Amin Bredan

Rituximab: modes of action, remaining dispute and future perspective.

Less than two decades ago, immunotherapy joined chemotherapy and radiotherapy as an effective approach for the treatment of cancer. The anti-CD20 monoclonal antibody, rituximab, is now used to treat almost all types of non-Hodgkins B-cell lymphomas, and it could be useful in the treatment of other diseases with B-cell involvement. Upon binding, rituximab induces death of the target cells. It seems to act not only by activating immune system defense mechanisms such as complement-dependent and antibody-dependent cellular cytotoxicity, but also by inducing direct cell death. In this paper, we review current knowledge on rituximab mechanisms of action, with particular attention to its direct effects, and also highlight potential future avenues of research.

The Libyan doctors' brain drain: an exploratory study

BackgroundMedical emigration from developing to developed countries is a well established phenomenon of substantial importance. Though Libya is classified as an upper-middle income country, it has been affected by this trend. This study was undertaken to identify some of the possible reasons behind the emigration of Libyan doctors and factors that might motivate them to return.FindingsSeventy-four completed questionnaires were analysed. Median age of the respondents was 43 years (33-60) and median duration of stay outside Libya was 15 years (6-29). Most of the participants were resident in Europe (66%). The desire to further their education and research was the main reason given by 88% of the respondents for leaving Libya, while 50% of them gave that as the main reason for staying abroad. One-third of the respondents (31%) cited economic factors as the main reason for not returning. None of the respondents ruled out returning to Libya, and about half of them stated that they definitely or probably will return to Libya. 58% ranked reform of the Libyan health system as the most important reason that could induce them to return to Libya.ConclusionThe study shows that reforming the health care system in Libya might induce some of the physicians who moved abroad mainly for educational and economic reasons to return to Libya to practice medicine.

Visibility of Arab countries in the world biomedical literature

Over the last four decades, most Arab countries have undergone considerable development and both undergraduate and postgraduate education have spread and improved. Moreover, the number of journals published in Arab countries has increased, which has provided an outlet for publishing research that is of local importance but is not of much interest to the scientific community at large and, thus, has a small chance of being accepted by well-established journals with a wide readership. However, as Arab countries are part of the developing world, their contribution to the biomedical research literature is modest. (Published: 3 March 2011) Citation: Libyan J Med 2011, 6 : 6325 - DOI: 10.3402/ljm.v6i0.6325

Writing readable prose - When planning a scientific manuscript, following a few simple rules has a large impact

The purpose of a scientific paper is to communicate results and analysis to the wider scientific community. The better a paper is written, the more readers it will attract and the more citations it is likely to receive. This alone should be sufficient to convince any scientist to put significant effort into his or her writing; unfortunately, this is rarely the case. More than a decade ago, Martin Gregory observed in Nature that “There are two kinds of scientific writing: that which is intended to be read, and that which is intended merely to be cited. The latter tends to be infected by an overblown and pompous style. The disease is ubiquitous, but often undiagnosed, with the result that infection spreads to writing of the first type” (Gregory, 1992). It seems that little has changed. The bulk of scientific literature is still almost unreadable, and is usually only read by scientists with a vested interest in the subject. Those who want to read about science for pleasure are advised to pick up the science pages of a newspaper or a popular‐science magazine instead. ![][1] Scientists cannot complain that they lack guidance: there is an abundance of literature on how to write clearly and understandably to attract the interest of the readers. Many journalists and professional authors will have read two standard books on writing good prose: On Writing Well (Zinsser, 1976) and The Elements of Style (Strunk & White, 1959). But these—and other books like them—are unknown to, or ignored by, most scientists. Although such books might not cater explicitly for scientific writing, they are nevertheless valuable as they explain how to organize material in a coherent way, and how to write a manuscript that is both informative and readable. More importantly, such books convey an important message: authors should write … [1]: /embed/graphic-1.gif

Depletion of peripheral blood B cells with Rituximab and phenotype characterization of the recovering population in a patient with follicular lymphoma

The monoclonal antibody Rituximab is useful for treatment of patients with B-cell non-Hodgkins lymphoma. We phenotypically analyzed reconstitution of peripheral B cells in a male patient with follicular lymphoma following their depletion with Rituximab. CD19+ and CD20+ B cell counts in peripheral blood decreased rapidly following Rituximab treatment. Six months after the end of treatment, a few CD19+ B cells were detected in peripheral blood. These cells had a naive B cell phenotype (IgD+, CD27-) and they expressed high levels of CD38 and CD24, which show that the B cell pool was repopulated mainly with immature, naive B cells.

