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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Introduction: Cosmetics have been utilized by most of the people irrespective of their race, gender, or age to beautify, modify, or improve the physical appearance. Many cosmetic products contain heavy metals as ingredients or impurities. Recent research has reported that these metals can cause many types of health and skin problems. Aims: The aim of this study is to detect the levels of heavy metals in some cosmetic products that are available in cosmetic shops around the city of Benghazi. Materials and Methods: Twenty-five of cheap facial cosmetic products that are widely in demand in cosmetic shops in Benghazi were collected in April 2016. The samples included eight kohl, seven eyeliners, and ten lipsticks. Metals including iron, copper, chromium, zinc, lead, and cadmium were analyzed in the selected samples using flame atomic absorption spectrophotometer after suitable digestion process. Results: Our results indicated that iron and copper were detected in all samples with concentration ranges varying from 0.5 to 124.5 mg/kg for iron and 1.8–51.4 mg/kg for copper. The concentration ranges of chromium, zinc, cadmium, and lead were varied from 0.0 to 7.25 mg/kg, 0.0 to 22.75, 0.0 to 125.0 mg/kg, and 0.0 to 20.25 mg/kg, respectively. Conclusions: The results showed that the selected metals were detected in most of the samples at varying concentrations. Kohl samples have the highest concentration of the analyzed metals. According to the maximum allowed limits recommended by the World Health Organization (WHO) for toxic metals in cosmetics, there was only one sample that had lead concentration higher than the maximum limit recommended by the WHO. In addition, there were twenty samples that had concentrations of cadmium above the WHO legislation limits.

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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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Aims: The aim of this work is to “predict” the remaining shelf-life of chloramphenicol (CH) eye drops, commercially marketed, using the theoretical “Longland–Rowbotham model,”” followed by confirmation of findings by practical means. Materials and Methods: The methods used for the evaluation of CH-eye drops included the assay of the active ingredient, sterility testing, and minimum inhibitory concentration (MIC) determination using official methods during 6 months stability study at variable temperatures (4, 25°C). Furthermore, a 3-month accelerated stability study was carried out. Statistical analysis tests included Student's t-test and analysis of variance. Results: The prediction model indicated that in pessimistic conditions, the remaining shelf life was reduced to a merely 1 month following production (this is versus the 2 years expiration date given by manufacturer). However, the samples analyzed throughout a 6-month stability study revealed that storing CH solution at 4°C or 25°C does not produce any statistical difference regarding drug content, MIC, or sterility. Accelerated stability studies for 3 months period showed that only after 2 months from storage at 55°C the drug will start to degrade and a statistical difference could be observed. Conclusion: Storing CH-eye drops at room temperature for up to 6 months appears to have no effect on the stability of this antibiotic.

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Nanotechnology is an emerging multidisciplinary technique that involves application based on the synthesis of molecules in nano-scale size range. Nanotechnology is also seen as new and fast emerging field that involves the manufacture, processing and application of structure, device and system by controlling shape and size in nanometer scale. The concept of nanotechnology is driven from the Greek word nano (meaning dwarf). The nano-particles are defined as a discrete entity that has dimensions of the order of 100 nm or less. It is the small size in combination with the chemical composition and surface structure that gives the nano-particles their unique features. The alterations in physical properties serve to enhance versatility and efficacy in product development, resulting in more effective industrial and medical applications. As a result of the widespread use of nanotechnology and nano-materials, these particles find their way into the environment. Therefore, a focus on the source of nano-particles in the environment and their effects is included. This review concentrate on the recent information about analytical developments to assess the occurrence, fate and behavior of nano-materials in environment. It also focuses on the applications of nanotechnology in environment, especially in the area of air and water purifications.

