A ‘Gift’ of Neoliberalism: English as the Language of Instruction in the GCC

Barnawi’s Neoliberalism and English Language Education Policies in the Arabian Gulf (2018) addresses language of instruction policies in the six Gulf states, Saudi Arabia, Kuwait, U.A.E., Qatar, Bahrain and Oman. Barnawi takes the reader through a comparison of national language policies throughout the Gulf. He presents the neoliberal Western ideological roots of these policies and the resulting clash with traditional Islamic worldviews. Further pointing out that Gulf countries seek to transform their economies from oil-based to knowledge-based economies and in doing so, English language skills have become commodified and serve as a means to guaranteed economic prosperity.  However, Barnawi does not offer an alternative vision to English medium instruction (EMI) for the reader to consider. Moreover, Barnawi has not successfully argued that the adoption of English language will by default lead to the adoption of Western cultural norms.  Missing from the analysis is an alternative framework that advocates for a culturally relevant education policy which addresses the needs of a citizenry who must be both globally competent and culturally grounded

Association of Menopause with Osteopenia and Osteoporosis: Results from Population Based Study Done in Karachi

INTRODUCTION One of the implications of menopause is postmenopausal osteoporosis, the resultant of bone remodeling in the skeleton secondary to estrogen deficiency. Bone remodeling rates have been shown to double at menopause, triple 13 years later and remain elevated till osteoporosis, contributing to the age related skeletal fragility in women. Proportion of elderly in Pakistan is growing steadily and persons more than 65 years are estimated to be 4%. Over half of women over the age of 60 years live in the developing countries. ABSTRACT Objective: To assess the association of osteopenia and osteoporosis with menopause and compare the health seeking behaviour of women related to menopause in different strata of society. Study Design: A cross-sectional study. Place and Duration of Study: Three different socioeconomic strata of Karachi from May till August 2004. Methodology: A sample of 925 women, over 35 years of age, was selected from 16 clusters of 250 households (50 houses in each cluster). All apparently healthy women having age between 35 and 50 years were selected in the cluster houses. Those who were not willing to be the part of the study or giving history of taking treatment for any disease for more than 4 weeks were excluded. In-depth interviews were conducted at their houses by the fourth year medical students trained and supervised by the senior faculty of the Medical College. T-scores were calculated to get BMD (Bone Mineral Density) for all the subjects through heel ultrasound. Results: A total of 287 women were found to be experiencing menopause. The mean age of menopause was 47.8 + 4.7 years. Out of those 287 women, 135 (47%) wanted their menses to continue and 235 (82%) had consulted a physician after menopause. There was a significantly lower score of BMD of postmenopausal women (mean = -1.833 + 0.65) compared to pre-menopausal women (mean = -1.597 + 0.60, p=0.016). Out of the 925 women interviewed, 53% had consulted a physician for various symptoms related to menopause. The symptoms experienced by pre-menopausal women included lack of sleep (25%), fear of becoming sterile (13%) and urinary incontinence (18%). Conclusion: The average age of menopause was found to be similar to other studies of the country. Lower bone mineral density was found in greater proportion among older females. Majority needed intervention inclusive of awareness through health education and medication. The symptoms experienced by menopausal women reported in literature include sleep disturbances inclusive of insomnia and quality of sleep. The bone mineral density is measured conventionally by Dual Energy X-ray Absorptiometry (DEXA), which is a costly and highly technical procedure. Ultrasound of heel is now frequently used and moderately comparable with DEXA for assessing the BMD in community studies and first level health care facilities due to its costeffectiveness and convenience. METHODOLOGY This cross-sectional study was conducted from May to August 2004, in Karachi. Sixteen clusters in three stratas of society (defined on the basis of socioeconomic status) were selected randomly through the Federal Bureau of Statistics. Each cluster consisted of approximately 250 households and from each cluster 50 houses were selected through systematic random sampling to get a total of 800 households. All women over 35 years of age in the houses were interviewed. Any house with no women in that age group was discarded and no replacement was done. The clusters consisted of six squatter settlements (2 each in North Nazimabad and Gulshan-e Iqbal while one each in Liaquatabad and Federal B Area), 5 middle income communities (3 in North Nazimabad and 2 in Gulshane-Iqbal) and 5 high income communities (2 each in North Nazimabad and Clifton and one in Gulshan-eIqbal) of Karachi. In-depth interviews were conducted at their houses by the fourth year medical students trained and supervised by the senior