Guillain–Barré syndrome in Arab countries: A systematic review

Systematic review of the frequency and clinical pattern of Guillain-Barré syndrome (GBS) in Arab countries was initiated by a keyword search of PubMed, Medline and Embase and examination of references in all relevant papers. Seven articles were included from Iraq (n=1), Kuwait (n=1), Libya (n=2), and Saudi Arabia (n=3). The only incidence report from the Arab world, a 1987 study from Libya, gives an incidence of 1.7 per 100,000 person-years. Some studies reported that GBS was more common in males and in people in their twenties and thirties. Five studies showed that GBS occurred more frequently during the colder months, and antecedent infection was reported in 26-76% of cases. Most patients had an ascending pattern of weakness and almost all patients had lower limb weakness and reduced or absent reflexes. Facial weakness was the most common cranial nerve involvement. Only one study classified the GBS patients according to electrophysiological findings and reported that 68% of the patients had demyelination type and 15% axonal type. Protein level in cerebrospinal fluid is elevated in most of the GBS patients. Mortality rate from GBS was up to 8%. This systematic review shows an immense deficit in epidemiological data on GBS in Arab countries. The limited data show that clinical pattern, sex and age distribution, reported antecedent infection, and GBS subtypes are similar to those in Western countries. However, further well-designed epidemiological studies on GBS in the Arab world are needed.

Rituximab Synergizes with Hydroxyurea or Vincristine in the Killing of Ramos Burkitt's Lymphoma B Cell Line

Rituximab is an effective immunotherapy for CD20-positive B-cell non-Hodgkins lymphoma. However, some patients show resistance, particularly those suffering from more aggressive lymphoma types, such as Burkitts lymphoma. Hence, Rituximab is commonly combined with several chemotherapeutic drugs. With a view to reduce the number of such drugs, we examined the effect of combining Rituximab individually with hydroxyurea, vincristine, or etoposide on the killing of Ramos Burkitt lymphoma cell line type I. Cell death was examined by using Annexin-V/propidium iodide staining. Combining Rituximab with hydroxyurea or vincristine resulted in a synergistic effect, whereas combining it with etoposide resulted in a subadditive effect. In single treatments, the percentage of cell death ranged from 23% (Rituximab) to 36% (hydroxyurea). Combining Rituximab with hydroxyurea or vincristine resulted in a synergistic effect (83% and 74% killing, respectively). In contrast, only a subadditive effect was noticed with etoposide (36%). We conclude that the synergistic effect of Rituximab with hydroxyurea or vincristine is worthy of further study, and that further in vitro screening of chemotherapeutics might identify chemo-immunotherapeutic combinations that are effective in vivo but less toxic than currently used regimens.

Why should you choose to publish in the Libyan Journal of Medicine

No abstract available. (Published: 21 July 2016) Citation: Libyan J Med 2016, 11 : 32756 -http://dx.doi.org/10.3402/ljm.v11.32756

The epidemiology of myasthenia gravis in Arab countries: a systematic review

The Arab world covers a large geographical area that spans Africa and Asia and has an estimated population of 360 million. Although Arabs live in different countries and possess economic, demographic, and social diversity, the populations of the Arab countries share, to a large extent, similar beliefs, customs, practices, and social behavior. Hence, they are generally considered to be a cohesive unit. Arab countries are defined as members of the Arab league: Algeria, Bahrain, Comoros, Djibouti, Egypt, Iraq, Jordan, Kuwait, Lebanon, Libya, Mauritania, Morocco, Oman, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, United Arab Emirates, and Yemen. Myasthenia gravis (MG) is an autoimmune disorder that impairs neuromuscular transmission and leads to muscle weakness. Determining the frequency of MG in different populations could help to increase our understanding of this condition. We undertook a systematic review of published studies of the epidemiology MG in Arab populations. Publications were identified by searching with the keywords “myasthenia gravis” and “specific country names” in PubMed, Medline (1946 to current), and Embase (1974 to current). References in all relevant studies were searched for additional publications. Only studies with data on the incidence and/or prevalence of MG published before March 30, 2014 and written in English were included. We could identify only 3 articles that fulfilled the inclusion criteria: 2 from Egypt and 1 from Libya. The incidence rate reported from Libya (Table 1) is similar to the worldwide incidence rate of 5.3 per million person-years estimated in a systematic review of population-based studies, but lower than what was considered to be a most accurate estimate of MG incidence rate (30 per million person-years) when 31 studies, mostly European, were reviewed systematically. However, the 6 studies from outside Europe reported annual incidence rates of 3–9 per million persons, which is more consistent with the Libyan study. The Libyan study showed a higher incidence rate of MG in young women and older men, as reported in several other studies. The prevalence rates reported in the 2 Egyptian studies (Table 1) are different from the estimated worldwide rate of 77.7 per million persons derived from a systematic review of population-based studies. It is noteworthy that the 2 Egyptian estimates are quite divergent, even though they were conducted by more or less the same research group of El-Tallawy et al. and used similar methodology (door-to-door survey), and the sizes of the study populations were not greatly different (50,000 and 62,583, respectively). Although the reasons for these variations are not clear, differences in local population genetics coupled with disparities in socioeconomic factors may provide an explanation. One of the Egyptian studies showed a difference in MG prevalence rate between urban and rural populations. This systematic review shows an immense deficit in epidemiological data on MG in Arab countries. Hence, there are many opportunities for further well-designed epidemiological studies on MG.

Why are journals from less-developed countries constrained to low impact factors?

No abstract available! (Published: 15 September 2014) Citation: Libyan J Med 2014, 9 : 25774 - http://dx.doi.org/10.3402/ljm.v9.25774