Showing papers in "Libyan Journal of Medicine in 2008"

Anatomic Variation of Sphenoid Sinus and Related Structures in Libyan Population: CT Scan Study

Abstract: Background: Sphenoid sinus is the most inaccessible paranasal sinus, enclosed within the sphenoid bone and intimately related to numerous vital neural and vascular structures. Anatomic variation of the sphenoid sinus is well documented and may complicate surgery in such a place. Objective: To outline the surgically risky anatomic variants of the sphenoid sinus as well as the variable relationships between the sinus and related neurovascular structures, for the safe removal of intrasphenoid and pituitary lesions. Materials and Methods: We undertook a prospective review of 300 paranasal sinus CT scans of Libyan patients; coronal CT scans were obtained by special parameter techniques. We assessed pneumatization of pterygoid process (PP), anterior clinoid process (ACP), and greater wing of sphenoid (GWS); we also examined protrusion and dehiscence of internal carotid artery (ICA), optic nerve (ON), maxillary nerve (MN), and vidian nerve (VN) into the sphenoid sinus cavity. Results: Pneumatization of PP, ACP, and GWS were seen in 87 (29%), 46 (15.3%), and 60 patients (20%), respectively. Protrusion of ICA, ON, MN, and VN were noticed in 123 (41%), 107 (35.6%), 73 (24.3%), and 81 patients (27%), respectively; dehiscence of these structures was encountered in 90 (30%), 92 (30.6%), 39 (13%), and 111 patients (37%), respectively. Statistically, there was a highly significant association between ACP pneumatization and ICA protrusion, ACP pneumatization and ON protrusion, PP pneumatization and VN protrusion; and GWS pneumatization and MN protrusion (p-value < 0.001). Conclusion: The sphenoid sinus is highly variable; this variability necessitates a comprehensive understanding of the regional sphenoid sinus anatomy by a detailed CT scan sinus examination before surgery in and around the sinus. This study indicates the possibility of a racial anatomical variation of the sphenoid sinus in the Libyan population. Key words: Sphenoid sinus, variation, internal carotid artery, optic nerve, maxillary nerve, vidian nerve, CT scan, Libyan.

The Acute Inflammatory Response in Trauma / Hemorrhage and Traumatic Brain Injury: Current State and Emerging Prospects

Abstract: Traumatic injury/hemorrhagic shock (T/HS) elicits an acute inflammatory response that may result in death. Inflammation describes a coordinated series of molecular, cellular, tissue, organ, and systemic responses that drive the pathology of various diseases including T/HS and traumatic brain injury (TBI). Inflammation is a finely tuned, dynamic, highly-regulated process that is not inherently detrimental, but rather required for immune surveillance, optimal post-injury tissue repair, and regeneration. The inflammatory response is driven by cytokines and chemokines and is partially propagated by damaged tissue-derived products (Damage-associated Molecular Patterns; DAMP's). DAMPs perpetuate inflammation through the release of pro-inflammatory cytokines, but may also inhibit anti-inflammatory cytokines. Various animal models of T/HS in mice, rats, pigs, dogs, and non-human primates have been utilized in an attempt to move from bench to bedside. Novel approaches, including those from the field of systems biology, may yield therapeutic breakthroughs in T/HS and TBI in the near future.

Seroprevalence of hepatitis B and C genotypes among young apparently healthy females of karachi-pakistan.

Abstract: Introduction: Although the prevalence of hepatitis virus infections in Pakistan is still unknown, limited data indicate that the exposure rate to HBV is 35-38% with 4% being carriers and 32% having anti-HBV surface antibodies through natural conversion [1,2,3]. Studies in Pakistan have shown that the prevalence rate of HCV is 4.8-14% for, and that it is continuously increasing. Hence there is an urgent need to create awareness about the prevalence of both hepatitis B and C, and to develop preventive measures aimed at minimizing the prevalence of these diseases in the country. Study Design: Prospective, descriptive study. The study took place from March 2002 till October 2006 at two university campuses in Karachi. Materials and methods: A total of 4000 healthy female students were screened for HBs Ag, anti-HBs antibodies and anti-HCV antibodies by rapid immunochromatography, ELISA and PCR. Results: A total of 3820 volunteers (95.5%) were negative by all three methods, 181 (4.5%) tested positive for HB surface antigen and 20 (0.5%) were positive for anti HB surface antibodies; 208 volunteers (5.2%) were positive for HCV. Double infection with HBV and HCV was found in only one patient (0.025%). Out of 180 HBs antigen positive samples 151 (83.89%) were genotype D, 28 (15.56%) showed mixed infection with genotypes B and D, and one patient (0.56%) showed mixed infection with genotypes C and D. Out of 208 samples positive for HCV antibodies, 107 (51.44%) were genotype 3a, 50 (24.04%) were mix of genotype 3a and 3b, 33 (15.87%) were genotype 3b, 10 (4.81%) were genotype 1b while, 8 (3.84%) samples could not be typed. Conclusion: Although the presence of these pathogenic viruses was not very high in our young healthy female population, it is still a matter of concern to control the unregulated spread of these deadly infections by promoting increased awareness and regular immunization programs in the community. Local manufacturing of vaccines and related products may reduce these infections. Key words: HBV, HCV, healthy females, genotypes.

Patterns Of Drug Prescribing In A Hospital In Dubai, United Arab Emirates

Abstract: To determine the pattern of drug prescription by consultants in a private hospital in Dubai, United Arab Emirates, 1190 prescriptions were collected from the hospital’s pharmacy over 30 days. In total, 2659 drugs were prescribed. The mean number of drugs per encounter was 2.2. Only 4.4% of all drugs prescribed were generic. Polypharmacy was observed in only 7.5% of all encounters. Information about the prescribing physician and the patient was invariably deficient. Name of patient, age, and gender were absent in 2.9%, 9.7%, and 12% of prescriptions, respectively. In addition, none of the prescriptions mentioned address, diagnosis, or allergy of the patient. Name of physician, signature, speciality and license or registration number were omitted in 12.2%, 10.3%, 20.3%, and 54.9% of prescriptions. The most commonly prescribed therapeutic classes of drugs (and principal drug in each class) were as follows: 23.4% non-steroidal anti-inflammatory drugs (NSAIDs, Diclofenac sodium being 51.6%), 21.4% antibiotics (amoxicillin-clavulanate 13.5%), and 11.5% gastrointestinal drugs (GI, Hyoscine-N-butylbromide 28.1%). Other therapeutic classes included endocrine drugs (6.1%), vitamin supplements (5.9%), nasal decongestants (4%), antihistaminics (3.8%) and cardiovascular drugs (2.6%). Antibiotic injections accounted for 7.4% of all antibiotics prescribed, which was equivalent to 1.6% of all prescriptions. Other agents prescribed in small proportions of encounters collectively amounted to 21.3%. This study reveals the prescription trends, and indicates possible areas of improvement in prescription practice. Key words: Patterns, prescribing, hospital, analysis

Neuroprotective effects of garlic a review.