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Aims: The aims of the present study were to evaluate the level of Libyan patients' expectations of and satisfaction with fixed prostheses (crowns, veneers, fixed partial denture, and dental implants). A further aim was to explore the level of patient's awareness and application of oral hygiene care pertaining to the fixed prosthesis. Materials and Methods: This was a cross-sectional survey. Self-reported questionnaires were administered to 320 patients wearing fixed prosthesis. The questions explored patient's subjective perception of and satisfaction with treatment outcome concerning esthetics, phonation, and masticatory function. In addition to questions related to their applied oral hygiene measures. Descriptive statistics and Spearman rank correlation coefficient tests were undertaken between the examined variables. P value was set at P < 0.05. Results: The majority (80.9%) of the patients were satisfied with their prosthesis; 78.4% were fulfilled with their chewing function; 85.3% were pleased with the esthetics; and 39.4% were satisfied by their speech. The fixed prosthesis met the expectations or partial expectations of 82.8% of the participants. Only 9.3% of the sample did not follow proper oral health care. There were moderate but significant correlation between the level of patients' expectations with and satisfaction from their prostheses (r = 0.387, P < 0.0001). Furthermore, the weak correlation between patient satisfaction and their application of oral hygiene measures was significant (r = 0.130, P = 0.020). Conclusions: Several factors (masticatory function, esthetic, and patient expectations) were correlated with the overall patients' satisfaction with their prosthesis. Dentist should continue to emphasize on the significance of maintaining good oral hygiene practice to improve patient satisfaction with their prostheses.

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Background: The association between maternal serum copper levels and premature rupture of membranes (PROM) is debated. Aims: This study aims to study the relationship between maternal serum copper levels and the incidence of PROM and to determine risk factors of PROM in Aleppo University Hospital of Obstetrics and Gynecology. Settings and Design: Sixty pregnant women were subjected for this study. Materials and Methods: Pregnant women were subjected for analyzing serum copper concentrations. Maternal serum copper levels were measured by atomic absorption spectroscope. Statistical Analysis: By SPSS (version 22.0). Results: A significant correlation was found between maternal serum copper levels and the incidence of PROM. The relationship presents when copper level is considered as a categorical variable, as mothers with copper deficiency were significantly more vulnerable for PROM (Odds ratios = 0.15, confidence intervals: 0.04–0.61, P = 0.002). Furthermore, the relationship presents when copper level is considered as a numerical variable, as mothers with lower serum copper levels were at significantly higher risk to develop PROM. Difference in means between the two groups was 40.87 μg/dL with CI (14.98–66.75) μg/dL (P = 0.003). Conclusion: Within its limitations, this study suggests a significant relationship between maternal serum copper levels and PROM.

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Introduction: Pulmonary involvement, such as Interstitial Lung Disease (ILD) and Pulmonary Hypertension (PH ), accounts for significant morbidity and is the leading cause of Systemic sclerosis (SSc)-related morbidity and mortality. The aim of the current study was to study the frequency of occurrence of ILD in SSc and to describe the clinical and radiological picture of pulmonary involvement in SSc. Patients and Methods: Forty patients attending different rheumatology clinics in eastern part of Libya between January 2018 and September 2020 were included. Basic details including age, gender, disease duration, detailed history, and clinical examination were noted. Autoimmune profiling included rheumatoid factor, antinuclear antibodies, and anti-Scl-70 antibodies. Pulmonary function test, chest X-ray (CXR), and high-resolution computed tomography of the chest (HRCT) in all patients were recorded. Data presented either as frequencies and percentages or as means ± standard deviation. Results: The male: female ratio was 1:9 with a mean age of 37.5 ± 9.6 years and duration of illness 6 ± 4 years. diffuse cutaneous SSc was seen in 62.5% of the patients. 77.5% of the participants had bilateral crepitation and 57.5% had loud P2. Presenting complaints included gastrointestinal reflux in 72.5%, digitalis ulcerations in 40%, and synovitis/arthritis of all patients. Other comorbidities included congestive heart failure in 12.5%, PH in 15%, and renal impairments in 7.5% of all patients. Anti-Scl-70 antibody was the most common in all patients (45%), followed by anti-centromere Ab (25%), anti-U3 RNP (10%), and anti-U1 RNP (5%). 72.5% of the participants had reticulonodular shadows on CXR. HRCT showed honeycombing as the predominant finding (37.5%). Echocardiograms showed that 15% of all patients have signs of PH. Duration of disease, dyspnea, cough, bilateral crepitations, and CXR were found to be significantly associated with extensive ILD (P < 0.05). Conclusion: ILD is a serious complication of SSc, it is more common among patients with dcSSc. Chest HRCT is very sensitive to detect ILD. A significant association was found in Libyan patients between the severity of ILD and the duration of disease, dyspnea, cough, bilateral crepts, and CXR.

