Global support and standardization of regulation for biosimilars approval owes much of its legacy to the World Health Organization (WHO), since the first guidance by the organization on the matter was released in 2009. Since then, and with over a decade of research, the 2022 revision provides opportunities for time and financial savings to pharmaceutical manufacturers aiming to prove similarity of a potential biosimilar product to some reference product, particularly by clarifying that the use of a non-local reference product as a comparator in certain studies is permissible. This declaration has important implications, particularly in the emerging biological markets of the Middle East and North Africa region, where WHO guidelines have been integral to the regulatory framework of over a dozen countries for more than a decade. This article aims to review the impact of this revision on these countries and relevant policies on non-local comparator usage. Since 2022, this revision has been adopted only in Egypt. Many North African countries are yet to adopt a first draft of the formalized guidance. This analysis revealed that, although many of these countries reference the WHO guidelines, hesitation remains in terms of sourcing comparator products outside the US or European countries. This likely translates to slow regional development and cooperation of functioning, sustainable biosimilars markets. Future studies will be necessary to evaluate the continued development of guidance within these countries and changes in comparator sourcing norms as more time is allowed for their policies to mature and adapt to new standards.

The aim of this work was to provide evidence on the presence of microplastics (MPs) in regurgitated Yellow-legged Gull pellets (n = 18) from Sfax salina (south-eastern Tunisia). This artificial area is subject to high anthropogenic pressure and hosts Yellow-legged Gulls, which are at the top of the trophic chain and can be used as sentinel species to monitor litter in the environment, including plastic pollution. The total number of MPs found in the samples was 309, 63.8 % fibres (4.95 ± 3.51 MPs/g) and 36.2 % fragments (2.87 ± 1.74 MPs/g). Micro-FTIR analysis evidenced that a large proportion of the fibres was attributed to artificial cellulose (40.7 %). Ethylene vinyl acetate (EVA) and polyethylene (PE) were found in the fragments.

UNASSIGNED: In the Near East and North Africa (NENA) region, crop production is being affected by various abiotic factors, including freshwater scarcity, climate, and soil salinity. As a result, farmers in this region are in search of salt-tolerant crops that can thrive in these harsh environments, using poor-quality groundwater. The main staple food crop for most of the countries in this region, Tunisia included, is barley.
UNASSIGNED: The present study was designed to investigate the sensitivity and tolerance of six distinct barley genotypes to aridity and salinity stresses in five different natural field environments by measuring their photosynthetic activity.
UNASSIGNED: The results revealed that tolerant genotypes were significantly less affected by these stress factors than sensitive genotypes. The genotypes that were more susceptible to salinity and aridity stress exhibited a significant decline in their photosynthetic activity. Additionally, the fluorescence yields in growth phases J, I, and P declined significantly in the order of humid environment (BEJ), semi-arid site (KAI), and arid environment (MED) and became more significant when salt stress was added through the use of saline water for irrigation. The stress adversely affected the quantum yield of primary photochemistry (φP0), the quantum yield of electron transport (φE0), and the efficiency by trapped excitation (ψ0) in the vulnerable barley genotypes. Moreover, the performance index (PI) of the photosystem II (PSII) was found to be the most distinguishing parameter among the genotypes tested. The PI of sensitive genotypes was adversely affected by aridity and salinity. The PI of ICARDA20 and Konouz decreased by approximately 18% and 33%, respectively, when irrigated with non-saline water. The reduction was even greater, reaching 39%, for both genotypes when irrigated with saline water. However, tolerant genotypes Souihli and Batini 100/1B were less impacted by these stress factors.The fluorescence study provided insights into the photosynthetic apparatus of barley genotypes under stress. It enabled reliable salinity tolerance screening. Furthermore, the study confirmed that the chlorophyll a fluorescence induction curve had an inflection point (step K) even before the onset of visible signs of stress, indicating physiological disturbances, making chlorophyll fluorescence an effective tool for identifying salinity tolerance in barley.

