Roba El Zibaoui

We present a case of a woman who underwent a successful bone marrow transplant for beta‐thalassemia major and later gave birth to a child who is compound heterozygous with HBB c.93‐21G>A and HBB c.316‐106C>G mutations to illustrate the critical gaps in reproductive risk assessment and genetic counseling. The prevalence of consanguinity, socioeconomic challenges, and the lack of a cohesive genetics health system in a thalassemia‐endemic country all contribute to poor implementation of genetic care. Strengthening the education of healthcare practitioners, implementing centralized medical record systems, and expanding access to genetic services are becoming increasingly fundamental for improving genetic health care delivery across the Middle East and North Africa region.

Background: During an evaluation for encephalitis, lumbar puncture (LP) plays a critical role in establishing a diagnosis. Repeat LP may be needed when the diagnosis remains in doubt, the specific etiology of encephalitis has not yet been identified, or to aid management decisions. However, findings on repeat LP have not been well characterized, potentially confounding interpretation. Here, we examine the clinical characteristics of patients with encephalitis who underwent repeat LP, the evolution of cerebrospinal fluid (CSF) parameters, and the indications for repeat LP during acute hospitalization. Method: This retrospective study analyzes LP and clinical data from 627 adults with all causes of encephalitis admitted between 2002 and 2022 across 2 hospital systems in Maryland and Texas. Results: Of the 627 patients, 184 (29.3%) underwent repeat LP, with a median interval of 6 days between procedures, and more commonly among those with more severe presentations. Patients were more likely to undergo repeat LP in autoimmune than in infectious encephalitis (42/113 [37.2%] vs 62/275 [22.5%], P = .003). In infectious cases, CSF white blood cell counts decreased when repeat LP occurred ≥7 days after initial LP (P = .016), whereas no decrease occurred in autoimmune cases. Repeat LP yielded a new diagnosis in 16/184 (8.6%). Among patients without initial pleocytosis, 51.4% developed pleocytosis on repeat LP, associated with worse outcomes. Diagnostic uncertainty was the most common indication. Conclusions: Repeat LPs are performed in one-third of encephalitis hospitalizations and are more common in patients with autoimmune etiologies, severe disease, or diagnostic uncertainty. Cerebrospinal fluid dynamics differ between infectious and autoimmune etiologies.

Background and Purpose : Natalizumab (NTZ) is widely used for patients with highly active relapsing–remitting multiple sclerosis (RRMS), but its discontinuation can lead to disease reactivation, significantly impacting Middle Eastern populations. This study aimed to assess the frequency of disease reactivation post‐NTZ discontinuation and identify possible demographic predictors. Methods : In this retrospective single‐center study, 171 patients with RRMS who received at least six consecutive NTZ infusions were analyzed. Clinical and radiological data were sourced from the AMIR registry. Binary and multivariate regression analyses were performed to identify factors associated with reactivation risk after 1 year, with a subset undergoing brain magnetic resonance imaging (MRI) segmentation and volumetric assessments. Results : Among 92 eligible patients, 16 (17%) showed disease reactivation. Prolonged washout periods (>3 months) significantly increased reactivation risk (hazard ratio [HR] 1.015, 95% CI 1.007–1.022, p < 0.001), whereas higher Expanded Disability Status Scale (EDSS) scores correlated with a reduced risk (HR 0.492, 95% CI 0.280–0.866, p < 0.014). In the subset of cases that underwent brain MRI segmentation, higher NTZ infusion numbers and delayed bridging therapy initiation were linked to increased reactivation risk. Conclusion : NTZ discontinuation requires thorough clinical evaluation for bridging therapy, yet optimal strategies remain undefined. Early bridging therapy initiation may mitigate reactivation, highlighting the need for further research on predictive factors and disease‐modifying therapy efficacy.

Purpose of Review: Alcohol consumption significantly contributes to global morbidity and mortality, particularly in individuals with alcohol-associated liver disease (ALD). This review aims to evaluate the effectiveness of public health policies in reducing alcohol-related harm, focusing on SAFER initiatives and World Health Organization (WHO) “best buys.” Recent Findings: Key strategies to reduce the affordability of alcohol, such as alcohol taxation, minimum unit pricing, and legislation, have proven effective in reducing alcohol consumption and ALD-related deaths. However, their success varies across different regions and populations. Innovative approaches to further mitigate alcohol-related harm are also explored. Summary: The review highlights the need for more robust, evidence-based public health policies to address alcohol-related diseases. A comprehensive, focused approach is essential to mitigate the global alcohol epidemic and its consequences, with an emphasis on policy refinement and greater understanding of alcohol-related harm.