Food Insecurity and Food Label Comprehension among Libyan Migrants in Australia.

Food security among migrants and refugees remains an international public health issue. However, research among ethnic minorities in Australia is relatively low. This study explored the factors that influence the understanding of food labelling and food insecurity among Libyan migrants in Australia. An online survey was completed by 271 Libyan migrant families. Data collection included the 18-item US Household Food Security Survey Module (for food security) and a question from the Food Standards Australia New Zealand Consumer Label Survey (for food labelling comprehension). Multivariable logistic regression modelling was utilised to identify the predictors of food label comprehension and food security. Food insecurity prevalence was 72.7% (n = 196) while 35.8% of families (n = 97) reported limited food label understanding. Household size, food store location, and food affordability were found to be significantly related to food insecurity. However, gender, private health insurance, household annual income, education, and food store type and location were found to be significantly related to food labelling comprehension. Despite the population's high educational status and food labelling comprehension level, food insecurity remained an issue among the Libyan migrants. Policy makers should consider the incorporation of food label comprehension within a broader food security approach for migrants.

Detection of Hyalomma rufipes in a recently arrived asylum seeker to the EU.

The importation of novel tick species to Europe and the emergence of tick-borne diseases have been of rising concern over the last decades. In May 2019, a total of 349 asylum seekers arrived in Malta by boat. Public health syndromic surveillance was conducted on all migrant boat arrivals. The incidental finding of a tick with anomalous morphology in a newly arrived migrant in Malta prompted an epidemiological investigation. Morphological identification of the tick followed by species identification using keys specific to North Africa was conducted and molecular testing for Crimean Congo haemorrhagic fever virus (CCHFV) was performed. Detailed interview and clinical examination of the case were conducted on arrival and follow-up interviews were undertaken 1- and 4-weeks post-arrival. A Hyalomma rufipes tick was identified on the chest of a 28-year-old male from Sudan. The patient reported malaise and headache on arrival. No further symptoms were reported during follow-up. There was no evidence of previous CCHFV infection or the presence of other ticks or pathogens on the patient. The investigation revealed that the H. rufipes tick had likely been acquired in Libya. This is the first report of the presence of a H. rufipes tick, the main vector for CCHFV, on a recently arrived migrant in Europe. This event highlights the importance of increasing awareness on the risk of tick-borne infections among recently arrived migrants in the Mediterranean countries and the need to consider tick screening as part of the health screening offered in the EU.

A first insight into genetic diversity of Mycobacterium bovis isolated from extrapulmonary tuberculosis patients in South Tunisia assessed by spoligotyping and MIRU VNTR.

INTRODUCTION: In Tunisia, almost 77% of clinically and bacteriologically diagnosed cases of extrapulmonary tuberculosis (EPTB) are zoonotic TB, caused by M. bovis. Although several studies have analyzed bovine TB in cattle in Tunisia, no study has evaluated the risk of transmission to humans in such an endemic country. We aimed to study the genetic diversity of M. bovis human isolates, to ascertain the causes of human EPTB infection by M. bovis and to investigate the distribution and population structure of this species in Tunisia. MATERIALS AND METHODS: A total of 110 M. bovis isolates taken from patients with confirmed EPTB were characterized by spoligotyping and MIRU-VNTR typing methods. RESULTS: Among the 15 spoligotypes detected in our study, 6 (SB0120, SB0121, SB2025, SB1200, SB1003 and SB0134) were the most prevalent (83.5%) of which SB0120, SB0121 and SB2025 were the most prevailing. MIRU-VNTR typing method showed a high genotypic and genetic diversity. The genetic differentiation based on MIRU-VNTR was significant between populations from South East (Tataouine, Medenine) and Central West (Gafsa, Sidi Bouzid, Kasserine) regions. Of note, 13/15 (86.7%) spoligotypes detected in our study were previously identified in cattle in Tunisia with different frequencies suggesting a peculiar ability of some genotypes to infect humans. Using combined spoligotyping and MIRU-VNTR method, a high clustering rate of 43.9% was obtained. Our results underlined that human EPTB due to M. bovis was more commonly found in female gender and in young patients. Most of our patients, 66.4% (73/110) were raw milk or derivatives consumers, whereas 30.9% (34/110) patients would have contracted EPTB through contact with livestock. The findings suggest that the transmission of Zoonotic TB caused by M. bovis to humans mainly occurred by oral route through raw milk or derivatives. CONCLUSION: Our study showed the urgent need of a better veterinary control with the implementation of effective and comprehensive strategies in order to reach a good protection of animals as well as human health.

