Immunity against Leishmania major requires rapid induction of a type 1 immune response in which t... more Immunity against Leishmania major requires rapid induction of a type 1 immune response in which tumor necrosis factor alpha (TNF-alpha) plays an essential role. Hence, vaccination strategies that simulate the protective immune response found in hosts that have recovered from natural infection provide a rational approach to combat leishmaniasis. One method for optimizing the qualitative and quantitative immune responses after vaccination is to use an adjuvant. In this study we demonstrate that the OprI lipoprotein (L-OprI) from Pseudomonas aeruginosa induces a long-term cellular (gamma interferon [IFN-gamma]) and humoral (immunoglobulin G2a) type 1 immune response against a truncated 32-kDa version (COOHgp63) of the 63-kDa major cell surface glycoprotein gp63. By contrast, immunization with COOHgp63 either fused to OprI nonlipoprotein or with no adjuvant did not result in the induction of type 1 immune responses. The adjuvanticity of L-OprI is strongly dependent on its capacity to induce TNF-alpha, since generation of type 1 immune responses is clearly delayed and impaired in TNF-alpha(-/-) mice. Vaccination with L-OprICOOHgp63 fusion protein protected BALB/c mice against L. major infection for at least 19 weeks. Vaccinated mice were largely free of lesions or clearly controlled lesion size on termination of the experiment. The control of disease progression in mice vaccinated with L-OprICOOHgp63 was associated with enhancement of antigen-specific IFN-gamma production. These data indicate that bacterial lipoproteins constitute appropriate adjuvants to include in vaccines against diseases in which type 1 immune responses are important for protection.
The hematologic values and prevalence of anemia in Libyan school children 6-19 yrs of age were in... more The hematologic values and prevalence of anemia in Libyan school children 6-19 yrs of age were investigated. The mean values of boys followed the normal pattern of rise with age. In girls, the mean values increased with age until age 15 yrs, and subsequently declined. The prevalence of low hemoglobin and of low hematocrit values was 3.2% and 11.3% respectively. The highest prevalence of low hemoglobin in boys and in girls was 4.6% (13-15 yrs) and 6.2% (16-19 yrs) respectively. The highest prevalence of low hematocrit was observed in age group 6-9 yrs in both sexes (boys 17.0%, girls 20.2%). Rates of prevalence of anaemia in Libyan school children were compared with those in Bahrain, Oman and USA.
A significant negative correlation was observed between mean corpuscular volume and erythrocyte c... more A significant negative correlation was observed between mean corpuscular volume and erythrocyte count in school children 6 to 14 years of age. Slopes of regression lines of MCV/RBC were significantly higher in anemics than in nonanemics, but no significant difference was observed between boys and girls.
Less than two decades ago, immunotherapy joined chemotherapy and radiotherapy as an effective app... more 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.
Systematic review of the frequency and clinical pattern of Guillain-Barré syndrome (GBS) in Arab ... more 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.
The monoclonal antibody Rituximab is useful for treatment of patients with B-cell non-Hodgkin's l... more The monoclonal antibody Rituximab is useful for treatment of patients with B-cell non-Hodgkin's 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.
We have previously described the development of cloning vectors for the production of OprI-based ... more 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.
ABSTRACT Nutritional status of Libyan primary school children was assessed in higher (Al‐Andulus,... more ABSTRACT Nutritional status of Libyan primary school children was assessed in higher (Al‐Andulus, A‐A) and lower (Abu‐Saleem, A‐S) socio‐economic areas of Tripoli. Sample size was 160 and 230 respectively, and ages ranged from 6 years to 9 years and 11 months. Linear growth was higher in A‐A children and prevalence of stunting (8.8%) was lower than in A‐S children (17.4%). Weight‐for‐height relationship was similar in the two areas for girls, but it was somewhat higher in A‐A boys than in A‐S boys. Prevalence of obesity was 9.6% in A‐A and 4.6% in A‐S children, but wasting was negligible in both the areas. Mean hemoglobin concentration was 13.7 g/dl in both areas for boys. In girls, it was higher in A‐A (13.8 g/dl) than in A‐S (13.5 g/dl). Prevalence of anemia was 0.6% and 1.3% in A‐A and A‐S respectively.
Rituximab is an effective immunotherapy for CD20-positive B-cell non-Hodgkin&... more 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.
