Middle East Research Articles

Long-Term Evaluation of Aerosol Optical Properties in the Levantine Region: A Comparative Analysis of AERONET and Aqua/MODIS

The focus on aerosol analysis in the Levantine Region is driven by climate-change impacts, the region’s increasing urban development and industrial activities, and its geographical proximity to major dust-source areas. This study conducts a comparative analysis of aerosol optical depth data from Aqua/MODIS and AERONET during different periods between 2003 and 2023 at four stations: IMS-METU-ERDEMLI (Mersin/Türkiye) (2004–2019), CUT-TEPAK (Limassol/Cyprus) (2010–2023), Cairo_EMA_2 (Cairo/Egypt) (2010–2023), and SEDE_BOKER (Sede Boker/Israel) (2003–2023). The objective is to evaluate the variability and reliability of AOD measurements between satellite and ground-based observations and to determine how well they represent regional climatology. The highest percentage of measurements within the expected error envelope was observed at the IMS-METU-ERDEMLI station, indicating the best agreement between MODIS and AERONET data at this location. The Seasonal-Trend Decomposition using Loess (STL) method revealed consistent spring and summer peaks influenced by dust transport from the Sahara and the Middle East, with lower values in winter. The study also considers the influence of cloud fraction on MODIS measurements and includes aerosol classification. A statistically significant slight positive trend in AOD values was identified at the IMS-METU-ERDEMLI station. Conversely, no significant trends were detected at the other stations. The results of this study agree with those of previous research on the impact of long-range dust transport on regional aerosol loadings, emphasizing the importance of integrating satellite and ground-based observations.

How Do Simulations Affect Career Decision Making? The Case of “Model Turkish Diplomacy”

Simulations are now long-established pedagogical tools in IR programs. Concomitant with this development, scholarly attention has been devoted to the impact of IR simulations on students. Recent research has found evidence to suggest that there is an association between IR simulations and students’ aspirations toward political and diplomatic careers. However, despite abundant research, we still have little knowledge about how IR simulations impact students’ perceptions of the diplomacy profession in general and the role of universities in this profession specifically. This study aims to fill these gaps by analyzing whether and how students’ opinions on the diplomacy profession and the role of universities in building diplomatic skills change after participating in “Model Turkish Diplomacy” simulations. It particularly focuses on how simulation experiences impact career decision-making processes among IR students. This study used a quasi-experimental design. Via convenience sampling, data was collected through pre- and post-simulation (online) survey questionnaires submitted to undergraduate IR students at Yildiz Technical University who enrolled in the courses “The Middle East Society and Politics” and “Diplomatic Correspondence” and volunteered to participate in simulations in the fall semester of 2023–2024.

Retinopathy risk factors in patients with type 2 diabetes on liraglutide.

Liraglutide, a glucagon-like peptide 1 receptor agonist, effectively treats type 2 diabetes(T2D) by lowering glucose levels, suppressing glucagon release, and promoting insulin secretion. Liraglutide has been shown to reduce body weight and glycated hemoglobin (HbA1c) levels and improve cardiovascular outcomes. However, evidence regarding the association between liraglutide and diabetic retinopathy in the Middle East is insufficient. Therefore, this study aimed to investigate the characteristics and risk factors of diabetic retinopathy in patients with T2D treated with liraglutide in Saudi Arabia. This retrospective cohort study was conducted on patients (≥14 years) with T2D treated with liraglutide between 2015 and 2021, who had a documented retinopathy assessment at baseline before liraglutide initiation and during follow-up, at King Abdulaziz Medical City (KAMC), Riyadh. Data collection included demographic information, retinopathy status, body mass index (BMI), and HbA1c level at baseline and follow-up after liraglutide use. The study included 181 patients with a mean age of 58.2 (9.8) years. Of these, 72.9% were females. At baseline, the median weight (interquartile range) was 88 (77-100) kg, diabetes duration was 19 (13-23.5) years, and HbA1c level was 9% (8-10%). Total of 69.6% were on insulin, 22.7% were on oral hypoglycemic agents, and 7.7% were on no other medications in addition to liraglutide. After a median of 2 years follow-up, both HbA1c level and weight decreased significantly (P < .001). Seventy-one of the 87 patients (81.6%) without retinopathy at baseline continued to show no retinopathy. Among patients with retinopathy at baseline, 25.5% showed improvement and 44.7% showed no change. In the multivariate binary mixed effect analysis, factors significantly associated with retinopathy were: use of insulin (odds ratio [OR]:2.68; 95% confidence interval [CI]: 1.18-6.09, P = .019), older age (OR:1.03; 95% CI: 1.00-1.06; P = .022), higher HbA1c level (OR:1.17; 95% CI: 1.02-1.34; P = .024), Hypertension (OR:2.56; 95% CI: 1.13-5.76; P=<.0001) and longer diabetes duration (OR:1.04; 95% CI: 1.00-1.08; P = .024). In conclusion, liraglutide use caused significant reductions in the HbA1c level and weight of patients with T2D. Most patients showed no change in retinopathy status after liraglutide use.

