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El-Shabrawi, M. H., and N. M. Kamal, "Burden of pediatric hepatitis C", World Journal of Gastroenterology, vol. 19, issue 44, pp. 7880-7888, 2013. hcv_burden.pdf
, "The burden of neurological conditions in north Africa and the Middle East, 1990-2019: a systematic analysis of the Global Burden of Disease Study 2019.", The Lancet. Global health, 2024. Abstract

BACKGROUND: The burden of neurological conditions in north Africa and the Middle East is increasing. We aimed to assess the changes in the burden of neurological conditions in this super-region to aid with future decision making.

METHODS: In this analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 data, we examined temporal trends of disability-adjusted life-years (DALYs; deaths and disabilities combined), deaths, incident cases, and prevalent cases of 14 major neurological conditions and eight subtypes in 21 countries in the north Africa and the Middle East super-region. Additionally, we assessed neurological DALYs due to 22 potentially modifiable risk factors, within four levels of classification, during the period 1990-2019. We used a Bayesian modelling estimation approach, and generated 95% uncertainty intervals (UIs) for final estimates on the basis of the 2·5th and 97·5th percentiles of 1000 draws from the posterior distribution.

FINDINGS: In 2019, there were 441·1 thousand (95% UI 347·2-598·4) deaths and 17·6 million (12·5-24·7) neurological DALYs in north Africa and the Middle East. The leading causes of neurological DALYs were stroke, migraine, and Alzheimer's disease and other dementias (hereafter dementias). In north Africa and the Middle East in 2019, 85·8% (82·6-89·1) of stroke and 39·9% (26·4-54·7) of dementia age-standardised DALYs were attributable to modifiable risk factors. North Africa and the Middle East had the highest age-standardised DALY rates per 100 000 population due to dementia (387·0 [172·0-848·5]), Parkinson's disease (84·4 [74·7-103·2]), and migraine (601·4 [107·0-1371·8]) among the global super-regions. Between 1990 and 2019, there was a decrease in the age-standardised DALY rates related to meningitis (-75·8% [-81·1 to -69·5]), tetanus (-88·2% [-93·9 to -76·1]), stroke (-32·0% [-39·1 to -23·3]), intracerebral haemorrhage (-51·7% [-58·2 to -43·8]), idiopathic epilepsy (-26·2% [-43·6 to -1·1]), and subarachnoid haemorrhage (-62·8% [-71·6 to -41·0]), but for all other neurological conditions there was no change. During 1990-2019, the number of DALYs due to dementias, Parkinson's disease, multiple sclerosis, ischaemic stroke, and headache disorder (ie, migraine and tension-type headache) more than doubled in the super-region, and the burden of years lived with disability (YLDs), incidence, and prevalence of multiple sclerosis, motor neuron disease, Parkinson's disease, and ischaemic stroke increased both in age-standardised rate and count. During this period, the absolute burden of YLDs due to head and spinal injuries almost doubled.

INTERPRETATION: The increasing burden of neurological conditions in north Africa and the Middle East accompanies the increasing ageing population. Stroke and dementia are the primary causes of neurological disability and death, primarily attributable to common modifiable risk factors. Synergistic, systematic, lifetime, and multi-sectoral interventions aimed at preventing or mitigating the burden are needed.

FUNDING: Bill & Melinda Gates Foundation.

TRANSLATIONS: For the Persian, Arabic and Turkish translations of the abstract see Supplementary Materials section.

Mokdad, A. H., "The burden of mental disorders in the Eastern Mediterranean region, 1990-2015: findings from the global burden of disease 2015 study.", International journal of public health, 2017 Aug 03. Abstract

OBJECTIVES: Mental disorders are among the leading causes of nonfatal burden of disease globally.

METHODS: We used the global burden of diseases, injuries, and risk factors study 2015 to examine the burden of mental disorders in the Eastern Mediterranean region (EMR). We defined mental disorders according to criteria proposed in the diagnostic and statistical manual of mental disorders IV and the 10th International Classification of Diseases.