faculty of the college. Interview and questions consisted of their knowledge, attitude and practices related to menopause. Their health problems related to menopause were assessed through directional questions asking about relevant signs and symptoms. BMD was measured through the use of heel ultrasound done at site and T-scores were calculated. The machine used for this study was USA made; model number 03329, Hologic Sahara, Bedford. Ethical approval was taken from the ethical committee of the college. BMD could only be measured for 925 women, out of whom 285 were postmenopausal. SPSS 11 was used for data entry and analysis. Association of BMD to age, menopausal status and socioeconomic status was tested by using Chi-square test. RESULTS A total of 285 women, out of the total 925 women tested for BMD, belonged to the menopausal group. The mean age of menopause was 47.094+4.689 years (95% CI, 46.82-47.64). Out of the total 925 women, 300 (32.4%) had osteopenia and 62 (6.7%) had osteoporosis. A higher proportion of women in low income group had lower BMD Fifty nine percent (n=541) women were experiencing symptoms related to menopause. These 541 women were asked as to how these symptoms were affecting their lives and 41.9%, (n=227) reported lack of sleep, 21.6% (n=117) had stress due to fear of becoming sterile and 30.4% 241 Association of menopause with osteopenia and osteoporosis: results from population based study done in Karachi someone, which included a close family member by 96 women, friends by 69 women and medical personnel by 184 women When asked about their health seeking behaviour, a majority of the women replied that one should consult a physician during pre-menopausal stage (53%), a lesser proportion believed in consulting during the menopausal stage (42%) and only 18% thought that consultation is required in postmenopausal stage. In postmenopausal stage, more women consulted a physician, even though they said that it was not required, with a significant (p<0.001) difference amongst socioeconomic groups. Only 31% of the women said that medication should be taken during menopausal time and there was a statistically significant difference amongst the three socioeconomic groups (p<0.001). Out of those 291 women, 51.5% (n=150) said use of hormones, 46.3% (n=135) said herbal drugs and 2% (n=6) named other drugs (refer to DISCUSSION The present sample of 285 menopausal women found the mean age of menopause to be 47 years, which is similar to the mean age quoted before in studies done in Pakistan. It was found that 32.4% women had osteopenia and 6.7% had osteoporosis, which is similar to the data reported from Pakistan. Older age was associated with osteopenia and osteoporosis; it was found that 16% women over the age of 45 years had osteoporosis, which was similar to western studies where one in 6 women over the age of 50 were affected. There was a need to cater to the needs of these menopausal women through primary health care services and training of private practitioners in dealing with such women. Mass Media could be used to address the issue and provide information to women with lower levels of education and limited access to health care providers. The investigators used ultrasound heel as an economical screening test for osteopenia and osteoporosis for this large sample but validity of the results would have been better with DEXA testing. CONCLUSION The average age of menopause was 47+4.7 years. Women with age above 45 years had significantly low BMD as compared to younger females. A majority of women were aware of manifestations specific of menopause and felt that they would need to consult the physicians during that time. In majority of females the quality of life was affected as they were not taking any proper medication for their symptoms. Acknowledgement: The authors are thankful for the technical support of Novartis Pharmaceutical Company, who extended their help by providing free BMD through their mobile unit

Chemical Profiling and Bioactivities of Selective Organic Compounds from Fruits of Olea ferruginea and its Comparison with Olea europaea

This study evaluate the chemical profiling and bioactivities of selective organic compounds from fruits of Olea ferruginea and its comparison with Olea europaea from three unexplored locations of Pakistan. The oil was characterized into fatty acids by GC-MS and FT-IR. Antioxidant activities were detected by DPPH, ABTS and H₂O₂ scavenging bioassays. For cytotoxicity, Brine-Shrimp-Cytotoxicity-Bioassay was tested. The extracted oil was checked against five bacterial strains. Higher quantity of phytochemicals and yields of oil were present in fruit of Olea ferruginea collected from Malakand as compared to other locations. Prominent inhibitory activity against E.coli and S.aureus was observed during antibacterial assay. Good quality oil with antioxidant properties obtained from fruit of Olea ferruginea from Malakand. The comparative studies revealed the same qualitative composition of both species but Olea europaea showed greater oil-yield than Olea ferruginea. In consequence, the wild species Olea ferruginea was found to be economical, wild and drought tolerant. This work is licensed under a Creative Commons Attribution 4.0 International License