The Egyptian Campaign and the Middle East

The Egyptian Campaign and the Middle East

Epidemiology of carbapenemase-producing Enterobacterales carriage in a paediatric tertiary health care centre of Ontario, Canada

Introduction: The epidemiology of carbapenemase-producing Enterobacterales (CPE) in hospitalized children in low endemicity settings is not well known. We aim to describe it in a large tertiary paediatric health care centre in Canada. Methods: A repeated point-prevalence study including all inpatients was conducted at the Hospital for Sick Children, Toronto, for surveillance purposes over 3 days serially in April 2017, April 2019, and April 2022. Patients in the emergency department and medical day units were excluded. Stools or rectal swabs were analyzed for CPE identification, with confirmatory testing at the provincial reference laboratory. Results: We detected CPE colonization in 0.4% (1/242), 0.7% (2/278), and 0.9% (2/220) of inpatients in 2017, 2019, and 2022, respectively. Identified CPE included OXA-48-like and NDM beta-lactamases in Escherichia coli and Klebsiella pneumoniae. All patients with CPE colonization had a history of travel or hospitalization outside of Canada, including in the Middle East and Asia. Discussion: CPE colonization in children hospitalized in this Canadian hospital was detected. A history of prolonged travel or hospitalization outside of Canada are risk factors that should be considered in targeted screening programs.

Drivers of change in social contracts: Building a conceptual framework

ABSTRACT Social contracts have recently re-emerged as a field of research. They can stabilize the relationship between state and society by establishing some predictability about the mutual deliverables between actors - especially if they are flexible for modifications to take account of changes in the framework conditions, the positions and preferences of their parties, and prevailing norms, values and ideologies. The question is, thus, when, why and how social contracts change. We argue that they change more continuously in countries with institutionalized mechanisms of renegotiation, such as parliamentary debates, open public discourse and interest group lobbying. These are more often democratic countries even if changes in democratic countries can also happen suddenly and unexpectedly. Autocratic countries, though, tend to be more resistant to regular change because they lack the procedures and mechanisms. This includes most countries in the Middle East and North Africa. Here, significant changes usually only take place if something unforeseen happens, such as a price shock, a pandemic, an earthquake or an invasion by a foreign country. At these ‘critical junctures’, at least one key actor in a country – often but not always the government – must react. This actor can, but does not have to, change its previous course.

Description of Sheep Pox Outbreak in Spain in 2022-2023: Challenges Found and Lessons Learnt in Relation with Control and Eradication of This Disease.

