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The study of an Arabic newspaper published by the British during World War II shows how photographs played an important role in the propaganda campaign to gain Arab support in the Middle East. While the newspaper purported to cover the war, in actuality, the content contained mostly cultural photographs that contributed to the Allies' implementation of psychological warfare, particularly emphasizing Arab identity, lifestyle in England, development in the Arab World, and the solid Arab–Allies relationship. The results of this study demonstrate how photographs played an important role in the propaganda machine, which, in this case, was intended to positively impress Arabs and Muslims in the Arabian Peninsula and turn them against the Axis. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) is a prevalent condition in our society, frequently accompanied by various interacting comorbidities. Among these, brain-related comorbidities such as stroke and transient ischemic attack (TIA) play a crucial role in exacerbating the severity of HF. The relationship between cerebrovascular accidents (CVAs) and HF across different left ventricular ejection fraction (LVEF) levels is not well understood. Objectives: This study aims to assess the impact of CVA including stroke and TIA on mortality and morbidity in patients with acute heart failure (AHF) stratified by LVEF. Methods: We conducted an analysis of consecutive patients admitted to 47 hospitals in seven Middle Eastern countries (Saudi Arabia, Oman, Yemen, Kuwait, United Arab Emirates, Qatar, and Bahrain) with AHF from February to November 2012 with AHF who were enrolled in a multinational registry of patients with HF. The study population consisted of patients with CVA and AHF, categorized into three groups based on EF: HF patients with preserved EF (HFpEF) (250%), HF patients with reduced EF (HFrEF) (<40%), and HF patients with mid-range EF (HFmrEF) (40%-49%). Univariate and multivariate statistical techniques were employed for the analysis. Results: Our study involved 370 patients, averaging 66.4 ± 13.2 years. In-hospital mortality for CVA and AHF patients was 8.4% (n = 31). Patients in different ranges of LVEF experienced comparable rates of hospitalization and mortality at both the 3-month and 12-month intervals. Left atrial enlargement (odd ratio [OR]: 3.27, 95% confidence interval [CI]: 1.33-9.32, P = 0.015) and noninvasive ventilation (OR: 6.17, 95% CI: 2.71-14.07, P < 0.001) were associated with a higher mortality rate while discharging on digoxin (OR: 0.14, 95% CI: 0.02-0.52, P = 0.011) was linked to lower mortality. The sole distinction among HF groups was observed in 12-month survival, with HFpEF patients having a superior survival rate of 91.7% compared to HFIEF patients at 77.5% and HFmrEF at 77.8% during this perio Conclusions: This study found significant differences in all-cause mortality at 12 months. Further research is warranted to better understand the mechanisms underlying these associations. [ABSTRACT FROM AUTHOR]