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Introduction: Solid dosage forms are the most commonly used dosage form for drug delivery, and tablets are more popular than capsules because of its lower production cost, minimal potential of content tampering, and the large number of designs of tablets for various applications. Aims: The aim of this work is to redesign amoxicillin hard gelatin capsules (HGCs), commonly filled into HGCs, into tablet dosage form by employing preformulation principles. Materials and Methods: Amoxicillin capsules were obtained from the local market for this purpose. Experiments included studies on flowability and effect of compression force, followed by addition of excipients, production of tablets by direct compression, and evaluation employing standard methods of friability, hardness, disintegration, dissolution, and simulation of release kinetics. Results: The flowability of powder was estimated using Carr's index, Hausner ratio, angle of repose, and bulk density. The flowability was found poor for amoxicillin alone or with starch but improved with talc. Compression force was found to be a significant factor on friability, hardness, and disintegration. The disintegration time was rapid in case of tablets containing starch compared to amoxicillin powder compressed alone. It was essential to include small amounts of disintegrant and a lubricant to optimize tablet properties. Dissolution rates for the prepared tablets were found to be acceptable, while some formulations showed a slow release profiles corresponding to their slow disintegration. Release kinetics was found to follow both the zero-order and matrix models. Conclusion: Amoxicillin capsules can be modified to a tablet dosage form with simple handling of preformulation properties.

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Background: COVID-19 disease became an outbreak declared by the WHO as a public health emergency that is explicitly threatening the globe. Measures must be taken to control it, and health-care workers' situations need to be assessed. Objectives: The study aimed to assess the knowledge, attitude, and practice of Sudanese pharmacists regarding COVID-19. Materials and Methods: The study was an online descriptive cross-sectional survey, conducted from April to June 2020, among the registered pharmacists in Khartoum, Sudan. Three hundred fifty registered pharmacists were asked to participate in this study, all of them were responded. An online standardized questionnaire was conducted, and data were collected by a convenience sampling method and analyzed using the Statistical Package for the Social Science. Descriptive and inferential statistics were performed. Results: Response rate was 100%, 65,7% of the participants were females. The median age was 27 years, 72.9% of the pharmacists were bachelor degree holders, and 73.1% of participants were community pharmacists. The years of experience were 1–5 years for 54.4% of them. About 69.4% of the participants had sufficient knowledge about COVID-19, 27.1% reported a positive attitude, and 62.6% reported a fair attitude. Moreover, 88.3% of them were wearing facemask, gloves, and frequently use sensitizers. Nearly 47.7% stated that they would not dispense any treatment of COVID-19 without a prescription. Tests revealed that knowledge was statistically significant with gender (P = 0.001) and attitude with age and years of experience (P = 0.039, 0.01), respectively. Conclusions: More than two-third of the participants have sufficient knowledge regarding COVID-19. Only one-tenth of them have a negative attitude, and their practice toward the disease was relatively good.

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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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Background: The distribution of ABO and rhesus (Rh) blood groups has been reported to be different in several world populations. There have been few studies about blood groups among Libyan population. Aims: The study aims to determine the distribution and frequency of ABO and Rh blood groups among Libyan population in Bani Waleed city. Subjects and Methods: The study group had included 344 participants of both genders aged between 15 and 80 years. Blood samples were collected for ABO and Rh blood group analysis from September to December 2018. Results: The percentage of male participants was 55.8% and 48.2% were female. The highest percentage (30.2%) were among the age group of 23–32 years. O blood group was the most common (43.6%), followed by A (31.7%), B (17.7%), and finally, AB blood group (7.0%). The percentage of Rh positive (Rh⁺) was 72.2% and of Rh negative (Rh⁻) was 23.8%. Moreover, the prevalence of ABO with Rh⁺ was 33.4%, 27.6%, 11.3%, and 4.7% for O⁺, A⁺, B⁺, and AB⁺, respectively. The prevalence of ABO with Rh⁻ was 9.9%, 6.11%, 4.1%, and 2.6% for O⁻, B⁻, A⁻, and AB⁻, respectively. Conclusion: The distribution of ABO blood group in the present study is ordered of O > A> B > AB with majority of Rh⁺ and higher frequencies of Rh⁻. The findings of this study will contribute in health services and use them as database to know detailed information of blood types such as for blood bank and blood transfusion and also to be used in population studies.

