Medical research and publications are the back-bone for advancing the medical field. We identifie... more Medical research and publications are the back-bone for advancing the medical field. We identified the Pubmed medical publications that are affiliated with Libya to shed some light on the contribution of this country's medical community to the PubMed database. All publications affiliated with Libya in the PubMed were counted over a five year period ending December 2006. We also used the same method to obtain data on the PubMed medical publications from Tunisia, Morocco and Yemen. Tunisia had the largest number of PubMed publications among the studied countries: 20.4 publications per million population per year and 7.2 publications per year per one billion US$ GDP. Libya had much fewer publications: 2.4 publications per million population per year and 0.4 publications per one billion US$ GDP. The citation frequency for Libyan published research was very low compared to Tunisian and Moroccan related research. This preliminary analysis shows that medical research output in Libya is about twenty times less than in other countries with similar backgrounds, and that it needs to be enhanced.
To The Editor: Having read Dr Benamer's views on medical teaching, we remembered our days as... more To The Editor: Having read Dr Benamer's views on medical teaching, we remembered our days as medical students [1]. We share Dr Benamer's and other's views that teaching in Libyan medical schools should shift from being subject focused to being learning focused [1,2]. We ...
Background: Treatment of idiopathic membranous nephropathy with nephrotic syndrome is still contr... more Background: Treatment of idiopathic membranous nephropathy with nephrotic syndrome is still controversial. There is currently little known about the clinical use of renal biomarkers which may explain contradictory results obtained from clinical trials. In order to assess whether IgG-uria can predict the outcome in membranous nephropathy, we examined the value of baseline EF-IgG in predicting remission and progression of nephrotic syndrome. Methods: In a prospective cohort of 84 (34 female) idiopathic membranous nephropathy patients with nephrotic syndrome we validated the ability of the clinically available urine biomarker, IgG, to predict the risk of kidney disease progression and the beneficial effect of immunosuppression with steroids and cyclophosphamide. The fractional excretion of IgG (FE-IgG) and α1-microglobulin (FE-α1m), urine albumin/creatinine ratio, and eGFR were measured at the time of kidney biopsy. Primary outcome was progression to end stage kidney failure or kidney function (eGFR) decline ≥ 50% of baseline. Patients were followed up for 7.2 ± 4.1 years (range 1-16.8).
contribute to the understanding of the poor renal survival in Urine excretion of protein HC in pr... more contribute to the understanding of the poor renal survival in Urine excretion of protein HC in proteinuric glomerular dispatients with glomerular diseases and nonselective proteinuria. eases correlates to urine IgG but not to albuminuria.
Background. Proteinuria is the hallmark of glomerular disease and non-selective proteinuria is of... more Background. Proteinuria is the hallmark of glomerular disease and non-selective proteinuria is often associated with progression to renal failure. The predictive value of urine IgG excretion was studied comprehensively in patients with nephrotic syndrome. In the present follow-up study, we examine the predictive value of IgG-uria in patients with idiopathic glomerular diseases with a wide range of proteinuia. Methods. A total of 189 (113 males and 76 females) patients with idiopathic glomerulonephritis and serum creatinine of less than 150 μ mol/L diagnosed between 1993 and 2004 were followed up to their last visit in 2009. Measurement of urine excretion of albumin, IgG, and protein HC were performed in the early morning of spot urine samples collected at the time of the diagnostic renal biopsy. Patients were stratifi ed according to urine protein concentrations and the progression rate to end-stage renal disease (ESRD) calculated using Kaplan -Meier survival analysis. ESRD was defi ned as the start of renal replacement therapy. Results. During the study follow-up time of 1429 person-years; 26 (13.8%) patients reached ESRD. The overall mean kidney survival time of studied patients with serum creatinine less than 150 were 13.4 years. The incidence rate of ESRD was ∼ 18 per 1000 person-years. Stratifi ed analysis identifi ed urinary excretion of IgG, but not albuminuria, as predictor of ESRD. The progression rate to ESRD was 36 per 1000 person-years in patients with urine IgG concentration exceeding 5 mg/mmol urine creatinine, compared to a progression rate of 6/1000 person-years for patients with lower levels of urine IgG. Conclusion . The fi ndings of the study suggest that at early stages, the level of IgG-uria is useful to be used in risk stratifi cation of patients with proteinuric glomerular diseases.
