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  Most popular articles (Since December 20, 2017)

 
 
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ORIGINAL RESEARCH ARTICLE
Knowledge, attitudes and practices of personal protective measures among hemodialysis nurses in Benghazi
LJ Abdulmalek
July-December 2017, 2(2):101-111
DOI:10.21502/limuj.013.02.2017  
BACKGROUND: This study intended to assess knowledge, attitudes, and practices regarding standard precautions concerning health care-associated infections (HAIs) among hemodialysis nurses in hemodialysis centers in Benghazi. METHODS: the study was a cross sectional study carried out during the period from 1-3-2014 till 30-9-2014. The data was gathered from hemodialysis nurses in hemodialysis centers in Benghazi by using a questionnaire and by direct interview. RESULTS: There were a total of 59 hemodialysis nurses in hemodialysis centers in Benghazi. All agreed to participate in the study. Although 92% of the nurses knew that their hands could be a source of health care-associated infections, but only 52% of nurses washed their hands before contacting another patient. Gloves were actually used by 98% of the nurses. 46% of the nurses were usually wearing masks when contacting a patient. Books and journals were the main source of information about (HAI) among 52% of the nurses. CONCLUSION: The nurses' knowledge of health care-associated infections did not modify their adherence to hand hygiene practices. This study recommend training programs for hemodialysis nurses about promoting higher hand hygiene standards and potential use of personal protective measures during their shifts in hemodialyais centers.
[ABSTRACT]   Full text not available  [PDF]
  45 16 -
Antimicrobial resistance profile and molecular characterization of methicillin-resistant staphylococcus isolates in Tripoli Central Hospital, Libya
SM Aetrugh, MA Aboshkiwa, WM Husien, ME Erhuma, M Corrente, E Grandolfo, MS Ellabib, TM Emahbes, MI Mustafa
January-June 2017, 2(1):74-83
DOI:10.21502/limuj.010.02.2017  
Background: Nosocomial infections caused by methicillin-resistant Staphylococci could lead to increased morbidity and mortality, but little is known about the prevalence of infections with these organisms in healthcare facilities and in the community in Tripoli. This study investigated the in vitro susceptibility of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase negative staphylococci (MRCNS) to antimicrobial agents, and determined the molecular characteristics of MRSA. Methods: This is a retrospective observational study aiming at determining the prevalence and antibiotic resistance pattern of (MRSA) and (MRCNS) isolated from non-duplicated clinical specimens in Tripoli Central Hospital (TCH) between June 2013 and June 2014. Isolates were identified using standard laboratory procedures. Antimicrobial susceptibility tests were carried out by disk diffusion method and automated systems. DNA of the MRSA isolates was used for PCR to determine the molecular analysis. Results: 218 isolates of Staphylococci were obtained, 71.6% were coagulase positive staphylococci (CPS) and 28.4% were coagulase negative staphylococci (CNS). 39.7% of CPS were MRSA, while 75.8% of CNS were MRCNS. The rates of hospital-acquired MRSA (HA-MRSA) and community-acquired MRSA (CA-MRSA) among MRSA isolates were 61.3% and 38.7% respectively. A similar trend was detected among MRCNS isolates, where 74.5% were HA-MRCNS and 25.5% were CA-MRCNS. All the MRSA and MRCNS isolates were susceptible (100%) to vancomycin, tigecycline, linezolid, quinupristin/dalfopristin, daptomycin and moxifloxacin. Generally, hospital-acquired strains showed higher resistance rates than community-acquired ones to the most commonly tested non-beta-lactam antibiotics. 35.5% of all staphylococcal isolates exhibited mecA+ gene and 12.9% expressed mecC+. Meanwhile, 38.7% of MRSA isolates harbored both mecA and mecC. However, 12.9% of MSSA isolates were negative for both mecA and mecC. The mecA gene was detectable in 59.1% and 40.9 % of HA-MRSA and CA-MRSA isolates respectively. Conclusion: Hospital-acquired MRSA and MRCNS isolates had higher resistance rates to non-beta lactam antimicrobial drugs than the respective community-acquired isolates. This was shown by early detection of mecC gene among MRSA isolates.
[ABSTRACT]   Full text not available  [PDF]
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Tooth size discrepancy in different malocclusion groups in Libya: a pilot study
F Elsheikhi, I Bugaighis, T Hamed
July-December 2017, 2(2):92-100
DOI:10.21502/limuj.012.02.2017  
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.
[ABSTRACT]   Full text not available  [PDF]
  9 0 -
EDITORIAL
Higher education in Libya: Challenges and future plans (in Arabic language)
Mustafa M El-Fakhri, Salma A Bukhatwa
January-June 2016, 1(1):27-34
DOI:10.21502/limuj.004.01.2016  
Educational institutions are the principle pillars for establishment of sustainable human development which leads to community progress. Therefore, it is essentially important to develop their infrastructure, programs, and financial resources and assure the quality of their outcome to effectively respond and fulfill community needs. With current unprecedented scientific advancement in all aspects of life, it is becoming a formidable task to stay internationally competent. Continuous development and improving educational programs are therefore a must. The future requirements of education are choosing quality over quantity and adopting modern, reliable teaching methods in order to acquire knowledge, develop skills and attitudes that comply with good professional practice to meet the challenge of globalization. Education in Libya is free for everyone from elementary school up to university level but the general decline in the quality of Libyan higher educational system within the last four decades is well recognized. The efficiency of its product has been proven to be inconsistent with the national economical and developmental needs. Internal challenges of the higher educational system in Libya that affecting its own performance are presented in this paper, even though this does not under estimate the effect of other external threats, but they just remain beyond the scope of this paper. These challenges include; lack of a national strategic plan, poor primary and secondary school output, excessive students' admission, structural problems, poor infrastructure, administrative and legal problems, poor academic staff performance, outdated curricula and teaching methods, poor financial resources, poor research and postgraduate programs. Inevitably, the first step in treatment of such situation is to adopt a national strategy for higher education to know where we stand and to decide where to go and how to reach there. This of course in addition to linking educational programs to local, national and international market needs and promoting investment in education.
[ABSTRACT]   Full text not available  [PDF]
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ORIGINAL RESEARCH ARTICLE
Beta-adrenergic receptor blockers effects on the antinociceptive action of imipramine against thermal induced pain in albino mice
HA Zawia, FA Blaou, AS Elhwuegi
January-June 2016, 1(1):17-26
DOI:10.21502/limuj.003.01.2016  
Introduction: Tricyclic antidepressant have been shown to be effective in treatment of pain of varying etiology, monoaminergic system seems to be implicated in this phenomena. This research examines the role of beta-adrenergic receptor blockers on the antinociceptive effect of imipramine in albino mice using thermal model of pain. Methods: Different groups of five animals each were injected intraperitoneal by different doses of imipramine only (2.5, 7.5,15, 30 mg/kg), atenolol (2 mg/kg), propranolol (6mg/kg), or the combination of the different doses of imipramine with the fixed dose of atenolol or propranolol. The degree of analgesia was measured as an increase in reaction time to pain in the hot plate one hour after drugs injections. Results: Imipramine produced dose dependent increase in reaction time from 129% with the lowest dose to 196% with the highest dose. One-way ANOVA analysis has shown that the addition of a fixed dose of propranolol antagonized significantly the increase in reaction time to 75% with the lowest dose and 118.9% with the highest dose of imipramine. On the other hand, atenolol failed to antagonize significantly the increase in reaction time induced by imipramine. Conclusion: Imipramine has a significant analgesic effect on albino mice in the hot plate test. The antinociceptive action of imipramine seems to be of central origin and possibly mediated, at least in part, by beta adrenergic receptors, as this analgesic effect can be blocked by propranolol, a centrally acting non-selective beta adrenergic receptor antagonist, but not with atenolol which blocks only the peripheral beta receptors.