Abstract: Garlic has been investigated extensively for health benefits, resulting in more than one thousand publications over the last decade alone. It is considered one of the best disease preventive foods, based on its potent and varied effects. Midlife risk factors for cardiovascular diseases, such as high serum total cholesterol, raised LDL, increased LDL oxidation, increased platelet aggregation, impaired fibrinolysis, hypertension and homocystinemia are important risk factors for dementia in later years. These risk factors play a major role in the genesis of atherosclerosis of vital arteries causing both cardiovascular and cerebrovascular disease. Garlic is best known for its lipid lowering and anti-atherogenic effects. Possible mechanisms of action include inhibition of the hepatic activities of lipogenic and cholesterogenic enzymes that are thought to be the genesis for dyslipidemias, increased excretion of cholesterol and suppression of LDL-oxidation. Oxidative stress caused by increased accumulation of reactive oxygen species (ROS) in cells has been implicated in the pathophysiology of several neurodegenerative diseases including Alzheimer's disease (AD). Several studies have demonstrated the antioxidant properties of garlic and its different preparations including Aged Garlic Extract (AGE). AGE and S-allyl-cysteines (SAC), a bioactive and bioavailable component in garlic preparations have been shown in a number of in vitro studies to protect neuronal cells against beta-amyloid (A ) toxicity and apoptosis. Thus the broad range of anti-atherogenic, antioxidant and anti-apoptotic protection afforded by garlic may be extended to its neuroprotective action, helping to reduce the risk of dementia, including vascular dementia and AD. Key words: garlic, anti-atherogenic, anti-oxidant, anti-apoptotic, neuroprotective

Reasons for Unwillingness of Libyans to Donate Organs after Death

Abstract: Introduction: Organ transplantation in Libya depends exclusively on donations from live relatives. This limitation increases mortality and prolongs the patients’ suffering and waiting time. Objectives: The aims of this study were to explore willingness to donate organs after death and to identify the reasons for refusal. Methods: A population-based cross-sectional study was conducted from April to July 2008 on a cluster sample of 1652 persons (58% males and 42% females). The questionnaire included demographic information and mainly enquired about willingness to donate organs after death and the reasons for refusal when applicable. Results: About one-third (29.7%) of participants were in favor of donating their organs after death, 60.1% refused and 10.2% were undecided. Willingness was significantly associated with being male, younger age, having a college or graduate degree, and being single (P <0.05 for all). Lack of adequate knowledge about the importance of deceased organ donation and uncertainty about its religious implications were the most predominant reasons for refusal (43.8% and 39.5%, respectively). Other reasons included ethical concerns about retrieving organs from dead bodies (37.9%), preference for being buried intact (28%), and uneasiness about the idea of cadaver manipulation (33%). Conclusion: There were a considerable resistance to deceased organ donation, especially among females, those of older age, married people, and those with a low education level. The barriers to cadaveric donations were lack of adequate knowledge, unease about body manipulation, and concerns about religious implications. Public educational campaigns should be coordinated with religious leadership. Key words: Reasons, Unwillingness, Libyan, Deceased organs, Donation.

Hypolipidemia: A Word of Caution

Abstract: Hypolipidemia is a decrease in plasma lipoprotein caused by primary (genetic) or secondary (acquired) factors. It is usually asymptomatic and diagnosed incidentally on routine lipid screening. The first report of hypocholesterolemia in the medical literature was in 1911 by Chauffard and coworkers, in patients with active tuberculosis [1]. Since then (about 95 years), only few dozens of studies were published in this regard. Unlike hyperlipidemia physicians are usually unaware of hypolipidemia, its causes and consequences. As the interest in aggressive management of hyperlipidemia increases, particularly with the available, relatively strong hypolipidemic drugs and the newer and probably stronger agents, the following question should be answered; how low can we go in serum levels. For the time being, it is difficult to give a certain limit for the safest and lowest level of serum cholesterol, but knowing the complications of hypolipidemia will raise awareness. What might appear as a simple mildly reduced serum lipid can be an indication of an underlying, serious problem. A systematic search of Pubmed for all the studies in the English language as well as the abstracts of publications in other languages related to hypolipidemia was undertaken. The following words were used in the search: hypolipidemia, hypocholesterolemia, hypobetalipoproteinemia, and statins. Search results were reviewed.

The Prevalence of Self-Reported Halitosis and Oral Hygiene Practices among Libyan Students and Office Workers

Abstract: Aims:The aims of this study were to assess the prevalence of self-reported halitosis, oral hygiene practices and related diseases among Libyan students and employees. Methods: Six hundred self-administered structured questionnaires were used to investigate self-perception of halitosis and oral hygiene practices among a group of Libyan volunteers. Chi square test was used to detect significant differences between frequencies and to test correlation between self-perception of halitosis and measures of oral hygiene. Results: Forty three percent of the subjects were males and 57% were females. Forty four percent of the males and 54% of the females revealed self-perception malodour. Malodour was reported with the highest frequency (68%) during wake up time. Malodour was perceived by 31.7% of the females and 23.4% of the males during the hand-on-mouth test (p=0.04). Significantly more females (89.9%) than males (75.7%) practiced brushing (p<0.001). Fifty one percent of the males and 49.6% of females had dental caries. Smoking was significantly (p<0.001) more prevalent among males (17%) than among females (1%). Brushing was practiced by 85% of non-smokers and 68% of smokers (p=0.004). About 71% of the subjects who practiced brushing reported malodour during wake up time in comparison to subjects who did not practice brushing (p=0.041). Conclusions: The prevalence of self-perceived malodour among the Libyan volunteers in this study is within the range of other studies. There is a great demand to reduce the incidence of dental caries and periodontal diseases. Key words: self-reported halitosis, dental caries, oral hygiene practices, gum bleeding.

