Exports and Economic Growth: The Arab Experience

This paper aims at analysing the relationship between exports and economic growth in the Arab countries using annual data for the period 1970-1999. Section two of this study presents a theoretical background of the relationship between exports and economic growth. Literature review is found in Section 3. In Section 4, the methodological issues of studying this relationship are discussed. Results of stationarity tests using Augmented Dickey-Fuller (ADF) and Phillips-Perron (PP) as well as Bivariate Johansen-Juseluis tests for cointegration are presented in Section 5. Stationarity tests suggest that time series are non-stationary in their levels and seem to be stationary in their first differences. Testing for long-run cointegration relationship using Johansen-Juseluis approach, it is found that in general there is no cointegration relationship between exports and GDP. For this reason, we abandoned the error correction model and tested for causality using different versions of Granger’s causality test. We found mixed results about the causal relationship between exports and GDP in Arab countries

The Penile Perception Score after distal hypospadias repair with tubularized incised plate and Mathieu

Objective: The aim of this study was to evaluate the Penile Perception Score (PPS) after repair of distal penile hypospadias using tabularized incised plate (TIP) and Mathieu procedures.Methods: A randomized controlled study was conducted at urology department from October 2013 to May 2014. It included 60 children who were divided into three groups: group A included 20 patients with distal hypospadias corrected using TIP; group B included 20 patients with distal hypospadias corrected using Mathieu; and group C included 20 children with normal male genitalia who were circumcised and considered as a control group.Results: There were no statistically significant differences between group A and group B in urologists’ and parents’ average sum of PPS evaluation, but urologists’ satisfaction was more than parents’ satisfaction. The PPS for TIP was 8.43 and 7.80 for urologists and parents, respectively. The difference was significant. The PPS for Mathieu were 8.04 and 7.89 for urologists and parents, respectively, with no significance. There were no statistically significant differences between group A and group B in the postoperative evaluation by urologists and by parents in meatus, glans, shaft skin, and general appearance. There were complications in 10% of cases from group A in the form of fistula, in 30% of cases from group B in the form of fistula in 25% and meatal stenosis in 5%, and no complication in group C.Conclusion: TIP showed better PPS score compared with Mathieu in hypospadias repair. However, the results of this study were not statistically significant. PPS was a good scale to evaluate hypospadias repair after surgery.Keywords: hypospadias, parents and urology, Penile Perception Scor

Filistin Gazze’de Al-Azhar Üniversitesi öğrencilerinin HIV/AIDS’e yönelik bilgi ve tutumlarının değerlendirilmesi

Objective: The study assessed the knowledge and attitudes of students’ at a university in Gaza regarding HIV/AIDS and identified differences in knowledge about HIV, and attitudes by gender, locality, and social and economic status. Methods: This descriptive study targeted 492 students of Al-Azhar University-Gaza. The participants completed self-administered questionnaires that included the following dimensions: socio-demographic, measurements of student's knowledge level and measurement of student's attitudes towards HIV/AIDS. Results: Findings showed moderate level of knowledge regarding HIV/AIDS although there was a very low of perception regarding the acceptance and sharing of HIV/AIDS persons. It means that only one third of the study respondents are willingness to be in close touch with people living with HIV or even communication with them, and less than fifty percent thought that it is their right to be engaged in a public or governmental job, stigma and discriminatory attitudes toward HIV/AIDS persons is high only 48% of the students thought it right to employ people living with HIV (PLHIV) and 35.5% refused to work in the same place with PLHIV. Conclusion: This study indicates the need for improving the level of knowledge as well as promoting the students' towards positive attitude

Obesity, diabetes and longevity in the Gulf: is there a Gulf Metabolic Syndrome?

