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Introduction The purpose of this study is to investigate the trends of the burden of ischemic heart disease (IHD) in the Eastern Mediterranean Region (EMR) countries from 1990 to 2019. Method Prevalence, disability-adjusted life years (DALYs), death, DALYs attribution risk factors, healthcare access and quality index (HAQ), and universal health care (UHC) were extracted from the database of the Global Burden of Disease study (GBD) for the EMR countries. Data stratification is based on the social demographic index (SDI). Cardiac rehabilitation data was obtained from the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) and other information was e obtained by an advanced search of individualized countries’ data. Result IHD age-standardized prevalence increased from 4.96% to 5.31% in the EMR from 1990-2019 while it decreased at the global level. In the EMR, the trend of age-standardized IHD death and DALYs rates decreased by 11.39% and 15.36% between 1990 and 2019 respectively, however, both rates were higher than the global rates. The burden of IHD in males was higher than females. The highest decrease of IHD age-standardized prevalence, death and DALYs rate in the EMR countries occurred in Bahrain (-3.72%, -64.95%and-69.08%, respectively). However, the most increase of prevalence happened in Oman with a change of 14.40% and for death and DALY rates was in Pakistan (29.62% and 31.93%, respectively) in the studied period. The top three attributed risk factor to IHD DALYs in the EMR in 2019 were high systolic blood pressure, high low-density lipoprotein cholesterol, and particular matter pollution. The 29-year trend of an attributed risk factor to IHD DALYs in the EMR (1990-2019) showed that the two factors of high fasting plasma glucose (64.03%) and high BMI (23.39%) had an increasing trend, respectively. Conclusion Our results showed an increased trend of the prevalence of IHD in the EMR that requires well planned prevention and treatment strategies. Developing and implementing programs to address the risk factors through health promotion and education, preventive programs, and medical care should be a priority for countries in this region.

BackgroundThe burden of heart failure (HF) is high globally, but information on its burden in the Eastern Mediterranean Region (EMR) is limited. This study provides a systematic analysis of the burden and underlying causes of HF in the EMR, including at the country level, between 1990 and 2019. MethodsWe used the 2019 Global Burden of Disease (GBD) data for estimates of prevalence, years lived with disability (YLDs), and underlying causes of HF in the EMR. Age-standardised prevalence, YLDs, and underlying causes of HF were compared by 5-year age groups (considering 15 years old and more), sex (male and female), and countries. FindingsIn contrast with the decreasing trend of HF burden globally, EMR showed an increasing trend. Globally, the HF age-standardised prevalence and YLDs decreased by 7.06% (95% UI: −7.22%, −6.9%) and 6.82% (95% UI: −6.98%, −6.66%) respectively, from 1990 to 2019. The HF age-standardised prevalence and YLDs in the EMR in 2019 were 706.43 (95% UI: 558.22–887.87) and 63.46 (95% UI: 39.82–92.59) per 100,000 persons, representing an increase of 8.07% (95% UI: 7.9%, 8.24%) and 8.79% (95% UI: 8.61%, 8.97%) from 1990, respectively. Amongst EMR countries, the age-standardised prevalence and YLDs were highest in Kuwait, while Pakistan consistently had the lowest HF burden. The dramatic increase of the age-standardised prevalence and YLDs were seen in Oman (28.79%; 95% UI: 28.51%, 29.07% and 29.56%; 95% UI: 29.28%, 29.84%), while Bahrain witnessed a reduction over the period shown (−9.66%; 95% UI: −9.84%, −9.48% and−9.14%; 95% UI: −9.32%, −8.96%). There were significant country-specific differences in trends of HF burden from 1990 to 2019. Males had relatively higher rates than females in all age groups. Among all causes of HF in 2019, ischemic heart disease accounted for the highest age-standardised prevalence and YLDs, followed by hypertensive heart disease. InterpretationThe burden of HF in the EMR was higher than the global, with increasing age-standardised prevalence and YLDs in countries of the region. A more comprehensive approach is needed to prevent underlying causes and improve medical care to control the burden of HF in the region. FundingNone.