The proteinuria selectivity index (SI) describes changes of the glomerular permeability for macro... more The proteinuria selectivity index (SI) describes changes of the glomerular permeability for macromolecules. In the present study, we examine the implications of SI as a diagnostic (199 patients) and a prognostic (49 patients) marker in glomerular diseases. Using SI based on a -macroglobulin (a -M-SI) or on IgM (IgM-SI) we found that minimal change nephropathy 2 2 could be discriminated by low SI values and crescentic necrotizing glomerulonephritis by high SI values compared to other diseases. SI based on IgG (IgG-SI) was less useful in determining specific diagnoses. During a follow-up of 46 months creatinine clearance (Cr cl) decreased 36% in a group of patients with high IgG-SI ( . 0.2) and 38% in a group of patients with high IgM-SI 23 23
To The Editor: Having read Dr Benamer's views on medical teaching, we remembered our days as... more To The Editor: Having read Dr Benamer's views on medical teaching, we remembered our days as medical students [1]. We share Dr Benamer's and other's views that teaching in Libyan medical schools should shift from being subject focused to being learning focused [1,2]. We ...
page number not for citation purpose) ae EDITORIAL Libyan J Med 2013. # 2013 Omran Bakoush et al.... more page number not for citation purpose) ae EDITORIAL Libyan J Med 2013. # 2013 Omran Bakoush et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License (https://creativecommons.org/licenses/by-nc/3.0/), permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Monocyte chemoattractant protein-1 (MCP-1), which is up regulated in kidney diseases, is consider... more Monocyte chemoattractant protein-1 (MCP-1), which is up regulated in kidney diseases, is considered a marker of kidney inflammation. We examined the value of urine MCP-1 in predicting the outcome in idiopathic glomerulonephritis. Between 1993 and 2004, 165 patients (68 females) diagnosed with idiopathic proteinuric glomerulopathy and with serum creatinine <150 µmol/L at diagnosis were selected for the study. Urine concentrations of MCP-1 were analyzed by ELISA in early morning spot urine samples collected on the day of the diagnostic kidney biopsy. The patients were followed until 2009. The progression rate to end-stage kidney disease was calculated using Kaplan-Meier survival analysis. End-stage kidney disease (ESKD) was defined as the start of kidney replacement therapy during the study follow-up time. Patients with proliferative glomerulonephritis had significantly higher urinary MCP-1 excretion levels than those with non-proliferative glomerulonephritis (p<0.001). The percentage of patients whose kidney function deteriorated significantly was 39.0% in the high MCP-1 excretion group and 29.9% in the low MCP-1 excretion group. However, after adjustment for confounding variables such as glomerular filtration rate (GFR) and proteinuria, there was no significant association between urine MCP-1 concentration and progression to ESKD, (HR=1.75, 95% CI=0.64-4.75, p=0.27). Our findings indicate that progression to end-stage kidney disease in patients with idiopathic glomerulopathies is not associated with urine MCP-1 concentrations at the time of diagnosis.
