Here we fill key chronological and archaeogenetic gaps for the Maghreb, from Epipalaeolithic to Middle Neolithic, by sequencing the genomes of nine individuals (to between 45.8- and 0.2-fold genome coverage). Notably, we trace 8,000 years of population continuity and isolation from the Upper Palaeolithic, via the Epipaleolithic, to some Maghrebi Neolithic farming groups. However, remains from the earliest Neolithic contexts showed mostly European Neolithic ancestry. We suggest that farming was introduced by European migrants and was then rapidly adopted by local groups. During the Middle Neolithic a new ancestry from the Levant appears in the Maghreb, coinciding with the arrival of pastoralism in the region, and all three ancestries blend together during the Late Neolithic. Our results show ancestry shifts in the Neolithization of northwestern Africa that probably mirrored a heterogeneous economic and cultural landscape, in a more multifaceted process than observed in other regions.

Characterising school-age health and function in rural Zimbabwe using the SAHARAN toolbox.

INTRODUCTION: We developed the School-Age Health, Activity, Resilience, Anthropometry and Neurocognitive (SAHARAN) toolbox to address the shortage of school-age assessment tools that combine growth, physical and cognitive function. Here we present i) development, acceptability and feasibility of the SAHARAN toolbox; ii) characteristics of a pilot cohort; and iii) associations between the domains measured in the cohort. METHODS: Growth was measured with anthropometry, knee-heel length and skinfold thicknesses. Bioimpedance analysis measured lean mass index and phase angle. Cognition was assessed using the mental processing index, derived from the Kaufman Assessment Battery for Children version 2, a fine motor finger-tapping task, and School Achievement Test (SAT). Physical function combined grip strength, broad jump and the 20m shuttle-run test to produce a total physical score. A caregiver questionnaire was performed in parallel. RESULTS: The SAHARAN toolbox was feasible to implement in rural Zimbabwe, and highly acceptable to children and caregivers following some minor modifications. Eighty children with mean (SD) age 7.6 (0.2) years had mean height-for-age (HAZ) and weight-for-age Z-scores (WAZ) of -0.63 (0.81) and -0.55 (0.85), respectively. Lean mass index and total skinfold thicknesses were related to WAZ and BMI Z-score, but not to HAZ. Total physical score was associated with unit rises in HAZ (1.29, 95% CI 0.75, 1.82, p<0.001), and lean mass index (0.50, 95% CI 0.16, 0.83, p = 0.004), but not skinfold thicknesses. The SAT was associated with unit increases in the mental processing index and child socioemotional score. The caregiver questionnaire identified high levels of adversity and food insecurity. CONCLUSIONS: The SAHARAN toolbox provided a feasible and acceptable holistic assessment of child growth and function in mid-childhood. We found clear associations between growth, height-adjusted lean mass and physical function, but not cognitive function. The SAHARAN toolbox could be deployed to characterise school-age growth, development and function elsewhere in sub-Saharan Africa.

Biochemical Profile and In Vitro Therapeutic Properties of Two Euhalophytes, Halocnemum strobilaceum Pall. and Suaeda fruticosa (L.) Forske., Grown in the Sabkha Ecosystem in the Algerian Sahara.

This study reports the biochemical profile and in vitro biological activities of the aerial part of two shrubs: Halocnemum strobilaceum and Suaeda fruticosa, a halophytes species native to saline habitats. The biomass was evaluated by determining its physiological properties and approximate composition. Hydro-methanolic extracts from Halocnemum strobilaceum and Suaeda fruticosa have been investigated for the inhibition of bacterial growth, the protection of proteins (albumin) from denaturation, and cytotoxicity to hepatocellular carcinomas (Huh-7 and HepG2). Their antioxidant activity was evaluated by five tests, including one that examined their ability to inhibit hydrogen peroxide (H2O2)-induced hemolysis. The profile of their phenolic compounds was also determined. These two euhalophytes had a high moisture content, high levels of photosynthetic pigments, elevated levels of ash and protein, low oxidative damage indices, MDA (Malondialdehyde) and proline, and low lipids levels. Their content was also characterized by a moderate acidity with good electrical conductivity. They contained abundant levels of phytochemicals and varied phenolic contents. Reverse phase high performance liquid chromatography (RP-HPLC) analysis revealed the presence of caffeic acid, p-coumaric acid, rutin, and quercetin in both plant extracts. On the pharmaceutical level, the two euhalophytes had anti-inflammatory, antibacterial, antioxidant, and cytotoxic properties, and therefore it was recommended to isolate and identify biologically active compounds from these plants and evaluate them in vivo.