Acceptability of post-mortem imaging among Muslim and non-Muslim communities.

OBJECTIVE:: People's views regarding autopsy vary according to their cultural and religious beliefs. This paper aims to determine the opinions towards this procedure among Muslims resident in Libya and Muslims and non-Muslims resident in the UK. Our long-term goal is to improve autopsy rates; whether conventional or through the use of post-mortem imaging. METHODS:: 400 questionnaires were distributed to the three communities, interrogating belief about post-mortem investigations. Descriptive statistics and non-parametric statistics were used to analyse the data. RESULTS:: Of the 400 distributed questionnaires, there was a high return rate of 320 (80%). All groups felt that children should be buried sooner than adults(p < 0.001), but 77% of Libyan Muslims thought that children should be buried within 12 h of death compared to 16% of UK Muslims and only 7% of UK non-Muslims (p < 0.001). More non-Muslims were unconcerned about a negative impact of traditional autopsy on the dignity of the corpse than Muslims (p < 0.001) and more Muslims responded that autopsy has a negative emotional effect on the family (p < 0.001). Type of death altered what sort of investigations were desired. In the case of homicide, Libyan Muslims were less likely to prefer CT (p < 0.001) or MRI (p = 0.001). Sex had no effect on the results of the survey. CONCLUSION:: Post-mortem imaging is acceptable to both Muslims and non-Muslims in Libya and the UK, but Muslims have a significant preference for post-mortem imaging compared to autopsy, except in homicidal cases. ADVANCES IN KNOWLEDGE:: (1) The ability of post-mortem imaging to preserve the dignity of the corpse is independent of religion, however, significantly more Muslims feel that autopsy has a negative emotional effect on the family of the deceased. (2) A significant majority of Muslims in Libya prefer to bury children within 12 h of death, while a delay of up to a week is acceptable in UK. (3) Muslims resident in UK have an attitude closer to that of the indigenous (non-Muslim) population and therefore, educational programmes may be successful in changing attitudes of Muslims in Libya and other predominantly Muslim countries.

[Prevalence of acid burns among asylum seekers hosted in an initial reception centre as an example of health assessment in a fragile population]. / La prevalenza di causticazioni in un centro di prima accoglienza per richiedenti asilo come esempio di valutazione sanitaria in una popolazione fragile.

OBJECTIVES: to evaluate the prevalence of acid burns among asylum seekers hosted in an initial reception centre and to evaluate if the prevalence is reduced after the introduction of the European Union (EU) regulation No. 29 (14th September 2016) that indirectly reduced the permanence time of the subjects on board of boats. DESIGN: cross-sectional study. SETTING AND PARTICIPANTS: 10,627 asylum seekers hosted in the centre for initial reception of Piedmont and Valle d'Aosta Regions (Northern Italy) between June 2016 and May 2017. MAIN OUTCOME MEASURES: frequencies of health problems and prevalence of second and third grade acid burns identified on arrival. RESULTS: among the asylum seekers coming to the centre, about 25% suffered at least from a mild disease, mainly cutaneous, respiratory, or digestive; 69 acid burns were identified (prevalence: 6.7‰, 95%CI 5.2-8.3), mainly located in the lower limbs and in the glutes. Median time between disembarkation and treatment is 2 days. Prevalence is significantly higher in women compared to men and a not-significant 20% reduction was observed comparing the situation before and after the introduction of the EU regulation No. 29. CONCLUSION: an assessment of the health status of asylum seekers that takes into account more than the identification of the rare life-threatening or infective diseases allows to take prompt action and to invest economical resources in the fields where they are more useful. This would facilitate a good health care for asylum seekers, that is the basis of an efficient functioning of services for integration.

