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Objective: The objective of this study is to determine the outcome and efficacy of Mulligan's mobilization with movement (MWM) with Maitland mobilization along with conventional therapy in the patients with knee osteoarthritis (OA). Materials and Methods: A randomized controlled trial study was performed at the Department of Physiotherapy, Mayo Hospital, Lahore, Pakistan. Sixty-two patients were selected for the study. MWM was introduced in half of the patients and Maitland mobilizations in the second half for 2 weeks. The goniometry, visual analog scale (VAS), knee range of motion (ROM), and Western Ontario McMaster OA (WOMAC) Index for knee OA were the assessment tools used to assess all patients before and after 2 weeks of intervention. Paired sample t-test was used for analysis of results. Results: The mean pre- and postdifferences in MWM group were 4.06 ± 0.99, 10.19 ± 3.87, and 19.41 ± 7.58 for VAS, ROM flexion, and WOMAC Index, respectively, while the pre- and postmean difference values for Maitland mobilization group were 3.355 ± 1.05, 10.19 ± 5.5, and 12.28 ± 7.029 for VAS, ROM flexion, and WOMAC Index, respectively. The mean differences of both treatment interventions individually were significant and showed that both were clinically effective in treating the patients of knee OA. Conclusion: It was concluded that patients in both groups showed improvement in pain, ROM, and functions.

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The purpose of this review is to examine the current Libyan medical education system, look at its positive and negative aspects, and to provide suggestions and recommendations that could help improve the quality of the system today. The current Libyan medical education system has aged, and unfortunately, cannot meet both societal needs and the new requirements from the World Federation of Medical Education (WFME). The WFME issued a strong statement to all international medical schools to meet its new accreditation standards by 2023 in order for them to be recognized internationally. Lacking almost 70% of the international standards, Libyan medical schools will require considerable amount of time and resources to solve the issue. The process of changing and updating the system will involve all parts of the learning environment, including students, teachers, curriculums, resources, research, and governing bodies.

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Background: Circumcision is a commonly practiced surgical procedure particularly in Islamic countries. As any other surgical procedure, it is attended by some complications of either early (e.g., bleeding) or late (e.g., meatal stenosis [MS]). Objectives: This study was designed to study the different clinical pictures, age at presentation, and management and outcome of postcircumcision MS. Patients and Methods: This is a retrospective study involving 86 children diagnosed with symptomatic MS and underwent meatotomy during the period from January 2010 to December 2018 at Hawari Center for Urology and Otolaryngology, Benghazi. The medical records of the patients reviewed included age at presentation, different clinical pictures, management, and outcomes. All patients were circumcised during the neonatal or infancy period. Results: Patients' age ranged between 3 and 13 years with a mean age of 5.14 years. More than three-quarters of the patients (84.8%) were between 3 and 8 years of age. Forty-six patients (53.4%) presented with pain (burning) during micturition; 17 patients (19.7%) with thin casting stream; 13 patients (15.11%) with thin dorsally deviated stream; five patients (5.8%) with sudden urge to micturiate; 3 (3.40%) patients with frequency of micturition; and only two patients (2.3%) with prolonged voiding time. All our patients operated by meatotomy as a day case procedure under general anesthesia, and there were no recurrences of MS symptoms in any case during the follow-up period. Conclusion: MS is a frequent late complication of neonatal circumcision; it should be excluded by careful meatal examination in any child who is circumcised particularly at the neonatal or nappy period and presented with abnormal micturition or even lower abdominal pain.

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Background: Hyperglycemia and hyperlipidemias are common clinical problem among users of glucocorticoids (GCs). The aim of the present study was to explore the effect of oral administration of the aqueous extract of Abelmoschus esculentus peel (AEPE) on hyperglycemia and hyperlipidemia induced in rats by dexamethasone (DEXA). Methods: Twenty-four rats were randomly divided into four equal groups. Each group was treated for 10 days either with 2% carboxymethylcellulose orally (normal control); 10 mg/kg DEXA subcutaneously (hyperglycemic group); 100 mg/kg AEPE orally plus 10 mg/kg DEXA subcutaneously (treatment group 1); or 200 mg/kg AEPE orally plus 10 mg/kg DEXA subcutaneously (treatment group 2). Animals were killed after 10 days of treatments by decapitation, their blood collected for the analysis of blood sugar and lipid profile. Results: Treatment with DEXA induced a significant increase in blood glucose and all lipids and a significant reduction in body weights. After 10 days of treatment, 100 mg/kg of AEPE was able to significantly reduce the effect of DEXA on triglycerides and low-density lipoprotein (LDL) only. 200 mg/kg of AEPE was able to significantly reduce the effect of DEXA on blood glucose levels, cholesterol, triglycerides, and LDL. Both doses of AEPE were able to increase high-density lipoprotein. Conclusion: This study suggests that the AEPE could be beneficial in protecting against GC-induced hyperglycemia and hyperlipidemia.

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Purpose: Investigation of the crystallinity of salbutamol sulfate a model drug used in the dry powder inhalation formulation. Materials and Methods: Salbutamol sulfate was supplied kindly by Lindopharm (Hilden, Germany). Salbutamol sulfate was milled using an air jet milling process, the particle size and morphology were determined using laser diffraction and the scanning electron microscopy. The drug was subjected to conditioning through storage at 52.8% and 75% relative humidity for 24 h, 1 week, and 2 weeks, respectively. The drug crystallinity was investigated using differential scanning calorimetry (DSC), X-ray diffraction, and water vapor sorption techniques. Results and Discussion: Conditioning of salbutamol sulfate after micronization lowers the glass transition (Tg) temperature of the amorphous parts present at particle surface, which enhances particle mobility for more rearrangement associated with water expelling. This transformation may result in deviation from the original particle size obtained after milling out of respirable range. DSC and X-ray diffraction show no detectable amorphous drug since no detectable Tg observed. Alternatively, water vapor sorption shows a small amount of amorphous salbutamol sulfate at the particle surface, which recrystallizes at 52.8% relative humidity after approximately 2 weeks of conditioning. Conclusion: The amorphous regions can be generated in crystalline materials during processing. The level of amorphous materials can affect every step of pharmaceutical formulation, storage, and stability. However, quantification of low levels of amorphous content still poses considerable challenge. This study confirms that, the water vapor sorption technique is useful in the quantification of a small amount of drug amorphous content.

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Aim: The study aimed to determine the bacterial etiology of upper tract respiratory infection in Abu-Sitta Hospital, Tripoli, Libya. Subjects and Methods: A total of 470 sputum specimens and 60 throat swabs were collected over a period of 1 year (From January 2014 to December 2014) from patients presented with clinical signs of upper respiratory tract infection at Abu-Sitta Hospital. Enrolled patients were sorted as inpatients or outpatients and by gender. Data were entered and analyzed using SPSS version 22.0. Variables were expressed as percentages. Differences in age and gender were analyzed using Chi-square test. Results: Of the total 530 screened samples, 80.5% were culture positive, where bacterial pathogens were detected in 83.7% of sputum specimens and in 56.5% of throat swabs. Streptococcus pneumoniae was the most prevalent (48%), followed by Pseudomonas aeruginosa (23%), Staphylococcus aureus (13%), Enterobacter (8%), Citrobacter freundil (5%), and latest with Klebsiella (3%). Conclusions: The spectrum of pathogenic bacterium causing upper respiratory infection in Abu-Sitta Hospital is considerably wide, with S. pneumoniae and P. aeruginosa being the major causative bacteria.

