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In the Middle East and Northern Africa (MENA), dry eye disease (DED) is often misdiagnosed or overlooked. This review summarizes a series of conversations with ophthalmologists in the region around a variety of climatic, lifestyle, and iatrogenic factors that contribute to specific features of DED in the MENA region. These considerations are further classified by patient lifestyle and surgical choices. All statements are based on discussions and formal voting to achieve consensus over three meetings. Overall, a deeper understanding of the disease characteristics of DED specific to MENA can better guide local eyecare practitioners on appropriate management and follow-up care. Additionally, population-based studies and patient and physician education on ocular surface diseases, together with the use of culturally appropriate and language-specific questionnaires can help ease the public health burden of DED in this region. [ABSTRACT FROM AUTHOR]

Neonatal respiratory failure (NRF) is an emergency which has not been examined extensively. We critically synthesized the contemporary in-hospital prevalence, mortality rate, predictors, aetiologies, diagnosis and management of NRF to better formulate measures to curb its burden. We searched MEDLINE and Google Scholar from 01/01/1992 to 31/12/2022 for relevant publications. We identified 237 papers from 58 high-income and low-and middle-income countries (LMICs). NRF prevalence ranged from 0.64 to 88.4% with some heterogeneity. The prevalence was highest in Africa, the Middle East and Asia. Globally as well as in Asia and the Americas, respiratory distress syndrome (RDS) was the leading aetiology of NRF. Neonatal sepsis was first aetiology in Africa, whereas in both Europe and the Middle East it was transient tachypnoea of the newborn. Independent predictors of NRF were prematurity, male gender, ethnicity, low/high birth weight, young/advanced maternal age, primiparity/multiparity, maternal smoking, pregestational/gestational diabetes mellitus, infectious anamneses, antepartum haemorrhage, gestational hypertensive disorders, multiple pregnancy, caesarean delivery, antenatal drugs, foetal distress, APGAR score, meconium-stained amniotic fluid and poor pregnancy follow-up. The NRF-related in-hospital mortality rate was 0.21–57.3%, highest in Africa, Asia and the Middle East. This death toll was primarily due to RDS globally and in all regions. Clinical evaluation using the Silverman-Anderson score was widely used and reliable. Initial resuscitation followed by specific management was the common clinical practice. Conclusion: NRF has a high burden globally, driven by RDS, especially in LIMCs where more aggressive treatment and innovations, preferably subsidized, are warranted to curb its alarming burden. What is Known: • Neonatal respiratory failure is a frequent emergency associated with a significant morbidity and mortality, yet there is no comprehensive research paper summarizing its global burden. • Neonatal respiratory failure needs prompt diagnosis and treatment geared at improving neonatal survival. What is New: • Neonatal respiratory failure has an alarmingly high global burden largely attributed to Respiratory distress syndrome. Low resource settings are disproportionately affected by the burden of neonatal respiratory failure. • Independent preditors of neonatal respiratory failure are several but can be classified into foetal, maternal and obstetrical factors. An illustrative pedagogical algorithm is provided to facilitate diagnosis and management of neonatal respiratory failure by healthcare providers. [ABSTRACT FROM AUTHOR]

Context Hepatitis E virus (HEV) as a hepatotropic virus is one of the major global health concerns. Autochthonous HEV transmitted by oral fecal-route in poor sanitation conditions as well as vertical and rarely blood transfusion. HEV occurrence is more common in developing countries and recently increased in developed countries too. Middle East (ME) and Eastern Mediterranean region (EMR) of WHO have been an endemic region for HEV infection. In this regard, we aimed to design a systematic review and pooled analysis to determine seroprevalence of anti-HEV antibody in ME and EMR countries. Evidence acquisition By using PRISMA guideline, data were collected from papers identified through PubMed, Web of Science, Science Direct, Scopus and also from some national and regional databases from January 1990 to June 2016. Serum anti-HEV antibody (IgG) used for HEV prevalence estimation. HEV prevalence in the ME, WHO EMR countries, and in total, calculated by each country population size based on 2015 UN report. Results overall, 62 papers with a total sample size of 31,673 were fulfilled our eligibility criteria and included in our project. Considering anti-HEV antibody (IgG), prevalence of HEV infection in the countries of ME, WHO EMR and in total were 12.17% (95% CI: 11.79–12.57), 11.81% (95% CI: 11.43–12.21), and 11.87% (95% CI: 11.52–12.23) respectively. Conclusions HEV seroprevalence in WHO EMR and ME countries has high rate and more considerations are needed for the prevention and control of this infection especially in high-risk groups such as pregnant women. [ABSTRACT FROM AUTHOR]

Correction to: Epidemiology and evolution of Middle East respiratory syndrome coronavirus, 2012-2020 Epidemiology and evolution of Middle East respiratory syndrome coronavirus, 2012-2020. Countries were colored according to the dominant transmission type: (i) zoonotic transmission plus human-to-human transmission, (ii) zoonotic transmission without human-to-human transmission, (iii) imported infection plus human-to-human transmission, and (iv) imported infection without human-to-human transmission The original paper has been updated. [Extracted from the article]