Solitude, Religious and Cultural Uniqueness in a Foreign Environment: Adjustments as an Arab Student.

Arab-Muslims have extremely religious-centered and restrictive cultural practices. Living in a foreign country where Islam is a minority religion and culture is categorically different entails a great deal of adjustment. This study explored how Arab-Muslim International Students live and cope in a non-Arab, non-Muslim country. The authors used phenomenological approach with Colaizzi's method of analysis to (1) explore the lived experience of the Arab students' academic and social life and (2) come up with recommendations that can be supported by universities in Philippines and other countries with Arab students. Emergent themes include Hybrid vision and empowerment from education beyond borders "Tatallo at wa kudurat," Stigma in the Arab world "Hallah," Islam as way of life "Al Islam: Manhaj Hayyat," and Future of the Arab-Muslim students "Wahaa." The major concepts that emerged from the lived experience of these students focused on the practical reasons for quality education, challenges along the way, culture shock, the stigma, and misconceptions about Arabs and Muslims. They experienced discrimination, the impact of stereotyping and misconceptions about the Arab-Muslims. Their tenacity of the Islam faith has become a coping mechanism and kept them enormously strong. They also strived to show the real meaning of being Muslim, and finally, looking forward to how they can become the oasis in the desert. The Arab-Muslim International Students experience difficult adjustments in a foreign country to acquire high quality education, while holding on to their Islam faith and keeping their culture intact.

War traumas in the Mediterranean area.

INTRODUCTION: The purpose is to explore the consequences of war and its impact on mental health with attention to the Mediterranean area. METHODS: Narrative review of consequences of war on mental health and on the mental health of the communities in the current crises in the Mediterranean region. RESULTS: A series of outbreaks of war are still raging in the Mediterranean region and producing horrible effects with a considerable number of refugees with unsatisfied needs. Studies relating to conflicts of the past suggest that the mental health consequences of these wars may affect future generations for many years. While violations of human rights are not new, what is new are attacks on medical institutions perceived to be traditionally Western. CONCLUSION: The scientific community has to fight violence through mediation of conflicts. The idea that science can improve lives is a concept that is found in the history of all Mediterranean cultures. The Greek and Roman medical tradition was saved thanks to doctors of the Arab courts when Christian fundamentalism fought science in the Middle Ages. Health institutions are the product of the great Islamic medical tradition as well as Western culture.

Post traumatic type 1 diabetes mellitus (insulin-dependent): a case report.

Most researchers have studied the influence of life stress as precipitating the onset of type 1 diabetes, but as the relationship between severe psychological trauma and diabetes has been a rarely studied subject in paediatric age group. Here, we report the case of a 10-year-old Libyan boy, without personal or familial diabetes mellitus history, which is presented to Moroccan medico-surgical field hospital, installed in Tunisia for refugees of the Libyan revolution, for type 1 diabetes appeared immediately after severe psychological trauma.

Klebsiella pneumoniae harbouring OXA-48 carbapenemase in a Libyan refugee in Italy.

A carbapenem-resistant Klebsiella pneumoniae was isolated from a blood-culture of an inpatient from Libya, hospitalized in the intensive-care unit of Negrar Hospital, Italy. The clinical isolate carried the following ß-lactamase genes, bla(TEM -1), bla(SHV -11), bla(OXA -1), bla(CTX -M-15) and bla(OXA -48), respectively. The bla(OXA -48) gene was inserted in the Tn1999.2 transposon type, carried on a conjugative, 60-kilobase plasmid, that presented an L/M backbone, hosted by a multidrug-resistant ST 101 K. pneumoniae strain. Our report highlights the international transfer of bla(OXA -48) gene and the importance of screening measures of multidrug-resistant Enterobacteriaceae.