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This article reviews suicide terrorism and existing understandings of the psychology of suicide bomber. Suicide attacks that take place in many different parts of the world are one of the most used methods by the terrorist organizations. Suicide terrorism as a type of terrorism carried out by suicide bombers wearing bomb vests or by assembled bomb vehicles attracts a lot of attention globally. Throughout human history, some people may attempt suicide at some point in their lives, and some of these attempts end in death. Suicide is an act of self-punishment and deliberate separation from the world. In other words, suicide is a pathological behavior that a person consciously does with the aim of ending his life and ends with success. The act of killing one's own life, which a person cannot make sense of and regards as abnormal, is such a complex and painful event. In this study, terror, suicide terrorism, suicide bombing will be studied, and the psychology of the suicide bomber will be examined.

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Recent studies have provided clear and convincing evidence that chronic stress contributes significantly to the pathogenesis and expression of cardiovascular diseases (CVDs). This bibliography is a systematic review on the impact of chronic stress on the cardiovascular system with a special reflection on the Libyan conflict. It is divided into two parts, Part 1 deals with types of chronic stresses, while Part 2 deals with mechanisms involved in chronic stress and their treatments. Medline/PubMed, Google Scholar, and Scopus databases were used to search for peer-reviewed papers dealing with the review theme. Stress can be classified into acute stress and chronic stress. Chronic stress can stem from underlying factors such as economic stress, social isolation stress, posttraumatic stress, and job strain stress. Economic stress is emerging as an important determinant of perceived health where different studies have found an inverse trend between risk factor burden and cardiovascular disease prevalence in urban and rural communities in high-, middle-, and low-income regions. Social stress is another factor that has been reported to be associated with a 2–3 fold increase in the incidence of CVD. Moreover, multiple studies have shown that patients suffering from posttraumatic stress disorder have increased resting heart rate, increased startle reaction, and increased blood pressure as responses to traumatic events. CVD is one of the health outcomes whose links with work stress have been well established based on numerous prospective studies.

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Background: Staphylococcus species are one of the most important healthcare-associated pathogens able to acquire and spread multidrug-resistant determinants. Objectives: The present study investigated and analyzed 110 potential Staphylococcus species isolated from various clinical and nonclinical samples at Brack hospital. Materials and Methods: A nonselective laboratory approach was applied, using cultural characteristics, Gram stain, and catalase reactivity followed by confirmation at the species levels and determination the susceptibility against antimicrobial agents using the Phoenix automated microbiological system. Results: In total, 57.5% were confirmed as species and subspecies of Staphylococcus represented by ten different species: nine subspecies of coagulase-negative staphylococci (CoNS) (76.2%) and one coagulase-positive staphylococci (CoNS) subspecies (23.8%). Of these strains, 16.6% were identified as methicillin-resistant staphylococci (MRS) mostly of the CoNS group expressing significant resistance to important antimicrobial classes. Conclusion: This study reports a high prevalence of various staphylococci species, particularly of CoNS group expressing multidrug resistance patterns of public health concern, from a healthcare setting in the south region of Libya. The identification of higher rate of MRCoNS underlines the importance of monitoring all multidrug-resistant staphylococci species requiring further epidemiological investigations.

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Background: Exposure to vanadium exhibits deleterious neurotoxicity. Doxycycline is a potential antioxidant that prevents the progression of disease through inhibition of lipid peroxidation. Objectives: This research investigates the neuroprotective effects of doxycycline, in different rat brain areas in an animal model intoxicated with vanadium. Materials and Methods: Male Sprague-Dawley rats were equally divided into the following four groups: control group, doxycycline-treated group, vanadium-treated group, and concomitant doses of doxycycline plus vanadium-treated group, all given orally for 10 consecutive days. The animals were watched daily for any signs of neurological defects. They were sacrificed by decapitation 24 h after the last dose. Brain was removed rapidly and dissected into cerebral cortex, cerebellum, and brain stem. Biochemical studies including the concentrations of phospholipids, cholesterol, cerebrosides, glutathione (GSH), acetylcholinesterase (AChE) activity, gangliosides, ascorbic acid, calcium, and lipid peroxidation levels were determined. Results: The results revealed that vanadium produced significant reduction in body and absolute brain weight, with neurological function deficits. Vanadium significantly decreased the concentrations of phospholipids, cholesterol, cerebrosides, and GSH and inhibited AChE activity together with significant increase in gangliosides, ascorbic acid, calcium, and lipid peroxidation levels compared to saline controls. Animals which were given the combined treatment of vanadium and doxycycline regained weight and became normal. Moreover, doxycycline reversed the effect of vanadium on the metabolic variables and inhibited lipid peroxidation nearing to normal levels to that of saline controls. Conclusion: These findings demonstrated the antioxidant or chelating action of doxycycline against vanadium neurotoxicity and its therapeutic potential to avert neurodegenerative changes in different rat brain areas.