Background: Clinical characteristics and outcomes in patients with type 2 diabetes mellitus (T2DM) and acute heart failure (AHF) patients with idiopathic cardiomyopathy are not well known. Objective: The objective of our study is to determine all-cause mortality in patients with idiopathic cardiomyopathy presenting with AHF. Methods: We analyzed the data from 509 consecutive patients with idiopathic cardiomyopathy presenting with AHF to 47 hospitals in seven Middle Eastern countries (Saudi Arabia, Oman, Yemen, Kuwait, United Arab Emirates, Qatar, and Bahrain) between February and November 2012. All patients were stratified according to T2DM. The analyses were performed using the univariate and multivariate statistical techniques. Results: The mean age of the cohort was 52.0 ± 14.8 years. Of the 509 patients, 123 (24.2%) had T2DM and had a higher incidence of major stroke than the nondiabetic group (11.4% vs. 2.8%; P = 0.001). Diabetic patients were also more likely to be associated with hypertension than those without diabetes mellitus (78.9% vs. 21.8%; P < 0.001). Multivariate logistic regression demonstrated that those with cardiogenic shock (adjusted odds ratio [aOR], 59.3; 95% confidence interval [CI]: 20.1-207; P = 0.001) and noninvasive ventilation (NIV) (aOR: 4.19; 95% CI: 1.33-13.1; P = 0.013) were associated with higher odds of all-cause in-hospital mortality. However, age (aOR: 1.00; 95% CI: 0.96-1.03; P = 0.792), T2DM status (aOR: 0.43; 95% CI: 0.10-1.51; P = 0.207), and atrial fibrillation (aOR: 3.95; 95% CI: 0.82-17.2; P = 0.07) were not associated with higher odds of all-cause inhospital mortality. Conclusions: In AHF patients with idiopathic cardiomyopathy, T2DM was not associated with higher odds of all-cause inhospital mortality. Patients on NIV and cardiogenic shock were demonstrated as the independent predictors of increased inhospital mortality. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study is to determine the impact of diabetes mellitus on all‐cause mortality and rehospitalization rates at 3 months and at 1 year in patients admitted with acute heart failure (AHF) stratified by left ventricular ejection fraction (EF). Methods and results: We analysed consecutive patients admitted to 47 hospitals in seven Middle Eastern countries (Saudi Arabia, Oman, Yemen, Kuwait, United Arab Emirates, Qatar, and Bahrain) with AHF from February to November 2012 with AHF who were enrolled in Gulf CARE, a multinational registry of patients with heart failure (HF). AHF patients were stratified into three groups: HF patients with reduced (EF) (HFrEF) (<40%), HF with mid‐range EF (HFmrEF) (40–49%), and HF patients with preserved EF (HFpEF) (≥50%). Analyses were performed using univariate and multivariate statistical techniques. The mean age of the cohort was 59 ± 15 years (ranging from 18 to 99 years), and 63% (n = 2887) of the patients were males. A total of 2258 (49%) AHF patients had diabetes mellitus. The mean EF was 37 ± 14%. A reduced EF was observed in 2683 patients (59%), whereas 962 patients (21%) had mid‐range and 932 patients (20%) had preserved EF. Multivariable analyses demonstrated no significant differences in all‐cause mortality between diabetics and non‐diabetics in all the three types of HF; at 3 months follow‐up: HFrEF [adjusted odds ratio (aOR), 1.30; 95% confidence interval (CI): 0.94–1.80; P = 0.119], HFmrEF (aOR, 0.98; 95% CI: 0.51–1.87; P = 0.952), and HFpEF (aOR, 0.69; 95% CI: 0.38–1.26; P = 0.225); and at 12‐months follow‐up: HFrEF (aOR, 1.25; 95% CI: 0.97–1.62; P = 0.080), HFmrEF (aOR, 1.07; 95% CI: 0.68–1.68; P = 0.783), and HFpEF (aOR, 1.07; 95% CI: 0.67–1.72; P = 0.779). There were also no significant differences in rehospitalization rates between diabetics and non‐diabetics in all the three types of HF; at 3 months follow‐up: HFrEF (aOR, 0.94; 95% CI: 0.74–1.19; P = 0.581), HFmrEF (aOR, 0.82; 95% CI: 0.53–1.26; P = 0.369), and HFpEF (aOR, 1.06; 95% CI: 0.64–1.78; P = 0.812); and at 12‐months follow‐up: HFrEF (aOR, 0.93; 95% CI: 0.73–1.17; P = 0.524), HFmrEF (aOR, 0.81; 95% CI: 0.56–1.17; P = 0.257), and HFpEF (aOR, 1.29; 95% CI: 0.82–2.05; P = 0.271). Conclusions: There were no significant differences in 3 and 12 months all‐cause mortality as well as rehospitalization rates between diabetics and non‐diabetic patients in all the three types of AHF patients stratified by left ventricular ejection fraction. [ABSTRACT FROM AUTHOR]

This paper addresses an important era of women's activism in Kuwait. In the 1950s, when the government recognized women's rights for education, the wave to obtain other civil rights clashed with culture, tradition and religion which became serious obstacles facing women in their struggle for basic rights. This historical study focuses on the establishment of two women's organizations -- the Arab Women's Development Society in December 1962 and the Kuwait Women's Cultural and Social Society in February 1963. To sway the negative image of women in a patriarchal society, women used activism as a public relations tool to achieve their social, civil and political rights. The study uses cultural-economic model (CEM) to illustrate how activism and public relations were articulated as synonymous to foster women's rights in Kuwait. Archived documents and content analysis of media content published in the 1960s reveal that activism played a vital role as a public relations strategy and that social activism was more effective than political activism. The study highlights the implications of culture within the context of both public relations and activism. • Study adopts the cultural-economic model of public relations to analyze activism in the womens rights movement of Kuwait. • Content analysis of newspapers and magazines suggests public relations and activism were synonymous to the women's rights movement in Kuwait. • Women's activism for social rights was more emancipatory than for political rights in an Islamic society such as Kuwait. • Study provides insight into public relations, activism and the Middle East. [ABSTRACT FROM AUTHOR]