Transcutaneous Electrical Nerve Stimulation (TENS) A Possible Aid for Pain Relief in Developing Countries

Abstract: Transcutaneous electrical nerve stimulation (TENS) refers to the delivery of electrical currents through the skin to activate peripheral nerves. The technique is widely used in developed countries to relieve a wide range of acute and chronic pain conditions, including pain resulting from cancer and its treatment. There are many systematic reviews on TENS although evidence is often inconclusive because of shortcomings in randomised control trials methodology. In this overview the basic science behind TENS will be discussed, the evidence of its effectiveness in specific clinical conditions analysed and a case for its use in pain management in developing countries will be made.

Clinical and Biochemical Characteristics of Polycystic Ovary Syndrome in Benghazi- Libya; A Retrospective study

Abstract: Background: Polycystic ovary syndrome (PCOS) is a common endocrine condition affecting women of reproductive age and characterized by chronic anovulation, hyperandrogenism, and polycystic ovaries. There are no published data on this syndrome in Libyan patients. Aims and objectives: To assess the frequency of clinical and biochemical features of PCOS in our patient population, and to compare this with data collected in other parts of the world. Subjects and methods: A retrospective analysis of patient records at the endocrine clinic in Benghazi was undertaken. Patient inclusion was according to Rotterdam ESHRE/ASRM criteria. Clinical features, associated diseases, family history, hormone levels, and ultrasonography results were analyzed. Results: The mean age of the 318 PCOS patients at presentation was 25.8 years (range 15-44 years), and the majority (67%) were 20-29 years old at presentation. Of all patients, 57% were obese (BMI _ 30), 93% had oligo- / amenorrhea, 91% were hirsute, and 74% had ultrasound features of polycystic ovaries. Diabetes mellitus was diagnosed in 9% of all PCOS patients and hypertension in 4%. Total serum testosterone was elevated in 26% of the patients, and serum prolactin was elevated in 31%. Thyroid disease was noted among 5.3% of the patients, and a history of diabetes or hypertension among first-degree relatives was seen in (16%) and (8%) of the patients respectively. Conclusion: Chronic anovulation and hirsutism are the dominant features of PCOS in our patient population. More than half were obese, and the prevalence of diabetes, hypertension and thyroid disease in our patients seemed to be underestimated in comparison to other parts of the world. Key words: polycystic, ovary, hirsutism, diabetes, obesity.

Nutritional status of under-five children in libya; a national population-based survey.

Abstract: Aim: To describe the nutritional status of children under-five years of age in Libya. Population and methods: A secondary analysis of data of 5348 children taken from a national representative, two-stage, cluster-sample survey that was performed in 1995. Results: Prevalence rates of underweight, wasting, stunting, and overweight were determined using standard definitions in reference to newly established WHO growth charts. The study revealed that 4.3% of children were underweight, 3.7% wasted, 20.7% stunted, and 16.2% overweight. Seventy percent of children had normal weight. Undernutrition was more likely to be found in males, in rural areas, and in underprivileged groups. Overweight was more likely found in urban, privileged groups. Wasting was more common in arid regions; stunting was more common in mountainous regions of Al-Akhdar, Al-Gharbi, and in Sirt. Al-Akhdar had the highest prevalence of overweight. Conclusion: The country had a low prevalence of underweight and wasting, moderate prevalence of stunting, and high prevalence of overweight. The country is in the early stages of transition with evidence of dual-burden in some regions. Similar surveys are needed to verify secular trends of these nutritional problems, particularly overweight. Libyan Journal of Medicine Vol. 3 (1) 2008: pp. 6-10

Libyan Medical Education; Time to Move Forward

Abstract: Medical education is a key factor in the progress of any country. The advancement of any nation is based in part on this type of education. Medical education world-wide has improved immensely over the past two decades, having undergone major changes. The progress of developing countries can be judged based on how they incorporate this field of education into everyday life, and how this impacts the healthcare that is provided [1, 2]. In Arab-speaking countries, the education system varies. Most of these countries, even the affluent ones with the best oil revenues, have endured difficulties due to their inefficiencies [3]. These are mainly due to the infrastructure of institutions, how financial resources are manipulated, and the lack of educational policies. In the 1970s and mid-1980s, Libyan medical education was envied by other Arab countries in North Africa and the Middle East who often sought to imitate its system. Since that time, this system failed to stay current and accommodate international standards that other contemporary systems had in place [4]. Libya has invested heavily in medical education by building medical schools all over the country. Furthermore, thousands of physicians have been sent to established universities in Europe and North America over the last thirty years to pursue specialized medical education abroad. Most have come back hoping to join the health system they envisioned. Many were disappointed, however, and regretted their return. Some have left again to practice elsewhere, and some remained, albeit frustrated. This forced difficult questions that had to be answered. This editorial attempts to identify the difficulty that the Libyan medical education system faces and how it could be reformed so that it can achieve its goals with an emphasis on education and research. Historically, Libyan medical education has been based on the British format of physician training. However, the universities have generally not maintained the same standards as the British. Therefore, Libyan medical schools need evaluation and revision to compete with other similar institutions around the world. Foremost, medical schools, hospitals, and other research institutions must refrain from appointing any person to a leadership position without a thorough examination of their credentials and educational background. To do less not only tarnishes the reputation of the institution they represent, but contributes to fostering less than desirable qualities in the teaching staff as well as the students. Those chosen for leadership positions in healthcare should be known for their mastery of scientific knowledge and their own personal academic achievements. It is important that they bring to their role an attitude that encourages collaboration, curriculum reform, and is open to change [5]. Furthermore, curriculum reform is essential in attracting not only an increased number of students, but well-prepared ones who challenge the system, contribute to future development, and may want to build their future careers in Libya after graduation. Currently, the failure rate of medical students is worrisome [6]. Curriculum reform should encourage self-directed learning and the teaching of a system-based care [7, 8]. It would be wise to identify goals and strategies to guide curriculum development [9]. Elective courses should include opportunities for students to obtain a broad range of concepts that will influence their future careers and help them to become proficient at teaching the next generation of students [10]. The medical schools must realize the importance of developing scientific research protocols with attention to research principles and ethics. Students must learn to complete research projects that prove or disprove their hypotheses which can then be published for others to share the knowledge. Not only does this help the students to understand the research model they are studying, but it lends credibility to the medical school as well. Clinical trials and participation in multi-center studies should be encouraged. Students should be involved in research early in their academic careers. Journal clubs, research and clinical seminars, and scientific meetings should be regular occurrences. The recent crises of the Libyan- Bulgarian HIV cases [11] shocked the world. Libyan universities played little or no role. Even related departments such as clinical immunology and microbiology were uninvolved. Such a tragedy provided an opportunity for scientific research development since it would rarely occur that a large number of children would be infected with a single and unique strain of HIV [12]. Ideally Libyan universities should have led the way with research when this happened. Instead other scientists with no connection to Libya led the investigation and gained international recognition for their input. Additionally, they imposed their scientific view in this case [13]. The Libyan health service failed to alert our society about this tragedy. Health officials involved were not open to public during the entire episode and were not questioned about this, which is difficult to understand. University staff should be encouraged to publish their research in internationally cited periodicals as part of their academic promotion. This will improve the image of higher education and encourage international contribution which is needed for any successful medical education system. International standards used to rate research, including number of publications and impact factor, should be embraced [14, 15]. A recent study published in the Libyan Journal of Medicine analyzed the contribution of Libyan scientists to international publications. Fewer contributions from Libya compared to other Arabic countries were apparent despite the monetary contribution to research [16]. This is alarming and disappointing. A group of independent scientists with strong academic backgrounds should be appointed to monitor the university activities and to offer guidance as the educational system evolves. The Libyan medical education system needs to recruit specialists in varying areas of medical science. Talented young physicians must be added to the teaching staff for new ideas to be generated and for the school to move forward [15]. We should strive to introduce areas of practice such as organ transplantation, trauma-critical care, endovascular, geriatrics, immunology, infectious disease, genetics, and advanced obstetrical care to a wider part of the country. We must add hospitalists and intensivists so that as patients are admitted to services, we provide the adequate focus that will restore them to health, and we can all learn from each other. We need to reorganize microbiology and pathology departments to become more practical and help with prevention and spread of nosocomial infections, and to guide us to care for those patients with multi-resistant organisms [17]. It is imperative that the Libyan board of medical specialties embraces modernization. We cannot foster the growth needed to provide the care our citizens deserve if we fail to recognize this. We need to enhance efficiency and the overall quality of healthcare delivered in Libya. Clinical health services (particularly secondary and tertiary) should be decentralized and reformed. Academic staff as well as students can share in the development. Currently patients often receive less than desirable care due to the lack of consolidated clinical records. Our ultimate goal should be to develop and incorporate an electronic medical record system that lets all involved share the patient record to improve the quality of care provided [18, 19]. Currently even emergency services and burn care lack such methods of communication, which is not acceptable. Medical ethics must also be evaluated. In a recent editorial, Elkhammas has suggested that medical schools should develop a curriculum to be taught across the country and stressed the urgent need for a code of ethics at all levels. Such codes are also needed for the secretary of health, the medical faculties, and for all hospitals. We need to form ethics committees that are multidisciplinary in all hospitals and teaching institutions [20, 21]. Libyan medical education suffers from a lack of synchronization and cooperation among the different sectors. This negatively affects our productivity [22, 23]. Academic physicians and scientists play little or no role in planning or supervising national health plans and programs. Our departmental leaders must assume this responsibility and seek out other coveted systems for guidance. The government has often relied on foreign graduates who lack experience in such problems, and this has damaged the credibility of our country's system [15]. Despite the obstacles that the Libyan medical education system faces, our medical graduates are trying their best to achieve success. Our graduates go on to assume leading roles in highly advanced institutes in Europe, North America and Asia. In the United States as an example, medical education entered a different era following the popular report by Flexner in 1910. Medical education has advanced since then, but several points are still valid today especially when it comes to medical education in Libya. We do need the formation of a medical education council to study the situation and reform medical education in Libya. We have to evaluate every medical school regarding skills, faculty, facility and curriculum. Hence it becomes an obligatory role for all sectors of Libyan medical education to strive to update and accommodate these badly needed reforms. Table 1 Essential Reforms Needed to Improve the Current Libyan Medical Education System

Effects of the oil and mucilage from flaxseed (linum usitatissimum) on gastric lesions induced by ethanol in rats.

Abstract: The anti-ulcer activity of the oil and mucilage obtained from flaxseed (Linum usitatissimum) was evaluated in a rat model of ethanol-induced gastric ulcer. Our results show that pretreatment of rats with flaxseed oil and flaxseed mucilage significantly reduced the number and length of gastric ulcers induced by ethanol. Flaxseed oil was more effective than flaxseed mucilage in reducing the number of ulcers. The reduction in ulcer severity (cumulative length in mm) provided by an oral dose of flaxseed oil (5 ml/kg) was more prominent than that obtained by ranitidine (50 mg/kg). This study indicates that both flaxseed oil and flaxseed mucilage can provide a cytoprotective effect against ethanol-induced gastric ulcers in rats.

Inducible Clindamycin Resistance among Staphylococci Isolated from Burn Patients.

Abstract: Clindamycin has been used successfully to treat pneumonia and soft-tissue infections caused by methicillin-resistant Staphylococcus aureus. However, inducible clindamycin resistance has been described as a cause of treatment failure of such infections. A total of 159 staphylococcal isolates from different clinical specimens from burn patients in Tripoli Burn Center were tested for inducible clindamycin resistance by the disk-diffusion induction test. Inducible clindamycin resistance was detected in 66.2% of 65 methicillin-resistant S. aureus isolates and in none of 55 methicillin-sensitive S. aureus, 10 methicillin-resistant coagulase negative staphylococci and 29 methicllin-sensitive coagulase negative staphylococci isolates. In our setting, clindamycin can be used for the treatment of infections due to staphylococci, but we recommend that staphylococci isolates, particularly methicillin-resistant S. aureus , are tested by the D-test before treatment. Key words: Inducible clindamycin resistance, Staphylococci, Burn patients, Libya

A technical report on the effect of electromagnetic radiation from a mobile phone on mice organs.