The burden of low back pain and its association with socio-demographic variables in the Middle East and North Africa region, 1990-2019.

BACKGROUND: Low back pain (LBP) is the most common musculoskeletal disorder globally. Providing region- and national-specific information on the burden of low back pain is critical for local healthcare policy makers. The present study aimed to report, compare, and contextualize the prevalence, incidence and years lived with disability (YLDs) of low back pain in the Middle East and North Africa (MENA) region by age, sex and sociodemographic index (SDI), from 1990 to 2019. METHODS: Publicly available data were obtained from the Global Burden of Disease (GBD) study 2019. The burden of LBP was reported for the 21 countries located in the MENA region, from 1990 to 2019. All estimates were reported as counts and age-standardised rates per 100,000 population, together with their corresponding 95% uncertainty intervals (UIs). RESULTS: In 2019, the age-standardised point prevalence and incidence rate per 100,000 in MENA were 7668.2 (95% UI 6798.0 to 8363.3) and 3215.9 (95%CI 2838.8 to 3638.3), which were 5.8% (4.3 to 7.4) and 4.4% (3.4 to 5.5) lower than in 1990, respectively. Furthermore, the regional age-standardised YLD rate in 2019 was 862.0 (605.5 to 1153.3) per 100,000, which was 6.0% (4.2 to 7.7) lower than in 1990. In 2019, Turkey [953.6 (671.3 to 1283.5)] and Lebanon [727.2 (511.5 to 966.0)] had the highest and lowest age-standardised YLD rates, respectively. There was no country in the MENA region that showed increases in the age-standardised prevalence, incidence or YLD rates of LBP over the measurement period. Furthermore, in 2019 the number of prevalent cases were highest in the 35-39 age group, with males having a higher number of cases in all age groups. In addition, the age-standardised YLD rates for males in the MENA region were higher than the global estimates in almost all age groups, in both 1990 and 2019. Furthermore, the burden of LBP was not associated with the level of socio-economic development during the measurement period. CONCLUSION: The burden attributable to LBP in the MENA region decreased slightly from 1990 to 2019. Furthermore, the burden among males was higher than the global average. Consequently, more integrated healthcare interventions are needed to more effectively alleviate the burden of low back pain in this region.

Comparative anti-herpes simplex virus type 1 and chemical profiling of Thymus capitatus and Artemisia herba-alba collected from North Africa.

Herpes simplex virus (HSV) can infect millions of people worldwide causing mild to life-threating infections. The current study demonstrates the first comparative anti-HSV type 1 activity and phytochemical investigation of Artemisia herba-alba and Thymus capitatus collected from Egypt and Libya. Liquid chromatography/mass spectrometry (LC/MS) analysis allowed the identification of 56 and 38 compounds in the Egyptian and Libyan Artemisia herba-alba ethanolic extracts, respectively, in addition to 46 and 50 compounds in the Egyptian and Libyan Thymus capitatus ethanolic extracts, respectively. Gas chromatography/mass spectrometry (GC/MS) analysis of their corresponding essential oils revealed the presence of 15, 17, 17 and 8 compounds in Egyptian and Libyan Artemisia herba-alba and Thymus capitatus, respectively. The major chemical classes of the identified compounds were phenolic acids, flavonoids and oxygenated monoterpenes. Evaluation of the anti-HSV1 activities of the studied extracts showed that the Egyptian Thymus capitatus ethanolic extracts were the most potent extract with more than 200-fold reduction in the viral PFU.