A retrospective study of laboratory-based enteric fever surveillance, Pakistan, 2012-2014

Introduction: The Surveillance for Enteric Fever in Asia Project (SEAP) is a multisite surveillance study designed to capture morbidity and mortality burden of enteric fever (typhoid and paratyphoid) in Bangladesh, Nepal, and Pakistan. We aim to describe enteric fever disease burden, severity of illness, and antimicrobial resistance trends in Pakistan.Methods: In this retrospective, cross-sectional study, laboratory records of hospitalized patients who received a blood culture in any of 3 Aga Khan University hospitals in Karachi and Hyderabad, Pakistan, from 2012 to 2014 were reviewed. A case was defined as having a positive blood culture for Salmonella Typhi (S. Typhi) or Salmonella Paratyphi (S. Paratyphi). Antimicrobial sensitivity patterns were characterized for all S. Typhi and S. Paratyphi isolates. Medical records were available for abstraction (demographics, clinical features, complications) only among hospitalized cases.Results: Of the 133017 blood cultures completed during the study period, 2872 (2%) were positive-1979 (69%) for S. Typhi and 893 (31%) for S. Paratyphi. Fluoroquinolone resistance was present in \u3e90% of both the S. Typhi and the S. Paratyphi isolates; almost none of the isolates were resistant to cephalosporins. Multidrug resistance (resistance to ampicillin, chloramphenicol, and cotrimoxazole) was observed in 1035 (52%) S. Typhi isolates and 14 (2%) S. Paratyphi isolates. Among S. Typhi and S. Paratyphi isolates, 666 (23%) were linked to hospitalized patients with medical records. Of the 537 hospitalized S. Typhi cases, 280 (52%) were aged 5-15 years, 133 (25%) were aged 2-4 years, 114 (21%) were aged \u3e15 years, and 10 (2%) were aged 0-1 years. Among the 129 hospitalized S. Paratyphi cases, 73 (57%) were aged \u3e15 years, 41 (32%) were aged 5-15 years, 13 (10%) were aged 2-4 years, and 2 (2%) were aged 0-1 years. Significant differences in symptomology between S. Typhi and S. Paratyphi cases were observed for nausea/vomiting, diarrhea, loss of appetite, and headache. Leukopenia, thrombocytopenia, and encephalopathy were the most commonly reported complications among enteric fever cases. No deaths were reported.Conclusion: Evidence of high antimicrobial resistance levels and disease severity support the need for continued surveillance and improved diagnostics for typhoid. Further prospective studies on vaccination as a tool for prevention of enteric fever in Pakistan are needed to inform disease intervention strategies

Lockdown stringency and paediatric self-harm presentations during COVID-19 pandemic: retrospective cohort study

Background Lockdown during the pandemic has had significant impacts on public mental health. Previous studies suggest an increase in self-harm and suicide in children and adolescents. There has been little research on the roles of stringent lockdown. Aims To investigate the mediating and predictive roles of lockdown policy stringency measures in self-harm and emergency psychiatric presentations. Method This was a retrospective cohort study. We analysed data of 2073 psychiatric emergency presentations of children and adolescents from 23 hospital catchment areas in ten countries, in March to April 2019 and 2020. Results Lockdown measure stringency mediated the reduction in psychiatric emergency presentations (incidence rate ratio of the natural indirect effect [IRRNIE] = 0.41, 95% CI [0.35, 0.48]) and self-harm presentations (IRRNIE = 0.49, 95% CI [0.39, 0.60]) in 2020 compared with 2019. Self-harm presentations among male and looked after children were likely to increase in parallel with lockdown stringency. Self-harm presentations precipitated by social isolation increased with stringency, whereas school pressure and rows with a friend became less likely precipitants. Children from more deprived neighbourhoods were less likely to present to emergency departments when lockdown became more stringent, Conclusions Lockdown may produce differential effects among children and adolescents who self-harm. Development in community or remote mental health services is crucial to offset potential barriers to access to emergency psychiatric care, especially for the most deprived youths. Governments should aim to reduce unnecessary fear of help-seeking and keep lockdown as short as possible. Underlying mediation mechanisms of stringent measures and potential psychosocial inequalities warrant further research

