Egypt Adrift Five Years After The Uprising

As Egypt approaches the fifth anniversary of its 2011 uprising, one would be forgiven for assuming that a major challenge to the regime of President Abdel Fattah el-Sisi was gathering coherence and force, based upon its panicked and paranoid current actions. But such a conclusion would be misplaced. The regime's overblown fears of a largely neutered opposition raise a pertinent question: What is driving the Egyptian security establishment's overbroad and suffocating repression?The run-up to January 25 has seen a major crackdown that has included arrests, disappearances, random searches (including random surveillance of social media accounts), the shuttering of nonpolitical cultural fora, such as art galleries, and a heightening of visa monitoring for foreigners. For this upcoming symbolic date, the regime will not be caught unaware and flat-footed -- it believes that the mistakes of 2011 will not be repeated any time soon.Speaking to Reuters, an official at Egypt's Homeland Security Agency explained the state's motivations for the crackdown quite bluntly, stating that "We have taken several measures to ensure activists don't have breathing space and are unable to gather, and several cafes and other meeting places have been closed, while some have been arrested in order to scare the rest."Whereas late 2010 was marked by creeping dissatisfaction, increasing boldness, and stepped-up organizational efforts among opposition actors, there are no corollaries in today's Egypt. While the government continues to fare poorly in terms of overall performance, political life is stunted by fear and fragmentation, and there are few avenues that allow for the amplification of dissatisfaction into a broad-based challenge to the regime. Opposition forces are fragmented and intimidated, while the regime, the state, and social elites retain a baseline of cohesion, and domestic and regional instability have produced quiescence in some sectors of society.It is clear that 2016 will not be the year of the next Egyptian uprising, let alone revolution. Yet, despite indications that, for the time being, the regime is safe from any popular threat, it is behaving as if it faces an imminent challenge. Its actions reveal a deeply ingrained worldview in which even minor forms of dissent and nonconformity are no longer permissible

Central Retinal Vein Occlusion with Therapeutic Level of Anticoagulation

Purpose. To describe a patient with two episodes of deep venous thrombosis and factor V Leiden mutation who presented with central retinal vein occlusion (CRVO) despite prophylactic use of warfarin sodium (Coumadin). Methods. A case report of a 44-year-old woman with a history of recurrent deep venous thrombosis and Factor V Leiden mutation was placed on lifelong prophylactic therapy with warfarin. The patient presented with CRVO in the left eye despite therapeutic levels of warfarin. Results. Extensive systemic evaluation disclosed high titers for antinuclear antibody (ANA). Conclusion. Systemic anticoagulation with warfarin may not preclude further thrombotic episodes. In younger patients presenting with retinal vein occlusion and pre-existing multiple thrombophilic risk factors, a multidisciplinary approach is recommended to explore other therapeutic options to avoid further thromboembolic complications

The Effect of Protein Supplementation on Body Muscle Mass and Fat Mass in Qataris PostBariatric Surgery: A Randomized Controlled Trial RCT

Background and objectives: Obesity is a chronic medical condition characterized by an accumulation of excess fat in the body that may lead to negative health consequences. Bariatric surgery has been shown to be the most effective type of interventions to achieve and sustain significant weight loss in morbidly obese people. The objective of this study was to examine the effectiveness of protein supplementation in reducing the risk of developing protein malnutrition and low muscle mass, in post-bariatric patients in Qatar. Methodology: This study is a double-blinded randomized control trial. Recruitment of participants began in early 2017 following the ethical approval of the trial (HMC IRB approval no. 16433/16). The intervention group received protein supplement that contain 20 g of protein while the placebo group received zero protein supplement. All participants were followed up for 1 month post-surgery. Randomization was done on a weekly basis within blocks of 8 or 10 patients. Independent Sample-T Test and Paired Sample-T Test were performed to assess the effect of the intervention. Results: The mean weight loss in the control group was 9.6 kg, while the intervention group mean weight loss was 10.7 kg (p = 0.03). Change in muscle mass percentage was +0.50% in the placebo group, and +2.3% in the intervention group (P = 0.149). Fat percentage change in the placebo group was − 1.6% and − 2.6% in the intervention group (P = 0.153). The percentage change in Albumin in the placebo group was 2.76% and 9.71% in the intervention group (P = 0.031). Conclusion: Our study has confirmed findings from multiple studies that protein supplementation in post-bariatric surgery patients is a successful intervention for healthy and balanced weight loss. This is yet another endorsement that surgery alone cannot put an end to obesity and must be combined with well-structured nutritional education so patients do not go back to their old habits and put the weight back on.qscienc