The Gulf is experiencing a pandemic of lifestyle-induced obesity and type 2 diabetes mellitus (T2DM), with rates exceeding 50 and 30%, respectively. It is likely that T2DM represents the tip of a very large metabolic syndrome iceberg, which precedes T2DM by many years and is associated with abnormal/ectopic fat distribution, pathological systemic oxidative stress and inflammation. However, the definitions are still evolving with the role of different fat depots being critical. Hormetic stimuli, which include exercise, calorie restriction, temperature extremes, dehydration and even some dietary components (such as plant polyphenols), may well modulate fat deposition. All induce physiological levels of oxidative stress, which results in mitochondrial biogenesis and increased anti-oxidant capacity, improving metabolic flexibility and the ability to deal with lipids. We propose that the Gulf Metabolic Syndrome results from an unusually rapid loss of hormetic stimuli within an epigenetically important time frame of 2-3 generations. Epigenetics indicates that thriftiness can be programmed by the environment and passed down through several generations. Thus this loss of hormesis can result in continuation of metabolic inflexibility, with mothers exposing the foetus to a milieu that perpetuates a stressed epigenotype. As the metabolic syndrome increases oxidative stress and reduces life expectancy, a better descriptor may therefore be the Lifestyle-Induced Metabolic Inflexibility and accelerated AGEing syndrome – LIMIT-AGE. As life expectancy in the Gulf begins to fall, with perhaps a third of this life being unhealthy – including premature loss of sexual function, it is vital to detect evidence of this condition as early in life as possible. One effective way to do this is by detecting evidence of metabolic inflexibility by studying body fat content and distribution by magnetic resonance (MR). The Gulf Metabolic Syndrome thus represents an accelerated form of the metabolic syndrome induced by the unprecedented rapidity of lifestyle change in the region, the stress of which is being passed from generation to generation and may be accumulative. The fundamental cause is probably due to a rapid increase in countrywide wealth. This has benefited most socioeconomic groups, resulting in the development of an obesogenic environment as the result of the rapid adoption of Western labour saving and stress relieving devices (e.g. cars and air conditioning), as well as the associated high calorie diet

Maternal Mortality Ratio and Universal Access to Reproductive Health Care in the State of Qatar between 1990 and 2012: A PEARL Study Analysis

Study Aim: The Millennium Development Goal (MDG)- 5 mandates a three quarters reduction in Maternal Mortality Ratio (MMR) and provision of universal access to reproductive health by 2015. Our study aims to analyze Qatar’s performance in achieving MDG 5 between 1990 and 2012.Study Design: A National Prospective cohort-studyData Source: Qatar Perinatal Registry (Q-Peri-Reg) for 2011 and 2012 dataMethods: National data on total deliveries, total births (live and stillbirths) and maternal mortality (during pregnancy to day 42 post-delivery) was collected from all public and private maternity units in Qatar (1st January 2011- December, 31st 2012) and compared with historical maternal mortality data (1990-2010) ascertained from the database of maternity and neonatal units of Women’s Hospital, annual reports of Hamad Medical Corporation and international reports. For inter country comparison, country data was extracted from World Health Statistics 2011(WHO).Results: The country wide live births were 20583 during 2011 and 22,225 during 2012 with two maternal deaths duringeach year giving an MMR of 9.85/100,000 and 8.99/100,000 live births respectively which was more than three quarters decline from an MMR of 49/100,000 in 1990. During 2011, 74.22% deliveries were normal vaginal (n 15076) and 25.78% (n 5238) by Caesarean section. 99.45 % of deliveries were attended by a trained birth attendant in a maternity facility while 0.55 % (n = 114) took place out of hospital. 100% of mothers had made at least one antenatal visit and 100% of live births were examined by a pediatrician and entered in national birth register. Qatar’s 2011 and 2012 MMR is significantly lower than the current global MMR of 260/100,000 and Eastern Mediterranean Region MMR of 320/100,000.Conclusion: Qatar has achieved its target MDG 5 well before 2015. Qatar’s 2011 and 2012 MMR is comparable to most high income countries. Qatar’s reproductive health system, with its universal access for all, provides a unique model to study the correlates and associations of maternal survival which can form the basis of global health systems improvement strategies

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Controversy and consensus on indications for sperm DNA fragmentation testing in male infertility: a global survey, current guidelines, and expert recommendations.