Assessment of heavy metals and macromineral in frequently used medicinal plants from Algerian Sahara traditional ethnopharmacopeia.

In this study, a total of 15 elements, both physiological and causing toxic effects, have been determined in 9 medicinal plants collected from their natural environment in the Algerian Sahara regions. The concentrations of elements were determined by inductively coupled plasma optical emission spectrometry (ICP-OES) after acid digestion and by the X-ray fluorescence spectrometry (XRF). By analyzing the spiked test and the reference materials, the accuracy of the measurements was determined. Our findings show differences in elements composition and concentration between the species under investigation, indicating differences in physiological function of the plant as a result of elemental interactions within it. The elements were quantified (in µg/g): Br (0.04-5.44), Cd (1.21-1.34), Co (1.12-64.35), Cr (1.51-59.05), Cu (1.81-9.28), Fe (94.26-668.55), Mn (16.34-70.77), Ni (1.5-53.64), Pb (1.18-2.55), Zn (1.21-310.80) and (in mg/g): Ca (4.23-4.70), Cl (21.98-117.91), P (28.92-30.49), S (4.15-11.95), Si (1.99-2.36). Mean element levels in medicinal plants were established in decreasing order as follows: Zn>Mn>Cu>Cr>Ni>Pb>Cd>Co. Except for nickel, which reached 53.64µg/g in the Capparis spinosa L species, heavy metal concentrations were found to be low in all samples. Based on traditional use, we can cautiously conclude that these medicinal plants pose no risk to users.

The spread of agriculture in Iberia through Approximate Bayesian Computation and Neolithic projectile tools.

In the present article we use geometric microliths (a specific type of arrowhead) and Approximate Bayesian Computation (ABC) in order to evaluate possible origin points and expansion routes for the Neolithic in the Iberian Peninsula. In order to do so, we divide the Iberian Peninsula in four areas (Ebro river, Catalan shores, Xúquer river and Guadalquivir river) and we sample the geometric microliths existing in the sites with the oldest radiocarbon dates for each zone. On this data, we perform a partial Mantel test with three matrices: geographic distance matrix, cultural distance matrix and chronological distance matrix. After this is done, we simulate a series of partial Mantel tests where we alter the chronological matrix by using an expansion model with randomised origin points, and using the distribution of the observed partial Mantel test's results as a summary statistic within an Approximate Bayesian Computation-Sequential Monte-Carlo (ABC-SMC) algorithm framework. Our results point clearly to a Neolithic expansion route following the Northern Mediterranean, whilst the Southern Mediterranean route could also find support and should be further discussed. The most probable origin points focus on the Xúquer river area.

Adaptogenic activity of Cinnamomum camphora, Eucalyptus globulus, Lavandula stœchas and Rosmarinus officinalis essential oil used in North-African folk medicine.

Depressive anxiety is one of the most emotional disorders in our industrial societies. Many treatments of phobias exist and are based on plant extracts therapies, which play an important role in the amelioration of the behavior. Our study aimed to evaluate the adaptogenic activity of different essential oils provided from local plants: Cinnamomum camphora (Camphora), Eucalyptus globulus (Blue gum), Lavandula stœchas (Topped lavender) and Rosmarinus officinalis (Rosemary) on Wistar rats. The adaptogenic activity was evaluated on the elevated plus-maze. The efficacy of the extract (200 mL/kg) was compared with the standard anxiolytic drug Diazepam® 1 mg. Animals administered by the essential oil of Lavandula stœchas, Cinnamomum camphora, Rosmarinus officinalis and Eucalyptus globulus showed a behavior similar to those treated with Diazepam®. For groups treated with the following essential oils: Rosmarinus officinalis, Lavandula stoechas and Cinnamomum camphora at a dose of 200 mL/kg, we notice an increase in the time spent on the open arms of the elevated plus-maze and a decrease in time spent on the closed arms of the elevated plus-maze, especially for Rosmarinus officinalis, which explains the anxiolytic effect of these plants. We also notice a decrease in the number of entries in closed arms, open arms and the number of passing to the central square. The increase in the number of entries to open arms with Eucalyptus globulus essential oil shows a reduction in anxiety behavior in rodents and this shows that these plants have an inhibitory effect.