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Introduction: Nephrotic syndrome (NS) is a clinical picture characterized by severe proteinuria, hypoalbuminemia, edema and hypercholesterolemia. A retrospective study was carried out in order to describe disease pattern in newly diagnosed NS of children admitted to Tripoli children hospital during the year 2014. Methods: The medical data of 56 patients aged between 1 year and 11 years diagnosed with idiopathic nephrotic syndrome were analysed using SPSS software. The data included gender differences, sensitivity to steroid therapy, relapses withen six months of follow up and the effect of variable factors such as family history, hypertension, hematuria, serum urea on the degree of relapse. Results: Out of 56 patients with newly diagnosed NS, 60.7% were boys and 39.3% were girls, with a mean age 4.2±2.2 years. Age was related significantly to the response to steroid therapy, where 79.5% of patients aged between 2-8 years (group 1) had steroid sensitive NS (SSNS) compared with only 41.7% of patients aged less than 2 years or more than 8 years (group 2) (P<0.001). Although girls relapsed more than boys (70.5% versus 57.1%) during six months of therapy, this difference was not statistically significant. Similarly, no other factors measured such as family history of NS, hypertension, hematuria, serum complement and urea had any effect on the percentage of relapse in patients with newly diagnosed NS. Conclusion: NS is one of the commonest reasons for admission to nephrology ward. It is more common in boys than girls. The age at presentation related significantly to the response to steroidal therapy. Regarding relapses, girls seems to relapse more frequent than boys and relapses was seen more in age group 1 than group 2, however, these differences were not significant. Other factors studied seems to have no effect on the relapse rate of children with newly diagnosed NS.

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This work was aimed at the use of dissolution testing and similarity factor to assess the level of damage taken by active drug microspheres during compression in tablet dosage form. To achieve that, combinations of suitable excipients were used to protect drug microspheres during compression. The excipients were used in the form of powders, granules or placebo pellets prepared by extrusion-spheronization technology. The excipients were evaluated alone, in combinations and post-compression into compacts. Preliminary experiments included assessing density, hardness, friability and disintegration of all the selected excipients. Based on such experiments it was found that the flowability of combination of powders was more acceptable than individual excipients. Two combinations of microcrystalline -starch and microcrystalline cellulose -calcium carbonate granules were selected to be compressed with pellets of the active pharmaceutical ingredient ketoprofen. In all the combinations used there was a significant amount of damage to drug pellets. The kinetics of drug release appears to follow the zero-order rate, which remained unchanged even when a significant degree of damage to pellets occurs. It was found that a high level of excipients is required in order to prepare microspheres as a rapid disintegrating tablet.

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Background: This study was conducted to determine the pattern of ocular trauma in Benghazi- Libya. Methods: All cases of ocular trauma admitted to Benghazi eye hospital from January 2011 to August 2012 were retrospectively reviewed for open- or closed-globe injury (OGI or CGI). Data extracted included age, sex, residence, initial and final visual acuity (VA), cause and treatment of injury. The injuries were classified by Ocular Trauma Classification System. Results: Out of the 805 patients, there were 540 patients (67.0%) with Closed Globe Injury and 254 patients (31.5%) with Open Globe Injury and 11 patients (1.3%) with mixed trauma. Conclusion: This analysis shows a pattern of eye injury largely similar to reports from other parts of the world. Eye injury affected mainly younger age groups and road traffic accidents were the most common cause.

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Background: The therapeutic effects of fresh garlic remain controversial. The aim of this study is to investigate whether supplementation of fresh garlic could improve blood glucose and cholesterol profile in Libyan diabetic patients with moderate blood cholesterol. Methods: Forty-six diabetic patients were randomly assigned to either fresh garlic alone (≈2 grams/day), or fresh garlic in combination with glibenclamide taken on an empty stomach every morning for a month. Serum blood glucose, cholesterol and blood pressure were measured before starting treatment and after the end of the treatment period. Results: Fresh garlic alone was able to decrease the mean serum cholesterol levels by 26 mg/dl (84% of the original base values), while the combination of fresh garlic and glibenclamide produced a 28 mg/dl decrease in the mean serum cholesterol (85% of the original base values). Fresh garlic alone was able as well to decrease the mean blood glucose levels by 20 mg/dl (85% of the original base values), while the combination of fresh garlic and glibenclamide produced a 60 mg/dl decrease in the serum glucose levels (72% of the original base values). Neither treatment had a significant effect on the mean systolic or diastolic blood pressures after 30 days of treatment. Conclusion: Administration of fresh garlic every morning for a month significantly reduced the blood cholesterol and fasting blood glucose levels in diabetic patients. Thus administering dietary fresh garlic daily to diabetic patients might have cardio-protective effects on diabetic patients.