No society is immune from disasters. Yet, resilient communities that have access to the needed information, as well as physical, economic, social, and human capitals, tend to prepare, respond, and recover from disasters better than other communities. Recently, a people-oriented approach of community resilience inducing a collaboration of various stakeholders has been advocated instead of the command and control approach widely adopted by governments. Nevertheless, there is a paucity of research on the role of the different stakeholders in promoting the different capitals of community resilience. Hence, this paper seeks to investigate the extent to which the different stakeholders are involved in community resilience. By distributing a questionnaire on 273 of the inhabitants of a newly-established, urban sub-district for repopulating vulnerable people in Cairo, the paper offers deep insight into the roles of the government, private sector, and NGOs in promoting community resilience and illuminates how each stakeholder prioritizes different capitals.

ObjectiveCardiac rehabilitation (CR) is a comprehensive model of secondary preventive care. There is a wide variety in implementation characteristics globally, and hence quality control is paramount. Thus, the International Council of Cardiovascular Prevention and Rehabilitation was urged to develop a CR registry. The purpose of this study was to test the perceived usability of the International Cardiac Rehabilitation Registry (ICRR) to optimise it.DesignThis was a qualitative study, comprising virtual usability tests using a think-aloud method to elicit feedback on the ICRR, while end-users were entering patient data, followed by semistructured interviews.SettingUltimately, 12 tests were conducted with CR staff (67% female) in low-resource settings from a variety of disciplines in all regions of the world but Europe before saturation was achieved.Primary outcome measureParticipants completed the System Usability Scale. Interviews were transcribed verbatim except to preserve anonymity, and coded using NVIVO by two researchers independently. The Unified Theory of Acceptance and Use of Technology 2 informed analysis.ResultsThe ICRR was established as easy to use, relevant, efficient, with easy learnability, operability, perceived usefulness, positive perceptions of output quality and high end-user satisfaction. System usability was 83.75, or ‘excellent’ and rated ‘A’. Four major themes were deduced from the interviews: (1) ease of approvals, adoption and implementation; (2) benefits for programmes, (3) variables and their definitions, as well as (4) patient report and follow-up assessment. Based on participant observation and utterances, suggestions for changes to the ICRR were implemented, including to the programme survey, on-boarding processes, navigational instructions, inclusion of programme logos, direction on handling unavailable data and optimising data completeness, as well as policies for authorship and programme certification.ConclusionsWith usability of the ICRR optimised, pilot testing shall ensue.

The Arab Spring revealed that when the youth are marginalized, they can resort to informal political movements that may be characterized by extremism and criminality. However, when they join formal groupings, such as political parties, and are well utilized within them, they can become an active political force. This article explores the extent to which American and Egyptian political parties offer opportunities for youth inclusion in their structure and decision-making processes. By conducting semi-structured interviews with young members of the largest two Egyptian parties and the Democratic and Republican parties in the United States, the study argues that when young people develop a long-term interest in politics, they join political parties. Moreover, they are included in the party structures and decision-making processes when they are included in party activities and positions, as well as trusted, heard, and supported within the party. The existence of a national plan and political will may even encourage cross-party youth collaboration.

With the sudden deaths of few animals in the Egyptian Giza Zoo (GZ), the debate was launched about zoo management and the limited resources available. In addition, the role of the different stakeholders, especially the non-governmental organizations (NGOs), in zoo management was also put into the forefront. Hence, the purpose of this qualitative study is to explore the extent to which NGOs are involved in the management of the GZ. By conducting seven semi-structured interviews with the GZ director and all the three officially registered NGOs that work in the field of animal rights and protection in Cairo and Giza, the study was able to reach at the following conclusions: First, the GZ is mainly adopting the regulatory and entertainment styles of zoo management offering little room to benefit from the advantages that the NGOs can offer. Second, the role of the NGOs ranges from criticizing, advising, helping when problems arise, to holding training sessions and conferences to increase the awareness of the GZ’s workers and build their capacities. Nevertheless, the NGOs are not involved in planning or fundraising. Finally, as a result of numerous factors including contradictory expectations and characteristics between the GZ and the NGOs, the relationship between the GZ and the NGOs can be described as conflicting as indicated by Onkila (Bus Strategy Environ 20:379–393, 2011).