CD59 deficiency is associated with chronic hemolysis and childhood relapsing immune-mediated polyneuropathy.

CD59 deficiency is a common finding in RBCs and WBCs in patients with chronic hemolysis suffering from paroxysmal nocturnal hemoglobinuria in which the acquired mutation in the PIGA gene leads to membrane loss of glycosylphosphatidylinositol-anchored membrane proteins, including CD59. The objective of the present study was to elucidate the molecular basis of childhood familial chronic Coombs-negative hemolysis and relapsing polyneuropathy presenting as chronic inflammatory demyelinating polyradiculoneuropathy in infants of North-African Jewish origin from 4 unrelated families. A founder mutation was searched for using homozygosity mapping followed by exome sequencing. The expression of CD59, CD55, and CD14 was examined in blood cells by flow cytometry followed by Western blot of the CD59 protein. A homozygous missense mutation, p.Cys89Tyr in CD59, was identified in all patients. The mutation segregated with the disease in the families and had a carrier rate of 1:66 among Jewish subjects of North-African origin. The mutated protein was present in the patients' cells in reduced amounts and was undetectable on the membrane surface. Based on the results of the present study, we conclude that the Cys89Tyr mutation in CD59 is associated with a failure of proper localization of the CD59 protein in the cell surface. This mutation is manifested clinically in infancy by chronic hemolysis and relapsing peripheral demyelinating disease.

Characterization of movement disorders in patients with familial Creutzfeldt-Jakob disease carrying the E200K mutation.

BACKGROUND: While myoclonus and ataxia are considered common in patients with familial Creutzfeld-Jakob disease (fCJD), other movement disorders are less prevalent. OBJECTIVES: To systemically evaluate the frequency of extrapyramidal signs and movement disorders in patients with fCJD. METHODS: A detailed neurological examination, with special emphasis on movement disorders and extrapyramidal signs, was conducted in 43 consecutive symptomatic CJD patients (26 males and 17 females; mean age 58.7 +/- 8.9 yrs, range 43-77 years) carrying the E200K mutation in the PRNPgene. RESULTS: Limb or gait ataxia was noted in 38 patients (88%) (37 patients, 86%, had ataxia at presentation). Myoclonus was evident in 25/43 patients (58%) (21 patients, 49%, at presentation). In 95% of the patients (41/43) (37/43, 86% at presentation) at least one extrapyramidal sign throughout the disease course was noted, the most prevalent being rigidity (28/43, 65% of the patients; and 22/43, 51% at presentation), followed by the glabellar sign (24/43, 56% of the patients; and 22/43, 51% at presentation), bradykinesia (19/43, 44%; and 15/43, 35% at presentation), dystonia (15/43, 35%; 12/43, 28% at presentation) and tremor (13/43, 30%; 12/43, 28% at presentation). CONCLUSIONS: In this unique population of fCJD patients, myoclonus was less prevalent than previously reported while other extrapyramidal signs were common and occurred at a relatively early stage of the disease. The high prevalence of movement disorders can be added to other phenomena characteristic of this familial disorder among Libyan lews. Whether this is attributable to the E200K mutation itself or to some other mechanism has still to be elucidated.

A case of OXA-48 carbapenemase-producing Klebsiella pneumoniae in a patient transferred to Slovenia from Libya, November 2011.

We report the first documented case of OXA-48-producing Klebsiella pneumoniae in Slovenia isolated from rectal surveillance cultures from a patient transferred from Libya. The patient was colonised with both ESBL-producing Escherichia coli and ESBL- and OXA-48-producing K. pneumoniae. Three further patients were colonised with ESBL-producing E. coli. This underscores the importance of an early warning system on European level and screening upon admission of patients transferred across borders and between healthcare systems.

Detection and partial characterization of herpesviruses from Egyptian tortoises (Testudo kleinmanni) imported into Italy from Libya.

