Accession of Lebanon to the Extractive Industries Transparency Initiative (EITI): Lessons Learned, Analysis, and Legal Aspects of Accession

توصي هذه الورقة بانضمام جمهورية لبنان إلى مبادرة الشفافية في مجال الصناعات الاستخراجية (EITI) إذ يستفيد لبنان من هذه الأخيرة من حيث الشفافية في القطاع الصناعي مما يخدم المصلحة العامة. كما تسهم مبادرة الشفافية في مجال الصناعات الاستخراجية (EITI) في تحسين الاقتصاد اللبناني والمساءلة من خلال تمكين المجتمعات وبناء علاقة بين الدولة والمجتمع المدني. كما تسهم مبادرة الشفافية في مجال الصناعات الاستخراجية (EITI) في بناء سمعة موثوق بها للبنان مما يجعل منه بيئة جاذبة للمستثمرين.This policy paper recommends that Lebanon should join the Extractive Industries Transparency Initiative (EITI). The EITI can benefit Lebanon by providing transparency in Lebanon’s industrial sector, which serves the public interest. It further could improve Lebanon’s economy and accountability by empowering communities and forming a relationship between government and civil society. The EITI also can help in building a trustworthy reputation for Lebanon, making Lebanon an appealing environment for investors

Low molecular weight heparin in COVID-19: benefits and concerns

Since its emergence, the COVID-19 pandemic had a dramatic impact on the public health worldwide and it scarred the medical, economical, and social determinants of health. Even after the significant vaccination advances, the disease of SARS-CoV-2 can manifest in severe presentations with life-threatening thromboembolic and multi-organ complications leading to notable morbidity and mortality. Clinicians and researchers are on continuous pursuit of investigating different approaches in the attempt to prevent the infection and minimize its severity. Although the COVID-19’s pathophysiology remains relatively unclear, it is well established now that coagulopathy, systemic thrombotic propensity, and a robust immunoinflammatory response are some of the most important determinants of its morbidity and mortality. Accordingly, research efforts have focused on addressing the inflammatory and hematological cascades using available agents to avoid thromboembolic events. Several studies and investigators have emphasized the importance of Low molecular weight heparin (LMWH), namely, Lovenox, in addressing these sequelae of the COVID-19 disease, either prophylactically or therapeutically. This review explores the benefits and concerns of employing LMWH, a widely used anticoagulant, in COVID-19 disease. It delves into Enoxaparin as a molecule, along with its pharmacology, mechanism of action, and clinical uses. It also reviews the current high-quality clinical evidence that highlight the role of enoxaparin in SARS-CoV-2 infection

Herpes Simplex Virus Type 2 Seroprevalence among Different National Populations of Middle East and North African Men

© 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Sexually Transmitted Diseases Association. Background There are limited data on herpes simplex virus type 2 (HSV-2) seroprevalence in the Middle East and North Africa (MENA). We examined country- and age-specific HSV-2 seroprevalence among select MENA populations residing in Qatar. Methods Sera were collected from male blood donors attending Hamad Medical Corporation between June 2013 and June 2016. Specimens were screened for anti-HSV-2 IgG antibodies following a 2-test algorithm: HerpeSelect 2 ELISA was used to identify HSV-2-positive specimens, and Euroline-WB was used to confirm positive and equivocal specimens for final HSV-2 status. Trends and associations with HSV-2 seropositivity were assessed. Results Of the 2077 tested sera, 61 were found and confirmed positive. The proportion of those confirmed positive increased steadily with HerpeSelect 2 ELISA index value, ranging from 16.3% for index values of 1.101 to 1.999 to 92.9% for index values of 4 or greater. Nationality-specific seroprevalence was 6.0% (95% confidence interval [CI], 4.1%-8.8%) in Qataris, 5.3% (95% CI, 2.5%-11.1%) in Iranians, 4.2% (95% CI, 1.8%-9.5%) in Lebanese, 3.1% (95% CI, 1.2%-7.7%) in Sudanese, 3.0% (95% CI, 1.4%-6.4%) in Palestinians, 2.2% (95% CI, 1.1%-4.3%) in Egyptians, 2.0% (95% CI, 1.0%-5.0%) in Syrians, 1.0% (95% CI, 0.3%-3.6%) in Jordanians, 0.7% (95% CI, 0.1%-3.7%) in Yemenis, and 0.5% (95% CI, 0.1%-2.8%) in Pakistanis. There was evidence for higher seroprevalence in older age groups. Conclusions The seroprevalence of HSV-2 was in the range of few percentage points. There were no major differences in seroprevalence by nationality. These findings add to our understanding of HSV-2 epidemiology in MENA and indicate unmet needs for sexual health and control of sexually transmitted infections.Funding text #1 From the *Infectious Disease Epidemiology Group, Weill Cornell Medicine—Qatar, Cornell University, Qatar Foundation—Education City; †Department of Biomedical Science, College of Health Sciences, and ‡BioMedical Research Center, Qatar University, Doha, Qatar; and §Department of Healthcare Policy and Research, Weill Cornell Medi-cine, Cornell University, Ithaca, NY Acknowledgments: The authors gratefully acknowledge the administrative support of Ms Adona Canlas. They are also grateful to Dr Asmaa Al-Marwani, Ms Maria Samatti, and Ms Sana Abohasera for their work on blood specimen collection. The authors are further grateful for sup-port provided by the Biostatistics, Epidemiology, and Biomathematics Research Core at Weill Cornell Medicine—Qatar. Funding text #2 Funding: Testing kits were provided through pilot funding by the Biomedical Research Program at Weill Cornell Medicine—Qatar. Funding text #3 G.K.N. acknowledges support by Qatar University internal grant No. QUST-CHS-SPR-15/16-7. L.J.A. and S.R.D. acknowledge study conception and design support through NPRP grant number 9-040-3-008 from the Qatar National Research Fund (a member of Qatar Foundation), and G.K.N. acknowledges support from the Qatar National Research Fund UREP grant number UREP18-001-3-001. The findings achieved herein are solely the responsibility of the authors

