An-Najah Staff

Macrovascular complications are common in diabetic hypertensive patients. Appropriate antihypertensive therapy and tight blood pressure control are believed to prevent or delay such complication. Objective: To evaluate utilization patterns of antihypertensive agents and blood pressure (BP) control among diabetic hypertensive patients with and without ischemic heart disease (IHD). Methods: Retrospective cohort study of all diabetic hypertensive patients attending Al-watani medical center from August 2006 until August 2007. Proportions of use of different antihypertensive drug classes were compared for all patients receiving 1, 2, 3, or 4 or more drugs, and separately among patients with and without IHD. Blood pressure control (equal or lower 130/80 mmHg) was compared for patients receiving no therapy, monotherapy, or combination therapy and separately among patients with and without IHD. Results: 255 patients were included in the study; their mean age was 64.4 (SD=11.4) years. Sixty one (23.9%) of the included patients was on target BP. Over 60% of the total patients were receiving angiotensin-converting enzyme inhibitors (ACEI)/ angiotensin receptor blocker (ARB), followed by diuretics (40.8%), calcium channel blockers (25.1%) and beta-blockers (12.5%). The majority (> 55%) of patients were either on mono or no drug therapy. More than 55% of patients with controlled BP were using ACE-I. More than half (50.8%) of the patients with controlled BP were on combination therapy while 42.3% of patients with uncontrolled BP were on combination therapy (p=0.24). More patient in the IHD achieved target BP than those in non-IHD group (p=0.019). Comparison between IHD and non-IHD groups indicated no significant difference in the utilization of any drug class with ACE-I being the most commonly utilized in both groups. Conclusions: Patterns of antihypertensive therapy were generally but not adequately consistent with international guidelines. Areas of improvement include increasing ACE-I drug combinations, decreasing the number of untreated patients, and increasing the proportion of patients with controlled BP in this population. RESUMEN Las complicaciones macrovasculares son frecuentes en pacientes diabéticos hipertensos. Se cree que un apropiado tratamiento antihipertensivo y un control estrecho de la presión arterial previenen o retrasan estas complicaciones. Objetivo: Evaluar los patrones de utilización de antihipertensivos y el control de la presión arterial (PA) en pacientes diabéticos hipertensos con y sin enfermedad isquémica cardiaca (EIC). Métodos: Estudio de cohorte retrospectivo de todos los pacientes diabéticos hipertensos que acudieron al centro médico Al-watani desde agosto 2006 a agosto 2007. Se compararon las proporciones de pacientes que recibían 1,2,3 o 4 o más medicamentos, y por separado los pacientes con y sin EIC. El control de presión arterial (menor o igual a 130/80 mmHg) se comparó en los pacientes recibiendo ningún tratamiento, monoterapia o tratamiento de combinación y por separado los que tenían o no EIC. Resultados: Se incluyeron en el estudio 255 pacientes; su media de edad era de 64,4 (DE=11,4) años. Sesenta y uno (23,9%) de los pacientes incluidos estaban en la presión arterial deseada. Más del 60% del total recibían inhibidores de la enzima convertidor de la angiotensina (IECA)/Antagonistas del receptor de angiotensina (ARA), seguidos de diuréticos (40,8%), bloqueantes de canales de calcio (25,1%), y betabloqueantes (12,5%). La mayoría (más del 55%) estaban en monoterapia o sin tratamiento. Más del 55% de los pacientes con la PA controlada utilizaban IECA. Más de la mitad (50,8%) de los pacientes con la PA controlada estaban con tratamiento de combinación, mientras que el 42,3% de los pacientes con PA descontrolada estaban con tratamiento combinado (p=0,24). Alcanzaron la PA deseada más pacientes del grupo EIC que del grupo no-EIC (p=0,019). La comparación entre los grupos EIC y no-EIC indicó que no había diferencia significativa en la utilización de ningún grupo de medicamentos con los IECA, siendo estos los más utilizados en los dos grupos. Conclusión: Los patrones de utilización de antihipertensivos fueron generalmente no consistentes con las recomendaciones internacionales. Las posibles mejoras incluyen aumentar las combinaciones de los IECA, disminuir la proporciona de pacientes no tratados, y aumentar la proporción de pacientes con PA controlada en esta población.

Middle Eastern countries (ME) are expected to face severe water shortages in the near future. As most conventional water resources are already developed or over exploited, there is a need to develop non-conventional options to bridge water shortages. These options include brackish and sea-water desalination and fresh water imports from outside the region either by sea or land. Technically, non-conventional options are possible and feasible, however, depending on many factors, these options are available at a high capital investment with different costs and are associated with some environmental and ecological impacts and political considerations. Water and other conflicts in the region along with funding problems are the main obstacles to the implementation of such options in the ME. Integrating conventional and non-conventional water development options are found to be a more viable combination on the long term. Cooperation between ME countries is found to be a key factor to overcoming water shortage using non-conventional options. Therefore, it is concluded that non-conventional water options should be encouraged in the region and should be utilized to overcome not only water shortages but also to resolve conflicts and restore economic growth, peace, and stability among regional parties and people.