A group of approximately 370 Egyptian tortoises (Testudo kleinmanni) and 36 spur-thighed tortoises (Testudo graeca) were illegally imported into Italy from Libya. Within 6 mo of their entry into Italy, all but 40 of the Egyptian tortoises had died with signs of severe stomatitis. Herpesviruses were detected from the tongues of seven Egyptian tortoises by polymerase chain reaction (PCR) and virus isolation. Sequencing of a portion of the UL39 homologue of the herpesviruses from three different tortoises demonstrated that the viruses were identical to one another and identical to a herpesvirus isolated from a Hermann's tortoise (Testudo hermanni) in Germany. This is the first description of the detection of a herpesvirus from diseased Egyptian tortoises. That these animals were imported into Europe from Libya provides circumstantial evidence for the presence of herpesviruses among tortoises in northern Africa.

'Libyan Trial': a verdict running counter to scientific evidence.

Sidaction's appeal regarding the sentencing of medical personnels in the Libyan-HIV infection cases.

The imaging appearance of Creutzfeldt-Jakob disease caused by the E200K mutation.

The E200K mutation on chromosome 20 can cause familial Creutzfeldt-Jakob disease (CJD). Patients with this mutation are clinically similar to those with sporadic CJD, but their imaging features are not well documented. We report here the quantitative and qualitative evaluation of the magnetic resonance (MR) imaging characteristics of this unique group of patients using three-dimensional spoiled gradient recalled (SPGR) echo images, diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) measurements, MR spectroscopy and a fluid-attenuated inversion recovery (FLAIR) sequence. The SPGR and ADC data were analyzed with SPM99. ANCOVA and regression models were used for a region-of-interest (ROI) analysis of ADC and metabolic ratios. CJD patients had a decreased fraction of gray matter and an increased fraction of cerebrospinal fluid (P=.001) in the cortex and cerebellum and increased ADC values in the cortex (P<.001). Focal decreases of ADC were found in the putamen via ROI analysis (548+/-83 vs. 709+/-9 microm(2)/s, P=.02). N-acetyl aspartate (NAA) was generally reduced, with the NAA/Cho ratio lowest in the cingulate gyrus. Qualitative assessment revealed hyperintensities on FLAIR, DWI or both in the putamen (three out of four patients), caudate (three out of four patients) and thalamus. These results provide a framework for future study of patients with genetically defined familial CJD.

Megalencephalic leukoencephalopathy with subcortical cysts; a founder effect in Israeli patients and a higher than expected carrier rate among Libyan Jews.

Megalencephalic leukoencephalopathy with subcortical cysts (MLC) is a progressive inherited neurological disorder characterized by macrocephaly, deterioration in motor functions and cerebellar ataxia. In Israel the disease is found in an increased frequency among Libyan Jews. The disease is caused by mutations in the MLC1 gene, which encodes a putative CNS membrane transporter. We describe three novel mutations (p.G59E, p.P92S, and 134_136insC) in seven MLC families. One of these mutations, p.G59E, was found in the vast majority of MLC patients in Israel. Screening of 200 normal Libyan Jewish individuals for the p.G59E mutation, revealed a carrier rate of 1/40 compared with an expected carrier rate of 1/81. Several explanations could account for this difference the most likely one is an admixture of the Libyan Jewish population.

Nosocomial outbreak of multiple bloodborne viral infections.

In resource-limited countries, nosocomial transmission of bloodborne pathogens is a major public health concern. After a major outbreak of human immunodeficiency virus (HIV) infection in approximately 400 children in 1998 in Libya, we tested HIV, hepatitis C virus (HCV), and hepatitis B virus (HBV) markers in 148 children and collected epidemiological data in a subgroup of 37 children and 46 parents. HIV infection was detected in all children but one, with HCV or HBV coinfection in 47% and 33%, respectively. Vertical transmission was ruled out by analysis of parents' serology. The children visited the same hospital 1-6 times; at each visit, invasive procedures with potential blood transmission of virus were performed. HIV and HCV genotypic analyses identified a HIV monophyletic group, whereas 4 clusters of HCV sequences were identified. To our knowledge, this is the largest documented outbreak of nosocomial HIV transmission.