Sheep pox and goat pox are infectious viral diseases that affect ovine and caprine animals and are caused by two viruses of the family Poxviridae, genus Capripoxvirus. Sheep pox has been traditionally endemic in Africa, the Middle East, and several Southeast Asian countries, but it is considered a transboundary disease capable of affecting previously free countries epidemically. It is a disease of compulsory immediate notification to the World Organization for Animal Health (WOAH) and the European Union (EU). On 19 September 2022, the disease reemerged in Spain, which had been free of it since 1968, causing a total of 30 outbreaks until 17 May 2023, when the last outbreak of the disease was reported. The control and eradication measures implemented were those laid down in EU legislation, based on the total stamping out of positive herds, zoning and restriction of movement, and strengthening of biosecurity and passive surveillance. This manuscript describes the outbreak, as well as assesses the challenges and lessons learned in relation to its management, with the aim of helping in the effective management of future outbreaks of this disease.

Identification, Characterization, and Homology Analysis of a Novel Strain of the Crimean-Congo Hemorrhagic Fever Virus from Yunnan, China.

Wildlife serve as potential microbial reservoirs, accounting for approximately 70% of emerging infectious diseases. Crimean-Congo hemorrhagic fever virus (CCHFV), which causes Crimean-Congo hemorrhagic fever (CCHF) in humans, is a highly pathogenic tick-borne virus prevalent in several parts of Asia, Africa, and Europe with high case fatality rates. Several CCHFV cases have been reported in Asia, the Middle East, Africa, and Southern and Eastern Europe. The disease is endemic in several parts of western China, particularly Xinjiang. Ticks of the genus Hyalomma have been identified as a principal vector and reservoir for CCHFV, although other tick species may also have a crucial role in maintaining CCHFV in endemic regions. On infection, CCHF begins as a nonspecific febrile illness that can progress to severe hemorrhagic manifestations with a higher case fatality due to the unavailability of vaccines or other therapeutic agents. In this study, we collected tissue samples from a wild dead Chinese serow (Capricornis milneedwardsii) and three Naemorhedus griseuses from Deqin County, Tibetan Autonomous Prefecture, Yunnan, China, to investigate for contagious viruses that could be transmitted to humans. We identified a novel CCHFV strain, YNDQL-415G, in the liver tissue of a dead C. milneedwardsii. We performed nucleotide and amino acid sequence homology on the full-length viral genome. The results revealed significant homology between the viral S segment to that of the Africa1 strain, while the M and L segments showed similarity with the Asia CCHFV strain, indicating potential gene reassortment in the YNDQL-415G strain. The genetic characterization of a novel CCHFV strain from a dead C. milneedwardsii raises concerns about the possibility of a new zoonotic infection. A regular survey program is recommended to track the distribution of wild animals as well as the viruses they may transmit to humans and other domestic mammals in the region.

Predictors of methotrexate adherence and patient's awareness of it in rheumatoid arthritis and its effect on quality of life.

Adherence studies among rheumatoid arthritis (RA) patients, in Egypt and throughout the Middle East region, are lacking. This study aimed to evaluate methotrexate (MTX) adherence in Rheumatoid arthritis (RA) patients and to identify specific non-adherence predictors. A cross-sectional observational study included 300 RA patients who were administered MTX for at least one year. The survey was completed through direct interviews. The demographic patient data were collected (age, education, sex, work status, disease duration, duration of MTX administration and current dose). Patients' adherence to MTX predictors for non-adherence, MTX side effects and functional disability were assessed in the study. Majority of respondents showed good MTX adherence, and more than 50% of patient's experienced MTX side effects. A large percentage of participants showed low knowledge about MTX nature and side effects. Most participants reported no or some difficulty in quality of life-related activities and functional disability. MTX adherence and awareness were positively correlated to many variables, including, age, educational level and disease duration, which in turn has its positive impact on the patient's quality of life. Still, more research is needed to determine the impact of non-adherence on the patient's health outcomes.