UNASSIGNED: This study aimed to assess the predictive factors of functional impairment in spondyloarthritis (SpA) patients assessed with bath ankylosing spondylitis functional index (BASFI) and Lequesne Index (LI).
UNASSIGNED: This retrospective study was conducted at the Rheumatology Department of Mohamed Kassab Institute of Orthopedics, Manubah, Tunisia, and collected data from 2008 to 2019 over a period of 4 months (August to November 2019). Socio-demographic and disease-related data of SpA patients were collected. Disease activity was assessed using the bath ankylosing spondylitis-global score (BASG-s) and the bath ankylosing spondylitis disease activity index (BASDAI). The spinal mobility was evaluated by the bath ankylosing spondylitis metrology index (BASMI). Structural progression was evaluated with the bath ankylosing spondylitis radiologic index (BASRI) and modified stoke ankylosing spondylitis spine score (mSASSS). A multivariate analysis was done to search for predictive factors associated with BASFI and LI.
UNASSIGNED: A total of 263 patients were included. The mean age was 38.9 ± 12.7 years and the gender ratio was 2.7. The mean age of onset of SpA was 27.6 ± 10.8 years and disease duration was 11.3 ± 9.5 years. Occupation was significantly associated with BASFI and LI scores. A significant functional impact was notably correlated with a long duration of the disease. The two scores were correlated with a limitation of spinal mobility (BASMI), a greater disease activity (BASDAI and erythrocyte sedimentation rate) and a greater impact of the disease on health status (BASG-s). Significant functional impairment was also correlated with structural impairment (mSASSS, BASRI and sacroiliitis grade). The variables independently related to BASFI were the mSASSS score and the BASDAI. The variables independently related to LI were profession (unemployed subjects had higher scores), the mSASSS score and the BASMI.
UNASSIGNED: Occupation, disease activity, mobility and structural progression predicted functional impairment in Tunisian SpA patients.

Global food systems face sustainability challenges like undernourishment, inequity, resource degradation, and pollution. Food production and consumption drive environmental change with greenhouse gas emissions, biodiversity loss, and land-system shifts. The climate change crisis has intensified concerns about the ecological impact of these systems. Sustainable food networks, such as community-supported agriculture, are promoting sustainable production and consumption through short supply chains. International bodies like the Food and Agriculture Organization (FAO) and the Consultative Group for International Agricultural Research (CGIAR) are also spearheading initiatives for more equitable and sustainable food systems. In Tunisia, where dryland areas predominate, the ongoing implementation of the Agroecology Initiative provides the context for this study, which explores the drivers and barriers of agroecological transformation in this challenging environment. The research focuses on stakeholder engagement, with a gender perspective to explore farmer perceptions. The study, conducted in the northwest of Tunisia in 2022-2023, involved focus groups, workshops, surveys, and questionnaires with various stakeholders. Findings highlight farmer organizations\' potential in promoting sustainable farming, with clear goals, diversified systems, and collaborations. However, challenges such as input scarcity, water shortage, low income, and marketing must be addressed. Results also indicate that over 90% of farmers who received assistance with agroecological practices reported a change in their ideas and practices. Fifty seven percent of the workshops participants identified the olive oil value chain as having the greatest potential for agroecological transformation, but it faces constraints such as climate, lack of policy incentives, training, funding, and difficulty in adopting technical innovations. Women\'s inclusion in agriculture, environmental, social, and economic challenges were also highlighted. Despite these obstacles, key drivers for agroecological transition were identified. These include the compatibility of many agroecological practices with existing farmer capabilities, their cultural and economic benefits, and the positive outcomes for environmental sustainability and health. The study advocates for a socio-technical systems analysis to address the root causes hindering Tunisia\'s agroecological transformation. A participatory approach is crucial to understanding priorities and developing a sustainable and resilient food system. Furthermore, the research underscores the importance of considering diverse farmer perspectives and tailoring strategies to support this critical transition effectively.

This study aimed to vividly describe the direct and severe health impacts of conflict in the Eastern Mediterranean Region (EMR) using data from the Global Burden of Disease (GBD). It also sought to quantify the staggering portion of economic damage attributable to the health burden of conflict and terrorism. From 1990 to 2019, the region endured the devastating effects of conflict and terrorism. These circumstances led to 64%, 50%, and 35% of all causes of Disability-Adjusted Life Years (DALYs) in Libya, Syria, and Palestine, respectively, in 2011, 2016, and 2008. These figures represent not just statistics but the profound human cost of these conflicts. The health-related economic burden (HEB) due to conflict was estimated at $4.6 billion in Iraq, $3.7 billion in Afghanistan, and $1.7 billion in Libya in current international dollars. However, due to missing data, the HEB could not be calculated for Yemen and Syria despite significant conflict-related DALYs. In 2019, the HEB to Current Health Expenditure (CHE) ratio, which indicates the proportion of the health-related economic burden compared to health expenditure, was 30% in Afghanistan and 25% in Iraq. This high ratio underscores the significant strain that conflict places on the health systems.