Analgesic and neuropharmacological effects of Xanthium indicum leaves

The present study investigated analgesic and some neuropharmacological effects of hydromethanolic extract of the leaves of Xanthium indicum Koenig in mice models. The analgesic activity was evaluated using hot plate ant tail immersion methods, and acetic acid-induced writhing test. The neuropharmacological effects were determined using hole-cross, open field, and thiopental-induced sleeping time tests. The extract, at the doses of 100, 200 and 400 mg/kg, produced a dose dependent and significant (p < 0.05-0.001) increase in pain threshold in hotplate test. However, in tail immersion method, the extract at 200 and 400 mg/kg dose levels displayed a significant (p < 0.05-0.001) increase in tail withdrawal reflex in a dose dependent manner. In either case, maximum analgesia was observed at 90 min after administration of test drugs and the standard drug Nalbuphine. In acetic acid-induced writhing test, the extract at all doses produced a significant (p <0.001) decrease in the number of writhes exhibited by the mice following intraperitoneal injection of acetic acid; the result was dose dependent and comparable to the reference drug Diclofenac-Na. Moreover, The extract displayed dose dependent suppression of locomotor activity as well as exploratory behavior in hole-cross and open field tests, and exerted sedative action through prolongation of thiopental-induced sleeping time. The results of the study supports that the Xanthium indicum leaves possesses analgesic and some neuropharmacological effects which might be linked to inhibition of both central and peripheral mechanisms of pain and justifies its use in folk medicine for the management of pain and inflammation.Colegio de Farmacéuticos de la Provincia de Buenos Aire

Performance evaluation of four type-specific commercial assays for detection of herpes simplex virus type 1 antibodies in a Middle East and North Africa population.

The number of diagnostic assays for the detection of herpes simplex virus type 1 (HSV-1) antibodies has increased over the years. However, their performance characteristics could vary among global populations. To investigate performance of two commercial ELISA kits, HerpeSelect1 ELISA and Euroimmun Anti-HSV-1 (gC1) ELISA (IgG); and two commercial immunoblot (IB)/Western blot (WB) assays, HerpeSelect1 and 2 Immunoblot IgG, and Euroimmun Anti-HSV-1/HSV-2 gG2 Euroline-WB (IgG/IgM); in detecting HSV-1 antibodies in a Middle East and North Africa (MENA) population. Blood specimens were collected from blood donors in Doha, Qatar, June 2013-2016. Twenty specimens were randomly selected from 10 MENA nationalities (Egypt, Iran, Jordan, Lebanon, Pakistan, Palestine, Qatar, Sudan, Syria, and Yemen; total = 200), and tested for HSV-1 antibodies. Across all six comparisons between assays, positive percent agreement ranged between 95.7% (95% CI: 91.4-98.3%) and 100.0% (95% CI: 97.8-100.0%). Negative percent agreement ranged between 86.2% (95% CI: 68.3-96.1%) and 96.2% (95% CI: 80.4-99.9%). Overall percent agreement ranged between 95.7% (95% CI: 91.7-97.8%) and 99.4% (95% CI: 96.7-99.9%). Cohen's kappa statistic ranged between 0.84 (95% CI: 0.73-0.95) and 0.98 (95% CI: 0.93-1.00). Compared against IB/WB, HerpeSelectand Euroimmun had sensitivities and specificities >96% and >86%, respectively. Positive and negative predictive values were >97% and >83%, respectively. The assays showed excellent concordance with one another, and with a high kappa statistic. The ELISA kits demonstrated robust diagnostic performance compared to the IB/WB assays. These findings support the assays' utility in clinical diagnosis and research in MENA populations

The Pediatric Allergy and Immunology Unit of Ain Shams University in times of SARS-CoV-2 pandemic: approach and challenges