PURPOSE: Sperm DNA fragmentation (SDF) testing was recently added to the sixth edition of the World Health Organization laboratory manual for the examination and processing of human semen. Many conditions and risk factors have been associated with elevated SDF; therefore, it is important to identify the population of infertile men who might benefit from this test. The purpose of this study was to investigate global practices related to indications for SDF testing, compare the relevant professional society guideline recommendations, and provide expert recommendations. MATERIALS AND METHODS: Clinicians managing male infertility were invited to take part in a global online survey on SDF clinical practices. This was conducted following the CHERRIES checklist criteria. The responses were compared to professional society guideline recommendations related to SDF and the appropriate available evidence. Expert recommendations on indications for SDF testing were then formulated, and the Delphi method was used to reach consensus. RESULTS: The survey was completed by 436 experts from 55 countries. Almost 75% of respondents test for SDF in all or some men with unexplained or idiopathic infertility, 39% order it routinely in the work-up of recurrent pregnancy loss (RPL), and 62.2% investigate SDF in smokers. While 47% of reproductive urologists test SDF to support the decision for varicocele repair surgery when conventional semen parameters are normal, significantly fewer general urologists (23%; p=0.008) do the same. Nearly 70% would assess SDF before assisted reproductive technologies (ART), either always or for certain conditions. Recurrent ART failure is a common indication for SDF testing. Very few society recommendations were found regarding SDF testing. CONCLUSIONS: This article presents the largest global survey on the indications for SDF testing in infertile men, and demonstrates diverse practices. Furthermore, it highlights the paucity of professional society guideline recommendations. Expert recommendations are proposed to help guide clinicians

Controversy and consensus on the management of elevated sperm DNA fragmentation in male infertility: a global survey, current guidelines, and expert recommendations

PURPOSE: Sperm DNA fragmentation (SDF) has been associated with male infertility and poor outcomes of assisted reproductive technology (ART). The purpose of this study was to investigate global practices related to the management of elevated SDF in infertile men, summarize the relevant professional society recommendations, and provide expert recommendations for managing this condition. MATERIALS AND METHODS: An online global survey on clinical practices related to SDF was disseminated to reproductive clinicians, according to the CHERRIES checklist criteria. Management protocols for various conditions associated with SDF were captured and compared to the relevant recommendations in professional society guidelines and the appropriate available evidence. Expert recommendations and consensus on the management of infertile men with elevated SDF were then formulated and adapted using the Delphi method. RESULTS: A total of 436 experts from 55 different countries submitted responses. As an initial approach, 79.1% of reproductive experts recommend lifestyle modifications for infertile men with elevated SDF, and 76.9% prescribe empiric antioxidants. Regarding antioxidant duration, 39.3% recommend 4-6 months and 38.1% recommend 3 months. For men with unexplained or idiopathic infertility, and couples experiencing recurrent miscarriages associated with elevated SDF, most respondents refer to ART 6 months after failure of conservative and empiric medical management. Infertile men with clinical varicocele, normal conventional semen parameters, and elevated SDF are offered varicocele repair immediately after diagnosis by 31.4%, and after failure of antioxidants and conservative measures by 40.9%. Sperm selection techniques and testicular sperm extraction are also management options for couples undergoing ART. For most questions, heterogenous practices were demonstrated. CONCLUSIONS: This paper presents the results of a large global survey on the management of infertile men with elevated SDF and reveals a lack of consensus among clinicians. Furthermore, it demonstrates the scarcity of professional society guidelines in this regard and attempts to highlight the relevant evidence. Expert recommendations are proposed to help guide clinicians

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely