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Migraine headache is a common, chronic, debilitating disease with a complex etiology. Current therapy for migraine headache comprises either treatments targeting acute migraine pain or prophylactic therapy aimed at increasing the length of time between migraine episodes. Recent evidence suggests that calcium gene-related peptide (CGRP) is a critical component in the pathogenesis of migraines. Fremanezumab, a monoclonal antibody against CGRP, was recently approved by the Food and Drug Administration (FDA) after multiple studies showed that it was well-tolerated, safe, and effective in the treatment of migraines. Further research is needed to elucidate the long-term effects of fremanezumab and CGRP-antagonists in general, and additional data is required in less healthy patients to estimate its effects in these populations and potentially increase the eligible group of recipients. This is a comprehensive review of the current literature on the efficacy and safety of fremanezumab for the treatment of chronic migraine. In this review we provide an update on the epidemiology, pathogenesis, diagnosis, and current treatment of migraine, and summarize the evidence for fremanezumab as a treatment for migraine.

The first case of COVID-19 was identified in Libya on 24/3/2020, and about 2 months later, the number of reported COVID-19 cases started to increase notably. The outbreak was first prominent in the southern region (Sabha) and then spread to the western and eastern parts of Libya. By 24/12/2020, the reported total number of deaths from COVID-19 reached 1415. There seems to be no published data on the size of the epidemic in Libya. Here, we estimated the number of Libyans exposed to COVID-19 by using a COVID-19 mortality adjusted mathematical model for the spread of infectious diseases. We estimated that 14–20% of the Libyan population have been exposed to the COVID-19 pandemic. Thus, the risk of spread of COVID-19 infections during the coming months is high, and a considerable number of Libyans, particularly the elderly and people with chronic diseases, should be protected against COVID-19 infection. This is particularly urgent in the light of unofficial reports that the relevant healthcare facilities are under extreme stress.

Doing research when resources are severely limited will always be challenging. But by sharing resources, collaborating internationally as well as locally, developing sustainable research lines and optimizing study concept and design, researchers can significantly increase their research output and enhance its quality.

Transactions of the London and Middlesex Archaeological Society, 2.30, 176-179

Dear Editor, Having read the article “Birth incidence of cerebral palsy in Tripoli, Libya: a population-based study,” published in issue 1 of volume 5 (2021) of Khalij-Libya Journal of Dental and Medical Research, I would like to express some concerns. First, the aim of the study stated at the end of the introduction is “to assess the prevalence and the most common causes for birth cerebral palsy ...” In the methods section, it states that “the study included a total of 200 patients of whom 64 were diagnosed with cerebral palsy,” without describing the inclusion and exclusion criteria for the 200 patients. But no prevalence rate based on the study is given anywhere in the main body of the paper: only the potential causes of cerebral palsy are described.

Having been experiencing years of political fragmentation and military conflict, Libya was poorly prepared to meet the challenges of the COVId-19 pandemic. Nevertheless, restriction of travel and social distancing rules were put in place days before the first case was detected. During the next two months, the number of cases grew gradually to 77 cases, followed by a rapid spread that has produced 3691 confirmed cases and 80 deaths by the end of July 2020. The turning point on 26 May 2020 was preceded three weeks earlier by the arrival of the first of a series of flights repatriating Libyans who became stranded abroad when air travel was suspended. In the first weeks of the surge, the number of cases was particularly high in the less densely populated southern region, raising questions about the implementation of social distancing and other protective measures in that region. The epidemic in Libya was modeled using the classical Susceptible-Exposed-Infected-Recovered (SEIR) mathematical model of infectious disease epidemics. Three scenarios were developed based on three estimates of the fraction of the population exposed to the disease (1.5, 2.5 and 3.5%). The modeling portrays the peak of the epidemic around early August and estimates that the number of deaths will flatten out around early November at between 250 and 600, depending on the parameter employed. More deaths than those estimated implies that it is more widespread than assumed. Greater promotion of awareness and understanding of social distancing practices and their value is needed, particularly in the south, and better protection of the elderly should decrease mortality.

