BACKGROUND:Head-to-head randomised trials or real-world studies comparing the safety and efficacy of natalizumab and anti-CD20 monoclonal antibodies are limited. This study aimed to compare the effectiveness and safety of natalizumab versus ocrelizumab/rituximab in a real-world cohort of relapsing-remitting multiple sclerosis (RRMS) patients using data from the Middle East and North Africa Committee for the Treatment and Research in Multiple Sclerosis (MENACTRIMS) registry. METHODS:This registry-based, retrospective, multicentre study was carried out in seven Middle Eastern countries by analysing data from the MENACTRIMS registry. All adults RRMS patients treated with natalizumab, rituximab or ocrelizumab and maintained on treatment for at least 12 months were included. Patients were matched using propensity scores. Primary outcomes were annualised relapse rate (ARR), confirmed disability progression and improvement and MRI activity. RESULTS:A total of 1954 patients met the inclusion criteria, with 1277 receiving anti-CD20 therapy (768 on rituximab and 509 on ocrelizumab) and 677 natalizumab. Natalizumab significantly reduced ARR compared with anti-CD20 therapies (0.062 vs 0.092, p=0.001). Confirmed disability progression rates, MRI outcomes and no evidence of disease activity (NEDA-3) were similar between the two groups. However, natalizumab demonstrated higher rates of disability improvement compared with anti-CD20 therapies (9.3% vs 5.5%, p=0.03). Adverse events were more frequent in the anti-CD20 group (36.4% vs 27.5% for natalizumab, p=0.001). CONCLUSION:In this large, real-world cohort, natalizumab was associated with lower ARR, greater likelihood of disability improvement, lesser adverse events, but lower persistence compared with anti-CD20 therapies. These findings provide valuable insights into the comparative efficacy and safety of these RRMS therapies, aiding clinicians in personalised treatment decisions.
Sleep disturbances are common in patients with migraine, and studies related to sleep architecture changes in those patients are few in the literature. In this study, the aim is to investigate sleep quality in patients with migraine, identifying polysomnographic abnormalities compared to healthy controls, and to correlate the different polysomnographic parameters and severity of headaches. This study was conducted on forty patients with migraine and forty healthy volunteers, as controls, of matching age and sex. The severity of headaches was assessed using the migraine disability assessment score (MIDAS). Sleep was assessed by the Pittsburgh Sleep Quality Index (PSQI) and overnight polysomnography (PSG) . In patients with migraine, the sleep architecture was worse, including low sleep efficiency(p < 0.001), prolonged sleep latency, reduced stage N3 sleep(p < 0.001), increased arousal index, and more frequent sleep stage change compared to healthy controls. Furthermore, There was a statistically significant correlation between migraine severity (MIDAS) in the patient group and sleep quality (PSQI) (p < 0.001).
Foreign body ingestion is a common clinical issue, but swallowing a full-sized toothbrush is exceptionally rare. We report a case of a 32-year-old Sudanese male with a three-year history of an accidentally ingested toothbrush. The patient presented with mild epigastric pain and intermittent dysphagia but no acute complications. Imaging, including X-ray and computed tomography, failed to identify the foreign body. Esophagogastroduodenoscopy revealed a complete toothbrush lodged in the stomach, with its head extending into the duodenum. The object was successfully removed intact using a polypectomy snare under conscious sedation, without mucosal injury or complications. This case highlights the diagnostic challenges posed by radiolucent foreign bodies and underscores the key role of endoscopy in both diagnosis and treatment. It also demonstrates that delayed endoscopic removal can be safely accomplished, though early retrieval remains essential to prevent serious outcomes such as perforation or obstruction.