RESULTS: Mental disorders contributed to 4.7% (95% uncertainty interval (UI) 3.7-5.6%) of total disability-adjusted life-years (DALYs), ranking as the ninth leading cause of disease burden. Depressive disorders and anxiety disorders were the third and ninth leading causes of nonfatal burden, respectively. Almost all countries in the EMR had higher age-standardized mental disorder DALYs rates compared to the global level, and in half of the EMR countries, observed mental disorder rates exceeded the expected values.

CONCLUSIONS: The burden of mental disorders in the EMR is higher than global levels, particularly for women. To properly address this burden, EMR governments should implement nationwide quality epidemiological surveillance of mental disorders and provide adequate prevention and treatment services.

Charara, R., M. Forouzanfar, M. Naghavi, M. Moradi-Lakeh, A. Afshin, T. Vos, F. Daoud, H. Wang, C. El Bcheraoui, I. Khalil, et al., "The Burden of Mental Disorders in the Eastern Mediterranean Region, 1990-2013.", PloS one, vol. 12, issue 1, pp. e0169575, 2017. Abstract

The Eastern Mediterranean Region (EMR) is witnessing an increase in chronic disorders, including mental illness. With ongoing unrest, this is expected to rise. This is the first study to quantify the burden of mental disorders in the EMR. We used data from the Global Burden of Disease study (GBD) 2013. DALYs (disability-adjusted life years) allow assessment of both premature mortality (years of life lost-YLLs) and nonfatal outcomes (years lived with disability-YLDs). DALYs are computed by adding YLLs and YLDs for each age-sex-country group. In 2013, mental disorders contributed to 5.6% of the total disease burden in the EMR (1894 DALYS/100,000 population): 2519 DALYS/100,000 (2590/100,000 males, 2426/100,000 females) in high-income countries, 1884 DALYS/100,000 (1618/100,000 males, 2157/100,000 females) in middle-income countries, 1607 DALYS/100,000 (1500/100,000 males, 1717/100,000 females) in low-income countries. Females had a greater proportion of burden due to mental disorders than did males of equivalent ages, except for those under 15 years of age. The highest proportion of DALYs occurred in the 25-49 age group, with a peak in the 35-39 years age group (5344 DALYs/100,000). The burden of mental disorders in EMR increased from 1726 DALYs/100,000 in 1990 to 1912 DALYs/100,000 in 2013 (10.8% increase). Within the mental disorders group in EMR, depressive disorders accounted for most DALYs, followed by anxiety disorders. Among EMR countries, Palestine had the largest burden of mental disorders. Nearly all EMR countries had a higher mental disorder burden compared to the global level. Our findings call for EMR ministries of health to increase provision of mental health services and to address the stigma of mental illness. Moreover, our results showing the accelerating burden of mental health are alarming as the region is seeing an increased level of instability. Indeed, mental health problems, if not properly addressed, will lead to an increased burden of diseases in the region.

Eknoyan, G., N. Lameire, R. Barsoum, K. - U. Eckardt, A. Levin, N. Levin, F. Locatelli, A. MacLeod, R. Vanholder, R. Walker, et al., "The burden of kidney disease: improving global outcomes.", Kidney international, vol. 66, issue 4, pp. 1310-4, 2004 Oct. Abstract

Chronic kidney disease (CKD) is a worldwide public health problem. There is an increasing incidence and prevalence of patients with kidney failure requiring replacement therapy, with poor outcomes and high cost. There is an even higher prevalence of patients in earlier stages of CKD, with adverse outcomes such as kidney failure, cardiovascular disease, and premature death. Patients at earlier stages of CKD can be detected through laboratory testing and their treatment is effective in slowing the progression to kidney failure and reducing cardiovascular events. The science and evidence-based care of these patients are universal and independent of their geographic location. There is a clear need to develop a uniform and global public health approach to the worldwide epidemic of CKD. It is to this end that a new initiative "Kidney Disease: Improving Global Outcomes" has been established. Its stated mission is "Improve the care and outcomes of kidney disease patients worldwide through promoting coordination, collaboration and integration of initiatives to develop and implement clinical practice guidelines."