[ABSTRACT]   Full text not available  [PDF]
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CASE REPORTS
“Gunshot injury to the pelvis”. The bullet voided through the urethra
AM Etabbal, AE EL Shaikhy
January-June 2017, 2(1):28-34
DOI:10.21502/limuj.004.02.2017  
Gunshot injuries (GSIs) are considered an emergency as life threatening. The gunshots injuries in the urinary tract are uncommon. The high-velocity of bullet can cause both a penetrating injury to the target organs as well as a blast injury to nearby structures, in addition to thermal injuries. In most cases, laparotomy is required to remove the bullet and to repair the injuries. The phenomenon of spontaneous migration of retained bullet to different parts of the body has been described in medical literature. Here, we present a patient who sustained penetrating GSI to the pelvis, without organ injuries, including the bladder. The bullet initially was retained within peri-vesical fat and the bladder wall while the mucosa remained intact, then it migrated into the bladder and came out through the urethra during voiding on the sixth day of the injury.
[ABSTRACT]   Full text not available  [PDF]
  4 1 -
ORIGINAL RESEARCH ARTICLE
Post-thyroidectomy permanent hypocalcemia and hypoparathyroidism: frequency and risk factors
MS Elsaeiti, KD Alsaeiti
January-June 2017, 2(1):84-91
DOI:10.21502/limuj.011.02.2017  
Background: Hypoparathyroidism is the most common complication after thyroidectomy and the main reason for frequent outpatients' visits; however, there is a poor understanding of its outcomes, and no clear follow-up strategies are available. We aimed to evaluate the frequency and risk factors of post-thyroidectomy hypocalcemia hypoparathyroidism in Libyan patients. Methods: A case series study was conducted. The serum calcium and parathyroid hormone level (PTH) were measured at least 8 months post thyroidectomy. Results: 124 patients were reviewed in this study; 19 (15.3 %) were males and 105 (84.7 %) were females. 30.6 % of males and 13.7% of females developed hypocalcemia and hypoparathyroidism. Total thyroidectomy (TT) was performed in 62.9 % of all patients, while 24.2% of all patients underwent near total thyroidectomy (NTT). 12.1% of all patients underwent bilateral subtotal thyroidectomy (BST) and 1 patient underwent hemi thyroidectomy (0.8%). The risk of hypocalcemia was higher in patients with malignant thyroid disease in comparison to benign thyroids (45.8 % vs. 27% of patients). Papillary thyroid carcinoma (PTC) was the most common cause of both hypocalcemia and hypoparathyroidism (45.5% for both) followed by Graves' disease (22.2% and 14.8% for hypocalcemia and hypoparathyroidism respectively). Hypocalcemia and hypoparathyroidism were more frequent in patients who underwent TT (19.2%), as compared to patients who underwent NTT (6.6 %). Among nine patients who were operated on twice, three patients had hypocalcemia, and two of them were found to be hypoparathyroid; one case is diagnosed with Graves' disease, while the other was diagnosed as PTC. Conclusion: Total thyroidectomy, and re-operation are associated with increased prevalence of permanent hypocalcemia and hypoparathyroidism when compared to less extensive thyroid resection modes.
[ABSTRACT]   Full text not available  [PDF]
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Necrotizing fascitis of male genitalia: A series of fifty-four consecutive patients
MH EL. Khafifi, KS Mohammed, W.E.Y Alaorfi, AR Osman
July-December 2017, 2(2):134-139
DOI:10.21502/limuj.017.02.2017  
BACKGROUND: Fournier's gangrene (FG) is a fulminant aggressive necrotizing fascitis affecting the external genitalia, perineum and anterior abdominal wall with significant mortality rate. The aim of the present study was to describe the associated risk factors, presentation, diagnosis, management and outcome of this condition in Benghazi, Libya. PATIENTS& METHODS: Over a period of twenty years (from January 1997 to October 2016) a series of 54 consecutive patients who were admitted to Urology Department, Hawari Center for Urology and Otolaryngology, Benghazi-Libya were evaluated retrospectively to assess the risk factors, etiology, management and outcome of this fatal disease. RESULTS: It was found that 37 (68.5%) of patients were diabetics and 24 patients (44.4%) had perianal abscess as predisposing factor. Mortality rate was 14.8% (8 patients). All cases diagnosed on clinical basis. The patients operated promptly by extensive debridement. Reconstructive surgery done by flap or graft in plastic department to close the skin defect in most of our patients (41 patients, 75.9%). CONCLUSION: The main co-morbidity and predisposing factors of FG are diabetes mellitus and perianal abscess respectively. Prompt aggressive debridement is the only management to save the patient's life.
