Middle Eastern Women between Oppression and Resistance: Case Studies of Iraqi, Palestinian and Kurdish Women of Turkey

Wars and conflicts have had a profound impact on women and gender in the Middle East. In this article, we aim to highlight the various ways in which the ongoing oppression and conflict in the Middle East shape the responses of the Iraqi, Palestinian and Kurdish women of Turkey and the object of their struggles. We go beyond the ‘Orientalist’ discourse, which depicts Middle Eastern women in armed conflicts as solely vulnerable and helpless victims, to discuss the resisting roles played by the Iraqi, Palestinian and Kurdish women of Turkey. Middle Eastern women have played and continue to play major roles in responding to society, gender and state oppression. While the Iraqi women in this study voice their resistance through conventional actions and wide civil-society activism that transcends the local level, the Palestinian women engage in unconventional unarmed or peaceful resistance through Sumud and cultural resistance as well as armed/non-peaceful acts of resistance. Finally, in the face of Turkish state oppression, the Kurdish women of Turkey also deploy non-peaceful resistance through becoming active fighters and engaging leadership positions in the Kurdistan Workers’ Party

Development of novel formulations to enhance in vivo transdermal permeation of tocopherol

Tocopherol represents a big challenge for transdermal permeation owing to its extreme hydrophobicity and large molecular mass. The aim of the present study was to develop alpha-tocopherol (T) topical formulations and evaluate the ex vivo and in vivo permeation. Franz diffusion cells were used for the ex vivo permeation, and neonatal rats were used for in vivo permeation. Seven gel formulations and 21 liquid formulations were investigated for physical stability, viscosity and permeation of T. Analysis of T was performed by a validated HPLC method using a UV detector.The ex vivo permeation from gel and emulsion formulations was very poor (0.001–0.015 %). The highest permeation was observed from monophasic liquid formulations containing dimethyl sulfuxide (DMSO), tocopheryl polyethylene glycols (TPGs), propylene glycol, ethanol, and 9.5 % T. The in vivo results demonstrated higher retention in the epidermis compared to subcutaneous tissues; 1377 and 1.13 µg g–1, respectively. Increasing T concentration from 4.8 to 9.5 % did not increase the amount permeated or % of T retained. It was concluded that simple solutions of T in presence of DMSO and TPGs are more promising systems for effective transdermal permeation; compared to gel, emulsion or oleaginous systems

Listening to Students’ and Teachers’ Voices: Online Teaching Practices Leading to EFL Learners ' Demotivation

This study was conducted in response to the online teaching practices which demotivate EFL learners in learning English from both the teachers' and students' perspectives so that it can provide an equal point of view. The study was done by distributing a questionnaire to 152 students of the State Islamic Madrasah in Tulungagung, East Java, Indonesia to find data related to those who experience demotivation in learning English and interviewing them in depth both directly and indirectly through voice notes in July to September 2022. The in-depth interview was also done to their English teachers. The result of qualitative data analysis revealed that students were demotivated, bored, and lazy during online learning because of two main factors, namely teachers, i.e., uninteresting teaching methods and techniques, lack of online teaching experience, teacher’s personality, and the usage of the online learning application. Meanwhile, the teachers perceive that their demotivating EFL teaching was resulted from students' learning loss, lack of students' learning involvement, and teachers' feeling insecure caused by some factors, namely the variety of online teaching methods, the accessibility of online learning media, family interference, and students' internal lack of motivation. Still, this demotivating online teaching and learning do not significantly implicate the students' achievement of English. These research results are pedagogically implemented to improve the quality of online teaching and learning English, mainly at the secondary levels

Essential Oils

Modern science has tended to use several natural substances that have little or no side effects in daily use or to treat many diseases. Among these materials are essential oils that represent one of the secondary metabolic products of many plants such as Terpenes and Terpenoids, Alkaloids, and the Phenolic compounds, which are extracted by special methods from different parts of the plants. Several applications were using the essential oils such as in the nutrition, cosmetic manufacture, and alternatives to synthetic medication that uses to treatment several infections and diseases as disinfection, as an anti-inflammatory, mouthwashes, as well as in cleaning and calm mood and pesticides. This review describes essential oils, methods of their extraction, and ways of utilization and their application

Evaluation of Anxiety and Depression among a Sample of Hypothyroidism-Treated Iraqi Patients

Background: Hypothyroidism is the most prevalent thyroid disorders worldwide.  Hypothyroidism manifestations are wide spectrum, affecting various systems in human body including the nervous system. Hypothyroidism can cause neuropsychiatric symptoms such as anxiety, depression and diminishing in attention, memory and executive function. Aim: to investigate the level of anxiety and depression in patients with hypothyroidism receiving levothyroxine treatment. Method: a cross-sectional study was conducted at Baghdad Center for Nuclear Medicine and Radiation Therapy from March to June 2022. The study population included patients of both genders, aged 18-65 years, diagnosed with hypothyroidism, were receiving levothyroxine treatment and have achieved euthyroid state for at least 2 months prior to their enrolment in the study. Based on levothyroxine dose, the enrolled patients were divided into two groups: low dose group < 1.7 µg/kg/day and high dose group ≥ 1.7 µg/kg. Hospital Anxiety and Depression Scale (HADS) was used for the evaluation of anxiety and depression. Result: The mean age of the participants was 40.35 ± 9.5 years with mean body mass index of 30.61 ± 5.72 kg/m2. The mean scores of anxiety and depression for the total sample are 8.72 ±3.46 and 7.80 ±2.83; respectively, there was statistically non-significant difference for anxiety and depression scores between the low dose group and the high dose group. Conclusion: the presence of anxiety and depression symptoms although the patients were in euthyroid state. However, socio-demographic and clinical characteristics did not significantly influence the scores of anxiety and depression

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries(1,2). However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world(3) and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health(4,5). However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular riskchanged from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.Peer reviewe

Von Willebrand Factor Gene Variants Associate with Herpes simplex Encephalitis

Herpes simplex encephalitis (HSE) is a rare complication of Herpes simplex virus type-1 infection. It results in severe parenchymal damage in the brain. Although viral latency in neurons is very common in the population, it remains unclear why certain individuals develop HSE. Here we explore potential host genetic variants predisposing to HSE. In order to investigate this we used a rat HSE model comparing the HSE susceptible SHR (Spontaneously Hypertensive Rats) with the asymptomatic infection of BN (Brown Norway). Notably, both strains have HSV-1 spread to the CNS at four days after infection. A genome wide linkage analysis of 29 infected HXB/BXH RILs (recombinant inbred lines-generated from the prior two strains), displayed variable susceptibility to HSE enabling the definition of a significant QTL (quantitative trait locus) named Hse6 towards the end of chromosome 4 (160.89-174Mb) containing the Vwf (von Willebrand factor) gene. This was the only gene in the QTL with both cis-regulation in the brain and included several non-synonymous SNPs (single nucleotide polymorphism). Intriguingly, in human chromosome 12 several SNPs within the intronic region between exon 43 and 44 of the VWF gene were associated with human HSE pathogenesis. In particular, rs917859 is nominally associated with an odds ratio of 1.5 (95% CI 1.11-2.02; p-value = 0.008) after genotyping in 115 HSE cases and 428 controls. Although there are possibly several genetic and environmental factors involved in development of HSE, our study identifies variants of the VWF gene as candidates for susceptibility in experimental and human HSE

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants.

BACKGROUND: Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. METHODS: We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. FINDINGS: The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. INTERPRETATION: Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. FUNDING: WHO