Middle Eastern countries (ME) are expected to face severe water shortages in the near future. As most conventional water resources are already developed or over exploited, there is a need to develop non-conventional options to bridge water shortages. These options include brackish and sea-water desalination and fresh water imports from outside the region either by sea or land. Technically, non-conventional options are possible and feasible, however, depending on many factors, these options are available at a high capital investment with different costs and are associated with some environmental and ecological impacts and political considerations. Water and other conflicts in the region along with funding problems are the main obstacles to the implementation of such options in the ME. Integrating conventional and non-conventional water development options are found to be a more viable combination on the long term. Cooperation between ME countries is found to be a key factor to overcoming water shortage using non-conventional options. Therefore, it is concluded that non-conventional water options should be encouraged in the region and should be utilized to overcome not only water shortages but also to resolve conflicts and restore economic growth, peace, and stability among regional parties and people.

Introduction Complementary and alternative medicine (CAM) has an important role in supportive cancer care in the Middle East and is often used in association with traditional medicine. This article provides a comprehensive review of published data on CAM research in supportive cancer care in the Middle East.
Methods and results A multi-disciplinary Middle-Eastern Research Group in Integrative Oncology (MERGIO) was established in six countries. Authors independently searched Medline database for articles in Arabic, Hebrew, French, and Turkish using oncology and CAM-related keywords. Articles were recorded according to the first author’s affiliation with an academic or clinical institution in the Middle East.
Results We identified 143 articles on CAM and cancer care that had been published in12 Middle-Eastern countries. Eighty-five articles were directly related to cancer supportive care. The latter included studies on the prevalence of CAM use by patients with cancer, aspects related to of doctor–patient communication, ethics and regulation, psychosocial aspects of CAM, CAM safety and quality assurance, studies of CAM education for health care providers, and ethno-botanical studies and reviews. Twenty-eight articles referred to clinical research on supportive care, and the use of specific CAM modalities that included acupuncture, anthroposophic medicine, dietary and nutritional therapies herbal medicine, homeopathy, mind–body medicine, shiatsu, therapeutic touch, and yoga.
Conclusions CAM-related supportive care research is prevalent in the Middle East, a fact that may serve as a basis for future multinational-multidisciplinary research work in supportive care in oncology.

Fifty three of Middle East avian influenza virus H5N1 strains were retrieved from GenBank Database. Other 23 H5N1 representative strains from Asian, Europe, Africa, and North America were also used in this study. Phylogenetic analysis and pairwise comparison of nucleotide and amino acid sequences of.hemagglutinin (HA) gene region of these strains revealed that the H5N1 viruses circulating in Middle East displayed high similarity. The HA protein of the virus contained multiple basic amino acid residues (QGERRRKKR) or (QGEGRRKKR) adjacent to the cleavage site between the HA1 and HA2 domains, showing the highly pathogenic characteristics. Further analyses of these H5N1 strains showed that all of them carried (Gln) 238Q and (Gly) 240G at the receptor binding pocket which indicates preferential binding to alpha-2,3-NeuAcGal receptors. Phylogenetic analysis also confirmed that these H5N1 viruses belonged to the Qinghai lineage or Astrakhan lineage of highly pathogenic avian influenza (HPAI) viruses H5N1 (subclade 2.2 or EMA). As a result, 2 closely related but distinguishable H5N1 sub-subclades are defined and called (2.2.1 (EMA-1) and 2.2.3 (EMA3).

Objective: To study hemagglutinin genetic evolution of some Middle East (ME) 2009 H1N1 pdm isolates and compared them with prototype vaccine strain (A/California/07/2009 (H1N1)), which is used as a vaccine strain in the Northern Hemisphere 2010-2011.
Methods: Nucleotide and/or amino acid sequences of HA gene of fifty-four of ME 2009 H1N1 pdm isolates were retrieved from GenBank Database by using Basic BLAST engine. Phylogenetic trees were established for both nucleotide and amino acid sequences using the Muscle algorithm of the computer program CLC free workbench 5.6.1 JRE software. Amino acids alignment was also done to compare between sequences HA1 domains of HA genes of ME 2009 H1N1 pdm isolates (n=39) with amino acid sequence of prototype vaccine strain A/California/07/2009 (H1N1).
Results: Phylogenetic analysis of amino acids and nucleotides of the HA gene of the ME 2009 H1N1 pdm isolates confirmed their evolutionary position in cluster with prototype vaccine strain (A/California/07/2009 (H1N1)) which is used as vaccine strain in the Northern Hemisphere 2010-2011. Antigenically, the ME 2009 H1N1 pdm isolates are homogeneous and closely related to prototype vaccine. Only a few amino acid substitutions in the HA among the Middle East 2009 H1N1 pdm isolates analyzed.
Conclusions: The current influenza vaccine is expected to provide a good protection against ME 2009 H1N1 pdm because it contains strains with H1 HA (A/California/07/2009 (H1N1)-like strain