Assessing pressure injury knowledge among Jordanian and Turkish nursing students: A cross-cultural comparison

AimPressure injuries, a prevalent issue in healthcare settings, have profound physical and emotional implications for patients and healthcare providers. However, further evidence is needed regarding the level of nursing students’ knowledge of pressure injuries in the Middle East, a region where healthcare is rapidly evolving. This study examines the knowledge levels regarding pressure injuries among nursing students in Jordan and Turkey. Materials and methodsThis cross-sectional study collected data from a randomly selected sample of 282 nursing students studying in two private and two Public Universities in Turkey and Jordan. Data was collected using a demographic survey and the Pressure Ulcer Knowledge Assessment Tool (PUKAT 2.0). ResultsThe overall knowledge scores among students were alarmingly low, with significant differences between Jordanian and Turkish cohorts, with Turkish students scoring higher. Moreover, a significant difference was observed between students' knowledge levels from public and private universities in Jordan, but no difference was found between students of the two Turkish universities. ConclusionThe knowledge gap among nursing students regarding pressure ulcers is a critical issue that needs immediate attention. These findings highlight the urgent need for improved educational strategies and standardized competencies in this aspect. This study strongly advocates for changing teaching strategies and incorporating evidence-based pressure injury prevention education into nursing curricula, interprofessional education initiatives, and continuous professional development for faculty. These measures can significantly enhance nursing students’ knowledge and improve patient care.

Emergence of imported cutaneous leishmaniasis caused by Leishmania major: a case series from Kerala, India.

Cutaneous leishmaniasis (CL) is often considered a 'great imitator' and is the most common form of leishmaniasis. The Leishmania species responsible for CL varies among countries, as these species exhibit specific distribution patterns. The increased mobility of people across countries has resulted in the imported incidences of leishmaniasis caused by non-endemic species of Leishmania. During 2023, we confirmed three CL cases caused by L. major from Kerala, India, and upon detailed investigation, these were identified to be imported from the Middle East and Kazakhstan regions. This is the first report of CL caused by L. major from Kerala. The lesion morphology, detection of anti-rK 39 antibody and Leishmania parasite DNA from the blood samples were the unique observations of these cases. Kerala, being an emerging endemic zone of visceral leishmaniasis (VL) and CL, the imported incidences of leishmaniasis by non-endemic species can pose a significant threat, potentially initiating new transmission cycles of leishmaniasis caused by non-endemic species.

Reinforcing the Resistance: Iran and the Levant in a Multipolar Middle East

Reinforcing the Resistance: Iran and the Levant in a Multipolar Middle East

Mental Health Service Use Among Middle Eastern Migrant Women

Mental Health Service Use Among Middle Eastern Migrant Women

Barriers to maintaining dignity for patients with schizophrenia: A qualitative study.

Since dignity is one of the fundamental rights of each patient, maintaining patients' dignity is essential. Unfortunately, in many cases, particularly among patients with schizophrenia (SCZ), dignity is not fully respected. Nonetheless, there is limited knowledge regarding this matter in Middle Eastern Nations. This study aimed to identify the barriers to maintaining dignity for patients with schizophrenia from the perspective of patients with schizophrenia, their family caregivers, and healthcare personnel. This qualitative study was conducted with patients (n = 16), family caregivers (n = 4), and healthcare personnel (n = 6) who were selected using a purposeful sampling method. The data were collected through semi-structured, in-depth face-to-face interviews until the data reached saturation. Data were analyzed using the Graneheim and Lundman method. The Research Ethics Committee of Urmia University of Medical Sciences (IR.UMSU.REC.1401.099). Analysis of the interviews revealed two main themes and five subthemes as the barriers to maintaining dignity for patients with schizophrenia. The main themes included "Black shadow of stigma" (three subthemes: "Facing the fear and discrimination of others," "Misconceptions in society," and "Social rejection") and "Facing violations" (two subthemes: "Basic human rights violation" and "Negative emotional responses"). Patients' dignity with schizophrenia was at a low level due to the negative attitude of society toward these patients. In this respect, the basic human rights violations, social rejection, and misconceptions were abundant in society and care centers. An in-depth comprehension of the threatening factors affecting dignity can assist policymakers in safeguarding their dignity through effective programs.