Background. Severe long-standing hypertension is associated with an increased urinary protein exc... more Background. Severe long-standing hypertension is associated with an increased urinary protein excretion. Methods. To investigate the mechanisms of this proteinuria, we measured the glomerular clearances and calculated the glomerular sieving coefficients (y) for neutral albumin (y o-alb ) and for native albumin (y alb ) in spontaneously hypertensive rats (SHR) at the ages of 3, 9 and 14 months, in comparison with age-matched normal control Wistar rats (NCR). The hypothesis was that increases in the glomerular permeability of both negatively charged and neutral albumin would indicate a preferential size-selective dysfunction of the glomerular capillary wall (GCW), while an increased permeability to negatively charged albumin, as compared with neutral albumin, predominantly would indicate a charge-selectivity dysfunction of the GCW. A tissue (renal) uptake technique together with urinary sampling was used to assess y. The glomerular filtration rate was assessed using the plasma to urine clearance of 51 Cr-EDTA. Results. The y alb in SHR increased 2.6 times at 14 months of age as compared with at 3 months, while there was no significant change of y alb in NCR with age. Furthermore, the increased y alb in old SHR correlated significantly with an increase in y o-alb (r ¼ 0.86, P<0.001), suggesting that albuminuria in old SHR primarily results from an increased number of rather unselective ('large') pores in the glomerular filter.
Background. The transport of large proteins across the glomerular capillary wall (GCW) may increa... more Background. The transport of large proteins across the glomerular capillary wall (GCW) may increase several fold in glomerular diseases. The occurrence of IgM in urine is a consequence of the presence of large defects or shunts in the GCW, whereas albuminuria is probably a result of an altered charge-and sizeselectivity of the GCW. In order to examine whether patho-morphological differences in¯uence the renal outcome in proteinuric glomerulopathies, we examined urinary excretion of IgM and albumin as prognostic markers of glomerular disease.
Background. Renal function at diagnosis is a strong predictor not only of renal survival but also... more Background. Renal function at diagnosis is a strong predictor not only of renal survival but also of patient survival of those with anti-neutrophil cytoplasmic antibody (ANCA)-associated small vessel vasculitis (ASVV). Apart from the renal function at diagnosis, there are no other established risk factors for renal outcome in ASVV. We have previously reported that in other forms of glomerular diseases, an increased urine excretion of IgM is an early marker of poor renal outcome. Methods. In this single-centre observational study, the prognostic significance of urine IgM excretion and other selected prognostic markers was studied in 83 consecutive patients (49 males, 34 females) with ASVV with renal involvement. Results. Patient survival at 1 and 5 years was 93 and 77%, respectively, and the corresponding figures for renal survival censored for death were 84 and 76%.
Background Immunoglobulin A nephritis (IgAN) is the most common primary glomerulonephritis worldw... more Background Immunoglobulin A nephritis (IgAN) is the most common primary glomerulonephritis worldwide. It is caused by accumulation of IgA1-containing immune complexes in the kidney resulting in renal failure, which is thought to be due to altered glycosylation of IgA with a decrease of 2-3-sialylated galactosides (NeuAcα2-3Gal).
Background: In clinical practice there is need for a simple and reliable test for determination o... more Background: In clinical practice there is need for a simple and reliable test for determination of impaired renal function. With reductions in GFR, the plasma cystatin C concentration (C, mg/l) will increase earlier than serum creatinine, and it is generally agreed that plasma cystatin C is only little affected by body weight, age or sex. However, some reports indicate that cystatin C may be influenced not only by GFR, but also by malignancy, inflammation and high doses of corticosteroids. The aim of the present study was to investigate how plasma cystatin C predicts GFR in distinct subcategories of patients with various disorders as well as in organ transplant patients. Methods: Plasma cystatin C was measured in 536 patients (age range 0.3 -96 years, 262 females, 274 males), consecutively referred to our hospital for determination of GFR by iohexol clearance. Correlations of log GFR vs. log cystatin C were used to compare plasma cystatin C and mea-
Background: Micro-albuminuria is a recognized predictor of cardiovascular morbidity and mortality... more Background: Micro-albuminuria is a recognized predictor of cardiovascular morbidity and mortality in patients with coronary artery disease. We have previously reported, in diabetic and non-diabetic patients, that an increased urinary excretion of IgM is associated with higher cardiovascular mortality. The purpose of this study was to investigate the pattern of urinary IgM excretion in patients with acute coronary syndrome (ACS) and its correlation to cardiovascular outcome.
Medical research and publications are the back-bone for advancing the medical field. We identifie... more Medical research and publications are the back-bone for advancing the medical field. We identified the Pubmed medical publications that are affiliated with Libya to shed some light on the contribution of this country&#39;s medical community to the PubMed database. All publications affiliated with Libya in the PubMed were counted over a five year period ending December 2006. We also used the same method to obtain data on the PubMed medical publications from Tunisia, Morocco and Yemen. Tunisia had the largest number of PubMed publications among the studied countries: 20.4 publications per million population per year and 7.2 publications per year per one billion US$ GDP. Libya had much fewer publications: 2.4 publications per million population per year and 0.4 publications per one billion US$ GDP. The citation frequency for Libyan published research was very low compared to Tunisian and Moroccan related research. This preliminary analysis shows that medical research output in Libya is about twenty times less than in other countries with similar backgrounds, and that it needs to be enhanced.
To The Editor: Having read Dr Benamer's views on medical teaching, we remembered our days as... more To The Editor: Having read Dr Benamer's views on medical teaching, we remembered our days as medical students [1]. We share Dr Benamer's and other's views that teaching in Libyan medical schools should shift from being subject focused to being learning focused [1,2]. We ...
Background: Treatment of idiopathic membranous nephropathy with nephrotic syndrome is still contr... more Background: Treatment of idiopathic membranous nephropathy with nephrotic syndrome is still controversial. There is currently little known about the clinical use of renal biomarkers which may explain contradictory results obtained from clinical trials. In order to assess whether IgG-uria can predict the outcome in membranous nephropathy, we examined the value of baseline EF-IgG in predicting remission and progression of nephrotic syndrome. Methods: In a prospective cohort of 84 (34 female) idiopathic membranous nephropathy patients with nephrotic syndrome we validated the ability of the clinically available urine biomarker, IgG, to predict the risk of kidney disease progression and the beneficial effect of immunosuppression with steroids and cyclophosphamide. The fractional excretion of IgG (FE-IgG) and α1-microglobulin (FE-α1m), urine albumin/creatinine ratio, and eGFR were measured at the time of kidney biopsy. Primary outcome was progression to end stage kidney failure or kidney function (eGFR) decline ≥ 50% of baseline. Patients were followed up for 7.2 ± 4.1 years (range 1-16.8).
contribute to the understanding of the poor renal survival in Urine excretion of protein HC in pr... more contribute to the understanding of the poor renal survival in Urine excretion of protein HC in proteinuric glomerular dispatients with glomerular diseases and nonselective proteinuria. eases correlates to urine IgG but not to albuminuria.
Background. Proteinuria is the hallmark of glomerular disease and non-selective proteinuria is of... more Background. Proteinuria is the hallmark of glomerular disease and non-selective proteinuria is often associated with progression to renal failure. The predictive value of urine IgG excretion was studied comprehensively in patients with nephrotic syndrome. In the present follow-up study, we examine the predictive value of IgG-uria in patients with idiopathic glomerular diseases with a wide range of proteinuia. Methods. A total of 189 (113 males and 76 females) patients with idiopathic glomerulonephritis and serum creatinine of less than 150 μ mol/L diagnosed between 1993 and 2004 were followed up to their last visit in 2009. Measurement of urine excretion of albumin, IgG, and protein HC were performed in the early morning of spot urine samples collected at the time of the diagnostic renal biopsy. Patients were stratifi ed according to urine protein concentrations and the progression rate to end-stage renal disease (ESRD) calculated using Kaplan -Meier survival analysis. ESRD was defi ned as the start of renal replacement therapy. Results. During the study follow-up time of 1429 person-years; 26 (13.8%) patients reached ESRD. The overall mean kidney survival time of studied patients with serum creatinine less than 150 were 13.4 years. The incidence rate of ESRD was ∼ 18 per 1000 person-years. Stratifi ed analysis identifi ed urinary excretion of IgG, but not albuminuria, as predictor of ESRD. The progression rate to ESRD was 36 per 1000 person-years in patients with urine IgG concentration exceeding 5 mg/mmol urine creatinine, compared to a progression rate of 6/1000 person-years for patients with lower levels of urine IgG. Conclusion . The fi ndings of the study suggest that at early stages, the level of IgG-uria is useful to be used in risk stratifi cation of patients with proteinuric glomerular diseases.