Immunity against Leishmania major requires rapid induction of a type 1 immune response in which t... more Immunity against Leishmania major requires rapid induction of a type 1 immune response in which tumor necrosis factor alpha (TNF-alpha) plays an essential role. Hence, vaccination strategies that simulate the protective immune response found in hosts that have recovered from natural infection provide a rational approach to combat leishmaniasis. One method for optimizing the qualitative and quantitative immune responses after vaccination is to use an adjuvant. In this study we demonstrate that the OprI lipoprotein (L-OprI) from Pseudomonas aeruginosa induces a long-term cellular (gamma interferon [IFN-gamma]) and humoral (immunoglobulin G2a) type 1 immune response against a truncated 32-kDa version (COOHgp63) of the 63-kDa major cell surface glycoprotein gp63. By contrast, immunization with COOHgp63 either fused to OprI nonlipoprotein or with no adjuvant did not result in the induction of type 1 immune responses. The adjuvanticity of L-OprI is strongly dependent on its capacity to induce TNF-alpha, since generation of type 1 immune responses is clearly delayed and impaired in TNF-alpha(-/-) mice. Vaccination with L-OprICOOHgp63 fusion protein protected BALB/c mice against L. major infection for at least 19 weeks. Vaccinated mice were largely free of lesions or clearly controlled lesion size on termination of the experiment. The control of disease progression in mice vaccinated with L-OprICOOHgp63 was associated with enhancement of antigen-specific IFN-gamma production. These data indicate that bacterial lipoproteins constitute appropriate adjuvants to include in vaccines against diseases in which type 1 immune responses are important for protection.
Scientific publication is a vital mission of medical schools and it is important to periodically ... more Scientific publication is a vital mission of medical schools and it is important to periodically document how well schools fulfil this mission. This study aimed to analyse the publication record of Libyan medical schools in international journals indexed in PubMed between 1988 and 2007. Medline was searched using PubMed for publications affiliated to Libya during 1988-2007. Out of 417 papers related to Libya, 348 (84%) are affiliated to the medical schools and related hospitals. More than 60% of the 348 papers are affiliated to Al-Arab Medical University, Benghazi, while Al-Fateh Medical University, Tripoli, contributed 103 papers (30%). The rest of the papers (n=25, 7%) were published by medical schools in other parts of the country. The publication rate declined by 3% annually between 1988 and 2007. The decline was mainly due to a decrease in the publication rate by Al-Arab Medical University, Benghazi. Overall, nine departments produced 10 or more papers each. Out of about 1675 staff members, there are only 148 first authors and 207 last authors. The estimated annual publication rate is 0.7 papers per 100 academic staff members. This study reveals that published scholarship of the Libyan medical schools is extremely low, that the publication rate has declined, and that most academic staff have no publications listed in PubMed. This issue needs urgent attention.
Background: It is well established that Libya is lagging behind its peers in biomedical research.... more 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.
Immunity against Leishmania major requires rapid induction of a type 1 immune response in which t... more Immunity against Leishmania major requires rapid induction of a type 1 immune response in which tumor necrosis factor alpha (TNF-alpha) plays an essential role. Hence, vaccination strategies that simulate the protective immune response found in hosts that have recovered from natural infection provide a rational approach to combat leishmaniasis. One method for optimizing the qualitative and quantitative immune responses after vaccination is to use an adjuvant. In this study we demonstrate that the OprI lipoprotein (L-OprI) from Pseudomonas aeruginosa induces a long-term cellular (gamma interferon [IFN-gamma]) and humoral (immunoglobulin G2a) type 1 immune response against a truncated 32-kDa version (COOHgp63) of the 63-kDa major cell surface glycoprotein gp63. By contrast, immunization with COOHgp63 either fused to OprI nonlipoprotein or with no adjuvant did not result in the induction of type 1 immune responses. The adjuvanticity of L-OprI is strongly dependent on its capacity to induce TNF-alpha, since generation of type 1 immune responses is clearly delayed and impaired in TNF-alpha(-/-) mice. Vaccination with L-OprICOOHgp63 fusion protein protected BALB/c mice against L. major infection for at least 19 weeks. Vaccinated mice were largely free of lesions or clearly controlled lesion size on termination of the experiment. The control of disease progression in mice vaccinated with L-OprICOOHgp63 was associated with enhancement of antigen-specific IFN-gamma production. These data indicate that bacterial lipoproteins constitute appropriate adjuvants to include in vaccines against diseases in which type 1 immune responses are important for protection.
The hematologic values and prevalence of anemia in Libyan school children 6-19 yrs of age were in... more The hematologic values and prevalence of anemia in Libyan school children 6-19 yrs of age were investigated. The mean values of boys followed the normal pattern of rise with age. In girls, the mean values increased with age until age 15 yrs, and subsequently declined. The prevalence of low hemoglobin and of low hematocrit values was 3.2% and 11.3% respectively. The highest prevalence of low hemoglobin in boys and in girls was 4.6% (13-15 yrs) and 6.2% (16-19 yrs) respectively. The highest prevalence of low hematocrit was observed in age group 6-9 yrs in both sexes (boys 17.0%, girls 20.2%). Rates of prevalence of anaemia in Libyan school children were compared with those in Bahrain, Oman and USA.