Abstract: To The Editor: Exposure to electromagnetic radiation (EMR) from mobile phones can cause detrimental effects on cell function, chromosomal aberrations, and tissue injuries [1–6]. The rapid expansion of mobile phones has lead to widespread concern for their safety. We examined the histopathological effects of direct exposure to this EMR from mobile phones in adult male Swiss albino mice. The animals were obtained from the biotechnology center, Tripoli, Libya, weighing from 25–30 grams, aged 10–12 weeks. The experiments were approved by state authorities and fol¬lowed guidelines of Egyptian law for animal protection. Mice were fed standard diets and water ad libitum. Plastic cages (diameter 45 cm by 11 cm height) were designed for this work. The roof of the cage was designed to receive the mobile phone from a distance of about 10 cm from the cage floor [7]. EMR was emitted from the Nokia 1112 device with a dimension of 104×44×17 in connection with Libyan network (Misurata, Libya). The distance between phone and mice was about 10 cm. The GSM mobile phones operate with microwave carrier frequencies in the GHz range (850–1900 MHz) [8–10]. Mice were divided into three groups. Group one was the control group (n=5) with mice unexposed to the mobile phone. Group two (n=5) were mice exposed for 1 hour every day for ten days while the cell phone was in answering state. Group three mice (n=5) were exposed for 12 hours per day while the cell phone was in standby state. Small pieces of liver, kidney and spleen were fixed in 10% buffered formalin for histological examination. These tissues were dehydrated in ethanol, embedded in paraffin wax, and stained with hematoxylin and eosin. Examination of liver sections of group two showed that the interlobular areas of all examined sections were rich in inflammatory cellular infiltration Fig. 1B), in comparison to the control group (Fig. 1A). Also, the hepatocytes appeared vacuolated and contained denser nuclei (Fig. 1B). Liver sections of group three showed more intensive inflammatory response around the central vein (Fig. 1C). Hepatocytes were swollen and their cytoplasm appeared to be highly vacuolated. Figure 1 Light micrograph of the liver sections. A Control liver with central vein and surrounding hepatocytes, sinusoids lined with Kupffer cells. B EMR exposed group for 1h with interlobular inflammatory cellular infiltrations and hepatocytic vacuolation. C ... All of the renal tissue sections of group two showed more mononuclear leukocytic infiltration between the renal tubules in addition to dilation of some tubules (Fig. 2B), in comparison to the control group (Fig. 2A). Also, some glomeruli were atrophied and some kidney tubules were vacuolated (Fig. 2B). Group three renal tissue sections appeared with some congested glomeruli, some vacuolated renal tubules, and some inflamed areas in between the kidney tubules (Fig. 2C). Figure 2 Light micrograph of the kidney sections. A Control kidney with normal glomeruli and renal tubules. B EMR exposed group for 1h with some atrophied glomeruli, leukocytic infiltrations between the kidney tubules and vacuolation of some tubules. C EMR exposed ... Splenic tissue sections of group two revealed enlarged white pulp with increased sinusoidal spaces (Fig. 3B), when compared to the control group (Fig. 3A). Some white pulp of group three tissue sections appeared to be fused (Fig. 3C). This disorganization was due to hyperplasia of the lymphoid tissue. Figure 3 Light micrograph of the spleen sections. A Control spleen with normal white and red pulps. B EMR exposed group for 1h with enlarged white pulps and dilated sinusoids. C EMR exposed group for 12h with fused white pulps, dilated sinusoids and hyperplasia ... In summary, repeated exposure to the electromagnetic radiation (EMR) emitted from mobile phones is able to induce hepatic, renal and splenic tissue damage. The degree of damage increased with time of exposure to EMR. Previously similar tissue changes have been described using lower frequency EMR [9, 11–13]. However our study was the first to expose the mobile phone itself to the animals. Extended investigations are required to establish the hazards of exposure to the EMR from mobile phones on humans.

Comparative Analysis of Patient Package Inserts of Local and Imported Anti-Infective Agents in Palestine

Abstract: Background and Objective: The patient package insert is an important source of drug information. The aim of this study was to evaluate and compare the PPI of the anti-infective agents manufactured in Palestine with the imported equivalents. Method: The selection criteria generated 15 different anti-infective agents available as 36 locally manufactured products and 15 imported equivalents. The design of the patient package insert was evaluated in terms of the number of words used in eight main headings and the presence or absence of certain information regarding nine statements. Results: Inserts of locally manufactured products have significantly fewer words than those of imported products with respect to warnings, dosage and administration, and side effects. The most significant difference was found in the warnings. Moreover, differences were found between inserts of local and imported products in terms of the presence of the nine informative statements. Locally manufactured products did not mention inactive ingredients, clinical pharmacology or date of last revision, but all of them provided information on the use of the drug during pregnancy and lactation and on the duration of therapy. However, in general they provided less information than the imported equivalents. Conclusion: Palestinian authorities and local manufacturers should implement appropriate measures to regulate the quality and quantity of information in the patient package insert of locally produced anti-infective agents. PPI improvement will better direct health practices to the benefit of the patients. Key words: patient package insert, evaluation, Palestine, drug information.

Skin and Systemic Manifestations of Jellyfish Stings in Iraqi Fishermen

Abstract: Background: Jellyfish stings are common worldwide with an estimated 150 million cases annually, and their stings cause a wide range of clinical manifestations from skin inflammation to cardiovascular and respiratory collapse. No studies on jellyfish stings have been carried out in Basra, Iraq. Objectives: To describe the immediate and delayed skin reactions to White Jellyfish (Rhizostoma sp.) stings and the types of local treatment used by fishermen. Methods and Materials: 150 fishermen were enrolled at three Marine stations in Basra, Iraq. Demographic data, types of skin reactions, systemic manifestations and kinds of treatments were collected. Results: Overall, 79% of fishermen in all three Marine stations gave a history of having been stung. The common sites of sings were the hands and arms followed by the legs. Most fishermen claimed that stings led to skin reactions within 5 minutes. The presenting complaints were itching, burning sensation, and erythematic wheals. A few days after the sting, new groups of painless and itchy erythematous monomorphic papular rashes developed at the site of the sting in 62% of cases as a delayed type of skin reaction that resolved spontaneously. The local remedies commonly used by the fishermen were seawater, tap water and ice. A few fishermen considered stings as insignificant and did not think there was a need to seek medical help. Conclusions: We conclude that jellyfish causes many stings among fishermen in the Basra region. Their stings lead to immediate and delayed skin reactions. Self-treatment by topical remedies is common. Key words: Contact dermatitis, Rhizostoma, Fishermen, Jellyfish stings, Iraq

Incisional Hernia in Women: Predisposing Factors and Management Where Mesh is not Readily Available

Abstract: Background / Aim: Incisional hernia is still relatively common in our practice. The aim of the study was to identify risk factors associated with incisional hernia in our region. The setting is the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria during a period when prosthetic mesh was not readily available. Patients and Methods: All the women who presented with incisional hernia between 1996 and 2005 were prospectively studied using a standard form to obtain information on pre-hernia (index) operations and possible predisposing factors. They all had open surgical repair and were followed up for 18-60 months. Results: Forty-four women were treated during study period. The index surgeries leading to the hernias were emergency caesarian section 26/44 (59.1%), emergency exploratory laparotomy 6/44 (13.6%), and elective surgeries 12/44 (27.3%). Major associated risk factors were the use of wrong suture materials for fascia repair, midline incisions, wound sepsis, and overweight. Conclusion: For elective surgeries, reduction of weight should be encouraged when appropriate, and transverse incisions are preferred. Absorbable sutures, especially chromic catgut, should be avoided in fascia closure. Antibiotics should be used for complicated obstetric cases. Key words: Incisional hernia, Women, Predisposing factos,Nigeria

Risk factors and genotypes of hepatitis C virus infection in libyan patients.

Abstract: Background: The prevalence and incidence of HCV infection varies geographically due to exposure to different risk factors. Identification of HCV genotype is important to defining the epidemiology of the disease. The objective of this study was to describe genotype distribution and its relation to risk factors among HCV infected patients attending virology clinic of the Department of Infectious Diseases at the Tripoli Medical Centre. Methods: The medical records of 891 Libyan chronic HCV infected patients registered and followed up from January 2003 to January 2007 were reviewed. Data gathered includes patient's age, gender, risk factors and family history of HCV infection. Statistical analysis was performed using t, x2 and contingency coefficient tests. Results: The mean age was 40.22±13.09 years. Two thirds of patients were males. Normal alanine aminotransferase (ALT) at diagnosis was found in 62% of the patients. HCV RNA < 2 million copies at diagnosis was found among 54% of patients. HCV genotype 1 (G1) was the most frequent (30.9%), followed by G4 (29.2%). Genotype 2 affected 19.3% and G3 13.6%. No classification of HCV genotype was available for 2% of the patients. Many subtypes of HCV were detected with different frequencies (G1a and b, G2a, b, c and a/c, G3a and G4a and c/d). All genotypes of HCV were more common among males (P<0.001). Genotype 3 was the most frequent among male patients (88.6%). Regarding the risk factors, 33% of patients had a history of hospitalization and/or surgical procedures, and 22.7% had a history of blood transfusion. A past history of intravenous drug abuse (IVDA) was reported by 15% of the patients, and 15.9% reported a history of dental procedures. The relationship between the genotype of HCV and risk factors was statistically significant (P<0.001). No history of risky exposure was found among 10.8% of patients. Conclusion: Genotypes 1 and 4 were more predominant among HCV infected patients. Males were affected more than females and they presented themselves to the clinic at a younger age. The results of this study strongly suggest the need for implementing strict infection control measures in hospitals and dental clinics to reduce the nosocomial transmission of HCV, as well as measures to control the problem of intravenous drug users in the community. Key words: Genotypes, HCV, Risk factors, Libyan patients.

Cystic hygroma in an adult; a case report.

Abstract: Lymphangioma is a benign infiltrative malformation of the lymphatic channels. Cystic lymphangioma or cystic hygroma is a subtype of lymphangioma which exhibits large macroscopic cystic space histologically. The cause of cystic hygroma is believed to be developmental defect or primary Multilocular cystic malformation of dilated lymphatic channels. Cystic hygroma is a common and distinct entity that is not manifested in the oral cavity but occurs in the neck as a large, deep diffuse swelling. They are usually found in the posterior triangle of the neck. They often cross the midline, reaching axilla and mediastinum. Such localization verifies the complexity and extent of the lymphatic system in the cervical region when compared to other regions of the body. The five main locations where cystic hygroma can occur are, cervical (75-90%), axillary (20%), inguinal, retroperitoneal and thoracic. They usually appear as solitary lesions. They are usually infiltrative, often separating fascial planes and incorporating nerves, muscles, and blood vessels. They are fluctuant, freely mobile, compressible, painless and transilluminate well. The skin overlying the lesion is normal and usually there is no associated lymphadenopathy. Various treatment modalities have been tried. Surgery has been the main form of treatment, but total removal is not possible in all cases because of the extent of the lesion, which sometimes involves vital structures. We report a case of cystic hygroma in a young male patient. Key words: Cystic hygroma, lymphangioma, lymphatic tissue.