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.

Causes of increased pollen exposure during Saharan-Sahel dust intrusions.

Airborne particulate matter such as mineral dust comes mainly from natural sources, and the African regions of Sahara and Sahel originate large amounts of the aerosols dispersed worldwide. There is little knowledge about the influence of dust episodes on airborne pollen concentrations, and although the centre and southeast of the Iberian Peninsula are frequently affected by dust intrusions, until now, no specific works have analysed the effect of these episodes on airborne pollen concentrations in these areas. The aims of this study were to analyse the simultaneous occurrence of airborne pollen peaks and Saharan-Sahel dust intrusions in the central and south-eastern Iberian Peninsula, and to study the weather conditions - air mass pathways and conditions of air temperature, relative humidity and atmospheric pressure - that influence the airborne pollen concentrations during dust episodes. The results showed that the rise in airborne pollen concentrations during dust episodes is apparent in inland Iberian areas, although not in coastal areas in the southeast where pollen concentrations are even observed to decrease, coinciding with prevailing easterly winds from the sea. Total pollen concentrations and specific pollen types such as Olea, Poaceae and Quercus showed an increase in the central Iberian Peninsula during dust episodes when two meteorological phenomena concur: 1) prevailing winds from extensive areas of major wind-pollinated pollen sources over a medium or short distance (mainly from western and southwestern areas); and 2) optimal meteorological conditions that favour pollen release and dispersal into the atmosphere (mainly high temperatures and subsequently low humidity in central areas). Both conditions often occur during the Saharan-Sahel dust intrusions in the centre. Maximum pollen peaks are therefore most likely to occur during dust episodes in the central Iberian Peninsula, thus dramatically increasing the risk of outbreaks of pollinosis and other respiratory diseases in the population.

Complementary and alternative medicine (CAM) for epilepsy treatment in the Middle East and North Africa (MENA) region.

INTRODUCTION: The aim of this study is to provide the reader with a review on Complementary and Alternative Medicine (CAM) treatment in epilepsy in the Middle East and North Africa (MENA) region, to describe the extent and factors associated with its use among patients with epilepsy (PWE), and to recommend how effectively we will be able to reduce this alarming use. MATERIAL AND METHODS: Retrospective literature search from 1945 to December 2019, regarding CAM use in the MENA region, using electronic databases (PubMed, Scopus, Google Scholar, Web of Science). CONCLUSION: The use of CAM and consultation of traditional healers for the treatment of epilepsy has so far been widespread practice for centuries in the MENA region. Lack of health professionals and non-adherence to conventional epilepsy treatment are strongly associated with the use of CAM. Improvement in the level of knowledge of epilepsy among PWE, healthcare professionals, including traditional healers, will educate PWE and their caregivers on potentially unsafe practices and promote adherence to Antiseizure Drugs (ASDs). Additionally, randomized controlled trials are needed to study the role and value of various CAM treatment options in PWEs.

Leaves of Cleome amblyocarpa Barr. And Murb. And Cleome arabica L.: Assessment of nutritional composition and chemical profile (LC-ESI-MS/MS), anti-inflammatory and analgesic effects of their extracts.