Mohamed, M. K., S. Deuffic-Burban, F. Carrat, G. Esmat, A. Ismail, H. El Makhzangy, B. Larouze, I. Abdelbar, A. - R. El-Zayadi, and A. - J. Valleron, "Burden of hepatitis C-related HCC mortality in Egypt due to pre-2000 infections", JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, vol. 21, no. 2, pp. A184, MAR, 2006. Abstract
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Mario, E., D. Hamza, and K. Abdel-Moein, "The Burden of Escherichia coli Pathotypes among Diarrheic Farm Animals: A Possible Zoonotic Relevance", Journal of Advanced Veterinary Research , vol. 13, issue 7, pp. 1376-1380, 2023.
Barsoum, R., "Burden of end-stage kidney disease: North Africa", Clinical nephrology 86 (13), 14, vol. 86, issue 13, pp. 14-18, 2016.
El-Shabrawi, M., M. Salem, maha Abou-Zekri, S. El-Naghi, F. Hassanin, T. El-Adly, and A. El-Shamy, "The burden of different pathogens in acute diarrhoeal episodes among a cohort of Egyptian children less than five years old.", Przeglad gastroenterologiczny, vol. 10, issue 3, pp. 173-80, 2015. Abstract

INTRODUCTION: Diarrhoea continues to cause significant morbidity in Egypt.

AIM: To determine the frequency and distribution of different enteropathogens in acute diarrhoeal episodes, utilising an expanded testing regimen, and to correlate clinical signs and symptoms associated with the detected pathogens.

MATERIAL AND METHODS: The case-control study enrolled 356 patients < 5 years old with acute diarrhoea and 356 age and sex-matched healthy controls. Both cases and controls underwent a full history and physical examination, and provided two rectal swab specimens and a stool sample. Laboratory analysis included stool culture, microscopy, and indirect methods.

RESULTS: Rotavirus was detected in 11% of patients. Enterotoxigenic Escherichia coli (ETEC), Campylobacter, Shigella, and Salmonella were detected in 7%, 3.7%, 1.1%, and 1.4% of patients, respectively; and in 11.1%, 3.1%, 0.6%, and 0.6% of controls, respectively, with no significant statistical difference. Cryptosporidium was detected in 3.9% of cases. Mixed infection was detected in 5.9% of cases and 0.9% of controls, with a significant difference (p < 0.001). No pathogen was detected in 66.3% of cases and in 83.5% of controls. Rotavirus infection was associated with recurrent vomiting, dehydration, and hospitalisation. Bacterial diarrhoea was associated with vomiting (52%) in ETEC infections, fever (80%) in Salmonella infections, mucus (100%) and blood (50%) in stools of Shigella infections, and convulsions (15%) in Campylobacter infections.

CONCLUSIONS: Rotavirus is a prominent cause of diarrhoea among Egyptian children. Despite utilising an expanded testing regimen, more work is still needed for identification of other enteropathogens that constitute other causative agents of diarrhoea.