Changes of some Health Indicators in Patients with Type 2 Diabetes: A Prospective Study in three Community Pharmacies in Sharjah, United Arab Emirates

Abstract: Aim: The study aimed to examine changes in some health indicators in people with type 2 diabetes mellitus, namely: reported self-care activity, health related quality of life, and patient opinion of the services provided by three community pharmacies in Sharjah, UAE. Method: A group of patients was followed over 24 months. Patients under investigation received reminders packages during the first three months of the study. No reminders were sent after 3 months after the study was underway. Repeated measures ANOVA were used to test differences between means over different periods. Results: All patients included in this study were found to have poor diet and exercise behavior at baseline. Three months into the study, more than 27% of the patients had acceptable diet, exercise, foot care and self-testing behavior. However, evaluation at six months and 24-months show that mean scores had almost returned to baseline levels. There were significant differences between the mean values of initial (baseline data) and final (at the end of the study) scores for general health (5.86, p=0.001), vitality (5.25, p<0.001), and role physical scales (3.81, p=0.02). There was a significant (p < 0.001) 25% increase in the patients' perception of the ability of the pharmacist to assist in decreasing blood glucose level. Conclusion: Ongoing reminder packages are needed for continued progress in self-care activities and for achieving lasting changes in the behavior. Implementation of such a strategy through community pharmacies could help to improve patients’ views of the quality of services received from these pharmacies and patient’s quality of life, which should improve patient’s drug therapy and reduce complications of diabetes. Key words: Diabetes, Self-care activity, Community pharmacists, Reminder packages, Patient’s opinion, Quality of life

Childhood Inflammatory Bowel Disease in Libya: Epidemiological and Clinical features

Abstract: Background & Aims: Inflammatory bowel disease is thought to be rare in Libya. The aim is to determine the prevalence of juvenile onset inflammatory bowel disease in Libya. Setting: Al-Fateh childrens’ hospital, Benghazi, Libya. Methods: This is a retrospective study of all cases diagnosed over 10 years (1997-2006) with either ulcerative colitis, Crohn’s disease or indeterminate colitis. Inclusion criteria were age <15 years at time of presentation who were resident in the eastern part of the country and who diagnosed with inflammatory bowel disease. Clinical features were outlined using a proforma. Results: Sixteen cases were diagnosed with inflammatory bowel disease, of whom 11 were males (M:F ratio of 1.5:1). The prevalence and incidence rates in the year 2006 were 3.6 and 0.9 per 100,000 children, respectively. The incidence rate increased from 0.2 in 2002 to 0.9 in 2006 (Z score of 39.87, p= 0.00). The age at presentation ranged from 5 months to 14 years. Nine had Crohn’s disease (6 males) and 6 had ulcerative colitis (4 males). One patient had indeterminate colitis. The most common clinical features were diarrhea in 10 (62.5%), abdominal pain, anorexia and weight loss in 9 (56.2%), anemia in 7 (43.75%) and vomiting in 6 (37%). Ileopancolitis was found in 3 patients whereas 6 patients had ileocecal disease. Conclusions: Childhood inflammatory bowel disease in this population is not so rare and it is increasing. The clinical pattern is similar to that reported by others. Key words: Inflammatory bowel disease, Ulcerative colitis, Crohn’s disease, Indeterminate colitis, Juvenile onset inflammatory bowel disease

Is Global Warming likely to cause an increased incidence of Malaria

Abstract: The rise in the average temperature of earth has been described as global warming which is mainly attributed to the increasing phenomenon of the greenhouse effect. It is believed that global warming can have several harmful effects on human health, both directly and indirectly. Since malaria is greatly influenced by climatic conditions because of its direct relationship with the mosquito population, it is widely assumed that its incidence is likely to increase in a future warmer world.This review article discusses the two contradictory views regarding the association of global warming with an increased incidence of malaria. On one hand, there are many who believe that there is a strong association between the recent increase in malaria incidence and global warming. They predict that as global warming continues, malaria is set to spread in locations where previously it was limited, due to cooler climate. On the other hand, several theories have been put forward which are quite contrary to this prediction. There are multiple other factors which are accountable for the recent upsurge of malaria: for example drug resistance, mosquito control programs, public health facilities, and living standards.

Metabolic Syndrome among Type-2 Diabetic Patients in Benghazi-Libya: A pilot study

Abstract: Background: Metabolic syndrome is a cluster of three out of five conditions that are due to hyperinsulinemia: abdominal obesity, atherogenic dyslipidemia (high triglycerides and/or low HDL), elevated blood pressure, and elevated plasma glucose. The syndrome is highly prevalent in patients with type-2 diabetes mellitus and often precedes the onset of hyperglycemia. It has been shown that metabolic syndrome is an independent clinical indicator of macro- and microvascular complications in diabetics. Aim and objectives: the aim of this pilot study was to estimate the frequency and characteristics of metabolic syndrome among type-2 diabetic patients in Benghazi. Patients and methods: This cross-sectional study involved 99 randomly selected adult patients with type-2 diabetes mellitus. The patients were interviewed and examined, and their lipid profiles were checked 9-12 hours after overnight fasting. Metabolic syndrome was defined according to the criteria of the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) and of the International Diabetes Federation (IDF). Results: About 92% of the patients had the metabolic syndrome according to ATP III criteria and 80.8% according to IDF criteria. Females were more affected, males with metabolic syndrome were significantly older, and females were significantly more obese. No significant difference was observed between males and females regarding waist circumference, HDL level and triglyceride level. The commonest and most important component of metabolic syndrome in the study group was low HDL. Conclusion: Metabolic syndrome is common among Libyans with type-2 diabetes mellitus, and it is significantly more common in females than males. The most significant predictor of metabolic syndrome in type-2 diabetic patients in Benghazi is low HDL. Key words: Metabolic, diabetes, hypertension, dyslipidemia, obesity, Benghazi, Libya.

The Prevalence of Inflammatory and Developmental Odontogenic Cysts in a Libyan Population

Abstract: Objective: The aim of this study was to determine the prevalence of odontogenic jaw cysts in a Libyan population and to compare the data with previously published reports from other countries. Materials and methods: We retrieved and analyzed 2190 case notes and biopsy records of the Department of Oral and Maxillofacial Surgery and the Department of Oral Pathology and Microbiology, Al Arab Medical Sciences University, Benghazi, Libya, dating from January 1990 to December 2005. There were 326 cases (14.8%) of diagnosed odontogenic cysts among the 2190 biopsies performed during this period. The cases were analyzed for age and sex distribution, site of presentation, association with impacted teeth, and the method of treatment. Results: The male to female ratio of patients was 1.3:1 Radicular cysts accounted for 222 cases (68.1%), followed by dentigerous cysts (n=49, 15%) and odontogenic keratocysts (n=43, 14.1%). Mean ages of the patients were, respectively, 31.7, 22.7 and 36.1 years. . The maxilla was more commonly involved than the mandible (1.3:1). The anterior maxilla was the commonest site (n=132, 37.4%) followed by the posterior mandible (n=96, 29.4%). Fifty three cases were associated with impacted teeth, and the highest frequency was for dentigerous cysts (n=37). Enucleation and curettage was performed on 300 patients, marsupialization on 14, and marginal/segmental resection on 12. Conclusion: To our knowledge, this is the first such study on a Libyan population. Our results are comparable to studies from other countries. Knowledge of the relative frequencies and sites of presentation of odontogenic cysts in different ethno-geographic backgrounds is essential for the early diagnosis and management of these benign yet potentially destructive lesions. Key words: polycystic, ovary, hirsutism, diabetes, obesity.

