The Libyan doctors' brain drain: an exploratory study

Background: Medical 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. Findings: Seventy-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. Conclusion: The 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

Should we start debating medical ethics in our daily practice?

Comment on: Elmahdi A. Elkhammas. Medical ethics in Libya: where to start? Libyan J Med 2007;1(2);AOP:06120

Scientific publication productivity of Libyan medical schools: a bibliometric study of papers listed in PubMed, 1988-2007

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Diagnostic and prognostic value of proteinuria in chronic renal diseases

To the extent that increased urinary protein excretion is an indicator of alterations of the glomerular capillary wall (GCW) and appearance of tubulointerstitial damage, proteinuria can be a good marker of the overall severity of the glomerular and tubulointerstitial damage, and therefore, the prognosis of glomerular diseases. Studies I, II, and III show that it is the type of proteinuria, rather than the degree of albuminuria, that predicts the progression in renal, proteinuric diseases. For instance, we found that the quantity of urinary IgM correlated to the decrease of glomerular filtration rate (GFR) in primary glomerular diseases,irrespective of the degree of albuminuria. 21% of patients with initial proteinuria with high IgM content developed end-stage renal failure compared to none of the patients with proteinuria with low IgM content. Patients who maintained high urinary IgM excretion during the course of glomerular disease showed a more rapid GFR decline over time compared to patients with maintained low IgM excretion despite persistent high degree of albuminuria. Changes in urinary IgG, but not in albumin excretion, during the course of the glomerular disease, correlated to changes in urinary protein HC excretion. Protein HC is a marker of impairment of the proximal tubular function. In study IV, we observed that patients with type 2 DN had a higher urinary excretion of high molecular weight proteins (IgG and IgM) than patients with type 1 DN, despite similar degree of albuminuria. This suggests partly different patho-physiological mechanisms in diabetic nephropathy (DN) in type 1 and type 2 diabetes mellitus. Patients with type 2 DN have a better preserved ratio of urinary excretion of IgG2/IgG4 than type 1 DN patients, indicating that the charge selectivity is less impaired in type 2 DN. Finally, old but not young hypertensive rats (study V) develop proteinuria as a result of a dysfunction of the glomerular capillary filter, affecting primarily its size-selectivity. The changes are functionally compatible with the appearance in the glomerular barrier of an increased number of unselective pores. Conclusions: During the course of glomerular diseases a maintained low urinary excretion of IgG or IgM indicates a salutary prognosis. Different patho-physiological mechanisms of albuminuria in type 1 and type 2 diabetes have been found, and hypertension induced proteinuria is primarily a size-selective disorder

Increased urine IgM excretion predicts cardiovascular events in patients with type 1 diabetes nephropathy

<p>Abstract</p> <p>Background</p> <p>Diabetic nephropathy, a major complication of diabetes, is characterized by progressive renal injury and increased cardiovascular mortality. An increased urinary albumin excretion due dysfunction of the glomerular barrier is an early sign of diabetic nephropathy. An increased urinary excretion of higher molecular weight proteins such as IgM appears with progression of glomerular injury. We aim here to study the prognostic significance of urine IgM excretion in patients with type 1 diabetes mellitus (type 1 diabetic nephropathy).</p> <p>Methods</p> <p>This is an observational study of 139 patients with type1 diabetes mellitus (79 males and 60 females) under routine care at the diabetic outpatient clinic at the Lund University Hospital. The median follow-up time was 18 years (1 to 22) years. Urine albumin and urine IgM concentration were measured at time of recruitment.</p> <p>Results</p> <p>Overall 32 (14 male and 18 female) patients died in a cardiovascular event and 20 (11 male and 9 female) patients reached end-stage renal disease. Univariate analysis indicated that patient survival and renal survival were inversely associated with urine albumin excretion (RR = 2.9 and 5.8, respectively) and urine IgM excretion (RR = 4.6 and 5.7, respectively). Stratified analysis demonstrated that in patients with different degrees of albuminuria, the cardiovascular mortality rate and the incidence of end-stage renal disease was approximately three times higher in patients with increased urine IgM excretion.</p> <p>Conclusion</p> <p>An increase in urinary IgM excretion in patients with type 1 diabetes is associated with an increased risk for cardiovascular mortality and renal failure, regardless of the degree of albuminuria.</p

Arab nations lagging behind other Middle Eastern countries in biomedical research: a comparative study

<p>Abstract</p> <p>Background</p> <p>Analysis of biomedical research and publications in a country or group of countries is used to monitor research progress and trends. This study aims to assess the performance of biomedical research in the Arab world during 2001–2005 and to compare it with other Middle Eastern non-Arab countries.</p> <p>Methods</p> <p>PubMed and Science Citation Index Expanded (SCI-expanded) were searched systematically for the original biomedical research publications and their citation frequencies of 16 Arab nations and three non-Arab Middle Eastern countries (Iran, Israel and Turkey), all of which are classified as middle or high income countries.</p> <p>Results</p> <p>The 16 Arab countries together have 5775 and 14,374 original research articles listed by PubMed and SCI-expanded, respectively, significantly less (p < 0.001) than the other three Middle Eastern countries (25,643 and 49,110). The Arab countries also scored less when the data were normalized to population, gross domestic product (GDP), and GDP/capita. The publications from the Arab countries also have a significantly lower (p < 0.001) citation frequency.</p> <p>Conclusion</p> <p>The Arab world is producing fewer biomedical publications of lower quality than other Middle Eastern countries. Studies are needed to clarify the causes and to propose strategies to improve the biomedical research status in Arab countries.</p

50% failure rate in final year medical exams; Whose fault is it?

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 remember one incident when our professor showed us an ECG and asked about the diagnosis. He was so furious when none of us was able to make the diagnosis to the extent that he left the lecture room without completing the teaching session. This is just one example among many that illustrates the lack of teaching skills so common in our medical institutions and the poor state of the Teacher-Student relationship.Therefore, it is not surprising that many students prefer not to attend lectures. In our view and from our experience, the formats of the lectures were organised around information designed for students to be memorised rather than learnt (spoon feeding) Which is one of the reasons why many students have found the teaching sessions simply boring and useless.In their attempts to overcome this problem, students tried to find ways to learn; acquiring knowledge through the organisation of discussion groups and seeking the help of senior students when necessary. These discussion groups mimic what has been recently introduced as Problem Based Learning (PBL) [3]. Even though these discussion groups may have lacked direction, they were perceived to be an important factor in the success of many students.Given the poor attendance rates to the lectures, the teachers failed to investigate the reasons behind this and take proactive steps to correct the problem. Because of the lack of teacher analysis and reflection it comes as no surprise that the format and quality of teaching has continued along the same traditional lines with the same problems being continually encountered.The point here is that many of these students went on to become highly successful physicians and surgeons in their working life amongst more modern teaching systems and approaches in the west. So it is logical to conclude that should the methods of teaching and teaching skills improve, the success rate among final year medical students will undoubtedly follow suit.It is our recommendation that in order to improve the success rate amongst students, a more modern way of teaching is urgently required [3]. Teachers first need to recognise that problems exist, and then act proactively to address them [4]. One way is the provision of ‘Train The Trainer’ and other similar courses to increase teaching skills, coupled with more discussion groups, clinical clerks, case presentations, increased student involvement during medical rounds and within lectures, and increased attendance at common procedures. All of the above will surely result in increasing the success rate beyond the current 50% passing rate for final year students

Urinary concentration of monocyte chemoattractant protein-1 in idiopathic glomerulonephritis: a long-term follow-up study.

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