, "The burden of different pathogens in acute diarrhoeal episodes among a cohort of Egyptian children less than five years old", Przegląd Gastroenterologiczny (Gastroenterology Review), vol. 10, issue 3, pp. 173-80, 2015.
Khalil, I., D. V. Colombara, M. H. Forouzanfar, C. Troeger, F. Daoud, M. Moradi-Lakeh, C. El Bcheraoui, P. C. Rao, A. Afshin, R. Charara, et al., "Burden of Diarrhea in the Eastern Mediterranean Region, 1990-2013: Findings from the Global Burden of Disease Study 2013.", The American journal of tropical medicine and hygiene, vol. 95, issue 6, pp. 1319-1329, 2016 Dec 07. Abstract

Diarrheal diseases (DD) are leading causes of disease burden, death, and disability, especially in children in low-income settings. DD can also impact a child's potential livelihood through stunted physical growth, cognitive impairment, and other sequelae. As part of the Global Burden of Disease Study, we estimated DD burden, and the burden attributable to specific risk factors and particular etiologies, in the Eastern Mediterranean Region (EMR) between 1990 and 2013. For both sexes and all ages, we calculated disability-adjusted life years (DALYs), which are the sum of years of life lost and years lived with disability. We estimate that over 125,000 deaths (3.6% of total deaths) were due to DD in the EMR in 2013, with a greater burden of DD in low- and middle-income countries. Diarrhea deaths per 100,000 children under 5 years of age ranged from one (95% uncertainty interval [UI] = 0-1) in Bahrain and Oman to 471 (95% UI = 245-763) in Somalia. The pattern for diarrhea DALYs among those under 5 years of age closely followed that for diarrheal deaths. DALYs per 100,000 ranged from 739 (95% UI = 520-989) in Syria to 40,869 (95% UI = 21,540-65,823) in Somalia. Our results highlighted a highly inequitable burden of DD in EMR, mainly driven by the lack of access to proper resources such as water and sanitation. Our findings will guide preventive and treatment interventions which are based on evidence and which follow the ultimate goal of reducing the DD burden.

Dwedar, R. A., "Burden of Device-Associated Infections in an Adult Medical and Surgical Intensive Care Units of a Tertiary Care Hospital in Egypt ", The Egyptian Journal of Medical Microbiology, vol. 29, issue 2, pp. 179-186, 2020.
Dwedar, R. A., D. M. El-Wakil, and A. R. Awad, "Burden of Device-Associated Infections in an Adult Medical and Surgical Intensive Care Units of a Tertiary Care Hospital in Egypt", The Egyptian Journal of Medical Microbiology, vol. 29, issue 2, pp. 179-186, 2020. 179-186_vol29no2april2020.pdf
Abdel-moein, K. A., and D. A. Hamza, "The burden of Coxiella burnetii among aborted dairy animals in Egypt and its public health implications.", Acta tropica, vol. 166, pp. 92-95, 2017 Feb. Abstract

Q fever is a zoonotic disease of mounting public health implications. Dairy animals are major reservoir for such disease whereas abortion is the main clinical outcome. The current study was conducted to investigate the burden of C. burnetii abortions among dairy animals in Egypt to provide more knowledge for better control of such disease. For this purpose, placental cotyledons and vaginal discharges from 108 aborted dairy animals (27 sheep, 29 goats, 26 cattle, 26 buffaloes) were examined for the presence of C. burnetii by nested PCR. Serum samples from 58 human contacts were examined for the presence of C. burnetii IgG antibodies using ELISA. Out of the 108 examined animals only one goat yielded positive result in both placental tissue and vaginal discharges with an overall prevalence 0.9% while that among goats is 3.4%. Moreover, the seroprevalence of C. burnetii IgG antibodies among the examined individuals was 19% whereas the prevalence in farmers is significantly higher than that among veterinarians and veterinary assistants. In conclusion, C. burnetii may play a role in dairy goat abortions rather than other dairy animals in Egypt while its public health implications cannot be ruled out.