The Inflammatory Bowel Disease Middle East Registry: Challenges Faced, and Lessons Learned from Setting Up a Multi-Country Patient Registry

The burden of inflammatory bowel disease is rising globally, including in the Middle East. There is a paucity of real-world data related to the disease and its treatment in many countries in this region. Patient registries can provide real-world evidence of disease incidence and aetiology, treatment and patient outcomes. The authors designed a non-interventional, multicentre registry to evaluate treatment pathways, resource consumption, and clinical outcomes of patients with inflammatory bowel disease in the Middle East. This article describes challenges faced, and lessons learned from setting up the registry. Registry development requires time, effort, expertise, and skills development to be functional and meet international standards. Careful consideration of legal, governance, ethical and financial issues; data protection and control, minimum data set, data quality assurance, data collection methods, inclusion criteria as well as data sources is critical to the development process. Our findings present stakeholders with a guide for the development and implementation of future registries in the Middle East and offer valuable lessons learned that other countries or regions can utilise as they address inflammatory bowel disease burden and establish their own registries.

Do artificial intelligence system adoptions foster production management supply chain performance in pharmaceutical manufacturing firms? An empirical exploring study from the MENA region

PurposeThe goal of this study is to better understand the driving force behind the use of artificial intelligence (AI) in pharmaceutical manufacturing firms (PMFs) that are recognized as developing countries in the Middle East and North Africa (MENA) region that are listed by the Chambers of the Industries of Jordan, the Kingdom of Saudi Arabia, Morocco, and Algeria. Furthermore, the effect of adopting and using AI in managing raw materials (RMs), products, parts, and components for PMFs through supply chains (SCs).Design/methodology/approachA self-administrated questionnaire survey was used to gather data from 95 out of 511 participating managers (e.g. manufacturing, supplying, IT, operational, and logistical managers) utilizing a quantitative technique with a random sample size. In fact, 18.8% of the 89 different manufacturing firms (MFs) in the MENA area responded, with five to six managers from each company. The raw data was analyzed using partial least squares structural equation modeling (PLS-SEM).FindingsThe study’s findings show that the readiness to embrace artificial intelligence (AI) in the production management supply chain performance (PMSCP) of pharmaceutical manufacturing firms in the Middle East and North Africa (MENA) is positively and significantly influenced directly and indirectly by sustainable strategic supplier reliability (SSSR), shipping process dependability (SPD), technological factors (TFs), and infrastructure transformational development capability (ITDC).Originality/valueAs the studied countries are growing economies, such study findings might offer insightful consequences for stakeholders and policymakers regarding the significance of using artificial intelligence system adoptions in pharmaceutical manufacturing enterprises in the MENA region. The managers may also concentrate on the strong positive direct and indirect links between SSSR, SPD, TFs, and ITDC preparedness to accept AI adoption and its applications and systems in supply chain and production management departments and the consequences of informational and product delivery.

Narrative disclosure and earnings quality: what is the nexus? Evidence from emerging countries

PurposeNarrative disclosures offer further elucidation of a company's financial performance beyond what is presented in numerical format. This can assist stakeholders in gaining a deeper comprehension of the elements that impact reported earnings, thereby improving the quality of financial information. The current research explores the impact of narrative disclosure on the earnings quality of firms listed on the Amman Stock Exchange (ASE).Design/methodology/approachAppropriating an index to measure the narrative disclosure level in the research sample firms, the research utilizes an analysis of the textual content of nonfinancial reports and statements issued by the management of the ASE-listed nonfinancial firms between 2013 and 2022. The financial statements issued in the annual financial reports are also adopted to extract data on earnings quality and the controlling variables. The analysis of the data and attainment of the findings necessitate using the panel data.FindingsIt is indicated that narrative disclosure affects earnings quality. To be precise, the greater the narrative disclosure, the lower the absolute value of the voluntary discretionary accruals and thus the higher the quality of accounting earnings.Research limitations/implicationsThe findings contribute to new research on disclosure issues, particularly narrative disclosure, which enhances reader confidence in financial and nonfinancial reports and prevents misleading and manipulated information.Originality/valueThis research helps decision-makers understand the relationship between reports, statements and earnings quality in a firm. It's unique in exploring this relationship, especially in developing countries. The study is the first of its kind in Jordan, known for its economic stability and strategic location in the Middle East, making its findings applicable to similar environments.