Encephalitozoon cuniculi is an obligate intracellular microsporidian parasite that infects a wide range of mammalian hosts. The present study investigated the prevalence of E. cuniculi in different animal hosts from different provinces of Egypt (Alexandria, Behera, and Assuit) using serological (IFAT and ELISA) and molecular (PCR) assays. A total of 324 serum and 274 urine samples were collected from seven different species of animals (cattle, buffaloes, sheep, goat, rabbit, dog, and rat). The results of serological examination confirmed the occurrence of antibodies against E. cuniculi in 38.9 % (126 out of 324) of the examined animals. The significant (P

The present study was planned to investigate the prevalence of Sarcocystis spp. among slaughtered water buffaloes (Bubalus bubalis) at Alexandria province, Egypt. Three hundred blood samples were collected from slaughtered buffaloes (5-7 years old). Two techniques were used to evaluate the seroprevalence of Sarcocystis spp., enzyme-linked immunosorbent assay (ELISA) and indirect haemagglutination assay (IHA). It was revealed that 203 (67.6 %) and 191 (63.6 %) of the tested serum samples were seropositive to Sarcocystis spp. by ELISA and IHA, respectively. The results of sensitivity and specificity of IHA relative to ELISA were 94 and 100 %, respectively. For molecular characterization of inter- and intra-species genetic polymorphism within Egyptian isolates of Sarcocystis spp. of water buffaloes, polymerase chain reaction (PCR) and polymerase chain reaction-restriction length polymorphisms (PCR-RFLPs) were performed on four macroscopic isolates. The isolates represented two different geographical regions of Egypt, Alexandria and Assuit provinces. Alexandria isolates (large and small-sized cyst of the same host) and Assuit isolates (large and small-sized cyst of the same host) were used. The 18S rDNA of the macroscopic cysts were characterized, in tandem, by four restriction endonucleases, RsaI, MboI, SspI and DraI. RsaI and MboI enzymes did not show any restriction sites for all isolates, leaving the amplified fragments without cutting. SspI showed two fragments in Alexandria and Assuit small-sized isolates cut by the enzyme at 600-700-bp fragments, while Alexandria and Assuit large-sized cysts amplicons were not digested by this enzyme. The fourth enzyme, DraI, cut the PCR product of Alexandria large-sized cysts into two fragments (420-780 bp), while Assuit large-sized amplicon was not cut. It could be concluded that there was a far distance between the two local isolates (small and large sized), but there were no differences between the large-sized isolates.

This study investigated the composition and structure of parasitic communities of Oreochromus niloticus with respect to levels of water quality in three ecosystems. A total of 360 O.niolticus were examined from three water courses. Idku lake (moderately polluted), Edfina; Natural Nile resources (polluted) and Mariout lake (severely polluted). Water samples were collected for determination of some water quality parameters and the concentration of heavy metals. Trematodes ,monogenes, protozoa, crustacea and acanthocephalan were found in all sample sites except Mariout lake where Acanthocephala and metacercaria of Clinostomum were completely absent. Ciliated protozoa predominated the parasitic infestation. The results also indicated that there was an inverse relationship between fish parasites communities and water quality parameters.

The present study evaluated the presence of specific antibodies against Besnoitia besnoiti in cattle and water buffalo (Bubalus bubalis) in Egypt. Sera from cattle (n = 216) and water buffaloes (n = 133) collected from five different provinces of Egypt (Behera, Alexandria, Assuit, Gharbia, and Matrouh) were analyzed. Testing for B. besnoiti antibodies by PrioCHECK® Besnoitia Ab 2.0 ELISA initially identified 13.75 % (48 out of 349) of individual sera as positive at the manufacturer’s suggested cutoff threshold, 15 percent positivity (PP). Statistically significant associations between B. besnoiti prevalence, species, sex, age, and geographical distribution were observed. Seropositive animals were distributed in all of the provinces from which animals were sampled except Gharbia province. Assuit province showed the highest percentage of infection (30.76 %) followed by Matrouh, Alexandria, and Behera provinces (25, 16.29, and 9.6 %, respectively). The highest infection rate of B. besnoiti was significantly higher in cattle (17.13 %) than in water buffaloes (9.02 %). Positive cases were observed in all age categories. While the highest infection rate (17.13 %) was recorded in the age group 5–10 years followed by the age group 1–5 years (15.38 %), and only one positive case (1.58 %) was recorded in the age group less than 1 year. The highest infection rate of B. besnoiti infection was recorded in the female animals (14.95 %) followed by the male animals (8.33). This is the first report on the detection of B. besnoiti in cattle and water buffaloes in Egypt.