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Background and Objectives: Tuberculosis (TB) is an important cause of childhood morbidity and mortality. Understanding the barriers to successful childhood TB treatment is vital to curbing the scourge of childhood TB. This study examined the outcomes and factors that influence the outcomes of childhood TB treatment in a South-East Nigerian tertiary hospital. Methods: A 10-year review of the medical records of under-15 year olds, who received anti-TB treatment at Nnamdi Azikiwe University Teaching Hospital, Nnewi, was carried out. Data were analyzed using SPSS version 20. Results: Majority of the 501 childhood TB cases were new (89.6%) and pulmonary (73.3%) TB cases. TB-HIV coinfection occurred in 42.5% of cases. The rate of successful treatment was 62.9%. About 57.5% completed treatment, 5.4% were cured, 7.0% were transferred out, 21.4% were lost to follow-up, 0.4% had treatment failure while 8.4% died. Majority (61.6%) of deaths or loss to follow-up occurred during the first 2 months of treatment. Factors significantly associated with treatment outcomes were ascertainment of HIV status (P = 0.049), disease site (P = 0.013), nutritional status (P = 0.039), Mantoux test result (P = 0.002), and period of treatment (P = 0.005). Conclusion: Findings indicate high rate of unsuccessful childhood TB treatment outcomes. Efforts should be intensified to ensure improved outcomes through proactive search for childhood TB cases, early diagnosis and treatment, as well as adherence to and completion of treatment. Special attention should be given to high-risk groups including those with unknown HIV status, extrapulmonary TB, and severe malnutrition. It is imperative to determine the HIV status of all childhood TB cases.

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Objective: Anterior crossbite presents when one or more of the upper incisors occlude lingual to lower incisors. Several techniques were used to correct anterior crossbite. The aim of this article was to present the treatment of anterior crossbite under skeletal Class I relationship using multilooped archwire. Methods: A 24-year-old female has a complaint of anterior crossbite. She has concave profile, all her teeth present except the maxillary canines, 4 mm reverse overjet, 4 mm crowding in the lower anterior and 25% overbite. The treatment was started in the lower arch by the extraction of the lower first premolars. Different arch sequences of nickel–titanium alloys, followed by different sequences of stainless steel archwires were used. Results: The correction of crossbite was achieved successfully within 18 months. Normal overjet and overbite and orthognathic profile were accomplished. Conclusion: The treatment of anterior crossbite was achieved using retraction multilooping arch to achieve normal overjet and overbite.

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Background: The metabolic syndrome (MS) is defined as a cluster of cardiovascular risk factors, including central obesity, dysglycemia, hypertension (HPN), elevated triglycerides (TGs), and reduced high-density lipoprotein cholesterol (HDL-C). MS increases the risk of cardiovascular disease and all-cause mortality. Objective: This study aims to estimate the prevalence of MS and its components among nondiabetic Libyan females using the definition proposed by National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III). Methods: A total of 122 randomly selected nondiabetic Libyan females were included in the study. Detailed medical history was obtained from all participants. Blood pressure, weight, height, waist and hip circumference were measured. Body mass index and waist–hip ratio were calculated. Fasting blood glucose (FBG) and lipid profile were collected. Standard oral glucose tolerance test with 75 GM glucose was performed. The MS was defined by ATP III and International Diabetes Federation criteria. Results: According to NCEP definition, the prevalence of the MS in the study group was 42.6%. The most common component was abdominal obesity (67.2%). FBG was ≥ 100 mg/dl in 47.5%. The prevalence of both HPN and low HDL-C was 45.9%. About 26.2% of the participants have their TG ≥ 150 mg/dl; all were MS patients. Conclusions: The prevalence of MS and cardiovascular risk factors were high among Libyan females. Public health authorities and health-care providers should implement strategies for prevention, screening, and management of cardiovascular risk factors to reduce the burden of its potential complications.