[ABSTRACT]   Full text not available  [PDF]
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Laparoscopic transabdominal preperitoneal hernia repair. Early experience of 37 patients
A Abuzalout Tawfik, S Taktuk Salah
January-June 2016, 1(1):35-44
DOI:10.21502/limuj.005.01.2016  
Introduction: Inguinal hernia repair is one of the most frequently performed procedures in surgery and many different techniques have been suggested. This report reviews our experience with 39 transabdominal preperitoneal (TAPP) hernia repairs in 37 patients. Methods: Thirty-seven patients have been admitted for inguinal hernia repair in Benghazi Medical Center and in Aljala hospital, Benghazi-Libya. Laparoscopic TAPP repair was considered for all reducible inguinal hernias aged (18–70 years). Data was prospectively collected from January 2009 to December 2013,including age, sex, BMI, hernia characteristics, complications, mean operative time and mean hospital stay. Patients with irreducible, obstructed or scrotal hernias, previous lower abdominal surgery, BMI more than thirty fiveand an American Society of Anesthesiologists (ASA) grade higher than II were excluded. Results: There were 34 males and 3 females, with a mean age of 33.4 ± 13.0 years and BMI of 24.6± 1.9. Mean operative time was 75 ±18.6 minutes .The mean hospital stay was one day ± 0.27. There was no conversion, mesh infection, bladder or vascular injury, death or recurrence after a median follow up for six months. Four minor complications occurred with two seroma formation, one wound bruising and one chronic groin pain due to tackers treated conservatively. Median return to normal activities was 10 days. One fourth of patients required no postoperative analgesia. Conclusion: Laparoscopic inguinal hernia repair was found in our study to be feasible, safe, with less postoperative pain, shorter hospital stay, and early return to normal activities.
[ABSTRACT]   Full text not available  [PDF]
  1 3 -
Knowledge towards breast cancer among Libyan women in Tripoli
YA Taher, AM Samud, GM Benhusein
January-June 2016, 1(1):58-68
DOI:10.21502/limuj.007.01.2016  
Introduction: Breast cancer in women is the commonest type of cancer worldwide. However, in Libya, ordinary systematic screening for breast cancer is neglected. Aim: The present study was aimed to evaluate the women's knowledge towards breast cancer and its risk factors. Methods: A cross-sectional survey, using self-administered questionnaire and face-to-face interviews was conducted at different places in Tripoli city along a period of nine months, from April-December 2013. Results: The mean age (±bSD) of the participating women was 48±b5 years and out of 284 contributors 84.5% were married. One hundred and eighty women (63.4%) stated that long-term use of contraceptive pills (> 5 years) increases the incidence rate of breast cancer. Besides, more than half of participants (157 women) specified that breast cancer is treated by surgery, chemotherapy and radiotherapy. However, although 50.7% of women reported that mammography and ultrasound are used for early detection, more than 60% of women believed that mammogram can cause cancer. In addition, our data demonstrate that increased knowledge was associated with women who know how to do self-examination and living in urban area. Conclusion: Our findings demonstrate that Libyan women have acceptable level of knowledge regarding breast cancer. However, improvement of the health systems and awareness regarding breast cancer is needed.