ETHNOPHARMACOLOGICAL RELEVANCE: The Cleomaceae family is known for its richness in secondary metabolites and different Cleome species are used in folk medicine. Cleome amblyocarpa and Cleome arabica are medicinal herbs used in Tunisia and other North Africa countries to treat various diseases such as diabetes, rheumatism, colic, pain and digestive disorders. AIM OF THE STUDY: To our knowledge, few data are available about the nutritional value, phytochemical components and biological effects of C. arabica and C. amblyocarpa cultivated in Tunisia. For this reason, the present survey aimed to determine the nutritional value, bioactive compounds and pharmacological properties of the leaves of these two species of Cleome. MATERIALS AND METHODS: To characterize and determine the bioactive compounds in both extracts of leaves of Cleome species, ultra-performance liquid chromatography-mass spectrometry (UPLC-MS) was used. The various nutritional parameters were analyzed, in particular the amounts of protein, carbohydrates, ash, fiber, and total lipids. Vitamin E and fatty acid profiles were also evaluated by HPLC-DAD-FLD and GC-FID, respectively. The acute toxic effects of leaf extracts in mice at concentrations of 100, 500 and 800 mg/kg body weight have been investigated. The anti-inflammatory effect of leaves extracts was examined by means of the in vitro and in vivo models. The in vivo anti-inflammatory test was assessed by means of the carrageenan induced paw edema in rats. For the in vitro anti-inflammatory assay, the red blood cells membrane stabilization and protein denaturation methods were employed. The analgesic effect of hydroalcoholic extracts of leaves was also assessed by acetic acid induced writhing model in mice. RESULTS: The phytochemical composition and the nutritional values of the leaves of C. amblyocarpa and C. arabica were determined. Our results revealed that the leaves of C. amblyocarpa are rich in flavonoids and glucosinolates. On the other hand, these latter metabolites are not present in the C. arabica extract and the leaves are characterized by the presence of flavones, methoxyflavones and their glycosides. Our findings revealed that the leaves of the two species contain a potential quantity of vitamins; proteins, carbohydrates and dietary fiber, and their hydroalcoholic extracts indicated substantial anti-inflammatory and antinociceptive activities in all the tests. Additionally, the data from the acute toxicity test proved that the leaf extracts did not cause any mortality or signs of toxicity in animals at doses up to 800 mg/kg CONCLUSIONS: The results obtained in this investigation demonstrated that the leaves of C. arabica and C. amblyocarpa are a valuable source of nutrients and active substances. Our observations support the traditional utilize of these two Cleome species for the treatment of painful diseases and as a source of natural anti-inflammatory agents.

Global Phosphorus Losses from Croplands under Future Precipitation Scenarios.

Phosphorus (P) losses from fertilized croplands to inland water bodies cause serious environmental problems. During wet years, high precipitation disproportionately contributes to P losses. We combine simulations of a gridded crop model and outputs from a number of hydrological and climate models to assess global impacts of changes in precipitation regimes on P losses during the 21st century. Under the baseline climate during 1991-2010, median P losses are 2.7 ± 0.5 kg P ha-1 year-1 over global croplands of four major crops, while during wet years, P losses are 3.6 ± 0.7 kg P ha-1 year-1. By the end of this century, P losses in wet years would reach 4.2 ± 1.0 (RCP2.6) and 4.7 ± 1.3 (RCP8.5) kg P ha-1 year-1 due to increases in high annual precipitation alone. The increases in P losses are the highest (up to 200%) in the arid regions of Middle East, Central Asia, and northern Africa. Consequently, in three quarters of the world's river basins, representing about 40% of total global runoff and home up to 7 billion people, P dilution capacity of freshwater could be exceeded due to P losses from croplands by the end of this century.

Current Recommendations for the Management of Stroke Patients in the Middle East in the Era of COVID-19 Pandemic; Statement from the MENA SINO.

COVID-19 pandemic has led to a change in the way we manage acute medical illnesses. This pandemic had a negative impact on stroke care worldwide. The World Stroke Organization (WSO) has raised concerns due to the lack of available care and compromised acute stroke services globally. The numbers of thrombolysis and thrombectomy therapies are declining. As well as, the rates and door-to treatment times for thrombolysis and thrombectomy therapies are increasing. The stroke units are being reallocated to serve COVID-19 patients, and stroke teams are being redeployed to COVID-19 centers. Covid 19 confirmed cases and deaths are rising day by day. This pandemic clearly threatened and threatening all stroke care achievements regionally. Managing stroke patients during this pandemic is even more challenging at our region. The Middle East and North Africa Stroke and Interventional Neurotherapies Organization (MENA-SINO) is the main stroke organization regionally. MENA-SINO urges the need to developing new strategies and recommendations for stroke care during this pandemic. This will require multiple channels of interventions and create a protective code stroke with fast triaging path. Developing and expanding the tele-stroke programs are urgently required. There is an urgent need for enhancing collaboration and cooperation between stroke expertise regionally and internationally. Integrating such measures will inevitably lead to an improvement and upgrading of the services to a satisfactory level.