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Background: Drug utilization studies conducted in Libya during the period 1991-2013, have pointed out the irrational use of antibiotics as a common practice that costs the health system more than 7.7 million Libyan Dinars / year. The aim of this study is to assess the trend of antimicrobial consumption in the Eastern region of Libya during 2012 – 2013. Methods: Antimicrobial consumption data from the years 2012 and 2013 were obtained mainly from Benghazi office, Medical Supply Organization (MSO; the only official drug-importing body in Libya). This study is concerned with antibiotics imported only to the Eastern region of Libya, population of which represents approximately 35% of total Libyan population. The WHO, Anatomical-Therapeutic-Chemical (ATC) classification and the Defined Daily Dose (DDD) methodology were used to calculate antibiotic consumption. The total antimicrobial consumption data were calculated as DDD/1000 inhabitants/day. Results: Total utilization of antibiotics decreased dramatically from 15.47 DDD/1000 inhabitants/day in 2012 to 4.30 DDD/1000 inhabitants/day in 2013 which in turn shows a significant decline compared to 41.72 DDD/1000 inhabitants/day during the period 1991-1993. Consumption of penicillins decreased from 19.902 DDD/1000 inhabitants/day during 1991-1993 to 1.896 DDD/1000 inhabitants/day during 2012-2013 with pattern of amoxicillin/clavulanic acid consumption equals to 3 times ampicillin consumption and is the highest compared to all penicillins. This was accompanied by a prominent increase in consumption of amphenicols and fusidic acid during 2012-2013 noting that fusidic acid consumption was the highest among all antibiotics. Conclusion: MSO since 2011 (post 17th February 2011 revolution) lost its control on importing medicines due to receiving many drugs as donations from different international sources without acceptable level of coordination. This has been reflected on drug purchasing policy of MSO during 2013, which failed to regain the previously accepted level of DDD/1000 inhabitants/day antibiotics consumption. The decreased consumption of penicillins together with increased consumption of amphenicols and fusidic acid complies with the pattern of antibiotic resistance reported previously in Libya. Similar studies should be conducted to evaluate national drug consumption under normal conditions to be compared with regional and international data.

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Background: It has been reported that Tempro-Mandibular-disorders (TMD) is the most common orofacial pain source of non-dental origin. The aim of this cross-sectional observational study is to explore the prevalence of signs and symptoms of TMD among a group of dental students in Benghazi-Libya. Methods: The examined group comprised 100 students [17 males and 83 females; mean age: 24.8±2.23 years. The assessment was undertaken following Helkimo's measures. The prevalence and severity of TMD was determined using a self-reported anamnestic questionnaire and clinical examination. Descriptive statistics was employed to explore the frequencies of the examined variables. Linear correlation coefficient was conducted between the reported symptoms and recorded signs and between the reported symptoms and the clinical dysfunction scores (CDS). The level of significance was set at P<0.05. Results: A total of 37% of the students reported some level of TMD symptoms [32% mild (Ai1); 5% severe (AiII)]. On the other hand, majority of the students (93%) demonstrated a range of TMD signs [76% mild (DiI); 17% moderate (DiII)]. Although linear correlation coefficient between the reported symptoms (Ai) and the recorded signs (Di) (r=0.32) and between the reported symptoms (Ai) and the CDS (r=0.37) were low, they were statistically significant (P<0.05). Conclusion: Mild to moderate prevalence of TMD appears to exist among Libyan dental students.