The proteinuria selectivity index (SI) describes changes of the glomerular permeability for macro... more The proteinuria selectivity index (SI) describes changes of the glomerular permeability for macromolecules. In the present study, we examine the implications of SI as a diagnostic (199 patients) and a prognostic (49 patients) marker in glomerular diseases. Using SI based on a -macroglobulin (a -M-SI) or on IgM (IgM-SI) we found that minimal change nephropathy 2 2 could be discriminated by low SI values and crescentic necrotizing glomerulonephritis by high SI values compared to other diseases. SI based on IgG (IgG-SI) was less useful in determining specific diagnoses. During a follow-up of 46 months creatinine clearance (Cr cl) decreased 36% in a group of patients with high IgG-SI ( . 0.2) and 38% in a group of patients with high IgM-SI 23 23
To The Editor: Having read Dr Benamer's views on medical teaching, we remembered our days as... more To The Editor: Having read Dr Benamer's views on medical teaching, we remembered our days as medical students [1]. We share Dr Benamer's and other's views that teaching in Libyan medical schools should shift from being subject focused to being learning focused [1,2]. We ...
page number not for citation purpose) ae EDITORIAL Libyan J Med 2013. # 2013 Omran Bakoush et al.... more page number not for citation purpose) ae EDITORIAL Libyan J Med 2013. # 2013 Omran Bakoush et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License (https://creativecommons.org/licenses/by-nc/3.0/), permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Monocyte chemoattractant protein-1 (MCP-1), which is up regulated in kidney diseases, is consider... more Monocyte chemoattractant protein-1 (MCP-1), which is up regulated in kidney diseases, is considered a marker of kidney inflammation. We examined the value of urine MCP-1 in predicting the outcome in idiopathic glomerulonephritis. Between 1993 and 2004, 165 patients (68 females) diagnosed with idiopathic proteinuric glomerulopathy and with serum creatinine &amp;amp;amp;amp;amp;amp;amp;amp;lt;150 µmol/L at diagnosis were selected for the study. Urine concentrations of MCP-1 were analyzed by ELISA in early morning spot urine samples collected on the day of the diagnostic kidney biopsy. The patients were followed until 2009. The progression rate to end-stage kidney disease was calculated using Kaplan-Meier survival analysis. End-stage kidney disease (ESKD) was defined as the start of kidney replacement therapy during the study follow-up time. Patients with proliferative glomerulonephritis had significantly higher urinary MCP-1 excretion levels than those with non-proliferative glomerulonephritis (p&amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). The percentage of patients whose kidney function deteriorated significantly was 39.0% in the high MCP-1 excretion group and 29.9% in the low MCP-1 excretion group. However, after adjustment for confounding variables such as glomerular filtration rate (GFR) and proteinuria, there was no significant association between urine MCP-1 concentration and progression to ESKD, (HR=1.75, 95% CI=0.64-4.75, p=0.27). Our findings indicate that progression to end-stage kidney disease in patients with idiopathic glomerulopathies is not associated with urine MCP-1 concentrations at the time of diagnosis.