Toward a multi-level strategy to reduce stigma in global mental health: overview protocol of the Indigo Partnership to develop and test interventions in low- and middle-income countries

There is increasing attention to the impacts of stigma and discrimination related to mental health on quality of life and access to and quality of healthcare. Effective strategies for stigma reduction exist, but most evidence comes from high-income settings. Recent reviews of stigma research have identified gaps in the field, including limited cultural and contextual adaptation of interventions, a lack of contextual psychometric information on evaluation tools, and, most notably, a lack of multi-level strategies for stigma reduction. The Indigo Partnership research programme will address these knowledge gaps through a multi-country, multi-site collaboration for anti-stigma interventions in low- and middle-income countries (LMICs) (China, Ethiopia, India, Nepal, and Tunisia). The Indigo Partnership aims to: (1) carry out research to strengthen the understanding of mechanisms of stigma processes and reduce stigma and discrimination against people with mental health conditions in LMICs; and (2) establish a strong collaborative research consortium through the conduct of this programme. Specifically, the Indigo Partnership involves developing and pilot testing anti-stigma interventions at the community, primary care, and mental health specialist care levels, with a systematic approach to cultural and contextual adaptation across the sites. This work also involves transcultural translation and adaptation of stigma and discrimination measurement tools. The Indigo Partnership operates with the key principle of partnering with people with lived experience of mental health conditions for the development and implementation of the pilot interventions, as well as capacity building and cross-site learning to actively develop a more globally representative and equitable mental health research community. This work is envisioned to have a long-lasting impact, both in terms of the capacity building provided to participating institutions and researchers, and the foundation it provides for future research to extend the evidence base of what works to reduce and ultimately end stigma and discrimination in mental health

Toward a multi-level strategy to reduce stigma in global mental health: overview protocol of the Indigo Partnership to develop and test interventions in low- and middle-income countries

There is increasing attention to the impacts of stigma and discrimination related to mental health on quality of life and access to and quality of healthcare. Effective strategies for stigma reduction exist, but most evidence comes from high-income settings. Recent reviews of stigma research have identified gaps in the field, including limited cultural and contextual adaptation of interventions, a lack of contextual psychometric information on evaluation tools, and, most notably, a lack of multi-level strategies for stigma reduction. The Indigo Partnership research programme will address these knowledge gaps through a multi-country, multi-site collaboration for anti-stigma interventions in low- and middle-income countries (LMICs) (China, Ethiopia, India, Nepal, and Tunisia). The Indigo Partnership aims to: (1) carry out research to strengthen the understanding of mechanisms of stigma processes and reduce stigma and discrimination against people with mental health conditions in LMICs; and (2) establish a strong collaborative research consortium through the conduct of this programme. Specifically, the Indigo Partnership involves developing and pilot testing anti-stigma interventions at the community, primary care, and mental health specialist care levels, with a systematic approach to cultural and contextual adaptation across the sites. This work also involves transcultural translation and adaptation of stigma and discrimination measurement tools. The Indigo Partnership operates with the key principle of partnering with people with lived experience of mental health conditions for the development and implementation of the pilot interventions, as well as capacity building and cross-site learning to actively develop a more globally representative and equitable mental health research community. This work is envisioned to have a long-lasting impact, both in terms of the capacity building provided to participating institutions and researchers, and the foundation it provides for future research to extend the evidence base of what works to reduce and ultimately end stigma and discrimination in mental health