UNASSIGNED: The study aimed to assess and compare both the chewing efficiency and the contact area between class I and class II of Angle\'s malocclusions.
UNASSIGNED: A total of 120 individuals aged between 19 and 30 years were examined and were divided into two groups according to Angle\'s class (Class I and class II). The chewing efficiency was quantified using the ViewGum software and two-colored chewing gum. The contact area was quantified using modeling wax and MATLAB software. All data were collected, then, analyzed using SPSS software 21. Data normality was checked through kurtosis test. Descriptive results were calculated. Matched sample t-tests were used to compare chewing efficiency measurements between right and left sides. Independent t-tests were used to compare chewing efficiency and the contact area between class I and class II of Angle\'s malocclusions. Linear regression and Pearson correlation were used to assess the correlation between chewing efficiency and the contact area. The significance level was fixed at p = 0.05.
UNASSIGNED: For group 1, the mean hue value on both sides was 0.086 ± 0.058. For group 2, it was 0.095 ± 0.055. The difference between both groups was statistically significant (p = 0.03). For group 1, the mean contact area was 49.91 ± 21.47 mm2. For group 2, it was 51.42 ± 19.76 mm2. The difference was statistically not significant (p = 0.4). The correlation between the contact area and the chewing efficiency in both groups was statistically significant and it was negative (in class I p = 0 and R = -0.616; in class II p = 0.01 and R = -0.408).
UNASSIGNED: The Chewing is better for patients with Angle\'s Class I malocclusion. The contact area is higher. Larger occlusal contact area leads to higher masticatory efficiency. Further studies should be conducted.

Twelve species in nine genera of Mycetophilidae are newly recorded from Morocco and from North Africa. Five species are described as new to science: Rymosiaebejerisp. nov., Leiaarcanasp. nov., Megophthalmidiaamsemlilisp. nov., Mycomyamirasp. nov., and Phthiniasnibbypinsaesp. nov. Three species are newly recorded from Gibraltar.

UNASSIGNED: This study aimed to construct geographically, temporally, and epidemiologically representative data sets for SARS-CoV-2 in North Africa, focusing on Variants of Concern (VOCs), Variants of Interest (VOIs), and Variants Under Monitoring (VUMs).
UNASSIGNED: SARS-CoV-2 genomic sequences and metadata from the EpiCoV database via the Global Initiative on Sharing All Influenza Data platform were analyzed. Data analysis included cases, deaths, demographics, patient status, sequencing technologies, and variant analysis.
UNASSIGNED: A comprehensive analysis of 10,783 viral genomic sequences from six North African countries revealed notable insights. SARS-CoV-2 sampling methods lack standardization, with a majority of countries lacking clear strategies. Over 59% of analyzed genomes lack essential clinical and demographic metadata, including patient age, sex, underlying health conditions, and clinical outcomes, which are essential for comprehensive genomic analysis and epidemiological studies, as submitted to the Global Initiative on Sharing All Influenza Data. Morocco reported the highest number of confirmed COVID-19 cases (1,272,490), whereas Tunisia leads in reported deaths (29,341), emphasizing regional variations in the pandemic\'s impact. The GRA clade emerged as predominant in North African countries. The lineage analysis showcased a diversity of 190 lineages in Egypt, 26 in Libya, 121 in Tunisia, 90 in Algeria, 146 in Morocco, and 10 in Mauritania. The temporal dynamics of SARS-CoV-2 variants revealed distinct waves driven by different variants.
UNASSIGNED: This study contributes valuable insights into the genomic landscape of SARS-CoV-2 in North Africa, highlighting the importance of genomic surveillance in understanding viral dynamics and informing public health strategies.

BACKGROUND: Nasopharyngeal carcinoma (NPC) is a multifactorial malignancy associated with both genetic and environmental factors. Polymorphic deletions of the phase I and phase II genes involved in the detoxification of potential carcinogens may be a risk factor for nasopharyngeal carcinoma. In this study, we investigated the relationship between CYP2E1 (rs3813867), CYP2A6, GSTM1(rs1183423000) and GSTT1(rs1601993659) gene variations and NPC risk in North African countries with the highest incidence of NPC (Morocco, Algeria and Tunisia). and the evaluation of the potential use of these variants as potential biomarkers for NPC management.
METHODS: A total of 600 NPC cases and 545 controls frequency-matched on ethnicity, sex, age and childhood household type, were recruited from three North African countries (Morocco, Algeria and Tunisia) and analysed. Genotyping of CYP2A6 and CYP2E1(rs3813867) was performed by polymerase chain reaction restriction (PCR)-fragment length polymorphism (RFLP) analysis and the GSTM1 (rs1183423000) and GSTT1(rs1601993659) genetic variations were evaluated using the PCR technique.
RESULTS: The genotype distributions of CYP2E1(rs3813867), CYP2A6, GSTM1(rs1183423000) and GSTT1(rs1601993659) genotypes did not differ significantly among NPC cases and controls (p > 0.05). Furthermore, our data did not reveal any association with smoking and the studied variants, even when the samples were stratified by the duration period of smoking.
CONCLUSIONS: In this large studied North African population, our findings suggest that the functional CYP2E1, CYP2A6, GSTM1 and GSTT1 variations did not influence NPC susceptibility.