Background: Klebsiella pneumoniae is one of the most important opportunistic pathogens causing serious complications in patients in hospitals and community. The clinical significance of K. pneumoniae is mainly due to its ability to acquire multiple antibiotic resistance genes. In this study we report the findings of a survey of plasmid mediated quinolone resistance in Extended-Spectrum β-lactamase (ESBL)-producing K. pneumoniae in Kuwait. Methods: Clinical samples were collected from the microbiology laboratories of three major hospitals. Isolates were confirmed as ESBL-producers by disc diffusion method and PCR for the presence of bla genes. Antimicrobial susceptibility testing and genetic analysis were performed to detect the presence of a number of genes conferring resistance to β-lactam and fluoroquinolone antimicrobial agents including blaSHV, blaTEM, aac (6')-Ib-cr, qnrA, qnrB and qnrS. Pulsed-field gel electrophoresis (PFGE) was used for typing the isolates. Results: In total 173 ESBL-producing K. pneumoniae were detected. qnr genes were identified in 27 (15.6 %) isolates and aac(6')-Ib Ib-cr gene in 26 (96 %). One (3.7 %) contained qnrA2, 21 harbored qnrB1 (78 %) and 5 (18.5 %) contained qnrS. Twenty one (78 %) isolates contained all three bla genes. PFGE showed diverse profiles. Conclusion: We identified for the first time the emergence of the mobile fluoroquinolone resistance qnrA2 in a clinical isolate in the middle east and also showed the dissemination of aac (6')-Ib-cr, qnrB, and qnrS genes among ESBL-producing K. pneumoniae in Kuwait. The abundance of plasmid mediated resistance to fluoroquinolones among ESBL-producing K. pneumoniae is alarming as it facilitates therapy failure. Preventing the spread of these isolates is crucial if we are to sustain the effectiveness of the limited choices we have left in antimicrobial therapy. [ABSTRACT FROM AUTHOR]

Objective: To investigate the frequency of ossification of the ligamentum flavum (OLF) in the spine among the Arab population in Kuwait using magnetic resonance imaging (MRI) surveillance of the whole spine. Subjects and Methods: A consecutive series of 102 patients with low back pain were recruited from the outpatient clinic of Mubarak AhKabeer Hospital, Kuwait. MRI.of the whole spine in the sagittal plane was obtained in at least two sequences (T1 and T2). The OLF was defined as low signal intensity thickening of the ligament in both (T1 and T2) sequences on the posterior margin of the spinal canal, causing indentation of the theca with or without cord compression. Results: Of (the 102 cases, 19 (18.6%) patients had OLF. Of the 19 positive cases, 12 (63.2%) were present at a single level, and 7 (36.8%) at multiple levels. A total of 26 OLF segments were identified in the following anatomical distribution: cervical: 15 (57.7%); upper thoracic (T1-T4): 1 (3.8%); mid thoracic (T5-T8): 4 (15.4%); lower thoracic (T9-T12): 4 (15.4%), and lumbar region: 2 (7.7%). Of the 19 OLF patients, 2 (10.5%) had tandem ossification of the posterior longitudinal ligament in the cervical spine and were symptomatic. Conclusions: The frequency of OLF appears to be high among this hospital-based cohort of the Arab population. OLF should be kept in mind if a patient presents with radiculopathy, particularly in the cervical region, for which surgical intervention is contemplated. [ABSTRACT FROM AUTHOR]

This study examined a behavioral model (based on the theory of planned behavior), in two different cultures (in the US., and in the Middle East), within the context of digital piracy. The model was extended by adding moral obligation as a factor influencing intention to pirate digital media. The results show, that while the overall model was significant in predicting the piracy behavior across the two cultures, there were differences in the influence of the individual variables. Subjective norm was only significant in the Middle East, and moral obligation was highly significant in the U.S. sample (while being of low significance in the Middle Eastern sample). Attitude and perceived behavioral control were found to be at least moderately significant in both cultures. [ABSTRACT FROM AUTHOR]