Dengue Virus Type 3, Brazil, 2002

An explosive epidemic of DENV-3 in 2002 was the most severe dengue epidemic reported in Brazil since dengue viruses were introduced

Toward a multi-level strategy to reduce stigma in global mental health: overview protocol of the Indigo Partnership to develop and test interventions in low- and middle-income countries

There is increasing attention to the impacts of stigma and discrimination related to mental health on quality of life and access to and quality of healthcare. Effective strategies for stigma reduction exist, but most evidence comes from high-income settings. Recent reviews of stigma research have identified gaps in the field, including limited cultural and contextual adaptation of interventions, a lack of contextual psychometric information on evaluation tools, and, most notably, a lack of multi-level strategies for stigma reduction. The Indigo Partnership research programme will address these knowledge gaps through a multi-country, multi-site collaboration for anti-stigma interventions in low- and middle-income countries (LMICs) (China, Ethiopia, India, Nepal, and Tunisia). The Indigo Partnership aims to: 1) carry out research to strengthen the understanding of mechanisms of stigma processes and reduce stigma and discrimination against people with mental illness in LMICs; and 2) establish a strong collaborative research consortium through the conduct of this programme. Specifically, the Indigo Partnership involves developing and pilot testing anti-stigma interventions at the community, primary care, and mental health specialist care levels, with a systematic approach to cultural and contextual adaptation across the sites. This work also involves transcultural translation and adaptation of stigma and discrimination measurement tools. The Indigo Partnership operates with the key principle of partnering with people with lived experience of mental illness for the development and implementation of the pilot interventions, as well as capacity building and cross-site learning to actively develop a more globally representative and equitable mental health research community. This work is envisioned to have a long-lasting impact, both in terms of the capacity building provided to participating institutions and researchers, and the foundation it provides for future research to extend the evidence base of what works to reduce and ultimately end stigma and discrimination in mental health

A prospective study of the importance of enteric fever as a cause of non-malarial febrile illness in patients admitted to Chittagong Medical College Hospital, Bangladesh

BACKGROUND: Fever is a common cause of hospital admission in Bangladesh but causative agents, other than malaria, are not routinely investigated. Enteric fever is thought to be common. METHODS: Adults and children admitted to Chittagong Medical College Hospital with a temperature of ≥38.0 °C were investigated using a blood smear for malaria, a blood culture, real-time PCR to detect Salmonella Typhi, S. Paratyphi A and other pathogens in blood and CSF and an NS1 antigen dengue ELISA. RESULTS: We enrolled 300 febrile patients with a negative malaria smear between January and June 2012: 156 children (aged ≤15 years) and 144 adults with a median (interquartile range) age of 13 (5-31) years and median (IQR) illness duration before admission of five (2-8) days. Clinical enteric fever was diagnosed in 52 patients (17.3 %), lower respiratory tract infection in 48 (16.0 %), non-specific febrile illness in 48 (16.0 %), a CNS infection in 37 patients (12.3 %), urinary sepsis in 23 patients (7.7 %), an upper respiratory tract infection in 21 patients (7.0 %), and diarrhea or dysentery in 21 patients (7.0 %). Malaria was still suspected in seven patients despite a negative microscopy test. S. Typhi was detected in blood by culture or PCR in 34 (11.3 %) of patients. Of note Rickettsia typhi and Orientia tsutsugamushi were detected by PCR in two and one patient respectively. Twenty-nine (9 %) patients died during their hospital admission (15/160 (9.4 %) of children and 14/144 (9.7 %) adults). Two of 52 (3.8 %) patients with enteric fever, 5/48 (10.4 %) patients with lower respiratory tract infections, and 12/37 (32.4 %) patients with CNS infection died. CONCLUSION: Enteric fever was confirmed in 11.3 % of patients admitted to this hospital in Bangladesh with non-malaria fever. Lower respiratory tract and CNS infections were also common. CNS infections in this location merit more detailed study due to the high mortality