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Despite a fair amount of progress on understanding human immunodeficiency virus (HIV) epidemiology globally, the Middle East and North Africa (MENA) region is the only region where knowledge of the epidemic continues to be very limited, and subject to much controversy. It has been more than 25 years since the discovery of HIV, but no scientific study has provided a comprehensive data-driven synthesis of HIV/AIDS (acquired immunodeficiency syndrome) infectious spread in this region. The current report provides the first comprehensive scientific assessment and data-driven epidemiological synthesis of HIV spread in MENA since the beginning of the epidemic. It is based on a literature review and analysis of thousands of widely unrecognized publications, reports, and data sources extracted from scientific literature or collected from sources at the local, national, and regional levels. The recommendations provided here focus on key strategies related to the scope of this report and its emphasis on understanding HIV epidemiology in MENA as a whole. The recommendations are based on identifying the status of the HIV epidemic in MENA, through this synthesis, as a low HIV prevalence setting with rising concentrated epidemics among priority populations. General directions for prevention interventions as warranted by the outcome of this synthesis are also discussed briefly, but are not delineated because they are beyond the scope of this report. This report was not intended to provide intervention recommendations for each MENA country.

Angina might persist or reoccur despite successful revascularisation with percutaneous coronary intervention (PCI) and antianginal therapy. Additionally, PCI in stable patients has not been shown to improve survival compared with optimal medical therapy. Trimetazidine is an antianginal agent that improves energy metabolism of the ischaemic myocardium and might improve outcomes and symptoms of patients who recently had a PCI. In this study, we aimed to assess the long-term potential benefits and safety of trimetazidine added to standard evidence-based medical treatment in patients who had a recent successful PCI. We did a randomised, double-blind, placebo-controlled, event-driven trial of trimetazidine added to standard background therapy in patients who had undergone successful PCI at 365 centres in 27 countries across Europe, South America, Asia, and north Africa. Eligible patients were aged 21–85 years and had had either elective PCI for stable angina or urgent PCI for unstable angina or non-ST segment elevation myocardial infarction less than 30 days before randomisation. Patients were randomly assigned by an interactive web response system to oral trimetazidine 35 mg modified-release twice daily or matching placebo. Participants, study investigators, and all study staff were masked to treatment allocation. The primary efficacy endpoint was a composite of cardiac death; hospital admission for a cardiac event; recurrence or persistence of angina requiring an addition, switch, or increase of the dose of at least one antianginal drug; or recurrence or persistence of angina requiring a coronary angiography. Efficacy analyses were done according to the intention-to-treat principle. Safety was assessed in all patients who had at least one dose of study drug. This study is registered with the EU Clinical Trials Register (EudraCT 2010-022134-89). From Sept 17, 2014, to June 15, 2016, 6007 patients were enrolled and randomly assigned to receive either trimetazidine (n=2998) or placebo (n=3009). After a median follow-up of 47·5 months (IQR 42·3–53·3), incidence of primary endpoint events was not significantly different between the trimetazidine group (700 [23·3%] patients) and the placebo group (714 [23·7%]; hazard ratio 0·98 [95% CI 0·88–1·09], p=0·73). When analysed individually, there were no significant differences in the incidence of the components of the primary endpoint between the treatment groups. Similar results were obtained when patients were categorised according to whether they had an elective or urgent PCI. 1219 (40·9%) of 2983 patients in the trimetazidine group and 1230 (41·1%) of 2990 patients in the placebo group had serious treatment-emergent adverse events. Frequencies of adverse events of interest were similar between the groups. Our results show that the routine use of oral trimetazidine 35 mg twice daily over several years in patients receiving optimal medical therapy, after successful PCI, does not influence the recurrence of angina or the outcome; these findings should be taken into account when considering the place of trimetazidine in clinical practice. However, the long-term prescription of this treatment does not appear to be associated with any statistically significant safety concerns in the population studied. Servier.

Coronavirus disease 2019 (COVID-19) has rapidly spread globally, forcing countries to apply lockdowns and strict social distancing measures. The aim of this study was to assess eating habits and lifestyle behaviours among residents of the Middle East and North Africa (MENA) region during the lockdown. A cross-sectional study among adult residents of the MENA region was conducted using an online questionnaire designed on Google Forms during April 2020. A total of 2970 participants from eighteen countries participated in the present study. During the pandemic, over 30 % reported weight gain, 6·2 % consumed five or more meals per d compared with 2·2 % before the pandemic (P < 0·001) and 48·8 % did not consume fruits on a daily basis. Moreover, 39·1 % did not engage in physical activity, and over 35 % spent more than 5 h/d on screens. A significant association between the frequency of training during the pandemic and the reported change in weight was found (P < 0·001). A significantly higher percentage of participants reported physical and emotional exhaustion, irritability and tension either all the time or a large part of the time during the pandemic (P < 0·001). Although a high percentage of participants reported sleeping more hours per night during the pandemic, 63 % had sleep disturbances. The study highlights that the lockdown due to the COVID-19 pandemic caused a variety of lifestyle changes, physical inactivity and psychological problems among adults in the MENA region.