Subnational mapping of HIV incidence and mortality among individuals aged 15–49 years in sub-Saharan Africa, 2000–18 : a modelling study

Background: High-resolution estimates of HIV burden across space and time provide an important tool for tracking and monitoring the progress of prevention and control efforts and assist with improving the precision and efficiency of targeting efforts. We aimed to assess HIV incidence and HIV mortality for all second-level administrative units across sub-Saharan Africa. Methods: In this modelling study, we developed a framework that used the geographically specific HIV prevalence data collected in seroprevalence surveys and antenatal care clinics to train a model that estimates HIV incidence and mortality among individuals aged 15–49 years. We used a model-based geostatistical framework to estimate HIV prevalence at the second administrative level in 44 countries in sub-Saharan Africa for 2000–18 and sought data on the number of individuals on antiretroviral therapy (ART) by second-level administrative unit. We then modified the Estimation and Projection Package (EPP) to use these HIV prevalence and treatment estimates to estimate HIV incidence and mortality by second-level administrative unit. Findings: The estimates suggest substantial variation in HIV incidence and mortality rates both between and within countries in sub-Saharan Africa, with 15 countries having a ten-times or greater difference in estimated HIV incidence between the second-level administrative units with the lowest and highest estimated incidence levels. Across all 44 countries in 2018, HIV incidence ranged from 2 ·8 (95% uncertainty interval 2·1–3·8) in Mauritania to 1585·9 (1369·4–1824·8) cases per 100 000 people in Lesotho and HIV mortality ranged from 0·8 (0·7–0·9) in Mauritania to 676· 5 (513· 6–888·0) deaths per 100 000 people in Lesotho. Variation in both incidence and mortality was substantially greater at the subnational level than at the national level and the highest estimated rates were accordingly higher. Among second-level administrative units, Guijá District, Gaza Province, Mozambique, had the highest estimated HIV incidence (4661·7 [2544·8–8120·3]) cases per 100000 people in 2018 and Inhassunge District, Zambezia Province, Mozambique, had the highest estimated HIV mortality rate (1163·0 [679·0–1866·8]) deaths per 100 000 people. Further, the rate of reduction in HIV incidence and mortality from 2000 to 2018, as well as the ratio of new infections to the number of people living with HIV was highly variable. Although most second-level administrative units had declines in the number of new cases (3316 [81· 1%] of 4087 units) and number of deaths (3325 [81·4%]), nearly all appeared well short of the targeted 75% reduction in new cases and deaths between 2010 and 2020. Interpretation: Our estimates suggest that most second-level administrative units in sub-Saharan Africa are falling short of the targeted 75% reduction in new cases and deaths by 2020, which is further compounded by substantial within-country variability. These estimates will help decision makers and programme implementers expand access to ART and better target health resources to higher burden subnational areas

Biallelic variants in PCDHGC4 cause a novel neurodevelopmental syndrome with progressive microcephaly, seizures, and joint anomalies.

PURPOSE: We aimed to define a novel autosomal recessive neurodevelopmental disorder, characterize its clinical features, and identify the underlying genetic cause for this condition. METHODS: We performed a detailed clinical characterization of 19 individuals from nine unrelated, consanguineous families with a neurodevelopmental disorder. We used genome/exome sequencing approaches, linkage and cosegregation analyses to identify disease-causing variants, and we performed three-dimensional molecular in silico analysis to predict causality of variants where applicable. RESULTS: In all affected individuals who presented with a neurodevelopmental syndrome with progressive microcephaly, seizures, and intellectual disability we identified biallelic disease-causing variants in Protocadherin-gamma-C4 (PCDHGC4). Five variants were predicted to induce premature protein truncation leading to a loss of PCDHGC4 function. The three detected missense variants were located in extracellular cadherin (EC) domains EC5 and EC6 of PCDHGC4, and in silico analysis of the affected residues showed that two of these substitutions were predicted to influence the Ca2+-binding affinity, which is essential for multimerization of the protein, whereas the third missense variant directly influenced the cis-dimerization interface of PCDHGC4. CONCLUSION: We show that biallelic variants in PCDHGC4 are causing a novel autosomal recessive neurodevelopmental disorder and link PCDHGC4 as a member of the clustered PCDH family to a Mendelian disorder in humans