IntroductionAcute clinical stroke trials are challenging to communicate to patients and families considering participation. Response adaptive randomization (RAR) is a technique that alters the proportion of trial subjects receiving active treatment, based on the outcomes of previous subjects. We aimed to determine how well interactive videos would improve understanding of a simulated acute stroke trial scenario that incorporated a design with RAR.MethodsWe performed a cross-sectional study of emergency department patients who were without stroke, altered mental status, or critical illness. Subjects viewed a hypothetical stroke and clinical trial scenario. They were randomized into one of four groups with either an RAR or fixed randomization clinical trial design and with either a standard consent video, or an interactive video.Results:We enrolled 720 participants. In the RAR group with interactive video, 128 out of 149 (85.9%) of the subjects were able to correctly identify the allocation method, compared to the 172 out of 285 (61.6%) in the RAR group with the uninterrupted video for an absolute increase of 25.6% (95% Cl 17-33%). The RAR group with interactive video had a higher odds of correct identification of allocation method (O.R. 2.767, 95% Cl [1.011 – 7.570] while controlling for age, sex, ethnicity, education, self-reported understanding of protocol, stroke awareness and agreement to participate in trial.Conclusions:The interactive video increased participant understanding of an RAR design in a simulated stroke scenario. Future research should focus on whether acute trial recruitment can be enhanced using similar techniques.

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SummaryHuman consanguinity is often attributed to poverty, lack of education and social insecurity. Nevertheless, kin unions continue to be arranged in socioeconomically transformed societies. This study examined the structure of families and marriages in the rich tribal society of the United Arab Emirates, which has had a high gross domestic product for the last two generations and currently has one of the highest in the world. The respondents were 217 national medical students whose families are proportionally distributed to the population of the country emirates. The rate of parental consanguinity (defined as a union of any two cousins) was 36%. The social status and mean size of consanguineous and non-consanguineous families were not significantly different. In non-consanguineous families, polygamy was more common and the number of half-siblings per family was higher. The extended families were on average 7% larger among non-consanguineous families. In contrast, for the extended families of the participants’ grandparents, non-consanguineous families were smaller than their consanguineous counterparts. Participants from consanguineous families indicated that marriage of either a son or daughter was more difficult to arrange than did participants from non-consanguineous families. Though consanguineous parents had their offspring marry consanguineously more often than non-consanguineous parents, the numbers of married offspring in the two groups of families were not different. Consanguineous parents have more difficulty than non-consanguineous parents in finding spouses for themselves and for their offspring, and they arranged kin marriages for their children more often.

Background: It is well established that Libya is lagging behind its peers in biomedical research. The aim of this study is to analyse all the original biomedical publications affiliated with Libya from 1973 to 2007. Methods: PubMed and the Science Citation Index Expanded were searched for 'original research' biomedical studies affiliated with Libya. The generated data were hand searched and 329 'original research' studies were included in the analysis. Results: The first study was published in 1973. Publication rate peaked to an average of 15.2 studies per year during 1986-1996 and dropped to an average of 8.8 studies per year during 1997-2007. Of 166 first authors; 41% were Libyans and 59% were expatriates. The latter contributed 104 studies between 1986 and 1996 and 36 studies between 1997 and 2007, while the Libyans contributed 63 and 61 studies in the two respective periods. Authors affiliated with Benghazi produced 67% of the published studies, while authors from Tripoli produced 30% and other medical schools, hospitals and research centres from other Libyan cities produced only 3%. Conclusion: This study showed a decline in biomedical research publication in Libya. We propose that the lack of a research culture among the Libyan medical professionals is one of the factors contributing to this decline, which coincided with the departure of expatriate doctors from Libya. Raising awareness of the importance of research and improving research skills among Libyan medical professionals may help to reverse the current trend.

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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

ABSTRACT 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-Hodgkin's 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.

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

Systematic review of the frequency and clinical pattern of Guillain-Barre 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 is an effective immunotherapy for CD20-positive B-cell non-Hodgkin's lymphoma. However, some patients show resistance, particularly those suffering from more aggressive lymphoma types, such as Burkitt's 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.

We have previously described the development of cloning vectors for the production of OprI-based outer membrane fusion proteins in E. coli (Cornelis et al., 1996) and now describe the construction of a new vector, containing a lacI(q) gene, resulting in tight repression of the promotor and allowing its use in other Gram (-) bacteria. The new pVUB3 expression vector encodes a truncated but active LacI(q)(341) repressor which binds to the single operator in the vector. A high repression of the trc promotor was observed, resulting in a very low basal leakage of expression and very high production levels of OprI or derivatives after IPTG induction in E. coli. Bacterial viability was not affected under uninduced conditions, but the number of viable cell counts decreased after production of large amounts of the outer membrane-bound OprI lipoprotein and its derivatives, both in E. coli and Salmonella typhimurium. This highly repressible system allows us to extend the use of OprI vectors in other Gram (-) bacteria, resulting in the production of outer membrane-bound lipid-modified molecules, opening the possibility for its application in the design of potential live Salmonella-based subunit vaccines.