Medulloblastomas are the most common malignant brain tumors in the pediatric population. Based on the idea that tumors with identical radio-genomic features should behave similarly, the 4 molecular subtypes are now widely accepted as a guide for the management and prognosis. The radiological features of medulloblastomas can predict the molecular subtype; thus, anticipating the subsequent disease progression. However, this has not been evaluated comprehensively. We aim to thoroughly study the association between the molecular subtypes and radiological features of medulloblastomas. Moreover, we aim to investigate the efficacy of this correlation with the use of progression-free survival and 5-year survival rates. A retrospective analysis was conducted for all histopathological confirmed medulloblastomas in pediatric patients (<16 years old) that were operated on in Kuwait over the past ten years (n = 44). The radiological, histological, and molecular characteristics were justifiably evaluated and analyzed in our sample. The overall progression-free survival after one year was noticed among 27 cases (≈44%) and the nonspecific 5-year survival was seen in 31 cases (≈70%) after a 5-year follow-up. Sonic Hedgehog and Wingless had the best outcomes, while group 3 showed the worst outcomes. Our findings did not support the association between most of the typical magnetic resonance imaging characteristics and survival rate. We further established that Sonic Hedgehog and Wingless biological types have a better prognosis. There was no association observed between the radiographic features, specifically the location, and the molecular subtype. [ABSTRACT FROM AUTHOR]

Objectives: We sought to estimate the mortality and morbidity in diabetic acute heart failure (AHF) patients stratified by left ventricular ejection fraction. Methods: We analyzed the data of patients with AHF from seven Middle Eastern countries (Bahrain, Oman, Yemen, Kuwait, UAE, Qatar, and Saudi Arabia) from February to November 2012, who were enrolled in a multinational registry of patients with heart failure (HF). Results: A total of 2258 AHF patients had diabetes mellitus. The mean age was 63.0±11.0 years (ranging from 18 to 99 years), and 60.3% (n = 1362) of the patients were males. The mean ejection fraction (EF) was 37.0±13.0%. HF with reduced EF (< 40%) (HFrEF) was observed in 1268 patients (56.2%), whereas 515 patients (22.8%) had mid-range (40-49%) (HFmrEF) and 475 patients (21.0%) had preserved EF (≥ 50%) (HFpEF). The overall cumulative all-cause mortalities at three- and 12-months follow-up were 11.8% (n = 266) and 20.7% (n = 467), respectively. Those with HFpEF were associated with lower three-months cumulative all-cause mortality compared to those with HFrEF (7.6% vs. 5.9%; adjusted odds ratio (aOR) = 0.54, 95% confidence interval (CI): 0.31-0.95; p = 0.031), but not significantly different when compared to those with HFmrEF (aOR = 0.86, 95% CI: 0.53-1.40; p = 0.554). There were largely no significant differences among the groups with regards to the 12-months all-cause cumulative mortality (11% vs. 11% vs. 10%; p = 0.984). There were also no significant differences in re-hospitalization rates between the three HF groups not only at three months (23% vs. 20% vs. 22%; p = 0.520), but at one-year follow-up (28% vs. 30% vs. 32%; p = 0.335). Conclusions: Three-month cumulative all-cause mortality was high in diabetic HFrEF patients when compared to those with HFpEF. However, there were no significant differences in mortality at one-year follow-up between the HF groups. There were also no significant differences in re-hospitalization rates between the HF groups not only at three months but also at one-year follow-up in the Middle East. [ABSTRACT FROM AUTHOR]