A study was conducted to investigate the protective and therapeutic effects of crude garlic (Allium sativum) against experimental infection with Eimeria stiedae in rabbits. Forty rabbits were divided into four groups of ten rabbits each: a healthy control group (HC); a challenged-garlic-protected group (CGP) which received a daily dose of 0.5 g/kg body weight (bwt) crude garlic for five successive days before challenge with E. stiedae; a challenged-garlic-treated group (CGT) which was treated with a daily dose of 0.5 g/kg bwt crude garlic for five successive days post-challenge; and an infected control group (IC). The challenge dose was 5 x 10(4) sporulated E. stiedae oocysts per rabbit. Mortality rate, body weight gain, feed conversion ratio and faecal oocyst count were evaluated throughout the experiment. At the end of the experiment, all rabbits were killed and histopathological examination was performed. No mortalities were recorded in the HC and CGP groups, whilst mortality was found to be 20% and 40% in the CGT and IC groups, respectively. CGP rabbits had better body weight gain and lower numbers of oocysts than those in the CGT and IC groups. Hepatic lesions were less severe in the CGP group than in the CGT and IC groups. These results showed that oral administration of crude garlic ameliorated the adverse impacts of hepatic coccidiosis on rabbits when used as a prophylactic, but garlic was less effective as a therapeutic.

Paramphistomiasis is a disease of domestic and wild ruminants caused by some digenetic trematodes of the superfamily Paramphistomoidea. Human infections with certain species of paramphistomes have been reported. Given their ubiquity and their abundance within hosts, it seems likely that the importance of these worms is underestimated globally. Based on the reported difficulties of morphological identification of paramphistomes, the development of alternative approaches to better delineate species is needed. Paramphistome samples examined during this study were cercariae, rediae from snail hosts and adult flukes obtained from slaughterhouses from Kenya, Tanzania, Egypt and Nepal. The results confirm that ITS2 is a good molecular marker for paramphistome identification and can be used to determine the affiliation of samples among the different taxa of Paramphistomoidea. Our 22 samples include eight species of paramphistomes. Ten samples of paramphistome larvae (cercariae or rediae) yielded seven species and the 12 samples of adult flukes from bovines yielded four, only one of which was not also represented among the larvae. We found three cases in which the sequences for adult worms and larvae matched, thus revealing the hosts involved locally in those particular life cycles. We interpret our specimens to include five species from Kenya, two from Nepal, two from Tanzania and one from Egypt. Bulinus forskalii was found infected with three species of paramphistomes. The results of the present study will help construct a framework to facilitate identification and eventually control of this underestimated cosmopolitan group of digeneans.

Background: Chlamydia trachomatis (CT) is a Sexually Transmitted Disease (STD); it leads to health complications and infertility if not treated. Aim: To provide a comprehensive epidemiological assessment of CT in Latin America and the Caribbean (LAC). Methods: This study followed Cochran and PRISMA guidelines. We conducted the search in PubMed, Embase, and LILACS databases. We estimated the pooled-mean CT prevalence using random-effects meta-analyses. We conducted random-effects meta-regressions to identify sources of heterogeneity and possible predictors of high prevalence. Results: The pooled-mean urogenital CT prevalence was 8.2% (95% CI: 7.5-9.1) for general populations, 14.0% (95%CI: 12.7-15.4) for female sex workers, 10.8% (95% CI: 8.4-13.4) for men who have sex with men, male sex workers, and transgenders, 16.1% (95% CI: 12.6-19.8) for symptomatic women, 25.4 (95% CI: 18.6-38.5) for symptomatic men, 9.7% (95%CI: 6.1-14) for HIV-positive individuals and individuals in HIV-discordant couples, and 11.9% (95 CI: 8.5-15.8) for STI clinic attendees. Urogenital CT prevalence appears to decrease with age, to be higher in women compared to men, and to increase by 1% yearly. Anorectal CT appears to be higher in men compared to women but shows no temporal trend. Discussion: Urogenital CT prevalence among general populations is higher than that in other world regions. Conclusion: LAC is burdened by CT infection. Public health response in LAC region is required to effectively tackle CT infection.