Dental Care Utilization and Satisfaction of Residential University Students

Abstract: Aim: The objective of this study was to provide information on the level of utilization and satisfaction of residential university students with the dental services provided by the dental clinic of a teaching hospital. Volunteers and Material: A stratified sampling technique was used to recruit volunteers from the outpatient clinic of the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. Information was collected by a self-administered questionnaire composed of questions that measure the level of utilization and satisfaction with the dental services provided. Questionnaires were provided to 650 randomly chosen students residing in the University hostels. There were 39 refusals, and 6 incomplete questionnaires were discarded. This left a sample size of 605 volunteers. Results: Forty seven students (7.8%) indicated that they visited the dental hospital within the last 12 months. Males and females utilized the dental services equally, and utilization increased with age and the number of years spent on campus. Anticipation of painful dental treatment, high dental charges, long waiting times and being too busy for a dental visit were cited as the most important impediments to seeking dental treatment. Females expressed greater satisfaction with the services. Conclusion: Dental service utilization among the students was found to be low. Oral health awareness campaigns, improving the quality of the services, and shortening the waiting time are expected to increase service utilization and satisfaction. Key words: dental care, utilization, satisfaction, young adults, Nigeria.

Effects of Gender and Seasonal Variation on the Prevalence of Bacterial Septicemia Among Young Children in Benin City, Nigeria

Abstract: Aim: To determine the effects of gender and seasonal variations on the prevalence of bacterial septicaemia among children 5 years and younger, and to identify the bacterial agents responsible for septicaemia and their antibiotic susceptibility profiles. Methods: Blood was collected from 1,724 children (967 males and 757 females) aged 1 day to 5 years with clinical signs and symptoms of septicaemia. This study was carried out from 1 January to 31 December 2007 at the University of Benin Teaching Hospital, Benin City, Nigeria. The blood samples were processed to diagnose bacterial septicaemia. Bacterial isolates were identified and susceptibility test was performed using standard techniques. Results: An overall prevalence of 22.10% of confirmed bacterial septicaemia was observed in this study. Generally, gender and seasonal variations did not significantly affect the prevalence of bacterial septicaemia, though females (50.57%) during the dry season had significantly (p < 0.001) higher prevalence than their male counterparts (19.91%). Staphylococcus aureus was the predominant bacterial isolate causing septicaemia in both seasons, while Citrobacter freundii was the least frequent. Pseudomonas aeruginosa was not recovered during the dry season. Most isolates were susceptible to gentamicin and cefuroxime, but only 1.44% of Staphylococcus aureus strains were susceptible to ceftriaxone. Conclusion: Bacterial septicaemia was observed in 22.1% of children 5 years and younger with clinical signs and symptoms of septicaemia. Seasonal variation did not affect the prevalence. Effect of gender was only noticed in the dry season, where females had a higher prevalence than males. Gentamicin and cefuroxime were the most active antibacterial agents. Rational use of antibiotics is advocated. Key words: Gender, Seasonal variation, Bacterial septicaemia

Assessing Interventions Available to Internally Displaced Persons in Abia State, Nigeria

Abstract: Internally displaced persons are faced with several problems, such as sexual violence, and deserve appropriate intervention, especially in view of the increasing prevalence of HIV/AIDS and other infections in Nigeria. This study attempts to assess interventions offered by governmental authorities and organizations to internally displaced persons and to identify gaps in services as well as to identify what needs to be strengthened. Method: The author reviewed relevant published and unpublished documents and collected data by interviews with semi-structured questions. Twenty-five organizations and government and police departments and 55 internally displaced persons were interviewed. Results: None of the organizations, including governmental institutions, provided social services or assistance in prevention of HIV/AIDS to internally displaced persons. The main services provided by 17 (68%) organizations to 43 (78.2%) of internally displaced persons were provision of food, clothing and money, but these were provided on an ad hoc basis. Only 3 organizations (12%) included spiritual counseling and resolution of communal conflicts in their services. Conclusion: The fact that most organizations, including the government, do not have services for internally displaced persons indicates lack of support for internally displaced persons. The government should be urged to include these people in most prevention services, including HIV/AIDS prevention and treatment. This should help reduce the national prevalence of HIV/AIDS Key words: Internally displaced, Interventions, HIV/AIDS, Conflicts, Nigeria

Hypersexual behavior following craniocerebral trauma an experience with five cases.

Abstract: Hypersexual behaviour is a recognized complication of head injuries which can be a source of great distress to patients and persons with whom these patients share significant relationships. In this article, we describe 5 patients who exhibited aberrant sexual behaviours following traumatic brain injury and discuss the relevant literature.

Care for People with Diabetes during The Moslem Pilgrimage (Haj) An Overview.

Abstract: Haj is one of the five cardinal components of Islam commonly known as the five pillars of Islam. Approximately two million Muslims perform it each year. Haj involves travel to the holy sites in and around Mecca and Medina during a specified short period of time in a limited space, not usually inhabited by such a large number of people. This article deals with the effects of this event on diabetes and its management. The importance of this arises from the fact during Haj, the person’s life routine changes as he travels to a different place of his own for a period of 4–6 weeks where geography, weather, diet, and habits are different. During Haj most people live what is effectively a very basic life in very crowded places. Therefore, medical conditions, such as diabetes, whose management depends on a stable routine, would predictably be affected significantly. People with diabetes should have enough time to consider a management plan for their diabetes. The objectives are to achieve a good control and avoid any complications that may be particularly associated with the conditions faced during Haj. Key words: Diabetes, Haj, Moslems, Ethnic, Hyperglycaemia, Hypoglycaemia.