Aims: This study aims to evaluate the incidence and impact of cardiorenal anaemia syndrome (CRAS) on all-cause mortality in acute heart failure (AHF) patients stratified by left ventricular ejection fraction (LVEF) status in the Middle East., Methods and Results: Data were analysed from 4934 consecutive patients admitted to 47 hospitals in seven Middle Eastern countries (Saudi Arabia, Oman, Yemen, Kuwait, United Arab Emirates, Qatar, and Bahrain) with AHF from February to November 2012. CRAS was defined as AHF with estimated glomerular filtration rate of <60 mL/min and low haemoglobin (<13 g/dL for men or <12 g/dL for women). Analyses were performed using univariate and multivariate statistical techniques. The overall mean age of the cohort was 59 ± 15 years, 62% (n = 3081) were men, and 27% (n = 1319) had CRAS. Co-morbid conditions were common including hypertension (n = 3014; 61%), coronary artery disease (n = 2971; 60%), and diabetes mellitus (n = 2449; 50%). A total of 79% (n = 3576) of the patients had AHF with reduced ejection fraction (HFrEF) (LVEF < 50%). CRAS patients were associated with major bleeding (1.29% vs. 0.6%; P = 0.017), blood transfusion (10.1% vs. 3.0%; P < 0.001), higher re-admission rate for AHF at 3 months' follow-up (27.6% vs. 18.8%; P < 0.001) and at 12 months' follow-up (34.3% vs. 26.2%; P < 0.001). Multivariate logistic regression demonstrated that patients with CRAS were associated with higher odds of all-cause mortality during hospital admission [adjusted odds ratio (aOR), 2.10; 95% confidence interval (CI): 1.34-3.31; P = 0.001], at 3 months' follow-up (aOR, 1.48; 95% CI: 1.07-2.06; P = 0.018), and at 12 months' follow-up (aOR, 1.45; 95% CI: 1.12-1.87; P = 0.004). Stratified analyses showed that CRAS patients with HFrEF were associated with higher odds of all-cause mortality during hospital admission (aOR, 2.03; 95% CI: 1.20-3.45; P = 0.009) and at 12 months' follow-up (aOR, 1.42; 95% CI: 1.06-1.89; P = 0.019) but not at 3 months' follow-up (aOR, 1.43; 95% CI: 0.98-2.09; P = 0.063). However, in AHF patients with preserved ejection fraction (LVEF ≥ 50%), CRAS was not associated with higher odds of all-cause mortality not only during hospital admission (aOR, 2.15; 95% CI: 0.84-5.55; P = 0.113) but also at 3 months' follow-up (aOR, 1.87; 95% CI: 0.93-3.76; P = 0.078) and at 12 months' follow-up (aOR, 1.59; 95% CI: 0.91-2.76; P = 0.101)., Conclusions: The incidence of CRAS was 27%. CRAS was associated with higher odds of all-cause mortality in AHF patients in the Middle East, especially in those with HFrEF., (© 2018 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.)

The molecular epidemiology and mechanisms of resistance of carbapenem-resistant Acinetobacter baumannii (CRAB) were determined in hospitals in the states of the Cooperation Council for the Arab States of the Gulf (Gulf Cooperation Council [GCC]), namely, Saudi Arabia, United Arab Emirates, Oman, Qatar, Bahrain, and Kuwait. Isolates were subjected to PCR-based detection of antibiotic resistance genes and repetitive sequence-based PCR (rep-PCR) assessments of clonality. Selected isolates were subjected to multilocus sequence typing (MLST). We investigated 117 isolates resistant to carbapenem antibiotics (either imipenem or meropenem). All isolates were positive for OXA-51. The most common carbapenemases were the OXA-23-type, found in 107 isolates, followed by OXA-40-type (OXA-24-type), found in 5 isolates; 3 isolates carried the ISAba1 element upstream of blaOXA-51-type. No OXA-58-type, NDM-type, VIM-type, or IMP-type producers were detected. Multiple clones were detected with 16 clusters of clonally related CRAB. Some clusters involved hospitals in different states. MLST analysis of 15 representative isolates from different clusters identified seven different sequence types (ST195, ST208, ST229, ST436, ST450, ST452, and ST499), as well as three novel STs. The vast majority (84%) of the isolates in this study were associated with health care exposure. Awareness of multidrug-resistant organisms in GCC states has important implications for optimizing infection control practices; establishing antimicrobial stewardship programs within hospital, community, and agricultural settings; and emphasizing the need for establishing regional active surveillance systems. This will help to control the spread of CRAB in the Middle East and in hospitals accommodating transferred patients from this region., (Copyright © 2015, American Society for Microbiology. All Rights Reserved.)

The molecular epidemiology and mechanisms of resistance of carbapenem-resistant Enterobacteriaceae (CRE) were determined in hospitals in the countries of the Gulf Cooperation Council (GCC), namely, Saudi Arabia, United Arab Emirates, Oman, Qatar, Bahrain, and Kuwait. Isolates were subjected to PCR-based detection of antibiotic-resistant genes and repetitive sequence-based PCR (rep-PCR) assessments of clonality. Sixty-two isolates which screened positive for potential carbapenemase production were assessed, and 45 were found to produce carbapenemase. The most common carbapenemases were of the OXA-48 (35 isolates) and NDM (16 isolates) types; 6 isolates were found to coproduce the OXA-48 and NDM types. No KPC-type, VIM-type, or IMP-type producers were detected. Multiple clones were detected with seven clusters of clonally related Klebsiella pneumoniae. Awareness of CRE in GCC countries has important implications for controlling the spread of CRE in the Middle East and in hospitals accommodating patients transferred from the region., (Copyright © 2014, American Society for Microbiology. All Rights Reserved.)