Cervical cancer screening by cytology and the burden of epithelial abnormalities in low resource settings: a tertiary-center 42-year study

BackgroundCytological screening remains a high-impact practice, particularly in low-resource settings, for preventing cervical cancer. The examination of screening practices over time and the prevalence of epithelial abnormalities have not been investigated in longitudinal studies in one of the largest countries in the Middle East and Africa.MethodsRoutine healthcare data, between March 1981 and December 2022, were extracted from the database of the Early Cancer Detection Unit in a tertiary referral university hospital in the Greater Cairo Region, Egypt. Cervical smears were obtained using a standardized technique and sent to the cytopathology laboratory for conventional cytology examination by expert pathologists. The anonymous data were analyzed to determine the temporal trend of the number of women screened each year and the prevalence of epithelial abnormalities.ResultsData included the results of satisfactory smears from 95120 women. The mean age (SD) of the women at the time of screening was 38.5 (10.5). None of the included women received an HPV vaccine. Abnormal epithelial cells were reported in 5174 women (5.44%). Of these epithelial abnormalities, the majority were low-grade squamous intraepithelial lesions in 4144 women (4.36%). Other abnormalities included atypical squamous cells in 378 women (0.40%), high-grade squamous intraepithelial lesions in 226 women (0.24%), atypical glandular cells not otherwise specified in 184 women (0.19%), adenocarcinoma in 165 women (0.17%), squamous cell carcinoma in 70 women (0.07%), and atypical glandular cells favoring neoplasms in 7 women (0.01%). Women who were at an early age at first intercourse, those who opted for routine cervical cytology screening, and those who were older at screening were more likely to have epithelial abnormalities. The yearly number of screened women was positively associated with the detection of low-grade squamous intraepithelial lesions (correlation coefficient [95% CI] = 0.84 [0.72, 0.91]) and negatively associated with the detection of squamous cell carcinoma (correlation coefficient [95% CI] = -0.55 [-0.73, -0.29]).ConclusionsThe small number of annually screened Egyptian women and the temporal trend in epithelial abnormalities critically demonstrate the need for establishing and scaling up a structured population-based program to achieve the goal of eliminating cervical cancer.

The Great War in the Middle East from a Poetic Bedouin Perspective: A Close Reading of Two Poems about the Sinai Campaign and the Battles in the Negev During World War I

ABSTRACT Through a close reading of two Bedouin poems about the World War I era, this article examines how Bedouin in northern Sinai and Palestine’s southern coastal plain perceived the moment at which the Ottomans lost their hold over this region. By anchoring symbolic expressions from each poem in their historical, cultural, and poetic contexts, this inquiry sheds some light on the feelings and outlooks of ordinary people in response to the war’s massive transformation of the area in which they lived.

Shaping de Facto Brain Drain A qualitative Enquiry of Push and Pull Factors of Emigration among Algerian Physicians Working Abroad

The aim of this research was to understand the different push and pull factors of physicians’ emigration from Algeria and how they perceived and experienced these factors. A qualitative analysis was conducted with actual emigrants to different countries. The findings were analyzed using a content analysis. A total of eight generalists medical-surgical and medical agreed to take part in this study. The participants were emigrants to the USA, the UK, France, Germany, Canada and the Middle East. Almost all participants agreed that the main drivers of emigration are: working conditions, personal motives and socio-economic factors for both the source and receiving country. Most participants perceive push factors as a source of fear and consider them as imprisonment that poses increased pressure, while pull factors are perceived as an alternative to emancipating from constraint in home country. The push and pull framework is significant in understanding different factors of emigration. Policy-makers need to make efforts to bridge the lacuna between donor and host countries and to reverse these losses into brain gain through in-depth reforms.