The Pediatric Allergy and Immunology (PAI) Unit of Ain Shams University, founded in 1988 by Professor Yehia El-Gamal and currently headed by Professor Shereen Reda, is a tertiary referral center for pediatric allergy, primary immunodeficiency, and rheumatology patients in Egypt. It serves more than 1300 patients with different immunological disorders, with an outpatient and inpatient sections and investigational laboratory. With the widespread of the SARS-CoV-2 and its declaration as a "pandemic", and owing to the heterogeneity of the different disorders managed and followed up in the unit, several measures have been taken in order to provide the necessary services for the patients. This service should maintain a rational balance between the need to mitigate the virus spread and to provide the optimum care for those who get infected, when in the meantime keep their original disease morbidity and mortality to the minimum. These measures were taken by the members of the PAI unit with the help of the head management team of Children’s Hospital, Ain Shams University and were subjected to continuous modification based on the evolving situation, emerging information, problems faced and the availability of human and medical resources

Pathogenesis and distribution of infective endocarditis in the pediatric population: a 20-year experience in a tertiary care center in a developing country

IntroductionInfective endocarditis is an infection of the endothelial surfaces of the heart. It is more prevalent in adults but its incidence in the pediatric population has been on the rise. The most important factor remains congenital heart disease and the most isolated pathogen is viridans group streptococcus.MethodsIn this manuscript, we present a 20-year experience of a major referral tertiary care center in diagnosing and treating pediatric patients with endocarditis. A retrospective analysis of records of patients who were diagnosed with infective endocarditis under the age of 18 years is presented in this study. Variables relating to the demographic, imaging, microbiologic and pathologic data are described. Outcomes relating to complications and need for surgical repair are also portrayed.ResultsA total of 70 pediatric patients were diagnosed with endocarditis in this time interval. The medical records of 65 patients were comprehensively reviewed, however the remaining 5 patients had severely missing data. Of the 65 patients, 55.4% were males, and the mean age at diagnosis was 7.12 years. More than half of the population (58.5%) had vegetation evident on echocardiography. The pulmonary valve was the most commonly affected (50%), followed by the mitral valve and tricuspid valves (15.6%). Most patients received empiric treatment with vancomycin and gentamicin. Viridans group streptococcus was the most frequently isolated organism (23.4%).ConclusionAmong pediatric patients diagnosed with endocarditis in this study, data pertaining to valve involvement and microbiologic information was consistent with the published literature. The incidence of complications and the need for surgical repair are not significantly correlated with demographic and clinical variables

Colonoscopic perforation leading to a diagnosis of Ehlers Danlos syndrome type IV: a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>Colonoscopic perforation is a rare but serious complication of colonoscopy. Factors known to increase the risk of perforation include colonic strictures, extensive diverticulosis, and friable tissues. We describe the case of a man who was found to have perforation of the sigmoid colon secondary to an undiagnosed connective tissue disorder (Ehlers-Danlos syndrome type IV) while undergoing surveillance for hereditary non-polyposis colorectal cancer.</p> <p>Case presentation</p> <p>A 33-year-old Caucasian man presented to our hospital with an acute abdomen following a colonoscopy five days earlier as part of hereditary non-polyposis colorectal cancer screening. His medical history included bilateral clubfoot. His physical examination findings suggested left iliac fossa peritonitis. A computed tomographic scan revealed perforation of the sigmoid colon and incidentally a right common iliac artery aneurysm as well. Hartmann's procedure was performed during laparotomy. The patient recovered well post-operatively and was discharged. Reversal of the Hartmann's procedure was performed six months later. This procedure was challenging because of dense adhesions and friable bowel. The histology of bowel specimens from this surgery revealed thinning and fibrosis of the muscularis externa. The patient was subsequently noted to have transparency of truncal skin with easily visible vessels. An underlying collagen vascular disorder was suspected, and genetic testing revealed a mutation in the collagen type III, α1 (<it>COL3A1</it>) gene, which is consistent with a diagnosis of Ehlers-Danlos syndrome type IV.</p> <p>Conclusions</p> <p>Ehlers-Danlos syndrome type IV, the vascular type, is a rare disorder caused by mutations in the <it>COL3A1 </it>gene on chromosome 2q31. It is characterized by translucent skin, clubfoot, and the potentially fatal complications of spontaneous large vessel rupture, although spontaneous uterine and colonic perforations have also been reported in the literature. The present case presentation describes the identification of Ehlers-Danlos syndrome type IV in a patient with a non-spontaneous colonic perforation secondary to an invasive investigation for another hereditary disorder pre-disposing him to colorectal cancer. Invasive procedures such as arteriograms and endoscopies are relatively contra-indicated in Ehlers-Danlos syndrome type IV. Alternatives with a lower risk of perforation, such as computed tomographic colonography, need to be considered for patients requiring ongoing colorectal cancer surveillance. Furthermore, management of vascular aneurysms in patients with Ehlers-Danlos syndrome type IV requires consideration of the risks of endovascular stenting, as opposed to open surgical intervention, because of tissue friability. Genetic and reproductive counseling should be offered to affected individuals and their families.</p

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London