Covid-19 pandemic research opportunity: Is the Middle East & North Africa (MENA) missing out?

BACKGROUND: The Covid-19 pandemic has caused fear and panic worldwide, forcing healthcare systems to disregard conventional practices and adopt innovation to contain the infection and death. Globally, there has been a rapid proliferation of research studies and clinical trials assessing risks, infectivity and treatment. METHODS: This review assesses the opportunities and challenges in the Middle East North Africa (MENA) region to engage in the conduct of high quality clinical trials during the Covid-19 pandemic. RESULTS: Opportunities are abundant for conducting clinical trials in MENA countries, including substantial cost savings, academic health centers, integrated health information systems, international accreditation, and international collaborations. Yet, the MENA region has missed out on opportunities to advance patient research during prior infectious disease outbreaks caused by the Severe Acute Respiratory Syndrome, Ebola, and the Middle East Respiratory Syndrome, as evidenced by the lack of concerted research and clinical trials from the region. A large vulnerable population, especially the poor expatriate work force, the current isolation of the health centers, and the lack of an expert network or field trained task force, all contribute to challenges preventing the formation of a pan Arab research enterprise for epidemics. CONCLUSION: Quality clinical research is critical during public health emergencies to identify treatments and solutions. The efficient conduct of clinical trials requires innovative strategies in research design, approval, and dissemination. Many countries in the MENA region have an opportunity to quickly ramp up research capacity and contribute significantly to the fight against the Covid-19 global threat.

National incidence, prevalence and disability-adjusted life years (DALYs) of common micronutrient deficiencies in Ethiopia from 1990 to 2017: estimates from the global burden of diseases study.

BACKGROUND: Understanding the national burden and trend of micronutrient deficiencies helps to guide effective intervention strategies under various circumstances. There is, however, a lack of evidence on trends, age- and sex-specific variations in Ethiopia. OBJECTIVE: This study aimed to provide evidence on the trends of common micronutrient deficiencies including, dietary iron, iodine, vitamin A and other nutritional deficiencies in Ethiopia, from 1990 to 2017, using findings from the Global Burden of Disease study. METHOD: We used estimates from the GBD 2017 study to report the incidence, prevalence and disability-adjusted life years of micronutrient deficiencies in Ethiopia from 1990 to 2017. All estimates, both crude counts, as well as all-age and age-standardized rates per 100,000 population, are accompanied by 95% uncertainty intervals (UIs). We summarized the age- and sex-specific patterns and we compared the burden with the sub-Saharan Africa and global estimate. RESULTS: From 1990 to 2017, the age-standardized prevalence rate of dietary iron, vitamin A and iodine deficiency decreased by 20.1%, 16.7%, and 91.6%, respectively. However, MNDs still account for a large number of DALYs in the country. In 2017, the all-age total DALYs due to dietary iron deficiency were estimated to be 448.4 thousand [95% UI: 298.9-640.7], accounting for 1.18% of the total DALYs. Similarly, the all-age total DALYs due to vitamin A deficiency were 397.8 thousand [256.1-589.2]. The total DALYs due to iodine deficiency were estimated to be 89.6 thousand [48.3-155.4]. CONCLUSIONS: Micronutrient deficiencies and associated morbidity and mortality are still high in Ethiopia compared with the sub-Saharan and global estimate. Adolescent and early adult females and children aged under-five are disproportionately affected segments of the population. Therefore, in collaboration with other sectors, the National Nutrition Program needs to place greater emphasis upon improving accessibility and utilization of nutrient-rich foods and supplementation, particularly for vulnerable groups of the population.