Abdel-moein, K. A., and D. Hamza, "The burden of Coxiella burnetii among aborted dairy animals in Egypt and its public health implications", Acta Tropica, vol. 166, pp. 92-95, 2017.
Barsoum, R. S., "Burden of chronic kidney disease: North Africa.", Kidney international supplements, vol. 3, issue 2, pp. 164-166, 2013 May. Abstract

North Africa (NAF) is composed of six countries located in the African Sahara, namely the Western Sahara, Morocco, Algeria, Tunisia, Libya, and Egypt. Common features between these countries include similar climate, ecology, population genetics, and the socioeconomic environment. This commonality reflects on the chronic kidney disease (CKD) profile in these countries. While there are some estimates on the epidemiology of end-stage kidney disease, that of earlier stages is unknown. Several national screening programs are currently addressing this issue, such as the EGIPT-CKD project in Egypt and the MAREMAR study in Morocco. Preliminary results from the former suggest a prevalence of proteinuria in 10.6% of the relatives of patients on regular dialysis treatment. Despite the lack of reliable registries, it was possible to gather information on the etiology of CKD by direct contact with leading nephrologists in those countries. It turns out that glomerulonephritis (GN) accounts for 9-20%, diabetes 11-18%, hypertensive nephrosclerosis 10-35%, chronic interstitial nephritis 7-17%, and polycystic disease 2-3%. Compared to two decades earlier, diabetes has become more common at the expense of GN, proliferative GN, and amyloidosis regressed in favor of IgA and membranous nephropathies in Tunisian adults. Conventional schistosomal nephropathies are regressing in favor of hepatitis C viral (HCV) nephropathy in Egyptians. Focal segmental glomerulosclerosis is increasing at the expense of proliferative GNs in the region at large. Access to regular dialysis has been optimized during the past decade, with favorable outcomes despite the high incidence of HCV infection, tuberculosis, and protein-calorie malnutrition. Kidney transplantation is available in all NAF countries except the Western Sahara. About 650 transplants are performed annually from live donors, the majority in Egypt, where data from the largest center in Mansoura display a 10-year graft survival of 62%. Many transplants are performed from living unrelated donors, particularly in Egypt, which creates an ethical debate. Legislation for deceased-donor transplantation has been passed successively over the past two decades in Tunisia, Morocco, Algeria, and Egypt, which is expected to reflect quantitatively and qualitatively on the transplantation activity in the near future.

Greco, L., L. Timpone, A. Abkari, M. Abu-Zekry, T. Attard, F. Bouguerr, P. Cullufi, A. Kansu, D. Micetic-Turk, Z. Mišak, et al., "Burden of Celiac Disease in the Mediterranean Area", World Journal of Gastroenterology, vol. 17, issue 45, pp. 4971-4978, 2011. AbstractCU-PDF

Aim: To estimate the burden of undiagnosed celiac disease (CD) in the Mediterranean area in terms of morbidity, mortality and health cost.

Soliman, A. R., A. Fathy, and S. Khashab, "the burden of anti-HCV genotype 4 positivity in renal transplant recipients 8 years follow up", int urol nephrol, vol. 45, issue 2013, pp. 1453-1461, 2013.
, "The burden of anti-HCV genotye-4 positivity in renal transplant recipients: 8 years follow-up. ", International Nephrology Urology, vol. 45, issue 5, pp. 1453-61, 2013.
, "The burden of anti-HCV genotye-4 positivity in renal transplant recipients: 8 years follow-up.", Int Urol Nephrol, vol. 45, issue 5, pp. 1453-1461, 2013.
Anwar, E., G. Hamdy, E. Taher, E. Fawzy, S. Abdulattif, and M. H. Attia, "Burden and Outcome of Vitamin D Deficiency Among Critically Ill Patients: A Prospective Study", Nutrition in Clinical Practice, vol. Volume 32 , issue 3, pp. 378– 384, 2017. vit_d_in__icu__final_.pdf
Anwar, E., G. Hamdy, E. Taher, E. Fawzy, S. Abdulattif, and M. H. Attia, "Burden and Outcome of Vitamin D Deficiency Among Critically Ill Patients: A Prospective Study", Nutrition in Clinical Practice, vol. Volume 32 , issue 3, pp. 378– 384, 2017. vit_d_in__icu__final_.pdf