[ABSTRACT]   Full text not available  [PDF]
  2 2 -
Studies and evaluation of compressed microspheres
Idris M El-Mahdi, Atef M Madi
January-June 2016, 1(1):6-16
DOI:10.21502/limuj.002.01.2016  
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.
[ABSTRACT]   Full text not available  [PDF]
  2 2 -
Inducible clindamycin resistance among Staphylococcal clinical isolates from Tripoli Central Hospital, Libya
SM Aetrugh, MA Aboshkiwa, KA Tawil, UM Shweref, ME Erhuma, MI Mustafa
July-December 2017, 2(2):128-133
DOI:10.21502/limuj.016.02.2017  
BACKGROUND: The resistance to antimicrobial agents among Staphylococci is an increasing problem. This has led to a renewed interest in the usage of macrolide-lincosamide-streptogramin B (MLSB) antibiotics to treat staphylococcal infections. Clinical failure has been reported due to multiple mechanisms that confer resistance to clindamycin antibiotics. The present study was to investigate the inducible clindamycin resistance among isolates of methicillin resistant Staphylococci by the D-test method. MATERIALS & METHODS: This study was conducted on 218 staphylococcal isolates obtained from different clinical specimens of outpatients and inpatients admitted to Tripoli Central Hospital (TCH), Libya. Methicillin resistance was detected by oxacillin, cefoxitin disc diffusion test (Kirby Bauer method) and confirmed by other biochemical tests. Detection of inducible clindamycin resistance was performed by D-test using erythromycin and clindamycin. RESULTS: Eighty-six out of 218 staphylococcal isolates were resistant to erythromycin,26 (11.9%) isolates were D-test positive indicating inducible (iMLSB) phenotype, 24 (11%) isolates exhibited constitutive (cMLSB) phenotype, while 36 (16.5%) showed true sensitivity to clindamycin indicating (MS) phenotype. The distribution of isolates showing iMLSB phenotype was 12 (19.4%) for methicillin-resistant Staphylococcus aureus (MRSA), 8 (17.0%) for methicillin-resistant coagulase-negative Staphylococci (MRCNS), 6 (6.4%) for methicillin-sensitive Staphylococcus aureus (MSSA) and 0 (0%) for methicillin-sensitive coagulase-negative Staphylococci (MSCNS). CONCLUSION: Higher prevalence of iMLSB phenotype was mainly associated with methicillin-resistant than methicillin-sensitive isolates. We recommend that D-test should be performed to facilitate the appropriate treatment of patients infected with Staphylococci.
[ABSTRACT]   Full text not available  [PDF]
  2 1 -
EDITORIAL
The benefits of global competitiveness
Mohamed Saad Ambarek
January-June 2016, 1(1):1-5
DOI:10.21502/limuj.001.01.2016  
Full text not available  [PDF]
  0 2 -
ORIGINAL RESEARCH ARTICLE
A descriptive retrospective study on children with newly diagnosed nephrotic syndrome presented to Tripoli Children Hospital during the period between Jan. to Dec. 2014
NR Rhuma, AS El Boeshi, LT Sabei, AM Kara
January-June 2016, 1(1):45-57
DOI:10.21502/limuj.006.01.2016  
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.
[ABSTRACT]   Full text not available  [PDF]
  2 0 -
The effect of imipramine on the behavior of albino mice in presence of selenium
SM Aburawi, SA Baayo
July-December 2016, 1(2):69-81
DOI:10.21502/limuj.008.01.2016  
Introduction: Imipramine, a tricyclic antidepressant used in the treatment of depression, anxiety, and other mental condition. Selenium is useful in managing depression and anxiety. Aim: The present study was aimed to investigate the behavior effects of imipramine in presence of selenium on anxiety, spontaneous motor activity and antidepressant behavior. Methods: Mice were divided into 5 groups of six each. Group 1 (control) was given 5ml/kg 1% Tween 80.Group 2 was given selenium (200 μg/kg). Group 3 was given diazepam (1 mg/kg).Group 4 mice was given imipramine (10 mg/kg).Group 5 was given combined treatment of selenium and imipramine. All drugs were injected as sub-acute (three doses), intraperitoneally and administered at 24, 5, and 1.0 hours before scoring. Animals were tested in the elevated plus maze, open field and forced swim test one hour after drugs injections. All drugs were given by intraperitoneal route. Results: Imipramine in the dose used had no anxiolytic effect and no effect on motor activity. Selenium has anxiolytic effect in the plus maze and no effect on spontaneous motor activity. The anxiolytic effect of selenium disappeared when given with imipramine. Both imipramine and Selenium alone produced significant antidepressant effect in the forced swim test, this effect disappeared when selenium was administered with imipramine. Conclusion: Both the anxiolytic effect of selenium and the antidepressant effect of imipramine and selenium was abolished when administered together.