\"What part does the imprisoned activist play in the conflict between regimes and their opponents around the world? Political incarceration today seems to offer the clearest evidence of a repressive regime, and of a determined political opposition. Yet surely there are more effective alternatives, for both states and their opponents, than incarceration. Imprisoned opponents, like those of the African National Congress in South Africa, or of Solidarity in Poland, or of the Irish Republican Army in Northern Ireland, may eventually claim or share power, while those who are executed or exiled will not pose the same threat. From the opposition's point of view, imprisonment, even though it deprives the movement of a valued contributor, is often a badge of honor. Our perceptions of political prisoners are awash in clichés and archetypes. We think of Nelson Mandela, or perhaps Václav Havel: good men, engaged in a moral struggle. But can that really be an acceptable definition, when Adolph Hitler too was a political prisoner? Can we understand what political prisoners are and what they do if we do not include those whose goals or ethics are different from our own? Dance in Chains--the title inspired by a song composed by a socialist on death row in a Warsaw prison 120 years ago--draws upon research in Poland, Ireland, South Africa and includes over a dozen different regimes over the last 150 years. These cases serve as pillars holding up a global investigation of the phenomenon. In each case, generations of political opponents have gone to prison since at least the turn of the twentieth century. Yet they also vary widely. Taken together, they yield a sufficiently wide spectrum to allow the reader to understand one of the central characters of modern political history\"--Provided by publisher.

This study examines the association between air pollution and economic growth based on the idea of environment Kuznets curve (EKC) hypothesis which suggests an inverted U-shaped link between air pollution and economic growth in six different regions including Latin America and the Caribbean, East Asia and the Pacific, Europe and Central Asia, South Asia, the Middle East and North Africa, and Sub-Saharan Africa over the period 2000 to 2018. This regional classification is done to investigate the regional differences of the EKC relationship for carbon emissions. Models based on panel data econometric models are employed to obtain empirical results. Random effect and fixed effect models are used in the present study. A multivariate framework is used in which carbon dioxide emission, per capita gross domestic product, trade openness, foreign direct investment, primary school enrollment, financial development indicator, and institutional quality that is measured by six indicators are included. The result is that the EKC hypothesis is supported in all the abovementioned regions except in the Sub-Saharan Africa region. Thus, the hypothesis that different regions have dissimilar EKC relationships is supported through the results of this research study.

The drying of the Tethys Sea—the progenitor of the modern Mediterranean, Black and Caspian seas—weakened the northern extension of the African monsoon and led to the creation of the Sahara desert about 7 million years ago. Sahara desert much older than we thought Most evidence suggests that the modern Sahara desert first arose between two and three million years ago, coinciding with the initiation of major glaciations in the Northern Hemisphere. This study puts Saharan origins much earlier. Zhongshi Zhang et al . show that the shrinkage of the Tethys Sea — the progenitor of the modern Mediterranean, Black and Caspian seas — weakened the northern extension of the African monsoon and led to the creation of the Sahara desert about seven million years ago. Such a dramatic revision could lead to new investigations of the Sahara in fields as diverse as geology, evolutionary biology and climatology. It is widely believed that the Sahara desert is no more than ∼2–3 million years (Myr) old 1 , with geological evidence showing a remarkable aridification of north Africa at the onset of the Quaternary ice ages 2 , 3 , 4 . Before that time, north African aridity was mainly controlled by the African summer monsoon (ASM) 5 , 6 , 7 , 8 , which oscillated with Earth’s orbital precession cycles. Afterwards, the Northern Hemisphere glaciation added an ice volume forcing on the ASM, which additionally oscillated with glacial–interglacial cycles 2 . These findings led to the idea that the Sahara desert came into existence when the Northern Hemisphere glaciated ∼2–3 Myr ago. The later discovery, however, of aeolian dune deposits ∼7 Myr old 9 suggested a much older age, although this interpretation is hotly challenged 1 and there is no clear mechanism for aridification around this time. Here we use climate model simulations to identify the Tortonian stage (∼7–11 Myr ago) of the Late Miocene epoch as the pivotal period for triggering north African aridity and creating the Sahara desert. Through a set of experiments with the Norwegian Earth System Model 10 and the Community Atmosphere Model 11 , we demonstrate that the African summer monsoon was drastically weakened by the Tethys Sea shrinkage during the Tortonian, allowing arid, desert conditions to expand across north Africa. Not only did the Tethys shrinkage alter the mean climate of the region, it also enhanced the sensitivity of the African monsoon to orbital forcing, which subsequently became the major driver of Sahara extent fluctuations. These important climatic changes probably caused the shifts in Asian and African flora and fauna observed during the same period 4 , 12 , 13 , 14 , with possible links to the emergence of early hominins in north Africa 15 , 16 .