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Background: E-Health is one of the recent major developments in health-care provision. Today's health professional students are considered digitally oriented, and this may endow them with the necessary capabilities to implement E-Health on graduation. Aim: This study aimed to assess students' views, use, confidence, and need for training on E-Health. Participants: Fourth-, 5^th- and internship-year students of the medical and dental schools at the Libyan International Medical University constituted the study population. Methodology: This is a cross-sectional study conducted using an online administered survey. Prior to implementation, the questionnaire was reviewed by experts and then piloted on a group of research-targeted students. Likert scale was used for most questions and few were in the form of short answers. Descriptive statistics were reported using SPSS software version 23.0. Results: One hundred and two students responded, and all responders were included for most select-response questions. The male-to-female ratio was 2:3, with a mean age of 24 ± 1.8 years. Medical students accounted for 52% of the participants. An average of 45% reported proficiency in written and spoken English. Only 12% have taken IT-related courses. Their view on E-Health was moderately positive with a mean of 3.5 ± 0.34 of 3.1 ± 1.029. In spite of this, 43% ± 3.9% had negative views on E-Health. Nearly 58% of the participants used digital tools and software with a mean score of 2.43 ± 0.6. Most students reported using social media, especially Facebook (mean 4.95 ± 1.7). The students reported a confidence level of information and communication technology (ICT) use of 3.4 ± 1.2. They also described their confidence in learning a new technology with a value of 3 ± 0.3. Almost 32.9% of the participants expressed an overall need for training on ICT tools. Conclusion: The overall preparedness of this group for ICT is moderate and needs improvement. This could be achieved through introducing changes in the taught curriculum.

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Diabetes mellitus is associated with microvascular and macrovascular complications. Diabetic neuropathy is the most common long-term complication of diabetes. The study was aimed at determining the prevalence of diabetic peripheral neuropathy and identifying its associated factors. Medical databases, including PubMed, Google Scholar, African Journal Online, and SCOPUS were searched and eligible studies were selected using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses algorithm. The prevalence of diabetic peripheral neuropathy in Nigeria was dependent on the modality used in diagnosing peripheral neuropathy. The overall prevalence of diabetic peripheral neuropathy in Nigeria was 31.2%–97.5%. The modality-dependent prevalences were 37%–97.5% (by biothesiometry), 41.7%–75% (by Michigan Neuropathy Screening Instrument), 31.2%–43.3% (by United Kingdom screening test), and 43.3%–69.9% (by diabetic neuropathic examination score). The associated factors were duration and control of diabetes, the age of the patient, presence of cardiovascular risk factors such as hypertension and dyslipidemia and other microvascular complications (e.g., diabetic retinopathy and nephropathy). The prevalence of diabetic peripheral neuropathy was found to be high in Nigeria and the associated risk factors were age, glycemic control, and cardiovascular risk factors.

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Introduction: The antimicrobial properties of Miswak (Salvadora persica) are well documented, and the use of its extracts in the formulation of toothpastes and mouth rinses are well established. Most of the literature agrees that the organic extracts are more effective than aqueous extracts. Aims: The aim of the study was to prepare aqueous Miswak extracts using three different methods. The difference between the methods is the amount of heating used for their preparation. Furthermore, to evaluate stability during storage of such extracts, their pH, and their antimicrobial activity. Materials and Methods: Miswak extracts were prepared by maceration, infusion, and decoction methods, followed by evaluation of their extraction efficiency, stability, pH, viscosity, and antimicrobial activity. Results: A correlation was found between pH of extracts and their viscosity. The pH of extract increases to 6.5 when extensive heat was used during preparation, which is close to the normal pH of saliva and oral cavity. The accompanied increase in viscosity was an indication of increased extraction efficiency. Suppression of freezing point confirmed such observation for extracts prepared by decoction. The only positive antibacterial activity was observed for decoction extract, but it was less than that of chlorhexiden. For minimum inhibitory concentration estimation, it was found that almost 50% w/v of the extract must be used to provide the minimum microbial inhibitory effect. Conclusions: Miswak components appear to be thermostable ingredients, and the method of decoction can produce stable and effective Miswak extract.

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