Support for the use of treated gray water as an alternative water resource in the Middle East and North Africa is high, especially given the lack of religious restrictions against its use, but several obstacles have kept application of treated gray water near 1 % in some areas. The largest of obstacles include the cost of treatment and the ambiguity surrounding the health safety of gray water and treated gray water. This paper aims to provide an overview of current gray water practices globally, with specific focus on household-level gray water practices in the Middle East and North Africa region, and highlight the need for cost reduction strategies and epidemiological evidence on the use of household-level gray water and treated gray water. Such actions are likely to increase the application of treated gray water in water-deprived areas of the Middle East and North Africa. [ABSTRACT FROM AUTHOR]

Background: Coronary Heart Disease (CHD) is rising in middle income countries. Population based strategies to reduce specific CHD risk factors have an important role to play in reducing overall CHD mortality. Reducing dietary salt consumption is a potentially cost-effective way to reduce CHD events. This paper presents an economic evaluation of population based salt reduction policies in Tunisia, Syria, Palestine and Turkey. Methods and Findings: Three policies to reduce dietary salt intake were evaluated: a health promotion campaign, labelling of food packaging and mandatory reformulation of salt content in processed food. These were evaluated separately and in combination. Estimates of the effectiveness of salt reduction on blood pressure were based on a literature review. The reduction in mortality was estimated using the IMPACT CHD model specific to that country. Cumulative population health effects were quantified as life years gained (LYG) over a 10 year time frame. The costs of each policy were estimated using evidence from comparable policies and expert opinion including public sector costs and costs to the food industry. Health care costs associated with CHDs were estimated using standardized unit costs. The total cost of implementing each policy was compared against the current baseline (no policy). All costs were calculated using 2010 PPP exchange rates. In all four countries most policies were cost saving compared with the baseline. The combination of all three policies (reducing salt consumption by 30%) resulted in estimated cost savings of $235,000,000 and 6455 LYG in Tunisia; $39,000,000 and 31674 LYG in Syria; $6,000,000 and 2682 LYG in Palestine and $1,3000,000,000 and 378439 LYG in Turkey. Conclusion: Decreasing dietary salt intake will reduce coronary heart disease deaths in the four countries. A comprehensive strategy of health education and food industry actions to label and reduce salt content would save both money and lives. [ABSTRACT FROM AUTHOR]

• Overview and evaluation of available literature using WBE to detect illicit drugs. • The WBE approach shows an improvement in quality over the recent years. • High cocaine and methamphetamine consumption rates are found in the USA. • Relatively low illicit drug consumption is found in the continent of Asia. Illicit drug use is complex, hidden and often highly stigmatized behaviour, which brings a vast challenge for drug surveillance systems. Drug consumption can be estimated by measuring human excretion products in untreated wastewater, known as wastewater-based epidemiology (WBE). Over the last decade, the application of wastewater-based epidemiology to monitor illicit drug loads increased and WBE is currently applied on a global scale. Studies from over the globe are evaluated with regard to their sampling method, analytical accuracy and consumption calculation, aiming to further reduce relevant uncertainties in order to make reliable comparisons on a global level. Only a limited number is identified as high-quality studies, so further standardization of the WBE approach for illicit drugs is desired especially with regard to the sampling methodology. Only a fraction of the reviewed papers explicitly reports uncertainty ranges for their consumption data. Studies which had the highest reliability are recently published, indicating an improvement in reporting WBE data. Until now, WBE has not been used in large parts of Africa, nor in the Middle East and Russia. An overview of consumption data across the continents on commonly studied drugs (cocaine, MDMA, amphetamine and methamphetamine) is provided. Overall, high consumption rates are confirmed in the US, especially for cocaine and methamphetamine, while relatively low illicit drug consumption is reported in Asia. [Display omitted] [ABSTRACT FROM AUTHOR]

Summary: This paper reviews the epidemiological data describing meningococcal disease in the Middle East and North Africa (MENA). While meningococcal disease remains an important cause of endemic and epidemic disease in many MENA countries, existing published epidemiological data appear limited, fragmented, and collected via disparate methodologies. Children aged 5 years and younger are predominantly affected, though outbreaks of the disease often affect older age groups. Whilst serogroup A remains a main cause of meningococcal disease in the region, cases of serogroup B, W-135, and Y have been increasingly reported over the last two decades in some countries. The Hajj pilgrimage is a key factor influencing outbreaks and transmission, and the use of vaccines has minimized the effects on the home countries of the pilgrims and has decreased global dissemination of disease. Wider use of available polyvalent meningococcal conjugate vaccines may provide broader protection against the range of serogroups causing disease or posing a threat in the region. In addition, strengthening regional surveillance systems and regularly publishing reports with reliable estimates of disease incidence, carriage, disease-related mortality, and sequelae may facilitate the development of appropriate interventions and public health strategies regarding meningococcal disease within the region. [Copyright &y& Elsevier]