Background. Severe long-standing hypertension is associated with an increased urinary protein exc... more Background. Severe long-standing hypertension is associated with an increased urinary protein excretion. Methods. To investigate the mechanisms of this proteinuria, we measured the glomerular clearances and calculated the glomerular sieving coefficients (y) for neutral albumin (y o-alb ) and for native albumin (y alb ) in spontaneously hypertensive rats (SHR) at the ages of 3, 9 and 14 months, in comparison with age-matched normal control Wistar rats (NCR). The hypothesis was that increases in the glomerular permeability of both negatively charged and neutral albumin would indicate a preferential size-selective dysfunction of the glomerular capillary wall (GCW), while an increased permeability to negatively charged albumin, as compared with neutral albumin, predominantly would indicate a charge-selectivity dysfunction of the GCW. A tissue (renal) uptake technique together with urinary sampling was used to assess y. The glomerular filtration rate was assessed using the plasma to urine clearance of 51 Cr-EDTA. Results. The y alb in SHR increased 2.6 times at 14 months of age as compared with at 3 months, while there was no significant change of y alb in NCR with age. Furthermore, the increased y alb in old SHR correlated significantly with an increase in y o-alb (r ¼ 0.86, P<0.001), suggesting that albuminuria in old SHR primarily results from an increased number of rather unselective ('large') pores in the glomerular filter.
Background. The transport of large proteins across the glomerular capillary wall (GCW) may increa... more Background. The transport of large proteins across the glomerular capillary wall (GCW) may increase several fold in glomerular diseases. The occurrence of IgM in urine is a consequence of the presence of large defects or shunts in the GCW, whereas albuminuria is probably a result of an altered charge-and sizeselectivity of the GCW. In order to examine whether patho-morphological differences in¯uence the renal outcome in proteinuric glomerulopathies, we examined urinary excretion of IgM and albumin as prognostic markers of glomerular disease.
Background. Renal function at diagnosis is a strong predictor not only of renal survival but also... more Background. Renal function at diagnosis is a strong predictor not only of renal survival but also of patient survival of those with anti-neutrophil cytoplasmic antibody (ANCA)-associated small vessel vasculitis (ASVV). Apart from the renal function at diagnosis, there are no other established risk factors for renal outcome in ASVV. We have previously reported that in other forms of glomerular diseases, an increased urine excretion of IgM is an early marker of poor renal outcome. Methods. In this single-centre observational study, the prognostic significance of urine IgM excretion and other selected prognostic markers was studied in 83 consecutive patients (49 males, 34 females) with ASVV with renal involvement. Results. Patient survival at 1 and 5 years was 93 and 77%, respectively, and the corresponding figures for renal survival censored for death were 84 and 76%.
Background Immunoglobulin A nephritis (IgAN) is the most common primary glomerulonephritis worldw... more Background Immunoglobulin A nephritis (IgAN) is the most common primary glomerulonephritis worldwide. It is caused by accumulation of IgA1-containing immune complexes in the kidney resulting in renal failure, which is thought to be due to altered glycosylation of IgA with a decrease of 2-3-sialylated galactosides (NeuAcα2-3Gal).
Background: In clinical practice there is need for a simple and reliable test for determination o... more Background: In clinical practice there is need for a simple and reliable test for determination of impaired renal function. With reductions in GFR, the plasma cystatin C concentration (C, mg/l) will increase earlier than serum creatinine, and it is generally agreed that plasma cystatin C is only little affected by body weight, age or sex. However, some reports indicate that cystatin C may be influenced not only by GFR, but also by malignancy, inflammation and high doses of corticosteroids. The aim of the present study was to investigate how plasma cystatin C predicts GFR in distinct subcategories of patients with various disorders as well as in organ transplant patients. Methods: Plasma cystatin C was measured in 536 patients (age range 0.3 -96 years, 262 females, 274 males), consecutively referred to our hospital for determination of GFR by iohexol clearance. Correlations of log GFR vs. log cystatin C were used to compare plasma cystatin C and mea-
Background: Micro-albuminuria is a recognized predictor of cardiovascular morbidity and mortality... more Background: Micro-albuminuria is a recognized predictor of cardiovascular morbidity and mortality in patients with coronary artery disease. We have previously reported, in diabetic and non-diabetic patients, that an increased urinary excretion of IgM is associated with higher cardiovascular mortality. The purpose of this study was to investigate the pattern of urinary IgM excretion in patients with acute coronary syndrome (ACS) and its correlation to cardiovascular outcome.
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