Predicting the environmental suitability for onchocerciasis in Africa as an aid to elimination planning

Recent evidence suggests that, in some foci, elimination of onchocerciasis from Africa may be feasible with mass drug administration (MDA) of ivermectin. To achieve continental elimination of transmission, mapping surveys will need to be conducted across all implementation units (IUs) for which endemicity status is currently unknown. Using boosted regression tree models with optimised hyperparameter selection, we estimated environmental suitability for onchocerciasis at the 5 × 5-km resolution across Africa. In order to classify IUs that include locations that are environmentally suitable, we used receiver operating characteristic (ROC) analysis to identify an optimal threshold for suitability concordant with locations where onchocerciasis has been previously detected. This threshold value was then used to classify IUs (more suitable or less suitable) based on the location within the IU with the largest mean prediction. Mean estimates of environmental suitability suggest large areas across West and Central Africa, as well as focal areas of East Africa, are suitable for onchocerciasis transmission, consistent with the presence of current control and elimination of transmission efforts. The ROC analysis identified a mean environmental suitability index of 071 as a threshold to classify based on the location with the largest mean prediction within the IU. Of the IUs considered for mapping surveys, 502% exceed this threshold for suitability in at least one 5 × 5-km location. The formidable scale of data collection required to map onchocerciasis endemicity across the African continent presents an opportunity to use spatial data to identify areas likely to be suitable for onchocerciasis transmission. National onchocerciasis elimination programmes may wish to consider prioritising these IUs for mapping surveys as human resources, laboratory capacity, and programmatic schedules may constrain survey implementation, and possibly delaying MDA initiation in areas that would ultimately qualify.SUPPORTING INFORMATION : FIGURE S1. Data coverage by year. Here we visualise the volume of data used in the analysis by country and year. Larger circles indicate more data inputs. ‘NA’ indicates records for which no year was reported (eg, ‘pre-2000’). https://doi.org/10.1371/journal.pntd.0008824.s001FIGURE S2. Illustration of covariate values for year 2000. Maps were produced using ArcGIS Desktop 10.6. https://doi.org/10.1371/journal.pntd.0008824.s002FIGURE S3. Environmental suitability of onchocerciasis including locations that have received MDA for which no pre-intervention data are available. This plot shows suitability predictions from green (low = 0%) to pink (high = 100%), representing those areas where environmental conditions are most similar to prior pathogen detections. Countries in grey with hatch marks were excluded from the analysis based on a review of national endemicity status. Areas in grey only represent locations masked due to sparse population. Maps were produced using ArcGIS Desktop 10.6 and shapefiles to visualize administrative units are available at https://espen.afro.who.int/tools-resources/cartography-database. https://doi.org/10.1371/journal.pntd.0008824.s003FIGURE S4. Environmental suitability prediction uncertainty including locations that have received MDA for which no pre-intervention data are available. This plot shows uncertainty associated with environmental suitability predictions colored from blue to red (least to most uncertain). Countries in grey with hatch marks were excluded from the analysis based on a review of national endemicity status. Areas in grey only represent locations masked due to sparse population. Maps were produced using ArcGIS Desktop 10.6 and shapefiles to visualize administrative units are available at https://espen.afro.who.int/tools-resources/cartography-database. https://doi.org/10.1371/journal.pntd.0008824.s004FIGURE S5. Environmental suitability of onchocerciasis excluding morbidity data. This plot shows suitability predictions from green (low = 0%) to pink (high = 100%), representing those areas where environmental conditions are most similar to prior pathogen detections. Countries in grey with hatch marks were excluded from the analysis based on a review of national endemicity status. Areas in grey only represent locations masked due to sparse population. Maps were produced using ArcGIS