[ABSTRACT]   Full text not available  [PDF]
  2 0 -
Vesicovaginal fistula diagnosis and repair, Benghazi-Libya (Nine years of experience)
AM Etabbal, RM El Kawafi, AS Greiw
July-December 2016, 1(2):93-105
DOI:10.21502/limuj.010.01.2016  
Introduction: Although most of vesicovaginal fistulas (VVF) are iatrogenic, they can also occur as a result of congenital anomalies, neoplastic changes, and complications of radiotherapy. In rural areas, the obstructed labor may lead to the development of VVF. However, the most common cause of VVF in developed areas is iatrogenic damage of the bladder tissue. Aim: To confirm that the immediate repair of iatrogenic urinary bladder injures during obstetric or gynecological surgeries prevents VVF formation, and to identify optimal time and outcome of surgical techniques of VVF repair. Patients & Methods: Prospective study was carried over 9 years and included 95 patients. These patients were divided into two groups; one group underwent immediate intra-operative repair of urinary bladder injuries (n=76), while other group presented with VVF and underwent either reconstructive or urinary diversion surgeries on elective bases (n=19). Results: The mean age of 19 cases having VVF was 29.4 ± 8.4 years. One case was missed and other 18 cases underwent abdominal repair (n=8), vaginal repair (n=5) and permanent urinary diversion (n=5). The time of repair ranged from 2 day to 7 months after detection of VVF. The success rate of post-surgical VVF repair was 92.3%. Conclusion: Immediate repair of urinary bladder injuries during obstetric or gynecological surgeries prevents development of VVF. Post-surgical VVF repair can be done in first post-operative days before inflammatory changes takes place. The result of VVF repair depends on the experience of the surgeon rather than the used surgical techniques.
[ABSTRACT]   Full text not available  [PDF]
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Reduction of cholesterol and fasting blood sugar levels by one month supplementation of fresh garlic in diabetic Libyan patients: A double blind, baseline controlled study
AI Banigesh, AR Hamad, AA Dihom, IM El-Mahdi
January-June 2017, 2(1):47-54
DOI:10.21502/limuj.007.02.2017  
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.
[ABSTRACT]   Full text not available  [PDF]
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The prevalence of temporomandibular disorders among a group of libyan dental students
I Bugaighis, R Elgehani, M Orafi, A Elatrash
January-June 2017, 2(1):64-73
DOI:10.21502/limuj.009.02.2017  
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.
[ABSTRACT]   Full text not available  [PDF]
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Presentation and management of hypopituitarism in Tripoli-Children Hospital 2000-2010
F BenRajab, HR Gajam, T Emahbes
July-December 2017, 2(2):112-119
DOI:10.21502/limuj.014.02.2017  
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.