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BACKGROUND: Hypopituitarism refers to complete or partial failure of pituitary hormones secretion that has a wide range of clinical manifestations which require hormone replacement to eliminate or minimize the symptoms and clinical signs of specific hormone deficiencies. We aimed to identify clinical presentation and management of hypopituitarism in pediatric age group. PATIENTS & METHODS: This is a case series study involving 35 patients who were diagnosed to have hypopituitarism due to different causes at Endocrine Clinic of Tripoli-Children Hospital from 2000 to 2010. Data were collected from patient's hard records in the clinic, which include age at presentation, sex, clinical presentation, associated illness, height, weight, extent of pituitary hormone deficiencies, pituitary imaging findings and hormone replacement status. RESULTS: Out of 35 patients 54.3% were males, 45.7% were females with median age at presentation (10±4.5) years. The most common clinical manifestation was short stature (68.6%) followed by hypoglycemia (14.3%) and delayed puberty (8.6%). 11.4% had Craniopharyngioma. MRI showed normal pituitary in 40% of patients, pituitary hypoplasia in 45.7%. Biochemically, growth hormone (GH) deficiency was evident in 82.9%, low TSH in 17.1%, low T4 in 14.3%, low serum cortisol level in 20%, low ACTH in 11.4%, low FSH in 8.6%, and low LH in 5.7%. The result also showed that 5.3% of males had low testosterone level and 18.8% of females had low estrogen level. Hormonal replacement included GH therapy (85.7%), thyroxine (62.9%), cortisol (45.7%) and sex hormone (31.4%). CONCLUSION: Most common clinical presentation of hypopituitarism was short stature. Symptoms of patients with hypopituitarism improved by appropriate hormonal replacement according to their needs.

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Objectives: This study aims to evaluate a novel tablet excipient obtained from local sources, Pearl millet Pannistumamericanum starch of family Poaceae which is used locally as food because of its high carbohydrate content. It was thought that the starch of Pearl millet Pannistumamericanum may serve as a tablet disintegrant. Methods: The excipient properties of Pearl millet starch as well as the pregelatinized form were studied in paracetamol tablets produced by wet and dry granulation methods of massing and screening and compared with maize starch BP. Results: Wet method showed superiority in all properties of both granules and tablets. Using wet method granulations Pearl millet Pannistumamericanum starch and maize starch BP have similar angle of repose, Carr's index, tapped density, bulk density, and Hausner's ratio, however, Pearl millet Pannistumamericanum starch has shown advantageous in some properties such as moisture content and swelling index. Tablet produced with Pearl millet Pannistumamericanum starch disintegrated almost the same of those produced with maize starch BP at all concentrations employed. It was also found that when used as a disintegrant, the pre-gelatinized form provide tablets with better hardness and friability values than maize starch BP. Conclusion: This study confirmed the suitability of Pearl millet Pannistumamericanum starch as an alternative to maize starch BP as a tablet disintegrant, particularly, in paracetamol tablet formulation.

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Background: Orthodontists need to evaluate intermaxillary tooth size discrepancy (TSD) prior to initiating treatment in order to achieve a stable treatment. Thus, the aim of the present study was to determine the prevalence of TSD in Libyan subjects among different malocclusion groups. Methods: A sample of 60 dental casts of Libyan subjects with different types of malocclusions (Class I, Class II div 1 and Class III) were included in the study. Each malocclusion group (20 dental casts) included equal numbers of males and females, 12-17 years of age. Mesio-Distal tooth measurements were extracted to compute the anterior and overall TSD ratios. Paired Student t-test was used to detect significant discrepancies between the paired teeth measurements. Analysis of Variance (ANOVA) and Tukey Honestly tests were undertaken to detect significant discrepancies among the malocclusion groups. Results: Paired t-test revealed that there were no significant discrepancies between the paired tooth widths except for the upper first molars, upper first premolars, lower lateral incisors and lower canines (P<0.010). ANOVA found no significant differences in the mean anterior TSD ratio in regard to malocclusion groups. However, a significant disparity was noticed in the mean overall TSD ratio among the different malocclusion categories (P<0.04). Conclusion: Statistically significant TSD between the examined malocclusion groups were observed only in the mean overall TSD ratio.

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