Desktop 10.6 and shapefiles to visualize administrative units are available at https://espen.afro.who.int/tools-resources/cartography-database. https://doi.org/10.1371/journal.pntd.0008824.s005FIGURE S6. Environmental suitability prediction uncertainty excluding morbidity data. This plot shows uncertainty associated with environmental suitability predictions colored from blue to red (least to most uncertain). Countries in grey with hatch marks were excluded from the analysis based on a review of national endemicity status. Areas in grey only represent locations masked due to sparse population. https://doi.org/10.1371/journal.pntd.0008824.s006FIGURE S7. Covariate Effect Curves for all onchocerciasis occurrences (measures of infection prevalence and disability). On the right set of axes we show the frequency density of the occurrences taking covariate values over 20 bins of the horizontal axis. The left set of axes shows the effect of each on the model, where the mean effect is plotted on the black line and its uncertainty is represented by the upper and lower confidence interval bounds plotted in dark grey. The figures show the fit per covariate relative to the data that correspond to specific values of the covariate. https://doi.org/10.1371/journal.pntd.0008824.s007FIGURE S8. Covariate Effect Curves for all onchocerciasis occurrences (measures of infection prevalence and disability). On the right set of axes we show the frequency density of the occurrences taking covariate values over 20 bins of the horizontal axis. The left set of axes shows the effect of each on the model, where the mean effect is plotted on the black line and its uncertainty is represented by the upper and lower confidence interval bounds plotted in dark grey. https://doi.org/10.1371/journal.pntd.0008824.s008FIGURE S9. ROC analysis for threshold. Results of the area under the receiver operating characteristic (ROC) curve analysis are presented below, with false positive rate (FPR) on the x-axis and true positive rate (TPR) on the y-axis. The red dot on the curve represents the location on the curve that corresponds to a threshold that most closely agreed with the input data. For each of the 100 BRT models, we estimated the optimal threshold that maximised agreement between occurrence inputs (considered true positives) and the mean model predictions as 0·71. https://doi.org/10.1371/journal.pntd.0008824.s009TABLE S1. Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) checklist. https://doi.org/10.1371/journal.pntd.0008824.s010TABLE S2. Total number of occurrence data classified as point and polygon inputs by diagnostic. We present the total number of occurrence points extracted from the input data sources by diagnostic type. ‘Other diagnostics’ include: DEC Patch test; Knott’s Method (Mazotti Test); 2 types of LAMP; blood smears; and urine tests. https://doi.org/10.1371/journal.pntd.0008824.s011TABLE S3. Total number of occurrence data classified as point and polygon inputs by location. https://doi.org/10.1371/journal.pntd.0008824.s012TABLE S4. Covariate information. https://doi.org/10.1371/journal.pntd.0008824.s013TEXT S1. Details outlining construction of occurrence dataset. https://doi.org/10.1371/journal.pntd.0008824.s014TEXT S2. Covariate rationale. https://doi.org/10.1371/journal.pntd.0008824.s015TEXT S3. Boosted regression tree methodology additional details. https://doi.org/10.1371/journal.pntd.0008824.s016APPENDIX S1. Country-level maps and data results. Maps were produced using ArcGIS Desktop 10.6 and shapefiles to visualize administrative units are available at https://espen.afro.who.int/tools-resources/cartography-database. https://doi.org/10.1371/journal.pntd.0008824.s017This work was primarily supported by a grant from the Bill & Melinda Gates Foundation OPP1132415 (SIH). Financial support from the Neglected Tropical Disease Modelling Consortium (https://www.ntdmodelling.org/), which is funded by the Bill & Melinda Gates Foundation (grants No. OPP1184344 and OPP1186851), and joint centre funding (grant No. MR/R015600/1) by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement which is also part of the EDCTP2 programme supported by the European Union (MGB).The Neglected Tropical Disease Modelling Consortium which is funded by the Bill & Melinda Gates Foundation, the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement which is also part of the EDCTP2 programme supported by the European Union (MGB).http://www.plosNTDS.orgam2022Medical Microbiolog