[ABSTRACT]   Full text not available  [PDF]
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Undescended testis: timing of referral and surgical intervention, Urology Center, Benghazi, Libya
OA Tarhoni, AM Etabbal, AF Trkawi
July-December 2017, 2(2):120-127
DOI:10.21502/limuj.015.02.2017  
BACKGROUND: Undescended testis (UDT) is the failure of testes to descend into the scrotum. It is classified according to the site of arrest into; Intra-abdominal, deep inguinal ring, canalicular, or emergent from the superficial inguinal ring. The diagnosis of UDT is mainly clinical and its treatment is usually surgical. The aim of our study is to analyze age distribution at the time of diagnosis and treatment to determine if the international guideline recommendations are followed in our institution or not. PATIENTS & METHODS: A retrospective study was carried at Urological Center by reviewing the files of 75 consecutive patients admitted to the hospital in the period from July 2011 to April 2014. A data flow sheet was used to record and analyze the patients' personal data, age at diagnosis, physical findings, type of surgical procedure, and the age of the patients at the time of surgery, as well as surgical findings. RESULTS: Total number of patients enrolled in the study was 75 patients. Fifty-two cases were diagnosed at birth, 14 cases discovered incidentally, and 9 cases were presented with reducible inguinal swelling with or without pain. The 75 patients had 93 UDTs, 49 UDTs on right side and 44 UDTs on left side. Sixty-nine UDTs were clinically palpable while the other 24 UDTs were not palpable (74.2% and 25.8% respectively). The mean age at the time of diagnosis was 3.7 ± 8.3 years. However, the mean age at the time of surgery was 10.8 ± 10 years. The surgical procedures performed were: orchiopexy (n=58, 62.3 %,), orchiopexy combined with ipsilateral hernial repair (n=16, 17.2%) and orchiectomy (n=19, 20.4%). CONCLUSION: In our institution, the mean age at orchiopexy was significantly delayed beyond the recommended time of surgery because of delayed diagnosis or referral.
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EDITORIAL
2016-A year of success for Libyan International Medical University Journal [IMUJ]
The editorial team (LIMUJ)
January-June 2017, 2(1):1-2
DOI:10.21502/limuj.001.02.2017  
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LETTER TO THE EDITOR
Importance of whole exome sequencing in diagnosis of diseases (the Libyan experience)
M Kara
January-June 2017, 2(1):35-39
DOI:10.21502/limuj.005.02.2017  
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ORIGINAL RESEARCH ARTICLE
Pattern of ocular trauma in Benghazi eye hospital, Benghazi, Libya
MM Gebril
January-June 2017, 2(1):40-46
DOI:10.21502/limuj.006.02.2017  
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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Antibiotics consumption in the Eastern Region Of Libya 2012-2013
AA Khalifa, SA Bukhatwa, MM Elfakhri
January-June 2017, 2(1):55-63
DOI:10.21502/limuj.008.02.2017  
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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Gastroprotective effects of 1-Hydroxy-2-phenylbenzimidazole in ethanol-induced gastric ulcers in rats
HM Ezgallaey, SM Abuskhuna, AM Dugani
July-December 2016, 1(2):82-92
DOI:10.21502/limuj.009.01.2016  
Introduction: Benzimidazole compounds are known for their reduction of gastric secretion by inhibition of H+/K+-ATPase enzyme. Aim: The gastroprotective activity of the synthesized 1-hydroxy-2-phenylbenzimidazole (HPB) is examined on gastric lesions induced in rats by the oral ingestion of ethanol. Methods: Gastroprotective activity was evaluated by estimation of the numbers and cumulative lengths of glandular gastric ulcers induce by ethanol. The effect of pretreatment with HPB given alone and in combination with ranitidine on the number and length of gastric ulcers; and as well as on gastric volume and total gastric acidity were investigated. Results: Pre-treatment of rats with HPB at the doses of 25 and 50 mg/kg IP, significantly decreased the number and the length of ethanol induced gastric ulcers compared to control group. The highest curative ratio 53.89% and the most reduction of gastric acidity were obtained with the highest dose of HPB (50 mg/kg) in combination with ranitidine. Histopathological findings confirmed the protective effect of the HPB. Conclusion: The synthesized benzimidazole derivative (HPB) provided a gastroprotective effects on ethanol-induced gastric lesions in rats. This protective activity may be partly due to its ability to attenuate acid secretion.
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