A significant negative correlation was observed between mean corpuscular volume and erythrocyte c... more A significant negative correlation was observed between mean corpuscular volume and erythrocyte count in school children 6 to 14 years of age. Slopes of regression lines of MCV/RBC were significantly higher in anemics than in nonanemics, but no significant difference was observed between boys and girls.
Less than two decades ago, immunotherapy joined chemotherapy and radiotherapy as an effective app... more 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.
Systematic review of the frequency and clinical pattern of Guillain-Barré syndrome (GBS) in Arab ... more 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.
The monoclonal antibody Rituximab is useful for treatment of patients with B-cell non-Hodgkin's l... more The monoclonal antibody Rituximab is useful for treatment of patients with B-cell non-Hodgkin's 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.
We have previously described the development of cloning vectors for the production of OprI-based ... more 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.
ABSTRACT Nutritional status of Libyan primary school children was assessed in higher (Al‐Andulus,... more ABSTRACT Nutritional status of Libyan primary school children was assessed in higher (Al‐Andulus, A‐A) and lower (Abu‐Saleem, A‐S) socio‐economic areas of Tripoli. Sample size was 160 and 230 respectively, and ages ranged from 6 years to 9 years and 11 months. Linear growth was higher in A‐A children and prevalence of stunting (8.8%) was lower than in A‐S children (17.4%). Weight‐for‐height relationship was similar in the two areas for girls, but it was somewhat higher in A‐A boys than in A‐S boys. Prevalence of obesity was 9.6% in A‐A and 4.6% in A‐S children, but wasting was negligible in both the areas. Mean hemoglobin concentration was 13.7 g/dl in both areas for boys. In girls, it was higher in A‐A (13.8 g/dl) than in A‐S (13.5 g/dl). Prevalence of anemia was 0.6% and 1.3% in A‐A and A‐S respectively.
Rituximab is an effective immunotherapy for CD20-positive B-cell non-Hodgkin&... more 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.
Immunity against Leishmania major requires rapid induction of a type 1 immune response in which t... more Immunity against Leishmania major requires rapid induction of a type 1 immune response in which tumor necrosis factor alpha (TNF-alpha) plays an essential role. Hence, vaccination strategies that simulate the protective immune response found in hosts that have recovered from natural infection provide a rational approach to combat leishmaniasis. One method for optimizing the qualitative and quantitative immune responses after vaccination is to use an adjuvant. In this study we demonstrate that the OprI lipoprotein (L-OprI) from Pseudomonas aeruginosa induces a long-term cellular (gamma interferon [IFN-gamma]) and humoral (immunoglobulin G2a) type 1 immune response against a truncated 32-kDa version (COOHgp63) of the 63-kDa major cell surface glycoprotein gp63. By contrast, immunization with COOHgp63 either fused to OprI nonlipoprotein or with no adjuvant did not result in the induction of type 1 immune responses. The adjuvanticity of L-OprI is strongly dependent on its capacity to induce TNF-alpha, since generation of type 1 immune responses is clearly delayed and impaired in TNF-alpha(-/-) mice. Vaccination with L-OprICOOHgp63 fusion protein protected BALB/c mice against L. major infection for at least 19 weeks. Vaccinated mice were largely free of lesions or clearly controlled lesion size on termination of the experiment. The control of disease progression in mice vaccinated with L-OprICOOHgp63 was associated with enhancement of antigen-specific IFN-gamma production. These data indicate that bacterial lipoproteins constitute appropriate adjuvants to include in vaccines against diseases in which type 1 immune responses are important for protection.
Scientific publication is a vital mission of medical schools and it is important to periodically ... more Scientific publication is a vital mission of medical schools and it is important to periodically document how well schools fulfil this mission. This study aimed to analyse the publication record of Libyan medical schools in international journals indexed in PubMed between 1988 and 2007. Medline was searched using PubMed for publications affiliated to Libya during 1988-2007. Out of 417 papers related to Libya, 348 (84%) are affiliated to the medical schools and related hospitals. More than 60% of the 348 papers are affiliated to Al-Arab Medical University, Benghazi, while Al-Fateh Medical University, Tripoli, contributed 103 papers (30%). The rest of the papers (n=25, 7%) were published by medical schools in other parts of the country. The publication rate declined by 3% annually between 1988 and 2007. The decline was mainly due to a decrease in the publication rate by Al-Arab Medical University, Benghazi. Overall, nine departments produced 10 or more papers each. Out of about 1675 staff members, there are only 148 first authors and 207 last authors. The estimated annual publication rate is 0.7 papers per 100 academic staff members. This study reveals that published scholarship of the Libyan medical schools is extremely low, that the publication rate has declined, and that most academic staff have no publications listed in PubMed. This issue needs urgent attention.
Background: It is well established that Libya is lagging behind its peers in biomedical research.... more 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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Papers by Amin Bredan